Morbid obesity with achalasia: a surgical challenge.
Achalasia is a relatively rare medical condition that is classically not associated with obesity. The surgical treatment of a simultaneous occurrence of these two diseases requires careful consideration, and only a few reports can be found in the literature combining a Heller myotomy with gastric bypass, duodenal switch, or gastric banding. We report the case of a 69-year-old female patient with early achalasia and obesity who underwent simultaneous laparoscopic gastric sleeve resection and robotic Heller myotomy. No intra- or postoperative complications occurred. A follow-up at 6 weeks showed a significant weight loss and resolved symptoms of achalasia. The case illustrates that a simultaneous gastric sleeve resection and robotic Heller myotomy might be an option for the treatment of concurrent obesity and achalasia.


[Four new mutations and polymorphic variants of the low density lipoprotein receptor in patients with familial hypercholesterolemia in Saint Petersburg].
In a collection of DNA samples from 100 unrelated patients with clinical features of familial hypercholesterolemia (FH), a search for mutations of exons 4 and 10 of the low-density lipoprotein (LDL) receptor gene was performed using heteroduplex and single-strand conformational polymorphism (SSCP) analyses followed by sequencing of amplified DNA fragments. Four new mutations of the LDL receptor gene were identified: C146R (c.499 T > C), A130P (c.451 G > C), G128G (c.477 T > C), and C188Y (c.626 G > A). Mutation A130P was assigned to the same chromosome with allele variant 447C. Two polymorphic sites in exon 10 of the LDL receptor gene (1413G/A and 1545C/T) were found in the Russian population for the first time. Based on the data obtained, familial hypercholesterolemia was confirmed in seven patients.


Single-step formation of a biorecognition layer for assaying histidine-tagged proteins.
The purpose of this work was to develop a simple procedure for the creation of a specific biorecognition layer for histidine-tagged (His-tagged) molecules. Such a layer was prepared by the spontaneous fusion of vesicles containing readily available plain (DOPC) and iminodiacetic acid (DOGS-NTA) phospholipids on a silica surface resulting in the formation of an NTA-containing supported lipid bilayer. The frequency surface acoustic waveguide device which supports Love waves was used to follow the real-time formation of the biorecognition layer. The mole percent of the DOGS-NTA phospholipids in the supported bilayer was optimized by following the kinetics of the fusion for the different NTA-containing lipids. Fluorescently labeled lipids were used with observations of the fluorescence recovery after photobleaching to confirm the presence of lipid bilayers. After saturating all NTA-molecules with Ni(2+), the binding of a His-tagged protein fragment within the concentration range of 0.04 and 0.4 mM to a 5 mol % DOGS-NTA/DOPC was detected; binding curves were used to calculate the apparent association constant k(on) = 2.56 x 10(4) M(-)(1) s(-)(1), dissociation constant k(off) = 1.3 x 10(-)(3) s(-)(1), and equilibrium constant k(eq) = 1.97 x 10(7) M(-)(1). The described method could find significant applications as a generic technique for preparing biorecognition layers for His-tagged proteins. In addition, the acoustic waveguide device, which provides high sensitivity together with flexibility in terms of the substrate material used, is shown to be an attractive alternative to direct optical biosensors.


False discovery rate estimation for large-scale homogeneous discrete p-values.
Large-scale homogeneous discrete p-values are encountered frequently in high-throughput genomics studies, and the related multiple testing problems become challenging because most existing methods for the false discovery rate (FDR) assume continuous p-values. In this article, we study the estimation of the null proportion and FDR for discrete p-values with common support. In the finite sample setting, we propose a novel class of conservative FDR estimators. Furthermore, we show that a broad class of FDR estimators is simultaneously conservative over all support points under some weak dependence condition in the asymptotic setting. We further demonstrate the significant improvement of a newly proposed method over existing methods through simulation studies and a case study.


[Anesthesia and analgesia in opiate dependence].
This review is devoted to problems that can arise in analgesia and anesthesia in opiate addicts. The following factors are especially important: psychic disorders, heart, lung, liver and kidney disease, AIDS, and tolerance to opiates. Withdrawal of opiates during the perioperative period has a detrimental effect, and the addicted patient should therefore receive generous premedication. Practical experience in the United States of America has shown that the prophylactic administration of methadone is beneficial and prevents withdrawal symptoms. General anesthesia and regional anesthesia are both possible. It is possible to give opiates during general anesthesia achieved with preparations given by inhalation (isoflurane), but it must be borne in mind that high doses are necessary because of these patients' tolerance levels. When regional anesthesia is used for surgery or for postoperative anesthesia, it is important to observe the neurological contraindications. High doses of opiates can be administered (s.c., i.m., p.o., continuous infusion) for postoperative analgesia in opiate addicts with no fear of respiratory depression, with further analgesic treatment as and when necessary (antidepressants, anti-inflammatory agents, neuroleptics, electroacupuncture). Attention is drawn to clonidine as a particularly good drug for the treatment of opiate withdrawal. Problems encountered with abstinent drug addicts are discussed.


Carcinomatous neuropathy. An ultrastructural study of ten cases.
Superficial peroneal nerve biopsies were studied from 10 patients with carcinomatous neuropathy. There were 6 patients with the sensorimotor form and 4 patients with the sensory form. In both forms of neuropathy, histometric studies showed a variable loss of myelinated fibers which was generally most severe in the sensory form. In most of the cases of the sensorimotor form, ultrastructural studies showed segmental demyelination with onion bulb formation and regeneration of myelinated fibers. In the sensory form, there was no segmental demyelination, the regeneration of myelinated fibers was minimal and all the cases showed a loss of unmyelinated fibers. In sensory neuropathy, the histometric and ultrastructural changes reflect the massive acute destruction of ganglion cells in the dorsal root ganglia. In sensorimotor neuropathy, the alterations indicate a slowly progressive degenerating process in which both axonal degeneration and segmental demyelination occurred.


A review study of the providing elderly care services in different countries.
Population aging leads to change of population structure and increase care needs. Lack of proper planning in this field will lead to occur increasing problems. In this paper, the review of the elderly care plans at various levels in some European and Asian countries, comparing these countries with Iran with the goal of using their experiences to enhance elderly plans have been done. This research was a review study of library documents and resources and systematic search. Data were collected using the resources, databases, scientific databases and websites of the Ministry of Health and Welfare of the studied countries. Based on this research in the studied countries, the care services of the elderly is based on the important principle of coordination between different organs of the country, followed by the creation of LTC insurance and provision of health and social services for the elderly and mainly the type of home care. In Iran country, providing appropriate services and cares for the elderly with existing plans and policies is not possible and the need to provide appropriate service packages based on the different systems of successful countries and applying the experiences of these countries is essential. Given the current status of the Iranian elderly population in terms of policies and plans and the types and methods of providing services, quality, access and financial resources allocated to this age group, compared to the studied countries, there is a well and integrated plan is essential.


[Effects of hyperthermia combined platinum-based drugs on ovarian cancer cell lines SKOV3].
To investigate the effects and mechanisms of hyperthermia combined with various platinum-based drugs cis-platinum (DDP), carboplatin (CBP), oxaliplatin (OXA) on the proliferation and apoptosis of ovarian cancer cell lines SKOV3. SKOV3 cells were treated with different concentrations of anticancer drugs DDP (final concentration respectively 0, 1.25, 2.5, 5.0, 10.0, 20.0 microg/mL), CBP and OXA (both final concentration respectively 0, 2.5, 5.0, 10.0, 20.0, 40 microg/mL) at a temperature of 42 degrees C for hyperthermia or 37 degrees C for normal temperature. Methyl thiazolyl tetrazolium (MTT) method was used to test growth ratios of ovarian cancer cell lines SKOV3. Real-time PCR was adopted to detect the expression level of excision repair cross-complementing group 1 (ERCC1) and Survivin mRNA in SKOV3 cells. DDP, CBP and OXA inhibited the growth of SKOV3 in a dose-dependent manner (P < 0.05). Hyperthermia could increase the sensitivity of SKOV3 to cis-platinum, carboplatin and oxaliplatin (P < 0.05). The half inhibitory concentration (IC50) values of DDP, CBP and OXA were (7.271 +/- 0.096) microg/mL, (37.609 +/- 0.779) microg/mL and (28.328 +/- 0.698) microg/mL respectively. When combined with hyperthermia, the IC50 values of DDP, CBP, and OXA were (2.075 +/- 0.244) microg/mL, (19.591 +/- 0.453) microg/mL, (19.089 +/- 0.424) microg/mL (P < 0.05). The increased sensitivity index was 2.075 +/- 0.244 for cis-platinum, 1.92 +/- 0.044 for carboplatin, 1.484 +/- 0.039 for oxaliplatin. After the treatment of hyperthermia, the expression of ERCC1 and Survivin mRNA showed downward trend. ERCC1 decreased more significantly in the group of hyperthermia combined with carboplatin, and Survivin decreased more significantly in the group of hyperthermia combined with oxaliplatin (P < 0.05). Hyperthermia can enhance the sensitivity of ovarian cancer SKOV3 cells to platinum-based drugs, which may be related to the down regulation of ERCC1 and Survivin expression.


[The assessment of subjective distress related to hyperacusis with a self-rating questionnaire on hypersensitivity to sound].
So far there has been no adequate measure to assess or illustrate, in terms of different levels, subjective distress related to hypersensitivity to sound. The here presented work describes and discusses the construction of a questionnaire to assess subjective distress related to hypersensitivity to sound (GUF). Between May and September 2000 226 patients that experienced suffering from hypersensitivity to sound as well as from chronic tinnitus, completed a first version of the questionnaire on admittance to the hospital. Of these patients 27.9 % were out-patients and 72.1 % were in-patients. In addition, the in-patients completed the questionnaire again during their last week of treatment. The 27 items of the GUF were interpreted by factor analysis to explore and determine the structure of the questionnaire; the number of items was reduced under the aspects of consistency and reliability. Finally, the revised version of the GUF underwent a first validation. The factor analysis shows three factors explaining 50.65 % variance (factor 1 [KRH], cognitive reactions to hyperacusis; factor 2 [ASV], actional/somatic behaviour; factor 3 [ERG], emotional reaction to external noises). First attempts to validate the questionnaire are promising; it appears that the GUF is also sensitive to therapy effects. The here presented questionnaire is suitable for identifying distinct levels of subjective distress related to hypersensitivity to sound. Thus, for the first time, there is an adequate measure for assessment available. Furthermore, results of part of the sample show that the GUF is also suitable for therapy evaluation.


