Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression
Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable using structural MRI. We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques. Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity. Normalization by intracranial volume nullified some between-group differences in volumetric measures. There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials.


Profiling of structurally labile oxylipins in plants by in situ derivatization with pentafluorobenzyl hydroxylamine.
A GC-MS-based method for the simultaneous quantification of common oxylipins along with labile and highly reactive compounds based on in situ derivatization with pentafluorobenzyl hydroxylamine to the corresponding O-2,3,4,5,6-pentafluorobenzyl oximes (PFB oximes) is presented. The approach covers oxo derivatives such as jasmonic acid (JA), 12-oxophytodienoic acid (OPDA), certain phytoprostanes, unsaturated oxo-acids, oxo-hydroxy acids, and aldehyde fragments from the polar head of fatty acids. In the positive electron impact-MS mode, the PFB oximes display characteristic fragment ions that greatly facilitate the identification of oxylipins in complex matrices. In addition, the fluorinated derivatives allow a highly selective and low-background analysis by negative chemical ionization. Besides showing the general value of the method for the identification of a broad range of oxylipins (18 examples), we also demonstrate sensitivity, linearity, and reproducibility for the quantification of JA, OPDA, 11-oxo-9-undecenoic acid, and 13-oxo-9,11-tridecadienoic acid. The efficiency of the method is demonstrated by differential profiling of these four oxylipins in lima bean leaves after mechanical wounding and feeding by the herbivore Spodoptera littoralis. Caterpillar feeding induced several oxylipins, whereas after wounding only the level of JA increased. The rapid in situ derivatization prevents the isomerization of cis-JA to trans-JA. The resting level of JA in lima beans showed an isomer ratio of 80:20 for trans/cis-JA. After wounding, de novo synthesis of JA alters the ratio to 20:80 in favor of the cis isomer.


Prevalence and pattern of eye disorders among commercial motorcycle riders in Ile-Ife, Osun state.
To describe the prevalence and pattern of eye disorders existing among commercial motorcycle riders (CMRs) in Ile-Ife, Osun State. Materials, Subjects and Methods: A total of 1626 registered CMRs operated in 40 registered motorcycle assembly units in Ile-Ife. Using a multi- staged random sampling technique, a total of 322 riders were randomly selected from 10 units. Equal number of 322 was selected from the sample space as control. Structured questionnaires were administered and ocular examination carried out. SA total of 312 (96.9%) CMRs had normal vision (better than 6/18) in the better eye. The observed prevalence of subnormal visual acuity (<6/18-3/60) was 3.1% (10 CMRs) while prevalence of monocular vision was 2.8% (9 riders). Cataract and glaucoma were the major causes of visual impairment and blindness. The common ocular conditions seen were presbyopia (11.8%), allergic conjunctivitis (11.5%), glaucoma suspect (8.1%), pterygium (4.7%), pingueculum (4.0%), uncorrected refractive error (3.7%) and cataract (2.8%). It was also observed that the longer the years of riding experience of these riders, the higher the occurrence of pterygium with a significant statistical impact of p value of 0.009. Presbyopia was also the commonest disorder amongst the control group (11.2%). Presbyopia was the most common finding from the study while the commonest anterior segment disorder was pterygium which was an occupation- related ocular disorder. Causes of blindness seen were avoidable.


Anatomy of pectoral fascia in relation to subfascial mammary augmentation.
The aim of this study is to elucidate the anatomic details of the pectoral fascia in relation to subfascial breast augmentation.Thirty-two breasts of Korean cadavers were dissected and studied grossly and microscopically. The superficial pectoral fascia (SPF) was easily undermined and separated with an Agris-Dingman dissector. A gentle pushing force by the dissector could stretch the SPF and extend the subfascial pocket further at the lateral border of pectoralis major muscle (PM). The dissector head stayed inside the pocket, not perforating through the fascia. Near the inferior border of PM at the level of the sixth intercostal space, the dissection was hard to advance down beyond rectus abdominis muscle (RA). Yet a continuous vigorous dissection led into the subcutaneous layer of the abdominal wall over RA. The SPF is thick and continues to superficial axillary fascia at the lateral end of the muscle. At the inferior border of the PM (sixth intercostal space), however, the pectoral fascia became thin and feeble. The subfascial implants should be placed under the SPF, laterally beyond the lateral border of PM and inferiorly under the glandular tissue of the breast below the sixth intercostal space.


Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet.
To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS fulfilling the ROME III criteria, who previously attended an outpatient clinic for low FODMAP diet (LFD) dietary management and assessment by a gastroenterologist, were invited to participate in a retrospective questionnaire analysis. The questionnaires were sent and returned by regular mail and gathered information on recall of dietary treatment, efficacy, symptoms, adherence, satisfaction, change in disease course and stool type, and quality of life. Before study enrolment all patients had to sign an informed written consent. One hundred and eighty patients were included, 131 (73%) IBS and 49 (27%) IBD patients. Median age was 43 years (range: 18-85) and 147 (82%) were females. Median follow-up time was 16 mo (range: 2-80). Eighty-six percent reported either partial (54%) or full (32%) efficacy with greatest improvement of bloating (82%) and abdominal pain (71%). The proportion of patients with full efficacy tended to be greater in the IBD group than in the IBS group (42% vs 29%, P = 0.08). There was a significant reduction in patients with a chronic continuous disease course in both the IBS group (25%, P < 0.001) and IBD group (23%, P = 0.002) along with a significant increase in patients with a mild indolent disease course of 37% (P < 0.001) and 23% (P = 0.002), respectively. The proportion of patients having normal stools increased with 41% in the IBS group (P < 0.001) and 66% in the IBD group (P < 0.001). One-third of patients adhered to the diet and high adherence was associated with longer duration of dietary course (P < 0.001). Satisfaction with dietary management was seen in 83 (70%) IBS patients and 24 (55%) IBD patients. Eighty-four percent of patients lived on a modified LFD, where some foods rich in FODMAPs were reintroduced, and 16% followed the LFD by the book without deviations. Wheat, dairy products, and onions were the foods most often not reintroduced by patients. These data suggest that a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients.


Malignant atrophic papulosis with severe gastrointestinal perforation and omental necrosis: a case report.
Malignant atrophic papulosis (MAP) is a rare disease with an extremely grim prognosis, death being due to gastrointestinal perforation and neurological disorders. We report a severe case of MAP in a 37-year old woman. The patient had three emergent laparotomies in 3 months for recurrent acute peritonitis due to omental thrombosis resulting in necrosis, multiple intestinal and mesenteric lesions, and severe gastrointestinal perforations. Multiple papular skin lesions were present for 1 year prior to surgery. Pathological findings revealed MAP. Surgical intervention was successful and the patient recovered smoothly but later died of malnutrition and septicaemia.


Energy expenditure and severity of injury and illness indices in multiple trauma patients.
To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors for trauma. Prospective, clinical study. General intensive care unit of a university teaching hospital. Immediate multiple trauma adult patients who required mechanical ventilation. Metabolic cart connected to the ventilator. Data on admission to the emergency department and during the first 24 hrs of intensive care unit admission were collected for computation of severity of injury and illness indices, respectively. Resting and total energy expenditures were derived at least 48 hrs after intensive care unit admission by continuous indirect calorimetry. Predicted basal energy expenditure was obtained using the Harris-Benedict equation and predicted total energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for trauma. Twenty-six multiple trauma adult patients completed the study. No statistically significant correlations were observed between both the resting energy expenditure and the total energy expenditure and the Injury Severity Score, Revised Trauma Score, Simplified Acute Physiologic Score II, Acute Physiology and Chronic Health Evaluation II score, and Glasgow Coma Scale score. A regression model of total energy expenditure was developed with the following variables: Harris-Benedict equation, heart rate, and minute ventilation (p = .01; r2 = .74). The resting energy expenditure/predicted basal energy expenditure ratio was 1.17+/-0.2 and the total energy expenditure/predicted total energy expenditure ratio was 0.76+/-0.1. In mechanically ventilated multiple trauma patients the energy expenditure is not correlated to the severity of injury and illness indices but is dependent on the Harris-Benedict equation in addition to heart rate and minute ventilation. Furthermore, this patient population is characterized by a moderate state of hypermetabolism, and the Harris-Benedict prediction modified with correction factors for trauma systematically overestimates the total energy expenditure.


Nurses' Perceptions and Attitudes Toward Use of Oral Patient-Controlled Analgesia.
Patient-controlled analgesia (PCA) administered intravenously is a generally well-accepted therapy by nurses and patients. PCA devices are now available for oral medications, allowing patients to self-administer pain pills without requesting them from the nurse. Successful introduction of new pain medication delivery devices can depend on nurses' knowledge and attitudes. The aim of this institutional review board approved project was to evaluate nurses' perceptions and attitudes toward using an oral PCA device for patients' pain. A 4-week study was designed and conducted at an academic medical center on an orthopedic unit and a women's health unit. Nurse participants received education on using the oral PCA device and were invited to complete a pre- and poststudy knowledge and attitude survey regarding pain management. Nurses and patients also completed a questionnaire about perceptions related to using the oral PCA device. Findings showed that nurses' attitudes toward using the oral PCA device were less favorable than those of patients, suggesting that nurses may require additional education for acceptance of this device. Results from 37 nurses showed improvement in overall knowledge and attitudes, from 70.8% pretest to 74.2% post-test. Although improvement was not statistically significant (p = .1637), two items showed significant improvement. Knowledge about the effectiveness of NSAIDS was 27.5% pretest compared with 60.0% post-test (p = .0028); and understanding about use of opioids in patients with a history of substance abuse was 50% pretest compared with 70% post-test (p = .0531). Helping nurses overcome the perceived barriers to use of an oral PCA device has potential implications for better pain management as well as enhanced patient satisfaction.


