Symptom profiles in the painDETECT Questionnaire in patients with peripheral neuropathic pain stratified according to sensory loss in quantitative sensory testing.
The painDETECT Questionnaire (PDQ) is commonly used as a screening tool to discriminate between neuropathic pain (NP) and nociceptive pain, based on the self-report of symptoms, including pain qualities, numbness, and pain to touch, cold, or heat. However, there are minimal data about whether the PDQ is differentially sensitive to different sensory phenotypes in NP. The aim of the study was to analyze whether the overall PDQ score or its items reflect phenotypes of sensory loss in NP as determined by quantitative sensory testing. An exploratory analysis in the Innovative Medicines Initiative Europain and Neuropain database was performed. Data records of 336 patients identified with NP were grouped into sensory profiles characterized by (1) no loss of sensation, (2) loss of thermal sensation, (3) loss of mechanical sensation, and (4) loss of thermal and mechanical sensation. painDETECT Questionnaire profiles were analyzed in a 2-factor analysis of variance. Patients with loss of thermal sensation (2 and 4) significantly more often reported pain evoked by light touch, and patients with loss of mechanical sensation (3 and 4) significantly more often reported numbness and significantly less often burning sensations and pain evoked by light touch. Although the PDQ was not designed to assess sensory loss, single items reflect thermal and/or mechanical sensory loss at group level, but because of substantial variability, the PDQ does not allow for individual allocation of patients into sensory profiles. It will be useful to develop screening tools according to the current definition of NP.


Undernutrition in Nigeria: dimension, causes and remedies for alleviation in a changing socio-economic environment.
Undernutrition in Nigeria is a long standing problem which has persisted since the 1960s and whose magnitude is on the increase. This is because food consumption, both in quality and quantity, has decreased appreciably, especially with the commencement of the structural adjustment programme (SAP) in 1986. Available studies from limited data have indicated that the introduction of economic reforms more than anything else has contributed to reduced food intake and the near collapse of nutrition oriented health delivery services. Since the economic reforms may continue into the next decade and beyond, sustainable remedies for alleviation of the problem are urgently needed. Suggested remedial programmes include increased support for the rural farmers, strengthening of the rural credit schemes that are specifically targeted at the poor, distribution of vitamin A and iron supplements in rural health centres, encouraging production of low cost weaning diets and integrating nutrition education in primary health care schemes and in educational curricula.


Preparation for marrow transplantation in Hodgkin's and non-Hodgkin's lymphoma using Bu/CY.
The results of autologous and allogeneic BMT in 44 patients with Hodgkin's or non-Hodgkin's lymphomas who received preparative therapy consisting of busulfan 16 mg/kg and cyclophosphamide 120 mg/kg are presented. Sixteen patients are surviving free of disease between 8 months and 6 years after transplantation. Thirteen patients either did not attain complete remission or experienced a recurrence of their disease. Fifteen patients died from treatment-related complications. Karnofsky score < or = 70, lactate dehydrogenase greater than twice normal and the development of hepatic veno-occlusive disease were associated with failure to achieve lymphoma-free survival.


Characterization of mouse Frizzled-3 expression in hair follicle development and identification of the human homolog in keratinocytes.
Frizzled genes encode a family of Wnt ligand receptors, which have a conserved cysteine-rich Wnt binding domain and include both transmembrane and secreted forms. Work by others has shown that experimental perturbation of Wnt signaling results in aberrant hair formation, hair growth, and hair structure. To date, however, there is no information on the contribution of individual Frizzled proteins to hair development. We now report that Frizzled-3 expression in skin is restricted to the epidermis and to the developing hair follicle. Northern analysis on total mouse skin mRNA revealed a single Frizzled-3 transcript of 3.7 kb. Reverse transcription-polymerase chain reaction and in situ hybridization analysis revealed Frizzled-3 expression in epidermal and hair follicle keratinocytes. Frizzled-3 transcripts are first detected in discrete foci in the developing epidermis of 13 d embryos and later in the hair follicle placodes of 15 d embryos, suggesting a role for this Frizzled isoform in follicle development. In 17 d embryos and 1 d old newborn mice Frizzled-3 expression is limited to suprabasal keratinocytes and is not seen in pelage follicles until 3 d postpartum. In 7 d old neonatal skin, Frizzled-3 is expressed throughout the epidermis and in the outer cell layers of hair follicles. We have also identified the mRNA encoding human Frizzled-3 in epidermal keratinocytes and in the HaCaT keratinocyte cell line. Human Frizzled-3 mRNA encodes a 666 amino acid protein with 97.8% identity to the mouse protein. The human Frizzled-3 gene was mapped using a radiation-hybrid cell line panel to the short arm of chromosome 8 between the markers WI-1172 and WI-8496 near the loci for the Hypotrichosis of Marie Unna and Hairless genes.


The Association Between Dietary Antioxidant Micronutrients and Cardiovascular Disease in Adults in the United States: A Cross-Sectional Study.
Background: Antioxidant micronutrients represent an important therapeutic option for the treatment of oxidative stress-associated cardiovascular diseases (CVDs). However, few studies have evaluated the relationship between the levels of multiple dietary antioxidants and CVDs. Objective: The study therefore aimed to evaluate associations between dietary antioxidants and total and specific CVDs among a nationally representative sample of adults in the US. Design: In total, 39,757 adults (>20 years) were included in this cross-sectional study from the 2005-2018 National Health and Nutrition Examination Survey. We analyzed dietary recall of 11 antioxidant micronutrients in this population. Multivariate logistic and weighted quantile sum (WQS) regression were both applied to examine the relationships between these antioxidants, alone and in combination, with the prevalence of all CVDs and specific CVDs. The linearity of these correlations was also explored using restricted cubic spline (RCS) regression. Results: Multivariate logistic models showed that, compared with the lowest quartile, the levels of 11 antioxidants in the highest quartile were independently associated with decreased total CVD (all P < 0.05). The WQS index showed that, when considered together, the 11 micronutrients were negatively correlated with total CVD (P < 0.001) and five specific CVDs (all P < 0.05), and selenium had the strongest association (weight = 0.219) with total CVD. Moreover, the RCS model demonstrated that iron, zinc and copper were all negatively and non-linearly correlated with total CVD, while the eight other micronutrients had non-significant, linear, negative relationships with total CVD (P for non-linearity >0.05). A piecewise binary logistic regression analysis showed that the inflection points in the relationships between CVD and iron, zinc and copper were 7.71, 6.61, and 0.74 mg/day, respectively. Conclusions: Our findings suggested that high levels of combined dietary antioxidant micronutrients are associated with decreased prevalence of CVDs, and that selenium has the greatest contribution to this association.


Bute's "Botanical tables": dictated by nature.
In the final years of his life, after a long and turbulent political career, John Stuart, third Earl of Bute, was at last free to indulge in one of his passions: botany. The publication of Linnaeus's "Systema naturae" in 1735 threw the botanical world into disarray and academic argument raged throughout Europe. The production of the "Botanical tables" (1785) was an ambitious project to explain Bute's individual view of Linnaeus's system of taxonomy and was particularly composed for the "Fair Sex". Twelve volumes were published privately and presented to family, royalty and botanical colleagues across Europe. The "Botanical tables" were illustrated by the renowned botanical artist, John Miller. The illustrations are both aesthetically pleasing and scientifically correct. In this paper we consider the circumstances of the production of the "Botanical tables" and explore how the original sets of this publication and original material have been dispersed.


An Attempt at a Unified Theory of the Neocortical Microcircuit in Sensory Cortex.
The neocortex performs a wide range of functions, including working memory, sensory perception, and motor planning. Despite this diversity in function, evidence suggests that the neocortex is made up of repeating subunits ("macrocolumns"), each of which is largely identical in circuitry. As such, the specific computations performed by these macrocolumns are of great interest to neuroscientists and AI researchers. Leading theories of this microcircuit include models of predictive coding, hierarchical temporal memory (HTM), and Adaptive Resonance Theory (ART). However, these models have not yet explained: (1) how microcircuits learn sequences input with delay (i.e., working memory); (2) how networks of columns coordinate processing on precise timescales; or (3) how top-down attention modulates sensory processing. I provide a theory of the neocortical microcircuit that extends prior models in all three ways. Additionally, this theory provides a novel working memory circuit that extends prior models to support simultaneous multi-item storage without disrupting ongoing sensory processing. I then use this theory to explain the functional origin of a diverse set of experimental findings, such as cortical oscillations.


Influence of reduced neuromuscular activity on the development of neonatal rat hindlimb muscle.
Normal ankle flexion and extension was inhibited in neonatal rats by applying an adhesive cast on the day of birth such that the tibialis anterior (TA) muscle of one hindlimb was immobilized in a shortened position. Casts were changed daily for 3 weeks, at which time animals were sacrificed. Immobilized TA muscles were significantly lighter in weight, and whole muscle and teased fiber fascicular lengths were significantly shorter. No effects were seen on fiber diameter profiles, total muscle fiber number or muscle cross-sectional area. Immobilized TA muscles had significantly lower phosphofructokinase activities, and lower slow-twitch fibers than contralateral muscles. The mitochondrial enzyme succinic dehydrogenase was unaffected by the reduced activity. It is apparent that, in a developing fast-twitch muscle such as the TA, myofibrillar ATPase histochemical patterns and glycolytic enzyme activity (phosphofructokinase) may be regulated by factors dependent upon neuromuscular activity. Mitochondrial enzymes, such as succinic dehydrogenase, seem to be regulated during development by factors which are not as sensitive to activity.


Influence of physicochemical properties on pharmacokinetics of non-viral vectors for gene delivery.
The influence of physicochemical properties on the in vivo pharmacokinetics of gene delivery vectors after systemic administration is reviewed based on our studies. We have been studying the development of DNA delivery systems, such as plasmid DNA complexed with cationic polymers (polyplexes) and cationic liposomes (lipoplexes). Even if target-recognizable ligand is incorporated into the system, the overall physicochemical properties, notably size and charge, are predominant factors influencing in vivo disposition characteristics of the vector. Based on this consideration, liver cell-specific carrier systems via receptor-mediated endocytosis were successfully developed by optimizing physicochemical characteristics. In conclusion, rational design of gene delivery vectors requires an understanding of their pharmacokinetics in relation to the physicochemical properties. Optimization of the physicochemical properties is important for successful in vivo gene delivery by non-viral vectors.


