Longitudinal relationship between Personal and Social Performance (PSP) and anxiety symptoms in schizophrenia.
We aimed to examine the longitudinal relationship between the personal and social functioning and anxiety symptoms in patients with schizophrenia. For this purpose, we confirmed the validity of the anxiety subscale of the Symptom-Checklist-90-Revised (SCL-90-R) and then applied the latent growth modeling method for longitudinal causal relationships. Five hundred and seventy-eight patients diagnosed with schizophrenia were evaluated and 369 patients were included in the study at baseline. After conducting Rasch model analyses for the validation of the anxiety subscale in the SCL-90-R, we applied latent growth model to determine the causal relationship between the PSP and the anxiety symptoms. The validity of the anxiety subscale of the SCL-90-R was confirmed based on the Rasch rating model, where the criteria for Infit, Outfit, item difficulty, and point-measure correlations were satisfied. The results from the latent growth model showed that the intercept and slope (rate of change) of the PSP negatively predicted the slope of anxiety symptoms along the longitudinal trajectory. Together with previous studies examining the predictive role of anxiety symptoms on quality of life, our longitudinal findings lend evidence for bidirectional effects between quality of life and anxiety symptoms. The transactional nature of the relationship between anxiety symptoms and quality of life warrant further investigation using a longitudinal cross-lagged design. The anxiety subscale of the SCL-90-R may be utilized by clinicians and researcher to make inferences about quality of life in addition to assessing anxiety symptoms in patients with schizophrenia.


Portuguese Physical Literacy Assessment for adolescents (15-18 years): validation using confirmatory factor and composite analyses.
The aim of this study was to assess the construct validity and reliability of the Portuguese Physical Literacy Assessment (PPLA) instruments (a questionnaire and a tool using teacher-reported data). We also investigated the conceptual and practical implications of reflective vs. formative measurement of Physical Literacy using the PPLA. Multiple Confirmatory Factor Analysis (CFA) and Confirmatory Composite Analysis (CCA) models were used complementarily to assess construct validity in a sample of 521 grade 10-12 Portuguese students from Lisbon, Portugal. Bifactor model-based indices (ω), Explained Common Variance (ECV), and Percentage of Uncontaminated Correlations (PUC) were used to assess score reliability and adequacy. Using CFA, an asymmetrical bifactor model (S*1-1) provided the best fit to the data [Robust Comparative Fit Index = 97, Robust Root Mean Square Error Of Approximation = 0.05 (0.04-0.06), Standardized Root Mean Square Residual (SRMR) = 0.04], while CCA resulted in the best absolute fit for single first-order composite models (dG, dL, and SRMR below or borderline of their 95% critical value). Through a reflective paradigm, the total PL score should not be used in isolation (ECV = 0.49, ωH = 0.71, lower than recommended 0.80). Subscales for the Physical, Psychological, and Social domains attained acceptable reliability scores (ωs = 0.76, 0.82, 0.80, and 0.60). A general trait of PL accounts for considerable variance in all indicators. We advise calculation of a total summed PL score and domain scores, which should be interpreted conjointly in applied settings. Despite both paradigms being tenable, future research efforts should use a bifactor measurement model, which permits disentanglement of the variance attributed to the general PL trait and its domains. Overall, evidence supported the construct validity and reliability of the PPLA for its intended use as an integrated tool to measure PL as a multidimensional construct in 15- to 18-year-old Portuguese students in a physical education setting.


Familial pancreatic cancer: genetic advances.
Beset by poor prognosis, pancreatic ductal adenocarcinoma is classified as familial or sporadic. This review elaborates on the known genetic syndromes that underlie familial pancreatic cancer, where there are opportunities for genetic counseling and testing as well as clinical monitoring of at-risk patients. Such subsets of familial pancreatic cancer involve germline cationic trypsinogen or PRSS1 mutations (hereditary pancreatitis), BRCA2 mutations (usually in association with hereditary breast-ovarian cancer syndrome), CDKN2 mutations (familial atypical mole and multiple melanoma), or DNA repair gene mutations (e.g., ATM and PALB2, apart from those in BRCA2). However, the vast majority of familial pancreatic cancer cases have yet to have their genetic underpinnings elucidated, waiting in part for the results of deep sequencing efforts.


A new treatment strategy for airway obstruction induced by a giant benign goiter: A case report.
Severe respiratory distress induced by airway obstruction requires prompt attention for restoration of normal function in the airway passage. A large benign thyroid goiter that compresses the trachea is a rare occurrence. Emergency thyroidectomy with dyspnea can increase the chance of surgical complications in such cases. Here, a rare case of dyspnea induced by a large goiter is reported and a safe and effective therapeutic strategy for treatment was demonstrated. First, a self-expandable metal stent was placed to relieve airway obstruction. A week later, total thyroidectomy under general anesthesia was performed. After 3 months, the metal stent was surgically removed. The findings of the present case report demonstrated that life-threatening airway obstruction secondary to benign goiter could be effectively treated by placing an airway stent, followed by thyroidectomy.


The late effects of cranial irradiation in childhood on the hypothalamic-pituitary axis: a radiotherapist's perspective.
Brain tumours make up nearly one-third of paediatric malignancies. Over time, advancements in oncological treatments like radiotherapy have helped reduce normal-tissue toxicity when treating cancers in the brain. However, clinicians are still facing a trade-off between treatment efficacy and potential side effects. The aim of this review is to address the late effects of cranial irradiation on the neuroendocrine system and to identify factors that make patients more vulnerable to radiation-induced endocrine sequelae. Radiation damage to the hypothalamic-pituitary axis, which orchestrates hormone release, can lead to endocrinopathy; up to 48.8% of children who have undergone cranial irradiation develop a hormone deficiency. This may lead to further health complications that can appear up to decades after the last treatment, lowering the patients' quality of life and increasing long-term costs as lifelong hormone replacement therapy may be required. Growth hormone deficiency is the most common sequelae, followed by either thyroid or gonadotropic hormone deficiency. Adrenocorticotropic hormone deficiency tends to be the least common. Identified factors that increase the risk of late endocrine deficiency include total radiation dose, age at treatment, and time since last treatment. However, as there are various other factors that may potentiate the damage, a universal solution proven to be most effective in sparing the endocrine tissues is yet to be identified. Until then, accounting for the identified risk factors during treatment planning may in some cases help reduce the development of endocrine sequelae in childhood cancer survivors.


Hydrogenated Amorphous Silicon Germanium Active Layer for Top Cell of a Multi Junction Cell Structure.
Intrinsic hydrogenated amorphous silicon-germanium (a-SiGe:H) alloy is generally used in the bottom cell because of its low band gap. The a-SiGe:H has a higher photo conductivity in comparison to the a-Si:H; thus, it is expected that the a-SiGe:H can show better short circuit current density than that of the a-Si:H based solar cell. Therefore, we optimized a-SiGe:H active layer that can be a suitable choice for the front cell of a multi junction.solar cell. Furthermore, we carried out a comparative study of the solar cells that have a-SiGe:H and a-Si:H as respective active layers. The a-SiGe:H based solar cells show higher short circuit current density, while the a-Si:H based cells show higheropen circuit voltage. The current-voltage characteristics of these cells are as follows: (a) V(oc) = 770 mV, J(sc) = 15.0 mA/cm2, FF = 64.5%, and η = 7.47% for a-SiGe:H based cell; and (b) V(oc) = 826 mV, J(sc) = 13.63 mA/cm2, FF = 72.0%, and η = 8.1% for a-Si:H based cell.


THE GENETIC BASIS OF DIFFERENCES IN GROWTH AND BEHAVIOR OF SPECIALIST AND GENERALIST HERBIVORE SPECIES: SELECTION ON HYBRIDS OF HELIOTHIS VIRESCENS AND HELIOTHIS SUBFLEXA (LEPIDOPTERA).
Two species of moths and their hybrids were studied to determine the genetic basis of host range. One species, Heliothis virescens (HV), has a broad host range and is an agricultural pest on cotton (Malvaceae), soybean (Fabaceae), and tobacco (Solanaceae). The other species, Heliothis subflexa (HS), has a narrow host range, feeding on plants in the genus Physalis (Solanaceae). Experiments were done to determine whether the abilities to feed on cotton, soybean, and tobacco were each under separate genetic control in HV (genetically uncorrelated) or whether feeding on all three hosts was genetically correlated. By repeatedly backcrossing hybrids to HS while selecting for high larval survival and weight on soybean, loci conferring the ability to feed on soybean were moved from HV into the genetic background of the specialist, HS. After six generations of selection on soybean we tested the selected line on soybean, cotton, Physalis, and tobacco to determine if ability to feed on soybean was correlated with feeding ability on these other hosts. We found no evidence to support the hypothesis that feeding on all three hosts was correlated and controlled by a single locus. Compared to HS, the survival and weight of the selected line were significantly higher on soybean, similar on tobacco and Physalis, and slightly, but not significantly, higher on cotton. We also conducted a behavioral choice test to determine if larval preference for soybean was correlated with preference for other hosts. The selected line larvae had higher preference for soybean and cotton than HS. Preference for tobacco was equal in the selected line and in HS. These results support the trends seen in survival and growth tests where performances on soybean and cotton appeared partially correlated and performances on soybean and tobacco were uncorrelated. In conclusion, the generalist, HV, did not have a single set of loci that governed feeding on soybean, cotton and tobacco. It is likely that some of the loci governing performance and preference for soybean also contributed to performance and preference for cotton and that the soybean loci examined did not interact negatively to lower performance and preference for Physalis, the specialist's host. This approach can be applied more widely to address evolutionary questions about host range and other ecological traits.


