Analysis of the relation between the sequence and secondary and three-dimensional structures of immunoglobulin molecules.
Methods of structural and statistical analysis of the relation between the sequence and secondary and three-dimensional structures are developed. About 5000 secondary structures of immunoglobulin molecules from the Kabat data base were predicted. Two statistical analyses of amino acids reveal 47 universal positions in strands and loops. Eight universally conservative positions out of the 47 are singled out because they contain the same amino acid in > 90% of all chains. The remaining 39 positions, which we term universally alternative positions, were divided into five groups: hydrophobic, charged and polar, aromatic, hydrophilic, and Gly-Ala, corresponding to the residues that occupied them in almost all chains. The analysis of residue-residue contacts shows that the 47 universal positions can be distinguished by the number and types of contacts. The calculations of contact maps in the 29 antibody structures revealed that residues in 24 of these 47 positions have contacts only with residues of antiparallel beta-strands in the same beta-sheet and residues in the remaining 23 positions always have far-away contacts with residues from other beta-sheets as well. In addition, residues in 6 of the 47 universal positions are also involved in interactions with residues of the other variable or constant domains.


[Dengue infection with fatal ending].
A 54-year-old man was admitted with fever following a trip to St. Maarten in the Dutch Antilles, from where he had returned 6 days earlier. One year prior to this he had been treated on an Intensive Care Unit for a severe influenza A infection. Physical examination revealed remarkably cold extremities, furthermore there was metabolic acidosis, extreme haemoconcentration, prolongation of prothrombin time and activated partial thromboplastin time. His clinical condition deteriorated rapidly and he died the day after admission. Neither IgG nor IgM antibodies against dengue were found, but PCR on dengue virus RNA was positive. Over past decades there has been a strong increase in the number of dengue virus infections in travellers returning from Southeast Asia, Central and South America, the Caribbean and Africa. Whilst in general a primary dengue virus infection does not result in severe disease, this case illustrates the potentially fatal consequences of dengue in travellers.


[Bilateral vocal cord paralysis in children].
Eighteen infantile cases with bilateral vocal cord paralysis were treated at our hospital from 1970 to 1993. All cases were diagnosed using a flexible fiberscope to examine the larynx. Direct laryngoscopy was performed under general anesthesia for the definite diagnosis and differential diagnosis from laryngomalacia, subglottic stenosis, tracheal stenosis, or laryngeal web. Bilateral vocal cord paralysis in children is a rare disease, there have been few and reported cases. Eight cases were male and 10 cases were female. Thirteen cases were congenital, 4 cases acquired and 1 case was unknown. The characteristic symptoms of bilateral vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. Associated anomalies and diseases included 3 cases of immature infant, 2 of myelomeningocele, and single cases of Arnold-Chiari malformation, cerebral palsy, hydrocephalus, laryngomalacia, William's syndrome, Wiedemann-Beckwith syndrome, hypoxia, esophageal hiatus hernia, gastroesophageal reflex, spina bifida, COFS syndrome, and cerebral atrophy. Laryngeal function was completely recovered in seven cases following growth of the children incompletely recovered in five cases, and 2 cases retained right vocal cord paralysis. Tracheostomy was performed in 2 cases. One case died from the original disease, and the other one case was unknown. Swallowing function, phonation and development were good. Our experience suggests that the airway with bilateral vocal cord paralysis in children can be managed well without the need for tracheostomy.


Two male siblings with a novel LRBA mutation presenting with different findings of IPEX syndrome.
LPS-responsive beige-like anchor (LRBA) protein deficiency is a disease of immune dysregulation with autoimmunity affecting various systems. Two male siblings with a novel LRBA mutation had different primary findings at admission: the younger sibling had chronic early-onset diarrhoea and the elder one had autoimmune haemolytic anaemia. During long-term follow-up for IPEX phenotype, both developed hypogammaglobulinaemia, enteropathy and lung involvement. The patients partially responded to immunosuppressive therapies. A homozygous c.2496C>A, p.Cys832Ter (p.C832*) mutation in the LRBA gene causing a premature stop codon was detected. After molecular diagnosis, abatacept, as a target-specific molecule, was used with promising results. LRBA deficiency is a recently defined defect, with variable presentations in different patients; a single, definitive treatment option is thus not yet available.


Autoimmune Pancreatitis and IgG4 Related Disease in Three Children.
We report 3 children who presented with fever and abdominal pain, deranged liver function tests, and on abdominal ultrasound were found to have an enlarged pancreas, substantial abdominal lymphadenopathy, and extrahepatic biliary duct dilatation. After ruling out malignancy, probable immunoglobulin G4-related disease (IgG4RD) associated with autoimmune pancreatitis was considered. This condition was first described in the adults and often mimics pancreatic cancer. It can involve multiple organs, either synchronously or metachronously, and is rarely reported in children. The disorder mostly responds to corticosteroid therapy and other immune suppression. We highlight the difficulty in diagnosing autoimmune pancreatitis/IgG4-related disease in children and illustrate the difference between pediatric and adult presentation.


Robotic Roux-en-Y gastric bypass: surgical technique and short-term experience from 329 cases.
minimally invasive bariatric surgery is clearly superior over open procedures including better early outcomes. Different surgical approaches are used to treat the severely obese, having Roux-en-Y gastric bypass (RYGB) being a highly frequent procedure. Robotic surgery overcomes some laparoscopic limitations adding ergonomics, articulating instruments and a three-dimensional high definition camera. Based on our vast robotic experience, we present our referred group case series and a standardized Robotic Roux-en-Y gastric bypass (rRYGB) technique as well as its outcomes. a review of a prospective maintained database was conducted in patients submitted to robotic Roux en Y bariatric surgery between April 2015 and July 2019. Surgical technique is described and illustrated. We also reported patients demographics, outcomes and its follow-up. a Retrospective analysis identified 329 patients submitted to Robotic Roux-en-Y gastric bypass. Both da Vinci Si and Xi platforms were used. Mean age was 34.4 years, with median BMI of 44.2 kg/m2. Mean console time was 102 min and there was no conversion. No surgical hospital readmission rates were seen in the first 30 days. this study represents our initial experience of robotic Roux-en-Y gastric bypass (rRYGB), its short outcomes and a standardized surgical technique. Our results encourage that rRYGB is technically feasible and safe, and might offer some advantages showing good outcomes and minimal complications.


Postmortem imaging: MDCT features of postmortem change and decomposition.
Multidetector computed tomography (MDCT) has emerged as an effective imaging technique to augment forensic autopsy. Postmortem change and decomposition are always present at autopsy and on postmortem MDCT because they begin to occur immediately upon death. Consequently, postmortem change and decomposition on postmortem MDCT should be recognized and not mistaken for a pathologic process or injury. Livor mortis increases the attenuation of vasculature and dependent tissues on MDCT. It may also produce a hematocrit effect with fluid levels in the large caliber blood vessels and cardiac chambers from dependent layering erythrocytes. Rigor mortis and algor mortis have no specific MDCT features. In contrast, decomposition through autolysis, putrefaction, and insect and animal predation produce dramatic alterations in the appearance of the body on MDCT. Autolysis alters the attenuation of organs. The most dramatic autolytic changes on MDCT are seen in the brain where cerebral sulci and ventricles are effaced and gray-white matter differentiation is lost almost immediately after death. Putrefaction produces a pattern of gas that begins with intravascular gas and proceeds to gaseous distension of all anatomic spaces, organs, and soft tissues. Knowledge of the spectrum of postmortem change and decomposition is an important component of postmortem MDCT interpretation.