Central nervous system infection in the pediatric population.
Infection of the central nervous system is a life-threatening condition in the pediatric population. Almost all agents can cause infection within the central nervous system and the extent of infection ranges from diffuse involvement of the meninges, brain, or the spinal cord to localized involvement presenting as a space-occupying lesion. Modern imaging techniques define the anatomic region infected, the evolution of the disease, and help in better management of these patients. Acute bacterial meningitis remains a major cause of mortality and long-term neurological disability. Fortunately, the incidence of infection after clean craniotomy is < 5%, but it leads to significant morbidity as well as fiscal loss. The most significant causative factor in postcraniotomy infections is postoperative CSF leak. Cerebral abscess related to organic congenital heart disease is one of the leading causes of morbidity and mortality in the pediatric population. The administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds.


Genetic studies on the Asmat population (Irian-Jaya, Indonesia).
The Asmat are a population of about 35,000 people living on the South-West coast of Irian-Jaya (Indonesia; New Guinea). This paper presents the results of enzyme group and serum protein group typings in a sample of Asmats living in the coastal region around Agats. Red cell enzyme polymorphisms (EaP, PGM1, 6-PGD, EsD, ADA and AK) could be typed in 154 blood samples, serum protein polymorphisms (Ge, alpha 1-AT, PLG, Tf and Hp) in 160 blood samples. The results of this study are discussed in detail.


Syncope as the Initial Manifestation of Advanced Nasopharyngeal Carcinoma: A Case Report.
Carotid sinus syndrome is a principal cause of syncope in the elderly. Syncope, associated with carotid sinus syndrome which is secondary to metastasis of advanced nasopharyngeal carcinoma, rarely occurs. The current study reported a 66-year-old woman, who presented with a history of frequent and recurrent syncope as the initial symptom, and was eventually diagnosed with advanced nasopharyngeal carcinoma. The positron emission tomography scan demonstrated a diagnosis of advanced nasopharyngeal carcinoma with involvement in carotid sheath space, and nasopharyngeal biopsy revealed non-keratinized nasopharyngeal carcinoma. After diagnosis and treatment, the patient had no recurrence of syncope. In summary, our case study suggests that great importance should be attached to potential intrinsic causes of syncope especially in the case of nasopharyngeal carcinoma, as it is an insidious malignancy which needs to be precisely identified.


A new pyridine-based 12-membered macrocycle functionalised with different fluorescent subunits; coordination chemistry towards Cu(II), Zn(II), Cd(II), Hg(II), and Pb(II).
The coordination chemistry of the new pyridine-based, N2S2-donating 12-membered macrocycle 2,8-dithia-5-aza-2,6-pyridinophane (L1) towards Cu(II), Zn(II), Cd(II), Hg(II), and Pb(II) has been investigated both in aqueous solution and in the solid state. The protonation constants for L1 and stability constants with the aforementioned metal ions have been determined potentiometrically and compared with those of ligand L2, which contains a N-aminopropyl side arm. The measured values show that Hg(II) in water has the highest affinity for both ligands followed by Cu(II), Cd(II), Pb(II), and Zn(II). For each metal ion considered, 1:1 complexes with L1 have also been isolated in the solid state, those of Cu(II) and Zn(II) having also been characterised by X-ray crystallography. In both complexes L1 adopts a folded conformation and the coordination environments around the two metal centres are very similar: four positions of a distorted octahedral coordination sphere are occupied by the donor atoms of the macrocyclic ligand, and the two mutually cis-positions unoccupied by L1 accommodate monodentate NO3- ligands. The macrocycle L1 has then been functionalised with different fluorogenic subunits. In particular, the N-dansylamidopropyl (L3), N-(9-anthracenyl)methyl (L4), and N-(8-hydroxy-2-quinolinyl)methyl (L5) pendant arm derivatives of L1 have been synthesised and their optical response to the above mentioned metal ions investigated in MeCN/H2O (4:1 v/v) solutions.


Downregulation of Notch-1/Jagged-2 in human colon tissues from Hirschsprung disease patients.
Recent studies have shown that the Notch pathways play important roles in the differentiation and development of neurons. Hirschsprung disease (HSCR) is characterized by the absence of intramural ganglion cells in the nerve plexuses of the distal gut. However, putative Notch function in enteric nervous system (ENS) development and the etiology of HSCR is unknown. The aganglionosis segments of 30 HSCR patients were introduced to investigate the expression pattern of Notch-1 and Jagged-2 using immunohistochemical staining, reverse transcriptase polymerase chain reaction (RT-PCR), and Western blot analysis. Intensive Notch-1 and Jagged-2 staining was detected in the submucosal and the myenteric plexuses in normal or oligoganglionosis segments. Aganglionosis segments from HSCR patients contained no plexuses and thus not labeled with Notch-1 and Jagged-2. Western blot analysis revealed reduced Notch-1 and Jagged-2 protein levels, and RT-PCR revealed reduced Notch-1 and Jagged-2 mRNA in the aganglionosis segments of HSCR patients. This study is the first illustration of Notch-1 and Jagged-2 expression in human tissues from non-cancerous disease and sets up the base for further investigations of Notch function in ENS development and intestinal motility.


Dissociation of human mid-dorsolateral from posterior dorsolateral frontal cortex in memory processing.
Work with non-human primates had previously demonstrated that the mid-dorsolateral frontal cortex, which comprises cytoarchitectonic areas 46 and 9, plays a critical role in the performance of non-spatial self-ordered working memory tasks, whereas the immediately adjacent posterior dorsolateral frontal cortex (area 8) is critical for the learning and performance of visual conditional associative tasks. The present study used positron emission tomography with magnetic resonance imaging to demonstrate the existence, within the human brain, of these two functionally distinct subdivisions of the lateral frontal cortex. These findings provide direct evidence that, just as the monkey brain, the human lateral frontal cortex is functionally heterogeneous and that comparable anatomical areas underlie similar functions in the two species.


CD38- and Leu6-positive cells in dermal lesions of mycosis fungoides.
The phenotypes of mononuclear cells in 16 patients with mycosis fungoides (MF) (8 were in tumor stage and 8 in pretumor stage) were tested by ABC immunochemical technique. The results showed that the percentage of CD38 and Leu6(+) cells in tumor stage was higher than that in pretumor stage. CD38 was identified to be a marker of the immature lymphocytes. The change of CD38 might be helpful in staging MF and predicting the prognosis of the disease. In addition, Leu6(+) cells, oval or round in shape and without dendritic processes were found in tumor stage, suggesting that they might be immature lymphoid cells. This feature needs further investigation.


Magnon-driven interfacial magnetoelectric coupling in Co/PMN-PT multiferroic heterostructures.
Magnon-driven interfacial magnetoelectric coupling in Co/PMN-PT multiferroic heterostructures is investigated at room temperature. The electric field controlled ferromagnetic resonance field possesses a loop-like curve, with a large resonance field shift between positive and negative remanent polarizations, which confirms a non-volatile strong magnetoelectric coupling. However, with a non-magnetic Ta layer inserted at the Co/PMN-PT interface, a piezostrain-induced butterfly-like curve of the resonance field versus applied electric field of the Co/Ta/PMN-PT multiferroic heterostructure is observed. Further, the non-volatile behavior of the resonance field changing with the applied electric field can be obtained, consistent with the result of polarization versus applied electric field curve, which can be attributed to the magnon-driven interfacial magnetoelectric coupling, showing a strong correlation of magnetization of Co thin film and the polarization of PMN-PT. The result is promising for the design of future multiferroic devices.


A rare case of Watson syndrome.
Watson for the first time reported a case series of children in a family that presented with pulmonary valve stenosis, mental retardation, short stature, and small brown color skin lesions that are known as cafe-au-lait spots. We present a rare new variant of the syndrome in an adult patient with severe pulmonary valve stenosis, main, left, and right pulmonary artery aneurysm, short stature, mental retardation, coronary artery disease, and skin lesions. The patient underwent open cardiac surgery with pulmonary valvotomy and aneurysmorrhaphy of the main pulmonary artery and its right and left branches. The postoperative course was uneventful and the six-month follow-up with transthoracic echocardiography revealed no recurrence of aneurysm of repairing pulmonary arteries and good clinical outcome of the patient. Our patient had a unique characteristic of aneurysm of the main pulmonary artery and its both branches that has rarely been reported previously in the medical literature.


The binding of precursor proteins to chloroplasts requires nucleoside triphosphates in the intermembrane space.
Protein import into chloroplasts is initiated by a binding interaction between a precursor protein and the surface of the outer envelope. The binding step was previously shown to be energy-dependent (Olsen, L. J., Theg, S. M., Selman, B. R., and Keegstra, K. (1989) J. Biol. Chem. 264, 6724-6729). We took advantage of the broad nucleotide specificity of the energy requirement for binding to investigate the site of the nucleoside triphosphate (NTP) requirement. GTP supported precursor binding to chloroplasts. It was not converted to ATP, as determined by direct ATP measurements, and was not transported across the inner envelope. Thus, GTP supported binding from either the intermembrane space or outside the outer membrane. To distinguish between an intermembrane space and an external NTP requirement, we experimentally manipulated the NTP levels inside and outside chloroplasts. Internally generated ATP was able to support binding in the presence of an external membrane-impermeant ATP trap. Therefore, since GTP supported binding from either the intermembrane space or outside the chloroplast, and ATP supported binding from either the intermembrane space or the stroma, we concluded that the site of NTP utilization for precursor binding to chloroplasts was the intermembrane space between the two envelope membranes.


