The First Stages of Liberalization of Public Hospitals in Iran: Establishment of Autonomous Hospitals and the Barriers.
Liberalization and decentralization of public sector has been triggered in some developing countries and in Iran by the Ministry of Health and Medical Education (MOHME) that granted autonomy to 54 public hospitals. However, establishment of such a complex organizational reform was rather unsuccessful. We aimed to explore the obstacles and barriers caused such a failure and their mechanisms. Using a qualitative approach in 2013, we consulted key informants at the autonomous hospitals and their affiliating universities. Data collection was done within two phases: (i) 276 unstructured questionnaires asking respondents of barriers, and (ii) 23 semi-structured interviews from the first phase's key respondents. The first phase data were analyzed using thematic analysis and the second's by framework approach based on the frame shaped at the first phase. Nine obstacles were recognized including "autonomous hospitals' board composition", "delay in announcing autonomous hospitals' charges by the MOHME", "lack of financing by the committed organizations", "poor follow up for implementation of the reform", "irregular board meetings", "lack of an external overseer", "shortage of full-time physicians", "lack of management stability", and "health insurance organizations' delayed payments". The MOHME and insurance organizations did not pay the reform expenses. There were some competing motives as well to slow the reform or to shut it down. The stages of policy formulation and implementation were done separately in Iran, so this big organizational reform encountered serious obstacles.


Concurrent Takayasu Arteritis and Vascular Ehlers-Danlos Syndrome: A Case Report.
Takayasu arteritis (TAK) is a rare primary systemic inflammatory vasculopathy. It is classified as a large-vessel vasculitis and is known to cause inflammatory aneurysms and vascular stenosis. Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant condition known to cause multiple aneurysms and arterial dissection at a young age owing to a mutation in the gene for type III collagen, COL3A1. Here, we present a case of TAK associated with vEDS with the development of multi-organ infarction of the brain, kidney, and spleen owing to multiple arterial aneurysms and stenosis of the internal carotid artery. The patient was successfully treated using anti-inflammatory agents, glucocorticoids, and tocilizumab with the addition of interventional radiology. In our case, a high inflammatory response led to vasculitis being the main cause of the disease with concurrent vEDS. When patients develop multiple aneurysms, stenosis, and dissections leading to multiple organ infarctions, a systemic differential diagnosis to consider concurrent vasculitis syndrome and non-inflammatory vasculopathy, including hereditary disorders, is important even with time constraints.


Nicotinic acetylcholine receptor genes on chromosome 15q25.1 are associated with nicotine and opioid dependence severity.
A locus on chromosome 15q25.1 previously implicated in nicotine, alcohol, and cocaine dependence, smoking, and lung cancer encodes subunits of the nicotinic acetylcholine receptor (nAChR) expressed in the mesolimbic system and thought to mediate substance dependence. Opioid dependence severity (ODS), nicotine dependence severity (NDS), smoking status and quantity, and the number of attempts to quit were assessed using questionnaire instruments in 505 subjects who were prescribed opioid medications for chronic pain in outpatient practice sites. Multivariate regression was used to test for genetic association of these phenotypes with 5 SNPs in the nAChR gene cluster on chromosome 15q25.1, adjusting for background variables. A coding variant in CHRNA5 (rs16969968[A]) was significantly associated with 1.4-unit higher ODS (p < 0.00017). A variant in the 3' untranslated region of CHRNA3 (rs660652[G]) was significantly associated with 1.7-fold higher odds of lifetime smoking (p < 0.0092), 1.1-unit higher NDS (p < 0.0007), 0.7 more pack-years of cigarette smoking (p < 0.0038), and 0.8 more lifetime attempts to quit (p < 0.0084). Our data suggest an association of DNA variants in the nAChR gene cluster on chromosome 15q25.1 with ODS, as well as NDS and related smoking phenotypes. While the association of this locus with NDS and smoking phenotypes is well known, the association with ODS, a dimension of opioid substance dependence, is novel and requires verification in independent studies.


Health care in Denmark.
In Denmark, federal control of medicine began as early as 1890. Last year the American College of Medical Group Administrators studied the evolution of that country's health care system and found that it may well have predictive value for American health care planners.


Genetics of susceptibility to Plasmodium falciparum: from classical malaria resistance genes towards genome-wide association studies.
Plasmodium falciparum represents one of the strongest selective forces on the human genome. This stable and perennial pressure has contributed to the progressive accumulation in the exposed populations of genetic adaptations to malaria. Descriptive genetic epidemiology provides the initial step of a logical procedure of consequential phases spanning from the identification of genes involved in the resistance/susceptibility to diseases, to the determination of the underlying mechanisms and finally to the possible translation of the acquired knowledge in new control tools. In malaria, the rational development of this strategy is traditionally based on complementary interactions of heterogeneous disciplines going from epidemiology to vaccinology passing through genetics, pathogenesis and immunology. New tools including expression profile analysis and genome-wide association studies are recently available to explore the complex interactions of host-parasite co-evolution. Particularly, the combination of genome-wide association studies with large multi-centre initiatives can overcome the limits of previous results due to local population dynamics. Thus, we anticipate substantial advances in the interpretation and validation of the effects of genetic variation on malaria susceptibility, and thereby on molecular mechanisms of protective immune responses and pathogenesis.


Thermally reversible aggregation of Gold nanoparticles in polymer nanocomposites through hydrogen bonding.
The ability to tune the state of dispersion or aggregation of nanoparticles within polymer-based nanocomposites, through variations in the chemical and physical interactions with the polymer matrix, is desirable for the design of materials with switchable properties. In this study, we introduce a simple and effective means of reversibly controlling the association state of nanoparticles based on the thermal sensitivity of hydrogen bonds between the nanoparticle ligands and the matrix. Strong hydrogen bonding interactions provide excellent dispersion of gold nanoparticles functionalized with poly(styrene-r-2-vinylpyridine) [P(S-r-2VP)] ligands in a poly(styrene-r-4-vinyl phenol) [P(S-r-4VPh)] matrix. However, annealing at higher temperatures diminishes the strength of these hydrogen bonds, driving the nanoparticles to aggregate. This behavior is largely reversible upon annealing at reduced temperature with redispersion occurring on a time-scale of ~30 min for samples annealed 50 °C above the glass transition temperature of the matrix. Using ultraviolet-visible absorption spectroscopy (UV-vis) and transmission electron microscopy (TEM), we have established the reversibility of aggregation and redispersion through multiple cycles of heating and cooling.


Struma ovarii mimicking a benign multicystic ovarian tumor: MR imaging in one case.
Struma ovarii is a rare form of mature teratoma of the ovary. A case of struma ovarii is presented with magnetic resonance (MR) imaging and pathologic findings. MR imaging showed a multiloculated cystic adnexal mass with well-defined margin and septum. Internal cystic spaces presented homogeneous signal intensity of fluid content in both T1-weighted and T2-weighted images. Subtle contrast enhancement was depicted in internal septi. Imaging features were indistinguishable from benign multicystic ovarian tumor, and different from the reported cases in the literature.


Overexpression of tomato thioredoxin h (SlTrxh) enhances excess nitrate stress tolerance in transgenic tobacco interacting with SlPrx protein.
The thioredoxin (Trx) system plays a vital function in cellular antioxidative defense. However, little is known about Trx in tomato under excess nitrate. In this study, we isolated the tomato gene encoding h-type Trx gene (SlTrxh). The mRNA transcript of SlTrxh in roots and leaves of tomato was induced incrementally under excess nitrate for 24 h. Subcellular localization showed that SlTrxh might localize in the cytoplasm, nucleus and plasma membrane. Enzymatic activity characterization revealed that SlTrxh protein possesses the disulfide reductase function and Cysteine (Cys) 54 is important for its activity. Overexpressing SlTrxh in tobacco resulted in increasing seed germination rate, root length and decreasing H2O2 and O2- accumulation, compared with the wild type (WT) tobacco under nitrate stress. While overexpressing SlTrxhC54S (Cysteine 54 mutated to Serine) in tobacco showed decreased germination rate and root length compared with the WT after nitrate treatment. After nitrate stress treatment, SlTrxh overexpressing transgenic tobacco plants have lower malonaldehyde (MDA), H2O2 contents and Reactive Oxygen Species (ROS) accumulation, and higher mRNA transcript level of NtP5CS, NtDREB2, higher ratio of ASA/DHA and GSH/GSSG, higher activities of ascorbate peroxidase and NADP thioredoxin reductase. Besides, SlTrxh overexpressing plants showed higher tolerance to Methyl Viologen (MV) in the seed germination and seedling stage. The yeast two-hybrid, pull-down, Co-immunoprecipitation and Bimolecular luciferase complementation assay confirmed that SlTrxh physically interacted with tomato peroxiredoxin (SlPrx). These results suggest that SlTrxh contributes to maintaining ROS homeostasis under excess nitrate stress interacting with SlPrx and Cys54 is important for its enzyme activity.


The remarkable hypoxia tolerance in Brandt's voles (Lasiopodomys brandtii).
Oxygen (O2 ) is essential for the survival of most animal species; however, O2 levels are lower than normal in certain spatiotemporal circumstances. Therefore, animals have to develop some strategies to face and adapt to this plight. This study compared the differences in survival, behavior, and hippocampal neurons under hypoxic conditions between Brandt's voles (Lasiopodomys brandtii) and Kunming mice (Mus musculus). Brandt's voles had longer survival times than did Kunming mice in 5%-6.5% O2 levels. Significant differences were observed in mortality between Brandt's voles and Kunming mice after 6 hr of exposure to 5%-7% O2 levels. The novel object recognition test (NORT) and neuronal nuclei staining revealed the presence of species-dependent learning deficits and neuron loss under hypoxic conditions. NORT and neuronal nuclei staining showed that the Kunming mice exposed to 7.5% O2 levels had significant learning deficits and neuronal loss compared with normoxia Kunming mice. Conversely, Brandt's voles exposed to 7.5% O2 levels had no significant learning deficits and neuronal loss compared with the normoxia group. Therefore, hypoxia showed significant effects on survival, cognitive behavior, and neuronal loss of the two species. Moreover, Brandt's voles showed stronger hypoxia tolerance than Kunming mice, and Brandt's voles hypoxia tolerance may root in their adaptive evolution to highland habitat environment. This research is meaningful for studying hypoxic adaptation in animals, and will promote the development of therapies for some illnesses such as stroke and cardiac arrest.