Catabolism of adenine nucleotides and its relation with intracellular phosphorylated metabolite concentration during ethanol oxidation in perfused rat liver.
Ethanol-induced perturbations in the energy metabolism and in the catabolism of adenine nucleotides were investigated by 31P NMR spectroscopy and HPLC analyses in perfused rat liver. Ethanol oxidation reduced the redox potential of the hepatocyte, leading to an intracellular accumulation of sn-glycerol 3-phosphate. This accumulation, in turn, led to a cytosolic P(i) depletion with stoichiometric relationship close to 1/1 for an initial period of 2 min. The concentration of nucleoside 5'-triphosphates (83 +/- 4% of ATP) was decreased during ethanol oxidation, reaching about 66% of its control value [2.88 +/- 0.02 mumol.(g of liver wet wt)-1] at high ethanol doses (10 and 70 mM). The depletion of P(i) relieved the inhibition exerted by this compound on AMP deaminase, key enzyme in the catabolism of adenine nucleotides. The degradation of AMP was monitored by HPLC analyses of the adenine nucleosides and bases released in the effluents. Integration over time of the total release of these metabolites accounted for the depletion of ATP recorded in the same time by 31P NMR spectroscopy. This result suggests that ATP depletion occurring during ethanol oxidation originated from an enhanced degradation of adenine nucleotides. There was a strong linear correlation (r2 = 0.92) between cytosolic P(i) level and allantoin release rate during ethanol perfusion. Cytosolic P(i) and allantoin release exhibited biphasic behavior, the recovery toward the initial levels being related to the release of P(i) in the cytoplasm during the complete catabolism of adenine nucleotides. Finally, the depletion of P(i) affected the glycogenolysis pathway, with a maximal inhibition of ca. 19% of the initial level.


Digital Design of a Universal Rat Intraoral Device for Therapeutic Evaluation of a Topical Formulation against Candida-Associated Denture Stomatitis.
Candida-associated denture stomatitis (DS) is a persistent and chronic oral infection of the denture-bearing palatal mucosa. DS stems from the ability of the fungal opportunistic pathogen Candida albicans to adhere to denture material and invade palatal tissue. Although DS is the most prevalent form of oral candidiasis, there are currently no feasible therapeutic strategies for the prevention of this recurrent condition. We developed a peptide-based antimicrobial bioadhesive formulation specifically designed for oral topical formulation. In this study, we aimed to evaluate the applicability of the novel formulation for the prevention of C. albicans colonization on denture material and development of clinical disease. To that end, using the latest technological advances in dental digital design and three-dimensional (3D) printing, we fabricated an intraoral device for rats with universal fit. The device was successfully installed and used to develop clinical DS. Importantly, by taking a preventative therapeutic approach, we demonstrated the potential clinical utility of the novel formulation as a safe and feasible prophylactic agent against DS.


Expression of phosphorylated heat shock protein 27 during corneal epithelial wound healing.
The 27-kDa heat shock protein (HSP27) has been implicated in wound healing in multiple tissues. We investigated the expression and localization of phosphorylated HSP27 during epithelial wound healing in the murine cornea. Corneas of 8- to 10-week-old C57BL6 mice were wounded by epithelial debridement (n = 40). Unwounded corneas served as controls (n = 3). After 3, 7, and 14 days, phosphorylated HSP27 localization in wounded corneas was observed by confocal immunohistochemistry and double immunogold labeling transmission immunoelectron microscopy. Western blot analysis was performed to determine expression levels of phosphorylated HSP27 in scraped epithelia. Phosphorylated HSP27 localization was also separately performed with confocal immunohistochemistry 8 hours after epithelial debridement to investigate the early epithelial wound-healing process. In unwounded corneas, phosphorylated HSP27 was localized only to the superficial epithelium. In contrast, phosphorylated HSP27 was localized in the basal and superficial epithelia 3 days after corneal epithelial wounding. After 7 and 14 days, HSP27 localization was similar to that in unwounded controls. Expression levels of phosphorylated HSP27 were greater in wounded corneal epithelia on day 3 than in unwounded controls and on day 14. After 8 hours, phosphorylated HSP27 expression was prominent in the leading edge of migrating corneal epithelium. Constitutive expression of phosphorylated HSP27 is limited to the superficial corneal epithelium in unwounded murine corneas. Changes in HSP27 epithelial distribution and expression levels after corneal epithelial wounding suggest that phosphorylated HSP27 plays a role in early phase of corneal epithelial wound healing.


10 J operation of a conductive-cooled Yb:YAG active-mirror amplifier and prospects for 100 Hz operation.
We report, to the best of our knowledge, the highest power conductive-cooled active-mirror amplifier (CcAMA) using Yb:YAG with a pulse energy of 10 J. By using four liquid-nitrogen circulating cooled laser heads, we achieved a repetition rate, pulse energy, and average power of 33.3 Hz, 9.3 J, and 310 W, respectively. The problem of wavefront distortion, which is difficult to solve with a large-aperture active-mirror laser, is suppressed by using reinforcing materials with the same thermal expansion coefficient. We have confirmed that the wavefront distortion is small (0.15λ P-V per head) at 100 Hz operation, which paves the way for 100 Hz operation with the CcAMA concept.


[Treatment and management of Chlamydophila felis infections in cats].
Chlamydophila felis is a common organism among cats and has been detected in up to 60% of cats with conjunctivitis or upper respiratory tract disease. Transmission is mainly caused by direct contact to symptomatic cats. Nevertheless, carriers without current clinical signs are able to shed the organism and, therefore, are a source of infection as well. Treatment and management of infection may be difficult as cats often live in close contact with shedding cats. The most common problem in multi-cat households is re-infection. The intracellular occurrence of Chlamydophila felis requires antibiotics that exhibit a good intracellular efficacy. In this review article, currently used treatment and management regimes are described and compared to each other.


Relationship between bilateral condylar bone change and mandibular morphology: a study using morphometry.
This study was undertaken to evaluate the relationship between bilateral condylar bone change (BCBC) and mandibular morphology. Thirty Japanese women with BCBC as diagnosed from computed tomographic scans were compared to 2 control groups: 26 Class I and 25 Class II Japanese women. All cephalograms were traced and scanned, and 14 homologous landmarks were digitized. Coordinates were used for cephalometric analysis, Procrustes analysis, Euclidean distance matrix analysis (EDMA), and thin-plate spline (TPS) analysis. Comparison of the cephalometric data for the BCBC and Class I groups revealed significant shrinkage in the condylar process and ramus height, in addition to a shorter body length. The centroid size showed that BCBC mean geometric forms were smaller than those of Class I and Class II. The landmark morphology of the BCBC group differed from both Class I and Class II, as shown by the residuals (P < .001). EDMA showed expansion of infradentale-pogonion (9.9%) and along the anterior slope height of the condyle (28.6%), while the posterior slope height decreased (21.6%). The vertical ramus height (gonioncondylion) also decreased by 11.8% in comparison to Class I. Compared to Class II, BCBC ramus height was shorter by 8.9%, condylar width decreased 13.7%, and the posterior condylar slope was 22% shorter. TPS analysis showed increased antegonial notching, a vertically expanded symphysis, and a collapsed and more horizontal condyle in the BCBC group. The combination of the above methods was very helpful in assessing mandibular morphology and showed that BCBC might be related not only to changes in the condyle, but may dictate changes in the rest of the mandible as well.


Detection of colour change in moving objects: temporal order judgment and reaction time analysis.
The time needed to detect changes in the colouration of a single moving stimulus becomes shorter with its increasing velocity (Kreegipuu et al, 2006 Vision Research 46 1848-1855). We examined the ability to detect colour change in moving chromatic bars or sinusoidal gratings through temporal order judgment (TOJ) and reaction time (RT) tasks to test whether the effect of velocity found in a previous study is universal and holds for different tasks and stimuli. The results demonstrate that the TOJ and simple RT to the colour change of a moving grating are insensitive to stimulus velocity. Therefore, we conclude that the process of comparison of the two internal representations of external events does not have access to temporal information precise enough to estimate the exact time when something enters our subjective awareness. The motion effect on colour-change perception seems to be confined to a single stimulus that moves across the visual field, to events that contain some spatial predictability, and to tasks that reflect the time of the change relatively directly.


Use of platelet-rich plasma in regenerative medicine: technical tools for correct quality control.
Platelet-rich plasma (PRP) injections are used in sports medicine and have been the subject of increased clinical interest. However, there have been very few reports of the composition of initial whole blood and the final PRP product. The objective of this study was to provide technical tools to perform a correct characterisation of platelets, leucocytes and red blood cells (RBCs) from whole blood and PRP. Blood and PRP were obtained from 26 healthy volunteers and prepared according to the varying parameters encountered within PRP process preparation and quantification (harvesting method, anticoagulant used, sampling method, counting method). Concentrations were measured at t=0, t=1, t=6 and t=24 hours. Sampling of blood in Eppendorf tubes significantly decreased platelet concentration over time, whereas sampling in Microvette EDTA-coated tube kept platelet concentration stable until 24 hours. A non-significant difference was observed in platelet counts in PRP with impedance (median (IQR): 521.8 G/L (505.3-524.7)) and fluorescence (591.5 G/L (581.5-595.8)) methods. Other studied parameters did not influence platelet concentrations in blood or PRP samples. Leucocytes and RBC counts were similar whatever the anticoagulant, sampling, harvesting and counting methods used for both blood and PRP samples. Systematic sampling of blood and PRP in EDTA-coated tubes for quality control is recommended. The use of a validated counter for PRP sample should also be taken into account.


