Association Between DCE-MRI Perfusion Histogram Parameters and EGFR and VEGF Expressions in Different Lauren Classifications of Advanced Gastric Cancer.
Objective: To investigate the correlations between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) perfusion histogram parameters and vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) expressions in advanced gastric cancer (AGC). Methods: This retrospective study included 80 pathologically confirmed patients with AGC who underwent DCE-MRI before surgery from February 2017 to May 2021. The DCE-MRI perfusion histogram parameters were calculated by Omni Kinetics software in four quantitative parameter maps. Immunohistochemical methods were used to detect VEGF and EGFR expressions and calculate the immunohistochemical score. Results: VEGF expression was relatively lower in patients with intestinal-type AGC than those with diffuse-type AGC (p < 0.05). For VEGF, Receiver operating characteristics (ROC) curve analysis revealed that Quantile 90 of Ktrans, Meanvalue of Kep and Quantile 50 of Ve provided the perfect combination of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for distinguishing high and low VEGF expression, For EGFR, Skewness of Ktrans, Energy of Kep and Entropy of Vp provided the perfect combination of sensitivity, specificity, PPV and NPV for distinguishing high and low EGFR expression. Ktrans (Quantile 90, Entropy) showed the strongest correlation with VEGF and EGFR in patients with intestinal-type AGC (r = 0.854 and r = 0.627, respectively); Ktrans (Mean value, Entropy) had the strongest correlation with VEGF and EGFR in patients with diffuse-type AGC (r = 0.635 and 0.656, respectively). Conclusion: DCE-MRI perfusion histogram parameters can serve as imaging biomarkers to reflect VEGF and EGFR expressions and estimate their difference in different Lauren classifications of AGC.


Screening concepts, characterization and structural analysis of microbial-derived bioactive lipopeptides: a review.
Lipopeptide biosurfactants are surface active biomolecules that are produced by a variety of microorganisms. Microbial lipopeptides have gained the interest of microbiologists, chemists and biochemists for their high biodiversity as well as efficient action, low toxicity and good biodegradability in comparison to synthetic counterparts. In this report, we review methods for the production, isolation and screening, purification and structural characterization of microbial lipopeptides. Several techniques are currently available for each step, and we describe the most commonly utilized and recently developed techniques in this review. Investigations on lipopeptide biosurfactants in natural products require efficient isolation techniques for the characterization and evaluation of chemical and biological properties. A combination of chromatographic and spectroscopic techniques offer opportunities for a better characterization of lipopeptide structures, which in turn can lead to the application of lipopeptides in food, pharmaceutical, cosmetics, agricultural and bioremediation industries.


Sound Production in Totally Edentulous Patients Before and After Prosthetic Treatment.
To study sound pronunciation in patients with total edentulism before and after prosthodontic treatment using complete removable dentures. Recordings of phonetically balanced phrases were made using a headset connected to a dictaphone to assess specific pronunciation defects in patients with total edentulism before and after prosthodontic treatment. The obtained sets of sounds were investigated using spectral analysis by calculating the average power spectra. The data of the experimental group was compared to the data of the control group, regarded as the norm. Analysis of the trajectory of the average power spectra in the range of 5300 to 6700 Hz makes it possible to develop a test of the waveform spectrum of a standard pronunciation and that of the phonemes before and after treatment of completely edentulous patients, as well as to compare the phonograms before and after the prosthetics. The shape of the trajectory of the spectra in the specified frequency range was measured by the expectation value and standard deviation value. A confidence interval of 95% was used to test for significant changes in spectra. By applying the spectral analysis to sound pronunciation, it was possible to objectively, qualitatively, and quantitatively analyze sound characteristics. It can also be used to evaluate the quality of the prosthodontic treatment. For the control group the average power spectrum of sounds was 193.1 ± 11.6 (t = 2.1; < 0.05) for "S;" 74.4 ± 3.7 (t = 5.5; < 0.001) for "F;" and 17.6 ± 2.4 (t = 4.2; < 0.001) for "V." The comparative analysis of the spectra of the experimental group patients showed that before treatment the average power spectrum of sounds was 91.7 ± 27.1 for "S;" 42.6 ± 3.6 for "F;" and 9.2 ± 0.5 for "V." After the treatment the average power spectrum of sounds of the experimental group patients were 220.4 ± 25.9 (t = 2.4; p < 0.01) for "S;" 139.0 ± 27.7 (t = 4.9; p < 0.001) for "F;" and 24.7 ± 4.8 (t = 4.4; p < 0.001) for "V." Spectral analysis of the sounds emitted before and after treatment is an informative method for the differential diagnostics of pronunciation defects. Sound analysis can be used efficiently in different stages of prosthodontic treatment to assess quality of treatment.


[Thoracoplasty].
Thoracoplasty was at 1st invented for the treatment of pulmonary tuberculosis during the days when no effective chemotherapeutic drugs for tuberculosis were available. Removal of some portions of the ribs by thoracoplasty deforms the chest wall and compresses tuberculous cavities. Since the introduction of potent anti-tuberculous drugs, thoracoplasty for pulmonary tuberculosis has been obsolete. Currently, thoracoplasty is mainly applied to reduction of the volume of the pleural space in the treatment of post-resectional space problems and in the treatment of thoracic empyema. Well-planned and safe resections of the affected ribs hold the keys to successful thoracoplasty. The procedure is performed alone or with muscle flaps or with omental flap, depending on the extent of space and the presence of bronchopleural fistula. Thoracic surgeons should know the current application of thoracoplasty.


Sterile Basics: Compounding Sterile Preparations with Cyclodextrins.
Complexation is a powerful therapeutic as well as a pharmaceutical tool. Many categories of medications contain complexes which aid in the solubilization and stabilization of the drugs they contain. Some also contain complexes which are useful for treating poisonings, increasing pharmacological activity, improving drug distribution, and enhancing bioavailability. In this article, we limit our discussion to organic molecular complexes.


Adolescent cocaine exposure enhanced negative affect following drug re-exposure in adult rats: Attenuation of c-Fos activation.
The goal of the present study was to utilize the adolescent drug experience as an emerging vulnerability factor for developing psychiatric comorbidities in adulthood that could, in turn, help to elucidate and/or hypothesize possible mechanisms contributing to higher relapse rates. The current results showed that adolescent cocaine exposure (15 mg/kg, intraperitoneally, seven days) during early-mid adolescence (postnatal days 33-39) enhanced negative affect in adulthood, by increasing behavioral despair following drug re-exposure and by increasing anhedonia. Thus, these behavioral data provided a good model to further ascertain the long-term cellular and molecular adaptations that might take place in the brain in response to adolescent cocaine exposure as well as the impact of drug re-exposure in adulthood. In this regard, the results showed that adolescent cocaine exposure did not modulate cell proliferation (Ki-67+ cells) or c-Fos protein activation in the dentate gyrus region of the hippocampus, but attenuated c-Fos activation in the dorsal striatum. These results proved that a history of cocaine exposure during adolescence increased the vulnerability to induce negative affect (i.e. emergence of psychiatric comorbidity) in adulthood while it decreased neuronal activation in the dorsal striatum. Interestingly, these effects were only observed following cocaine re-exposure in adulthood, suggesting that avoiding drug contact in adulthood could prevent the long-term negative effects induced by adolescent cocaine.


The earnings of male immigrants in England: evidence from the quarterly LFS.
"In this paper we estimate earnings functions for native born and foreign born white and non-white males in the English labour market, using data from the Quarterly Labour Force Survey.... Our results highlight the importance of distinguishing between native born and foreign born males when investigating the labour market experience of ethnic minorities. Furthermore, the earnings performance amongst white immigrants varies considerably."


Dufulin Intervenes the Viroplasmic Proteins as the Mechanism of Action against Southern Rice Black-Streaked Dwarf Virus.
Southern rice black-streaked dwarf virus (SRBSDV) causes disease in crops, which reduces the quality and yield. Several commercial antiviral agents are available to control the SRBSDV induced disease. However, the mechanism of antiviral agents controlling SRBSDV is largely unknown. Identifying targets in SRBSDV is a key step of antiviral agent discovery. Here, we investigated the potential protein target of the antiviral agent dufulin. We cloned and expressed a soluble viroplasmic P6 protein in the prokaryote Escherichia coli and the eukaryote Spodoptera frugiperda 9. The dissociation constants of dufulin with the purified P6 protein from E. coli and S. frugiperda 9 expression systems were 4.49 and 4.95 μM, respectively, indicating a strong binding affinity between dufulin and P6 protein. In vivo, dufulin significantly inhibited the expression of both P6 protein and P6 gene in the SRBSDV-infected rice leaves. This inhibition on P6 protein expression was also observed in transformed Nicotiana benthamiana where the P6 was overexpressed. Our data also showed that dufulin inhibited the duplication of SRBSDV in a dose-dependent manner in infected rice leaves with a half maximum effective concentration of 3.32 mM. It is therefore concluded that dufulin targets the viroplasmic protein P6 to inhibit the virulence of SRBSDV.


Explaining immigrant naturalization.
"Prior research on immigrant naturalization has focused mainly on the effects of immigrants' adaptation experiences and demographic characteristics on their propensity to naturalize. This article proposes a broader analytical framework which incorporates immigrants' individual characteristics and larger social contexts in the country of origin and the country of destination to explain the likelihood of citizenship acquisition. The framework is tested for a cohort of recent immigrants, using the PUMS data from the 1980 U.S. census. The results show that economic, political, social, cultural and geographical conditions in the country of origin, and immigrants ethnic communities and urban concentration in the country of destination, to a large extent influence immigrants' propensity for naturalization and that, net of the contextual factors, many of the immigrants' adaptation and demographic characteristics are also significant predictors of citizenship acquisition."