MS-Net: Learning to assess the malignant status of a lung nodule by a radiologist and her peers.
Automatically assessing the malignant status of lung nodules based on CTscan images can help reduce the workload of radiologists while improving their diagnostic accuracy. Despite remarkable progress in the automatic diagnosis of pulmonary nodules by deep learning technologies, two significant problems remain outstanding. First, end-to-end deep learning solutions tend to neglect the empirical (semantic) features accumulated by radiologists and only rely on automatic features discovered by neural networks to provide the final diagnostic results, leading to questionable reliability, and interpretability. Second, inconsistent diagnosis between radiologists, a widely acknowledged phenomenon in clinical settings, is rarely examined and quantitatively explored by existing machine learning approaches. This paper solves these problems. We propose a novel deep neural network called MS-Net, which comprises two sequential modules: A feature derivation and initial diagnosis module (FDID), followed by a diagnosis refinement module (DR). Specifically, to take advantage of accumulated empirical features and discovered automatic features, the FDID model of MS-Net first derives a range of perceptible features and provides two initial diagnoses for lung nodules; then, these results are fed to the subsequent DR module to refine the diagnoses further. In addition, to fully consider the individual and panel diagnosis opinions, we propose a new loss function called collaborative loss, which can collaboratively optimize the individual and her peers' opinions to provide a more accurate diagnosis. We evaluate the performance of the proposed MS-Net on the Lung Image Database Consortium image collection (LIDC-IDRI). It achieves 92.4% of accuracy, 92.9% of sensitivity, and 92.0% of specificity when panel labels are the ground truth, which is superior to other state-of-the-art diagnosis models. As a byproduct, the MS-Net can automatically derive a range of semantic features of lung nodules, increasing the interpretability of the final diagnoses. The proposed MS-Net can provide an automatic and accurate diagnosis of lung nodules, meeting the need for a reliable computer-aided diagnosis system in clinical practice.


Singlet La and Lb Bands for N-Acenes (N = 2-7): A CASSCF/CASPT2 Study.
In this work CASPT2 calculations of polyacenes (from naphthalene to heptacene) were performed to find a methodology suitable for calculations of the absorption spectra, in particular of the La (B2u state) and Lb (B3u state) bands, of more extended systems. The effect of the extension of the active space and of freezing σ orbitals was investigated. The MCSCF excitation energy of the B2u state is not sensitive to the size of the active space used. However, the CASPT2 results depend strongly on the amount of σ orbitals frozen reflecting the ionic character of the B2u state. On the other hand, the excitation energies of the B3u state are much more sensitive to the size of the active space used in the calculations reflecting its multiconfigurational character. We found a good agreement with experimental data for both bands by including 14 electrons in 14 π orbitals in the active space followed by the CASPT2(14,14) perturbation scheme in which both σ and π orbitals are included.


Investigation of Monosodium Glutamate Alternatives for Content of Umami Substances and Their Enhancement Effects in Chicken Soup Compared to Monosodium Glutamate.
This research aimed to compare the effects of monosodium glutamate (MSG) and its alternatives on sensory characteristics of chicken soup. High-performance liquid chromatography analysis was carried out to quantify umami substances in potential MSG alternatives. Two mushroom extracts (CE and MC), one tomato extract (TC), and one yeast extract (YE) powders were selected due to their high equivalent umami concentration (EUC). These extracts together with MSG were then applied individually at four different levels (CE, MC, TC, MSG: 0.05%, 0.1%, 0.2%, 0.4%; YE: 0.0125%, 0.025%, 0.05%, 0.1%) in chicken soup in order to compare their impact on major sensory attributes using the degree of difference from control (DODC) test. Our results showed that all four extracts at all the usage levels exhibited an enhancement effect on the overall flavor, meaty flavor, saltiness, and umami taste. The extent of enhancement depended on the type of the alternative and its usage level. Higher levels of MSG alternatives (except YE) suppressed the chicken flavor. YE had similar enhancement effects as MSG on umami and salty tastes already at lower usage levels. At the lowest concentration, TC showed a stronger enhancement effect than MSG, but its effect on most attributes decreased as the usage dose increased. Compared to CE, the other mushroom extract MC resembled MSG at most levels. Overall, the closest synergistic effect in chicken soup was noted with 0.1% MSG, 0.1% MC, and 0.025% YE. PRACTICAL APPLICATION: This study compared the enhancement effects of MSG and selected alternatives in chicken soup. Results will help food manufacturers who would like to replace MSG with natural umami substances in soup products to enhance flavor and reduce sodium chloride.


Diffusion tensor imaging findings suggestive of white matter alterations in a canine model of mucopolysaccharidosis type I.
Purpose We investigated fractional anisotropy (FA) and radial diffusivity (RD) in a canine model of mucopolysaccharidosis (MPS). We hypothesized that canines affected with MPS would exhibit decreased FA and increased RD values when compared to unaffected canines, a trend that has been previously described in humans with white matter diseases. Methods Four unaffected canines and two canines with MPS were euthanized at 18 weeks of age. Their brains were imaged using high-resolution diffusion tensor imaging (DTI) on a 7T small-animal magnetic resonance imaging system. One hundred regions of interest (ROIs) were placed in each of four white matter regions: anterior and posterior regions of the internal capsule (AIC and PIC, respectively) and anterior and posterior regions of the centrum semiovale (ACS and PCS, respectively). For each specimen, average FA and RD values and associated 95% confidence intervals were calculated from 100 ROIs for each brain region. Results For each brain region, the FA values in MPS brains were consistently lower than in unaffected dogs, and the RD values in MPS dogs were consistently higher, supporting our hypothesis. The confidence intervals for affected and unaffected canines did not overlap in any brain region. Conclusion FA and RD values followed the predicted trend in canines affected with MPS, a trend that has been described in humans with lysosomal storage and dysmyelinating diseases. These findings suggest that the canine model parallels MPS in humans, and further indicates that quantitative DTI analysis of such animals may be suitable for future study of disease progression and therapeutic response in MPS.


Rosacea fulminans associated with pegylated interferon alpha-2B and ribavirin therapy.
Rosacea fulminans is characterized by the sudden onset of large, coalescing nodules and draining sinuses on the face. A few reports have linked medications to this condition, but none have described the onset of rosacea fulminans with pegylated interferon or ribavirin therapy. We report a patient who presented with rosacea fulminans after initiation of therapy for Hepatitis C.


Sequential therapy with sorafenib and sunitinib in renal cell carcinoma.
Sunitinib and sorafenib are small-molecule tyrosine kinase inhibitors (TKI) with antitumor activity in advanced renal cell carcinoma. A retrospective study was conducted to assess the response of renal cell carcinoma to sequential treatment with these two agents. Tumor response was evaluated by using Response Evaluation Criteria In Solid Tumors (RECIST) criteria in patients failing first-line therapy with either sunitinib or sorafenib and subsequently receiving second-line therapy with the other TKI agent. Twenty-nine patients received sorafenib followed by sunitinib (Group A), and 20 patients received sunitinib followed by sorafenib (Group B). TKI drugs were terminated in 6 (12%) patients in Group A and 4 (8%) in Group B because of toxicity. Median duration of stable disease for Groups A and B was 20 and 9.5 weeks, respectively. Median time from starting first TKI to disease progression after second TKI (time to progression) in Groups A and B was 78 and 37 weeks, respectively. Multivariate analysis revealed that Group B had a shorter time to progression than Group A (risk ratio [RR] 3.0; P=.016). Median overall survival was 102 and 45 weeks in Groups A and B, respectively (P=.061). The longer duration of disease control in patients who received sorafenib followed by sunitinib warrants further investigation.


The stringent response controls catalases in Pseudomonas aeruginosa and is required for hydrogen peroxide and antibiotic tolerance.
Pseudomonas aeruginosa, a human opportunistic pathogen, possesses a number of antioxidant defense enzymes under the control of multiple regulatory systems. We recently reported that inactivation of the P. aeruginosa stringent response (SR), a starvation stress response controlled by the alarmone (p)ppGpp, caused impaired antioxidant defenses and antibiotic tolerance. Since catalases are key antioxidant enzymes in P. aeruginosa, we compared the levels of H2O2 susceptibility and catalase activity in P. aeruginosa wild-type and ΔrelA ΔspoT (ΔSR) mutant cells. We found that the SR was required for optimal catalase activity and mediated H2O2 tolerance during both planktonic and biofilm growth. Upon amino acid starvation, induction of the SR upregulated catalase activity. Full expression of katA and katB also required the SR, and this regulation occurred through both RpoS-independent and RpoS-dependent mechanisms. Furthermore, overexpression of katA was sufficient to restore H2O2 tolerance and to partially rescue the antibiotic tolerance of ΔSR cells. All together, these results suggest that the SR regulates catalases and that this is an important mechanism in protecting nutrient-starved and biofilm bacteria from H2O2- and antibiotic-mediated killing.


Post Hoc Analyses of Anxiety Measures in Adult Patients With Generalized Anxiety Disorder Treated With Vilazodone.
To investigate vilazodone, currently approved for major depressive disorder in adults, for generalized anxiety disorder (GAD). Three randomized, double-blind, placebo-controlled studies showing positive results for vilazodone (2,040 mg/d) in adult patients with GAD (DSM-IV-TR) were pooled for analyses; data were collected from June 2012 to March 2014. Post hoc outcomes in the pooled intent-to-treat population (n = 1,462) included mean change from baseline to week 8 in Hamilton Anxiety Rating Scale (HARS) total score, psychic and somatic anxiety subscale scores, and individual item scores; HARS response (≥ 50% total score improvement) and remission (total score ≤ 7) at week 8; and category shifts, defined as HARS item score ≥ 2 at baseline (moderate to very severe symptoms) and score of 0 at week 8 (no symptoms). The least squares mean difference was statistically significant for vilazodone versus placebo in change from baseline to week 8 in HARS total score (-1.83, P < .0001) and in psychic anxiety (-1.21, P < .0001) and somatic anxiety (-0.63, P < .01) subscale scores; differences from placebo were significant on 11 of 14 HARS items (P < .05). Response rates were higher with vilazodone than placebo (48% vs 39%, P < .001), as were remission rates (27% vs 21%, P < .01). The percentage of patients who shifted to no symptoms was significant for vilazodone on several items: anxious mood, tension, intellectual, depressed mood, somatic-muscular, somatic-sensory, cardiovascular, respiratory, and autonomic symptoms (P < .05). Treatment with vilazodone versus placebo was effective in adult GAD patients, with significant differences between treatment groups found on both psychic and somatic HARS items. ClinicalTrials.gov identifiers: NCT01629966, NCT01766401, NCT01844115.


