Radiologist-supervised ketamine sedation for solid organ biopsies in children and adolescents.
Pediatric interventional radiologists are frequently challenged when faced with organ biopsies. Because of the need for patient immobility and the potential risk of morbidity with patient movement during biopsies, many radiologists prefer general anesthesia to sedation. We present our experience with radiologist-supervised ketamine sedation in pediatric patients undergoing renal and hepatic biopsies. Quality assurance data were accessed from a computerized database that prospectively collects demographics, outcome parameters, and adverse events on all patients who receive ketamine sedation. Patients received an IV ketamine bolus of 2 mg/kg followed by a continuous infusion of ketamine of up to 150 mcg/kg/min titrated to the responsiveness of the patient. Sixty-five children received ketamine for liver (n = 35) and renal (n = 30) biopsies. The mean age of the study group was 7.0 +/- 2.7 (SD) years. The cohort included patients with an American Society of Anesthesiologists (ASA) physical status classification of ASA 1 (3%), ASA 2 (78%), and ASA 3 (19%). The duration of ketamine sedation averaged 39 +/- 20 (SD) minutes, with an average procedure time of 32 +/- 19 (SD) minutes. All procedures were successfully completed, and there were no major adverse events. Interventional radiologists performing solid organ biopsies in the pediatric population often use general anesthesia to ensure immobility, adequate analgesia, and safe conditions. Our experience suggests that interventional radiologists may supervise a nurse-administered ketamine protocol to provide safe, effective analgesia and sedation for liver and renal biopsies.


Participating in Faculty-Supervised Extracurricular Experiential Learning Activities Contributes to Dietetic Competency Development.
Purpose: To examine the relationship between Food and Nutrition graduates' involvement in faculty-supervised extracurricular experiential learning activities (FEEs) and the development of dietetic competencies. Methods: An original web-based survey, assessing involvement in FEEs and self-perceived level of Canadian dietetic competencies, was administered to Brescia University College Food and Nutrition graduates for graduation years 2011-2017. Competency scores were calculated for each respondent in 4 practice areas (Professional Practice, Communication and Collaboration, Population and Public Health, and Management), and summed for a Total Competency Score. Multiple linear regressions were used to assess predictors of competency scores. Results: The final sample consisted of 233 respondents who participated in 1.9 ± 1.1 FEEs. The highest average competency score (out of 100) was Communication and Collaboration (59.7 ± 31.7); the lowest was Management (40.3 ± 30.9). Total hours spent and breadth of experiences in FEEs were significant predictors of all scores (P < 0.05). Depth of experiences was a significant predictor of all competency scores (P < 0.05) except for Management (P = 0.27). Conclusions: Participation in FEEs contributes to Food and Nutrition students' development of entry-level dietetic competencies; therefore, counting some FEEs as curricular credits may be warranted. Given the prominence of competency-based learning assessments, these results also have implications for faculty resources, budgets, and collective agreements.


Effects of hippotherapy on gross motor function and functional performance of children with cerebral palsy.
The purpose of our study was to investigate the effects of hippotherapy on gross motor function and functional performance in children with spastic cerebral palsy (CP). We recruited 34 children (M:F=15:19, age: 3-12 years) with spastic CP who underwent hippotherapy for 45 minutes twice a week for 8 weeks. Twenty-one children with spastic CP were recruited for control group. The distribution of gross motor function classification system level and mean age were not significantly different between the two groups. Outcome measures, including the Gross Motor Function Measure (GMFM)-66, GMFM-88 and the Pediatric Evaluation of Disability Inventory: Functional Skills Scale (PEDI-FSS), were assessed before therapy and after the 8-weeks intervention as outcome measures. There were no significant differences between intervention and control groups in mean baseline total scores of GMFM-66, GMFM-88 or PEDI-FSS. After the 8-weeks intervention, mean GMFM-66 and GMFM-88 scores were significantly improved in both groups. However, the hippotherapy group had significantly greater improvement in dimension E and GMFM-66 total score than the control group. The total PEDI-FSS score and the sub-scores of its 3 domains were significantly improved in the hippotherapy group, but not in the control group. The results of our study demonstrate the beneficial effects of hippotherapy on gross motor function and functional performance in children with CP compared to control group. The significant improvement in PEDI-FSS scores suggests that hippotherapy may be useful to maximize the functional performance of children with CP.


Appreciation of Pattern in Diagnosis of Lung Adenocarcinoma from Cytology Specimen: Our Experience with Fine Needle Aspiration Cytology and Cell Block in a Resource Constraint Setup.
Advent of personalised treatment needs correct diagnosis of lung adenocarcinoma with its molecular subtyping. Minimal use of special stain or immunohistochemistry (IHC) in small specimens save material for molecular testing. Various histologic patterns in adenocarcinoma (ADC) subtypes have different prognostic implications and current recommendation is to describe these patterns in small specimens. Aim of this study was to diagnose adenocarcinoma from cytology specimens depending on adenocarcinoma pattern on fine needle aspiration smears and cell blocks. We also studied the additional role of cell blocks as a platform for special stain and IHC. Conventional smears and cell block (CB) preparation were examined from transthoracic CT guided FNA samples of suspicious lung malignancy cases. Clear defining architectural pattern and cytomorphological features in favour of adenocarcinoma were evaluated and mucin stain and IHC were used as and when required. A total of 86 cases were included in this study, of which 83 cases were diagnosed as adenocarcinoma, 52 (62.5%) showed clear cut evidence of adenocarcinoma from smears and CBs. CB morphology alone aided the diagnosis in 12. Various ADC patterns in combination or alone were appreciated in these 64 cases. Sixteen needed mucin stain and 3 needed IHC for diagnosis. Forty one were ADC with solid pattern of which 39 showed high nuclear grade. Adequately cellular FNA smears and corresponding cell blocks of optimal quality can aid effectively in diagnosing adenocarcinoma and appreciating its pattern. Therefore, it would minimize the need for special stain and/or IHC with preservation of more material for molecular testing.


The relationship between maternal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGFBP-3 to gestational age and preterm delivery.
To investigate the relationship between levels of insulin-like growth factors 1 and 2 (IGF-1, IGF-2), and insulin-like growth factor binding protein 3 (IGFBP-3) in antenatal maternal serum and gestational age at delivery. Prospective cohort study of 1650 low-risk Caucasian women in a London University teaching hospital. Maternal IGF-1, IGF-2 and IGFBP-3 were measured in maternal blood at booking and analyzed with respect to gestational age at delivery. There was no significant association between maternal IGF-1 or IGF-2 and preterm birth (PTB). A significant reduction in mean IGFBP-3 levels was noted with delivery <32 completed weeks (P=0.02). Maternal mean IGFBP-3 levels are significantly reduced in cases complicated by delivery <32 completed weeks.


Ultrasound Cycloplasty in Chinese Glaucoma Patients: Results of a 6-Month Prospective Clinical Study.
The aim of this study was to evaluate the short-term efficacy and safety of ultrasound cycloplasty (UCP) procedure in Chinese glaucoma patients. As a single-center, prospective, noncomparative study, 23 eyes of 23 patients suffering from glaucoma with uncontrolled intraocular pressure (IOP) ≥21 mm Hg underwent a multidose UCP treatment with the activations of 6, 8, or10 sectors. Types of glaucoma include primary open-angle glaucoma (7/23), primary angle closure glaucoma (PACG) (9/23), and secondary glaucoma (SG) (7/23). A complete ophthalmic examination including intraocular pressure (IOP) measurements was performed before UCP procedure and at 1 day, 1 month, 3 months, and 6 months after the procedure. An IOP reduction of ≥20% and IOP >5 mm Hg without increasing hypotensive medication at the follow-up visit was defined as therapeutic success. The postoperative complications were also recorded and compared to baseline for safety evaluation. The mean baseline IOP of 23 treated eyes was 37.2 ± 12.1 mm Hg. The IOP reduction after UCP procedure was 23, 49, 33, and 34% at 1 day, 1 month, 3 months, and 6 months, respectively. Thus, the corresponding overall therapeutic success rates reached 61% (14/23), 83% (19/23), 65% (15/23), and 61% (14/23), respectively. Baseline IOPs of 8- and 10-sector groups (37.0 ± 9.9 mm Hg and 50.1 ± 12.2 mm Hg) were significantly higher than that of 6 sector groups (30.1 ± 8.2 mm Hg). Therapeutic success rates of 6-, 8-, and 10-sector groups reached 44% (4/9), 56% (5/9), and 100% (5/5), respectively. There were the highest percentage of IOP reduction (50 and 41%) and therapeutic success rate (6/7; 86% and 7/9; 78%) in the SG group and PACG group, respectively. In addition, preoperative ocular pain symptoms of 4 patients were all disappeared within 1 week after UCP. No serious intraoperative or postoperative complications occurred. UCP procedure is an effective and well-tolerated treatment to reduce IOP in Chinese glaucoma patients, which offered a novel alternative for glaucoma treatment.


Zonula occludens toxin synthetic peptide derivative AT1002 enhances in vitro and in vivo intestinal absorption of low molecular weight heparin.
Zonula occludens toxin (Zot) is an enterotoxin obtained from the bacterium vibrio cholerae that has been shown to reversibly and safely open the tight junctions and enhance paracellular transport. AT1002 is a novel synthetic hexapeptide derived from Zot. The hypothesis to be tested in this study is that AT1002 enhances the oral absorption of ardeparin, a low molecular weight heparin (LMWH). To test this hypothesis, drug transport through Caco-2 cell monolayers was monitored in the presence and absence of AT1002. Regional permeability studies using rat intestine were performed. Cell viability in the presence of various concentrations of enhancer was determined. The absorption of ardeparin after oral administration in rats was measured by anti-factor Xa assay. Furthermore, the eventual mucosal and epithelial damage was histologically evaluated. Higher ardeparin permeability (approximately 2-fold) compared to control was observed in the presence of 0.025% of AT1002. Regional permeability studies revealed that the permeability of ardeparin across the duodenal membrane was improved by the AT1002. Cell viability studies showed no significant cytotoxicity below 0.0028% of AT1002. In the presence of 100 microg/kg of AT1002, ardeparin oral bioavailability was significantly increased (F(relative/s.c) approximately 20.5%). Furthermore, AT1002 at a dose of 100 microg/kg did not induce any observable morphological damage on gastrointestinal (GI) tissues in vivo. These in vivo and in vitro results suggest that the co-administration of LMWH with AT1002 may be a useful delivery strategy to increase its permeability and hence oral absorption.