Pathophysiology of exercise intolerance in breast cancer survivors with preserved left ventricular ejection fraction.
Breast cancer (BC) survival rates have improved during the past two decades and as a result older BC survivors are at increased risk of developing heart failure (HF). Although the HF phenotype common to BC survivors has received little attention, BC survivors have a number of risk factors associated with HF and preserved ejection fraction (HFPEF) including older age, hypertension, obesity, metabolic syndrome and sedentary lifestyle. Moreover, not unlike HFPEF, BC survivors with preserved left ventricular ejection fraction (BCPEF) have reduced exercise tolerance measured objectively as decreased peak oxygen uptake (peak VO2). This review summarizes the literature regarding the mechanisms of exercise intolerance and the role of exercise training to improve peak VO2 in BCPEF.


HIV-1 Protease, Reverse Transcriptase, and Integrase Variation.
HIV-1 protease (PR), reverse transcriptase (RT), and integrase (IN) variability presents a challenge to laboratories performing genotypic resistance testing. This challenge will grow with increased sequencing of samples enriched for proviral DNA such as dried blood spots and increased use of next-generation sequencing (NGS) to detect low-abundance HIV-1 variants. We analyzed PR and RT sequences from >100,000 individuals and IN sequences from >10,000 individuals to characterize variation at each amino acid position, identify mutations indicating APOBEC-mediated G-to-A editing, and identify mutations resulting from selective drug pressure. Forty-seven percent of PR, 37% of RT, and 34% of IN positions had one or more amino acid variants with a prevalence of ≥1%. Seventy percent of PR, 60% of RT, and 60% of IN positions had one or more variants with a prevalence of ≥0.1%. Overall 201 PR, 636 RT, and 346 IN variants had a prevalence of ≥0.1%. The median intersubtype prevalence ratios were 2.9-, 2.1-, and 1.9-fold for these PR, RT, and IN variants, respectively. Only 5.0% of PR, 3.7% of RT, and 2.0% of IN variants had a median intersubtype prevalence ratio of ≥10-fold. Variants at lower prevalences were more likely to differ biochemically and to be part of an electrophoretic mixture compared to high-prevalence variants. There were 209 mutations indicative of APOBEC-mediated G-to-A editing and 326 mutations nonpolymorphic treatment selected. Identification of viruses with a high number of APOBEC-associated mutations will facilitate the quality control of dried blood spot sequencing. Identifying sequences with a high proportion of rare mutations will facilitate the quality control of NGS. Most antiretroviral drugs target three HIV-1 proteins: PR, RT, and IN. These proteins are highly variable: many different amino acids can be present at the same position in viruses from different individuals. Some of the amino acid variants cause drug resistance and occur mainly in individuals receiving antiretroviral drugs. Some variants result from a human cellular defense mechanism called APOBEC-mediated hypermutation. Many variants result from naturally occurring mutation. Some variants may represent technical artifacts. We studied PR and RT sequences from >100,000 individuals and IN sequences from >10,000 individuals to quantify variation at each amino acid position in these three HIV-1 proteins. We performed analyses to determine which amino acid variants resulted from antiretroviral drug selection pressure, APOBEC-mediated editing, and naturally occurring variation. Our results provide information essential to clinical, research, and public health laboratories performing genotypic resistance testing by sequencing HIV-1 PR, RT, and IN.


Colonoscopy: basic principles and novel techniques.
Colonoscopy is considered the 'gold standard' for detection and removal of premalignant lesions in the colon. However, studies suggest that colonoscopy is less protective for right-sided than for left-sided colorectal cancer. Optimizing the effectiveness of colonoscopy is a continuous process, and during the past decade several important quality indicators have been defined that can be used to measure the performance of colonoscopy and to identify areas for quality improvement. The quality of bowel preparation can be enhanced by split-dose regimens, which are superior to single-dose regimens. Cecal intubation rates should approximate 95% and can be optimized by good technique. In selected patients, specific devices can be used to facilitate cecal intubation. Adenoma detection rates should be monitored and exceed a minimum of 25% in men and 15% in women. To this aim, optimal withdrawal technique and adequate time for inspection are of utmost importance. Of all advanced imaging techniques, chromoendoscopy is the only technique with proven benefit for adenoma detection. Finally, the technique of polypectomy affects the number of complications as well as the success of completely removing a lesion. In this Review, we provide an overview of both standard and novel colonoscopy techniques and their impact on quality indicators.


Using High-Risk Adolescents' Voices to Develop a Comprehensible Cognitive Behavioral Therapy-Based Text-Message Program.
At-risk adolescents' comprehension of, and preferences for, the content of a text-message (SMS) delivered, cognitive behavioral therapy (CBT)-based depression prevention intervention was investigated using two qualitative studies. Adolescents with depressive symptoms and a history of peer violence were recruited from an urban emergency department. Forty-one participants completed semi-structured qualitative interviews. Thematic analysis using deductive and inductive codes were used to capture a priori and emerging themes. Five major themes were identified: CBT-based messages resonated with at-risk adolescents; high levels of peer violence, comorbid symptoms, and prior exposure to the mental health system were variables affecting preferred content; participants endorsed emotional regulation messages, but found mindfulness content difficult to understand via SMS; cognitive awareness and restructuring content was most acceptable when framed by self-efficacy content; adolescent participants generated applicable CBT content in their own voices. Overall, CBT-informed content was able to be distilled into 160-character text messages without losing its comprehensibility.


Expression of mRNA for 55-kDa and 75-kDa tumor necrosis factor (TNF) receptors in mouse cerebrovascular endothelium: effects of interleukin-1 beta, interferon-gamma and TNF-alpha on cultured cells.
The interactions between tumor necrosis factor-alpha (TNF-alpha) and its receptors have been implicated to play an important role in the pathogenesis of experimental autoimmune encephalomyelitis (EAE). The effects of cytokines on the steady state levels of TNF receptor (TNFr) mRNA in cerebrovascular endothelial cells (CVE) cultured from EAE-susceptible (SJL/J) and EAE-resistant (BALB/c) mice were examined. Interferon-gamma and interleukin-1 beta up-regulated the levels of both the 55-kDa and 75-kDa TNFr mRNA, while TNF-alpha had no effect. No differences were observed in cytokine-induced TNFr mRNA levels between BALB/c and SJL/J CVE that might explain differences in EAE susceptibility.


The impact of industry representative's visits on utilization of coronary stents.
The interaction between physicians and industry is complex and essential for improvement of medical care. However, conflict of interests may affect decision process. Our aim was to test if promotional visits by industry representatives affect treatment patterns and the use of various stents during percutaneous coronary interventions. Medical records of 1,145 consecutive patients who underwent percutaneous coronary intervention in an academic institution over 1-year period were retrospectively reviewed and linked to presence or absence of industry representative. We compared use of bare-metal stents, drug-eluting stents (DES), and balloon catheters according to company presence. A total of 1,785 stents were implanted in 1,145 patients; 60.8% were DES. More DES per case were implanted when a representative was present (1.71 ± 0.9 vs 1.60 ± 0.93, P = .023). There was no difference in the utilization of balloons and bare-metal stents between groups. Stent cost per case was higher when a representative was present (Can $1,703.5 ± 1,314.4 vs 1,468.9 ± 1,273.3, P < .001). For all companies marketing DES, there was increase in the use of the company's DES when their sale representative was present with less use of the competitors' stents. Sale representative presence was associated with increased use of the representative company's stents during percutaneous coronary interventions. The effect was more pronounced on use of the company's DES and resulted in higher procedural cost.


A Case of Pediatric Auricular Erythromelalgia.
Erythromelalgia is a rare clinical syndrome involving erythema, warmth, and burning pain in one or more of the extremities. Primary erythromelalgia is idiopathic and can begin during childhood or adulthood. In the pediatric population, auricular erythromelalgia is rare, and its etiology is not well understood. We present a case of a four-year-old boy who presented with recurrent episodes of red, painful pinnae. We also discuss previous literature on red ear syndrome and erythromelalgia.


Determination of prooxidant--antioxidant balance after acute coronary syndrome using a rapid assay: a pilot study.
The purpose of the current study was to investigate a novel measure of oxidative stress in patients with acute coronary syndrome (ACS) using a pro-oxidant-antioxidant balance (PAB) assay, which is simple and rapid. Blood samples were taken from 94 patients admitted with ACS. Pro-oxidant-antioxidant balance values were determined in the first and second 12 hours after the onset of symptoms and compared with values for 81 age- and sex-matched controls. The mean PAB values in the first and second 12-hour samples of patients were both significantly higher than that of controls (P < .001). Among patients, PAB values were also significantly higher in the second samples compared with the first samples (P < .001). These findings indicate a heightened state of oxidative stress following ACS and suggest that the PAB value may be considered as a cardiovascular risk predictor to estimate the extent of oxidative stress.


Z-Selectivity in olefin metathesis with chelated Ru catalysts: computational studies of mechanism and selectivity.
The mechanism and origins of Z-selectivity in olefin metathesis with chelated Ru catalysts were explored using density functional theory. The olefin approaches from the "side" position of the chelated Ru catalysts, in contrast to reactions with previous unchelated Ru catalysts that favor the bottom-bound pathway. Steric repulsions between the substituents on the olefin and the N-substituent on the N-heterocyclic carbene ligand lead to highly selective formation of the Z product.


Future health services--a challenge for disabled people.
Living as a disabled person in our society raises many challenges--physical, economic, political. The struggle by disabled people to escape the medical model and enter the paths of integration have not been easy. This paper explores options for participation and consumer impact.


