Determinants of Delay in Seeking Malaria Treatment for Under-Five Children at Gambella Town, Southwest Ethiopia: A Case-Control Study.
Most of the malaria-related complications in children are due to delay in the treatment-seeking of caregivers. The objective of this study was to identify determinants of delay in seeking malaria treatment for under-five children in Gambella town, Ethiopia. A case-control study was conducted in March 2017 among caregivers/parents consecutively included in the study. Data were collected by face-to-face interviews using a structured questionnaire. Descriptive statistics and logistic regression were, respectively, used for descriptive and analytical data analyses. Adjusted odds ratios and 95% CI were, respectively, calculated to assess the strength of association and statistical significance. A total of 153 cases and 153 control caregivers/parents participated in the study giving a response rate of 100%. The mean age of cases and controls was 29.4 years (SD ± 6.0 years) and 29.63 years (SD ± 7.8 years), respectively. Being housewife (AOR = 2.50; 95% CI: 1.47-4.22), having no history of child mortality (AOR = 3.70; 95% CI: 1.79-7.64), and chewing khat (AOR = 3.50; 95% CI: 1.57-7.68) were significantly associated with delay in seeking malaria treatment for under-five children among the caregivers. Conclusion and Recommendation. Comprehensive community-based malaria prevention and control education should be given for the caregivers in the town giving due emphasis to housewives, khat-chewers, and the caregivers with no story of child death to better promote early malaria treatment-seeking for under-five children.


[Parameters to judge the stability of wrist after the four-corner arthrodesis].
To find out some parameters to judge the stability of the wrists after tour-corner arthrodesis and to explore the strategy for improving the range of motion (ROM) of the wrist after four-corner arthrodesis. After the simulated four-corner arthrodesis was performed in both wrists of 8 men and 4 women cadaver, the wrists were fixed on the wrist motor simulator; and wrist movement including flexion, extension, radial deviation, ulnar deviation was simulated. The standard posteroanterior and lateral radiographs were taken for measuring the change of capitolunate angle (alpha), radiolunate angle (beta), capitolunate posteroanterior angle (theta), the height (H) and width (W) of the fused four carpal bone bloc. There were statistically significant differences in alpha, beta, theta angles (P<0.01) in the case of 50 degrees flexion or 40 degrees extension, and in H and W values (P<0.05) in the case of 25 degrees ulnar deviation or 15 degrees radial deviation when compared with before movement. Capitolunate angle, radiolunate angle, capitolunate posteroanterior angle, the height and the width of the fused four carpal bone bloc can be used to judge the stability of the wrists after four-corner arthrodesis.


Association between a polymorphism in the promoter region of the dopamine D2 receptor gene and schizophrenia in Japanese subjects: replication and evaluation for antipsychotic-related features.
To replicate a previously found negative association between the Del allele of the -141C Ins/Del polymorphism in the 5'-promoter region of the dopamine D2 receptor gene (DRD2) and schizophrenia in Japanese subjects and to examine whether this polymorphism is related to the features of antipsychotic drug treatment, we genotyped 94 control subjects and 234 schizophrenic patients. The schizophrenic patients had a significantly lower frequency of the Del allele (p < 0.05). We found a non-significant trend towards a higher frequency of the Del allele in schizophrenic patients susceptible to neuroleptic-induced extrapyramidal symptoms. The daily dosage of haloperidol, the steady-state concentration of serum haloperidol per daily dosage, and the recent 1-yr cumulative neuroleptic dosage were lower in patients with the Del/Del genotype than in the other patients. These findings support the view that the polymorphism is associated with schizophrenia in Japanese subjects and provide hints for further attempts to establish the relationship between this polymorphism and the features of antipsychotic drug treatment.


Bone ultrasound velocity in pediatric intensive care unit: a pilot study.
Bone loss has been documented in adults in intensive care wards. Children admitted to pediatric intensive care units (PICU) are also exposed to many potential risk factors for bone loss such as immobilization, catabolic state, and nutritional depletion. Quantitative ultrasound technique that measures speed of sound (SOS) correlates with bone mineral density (BMD) and strength. Herein is a clinical prospective longitudinal, observational pilot study to evaluate early bone changes that occur during the first few days of PICU admission. Children are hospitalized in a pediatric intensive under general anesthesia and muscle paralysis. Bone SOS at the mid-shaft tibia was measured on the first day of hospitalization and on days 2 to 3 thereafter. Nineteen children were studied. Bone SOS decreased during the first 3 days of hospitalization from 3,297 ± 315 to 3,260 ± 311 m/min (p < 0.05). The decrease was approximately 1% of the original SOS over the first 2 to 3 days of admission. There is a significant decrease in bone strength after 3 days in pediatric patients admitted to an intensive care department. Longitudinal studies of a larger group of children are necessary to determine the clinical meaning of the results and to possibly evaluate preventive approaches.


Bivariate flow karyotyping of acute myelocytic leukemia in the BNML rat model.
Univariate as well as bivariate flow karyotyping has been performed on chromosome suspensions obtained from the Brown Norway myelocytic leukemia (BNML), a rat model for human acute myelocytic leukemia (AML). Flow karyograms were obtained from both the in vivo transplantable parent line and from an in vitro established cell line. Density gradient centrifugation performed on cells arrested in mitosis resulted in an enrichment of mitotic cells. Furthermore, with this procedure leukemic and nonleukemic cells could be separated. Univariate analysis with propididum iodide (PI) as a DNA stain revealed the position of the several tumor-specific marker chromosomes in the in vitro cell line. Estimations of the peak position of the various chromosomes was done by comparing the univariate flow karyogram with a computer-simulated karyogram from the BNML that was derived from the mean length of the individual chromosomes in conventionally prepared metaphase slides. By comparing the bivariate flow karyogram of the in vivo BNML cells with the flow karyogram of normal BN cells, it was clearly demonstrated which peaks are involved in the altered chromosomal pattern of the BNML. No differences were found between the flow karyograms of the in vitro- and the ex vivo-derived chromosome suspensions in this rat leukemia model.


Short-term occupations at high elevation during the Middle Paleolithic at Kalavan 2 (Republic of Armenia).
The Armenian highlands encompasses rugged and environmentally diverse landscapes and is characterized by a mosaic of distinct ecological niches and large temperature gradients. Strong seasonal fluctuations in resource availability along topographic gradients likely prompted Pleistocene hominin groups to adapt by adjusting their mobility strategies. However, the role that elevated landscapes played in hunter-gatherer settlement systems during the Late Pleistocene (Middle Palaeolithic [MP]) remains poorly understood. At 1640 m above sea level, the MP site of Kalavan 2 (Armenia) is ideally positioned for testing hypotheses involving elevation-dependent seasonal mobility and subsistence strategies. Renewed excavations at Kalavan 2 exposed three main occupation horizons and ten additional low densities lithic and faunal assemblages. The results provide a new chronological, stratigraphical, and paleoenvironmental framework for hominin behaviors between ca. 60 to 45 ka. The evidence presented suggests that the stratified occupations at Kalavan 2 locale were repeated ephemerally most likely related to hunting in a high-elevation within the mountainous steppe landscape.


Do attitudes about unhealthy alcohol and other drug (AOD) use impact primary care professionals' readiness to implement AOD-related preventive care?
To explore the association between primary care professionals' (PCPs) attitudes towards unhealthy alcohol and other drug (AOD) use (from risky use through dependence) and readiness to implement AOD-related preventive care. Primary care professionals from five health centres in Sao Paulo were invited to complete a questionnaire about preventive care and attitudes about people with unhealthy AOD use. Logistic regression models tested the association between professional satisfaction and readiness. Multiple Correspondence Analysis assessed associations between stigmatising attitudes and readiness. Of 160 PCPs surveyed, 96 (60%) completed the questionnaire. Only 25% reported implementing unhealthy AOD use clinical prevention practices; and 53% did not feel ready to implement such practices. Greater satisfaction when working with people with AOD problems was significantly associated with readiness to implement AOD-related preventive care. In Multiple Correspondence Analysis two groups emerged: (i) PCPs ready to work with people with unhealthy AOD use, who attributed to such patients lower levels of dangerousness, blame for their condition and need for segregation from the community (suggesting less stigmatising attitudes); and (ii) PCPs not ready to work with people with unhealthy AOD use, who attributed to them higher levels of dangerousness, blame, perceived level of patient control over their condition and segregation (suggesting more stigmatising attitudes). More stigmatising attitudes towards people with unhealthy AOD use are associated with less readiness to implement unhealthy AOD-related preventive care. Understanding these issues is likely essential to facilitating implementation of preventive care, such as screening and brief intervention, for unhealthy AOD use. [Amaral-Sabadini MB, Saitz R, Souza-Formigoni MLO. Do attitudes about unhealthy alcohol and other drug (AOD) use impact primary care professionals' readiness to implement AOD-related preventive care?


The mTOR Pathway in Pluripotent Stem Cells: Lessons for Understanding Cancer Cell Dormancy.
Currently, the success of targeted anticancer therapies largely depends on the correct understanding of the dormant state of cancer cells, since it is increasingly regarded to fuel tumor recurrence. The concept of cancer cell dormancy is often considered as an adaptive response of cancer cells to stress, and, therefore, is limited. It is possible that the cancer dormant state is not a privilege of cancer cells but the same reproductive survival strategy as diapause used by embryonic stem cells (ESCs). Recent advances reveal that high autophagy and mTOR pathway reduction are key mechanisms contributing to dormancy and diapause. ESCs, sharing their main features with cancer stem cells, have a delicate balance between the mTOR pathway and autophagy activity permissive for diapause induction. In this review, we discuss the functioning of the mTOR signaling and autophagy in ESCs in detail that allows us to deepen our understanding of the biology of cancer cell dormancy.