Separation from family and its impact on the mental health of Sudanese refugees in Australia: a qualitative study.
This study explored the impact of separation from family members on the mental health and wellbeing of Sudanese refugees in Australia, and the coping strategies used. In-depth interviews were conducted with Sudanese community representatives and health workers, primary and mental health care practitioners, health service managers and policy makers. Interviews were analysed using thematic analysis. Separation was perceived as having a negative impact on the mental health of Sudanese refugees in Australia, and manifested in concern about the safety of relatives abroad and in changing roles. The pressure to send money home emerged as a high priority for Sudanese refugees, often superseding local concerns. Several strategies were used to bridge the separation gap, including maintaining contact through the use of information communication technologies, and family-reunification. Separation from family can be an ongoing source of stress and sadness among refugees in countries such as Australia. While resettling refugees are actively taking steps to cope with the impact of separation, awareness of the issue in mainstream services appears to be low. Separation from family continues to affect refugees' lives in countries of resettlement. While it may be difficult to alter the course of the monumental circumstances that cause forced migration, service providers can support refugees' coping abilities by understanding these global-local intersections.


Patch testing with natural rubber latex.
Immediate-type hypersensitivity to natural rubber latex (NRL) may be associated with chronic eczema, and it has recently been suggested that NRL should be used as a patch-test allergen. However, a standardized preparation does not exist, and experience of patch testing with this substance is extremely limited. The aims of our study were to investigate the patch-test response to different preparations of NRL amongst patients with suspected contact dermatitis. 608 patients were patch tested with a latex series which included wet and dry preparations of undiluted high-ammonia (HA) NRL and low-ammonia thiuram-containing NRL. Cutaneous reactions to 1 or more NRL patches were noted in 24 patients. None of these were strong allergic reactions (> +), and in 15 patients, the responses were only doubtful (?+). Positive patch tests were observed in 9 patients, and were probably due to concurrent thiuram allergy in 6. In the remaining 3 patients, the reactions had subsided by the 2nd reading and may have represented false positives. None of the patients showed consistent allergic reactions to all NRL patches, and most of the doubtful readings had resolved within 4 days, suggesting that they were irritant rather than weak allergic responses. Patch testing to dry HA latex was associated with the least number of reactions. We conclude that allergic patch test reactions to NRL are uncommon, and as reactions are usually weak and difficult to interpret, we suggest that patch testing with NRL should remain experimental until further studies have been undertaken.


Minimally invasive treatment of distal tibial fractures with locking and non-locking plates.
The purpose of this study was to evaluate the clinical performances of stainless steel nonlocking plates and titanium locking plates in minimally invasive medial plating of extra-articular metaphyseal fractures of the distal tibia. Between 2004 and 2006, 43 patients who sustained closed fractures of the distal tibia metaphysis were managed with either a stainless steel nonlocking plate (Group 1, n = 21) or a titanium locking plate (Group 2, n = 22). Clinical and radiographic data were retrospectively reviewed. Function was assessed with use of the American Orthopaedic Foot and Ankle Society ankle-hindfoot instrument. The average followup period was 25 months. The average AOFAS foot and ankle scores in Group 1 and Group 2 at final followup were 85 and 81, respectively. Fracture reduction was anatomical or nearly anatomical without angular displacement in all cases except one patient in Group 2. (p > 0.05) The average time to full, unprotected weightbearing in Group 1 and Group 2 were 15 weeks and 18 weeks, respectively (p < 0.05). Minimally invasive medial plating with titanium locking plates resulted in prolonged secondary healing both in comminuted and simple fracture patterns compared to conventional stainless steel nonlocking plates. We believe that in biological fixation of distal tibial fractures, similarly good results may be obtained with both materials as the locking technology had a greater effect on stability.


The role of T helper cell subsets in pathogenesis of Systemic Lupus Erythematosus and their relation to disease activity.
The chemokine receptors expression dictates the spectrum of action of chemokines. One possible role of chemokines in autoimmune diseases, such as Systemic Lupus Erythematosus (SLE), is to facilitate the migration of lymphocytes to specific target organs thus accounting for the accumulation of T-cells in different organs, and subsequent disease manifestations. In the present study we investigated the surface expression of the chemokine receptors CXCR3 and CCR5 on CD4-positive T-helper lymphocytes in patients with active SLE, patients in remission, and in healthy subjects. Furthermore, a possible correlation between these cytokine receptors and SLE disease activity index (SLEDAI) was investigated. The study included 48 patients; all met at least four of the 11 American College of Rheumatology (ACR) diagnostic criteria for SLE. They were subdivided according to their SLEDAI into 2 groups: active SLE group of 28 patients with SLEDAI (> or = 6), and 20 SLE patients in remission with SLEDAI (< 6). Twenty age and sex matching healthy subjects were included as controls. We found that patients in the active SLE group had significantly elevated the mean expressions of CXCR3 and CCR5 on the surface of CD4+ T-lymphocytes than in the SLE patients in remission and healthy controls. The SLE patients in remission were found to have substantial reduced CD4+ CXCR3+ expression in comparison to healthy controls. Interestingly, a significant positive correlation was found between SLEDAI and each mean level of CD4+ CXCR3 and CD4+ CCR5+ in all SLE patients. In conclusion, this study revealed that the surface expression of the chemokine receptors CXCR3 and CCR5 on CD4+ T cells were increased markedly in patients with active SLE more than SLE patients in remission and the healthy subjects, this increase correlated positively with the SLEDAI. A larger study should be conducted to examine the role of CXCR3 and CCR5 expression in predicting disease activity in SLE patients.


Measurement equivalence of seven selected items of posttraumatic growth between black and white adult survivors of Hurricane Katrina.
This study examined the equivalence or comparability of the measurement properties of seven selected items measuring posttraumatic growth among self-identified Black (n = 270) and White (n = 707) adult survivors of Hurricane Katrina, using data from the Baseline Survey of the Hurricane Katrina Community Advisory Group Study. Internal consistency reliability was equally good for both groups (Cronbach's alphas = .79), as were correlations between individual scale items and their respective overall scale. Confirmatory factor analysis of a congeneric measurement model of seven selected items of posttraumatic growth showed adequate measures of fit for both groups. The results showed only small variation in magnitude of factor loadings and measurement errors between the two samples. Tests of measurement invariance showed mixed results, but overall indicated that factor loading, error variance, and factor variance were similar between the two samples. These seven selected items can be useful for future large-scale surveys of posttraumatic growth.


