Effects of early and later life environmental enrichment and personality on attention bias in pigs (Sus scrofa domesticus).
We investigated effects of early and later life housing on attention bias, as an indicator of affective state, in pigs differing in coping style [reactive (LR) vs. proactive (HR)]. Pigs (n = 128) in barren or enriched housing from birth (B1 vs. E1) that experienced either a switch in housing at 7 weeks of age or not (creating B1B2, B1E2, E1E2, and E1B2 treatments), were studied in a 180-s attention bias test at 11 weeks. Pigs exposed to a 10-s-auditory-and-sudden-motion threat in the test arena paid more attention to the location of the threat, were more vigilant, showed less eating, more walking and were more likely to utter high-pitched vocalisations than non-threat pigs. During threat presence, HR pigs from post-switch enriched housing (E2-HR, i.e., B1E2 + E1E2) showed more vigilance but less exploration than others. After threat removal, no effects were found on time spent paying attention to the threat, vigilance, and eating, but E2-HR pigs paid attention to the threat more frequently, were more likely to utter high-pitched vocalisations and walked more compared to (part of) other groups, suggesting the most negative affective state in these animals. E2 pigs grunted more than B2 pigs. Thus, current housing, but not early life housing, affected behaviour in a personality-dependent manner in this attention bias test. Housing effects were opposite to expectation, possibly due to the short-term effect of the relative contrast between the home pens of the pigs and the test room. This potentially overruled putative long-term effects of environmental conditions on attention bias.


Multiple specificity recognition motifs enhance plant mitochondrial RNA editing in vitro.
Analysis of RNA editing in plant mitochondria has at least in vitro been hampered by very low activity. Consequently, none of the trans-acting factors involved has yet been identified. We here report that in vitro RNA editing increases dramatically when additional cognate recognition motifs are introduced into the template RNA molecule. Substrate RNAs with tandemly repeated recognition elements enhance in vitro RNA editing from 2-3% to 50-80%. The stimulation is not influenced by the editing status of a respective RNA editing site, suggesting that specific recognition of a site can be independent of the edited nucleotide itself. In vivo, attachment of the editing complex may thus be analogously initiated at sequence similarities in the vicinity of bona fide editing sites. This cis-acting enhancement decreases with increasing distance between the duplicated specificity signals; a cooperative effect is detectable up to approximately 200 nucleotides. Such repeated template constructs promise to be powerful tools for the RNA affinity identification of the as yet unknown trans-factors of plant mitochondrial RNA editing.


The various renal manifestations of the nephropathic form of cystinosis.
Three phenotypic forms of cystinosis (nephropathic, juvenile-onset and benign adult forms) are well recognized. That not all infants and children have the classical nephropathic form with Fanconi's syndrome is illustrated by 2 of the 3 patients in this report. Case 1 had the typical nephropathic form with generalized proximal tubular dysfunction. In contrast, case 2 had transient features of Bartter's syndrome which preceded the manifestations of Fanconi's syndrome. Case 3 was more complex because he first presented with a syndrome of nephrogenic diabetes insipidus. He then developed features of Fanconi's syndrome as well as metabolic acidosis, hyponatremia and hyperkalemia. The failure of deoxycorticosteroid administration to elevate the serum concentration suggested, in retrospect, that he may also have had a form of acquired pseudohypoaldosteronism.


Umbilical hemorrhage as first manifestation in a case of cirrhosis.
Portal hypertension is often associated with an extensive collateral circulation. The paraumbilical vein is a relatively common collateral pathway recognized in these patients but cutaneous bleeding from the umbilicus is rare; the same as first manifestation of cirrhosis is exceptional. We report a case of umbilical venous bleed causing hemodynamic compromise, which turned out to be a case of alcoholic cirrhosis with portal hypertension. The patient was managed with suture ligation of the vessels.


Neutral endopeptidase and angiotensin-converting enzyme inhibitors increase nitric oxide production in isolated canine coronary microvessels by a kinin-dependent mechanism.
Bradykinin is a substrate for both neutral endopeptidase 24.11 (NEP) and angiotensin-converting enzyme (ACE). Our previous studies showed that ACE inhibitors can stimulate nitric oxide production in coronary microvessels, which is mediated by local kinins. Whether inhibition of NEP also can affect local vascular NO production has not been established. To determine the role of NEP in the control of NO production, coronary microvessels were isolated from seven mongrel dogs. Two NEP inhibitors, phosphoramidon and thiorphan, and an ACE inhibitor, ramiprilat, were used. Nitrite, the metabolite of NO in aqueous solution, was measured by using the Griess reaction. Phosphoramidon and thiorphan (10(-6) M) increased nitrite production from 80 +/- 6 to 136 +/- 6 and 144 +/- 7 pmol/mg, respectively. Ramiprilat (10(-8) M) increased nitrite production from 78 +/- 6 to 155 +/- 7 pmol/mg wet weight. The effect of these agents on nitrite release was blocked by L-NAME, which inhibits NO synthase, HOE-140, which blocks bradykinin B2-receptor, and dichloroisocoumarin, which blocks kinin-forming enzymes. These results clearly indicate that inhibition of kinin metabolism by using neutral endopeptidase inhibitors increases NO production from coronary microvessels. Thus neutral endopeptidase plays an important role in local kinin-modulated NO production in the coronary microcirculation and NEP inhibitors may be useful clinical tools in treatment of cardiovascular disease.


The Curative Effect of Shuangshen Decoction Combined with Immunological Preparations in the Treatment of Pediatric Nephrotic Syndrome and Its Influence on the Rate of Complicated Infection and Recurrence.
To explore the curative effect of Shuangshen Decoction combined with immunological preparations in the treatment of pediatric nephrotic syndrome and its influence on concurrent infection and recurrence rate. Ninety children with nephrotic syndrome were divided into the routine group and the combined group. The routine group received conventional treatment and immune agents, and the combined group was treated with Shuangshen Decoction on the basis of the routine group. The clinical indexes of the two groups were analyzed and followed up. The infection rate and recurrence rate were calculated. The TCM syndrome scores in the combined group were significantly lower than those in the routine group. The total effective rate of the combined group was significantly higher than that of the routine group. The recurrence rate and infection rate of the combined group were significantly lower than those of the routine group. The incidence of adverse reactions in the combined group was significantly lower than that in the routine group. Shuangshen Decoction combined with immune preparations is effective in treating pediatric nephrotic syndrome and can reduce the incidence of adverse reactions, infection rate, and recurrence rate.


Stability of the DDD pacing mode in patients 80 years of age and older.
We reviewed the records of 119 consecutive patients aged 80 years or older (mean age 84 +/- 3.7 years) in whom a dual chamber pacemaker was implanted between 1984 and 1991. Follow-up data was available up to February 1993. Immediate postimplantation complications were rare. Nine patients were lost to follow-up, all within 6 months of implantation. An additional seven patients died within 6 months of implantation. Long-term follow up for at least 6 months from implantation was available for 103 of the 119 patients (87%). Of these 89 (86%) remained in functioning DDD mode for a mean of 22 +/- 15 months from implantation. Nine patients were reprogrammed to VVI mode, six due to atrial fibrillation and three due to failure of atrial sensing or pacing. One patient was programmed DVI for failure of atrial sensing; 94 of 112 patients (84%) whose status was definitely known in February 1993 remained in functioning DDD mode until death or last follow-up. Cumulative survival in DDD mode was 78% at 30 months. We conclude that DDD pacing is stable in the great majority of patients in their ninth and tenth decades who present with rhythms amenable to dual chamber pacing and who have no history of sustained atrial fibrillation.


An Analysis of BMP1 Associated with m6A Modification and Immune Infiltration in Pancancer.
This research explores the underlying link between diagnosis and therapy between bone morphogenetic protein 1 (BMP1) and various cancers. Three immunotherapeutic cohorts, by the composition of IMvigor210, GSE35640, and GSE78220 were obtained from previously published articles and the Gene Expression Omnibus database. The different expressions of BMP1 in various clinical parameters were conducted, and prognostic analysis was executed utilizing Cox proportional hazard regression and Gene Expression Profiling Interactive Analysis. Moreover, the correlation between BMP1 and tumor microenvironment was analyzed using ESTIMATE and CIBERSORT algorithms. Tumor mutational burden and microsatellite instability were also included. The correlation between m6A modification and the gene expression level was analyzed using Tumor IMmune Estimation Resource, the University of Alabama at Birmingham Cancer data analysis portal. Gene Set Cancer Analysis analyzed the correlation of BMP1 expression level with copy number variations and methylation. Furthermore, the correlation between BMP1 and therapeutic response after antineoplastic drug use was illustrated for further discussion. BMP1 expression had significant differences in 14 cancers. It presented an intimate relationship with immune-relevant biomarkers. A variation analysis indicated that BMP1 had a significant association with immunotherapeutic response. The expression level of BMP1 was closely associated with insulin-like growth factor binding protein 3, an m6A modification relative gene. Except for a few cancer types, methylation negatively correlated with BMP1, and copy number variations positively correlated with BMP1. Notably, low BMP1 expression was connected with immunotherapeutic response in the cohorts, and its expression was related to increased sectional sensitivity of drugs. BMP1 may serve as a potential biomarker for prognostic prediction and immunologic infiltration in diversified cancers, providing a new thought approach for oncotherapy.


Clinical evaluation of the carbon dioxide laser for burn wound excisions: a comparison of the laser, scalpel, and electrocautery.
The use of a 100 watt carbon dioxide laser for surgical excisions of burn eschar was evaluated in 13 patients with symmetrical burns. In each patient, laser excision was compared with either scalpel or electrocautery excision of a comparable area. Graft "take," blood loss, and operative speed were measured. Graft "take" following laser excisions was comparable to that obtained when either scalpel or electrocautery was used. Regression analysis indicates that laser excisions involved 29% of the blood loss encountered with scalpel excisions and that laser speed was 1.49 times scalpel speed. Although laser blood loss was 60% of electrocautery blood loss, laser speed was significantly slower: 73% of electrocautery speed. These differences, however, were of small clinical consequence. It is felt that the surgical arm of this laser is at present quite awkward and is in need of technological refinement if the full potential of the laser is to be realized.


