[Three cases of organophosphate poisoning treated with pralidoxime iodide and whole-bowel irrigation].
We encountered three cases of organophosphate poisoning treated with pralidoxime iodide (PAM) and whole-bowel irrigation without atropine sulfate. All patients recovered without persistence or recurrence of toxic symptoms and without any somatic after effects. In case 1, a 48-year-old woman ingested approximately 5 g of ethylthiometon in a suicide attempt. She was transferred to the hospital because of cardiopulmonary arrest. After resuscitation, she was transferred to our center. She was placed on a ventilator and received i.v. PAM and polyethylene glycol-electrolyte through a nasojejunal tube for whole-bowel irrigation. Six days later, serum ChE was improved. In case 2, a 51-year-old man ingested approximately 30 g of malathion in a suicide attempt and was transferred to our center because of dyspnea. He was treated with PAM and whole-bowel irrigation, but did not require a respirator. Serum ChE already showed improvement the following day. In case 3, a 31-year-old man ingested approximately 50 g of DEP in a suicide attempt and was transferred to our center because of unconsciousness. He was treated with a respirator, PAM and whole-bowel irrigation. Serum ChE improved within two days. These cases suggest the possibility that preferential whole-bowel irrigation without atropine sulfate prevents the persistence or recurrence of the toxic effects of organophosphate.


Molecular detection of opportunistic pathogens and insights into microbial diversity in private well water and premise plumbing.
Private well water systems in rural areas that are improperly maintained will result in poor drinking water quality, loss of water supply, and pose human health risk. The purpose of this study was to investigate the occurrence of fecal indicator bacteria (FIB) and opportunistic pathogens in private well water in rural areas surrounding New Orleans, Louisiana. Our results confirmed the ubiquitous nature of Legionella (86.7%) and mycobacteria (68.1%) in private well water in the study area, with gene concentration ranged from 0.60 to 5.53 and 0.67 to 5.95 Log10 of GC/100 mL, respectively. Naegleria fowleri target sequence was detected in 16.8% and Escherichia coli was detected in 43.4% of the water samples. Total coliform, as well as Legionella and mycobacteria genetic markers' concentrations were significantly reduced by 3-minute flushing. Next-generation sequencing (NGS) data indicated that the abundance of bacterial species was significantly increased in water collected in kitchens compared with samples from wells directly. This study provided integrated knowledge on the persistence of pathogenic organisms in private well water. Further study is needed to explore the presence of clinical species of those opportunistic pathogens in private well water systems to elucidate the health risk.


[The diagnosis of prostatic carcinoma].
Thanks to the combination of high-resolution transrectal ultrasound and the "Biopty-Gun", it has now become possible for the first time to obtain multiple punch biopsies of the prostate, painlessly and with few complications. "Mapping" of the prostate by 6 randomized punch biopsies permits an evaluation of the sensitivity and specificity of such screening procedures as digital rectal examination (DRE), prostate-specific antigen (PSA) and transrectal ultrasound (TRUS). In addition, randomized biopsies provide reliable information about prostatic carcinomas with a significant volume. The indications and efficacy of the various diagnostic methods are discussed in detail.


Periodontal pathogens stimulate CC-chemokine production by mononuclear and bone-derived cells.
Chemokines are chemotactic cytokines that stimulate recruitment of leukocytes. Monocyte chemoattractant protein-1, macrophage inflammatory protein-1alpha, and RANTES (regulated on activation, normal T cell expressed, and secreted) are 3 well-characterized CC-chemokines that regulate mononuclear cell recruitment. The recruitment of inflammatory cells is of particular importance in the oral cavity because of the likelihood that cells will be challenged with bacteria either during acute infection or following surgical procedures. Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans are putative periodontal pathogens that may be harbored in subgingival and supragingival plaque. The capacity of the host to respond to these bacteria by the elaboration of chemoattractants may represent an important defense mechanism. In the present study, we examined CC-chemokine production by human mononuclear cells and bone-derived cells in response to P. gingivalis, A. actinomycetemcomitans and lipopolysaccharides (LPS) stimulation in vitro. The chemokines produced were measured by ELISA. The results demonstrate that P. gingivalis and A. actinomycetemcomitans induce high levels of MIP-1alpha in mononuclear cells. P. gingivalis and A. actinomycetemcomitans stimulated high levels of MCP-1 in bone-derived cells and induced moderate levels of RANTES production in both mononuclear and osteoblastic cells. In mononuclear cells, LPS induced high levels of MIP-1alpha and RANTES and moderate levels of MCP-1; in osteoblasts LPS only induced MCP-1. The capacity of bacteria to induce a given chemokine depends upon the cell type stimulated. That different cell types would exhibit differences in the CC-chemokines produced under the same stimulus provides a mechanism to explain tissue-specific recruitment of leukocytes.


Insulin, glucagon and somatostatin content of the non-obese diabetic (NOD) mouse pancreas and plasma virus antibodies to Coxsackie B- and reoviruses.
The amounts of insulin, glucagon and somatostatin in the pancreas of NOD mice were determined and the results were compared with those of normal ICR-strain mice, and plasma antibodies to Coxsackie B-3 and reovirus types 1, 2 and 3 were measured. In the pancreas of NOD mice with fasting plasma glucose (FPG) less than 140 mg/100 ml, the insulin content of the male mice was similar to that of the normal controls, ranging to 3.55 +/- 0.31 U/g wet weight of pancreas, but it was already significantly decreased to 0.85 +/- 0.52 U/g in the female mice. In the NOD mice with FPG more than 201 mg/100 ml, it was 0.002 +/- 0.001 U/g. The glucagon content of the pancreas was 7.76 +/- 0.89 micrograms/g in the normal controls and it was decreased slightly in the NOD mice, but the values among the NOD mice were not significantly different. Pancreas somatostatin showed a tendency to be higher in the NOD mice with FPG more than 201 mg/100 ml. Histologically cell infiltration into the pancreatic islets was conspicuous in the hyperglycemic NOD mice, but it was found even in the normoglycemic NOD. Plasma antibodies to Coxsackie B-3 Virus and reovirus types 1, 2 and 3 were not detected at any stage of FPG.


Non-Heart-Beating Donor Heart Transplantation: Breaking the Taboo.
Roughly 60% of hearts offered for transplantation are rejected because of organ dysfunction. Moreover, hearts from circulatory-dead patients have long been thought to be non-amenable for transplantation, unlike other organs. However, tentative surgical attempts inspired by the knowledge obtained from preclinical research to recover those hearts have been performed, finally culminating in clinically successful transplants. In this review we sought to address the major concerns in non-heart-beating donor heart transplantation and highlight recently introduced developments to overcome them.


[Bacterial contamination of anesthesiologists' hands and the efficacy of handwashing].
The purpose of this study was to examine bacterial contamination, especially by transient skin flora, that were on the hands of trainee and diplomate anesthesiologists during general anesthesia as well as to evaluate the efficacy of washing hands with running water or with three alcohol based antiseptic solutions using a modified glove juice method. The bacterial counts on the anesthesiologists' hands were 3.21 +/- 0.66 [log10 (mean +/- SD)] during induction, 255 +/- 1.15 during maintenance of anesthesia, 2.67 +/- 1.10 during extubation and 3.57 +/- 0.74 at the end of anesthesia. The diplomates' hands were more contaminated than those of the trainees during both intubation and extubation. Washing hands with running water or antiseptic solutions was effective to reduce bacterial contamination, but there was no disinfectant effect of antiseptic solutions against the bacteria that adhered to the hands after drying those solutions. Therefore to prevent nosocomial infection, anesthesiologists should wash their hands with running water or the antiseptic solution after each contact.


Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009-2019.
The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4, T-lymphocytes, and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2-7.8, P=0.03), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1-8.1, P=0.001), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P=0.001) (AHR = 2.5; 95% CI, 1.4-4.7, P=0.021) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.


Experimental study of the dimensionality of black-eye patterns.
The spatial structure of one type of Turing pattern named "black eyes" is studied in experiments using the chlorite-iodide-malonic acid reaction in spatial open reactor. The purpose of the work is to verify (or falsify) two possible theoretical interpretations of black-eye pattern formation: the projection of a body-centered-cubic (bcc) structure onto the plane vertical to the body diagonal and the spatial resonance of larger wave vectors with the fundamental ones. The latter happens when the mode of the larger wave vectors becomes linearly unstable, as the system goes far beyond the onset of Turing bifurcation. Our experimental results give evidence that black-eye patterns are not a projection of the bcc structure, so that the interpretation of a three-dimensional structure can be ruled out. The observations in the experiment also suggest another possible mechanism for the formation of black eyes.


[Relationship between iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid washout ratio and oxygen consumption in normal and ischemic myocardium].
The relationship between oxygen consumption and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) washout at rest and after exercise was investigated in normal and ischemic myocardium. Sixteen healthy volunteers and 14 patients with ischemic heart disease were examined. After injection of 111MBq of 123I-BMIPP, serial single photon emission computed tomography imaging was performed to evaluate washout ratio after 30 min and 1 hour of rest and after exercise. In the volunteers, the mean washout ratio was 3.3 +/- 3.5% after 1 hour of rest and increased during exercise. The exercise washout ratio showed a better correlation with net pressure rate product (net PRP: cumulative values of PRP during exercise) than with the peak PRP. The exercise washout ratio showed a strong correlation with the net PRP in the range from 180 to 300 x 10(3) mmHg. beat/min and a plateau of 10-15%. In the nine ischemic patients with net PRP > or = 300 x 10(3) mmHg.beat/min, the exercise washout ratio values were significantly elevated in normal segments relative to ischemic segments (10.1 +/- 1.9% vs 4.7 +/- 2.9%, p < 0.001). In the five ischemic patients with net PRP < 300 x 10(3) mmHg.beat/min, washout ratio at rest and after exercise did not differ significantly between normal and ischemic segments. 123I-BMIPP washout ratio increased with increased oxygen consumption during exercise in normal myocardium but not in ischemic myocardium. The patient must exercise before fatty acid metabolism can be compared between normal and ischemic myocardium.