JumonjiC demethylase inhibitors show potential for targeting chemotherapy-resistant lung cancers.
Resistance to standard taxane-platin chemotherapy and tumor relapse are a major challenge in the treatment of non-small cell lung cancers (NSCLC). Our recent study identified JumonjiC demethylase inhibitors as a highly potent therapeutic strategy for targeting chemoresistant tumors and for preventing the emergence of drug-tolerant clones from taxane-platin treated NSCLCs.


Knowledge and Attitude Towards Tobacco Smoking among 13-15 Year-Old School Children in Viet Nam - Findings from GYTS 2014.
Studies have shown that smoking is a learnt behavior, often initiated during adolescence. This paper aims to describe tobacco-related knowledge, attitude and associations among school adolescents aged 13-15 with exposure to anti-smoking information. Using data from the Global Youth Tobacco Survey (GYTS) in Viet Nam, 2014, knowledge was measured through 4 questions about tobacco use, and attitude was assessed through 3 questions on personal, social and environmental aspects. Students giving most anti-tobacco responses to all questions were considered as having correct knowledge or appropriate attitude or both. Access to anti-smoking information was determined by exposure to any media messages on tobacco control during the past 30 days and teaching in school about the danger of tobacco use during the past 12 months. A substantial percentage of students thought that being near others who smoke might be harmful to them and smoking is harmful to health (89.4% and 89.6% respectively). However, only 46.4% reported that it is definitely difficult to quit smoking and 66.9% thought that smoking for only 1 or 2 years, once stopped, is harmful to health. Slightly more than half of the respondents reported appropriate attitude that young smokers have fewer friends than others and smoking makes them less attractive and less comfortable at social events. Noticing anti-smoking messages in the media together with having lessons in school about the dangers of tobacco substantially increased the likelihood of having correct knowledge, appropriate attitude and both. Despite relatively high awareness about smoking harms, effective educational communication is still highly needed to improve the level of comprehensive knowledge and an appropriate attitude regarding tobacco use.


Controlling Below-Threshold Nonsequential Double Ionization via Quantum Interference.
We show through simulation that quantum interference in nonsequential double ionization can be used to control the recollision excitation with subsequent ionization (RESI) mechanism. This includes the shape, localization, and symmetry of RESI electron-momentum distributions, which may be shifted from a correlated to an anticorrelated distribution or vice versa, far below the direct ionization threshold intensity. As a testing ground, we reproduce recent experimental results by employing specific coherent superpositions of excitation channels. We examine two types of interference, from electron indistinguishability and intracycle events, and from different excitation channels. These effects survive focal averaging and transverse-momentum integration.


Roles of Candida albicans Gat2, a GATA-type zinc finger transcription factor, in biofilm formation, filamentous growth and virulence.
Candida albicans is the most common human fungal pathogen, causing not only superficial infections, but also life-threatening systemic disease. C. albicans can grow in several morphological forms including unicellular yeast-form, elongated hyphae and pseudohyphae. In certain natural environments, C. albicans also exists as biofilms, which are structured and surface-attached microbial communities. Transcription factors play a critical role in morphogenesis and biofilm development. In this study, we identified four adhesion-promoting transcription factors (Tec1, Cph1, Ume6 and Gat2) by screening a transcription factor overexpression library. Sequence analysis indicates that Gat2 is a GATA-type zinc finger transcription factor. Here we showed that the gat2/gat2 mutant failed to form biofilms on the plastic and silicone surfaces. Overexpression of GAT2 gene promoted filamentous and invasive growth on agar containing Lee's medium, while deletion of this gene had an opposite effect. However, inactivation of Gat2 had no obvious effect on N-acetyl-glucosamine (GlcNAc) induced hyphal development. In a mouse model of systemic infection, the gat2/gat2 mutant showed strongly attenuated virulence. Our results suggest that Gat2 plays a critical role in C. albicans biofilm formation, filamentous growth and virulence.


[The skin and menopause].
The estrogen deficit occurring at menopause manifests itself under various modalities in the diverse organs and their functions. Skin does not escape this global involutive process. In addition to the effects of chronological ageing, sunlight exposure and other environmental and endogenous stimuli, the climacteric appears to exert some dramatic consequences on skin biology and aspect. The epidermis, its adnexae and the dermis are altered by this process. The epidermis may become xerotic and exhibits altered functions. The dermis thins out and its elasticity decreases in concert with the decline in bone mass. The skin microcirculation is impaired. These aspects are some of the better-worked out skin climacteric changes of which in turn seem to be stabilized or in part reversible with hormone replacement therapy (HRT).


Social capital and health in the least developed countries: a critical review of the literature and implications for a future research agenda.
Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword 'social capital' combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and 2 in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualisations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries.


Laserlight cues for gait freezing in Parkinson's disease: an open-label study.
Freezing of gait (FOG) and falls are major sources of disability for Parkinson's disease (PD) patients, and show limited responsiveness to medications. We assessed the efficacy of visual cues for overcoming FOG in an open-label study of 26 patients with PD. The change in the frequency of falls was a secondary outcome measure. Subjects underwent a 1-2 month baseline period of use of a cane or walker without visual cues, followed by 1 month using the same device with the laserlight visual cue. The laserlight visual cue was associated with a modest but significant mean reduction in FOG Questionnaire (FOGQ) scores of 1.25 ± 0.48 (p = 0.0152, two-tailed paired t-test), representing a 6.6% improvement compared to the mean baseline FOGQ scores of 18.8. The mean reduction in fall frequency was 39.5 ± 9.3% with the laserlight visual cue among subjects experiencing at least one fall during the baseline and subsequent study periods (p = 0.002; two-tailed one-sample t-test with hypothesized mean of 0). Though some individual subjects may have benefited, the overall mean performance on the timed gait test (TGT) across all subjects did not significantly change. However, among the 4 subjects who underwent repeated testing of the TGT, one showed a 50% mean improvement in TGT performance with the laserlight visual cue (p = 0.005; two-tailed paired t-test). This open-label study provides evidence for modest efficacy of a laserlight visual cue in overcoming FOG and reducing falls in PD patients.


Controlling olefin isomerization in the heck reaction with neopentyl phosphine ligands.
The use of neopentyl phosphine ligands was examined in the coupling of aryl bromides with alkenes. Di-tert-butylneopentylphosphine (DTBNpP) was found to promote Heck couplings with aryl bromides at ambient temperature. In the Heck coupling of cyclic alkenes, the degree of alkene isomerization was found to be controlled by the choice of ligand with DTBNpP promoting isomerization to a much greater extent than trineopentylphosphine (TNpP). Under optimal conditions, DTBNpP provides high selectivity for 2-aryl-2,3-dihydrofuran in the arylation of 2,3-dihydrofuran, whereas TNpP provided high selectivity for the isomeric 2-aryl-2,5-dihydrofuran. A similar complementary product selectivity is seen in the Heck coupling of cyclopentene. Heck coupling of 2-bromophenols or 2-bromoanilides with 2,3-dihydrofurans affords 2,5-epoxybenzoxepin and 2,5-epoxybenzazepins, respectively.