Simple sling incision for the treatment of iatrogenic urethral obstruction.
To review a single-institution experience with sling incision to treat urethral obstruction resulting from pubovaginal sling placement. Urethrolysis involving full mobilization of the urethra has traditionally been used to treat urethral obstruction resulting from a pubovaginal sling. Recently, sling incision has been reported to be a technically simpler, less potentially morbid technique to relieve such obstruction. The charts of 14 women with iatrogenic urethral obstruction from pubovaginal slings who were treated with simple sling incision were reviewed. Presenting symptoms and physical findings and outcomes (primarily resolution of obstructive and irritative symptoms, change in postvoid residual volume, and change in continence status) were evaluated. Eleven patients had a biologic sling and three a mid-urethral polypropylene mesh sling. All patients had either obstructive or irritative findings or retention and 10 of 14 had an elevated postvoid residual volume. The average follow-up was 12 months. Overall, 13 (93%) of 14 had complete or significant improvement of presenting complaints, and 1 (7%) eventually required formal urethrolysis. Of the 13 with resolution of presenting complaints, 3 had residual irritative symptoms. Although 3 (21%) of 14 had some element of recurrent stress urinary incontinence, only 1 (7%) required treatment. Simple sling incision is an effective, technically simple, and safe treatment for women with iatrogenic urethral obstruction after placement of a pubovaginal sling. Its results are comparable to those of formal urethrolysis, and it may be considered as first-line treatment for iatrogenic obstruction after a sling procedure.


Aromatase Deficiency due to a Novel Mutation in CYP19A1 Gene
Aromatase deficiency is a rare autosomal recessive genetic disorder with an unknown incidence. Aromatase converts androgens into estrogen in the gonadal and extra-gonadal tissues. Aromatase deficiency causes ambiguous genitalia in the female fetus and maternal virilization (hirsutism, acne, cliteromegaly, deep voice) during pregnancy due to increased concentration of androgens. A 19 months old girl patient was assessed due to presence of ambiguous genitalia. There were findings of maternal virilization during pregnancy. The karyotype was 46,XX. Congenital adrenal hyperplasia was not considered since adrenocorticotropic hormone, cortisol, and 17-hydroxyprogesterone levels were within normal ranges. At age two months, follicle-stimulating hormone and total testosterone levels were elevated and estradiol level was low. Based on these findings, aromatase deficiency was suspected. A novel homozygous mutation IVS7-2A>G (c.744-2A>G) was identified in the CYP19A1 gene. Pelvic ultrasound showed hypoplasic ovaries rather than large and cystic ovaries. We identified a novel mutation in the CYP19A1 gene in a patient who presented with ambiguous genitalia and maternal virilization during pregnancy. Presence of large and cystic ovaries is not essential in aromatase deficiency.


Desmoplastic trichoepithelioma with pseudocarcinomatous hyperplasia: a report of three cases.
We report three cases of desmoplastic trichoepithelioma (DTE) with overlying pseudocarcinomatous hyperplasia. All three cases developed on the face of patients in their second decade. In spite of their young age, a diagnosis of squamous cell carcinoma was considered for each case, given the unusual juxtaposition of these two well-known simulators of malignancy. Awareness of this potential association may avert a misdiagnosis of malignancy.


The role of spinal opioid receptors in antinociceptive effects produced by intrathecal administration of hydromorphone and buprenorphine in the rat.
The intrathecal administration of morphine has been the standard therapy to control long-term intractable pain. Recently, a panel of pain therapy experts suggested that because of the lack of efficacy or because of the side effects produced by morphine in some patients, other drugs, such as hydromorphone and buprenorphine, should be investigated for their analgesic properties. We designed this study to compare the efficacy of intrathecal hydromorphone and buprenorphine to suppress thermal nociception in male Sprague-Dawley rats. An additional objective was to understand whether hydromorphone and buprenorphine bind and act as agonists to mu-, delta-, and kappa-spinal opioid receptors. Intrathecally-administered hydromorphone and buprenorphine produced a dose- and time-dependent increase in the tail-flick response latency in rats. The 50% effective dose value for the antinociceptive effect of buprenorphine and hydromorphone were 4 and 69.5 nmol/L, respectively. Both drugs act as agonists to mu-opioid receptors, as determined by their ability to displace [(3)H]-DAMGO from the spinal opioid receptors and by the ability of an opioid receptor antagonist, naloxone, to reverse their antinociceptive effects. Buprenorphine also has an agonistic effect on the kappa-opioid receptors. For the first time, we report that intrathecal buprenorphine is approximately 17 times more effective than hydromorphone in inhibiting thermal pain, and buprenorphine produces its antinociceptive effect by acting as an agonist at both mu- and kappa-spinal opioid receptors. Naloxone administered intrathecally was effective in preventing the antinociceptive effects of subsequent intrathecal injections of buprenorphine. Hydromorphone and buprenorphine are two important drugs used for pain relief. We observed that intrathecal buprenorphine is 17 times more potent than hydromorphone to inhibit pain in rats. Both drugs exert their effects through specific spinal opioid receptors.


[Human gammaglobulin tolerance: shared idiotypy of T-cell suppressor factor and antibodies (author's transl)].
A factor from human gammaglobulin (HGG) high-zone-tolerant CBA splenic T cells has been produced in optimal conditions after a 16-h culture in CBA mice. A CBA anti-(CBA anti-HGG) serum, purified on HGG, and referred to as antiidiotypic serum, has been coupled to Sepharose-4B. The factor can be adsorbed by this antiidiotypic serum but to a smaller extent than by anti-Iak. The existence of shared idiotypic determinants by factor and antibodies is discussed.


Vectorcardiographic evaluation of postoperative changes in patients with interatrial septal defect: a review of 55 cases.
The pre- and post-operative vectorcardiograms of 55 patients with atrial septal defect (ASD) are discussed. Forty-nine were of ostium secundum type and six of ostium primum type. The criteria used to study the regression of right ventricular hypertrophy were: in the horizontal plane, the ratio of anterior-over-posterior forces, the right-over-left forces and the rotation of the body of the QRS loop; in the frontal plane, the direction of half-area vector. Using these criteria, 46 out of 49 patients with defects of the ostium secundum type had vectorcardiographic evidence of regression of right ventricular hypertrophy. Marked clinical improvement was also demonstrated in all these patients. The three patients in whom improvement was not demonstrated on the vectorcardiogram had persistence of a cardiac defect. Following surgery two children with ostium primum defects showed no change in the frontal plane, whereas in the horizontal plane a normalization of vectorial forces was observed.


Transforming the field: the role of academic health centers in promoting and sustaining equity based community engaged research.
Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. This article describes the feasibility and preliminary findings from engaging champion teams from three very different academic health centers. We reflect on the learnings from Engage for Equity PLUS; the adaptation of the intervention design and implementation, including the development of a new institutional assessment using mixed research methods; and our organizational theory of change. In summary, our design and preliminary data from the three academic health centers provide support for new attention to the role of institutional practices and processes needed to sustain equity-based patient and community-engaged research and CBPR and transform the field.


Magic and mystery of microRNA-32.
MicroRNAs (miRNAs) are a group of endogenous, small (∼22 nts in length) noncoding RNA molecules that function specifically by base pairing with the mRNA of genes and regulate gene expression at the post-transcriptional level. Alterations in miR-32 expression have been found in numerous diseases and shown to play a vital role in cell proliferation, apoptosis, oncogenesis, invasion, metastasis and drug resistance. MiR-32 has been documented as an oncomiR in the majority of related studies but has been also verified as a tumour suppressor miRNA in conflicting reports. Moreover, it has a crucial role in metabolic and cardiovascular disorders. This review provides an in-depth look into the most recent finding regarding miR-32, which is involved in the expression, regulation and functions in different diseases, especially tumours. Additionally, this review outlines novel findings suggesting that miR-32 may be useful as a noninvasive biomarker and as a targeted therapeutic in several diseases.


Effects of electroacupuncture on orphanin FQ immunoreactivity and preproorphanin FQ mRNA in nucleus of raphe magnus in the neuropathic pain rats.
Orphanin FQ (OFQ) is an endogenous ligand for opioid receptor-like-1 (ORL1) receptor. Previous studies have shown that both OFQ immunoreactivity and preproorphanin FQ (ppOFQ) mRNA expression could be observed in the brain regions involved in pain modulation, e.g., nucleus of raphe magnus (NRM), dorsal raphe nucleus (DRN), and ventrolateral periaqueductal gray (vlPAG). It was reported that electroacupuncture (EA) has analgesic effect on neuropathic pain, and the analgesic effect was mediated by the endogenous opioid peptides. In the present study, we investigated the effects of EA on the changes of OFQ in the neuropathic pain rats. In the sciatic nerve chronic constriction injury (CCI) model, we investigated the changes of ppOFQ mRNA and OFQ immunoreactivity in NRM after EA by in situ hybridization (ISH) and immunohistochemistry methods, respectively. Then, the ppOFQ mRNA-positive and OFQ immunoreactive cells were counted under a computerized image analysis system. The results showed that expression of ppOFQ mRNA decreased and OFQ immunoreactivity increased after EA treatment in the neuropathic pain rats. These results indicated that EA modulated OFQ synthesis and OFQ peptide level in NRM of the neuropathic pain rats.


