Shading and litter mediate the effects of soil fertility on the performance of an understorey herb.
Soil fertility and topographic microclimate are common determinants of plant species distributions. However, biotic conditions also vary along these abiotic gradients, and may mediate their effects on plants. In this study, we investigated whether soils and topographic microclimate acted directly on the performance of a focal understorey plant, or indirectly via changing biotic conditions. We examined direct and indirect relationships between abiotic variables (soil fertility and topographic microclimate) and biotic factors (overstorey and understorey cover, litter depth and mycorrhizal colonization) and the occurrence, density and flowering of a common understorey herb, Trientalis latifolia, in the Klamath-Siskiyou Mountains, Oregon, USA. We found that the positive effects of soil fertility on Trientalis occurrence were mediated by greater overstorey shading and deeper litter. However, we did not find any effects of topographic microclimate on Trientalis distribution that were mediated by the biotic variables we measured. The predictive success of Trientalis species distribution models with soils and topographic microclimate increased by 12 % with the addition of the biotic variables. Our results reinforce the idea that species distributions are the outcome of interrelated abiotic gradients and biotic interactions, and suggest that biotic conditions, such as overstorey density, should be included in species distribution models if data are available.


Water Relations and Photosynthesis of a Desert CAM Plant, Agave deserti.
The water relations and photosynthesis of Agave deserti Engelm., a plant exhibiting Crassulacean acid metabolism, were measured in the Colorado desert. Although no natural stomatal opening of A. deserti occurred in the summer of 1975, it could be induced by watering. The resistance for water vapor diffusion from a leaf (R(WV)) became less than 20 sec cm(-1) when the soil water potential at 10 cm became greater than -3 bars, as would occur after a 7-mm rainfall. As a consequence of its shallow root system (mean depth of 8 cm), A. deserti responded rapidly to the infrequent rains, and the succulent nature of its leaves allowed stomatal opening to continue for up to 8 days after the soil became drier than the plant. When the leaf temperature at night was increased from 5 to 20 C, R(WV) increased 5-fold, emphasizing the importance of cool nighttime temperatures for gas exchange by this plant. Although most CO(2) uptake occurred at night, a secondary light-dependent rise in CO(2) influx generally occurred after dawn. The transpiration ratio (mass of water transpired/mass of CO(2) fixed) had extremely low values of 18 for a winter day, and approximately 25 for an entire year.


Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review.
This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants. An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups. A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies. In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.


Surgical repair of large meningomyeloceles.
Successful repair of 8 large meningomyeloceles is reported. Because these defects varied in size, shape, and location, no single procedure applied to all. Advancement flaps and both vertical and horizontal bipedicle flaps were used successfully. The latissimus dorsi and gluteus maximus muscles have been used as paired flaps. All four muscles can be mobilized simultaneously. Muscle flaps are preferable to skin flaps when feasible. The sac remnant is also available to contribute to closure when all else fails. Embryology and pathological anatomy are reviewed.


Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians.
Type 2 Diabetes is a metabolic disorder characterized by hyperglycemia that causes numerous complications with significant long-term morbidity and mortality. The disorder is primarily due to insulin resistance particularly in liver, skeletal muscle, and adipose tissue. In this review, we detail the hormonal mechanisms leading to the development of diabetes and discuss whether intermittent fasting should be considered as an alternative, non-medicinal treatment option for patients with this disorder. We searched PubMed, Ovid MEDLINE, and Google Scholar databases for review articles, clinical trials, and case series related to type 2 diabetes, insulin resistance, and intermittent fasting. Articles were carefully reviewed and included based on relevance to our topic. We excluded abstracts and any non-English articles. The majority of the available research demonstrates that intermittent fasting is effective at reducing body weight, decreasing fasting glucose, decreasing fasting insulin, reducing insulin resistance, decreasing levels of leptin, and increasing levels of adiponectin. Some studies found that patients were able to reverse their need for insulin therapy during therapeutic intermittent fasting protocols with supervision by their physician. Current evidence suggests that intermittent fasting is an effective non-medicinal treatment option for type 2 diabetes. More research is needed to delineate the effects of intermittent fasting from weight loss. Physicians should consider educating themselves regarding the benefits of intermittent fasting. Diabetic patients should consult their physician prior to beginning an intermittent fasting regimen in order to allow for appropriate oversight and titration of the patients medication regimen during periods of fasting.


Identification of Candidate Biomarkers for Salt Sensitivity of Blood Pressure by Integrated Bioinformatics Analysis.
In the current study, we aimed to identify potential biomarkers for salt sensitivity of blood pressure (SSBP), which may provide a novel insight into the pathogenic mechanisms of salt-sensitive hypertension. Firstly, we conducted weighted gene coexpression network analysis (WGCNA) and selected a gene module and 60 hub genes significantly correlated to SSBP. Then, GO function and KEGG signaling pathway enrichment analysis and protein-protein interaction (PPI) network analysis were performed. Furthermore, we identified a five-gene signature with high connectivity degree in the PPI network and high AUC of ROC curves, which may have high diagnosis value for SSBP. Moreover, through combining two gene screening methods, we identified 23 differentially expressed circRNAs and selected the top 5% circRNAs (1 circRNA) with the highest connectivity degree in the coexpression network as hub circRNA highly associated with SSBP. Finally, we carried out RT-qPCR to validate the expression of five hub genes, and our results showed that the expression of HECTD1 (P = 0.017), SRSF5 (P = 0.003), SRSF1 (P = 0.006), HERC2 (P = 0.004), and TNPO1 (P = 0.002) was significantly upregulated in the renal tissue in salt-sensitive rats compared to salt-resistant rats, indicating that these five hub genes can serve as potential biomarkers for SSBP.


HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups.
To assess trends in HIV risk behaviors over a 3-year period in eight population groups in Bangkok, Thailand. Using a repeated cross-sectional survey design with a structured questionnaire, we collected five sets of self-reported sexual behavior data related to HIV risk from the following subject groups at the same sampling sites during 1993-1996: direct and indirect female sex workers, male attenders of sexually transmitted disease (STD) clinics, female attenders of antenatal care clinics, male and female vocational students, and male and female factory workers. Reported patronage of commercial sex by the three male groups declined by an overall average of 48% over the 3-year period. Other non-regular sexual partnerships declined among male STD clinic attenders and vocational students. Condom use during most recent sexual intercourse between sex workers and clients peaked at high levels (>90%) in the early data waves, while among indirect sex workers and their clients, consistent condom usage increased from 56% to 89%. Low condom use persisted among sex workers and their non-paying sex partners. Single women reported low levels of sexual activity and condom use with no signs of an increase. Similarly, married women from antenatal clinics reported low condom use with their husbands, with no change throughout the period of the study. HIV risk behavioral surveillance is a useful way of determining whether behavior change has occurred in specific population groups. The results here confirm and add to a growing set of evidence of risk behavior reduction in Thailand. The behavioral changes did not occur uniformly but varied depending on the sexual dyad and the population group under study. Behavioral surveillance should be promoted and its methodologies strengthened in attempts to understand the local dynamics of HIV epidemics.


From low hematocrit physiology to isovolemic hemodilution.
The aim of this study, starting from some concepts of physiology, was to deal with the ever growing question of intentional anemia. Physiology suitably expresses the linear relationship between hematocrit and blood fluidity, and at the same time explains how viscosity and aggregability are important co-factors in the circulation, in disease and in thromboembolic complications. The need to understand how a low hematocrit level, compared to the volemia, is a fundamental requirement in surgery, and even more so in surgery with a high risk of embolism, like orthopedic traumatology surgery. Normovolemic hemodilution was analyzed both for the risks it involves and for how much it sticks to the changes induced by a similar situation on the various organs and apparatus. The authors, based on their experience in the field of anesthesiology, propose an operating schedule to safely perform intentional normovolemic hemodilution, describing the preoperative, intraoperative and finally the postoperative period. In conclusion, the authors advocate a wider use of this technique, confirming its safety in relation to volemia.


Identifying KDIGO Trajectory Phenotypes Associated with Increased Inpatient Mortality.
Acute kidney injury (AKI) is a complex systemic syndrome associated with high morbidity and mortality and risk for the subsequent development of renal and non-renal complications. Nearly 50% of patients in the ICU experience AKI. AKI severity is a key metric for evaluating patients risk of hospital mortality. Current AKI stratification is based on absolute changes in Serum Creatinine (SCr) and the maximal increase relative to the patients baseline value. However, such measurement does not consider either the progression or duration of AKI, both of which are associated with adverse outcomes post-AKI. In this article, by leveraging a large volume of SCr temporal variabilities, we present a novel model called Trajectory of Acute Kidney Injury (TAKI) for the identification of AKI trajectory subtypes. Experimental results demonstrate that TAKI is better than the existing trajectory subtyping methods on both the inpatient mortality stratification and the post-7-day AKI progression estimation. With TAKI, it is found that the trend of KDIGO trajectory appears to be more highly associated with inpatient mortality rates than the maximum KDIGO score.


Creative limb-salvage surgical and endovascular revascularization strategies in treating critical limb ischemia.
Critical limb ischemia (CLI) is implicated in cases of between 220,000 to 240,000 amputations in the United States and Europe annually. Over the last five years, great technical strides have been made in both the surgical and nonsurgical endovascular treatments of CLI. This chapter analyzes and highlights those creative limb salvage strategies now used to treat CLI and save limbs.


