[Ecologic view: a web in the nursing].
From the revolutionary changes in reality concept, caused by physics and modern thoughts, new consistent vision of the world emerge and it is influenced from the classic physics to quantum physics transition. The aim of this study is to show Capra's thoughts influenced the ecologic nursing care dissemination. The new paradigm can be called an ecologic view in a wider and deeper perspective. Health in the holistic view of men with its relationship encompass an ecological thought in which requires nurses'competence area. Also it needs a critical thinking towards knowing, being and doing in order to compromise changes to raise emotions, enchantment and to take care of nature for the quality and existence of humanity.


Effects of feeding organic trace minerals on milk production and reproductive performance in lactating dairy cows: a meta-analysis.
The objectives of this meta-analysis were to evaluate the effectiveness of supplementation with the organic trace minerals (OTM; Availa-4 and 4-Plex, Zinpro Corp., Eden Prairie, MN) on milk yield, composition, and component yields and reproductive performance in dairy cows. Twenty research papers and reports on the effects of OTM were considered in this meta-analysis. Criteria for inclusion in the study were information on the form of OTM, an adequate description of randomization, production and reproduction data, and associated measures of variance (SE or SD) and P-values. The OTM increased milk production by 0.93 kg [95% confidence interval (CI)=0.61 to 1.25], milk fat by 0.04 kg (95% CI=0.02 to 0.05), and milk protein by 0.03 kg (95% CI=0.02 to 0.04) per day. Milk SCC was not different in cows supplemented with OTM. All production outcomes except milk solids (yield) and milk SCC were heterogeneous. Meta-regression analysis showed that feeding before calving, feeding for a full lactation after calving, and the use of other supplements increased responses over feeding after calving only, feeding for part of lactation, or not using other supplements, respectively. Supplementation of cows with OTM reduced days open (weighted mean difference=13.5 d) and number of services per conception (weighted mean difference=0.27) in lactating dairy cows. The risk of pregnancy on d 150 of lactation was greater in cows fed OTM (risk ratio=1.07), but OTM had no significant effect on the interval from calving to first service and 21-d pregnancy rate. There was no evidence of heterogeneity for any of the reproductive outcomes evaluated. The results of this meta-analysis showed that organic trace mineral supplementation could improve production and reproduction in lactating dairy cows.


[Experience of continuous fluid therapy in successfully rescuing a patient with acute severe paraquat poisoning].
Paraquat (PQ) poisoning has become one of the common pesticide poisoning in China. PQ is extremely toxic to human beings. The fatality rate of oral PQ poisoning is more than 90%. So far, there is no specific antidote. Seek effective treatment measures for PQ poisoning has become the focus of clinical medical research. In November 2017, a patient with acute severe PQ poisoning was treated in the intensive care unit (ICU) of Shouguang People's Hospital Affiliated to Weifang Medical College. The patient refused blood purification therapy and was rescued successfully only by continuous fluid therapy, diuresis, catharsis and routine treatment. By reviewing the treatment process of this case, new treatment ideas for the clinical treatment of PQ poisoning in primary hospitals were provided. Patients with acute PQ poisoning should be rescued by immediate administration of emetic, gastric lavage, catharsis and oral montmorillonite powder. For those without dysfunction of heart, lung and and kidney, a large amount of fluid treatment and diuresis should be given immediately to promote the excretion of poison. The key to improve the success rate of rescue of acute PQ poisoning is to eliminate PQ from the body as soon as possible.


Gender differences in the factors influencing consistent condom use among young people in Tanzania.
AIDS has become a major cause of death in Tanzania and young people represent the most vulnerable group. Recent HIV prevalence data showed that young women are more likely than young men to become infected. This paper examined commonalties and differences in the sociodemographic and ideational predictors of condom use among young men and women in Tanzania. The data derive from a 2004 sample survey among young people aged 15-24 years in five regions of Tanzania. The sample on which the analyses were based included 1,523 single women and 1,200 single men. An ideation framework guided the analyses of the predictors of consistent condom use. Logistic regression was the main analytic method used and separate models were estimated for men and women. The most significant correlates of consistent condom use for men included perceived self-efficacy for correct condom use, discussing condom use with friends, and perceived self-efficacy for using condoms with a long-term partner. Discussing condom use with a sex partner and the perceived self-efficacy to refuse sex if the sex partner refused to use a condom were the most significant predictors for women. One implication of the findings is that for men, effective interventions should emphasize correct condom use know-how and address the issue of negative peer pressure and group norms around condom use. For women, interventions should focus on sexual empowerment.


[Cerebrovascular disorders as a manifestation of a generalized disease].
During the last years several risk factors for cerebrovascular disease (CVI) could be identified by epidemiologic studies; the incidence of CVI, like that of coronary artery disease, seems to be closely related to high blood pressure, hyperlipidaemia, smoking and diabetes mellitus. The diagnostic difficulties in CVI, especially concerning the localization and size of vascular lesions, explain controversal results in the evaluation of different clinical studies. A comparison of these results is often hard to perform also out of the different statistical methods applied in the various trials. The development of improved diagnostic methods, especially ultrasonography, which allow a better definition of disease processes, offers an advantage for controlled screening and intervention trials. After all further improvements in disease prevention as well as in diagnostic and therapeutic procedures require an intensive co-operation between internal medicine and neurology.


Qualitative and quantitative platelet defect with bleeding symptoms as presenting feature of non Hodgkin lymphomas.
A young man with bleeding symptoms, mild thrombocytopenia and abundant marrow megakaryocytes was classified as having idiopathic thrombocytopenic purpura. Neither prednisone therapy nor splenectomy modified the clinical picture. Subsequently, a severe defect of platelet aggregation and release reaction was demonstrated. Fifteen months after the onset of bleeding symptoms, fever and hepatomegaly appeared and the diagnosis of T cell non Hodgkin lymphoma was made on the basis of a histologic review of paraffin sections of the spleen. Chemotherapy induced remission of the lymphoma, disappearance of bleeding symptoms and normalization of the platelet count and function.


Can we define patients with no chance of survival after out-of-hospital cardiac arrest?
To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. Various ambulance organisations in Sweden. Prospective observational study. Among the 16,712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.


Clinical applications of power spectral analysis of electromyographic investigations in muscle function.
Electromyographic (EMG) power spectral analysis of the electrical signals produced by a contracting muscle is emerging as a useful clinical tool. It has the potential to measure objectively the fatigue rate of individual muscles during an exertion. This technical note gives a simple introduction to the spectral changes of the EMG signals during fatigue. It outlines the technical aspects of EMG investigations including the data collection, signal analysis and its interpretation. The clinical applications, its present limitations and future applications are also given. The correct use and interpretation of the power spectral analysis in the clinical environment is important for its further development as a clinical measurement.


Complexation of buffer constituents with neutral complexation agents: part II. Practical impact in capillary zone electrophoresis.
This article elucidates the practical impact of the complexation of buffer constituents with complexation agents on electrophoretic results, namely, complexation constant determination, system peak development, and proper separation of analytes. Several common buffers, which were selected based on the pH study in Part I of this paper series (Riesová, M.; Svobodová, J.; Tošner, Z.; Beneš, M.; Tesařová, E.; Gaš, B. Anal. Chem., 2013, DOI: 10.1021/ac4013804); e.g., CHES, MES, MOPS, Tricine were used to demonstrate behavior of such complex separation systems. We show that the value of a complexation constant determined in the interacting buffers environment depends not only on the analyte and complexation agent but it is also substantially affected by the type and concentration of buffer constituents. As a result, the complexation parameters determined in the interacting buffers cannot be regarded as thermodynamic ones and may provide misleading information about the strength of complexation of the compound of interest. We also demonstrate that the development of system peaks in interacting buffer systems significantly differs from the behavior known for noncomplexing systems, as the mobility of system peaks depends on the concentration and type of neutral complexation agent. Finally, we show that the use of interacting buffers can totally ruin the results of electrophoretic separation because the buffer properties change as the consequence of the buffer constituents' complexation. As a general conclusion, the interaction of buffer constituents with the complexation agent should always be considered in any method development procedures.


Altered regulation of apolipoprotein A-IV gene expression in the liver of the genetically obese Zucker rat.
Apolipoprotein (apo) A-IV, a structural component of chylomicrons and high-density lipoproteins, may play a role in the catabolism of triglyceride-rich lipoproteins and in reverse cholesterol transport. To study the regulation of apoA-IV gene expression by genetic and nutritional factors, we determined the effect of a fish oil-rich and a sucrose-rich diet on apoA-IV gene transcription and nuclear and total cellular apoA-IV mRNA abundance in livers of genetically obese, hyperlipoproteinemic (fa/fa) Zucker rats and their lean (Fa/-) littermates. In obese rats fed chow, hepatic apoA-IV gene expression was more than twofold higher than in lean rats because of a post-transcriptional mechanism. apoA-I gene expression and apoC-III mRNA levels, studied as controls, were similar in both groups. The fish oil-rich diet reduced total cellular apoA-IV mRNA abundance transcriptionally to 34 +/- 4% of basal values in lean rats, but did not alter apoA-IV gene expression in obese rats. In contrast, this diet reduced apoA-I gene expression in both lean and obese animals. The sucrose-rich diet increased apoA-IV gene expression twofold in both lean and obese rats. Thus, genetic obesity alters the response of hepatic apoA-IV gene expression to a lipid-lowering diet rich in fish oil by a mechanism affecting transcriptional regulation.


Transmission of flea-borne zoonotic agents.
Flea-borne zoonoses such as plague (Yersinia pestis) and murine typhus (Rickettsia typhi) caused significant numbers of human cases in the past and remain a public health concern. Other flea-borne human pathogens have emerged recently (e.g., Bartonella henselae, Rickettsia felis), and their mechanisms of transmission and impact on human health are not fully understood. Our review focuses on the ecology and epidemiology of the flea-borne bacterial zoonoses mentioned above with an emphasis on recent advancements in our understanding of how these organisms are transmitted by fleas, maintained in zoonotic cycles, and transmitted to humans. Emphasis is given to plague because of the considerable number of studies generated during the first decade of the twenty-first century that arose, in part, because of renewed interest in potential agents of bioterrorism, including Y. pestis.