Radiopharmaceutical Extravasation: Pragmatic Radiation Protection.
Inadvertent injection of a radiopharmaceutical agent into a patient's arm tissue instead of into the appropriate blood vessel can cause the injection to infiltrate underlying tissue and produce a potentially substantial, localized irradiation to the patient's arm and skin tissue. When this type of misadministration occurs, called an extravasation, it should be recognized, mitigated, and monitored for patient health and safety. Immediate symptoms of radiopharmaceutical extravasation may include swelling, edema, pain, or numbness in the vicinity of the extravasation site; inflammation; and drainage from the site. Some infiltrations may go unnoticed until later. Pragmatic elements of radiation safety include imaging to assess the geometry, volume, and anatomic distribution of activity, collection of tissue count-rate data over retention times, calibration against known activity levels, and dosimetry to help clinicians determine whether an extravasation is severe and whether the patient should be followed for adverse tissue reactions.


Biomechanical analysis between PEEK and titanium screw-rods spinal construct subjected to fatigue loading.
An in vitro fatigue loading test with porcine specimens. To comparatively analyze the in vitro biomechanical performance of Polyetheretherketone (PEEK) and Titanium rods construct subjected to a battery of fatigue loading testing. PEEK rods construct has been proposed to allow better load sharing among spinal components than the more traditional Titanium rods constructs. However, such proposal has largely derived from single-load in vitro testing and the biomechanical differences when subjected to fatigue loading remain unknown. Twenty-four fresh 4-level motion segment were harvested from porcine. Specimens were randomly assigned into 3 groups: (1) intact, (2) destabilized group with Titanium alloy rods, and (3) destabilized group with PEEK rods. All specimens were subjected to a fatigue loading procedure with the disk height and intradiscal pressure (IDP) of the instrumented and adjacent levels were recorded and used for analysis. The stress levels on the rods and bone stress near the screw-bone interface were also collected to investigate the likely failure rates of the 2 constructs. Titanium rods construct demonstrated a minimum amount of loss of disk height and IDP at the instrumented level; however, a significant loss of the disk height and IDP at adjacent levels compared with the intact spine were identified. In contrast, the disk height and IDP of the PEEK rods were found to be comparable with those of the intact spine for all levels. The PEEK rods group also showed significantly less bone stress near the screw-bone interface compared with the Titanium rods group. The current study has demonstrated the differences in biomechanical characteristics of PEEK and Titanium rods construct when subjected to fatigue loading. More specifically, the result is indicative of the potential benefits of the PEEK rods construct in reducing the risks of adjacent segment disease and implant failure rates.


SAT-assembly: a new approach for designing self-assembling systems.
We propose a general framework for solving inverse self-assembly problems, i.e. designing interactions between elementary units such that they assemble spontaneously into a predetermined structure. Our approach uses patchy particles as building blocks, where the different units bind at specific interaction sites (the patches), and we exploit the possibility of having mixtures with several components. The interaction rules between the patches is determined by transforming the combinatorial problem into a Boolean satisfiability problem (SAT) which searches for solutions where all bonds are formed in the target structure. Additional conditions, such as the non-satisfiability of competing structures (e.g. metastable states) can be imposed, allowing to effectively design the assembly path in order to avoid kinetic traps. We demonstrate this approach by designing and numerically simulating a cubic diamond structure from four particle species that assembles without competition from other polymorphs, including the hexagonal structure.


Cardioprotective effect of 5-lipoxygenase gene (ALOX5) silencing in ischemia-reperfusion.
It is well known that 5-lipoxygenase derivates of arachidonic acid play an important pathogenic role during myocardial infarction. Therefore, the gene encoding arachidonate 5-lipoxygenase (ALOX5) appears to be an attractive target for RNA interference (RNAi) application. In experiments on cultivated cardiomyocytes with anoxia-reoxygenation (AR) and in vivo using rat model of heart ischemia-reperfusion (IR) we determined influence of ALOX5 silencing on myocardial cell death. ALOX5 silencing was quantified using real-time PCR, semi-quantitative PCR, and evaluation of LTC(4) concentration in cardiac tissue. A 4.7-fold decrease of ALOX5 expression (P < 0.05) was observed in isolated cardiomyocytes together with a reduced number of necrotic cardiomyocytes (P < 0.05), increased number live (P < 0.05) and unchanged number of apoptotic cells during AR of cardiomyocytes. Downregulation of ALOX5 expression in myocardial tissue by 19% (P < 0.05) resulted in a 3.8-fold reduction of infarct size in an open chest rat model of heart IR (P < 0.05). Thus, RNAi targeting of ALOX5 protects heart cells against IR injury both in culture and in vivo.


Heteroatom-Doped Amorphous Cobalt-Molybdenum Oxides as a Promising Catalyst for Robust Hydrogen Evolution.
The simultaneous manipulation of the catalytic activity and intrinsic electrical conductivity in a unified system is difficult yet meaningful to unravel the possible strategy that can enhance the hydrogen evolution reaction (HER) performance. Therefore, we propose a simple strategy to enhance the HER performance based on low-temperature redox reaction with ZIF-67@ZIF-8 as a sacrificial template to prepare zinc-doped amorphous CoMo8Ox (denoted as Zn/aCMO). Benefiting from the excellent compositional- and amorphous-based structural advantages of more exposure active sites, optimized electron transfer as well as a stable frame structure, the as-prepared electrode can drive hydrogen evolution at current densities of 10, 50, and 100 mA cm-2, which need ultralow overpotentials of 59, 138, and 189 mV, respectively, and the Tafel slope of the electrode was 66.2 mV dec-1 (1 M KOH). Meanwhile, the intrinsic activity of the prepared low-cost electrocatalyst was also determined, and the turnover frequency was up to 1.49 s-1 at an overpotential of 100 mV. In addition, after continuous testing for 160 h, there was a slight decay at the overpotential of 130 mV.


Antral motility in patients with cirrhosis with or without gastric antral vascular ectasia.
Gastric motility has not been extensively studied in patients with cirrhosis and gastric antral vascular ectasia (GAVE) may be associated with antropyloric dysfunction. This study therefore looked at antral motility using ultrasound in patients with alcoholic cirrhosis with or without GAVE. Twenty six patients were included: 10 patients with cirrhosis without GAVE, eight patients with cirrhosis and GAVE, and eight controls without liver disease. Measurement of antral area and antral contractions (amplitude and frequency) was performed for three hours after ingestion of a standardised solid-liquid meal. Antral area half time (mean (SD)) was not significantly increased in patients with cirrhosis without GAVE (84 (42) min), but increased by 120% (123 (43) min; p < 0.01) in patients with GAVE compared with controls (56 (26) min). GAVE patients exhibited the same frequency and amplitude of antral contractions at each time point as controls and had the same tendency to increase these values over time although this was attenuated in the late postprandial phase. In contrast, cirrhotic patients without GAVE exhibited a significantly higher frequency and amplitude of antral contractions during the initial postprandial phase but showed no change in either frequency or amplitude over time. In conclusion, in cirrhosis there is an abnormal antral motor response to a meal, which has a different pattern over time in patients with or without GAVE.


An extreme and unusual variant of Ramsay Hunt syndrome.
Ramsay Hunt syndrome is characterized by facial nerve paralysis, herpetic vesicles in or around the ear and pain often associated with vestibulocochlear nerve involvement. It is thought to be a cranial polyneuropathy caused by the herpes zoster virus. We present an extreme and unusual variant of this disease with involvement of VIIth, VIIIth, Xth, XIth and XIIth cranial nerves as well as C2-4 sensory dermatomes and profound systemic upset which caused some diagnostic uncertainty.


Measuring 8-250 ps short pulses using a high-speed streak camera on kilojoule, petawatt-class laser systems.
Short-pulse measurements using a streak camera are sensitive to space-charge broadening, which depends on the pulse duration and shape, and on the uniformity of photocathode illumination. An anamorphic-diffuser-based beam-homogenizing system and a space-charge-broadening calibration method were developed to accurately measure short pulses using an optical streak camera. This approach provides a more-uniform streak image and enables one to characterize space-charge-induced pulse-broadening effects.


A mechanism-based kinetic analysis of succinimide-mediated deamidation, racemization, and covalent adduct formation in a model peptide in amorphous lyophiles.
The succinimide intermediate generated during deamidation of asparagine-containing peptides and proteins has been implicated as having a role in the formation of multiple types of degradants in addition to hydrolysis products, including racemization products and, more recently, amide-linked, nonreducible protein and peptide aggregates. The formation of alternative degradants may be particularly important in solid-state formulations. This study quantitatively examines the role of the succinimide intermediate in hydrolysis, racemization, and covalent, amide-linked adduct formation in amorphous lyophiles. The degradation of a model peptide, Gly-Phe-L-Asn-Gly, and its L- or D-succinimide intermediates were examined in lyophiles containing hydroxypropyl methylcellulose and varying amounts of excess Gly-Val. Disappearance of the starting reactants and formation of up to 10 degradants were monitored when lyophiles were exposed to either 27°C/40% relative humidity (RH) or 40°C/75 RH using a stability indicating high-performance liquid chromatography method. Terminal degradant profiles were the same when the starting reactant was either Gly-Phe-L-Asn-Gly or its succinimide intermediate. Nucleophilic attack occurred preferentially at the α-carbonyl of the succinimide intermediate at ratios of approximately 2:1 for both water and the N-terminus of Gly-Val as the attacking nucleophiles. A mechanism-based kinetic model analysis indicates that hydrolysis, racemization, and covalent, amide-linked adduct formation all proceed via the succinimide intermediate.


