Paratesticular sarcomas: a case series and literature review.
Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings. Ultrasound in each case confirmed an extratesticular mass. Only the second gentleman complained of associated pain, however he had experienced scrotal trauma in the preceding weeks. Only one patient had suspicions of metastatic disease, with a 9 mm pulmonary nodule on computed tomography. All patients underwent a radical inguinal orchidectomy with high ligation of the spermatic cord, in keeping with best accepted guidelines. Histology confirmed a well-differentiated liposarcoma, a dedifferentiated liposarcoma and a leiomyosarcoma respectively, all high grade. One gentleman returned to theatre for re-excision of margins. Our case series emphasises the need for full multidisciplinary team specialist sarcoma input, as well as radical resection with judicious margins in order to reduce the risk of local recurrence, in the treatment of these rare tumours.


Effects of miR-9-5p on the migration, invasion and epithelial-mesenchymal transition process in cervical squamous cell carcinoma.
Cervical squamous cell carcinoma is the most common cancer in female reproductive system. This study aims to explore the effect of microRNA-9-5p (miR-9-5p) on the migration, invasion, and epithelial-mesenchymal transition (EMT) process of cervical squamous cells. Bioinformatics were used to predict the miRNAs that could bind to E-cadherin (E-cad). The Cancer Genome Atlas (TCGA) database was used to analyze and extract significantly differentially expressed miRNAs from part of cervical squamous cell carcinoma tissues and normal cervical tissues, and miR-9-5p was selected as the main research target. The translated regions (UTR) of wild-type E-cad (E-cad-WT 3'-UTR) or the 3'-UTR of mutant E-cad (E-Cad-MUT 3'-UTR) was transfected with miR-9-5p mimic normal control (NC), and miR-9-5p mimic was co-transfected human embryonic kidney cells (293T). The relationship between miR-9-5p and E-cad was detected by double luciferase assay. The expression of miR-9-5p in normal cervical epithelial cell lines (H8) and cervical squamous cell lines (C33A, siha, caski and Me180) were detected by quantitative real-time PCR. Then, the experiments were divided into groups as follows: a block control group, an overexpression control group (mimic-NC group), a miR-95p overexpression group (mimic group), an inhibitory expression control group (inhibitor-NC group), and a miR-9-5p inhibitory expression group (inhibitor group). The changes of migration ability were detected by scratch assay. Transwell invasion assay was used to analyze the changes of invasion ability, and the mRNA and protein changes of E-cad and vimentin were detected by quantitative real-time PCR and Western blotting. MiR-9-5p had a targeting binding relationship with E-cad. Compared with the normal cervical tissue H8 cell line, the miR-9-5p was highly expressed in cervical cancer cell lines (C33A, siha, caski and Me180) (all P<0.05). The luciferase activity of E-cad-MUT was increased compared with that of E-cad-WT in miR-9-5p mimic cells (P<0.05). Compared with the blank control group, the protein and mRNA expressions of E-cad were decreased in the miR-9-5p mimic group (both P<0.05), which were increased in the miR-9-5p inhibitor group (both P<0.05). Compared with H8 cell line, the miR-9-5p was highly expressed in the cervical squamous cell lines (all P<0.05). Compared with the mimic-NC group, the distance of wound healing, the number of caski and Me180 cells invaded below the membrane, and the mRNA and protein expressions of vimentin were all increased in the miR-9-5p mimic group (all P<0.05), while the mRNA and protein of E-cad were decreased (both P<0.05). Compared with the inhibitor-NC group, the distance of wound healing, the number of caski and Me180 cells invading the membrane, and the mRNA and protein expressions of vimentin were decreased in the miR-9-5p inhibitor group (all P<0.05), but the mRNA and protein expressions of E-cad were increased (both P<0.05). The miR-9-5p is highly expressed in cervical squamous cell carcinoma, which can increase the migration and invasion ability, and promote the EMT process of cancer cells.


Role of Epidermal Growth Factor Receptor (EGFR) and Its Ligands in Kidney Inflammation and Damage.
Chronic kidney disease (CKD) is characterized by persistent inflammation and progressive fibrosis, ultimately leading to end-stage renal disease. Although many studies have investigated the factors involved in the progressive deterioration of renal function, current therapeutic strategies only delay disease progression, leaving an unmet need for effective therapeutic interventions that target the cause behind the inflammatory process and could slow down or reverse the development and progression of CKD. Epidermal growth factor receptor (EGFR) (ERBB1), a membrane tyrosine kinase receptor expressed in the kidney, is activated after renal damage, and preclinical studies have evidenced its potential as a therapeutic target in CKD therapy. To date, seven official EGFR ligands have been described, including epidermal growth factor (EGF) (canonical ligand), transforming growth factor-α, heparin-binding epidermal growth factor, amphiregulin, betacellulin, epiregulin, and epigen. Recently, the connective tissue growth factor (CTGF/CCN2) has been described as a novel EGFR ligand. The direct activation of EGFR by its ligands can exert different cellular responses, depending on the specific ligand, tissue, and pathological condition. Among all EGFR ligands, CTGF/CCN2 is of special relevance in CKD. This growth factor, by binding to EGFR and downstream signaling pathway activation, regulates renal inflammation, cell growth, and fibrosis. EGFR can also be "transactivated" by extracellular stimuli, including several key factors involved in renal disease, such as angiotensin II, transforming growth factor beta (TGFB), and other cytokines, including members of the tumor necrosis factor superfamily, showing another important mechanism involved in renal pathology. The aim of this review is to summarize the contribution of EGFR pathway activation in experimental kidney damage, with special attention to the regulation of the inflammatory response and the role of some EGFR ligands in this process. Better insights in EGFR signaling in renal disease could improve our current knowledge of renal pathology contributing to therapeutic strategies for CKD development and progression.


Graphene oxide bound silica for solid-phase extraction of 14 polycyclic aromatic hydrocarbons in mainstream cigarette smoke.
Polycyclic aromatic hydrocarbons (PAHs) were considered as a source of carcinogenicity in mainstream cigarette smoke (MSS). Accurate quantification of these components was necessary for assessing public health risk. In our study, a solid-phase extraction (SPE) method using graphene oxide (GO) bound silica as adsorbent for purification of 14 PAHs in MSS was developed. During SPE process, large matrices interferences of MSS were adsorbed on SPE column. The result of FTIR spectra demonstrated that these matrices interferences were adsorbed on GO mainly through OH and CO groups. The concentrations of PAHs in MSS extract were determined by gas chromatography-mass spectrometry (GC-MS). The limit of detection (LOD) and limit of quantification (LOQ) of the developed method for 14 PAHs ranged from 0.05 to 0.36 ng/cig and 0.17 to 1.19 ng/cig, respectively. The accuracy of the measurement of 14 PAHs was from 73 to 116%. The relative standard deviations of intra- and inter-day analysis were less than 7.8% and 13.9%, respectively. Moreover, the developed method was successfully applied for analysis of real cigarette containing 1R5F reference cigarette and 12 top-selling commercial cigarettes in China.


Outbreak of cryptosporidiosis among veterinary students.
In January 2007, six veterinary students became infected with Cryptosporidium species, and records indicated that another student had been diagnosed in November 2006. It was established that the seven students had worked with cattle from the same farm. Microbiological tests indicated that they were infected with Cryptosporidium parvum. Subtyping by sequence analysis indicated a common source of infection for five of the students, but there was insufficient material to type the other two samples. Investigations indicated that the outbreak was caused by a lapse in hygiene, particularly handwashing, on a farm with enzootic C parvum in calves.


The psychosocial assessment of patients discharged from accident and emergency departments after deliberate self-poisoning.
One-third of accident and emergency (A & E) patients who deliberately take an overdose are not admitted to hospital, and this proportion is increasing. We conducted an audit of 300 case records of such patients from two different district health authorities in London. We found that only 4% of patients were assessed in the manner recommended by the Department of Health and 10% had no psychosocial assessment whatsoever. We recommend specific training, an assessment form, regular audit, and communication with the general practitioner.


Hydrogen Sulfide Contributes to Uterine Quiescence Through Inhibition of NLRP3 Inflammasome Activation by Suppressing the TLR4/NF-κB Signalling Pathway.
The NLRP3 inflammasome plays a critical role in inflammatory responses in various diseases. Our previous study showed that NLRP3 expression was significantly increased in human pregnancy tissue during term labour. Therefore, we explored whether NLRP3 participated in inflammatory responses of preterm and term labour and whether this process could be relieved by H2S, one anti-inflammatory gasotransmitter. Human myometrium was obtained from non-labouring and labouring women. Mouse myometrium was obtained from LPS-induced infectious preterm labour. Uterine smooth muscle cells were isolated from non-labouring women's myometrial tissues, transfected with siRNA, and treated cells with IL-1β, H2S donor NaHS, NF-κB inhibitor BAY 11-7082 and TLR4 inhibitorTAK-242. The NLRP3 inflammasome, CSE, CBS, TLR4, uterine contraction-associated proteins (CAPs), NF-κB activation and inflammatory cytokine expression were assessed by Western blotting and RT-PCR. The NLRP3 inflammasome, TLR4 and activated NF-κB expression were upregulated in human term labour, mouse preterm labour and human uterine smooth muscle cells treated with IL-1β. NLRP3 levels were negatively correlated with CSE and CBS expression. Treatment with the H2S donor NaHS delayed LPS-induced preterm birth in mice and inhibited NLRP3 inflammasome activation. In siNLRP3-transfected cells, there was a significant decrease in the expression of CAPs and inflammatory cytokines compared with IL-1β stimulation. In addition, treatment with the H2S donor NaHS inhibited NLRP3 inflammasome activation, reduced the expression of uterine contraction-associated proteins and inflammatory cytokines and reduced the activation of TLR4 and NF-κB compared with stimulation with IL-1β in human uterine smooth muscle cells. Furthermore, treatment of uterine smooth muscle cells with BAY 11-7082 and TAK-242 found that NLRP3 activation was regulated by the TLR4 and NF-κB pathways. H2S suppresses CAP expression and the inflammatory response and contributes to uterine quiescence by inhibiting the TLR4/NF-κB signalling pathway and downstream NLRP3 inflammasome activation. Thus, H2S contributes to uterine quiescence through inhibition of NLRP3 inflammasome activation by suppressing the TLR4/NF-κB signalling pathway.