Micro-RNA-375 inhibits lung surfactant secretion by altering cytoskeleton reorganization.
Lung surfactant is secreted via exocytosis of lamellar bodies from alveolar epithelial type II cells. Whether micro-RNAs regulate lung surfactant secretion is unknown. Micro-RNA-375 (miR-375) has been shown to be involved in insulin secretion. In this article, we report that the overexpression of miR-375 inhibited lung surfactant secretion. However, miR-125a, miR-30a, miR-1, miR-382 and miR-101 did not influence lung surfactant secretion. miR-375 had no effects on surfactant synthesis or the formation of lamellar bodies. However, miR-375 did abolish the lung surfactant secretagogue-induced disassembly and reassembly of cytoskeleton. Our results suggest that miR-375 regulates surfactant secretion via the reorganization of cytoskeleton.


Assignment-free solution NMR method reveals CesT as an unswapped homodimer.
The X-ray structure of the homodimeric chaperone CesT is the only structure among the type three secretion system (TTSS) chaperones that shows a domain swap. This swap has potential importance for the mechanism of effector translocation through a TTSS. Here we present two nuclear magnetic resonance strategies exploiting pre-existing structural models and residual dipolar couplings (RDCs), which reveal the unswapped 35.4-kDa dimer to be present in solution. Particularly efficient is the discrimination of a swapped and unswapped structural state performed simultaneously to automatic backbone assignment using only HN-RDCs and carbonyl backbone chemical shifts. This direct approach may prove to be generally useful to rapidly differentiate two structural models.


The effects of noise-induced hair cell lesions on cochlear electromechanical responses: A computational approach using a biophysical model.
A biophysically inspired signal processing model of the human cochlea is deployed to simulate the effects of specific noise-induced inner hair cell (IHC) and outer hair cell (OHC) lesions on hearing thresholds, cochlear compression, and the spectral and temporal features of the auditory nerve (AN) coding. The model predictions were evaluated by comparison with corresponding data from animal studies as well as human clinical observations. The hearing thresholds were simulated for specific OHC and IHC damages and the cochlear nonlinearity was assessed at 0.5 and 4 kHz. The tuning curves were estimated at 1 kHz and the contributions of the OHC and IHC pathologies to the tuning curve were distinguished by the model. Furthermore, the phase locking of AN spikes were simulated in quiet and in presence of noise. The model predicts that the phase locking drastically deteriorates in noise indicating the disturbing effect of background noise on the temporal coding in case of hearing impairment. Moreover, the paper presents an example wherein the model is inversely configured for diagnostic purposes using a machine learning optimization technique (Nelder-Mead method). Accordingly, the model finds a specific pattern of OHC lesions that gives the audiometric hearing loss measured in a group of noise-induced hearing impaired humans.


A new classification for female infertility.
Infertility is defined as the inability of a couple to conceive after 12 months of regular, unprotected intercourse. However infertility is a clinical presentation and not a disease. Thus to be able to offer a new classification, it is necessary to apply a clinical presentation (philosophy) suggested by the University of Calgary in 1991. In recent years several classification algorithms have been proposed which apply key predictors of clinical, imaging, or morphological types to determine the diseases that can cause infertility. On the other hand, an algorithm is a product of an expert's mind after many years of practice and experience, which is too difficult to understand by a medical student. However there has not been any simple schematic classification based on a logical justification applying integration of etiologies with basic science to break down etiologies into categories, subcategories and disease classes of this clinical presentation. Because etiology has also become an important criterion for the characterization of causes of infertility, a classification proposal is presented here that attempts to include all relevant (basic science) features of the causative diseases of this clinical presentation.


The association between psychological distress, alcohol use and physical non-communicable diseases in a nationally representative sample of South Africans.
This study examines the associations between symptoms of mental disorders and diabetes and hypertension in a nationally representative sample of South Africans. We examined unadjusted and adjusted associations of socio-demographic characteristics, alcohol use and psychological distress with diabetes and hypertension. Multivariate logistic regression revealed that hypertension is significantly associated with age, while diabetes is significantly associated with age, population group and psychological distress. The association between psychological distress and diabetes found here suggests the usefulness of additional research using more detailed measures of psychiatric disorders in local studies and reinforces clinical calls for attention to psychiatric screening in patients with diabetes.


Factor V Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with coronary disease.
Oral contraceptive use in women with factor V Leiden is associated with increased rates of venous thromboembolic events (VTEs). However, the effects of hormone replacement therapy (HRT) in postmenopausal women with factor V Leiden are not known. A nested case-control study was conducted among women with established coronary disease enrolled in 2 randomized clinical trials of HRT, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Estrogen Replacement and Atherosclerosis (ERA) trial. The Leiden mutation was present in 8 (16.7%) of 48 cases with VTE compared with only 7 (6.3%) of 112 controls (odds ratio [OR](Leiden) 3.3, 95% CI 1.1 to 9.8; P=0.03). In women without the factor V Leiden mutation, risk associated with HRT use was significantly increased (OR(HRT) 3.7, 95% CI 1.4 to 9.4; P<0.01). On the other hand, in women with the factor V Leiden mutation, the estimated risk associated with HRT was increased nearly 6-fold, although the CIs were wide and included unity (OR(HRT) 5.7, 95% CI 0.6 to 53.9; P=0.13). The OR for women with the Leiden mutation who were also assigned to HRT compared with wild-type women assigned to placebo was 14.1 (95% CI 2.7 to 72.4, P=0.0015). In women with the factor V Leiden mutation who were treated with HRT, the estimated absolute incidence of VTE was 15.4 of 1000 per year compared with 2.0 of 1000 per year in women without the mutation who were taking a placebo (P=0.0015). On the basis of these data, in women with coronary disease, the estimated number needed to screen for factor V Leiden to avoid an HRT-associated VTE during 5 years of treatment is 376. If factor V Leiden genotyping becomes less expensive, it could be cost effective to screen for the presence of the mutation before instituting HRT in women with coronary disease.


[Thyrotropin receptor antibodies (TRAb) as a test of surgical treatment effectiveness in Graves-Basedow's diseases].
The aim of the study was to assess the relations between the concentration of antibodies against TSH receptors (TRAb) and the outcome of the surgical treatment in Graves-Basedow's disease. The studies were performed in 30 patients (age range--18-50, mean -37) operated on for Graves-Basedow's disease and in 20 healthy controls. In control group, the TRAb concentration was mean -2.75 +/- 2.06 U/l, the TSH mean -1.06 +/- 0.53 mlU/l, and FT4 mean -14.71 +/- 2.15 pmol/l. The thyroid volume was mean -14.45 +/- 2.37 ml. In the group operated on antibody concentration was determined before and 12 months after the surgery. The TSH and FT4 concentrations were also determined before and 12 months after the operation. Moreover, the size of the thyroid remnant was assessed ultrasonographically 12 months after the procedure. The results showed the effectiveness of the surgical treatment, i.e. hyperthyroidism was not observed in 22 out of 30 patients. Among these 22 patients, euthyreosis was found in 14 cases (46%) and hypothyreosis was observed in 8 cases (27%). In the euthyreosis group, the pre-operative TRAb concentration was mean -24.00 +/- 11.04 U/l. 12 months after the operation, the decreased levels of antibodies were found in 13 patients (mean -6.14 +/- 5.71 U/l). In the hypothyreosis group, the pre-operative TRAb concentration was mean -24.50 +/- 10.43 U/l. After the surgical procedure, TRAb levels were normal in all patients, the average values being 2.13 +/- 1.34 U/l. In 8 patients with recurrent hyperthyroidism (27%), TRAb concentration before the surgery was higher, mean -107.25 +/- 56.69 U/l. 12 months after subtotal strumectomy, the patients in this group still did not show normal TRAb levels (mean -54.25 +/- 51.61 U/l). Moreover, the relations between the size of the thyroid remnant and the TRAb level were evaluated. In the group with recurrent hyperthyroidism and high TRAb levels, the thyroid size (volume) left was mean -12.10 +/- 6.25 ml, in the euthyreosis group mean -5.54 +/- 2.23 ml, while in the hypothyreosis group it was mean -4.86 +/- 1.14 ml.


Sheep's coping style can be identified by unsupervised machine learning from unlabeled data.
The objective of this study was to define coping style of sheep by using unsupervised machine learning approaches. A total of 105 Norduz sheep (age 3-5 years) were subjected to a 5-minute arena test. Agglomerative Hierarchical Clustering (HCA) was performed on scores of selected principal components retained from Principal Components Analysis (PCA) on arena behaviors to identify sheep coping style. Initially, the variables retained for the PCA were determined with Bartlett's test for sphericity and Kaiser-Meyer-Olkin (KMO) measure of sample adequacy. Seven behavioral variables with KMO values greater than 0.5 were used for final PCA: the average distance to group sheep (DTG), the average distance to stimulus (DTS), the duration of locomotion (LOC), the total number of zone boundaries crossed during the test (CRS), the total number of times that tested sheep sniffed stimulus (NSS), latency to the first sniff the stimulus (LSS), and subjective scores (SCR) scored by an observer on a scale from 1 to 5 (1: extremely calm, 5: extremely restless). The first two components, which were the only ones with an eigenvalue greater than one, accounted for 70.32% of the total variation and were used for clustering analysis. Clustering tendency showed that the scores for the first two components were suitable for clustering (Hopkins' H = 0.852). Several cluster validity indexes were used to obtain aggregated results to determine the most appropriate clustering method and number of clusters. Five different clustering methods: k-means and hierarchical clustering with Ward, average, single and complete linkage were compared. Bootstrap resampling was used to evaluate the stability of a given cluster using the Jaccard coefficient. The clustering method and number of clusters corresponding to the highest rank aggregation score from the bootstrap resampling indicate that the hierarchical clustering method with average linkage and 5 clusters is the most suggested clustering method. However, Ward's algorithm identified the strongest clustering structure for hierarchical clustering, as it had the highest agglomerative coefficient value (0.98). When both Jaccard and aggregation scores are considered together, Ward's method with 3 clusters was selected as the most appropriate method. Sheep were classified into three coping styles (CS) based on HCA results as reactive (Cluster 1, n = 71), intermediate (Cluster 2, n = 22) or proactive (Cluster 3, n = 12). Coping style had significant effect on behavioral variables, DTG, DTS, LOC, CRS and NSS (P < 0.05). The individuals that have proactive coping style had the highest mean values for the variables DTG, DTS and LOC and SCR (P < 0.0001). This indicates that proactive sheep are more active then reactive sheep. The CRS, LOC and NSS mean values were higher for intermediate sheep compared to reactive sheep (P < 0.05). The NSS values were higher for intermediate sheep compare to proactive sheep (P < 0.0001). The findings of the current study show that distinct coping styles in sheep may be identified based on behaviors recorded in an arena test. The findings also revealed that sheep's coping style can be objectively identified by unsupervised machine learning from unlabeled behavioral data.