Quality or Quantity of Proteins in the Diet for CKD Patients: Does "Junk Food" Make a Difference? Lessons from a High-Risk Pregnancy.
How to manage patients with severe kidney disease in pregnancy is still a matter of discussion, and deciding if and when to start dialysis is based on the specialist's experience and dialysis availability. The effect of toxic substances usually cleared by the kidney may be more severe and readily evident. The review, and related case, underlines the importance of considering the presence of additives in food in delicate conditions, such as CKD pregnancy. The Case: A 39-year-old indigenous woman from a low-resourced area in Mexico was referred to the obstetric nephrology at 25 gestational weeks because of serum creatinine at 3.6 mg/dL, hypertension on low-dose alpha-methyl-dopa, and nephrotic-range proteinuria. Kidney ultrasounds showed small poorly differentiated kidneys; foetal ultrasounds detected a female foetus, normal for gestational age. The patient's baseline protein intake, which was estimated at 1.2-1.3 g/kg/day, was mostly of animal-origin (>70%) poor-quality food ("junk food"). In the proposed diet, protein intake was only slightly reduced (1.0-1.2 g/kg/day), but the source of proteins was changed (only 30% of animal origin) with attention to food quality. A remarkable decrease in BUN was observed, in concomitance with adequate dietary follow-up, with rapid rise of BUN when the patient switched temporarily back to previous habits. A healthy female baby weighing 2,460 g (11th centile for gestational age) was delivered at 37 gestational weeks. Discussion and Literature Review: While data on patients with chronic kidney disease are scant, the long list of contaminants present in food, especially if of low quality, should lead us to reflect on their potential negative effect on kidney function and make us realize that eating healthy, unprocessed "organic" food should be encouraged, in delicate conditions such as pregnancy and breastfeeding and for young children, in particular when kidney function is failing. The case herein described gave us the opportunity to reflect on the importance of diet quality and on the potential risks linked to food additives, many of which, including phosphates and potassium, are not declared on food labels, while others, including dyes, antioxidants, thickeners, emulsifiers, and preservatives, are qualitatively, but not quantitatively, reported.


[Effect of opening point method of ziwu liuzhu on myocardial ischemia in the patient of stroke].
To observe effect of opening point method of ziwu liuzhu on myocardial ischemia in the patient of stroke. Thirty cases of stroke with myocardial ischemia were treated with opening acupoint according to time of the combination of reinforcing mother point and reducing son point of the heart channel in nazi method of ziwu liuzhu, and 30 cases in the control group were treated with acupuncture at Guangming (GB 37). Changes of electrocardiogram before and after treatment were recorded. ST-T segment raised significantly 30 min after treatment with ziwu liuzhu needling method as compared with the control group (P < 0.05), the treatment group being better than the control group. Excessive and deficient changes of the qi and blood in the meridians and collaterals are correlated with time rhythm, and ziwu liuzhu needling method can increase clinical therapeutic effect.


An unusual case of polydactyly.
Polydactyly is defined as a congenital anomaly of the hand or foot with the presence of supernumerary digits. The frequency of polydactyly varies widely among populations. It can occur as an isolated condition or as a feature of a congenital condition. In the literature, the condition is commonly described in combination with an apparent congenital deformity. We describe a case of polydactyly with no other obvious, macroscopically visible anomaly. A 21-year-old man presented with a sprained left ankle. On examination, a slightly irregularly shaped fifth digit of the left foot that appeared like a tailor's bunion was observed. The patient reported slight weight-bearing pain and tenderness over the navicular bone. No fractures were seen on radiographs, but they revealed an os tibiale externum, an extra metatarsal bone conjoined distally with the fifth metatarsal, and an extra hypoplastic proximal phalanx. No obvious signs of deformity were present. A bunionette, which was an extra hypoplastic proximal phalanx, was observed at the base of the fifth toe. Few published reports have described isolated polymetatarsia, and none of those describe supernumeral digits. A comprehensive search of the literature found no cases identical to ours.


Infection control programs at children's hospitals: a description of structures and processes.
Infection control (IC) structures and processes determine the effectiveness of surveillance efforts to prevent infections in health care settings. A survey was sent to 56 children's hospitals collaborating in the Pediatric Prevention Network (PPN). Completed surveys were returned from 48 hospitals. Responsibility for the IC program resided with the medical director (21%); vice president for patient care (18%); quality improvement director (17%); other senior hospital administrator (15%); or other hospital personnel (18%). Forty-two hospitals had an IC committee; 32 had antimicrobial restriction/control policies; and 21 had an antimicrobial restriction/control task force or committee. Components of antimicrobial restriction programs included infectious disease specialist approval, restricted formularies, selective susceptibility test reporting, and staff education programs. Many methods were used to detect infections, including microbiology laboratory reports (100%); record reviews (98%); informal reports from providers (90%); and readmission reviews (77%). Children's hospitals vary widely in how they design and implement their IC functions. These variations influence adverse event detection and nosocomial infection rate calculations. If medical errors, including nosocomial infections, are to be detected and hospital rates compared, standardized methods to collect, analyze, and report data are needed. The PPN has initiated activities to standardize surveillance and IC practices in participating hospitals.


Sleep in psychiatric disorders: where are we now?
Although the precise function of sleep is unknown, decades of research strongly implicate that sleep has a vital role in central nervous system (CNS) restoration, memory consolidation, and affect regulation. Slow-wave sleep (SWS) and rapid eye movement (REM) sleep have been of significant interest to psychiatrists; SWS because of its putative role in CNS energy recuperation and cognitive function, and REM sleep because of its suggested involvement in memory, mood regulation, and possible emotional adaptation. With the advent of the polysomnogram, researchers are now beginning to understand some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. The same neurochemistry that controls the sleep-wake cycle has also been implicated in the pathophysiology of numerous psychiatric disorders. Thus it is no surprise that several psychiatric disorders have prominent sleep symptoms. This review will summarize normal sleep architecture, and then examine sleep abnormalities and comorbid sleep disorders seen in schizophrenia, as well as anxiety, cognitive, and substance abuse disorders.


Blood salvage and allogenic transfusion needs in revision hip arthroplasty.
Blood transfusions frequently are required after revision total hip arthroplasty, and although autologous and allogenic transfusions are effective in replacing blood loss, they are not without risks. To reduce the dependency on these types of transfusions, intraoperative blood collection and return by autotransfusion replacement systems are being used as an alternative or conjunctive therapy. We retrospectively reviewed 147 hip revision surgeries to determine if autotransfusion replacement systems return from the Cell Saver or the OrthoPat decreased the need for allogenic blood. We also questioned if components revised and preoperative hematocrit were risk factors for allogenic transfusion. The two blood salvage systems were compared for blood loss, autotransfusion replacement systems collection and return, allogenic use, and the implants replaced. Both systems were found to replace at least 42% of blood lost during surgery, averaging a return of 370 mL. Allogenic blood transfused was reduced by 31% with the use of an autotransfusion replacement systems machine. Risk factors found to be associated with the need for allogenic transfusions are femoral component revision or femoral and acetabular revision, preoperative hematocrit less than 45%, and autotransfusion replacement systems return greater than 300 mL. Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.


Accurate assessment of the bioactivities of redox-active polyphenolics in cell culture.
Phenolic compounds are widely known for their roles as antioxidants and anti-inflammatory agents, as well as for their epidemiological association with reduced risks for certain types of diseases. In the present study, we used rabbit peripheral blood mononuclear cells (PBMCs) to evaluate possible artifacts that result from the reactivity of polyphenolics. We evaluated several common methods for cytotoxicity tests using nine polyphenolics, representing several major classes of tannins and their subunits. For three of those phenolics, we investigated whether or not the bioactivities of the phenolics were altered by spontaneous oxidation. Our study showed that many of the nine tested tannins interfered with the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, which is commonly used to measure cell viability. A better method for determining cell viability is the luciferin/luciferase ATP assay, and using that method, we found that several tannins are toxic to PBMCs. We measured TNF-alpha production to assess possible anti-inflammatory activity, and found that only apigenin inhibited TNF-alpha production in LPS-stimulated cells (EC 50 1.0 microg/mL). The other polyphenolic compounds we tested either had no effect on TNF-alpha or increased its production. However, our data indicated that spontaneous oxidation altered the activity of phenolics, eliminating their toxicity. This study shows that the chemical reactivity of phenolics can significantly affect attempts to evaluate bioactivity in cultured cells and that particular attention should be paid to both methods for determining toxicity and to spontaneous oxidation of tannins during cell testing.


Results of a randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of a botulinum toxin type A topical gel for the treatment of moderate-to-severe lateral canthal lines.
Injections of botulinum toxin type A are commonly used to treat facial wrinkles; however, undesirable effects are associated with injections (e.g., pain, bruising, ptosis, immunogenicity, and needle aversion). To address these issues, RT001 Botulinum Toxin Type A Topical Gel is being developed for the treatment of lateral canthal lines. To assess the safety and efficacy of RT001 for the treatment of lateral canthal lines in a randomized, double-blind, placebo-controlled study. Adult subjects were enrolled to receive a single treatment of RT001 (n=45) or placebo (n=45) applied topically in the lateral canthal area. The primary endpoint was the composite of the Investigator Global Assessment of Lateral Canthal Line Severity (IGA-LCL) and the Patient Severity Assessment of lateral canthal line severity (PSA) defined as a 2-point or greater improvement on both scales. At four weeks, 44.4 percent of subjects treated with RT001 achieved a 2-point or greater improvement on a rigorous composite of both the IGA-LCL and PSA scales compared to 0.0% for the placebo subjects (P<0.0001). At four weeks, 88.9 percent of subjects achieved clinically relevant improvement by investigator assessment. Adverse events were mild in severity and unrelated to study treatment. RT001 appears to be a safe and well-tolerated treatment for improvement of lateral canthal lines.