Bioactivation of N-hydroxy-2-acetylaminofluorenes by N,O-acyltransferase: substituent effects on covalent binding to DNA.
N-Acetoxyarylamines are reactive metabolites that lead to arylamine adduct formation with biological macromolecules. A series of 7-substituted-N-hydroxy-2-acetylaminofluorenes were converted to reactive N-acetoxyarylamines by enzymatic N,O-acyltransfer in the presence of DNA. The N-arylhydroxamic acid substrates that contained electronegative 7-substituents formed greater amounts of DNA adducts than either the unsubstituted compound (N-OH-AAF) or those analogs that contained electron-donating groups in the 7-position. Glutathione did not decrease the rates of DNA adduct formation, but other nucleophiles, such as potassium O-ethylxanthate, thiourea and N-acetylmethionine, inhibited adduct formation by the 7-Br-substituted compound (7-Br-N-OH-AAF) and the unsubstituted parent compound (N-OH-AAF). Nucleophiles, reducing agents (e.g. ascorbic acid) and spin-trapping agents had minimal effect on DNA adduct formation by the bioactivated form of 7-acetyl-2-(N-hydroxy-acetylamino)fluorene (7-Ac-N-OH-AAF). Triethylphosphite, an agent that reacts with aryl nitrenes, caused a concentration-dependent reduction in the amount of DNA adduct formed subsequent to bioactivation of 7-Ac-N-OH-AAF, but did not influence adduct formation when N-OH-AAF and 7-Br-N-OH-AAF were the substrates. The results indicate that a change in the reaction mechanism(s) responsible for DNA adduct formation occurred when the strongly electronegative acetyl group was incorporated into the 7-position of N-OH-AAF. It is proposed that a nitrene intermediate is involved in the formation of covalent adducts with DNA when 7-Ac-N-OH-AAF is activated by N,O-acyltransfer.


Characterization of Bacillus subtilis mutants temperature-sensitive in the synthesis of ribonucleic acid.
Two mutants of Bacillus subtilis temperature-sensitive in RNA synthesis were isolated. One mutation (rna-20) was demonstrated to be an allele of a previously identified gene (Riva et al., 1976). The other mutation (rna-16) identified a different gene and was mapped near aroI. The rna-16 mutation at the permissive temperature affected the spore outgrowth process. Purified RNA polymerase from rna-16 did not show any temperature sensitivity or structural defect.


Analysing the role of the PICU nurse to guide education of new graduate nurses.
One strategy to address the current nursing shortage in specialty areas has been to introduce graduate nurse programs. However introducing novice nurses to specialty areas raises concerns around education and competency which, in turn, highlights the need to identify and prioritise the elements of competent paediatric intensive care unit (PICU) nursing care considered essential to safe practice. To determine the key knowledge, skills and attributes of competent level PICU nurses. A practice analysis survey of 15 nurse educators was conducted in all eight Australian and New Zealand PICUs during 2008. Three areas of practice essential to PICU nursing competence were explored: patients most commonly cared for; frequency and criticality of activities performed; and level of independence against critical care nursing competency standards. Data were analysed using descriptive statistics. Cardiac and respiratory problems accounted for over 50% of patients cared for by competent level nurses. Cardiac and respiratory activities were therefore also ranked as the most important activities. Respondents identified that competency domains of teamwork and professional practice are performed with minimal supervision, whereas clinical problem solving requires supervision and assistance. PICU nurses are performing activities and caring for a breadth of complex patients within a year of entering the workforce. Using a practice analysis to define actual practice and expectations can assist in the identification and prioritisation of content for graduate and other educational programs.


Targeted temperature management in neurological intensive care unit.
Targeted temperature management (TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy (HIE). In addition, TTM is also useful for treatment of elevated intracranial pressure (ICP). HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit (ICU). The most common cause of HIE is cardiac arrest. Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest. Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies. Several methods of TTM have been reported in the literature. TTM can apply to various clinical conditions associated with hypoxic/ischemic brain injury and elevated ICP in Neurologic ICU.


Reduction of furfural to furfuryl alcohol by ethanologenic strains of bacteria and its effect on ethanol production from xylose.
The ethanologenic bacteria Escherichia coli strains KO11 and LYO1, and Klebsiella oxytoca strain P2, were investigated for their ability to metabolize furfural. Using high performance liquid chromatography and 13C-nuclear magnetic resonance spectroscopy, furfural was found to be completely biotransformed into furfuryl alcohol by each of the three strains with tryptone and yeast extract as sole carbon sources. This reduction appears to be constitutive with NAD(P)H acting as electron donor. Glucose was shown to be an effective source of reducing power. Succinate inhibited furfural reduction, indicating that flavins are unlikely participants in this process. Furfural at concentrations >10 mM decreased the rate of ethanol formation but did not affect the final yield. Insight into the biochemical nature of this furfural reduction process may help efforts to mitigate furfural toxicity during ethanol production by ethanologenic bacteria.


Second-hand smoke is an adjuvant for T helper-2 responses in a murine model of allergy.
Epidemiologic studies have suggested that "second-hand smoke" increases the incidence and severity of allergies and asthma. To address this, we developed a murine model that included generation of and exposure to environmental tobacco smoke (ETS) followed by aerosolized Ag challenge. We report herein that exposure of OVA-sensitized BALB/c mice to ETS elicits a rapid and prolonged exaggerated response with respect to IgE, IgG1, eosinophils, and Th2 cytokines (particularly IL-4 and IL-10). There was a significant increase (p = 0.0159) in the total cells of the bronchoalveolar lavage in OVA-sensitized mice exposed to ETS when compared with those in ambient air. This is the first experimental data to demonstrate that "second-hand smoke" up-regulates the allergic response to inhaled Ag. The results have important health implications for children and allergic individuals residing in households with smokers.


[Bleeding as a Leading Symptom in the Interdisciplinary Emergency Department].
Acute bleeding is a common and challenging condition in the emergency room. The need for staff and medical resources in these patients depends on the clinical status and extent of the bleeding. The causes of acute bleeding are heterogeneous. Patients may appear in an emergency department with gastrointestinal, traumatic, intracerebral, gynecological or urological bleeding. Bleeding may be triggered or aggravated by underlying diseases or the use of anticoagulants or antiplatelet therapy. The treatment can range from general measures to complex intensive care with antidotes, blood coagulation and transfusion management. Nevertheless, the initial management in such cases is often the same.The purpose of this article is to give an overview of the different types of acute bleeding in an emergency room and how to overcome these specific challenges. Important is the initial management with appropriate general measures to stabilize the patient to avoid serious complications. It is helpful to set up structured processes for these cases.


Rationally Designed Solution-Processible Conductive Carbon Additive Coating for Sulfide-based All-Solid-State Batteries.
Sulfide-based all-solid-state batteries (ASSBs) have emerged as promising candidates for next-generation energy storage systems owing to their superior safety and energy density. A conductive agent is necessarily added in the cathode composite of ASSBs to facilitate electron transport therein, but it causes the decomposition of the solid electrolyte and ultimately the shortening of lifetime. To resolve this dilemmatic situation, herein, we report a rationally designed solution-processible coating of zinc oxide (ZnO) onto vapor-grown carbon fiber as a conductive agent to reduce the contact between the carbon additive and the solid electrolyte and still maintain electron pathways to the active material. ASSBs with the carbon additive with an optimal coating of ZnO have markedly improved cycling performance and rate capability compared to those with the bare conductive agent, which can be attributed to hindering the decomposition of the solid electrolytes. The results highlight the usefulness of controlling the interparticle contacts in the composite cathodes in addressing the challenging interfacial degradation of sulfide-based ASSBs and improving their key electrochemical properties.


MITOCHONDRIAL DNA VARIATION IN THE FUNGUS ATKINSONELLA HYPOXYLON INFECTING SYMPATRIC DANTHONIA GRASSES.
The purpose of this study was to determine how host identity and geographic proximity were related to genetic variation in the fungus Atkinsonella hypoxylon infecting four sympatric Danthonia grasses. We analyzed 192 A. hypoxylon isolates from 48 geographic sites for mitochondrial DNA (mtDNA) variation by restriction digestion of total DNA with EcoRI, BamHI, and PstI, and subsequent hybridization with purified A. hypoxylon mtDNA. Thirtynine haplotypes were identified. UPGMA cluster analysis showed that mtDNA type is highly correlated with host-species group; isolates from Danthonia compressa and D. spicata formed one branch of the phenogram, and isolates from D. epilis and D. sericea formed the other. Restriction maps of the most common mtDNA haplotypes infecting each host-species pair revealed a 30-kb size difference and a minimum of eight length changes and one restrictionsite change between them. Mapping of the mutation differences among all haplotypes occurring at North Carolina sites resulted in two distinct gene trees corresponding to the two Danthonia species groups, corroborating the phenetic analysis. The results indicate a high degree of host-dependent isolation and establish the existence of host races in A. hypoxylon. Possible mechanisms responsible for this isolation are discussed. Little differentiation existed between isolates from within a Danthonia species pair, and some variation was explained by geographic origin. Analysis of progeny from a natural sexual cross revealed that mitochondria are maternally inherited in A. hypoxylon.


Acquired Acrodermatitis Enteropathica Syndrome in a Kidney Transplant Receipt: A Case Report.
Acrodermatitis enteropathica syndrome (AE) is a clinical entity that results in severe zinc deficiency. It can be genetic or acquired. Acquired AE has been reported in patients with chronic liver disease, malabsorption syndrome, sickle cell anemia, and chronic renal failure. We present a kidney transplant recipient with skin rash and watery diarrhea. The patient had low serum zinc levels, which quickly resolved after zinc supplementation. Skin biopsy showed cytoplasmic pallor and vacuolization and ballooning degeneration of keratinocytes within the superficial epidermis, which may have led to confluent necrosis of keratinocytes. Large amounts of keratinosome-derived lamellae were found in the intercellular spaces in the keratinized area, probably related to disturbance of keratinosome metabolism due to zinc deficiency.


[First isolation of S. zanzibar in Turkey].
Author reports first isolation of a Salmonella zanzibar serotype from the stool culture of an 8 year old boy with gastroenteritis in Ankara.