Is the indicator magnifying window for insulin pens helpful for elderly diabetic patients?
Patients with type 2 diabetes who require insulin therapy are commonly elderly and have poor visual acuity. In this study, we examined the clinical usefulness of the indicator magnifying window (IMW) for elderly patients with type 2 diabetes. We recruited 50 patients with type 2 diabetes over the age of 60 who had used insulin pens for glucose control. They were asked to set the insulin pen at randomly selected doses with or without an IMW. We assessed dosing accuracy, convenience, self-confidence, need for eyeglasses, preference, and willingness to recommend the IMW to other patients. Although the IMW did not improve the dosing accuracy or convenience, it significantly decreased the need for eyeglasses. Overall, the clinical usefulness of the IMW is quite limited in elderly patients with type 2 diabetes.


Degree of Conversion of Resin-Modified Glass Ionomer Cement Containing Hydroxyapatite Nanoparticles.
Hydroxyapatite (HA) nanoparticles are used to improve the physical and mechanical properties of glass ionomers (GIs). This study aimed to assess the effect of addition of different weight percentages of nano-HA on degree of conversion (DC) of Fuji II LC GI cement using a spectrometer. In this in vitro experimental study, 30 samples were fabricated of Fuji II LC (improved) GI cement in six groups (n=5) containing 0%, 1%, 2%, 5%, 7% and 10wt% nano-HA. The obtained paste in each group was subjected to Fourier-transform infrared spectroscopy (FTIR) before curing to assess the monomer to polymer DC percentage. The paste was then light-cured and underwent FTIR again. One-way ANOVA was applied to compare the DC percentage of different groups. Pairwise comparisons were performed using the Tukey's test. The DC was 57.88±0.57% in 0%, 60.04±0.63% in 1%, 66.92±0.54% in 2%, 65.5±0.71% in 5%, 51.49±0.24% in 7% and 50.09±0.32% in 10% nano-HA group. The difference in DC among the groups was statistically significant (P<0.0001). The highest DC was noted in 2% nano-HA and the lowest DC was found in 10% nano-HA group. Pairwise comparisons revealed significant differences between the groups in DC (P<0.0001). Increasing the weight percentage of nano-HA to 2% increased the DC but increasing the nano-HA weight percentage over 5% decreased the DC of resin-modified glass ionomer cement (RMGIC). The highest DC was noted in 5w% and 2w% nano-HA groups. Thus, 5w% and 2w% nano-HA can be used to improve the DC of RMGIC.


Microscopic aspects of macrophage system cells in hemorrhagic stroke in humans.
Stroke is an important public health issue because it has high morbidity and mortality rates. In addition, it has one of the highest rates of disability in adults. Recent data show that macrophage system cells, especially microglial cells, are involved both in neuroprotective processes and in the neurotoxicity, depending on the type and extent of the brain damage. In our study, using histology and immunohistochemistry techniques, we evaluated the macrophage-type cell reaction in cerebral hemorrhage. We found that the number of CD68-positive cells increased 7-8 folds per square millimeter of cortical surface in the cerebral parenchyma adjacent to the hemorrhage. We identified a large number of perivascular-activated macrophages, in areas distant to the hemorrhage, showing that individuals with hemorrhagic stroke have profound and extensive alterations of the blood-brain barrier.


Effects of perivascular Botulinum Toxin-A application on vascular smooth muscle and flap viability in the rat.
Botulinum toxin-A (BTX) has become a widely used pharmacologic agent for esthetic surgeons and those who treat neuromuscular and gastrointestinal conditions. Until recently, there has been very little basic science research related to how this powerful agent may be useful when applied to vessels. The mechanism of action of this agent suggests that it may be useful in treating vasospastic conditions and ischemic tissues. We present data from experiments conducted to establish whether perivascular application of BTX decreases skin flap necrosis in an island pedicle skin flap in the rat. Using an ischemic ventral pedicled island cutaneous flap model, 30 adult Sprague-Dawley rats were divided into groups and treated with BTX, papaverine, or saline to the intact vascular pedicle to determine the percentage of tissue necrosis and ischemia. Flaps were elevated, and the pedicle treated with 1 of the 3 agents, and the flaps reinset. Analysis of the percentage of flap necrosis and areas of flap ischemia were evaluated on postoperative day 4. There were no differences in area of flap necrosis between BTX-, papaverine-, and saline-treated animal groups. There was a significant decrease in flap ischemia in the papaverine-treated group compared with both BTX and saline (P < 0.01). When necrotic and ischemic areas were combined, papaverine again showed a protective effect when compared with the BTX- and saline-treated groups (P < 0.04). In our ischemic pedicled island cutaneous flap model, papaverine showed the greatest protective effect against skin flap ischemia compared with BTX and saline. However, our data suggest that BTX may provide a protective effect after the first several days following flap elevation.


Supplementation of porcine in vitro maturation medium with FGF2, LIF, and IGF1 enhances cytoplasmic maturation in prepubertal gilts oocytes and improves embryo quality.
In porcine in vitro production (IVP) systems, the use of oocytes derived from prepubertal gilts, whilst being commercially attractive, remains challenging due to their poor developmental competence following in vitro maturation (IVM). Follicular fluid contains important growth factors and plays a key role during oocyte maturation; therefore, it is a common supplementation for porcine IVM medium. However, follicular fluid contains many poorly characterized components, is batch variable, and its use raises biosecurity concerns. In an effort to design a defined IVM system, growth factors such as cytokines have been previously tested. These include leukaemia inhibitory factor (LIF), fibroblast growth factor 2 (FGF2), and insulin-like growth factor 1 (IGF1), the combination of which is termed 'FLI'. Here, using abattoir-derived oocytes in a well established porcine IVP system, we compared follicular fluid and FLI supplementation during both IVM and embryo culture to test the hypothesis that FLI can substitute for follicular fluid without compromising oocyte nuclear and cytoplasmic maturation. We demonstrate that in oocytes derived from prepubertal gilts, FLI supplementation enhances oocyte meiotic maturation and has a positive effect on the quality and developmental competence of embryos. Moreover, for the first time, we studied the effects of follicular fluid and FLI combined showing no synergistic effects.


[Apoptosis in hypertensive cardiopathy].
Numerous hypothesis have been considered to explain the fundamental mechanism(s) for the development of systolic dysfunction and heart failure in animals and humans with arterial hypertension. Besides contractile disturbances of cardiomyocytes and interstitial and perivascular fibrosis, cardiomyocyte loss is now being considered as one of the determinant factors of the maladaptive processes implicated in the transition from compensated to decompensated left ventricular hypertrophy. Much experimental evidence suggests that exaggerated apoptosis may account for the loss of cardiomyocytes in the hypertensive left ventricle. Furthermore, some factors intrinsic and extrinsic to the cardiomyocyte have emerged recently as potential candidates to trigger apoptosis. The elucidation of the possible interactions between these factors may be of major interest to prevent the progression to heart failure in patients with hypertensive heart disease.


Platelet-Rich Fibrin Scaffolds for Cartilage and Tendon Regenerative Medicine: From Bench to Bedside.
Nowadays, research in Tissue Engineering and Regenerative Medicine is focusing on the identification of instructive scaffolds to address the requirements of both clinicians and patients to achieve prompt and adequate healing in case of injury. Among biomaterials, hemocomponents, and in particular Platelet-rich Fibrin matrices, have aroused widespread interest, acting as delivery platforms for growth factors, cytokines and immune/stem-like cells for immunomodulation; their autologous origin and ready availability are also noteworthy aspects, as safety- and cost-related factors and practical aspects make it possible to shorten surgical interventions. In fact, several authors have focused on the use of Platelet-rich Fibrin in cartilage and tendon tissue engineering, reporting an increasing number of in vitro, pre-clinical and clinical studies. This narrative review attempts to compare the relevant advances in the field, with particular reference being made to the regenerative role of platelet-derived growth factors, as well as the main pre-clinical and clinical research on Platelet-rich Fibrin in chondrogenesis and tenogenesis, thereby providing a basis for critical revision of the topic.


Surface modification of polymers treated by various fluorinating media.
Fluorination processes of polymer surfaces are able to lead to drastic modifications of the surface properties without changing the bulk characteristics of the virgin material. In this paper, two types of polymers, i.e. ultrahigh molecular weight polyethylene (UHMWPE) and high density polyethylene (HDPE), are considered. The surface of these materials have been modified using two different fluorination routes, both carried out at room temperature: the direct fluorination with 10% F2 + 90% He gaseous mixtures and the radio-frequency plasma-enhanced fluorination (PEF) using either O2/CF4 mixtures or c-C4F8. The effect of these processes on the surface of the polymer samples are compared using mostly XPS results. The different components of the C1s spectra are assigned in term of CFx bonding, giving valuable information on the surface fluorination rate.


Accelerating metabolism and transmembrane cation flux by distorting red blood cells.
Under static conditions, mammalian red blood cells (RBCs) require a continuous supply of energy, typically via glucose, to maintain their biconcave disc shape. Mechanical distortion, in a complementary way, should lead to increased energy demand that is manifest in accelerated glycolysis. The experimental challenge in observing this phenomenon was met by reversibly and reproducibly distorting the cells and noninvasively measuring glycolytic flux. This was done with a gel-distorting device that was coupled with 13C nuclear magnetic resonance (NMR) spectroscopy. We measured [3-13C]l-lactate production from [1,6-13C]d-glucose in the RBCs suspended in gelatin gels, and up to 90% rate enhancements were recorded. Thus, for the first time, we present experiments that demonstrate the linkage of mechanical distortion to metabolic changes in whole mammalian cells. In seeking a mechanism for the linkage between shape and energy supply, we measured transmembrane cation flux with Cs+ (as a K+ congener) using 133Cs NMR spectroscopy, and the cation flux was increased up to fivefold. The postulated mechanism for these notable (in terms of whole-body energy consumption) responses is stimulation of Ca-adenosine triphosphatase by increased transmembrane flux of Ca2+ via the channel protein Piezo1 and increased glycolysis because its flux is adenosine triphosphate demand-regulated.