Physiological and cognitive mediators for the association between self-reported depressed mood and impaired choice stepping reaction time in older people.
The aim of the study was to use path analysis to test a theoretical model proposing that the relationship between self-reported depressed mood and choice stepping reaction time (CSRT) is mediated by psychoactive medication use, physiological performance, and cognitive ability. A total of 280 retirement village residents, aged 62-95 years, undertook tests of CSRT, which required them to step onto one of four panels that were illuminated in a random order. Depressed mood was assessed using the 30-item Geriatric Depression Scale (GDS). The participants were also tested on physiological and cognitive performance, including quadriceps strength, balance, complex attention (Trail Making Test [TMT] B), simple reaction time, reported level of exercise, and use of psychoactive medications. A total of 51 participants (18%) showed mild to severe depression. Those with higher GDS scores had significantly increased CSRT and worse performance on all physiological and cognitive parameters. CSRT was also significantly associated with all other measures. The final path analysis model revealed an association between self-reported depression and CSRT that was mediated by two paths, one through quadriceps strength and the other through TMT B with both mediating variables then influencing CSRT via simple reaction time and balance. The findings suggest that self-reported depressed mood is related to slowed performance on a CSRT task and that this relationship is explained by underlying physiological and cognitive impairments.


A digital map of Public-Use Microdata Areas in the 1990 U.S. census.
"Public-Use Microdata Areas (PUMAs) are the smallest geographic units for which many U.S. Census variables are reported. In particular, 1990 microdata records for households and individuals can be aggregated only by PUMA, metropolitan area, state, and region. The Census Bureau distributes maps of these PUMAs only on paper, however, and only for individual states. This note describes the construction of a national, digital base map of the PUMAs used in the 1990 U.S. Census microdata files (5% sample)."


Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent.
The current concepts of autonomy, surrogate autonomy and informed consent often lead to futile and expensive care at the ends of life. They may impinge on the dignity of the patient as well as subject society to unwarranted expense. In order to provide affordable healthcare for all, these concepts are in need of modification.


Clinical and pharmaceutical success from discovery to regulatory approval: biomarkers, modeling and analytical technologies.
The 8th Annual Shanghai Symposium on Clinical and Pharmaceutical Solutions through Analysis (CPSA): Clinical and Pharmaceutical Success from Discovery to Regulatory Approval: Biomarkers, Modeling and Analytical Technologies (CPSA Shanghai 2017); Renaissance Shanghai Pudong Hotel, Shanghai, China, 12-14 April 2017 was held on 12-14 April 2017 in Shanghai, China. The meeting was featured with highly interactive events including diversified symposia, workshops, roundtable discussions, conference awards and poster sessions. There were over 220 participants with 61 oral presentations and 20 posters presented. In addition, the meeting included a preconference workshop with an inaugural session on the evaluation of quality and efficacy for generic drugs in China.


Breech presentation: increasing maternal choice.
Pregnant women with a third trimester breech presentation are almost invariably offered Caesarean section as the mode of delivery of first choice, especially when external version has failed to turn the fetus to cephalic. However, increasingly women are resorting to alternatives, to avoid either operative delivery or manipulative intervention in late pregnancy. This paper reviews some of the options for women with breech presentation, focusing especially on integrating these options into conventional maternity care.


A comparative analysis of differentially expressed genes in rostral and caudal regions after spinal cord injury in rats.
The initial mechanical damage of a spinal cord injury (SCI) triggers a progressive secondary injury cascade, which is a complicated process integrating multiple systems and cells. It is crucial to explore the molecular and biological process alterations that occur after SCI for therapy development. The differences between the rostral and caudal regions around an SCI lesion have received little attention. Here, we analyzed the differentially expressed genes between rostral and caudal sites after injury to determine the biological processes in these two segments after SCI. We identified a set of differentially expressed genes, including Col3a1, Col1a1, Dcn, Fn1, Kcnk3, and Nrg1, between rostral and caudal regions at different time points following SCI. Functional enrichment analysis indicated that these genes were involved in response to mechanical stimulus, blood vessel development, and brain development. We then chose Col3a1, Col1a1, Dcn, Fn1, Kcnk3, and Nrg1 for quantitative real-time PCR and Fn1 for immunostaining validation. Our results indicate alterations in different biological events enriched in the rostral and caudal lesion areas, providing new insights into the pathology of SCI.


Cognitive arithmetic across cultures.
Canadian university students either of Chinese origin (CC) or non-Asian origin (NAC) and Chinese university students educated in Asia (AC) solved simple-arithmetic problems in the 4 basic operations (e.g., 3 + 4, 7 - 3, 3 x 4, 12 divided by 3) and reported their solution strategies. They also completed a standardized test of more complex multistep arithmetic. For complex arithmetic, ACs outperformed both CCs and NACs. For simple arithmetic, however, ACs and CCs were equal and both performed better than NACs. The superior simple-arithmetic skills of CCs relative to NACs implies that extracurricular culture-specific factors rather than differences in formal education explain the simple-arithmetic advantage for Chinese relative to non-Asian North American adults. NAC's relatively poor simple-arithmetic performance resulted both from less efficient retrieval skills and greater use of procedural strategies. Nonetheless, all 3 groups reported using procedures for the larger simple subtraction and division problems, confirming the importance of procedural knowledge in skilled adults' performance of elementary mathematics.


[Clinical management of adenomatous polyposis in patients with hereditary non-polyposis colorectal cancer and familial adenomatous polyposis].
To investigate the validity and safety of different doses of non-steroidal anti-inflammatory drugs (NSAID) in attempting to maintain the regression of colorectal adenomas in patients with familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). Twenty-two FAP patients who were willing to receive celecoxib were randomly divided into 2 groups 400 mg/d group (n = 8, taking celecoxib 400 mg/d) and 200 mg/d group (n = 10, taking celecoxib 200 mg/d). Four FAP patients who refused celecoxib and selected aspirin 80 mg/d instead. Six HNPCC patients were given celecoxib 400 mg daily. The treatment lasted for 24 months in all groups. The efficacy was evaluated respectively by the number and grade of polyps by coloscopy every 3 months in the first year and every 6 months in the second year. Either dose of celecoxib could reduce polyps in the FAP patients, with a polyps reduction rate of 86.6% (280/323) in the 400 mg group, significantly higher than that in the 200 mg group [51.81% (129/249) of the aspirin group]. In 5 of the 6 HNPCC patients the polyps completely vanished after 9 months of treatment. Side effects, such as arrhythmia, angina pectoris, and nervous headache, were observed in the celecoxib 400 mg/d group. The side effects could be reversed by decreasing the dose of celecoxib or using aspirin instead. Only one patient in the celecoxib 200 mg/d group showed side effects. Celecoxib 400 mg daily is more effective but has more side effects. At first the patients should be treated with celecoxib 200 mg daily for a long time, or 400 mg/d in the first 6 months and then with a daily dose of 200 mg/d to maintain the treatment effects. Soluble aspirin has similar effects.


Comparison of the ability of wavelet index and bispectral index for reflecting regain of consciousness in patients undergone surgery.
Wavelet index (WLI) is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index (BIS) in patients regain of consciousness (ROC) in the absence of frontalis electromyographic (EMG) interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery. Twelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator's hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness (LOC1). Tunstall's isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation, endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness (ROC1) and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness (LOC2). After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness (ROC2). The BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance (P < 0.05). Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances (P < 0.05) between ROC1 and LOC1. This study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.


The relation between glutathione S-Transferase M1 null-genotype and cardiac problems in beta-thalassemia.
This work was carried out to investigate the role of Glutathione S-Transferase M1 (GSTM1) null genotype frequency in prognosis of β-thalassemia, and to detect the correlation between GSTM1 null genotype and appearance of cardiac complications in β-thalassemia. The studied groups in the present work were divided to three groups (group I: 20 healthy subjects, group II: 56 β-thalassemic patients and group III: 16 β-thalassemic patients with cardiac complications were taken from group II). The measurement of human high sensitive C-reactive protein (hs-CRP) was performed using nephelometry. GSTM1 genotype was detected by Polymerase Chain Reaction (PCR) and cardiac complications were determined by using Echocardiography. A statistically significant increase in hs-CRP and interleukin-6 (IL-6) levels was found in β-thalassemic patients with cardiac complications compared to normal subjects. Results showed no relation between GSTM1 null genotype frequency neither with β-thalassemia nor with cardiac complications appearance, where the interaction between GSTM1 null genotype in β-thalassemic patients with cardiac complications and healthy subjects were insignificant compared to subjects with GSTM1 non-null genotype. GSTM1 null genotype frequency has no role in β-thalassemia or cardiac complications appearance.