Simian virus 40 large T antigen targets the spindle assembly checkpoint protein Bub1.
The mitotic spindle checkpoint protein Bub1 has been found to be mutated at low frequency in certain human cancers characterized by aneuploidy. Simian virus 40 large T antigen efficiently immortalizes rodent cells and occasionally transforms them to tumorigenicity. T antigen can also cause genomic instability, inducing chromosomal aberrations and aneuploidy. Here, we report an interaction between Bub1 and T antigen. T antigen coimmunoprecipitates with endogenous Bub1 and Bub3, another component of the spindle checkpoint complex. Genetic analysis demonstrates that the interaction of T antigen with Bub1 is not required for immortalization but is closely correlated with transformation. T antigen induces an override of the spindle checkpoint dependent on Bub1 binding. This interaction with proteins of the spindle checkpoint machinery suggests another role for T antigen and provides insight into its ability to cause chromosomal aberrations, aneuploidy, and transformation.


Effects of Launaea sarmentosa Extract on Lipopolysaccharide-Induced Inflammation via Suppression of NF-κB/MAPK Signaling and Nrf2 Activation.
Launaea sarmentosa has been extensively used as a nutrient herb in traditional Vietnamese remedies for the treatment of various diseases, especially inflammatory diseases. However, no detailed research has been conducted examining the molecular mechanisms involved in the suppression of inflammatory response. Here, we studied the effects of L. sarmentosa methanol extract on lipopolysaccharide (LPS)-induced inflammation using RAW 264.7 macrophages. The extract demonstrated potent antioxidant activity owing to the presence of polyphenolic and flavonoid components. Pretreatment with the extract inhibited LPS-mediated secretion of nitric oxide, reactive oxygen species, and tumor necrosis factor-α as well as the expression of inflammatory cytokines. Furthermore, the activation of the nuclear factor-kappa B pathway and phosphoinositide-3-kinase/protein kinase B pathways was blocked by the extract by inhibiting Akt phosphorylation. Additionally, the mitogen-activated protein kinase pathway was suppressed, and endoplasmic reticulum stress was attenuated. Furthermore, the extract promoted the activity of nuclear factor erythroid-2-related factor 2 resulting in the up-regulation of heme oxygenase-1 pathway, leading to the suppression of oxidative stress and inflammatory response. Taken together, the results indicate that L. sarmentosa exhibits anti-inflammatory effects, and hence, can be further developed as a novel drug for the treatment of diseases associated with excessive inflammation.


Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas.
The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE. Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013-November 2017) (control group) using the Mann-Whitney U test. A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p-value = 0.046). PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA.


High-capacity optical long data memory based on enhanced Young's modulus in nanoplasmonic hybrid glass composites.
Emerging as an inevitable outcome of the big data era, long data are the massive amount of data that captures changes in the real world over a long period of time. In this context, recording and reading the data of a few terabytes in a single storage device repeatedly with a century-long unchanged baseline is in high demand. Here, we demonstrate the concept of optical long data memory with nanoplasmonic hybrid glass composites. Through the sintering-free incorporation of nanorods into the earth abundant hybrid glass composite, Young's modulus is enhanced by one to two orders of magnitude. This discovery, enabling reshaping control of plasmonic nanoparticles of multiple-length allows for continuous multi-level recording and reading with a capacity over 10 terabytes with no appreciable change of the baseline over 600 years, which opens new opportunities for long data memory that affects the past and future.


[New microbiological approach to analyzing the sanitary and ecological status of natural water reservoirs].
The paper shows that in addition to the qualitative characteristics that are of rather informative value for evaluation of the sanitary and ecological conditions of environmental objects, there are suitable qualitative characteristics that may reveal the changes preceding irreversible changes in the natural environment. As such, the factors of persistence which are rather widely prevalent in aquatic microorganisms. By taking into account that the persistent properties of microorganisms label an ecological affiliation of bacteria, ecological type-specific differences of hydrobionts in persistent characteristics, they may be used as informative criteria for an indicator value in sanitary and ecological work. The value of these materials is great in the applied point of view as just now they open up vistas for microbiological monitoring and ecological studies of natural water reservoirs.


How is the Theoretical Domains Framework applied in designing interventions to support healthcare practitioner behaviour change? A systematic review.
The use of theory is recommended to support interventions to promote implementation of evidence-based practices. However, there are multiple models of behaviour change which can be complex and lack comprehensiveness and are therefore difficult to understand and operationalize. The Theoretical Domains Framework sought to address these problems by synthesizing 33 models of behaviour or behaviour change. Given that it is 15 years since the first publication of the Theoretical Domains Framework (TDF), it is timely to reflect on how the framework has been applied in practice. The objective of this review is to identify and narratively synthesize papers in which the TDF, (including frameworks that incorporate the TDF) have been used have been used to develop implementation interventions. We searched MEDLINE, PsychINFO, CINAHL and the Cochrane databases using the terms: 'theoretical domains framework*' or TDF or Capability, Opportunity, Motivation to Behaviour (COM-B) or 'behav* change wheel' or 'BCW' AND implement* or improv* or quality or guideline* or intervention* or practice* or EBP or 'evidence based practice' and conducted citation and key author searches. The included papers were those that used any version of the TDF published from 2005 onwards. The included papers were subject to narrative synthesis. A total of 3540 papers were identified and 60 were included. Thirty-two papers reported intervention design only and 28 reported intervention design and testing. Despite over 3000 citations there has been limited application to the point of designing interventions to support the best practice. In particular use of the framework has not been tried or tested in non-western countries and barely used in non-primary or acute care settings. Authors have applied the framework to assess barriers and facilitators successfully but reporting of the process of selection of behaviour change techniques and intervention design thereafter was variable. Despite over three thousand citations of the framework there has been limited application to the point of designing interventions to support best practice. The framework is barely used in non-western countries or beyond primary or acute care settings. A stated purpose of the framework was to make psychological theory accessible to researchers and practitioners alike; if this is to be fully achieved, further guidance is needed on the application of the framework beyond the point of assessment of barriers and facilitators.


Modular Dual-Tasked C-H Methylation via the Catellani Strategy.
We report a dual-tasked methylation that is based on cooperative palladium/norbornene catalysis. Readily available (hetero)aryl halides (39 iodides and 4 bromides) and inexpensive MeOTs or trimethylphosphate are utilized as the substrates and methylating reagent, respectively. Six types of "ipso" terminations can modularly couple with this "ortho" C-H methylation to constitute a versatile methylation toolbox for preparing diversified methylated arenes. This toolbox features inexpensive methyl sources, excellent functional-group tolerance, simple reaction procedures, and scalability. Importantly, it can be uneventfully extended to isotope-labeled methylation by switching to the corresponding reagents CD3OTs or 13CH3OTs. Moreover, this toolbox can be applied to late-stage modification of biorelevant substrates with complete stereoretention. We believe these salient and practical features of our dual-tasked methylation toolbox will be welcomed by academic and industrial researchers.


Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation.
Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo-monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28-year-old woman, gravida 1, para 1 at 24 weeks of gestation was referred because of suspected polyhydroamnios in an MD twin. Ultrasound suggested twin-twin transfusion syndrome stage III, spontaneous rupture of the dividing membranes and cord entanglement. Fetoscopic laser photocoagulation (FLP) was performed using the Nd:YAG laser on 12 placental vascular connections. Fetoscopy revealed the spontaneous rupture of the dividing membrane and cord entanglement. The remainder of the pregnancy was managed as a monoamniotic twin gestation. Elective cesarean section was performed at 32 weeks of gestation following antenatal steroids and concordantly grown healthy male infants were delivered.


Platelet aggregation in septic shock. Effect of pentoxifylline.
In contrast to normal individuals, patients suffering from adult respiratory distress syndrome (ARDS) due to septic shock had increased platelet aggregation and circulatory platelet aggregates in blood. In vitro incubation with pentoxifylline (Trental) decreases platelet aggregates. This suggests that in addition to its platelet aggregation inhibitory effect, it also causes platelet disaggregation. Platelet aggregate patterns were shown to normalize two weeks after clinical recovery.


Recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation.
Non-alcoholic steatohepatitis was coined in 1980 to describe pathological and clinical features of non-alcoholic disease associated with pathological features, commonly seen in alcoholic-liver disease itself. It is now a well-recognised cause of end-stage liver disease and a rare cause of orthotopic liver transplantation. A small number of cases with recurrent non-alcoholic steatohepatitis following liver transplantation have been reported, however de novo non-alcoholic steatohepatitis in the liver allograft is not well recognised. We report four cases of non-alcoholic steatohepatitis following orthotopic liver transplantation describing the factors related with the pathology. The recurrence of fatty infiltration occurred within 21 months and transition from mild steatosis to non-alcoholic steatohepatitis and early fibrosis was observed within 60 months post transplant in all four patients. All four cases had association with one or multiples risk factors (obesity, type 2 diabetes and/or hyperlipidemia). Management of this risk factors may play a therapeutic role in the prevention of recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation.


Trends of diet and blood pressure in Guangzhou, South China.
As part of the International Cooperative Cardiovascular Diseases and Alimentary Comparison (CAR-DIAC) Study surveys to determine the relationship of dietary factors to blood pressure were carried out in 1985 (pilot study) and 1989 (core study). Thirteen men and 16 women, and 102 men and 115 women aged 50-54 in the rural population of Panyu county in Guangzhou were randomly selected for the pilot and core studies, respectively. Blood pressure was measured by an automatic system and 24-h urine collection by aliquot cups. All urinary specimens were analyzed in the WHO Collaborating Center (Izumo, Japan). Seven hypertensive cases and 17 borderline cases of hypertension were found in 1989 but none in 1985. Mean systolic blood pressure (SBP) and diastolic blood pressures (DBP) were increased, and the intake of dietary sodium (Na), sodium chloride (NaCl), and the ratio of sodium to potassium (Na/K) were increased markedly. The intake of magnesium (Mg) was decreased in 1989. Correlation analyses showed that body mass index was positively related to SBP and DBP (p less than 0.05), Na and NaCl were positively related only to DBP (p less than 0.05), and Mg was inversely related to SBP but with no statistical significance. These results indicate that trends of rise of prevalence rate of hypertension and mean values of SBP and DBP in association with increased dietary Na and decreased Mg intake may be due to rapid changes in dietary habits, changes in lifestyle, and the differing socioeconomic status in the area and may highlight the importance of dietary factors in the prevention of hypertension.