Bone marrow transplantation: clinical and radiologic aspects.
With the advent of histocompatibility typing, use of bone marrow transplantation for treating hematogenous cancer has dramatically increased. Marrow grafting is preceded by intense immunosuppressive, marrow ablative treatment, usually with high-dose chemotherapy and whole-body irradiation. Because the recipient may be immunocompromised for months after transplantation due to this regimen, complications are numerous. Complications are classified according to the following intervals: pre-engraftment (from pretransplantation treatment to engraftment), postengraftment (3 months afterward), and delayed (longer than 3 months after engraftment). Pre-engraftment complications include bacterial, fungal, and viral infections; tissue-damaging effects (eg, toxic pneumonitis); hepatic veno-occlusive disease; and graft rejection. Postengraftment complications include viral, fungal, and protozoal infections; acute graft-versus-host disease (GVHD); and pneumatosis intestinalis. Delayed complications include chronic GVHD and recurrence of cancer. As part of the follow-up team, radiologists should be familiar with clinical aspects of marrow transplantation and be alert for early, potential life-threatening complications.


Multicenter study of photorefractive keratectomy for myopia of 6.00 to 8.00 diopters. VISX Moderate Myopia Study Group.
To summarize the initial results of excimer laser photorefractive keratectomy (PRK) on 89 eyes of 80 patients with moderate myopia (myopia of -6.00 to -8.00 diopters [D]; mean -6.98 +/- 0.90 D) at nine investigational sites. All treatments used an argon fluoride excimer laser (VISX, Inc, Santa Clara, Calif) using standard settings. Sixty eyes received single-zone 6.0-millimeter ablations and 29 eyes received two-zone ablations. Follow up ranged from 1 month (n = 89) to 6 months (n = 46). At 3 months, uncorrected visual acuity measured 20/40 or better in 75% and 20/20 or better in 18%; 78% were within +/- 1.00 D of intended correction, 38% were within +/- 0.50 D, and 9% lost two or more lines of spectacle-corrected visual acuity. At 6 months, uncorrected visual acuity measured 20/40 or better in 74% and 20/20 or better in 17%; 67% were within 1.00 D of intended correction, 38% within 0.50 D, and 2% (1/46) lost two lines of spectacle-corrected visual acuity. PRK for moderate myopia with large diameter ablation zones appears safe and more predictable than that done using smaller ablation zone diameters. Longer follow up is needed to better define stability, the effects of postoperative corticosteroids, and the use of single-versus double-zone ablations.


Intranasal insulin attenuates the hypothalamic-pituitary-adrenal axis response to psychosocial stress.
Previous studies have shown that intranasally administered insulin exerts an inhibitory influence on the basal hypothalamic-pituitary-adrenal (HPA) axis activity. To date, however, it remains unclear as to whether intranasal insulin does furthermore affect HPA axis responsiveness in situations of stress. Here, we tested whether intranasally administered insulin attenuates the HPA axis response to psychosocial stress. Fifty minutes before being exposed to the Trier Social Stress Test (TSST), 26 healthy young male participants received a single intranasal dose of human insulin (40 I.U.) or placebo in a placebo controlled, double-blind between-subject design. Plasma cortisol, saliva cortisol, heart rate, and blood pressure were measured at resting baseline and in response to the TSST. Plasma cortisol (P<.001) and saliva cortisol (P<.001) increased in response to stress, as did heart rate (P<.001) and blood pressure (P<.001). Intranasal insulin did not influence plasma or saliva cortisol, heart rate, blood pressure, blood glucose, and plasma insulin levels at baseline. However, intranasal insulin diminished the saliva cortisol (two-way ANOVA; treatment by time interaction: P=.05) and plasma cortisol (two-way ANOVA; treatment by time interaction: P=.05) response to the TSST without affecting heart rate, and blood pressure stress reactivity. Our data show that a single intranasal insulin administration effectively lowers stress-induced HPA axis responsiveness. Intranasal insulin may offer a therapeutic potential to prevent hyperactivity of the HPA system.


Ultrastructural features of adenoma malignum of the uterine cervix: demonstration of gastric phenotypes.
Histochemical staining has shown that so-called adenoma malignum (the mucinous type of minimal deviation adenocarcinoma [mucinous MDA]) of the uterine cervix expresses gastric phenotypes. The present ultrastructural study was undertaken to explore the fine structure and phenotypic expression of this tumor, and to make comparisons with normal cervical glands and gastric pyloric mucosa. Post-embedding, double-immunogold staining for gastric gland mucous cell mucin (HIK1083-reactive mucin) and lysozyme revealed localization exclusively to the matrix and to the core of the mucin granules, respectively, both in mucinous MDA and gastric pyloric mucosa. Mucin granules of normal cervical gland cells lacked core structures and showed no immunoreactivity with HIK1083 or lysozyme. Thus, mucinous MDA was confirmed to be a tumor expressing gastric phenotypes ultrastructurally. Both markers should be useful for the identification of tumor cells.


Differential Effects of APOE Genotypes on the Anterior and Posterior Subnetworks of Default Mode Network in Amnestic Mild Cognitive Impairment.
The apolipoprotein E (APOE) ɛ4 carriers are at increased risk of developing Alzheimer's disease (AD) while the ɛ2 carriers appear to be protected against the disease. The default mode network (DMN), based in ventromedial prefrontal cortex (vmPFC) and posterior cingulate cortex (PCC), consists of functionally differentiable anterior and posterior subnetworks. This study was to investigate whether there are differential effects of APOE polymorphisms on DMN subnetworks in amnestic mild cognitive impairment (aMCI). Functional connectivity (FC) analyses were performed in DMN subnetworks in 74 aMCI (9 APOE ɛ2ɛ3, 44 ɛ3ɛ3, and 21 ɛ3ɛ4) and 105 healthy controls (HC; 32 APOE ɛ2ɛ3, 39 ɛ3ɛ3, and 34 ɛ3ɛ4). Logistic regression analysis was performed to obtain a model for classifying aMCI and HC. Significant interactions of APOE by aMCI on FCs were found in right cerebellum posterior lobe, left lingual gyrus, and right middle cingulate cortex in the vmPFC subnetwork, and bilateral fusiform gyrus, left inferior frontal gyrus, and left precuneus in the PCC subnetwork. The impairment of episodic memory for ɛ4-carriers in aMCI negatively correlated with altered FC between vmPFC and right middle cingulate cortex, while positively correlated with altered FC between PCC and left fusiform gyrus. A model composed of episodic memory and FCs dexterity correctly classified 89.4% of aMCI and HC. APOE ɛ4 and ɛ2 alleles differentially mediate anterior and posterior DMN subnetworks. Furthermore, it further suggests that the anterior and posterior DMN subnetworks in aMCI play an opposing role on the impairment of episodic memory.


Overexpression of the suppressor of cytokine signalling 3 (SOCS3) in severe atopic dermatitis.
Immunoregulatory conditions in atopic dermatitis (AD) involve both Th1 and Th2, although primarily Th2. The suppressor of cytokine signalling 3 (SOCS3) may mediate Th2 regulatory response through negative regulation of Th1 pathways. We examined SOCS3 expression in skin lesions of patients with severe AD and compared it with that in patients with the Th1 disorder, psoriasis. We assessed SOCS3 expression in skin lesions from seven patients with severe AD and five patients with typical psoriasis, and in skin from three normal subjects, using immunohistochemical staining, in situ hybridization and reverse transcription PCR. Strong SOCS3 expression was found in skin lesions in all patients with AD, but only weak expression in patients with psoriasis and in normal subjects. Overexpression of SOCS3 is prominent in the skin of patients with severe AD and consequently may prove useful for evaluating the severity of AD as a Th2-dominant condition.