The transcriptional regulator YY1 binds to the 5'-terminal region of B19 parvovirus and regulates P6 promoter activity.
We performed a systematic study to identify cellular factors that bound to the terminal repeat region of B19 parvovirus. Using electrophoretic mobility shift assays, we detected one cellular factor which prominently bound to the repeat region. The factor was purified from K562 nuclear extract by specific DNA affinity column chromatography and identified as YY1, a multifunctional transcription factor. Of multiple possible YY1 binding sites in the upstream region of the P6 promoter, three showed specific strong binding. Transcription enhancement by YY1 was demonstrated in vitro by transient transfection assays. In studies using truncated and mutated versions of this region, YY1 activity was diminished by the alteration of any two of these three sites and abolished by the alteration of all three sites. Our results suggest that YY1 is a positive regulator of B19 parvovirus transcription.


Effects of carrier frequency and background noise on the detection of mixed modulation.
This article is concerned with the mechanisms underlying the detection of amplitude modulation (AM), frequency modulation (FM), and mixed modulation (MM), i.e., simultaneously occurring AM and FM. In a previous study [B. C. J. Moore and A. Sek, J. Acoust. Soc. Am. 92, 3119-3131 (1992)], psychometric functions were measured for the detection of AM alone and FM alone, using a 10-Hz modulation rate and a 1-kHz carrier frequency. Detectability was then measured for combined AM and FM, with modulation depths selected so that each type of modulation would be equally detectable if presented alone. The detectability of the combined AM and FM was better than would be predicted if the two types of modulation were coded completely independently. Significant effects of relative modulator phase were found when detectability was relatively high, but these effects were not correctly predicted by either of two excitation-pattern models considered. The first experiment reported here was similar to the earlier experiment, but performance was compared for carrier frequencies of 1 and 6 kHz; at the latter frequency, neural synchrony to the stimulus fine structure (phase locking) does not occur. The results at both carrier frequencies were similar to those of our earlier experiment, suggesting that the presence or absence of phase-locking information plays little role in the detection of MM. The second experiment was again similar, but bands of noise were used to mask selectively either the upper or lower side of the excitation pattern of the modulated carrier. The phase effects in this case were in the direction predicted by excitation pattern models. The overall pattern of the results could be predicted reasonably well using a multichannel excitation pattern model based on the assumption that listeners use an unweighted sum of decision variables across all suprathreshold channels with a positive signal-to-noise ratio.


Self-perceived Mental Health Status and Uptake of Fecal Occult Blood Test for Colorectal Cancer Screening in Canada: A Cross-Sectional Study.
While colorectal cancer (CRC) is one of the most preventable causes of cancer mortality, it is one of the leading causes of cancer death in Canada where CRC screening uptake is suboptimal. Given the increased rate of mortality and morbidity among mental health patients, their condition could be a potential barrier to CRC screening due to greater difficulties in adhering to behaviours related to long-term health goals. Using a population-based study among Canadians, we hypothesize that self-perceived mental health (SPMH) status and fecal occult blood test (FOBT) uptake for the screening of CRC are associated. The current study is cross-sectional and utilised data from the Canadian Community Health Survey 2011-2012. Multinomial logistic regression analysis was undertaken to assess whether SPMH is independently associated with FOBT uptake among a representative sample of 11 386 respondents aged 50-74 years. Nearly half of the respondents reported having ever had FOBT for CRC screening, including 37.28% who have been screened within two years of the survey and 12.41% who had been screened more than two years preceding the survey. Respondents who reported excellent mental health were more likely to have ever been screened two years or more before the survey (adjusted odds ratio [AOR] = 2.08; 95% CI, 1.00-4.43) and to have been screened in the last two years preceding the survey (AOR = 1.53; 95% CI, 0.86-2.71) than those reported poor mental health status. This study supports the association between SPMH status and FOBT uptake for CRC screening. While the efforts to maximize CRC screening uptake should be deployed to all eligible people, those with poor mental health may need more attention.


Analytical techniques and method validation for the measurement of selected semivolatile and nonvolatile organofluorochemicals in air.
The widespread use of semi- and nonvolatile organofluorochemicals in industrial facilities, concern about their persistence, and relatively recent advancements in liquid chromatography/mass spectrometry (LC/MS) technology have led to the development of new analytical methods to assess potential worker exposure to airborne organofluorochemicals. Techniques were evaluated for the determination of 19 organofluorochemicals and for total fluorine in ambient air samples. Due to the potential biphasic nature of most of these fluorochemicals when airborne, Occupational Safety and Health Administration (OSHA) versatile sampler (OVS) tubes were used to simultaneously trap fluorochemical particulates and vapors from workplace air. Analytical methods were developed for OVS air samples to quantitatively analyze for total fluorine using oxygen bomb combustion/ion selective electrode and for 17 organofluorochemicals using LC/MS and gas chromatography/mass spectrometry (GC/MS). The experimental design for this validation was based on the National Institute of Occupational Safety and Health (NIOSH) Guidelines for Air Sampling and Analytical Method Development and Evaluation, with some revisions of the experimental design. The study design incorporated experiments to determine analytical recovery and stability, sampler capacity, the effect of some environmental parameters on recoveries, storage stability, limits of detection, precision, and accuracy. Fluorochemical mixtures were spiked onto each OVS tube over a range of 0.06-6 microg for each of 12 compounds analyzed by LC/MS and 0.3-30 microg for 5 compounds analyzed by GC/MS. These ranges allowed reliable quantitation at 0.001-0.1 mg/m3 in general for LC/MS analytes and 0.005-0.5 mg/m3 for GC/MS analytes when 60 L of air are sampled. The organofluorochemical exposure guideline (EG) is currently 0.1 mg/m3 for many analytes, with one exception being ammonium perfluorooctanoate (EG is 0.01 mg/m3). Total fluorine results may be used to determine if the individual compounds quantified provide a suitable mass balance of total airborne organofluorochemicals based on known fluorine content. Improvements in precision and/or recovery as well as some additional testing would be needed to meet all NIOSH validation criteria. This study provided valuable information about the accuracy of this method for organofluorochemical exposure assessment.


Nerve lesions associated with shoulder dislocation; an electrodiagnostic study of 11 cases.
Electrodiagnostic examination of 11 patients with shoulder dislocation revealed nerve damage not previously reported. Although axillary nerve lesions were most common, posterior cord and musculocutaneous nerve damage occurred each in five cases. The mechanism of injury was important. The most surprising patterns were associated with blunt injury or recurrent spontaneous dislocation.


Abundant plankton-sized microplastic particles in shelf waters of the northern Gulf of Mexico.
Accumulation of marine debris is a global problem that affects the oceans on multiple scales. The majority of floating marine debris is composed of microplastics: plastic particles up to 5 mm in diameter. With similar sizes and appearances to natural food items, these small fragments pose potential risks to many marine organisms including zooplankton and zooplanktivores. Semi-enclosed seas are reported to have high concentrations of microplastics, however, the distribution and concentration of microplastics in one such system, the Gulf of Mexico, remains unknown. Our study documented and characterized microplastics in continental shelf waters off the Louisiana coast in the northern Gulf of Mexico, using bongo nets, neuston nets, and Niskin bottles. Additionally, we compared the size distributions of microplastics and zooplankton collected using the nets. Plastics were manually sorted from the samples, documented, and measured using digital microscopy. Confirmation of putative plastics was carried out by hydrofluoric acid digestion and a subsample was analyzed using FTIR microscopy. Estimated concentrations of microplastics collected on the inner continental shelf during this study are among the highest reported globally. Total microplastic concentrations ranged from 4.8 to 8.2 particles m-3 and 5.0-18.4 particles m-3 for the bongo and neuston samples, respectively. Niskin bottles collected smaller plastic particles than the nets and indicated total microplastic concentrations (primarily fibers) from 6.0E4 - 15.7E4 particles m-3. Microplastic concentrations were greater than the abundances of all but four of the five most abundant taxa from bongo nets and were not statistically different from the abundances of any of the most numerous taxa from neuston nets. Sizes of microplastics and zooplankton partially or completely overlapped, suggesting the potential for confusion with natural prey.


Rapamycin promotes vascular smooth muscle cell differentiation through insulin receptor substrate-1/phosphatidylinositol 3-kinase/Akt2 feedback signaling.
The phenotypic plasticity of mature vascular smooth muscle cells (VSMCs) facilitates angiogenesis and wound healing, but VSCM dedifferentiation also contributes to vascular pathologies such as intimal hyperplasia. Insulin/insulin-like growth factor I (IGF-I) is unique among growth factors in promoting VSMC differentiation via preferential activation of phosphatidylinositol 3-kinase (PI3K) and Akt. We have previously reported that rapamycin promotes VSMC differentiation by inhibiting the mammalian target of rapamycin (mTOR) target S6K1. Here, we show that rapamycin activates Akt and induces contractile protein expression in human VSMC in an insulin-like growth factor I-dependent manner, by relieving S6K1-dependent negative regulation of insulin receptor substrate-1 (IRS-1). In skeletal muscle and adipocytes, rapamycin relieves mTOR/S6K1-dependent inhibitory phosphorylation of IRS-1, thus preventing IRS-1 degradation and enhancing PI3K activation. We report that this mechanism is functional in VSMCs and crucial for rapamycin-induced differentiation. Rapamycin inhibits S6K1-dependent IRS-1 serine phosphorylation, increases IRS-1 protein levels, and promotes association of tyrosine-phosphorylated IRS-1 with PI3K. A rapamycin-resistant S6K1 mutant prevents rapamycin-induced Akt activation and VSMC differentiation. Notably, we find that rapamycin selectively activates only the Akt2 isoform and that Akt2, but not Akt1, is sufficient to induce contractile protein expression. Akt2 is required for rapamycin-induced VSMC differentiation, whereas Akt1 appears to oppose contractile protein expression. The anti-restenotic effect of rapamycin in patients may be attributable to this unique pattern of PI3K effector regulation wherein anti-differentiation signals from S6K1 are inhibited, but pro-differentiation Akt2 activity is promoted through an IRS-1 feedback signaling mechanism.