Selective influence of test anxiety on reading processes.
The aim of this research is to explore whether comprehension is impaired by test anxiety, whether the anxious person spends compensatory reading time, and which cognitive processes are affected. High- and low-anxiety students read texts word by word with the moving-window technique under test conditions. Multiple regression analyses on word-reading times were computed with a number of psycholinguistic variables--assumed to map onto specific processes--serving as predictors. Results indicated that anxiety did not impair comprehension, but increased word-reading times, which were affected interactively by anxiety and specific psycholinguistic variables (end of clause, serial position within the text, narrativity, and summary). These data reveal that anxious readers need to employ a greater amount of processing resources than their non-anxious counterparts to obtain a similar comprehension level. Furthermore, the interactive effects suggest that anxiety is selectively detrimental to the efficiency of text-level processes, such as those involved in integrating information across sentences. In contrast, anxiety does not impair low-level processes, such as encoding and lexical access.


Role of renal kallikrein in modulating the antihypertensive effect of a single oral dose of captopril in normal- and low-renin essential hypertensives.
The antihypertensive efficacy of angiotensin converting enzyme (ACE) inhibitors may result from the blockade of angiotensin II formation but also, theoretically, from the inhibition of kinin breakdown. To test whether a blunted activity of the kallikrein-kinin system might account for the failure of ACE inhibitors in lowering blood pressure (BP) in patients in whom the renin-angiotensin system (RAS) is not enhanced, 31 essential hypertensives with normal or low plasma renin activity (PRA) were evaluated before and after a single oral dose (50 mg) of captopril. A significant fall, in both systolic and diastolic BP, was obtained in the subgroup of patients who were classified as 'normal-kallikrein hypertensives' according to whether their pretreatment urinary kallikrein excretion was within the normal range, while no significant change in BP was observed in 'low-kallikrein hypertensives'. Furthermore, the mean percentage fall in mean BP, throughout the 2 h following captopril administration, was significantly related to the basal value of urinary kallikrein excretion (r = 0.47, P less than 0.05) in all the patients. Our results suggest that blunted activity of the kallikrein system might be responsible for failure of captopril to lower BP in some hypertensive patients.


A case-control study of VDRL-positive antenatal clinic attenders at the Port Moresby General Hospital Antenatal Clinic and Labour Ward to determine outcomes, sociodemographic features and associated risk factors.
Between June 2001 and December 2002, 152 antenatal patients at Port Moresby General Hospital who were Venereal Disease Research Laboratory (VDRL) serology positive and 150 unselected antenatal patients who tested negative were studied to determine the gestational age at which the tests were performed, the time it took for results to become available, the proportion of patients who received treatment, the sociodemographic characteristics associated with VDRL positivity and the effect of VDRL positivity on maternal and perinatal outcomes. The prevalence rate of VDRL positive among antenatal clinic attenders in Port Moresby at that time was 4.4%. Of the 152 VDRL-positive patients in this study 97% were also Treponema pallidum haemagglutination (TPHA) positive. Significantly more of the positive patients were of highlands origin, lived in settlements, had previous marriages, had lower parities, delivered preterm babies, had stillbirths, had growth-restricted babies and had babies with lower Apgar scores at both 1 and 5 minutes. The mean birthweight was significantly lower among the positive patients. Significantly more of the positive patients were married to spouses with occupations which were regarded as 'risky' for sexually transmitted infections. There was no difference between the two groups with respect to patient's education, marital status, husband's education, gestational age at delivery and the number of days the baby spent in the Special Care Unit. The study concluded that the current antenatal screening does not provide adequate coverage for our patients. If the current availability of clinic-based strip tests provided by a non-government organization can be continued by the Ministry of Health we should be able to overcome this problem.


The haplotype distribution of two genes of citrus tristeza virus is altered after host change or aphid transmission.
Genetic variability of citrus tristeza virus (CTV) was studied using the haplotypes detected by single-strand conformation polymorphism (SSCP) analysis of genes p18 and p20 in six virus populations of two origins. The Spanish group included a CTV isolate and subisolates obtained by graft-transmission to different host species. The other included two subisolates aphid-transmitted from a single Japanese isolate. The homozygosity observed for gene p20 was always significantly higher than that expected under neutral evolution, whereas only three populations showed high homozygosity for p18, suggesting stronger host constraints for p20 than for p18. Sequential transmissions of a Spanish isolate to new host species increased the difference between its population and that of the successive subisolates for gene p18, as estimated by the F statistic. Analysis of molecular variance indicated that variation between both groups of populations was not statistically significant, whereas variations between populations of the same group or within populations were significant for both genes studied. Our data indicate that selection affects the haplotype distribution and that adaptation to a new host can be as important or more as the geographical origin. Variation of the CTV populations after host change or aphid transmission may explain in part the wide biological variability observed among CTV isolates.


[Significance of marketing in public health].
Issues of new marketing relations being formed in national public health system are discussed. Presence and essence of such relationships is defined. Their possible formalized notions, logic of interplay of elements of public health marketing systems and elements of general marketing and medical services marketing is offered for discussion.


The effect of dietary nitrate on macro- and microvascular function: A systematic review.
Previous studies have investigated the impact of dietary nitrate on vascular function due to the association between dietary nitrate ingestion and improvement in nitric oxide (NO) bioavailability. Considering that NO can present different effects through vascular beds (macro- vs. microvasculature) due to the specific characteristic (function and morphology) that each vessel exhibits, it is crucial to investigate the effect of dietary nitrate ingestion on the macro- and microvascular function to understand the effect of nitrate on vascular function. For this reason, this review aimed to evaluate the impact of dietary nitrate on macro- and microvascular function in humans. A total of 29 studies were included in the systematic review, of which 19 studies evaluated the effect of nitrate supplementation on macrovascular function, eight studies evaluated the effect on microvascular function, and two studies evaluated the impact on both macro- and microvascular function. The literature suggests that dietary nitrate ingestion seems to improve the vascular function in macrovasculature, whereas microvascular function appears to be modest. Future studies investigating the effect of nitrate ingestion on vascular function should focus on measuring macro- and microvascular function whenever possible so that the impact of nitrate-rich foods on vascular segments could be better understood.


[Dynamic biliary manometry: display modelling and graphic interpretation].
Tendencies of development of biliary manometry have been analyzed. Key advantages and problems of manometric investigation of biliary tracts have been summarized. New method of graphic registration and pressure monitoring in biliary tracts called biliary manometry has been suggested. Characteristic types of manometric curves were determined using stand modelling, their physical and mathematical analysis was conducted, clinical analogues have been suggested. The emphasis has been made on expediency of its further elaboration and clinical application.


Autotrophic growth on carbon disulfide is a property of novel strains of Paracoccus denitrificans.
Three distinct strains (KL1, KS1, and KS2) of facultatively chemolitho-autotrophic bacteria able to use carbon disulfide or carbonyl sulfide as sole energy substrates were identified as novel strains of Paracoccus denitrificans. Evidence for their identity as biovars of P. denitrificans and as close relatives of Paracoccus versutus is based on their DNA composition, total sequencing of the genes for their 16S rRNA, muropeptide profiles, amino acid composition of peptidoglycan, kinetics of murein degradation by lysozyme, possession of large plasmids (91-98 kb) and megaplasmids (> 450 kb), and plasmid transfer between the strains and with P. denitrificans and P. versutus. No functions have been identified for the 91- to 98-kb plasmids of strains KL1 and KS2, but curing strain KL1 of its plasmid did not affect growth on carbon disulfide, thiosulfate or succinate. Emendation of the formal description of Paracoccus denitrificans is presented. Autotrophic growth on carbon disulfide and thiosulfate was confirmed by 14CO2 fixation. Evidence is presented for initiation of carbon disulfide oxidation by an NADH-dependent oxygenase. Cell-free extracts catalyzed (1) NADH-stimulated uptake of oxygen in the presence of carbon disulfide, and (2) carbon-disulfide-stimulated oxidation of NADH. The activity was not sedimented at 50,000 x g. Intermediates in aerobic carbon disulfide metabolism were shown by GC and GC/MS to include carbonyl sulfide and hydrogen sulfide, but anaerobic production of COS and H2S from carbon disulfide did not occur. SDS-PAGE of cell-free extracts showed polypeptides that were unique to growth on carbon disulfide, common to carbon disulfide and carbonyl sulfide, or found after growth on carbon disulfide, carbonyl sulfide or thiosulfate. The possible identity of these as proteins involved in sulfur compound metabolism is discussed.


Additive effects of temperature and infection with an acanthocephalan parasite on the shredding activity of Gammarus fossarum (Crustacea: Amphipoda): the importance of aggregative behavior.
Climate change can have critical impacts on the ecological role of keystone species, leading to subsequent alterations within ecosystems. The consequences of climate change may be best predicted by understanding its interaction with the cumulative effects of other stressors, although this approach is rarely adopted. However, whether this interaction is additive or interactive can hardly be predicted from studies examining a single factor at a time. In particular, biotic interactions are known to induce modifications in the functional role of many species. Here, we explored the effect of temperature on leaf consumption by a keystone freshwater shredder, the amphipod Gammarus fossarum. This species is found at high densities in the wild and relies on aggregation as an antipredator behavior. In addition, gammarids regularly harbor acanthocephalan parasites that are known to induce multiple effects on their hosts, including modifications on their functional role. We thus assessed the cumulative effect of both intraspecific interactions and parasitism. Consumption tests were conducted on gammarids, either naturally infected with Pomphorhynchus tereticollis or uninfected, feeding alone or in groups. Our results show that increased temperatures induced a significant increase in consumption, but only to a certain extent. Interestingly, consumption at the highest temperature depended on amphipod density: Whereas a decrease was observed for single individuals, no such effect on feeding was observed for individuals in groups. In addition, infection by acanthocephalan parasites per se significantly negatively impacted the shredding role of gammarids. Overall, the combined effects of parasitism and temperature appeared to be additive. Thus, future studies focusing on the impact of climate change on the functional role of keystone species may benefit from a multimodal approach under realistic conditions to derive accurate predictions.