Peritoneal Equilibration Test Reference Values Using a 3.86% Glucose Solution During the First Year of Peritoneal Dialysis: Results of a Multicenter Study of a Large Patient Population.
The original peritoneal equilibration test (PET) was used to classify peritoneal dialysis (PD) patients using a 2.27% glucose solution. It has since been suggested that a 3.86% glucose solution be used because this provides better information about ultrafiltration (UF) capacity and the sodium (Na) sieving of the peritoneal membrane. The aim of this study was to determine reference values for a PET using a 3.86% glucose solution (PET-3.86%). We evaluated the PET-3.86% in a large population of incident PD patients attending 27 Italian dialysis centers. We evaluated the results of 758 PET-3.86% in 758 incident PD patients (1 test per patient). The mean duration of PD was 5 ± 3 months. The ratio of the concentrations of creatinine in dialysate/plasma (D/PCreat) was 0.73 ± 0.1 (median 0.74). The ratio between the concentrations of glucose at the end/beginning of the test (D/D0) was 0.25 ± 0.08 (median 0.24). Ultrafiltration uncorrected and corrected for bag overfill was respectively 776 ± 295 mL (median 781 mL) and 675 ± 308 mL (median 689 mL). Sodium sieving was 8.4 ± 3.8 mmol/L (median 8.0 mmol/L). The results of the study provide PET-3.86% reference values for the beginning of PD that can be used to classify PD patients into transport classes and monitor them over time.


Silent myocardial ischemia.
The documentation of abnormalities related to myocardial ischemia, whether symptomatic or silent, is of central importance. Whenever this information is available, it should be used in the overall assessment of the patient at risk for adverse outcome. The level of concern for treatment of CAD should be based on the risk implications associated with the ischemia-related abnormalities detected during objective testing rather than on the presence or absence of pain. The exercise stress test is still the single most useful test to begin the evaluation of a patient with an analyzable ST segment. In persons suspected of having CAD, the detection of ischemic-type ST-segment depression, at a low workload (e.g., < 120 beats/min or < 6.5 METS) of > 2 mm magnitude or persisting for more than 6 min implies high risk for adverse outcome. Asymptomatic ischemia during everyday activities, detected by Holter monitoring, in the high-risk patient, most probably adds additional risk beyond the risk of an abnormal stress test alone. Left ventricular imaging by two-dimensional echocardiography, RNA, angiogram, vest, etc, showing an ejection fraction > or = 40%, reversible wall motion abnormalities in multiple regions and redistribution defects or a failure to increase ejection fraction during exercise even if the patient remains asymptomatic, also imply high risk. The presence of any of these abnormal findings, regardless of symptoms, should therefore prompt as high a degree of concern as with ischemia-related signals associated with pain. Thus any therapy chosen should be directed toward elimination of transient ischemia, not just relief of symptoms that may or may not be ischemia related. If this course is chosen, the efficacy of the therapeutic regimen and possible progression of CAD should be assessed with follow-up testing for ischemia. We believe that risk factor modification and aspirin should be considered for most, if not all, patients in whom ischemia, silent or symptomatic, is suspected or detected. If symptoms or ischemia suggesting low risk is present, anti-ischemic medical therapy may be considered, but follow-up is advised. If a high-risk ischemic signal, even without symptoms, is detected, medical therapy should be used to attempt to modify the signal. If the ischemic signal suggesting high risk persists despite medical therapy, revascularization should be considered. Until additional data from large clinical trials are available, this approach appears to have the greatest likelihood of modifying the adverse outcome of CAD.


The effect of chloroquine, quinacrine, and metronidazole on both soybean plants and soil microbiota.
Chloroquine, quinacrine, and metronidazole are used extensively for therapeutic purposes. Substantial quantities of these compounds end up in the environment. The potential effect of these compounds on soybean and on the protozoa in soil was assessed. The growth of soybean plants was affected by increasing concentrations of the chloroquine, metronidazole, and quinacrine dihydrochloride. The plants were particularly sensitive to low concentrations of metronidazole. The number of bacteria and protozoa in soil was either unchanged or increased in the presence of chloroquine and quinacrine. However, in the presence of only 0.5 mg metronidazole g(-1) soil, the density of protozoa in the rhizosphere was reduced by a 10-fold.


Achieving Site Selectivity in Metal-Catalyzed Electron-Rich Carbene Transfer Reactions from N-Tosylhydrazones.
Catalyst control of the site-selectivity of electron-rich alkyl, aryl disubstituted carbenes generated in situ from o-alkenyl-substituted N-tosylhydrazones was achieved in this study. Exposure of these substrates to copper iodide triggered the formation of α-alkoxy 2H-naphthalenones. This investigation established that changing the catalyst to a rhodium(II) carboxylate turned off cyclization and migration of the electron-rich metal carbene with the β-carboxylate and turned on allylic C-H bond functionalization to diastereoselectively afford 1H-indenes. Examination of the scope of this reaction revealed that ethereal, aminomethylene, and unactivated 2° C-H bonds could be functionalized.


The effect of state of health on organ distribution and excretion of systemic plutonium in the Mayak workers.
The extrapulmonary distribution of plutonium in 20 organs (excluding the respiratory tract) was studied in workers who chronically inhaled plutonium at the radiochemical plants of the Mayak Production Association (Ozyorsk, Russia). The data were obtained by radiochemical analysis of soft tissue and bones samples collected at autopsy of 591 workers. The systemic plutonium distribution was determined in healthy individuals as well as in those with health impairment, specifically for those with liver diseases. Twenty-five years after the beginning of inhalation, systemic fractions in the liver and skeleton of individuals who were healthy at the time of death approximate the ratio 45%:45% proposed in the International Commission on Radiological Protection (ICRP) Publication 30. Pathological processes in the liver, accompanied by fatty dystrophy of hepatocytes, increased plutonium clearance from the liver. There was a considerable shift of the plutonium from the liver to the skeleton in individuals who died from liver disease. The average fractions of systemic plutonium in the liver and skeleton of those individuals were 14% and 78% respectively, which did not correspond to ICRP models, indicating a significant effect of disease conditions. Plutonium that was not redistributed was excreted. The urinary excretion rate of plutonium also correlated with state of health. The observed excretion as a fraction of systemic content was 1.64 x 10(-5) d(-1) for individuals in good health and 2.34 x 10(-5) d(-1) for individuals with various chronic diseases. The current models do not account for the influence of different pathological processes in the body on plutonium distribution and retention in systemic organs. This could have significant consequences for dosimetry calculations and risk estimations.


Signaling and regulation by a mammalian glucocorticoid receptor in Drosophila cells.
We demonstrate that the rat glucocorticoid receptor enhanced transcription in cultured Drosophila cells from Drosophila promoters linked to glucocorticoid response elements (GREs); promoters either containing or lacking a TATA box were rendered hormone inducible. Enhancement was dependent on the receptor, GREs, and the presence of an agonist ligand such as dexamethasone. The specific activities and relative efficacies of a series of potential ligands were generally similar in Drosophila and mammalian cells, except that dexamethasone mesylate, a potent antagonist in mammalian cells, was a strong agonist in Drosophila cells. A composite GRE, which mediates either positive or negative glucocorticoid regulation in animal cells depending on the presence and composition of the AP-1 transcription factor, conferred hormone-dependent enhancement, but not repression, in Drosophila cells. These results indicate that factors in addition to the receptor and GRE sequences participate as determinants of both signal transduction and transcriptional regulation by the glucocorticoid receptor, and that Drosophila cells carry functional homologs of many or all of those factors. Moreover, receptor activity can be exploited to obtain regulated gene expression in Drosophila.


Interferon-induced inhibition of lymphocyte circulation: lack of effect on humoral immune responses to T-dependent or T-independent antigens.
We have previously demonstrated that interferon (IFN) transiently inhibits the number of recirculating thoracic duct lymphocytes (TDL), while other researchers have demonstrated similar decreases in lymphocytes in peripheral blood. In the present study we examined whether or not this decreased lymphocyte recirculation contributes to IFN's suppressive effects on antibody formation. Immunizing at varying times during the period of maximal decrease in lymphocyte recirculation, there are no significant differences in the number of plaque-forming cells (PFC) or antibody titers generated to either a T-dependent antigen, sheep erythrocytes (SRBC) or a T-independent antigen, Type III pneumococcal polysaccharide (SSS-III). These results suggest that: (i) the suppressive effects of IFN on antibody responses are not related to changes in lymphocyte recirculation and (ii) lymphocyte circulation is not required during the early phases of the humoral immune response to antigens.


Molecular phylogeny of Vespidae (Hymenoptera) and the evolution of sociality in wasps.
The oriental Stenogastrinae is a group in which there is considerable interest as regards the study of evolution of sociality in wasps, because they show broad diversity in social behavior. Using cladistic analysis on morphological and behavioral data, they have been grouped together with the social Vespinae and Polistinae in the family of Vespidae. This is not without dispute, because several other morphological and behavioral characters separate Stenogastrinae from the other Vespidae subfamilies. DNA sequences were obtained from nuclear 28S ribosomal DNA and the mitochondrial 16S ribosomal DNA of two Apis species and nine social and three solitary wasp species of the family Vespidae. Solitary wasps of the family Braconidae and Pteromalidae were used as outgroups. Parsimony, distance, and maximum-likelihood methods of both mitochondrial and nuclear DNA did not support the conventional phylogenetic position of Stenogastrinae. In all phylogenetic reconstructions, the solitary Eumeninae were a sister taxon to the Polistinae + Vespinae cluster. The analyzed sequences provide strong evidence that sociality has independently evolved twice in the Vespidae.