Polymorphisms of the Flavin containing monooxygenase 3 (FMO3) gene do not predispose to essential hypertension in Caucasians.
The recessive disorder trimethylaminuria is caused by defects in the FMO3 gene, and may be associated with hypertension. We investigated whether common polymorphisms of the FMO3 gene confer an increased risk for elevated blood pressure and/or essential hypertension. FMO3 genotypes (E158K, V257M, E308G) were determined in 387 healthy subjects with ambulatory systolic and diastolic blood pressure measurements, and in a cardiovascular disease population of 1649 individuals, 691(41.9%) of whom had a history of hypertension requiring drug treatment. Haplotypes were determined and their distribution noted. There was no statistically significant association found between any of the 4 common haplotypes and daytime systolic blood pressure in the healthy population (p = 0.65). Neither was a statistically significant association found between the 4 common haplotypes and hypertension status among the cardiovascular disease patients (p = 0.80). These results suggest that the variants in the FMO3 gene do not predispose to essential hypertension in this population.


Support Grandparents Give to Their Adult Grandchildren.
Many grandparents are involved in young grandchildren's lives, but we know little about grandparents' support of adult grandchildren. This study assessed frequency of different types of support that grandparents provided to adult grandchildren and examined potential explanations for such support (e.g., affection, grandchildren's needs, parents' support). Grandparents in The Family Exchanges Study Wave 2 (N = 198; Mage = 80.19) reported how often they provided six types of support to a focal adult grandchild. Multiple regressions revealed that grandparents' affective ties with an adult grandchild were associated with more frequent listening, emotional support, and companionship. Grandparents also provided more frequent emotional support to adult grandchildren when parents incurred life problems, and more frequent companionship and financial support when parents were not employed. Moreover, grandparents' listening, advice, and companionship with adult grandchildren were positively associated with the parents providing these types of support to grandchildren. Consistent with solidarity theory, grandparents experiencing greater affective ties with their grandchildren are invested in these ties regardless of family needs. Findings also offer limited evidence for the family watchdog model in that grandparents provide more support to grandchildren when parents incur problems, even though those parents may still provide support.


Risk factors for developing de novo autoimmune hepatitis associated with anti-glutathione S-transferase T1 antibodies after liver transplantation.
De novo autoimmune hepatitis (de novo AIH) is a rare form of graft dysfunction that develops after liver transplantation (LT) in patients transplanted for conditions other than autoimmune disorders. Although characterized by biochemical, serological, and histological features of AIH, de novo AIH is sometimes associated with atypical serum autoantibodies, many of which are directed against glutathione S-transferase T1 (anti-GSTT1). GSTT1 donor/recipient genotype mismatch has been suggested as a necessary condition for the appearance of autoantibodies and de novo AIH. However, clinically evident disease is not observed in all patients with anti-GSTT1 antibodies. We examined the incidence of de novo AIH and its conditioning (risk) factors in patients with anti-GSTT1 antibodies. Anti-GSTT1 autoantibodies were detected in 29 of 419 [6.9%; 95% confidence interval (CI), 4.9-9.8] consecutive adult LT recipients with donor/recipient GSTT1 mismatch. Twenty of 27 assessable patients (74%) developed de novo AIH after a median follow-up of 26 months (95% CI, 19.2-32.8). The probability of de novo AIH was 11%, 44%, and 60% 12, 24, and 36 months after LT, respectively. No relationship emerged between de novo AIH and recipient gender, donor and recipient age, rejection episodes, immunosuppressive regime, allelic GSTT1 expression, human leukocyte antigen distribution, or cytomegalovirus infection. Multivariate analysis identified male donor [hazard ratio (HR), 3.3; 95% CI, 1.18-9.26; P = 0.018], nonalcoholic etiology (HR, 4.67; 95% CI, 1.64-13.3; P = 0.002), and high anti-GSTT1 titer (HR, 2.98; 95% CI, 1.04-8.57; P = 0.035) as independent predictors of de novo AIH. Most patients with anti-GSTT1 antibodies and donor/recipient GSTT1 mismatch developed clinically evident de novo AIH after LT. The risk of developing the disease was increased by male donor gender, nonalcoholic etiology of original liver disease, and a high anti-GSTT1 titer.


Levetiracetam may be more effective for late-onset partial epilepsy.
Many agents are available for treating epilepsy; however, population studies have failed to show overall differences in efficacy for a given seizure type. Clinical experience suggests that certain individuals will respond to a given agent while others with the same seizure type will not. To examine a population of patients who received one of the newer antiepileptic drugs, levetiracetam, and to identify those who had either a dramatic improvement or a significant worsening of seizures. Retrospective medical record review of patients with refractory epilepsy. Patients who responded well to levetiracetam therapy were older at the onset of epileptic seizure than those who did not (mean [SD] age, 51 [5] vs 27 [3] years; P<.05). This was also true of the subset of patients who had localization-related epilepsy. Patients with temporal lobe onset were likely to do well whereas patients with frontal lobe onset were not. These results suggest that certain subpopulations may be particularly likely to respond to levetiracetam therapy. These need to be confirmed in a larger prospective trial; however, looking for specific characteristics of patients who respond to certain drugs may lead to useful guidelines for drug choices in treating epilepsy.


Intrasellar cavernous hemangioma.
We present a very rare case of an intrasellar cavernous hemangioma mimicking, clinically and neuroradiologically, the presence of a nonfunctioning pituitary adenoma. It was possible to diagnose this benign, congenital vascular malformation only through a histological examination.


[Analysis of articles published in Chinese Journal of Burns winning high citation rate during 2000-2009].
To analyze the inherent quality of articles published in our journal enjoying high citation rate, and to explore strategies on improving impact of papers. Scientific papers published in Chinese Journal of Burns from February 2000 to December 2009, with citation rate equal to or higher than 20 times were collected for classification according to their publication year, publication form, subject distribution, regional and institutional distribution, frequency of authors appeared in those published papers, frequency of winning prizes, and sources of fund (national, ministerial, or provincial). Data were processed by Microsoft Excel software. Altogether 64 scientific papers with high citation rate were published from 2000 to 2006. Original articles and expert forum accounted for 55 (86.0%). Twenty-one articles of clinical study were cited frequently, among them one was cited for 79 times. Articles dealing with subjects with popular interest or cutting-edge problems were cited frequently. Most articles winning high citation rate were originated from institutions located in Chongqing, Beijing, Shanghai, and Xi'an, etc. Those scientific papers which were instructed by specialists, with high level foundation and won prizes were cited with high frequency. The top 20 articles were mainly cited by excellent doctoral dissertations and master theses originated from 11 institutions for higher education, and source journals of Chinese Scientific and Technical Papers and Citations Database. Authors should emphasize subject planning in order to compose papers with high quality. The editorial board should make arrangements with influential specialists with related skills for their contributions based on subjects of popular interest concerning the cutting-edge problems of the specific specialty, and pay close attention to papers on clinical study and those with funding from high levels, to improve impact of the articles.


The early molecular epidemiology of the swine-origin A/H1N1 human influenza pandemic.
Swine-origin pandemic human influenza A virus (H1N1pdm) has spread rapidly around the world since its initial documentation in April 2009. Here we have updated initial estimates of the rate of molecular evolution and estimates of the time of origin of this virus in the human population using the large number of viral sequences made available as part of the public health response to this global pandemic. Currently sampled H1N1pdm sequences share a most recent common ancestor in the first 7 weeks of 2009 with the implication that the virus was transmitting cryptically for up to 3 months prior to recognition. A phylogenetic reconstruction of the data shows that the virus has been circling the globe extensively with multiple introductions into most geographical areas.


Successful allogeneic hematopoietic stem cell transplantation in a boy with X-linked inhibitor of apoptosis deficiency presenting with hemophagocytic lymphohistiocytosis: A case report.
X-linked inhibitor of apoptosis (XIAP) deficiency, also known as X-linked lymphoproliferative syndrome type 2 (XLP2), is a rare inherited primary immunodeficiency resulting from the XIAP (also known as BIRC4) mutation. XIAP deficiency is mainly associated with familial hemophagocytic lymphohistiocytosis (HLH) phenotypes, and genetic testing is crucial in diagnosing this syndrome. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the only successful strategy for the treatment of this disease; however, a limited number of studies has been published concerning the outcomes of allogeneic HSCT in patients with XIAP deficiency. The present study reported a successful allogeneic HSCT performed to treat XIAP deficiency in a Chinese boy presenting with HLH. Polymerase chain reaction and DNA sequencing were performed to confirm the diagnosis of XIAP deficiency, and allogeneic HSCT was performed. Genetic tests revealed a two-nucleotide deletion (c.1021_1022delAA) in the patient, which was inherited from his mother, and resulted in frameshift mutation and premature stop codon (p.N341fsX348); this is considered to be a disease-causing mutation. The XIAP deficiency patient underwent allogeneic HSCT, receiving busulfan-containing reduced intensity myeloablative conditioning regimen, with a good intermediate follow-up result obtained. Therefore, genetic testing is essential to confirm the diagnosis of XIAP deficiency and detect the carrier of mutation. The present case study may promote the investigation of allogeneic HSCT in patients with XIAP deficiency.


Serum pepsinogen I and gastrin concentrations in children positive for Helicobacter pylori.
Serum pepsinogen I, serum gastrin concentration, and inflammatory scores were measured in a population of 71 children undergoing upper gastrointestinal endoscopy for investigation of upper abdominal pain. Forty four were initially colonised with Helicobacter pylori. The indices were measured before treatment (in 71 children), one month (in 41 children), and six months (in 21 children) after stopping treatment. Before treatment there was a significant correlation between serum pepsinogen concentration, total inflammatory score, and H pylori state, but no correlation between serum gastrin concentrations and H pylori state. Similarly, the total inflammatory score and serum pepsinogen concentrations were significantly correlated. There was no such correlation in children negative for H pylori. After treatment the inflammatory score improved in those patients in whom H pylori had been eradicated. There was also a significant fall in serum pepsinogen I and serum gastrin concentration in those patients in whom H pylori had been eradicated. These results were similar to those found six months after treatment had been stopped. These findings suggest that the serum pepsinogen I concentration could be considered a useful marker for gastritis and can be used as an index of severity of gastritis in H pylori positive subjects. The measurement of serum gastrin concentrations does not give useful information.


