CCAAT/Enhancer Binding Protein β-Mediated MMP3 Upregulation Promotes Esophageal Squamous Cell Cancer Invasion In Vitro and Is Associated with Metastasis in Human Patients.
Aims: Metastasis is a significant obstacle to curing esophageal squamous cell carcinoma (ESCC). The CCAAT/enhancer binding protein β (C/EBPβ) and matrix metalloproteinase 3 (MMP3) are thought to play key roles in cancer invasion and metastasis. In this study, we aimed to detect whether C/EBPβ-mediated tumor invasion was dependent on MMP3. In addition, we determined whether C/EBPβ upregulation was associated with MMP3 levels and metastatic status in patients with ESCC. Materials and Methods: A total of 126 patients with ESCC were recruited for this study. The mRNA and protein levels of C/EBPβ and MMP3 in ESCC cell lines and specimens from ESCC patient were determined by reverse transcription-polymerase chain reaction and western blot, respectively. Tumor cell invasion was analyzed using an in vitro Matrigel Invasion Assay. The correlation between C/EBPβ and MMP3 expression was determined by Pearson's correlation analysis. Results: Both mRNA and protein levels of MMP3 were upregulated by C/EBPβ overexpression and downregulated by C/EBPβ siRNA in KYSE150 cell cultures. The promotion of ESCC cell invasion through C/EBPβ was inhibited by MMP3 siRNA. The level of C/EBPβ was correlated with MMP3 and metastatic status in patients with ESCC. Conclusions: C/EBPβ upregulation promoted tumor cell invasion in an MMP3-dependent manner in vitro and was associated with metastatic status in ESCC.


Steroidal saponins from fresh stems of Dracaena angustifolia.
Six new steroidal saponins (1-6), angudracanosides A-F, were isolated from fresh stems of Dracaena angustifolia, together with eight known compounds. The structures of compounds 1-6 were determined by detailed spectroscopic analyses and chemical methods. Antifungal testing of all compounds showed that 6 and 7 were active against Cryptococcus neoformans with IC(50)s of 9.5 and 20.0 μg/mL, respectively.


Recognition of nucleic acid ligands by toll-like receptors 7/8: importance of chemical modification.
Toll-like receptors 7 and 8 (TLR7/8), known as pattern recognition receptors (PRR), are currently viewed as important targets for the development of new therapies for multiple diseases. Therefore, manipulating the immune response by using TLR7/8 agonists or antagonists might be of therapeutic value. Nucleic acid-like structures are well-known TLR7/8 ligands, such as single-stranded RNA (ssRNA), small interfering RNA (siRNA), CpG-oligodeoxynucleotides (ODNs) and nucleoside analogues. However, these nucleic acid TLR7/8 ligands show a variety of pharmacological properties and change of their structures offers a high degree of diversity. Unnatural modified nucleosides have been explored to expand the properties and the applications of nucleic acid. In this regard, chemical modification of nucleosides is very useful for production of specific pharmacological qualities of nucleic acid TLR7/8 ligands. In this review, we will summarize the characteristics of nucleic acid TLR7/8 ligand system and describe the applications of chemical modifications, with a focus on potency and structure-activity relationships (SAR).


Comparison of Telfa Rolling and a Closed Washing System for Autologous Fat Processing Techniques in Postmastectomy Breast Reconstruction.
The purpose of this study was to compare the commonly used fat grafting techniques-Telfa rolling and a closed washing system-in breast reconstruction patients. Consecutive patients undergoing fat grafting were retrospectively reviewed and grouped by technique. Patients with less than 180 days of follow-up were excluded. Demographics, operative details, and complications were compared using univariate analysis with significance set at p < 0.05. Between January of 2013 and September of 2017, 186 women underwent a total of 319 fat grafting procedures. There was no difference in demographics, number of procedures performed, volume of fat grafted, and number of days after reconstruction that fat grafting was performed between groups (p > 0.05). Telfa rolling patients had longer operative times for second fat grafting procedures (implant exchange often completed prior) [100.0 minutes (range, 60.0 to 150.0 minutes) versus 79.0 minutes (range, 64.0 to 94.0 minutes); p = 0.03]. Telfa rolling breasts had more palpable masses requiring imaging (26.0 percent versus 14.4 percent; p = 0.01) and an increased incidence of fat necrosis (20.6 percent versus 8.0 percent; p < 0.01). The closed washing system was found to be an independent predictor of decreased rates of imaging-confirmed fat necrosis (OR, 0.29; p = 0.048). There was no difference in fat necrosis excision or cancer recurrence between the groups. The closed washing system was independently associated with decreased rates of imaging-confirmed fat necrosis compared to Telfa rolling without an increase in other complications. Therapeutic, III.


Natriuretic peptides for guiding heart failure therapy.
Use of natriuretic peptide to guide heart failure therapy represents a promising option. Although natriuretic peptides provide accurate diagnostic and independent incremental prognostic information, their use to gauge and titrate therapy is not yet fully realized.


Studying optimal healing environments: challenges and proposals.
The concept of optimal healing environments has strong face validity, but it is difficult to operationalize the complexity of the human dimensions that comprise the process of healing. Only rigorous evidence can justify the tremendous resources necessary to create optimal healing environments. This article outlines the current challenges of studying optimal healing environments from a clinical epidemiology perspective and discusses the major potential obstacles to include human resources, relationship-centered care competencies, dysfunctional educational and health care systems, research competencies, credibility, dispersed and unfocused current evidence base, and the actual logistical methodological difficulties. The concept of optimal healing environments is a paradigm shift in the delivery and study of medical care, and such an initiative will likely take decades to transition. However, there are feasible activities that can currently be undertaken to expedite this transition, chief of which is establishing a coalition of influential societies to forge an agenda on several fronts. Research activities presently should focus on validating and simplifying measurement tools for healing-related outcomes constructs, expanding the versatility and use of qualitative methods, as well as synthesizing research evidence to help clarify the current evidence base and the future research agenda.


Light scattering in Intralipid-10% in the wavelength range of 400-1100 nm.
The absorption, scattering, and anisotropy coefficients of the fat emulsion Intralipid-10% have been measured at 457.9, 514.5, 632.8, and 1064 nm. The size and shape distributions of the scattering particles in Intralipid-10% were determined by transmission electron microscopy. Mie theory calculations performed by using the particle size distribution yielded values for the scattering and anisotropy coefficients from 400 to 1100 nm. The agreement with experimental values is better than 6%.


A Prospective Study of AFree Oral Spray as an Adjuvant Therapy for Mild and Moderate COVID-19 in Community Health Stations: Clinical Progression and Viral Clearance Outcomes.
The aim of this study was to evaluate the safety and efficacy of AFree oral spray, in combination with Standard of Care, in treating mild to moderate COVID-19 patients. This was an open-label, single-blinded, and controlled randomized clinical trial. The study involved 1,252 patients, who were randomly assigned to either the control or study group, with 626 patients in each group. Patients in the control group were treated with Standard of Care recommended by the Ministry of Health of Vietnam, while patients in the study group received AFree oral spray in addition to Standard of Care for a period of 10 days. The clinical progression and outcomes of both groups were compared. The results showed that the proportion of patients with clinical symptoms on the 5th, 7th and 10th days were significantly lower in the study group (45.05%, 3.19% and 0%, respectively) compared to the control group (86.10%, 67.73% and 22.84%, respectively). Additionally, the rate of Real-time PCR test positivity for COVID-19 was significantly lower in the study group compared to the control group on the 4th, 7th, and 10th days (82.75% vs. 98.72%, 9.27% vs. 92.97%, and 1.12% vs. 50.48%, respectively). Furthermore, no side effects or complications related to AFree oral spray were recorded in the study group. The use of AFree oral spray resulted in significant improvements in clinical symptoms, recovery time, and viral clearance in COVID-19 patients with mild to moderate symptoms. This therapy has been shown to be safe and can be used as an adjuvant treatment for COVID-19 as well as other respiratory viral infections.


Toward a pharmacophore for kinase frequent hitters.
Small molecule protein kinase inhibitors are widely employed as biological reagents and as leads in the design of drugs for a variety of diseases. One of the hardest challenges in kinase inhibitor design is achieving target selectivity. By utilizing X-ray structural information for four promiscuous inhibitors, we propose a five-point pharmacophore for kinase frequent hitters, demonstrate its ability to discriminate between frequent hitters and selective ligands, and suggest a strategy for selective inhibitor design.


Oklahoma City's killer tornadoes: how local hospitals responded to yet another extreme disaster.
On the evening of May 3rd, a group of high-powered tornadoes tore through Oklahoma--leaving more than 40 people dead and hundreds injured. The main twister formed about 45 miles south of Oklahoma City and was classified F5, the most severe type of tornado, with winds of more than 260 mph. It cut a path one mile wide; stayed on the ground for more than four hours; and, along with other twisters, demolished 60 miles of countryside. More than 7,000 homes were destroyed or damaged, and more than 5,000 families were left homeless. Oklahoma City was hit the hardest, with about 1,500 homes leveled in the storm. A total of 755 people were injured in Oklahoma City and the surrounding area, testing local hospital disaster plans to the maximum. The same hospitals had been called on in April 1995 to handle the over 500 persons injured in the bombing of the Alfred P. Murrah Federal Building, a terrorist blast that killed 168. The hospitals' latest response to a disaster situation is recorded in this report.


Autophagy in the Neuronal Ceroid Lipofuscinoses (Batten Disease).
The neuronal ceroid lipofuscinoses (NCLs), also referred to as Batten disease, are a family of neurodegenerative diseases that affect all age groups and ethnicities around the globe. At least a dozen NCL subtypes have been identified that are each linked to a mutation in a distinct ceroid lipofuscinosis neuronal (CLN) gene. Mutations in CLN genes cause the accumulation of autofluorescent lipoprotein aggregates, called ceroid lipofuscin, in neurons and other cell types outside the central nervous system. The mechanisms regulating the accumulation of this material are not entirely known. The CLN genes encode cytosolic, lysosomal, and integral membrane proteins that are associated with a variety of cellular processes, and accumulated evidence suggests they participate in shared or convergent biological pathways. Research across a variety of non-mammalian and mammalian model systems clearly supports an effect of CLN gene mutations on autophagy, suggesting that autophagy plays an essential role in the development and progression of the NCLs. In this review, we summarize research linking the autophagy pathway to the NCLs to guide future work that further elucidates the contribution of altered autophagy to NCL pathology.