Intestinal receptor for heat-stable enterotoxin of Escherichia coli is tightly coupled to a novel form of particulate guanylate cyclase.
A novel form of particulate guanylate cyclase tightly coupled by cytoskeletal components to receptors for heat-stable enterotoxin (ST) produced by Escherichia coli can be found in membranes from rat intestinal mucosa. Intestinal particulate guanylate cyclase was resistant to solubilization with detergent alone, with only 30% of the total enzyme activity being extracted with Lubrol-PX. Under similar conditions, 70% of this enzyme was solubilized from rat lung membranes. The addition of high concentrations of sodium chloride to the extraction buffer resulted in greater solubilization of particulate guanylate cyclase from intestinal membranes. Although extraction of intestinal membranes with detergent and salt resulted in greater solubilization of guanylate cyclase, a small fraction of the enzyme activity remained associated with the particulate fraction. This activity was completely resistant to solubilization with a variety of detergents and chaotropes. Particulate guanylate cyclase and the ST receptor solubilized by detergent retained their abilities to produce cyclic GMP and bind ST, respectively. However, ST failed to activate particulate guanylate cyclase in detergent extracts. In contrast, guanylate cyclase resistant to solubilization remained functional and coupled to the ST receptor since enzyme activation by ST was unaffected by various extraction procedures. The possibility that the ST receptor and particulate guanylate cyclase were the same molecule was explored. ST binding and cyclic GMP production were separated by affinity chromatography on GTP-agarose. Similarly, guanylate cyclase migrated as a 300,000-dalton protein, while the ST receptor migrated as a 240,000-dalton protein on gel filtration chromatography. Also, thiol-reactive agents such as cystamine and N-ethylmaleimide inhibited guanylate cyclase activation by ST, with no effect on receptor binding of ST. These data suggest that guanylate cyclase and the ST receptor are independent proteins coupled by cytoskeletal components in membranes of intestinal mucosa.


Clinical results of epidural spinal cord electrical stimulation in patients affected with limb-threatening chronic arterial obstructive disease.
Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4 +/- 10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. The overall limb salvage rate was 42%. Pain control was obtained in 80% of patients at the one-year and 75% at the two-year follow-up, with infrequent use of pain relievers. Despite the poor clinical results observed, the limb salvage rate testifies to the effectiveness of ESES in limb-threatening ischemia. Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods. In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.


Activated pancreatic stellate cells sequester CD8+ T cells to reduce their infiltration of the juxtatumoral compartment of pancreatic ductal adenocarcinoma.
Pancreatic ductal adenocarcinoma (PDAC) is characterized by a prominent desmoplastic microenvironment that contains many different immune cells. Activated pancreatic stellate cells (PSCs) contribute to the desmoplasia. We investigated whether distinct stromal compartments are differentially infiltrated by different types of immune cells. We used tissue microarray analysis to compare immune cell infiltration of different pancreaticobiliary diseased tissues (PDAC, ampullary carcinoma, cholangiocarcinoma, mucinous cystic neoplasm, chronic inflammation, and chronic pancreatitis) and juxtatumoral stromal (<100 μm from tumor) and panstromal compartments. We investigated the association between immune infiltrate and patient survival times. We also analyzed T-cell migration and tumor infiltration in LSL-KrasG12D/+; LSL-Trp53R172H/+; Pdx-1-Cre (KPC) mice and the effects of all-trans retinoic acid (ATRA) on these processes. Juxtatumoral compartments in PDAC samples from 2 independent groups of patients contained increased numbers of myeloperoxidase(+) and CD68(+) cells compared with panstromal compartments. However, juxtatumoral compartments of PDACs contained fewer CD8(+), FoxP3(+), CD56(+), or CD20(+) cells than panstromal compartments, a distinction absent in ampullary carcinomas and cholangiocarcinomas. Patients with PDACs that had high densities of CD8(+) T cells in the juxtatumoral compartment had longer survival times than patients with lower densities. In KPC mice, administration of ATRA, which renders PSCs quiescent, increased numbers of CD8(+) T cells in juxtatumoral compartments. We found that activated PSCs express cytokines, chemokines, and adhesion molecules that regulate T-cell migration. In vitro migration assays showed that CD8(+) T cells, from patients with PDAC, had increased chemotaxis toward activated PSCs, which secrete CXCL12, compared with quiescent PSCs or tumor cells. These effects could be reversed by knockdown of CXCL12 or treatment of PSCs with ATRA. Based on studies of human PDAC samples and KPC mice, activated PSCs appear to reduce migration of CD8(+) T cells to juxtatumoral stromal compartments, preventing their access to cancer cells. Deregulated signaling by activated PSCs could prevent an effective antitumor immune response.


On the characteristics of the parameters of a life table function.
This study is based on a mathematical model for the life table survivorship function developed by the author, "the form of which has been logically arrived at in a manner such that the simple but the well known constraints of the life table functions can be met by the model. There are basically three parameters in the model which can be estimated by the method of least squares after the variables are subjected to appropriate transformations. The characteristics of these parameters have been investigated in this paper which [makes] it readily apparent that the model can provide good approximations to a wide variety of life tables." (summary in FRE, ITA)


Access to medical care, dental care, and prescription drugs: the roles of race/ethnicity, health insurance, and income.
After accounting for socioeconomic factors and other demographic characteristics, racial/ethnic disparities in access to care were examined. Using nationally representative data on 34,403 individuals from the 2004 Medical Expenditure Panel Survey (MEPS), multiple logistic regression analyses for five outcome measures were conducted: self-reports of being unable to get medical care, dental care, or prescriptions in the past year; and having no doctor or dentist visits in the past year. The main independent variables were race/ethnicity, income, and insurance status. Blacks and Hispanics were less likely to report difficulties in accessing medical care, dental care, and prescriptions as compared to whites. These disparities occurred primarily among the uninsured and Medicaid insured. More objective measures of utilization (ie, no doctor visit or dental visit during the past year) showed that minorities experienced less access than whites. Racial/ethnic disparities in access to care persist, and cannot be entirely explained by socioeconomic differences. In addition, the nature of these disparities depends on the socioeconomic position of racial/ethnic groups as well as the access measure used.


Combining Activity Trackers With Motivational Interviewing and Mutual Support to Increase Physical Activity in Parent-Adolescent Dyads: Longitudinal Observational Feasibility Study.
An essential component of any effective adolescent weight management program is physical activity (PA). PA levels drop dramatically in adolescence, contributing to the rising prevalence of adolescent obesity. Therefore, finding innovative interventions to address this decline in PA may help adolescents struggling with weight issues. The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smartphone apps, can engage, motivate, and foster support among users while simultaneously providing feedback on their PA progress. The objective of our study was to evaluate the effect of a 10-week pilot study using smartphone-enabled activity tracker data to tailor motivation and goal setting on PA for overweight and obese adolescents and their parents. We queried enrolled adolescents, aged 14 to 16 years, with a body mass index at or above the 85th percentile, and 1 of their parents as to behaviors, barriers to change, and perceptions about exercise and health before and after the intervention. We captured daily step count and active minutes via activity trackers. Staff made phone calls to dyads at weeks 1, 2, 4, and 8 after enrollment to set daily personalized step-count and minutes goals based on their prior data and age-specific US national guidelines. We evaluated dyad correlations using nonparametric Spearman rank order correlations. We enrolled 9 parent-adolescent dyads. Mean adolescent age was 15 (SD 0.9) years (range 14-16 years; 4 female and 5 male participants); mean parent age was 47 (SD 8.0) years (range 36-66 years). On average, adolescents met their personalized daily step-count goals on 35% (range 11%-62%) of the days they wore their trackers; parents did so on 39% (range 3%-68%) of the days they wore their trackers. Adolescents met their active-minutes goals on 55% (range 27%-85%) of the days they wore their trackers; parents did so on 83% (range 52%-97%) of the days. Parent and adolescent success was strongly correlated (step count: r=.36, P=.001; active minutes: r=.30, P=.007). Parental age was inversely correlated with step-count success (r=-.78, P=.01). Our findings illustrate that parent-adolescent dyads have highly correlated PA success rates. This supports further investigation of family-centered weight management interventions for adolescents, particularly those that involve the parent and the adolescent working together.


A nurse's story. The journey of a staff nurse.
This article describes the professional growth of a nurse who journeyed from being a staff nurse to becoming a coordinator of a national program. The critical turning points that fostered this nurse's development are detailed. The guidance and support of the nursing and hospital administration as well as the mentorship of fellow professionals were key in this developmental process. The communication of this story contributes to the varied tapes-try of professional nursing.


Differential transport of DNA by a rectified Brownian motion device.
An interdigitated electrode array (IDEA) device has been designed and used to transport DNA based on a Brownian ratchet mechanism. This migration is produced by the periodic formation of an asymmetric sawtooth electric field in the device. Oligonucleotides of 25, 50, and 100 bases in length were tested using two different array geometries. DNA transport as a function of DNA size, electric field frequency, and array geometry is shown to be in qualitative agreement with theory. Such a device could provide for DNA separations over a broad size range, and can be readily scaled as a component in a microfabricated DNA analysis system.


Atypical Hepatic Mesenchymal Hamartoma: Histologic Appearance, Immunophenotype, and Molecular Findings.
Hepatic mesenchymal hamartoma is a rare benign neoplasm principally encountered in young children. Its origin is unknown. We report an unusual hepatic mesenchymal hamartoma in a 7-month-old girl, including histopathologic findings, immunophenotype, and karyotype. Chromosomal microarray analysis of tumoral tissue and circulating lymphocytes found 4 copies of a segment at 1q44 and fluorescence in situ hybridization indicated tandem triplication, ascribed to expansion of a paternal tandem duplication. This genetic abnormality may have played a role in pathogenesis.