Vascular architecture of 3-methyl choranthrene-induced rat fibrosarcoma demonstrated by scanning electron microscopy of resin casts.
A detailed knowledge of the vascular system of tumors is requisite to a clear understanding of tumor physiology and pathology. Accordingly, in this study, examination was made of the vascular architecture of rat fibrosarcomas induced by 3-methyl choranthrene by scanning electron microscopy of resin casts to observe the three-dimensional vascular pattern of the sarcoma. The results were compared with those of corresponding serial sections of India ink-injected tissue. The major arteries in and around tumors appeared devoid of intra-arterial cushions which regulate blood flow. The arterial lining of resin casts was smooth just at the site where it entered the tumor. This may possibly be indication of degeneration and loss of the smooth muscle layer in the vascular wall. Casts of capillaries were very thin from 4 to 6 microns in diameter and very few sprouts could be seen. Capillaries, frequently present in superficial regions of the tumor, formed a rich irregular fine polygonal network. In fibrous tissue in deeper regions of the tumor, this network was coarse. The absence of intra-arterial cushions and degeneration of muscle cells may thus possibly be the reason for the characteristic haemodynamics of tumors.


Validated ligand mapping of ACE active site.
Crystal structures of angiotensin-converting enzyme (ACE) complexed with three inhibitors (lisinopril, captopril, enalapril) provided experimental data for testing the validity of a prior active site model predicting the bound conformation of the inhibitors. The ACE active site model - predicted over 18 years ago using a series of potent ACE inhibitors of diverse chemical structure - was recreated using published data and commercial software. Comparison between the predicted structures of the three inhibitors bound to the active site of ACE and those determined experimentally yielded root mean square deviation (RMSD) values of 0.43-0.81 A, among the distances defining the active site map. The bound conformations of the chemically relevant atoms were accurately deduced from the geometry of ligands, applying the assumption that the geometry of the active site groups responsible for binding and catalysis of amide hydrolysis was constrained. The mapping of bound inhibitors at the ACE active site was validated for known experimental compounds, so that the constrained conformational search methodology may be applied with confidence when no experimentally determined structure of the enzyme yet exists, but potent, diverse inhibitors are available.


Male university students' views, attitudes and behaviors towards family planning and emergency contraception in Turkey.
To determine male university students' views, attitudes and behavior towards family planning and emergency contraception as an important aspect of reproductive health. This descriptive study was carried out with 278 men who were chosen using the convenience sampling method at several universities in Istanbul during the spring semester of 2005. Data were obtained through interviews with men by means of a 32 item self-administered questionnaire. Data analyses were made with the Statistical Package for the Social Sciences (SPSS). Almost all of the men (96.6%) were single. Students' (n = 200) average age at their first sexual intercourse experience was 17.4 years. Seventy-three percent of the students used a family planning (FP) method in their first sexual experiences (69.5% used a condom). The male condom is the most well known (95.8%) and commonly used (70.1%) FP method. The number of students taking a shared responsibility for FP was 79.4%. One third of the students had negative attitudes towards vasectomy and 1/5 of them were against the use of condoms. The percentage of the students who had heard about emergency contraception (EC) was 14.5%. Male university students who are sexually active generally do not have enough knowledge about FP and EC. They tend to engage in high-risk behavior. It is imperative that education and counseling in reproductive and sexual health must be offered to all young men. In addition, men's attitudes toward contraceptive methods should be evaluated in other cultures and useful comparisons made with Turkey.


Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism.
Recently, the number of performed CT-angiographies to diagnose pulmonary embolism (PE) rised markedly, while the incidence of PE hardly increased. This low yield of CT-angiography leads to more patients exposed to radiation and higher costs. The diagnostic value of age, C-reactive protein (CRP) and D-dimer in PE was investigated. Additionally an age-adjusted D-dimer cutoff level [age-adjusted cutoff = age/100 mg/L] was compared with the conventional cutoff level in diagnosing PE for patients ≥50 yr. This observational study (2004-2007) included all consecutive patients suspected for PE presenting on the emergency department with a performed CT-angiography after measuring CRP and D-dimer levels. Of 4609 patients suspected for PE, 1164 patients underwent CT-angiography of whom 309 (26.5%) had PE. Correlation between CRP and D-dimer was 0.42 (P < 0.001). D-dimer and age correlated positively (rs = 0.33, P < 0.001), but only in patients >50 yr and independent of PE. Multivariate regression analysis showed significant contribution of age, D-dimer and age-adjusted D-dimer for diagnosing PE, but not for CRP. Using an age-adjusted D-dimer cutoff value increased specificity from 37% to 50%, whereas sensitivity declined from 96% to 90%. Applying this age-adjusted cutoff level in patients ≥70 yr, specificity increased from 18% to 40%, while sensitivity decreased from 96% to 88%. In the prediction of PE, age and D-dimer levels are relevant, while CRP level is not. Using an age-adjusted D-dimer cutoff in older patients remarkably improves the specificity of D-dimer testing with a minor decline in sensitivity. This may increase the yield of CT-angiography in diagnosing PE.


Timely topic: anaplastic lymphoma kinase (ALK) spreads its influence.
Anaplastic lymphoma kinase (ALK) is normally not expressed in human tissues except selected sites in the nervous system. Its expression and constitutive activation as a result of a chromosomal translocation involving 2p23 plays a pivotal role in the genesis of anaplastic large cell lymphoma. ALK expression has been instrumental in defining a homogeneous subset from the category of anaplastic large cell lymphoma, characterised by occurrence in young patients, primary systemic presentation, favorable prognosis, a broad morphological spectrum, nuclear and/or cytoplasmic immunostaining for ALK protein, and a number of possible fusion partner genes such as NPM, ATIC, TFG, TPM3 and CLTCL. Recently ALK has been implicated in the genesis of another tumour type, the inflammatory myofibroblastic tumours. The ALK-positive examples occur in children and young adults, involving a variety of sites, such as the abdomen, mesentery, liver, bladder, mediastinum, lung and bone. The partner genes identified in some cases are TPM3 (tropomyosin 3) and TPM4 (tropomyosin 4). These molecular findings also further support the neoplastic nature of at least a subset of inflammatory myofibroblastic tumours.


Induction of anesthesia with diazepam-ketamine and midazolam-ketamine in greyhounds.
Anesthesia was induced in 14 greyhounds with a mixture of diazepam or midazolam (0.28 mg/kg) and ketamine (5.5 mg/kg), and maintained with halothane. There were no significant differences in weight, age, or duration of anesthesia between the treatment groups. Time to intubation with diazepam-ketamine (4.07 +/- 1.43 min) was significantly longer than with midazolam-ketamine (2.73 +/- 0.84 min). Heart rate, respiratory rate, PaCO2, and arterial pH did not vary significantly during anesthesia in either treatment group. Arterial blood pressures, PaO2, halothane vaporizer setting, and body temperature changed significantly from baseline values in both treatment groups during anesthesia. Times to sternal recumbency and times to standing were not significantly different. These data suggest that both diazepam-ketamine and midazolam-ketamine are useful anesthetic combinations in greyhounds. In combination with ketamine, midazolam offers little advantage over diazepam.


Learning performance is influenced by the social environment in cichlid fishes.
It has been hypothesised that some specialised cognitive abilities may have evolved because of the challenges of living in complex social environments. Therefore, more-social species might be able to learn faster than less-social species. The aim of this study was to develop a learning framework to test how more- and less-social Lamprologine cichlid fishes perform across associative learning tasks. These cichlids are a group of closely related species with similar ecologies and life histories but varying degrees of sociality, making them an ideal group for comparative learning studies. We found that three nongrouping cichlids (Telmatochromis temporalis, Lamprologus meleagris, and Neolamprologus tretocephalus) outperformed three closely related highly social, cooperatively breeding cichlids (N. pulcher, N. multifasciatus, and Julidochromis dickfeldi) on an associative learning task based on food rewards. However, we hypothesised that these differences may be caused by the social environment during testing and might not reflect true cognitive differences. Indeed, when we drilled down and compared just two species across four different social conditions, we found that the social environment during learning trials affected the performance of the highly social N. pulcher and the less-social T. temporalis differently. We then performed further experiments with both N. pulcher and T. temporalis under more natural social settings. Under these more natural social conditions, we found that N. pulcher learned to differentiate accessible and inaccessible shelters faster than T. temporalis. These findings highlight the potential for expanding comparative experiments investigating the relationship between sociality and cognition and emphasise the crucial role social environment plays in learning outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Obstetric ultrasound: where are we and where are we going?
Diagnostic ultrasound (DUS) is, arguably, the most common technique used in obstetrical practice. From A mode, first described by Ian Donald for gynecology in the late 1950s, to B mode in the 1970s, real-time and gray-scale in the early 1980s, Doppler a little later, sophisticated color Doppler in the 1990s and three dimensional/four-dimensional ultrasound in the 2000s, DUS has not ceased to be closely associated with the practice of obstetrics. The latest innovation is the use of artificial intelligence which will, undoubtedly, take an increasing role in all aspects of our lives, including medicine and, specifically, obstetric ultrasound. In addition, in the future, new visualization methods may be developed, training methods expanded, and workflow and ergonomics improved.