Birth weight and its relationship to size attained and relative fat distribution at 7 to 12 years of age.
The relationship between birth weight and relative subcutaneous fat distribution at school age was considered in 131 boys and 106 girls 7 to 12 years of age. Relative fat distribution at school age was estimated with the ratio of the subscapular to triceps skinfolds (S/T) for the total sample, and with the ratio of the sum of two trunk (subscapular, midaxillary) to the sum of two extremity (triceps, medial calf) skinfolds (T/E) for subsamples of 102 boys and 63 girls. There were no sex differences in the S/T ratio (mm/mm), boys 0.62 +/- 0.15, girls 0.63 +/- 0.18; T/E ratio (mm/mm), boys 0.58 +/- 0.13, girls 0.59 +/- 0.16; and BMI (kg/m2), boys 17.1 +/- 2.4, girls 16.9 +/- 2.2. Second order partial correlations, controlling for age and the BMI or age and sum of skinfolds, between birth weight and the skinfold ratios are, respectively, -0.22 and -0.20 (p < 0.01) for S/T and -0.29 and -0.32 (p < 0.01) for T/E in girls, and -0.18 and -0.17 (p < 0.05) for S/T and -0.06 and -0.6 for T/E in boys. Though low, the correlations suggest that as birth weight decreases proportionally more subcutaneous fat is accumulated on the trunk than on the extremities, more so in females than in males. Results of stepwise multiple regression analyses indicate that birth weight accounts for from 2% to 8% of the variance in relative subcutaneous fat distribution at school age.


Optical Waveguide Structures for CO(2) Lasers.
Thin-film waveguide structures consisting of epitaxially grown low-carrier-concentration GaAs and having two distinct index profiles have been investigated with a 10.6-microm C0(2) laser. Results of Schottky barrier and Hall measurements show that the carrier concentration of some of these films is less than 10(12) cm(-3), and the resistivity can be as high as 1.4 x 10(5) ?-cm. Guided-wave modes were excited by means of a germanium prism or phase grating coupler. When the index difference Deltan between the undoped film and the substrate is approximately 0.3 (strong guide), a number of modes can be obtained with a typical angular full width at half maximum intensity Delta(theta) (1/2) of <0.5 degrees . For guides having thickness greater than 20 microm, the measured losses are <1 dB/cm for N <10(13) cm(-3) and 1.7 dB/cm for N = 4 x 10(15) cm(-3). Simultaneous excitation of two orthogonal guided-wave modes, i.e., TE(m) and TM(m) for m </= 2, is possible in this structure. For Deltan approximately 10(-3) (weak guide) only one mode can be excited by means of a phase grating coupler with a typical Deltatheta((1/2)) of approximately degrees . Measurements were also made of the transmission and cutoff characteristics of the TE and TM modes in weak guides as a function of the guide thickness that varied between 20 micro and 50 micro Results indicate that optical transmission decreases rapidly as the thickness of the weak guide decreases toward the cutoff value.


CD31+ Extracellular Vesicles From Patients With Type 2 Diabetes Shuttle a miRNA Signature Associated With Cardiovascular Complications.
Innovative biomarkers are needed to improve the management of patients with type 2 diabetes mellitus (T2DM). Blood circulating miRNAs have been proposed as a potential tool to detect T2DM complications, but the lack of tissue specificity, among other reasons, has hampered their translation to clinical settings. Extracellular vesicle (EV)-shuttled miRNAs have been proposed as an alternative approach. Here, we adapted an immunomagnetic bead-based method to isolate plasma CD31+ EVs to harvest vesicles deriving from tissues relevant for T2DM complications. Surface marker characterization showed that CD31+ EVs were also positive for a range of markers typical of both platelets and activated endothelial cells. After characterization, we quantified 11 candidate miRNAs associated with vascular performance and shuttled by CD31+ EVs in a large (n = 218) cross-sectional cohort of patients categorized as having T2DM without complications, having T2DM with complications, and control subjects. We found that 10 of the tested miRNAs are affected by T2DM, while the signature composed by miR-146a, -320a, -422a, and -451a efficiently identified T2DM patients with complications. Furthermore, another CD31+ EV-shuttled miRNA signature, i.e., miR-155, -320a, -342-3p, -376, and -422a, detected T2DM patients with a previous major adverse cardiovascular event. Many of these miRNAs significantly correlate with clinical variables held to play a key role in the development of complications. In addition, we show that CD31+ EVs from patients with T2DM are able to promote the expression of selected inflammatory mRNAs, i.e., CCL2, IL-1α, and TNFα, when administered to endothelial cells in vitro. Overall, these data suggest that the miRNA cargo of plasma CD31+ EVs is largely affected by T2DM and related complications, encouraging further research to explore the diagnostic potential and the functional role of these alterations.


Oxidative stress induces tyrosine phosphorylation of PDGF alpha-and beta-receptors and pp60c-src in mesangial cells.
Reactive oxygen species are autocrine and paracrine modulators of cell behavior. Hydrogen peroxide, a cellular oxidant, has been shown to stimulate mesangial cell proliferation. In the present study we analyzed the H2O2-induced early signaling events. Immunofluorescence analysis revealed a H2O2 induced dose-dependent increase in tyrosine phosphorylation. Short treatment (2 or 5 min) with 5 mM H2O2 induced a mitogenic response and a significant (P < 0.01) increase in the number of cells compared to non-treated controls. Proteins extracted from H2O2 (0.1 to 10 mM) treated cells were separated on SDS-PAGE and subjected to immunoblot analysis with anti-phosphotyrosine. A dose-dependent induction of tyrosine phosphorylation of 180 kDa, 120 kDa and 60 kDa proteins was observed within 1 to 10 minutes. By sequentially using immunoprecipitation and immunoblotting the 180 kDa tyrosine phosphorylated band was shown to represent both PDGF alpha- and beta-receptors. The tyrosine phosphorylated 60 kDa protein was identified as the cytoplasmic protein tyrosine kinase pp60c-src. The c-src phosphorylation was associated with an inhibition of c-src kinase activity, suggesting phosphorylation of tyrosine 527 in the c-src regulatory domain. Pretreatment with catalase completely abrogated the H2O2-induced PDGF receptor and c-src tyrosine phosphorylation. These data support the notion that the activation of a signaling pathway involving the PDGF receptors and c-src contributes to the mitogenic effects of reactive oxygen species.


The systemic-immune-inflammation index predicts the recurrence of atrial fibrillation after cryomaze concomitant with mitral valve surgery.
Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). The systemic inflammation indexes are easily evaluated and predict AF development. However, it's role in prediction of recurrence of AF is unknown. We aim to explore the association between the systemic inflammation indexes and recurrence of AF in patients underwent cryoablation (CryoMaze) concomitant with mitral valve surgery. We examined systemic inflammation indexes during perioperative period in 122 patients between 2015 and 2018. Systemic inflammation indexes were developed by systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio. Univariate and multivariate analyses were performed to examine the association of each markers with recurrence of AF. Of the 122 patients included in this study, 22 patients (18%) experienced AF recurrence after CryoMaze concomitant with mitral valve surgery. There is no significant difference between each systemic inflammation indexes before surgery and recurrence of AF. In univariate analysis, MLR after surgery 3 days, PLR, MPLR, NLR, SII after surgery 7 days were able to predict recurrence of AF. In multivariate analyses, SII ≥ 1696 independently predicted recurrence (OR, 3.719; 95% CI, 1.417-9.760). Interestingly, baseline SII showed no significant in prediction of recurrence. It was sharply elevated after surgery and dropped slowly. In patients of recurrence, SII after 7 days of surgery increased again. The raised SII again was associated with an increased risk of the postoperative recurrence of AF and independently predicted the late recurrence of AF after CryoMaze concomitant with mitral valve surgery.


Incorporation of fluorous glycosides to cell membrane and saccharide chain elongation by cellular enzymes.
A series of fluorous-tagged glycosides with different number of fluorine atoms are incorporated into the cells, transported to Golgi, elongated by cellular enzymes, and then released to the culture medium. Fluorine content strongly affects on the affinity for cell membrane and glycosylation. Essentially, the fluorocarbon chain in fluorous compound and the hydrocarbon chain are not miscible. However, the fluorous-tagged glycosides have affinity for cell membrane because of its amphiphilicity. The affinity of fluoro-amphiphilic compound for cell membrane is discussed using critical micelle concentration. The separation of glycosylated products by solvent extraction or fluorous solid phase extraction cartridges is also discussed.