CAG/CTG repeat expansions at the Huntington's disease-like 2 locus are rare in Huntington's disease patients.
The authors report a large series of patients with Huntington disease (HD)-like phenotype without CAG repeat expansions in the IT15 gene that were screened for the newly identified CAG/CTG expansion in the gene encoding junctophilin-3. Normal alleles in controls had from 8 to 28 repeats. A single patient of North African origin with typical HD carried an allele with 50 uninterrupted repeats, representing approximately 2% of the non-IT15 HD patients tested. Therefore, further genetic heterogeneity is expected in HD.


Tracheal stenosis measured by the acoustic reflection technique.
We examined the usefulness of the acoustic reflection technique for measurement of airway area in 6 patients with tracheal stenosis. In each patient, we obtained airway area by acoustic reflections in the upright position, maximal expiratory and inspiratory flow-volume curve, and radiographs of the trachea. We identified acoustic and radiographic stenotic segments and compared their length, their distances from the glottis, and their cross-sectional areas. We found that (1) in all subjects except one, flow-volume curves did not suggest upper airway obstruction, (2) tracheal stenosis was confirmed by acoustic and radiographic measurements in all subjects, and (3) area of the stenotic segment showed less variation with lung volume than that of the nonstenotic segment. Length of the stenotic segment (mean +/- SE) was found to be 4.9 +/- 0.2 cm (acoustic versus 4.8 +/- 0.3 cm (radiographic); distance between the midglottis and maximal stenosis was 5.7 +/- 0.4 cm (acoustic) and 5.6 +/- 0.6 cm (radiographic); minimal acoustic cross-sectional area was 1.7 +/- 0.1 cm2 versus a radiographic circular cross-sectional area of 1.2 +/- 0.1 cm2. During slow expiration from total lung capacity to residual volume, average cross-sectional area of the stenotic segment decreased by 19.5 +/- 3.0% (mean +/- SE), whereas that of the distal nonstenotic segment decreased by 48.5 +/- 2.2% and that of the proximal nonstenotic segment by 43.6 +/- 5%. We conclude that the acoustic technique, which is rapid and noninvasive, is useful in confirming tracheal stenosis in patients with normal flow-volume curves, and in assessing elastic properties of the trachea.


Constitutive expression of human angiostatin in Pichia pastoris using the GAP promoter.
The GAP gene promoter was amplified from P. pastoris GS115 and used to replace the AOX1 promoter (P(AOX1)) on pPIC9K resulting in plasmid pGAP9K. The recombinant expression vector pGAP9K-AS was constructed by inserting the angiostatin gene(AS) into pGAP9K. pGAP9K-AS was then transformed into P. pastoris GS115. The multi-copy integration transformant P. pastoris GS115 (pGAP9K-AS) was used to investigate the constitutive expression of angiostatin in P. pastoris. The expression of angiostatin reached its peak after 4 d of culture in P. pastoris GS115 (pGAP9K-AS) while the angiostatin expressed in P. pastoris GS115 (pPIC9K-AS) after 4 d of induction or 5 d of culture is only 70% of that expressed by P. pastoris GS115 (pGAP9K-AS). The AS expression in inducible system reached the peak after 6 d of induction but the expressed AS was only 86% of that from constitutive system. The results of anti-angiogenic and antitumor activity assay showed that AS expressed from both constitutive and inducible system inhibited the CAM angiogenesis and suppressed B16 melanoma in C57BL/6J mouse and that the tumor inhibition rates reached 90.63% and 90.54%, respectively. The above data indicates that the constitutive promoter P(GAP) can served as an effective alternative to the inductive promoter P(AOX1) to express AS and other proteins in P. pastoris.


Oxidant stress and constrictor reactivity impair cerebral artery dilation in obese Zucker rats.
This study tested the hypothesis that evolution of the metabolic syndrome in obese Zucker rats (OZR) leads to impaired dilator reactivity of cerebral resistance arteries vs. responses determined in lean Zucker rats (LZR). Middle cerebral arteries (MCA) from 17-wk-old male LZR and OZR were isolated and cannulated with glass micropipettes. Vascular reactivity was assessed in response to challenge with ACh, sodium nitroprusside (SNP), reductions and elevations in Po2, 5-HT, and increased intralumenal pressure. Vessels were treated with the free radical scavenger 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (tempol) to assess the role of superoxide production in altering reactivity, and passive vascular wall mechanics was assessed in each vessel. Vascular superoxide production was assessed in isolated arteries using fluorescence microscopy. Vessel dilation to ACh and hypoxia was impaired in OZR vs. LZR, although responses to SNP were normal. Vessel constriction to 5-HT, elevated Po2, and elevated intralumenal pressure was enhanced in OZR vs. LZR. Fluorescence microscopy demonstrated an increased superoxide production in arteries of OZR vs. LZR, correctable by incubation with tempol. Although treatment of vessels from OZR with tempol improved dilation to ACh and hypoxia, constrictor responses to 5-HT, elevated Po2, and pressure were not altered by tempol treatment. Indexes of vessel wall mechanics were comparable between groups. These results suggest that vasodilator reactivity of MCA of OZR in response to endothelium-dependent dilator stimuli is impaired vs. LZR and that this may represent a reduced bioavailability of signaling molecules due to oxidant scavenging. However, oxidative stress-independent increases in myogenic tone and constrictor reactivity may contribute to blunted dilator responses of cerebral microvessels.


From assurance to coproduction: a century of improving the quality of health-care service.
Over the last century, the invitation to improve health-care service quality has taken many different forms: questions, observations, methods, tools and actions have emerged and evolved to create relevant 'improvement work.' In this paper we present three phases of this work. The basic frameworks used in these phases have not supplanted each other, but they have been layered one upon the next over time. Each brought important new thinking, new change opportunities and a new set of limits. The important messages of each need to be carried together into the future, as must the sense of curiosity and possibility about the commonalities that has driven this evolution. Literature, personal experience and other artifacts were reviewed to develop this description of how the focus on quality work has evolved (and continues to evolve) over the last century. We describe three phases. Quality 1.0 seeks to answer the question 'How might we establish thresholds for good healthcare services?' It described certain 'basic' standards that should be used to certify acceptable performance and capability. This led to the formation of formal processes for review, documentation and external audits and a system for public notice and recognition. Over time, the limits and risks of this approach also became more visible: a 'micro-accounting compliance' sometimes triumphed over what might be of even greater strategic importance in the development and operations of effective systems of disease prevention and management to improve outcomes for patients and families. Quality 2.0 asked 'How might we use enterprise-wide systems for disease management?' It added a focus on the processes and systems of production, reduction of unwanted variation, the intrinsic motivation to take pride in work, outcome measurement and collaborative work practices as ways to improve quality, modeled on experiences in other industries. Quality 3.0 asks 'How might we improve the value of the contribution that healthcare service makes to health?' It requires careful consideration of the meaning of 'service' and 'value', service-creating logic, and prompts us to consider both relationships and activities in the context of the coproduction of health-care services. Efforts to improve the quality and value of health-care services have evolved over the last century. With each success have come new challenges and questions, requiring the addition of new frames and approaches.


Genotype-specific neutralizing antibody titers against Japanese encephalitis virus genotypes 1 and 3 in horses immunized with a genotype 3 vaccine.
Japanese encephalitis is one of the most important mosquito-borne and zoonotic diseases in Asia and the Pacific region. Although the dominant Japanese encephalitis virus (JEV) genotype has shifted from G3 to G1 in Korea since 1990, a G3 strain (Anyang 300) has been used in vaccines for horses for almost 40 years. This study aimed to investigate the seroconversion rates and geometric mean titers (GMTs) of virus-neutralizing antibodies (VNAs) against JEV G1 and G3 in horses immunized with the G3 vaccine. Serum samples of 1,231 horses immunized with the Anyang 300 vaccine were collected in 2018. VNA titers against JEV KV1899 (G1) and Anyang 300 (G3) were measured in all serum samples using the virus neutralization test. Titers were analyzed according to blood sampling time (prior to and following annual revaccination), age, and region. Rates of VNA titer >10 were 45.1% and 77.8% for G1, and 49.1% and 82.9% for G3 in samples taken before and after revaccination, respectively. GMTs of genotype-specific VNAs against JEV G1 and G3 were 8.3 and 11.6 before revaccination and rose to 27.2 and 65.4 following revaccination. Overall sero-positivity did not significantly differ between genotypes, but GMTs significantly differed among genotypes and sampling times. No significant difference was found in GMTs among age groups or regions. Genotype-specific neutralizing antibody titers against JEV G1 and G3 differed significantly in horses immunized with the G3 vaccine. Antigenic differences between genotypes could reduce the vaccine's efficacy, requiring the development of a new vaccine.