Evaluation of a multitest microtechnique for yeast identification.
A new, multitest, microtechnique system, API 20C (Analytab Products Inc. Clinical Yeast System), was evaluated by comparing it to the U.S. Center for Disease Control (CDC) standard techniques for the identification of yeast. Forty-four yeast strains isolated from clinical specimens were tested by fermentation and assimilation. Six fermentation carbohydrates and ten assimilation carbohydrates were compared. API results were read after incubation of 24 and 48 hours while the standard CDC system was read after 48 hours and 14 days when needed. One hundred per cent agreement in identification was found between the two systems in the strains studied. Growth in the presence of actidione was tested by the API strip only and gave unreliable results with nine per cent of the strains tested. The API 20 Clinical Yeast System provides a reliable and rapid approach to yeast identification enabling the clinical laboratory to completely identify a yeast organism in 48 hours instead of the usual four to 14 days. A cost comparison showed the API system to be significantly more economical than the conventional method of identification.


Compound heterozygosity for a frame shift mutation and a likely pathogenic sequence variant in the planar cell polarity—ciliogenesis gene WDPCP in a girl with polysyndactyly, coarctation of the aorta, and tongue hamartomas.
We report on a young girl with polysyndactyly, coarctation of the aorta, and tongue hamartomas. These features are similar to those reported in individuals with variant forms of orofaciodigital syndrome known as congenital heart defects, hamartomas of the tongue and polysyndactly (CHDHTP: OMIM 217085) [Örstavik et al., 1992] and orocardiodigital syndrome [Digilio et al., 1996]. Whole exome sequencing revealed that she is a compound heterozygote for a frame shift mutation and a likely pathogenic sequence variant in WDPCP, a gene that regulates planar cell polarity and ciliogenesis. Results of genotyping in her parents and unaffected siblings were consistent with autosomal recessive inheritance of the mutation and the WDPCP variant. These results suggest that disruption of planar cell polarity and ciliogenesis may result in this unusual form of orofaciodigital syndrome.


Volume holographic imaging endoscopic design and construction techniques.
A reflectance volume holographic imaging (VHI) endoscope has been designed for simultaneous in vivo imaging of surface and subsurface tissue structures. Prior utilization of VHI systems has been limited to ex vivo tissue imaging. The VHI system presented in this work is designed for laparoscopic use. It consists of a probe section that relays light from the tissue sample to a handheld unit that contains the VHI microscope. The probe section is constructed from gradient index (GRIN) lenses that form a 1:1 relay for image collection. The probe has an outer diameter of 3.8 mm and is capable of achieving 228.1 ?? lp / mm resolution with 660-nm Kohler illumination. The handheld optical section operates with a magnification of 13.9 and a field of view of 390 ?? ? m × 244 ?? ? m . System performance is assessed through imaging of 1951 USAF resolution targets and soft tissue samples. The system has also passed sterilization procedures required for surgical use and has been used in two laparoscopic surgical procedures.


Single Center Retrospective Analysis of Conventional and Radial TIG Catheters for Transradial Diagnostic Coronary Angiography.
Current guidelines favor the radial approach for coronary angiography. Therefore, specialty radial diagnostic catheters were designed to engage both coronary arteries with a single device. However, it is unclear if single catheters are superior to conventional catheters. A retrospective analysis was performed of consecutive right radial coronary angiographies to determine catheter use, fluoroscopy time, radiation dosage, and consumption of contrast. Procedures were performed with a single TIG catheter or conventional catheters (CONV). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded. 273 transradial procedures were performed successfully. 95 procedures were performed with CONV and 178 procedures with a TIG. Crossover to additional catheters was higher in TIG (15.2%) compared to CONV (5.3%, p = 0.02). Fluoroscopy time was comparable between CONV and TIG, without crossover (2.2 ± 1.2 min versus 2.3 ± 1.2 min; n.s.), however, greater in the case of crossover for CONV (5.8 ± 0.7) and TIG (7.6 ± 3.0; p = 0.0001). Radiation dosage was similar in CONV and the TIG, without crossover (1419 ± 1075, cGy∗cm(2) versus 1690 ± 1138; n.s.), however, greater for CONV (2374 ± 620) and TIG (3733 ± 2281, p = 0.05) with crossover. Overall, the amount of contrast was greater in TIG (56 ± 13 mL) versus CONV (48 ± 3 mL; p = 0.0003). CONV femoral catheters may be the primary choice for radial approach.


Comparison of direct and indirect costs of abnormal uterine bleeding treatment with global endometrial ablation and hysterectomy.
The objective was to compare abnormal uterine bleeding (AUB) direct healthcare costs and indirect work absence or short-term disability costs associated with treatment with second-generation global endometrial ablation (GEA) or hysterectomy. Women aged 30-55 years with AUB who underwent GEA or hysterectomy during 2006-2010 were identified in the Truven Health MarketScan(®) Commercial and Health and Productivity Management databases. Two-thirds (66.3%) of the 61,602 study patients underwent GEA compared with hysterectomy (33.7%). Hysterectomy patients had higher treatment costs (US$12,147 vs 5837; p < 0.001), higher annual absenteeism costs (US$7543 vs 5621; p < 0.001), were four-times more likely to have a short-term disability claim (84 vs 21%; p < 0.001) and had higher per-patient short-term disability costs (US$5744 vs 1361; p < 0.001). Overall hysterectomy costs were approximately twice those of GEA.


Effects of Hypobaric Treatments on the Quality, Bioactive Compounds, and Antioxidant Activity of Tomato.
Hypobaric treatment is becoming a potential technology to protect fruits from postharvest decay. The objective of this study was to investigate the effects of hypobaric treatments on storage quality, bioactive compounds, and antioxidant activity of tomato fruit. In this study, green tomatoes (cv. "Fen guan") were treated with hypobaric pressures (0.04 and 0.07 MPa) at ambient temperature (20 ℃) for 28 d. The results showed that under hypobaric storage, the respiration rates significantly declined and the respiratory peaks postponed 12 and 8 d by 0.04 and 0.07 MPa treatments, respectively, compared to control. Total soluble solid, titratable acidity, ascorbic acid, and lycopene were retained by hypobaric treatment. Moreover, ascorbic acid contents treated with 0.04 and 0.07 MPa were, respectively, 37% and 26% higher than control at day 24 and the contents of total polyphenols were, respectively, 1.28 and 1.11 times higher than control. Production and accumulation of toxic substances were significantly restrained. The ethanol content decreased, respectively, by 53% and 84% than control. At later storage period, the superoxide dismutase activity in treated fruits was about 0.58 U/(g·FW·min), whereas only 0.29 U/(g·FW·min) in control. Hypobaric treatment not only maintained a high activity of superoxide dismutase and peroxidase (POD), but also improved antioxidant capacity. All the results indicated that hypobaric treatment was a potential helpful method to protect the quality and nutrition of tomato and prolong ripening of tomato. Furthermore, the effect of 0.04 MPa hypobaric treatment was found better than 0.07 MPa.


Cutaneous Crohn disease without gastrointestinal involvement in a 9-year-old boy.
Cutaneous Crohn disease (CCD) is a rare dermatologic manifestation of Crohn disease and is defined as noncaseating, granulomatous skin lesions noncontiguous with the gastrointestinal tract. It most commonly affects the skin of the legs, although genital CCD is the most common presentation in children. Diagnosis of CCD is made by a combination of clinical and histopathological findings. Therapeutic options include topical, intralesional, and systemic corticosteroids as well as topical and systemic immunosuppressants and immunomodulators. Surgical excision may be considered for refractory cases. We report CCD in a 9-year old boy with penile swelling, granulomatous cheilitis-like lesions, and perianal plaques.


Inter- and intra-rater reliability of diffusion tensor imaging parameters in the normal pediatric spinal cord.
To assess inter- and intra-rater reliability (agreement) between two region of interest (ROI) methods in pediatric spinal cord diffusion tensor imaging (DTI). Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects (mean age = 12.10 years) was used to assess for reliability. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. ROIs were placed on axial B0 maps along the cervical spine using free-hand and fixed-size ROIs. Agreement analyses for fractional anisotropy (FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation (ICC) and Cronbach's alpha statistical methods. Inter- and intra-rater agreement between the two ROI methods showed moderate (ICC = 0.5) to strong (ICC = 0.84). There were significant differences between raters in the number of pixels selected using free-hand ROIs (P < 0.05). However, no significant differences were observed in DTI parameter values. FA showed highest variability in ICC values (0.10-0.87). Cronbach's alpha showed moderate-high values for raters and ROI methods. The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.


[Bouveret'S syndrome: gastric outlet obstruction by a gallstone].
This rare syndrome first described by Bouveret in 1896, occurs when a stone migrates through a cholecysto or choledochoduodenal jistula lodging in the duodenal bulb and resulting in obstruction. Up to date, less than 100 cases reported in the literature. This rare type of gallstone ileus can be diagnosed and treated endoscopically, although there are a few previous reports of successful endoscopic, removal. However, surgical removal is safe and effective but the most controversial aspect is the proper treatment, simple enterotomy and removal ofthe gallstone alone or enterolithotomy in association with cholecystectomy and dejinitive correction ofthe biliodigestive fistula. This paper presents a case report of a 65 year old man with gastric outlet obstruction caused by a large gallstone. The diagnose and treatment of this case who was admitted in 1.General Surgical Department of Taksim Teaching and Research Hospital was researched under the reference of recent literature.