[Evaluation of a program for the care of the diabetic. A 40-month continuity study].
To evaluate the long term efficacy of a program of attention to diabetes mellitus. A continued 40-month follow-up study in a group of 47 diabetic patients treated with insulin (21 type I and 26 type II) with a mean age of 45.8 years and a mean duration of diabetes of 8.1 years. These patients were seen in the hospital outpatient clinic during the initial 12 months and in community clinics during the remaining 12 months. Mean basal glycemia (7.4 +/- 1.5 mmol/l) and HbA1 (8.3 +/- 1.1%) at 40 months were significantly lower than those in the initial 12 months (8.8 +/- 2.4 mmol/l and 9.2 +/- 1.2%; p less than 0.001) and in the beginning of the study (4.2 mmol/l and 11.2 +/- 1.9%; p less than 0.0001). In type II diabetics, cholesterol and triglyceride levels showed a significant reduction from the mean first year levels (6.2 +/- 0.9 and 1.6 +/- 0.9 mmol/l) to those in the 12-40 months period (5.8 +/- 0.8 and 1.3 +/- 0.5; p less than 0.01 in both instances). Initially, 22 diabetics (46%) used rapid acting insulin; at the end, 37 had included these preparations in their treatment (78%; p less than 0.001). Only 7 patients (14%) used multiple insulin doses at the beginning. After 40 months, 29 (61%) were treated with 3-4 insulin injections per day (p less than 0.0001). In 43 patients (91%) no severe hypoglycemic crisis had developed. In 45 (95%) macroproteinuria was not detected and 40 (85%) had not developed microangiopathic lesions in the retina or microangiopathic involvement elsewhere as evaluated with the available techniques. Psychical depression was evaluated at 40 months using a semiquantitative scale questionnaire. The overall responses in the intervention group (n = 20; 25.4 +/- 4.6) showed lower depression levels (higher scores) than a control group ( n = 22; 22.4 +/- 4.9; p less than 0.02) constituted by diabetics with similar characteristics but who had not been following the program. The programs for the attention to the diabetic are effective in the long term to achieved and sustain metabolic control, the acquired knowledge and, to a sizeable degree, the compliance with therapy, provided that they integrate the teaching with the treatment. It is very likely that these programs reduce the risk of late features of the disease and the tendency to depression, independently from the place where the patient is controlled.


[Sotrovimab in controlling SARS-CoV-2 infection].
The new monoclonal antibodies - VIR -7831 (sotrovimab) and VIR- 7832 - show an action directly targeting the SARS-CoV-2 spike glycoprotein. Moreover, they strongly neutralize in vitro the wild-type Corona virus variants and the omicron variant. Sotrovimab is a monoclonal antibody capable of neutralizing SARS-CoV-2 as well as other sarbecoviruses (SARS-CoV-1 and SARS-CoV). The administration of 500 mg sotrovimab as a 1-hour intravenous infusion in 291 patients with COVID-19 with mild to moderate severity of symptoms prevented disease progression and the need for hospitalization.


Neonates With Complex Cardiac Malformation and Congenital Diaphragmatic Hernia Born to SARS-CoV-2 Positive Women-A Single Center Experience.
Our understanding of the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnancies and perinatal outcomes is limited. The clinical course of neonates born to women who acquired coronavirus disease 2019 (COVID-19) during their pregnancy has been previously described. However, the course of neonates born with complex congenital malformations during the COVID-19 pandemic is not known. We report a case series of seven neonates with congenital heart and lung malformations born to women who tested positive for SARS-CoV-2 during their pregnancy at a single academic medical center in New York City. Six infants had congenital heart disease and one was diagnosed with congenital diaphragmatic hernia. In all seven infants, the clinical course was as expected for the congenital lesion. None of the seven exhibited symptoms generally associated with COVID-19. None of the infants in our case series tested positive by nasopharyngeal test for SARS-CoV-2 at 24 hours of life and at multiple points during their hospital course. In this case series, maternal infection with SARS-CoV-2 during pregnancy did not result in adverse outcomes in neonates with complex heart or lung malformations. Neither vertical nor horizontal transmission of SARS-CoV-2 was noted.


The influence of familial pancreatic cancer on postoperative outcome in pancreatic cancer: relevance to adjuvant chemotherapy.
Familial pancreatic cancer (FPC) is defined as a family in which at least two first-degree relatives have pancreatic cancer (PC). The prognostic significance of PC in an FPC family after surgery is not fully understood. This was a retrospective study of 427 patients who underwent pancreatectomy for pancreatic ductal adenocarcinoma between January 2008 and December 2016. PC patients who also had at least one first-degree relative with PC were defined as FPC patients. The associations between recurrence and clinicopathological characteristics were analyzed for both FPC and non-FPC patients. FPC patients accounted for 31 of the 427 (7.3%) patients. Recurrence occurred in 72.1% of the total cohort and in 87.1% of the 31 FPC patients. Multivariate analysis showed that being an FPC patient was an independent predictor for relapse-free survival (RFS) (hazard ratio [HR] 1.52, P = 0.038). Although univariate analysis revealed that being an FPC patient was significantly associated with poorer overall survival (OS) (P < 0.001), multivariate analysis showed that being an FPC patient was not an independent predictor for OS (P = 0.164). Dichotomization of the 427 patients into those who received (n = 317: 17 FPC and 300 non-FPC patients) and did not receive (n = 110: 14 FPC and 96 non-FPC patients) adjuvant chemotherapy revealed that being an FPC patient was an independent predictor for RFS (HR 2.50, P < 0.001) and OS (HR 2.30, P = 0.003) only for patients who received adjuvant chemotherapy. This study has shown that being an FPC patient is a significant prognostic indicator for PC patients who undergo resection and receive adjuvant chemotherapy.


Cerebrospinal fluid τ protein in differential diagnosis of Alzheimer's disease and vascular dementia in Chinese population: a meta-analysis.
To assess whether biomarker τ protein could differentiate between Alzheimer's disease (AD) and vascular dementia (VaD). We conducted a comprehensive search to identify studies on τ protein, patients with AD, and patients with VaD. Cerebrospinal fluid (CSF) τ protein levels were compared to discriminate among patients with AD, healthy controls, and patients with VaD by a meta-analysis. Patients with AD exhibit significantly higher CSF τ protein levels than healthy controls or patients with VaD in the Chinese population. Our findings suggested that CSF τ protein levels were found to be significantly associated with AD in the Chinese population. Measurement of τ protein could help in attenuating the strict distinction between AD and VaD.