[Delayed effect of 2-amino-4-acetylthiazolo[5, 4-b]indole hydrobromide on physical capability in mice].
The effect of 2-amino-4-acetylthiazolo[5, 4-b]indole hydrobromide (compound VM-605), a new antihypoxic drug and an analog of antihypoxant amtizole, on physical capability was studied in mice under swimming test conditions. The action of VM-605 depended both on the terms of testing upon administration of the drug and on the psychoemotional type of test animals. Maximum increase of the physical capacity in test mice was observed in delayed (up to 72 h) period after drug injection rather than in early (within 1-3 h) period. This increase was more typical of emotionally active and high-stress-resistant mice that were preliminarily selected in open field and forced swimming tests. It is suggested that delayed effects of VM-605 on physical capacity are related to the formation of active metabolites of the drug.


Strange formation of N-hydroxy-3,3-dimethyl-2,6-diarylpiperidin-4-one and its oxime derivative--synthesis, stereochemistry, antibacterial and antifungal activity.
A collection of novel N-hydroxy-3,3-dimethyl-2,6-diarylpiperidin-4-one oximes 28-32 are synthesized, characterized by melting point, elemental analysis, MS, FT-IR, one-dimensional NMR (1H & 13C) and two dimensional Noesy spectroscopic data and evaluate for their in vitro antibacterial and antifungal activities. Compound 32, exerted a wide range of antibacterial activities against the entire tested gram-positive and gram-negative bacterial strains except Escherichia coli, besides compound 30, which is more active against Klebsiella pneumoniae, a gram-negative coccus. Compound 29 exerted strong antifungal activities against Aspergillus flavus and Microsporum gypseum. In addition, compound 32 is more potent against Rhizopus.


Dual-Array Passive Acoustic Mapping for Cavitation Imaging With Enhanced 2-D Resolution.
Passive acoustic mapping (PAM) techniques have been developed for the purposes of detecting, localizing, and quantifying cavitation activity during therapeutic ultrasound procedures. Implementation with conventional diagnostic ultrasound arrays has allowed planar mapping of bubble acoustic emissions to be overlaid with B-mode anatomical images, with a variety of beamforming approaches providing enhanced resolution at the cost of extended computation times. However, no passive signal processing techniques implemented to date have overcome the fundamental physical limitation of the conventional diagnostic array aperture that results in point spread functions with axial/lateral beamwidth ratios of nearly an order of magnitude. To mitigate this problem, the use of a pair of orthogonally oriented diagnostic arrays was recently proposed, with potential benefits arising from the substantially expanded range of observation angles. This article presents experiments and simulations intended to demonstrate the performance and limitations of the dual-array system concept. The key finding of this study is that source pair resolution of better than 1 mm is now possible in both dimensions of the imaging plane using a pair of 7.5-MHz center frequency conventional arrays at a distance of 7.6cm. With an eye toward accelerating computations for real-time applications, channel count reductions of up to a factor of eight induce negligible performance losses. Modest sensitivities to sound speed and relative array position uncertainties were identified, but if these can be kept on the order of 1% and 1 mm, respectively, then the proposed methods offer the potential for a step improvement in cavitation monitoring capability.


Cloning and sequencing of the novel abortive infection gene abiH of Lactococcus lactis ssp. lactis biovar. diacetylactis S94.
A gene which encodes resistance by abortive infection (Abi+) to bacteriophage was cloned from Lactococcus lactis ssp. lactis biovar. diacetylactis S94. This gene was found to confer a reduction in efficiency of plating and plaque size for prolate-headed bacteriophage phi 53 (group I of homology) and total resistance to the small isometric-headed bacteriophage phi 59 (group III of homology). The cloned gene is predicted to encode a polypeptide of 346 amino acid residues with a deduced molecular mass of 41 455 Da. No homology with any previously described genes was found. A probe was used to determine the presence of this gene in two strains on 31 tested.


Treating Opioid Use Disorder in Peripartum Mothers: A Look at the Psychodynamics, Neurobiology, and Potential Role of Oxytocin.
The peripartum period (pregnancy and postpartum) is a unique time filled with psychodynamic and biological changes that are critical in affecting the lives of mother and baby. Attachment, the biologically based emotional connection between a caregiver and infant, is critical to the development of the child. The early interactions in an infant's life shape their reward neuro-circuitry and the development of their internal working models and styles of attachment. Opioid use disorders in the mother affect the psychodynamics and neurobiology of attachment. There is significant overlap between the neurobiology of attachment and that of opioid use disorders. In this article, we hope to describe how opioid use disorders affect mother-infant attachment and how psychodynamic psychotherapy that is informed by attachment theory may be a potential treatment for mothers with opioid use disorders. Further, oxytocin plays a role in the attachment process and may function abnormally in mothers with opioid use disorders. As oxytocin affects attachment, administration of oxytocin during postpartum mother-infant interactions in the setting of psychotherapy may facilitate bonding and promote recovery from opioid use disorders in the peripartum population.


Improving services for parents with intellectual disability and their families: Views of Canadian social service workers.
How adults with intellectual disability fare in the parenting role depend, to varying degrees, on the adequacy of supports and services provided. The available research suggests that service providers are often ill-equipped to accommodate their support needs. The purpose of this qualitative descriptive study was to explore the perspectives of Canadian social service workers on what is required to improve services and build systems capacity to more effectively support parents with intellectual disability, their children and families. A total of 39 workers, identified by parents with intellectual disability as their key workers, were interviewed. To build systems capacity to support these parents and families, and to address institutionalised discrimination, key workers highlighted the need for entry-to-practice and continuing professional education to develop worker capabilities for reflective practice, relationship-building and research utilisation; accommodative caseload management, giving workers the time, flexibility and the professional supervision they need to deal with complexity and fashion individualised service responses; and, a common framework, with defined service pathways, to facilitate interagency case planning and, in turn, continuity in service provision. The question is not whether adults with intellectual disability can be effectively supported in the parenting role; the question is whether the political will exists to do what is necessary to ensure they are.


Antimicrobial and anti-caries effects of a novel cystatin from sugarcane on saliva-derived multi-species biofilms.
This study evaluated the antimicrobial (anti-biofilm) and anti-caries (enamel demineralization prevention) effects of a new cystatin derived from sugarcane (CaneCPI-5). Microcosm biofilm was produced on bovine enamel specimens (4 x 4 mm; n=48) from a mixture of human saliva and McBain saliva at the first 8 h. From this moment until the end of the experiment, the enamel specimens were exposed to lsaMcBain saliva containing 0.2% sucrose and, once a day, they were treated with the test solutions for 1 min. This treatment was performed for 5 days. The solutions evaluated were: PBS (negative control), 0.12% chlorhexidine (positive control), 0.1 mg/ml CaneCPI-5 and 1.0 mg/ml CaneCPI-5. The biofilm viability was determined by fluorescence using confocal microscopy and the enamel demineralization was quantified using transverse microradiography (TMR). The data were analyzed by ANOVA/Tukey or Kruskal-Wallis/Dunn tests for biofilm and enamel, respectively (p<0.05). With respect to the antimicrobial effect, all treatment solutions significantly reduced the biofilm viability compared with PBS. The best antimicrobial effect was found for 1.0 mg/ml CaneCPI-5 (82.37±10.01% dead bacteria) that significantly differed from 0.12% chlorhexidine (73.13±15.07% dead bacteria). For the anti-caries effect, only 0.12% chlorhexidine (ΔZ: 2610, 1683-4343) performed significantly better than PBS (ΔZ: 8030, 7213-9115), but 0.12% chlorhexidine did not significantly differ from 0.1 mg/ml Cane-CPI-5. Under this experimental model, CaneCPI-5 significantly reduced the biofilm viability, but this effect was not reflected on its anti-caries potential.


Data transmission under high scattering based on OAM-basis transmission matrix.
Multiplexing of orbital angular momentum (OAM) channels is an important method to increase the optical communication capacity at present, but the multiple scattering and distortion of long-distance optical communication greatly limit its application. Here, a data transmission method based on an OAM-basis transmission matrix (TM) under high scattering is proposed. In this method, OAM modes are directly encoded by the OAM-basis TM, and the incident power spectral distribution of OAM modes can be directly acquired by the intensity profile of the speckle field on the camera. This method can realize the multiplexing of a large number of OAM channels and is easy to perform. Experimentally, we have achieved a maximum of 800 OAM modes multiplexed, and a bit error rate of 0.01% in the data transmission of color images.


Effect of literacy and education on the visuoconstructional ability of non-demented elderly individuals.
Learning to read and to write influences not only verbal skills but also global cognitive performance. Our study aimed to compare the visuoconstructional abilities of elderly illiterates with those of elderly literates. A total of 125 healthy subjects over 65 years old were recruited. Korean version of Mini-Mental State Examination (K-MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) constructional praxis examination were used. We divided subjects into three groups (educated literate n = 53, uneducated literate n = 36 and uneducated illiterate n = 36). Interlocking pentagons drawing, a part of the K-MMSE, was scored using the 6-point hierarchical scale. The uneducated-illiterate group obtained significantly lower scores than did the other two groups. Scores on the ADAS-cog constructional praxis test were highest in the educated-literate group and those in the uneducated-illiterate group obtained the lowest scores. We demonstrated that illiteracy influences not only language performance but also visuoconstructional functioning.