Effects of dietary calcium to phosphorus ratio and addition of phytase on growth performance of nursery pigs.
Two studies were conducted to evaluate the growth performance and percentage bone ash of nursery pigs fed various combinations of Ca and P provided by inorganic sources or phytase. In Exp. 1, pens of pigs (n = 720, initially 6.1 ± 0.98 kg) were blocked by initial BW. Within blocks, pens were randomly assigned to one of six treatments (12 pens per treatment) in a three-phase diet regimen. Treatments were arranged in a 2 × 3 factorial with main effects of Ca (0.58% vs. 1.03%) and standardized total tract digestible (STTD) P (0.33% and 0.45% without phytase, and 0.45% with 0.12% of the P released by phytase). During treatment period, Ca × P interactions were observed for all growth criteria (P < 0.05). When diets had low Ca, pigs fed 0.45% STTD P with phytase had greater (P < 0.01) ADG and ADFI than those fed 0.33% or 0.45% STTD P without phytase. When high Ca was fed, ADG and ADFI were similar among pigs fed 0.45% STTD P with or without phytase and were greater than those fed 0.33% STTD P. Gain:feed was reduced (P < 0.01) when high Ca and low STTD P were fed relative to other treatments. On d 21, radiuses were collected from 1 pig per pen for bone ash analysis. Pigs fed 0.33% STTD P had decreased (P < 0.05) percentage bone ash than those fed 0.45% STTD P with or without phytase when high Ca was fed, but this P effect was not observed for low Ca diets (Ca × P interaction, P = 0.007). In Exp. 2, 36 pens (10 pigs per pen, initially 6.0 ± 1.08 kg) were used in a completely randomized design. Treatments were arranged in a 2 × 3 factorial with the main effects of STTD P (at or above NRC [NRC. 2012. Nutrient Requirements of Swine. 11th rev. ed. Washington (DC): National Academic Press.] requirement estimates) and total Ca (0.65, 0.90, and 1.20%). Experimental diets were fed during phases 1 and 2, followed by a common phase 3 diet. Diets at NRC (2012) P level contained 0.45% and 0.40% STTD P, compared with 0.56% and 0.52% for diets greater than the NRC (2012) estimates, in phase 1 and 2, respectively. During treatment period, increasing Ca decreased (linear, P = 0.006) ADG, but increasing STTD P marginally increased (P = 0.084) ADG, with no Ca × P interaction. When diets contained NRC (2012) P levels, pigs fed 1.20% Ca had decreased (P < 0.05) G:F than those fed 0.65% or 0.90% Ca; however, when high STTD P were fed, G:F was not affected by Ca (Ca × P interaction, P = 0.018). In conclusion, excess Ca decreased pig growth and percentage bone ash when diets were at or below NRC (2012) requirement for STTD P, but these negative effects were alleviated by adding monocalcium P or phytase to the diet.


Case report: Multiple gastrointestinal perforations in a rare musculocontractural Ehlers-Danlos syndrome with multiple organ dysfunction.
A 36-year-old male with congenital equinovarus deformity was admitted to the hospital due to worsen deformity. He was known to have ear perforation in childhood. After hospitalization, he received equinovarus correction surgery, fourth toe osteotomy, and external fixation for right foot during the procedure. During his hospital stay, the patient has been treated with multiple gastrointestinal perorations, accompanied with multiple organ dysfunction and fragile soft tissues. During his in-hospital stay, multiple organ dysfunctions were observed, including the heart, kidney, liver, and intestines. In order to identify the mutation site, whole-exome sequencing (WES) was performed, and further verified with Sanger sequencing analysis in this patient. One-site mutation located at CHST14 [c.883_884del, p (Phe295Cysfs*5)] was identified in this patient, whereas this mutation was not observed in other 100 healthy controls. Also, this variant has not been reported in public databases (ExAC and gnomAD). Our report showed that unanticipated multiple tissue deformation observed the musculocontractural EDS patient was caused by mutation located at CHST14 [c.883_884del, p (Phe295Cysfs*5)] induced truncated CHST14 protein.


Helicobacter pylori but not high salt induces gastric intraepithelial neoplasia in B6129 mice.
Helicobacter pylori is responsible for most human stomach cancers. Gastric cancer also is overrepresented in populations consuming high-salt diets. Attempts to test the hypothesis that high salt promotes H. pylori carcinogenesis have been hindered by the lack of a wild-type mouse model. Based on pilot observations of unexpectedly early gastric adenocarcinoma in C57BL/6 x 129S6/SvEv (B6129) mice infected with Helicobacter felis, we conducted a study to characterize H. pylori infection in these mice and to determine whether high salt promotes tumorigenesis. Male and female mice were gavaged with H. pylori Sydney strain-1 or vehicle only and divided into four groups based on infection status and maintenance on a basal (0.25%) or high (7.5%) salt diet. In uninfected mice, the high-salt diet enhanced proliferation and marginally increased parietal cell mucous metaplasia with oxyntic atrophy. Lesions in H. pylori infected mice without regard to diet or gender were of equivalent severity and characterized by progressive gastritis, oxyntic atrophy, hyperplasia, intestinal metaplasia, and dysplasia. Infected mice on the high-salt diet exhibited a shift in antimicrobial humoral immunity from a Th1 to a Th2 pattern, accompanied by significantly higher colonization and a qualitative increase in infiltrating eosinophils. No mice developed anti-parietal cell antibodies suggestive of autoimmune gastritis. At 15 months of age infected mice in both dietary cohorts exhibited high-grade dysplasia consistent with gastric intraepithelial neoplasia. In summary, we report for the first time H. pylori-induced gastric intraepithelial neoplasia in a wild-type mouse model and show no additive effect of high-salt ingestion on tumor progression.


Langer-Giedion Syndrome: a Rare Case Report.
Langer-Giedion syndrome is a very uncommon autosomal dominant genetic disorder caused by the deletion of chromosomal material. It is characterized by multiple bony exostosis, short stature, mental retardation, and typical facial features. The characteristic appearance of individuals includes sparse scalp hair, rounded nose, prominent philtral area and thin upper lip. Some cases with this condition have loose skin in childhood which typically resolves with age. Oral and dental manifestations include micrognathia, retrognathia, hypodontia, and malocclusion based on cephalometric analysis. This report presents a case of Langer-Giedion syndrome in a 10-year-old child.


Use of larger versus smaller drug-safety databases before regulatory approval: the trade-offs.
Although efforts to revamp the drug-safety system have been directed at strengthening postmarketing surveillance, strategies for the preapproval stage may be useful. One strategy would be to require larger sample sizes in preapproval safety databases. To evaluate the potential benefits and costs of this approach, we developed a hypothetical model to estimate the expected incremental number of adverse drug events that could be avoided in a postapproval population. We found that the potential to limit adverse events can be an important consideration in sample-size determinations for preapproval trials. Requiring larger preapproval databases could be a cost-effective means of reducing adverse events in postapproval populations.


[Soil seed banks of different grassland types of Alashan arid desert region, Inner Mongolia].
Investigations on the soil seed banks of different grassland types of Alashan arid desert region in Inner Mongolia showed that when the altitudes of sampling plots increased from 1,370 m to 1,750 m, the soil seed densities of natural grasslands decreased from 326 grain.m-2 to 76 grain.m-2. At the altitude of 1,100 m, the soil seed density was 56 grain.m-2 in typical desert plot, but only 8 grain.m-2 in the sand dune plot. After the vegetation was restored with Artemisa sphaerocephala on sand dune, its soil seed density increased obviously, almost as 17-29 times as sand dune's. In this study, 31 seeds m-2 were sampled, which belonged to 11 families. Among them, annual plants accounted for 77%, 100% and 70%, perennial plants accounted for 21%, 0 and 16%, and semi-shrubs accounted for 2%, 0 and 14%, respectively for natural grassland, sand dune and sown grassland. Shrub seeds were not found in all the soil seed bank plots. When the altitudes of sampling plots increased from 1,100 m to 1,750 m, the species richness (Margalet index) of soil seed banks of natural grasslands increased from 1.49 to 2.77, and the species diversity (Shannon-Winner index) increased from 0.697 to 0.917.


Enhanced release of IgE-dependent early phase mediators from nasal polyp tissue.
The mast cell is a crucial effector cell in allergic rhinitis and other inflammatory diseases. During the acute allergic reaction preformed mediators such as histamine, but also de novo produced mediators such as leukotrienes (LTC4/D4/E4) and prostaglandins (PGD2) are released. Mast cells represent targets for therapeutic intervention, and thus a human ex-vivo model to stimulate mast cells taken from mucosal sites would be instrumental for drug intervention studies. We have aimed to activate mast cells within ex-vivo human nasal tissue by IgE/anti-IgE specific (epsilon chain specific) stimulations and in this respect to test the usability of nasal polyps versus inferior turbinates Biopsy samples were collected from patients with nasal polyps and inferior turbinates from patients who underwent sinus or septal surgery. Tissue fragments were primed with IgE 1 mug/ml for 60 minutes and then stimulated for 30 minutes with tissue culture medium (negative control), anti-IgE 10 mug/ml, anti-IgE 30 mug/ml and ionomycin 10 muM (positive control). Histamine, leukotrienes and PGD2 were measured in supernatants. To help provide an understanding of the extent of the response, the number of tryptase and FcepsilonRIalpha positive cells was evaluated by means of immunohistochemistry and the FcepsilonRIalpha-chain was measured by means of quantitative PCR in the nasal polyp and inferior turbinate tissues. Finally, the correlation between IgE concentrations in the nasal tissue and the release of mediators was analysed. Stimulations with anti-IgE on IgE-primed nasal tissue fragments lead to a concentration-dependent release of histamine, leukotrienes and PGD2. The release of these early phase mediators was significantly higher in nasal polyps compared to inferior turbinates, although tryptase, FcepsilonRIalpha positive cells and FcepsilonRIalpha-chain transcripts were equally present in both groups. No correlation was found between baseline concentrations of IgE, and the release of histamine, LTC4/LTD4/LTE4 and PGD2 after stimulation. This human nasal challenge model mimics the allergic early phase reaction. The release of histamine, cys-leukotrienes and PGD2 was significantly higher in nasal polyps versus inferior turbinates, however, this observation could not be explained by differences in mast cell or FcepsilonRI+ cell numbers.