Associations of herd-level housing, management, and lameness prevalence with productivity and cow behavior in herds with automated milking systems.
Lameness is problematic for herds with automated milking systems (AMS) due to negative effects on milking frequency and productivity. The objective of this study was to evaluate how management, barn design, and the prevalence of lameness relate to productivity and behavior at the herd level in AMS. Details about barn design, stocking density, and management were collected from 41 AMS farms in Canada (Ontario: n=26; Alberta: n=15). We collected milking data for all cows on each farm, plus lying behavior data for 30 cows/farm during a 6-d period. Farms averaged 105±56 lactating cows and 2.2±1.3 AMS units. Forty cows/farm were gait scored (or 30% of cows for herds with >130 cows) using a numerical rating system (NRS; 1=sound to 5=extremely lame). Cows were defined as clinically lame with NRS ≥3 (mean=26.2±13.0%/herd) and severely lame with NRS ≥4 (mean=2.2±3.1%/herd). The prevalence of both clinical and severe lameness were negatively associated with environmental temperature. Clinical lameness tended to be less prevalent with more frequent scraping of manure alleys. The prevalence of severe lameness was positively associated with stocking density and curb height of the lying stalls. Milking frequency/cow per day was negatively related to the ratio of cows to AMS units. Doubling the prevalence of severe lameness (i.e., from 2.5 to 5%) was associated with reductions in milk production of 0.7kg/cow per day and 39kg/AMS per day. Milk/AMS was positively associated with more cows/AMS (+32kg/cow). Fewer cows were fetched to the AMS with more frequent alley scraping. Lying behavior was associated with the frequency of feed push-ups, stall base, and environmental temperature. These results highlight the need for AMS producers to identify and reduce clinical lameness because 26% of cows/herd were clinically lame. Further, the results indicate that more frequently scraped alleys and optimal stocking densities are associated with improved cow mobility, productivity, and voluntary milking behavior.


Blood platelets of the African elephant.
Platelet counts of 22 elephants varied between 229 x 10(9) and 622 x 10(9)/L. Light microscopy showed the platelets to be small, while electron microscopy revealed well preserved but activated platelets with some morphological differences from other mammalian platelets. Dense bodies, alpha-granules, glycogen and mitochondria were present in most sections. Microtubules and the surface connecting canalicular system appeared to be absent, but numerous filamentous structures and Golgi bodies were observed.


Neural mechanism of pressor action of nitric oxide synthase inhibitor in anesthetized monkeys.
Intravenous injection of NG-nitro-L-arginine (L-NA), a nitric oxide synthase inhibitor, elevated mean blood pressure by 29.0 +/- 4.9 mm Hg and decreased heart rate by 40.7 +/- 5.6 beats per minute in anesthetized Japanese monkeys (n = 6), whereas NG-nitro-D-arginine was without effect. After pretreatment with pentolinium, the magnitude of the pressure elevation by L-NA was significantly less than that after pretreatment with phentol-amine. The reduced blood pressure by either of the pretreatment drugs was compensated to control levels by a continuous infusion of angiotensin II before L-NA administration. Isolated monkey distal mesenteric arteries (150 to 200 microns OD) without endothelium responded to nerve stimulation by nicotine with a contraction, which was abolished by prazosin alone or in combination with alpha, beta-methylene ATP. In the strips thus treated and contracted with prostaglandin F2 alpha, nicotine caused a relaxation that L-NA abolished. L-NA but not NG-nitro-D-arginine reversed the inhibition. Histochemical staining of NADPH diaphorase, considered to be identical to nitric oxide synthase in neuronal tissues, demonstrated that positively stained nerve fibers were consistently present in the adventitia of monkey distal mesenteric arteries and arterioles. These results strongly suggest that nitroxidergic vasodilator nerves innervate peripheral small arteries and arterioles in the monkey and that these nerves participate in the regulation of systemic blood pressure. High blood pressure caused by nitric oxide synthase inhibitors is associated with an elimination of nitroxidergic nerve function together with an impairment of the basal release of nitric oxide from the endothelium.


Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale.
Maintaining the existing gingival architecture of a failing maxillary anterior tooth is essential in achieving an optimal aesthetic result. Immediate implant placement has been advocated to minimize tissue loss following extraction. The incorporation of a customized temporary abutment and immediate fixed provisionalization facilitates maintenance of the gingival architecture for optimal aesthetics and eliminates the need for a removable provisional prosthesis during the healing phase. This article describes the surgical and prosthodontic approach of this procedure as well as its clinical rationale.


Elevated fibrin(ogen) degradation products in the adult respiratory distress syndrome.
During a 60-h period after the onset of either the adult respiratory distress syndrome (ARDS) in 14 patients, or similar predisposing conditions without respiratory insufficiency (non-ARDS) in 12 patients, blood was obtained 3 times for assessment of coagulation, fibrinolysis, and complement. Platelet counts decreased progressively in both groups, and a platelet release protein, Beta-thromboglobulin, was similarly increased in both groups. Fibrinopeptide A concentrations were similarly increased in both groups. Hemolytic activity of complement components C3 and C5 was within the normal range in both groups. In contrast, the fibrin/fibrinogen degradation product, D-antigen, was significantly increased in the ARDS group over all time periods (p < 0.01). These findings suggested that higher concentrations of circulating fibrin/fibrinogen degradation products are associated with ARDS itself, either as a marker or more extensive microvascular injury or as a possible mediator of injury.


Household secondary attack rates and risk factors during periods of SARS-CoV-2 Delta and Omicron variant predominance in the Republic of Korea.
The household secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important indicator for community transmission. This study aimed to characterize transmission by comparing household SARs and identifying risk factors during the periods of Delta and Omicron variant predominance in Republic of Korea. We defined the period of Delta variant predominance (Delta period) as July 25, 2021 to January 15, 2022, and the period of Omicron variant predominance (Omicron period) as February 7 to September 3, 2022. The number of index cases included was 214,229 for the Delta period and 5,521,393 for the Omicron period. To identify the household SARs and risk factors for each period, logistic regression was performed to determine the adjusted odds ratio (aOR). The SAR was 35.2% for the Delta period and 43.1% for the Omicron period. The aOR of infection was higher in 2 groups, those aged 0 to 18 years and ≥75 years, compared to those aged 19 to 49 years. Unvaccinated individuals (vs. vaccinated individuals) and individuals experiencing initial infection (vs. individuals experiencing a second or third infection) had an increased risk of infection with SARS-CoV-2. This study analyzed the household SARs and risk factors. We hope that the results can help develop age-specific immunization plans and responses to reduce the SAR in preparation for emerging infectious diseases or potential new variants of SARS-CoV-2.