Content Validity of a Psychotherapeutic Intervention Model in Nursing: A Modified e-Delphi Study.
To estimate the content validity of a psychotherapeutic intervention model in nursing. Mental health nurses encounter great extrinsic difficulties when it comes to providing psychotherapeutic interventions due to the fact that they are not allowed to perform such practice in some countries. In this light, the pursuit of a psychotherapeutic intervention model in nursing seems germane to guide the professionals' psychotherapeutic practice, contributing hereof to increase mental health nurses' professional autonomy. Modified e-Delphi. Data were collected from October 2015 to January 2016 by means of three rounds of online questionnaires. The initial questionnaire was structured into five sections: general structure of the model, patients' exclusion criteria, assessment framework, nursing diagnoses, and nursing psychotherapeutic interventions. From the 42 experts invited, at least twenty (20) participated in each round. The experts achieved consensus with regard to the conclusion that nursing psychotherapeutic interventions should always seek to address a nursing diagnosis. These defined furthermore that a psychotherapeutic intervention model in nursing should be exercised by means of 3 to 12 sessions using Nursing Interventions Classification (NIC) as a resource. Finally, experts deemed that the model should follow the principles of integrative psychotherapy, so that techniques from different schools of psychotherapy could therefore be used in conjunction to promote the resolution of a nursing diagnosis. Achieving consensus about the structure of a psychotherapeutic intervention model in nursing is imperative to guide nurses in the provision of nursing psychotherapeutic interventions and to enable an effective evaluation of the health gains associated with its implementation.


[Opinion of the Czech Atherosclerosis Society's committee (CSAT) on the ESC/EAS guidelines related to the diagnostics and treatment of dyslipidemias issued in 2011].
This position statement of the Executive Committee of the Czech Society for Atherosclerosis (CSAT) summarizes the most important aspects and novelties of the latest European guidelines for the management of dyslipidemia. In particular the position statement comments on: cardiovascular risk stratification, indications for plasma lipid and lipoprotein levels assessment as well as target lipid values, evaluation of current options for both lifestyle and pharmacological treatment of lipid metabolism disorders and, also, recommendation for laboratory monitoring of patients treated with lipid lowering agents. The statement deals with actual concepts of management of dyslipiemia in everyday practice, e.g. therapy of dyslipidemia in special patients´ groups. This statement does not replace the latest guidelines but focuses on the changes from the former guidelines for dyslipidemia management, published by CSAT in 2007.


MicroRNA-125a-5p inhibits invasion and metastasis of gastric cancer cells by targeting BRMS1 expression.
Accumulating studies have demonstrated microRNAs (miRNAs/miRs) have an important role in multiple processes of human malignant tumor development and progression. Decreased expression of miR-125a-5p has been observed in several types of cancer, including gastric cancer (GC). However, the mechanism and exact function of miR-125a-5p in GC have not been largely elucidated. In the present study, reverse transcription-quantitative polymerase chain reaction indicated that the expression of miR-125a-5p was downregulated in GC tissues and cell lines compared with matched normal tissues (P<0.01) and normal gastric mucosa cell lines (P<0.01), respectively. Moreover, clinical pathological characteristics and Kaplan-Meier analysis indicated that a low expression of miR-125a-5p was not only associated with lymph metastasis, peritoneal dissemination and advanced tumor-node metastasis stage but also affected the prognosis of GC patients. Compared with miR-control-transfected GC cells, markedly decreased migration and invasion was observed in GC cells that overexpress miR-125a-5p. By contrast, increased metastasis and invasion were observed in miR-125a-5p-knocked down cells compared with the control. Furthermore, luciferase reporter assays indicated that breast cancer metastasis suppressor 1 (BRMS1) was a direct target of miR-125a-5p. Notably, a positive correlation between the levels of BRMS1 and miR-125a-5p in GC tissues was observed, and BRMS1 expression was indicated to be regulated by miR-125a-5p in GC cells. In conclusion, miR-125a-5p may act as a tumor suppressor by targeting the metastasis-inhibitory gene, BRMS1. The data suggesting that BRMS1 is a potential target gene of miR-125a-5p, may provide novel insight into miRNA regulation of human gene expression, and a useful target for gene therapy of GC.


Nanolithography of single-layer graphene oxide films by atomic force microscopy.
Atomic force microscopy-based nanolithography is used to generate the single-layer graphene oxide (GO) patterns on Si/SiO(2) substrates. In this process, a Si tip is used to scratch GO films, resulting in GO-free trenches. Using this method, various single-layer GO patterns such as gaps, ribbons, squares, triangles, and zigzags can be easily fabricated. By using the GO patterns as templates, the hybrid GO-Ag nanoparticle patterns were obtained. Our study provides a flexible, simple, convenient method for generating GO patterns on solid substrates, which could be useful for graphene material-based device applications.


Combining GRP78 suppression and MK2206-induced Akt inhibition decreases doxorubicin-induced P-glycoprotein expression and mitigates chemoresistance in human osteosarcoma.
P-glycoprotein (P-gp) overexpression is associated with poor prognosis and drug-resistance in osteosarcoma (OS), but the underlying mechanisms remain incompletely understood. Here, we examined the regulation of P-gp, GRP78, and phospho-Akt in doxorubicin (DOX)-treated OS cells. DOX induced P-gp expression, which was associated with increased GRP78 levels and Akt activation in vitro and in vivo. Functional analysis showed that Akt induces P-gp and GRP78 expression, which contributes to the DOX-induced Akt activation. Examination of the relationship between Akt and GRP78 demonstrated that GRP78 suppression attenuates the Akt activity in OS parental sensitive and resistant cells, indicating that GRP78 is required for full Akt activity. Inhibition of Akt activity using MK2206 decreased GRP78 expression in OS cells, which enhanced the inhibitory effect of MK2206 on P-gp expression. GRP78 knockdown combined with MK2206 suppressed the development of DOX resistance in OS cells and inhibited the in vivo tumor growth in the presence of DOX. These results support the development of novel therapeutic strategies that target GRP78 and Akt to sensitize OS cells for chemotherapy.


New equations for calculating the components of energy expenditure in infants.
To derive new equations for 24-hour energy expenditure (24-h EE; kcal/d) and resting (RMR; kcal/d) and sleeping metabolic rates (SMR; kcal/d) in young infants by using the Enhanced Metabolic Testing Activity Chamber (EMTAC). Data from 50 (25 male/25 female) healthy normally growing infants (4.9 +/- 1.6 months, 7.1 +/- 1.4 kg, 65 +/- 5 cm) who had 24-h EE, RMR, and SMR extrapolated from 4- to 6-hour metabolic measurements in the EMTAC were used to derive new equations for 24-h EE, RMR, and SMR. Equations were derived by means of multiple regression analysis (SPSS 8.0), with weight alone or with length and weight entered as independent variables. Similar data from 10 additional test infants (4 male/6 female, 5.1 +/- 0.6 months, 7.5 +/- 1.0 kg, 65 +/- 5 cm) were used to cross-validate the new equations. Twenty-four-hour EE, RMR, and SMR were 79.6 +/- 19.2, 66.8 +/- 15.1, and 62.3 +/- 10.3 kcal/kg per day, respectively. No differences existed in RMR (kcal/kg per day) from the 10 test infants between the weight (68.6 +/- 1.9) and height-weight based equations (68.4 +/- 6.1) or that measured by the EMTAC (67.6 +/- 10.2). Weight was the major predictor of 24-h EE, RMR, and SMR. The WHO, Schofield-weight and weight-height equations underestimated (P <.05) by 19%, whereas the new equations were within 4% of RMR obtained from the EMTAC. The new equations for assessing energy requirements in healthy infants are more accurate than those previously published that underestimated 24-h EE by 15 kcal/kg per day.


Primary treatment of battle casualties in the Lebanon War, 1982.
The experience of the Israel Defense Forces in the early management of battle casualties in the Lebanon War, 1982, is discussed. This report deals with 1,561 battle casualties evacuated to hospitals over a 15-week period.


Synthesis and characterization of a novel liver-targeted prodrug of cytosine-1-beta-D-arabinofuranoside monophosphate for the treatment of hepatocellular carcinoma.
Cytotoxic nucleosides have proven to be ineffective for the treatment of hepatocellular carcinoma (HCC) due, in part, to their inadequate conversion to their active nucleoside triphosphates (NTP) in the liver tumor and high conversion in other tissues. These characteristics lead to poor efficacy, high toxicity, and a drug class associated with an unacceptable therapeutic index. Cyclic 1-aryl-1,3-propanyl phosphate prodrugs selectively release the monophosphate of a nucleoside (NMP) into CYP3A4-expressing cells, such as hepatocytes, while leaving the prodrug intact in plasma and extrahepatic tissues. This prodrug strategy was applied to the monophosphate of the well-known cytotoxic nucleoside cytosine-1-beta-D-arabinofuranoside (cytarabine, araC). Compound 19S (MB07133), in mice, achieves good liver targeting compared to araC, generating >19-fold higher cytarabine triphosphate (araCTP) levels in the liver than levels of araC in the plasma and >12-fold higher araCTP levels in the liver than in the bone marrow, representing a >120-fold and >28-fold improvement, respectively, over araC administration.


True Nondisjunction of Whole Bivalents in Oocytes with Attachment and Congression Defects.
Chromosome segregation in mammalian oocytes is prone to errors causing aneuploidy with consequences such as precocious termination of development or severe developmental disorders. Aneuploidy also represents a serious problem in procedures utilizing mammalian gametes and early embryos in vitro. In our study, we focused on congression defects during meiosis I and observed whole nondisjoined bivalents in meiosis II as a direct consequence, together with a substantially delayed first polar body extrusion. We also show that the congression defects are accompanied by less stable attachments of the kinetochores. Our results describe a process by which congression defects directly contribute to aneuploidy.