[Chronic hemorrhagic pyothorax treated with preoperative internal thoracic and intercostal arterial embolization and perioperative non-invasive positive pressure ventilation].
We reported successful surgery for chronic hemorrhagic empyema with severe right heart insufficiency. The preoperative embolization of right internal thoracic artery and intercostals arteries was effective for the control of intraoperative bleeding. Non-invasive positive pressure ventilation (NIPPV) was useful for the perioperative respiratory management. A 62-year-old female with a history of right pneumonectomy and thoracoplasty for pulmonary tuberculosis was admitted because of dyspnea on effort on Dec 5th 2002. Her right heart insufficiency was worsened gradually. On May 20th 2003, we performed the transcatheter embolization of right internal thoracic and intercostals arteries for the control of intraoperative bleeding. The next day, the curettage and fenestration was performed for intraoperative cardiac dysfunction. The intraoperative bleeding was 1,596 ml and operative time was 2 hours 24 minutes. Due to CO2 narcosis, the ventilator under the intratracheal tube was needed for respiratory management in the postoperative course. The switching of the respiratory management with NIPPV from the intratracheal tube during 8 days, her respiratory and general conditions had been improved gradually. Because of methicillin-resistant Staphylococcus aureus (MRSA) infection of thoracic cavity, the radical thoracoplasty following the latissimus dorsi muscules flap and the omentopexy was performed. The operative course was uneventful and she needed overnight NIPPV without O2 inhalation and was discharged.


Law No. 92 creating a Fund for Childhood Development, 4 May 1988.
This law creates in Ecuador a Fund for Childhood Development designed to finance aid programs for children that expand the attention given to their needs and improve the quality of services. The fund is to be financed from a variety of sources including a tax on salaries, petroleum, and lotteries. The Fund is to be administered by the National Child and Family Institute.


Presence of Polypeptides of Cytoplasmic and Chloroplastic Origin in Isolated Photoactive Preparations of Photosystems I and II in Chlamydomonas reinhardi y-1.
Photoactive preparations were obtained by treatment of photosynthetic membranes with lipid micelles and deoxycholate.A photosystem I preparation can be extracted from the membranes by both lipid micelles and deoxycholate, whereas the photosystem II preparation remains in a particulate state.The photosystem II preparation exhibits electron transfer activity measured by photoreduction of 2,6-dichlorophenolindophenol with 1,5-diphenylcarbazide as an electron donor and has a ratio of chlorophyll a/b of 1.4. This preparation contains three major polypeptides of cytoplasmic origin and two of chloroplastic origin.The photosystem I preparation exhibits high rates of methylviologen photoreduction with ascorbate and 2,6-dichlorophenolindophenol as electron donors and does not contain chlorophyll b. This preparation contains two major polypeptides of chloroplastic origin and one of cytoplasmic origin. These results indicate that both cytoplasm and chloroplast contribute polypeptides for the formation of photosystems I and II in Chlamydomonas reinhardi.


Organochlorine pesticide exposure and thyroid function: a study in human subjects.
We examined the serum levels of thyroxine and thyroid stimulating hormone in 103 rural subjects with respect to blood levels of organochlorine pesticide and occupation. We found that 24.3% of study subjects had depleted thyroxine levels in association with significantly lower organochlorine pesticide residues in blood. Sex, nutritional status, thyromegaly, or handling of pesticides in the course of work were not found to be factors contributing to depleted thyroxine levels.


Vaccination with DNA encoding internal proteins of influenza virus does not require CD8(+) cytotoxic T lymphocytes: either CD4(+) or CD8(+) T cells can promote survival and recovery after challenge.
DNA vaccination offers the advantages of viral gene expression within host cells without the risks of infectious virus. Like viral vaccines, DNA vaccines encoding internal influenza virus proteins can induce immunity to conserved epitopes and so may defend the host against a broad range of viral variants. CD8(+) cytotoxic T lymphocytes (CTL) have been described as essential effectors in protection by influenza nucleoprotein (NP), although a lesser role of CD4(+) cells has been reported. We immunized mice with plasmids encoding influenza virus NP and matrix (M). NP + M DNA allowed B6 mice to survive otherwise lethal challenge infection, but did not protect B6-beta(2)m(-/-) mice defective in CD8(+) CTL. However, this does not prove CTL are required, because beta(2)m(-/-) mice have multiple immune abnormalities. We used acute T cell depletion in vivo to identify effectors critical for defense against challenge infection. Since lung lymphocytes are relevant to virus clearance, surface phenotypes and cytolytic activity of lung lymphocytes were analyzed in depleted animals, along with lethal challenge studies. Depletion of either CD4(+) or CD8(+) T cells in NP + M DNA-immunized BALB/c mice during the challenge period did not significantly decrease survival, while simultaneous depletion of CD4(+) and CD8(+) cells or depletion of all CD90(+) cells completely abrogated survival. We conclude that T cell immunity induced by NP + M DNA vaccination is responsible for immune defense, but CD8(+) T cells are not essential in the active response to this vaccination. Either CD4(+) or CD8(+) T cells can promote survival and recovery in the absence of the other subset.


Prospective renal allograft matching by pool primed lymphocyte typing. No correlation because of poor responses of prospective recipients.
In many transplantation systems, the strength of the allograft response correlates with the magnitude of the in vitro mixed lymphocyte culture (MLC) reaction. Because this reaction requires 5 days, it has not been applicable to the prospective matching of cadaver renal allograft donors to the best available potential recipient. The pool primed lymphocyte test (pPLT) is a modification of the standard MLC assay; it measures primed lymphocyte responses after 24 to 30 hr of culture and these results correlate with data obtained after 5 days in the MLC. In this report, we analyze pPLT data from 69 recipients of cadaver renal transplants. No correlation between pPLT response and graft survival was found. Multiple factors were identified that influenced the magnitude of the pPLT response for these patients. Many uremic patients were unable to give any pPLT response, and some cadaver spleen cells were nonstimulatory. Nevertheless, the strength of pPLT responses by control individuals who did respond showed a positive correlation with their MLC responses. Thus, we feel the concept of using pPLT for prospective matching is sound; however, a number of technical variables make it impractical at present for routine transplant matching.


Leclercia adecarboxylata as Emerging Pathogen in Human Infections: Clinical Features and Antimicrobial Susceptibility Testing.
(1) Background: Leclercia adecarboxylata (L. adecarboxylata) is a gram-negative bacillus of the Enterobacteriaceae family, which is uncommonly isolated from clinical specimens. L. adecarboxylata is considered as an aquatic opportunistic pathogen and most of the human infections are polymicrobial and usually occur in immunocompromised hosts. (2) Methods: In this retrospective study, we included all L. adecarboxylata strains since the introduction of MALDI-TOF MS in the Microbiology Department of Nord Franche-Comté Hospital, France (from 1 March 2015 to 31 July 2019). We studied demographic characteristics, comorbidities, characteristics of the current infection and outcome as well as antimicrobial susceptibility testing in all isolates. (3) Results: A total of 8 samples were identified (in 6 patients (4M/2F), with a recurrent L. adecarboxylata infection in 2 patients). The patients' mean age was 66.2 years (range: 19-84). All patients were considered as immunocompetent, except a peritoneal dialysis patient with kidney transplantation. An exposition to an aquatic environment was identified in one patient. The most prevalent clinical feature was catheter-associated male urinary tract infection (in 3 cases) followed by ventilator-associated pneumonia (in 2 cases). One of 6 patients presented L. adecarboxylata bacteremia. L. adecarboxylata was part of a polymicrobial infection in 4 patients. The isolates showed a high susceptibility to all tested antibiotics, except one strain, which was resistant to fosfomycin. All patients with L. adecarboxylata infection were treated with antibiotics with a favorable outcome. (4) Conclusion: This study confirms the pathogenicity of L. adecarboxylata, even in immunocompetent patients, with a high susceptibility to antibiotics.


Carbenoxolone Disodium Treatment for Canine Pituitary-Dependent Hyperadrenocorticism.
Pituitary-dependent hyperadrenocorticism (PDH) is mainly caused by pituitary corticotroph tumors in dogs. A characteristic feature of corticotroph tumors is their resistance to negative feedback by glucocorticoids. In some animal species, including dogs, the aberrant expression of 11β-hydroxysteroid dehydrogenase (11HSD), a cortisol metabolic enzyme, is observed in corticotroph tumors. We previously reported that carbenoxolone (CBX), an inhibitor of 11HSD, suppressed ACTH secretion from the pituitary gland, and decreased cortisol concentrations in healthy dogs. Therefore, the aim of this study was to investigate the therapeutic effects of CBX on dogs with PDH. Six dogs with PDH were treated with 60 to 80 mg/kg/day of CBX for 6 weeks, followed by trilostane, which is a commonly used agent for canine PDH. CBX treatment led to a gradual decrease in both basal and in corticotropic releasing hormone (CRH)-stimulated plasma ACTH concentrations and CRH-stimulated serum cortisol concentrations, without side effects. However, basal and stimulated ACTH and cortisol concentrations remained higher than those of healthy dogs, and clinical symptoms such as polydipsia and polyuria were not ameliorated. After a 2-week wash-out interval, trilostane was administered for 2 weeks. Although basal plasma ACTH concentrations were higher after trilostane treatment than CBX treatment, polydipsia and polyuria resolved in all six dogs. The reason for the lack of improvement in polydipsia and polyuria with CBX treatment is unclear. Other mechanisms, in addition to a partial decrease in ACTH secretion, are likely to be involved. In conclusion, this is the first study to report the in vivo effects of CBX in dogs with PDH. The findings suggest that CBX inhibits ACTH secretion from canine pituitary tumors, resulting in lower cortisol concentrations.