Three-dimensional visualization of bioactive glass-bone integration in a rabbit tibia model using synchrotron X-ray microcomputed tomography.
Synchrotron X-ray microcomputed tomography (SR microCT), with a micron resolution, was used to evaluate the osteoconduction and osteointegration by borate bioactive glass after implantation 12 weeks in a rabbit tibia model. The study focused on the biomaterial-bone interface. Results from SR microCT two-dimensional and three-dimensional (3D) reconstructions provided precise imaging of the biomaterial-bone integration and detailed microarchitecture of both the bone-like glass graft and the newly formed trabecular bone. Osteoconduction, the formation of new trabecular bone within a tibia defect, occurred only in the tibiae implanted with teicoplanin-loaded borate glass but not in those with teicoplanin-loaded CaSO(4) beads, indicating the excellent biocompatibility of the glass implants. 3D reconstruction of the tibiae also showed the infiltration of vascular tissue in both the bioactive glass graft and the new trabecular bone. This study indicates that SR microCT can serve as a valuable complementary technique for imaging bone repair when using bioactive glass implants.


Simplified synthesis of isotopically labeled 5,5-dimethyl-pyrroline N-oxide.
5,5-Dimethylpyrroline N-oxide (15N) and 5,5-di(trideuteromethyl)pyrroline N-oxide were synthesized from the respective isotopically labeled 2-nitropropane analogs obtained from the reaction of sodium nitrate with 2-halopropanes. This facile, straightforward process allows synthesizing isotopically labeled DMPO analogs in a 4-step reaction without special equipment.


Exhaustion and burnout in the healthcare system in Greece: A cross-sectional study among internists during the COVID-19 lockdown.
The COVID-19 pandemic has rapidly changed everyday life around the world. The situation created by the COVID-19 pandemic has been shown to be associated with severe mental health problems in frontline medical and nursing staff. The aim of this study was to investigate exhaustion, disengagement, secondary traumatic stress, compassion satisfaction, burnout, as well as depression, anxiety and stress among internists in Greece, during the second lockdown period. Internists were approached through the Internal Medicine Society of Greece and a total of 117 participated in the study (response rate: 15.3%). The participants responded through a Google form on the Depression, Anxiety and Stress Scale - 21, the Oldenburg Burnout Inventory (OLBI) and the Professional Quality of Life Scale version 5 (ProQOL-5). Exhaustion was found in the majority of the participants (88%), 65.8% met the criteria for at least moderate levels of compassion satisfaction and 71.8% presented moderate levels of burnout. Furthermore, about half of the participants met the criteria for moderate to extremely severe levels of depression, anxiety and stress. Finally, regression analyses showed that depression was associated with both the OLBI and ProQOL-5 scales. The majority of the internists, during the lockdown period in Greece, were evaluated as "exhausted", with high rates of negative psychological symptoms. The present study, despite the limitations, highlights the impact of the COVID-19 pandemic on internists, which triggered a shift in attention onto the treatment, and especially the prevention, of stressful situations for health professionals.


Rapid Accumulation of gamma-Aminobutyric Acid and Alanine in Soybean Leaves in Response to an Abrupt Transfer to Lower Temperature, Darkness, or Mechanical Manipulation.
Soybean (Glycine max [L.] Merr) leaves contain a low level (0.05 micromole per gram fresh weight) of gamma-aminobutyric acid (Gaba) but the concentration of this non-protein amino acid increased to 1 to 2 micromoles per gram fresh weight within 5 minutes after transfer of plants or detached leaves from 33 degrees C to 22 degrees C or lower temperatures. A parallel decrease occurred in the concentration of glutamate. Accumulation of Gaba was also triggered by mechanical damage to the soybean leaves, but in plants subjected to a gradual reduction in temperature (2 degrees C per minute) only a small increase in Gaba occurred. A rapid increase in the concentration of alanine and decrease in glycine occurred upon transfer of the soybean plants to darkness and was not influenced by temperature. When plants were returned to normal growing conditions, all changes in amino acid concentrations were fully reversed in 1 hour.In soybean leaf discs incubated with [(14)C]glutamate, a rapid accumulation of [(14)C]Gaba was detected, and glutamate decarboxylase activity of the soybean leaf considerably exceeded (>30-fold) that of Gaba pyruvate transaminase. Part of the transaminase was localized in the mitochondria, but glutamate decarboxylase was not associated with any organelle or membrane component of the leaf cell. We consider that Gaba accumulation results from some change in intracellular compartmentation of the cell triggered by low temperature shock or mechanical damage. The accumulation of alanine due to a light-dark transition could be accounted for by transamination. [(14)C]Alanine formation was demonstrated when soybean leaf extracts were incubated with glutamate, aspartate, or serine and [(14)C]pyruvate.The changes in amino acid concentrations described for soybean leaves were demonstrated for all the vegetative tissues of the soybean plant and at variable rates in the leaves of a range of plant species. The response in detached tomato (Lycopersicon esculentum Mill.) leaves was of a similar magnitude to soybean. Thus, precautions are necessary to minimize changes in amino acid composition induced by manipulation and extraction of plant material.


Promoting children's rights to health and well-being in the United States.
The United States has a highly sophisticated pediatric healthcare system and spends more than any other country per capita on children's healthcare. However, not all children have access to needed and affordable health care and the life expectancy and health outcomes of children in the country are worse than in any other industrialized nation. These nations typically offer universal healthcare for children as part of a robust recognition of a children's rights framework. In 1989 the United Nations adopted the Convention on the Rights of the Child that recognizes the right of the child to the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Currently the United States is the only United Nations member country that has not ratified the Convention on the Rights of the Child. This paper outlines the potential benefits of adopting a child rights approach based on the principles and provisions of the Convention on the Rights of the Child. The fact that countries who invest much less in healthcare compared to the United States can achieve better health outcomes provides the certainty that a solution is possible and within reach.


Mechanisms of B-Cell Oncogenesis Induced by Epstein-Barr Virus.
Epstein-Barr virus (EBV) is a ubiquitous gammaherpesvirus which asymptomatically infects the majority of the world population. Under immunocompromised conditions, EBV can trigger human cancers of epithelial and lymphoid origin. The oncogenic potential of EBV is demonstrated by in vitro infection and transformation of quiescent B cells into lymphoblastoid cell lines (LCLs). These cell lines, along with primary infection using genetically engineered viral particles coupled with recent technological advancements, have elucidated the underlying mechanisms of EBV-induced B-cell lymphomagenesis.


Efficient water reduction with gallium phosphide nanowires.
Photoelectrochemical hydrogen production from solar energy and water offers a clean and sustainable fuel option for the future. Planar III/V material systems have shown the highest efficiencies, but are expensive. By moving to the nanowire regime the demand on material quantity is reduced, and new materials can be uncovered, such as wurtzite gallium phosphide, featuring a direct bandgap. This is one of the few materials combining large solar light absorption and (close to) ideal band-edge positions for full water splitting. Here we report the photoelectrochemical reduction of water, on a p-type wurtzite gallium phosphide nanowire photocathode. By modifying geometry to reduce electrical resistance and enhance optical absorption, and modifying the surface with a multistep platinum deposition, high current densities and open circuit potentials were achieved. Our results demonstrate the capabilities of this material, even when used in such low quantities, as in nanowires.


Gas cascade amplification in ultra-high-resolution environmental scanning electron microcopy.
We describe a feedback mechanism in the gas cascade amplification process used in magnetic immersion lens environmental scanning electron microcopy (ESEM). Feedback dominates gas gain under the conditions typically used for ultra-high-resolution ESEM and gives rise to novel dependencies of the imaging signal and noise on microscope operating parameters. It is ascribed tentatively to the generation of free electrons upon de-excitation of metastable species in the gas cascade. The results have implications for optimization of ESEM systems for applications such as critical dimension metrology and real-time imaging of nanostructure growth by gas mediated electron beam induced deposition.


Predisposing Factors, Microbial Characteristics, and Clinical Outcome of Microbial Keratitis in a Tertiary Centre in Hong Kong: A 10-Year Experience.
Purpose. To study the risk factors, microbial profile, antibiotic susceptibility pattern, and outcome for microbial keratitis over the past 10 years in a tertiary center in Hong Kong. Methods. All cases with corneal scraping performed in Queen Mary Hospital, Hong Kong from January 2004 to December 2013 were included. Clinical outcome was defined as poor if the final visual acuity (VA) was abnormal or worse than presenting VA, a major complication occurred, or therapeutic keratoplasty was required. Results. 347 scrapes were performed in the 10-year period growing 130 microorganisms (32.3% culture positive rate). Contact lens use was the commonest risk factor. The commonest isolates were coagulase-negative Staphylococcus and Pseudomonas aeruginosa. Fluoroquinolone susceptibility was tested in 47 Gram-negative bacteria with 93.6% susceptibility (100% for Pseudomonas). 90.7% of cases had good visual outcome. Multivariate logistic regression showed age (p = 0.03), trauma (p = 0.006), and ulcer size >3 mm (p = 0.039) to be independently associated with poor outcome. Conclusion. There was no shifting trend in the isolate distribution or emergence of resistant strains in our study. Contact lens wear was the commonest risk factor, with Pseudomonas being the most frequent isolate in this group. It remained 100% susceptible to fluoroquinolones and 97% cases had good visual outcome.


Amorphous manganese-calcium oxides as a possible evolutionary origin for the CaMn₄ cluster in photosystem II.
In this paper a few calcium-manganese oxides and calcium-manganese minerals are studied as catalysts for water oxidation. The natural mineral marokite is also studied as a catalyst for water oxidation for the first time. Marokite is made up of edge-sharing Mn(3+) in a distorted octahedral environment and eight-coordinate Ca(2+) centered polyhedral layers. The structure is similar to recent models of the oxygen evolving complex in photosystem II. Thus, the oxygen evolving complex in photosystem II does not have an unusual structure and could be synthesized hydrothermally. Also in this paper, oxygen evolution is studied with marokite (CaMn₂O₄), pyrolusite (MnO₂) and compared with hollandite (Ba(0.2)Ca(0.15)K(0.3)Mn(6.9)Al(0.2)Si(0.3)O(16)), hausmannite (Mn₃O₄), Mn₂O₃.H₂O, Ca Mn₃O₆.H₂O, CaMn₄O₈.H₂O, CaMn₂O₄.H₂O and synthetic marokite (CaMn₂O₄). I propose that the origin of the oxygen evolving complex in photosystem II resulted from absorption of calcium and manganese ions that were precipitated together in the archean oceans by protocyanobacteria because of changing pH from ~5 to ~8-10. As reported in this paper, amorphous calcium-manganese oxides with different ratios of manganese and calcium are effective catalysts for water oxidation. The bond types and lengths of the calcium and manganese ions in the calcium-manganese oxides are directly comparable to those in the OEC. This primitive structure of these amorphous calcium-manganese compounds could be changed and modified by environmental groups (amino acids) to form the oxygen evolving complex in photosystem II.