Controversies concerning diagnostic guidelines for anomalies of the enteric nervous system: a report from the fourth International Symposium on Hirschsprung's disease and related neurocristopathies.
Intestinal Dysganglionoses (IDs) represent a heterogeneous group of Enteric Nervous System anomalies including Hirschsprung's disease (HD), Intestinal Neuronal Dysplasia (IND), Internal Anal Sphincter Neurogenic Achalasia (IASNA) and Hypoganglionosis. At present HD is the only recognised clinico-pathological entity, whereas the others are not yet worldwide accepted and diagnosed. This report describes the areas of agreement and disagreement regarding definition, diagnosis, and management of IDs as discussed at the workshop of the fourth International Meeting on "Hirschsprung's disease and related neurochristopathies." The gold standards in the preoperative diagnosis of IDs are described, enlighting the importance of rectal suction biopsy in the diagnostic workup. The most important diagnostic features of HD are the combination of hypertrophic nerve trunks and aganglionosis in adequate specimens. Acetylcholinesterase staining is the best diagnostic technique to demonstrate hypertrophic nerve trunks in lamina propia mucosae, but many pathologist from different centers still use H&E staining effectively. Moreover, the importance of an adequate intraoperative pathological evaluation of the extent of IDs to avoid postoperative complications is stressed. Although it is not clear whether IND is a separate entity or some sort of secondary acquired condition, it is concluded that both IND and IASNA do exist. Other interesting conclusions are provided as well as detailed results of the discussion. Further investigation is needed to resolve the many controversies concerning IDs. The fourth International Conference in Sestri Levante stimulated discussion regarding these entities and led to the International guidelines to serve the best interest of our patients.


Docosahexaenoic acid sources for the developing brain during intrauterine life.
Docosahexaenoic acid (DHA, 22: 6n-3) and arachidonic acid (AA, 20: 4n-6) provision to the developing fetus, with emphasis towards brain and vascular system growth, is a subject of increasing concern particularly under pathological conditions associated with premature birth or in utero growth restriction following obstruction of the maternal-fetal blood flow. Most of DHA, but also AA accretion under physiological conditions, is maternally dependent and requires adequate maternal nutrition and normally functioning placental-fetal circulation. It has been demonstrated that unlike other fatty acids (FA), DHA is preferentially transported across the placenta into the fetal circulation. The selective transplacental DHA transfer is probably mediated by specific carrier proteins. While some of the latter may be acting in fetal organs, the mechanism(s) for the selective accumulation of DHA in brain is still unknown. The fetal brain and also the fetal liver are capable of producing DHA from linolenic (LnA, 18:3 n-3) acid. How effective this local elongation-desaturation mechanism for DHA provision is and to what degree this route is activated in premature births is not clear. Transfer of DHA via the fetal gastrointestinal tract is an additional route to provide DHA to other fetal organs. As indicated by animal model studies, it holds the potential for DHA supply when the maternal pathway is compromised.


Arousal responses to chemical stimuli during sleep.
Arousal from sleep is an important component of any co-ordinated response to an external stimulus. Respiratory stimuli imposed during sleep are capable of eliciting arousal responses as well as the classic ventilatory responses Considerable survival advantage may result as a consequence of intact arousal mechanisms. Developmental studies of arousal responses to respiratory stimuli are lacking. Arousal responses to chemoreceptor stimuli have been examined in adult tracheotomized dogs, both before and following bilateral surgical denervation of the carotid bodies. Prior to denervation of the carotid bodies arousal in response to isocapnic progressive hypoxia occurred at an arterial oxygen saturation (SaO2) of 83% during slow-wave sleep and 70% in rapid-eye-movement sleep. Airway occlusion induced arousal from Slow-wave-sleep at SaO2 of 88% and from rapid-eye-movement sleep at SaO2 of 84%. Following denervation of the carotid bodies, arousal failed to occur in response to either progressive hypoxia or airway occlusion despite desaturation to 60% in Slow-wave sleep and 50% in rapid-eye-movement-sleep, at which level experiments were arbitrarily terminated. The effect of sleep fragmentation on arousal responses of sleeping dogs to chemoreceptor stimuli has also been studied. A marked impairment of both hypoxic and hypercapnic arousal was produced by sleep fragmentation. The consequences of interfering with arousal mechanisms in experimental animals indicates the considerable potential for similar dysfunction in man to contribute to the pathophysiology of the clinical syndromes of obstructive sleep apnoea and sudden infant death.(ABSTRACT TRUNCATED AT 250 WORDS)


Compensatory Strategies Due to Knee Flexion Constraint during Gait of Non-Disabled Adults.
Constraining knee flexion of non-disabled individuals could further our understanding regarding the importance of knee joint during gait, which is a common disturbance in individuals with gait impairment. In this study we investigated whether a mechanical constraint of knee flexion in non-disabled adults would lead to compensatory strategies. Eleven non-disabled male adults walked without and with an orthosis that permitted full extension and limited knee flexion up to either 45° or 30°. We analyzed the temporal organization of lower limb kinematics and electromyograms of the rectus femoris, vastus medialis and lateralis, tibialis anterior, semitendinosus, biceps femoris, and gastrocnemius medialis and lateralis. Non-disabled adults compensated for the reduced knee flexion by increasing hip and ankle joint excursions and ankle flexor activation amplitude. Also, these adults shortened pre-swing and lengthened swing duration in the constrained limb and increased the activity of bifunctional hip extensor and knee flexor muscles in the constrained limb in relation to the unconstrained limb. The use of an orthosis that limited knee flexion in non-disabled adults leaded to compensatory strategies in the temporal organization of joint excursions and muscle activations in the constrained limb. The compensatory effects were correlated with the extent of knee flexion constraint.


[Amino acid composition of the unresorbed peptide fractions of the distal part of the small intestine in rats. II. Feeding of field-bean protein isolate with and without the addition of dialdehyde starch and of protein texturates from it].
Rats were fed diets containing 20% protein in the form of casein, protein isolate from sunflower seeds, protein isolate from field beans, model protein texturate made from field-bean protein isolate or model protein texturate made from field-bean protein isolate treated with dialdehyde starch and a nitrogenfree diet. The content in the distal small intestine of the rats was collected 3 hours after feeding, and the amino-acid compositions of the TCA-precipitable and TCA-soluble peptides (after separation of free amino acids) of the content were studied. The comparison of the amino-acid compositions of the two peptide fractions with the respective dietary protein showed no agreement. On the contrary, the comparison of the amino-acid compositions of the two peptide fractions determined after protein-free diet with those found after protein ingestion were in good agreement, independently of the kind of dietary protein. The comparison of the two peptide fractions with one another revealed an increased degree of proteolytic decomposition of the TCA-soluble peptides. As compared to the other protein-containing diets and to the protein-free diet, diets containing field-bean protein caused an increase of TCA-precipitable peptides and an increase of glycine in both fractions. This was also observed in model protein texturates containing only 30% field-bean protein. Treatment with dialdehyde starch produces certain alterations of the basic amino acids and their accumulation in the fractions of undigested peptide.


Unveiling singlet oxygen spin trapping in catalytic oxidation processes using in situ kinetic EPR analysis.
Singlet oxygen (1O2) plays a pivotal role in numerous catalytic oxidation processes utilized in water purification and chemical synthesis. The spin-trapping method based on electron paramagnetic resonance (EPR) analysis is commonly employed for 1O2 detection. However, it is often limited to time-independent acquisition. Recent studies have raised questions about the reliability of the 1O2 trapper, 2,2,6,6-tetramethylpiperidine (TEMP), in various systems. In this study, we introduce a comprehensive, kinetic examination to monitor the spin-trapping process in EPR analysis. The EPR intensity of the trapping product was used as a quantitative measurement to evaluate the concentration of 1O2 in aqueous systems. This in situ kinetic study was successfully applied to a classical photocatalytic system with exceptional accuracy. Furthermore, we demonstrated the feasibility of our approach in more intricate 1O2-driven catalytic oxidation processes for water decontamination and elucidated the molecular mechanism of direct TEMP oxidation. This method can avoid the false-positive results associated with the conventional 2D 1O2 detection techniques, and provide insights into the reaction mechanisms in 1O2-dominated catalytic oxidation processes. This work underscores the necessity of kinetic studies for spin-trapping EPR analysis, presenting an avenue for a comprehensive exploration of the mechanisms governing catalytic oxidation processes.


Nurses' Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses.
The 'second victim' phenomenon, (SVP) refers to a health professional who was involved in an adverse event (AE) and continues to suffer from the event to the detriment of personal and professional functioning. The second victims' natural history of recovery model predicts stages of the phenomenon from AE occurrence until the 'moving on' stage and serves as a suitable structure for many organizational support programs worldwide. Using the second victims' natural history of recovery model to examine the impact of the SVP on Israeli nurses, with a specific focus on the organizational support they felt they required compared with the support they felt that they had received from their organizations. Fifteen in-depth interviews were conducted, using a semi-structured questionnaire, among nurses who had experienced the SVP. The interviews were recorded subject to the interviewees' consent, transcribed, and analyzed using thematic content analysis. Throughout all six stages of recovery, all interviewees reported physical and emotional manifestations following exposure to an AE, regardless of the type of event or severity. They also reported difficulty in emotion regulation, as well as damage to functioning and overall quality of life. Most of the nurse interviewees reported a need to share the events with someone, but, despite this desire to receive appropriate support, almost none of them proactively requested help from a professional source, nor did their organizational management initiate proactive support. This lack of referral for further assistance is possibly explained through limited awareness of the SVP as a valid response to an AE, a perceived lack of legitimacy to receive organizational support, and personal barriers that accompany the phenomenon. Appropriate organizational support, offered proximal to an AE as well as over time, is essential for the nurse, the patient, and the organization. Personal barriers, together with limited awareness, may challenge the identification and provision of appropriate assistance. Hence, it is important to address the phenomenon as part of the general organizational policy to improve the quality of care and patient safety.


No agreement between the Rorschach and self-assessed personality traits derived from the Comprehensive System.
Eighty psychiatric patients with different clinical diagnoses completed the Rorschach (Exner, 1993), the MMPI-2 (Butcher et al., 1989) and also rated 51 written personality descriptions derived from the Comprehensive System (SAPCS). The 51 self-descriptions were constructed by the authors with the objective to achieve maximum overlap with the interpretive guidelines suggested for Rorschach Comprehensive System (RCS) variables, while simultaneously fitting with how patients could be expected to describe themselves in self-rating. With evidence of (1) independent judges' ability to correct classification of the items, (2) item test-retest stability, (3) sensitivity and specificity, measuring psychological adaptive capacity and vulnerability/pathology, and (4) item inter-correlation with the MMPI-2, patient's SAPCS ratings were expected to significantly converge with corresponding RCS measures. However, including all variable pairings, the mean correlation suggests that SAPCS statements overlapping with RCS interpretive statements do not measure the same constructs as the RCS variables to which the interpretive statements are referring. Standard validity scales in the MMPI-2 and first factor-related test interaction style did not predictably moderate the relation between RCS indices and the RCS-near self descriptions.


