Prostate ultrasound imaging: evaluation of a two-step scoring system in the diagnosis of prostate cancer.
This study aims to investigate the feasibility and performance of a two-step scoring system of ultrasound imaging in the diagnosis of prostate cancer. 75 patients with 888 consecutive histopathologically verified lesions were included in this study. Step 1, an initial 5-point scoring system was developed based on conventional transrectal ultrasound (TRUS). Step 2, a final scoring system was evaluated according to contrast-enhanced transrectal ultrasound (CE-TRUS). Each lesion was evaluated using the two-step scoring system (step 1 + step 2) and compared with only using conventional TRUS (step 1). 888 lesions were histologically verified: 315 of them were prostate cancer from 46 patients and 573 were benign prostatic hypertrophy (BPH) from 29 patients. According to the two-step scoring system, 284 lesions were upgraded and 130 lesions were downgraded from step 1 to step 2 (this means using step 2 to assess the results by step 1). However, 96 cases were improperly upgraded after step 2 and 48 malignant lesions were still missed after step 2 as score-1. For the two-step scoring system, the sensitivity, specificity, and accuracy were 84.7%, 83.2%, and 83.7%, respectively, versus 22.8%, 96.6%, and 70.4%, respectively, for conventional TRUS. The area under the ROC curve (AUC) for lesion diagnosis was 0.799-0.952 for the two-step scoring system, versus 0.479-0.712 for conventional TRUS. The difference in the diagnostic accuracy of the two-step scoring system and conventional TRUS was statistically significant (P<0.0001). The two-step scoring system was straightforward to use and achieved a considerably accurate diagnostic performance for prostate cancer. The application of the two-step scoring system for prostate cancer is promising.


A short story on how chromophore is hydrolyzed from rhodopsin for recycling.
The photocycle of visual opsins is essential to maintain the light sensitivity of the retina. The early physical observations of the rhodopsin photocycle by Böll and Kühne in the 1870s inspired over a century's worth of investigations on rhodopsin biochemistry. A single photon isomerizes the Schiff-base linked 11-cis-retinylidene chromophore of rhodopsin, converting it to the all-trans agonist to elicit phototransduction through photoactivated rhodopsin (Rho*). Schiff base hydrolysis of the agonist is a key step in the photocycle, not only diminishing ongoing phototransduction but also allowing for entry and binding of fresh 11-cis chromophore to regenerate the rhodopsin pigment and maintain light sensitivity. Many challenges have been encountered in measuring the rate of this hydrolysis, but recent advancements have facilitated studies of the hydrolysis within the native membrane environment of rhodopsin. These techniques can now be applied to study hydrolysis of agonist in other opsin proteins that mediate phototransduction or chromophore turnover. In this review, we discuss the progress that has been made in characterizing the rhodopsin photocycle and the journey to characterize the hydrolysis of its all-trans-retinylidene agonist.


Adrenergic modulation of preoperative anxiety: a comparison of temazepam, clonidine, and timolol.
To assess the influence of adrenergic modulation on preoperative anxiety, we used a randomized, double-blind, placebo-controlled trial to compare temazepam, clonidine, and timolol as preanesthetic medications in patients undergoing minor orthopedic surgery. All the active treatments resulted in less preoperative anxiety than the placebo (control) did. Induction of anesthesia was smoother in all the treated patients compared with the control group. Recovery was slowest in the temazepam and clonidine groups, but there were no significant differences between the groups after 90 min. Cardiovascular changes were most marked in the timolol group. Pain scores were lower in the temazepam and clonidine series in the early postoperative period. Neither clonidine nor timolol offers any major advantage over temazepam for premedication in these patients.


STING-dependent type I IFN production inhibits cell-mediated immunity to Listeria monocytogenes.
Infection with Listeria monocytogenes strains that enter the host cell cytosol leads to a robust cytotoxic T cell response resulting in long-lived cell-mediated immunity (CMI). Upon entry into the cytosol, L. monocytogenes secretes cyclic diadenosine monophosphate (c-di-AMP) which activates the innate immune sensor STING leading to the expression of IFN-β and co-regulated genes. In this study, we examined the role of STING in the development of protective CMI to L. monocytogenes. Mice deficient for STING or its downstream effector IRF3 restricted a secondary lethal challenge with L. monocytogenes and exhibited enhanced immunity that was MyD88-independent. Conversely, enhancing STING activation during immunization by co-administration of c-di-AMP or by infection with a L. monocytogenes mutant that secretes elevated levels of c-di-AMP resulted in decreased protective immunity that was largely dependent on the type I interferon receptor. These data suggest that L. monocytogenes activation of STING downregulates CMI by induction of type I interferon.


HIV Testing Trends at Visits to Physician Offices, Community Health Centers, and Emergency Departments - United States, 2009-2017.
In 2019, the U.S. Department of Health and Human Services launched the Ending the HIV Epidemic: A Plan for America (EHE) initiative to end the U.S. human immunodeficiency virus (HIV) epidemic by 2030. A critical component of the EHE initiative involves early diagnosis of HIV infection, along with prevention of new transmissions, treatment of infections, and response to HIV outbreaks (1). HIV testing is the first step in identifying persons with HIV infection who need to be engaged in treatment and care as well as persons with a negative HIV test result and who are at high risk for infection and can benefit from HIV preexposure prophylaxis (PrEP) and other prevention services. These opportunities are often missed for persons receiving clinical services in ambulatory care settings (2). Data from the 2009-2016 National Ambulatory Medical Care Survey (NAMCS) and 2009-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed to estimate trends in HIV testing at visits by males and nonpregnant females to physician offices, community health centers (CHCs), and emergency departments (EDs) in the United States. HIV tests were performed at 0.63% of 516 million visits to physician offices, 2.65% of 37 million visits to CHCs, and 0.55% of 87 million visits to EDs. The percentage of visits with an HIV test did not increase at visits to physician offices during 2009-2016, increased at visits to CHC physicians during 2009-2014, and increased slightly at visits to EDs during 2009-2017. All adolescents and adults should have at least one HIV test in their lifetime (3). Strategies that reduce clinical barriers to HIV testing (e.g., clinical decision supports that use information in electronic health records [EHRs] to order an HIV test for persons who require one or standing orders for routine opt-out testing) are needed to increase HIV testing at ambulatory care visits.


Spatial influence on the distribution of downhill skiers in Sweden.
This study investigates empirically how natural snow depth affects the number of downhill skiers. Data include the number of skier visits for the 32 largest ski resorts in Sweden from the 1998/1999 to the 2018/2019 seasons. Results of spatial dynamic estimations show that an increase in natural snow depth in the ski area has a significant negative impact on the number of skier visits in the short term, although the magnitude is small. This implies that a snow deficit leads to increased demand for downhill skiing both directly and indirectly (in the neighbouring areas). The variable snow depth in the neighbouring ski areas is not significantly different from zero, indicating that no spatial substitution takes place. There is, however, a strong positive relationship between skier visits to neighbouring areas, revealing that ski resorts are complements rather than substitutes. The long-term influence of snow depth is not significant, implying that the ski business is independent of variations in snow depth. Instead, the number of skier visits is mainly determined by past visits, revealing a high degree of persistence.


Malabsorption Secondary to Gout-Induced Amyloidosis.
Many chronic inflammatory conditions can lead to systemic amyloidosis. However, secondary amyloidosis has rarely been associated with gout, and the literature reports only a handful of cases, all presenting with renal disease. We report a patient with a history of poorly controlled gout who presented with malabsorption. Endoscopic biopsies confirmed a diagnosis of small intestinal amyloidosis. This was believed to be a consequence of gout. Interestingly, renal involvement was subclinical. Our case raises awareness of this rare association and highlights the importance of considering a diagnosis of amyloidosis in patients who present with the combination of gout and gastrointestinal symptoms.


Transformation and genomic restriction mapping of Rochalimaea spp.
Transformation procedures using electroporation were established for Rochalimaea quintana. Several cosmid/plasmids possessing the RK2 or RSF1010 origin of replication were successfully inserted. Plasmid retention and replication were verified by antibiotic resistance and Southern blot analysis. The highest level of transformation was obtained at a voltage field strength of 12.5 kV/cm with a pulse time of 10 miliseconds. Transformation efficiency was low (0.3%) with approximately 10(5) transformants/microgram of DNA. One construct, designated pAG10, reached sufficient levels in R. quintana to be isolated by density gradient centrifugation. Analysis of this plasmid after several cycles of growth in R. quintana revealed no obvious modifications. Physical maps of Rochalimaea spp. chromosomal DNA using pulse-field electrophoresis are being developed. Digestion of R. vinsonii chromosomal DNA with NotI or SfiI resulted in three and one fragments, respectively. When R. quintana was digested in a similar manner, both NotI and SfiI produced four fragments. Double digestion of R. quintana DNA with NotI and SfiI yield seven fragments ranging in size from 11 to 925 kb. Summing the fragments indicate an approximate genome size of 2.1 x 10(6) bp for R. vinsonii and 1.7 x 10(6) bp for R. quintana chromosomal DNA.


Culture, personality, and subjective well-being: integrating process models of life satisfaction.
The authors examined the interplay of personality and cultural factors in the prediction of the affective (hedonic balance) and the cognitive (life satisfaction) components of subjective well-being (SWB). They predicted that the influence of personality on life satisfaction is mediated by hedonic balance and that the relation between hedonic balance and life satisfaction is moderated by culture. As a consequence, they predicted that the influence of personality on life satisfaction is also moderated by culture. Participants from 2 individualistic cultures (United States, Germany) and 3 collectivistic cultures (Japan, Mexico, Ghana) completed measures of Extraversion, Neuroticism, hedonic balance, and life satisfaction. As predicted, Extraversion and Neuroticism influenced hedonic balance to the same degree in all cultures, and hedonic balance was a stronger predictor of life satisfaction in individualistic than in collectivistic cultures. The influence of Extraversion and Neuroticism on life satisfaction was largely mediated by hedonic balance. The results suggest that the influence of personality on the emotional component of SWB is pancultural, whereas the influence of personality on the cognitive component of SWB is moderated by culture.