Unraveling the structure and mechanism of acetyl-coenzyme A synthase.
The bifunctional enzyme carbon monoxide dehydrogenase/acetyl-coenzyme A (CoA) synthase (CODH/ACS) is a key enzyme in the Wood-Ljungdahl pathway of carbon fixation. Carbon monoxide is combined with a methyl group and ultimately converted to acetyl-CoA at a unique Ni-containing bimetallic site in the A-cluster of this enzyme. Despite years of extensive biochemical and spectroscopic studies and the recent report of three separate crystal structures, the mechanism by which acetyl-CoA is synthesized is still unknown. Over the past two years there have been a number of significant developments regarding ACS. This Account critically examines these recent developments and especially focuses on those areas that are still a matter of debate.


Effectiveness of nitrendipine, 20 mg once daily in the management of hypertension in general practice.
The effectiveness of nitrendipine, given as a single 20 mg tablet in the morning, was evaluated in general practice in 6,058 hypertensive patients. They filled in a questionnaire on their activities and previous antihypertensive treatment, if any. Visits were planned after 2, 6, and 12 weeks. Then, patients and general practitioners gave their assessment of the treatment. Eighty-four percent completed the 12-week study while receiving 20 mg of nitrendipine once daily. Adverse events were observed in 26% of the patients, mainly during the first 2 weeks, where flushing and peripheral edema occurred in 9 and 7% of the patients, respectively. Both led to withdrawal of 4% of the included patients over 3 months. A supine diastolic blood pressure below 90 mm Hg was achieved in 65% of the patients, irrespective of age, sex, activity, smoking habits, and presence of diabetes or previous antihypertensive therapy. In conclusion, this large-scale study further established the effectiveness of nitrendipine as monotherapy given once daily in most hypertensive patients. Eight patients in 10 felt they had benefited from the treatment. The investigators were satisfied with the results in 66% of the patients. They considered that the main advantage of nitrendipine was ease of use.


Autophagy induced by 2-deoxy-D-glucose suppresses intracellular multiplication of Legionella pneumophila in A/J mouse macrophages.
Legionella pneumophila Philadelphia-1 (Lp-1) can grow intracellularly in A/J mouse peritoneal macrophages (A/J Mphi). We previously reported that 2-deoxy-D-glucose (2dG), when added in macrophage culture medium, inhibited the intracellular multiplication of Lp-1 in A/J Mphi. We found that 1 mM of 2dG causes LC3-II-conversion that reflects an induction of autophagy and that 1 and 10 mM of 2dG induced apoptosis associated with caspase-4 activation. We therefore investigated whether 2dG-induced autophagy or apoptosis suppresses the replication ofLp-1 in 2dG-treated A/J Mphi. When the autophagy-related (Atg)gene Atg5 was knocked down by RNA interference, the Atg5-siRNA-transfected cells revealed an enhanced replication of Lp-1 in A/J Mphi compared with the non-targetting siRNA-transfected cells. However, caspase-4 inhibitor did not affect the 2dG-induced inhibition of intracellular multiplication of Lp-1 in A/J Mphi. These findings suggested that autophagy, not apoptosis, suppressed the intracellular growth of Lp-1 in A/J Mphi when 1 or 10 mM of 2dG were added to the culture media.


Nanostructured Lipid Carriers Engineered as Topical Delivery of Etodolac: Optimization and Cytotoxicity Studies.
Etodolac (ETD), a nonsteroidal anti-inflammatory drug, exhibits antinflammatory, analgesic, and antipyretic activity. The main type of ETD administration is oral route, which is associated with significant systemic side effects. Nanostructured lipid carriers (NLC), a modern lipid formulation, are non-toxic, biocompatible, can improve the solubility and stability of drugs. Nanostructured lipid carriers (NLC) containing etodolac were prepared by a melt-emulsification and ultrasonication technique. Full factorial design (FFD) was applied to optimize the composition of NLC and their properties such as zeta potential, polidyspersity index, and entrapment efficiency. Formulations consisting of Capryol 90, glicerol monostearate, and Tween 20 displayed particle size below 300 nm, encapsulated drug with efficiency of approximately 87% and prolonged drug release up to 24 h. Stable formulations displayed moderately negative surface charge suggesting their limited ability to interact with skin surface but simultaneously presenting their lower risk to cause cell-membrane disruption. In fact, cytotoxicity assessment using human dermal fibroblasts and human epidermal keratinocytes revealed that etodolac-loaded NLC had no important impact on skin cells viability evaluated in vitro, which might evidence that NLC formulations are safe for dermal delivery. The studies developed were relatively fast and simple, requiring no specialized equipment method to prepare NLC as ETD carriers ensuring better solubility and prolonged drug release.


Correlation between pretransplantation test dose cyclosporine pharmacokinetic profiles and posttransplantation sirolimus blood levels in renal transplant recipients.
We sought to determine whether pretransplantation test dose pharmacokinetic measurements of cyclosporine (CsA) concentrations would forecast the posttransplantation blood concentrations of sirolimus in renal transplant patients treated de novo with CsA, sirolimus, and prednisone. All 44 renal transplant recipients enrolled in Phase I/II studies of de novo posttransplantation therapy with sirolimus, CsA, and prednisone underwent pretransplantation pharmacokinetic profiling after having received paired intravenous (i.v.) and oral test doses of CsA. After transplantation, all patients were treated with CsA on a once- or twice-daily schedule (according to a concentration-controlled regimen), with tapering doses of prednisone, and with fixed doses of sirolimus on a once-daily schedule. Patients were divided into four cohorts based on the deviation of their pretransplantation CsA clearance or bioavailability values from the mean. Patients with high pretransplantation CsA clearance rates displayed a significantly lower mean posttransplantation value of sirolimus trough concentrations than patients with low pretransplantation CsA clearance rates. In contrast, values for pretransplantation absolute oral CsA bioavailability failed to correlate with the mean posttransplantation concentration of sirolimus but did predict posttransplantation CsA bioavailability. Therefore, pretransplantation CsA clearance rate estimates may forecast posttransplantation sirolimus concentrations, possibly guiding use of sirolimus therapy to achieve an optimal ratio of concentration-dependent immunosuppressive versus toxic effects.


The Severe Impairment Battery predicts functional abilities in an inpatient geriatric population.
There is limited research examining the relationship between cognition in severe dementia and functional skills. The aim of the present study was to examine the relationship between the Severe Impairment Battery (SIB) and functional abilities as measured by the Assessment of Instrumental Function (AIF) in an acute inpatient geriatric psychiatry setting. Analyses showed significant correlation between the SIB and the AIF. Multiple regression demonstrated that SIB scores accounted for 44% of the variance in adaptive functioning. These results replicate some of the prior data examining the relationship between the cognition and functional abilities and extend these findings into the inpatient setting with more severely impaired patients.


Habituation to auditory distractors in a cross-modal, color-word interference task.
The speed of naming the color of a colored square was examined with acoustic distraction to study the effects of the formation of a mental representation (neural model) of distractors. In Experiment 1, practice with the distractors (color words, noncolor words, and tones) was examined, and in Experiments 2 and 3 each color-naming trial was preceded by preexposures to sounds that could be dissimilar, similar, or identical to the upcoming auditory distractor. Consistency in the identity of ignored sounds, whether during color-naming practice or between preexposures and test, reduced interference with color naming. Consistency in voice played no role, and attended preexposures were ineffective in reducing interference. Given these results, the authors propose that mental representations of distractors include information about their task relevance, which modulates disruption of the primary task.


[A study of brain temperature in patients with severe head injuries].
The significance of brain temperature was investigated in patients with severe head injuries. In thirty patients in a state of coma due to severe head injury (Glasgow coma scale of less than 8), brain temperature (Tb), rectal temperature (Tr), and intracranial pressure (ICP) were measured. In 21 out of these patients, cerebral blood flow (CBF) was measured by means of transcranial Doppler effect (TCD), and pulsatility index (PI) was calculated from TCD findings. The outcome was assessed by the Glasgow outcome scale (GOS) 1 month after the head injury. The patients were classified into 4 groups according to the differences (delta T) between Tb and Tr. Group I (11 patients) was defined as always having a higher Tb than Tr, Group II (14) as always having a higher Tr than Tb, Group III (3) was as having no significant differences between Tb and Tr, and Group IV (2) was as having delta T change from plus to minus or from minus to plus during the course of monitoring. As regards the intracranial lesions, no significant differences among these groups were recognized. P.I, at 6 hours after operation, was 1.1 +/- 0.1 (N = 10) in Group I, and was 3.4 +/- 1.9 (N = 9) in Group II. The difference between these two values was statistically significant. The outcome of Group I was better than that of the other groups. The brain temperature is thought to reflect the CBF in the human brain.(ABSTRACT TRUNCATED AT 250 WORDS)


Idioms of Attachment: Performative Dimensions of Object Relating, Affect, and Connection.
Classical attachment theory has yielded rich explanations for behavior by classifying attachment into "styles" such as avoidant and ambivalent. Modern attachment theory has deepened our understanding of these formations by integrating knowledge about affect regulation and cognitive narratives. In looking at how attachment manifests in the phenomenal, sensation-evoking world, we draw on the work of postmodern performance theorist Judith Butler and others to get a clarified picture not just of one's style of attaching but of the specific ways that attachment behaviors are rehearsed, repeated, and refined over time. We look at attachment at the level of lived experience, rather than merely that of signification, to gain insights on how to interpret and work with attachment-laden behaviors in the therapeutic relationship.