Electron microscopic aspects of the effects of certain prostaglandin analogs on mouse testes.
Prostaglandins were highlighted in the seminal plasma and then in the rest of the male and female genital tract. Prostaglandin analogs, firstly used in obstetrics and gynecology, are now widespread in both sexes, especially in the treatment of gastric and duodenal ulcers, glaucoma, etc. Therefore, we tried to highlight the effects of repeated administration of Cloprostenol and CIPG isopropyl ester (both prostaglandin F2α analogs) for the male gonad. In our experiment, we used Cloprostenol and CIPG isopropyl ester. We used three groups of white, male mice, aged 50-80 days, kept in standard laboratory conditions, which received the same feed. Each group included 12 mice. The first batch was the control group and received no substance at all. The second batch received 25 μg/kg of Cloprostenol dose per body per day, intraperitoneal administration (a single dose per day) on a daily basis for a four weeks period of time. The third batch received a 25 μg/kg CIPG isopropyl ester dose per body/day intraperitoneal administration (a single dose per day) on a daily basis for a four weeks period of time. After 7, 14 and 28 days of treatment, we sacrificed four animals in each of the batches by cutting their carotid arteries. The prostanoid analogs we used, Cloprostenol and CIPG isopropyl ester, have similar actions on male gonad in mice. These analogs induced significant changes in the evolution of the spermatogenesis and spermiogenesis. In relation to the treatment duration there were cellular changes suggesting apoptosis in different stages. With regard to spermiogenesis, the ultrastructural aspects indicate a decrease of the sperm structuring processes, especially in the acrosomal apparatus and chromatin.


DLVO interactions of carbon nanotubes with isotropic planar surfaces.
Knowledge of the interaction between carbon nanotubes (CNTs) and planar surfaces is essential to optimizing CNT applications as well as reducing their environmental impact. In this work, the surface element integration (SEI) technique was coupled with the DLVO theory to determine the orientation-dependent interaction energy between a single-walled carbon nanotube (SWNT) and an infinite isotropic planar surface. For the first time, an analytical formula was developed to describe accurately the interaction between not only pristine but also surface-charged CNTs and planar surfaces with arbitrary rotational angles. Compared to other methods, the new analytical formulas were either more convenient or more accurate in describing the interaction between CNTs and planar surfaces, especially with respect to arbitrary angles. The results revealed the complex dependences of both force and torque between SWNTs and planar surfaces on the separation distances and rotational angles. With minor modifications, the analytical formulas derived for SWNTs can also be applied to multiwalled carbon nanotubes (MWNTs). The new analytical expressions presented in this work can be used as a robust tool to describe the DLVO interaction between CNTs and planar surfaces under various conditions and thus to assist in the design and application of CNT-based products.


Transglabellar subcranial approach for the management of nasal masses with intracranial extension in pediatric patients.
To describe the use of the transglabellar subcranial approach for the management of congenital nasal masses in the pediatric population. Case series. Medical records of 5 patients who underwent resection of congenital nasal lesions via the subcranial approach were reviewed. Five children underwent successful resection of congenital nasal lesions with intracranial extension via the subcranial approach. Lesions resected included nasal dermoids with intracranial extension (n = 3) and encephaloceles (n = 2). Patient age at the time of operation ranged from 13 months to 15 years. All lesions were resected successfully, and there have not been any recurrences. Follow-up has ranged from 1 to 12 years. There has been no apparent negative effect on facial growth in any of these patients. The subcranial approach is an effective technique for the resection of nasal masses with intracranial extension. These lesions have traditionally been managed with lateral rhinotomy, midface degloving, or external rhinoplasty approaches combined with a frontal craniotomy. The subcranial approach offers several advantages over a traditional frontal craniotomy. It provides excellent exposure, minimizes frontal lobe retraction, reduces the likelihood of cerebrospinal fluid leakage, and provides for an excellent cosmetic result. Long-term follow-up in 5 pediatric patients has shown no recurrence or negative effect on craniofacial growth. These factors make the transglabellar subcranial approach a useful and safe technique for the management of nasal lesions with intracranial extension in very young patients.


Integrative analyses for omics data: a Bayesian mixture model to assess the concordance of ChIP-chip and ChIP-seq measurements.
The analysis of different variations in genomics, transcriptomics, epigenomics, and proteomics has increased considerably in recent years. This is especially due to the success of microarray and, more recently, sequencing technology. Apart from understanding mechanisms of disease pathogenesis on a molecular basis, for example in cancer research, the challenge of analyzing such different data types in an integrated way has become increasingly important also for the validation of new sequencing technologies with maximum resolution. For this purpose, a methodological framework for their comparison with microarray techniques in the context of smallest sample sizes, which result from the high costs of experiments, is proposed in this contribution. Based on an adaptation of the externally centered correlation coefficient ( Schäfer et al. 2009 ), it is demonstrated how a Bayesian mixture model can be applied to compare and classify measurements of histone acetylation that stem from chromatin immunoprecipitation combined with either microarray (ChIP-chip) or sequencing techniques (ChIP-seq) for the identification of DNA fragments. Here, the murine hematopoietic cell line 32D, which was transduced with the oncogene BCR-ABL, the hallmark of chronic myeloid leukemia, was characterized. Cells were compared to mock-transduced cells as control. Activation or inhibition of other genes by histone modifications induced by the oncogene is considered critical in such a context for the understanding of the disease.


Genetic mapping of sulfur assimilation genes reveals a QTL for onion bulb pungency.
Onion exhibits wide genetic and environmental variation in bioactive organosulfur compounds that impart pungency and health benefits. A PCR-based molecular marker map that included candidate genes for sulfur assimilation was used to identify genomic regions affecting pungency in the cross 'W202A' x 'Texas Grano 438'. Linkage mapping revealed that genes encoding plastidic ferredoxin-sulfite reductase (SiR) and plastidic ATP sulfurylase (ATPS) are closely linked (1-2 cM) on chromosome 3. Inbred F(3) families derived from the F(2 )population used to construct the genetic map were grown in replicated trials in two environments and bulb pungency was evaluated as pyruvic acid or lachrymatory factor. Broad-sense heritability of pungency was estimated to be 0.78-0.80. QTL analysis revealed significant associations of both pungency and bulb soluble solids content with marker intervals on chromosomes 3 and 5, which have previously been reported to condition pleiotropic effects on bulb carbohydrate composition. Highly significant associations (LOD 3.7-8.7) were observed between ATPS and SiR Loci and bulb pungency but not with bulb solids content. This association was confirmed in two larger, independently derived F(2) families from the same cross. Single-locus models suggested that the partially dominant locus associated with these candidate genes controls 30-50% of genetic variation in pungency in these pedigrees. These markers may provide a practical means to select for lower pungency without correlated selection for lowered solids.


Measles in children with HIV infection: report of five cases.
Patients with AIDS have a high incidence of skin problems due to the immunosuppression and malnourishment that are inherent to the progression of this disease. Clinical manifestation of these skin lesions and their severity are different in AIDS patients. We made a prospective study of five cases of measles in children with HIV infection during a community outbreak, and there were typical as well as atypical forms of the disease, including one case with negative serology. There were pulmonary complications, but none of the patients died. The anti-retroviral treatment may have contributed to the decrease in measles morbidity in these pediatric AIDS patients.


Cytotoxic T lymphocytes against HIV.
HIV-1 infection has clearly been shown to induce a vigorous CTL response in infected people, and this response is present at a time when immune function otherwise is globally impaired. HIV-1-specific CTL are detectable both in peripheral blood and tissues of infected people, and are aimed at multiple viral proteins. The precise epitopes recognized by these CTL are now being defined, and the establishment of CTL clones should facilitate further functional analysis of these cells. However, the central question as to the clinical relevance of HIV-1-specific CTL remains. By analogy with animal model systems of virus infection, it is reasonable to postulate that HIV-1-specific CTL serve a protective role as a host defense. In this regard, in vitro data indicate that HIV-1-specific CTL can suppress viral replication, and longitudinal clinical studies indicate that the vigorous CTL activity seen in the early stages of infection declines with disease progression. Alternatively, the presence of HIV-1-specific CTL in tissues such as the lung and brain have to at least raise the possibility that these cells may be contributing to the pathologic consequences of infection. In addition, the relative protective effects of virus-specific CTL compared to other effector mechanisms such as ADCC and neutralizing antibodies remain to be determined. Nevertheless, recent data in the SIV vaccine model give reason for encouragement that a state of protective immunity can be achieved in AIDS-like illness caused by retroviruses. The search continues presently not only for the parameters which define protective immunity in HIV-1 infection, but also for the ideal HIV-1 immunogens to be used for vaccination of human populations.


The Canadian occupational performance measure for patients with stroke: a systematic review.
[Purpose] This study investigated whether the Canadian Occupational Performance Measure is a suitable outcome measure for assessing patients with stroke in research and clinical settings. [Subjects and Methods] The study included into two parts: (1) an investigation of the reliability and validity of the Canadian Occupational Performance Measure for patients with stroke and (2) an exploration of Canadian Occupational Performance Measure results in randomized controlled trials of patients with stroke. For this review, the study searched the MEDLINE, PubMed, and CINAHL Plus with Full Text databases for articles published before September 2015. [Results] Finally, three eligible articles were collected in part 1, and ten randomized controlled trials studies were collected in part 2. The findings of part 1 revealed that the Canadian Occupational Performance Measure had efficient test-retest reliability, however, the Canadian Occupational Performance Measure revealed weak associations with other assessment tools such as Barthel Index used for patients with stroke. Six of the randomized controlled trials studies used the Canadian Occupational Performance Measure as a primary outcome and two as a secondary outcome, while the other two as a goal-setting instrument. [Conclusion] This review indicates that the Canadian Occupational Performance Measure is appropriate for clinicians, including physiotherapists, in assessing outcome for patients with stroke. The Canadian Occupational Performance Measure can assist patients in identifying their outcome performance and provide therapists with directions on interventions.