A contribution to genetic etiology of complex regional pain syndrome type I (algodystropy syndrome) based on quantitative analysis of digitopalmar dermatoglyphics in sixty men.
The patterns of the ridges of the skin of the fingers and palms were determined in sixty men with complex regional pain syndrome (type I) as a measure of disease prevention. The study included 25 dermatoglyphic traits: number of epidermal ridges on all ten fingers; their sum for five and ten fingers; four traits on both palms, i.e. between a-b, b-c and c-d triradii; atd angles: and their bilateral sum. The data obtained were compared with those recorded in a control group of 200 pairs of imprints of phenotipycally healthy male adults from the Zagreb area. Statistically significant difference from control values were found in 12 dermatoglyphic variables, including an increased sum of ridges on nine fingers (except for left second finger pad), and total sum for five and ten fingers. These findings suggested the polygenic system responsible for development of dermatoglyphics to be identical with some polygenic loci for the onset of algodystrophy syndrome, which might prove useful in disease prevention (e.g., taking fingerprints following a trauma and before rehabilitation), and to facilitate identification of risk groups, and thus the treatment for this longterm and yet obscure syndrome.


Engineering integrated digital circuits with allosteric ribozymes for scaling up molecular computation and diagnostics.
Here we describe molecular implementations of integrated digital circuits, including a three-input AND logic gate, a two-input multiplexer, and 1-to-2 decoder using allosteric ribozymes. Furthermore, we demonstrate a multiplexer-decoder circuit. The ribozymes are designed to seek-and-destroy specific RNAs with a certain length by a fully computerized procedure. The algorithm can accurately predict one base substitution that alters the ribozyme's logic function. The ability to sense the length of RNA molecules enables single ribozymes to be used as platforms for multiple interactions. These ribozymes can work as integrated circuits with the functionality of up to five logic gates. The ribozyme design is universal since the allosteric and substrate domains can be altered to sense different RNAs. In addition, the ribozymes can specifically cleave RNA molecules with triplet-repeat expansions observed in genetic disorders such as oculopharyngeal muscular dystrophy. Therefore, the designer ribozymes can be employed for scaling up computing and diagnostic networks in the fields of molecular computing and diagnostics and RNA synthetic biology.


Documentation of body mass index and control of associated risk factors in a large primary care network.
Body mass index (BMI) will be a reportable health measure in the United States (US) through implementation of Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network. We conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7/05 - 12/06. We defined BMI category as normal weight (NW, 18-24.9 kg/m2), overweight (OW, 25-29.9), and obese (OB, >or= 30). We measured documentation (yes/no) and control (above/below) of the following three risk factors: blood pressure (BP) <or=130/<or=85 mmHg, low-density lipoprotein (LDL) <or=130 mg/dL (3.367 mmol/L), and fasting glucose <100 mg/dL (5.55 mmol/L) or casual glucose <200 mg/dL (11.1 mmol/L). BMI was documented in 48,376 patients (61%, range 34-94%), distributed as 30% OB, 34% OW, and 36% NW. Documentation of all three risk factors was higher in obesity (OB = 58%, OW = 54%, NW = 41%, p for trend <0.0001), but control of all three was lower (OB = 44%, OW = 49%, NW = 62%, p = 0.0001). The presence of cardiovascular disease (CVD) or diabetes modified some associations with obesity, and OB patients with CVD or diabetes had low rates of control of all three risk factors (CVD: OB = 49%, OW = 50%, NW = 56%; diabetes: OB = 42%, OW = 47%, NW = 48%, p < 0.0001 for adiposity-CVD or diabetes interaction). In a large primary care network BMI documentation has been incomplete and for patients with BMI measured, risk factor control has been poorer in obese patients compared with NW, even in those with obesity and CVD or diabetes. Better knowledge of BMI could provide an opportunity for improved quality in obesity care.


Supraorbital eyebrow approach to skull base lesions.
We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.


Evaluation of acne quality of life and clinical severity in acne female adults.
Acne is a common disease especially among teenagers. It has a considerable psychological impact on affected individuals. The aim of this paper was to assess if the effect of acne on acne-related quality of life is correlated to acne clinical severity. 112 university female students attending the university medical clinics with acne complaints were examined. Cardiff Acne Disability Index (CADI) was used to assess acne-related quality of life, and global acne grading system (GAGS) was used to assess clinical severity of acne. There was no correlation between acne severity (GAGS scoring system) and quality of life impairment as assessed by CADI score (r = 0.145, P = .127). Additionally, CADI score did not correlate with disease duration or age of patients. We therefore conclude that acne clinical severity alone does not affect acne-related quality of life changes. Many other factors might play a role.


Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study.
Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health and, particularly, mental health, is poorly understood. We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (Oxford University/AstraZeneca, November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, including the completion of the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression). Peri-pandemic, individuals indicated whether they or someone in their household was shielding; that is, people judged by the UK National Health Service as being particularly clinically vulnerable who were therefore requested to remain at home. Intention to take up vaccination for COVID-19 was also self-reported. In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine-hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to vaccine-hesitancy. People with a physical condition were more likely to take up the potential offer of a COVID-19 vaccination. These effects were not apparent for indices of mental health.Key messagesIn understanding predictors of COVID-19 vaccine hesitancy, the role of physical and mental health has not been well-examined despite both groups seemingly experiencing an elevated risk of the disease.In a large UK cohort study, people with a pre-pandemic physical condition were more likely to take up the theoretical offer of vaccination.There were no apparent effects for indices of pre-pandemic mental health.


An open-label study of quetiapine in the treatment of fibromyalgia.
The aim of this exploratory study was to systematically assess the potential effectiveness and tolerability of quetiapine, an atypical antipsychotic, for the treatment of patients with fibromyalgia. This was a unicentre, open-label study conducted in thirty-five outpatients, 18 years or older, who met the ACR criteria for fibromyalgia and who had not satisfactorily responded to their previous fibromyalgia treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added to their original treatment regimen for 12 weeks. The primary outcome measure was the mean change from baseline to endpoint in the Fibromyalgia Impact Questionnaire (FIQ) total score. Secondary efficacy measures included mean changes from baseline to endpoint in the scores of the Clinical Global Impression (CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), 12-Item Short Form Health Survey (SF-12), and individual items of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9, 93.3% females) had a postbaseline evaluation and constituted the intent-to-treat efficacy sample. Mean FIQ total score decreased significantly by 10.2 points from a baseline of 63.2 to 53.0 at study endpoint (p<0.001). A statistically significant reduction was observed in FIQ stiffness and FIQ fatigue subscores but not in FIQ pain subscore. Large effect sizes were observed for the FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while moderate effect sizes (i.e.> or =0.50) were encountered in the FIQ fatigue, FIQ stiffness and SF-12 mental component summary. Quetiapine was safely administered and well tolerated. Despite the lack of effect on pain, the significant and relevant improvement in overall efficacy measures and quality of life suggests that quetiapine may be a valuable drug for treatment of patients with fibromyalgia that should be further tested in double-blind, placebo-controlled trials.


Complications of neck dissection.
Neck dissection is a surgical procedure used in the diagnosis and treatment of head and neck cancer. The neck dissection involves excising the lymph nodes in specified regions of the neck with or without removing the sternocleidomastoid muscle, the internal jugular vein, and the spinal accessory nerve. The removal of cervical lymph nodes not only aids in staging the malignancy but also treats the nodal disease and dictates further treatment such as radiation therapy. Because of the proximity of vital structures, certain risks and complications are inherent to this operation. The prevention, recognition, and treatment of early and late complications of neck dissection are discussed.


The validity of subscores for a credentialing test.
Subscores resulting from the administration of high-stakes tests to candidates for credentials in the health professions are desirable for two reasons. First, failing candidates want a profile of performance to plan future remedial studies. Second, training institutions want a profile of performance for their graduates to better evaluate their training. The validity of the interpretation or use of subscores depends on a summative judgment based on a combination of reasoning and empirical analyses, known as validation. We describe this reasoning process and show that with a large credentialing test the validity of any subscore interpretation or use can and should be studied systematically. Validity evidence should be established to support the interpretation and use of subscores that we intend to report. Some principles arise in this study related to the validity of subscores, and some procedures are proposed to help testing program personnel better validate the use of subscores.


Lipoprotein(a) Induces Vesicular Cardiovascular Calcification Revealed With Single-Extracellular Vesicle Analysis.
Lipoprotein(a) (Lp[a]) blood levels >50 mg/dL is a major cardiovascular disease risk factor in humans. Lp(a) associates with increased cardiovascular calcification, a critical pathology with no clinically available drug therapies. The mechanisms through which Lp(a) increases cardiovascular calcification risk remain undefined. We hypothesized that Lp(a) promotes the release of calcifying extracellular vesicles (EVs) that contribute to formation of microcalcification in cardiovascular tissues. Here, we show Lp(a) increased calcification in both primary human smooth muscle cells (SMCs) and valvular interstitial cells (VICs), potentially through inflammation-related mechanisms that were suppressed with E06 antibody that neutralizes pro-inflammatory oxidized phospholipids. Incubating human SMCs and VICs with Lp(a) altered the composition of EVs, increasing CD29+/tetraspanin- microvesicle release, demonstrated with a tailored single-EV microarray assay that can distinguish multivesicular body-derived exosomes and plasma membrane budded microvesicles at a single-vesicle level. Lp(a) stimulation led to release of SMC and VIC EVs that readily calcified in acellular 3D-collagen hydrogels mimicking formation of ectopic microcalcification occurring in extracellular matrix of human atherosclerotic arteries and stenotic aortic valves. Our study mechanistically demonstrates that Lp(a) partially mediates cardiovascular calcification formation via inducing the release of calcifying EVs. Additionally, we provide a customized method to assess calcifying EVs at a single-vesicle level that can be more broadly applied to assist in quantitatively differentiating exosome and microvesicle EV subpopulations.


In vivo measurement of phytochrome in tomato fruit.
Presence of phytochrome in two kinds of tomatoes (Lycopersicon esculentum Mill.), the yellow lutescent strain and cherry tomatoes (L. esculentum Mill. var. cerasiformecv. Red Cherry), was established by measuring the absorption difference spectra of the whole fruit after irradiation with red and with far red light. Phytochrome content was determined in yellow lutescent tomatoes and decreased gradually during the ripening period.