Usefulness and safety of transbronchial lung cryobiopsy for reassessment of treatment in the clinical course of diffuse parenchymal lung disease.
The usefulness and safety of transbronchial lung cryobiopsy (TBLC) for reassessment of diffuse parenchymal lung disease (DPLD) with progression is still unknown. Our purpose was to clarify the usefulness and safety of TBLC for reassessment of DPLD with progression. This retrospective study included 31 patients with DPLD diagnosed by surgical lung biopsy who progressed in the clinical course and underwent TBLC for reassessment between January 2017 and September 2019 at Kanagawa Cardiovascular & Respiratory Center. Two pulmonologists independently selected the clinical diagnosis, treatment strategy, and confidence level of the treatment strategy based on clinical and radiological information with and without pathological information from TBLC. A consensus was reached among the pulmonologists regarding the clinical diagnosis, treatment strategy, and confidence level of the treatment strategy. Complications of TBLC were also examined. Seven (22.6%), 5 (16.1%), and 6 (19.4%) of clinical diagnosis was changed after TBLC for Pulmonologist A, for Pulmonologist B, and for consensus, respectively. The treatment strategy was changed in 7 (22.6%), 8 (25.9%), and 6 (19.4%) cases after TBLC for Pulmonologist A, for Pulmonologist B and for consensus, respectively. The definite or high confidence level of the consensus treatment strategy was 54.8% (17/31) without TBLC and 83.9% (26/31) with TBLC. There were 6 cases of moderate bleeding, but no other complications were noted. Pathological information from TBLC may contribute to decision-making in treatment strategies for the progression of DPLD, and it may be safely performed.


Hepatic vein stenosis and inferior vena cava stenosis in a patient with chronic obstructive pulmonary disease.
The case is presented of a patient with stenosis of the intrahepatic portion of the inferior vena cava and the terminal part of hepatic veins, a state manifesting itself in ascites resistant to treatment. The case was originally seen as decompensated cirrhosis of the liver. Once properly diagnosed, it was successfully treated with angioplasty and subsequent anticoagulation. After all the relevant hypercoagulation states potentially leading to IVC and hepatic vein stenosis were ruled out, the cause of the patient's stenosis could be traced to: 1. secondary polycythemia concomitant to severe pulmonary obstruction disease and 2. simultaneous corticosteroid therapy. This cause has not been described in literature before.


Auxin flow-mediated competition between axillary buds to restore apical dominance.
Apical dominance is one of the fundamental developmental phenomena in plant biology, which determines the overall architecture of aerial plant parts. Here we show apex decapitation activated competition for dominance in adjacent upper and lower axillary buds. A two-nodal-bud pea (Pisum sativum L.) was used as a model system to monitor and assess auxin flow, auxin transport channels, and dormancy and initiation status of axillary buds. Auxin flow was manipulated by lateral stem wounds or chemically by auxin efflux inhibitors 2,3,5-triiodobenzoic acid (TIBA), 1-N-naphtylphtalamic acid (NPA), or protein synthesis inhibitor cycloheximide (CHX) treatments, which served to interfere with axillary bud competition. Redirecting auxin flow to different points influenced which bud formed the outgrowing and dominant shoot. The obtained results proved that competition between upper and lower axillary buds as secondary auxin sources is based on the same auxin canalization principle that operates between the shoot apex and axillary bud.


Hip protectors for preventing hip fractures in the elderly.
Hip fracture in the elderly is usually the result of a simple fall. Hip protectors have been advocated as a means to reduce the risk of sustaining a fracture in a fall on the hip. To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. We searched the Cochrane Musculoskeletal Injuries Group specialised register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of relevant articles. Identified trialists were contacted. Date of the most recent search: December 2000. All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. In this second update, a further trial has been included to bring the total number of included trials to seven (3553 participants). All studies involved elderly people in nursing homes or residential care or supported living at home, four within the Scandinavian countries, one in Japan, one in the United Kingdom and one in Australia. The three largest studies involving 3210 participants randomised by care unit, nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study lasting only 12 weeks. Summation of results from the other six studies gave an occurrence of hip fractures of 29/1313 (2.2%) for those allocated to wear hip protectors, against 130/2099 (6.2%) to those not allocated to wear protectors. However, due to the large number of participants allocated by cluster randomisation, it was not possible to determine if this difference between groups was statistically significant. No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. Hip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. The generalisation of the results is unknown beyond high-risk populations. Cost effectiveness is unclear. Results from ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.


Paracoccidioidomycosis in organ transplant recipient: case report.
Paracoccidioidomycosis is a common disease in Latin America but it is rare in organ transplant recipient patients. We report on a case of such mycosis in a renal transplant recipient. The patient presented with a large lung cavity on the left lower lobe, a rare radiological presentation of paracoccidioidomycosis. Unusual clinical and radiological manifestations of Paracoccidioides brasiliensis infection can occur in immunocompromised patients.


Hepatitis B seroprevalence among University of Malaya Students in the Post-universal Infant Vaccination Era.
A nationwide HBV vaccination for neonates in the Expanded Programme on Immunization (EPI) was implemented in Malaysia in 1989. The objective of this study was to investigate the prevalence of HBsAg, anti-HBs and anti-HBc among the new student intakes in the Faculties of Medicine and Dentistry, University of Malaya from 2005 to 2011. All new students enrolled for undergraduate and postgraduate courses were screened for HBV infection. Serum samples collected were tested for the presence of HBsAg, anti-HBs and anti-HBc with the use of fully automated analysers. Statistical analyses were done using Open Epi version 2.3.1 The overall HBsAg prevalence among the 2923 new intakes was 0.62%. The HBsAg prevalence rate was 1.08% (15/1390) for those born before 1989 and only 0.20% (3/1533) among those born in or after 1989. By year of testing, HBsAg prevalence declined steadily from 1.27% (5/394) in 2005 to 1.20% (5/418) in 2006, 0.95% (4/421) in 2007, 0.49% (2/410) in 2008, 0.49% (2/407) in 2009 and finally 0% in both 2010 (0/445) and 2011 (0/428). Although 66.14% of those vaccinated during infancy had no demonstrable immunity at the time of screening, only 6 (0.39%) students were found to have anti-HBc, including the 3 who were HBsAg positive. These findings suggested effective prevention of HBV transmission with the universal and voluntary vaccination programs in Malaysia.


In vivo dosimetry with optically stimulated luminescent dosimeters, OSLDs, compared to diodes; the effects of buildup cap thickness and fabrication material.
For external beam in vivo measurements, the dosimeter is normally placed on the patient's skin, and the dose to a point of interest inside the patient is derived from surface measurements. In order to obtain accurate and reliable measurements, which correlate with the dose values predicted by a treatment planning system, a dosimeter needs to be at a point of electronic equilibrium. This equilibrium is accomplished by adding material (buildup) above the detector. This paper examines the use of buildup caps in a clinical setting for two common detector types: OSLDs and diodes. Clinically built buildup-caps and commercially available hemispherical caps are investigated. The effects of buildup cap thickness and fabrication material on field-size correction factors, C(FS), are reported, and differences between the effects of thickness and fabrication material are explained based on physical parameters. Measurements are made on solid water phantoms for 6 and 15 MV x-ray beams. Two types of dosimeters are used: OSLDs, InLight∕OSL Nanodot dosimeters (Landauer, Inc., Glenwood, IL) and a P-type surface diode (Standard Imaging, Madison, WI). Buildup caps for these detectors were fabricated out of M3, a water-equivalent material, and sheet-metal stock of Al, Cu, and Pb. Also, commercially available hemispherical buildup caps made of plastic water and brass (Landauer, Inc., Glenwood, IL) were used with Nanodots. OSLDs were read with an InLight microStar reader (Landauer, Inc., Glenwood, IL). Dose calculations were carried out with the XiO treatment planning system (CMS∕Elekta, Stockholm) with tissue heterogeneity corrections. For OSLDs and diodes, when measurements are made with no buildup cap a change in C(FS) of 200% occurs for a field-size change from 3 cm × 3 cm to 30 cm × 30 cm. The change in C(FS) is reduced to about 4% when a buildup cap with wall thickness equal to the depth of maximum dose is used. Buildup caps with larger wall thickness do not cause further reduction in C(FS). The buildup cap fabrication material has little or no effect on C(FS). The perturbation to the delivered dose caused by placing a detector with a buildup cap on the surface of a patient is measured to be 4%-7%. A comparison between calculated dose and dose measured with a Nanodot and a diode for 6 and 15 MV x-rays is made. When C(FS) factors are carefully determined and applied to measurements made on a phantom, the differences between measured and calculated doses were found to be between ±1.3%. OSLDs and diodes with appropriate buildup caps can be used to measure dose on the surface of a patient and predict the delivered dose to depth dmax in a range of ±1.3% for 100 cGy. The buildup cap: can be fabricated from any material examined in this work, is best with wall thickness dmax, and causes a perturbation to the delivered dose of 4%-7% when the wall thickness is dmax. OSLDs and diodes with buildup caps can both give accurate measurements of delivered dose.


Wnt3 and Gata4 regulate axon regeneration in adult mouse DRG neurons.
Neurons in the adult central nervous system (CNS) have a poor intrinsic axon growth potential after injury, but the underlying mechanisms are largely unknown. Wingless-related mouse mammary tumor virus integration site (WNT) family members regulate neural stem cell proliferation, axon tract and forebrain development in the nervous system. Here we report that Wnt3 is an important modulator of axon regeneration. Downregulation or overexpression of Wnt3 in adult dorsal root ganglion (DRG) neurons enhances or inhibits their axon regeneration ability respectively in vitro and in vivo. Especially, we show that Wnt3 modulates axon regeneration by repressing mRNA translation of the important transcription factor Gata4 via binding to the three prime untranslated region (3'UTR). Downregulation of Gata4 could restore the phenotype exhibited by Wnt3 downregulation in DRG neurons. Taken together, these data indicate that Wnt3 is a key intrinsic regulator of axon growth ability of the nervous system.