Intracardiac hemodynamics in man during short periods of head-down and head-up tilt.
The intracardiac hemodynamic responses to short periods of 70 degrees head-down and head-up tilts were studied in 12 normal male subjects, ages 19-24 years. Echo-Doppler techniques were used to measure the transmitral and transaortic flow velocities as well as cardiac index, and to evaluate the peripheral impedance. Head-down tilt (HDT) rapidly induced an increase (9.7%, p < 0.05) in the early passive filling of the left ventricle (ME peak of the transmitral flow velocity curve) and in transaortic flow velocity (8%, p < 0.05), as well as in cardiac output (6%, p < 0.05). In spite of a peripheral vasodilation, the blood pressure increased (7%, p < 0.05 for the systolic; 15%, p < 0.01 for the diastolic) and remained at a high level for the 5 min of the experiment. Head-up tilt (HUT) induced inverse responses; i.e., a large initial decrease in the transmitral (-15%, p < 0.05) and transaortic (-16%, p < 0.001) flows. The shape of the arterial peripheral flow indicated an increased vascular impedance. After a short drop, the blood pressure rapidly recovered a level statistically close to that of the pretest. In both cases, tachycardia occurred. We conclude that, in man, the cardiac responses to the changes in posture appear to be related more to the passive changes in ventricular filling due to the blood shift than to the nervous regulation by the arterial baroreflexes, whereas these reflexes mainly act in the control of the vascular impedance.


Variable infectivity of third-stage larvae of Brugia malayi.
Infectivity of third-stage larvae of Brugia malayi was assessed following intraperitoneal inoculation into jirds, Meriones unguiculatus. Larvae were of two ages and were derived from two sites in Aedes aegypti mosquitoes, i.e., specimens collected from the thorax 11 days after infection and from the head on day 14. Larvae from the thorax had just completed the second moult and measured 990 to 1100 micron in length. Only 6% of these specimens developed to adult worms in jirds. Larvae that migrated to the head were 1400 to 1700 micron long on day 14 and, in contrast, 23% of the inocula developed to adult worms. This study establishes that all third-stage larvae, regardless of their age or location in the arthropod host, are potentially infective. However, pronounced physical maturation does seem to be accompanied by a marked increase in infectivity.


The first pentagonal-bipyramidal vanadium(III) complexes with a Schiff-base N3O2 pentadentate ligand: synthesis, structure and magnetic properties.
A series of three mononuclear pentagonal-bipyramidal V(iii) complexes with the equatorial pentadentate N3O2 ligand (2,6-diacethylpyridinebis(benzoylhydrazone), H2DAPBH) in the different charge states (H2DAPBH0, HDAPBH1-, DAPBH2-) and various apical ligands (Cl-, CH3OH, SCN-) were synthesized and characterized structurally and magnetically: [V(H2DAPBH)Cl2]Cl·C2H5OH (1), [V(HDAPBH)(NCS)2]·0.5CH3CN·0.5CH3OH (2) and [V(DAPBH)(CH3OH)2]Cl·CH3OH (3). All three complexes reveal paramagnetic behavior, resulting from isolated S = 1 spins with positive zero-field splitting energy expected for the high-spin ground state of the V3+ (3d2) ion in a PBP coordination. Detailed high-field EPR measurements for compound 3 show that its magnetic properties are best described by using the spin Hamiltonian with the positive ZFS energy (D = +4.1 cm-1) and pronounced dimer-like antiferromagnetic spin coupling (J = -1.1 cm-1). Theoretical analysis based on superexchange calculations reveals that the long-range spin coupling between distant V3+ ions (8.65 Å) is mediated through π-stacking contacts between the planar DAPBH2- ligands of two neighboring [V(DAPBH)(CH3OH)2]+ complexes.


Professional Identity Formation in an Advanced Pharmacy Practice Experience Emphasizing Self-Authorship.
Objective. To examine the extent to which reflective essays written by graduating pharmacy students revealed professional identity formation and self-authorship development. Design. Following a six-week advanced pharmacy practice experience (APPE) grounded in Baxter-Magolda's Learning Partnerships Model of self-authorship development, students completed a culminating reflective essay on their rotation experiences and professional identity formation. Assessment. Thematic and categorical analysis of 41 de-identified essays revealed nine themes and evidence of all Baxter-Magolda's domains and phases of self-authorship. Analysis also suggested relationships between self-authorship and pharmacist professional identity formation. Conclusion. Results suggest that purposeful structuring of learning experiences can facilitate professional identity formation. Further, Baxter-Magolda's framework for self-authorship and use of the Learning Partnership Model seem to align well with pharmacist professional identify formation. Results of this study could be used by pharmacy faculty members when considering how to fill gaps in professional identity formation in future course and curriculum development.


A suspected case of a multiple autoimmune syndrome in a poodle dog.
A 9-year-old castrated male poodle dog was presented with icterus, anorexia, and lethargy. The dog was diagnosed with hypothyroidism 1 month before and was treated with levothyroxine. Severe anaemia with spherocytes, positive saline agglutination test, and hyperbilirubinemia indicated immune-mediated haemolytic anaemia (IMHA). Therefore, immunosuppressive therapy with prednisolone, mycophenolate mofetil, and danazol was started. Although the IMHA was well controlled, during tapering of prednisolone, acute multiple joint swelling and oedema suspected immune-mediated polyarthritis occurred twice. First, clinical symptoms improved as the dosage of prednisolone increased. However, the dog showed severe adverse effects to the steroid. Second time, we added leflunomide as another immunosuppressant, and clinical signs of arthritis disappeared. About 3 weeks later, despite the immunosuppressive therapy, skin lesions resembling an autoimmune dermatologic disorder spread throughout the body. Addition of cyclosporine resolved the skin lesions. This is a case report of a dog showing several sporadic clinical signs related to multiple autoimmune syndromes and their management using different immunosuppressant drugs.


Genes involved in Haemophilus influenzae type b capsule expression are frequently amplified.
The genes involved in Haemophilus influenzae type b capsule expression are present as a duplication of an approximately 18-kb DNA segment (the Cap b locus). It has been shown previously that recombination occurs between the two copies of the repeat, resulting in deletion of one copy and loss of capsule expression at frequencies of 0.1%-0.5%. The present study tested the hypothesis that the duplicated arrangement could serve as a template for further amplification of capsule gene sequences. Southern hybridization analysis of 66 type b invasive isolates showed that amplifications exist and are moderately common (23/66 were amplified). In addition to three copies of the 18-kb repeat, four copies were detected in some strains, and up to five copies in 1 isolate. By ELISA, a five-copy strain made about six times more capsular polysaccharide than did an isogenic two-copy derivative. The evolutionary significance of the duplicated arrangement may be its ability to rapidly amplify under conditions where it is advantageous to produce more capsule.


Thiol redox proteomics seen with fluorescent eyes: the detection of cysteine oxidative modifications by fluorescence derivatization and 2-DE.
There is increasing evidence that several reversible oxidative post-translational modifications of protein cysteines participate in cell signalling. Specific proteomic techniques are required to identify these modifications and to study their regulation in different cell processes, that are collectively known as thiol redox proteomics. Recently, fluorescence derivatization methods have been developed that enable these post-translational modifications to be studied using proteomic workflows based on two-dimensional electrophoresis, which is a relatively accessible and affordable technique. As well as enabling a large number of samples to be processed, two-dimensional electrophoresis has the advantage that it does not rely on the intensive use of mass spectrometers. This methodology allows to "visualise" redox changes in a broad context and, although identification of the modified residues is not so straightforward, complementary derivatization can overcome this drawback. Here we review the different derivatization strategies that have been employed in these studies, comparing their advantages and potential limitations. We also review the applications and results obtained, with particular emphasis on those involving (patho)physiological stimuli, thereby showing the potential of these techniques to study the thiol redox proteome.


A possible mechanism of ammonium ion regulation of photosynthetic carbon flow in higher plants.
Addition of NH(4) (+) to the photosynthesizing leaf cells of Dolichos lab lab L. var. Lignosis Prain and leaf discs of Vigna sinensis L. savi ex Hassk caused a significant increase in the flow of photosynthetic carbon toward amino acids with a concomitant decrease toward sugars without affecting the over-all photosynthetic rate. Similar diversion of photosynthetic carbon away from sugars was also observed in the photosynthesizing isolated chloroplasts of V. sinensis, but the latter differed in that they accumulated organic acids rather than amino acids. In an effort to understand the mechanism of NH(4) (+)-mediated regulation, the specific and total activities of NAD(P)-glutamate dehydrogenase, glutamine synthetase, pyruvate kinase, alkaline fructose 1,6-bisphosphatase, and NAD(P)-glyceraldehyde-3-phosphate dehydrogenase of the cells of D. lab lab were checked but none was affected by the added ammonium salts even after prolonged incubation. At certain concentrations, ammonium ions abolished the light activation of NADP-glyceraldehyde-3-phosphate dehydrogenase and alkaline fructose 1,6-bisphosphatase in isolated chloroplasts from dark-adapted Vigna leaves without interfering with the basal dark activity of these enzymes. Based on these observations, a possible mechanism of action of NH(4) (+) in regulating the photosynthetic carbon flow is postulated.


[Survival of persons with hantavirus infection diagnosed in Paraná State, Brazil].
Hantavirus infection is an emerging disease with public health impact. Since the signs and symptoms are nonspecific and easily confused with those of other diseases, the prognosis could be improved by knowledge of the factors potentially contributing to the outcome. The study aimed to identify the factors associated with survival time in persons with hantavirus infection. This was a study of confirmed cases of hantavirus infection from January 1992 to June 2016 in Paraná State, Brazil. Each case presented two possible competitive outcomes: death or cure. Survival analysis used a competitive risks model and outcome probabilities estimated by the Aalen-Johansen estimator. The measure of association was the hazards ratio (HR) with 95% confidence interval (95%CI). Of the 280 individuals with hantavirus infection, 107 (38.21%) evolved to death, 161 (57.5%) to cure, and 12 (4.29%) were censored. The final survival model consisted of the use of mechanical ventilation for death (HR = 2.86; 95%CI: 1.76-4.64; p = 0.00002), hemorrhagic signs for death (HR = 2.86; 95%CI: 1.69-4.84; p = 0.00009) and for cure (HR = 0.66; 95%CI: 0.45-0.95; p = 0.03), headache for cure (HR = 1.99; 95%CI: 1.12-3.54; p = 0.02), and age under 20 years for cure (HR = 1.73; 95%CI: 1.05-2.84; p = 0.03). Hemorrhagic signs and use of mechanical ventilation are factors associated with the severity of cases and do not allow sufficient time to reverse the outcome. However, these signs of severity corroborate the argument of the importance of timely suspicion, allowing adequate clinical management to reduce case-fatality.