Volatile-Organic-Compound-Intercepting Solar Distillation Enabled by a Photothermal/Photocatalytic Nanofibrous Membrane with Dual-Scale Pores.
Solar distillation is emerging as a robust and energy-effective tool for water purification and freshwater production. However, many water sources contain harmful volatile organic compounds (VOCs), which can evaporate through the photothermal evaporators and be collected together with distilled water, or even be enriched in the distilled water. In view of the penetration of volatile organic compounds, herein, we rationally demonstrate a dual-scale porous, photothermal/photocatalytic, flexible membrane for intercepting volatile organic compounds during solar distillation, which is based on a mesoporous oxygen-vacancy-rich TiO2-x nanofibrous membrane (m-TiO2-x NFM). The dual-scale porous structure was constructed by micrometer-sized interconnected tortuous pores formed by the accumulation of m-TiO2-x nanofibers and nanometer-sized pores in the m-TiO2-x individual nanofibers. Consequently, the membrane can sustainably in situ intercept VOCs by providing more photocatalytic reactive sites for collision (mainly by mesopores) and longer tortuous channels for prolonging VOC retention (mainly by micrometer-sized pores); thus, it results in less than 5% of phenol residual in distilled water. As a proof of concept, when the m-TiO2-x NFM is employed to purify practical river water in an evaporation prototype under real solar irradiation, complex volatile natural organic contaminants can be effectively intercepted and the produced distilled water meets the drinking water standards of China. This development will promote the application prospects of solar distillation.


Pubertal Maturation and Trajectories of Depression During Early Adolescence.
Beginning at puberty, prevalence of depression in females rises dramatically. The physical changes of puberty coincide with a period of social flux, during which relationships become less stable and more prone to conflict. While this social upheaval is normatively distressing for girls, it may be especially so for girls with cognitive styles that leave them more susceptible to depression. The present study investigated depressive symptoms at two time points during early pubertal maturation. N = 110 girls (M age = 11.57, SD = 0.98) reported on depressive symptomology, pubertal maturation, ruminative coping style, frequency of peer conflict, and rejection sensitivity. Multivariate analyses suggest more advanced pubertal development and greater rejection sensitivity at Time 1 predicted higher levels of depressive symptoms at Time 2, after accounting for baseline levels of depressive symptoms and all other social and cognitive correlates of depression. This effect was also found in early maturing girls. Menarche status was not significant. Since menarche occurs toward the end of puberty, results suggest that risk for worsening depression is not associated with completing puberty, or with menstruation itself. Rather, increases in depressive symptoms seem to be associated with physical changes that emerge early in the pubertal transition, especially for early maturing girls, paired with anticipatory concerns about social rejection.


Comparative assessment of the inhibition of recombinant human CYP19 (aromatase) by azoles used in agriculture and as drugs for humans.
Azoles (imidazoles and triazoles) are used as antifungal agents in agriculture and in medicine, and also for antiestrogen therapy, e.g., for breast cancer treatment. Antifungal activity is based on inhibition of fungal CYP51 (lanosterol 14alpha-demethylase), and estrogen biosynthesis reduction is due to azole inhibition of CYP19 (aromatase). Inhibition of aromatase by antifungal agents is usually an unwanted side effect and may cause endocrine disruption. A fluorimetric assay based on human recombinant CYP19 enzyme with dibenzylfluorescein as a substrate was used to compare the inhibitory potency of 22 azole compounds. Dose responses were established and duplicate datasets were analyzed with a nonlinear mixed-effects model with cumulative normal distribution for the logarithm of concentration. IC50 values (50% inhibitory concentration) of 13 fungicides used in agriculture ranged more than 700-fold, starting from 0.047 microM. The potency of seven human drugs spanned more than 7000-fold, starting from 0.019 microM. Most potent fungicides included prochloraz, flusilazole, and imazalil, and most potent medicinal antifungals were bifonazole, miconazole, and clotrimazole. These in vitro data indicate that the top-ranking azoles used as antifungal agents or drugs are as potent inhibitors of aromatase as are antiestrogen therapeutics used to treat breast cancer. These putative effects of azole agents and drugs on steroid biosynthesis and sex hormone balance should be considered when used in human subjects and also in wildlife exposed to azole fungicides used in agriculture.


Protection against streptococcal cell wall-induced arthritis by pretreatment with the 65-kD mycobacterial heat shock protein.
We report that streptococcal cell wall (SCW)-induced arthritis in rats, a T cell-dependent chronic, erosive polyarthritis, can be prevented by pretreatment of the rats with the mycobacterial 65-kD heat shock protein. This 65-kD protein shows extensive amino acid homology with prokaryotic and eukaryotic 65-kD heat shock proteins and is a ubiquitous bacterial common antigen. Both the clinical and histopathologic manifestations of the arthritis were prevented completely when rats were pretreated with 50 micrograms of 65-kD protein intraperitoneally at 35, 25, 15, or 5 d before administration of SCW. In such protected rats, SCW-specific T cell responses were suppressed, as compared with responses in arthritic rats. Pretreatment with 65-kD protein had no effect on the production of antibodies against SCW, on a nonspecific inflammatory reaction (zymosan-induced arthritis), or on general cellular immunity in vivo (delayed type hypersensitivity reaction to a nonrelated protein antigen). Furthermore, the protection against SCW arthritis was transferable by splenic T cells to naive recipients. Our data show that pretreatment with the 65-kD mycobacterial heat shock protein protects rats against a subsequent bacterium-induced arthritis. This protection is immunologically specific and resides in the lymphoid cell population.


[Temporal and structural differences in the care of obese and non-obese people in nursing homes].
Obesity is a common disease in Germany. Although care facilities are confronted with an increasing number of obese people, the care of them in nursing homes is barely investigated. The present study examines the amount of work using the example of the activity of dressing obese and non-obese nursing home residents and discloses with its temporal and structural differences. In five nursing homes in Berlin a fully structured observational study based on a convenience sample was conducted. 48 nurses were observed while performing the activity of dressing 70 residents aged 65 years and older. The residents' demographic data and medical diagnoses were taken from the nursing records. Information about the functional/cognitive status and pain events were collected by using the interRAI Contact Assessment. Further data regarding the nurses were obtained through face-to-face interviews. The results show a significant correlation between Body Mass Index and the required time of dressing. No correlations exist between age, qualifications and nurses' level of education and the time of dressing. Structural differences in the care of obese and non-obese residents appear by changes of, single activity sequences. The care of the obese residents is associated with increased time requirements and structurally differs from the care of the non-obese residents. This should lead to further research because it has implications for staffing in nursing homes.


Two different glycosyltransferase defects that result in GalNAc alpha-O-peptide (Tn) expression.
This study shows for the first time that different glycosyltransferase defects in the biosynthesis of O-linked oligosaccharides give rise to the same GalNAc alpha-O-Ser/Thr determinant on Tn erythrocytes and colorectal carcinoma cells. The O-linked oligosaccharides isolated from the glycophorins of Tn erythrocytes contained predominantly alpha-N-acetylgalactosamine-O-Ser/Thr (Tn antigen) and sialyl-Tn. A marked reduction in normal sialylated oligosaccharides was also observed. Monoclonal antibody BRIC 111 raised against Tn erythrocytes reacted with both Tn erythrocytes and colorectal carcinoma tissues. Weak staining was detected in the supranuclear area and at the surface membranes in normal colorectal cells, but was absent from goblet cell vesicles. An increase in supranuclear staining over controls was found in tumour tissue and in the majority of resection margin specimens. The highest levels of staining were present in transitional mucosa, adjacent to the tumours where goblet vesicles were also positive. Glycosylation defects in the same patients were further studied by determination of the activity of glycosyltransferases in mucosal tissue from control and cancer patients. The reduction in or loss of beta 1-3 N-acetylglucosaminyl transferase activity to GalNAc-peptide in asialo-ovine submaxillary gland glycoprotein was detected by direct assay and by isolation of the oligosaccharides from the incubation products. No differences in N-acetylglucosaminyl-, galactosyl- or sialyl-transfer to Gal beta 1-3GalNAc in antifreeze glycoprotein or in sialyl transferase to asialo-ovine submaxillary gland glycoprotein were detected. Our study shows that the GalNAc alpha-O-Ser/Thr determinant on Tn erythrocytes and in colorectal carcinoma results from different glycosyltransferase defects in separate biosynthetic pathways for haematopoietic and epithelial tissues.


Mothers of children in ABIS, a population-based screening for prediabetes, experience few ethical conflicts and have a positive attitude.
Screening is supposed to create less anxiety among first-degree relatives of diabetic patients where the risk of developing diabetes already is well known. It has also been argued that screening of a general child population should never be performed unless identified high-risk individuals can be offered intervention to prevent diabetes. However, the empirical data are scarce, especially regarding what opinions patients or their parents have of these matters/issues themselves. We have therefore tried to evaluate mothers' attitudes to and ethical views on participation in a research screening for prediabetes in an unselected birth cohort. All 21,700 mothers of children in southeast Sweden born between 1 October 1997 and 1 October 1999 were asked to participate in ABIS (All Babies in Southeast Sweden). They were given information about the design of the study and that HLA types and autoantibodies will be determined in order to predict diabetes, but that no prevention of diabetes will be offered unless future studies show effective methods. After informed consent, 78.6% of mothers let their babies participate (17,055 children) despite a quite laborious study protocol. Explorative in-depth semistructured interviews were performed in 21 mothers, of whom 15 were strategically selected to get as many various attitudes as possible and of whom 6 chose not to participate in ABIS. All interviewed mothers were positive to the ABIS project. We conclude that a well-designed screening program to detect individuals in the general population with high risk of developing diabetes does not evoke anxiety nor severe ethical conflicts.


The clinical impact of serrated colorectal polyps.
Serrated polyps (SPs) of the colorectum pose a novel challenge to practicing gastroenterologists. Previously thought benign and unimportant, there is now compelling evidence that SPs are responsible for a significant percentage of incident colorectal cancer worldwide. In contrast to conventional adenomas, which tend to be slow growing and polypoid, SPs have unique features that undermine current screening and surveillance practices. For example, sessile serrated polyps (SSPs) are flat, predominately right-sided, and thought to have the potential for rapid growth. Moreover, SSPs are subject to wide variations in endoscopic detection and pathologic interpretation. Unfortunately, little is known about the natural history of SPs, and current guidelines are based largely on expert opinion. In this review, we outline the current taxonomy, epidemiology, and management of SPs with an emphasis on the clinical and public health impact of these lesions.


Acute esophageal necrosis caused by alcohol abuse.
Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.