The use of head CT scanning in mild head injury.
To determine the number of brain CT scans carried out in patients with mild head injury (MHI) during 13 months of trauma registry, and to investigate means of reducing the rate of unnecessary scans. During a trauma registry (from August 23, 1999 to September 21, 2000) in 6 general Hospitals (Imam Hussein, Moayer, Sina, Hafteteer, Imam Khomeini and Shariatti) in Tehran, Iran, 1209 cases with Glasgow Coma Scale (GCS) score >13 underwent brain CT scan. To be included in the study, patients must have sustained their injury within one week prior to presentation to Emergency Rooms, and were hospitalized for more than 24 hours. The attending physicians formally reported all brain CT scan findings. For 1209 patients, there were the following characteristics: mean age was 29.4 years; the main cause of injury was traffic accidents (60.1%), followed by falls (28.5%), fights (7.2%), and other reasons (4.2%). Seventy-seven cases (6.4%) had a GCS score of 13, 212 (17.5%) had a score of 14, and 920 (76%) had a score of 15. A total of 481 abnormalities on CT scan were reported for 405 patients (33.5%) with positive report of brain CT scan, while 804 cases (66.5%) did not report abnormalities. The most common intracranial lesion was epidural hemorrhage with 146 cases (30.3%). The rate of negative reporting of brain CT scan in patients who had GCS score of 15 was 72.2%. Patients who have GCS score of 13 or 14 on admission should be considered to have a moderate rather than a mild head injury. For reduction of unnecessary brain CT scan performance in MHI patients, we must define the appropriate criteria.


'Care left undone' during nursing shifts: associations with workload and perceived quality of care.
There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure-'missed care'. To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of 'missed care' (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as 'failing' on patient safety, compared with 2.4 where patient safety was rated as 'excellent' (p < 0.001). Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of 'missed care' as an early warning measure to identify wards with inadequate nurse staffing.


Intramedullary spinal cord metastasis to the cauda equina in a patient with HER2-positive metastatic breast cancer: A case report.
The rate of metastasis to the central nervous system is high in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer patients. Metastatic cauda equina tumors are characterized by rapid progression of symptoms, thus signifying the requirement of their early treatment. However, these tumors are rarely reported, and their optimal treatment options have not been established yet. Here, we report a case study of a patient with HER2-positive breast cancer that metastasized to the cauda equina. The patient underwent urgent surgery to relieve the spinal cord compression. The pain in her back and lower limbs was greatly reduced. Unfortunately, her ability to walk did not improve sufficiently. Overall, surgical treatment may be a favorable option to improve a patient's quality of life.


[Evaluation of hemodynamics in cerebral infarction using MRI with FAIR sequence].
In comparison with 99mTc-ECD SPECT, the usefulness for evaluation of cerebral blood flow by the perfusion images using MRI with FAIR sequence was studied in ischemic stroke patients. Among 27 cases, 15 patients showed lacunar infarctions and 12 patients showed cortical infarctions determined by T2 weighted MR images. FAIR images were obtained as single images at the slice position running through the basal ganglia or corona radiata. The inversion times(TI) were varied, ranging from 800 to 1,400 msec. In 15 patients without definite low perfusions in the SPECT study, FAIR images showed sequentially proxymal arterial branches in early phase and distal arterial branches or capillary beds in the cortical tissues in a late phase as the TI was elongated. Nine of the 12 patients with low cerebral perfusions in the SPECT study showed perfusion defects in FAIR imaging. Five of the 12 patients with a small low cerebral perfusion area in the SPECT study showed a delay of the depiction of cortical arteries along with TI elongation. In 3 patients, ischemic lesions demonstrated by the SPECT study was not shown in the MRI study because of motion artifacts. In conclusion, FAIR imagings are considered to be useful in the evaluation of cerebral flow dynamics in the ischemic stroke patients.


Follicular helper T cell in immunity and autoimmunity.
The traditional concept that effector T helper (Th) responses are mediated by Th1/Th2 cell subtypes has been broadened by the recent demonstration of two new effector T helper cells, the IL-17 producing cells (Th17) and the follicular helper T cells (Tfh). These new subsets have many features in common, such as the ability to produce IL-21 and to express the IL-23 receptor (IL23R), the inducible co-stimulatory molecule ICOS, and the transcription factor c-Maf, all of them essential for expansion and establishment of the final pool of both subsets. Tfh cells differ from Th17 by their ability to home to B cell areas in secondary lymphoid tissue through interactions mediated by the chemokine receptor CXCR5 and its ligand CXCL13. These CXCR5+ CD4+ T cells are considered an effector T cell type specialized in B cell help, with a transcriptional profile distinct from Th1 and Th2 cells. The role of Tfh cells and its primary product, IL-21, on B-cell activation and differentiation is essential for humoral immunity against infectious agents. However, when deregulated, Tfh cells could represent an important mechanism contributing to exacerbated humoral response and autoantibody production in autoimmune diseases. This review highlights the importance of Tfh cells by focusing on their biology and differentiation processes in the context of normal immune response to infectious microorganisms and their role in the pathogenesis of autoimmune diseases.


Immunotherapeutic Strategies in Cancer and Atherosclerosis-Two Sides of the Same Coin.
The development and clinical approval of immunotherapies has revolutionized cancer therapy. Although the role of adaptive immunity in atherogenesis is now well-established and several immunomodulatory strategies have proven beneficial in preclinical studies, anti-atherosclerotic immunotherapies available for clinical application are not available. Considering that adaptive immune responses are critically involved in both carcinogenesis and atherogenesis, immunotherapeutic approaches for the treatment of cancer and atherosclerosis may exert undesirable but also desirable side effects on the other condition, respectively. For example, the high antineoplastic efficacy of immune checkpoint inhibitors, which enhance effector immune responses against tumor cells by blocking co-inhibitory molecules, was recently shown to be constrained by substantial proatherogenic properties. In this review, we outline the specific role of immune responses in the development of cancer and atherosclerosis. Furthermore, we delineate how current cancer immunotherapies affect atherogenesis and discuss whether anti-atherosclerotic immunotherapies may similarly have an impact on carcinogenesis.


An analysis of the subunit structure of the crystalloid protein complex from castor bean endosperm.
Chromatographic and electrophoretic studies have shown that the subunits of the crystalloid protein, isolated from mature castor bean (Ricinus communis L. cv Hale) seed endosperm protein bodies, are heterogeneous with molecular weights in the range 49 to 53.5 kilodaltons (kD), and are quantitatively in unequal amounts. Each subunit comprises an alphabeta polypeptide pair which are reduced by 2-mercaptoethanol in two subgroups with molecular weights in the 29 to 34 kD and 20.5 to 23.5 kD ranges. Subunits and corresponding polypeptide pairs are also seen to be heterogeneous in pI following isoelectric focusing. In general, large polypeptides are acidic (pI 4.8-6.2) and small polypeptides basic (pI 7.4-9.4), although overlap of some isoelectric isomers does occur, notably in polypeptides derived from subunits which are quantitatively present in smaller amounts.


Multivariate Analysis of Risk Factor for Mortality and Feasibility of Extracorporeal Membrane Oxygenation in High-Risk Thoracic Surgery.
Extracorporeal membrane oxygenation (ECMO) as intraoperative cardiorespiratory support during lung transplantation is well known, but use for other types of surgery are limited. To assess risk factor for mortality after high-risk thoracic surgery and feasibility of ECMO, we reviewed. This study was an observational study. Between January 2011 and October 2018, 63 patients underwent thoracic surgery with ECMO for severe airway disease, pulmonary insufficiency requiring lung surgery, and other conditions. In all, 46 patients remained alive at 30 days after surgery. The mean patient age was 50.38 ± 16.16 years. ECMO was most commonly used to prevent a lethal event (34 [73.9%]) in the Survival (S) group and rescue intervention (13 [76.5%]) in the Non-survival (N) group. In all, 11 patients experienced arrest during surgery (S vs N: 2 [4.3%] vs 9 [52.9%], p ≤0.001). The multivariate analysis revealed that arrest during surgery (odds ratio [OR], 24.44; 95% confidence interval [CI], 1.82-327.60; p = 0.016) and age (OR, 7.47; 95% CI, 1.17-47.85; p = 0.034) were independently associated with mortality. ECMO provides a safe environment during thoracic surgery, and its complication rate is acceptable except for extracorporeal cardiopulmonary resuscitation (ECPR).


Prevalence and putative risk markers of challenging behavior in students with intellectual disabilities.
Numerous studies have reported a high prevalence of challenging behavior among students with intellectual disabilities (ID). They discuss different putative risk markers as well as their influence on the occurrence of challenging behavior. The study investigates the prevalence of challenging behavior and evaluates in terms of a replication study well-known putative risk markers among a representative sample of students with ID (N=1629) in Bavaria, one of the largest regions in Germany. The research is based on a modified version of the Developmental Behavior Checklist (DBC). Findings indicate a prevalence rate of 52% for challenging behavior. The following putative risk markers are associated with challenging behavior: intense need for care, male gender, lack of communication skills, and residential setting. These risk markers explain 8.4% of the variance concerning challenging behavior. These results reveal that challenging behavior either is to a large extent determined by situations and interactions between individuals and environment and cannot be explained by the measured individual and social risk markers alone, or it is determined by further risk markers that were not measured.


Posttraumatic sequelae in a community hit by an avalanche.
The posttraumatic sequelae for 104 adult inhabitants from the town of Flateyri, Iceland, were studied 10 weeks after an avalanche hit the town killing 20 people. Eighty-seven adults from the neighboring town of Thingeyri constituted a control group. On the basis of the General Health Questionnaire (GHQ-30), 25% of the Flateyri group (twice as many than in Thingeyri) reached a level of psychiatric caseness. The most common symptoms were intrusive thoughts and feelings, tension, sadness, and anxiety. The loss of family members was associated with symptomatology. A high number of former life events correlated more strongly with distress symptoms than with the individual appraisal of these events. Distress symptoms were related to gender, age, and education.