Serial phenotypic analysis of mouse peripheral blood leukocytes.
Repeated phenotypic analysis of mouse peripheral blood leukocytes over short periods of time (2 weeks) has been difficult because of the very limited volumes of blood available under guidelines of the Institutional Animal Care and Use Committee. The loss of leukocytes and variations among laboratories during conventional flow cytometry sample preparation based on lysing and repeated washing have been limiting factors when measuring multiple parameters in small samples. We describe a method of phenotypic analysis using a no-lyse, no-wash staining technique combined with fluorescent triggering for data collection that can be performed on volumes of 20 muL or less of whole blood per set of markers in one tube. This method allows repeated phenotypic analysis of peripheral whole blood from mice. Fluorescent triggering with anti-CD45-PE/Cy5 antibody allows high-quality phenotypic data to be collected for CD4, CD8, TcR- beta, CD45R (B220), CD11b, and Gr-1 epitopes on leukocytes from mouse peripheral blood without lysis. The markers selected cover the major populations in peripheral mouse blood. Reproducibility and time-course data are presented for sampling periods as long as 4 weeks. Data produced by flow cytometers manufactured by two different companies show well-correlated results. An instrument equipped with a gated amplifier or a photomultiplier tube suitable for Cy7 conjugates could measure additional parameters. Because of interference from unlysed erythrocytes, scatter parameters are not useful for identifying cell populations with this method.


Hexavanadate-Organogold(I) Hybrid Compounds: Synthesis by the Azide-Alkyne Cycloaddition and Density Functional Theory Study of an Intriguing Electron Density Distribution.
The fully oxidized Lindqvist-type hexavanadate compounds decorated by phosphine-derivatized Au(I) moieties oriented in a transoid fashion (n-Bu4N)2[V6O13{(OCH2)3CCH2(N3C2C6H5)AuP(C6H4OMe)3}2] (POMNAu) and (n-Bu4N)2[V6O13{(OCH2)3CCH2OCH2(C2N3H)AuP(C6H4OMe)3}2] (POMCAu) have been prepared by azide-alkyne cycloaddition reactions and characterized by various techniques, including NMR, IR, and UV/vis spectroscopy and electrospray ionization mass spectrometry. Electronic structure calculations unveil the potential of these model hybrid junctions for application in controlled charge-transport experiments on substrate surfaces.


A Preliminary Investigation of Deficits in Executive Functions of Adults With Attention Deficit Hyperactivity Disorder.
Several studies over the past two decades have investigated the neuropsychological deficits in children with attention deficit hyperactivity disorder (ADHD), but much less has been done on adults. This study aimed to assess the deficits in executive functions of adults with ADHD, especially in the areas of attention, inhibition, impulsivity, and planning. Twenty-four adults (18 years and older) diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria, and also assessed with Conners' Adult ADHD Rating Scale, participated in the study. Executive functions in cases were compared with 20 matched controls through the three instruments of Tower of London (TOL), Continuous Performance Test (CPT), and Stroop test. Performance of cases was weaker than that of the control group in TOL. The difference was significant in subsequent thinking time in most of the trials and number of movements only at level 2. In CPT, the adults with ADHD made more commission errors. In addition, the ADHD cases made more errors in the word card of the Stroop test, and the time they spent reading all three cards was significantly longer than that of the control group. Our study suggests that several deficits in executive functions related to ADHD persist into adulthood, such as impairments in planning time and set shifting, response inhibition, impulsivity, and visuolingual processing. However, simple (visual-motor processing) and sustained attention might improve with age.


Puzzling Bubble Rise Speed Increase in Dense Granular Suspensions.
We present an anomalous experimental observation on the rising speed of air bubbles in a Hele-Shaw cell containing a suspension of spherical, neutrally buoyant, non-Brownian particles. Strikingly, bubbles rise faster in suspensions as compared to particle-less liquids of the same effective viscosity. By carefully measuring this bubble speed increase at various particle volume fraction and via velocity field imaging, we demonstrate that this strange bubble dynamics is linked to a reduction in the bulk dissipation rate. A good match between our experimental data and computations based on a Suspension Balance Model (SBM) illustrates that the underlying mechanism for this dissipation-rate deficit is related to a nonuniform particle distribution in the direction perpendicular to the channel walls due to shear-induced particle migration.


Warming macrophages to febrile range destabilizes tumor necrosis factor-alpha mRNA without inducing heat shock.
We have previously reported that sustained tumor necrosis factor (TNF)-alpha expression is suppressed by temperatures in the febrile range in human macrophages. In this study, we examined the mechanisms of high-temperature-induced macrophage TNF suppression in the RAW 264.7 macrophage cell line. Incubating lipopolysaccharide (LPS)-stimulated RAW 264.7 cells at 40 degrees C reduced TNF secretion by 92% and peak TNF mRNA levels by 43% compared with cells incubated at 37 degrees C (P < 0.05) but did not affect levels of glyceraldehyde-3-phosphate dehydrogenase, beta-actin, or interleukin-6 mRNA. TNF mRNA half-life, measured after transcriptional arrest with actinomycin D, was reduced from 21.8 +/- 3.6 min in LPS-stimulated RAW 264.7 cells at 37 degrees C to 16.0 +/- 1.8 min at 40 degrees C (P < 0.03), but these cells at 40 degrees C did not alter transcription rate or TNF mRNA polysome association. TNF mRNA destabilization occurred at temperatures below the threshold (43 degrees C) for the generalized heat shock response in these cells. We conclude that heating macrophages to febrile-range temperatures attenuates sustained TNF expression by modulating posttranscriptional processing, including acceleration of TNF mRNA decay.


Microarray patches enable the development of skin-targeted vaccines against COVID-19.
The COVID-19 pandemic is a serious threat to global health and the global economy. The ongoing race to develop a safe and efficacious vaccine to prevent infection by SARS-CoV-2, the causative agent for COVID-19, highlights the importance of vaccination to combat infectious pathogens. The highly accessible cutaneous microenvironment is an ideal target for vaccination since the skin harbors a high density of antigen-presenting cells and immune accessory cells with broad innate immune functions. Microarray patches (MAPs) are an attractive intracutaneous biocargo delivery system that enables safe, reproducible, and controlled administration of vaccine components (antigens, with or without adjuvants) to defined skin microenvironments. This review describes the structure of the SARS-CoV-2 virus and relevant antigenic targets for vaccination, summarizes key concepts of skin immunobiology in the context of prophylactic immunization, and presents an overview of MAP-mediated cutaneous vaccine delivery. Concluding remarks on MAP-based skin immunization are provided to contribute to the rational development of safe and effective MAP-delivered vaccines against emerging infectious diseases, including COVID-19.


Bilateral hemiballism-hemi-chorea presenting in a diabetes taiwanese woman.
Hemiballism-hemichorea (HB-HC) is a hyperkinetic disorder characterized by continuous involuntary movements of the extremities. It could be associated with non-insulin dependent diabetes mellitus. A very few cases of bilateral HB-HC have been reported until today. We describe here the case of a Taiwanese woman (85 years old) presenting with bilateral HB-HC and diabetes mellitus.


Achievement of cardiometabolic goals among diabetic patients in Spain. A nationwide population-based study.
No previous study has reported a comprehensive assessment of the attainment of cardiometabolic goals in the diabetic population of a European country. We examined the achievement of cardiometabolic goals among diabetics in Spain. A cross-sectional survey was performed in 2008-2010 among 12,077 individuals representative of the Spanish population aged ≥18 years. Information on cardiometabolic characteristics was collected at the participants' homes through structured questionnaires, physical examination, and fasting blood samples. Attainment of cardiometabolic goals was evaluated according to the most well-known guidelines. A total of 834 individuals had diabetes (fasting serum glucose ≥126 mg/dl, or glycosylated hemoglobin ≥6.5%,) or were being treated with oral antidiabetic drugs or insulin). Among diabetic patients, 661 (79.2%) were aware of their condition. Among the aware diabetic patients, only 11.4% had neither general (body mass index <25 kg/m(2)) nor abdominal obesity (waist circumference ≤102 cm in men and ≤88 cm in women), 8.6% consumed <7% of calories daily from saturated fats, and 41.1% achieved the recommendation on weekly physical activity. About 71% had glycosylated hemoglobin <7%, 22% had blood pressure <130/80 mmHg, and 36% reached the LDL-cholesterol goal of <100 mg/dl. Although a large proportion of aware diabetic individuals received lifestyle medical advice, only 38% of overweight individuals and 20% of daily smokers were offered a specific strategy for weight loss or quitting smoking, respectively. In a European country with universal healthcare coverage, achievement of many cardiometabolic goals, in particular lifestyle, among aware diabetic individuals is poor. This suggests a need for improvement in both clinical guidelines' implementation and patients' adherence.


Improving limits of detection for B-type natriuretic peptide using PC-IDMS: an application of the ALiPHAT strategy.
Hydrophobic tagging of biomolecules has been reported by our group and others to increase their ionization efficiency during electrospray ionization and facilitate their detection by mass spectrometry. As such, hydrophobic tagging should provide a viable method for augmenting MS-based quantification of low abundance proteins by decreasing their detection limits. Herein we have evaluated two commercial alkylation reagents and several newly synthesized hydrophobic alkylation reagents for their utility in quantifying B-type Natriuretic Peptide, a low abundance cardiac biomarker, by protein cleavage isotope dilution mass spectrometry. For the cysteine containing tryptic peptide evaluated, a approximately 3.5-fold decrease in the detection limit was observed for the best performing hydrophobic reagent, 2-iodo-N-octylacetamide, relative to the commonly used alkylation reagent, iodoacetamide. Additionally, we have evaluated the use of nonpolar surface areas as a metric for assessing the effectiveness of the alkylation reagents in improving ESI response.