Development of a coping with stress scale for a non-western population of children and adolescents.
In the related literature numerous instruments have been developed to measure children and adolescents' coping with stress. Considering the cultural differences in individuals' choice for coping strategies, along with the limitations of the existing measures of coping for children and adolescents (e.g., being derived from coping measures developed for adults; unrepresentative samples with limited age range, etc.), the current study aimed to construct a self-report coping scale for a non-western population of children and adolescents. The study design included both qualitative and quantitative methodology. Three consecutive studies were conducted for the development and validation of the Children and Adolescents' Coping with Stress Scale (CACSS), a self-report measure assessing coping strategies of children and adolescents aged from 9 to 18 in response to self-identified stressors. Exploratory and confirmatory factor analyses resulted in a 61-item CACSS with 10 factors. The scale appears to have a clear factor structure; sufficient temporal stability; and good convergent, discriminant, and construct validity. By addressing limitations of existing coping scales, CACSS is believed to contribute to the literature as a developmentally appropriate and multidimensional tool.


Characterization of the catalytic properties of the membrane-anchored metalloproteinase ADAM9 in cell-based assays.
ADAM9 (A Disintegrin And Metalloprotease 9) is a membrane-anchored metalloproteinase that has been implicated in pathological retinal neovascularization and in tumor progression. ADAM9 has constitutive catalytic activity in both biochemical and cell-based assays and can cleave several membrane proteins, including epidermal growth factor and Ephrin receptor B4; yet little is currently known about the catalytic properties of ADAM9 and its post-translational regulation and inhibitor profile in cell-based assays. To address this question, we monitored processing of the membrane-anchored Ephrin receptor B4 (EphB4) by co-expressing ADAM9, with the catalytically inactive ADAM9 E > A mutant serving as a negative control. We found that ADAM9-dependent shedding of EphB4 was not stimulated by three commonly employed activators of ADAM-dependent ectodomain shedding: phorbol esters, pervanadate or calcium ionophores. With respect to the inhibitor profile, we found that ADAM9 was inhibited by the hydroxamate-based metalloprotease inhibitors marimastat, TAPI-2, BB94, GM6001 and GW280264X, and by 10 nM of the tissue inhibitor of metalloproteinases (TIMP)-3, but not by up to 20 nM of TIMP-1 or -2. Additionally, we screened a non-hydroxamate small-molecule library for novel ADAM9 inhibitors and identified four compounds that selectively inhibited ADAM9-dependent proteolysis over ADAM10- or ADAM17-dependent processing. Taken together, the present study provides new information about the molecular fingerprint of ADAM9 in cell-based assays by showing that it is not stimulated by strong activators of ectodomain shedding and by defining a characteristic inhibitor profile. The identification of novel non-hydroxamate inhibitors of ADAM9 could provide the basis for designing more selective compounds that block the contribution of ADAM9 to pathological neovascularization and cancer.


A novel highly sensitive, rapid and safe Rift Valley fever virus neutralization test.
Antibodies specific for Rift Valley fever virus (RVFV) can be detected by diverse methods, including ezyme-linked immunosortbent assay (ELISA) and virus neutralization test (VNT). The VNT is superior in sensitivity and specificity and is therefore considered the gold standard serological assay. Classical VNTs make use of virulent RVFV and therefore have to be performed in biosafety level 3 laboratories. Here, we report the development of a novel VNT that is based on an avirulent RVFV expressing the enhanced green fluorescent protein (eGFP), which can be performed safely outside level 3 biocontainment facilities. Evaluation with a broad panel of experimental sera and field sera demonstrated that this novel VNT is faster and more sensitive than the classical VNT.


Smoking-Induced Acute Eosinophilic Pneumonia in a 15-year-old Girl: A Case Report.
Acute eosinophilic pneumonia is a very rare disease that is characterized by acute febrile respiratory failure, diffuse bilateral infiltrates on chest X-ray, and eosinophilia in bronchoalveolar lavage fluid in the absence of infection. We present the case of a 15-year-old girl diagnosed with smoking-induced acute eosinophilic pneumonia. A previously healthy young girl with a 1-day history of fever presented with cough, dyspnea, and diffuse bilateral infiltrates on chest X-ray. She had started smoking only 3 weeks before presentation. She was diagnosed by bronchoalveolar lavage fluid tests and lung biopsy and dramatically improved after steroid treatment. We emphasize that acute eosinophilic pneumonia must be considered when acute pneumonia does not respond to broad-spectrum antibiotics. Effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality.


Oxytocin and Social Sensitivity: Gene Polymorphisms in Relation to Depressive Symptoms and Suicidal Ideation.
Although the neuropeptide oxytocin has been associated with enhanced prosocial behaviors, it has also been linked to aggression and mental health disorders. Thus, it was suggested that oxytocin might act by increasing the salience of social stimuli, irrespective of whether these are positive or negative, thus increasing vulnerability to negative mental health outcomes. The current study (N = 243), conducted among white university students, examined the relation of trauma, depressive symptoms including suicidal ideation in relation to a single nucleotide polymorphism (SNP) within the oxytocin receptor gene (OXTR), rs53576, and a SNP on the CD38 gene that controls oxytocin release, rs3796863. Individuals with the polymorphism on both alleles (AA genotype) of the CD38 SNP had previously been linked to elevated plasma oxytocin levels. Consistent with the social sensitivity perspective, however, in the current study, individuals carrying the AA genotype displayed elevated feelings of alienation from parents and peers as well as increased levels of suicidal ideation. Moreover, they tended to report elevated depressive symptoms compared to CC homozygotes. It was also observed that the CD38 genotype moderated the relation between trauma and suicidal ideation scores, such that high levels of trauma were associated with elevated suicidal ideation among all CD38 genotypes, but this relationship was stronger among individuals with the AA genotype. In contrast, there was no relationship between the OXTR SNP, rs53576, depression or suicidal ideation. These findings support a social sensitivity hypothesis of oxytocin, wherein the AA genotype of the CD38 SNP, which has been considered the "protective allele" was associated with increased sensitivity and susceptibility to disturbed social relations and suicidal ideation.


Combined baseline and one-month changes in big endothelin-1 and brain natriuretic peptide plasma concentrations predict clinical outcomes in patients with left ventricular dysfunction after acute myocardial infarction: Insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) study.
Increased levels of neuro-hormonal biomarkers predict poor prognosis in patients with acute myocardial infarction (AMI) complicated by left ventricular systolic dysfunction (LVSD). The predictive value of repeated (one-month interval) brain natriuretic peptides (BNP) and big-endothelin 1 (BigET-1) measurements were investigated in patients with LVSD after AMI. In a sub-study of the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS trial), BNP and BigET-1 were measured at baseline and at 1month in 476 patients. When included in the same Cox regression model, baseline BNP (p=0.0003) and BigET-1 (p=0.026) as well as the relative changes (after 1month) from baseline in BNP (p=0.049) and BigET-1 (p=0.045) were predictive of the composite of cardiovascular death or hospitalization for worsening heart failure. Adding baseline and changes in BigET-1 to baseline and changes in BNP led to a significant increase in prognostic reclassification as assessed by integrated discrimination improvement index (5.0%, p=0.01 for the primary endpoint). Both increased baseline and changes after one month in BigET-1 concentrations were shown to be associated with adverse clinical outcomes, independently from BNP baseline levels and one month changes, in patients after recent AMI complicated with LVSD. This novel result may be of clinical interest since such combined biomarker assessment could improve risk stratification and open new avenues for biomarker-guided targeted therapies. In the present study, we report for the first time in a population of patients with reduced LVEF after AMI and signs or symptoms of congestive HF, that increased baseline values of BNP and BigET-1 as well as a further rise of these markers over the first month after AMI, were independently predictive of future cardiovascular events. This approach may therefore be of clinical interest with the potential of improving risk stratification after AMI with reduced LVEF while further opening new avenues for biomarker-guided targeted therapies.


The Effect of Reflection on Nurse-Patient Communication Skills in Emergency Medical Centers.
Introduction: Reflection is formed through deep reflection on the event or a certain clinical position. The aim of this study was to determine the effect of reflection on nurse-patient communication skills of nurses working in emergency departments. Methods: This interventional study was conducted on intervention and control groups and with a pretest-posttest design. 142 nurses working in the emergency departments of hospitals affiliated to Golestan University of Medical Sciences were enrolled in the study in 2015, and randomly divided into two groups. During eight weeks of the study, the intervention group was asked to write their clinical experiences with regard to communication issues with their patients. Before the intervention, the communication skills of both groups were compared using a questionnaire. Data analysis was performed, using independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests. Results: Of the 142 nurses, 122 nurses had full participation. In the intervention group the mean scores of verbal communication skills, non-verbal communication skills, general communication skills and communication skills based on patient safety were statistically significant, but there was no significant difference in the control group. Conclusion: The results showed that eight weeks of reflection by nurses is an effective intervention in dimensions of communication skills. We therefore suggest that a reflective writing be encouraged as a vital tool for improving communication competency among emergency department nurses.


[The anatomico-radio-clinical forms of onset in pulmonary tuberculosis].
The aim of the study was to analyze the frequency of various radio-clinical forms of onset in newly discovered TB cases, in the area of the Sibiu dispensary on a period of 3 years (1992-1994). In the 327 cases included in the study, there was an equal sex ratio, with a symptomatic period of at least 3 months before the diagnosis. There was an increased percentage of unilateral cavitary forms, with an equal distribution in city and rural area. The severe forms were more frequent in villages and in male patients. The young patients (under 24) had mostly cavitary forms. The cavitary forms were more frequently associated with other illnesses than the caseous forms.