Comparison of linear discriminant analysis methods for the classification of cancer based on gene expression data.
More studies based on gene expression data have been reported in great detail, however, one major challenge for the methodologists is the choice of classification methods. The main purpose of this research was to compare the performance of linear discriminant analysis (LDA) and its modification methods for the classification of cancer based on gene expression data. The classification performance of linear discriminant analysis (LDA) and its modification methods was evaluated by applying these methods to six public cancer gene expression datasets. These methods included linear discriminant analysis (LDA), prediction analysis for microarrays (PAM), shrinkage centroid regularized discriminant analysis (SCRDA), shrinkage linear discriminant analysis (SLDA) and shrinkage diagonal discriminant analysis (SDDA). The procedures were performed by software R 2.80. PAM picked out fewer feature genes than other methods from most datasets except from Brain dataset. For the two methods of shrinkage discriminant analysis, SLDA selected more genes than SDDA from most datasets except from 2-class lung cancer dataset. When comparing SLDA with SCRDA, SLDA selected more genes than SCRDA from 2-class lung cancer, SRBCT and Brain dataset, the result was opposite for the rest datasets. The average test error of LDA modification methods was lower than LDA method. The classification performance of LDA modification methods was superior to that of traditional LDA with respect to the average error and there was no significant difference between theses modification methods.


Efficient equilibration of confined and free-standing films of highly entangled polymer melts.
Equilibration of polymer melts containing highly entangled long polymer chains in confinement or with free surfaces is a challenge for computer simulations. We approach this problem by first studying polymer melts based on the soft-sphere coarse-grained model confined between two walls with periodic boundary conditions in two directions parallel to the walls. Then, we insert the microscopic details of the underlying bead-spring model. Tuning the strength of the wall potential, the monomer density of confined polymer melts in equilibrium is kept at the bulk density even near the walls. In a weak confining regime, we observe the same conformational properties of chains as in the bulk melt showing that our confined polymer melts have reached their equilibrated state. Our methodology provides an efficient way of equilibrating large polymer films with different thicknesses and is not confined to a specific underlying microscopic model. Switching off the wall potential in the direction perpendicular to the walls enables to study free-standing highly entangled polymer films or polymer films with one supporting substrate.


Promoter choice for retroviral vectors: transcriptional strength versus trans-activation potential.
Gene expression from retroviral vectors can be driven by either the retroviral long terminal repeat (LTR) promoter or by cellular or viral promoters located internally in an LTR-deleted self-inactivating vector design. Adverse events in a gene therapy clinical trial for X-linked severe combined immune deficiency have led to the realization that the enhancer/promoter elements contained within integrated vectors may also act outside the vector genome to trans-activate host genes. Ideally, the gene expression system chosen for a vector should possess a low probability of trans-activation while still being able to support adequate levels of transgene expression. However, the parameters that define these specific characteristics are unknown. To gain insight into the mechanism of trans-activation, we compared a panel of commonly used retroviral LTRs and cellular and viral promoters for their ability to drive gene expression and to trans-activate a nearby minimal promoter in three different cell lines. These studies identified two elements, the cytomegalovirus enhancer/chicken beta-actin (CAG) and elongation factor (EF)-1alpha promoters, as being of potential value for use in vectors targeting lymphoid cells, as these elements exhibited both high levels of reporter gene expression and relatively low levels of trans-activation in T cells.


Effects of enalapril on lymphocyte sodium, potassium, magnesium and calcium levels in patients with severe congestive heart failure.
Fifteen patients (median age 73 years) with severe congestive heart failure were treated with Enalapril for a total of 12 weeks with a significant improvement in their right atrial pressures and in their functional state. Renal function, serum potassium, magnesium and calcium levels were unchanged. Lymphocyte sodium, potassium and calcium levels were generally lower than control values throughout the study but these differences were only statistically significant early in the study. Lymphocyte magnesium levels were unchanged. These findings are in contrast to those previously reported in the literature for such patients treated with conventional diuretics.


On the phenomenon of large photoluminescence red shift in GaN nanoparticles.
We report on the observation of broad photoluminescence wavelength tunability from n-type gallium nitride nanoparticles (GaN NPs) fabricated using the ultraviolet metal-assisted electroless etching method. Transmission and scanning electron microscopy measurements performed on the nanoparticles revealed large size dispersion ranging from 10 to 100 nm. Nanoparticles with broad tunable emission wavelength from 362 to 440 nm have been achieved by exciting the samples using the excitation power-dependent method. We attribute this large wavelength tunability to the localized potential fluctuations present within the GaN matrix and to vacancy-related surface states. Our results show that GaN NPs fabricated using this technique are promising for tunable-color-temperature white light-emitting diode applications.


Virtual Scribe Services Decrease Documentation Burden Without Affecting Patient Satisfaction: A Randomized Controlled Trial.
Virtual scribe services (VSS) are a contemporary take on the in-person scribes utilized as a means to reduce administrative burden on physicians and enhance the physician-patient interaction. The purpose of this study was to determine whether VSS use could decrease the time an orthopaedic foot and ankle surgeon spends on documentation without diminishing the patient experience as compared with traditional postencounter dictation (TD). Fifty patients presenting for first-time visits with a single orthopaedic foot and ankle surgeon were prospectively enrolled and randomized to VSS or TD prior to the physician-patient encounter. Time spent with the patient in the exam room and time spent documenting away from the patient were recorded. A postencounter survey assessed patient satisfaction, perception of physician empathy, understanding of the plan, and perception of the amount of time spent with the physician. Of 50 patients enrolled, 25 were randomized to VSS. Time spent documenting away from the patient differed significantly between VSS and TD (1.2 ± 0.7 minutes for VSS vs 5.8 ± 1.7 minutes for TD, P < .001) as did time elapsed between the end of the visit and the start of dictation (0 ± 0 for VSS vs 118.2 ± 72.7 minutes for TD, P < .001). There was a trend toward more time spent with the patient in the VSS group than in the TD group (14.2 ± 5.9 minutes for VSS vs 11.4 ± 5.1 minutes for TD, P = .069). There were no differences between groups in survey responses regarding satisfaction, empathy, understanding, or perception of sufficient time spent with the physician (P > .05 for each). VSS use in an orthopaedic foot and ankle practice significantly decreased documentation time and allowed for completion of documentation during patient visits without differences in quality metrics as compared to TD. Orthopaedic surgeons can consider VSS a HIPAA-compliant documentation option with time savings and no measurable difference in patient satisfaction. Level II: Randomized controlled trial.


A risk model for ovarian carcinoma patients using CA 125: time to normalization renders second-look laparotomy redundant.
We evaluated the incorporation of CA 125 normalization times into a prognostic model based on pretreatment variables in patients with ovarian carcinoma to determine if they could render second-look laparotomy (SLL) redundant. A total of 54 consecutive patients with ovarian carcinoma who underwent SLL between 1985 and 1990 were included in this analysis. At diagnosis, all of the patients had abnormal CA-125 serum levels, which fell to within the normal range during chemotherapy. Cox's model was used to select pretreatment variables relevant for prognosis. The influence of the time to normalization of CA 125 (< or = vs. > 1 months) and the capability of SLL results to modify prognostic prediction, were also evaluated. The size of the residual tumor at the beginning of therapy, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) were independently predictive of survival. The time to normalization of CA 125 serum levels (analyzed either as -a continuous or as a two-category variable) also had an independent prognostic role when included in the model. When we examined the inclusion of both CA 125 parameter and SLL into the model together, we found that only CA 125 continued to have an independent prognostic relevance. On the basis of the two pretreatment parameters (PS and tumor size) and of this response parameter (time to normalization of CA 125 values) we selected six subgroups of patients having different outcomes (log rank test of equality over-strata < 0.001). Patients with good prognostic pretreatment variables, and those with intermediate prognosis at the beginning of therapy who showed a quick normalization of CA 125, had an 80% 5-year survival, compared with 16% 5-year survival in the remaining patients. (P < 0.0001). Our data suggest that the survival of patients with advanced ovarian carcinoma could be accurately predicted by considering some pretreatment variables and time to CA 125 normalization together, without performing SLL. Our risk model, however, needs to be validated by larger prospective trials, to draw any definitive conclusions about the abandonment of surgically defined response.


The formation of organogels and helical nanofibers from simple organic salts.
Simple organic salts based on aniline-derived cations and D-tartrate anions formed organogels and helical nanofibers. The organic salt (p-fluoroanilinium)(D-tartrate) was found to generate an organogel despite the absence of a hydrophobic alkyl chain, whereas (p-iodoanilinium)(D-tartrate) formed helical nanofibers in braided ropelike structures through a rolling-up process. The helicity of these nanofibers could be reversed by changing the growth solvent. The driving forces responsible for the formation of the nanofibers were determined to be 1D OH⋅⋅⋅O(-) hydrogen-bonding interactions between D-tartrate anions and π stacking of anilinium cations, as well as steric hindrance between the hydrogen-bonded chains.


Sesbania Gum-Supported Hydrophilic Electrospun Fibers Containing Nanosilver with Superior Antibacterial Activity.
In this contribution, we report for the first time on a new strategy for developing sesbania gum-supported hydrophilic fibers containing nanosilver using electrospinning (SG-Ag/PAN electrospun fibers), which gives the fibers superior antibacterial activity. Employing a series of advanced technologies-scanning electron microscopy, transmission electron microscopy, Fourier transform infrared spectroscopy, UV-visible absorption spectroscopy, X-ray photoelectron spectroscopy, and contact angle testing-we characterized the as-synthesized SG-Ag/PAN electrospun fibers in terms of morphology, size, surface state, chemical composition, and hydrophilicity. By adjusting the synthesis conditions, in particular the feed ratio of sesbania gum (SG) and polyacrylonitrile (PAN) to Ag nanoparticles (NPs), we regulated the morphology and size of the as-electrospun fibers. The fibers' antibacterial properties were examined using the colony-counting method with two model bacteria: Escherichia coli (a Gram-negative bacterium) and Staphylococcus aureus (a Gram-positive bacterium). Interestingly, compared to Ag/PAN and SG-PAN electrospun fibers, the final SG-Ag/PAN showed enhanced antibacterial activity towards both of the model bacteria due to the combination of antibacterial Ag NPs and hydrophilic SG, which enabled the fibers to have sufficient contact with the bacteria. We believe this strategy has great potential for applications in antibacterial-related fields.