[Massive hemoptysis: experience of a surgical unit].
Massive hemoptysis is a clinical entity characterized by its unpredictable and potential lethal course. We studied retrospectively the observations of 25 patients hospitalized in our surgical unit. We collected all the demographic, clinical and surgical data. A male predominance with a sex-ratio of 2,1 was noted. The average age was 45 years, with extremes of 17 and 75. The dominant cause was bronchiectasis. Twenty patients were operated on. The surgery consisted of a pulmonary resection in 9 cases (45%), an atypical lung resection in 4 cases (20%), a resection of an aspergilloma in 2 cases (10%), a kystectomy of hydatic cyst in 4 cases (20%) and one arterial ligature (5%). Five patients (25%) had emergent surgery, and 15 (75%) delayed surgery. Hospital mortality was 20% in the first group and 6.66% in the second. No recurrence of bleeding was observed after an average follow-up of 7 months. Surgery remains a therapy of choice for massive hemopysis. It must as far as possible be avoided during active bleeding.


Severe hypoglycemia and finger clubbing in a patient with a BRCA1 mutation in a solitary fibrous tumor: a case report.
Solitary fibrous tumors (SFTs) are rare tumors that stem from mesenchymal cells of submesothelial tissues belonging to the pleura. They can occur in many places such as the spinal canal, intracranial, neck, kidney, liver, pelvis, limbs and other places, most commonly in the chest and abdomen. Pleural SFTs are one of the most common types, and are common in middle-aged people. Pleural SFTs can have an insidious expression, such that the illness can progress for years before diagnosis. SFTs can induce paraneoplastic syndromes, such as reactive hypoglycemia [Doege-Potter syndrome (DPS)] or hypertrophic osteoarthropathy [Pierre-Marie-Bamberger syndrome (PMBS)]. In this article, we report a case study of a 51-year-old man with pleural SFTs. Preoperative imaging examinations, including chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), showed a huge mass in the right thoracic cavity, compressing surrounding tissues and organs and may invade other tissues. In addition, he suffers from severe hypoglycemia and finger clubbing, and has successfully undergone a complete resection, and now attends regular follow-up appointments. The paraneoplastic syndromes have resolved, and no recurrence has been found. Importantly, we used next-generation sequencing (NGS) to explore the molecular characteristics of the patient's pathological tissue at the DNA level and mRNA level, and found that breast cancer gene 1 (BRAC1) mutations may be an important pathogenic factor.


The effect of human saliva substitutes in an erosion-abrasion cycling model.
Saliva may affect dental erosion-abrasion by reducing demineralization, enhancing remineralization, and acting as lubricant. This study tested the effect of human saliva substitutes in an erosion-abrasion cycling model designed for enamel and root dentin. Specimens were randomly assigned into the following groups (n = 8): artificial saliva (AS), artificial saliva + mucin (AS+M), deionized water (DIW, negative control), and pooled human saliva (HS, clinical reference). Each group was submitted to a cycle of 5 min in 1% citric acid (pH 3.75), 30 min in the testing solutions, and toothbrushing (enamel, 500 strokes; dentin, 150 strokes, approximately 200 g load) in fluoridated dentifrice (1,100 p.p.m. NaF) slurry. Specimens were rinsed and dried after each procedure. This cycle was repeated three times each day, for 3 d. Substrate loss was measured daily using optical profilometry. Analysis of variance (anova) and Tukey tests (alpha=0.05) showed a significant increase in enamel and dentin wear throughout the experiment for all groups. At the end of the experiment, enamel wear for each group was ranked as: (AS)<(AS+M) and (HS)<(DIW), with AS+M not differing from HS. For dentin, groups AS and AS+M did not differ from each other or from DIW, but showed significantly higher wear than HS. The artificial saliva with mucin showed promise as a potential substitute for human saliva in the enamel erosion-abrasion cycling model. For dentin, none of the artificial salivas performed similarly to human saliva.


Hepatic FGF21 preserves thermoregulation and cardiovascular function during bacterial inflammation.
Sickness behaviors, including anorexia, are evolutionarily conserved responses to acute infections. Inflammation-induced anorexia causes dramatic metabolic changes, of which components critical to survival are unique depending on the type of inflammation. Glucose supplementation during the anorectic period induced by bacterial inflammation suppresses adaptive fasting metabolic pathways, including fibroblast growth factor 21 (FGF21), and decreases survival. Consistent with this observation, FGF21-deficient mice are more susceptible to mortality from endotoxemia and polybacterial peritonitis. Here, we report that increased circulating FGF21 during bacterial inflammation is hepatic derived and required for survival through the maintenance of thermogenesis, energy expenditure, and cardiac function. FGF21 signaling downstream of its obligate coreceptor, β-Klotho (KLB), is required in bacterial sepsis. However, FGF21 modulates thermogenesis and chronotropy independent of the adipose, forebrain, and hypothalamus, which are operative in cold adaptation, suggesting that in bacterial inflammation, either FGF21 signals through a novel, undescribed target tissue or concurrent signaling of multiple KLB-expressing tissues is required.


Evidence that aquaporin 1 is a major pathway for CO2 transport across the human erythrocyte membrane.
We report here the application of a previously described method to directly determine the CO2 permeability (P(CO2)) of the cell membranes of normal human red blood cells (RBCs) vs. those deficient in aquaporin 1 (AQP1), as well as AQP1-expressing Xenopus laevis oocytes. This method measures the exchange of (18)O between CO2, HCO3(-), and H2O in cell suspensions. In addition, we measure the alkaline surface pH (pH(S)) transients caused by the dominant effect of entry of CO2 vs. HCO3(-) into oocytes exposed to step increases in [CO2]. We report that 1) AQP1 constitutes the major pathway for molecular CO2 in human RBCs; lack of AQP1 reduces P(CO2) from the normal value of 0.15 +/- 0.08 (SD; n=85) cm/s by 60% to 0.06 cm/s. Expression of AQP1 in oocytes increases P(CO2) 2-fold and doubles the alkaline pH(S) gradient. 2) pCMBS, an inhibitor of the AQP1 water channel, reduces P(CO2) of RBCs solely by action on AQP1 as it has no effect in AQP1-deficient RBCs. 3) P(CO2) determinations of RBCs and pH(S) measurements of oocytes indicate that DIDS inhibits the CO2 pathway of AQP1 by half. 4) RBCs have at least one other DIDS-sensitive pathway for CO2. We conclude that AQP1 is responsible for 60% of the high P(CO2) of red cells and that another, so far unidentified, CO2 pathway is present in this membrane that may account for at least 30% of total P(CO2).


Theorizing fear of crime: beyond the rational/irrational opposition.
Much has been written about the 'social problem' of fear of crime in the criminological and sociological literature in recent years. We would argue that thus far in this literature, however, there has been too much emphasis on the question 'How rational is people's fear of crime?', a question that largely reduces the complexity of the phenomenon and positions a 'biased' lay response against an 'expert' objective judgment. In this article, we review different epistemological perspectives that can be offered to understand in greater depth the fear of crime phenomenon. We place particular emphasis on those hermeneutic perspectives that go beyond the models of the rationalist, individualistic subject to exploring issues of symbolic representation, discourse and the micro - and macro-contexts in which fear of crime is experienced and given meaning. We also draw upon two case studies from our own empirical research into fear of crime, conducted with the intention of exploring the situated narratives, cultural representations and different levels of symbolic meaning that contribute to the dynamic constitution of fear.


Larvicidal activity of synthetic tropane alkaloids against Ascia monuste orseis (Lepidoptera: Pieridae).
Tropane alkaloids are known to play a role in plant defence. By blocking acetylcholine receptors, they exert insecticidal and deterrent effects against herbivore insects. Carbamates are an important class of chemical insecticides that also inhibit acetyl cholinesterase. The objective of this work was to synthesise a series of tropane alkaloids bearing a carbamate group, and to evaluate their effects against the pest Ascia monuste. The effects of the most active compounds were evaluated on the A. monuste predator Solenopsis saevissima and on the pollinator Tetragonisca angustula. The synthesis of carbamate-tropane alkaloids was accomplished in 4-5 steps from commercially available ketones. Results from bioassays showed that compounds 6a, 10a and 14a presented higher activities against second-instar larvae of A. monuste, with LD50 values of 1.01, 3.76 and 1.92 µg substance mg-1 insect, and TL50 values of 7.0, 15.0 and 5.0 h respectively. These compounds were also tested for their selectivity in favour of S. saevissima and T. angustula. Compound 6a, which showed the highest activity against A. monuste, also showed lower toxicity against S. saevissima. Tropane alkaloid derivatives bearing a carbamate group show potential for the development of novel insecticides against A. monuste. © 2017 Society of Chemical Industry.


[Mills' syndrome].
Mills' syndrome is an idiopathic, slowly progressive ascending spastic hemiparesis. Some authors consider it as a unilateral variant of progressive lateral sclerosis. Due to the rarity of the disease and the slow clinical course, this article presents a clinical case and discusses the diagnostic criteria for the syndrome.