Molecular dynamics simulation of O2 sticking on Pt(111) using the ab initio based ReaxFF reactive force field.
The molecular dynamics technique with the ab initio based classical reactive force field ReaxFF is used to study the adsorption dynamics of O(2) on Pt(111) for both normal and oblique impacts. Overall, good quantitative agreement with the experimental data is found at low incident energies. Specifically, our simulations reproduce the characteristic minimum of the trapping probability at kinetic incident energies around 0.1 eV. This feature is determined by the presence of a physisorption well in the ReaxFF potential energy surface (PES) and the progressive suppression of a steering mechanism when increasing the translational kinetic energy (or the molecule's rotational energy) because of steric hindrance. In the energy range between 0.1 and 0.4 eV, the sticking probability increases, similar to molecular beam sticking data. For very energetic impacts (above 0.4 eV), ReaxFF predicts sticking probabilities lower than experimental sticking data by almost a factor of 3 due to an overall less attractive ReaxFF PES compared to experiments and density functional theory. For oblique impacts, the trapping probability is reduced by the nonzero parallel momentum because of the PES corrugation and does not scale with the total incident kinetic energy. Furthermore, our simulations predict quasispecular (slightly supraspecular) distributions of angles of reflection, in accordance with molecular beam experiments. Increasing the beam energy (between 1.2 and 1.7 eV) causes the angular distributions to broaden and to exhibit a tail toward the surface normal because molecules have enough momentum to get very near the surface and thus probe more corrugated repulsive regions of the PES.


[Application of the fusafungine in perioperative period in patients after tonsillectomy].
The only treatment method in chronic palatine tonsillitis is the removal of tonsils (tonsillectomy). The study aimed at a clinical evaluation of postoperative fusafungine use in patients who underwent tonsillectomy. The study included 200 patients who underwent tonsillectomy for chronic palatine pyotonsillitis in the Otolaryngology Clinic of the Military Institute for the Health Services in Warsaw between 2000 and 2002. The patients were divided into two groups, each group including 100 patients: group I--patients who underwent tonsillectomy, including 67 females and 33 males, aged 16 to 52 (mean age 34.8), in whom fusafungine was used; group II--patients who underwent tonsillectomy, including 58 females and 42 males, aged 17 to 56 (mean age 36.1), who did not receive fusafungine. The subjects were observed during the first 14 days following the operation. The treatment was administered from the first day after the operation, by spraying 4 doses into the throat, 4 times a day, at 8.00 hrs, 12.00 hrs, 16.00 hrs and 20.00 hrs. The two groups were then compared in terms of: symptoms of sore throat, body temperature, swallowing difficulties, the course of healing, appearance of the pharyngeal mucosa, quality of life and general affection. Post-tonsillectomy fusafungine use was found to improve the patients' quality of life, appeases the sore throat and swallowing difficulties, decreases the need for general antibiotic therapy; the above results are statistically significant. Fusafungine was not found to influence body temperature, the appearance of the pharyngeal mucosa or the healing process.


Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.
A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.


Engineering arsenic tolerance and hyperaccumulation in plants for phytoremediation by a PvACR3 transgenic approach.
Arsenic (As) pollution is a global problem, and the plant-based cleanup of contaminated soils, called phytoremediation, is therefore of great interest. Recently, transgenic approaches have been designed to develop As phytoremediation technologies. Here, we used a one-gene transgenic approach for As tolerance and accumulation in Arabidopsis thaliana . PvACR3, a key arsenite [As(III)] antiporter in the As hyperaccumulator fern Pteris vittata , was expressed in Arabidopsis , driven by the CaMV 35S promoter. In response to As treatment, PvACR3 transgenic plants showed greatly enhanced tolerance. PvACR3 transgenic seeds could even germinate and grow in the presence of 80 μM As(III) or 1200 μM arsenate [As(V)] treatments that were lethal to wild-type seeds. PvACR3 localizes to the plasma membrane in Arabidopsis and increases arsenite efflux into external medium in short-term experiments. Arsenic determination showed that PvACR3 substantially reduced As concentrations in roots and simultaneously increased shoot As under 150 μM As(V). When cultivated in As(V)-containing soil (10 ppm As), transgenic plants accumulated approximately 7.5-fold more As in above-ground tissues than wild-type plants. This study provides important insights into the behavior of PvACR3 and the physiology of As metabolism in plants. Our work also provides a simple and practical PvACR3 transgenic approach for engineering As-tolerant and -hyperaccumulating plants for phytoremediation.


[The senior students perception about basic nursing tools and their applicability].
This paper presents a descriptive exploratory study of student's perception about the applicability of basic nursing tools on the daily professional practice. Results highlights the factors that contribute to the continuity of dichotomy between theory and practice and the possibilities of overcoming/transformation of this reality. In addition, the study shows that the concretization of the know-how in nursing requires from each nurse to be aware of his/her personal, professional and social responsibility to offer a high quality health care, through the full professional know-how and knowledge.


About face: left-hemisphere involvement in processing physiognomies.
Three experiments were concluded to investigate the involvement of the two cerebral hemispheres in processing faces. Perceptual discrimination of pairs of faces was equally speedy overall when the stimuli were presented in the right visual field (RVF) or left visual field (LVF). For faces differing in one or two features, however, a qualitatively different pattern of results was obtained for the two visual fields, and an RVF advantage emerged when the difference lay in the upper part of the faces (Experiment 1). An examination of the discriminability of the facial features from which the faces were constructed (Experiment 2) showed that the processes involved in RVF comparisons of faces were not dependent on the saliency of the features but, rather, followed a top-to-bottom serial analysis of the stimuli; the speed of the processing involved in LVF presentations was a function of the degree of similarity of the different comparison faces. Evidence for a serial type of comparison faces were used (Experiment 3). It was concluded that even though comparisons were equally speedy overall in LVF and RVF presentations, qualitatively different processes take place in the two hemispheres, which prove competent at processing faces, each in its own way. Some methodological problems inherent in tachistoscopic studies are discussed, and it is proposed that the quality of the stimulus representation achieved or required for cognitive processing may be determinant in the emergence of functional hemispheric asymmetries.


In vivo fluorescence imaging of tumors using molecular aptamers generated by cell-SELEX.
Poor sensitivity and low specificity of current molecular imaging probes limit their application in clinical settings. To address these challenges, we used a process known as cell-SELEX to develop unique molecular probes termed aptamers with the high binding affinity, sensitivity, and specificity needed for in vivo molecular imaging inside living animals. Importantly, aptamers can be selected by cell-SELEX to recognize target cells, or even surface membrane proteins, without requiring prior molecular signature information. As a result, we are able to present the first report of aptamers molecularly engineered with signaling molecules and optimized for the fluorescence imaging of specific tumor cells inside a mouse. Using a Cy5-labeled aptamer TD05 (Cy5-TD05) as the probe, the in vivo efficacy of aptamer-based molecular imaging in Ramos (B-cell lymphoma) xenograft nude mice was tested. After intravenous injection of Cy5-TD05 into mice bearing grafted tumors, noninvasive, whole-body fluorescence imaging then allowed the spatial and temporal distribution to be directly monitored. Our results demonstrate that the aptamers could effectively recognize tumors with high sensitivity and specificity, thus establishing the efficacy of these fluorescent aptamers for diagnostic applications and in vivo studies requiring real-time molecular imaging.


QTL mapping of genome regions controlling temephos resistance in larvae of the mosquito Aedes aegypti.
The mosquito Aedes aegypti is the principal vector of dengue and yellow fever flaviviruses. Temephos is an organophosphate insecticide used globally to suppress Ae. aegypti larval populations but resistance has evolved in many locations. Quantitative Trait Loci (QTL) controlling temephos survival in Ae. aegypti larvae were mapped in a pair of F3 advanced intercross lines arising from temephos resistant parents from Solidaridad, México and temephos susceptible parents from Iquitos, Peru. Two sets of 200 F3 larvae were exposed to a discriminating dose of temephos and then dead larvae were collected and preserved for DNA isolation every two hours up to 16 hours. Larvae surviving longer than 16 hours were considered resistant. For QTL mapping, single nucleotide polymorphisms (SNPs) were identified at 23 single copy genes and 26 microsatellite loci of known physical positions in the Ae. aegypti genome. In both reciprocal crosses, Multiple Interval Mapping identified eleven QTL associated with time until death. In the Solidaridad×Iquitos (SLD×Iq) cross twelve were associated with survival but in the reciprocal IqxSLD cross, only six QTL were survival associated. Polymorphisms at acetylcholine esterase (AchE) loci 1 and 2 were not associated with either resistance phenotype suggesting that target site insensitivity is not an organophosphate resistance mechanism in this region of México. Temephos resistance is under the control of many metabolic genes of small effect and dispersed throughout the Ae. aegypti genome.


Dual-output fs/ps burst-mode laser for megahertz-rate rotational coherent anti-Stokes Raman scattering.
A burst-mode laser system is developed for hybrid femtosecond/picosecond (fs/ps) rotational coherent anti-Stokes Raman scattering (RCARS) at megahertz rates. Using a common fs oscillator, the system simultaneously generates time synchronized 1061 nm, 274 fs and 1064 nm, 15.5 ps pulses with peak powers of 350 MW and 2.5 MW, respectively. The system is demonstrated for two-beam fs/ps RCARS in N2 at 1 MHz with a signal-to-noise ratio of 176 at room temperature. This repetition rate is an order of magnitude higher than previous CARS using burst-mode ps laser systems and two to three orders of magnitude faster than previous continuously pulsed fs or fs/ps laser systems.


Predicting Injury: Challenges in Prospective Injury Risk Factor Identification.
Musculoskeletal injury-prediction methods vary and may have limitations that affect the accuracy of results and clinical meaningfulness. Research examining injury risk factors is meaningful, but attempting to extrapolate injury risk from studies that do not prospectively assess injury occurrence may limit clinical applications. Injury incidence is a vital outcome measure, which allows for the appropriate interpretation of injury-prediction analyses; a lack of injury-incidence data may decrease the accuracy and increase the uncertainty of injury-risk estimates. Extrapolating results that predict an injury risk factor to predicting actual injuries may lead to inappropriate clinical decision-making models. Improved understanding of the limitations of injury-prediction methods, specifically those that do not prospectively assess injuries, will allow clinicians to better assess the clinical meaningfulness of the results.