Relationship Between Psychological Responses and the Appraisal of Risk Communication During the Early Phase of the COVID-19 Pandemic: A Two-Wave Study of Community Residents in China.
The novel coronavirus disease (COVID-19) has affected hundreds of millions of people worldwide. Data collection in the ascending phase is crucial to address a rapidly evolving crisis by helping us understand the uncertain relationship between risk communication and psychological responses. Data were collected from 26 January 26, 2020, until February 17, 2020, with a mean test-retest interval of 16 days. A total of 846 adults from four residential communities in high-risk areas (Wuhan city) and low-risk areas (Zhengzhou city) were invited to complete a set of Internet-based questionnaires measuring the adoption of preventive behaviors, appraisal of risk communication, anxiety level, and susceptibility to emotional contagion. At the baseline assessment (Wave 1), 58 withdrew from the study, and 788 (433 females) completed the questionnaires. At the Wave 2 survey, 318 (185 females) adults from Wave 1 were retained. The results from cross-lagged models demonstrated reciprocal negative associations between anxiety and risk communication and between the appraisal of risk communication and the adoption of preventive behaviors. In addition, a higher appraisal of risk communication in the initial period of the outbreak mitigated the respondents' susceptibility to emotional contagion later on. Susceptibility to emotional contagion was positively associated with preventive behaviors taken. Furthermore, multiple-group structural equation modeling suggested that risk communication was more likely to affect the susceptibility to emotional contagion of people on the frontline of the outbreak than people living in low-risk areas. This study demonstrated the importance of risk communication aimed at encouraging appropriate countermeasures against virus outbreaks.


Lamellar keratitis following laser-assisted in situ keratomileusis.
Distinguishing between an infectious or sterile lamellar keratitis is the most important first step in evaluating patients with interface infiltrates after LASIK. The mechanisms by which infectious keratitis develops are more straightforward than for DLK and deal with the introduction of microbial pathogens into the lamellar flap during LASIK. Prevention emphasizes reducing contamination risks and treating any pre-existing ocular infections. The mechanisms of the development of DLK are likely multifactorial, and factors such as microkeratome debris, eyelid secretions, other debris, epithelial defects, and bacterial endotoxin have been suggested. Overall, much remains to be elucidated in order to devise effective prevention measures.


The family structure in contemporary Japan.
The applicability of models of the family developed in the disciplines of sociology and cultural anthropology to the modern Japanese family is considered. "Our aim is to understand the contemporary Japanese family from two perspectives: the family as an economic unit and the family as a social security provider based on the arrangement and analysis of materials and statistics concerning current structure, form, type, and size of the contemporary Japanese family." Data are primarily from the annual survey undertaken by the Ministry of Health and Welfare on living conditions.


Cancer-associated mutations activate the nonreceptor tyrosine kinase Ack1.
Ack1 is a nonreceptor tyrosine kinase that participates in tumorigenesis, cell survival, and migration. Relatively little is known about the mechanisms that regulate Ack1 activity. Recently, four somatic missense mutations of Ack1 were identified in cancer tissue samples, but the effects on Ack1 activity, and function have not been described. These mutations occur in the N-terminal region, the C-lobe of the kinase domain, and the SH3 domain. Here, we show that the cancer-associated mutations increase Ack1 autophosphorylation in mammalian cells without affecting localization and increase Ack1 activity in immune complex kinase assays. The cancer-associated mutations potentiate the ability of Ack1 to promote proliferation and migration, suggesting that point mutation is a mechanism for Ack1 deregulation. We propose that the C-terminal Mig6 homology region (MHR) (residues 802-990) participates in inhibitory intramolecular interactions. The isolated kinase domain of Ack1 interacts directly with the MHR, and the cancer-associated E346K mutation prevents binding. Likewise, mutation of a key hydrophobic residue in the MHR (Phe(820)) prevents the MHR-kinase interaction, activates Ack1, and increases cell migration. Thus, the cancer-associated mutation E346K appears to destabilize an autoinhibited conformation of Ack1, leading to constitutively high Ack1 activity.


[M. von Ardenne's multi-step cancer therapy and variations--universally applicable in oncology? Documentation No.23].
M. von Ardenne advances 2 concepts for the treatment of cancer: the Multistep-Cancer-Therapy (MCT) and the O2-Multistep-Immunostimulation (O2-MIS). Since the properties of cancer tissues postulated by. M. von Ardenne are considered common to all malignant tumours, MCT and O2-MIS can be employed in any type of malignancy. These concepts are recommended for cancer therapy and prophylaxis. The 1989 concept consists of the combination of O2-MIS (thymus) for 18 days followed by MCT on the 19th day. O2-MIS can be done on an outpatient basis, whereas MCT must be carried out in hospital. An investment of 5000 to 10,000 Fr. is needed to provide O2-MIS in a medical practice. In 1959, Prof. Dr. h. c. mult. M. von Ardenne transferred from research in the field of physics to cancer research. He published the basic concept of MCT in 1965, from which the Oxygen-Multistep-Therapy (SMT) and the O2-MIS were later derived. Most of the proponents are found in the former Federal Republic of Germany, where the SMT-Society is responsible for the dissemination of the ideas and apparatus. The mechanism of action of MCT consists of the irreversible occlusion of tumor blood vessels as a result of "elective over-acidification of the cancer cells and tumour tissue by stimulating the aerobic fermentation metabolism of cancer cells discovered by O. Warburg in 1924". O2-MIS, on the other hand, works by potentiating non-specific defences. Contrary to his claims, von Ardenne has so far been unable to demonstrate a reproducible efficacy either for the MCT or for O2-MIS against cancer in man. Despite a supposedly large number of patients treated, no clinical trials have yet been published.(ABSTRACT TRUNCATED AT 250 WORDS)


[Contaminative features of heavy metals for tidal sediment cores in Tianjin Bohai Bay].
Three sediment cores were collected in Nov. of 2003 from Dagu estuary to Qikou estuary. The grain size, TOC and heavy metal contents of core sediments were analyzed in order to study the geochemical characteristics, contamination features and the spatial and vertical distribution characters for heavy metals of tidal zones in Bohai Bay. The grain size of tidal sediments becomes finer from north to south. Ultrafine, fine and power sand are the main compositions in the sediment of Dagu and Duliujian estuary. The sediment of Qikou estuary is mainly composed by power and ultrafine sand. The vertical distribution trends of three sediment cores indicate that the grain-size becomes bigger from the bottom to the upper. The distribution of Fe, Al, Mn contents has distinct negative correlation with the grain-size of sediment, that is to say, the fine-grained sediments have higher contents of Fe, Al, Mn. Pb, Zn and Cd are the dominating contaminative elements in tidal sediments of Bohai Bay. Their contents are higher than the corresponding environmental background values, indicating of the anthropogenic enrichment.


Monomorphic ventricular tachycardia as the primary presentation of an anterior STEMI.
Traditionally sustained monomorphic ventricular tachycardia (SMVT) is associated with areas of myocardial scar such as that of chronic coronary artery disease. We present a case of SMVT in the initial setting of an acute myocardial infarction in a previously healthy individual suggesting that acute ischemia can give rise to SMVT.


Inflammatory bowel disease of the elderly: a wake-up call.
As the baby-boomer generation enters the ranks of the elderly (defined as patients over 60 years of age), the increased burden of managing older inflammatory bowel disease (IBD) patients requires recognition of the impact of comorbid disease, polypharmacy, and surgical candidacy criteria. There is a surprisingly positive response to newer therapies and surgery, provided that a distinction is made between "fit elderly" and "frail elderly" patients. The former group should not be denied access to the newer biologics, clinical trials, or surgical alternatives on the basis of age alone. There is a need for clinicians caring for elderly IBD patients to be cognizant of the multiple and often disguised conditions contributing to disease management as well as the importance for careful allocation of health resources.


Proteomic Profiling of Human Hepatic Stellate Cell Line LX2 Responses to Irradiation and TGF-β1.
Hepatic stellate cells (HSCs) are the main target of radiation damage and primarily contribute to the development of radiation-induced liver fibrosis. However, the molecular events underlying the radiation-induced activation of HSCs are not fully elucidated. In the present study, human HSC line LX2 was treated with X-ray irradiation and/or TGF-β1, and profibrogenic molecules were evaluated. The iTRAQ LC-MS/MS technology was performed to identify global protein expression profiles in LX2 following exposure to different stimuli. Irradiation or TGF-β1 alone increased expression of α-SMA, collagen 1, CTGF, PAI-1, and fibronectin. Irradiation and TGF-β1 cooperatively induced expression of these profibrotic markers. In total, 102, 137, 155 dysregulated proteins were identified in LX2 cell samples affected by irradiation, TGF-β1, or cotreatment, respectively. Bioinformatic analyses showed that the three differentially expressed protein sets were commonly associated with cell cycle and protein processing in endoplasmic reticulum. The expression of a set of proteins was properly validated: CDC20, PRC1, KIF20A, CCNB1, SHCBP, TACC3 were upregulated upon irradiation or irradiation and TGF-β1 costimulation, whereas SPARC and THBS1 were elevated by TGF-β1 or TGF-β1 plus irradiation treatment. Furthermore, CDC20 inhibition suppressed expression of profibrotic markers in irradiated and TGF-β1-stimulated LX2 cells. Detailed data on potential molecular mechanisms causing the radiation-induced HSC activation presented here would be instrumental in developing radiotherapy strategies that minimize radiation-induced liver fibrosis.


Eosinophil-Derived Neurotoxin (EDN/RNase 2) and the Mouse Eosinophil-Associated RNases (mEars): Expanding Roles in Promoting Host Defense.
The eosinophil-derived neurotoxin (EDN/RNase2) and its divergent orthologs, the mouse eosinophil-associated RNases (mEars), are prominent secretory proteins of eosinophilic leukocytes and are all members of the larger family of RNase A-type ribonucleases. While EDN has broad antiviral activity, targeting RNA viruses via mechanisms that may require enzymatic activity, more recent studies have elucidated how these RNases may generate host defense via roles in promoting leukocyte activation, maturation, and chemotaxis. This review provides an update on recent discoveries, and highlights the versatility of this family in promoting innate immunity.