The value of endothelium dependent vasodilatation in diagnosing coronary artery disease and its comparison with the results of routine diagnostic tests.
To determine the predictive value of flow-mediated vasodilation (FMD) compared with angina pectoris, exercise electrocardiography, and myocardial perfusion imaging (MPI). This study was carried out in Shahid Madani Heart Center, Tabriz, Iran from April 2004 to September 2006. A total of 92 patients with chest pain syndrome were enrolled in this study. Using high resolution ultrasound system endothelial function was evaluated, and the result of the flow-mediated dilation (FMD%) was defined as the percent change in the internal diameter of the brachial artery during reactive hyperemia related to baseline. Coronary artery disease (CAD) was documented in 77 (83.7%) patients. The percentage of FMD was lower in patients with CAD compared with those +/- 4.61, p=0.001). In comparison with typical anginal chest pain (sensitivity 46.7%, specificity 80%), exercise stress test (sensitivity 75%, specificity 60%), and MPI (sensitivity 96.5, specificity 55.6%) the receiver operator characteristic curve showed the percentage FMD optimal cut-off value as </=7.41 with a sensitivity of 87.0%, specificity of 66.7%, negative predictive value of 93.0%, and positive predictive value of 50%. In patients with chest pain syndrome, the FMD is a sensitive indicator of CAD with moderate specificity that is unable to predict accurately the extent and severity of it.


National survey to estimate sodium and potassium intake and knowledge attitudes and behaviours towards salt consumption of adults in the Sultanate of Oman.
To estimate population sodium and potassium intakes and explore knowledge, attitudes and behaviour (KAB) towards the use of salt in adults in the Sultanate of Oman. National cross-sectional population-based survey. Proportional random samples, representative of Omani adults (18 years or older), were obtained from all governorates of the Sultanate of Oman. Five hundred and sixty-nine (193 men, 376 women; 18 years or older) were included in the analysis (response rate 57%). Mean age was 39.4 years (SD 13.1). Participants attended a screening including demographic, anthropometric and physical measurements. We assessed dietary sodium, potassium and creatinine by 24-hour urinary sodium (UNa), potassium (UK) and creatinine (UCr) excretions. We collected KAB by a questionnaire on an electronic tablet. Mean UNa was 144.3 (78.8) mmol/day, equivalent to 9.0 g of salt/day and potassium excretion 52.6 (32.6) mmol/day, equivalent to 2.36 g/day, after adjusting for non-urinary losses. Men ate significantly more sodium and potassium than women. Only 22% of the sample had a salt intake below the WHO recommended target of 5 g/day and less than 10% met WHO targets for potassium excretion (>90 mmol/day). While 89.1% of those interviewed knew that consuming too much salt could cause serious health problems and only 6.9% felt they were using too much added salt, one in two participants used always or often salt, salty seasonings or salty sauces in cooking or when preparing food at home. In the Sultanate of Oman, salt consumption is higher and potassium consumption lower than recommended by WHO, both in men and in women. The present data provide, for the first time, evidence to support a national programme of population salt reduction to prevent the increasing burden of cardiovascular disease in the area.


Identification and characterization of Nornicotine degrading strain Arthrobacter sp. NOR5.
Nornicotine, the primary nicotine metabolite that is formed through demethylation of nicotine in the genus Nicotiana tabacum L. Nornicotine is not only a precursor of tobacco-specific nitrosamine N-nitrosonornicotine but also have detrimental effects to human health. Till now, information on the biotransformation of nornicotine is limited. Herein, we identified and characterized a bacterium Arthrobacter sp. strain NOR5, utilized nornicotine as the sole of carbon and energy source, and degraded 500 mg/L nornicotine completely within 60 h under the optimum conditions of pH 7.0 and 30 °C. In this study, we not only identified previously reported intermediate metabolites such as 6-OH-nornicotine, 6-OH-mysomine, 6-OH-pseudooxy-nornicotine (6HPONor) but also identified a new intermediate metabolite 2,6-di-OH-pseudooxy-nornicotine (2,6DHPONor) by UV spectroscopy and liquid chromatography coupled with time of flight mass spectrometry. About half of 6HPONor could be transformed into 2,6DHPONor that was identified as a novel catabolic intermediate of nornicotine. By the addition of an electron acceptor 2,6-dichlorophenolindophenol (DCIP), the cell-free extract exhibited inducible 6HPONor dehydrogenase activity at 179 ± 60 mU/mg that could convert 6HPONor to 2,6DHPONor. Our study demonstrated that Arthrobacter sp. strain NOR5 has a high potential to degrade the nornicotine completely.


Food Insecurity among Low-Income Food Handlers: A Nationwide Study in Brazilian Community Restaurants.
This study aims to evaluate food insecurity (FI) among Brazilian Community restaurant food handlers and its associated factors. This cross-sectional study was performed with a representative sample of 471 food handlers working in community restaurants (CR) from all Brazilian regions. Participants are mostly female (62.2%), ≤40 years old (67.7%), with a partner (52.0%), and with up to eight years of education (54.1%). Predictors of participants' socioeconomic status and CR geographic location are associated with the household food insecurity categories (p < 0.05). The predictors of socioeconomic conditions are associated with mild and moderate/severe FI category. Workers with less education are twice as likely to belong to the category with the highest FI severity. Lower per capita household income increased the chances of belonging to the mild insecurity category by 86%. It more than doubled the chance to be in the category of moderate/severe insecurity. Predictors of health status, lifestyle, and work are not associated with any multinomial outcome categories. However, working in the South, Southeast, or Midwest regions of Brazilian decreased the chances of belonging to one of the FI categories, with significance only for the mild category. Variables that show an association for this population are per capita household income for the different levels of FI and the CR region for mild FI. A high prevalence of FI in this population points to the need for more studies with low-income workers to prevent FI and its health consequences.


Laquinimod in the treatment of relapsing remitting multiple sclerosis.
Laquinimod is a new once-daily oral administrable agent, which is under investigation in a phase 3 clinical trial for relapsing remitting multiple sclerosis (RRMS) and in a phase 2 clinical trial for primary progressive MS (PPMS). The pharmacokinetic, pharmacodynamic and the safety profiles of laquinimod are covered in this review. In preclinical studies, the ability to prevent both experimental autoimmune encephalomyelitis and experimental autoimmune neuritis has been demonstrated. Reduced cell infiltration, demyelination, axonal damage and a shift of T-helper cell responses have been shown. Accordingly, in human studies, a decrease of pro-inflammatory and an increase of anti-inflammatory cytokines have been measured and a significant reduction of disease progression and a decrease in brain volume loss has been demonstrated. During all clinical studies a favorable safety profile was observed for 0.6mg laquinimod. New information about cardiovascular events is prompting the discontinuation of higher dosing regimens in both ongoing trials. Laquinimod is a first in class oral agent with high potential to reduce disease progression in RRMS and PPMS. Owing to its favorable safety profile, a combination with 0.6mg laquinimod and other disease modifying therapies could be an option in future MS therapy.


Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction?
Single institution, retrospective cohort study of 49 consecutive patients with Lenke I adolescent idiopathic scoliosis, all operated by a single surgeon using identical surgical technique and type of instrumentation. To evaluate the early coronal and sagittal correction of main thoracic adolescent idiopathic scoliosis using all-pedicle screw instrumentation and to determine whether implant density influences correction. There is an increasing trend in the use of pedicle screws in scoliosis correction surgery, particularly in using segmental all-pedicle screw constructs. No previous studies have investigated whether higher pedicle screw implant density improves correction of scoliosis in vivo. Forty-nine consecutive patients with Lenke I main thoracic adolescent idiopathic scoliosis underwent single stage posterior correction and instrumented spinal fusion with pedicle screw fixation between 2006 and 2008. Pre- and postoperative radiographs were analyzed. Mean patient age at the time of operation was 14.4 years (range: 11-19.7 years). The preoperative main thoracic curve of 60.0 degrees +/- 13.4 degrees was corrected to 17.4 degrees +/- 6.9 degrees (69.9% correction) on the postoperative radiographs. The preoperative thoracic kyphosis of 20.0 degrees +/- 10.2 degrees decreased to 11.6 degrees +/- 4.9 degrees after surgery. There was a significant correlation between decrease in sagittal kyphosis and magnitude of coronal Cobb angle correction (P = 0.002). There was no correlation between implant density and magnitude of coronal or sagittal curve correction, with and without curve flexibility taken into consideration. Pedicle screw constructs provided excellent coronal correction of thoracic idiopathic scoliosis, however, this was at the expense of sagittal contour. Bilateral segmental pedicle screw fixation did not improve curve correction compared with unilateral or alternate segmental fixation.


Depression in the elderly. Characteristics and clinical management.
Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.