[Immunochemical tests for the risk of inflammatory diseases].
Immunochemical measurements of the blood serum acute-phase proteins (APP)--C-reactive, pregnancy-related alpha 2-glycoprotein, lactoferrin, immunoglobulins A, M, and G, carried out in 153 healthy men and 46 children, has revealed that an elevated level of at least one, and, more so, of two or three APP evidences the presence of an inflammatory process in the examinee. In a number of cases enhanced APP production correlated with a marked reduction of IgA and IgG concentrations. Measurements of APP may be employed as available laboratory screening markers of nonspecific latent inflammation in adults and children.


Sequence context analysis of 8.2 million single nucleotide polymorphisms in the human genome.
We analyzed n-mers (n=3-8) in the local environment of 8,249,446 human SNPs and compared their distribution with that in the genome reference sequences. The results revealed that the short sequences, which contained at least one CpG dinucleotide, occurred more frequently in the local SNP sequences than in the genome sequences. To exclude the hypermutability effect of the methylated CpG dinucleotides on the sequence context of SNPs, we examined the distribution patterns for each of the six categories of substitution. We observed the similar pattern (i.e., CpG-containing n-mers vs. non-CpG-containing n-mers) in SNP categories A/G, C/T and C/G but the opposite pattern in category A/T. We next identified 34,928 putative CpG islands in the human genome and located 133,591 SNPs within these islands. In the CpG islands, CpG SNPs were 3.92-fold less prevalent relative to the presence of CpG dinucleotides. Conversely, in the human genome, the frequency of CpG dinucleotides at the polymorphic sites was 6.09 times that in the genome reference sequences. These results support the previous views of mutational suppression at the CpG sites in the CpG islands and hypermutability of the methylated CpG dinucleotides that are prevalent in the non-CpG island sequences in the human genome. Our study represents a comprehensive investigation of the sequence context of SNPs in the human genome and in human CpG islands.


Mansonelliasis, a neglected parasitic disease in Haiti.
Reported in Haiti as early as 1923, Mansonella ozzardi is still a neglected disease ignored by the health authorities of the country. This review is an update on the geographic distribution of the coastal foci of mansonelliasis in Haiti, the epidemiological profile and prevalence rates of microfilariae in people living in endemic areas, the clinical impact of the parasite on health and the efficiency of the transmission of the parasite among three Culicoides biting-midge species identified as vectors in Haiti. Additionally, interest in establishing a treatment programme to combat this parasite using a single dose of ivermectin is emphasised.


Searching for quantitative entropy-enthalpy compensation among protein variants.
Entropy-enthalpy (SH) compensation occurs when a small change in DeltaG is caused by large, and nearly compensatory, changes in DeltaH and DeltaS. It is considered a ubiquitous property of reactions in water. Because water is intimately involved in protein stability, SH compensation among protein variants, if it exists, could lead to important knowledge about protein-water interactions. In light of recent theoretical work on SH compensation, we gathered thermodynamic data for >200 protein variants to seek evidence for the simplest quantitative model of SH compensation (i.e., The van't Hoff denaturation enthalpy divided by the van't Hoff denaturation entropy is a constant). We conclude that either the data are insufficient to support the idea that quantitative SH compensation is a general feature of variant proteins or that such compensation does not exist. This study reinforces the idea that DeltaH-versus-DeltaS plots should not be used to provide evidence for SH compensation.


Differences in the relationship of marijuana and tobacco by frequency of use: A qualitative study with adults aged 18-34 years.
Co-use of marijuana and tobacco is increasing among adults in the United States, but little research exists examining why co-use occurs. Changing marijuana policies make understanding the relationship between marijuana and tobacco critical. This study aimed to assess how adult co-users of marijuana and tobacco qualitatively conceptualize and describe their use and whether variation exists by frequency of use. Forty-eight past-month co-users aged 18-34 years completed semistructured, 1-on-1 qualitative interviews in Washington State (United States) in 2014. Interviews were digitally recorded, transcribed verbatim, coded, and analyzed overall and across frequency of use strata (high-tobacco/high-marijuana, high-tobacco/low-marijuana, low-tobacco/high-marijuana, and low-tobacco/low-marijuana). High-tobacco use was daily use; high-marijuana use was use on ≥20 of the past 30 days. The relationship between tobacco and marijuana varied by frequency of use and was strongest among high-tobacco use groups. Participants described the following patterns of and reasons for use: sequential use (e.g., using within short succession; due to addiction/habit, to enhance the high, or to counteract the effects of 1 substance), substitution (e.g., using in different times/places; due to liking the general act of smoking, limitations on when/where they could use a substance, or as a way to quit or cut down on 1 substance), or coadministration (e.g., simultaneous use; to adjust the dose of either tobacco or marijuana or to modulate the high/improve the flavor). Relationships between tobacco and marijuana varied based on frequency of use. These data can inform future surveillance and aid in the development of theoretical frameworks to explain why co-use occurs. (PsycINFO Database Record


Electrophysiological Pattern and Predictors of Functional Outcome of Patients with Guillain Barre Syndrome at a Tertiary Care Hospital in Pakistan.
To determine electrophysiological pattern and predictors of functional outcomes of patients with Gullain Barre Syndrome (GBS) at a tertiary care hospital. Observational study. Shifa International Hospital, Islamabad, Pakistan from January 2016 to July 2020. A total of 62 patients with GBS of all age groups, gender, locations and those with no other primary diagnosis such as poliomyelitis, botulism, hysterical paralysis, toxin neuropathy and diabetic neuropathy were included. Functional outcome using modified Rankin Scale (mRS) and HUGHES score were recorded at presentation, on discharge and 6-month follow-up. Results of this study were analyzed using SPSS version 20. There were 69% males with mean age of 31 ± 21years. The frequency of different GBS variants were 53% acute inflammatory demyelinating polyneuropathy (AIDP), 29% acute motor axonal neuropathy (AMAN), 11% acute motor and sensory axonal neuropathy (AMSAN) and pure sensory and atypical GBS were 2% each. The frequency of various antecedent events was recorded in 33 patients, including respiratory tract infection in 9 (14%) and diarrhea/vomiting in 13 (21%) patients. AIDP and AMSAN had a good prognosis where 31 (77%) patients out of the 40 fully recovered with HUGHES score 0-2 after 6 months. AMAN had poor prognosis as 2 (12%) patients died in the Hospital. Majority (n=32, 52%) of the patients were treated with plasmapheresis. In this study population, AIDP was the most common variant with good prognosis and AMAN variant had the worst prognosis. Key Words: Guillain Barre syndrome (GBS), Acute inflammatory demyelinating polyneuropathy (AIDP), Acute motor axonal neuropathy (AMAN), Peripheral neuropathy, Lower limb weakness, Acute motor and sensory axonal neuropathy (AMSAN), Sensory neuropathy, Autoimmune disease.


The relationship of quality of life, depression, and caregiver burden in outpatients with congestive heart failure.
Primary caregivers of patients with congestive heart failure withstand enormous burden, often sacrificing their own quality of life. The relationship between caregiver burden and depression and patient quality of life and depression in this setting is unknown. Fifty outpatients were prospectively administered the Minnesota Living with Heart Failure Questionnaire and Beck Depression Inventory II (BDI-II). Caregivers were administered the Zarit Caregiver Burden Interview and BDI-II. The mean quality of life score was 35, and 26% had a BDI-II score >10. The mean Zarit Caregiver Burden Interview score was 16. Minnesota Living with Heart Failure Questionnaire, BDI-II, and Zarit Caregiver Burden Interview scores were all associated with lower ejection fraction, need for hospitalization, increased number of medications, and comorbidities. Patient Minnesota Living with Heart Failure Questionnaire score correlated with patient BDI-II, caregiver BDI-II, and Zarit Caregiver Burden Interview scores. Caregiver burden score correlated with both caregiver BDI-II and patient BDI-II. Death or hospitalization at 6 months was associated with caregiver burden and depressive symptoms and with patient quality of life and depressive symptoms. Caregivers of patients with congestive heart failure experience high caregiver burden and prevalence of depressive symptoms, which are related to the patient disease burden.


Effects of temperature on the sensitivity of sludge worm Tubifex tubifex Müller to selected heavy metals.
The present study evaluates the effect of temperature on the sensitivity of the freshwater tubificid sludge worm Tubifex tubifex Müller to 10 heavy metal ions. Metals used in this study were cadmium, chromium, cobalt, copper, iron, lead, manganese, mercury, nickel, and zinc. The acute toxicity of these heavy metals was studied at 15, 20, 25, and 30 degrees C. The percentage mortality, relative toxicity, and EC50 values and their 95% confidence limits from 24 to 96 h were determined at varying temperatures. The EC50 values (mg/liter) of metal ions at 15 degrees C were Hg2+, 0.034; Cu2+, 0.340; Cr6+, 1.846; Zn2+, 10.99; Ni2+, 25.10; Cd2+, 56; Fe3+, 86.09; Co2+, 239.39; Pb2+, 456.76; and Mn2+, 164.55. At 30 degrees C the values were Hg2+, 0.014; Cu2+, 0.031; Cr6+, 0.872; Zn2+, 3.37; Ni2+, 18; Cd2+, 28.55; Fe3+, 71.26; Co2+, 95.35; Pb2+, 165.22; and Mn2+, 239.39. The results indicate that the acute toxicity of cadmium, chromium, cobalt, copper, lead, mercury, nickel, and zinc increases with temperature increase. The toxicity of manganese was not influenced by temperature, and temperature had little effect on iron toxicity. The rank order of toxicity of metal ions at 15, 20, 25, and 30 degrees C is presented and discussed. It is concluded that temperature is an important factor in short-term acute toxicity tests. The study indicates that seasonal temperature changes are an important variable in determining the amount of heavy metals that may be safely released from metal industries and other similar sources into the aquatic environment. Influence of temperature on the short- and long-term toxicity of chemicals should be considered for establishing appropriate water-quality criteria and standards to protect aquatic flora and fauna and human health.