Changes in posterior airway space and mandibular plane hyoid distance following mandibular advancement DO.
To study the changes in posterior airway space (PAS) and mandibular plane hyoid (MPH) distance following mandibular advancement using distraction osteogenesis (DO). A prospective study was conducted at a tertiary care dental center from May 2009 to May 2014. Twenty-five consecutively operated patients of mandibular hypoplasia who underwent mandibular advancement using distraction with at least 12 months follow-up were included in the study. The study group comprised 15 males and 10 females with an age range of 15-30 years (mean 22 years). Presurgical and postsurgical cephalometric changes were compared to determine the changes in PAS and MPH distance. The mean distraction achieved was 14.50 mm. The mean preoperative MPH was 18.88 mm and mean postoperative MPH was 13.16 mm with a resultant reduction by 32%. Mean preoperative PAS was 6.48 mm and mean postoperative PAS was 11.08 mm. Mean increase in PAS was 75%. Mean preoperative and postoperative SNB values were 75.4° and 79.52°, respectively. The results were statistically analyzed using paired "Student's t-test." From this study, it is concluded that statistically significant changes were achieved in MPH and SNB. Although change in PAS was statistically insignificant, it may have clinical applications, especially in the field of Phase II surgical management of obstructive sleep apnea.


Hepatitis B Virus Infection in the General Population of Iran: An Updated Systematic Review and Meta-Analysis.
The hepatitis B virus (HBV) is a major global public health problem, affecting more than 2 billion people worldwide. Accurate and updated data on HBV prevalence is important for further planning to control the infection. The aim of this study was to update the prevalence estimate of HBV infection in the general population of Iran. A systematic review was done for data on the prevalence of HBV infection in the general Iranian population published between Jan. 1, 1990, and Jan. 1, 2016, in both international and national databases, including PubMed, Scopus, Web of Science, Scientific Information Database, IranMedex, and Magiran. All papers with clearly described time and location of the study, proper sampling strategies, and proper analysis methods were included in the present study. Data were extracted by two independent reviewers. Prevalence of HBV infection with a 95% confidence interval (CI) was calculated using Stata software, version 13. The polled estimated prevalence of HBV infection in the general population of Iran was 2.2 % (95% CI: 1.9% - 2.6%). The highest prevalence of HBV infection (8.9%, 95% CI: 7.6% - 10.2%) was reported from Golestan province, and the lowest prevalence (0.7%, 95% CI: 0.4% - 1.1%) was seen in Kermanshah province. The prevalence of HBV infection was estimated at 3% (95% CI: 2.2% - 3.8%) for Iranian males and 1.7% (95% CI: 1.2% - 2.3%) for Iranian females. The prevalence of HBV infection in the general population of Iran was 2.9% (95% CI: 2.5% - 3.4%) before 2010 and 1.3% (95% CI: 0.9% - 1.7%) after 2010. In total, Iran was classified within the low-intermediate HBV prevalence areas (2% - 4%), while according to recent data (after 2010), Iran was classified within the low HBV prevalence areas (< 2%), indicating that preventive measures conducted in Iran have been effective.


Activity of neurons in cortical area MT during a memory for motion task.
We recorded the activity of middle temporal (MT) neurons in 2 monkeys while they compared the directions of motion in 2 sequentially presented random-dot stimuli, sample and test, and reported them as the same or different by pressing one of 2 buttons. We found that MT neurons were active not only in response to the sample and test stimuli but also during the 1,500-ms delay separating them. Most neurons showed a characteristic pattern of activity consisting of a small burst of firing early in the delay, followed by a period of suppression and a subsequent increase in firing rate immediately preceding the presentation of the test stimulus. In a third of the neurons, the activity early in the delay not only reflected the direction of the sample stimulus, but was also related to the range of local directions it contained. During the middle of the delay the majority of neurons were suppressed, consistent with a gating mechanism that could be used to ignore task-irrelevant stimuli. Late in the delay, most neurons showed an increase in response, probably in anticipation of the upcoming test. Throughout most of the delay there was a directional signal in the population of MT neurons, manifested by higher firing rates following the sample moving in the antipreferred direction. Whereas some of these effects may be related to sensory adaptation, others are more likely to represent a more active task-related process. These results support the hypothesis that MT neurons actively participate in the successful execution of all aspects of the task requiring processing and remembering visual motion.


The glass-liquid transition of water on hydrophobic surfaces.
Interactions of thin water films with surfaces of graphite and vitrified room-temperature ionic liquid [1-butyl-3-methylimidazolium hexafluorophosphate ([bmim][PF(6)])] were investigated using time-of-flight secondary ion mass spectrometry as a function of temperature and annealing time to elucidate the glass-liquid transition of water at the molecular level. Surface diffusion of water occurs at temperatures higher than 120 K, thereby forming three-dimensional clusters (a two-dimensional layer) on the [bmim][PF(6)] (graphite) surface. The hydrophobic effect of the surface decreases with increasing coverage of water; the bulklike properties evolve up to 40 ML, as evidenced by the occurrence of film dewetting at around the conventional glass transition temperature (140 K). Results also showed that aging is necessary for the water monolayer (a 40 ML water film) to dewet the graphite ([bmim][PF(6)]) surface. The occurrence of aging is explainable by the successive evolution of two distinct liquids during the glass-liquid transition: low density liquid is followed by supercooled liquid water. The water monolayer on graphite is characterized by the preferred orientation of unpaired OH groups toward the surface; this structure is arrested during the aging time despite the occurrence of surface diffusion. However, the water monolayer formed on the [bmim][PF(6)] surface agglomerates immediately after the commencement of surface diffusion. The structure of low density liquid tends to be arrested by the attractive interaction with the neighbors.


Quality assurance in radiation therapy: clinical and physical aspects. Manpower requirements in training and certification of technologists and dosimetrists.
The rapid expansion of radiation oncology has created a shortage in the number of personnel adequately trained in radiation therapy technology. An estimate of present needs for graduate radiation therapy technologists is on the order of 2000 to 2500 additional individuals. This shortage of technologists and the highly technical nature of radiation oncology not only makes apparent the need for increased activity in training individuals in radiation therapy but also points out the need for continuing education of individuals currently employed in the field. A team of highly trained individuals is required to obtain the optimal results with radiation therapy treatment. The minimum number of health care professionals for any center administering radiation therapy should include a radiation oncologist, a radiation therapy technologist, a nurse and a radiation therapy physicist or dosimetrist under the supervision of a consulting radiation therapy physicist. There is no consensus as to the number of individuals required in each position as the patient load is increased. A discussion of manpower needs in radiation therapy technology and dosimetry, and the role of radiation therapy technologists and dosimetrists in quality assurance will be discussed. The discussion will also include recommendations for minimum or basic staffing requirements for any center administering radiation therapy, regional or community hospitals and optimal standards now in effect at an advanced facility.


A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.
Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.


2002 Connecticut health policymaker survey.
In Spring 2002, Connecticut health policymakers in executive and legislative branches of government were surveyed to assess their needs for health policy information and their perceptions of upcoming health challenges facing Connecticut citizens; a similar survey was conducted in 2000. Policymakers receive information from a wide variety of sources; most often from within state government--state agencies and legislative staff--and from health advocacy organizations/coalitions. The most trusted sources of information are legislative staff, journals/publications, and state agencies. The areas of greatest need for information were: health-care financing, the uninsured, prescription drug coverage, long-term care, and mental health/substance abuse. Between 2000 and 2002, concerns over the costs of health care have increased significantly. Connecticut policymakers prefer to receive information in short, one, or two-page fact sheets.


[Health research in Madagascar: state-of-the-art, challenges and perspectives].
The evolution and contemporary challenges of health research (HR) in Madagascar are poorly documented. We aim to gain insights on the factors that shape Madagascar's National Health Research System (NHRS) to better understand their influence. We conducted a qualitative case study, which included a documentary review and semi-structured interviews with 38 key informants. We carried out a thematic analysis and used the WHO/AFRO NHRS Barometer to structure the presentation of the results. There is no legislative framework to support HR activities and institutions. There is, however, a policy document outlining national priorities for HS. Human resources for HR are insufficient, due to challenges in training and retaining researchers. International collaboration is almost the only source of HR funding. Collaborations contribute to developing human and institutional capacity, but they are not always aligned with research carried out locally and the country's priority health needs. Incomplete efforts to improve regulation and low public investment in research training and research implementation reflect an insufficient commitment to HR by the government. Negotiating equitable international partnerships, the availability of public funding, and aligning HR with national health priorities would constitute a solid basis for the development of the NHRS in Madagascar.


Rescue therapy with alemtuzumab in B cell/antibody-mediated multiple sclerosis.
Alemtuzumab exerts its clinical efficacy by its specific pattern of depletion and repopulation of different immune cell subsets. Recently, single cases of multiple sclerosis patients who developed severe exacerbation after the first alemtuzumab application, accompanied by re-appearance of peripheral B cells, were reported. Here we present a case with underlying B cell-driven multiple sclerosis that impressively improves after alemtuzumab, although peripheral B cell repopulation took place. Our detailed clinical, histopathological, imaging and immunological data suggest that alemtuzumab can act as an effective rescue treatment in highly active B cell-driven and antibody/complement-mediated multiple sclerosis type II patients.


Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome.
First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors. Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension. Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived. This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.


The year in cardiology 2013: acute coronary syndromes.
Patients presenting with acute coronary syndromes (ACS) remain a challenging medical condition with potential in improving outcome despite major advances over recent years. During the year 2013, progress has been made with respect to a better understanding of the underlying mechanisms and diagnosing ACS. In addition, new studies provided fundamental insights the optimal management, particularly with respect to the best antithrombotic regimen.