Microbial mineralization of cellulose in frozen soils.
High-latitude soils store ~40% of the global soil carbon and experience winters of up to 6 months or more. The winter soil CO2 efflux importantly contributes to the annual CO2 budget. Microorganisms can metabolize short chain carbon compounds in frozen soils. However, soil organic matter (SOM) is dominated by biopolymers, requiring exoenzymatic hydrolysis prior to mineralization. For winter SOM decomposition to have a substantial influence on soil carbon balances it is crucial whether or not biopolymers can be metabolized in frozen soils. We added 13C-labeled cellulose to frozen (-4 °C) mesocosms of boreal forest soil and followed its decomposition. Here we show that cellulose biopolymers are hydrolyzed under frozen conditions sustaining both CO2 production and microbial growth contributing to slow, but persistent, SOM mineralization. Given the long periods with frozen soils at high latitudes these findings are essential for understanding the contribution from winter to the global carbon balance.


Design, synthesis and properties of near-infrared molecular switches containing a fluorene ring.
Three molecular switches containing a fluorene ring were designed and synthesized. The introduction of the amino group substituted fluorene ring resulted in the target molecular switches having some optical properties in the near-infrared region. It was demonstrated that the N-substituents on the fluorene rings and the switch units both had great influence on the molecular switch optical properties including the absorption maximum, absorption intensity and fluorescence quantum yield. The open-ring forms and showed obvious solvatochromic behaviour. The closed-ring forms and showed obvious hydrochromic behaviour in MeCN/water binary solvent systems and acidichromic behaviour in MeCN solution with high reversibility. Especially, the distinct off-on fluorescence signal in the near-infrared region using the stimuli of acid means that the designed compounds have great potential application value in the field of biological sensing.


Experimentally induced social inclusion influences behavior on trust games.
Being socially excluded is profoundly distressing. It is unknown whether exclusion renders victims vulnerable to manipulation or whether excluded individuals become more cautious about being exploited by, and less trusting of, the person who excluded them. We investigated this by testing how much participants trust people who have socially included or excluded them. Inclusion and exclusion were manipulated using Cyberball (a virtual ball game) and, after playing Cyberball, participants played trust games. In a Reputation group participants played trust games with players from Cyberball; in the No Reputation group, participants played with strangers. Inclusion/exclusion manipulation interacted with Group such that participants in the Reputation group trusted individuals who included them more than those who excluded them, whereas inclusion/exclusion made no difference to trust in the No-Reputation group. Our findings suggest that exclusion does not increase gullibility, but that reputation is transferred from a social to an economic setting so that social inclusion increases trust.


Making Roots, Shoots, and Seeds: IDD Gene Family Diversification in Plants.
The INDETERMINATE DOMAIN (IDD) family of transcriptional regulators controls a diversity of processes in a variety of plant tissues and organs and at different stages of plant development. Several recent reports describe the genetic characterization of IDD family members, including those that are likely to regulate C4 kranz anatomy, with implications for the engineering of C4 traits into C3 crops. In this review we summarize the reported functions of IDD members in the regulation of metabolic sensing and leaf, root, seed, and inflorescence development. We also provide an IDD phylogeny for the grasses and suggest future directions and strategies to define the function of IDDs in C4 photosynthesis and other developmental processes.


Prevalence of intestinal parasites in pet shop kittens in Japan.
The present study examined the prevalence of intestinal parasites in kittens from five pet shops in East Japan. Fresh faecal samples were collected from 555 kittens (aged 1-3 months) on a single occasion. The samples were tested for the presence of Giardia species coproantigen using a commercially available enzyme-linked immunosorbent assay kit. Other intestinal parasites were identified microscopically using the formalin-ethyl acetate sedimentation technique. The overall prevalence of intestinal parasites was 27.2%; two genera of protozoa (Giardia species and Cystoisospora species) and one nematode (Toxocara cati) were detected. Faecal condition was not related to intestinal parasite infections. Significant differences among the pet shops were observed in the overall prevalence of intestinal parasites and the presence of Cystoisospora species infections.


Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series.
Over the last two decades, rituximab (RTX) has played an important role in the treatment of some lymphoproliferative malignancies and immune-mediated diseases. RTX administration is generally safe and well-tolerated, but side effects including late-onset neutropenia, hypogammaglobulinemia, hepatitis B reactivation and rare cases of progressive multifocal leukoencephalopathy have been observed after its administration. Although there are no absolute contraindications regarding its use in people living with HIV (PLWH), the prescription of this drug has been principally limited in patients with oncohematological diseases. In this report, we described the outcome of four PLWH who underwent RTX therapy after the diagnosis of immune-mediated renal disease. The main RTX-associated adverse effects were leukopenia, late-onset neutropenia and decline of CD4+ and CD8+ T-cell counts. In addition, two of the four patients experienced pneumonia requiring hospitalization within six months from the last RTX infusion. We suggest that RTX should be used with caution in PLWH until further evidence emerges on its safety profile in this vulnerable population.


[Correlation between the kinetics of plasma EBV DNA levels and clinical response during treatment in patients with nasopharyngeal carcinoma].
Nasopharyngeal carcinoma(NPC) is an EB virus (EBV) related cancer. Recently, it was reported that EBV DNA can be detected in NPC patients' plasma or serum. This study was designed to investigate the correlation between the kinetics of plasma EBV DNA levels and clinical response during concomitant chemo-radiotherapy in the locally advanced nasopharyngeal carcinoma patients. Blood samples from 20 patients were collected weekly during chemo-radiotherapy(7 times, in total). The first blood sample was collected before treatment. The content of EBV DNA in the samples were detected by using fluorescent quantitative PCR method in the PE Appliance Biosystems 7700 Sequence Detector. Before treatment, plasma EBV DNA was detectable in the plasma of 90% (18/20) NPC patients. The median concentration was 150,000(copies/ml). Two patients' plasma EBV DNA could not be detected during the whole course of treatment. Among 18 EBV DNA-positive patients, 3 patients had a continuously high EBV DNA and clinical examination after treatment indicated that they had residual tumors. Seven patients'plasma EBV DNA levels had a rapid decline to be undetectable. Eight patients' plasma EBV DNA levels got a slow decline, but the EBV DNA could not be detected at the end of therapy as well. Clinical examination revealed that all of these 15 patients had complete tumor regression. Kinetic analysis of plasma EBV DNA during treatment may be a useful tool to monitor the treatment response in NPC patients. Further investigation is warranted.


Evaluation of season, temperature, and water stress effects on stomata using a leaf conductance model.
A model was developed earlier describing conductance for three conifers (Picea engelmannii Parry ex Engelm., Abies lasiocarpa [Hook.] Nutt., and Pinus contorta var. latifolia Engelm.) and one hardwood (Populus tremuloides Michx.) using only two terms, photosynthetic photon flux density (PPFD) and absolute humidity difference from leaf to air (DAH). Using residual analysis techniques (actual minus estimated conductance), it was determined that no seasonal or temperature effects existed that were not taken into account with PPFD and DAH. However, conductance was reduced on days following cold nights (below 4 degrees C) or, in aspen, when xylem pressure potential was below -20 bars (1 bar = 10(5) Pa). The following model takes these terms into account: Conductance = b(1) ( radicalPPFD/ radicalDAH) + b(2) ( radicalPPFD/DAH) + b(3) ( radicalPPFD/DAH(2)) + b(4)f(T(min)) + b(5)f(psi(threshold)), where the first three terms describe normal conductance, and the last two terms account for reductions in conductance caused by cold night temperatures or water stress.


The Legality and Ethics of Mandating COVID-19 Vaccination.
In light of ongoing concerns in the US that COVID-19 vaccine uptake is stagnating and that cases remain high amongst the unvaccinated, there is growing interest in increasing uptake by mandating vaccination. COVID-19 vaccine mandates must be understood and assessed in terms of who is requiring vaccination and who is required to be vaccinated. This essay considers the legal and ethical implications of states mandating vaccination for children and adults, as well as of employers mandating vaccines for employees. We conclude that COVID-19 vaccine mandates are legally and ethically permissible.


Retinoic acid-mediated increase in TrkA expression is sufficient to elicit NGF-dependent survival of sympathetic neurons.
Sympathetic neurons depend on the classical neurotrophin NGF for survival by the time they innervate their targets, but the mechanisms controlling the onset of NGF responsiveness in developing neuroblasts have not been defined. Immature chick sympathetic neurons are unresponsive to NGF, but express low mRNA levels of the high-affinity NGF receptor trkA. Treatment with retinoic acid (RA) leads to increased levels of both trkA mRNA and protein, a response mediated through retinoic acid receptor alpha (RAR alpha). Ectopic expression of trkA in these cells results in the ability to survive with NGF, suggesting that RA-induced trkA expression is sufficient to elicit NGF-dependent survival. Our data establish a mechanism controlling NGF responsiveness and implicate a function for RA at defined late stages of neuron development.


Omentalisation in the treatment of sublumbar abscessation: long-term outcome in 10 dogs.
The objectives of this study were to report the technique of omentalisation for the management of sublumbar abscessation associated with suspected migrating plant material, the intraoperative and postoperative complications that occurred and the long-term outcome of the cases. A retrospective case series of dogs (n=10) with sublumbar abscessation managed by exploration and drainage combined with omentalisation of the abscess cavity is reported in this study. The sublumbar area was approached through a ventral midline coeliotomy, the abscess was explored, drained, debrided and subsequently packed with omentum. One dog sustained an aortic rupture during exploration of the abscess, the aorta was repaired; there were no postoperative complications. There was long-term (>12 months) resolution of clinical signs in all dogs. Drainage and omentalisation of sublumbar abscesses resulted in complete resolution of signs in all dogs and was associated with a low incidence of complications. Omentalisation is an effective treatment for dogs presenting with sublumbar abscesses associated with suspected migrating plant material.