Pharmacological and ocular hypotensive properties of topical carbonic anhydrase inhibitors.
There was a time gap of over 40 years between the demonstrated oral effectiveness of acetazolamide in lowering the intraocular pressure (IOP) of glaucoma patients and the introduction of a topical carbonic anhydrase (CA) inhibitor. This is due to the fact that CA-II, the isoenzyme which most likely plays an important role in the production of aqueous humor in humans, must be essentially inhibited by 100% to elicit a pharmacological response. The lack of success with earlier attempts to obtain a topical agent stems from an inability to attain and maintain a sufficiently high intraocular concentration of drug to achieve the required inhibition of CA. Dorzolamide and brinzolamide are two topical CA inhibitors which are currently available to treat ocular hypertension and/or glaucoma. Dorzolamide is a very potent inhibitor of CA-II and its site of action is local within the eye. Like oral CA inhibitors, topically applied dorzolamide lowers IOP by decreasing the production of aqueous humor. The drug is used in monotherapy as a 2% solution administered three times daily. Its ocular hypotensive effect is comparable to that of timolol at peak but is somewhat less at trough. The IOP lowering effect of timolol is enhanced by the twice daily administration of 2% dorzolamide either concomitantly or in combination. Topically applied dorzolamide is generally well tolerated and had a low drop-out rate in clinical studies. The most frequent ocular adverse experience is burning and/or stinging. Corneal and lenticular problems have generally not been encountered with long-term therapy with dorzolamide. Topically applied dorzolamide penetrates directly to the posterior segment of the eye and its presence is consistent with the initial report that dorzolamide increases retinal blood flow velocity in patients with normal tension glaucoma. The most frequent systemic adverse experience is a transient bitter taste. Biochemical changes indicative of the systemic inhibition of CA have not been observed in monotherapy studies lasting up to 2 years. This is in harmony with the inability of dorzolamide at steady-state to saturate CA in the red blood cell and the failure to detect its presence in plasma. A 1% suspension of brinzolamide is comparable to 2% dorzolamide in lowering IOP, both drugs being administered three times daily. Although brinzolamide has a lower incidence of burning/ stinging, it elicits more blurred vision.


Photography of the histological and radiological analysis of the ligaments of the distal radioulnar joint.
This project was undertaken as part of the PhD research project of Paul Malone, Pricipal Investigator, Covance plc, Harrogate. Mr Malone approached the photography department for involvement in the study with the aim of settling the current debate on the anatomical and histological features of the distal radioulnar ligaments by capturing the anatomy photographically throughout the process of dissection via a microtome. The author was approached to lead on the photographic protocol as part of her post-graduate certificate training at Staffordshire University. High-resolution digital images of an entire human arm were required, the main area of interest being the distal radioulnar joint of the wrist. Images were to be taken at 40 μm intervals as the specimen was sliced. When microtomy was undertaken through the ligaments images were made at 20 μm intervals. A method of suspending a camera approximately 1 metre above the specimen was devised, together with the preparation for the capture, processing and storage of images. The resulting images were then to be subject to further analysis in the form of 3-Dimensional reconstruction, using computer modelling techniques and software. The possibility of merging the images with sequences obtained from both CT & MRI using image handling software is also an area of exploration, in collaboration with the University of Manchester's Visualisation Centre.


[Epileptic seizures in non-ketotic hyperglycemia].
Seizures are common in hyperglycemia and are often the first manifestation particularly in non-ketotic hyperglycemia (NKH). Published reports emphasize partial motor seizures almost exclusively. Here we present the clinical, biological and electrophysiological features of 22 consecutive patients with NKH who developed focal seizures and were treated in our department. Neurological exam was normal in 15 cases. When abnormal, it showed postictal obnubilation or diabetic polyneuropathy. Interictal EEG (obtained in 17 patients) showed focal or generalised slowing in 65% of cases, and ictal EEG (six patients) showed rapid spikes most often unilateral. CTs were normal in 77% of cases, and showed age-compatible cortico-subcortical atrophy in the others. All patients were alert, with glucose values between 13.6 and 55 mmoles/l and osmolarity values increased in all cases to a mild or moderate extent (266-309.20 mosm/l). Three out of 22 patients (14%) presented with motor epilepsy partialis continua. In 11/22 cases (50%), diabetes mellitus had not been diagnosed previously. Seizures associated with NKH were resistant to anticonvulsant treatment but responded well to insulin therapy and rehydration. They subsided completely in an average of 4 days, and only one patient had to be transiently transferred to ICU. We conclude on the importance of an early diagnosis of this condition to prevent malignant evolution of the epileptic syndrome into a state of hyperosmolarity and coma associated with a much higher mortality.


Enhanced solubility and bioavailability of sibutramine base by solid dispersion system with aqueous medium.
To develop a novel sibutramine base-loaded solid dispersion with improved solubility bioavailability, various solid dispersions were prepared with water, hydroxypropylmethyl cellulose (HPMC), poloxamer and citric acid using spray-drying technique. The effect of HPMC, poloxamer and citric acid on the aqueous solubility of sibutramine was investigated. The physicochemical properties of solid dispersion were investigated using scanning electron microscopy (SEM), differential scanning calorimetry (DSC) and X-ray powder diffraction. The dissolution and pharmacokinetics in rats of solid dispersion were evaluated compared to the sibutramine hydrochloride monohydrate-loaded commercial product (Reductil). The sibutramine base-loaded solid dispersion gave two type forms. Like conventional solid dispersion system, one type appeared as a spherical shape with smooth surface, as the carriers and drug with relatively low melting point were soluble in water and formed it. The other appeared as an irregular form with relatively rough surface. Unlike conventional solid dispersion system, this type changed no crystalline form of drug. Our results suggested that this type was formed by attaching hydrophilic carriers to the surface of drug without crystal change, resulting from changing the hydrophobic drug to hydrophilic form. The sibutramine-loaded solid dispersion at the weight ratio of sibutramine base/HPMC/poloxamer/citric acid of 5/3/3/0.2 gave the maximum drug solubility of about 3 mg/ml. Furthermore, it showed the similar plasma concentration, area under the curve (AUC) and C(max) of parent drug, metabolite I and II to the commercial product, indicating that it might give the similar drug efficacy compared to the sibutramine hydrochloride monohydrate-loaded commercial product in rats. Thus, this solid dispersion system would be useful to deliver poorly water-soluble sibutramine base with enhanced bioavailability.


In silico virtual screening for the identification of novel inhibitors against dihydrodipicolinate reductase (DapB) of Mycobacterium tuberculosis, a key enzyme of diaminopimelate pathway.
Non-compliance to lengthy antituberculosis (TB) treatment regimen, associated side effects, and emergence of drug-resistant strains of Mycobacterium tuberculosis (M. tb) emphasize the need to develop more effective anti-TB drugs. Here, we have evaluated the role of M. tb dihydrodipicolinate reductase (DapB), a component of the diaminopimelate pathway, which is involved in the biosynthesis of both lysine and mycobacterial cell wall. We showed that DapB is essential for the in vitro as well as intracellular growth of M. tb. We further utilized M. tb DapB, as a target for identification of inhibitors by employing in silico virtual screening, and conducted various in vitro screening assays to identify inhibitors with potential to inhibit DapB activity and in vitro and intracellular growth of M. tb with no significant cytotoxicity against various mammalian cell lines. Altogether, M. tb DapB serves as an important drug target and a hit molecule, namely, 4-(3-Phenylazoquinoxalin-2-yl) butanoic acid methyl ester has been identified as an antimycobacterial molecule in our study.


TIEG1 deficiency confers enhanced myocardial protection in the infarcted heart by mediating the Pten/Akt signalling pathway.
The transforming growth factor (TGF)-β-inducible early gene-1 (TIEG1) plays a crucial role in modulating cell apoptosis and proliferation in a number of diseases, including pancreatic cancer, leukaemia and osteoporosis. However, the functional role of TIEG1 in the heart has not been fully defined. In this study, we first investigated the role of TIEG1 in ischaemic heart disease. For in vitro experiments, cardiomyocytes were isolated from both TIEG1 knockout (KO) and wile-type (WT) mice, and the apoptotic ratios were evaluated after a 48‑h ischaemic insult. A cell proliferation assay was performed after 7 days of incubation under normoxic conditions. In addition, the angiogenic capacity of endothelial cells was determined by tube formation assay. For in vivo experiments, a model of myocardial infarction (MI) was established using both TIEG1 KO and WT mice. Echocardiography was performed at 3 and 28 days post-MI, whereas the haemodynamics test was performed 28 days post-MI. Histological analyses of apoptosis, proliferation, angiogenesis and infarct zone assessments were performed using terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling (TUNEL) staining, BrdU immunostaining, α-smooth muscle actin (α-SMA)/CD31 immunostaining and Masson's trichrome staining, respectively. Changes in the expression of related proteins caused by TIEG1 deficiency were confirmed using both reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis. Our results demonstrated that the absence of TIEG1 prevented cardiomyocytes from undergoing apoptosis and promoted higher proliferation; it stimulated the proliferation of endothelial cells in vitro and in vivo. Improved cardiac function and less scar formation were observed in TIEG1 KO mice, and we also observed the altered expression of phosphatase and tensin homolog (Pten), Akt and Bcl-2/Bax, as well as vascular endothelial growth factor (VEGF). On the whole, our findings indicate that the absence of TIEG1 plays a cardioprotective role in ischaemic heart disease by promoting changes in Pten/Akt signalling.


Gender identity disorder: a literature review from a developmental perspective.
The present paper reviews the theoretical and empirical literature on children and adolescents with gender variant behaviors. The organizational framework underlying this review is one that presents gender behavior in children and adolescents as a continuum rather than as a dichotomy of normal versus abnormal categories. Seven domains are reviewed in relation to gender variant behavior in general, and to Gender Identity Disorder (GID) in particular: theories of normative gender development, phenomenology, prevalence, assessment, developmental trajectories, comorbidity and treatment.


Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.
We examined the prevalence and prognostic importance of silent myocardial ischemia detected by continuous electrocardiographic monitoring in 70 patients with unstable angina. All the patients received intensive medical treatment with nitrates, beta-blockers, and calcium-channel blockers. Continuous electrocardiographic recordings were made during the first two days in the coronary care unit to quantify the frequency and duration of asymptomatic ischemic episodes, defined as a transient ST-segment shift of 1 mm or more. Thirty-seven patients (Group 1) had at least one episode of silent ischemia, and the other 33 patients had no silent ischemia (Group 2). Over the subsequent month, myocardial infarction occurred in 6 patients in Group 1 and in only 1 in Group 2 (P less than 0.01); bypass surgery or angioplasty was required for recurrent symptomatic angina in 10 patients in Group 1 and only 3 in Group 2 (P = 0.02). Survival-curve analysis demonstrated that silent ischemia was associated with these outcomes (P less than 0.002), and multivariate analysis showed that silent ischemia was the best predictor of these outcomes among the 15 variables tested (P less than 0.002). Patients in Group 1 with 60 minutes or more of silent ischemia per 24 hours had a worse prognosis than those with under 60 minutes per 24 hours (P = 0.04). Silent ischemia occurred in more than 50 percent of our patients with unstable angina, despite intensive medical therapy, and it identified a subset who were at high risk for early unfavorable outcomes.