Expression of monocyte and lymphocyte adhesion molecules is increased in isolated coronary artery ectasia.
Coronary artery ectasia is defined as localized or diffuse dilation of the coronary arteries exceeding the 1.5-fold of normal adjacent segment. Scarce data are available about the role of inflammation in coronary artery ectasia. In the present study, we aimed to evaluate the expression of CD11b and CD45 adhesion molecules in peripheral blood granulocytes, monocytes and lymphocytes from the patients with coronary artery ectasia as possible indicators of inflammation. The study consisted of 14 patients who had angiographically normal coronary arteries with coronary artery ectasia and 13 age and sex-matched controls without coronary artery ectasia. Cell surface adhesion molecules were detected by direct immunofluorescence evaluated by flow cytometry using monoclonal antibodies tagged with fluorescent markers. Venous blood samples were taken after coronary angiography. Mean fluorescence intensity of CD45 (33.8+/-3.1 vs. 13.0+/-0.7, P<0.001) and CD11b (39.1+/-13.5 vs. 19.5+/-1.32, P<0.001) on the monocyte surface of patients with coronary artery ectasia were higher than those of controls. Similarly in patients with coronary artery ectasia, the expression of CD11b (7.5+/-0.61 vs. 5.6+/-0.2, P=0.009) and CD45 (47.5+/-3.6 vs. 36.2+/-2.5, P=0.02) on lymphocytes was also significantly higher than those of controls. Increased levels of cellular adhesion molecules in patients with coronary artery ectasia may be an indicator of endothelial activation and inflammation and are likely to be in the causal pathway leading to coronary artery ectasia.


Simple Silica Column-Based Method to Quantify Inorganic Polyphosphates in Cartilage and Other Tissues.
Inorganic polyphosphates (polyP) play a multitude of roles in mammalian biology. PolyP research is hindered by the lack of a simple and sensitive quantification method. The aim of this study was to develop a robust method for quantifying the low levels of polyP in mammalian tissue such as cartilage, which is rich in macromolecules that interfere with its determination. Native and in vitro formed tissues were digested with proteinase K to release sequestrated polyP. The tissue digest was loaded on to silica spin columns, followed by elution of bound polyP and various treatments were assessed to minimize non-polyP fluorescence. The eluent was then quantified for polyP content using fluorometry based on DAPI (4',6-diamidino-2-phenylindole) fluorescence shift occurring with polyP. Proteinase K pretreatment reduced the inhibitory effect of proteins on polyP recovery. The eluent was contaminated with nucleic acids and glycosaminoglycans, which cause extraneous fluorescence signals. These were then effectively eliminated by nucleases treatment and addition of concentrated Tris buffer. PolyP levels were quantified and recovery ratio determined using samples spiked with a known amount of polyP. This silica spin column method was able to recover at least 80% of initially loaded polyP, and detect as little as 10-10 mol. This sensitive, reproducible, easy to do method of quantifying polyP will be a useful tool for investigation of polyP biology in mammalian cells and tissues. Although the protocol was developed for mammalian tissues, this method should be able to quantify polyP in most biological sources, including fluid samples such as blood and serum.


Synonymies, transferences, redescriptions and new species in Lamiinae (Coleoptera, Cerambycidae).
The differences between Psapharochrus Thomson, 1864 and Acanthoderes Audinet-Serville, 1835 (as well as the current subgenera of the latter) are discussed. Pteridotelus hematopus (Lameere, 1884) is synonymized with Pteridotelus laticornis White, 1855, and the species is redescribed. Psapharochrus abstersus (Bates, 1880) and Psapharochrus pupillatus (Bates, 1880) are transferred to Acanthoderes (Scythropopsis) and redescribed. Desmiphora (Desmiphora) senicula Bates, 1866 is synonymized with D. (D.) elegantula White, 1855; the species is redescribed, the holotype of D. (D.) elegantula figured for the first time, and newly recorded for the Brazilian states of Mato Grosso do Sul and São Paulo. Desmiphora (Desmiphora) normae sp. nov. from the Brazilian state of Bahia, is described and illustrated.


Protocol for a Systematic Review and Meta-Analysis of Lithium, Anticonvulsive or atypical antipsychotic Drugs for Treatment of Refractory Obsessive-Compulsive Disorder.
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that causes significant distress to the afflicted individual. About half of OCD patients treated with an adequate trial of serotonin reuptake inhibitors fail to fully respond to treatment and continue to exhibit significant symptoms. Therefore, there is a need for other agents to alleviate the symptoms of these disorders. In spite of considerable research including numerous randomized controlled trials and systematic reviews, there exists uncertainty regarding what treatments are effective. In this systematic review, we evaluated the efficacy of mood stabilizers in treatment-refractory OCD. We conducted a meta-analysis of all randomized clinical trials evaluating lithium, anticonvulsive agents or atypical antipsychotic drugs for OCD to determine which therapies show more effective than a placebo, in reducing obsessive-compulsive symptoms. We acquired eligible studies through a systematic search of Cochrane Central Registry of Controlled Trials, MEDLINE, EMBASE, PsycINFO, Scopus, ProQuest and Google scholar. We conducted meta-analyses to establish the effect of lithium, anticonvulsive agents, or atypical antipsychotic drugs on patient-important outcomes when possible. To assess relative effects of treatments, we constructed a random effect model. Our review was the first to evaluate all treatments for OCD, to provide the relative effectiveness of lithium, anticonvulsive agents, or atypical antipsychotic drugs, and prioritize patient-important outcomes with a focus on functional gains. Our review facilitated the evidence-based management of patients with resistant OCD, and identified the key areas for future research.


Anatolian origins and diversification of Aethionema, the sister lineage of the core Brassicaceae.
The Irano-Turanian region harbors three biodiversity hotspots and ∼25% of Brassicaceae species are endemic to the region. Aethionema (∼61 species) is the sister lineage to the core Brassicaceae and occurs mainly in the Irano-Turanian region. The evolutionary important position of Aethionema makes it an ideal reference for broader comparative genetics and genomics. To understand the evolution of Aethionema, and for a broader understanding of crucifer evolution, a time-calibrated phylogenetic tree and biogeographical history of the genus is needed. Seventy-six plastome coding regions and nuclear rDNA genes, mainly from herbarium material, covering 75% of all Aethionema species, were used to resolve a time-calibrated Aethionema phylogeny. The different clades were characterized based on four morphological characters. The ancestral area of Aethionema was estimated with historical biogeographical analyses. Three well-supported major clades within Aethionema were resolved. The ancestral area reconstruction and divergence-time estimates are consistent with major dispersal events during the Pliocene from the Anatolian Diagonal. We find that most Aethionema lineages originated along the Anatolian Diagonal, a floristic bridge connecting the east to the west, during the Pliocene. The dispersal of Aethionema correlates with the local geological events, such as the uplift of the Anatolian and Iranian plateaus and the formation of the major mountain ranges of the Irano-Turanian region. Knowing the paleo-ecological context for the evolution of Aethionema, in addition to the other lineages of Brassicaceae, facilitates our broader understanding for trait evolution and species diversification across the Brassicaceae.


Lessons learned from implementation of a perinatal documentation system.
Implementation of an electronic medical record (EMR) system is a complex process with broad implications. In a Midwestern hospital perinatal setting, EMR implementation involved several critical steps: strategic planning and project goal setting; project structure and governance; system requirements analysis; vendor selection and contract negotiation; and EMR training. No difference in patient care activities and communications among clinicians was found between pre- and post-EMR implementation; however, nurses' perceptions of EMR were more negative afterward. Lessons learned and implications are provided.


Angle imaging: advances and challenges.
Primary angle closure glaucoma (PACG) is a major form of glaucoma in large populous countries in East and South Asia. The high visual morbidity from PACG is related to the destructive nature of the asymptomatic form of the disease. Early detection of anatomically narrow angles is important and the subsequent prevention of visual loss from PACG depends on an accurate assessment of the anterior chamber angle (ACA). This review paper discusses the advantages and limitations of newer ACA imaging technologies, namely ultrasound biomicroscopy, Scheimpflug photography, anterior segment optical coherence tomography and EyeCam, highlighting the current clinical evidence comparing these devices with each other and with clinical dynamic indentation gonioscopy, the current reference standard.


[Cytogenetic and biochemical assay of an unidirectional effect of chronic combined exposure of laboratory animals to isoeffective concentrations of chemical substances].
Chronic combined exposure to low concentrations of chemical substances (equal to the maximal admissible limits for space vehicles) is fraught with an increase in chromosomal aberrations in bone marrow cells as compared with the spontaneous chromosome aberration rate. In addition to the cytogenetic evidence, there were also statistical phase shifts in metabolic parameters of erythrocytes (enzymes involved in the basal metabolism and a number of metabolites), leukocyte count in peripheral blood, and the total quantity of karyocytes in the bone marrow. No significant changes were found in organs of the immune and reproductive systems.


Sorptive extraction techniques in sample preparation for organophosphorus pesticides in complex matrices.
Organophosphorus pesticides (OPPs), widely known as persistent organic pollutants, are the most popular contaminants in agriculture products in developing countries. The determination of OPPs in complex matrices, such as food, environmental and biological samples, usually requires extensive sample pretreatment. This review focuses on the sorptive extraction techniques applied as sample pretreatment for OPPs in complex matrices, including solid-phase extraction (SPE) and solid-phase microextraction (SPME). These methods are evaluated and the applications of each technique are demonstrated extensively with many practical examples.


Precursor anion states in dissociative electron attachment to chlorophenol isomers.
We report a theoretical study on low-energy (<10 eV) elastic electron scattering from chlorophenol isomers, namely, para-chlorophenol (pCP), meta-chlorophenol (mCP), and ortho-chlorophenol (oCP). The calculations were performed with the Schwinger multichannel method with pseudopotentials, and analysis of the computed integral cross sections and virtual orbitals revealed one σCCl (∗), one σOH (∗), and three π(∗) shape resonances. We show that electron capture into the two lower lying π(∗) orbitals initiates dissociative processes that lead to the elimination of the chloride ion, accounting for the two overlapping peaks where this fragment was observed. Despite the relatively small differences on the energetics of the π(∗) resonances, a major isomeric effect was found on their corresponding autodetachment lifetimes, which accounts for the observed increasing cross sections in the progression pCP < mCP < oCP. In particular, dissociation from the π1 (∗) anion of pCP is largely suppressed because of the unfavorable mixing with the σCCl (∗) state. We found the intramolecular hydrogen bond present in oCP to have the opposite effects of stabilizing the σCCl (∗) resonance and destabilizing the σOH (∗) resonance. We also suggest that the hydrogen abstraction observed in chlorophenols and phenol actually takes place by a mechanism in which the incoming electron is directly attached to the dissociative σOH (∗) orbital.