Self-reported exercise before age 40: influence on quantitative skeletal ultrasound and fall risk in the elderly.
To compare musculoskeletal factors with bone structure, as measured by quantitative ultrasound (QUS) at the calcaneus, and their potential to predict fall risk in geriatric inpatients. Longitudinal. Two geriatric hospitals in Switzerland. A total of 134 of 207 long-stay geriatric patients (96 women, 38 men) who were able to perform the timed up and go (TUG) test. Five musculoskeletal tests: 2 functional tests (TUG, for mobility; functional reach test, for balance), and 3 muscle strength tests (knee flexor, knee extensor, grip). Falls were monitored prospectively in a subgroup of 94 mobile subjects of 1 geriatric hospital throughout each individual length of stay (median, 31.4wk: interquartile range, 16-56.4wk). Functional and strength tests, mobility status, and self-reported exercise before age 40 were musculoskeletal factors to be compared with QUS. QUS was higher in mobile subjects without walking aid (p < .0001) and correlated significantly with muscle strength (knee flexor: r = .36; knee extensor: r = .30) and functional tests (TUG: r = -.25; functional reach: r = .16). Women who reported regular exercise before age 40 had higher QUS (p = .01) and fewer falls (p = .01). Falls were less frequent in subjects with walking aid (p = .03). No single musculoskeletal test, but rather a combination of demographic variables, musculoskeletal factors, and QUS could predict 76% of total variation of fall risk. This study showed the important impact of current mobility and muscle strength status on bone structure, as measured by QUS at the calcaneus. In addition, a beneficial effect of former exercise on QUS and fall risk at advanced age could be documented in women. Both findings support life-long engagement in exercise, which might be particularly meaningful for women.


Standardizing flow cytometry: construction of a standardized fluorescence calibration plot using matching spectral calibrators.
Calibration of flow cytometers is becoming an increasingly important issue for both quality control of instrument performance and quantitation of antibody binding capacity of cells. Due to the numerous different instruments and analysis software currently available, a standardized method of calibration is necessary if interlaboratory comparison of instrument performance and antibody binding is to be achieved. This report describes a new methodology to obtain a standard calibration plot that can be derived from all instruments and from which specific instrument-independent performance parameters may be calculated that can be used to directly compare the performance and setup of these instruments. The requirements that the calibrated standards must meet are discussed, as well as the acceptable ranges proposed for the instrument-independent performance parameters. In addition, data are presented from standard calibration plots generated by different flow cytometers in numerous laboratories. The corresponding Primary Performance Parameters calculated from these plots are presented and compared. It is expected that the use of this calibration method may help standardize flow cytometric measurements and will provide instrument-independent performance parameters to monitor quality control of instruments and reagents.


Birth Outcomes in Children Fathered by Men Treated with Anti-TNF-α Agents Before Conception.
The safety of paternal use of anti-tumor necrosis factor-α (TNF-α) agents immediately prior to conception is practically unknown. On the basis of nationwide data from Danish health registries, we examined the association between paternal use of anti-TNF-α agents within 3 months before conception and adverse birth outcomes. This nationwide cohort study is based on data from all women who had a live born singleton child in Denmark from 1 January 2007 through 2013. Children fathered by men treated with anti-TNF-α agents within three months before conception constituted the exposed cohort (N=372), and children fathered by men not treated before conception constituted the unexposed cohort (N=399,498). The outcomes were congenital abnormalities (CAs), preterm birth, and small for gestational age (SGA). We adjusted for multiple covariates, and considered paternal underlying disease and concomitant medication. The adjusted risks of CAs and preterm birth were close to unity, and the adjusted odds ratio (OR) for SGA was 1.70 (95% confidence interval (CI): 0.94-3.09). Restricting our analysis to fathers with inflammatory bowel disease, we found no increased risk of CAs or SGA, and the adjusted OR for pretem birth was 1.42 (95% CI: 0.52-3.86). Restricting our analysis to fathers with rheumatologic/dermatological diseases, we found no increased risk of CAs or preterm birth, and the adjusted OR for SGA was 1.70 (95% CI: 0.74-3.89). Our results are overall reassuring regarding the safety of paternal preconceptional use of anti-TNF-α agents. The result regarding SGA should, however, be interpreted with caution as we found an increased risk, although not significantly increased.


Safety and efficacy of enoxaparin treatment in venous thromboembolic disease during acute leukemia.
Venous thromboembolism (VTE) is a quite common complication in acute leukemia, although its real incidence is unknown. The best treatment of this complication is still a matter of debate due to the very high risk of hemorrhage in this group of patients. From December 2000 to December 2002 four Caucasian patients with acute leukemia developed VTE complications. The patients were three men and one woman, mean age 55.7 years (range, 27-77). Two patients with acute lymphoid leukemia (L1 and L2 according to the FAB classification) developed deep venous thrombosis during the administration of chemotherapy; one patient with acute myeloid leukemia (AML, M2 according to the FAB classification) had pulmonary thromboembolism at diagnosis, while another AML patient (M4 according to FAB) showed deep venous thrombosis as the first symptom of leukemia. The clinical diagnosis of symptomatic VTE was confirmed by objective imaging procedures including lower limb venous color Doppler imaging in all cases and a ventilation-perfusion lung scan in one case. All patients were treated with enoxaparin 100 IU/kg subcutaneously twice daily for one month, followed by 150 IU/kg once daily for at least five months. When the platelet count was below 20,000 x 10(9)/L, the dose was reduced by 50%. During antithrombotic treatment neither VTE recurrences nor hemorrhagic complications or heparin-induced thrombocytopenia occurred. The platelet count at the beginning of enoxaparin treatment was very low (mean, 55,750 x 109/L; range, 12,000-121,000 x 10(9)/L) and treatment did not affect platelet recovery. Enoxaparin proved to be efficacious and safe in the management of deep venous thrombosis with or without pulmonary embolism in patients affected by acute leukemia. Enoxaparin cured acute venous thrombosis, prevented recurrences and did not cause any hemorrhagic complications despite prolonged severe thrombocytopenia.


Repeated liver resection for recurrent liver cancer.
Patients with cancer recurrence limited to the liver alone after a first liver resection may be candidates for a repeat resection. Some 191 second and ten third liver resections for recurrent colorectal metastases, and 128 second and ten third liver resections for recurrent hepatocellular carcinoma (HCC), were evaluated after reviewing the literature. The 5-year survival rate after second liver resection for colorectal metastases was 26 per cent with a median survival time of 30 months. Mortality and morbidity rates were 1.2 and 27.4 per cent respectively. The 5-year survival rate after second resection for HCC was 40 per cent with a median survival time of 40 months. The operative mortality rate was 2.3 per cent; morbidity occurred in 13 per cent of patients with HCC. Survival after primary colorectal resection was significantly better for patients with metachronous metastases than for those with synchronous disease; survival correlated with a long interval between the first and second liver resection (in both colorectal liver cancer and HCC). Repeated liver resection may be performed in selected patients and yield a similar survival to that obtained after first liver resection.


D2-like receptor-mediated inhibition of Na+-K+-ATPase activity is dependent on the opening of K+ channels.
This study examined the effects of D2-like dopamine receptor activation on Na+-K+-ATPase activity while apical-to-basal, ouabain-sensitive, amphotericin B-induced increases in short-circuit current and basolateral K+ (I(K)) currents in opossum kidney cells were measured. The inhibitory effect of dopamin on Na+-K+-ATPase activity was completely abolished by either D1- or D2-like receptor antagonists and mimicked by D1- and D2-like receptor agonists SKF-38393 and quinerolane, respectively. Blockade of basolateral K+ channels with BaCl2 (1 mM) or glibenclamide (10 microM), but not apamin (1 microM), totally prevented the inhibitory effects of quinerolane. The K+ channel opener pinacidil decreased Na+-K+-ATPase activity. The inhibitory effect of quinerolane on Na+-K+- ATPase activity was abolished by pretreatment of opossum kidney cells with pertussis toxin (PTX). Quinerolane increased I(K) across the basolateral membrane in a concentration-dependent manner; this effect was abolished by pretreatment with PTX, S-sulpiride, and glibenclamide. SKF-38393 did not change I(K). Both H-89 (protein kinase A inhibitor) and chelerythrine (protein kinase C inhibitor) failed to prevent the stimulatory effect of quinerolane on I(K). The stimulation of the D2-like receptor was associated with a rapid hyperpolarizing effect, whereas D1-like receptor activation was accompanied by increases in cell membrane potential. It is concluded that stimulation of D2-like receptors leads to inhibition of Na+-K+-ATPase activity and hyperpolarization; both effects are associated with the opening of K+ channels.


Depression in the elderly. How to recognize masked symptoms and choose appropriate therapy.
Depression in the elderly is one of the most serious undiagnosed health problems in the United States. All physicians who care for elderly patients need to become aware of the signs of masked depression and treat it vigorously. Dr Yesavage explains how to differentiate depression from dementia, describes useful diagnostic screening tests, and offers recommendations for pharmacologic treatment of geriatric depression.


Ambient Glutamate Promotes Paroxysmal Hyperactivity in Cortical Pyramidal Neurons at Amyloid Plaques via Presynaptic mGluR1 Receptors.
Synaptic dysfunctions and altered neuronal activity play major role in the pathophysiology of Alzheimer's disease (AD), with underlying mechanisms largely unknown. We report that in the prefrontal cortex of amyloid precursor protein-presenilin 1 and APP23 AD mice, baseline activity of pyramidal cells is disrupted by episodes of paroxysmal hyperactivity. Induced by spontaneous EPSC bursts, these incidents are prevalent in neurons proximal to amyloid plaques and involve enhanced activity of glutamate with metabotropic effects. Abolition of EPSC bursts by tetrodotoxin and SERCA ATPase blockers thapsigargin or cyclopiasonic acid suggests their presynaptic origin and sensitized store-released calcium. Accordingly, the rate of EPSC bursts activated by single axon stimulation is enhanced. Aggravation of the hyperactivity by blockers of excitatory amino acid transporter (±)-HIP-A and DL-TBOA together with histochemical and ultrastructural evidence for enrichment of plaque-related dystrophies with synaptic vesicles and SNARE protein SNAP-25 infer the later as hot-spots for ectopic release of glutamate. Inhibition of EPSC bursts by I/II mGluR1 blocker MCPG or selective mGluR1 antagonist LY367385 implicate metabotropic glutamatergic effects in generation of paroxysmal bursts. These findings demonstrate for the first time that at amyloid plaques, enhanced activity of nonsynaptic glutamate can promote irregular EPSC bursts with hyperactivity of pyramidal cells via mGluR1 receptors.