Eavesdropping and signal matching in visual courtship displays of spiders.
Eavesdropping on communication is widespread among animals, e.g. bystanders observing male-male contests, female mate choice copying and predator detection of prey cues. Some animals also exhibit signal matching, e.g. overlapping of competitors' acoustic signals in aggressive interactions. Fewer studies have examined male eavesdropping on conspecific courtship, although males could increase mating success by attending to others' behaviour and displaying whenever courtship is detected. In this study, we show that field-experienced male Schizocosa ocreata wolf spiders exhibit eavesdropping and signal matching when exposed to video playback of courting male conspecifics. Male spiders had longer bouts of interaction with a courting male stimulus, and more bouts of courtship signalling during and after the presence of a male on the video screen. Rates of courtship (leg tapping) displayed by individual focal males were correlated with the rates of the video exemplar to which they were exposed. These findings suggest male wolf spiders might gain information by eavesdropping on conspecific courtship and adjust performance to match that of rivals. This represents a novel finding, as these behaviours have previously been seen primarily among vertebrates.


In vitro antimicrobial activity of the human neutrophil cytosolic S-100 protein complex, calprotectin, against Capnocytophaga sputigena.
Calprotectin is a complex of two anionic proteins found in abundance in the cytosol of neutrophils, certain macrophages, and oral epithelial keratinocytes. Bacteria of the genus Capnocytophaga are pathogens of periodontal origin which can cause systemic infection in neutropenic subjects. Recently, it has been observed that Capnocytophaga may be internalized by neutrophils within the cytosol rather than within a membrane-delimited phagosome. The purpose of this study was to test the in vitro antibacterial effect of the cytosolic complex, calprotectin, against Capnocytophaga sputigena. Calprotectin was purified from the cytosol of human neutrophils by gel filtration and anion exchange FPLC, and it exerted potent in vitro antimicrobial effects against C. sputigena. Net bacteriostatic activity was exerted up to 18 h, after which bactericidal effects were observed. Both net bacteriostatic and bactericidal activity occurred at concentrations above 20 micrograms/mL and exhibited identical dose-response characteristics. Particle counts increased in the presence of calprotectin, despite net bacteriostasis as assessed by changes in colony-forming units (CFU). Dose-response characteristics and direct particle counts suggested that net bacteriostatic effects were the result of balanced cell division and death, rather than suspension of cell division. We conclude that calprotectin can be a significant contributor to host defense against infection by Capnocytophaga.


Toxicity of 4-nonylphenol to Tubifex tubifex and Chironomus riparius in 28-day whole-sediment tests.
Concern has been growing recently over the toxicity and the mimicking properties of 4-nonylphenol (4NP), the most persistent breakdown product of the nonionic surfactant nonylphenol ethoxylates, broadly used in industrial cleaning processes. Twenty-eight-day tests were performed to evaluate the toxicity and the effects on reproduction of 4NP spiked sediment to the benthic invertebrates Tubifex tubifex and Chironomus riparius. 4NP was directly added to the wet sediment, avoiding any solvent. The EC50 value for the emergence of chironomids was 380 microg 4NP g(-1) dry weight (dw); the EC50 values for the deposition of cocoons and the development of young worms were very similar (428 and 420 microg g(-1) dw, respectively). Regarding NP estrogenic activity and its effects on reproduction and development, no significant differences were noted in the sex ratio of the emerged chironomids when exposed to 4NP compared to the controls, but the emerged chironomids did not lay eggs at concentrations higher than the EC10 (250 microg 4NP g(-1) dw). Furthermore, at concentration of 610 microg 4NP g(-1) dw an interference in the development of the gonads of adult worms was observed, but it was impossible to determine whether this effect was due to 4NP toxicity or to its hormone mimicking properties.


Judgment, 25 February 1988.
The Supreme Court of Colombia dismissed an action against the defendant that charged him with performing an abortion as a consequence of his murdering a pregnant woman. It held that there had been no crime of abortion since one of the elements of the crime is intention, and here the defendant had only intended to kill the pregnant woman, not to cause an abortion. It let stand, however, murder charges against the defendant.


The invulnerability of adult neurons: a critical role for p73.
Here, we investigated the intracellular mechanisms that underlie the relative invulnerability of adult versus developing dorsal root ganglion (DRG) sensory neurons. In culture, adult neurons were resistant to stimuli that caused apoptosis of their neonatal counterparts. In both adult and neonatal neurons, death stimuli induced the apoptotic c-Jun N-terminal protein kinase (JNK) pathway, but JNK activation only caused death of neonatal neurons, indicating that adult neurons have a downstream block to apoptosis. Expression of the dominant-inhibitory p53 family member, DeltaNp73, rescued JNK-induced apoptosis of neonatal neurons, suggesting that it might participate in the downstream apoptotic block in adult neurons. To test this possibility, we examined adult DRG neurons cultured from p73+/- mice. Adult p73+/- DRG neurons were more vulnerable to apoptotic stimuli than their p73+/+ counterparts, and invulnerability could be restored to the p73+/- neurons by increased expression of DeltaNp73. Moreover, although DRG neuron development was normal in p73+/- animals in vivo, axotomy caused death of adult p73+/- but not p73+/+ DRG neurons. Thus, one way adult neurons become invulnerable is to enhance endogenous survival pathways, and one critical component of these survival pathways is p73.


Catalytic probe lithography: catalyst-functionalized scanning probes as nanopens for nanofabrication on self-assembled monolayers.
This article describes the use of scanning catalytic probe lithography for nanofabrication of patterns on self-assembled monolayers (SAMs) of reactive adsorbates. Catalytic writing was carried out by scanning over bis(omega-tert-butyldimethyl-siloxyundecyl)disulfide SAMs using 2-mercapto-5-benzimidazole sulfonic acid-functionalized gold-coated AFM tips. The acidic tips induced local hydrolysis of the silyl ether moieties in the contacted areas, and thus patterned surfaces were created. Diffusion effects arising from the use of an ink were excluded in these type of experiments, and therefore structures with well-defined shapes and sizes were produced. The smallest lines drawn by this technique were about 25 nm wide, corresponding to the actual contact area of the tip. Lateral force microscopy studies performed on different SAMs helped to clarify the nature and cause of the friction contrasts observed by AFM. Dendritic wedges with thiol functions inserted into the catalytically written areas, thus enhancing the height contrast. The created patterns open possibilities to build 3D nanostructures.


Defined Nutrient Diets Alter Susceptibility to Clostridium difficile Associated Disease in a Murine Model.
Clostridium difficile is a major identifiable and treatable cause of antibiotic-associated diarrhea. Poor nutritional status contributes to mortality through weakened host defenses against various pathogens. The primary goal of this study was to assess the contribution of a reduced protein diet to the outcomes of C. difficile infection in a murine model. C57BL/6 mice were fed a traditional house chow or a defined diet with either 20% protein or 2% protein and infected with C. difficile strain VPI10463. Animals were monitored for disease severity, clostridial shedding and fecal toxin levels. Select intestinal microbiota were measured in stool and C. difficile growth and toxin production were quantified ex vivo in intestinal contents from untreated or antibiotic-treated mice fed with the different diets. C. difficile infected mice fed with defined diets, particularly (and unexpectedly) with protein deficient diet, had increased survival, decreased weight loss, and decreased overall disease severity. C. difficile shedding and toxin in the stool of the traditional diet group was increased compared with either defined diet 1 day post infection. Mice fed with traditional diet had an increased intestinal Firmicutes to Bacteroidetes ratio following antibiotic exposure compared with either a 2% or 20% protein defined nutrient diet. Ex vivo inoculation of cecal contents from antibiotic-treated mice showed decreased toxin production and C. difficile growth in both defined diets compared with a traditional diet. Low protein diets, and defined nutrient diets in general, were found to be protective against CDI in mice. Associated diet-induced alterations in intestinal microbiota may influence colonization resistance and clostridial toxin production in a defined nutrient diet compared to a traditional diet, leading to increased survival. However, mechanisms which led to survival differences between 2% and 20% protein defined nutrient diets need to be further elucidated.


Involuntary treatment and competence to proceed in the criminal process: capital and noncapital cases.
Recent cases raise a series of questions regarding the involuntary administration of treatment intended to restore or maintain competence to proceed in the criminal process. As is often the case, these matters take on a special urgency in the context of capital punishment. The analysis presented in this paper suggests that the relevant interests that courts should consider in deciding whether to order the involuntary administration of treatment to restore or maintain competence converge to a greater degree than one might initially expect. When the applicable conception of medical interests is appropriately defined and the state's interest in protecting the integrity of the process is given appropriate weight, the legally protected state and individual interests converge to a substantial degree. Protecting both sets of interests may require a variety of procedures designed to avoid misguided interventions with the potential to undermine both sets of interests. Finally, this analysis provides an approach that allows the courts to grant appropriate weight to the professional ethics of those who perform evaluations and deliver treatment in these contexts.