Developing an integrated microsimulation model for the impact of fiscal policies on child health in Europe: the example of childhood obesity in Italy.
We developed an integrated model called Microsimulation for Income and Child Health (MICH) that provides a tool for analysing the prospective effects of fiscal policies on childhood health in European countries. The aim of this first MICH study is to evaluate the impact of alternative fiscal policies on childhood overweight and obesity in Italy. MICH model is composed of three integrated modules. Firstly, module 1 (M1) simulates the effects of fiscal policies on disposable household income using the tax-benefit microsimulation program EUROMOD fed with the Italian EU-SILC 2010 data. Secondly, module 2 (M2) exploits data provided by the Italian birth cohort called Nascita e Infanzia: gli Effetti dell'Ambiente (NINFEA), translated as Birth and Childhood: the Effects of the Environment study, and runs a series of concatenated regressions in order to estimate the prospective effects of income on child body mass index (BMI) at different ages. Finally, module 3 (M3) uses dynamic microsimulation techniques that combine the population structure and incomes obtained by M1, with regression model specifications and estimated effect sizes provided by M2, projecting BMI distributions according to the simulated policy scenarios. Both universal benefits, such as universal basic income (BI), and targeted interventions, such as child benefit (CB) for poorer households, have a significant effect on childhood overweight, with a prevalence ratio (PR) in 10-year-old children-in comparison with the baseline fiscal system-of 0.88 (95%CI 0.82-0.93) and 0.89 (95%CI 0.83-0.94), respectively. The impact of the fiscal reforms was even larger for child obesity, reaching a PR of 0.67 (95%CI 0·50-0.83) for the simulated BI and 0.64 (95%CI 0.44-0.84) for CB at the same age. While both types of policies show similar effects, the estimated costs for a 1% prevalence reduction in overweight and obesity with respect to the baseline scenario is much lower with a more focalised benefit policy than with universal ones. Our results show that fiscal policies can have a strong impact on childhood health conditions. Focalised interventions that increase family income, especially in the most vulnerable populations, can help to prevent child overweight and obesity. Robust microsimulation models to forecast the effects of fiscal policies on health should be considered as one of the instruments to reach the Health in All Policies (HiAP) goals.


Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: Does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy?
Left-sided breast cancer radiotherapy has been associated with an increase in cardiac mortality. This study investigated the potential heart-sparing effect of volumetric-modulated arc radiotherapy (VMAT). We compared VMAT to tangential intensity-modulated radiotherapy (t-IMRT) in the loco-regional treatment of left-sided breast cancer, including internal mammary nodal irradiation, based on deep inspiration breath-hold (DIBH) and free-breathing (FB). Radiotherapy for 15 patients was re-planned. Four plans were compared: t-IMRT-DIBH; VMAT-DIBH; t-IMRT-FB; VMAT-FB. Prescribed dose was 50 Gy in 25 fractions. T-IMRT plans were generated using tangentially orientated fields. VMAT plans were generated using two partial arcs (average arc 190°). Mean heart dose (MHD) was 5 ± 2.4 Gy, 5.7 ± 1.4 Gy, 9.7 ± 3.3 Gy and 8.1 ± 2.0 Gy for t-IMRT-DIBH, VMAT-DIBH, IMRT-FB and VMAT-FB respectively. The difference in MHD between IMRT-DIBH and VMAT-DIBH was not significant (P = 0.14). VMAT-DIBH significantly spared the volume of heart irradiated to doses of 20 Gy and above (p < 0.05), however, resulted in a significantly higher V5 Gy (P < 0.001), compared to t-IMRT-DIBH. VMAT-DIBH resulted in higher combined lung mean (11 ± 0.8 Gy vs. 8.8 ± 1.1 Gy, P < 0.001) and higher contralateral breast mean dose (5 ± 1 Gy vs. 1.6 ± 1.2 Gy, P < 0.001) compared with t-IMRT-DIBH. On average, there was no significant difference in MHD between VMAT-DIBH and t-IMRT-DIBH. However, VMAT-DIBH was found to benefit a select group of patients. For patients in whom the MHD was >6.3 Gy with t-IMRT-DIBH, the use of VMAT-DIBH resulted in a benefit in reducing the MHD.


Assessing students' professionalism: considering professionalism's diverging definitions.
Although most health education programs assess students' professionalism, there is little clarity within the health education literature on the definition of professionalism. This makes assessment of students' professionalism a potentially flawed activity. This literature review clarifies professionalism by bringing together diverging definitions from across a number of health disciplines and discusses the complexities and limitations of these definitions. A search was conducted within the medical and health science education literature to identify articles that discussed professionalism and its assessment. Theoretical, qualitative and empirical research were included in the review. The literature defines professionalism as upholding professional values, as demonstrating professional attitudes or demonstrating professional behaviours. Each of these perspectives influences how professionalism is to be assessed, with each perspective having its own limitations. The behavioural perspective is simple to assess, but it has been criticised for being too superficial. The values perspective has the potential to develop professionals who are motivated by philanthropic values, but values can be difficult to identify and assess. Attitudes are complex in their structure, but they are less superficial than behaviours and can be assessed with attitudinal scales. Health professions educators should ideally assess all three perspectives of professionalism, however, this may not be realistic given the already laden curricula and the demands on educators. Educators may decide to only assess one perspective and given its advantages, the attitudes perspective may be a useful starting point.


Clinical implementation of molecular methods in detection of microorganisms from blood with a special focus on PCR electrospray ionization mass spectrometry.
The ongoing improvement and development of state-of-the-art diagnostic methods indicate that we are in an era of revolution in clinical microbiological diagnosis of infectious diseases. Non-culture-based methods have the possibility to play a central role in delivering personalized microbiological diagnoses of severe infections. The PCR electrospray ionization mass spectrometry (PCR/ESI-MS) system is built on the principle of universal detection and specific identification. The performance studies using PCR/ESI-MS on whole blood samples, as well as our experiences, indicate that this method provides useful clinical information. These types of modern molecular methods deserve further development for broad implementation into clinical practices. Areas covered: The review describes briefly hitherto developed molecular assays in detection of microorganisms directly from whole blood and focuses on the clinical implementation of PCR/ESI-MS. Expert opinion: The detection of an extensive broad-spectrum of microorganisms directly from whole blood samples with a series of tests that are run automatically with a turn-around time of 8 h would be a desirable diagnostic tool for the clinical microbiology laboratories. We believe that the clinical experience with PCR-ESI MS may guide the development and establishment of similar state-of-the-art diagnostic technologies in medicine in the future.


Bayesian latent trait modeling of migraine symptom data.
Definition of disease phenotype is a necessary preliminary to research into genetic causes of a complex disease. Clinical diagnosis of migraine is currently based on diagnostic criteria developed by the International Headache Society. Previously, we examined the natural clustering of these diagnostic symptoms using latent class analysis (LCA) and found that a four-class model was preferred. However, the classes can be ordered such that all symptoms progressively intensify, suggesting that a single continuous variable representing disease severity may provide a better model. Here, we compare two models: item response theory and LCA, each constructed within a Bayesian context. A deviance information criterion is used to assess model fit. We phenotyped our population sample using these models, estimated heritability and conducted genome-wide linkage analysis using Merlin-qtl. LCA with four classes was again preferred. After transformation, phenotypic trait values derived from both models are highly correlated (correlation = 0.99) and consequently results from subsequent genetic analyses were similar. Heritability was estimated at 0.37, while multipoint linkage analysis produced genome-wide significant linkage to chromosome 7q31-q33 and suggestive linkage to chromosomes 1 and 2. We argue that such continuous measures are a powerful tool for identifying genes contributing to migraine susceptibility.


Gender difference in m-CPP challenge test in healthy volunteers.
Challenge test with oral m-CPP and placebo were performed in 12 healthy, young volunteers (6 male, 6 female) in a double-blind, placebo-controlled, cross-over study to assess possible gender differences in serotonergic responsivity. Women but not men showed significant prolactin and anxiety increase after administration of 0.25 mg/kg oral m-CPPP. Core temperature increased in both sexes compared to placebo. m-CPP induced significant physical symptoms only in men. Gender differences in serotonergic functions may have clinical significance with regard to differences in rates of some psychiatric disorders between the sexes.


Postoperative diaphragmatic dysfunction in patients undergoing open-heart surgery.
Diaphragmatic elevation after cardiac surgery may result in compromized post operative respiratory function, prolonged ventilator use, longer intensive care unit (ICU) stays, poor quality of life and even mortality. 200 patients receiving open-heart surgery during the two years from October 1990 to October 1992 were studied retrospectively. 26 patients developed postoperative diaphragmatic elevation (Group 2). On the other hand, 174 patients did not (Group 1). The mean age of Group 1 (37.3 +/- 20.0 years) was younger than that of Group 2 (57.4 +/- 9.1 years), P < 0.0001. The mean aortic cross-clamp time was 70.1 +/- 38.1 minutes in Group 1. On the other hand, Group 2 had a longer crossclamp time (84.5 +/- 31.3 Minutes), p < 0.03. Our study revealed that the patients who suffered post operative diaphragmatic dysfunction were older and had a longer aortic crossclamp time than the patients who did not.


High but stable incidence of subdural haematoma in haemodialysis--a single-centre study.
The incidence of subdural haematoma (SDH) is high in haemodialysis (HD), with data suggesting an increasing incidence over time. The prognosis remains poor with 40% mortality at 30 days. The extent of this problem in non-US populations has not been described in the literature. We conducted a retrospective, single-centre UK study of non-traumatic SDH in patients established on maintenance HD between 1 January 2002 and 1 June 2009. The prevalence of SDH was 0.4% at our centre with an overall annual incidence of 189 per 100 000 patients. SDH was associated with increased patient age (mean 71.3 +/- 8.5 years) but not associated with a higher prevalence of major comorbid conditions and antiplatelet or anticoagulant use. Mortality was high (46% at 30 days, 58% at 1 year). We did not observe a trend to increasing prevalence of this condition over time. Conclusions. SDH has a higher (>20 times) incidence in HD patients than in the general population and is associated with high mortality. Although the prevalence in this study was lower than in published US studies, the incidence rate is similar. Further studies to validate prognostic criteria that guide decisions regarding surgery are required.