Prader-Willi syndrome: From genetics to behaviour, with special focus on appetite treatments.
Prader-Willi syndrome (PWS) is a neurodevelopmental disorder resulting from a deletion in the expression of the paternally derived alleles in the region of 15q11-q13. PWS has a prevalence rate of 1:10,000-1:30,000 and is characterized by marked endocrine abnormalities including growth hormone deficiency and raised ghrelin levels. The hyperphagic phenotype in PWS is established over a number of phases and is exacerbated by impaired satiety, low energy expenditure and intellectual difficulties including obsessive-compulsive disorder and/or autistic behaviours. Clinical management in PWS typically includes familial/carer restriction and close supervision of food intake. If the supervision of food is left unmanaged, morbid obesity eventuates, central to the risk of cardiorespiratory disorder. None of the current appetite management/intervention strategies for PWS include pharmacological treatment, though recent research shows some promise. We review the established aberrant genetics and the endocrine and neuronal attributes which may determine disturbed regulatory processes in PWS. Focusing on clinical trials for appetite behaviours in PWS, we define the effectiveness of pharmacological treatments with a view to initiating and focusing research towards possible targets for modulating appetite in PWS.


Community interest in predictive genetic testing for susceptibility to major depressive disorder in a large national sample.
Despite international concern about unregulated predictive genetic testing, there are surprisingly few data on both the determinants of community interest in such testing and its psychosocial impact. A large population-based public survey with community-dwelling adults (n=1046) ascertained through random digit dialling. Attitudes were assessed by structured interviews. The study found strong interest in predictive genetic testing for a reported susceptibility to depression. Once the benefits and disadvantages of such testing had been considered, there was significantly greater interest in seeking such a test through a doctor (63%) compared to direct-to-consumer (DTC; 40%) (p<0.001). Personal history of mental illness [odds ratio (OR) 2.58, p<0.001], self-estimation of being at higher than average risk for depression (OR 1.92, p<0.001), belief that a genetic component would increase rather than decrease stigma (OR 1.62, p<0.001), and endorsement of benefits of genetic testing (OR 3.47, p<0.001) significantly predicted interest in having such a test. Despite finding attitudes that genetic links to mental illness would increase rather than decrease stigma, we found strong community acceptance of depression risk genotyping, even though a predisposition to depression may only manifest upon exposure to stressful life events. Our results suggest that there will be a strong demand for predictive genetic testing.


Recurrent endometrial cancer arising in the round ligament.
An unusual case of recurrent endometrial carcinoma presenting as a round ligament metastasis is discussed. The primary lesion detected six years earlier was a well-differentiated lesion with less than 50% myometrial invasion located in the fundus. A persistent inguinal swelling represented a metastasis to the round ligament. Histologic examination revealed a poorly differentiated adenocarcinoma. Patients with early stage well-differentiated endometrial carcinoma are not immune from late recurrence.


[Modification of MSWI fly ash by using anionic chelating surfactant].
This paper aims at the reutilization and stabilization of municipal solid waste incineration (MSWI) fly ash to produce a high value added product. The effects of anionic chelating surfactants on the surface modification and fixing capacity of MSWI fly ash were primarily explored. Based on the indexes of active ratio and analysis of IR-spectrometer, the active ratio of ACS1 modified fly ash can be found higher than 95% under the condition of surfactant dosage at 7.0mL/100g fly ash, modification time at 15min and temperature at 75 degrees C . Moreover, Anionic chelating surfactant shows a strong fixing capacity for heavy metals by the United States Environmental Protection Agency's Toxicity Characteristic Leaching Procedure (TCLP).


The small fibrinopeptide Bβ15-42 as renoprotective agent preserving the endothelial and vascular integrity in early ischemia reperfusion injury in the mouse kidney.
Disruption of the renal endothelial integrity is pivotal for the development of a vascular leak, tissue edema and consequently acute kidney injury. Kidney ischemia amplifies endothelial activation and up-regulation of pro-inflammatory mechanisms. After restoring a sufficient blood flow, the kidney is damaged through complex pathomechanisms that are classically referred to as ischemia and reperfusion injury, where the disruption of the inter-endothelial connections seems to be a crucial step in this pathomechanism. Focusing on the molecular cell-cell interaction, the fibrinopeptide Bβ15-42 prevents vascular leakage by stabilizing these inter-endothelial junctions. The peptide associates with vascular endothelial-cadherin, thus preventing early kidney dysfunction by preserving blood perfusion efficacy, edema formation and thus organ dysfunction. We intended to demonstrate the early therapeutic benefit of intravenously administered Bβ15-42 in a mouse model of renal ischemia and reperfusion. After 30 minutes of ischemia, the fibrinopeptide Bβ15-42 was administered intravenously before reperfusion was commenced for 1 and 3 hours. We show that Bβ15-42 alleviates early functional and morphological kidney damage as soon as 1 h and 3 h after ischemia and reperfusion. Mice treated with Bβ15-42 displayed a significantly reduced loss of VE-cadherin, indicating a conserved endothelial barrier leading to less neutrophil infiltration which in turn resulted in significantly reduced structural renal damage. The significant reduction in tissue and serum neutrophil gelatinase-associated lipocalin levels reinforced our findings. Moreover, renal perfusion analysis by color duplex sonography revealed that Bβ15-42 treatment preserved resistive indices and even improved blood velocity. Our data demonstrate the efficacy of early therapeutic intervention using the fibrinopeptide Bβ15-42 in the treatment of acute kidney injury resulting from ischemia and reperfusion. In this context Bβ15-42 may act as a potent renoprotective agent by preserving the endothelial and vascular integrity.


Overlapping phenotypes in OFD type II and OFD type VI: report of two cases.
Mohr syndrome [orofaciodigital (OFD) syndrome type II] is an autosomal recessive condition that presents with short stature, broad or a bifid nasal tip, orofacial clefts, hypertrophied oral frenulae, tongue nodules or lobulated tongue, and digital anomalies. The features of OFD type II overlap with those of OFD type VI, Joubert syndrome, and short rib polydactyly (Majewski syndrome). Patients with OFD seen in our genetics in the last 4 years were reviewed. Of the five patients with OFD seen, two had Y-shaped metacarpals and other abnormalities consistent with the phenotypic spectrum of Mohr syndrome. They also had the additional radiological features of hypoplastic middle phalanges of index fingers and a hypertrophied or enlarged metatarsal with multiple phalanges arising from it. We hypothesize that type II and type VI OFD syndromes represent a continuum of the same phenotypic spectrum with severe central nervous system abnormalities at the more severe end of the spectrum.


[Quantitative assessment of Parkinsonian rigidity by vessel Doppler ultrasonography].
To investigate the value of quantitative assessment of parkinsonian rigidity by vessel Doppler ultrasonography. The diameter of the rigid limbs, including radial artery and vein, ulnar artery and vein, brachial veins, popliteal vein, anterior tibial vein, and posterior tibial vein in twelve individuals with PD and twelve age matched controls were measured by ultrasonography in both "on" and "off" states. Meanwhile the UPDRS unified Parkinson's disease rating scale for rigidity were also recorded both in "on" and "off " states by experienced neurologists. The mean diameter of radial vein, ulnar vein, brachial vein, popliteal vein, anterior tibial vein and posterior tibial vein, were 1.14, 1.13, 2.47, 3.85, 1.89, and 1.33 mm respectively in "off " state (group "A"), and were 1.58, 1.54, 2.88, 4.65, 2.27, and 1.69 mm respectively in "on" states (group "B") among the PD patients. The diameters of corresponding vessels in the controls (group "C") were 2.07, 1.69, 4.15, 5.07, 2.63, and 1.99 mm respectively. The data increased from group "A" to "C" gradually. Paired samples t tested showed a significant difference between the data of group A and group B (P = 0.00 approximately 0.03) and between group A and group C (P = 0.00 approximately 0.02) and no significant difference between group B and group C (P > 0.05, except for brachial vein with P = 0.02). The data of vein diameters in rigid limbs were correspondent to the UPDRS scores for rigidity with the correlation coefficient of 0.71, 0.82, 0.91, 0.73 (all P < 0.01), 0.60 P < 0.05 , and 0.77 P < 0.01) for the above mentioned vessels respectively. The diameter of distant veins in limbs can be adopted as objective and quantitative indicators for parkinsonian rigidity and contribute to the evaluation of therapeutical effects.


Capital breeding and allocation to life-history demands are highly plastic in lizards.
The use of stored resources to fuel reproduction, growth, and self-maintenance in the face of uncertain nutrient availability is a tactic common to many organisms. The degree to which organisms rely on stored resources in response to varied nutrients, however, is not well quantified. In this study, we used stable isotope methods to quantify the use of stored versus incoming nutrients to fuel growth and egg and fat body development in lizards under differing nutrient regimes. We found that the degree of capital breeding is a function of an individual's body condition. Furthermore, given sufficient income, lizards in poor condition can allocate simultaneously to storage, growth, and reproduction and "catch up" in body size and reproductive allocation to better-conditioned animals. Using natural variation in the δ(13)C of environmental nutrient pulses, we also found a high degree of variation in capital breeding in a lizard community. These findings demonstrate that capital breeding in lizards is not simply a one-way flow of endogenous stores to eggs but is a function of the condition state of individuals and seasonal nutrient availability. We use our findings to comment on capital breeding in lizards and the utility of the capital-income concept in general.