A novel school-based approach to screening for attention deficit hyperactivity disorder.
Current approaches to screening for ADHD result in high rates of false positives. A proof of concept study to investigate the added benefits in the school-based detection of ADHD of adding a standardised teacher to teacher interview to traditional parent and teacher report questionnaires. A school-based study of diagnostic accuracy of ADHD using a novel 2-stage screening process. Participants were all 1026 pupils enrolled in grades 1 to 6 (ages 6-12 years) of a school in Hunan Province, China. The primary outcome was a diagnosis of ADHD on the Kiddie Schedule for Affective Disorders and Schizophrenia Present Lifetime version. 230 (22.4%) of the 1026 students screened positive at Stage 1 (parent and teacher questionnaires) (Sensitivity 0.86 [95% CI, 0.75 to 0.96], specificity 0.80 [95% CI, 0.78-0.83], false positive rate 0.20 (95% CI, 0.18 to 0.23), false negative rate was 0.14 (95% CI, 0.12 to 0.16). 65 remained screen-positive at the Stage 2 screen (teacher to teacher SNAP-IV interview). 36/65 (55.4%) of these Stage 2 screen positive participants and 1/144 (0.7%) of the screen negative subjects met DSM-IV criteria for ADHD (sensitivity 0.83 [95% CI, 0.71-0.95]; specificity of 0.97 [95% CI, 0.96-0.98]; false positive rate 0.03 [95% CI, 0.01 to 0.04], false negative rate 0.16 [95% CI, 0.15 to 0.19]. Adding teacher to teacher interviews to traditional questionnaire-based screening has the potential to improve the clinical utility of school-based screening for ADHD reducing the proportion of false positives, without a negative impact on sensitivity.


Crystal structure of the YajQ-family protein XC_3703 from Xanthomonas campestris pv. campestris.
As an important bacterial second messenger, bis-(3',5')-cyclic diguanylate (cyclic di-GMP or c-di-GMP) has been implicated in numerous biological activities, including biofilm formation, motility, survival and virulence. These processes are manipulated by the binding of c-di-GMP to its receptors. XC_3703 from the plant pathogen Xanthomonas campestris pv. campestris, which belongs to the YajQ family of proteins, has recently been identified as a potential c-di-GMP receptor. XC_3703, together with XC_2801, functions as a transcription factor activating virulence-related genes, which can be reversed by the binding of c-di-GMP to XC_3703. However, the structural basis of how c-di-GMP regulates XC_3703 remains elusive. In this study, the structure of XC_3703 was determined to 2.1 Å resolution using the molecular-replacement method. The structure of XC_3703 consists of two domains adopting the same topology, which is similar to that of the RNA-recognition motif (RRM). Arg65, which is conserved among the c-di-GMP-binding subfamily of the YajQ family of proteins, together with Phe80 in domain II, forms a putative c-di-GMP binding site.


Histochemical study of polysaccharides in some arteries of the region of the heart of black vulture (Coragyps atratus).
A comparative histochemical study of polysaccharides in some arteries of the region of the heart of black vulture was performed. With some exceptions, no variation in polysaccharides composition in all arteries studied were shown. Arterial walls present a sialo-mucopolysaccharidic complex and it is composed of: sialic acid, neutral mucopolysaccharides, hyaluronic acid and chondroitin sulfates. The concentration of these carbohydrates, mainly of the acidic ones, decrease from the inner portions of the media toward the adventitia.


Monte Carlo simulation of crystal-fluid coexistence states in the hard-sphere system under gravity with stepwise control.
Monte Carlo (MC) simulations were performed for hard spheres (with diameter sigma and mass m) placed between well-separated upper and lower hard walls. A periodic boundary condition was imposed in the horizontal direction. The system was exposed to the gravitational field with the acceleration due to gravity g. After preparing a melt as the initial state, g was increased stepwise up to mgsigma/k(B)T(identical with g(*))=1.5 or 2.0 with an increment Deltag(*) = 0.1; k(B)T is the temperature multiplied by Boltzmann's constant. We maintained g(*) at each value for 2.0 x 10(5) MC cycles. The transition of the system into a metastable state such as a polycrystalline state due to trapping phenomena was successfully avoided. A monotonic increase and subsequent saturation were observed for the development of the crystalline region formed at the bottom of the system. The development of this region accompanied a shrinkage of the defective (or less ordered) crystalline region that was formed between the bottom region and the fluid phase. As the development of the bottom region almost saturated, the defective region grew upward again.


Mediators and Effect Modifiers of the Causal Pathway Between Child Exposure to Domestic Violence and Internalizing Behaviors Among Children and Adolescents: A Systematic Literature Review.
Childhood exposure to domestic violence (DV) can lead to mental health problems including internalizing symptoms. This systematic literature review aimed to identify individual-, familial-, and community-level factors that mediate or modify the effect of DV exposure on internalizing symptoms among children and adolescents. This systematic literature review was registered with PROSPERO, registration number: CRD42019127012. MEDLINE, EMBASE, and PsycINFO were searched between 1990 and 2018 for peer-reviewed, quantitative, longitudinal studies published in English. Backreferencing and key journal hand searches were conducted. Twelve longitudinal studies were included. These investigated how factors amenable to change either mediate or modify the effect of exposure to DV on internalizing symptoms (using validated measures) in children and adolescents up to 18 years within a general population. Study quality was assessed using the Newcastle-Ottawa risk of bias tool, and a sample of studies were second reviewed by authors. One individual-level mediator was identified, namely emotional intelligence, and two effect modifiers were identified: relational victimization and participation in extracurricular activities. Familial mediators included maladaptive parenting and parenting stress, while effect modifiers included positive parenting (maternal warmth and availability) and family social support. No community-level factors were identified. All research was conducted in the United States, most focused on risk, and the majority measured outcomes in middle childhood. Nevertheless, these findings suggest that interventions provided to families exposed to intimate partner violence need to target both child and familial factors in order to successfully reduce children's internalizing symptoms.


The Delphi technique: a critique.
The development of the Delphi technique, as a survey method of research, and examples of its use are described. The technique's key characteristics, anonymity, use of experts and controlled feedback, are examined. The method's usefulness in structuring group communication for the discussion of specific issues and as an aid to policy making is discussed in the light of the technique's perceived drawbacks and limitations.


Distributed Storage Algorithm for Geospatial Image Data Based on Data Access Patterns.
Declustering techniques are widely used in distributed environments to reduce query response time through parallel I/O by splitting large files into several small blocks and then distributing those blocks among multiple storage nodes. Unfortunately, however, many small geospatial image data files cannot be further split for distributed storage. In this paper, we propose a complete theoretical system for the distributed storage of small geospatial image data files based on mining the access patterns of geospatial image data using their historical access log information. First, an algorithm is developed to construct an access correlation matrix based on the analysis of the log information, which reveals the patterns of access to the geospatial image data. Then, a practical heuristic algorithm is developed to determine a reasonable solution based on the access correlation matrix. Finally, a number of comparative experiments are presented, demonstrating that our algorithm displays a higher total parallel access probability than those of other algorithms by approximately 10-15% and that the performance can be further improved by more than 20% by simultaneously applying a copy storage strategy. These experiments show that the algorithm can be applied in distributed environments to help realize parallel I/O and thereby improve system performance.


Chlorambucil in sarcoidosis.
Ten patients with biopsy-proven sarcoidosis with progressive disease were treated with chlorambucil alone or in combination with corticosteroids. Eight of these ten patients showed some degree of improvement which may be attributable to chlorambucil. The responsive patients showed beneficial effects within three months of starting chlorambucil therapy. It is concluded that chlorambucil may be worth a trial in patients with progressive disease unresponsive to corticosteroids or where corticosteroids are contraindicated.


Expanding the spectrum of cognitive outcomes after temporal lobe epilepsy surgery: A prospective study of theory of mind.
Because temporal lobe epilepsy (TLE) can impair theory of mind (ToM), we examined the effects of anterior temporal lobectomy (ATL) by comparing the preoperative to postoperative ToM course with that of other cognitive functions characteristically impaired in TLE. Eighty-five patients with left (n = 39) or right (n = 46) drug-resistant TLE and an age at epilepsy onset of >12 (n = 54) or ≤12 years (n = 31) were evaluated before and 1 year after surgery; 40 healthy controls were assessed at baseline. The participants' recognition and comprehension of faux pas (FPs) or correct rejection of nonexistent FPs was assessed using the Faux Pas task; and their language, memory, and planning were, respectively, assessed using the Boston Naming, Short Story, and Tower of London tests. Baseline ToM was impaired in the patients with left or right TLE in comparison with the controls, and significantly influenced by education and age at seizure onset, with more severe deficits being observed in those with less education and an age at onset of ≤12 years. After ATL, their recognition and comprehension of FPs was unchanged, whereas the rejection of nonexistent FPs improved in the patients with early seizure onset. Education, preoperative ToM, postoperative executive function, and fluid intelligence and the number of antiepileptic drugs predicted postoperative ToM. Postoperative naming and episodic memory were associated with ATL laterality and education, and planning was associated with age at seizure onset and chronological age. After ATL, the components of ToM may be unchanged or slightly improved depending on cognitive reserve and age at seizure onset, thus suggesting that ATL does not further aggravate the deficits caused by TLE. Moreover, the course of ToM is distinct from that of other cognitive functions. These findings expand the spectrum of the cognitive phenotypes associated with TLE and ATL, and offer potential elements for individual prognoses.


c-Myb regulates NOX1/p38 to control survival of colorectal carcinoma cells.
The c-Myb transcription factor is important for maintenance of immature cells of many tissues including colon epithelium. Overexpression of c-Myb occurring in colorectal carcinomas (CRC) as well as in other cancers often marks poor prognosis. However, the molecular mechanism explaining how c-Myb contributes to progression of CRC has not been fully elucidated. To address this point, we investigated the way how c-Myb affects sensitivity of CRC cells to anticancer drugs. Using CRC cell lines expressing exogenous c-myb we show that c-Myb protects CRC cells from the cisplatin-, oxaliplatin-, and doxorubicin-induced apoptosis, elevates reactive oxygen species via up-regulation of NOX1, and sustains the pro-survival p38 MAPK pathway. Using pharmacological inhibitors and gene silencing of p38 and NOX1 we found that these proteins are essential for the protective effect of c-Myb and that NOX1 acts upstream of p38 activation. In addition, our result suggests that transcription of NOX1 is directly controlled by c-Myb and these genes are strongly co-expressed in human tumor tissue of CRC patients. The novel c-Myb/NOX1/p38 signaling axis that protects CRC cells from chemotherapy described in this study could provide a new base for design of future therapies of CRC.