An analysis of drug resistance among people living with HIV/AIDS in Shanghai, China.
Understanding the mechanisms of drug resistance can facilitate better management of antiretroviral therapy, helping to prevent transmission and decrease the morbidity and mortality of people living with HIV/AIDS. However, there is little data about transmitted drug resistance and acquired drug resistance for HIV/AIDS patients in Shanghai. A retrospective cohort study of HIV-infected patients who visited the Department of Infectious Disease from June 2008 to June 2015 was conducted in Shanghai, China. Logistic regression analysis was performed to analyze risk factors for drug resistance among HIV-infected people with virological failure. The related collected factors included patient age, gender, marital status, infection route, baseline CD4 count, antiretroviral therapy regimens, time between HIV diagnosis and initiating antiretroviral therapy. Factors with p<0.1 in the univariate logistic regression test were analyzed by multivariate logistic regression test. There were 575 subjects selected for this study and 369 participated in this research. For the antiretroviral therapy drugs, the rates of transmitted drug resistance and acquired drug resistance were significantly different. The non-nucleoside reverse transcriptase inhibitor (NNRTI) had the highest drug resistance rate (transmitted drug resistance, 10.9%; acquired drug resistance, 53.3%) and protease inhibitors (PIs) had the lowest drug resistance rate (transmitted drug resistance, 1.7%; acquired drug resistance, 2.7%). Logistic regression analysis found no factors that were related to drug resistance except marital status (married status for tenofovir: odds ratio = 6.345, 95% confidence interval = 1.553-25.921, P = 0.010) and the time span between HIV diagnosis and initiating antiretroviral therapy (≤6M for stavudine: odds ratio = 0.271, 95% confidence interval = 0.086-0.850, P = 0.025; ≤6M for didanosine: odds ratio = 0.284, 95% confidence interval = 0.096-0.842, P = 0.023; ≤6M for tenofovir: odds ratio = 0.079, 95% confidence interval = 0.018-0.350,P<0.001). NNRTI had a higher DR rate compared with nucleoside reverse transcriptase inhibitor (NRTI) and PIs, consequently, LPV/r was a reasonable choice for patients with NNRTI drugs resistance in China. Only married status and a time span≤6 month between the HIV confirmed date and the time initiating antiretroviral therapy were risk factors for TDF drug resistance. Both baseline HIV-RNA load and resistance test is crucial for TDR diagnosis, and frequent monitoring of HIV-RNA load is crucial for ADR identification and intervention. Treatment adherence still plays a positive role on the outcome of ART.


Regulatory noncoding RNAs: potential biomarkers and therapeutic targets in acute myeloid leukemia.
The noncoding RNAs (ncRNA) comprise a substantial segment of the human transcriptome and have emerged as key elements of cellular homeostasis and disease pathogenesis. Dysregulation of these ncRNAs by alterations in the primary RNA motifs and/or aberrant expression levels is relevant in various diseases, especially cancer. The recent research advances indicate that ncRNAs regulate vital oncogenic processes, including hematopoietic cell differentiation, proliferation, apoptosis, migration, and angiogenesis. The ever-expanding role of ncRNAs in cancer progression and metastasis has sparked interest as potential diagnostic and prognostic biomarkers in acute myeloid leukemia. Moreover, advances in antisense oligonucleotide technologies and pharmacologic discoveries of small molecule inhibitors in targeting RNA structures and RNA-protein complexes have opened newer avenues that may help develop the next generation anti-cancer therapeutics. In this review, we have discussed the role of ncRNA in acute myeloid leukemia and their utility as potential biomarkers and therapeutic targets.


Psl trails guide exploration and microcolony formation in Pseudomonas aeruginosa biofilms.
Bacterial biofilms are surface-associated, multicellular, morphologically complex microbial communities. Biofilm-forming bacteria such as the opportunistic pathogen Pseudomonas aeruginosa are phenotypically distinct from their free-swimming, planktonic counterparts. Much work has focused on factors affecting surface adhesion, and it is known that P. aeruginosa secretes the Psl exopolysaccharide, which promotes surface attachment by acting as 'molecular glue'. However, how individual surface-attached bacteria self-organize into microcolonies, the first step in communal biofilm organization, is not well understood. Here we identify a new role for Psl in early biofilm development using a massively parallel cell-tracking algorithm to extract the motility history of every cell on a newly colonized surface. By combining this technique with fluorescent Psl staining and computer simulations, we show that P. aeruginosa deposits a trail of Psl as it moves on a surface, which influences the surface motility of subsequent cells that encounter these trails and thus generates positive feedback. Both experiments and simulations indicate that the web of secreted Psl controls the distribution of surface visit frequencies, which can be approximated by a power law. This Pareto-type behaviour indicates that the bacterial community self-organizes in a manner analogous to a capitalist economic system, a 'rich-get-richer' mechanism of Psl accumulation that results in a small number of 'elite' cells becoming extremely enriched in communally produced Psl. Using engineered strains with inducible Psl production, we show that local Psl concentrations determine post-division cell fates and that high local Psl concentrations ultimately allow elite cells to serve as the founding population for initial microcolony development.


[Bronchial caliber study: a continuous challenge in pneumology].
The caliber and the bronchial wall represent the anatomical substratum of several diseases of the respiratory tract. Many investigations allow qualitative and quantitative approaches but none can appreciate exactly the injuries degree and the lesions extent. The radiological methods are powerful in particular the high resolution computed tomography with great in-depth descriptive capacity. The respiratory functional tests with a variable sensitivity allow a dynamic but indirect analysis, the provocation test studies bronchial hyperresponsiveness and the plethysmography measures the airways specific resistance. The bronchoscopy explores the bronchi directly but is confronted with the problem of the image distortion. The fields of studies of the bronchial gauge are vast including all bronchopulmonary pathology and the correlation of two different methods allows a better evaluation.


Association of Hepatitis C Virus Replication with the Catecholamine Biosynthetic Pathway.
A bidirectional negative relationship between Hepatitis C virus (HCV) replication and gene expression of the catecholamine biosynthetic enzyme L-Dopa decarboxylase (DDC) was previously shown in the liver and attributed at least to an association of DDC with phosphatidylinositol 3-kinase (PI3K). Here, we report that the biosynthesis and uptake of catecholamines restrict HCV replication in hepatocytes, while HCV has developed ways to reduce catecholamine production. By employing gene silencing, chemical inhibition or induction of the catecholamine biosynthetic and metabolic enzymes and transporters, and by applying the substrates or the products of the respective enzymes, we unravel the role of the different steps of the pathway in viral infection. We also provide evidence that the effect of catecholamines on HCV is strongly related with oxidative stress that is generated by their autoxidation in the cytosol, while antioxidants or treatments that lower cytosolic catecholamine levels positively affect the virus. To counteract the effect of catecholamines, HCV, apart from the already reported effects on DDC, causes the down-regulation of tyrosine hydroxylase that encodes the rate-limiting enzyme of catecholamine biosynthesis and suppresses dopamine beta-hydroxylase mRNA and protein amounts, while increasing the catecholamine degradation enzyme monoamine oxidase. Moreover, the NS4B viral protein is implicated in the effect of HCV on the ratio of the ~50 kDa DDC monomer and a ~120 kDa DDC complex, while the NS5A protein has a negative effect on total DDC protein levels.


Performance of non-invasive respiratory function indices in predicting clinical outcomes in patients hospitalized for COVID-19 pneumonia in medical and sub-intensive wards: a retrospective cohort study.
Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease which can lead to acute respiratory distress syndrome requiring ventilatory support and intensive care unit admission. The aim of our study is to evaluate the performance of two non-invasive respiratory function indices (the ROX index and the SatO2/FiO2 ratio), as compared to the traditional PaO2/FiO2 ratio, in predicting a clinically relevant composite outcome (death or intubation) in hospitalized patients for COVID-19 pneumonia. Four hospital centers in Northern Italy conducted an observational retrospective cohort study during the first wave of COVID-19 pandemic. Four hundred and fifty-six patients with COVID-19 pneumonia admitted to medical or sub-intensive wards were enrolled. Clinical, laboratory, and respiratory parameters, for the calculation of different indices, were measured at hospital admission. In medical wards (Verona and Padua) the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio were able to predict intubation or death with good accuracy (AUROC for the PaO2/FiO2 ratio, ROX index and SatO2/FiO2 ratio of 75%, 75% and 74%, respectively). Regarding sub-intensive wards (Milan and Mantua), none of the three respiratory function indices was significantly associated with the composite outcome. In patients admitted to medical wards for COVID-19 pneumonia, the ROX index and the SatO2/FiO2 ratio demonstrated not only good performance in predicting intubation or death, but their accuracy was comparable to that of the PaO2/FiO2 ratio. In this setting, where repeated arterial blood gas tests are not always feasible, they could be considered a reliable alternative to the invasive PaO2/FiO2 ratio.


A review of sigma models for quantum chaotic dynamics.
We review the construction of the supersymmetric sigma model for unitary maps, using the color-flavor transformation. We then illustrate applications by three case studies in quantum chaos. In two of these cases, general Floquet maps and quantum graphs, we show that universal spectral fluctuations arise provided the pertinent classical dynamics are fully chaotic (ergodic and with decay rates sufficiently gapped away from zero). In the third case, the kicked rotor, we show how the existence of arbitrarily long-lived modes of excitation (diffusion) precludes universal fluctuations and entails quantum localization.


Tachygastria induced by gastric electrical stimulation is mediated via alpha- and beta-adrenergic pathway and inhibits antral motility in dogs.
It is known that tachygastria is associated with gastric hypomotility and retrograde gastric electrical stimulation (RGES) delays gastric emptying and is proposed for treating obesity. The aim was to investigate the effects and mechanisms of RGES on postprandial antral contraction in dogs. Seven dogs were implanted with a gastric cannula and three pairs of gastric serosal electrodes. Antral contractions and gastric myoelectrical activity were recorded immediately after a solid meal, with or without RGES, or with GES on the corpus, or with RGES under administration of propranolol. The stimulus was composed of long pulses with a tachygastrial frequency. (i) GES at the tachygastrial frequency impaired gastric myoelectrical activity and induced tachygastria (anovaP<0.05). (ii) GES at the tachygastrial frequency suppressed antral contractions (anovaP<0.01) and the effect was stronger with retrograde stimulation than forward stimulation (P<0.05). (iii) GES-induced tachygastria was correlated with antral hypomotility (r=-0.60, P=0.01). (iv) Propranolol and phentolamine abolished GES-induced tachygastria and antral hypomotility. Long-pulse RGES at a tachygastrial frequency suppresses postprandial antral contractions, which is attributed to an induction of tachygastria via the alpha- and beta-adrenergic pathway.