Alteration in keratinocyte ganglioside content in basal cell carcinomas.
We examined the ganglioside content of normal human keratinocytes and basal cell carcinomas (BCC). The total ganglioside content of the epidermis was 0.098 +/- 0.01 microgram lipid-bound sialic acid/mg dry weight. GM3 was the predominant ganglioside of epidermis. GM2 and GD3 were also found in significant amounts. Polysialylated gangliosides were identified in only small amounts. In contrast to all other body locations, breast epidermis showed large amounts of GM1. The total ganglioside content of nodular and sclerosing facial BCC was approximately 3.5 times that of normal facial epidermis. This marked elevation of total ganglioside was not affected by dermal ganglioside contamination, because the total ganglioside content of the dermis was similar to that of the epidermis. The relative percentage of GM2 was significantly decreased, whereas the relative percentage of GM3 was slightly decreased in BCC. 9-O-acetyl-GD3 was present in the BCC, but not in normal epidermis or dermis. 9-O-acetyl-GD3 may be a surface marker for BCC. Furthermore, the alterations in amount and composition of individual gangliosides on neoplastic membranes may lead to novel therapeutic interventions.


Toward accurate attenuation correction in SPECT without transmission measurements.
The current trend in attenuation correction for single photon emission computed tomography (SPECT) is to measure and reconstruct the attenuation coefficient map using a transmission scan, performed either sequentially or simultaneously with the emission scan. This approach requires dedicated hardware and increases the cost (and in some cases the scanning time) required to produce a clinical SPECT image. Furthermore, if short focal-length fan-beam collimators are used for transmission imaging, the projection data may be truncated, leading to errors in the attenuation coefficient map. Our goal is to obtain information about the attenuation distribution from only the measured emission data by exploiting the fact that only certain attenuation distributions are consistent with a given emission dataset. Ultimately this consistency information will either be used directly to compensate for attenuation or combined with the incomplete information from fan-beam transmission measurements to produce a more accurate attenuation coefficient map. In this manuscript the consistency conditions (which relate the measured SPECT data to the sinogram of the attenuation distribution) are used to find the uniform elliptical attenuation object which is most consistent with the measured emission data. This object is then used for attenuation correction during the reconstruction of the emission data. The method is tested using both simulated and experimentally acquired data from uniformly and nonuniformly attenuating objects. The results show that, for uniform elliptical attenuators, the consistency conditions of the SPECT data can be used to produce an accurate estimate of the attenuation map without performing any transmission measurements. The results also show that, in certain circumstances, the consistency conditions can prove useful for attenuation compensation with nonuniform attenuators.


Allele and genotype frequencies of CYP3A4, CYP2C19, and CYP2D6 in Han, Uighur, Hui, and Mongolian Chinese populations.
This study was carried out to estimate the allele and genotype frequencies of common variants in the CYP3A4, CYP2C19, and CYP2D6 in the Han, Uighur, Hui, and Mongolian Chinese populations and compare genetic polymorphisms difference between the Han and minority Chinese ethnicities. We evaluated 672 unrelated, healthy Chinese volunteers (Han: 136; Uighur: 214; Hui: 164; Mongolian: 158). Genomic DNA was extracted from peripheral leukocytes and genotyped for CYP3A4*18, CYP2C19*2, *3, and CYP2D6*10 by polymerase chain reaction-restriction fragment length polymorphism analysis. The allele frequencies of CYP3A4*18 in the Han, Uighur, Hui, and Mongolian Chinese population were 18.4%, 14.0%, 19.2%, and 20.3%, respectively; the allele frequencies of CYP2C19*2 were 38.6%, 32.5%, 49.4%, and 41.5%, respectively; the allele frequencies of CYP2C19*3 were 5.2%, 2.1%, 5.2%, and 4.4%, respectively; and the allele frequencies of CYP2D6*10 were 57.4%, 22.4%, 39.7%, and 46.5%, respectively. The results showed that there was no significant ethnic difference in the distribution of CYP3A4*18 and CYP2C19*3 genotypes in the Han, Uighur, Hui, and Mongolian Chinese populations. For CYP2C19*2, the Han were not significantly different from the Uighur, Hui, or Mongolian; however, the Uighur were significantly lower than the Hui and the Mongolian, and the Mongolian were significantly lower than the Hui. For CYP2D6*10, the Mongolian were not significantly different from the Han and the Hui. However, the Uighur were significantly lower than the other three. Our findings confirm the existence of interethnic differences in the CYP2C9, CYP2C19, and CYP2D6 alleles and genotype frequencies in the Han, Uighur, Hui, and Mongolian Chinese populations.


Rehabilitation of visual processing deficits following brain injury.
Visual processing deficits are a common sequelae in individuals who have sustained a brain injury, Visual processing includes the acquisition of visual information and the appropriate use and manipulation of that information based upon task or environmental demands, Following brain injury, visual processing deficits can manifest in various ways, and will likely interfere with the patient's progress and rehabilitation outcome, This article describes the importance of understanding and accurately identifying visual processing deficits and implementing specific rehabilitation strategies to maximize functional independence.


The nature of the use and users of the Midwest Regional Medical Library.
Using a 10 percent random sample of all requests submitted to the Midwest Regional Medical Library during 1968-1969, this study has revealed that physicians constitute the user group making the most requests, that physicians request periodical materials most, that 86.6 percent of materials requested were for periodicals, and that over one-third of materials requested was more than ten years old. It was found that 66.3 percent of requests were filled, that "Pathology, Diseases, and Treatment" was the subject category with the highest percentage of requests, and that this category and Materia Medica were the subjects accounting for over 50 percent of the requests from all users. The subject categories most frequently requested by physicians were found to be the same (Pathology, Diseases, and Treatment and Materia Medica) as for educators and researchers. The most requests from students were in the Materia Medica and "other" subject categories. These findings are significant for drawing up acquisition policy for both the John Crerar Library, which supplies the physical facilities for the MRML, and the borrowing library which submits the requests for users.


Introducing INSPIRE: an implementation research collaboration between the Department of Foreign Affairs, Trade and Development Canada and the World Health Organization.
The government of Canada, through the Department of Foreign Affairs, Trade and Development (DFATD) has supported global efforts to reduce the impact of the HIV pandemic. In 2012, WHO and DFATD launched an implementation research initiative to increase access to interventions that were known to be effective in the prevention of mother-to-child transmission of HIV and to learn how these could be successfully integrated with other essential services for mothers and children. In addition to facilitating the implementation research projects, DFATD and WHO promoted four approaches: (1) Country-specific implementation research prioritization exercises, (2) Ministry of Health involvement, (3) Country-led, innovative, high-quality research, and (4) Leveraging regional networks and learning opportunities. While no single aspect of INSPIRE is unique, the process endeavors to promote and support high-quality, rigorous, locally-led implementation research that will have a substantial impact on the health and survival of HIV-infected women and their children.


Medical aspects of pregnancy.
Women's health physicians should play a key role in preconception counseling and management of medical problems during pregnancy. Precautions recommended to reduce the risk of exposure to potential teratogens, medications, and medical interventions are discussed. The U.S. Food and Drug Administration categorization of medications given during pregnancy is reviewed, and medications commonly used in pregnancy are listed. The basics of preconception counseling and routine prenatal care are reviewed, and guidelines for optimum preconception control of common medical conditions are summarized. Serious medical problems in pregnancy include hypertension, diabetes mellitus, thromboembolic disorders, asthma, thyroid disease, seizure disorder, infections, systemic lupus erythematosus, hematologic disorders, cardiac disease, and gastrointestinal disorders. Therefore, both physician and patient need to emphasize a preventive medicine approach to ensure the best outcome for both mother and child.


Selective IgA deficiency in Japanese blood donors: frequency and statistical analysis.
The incidence of selective IgA deficiency (SIgAD) was determined in a healthy adult population of 222,597 Japanese volunteer blood donors. Of the blood donors screened, only 0.007% (1:14,840) were found to be IgA-deficient (less than 10 mg/dl) by means of the double diffusion method, while 0.005% (1:18,500) were less than 5 mg/dl, and 0.003% (1:31,800) were less than 1 mg/dl by means of the single radial immunodiffusion method. Statistical analysis of the results clearly showed that the incidence of SIgAD in Japanese blood donors is very much lower than that in blood donors of European ancestry. The Japanese population may occupy a unique position in the ethnical peculiarities. Anti-IgA antibodies were found in 3 (25.0%) of 12 IgA-deficient blood donors whose IgA levels were less than 5 mg/dl, a prevalence rate comparable to that in donors of European ancestry. Although it is difficult to develop a suitable file of IgA-deficient donors in Japan, the establishment of a Rare Donor Registry System on IgA deficiency is a matter of urgency.


Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa.
Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector "active patients" (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70-2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81-4.04] and 1.51 [95% CI, 1.18-1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96-2.86); population attributable fraction 8.5% (95% CI, 6.1-11.1). While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.


A risk assessment model to evaluate the role of fecal contamination in recreational water on the incidence of cryptosporidiosis at the community level in Ontario.
A quantitative microbial risk assessment model was developed to simulate the role of recreational water contact in the transmission of cryptosporidiosis in a model Ontario community. Stochastic simulations were based on plausible modes of contamination of a pool (literature derived), river (site-specific), and recreational lakes (literature derived). The highest estimated risks of infection were derived from the (highly contaminated) recreational lake scenario, considered the upper end for risk of infection for both children (10 infections per 1,000 swims [5 per thousand: two infections per 1,000 swims; 95 per thousand: three infections per 100 swims]) and adults (four infections per 1,000 swims [5 per thousand: four infections per 1,000 swims; 95 per thousand: one infection per 100 swims]). Simulating the likely Cryptosporidium oocyst concentration in a lane pool that a child would be exposed to following a diarrheal fecal release event resulted in the third highest mean risk of infection (four infections per 10,000 swims [5 per thousand: three infections per 100,000; 95 per thousand: 10 infections per 10,000 swims]). The findings from this study illustrate the need for systematic and standardized research to quantify Cryptosporidium oocyst levels in Canadian public pools and recreational beaches. There is also a need to capture the swimming practices of the Canadian public, including most common forms and frequency measures. The study findings suggest that swimming in natural swim environments and in pools following a recent fecal contamination event pose significant public health risks. When considering these risks relative to other modes of cryptosporidiosis transmission, they are significant.