Influence of intense THz radiation on spin state of photoswitchable compound Cu(hfac)2L(Pr).
The family of magnetoactive compounds Cu(hfac)(2)L(R) exhibits thermo- and photoswitching phenomena promising for various applications. Photoswitching of the Cu(hfac)(2)L(Pr) compound can be observed at temperatures below 20 K and is accompanied by transition to metastable structural state. Reverse conversion to stable structure could not be induced by light of near-IR-vis-UV regions up to date. The far-IR spectra of metastable and stable structural states are different and show characteristic absorption lines in the range of 170-240 cm(-1). These frequencies are accessible by NovoFEL - high-power THz free-electron laser user facility in Novosibirsk. We investigate selective influence of THz radiation on relaxation processes from metastable to stable structural state, which can be monitored by electron paramagnetic resonance (EPR). For this purpose, the experimental station based on X-band EPR spectrometer has been constructed by the THz beamline of NovoFEL and equipped with multimodal THz waveguide allowing to fed radiation directly into the EPR resonator. It has been found that irradiation of studied compound with high-power THz light causes significant but nondestructive increase of its temperature. Apart from this effect, no resonant influence of THz irradiation on relaxation processes has been observed. The experimental results have been rationalized taking into account vibrational relaxation times of the studied compound. Further experiments based on pulse heating by THz radiation have been proposed.


Parental Grief After Offspring Suicide and Adaptation to the Loss in Japan.
Several reports have indicated that grief and mental health outcomes of people bereaved by suicide vary by their relationship to the deceased. Parents who have lost offspring experience higher levels of distress than those with other relationships to the deceased. However, there are limited studies investigating the experience of parental bereavement by suicide, and further research is needed. The present study aimed to clarify the differences in grief reactions between bereaved parents and those with other relationships to the deceased in Japan and explore a statistical model of adaptation to the loss. In total, 105 bereaved participants completed a questionnaire covering grief reaction, meaning reconstruction, mental health, social context, and demographic variables. Parents scored higher on several grief reaction items and lower in sense-making than those with other relationships. In addition, path analysis showed that sense-making acted as a moderator in the experience of loss of offspring and grief reaction.


[Micropapillary urothelial carcinoma of the bladder: case report and review of the literature].
Micropapillary urothelial carcinoma (MCP) of the urinary bladder is an rare anatomopathology variant of aggressive behaviour. It is usually found as a high grade and stage carcinoma, and doesn't differ clinically from normal cell carcinoma of the bladder. Treatment should be early and aggressive, because radiotherapy and chemotherapy have shown limited results the therapy is surgically based. The diagnosis of this disease is required because its metastasic capacity is associate with a significantly increased mortality risk. In this study we report the case of a 64 years old man with a long development hematuria diagnosed of Micropapillary carcinoma infiltrating the bladder involving the ureter.


Use of tissue culture to examine neurotoxicity of contrast media.
The effect of small concentrations of diatrizoate, ioglycamate, and iopanoate salts on cultured sympathetic ganglia was studied. Biliary contrast media in clinical blood concentrations caused severe degeneration of cultured neurons, but similar concentrations of diatrizoate caused no effect. This technique may be used to measure the direct neurotoxicity or general cytotoxicity of contrast media.


THE BIOGEOGRAPHIC EVIDENCE SUPPORTING THE PLEISTOCENE FOREST REFUGE HYPOTHESIS.
The prevailing explanation for the observed distributional patterns and areas of endemism of tropical forest organisms is the Pleistocene refuge hypothesis, which proposes that wide-ranging ancestral taxa were isolated into forest refuges during certain glacial periods, and that this isolation provided them with the opportunity to speciate. John Endler has recently argued that two predictions of the refuge hypothesis-that contact zones between vicars should be between refuges and that contact zones of rapidly reproducing butterflies should be wider than those of more slowly reproducing birds-are not borne out by the evidence. Endler therefore rejects the refuge hypothesis. We show that the data available are far too imprecise to permit any conclusions regarding contact zone widths and that, according to our reanalysis of the African bird data used by Endler, all the contact zones between vicars do indeed occur between refuges, exactly where they are expected. Additional strong support for the refuge hypothesis comes from the existence of many taxa endemic to the particular forest areas which have been postulated as refuges and from fragmented taxa which are still allopatric, never having come into secondary contact.


Preparedness of Frontline Doctors in Jordan Healthcare Facilities to COVID-19 Outbreak.
The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors' readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported score of preparedness to deal with COVID-19 patients was 4.9 ± 2.4. Doctors having institutional protocols for dealing with COVID-19 cases and those with sustained availability of PPE reported higher scores of preparedness (5.5 ± 2.3 and 6.2 ± 2.1 with p < 0.001, respectively). Correlations with knowledge score, adherence to PPE score, and psychological impacts were investigated. The study revealed multiple challenges and insufficiencies that can affect frontline doctors' preparedness. Policy makers are urged to take these findings into consideration and to act promptly.


Change in coronary artery calcification score due to cinacalcet hydrochloride administration.
We examined the influence of cinacalcet on vascular calcification by measuring the coronary artery calcification score (CACS) in hemodialysis patients who received cinacalcet. The cinacalcet treatment group consisted of eight hemodialysis patients with secondary hyperparathyroidism who received cinacalcet for 7-14 months. The mean CACS change in the treatment group was -0.094/year, showing a decreasing tendency, while that in the control group showed an increasing tendency of 0.034/year. The mean CACS change showed a tendency for improvement in the treatment group, but no significant difference from that in the control group was observed as the number of cases was small (P = 0.102). The results of this study suggest that cinacalcet is effective in preventing the progress of extraosseous calcification.


The role of Doppler indices in predicting intra ventricular hemorrhage and perinatal mortality in fetal growth restriction.
The aim of this study is to determine whether Doppler indices predict intra-ventricular hemorrhage and perinatal mortality in fetal growth restricted pregnancies (FGR). In this cohort study, 43 FGR fetuses underwent multi-vessel Doppler ultrasounds weekly or twice weekly after admission. Blood gases of the umbilical cord were analyzed immediately after delivery. Ultrasonography of the neonatal brain was performed after birth. Intra ventricular hemorrhage (IVH) and perinatal mortality were studied as outcomes. The median gestational age at the diagnosis of fetal growth restriction was 31 weeks, and the median age at delivery was 33.4 weeks. Seven cases had IVH. The chance of IVH was about five times greater in cases of absent/reversed umbilical diastolic flow (AREDF). The predicting factors for IVH were gestational age at delivery, birth weight, and acidosis. Nine neonates died in the neonatal period. AREDF, the Resistance Index of middle cranial artery (MCA/RI) and umbilical artery (UA), and absent/reversed "a" waves in ductus venosus (DV) were the Doppler indices predicting perinatal mortality. The other prognostic factors for perinatal mortality were gestational age at diagnosis and delivery, final amniotic fluid, Apgar score, and acidosis. Doppler indices, such as AREDF, can be predictors of IVH or perinatal death, and an absent or reversed "a" wave in the ductus venosus and the hypoxic index can be significant predictors of death in fetuses with fetal growth restriction. However, other important factors for IVH were gestational age at delivery and birth weight. The most important factors predicting perinatal mortality were gestational age, birth weight, acidosis, low AF, and low Apgar score.


[Pharmacokinetic characteristics of tetramethylpyrazine and study on hemorheology in rat model of spleen deficiency syndrome].
In this experiment, the essence of Spleen Deficiency Syndrome (SDS) was explored with the rat model of SDS using tetramethylpyrazine (TMP). 120 Wistar rats were divided into two groups, 60 each for control and test group, they were treated with normal saline and reserpine respectively. The hemorheological parameters were also studied in 6 each of both groups. The pharmacokinetic properties were investigated in the remaining control group and test group. (1) Two-compartment open model of the control group was turned into that of one-compartment in test group; (2) The SDS model significantly affected the absorption and distribution of TMP in rats. AUC was much higher and serum concentration of TMP increased significantly than that of control. Hemorheological parameters (viscosity of whole blood, fibrinogen, etc.) increased significantly (P < 0.05-0.01), it demonstrated that the SDS model was in a state of Blood Stasis. It might be one of the pharmacokinetic mechanisms of TMP in the SDS model of rats.


Is There a Role for Self-Referral in Pediatric Weight Management?
Background: A physician or health care provider (HCP) referral is usually needed for children to access multidisciplinary health services for obesity management; however, offering families the option to self-refer can enhance equity and access to care. Methods: We completed a retrospective medical record review to explore patient characteristics and program engagement of children with obesity who were self- (n = 18) or HCP-referred (n = 120) for obesity management. Results: Our descriptive data suggested that children who were self-referred presented with a healthier clinical profile and missed fewer appointments than their peers referred by HCPs. Conclusions: Prospective research is needed to examine whether health services and treatment outcomes differ between self- and HCP-referred children in obesity management.


Binary Eluent Based Vortex-Assisted Matrix Solid-Phase Dispersion for the Extraction and Determination of Multicomponent from Musk by Gas Chromatography-Mass Spectrometry.
A green, flexible, and effective strategy was proposed to quantify four target compounds (muscone, ethyl palmitate, ethyl oleate, and ethylparaben) from musk by binary eluent based vortex-assisted matrix solid-phase dispersion (MSPD) extraction coupled with GC/MS. Single-factor tests and orthogonal design were employed to optimize the MSPD parameters. In addition, the binary eluent system, methanol, and ethyl acetate 3 : 7 (v/v) were used to extract the target analytes. Finally, C 18 was applied as the easily available dispersant and the sample powder was ground for 2 min. Thereafter, the mixture was rapidly extracted with the binary eluents under whirling for 3 min. Eventually, the analysis of the samples was completed within 12 min by GC/MS. All correlation coefficients (r) of four targets were more than 0.9991. The recoveries of all target compounds ranged from 92.8% to 101% while their RSDs were less than 6.94%. There was no significant matrix interference for the analysis. Thus, the combination of vortex-assisted MSPD with GC/MS was considered as a novel, rapid, and environmentally friendly quantitative approach for musk samples.