CD10 expression in pure stromal and sex cord-stromal tumors of the ovary: an immunohistochemical analysis of 101 cases.
CD10 has been recently advocated as a good immunohistochemical marker for endometrial stromal tumors. Metastatic endometrial stromal tumors to the ovary and primary endometrioid stromal sarcomas may show overlapping histological features with pure stromal and sex cord-stromal tumors (SCSTs). We investigated CD10 expression in a large series of pure stromal and SCSTs of the ovary to ascertain whether CD10 may aid in this differential diagnosis. Archival material from 11 fibromas, 10 thecomas, 10 sclerosing stromal tumors (SSTs), 10 adult granulosa cell tumors (AGCTs), 4 luteinized AGCTs, 9 juvenile granulosa cell tumors (JGCTs), 9 Sertoli cell tumors, 9 Sertoli-Leydig cell tumors, 11 sex cord tumors with annular tubules, 10 steroid cell tumors (StCTs), and 8 fibrosarcomas of the ovary were immunostained for CD10. The percentage of cells stained (<5%, 5%-39%, 40%-75%, and >75%) and intensity of staining (1+, 2+, 3+) were evaluated. CD10 was expressed in 7 of 10 thecomas (4 with 5%-75% and mostly 1+), 9 of 10 SSTs (7 with 5%-39% + cells, mostly 1+), 9 of 10 AGCTs (<5%-39%, four 1+, five 2+), 1 of 4 luteinized AGCTs (<5% and 1+), 8 of 9 JGCTs (mostly <5% to 39% and +1), 4 of 9 Sertoli cell tumors (either focal or >75% with variable intensity), 4 of 9 Sertoli-Leydig cell tumors (mostly <10% with variable staining), with the Leydig cells being positive in only 1 tumor (1+ and <5%), and 7 of 10 StCTs (4 tumors with more than 75% + cells, from 1+ to 3+). All fibromas, all but 1 fibrosarcoma (<5% and 1+), and all sex cord tumors with annular tubules were CD10 negative. CD10 expression was frequently seen in StCTs, SSTs, and thecomas of the ovary, although the latter 2 categories usually showed only faint immunoreactivity. In conclusion the frequency and intensity of CD10 immunoreactivity in pure stromal and sex cord-stromal ovarian tumors are low and contrast with the typical strong and diffuse immunostaining seen in endometrial stromal tumors; however, faint CD10 positivity is consistent with the diagnosis of ovarian SCST. Steroid cell tumors are often positive for CD10, but these tumors do not pose problems in differential diagnosis with endometrial stromal tumors. CD10 may play a useful role in aiding the differential between endometrial stromal tumors in the ovary and SCST and stromal tumors.


Marine copepod diversity patterns and the metabolic theory of ecology.
Temperature is a powerful correlate of large-scale terrestrial and marine diversity patterns but the mechanistic links remain unclear. Whilst many explanations have been proposed, quantitative predictions that allow them to be tested statistically are often lacking. As an important exception, the metabolic theory of ecology (MTE) provides a rather robust technique using the relationship between diversity, temperature and metabolic rate in order to elucidate the ultimate underlying mechanisms driving large-scale diversity patterns. We tested if the MTE could explain geographic variations in marine copepod diversity on both ocean-wide and regional scales (East Japan Sea and North East Atlantic). The values of the regression slopes of diversity (ln taxonomic richness) over temperature (1/kT) across all spatial scales were lower than the range predicted by the metabolic scaling law for species richness (i.e. -0.60 to -0.70).We therefore conclude that the MTE in its present form is not suitable for predicting marine copepod diversity patterns. These results further question the applicability of the MTE for explaining diversity patterns and, despite the relative lack of comparable studies in the marine environment, the generality of the MTE across systems.


Inhibitory effect of epinastine on the type II-IV allergic reactions in mice, rats and guinea pigs.
The inhibitory effect of epinastine (WAL 801 CL, CAS 80012-43-7) on types II, III and IV allergic reactions was studied. Epinastine caused an inhibition of type II allergic reactions: 1. the swelling of rat foot pad induced by a subcutaneous injection of anti-rat rabbit antiserum, and 2. lethality induced by an intravenous injection of anti-SRBC (sheep red blood cells) rabbit serum into guinea pigs (Forssman systemic reaction). The drug also caused an inhibition of the early phase in active Arthus reaction in guinea pigs (type III reactions). However, no significant inhibition was detected in the delayed-hypersensitivity reaction (type IV allergic response) induced by sheep red blood cells or picryl chloride in mice.


Ex-PRESS mini glaucoma shunt: surgical technique and review of clinical experience.
Glaucoma is a leading cause of worldwide blindness. Treatment of this chronic disease, centered on lowering intraocular pressure (IOP), may require surgical intervention when medical and/or laser therapy fail to control IOP. Traditional glaucoma surgery, such as trabeculectomy, has been performed for decades and has a proven track record of success. Unfortunately, many complications such as hypotony and slow visual recovery are known to occur and can lead to significant patient morbidity. New devices are being developed to allow surgeons increased control with more predictable postoperative results. One such device, the Ex-PRESS mini glaucoma shunt, has undergone changes in design and method of insertion making it more appealing for use in patients requiring IOP-lowering surgery. We summarize pertinent literature and expand on the future role of this device in glaucoma surgery.


A phase I/II study of neoadjuvant liposomal doxorubicin, paclitaxel, and hyperthermia in locally advanced breast cancer.
The prognosis for locally advanced breast cancer (LABC) patients continues to be poor, with an estimated five-year survival of only 50-60%. Preclinical data demonstrates enhanced therapeutic efficacy with liposomal encapsulation of doxorubicin combined with hyperthermia (HT). Therefore this phase I/II study was designed to evaluate the safety and efficacy of a novel neoadjuvant combination treatment of paclitaxel, liposomal doxorubicin, and hyperthermia. Eligible patients received four cycles of neoadjuvant liposomal doxorubicin (30-75 mg/m(2)), paclitaxel (100-175 mg/m(2)), and hyperthermia. They subsequently underwent either a modified radical mastectomy or lumpectomy with axillary node dissection followed by radiation therapy and then eight cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy. Forty-seven patients with stage IIB-III LABC were enrolled and 43 patients were evaluable. Fourteen patients (33%) had inflammatory breast cancer. Combined (partial + complete) clinical response rate was 72% and combined pathological response rate was 60%. Four patients achieved a pathologically complete response. Sixteen patients were eligible for breast-conserving surgery. The cumulative equivalent minutes (CEM 43) at T90 (tenth percentile of temperature distribution) was significantly greater for those with a pathological response. Four-year disease-free survival was 63% (95% CI, 46%-76%) and the four-year overall survival was 75% (95% CI, 58-86%). Neoadjuvant therapy using paclitaxel, liposomal doxorubicin and hyperthermia is a feasible and well tolerated treatment strategy in patients with LABC. The thermal dose parameter CEM 43 T90 was significantly correlated with attaining a pathological response.


Rodlike particles in gas discharge plasmas: theoretical model.
Recently, complex plasmas with strongly asymmetric (rodlike) particles were investigated experimentally in rf and dc discharges [V. I. Molotkov et al., JETP Lett. 71, 102 (2000); B. M. Annaratone et al., Phys. Rev. E 63, 036406 (2001)]. In this paper, a theoretical model is proposed which describes the behavior of such systems. Major results of the proposed model are the following: Equilibrium charge is calculated for particles orientated perpendicular and parallel to the ion flux (electric field); equilibrium states of particles (orientation angle and levitation height) are obtained; energy of electrostatic interaction between rods is derived, depending on the mutual orientation. Comparison of experimental and theoretical results shows quite good agreement. In conclusion, some important theoretical issues as well as possible new experiments are discussed.


Traumatic tricuspid regurgitation associated with congenital partial pericardial defect.
Traumatic tricuspid regurgitation (TR) and congenital pericardial defects are rare conditions, there being fewer than 200 recorded cases of each. Here we describe the interesting case of a patient with traumatic TR due to rupture of chordae tendineae in association with a congenital pericardial defect. We suggest that the association of traumatic TR and congenital pericardial defect has a high probability of occurrence. We hypothesize that traumatic rupture of valvular structures occurs readily in patients with congenital pericardial defects.


Synthesis and evaluation of antimicrobial activity of 4H-pyrimido[2,1-b]benzothiazole, pyrazole and benzylidene derivatives of curcumin.
A novel, one-pot, simple, efficient procedure for 4H-pyrimido[2,1-b]benzothiazole (4a-h), pyrazole (6a-d) and benzylidene (7a-d) derivatives of curcumin under solvent and solvent free conditions in microwave with good yield is have been synthesized. The synthesized compounds were evaluated for their antibacterial activity against gram-positive and gram-negative bacteria viz. Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella typhi, Escherichia coli, Bacillus cereus and Providencia rettgeri and antifungal activity against fungi viz Aspergillus niger, Aspergillus fumigates, Aspergillus flavus. Detailed mechanistic study shows reaction proceeds through Knoevenagel type intermediate 3a which has been suggested as key intermediate for reaction (Fig. 3).


Mobile-based blended learning for capacity building of health providers in rural Afghanistan.
Mobile-based blended learning initiative was launched in November 2014 in Badakshan province of Afghanistan by Tech4Life Enterprises, Aga Khan Health Service, Afghanistan (AKHS, A), and the University of Calgary, Canada. The goal of this initiative was to improve knowledge of health providers related to four major mental health problems, namely depression, psychosis, post-traumatic stress disorder (PTSD) and drug abuse. This paper presents the results of quasi-experimental study conducted in 4 intervention districts in Badakshan for improvement in the knowledge among health providers about depression. The results were compared with three control districts for the change in knowledge scores. Sixty-two health providers completed pre and post module questionnaires from case district, while 31 health providers did so from the control sites. Significant change was noticed in the case districts, where overall knowledge scores changed from 45% in pre-intervention test to 63% in post-intervention test. Overall background knowledge of pre to post module test scores changed from 30% to 40%, knowledge of symptoms showed correct responses raised from 25% to 44%, knowledge related to causes of depression from overall districts showed change from 22% to 51%, and treatment knowledge of depression improved from 29% to 35%. Average gain in scores among cases was 16.06, compared to 6.8 in controls. The study confirms that a blended Learning approach with multiple learning techniques for health providers in Badakshan, Afghanistan, enhanced their knowledge and offers an effective solution to overcome challenges in continuing education. Further research is needed to confirm that the gains in knowledge reported here translate into better practice and improved mental health.


Clinical and epidemiological characterisation of Burkitt's lymphoma: an eight-year case study at Komfo Anokye Teaching Hospital, Ghana.
Endemic Burkitt's lymphoma (BL) is a juvenile malignant neoplasm of B-lymphocyte origin, markedly affected by climate, vegetation and geographical location. This real country-based, cross-sectional, retrospective study reviews all out-patient clinical records of patients histologically and/or clinically diagnosed with BL from January, 2000 to December, 2007 at the Komfo Anokye Teaching Hospital, Ghana, a country within the malaria and lymphoma belts of the world. The aim of the study is to clinically and epidemiologically characterise all cases of BL over an eight-year period to ascertain the most common form of BL demographically prevalent. A mean age of 6.9 +/- 2.7 (range: 1-16) was observed. Males generally dominated in incidence (M:F=1.43:1, P<0.001) and significantly with facial presentation (P<0.05). Females weakly dominated in abdominal tumour presentation (P>0.05). The age range 4-8 years was the high risk range (P<0.001) for both sexes. Males were affected early in life (4-7 years) compared to their female counterparts (6-11 years). Of the 551 cases reviewed, 48.3%, 32.7%, 15.8% and 3.3% involved the face, abdomen, combined facial and abdominal and either facial or abdominal with central nervous system (CNS) involvement (usually paraplegia), respectively. An intriguing observation was evident between facial and combined facial and abdominal cases which exhibited reversed trends in incidence. Three regions within the forest zone showed significantly higher (P<0.001) incidences compared to the seven cohorts from the coastal and savannah agro-ecological zones of Ghana. No region was explicitly associated with any particular clinical presentation. The study has shown that although BL can present with demographic patterns in prevalence within a given geographical location, no clinical characterisation is associated with such patterns.


Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae).
Fracture sequelae of the proximal part of the humerus are challenging conditions, and various treatment options have been described. The purpose of this multicenter study was to analyze the clinical and radiographic outcomes as well as the complications following semiconstrained reverse total shoulder arthroplasty for the treatment of nonunion of a surgical neck fracture of the proximal part of the humerus. Thirty-two patients with a mean age of sixty-eight years (range, forty-eight to eighty-three years) managed with a reverse shoulder arthroplasty for the treatment of nonunion of a proximal humeral fracture were analyzed clinically and radiographically. The mean duration of follow-up was four years (range, two to twelve years). The Constant score, active shoulder mobility, all complications, and revision procedures were recorded. The mean Constant score increased from 14.2 points (range, 2 to 35 points) to 46.6 points (range, 6 to 75 points) (p < 0.001). The mean shoulder flexion increased from 42.9° (range, 0° to 160°) to 109.7° (range, 0° to 170°) (p < 0.001), and the mean external rotation increased from 0.5° (range, -40° to 60°) to 13.1° (range, -30° to 60°) (p < 0.005). No component loosening occurred, but 50% (sixteen) of the patients had radiographic evidence of scapular notching. There were thirteen complications (41%) leading to nine revision surgical procedures (28%). The most common complication was a dislocation following reverse shoulder arthroplasty, which occurred in 34% (eleven) of the patients. An intraoperative resection of the humeral head fragment and the tuberosities was associated with increased risk of dislocation (p < 0.007). Nonunions of the proximal part of the humerus can be treated with reverse shoulder arthroplasty. Although clinical outcomes improved significantly, we found an unacceptably high rate of dislocations associated with intraoperative resection of the tuberosities. The tuberosities and the attached rotator cuff should be preserved if possible to reduce the risk of dislocation after reverse total shoulder arthroplasty.


Mechanistic Insight into Palladium-Catalyzed Cycloisomerization: A Combined Experimental and Theoretical Study.
The cycloisomerization of enynes catalyzed by Pd(OAc)2 and bis-benzylidene ethylenediamine (bbeda) is a landmark methodology in transition-metal-catalyzed cycloisomerization. However, the mechanistic pathway by which this reaction proceeds has remained unclear for several decades. Here we describe mechanistic investigations into this reaction using enynamides, which deliver azacycles with high regio- and stereocontrol. Extensive 1H NMR spectroscopic studies and isotope effects support a palladium(II) hydride-mediated pathway and reveal crucial roles of bbeda, water, and the precise nature of the Pd(OAc)2 pre-catalyst. Computational studies support these mechanistic findings and lead to a clear picture of the origins of the high stereocontrol that can be achieved in this transformation, as well as suggesting a novel mechanism by which hydrometalation proceeds.


Taking on the Obesity Epidemic : Researchers Wage a Big Fat Fight in Efforts to Combat This Global Health Issue.
If obesity were tied only to too much food or too little physical activity, the cure would be a simple matter of counting calories or keeping track of steps with a pedometer. Unfortunately, obesity is much more complex. Many other factors come into play, including so-called hunger genes that make a person more susceptible to obesity, infection with certain pathogens linked to weight gain, hormones that dampen or stimulate appetite, sleep disruption that can trigger overeating, and social networks that can promote obesity.


Better resource utilization and quality of care for cervical cancer screening in low-resourced districts using an internet-based expert system.
Screening tools are critical in the early prevention of cervical cancers. Acetic-acid based colposcopy test provides an affordable solution but is often challenged by the lack of experienced doctors in under-developed districts. To evaluate the feasibility of an internet-based expert system to better utilize the expert knowledge. A centralized internet-based expert system was developed to upload acetowhite images acquired by an integrated colposcopy device at remote healthcare centers. The detection rates of high grade cervical intraepithelial neoplasia (CIN) during two consecutive years (installed in the second year) were collected at two study sites and twelve control sites. No difference in the detection rate was observed between study and control sites at baseline (year 1); however, greater detection rates were found at study sites after introducing the internet-based expert system (year 2). Comparing the detection rates at each site between year 1 and year 2, the study site exhibited improved detection rates. User feedbacks suggested "great learning experience from expert feedback" as the most recognized benefits. This study shows the feasibility of an internet-based expert system in screening cervical cancers and lays the foundation to future population-level application in under-developed districts.


Evaluation of the adjuvant effect of silver nanoparticles both in vitro and in vivo.
The immunological adjuvant effect of silver nanoparticles (AgNPs) was investigated both in vitro and in vivo. The in vivo adjuvant effect of AgNPs was evaluated with model antigen ovalbumin (OVA) and bovine serum albumin (BSA) in mice by intraperitoneal and subcutaneous immunization. Serum antigen-specific IgG level significantly increased in AgNPs-treated mice comparing to the control group. AgNPs induced the increase of IgG1/IgG2a ratio and antigen-specific IgE, indicating that AgNPs elicited Th2-biased immune responses. By in vitro assay, the mechanism of adjuvant effect was explored. After 48h treatment with AgNPs, both the number of leukocytes and levels of cytokines TNF-α and IFN-γ in abdominal lavage fluid of mice increased. The expression of the major histocompatibility complex class II molecule on the surface of peritoneal macrophages significantly increased. AgNPs can be easily phagocytosed by peritoneal macrophages, while do not affect antigen uptake by the cell. We therefore conclude that AgNPs have significant adjuvant effect and the mechanism of this effect is mainly ascribed to the recruitment and activation of local leukocytes and especially macrophages. For the first time we found the remarkable adjuvant effect of AgNPs, and the result is beneficial for the future applications, especially in biomedicine.


Emerging roles of transmembrane-type tight junction proteins in cancers.
Tight junctions (TJs) are the most apical components of the cell-cell adhesion machinery in epithelial and endothelial cells and they play essential roles in homeostasis. Recent studies have revealed that aberrant expression of tight junction proteins (TJPs) is frequently observed in various type of cancers. Here we review cancer-associated aberrant expression of TJPs with focus on transmembrane-type TJPs including claudins, junctional adhesion molecule-A (JAM-A), and occludin. Some transmembrane-type TJPs are upregulated at the early neoplastic stage and their expression persists during dedifferentiation. Aberrant expression of TJPs contributes to proliferation, invasion, and dysregulated signaling of cancer cells. In addition to an increase in their expression level, their localization is altered from a TJ-restricted pattern to distribution throughout the whole cell membrane, making them suitable as therapeutic targets. Extracellular domains of transmembrane-type TJPs can be approached by target drugs not only from the lumen side (apical side) but also from the extracellular matrix side (basal side), including blood vessels. Aberrantly expressed TJPs are potential useful diagnostic markers as well as therapeutic targets for cancers.


Intrahepatic bile duct and portal vein anatomy revisited.
Seventeen normal cadaver livers were studied to assess the anatomic relationship of bile ducts to portal veins. The common bile duct, main portal vein, and hepatic artery were cannulated and injected with air, dilute contrast medium, and mineral oil, respectively. The livers were placed in anatomic position and examined with computed tomography. In the lateral segment of the left hepatic lobe, the bile ducts were anterior to the portal vein in seven cases, posterior in seven, and tortuous (ie, both anterior and posterior) in three. In the medial segment of the left lobe, the bile ducts were anterior in four cases, posterior in four, tortuous in three, and not seen in six. In the right lobe, the bile ducts were anterior in nine cases, posterior in five, tortuous in one, and not seen in two. In the porta hepatis, the bile ducts were anterior in ten cases, posterior in one, tortuous in five, and not seen in one. Histologic findings confirmed the anterior and posterior location of the bile ducts relative to the portal veins. These findings contradict the commonly held view of intrahepatic bile ducts being anterior to the portal vein and are clinically significant for techniques such as bile duct drainage.


BK Virus-associated Hemorrhagic Cystitis in Patients with Allogeneic Hematopoietic Cell Transplantation: Report of Three Cases.
BK viras is a human polyoma viras. It is acquired in early childhood and remains life-long latent in the genitourinary system. BK virus replication is more common in receiving immunosuppressive therapy receiving patients and transplant patients. BK virus could cause hemorrhagic cystitis in patients with allogeneic stem cell transplantation. Hemorrhagic cystitis is a serious complication of hematopoietic stem cell transplantation. Hemorrhagic cystitis could cause morbidity and long stay in the hospital. Diagnosis is more frequently determined by the presence of BK virus DNA detected with quantitative or real-time PCR testing in serum or plasma and less often in urine. The reduction of immunosuppression is effective in the treatment of BK virus infection. There are also several agents with anti-BK virus activity. Cidofovir is an active agent against a variety of DNA viruses including poliomyoma viruses and it is a cytosine nucleotide analogue. Intravenous immunoglobulin IgG (IVIG) also includes antibodies against BK and JC (John Cunningham) viruses. Hereby, we report three cases of hemorrhagic cystitis. Hemorrhagic cystitis developed in all these three cases of allogeneic stem cell transplantation due to acute myeloid leukemia (AML). BK virus were detected as the cause of hemorrhagic cystitis in these patients. Irrigation of the bladder was performed. Then levofloxacin 1 x750 mg intravenous and IVIG 0.5 gr/kg were started. But the hematuria did not decreased. In the first case, treatment with leflunomide was started, but patient died due to refractory AML and severe graft-versus-host disease after 4th day of leflunamide and levofloxacin treatments. Cidofovir treatment and the reduction of immunosuppressive treatment decreased the BK virus load and resulted symptomatic improvement in the second case. Initiation of cidofovir was planned in the third case. Administration of cidofovir together with the reduction of immunosuppression in the treatment of hemorrhagic cystitis associated with BK virus in allogeneic stem cell transplant recipients could be a good option.