Modern dying: from securing rights to meeting needs.
Modern medicine has transformed the dying experience. In the developed world, most of us no longer die from infectious diseases and sudden accidents, but from chronic illnesses that progressively worsen. Yet the U.S. healthcare system is not designed to meet the needs of people with chronic illness or of frail elders. In addition, our system incentivizes the use of technologies that are often helpful when an underlying condition is reversible but, when used very near the end of life, may only postpone the dying process and increase burdens on the patient. This state of affairs renders many people near the end of life without adequate symptom control, little or no social and psychological support, and inadequate involvement in decisions about when and how best to use modern technologies. This paper traces efforts over the last three decades to address problems related to modern dying. The author sees three phases: early work focused on securing patients' rights to refuse unwanted treatments, the next phase focused on building the specialty of palliative medicine, and the third and future phase must redesign our healthcare system to better align with how we die in the 21st century.


High association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with recurrent aphthous stomatitis.
Recurrent aphthous stomatitis (RAS) is a common ulcerative disease of the oral mucosa. Oral ulcers are also the most common feature of Behçet's disease (BD). Association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with BD has been reported in Turkish population. The aim of the present study was to investigate the possible association between ACE gene I/D polymorphism and RAS, and evaluate if there was an association with clinical features in a relatively large cohort of Turkish patients. The study included 198 patients affected by RAS and 214 healthy controls. ACE gene I/D polymorphism genotypes were determined using polymerase chain reaction with I and D allele-specific primers. The genotype and allele frequencies of I/D polymorphism showed statistically significant differences between RAS patients and controls (p < 0.0001 and p < 0.0001, respectively). After stratifying RAS patients according to clinical and demographical characteristics, no significant association was observed. In conclusion, the results of this study suggest that I/D polymorphism of the ACE gene was positively associated with predisposition to develop RAS in Turkish population. Further studies with larger populations are recommended.


Surface antigenic determinant of epimastigote forms common to trypomastigote and amastigote forms of different strains of Trypanosoma cruzi.
A fraction (FA) has been isolated from the sediment obtained from Trypanosoma cruzi of epimastigote lysates centrifuged at 1500 x g, for 30 min. This fraction, obtained by extracting sediments, for 10 min, with ice-cold 0.1 N NaOH, exhibited a single component, a glycoprotein, when analysed by electrophoresis in 1% agarose gel and presented a single faint precipitation line in immunoelectrophoresis experiments. FA components were unable to penetrate polyacrylamide gel matrix, even when 1% SDS 4% polyacrylamide gels were used, unless previously hydrolyzed by parasite proteinase. Under this condition FA preparations presented at least four glycoproteins components as detected by electrophoresis in 1% SDS 15% polyacrylamide gels. FA obtained from Y strain was able to inhibit agglutination reactions between anti-epimastigote sera and epimastigote of either Y or Nic strains. Anti-FA antibodies, elicited in 4 out of 12 rabbits inoculated with this fraction, gave positive immunofluorescence and immunoperoxidase reactions with blood trypomastigota and tissue amastigota, obtained from mice infected with any of 6 different strains of T. cruzi. These reactions which were inhibited by FA preparations were completely abolished if antisera were absorbed with living epimastigota of Y or Nic strains.


Combination therapy with rifampicin or fosfomycin in patients with Staphylococcus aureus bloodstream infection at high risk for complications or relapse: results of a large prospective observational cohort.
To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin. In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs). A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46-0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35-0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36-0.91). Upon agent-specific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions. In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.


N-Promoted Ru1/TiO2 single-atom catalysts for photocatalytic water splitting for hydrogen production: a density functional theory study.
We propose a universal dimer-doping strategy to improve the photocatalytic water splitting activity of Ru1/TiO2 single-atom catalysts, in which the N atom is simultaneously doped. First-principles calculations show that the N dopants promote the substitution of Ti with Ru on the anatase TiO2(101) surface by chemical bonding between Ru and N, and increase the stability of the system. Isolated Ru1 atoms act as active sites for the reduction of protons, and Ru1-N1/TiO2 has a hydrogen evolution activity comparable to that of Pd. The impurity bands within the band gap lead to a significant red-shift of the absorption edge towards the visible region, improving the photoabsorption and photocatalytic performance of TiO2 under sunlight. The reason is the charge compensation effect localized to the doped Ru-N dimers. We expect that this generic scheme that simultaneously realizes band-structure tailoring and reaction control also applies to other single-atom loaded oxide-based photocatalytic systems.


Preparation of spirodiclofen monoclonal antibody and establishment of indirect competitive enzyme-linked immunosorbent assay.
Spirodiclofen, a spirocyclic tetronic acid derivative, has excellent acaricidal effect and is used worldwide to control the majority of important mite species. For monitoring its residue in food and environmental samples, two haptens containing different spacer arms were synthesized, a monoclonal antibody (mAb 5A4) against spirodiclofen was prepared, and a heterologous indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) was established. The 50% inhibition concentration (IC50) of ic-ELISA was 25.46 ng/mL, and the working range was 5.59-133.85 ng/mL. The ic-ELISA showed no cross-reactivity with structural analogs of spirodiclofen and other commonly-used acaricides. The average recoveries from Shiranui citrus samples and Yangtze River water were 85.62%-97.74% and 85.95%-99.30%, respectively. In the analysis of 12 citrus samples, the results of the ic-ELISA were quite similar to those of ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Hence, the new immunosorbent assay provides a substitute method for the qualitative and quantitative of spirodiclofen in food and environmental samples.


Sub-ppt Mass Spectrometric Detection of Therapeutic Drugs in Complex Biological Matrixes Using Polystyrene-Microsphere-Coated Paper Spray.
Polystyrene (PS) is a class of polymer materials that offers great potential for various applications. However, the applications of PS microspheres in paper spray mass spectrometry are largely underexplored. Herein we prepared a series of PS microspheres via a simple dispersion polymerization and then used them as coating materials for paper spray mass spectrometry (MS) in high-sensitivity analysis of various therapeutic drugs in complex biological matrixes. In the preparation of PS-coated papers, the coating method was found playing a key role in determining the performance of the resulting paper substrate in addition to other parameters (e.g., starch type and amount, PS coating amount, and spray solvent). We also found that as a solvent was applied on PS-coated paper for paper spray, the analytes of interest would be first extracted out and then moved to the tip of paper triangle for spray along with the applied solvent. In the process, the surface energy of PS particles had a strong impact on the desorption performance of analytes from PS-coated paper substrate, and the PS with a high surface energy favored the elution of analytes to allow a high MS sensitivity. When the prepared PS coated paper was used as a substrate for paper spray, it gave high sensitivity in analysis of therapeutic drugs in various biological matrixes such as whole blood, serum, and urine with excellent repeatability and reproducibility. In contrast to uncoated filter paper, an improvement of 10-546-fold in sensitivity was achieved using PS-coated paper for paper spray, and an estimated lower limit of quantitation (LLOQs) in the range of 0.004-0.084 ng mL-1 was obtained. The present study is significant in exploring the potential of PS for high-sensitivity MS analysis, and it provides a promising platform in the translation of the MS technique to clinical applications.


Detecting early esophageal cancers, with special reference to the intraepithelial stage.
Early-stage esophageal cancers, particularly intraepithelial cancers, are extremely difficult to detect because patients have no particular complaints and x-ray is so often useless. Only panendoscopic examination has proved highly effective in discerning lesions. Lugol-combined panendoscopic examination is not only feasible, but also effective in spotting the presence and spread of lesions.


Joining mutants of RAG1 and RAG2 that demonstrate impaired interactions with the coding-end DNA.
In V(D)J joining of antigen receptor genes, two recombination signal sequences (RSSs), 12- and 23-RSSs, form a complex with the protein products of recombination activating genes, RAG1 and RAG2. DNaseI footprinting demonstrates that the interaction of RAG proteins with substrate RSS DNA is not just limited to the signal region but involves the coding sequence as well. Joining mutants of RAG1 and RAG2 demonstrate impaired interactions with the coding region in both pre- and postcleavage type complexes. A possible role of this RAG coding region interaction is discussed in the context of V(D)J recombination.


Multi-state models for bone marrow transplantation studies.
High-dose chemotherapy followed by stem cell recovery, more commonly called a bone marrow transplant, is a common treatment for a number of diseases. This article examines four problems commonly encountered when dealing with bone marrow transplant studies. First, we look at the problem of competing causes of failure and at methods based on a multi-state model to estimate meaningful probabilities for these risks. Second, we examine methods for estimating the prevalence of an intermediate condition, here the prevalence of chronic GVHD. Third, we look at the problem of modeling the post transplant recovery process and we provide two examples of how these estimates can be used to assess dynamically a patient's prognosis or how these probabilities can be used to design trials of new therapy. Finally, we present an estimate of a new measure of treatment efficiency, the current leukemia free survival function, which is derived from a multi-state model approach.


PSMA-targeting iron oxide magnetic nanoparticles enhance MRI of preclinical prostate cancer.
To evaluate the potential of newly-developed, biocompatible iron oxide magnetic nanoparticles (MNPs) conjugated with J591, an antibody to an extracellular epitope of PSMA, to enhance MRI of prostate cancer. Specific binding to PSMA by J591-MNP was investigated in vitro. MRI studies were performed on orthotopic tumor-bearing NOD.SCID mice 2 h and 24 h after intravenous injection of J591-MNPs, or non-targeting MNPs. In vitro, MNPs did not affect prostate cancer cell viability, and conjugation to J591 did not compromise antibody specificity and enhanced cellular iron uptake. Magnetic resonance contrast of tumors was increased in vivo using PSMA-targeting MNPs, but not by non-targeting MNPs. This provides proof-of-concept that PSMA-targeting MNPs have potential to enhance magnetic resonance detection/localization of prostate cancer.