Noninvasive measurement of steroid hormones in zebrafish holding-water.
Zebrafish (Danio rerio) has recently emerged as a new animal model in neuroendocrinology and behavior (e.g., stress physiology and ecotoxicology studies). In these areas, the concentrations of steroid hormones in the blood are often used to study the endocrinological status of individuals. However, due to the small body size of zebrafish, blood sampling is difficult to perform and the amount of plasma obtained per sample for assaying hormones is very small (ca. 1-5 μL), and therefore most studies have been using whole-body hormone concentrations, which implies sacrificing the individuals and hampers sequential sampling of the same individual. Here a noninvasive method to assay steroid hormones from zebrafish holding-water, based on the fact that steroids are released into the fish holding-water through the gills by passive diffusion, is validated. Cortisol and the androgen 11-ketotestosterone (KT) were measured in water samples and compared to plasma levels in the same individuals. Cortisol released to holding-water correlates positively with plasma concentrations, but there was a lack of correlation between KT water and circulating levels. However, KT levels showed a highly significant sex difference that can be used to noninvasively sex individuals. An ACTH challenge test demonstrated that an induced increase in circulating cortisol concentration can be reliably detected in holding-water levels, hence attesting the responsiveness of holding-water levels to fluctuations in circulating levels.


Evaluation of the effect of Heterorhabditis bacteriophora (HP88) on Stomoxys calcitrans (Linnaeus, 1758) larvae (Diptera: Muscidae) in sugarcane bagasse ash.
The purpose of this study was to evaluate the effect of the EPN Heterorhabditis bacteriophora HP88 on Stmoxys. calcitrans larvae in sugarcane bagasse ash. Groups of 10 stable fly larvae were placed in Petri dishes containing filter paper and bagasse ash. Concentrations of 50, 150 and 250 EPNs/larva of S. calcitrans in four milliliters of distilled water were added to each plate. In the control group contained only distilled water, without EPNs. The bioassay had three replications and was maintained at 27 ± 1°C and 70-80% relative humidity. It was observed that mortality rate in all treated groups was significantly higher than in the control group (26,6%). The mortality rate in the presence of 50 EPNs/larva (46,6%) was lower than in 150 EPNs/larva (76,3%), which in turn was lower than 250 EPNs/larva group (93,3%). It was verified by analysis of variance and regression that there was a linear pattern of mortality, that is, the higher the EPNs/larva concentration, the higher the larval mortality. It was concluded that EPN H. bacteriophora HP88 was capable of infecting and causing mortality of stable fly larvae in sugarcane bagasse ash.


Analisys of the therapeutic factors in the Therapeutic Community Podsused among the war related diagnosis and the others.
Therapeutic community/TC/ is a sociotherapeutic method that uses sociotherapeutic and psychotherapeutic techniques for various mental disorders. In Croatia, during and after the war many war veterans have been in treatment through TC and many of them still participate in it. Majority of them were diagnosed with PTSD diagnosis, but some of them also had other diagnosis, e.g. depression, paranoid delusion, etc. In this paper we describe principles of TC that we use in Croatia and we also try to find out which curative factors of TC are the most important for this population. We applied semistructured intervju based on Yalom book of practice and theory of psychotherapy to explore what factors do war veterans find the most important and relevant for their resilience and better coping with everyday issues.


Long-term mortality after pulmonary artery denervation stratified by baseline functional class in patients with pulmonary arterial hypertension: Long-term mortality after PADN stratified by functional class.
This study aimed to assess the long-term effects of pulmonary artery denervation (PADN) on mortality in patients with pulmonary arterial hypertension (PAH). Between March 2012 and March 2018, a total of 120 patients with PAH, who underwent PADN treatment and were prospectively followed up, were analysed. Patients were classified into World Health Organization (WHO) Functional Class I and II (FC 1-2; n=46) and Functional Class III and IV (FC 3-4; n=74) according to their FC prior to PADN. The primary endpoint was lung transplantation-free mortality until March 2021. The secondary endpoint was a change in the six-minute walk distance (6MWD). During the median of 4.8 years of follow-up, 23 (19.2%) patients died, predominantly from the FC 3-4 group (25.7%), compared to 8.7% in the FC 1-2 group (p=0.034). The mortality rate at one year (2.2% vs 12.2%, p=0.087) and three years (6.5% vs 17.6%, p=0.102) was numerically low in the FC 1-2 group versus the FC 3-4 group, respectively. The median net increase of 6MWD was +29 m in the FC 1-2 group, compared to +60.5 m in the FC 3-4 group (p=0.037). PADN results in significant improvements in survival at long-term follow-up, especially in patients with PAH in FC 3-4. This study was the continuation of the PADN-1 study which was registered at URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.


Identification and characterization of dppA, an Escherichia coli gene encoding a periplasmic dipeptide transport protein.
We describe the isolation and analysis of an Escherichia coli gene, dppA, and its role in dipeptide transport. dppA maps near min 79 and encodes a protein (DppA) that has regions of amino acid similarity with a peptide-binding protein from Salmonella typhimurium (OppA). Like OppA, DppA is found in the periplasmic space and thus is most likely a dipeptide-binding protein. Insertional inactivation of dppA results in the inability of a proline auxotroph to utilize Pro-Gly as a proline source. dppA-dependent Pro-Gly utilization does not require any of the three major proline transport systems, demonstrating that DppA is not simply a dipeptidase. An in vivo competition assay was used to show that DppA is probably involved in the transport of dipeptides other than Pro-Gly. Transcription of dppA is repressed by the presence of casamino acids, suggesting that the cell alters its dipeptide transport capabilities in response to an environmental signal.


Challenges in rehabilitation and continuum of care provision after knee replacement: a mixed-methods study from a low- and middle-income country.
Continuum-of-care is crucial following knee replacement. This is an understudied area in the context of low- and middle-income countries. We report findings of a mixed-methods study conducted to understand patient's postoperative experiences in following unsupervised home-based physiotherapy protocols and healthcare provider's experiences in providing rehabilitation care. Consecutive adults (n = 79) scheduled or had undergone knee replacement, attending an urban tertiary care hospital in India completed a 22-item questionnaire to gauge attitude towards physical rehabilitation. We conducted in-depth interviews with nine patients, ten physiotherapists, and three surgeons using a phenomenology approach. Data were interpreted using the capability, opportunity, and motivation-behaviour (COM-B) framework. Patients were motivated to do exercises and valued family support during the recovery period. However, they desired physiotherapy support, especially during the early recovery period due to post-operative pain. Healthcare providers reported poor adherence with the exercise regimen and desired a mechanism to monitor patient progress after discharge. Patients and health care providers identified accessibility to rehabilitation centre as a major barrier in availing affordable and reliable physiotherapy services. There is a need for a continuum of care to improve patient experience during recovery and for health care providers to monitor progress and provide personalised progressive exercise therapy.


Fondaparinux for prevention of venous thromboembolism in major orthopedic surgery.
To review clinical information related to fondaparinux, a synthetic pentasaccharide recently approved for the prevention of deep-vein thrombosis (DVT) in patients undergoing major orthopedic surgeries and for extended DVT prophylaxis after hip fracture surgery. Primary and review articles were identified by MEDLINE (1983-June 2003) using the key words pentasaccharide, Org31540, SR90107A, DVT prophylaxis, and fondaparinux. Additional sources were found listed in articles, abstracts, and unpublished data on file from the manufacturer. Articles selected were based on their coverage of the pharmacology, pharmacokinetics, safety, and efficacy of fondaparinux. All of the articles identified were evaluated and all information deemed relevant was included. Fondaparinux is a selective antithrombin-dependent, indirect inhibitor of activated factor Xa. It has a favorable and predictable pharmacokinetic profile when administered subcutaneously, and has a long half-life, allowing once-daily dosing. Fondaparinux lacks in vitro cross-reactivity with heparin-induced antibodies. Major Phase III studies have demonstrated that subcutaneous fondaparinux sodium 2.5 mg given at least 6 hours postoperatively resulted in a 55% reduction in the risk of venous thromboembolism (VTE) in patients undergoing hip fracture surgery, total hip replacement surgery, or knee replacement surgery compared with standard enoxaparin therapy. It has a safety profile similar to that of enoxaparin with respect to clinically relevant major bleeding, including fatal bleeding, nonfatal bleeding, and bleeding requiring repeat surgery. The use of fondaparinux for prolonged prophylaxis after hip fracture has demonstrated further reduction in VTE events without increasing the risk of bleeding. Fondaparinux is the first of a new class of synthetic factor Xa inhibitors that demonstrated greater efficacy compared with enoxaparin for the prevention of VTE in major orthopedic surgery without an increase in clinically relevant bleeding. Given the favorable cost-effectiveness analysis and improved efficacy profile, fondaparinux should be considered for formulary addition for DVT prophylaxis in patients undergoing hip and knee replacement surgery. In patients undergoing hip fracture surgery, fondaparinux should be considered the DVT prophylaxis of choice. Extended thromboprophylaxis up to 28 days resulted in additional reduction in VTE (both symptomatic and venography-proven DVT) in patients with hip fracture surgery.


Align or not to align? Resolving species complexes within the Caloplaca saxicola group as a case study.
The Caloplaca saxicola group is the main group of saxicolous, lobed-effigurate species within genus Caloplaca (Teloschistaceae, lichen-forming Ascomycota). A recent monographic revision by the first author detected a wide range of morphological variation. To confront the phenotypically based circumscription of these taxa and to resolve their relationships morphological and ITS rDNA data were obtained for 56 individuals representing eight Caloplaca species belonging to the C. saxicola group. We tested the monophyly of these eight morphospecies by performing maximum parsimony, maximum likelihood and two different types of Bayesian analyses (with and without a priori alignments). Restricting phylogenetic analyses to unambiguously aligned portions of ITS was sufficient to resolve, with high bootstrap support, five of the eight previously recognized species within the C. saxicola group. However, phylogenetic resolution of all or most of the eight species currently included as two distinct subgroups within the C. saxicola group was possible only by combining morphological characters and signal from ambiguously aligned regions with the unambiguously aligned ITS sites or when the entire ITS1 and 2 regions were not aligned a priori and included as an integral component of a Bayesian analysis (BAli-Phy). The C. arnoldii subgroup includes C. arnoldii, comprising four subspecies, and the C. saxicola subgroup encompasses seven species. Contrary to the C. saxicola subgroup, monophyly of taxa included within the C. arnoldii subgroup and their relationships could not be resolved with combined ITS and morphological data. Unequivocal morphological synapomorphies for all species except C. arnoldii and C. pusilla are recognized and presented.