[The immediate results of transendoscopic sclerotherapy in hemorrhaging varices, tumors and polyps and in the Mallory-Weiss syndrome].
In 1982 four Japanese authors Okaba, Honda, Toshiba and Asami reported at the International Symposium in Tokyo on successful transendoscopic sclerosification of bleeding ulcer, around which a sclerosifying agent or absolute alcohol was injected with or without epinephrine. Alcohol suppresses bleeding, causing local dehydration, coagulation and sclerosis of the bleeding tissue, thus producing hemostasis. For the last two years the authors have gained some experience in the application of periulcer and peritumor sclerosification with the sclerosifying agent etoxysclerol (3 per cent solution) and pure 96 per cent ethanol + 1 ampoule epinephrine. As regards the bleeding site, patients with the following nosologic entities were treated: gastric ulcer--24 patients; duodenal ulcer--13; gastric cancer--6; anastomotic ulcer--2; acute ulcer--7; Mallory-Weiss syndrome--10 patients. The results may be summarized as follows: temporary hemostasis was achieved in 21 patients, bleeding recurred in 8 and 9 patients required emergency surgery. Complete and ultimate hemostasis was attained in 29 patients (46.7 per cent). Nine patients died of hemorrhage.


Novel Cellulose Acetate-Based Monophasic Hybrid Membranes for Improved Blood Purification Devices: Characterization under Dynamic Conditions.
A novel cellulose acetate-based monophasic hybrid skinned amine-functionalized CA-SiO2-(CH2)3NH2 membrane was synthesized using an innovative method which combines the phase inversion and sol-gel techniques. Morphological characterization was performed by scanning electron microscopy (SEM), and the chemical composition was analyzed by Fourier transform infrared spectroscopy in attenuated total reflection mode (ATR-FTIR). The characterization of the monophasic hybrid CA-SiO2-(CH2)3NH2 membrane in terms of permeation properties was carried out in an in-house-built single hemodialysis membrane module (SHDMM) under dynamic conditions. Permeation experiments were performed to determine the hydraulic permeability (Lp), molecular weight cut-off (MWCO) and the rejection coefficients to urea, creatinine, uric acid, and albumin. SEM confirmed the existence of a very thin (<1 µm) top dense layer and a much thicker bottom porous surface, and ATR-FTIR showed the main bands belonging to the CA-based membranes. Permeation studies revealed that the Lp and MWCO of the CA-SiO2-(CH2)3NH2 membrane were 66.61 kg·h-1·m-2·bar-1 and 24.5 kDa, respectively, and that the Lp was 1.8 times higher compared to a pure CA membrane. Furthermore, the CA-SiO2-(CH2)3NH2 membrane fully permeated urea, creatinine, and uric acid while completely retaining albumin. Long-term filtration studies of albumin solutions indicated that fouling does not occur at the surface of the CA-SiO2-(CH2)3NH2 membrane.


Crystal-plane-dependent effects of antifreeze glycoprotein impurity for ice growth dynamics.
An impurity effect on ice crystal growth in supercooled water is an important subject in relation to ice crystal formation in various conditions in the Earth's cryosphere regions. In this review, we consider antifreeze glycoprotein molecules as an impurity. These molecules are well known as functional molecules for controlling ice crystal growth by their adsorption on growing ice/water interfaces. Experiments on free growth of ice crystals in supercooled water containing an antifreeze protein were conducted on the ground and in the International Space Station, and the normal growth rates for the main crystallographic faces of ice, namely, basal and prismatic faces, were precisely measured as functions of growth conditions and time. The crystal-plane-dependent functions of AFGP molecules for ice crystal growth were clearly shown. Based on the magnitude relationship for normal growth rates among basal, prismatic and pyramidal faces, we explain the formation of a dodecahedral external shape of an ice crystal in relation to the key principle governing the growth of polyhedral crystals. Finally, we emphasize that the crystal-plane dependence of the function of antifreeze proteins on ice crystal growth relates to the freezing prevention of living organisms in sub-zero temperature conditions. This article is part of the theme issue 'The physics and chemistry of ice: scaffolding across scales, from the viability of life to the formation of planets'.


Production and characterization of monoclonal antibodies to the subunits of human phosphofructokinase: new tools for the immunochemical and genetic analyses of isozymes.
Recently we have demonstrated that human phosphofructokinase (PFK; ATP: D-fructose-6-P, 1-phosphotransferase; EC.188.8.131.52) is under the control of three structural loci that code for M (muscle-type), L (liver-type), and P (platelet-type) subunits: random tetramerization of these subunits produces various isozymes. In this study, we have produced and characterized BALB/c hybridoma antibodies to the M- and L-type subunits of human PFK. The specific antibodies were detected by an enzyme-immunoprecipitation assay using Staphylococci-bearing protein A as an immunoadsorbent. Of the wells tested using red blood cell (RBC) PFK (M + L), 61% were positive. Only one M-specific hybridoma was identified. The one anti-M and 4 anti-L antibodies were characterized for their biochemical and immunochemical specificities. To define the combining specificities of these antibodies, we compared their reactivity and that of monospecific rabbit anti-M antiserum with muscle and liver PFKs from 15 different vertebrate species. The rabbit anti-M shows strong cross-reactivity with the muscle PFKs from all the species studied. In contrast, the monoclonal anti-M reacts exclusively with muscle PFKs from primates. Two of four anti-L antibodies react only with human L-PFK, whereas the other two react with that from a few other vertebrate species as well. Taken together, these data suggest that primate-specific antibodies recognize evolutionarily, recently acquired antigenic determinants, whereas the antibodies reactive with PFKs from distantly related species recognize conserved determinants. The differential immunoreactivities of muscle and liver PFKs strongly suggest the presence of distinct isozymes in all the vertebrate species studied. These studies demonstrate that it is feasible to produce and characterize monoclonal antibodies that distinguish among isozymes with structural and functional similarities. These antibodies provide sensitive tools in the analyses of isozyme structure, genetics, and related fields.


Lung delivery of aerosolized dextran.
The ability of nebulizers to deliver dextran (nominal molecular mass, 4,000 g/mol) to the lung as an inhaled aerosol is evaluated by in vitro experimental methods and mathematical models. Dextran in isotonic saline was aerosolized by four nebulizer types (Pari LC STAR, Hudson T-Updraft II, Acorn II, and Sonix 2000) at dextran concentrations </= 400 mg/ml and with 2.5- and 4-ml volume fills. Aerosols inhaled during breath simulation were characterized by in-line phase Doppler anemometry, filter collection, osmometry, and gravimetry. Mathematical models were used to estimate amounts of the characterized aerosols depositing in the different regions of lung models, and mathematical models of mucous thickness were then developed to estimate initial concentrations of the depositing dextran in the mucus of each conducting airway generation. Models of three subjects (4 yr old, 8 yr old, and adult) were used. The high viscosity of the dextran solutions tested (up to seven times that of water) negatively impacts nebulization, and results in poor performance with most delivery systems tested. Our results suggest that airway mucosal dextran concentrations associated with efficacy in previous animal and in vitro models are achievable with reasonable delivery times (</= 12 min) with only one of the delivery systems/formulations tested: the Pari LC STAR nebulizer, using a 2. 5-ml volume fill and a dextran concentration of 200 mg/ml.


3-pyridylcarbene and 3-pyridylnitrene: ring opening to nitrile ylides.
Photolysis of 3-pyridyldiazomethane in an Ar matrix at 7-10 K gives 3-pyridylcarbene. Further photolysis causes ring opening to nitrile ylide 26 (formonitrile pent-2-en-4-ynylide) as the major reaction together with a minor amount of ring expansion to 1-azacyclohepta-1,3,4,6-tetraene, 27. Matrix photolysis of 3-azidopyridine leads to ring opening to formonitrile N-cyanovinylmethylide, 33.


Application of Multiple Linear Regression and Extended Principal-Component Analysis to Determination of the Acid Dissociation Constant of 7-Hydroxycoumarin in Water/AOT/Isooctane Reverse Micelles.
The apparent pK(a) of dyes in water-in-oil microemulsions depends on the charge of the acid and base forms of the buffers present in the water pool. Extended principal-component analysis allows the precise determination of the apparent pK(a) and of the spectra of the acid and base forms of the dye. Combination with multiple linear regression increases the precision. The pK(a) of 7-hydroxycoumarin (umbelliferone) was spectrophotometrically measured in a water/AOT/isooctane microemulsion in the presence of a series of buffers carrying different charges at various different water/surfactant ratios. The spectra of the acid and base forms of the dye in the microemulsion are very similar to those in bulk water in the presence of Tris and ammonia. The presence of carbonate changes somewhat the spectrum of the acid form. Results are discussed taking into account the profile of the electrostatic potential drop in the water pool and the possible partition of umbelliferone between the aqueous core and the surfactant. The pK(a) values corrected for these effects are independent of w(0) and are close to the value of the pK(a) in bulk water. Copyright 2000 Academic Press.


Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning.
Previous research has shown that reading ability is a stronger predictor of cognitive functioning than years of education, particularly for African Americans. The current study was designed to determine whether the relative influence of literacy and education on cognitive abilities varies as a function of race or socioeconomic status (SES). We examined the unique influence of education and reading scores on a range of cognitive tests in low- and higher-SES African Americans and Whites. Literacy significantly predicted scores on all but one cognitive measure in both African American groups and low-SES Whites, while education was not significantly associated with any cognitive measure. In contrast, both education and reading scores predicted performance on many cognitive measures in higher-SES Whites. These findings provide further evidence that reading ability better predicts cognitive functioning than years of education and suggest that disadvantages associated with racial minority status and low SES affect the relative influence of literacy and years of education on cognition.