The utility of Jerk-locked back averaging technique in diagnosis of generalized myoclonic epilepsy with normal scalp EEG: A case report.
The diagnosis of myoclonic epilepsy and the classification of generalized or partial type may be challenging, especially when the scalp electroencephalogram (EEG) is normal. In such situation, how to apply another electrophysiological technique to begin the diagnosis and classification? The utility of Jerk-locked back averaging technique has been described in our case. A Chinese patient (male, 21 years old) presented with frequent unilateral or bilateral shoulder-jerking. He has an epilepsy history of complex partial seizure (CPS) or secondary tonic-clonic seizure (sGTCS) for 10 years. After admission, scalp EEG was performed with the normal result when the patient showed the jerks. According to the patient's clinical presentation, we suspected myolconic seizure, but there was lack of objective evidence. Then we used Jerk-locked back averaging technique to help begin the diagnosis. A bilateral-symmetrical time-locked, evoked cortical averaging potential that preceded the jerk has been found. So the jerks were considered as cortical origin and generalized myoclonic seizure was confirmed. So in this situation, we added another antiepileptic drug of Levetiracetam (1500 mg/24 h). One week later, the jerk seizure had disappeared, and in the following visit, he had an improved prognosis with decreased seizure frequency. Generalized polyspike-slow wave in EEG was common to see in myoclonic seizure and can help to make the classification. However, it should not dissuade clinicians from the diagnosis of myoclonic epilepsy with normal scalp EEG. Under this condition, we may apply other electrophysiological technique such as Jerk-locked back averaging technique, to give objective evidence to verify the cortical origin.


Association between occult hepatitis B infection and the risk of hepatocellular carcinoma: a meta-analysis.
The association between occult hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) remains controversial. We conducted a meta-analysis of prospective studies and retrospective studies to examine whether occult HBV infection increases the risk of HCC. Two independent reviewers searched databases for eligible studies published in English or Chinese dated from 1966 to 6 April 2010. The odds ratios or the relative risks (RRs) of each study were considered respectively. We identified 16 eligible studies. A significantly increased risk of HCC was found in subjects with occult HBV infection in comparison with non-infected controls in both retrospective [OR(unadjusted) =6.08, 95% confidence interval (CI)=3.45-10.72] and prospective studies (RR(adjusted) =2.86, 95% CI=1.59-4.13), and occult HBV increased the risk for HCC in both hepatitis C virus (HCV)-infected populations (summary RR=2.83, 95% CI=1.56-4.10) and in non-infected populations (OR(unadjusted) =10.65, 95% CI=5.94-19.08). A higher prevalence of occult HBV was observed in individuals who were positive for anti-HBs and anti-HBc (OR(unadjusted) =1.81, 95% CI=1.06, 3.09). Our findings suggest that occult HBV infection was associated with an increased risk of HCC. Occult HBV may serve as a cofactor in the development of HCV-related HCC, and it may also play a direct role in promoting Non-B and Non-C HCC growth. Suggestive evidence indicates that individuals with a concomitant presence of anti-HBs and anti-HBc had an increased risk of occult HBV infection. However, further studies are needed to clarify these observations.


Electron transfer reactions for image and image-derived states in dielectric thin films.
We have studied the cross section for electron trapping that occurs at the surfaces and interfaces of a variety of thin dielectric films (n-octane, methanol, n-butanol, and difluoromethane) that are grown on Kr buffer films. When such films are bombarded with electrons of very low incident energies (E less, similar 300 meV), charging cross sections up to the order of 10(-14) cm(2) are measured for submonolayer quantities of a variety of coadsorbed molecules: CH(3)I, CH(3)Br, CH(3)Cl, and CO(2). These huge cross sections are ascribed to the formation of image states at the dielectric film interfaces, which trap incoming electrons and, via coupling to the adsorbate electron affinity levels, dramatically enhance the capture probability. We have also shown that thin film dielectric layer structures can be created which display image-derived states, such as a "quantum well" in a sandwich structure with two "electron barrier" layers surrounding a Kr and adsorbate spacer film. These phenomena are shown to be of a general nature, occurring for a wide variety of molecular thin films, and depend on the dielectric constant and electron affinity of the selected species. We also report the absolute cross section for dissociative electron attachment of submonolayer CH(3)I adsorbed on Kr thin films.


Use of ABR threshold and OAEs in detection of noise induced hearing loss.
To determine which measure is the most sensitive to noise induced hearing loss (NIHL): auditory nerve brainstem response (ABR), distortion product otoacoustic emission (DPOAE) or transient evoked otoacoustic emission (TEOAE), and how to assess possible changes in these responses. Four groups of rats were exposed to various durations of 113 dB SPL broadband noise: 5 or 10 minutes (temporary changes in cochlear function), and 3 or 4 hours (permanent changes). Group means and data from individual animals were compared before and after exposure. Mean group DPOAE amplitude reduction showed no clear advantage over mean ABR threshold elevation in detection of temporary and permanent NIHL. Data from individual rats, however, indicated a clinical advantage for DPOAEs in detecting slight temporary, but not permanent, changes. TEOAEs were more sensitive in detecting changes in individual rats than as a group measure. TEOAE and DPOAE monitoring may improve detection of NIHL, though it should be used in conjunction with audiometric threshold monitoring.


Receptor for anionic pyrene derivatives provides the basis for new biomembrane assays.
This study describes a new receptor cyclen 1 capable of strong selective binding of pyrene-based anionic dyes under near-physiological conditions. This receptor comprises four naphthylthiourea groups tethered to a cyclen core via an ester linkage. The complexation behavior of cyclen 1 receptor is characterized by a series of (1)H NMR, microcalorimetry, UV-vis, and fluorometry experiments. The relevance of structural features of this receptor to its recognition function is assessed using control compounds that lack some of the groups found in cyclen 1. The specificity of cyclen 1 toward pyrene-based dyes is assessed through experiments using dyes with different molecular organization. The most important finding was the ability of cyclen 1 to bind efficiently to a pH-sensitive dye pyranine, a dye that is commonly used in various biomembrane assays. The high affinity of cyclen 1 to pyranine, its impermeability to the lipid bilayer membrane, fast kinetics of binding, and ability to quench the pyranine's fluorescence were used as a basis for a new membrane leakage assay. This membrane leakage assay is fully compatible with the commonly applied pH-stat transport assay, and therefore it allows for differentiation of the ion transport and nonselective leakage mechanisms within a single set of experiments. The ability of cyclen 1 to quench the fluorescence of pyranine also finds limited applicability to the detection of endovesiculation.


Regional fibre stress-fibre strain area as an estimate of regional blood flow and oxygen demand in the canine heart.
1. In the present study the relation between regional left ventricular contractile work, regional myocardial blood flow and oxygen uptake was assessed during asynchronous electrical activation. 2. In analogy to the use of the pressure-volume area for the estimation of global oxygen demand, the fibre stress-fibre strain area, as assessed regionally, was used to estimate regional oxygen demand. The more often used relation between the pressure-sarcomere length area and regional oxygen demand was also assessed. 3. Experiments were performed in six anaesthetized dogs with open chests. Regional differences in mechanical work were generated by asynchronous electrical activation of the myocardial wall. The ventricles were paced from the right atrium, the left ventricular free wall, the left ventricular apex or the right ventricular outflow tract. Regional fibre strain was measured at the epicardial anterior left ventricular free wall with a two-dimensional video technique. 4. Regional fibre stress was estimated from left ventricular pressure, the ratio of left ventricular cavity volume to wall volume, and regional deformation. Total mechanical power (TMP) was calculated from the fibre stress-fibre strain area (SSA) and the duration of the cardiac cycle (tcycle) using the equation: TMP = SSA/tcycle. Regional myocardial blood flow was measured with radioactive microspheres. Regional oxygen uptake was estimated from regional myocardial blood flow values and arteriovenous differences in oxygen content. 5. During asynchronous electrical activation, total mechanical power, pressure-sarcomere length area, myocardial blood flow and oxygen uptake were significantly lower in early than in late activated regions (P < 0.05). 6. Within the experiments, the correlation between the pressure-sarcomere length area and regional oxygen uptake was not significantly lower than the one between total mechanical power (TMP) and regional oxygen uptake (VO2,reg). However, variability of this relation between the experiments was less for total mechanical power. Pooling all experimental data revealed: VO2,reg = k1 TMP+k2, with k1 = 4.94 +/- 0.31 mol J-1 k2 = 24.2 +/- 1.9 mmol m-3 s-1 (means +/- standard error of the estimate). 7. This relation is in quantitative agreement with previously reported relations between the pressure-volume area and global oxygen demand. The results indicate that asynchronous electrical activation causes a redistribution of mechanical work and oxygen demand and that regional total mechanical power is a better and more general estimate of regional oxygen demand than the regional pressure-sarcomere length area.


Predicting Condom Use among Undergraduate Students Based on the Theory of Planned Behaviour, Coquimbo, Chile, 2016.
Background: Sexually transmitted infections and pregnancy in adolescents are acknowledged public health problems in many countries. Although it is known that the proper use of condoms allows avoiding these health problems, their use in Chile is still limited, for unknown reasons. Objective: Based on planned behavioural theory, the aim was to validate a behaviour model regarding condom use by measuring the influence of the variables that predict this use among Chilean university students. Methods: A cross-sectional descriptive study was carried out in October 2016 among 151 Chilean university students belonging to the health and engineering areas. The information was collected through a self-administered survey. The sample was divided into two groups: stable and not stable relationships. Partial least squares (PLS) regression was used for the analysis. Results: It was possible to explain the condom use of the students by 57%. The attitude was the main variable related to the intention of using condoms, together with the perceived behavioural control. Additionally, there are statistically significant differences in the variables that predict condom use among students with stable relations compared to those without a stable relationship. Conclusions: The planned behavioural theory is useful for predicting condom use behaviour when students have a stable partner.