Two Health or Not Two Health? That Is the Question.
How much drug-resistant infections in livestock contribute to disease in humans is controversial. While zoonoses are a prominent cause of emerging infections, and the profligate use of antibiotics as growth promoters is expected to lead to the spread of resistance, this resistance could remain concentrated in animal pathogens and only rarely spill over into humans. A recent paper compares genomes of Escherichia coli isolates from human bloodstream infections in England, focused on the Cambridge area, with isolates collected from farms and the food chain in the east of the country, seeking evidence of transmission (C. Ludden, K. E. Raven, D. Jamrozy, T. Gouliouris, et al., mBio 10:e02693-18, 2019, https://doi.org/10.1128/mBio.02693-18). While the human and livestock populations were clearly distinct, with very limited evidence for transmission of E. coli or resistance elements to humans, the results also illustrate our limited ability to infer historical transmission events from even the best samples. The implications for the One Health framework, aiming to unify human and veterinary medicine, are discussed.


Tumor of the liver (hepatocellular and high grade neuroendocrine carcinoma): a case report and review of the literature.
We describe a rare hepatic collision tumor composed of a hepatocellular carcinoma and a high-grade neuroendocrine carcinoma. The patient, a 50-year-old man, underwent a partial hepatectomy because of a 5.0-cm mass. The tumor had two distinctive patterns. The majority of the tumor was a high-grade neuroendocrine carcinoma with features of a small cell carcinoma that was positive for chromogranin, synaptophysin, and cytokeratin 19 and negative for hepatocellular antigen and alpha-fetoprotein (AFP). The second component was a moderately differentiated hepatocellular carcinoma that was positive for hepatocellular antigen and AFP and negative for neuroendocrine markers. The two tumors were separated by fibrous bands. In areas where they collided, there was no transition or intermingling of cells between the two components, thus, it is different from the combined type of tumors. After removal of the tumor, the patient had intrahepatic and mesenteric recurrences within a follow-up period of 16 months.


Comparison of ramosetron's and ondansetron's preventive anti-emetic effects in highly susceptible patients undergoing abdominal hysterectomy.
This study compared the preventive effects of ramosetron and ondansetron on postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing abdominal hysterectomy. In a prospective, randomized, double-blinded study, a total of 120 highly susceptible women (nonsmokers, those receiving opioid-based IV patient-controlled analgesia [PCA]) undergoing abdominal hysterectomy were included in the study. Patients were divided into 2 groups and each group received either 0.3 mg of ramosetron or 4 mg of ondansetron, IV. All patients received fentanyl-based IV PCA during the 48 h postoperative periods. The incidences of PONV and side effects of 5-HT(3) antagonists (headache and dizziness) were assessed at 3 intervals (<2 h, 2-24 h and 24-48 h) postoperatively. Patients in the ramosetron group showed a significantly higher ratio of complete response and lower incidence of nausea during the 24-48 h interval after surgery compared with those the ondansetron group. Ramosetron (0.3 mg) is more effective in preventing delayed PONV in highly susceptible women undergoing abdominal hysterectomy compared with ondansetron (4 mg).


Coaching skills for employee development.
Chief nursing officers, in a national research study called the Nursing Leadership Edge, ranked employee coaching and development as the number one leadership skill required in their jobs. As one chief nursing officer said, "Our success depends on having a support team that is successful and perceived by others as being successful. We need to develop our staff to ensure their success."


Evaluation of the hypertensive patients in southeastern Anatolia; demographic features and target organ damage.
We investigated the socio-demographic characteristics, blood and pulse pressure, and end organ damage of hypertensive patients applying to an outpatient cardiology clinic in southeastern Anatolia. End organ damage in 100 consecutive hypertensive patients was defined by left ventricular hypertrophy, retinopathy, and albuminuria. The determined independent risk factors of left ventricular hypertrophy were advanced age and low educational level; of nephropathy were high pulse pressure and unawareness of the name of anti-hypertensive drug; and for retinopathy were high pulse pressure and female gender. In order to prevent end organ damage, the most important aspect to focus on is patient training and pulse pressure.


Laser spectroscopic and theoretical studies of encapsulation complexes of calix[4]arene.
The complexes between the host calix[4]arene (C4A) and various guest molecules such as NH(3), N(2), CH(4), and C(2)H(2) have been investigated via experimental and theoretical methods. The S(1)-S(0) electronic spectra of these guest-host complexes are observed by mass-selected resonant two-photon ionization (R2PI) and laser-induced fluorescence (LIF) spectroscopy. The IR spectra of the complexes formed in molecular beams are obtained by IR-UV double resonance (IR-UV DR) and IR photodissociation (IRPD) spectroscopy. The supramolecular structures of the complexes are investigated by electronic structure methods (density functional and second order perturbation theory). The current results for the various molecular guests are put in perspective with the previously reported ones for the C4A-rare gas (Rg) (Phys. Chem. Chem. Phys. 2007, 126, 141101) and C4A-H(2)O complexes (J. Phys. Chem. A, 2010, 114, 2967). The electronic spectra of the complexes of C4A with N(2), CH(4), and C(2)H(2) exhibit red-shifts of similar magnitudes with the ones observed for the C4A-Rg complexes, whereas the complexes of C4A with H(2)O and NH(3) show much larger red-shifts. Most of the IR-UV DR spectra of the complexes, except for C4A-C(2)H(2), show a broad hydrogen-bonded OH stretching band with a peak at ~3160 cm(-1). The analysis of the experimental results, in agreement with the ones resulting from the electronic structure calculations, suggest that C4A preferentially forms endo-complexes (guests inside the host calizarene cavity) with all the guest species reported in this study. We discuss the similarities and differences of the structures, binding energies, and the nature of the interaction between the C4A host and the various guest species.


Association of busulfan area under the curve with veno-occlusive disease following BMT.
Busulfan pharmacokinetics, specifically area under the concentration curve (AUC), have been correlated with the occurrence of veno-occlusive disease (VOD) following BMT. To evaluate the risk of VOD, we studied 66 patients who received pharmacotherapeutically monitored busulfan regimens in combination with CY, etoposide (VP16) and/or Ara-C in preparation for BMT. These patients received a total of 16 doses of busulfan dosed as 1 mg/kg/dose q 6 h beginning at 09.00 (n = 39), 18.00 (n = 2), 21.00 (n = 1) or 24.00 (n = 24) h. With the first dose, blood samples were obtained at baseline, every 15-30 min for 2 h, then every 1-2 h for 4 h. Blood was analyzed for busulfan concentration by high performance liquid chromatography and AUC calculated by the trapezoidal rule. Seventeen patients (25.8%) were not evaluable for AUC calculation due to slow absorption and/or elimination: 13 of 27 (48.1%) received the first dose between 18.00-24.00 vs four of 39 (10.2%) patients who received the first dose at 09.00 (P < 0.001). Eighteen of 51 (35.3%) evaluable patients had an AUC > 1500 mumol x min/l; 10 of whom received doses reduced proportionally to achieve an AUC = 1200 mumol x min/l starting with the 10th to 15th dose. Six of 18 (33.3%) patients with an initial AUC > 1500 mumol x min/l developed VOD vs one of 33 (3.0%) patients with an initial AUC < 1500 mumol x min/l (relative risk = 11.1; P = 0.0056). Other pharmacokinetic parameters, age, gender, type of BMT, previous therapy or pre-transplant liver function tests were not predictive of VOD. A higher incidence of VOD occurred in patients receiving BUCY (4 of 10) compared to those receiving BUCYAra-C (1 of 18) or BUCYVP16 (7 of 38), which could not be attributed to increased busulfan exposure in the BUCY patients. Routine pharmacotherapeutic monitoring of busulfan is recommended with further study to evaluate the impact of earlier and greater overall dose reduction in patients with high initial busulfan exposures.


Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice.
Preterm-born children are at risk for later neurodevelopmental problems and cardiometabolic diseases; early-life growth restriction and suboptimal neonatal nutrition have been recognized as risk factors. Prevention of these long-term sequelae has been the focus of intervention studies. High supplies of protein and energy during the first weeks of life (i.e., energy > 100 kcal kg-1 day-1 and a protein-to-energy ratio > 3 g/100 kcal) were found to improve both early growth and later neurodevelopmental outcome. Discontinuation of this high-energy diet is advised beyond 32-34 weeks postconceptional age to prevent excess fat mass and possible later cardiometabolic diseases. After discharge, nutrition with a higher protein-to-energy ratio (i.e., > 2.5-3.0 g/100 kcal) may improve growth and body composition in the short term.Conclusion: Preterm infants in their first weeks of life require a high-protein high-energy diet, starting shortly after birth. Subsequent adjustments in nutritional composition, aimed at achieving optimal body composition and minimizing the long-term cardiometabolic risks without jeopardizing the developing brain, should be guided by the growth pattern. The long-term impact of this strategy needs to be studied. What is Known: • Preterm infants are at risk for nutritional deficiencies and extrauterine growth restriction. • Extrauterine growth restriction and suboptimal nutrition are risk factors for neurodevelopmental problems and cardiometabolic disease in later life. What is New: • Postnatally, a shorter duration of high-energy nutrition may prevent excess fat mass accretion and its associated cardiometabolic risks and an early switch to a protein-enriched diet should be considered from 32-34 weeks postconceptional age. • In case of formula feeding, re-evaluate the need for the continuation of a protein-enriched diet, based on the infant's growth pattern.


A mathematical programming model for scheduling of nurses' labor shifts.
In this study, a mathematical programming model is proposed for scheduling problem of nurses' labor shifts. The developed mathematical programming model's aim is to minimize nurses' total idle waiting time during a week planning horizon. In this model, investigated constraints are as follows: (1) Maximum total working time a week for each nurse must not be exceeded. (2) After a nurse works a shift, the nurse can be assigned to another shift after two shifts at least. This constraints-set ensures resting of the nurse after the nurse works a shift. (3) Total number of nurses worked for each shift must be controlled with maximum and minimum bounds given for number of nurses for each shift. In this manner, total number of nurses worked for each shift is between maximum and minimum limit-values given for each shift. This constraint ensures flexibility to the user to determine number of nurses for each shift. (4) The decision variable that shows nurse-shift assignment pairs is 0 or 1. In this study, maximum total working time a week for a nurse, total number of nurses in a health service, maximum and minimum numbers of nurses worked a shift are user-specified parameters. In this way, this model can be adapted for the studies with different values of these parameters. In this study, the developed model is illustrated using a numerical example and then LINGO8.0 software is used to ensure the global optimum solution of the developed model. Results and also sensitivity analysis carried out for this example are presented in the study.