Histochemical analysis of seed reserve mobilization in Passiflora edulis Sims fo. flavicarpa O. Deg. (yellow passion fruit) during germination.
In the present work, we analyzed the histochemical aspects of Passiflora edulis seeds reserve mobilization during the first ten days of germination. Our results showed that mainly lipids present in the endosperm are used as a reserve source, and their levels reduce at the same time the radicle protrudes, between the fourth and sixth day of sowing. Furthermore, protein bodies are present in the cotyledons, which are degraded as germination occurs and are almost depleted by the time of radicle protrusion. Starch grains also appear in the late germination period, and it is not clear if there is any reserve wall polysaccharide consumption in the endosperm.


The Goeckerman regimen for the treatment of moderate to severe psoriasis.
Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.


On the sample size for one-sided equivalence of sensitivities based upon McNemar's test.
In this paper we formalize the problem of testing the one-sided equivalence in the sensitivities of two medical diagnostic tests under a matched-pair study design. We derive conditional and unconditional sample size formulae which are decreasing functions of the probability of being diagnosed by both tests. We calculate upper boundary and midpoint sample sizes. Results of a Monte Carlo simulation study that compares the proposed sample size formulae with that of Lachenbruch suggest that our midpoint conditional sample size is the best choice to obtain the desired power for the type of equivalence studies discussed in the paper.


von Willebrand factor promotes leukocyte extravasation.
von Willebrand factor (VWF) is an important player in hemostasis but has also been suggested to promote inflammatory processes. Gene ablation of VWF causes a simultaneous defect in P-selectin expression making it difficult to identify VWF-specific functions. Therefore, we analyzed whether blocking antibodies against VWF would be able to interfere with neutrophil extravasation. We found that these antibodies inhibited neutrophil recruitment into thioglycollate-inflamed peritoneum and KC-stimulated cremaster by approximately 50%. Whereas platelet-VWF was not involved, the contribution of VWF to granulocyte recruitment was strictly dependent on the presence of platelets and the accessibility of their VWF-receptor glycoprotein Ib. Surprisingly, platelet P-selectin was largely dispensable for leukocyte extravasation, in agreement with our observation that anti-VWF antibodies did not affect leukocyte rolling and adhesion. Searching for possible effects downstream of leukocyte capture, we found that anti-VWF antibodies significantly inhibited thioglycollate-induced vascular permeability. The increase of permeability was independent of circulating granulocytes, showing that it was not a side effect of neutrophil diapedesis. Collectively, our results demonstrate that VWF-associated platelets strongly support neutrophil extravasation at a step downstream of leukocyte docking to the vessel wall. This step could be related to leukocyte diapedesis facilitated by destabilization of the endothelial barrier.


Bacterial outer membrane and cell wall penetration and cell destruction by polluting chemical agents and physical conditions.
In the environment, bacteria and other microorganisms are subjected to a variety of constantly changing chemical and physical agencies. Chemical ones include antimicrobial compounds (both biocides and antibiotics), pollutants, drugs, cosmetic and pharmaceutical ingredients and pesticides. The physical agents include desiccation and drying, osmotic pressure, hydrostatic pressure, temperature and pH changes and radiations (ultraviolet, sunlight, ionizing). Bacteria must thus adapt to survive these inimicable conditions. Organisms such as bacterial spores usually survive, whereas other types of microorganisms may be much more susceptible. Depending on the type of organism, the bacterial cell wall, outer membrane or the spore outer layers may act as permeability barriers to the intracellular uptake of antibiotics and biocides. Some antibacterial agents interact with, and damage or modify, the outer components. Physical agencies are known to damage the cytoplasmic membrane or to produce alterations in DNA or proteins or enzymes. Nevertheless, significant damage to the cell wall or outer membrane may also occur. Four types of organisms are considered: cocci, mycobactria, Gram-negative bacteria and bacterial spores. The nature of the damage inflicted on, or in some cases prevented by, their outer cell layers is discussed for each type of organism.


Stimulation of growth-hormone release with clonidine does not distinguish individual cases of idiopathic Parkinson's disease from those with striatonigral degeneration.
Multiple System Atrophy (MSA) and idiopathic Parkinson's disease (PD) can be difficult to distinguish. There is an ongoing debate about the diagnostic value of the growth-hormone response to clonidine (CGH-test) in PD and MSA. We investigated whether the CGH-test can identify individual patients in the early stages of PD (n = 21) and Striatonigral Degeneration (SND, n = 11), a particular variety of MSA. Patients were diagnosed on the basis of clinical criteria and IBZM-SPECT. Clonidine induced a greater total serum growth-hormone production in PD than in SND (p = 0.01). However, taking the difference in prevalence of PD and SND into account, and because of the low likelihood ratios of the test, an increase of GH after clonidine increases the pre-test probability for PD by about only 5 %, while an absent response of GH also increases the pre-test probability for SND by about 5 %. We conclude that the CGH-test discriminates between groups of patients with PD and SND, but has little practical diagnostic value for identifying individual patients.


Inhibitory plant serpins with a sequence of three glutamine residues in the reactive center.
Serpins appear to be ubiquitous in eukaryotes, except fungi, and are also present in some bacteria, archaea and viruses. Inhibitory serpins with a glutamine as the reactive-center P1 residue have been identified exclusively in a few plant species. Unique serpins with a reactive center sequence of three Gln residues at P3-P1 or P2-P1' were isolated from barley and wheat grain, respectively. Barley BSZ3 was an irreversible inhibitor of chymotrypsin, with a second-order association rate constant for complex formation k(a)' of the order of 10(4) M(-1) s(-1); however, only a minor fraction of the serpin molecules reacted with chymotrypsin, with the majority insensitive to cleavage in the reactive center loop. Wheat WSZ3 was cleaved specifically at P8 Thr and was not an inhibitor of chymotrypsin. These reactive-center loops may have evolved conformations that are optimal as inhibitory baits for proeinases that specifically degrade storage prolamins containing Gln-rich repetitive sequences, most likely for digestive proteinases of insect pests or fungal pathogens that infect cereals. An assembled full-length amino acid sequence of a serpin expressed in cotton boll fiber (GaZ1) included conserved regions essential for serpin-proteinase interaction, suggesting inhibitory capacity at a putative reactive center P2-P2' with a sequence of four Gln residues.


Natural Antibodies as Rheostats for Susceptibility to Chronic Diseases in the Aged.
Natural antibodies are spontaneously produced in the absence of infection or immunization, and are both anti-microbial and autoreactive. Autoreactive natural antibodies can bind noxious molecules, such as those involved in clinical situations of atherosclerosis (oxLDL), malignancy (NGcGM3), and neurodegeneration (amyloid, tau) and can affect the fate of their targets or the cells bearing them to maintain homeostasis. Clinically relevant natural antibodies have been shown to decline with advancing age in those few situations where measurements have been made. Consistent with this, human B-1 cells that are thought to be responsible for generating natural antibodies also decline with advancing age. These findings together suggest that an age-related decline in amount or efficacy of homeostatic natural antibodies is associated with relative loss of protection against molecules involved in several diseases whose incidence rises in the older age population, and that those individuals experiencing greatest loss are at greatest risk. In this view, natural antibodies act as rheostats for susceptibility to several age-related diseases. These considerations suggest that administration of natural antibodies, or of factors that maintain B-1 cells and/or enhance production of natural antibodies by B-1 cells, may serve to counteract the onset or progression of age-related chronic illness.


Colon Macrophages Polarized by Commensal Bacteria Cause Colitis and Cancer through the Bystander Effect.
Intestinal commensal bacteria have recently been shown to trigger macrophages to produce diffusible clastogens (or chromosome-breaking factors) through a bystander effect (BSE) that mediates DNA damage and induces chromosomal instability in neighboring cells. Colon macrophages appear central to colon carcinogenesis and BSE through the expression of tumor necrosis factor-α (TNF-α) and cyclooxygenase-2 (COX-2). The former induces netrin-1, a regulator of intestinal epithelial cell apoptosis, and the latter generates trans-4-hydroxy-2-nonenal (4-HNE), an endogenous mutagen. To test whether colon macrophages are key effectors for BSE, we depleted these cells in interleukin-10 knockout mice colonized with Enterococcus faecalis using encapsulated liposomal clodronate (ELC), a bisphosphonate that causes macrophage apoptosis. We observed that E. faecalis polarizes colon macrophages to an M1 phenotype. In addition, depleting these cells suppressed COX-2 and TNF-α, blocked the formation of 4-HNE protein adducts, and inhibited up-regulation of netrin-1-all markers for BSE. Finally, treatment with ELC prevented colitis, β-catenin activation, and cancer formation. These results show that selected human commensals can polarize colon macrophages to the M1 phenotype and, when activated, serve as the key effector for bacterial-induced BSE. Our findings suggest that depleting M1-polarized macro-phages is a mechanism for the chemopreventive activity of bisphosphonates and that it represents a new strategy for preventing colon cancer induced by intestinal commensals.


Revealing the Joint Mechanisms in Traditional Data Linked With Big Data.
Recent technological advances have made it possible to study human behavior by linking novel types of data to more traditional types of psychological data, for example, linking psychological questionnaire data with genetic risk scores. Revealing the variables that are linked throughout these traditional and novel types of data gives crucial insight into the complex interplay between the multiple factors that determine human behavior, for example, the concerted action of genes and environment in the emergence of depression. Little or no theory is available on the link between such traditional and novel types of data, the latter usually consisting of a huge number of variables. The challenge is to select - in an automated way - those variables that are linked throughout the different blocks, and this eludes currently available methods for data analysis. To fill the methodological gap, we here present a novel data integration method.