Efficacy of low-dose ibuprofen in acute migraine treatment: systematic review and meta-analysis.
Nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen have been shown to be effective in treating migraine. To evaluate the efficacy of low-dose ibuprofen for treatment of acute migraine attack. Clinical trials were identified through electronic searches (MEDLINE, EMBASE, EBM review, and the Cochrane Library) up to November 2006 and historical searches of relevant articles. Studies were included if they (1) were double-blind, randomized, placebo-controlled trials that evaluated ibuprofen tablets in moderate or severe migraine attacks in patients greater than 16 years of age, (2) evaluated at least one migraine attack, and (3) reported headache relief, pain-free, sustained pain-free, or relief of other migraine-associated symptoms at 2 hours. The MeSH search terms used were migraine disorders, headache, vascular headache, ibuprofen, adult, and clinical trial. This was followed by a key word search using migraine, cephalalgia, and cephalgia as key words. The reference lists of relevant articles were also scanned to identify possible published trials. There was no language restriction. Two authors extracted data independently. Disagreements were resolved through discussion. Ibuprofen 200 and 400 mg were more effective than placebo in reducing pain intensity and eliminating pain (pain-free) within 2 hours in adults with moderate or severe migraine attacks. For the 200 mg dose, the number needed to treat was 8 (95% CI 5 to 20) for headache relief and 13 (95% CI 8 to 50) for pain-free. The risk ratios for headache relief and pain-free were 1.89 (95% CI 1.45 to 2.46; p < 0.0001) and 2.15 (95% CI 1.24 to 3.73; p = 0.0063), respectively, for ibuprofen 400 mg. The 24-hour sustained pain-free outcome with ibuprofen was no better than with placebo. Ibuprofen 400 mg increased the chance of relief in photophobia and phonophobia by 30% (95% CI 8 to 57; p < 0.01) and 49% (95% CI 23 to 81; p < 0.0001), respectively. The available evidence suggests that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing. Due to the limited data and the shortcomings of the available evidence, further studies are needed.


Impact of the program life in traffic and new zero-tolerance drinking and driving law on the prevalence of driving after alcohol abuse in Brazilian capitals: An interrupted time series analysis.
Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals. An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016. The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application. The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.


Validation assay for total flavonoids, as rutin equivalents, from Trichilia catigua Adr. Juss (Meliaceae) and Ptychopetalum olacoides Bentham (Olacaceae) commercial extract.
An ultraviolet spectrophotometric method was validated for total flavonoid quantitation, as rutin equivalents, present in the Trichilia catigua Adr. Juss (Meliaceae) and Ptychopetalum olacoides Bentham (Olacaceae) commercial extract. Parameters as linearity, interval (range), specificity, estimated limit of detection (LOD, microg/mL), estimated limit of quantitation (LOQ, microg/mL), recovery (R, %), precision or relative standard deviation (RSD, %), and accuracy (E, %) were established. The analytical method was validated according to the experimental results: correlation coefficient (r = 0.9997); interval (RSD = 0.15-0.47%; E = 98.98-101.24%); specificity to total flavonoids quantitation, as rutin equivalents, at wavelength 361.0 nm; LOD = 0.09 microg/mL and LOQ = 0.27 microg/mL; R = 99.36-102.14%; adequate intra- and interrun precision (0.30-0.49% and 0.31-0.81%), and intra- and interrun accuracy (100.60-102.38% and 98.58-100.38%).


[Alpha2-macroglobulin gene polymorphism in patients with Alzheimer's disease].
Recent studies suggest that alpha 2-macroglobulin (alpha 2 m) may play a role in the pathogenesis of Alzheimer's Disease (AD). The presence of alpha 2-macroglobulin G/G genotype is thought to increase the risk of AD. The aim of the study was to analyse alpha 2 m polymorphism in two groups: AD patients (n = 60, F = 41, M. = 19, mean age 73.3 +/- 6.3) and non-demented control group (n = 58, F = 36, M. = 22, mean age 73.1 +/- 8.3, mean MMSE score 27). Frequencies of genotypes A/A, A/G, G/G in AD group were: 0.46: 0.42: 0.12. In control group those frequencies were: 0.40: 0.48: 0.12. The lack of statistically significant difference between G/G frequencies in both groups of patients may suggest that alpha 2-macroglobulin G/G genotype is not a risk factor for AD.


Identification of Susceptibility Loci for Spontaneous Coronary Artery Dissection.
Spontaneous coronary artery dissection (SCAD), an idiopathic disorder that predominantly affects young to middle-aged women, has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death. To identify common single-nucleotide variants (SNVs) associated with SCAD susceptibility. This single-center genome-wide association study examined approximately 5 million genotyped and imputed SNVs and subsequent SNV-targeted replication analysis results in individuals enrolled in the Mayo Clinic SCAD registry from August 30, 2011, to August 2, 2018. Data analysis was performed from June 21, 2017, to December 30, 2019. Genetic loci and positional candidate genes associated with SCAD. This study included 484 white women with SCAD (mean [SD] age, 46.6 [9.2] years) and 1477 white female controls in the discovery cohort (mean [SD] age, 64.0 [14.5] years) and 183 white women with SCAD (mean [SD] age, 47.1 [9.9] years) and 340 white female controls in the replication cohort (mean [SD] age, 51.0 [15.3] years). Associations with SCAD risk reached genome-wide significance at 3 loci (1q21.3 [OR, 1.78; 95% CI, 1.51-2.09; P = 2.63 × 10-12], 6p24.1 [OR, 1.77; 95% CI, 1.51-2.09; P = 7.09 × 10-12], and 12q13.3 [OR, 1.67; 95% CI, 1.42-1.97; P = 3.62 × 10-10]), and 7 loci had evidence suggestive of an association (1q24.2 [OR, 2.10; 95% CI, 1.58-2.79; P = 2.88 × 10-7], 3q22.3 [OR, 1.47; 95% CI, 1.26-1.71; P = 6.65 × 10-7], 4q34.3 [OR, 1.84; 95% CI, 1.44-2.35; P = 9.80 × 10-7], 8q24.3 [OR, 2.57; 95% CI, 1.76-3.75; P = 9.65 × 10-7], 15q21.1 [OR, 1.75; 95% CI, 1.40-2.18; P = 7.23 × 10-7], 16q24.1 [OR, 1.91; 95% CI, 1.49-2.44; P = 2.56 × 10-7], and 21q22.11 [OR, 2.11; 95% CI, 1.59-2.82; P = 3.12 × 10-7]) after adjusting for the top 5 principal components. Associations were validated for 5 of the 10 risk alleles in the replication cohort. In a meta-analysis of the discovery and replication cohorts, associations for the 5 SNVs were significant, with relatively large effect sizes (1q21.3 [OR, 1.77; 95% CI, 1.54-2.03; P = 3.26 × 10-16], 6p24.1 [OR, 1.71; 95% CI, 1.49-1.97; P = 4.59 × 10-14], 12q13.3 [OR, 1.69; 95% CI, 1.47-1.94; P = 1.42 × 10-13], 15q21.1 [OR, 1.79; 95% CI, 1.48-2.17; P = 2.12 × 10-9], and 21q22.11 [OR, 2.18; 95% CI, 1.70-2.81; P = 1.09 × 10-9]). Each index SNV was within or near a gene highly expressed in arterial tissue and previously linked to SCAD (PHACTR1) and/or other vascular disorders (LRP1, LINC00310, and FBN1). This study revealed 5 replicated risk loci and positional candidate genes for SCAD, most of which are associated with extracoronary arteriopathies. Moreover, the alternate alleles of 3 SNVs have been previously associated with atherosclerotic coronary artery disease, further implicating allelic susceptibility to coronary artery atherosclerosis vs dissection.


Effect of Antirotational Two-Piece Titanium Base on the Vertical Misfit, Fatigue Behavior, Stress Concentration, and Fracture Load of Implant-Supported Zirconia Crowns.
This study investigated the effects of antirotational titanium bases on the mechanical behavior of CAD/CAM titanium bases used for implant-supported prostheses. The aim was to assess the impact on the marginal fit, fatigue behavior, stress concentration, and fracture load of implant-supported CAD/CAM zirconia crowns. Forty titanium implants were divided into two groups: those with antirotational titanium bases (ARs) and those with rotational titanium bases (RTs). Torque loosening and vertical misfit were evaluated before and after cyclic fatigue testing (200 N, 2 Hz, 2 × 106 cycles). Fracture resistance was assessed using a universal testing machine (1 mm/min, 1000 kgf), and failed specimens were examined with microscopy. Three-dimensional models were created, and FEA was used to calculate stress. Statistical analysis was performed on the in vitro test data using two-way analysis of variance and Tukey's test (α = 0.5). Results show that the presence of an antirotational feature between the implant and titanium base reduced preload loss and stress concentration compared to rotational titanium bases. However, there were no differences in vertical misfit and resistance to compressive load.


Diversity and divergence of the glioma-infiltrating T-cell receptor repertoire.
Although immune signaling has emerged as a defining feature of the glioma microenvironment, how the underlying structure of the glioma-infiltrating T-cell population differs from that of the blood from which it originates has been difficult to measure directly in patients. High-throughput sequencing of T-cell receptor (TCR) repertoires (TCRseq) provides a population-wide statistical description of how T cells respond to disease. We have defined immunophenotypes of whole repertoires based on TCRseq of the α- and β-chains from glioma tissue, nonneoplastic brain tissue, and peripheral blood from patients. Using information theory, we partitioned the diversity of these TCR repertoires into that from the distribution of VJ cassette combinations and diversity due to VJ-independent factors, such as selection due to antigen binding. Tumor-infiltrating lymphocytes (TILs) possessed higher VJ-independent diversity than nonneoplastic tissue, stratifying patients according to tumor grade. We found that the VJ-independent components of tumor-associated repertoires diverge more from their corresponding peripheral repertoires than T-cell populations in nonneoplastic brain tissue, particularly for low-grade gliomas. Finally, we identified a "signature" set of TCRs whose use in peripheral blood is associated with patients exhibiting low TIL divergence and is depleted in patients with highly divergent TIL repertoires. This signature is detectable in peripheral blood, and therefore accessible noninvasively. We anticipate that these immunophenotypes will be foundational to monitoring and predicting response to antiglioma vaccines and immunotherapy.