Taking our case public.
Key protections are lacking in this state concerning patients' rights. Where do physicians and patients stand on this issue? Medical Society of New Jersey President Irving Ratner, MD, offers views and perspectives on patient protection.


Sleep disorders in patients with myasthenia gravis: a systematic review.
[Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9-490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed.


A perfectly matched layer applied to a reactive scattering problem.
The perfectly matched layer (PML) technique is applied to a reactive scattering problem for accurate domain truncation. A two-dimensional model for dissociative adsorbtion and associative desorption of H(2) from a flat surface is considered, using a finite difference spatial discretization and the Arnoldi method for time-propagation. We compare the performance of the PML to that of a monomial complex absorbing potential, a transmission-free complex absorbing potential, and to exterior complex scaling. In particular, the reflection properties due to the numerical treatment are investigated. We conclude that the PML is accurate and efficient, especially if high accuracy is of significance. Moreover, we demonstrate that the errors from the PML can be controlled at a desired accuracy, enabling efficient numerical simulations.


Cell saver autologous transfusion: metabolic consequences of washing blood with normal saline.
To evaluate acid-base and electrolyte changes in high volume cell saver autologous blood transfusion when normal saline (0.9% NaCl) is used as the wash solution. Open-label study. Nine anesthetized and anticoagulated mongrel dogs underwent 15 cycles of cell saver autologous blood transfusion. Eight percent of the circulating blood volume (125 mL) was withdrawn, washed with normal saline, and retransfused for each cycle. Analyses of acid-base, electrolyte, and hematologic parameters were performed on both systemic and the washed blood. The washed blood had increased levels of sodium and chloride. There were decreased levels in pH, Pco2, total CO2 (bicarbonate), lactic acid, potassium, total and ionized calcium, magnesium, inorganic phosphorus, total protein, and albumin. Systemically, in the animals, by the end of the study, there were significant increases in the levels of chloride, inorganic phosphorus, hemoglobin, and hematocrit and significant decreases in the levels of pH, total CO2, total and ionized calcium, magnesium, total protein, and albumin. Acid-base, electrolyte, and hematologic changes occur when normal saline is used as the wash solution in high volume cell saver autologous blood transfusion. The washed blood with its elevation of sodium and chloride appears to reflect the constituents of the wash solution, normal saline. The depletion in the washed blood of PCO2, total CO2, potassium, total calcium, ionized calcium, magnesium, phosphorus, total protein, and albumin we feel is because of the absence of these electrolytes in the wash solution and their physical removal during salvaged blood separation and washing. The systemic acid-base and electrolyte changes primarily reflect the electrolyte pattern of the reinfused washed blood except for inorganic phosphorus. Inorganic phosphorus was maintained systemically, despite its wash out in the cell salvage process. This paradoxical finding may be caused by intracellular to extracellular inorganic phosphorus flux caused by the progressive systemic metabolic acidosis.


A detailed 3D finite element analysis of the peeling behaviour of a gecko spatula.
This paper presents a detailed finite element analysis of the adhesion of a gecko spatula. The gecko spatulae form the tips of the gecko foot hairs that transfer the adhesional and frictional forces between substrate and foot. The analysis is based on a parameterised description of the 3D geometry of the spatula that only requires 12 parameters. The adhesion is described by a nonlinear computational contact formulation that accounts for the van der Waals interaction between spatula and substrate. The spatula adhesion model is implemented using an enriched contact finite element formulation recently developed by the first author. The finite element model is then used to simulate the peeling behaviour of the gecko spatula under applied vertical and rotational loading for various model parameters. Variations of the material stiffness, adhesional strength and range, stiction, spatula size and spatula inclination are considered to account for the natural variation of spatula properties. The study demonstrates that the spatula can function over a wide range of conditions. The computed pull-off forces are in agreement with experimental results reported in the literature. The study also examines the energy required for the spatula pull-off. The proposed model is ideal to study the influence of substrate roughness on the spatula adhesion, as is finally demonstrated.


[Fertility preservation].
Fertility preservation should be considered in girls and young women faced with a potentially gonadotoxic treatment such as chemotherapy. IVF can be performed with the aim to collect and freeze the oocytes, or ovarian tissue can be cryopreserved and transplanted back to the patient at a later stage. Whichever method is chosen depends upon the age of the patient, the gonadotoxicity of her treatment and the time frame. It is important to refer young cancer patients to fertility preservation counselling before treatment starts, as argued in this review.


Socio-Economic Determinants of Health Literacy in High School Students: A Cross-Sectional Study.
Today, a person's health literacy (HL) is perceived as a critical determinant for their health. It is well known that limited health literacy is associated with harmful health behaviours, the lower use of preventive services, problems in making use of healthcare resources and poor skills for the self-management of chronic disorders. This study analysed the level and factors associated with HL in high school students in southern Poland. The study is based on the data from a paper-and-pencil survey of high schools students in the Malopolska Voivodshop. The students were selected using a two-stage cluster random sampling procedure. The level of HL was assessed with the European Health Literacy Survey Questionnaire, consisting of 47 items. Univariate logistic and linear regression models were applied to analyse the association between general HL score and the main domain-specific indices. The respondents whose parents had attended University and came from more affluent families were less likely to demonstrate limited HL. There was a significant positive relationship between the self-assessment of the economic situation, size of accommodation, the level of expenditure on a mobile phone and receiving external support, the size of the book collection at home, and domain-specific HL sub-indices. In conclusion, among socio-demographic factors, the parents' education is the only consistent predictor of the level of HL in high school students. Furthermore, most variables reflecting the economic status of the respondent's family are significantly associated with the general HL score and its sub-indices.


[The clinical efficacy of roxithromycin in patients with acute odontogenic infections].
The clinical efficacy of a macrolide antibiotic, roxithromycin, was evaluated in 24 patients affected by acute odontogenic infections. Patients were treated with a first dose of 300 mg p.o. which was followed by 150 mg p.o. 12-hourly for the following two days. Total responses were evaluated by an arbitrary scale. The results showed that an excellent and good response was obtained in 99.96% of treated patients. On the basis of clinically compared data and the drug safety it may be concluded that roxithromycin can be successfully used in the treatment of odontogenic infections.


Skin and Systemic Inflammation in Schnitzler's Syndrome Are Associated With Neutrophil Extracellular Trap Formation.
Schnitzler's syndrome is a rare autoinflammatory disorder characterized by interleukin-1ß-mediated and neutrophil-dominated inflammation. Neutrophil extracellular traps (NETs) are web-like structures of decondensed chromatin, histones, and antimicrobial peptides released by neutrophils. NETs were initially described in the context of pathogen defense but are also involved in autoimmune-mediated skin diseases. Here, we assessed the role of neutrophil extracellular trap formation (NETosis) in Schnitzler's syndrome. Immunofluorescence co-staining of myeloperoxidase and subnucleosomal complex was performed on lesional skin samples from patients with Schnitzler's syndrome, other neutrophilic dermatoses (cryopyrin-associated periodic syndrome, Sweet syndrome, and pyoderma gangrenosum), urticarial vasculitis and chronic spontaneous urticaria as well as healthy control skin. Blood neutrophils from patients with Schnitzler's syndrome and controls were isolated, and NETosis was induced by phorbol 12-myristate 13-acetate (PMA). Also, NETosis of control neutrophils induced by symptomatic Schnitzler's syndrome sera, cytokines and sub-threshold PMA doses was studied. Immunofluorescence co-staining revealed widespread and substantial NET formation in lesional skin of Schnitzler's syndrome patients but absence of NETs in chronic spontaneous urticaria and control skin. Neutrophils undergoing NETosis were observed in the skin of other neutrophilic diseases too. Correspondingly, blood neutrophils from Schnitzler's syndrome patients showed significantly elevated NETosis rates compared to control neutrophils following stimulation with PMA. Increased NETosis correlated well with high levels of C-reactive protein (CRP). SchS patients with the lowest NETosis rates had persistent joint and bone pain despite IL-1 blockade. Stimulation of control neutrophils and sub-threshold PMA with sera of symptomatic Schnitzler's syndrome patients disclosed enhanced NETosis as compared to control sera. Our results suggest that the induction of NET formation by neutrophils contributes to skin and systemic inflammation and may support the resolution of local inflammation in Schnitzler's syndrome.


Quantifying the variability between multiple multiplanar reconstructions of computed tomography scans.
Multiplanar reconstructions of computed tomography (CT) scans can alleviate issues with bone or joint positioning during scan acquisition. The repeatability of these reconstructions is dependent on human operators applying reconstruction criteria, and therefore is subject to error, which could affect measurement reliability for angular or spatial measurements made for orthopaedic surgery. We describe a method for quantifying inter-reconstruction variability numerically and graphically using metadata from the CT header to find vectors describing reconstruction axis alignment. The approach is demonstrated using 3 sets of computed tomographic reconstructions of 24 vulpine femorotibial joints. Vectors describing axis alignments permitted identification and subsequent analysis of deviations from optimal alignment between reconstruction sets. For the worked example, alignment deviations equivalent to femoral abduction/adduction were nearly twice those for extension/flexion, and simulation of the effects of these deviations on measurements closely matched published data. The method presented here is straightforward and permits numerical and graphical analysis of reconstruction variability. Reconstruction alignment variability should be considered before adopting new reconstruction criteria for clinical use, and evaluated whenever there is suspicion that reconstruction variability could unduly influence subsequent measurements. These evaluations may help drive improvements in reconstruction criteria. The methods described here could also be employed for comparing patient positioning between scans and between different scan modalities.