Comparison of pulsed-field gel electrophoresis and amplified fragment length polymorphism techniques for investigating outbreaks of enteritis due to campylobacters.
Campylobacters are the most commonly reported cause of acute bacterial enteritis in the United Kingdom and United States, with poultry, milk, and water implicated as sources or vehicles of infection. The majority of campylobacter infections are sporadic, although outbreaks may occur, and these provide an opportunity to evaluate genotypic fingerprinting techniques. In this study, pulsed-field gel electrophoresis (PFGE) was compared with single-enzyme-amplified fragment length polymorphism (SAFLP). The results for the three separate episodes indicated that SAFLP and PFGE both clustered the strains from the first incident as 100% homologous. The strains from the second and third incidents clustered as distinct from both the first incident and from each other. PFGE is well recognized as a discriminatory fingerprinting technique for campylobacters; however, SAFLP has proven to be equally discriminatory, but far less labor intensive and with the added advantages of less "hands-on" time and inexpensive equipment, it is an excellent alternative to PFGE for investigation of outbreaks.


Functional Morphology of Prey Ingestion by Placetron wosnessenskii Schalfeew Zoeae (Crustacea: Anomura: Lithodidae).
The relationship between the morphology and functions of the feeding appendages of first-stage zoeae of the lithodid crab Placetron wosnessenskii Schalfeew during ingestion is explored in this study. The preoral chambers of these zoeae are bordered on all sides, with the labrum and mandibles forming the anterior borders, the paragnaths and sternal projection together creating the posterior boundaries, and the maxillules forming the sides. The maxillules are the sole pair of appendages responsible for prey manipulation immediately preceding ingestion. Maxillules are capable of remarkable plasticity of movement, enabling them to grasp, control, and redirect violently struggling prey (Artemia sp. metanauplii). The asymmetrical mandibles tear and grind the prey, working against each other with rotating motions. Two separate ratchet-like coordinations of the appendages were seen, each of which enabled the zoea to maintain a firm grasp on the prey while renewing points of leverage for ingestion. The mandibles hold prey in position while the maxillules regrab it to push it farther into the mouth. Similarly, the labrum holds the prey while the mandibles prepare for a new grinding rotation. Capture and ingestion of an algal cell by a rapid outward flinging and inward clasping of the mouthparts was seen in one videotaped sequence. Gut fluorescence after introduction of various algal species reveals an ability to ingest a range of particle sizes. This plasticity of feeding behaviors allows the zoeae to ingest a range of food items, and thus meet their nutritional needs.


Characterisation of mildew resistant wheat-rye substitution lines and identification of an inverted chromosome by fluorescent in situ hybridisation.
Seven different mildew resistant wheat lines derived from crosses between triticale and bread wheat were examined by molecular cytogenetics and chromosome C-banding in order to determine their chromosomal composition. Genomic in situ hybridisation (GISH) showed the presence of rye germplasm in all the lines and identified three substitution lines, three double substitution lines and one addition-substitution line. C-banding identified rye chromosomes 1R and 4R in the addition-substitution line, rye chromosomes 1R and 6R in two substitution lines and 1R and 2R in the third line, and rye chromosome 1R in the three substitution lines. Two of the latter lines (7-102 and 7-169) contained a modified form of the chromosome; fluorescent in situ hybridisation (FISH) using five different repetitive DNA-probes showed a pericentric inversion of 1R in both lines. The breakpoints of the 1R inversion were between (1) the 5S rDNA site and the NOR-region on the satellite of the short arm, and (2) between two AAC(5) sites close to the centromere on the long arm. The role of the rye chromosomes in the mildew resistance, the utilisation of the inverted 1R and the significance of the lines in wheat breeding are discussed.


The effects of homocysteine and MTHFR genotype on hip bone loss and fracture risk in elderly women.
Few studies have evaluated the effects of homocysteine and methylenetetrahydrofolate reductase (MTHFR) genotype on age-related bone loss. In our 5-year cohort study with 1,213 women aged 70-85 years, high homocysteine is associated with greater hip bone loss but not fracture risk. The effect of MTHFR genotype on bone density and fracture is weak. Previous studies on the effects of homocysteine and MTHFR genotype on bone mineral density (BMD) and osteoporotic fracture risk have shown inconsistent results. Few studies have evaluated their effects on age-related bone loss. We evaluated the effects of homocysteine and MTHFR genotype variation on hip BMD and fracture risk over 5 years in a cohort of 1,213 community-dwelling women aged 70-85 years. Nutritional intake and prevalent fracture status were assessed at baseline, plasma homocysteine was measured at year 1, and hip dual-energy X-ray absorptiometry (DXA) BMD was measured at years 1 and 5. Clinical incident osteoporotic fractures confirmed by radiographic report were collected throughout the study and the MTHFR gene C677T and A1298C polymorphisms genotyped. Data were analyzed using analysis of covariance and Cox proportional hazard regression. The highest tertile of homocysteine was associated with a greater hip BMD loss over 4 years (-2.8%) compared to the middle (-1.6%) and lowest tertiles (-1.2%) (P < 0.001). This effect remained after adjustment for covariates. There was no effect of homocysteine on fracture prevalence or incidence. MTHFR gene variation was only weakly related to one of the bone outcome measures. In this study population, high homocysteine is associated with greater hip bone loss but not fracture risk.


Effect of Preferential Orientation of Lamellae in the Interfacial Region between a Block Copolymer-based Pressure-Sensitive Adhesive and a Solid Substrate on the Peel Strength.
We have investigated the relationship between the peel strength of a block copolymer-based pressure-sensitive adhesive comprising of poly(methyl methacrylate) (PMMA) and poly(n-butyl acrylate) (PnBA) components from the substrate and the microdomain orientations in the interfacial region between the adhesive and the substrate. For the PMMA substrate, the PMMA component in the adhesive with a strong affinity for the substrate is attached to the surface of the substrate during an aging process of the sample at 140 °C. Next, the PMMA layer adjacent to the substrate surface is overlaid with a PnBA layer, which gets covalently connected, resulting in the horizontal alignment of the lamellae in the interfacial region. The peel strength of the adhesive substantially increases during aging at 140 °C, which takes the same time as the completion of the horizontally oriented lamellar structure. However, in the case of the polystyrene (PS) substrate, both the components in the adhesive repel the substrate, leading to the formation of the vertically oriented lamellar structure. As a result, the peel strength of the adhesive with respect to its PS substrate does not entirely increase on aging. It is suggested that the peel strength of the adhesive is highly correlated with the interfacial energy between the adhesive and substrate, which can be estimated from the microdomain orientation in the interfacial region.


Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up.
Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Case series; Level of evidence, 4. This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.


Reduced oxygen concentration during in vitro oocyte maturation alters global DNA methylation in the maternal pronucleus of subsequent zygotes in cattle.
Preimplantation epigenetic reprogramming is sensitive to the environment of the gametes and the embryo. In vitro maturation (IVM) of bovine oocytes is a critical step of embryo in vitro production procedures and several factors influence its efficiency, including atmospheric oxygen tension. The possibility that the IVM environment can alter this process is tested by determining whether the global DNA methylation pattern (measured via immunofluorescent labeling of 5-methylcytosine [5meC]) in the parental pronuclei of bovine zygotes produced from cumulus-oocyte complexes matured under low (5%) and atmospheric (~20%) oxygen tension. Normalized 5meC signals differed significantly between maternal and paternal pronuclei of oocytes matured in vitro at 5% oxygen (p ≤ 0.05). There was a significant difference of 5meC between maternal pronuclei of oocytes matured at 5% oxygen and 20% oxygen ( p ≤ 0.05). The relative methylation level (normalized fluorescence intensity of paternal pronucleus divided by the normalized fluorescence intensity of maternal pronucleus) subsequent to maturation in vitro at 5% and 20% oxygen was also significantly altered ( p ≤ 0.05). Our results show that the pattern of global DNA methylation in the maternal pronucleus of bovine zygotes is affected by maturing the oocytes under low oxygen tension which may have an impact on early embryonic development. These data may contribute to the understanding of possible effects of IVM conditions on pronucleus reprogramming.


Evidence-based nutrition.
What are the objectives of an ideal diet? Are they to prolong life or maximize quality adjusted life expectancy? Does this focus on individuals or on the population at large, taking equity and resources into account? What about externalities that should take into account cultural heritage, protection of the environment and macroeconomic considerations? Few people have the experience, expertise and knowledge to adequately address these questions. It is only feasible to argue that there are two approaches in order to establish the proper diet, with the limited objective of longevity. Contrary to the assertions of several influential groups, there is no such thing as a 'positive health', and longevity can only be defined as the inverse of mortality from all causes. The crucial questions are: do we need to study the proper diet to reduce incidence of and mortality from particular common diseases and then find the common elements in these various diets in order to construct de novo the ideal diet (bottom up approach)? Alternatively, is it better to harvest the experience of various cultures whose diets appear to protect against premature morbidity and mortality (top down approach)? The first approach would rely on associations between food groups, foods and nutrients on the one hand and the incidence of specific diseases on the other, whereas the second would evaluate and quantify the effects of 'natural' diets on longevity. The first approach has been largely followed by mainstream nutritional epidemiologists, whereas the second has been advocated by a few international experts.