Evaluating rotational kinematics of the knee in ACL reconstructed patients using 3.0 Tesla magnetic resonance imaging.
Injury to the anterior cruciate ligament (ACL) is common. While prior studies have shown that surgical reconstruction of the ACL can restore anterior-posterior kinematics, ACL-injured and reconstructed knees have been shown to have significant differences in tibial rotation when compared to uninjured knees. Our laboratory has developed an MR compatible rotational loading device to objectively quantify rotational stability of the knee following ACL injuries and reconstructions. Previous work from our group demonstrated a significant increase in total tibial rotation following ACL injuries. The current study is a prospective study on the same cohort of patients who have now undergone ACL reconstruction. We hypothesize that ACL reconstructed knees will have less tibial rotation relative to the pre-operative ACL deficient condition. We also hypothesize that ACL reconstructed knees will have greater rotational laxity when compared to healthy contralateral knees. Patients. Six of the ACL injured patients from our initial study who had subsequently undergone ACL reconstruction were evaluated 8.1 ± 2.9 months after surgery. All patients underwent single-bundle ACL reconstruction using anteromedial portal drilling of the femoral tunnel with identical post-operative regimens. Magnetic Resonance (MR) Imaging. Patients were placed in a supine position in the MR scanner on a custom-built loading device. Once secured in the scanner bore, an internal/external torque was applied to the foot. The tibiae were semi-automatically segmented with in-house software. Tibial rotation comparisons were made within subjects (i.e. side-to-side comparison between reconstructed and contralateral knees) and differences were explored using paired sample t-tests with significance set at p=0.05. Regarding tibial rotation, in the ACL deficient state, these patients experienced an average of 5.9 ± 4.1° difference in tibial rotation between their ACL deficient and contralateral knees. However, there was a -0.2 ± 6.1° difference in tibial rotation of the ACL reconstructed knee when compared to the contralateral uninjured knee. Regarding tibial translation, ACL deficient patients showed a difference of 0.75 ± 1.4mm of anterior tibial translation between injured and healthy knees. After ACL reconstruction, there was a 0.2 ± 1.1mm difference in coupled anterior tibial translation of the ACL reconstructed knee compared to the contralateral knee. No significant differences in contact area between the two time points could be discerned. The objective of our study was to assess the rotational laxity present in ACL reconstructed knees using a previously validated MRI-compatible rotational loading device. Our study demonstrated that ACL reconstruction can restore rotational laxity under load. This may speak to the benefit of an anteromedial drilling technique, which allows for a more horizontal and anatomically appropriate graft position.


Possible role of serotonin in Merkel-like basal cells of the taste buds of the frog, Rana nigromaculata.
Merkel-like basal cells in the taste buds of the frog were examined by fluorescence histochemistry, immunohistochemistry and electron microscopy. There were about 16-20 basal cells arranged in a radial fashion at the base of each taste bud. These cells were strongly immunopositive for serotonin antiserum. They were characterised by the presence of numerous dense-cored granules in the cytoplasm ranging from 80 to 120 nm in diameter, and of microvilli protruding from the cell surface. For 4 mo after sensory denervation by cutting the gustatory nerves, all cell types of the taste bud were well preserved and maintained their fine structure. Even at 4 mo after denervation, the basal cells exhibited a strong immunoreaction with serotonin antiserum. To investigate the function of serotonin in the basal cells in taste bud function, serotonin deficiency was induced by administration of p-chlorophenylalanine (PCPA), an inhibitor of tryptophan hydroxylase, and of p-chloroamphetamine (PCA), a depletor of serotonin. After administration of these agents to normal and denervated frogs for 2 wk, a marked decrease, or complete absence, of immunoreactivity for serotonin was observed in the basal cells. Ultrastructurally, degenerative changes were observed in both types of frog; numerous lysosome-like myelin bodies were found in all cell types of the taste buds. The number of dense-cored granules in the basal cells also was greatly decreased by treatment with these drugs. Serotonin in Merkel-like basal cells appears to have a trophic role in maintenance of the morphological integrity of frog taste bud cells.


Description of the effect of patient flow, junior doctor supervision and pandemic preparation on the ability of emergency physicians to provide direct patient care.
Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Factors Associated with Appropriate Gestational Weight Gain among Women with Obesity.
This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case-control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (<11 or >20 pounds) versus aGWG (11-20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. · Physician reinforcement of nutritional counseling by a dietitian is crucial for obese women.. · Physical inactivity and unemployment are associated with inappropriate gestational weight gain.. · Nutritional counseling is associated with appropriate gestational weight gain in women with BMI ≥40..


Blood pressure and blood viscosity are not correlated in normal healthy subjects.
The relationship between blood viscosity, hematocrit (Hct), and mean arterial blood pressure (MAP) was studied in a healthy population of 91 men and 66 women with an average age of 30.6 ± 8.0 years, from the city of Victoria de Durango (1800 m elevation). In women and men, Hct values were 42.4% ± 2.9% and 47.2% ± 2.3%, blood viscosities were 4.5 ± 0.7 and 6.1 ± 1.0 cP, and MAP was 83.0 ± 6.8 and 88.0 ± 6.1 mmHg, respectively. The correlation between blood viscosity and Hct was linear and positive (r(2) = 0.48) and identical to that of previous studies reported in the literature when men and women are taken as a single group. Separating the data by gender yielded positive, linear correlations (r(2) = 0.18 and 0.10, respectively) with identical slopes, however blood viscosity for men was 1.2 cP greater than in women (P = 0.02). MAP and blood viscosity (and Hct) were not statistically associated when men and women were analyzed separately and were weakly positively correlated (r(2) = 0.08, P < 0.02) when treated as a group. The present results suggest that studies that show a positive correlation between MAP and blood viscosity (and Hct) do not differentiate data according to gender, or involve populations that do not compensate for increased blood viscosity and potentially increased shear stress.


Intrapreoptic microinjection of TNF-alpha enhances non-REM sleep in rats.
Tumor necrosis factor-alpha (TNFalpha) is involved in sleep regulation. Peripheral or central administration of TNFalpha induces non-rapid eye movement sleep (NREMS) in many species. However, the brain site responsible for TNF-enhanced NREMS remains unclear. Thus, we tested the hypothesis that the preoptic area (POA) of the anterior hypothalamus, a crucial site for sleep regulation, is involved in TNF-induced sleep responses in rats. Unilateral microinjection of TNFalpha (2, 20 and 100 ng) or a TNF receptor fragment (TNFRF; 1.25, 5.0 and 12.5 microg) into the POA was performed at dark onset and light onset, respectively. The two higher doses of TNFalpha increased NREMS and brain temperature with little effect on REMS and EEG slow wave activity. These effects were lost after the heat-treatment of TNFalpha. The two higher doses of the TNFRF decreased NREMS without affecting the other parameters measured. Combined with previous results showing diurnal variations of TNFalpha in the hypothalamus, the present data suggest that POA TNFalpha is involved, in part, in the regulation of physiological sleep.


Comparative analysis of the characteristics of carbonaceous material obtained via single-staged steam pyrolysis of waste tires.
The two-stage technology of porous carbonaceous material obtained via pyrolysis in inert medium with subsequent activation by steam is well known. While steam could be a suitable substance for pyrolysis as well, single-staged technology for waste tire recycling is yet to be developed. A comparative analysis of the characteristics of the carbonaceous materials obtained by the single-staged steam pyrolysis of waste tires was carried out, which could provide a theoretical background for the development of such technology. The steam pyrolysis was performed in a tubular reactor in an overheated steam medium (500°C with 5 kg/h mass flow rate). The technical characteristics of the obtained samples were evaluated in the context of their potential for further application as absorbent and raw material for rubber production according to Chemical Abstracts Service No. 1333-86-4. The composition and physico-chemical properties of the obtained samples were studied using BET and thermogravimetric analysis, atomic emission, transmission and scanning electron microscopies, Raman, X-ray diffraction, and photoelectron spectroscopies. The results revealed that the structure and properties of all obtained carbonaceous material samples were similar. The samples consisted of amorphous carbon (with a disordered graphite lattice) and contained a significant amount of metal oxides. According to experimental data, zinc was present in the form of ZnO with a binding energy of 1022.4 eV, while sulfur was observed in the form of sulfide and oxysulfide with binding energies of 161.8 and 163.2 eV, respectively. According to electron microscopy, the morphology of samples was represented by a set of spherical agglomerates comprising nanosized particles. According to the BET analysis of the samples, the specific surface area varied in the range between 52.0 and 66.0 m2/g and the pore volume values were within a range of 0.53-0.87 cm3/g, while the average pore size varied from 412 to 527 Å.Implications: Our paper presents original research in the field of characterization of solid material obtained by single-staged steam gasification of waste tires, which were produced and exploited in conditions of Russia. Modern technology allows thermal utilization of waste tires by obtaining powders of carbonaceous material, which could be used as fuel, adsorbent, etc., but this process usually consists of two stages - pyrolysis in inert medium and activation in steam or carbon dioxide. One of the most promising directions of technological development is simplifying this process into single step, ensuring that the obtained material could be used as carbon black or adsorbent for gas steam cleansing. No data on suitability of carbonaceous material obtained by single-step steam pyrolysis of all-season waste tires to be adsorbent and/or carbon black is present in the literature. In order to evaluate the suitability of the obtained material to be adsorbent, the high specific surface area should be determined, while CAS technical standards specify many chemical and physical properties of industrial carbon black.The aim of the current article is to study the properties of carbonaceous material obtained during single-staged steam gasification of four different all-season tires (due to their widespread application worldwide) and evaluate its fitness as industrial-scale carbon black or adsorbent. The additional problem addressed was the evaluation of the variation in characteristics of carbonaceous material obtained due to different origins of tires. Experiments were conducted in a tubular lab reactor in order to simplify the experimental procedure while ensuring the applicability of the obtained results to practical conditions.The obtained results could be used for the development of the technology for closed-cycle tire processing (because black carbon is used for tire production) and adsorbent production. The characteristics of the materials obtained allow us to choose optimal parameters for such treatment and develop special policies and programs, which will integrate and regulate waste tire utilization via steam gasification.