Asymmetric spiral chimeras on a spheric surface of nonlocally coupled phase oscillators.
The spiral chimera state shows a remarkable spatiotemporal pattern in a two-dimensional array of oscillators for which the coherent spiral arms coexist with incoherent cores. In this work, we report on an asymmetric spiral chimera having incoherent cores of different sizes on the spherical surface of identical phase oscillators with nonlocal coupling. This asymmetric spiral chimera exhibits a strongly symmetry-broken state in the sense that not only the coherent and incoherent domains coexist, but also their incoherent cores are nonidentical, although the underlying coupling structure is symmetric. On the basis of analyses along the Ott-Antonsen invariant manifold, the bifurcation conditions of asymmetric spiral chimeras are derived, which reveals that the asymmetric spiral chimera state emerges via a supercritical symmetry-breaking bifurcation from the symmetric spiral chimera. For the coupling function composed of two Legendre modes, rigorous stability analyses are carried out to present a complete stability diagram for different types of spiral chimeras, including the stationary symmetric and asymmetric spiral chimeras as well as breathing asymmetric spiral chimera. For the general coupling scheme the asymmetric spiral chimera occurs as a result of competition between the odd and even Legendre modes of the coupling function. Our theoretical findings are verified by using extensive numerical simulations of the model system.


Intracellular location, complex formation, and function of the transporter associated with antigen processing in yeast.
Peptide transport across the membrane of the endoplasmic reticulum (ER) gains increasing importance in view of its potential function in selective protein degradation and antigen processing. An example for peptide transport in the ER is the transporter associated with antigen processing (TAP), which supplies peptides for the formation of major-histocompatibility-complex class-I complexes. Here, we have expressed human TAP1 and TAP2 in the yeast Saccharomyces cerevisiae. Expression of both genes resulted in the formation of a stable TAP heterodimer that was localized mainly in the ER. Although a minor fraction of TAP is found in the plasma membrane, TAP is unable to restore a-factor secretion in a mutant cell line that lacks the yeast mating-factor transporter Ste6. Nevertheless, in vitro studies with microsomal vesicles demonstrated that the TAP complex is fully functional in the ER membrane in terms of selective peptide binding, ATP-dependent transport, and specific inhibition by the viral protein of herpes simplex virus ICP47. This offers opportunities for topological, structural and mechanistic studies as well as genetic screenings for TAP functionality.


[Cytologic diagnosis of mediastinal diseases].
The diagnosis of mediastinal tumors is based on morphological findings, on cytological among other things. Results of cytologic diagnosis of tumors of the anterior mediastinum in 79 patients are analyzed. Malignant thymomas were diagnosed by this method in 41 patients. The method verified the following thymoma variants: lymphoepithelial in 19 (46.3%), granulomatous in 7 (17.1%), spindle-cell in 2 (4.9%), lymphoid in 1 (2.4%), and malignant thymoma of an undefined form in 12 (29.3%). No surgery was carried out in 21 cases because the patients refused from it or their condition was grave. Treatment of these patients was based on the cytological findings. Results of cytological studies are compared with histological findings. The efficacy of the cytological method was 93.7%.


Transmembrane domain-dependent sorting of proteins to the ER and plasma membrane in yeast.
Sorting of membrane proteins between compartments of the secretory pathway is mediated in part by their transmembrane domains (TMDs). In animal cells, TMD length is a major factor in Golgi retention. In yeast, the role of TMD signals is less clear; it has been proposed that membrane proteins travel by default to the vacuole, and are prevented from doing so by cytoplasmic signals. We have investigated the targeting of the yeast endoplasmic reticulum (ER) t-SNARE Ufe1p. We show that the amino acid sequence of the Ufe1p TMD is important for both function and ER targeting, and that the requirements for each are distinct. Targeting is independent of Rer1p, the only candidate sorting receptor for TMD sequences currently known. Lengthening the Ufe1p TMD allows transport along the secretory pathway to the vacuole or plasma membrane. The choice between these destinations is determined by the length and composition of the TMD, but not by its precise sequence. A longer TMD is required to reach the plasma membrane in yeast than in animal cells, and shorter TMDs direct proteins to the vacuole. TMD-based sorting is therefore a general feature of the yeast secretory pathway, but occurs by different mechanisms at different points.


Temporal patterns of adherence to medications and behavioral treatment and their relationship to patient characteristics and treatment response.
The primary analyses of the COMBINE Study revealed significant naltrexone and Combined Behavioral Intervention (CBI) main effects on drinking outcomes but failed to find additional benefits of the combination of treatments. Investigating differences in patterns of adherence over time may shed light on the treatment effects in COMBINE. The goals of the study were to identify trajectories of medication adherence and participation in CBI, to estimate predictive and moderating effects of adherence trajectories on drinking outcomes and to characterize subjects in adherence trajectories. The results of these analyses may suggest approaches to improving adherence in order to ultimately improve treatment outcome. We used a trajectory-based approach to identify patterns of treatment adherence separately for naltrexone, acamprosate and CBI adherence. Logistic regression and general linear models assessed associations among adherence trajectories, drinking outcomes and patient characteristics. Three trajectories of adherence were identified for each treatment: "excellent adherers", "late non-adherers" and "early non-adherers" and there was good agreement among adherence trajectories with different treatments. "Excellent adherers" had significantly higher percent days abstinent (PDA) and lower percent heavy drinking days (PHDD). CBI significantly decreased PHDD for subjects on acamprosate in the "early non-adherers with medication" trajectory (p=0.01). Either naltrexone or acamprosate was associated with lower PHDD than placebo for "early non-adherers with CBI" (p<0.01). Receiving active medication decreased the likelihood to be in the excellent medication adherence trajectory. Younger age, greater drinking severity, dissatisfaction with the medicine and session frequency, adverse events and lack of benefit were related to less favorable medication adherence trajectories. "Excellent adherers with CBI" were significantly more satisfied with the CBI counselor. Patterns of treatment adherence appear to be a participant characteristic. Individuals who fail to adhere early in treatment have worse outcomes regardless of treatment. However, treatment outcomes of participants who exhibit early problems with adherence to one treatment modality could potentially be improved by offering an alternative behavioral or pharmacologic treatment.


Curare modification of suxamethonium blockade.
Tubocurare (0.125 mg.kg-1 or 0.25 mg.kg-1) was injected 10 s before 1 mg.kg-1 suxamethonium in patients anaesthetised with enflurane 1-1.5%. Measurement of electromyographic response was recorded using a 0.2 Hz train-of-four every 20 s. The modified blocks were slower in onset, of lesser intensity, and of shorter duration than that of suxamethonium alone, but were much closer to those of suxamethonium than of tubocurare. However, the train-of-four fade observed during onset of the modified blocks were similar to that of their tubocurare controls and significantly different from the suxamethonium group. We conclude that effective amounts of tubocurare are present in the neuromuscular junction within the 30 s following intravenous injection of the drugs, and this affects the onset of action of the suxamethonium block. The presence of train-of-four fade during a predominantly agonist block is difficult to explain on the basis of diminished acetylcholine release and a postsynaptic site of action of suxamethonium.


Prevalence and magnitude of perinatal substance exposures in California.
Perinatal substance exposure has been linked to many neonatal and obstetrical complications. There have been few population-based epidemiologic studies to identify the prevalence and demographic profiles associated with drugs, alcohol, and smoking during pregnancy. We studied a fully probabilistic stratified-cluster sample to estimate the prevalence of perinatal substance exposures in California in 1992. Urine samples from 29,494 women presenting for delivery in 202 hospitals were coded and screened for toxins; the results of toxicology screening were later linked by code number to the subjects' demographic variables and their reported use of tobacco and prescribed drugs. Urinary toxicologic tests provide conservative estimates because they can detect only very recent substance use. The weighted prevalence for perinatal substance exposure was 5.16 percent for the use of one or more drugs, 6.72 percent for alcohol (analyzed independently), and 8.82 percent for self-reported smoking. The percentage of women testing positive for any drug, including alcohol, was 11.35 percent. Estimates for racial and ethnic groups varied widely. Black women had the highest prevalence of total drug use (14.22 percent), alcohol use (11.58 percent), cocaine use (7.79 percent), and tobacco use (20.12 percent). Most drug exposures occurred among white non-Hispanic and Hispanic women. White non-Hispanic women had the second highest prevalence rate for the use of one or more drugs (6.79 percent) and self-reported tobacco use (14.82 percent). Hispanic women had the second highest prevalence rate for alcohol (6.87 percent). In California in 1992, there were 67,361 estimated perinatal exposures to one or more drugs, including alcohol, and 52,346 self-reported exposures to tobacco. These findings have clinical and public health implications.


Response to selection for time interval between ovipositions in the hen.
Data were collected from seven generations of selection for reduced time interval between oviposition in a line of Single Comb White Leghorns. This study involved 151 sires, 539 dams, and 2100 female progeny. Oviposition time was measured from 174 to 280 days of age. The only deliberate selection practiced was for reduced oviposition time interval. The mating system was random with the restriction of full or half sib matings. The reduction in oviposition time interval has been 73 minutes or 4.8 percent. There were no significant changes for total egg number, body weight or age at first egg. Rate of lay after reaching 50 percent production to 280 days has increased (P less than .07). Egg weight has declined five percent. Heritability estimates for intra-clutch time interval from correlations were .33 +/- .08, .36 +/- .09 and .35 +/- .15 by sire, dam, and combined components, respectively, .36 +/- .15 by regression of offspring on dam and .39 for realized. The magnitude of the selection differential decreased, over time. The genetic correlation of time interval with early production (280 days) was --.43 +/- .13, and with total egg production (500 days) was .20 +/- .27. The genetic correlations of time interval with egg weight and age at first egg were high and positive; and with body weight, it was negative. The increase in clutch size and the days between clutches during the time of this study were both highly significant.