Multi-Dimensional Dataset of Open Data and Satellite Images for Characterization of Food Security and Nutrition.
Nutrition is one of the main factors affecting the development and quality of life of a person. From a public health perspective, food security is an essential social determinant for promoting healthy nutrition. Food security embraces four dimensions: physical availability of food, economic and physical access to food, food utilization, and the sustainability of the dimensions above. Integrally addressing the four dimensions is vital. Surprisingly most of the works focused on a single dimension of food security: the physical availability of food. The paper proposes a multi-dimensional dataset of open data and satellite images to characterize food security in the department of Cauca, Colombia. The food security dataset integrates multiple open data sources; therefore, the Cross-Industry Standard Process for Data Mining methodology was used to guide the construction of the dataset. It includes sources such as population and agricultural census, nutrition surveys, and satellite images. An open multidimensional dataset for the Department of Cauca with 926 attributes and 9 rows (each row representing a Municipality) from multiple sources in Colombia, is configured. Then, machine learning models were used to characterize food security and nutrition in the Cauca Department. As a result, The Food security index calculated for Cauca using a linear regression model (Mean Absolute Error of 0.391) is 57.444 in a range between 0 and 100, with 100 the best score. Also, an approach for extracting four features (Agriculture, Habitation, Road, Water) of satellite images were tested with the ResNet50 model trained from scratch, having the best performance with a macro-accuracy, macro-precision, macro-recall, and macro-F1-score of 91.7, 86.2, 66.91, and 74.92%, respectively. It shows how the CRISP-DM methodology can be used to create an open public health data repository. Furthermore, this methodology could be generalized to other types of problems requiring the creation of a dataset. In addition, the use of satellite images presents an alternative for places where data collection is challenging. The model and methodology proposed based on open data become a low-cost and effective solution that could be used by decision-makers, especially in developing countries, to support food security planning.


[Effects of anti-platelet drugs on myocardial no-reflow after acute myocardial infarction and reperfusion: experiment with mini-swine model].
To evaluate the effects of anti-platelet drugs on myocardial no-reflow after acute myocardial infarction (AMI) and reperfusion. Thirty-two mini-swine were randomized into 4 equal groups: Control Group, without any intervention; Group A approximately C, pretreated with aspirin-clopidogrel (A-C) combination (300 mg loading dose followed by 75 mg per day of clopidogrel and 10 mg x kg(-1) x d(-1) of aspirin for 3 days), Group Tirofiban, given an intravenous infusion of tirofiban (15 microg/kg in intravenous bolus followed by 0.5 microg x kg(-1) x min(-1) in continuous intravenous infusion from 30 min before occlusion to the end of protocol; and Sham Operation Group, undergoing sham operation. The former 3 groups underwent three-hour occlusion of the left anterior descending (LAD) coronary artery followed by one-hour reperfusion Before the adminisfration of drngs and hefore lipation of LAD flood sanpks were collocfed to detoif the platelet aggregation rate (PAR). Hemodynamic examination and myocardial contrast echocardiography (MCE) were performed before AMI, 3 h after AMI, and 1 h after reperfusion. The coronary ligation area (LA) and area of no-reflow (ANR) were determined with both MCE in vivo and pathological examination after the swine were killed. The platelet aggregation rates (MAR) after AMI were 46.8% and 45.7% respectively in tirofiban group and A-C Combination group, and significantly decreased to 12.9% and 14.3% respectively after the administration of drugs (both P < 0.01) with equivalent potency (P > 0.05). The left ventricular function was significantly improved in tirofiban group in comparison with control group (P < 0.05 - 0.01), the coronary blood flow volume (CBV) 1 h after reperfusion was 73.2% in tirofiban group, significantly higher than that of control group (45.8%, P < 0.01), and the ANR of tirofiban group was 22.8% and 23.2% judged by MCE and pathological examination respectively, both significantly smaller than those of control group (78.5% and 82.3%, both P < 0.01), and the NA of tirofiban group was 89.2%, significantly smaller than that of Control Group (98.5%, P < 0.05). However, there were not significant differences in left ventricular function, central blood volume, ANR and NA between A-C combination group and control group (all P > 0.05). Tirofiban is markedly effective in attenuating myocardial no-reflow after reperfusion; in contrast, A-C combination is totally ineffective.


Ultrasound-Combined Sterilization Technology: An Effective Sterilization Technique Ensuring the Microbial Safety of Grape Juice and Significantly Improving Its Quality.
: The effects of ultrasound (US), thermosonication (TS), ultrasound combined with nisin (USN), TS combined with nisin (TSN), and conventional thermal sterilization (CTS) treatments on the inactivation of microorganisms in grape juice were evaluated. TS, TSN, and CTS treatments provided the desirable bactericidal and enzyme inactivation, and nisin had a synergistic lethal effect on aerobic bacteria in grape juice while not having any obvious effect on the mold and yeast. Compared with CTS, the sensory characteristics of grape juice treated with TS and TSN are closer to that of fresh juice, its microbial safety is ensured, and the physicochemical properties are basically unchanged. More importantly, the total phenolic content and antioxidant capacity of juice treated with TS and TSN were significantly increased, and the total anthocyanin and flavonoid contents were largely retained. Taken together, these findings suggest that TS and TSN has great potential application value and that it can ensure microbial safety and improve the quality of grape juice.


Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina.
The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina. We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed. One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach's alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson's correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6-8 for mild cases, 9-14 for moderate and 15 or more for severe depressive symptoms respectively. The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.


An audit of assessment rooms for mental health assessments in Ireland's emergency departments.
To audit compliance of mental health assessment rooms in Irish adult emergency departments (EDs) which are open 24 hours on 7 days a week with standards identified by the Psychiatric Liaison Accreditation Network (PLAN). A self-audit tool was sent via email to Clinical Nurse Specialists and Consultant Psychiatrists in Ireland's 26 Adult EDs that are open 24 hours on seven days a week. Results were collated and are presented ensuring anonymity. A response rate of 100% was achieved. Full or substantial compliance with PLAN standards was recorded in 73% of services. In seven services, the rooms used for mental health assessments were unsuitable when measured against the PLAN standards. A number of services identified the presence of ligature points within the rooms. The Health Service Executive (HSE) National Clinical Programme for the Assessment and Management of patients presenting to the ED following self-harm is committed to achieving 100% compliance with PLAN standards in all services. Recommendations include introducing formal ligature risk assessments and risk assessments of the use of the assessment rooms. The Chief Executive Officers of all hospital groups were informed of the results of the audits and advised on recommendations for each hospital ED.


Amelogenins regulate expression of genes associated with cementoblasts in vitro.
Amelogenins are major proteins expressed by ameloblasts during development of the crown (enamel and dentin). These matrix proteins guide crystal habits of the mineral phase of developing enamel and are possible regulators of other genes/proteins during development and maturation of crown and root (dentin and cementum). This study focused on defining the effect that a specific proteolytic cleavage product of amelogenin, tyrosine-rich amelogenin peptide (TRAP), has on cementoblast behavior. Immortalized cementoblasts (OCCM-30) were exposed to TRAP in vitro. Cells treated with TRAP were evaluated for cell proliferation, gene expression for osteocalcin (OCN), osteopontin (OPN), and bone sialoprotein (BSP), and induction of mineral nodule formation. No significant difference in cell proliferation was found between vehicle-treated cells and those treated with TRAP for up to 9 d after treatment. Gene expression of OCN, OPN, and BSP in TRAP-treated cementoblasts showed down-regulation, up-regulation, and no significant change, respectively, relative to vehicle control. A marked decrease in mineral nodule formation was found in cells treated with TRAP compared with the vehicle control, in a dose-dependent manner. These data, along with our previous results demonstrating similar activity with full-length amelogenin and leucine-rich amelogenin peptide (LRAP), suggest that amelogenin-like molecules regulate mesenchymal cell behavior.


Detection of perioperative coronary vasospasm on iodine-123-MIBG, thallium-201 and iodine-123-BMIPP myocardial SPECT images.
A 64-yr-old woman, who had no history of anginal attack, underwent cholecystectomy under general anesthesia. A few hours after successful surgery, the EKG showed T-wave inversions with QT-interval prolongations and torsades de pointes. The [123I]MIBG scintigraphic findings revealed marked denervation in the anteroseptal and inferoposterior myocardium, whereas 201TI myocardial SPECT showed only slightly reduced tracer uptake in those areas. The [123I]BMIPP scans showed abnormal fatty acid metabolism in the anteroseptal myocardium. Coronary angiogram detected no fixed stenosis, but coronary vasoconstriction in the left anterior descending artery was induced by intracoronary injection of acetylcholine. In our patient, the findings of cardiac imaging with [123I]MIBG, 201TI and [123I]BMIPP led to coronary angiography and the final diagnosis of probable perioperative coronary vasospasm.


Trade-Off between Redox Potential and the Strength of Electrochemical CO2 Capture in Quinones.
Electrochemical carbon dioxide capture recently emerged as a promising alternative approach to conventional energy-intensive carbon-capture methods. A common electrochemical capture approach is to employ redox-active molecules such as quinones. Upon electrochemical reduction, quinones become activated for the capture of CO2 through a chemical reaction. A key disadvantage of this method is the possibility of side-reactions with oxygen, which is present in almost all gas mixtures of interest for carbon capture. This issue can potentially be mitigated by fine-tuning redox potentials through the introduction of electron-withdrawing groups on the quinone ring. In this article, we investigate the thermodynamics of the electron transfer and chemical steps of CO2 capture in different quinone derivatives with a range of substituents. By combining density functional theory calculations and cyclic voltammetry experiments, we support a previously described trade-off between the redox potential and the strength of CO2 capture. We show that redox potentials can readily be tuned to more positive values to impart stability to oxygen, but significant decreases in CO2 binding free energies are observed as a consequence. Our calculations support this effect for a large series of anthraquinones and benzoquinones. Different trade-off relationships were observed for the two classes of molecules. These trade-offs must be taken into consideration in the design of improved redox-active molecules for electrochemical CO2 capture.