Anti-NMDA encephalitis: an uncommon, autoimmune mediated form of encephalitis.
We report an interesting case of a 19 year old female with findings on MRI suggestive of viral encephalitis. An extensive workup was negative for infectious causes and she was subsequently diagnosed with anti-NMDA encephalitis. Anti-NMDA encephalitis is a highly lethal but treatable form of autoimmune encephalitis that has recently been characterized. It is frequently found in young women and associated with an underlying teratoma. Although rare, this diagnosis should be considered in young females for whom a rapid onset of encephalitis cannot be explained by more common causes.


Pain assessment in people with dementia.
Pain in older adults is very often undertreated, and it may be especially so in older adults with severe dementia. Changes in a patient's ability to communicate verbally present special challenges in treating pain, and unrelieved pain can have serious consequences, including declines in physical function and diminished appetite. The Pain Assessment in Advanced Dementia (PAINAD) scale has been designed to assess pain in this population by looking at five specific indicators: breathing, vocalization, facial expression, body language, and consolability. A trained nurse or other health care worker can use the scale in less than five minutes of observation. For an online video showing nurses using the PAINAD scale and other pain-assessment tools, go to http://links.lww.com/A251.


Kynurenic acid, by targeting α7 nicotinic acetylcholine receptors, modulates extracellular GABA levels in the rat striatum in vivo.
Kynurenic acid (KYNA) is an astrocyte-derived non-competitive antagonist of the α7 nicotinic acetylcholine receptor (α7nAChR) and inhibits the NMDA receptor (NMDAR) competitively. The main aim of the present study was to examine the possible effects of KYNA (30 - 1000 nm), applied locally by reverse dialysis for 2 h, on extracellular GABA levels in the rat striatum. KYNA concentration-dependently reduced GABA levels, with 300 nm KYNA causing a maximal reduction to ~60% of baseline concentrations. The effect of KYNA (100 nm) was prevented by co-application of galantamine (5 μm), an agonist at a site of the α7nAChR that is very similar to that targeted by KYNA. Infusion of 7-chlorokynurenic acid (100 nm), an NMDAR antagonist acting selectively at the glycineB site of the receptor, affected neither basal GABA levels nor the KYNA-induced reduction in GABA. Inhibition of endogenous KYNA formation by reverse dialysis of (S)-4-(ethylsulfonyl)benzoylalanine (ESBA; 1 mm) increased extracellular GABA levels, reaching a peak of 156% of baseline levels after 1 h. Co-infusion of 100 nm KYNA abolished the effect of ESBA. Qualitatively and quantitatively similar, bi-directional effects of KYNA on extracellular glutamate were observed in the same microdialysis samples. Taken together, the present findings suggest that fluctuations in endogenous KYNA levels, by modulating α7nAChR function, control extracellular GABA levels in the rat striatum. This effect may be relevant for a number of physiological and pathological processes involving the basal ganglia.


[Influence of quick intraoperative measurements of intact parathyroid hormone in the surgical management of primary hyperparathyroidism].
To evaluate whether a quick parathyroid hormone assay that measures intact parathyroid hormone (iPTH) level intraoperatively has modified the surgical strategy for primary hyperparathyroidism in the Meixoeiro Hospital in Vigo (Pontevedra, Spain). An observational, analytic, historic cohort study was performed. Two study groups were established. In group 1 (n = 28) iPTH levels were not measured intraoperatively. In group 2 (n = 39) iPTH was measured intraoperatively. iPTH was monitored using blood samples from cannulated peripheral veins. A positive test was defined as a decrease in iPTH level of >or= 50% of the baseline preincision level at 10 minutes postexcision, even when the baseline value was outside the normal range. The dependent variables evaluated were operating time, the number of parathyroid glands visualized, the number of parathyroid glands biopsied, length of postoperative hospital stay, unilateral exploration, and the percentages of cure, persistence, and recurrence in each group. Group 2 showed a statistically significant decrease in operating time (144.7 +/- 62.1 versus 178.8 +/- 57.5 minutes; p = 0.025), the number of parathyroid glands visualized (1.9 +/- 0.9 versus 2.8 +/- 1.3; p = 0.002), the number of parathyroid glands biopsied (1.5 +/- 0.9 versus 2.2 +/- 1.4; p = 0.025), and the need for bilateral exploration (30.77% versus 85.72%) in comparison with group 1. No significant differences were observed in length of postoperative hospital stay or in the percentages of cure (94.8% versus 92.85%), persistence (5.12% versus 7.14%), and recurrence (2.56% versus 3.57%). In our hospital, intraoperative measurement of iPTH improved the surgical strategy of primary hyperparathyroidism and has therefore been included in our routine treatment protocol.


Induction of PP2A Bβ, a regulator of IL-2 deprivation-induced T-cell apoptosis, is deficient in systemic lupus erythematosus.
The activity and substrate specificity of the ubiquitously expressed phosphatase PP2A is determined by the type of regulatory (B) subunit that couples to the catalytic/scaffold core of the enzyme. We determined that the Bβ subunit (PPP2R2B) is expressed in resting T cells, its transcription is down-regulated during T-cell activation, and up-regulated in conditions of low IL-2. Specifically, high levels of PP2A Bβ were produced during IL-2 deprivation-induced apoptosis, whereas Fas ligation had no effect. Forced expression of the Bβ subunit in primary human T cells was sufficient to induce apoptosis, whereas silencing using siRNA protected activated T cells from IL-2 withdrawal-induced cell death. Because T-cell apoptosis is known to be altered in T cells from patients with systemic lupus erythematosus, we analyzed the regulation of PP2A Bβ in this autoimmune disease. We found that levels of PP2A Bβ did not increase upon IL-2 deprivation in 50% of the patients. Remarkably, this defect was accompanied by resistance to apoptosis. Importantly, kinetics of cell death were normal in cells of patients that up-regulated PP2A Bβ in a normal manner. We have identified a unique role for the phosphatase PP2A, particularly the holoenzyme formed by PP2A Bβ. Bβ appears to trigger apoptosis of T cells in the absence of IL-2 and probably contributes to the termination of a no-longer-needed immune response. We propose that defective production of PP2A Bβ upon IL-2 deprivation results in apoptosis resistance and longer survival of autoreactive T cells, in a subset of SLE patients.


Perceptions of health care providers' communication: relationships between patient-centered communication and satisfaction.
Specific communication practices of multiple professionals in health care settings can impact patient outcomes. This study, conducted at a large Children's Hospital, sought to determine the extent to which patient-centered communication (PCC) affected satisfaction with communication and with care itself. Parents of child patients (N = 195) reported on the communication practices of physicians, nurses, and hospital staff members during their most recent stay in the hospital. Surveys were completed on site. Health care providers' use of PCC behaviors, especially immediacy and perceived listening, was positively associated with satisfaction with care and with communication. In addition, PCC behaviors were perceived to be used more frequently with children in better health than with children with poorer health status.


Crossing the other side of the algorithm: a challenging case of adrenal Cushing's syndrome.
The diagnosis of endogenous Cushing's syndrome and its aetiology involved documenting the hypercotisolism and then determining whether that hypercortisolism is adrenocorticotropic hormone-dependent (ACTH-dependent) or not. Hence, following the algorithm, an undetected ACTH level points to an adrenal Cushing's while a detectable or elevated ACTH level points to either a pituitary or ectopic Cushing's syndrome. The authors present a case of florid adrenal Cushing's syndrome initially presenting with a normal ACTH level, which led to the investigation for an ACTH-secreting tumour. Adding to the confusion, a MRI done showed an intrasellar focus. Knowledge of how ACTH-dependent (versus ACTH-independent) Cushing's syndrome manifests clinically, supported by results of repeat laboratory tests, led to the true diagnosis. This case illustrates that a detectable ACTH does not rule out an adrenal Cushing's syndrome nor does a positive pituitary imaging confirm Cushing's disease.


Surgical thyroparathyroidectomy prevents progression of 5TGM1 murine multiple myeloma in vivo.
The 5TGM1 multiple myeloma transplanted C57BL6/KaLwRij model recapitulates many disease features including monoclonal paraprotein production as well as the development of osteolytic bone lesions. Since a significant association between serum parathyroid hormone PTH variations, bone anabolism and myeloma progression in patients receiving proteasome inhibitors exists, this study investigated the effect of the PTH axis on murine myeloma development in vivo. C57BL6/KaLwRij myeloma-bearing mice underwent thyroparathyroidectomy (TPTX) before and after 5TGM1 cell transplantation. TPTX significantly and permanently inhibited 5TGM1 myeloma cell engraftment and prevented multiple myeloma growth and progression. These data support the hypothesis that the PTH axis is an important mediator of myeloma bone disease.


The occurrence of the Tullio phenomenon in congenitally deaf children.
One hundred and fifty deaf children between 5 and 16 years old of the 'Rudolf Mees' Institute were investigated in search of the Tullio phenomenon with nystagmus as a criterion. Seventy-six out of those 300 ears were positive. A functioning (calorically excitable) pars superior of the labyrinth was a 'conditio sine qua non' for this reflex. We may assume that deaf ears which show a positive Tullio phenomenon have a labyrinthine pathology of the Mondini-Alexander type and that this symptom is a pathologic one.


Wnt signaling: the good and the bad.
Since the first Wnt gene was identified in 1982, the functions and mechanisms of Wnt signaling have been extensively studied. Wnt signaling is conserved from invertebrates to vertebrates and regulates early embryonic development as well as the homeostasis of adult tissues. In addition, both embryonic stem cells and adult stem cells are regulated by Wnt signaling. Deregulation of Wnt signaling is associated with many human diseases, particularly cancers. In this review, we will discuss in detail the functions of many components involved in the Wnt signal transduction pathway. Then, we will explore what is known about the role of Wnt signaling in stem cells and cancers.