Acrylamide inhibits nerve sprouting induced by botulinum toxin type A.
Botulinum toxin type A is a potent muscle relaxant that blocks the transmission and release of acetylcholine at the neuromuscular junction. Intramuscular injection of botulinum toxin type A has served as an effective and safe therapy for strabismus and focal dystonia. However, muscular weakness is temporary and after 3-4 months, muscle strength usually recovers because functional recovery is mediated by nerve sprouting and reconstruction of the neuromuscular junction. Acrylamide may produce neurotoxic substances that cause retrograde necrotizing neuropathy and inhibit nerve sprouting caused by botulinum toxin type A. This study investigated whether acrylamide inhibits nerve sprouting after intramuscular injection of botulinum toxin type A. A tibial nerve sprouting model was established through local injection of botulinum toxin type A into the right gastrocnemius muscle of Sprague-Dawley rats. Following intramuscular injection, rats were given intraperitoneal injection of 3% acrylamide every 3 days for 21 days. Nerve sprouting appeared 2 weeks after intramuscular injection of botulinum toxin type A and single-fiber electromyography revealed abnormal conduction at the neuromuscular junction 1 week after intramuscular injection of botulinum toxin type A. Following intraperitoneal injection of acrylamide, the peak muscle fiber density decreased. Electromyography jitter value were restored to normal levels 6 weeks after injection. This indicates that the maximal decrease in fiber density and the time at which functional conduction of neuromuscular junction was restored were delayed. Additionally, the increase in tibial nerve fibers was reduced. Acrylamide inhibits nerve sprouting caused by botulinum toxin type A and may be used to prolong the clinical dosage of botulinum toxin type A.


Understanding of hazardous waste incineration through computational fluid-dynamics simulation.
Rotary kiln incinerators are widely used in the incineration of hazardous wastes of various types. However, the complex transport and chemical processes within the kiln system are still not well understood. The complete destruction of hazardous compounds depends very much on gas mixing behavior of different air and waste streams, the distribution of gas temperature and residence time within the kiln and the secondary combustion chamber (SCC). Due to large variations of waste types and difficulties in feed characterization (physical, chemical and thermal properties), the incineration process meets great challenges in a smooth operation, with substantial fluctuations of gas temperatures within the system. The temperature fluctuations lead to uncertainties in the process chemistry and difficulties in emission control. The newly enforced regulations from the European Union with stricter emission levels require a better understanding of the incineration process and improved process control for lower emissions and a better environmental impact. In order to get better understanding of the incineration process within the rotary kiln system, research was carried out to study the kiln behavior in relation to better process control. One of the focuses was on the process simulation by using Computational Fluid-dynamics (CFD) to characterize gas flow, temperature distribution and waste combustion in the rotary kiln incinerator. Temperature measurement of the operating rotary kiln incinerator at AVR-Chemie, located at the Rotterdam harbor in The Netherlands, was conducted to validate the CFD model and to provide the information to kiln operators at AVR. This paper will address the environmental issues related to the hazardous waste incineration, and summarize the results from the current research project for the simulation of gas flow and mixing, combustion heat transfer, and new ideas to use CFD simulation results for process control of an incineration plant.


Five years after development of the national disability, health and rehabilitation plan for Ukraine: Achievements and challenges.
In 2015, technical consultation to support development of the National Disability, Health and Rehabilitation Plan in Ukraine was carried out by the Rehabilitation Advisory Team of the International Society of Physical and Rehabilitation Medicine. Recommendations for actions and projects to improve rehabilitation services within the healthcare system in Ukraine were developed, proposed and implemented. The achieve-ments in the subsequent 5 years include establishing, training and enabling employment at health-care facilities for new rehabilitation professionals (physical and rehabilitation medicine physi-cians, physical therapists, occupational therapists), commencing implementation of the International Classification of Functioning, Disability and Health (ICF), and increasing rehabilitation knowledge among Ukrainian communities and decision-makers. The main challenges include inappropriate healthcare legislation for developing modern rehabilitation services, gaps in the clinical environment and quality control for training rehabilitation professionals, and the slow pace of implementation of the ICF. A gen-eral facilitator is the ongoing healthcare reform in Ukraine, especially its continuation to secondary and tertiary healthcare levels. Future high-priority activ-ities will include amendments to basic healthcare legislation, and introducing a bio-psycho-social approach for the provision of rehabilitation services at all healthcare levels and all rehabilitation treatment phases, starting with the most debilitating health conditions. It will be important to continue collaboration with European and international partners.


Trends in Legionnaires' Disease-Associated Hospitalizations, United States, 2006-2010.
Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires' disease-associated hospitalization in the United States. In this study, we estimated the annual incidence of Legionnaires' disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires' disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in short-stay hospitals in the United States, excluding federal, military, and Veterans Administration hospitals. All discharges assigned with the Legionnaires' disease International Classification of Diseases 9th Clinical Modification discharge diagnostic code (482.84) were included in this study. We observed the annual incidence and number of Legionnaires' disease-associated hospitalizations (per 100 000 population) in the United States by year, age, sex, race, and region. Over a 5-year period, 14 574 individuals experienced Legionnaires' disease-associated hospitalizations in the United States The annual population-adjusted incidence (per 100 000 population) of Legionnaires' disease-associated hospitalizations was 5.37 (95% confidence interval [CI], 5.12-5.64) in 2006, 7.06 (95% CI, 6.80-7.40) in 2007, 8.77 (95% CI, 8.44-9.11) in 2008, 17.07 (95% CI, 16.62-17.54) in 2009, and 9.66 (95% CI, 9.32-10.01) in 2010. A summer peak of Legionnaires' disease-associated hospitalizations occurred from June through September in 2006, 2007, 2008, and 2010. Legionnaires' disease-associated hospitalizations significantly increased over the 5-year study period. The increasing disease burden of Legionnaires' disease suggests that large segments of the US population are at risk for exposure to this waterborne pathogen.


Electroacupuncture Versus Analgesics for Patients with Stage IIIB Cervical Cancer Post Cisplatin Chemotherapy.
Background: The prevalence of pain at advanced cervical cancer stages is increasing. Existing World Health Organization recommendations for management comprises a 3-step ladder of analgesic therapy but this still cannot address this pain optimally. An alternative therapy used to reduce pain, acupuncture, is almost without side-effects, is safe, and is easy to implement. This study compared electroacupuncture (EA) versus paracetamol 500 mg +10-mg codeine therapy for patients with stage-IIIB cervical cancer post cisplatin chemotherapy. Materials and Methods: Participants were divided into 2 groups (treatment and control groups). A quasiexperimental study was conducted using a nonequivalent control group pretest-post-test design. Participants in the treatment group were given EA for 30 minutes 10 times over 3 weeks, while participants in the control group were given paracetamol 3 × 500 mg and codeine 3 × 10 mg orally every day for 3 weeks. Statistical analysis used paired t-tests, a Wilcoxon test, an independent t-test, or a Mann-Whitney-U test with P < 0.05. Results: Pretest and post-test pain-scale levels were 5.39 ± 0.62 and 4.57 ± 0.88, respectively (P < 0.001). Average endorphin-β levels at pretest and post-test were 571.80 ± 281.13 and 491.14 ± 272.14, respectively (P = 0.818). Median values of quality of life at pretest and post-test were 681.75 (range: 503.80-915.20) and 635.25 (range: 538.20-781.20; P = 0.383), respectively. Conclusions: Pain-control therapy using drugs or EA produces similar results. However, EA, subjectively, produces improved pain-scale results better than pharmaceuticals.


Populations do not become less genetically diverse or more differentiated towards the northern limit of the geographical range in clonal Vaccinium stamineum (Ericaceae).
Geographically peripheral populations are expected to exhibit lower genetic diversity and higher differentiation than central populations because of their smaller size and greater spatial isolation. In plants, a shift from sexual to clonal asexual reproduction may further reduce diversity and increase differentiation. Here, these predictions were tested by assaying 36 inter-simple sequence repeat (ISSR) polymorphisms in 21 populations of the woody, clonal plant Vaccinium stamineum in eastern North America, from the range center to its northern limit where it has 'threatened' status. Populations decline in frequency, but not size or sexual reproductive output, across the range. Within-population diversity did not decline towards range margins. Modest genetic differentiation among populations increased slightly towards range margins and in small populations with high clonal propagation and low seed production, although none of these trends was significant. Low seed production and high clonal propagation were not associated with large-scale clonal spread. By combining demographic and genetic data, this study determined that increased population isolation, rather than reduced population size, can account for the weak increase in genetic differentiation at range margins.


Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review.
Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.


Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery.
Cardiac surgery is frequently associated with prolonged endotracheal intubation. Because oral feeding is an important component of patient recovery after high-risk surgery, we sought to examine the contribution of dysphagia in the recuperation process after prolonged endotracheal intubation. All 254 adult patients who survived cardiac surgery between 2001 and 2004 at the Toronto General Hospital and in whom endotracheal intubation lasted for 48 hours or longer were eligible for our retrospective review. We used multivariate regression analysis and parametric modelling to identify patient-specific characteristics associated with postextubation dysphagia and the subsequent resumption of normal oral feeding. Dysphagia was diagnosed in 130 (51%) patients. Incremental factors associated with an increased risk for postextubation dysphagia included duration of endotracheal intubation (p < 0.001), the occurrence of a perioperative cerebrovascular event (p = 0.014) and the presence of perioperative sepsis (p = 0.016). Neither preoperative patient risks nor index procedural characteristics were influential factors. The occurrence of dysphagia (p < 0.001) and the duration of endotracheal intubation (p < 0.001) were the only independent factors associated with a delayed return to normal oral feeding. In contrast, several independent factors were associated with a delay to hospital discharge, including the presence of dysphagia (p < 0.001), occurrence of perioperative stroke (p < 0.001), duration of endotracheal intubation (p < 0.001) and number of endotracheal intubation events (p < 0.006). Dysphagia is more common in patients with prolonged endotracheal intubation after cardiac surgery than has previously been reported. The duration of postoperative endotracheal intubation is a strong predictor of subsequent dysphagia that both prolongs the return to normal oral feeding and delays subsequent hospital discharge. Patient-or procedure-specific factors are not good predictors. To accelerate discharge of high-risk patients, aggressive nutritional supplementation should pre-empt extubation and swallowing surveillance should follow.