Periorbital hematoma secondary to sinusitis in a child.
Periorbital abscess secondary to sinusitis is a well-recognized entity in children. However, subperiosteal hematoma is extremely rare and has been reported in only four adult patients. This article presents the case of a 4-year-old girl with sinusitis, proptosis, and decreased visual acuity. Surgical exploration of the orbit revealed the presence of a large organizing subperiosteal hematoma that was drained. The presence of a periorbital hematoma should be suspected in patients with acute onset of proptosis and findings of a periorbital mass and sinusitis on computed tomographic scan.


Feeding regimen by sire family interactions on growth, immunocompetence, and disease resistance in chickens.
Progeny from matings of 12 sires from a White Plymouth Rock line selected for high juvenile BW and 96 dams from a White Leghorn line selected for low antibody production to SRBC were reared under alternate-day (AD) or ad libitum (AL) feeding regimens. Within a feeding regimen males were heavier than females, and within a sex, chicks fed AL were heavier than those fed AD. Feeding regimen by sire family interactions were significant for BW at 21 d of age for both male and female progeny. The interaction was due to differences among sires in the magnitude of the AD: AL relationship. Product moment correlation coefficients between feeding regimens for male and female progeny of sire families for 21-d BW were essentially zero, which was consistent with the sire family by feeding regimen interactions observed at this age. At 41 d of age, relative to BW, weights of empty esophagus plus crop and of crop contents were greater for AD than AL chicks. There were differences among sire families for crop content and breast weights relative to BW. Lesion scores to Escherichia coli challenge were lower and antibody titers to SRBC antigen were higher in AD than in AL chicks. Sire families differed in antibody titers to SRBC antigen. Feeding regimen by sire family interactions were significant for percentage change in BW 144 h after E. coli challenge and lesion scores were greater for AL than AD chicks.


Unilateral laparoscopic ovariectomy in a red fox (Vulpes vulpes) with an ovarian cyst.
Unilateral laparoscopic ovariectomy was attempted in a red fox (Vulpes vulpes) with an ovarian cyst through single portal access. The ovarian cyst was resistant to conservative therapy using gonadotropin-releasing hormone. A 10-mm laparoscope with an operating channel was introduced into the abdomen via a 12-mm umbilical portal. The left ovary and cyst (34.1 x 30.8 mm) were fixed to the left abdominal wall by a transabdominal suspension suture. The ovarian pedicles and ligaments were progressively cauterized and transected with a multifunction bipolar electrocoagulation forceps. The resected cystic ovary was exteriorized through the umbilical portal site. The surgical time was 42 min, and no intra- and postoperative complications were encountered. Two months after the surgery mating was observed, and the fox gave birth to three healthy cubs 56 days after the mating. This is the first report of using laparoscopy in the red fox with an ovarian cyst.


Biomarkers of cardiac injury: an update.
Conventional and promising new markers of myocardial injury have become an important diagnostic tool and their prognostic significance is also recognized. In addition, they help identify patients who will derive the most benefit from therapeutic interventions. The literature was searched from the websites of the National Library of Medicine (http://www.ncbi.nlm.nih.gov/) and PubMed Central, the U.S. National Library of Medicine's digital archive of life sciences journal literature (http://www.pubmedcentral.nih.gov/). The data were accessed from books and journals that published relevant articles in this field. The diagnosis of acute myocardial infarction (AMI) has traditionally relied on the combination of chest pain, ECG features, and elevation in serum markers. However, chest symptoms are frequently atypical or absent and ECG changes may be nonspecific or absent. Hence, the diagnosis of acute coronary syndromes has become increasingly dependent on serum markers of cardiac injury. Among them, creatine kinase (CK) is an effective and widely used test, with the recent CKMB assay offering greater specificity and sensitivity. Cardiac troponins facilitate early and rapid diagnosis, enable effective risk stratification in patients with AMI (with or without traditional criteria for MI), and identify those who will benefit from aggressive medical or surgical intervention. Recent data suggest the potential of myoglobin and CKMB isoforms as sensitive markers in the early hours after symptom onset. Cardiac-specific troponins help in rapid diagnosis, prognostication, and treatment of AMI. Troponins also facilitate early detection of recent infarction owing to their prolonged diagnostic window and also aid in the detection of "microinfarction.'' CKMB is used to detect reinfarction or infarct extension, if levels rise again after declining. Finally, novel biochemical markers are receiving attention in ongoing trials. They may prove to be more effective in diagnosis and prognosis than their existing counterparts.


Identifying Patient Characteristics That Predict Drug-Induced Sleep Endoscopy Anatomy.
To examine if age, sex, body mass index (BMI), neck circumference, or apnea-hypopnea index can predict whether a patient will demonstrate velopharyngeal complete circumferential (CC) collapse on drug-induced sleep endoscopy (DISE). Single-center retrospective review at The Ohio State Wexner Medical Center of 289 patients between March 2014 and June 2020. Quaternary care hospital. Patient characteristic and DISE information was extracted from charts and summarized with mean and standard deviation for continuous variables and count and percentage for categorical. CC collapse and patient characteristic associations were explored: 2-sample t test for continuous and chi-square test for categorical. Classification and regression tree (CART) analysis with 3-fold cross-validation was employed to search for the best CC collapse predictors. Male and female BMI and female neck circumference were correlated to velopharyngeal CC collapse, with BMI more strongly correlated. CART analysis for males showed that a BMI ≤34.8 kg/m2 is associated with an 89.4% chance of not demonstrating velopharyngeal CC collapse vs 48% for BMI >34.8 (area under the curve [AUC] = 0.705; AUC >0.7 is acceptable). For females, the CART analysis showed that a BMI ≤36.4 is associated with a 98.4% of not demonstrating velopharyngeal CC collapse vs 30.8% for BMI >36.4 (AUC = 0.73). For females, a neck circumference ≤38.05 cm is associated with a 100% chance of not demonstrating velopharyngeal CC collapse vs 18.4% for >38.05 cm (AUC = 0.72). The BMI values for males and females and the female neck circumference values established by the CART model may accurately predict DISE anatomy and possible candidacy for hypoglossal nerve stimulation.


Balancing acting and adapting: a qualitative study of medical students' experiences of early clinical placement.
Clinical learning experience is an important part of medical education. In the clinical learning environment, students are exposed to various aspects of medical care and may train their skills under supervision. Supervision, in which students' learning needs and the outcomes of placements are met, is essential. The aim of this study was to explore medical students' experiences of the early stages of clinical training. In 2021, 18 individual semi-structured interviews were conducted with medical students after their first clinical placements in semester 5. The interviews were transcribed verbatim and analyzed using qualitative content analysis according to Graneim and Lundman. The findings resulted in an overall theme: balancing acting and adapting. Three categories described that the clinical learning environment was a big leap from campus, that personal relationships influenced learning, and that the organization of clinical placements was suboptimal. The students were encouraged to push themselves forward to practice clinical skills. This, however, did not suit all the students; the cautious ones risked becoming passive spectators. The intended learning outcomes were not frequently used; rather, the supervisors asked the students what they had learned, or the students focused on what seemed to be important on the ward. The students tried to adapt to their supervisors' working situation and not to be a burden to them. Our findings show that the transition from learning on campus was sometimes abrupt, as the students had to switch to a more active learning role. Ad hoc solutions in supervision occurred, which contributed to the experience that educational responsibilities were downgraded and the opportunities for clinical training varied. Rather than trying to change the circumstances, the students opted to adapt to the busy clinical learning environment.


A feedback mechanism controls rDNA copy number evolution in yeast independently of natural selection.
Ribosomal DNA (rDNA) is the genetic loci that encodes rRNA in eukaryotes. It is typically arranged as tandem repeats that vary in copy number within the same species. We have recently shown that rDNA repeats copy number in the yeast Saccharomyces cerevisiae is controlled by cell volume via a feedback circuit that senses cell volume by means of the concentration of the free upstream activator factor (UAF). The UAF strongly binds the rDNA gene promoter, but is also able to repress SIR2 deacetylase gene transcription that, in turn, represses rDNA amplification. In this way, the cells with a smaller DNA copy number than what is optimal evolve to increase that copy number until they reach a number that sequestrates free UAF and provokes SIR2 derepression that, in turn, blocks rDNA amplification. Here we propose a mathematical model to show that this evolutionary process can amplify rDNA repeats independently of the selective advantage of yeast cells having bigger or smaller rDNA copy numbers. We test several variants of this process and show that it can explain the observed experimental results independently of natural selection. These results predict that an autoregulated feedback circuit may, in some instances, drive to non Darwinian deterministic evolution for a limited time period.


Sociodemographic, lifestyle, and medical risk factors for visual impairment in an urban asian population: the singapore malay eye study.
To describe the associations between sociodemographic, lifestyle, and medical risk factors and visual impairment in a Southeast Asian population. Population-based cross-sectional study of 3280 (78.7% response rate) Malay Singaporeans aged 40 to 80 years. Participants underwent a standardized interview, in which detailed sociodemographic histories were obtained, and clinical assessments for presenting and best-corrected visual acuity. Visual impairment (logMAR > 0.30) was classified as unilateral (1 eye impaired) or bilateral (both eyes impaired). Analyses used multivariate-adjusted multinomial logistic regression. Older age and lack of formal education was associated with increased odds of both unilateral and bilateral visual impairment based on presenting and best-corrected visual acuity. The odds doubled for each decade older, and lower education increased the odds 1.59- to 2.83-fold. Bilateral visual impairment was associated with being unemployed (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.30-2.60), widowed status (OR, 1.51; 95% CI, 1.13-2.01), and higher systolic blood pressure (OR, 1.96; 95% CI, 1.44-2.66). Diabetes was associated with unilateral (OR, 1.47; 95% CI, 1.10-1.95) and bilateral (OR, 1.69; 95% CI, 1.23-2.32) visual impairment using best-corrected visual acuity. Older age, lower education, unemployment, being widowed, diabetes, and hypertension were independently associated with bilateral visual impairment. Public health interventions should be targeted to these at-risk populations.