Risk factors for meniscal tears: a systematic review including meta-analysis.
Systematic review with meta-analysis. To review and critically appraise the literature for factors that increase the risk for meniscal tears. Meniscal tears are an important cause of disability and time lost from work, and are associated with a 4-fold increase in the long-term risk of knee osteoarthritis. Knowledge of the risk factors that lead to meniscal tears can help to correctly diagnose knee injuries and is important to the development of prevention strategies for knee osteoarthritis. A search of the Cochrane Database of Systematic Reviews, MEDLINE, and Embase, from 1950 to January 2012, and a hand search of reference lists of all initially selected studies, without restriction on language or date of publication, were conducted. Prospective, retrospective, and case-control studies that included individuals over 16 years of age, who had no previous meniscal injuries or surgeries, were selected. A meta-analysis for 17 risk factors was performed. Where considerable heterogeneity among studies was present or the data did not provide sufficient information to perform a meta-analysis, a qualitative synthesis was conducted. Eleven studies, with a total of 7358 participants, were selected for systematic review. Data were available for meta-analysis for 10 of the 11 studies. Qualitative analysis was conducted using data from 3 of the 11 studies. Results showed strong evidence that age (older than 60 years), gender (male), work-related kneeling and squatting, and climbing stairs (greater than 30 flights) were risk factors for degenerative meniscal tears. We also found strong evidence that playing soccer and playing rugby were strong risk factors for acute meniscal tears. Waiting longer than 12 months between the anterior cruciate ligament injury and reconstructive surgery was a strong risk factor for a medial meniscal tear but not for a lateral meniscal tear. The literature indicates a number of risk factors leading to either degenerative or acute meniscal tears, with some of these factors being potentially modifiable. Prognosis, level 2a.


Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995.
Improving diagnosis of prosthetic joint infections (PJIs) has become an increasing challenge due to a steadily rising number of patients with prosthetic implants. Based on a systematic literature search we have ascertained the evidence base for improvement of culture diagnosis. We searched PubMed/MEDLINE using the medical subject heading (MeSH) 'prosthesis-related infections' 1995 through 2010 without further restrictions. An analogous search was conducted for ISI Web of Knowledge. A total of 1409 reports were screened for original results, obtained by methods described in sufficient detail to make replication possible. We gave priority to methods for sample preparation, culture media, culture methods and incubation time. Clinical sensitivity and specificity were calculated where possible. We found evidence to support superiority of cultures obtained from the diluent after sonication of prosthetic implants in comparison with culturing tissue biopsies. Sonication parameters and accessory steps have been studied extensively, and thresholds for significant growth have been defined. Conversely, methods for processing of soft tissue biopsies have been studied to a limited extent. Culture of synovial fluid in blood culture vials has been shown to be more sensitive (90-92 %) than intraoperative swab cultures (68-76 %) and tissue cultures (77-82 %). Formal evaluation of agar media for culturing PJI specimens seemed to be lacking. The polymicrobial nature of PJIs supports the routine use of an assortment of media suitable for recovery of fastidious, slow-growing, anaerobic and sublethally damaged bacteria. A number of studies supported an incubation period for up to 14 days. Although we identified evidence-based improvements of culture methods, there is a need for more studies especially with regard to tissue biopsies. Culturing remains an important means to identify and characterize pathogenic micro-organisms and supplements the increasing number of culture-independent assays.


Quantifying heterogeneity in mood-alcohol relationships with idiographic causal models.
Ecological momentary assessment (EMA) studies have provided conflicting evidence for the mood regulation tenet that people drink in response to positive and negative moods. The current study examined mood-to-alcohol relationships idiographically to quantify the prevalence and intensity of relationships between positive and negative moods and drinking across individuals. We used two EMA samples: 96 heavy drinking college students (sample 1) and 19 young adults completing an ecological momentary intervention (EMI) for drinking to cope (sample 2). Mood and alcohol use were measured multiple times per day for 4-6 weeks. Mood-alcohol relationships were examined using three different analytic approaches: standard multilevel modeling, group causal modeling, and idiographic causal modeling. Both multilevel modeling and group causal modeling showed that participants in both samples drank in response to positive moods only. However, idiographic causal analyses revealed that only 63% and 21% of subjects (in samples 1 and 2, respectively) drank following any positive mood. Many subjects (24% and 58%) did not drink in response to either positive or negative mood in their daily lives, and very few (5% and 16%) drank in response to negative moods throughout the EMA protocol, despite sample 2 being selected specifically because they endorse drinking to cope with negative mood. Traditional group-level analyses and corresponding population-wide theories assume relative homogeneity within populations in mood-alcohol relationships, but this nomothetic approach failed to characterize accurately the relationship between mood and alcohol use in approximately half of the subjects in two samples that were demographically and clinically homogeneous. Given inconsistent findings in the mood-alcohol relationships to date, we conclude that idiographic causal analyses can provide a foundation for more accurate theories of mood and alcohol use. In addition, idiographic causal models may also help improve psychosocial treatments through direct use in clinical settings.


The urinary system.
The urinary system plays an important role in regulating fluid and electrolyte balance and maintaining homeostatic balance within the body. Assessment and management of fluid and electrolyte balance is a vital part of the nurses' role, therefore it is important that nurses understand the functions of the urinary system. This article explores the anatomy and physiology of the urinary system, with reference to the production and excretion of urine. It also provides an overview of urinary tract infection.


Online Teaching in Medical Training: Establishing Good Online Teaching Practices from Cumulative Experience.
Online teaching has the potential to transcend geographical boundaries, is flexible, learner centered and can help students develop self-directed learning skills. The recently introduced competency-based curriculum has also advocated e-learning as an indispensable tool for self-directed learning. For effective online learning, good online teaching practices should be adopted. These include alignment of online teaching and learning with delivery of curriculum and objectives, synchronous, and asynchronous interaction between teacher and student, encouraging the development of higher-order thinking skills, active learning, and self-directed learning in students. In addition, good online teaching practices should have an inbuilt component of feedback and provide for effective time management, respect for diverse talents and ways of learning with continuous monitoring and mentoring of the learners. Online assessments, both formative and summative should also aim to ensure student involvement in the process. Capacity building of faculty through faculty development programs for the development of specific competencies such as social competency, pedagogical competency, managerial competency, and technical competency in the times of COVID-19 is now recognized as the need of the hour. Although online teaching and learning in medical education is new, it has the potential to become mainstream in future.


Merits of intralesional fibrin glue injection in surgery for cavernous sinus cavernous hemangiomas. Technical note.
In planning surgical treatment for extraaxial cavernous hemangiomas, care should be taken to control severe tumor bleeding. The authors present a case of a large cavernous hemangioma of the cavernous sinus, which was completely removed with the aid of multiple intratumoral injections of fibrin glue. This novel method is very effective for preventing excessive blood loss during surgery for this type of lesion.


Therapeutic strategy for lower limb lymphedema and lymphatic fistula after resection of a malignant tumor in the hip joint region: a case report.
Lymphatic fistula complicating lymphedema is thought to occur due to communication between lymph vessels and the skin, which has yet to be shown objectively. The objective of this case report is to show the pathology and treatment using simultaneous lymphatic fistula resection and lymphatico-venous anastomosis (LVA). A 40-year-old woman underwent extended resection and total hip arthroplasty for primitive neuroectodermal tumor in the right proximal femur 23 years ago. Right lower limb lymphedema developed immediately after surgery and lymphatic fistula appeared in the posterior thigh. On ICG lymphography, lymph reflux toward the distal side dispersing in a fan-shape reticular pattern from the lymphatic fistula region was noted after intracutaneous injection of ICG into the foot. We performed simultaneous lymphatic fistula resection and of LVA. Pathological examination showed that the epidermis and stratum corneum of the healthy skin were lost in the lymphatic fistula region. Dilated lymph vessels were open in this region. The examinations provide the first objective evidence that the cause of lymphatic fistula may be lymph reflux from lymphatic stems to precollectors through lymphatic perforators.


Halogen Bond of Halonium Ions: Benchmarking DFT Methods for the Description of NMR Chemical Shifts.
Because of their anisotropic electron distribution and electron deficiency, halonium ions are unusually strong halogen-bond donors that form strong and directional three-center, four-electron halogen bonds. These halogen bonds have received considerable attention owing to their applicability in supramolecular and synthetic chemistry and have been intensely studied using spectroscopic and crystallographic techniques over the past decade. Their computational treatment faces different challenges to those of conventional weak and neutral halogen bonds. Literature studies have used a variety of wave functions and DFT functionals for prediction of their geometries and NMR chemical shifts, however, without any systematic evaluation of the accuracy of these methods being available. In order to provide guidance for future studies, we present the assessment of the accuracy of 12 common DFT functionals along with the Hartree-Fock (HF) and the second-order Møller-Plesset perturbation theory (MP2) methods, selected from an initial set of 36 prescreened functionals, for the prediction of 1H, 13C, and 15N NMR chemical shifts of [N-X-N]+ halogen-bond complexes, where X = F, Cl, Br, and I. Using a benchmark set of 14 complexes, providing 170 high-quality experimental chemical shifts, we show that the choice of the DFT functional is more important than that of the basis set. The M06 functional in combination with the aug-cc-pVTZ basis set is demonstrated to provide the overall most accurate NMR chemical shifts, whereas LC-ωPBE, ωB97X-D, LC-TPSS, CAM-B3LYP, and B3LYP to show acceptable performance. Our results are expected to provide a guideline to facilitate future developments and applications of the [N-X-N]+ halogen bond.