Combined use of proacrosin immunocytochemistry and autosomal DNA in situ hybridisation for evaluation of human ejaculated germ cells.
The recently reported human pregnancies and births after fertilising oocytes with round spermatids recovered from the ejaculate of men with non-obstructive azoospermia have underscored the need for a more accurate evaluation of the nuclear and cytoplasmic maturation status of ejaculated germ cells. In this study we describe our first experience with a method combining the immunocytochemical visualisation of proacrosin with autosomal DNA fluorescence in situ hybridisation (FISH) to assess ejaculated germ cells from patients with a spermiogenesis defect. The proacrosin immunoreactivity, analysed with the use of the monoclonal antibody 4D4, has been detected in cells of round spermatid size presenting a haploid FISH figure as well as in larger cells whose ploidy corresponds to primary and secondary spermatocytes. These observations are in agreement with previously published results obtained, with the use of the same antibody, by immunocytochemical analysis of histological sections of testicular tissue. All the cells of round spermatid size possessing proacrosin immunoreactivity were found to be haploid by FISH. On the other hand, some of the haploid cells of round spermatid size did not possess proacrosin immunoreactivity. The structural pattern of proacrosin immunoreactivity was highly variable both in spermatids and in younger spermatogenic cells. These data show that cell size is the main criterion to be used for the identification of ejaculated round spermatids, whereas the presence of the developing acrosome represents only an auxiliary criterion. The scoring of acrosomal development in ejaculated spermatids may be useful as part of pre-treatment diagnosis before the inclusion of infertile couples in a spermatid conception programme.


Pre-partum leucocytic activity and retained placenta.
An investigation concerning the association of the leucocytecotyledon reaction and the expulsion of the placenta is described. The in vitro reaction does not appear to be individual-specific. It is thus possible to determine the activity of the leucocytes against a cotyledon before parturition. The leucocytes of cows which will develop a retained placenta have lowered activity against the chemotactic stimulus of a cotyledon; this reduced activity of the leucocytes can be observed some days before parturition.


Botulinum toxin therapy for chronic anal fissures: where are we at currently?
Botulinum toxin (Botox) injection for chronic anal fissure (CAF) is commonly performed, yet there remains no consensus on optimal dosage or frequency of injections required to achieve complete resolution of anal fissure. The aim of this study was to determine the effectiveness of Botox and side-effect profile in the management of CAF. A retrospective clinical study of patients between 2010 and 2014 who underwent a Botox injection for CAF at a tertiary centre was performed. The effectiveness of Botox was measured using standardized outcomes including overall healing rate, presence of anal pain, recurrence and need for repeat botulinum injection. Binary outcomes were assessed using logistic regression model. The analysis was performed using Stata version 13 (StataCorp, College Station, TX, USA). One hundred and one patients underwent 126 Botox injections within the study period. The mean first post-operative visit was at 1 month. The overall recurrence rate was 32%. The majority of patients were given 33 U. No statistically significant relationship between dose and recurrence was identified. The presence of pain at the first post-operative visit was a predictor of future recurrence (odds ratio 3.92, confidence interval 1.58-9.74, P = 0.003). Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post-procedure visit.


Lamellar Nanocomposite Based on a 1D Crayfish-like CeIII-Substituted Phospho(III)tungstate Semiconductor and Polyaniline Used as a High-Performance Humidity Sensing Device.
In order to meet people's demand for intelligent management of daily life and health, manufacturing and developing humidity monitoring equipment with convenience, high sensitivity, easy miniaturization, and low cost is particularly important in the era of rapid development of artificial intelligence and the Internet of Things. Polyaniline (PANI) is an attractive humidity sensing material due to its designable functional properties. However, PANI modified polyoxometalates (POMs) for humidity sensing are still rare. As a proof of concept, a novel moisture sensing composite material was obtained based on PANI and a novel 1D rare-earth-substituted phospho(III)tungstate [H2N(CH3)2]9Na3H6[Ce2(H2O)3W5O13(C2O4)][HPIIIW9O33]2[(HPIII)2W15O54]·42H2O (1). Notably, the anion structure of 1 contains trivacant Keggin-type [B-α-HPIIIW9O33]8- and Dawson-like [(HPIII)2W15O54]10- subunits linked by a heterometallic [Ce2(H2O)3W5O32(C2O4)]30- cluster. Furthermore, the 1/PANI composite shows a typical semiconductive characteristic with a "band-like" conductive mechanism. The fabricated 1/PANI-based humidity sensing device exhibits a broad sensing range (11∼97% relative humidity), fast response/recovery time (3.45 s/3.24 s), good repeatability, and long-term stability (over 3 months). Additionally, the possible sensing mechanism is proposed. This work offers an enormous possibility for the design of high-performance humidity sensing materials through POM material chemistry.


Cloning and characterization of an AAC(6') gene from Serratia marcescens.
A gene encoding AAC(6') mediated resistance to netilmicin and amikacin was cloned from the chromosome of a nosocomial strain of Serratia marcescens into the BamHI site of pACYC184. The resistance determinant was localized to a sequence of approximately 1 kb. A 490 base pair BamHI-PvuII restriction fragment from the cloned DNA was used as a probe in Southern hybridization studies. Homology with a 920 base pair fragment of PvuII digested S. marcescens DNA from AAC(6')-producing strains was observed. No homology was detected with aminoglycoside sensitive S. marcescens or Escherichia coli.


Study of the Anti-Staphylococcal Potential of Honeys Produced in Northern Poland.
The antimicrobial activity of 144 samples of honeys including 95 products from apiaries located in Northern Poland was evaluated. The antibacterial activity of those natural products, their thermal stability, and activity in the presence of catalase was investigated by microdilution assays in titration plates. The MTT assay was performed for the determination of anti-biofilm activity. Spectrophotometric assays were used for the determination of antioxidant potential, total phenolic content, and ability to generate hydrogen peroxide. Some of the investigated honeys exhibited surprisingly high antimicrobial, especially anti-staphylococcal, potential, with Minimal Inhibitory Concentration (MIC) values of only 1.56% (v/v). Much higher resistance was observed in the case of staphylococci growing as biofilms. Lower concentrations of the product, up to 12.5% (v/v) stimulated its growth and effective eradication of biofilm required concentration of at least 25% (v/v). Hydrogen peroxide has been identified as a crucial contributor to the antimicrobial activity of honeys supplied by Polish beekeepers. However, some of the results suggest that phytochemicals, especially polyphenols, play an important role depending on botanical source (both positive, e.g., in the case of buckwheat honeys as well as negative, e.g., in the case of some rapeseed honeys) in their antimicrobial potential.


Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients.
Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.


Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases.
Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a "clipless" adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn's disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools-ultrasonic, bipolar or mixed scissors-and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn's disease, 48 by Cushing's disease. Surgery mean operative time was 137.33 min (range 100-180 min) during the learning curve adrenalectomies and 98.5 min (range 70-180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60-280) and 96.98 mL (range 50-280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a "clipless" adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.


Temperature monitoring in the neonate: a comparison of axillary and rectal temperatures.
This study investigated the differences between temperature taking in neonates by the axillary method and by the rectal method. A sample of 46 normal full-term neonates had axillary and rectal temperatures monitored for ten minutes by each method with mercury in glass thermometers. There were significant differences found between axillary and rectal temperatures when compared minute for minute. Stabilized axillary and stabilized rectal temperatures were not tested for difference because axillary temperatures did not meet the criteria for stabilization. A significant positive correlation was found between axillary and rectal temperatures. Axillary temperature taking may be a practical method for neonatal temperature monitoring.


Subacute default mode network dysfunction in the prediction of post-stroke depression severity.
To identify patterns of rest functional connectivity (FC) in the whole brain with the default mode network (DMN) soon after stroke and to explore the predictive accuracy of the strength of rest FC in specific areas on poststroke severity of depression and anxiety symptoms. The protocol was accepted by the local ethics board, and all patients provided informed consent to participate. Resting-state functional magnetic resonance (MR) images were acquired 10 days after a first stroke in 24 patients without a history of psychiatric illness. Independent component analysis was used to isolate the DMN in each subject. Hamilton Depression Rating Scale (HDRS) 17 and Hamilton Anxiety Rating Scale (HARS) were recorded 10 days and 3 months after the stroke. Associations between severity of anxiety or depression symptoms and DMN functional connectivity were investigated with whole-brain analyses by using statistical parametric mapping software and were adjusted for age, sex, manual laterality, and National Institutes of Health Stroke Severity scores. Correlations were considered significant if P<.001, with a cluster size of more than 50 voxels. Ten days after stroke, anxiety severity was correlated with functional connectivity in the middle temporal cortex and the anterior midcingulate cortex, while at 3 months after stroke, a correlation was observed with the middle temporal cortex and the posterior cingulate cortex. Poststroke depressive symptom severity did not correlate with functional connectivity changes at 10-day follow-up, while the HDRS 17 score was correlated with functional connectivity in the left middle temporal cortex and precuneus at 3-month follow-up. These results suggest that a dysfunction of DMN functional connectivity involved in emotional control is associated with the severity of poststroke depression. Further studies are necessary to determine the mechanisms of this functional impairment.


Hypolipidemic effects of Alismatis rhizome on lipid profile in mice fed high-fat diet.
To investigate the effect of Alismatis rhizome (AR) extract on lipid profile in mice fed high-fat diet. The study was performed in Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, Wuhan, China, between December 2009 and June 2010. Forty male Kunming mice (8-week-old) were randomly divided into 4 groups and were treated for 4 weeks: Group 1: normal control, Group 2: high-fat control, Group 3: positive control and Group 4: AR 2.26 g/kg. The hypolipidemic effects of AR were evaluated by serum lipids, liver lipids, and reverse transcriptase polymerase chain reaction. Serum aminotransferases and histopathological changes were also measured. Alismatis rhizome treatment resulted in an obvious decrease in serum and liver cholesterol, triglyceride along with elevated serum high-density lipoprotein cholesterol in hyperlipidemic mice. The histopathological results showed that adipose vacuoles in AR treated mice liver were almost identical to those of normal control mice. Serum alanine transaminase, aspartate aminotransferase and the relative liver weight in AR treated mice were decreased significantly. Alismatis rhizome substantially decreased the mRNA expression of 3-hydroxy-3-methylglutaryl coenzyme A reductase (Hmgcr), while the expressions of sterol regulatory element binding factor 2 (Srebf2) and cholesterol 7alpha-hydroxylase (Cyp7a1) were marginally affected. These results confirmed the efficacy of AR in the treatment of hyperlipidemia. Alismatis rhizome may act by decreasing the liver synthesis of cholesterol, rather than by increasing the cholesterol catabolism.