Body dysmorphic disorder in patients with an eating disorder: prevalence and characteristics.
Body dysmorphic disorder (BDD), an abnormal preoccupation with perceived defects in one or more body parts, and eating disorders (ED) share several essential clinical features, making it sometimes difficult to differentiate between the two disorders. The aims of this study were to assess the prevalence of BDD in patients with ED and to compare characteristics of ED patients with and without BDD. We measured dysmorphic appearance concerns and behaviors, ED symptoms, general psychopathology, and quality of life in 158 patients seeking treatment for ED. Forty-five percent screened positive for BDD. Patients with both disorders (ED + BDD) had significantly more dysmorphic appearance concerns, had more psychopathology, and were dissatisfied with a larger number of body parts than patients with ED only. The differences remained significant even after correcting for severity of eating disorder psychopathology. This finding suggests that BDD is a distinct comorbid disorder in almost half of the patients with ED. It is thus important to recognize and treat the manifestation of BDD in patients with both disorders. Given that the treatment of BDD is different from that of ED, it is important to recognize BDD.


The Polygenic Map of Keloid Fibroblasts Reveals Fibrosis-Associated Gene Alterations in Inflammation and Immune Responses.
Due to many inconsistencies in differentially expressed genes (DEGs) related to genomic expression changes during keloid formation and a lack of satisfactory prevention and treatment methods for this disease, the critical biomarkers related to inflammation and the immune response affecting keloid formation should be systematically clarified. Normal skin/keloid scar tissue-derived fibroblast genome expression data sets were obtained from the Gene Expression Omnibus (GEO) and ArrayExpress databases. Hub genes have a high degree of connectivity and gene function aggregation in the integration network. The hub DEGs were screened by gene-related protein-protein interactions (PPIs), and their biological processes and signaling pathways were annotated to identify critical biomarkers. Finally, eighty-one hub DEGs were selected for further analysis, and some noteworthy signaling pathways and genes were found to be closely related to keloid fibrosis. For example, IL17RA is involved in IL-17 signal transduction, TIMP2 and MMP14 activate extracellular matrix metalloproteinases, and TNC, ITGB2, and ITGA4 interact with cell surface integrins. Furthermore, changes in local immune cell activity in keloid tissue were detected by DEG expression, immune cell infiltration, and mass CyTOF analyses. The results showed that CD4+ T cells, CD8+ T cells and NK cells were abnormal in keloid tissue compared with normal skin tissue. These findings not only support the key roles of fibrosis-related pathways, immune cells and critical genes in the pathogenesis of keloids but also expand our understanding of targets that may be useful for the treatment of fibrotic diseases.


Antidepressants: knowledge and use among nursing students.
This study examined the knowledge of nursing students in regard to using antidepressant medication and proposes actions such that nurses contribute to a safe and effective antidepressant therapy. This cross-sectional and descriptive study was conducted in a public nursing school in the state of São Paulo, Brazil, between March and November 2008. Fifty-two (19%) out of the 273 participants were using or had used antidepressants. Instruction concerning the use of antidepressants was provided by physicians. Even after receiving instruction concerning the antidepressant treatment before its administration, the majority of users (chi(1)2=0.07, p> 0.05) still had doubts about its use. Fluoxetine was the most prevalent antidepressant. Actions to improve knowledge concerning the use of antidepressant medications, their side and therapeutic effects, seem to be necessary and relevant.


Electro-microchip DNA-biosensor for bacteria detection.
This paper presents a bacteria biosensor based on DNA hybridization detection with an electro-microchip transducer. Acinetobacter baumannii was chosen as DNA sample source, because the occurrence of bacteremia caused by Acinetobacter baumannii is high in hospitals worldwide. Our strategy is based on DNA hybridization of PCR amplified bacteria DNA with biotin labelled primers and detection enhancement using gold-streptavidin nanoparticles and Ag(+)-hydroquinone solution. Gold nanoparticles catalyze silver ions reduction by hydroquinone. The gradually precipitated silver metal between the two electrodes of the electro-microchip allows electrons to pass. The detection limit for Acinetobacter baumannii genomic DNA sample is 0.825 ng mL(-1) (1.2 fM). Probe specificity was investigated by screening various species of bacteria, various strains of a single species and various species of a single genus. The proposed DNA hybridization method is easy, convenient, and rapid. Moreover, it has potential applications in detection of bacteria causing infections and clinical diagnosis.


Recent Epidemiological Changes in Group B Streptococcus Among Pregnant Korean Women.
Although group B Streptococcus (GBS) colonization rate among pregnant Korean women is lower than that among women from many Western countries, recent data show an upward trend. We investigated recent epidemiological changes in GBS among pregnant Korean women in terms of colonization rate, antimicrobial susceptibility, serotype, and resistance genotype. Vaginal and anorectal swab specimens from 379 pregnant Korean women were cultured on Strep B Carrot Broth with GBS Detect (Hardy Diagnostics, USA), selective Todd-Hewitt broth (Becton Dickinson, USA), and Granada agar plate medium (Becton Dickinson). The antimicrobial susceptibility, serotypes, and macrolide-lincosamide-streptogramin B (MLSB) resistance genes of the GBS isolates were tested. The GBS colonization rate among pregnant Korean women was 19.8% (75/379). Colonization rates using Strep B Carrot Broth with GBS Detect, selective Todd-Hewitt broth, and Granada agar plate medium cultures were 19.5%, 19.3%, and 15.0%, respectively. Six pregnant women were colonized by non-beta-hemolytic GBS and were detected only in Strep B Carrot Broth with GBS Detect. Resistance rates of GBS to clindamycin, erythromycin, and tetracycline were 16.0%, 28.0%, and 42.7%, respectively. The most common GBS serotypes were V (22.7%), VIII (20.0%), and III (20.0%). The frequency of MLSB resistance genes erm(B) and erm(TR) were 63.6% and 36.4%, respectively. The GBS colonization rate among pregnant Korean women has risen to levels observed in Western countries. To accurately evaluate GBS epidemiology among pregnant Korean women, periodic studies in multiple centers, including primary clinics, are necessary.


Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea.
Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA. After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture. Of the 58 patients completed the study, 38 patients had OSA (apnea hypopnea index [AHI] >5) with median preoperative AHI of 18 events per hour and 20 non-OSA patients had median preoperative AHI of 2. AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery. Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.


Effects of diet, exercise and anorexigenic drugs on serum thyroid hormones.
The serum levels of T4, T3 and rT3 were estimated in moderately obese women treated with diet (900-1000 kcal) and 4 h of exercise, supplemented with placebo or anorexigenic drugs (phenmetrazine, phentermine and mazindol). After 12 days of treatment, no change in serum T4 occurred in the placebo group (-4%), while in the groups with anorexigenic drugs a significant rise of T4 was observed (phenmetrazine +33%, phentermine +14% and mazindol +20%). Serum T3 decreased significantly in the placebo and the anorexigenic groups to a similar extent (from -21% to -27%) with the exception of mazindol. We did not notice any decrease of T3 in this group (-3%). A rising trend of serum rT3 was observed in all 4 groups, with a statistical significance for mazindol only. It is suggested that 1) a combined energy deficit produced by diet and exercise leads to a pattern of serum thyroid hormones similar to that observed in resting patients on a total fast; 2) the rise of serum T4 after the administration of anorexigenic drugs is due to their sympathomimetic effects; 3) the largest weight decrease observed in the mazindol group (6.7 kg) may be due to the unchanged serum T3 level, while in the other groups a decrease of serum T3 was observed. The lowest weight loss was observed in the placebo group (4.9 kg) with a pronounced decrease of T3 (-24%).


High-Quality Draft Single-Cell Genome Sequences of Two Gammaproteobacteria Strains Sampled from Soil in a Strawberry Farm.
Here, we present high-quality draft single-cell genome sequences of Gammaproteobacteria strains BBSC-SA01 and BBSC-SA02, obtained from uncultivated cells of soil in a strawberry farm using the single-cell sequencing platform bit-MAP. These draft genomes putatively represent novel species within Gammaproteobacteria and allow further investigation into the soil microbiome.


Biomarkers in congenital heart disease.
The population of adults with congenital heart disease (CHD) now exceeds the population of children with CHD. The long-term management of these patients relies on sequential assessment of anatomy and physiology and integration with symptoms, all targeted toward decision making around intervention. The advances in technology have vastly improved our assessment of anatomy and function. However, while the assessment of chronic heart failure in acquired heart disease has been revolutionized by the proven utility of cardiac biomarkers, their use in adult CHD is still being assessed.


Faunistic inventory and zoogeographical analysis of the ground beetles (Coleoptera, Carabidae) of Garf Raydah Nature Reserve, Southwestern of Saudi Arabia, and description of a new species of Paussinae.
Study of ground beetles of the Garf Raydah Nature Reserve, located in the Asir Mountains of southwestern Kingdom of Saudi Arabia (KSA) resulted in one species, Paussus abditus Nagel, sp. n. described as new to science. Thirteen species (21.3%) are reported as new country records and fifteen species (24.6%) are new records for Asir Province. Adult beetles were collected from 2013 to 2017. The determination of this material yielded a total of 61 species in 40 genera and 17 tribes belonging to nine subfamilies of Carabidae. The species richness represented approximately 36.1% of carabid species previously reported from KSA. The most species rich tribes were the Lebiini (20 species), the Harpalini (10 species), and the Bembidiini (6 species). The life form analysis of adults indicated 18 life form types that are grouped into three categories, Zoophagous (77.1%), Mixophytophagous (18.0%), and Myrmecophilous (4.9%). Zoogeographical analyses indicated that the Afrotropical (19.3%) and the Saharo-Arabian (19.3%) species dominate the carabid fauna of this region of KSA. Coryza cf. maculata (Nietner, 1856) is considered the only Oriental representative. Only one cosmopolitan species, Perigona nigriceps (Dejean, 1831), was collected. Eleven endemics were identified; six species are considered KSA endemics and five are Arabian Peninsula endemics.