Do obsessive compulsive symptoms mediate the relationship between maternal eating psychopathology and restrictive feeding practices?
Symptoms of maternal eating disorders have been linked with the use of maladaptive restrictive child feeding practices. However, how these symptoms impact upon restriction in child feeding is poorly understood. The aims of this research were to assess whether symptoms of obsessive compulsiveness, which are often comorbid with eating disorder symptoms, mediate the relationships between maternal eating disorder symptoms and the use of restrictive feeding practices. A total of 128 mothers of children aged 2-6 years completed measures of their restrictive feeding practices, symptoms of eating disorders, and obsessive compulsiveness. Maternal restriction was positively correlated with symptoms of drive for thinness, bulimia, and checking and cleaning obsessions and compulsions. Cleaning obsessions and compulsions mediated the relationships between maternal drive for thinness and feeding restriction. Cleaning obsessions and compulsions may help to explain the relationships between some symptoms of maternal eating disorders and the use of restrictive feeding practices.


Increased Risk of Post-Thrombolysis Intracranial Hemorrhage in Acute Ischemic Stroke Patients with Leukoaraiosis: A Meta-Analysis.
Leukoaraiosis is common in patients with acute ischemic stroke. The results from many studies investigating the association between leukoaraiosis and intracranial hemorrhage after thrombolysis remain conflicting. A meta-analysis was performed to compare the risk of post-thrombolytic intracranial hemorrhage in patients with and without leukoaraiosis. Relevant reports were identified by searching PubMed, EmBase, Cochrane Library, and ISI Web of Science through December 2015 using a combination of subjective and random terms. Eligible studies that were original articles with a clear definition of leukoaraiosis and intracranial hemorrhage were selected and analyzed. Funnel plots, Egger's test, and Begg's test were conducted to assess the publication bias. Sensitivity analysis was also performed to evaluate the influence of each individual study. Eleven trials that enrolled 6912 participants were included. There was a significantly increased risk for acute ischemic stroke patients with leukoaraiosis (odds ratio: 1.89, 95% confidence interval 1.51-2.37, P<0.001). Low heterogeneity and less publication bias was detected among these studies. The results of both computed tomography and magnetic resonance imaging performed on the subgroups of leukoaraiosis were significant. Furthermore, an association between leukoaraiosis and symptomatic intracranial hemorrhage was also confirmed. The odds ratios remained stable with no obvious variations on the sensitivity analysis. The limitations consisted of types of including trials and not matching some baseline variables. The results of this meta-analysis show that leukoaraiosis approximately doubles the incidence of intracranial hemorrhage after thrombolytic therapy. However, it does not critically affect decision making regarding thrombolysis for patients with acute ischemic stroke. Additional investigations are required.


SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed?
SARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who are less susceptible to adverse clinical outcomes and are often asymptomatic. We conducted this prospective multicentre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return to play. Junior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting ECG, echocardiogram and exercise ECG testing. Further investigations were performed in cases of abnormal findings. A total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%) and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation was found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return to play was achieved after complete clinical resolution. The prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.


Current View in Platinum Drug Mechanisms of Peripheral Neurotoxicity.
Peripheral neurotoxicity is the dose-limiting factor for clinical use of platinum derivatives, a class of anticancer drugs which includes cisplatin, carboplatin, and oxaliplatin. In particular cisplatin and oxaliplatin induce a severe peripheral neurotoxicity while carboplatin is less neurotoxic. The mechanisms proposed to explain these drugs' neurotoxicity are dorsal root ganglia alteration, oxidative stress involvement, and mitochondrial dysfunction. Oxaliplatin also causes an acute and reversible neuropathy, supposed to be due by transient dysfunction of the voltage-gated sodium channels of sensory neurons. Recent studies suggest that individual genetic variation may play a role in the pathogenesis of platinum drug neurotoxicity. Even though all these mechanisms have been investigated, the pathogenesis is far from clearly defined. In this review we will summarize the current knowledge and the most up-to-date hypotheses on the mechanisms of platinum drug-induced peripheral neurotoxicity.


Restraining and neck cutting or stunning and neck cutting of veal calves.
Brain and heart activities were measured in 31 veal calves during restraining and rotating followed by neck cutting with or without stunning to evaluate welfare. After neck cutting correlation dimension analyses and %power of EEG beta wave fraction decreased gradually to lower values resulting in an induction of unconsciousness lasting on average 80s. Corneal reflex response ceased 135±57s after neck cutting. The CD scores and the %power of beta waves fell immediately after post-cut captive bolt and pre-cut electrical stunning to levels indicating unconsciousness. Heart rate in lairage increased upon entrance to the restrainer and again after rotation, heart rate variability decreased. Rotating the restrainer 90°, 120° or 180° compromised veal calf welfare and should be avoided. It is recommended to use post-cut captive bolt stunning or pre-cut electrical stunning inducing immediate unconsciousness.


Reliability of slice-encoding for metal artefact correction (SEMAC) MRI to identify prosthesis loosening in patients with painful total hip arthroplasty - a single centre, prospective, surgical validation study.
To validate reliability of slice-encoding for metal artefact correction (SEMAC)-MRI findings in prosthesis loosening detection by comparing them to surgical outcomes (gold standard) in symptomatic patients following hip arthroplasties. To evaluate periprosthetic anatomical structures in symptomatic patients to identify an alternative cause of hip symptoms. We prospectively followed 47 symptomatic patients (55 hips, 39 painful hips - group P and 16 control hips - group C) at our institution from 2011 to 2016. We acquired 1.5 T MRI conventional and SEMAC-MRI images for all patients. Two consultants scored MRI for osteolysis and marrow oedema zone-wise using predefined signal characteristics and settled scoring variations by consensus. We used Spearman Rank-Order Correlation for correlation analysis and used OMERACT (Outcome Measures in Rheumatology) filter pillars to validate SEMAC-MRI findings. Eleven patients needed revision surgery, all from group P. None from group C required revision surgery. Remaining 28 hips in the group P were managed conservatively pain completely resolved in 21 hips, eight hips had trochanteric bursitis, eight had extraarticular cause and the remaining five hips had spontaneous pain resolution. We found moderate-to-weak correlation between SEMAC-MRI findings for prosthesis loosening and revision surgery outcomes. Sensitivity, Specificity, PPV and NPV in Group P were (72.7, 64.3, 44.4, 85.7%) in T1W-SEMAC, (90.9, 46.4, 40.0, 92.9%) in STIR-SEMAC and (36.3, 78.5, 40.0, 75.8%) in PDW-SEMAC. Negative SEMAC-MRI results can effectively exclude prosthesis loosening confirmed on revision surgery and SEMAC-MRI can detect alternative cause of hip pain accurately. Negative SEMAC-MRI in painful THA patients can effectively exclude prosthesis loosening as a cause.


Routine application of the polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples.
To investigate the use of the polymerase chain reaction (PCR) in the routine laboratory for the detection of Mycobacterium tuberculosis in clinical samples. Samples were divided and processed separately for the detection of M tuberculosis by microscopy, culture and PCR. After DNA extraction, PCR was performed with primers specific for the insertion element IS6110 and the product was analysed by agarose gel electrophoresis, Southern blotting or dot blotting and hybridisation with a digoxigenin labelled internal probe. Each sample was tested for inhibitors of Taq polymerase with the aid of an internal control. Multiple negative and positive controls were used to monitor each step of the procedure. The data from two laboratories, using the same operating procedures, were combined. Of 1957 specimens, 79 (4%) were culture and PCR positive, while 1839 (93.9%) were negative in both tests. Thirty specimens (1.5%) were PCR positive only and nine (0.5%) were culture positive but PCR negative. Using culture and clinical history as the gold standard, sensitivity and specificity for PCR were 92.1% and 99.8%, respectively. With elaborate precautions, PCR is a suitable and reliable method for the detection of M tuberculosis in clinical samples in a routine microbiology laboratory.


Monosodium glutamate intake increases hemoglobin level over 5 years among Chinese adults.
The aim of this analysis was to determine the relationship between monosodium glutamate (MSG) intake and change in hemoglobin (Hb) levels and the risk of anemia over 5 years in 1197 Chinese men and women who participated in the Jiangsu Nutrition Study (JIN). MSG intake and Hb were quantitatively assessed in 2002 and followed up in 2007. Diet and lifestyle factors were assessed at both time points. There was a positive association between MSG intake and increase in Hb among men but not women. In the multivariate model adjusting for demographic and lifestyle factors as well as baseline dietary pattern, the beta values and 95% confidence interval for Hb changes across quartiles of MSG intake were 0, 0.67(0.04-1.29), 0.99(0.38-1.60), 0.73(0.13-1.34) among men (p for trend 0.091); 0, -0.01(-0.45-0.43), 0.23(-0.25-0.71), and -0.45(-0.96-0.05) among women (p for trend 0.087). Among anemic participants at baseline, there was a significant inverse association between MSG intake and the risk of anemia at follow-up. Comparing extreme quartiles of MSG intake among those anemic at baseline, the relative risk for persistent anemia at follow-up was 0.49 (95% CI: 0.28-0.86, p < 0.01). The association was independent of dietary patterns and lifestyle factors. A dose-response relationship between MSG intake and increase in Hb levels among anemic participants was seen. MSG intake may have independent Hb-increasing effects, especially among men and those anemic at baseline.