New Insights into the Role of Al2 O3 in the Promotion of CuZnAl Catalysts: A Model Study.
The Cu/Al2 O3 /ZnO(0001)-Zn ternary model catalysts and their binary analogues were prepared and characterized. It was found that Al2 O3 grew on the ZnO(0001)-Zn surface by a layer-by-layer model, whereas Cu grew on the ZnO(0001)-Zn surface as two-dimensional clusters up to 0.2 monolayers (ML), and thereafter formed three-dimensional clusters. Because of the layer-by-layer growth of Al2 O3 on the ZnO(0001)-Zn, Cu/Al2 O3 can be considered without the effect of ZnO. Ternary model catalyst Cu/Al2 O3 /ZnO(0001)-Zn, which has all three parts on the surface, was prepared by deposition of Cu on the surface of Al2 O3 /ZnO(0001)-Zn. Low-energy ion scattering spectra showed that Cu preferred to locate at the Al2 O3 /ZnO interfaces. Compared with Cu/ZnO, the addition of Al2 O3 obviously suppressed the reduction of copper oxides and led to a higher concentration of Cu+ . The Cu clusters were found to be covered by thin ZnOx overlayers after reduction of Cu/Al2 O3 /ZnO(0001)-Zn by using H2 . Therefore, the high activity of industrial Cu/ZnO/Al2 O3 catalysts may origin from Cu+ -rich clusters at the Al2 O3 /ZnO interface that are covered by thin ZnOx overlayers.


The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men.
Testosterone has immune-modulating properties, and current in vitro evidence suggests that testosterone may suppress the expression of the proinflammatory cytokines TNFalpha, IL-1beta, and IL-6 and potentiate the expression of the antiinflammatory cytokine IL-10. We report a randomized, single-blind, placebo-controlled, crossover study of testosterone replacement (Sustanon 100) vs. placebo in 27 men (age, 62 +/- 9 yr) with symptomatic androgen deficiency (total testosterone, 4.4 +/- 1.2 nmol/liter; bioavailable testosterone, 2.4 +/- 1.1 nmol/liter). Compared with placebo, testosterone induced reductions in TNFalpha (-3.1 +/- 8.3 vs. 1.3 +/- 5.2 pg/ml; P = 0.01) and IL-1beta (-0.14 +/- 0.32 vs. 0.18 +/- 0.55 pg/ml; P = 0.08) and an increase in IL-10 (0.33 +/- 1.8 vs. -1.1 +/- 3.0 pg/ml; P = 0.01); the reductions of TNFalpha and IL-1beta were positively correlated (r(S) = 0.588; P = 0.003). In addition, a significant reduction in total cholesterol was recorded with testosterone therapy (-0.25 +/- 0.4 vs. -0.004 +/- 0.4 mmol/liter; P = 0.04). In conclusion, testosterone replacement shifts the cytokine balance to a state of reduced inflammation and lowers total cholesterol. Twenty of these men had established coronary disease, and because total cholesterol is a cardiovascular risk factor, and proinflammatory cytokines mediate the development and complications associated with atheromatous plaque, these properties may have particular relevance in men with overt vascular disease.


Imaging cytosolic translocation of Mycobacteria with two-photon fluorescence resonance energy transfer microscopy.
Transition from latency to active tuberculosis requires Mycobacterium tuberculosis (Mtb) to penetrate the phagosomal membrane and translocate to the cytosol of the host macrophage. Quantitative two-photon fluorescence resonance energy transfer (FRET) microscopy is developed to measure cytosolic translocation using Mycobacterium marinum (Mm) as a model organism for Mtb. Macrophages were infected with Mm or non-pathogenic Mycobacterium smegmatis (Ms) as a control, then loaded with a FRET substrate. Once translocation occurs, mycobacterium-bearing β-lactamase cleaves the substrate, resulting in decrease of FRET signal. Quantification of this FRET signal change revealed that Mm, but not Ms, is capable of translocating to the cytosol.


Controlled release of subretinal fluid.
Drainage os subretinal fluid is generally regarded as being unnecessary when local buckling procedures are carried out, particularly when the buckle is placed radially, unless the patient has chronic glaucoma or the choroidal vessels are markedly sclerosed.However, there are many cases of retinal detachment where the eye is otherwise normal and where radial procedure is the detachment operation of choice in which a limited and controlled release of subretinal fluid will help considerably in the localisation, treatment by cryotherapy and final positioning of the tear on the buckle. This paper describes the technique employed and the advantages which may be gained by using this method in cases of deep bullous detachment of the retina. The results which have been obtained in cases in which this method has been used during the last 3 years are described.


DNA polyfluorophores for real-time multicolor tracking of dynamic biological systems.
Dye-ing to live: Spectral limitations of common organic dyes make it difficult or impossible to visualize and follow multiple biological components in rapidly moving systems. The development of a multispectral set of improved DNA-scaffolded fluorophores is described. Their use in multicolor cellular imaging (see scheme) and in tracking of biological motions on the subsecond timescale is demonstrated.


A State-of-Art Review of the Vicious Circle of Sleep Disorders, Diabetes and Neurodegeneration Involving Metabolism and Microbiota Alterations.
In the context of neurodegenerative disorders, cognitive decline is frequently reported in older population. Recently, numerous metabolic pathways have been implicated in neurodegeneration, including signaling disruption of insulin and other glucose-regulating hormones. In fact, Alzheimer's disease has now been considered as "type-3 diabetes". In this review, we tried to clarify the role of sleep impairment as the third major player in the complex relationship between metabolic and neurodegenerative diseases. Altered sleep may trigger or perpetuate these vicious mechanisms, leading to the development of both dementia and type 2 diabetes mellitus. Finally, we analyzed these reciprocal interactions considering the emerging role of the gut microbiota in modulating the same processes. Conditions of dysbiosis have been linked to circadian rhythm disruption, metabolic alterations, and release of neurotoxic products, all contributing to neurodegeneration. In a future prospective, gut microbiota could provide a major contribution in explaining the tangled relationship between sleep disorders, dementia and diabetes.


Diabetic retinopathy and urinary albumin excretion rate in type II (non-insulin-dependent) diabetic patients.
The aim of this study was to access the associations between urinary albumin excretion rate (AER) and diabetic retinopathy and its major risk factors in 105 type II non-insulin-dependent diabetic (NIDDM) patients. In 44.7% of the patients, there were no signs of retinopathy (NR), whereas 30.4% had background (BR) and 24.7% proliferative retinopathy (PR). Patients with retinopathy, both BR and PR, were older and the duration of diabetes was longer, than in the group consisting of patients with NR. Patients with retinopathy had elevated AER (BR: 9.4 +/- 2.8 micrograms/min, PR: 19.3 +/- 1.7 micrograms/min; vs. NR: 4.3 +/- 2.1 micrograms/min, p < 0.001). Patients with retinopathy had a higher systolic blood pressure and the metabolic control was worse than those without retifiopathy. In the diabetic group as a whole, raised AER was correlated with the duration of diabetes (rs = 0.287, p < 0.01) and systolic blood pressure (rs = 0.269; p < 0.01).


Direct anterior approach for hip resurfacing: surgical technique and complications.
The direct anterior approach (DAA) for hip resurfacing arthroplasty is a technically difficult approach but theoretically reduces the soft tissue trauma to the hip because it does not require muscle detachments from the bone. Furthermore, the patient is in the supine position facilitating fluoroscopy to control component placement. However, the complications associated with the learning curve and functional outcome scores are not well defined in the literature. We therefore asked how our first 57 operations using the anterior approach and special table extension compared with that in the literature with regard to (1) complication rate; (2) functional outcome scores; (3) component placement; and (4) length of stay. We retrospectively reviewed 51 patients who underwent 57 hip resurfacing procedures using a DAA. There were 45 men and six women with an average age of 51 years (range, 31-63 years) and a body mass index of 28.7 kg/m(2) (range, 19.7-42.0 kg/m(2)). The minimum followup was 0.3 months (mean, 8.7 months; range, 0.3-24.9 months). There were three atraumatic (5%) and one posttraumatic (1.8%) femoral neck fractures. Average HOOS scores were equal to or better than averages reported for total hip arthroplasty. Average cup inclination was 36.5° (range, 25°-48°). The average length of stay was 2.11 days (range, 1-4 days). The surgical approach for anterior hip resurfacing is technically difficult but may have some clinical benefits. Surgeons interested in using the DAA for hip resurfacing should be very familiar with the DAA for total hip arthroplasty and with hip resurfacing.


Xyloglucan endotransglucosylase activity loosens a plant cell wall.
Plant cells undergo cell expansion when a temporary imbalance between the hydraulic pressure of the vacuole and the extensibility of the cell wall makes the cell volume increase dramatically. The primary cell walls of most seed plants consist of cellulose microfibrils tethered mainly by xyloglucans and embedded in a highly hydrated pectin matrix. During cell expansion the wall stress is decreased by the highly controlled rearrangement of the load-bearing tethers in the wall so that the microfibrils can move relative to each other. Here the effect was studied of a purified recombinant xyloglucan endotransglucosylase/hydrolase (XTH) on the extension of isolated cell walls. The epidermis of growing onion (Allium cepa) bulb scales is a one-cell-thick model tissue that is structurally and mechanically highly anisotropic. In constant load experiments, the effect of purified recombinant XTH proteins of Selaginella kraussiana on the extension of isolated onion epidermis was recorded. Fluorescent xyloglucan endotransglucosylase (XET) assays demonstrate that exogeneous XTH can act on isolated onion epidermis cell walls. Furthermore, cell wall extension was significantly increased upon addition of XTH to the isolated epidermis, but only transverse to the net orientation of cellulose microfibrils. The results provide evidence that XTHs can act as cell wall-loosening enzymes.