C1q/TNF-related protein-12 (CTRP12), a novel adipokine that improves insulin sensitivity and glycemic control in mouse models of obesity and diabetes.
Despite the prevalence of insulin resistance and type 2 diabetes mellitus, their underlying mechanisms remain incompletely understood. Many secreted endocrine factors and the intertissue cross-talk they mediate are known to be dysregulated in type 2 diabetes mellitus. Here, we describe CTRP12, a novel adipokine with anti-diabetic actions. The mRNA and circulating levels of CTRP12 were decreased in a mouse model of obesity, but its expression in adipocytes was increased by the anti-diabetic drug rosiglitazone. A modest rise in circulating levels of CTRP12 by recombinant protein administration was sufficient to lower blood glucose in wild-type, leptin-deficient ob/ob, and diet-induced obese mice. A short term elevation of serum CTRP12 by adenovirus-mediated expression improved glucose tolerance and insulin sensitivity, normalized hyperglycemia and hyperinsulinemia, and lowered postprandial insulin resistance in obese and diabetic mice. CTRP12 improves insulin sensitivity in part by enhancing insulin signaling in the liver and adipose tissue. Further, CTRP12 also acts in an insulin-independent manner; in cultured hepatocytes and adipocytes, CTRP12 directly activated the PI3K-Akt signaling pathway to suppress gluconeogenesis and promote glucose uptake, respectively. Collectively, these data establish CTRP12 as a novel metabolic regulator linking adipose tissue to whole body glucose homeostasis through insulin-dependent and independent mechanisms.


Differential regulation of Leydig cell 3beta-hydroxysteroid dehydrogenase/delta5-delta4-isomerase activity by gonadotropin and thyroid hormone in a freshwater perch, Anabas testudineus (Bloch).
Leydig cells were isolated from the perch testes belonging to the pre-spawning stage by collagenase treatment and mechanical separation followed by percoll gradient. They were incubated in vitro either for 5 h or at different times in the absence (control) or presence of piscine gonadotropin (GTH, 2 microg (1 x 10(6) cells)(-1)) or 3,5,3'-triiodothyronine (T3, 50 ng (1 x 10(6) cells(-1)) or T3-induced protein (TIP, 2 microg (1 x 10(6) cells)(-1)). 3Beta-hydroxysteroid dehydrogenase/delta5-delta4-isomerase (3beta-HSD) activity was determined by the conversion of [3H]delta5-dehydroepiandrosterone (DHEA) to [3H]delta4-androstenedione or [3H]delta5-pregnenolone to [3H]delta4-progesterone (P4) or by spectrophotometric estimation of NADH formation from NAD. T3 significantly increased (P < 0.01) both delta5-DHEA to delta4-androstenedione and delta5-pregnenolone to delta4-P4 conversion in Leydig cells indicating stimulation of 3beta-HSD activity. T3 stimulation of 3beta-HSD activity could be inhibited by cycloheximide (50 microg ml(-1)) suggesting the involvement of T3-induced protein (TIP) which was isolated and purified earlier in this laboratory from goat Leydig cells [15]. Addition of TIP or GTH significantly stimulated Leydig cell 3beta-HSD activity (P < 0.01). However, there was a difference between TIP and GTH stimulation in time kinetic study where TIP enhanced 3beta-HSD activity at 1 h (P < 0.05), reached its peak at 3 h (P < 0.01) and then plateaued till 8 h. GTH, on the other hand, did not show any stimulation of 3beta-HSD activity for 2 h, stimulation was marked only at 3 h (P < 0.05), reached a peak at 6 h (P < 0.01) and then leveled off. Determination of Km and Vmax of the enzyme showed an increase in the velocity of reaction by GTH with unaltered Km. TIP increased both velocity and affinity of the enzyme. GTH significantly increased the synthesis of 3beta-HSD protein at 3 h (P < 0.01) reaching maximal stimulation at 6 h which clearly coincided with the enzyme activity. In contrast, TIP had no effect on 3beta-HSD protein synthesis, but its direct addition to 3beta-HSD enzyme preparation in vitro caused significant augmentation of the enzyme activity (P < 0.01) suggesting thereby its modulatory effect on the enzyme. Results, therefore, show that although both T3 and GTH stimulated perch testicular Leydig cell 3beta-HSD activity, T3 effect was not direct but mediated via TIP and there is a clear distinction between GTH and TIP stimulation. GTH increased the enzyme activity by stimulating 3beta-HSD protein synthesis while TIP acts directly on the enzyme modulating it from less active to more active state.


Thigh circumference and diabetes: obesity as a potential effect modifier.
Thigh circumference is associated with diabetes risk; however, the role of obesity as a potential effect modifier has not been well studied. We examined the association between thigh circumference and diabetes in a cross-sectional study of 384 612 Koreans aged 30 to 79 years. The association between diabetes and thigh circumference in relation to body mass index (BMI) was analyzed among 315 628 participants, using multivariate logistic regression. Thigh circumference was categorized into 9 percentile categories-namely, the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles-and the 50th percentile was used as the reference value for thigh circumference. Separate analyses were performed for men and women. The association of thigh circumference with diabetes showed contradictory patterns before and after adjustment for BMI and waist circumference. Small thigh circumference was associated with greater risk of diabetes among men and women. This relationship was stronger among participants younger than 50 years, although age was not a significant effect modifier. BMI was a significant effect modifier among men with a BMI of less than 25 kg/m(2). Among women, diabetes risk increased with smaller thigh circumference. Small thigh circumference was associated with diabetes, and this association was stronger among participants with a BMI of less than 25 kg/m(2). Thigh circumference might be a useful diabetes marker in lean populations.


Offset reduction in Hall effect measurements using a nonswitching van der Pauw technique.
A nonswitching van der Pauw technique, which uses two electrically isolated alternating current sources operating at two different frequencies and two lock-in amplifiers, is suggested for Hall effect measurements. Parasitic offset voltage, typical for this type of measurements, is reduced by averaging two sets of data accumulated simultaneously. Application of the technique is particularly useful when the offset changes on a time scale comparable to the measurement cycle.


Health-related quality of life in burning mouth syndrome - a case-control study.
Objectives The cardinal symptom of burning mouth syndrome (BMS) is long-lasting pain and comprehensive health-related quality of life (HRQL) assessments may estimate how well patients with BMS live in relation to their health issues. The aims of the study were to explore general and BMS-specific HRQL based on an HRQL model and to compare HRQL in patients with BMS and age-matched controls. Methods For this case-control study 56 female patients with BMS and 56 female controls completed the following: A general questionnaire with Global items for life satisfaction, general health and oral health; General Population-Clinical Outcomes in Routine Evaluation (GP-CORE); Hospital Anxiety and Depression Scale (HADS); and Oral Health Impact Profile-14 (OHIP-14). Patients with BMS completed additional questionnaires which included BMS-problem severity, a global item for ratings of overall severity perceptions measured by visual analog scale (VAS); and BMS-modified Multidimensional Pain Inventory-Swedish version (MPI-S). BMS-modified MPI-S includes the three subscales Pain severity, Interference and Social support. Results Patients with BMS scored worse on all global items, GP-CORE, HADS and OHIP-14 compared to controls and the differences were large. Patients with severe BMS problems, as defined by a median split on BMS-problem severity, scored worse on the BMS-modified MPI-S subscale Pain severity and the difference was large. Conclusions We found clearly impaired general HRQL in patients with BMS compared to controls. For specific HRQL, the severity of pain was worse among patients with higher overall BMS-problem severity. The HRQL model with global ratings together with physical, psychological and social concepts has capacity to increase comparability and validity of studies, however further evaluations of the measures are needed. The HRQL model may be used over time to increase the understanding of different HRQL aspects and their internal relationships. In clinical settings, with an increased knowledge of one´s own distinctive quality of life abilities and restrictions, the patients with BMS can be guided and supported to manage their long-lasting pain. The HRQL model may be an aid toward bridging distinctions between general and oral health to further encourage collaboration between medicine and odontology.


Examination of the cognitive effects of cimetidine in normal elderly volunteers.
The authors evaluated the cognitive effects of acute challenges with the H2 receptor-antagonist cimetidine in normal older volunteers. The study was a double-blind, placebo-controlled, crossover study of 12 volunteers, average age 71.25 years. Baseline assessment was followed by randomized administration of a placebo or ascending doses of cimetidine (400 mg, 800 mg, or 1,600 mg) in test sessions separated by 1 week. Cognitive performance was evaluated with a 1-hour battery of tests beginning 90 minutes after administration of a single dose of drug (or placebo). There were no significant cognitive decrements associated with cimetidine. Despite numerous case reports of cognitive toxicity, this study found no observable decrements in cognitive performance in a group of healthy elderly subjects; therefore, case reports in the literature may be reporting effects for patients with specific impairments or sensitivities.


Identification and validation of potential reference gene for effective dsRNA knockdown analysis in Chilo partellus.
Chilo partellus is an invasive polyphagous pest that has not been effectively managed with chemical pesticides. To select potential dsRNAs for use in an alternate control strategy, it is crucial to identify and evaluate stable reference genes for knockdown expression studies. This study evaluates the expression stability of seven candidate reference genes in C. partellus larvae fed on crude bacterially-expressed dsRNAs and purified dsRNAs at different time intervals, as well as the developmental stages and sexes. The expression stabilities of the reference genes were evaluated with different software programmes, such as BestKeeper, NormFinder, deltaCt, geNorm, and RefFinder. The overall results rank ELF as the most stably expressed reference gene when larvae were fed with crude bacteria-induced dsRNAs and purified dsRNA. However, Tubulin and HSP70 were more stable under different developmental stages and sexes. The expression levels of larvae that were fed crude bacteria-induced dsRNAs of Chitinase and Acetylcholinesterase were normalized with the four most stable reference genes (ELF, HSP70, V-ATPase and Tubulin) and the least stable reference gene (18S and HSP70) based on the geNorm algorithm. The least stable reference gene showed inconsistent knockdown expression, thereby confirming that the validation of a suitable reference gene is crucial to improve assay accuracy for dsRNA-targeted gene selection in C. partellus.