Differential effects of cortical lesions in humans.
The best-known example of motor deficits after cortical lesions is contralateral paresis and spasticity after damage to the precentral motor strip. After recovery the residual motor functions can be used in a purposive and skillful manner. In patients with lesions of the supplementary motor area (SMA) and cingulate gyrus transient akinesia and mutism have been described. Lesions restricted to more lateral parts of the premotor field interfere with proximal muscle function and interlimb coordination, whereas distal motor activity and bimanual coordination are unimpaired. In contrast, hand function in patients with parietal lesions is severely disturbed. This dysfunction includes deficits such as ataxia, dysmetria and postural instability that are typically observed in deafferented patients. Severe disturbances of the purposive behaviour of the hand during exploratory finger movements and manipulation of objects are seen in patients with posterior parietal lesions. Observations in human patients are compatible with the hypothesis that lesions of the frontal agranular motor fields interfere with the control of postural and force control whereas parietal lesions are associated with motor programme disorders affecting the use of the hand or the eye as a sense organ or affecting more complex motor behaviour.


The level of connective tissue growth factor in sera of patients with hepatitis B virus strongly correlates with stage of hepatic fibrosis.
Connective tissue growth factor (CTGF) plays a crucial role in the formation and development of hepatic fibrosis. The aim of this study was to establish a method for CTGF determination in order to investigate the level of CTGF in the sera of patients with hepatitis B virus, and to assess the correlation between CTGF concentration and stage of hepatic fibrosis. A CTGF C-terminal region gene was obtained by RT-PCR of human mesangial kidney cells and inserted into pET-32a((+)) vector. Recombinant protein was obtained by expression and purification of the fused protein. Polyclonal and monoclonal antibodies were prepared to establish a sandwich ELISA method. CTGF levels in 18 healthy serum samples and 83 serum samples from patients with hepatitis B virus were assessed. A simple, sensitive, and noninvasive method of determining CTGF levels was successfully established. CTGF levels in the sera of patients with hepatitis B were significantly increased compared controls (p < 0.001). There was a strong correlation between CTGF concentration and fibrotic stage (r = 0.8906, p < 0.005). No significant association was found between CTGF level and the grade of hepatic inflammation (p > 0.05). The area under the receiver operating characteristic (ROC) curves of CTGF was 0.681 for identification of significant fibrosis, and 0.759 for the diagnosis of middle- and late-stage fibrosis. Accuracy of CTGF assessment was independent of age, renal function, liver function, platelet count, or other biochemical markers of liver fibrosis (all p > 0.05). No significant correlation was found between CTGF and several humoral factors associated with liver fibrosis (all p > 0.05). The levels of CTGF in the sera of patients with hepatitis B were strongly associated with the stages of hepatic fibrosis, and CTGF may become a useful diagnostic aid in assessing hepatic fibrosis.


Strengthening Communication and Collaboration in the Fragmented German Healthcare System: A Mixed-Method Evaluation of an Interdisciplinary Network for Parkinson's Disease.
To improve Parkinson's disease (PD) care, interdisciplinary and patient-centered treatment is mandatory. A key problem in many healthcare systems is the limited and unspecific communication among different healthcare professionals. Optimal collaboration between various professionals involved is indispensable. Parkinson's Network Münsterland + (PNM +) is an interdisciplinary network of medical and non-medical experts involved in the treatment of PD patients in Germany. The aim of this evaluation was to analyze the network structures of PNM+ as well as communication and collaboration between PNM + partners. A mixed methods approach was applied consisting of a social network analysis, a validated questionnaire on team effectiveness and semi-structured interviews focusing on perceived barriers and supportive aspects of PNM + . Quantitative and qualitative data suggested increased collaboration between professionals within PNM + . The reciprocity of connections was 0.522 in the network of professional contacts. Regular exchanges in terms of interdisciplinary panel meetings and working groups stimulated knowledge transfer, leading to greater specialization of general neurologists and therapists in PD. The progressive density of the network from 0.136 to 0.279 illustrates the growing cooperation of PNM + partners. Interviewed partners requested more patient-specific collaboration but expected this to happen as the network evolved. Overall, PNM + has already improved both diagnosis and therapy thanks to knowledge transfer. Structured treatment recommendations helped to improve communication between healthcare professionals. PNM+ stimulated exchange between different healthcare professionals involved in the treatment of PD patients. This overcomes specific barriers within Germany's highly fragmented healthcare system, such as the lack of communication between these disciplines.


Acute myeloid leukemia relapsing as gynecomastia.
Granulocytic sarcoma (GS) is an increasingly common relapse feature of acute myeloid leukemia (AML), late in the disease course or post bone marrow transplantation (BMT). Any solid organ can be affected, and there have been a number of reports of GS in breast tissue in female patients. We present a unique case of GS in a male AML patient, presenting as painless gynecomastia immediately before BMT at advanced disease. Aberrant expression of CD56 was found in the relapsed GS tissue but not in the original AML clone. Twelve months after allogeneic BMT, leukemia relapsed again in the same breast, with normal marrow morphology and full donor chimerism. The lesion failed to respond to donor lymphocyte infusion, chemotherapy and radiotherapy, and disseminated to other subcutaneous tissues.


A new cognate aptamer pair-based sandwich-type electrochemical biosensor for sensitive detection of Staphylococcus aureus.
A pair of aptamers for Staphylococcus aureus (S. aureus) is immensely needed for developing sandwich-type signal-on electrochemical aptasensors. In this study, we have successfully developed a cognate pair of aptamers that bind to S. aureus simultaneously, among many aptamer candidates screened out after a total of ten rounds of bacterial cell-based systemic evolution of ligands by exponential enrichment (SELEX). The obtained aptamer candidates have been estimated by using flow cytometry and confocal microscope, to evaluate their binding affinity and specificity to the target cells. The screening for sandwich-type binding of cognate pair of aptamers with S. aureus was conducted by enzyme-based colorimetric assay and confirmed by circular dichroism (CD), two-color fluorescence imaging analysis, additionally. The cognate pair of two aptamers, named SA37 and SA81, showed very good affinity and specificity to S. aureus with their dissociation constants (Kd) of 16.5 ± 3.4 nM and 14.47 ± 8.18 nM, respectively. These newly discovered cognate pair of aptamers have been very successfully implemented to develop a sandwich-type signal-on electrochemical biosensor with the limit of detection (LOD) of 39 CFUs and 414 CFUs in buffer and spiked tap water samples, respectively. This study showed that this cognate pair of aptamers-based detection of S. aureus enables simple, rapid, and robust biosensors for food safety management.


Association of daytime napping with incident cardiovascular disease in a community-based population.
To investigate the association between self-reported daytime napping habits and cardiovascular disease (CVD) in a large community-based study population. Of the 4170 participants, 55.5% were women and the mean age was 63.1 years (SD, 11.0 years). CVD included cardiovascular death, congestive heart failure, myocardial infarction, stroke, angina, and revascularization and was defined as the first confirmed incidence of CVD during an average 11-year follow-up. Self-reported daytime napping habits were recorded using baseline questionnaires. Backward stepwise Cox regression analysis was used to explore the relationship between CVD and napping habits. In this study, 914 participants with CVD (21.9%) were observed. Participants who took regular long naps had a higher prevalence of incident CVD than did those who took regular short naps, irregular naps, or no naps (34.5% vs. 28.4%, 22.4%, 16.6%, respectively; P < 0.001). In the final backward stepwise Cox regression model, regular long naps were found to be associated with CVD (HR: 1.403, 95% CI: 1.079-1.825, P = 0.012). Regular long daytime napping was an independent risk factor for CVD. Healthy sleep habits may promote human health and prevent CVD. ClinicalTrials.gov Identifier: NCT00005275.


Disturbance of purine nucleotide metabolism: a possible early key event in development of intestinal damage induced by chemotherapy.
Protective strategies to minimize the hematological toxicity in connection with bone marrow transplantation (BMT) have been successful, but toxicity to the gastrointestinal tract prevents further dose escalation and therefore limits the application of the treatment. As it is known that chemotherapy leads to disruption of the intestinal barrier and morphological changes of mitochondria in enterocytes, this study was conducted in order to investigate intestinal energy metabolism and permeability after intensive cytotoxic therapy in rats. Intestinal damage was produced by intraperitoneal administration of the cytostatic etoposide. Intestinal permeability was assessed by a [51Cr]EDTA absorption test and intestinal purine nucleotide content by a high-performance liquid chromatography (HPLC) technique. Four hours after the administration of etoposide, and the next 48 hr, there was a significant increase in the intestinal permeability (P < 0.05) and a significant reduction of the purine nucleotide content in the intestinal epithelial cells (P < 0.01) as compared to control animals. This early disturbance in enterocyte energy metabolism may be a key event in the development of the intestinal damage, induced by chemotherapy, and an explanation for the early disruption of the intestinal barrier demonstrable before morphological changes are evident.


Effects of Extractives on Dimensional Stability, Dynamic Mechanical Properties, Creep, and Stress Relaxation of Rice Straw/High-Density Polyethylene Composites.
The removal of rice straw extractives increases the interphase adhesion between rice straw and the high-density polyethylene (HDPE) matrix, while eradicating the inner defects of rice straw/HDPE composites. This study investigated the effect of rice straw extractives removal on the dimensional stability (water uptake and thermal expansion), dynamic mechanical properties, creep, and stress relaxation of rice straw/HDPE composites. Cold water (CW), hot water (HW), and 1% alkaline solution (AL) extraction methods were utilized to remove rice straw extractives. Extracted and unextracted rice straws were mixed with HDPE, maleated polyethylene (MAPE), and Polyethylene wax to prepare composites via extrusion. Removal of rice straw extractives significantly improved the dimensional stability, dynamic mechanical properties, and creep and stress relaxation of rice straw/HDPE composites, with the exception of the thickness swelling of the AL/HDPE and the thermal expansion of the rice straw/HDPE composites. HW/HDPE exhibited the best comprehensive performance.