Impulse oscillometry and respiratory symptoms in World Trade Center responders, 6 years post-9/11.
This study evaluated whether impulse oscillometry (IOS) testing revealed signs of respiratory disease in New York State (NYS) World Trade Center (WTC) responders in comparison with unexposed NYS employees. It also compared self-reported respiratory symptoms between the two groups, 6 years post-9/11. For this evaluation participants completed a self-administered questionnaire regarding respiratory symptoms. IOS testing included measures of resistance and reactance to assess for peripheral versus central airway effects. Two hundred forty-eight subjects (99 exposed and 149 unexposed) were included in the final analysis. Since September 11, 2001, NYS responders were more likely to report new or worsening cough in the absence of a respiratory infection, cough consistent with chronic bronchitis, current respiratory symptoms, or lower respiratory symptoms in the last 12 months. Significant associations were found between IOS indices and gender, smoking history, and obesity. When comparing exposed and unexposed participants, there were no significant differences in the geometric means of the IOS indices. Responders who used a respirator with canister demonstrated significantly lower respiratory resistance at 5 and 20 Hz (R5 and R20). While this study has provided no evidence of an association between WTC exposure and peripheral airways disease in this cohort of responders, results do suggest that use of a respirator with canister may be protective for central airways in responders exposed to dust and smoke. This emphasizes the importance of stressing proper respirator use in planning responses to future disasters. Our control data also provide useful reference values for future IOS research.


Label-free hyperspectral imaging and quantification methods for surgical margin assessment of tissue specimens of cancer patients.
Hyperspectral imaging (HSI) is a relatively new modality in medicine and can have many potential applications. In this study, we developed label-free hyperspectral imaging for tumor margin assessment. HSI data, hypercube (x,y,λ), consists of a series of images of the same field of view that are acquired at different wavelengths. Every pixel in the hypercube has an optical spectrum. We collected surgical tissue specimens from 16 human subjects who underwent head and neck (H&N) cancer surgery. We acquired both HSI, autofluorescence images, and fluorescence images with 2-NBDG and proflavine from the specimens. Digitized histologic slides were examined by an H&N pathologist. We developed image preprocessing and classification methods for HSI data and differentiate cancer from benign tissue. The hyperspectral imaging and classification method was able to distinguish between cancer and normal tissue from oral cavity with an average accuracy of 90±8%, sensitivity of 89±9%, and specificity of 91±6%. This study suggests that label-free hyperspectral imaging has great potential for surgical margin assessment in tissue specimens of H&N cancer patients. Further development of the imaging technology and quantification methods is warranted for its application in image-guided surgery.


Effects of Nitrogen Supplementation Status on CO2 Biofixation and Biofuel Production of the Promising Microalga Chlorella sp. ABC-001.
The use of microalgal biomass as feedstock for biofuels has been discussed for decades as it provides a sustainable approach to producing fuels for the future. Nonetheless, its feasibility has not been established yet and various aspects of biomass applications such as CO2 biofixation should also be explored. Therefore, in this study, the CO2 biofixation and lipid/carbohydrate production potential of Chlorella sp. ABC-001 were examined under various nitrogen concentrations. The highest biomass productivity and CO2 biofixation rate of 0.422 g/l/d and 0.683 g/l/d, respectively, were achieved under a nitrogen-rich condition (15 mM nitrate). Carbohydrate content was generally proportional to initial nitrate concentration and showed the highest value of 41.5% with 15 mM. However, lipid content showed an inverse relationship with nitrogen supplementation and showed the highest value of 47.4% with 2.5 mM. In consideration as feedstock for biofuels (bioethanol, biodiesel, and biogas), the sum of carbohydrate and lipid contents were examined and the highest value of 79.6% was achieved under low nitrogen condition (2.5 mM). For lipid-based biofuel production, low nitrogen supplementation should be pursued. However, considering the lower feasibility of biodiesel, pursuing CO2 biofixation and the production of carbohydrate-based fuels under nitrogenrich condition might be more rational. Thus, nitrogen status as a cultivation strategy must be optimized according to the objective, and this was confirmed with the promising alga Chlorella sp. ABC-001.


Optimising outputs from a validated online instrument to measure health-related quality of life (HRQL) in dogs.
Measurement of health-related quality of life (HRQL) is becoming increasingly valuable within veterinary preventative health care and chronic disease management, as well as in outcomes research. Initial reliability and validation of a 22 item shortened version of VetMetrica (VM), structured questionnaire instrument to measure HRQL in dogs via a mobile application was reported previously. Meaningful interpretation and presentation of the 4 domain scores comprising the HRQL profile generated by VM is key to its successful use in clinical practice and research. Study one describes transformation of domain scores from 0-6 to 0-100 and normalisation of these based on the healthy canine population in two age ranges, such that a score of 50 on a 0-100 scale represents the score for the age-related average healthy dog, and establishment of a threshold to assess domain-specific health status for individual dogs. This provides the clinician with a simple method of ascertaining the health status of an individual dog relative to the average healthy population in the same age group (norm-based scoring). Study two determines the minimum important difference (MID) in domain scores which represents the smallest improvement in score that is meaningful to the dog owner, thus providing the clinician with a means of recognising what is likely to be a significant improvement in scores for an individual dog over time. Visual representation of these guidelines for the purpose of interpreting VM profile scores is presented using case studies.


Accumulation and Effect of Silver Nanoparticles Functionalized with Spirulina platensis on Rats.
The effect of unmodified and functionalized Spirulina platensis biomass silver nanoparticles on rats during prolonged oral administration was assessed. Silver nanoparticles were characterized by using transmission electron microscopy, while their uptake by the biomass was confirmed using scanning electron microscopy and energy dispersive analysis. The content of silver in the different organs of rats after a period of administration (28 days) or after an additional clearance period (28 days) was ascertained by using neutron activation analysis. In animals administrated with the unmodified nanoparticles, the highest content of silver was determined in the brain and kidneys, while in animals administrated with AgNP-Spirulina, silver was mainly accumulated in the brain and testicles. After the clearance period, silver was excreted rapidly from the spleen and kidneys; however, the excretion from the brain was very low, regardless of the type of nanoparticles. Hematological and biochemical tests were performed in order to reveal the effect of nanoparticles on rats. The difference in the content of eosinophils in the experimental and control groups was statistically significant. The hematological indices of the rats did not change significantly under the action of the silver nanoparticles except for the content of reticulocytes and eosinophils, which increased significantly. Changes in the biochemical parameters did not exceed the limits of normal values. Silver nanoparticles with the sizes of 8-20 nm can penetrate the blood-brain barrier, and their persistence after a period of clearance indicated the irreversibility of this process.


Lipopolysaccharide pretreatment of the udder protects against experimental Escherichia coli mastitis.
Exposure to pathogen-associated molecular patterns such as LPS can cause an immune refractory state in mammals known as endotoxin tolerance (ET), resulting in a decreased inflammatory response after pathogen contact. This ET concept was used to reduce the severity of an experimentally-induced clinical mastitis. Cows were pretreated with 1 µg LPS per udder quarter and challenged 72 h (group L72EC) or 240 h (group L240EC) later with 500 CFU Escherichia coli. Pretreated animals showed no leukopenia after challenge, no (L72EC), or only slightly (L240EC), elevated body temperature and significantly reduced systemic and local clinical scores compared with cows that were not pretreated. Whereas an increase of milk somatic cell count after the E. coli challenge was abrogated in L72EC animals, it was significantly delayed in the L240EC group. In both pretreated groups the bacterial load in milk was markedly reduced. Based on the expression of inflammation-related genes in lobulo-alveolar mammary tissue, the tolerizing effect of LPS pretreatment is based on the inhibited up-regulation of inflammatory (TNF-α, IL-6, CXCL8, CCL20) and anti-inflammatory genes (IL-10, IRAK-M). These findings indicate that the concept of ET may be usefully applied as mastitis prophylaxis facilitating a rapid response to microbial infection and avoiding dysregulated inflammation.


Comfort at the end of life: palliative care policy.
Despite the lack of evidence for improvement in symptom relief, quality of life, or length of survival, patients who are terminally ill often are subjected to unnecessary invasive procedures and denied the symptom relief that modern technology and pharmacology make possible. Nursing administrators are in an ideal position to initiate interdisciplinary policy changes in this area and are encouraged to become familiar with the principles of palliative care. A recently developed policy is described and a review of supportive literature is given.


Legal versus illegal U.S. immigration and source country characteristics.
"Based on micro data from the Immigration and Naturalization Service (INS) on legal immigrants as well as on legalization applications that followed the passage of IRCA [the Immigration Reform and Control Act of 1986], this study exploits the variation in legal and illegal immigration flows across seventy source countries to examine the sensitivity of immigration flows to underlying source country characteristics. The study finds that earnings in the source country and the distance from the United States form significant deterrents of both legal and illegal immigration flows. We also find that illegal immigration is more sensitive to such factors than is legal immigration." The impact of the North American Free Trade Agreement on U.S. immigration from Mexico is also assessed.


A pilot study of psychiatry resident psychotherapy competency: the impact of resident attitude and demographics.
In psychiatry education, psychotherapy knowledge, skills, and attitudes are new competency objectives. Two faculty members independently ranked psychiatry residents for psychotherapy competency. A rank of 1 indicated the most competency and a rank of 15 indicated the least competency for the resident psychotherapist. Several demographic and attitudinal variables of the residents were examined for relationships with psychotherapy competence. When the competency rankings of the two faculty members were compared, they demonstrated a high level of agreement (spearman r = 0.74, p = 0.0016). Of the variables studied, resident age (r = .61, p = .015) and personal attitude toward psychotherapy (S=29, p = .026) were significantly associated with psychotherapy competency. Both variables remained independently significant after statistical adjustment. Our study indicates that psychiatry resident attitude and age may influence psychotherapy competency. These markers for psychotherapy competency may assist training programs with resident selection parameters and may enhance psychotherapy educational strategies for residents predicted to require assistance in achieving competency.