[PARASITARY INFECTIONS OF THE LIVER]
In Perú three are the parasites which affect frequently the liver: Entamoeba histolytica, Echinococcus granulosus and hepatic Fasciola.Amebic liver abscess can start acutely or insidiously with fever and right upper quadrant abdominal pain, with or without liver or intercostal tenderness. The main complications are thoracic, peritoneal or pericardial extension (left lobe abscess). Diagnosis by images study and serology techniques are effective. Currently, Metronidazole is the treatment of choice.Hydatid liver cyst is usually asymptornatic until it produces a mass effect, allergic reactions or a cyst infection occurs as a result of rupture of the cyst to the billary ducts. Rupture to the peritoneum produces secondary seeding with protoscolices which develop into multiple intraabdominal cysts. Study techniques by images and serology methods are also very helpful for diagnosis. Surgery is the most successful treatment but there is also the possibility of medical treatment with Albendazole or a combination of both.Hepatic fascioliasis can be asymptornatic or produce fever, right upper quadrant abdominal pain and hypereosinophilia during the invasive phase, or billary tract obstruction during the chronic phase, which sometimes is only diagnosed during surgical operation. Hemobilia and biliary cirrhosis have been described as complications. During the invasive phase it is based y serological methods, and during the chronic phase diagnosis is made by detection of parasite's eggs in stools. Presently, the treatment of choice is with Triclabendazole.


Preclinical activity of ketoconazole in combination with calcitriol or the vitamin D analogue EB 1089 in prostate cancer cells.
Ketoconazole is a general inhibitor of P450 enzymes, of which some are necessary for androgen biosynthesis and the metabolism of vitamin D compounds. We tested the growth inhibitory activity of ketoconazole combined with 1,25-dihydroxyvitamin D3 (calcitriol) and with the vitamin D analogue EB 1089 in a preclinical model of prostate cancer. Clonal assays with primary cultures of human prostatic cancer cells were performed to test anti-proliferative effects of ketoconazole alone or in combination with calcitriol or EB 1089. Enzyme substrate reactions were done to determine whether the ability of ketoconazole to potentiate the activity of calcitriol or EB 1089 was due to the inhibition of 25-hydroxyvitamin D3-24-hydroxylase (24-hydroxylase), the enzyme that initiates conversion of active vitamin D compounds to inactive products. Ketoconazole, calcitriol and EB 1089 each inhibited the growth of prostatic cancer cells. In combination 0.1 microg./ml. ketoconazole potentiated growth inhibitory activity of calcitriol 50-fold and EB 1089 10-fold. Induction of 24-hydroxylase by calcitriol or EB 1089 was partially blocked by this level of ketoconazole. Combination therapy with ketoconazole and calcitriol or EB 1089 may enhance antitumor activities of vitamin D compounds for prostate cancer and alleviate side effects of vitamin D deficiency that are likely associated with ketoconazole therapy.


Legibility and subjective preference for color combinations in text.
This study examined legibility performance and subjective preference for text/background color combinations displayed on a video monitor. Luminance contrast was fixed at two preoptimized levels, either with text brighter than the background (10:1) or vice versa (1:6.5). In Experiment 1, 32 subjects rated about 800 color combinations. No evidence suggested differential effects of luminance polarity or hue, with the only exception that cool background colors (blue and bluish cyan) tended to be preferred for the light-on-dark polarity. Saturation had the most important influence on ratings. Any desaturated color combination appears to be satisfactory for text presentation. In Experiment 2 a reduced set of 18 color combinations was investigated with a new sample of 18 subjects. Reading and search times as well as multidimensional ratings were evaluated. There was no evidence for an influence of luminance polarity or chromaticity on performance. Subjective ratings corresponded well with the results of Experiment 1.


Resolving the Interactome of the Human Macrophage Immunometabolism Regulator (MACIR) with Enhanced Membrane Protein Preparation and Affinity Proteomics.
Expression of the macrophage immunometabolism regulator gene (MACIR) is associated with severity of autoimmune disease pathology and with the regulation of macrophage biology through unknown mechanisms. The encoded 206 amino acid protein lacks homology to any characterized protein sequence and is a disordered protein according to structure prediction algorithms. To identify interactions of MACIR with proteins from all subcellular compartments, a membrane solubilization buffer is employed, that together with a high affinity EF hand based pull down method, increases the resolution of quantitative mass spectrometry analysis with significant enrichment of interactions from membrane bound nuclear and mitochondrial compartments compared to samples prepared with radioimmunoprecipitation assay buffer. A total of 63 significant interacting proteins are identified and interaction with the nuclear transport receptor TNPO1 and the trafficking proteins UNC119 homolog A and B are validated by immunoprecipitation. Mutational analysis in two candidate nuclear localization signal motifs in the MACIR amino acid sequence shows the interaction with TNPO1 is likely via a non-classical proline/tyrosine-nuclear localization signal motif (aa98-117). It is shown that employing a highly specific and high affinity pull down method that performs efficiently in this glycerol and detergent rich buffer is a powerful approach for the analysis of uncharacterized protein interactomes.


Statistical Significance of the Maximum Hardness Principle Applied to Some Selected Chemical Reactions.
The validity of the maximum hardness principle (MHP) is tested in the cases of 50 chemical reactions, most of which are organic in nature and exhibit anomeric effect. To explore the effect of the level of theory on the validity of MHP in an exothermic reaction, B3LYP/6-311++G(2df,3pd) and LC-BLYP/6-311++G(2df,3pd) (def2-QZVP for iodine and mercury) levels are employed. Different approximations like the geometric mean of hardness and combined hardness are considered in case there are multiple reactants and/or products. It is observed that, based on the geometric mean of hardness, while 82% of the studied reactions obey the MHP at the B3LYP level, 84% of the reactions follow this rule at the LC-BLYP level. Most of the reactions possess the hardest species on the product side. A 50% null hypothesis is rejected at a 1% level of significance.


The Progress of Global Antimicrobial Resistance Governance and Its Implication to China: A Review.
China has great potential for engaging in global actions on antimicrobial resistance (AMR) control. This study aims to summarize the process of global AMR governance and provide relevant policy recommendations on how China could take more initiative in the global AMR governance. We searched for academic articles and official document published or issued before December 2020 in e-journal databases, official websites of major organizations, and the relevant national ministries. This review revealed that global action on AMR control has experienced three stages: (1) The beginning stage (1980s and 1990s) when actions were mainly sponsored by high-income countries and AMR surveillance was focused on hospitals; (2) The rapid development stage (2000-2010) when global AMR governance began to concentrate on joint actions in multi-sectors, and developing countries were gradually involved in global actions; (3) The comprehensive stage (2011 to present) when global actions on AMR have covered various fields in different countries. China's AMR governance has fallen behind at the beginning but recently began to catch up with the global trend. The central government should take a far-fetched view, act decisively and positively towards the global efforts of addressing AMR to play a more active and greater role on the international stage.


The pursuit of stability in halide perovskites: the monovalent cation and the key for surface and bulk self-healing.
We find significant differences between degradation and healing at the surface or in the bulk for each of the different APbBr3 single crystals (A = CH3NH3+, methylammonium (MA); HC(NH2)2+, formamidinium (FA); and cesium, Cs+). Using 1- and 2-photon microscopy and photobleaching we conclude that kinetics dominate the surface and thermodynamics the bulk stability. Fluorescence-lifetime imaging microscopy, as well as results from several other methods, relate the (damaged) state of the halide perovskite (HaP) after photobleaching to its modified optical and electronic properties. The A cation type strongly influences both the kinetics and the thermodynamics of recovery and degradation: FA heals best the bulk material with faster self-healing; Cs+ protects the surface best, being the least volatile of the A cations and possibly through O-passivation; MA passivates defects via methylamine from photo-dissociation, which binds to Pb2+. DFT simulations provide insight into the passivating role of MA, and also indicate the importance of the Br3- defect as well as predicts its stability. The occurrence and rate of self-healing are suggested to explain the low effective defect density in the HaPs and through this, their excellent performance. These results rationalize the use of mixed A-cation materials for optimizing both solar cell stability and overall performance of HaP-based devices, and provide a basis for designing new HaP variants.


Managing the hospital's portfolio of information systems.
Information systems are becoming of such strategic importance that planning for them must not be left to weak selection processes that executives are tempted to avoid diplomatically because of the difficulty and the internal friction that determined management might cause. Presented here is a methodology for planning the evolution of information systems.


Ambulatory activity associations with cardiovascular and metabolic risk factors in smokers.
We examined the association between ambulatory activity and biological markers of health in smokers. Baseline data from 985 subjects enrolled in a pharmacologic smoking cessation trial were examined. Body size, blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), total and small LDL particles, LDL size, high density lipoprotein cholesterol, triglycerides (TG), C-reactive protein (CRP), creatinine, fasting glucose, and hemoglobin A1c were assessed in relation to pedometer-assessed ambulatory activity, as was the odds of metabolic syndrome and CRP > 3 mg/L. Effect modification by gender was examined. Only waist circumference was lower with greater steps/day in the men and women combined (P(trend) < 0.001). No other significant relationships were noted in men, while women with ≥ 7500 steps/day had lower weight, BMI, CRP, TG, total, and small LDL particles compared with those with < 7500 steps/day. These women also had 62% and 43% lower odds of metabolic syndrome and elevated CRP, respectively, compared with the less active women. Adjustment for BMI attenuated all the associations seen in women. Greater ambulatory activity is associated with lower levels of metabolic and cardiovascular risk factors in female smokers which may, in part, be mediated by a reduction in BMI.