Immunogenicity of variable regions of the surface envelope glycoprotein of HTLV type I and identification of new major epitopes in the 239-261 region.
The reactivity of sera of 96 individuals infected with human T-cell leukemia virus type I (HTLV-I) was tested against various synthetic peptides corresponding to the gp46 immunodominant antigenic domains: residues 86-107, 175-199, and 239-261. The frequency of reactive sera was higher for 175-199 (93%) than for 239-261 (78%) or 86-107 (24%) with some variations in geographical regions and in diseases. The region 239-261 was extensively analyzed and five (linear or conformational) epitopes were found. The reactivity of sera toward functional or immunodominant domains may depend on the sequence of the infecting virus, and the role of three frequent substitutions (asparagine by tyrosine, proline by serine, and serine by proline or leucine at positions 93, 192, and 250 respectively) was established. Finally, the role of the genetic background of the host may condition the humoral immune response as individuals infected by HTLV-Is harboring the same predicted gp46 peptide sequence may recognize one, several, or all regions examined.


Utilizing a novel radiographic image segmentation method for the assessment of periodontal healing following regenerative surgical treatment.
The aim of the current article was to present a radiographic method to determine the surface area of newly formed periodontal attachment, as well as to analyze volumetric and morphologic changes after regenerative periodontal treatment. In this retrospective study, 11 singular intrabony periodontal defects were selected for minimally invasive surgical treatment and 3D evaluation. 3D virtual models were acquired by the segmentation of pre- and postoperative CBCT scans. This study determined the surface area of baseline periodontal attachment (RSA-A) and defect-involved root surface (RSA-D) on the preoperative 3D models, and the surface area of new periodontal attachment (RSA-NA) on the postoperative models. Finally, cumulative change of periodontal attachment (∆RSA-A) was calculated and Boolean subtraction was applied on pre- and postoperative 3D models to demonstrate postoperative 3D hard tissue alterations. The average RSA-A was 84.39 ± 33.27 mm2, while the average RSA-D was 24.26 ± 11.94 mm2. The average surface area of RSA-NA after regenerative periodontal surgery was 17.68 ± 10.56 mm2. Additionally, ∆RSA-A was determined to assess the overall effects of ridge alterations on periodontal attachment, averaging 15.53 ± 12.47 mm2, which was found to be statistically significant (P = .00149). Lastly, the volumetric hard tissue gain was found to be 33.56 ± 19.35 mm3, whereas hard tissue resorption of 26.31 ± 38.39 mm3 occurred. The proposed 3D radiographic method provides a detailed understanding of new periodontal attachment formation and hard tissue alterations following regenerative surgical treatment of intrabony periodontal defects.


The comparison of epidural fentanyl, epidural lidocaine, and intravenous fentanyl in patients undergoing gastrectomy.
This study was conducted prospectively to compare the effect of epidural fentanyl (EP-F), epidural lidocaine (EP-L), and intravenous fentanyl (IV-F) on hemodynamic and hormonal responses to surgery and postoperative analgesic requirement in 30 patients undergoing gastrectomy during isoflurane anesthesia. An epidural catheter was placed via the T8-9 interspace. Group EP-F received fentanyl 2 micrograms/kg in 10 mL saline, and Group EP-L, 10 mL 1.5% lidocaine, epidurally; Group IV-F was given fentanyl, 2 micrograms/kg, IV. Fifty percent of the original dose was repeated every hour. Hemodynamic data and plasma hormonal levels were compared between those before and those at 1 h after skin incision. The total number of analgesic administrations within the first 48 h postoperatively were compared. Group EP-L developed more frequent episodes of hypotension. Group IV-F required higher isoflurane concentrations and the plasma epinephrine levels increased more than in Groups EP-F and EP-L. In Groups EP-L and IV-F, the plasma antidiuretic hormone (ADH) level increased more than in Group EP-F. In Groups EP-F and IV-F, the plasma cortisol and adrenocorticotropic hormone (ACTH) levels increased more than in Group EP-L. The use of postoperative analgesics was significantly less in Group EP-F. In conclusion, in Group EP-F, attenuated hormonal responses to surgery was accompanied with less hypotension and postoperative analgesic requirements were reduced.


Alcoholics' selective attention to alcohol stimuli: automated processing?
This study investigated alcoholics' selective attention to alcohol words in a version of the Stroop color-naming task. Alcoholic subjects (n = 23) and nonalcoholic control subjects (n = 23) identified the color of Stroop versions of alcohol, emotional, neutral and color words. Manual reaction times (RTs), skin conductance responses (SCRs) and heart rate (HR) were recorded. Alcoholics showed overall longer RTs than controls while both groups were slower in responding to the incongruent color words than to the other words. Alcoholics showed longer RTs to both alcohol (1522.7 milliseconds [ms]) and emotional words (1523.7 ms) than to neutral words (1450.8 ms) which suggests that the content of these words interfered with the ability to attend to the color of the words. There was also a negative correlation (r = -.41) between RT and response accuracy to alcohol words for the alcoholics, reflecting that the longer time the alcoholics used to respond to the color of the alcohol words, the more incorrect their responses were. The alcoholics also showed significantly greater SCRs to alcohol words (0.16 microSiemens) than to any of the other words (ranging from 0.04-0.08 microSiemens), probably reflecting the emotional significance of the alcohol words. Finally, the alcoholics evidenced smaller HR acceleration to alcohol (1.9 delta bpm) compared to neutral (2.8 delta bpm), which could be related to difficulties alcoholics experience in terminating their attention to the alcohol words. These findings indicate that it is difficult for alcoholics to regulate their attention to alcohol stimuli, suggesting that alcoholics' processing of alcohol information is automated.


World demographic scenario of the 21st century, with special reference to Sri Lanka.
"The objective of this paper...is to highlight the World Demographic Scenario of the 21st century, with special reference to Sri Lanka." Aspects considered include world population trends, spatial distribution, migration, fertility, age distribution, health, the present demographic situation in Sri Lanka, and the country's National Action Plan for Reproductive Health.


Autofluorescence imaging to identify oral malignant or premalignant lesions: Systematic review and meta-analysis.
The aim is to evaluate the accuracy of autofluorescence for screening oral cancer in comparison with toluidine blue staining and clinical examination. Oral mucosal disorders detected by autofluorescence were compared with those detected using toluidine blue staining. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic odds ratio (DOR) for autofluorescence was 8.197 (95% confidence interval, 4.018-16.723). The area under the summary receiver operating characteristic curve (AUC) was 0.815. Compared with toluidine blue, autofluorescence had a similar sensitivity, negative predictive value, and AUC but a lower specificity and DOR. Compared with clinical examination, the autofluorescence had a higher sensitivity but lower specificity, DOR, and AUC. Although the diagnostic accuracy of autofluorescence in the screening work-up of oral cancer and precancer was more sensitive than those of clinical examination and toluidine blue staining, it was not accurate enough to be used alone reliably.


Genome Comparison Reveals Mutation Hotspots in the Chloroplast Genome and Phylogenetic Relationships of Ormosia Species.
The papilionoid legume genus Ormosia comprises approximately 130 species, which are distributed mostly in the Neotropics, with some species in eastern Asia and northeastern Australia. The taxonomy and evolutionary history remain unclear due to the lack of a robust species-level phylogeny. Chloroplast genomes can provide important information for phylogenetic and population genetic studies. In this study, we determined the complete chloroplast genome sequences of five Ormosia species by Illumina sequencing. The Ormosia chloroplast genomes displayed the typical quadripartite structure of angiosperms, which consisted of a pair of inverted regions separated by a large single-copy region and a small single-copy region. The location and distribution of repeat sequences and microsatellites were determined. Comparative analyses highlighted a wide spectrum of variation, with trnK-rbcL, atpE-trnS-rps4, trnC-petN, trnS-psbZ-trnG, trnP-psaJ-rpl33, and clpP intron being the most variable regions. Phylogenetic analysis revealed that Ormosia is in the Papilionoideae clade and is sister to the Lupinus clade. Overall, this study, which provides Ormosia chloroplast genomic resources and a comparative analysis of Ormosia chloroplast genomes, will be beneficial for the evolutionary study and phylogenetic reconstruction of the genus Ormosia and molecular barcoding in population genetics and will provide insight into the chloroplast genome evolution of legumes.


Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines.
Health services cannot be delivered without an adequate, competent health workforce. Evidence suggests a direct relationship between density of health workforce and health outcomes. The Philippines is faced with health workforce challenges including shortages, inequitable distribution and inadequate skill mix which hinder health service delivery. Evidence-based workforce planning is, therefore, critical to achieve universal health care. The Philippines adopted the World Health Organization's workload indicators of staffing need methodology. Using a multistage sampling method, nine regions with poor health indicators in tuberculosis, family planning, and maternal child health were identified. Physicians, nurses, midwives, and medical technologists were prioritized in the study from 89 primary care health facilities (barangay health stations, rural health units, and city health offices). Data was collected using in-depth interviews, document reviews, observations, and field visits. The workload indicators of staffing need software were used for data analysis to determine staffing requirements and analyse workforce pressure. The study showed varied results in terms of staffing requirements and workload pressure across cadres and facility types. Some health facilities exhibited staff shortages and high workload pressure. Out of the 40 rural health units and city health offices, only three had the required physicians needed and 22 facilities had a shortage of physicians working under high workload pressure. Other facilities had excess staff compared to the calculated requirements. Nurses at the rural health units showed high workload pressure. Ten rural health units had no medical technologists. Midwives at barangay health stations exhibited extremely low workload pressures. The study identifies the need for the Philippine Health System, both through the Department of Health and the local governments to efficiently optimize the available health workers by revising the services offered at the primary health care facilities. The results provide evidence for staffing requirements at various levels of care based on workloads, scope of practice and time taken to undertake specific tasks at the barangay health stations, rural health units and city health offices to be integrated into the human resources for health management systems.