The role of Kupffer cell activation in immune liver damage induced by trichloroethylene associated with the IFN-γ/STAT1 signaling pathway.
Trichloroethylene (TCE) is a metal detergent commonly used in industry that can enter the human body through the respiratory tract and skin, causing occupational medicamentosa-like dermatitis due to TCE (OMDT) and multiple organ damage, including liver failure. However, the pathogenesis of liver injury remains unclear. Kupffer cells (KCs) are important tissue macrophages in the body because the polarization of KCs plays a crucial role in immune-mediated liver injury. However, the mechanism of KCs polarization in TCE-induced immune liver injury has not been thoroughly elucidated. In this study, we investigated the effect of TCE-induced KCs polarization on liver function and signal transduction pathways using the TCE sensitization model developed by our group. BALB/c mouse skin was exposed to TCE for sensitization, and an increase in the expression of M1 macrophage-specific markers (CD16/CD32, iNOS), M1 macrophage-specific cytokines IL-1β, and IFN-γ, P-JAK-1 and P-STAT1 levels were also found to be dramatically increased. When using low doses of gadolinium trichloride (GdCl3), the expression of these proteins and mRNA was significantly reduced. This phenomenon indicates that GdCl3 blocks TCE-induced polarization of KCs and suggests that the IFN-γ/STAT1 signaling pathway may be involved in the polarization process of KCs. These findings clarify the relationship between the polarization of KCs and immune liver injury and highlight the importance of further study of immune-mediated liver injury in TCE-sensitized mice.


Emotional Intelligence and Delivering Bad News in Professional Nursing Practice.
Delivering bad news often impacts nurses' emotional well-being and relationships with patients. However, most practice models do not offer a sufficient solution to the distress and reduced job satisfaction that may thus arise. This paper offers a critique of theoretical frameworks for breaking bad news in clinical settings, with the aim of highlighting the inadequate evidence available to guide nursing practice with regard to managing the emotional burden of breaking bad news. Firstly, the concept of emotional intelligence is introduced, followed by an overview of the impact of delivering bad news on the psychological well-being of healthcare workers. Several models for delivering bad news in clinical practice were then presented to emphasise the lack of evidence regarding ways of mitigating the burden associated with breaking bad news. Key components of emotional intelligence are highlighted to increase awareness of this factor among nurses and enable them to improve their interpersonal skills to mitigate the impact of breaking bad news. Enabling nurses to develop emotional self-awareness before utilising these frameworks will likely lead to increased nurse retention rates and improve reflective practice and communication skills, which could, in turn, strengthen nurse-patient relationships and subsequent care planning.


Early detection and therapeutics.
Early detection, including cancer screening and surveillance, is emerging as one of the most important topics in modern oncology. Because symptomatic presentation remains the predominant route to cancer diagnosis, there is a growing interest in developing techniques to detect the disease at an early, curative stage. Moreover, growing understanding of cancer biology has paved the way for prevention studies with the focus on therapeutic interventions for premalignant conditions. Where there is a recognisable precursor stage, such as a colorectal adenoma or Barrett's metaplasia, the removal of abnormal tissue prevents the development of cancer and enables stratification of the patient to a high-risk group requiring further surveillance. Here, we provide a review of the available technologies for early diagnosis and minimally-invasive treatment.


Bilateral central retinal vein occlusion associated with multiple myeloma.
To report a case of simultaneous bilateral central retinal vein occlusion (CRVO) associated with multiple myeloma. A 65-year-old woman had sudden, painless loss of vision in both eyes for 20 days. Ophthalmologic examination revealed bilateral CRVO. Appropriate medical workup was conducted, and multiple myeloma was diagnosed as the underlying cause. Clinical support and chemotherapy effectively controlled paraprotein production, leading to improvement of both systemic and ocular alterations. Many conditions have been noted to be associated with CRVO. Based on a Medline search, this is the first report of simultaneous bilateral CRVO as the first manifestation of multiple myeloma, illustrating the need for a primary care ophthalmologist to be involved in the basic assessment for associated underlying diseases in retinal disorders.


Axillary lymphadenopathy due to Swanson implants.
We describe a case of unilateral axillary lymphadenopathy in an elderly woman with a long history of rheumatoid arthritis, 7 years status post placement of Swanson silastic elastomer implants in her right hand with good surgical outcome and with no outward reason for adenopathy. Though there was concern for malignancy, pathologic evaluation of the lymph node revealed foreign body giant cells reacting to silastic from her hand implants and no evidence of malignancy. This is only the 10th such case reported, despite the number of implants placed.


[Identification of mechanisms of the calcium signaling at influence of estradiol on porcine oocytes, stimulated by theophillin and somatotropin].
Through the use of inhibitory analysis by using the fluorescent probe chlortetracycline examined the effects of estradiol on the mobilization of Ca2+ from intracellular stores of porcine oocytes stimulated by growth hormone and theophylline. It is shown that somatotropin or theophylline stimulates the mobilization of Ca2+ from intracellular stores of oocytes in control group, while their combined action does not lead to an additional exit of Ca2+ from intracellular stores. Inhibitor of protein kinase C had no effect on the release of Ca2+--from oocyte stimulated by growth hormone or theophylline. In estradiol-treated oocytes, only the combined effects of growth hormone and theophylline stimulates the release of Ca2+ from intracellular stores, and that the release of Ca2+ is reduced by the use of an inhibitor of protein kinase C. In the presence of estradiol, an inhibitor of microtubule polymerization blocked the release of Ca2+ stimulated by the combined action of growth hormone and theophylline. Incubation of oocytes in the medium with the subsequent addition of ADP and GDP have an inhibitory effect on the release of Ca2+ from intracellular stores, stimulated joint action of growth hormone and theophylline. The findings suggest the involvement of estradiol in the mechanisms of calcium signaling in porcine oocytes.


Characterization and expression analysis of a gene encoding a secreted lipase-like protein expressed in the salivary glands of the larval Hessian fly, Mayetiola destructor (Say).
In a salivary gland transcriptomics study we identified a cDNA with a full-length open reading frame for a gene (MdesL1) encoding a lipase-like protein expressed in the salivary glands of the larval Hessian fly, Mayetiola destructor (Say). Fluorescent in situ hybridization on salivary polytenes positioned MdesL1 on the long arm of Autosome 1. BLASTp and conserved domain searches revealed the deduced amino acid sequence contained a lipase superfamily domain with similarity to lipases and phospholipases from other insects. A secretion signal peptide was identified at the amino terminus of the deduced amino acid sequence. Analysis of the transcript of MdesL1 in larval Hessian fly tissues by quantitative real-time PCR (qPCR) revealed the greatest abundance was in salivary glands. Analysis of transcript levels during development showed the greatest level was detected in feeding 1st-instar and early 2nd-instar larvae. Transcript levels increased dramatically over time in larvae feeding on susceptible wheat but were detected at low levels in larvae feeding on resistant wheat. These data suggest the protein encoded by MdesL1 is likely secreted into host-plant cells during larval feeding and could be involved in extra-oral digestion and changes in host-cell permeability or in generating a second messenger in a host-cell-signaling cascade.


Degradation of fungal prion HET-s(218-289) induces formation of a generic amyloid fold.
The prion-forming domain of the fungal prion protein HET-s, HET-s(218-289), is known from solid-state NMR studies to have a β-solenoidal structure; the β-solenoid has the cross-β structure characteristic of all amyloids, but is inherently more complex than the generic stacked β-sheets found in studies of small synthetic peptides. At low pH HET-s(218-289) has also been reported to form an alternative structure, which has not been characterized. We have confirmed by x-ray fiber diffraction that HET-s(218-289) adopts a β-solenoidal structure at neutral pH, and shown that at low pH, it forms either a β-solenoid or a stacked β-sheet structure, depending on the integrity of the protein and the conditions of fibrillization. The low pH stacked-sheet structure is usually formed only by proteolyzed HET-s(218-289), but intact HET-s(218-289) can form stacked sheets when seeded with proteolyzed stacked-sheet HET-s(218-289). The polymorphism of HET-s parallels the structural differences between the infectious brain-derived and the much less infectious recombinant mammalian prion protein PrP. Taken together, these observations suggest that the functional or pathological forms of amyloid proteins are more complex than the simple generic stacked-sheet amyloids commonly formed by short peptides.


[Failure in the control of the number of traffic accident victims in Spain. Is this a result of the correct answer to the wrong question?].
Although various measures have been implemented in Spain with the aim to modifying the behavior of motor vehicle users, it has not been observed a descending trend in traffic accident and injuries from traffic accident. This article considers the question of whether the measures taken to reduce motor vehicle crash-related injuries in Spain have targeted the causes that are truly responsible for this trend. Using several sources of data, beginning in 1990 it has been observed a significant reduction in traffic accidents and their consequences, but in the second half of the 90s the growth in motor vehicle crash-related injuries was similar to the increase observed in the 80s. Likewise per capita alcohol consumption shows a downward trend from 1980 while the number of injuries has been strong associated with the economic cycle during the last twenty years. We conclude pointing out that intervention measures to control this problem in Spain have focused mainly on modifying behaviour that increases the risk and severity of traffic accident injuries and have ignored the macro-economic determinants that explain the trend in the frequency of this health problem.


Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus.
Acute asthmatic exacerbation in children causes economic burdens both directly and indirectly. The GINA guideline does mention the use of inhaled or oral corticosteroids in the treatment of asthmatic exacerbation, it provides little practical guidance on the use of nebulized corticosteroid. To review and recommend the practical considerations in the use of nebulized corticosteroid in children with acute asthmatic exacerbation. This consensus was developed by a group of expert pediatricians in respiratory and allergy fields in Thailand. The recommendations were made based on a review of published studies and clinical opinions. The eligible studies were confined to those published in English, and randomized controlled trials and meta-analyses involving nebulized corticosteroids in asthmatic exacerbation in children aged between 1-18 years. There were 13 randomized controlled-trial studies published from 1998 to 2017. Nine of the 13 studies compared nebulized with systemic corticosteroid conducted in moderate to severe exacerbation, while the remaining four compared nebulized corticosteroid with placebo conducted in mild to severe exacerbation. The admission rate was significantly lower in severe exacerbation (one study) and pooled four mild to severe exacerbation studies comparing with placebo (p 0.022). Other clinical parameters were significantly improved with nebulized corticosteroid such as clinical scores, systemic corticosteroid/bronchodilator use, or shorter ER stays. Only one study used fluticasone, while the other 12 studies conducted by budesonide (92.31%). Nebulized corticosteroid may offer an effective therapeutic option for the management of acute exacerbation of asthma in all severities. Nebulized budesonide is the preferred corticosteroid.