Comparative Gene Expression Analysis of Two Mouse Models of Autism: Transcriptome Profiling of the BTBR and En2 (-/-) Hippocampus.
Autism spectrum disorders (ASD) are characterized by a high degree of genetic heterogeneity. Genomic studies identified common pathological processes underlying the heterogeneous clinical manifestations of ASD, and transcriptome analyses revealed that gene networks involved in synapse development, neuronal activity, and immune function are deregulated in ASD. Mouse models provide unique tools to investigate the neurobiological basis of ASD; however, a comprehensive approach to identify transcriptional abnormalities in different ASD models has never been performed. Here we used two well-recognized ASD mouse models, BTBR T(+) Itpr3 (tf) /J (BTBR) and Engrailed-2 knockout (En2 (-/-)), to identify conserved ASD-related molecular signatures. En2 (-/-) mice bear a mutation within the EN2 transcription factor homeobox, while BTBR is an inbred strain with unknown genetic defects. Hippocampal RNA samples from BTBR, En2 (-/-) and respective control (C57Bl/6J and En2 (+/+)) adult mice were assessed for differential gene expression using microarrays. A total of 153 genes were similarly deregulated in the BTBR and En2 (-/-) hippocampus. Mouse phenotype and gene ontology enrichment analyses were performed on BTBR and En2 (-/-) hippocampal differentially expressed genes (DEGs). Pathways represented in both BTBR and En2 (-/-) hippocampal DEGs included abnormal behavioral response and chemokine/MAP kinase signaling. Genes involved in abnormal function of the immune system and abnormal synaptic transmission/seizures were significantly represented among BTBR and En2 (-/-) DEGs, respectively. Interestingly, both BTBR and En2 (-/-) hippocampal DEGs showed a significant enrichment of ASD and schizophrenia (SCZ)-associated genes. Specific gene sets were enriched in the two models: microglial genes were significantly enriched among BTBR DEGs, whereas GABAergic/glutamatergic postsynaptic genes, FMRP-interacting genes and epilepsy-related genes were significantly enriched among En2 (-/-) DEGs. Weighted correlation network analysis (WGCNA) performed on BTBR and En2 (-/-) hippocampal transcriptomes together identified six modules significantly enriched in ASD-related genes. Each of these modules showed a specific enrichment profile in neuronal and glial genes, as well as in genes associated to ASD comorbidities such as epilepsy and SCZ. Our data reveal significant transcriptional similarities and differences between the BTBR and En2 (-/-) hippocampus, indicating that transcriptome analysis of ASD mouse models may contribute to identify novel molecular targets for pharmacological studies.


A modified simulated annealing algorithm for parameter determination for a hybrid virtual model.
In this work we present an algorithm based on the simulated annealing (SA) method for electron beam spectrum reconstruction from central axis PDD data. We use a simulated beam in order to assess the accuracy of the method, and compare it with others usually employed. We found that our modified SA algorithm produced excellent reconstructed PDDs and beam profiles and improved reconstructed spectra. We also tested our method for the simultaneous determination of an electron energy spectrum and the position of a trimmer from central axis PDD data, and found this to be sufficient for the determination of the physical parameters of this hybrid model.


Laser flash photolysis studies of the kinetics of reduction of ferredoxins and ferredoxin-NADP+ reductases from Anabaena PCC 7119 and spinach: electrostatic effects on intracomplex electron transfer.
The influence of electrostatic forces on the formation of, and electron transfer within, transient complexes between redox proteins was examined by comparing ionic strength effects on the kinetics of the electron transfer reaction between reduced ferredoxins (Fd) and oxidized ferredoxin-NADP+ reductases (FNR) from Anabaena and from spinach, using laser flash photolysis techniques. With the Anabaena proteins, direct reduction by laser-generated flavin semiquinone of the FNR component was inhibited by complex formation at low ionic strength, whereas Fd reduction was not. The opposite results were obtained with the spinach system. These observations clearly indicate structural differences between the cyanobacterial and higher plant complexes. For the complex formed by the Anabaena proteins, the results indicate that electrostatic forces are not a major contributor to complex stability. However, the rate constant for intracomplex electron transfer had a biphasic dependence on ionic strength, suggesting that structural rearrangements within the transient complex facilitate electron transfer. In contrast to the Anabaena complex, electrostatic forces are important for the stabilization of the spinach Fd:FNR complex, and changes in ionic strength had little effect on the limiting rate constant for intracomplex electron transfer. This suggests that in this case the geometry of the initial collisional complex is optimal for reaction. These results provide a clear illustration of the differing roles that electrostatic interactions may play in controlling electron transfer between two redox proteins.


Vascular pericytes not only regulate growth, but also preserve prostacyclin-producing ability and protect against lipid peroxide-induced injury of co-cultured endothelial cells.
Interactions between vascular pericytes and endothelial cells were studied. Bovine retinal pericytes were found not only to inhibit growth of co-cultured human umbilical endothelial cells, but also to cause significant stimulation of prostacyclin production in the endothelial cells, both of which were achieved by close apposition of the two cell types. Substitution of a fibroblast feeder layer for the pericytes gave no change. Moreover, pericytes could confer protection against lipid peroxide-induced injury of endothelial cells, as determined by the release of [3H]-2-deoxy-D-glucose from radiolabeled endothelial cells. These results indicate that pericytes provide instructive signals to adjacent endothelial cells, helping to maintain microvascular homeostasis.


[Inhibitory Effect of Decitabine on Proliferation of MDS-L Cells and Its Mechanism].
To investigate the inhibitory effect of decitabine (DAC) in various dosages on the proliferention of MDS-RAEB cell line MDS-L and its mechanism. LC-MS/MS method was used to test the blood DAC concentration of 2 groups of MDS patients being treated with DAC 20 and 15 mg/m2×5 d. In according to the various blood DAC concentration levels, the MDS-L cells were treated with different DAC dosages for 24, 48, 72 and 96 h, respectively. The CCK-8 method was applied to determine the cell proliferation, the flow cytometry was used to analyze the cell cycle and cell apoptosis changes, the P15INK4B DNA methylation status was measured by methylation specific PCR using EZ DNA Methylation-Gold Kit. The blood DAC concentration of MDS patients treated with DAC 20 mg/m2×5 d was 174.08±80.15(84.7-311) ng/ml, which was significantly higher than 89.87±32.94(43.2-165)ng/ml for the group treated with 15 mg/m2×5 d (P=0.014). DAC could notably inhibit the proliferation of MDS-L cells, and the effect was in dose- and- time-dependent manner(r=0.786). However, when DAC concentration was ≥0.1 µg/ml, the proliferation inhibition rates were not significantly different between various dosages. After DAC treatment, MDS-L cells in G1 phase increased notably, while cells in S phase decreased significantly. Also, the P15INK4B DNA methylation status of MDS-L cells decreased after being treated with DAC for 96 h, but the difference was not significant between various dosages. DAC can significantly suppress MDS-L cell proliferation, block MDS-L cells in G1 phase and induce the apoptosis at low concentration (0.1-0.2 µg/ml).


Folding studies of pH-dependent collagen peptides.
Synthetic collagen model peptides containing carboxylate-modified hydroxyproline residues (P(E)) have been shown to form a collagen triple helix at low pH (1). Based on the fact that P(E)-containing peptides unfold on demand by altering the pH, we investigated the folding kinetics of a series of these collagen-based peptides. Refolding data indicated that the introduction of P(E) residues within a peptide affects the stability and refolding of the collagen peptides through electrostatic interactions and steric hindrance. Moreover, the specific placement of the P(E) residues within the collagen peptides allowed for selective testing for possible nucleation sites at the termini or the center of the peptides. Specifically, the data demonstrated that collagen peptides may nucleate from either terminally or internally located repeating sequences of Pro-Hyp-Gly. These studies indicate that the P(E) residue may play a useful role as a tool for studying the folding mechanism of synthetic collagen peptides.


Intimal staining for visibility enhancement during microanastomoses.
Absolute perfection in microvascular surgery continues to be thwarted by technical inadequacies in construction of the microanastomosis. Occasionally this is a consequence of limited visualization or misidentification of the intima proper predisposing to thrombosis. At least in rats, we have demonstrated that intimal staining with clinically inert vital dyes has enhanced gross appreciation of the exact intimal location. This maneuver has simplified suture placement without evidence of any associated increased risk of anastomotic failure.


Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer.
To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.