Endoscopic thoracic sympathectomy for primary palmar hyperidrosis.
Primary hyperhidrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this is aggravated by emotional factors and by heat. Hyperhidrosis can be seen in the palms of the hands, armpits, soles of the feet and face. The principal characteristic of this disease is the intense discomfort of patients, which affects their social and professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection, liposuction, excision of sweat glands, and thoracic sympathectomy. Between January 1998 and August 2007, a prospective study of endoscopic thoracic sympathectomies for palmar hyperhidrosis was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample comprised of 322 patients with a mean age of 24 years. At Apollo Hospital, New Delhi, India, bilateral video-assisted thoracoscopic T3 level sympathectomies were performed in all cases. All patients had immediate cessation of palmar hyperhidrosis. The mean postoperative stay was 1.1 days. A questionnaire was completed based on their response to a telephone conversation or e-mail. A paired t test and Wilcoxon test was performed on these data and it showed significant improvement in quality of life. Compensatory sweating was found to be the most troublesome side effect for all patients. It was seen in 63% of the patients. This is similar to other reports of compensatory sweating; however, the figure decreases to 29% if we disregard the percentage of patients who reported only mild compensatory sweating. In view of the low morbidity and zero mortality rate of this surgical technique, we recommend it as a method of treatment for palmar hyperhidrosis. Thoracic sympathectomy eliminates palmar hyperhidrosis with minimal recurrence (1% in our series) and produces a high rate of patient satisfaction.


Structural Origins of Voltage Hysteresis in the Na-Ion Cathode P2-Na0.67[Mg0.28Mn0.72]O2: A Combined Spectroscopic and Density Functional Theory Study.
P2-layered sodium-ion battery (NIB) cathodes are a promising class of Na-ion electrode materials with high Na+ mobility and relatively high capacities. In this work, we report the structural changes that take place in P2-Na0.67[Mg0.28Mn0.72]O2. Using ex situ X-ray diffraction, Mn K-edge extended X-ray absorption fine structure, and 23Na NMR spectroscopy, we identify the bulk phase changes along the first electrochemical charge-discharge cycle-including the formation of a high-voltage "Z phase", an intergrowth of the OP4 and O2 phases. Our ab initio transition state searches reveal that reversible Mg2+ migration in the Z phase is both kinetically and thermodynamically favorable at high voltages. We propose that Mg2+ migration is a significant contributor to the observed voltage hysteresis in Na0.67[Mg0.28Mn0.72]O2 and identify qualitative changes in the Na+ ion mobility.


Ginsenoside Rh2 inhibits thyroid cancer cell migration and proliferation via activation of miR-524-5p.
Thyroid cancer is an important disease that threatens the health of humans. Ginsenoside Rh2 is known as an anticancer molecule; however, its function in thyroid cancer cells has not been reported. In the present study, we identified that Rh2 treatment of the thyroid cancer cell line K1 inhibited cell migration and proliferation. We determined the Rh2 function in thyroid cancer cell lines. By RT-PCR, expression of miR-524-5p and related genes were determined. The cell phenotype including cell migration and proliferation were detected after serials treatment. The relevant protein level were checked by Western blot. Interestingly, we observed that miR-524-5p, a type of miRNA, had lower expression in the thyroid cancer cell lines TPC-1, K1, and NPA than in the normal thyroid cell line Nthyri3-1. Additionally, Rh2 treatment induced miR-524-5p expression. Further examination using overexpression of miR-524-5p identified that the miR-524-5p mimic inhibited cell migration and proliferation of the K1 line. Similar to Rh2-treated cells, the miR-524-5p mimic-expressing cells had increased E-cadherin and reduced vimentin levels compared to the control cells. Next, we examined the relationship between Rh2 and miR-524-5p with respect to thyroid cell migration and proliferation. Treatment with Rh2 and miR-524-5p inhibitor suppressed Rh2 action on K1 thyroid cell migration and proliferation, and the rates were similar to those in control cells, suggesting that Rh2 might induce miR-524-5p expression to inhibit thyroid cancer cell migration and proliferation. Our analyses identified Rh2 and miR-524-5p action on thyroid cancer cell migration and proliferation as well as the linkage between Rh2 and miR-524-5p in thyroid cancer cell development.


Erythrocyte malondialdehyde and glutathione levels in vitiligo patients.
Vitiligo is an acquired and progressive hypomelanotic disease that manifests as circumscribed depigmented patches on the skin. Although the precise mechanism remains to be elucidated, an imbalance of the oxidant/antioxidant system has been proposed as an important etiologic mechanism. The objective of this study was to evaluate the oxidant/antioxidant status of vitiligo patients at the erythrocyte level. Fifty-three vitiligo patients and 65 phototype-, age-, and sex-matched healthy controls were included in this study. Blood samples were collected from all subjects, and all patients were instructed to answer a questionnaire. Erythrocyte levels of malondialdehyde (MDA) and glutathione (GSH) were measured. All patients were told to answer a questionnaire regarding their habitual behavior, including frequency of smoking and type of diet. We observed significantly lower levels of GSH in vitiligo patients, but the levels of MDA did not differ between patients and controls. Vitiligo patients who smoked showed significantly lower GSH levels compared to non-smoking patients, but the levels of MDA were unchanged between the 2 groups. From our results, we conclude that reduced erythrocytic or systemic GSH levels constitute a distinctive feature in vitiligo patients regardless of disease activity.


Form, function, and regulation of protein tyrosine phosphatases and their involvement in human diseases.
Protein tyrosine phosphatases (PTPs) are a family of enzymes that modulate the cellular level of tyrosine phosphorylation. Based on cellular location, they are classified as receptor like or intracellular PTPs. Structure and function studies have led to the understanding of the enzymatic mechanism of this class of enzymes. Proper targeting of PTPs is essential for many cellular signalling events including antigen induced proliferative responses of B and T cells. The physiological significance of PTPs is further unveiled through mice gene knockout studies and human genome sequencing and mapping projects. Several PTPs are shown to be critical in the pathogenesis of human diseases.


Preeclampsia as chronic disseminated intravascular coagulation. Study of two parameters: thrombin-antithrombin III complex and D-dimers.
Determinations of coagulation/fibrinolysis parameters thrombin-antithrombin III complex (TAT) and D-dimers (cross-linked fibrin degradation product) were carried out in order to prove that preeclampsia is a chronic disseminated intravascular coagulation (DIC) state. Besides the parameters TAT and D-dimers, antithrombin III (ATIII), fibrin degradation products and platelets were measured as well. Even in normal pregnancy there is an activation of coagulation, reflected in a hypercoagulative state that is proceeding down to the formation of thrombin. This thrombin is, however, nearly completely inactivated by ATIII, so that no fibrin is formed. This inactivation is solely reflected by the increase of TAT in the blood. In preeclampsia, however, where no such rapid changes as in acute DIC occur, the increase of TAT is accompanied by a decrease of ATIII and platelet counts and an increase of D-dimers; this demonstrates much more clearly the chronic DIC nature of preeclampsia than the results from studies carried out so far.


Quantification of vascular endothelial growth factor, interleukin-8, and basic fibroblast growth factor in plasma of cancer patients and healthy volunteers - comparison of ELISA and microsphere-based multiplexed immunoassay.
Vascular endothelial growth factor (VEGF), interleukin-8 (IL-8) and basic fibroblast growth factor (basic FGF) are angiogenic growth factors which may be useful as biomarkers in drug development, where they could give early information on the antiangiogenic activity of novel anticancer compounds. We compared two commercially available assays, enzyme linked immunosorbent assay (ELISA) and a multiplexed bead-based immunoassay (xMAP), for the quantification of these factors in plasma samples from more than 100 cancer patients and healthy individuals. For VEGF and IL-8, but not for basic FGF, xMAP was more sensitive than the respective ELISA. This was true for healthy subjects as well as for cancer patients. Intraassay precision was comparable between both assay formats. Linear regression analysis of VEGF concentrations demonstrated a good correlation between ELISA and xMAP. Bland-Altman analysis showed a systematic difference between both assays, with ELISA giving higher concentration values. VEGF levels were higher in female volunteers, and both assays were able to detect this difference. Multiplexed microsphere-based immunoassays have the potential to substitute ELISA for the detection of proangiogenic growth factors in clinical studies. Their shorter assay times and their ability to quantify multiple analytes in a small sample volume are advantageous.


Decreased platelet serotonin levels in systemic lupus erythematosus.
Platelet serotonin levels were measured in 41 patients with systemic lupus erythematosus (SLE) and 36 normal controls. SLE patients had significantly lower mean serotonin levels (243 +/- 131 versus 414 +/- 175 ng/10(9) platelets, P less than 0.001); the lowest levels occurred in those patients with active disease. No differences in mean platelet serotonin levels were found when we compared patients with or without a history of renal disease, thrombocytopenia, or neuropsychiatric involvement. Decreased release of platelet granule constituents, as measured by plasma levels of the alpha-granule protein, beta-thromboglobulin.


Does hypertension increase mortality risk from lung cancer? A prospective cohort study on smoking, hypertension and lung cancer risk among Korean men.
To examine the effects of hypertension on lung cancer prospectively and to determine the interactive effect of hypertension and smoking on lung cancer risk. A prospective cohort study. The cohort comprised 452,645 Korean men, aged 35-64 years, who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1992 and 1994. Multivariate Cox proportional hazard models were tested, controlling for age, smoking status, exercise, body mass index, alcohol use, diabetes and serum cholesterol concentration. Deaths from lung cancer. At baseline, 261 080 persons (58.3%) were identified as current cigarette smokers. Between 1995 and 1999, 883 deaths from lung cancer (44.8/100,000 person-years) occurred. An initial finding indicated that hypertension increased the mortality risk of lung cancer [risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1-1.5]. However, after stratification for smoking status, the risk ratio was increased only for current smokers (RR 1.4, 95% CI 1.2-1.6). When the interaction term was included in the multivariate model, there was a significant interactive effect of hypertension with current smoking (RR 1.8, 95% CI 1.0-3.1) on the risk of death from lung cancer, whereas the effect of hypertension itself did not attain significance. Hypertension was not an independent risk factor in lung cancer-related deaths, but it increased the modest risk of lung cancer death among current smokers.