[An experimental study on the therapeutic effects of eustachian tube surfactant in barotitis media].
To observe the effect of surfactant on eustachian tube (ET) on the opening of ET as well as it's therapeutic role in barotitis media (BM). 50 guinea pigs were successfully established as BM models by stimulated ascending in altitude chamber. Parts of the models were treated with by middle ear flushing with nature ETS, artificial ETS, artificial phospholipid and saline, after which the eustachian tube pressure opening level (POL) of each group was tested. Others were injected with 1 ml artificial ETS in on side of the middle ear, and 1 ml of saline in the other served as control. Natural ETS decreased the POL from 11.98 to 6.11 kPa (P < 0.01); Artificial ETS reduced the POL from 11.91 to 6.67 kPa (P < 0.01), there were no significant differences between the two groups. Artificial phospholipid decreased the POL from 11.86 to 8.61 kPa (P < 0.05), which was not as effective as natural ETS. While the POL of saline group remained unchanged. After one week of artificial ETS treatment, the congestion in drum membrane alleviated, the hearing threshold of ETS group improved and the effusion in tympanic cavity lessened. The results suggest that artificial ETS is as effective as nature ETS to facilitates the opening of eustachian tube. Artificial ETS may exert therapeutic effects on BM.


Heart Rate Information-Based Machine Learning Prediction of Emotions Among Pregnant Women.
In this study, the extent to which different emotions of pregnant women can be predicted based on heart rate-relevant information as indicators of autonomic nervous system functioning was explored using various machine learning algorithms. Nine heart rate-relevant autonomic system indicators, including the coefficient of variation R-R interval (CVRR), standard deviation of all NN intervals (SDNN), and square root of the mean squared differences of successive NN intervals (RMSSD), were measured using a heart rate monitor (MyBeat) and four different emotions including "happy," as a positive emotion and "anxiety," "sad," "frustrated," as negative emotions were self-recorded on a smartphone application, during 1 week starting from 23rd to 32nd weeks of pregnancy from 85 pregnant women. The k-nearest neighbor (k-NN), support vector machine (SVM), logistic regression (LR), random forest (RF), naïve bayes (NB), decision tree (DT), gradient boosting trees (GBT), stochastic gradient descent (SGD), extreme gradient boosting (XGBoost), and artificial neural network (ANN) machine learning methods were applied to predict the four different emotions based on the heart rate-relevant information. To predict four different emotions, RF also showed a modest area under the receiver operating characteristic curve (AUC-ROC) of 0.70. CVRR, RMSSD, SDNN, high frequency (HF), and low frequency (LF) mostly contributed to the predictions. GBT displayed the second highest AUC (0.69). Comprehensive analyses revealed the benefits of the prediction accuracy of the RF and GBT methods and were beneficial to establish models to predict emotions based on autonomic nervous system indicators. The results implicated SDNN, RMSSD, CVRR, LF, and HF as important parameters for the predictions.


Outcomes of Liver Resection in the Elderly: Is it safe?
There has been an increase in the incidence of neoplasms of the liver in recent years, although there is still a fear of performing aggressive surgical procedures in elderly patients, especially regarding hepatic surgery. The objective of this study was to analyse the influence of age on the morbidity and mortality of patients undergoing hepatic resection. This was a study of 414 patients who underwent 447 hepatic resections between November 1993 and December 2010. The patients were divided into two groups according to whether they were ≤ 65 or > 65 years of age. The elderly group included 113 resections, while the young group was composed of 334 procedures. The elderly group had more malignant lesions and more comorbidities. With regard to the transoperative and post-operative data, the two groups displayed similar results. According to the multivariate analysis, cirrhosis and the use of transoperative pedicular clamping were independent predictors of morbidity. Cirrhosis was also an independent predictor of mortality. The results indicate that age is not a predisposing factor for the worsening of results of hepatic resection in selected patients, especially with regard to cirrhosis. Moreover, surgeons must avoid the use of transoperative pedicular clamping.


Grasping with the eyes of your hands: hapsis and vision modulate hand preference.
Right-hand preference has been demonstrated for visually guided reaching and grasping. Grasping, however, requires the integration of both visual and haptic cues. To what extent does vision influence hand preference for grasping? Is there a hand preference for haptically guided grasping? Two experiments were designed to address these questions. In Experiment 1, individuals were tested in a reaching-to-grasp task with vision (sighted condition) and with hapsis (blindfolded condition). Participants were asked to put together 3D models using building blocks scattered on a tabletop. The models were simple, composed of ten blocks of three different shapes. Starting condition (Vision-First or Hapsis-First) was counterbalanced among participants. Right-hand preference was greater in visually guided grasping but only in the Vision-First group. Participants who initially built the models while blindfolded (Hapsis-First group) used their right hand significantly less for the visually guided portion of the task. To investigate whether grasping using hapsis modifies subsequent hand preference, participants received an additional haptic experience in a follow-up experiment. While blindfolded, participants manipulated the blocks in a container for 5 min prior to the task. This additional experience did not affect right-hand use on visually guided grasping but had a robust effect on haptically guided grasping. Together, the results demonstrate first that hand preference for grasping is influenced by both vision and hapsis, and second, they highlight how flexible this preference could be when modulated by hapsis.


Improving palliation in pancreatic cancer: intraoperative celiac plexus block for pain relief.
Most patients with pancreatic carcinoma are not curable. Surgical palliation of obstructive jaundice and gastric outlet obstruction leaves many patients with severe pain from pancreatic carcinoma. Anesthesiologists have drawn increasing attention to the successful use of postoperative percutaneous celiac plexus block for the treatment of pancreatic pain. Ironically, little attention has been paid to celiac plexus block during laparotomy. We reviewed the cases of 12 patients with pancreatic carcinoma and severe abdominal pain who were treated surgically. All patients had operative celiac plexus block with absolute alcohol at the time of exploratory laparotomy for biliary bypass, gastroenterostomy, or tumor biopsy. Complete postoperative pain relief was obtained in 10 of the 12 patients; two had only partial relief. No operative complications were related to celiac plexus block; one patient died postoperatively of pneumonia. Average postoperative hospital stay was 13 days and average postoperative survival was 3 1/2 months. Most patients had excellent pain relief for at least 2 months or until death. Because most patients treated surgically for pancreatic carcinoma are receiving only palliation with biliary bypass or gastroenterostomy, surgeons should pay increased attention to pain relief. Operative celiac plexus block is easy, safe, and highly effective in relieving the agonizing pain of pancreatic carcinoma.


Childhood rituals and executive functions.
Repetitive and ritualistic behaviours (RRBs) are a feature of both typical and atypical development. While the cognitive correlates of these behaviours have been investigated in some neurodevelopmental conditions these links remain largely unexplored in typical development. The current study examined the relationship between RRBs and executive functions (EF) in a sample of typically developing children aged between 37 and 107 months. Results showed that cognitive flexibility, and not response inhibition or generativity, was most strongly associated with the frequency of RRBs in this sample. In younger children (<67.5 months) cognitive flexibility was significantly associated with 'Repetitive Behaviours' but in older children (>67.5 months) cognitive flexibility was associated with both 'Just Right' and 'Repetitive Behaviour', suggesting that the association between EF and RRBs may become stronger with age in typically developing children.


Optimal nutrition should improve the outcome and costs of radical cystectomy.
Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enteral nutrition (6.5%), but a larger proportion (29%) felt enteral nutrition was the 'optimal' feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enteral nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enteral nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.


Feasibility of community health workers using a clinical decision support system to screen and monitor non-communicable diseases in resource-poor settings: study protocol.
It is imperative that coordinated and systematic action is undertaken, at all levels, to minimize the consequences of the growing global burden of non-communicable diseases (NCDs). An integrated multi-disciplinary primary care-based preventive program has the potential to reduce lifestyle-related risk factors contributing to NCDs. Accredited Social Health Activists (ASHAs), who are community health workers (CHWs), may be employed to screen populations for NCDs in rural India. To enable ASHAs to be supported when they are on their own in the community, we have developed a clinical decision support system (CDSS) "Arogya Sahyog" (a Hindi term meaning 'health assistant') to guide them through the process. Herein, we describe the protocol for testing this CDSS and the associated community-based management program for people with NCDs. This mixed-method study involving both qualitative and quantitative approaches will be conducted in two phases to test: (I) feasibility of the CDSS itself, and (II) feasibility of utilizing the app to develop capacity within the ASHA workforce. First, we will use a semi-structured questionnaire to determine details about the acceptance of using the app, satisfaction with the CDSS, perceived barriers, ideas for improvement, and willingness to use the CDSS. We will also test the usability of this CDSS for the identification of people with hypertension, with or without co-morbidities, by ASHAs and their supervisors. The CDSS will be installed on a tablet and is designed to help ASHAs to screen, provide lifestyle advice, and refer critical patients to primary care physicians. Second, to develop capacity within the ASHA workforce, ASHAs will be taught about NCDs, so they can motivate people to adhere to healthy activities and self-manage their NCDs. We will also test whether this training program improves ASHAs' knowledge about NCDs. We will further evaluate ASHAs' capacity to provide health promotional interventions to patients with, or at risk of, NCDs using the tablet device. The study will enable us to test a CDSS and an educational training program. Specifically, we will test whether the program is user-friendly, easy-to-comprehend, easy-to-deliver, workflow-oriented, and comprehensive. We will determine whether mobilizing this ASHA workforce with the support of a CDSS could result in better management of hypertension and co-morbidities than usual care.