Regulation of corticotropin-releasing hormone receptor type 1alpha signaling: structural determinants for G protein-coupled receptor kinase-mediated phosphorylation and agonist-mediated desensitization.
Attenuation of CRH receptor type 1 (CRH-R1) signaling activity might involve desensitization and uncoupling of CRH-R1 from intracellular effectors. We investigated the desensitization of native CRH-R in human myometrial cells from pregnant women and recombinant CRH-R1alpha stably overexpressed in human embryonic kidney (HEK) 293 cells. In both cell types, CRH-R1-mediated adenylyl cyclase activation was susceptible to homologous desensitization induced by pretreatment with high concentrations of CRH. Time course studies showed half-maximal desensitization occurring after approximately 40 min of pretreatment and full recovery of CRH-R1alpha functional response within 2 h of removal of CRH pretreatment. In HEK 293 cells, desensitization of CRH-R1alpha was associated with receptor phosphorylation and subsequent endocytosis. To analyze the mechanism leading to CRH-R1alpha desensitization, we overexpressed a truncated beta-arrestin (319-418) and performed coimmunoprecipitation and G protein-coupled receptor kinase (GRK) translocation studies. We found that GRK3 and GRK6 are the main isoforms that interact with CRH-R1alpha, and that recruitment of GRK3 requires Gbetagamma-subunits as well as beta-arrestin. Site-directed mutagenesis of Ser and Thr residues in the CRH-R1alpha C terminus, identified Thr399 as important for GRK-induced receptor phosphorylation and desensitization.We conclude that homologous desensitization of CRH-R1alpha involves the coordinated action of multiple GRK isoforms, Gbeta gamma dimers and beta-arrestin. Based on our identification of key amino acid(s) for GRK-dependent phosphorylation, we demonstrate the importance of the CRH-R1alpha carboxyl tail for regulation of receptor activity.


Deletions in the tRNA(Lys) primer-binding site of human immunodeficiency virus type 1 identify essential regions for reverse transcription.
The initiation of human immunodeficiency virus type 1 (HIV-1) reverse transcription occurs by the extension of a tRNA primer bound near the 5' end of the genomic RNA at a position termed the primer-binding site (PBS). The PBS is an 18-nucleotide region of the HIV-1 genome complementary to cellular tRNA(Lys). To further investigate the sequence requirements for the PBS in reverse transcription, deletions in the PBS were created and subcloned into a plasmid containing the infectious HIV-1 proviral genome. The mutations deleted the entire PBS (delta PBS) or the first 9 (delta 1-9), the second 9 (delta 10-18), or 12 (delta 7-18) nucleotides of the PBS. An additional mutation in the PBS was created in which the second nine nucleotides were deleted and nine additional nucleotides were substituted [Lys(1-9)]. The transfection of plasmids containing the wild-type or mutant proviral genomes into tissue culture cells resulted in expression of the HIV-1 gag and env gene products, as determined by immunoprecipitation using sera from AIDS patients. HIV-1 virus was released from the transfected cells, as determined by analysis of the supernatants for reverse transcriptase activity. The infectivity of the viruses derived from the transfection was examined by coculture experiments with SupT1 cells, which support high-level replication of HIV-1. The transfection of plasmids containing HIV-1 proviral genomes with the delta PBS and PBS (delta 1-9) mutations did not produce infectious virus. In contrast, the HIV-1 proviral genomes with the delta 10-18, delta 7-18, and Lys(1-9) mutations in the PBS produced infectious virus upon transfection, although the kinetics of appearance was significantly delayed for the mutant viruses compared with the wild type. To further explore the nature of this defect, the PBS region from integrated proviral genomes was amplified by polymerase chain reaction and individual DNA products were subcloned into M13mp19, followed by a sequence analysis of the PBS region from individual M13 phage clones. In each of the PBS regions examined, the 18-nucleotide PBS complementary to tRNA(Lys) was present. However, nucleotide deletions and insertions were found 3' to the PBS from the samples derived from the transfection of plasmids containing mutant proviral genomes. Upon reinfection, the revertant viruses maintained the deletions 3' to the PBS and had kinetics of replication similar to that of the wild-type virus.(ABSTRACT TRUNCATED AT 400 WORDS)


Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness.
Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.


A novel insight into Gene Ontology semantic similarity.
Existing methods for computing the semantic similarity between Gene Ontology (GO) terms are often based on external datasets and, therefore are not intrinsic to GO. Furthermore, they not only fail to handle identical annotations but also show a strong bias toward well-annotated proteins when being used for measuring similarity of proteins. Inspired by the concept of cellular differentiation and dedifferentiation in developmental biology, we propose a shortest semantic differentiation distance (SSDD) based on the concept of semantic totipotency to measure the semantic similarity of GO terms and further compare the functional similarity of proteins. Using human ratings and a benchmark dataset, SSDD was found to improve upon existing methods for computing the semantic similarity of GO terms. An in-depth analysis shows that SSDD is able to distinguish identical annotations and does not depend on annotation richness, thus producing more unbiased and reliable results. Online services can be accessed at the Gene Functional Similarity Analysis Tools website (GFSAT: http://nclab.hit.edu.cn/GFSAT).


A combination of two novel VARS2 variants causes a mitochondrial disorder associated with failure to thrive and pulmonary hypertension.
The VARS2 gene encodes a mitochondrial valyl-transfer RNA synthetase which is used in mitochondrial translation. To date, several patients with VARS2 pathogenic variants have been described in the literature. These patients have features of lactic acidosis with encephalomyopathy. We present a case of an infant with lactic acidosis, failure to thrive, and severe primary pulmonary hypertension who was found to be a compound heterozygote for two novel VARS2 variants (c.1940C>T, p.(Thr647Met) and c.2318G>A, p.(Arg773Gln)). The patient was treated with vitamin supplements and a carbohydrate-restricted diet. The lactic acidosis and failure to thrive resolved, and he showed good growth and development. Functional studies and molecular analysis employed a yeast model system and the VAS1 gene (yeast homolog of VARS2). VAS1 genes harboring either one of two mutations corresponding to the two novel variants in the VARS2 gene, exhibited partially reduced function in haploid yeast strains. A combination of both VAS1 variant alleles in a diploid yeast cell exhibited a more significant decrease in oxidative metabolism-dependent growth and in the oxygen consumption rate (reminiscent of the patient who carries two mutant VARS2 alleles). Our results demonstrate the pathogenicity of the biallellic novel VARS2 variants. KEY MESSAGES: • A case of an infant who is a compound heterozygote for two novel VARS2 variants. • This infant displayed lactic acidosis, failure to thrive, and pulmonary hypertension. • Treatment of the patient with a carbohydrate-restricted diet resulted in good growth and development. • Studies with the homologous yeast VAS1 gene showed reduced function of corresponding single mutant in haploid yeast strains. • A combination of both VAS1 variant alleles in diploid yeast exhibited a more significant decrease in function, thereby confirming the pathogenicity of the biallellic novel VARS2 variants.


Prevalence and Trends of Patient-Reported Outcome Measures Used in Hip Arthroscopy.
The aim of this review was to determine the prevalence of patient-reported outcome measures concerning outcomes of arthroscopic hip surgery. The PubMed database was comprehensively reviewed in March 2016 using the key terms "hip" and "arthroscopy." A total of 192 eligible studies were identified. The most commonly used patient-reported outcome measures were the modified Harris Hip score (61%) and the Non-arthritic Hip Score (27%). Seventy-one percent of total patient-reported outcome measures articles were published between 2011 and 2015. The modified Harris Hip score, Nonarthritic Hip Score, and Hip Outcome Score remain the most commonly used patient-reported outcome measures in studies concerning outcomes of hip arthroscopy, and this has increased in the past 5 years. [Orthopedics. 2019; 42(3):e305-e308.].


Financial performance of primary care physician practices prior to electronic health record implementation.
While electronic health records (EHRs) are being widely implemented across the nation, few empirical data are currently available regarding their potential impact on financial performance and resource use. HealthTexas Provider Network is implementing a networkwide EHR, providing a unique opportunity to describe and evaluate fiscal effects. We conducted a retrospective, longitudinal observational study of financial performance related to inputs and income- and productivity-related outputs for the 33 primary care practices (July 2002-April 2006). Models for each outcome were constructed to test for a linear trend over time, adjusted for practice characteristics. F tests based on these models were used to determine the effect of each adjustor and to determine existence of a trend in each outcome. The observed staff per physician full-time equivalent (FTE) (3.6) was similar to staffing ratios reported for other primary care-only practices, while observation of 4692 work relative value units per physician FTE annually was higher than reported nationally. Significant monthly trends were identified for three of the outcome measures. During the pre-EHR baseline period, staffing ratios were equivalent to and physician productivity greater than reports available for these measures nationally or in other settings. Identification of time trends in three measures will allow these to be accounted for in the model used to evaluate the financial performance impact of EHR implementation.


Shewanella loihica sp. nov., isolated from iron-rich microbial mats in the Pacific Ocean.
A novel marine bacterial strain, PV-4(T), isolated from a microbial mat located at a hydrothermal vent of Loihi Seamount in the Pacific Ocean, has been characterized. This micro-organism is orangey in colour, Gram-negative, polarly flagellated, facultatively anaerobic and psychrotolerant (temperature range, 0-42 degrees C). No growth was observed with nitrate, nitrite, DMSO or thiosulfate as the electron acceptor and lactate as the electron donor. The major fatty acid detected in strain PV-4(T) was iso-C(15 : 0). Strain PV-4(T) had ubiquinones consisting mainly of Q-7 and Q-8, and possessed menaquinone MK-7. The DNA G+C content of the strain was 53.8 mol% and the genome size was about 4.5 Mbp. Phylogenetic analyses based on 16S rRNA gene sequences placed PV-4(T) within the genus Shewanella. PV-4(T) exhibited 16S rRNA gene sequence similarity levels of 99.6 and 97.5 %, respectively, with respect to the type strains of Shewanella aquimarina and Shewanella marisflavi. DNA from strain PV-4(T) showed low mean levels of relatedness to the DNAs of S. aquimarina (50.5 %) and S. marisflavi (8.5 %). On the basis of phylogenetic and phenotypic characteristics, the bacterium was classified in the genus Shewanella within a distinct novel species, for which the name Shewanella loihica sp. nov. is proposed. The type strain is PV-4(T) (=ATCC BAA-1088(T)=DSM 17748(T)).