A Cardiac Deep Learning Model (CDLM) to Predict and Identify the Risk Factor of Congenital Heart Disease.
Congenital heart disease (CHD) is a critical global public health concern, particularly when it comes to newborn mortality. Low- and middle-income countries face the highest mortality rates due to limited resources and inadequate healthcare access. To address this pressing issue, machine learning presents an opportunity to develop accurate predictive models that can assess the risk of death from CHD. These models can empower healthcare professionals by identifying high-risk infants and enabling appropriate care. Additionally, machine learning can uncover patterns in the risk factors associated with CHD mortality, leading to targeted interventions that prevent or reduce mortality among vulnerable newborns. This paper proposes an innovative machine learning approach to minimize newborn mortality related to CHD. By analyzing data from infants diagnosed with CHD, the model identifies key risk factors contributing to mortality. Armed with this knowledge, healthcare providers can devise customized interventions, including intensified care for high-risk infants and early detection and treatment strategies. The proposed diagnostic model utilizes maternal clinical history and fetal health information to accurately predict the condition of newborns affected by CHD. The results are highly promising, with the proposed Cardiac Deep Learning Model (CDLM) achieving remarkable performance metrics, including a sensitivity of 91.74%, specificity of 92.65%, positive predictive value of 90.85%, negative predictive value of 55.62%, and a miss rate of 91.03%. This research aims to make a significant impact by equipping healthcare professionals with powerful tools to combat CHD-related newborn mortality, ultimately saving lives and improving healthcare outcomes worldwide.


Estrogen effects on cognition in menopausal women.
There is now considerable evidence from basic neuroscience that estrogen influences aspects of brain chemistry and brain morphology known to be important for memory functions. Prospective, controlled studies of surgically and naturally menopausal women demonstrated that exogenous estrogen enhanced short- and long-term memory and the capacity for learning new associations, whereas visual memory was unaffected. Healthy, 65 year-old women who took estrogen also performed significantly better than estrogen-nonusers who were matched for age, socioeconomic status, and years of formal education. Finally, in 32-year-old women with uterine myomas, a gonadotropin-releasing hormone agonist (GnRH-a) resulted both in ovarian suppression and in a decrease in verbal memory which was reversed by addition of estrogen to the GnRH-a treatment. Taken together, these findings suggest that estrogen helps to maintain verbal memory and enhances the capacity for new learning in women, whereas other cognitive functions such as verbal memory are seemingly unaffected by this steroid hormone.


The comparison of alpha lipoic acid with methylprednisolone and sucralfate in subacute wound healing corrosive esophagus-induced rats: An experimental study.
This study aims to compare methylprednisolone frequently used in the therapeutic practices of corrosive esophagus burns, sucralfate, a protective material of mucosal surfaces, and alpha lipoic acid, the most potent antioxidant in a rat model. A total of 40 female Sprague-Dawley rats were used in this study. The rats were equally divided into control, alpha lipoic acid, methylprednisolone, and sucralfate groups (n=10). A corrosive esophagus burn was created by using 10% pH:12 sodium hydroxide. No treatment was applied to the control group, and each group was given their own treatment. The treatment was continued regularly until the eighth day, when they were sacrificed. The corrosive esophagus burn lines were removed and tissue sections were stained with hematoxylin and eosin. The difference in ulceration in the group treated with alpha lipoic acid was significant, compared to the other groups. The most excellent complete epithelialization and complete re-epithelialization were observed in the alpha lipoic acid group. The difference between the groups was significant, with complete re-epithelialization being the lowest in the control and methylprednisolone groups (42.9% and 12.5%, respectively) and the highest in the alpha lipoic acid group (77.8%). In terms of ulceration and re-epithelialization, comparable values were found in the alpha lipoic acid group. The main difference was that the inflammation levels in the sucralfate group were lower and more favorable than the other groups in this period. The glutathione level was significantly higher in the alpha lipoic acid group and decreased the tissue hydroxyproline level. Alpha lipoic acid reduces esophageal ulceration, severity and prevalence of inflammation, severity and prevalence of fibrosis, decreases tissue damage by increasing blood glutathione level, and also reduces stricture in corrosive esophagus burns in rats.


[Measurement of ocular position using Purkinje images. Part 2. The measurement of ocular position in subjects wearing spectacles].
The first and the fourth Purkinje images are formed by the front surface of the cornea and the posterior surface of the lens. This measurement system is based on the principle of aligning one image with the other horizontally. It produces a precise measurement of the horizontal ocular position. I measured ocular position using this system when the subjects wore spectacles. The subjects gazed at a target position that was placed horizontally at 5 degrees intervals within a range of 25 degrees from the center to both sides. I analyzed the differences between the target position and the measurement data obtained by this system. The higher the refractive power of the lens the subjects wore, and the further the target position was from the center the greater were the differences between them. If the fixed target was placed within +/- 10 degrees, the difference was less than 0.5 degrees in all the spectacle lenses tested. I concluded that the measurements obtained with this system were useful even when the subjects wore spectacles.


Organic azide inhibitors of cysteine proteases.
Cysteine proteases are crucial regulatory enzymes in human physiology and disease. Inhibitors are usually designed with reactive electrophiles to covalently bond to the catalytic cysteinyl sulfur, and consequently they also indiscriminately interact with biological thiolates and other nucleophiles, leading to toxic side effects in vivo. Here we describe an alternative to using reactive electrophiles, demonstrating the use of a much less reactive azidomethylene substituent (-CH2-N3) that confers potent inhibition of cysteine proteases. This new approach resulted in potent, reversible, competitive inhibitors of caspase-1 (IC50 < 10 nM), with significant advantages over aldehydes such as high stability in vitro to thiols (10 mM dithiothreitol (pH 7.2), 20 mM glutathione (pH 7.2, 9, 11)) and aqueous media, as well as some highly desirable druglike features. It was also demonstrated that azides can be incorporated into inhibitors of other caspases (e.g. 3, 8) and cathepsins (e.g. K, S, B), indicating the versatility of this valuable new approach to cysteine protease inhibition.


Laser Doppler flowmetry for estimation of bone blood flow: studies of reproducibility and correlation with microsphere technique.
The blood flow in the femoral condyles of six pigs was measured by the microsphere technique and by laser Doppler flowmetry (LDF) before and after clamping of the external iliac artery. A significant decrease in the bone blood flow was found with both microsphere and LDF measurements, and a high correlation was found between the two methods. After release of the arterial clamp, the LDF values rapidly returned to approximately the same values as before clamping. In a second part of the study, the LDF output signal was studied in the intertrochanteric area of eight patients. The reproducibility of two LDF measurements at the same location was within 15%. The temporal variability of the LDF signal during 10 min of recording showed only slight variations. It is concluded that LDF is relative in nature and that the mean LDF output signal is suitable for monitoring dynamic responses of the bone blood flow to various stimuli. Several consecutive measurements have to be performed if the blood flow at different locations of a specific bone are to be compared with each other.


Relating Silica Scaling in Reverse Osmosis to Membrane Surface Properties.
We investigated the relationship between membrane surface properties and silica scaling in reverse osmosis (RO). The effects of membrane hydrophilicity, free energy for heterogeneous nucleation, and surface charge on silica scaling were examined by comparing thin-film composite polyamide membranes grafted with a variety of polymers. Results show that the rate of silica scaling was independent of both membrane hydrophilicity and free energy for heterogeneous nucleation. In contrast, membrane surface charge demonstrated a strong correlation with the extent of silica scaling (R2 > 0.95, p < 0.001). Positively charged membranes significantly facilitated silica scaling, whereas a more negative membrane surface charge led to reduced scaling. This observation suggests that deposition of negatively charged silica species on the membrane surface plays a critical role in silica scale formation. Our findings provide fundamental insights into the mechanisms governing silica scaling in reverse osmosis and highlight the potential of membrane surface modification as a strategy to reduce silica scaling.


The Molecular Mechanisms of Ciprofloxacin Resistance in Clinical Campylobacter jejuni and Their Genotyping Characteristics in Beijing, China.
We assessed the susceptibility of 182 Campylobacter jejuni isolates from patients with diarrhea to eight antibiotics and analyzed the molecular mechanisms of ciprofloxacin resistance as well as the genetic characteristics based on multilocus sequence typing (MLST). The C257T mutation was found on the quinolone resistance-determining region (QRDR) of the gyrA gene in all ciprofloxacin-resistant strains. Mutations on the QRDR of the gyrB gene were silent. A total of 74 strains had 7 inverted repeat (IR) (a 16-bp IR on the intergenic region between cmeR and cmeABC) mutation polymorphisms. Compared with strains without the IR mutations, strains with the IR mutations had higher resistance rates to ciprofloxacin (94.6% vs. 83.3%), nalidixic acid (94.6% vs. 83.3%), tetracycline (98.6% vs. 85.2%), doxycycline (91.9% vs. 71.3%), florfenicol (59.5% vs. 17.6%), chloramphenicol (25.7% vs. 4.6%), gentamicin (16.2% vs. 3.7%), and multidrug resistance than those without IR mutations (all p < 0.05). With C257T mutation alone, 89.9% strains with minimum inhibitory concentration (MIC) values focused on 16, 32, and 64 μg/mL, whereas strains with C257T mutation in combination with the IR mutations had a higher ciprofloxacin resistance level with 88.6% MIC values focused on 64, 128, and 512 μg/mL (p < 0.0001). The strains in this study showed a high genetic variability based on MLST with 117 sequence types (STs), 37 of which were novel. CC-21 was the most common clonal complex (CC) followed by CC-353 and CC-45. No association was found between STs and ciprofloxacin resistance. In conclusion, the C257T mutation on gyrA was the major mechanism for ciprofloxacin resistance, and the C257T mutation in combination with the IR mutations might result in more severe ciprofloxacin resistance to C. jejuni.