Control of mid-spatial frequency errors considering the pad groove feature in smoothing polishing process.
Mid-spatial frequency error (MSFR) should be strictly controlled in modern optical systems. As an effective approach to suppress MSFR, the smoothing polishing (SP) process is not easy to handle because it can be affected by many factors. This paper mainly focuses on the influence of the pad groove, which has not been researched yet. The SP process is introduced, and the important role of the pad groove is explained in detail. The relationship between the contact pressure distribution and the groove feature including groove section type, groove width, and groove depth is established, and the optimized result is achieved with the finite element method. The different kinds of groove patterns are compared utilizing the numerical superposition method established scrupulously. The optimal groove is applied in the verification experiment conducted on a self-developed SP machine. The root mean square value of the MSFR after the SP process is diminished from 2.38 to 0.68 nm, which reveals that the selected pad can smooth out the MSFR to a great extent with proper SP parameters, while the newly generated MSFR due to the groove can be suppressed to a very low magnitude.


An insight into major signaling pathways and protein-protein interaction networks involved in the pathogenesis of gestational diabetes mellitus.
Gestational diabetes mellitus (GDM) is associated with the increase of glucose in the blood rather than being absorbed by the cells. A better understanding of the signaling pathways is necessary to understand the pathophysiology of GDM. This study provides details about a series of signaling pathways and protein-protein interactions involved in the pathogenesis of GDM and their evaluations in GDM development. Protein-protein interactions were found between proteins of several signaling pathways that suggest interlink between these signaling pathways. Protein-protein interactions were generated with high confidence interaction scores based on textmining, cooccurrence, coexpression, neighborhood, gene fusion, experiments, and databases. The dysregulation of signaling pathways may also contribute to the increased risk of complications associated with GDM in the mother and child. Further, studies on signaling pathways involved in the pathogenesis of GDM would help in the development of an effective intervention to prevent GDM along with the identification of key targets for effective therapies in the future.


EGCG Inhibits Tumor Growth in Melanoma by Targeting JAK-STAT Signaling and Its Downstream PD-L1/PD-L2-PD1 Axis in Tumors and Enhancing Cytotoxic T-Cell Responses.
Over the last decade, therapies targeting immune checkpoints, such as programmed death-1 (PD-1), have revolutionized the field of cancer immunotherapy. However, low response rates and immune-related adverse events remain a major concern. Here, we report that epigallocatechin gallate (EGCG), the most abundant catechin in green tea, inhibits melanoma growth by modulating an immune response against tumors. In vitro experiments revealed that EGCG treatment inhibited interferon-gamma (IFN-γ)-induced PD-L1 and PD-L2 expression and JAK-STAT signaling. We confirmed that this effect was driven by inhibiting STAT1 gene expression and STAT1 phosphorylation, thereby downregulating the PD-L1/PD-L2 transcriptional regulator IRF1 in both human and mouse melanoma cells. Animal studies revealed that the in vivo tumor-inhibitory effect of EGCG was through CD8+ T cells and that the inhibitory effect of EGCG was comparable to anti-PD-1 therapy. However, their mechanisms of action were different. Dissimilar to anti-PD-1 treatment that blocks PD-1/PD-L1 interaction, EGCG inhibited JAK/STAT signaling and PD-L1 expression in tumor cells, leading to the re-activation of T cells. In summary, we demonstrate that EGCG enhances anti-tumor immune responses by inhibiting JAK-STAT signaling in melanoma. EGCG could be used as an alternative treatment strategy to target the PD-L1/PD-L2-PD-1 axis in cancers.


The de Morton mobility index is a feasible and valid mobility assessment tool in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease.
There is no accepted standard for measuring mobility in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The objective of this study was to assess convergent, discriminant, and known-group validity and floor/ceiling effects of the de Morton Mobility Index (DEMMI) in hospitalized patients with AECOPD. Individuals with AECOPD (n = 22) admitted to an acute care hospital medical ward were recruited. Data on the DEMMI, gait speed, daytime energy expenditure, step counts, 6-minute walk distance (6MWD), dyspnea, respiratory and heart rates, quality of life, and oxygen supplementation were collected on day 3 of admission. The DEMMI demonstrated convergent validity with the 6MWD and gait velocity measures (Spearman's ρ 0.69 and 0.61, respectively; p < 0.003) but not with measures of physical activity or respiratory impairment. Discriminant validity was present, with no correlation between the DEMMI and quality of life and resting heart rate. Known-group validity (gait aids vs. no gait aids) was demonstrated (p = 0.009). There was no floor effect but there was evidence of a possible ceiling effect (14% of participants received a perfect score). The DEMMI is feasible and showed moderate to strong validity with measures of observed physical function in hospitalized patients with AECOPD.


Five Years of Deferasirox Therapy for Cardiac Iron in β-Thalassemia Major.
Myocardial siderosis in β-thalassemia major (β-TM) remains the leading cause of death. Deferasirox (DFX), a new iron chelation treatment, has proved to be effective in reducing or preventing cardiac iron burden in thalassemic patients according to clinical trials with maximum duration of up to 3 years except one that was recently published and lasted 5 years. The aim of this study was to evaluate the efficacy of DFX in reducing or preventing cardiac iron burden in 23 patients with β-TM after 5 years of therapy. All patients had a magnetic resonance imaging (MRI) T2* evaluation of their cardiac iron load before starting DFX therapy and after a period of 5 years. Ferritin levels and left ventricular ejection fraction (LVEF) were also evaluated at the same time. Deferasirox was administered in a starting dose of 30 mg/kg/day and never increased to more than 40 mg/kg/day. The MRI T2* cardiac iron load mean values before DFX was 32.82 ± 10.86 ms, and after 32.13 ± 7.74 ms, showing a stability in MRI T2* myocardial value but a significant improvement in two patients with an intermediate iron load (12 vs. 23 ms). The mean LVEF value was 68.43 ± 7.08% before treatment with DFX and 67.95 ± 5.94% after DFX therapy without significant change. Our results confirm previous studies that DFX is considered an effective chelating agent used as monotherapy for at least 5 years and is more efficacious in moderate to severe cardiac iron loaded thalassemic patients.


The Central Role of Bicarbonate in the Electrochemical Reduction of Carbon Dioxide on Gold.
Much effort has been devoted in the development of efficient catalysts for electrochemical reduction of CO2. Molecular level understanding of electrode-mediated process, particularly the role of bicarbonate in increasing CO2 reduction rates, is still lacking due to the difficulty of directly probing the electrochemical interface. We developed a protocol to observe normally invisible reaction intermediates with a surface enhanced spectroscopy by applying square-wave potential profiles. Further, we demonstrate that bicarbonate, through equilibrium exchange with dissolved CO2, rather than the supplied CO2, is the primary source of carbon in the CO formed at the Au electrode by a combination of in situ spectroscopic, isotopic labeling, and mass spectroscopic investigations. We propose that bicarbonate enhances the rate of CO production on Au by increasing the effective concentration of dissolved CO2 near the electrode surface through rapid equilibrium between bicarbonate and dissolved CO2.


Higher magnification microsurgical repair of donor artery dissection in superficial temporal artery to middle cerebral artery anastomosis--technical note.
Donor artery dissection is a known cause of technical failure in microvascular anastomosis. A method for detection and direct repair of donor artery dissection before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is described using a high magnification operating microscope (maximum 50.4× magnification). Before STA-MCA anastomosis, the stump of the STA is stained using methylrosaniline chloride (pyoctaninum blue) and is observed under higher magnifications. Microsurgical suturing of the arterial dissection is performed before the anastomosis procedure under the high magnification microscope. This method was used in two patients with symptomatic hemodynamic cerebrovascular occlusive disease. Postoperative angiography revealed good patency and no complications occurred. This method may be useful for detection and direct repair of arterial dissection in small vessel walls before STA-MCA anastomosis.


Injectable Erythrocyte Gel Loaded with Bulleyaconitine A for the Treatment of Rheumatoid Arthritis.
Rheumatoid arthritis (RA) is a systemic autoimmune disease with clinical manifestations including joint cartilage, synovitis, and bone damage. Here we developed an injectable erythrocyte gel loaded with Bulleyaconitine A (BLA) for the treatment of RA and demonstrated its anti-inflammatory effects in vivo and in vitro. In vitro experiments showed that BLA could effectively down-regulate the expression of pro-inflammatory factor in activated macrophages through the nuclear factor-κB (NF-κB) pathway. In vivo experiments have shown that the injection of BLA@RBCs in the inflammatory joints of CIA mice increases the local concentration of BLA in a long time. Improved therapeutic outcomes and reduced toxicity of BLA are demonstrated in our work. Together, the developed BLA@RBCs drug delivery system provides an alternative strategy to treat RA joints and shows high potential in clinical RA treatment.


Single-molecule imaging of platinum ligand exchange reaction reveals reactivity distribution.
Single-molecule fluorescence microscopy provided information about the real-time distribution of chemical reactivity on silicon oxide supports at the solution-surface interface, at a level of detail which would be unavailable from a traditional ensemble technique or from a technique that imaged the static physical properties of the surface. Chemical reactions on the surface were found to be uncorrelated; that is, the chemical reaction of one metal complex did not influence the location of a future chemical reaction of another metal complex.


Actinobacillus suis septicaemia in two foals.
A 24-hour-old Hackney ony filly developed signs of weakness, depression and a poor suck reflex, with harsh lung sounds over both fields, and a 48-hour-old Arabian colt from a normal birth which had sucked vigorously developed loose stools and became depressed, weak and anorectic. Both foals had serum IgG concentrations greater than 800 mg/dl, but each had a severe neutropenia with a left shift, and blood cultures from both of them yielded Actinobacillus suis. The A suis isolates had different antimicrobial susceptibility patterns and, in the case of the Arabian, the isolate was resistant to commonly used broad spectrum antimicrobial agents.