The macroeconomic burden of noncommunicable diseases and mental health conditions in South America.
Noncommunicable diseases and mental health conditions (referred to collectively as NMHs) are the greatest cause of preventable death, illness, and disability in South America and negatively affect countries' economic performance through their detrimental impacts on labor supply and capital investments. Sound, evidence-based policy-making requires a deep understanding of the macroeconomic costs of NMHs and of their distribution across countries and diseases. The paper estimates and projects the macroeconomic burden of NMHs over the period 2020-2050 in 10 South American countries. We estimate the impact of NMHs on gross domestic product (GDP) through a human capital-augmented production function approach, accounting for mortality and morbidity effects of NMHs on labor supply, for the impact of treatment costs on physical capital accumulation, and for variations in human capital by age. Our central estimates suggest that the overall burden of NMHs in these countries amounts to $7.3 trillion (2022 international $, 3% discount rate, 95% confidence interval: $6.8-$7.8 trillion). Overall, the macroeconomic burden of NMHs is around 4% of total GDP over 2020-2050, with little variation across countries (from 3.2% in Peru to 4.5% in Brazil). In other words, without NMHs, annual GDP over 2020-2050 would be about 4% larger. In most countries, the largest macroeconomic burden is associated with cancers. Results from the paper point to a significant macroeconomic burden of NMHs in South America and provide a strong justification for investment in NMH prevention, early detection, treatment, and formal and informal care.


Retrospective Evaluation of Metformin and/or Metformin Plus a New Polysaccharide Complex in Treating Severe Hyperinsulinism and Insulin Resistance in Obese Children and Adolescents with Metabolic Syndrome.
Background: Pharmacological treatment of obesity and glucose-insulin metabolism disorders in children may be more difficult than in adults. Thus, we evaluate the effects of metformin in comparison with metformin plus a polysaccharide complex (Policaptil Gel Retard®, PGR) on body weight and metabolic parameters in obese children and adolescents with metabolic syndrome (MetS). Patients and methods: We retrospectively collected 129 children and adolescents (67 girls, 62 boys; median age 12.6 years) treated for a minimum of two years with metformin and low glycemic index (LGI) diet. Of these, 71 patients were treated with metformin plus PGR after at least 12 months of metformin alone. To minimize the confounding effect of the LGI on auxological and metabolic parameters, the patients were compared with age-, sex-, and BMI-matched control group with obesity and MetS (51 subjects; 24 males, 27 females) treated only with a LGI diet. Assessments included lipids, glucose and insulin (fasting and after oral glucose tolerance test) concentrations. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Matsuda, insulinogenic and disposition indices were calculated. Results: Metformin treatment led to a significant reduction in BMI SDS (p < 0.0001), with a significant difference in ΔBMI SDS between patients and controls (p < 0.0001). Moreover, metformin treated patients showed a reduction in HOMA-IR (p < 0.0001), HbA1c levels (p < 0.0001) and a significant increase in Matsuda index (p < 0.0001) in respect to the reduction discovered in controls (p < 0.05). Moreover, in contrast to the group treated with metformin alone and controls, patients treated with metformin plus PGR showed a further reduction in BMI SDS (p < 0.0001), HOMA-IR (p < 0.0001), HbA1c (p < 0.0001), total, HDL and LDL cholesterol (p < 0.0001), as well as an increase in Matsuda (p < 0.0001), disposition (p < 0.005) and insulinogenic (respectively, p < 0.05 and p < 0.0001) indices. Conclusions: Metformin appears to show short-term efficacy in reducing BMI, adiposity and glucose and insulin parameters in obese children and adolescents with MetS. However, PGR added to metformin may be useful to potentiate weight loss and to improve glucose-insulin metabolism and adiposity parameters in these patients.


The pathogenicity of enterococci.
In order to produce infection, enterococci must be able to colonize host tissues, resist the host's non-specific and immune defence mechanisms and produce pathological changes. With regard to colonization of host tissues, adherence assays have shown that enterococci can attach to intestinal and urinary tract epithelial cells and heart cells by means of adhesins expressed on the bacterial surface. The expression of these adhesins by enterococci has further been shown to be affected by bacterial growth conditions. In addition, the adherence of Enterococcus faecalis to renal tubular cells in vitro is enhanced if the organisms produce aggregation substance, a proteinaceous surface material that aggregates donor and recipient bacteria to facilitate plasmid transfer. Bacterial growth conditions also affect the interaction of enterococci with polymorphonuclear leucocytes (PMNLs), with serum-grown organisms showing less association with PMNLs than organisms grown in broth. Efficient killing of enterococci by PMNLs in vitro requires the presence of serum complement proteins and is enhanced by anti-enterococcal antibodies. Enterococci produce a number of factors that may be associated with pathological changes in the host. Both sex pheromones and plasmid-encoded pheromone inhibitors produced by E. faecalis are chemotactic for PMNLs in vitro, and may mediate, at least in part, the inflammatory response often associated with enterococcal infection. E. faecalis may also produce a plasmid-encoded haemolysin, which is associated with increased severity of infection. In addition, enterococci are capable of inducing platelet aggregation and tissue factor-dependent fibrin production, which may be relevant to the pathogenesis of enterococcal endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)


Benign lichenoid keratosis: a clinical and pathologic reappraisal of 1040 cases.
Benign lichenoid keratosis, otherwise known as lichen planus-like keratosis, is a common, cutaneous entity that is often confused with cutaneous malignancy. Few studies have examined the multiple clinical and pathologic guises of this entity, particularly within the context of clinical pathologic correlation or magnitude of this study. We examined the epidemiologic, clinical, and pathologic attributes of 1040 consecutive cases of benign lichenoid keratosis referred for pathologic examination at a busy laboratory over an entire year. Clinical parameters assessed included the age, anatomic location, gender, and multiplicity of the lesions. Pathologic attributes were assessed yielding discernment of five different subtypes that included a classic type, bullous type, atypical type with cytologically atypical lymphocytes, an early or interface type, and a late regressed or atrophic type. The results yielded an average age at presentation of 59.5 years with an age range of 36 to 87 years. The gender frequency was 76% female, 24% male. The trunk was the most common location (76%), followed by the extremities (33%) and head and neck (7%); 8% of patients presented with two lesions and less than 1% with three lesions prompting consideration of lichen planus. The classic, atypical, and bullous forms of the disease clinically presented with erythematous papule/plaque(s). The early or interface type showed erythematous to hyperpigmented brown macules and the regressed or atrophic type presented as violaceous papules or irregularly distributed macular pigmentation; 81% of the lesions showed the classic histology consisting of epidermal acanthosis with a band-like lichenoid lymphocytic infiltrate. Variable numbers of plasma cells, eosinophils, and neutrophils were identified as well as epidermal parakeratosis distinguishing these lesions from typical lichen planus. The bullous variant showed intraepidermal or subepidermal bullous cavities with a dense associated lymphocytic infiltrate and increased numbers of necrotic basilar layer keratinocytes. The atypical variant showed features of the classic type with scattered enlarged CD-3, CD-30 (+) lymphocytes possessing hyperchromatic, irregular nuclei. The early interface type showed single lymphocytes aligned along the dermoepidermal junction without epidermal acanthosis and adjacent lentigo. The regressed or atrophic variant showed epidermal atrophy with papillary dermal scarring, patchy lymphocytic infiltrates and melanin incontinence. The clinicopathologic spectrum of benign lichenoid keratosis is broad and encompasses several unrelated entities. An awareness of its expanded presentation is essential to avoid misdiagnosis and may serve as an important forerunner of pathogenic discernment.


Extrahippocampal Radiomics Analysis Can Potentially Identify Laterality in Patients With MRI-Negative Temporal Lobe Epilepsy.
Objective: The objective of the study was to investigate whether radiomics features of extrahippocampal regions differ between patients with epilepsy and healthy controls, and whether any differences can identify patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE). Methods: Data from 36 patients with hippocampal sclerosis (HS) and 50 healthy controls were used to construct a radiomics model. A total of 1,618 radiomics features from the affected hippocampal and extrahippocampal regions were compared with features from healthy controls and the unaffected side of patients. Using a stepwise selection method with a univariate t-test and elastic net penalization, significant predictors for identifying TLE were separately selected for the hippocampus (H+) and extrahippocampal region (H-). Each model was independently validated with an internal set of MRI-negative adult TLE patients (n = 22) and pediatric validation cohort with MRI-negative TLE (n = 20) from another tertiary center; diagnostic performance was calculated using area under the curve (AUC) of the receiver-operating-characteristic curve analysis. Results: Forty-eight significant H+ radiomic features and 99 significant H- radiomic features were selected from the affected side of patients and used to create a hippocampus model and an extrahippocampal model, respectively. Texture features were the most frequently selected feature. Training set showed slightly higher accuracy between hippocampal (AUC = 0.99) and extrahippocampal model (AUC = 0.97). In the internal validation and external validation sets, the extrahippocampal model (AUC = 0.80 and 0.92, respectively) showed higher diagnostic performance for identifying the affected side of patients than the hippocampus model (AUC = 0.67 and 0.69). Significance: Radiomics revealed extrahippocampal abnormality in the affected side of patients with TLE and could potentially help to identify MRI-negative TLE. Classification of Evidence: Class IV Criteria for Rating Diagnostic Accuracy Studies.