Escape-echo bigeminy.
Escape-capture bigeminy is a well-known arrhythmia characterized by group beating of a junctional beat followed by a conducted sinus beat. We report a variant of this arrangement where a junctional beat gives rise to a retrograde P wave, which is then conducted back to the ventricles producing a hitherto undescribed combination (escape-echo bigeminy) resembling escape-capture bigeminy. The clinical significance of escape-echo bigeminy appears similar to that of classic escape-capture bigeminy.


[Screening of metabolic syndrome in the perimenopause].
There are few studies conducted in Mexico on increasing rates of cardiovascular diseases in postmenopausal patients with metabolic syndrome. To determine frequency of metabolic syndrome in women of 40 to 55 years old, that are in perimenopause and go to the external consultation of the Materno Infantil Inguarán Hospital. We made transversal, observational, and prospective study, including women of 40 to 55 years old, that went to external consultation of the Materno Infantil Inguarán Hospital, since January to June 2007 (n=60). To all the patients it was taken them blood samples in uninformed stop to value glucose, triglycerides, HDL, pressure blood and Body Measure Index and wais-to-hip ratio. The patients went to the Hospital by gynecologic pathology. We found Metabolic Syndrome frequency and the abnormal factors were triglyceride, waist circumference. We found high frequency hypertrglyceridemia and central obesity. In the perimenopause patients, to exist high frequency and predominance in the 40 and 50 years old, hers were asymptomatic. Before to be important to made screening in this patients, be cheap, and we can to prevent chronic disease such as Diabetes Mellitus Type 2 and Arterial Hypertension. Increase quality of live in this group of patients.


Clinical outcomes of follicular tumor of uncertain malignant potential of the thyroid: real-world data.
Thyroid tumors arising from follicular cells can generally be divided into malignant and benign tumors. However, some cases are difficult to clearly diagnose whether they are benign or malignant. Therefore, in the most recent version of World Health Organization (WHO) classification, some borderline lesions such as follicular tumor of uncertain malignant potential (FT-UMP), well-differentiated tumor of uncertain malignant potential (WDT-UMP), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were proposed. In this study, we investigated the clinical aspects, including the prognosis, of FT-UMP patients. We investigated the clinical features of 339 patients with FT-UMP. On ultrasound, 68% of the tumors were diagnosed as intermediate, and only 5% of those tumors were diagnosed as malignant. On cytology, 40% of the tumors were diagnosed as follicular neoplasm, and only 1% of these were suspected to be or diagnosed as malignancy. The diagnosis was based on questionable capsular invasion for 332 patients, questionable vascular invasion for 2 patients, and both for 5 patients. Eighty-six percent of the tumors showed low cell proliferation activity. To date, five patients (1%) have shown distant recurrence during postoperative follow-up and underwent various treatments such as radioactive iodine therapy, orthopedic surgery, and denosumab injection. None of these patients have died due to thyroid carcinoma. Our findings suggest that FT-UMP is generally an indolent disease, but some patients show distant recurrence. Physicians should carefully follow patients, although it remains unknown how long they should be observed after surgery.


Effects of an alternative host on the prevalence and intensity of infection of a bumble bee parasite.
Several bee parasites are transmitted through flowers, and some of them can infect multiple host species. Given the shared use of flowers by bee species, parasites can potentially encounter multiple host species, which could affect the evolution of parasite virulence. We used the trypanosomatid parasite Crithidia bombi and its host, the common eastern bumble bee (Bombus impatiens), to explore the effect of infecting an alternative host, the alfalfa leaf-cutter bee (Megachile rotundata), on parasite infectivity and ability to replicate. We conducted a serial passage experiment on primary and alternative hosts, assessing infectivity and intensity of infection during five passes. Parasite cells from each pass through the alternative host were also used to infect a group of primary hosts. We found that serial passes through the alternative host increased infectivity, but there was no effect on intensity of infection. Interestingly, both the probability and intensity of infection on the primary host increased after serial passage through the alternative host. This increase in intensity of infection could be due to maladaptation after selection of new C. bombi strains has occurred in the alternative host. This study suggests that host switching has the potential to affect the adaptation of bee parasites to their hosts.


Bone regeneration potential of allogeneic or autogeneic mesenchymal stem cells loaded onto cancellous bone granules in a rabbit radial defect model.
For developing a clinically effective bone regeneration strategy, we compare the bone regeneration potential of cultured allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) and of autologous BM-MSCs loaded onto allogeneic cancellous bone granule scaffolds. A critical-sized segmental bone defect was made at the mid-shaft of both radiuses in 19 New Zealand White rabbits (NWRs). In the experimental group, allogeneic BM-MSCs loaded onto small-sized allogeneic cancellous bone granules (300~700 um in diameter) were implanted in one side of a bone defect. In the control group, autologous BM-MSCs loaded onto allogeneic cancellous granules were grafted in the other side. Bone regeneration was assessed by radiographic evaluation at 4, 8, 12 and 16 weeks post-implantation and by micro-computed tomography (micro-CT) and histological evaluation at 8 and 16 weeks. The experimental groups showed lower bone quantity indices (BQIs) than the control groups at 12 and 16 weeks (p < 0.05), although no significant difference was observed at 4 and 8 weeks (p > 0.05). Micro-CT analysis revealed that both groups had similar mean total bone volume and other parameters including trabecular thickness, number and separation at either 8 or 16 weeks. Only bone surface area revealed less area in the experimental group at 16 weeks. Histological evaluation of 8-week and 16-week specimens showed similar biologic processes of new bone formation and maturation. There was no inflammatory reaction indicating an adverse immune response in both allogeneic and autologous MSC groups. In conclusion, allogeneic BM-MSCs loaded onto allogeneic cancellous bone granules had comparable bone regeneration potential to autologous BM-MSCs in a rabbit radial defect model.


Two-dimensional oxide on Pd(111).
The oxidation of Pd(111) leads to an incommensurate surface oxide, which was studied by the use of scanning tunneling microscopy, surface x-ray diffraction, high resolution core level spectroscopy, and density functional calculations. A combination of these methods reveals a two-dimensional structure having no resemblance to bulk oxides of Pd. Our study also demonstrates how the atomic arrangement of a nontrivial incommensurate surface can be solved by molecular dynamics in a case where experimental techniques alone give no solution.


Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: a single institution's early learning curve.
The gold standard for mediastinal lymph node evaluation is mediastinoscopy, which is invasive and allows access to only a limited number of mediastinal lymph node (MLN) stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) is emerging as a useful, less invasive technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). We report our initial experience with this procedure. Using our prospectively maintained database, we performed a single-institution retrospective chart review. Our study group consisted of all patients at the University of Minnesota who underwent EBUS-FNA for evaluation of mediastinal lymphadenopathy or for thoracic malignancy staging from September 1, 2006, through December 15, 2007. To assess our learning curve, we plotted the cumulative sensitivity (%) and accuracy (%) of our EBUS-FNA results as a function of the number of procedures we performed. During the study period, 100 patients underwent EBUS, 92 with FNA. Of these, 56 patients (34 women, 22 men; mean age, 60.4 +/- 13.7 years) met our inclusion criteria. We found no complications. After our first 10 procedures, the sensitivity of our EBUS-FNA results was 96.2%; accuracy was 97.8% (rates comparable with other large series in the literature). We conclude that the learning curve for EBUS-FNA for thoracic surgeons is about 10 procedures.


Risk factors associated with survival in surgically treated large cell neuroendocrine carcinoma of the lung.
Pulmonary large cell neuroendocrine carcinomas (LCNEC) are one of the rare malignant neoplasms of the lung. A standard management model for LCNEC has not yet been established and the poor prognostic factors and treatment modalities are still uncertain. LCNEC are fairly rare and have a poor prognosis. Determination of the risk factors associated with survival can contribute to its management. In this retrospective study, we analyzed the data of 42 patients. We obtained the data about the age, gender, smoking history, symptoms, tumor size, tumor location, pathological type, TNM stage, treatments, surgical modality, length of hospital stay, postoperative complications, disease-free survival and total survival from the hospital electronic files of the patients. Then we analyzed the relationship between these data and survival. 40 (95.24%) were male, and the mean age was 64.26 ±8.62. 12 (28.57%) patients were in stage I, 14 (33.3%) were in stage II, 15 (35.71%) were in stage III and only 1 (2.38%) patient was in stage IV. 15 (35.71%) had sublobar resection (wedge resection (n = 13) + segmentectomy (n = 2), 24 (57.14%) had lobectomy and 3 (7.14%) had pneumonectomy. The mean overall survival (OS) time was 34.86 ±30.11 months. 1-year, 3-year and 5-year survival rates of the patients were 73.80%, 47.61% and 19.04%, respectively. T stage (HR = 8.956, 95% CI: 1.521-11.034, p = 0.005) N stage (HR = 5.984, 95% CI: 1.127-7.982, p = 0.028) were independent risk factors for OS. The overall survival in LCNEC was poor and the tumor size and the nodal stage were independent risk factors for overall survival.