Quantitative determination of the stability of the implant-tissue interface using resonance frequency analysis.
Bone anchored implants are now being used in dentistry for supporting intraoral and craniofacial prostheses. Although high success rates have been reported, a small number of implants may fail during the early healing phase or lateral in function. Currently available clinical methods to determine implant stability and osseointegration are relatively crude and may entail percussing a fixture with a blunt instrument. Radiographs are of value, but a standardised technique is necessary to ensure repeatability. This investigation was designed to study the application of a non-invasive test method using resonance frequency analysis to make quantitative measurements of the stability of the implant tissue interface in-vitro and in-vivo. The resonance frequency of a small transducer was measured when attached to implants embedded at different heights in an aluminum block. A strong correlation (r = 0.94, p < 0.01) was observed between the observed frequency and the height of implantation fixture exposed. The change in stiffness observed in the bone surrounding an implant during healing was modelled by embedding implants in self-curing polymethylmethacrylate and measuring the resonance frequency at periods during polymerisation. A significant increase in resonance frequency was observed related to the increase in stiffness. Resonance frequency measurements were also made on implants in-vivo and the results correlated well with the in-vitro findings.


Insights and Challenges of Multi-Scale Modeling of Sarcomere Mechanics in cTn and Tm DCM Mutants-Genotype to Cellular Phenotype.
Dilated Cardiomyopathy (DCM) is a leading cause of sudden cardiac death characterized by impaired pump function and dilatation of cardiac ventricles. In this review we discuss various in silico approaches to elucidating the mechanisms of genetic mutations leading to DCM. The approaches covered in this review focus on bridging the spatial and temporal gaps that exist between molecular and cellular processes. Mutations in sarcomeric regulatory thin filament proteins such as the troponin complex (cTn) and Tropomyosin (Tm) have been associated with DCM. Despite the experimentally-observed myofilament measures of contractility in the case of these mutations, the mechanisms by which the underlying molecular changes and protein interactions scale up to organ failure by these mutations remains elusive. The review highlights multi-scale modeling approaches and their applicability to study the effects of sarcomeric gene mutations in-silico. We discuss some of the insights that can be gained from computational models of cardiac biomechanics when scaling from molecular states to cellular level.


Vection induced by illusory motion in a stationary image.
Ilusory self-motion (vection) can be induced by large areas of visual motion stimulation. Here we demonstrate for the first time that illusory expansion can induce vection in the absence of any physical display motion.


Circadian clocks in mood-related behaviors.
The circadian clock organizes biochemical and physiological processes of an organism in a temporal fashion. This temporal organization is crucial to avoid interference of processes that have adverse effects on each other. Thus, disruption of temporal organization can lead to health problems and behavioral disorders related to mood alterations. To alleviate the consequences of a disrupted temporal organization in the body, it is of importance to understand the processes involved in the synchronization of all body clocks and their phase relationship to the environmental day/night cycle at the mechanistic level. This review will focus on internal and external factors affecting synchronization and function of the circadian system and highlight connections to mood-related behavior.


Elbow Dislocation and Subluxation Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014.
Examination of the incidence of elbow dislocation and subluxation injuries in the collegiate athlete population is limited. To determine the incidence of elbow dislocation and subluxation injuries in the National Collegiate Athletic Association (NCAA) and investigate the risk factors involved. Descriptive epidemiology study. All elbow subluxation and dislocation injuries from the 2009-2010 through 2013-2014 academic years in the NCAA Injury Surveillance Program database were extracted. The incidence was calculated for different injuries, sports, activity, time in game, competition status, and injury characteristics. Such differences were compared by use of risk ratios to determine risk factors for injury. The overall incidence of elbow instability injuries was 0.04 per 10,000 athlete-exposures (AEs). Elbow dislocations were more common, with 553 injuries (82.2%, 0.03/10,000 AEs), while elbow subluxations were the minority, with 119 injuries (17.8%, 0.01/10,000 AEs). Men's wrestling had the highest incidence of elbow instability (1.08/10,000 AEs), more than women's gymnastics (0.74), men's football (0.11), and women's volleyball (0.06). All injuries occurred via a contact mechanism, and 99.2% were new injuries. Sixty-nine percent of injuries kept athletes sidelined for more than 2 weeks. Injuries were 3 times more likely to occur in competition (0.08/10,000 AEs) than practice (0.03/10,000 AEs). Injuries sustained during competition were 1.4 times more likely to occur early in the match than late. Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes, with a number of associated risk factors. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from these return-to-play data to best manage expectations and outcomes.


BTK mutations selectively regulate BTK expression and upregulate monocyte XBP1 mRNA in XLA patients.
Mutations in the Bruton agammaglobulinemia tyrosine kinase (BTK) gene are responsible for X-linked agammaglobulinemia (XLA). Unfolded or misfolded proteins can trigger stress pathways in the endoplasmic reticulum (ER), known as unfolded protein response (UPR). The aim was to clarify the involvement of UPR in XLA pathophysiology. By reverse transcription-quantitative PCR, we evaluated the expression of BTK and 12 UPR-related genes in eight patients. Moreover, we assessed the BTK protein expression and pattern in the patients' monocytes by flow cytometry and fluorescence immunocytochemistry. We found a reduced BTK expression in patients with stop codon mutations (P < 0.02). However, missense mutations did not affect BTK expression. Flow cytometry showed a reduction of BTK in patients which was corroborated by an absent or nonfunctional protein synthesis revealed by immunocytochemistry. In contrast with the other UPR-related genes, X-box binding protein 1 (XBP1) was markedly upregulated in the patients (P < 0.01), suggesting Toll-like receptor (TLR) activation since BTK directly interacts with TLRs as a negative regulator and XBP1 can be activated in direct response to TLR ligation. Different BTK mutations can be identified by the BTK expression. Inasmuch as UPR-related genes were downregulated or unaltered in patients, we speculate the involvement of the TLRs-XBP1 axis in the XLA pathophysiology. Such data could be the basis for further studies of this novel pathomechanism concerning XLA.


Tetralogy of Fallot with isolated levocardia in a young female.
Tetralogy of Fallot is the most common cyanotic congenital heart disease. It consists of right ventricular outflow tract obstruction, a ventricular septal defect, abnormally located aorta and right ventricular hypertrophy. It usually occurs as an isolated anomaly with a normally placed heart and abdominal viscera. We present a case of a 19 years old female who presented with a prolonged history of shortness of breath (SOB) and cyanosis. After undergoing echocardiography and cardiac computed tomography angiogram (CTA), she was diagnosed to be a case of Tetrology of Fallot (TOF) in association with situs inversus with levocardia also termed 'isolated levocardia'. The patient underwent surgical correction and she was asymptomatic with no residual cardiac defects on follow up after 6 months. Isolated levocardia is a rare condition that is usually associated with severe cardiac defects and a low life expectancy in untreated patients. It is unusual for it to be diagnosed in adults as in our case.


Urethroplasty Outcomes for Pars Fixa Urethral Strictures Following Gender-affirming Phalloplasty and Metoidioplasty: A Retrospective Study.
To evaluate outcomes of three urethroplasty techniques for pars fixa (PF) urethral strictures and provide a treatment algorithm based on stricture characteristics. The PF is an essential anatomic region of the neourethra created in gender-affirming phalloplasty and metoidioplasty. Urethral strictures in this region present a reparative challenge given its unique anatomy and vascularization. A total of 41 urethroplasties performed on 41 patients between March 2018 and June 2021 were reviewed at two surgical centers. A Heineke-Mikulicz (HM) repair was done for strictures under 20 mm when the proximal and distal urethral segments were mobile and supported a tension-free closure. Substitution urethroplasty with ventral onlay buccal mucosal graft was utilized for strictures under 40 mm not suitable for HM repair. Complex or long (≥40 mm) strictures were treated by two-stage Johansen urethroplasty. Success of each surgical approach was defined by a minimum of 12-month follow-up without the need for a repeat intervention. Mean follow-up was 30.2 months (range: 12.4-52.0 months). Mean stricture length was 16.9 mm (range: 2-55 mm). Most strictures (46%) were located at the distal PF. HM urethroplasty had a success rate of 44% (n = 16). Substitution urethroplasty had a success rate of 92% (n = 13). Two-stage Johansen urethroplasty had a success rate of 75% (n = 12). The success rates of PF urethral stricture repair ranged from 44% to 92% depending on the surgical approach, and the best reparative procedure depends on stricture length, severity, and local tissue mobility.


Urgent liver transplantation for biliary atresia: the experience in Bicêtre.
According to French rules for cadaver organ sharing, children with biliary atresia (BA) complicated with acute necrosis (ALN) can be registered on the waiting list for liver transplantation (LT) in a special intermediate grade urgent code. Over a 7 years period, 100 children have been submitted to elective LT for BA and 15 to urgent LT. Urgent procedures accounted for 25% of LT for BA in patients aged 0-2 years and 67% (8/12) in patients under 1 year of age. Children actuarial survival at 1, 12 and 48 months was respectively 66%, 60% and 60% versus 92%, 86% and 85%, deaths occurring earlier in the urgent group. Graft actuarial survival at 1, 12 and 48 months were 60%, 53% and 53% versus 85%, 77% and 76% (p < 0.05), respectively. Outcome of children and grafts after LT is not significantly different in BA cases and in other urgent indications, excluding retransplantations. In a LT program based on cadaver organ donation, allocation of in an urgent registration code to children with BA and ALN offers them more than 50% chance to escape death and does not result in wasting of grafts.


Stress fractures in 51 runners.
A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.


Molecular events in gastric carcinogenesis.
Gastric cancer represents an important problem for the public health, being one of the main causes of mortality. At present, it represents the second cause of mortality due to cancer, after the bronchopulmonary cancer in men and the fourth cause of mortality in women. Important progresses have been made in the last couple of years in determining the neoplastic etiopathogenesis, but it cannot be affirmed that the genetic mutations chain, which leads to the appearance of the malignant cell, has been fully understood.