Outer acrosomal membrane of guinea pig spermatozoa: isolation and structural characterization.
We describe a protocol to isolate a highly enriched fraction of outer acrosomal membrane from guinea pig spermatozoa and present new data on the ultrastructure of this membrane domain. Cauda epididymal spermatozoa were suspended into a low ionic strength buffer and subjected to brief homogenization; this stripped the plasma membrane from the spermatozoa and severed the acrosomal apical segment from the spermatozoon. The crescent-shaped apical segments retained the outer acrosomal membrane and specific components of the acrosomal matrix. Enriched fractions of apical segments were isolated on discontinuous sucrose gradients and the outer acrosomal membrane purified by subsequent centrifugation onto Percoll density gradients. The isolated outer acrosomal membrane did not form vesicles, but instead rolled up into spiral sheets. Both thin section and negatively stained specimens revealed a paracrystalline arrangement of filaments associated with the luminal surface of the membrane. The isolated outer acrosomal membrane revealed a limited number of polypeptides by SDS-PAGE, and the polypeptide pattern was distinct from the plasma membrane fraction. The isolated acrosomal membranes possessed no ouabain sensitive Na+,K+-ATPase activity, whereas about 20% of the ATPase activity of the plasma membrane enriched fraction was inhibited by ouabain. The potential function of the structural differentiations of the outer acrosomal membrane in the membrane fusion events of the acrosome reaction is discussed.


Establishing a postgraduate qualification in remote health care.
The British Antarctic Survey (BAS) provides medical care for the scientists and support staff working on British scientific bases and research vessels in the Antarctic. The BAS directs significant resources towards medical research, so a doctor who does not complete the research component of the programme of training and medical duties represents a partially wasted investment. Additionally, the professional experience gained by the doctor is appropriate for a postgraduate qualification. For these reasons, the training, clinical placement and research undertaken by doctors were formalized as a masters degree in 1992. The objectives of the MSc degree were to optimize the benefits of the training and research for Antarctic doctors and their patients, and to improve the quality of the research output. In the three years before the degree was introduced, only 25% of doctors produced a useful research output. Following the introduction of the MSc, this figure rose to 88%.


Synthesis of mono- and digalactosyldiacylglycerol in isolated spinach chloroplasts.
Purified, intact chloroplasts of Spinacia oleracea L. synthesize galactose-labeled mono- and digalactosyldiacylglycerol (MGDG and DGDG) from UDP-[U-(14)C]galactose. In the presence of high concentrations of unchelated divalent cations they also synthesize tri- and tetra-galactosyldiacylglycerol. The acyl chains of galactose-labeled MGDG are strongly desaturated and such MGDG is a good precursor for DGDG and higher oligogalactolipids. The synthesis of MGDG is catalyzed by UDP-Gal:sn-1,2-diacylglycerol galactosyltransferase, and synthesis of DGDG and the oligogalactolipids is exclusively catalyzed by galactolipid:galactolipid galactosyltransferase. The content of diacylglycerol in chloroplasts remains low during UDP-Gal incorporation. This indicates that formation of diacylglycerol by galactolipid:galactolipid galactosyltransferase is balanced with diacylglycerol consumption by UDP-Gal:diacylglycerol galactosyltransferase for MGDG synthesis. Incubation of intact spinach chloroplasts with [2-(14)C]acetate or sn-[U-(14)C]glycerol-3-P in the presence of Mg(2+) and unlabeled UDP-Gal resulted in high (14)C incorporation into MGDG, while DGDG labeling was low. This de novo made MGDG is mainly oligoene. Its conversion into DGDG is also catalyzed, at least in part, by galactolipid:galactolipid galactosyltransferase.


Availability, health-care costs, and utilization patterns of biologics in Taiwan.
To provide an overview of the use of biologics in Taiwan, including the access to new biologics, the impact of this access on the growth of health-care expenditure, and the utilization patterns. We first conducted a market-level analysis to investigate the availability of global biologics in Taiwan as well as the growth and concentration of aggregate spending on biologics. We then conducted a patient-level analysis to investigate the costs and utilization patterns for selected new biologics. We found that the concentration index is such that the 20 leading biologics in Taiwan account for more than 90% of the total spending on biologics. In our patient-level study on four biologics, the annual cost of treatment per patient ranged from NT$100,000 to NT$400,000. The prevalence rate of the user was between 6.5 and 37.2 per 100,000 of population. The treatment costs were inversely related to the prevalence rate of users. We also found that physicians in larger and public hospitals were more likely to prescribe new biologics to their patients compared with their counterparts practicing in smaller and private hospitals. In addition, we found that physicians were more likely to prescribe biologics to patients with more severe diseases and higher comorbidities. We conclude that public spending on biologics in Taiwan is highly targeted toward about 20 products with higher annual expenditures and growth rates and that the utilization of these biologics is targeted at a small number of patients. In addition, the access to these costly biologics is not uniform among patients in a country with universal coverage for prescription drugs.


Opioid biology: the next set of questions.
A range of biologically different opioid peptides are synthesised as components of three distinct precursors, pro-opiomelanocortin, proenkephalin, and prodynorphin. They interact with a number of receptors which have so far been characterised as mu, delta, kappa, sigma, and epsilon. It is unclear which ligands bind to which receptors under physiological circumstances, but preferential in vitro interactions include enkephalins with delta receptors, dynorphin with kappa receptors, and beta-endorphin with epsilon receptors. Post-translational processing determines which of several opioid products are produced from each precursor, but the identity of the enzymes involved and regulation of processing is unknown. Opioid involvement in the neuroendocrine and cardiovascular systems is reviewed. Naloxone-sensitive opioid mechanisms are implicated in the control of gonadotrophin and adrenocorticotropic hormone secretion and in the hypotension of various types of shock. The investigation of possible dynorphin involvement in neurohypophysial function is taking place because vasopressin and dynorphin A (1-8) have been shown to coexist in the neurosecretory vesicles of magnocellular neurons.


Assessing the phytoavailability of dieldrin residues in charcoal-amended soil using tenax extraction.
Consecutive and single Tenax extractions were applied to characterize the effectiveness of activated charcoal (AC) amendments to reduce the phytoavailability of dieldrin in a natively contaminated horticultural soil. Dieldrin desorption from untreated and 800 mg(AC) kg(-1) soil was well described by a model with three dieldrin fractions of different kinetics: a rapidly (F(rap)), slowly (F(slow)), and very slowly (F(v.slow)) desorbing fraction. The AC amendment resulted in a transfer of dieldrin from the F(slow) to the F(v.slow) fraction. The F(v.slow) increased by nearly 10% compared to the control soil. Dieldrin extractability by Tenax from AC amended soils was not influenced by the cultivation of cucumber plants indicating the stability of this remediation technique. Dieldrin extractability by Tenax at the beginning of plant growth correlated only weakly with the dieldrin content of the cucumbers at harvest. Therefore, the potential of Tenax extractions to predict the uptake of dieldrin by cucumbers appears to be limited.


The slower the better? Does the speaker's speech rate influence children's performance on a language comprehension test?
The aim of this study was to examine the effects of speech rate on children's performance on a widely used language comprehension test, the Test for Reception of Grammar, version 2 (TROG'2), and to explore how test performance interacts with task difficulty and with the child's working memory capacity. Participants were 102 typically-developing Swedish-speaking children randomly assigned to one of the three conditions; the TROG'2 sentences spoken by a speech-language pathologist with slow, normal or fast speech rate. Results showed that the fast speech rate had a negative effect on the TROG'2 scores and that slow rate was more beneficial in general. However, for more difficult tasks the beneficial effect of slow speech was only pronounced for children with better scores on a working memory task. The interpretation is that slow speech is particularly helpful when children do not yet fully master a task but are just about to grasp it. These results emphasize the necessity of careful considerations of the role dynamic aspects of examiner's speech might play in test administration and favour digitalized procedures in standardized language comprehension assessment.


Evaluation of Severe Acute Respiratory Syndrome surveillance caused by respiratory viruses in a pediatric unit, 2013 to 2019.
To evaluate severe acute respiratory syndrome surveillance in a pediatric unit. Descriptive study of reported severe acute respiratory syndrome cases with the detection of respiratory viruses in the nasopharyngeal sample of patients hospitalized between 2013 and 2019, in a reference hospital in the Federal District, Brazil. A total of 269 children had one or more viruses detected, resulting in 280 viruses, of which 152 (54%) were respiratory syncytial virus. The detection of respiratory syncytial virus was higher during the autumn-winter period. Children´s median age was 6.9 months, 156 (58%) were male, 104 (39%) had comorbidity, 197 (73%) required mechanical ventilation, 241 (90%) received antibiotics, and 146 (54%) oseltamivir. There were 19 (7%) deaths. The median time from symptom onset to sample collection was 5 days and the median time from sample collection to final results was 6 days. The system needs to reduce the time to deliver results so that inappropriate use of antibiotics and antivirals can be avoided. Moreover, the burden of viral pneumonia was relevant and the system must be flexible enough to include emerging viruses in order to be useful in responding to public health emergencies caused by respiratory viruses.


Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment.
The present study examined the associations between craniofacial dimensions, head posture, bite force, and symptoms and signs of temporomandibular disorders (TMD). The sample comprised 96 children (51F, 45M) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entailing health risks. Symptoms and signs of TMD were assessed by 37 variables describing the occurrence of headache and facial pain, clicking, jaw mobility, tenderness of muscles and joints, and the Helkimo Anamnestic and Dysfunction indices. Craniofacial dimensions (33 variables), and head and cervical posture (nine variables) were recorded from lateral cephalometric radiographs taken with the subject standing with the head in a standardized posture (mirror position). Dental arch widths were measured on plaster casts and bite force was measured at the first molars on each side by means of a pressure transducer. Associations were assessed by Spearman correlations and multiple stepwise logistic regression analyses. The magnitudes of the significant associations were generally low to moderate. On average, temporomandibular joint (TMJ) dysfunction was seen in connection with a marked forward inclination of the upper cervical spine and an increased craniocervical angulation, but no firm conclusion could be made regarding any particular craniofacial morphology in children with symptoms and signs of TMJ dysfunction. Muscle tenderness was associated with a 'long face' type of craniofacial morphology and a lower bite force. Headache was associated with a larger maxillary length and increased maxillary prognathism. A high score on Helkimo's Clinical Dysfunction Index was associated with smaller values of a number of vertical, horizontal, and transversal linear craniofacial dimensions and a lower bite force.