Thyrotropin-releasing hormone induces opposite effects on Ca2+ channel currents in pituitary cells by two pathways.
Thyrotropin-releasing hormone (TRH) stimulates pituitary secretion by steps involving a cytosolic Ca2+ rise. We examined various pathways of Ca2+ elevation in pituitary GH3 cells. By using the patch clamp technique in the whole-cell configuration and Ba2+ as divalent charge carrier through Ca2+ channels, TRH (1 microM) reversibly reduced the current by about 55%. This hormonal effect was prevented by infusing guanine 5'-[beta-thio]diphosphate (GDP[beta S]) intracellularly but not by pretreating the cell with pertussis toxin (PT). Since PT-insensitive guanine nucleotide-binding regulatory (G) proteins are known to mediate a hormone-stimulated inositol trisphosphate-mediated Ca2+ release from intracellular stores, we assume that the inhibitory effect of TRH on Ba2+ currents through Ca2+ channels is caused by the increased intracellular Ca2+. To prevent a Ca(2+)-release-dependent inhibition of Ca2+ channels, we preincubated GH3 cells in a medium free of divalent charge carriers and measured the Na+ current through Ca2+ channels. When fura-2 was used as indicator for the cytosolic Ca2+, TRH induced a release from intracellular stores only once and had no effect on the intracellular Ca2+ concentration during further applications. In line with this observation, TRH initially reduced the Na+ current through Ca2+ channels but stimulated it during subsequent applications. The stimulation was sensitive to GDP[beta S] and was abolished by pretreatment with PT, suggesting that the stimulatory action of TRH is mediated by a G protein different from the one that functionally couples the receptor to phosphatidylinositol 4,5-bisphosphate hydrolysis. In conclusion, the present data suggest that TRH increases the intracellular Ca2+ concentration by two interacting pathways, that release from intracellular stores causes a secondary blockage of Ca2+ channels, and that, especially with empty intracellular Ca2+ stores, Ca2+ channels are stimulated by a PT-sensitive G protein.


Site-specific formation of abasic lesions in DNA.
A method for the introduction of depurinated lesions in DNA is described, and is based on the formation of a covalent cross-link between an antisense oligonucleotide probe and the target DNA sequence followed by an unexpectedly mild thermal depurination.


Pituitary ablation for diabetic retinopathy.
Pituitary ablation was performed on 26 patients with advanced diabetic retinopathy by pituitary stalk section (nine patients) or transphenoidal hypophysectomy (17 patients). After a latent period varying from six to 12 months, retinal hemorrhages disappeared, vitreous hemorrhages stopped and new vessels regressed. Eight of 10 patients followed up for more than a year had a complete remission, although in one of two patients whose ablation was incomplete the retinopathy remained active. Preoperative visual acuity levels were preserved in 47 of 50 eyes of patients followed up for a mean period of 12 months. Three patients have died, two from causes related to their operation. Twenty of the survivors have continued in their usual occupation. Pituitary ablation is effective in preventing the progressive visual deterioration usually associated with advanced diabetic retinopathy.


Liver Transplantation for Rapidly Progressive Giant Hepatic Hemangioma With Diffuse Hemangiomatosis.
Cavernous hemangiomas are the most common benign tumors of the liver and are usually asymptomatic. On the other hand, giant hemangioma and diffuse hepatic hemangiomatosis may become symptomatic by causing compression on adjacent structures, rupture, or consumptive coagulopathy. The coexistence of these 2 entities in an adult is extremely rare, and the literature, especially on their management, is sparse. We report the case of a young woman who developed a rapidly growing recurrent giant hemangioma and diffuse hepatic hemangiomatosis with significant pressure effects, raising the suspicion of a malignant tumor. She had previously undergone a liver resection and an aborted attempt at liver transplant elsewhere. As a preoperative measure, with an aim to shrink the tumor, she underwent arterial embolization and chemotherapy. After this procedure, she underwent deceased donor liver transplant. Her postoperative period was uneventful, and she was well at her 6-month follow-up. We highlight the challenges involved and the need for a multidisciplinary approach in managing these lesions. Liver transplant is an excellent option for patients who develop life-threatening complications or poor quality of life due to these benign liver tumors.


Macrolide resistance in Belgian Streptococcus pneumoniae.
The genetic basis of macrolide resistance was characterized in 59 Streptococcus pneumoniae isolates. All isolates were collected in 1995 and 1997 and were from invasive infections. The majority of the isolates (54 of 59 isolates) were erythromycin and clindamycin resistant (MLS(B)-phenotype) and carried the ermAM gene. Five isolates were erythromycin resistant but clindamycin susceptible (M-phenotype). Using PCR the mefE gene was detected in these five isolates. Contrary to the situation found in Canada and the USA, mefE-mediated erythromycin resistance in S. pneumoniae is uncommon in Belgium.


[Impact of fatty degeneration of the suparspinatus and infraspinatus msucles on the prognosis of surgical repair of the rotator cuff].
Rupture of the cuff tendons can induce a fatty degeneration of cuff muscles. In 1989 the authors proposed a grading in 5 stages of this degeneration based on CT scan. The purpose of this study was to determine whether this degeneration had an influence on anatomical and clinical results after surgical repair of the cuff. Seventy-four patients operated for a ruptured cuff had prospectively a pre-operative CT scan grading of muscular degeneration, and a post-operative anatomical control by opaque arthrography at about 10.5 months follow-up. Forty-four patients were males and 30 were females. The mean age at operation was 58.7 (40 to 75). Fifty-two ruptures were large involving the supraspinatus and infraspinatus in 17 cases, the supraspinatus and the subscapularis in 20 cases and all three tendons in 15 patients. Twenty-two ruptures were smaller and involved only the supraspinatus. To repair the cuff, it was necessary to advance the supraspinatus muscle in 28 cases and both supra and infraspinatus in 24 cases. No patient was lost for follow-up, and 51 of the 56 having more than one year of follow-up (mean 3 years, maximum 7.5 years) were evaluated according to Constant and Murley score. Two reoperated patients were excluded from the final analysis. Complete supraspinatus tears after repair recurred in 16 cases (22 p.cent). No infraspinatus rupture occurred after 32 infraspinatus repairs. Re-tears were observed only when a muscular advancement had been performed. Except in one case, re-tears occurred only when supraspinatus and/or infraspinatus were degenerated. The mean Constant score at revision for 49 patients was 66.6 points. According to this scoring system, 67.3 p.cent had a satisfactory result, 24.5 p.cent a fair result, and 8.2 p.cent a bad result. The mean score of the 39 patients having a continent cuff was 67.4 points, and was not significatively better than that of the patients with a re-tear (63.7 points). The best results were noted for the postero-superior tears (74.6 points). The type of repair had no significative influence on the final Constant score. The best improvements in external rotation were observed when a double advancement was performed. The stage of fatty degeneration, particularly of the infraspinatus, had an influence on the final range of motion, particularly in external rotation, and on the final strength. The fatty degeneration of supra and infraspinatus is an important prognostic factor of the anatomical and functional results after surgical repair of the cuff. More-over, when it is present, the surgeon may have some difficulties to close the tear during surgery. This study confirms that it is probably better to operate rotator cuff tears before the appearance of irreversible muscular damage, particularly when the lesions extend posteriorly to the supraspinatus.


Elastase activity in cartilage extracts and synovial fluids from subjects with osteoarthritis or rheumatoid arthritis: the prominent role of metalloproteinases.
Polymorphonuclear leukocyte (PMN) elastase is able to degrade the extra-cellular matrix components of cartilage. However, in vitro several proteinases can degrade elastin. The purpose of this study was to evaluate the role of the serine proteinases and metalloproteinases in the elastase activity measured in cartilage extracts from patients with osteoarthritis (OA), as well as in synovial fluid (SF) from patients with rheumatoid arthritis (RA) and OA. Elastase activity was determined using synthetic low molecular weight substrates and radiolabelled insoluble elastin. Aminophenyl mercuric acetate was used to activate the prometalloproteinases. Elastase activity, measured using synthetic substrates, was higher in BA SF (0.76 + 0.03 microU/ml, n = 12) than in OA SF (0.14 + 0.04 microU/ml, n = 12) (p < 0.001). This activity was inhibited by metal chelating agents: 86% inhibition in OA and 75% inhibition in RA. However, in RA SF the inhibitor of serine proteinase (PMSF) also induced a 40% inhibition. Elastase activity, measured using radiolabelled elastin, in OA SF and RA SF samples and in OA cartilage extract was very low, but increased following activation by mercurial agents. Again this activity was inhibited by metal chelating agents. Taken together these results indicate that elastase activity (measured by standard methods) in OA and RA SF is mainly due to metalloenzymes.


Changes in Parental Hopes for Seriously Ill Children.
Hopes of parents of children with serious illness play an important role in decision-making and coping. Little is known about how parent hopes change over time. We describe the changes in parent hopes across multiple domains and time intervals, examine hopes in a subgroup of parents whose child died, and explore the maintenance of domains over time. In a mixed-methods prospective cohort study on decision-making, parents of seriously ill children reported demographic characteristics and hopes at baseline and reported any changes in hopes at 4-, 8-, 12-, 16-, and 20-month follow-up visits. Hopes were coded into 9 domains. Hope changes and domain changes were identified for each parent at each visit. One hundred and ninety-nine parents of 158 patients most often reported hopes in the domains of quality of life (75%), physical body (69%), future well-being (47%), and medical care (34%). Hope percentages increased over time for quality of life (84%), future well-being (64%), and broader meaning (21%). The hope domains reported by parents of children who died were similar to the rest of the sample. The majority of parents who completed 5 to 6 follow-up visits changed at least 1 domain. At the individual parent level, some domains revealed considerable change over time, whereas other domains were stable among a subset of parents. The specific hopes and overall areas of hope of parents of seriously ill children vary over time, although most hopes fall within 4 major areas. Accordingly, clinicians should regularly check with parents about their current hopes.


Prevention of meconium aspiration syndrome: an update and the Baylor experience.
The approach to preventing meconium aspiration syndrome (MAS) in the newborn has changed markedly over the last 30 years. In the late 1970s, all infants born through meconium-stained amniotic fluid (MSAf) had upper-airway suctioning before delivery of the shoulders and then had tracheal intubation and suctioning in the delivery room. Now suctioning of the upper airway is no longer recommended, and only "depressed" infants are intubated for tracheal suctioning. The incidence of MAS and the associated high mortality rate have both declined significantly over time. This is due to improved antepartum and intrapartum obstetrical management as well as the postdelivery resuscitation of the neonate born through MSAf. MAS is no longer considered to be solely a postnatal disorder that is preventable with routine delivery room suctioning of the trachea; rather, it is considered a complex and multifactorial disorder with antenatal as well as intrapartum factors. The incidence and severity of MAS have been positively affected by a combined obstetrical and neonatal approach to the infant born through MSAf. In this article, we detail our experience at Baylor University Medical Center with MAS and its prevention and review the current literature.