Next steps in research on aggression in borderline personality disorder: Commentary on "Aggression in borderline personality disorder--A multidimensional model".
Comments on the article by F. Mancke et al. (see record 2015-31349-001). The article proposes a multidimensional model of aggression in borderline personality disorder (BPD) on the basis of an overview of empirical studies supporting the proposed dimensions. We applaud the authors for the timeliness of this piece and their comprehensive summary of the empirical literature on aggression in BPD. We highlight several issues for further attention and study. We first discuss the proposed multidimensional model itself with an emphasis on the choice of constructs, clinical applications, and limitations. We acknowledge the importance of this first step in model-building (i.e., the identification of potentially important dimensions as inferred from variable-focused, group-based comparisons). However, we encourage the necessary next steps-a movement toward a mechanistic and dynamic understanding of these dimensions that relies more heavily on a person-centered approach and enhances clinical relevance. In that spirit, we make some suggestions for future research on aggression in BPD that may have increased translational value for prevention and intervention.


Activity of epimerases in in vitro cultured fibroblasts.
The process of collagen and proteoglycan synthesis in the in vitro cultured fibroblasts was studied by four original histoenzymological methods: UDP-glucuronic-5-epimerase, hydroxyproline epimerase, UDP-4-epimerase and UDP-N-acetyl-glucosamine epimerase. The process of epimerasization varied in terms of the cell growth stages. Synthesis of collagen and proteoglycans developed in the cells of the same culture but with various intensities in different cell groups.


Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: Individual patient data meta-analysis of randomized trials.
Assessment of minimally invasive pancreatoduodenectomy (MIPD) in patients with pancreatic ductal adenocarcinoma (PDAC) is scarce and limited to non-randomized studies. This study aimed to compare oncological and surgical outcomes after MIPD compared to open pancreatoduodenectomy (OPD) for patients after resectable PDAC from published randomized controlled trials (RCTs). A systematic review was performed to identify RCTs comparing MIPD and OPD including PDAC (Jan 2015-July 2021). Individual data of patients with PDAC were requested. Primary outcomes were R0 rate and lymph node yield. Secondary outcomes were blood-loss, operation time, major complications, hospital stay and 90-day mortality. Overall, 4 RCTs (all addressed laparoscopic MIPD) with 275 patients with PDAC were included. In total, 128 patients underwent laparoscopic MIPD and 147 patients underwent OPD. The R0 rate (risk difference(RD) -1%, P = 0.740) and lymph node yield (mean difference(MD) +1.55, P = 0.305) were comparable between laparoscopic MIPD and OPD. Laparoscopic MIPD was associated with less perioperative blood-loss (MD -91ml, P = 0.026), shorter length of hospital stay (MD -3.8 days, P = 0.044), while operation time was longer (MD +98.5 min, P = 0.003). Major complications (RD -11%, P = 0.302) and 90-day mortality (RD -2%, P = 0.328) were comparable between laparoscopic MIPD and OPD. This individual patient data meta-analysis of MIPD versus OPD in patients with resectable PDAC suggests that laparoscopic MIPD is non-inferior regarding radicality, lymph node yield, major complications and 90-day mortality and is associated with less blood loss, shorter hospital stay, and longer operation time. The impact on long-term survival and recurrence should be studied in RCTs including robotic MIPD.


Improved lipid profiles and maintenance of virologic control in heavily pretreated HIV-infected patients who switched from stavudine to tenofovir treatment.
A retrospective chart analysis of 66 human immunodeficiency virus type 1 (HIV-1)-infected patients whose treatment was switched from stavudine to tenofovir without any other treatment changes was conducted. The mean total cholesterol values decreased significantly within 3 months after the tenofovir substitution and remained significantly less than baseline values during 18 months of follow-up (mean decrease, 36 mg/dL; P = .002). Regimens containing tenofovir provided effective control of HIV-1 infection, with stable CD4+ cell counts and continued suppression of plasma HIV-1 level following the treatment switch from stavudine.


A Survey of Current Knowledge on Sexually Transmitted Diseases and Sexual Behaviour in Italian Adolescents.
Worldwide, 500 million people a year acquire a sexually transmitted disease (STD). Adolescents, accounting for 25% of the sexually active population, are the most affected. To analyze sexual behavior among Italian adolescents and their knowledge of STDs, with the goal of preventing their transmission, a questionnaire was administered to 2867 secondary school students (1271 males and 1596 females) aged 14-21 years. For the study, 1492 students were interviewed in Genoa (Northern Italy) and 1375 in Lecce (Southern Italy). For 37% of the respondents, parents and teachers were the main source of information on sex, and 95% believed that school should play the primary role in sex education. However, only 9% considered the sex education they received in school good. Noteworthy, only 0.5% of the teenagers recognized the sexually transmitted diseases from a list of diseases, and 54% of them did not know what a Pap test was. Confusion about the meaning of contraception and prevention was evident; only 22% knew that condoms and abstinence are the only methods for preventing STDs. Finally, a consistent number of students are exposed to risk factors for STDs transmission; e.g., alcohol and recreational drug use, promiscuity and improper condom use. On the basis of our study, there is an urgent need for the introduction of sex education as a proper subject in Italian schools.


Characterization of monoclonal antibodies to the globular domain of collagen IV.
Monoclonal antibodies were produced against NC1, the globular noncollagenous domain of collagen IV, isolated from bovine glomerular basement membrane. Cells from eight positive wells were cloned and the resulting monoclonal antibodies were studied in detail by immunofluorescence on human kidney sections, by Western blot and by ELISA against denatured subunits from NC1 hexamers and against native NC1 hexamers from different tissues. The monoclonal antibodies could be divided into two groups. Firstly, those monoclonal antibodies that, in ELISA and Western blot, reacted with peptides related to the alpha 1 chain of collagen IV and stained all basement membranes in the kidney. Secondly, a monoclonal antibody that, in ELISA and Western blot, reacted with peptides related to the Goodpasture antigen, the alpha 3 chain of collagen IV. When this antibody was applied to human kidney sections it stained the glomerular basement membrane very intensively. Bowman's capsule and some tubular basement membrane were also stained, although to a lesser extent. This staining pattern is the same as that observed with sera from patients with Goodpasture's syndrome. An attempt was made to separate different subtypes of the NC1 hexamer. A monoclonal antibody from the first group was used to make an affinity chromatography column. Glomerular basement membrane digested with collagenase was separated on this column and the collected fractions were analyzed by ELISA and SDS-PAGE. The result from this study support the idea that glomerular basement membrane is composed of at least two different subtypes of type IV collagen.


The effect of willpower workshop on anxiety, depression, and the excitement components in the students of Shiraz university of medical sciences.
The current study aimed at evaluating the effect of willpower workshop on anxiety, depression, and the Granovsky excitement components among the students of Shiraz University of Medical Sciences in the academic year 2016--2017. Students (140) were selected by the simple random sampling method and allocated into two equal groups of intervention (willing) and control, each of 52 individuals. Data collection instruments were the Garnefski cognitive emotion regulation scale and the Beck depression and anxiety inventories. The data were collected twice, before intervention and after the intervention (9 months after the study completion and holding the workshops). The control subjects received no intervention but were interviewed every 3 months. The results of the current study indicated no significant differences in demographic variables and pretest scores between the groups, which indicate the homogeneity of the groups. In other words, there were no significant differences between the groups regarding demographic characteristics before the intervention (P > 0.05). In addition, to compare the intervention and control groups, the Mann--Whitney U test was used and the results showed a significant difference in posttest results between the study groups (P < 0.05). Also, there was a significant difference between the pretest and posttest results of each group (P < 0.05). Results of the current study indicated that training the stress, coping and willpower strengthening skills, based on the Granovsky excitement components, could promote psychophysical health and reduce anxiety and stress among the studied students.


Adjuvant efficacy of mOMV against avian influenza virus infection in mice.
Highly pathogenic avian influenza H5N1 viruses are found chiefly in birds and have caused severe disease and death in infected humans. Development of influenza vaccines capable of inducing heterosubtypic immunity against a broad range of influenza viruses is the best option for the preparedness, since vaccination remains the principal method in controlling influenza viral infections. Here, a mOMV-adjuvanted recombinant H5N2 (rH5N2) whole virus antigen vaccine with A/Environment/Korea/W149/06(H5N1)-derived H5 HA and A/Chicken/Korea/ma116/04(H9N2)-derived N2 NA in the backbone of A/Puerto Rico/8/34(H1N1) was prepared and generated by reverse genetics. Groups of mice were vaccinated by a prime-boost regime with the rH5N2 vaccine (1.75 μg of HA with/without 10 μg mOMV or aluminum hydroxide adjuvant for comparison). At two weeks post-immunizations, vaccinated mice were challenged with lethal doses of 10(3.5) EID50/ml of H5N1 or H9N2 avian influenza viruses, and were monitored for 15 days. Both mOMV- and alum-adjuvant vaccine groups had high survival rates after H5N1 infection and low levels of body weight changes compared to control groups. Interestingly, the mOMV-adjuvanted group induced better cross-reactive antibody responses serologically and promoted cross-protectivity against H5N1 and H9N2 virus challenges. Our results suggest that mOMV could be used as a vaccine adjuvant in the development of effective vaccines used to control influenza A virus transmission.