Opening new horizons in regenerative dermatology using platelet-based autologous therapies.
Biological therapeutic therapies are gaining the attention of scientists and medical doctors. Accumulating evidence suggests that blood-derived autologous therapies are safe and effective treatments for skin repair and wound healing. The fibrin network formed after plasmatic activation and the autologous growth factors released when platelets degranulate constitute a real biological medicine that has been shown to promote cell recruitment, stimulate new blood vessel formation, reduce inflammation as well as protect from local infections. This perspective highlights recent basic and clinical results published on blood-derived autologous therapies in the field of regenerative dermatology and discusses potential challenges and future prospects.


Seeing the forests for the more than the trees.
Assessing the health effects of deforestation is difficult because of the rate at which the world's forests are disappearing. From 1990 to 1995 alone, the world lost a total area of forest cover nearly twice the size of Italy. Deforestation, which is caused by human population growth and encroachment, clearance for agricultural production, and the growing worldwide demand for wood products, has been linked with effects ranging from local changes in climatic and disease patterns to global climate change and biodiversity loss. Deforestation is responsible for about 25% of net annual releases of carbon dioxide into the atmosphere and also lessens the amount of forest available to absorb greenhouse gas emissions. Deforestation also causes a tremendous loss of biodiversity worldwide. It is estimated that over the next 50 years deforestation will rank as the single greatest cause of species loss.


Pediatric posterior fossa syndrome (PFS): nursing strategies in the post-operative period.
Posterior fossa syndrome (PFS), or cerebellar affective syndrome, is a severe and distressing complication that may occur in up to 40% of children following posterior fossa brain tumour resection. Depending on the type, size and location of the tumour, clinical presentations of PFS can vary widely. Patients may exhibit mutism, emotional lability, high-pitched crying (sole form of vocalization), poor oral intake, extreme irritability, decreased motor movements and urinary retention. Typically, the onset of the syndrome occurs one to five days after surgery resulting in a devastating situation for patients and families. PFS may persist up to four months with resultant long-term impairments and permanent disability. The development and initiation of nursing strategies for patients with PFS is critical. They support family coping decrease stress and anxiety after surgery and, ultimately, enable optimal patient and family outcomes. By managing acute symptoms, promoting rehabilitation and initiating strategies to restore behavioural and physiological function, neurosurgical nurses play an essential and instrumental role.


Selection of the Amino Acid and Saccharide That Increase the Tetracycline Susceptibility of Vibrio splendidus.
Bacterial persister cells are a subpopulation of isogenic bacteria with characteristics of reduced metabolic activity and multidrug antibiotic resistance. Our lab had previously proved that Vibrio splendidus could form persister cells both naturally and after stimulation. However, the conditions for the waking up of V. splendidus persister cells remain marginal. In this study, the carbon sources that could wake up V. splendidus persister cells were selected from 20 amino acids and eight saccharides. The result showed that L-glutamic acid, L-aspartic acid, L-arginine, L-phenylalanine, L-leucine, maltose, D-galactose, sorbitol, mannose, N-acetyl-D-glucosamine, D-glucose, and D-fructose could wake up the V. splendidus persister cells. The chemotaxis activity of both exponential cells and regrown persister cells on plate containing each of the selected carbon source are also high. The existence of the selected carbon source can affect the antibiotic susceptibility of V. splendidus. When L-glutamic acid, L-aspartic acid, L-phenylalanine, and D-glucose were separately added into the cultured V. splendidus simultaneously with tetracycline, V. splendidus could be completely eliminated, while the addition of L-alanine and D-galactose could not. Our study suggested that V. splendidus persister cells could revive in the presence of specific carbon sources, and the addition of these exogenous nutrients could increase the tetracycline susceptibility of V. splendidus.


The effect of divalproex sodium on viral load: a retrospective review of HIV-positive patients with manic syndromes.
In vitro studies report that valproic acid causes an increase in HIV-1 replication. This retrospective study examines a sample of patients with HIV disease and behavioural disturbances, for which the treatment of choice is divalproex sodium (DVP), to determine whether DVP causes an increase in HIV-1 replication. A chart and database review identified 15 patients with HIV disease presenting with either 1) mania or hypomania or 2) dementia with mania or with hypomania or behavioural disturbances. HIV-1 viral load was compared before and after mood stabilizer initiation. Eleven patients started therapy with DVP, and 4 patients declined treatment with a mood stabilizer. Nine of the 11 patients taking DVP were also receiving antiretroviral therapy. HIV-1 viral load did not increase in 6 of the 9 patients who had measurements between 1 week and 3.5 months after DVP initiation. No follow-up was available for the other 3 patients. Of the 2 patients receiving DVP but not antiretroviral medication, 1 had an increase of 0.17 log in HIV-1 viral load at 4 months. No follow-up record was available for the second patient. The 4 patients not taking DVP were all on antiretroviral therapy; viral loads in 2 of them remained nondetectable over 3 to 4 months, and 1 had an increase of 0.32 log in HIV-1 viral load at 3 months. No follow-up record was available for the fourth patient. These preliminary data suggest that, in the presence of effective antiretroviral therapy, HIV-1 viral load appears not to be adversely affected by the administration of DVP. The results for the patients receiving DVP in the absence of antiretroviral medication remain indeterminate. Further prospective study is required.


Kinetin increases water permeability of phosphatidylcholine lipid bilayers.
Kinetin is shown to increase substantially the water permeability of liposomes composed of several types of phosphatidylcholines including the natural phospholipids egg lecithin and asolectin and the synthetic phospholipids dimyristoylphosphatidylcholine and dipalmitoylphosphatidylcholine. Kinetin effects were measured from 16.3 micromolar to 2.4 millimolar at temperatures from 10 degrees C to 50 degrees C and at pH 2.0, 7.0, and 11.0. Temperature studies indicate that kinetin produces a larger increase in water permeability with membranes in the more fluid liquid crystalline state. Kinetin is also shown to enhance [(14)C]glucose permeability and perhaps promotes membrane aggregation. From these experiments, we conclude that kinetin may produce its initial effect by altering the lipid bilayer portion of membranes.


Growth analysis of chickens fed diets varying in the percentage of metabolizable energy provided by protein, fat, and carbohydrate through artificial neural network.
A radial basis function neural network (RBFN) approach was used to develop a multi-input, multi-output model for the effect of diets varying in the percentage of ME provided by protein (% ME(P)), fat (% ME(F)), and carbohydrate (% ME(C)) on live weight gain, protein gain, and fat gain in growing chickens. Thirty-three data lines representing response of the White Leghorn male chickens during 23 to 33 d of age to the diets varying in the % ME(P), % ME(F), and % ME(C) were obtained from literature and used to train the RBFN model. The prediction values of the RBFN model were compared with those obtained by multiple regression models to assess the fitness of these 2 methods. The fitness of the models was tested using R2, MS error, mean absolute deviation, residual SD, and bias. The developed RBFN model was used to evaluate the relative importance of each input parameter on chicken growth using a sensitivity analysis method. The calculated statistical values corresponding to the RBFN model showed a higher accuracy of prediction than multiple regression models. The sensitivity analysis on the model indicated that dietary % ME(P) is the most important variable in the growth of chickens, followed by dietary % ME(F) and % ME(C). It was found that the RBFN model is an appropriate tool to recognize the patterns of input-output data or to predict chicken growth in terms of live weight gain, protein gain, and fat gain given the proportion of dietary percentage of ME intake supplied through protein, fat, or carbohydrates.


Identifying paraplegia risk associated with thoracic endografting.
Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them had previously undergone open abdominal aortic aneurysm repair, and 13 (92.9%) required coverage of more than 20 cm of the aorta. Cerebrospinal fluid drainage was instituted in 7/8 paraplegic patients. Eight (57.1%) of the 14 patients recovered fully, 2 (14.3%) experienced partial recovery, and 4 (28.6%) had significant neurological deficits. Paraplegia following thoracic endografting appears to be associated with female sex, long-segment coverage of the thoracic aorta, and aneurysmal disease.


Idiopathic retroperitoneal fibrosis causing unilateral ureteral and sigmoid colon obstruction: A case report.
The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology. A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments. RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases.


Paper terahertz wave plates.
We present a low-cost terahertz wave plate based on form birefringence fabricated using ordinary paper. Measurements of the transfer function of the wave plate between polarizers closely agree with predictions based on the measured complex indices of refraction of the effective medium. For the design frequency, the dependence on wave plate angle also agrees with theory.


Pitfalls and tips in inoue balloon mitral commissurotomy.
Balloon mitral commissurotomy is a safe and effective alternative therapeutic modality in selected patients with significant rheumatic mitral stenosis. Since its introduction in 1984, Inoue balloon mitral commissurotomy has gained wider acceptance over other balloon valvuloplasty techniques because it is technically less demanding and associated with fewer complications. Nevertheless, certain pitfalls which may make the procedure more difficult or create complications are sometimes encountered. In this article, we offer tips to facilitate a safe and expeditious execution of Inoue balloon mitral commissurotomy based on our experience with over 1,000 procedures.