Meningioma en plaque A case report.
Meningiomas as anatomo-pathological entities were first described in the sixteenth century, but it was Harvey Cusching who in 1922 proposed to identify them with the term "meningioma". They are the most common intracranial tumors, occur between middle and late age and prefer female sex. The symptoms depend on their position with respect to the brain regions. These are mostly benign neoplasms, but there are atypical and even malignant forms. Plaque meningioma refers to a specific macroscopic aspect of the meningioma, due to diffuse dural involvement and usually with extracranial extension. We report here a case of plaque convex meningioma with typical grade I. Key Words: En plaque, Meningioma, WHO Meningioma.


Patterns of Maxillofacial Fractures in Uttar Pradesh, India.
This study aimed to obtain dependable epidemiologic data of the variation in cause and characteristics of maxillofacial fractures by identifying, describing, and quantifying trauma. This retrospective study was conducted in the state of Uttar Pradesh, India, over 1 year, based on a systematic computer-assisted database search from March 2015 to March 2016 for maxillofacial fractures. The demographics, etiology, geographic distribution, date of injury, site and number of fractures, and type of intervention were recorded for each. The study population consisted of 1,000 patients with 1,543 fractures. The male:female ratio was 8:1. A peak incidence of fractures was seen in the third decade (mean age: 30.3) with maximum patients younger than 40 years (80.8%). The incidence of fractures was highest in spring (42.9%). Road traffic accidents were the most common cause of trauma (64.4%) and mainly involved two wheelers (60.2%). Single-site fractures were most common. Mostly zygomatic (45.1%) and mandibular fractures (44.4%) were encountered, accounting for approximately 90% of all fractures. The main site of mandibular fractures was the body (34.4%); 46.2% of fractures underwent open reduction and internal fixation (ORIF) while 53.8% were treated by closed methods. The study provides important data to contrive future plans for injury prevention. The trend of most traffic-related injuries continues with the increasing traffic on roads. Zygomatic complex and mandibular fractures remain the most frequent. The major populations at risk are young men and those driving two wheelers. The use of helmets could achieve a large reduction in maxillofacial fractures. Awareness for preventive measures and safety guidelines should be propagated and legislation on traffic rules strictly reinforced.


Nasal delivery of recombinant human growth hormone: in vivo evaluation with Pheroid technology and N-trimethyl chitosan chloride.
It was the aim of this study to investigate the possible enhancement of the absorption of recombinant human growth hormone (rhGH) in the nasal cavity, in the presence of a polymeric absorption enhancer, N-trimethyl chitosan chloride (TMC) and a fatty acid-based delivery system, Pheroid. Two types of Pheroid formulations, Pheroid vesicles and Pheroid microsponges were characterized and evaluated with regard to particle size and morphology. In vivo bioavailability studies in rats were performed and the nasal bioavailability of Pheroid vesicles and Pheroid microsponges were compared relative to subcutaneous administration. The results were also compared with different N-trimethyl chitosan chloride (TMC) formulations, TMC H-L and TMC H-H, well studied absorption enhancers. Pheroid vesicles and Pheroid microsponges showed a size distribution of approxiamately 2-3 microm and 3-4 microm for Pheroid vesicles and Pheroid microsponges respectively. Using specific RIA, the relative bioavailability of rhGH after comparison with subcutaneous injection was determined to be 38.9, 128.5, 39.9, 136.3, and 8.3 % for Pheroid microsponges, Pheroid vesicles, TMC H-H, TMC H-L and control group (intranasal rhGH alone), respectively. All the enhancers showed significant absorption enhancement (P < 0.05) with the highest effect observed with TMC H-L. All the enhancers may have promising potential as safe and effective nasal absorption enhancers of rhGH.


Determination of free interstitial concentrations of piperacillin-tazobactam combinations by microdialysis.
The investigation of tissue penetration and distribution of antibiotics is of great importance, since infections occur mostly in the tissues. The aim of this study was to investigate the pharmacokinetics of piperacillin and tazobactam, alone and in combination, by measuring total plasma and free interstitial concentrations, and to examine the relationship between free levels of both drugs in blood and those in the extracellular space. Piperacillin and tazobactam were administered, alone and in combination, to anaesthetized rats as a single iv bolus dose. Total plasma concentrations and free extracellular concentrations were quantified by HPLC. In-vivo microdialysis sampling was used to study the free tissue distribution patterns of both drugs. The pharmacokinetics of piperacillin and tazobactam in plasma were consistent with a two-compartment body model. Piperacillin pharmacokinetics were not influenced by co-administration of tazobactam. Tazobactam's volumes of distribution and clearance were decreased by the co-administration of piperacillin and the area under the curve was significantly increased. Comparisons between calculated free concentrations in the peripheral compartment for both drugs and measured free extracellular concentrations revealed excellent agreement. For piperacillin and tazobactam, alone and in combination, predictions of the concentration-time profiles of free drug in the peripheral compartment can be made on the basis of plasma data.


Awareness of and practice toward cancer prevention recommendations: results of the Korean National Cancer Prevention Awareness and Practice Survey in 2021.
This study reports data regarding the awareness and practice of cancer prevention among Koreans in 2021 and behavioral changes during the coronavirus disease 2019 (COVID-19) pandemic. We collected Cancer Prevention Awareness and Practice Survey data through face-to-face interview surveys using a structured questionnaire completed by 4,000 randomly selected men and women aged between 20 years and 74 years in 17 provinces. We examined the awareness and practice of 10 cancer prevention recommendations and evaluated their associations with potential risk factors through multiple logistic regression analysis adjusted for age, gender, residence, marital status, education, and income. Eighty percent of participants knew that cancer is preventable, while 45% practiced cancer prevention. Cancer prevention practice tended to be more common among older participants (adjusted odds ratio [aOR], 1.39 per 10-year increment; 95% confidence interval [CI], 1.29 to 1.49) and less common among rural inhabitants (aOR, 0.66; 95% CI, 0.51 to 0.86) than among urban residents and among single people (aOR, 0.55; 95% CI, 0.45 to 0.66) than among married people. Practices were the highest for avoiding burned or charred foods (87.6%) and lowest for vaccination against human papillomavirus (14.5%). Refusal to follow recommendations was most common for avoiding alcohol consumption (7.9%). The most difficult recommendations to follow were (1) regular exercise (57.7%); (2) maintaining a healthy body weight (46.1%); and (3) avoiding alcohol (40.1%). The most significant COVID-19-related changes were less exercise (32.5%) and increased body weight (25.6%). The awareness of cancer prevention was high, but the practice was low. Recommendations targeting awareness and practice need to be further promoted.


Polypill: for Pollyanna.
A single pill containing a statin, thiazide diuretic, beta-blocker, angiotensin receptor antagonist, folate and ASA has been proposed for all people over age 55, with the aim of reducing cardiovascular disease by 80%. Unfortunately, there are insurmountable problems with choosing appropriate constituents of any such single remedy. Adverse effects, drug interactions, inter-individual variation in drug metabolism, and underlying causes of hypertension that differ between patients require individualized therapy. A single pill that will succeed in all patients is not only practically, but conceptually, an inappropriate approach for the prevention of cardiovascular disease.


Bacillus safensis sp. nov., isolated from spacecraft and assembly-facility surfaces.
Thirteen strains of a novel spore-forming, Gram-positive, mesophilic heterotrophic bacterium were isolated from spacecraft surfaces (Mars Odyssey Orbiter) and assembly-facility surfaces at the Jet Propulsion Laboratory in California and the Kennedy Space Center in Florida. Phylogenetic analysis of 16S rRNA gene sequences has placed these novel isolates within the genus Bacillus, the greatest sequence similarity (99.9 %) being found with Bacillus pumilus. However, these isolates share a mere 91.2 % gyrB sequence similarity with Bacillus pumilus, rendering their 16S rRNA gene-derived relatedness suspect. Furthermore, DNA-DNA hybridization showed only 54-66 % DNA relatedness between the novel isolates and strains of B. pumilus. rep-PCR fingerprinting and previously reported matrix-assisted laser desorption/ionization time-of-flight mass spectrometry protein profiling clearly distinguished these isolates from B. pumilus. Phenotypic analyses also showed some differentiation between the two genotypic groups, although the fatty acid compositions were almost identical. The polyphasic taxonomic studies revealed distinct clustering of the tested strains into two distinct species. On the basis of phenotypic characteristics and the results of phylogenetic analyses of 16S rRNA and gyrB gene sequences, repetitive element primer-PCR fingerprinting and DNA-DNA hybridization, the 13 isolates represent a novel species of the genus Bacillus, for which the name Bacillus safensis sp. nov. is proposed. The type strain is FO-36b(T) (=ATCC BAA-1126(T)=NBRC 100820(T)).


Relation Between Autonomic Nervous Activity after Pulmonary Vein Isolation and Recurrence in Paroxysmal Atrial Fibrillation Patients.
Pulmonary vein isolation (PVI) has been widely used for the treatments of paroxysmal atrial fibrillation (PAF); however, AF recurrence remains a significant challenge. We evaluated relation between autonomic nervous activity and AF recurrence using heart rate variability (HRV) and deceleration and acceleration capacity (DC/AC) analyses. High-resolution Holter electrocardiogram was performed in 56 PAF patients pre- and 3 and 6 months post-PVI by cryoballoon. HRV and DC/AC analysis data were compared between the non-recurrence and recurrence groups. AF recurrence occurred in 10 cases. Total heart beats and maximum heart rate significantly decreased and minimum heart rate increased only in the non-recurrence group post-PVI. In HRV analysis, root mean square successive difference (RMSSD), low-frequency components (LF), high frequency components (HF) and LF/HF significantly decreased only in the non-recurrence group at both 3 and 6 months post-PVI; in contrast, significant decreases in RMSSD, LF and HF were observed in the recurrence group only at 6 months. In DC/AC analysis, DC significantly decreased in both groups post-PVI; in contrast, AC increased only in the non-recurrence group, resulting in significantly greater [AC]/DC ratio in the recurrence group at 3 months post-PVI. To prevent AF recurrence after PVI, it is important not only to reduce vagosympathetic overall activity but also to minimize imbalance between vagosympathetic reflex responses.