Chronic sweet intake lowers pain thresholds without changing brain mu- or delta-opiate receptors.
Sprague-Dawley rats drank sweetened (3% dextrose + 0.144% saccharin, w/v) or unflavored water for 18 days and subsequent pain reactivity was assessed using a hot plate. Compared to the rats that consumed unflavored water, the rats that consumed sweet water responded more quickly on the hot plate indicating that their threshold for pain was lowered. Another group of rats given identical exposure to the fluids had their brains prepared for measuring opiate receptor binding using the delta-receptor ligand [3H]D-Ala-D-Leu-enkephalin ([3H]DADLE) and the mu-receptor selective ligand [3H]Tyr-D-Ala-Gly-MePhe-Gly-ol ([ 3H]DAGO). Binding of these opiates to mu- and delta-receptors in the cerebral cortex, striatum, hippocampus, hypothalamus, brain stem, and remaining brain regions was the same for the rats that drank sweet fluids and those that drank unflavored water. These findings suggest that drinking sweet fluids lowers pain thresholds but does not alter mu- and delta-receptors.


CRISPR and biochemical screens identify MAZ as a cofactor in CTCF-mediated insulation at Hox clusters.
CCCTC-binding factor (CTCF) is critical to three-dimensional genome organization. Upon differentiation, CTCF insulates active and repressed genes within Hox gene clusters. We conducted a genome-wide CRISPR knockout (KO) screen to identify genes required for CTCF-boundary activity at the HoxA cluster, complemented by biochemical approaches. Among the candidates, we identified Myc-associated zinc-finger protein (MAZ) as a cofactor in CTCF insulation. MAZ colocalizes with CTCF at chromatin borders and, similar to CTCF, interacts with the cohesin subunit RAD21. MAZ KO disrupts gene expression and local contacts within topologically associating domains. Similar to CTCF motif deletions, MAZ motif deletions lead to derepression of posterior Hox genes immediately after CTCF boundaries upon differentiation, giving rise to homeotic transformations in mouse. Thus, MAZ is a factor contributing to appropriate insulation, gene expression and genomic architecture during development.


[Efficacy of Acupuncture Combined with Fire Dragon Moxibustion for Patients with Cervical Spondylotic Radiculopathy of Kidney-Deficiency-Cold Type].
To compare the therapeutic effects of acupuncture combined with fire dragon moxibustion and simple acupuncture therapy in the treatment of patients with cervical spondylotic radiculopathy (CSR) of kidney-deficiency-cold type. Ninety kidney-deficiency-cold type CSR outpatients were randomly divided into control (acupuncture, n=40) and treatment (acupuncture +moxibustion, n=50) groups. Acupuncture stimulation was applied to Dazhui (GV 14), Ganshu (BL 18), Tianzhu (BL 10) and Houxi (SI 3), Jiaji (EX-B 2), Taixi (KI 3), Shenmai (BL 62), Zusanli (ST 36), Shenshu (BL 23), etc once daily, 5 times a week, and two weeks altogether, except the weekend. In addition, for patients of the treatment group, herbal medicinal powder separated-fire dargon moxibustion was applied to the patient's back from GV14 and Fengmen (BL 12) on the top to Zhibian (BL 54) area at the buttock, once every 3 days, 5 times altogether. The therapeutic effect was evaluated according to "CSR-20-points scale" including 3 aspects as neck-shoulder pain, upper-limb pain-numbness, finger numbness; working and daily life ability and physical conditions (Spurling tests, sensory, myodynamia and tendon reflex). ① After the treatment, CSR-20-points scores in both treatment and control groups were significantly increased in comparison with pre-treatment in each group (P<0.05), with the score being markedly higher in the treatment group than in the control group (P<0.05). ② Of the 40 and 50 cases in the control and the treatment group, 2 and 13 were cured, 14 and 24 experienced a remarkable improvement, 12 and 11 were effective, and 12 and 2 failed, with the total effective rates being 70.0%(28/40) and 96.0%(48/50), respectively. The therapeutic effect of the treatment group was notably better than that of the control group (P<0.05). Acupuncture combined with fire dragon moxibustion is superior to simple acupuncture therapy in improving clinical symptoms of patients with CSR of kidney-deficiency-cold type, being a recommendable scheme in clinical practice.


Surface functionalized hydrophobic porous particles toward water treatment application.
A microfluidic-based approach for the fabrication of organic contaminants absorbing core-shell particles is demonstrated. The hydrophobic porous core absorbs oil while the hydrophilic surface enables the particles to be well-dispersed in aqueous solutions. These particles can uptake oil from aqueous solution saturated with oil or via direct contact with oil blobs as depicted in the figure.


Investigation of effective factors on traumatic amputations due to road traffic accidents.
To determine factors associated with the locations, types and levels of traumatic limb amputations caused by road traffic accidents. The files sent by the courts to the expert committee chaired by the authors for the determination of applicants' disability rate over the 10-year period between 2011 and 2020 were examined retrospectively. Of the 27 cases with traumatic amputations caused by road traffic accidents, 63% of them were male and the mean age of the cases was 29.0 ± 20.0 years. The cases comprised 12 passengers, 10 pedestrians, and 5 drivers. Of all, 66.7% of the amputations were caused by automobile accidents, 59.3% of them were in lower limbs, 51.9% of them were on the right side, and most of them occurred below the elbow/knee levels. Amputations occurred more frequently in lower limbs that are contralateral to the side of the traffic flow, in drivers, and in front seat passengers. The findings in this preliminary study need to be confirmed in studies to be conducted in larger series. The findings of these studies will shed light on technological developments that can be used in the prevention of serious injuries that lead to post-accident traumatic amputations.


Simian Varicella Virus Is Present in Macrophages, Dendritic Cells, and T Cells in Lymph Nodes of Rhesus Macaques after Experimental Reactivation.
Like varicella-zoster virus (VZV), simian varicella virus (SVV) reactivates to produce zoster. In the present study, 5 rhesus macaques were inoculated intrabronchially with SVV, and 5 months later, 4 monkeys were immunosuppressed; 1 monkey was not immunosuppressed but was subjected to the stress of transportation. In 4 monkeys, a zoster rash developed 7 to 12 weeks after immunosuppression, and a rash also developed in the monkey that was not immunosuppressed. Analysis at 24 to 48 h after zoster revealed SVV antigen in the lung alveolar wall, in ganglionic neurons and nonneuronal cells, and in skin and in lymph nodes. In skin, SVV was found primarily in sweat glands. In lymph nodes, the SVV antigen colocalized mostly with macrophages, dendritic cells, and, to a lesser extent, T cells. The presence of SVV in lymph nodes, as verified by quantitative PCR detection of SVV DNA, might reflect the sequestration of virus by macrophages and dendritic cells in lymph nodes or the presentation of viral antigens to T cells to initiate an immune response against SVV, or both. VZV causes varicella (chickenpox), becomes latent in ganglia, and reactivates to produce zoster and multiple other serious neurological disorders. SVV in nonhuman primates has proved to be a useful model in which the pathogenesis of the virus parallels the pathogenesis of VZV in humans. Here, we show that SVV antigens are present in sweat glands in skin and in macrophages and dendritic cells in lymph nodes after SVV reactivation in monkeys, raising the possibility that macrophages and dendritic cells in lymph nodes serve as antigen-presenting cells to activate T cell responses against SVV after reactivation.


An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources.
To review the ability of an abbreviated, high-risk, screening, breast MRI protocol to detect cancer and save resources. High-risk screening breast MR images were reviewed, from both an abbreviated protocol and a full diagnostic protocol. Differences in cancer detection, scanner utilization, interpretation times, and need for additional imaging were recorded in an integrated data form, and reviewed and compared. A total of 568 MRI cases were reviewed, with the abbreviated and full protocols. No difference was found in the number of cancers detected. Scan times were decreased by 18.8 minutes per case, for a total of 10,678 minutes (178 hours). Interpretation time, on average, was 1.55 minutes for the abbreviated protocol, compared with 6.43 minutes for the full protocol. Review of the full protocol led to a significant change in the final BI-RADS® assessment in 12 of 568 (2.1%) cases. Abbreviated MRI is as effective as full-protocol MRI for demonstration of cancers in the high-risk screening setting, with only 12 (2.1 %) cases recommended for additional MRI evaluation. The efficiency and resource savings of an abbreviated protocol would be significant, and would allow for opportunities to provide MRI for additional patients, as well as improved radiologist time management and workflow, with the potential to add real-time MRI interpretation or double reading.


A Novel Thioredoxin-Like Protein of Babesia microti Involved in Parasite Pathogenicity.
Babesiosis poses a serious threat to immunocompromised individuals and the major etiological species of Babesia for human babesiosis is Babesia microti. Merozoites are a critical stage in the life cycle of Babesia microti. Several merozoite proteins have been demonstrated to play important roles in this process; however, most of the merozoite proteins of B. microti remain unknown. In the present study, we identified a novel merozoite protein of B. microti with similar structure to the thioredoxin (Trx)-like domain of the Trx family, which was named as B. microti Trx-like protein (BmTLP). Western blot assays demonstrated that this protein was expressed by B. microti during the erythrocytic infection process, and its expression peaked on day 7 post-infection in vivo. Immunofluorescence assay further showed that this protein is mainly expressed in B. microti merozoites. BmTLP hold both heparin- and erythrocyte-binding properties, which are critical functions of invasion-related proteins. Immunization with recombinant BmTLP imparted significant protection against B. microti infection in mice. Taken together, these results suggest that the novel merozoite protein, BmTLP, is an important pathogenic molecule of B. microti and may be a possible target for the design of babesiosis control strategy.