Limb preference and skeletal asymmetry in the cane toad, Bufo marinus (Anura: Bufonidae).
Two forms of skeletal asymmetry were identified in a population of cane toads, Bufo marinus, an exotic species in Australia. Fluctuating asymmetry characterised the lengths and weights of the long bones of the forelimbs and hindlimbs. Directional asymmetry was observed in the structure of the pectoral girdle of the toads, with the right epicoracoid positioned ventral to the left epicoracoid in 88% of the skeletons examined. Morphological data from a cohort of individuals were correlated with limb preferences determined from 10 consecutive trials in which the toads were inverted and briefly submerged in water while bilaterally clasping the experimenter's fingers. The toad's left forelimb was released first to enable the right forelimb to exert force against the experimenter's fingers and so control righting the body of the toad in 90% of trials. Asymmetries in the long bones of the forelimbs and pectoral girdles of the toads did not correlate significantly with the strength of preference for the right forelimb, although asymmetry of the weight of the tibiafibulae did correlate significantly with percent right forelimb preference. Age, or nutritional status, was a factor in the right forelimb preference: the preference for the use of the right forelimb was strongest in toads possessing longer and heavier long bones of both the forelimbs and hindlimbs. These results provide insight into the interaction between skeletal development and lateralised motor behaviour in an anuran species.


Cellular and Molecular Pathways Leading to External Root Resorption.
External apical root resorption during orthodontic treatment implicates specific molecular pathways that orchestrate nonphysiologic cellular activation. To date, a substantial number of in vitro and in vivo molecular, genomic, and proteomic studies have supplied data that provide new insights into root resorption. Recent mechanisms and developments reviewed here include the role of the cellular component-specifically, the balance of CD68+, iNOS+ M1- and CD68+, CD163+ M2-like macrophages associated with root resorption and root surface repair processes linked to the expression of the M1-associated proinflammatory cytokine tumor necrosis factor, inducible nitric oxide synthase, the M1 activator interferon γ, the M2 activator interleukin 4, and M2-associated anti-inflammatory interleukin 10 and arginase I. Insights into the role of mesenchymal dental pulp cells in attenuating dentin resorption in homeostasis are also reviewed. Data on recently deciphered molecular pathways are reviewed at the level of (1) clastic cell adhesion in the external apical root resorption process and the specific role of α/β integrins, osteopontin, and related extracellular matrix proteins; (2) clastic cell fusion and activation by the RANKL/RANK/OPG and ATP-P2RX7-IL1 pathways; and (3) regulatory mechanisms of root resorption repair by cementum at the proteomic and transcriptomic levels.


Electrospraying of environmentally sustainable alginate microbeads for cosmetic additives.
Polymer microbeads (MBs) for scrubbing additives have generally been prepared from non-biodegradable synthetic polymers. The worldwide pollution of the marine ecosystem by microplastics urgently demands novel environment-friendly MBs. In this study, Ca-alginate MBs were fabricated by electrospraying an aqueous alginate solution into distilled water containing calcium ions. The size and shape of the Ca-alginate MBs were controlled by electrospraying parameters, such as nozzle diameter and solution concentration. As the alginate concentration and needle diameter were increased, the size of alginate MBs was gradually increased, because of the higher mass flow rate. In addition, the adsorption and degradation behavior of alginate MBs were examined using model contaminants and sea water, respectively. In particular, alginate MBs rapidly degraded in sea water, due to the reversible ion-exchange reaction between Ca2+ in MBs and Na+ in sea water. Therefore, the electrosprayed Ca-alginate MBs offer a promising alternative for environment-friendly cosmetic additives.


Near Surface Mounted Composites for Flexural Strengthening of Reinforced Concrete Beams.
Existing structural components require strengthening after a certain period of time due to increases in service loads, errors in design, mechanical damage, and the need to extend the service period. Externally-bonded reinforcement (EBR) and near-surface mounted (NSM) reinforcement are two preferred strengthening approach. This paper presents a NSM technique incorporating NSM composites, namely steel and carbon fiber-reinforced polymer (CFRP) bars, as reinforcement. Experimental and analytical studies carried out to explore the performance of reinforced concrete (RC) members strengthened with the NSM composites. Analytical models were developed in predicting the maximum crack spacing and width, concrete cover separation failure loads, and deflection. A four-point bending test was applied on beams strengthened with different types and ratios of NSM reinforcement. The failure characteristics, yield, and ultimate capacities, deflection, strain, and cracking behavior of the beams were evaluated based on the experimental output. The test results indicate an increase in the cracking load of 69% and an increase in the ultimate load of 92% compared with the control beam. The predicted result from the analytical model shows good agreement with the experimental result, which ensures the competent implementation of the present NSM-steel and CFRP technique.


Using isoproterenol stress echocardiography to predict the response to carvedilol in patients with dilated cardiomyopathy.
Trials have demonstrated that carvedilol can produce hemodynamic, symptomatic, and prognostic improvements in dilated cardiomyopathy (DCM), but some DCM patients have deteriorated after carvedilol, developing congestive heart failure. The present study investigated the use of isoproterenol (ISP) stress echocardiography to select those patients with DCM who would respond to carvedilol. ISP was infused intravenously in 22 patients with DCM and they were classified into 2 groups based on the left ventricular systolic response: good response to ISP [change in fractional shortening (FS) with ISP > 0.05, n=13] and poor response to ISP (change < or = 0.05, n=9). In the good response group, FS significantly increased from 0.12+/-0.04 to 0.17+/-0.08 (mean+/-SD, p<0.05) with carvedilol, and 7 patients improved symptomatically (New York Heart Association class). However, in the poor response group, no significant difference was observed between FS at baseline and that at the end of follow-up. Moreover, only 1 patient in the poor response group improved symptomatically. ISP stress echocardiography can assist in selecting patients with DCM who will respond positively to carvedilol.


[Clinical examination of the shoulder and diagnostic maneuvers].
The authors review in this article the anamnestic and examination steps of a patient suffering from chronic shoulder pain. They first remind the reader of the muscles intervening in the different shoulder's movements and then go over to the systematic review of the information disclosed by the disorders of the shoulder's motion, whether passively actively or against resistance. They describe the most important diagnosis tests. They finally describe an examination strategy that makes it possible to take a rational clinical decision.


Labor markets and economic inequality in the United States since the end of the 1970s.
By most measures, the United States is the most unequal of the world's advanced capitalist economies, and inequality has increased substantially over the past 30 years. This article documents trends in the inequality of three key economic distributions--hourly earnings, annual incomes, and net wealth--and relates these developments to changes in economic and social policy over the past three decades. The primary cause of high and rising inequality is the systematic erosion of the bargaining power of lower- and middle-income workers relative to their employers, reflected in the erosion of the real value of the minimum wage, the decline in unions, widescale deregulation of industries such as airlines and trucking, the privatization and outsourcing of many state and local government activities, increasing international competition, and periods of restrictive macroeconomic policy.


Transcranial Doppler sonography in children: review of a seven-year experience.
We report the use of transcranial Doppler sonography (TCD) examinations in children (mean age 12.7 years; range 0.5-18 years) without an open fontanelle, using TCD equipment with a 2 MHz pulse wave transducer. Our results over a 7-year period are described. A total of 858 children were referred from the paediatric outpatient department. All patients were divided into three groups according to the reason for referral. We found positive pathological results in the following: (1) headache and orthostatic dysregulation (0.4%, three out of 728); (2) acute neurological symptoms (5.4%, six out of 112); (3) other indications (22.2%, four out of 18). The positive predictive value of finding an abnormality was very low (0.50). TCD examination is ineffective in children with non-specific headache or orthostatic dysregulation due to the specific limitations of this method. We found a higher percentage of abnormal results in children referred for other indications. However, since these children usually undergo MR imaging (and MR angiography, if necessary), in our opinion the TCD examination does not add any additional information. The value of TCD in children is not in the primary diagnosis of disease but in the follow up of known vascular processes (e.g. stenoses) or in chronic diseases including angiitis and sickle cell disease.


Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion.
The treatment of thoracolumbar burst fracture is a controversial issue. Although spinal fusion has been a touchstone of spinal fixation, nonfusion technique have become raising its popularity recently. Some studies suggested that nonfusion had several advantages over fusion. The aim of this prospective study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion. For this purpose, 42 consecutive patients were assigned to two groups. Group 1 included 21 patients treated by long segment instrumentation with fusion (WF), whereas Group 2 included 21 patients treated by long segment instrumentation without fusion (WOF). Long segment instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. Measurements of local kyphosis, sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up. Moreover, there was no difference between the two groups according to low back outcome score. Also, implant failure rate (4.7%) was quite low in both groups. However, WF group had prolonged operative time, increased blood loss and donor site morbidity. Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures.


[Control of population growth in China].
"By way of introduction the study outlines the serious problems caused by the huge mass of population, and the problems associated with the strict birth control introduced by [the] Chinese government. The prevailing administrative methods, previously applied under the conditions of centralised planned economy, have lost much of their effectiveness in the developing market economy. The author analyses what other methods might be applied, in addition to (sometimes instead of) those referred [to] above, being in line with the market and based on the interests of families and communities." (SUMMARY IN ENG)


Toward the Role of L2 Enjoyment in EFL Students' Academic Motivation and Engagement.
Since students' academic success is tied to their academic motivation and engagement, determining the predictors of these two variables seems critical. So, several inquiries have inspected the role of students' emotional and personal variables in their academic motivation and engagement. Nonetheless, the function of L2 enjoyment as an important emotional factor has remained elusive. Moreover, no inquiry has reviewed this issue neither systematically nor theoretically. To fill these lacunas, this review study aims to explain definitions, dimensions, and theoretical frameworks of L2 enjoyment, student academic motivation, and student academic engagement. This study also intends to outline the positive consequences of L2 enjoyment for students' academic engagement and motivation. Relying on the theoretical and empirical evidence, the positive role of L2 enjoyment in raising EFL students' engagement and motivation was firmly affirmed. Finally, the implications of the findings are discussed.


Microhabitat selection by sea turtles in a dynamic thermal marine environment.
1. Reproductive fitness is often compromised at the margins of a species' range due to sub-optimal conditions. 2. Set against this backdrop, the Mediterranean's largest loggerhead sea turtle (Caretta caretta) rookery at Zakynthos (Greece) presents a conundrum, being at a very high latitude for this species, yet hosting a high concentration of nesting. 3. We used visual surveys combined with global positioning system (GPS) tracking to show that at the start of the breeding season, individuals showed microhabitat selection, with females residing in transient patches of warm water. As the sea warmed in the summer, this selection was no longer evident. 4. As loggerhead turtles are ectothermic, this early season warm-water selection presumably speeds up egg maturation rates before oviposition, thereby allowing more clutches to be incubated when sand conditions are optimal during the summer. 5. Active selection of warm waters may allow turtles to initiate nesting at an earlier date.