Hydrolysis of atrial and brain natriuretic peptides by the human astrocytoma clone D384 and the neuroblastoma line SH-SY5Y.
The content of membrane peptidases has been compared in the human astrocytoma clone D384 and the human neuroblastoma line SH-SY5Y. Endopeptidase-24.11 (neutral endopeptidase, EC 184.108.40.206) was detectable only on the astrocytoma cells whereas angiotensin-converting enzyme (EC 220.127.116.11) was selectively expressed on the neuroblastoma line. Dipeptidyl peptidase IV (EC 188.8.131.52) was also abundant on the astrocytoma line. The presence of both endopeptidase-24.11 and dipeptidyl peptidase IV on D384 cells was confirmed by immunohistochemistry. A membrane preparation from D384 cells hydrolyzed both atrial natriuretic peptide and brain natriuretic peptide and, in both cases, the pattern of metabolism was similar to that seen with purified endopeptidase-24.11. The endopeptidase-24.11 inhibitor, phosphoramidon, at 1 microM abolished natriuretic peptide metabolism. The neuroblastoma line, which lacked endopeptidase-24.11, failed to metabolise atrial natriuretic peptide and brain natriuretic peptide, emphasizing the key role of the endopeptidase in hydrolyzing these regulatory peptides at the cell surface.


FIB-4 stage of liver fibrosis predicts incident heart failure among HIV-infected and uninfected patients.
Liver fibrosis is common, particularly in individuals who are infected with human immunodeficiency virus (HIV). HIV-infected individuals have excess congestive heart failure (CHF) risk compared with uninfected people. It remains unknown whether liver fibrosis stage influences the CHF risk or if HIV or hepatitis C virus (HCV) infection modifies this association. Our objectives were to assess whether 1) stage of liver fibrosis is independently associated with incident CHF and 2) the association between stage of liver fibrosis and incident CHF is modified by HIV/HCV status. Participants alive on or after April 1, 2003, in the Veterans Aging Cohort Study were included. Those without prevalent cardiovascular disease were followed until their first CHF event, death, last follow-up date, or December 31, 2011. Liver fibrosis was measured using the fibrosis 4 index (FIB-4), which is calculated using age, aminotransferases, and platelets. Cox proportional hazards regression models were adjusted for cardiovascular disease risk factors. Among 96,373 participants over 6.9 years, 3844 incident CHF events occurred. FIB-4 between 1.45 and 3.25 (moderate fibrosis) and FIB-4 > 3.25 (advanced fibrosis/cirrhosis) were associated with CHF (hazard ratio [95% confidence interval], 1.17 [1.07-1.27] and 1.65 [1.43-1.92], respectively). The association of advanced fibrosis/cirrhosis and incident CHF persisted regardless of HIV/HCV status. Moderate and advanced liver fibrosis/cirrhosis are associated with an increased risk of CHF. The association for advanced fibrosis/cirrhosis persists even among participants without hepatitis C and/or HIV infection. Assessing liver health may be important for reducing the risk of future CHF events, particularly among HIV and hepatitis C infected people among whom cardiovascular disease risk is elevated and liver disease is common. (Hepatology 2017;66:1286-1295).


Oxygen consumption of animals and tissues as a function of temperature.
The generally accepted view that rates of oxygen consumption of tissues and poikilotherms increase regularly with rising temperature was subjected to careful examination using brain slices and skin of rats and nine different species of aquatic and terrestrial animals. It was found that, although there are statements in the literature to the contrary, the influence of temperature is a regular one and respiration increases with rising temperature so that when rates of oxygen consumption are plotted against temperature the resulting curve is regular without dips or peaks except the maximum expected at the optimum temperature.


Local temperature rises influence in vivo electroporation pore development: a numerical stratum corneum lipid phase transition model.
Electroporation is an approach used to enhance transdermal transport of large molecules in which the skin is exposed to a series of electric pulses. Electroporation temporarily destabilizes the structure of the outer skin layer, the stratum corneum, by creating microscopic pores through which agents, ordinarily unable to pass into the skin, are able to pass through this outer barrier. Long duration electroporation pulses can cause localized temperature rises, which result in thermotropic phase transitions within the lipid bilayer matrix of the stratum corneum. This paper focuses on electroporation pore development resulting from localized Joule heating. This study presents a theoretical model of electroporation, which incorporates stratum corneum lipid melting with electrical and thermal energy equations. A transient finite volume model is developed representing electroporation of in vivo human skin, in which stratum corneum lipid phase transitions are modeled as a series of melting processes. The results confirm that applied voltage to the skin results in high current densities within the less resistive regions of the stratum corneum. The model captures highly localized Joule heating within the stratum corneum and subsequent temperature rises, which propagate radially outward. Electroporation pore development resulting from the decrease in resistance associated with lipid melting is captured by the lipid phase transition model. As the effective pore radius grows, current density and subsequent Joule heating values decrease.


Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital.
The study was carried out with the aim of evaluation of the adverse drug reaction profile of anti-snake venom serum (ASV) in a rural tertiary care hospital. An observational study was conducted in SRTR Medical College, Ambajogai, Maharashtra, India. A total number of 296 indoor case papers of snake bite from February to September 2011 and June to August 2012 were retrieved from the record section and the antivenom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed. Vasculotoxic snake bites were more common (50.61%) than neuroparalytic ones (22.56%). Mild envenomation was the commonest presentation. A total of 92 (56.10%) patients who received ASV suffered from antivenom reactions. The most common nature of reaction was chills, rigors (69.56%) followed by nausea and vomiting (34.8%). 10-15% patients suffered from moderate to severe reactions like hypotension and sudden respiratory arrest. We did not find any dose response relationship of ASV to risk of reactions (odds ratio 0.37). Intradermal sensitivity test was performed in about 72% cases. Our study showed a higher incidence of reactions to ASV at our institute.


Psychopathology in male and female intravenous drug users with and without HIV infection.
The authors report on results of systematic clinical assessment of psychopathology among HIV-positive and HIV-negative intravenous drug users. As part of a multidisciplinary baseline assessment, 147 male (85 HIV-positive and 62 HIV-negative) and 76 female (39 HIV-positive and 37 HIV-negative) intravenous drug users were evaluated with the Structural Clinical Interview for DSM-III-R and measures of psychiatric symptom severity, global functioning, and stress. Prevalence of a diagnosis of current depression (26%) and severity of depressive and anxiety symptoms in both HIV-positive and HIV-negative subjects were greater than in the general community, but not greater than in other studies of intravenous drug users. HIV-positive men had a higher prevalence of depressive disorders than HIV-negative men (33% and 16%, respectively), although this pattern was not found among women (26% and 30%). Diagnosis of depressive disorders and severity of depressive and anxiety symptoms were associated with a symptom-based measure of HIV illness stage, but not with indices of immune functioning (CD4+ cell count and CD4+ cell percent). Despite selective associations between HIV illness variables and depression, high rates of depression across HIV status in this cohort suggest that intravenous drug use and associated factors are more salient than HIV illness factors in understanding psychopathology in this population.


Cytotoxic lesion of corpus callosum after COVID-19 vaccination: case report.
Cytotoxic lesions of corpus callosum (CLOCCs) are associated with many disease entities. Serious neurological complications after coronavirus disease 2019 (COVID-19) vaccination are rare. A 20-year-old man presented with severe headache for 2 days. He had received the first dose of ChAdOx1nCoV-19 COVID-19 vaccine 5 days ago. Persistent dull headache occurred on the third day after vaccination and intensified gradually to awaken him from sleep at night. No neck stiffness was observed. Brain magnetic resonance angiography (MRA) 9 days after vaccination revealed an oval-shaped diffusion-weighted restriction lesion at the splenium of corpus callosum with a mildly high signal intensity on T2-weighted images (T2WI) and low signal intensity on apparent diffusion coefficient (ADC) imaging but without enhancement after contrast injection. A COVID-19 polymerase chain reaction test was negative. A blood test revealed slight leukocytopenia, thrombocytopenia, and hyponatremia. Further autoimmune and hematological studies were normal. A cerebrospinal fluid study revealed normal intracranial pressure. The patient's headache improved gradually. Follow-up brain MRA 5 weeks after vaccination revealed complete disappearance of the diffusion-weighted restriction lesion of the splenium. CLOCCs are rare transient adverse effect of COVID-19 vaccination possibly related to a cytokine storm. The splenic lesion might disappear spontaneously with a good prognosis.


Intelligent Drone Positioning via BIC Optimization for Maximizing LPWAN Coverage and Capacity in Suburban Amazon Environments.
This paper aims to provide a metaheuristic approach to drone array optimization applied to coverage area maximization of wireless communication systems, with unmanned aerial vehicle (UAV) base stations, in the context of suburban, lightly to densely wooded environments present in cities of the Amazon region. For this purpose, a low-power wireless area network (LPWAN) was analyzed and applied. LPWAN are systems designed to work with low data rates but keep, or even enhance, the extensive area coverage provided by high-powered networks. The type of LPWAN chosen is LoRa, which operates at an unlicensed spectrum of 915 MHz and requires users to connect to gateways in order to relay information to a central server; in this case, each drone in the array has a LoRa module installed to serve as a non-fixated gateway. In order to classify and optimize the best positioning for the UAVs in the array, three concomitant bioinspired computing (BIC) methods were chosen: cuckoo search (CS), flower pollination algorithm (FPA), and genetic algorithm (GA). Positioning optimization results are then simulated and presented via MATLAB for a high-range IoT-LoRa network. An empirically adjusted propagation model with measurements carried out on a university campus was developed to obtain a propagation model in forested environments for LoRa spreading factors (SF) of 8, 9, 10, and 11. Finally, a comparison was drawn between drone positioning simulation results for a theoretical propagation model for UAVs and the model found by the measurements.