The impact of PEG-induced drought stress on seed germination and seedling growth of different bread wheat (Triticum aestivum L.) genotypes.
Wheat is an important crop, used as staple food in numerous countries around the world. However, wheat productivity is low in the developing world due to several biotic and abiotic stresses, particularly drought stress. Non-availability of drought-tolerant wheat genotypes at different growth stages is the major constraint in improving wheat productivity in the developing world. Therefore, screening/developing drought-tolerant genotypes at different growth stages could improve the productivity of wheat. This study assessed seed germination and seedling growth of eight wheat genotypes under polyethylene glycol (PEG)-induced stress. Two PEG-induced osmotic potentials (i.e., -0.6 and -1.2 MPa) were included in the study along with control (0 MPa). Wheat genotypes included in the study were 'KLR-16', 'B6', 'J10', '716', 'A12', 'Seher', 'KTDH-16', and 'J4'. Data relating to seed germination percentage, root and shoot length, fresh and dry weight of roots and shoot, root/shoot length ratio and chlorophyll content were recorded. The studied parameters were significantly altered by individual and interactive effects of genotypes and PEG-induced osmotic potentials. Seed germination and growth parameters were reduced by osmotic potentials; however, huge differences were noted among genotypes. A reduction of 32.83 to 53.50% was recorded in seed germination, 24.611 to 47.75% in root length, 37.83 to 53.72% in shoot length, and 53.35 to 65.16% in root fresh weight. The genotypes, 'J4', 'KLR-16' and 'KTDH-16', particularly 'J4' better tolerated increasing osmotic potentials compared to the rest of the genotypes included in the study. Principal component analysis segregated these genotypes from the rest of the genotypes included in the study indicated that these can be used in the future studies to improve the drought tolerance of wheat crop. The genotype 'J4' can be used as a breeding material to develop drought resistant wheat genotypes.


Effects of sex and early maternal abuse on adrenocorticotropin hormone and cortisol responses to the corticotropin-releasing hormone challenge during the first 3 years of life in group-living rhesus monkeys.
In this study we investigated the development of the hypothalamic-pituitary-adrenal (HPA) axis in 21 group-living rhesus monkeys infants that were physically abused by their mothers in the first few months of life and in 21 nonabused controls. Cortisol and adrenocorticotropin hormone (ACTH) responses to a corticotropin-releasing hormone (CRH) challenge were assessed at 6-month intervals during the subjects' first 3 years of life. Abused infants exhibited greater cortisol responses to CRH than controls across the 3 years. Abused infants also exhibited blunted ACTH secretion in response to CRH, especially at 6 months of age. Although there were no significant sex differences in abuse experienced early in life, females showed a greater cortisol response to CRH than males at all ages. There were no significant sex differences in the ACTH response to CRH, or significant interactions between sex and abuse in the ACTH or cortisol response. Our findings suggest that early parental maltreatment results in greater adrenocortical, and possibly also pituitary, responsiveness to challenges later in life. These long-term alterations in neuroendocrine function may be one the mechanisms through which infant abuse results in later psychopathologies. Our study also suggests that there are developmental sex differences in adrenal function that occur irrespective of early stressful experience. The results of this study can enhance our understanding of the long-term effects of child maltreatment as well as our knowledge of the development of the HPA axis in human and nonhuman primates.


Biochemical aspects of autologous fibrin glue derived from ammonium sulfate precipitation.
The autologous fibrin glue (AFG) was produced from 30 human donors using the ammonium sulfate precipitation method, and a study of its biochemical composition was performed. The fibrinogen concentration ranged 13 to 57 mg/mL, the yield averaged 54.6%, and there was a direct relationship between the level of fibrinogen in plasma and AFG which had been made from the same donor's plasma. Our results suggest that the quality of this category of AFG depends partially on the fibrinogen level of donor's plasma. Quality control of the AFG is discussed. Additionally, the effectiveness of three fibrinolysis inhibitors were compared to find an optimum one which inhibits autofibrinolysis of this glue. Tranexamic acid and epsilon aminocaproic acid (EACA) were acceptable alternatives to aprotinin.


Multiple heterosexual partners and condom use among Hispanics and non-Hispanic whites.
A telephone survey of 1,592 Hispanic and 629 non-Hispanic white men and women aged 18-49, randomly selected from nine states in the northeastern and southwestern United States, found that married Hispanic men are more likely to have had two or more heterosexual partners in the previous 12 months than are married non-Hispanic men (18% and 9%, respectively). A large proportion of unmarried men (60% of Hispanics and 54% of non-Hispanic whites) report having had more than one partner in the past 12 months. After adjusting for other variables, the odds of having multiple partners are 2.5 times higher among Hispanic men aged 18-24 than among those aged 41-49 and 1.8 times higher among those who live in the Northeast than among those in the Southwest. Highly acculturated Hispanic men are less likely to have multiple partners than are less acculturated men. Among Hispanic women, those who are moderately or highly acculturated are more likely to have multiple partners (odds ratios of 4.9 and 8.4, respectively) than are less acculturated women. About half of men and women with multiple partners report always using condoms with secondary heterosexual partners.


CRNA-physician collaboration in anesthesia.
The benefits of collaboration in healthcare have been linked positively with higher patient satisfaction, improved patient outcomes, enhanced nursing staff satisfaction, and decreased hospital costs. A sample of nurse anesthetists and anesthesiologists affiliated with postgraduate training programs in the state of Texas responded to a survey designed to gather attitudes toward physician-nurse collaboration using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Two-hundred seventy surveys were completed by 62 anesthesiologists and 208 nurse anesthetists. The mean for the total scores on attitudes toward collaboration for anesthesiologists was 44.4 (+/- SD 8.7) and 51.8 (+/- SD 2.7) for nurse anesthetists. Mean scores were consistently higher in the 4 subscales (showed stronger agreement) for nurse anesthetists than for anesthesiologists. No significant differences in attitudes were found between men and women for the total sample. However, the health discipline showed a statistically significant difference. These findings suggest that Certified Registered Nurse Anesthetists who deal with role conflict or unclear expectations as well as limited scope of practice may have increased job stress and dissatisfaction.


Update on the molecular physiology of organic anion transporters.
Organic anion transporters (OATs) mediate the renal absorption and excretion of a wide range of metabolites and xenobiotics. We discuss the recent advances that have been made in elucidating the binding and transport characteristics of OATs, new insights into their physiological role and regulation by various factors, and pharmacogenetics. Overlapping substrate specificity among the OATs is well established. However, recent findings have suggested distinct differences in the structural binding determinants among the OATs, which have important implications for understanding drug interactions and drug design. A potential role for OATs in blood pressure regulation and remote sensing has been reported. Meanwhile, factors regulating the expression of OATs continue to be identified and characterized. The effect of renal ischemia on OAT expression and function is currently being explored. Finally, recent studies identifying various OAT polymorphisms may facilitate prediction of individual drug response and toxicity. As progress is made in unveiling the many functional aspects of the OATs, it is becoming clear that their significance is not only limited to a role in drug elimination from the body, but also extends to other vital physiological roles. Further delineation of the function and regulation of the OATs will uncover enormous potential clinical and pharmacological applications.