The relationship between extracurricular activities assessed during selection and during medical school and performance.
Several medical schools include candidates' extracurricular activities in their selection procedure, with promising results regarding their predictive value for achievement during the clinical years of medical school. This study aims to reveal whether the better achievement in clinical training of students selected on the basis of their extracurricular activities could be explained by persistent participation in extracurricular activities during medical school (msECAs). Lottery-admitted and selected student admission groups were compared on their participation in three types of msECAs: (1) research master, (2) important board positions or (3) additional degree programme. Logistic regression was used to measure the effect of admission group on participation in any msECA, adjusted for pre-university GPA. Two-way ANCOVA was used to examine the inter-relationships between admission group, participation in msECAs and clerkship grade, with pre-university GPA as covariate. Significantly more selected students compared to lottery-admitted students participated in any msECA. Participation in msECAs was associated with a higher pre-university GPA for lottery-admitted students only, whereas participation in msECAs was associated with higher clerkship grades for selected students only. These results suggest that persistent participation in extracurricular activities of selected students favours better clinical achievement, supporting the inclusion of ECAs in the selection procedure. More insight in the rationale behind participation in extracurricular activities during medical school may explain differences found between lottery-admitted and selected students.


The pathophysiology of heart failure with preserved ejection fraction and its therapeutic implications.
Heart failure with preserved ejection fraction (HFPEF) is a common syndrome, accounting for nearly one half of all heart failure patients. It mostly affects the elderly, usually with multiple comorbidities, and has a poor prognosis, with high mortality rates and a significant impact on quality of life. Nevertheless, evidence-based therapeutic strategies for the management of HFPEF are still lacking, and so treatment remains largely empirical. This is probably why current treatment of HFPEF has not led to a significant improvement in prognosis. In this review article we will discuss the pathophysiology of HFPEF and its implications for the best treatment strategies to apply in these patients. We will also review the evidence supporting the use of each therapy in HFPEF. In addition, we will consider how an understanding of the pathophysiology of HFPEF can help in developing new therapeutic strategies that will improve the prognosis of this syndrome. Until new evidence-based clinical data are available, treatment of HFPEF should remain multidisciplinary and individualized to each patient.


ATM is required for efficient recombination between immunoglobulin switch regions.
Ataxia telangiectasia mutated (ATM) kinase is critical for initiating the signaling pathways that lead to cell cycle checkpoints and DNA double strand break repair. In the absence of ATM, humans and mice show a primary immunodeficiency that includes low serum antibody titers, but the role of ATM in antigen-driven immunoglobulin gene diversification has not been defined. Here, we show that although ATM is dispensable for somatic hypermutation, it is required for efficient class switch recombination (CSR). The defect in CSR is not due to alterations in switch region transcription, accessibility, DNA damage checkpoint protein recruitment, or short-range intra-switch region recombination. Only long-range inter-switch recombination is defective, indicating an unexpected role for ATM in switch region synapsis during CSR.


Comparison of a low-osmolar contrast medium, iopamidol, and an iso-osmolar contrast medium, iodixanol, in MDCT coronary angiography.
To prospectively compare iopamidol 370, which is a low-osmolar contrast medium and iodixanol 320, which is an iso-osmolar contrast medium, in terms of image quality and nonserious adverse effects that have the potential to influence the image quality in a 16-slice multi-detector row computed tomography coronary angiography. Sixty patients were divided into two groups to receive iodixanol 320 or iopamidol 370. Image quality was assessed, using a five-point grading scale. Differences in the mean attenuation (Hounsfield units) at the origin of the coronary arteries and on the ascending aorta in both the groups were compared. The number and intensity of adverse effects were compared between the two groups. The mean attenuation values of the ascending aorta and the origins of the coronary arteries for the two groups showed no significant difference (P≥0.41). There was no significant difference in terms of image quality between the two groups on all evaluated segments. There was a statistically significant difference in the number of adverse effects (P=0.001) between the two groups. However, in both the iodixanol group and the iopamidol group, there was no significant difference in terms of image quality between the patients with and without adverse effects. The frequency of adverse effects is lower in the iodixanol group than the iopamidol group. Iodixanol 320 can provide both vascular enhancement and image quality, which is similar to iopamidol 370 in a 16-slice multi-detector row computed tomography coronary angiography. There was no significant difference in terms of overall image quality between the patients with and without adverse effects in either of the groups.


Valorization of raw materials from agricultural industry for astaxanthin and β-carotene production by Xanthophyllomyces dendrorhous.
Waste deriving from food and agro-industries is a growing problem in our modern society. In order to reduce food waste and its associated impacts over the environment and public health, innovative strategies for the conversion of food wastes in added value products are studied. Whey is one of the prominent waste deriving from Sicilian diary industry. The growth and the carotenoid biosynthesis of the yeast Xanthophyllomyces dendrorhous by its cultivation in pre-treated whey were studied. The study showed the possibility of increasing the astaxanthin productivity from X. dendrorhous in a batch fermentative process under continuous illumination. Our work is focused on the importance of carotenogenesis by X. dendrorhous on whey for the economic and ecological aspect. The results obtained in the study provide useful information about the possible use of this waste material for carotenogenesis from X. dendrorhous.


Evaluation of polypropylene mesh coated with biological hydrogels for temporary closure of open abdomen.
Polypropylene mesh, as a temporary abdominal closure device, may cause mechanical intestine injury and inflammatory response. Chitosan/gelatin hydrogel has excellent biocompatibility, soft and elastic properties. This work is to assess the effects of the chitosan/gelatin hydrogel coated polypropylene mesh on open abdomen wounds. Histological analysis and detection of healing-related factors were conducted to evaluate the inflammation and wound healing process. After 1-day implantation in a murine model of open abdomen, the coated polypropylene mesh, compared with simple polypropylene mesh, demonstrated well protection of the intestine serosa. After 14-day implantation, it reduced the inflammation response by down-regulating the cytokines interleukin-6 and tumor necrosis factor-α, and up-regulating the anti-inflammatory factor interleukin-10. Meanwhile, the composite stimulated granulation tissue growth, and promoted matrix deposition and angiogenesis after 7 and 14 days. In conclusion, the modified temporary abdominal closure composite could significantly protect the intestines from mechanical damage and accelerate wound healing.


Temperament and psychopathology amongst siblings of probands with depressive and anxiety disorders.
Thirteen (42%) of 31 siblings of 29 probands with depression (n = 21) or anxiety disorders (n = 8) attending a clinic met DSM-IIIR criteria for psychiatric disorder, a rate nearly three times greater than reported from community studies. The diagnoses were heterogeneous. Compared with probands, sibling cases had half the level of comorbidity and significantly lower levels of psychosocial impairment. Comparisons of temperamental characteristics showed that higher levels of emotionality, but no other aspect of temperament, was associated with an increased likelihood of a sibling being a case. Higher emotionally in all cases (sibs and probands) was associated with greater comorbidity in general and the diagnoses of dysthymia and separation anxiety in particular.


High-throughput Minitaturized RNA-Seq Library Preparation.
Advances in next-generation sequencing technologies have allowed RNA sequencing to become an increasingly time efficient, cost-effective, and accessible tool for genomic research. We present here an automated and miniaturized workflow for RNA library preparation that minimizes reagent usage and processing time required per sample to generate Illumina compatible libraries for sequencing. The reduced-volume libraries show similar behavior to full-scale libraries with comparable numbers of genes detected and reproducible clustering of samples.


Transient vortex events in the initial value problem for turbulence.
A vorticity surge event that could be a paradigm for a wide class of bursting events in turbulence is studied. The coherent mechanism is characterized by locally transverse vortex configurations that are intrinsically helical in both physical and Fourier space when there is a peak of the maximum vorticity parallel omega parallel(infinity)(t). At no time are nonhelical, antiparallel vorticity elements observed. This event precedes the appearance of the traditional signatures of an energy cascade such as strong growth of the dissipation, spectra approaching -5/3, and strongly Beltramized vortex tubes. Comparing how different large-eddy simulations reproduce these properties demonstrates the importance of properly modeling nonlinear transport of both energy and helicity.


An Internally Consistent Thermodynamic Model for the System CaO-MgO-Al2O3-SiO2 Derived Primarily from Phase Equilibrium Data.
An internally consistent thermodynamic model for the subsolidus system CaO-MgO-Al2O3-SiO2 (CMAS) was developed and refined using primarily data from phase equilibrium experiments. The solution properties of pyroxenes and garnet were approximated with an ionic model, with independent mixing on adjacent crystallographic sites. This approach simplified the calculation of phase relations by allowing sequential calculation of the site occupancies. Enthalpy, entropy, and volume differences, nominally at 970 K, were derived for all participating phases by matching as closely as possible the experimentally observed phase relations. Although thermochemical measurements were not used directly in the refinement, the results were continuously monitored and compared with the thermochemical data to achieve a close match. The new model can be used to calculate phase diagrams for the CMAS system and its subsystems in the whole pressure range of the upper mantle. Simple empirical corrections for the effects of Na, Fe, Cr, etc., could potentially be introduced to make the model applicable to the thermobarometry of chemically complex mantle materials. Application of the new model to garnet lherzolite xenoliths from northern Lesotho and garnet peridotites from Norway supports the proposals for higher temperatures of the continental lithosphere.


New dress on an old pig? ACOs tie payment to accountability, outcomes.
Some physicians, hospital executives, and health care policy analysts are pushing accountable care organizations (ACOs) to replace fee-for-service medicine. In an ACO, physicians and other health care professionals have financial incentives to contain costs and improve quality by coordinating care for a specific group of patients. Hospitals, physicians, and other health care professionals in the organization share the savings.