Size determination of red blood cell aggregates induced by dextran using ultrasound backscattering phenomenon.
Different methods are commonly used to study the red blood cell aggregation phenomenon. The major interest of the ultrasonic method presently discussed is to assess the mean size of red blood cell (RBC) aggregates by measuring ultrasonic intensity backscattered by blood. Applying Rayleigh theory of sound to blood medium, one can show that the scattered ultrasonic intensity is proportional to the 6th power of the size of the RBC aggregates. The ultrasonic method is used to evaluate the mean size of RBC aggregates induced by dextrans. RBCs are suspended at various hematocrits H, in solution of dextrans of different molecular weights M and at different weight concentrations Cw. Results are presented by using the ultrasonic backscattering coefficient chi which is a relevant quantity in a scattering experiment. For suspensions of RBCs aggregated with dextran of molecular weight 70,000 dalton (dextran 70) at concentration Cw = 40 g/l, variations of chi as a function of H are similar to those obtained for normal blood. At a fixed hematocrit, variation of chi versus Cw for dextran 70 exhibits a maximum at 40 g/l. In the case of RBCs suspended at hematocrit 20% and aggregated with dextrans of molecular weight M, 70,000 less than or equal to M less than or equal to 2,000,000, the variations of chi versus molar concentration Cm are similar to those of the microscopic aggregation index defined by Chien (1). Finally, a statistical model of the blood structure previously described (2) is applied to evaluate the mean size of the aggregates. According to this model, the mean size of aggregates is independent of hematocrit for H less than or equal to 40% and independent of the molecular weight of dextran for M greater than or equal to 150,000 dalton.


Identification of N-Glycosites in Chicken Egg White Proteins Using an Omics Strategy.
Chicken egg white (CEW) is a perfect source of natural proteins that possesses outstanding functional properties and various bioactivities. The glycosylation structure of CEW proteins plays important roles in their functions, bioactivities, and allergies. The present work attempted to identify N-glycosites of CEW proteins using an omics strategy. CEW proteins were digested with trypsin and chymotrypsin; glycopeptides were enriched and deglycosylated using PNGase F in H218O water, followed by analysis using high-performance liquid chromatography/tandem mass spectrometry (HPLC-MS/MS). A total of 71 N-glycosites in 26 CEW glycoproteins were identified. Web-Logo analysis showed that most of the N-glycosites were at N-X-T (55%) and N-X-S (32%). Furthermore, two-dimensional electrophoresis of CEW clusterin demonstrated a series of spots horizontally distributed at 35-37 kDa with an extremely wide isoelectric point range of 4.54-6.68, indicating the heterogeneity of glycosylation of CEW clusterin. These results provided important information for the understanding of the structures, functions, and bioactivities of CEW glycoproteins.


Acute calcific periarthritis of the finger joints: a syndrome of women.
We describe a 33-year-old woman with acute calcific periarthritis (ACP) of the interphalangeal joint of the thumb and review 42 reported cases of ACP involving the finger joints. A computer assisted literature search for reported cases of ACP involving the finger joints was performed. Clinical features of our case and those fulfilling the criteria for entry into this study were analyzed.


The Association Between Covariates, with Emphasis on Maternal Body Mass Index, and Duration of Exclusive and Total Breastfeeding.
Objective: The aim of this study was to evaluate the association between possible covariates, with emphasis on maternal body mass index (BMI), on exclusive breastfeeding and on total breastfeeding during the first postnatal year. Design: A longitudinal study encompassing 723 women who were followed during the first postnatal year Methods: Data concerning pregnancy, delivery, neonatal period, and breastfeeding were extracted from respective medical records. Sociodemographic data on the participants were self-reported. The Cox Proportional Hazard Model was used for investigating the effects of different covariates. Results: Compared with women with BMI <25.0, obese women ran a higher risk of ceasing exclusive breastfeeding prematurely (Hazard ratio [HR] = 1.38, p = 0.009). Multiparous women had a lower risk of ceasing the exclusive breastfeeding prematurely, than primiparous women (HR = 0.78, p = 0.009). Concerning exclusive breastfeeding as well as total breastfeeding, the risk of prematurely ceasing the breastfeeding decreased with increasing age (p = 0.028 and p ≤ 0.001, respectively). Median duration of exclusive breastfeeding was shorter among obese women compared with women with BMI <30.0 (3.0 months versus 6.0 months). Corresponding figures for total breastfeeding were 4.0 months versus 8.0 months. Concerning parity and exclusive breastfeeding, there was no difference in median duration between primiparous women and multiparous women (4.0 months), whereas multiparous women had a longer median duration of total breastfeeding, than primiparous women (8.0 months versus 7.0 months). Conclusion: The risk of ceasing exclusive breastfeeding prematurely is high among obese women. This result indicates the need for targeted supportive interventions, individualized according to BMI. With increasing age, the risk of ceasing breastfeeding prematurely decreases, and compared with primiparous women, multiparous women run a lower risk of ceasing exclusive breastfeeding prematurely.


Reforming health insurance: realistic options and hard choices.
The persistently high number of people reporting that they have no health insurance has precipitated a number of new comprehensive proposals to extend coverage to most Americans. Such proposals must find solutions to fundamental problems that have thus far eluded policymakers, including the role of government regulation, how much to spend, and who should pay. The experience of the 1990s suggests that an effective policy would offer more choices of health plans through the private market, limit unnecessary government regulation, and provide appropriate subsidies to individuals.


Comparing the effectiveness of the mini-lecture technique to role-playing in a dental psychology course.
The array of instructional methods utilized in teaching behavioral sciences to dental students has included both teacher-centered and student-centered approaches. The purpose of this study was to evaluate the effectiveness of two small-group treatments, mini-lecture and role-playing, in teaching dental psychology. Freshman dental students were randomly assigned to 12 groups. Groups were then assigned to one of six dentist-pyschologist teaching teams so that each team taught one mini-lecture and one role-playing group. Teaching teams taught seven sessions in which each mini-lecture/role-playing pair of groups received parallel subject matter. Following instruction, two outcome measures were administered: (1) an achievement post-test measuring factual recall, and (2) a measure of facilitative communication. Results indicated that mini-lectures were more effective than role-playing in effecting student mastery of factual information. There were no significant differences between the instructional treatments in teaching facilitative communication skills.


Epidemiological dynamics of hepatitis C virus among 747 German individuals: new subtypes on the advance.
This study demonstrates the dynamics in the epidemiology of hepatitis C virus subtypes. Subtypes 3a and 4a have become increasingly prevalent in patients where an infection within recent years can be assumed. Evidence is presented that the subtypes observed among younger patients can spread rapidly and lead to significant changes in the subtype distribution.


High-sensitivity PCR detection of parvovirus B19 in plasma.
Parvovirus B19 (B19) is a human pathogen transmitted to susceptible individuals via respiratory secretions and contaminated blood or blood products. B19 levels in pooled plasma of less than 10(4) genome equivalents/ml may not be infectious, while those greater than 10(7)/ml are capable of transmitting infection. A World Health Organization (WHO) B19 DNA international standard has been recently introduced. The purpose of the present work was to develop a PCR-enzyme-linked immunosorbent assay (PCR-ELISA) calibrated against the WHO B19 DNA international standard which could easily and reliably detect B19 DNA levels in plasma above 10(4) IU/ml (6.5 x 10(3) genome equivalents/ml). A B19 PCR-ELISA system was developed which uses a dinitrophenylated oligonucleotide probe to detect immobilized biotinylated amplicons following single-round PCR amplification. The level of B19 DNA (in international units per milliliter) in individual and pooled plasma specimens was evaluated. Proteinase K treatment of plasma was found to be sufficient to quantitatively release B19 DNA. The B19 PCR-ELISA had a sensitivity of detection of 1.6 x 10(3) IU/ml B19 DNA and a dynamic range extending from 8 to 1,000 IU of B19 DNA (equivalent to 1.6 x 10(3) to 2 x 10(5) IU of B19 DNA/ml). Furthermore, the antibody profile of pooled plasma products was determined in terms of B19 immunoglobulin G (IgG) (in international units per milliliter). The B19 IgG level was found to be 64.7 +/- 17.5 IU/ml (mean +/- standard deviation). The B19 PCR-ELISA, which is calibrated against the B19 DNA international standard, may have an application for the rapid screening of plasma minipools for B19 DNA, thereby leading to an improvement in blood product safety.


Latarjet in women for anterior shoulder instability: a case series analysis.
The Latarjet procedure is traditionally used to treat chronic anterior shoulder instability associated with glenoid bone loss. However, few series have analyzed outcomes in a female-only population. The objective of this study was to evaluate the clinical and radiological outcomes of a Latarjet bone block in this specific population. This single-center retrospective study included 15 women (mean age 35 ± 11.3; 19-60) reviewed with a minimum follow-up of 2 years. The procedure was performed using the open bone block screw technique (n = 7) or by arthroscopy with cortical button (n = 8). Clinical evaluation was based on active range of motion measurements, Rowe and Walch-Duplay scores, and subjective shoulder value (SSV). Radiographic analysis explored bone block healing at the last follow-up. At a mean follow-up of 48 months (32-86), no recurrence was reported. The mean Rowe score was 91 points (70-100), Walch-Duplay 90 points (60-100), and SSV 87% (70-100). The active mobilities reached 169° (± 9°) in elevation, 57° (± 15°) in external rotation at side, and 89° (± 6°) in abduction. The return-to-sport rate was 91%. Five patients experienced persistent anterior pain, with screws requiring hardware removal in 2 (p = 0.02). Radiological assessment detected one case of nonunion (7%). Women treated with the Latarjet procedure experienced satisfactory midterm clinical outcomes. The arthroscopic technique using cortical button fixation seems to avoid residual anterior pain requiring hardware removal.


Retinol and retinaldehyde specifically increase alpha1-proteinase inhibitor in the human cornea.
alpha1-Proteinase inhibitor is a serpin and can inhibit most serine proteinases. The cornea is one of several extrahepatic tissues that synthesizes this inhibitor. In the presence of retinol, corneal alpha1-proteinase inhibitor levels were increased 3.8-fold. The maximal response was achieved 2 h after the addition of retinol (1 microM final concentration) to the culture medium. A similar increase in alpha1-proteinase inhibitor was observed with retinaldehyde (1 nM final concentration). Concentrations of alpha1-proteinase inhibitor in other tested cells (Hep G2, CaCo 2, MCF-7, monocytes and macrophages) remained unchanged in the presence of retinol. Retinoic acid did not affect alpha1-proteinase inhibitor levels in the cornea or the other cells tested. The acute-phase cytokine, interleukin-6, increased alpha1-proteinase inhibitor levels in all tested tissues/cells except the cornea. These results demonstrate that alpha1-proteinase inhibitor levels are controlled differently in the cornea compared with other tissues/cells. alpha1-Proteinase inhibitor is the first protein identified whose levels are regulated by a mechanism supported by retinol and retinaldehyde but not retinoic acid.