Fragment analysis represents a suitable approach for the detection of hotspot c.7541_7542delCT NOTCH1 mutation in chronic lymphocytic leukemia.
The hotspot c.7541_7542delCT NOTCH1 mutation has been proven to have a negative clinical impact in chronic lymphocytic leukemia (CLL). However, an optimal method for its detection has not yet been specified. The aim of our study was to examine the presence of the NOTCH1 mutation in CLL using three commonly used molecular methods. Sanger sequencing, fragment analysis and allele-specific PCR were compared in the detection of the c.7541_7542delCT NOTCH1 mutation in 201 CLL patients. In 7 patients with inconclusive mutational analysis results, the presence of the NOTCH1 mutation was also confirmed using ultra-deep next generation sequencing. The NOTCH1 mutation was detected in 15% (30/201) of examined patients. Only fragment analysis was able to identify all 30 NOTCH1-mutated patients. Sanger sequencing and allele-specific PCR showed a lower detection efficiency, determining 93% (28/30) and 80% (24/30) of the present NOTCH1 mutations, respectively. Considering these three most commonly used methodologies for c.7541_7542delCT NOTCH1 mutation screening in CLL, we defined fragment analysis as the most suitable approach for detecting the hotspot NOTCH1 mutation.


Special Report From the Society for the Advancement of Blood Management: The Choosing Wisely Campaign.
Over 7 years ago, the American Board of Internal Medicine Foundation (ABIM) created the national Choosing Wisely campaign with the purpose of encouraging active dialogue between health care providers and patients, focusing on appropriateness, quality care, and resource management. This special communication from the Society for the Advancement of Blood Management (SABM) serves to highlight the society's recent participation in the Choosing Wisely campaign, encouraging sensible dialogue between clinicians and our patients with the intent to promote patient-centered, evidence-based care. The article addresses the rationale and supportive data for the 5 SABM Choosing Wisely recommendations.


Sudden infant death syndrome: is it a transepithelial transport disorder?
The first limiting factor of dietary zinc deficiency has been described as a loss of the protective role of zinc against auto-oxidation of membrane sulfhydryl (SH) compounds. It has now been established that the prohormones (nutriuretic peptides) of the intestinal guanylin family are activated extracellularly by conversion of cysteines in the peptide to disulfide bridges. The induction of uroguanylin mRNA is elevated in intestinal zinc deficiency and nutriuretic peptides regulate epithelial transport of salt and water. Nitric oxide (NO) is also a modulator of salt and water transport. The constitutive forms of nitric oxide synthase (cNOS) in neurons and endothelial cells are calcium-dependent. The inducible form of nitric oxide synthase (iNOS) is activated by bacterial entero-toxins and damaged mucosa with NO penetrating the cell and acting directly on guanylate cyclase. The activated receptor-guanylate cyclases initiating the intracellular cycle 3'-5' guanasine monophosphate (cyclic GMP) cascade in target cells results in a flux of chloride and water into the intestinal lumen. Most of the actions of NO are mediated by activation of cyclic GMP. High-altitude pulmonary edema (HAPE) is associated with a defect in transepithelial water transport. It is suggested that dietary zinc, by modulating thiol oxidation to disulfides in guanylin prohormones to active hormones, is associated with salt and water secretion such that the overworked heart in hypoxemia increases the production and release of natriuretic peptides to activate guanylate cyclase receptors in target tissue in sudden infant death syndrome.


Complete Surgical Resection of a Leiomyosarcoma Arising from the Inferior Vena Cava.
A 76-year-old Japanese man was referred to our hospital with chief complaint of right hypochondoralgia. Abdominal ultrasound showed a retroperitoneal tumor in the suprarenal region of the right kidney. Computed tomography revealed an enhanced lobular tumor with irregular, circumscribed, and indistinct border. Ultrasound-guided biopsy was performed. The tumor consisted of spindle-shaped cells with a giant nucleus and multinuclear cells. The diagnosis was leiomyosarcoma by immunohistochemical staining. The patient underwent surgery accessed by a right eighth intercostal thoracoabdominal incision. The tumor was completely resected, accompanied by removal of the posterosuperior segment of the right hepatic lobe, right adrenal gland, and a portion of the inferior vena cava (IVC). The histopathologic diagnosis was leiomyosarcoma arising from the IVC. We present a rare case of a successfully managed leiomyosarcoma of the IVC. This case suggests the importance of curative surgical resection of the tumor due to low efficacy of adjuvant chemotherapy for leiomyosarcoma.


T cell-T cell activation in multiple sclerosis.
Activated T cells are able to stimulate proliferation in resting T cells through an antigen non-specific mechanism. The in vivo usefulness of this T cell-T cell activation is unclear, but it may serve to amplify immune responses. T cell-T cell activation could be involved in the well-documented occurrence of multiple sclerosis (MS) exacerbations following viral infections. Excessive activation via this pathway could also be a factor in the etiology of MS. We tested the hypothesis that excessive T cell-T cell activation occurs in MS patients using in vitro proliferation assays comparing T cells from MS patients to T cells from controls. When tested as responder cells, T cells from MS patients proliferated slightly less after stimulation with previously activated cells than T cells from controls. When tested as stimulator cells, activated cells from MS patients stimulated slightly more non-specific proliferation than activated cells from controls. Neither of these differences were statistically significant. We conclude that T cell proliferation in response to activated T cells is similar in MS and controls.


Nanoscale imaging of rat atrial myocytes by scanning ion conductance microscopy reveals heterogeneity of T-tubule openings and ultrastructure of the cell membrane.
In contrast to ventricular myocytes, the structural and functional importance of atrial transverse tubules (T-tubules) is not fully understood. Therefore, we investigated the ultrastructure of T-tubules of living rat atrial myocytes in comparison with ventricular myocytes. Nanoscale cell surface imaging by scanning ion conductance microscopy (SICM) was accompanied by confocal imaging of intracellular T-tubule network, and the effect of removal of T-tubules on atrial excitation-contraction coupling (EC-coupling) was observed. By SICM imaging, we classified atrial cell surface into 4 subtypes. About 38% of atrial myocytes had smooth cell surface with no clear T-tubule openings and intracellular T-tubules (smooth-type). In 33% of cells, we found a novel membrane nanostructure running in the direction of cell length and named it 'longitudinal fissures' (LFs-type). Interestingly, T-tubule openings were often found inside the LFs. About 17% of atrial cells resembled ventricular myocytes, but they had smaller T-tubule openings and a lower Z-groove ratio than the ventricle (ventricular-type). The remaining 12% of cells showed a mixed structure of each subtype (mixed-type). The LFs-, ventricular-, and mixed-type had an appreciable amount of reticular form of intracellular T-tubules. Formamide-induced detubulation effectively removed atrial T-tubules, which was confirmed by both confocal images and decreased cell capacitance. However, the LFs remained intact after detubulation. Detubulation reduced action potential duration and L-type Ca2+channel (LTCC) density, and prolonged relaxation time of the myocytes. Taken together, we observed heterogeneity of rat atrial T-tubules and membranous ultrastructure, and the alteration of atrial EC-coupling by disruption of T-tubules.


How, When and Where to Discuss Do Not Resuscitate: A Prospective Study to Compare the Perceptions and Preferences of Patients, Caregivers, and Health Care Providers in a Multidisciplinary Lung Cancer Clinic.
Do Not Resuscitate (DNR) is a significant but challenging part of end-of-life discussions when dealing with incurable lung cancer patients. We have explored the perceptions and preferences of patients, their caregivers (CGs), and health care providers (HCPs) and the current practice and opinions on DNR discussions in a multidisciplinary lung cancer clinic. This is a prospective descriptive study with a mixed quantitative and qualitative methodology to capture perceptions of the participants. To obtain a rich description of participant responses to questionnaire items, we employed a 'think aloud' process that prompted participants to immediately verbalize their thoughts when responding to questionnaire items. We used content analysis and constant comparison techniques to identify, code and categorize primary themes in the captured data. Ten patients with advanced-stage lung cancer; nine CGs from the lung clinic and ten HCPs from the Thoracic Disease Site Group (DSG) were enrolled in the study. Most patients had only a limited understanding of DNR. Most CGs had a fair to good understanding of DNR. Most HCPs perceived their patients to have understood DNR most of the time. When patients were interviewed, a theme of "anticipated discussion" about DNR was identified. Patients and CGs expressed having faith in the system and responsible physicians as to when to discuss DNR. HCPs embraced a clinician preference-based decision-making approach to engaging in DNR discussions. They desired more resources, more knowledge, more structure and more time to discuss DNR. Most HCPs felt that it would be worth conducting a prospective clinical trial to determine the best time to discuss DNR. This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around DNR discussions in order to reduce the emotional pain of dying patients, their CGs and HCPs.


Survival of pathogenic bacteria in compost with special reference to Escherichia coli.
Application of compost in agricultural practice could potentially cause contamination of foodstuffs with pathogenic bacteria such as Escherichia coli O157:H7 (E. Coli O157). We investigated pathogenic bacteria in compost collected from the compost facilities, and evaluated the survival of E. coli K12 and O157 in laboratory experiments. Out of 19 compost product samples, coliform bacteria and salmonella were detected in 7 and 3 samples respectively. The number of coliform bacteria was 1.8 x 10(2) to 2.5 x 10(6) CFU/g dw and that of salmonella was 4.2 x 10(1) to 6.0 x 10(3) CFU/g dw. Moreover, coliform bacteria, fecal coliform, E. coli and salmonella were detected during composting at 54 degrees C to 67 degrees C. The results indicated that moisture content was a very important factor to the heat sensitivity of pathogenic bacteria in compost, E. coil in compost of high moisture content was more sensitive than that in compost of low moisture content, cells harvested in logarithmic phase was more sensitive than these in stationary phase, and E. coli K12 was more sensitive than E. coli O157. Based on the D values, the lethal time of E. coli K12 and O157 from l0(8) to 10(0) CFU/g dw were 16.3 and 28.8 min, respectively, at 60 degrees C in compost with 40% moisture content. However, some E. coil cells survived in composting process at 54 degrees C to 67 degrees C. Water potential (low moisture content) and physiological aspects of bacteria (stationary phase) could explain only in part of the prolonged survival of E. coil in compost, and there should be some other factors that are conducive to bacterial survival in compost.


A practical approach to breathing control in primary care.
Breathlessness is a common but complex symptom which has a wide range of causes and presentations. Living with breathlessness can have a considerable impact on a person's quality of life, but even slight improvements in breathing control have significant benefits for patients. This article explores different breathing control techniques which can help clinicians working in primary care to support these patients.