Quantification of levetiracetam in human plasma by liquid chromatography-tandem mass spectrometry: application to therapeutic drug monitoring.
A rapid, selective, reliable, precise, accurate, and reproducible tandem mass spectrometric (MS-MS) method for the quantification of levetiracetam (LEV) in human plasma using adenosine as an internal standard (IS) has been developed and validated. The drug and IS were extracted by solid phase extraction (SPE) technique and analyzed on Symmetry((R)) C(18) column (5 microm, 3.9 mm x 50 mm) using a mobile phase of methanol-water-formic acid (97:03:0.25, v/v/v) at a flow rate of 0.2 ml/min. Quantitation was achieved using a positive electrospray ionization (ESI+) interface employing multiple reaction monitoring (MRM) mode at MRM transitions m/z 171>126 and m/z 268>136 for LEV and IS, respectively. The method was validated over the concentration range of 1.0-40 microg/ml (r>0.99) with a limit of quantification of 1.0 microg/ml (R.S.D.%; 4.1 and Bias%; -9.0 to + 11.0%). Intra- and inter-run precision of LEV assay at three concentrations ranged from 0.6 to 8.9% with accuracy (bias) varied from -4.0 to 8.6% indicating good precision and accuracy. Analytical recoveries of LEV and IS from spiked human plasma were in the range of 91.7-93.4% and 80.2-84.1%, respectively. Stability of LEV in human plasma samples at different conditions showed that the drug was stable under the studied conditions. Matrix effect study showed a lack of matrix effect on mass ions of LEV and IS. The described method compared well with the commercial HPLC-UV method of Chromsystem (r(2)=0.99). The suitability of the developed method for therapeutic drug monitoring was demonstrated by measuring LEV in human plasma samples of epileptic patients treated with LEV.


Angioedema secondary to angiotensin-converting enzyme inhibitors.
Angioedema secondary to angiotensin-converting enzyme (ACE) inhibitors is rare, but it is a side effect which is likely to be seen more frequently because of the increased use of these drugs to treat cardiac failure and hypertension. Presentation is variable and the diagnosis may go unrecognized for many months or years. The cases reported illustrate problems both in the diagnosis and management of this life-threatening condition.


Genetic differentiation of the two subspecies of the smooth newt inhabiting Romania, Triturus vulgaris vulgaris and T.v. ampelensis (Urodela, Salamandridae) as revealed by enzyme electrophoresis.
Starch gel electrophoresis was applied to quantify genetic variation and divergence in samples from Romanian populations of the nominal form of the smooth newt Triturus vulgaris and those of the endemic Romanian subspecies T.v. ampelensis, a population from a parapatric area was additionally included. All the samples had similar levels of genetic variation measured by the mean heterozygosity, proportion of polymorphic loci, and mean number of alleles per locus. T.v. ampelensis samples were genetically clearly different from the nominal form samples, the mean genetic distance between the two subspecies was being estimated as DN = 0.114. No fixed differences in allele composition between the two subspecies were found, although some of the alleles were found either exclusively in the nominal form (Aat-1) or in T.v. ampelensis (Mpi a). Other alleles at these loci together with Mdh-1 differed markedly in frequency. The population from the parapatric area was intermediate in allelic composition, but grouped together with the T.v. ampelensis samples in a maximum likelihood tree (99.7% bootstrap support for this grouping). The data indicate that the two subspecies interbreed in a parapatric zone. The molecular clock applied to electrophoretic data indicates that these two forms split during the Pleistocene.


Molecular characterization of mitochondrial transferRNAGln and transferRNAMet A4401G mutations in a Chinese family with hypertension.
Mutations in mitochondrial (mt)transfer (t)RNA (mt‑tRNA) have been reported to serve important roles in hypertension. To determine the underlying molecular mechanisms of mt‑tRNA mutations in hypertension, the present study screened for mt‑tRNA mutations in a Chinese family with a high incidence of essential hypertension. Sequence analysis of the mt‑tRNA genes in this family revealed the presence of an A4401G mutation in the glycine‑and methionine‑tRNA genes, and a G5821A mutation in the cysteine‑tRNA (tRNACys) gene. The G5821A mutation was located at a position conserved in various species, and disrupted G6‑C67 base‑pairing. It was hypothesized that the G5821A mutation may decrease the baseline expression levels of tRNACys, and consequently result in failure of tRNA metabolism. The A4401G mutation was reported to cause the mitochondrial dysfunction responsible for hypertension. Thus, the combination of G5821A and A4401G mutations may contribute to the high incidence of hypertension in this family. Mt‑tRNA mutations may serve as potential biomarkers for hypertension.


Reference centile charts of first-trimester aneuploidy screening & Doppler parameters for Indian population.
The risk estimation for foetal aneuploidies in the first trimester of pregnancy uses reference curves based on western data. The objective of this study was to construct the reference curves of first-trimester foetal aneuploidy screening parameters for the Indian women. : Cross-sectional data were obtained from 1204 singleton pregnancies between the crown-rump length (CRL) of 40-84 mm. Linear regression models were constructed; the mean, median and standard deviation were derived as a function of CRL. The mean value of CRL was 61.3 mm. The regression analysis showed a significant correlation between all variables and CRL (P< 0.001). There was a positive correlation of CRL with nuchal translucency (NT) (y=0.010x+0.629, R2=0.116) and pregnancy-associated plasma protein-A (PAPP-A) (y=0.107x-1.079, R2=0.173), whereas inverse correlation was seen with free β-human chorionic gonadotropin (β-hCG) (y=-0.409x+75.025, R2=0.018) and Doppler parameters pulsatility index (PI) (y=-0.008x+1.924 R2=0.053). The centile charts of NT, PAPP-A, free β-hCG and uterine artery (Ut A) Doppler PI were constructed. The reference centile charts of first trimester aneuploidy screening along with Doppler parameters were derived in Indian pregnant women. These centile charts may be used as a reference for clinical use in Indian population.


The use of Lactobacillus plantarum esterase genes: a biotechnological strategy to increase the bioavailability of dietary phenolic compounds in lactic acid bacteria.
In Lactobacillus plantarum the metabolism of hydroxybenzoic and hydroxycinnamic acid derivatives follows a similar two-step pathway, an esterase action followed by a decarboxylation. The L. plantarum esterase genes involved in these reactions have been cloned into pNZ8048 or pT1NX plasmids and transformed into technologically relevant lactic acid bacteria. None of the strains assayed can hydrolyse methyl gallate, a hydroxybenzoic ester. The presence of the L. plantarum tannase encoding genes (tanALp or tanBLp) on these bacteria conferred their detectable esterase (tannase) activity. Similarly, on hydroxycinnamic compounds, esterase activity for the hydrolysis of ferulic acid was acquired by lactic acid bacteria when L. plantarum esterase (JDM1_1092) was present. This study showed that the heterologous expression of L. plantarum esterase genes involved in the metabolism of phenolic acids allowed the production of healthy compounds which increase the bioavailability of these dietary compounds in food relevant lactic acid bacteria.


Mapping of a major susceptibility locus for Graves' disease (GD-1) to chromosome 14q31.
The autoimmune thyroid diseases (AITD), encompassing Graves' disease (GD) and Hashimoto's thyroiditis (HT), occur in genetically susceptible individuals. In order to identify the AITD susceptibility genes, we have studied DNA markers in the regions of 8 candidate genes: (1) the HLA region, (2) the TSH receptor, (3) thyroid peroxidase, (4) thyroglobulin, (5) IDDM-4, (6) IDDM-5, (7) Immunoglobulin heavy chain gene and (8) CTLA-4. One hundred and seven subjects from 19 informative families were studied, 14 subjects had GD and 32 subjects had HT. LOD scores were maximized assuming both dominant and recessive modes of inheritance. No linkage was found for any marker in patients with HT. In patients with GD, negative LOD scores were obtained for all the candidate genes, except for markers in the TSH receptor region on chromosome 14q31. Positive LOD scores were found for several markers on 14q31. Marker D14S81 gave the highest score (Z max = 2.05, theta = 0.01) assuming a dominant mode of inheritance and a penetrance of 0.8. These data confirm our previous observations of a lack of a necessary disease locus for AITD in the HLA gene region. Further, the data suggest the presence of an important susceptibility gene on 14q31 but at a considerable distance from the TSH receptor gene.


Determining the Transformation Kinetics of Water Oxidation Intermediates on Hematite Photoanode.
The oxygen evolution reaction (OER) from water is a sequential oxidation reaction process, involved in transformation of multiple reaction intermediates. For photo(electro)catalytic OER, revealing the intermediates transformation kinetics is quite challenging due to its coupling with photogenerated charge dynamics. Herein, we specifically study the transformation kinetics of the OER intermediates in rationally thin hematite photoanodes through increasing the ratio between surface intermediates and photogenerated charges in bulk. We directly identify the formation and consumption kinetics of one-hole OER intermediate (FeIV═O) in photoelectrochemical water oxidation using operando transient absorption (TA) spectroscopy. The microsecond formation kinetics of the FeIV═O species are sensitively changed by the excitation mode of Fe2O3. The subsecond consumption kinetics are closely dependent on surface FeIV═O species density, demonstrating that the cooperation of FeIV═O intermediates is the key to accelerating water oxidation kinetics on the Fe2O3 surface. This work provides insight into understanding and controlling water oxidation reaction kinetics on Fe2O3 surface.