Genetics of Legionella pneumophila.
Legionella pneumophila is a facultative intracellular pathogen capable of entering and growing in a variety of phagocytic cells including free-living amoebae as well as alveolar macrophages and monocytes. A genetic analysis of L. pneumophila should facilitate the identification of bacterial factors that promote the intracellular lifestyle of this organism.


Behavioral treatments for pediatric feeding disorders.
The effectiveness of behavioral interventions for pediatric feedings problems has been well documented. However, the application of these procedures in the real world is often more complex and difficult than research reports reveal. Multiple factors such as the child's medical condition and history, medical monitoring requirements, and the need to adjust treatment procedures as intervention progresses make it difficult to follow the best-laid plans developed from reading structured and highly controlled experimental applications. This article details factors to be considered in the actual clinical-based application of behavioral procedures in the treatment of pediatric feeding problems. A description of how referrals are generated and initial assessment is conducted, and a model for inpatient treatment is presented. In addition, the need for efficient and effective treatment in the real world is stressed.


The impact of regular ecstasy use on memory function.
To assess memory impairment in a group of regular users of ecstasy compared with a group of regular users of cannabis, after accounting for possible confounding factors such as other drug use, premorbid intelligence and psychopathology. Comparative and regression analysis was used to determine the presence or absence of a difference in memory function between 40 regular ecstasy users and 37 regular users of cannabis, who were interviewed at the National Drug and Alcohol Research Centre in Sydney, Australia. Regression analysis was used to find associations between life-time exposure to ecstasy use and memory performance. Memory function was assessed using an age-standardized memory test. Other scales were used to assess premorbid intelligence, physical and psychological health, drug withdrawal and other drug use. Initial comparative analysis showed a trend towards a significantly poorer performance by the regular ecstasy-using group on the 'auditory immediate memory' and 'auditory delayed memory' indices. When regression analysis was performed an estimate of verbal intelligence was found to be the most predictive of most memory indices including 'auditory immediate memory' and 'auditory delayed memory'. Life-time exposure to ecstasy was not predictive of the memory indices. The current frequency of cannabis use was found to have some predictive effect for immediate and delayed visual memory. This study does not show memory impairment in a group of ecstasy users relative to cannabis using controls. The previously reported association of life-time exposure to ecstasy and memory was not found. The findings may indicate a confounding role of cannabis use, as has been recently reported.


Developmental Regulation of (1-->3, 1-->4)-beta-Glucanase Gene Expression in Barley : Tissue-Specific Expression of Individual Isoenzymes.
Two genes encode (1-->3,1-->4)-beta-d-glucan 4-glucanohydrolase (EC 184.108.40.206) isoenzymes EI and EII in barley (Hordeum vulgare L.). Specific DNA probes have been used in Northern analyses to examine the developmental regulation of individual (1-->3,1-->4)-beta-glucanase genes in the aleurone and scutellum of germinated grain and in young leaves and young roots. In aleurone and scutella excised from germinated grain, mRNAs encoding both isoenzymes are present but developmental patterns differ between the two tissues. Thus, levels of both isoenzyme EI and EII mRNA increase significantly in the aleurone between 1 and 3 days after the initiation of germination. In the scutellum, isoenzyme EI mRNA predominates and decreases as germination proceeds. Isoenzyme EI mRNA appears in young leaves approximately 8 days after the initiation of germination and levels rise until about 20 days. Enzyme activity in leaf extracts parallels the development of isoenzyme EI mRNA. No isoenzyme EII mRNA is detected in the leaves in this period. Analysis of RNA from different leaf segments indicates that the isoenzyme EI mRNA is distributed relatively evenly along the length of the leaf. In young roots, mRNA encoding (1-->3,1-->4)-beta-glucanase isoenzyme EI is detected at high levels 3 to 6 days after the initiation of germination; again, little or no isoenzyme EII mRNA is found. Overall, transcription of the (1-->3,1-->4)-beta-glucanase isoenzyme EII gene appears to be restricted to the germinating grain, whereas isoenzyme EI is expressed in a wider range of tissues during seedling development.


Overexpression of the epidermal growth factor receptor confers migratory properties to nonmigratory postnatal neural progenitors.
Approaches to successful cell transplantation therapies for the injured brain involve selecting the appropriate neural progenitor type and optimizing the efficiency of the cell engraftment. Here we show that epidermal growth factor receptor (EGFR) expression enhances postnatal neural progenitor migration in vitro and in vivo. Migratory NG2-expressing (NG2+) progenitor cells of the postnatal subventricular zone (SVZ) express higher EGFR levels than nonmigratory, cortical NG2+ cells. The higher endogenous EGFR expression in SVZ NG2+ cells is causally related with their migratory potential in vitro as well as in vivo after cell engraftment. EGFR overexpression in cortical NG2+ cells by transient transfection converted these cells to a migratory phenotype in vitro and in vivo. Finally, cortical NG2+ cells purified from a transgenic mouse in which the EGFR is overexpressed under the CNP promoter exhibited enhanced migratory capability. These findings reveal a new role for EGFR in the postnatal brain and open new avenues to optimize cell engraftment for brain repair.


Addressing racism in the healthcare encounter: The role of clinical ethics consultants.
Justice is a core principle in bioethics, and a fair opportunity to achieve health is central to this principle. Racism and other forms of prejudice, discrimination, or bias directed against people on the basis of their membership in a particular racial or ethnic group are known contributors to health inequity, defined as unjust differences in health or access to care. Though hospital-based ethics committees and consultation services routinely address issues of justice that arise in the course of patient care, there is variability in whether and how racism and other causes of health inequities are addressed. In this paper, we describe a novel structure and process for addressing health equity within clinical ethics consultation. In addition, we discuss the barriers and challenges to its success, many of which are rooted in the identities, norms and assumptions that underlie traditional clinical ethics consultation. We offer pragmatic recommendations and conclude with unresolved questions that remain as we work to adapt the structure of a clinical ethics consultation service to improve attention to issues of health equity and promote anti-racism in patient care and institutional policy.


An anatomic study of the latissimus dorsi-rib flap: an extension of the subscapular combined flap.
The anatomy of the vascular perforators between the latissimus branch of the thoracodorsal vessels and the lateral branch of the dorsal rami of the intercostal vessels was studied in a series of 10 dissections in 5 preserved cadavers to develop the latissimus dorsi myocutaneous flap combined with a vascularized rib. The distances between the communicating perforators and the spinous process and the iliac crest, which become a good guide for design of the rib flap, were measured. An extension of the combined flap including the scapular osteocutaneous flap, latissimus dorsi myocutaneous flap, and vascularized eleventh and twelfth ribs that is nourished by a "single" subscapular vascular system was demonstrated. This technique, which provides a large amount of skin, muscle, and bone, is very effective for reconstruction of an extended composite maxillary and mandibular defect.


Mesenchymal Epithelial Transition (MET): A Key Player in Chemotherapy Resistance and an Emerging Target for Potentiating Cancer Immunotherapy.
The MET protein is a cell surface receptor tyrosine kinase predominately expressed in epithelial cells. Upon binding of its only known ligand, hepatocyte growth factor (HGF), MET homodimerizes, phosphorylates, and stimulates intracellular signalling to drive cell proliferation. Amplification or hyperactivation of MET is frequently observed in various cancer types and it is associated with poor response to conventional and targeted chemotherapy. More recently, emerging evidence also suggests that MET/HGF signalling may play an immunosuppressive role and it could confer resistance to cancer immunotherapy. In this review, we summarized the preclinical and clinical evidence of MET's role in drug resistance to conventional chemotherapy, targeted therapy, and immunotherapy. Previous clinical trials investigating MET-targeted therapy in unselected or METoverexpressing cancers yielded mostly unfavourable results. More recent clinical studies focusing on MET exon 14 alterations and MET amplification have produced encouraging treatment responses to MET inhibitor therapy. The translational relevance of MET inhibitor therapy to overcome drug resistance in cancer patients is discussed.


Influence of exercise and quiet rest on state anxiety and blood pressure.
A series of investigations was performed in which Ss rested quietly for 40-min and performed aerobic exercise on separate occasions. Blood pressure (BP) and state anxiety were assessed prior to and following the conditions. In the first experiment, 15 normotensive Ss were assessed during the 3-h following the treatments. The results revealed that state anxiety and BP were reduced following both conditions. The exercise-induced BP reductions remained significant for 2 to 3 h (P less than 0.05), whereas the BP reductions returned to baseline within 20-min following cessation of quiet rest. The second experiment involved an evaluation of the effects of exercise and quiet rest on 15 pharmacologically controlled hypertensive Ss. A significant reduction in systolic BP (P less than 0.05) was observed following exercise and quiet rest. State anxiety was reduced following quiet rest and exercise (P less than 0.05). It is concluded that exercise and quiet rest have similar effects on state anxiety, and both conditions are followed by a transitory reduction in blood pressure. These anti-anxiety effects, however, are sustained for a longer period following exercise.


Social representations of low-income diabetic women according to the health-disease process.
The purpose of this article is to identify the social representations of low-income diabetic women according to the health-disease process. This is a descriptive, exploratory study. Eight participants, all of them patients at a basic health unit in Ribeirão Preto, were interviewed in 2003. The data were organized according to thematic content analysis and analyzed according to theory of social representations. Diabetes is related to negative feelings, such as shock, anger and sadness; the diet plan is linked to the loss of pleasure, and also to health risks. The diabetic women showed an ambivalent relation to medication, perceived it as both tiring and as a resource that promotes well-being and improvements in quality of life. The negative representation of health services seems to interfere with the behavior of adherence to pharmacological treatment. Understanding the representations of women with diabetes contributes to integral healthcare for diabetic patients.