In vitro genotoxicity assessment of dinitroaniline herbicides pendimethalin and trifluralin.
Pendimethalin and trifluralin are widely used dinitroaniline herbicides. Both compounds can be found as residue levels in agricultural products. This study was conducted in order to provide necessary information for the risk assessment of pendimethalin and trifluralin. In this study, reactive oxygen species (ROS) levels were measured to examine the potential of both compounds to induce oxidative damage in Chinese hamster lung fibroblast (V79) cells. Also, the genotoxic effects of pendimethalin and trifluralin at the concentration range of 1-500 μM was determined. Single cell gel electrophoresis (comet) and micronucleus assays were used on human peripheral lymphocytes and V79 cells for the genotoxicity assessment. The cell viability of two dinitroaniline herbicides were determined by the use of neutral red uptake assay on V79 cells. IC50 values were determined as 66 μM and 128 μM for pendimethalin and trifluralin, respectively. They significantly increased ROS levels on V79 cells for 1-24 h. Both herbicides significantly induced the DNA damage and showed genotoxicity on lymphocytes and V79 cells. Micronucleus frequency increased significantly after pendimethalin and trifluralin treatment of the lymphocytes and V79 cells. Therefore, we concluded that both of the herbicides induced the genotoxicity through the activation of oxidative stress pathway and chromosomal damage.


Morphine metabolism in opiate dependent and normal men by double isotope techniques.
A mixture of morphine-63H and morphine-N-14CH3 was administered to an opiate dependent and to a normal male subject. In both subjects the urinary excretion of radioactivity was rapid and exceeded 85% of the dose over 72 hours. The extent and time pattern of N-demethylation differed in the two subjects with N-demethylation of morphine being slower and less in the opiate addict. The use of the double isotope technique in detecting small changes in morphine metabolism is discussed.


Psychotherapy of the postdysthymic patient.
Many patients with dysthymia respond to antidepressant pharmacotherapy. Psychotherapy of dysthymic patients has received less study, but it may have efficacy as a primary treatment or as complement to pharmacotherapy. This preliminary report offers an impression of the value of psychotherapy for 21 dysthymic responders to antidepressant medication. Successful pharmacotherapy appeared to relieve not only depressive symptoms, but also seemingly characterological traits. Yet patients who felt better than ever before lacked social skills whose development dysthymia had retarded. Case examples illustrate the importance of psychotherapy in developing personality and fostering appropriate risk-taking. Prescription of combined pharmaco- and psychotherapy may be appropriate in dysthymia.


Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001.
To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection. Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000-19 000). It was estimated that 6500 (5000-8000) people were living with HCV-related cirrhosis in 2001, that 175 (130-210) people developed HCV-associated liver failure, and that there were 50 (40-60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease. Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.


Exercise to Support Indigenous Pregnant Women to Stop Smoking: Acceptability to Māori.
Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance.


The transcription factor activating enhancer-binding protein epsilon (AP-2ε) regulates the core promoter of type II collagen (COL2A1).
The transcription factor activating enhancer-binding protein epsilon (AP-2ε) was recently shown to be expressed during late chondrocyte differentiation, especially in hypertrophic chondrocytes. In this study, we were able to reveal that the promoter of the type II collagen (COL2A1) gene, encoding the extracellular matrix protein type II collagen, is specifically regulated by AP-2ε. Expression of COL2A1 is downregulated at the transition of chondroblasts into hypertrophic chondrocytes and our data provide evidence that AP-2ε is involved in this process. In reporter gene assays, overexpression of AP-2ε in cartilaginous cell lines resulted in a significant reduction in COL2A1 core promoter activity of ~ 45%. Furthermore, we found that this process is dose-dependent and highly specific for the epsilon isoform. Computational analysis offered only a single putative AP-2-binding motif within the chosen promoter fragment but site-directed mutagenesis revealed this motif to be regulatory inactive. After expanding our screening to motifs containing minor differences from the classical AP-2 consensus sequence (5'-GCCN3 GGC-3'), we determined the sequence 5'-GCCCAGGC-3' ranging from position -128 to -135 bp as an important regulatory site and responsible for COL2A1 downregulation through AP-2ε. Interaction of AP-2ε with the COL2A1 promoter at this site was confirmed by chromatin immunoprecipitation and electromobility shift assay. Further, our experiments suggest that at least one additional factor is involved in this process. This is the first study to prove regulation of COL2A1 by AP-2ε highlighting the role of the transcription factor as a modulator of cartilage development.


Difficult airway management in a polytraumatized patient with osteogenesis imperfecta and multiple congenital spinal and thoracic deformities and severe kyphoscoliosis: case report.
Airway management in a polytraumatized patient with severe spinal and thoracic deformities demands detailed investigation of anatomical characteristics of the head, neck and airways, as well as thoracic configuration, before attempting endotracheal intubation. This enables the physician to predict a difficult airway and prepare for difficult airway management. We present a case of a 50-year-old polytraumatized patient with multiple congenital bone deformities associated with the syndrome of osteogenesis imperfecta and severe kyphoscoliosis, unable of lying on his back due to gibbus, who was successfully intubated in first attempt using video laryngoscope and only mild sedation. In patients with such severe multiple deformities, the use of video laryngoscope or Bonfils rigid endoscope should be mandatory in order to ensure success of intubation in first attempt and to avoid the possible aspiration of gastric contents.


[Comparison of open preperitoneal repair and Lichtenstein herniorraphy on the surgical treatment of inguinal hernia].
To evaluate the safety and effectiveness of open preperitoneal herniorraphy comparing with traditional Lichtenstein tension-free herniorraphy on the surgical treatment of inguinal hernia. The clinical data of 249 patients with inguinal hernia admitted from October 2008 to December 2013 were reviewed retrospectively.Eighty-three patients received preperitoneal herniorraphy (preperitoneal group), there were 76 male and 7 female patients with a mean age of (70 ± 10) years.One hundred and seventy-three patients underwent Lichtenstein procedure (Lichtenstein group), there were 162 male and 11 femal patients with a mean age of (60 ± 16) years. The peri-operative performance, recurrence rate and postoperative morbidities of the patients underwent preperitoneal herniorraphy and traditional Lichtenstein herniorraphy were analyzed. The operation time of the preperitoneal group (60 ± 11) minutes was significantly shorter than the Lichtenstein group (63 ± 8) minutes (t = -2.16, P = 0.032). The preperitoneal group showed significantly earlier out-of-bed activity ((6.2 ± 1.8) hours) than the Lichtenstein group ((15.0 ± 2.8) hours) (t = -13.2, P = 0.000). The visual analogue scale score on 24 hours postoperative was also lower in the preperitoneal group (4.0 ± 0.9) than in the Lichtenstein group (4.6 ± 1.4) (t = -4.11, P = 0.000). The two groups had no significant difference on the cost. There was one incision infection in preperitoneal group (1.20%).Four fat liquefaction (2.31%) and one patch rejection (0.58%) were found in Lichtenstein group. The incidence of complication of the two groups had no significant difference (P > 0.05). All the patients were followed up for 6 to 36 months, and there was no recurrence among all these patients. There is no significant difference on the safety and effectiveness between preperitoneal herniorraphy and traditional Lichtenstein procedure on inguinal hernia.Open preperitoneal herniorraphy and can be applied for surgical treatment of recurrent or femoral hernia.


[Identification of fruits of Xanthium sibiricum Patr. and X. mongolicum Kitag].
The protein electrophorogram, tissue separation picture and complete powder characteristic picture of these two kinds of fruit of siberian cocklebur are made for the first time, and TLC chromatograms of different solvent extracts are also presented. All these present a scientific basis for crude drugs selling, breed identification and composition analysis of the fruit of siberian cocklebur.


Optimising conditions and environments for digital participation in later life: A macro-meso-micro framework of partnership-building.
The ongoing digitalisation of societies, exacerbated by the COVID-19 pandemic, has led to increased efforts to ensure the digital inclusion of older adults. Digital inclusion strategies throughout the COVID-19 pandemic predominantly focused on increasing access and basic digital literacy of Information and Communication Technologies (ICTs) for all members of society. Older adults, who are more likely to experience digital exclusion, are amongst the target groups of digital inclusion strategies. We propose that beyond digital inclusion, there is a need to focus on digital participation and optimise opportunities for everyone to participate in communities and society in post-pandemic times. Creative digital skills are the foundation of digital participation and can lead to a variety of contributions. Digital participation offers conditions that support agency and active contributions in a digitalised society. Taking macro-, meso-, and micro-level enablers of digital participation in later life into account, we argue for the establishment and implementation of multi-layered and multisectoral partnerships that address environmental factors (including social and physical dimensions) of digital participation and create opportunities for diverse, meaningful and fulfilling engagement with ICTs in later life. The partnership approach can be used in designing and implementing digital participation programmes and should be further evaluated against the needs and lived experiences of older individuals. Foresighted research is needed to investigate key factors of effective partnerships for optimising environments for digital participation in later life.


SELECTION ON THE COLOR POLYMORPHISM IN HAWAIIAN HAPPY-FACE SPIDERS: EVIDENCE FROM GENETIC STRUCTURE AND TEMPORAL FLUCTUATIONS.
Throughout this century genetic polymorphisms for color have been widely used as a research tool to allow insights into key evolutionary processes. Although color variants can often be diverse within populations, frequencies of different morphs may be similar across populations, either as a result of balancing selection or gene flow. Under these circumstances selection can be extremely difficult to demonstrate. Here we test for balancing selection on the naturally occurring color forms of the Hawaiian happy-face spider, Theridion grallator with two approaches. First, allozyme loci are used to generate a null model against which to test selection. Frequencies of alleles involved in the color polymorphism of T. grallator are used to generate another estimate for comparison. The results suggest that statistically similar frequencies of color morphs among populations of T. grallator may be maintained by some form of balancing selection. Second, we make use of an unusual event in which the normally stable frequencies of unpatterned and patterned morphs within a population were found to have shifted toward an excess of unpatterned morphs. We scored offspring of all fertilized, unpatterned (bottom-recessive) females found during this period of skewed morph frequencies and also in a year when morph frequencies were normal to deduce paternal color phenotypes. Mating was found to be random in the normal year, but in the perturbed year females had mated with rare (patterned) males twice as frequently as expected on the basis of the frequency of this morph type in the population. Both of these results are consistent with selection operating on the color polymorphism, and we speculate that apostatic selection, perhaps mediated by bird predators, may provide the mechanism.