Aortic valve repair via neo-chordae technique: mechanistic insight through numerical modelling.
Recently, the neo-chordae technique (NCT) was proposed to stabilize the surgical correction of isolated aortic valve (AV) prolapse. Neo-chordae are inserted into the corrected leaflet to drive its closure by minimal tensions and prevent relapses. In a previous in vitro study we analysed the NCT effects on healthy aortic roots (ARs). Here we extend that analysis via finite element models (FEMs). After successfully replicating the experimental conditions for validation purposes, we modified our AR FEM, obtaining a continent AV with minor isolated prolapse, thus representing a realistic clinical scenario. We then simulated the NCT, and systematically assessed the acute effects of changing neo-chordae length, opening angle, asymmetry and insertion on the aorta. In the baseline configuration the NCT restored physiological AV dynamics and coaptation, without inducing abnormal leaflet stresses. This outcome was notably sensitive only to neo-chordae length, suggesting that the NCT is a potentially easy-to-standardize technique. However, this parameter is crucial: major shortenings (6 mm) prevent coaptation and increase leaflet stresses by 359 kPa, beyond the yield limit. Minor shortenings (2-4 mm) only induce a negligible stress increase and mild leaflet tethering, which however may hamper the long-term surgical outcome.


Environmental effect of air versus gas tamponade in the management of rhegmatogenous retinal detachment VR surgery: A multicentre study of 3,239 patients.
To report the potential reduction of carbon emissions by utilising air-tamponade (AT), where possible, instead of fluorinated gases in the management of rhegmatogenous retinal detachment (RRD). We compared the carbon CO2 emissions produced at two large tertiary referral vitreoretinal (VR) centres where RRD are exclusively repaired using fluorinated gases to a tertiary VR mass of each gas used according to the Intergovernmental Panel on Climate Change. Retrospective, continuous, comparative multicentre study of all procedures using fluorinated gases between 01/01/17-31/12/20 at the Manchester Royal Eye Hospital (MREH) and Birmingham and Midland Eye Centre (BMEC), and between 01/01/19-31/12/2020 at the University Hospitals Coventry and Warwickshire (UHCW). We report on 3,239 (SF6:1,415 [43.7%], C2F6:1,235 [38.1%], C3F8:541 [16.7%], Air:48 [1.5%]) procedures. UHCW and BMEC utilise single use 30ml and 75ml cannisters, respectively and MREH use multi-use gas cylinders. UHCW used AT in 48 (70%) of RRD repairs. Mean equivalent mass CO2/patient was MREH:115.9kg, BMEC:7.9kg and UHCW:1.9kg. If assuming all centres used 30ml cannisters, the mean equivalent mass CO2/patient was MREH:3.5 kg, BMEC:3.1kg and UHCW:1.9kg. AT enabled UHCW to greatly reduce the need for the most environmentally damaging SF6 gas, leading to lower CO2 emissions by 47.0% and 41.1% compared to MREH and BMEC, respectively. We demonstrate how AT vs. the fluorinated gases can reduce in carbon footprint in the management of RRD. Further studies are required to determine the most 'environment-friendly' intraocular tamponade without compromising patient outcomes centre that also routinely employs AT in selected RRD cases.


Health in Prison: Does Penitentiary Medicine in Italy Still Exist?
Despite the detailed legislative developments that have occurred within the context of prison medicine in Italy, problems of a management nature continue to affect prisoner health and management, which in turn impact the prison system's ability to offer prisoners a real opportunity for rehabilitation. Certain behavioral aspects reported in prisons may alter and negatively impact the normal doctor-patient relationship, including elements that hinder the therapeutic alliance and impede proper clinical risk prevention and management. However, practical steps may be taken in connection with the analysis of flows and healthcare services that may enable prison administrations to bring about a true, modern restructure of the prison system.


Obstetric outcomes following atrial and arterial switch procedures for transposition of the great arteries (TGA) - A single, tertiary referral centre experience over 20 years.
Repair of transposition of the great arteries usually involves an atrial switch or arterial switch operation, which can complicate physiological adaptation to the demands of pregnancy and adversely affect the fetus. We retrospectively compared outcomes of 48 completed pregnancies in 23 women with surgically corrected transposition of the great arteries (38 atrial switch/10 arterial switch operation) under joint cardiac-obstetric care in our tertiary referral clinic between 1997 and 2017. Most women delivered vaginally (85%). The pre-term delivery rate was high (atrial switch 39%; arterial switch operation 40%). Small for gestational age occurred in 56% of babies, significantly more in the atrial switch group (66%) than arterial switch operation (20%), p = 0.013. Women with surgically corrected transposition of the great arteries wishing to become pregnant are at high risk of obstetric complications, primarily pre-term delivery and small for gestational age baby. They require more careful ultrasound surveillance beyond 36 weeks' gestation and/or may benefit from early induction of labour. Trial registration: Text/Not applicable.


Dynamic pathways to mediate reactions buried in thermal fluctuations. II. Numerical illustrations using a model system.
The framework recently developed for the extraction of a dynamic reaction coordinate to mediate reactions buried in thermal fluctuation is examined with a model system. Numerical simulations are carried out for an underdamped Langevin equation with the Müller-Brown potential surface, which contains three wells and two saddles, and are compared to the prediction by the theory. Reaction probabilities for specific initial conditions of the system as well as their average over the Boltzmann distribution are investigated in the position space and in a space spanned by the position coordinates and the velocities of the system. The nonlinear couplings between the reactive and the nonreactive modes are shown to have significant effects on the reactivity in the model system. The magnitude and the direction of the nonlinear effect are different for the two saddles, which is found to be correctly reproduced by our theory. The whole position-velocity space of the model system is found to be divided into the two distinct regions: One is of mainly reactive (with reaction probability more than half) initial conditions and the other, the mainly nonreactive (with reaction probability less than half) ones. Our theory can actually assign their boundaries as the zero of the statistical average of the new reaction coordinate as an analytical functional of both the original position coordinates and velocities of the system (solute), as well as of the random force and the friction constants from the environment (solvent). The result validates the statement in the previous paper that the sign of the reaction coordinate thus extracted determines the fate of the reaction. Physical interpretation of the reactivity under thermal fluctuation that is naturally derived, thanks to the analyticity of the theoretical framework, is also exemplified for the model system.


15N NMR investigation of the covalent binding of reduced TNT amines to soil humic acid, model compounds, and lignocellulose.
The five major reductive degradation products of TNT-4ADNT (4-amino-2,6-dinitrotoluene), 2ADNT (2-amino-4,6-dinitrotoluene), 2,4DANT (2,4-diamino-6-nitrotoluene), 2,6DANT (2,6-diamino-4-nitrotoluene), and TAT (2,4,6-triaminotoluene)-labeled with 15N in the amine positions, were reacted with the IHSS soil humic acid and analyzed by 15N NMR spectrometry. In the absence of catalysts, all five amines underwent nucleophilic addition reactions with quinone and other carbonyl groups in the soil humic acid to form both heterocyclic and nonheterocyclic condensation products. Imine formation via 1,2-addition of the amines to quinone groups in the soil humic acid was significant with the diamines and TAT but not the monoamines. Horseradish peroxidase (HRP) catalyzed an increase in the incorporation of all five amines into the humic acid. In the case of the diamines and TAT, HRP also shifted the binding away from heterocyclic condensation product toward imine formation. A comparison of quantitative liquid phase with solid-state CP/MAS 15N NMR indicated that the CP experiment underestimated imine and heterocyclic nitrogens in humic acid, even with contact times optimal for observation of these nitrogens. Covalent binding of the mono- and diamines to 4-methylcatechol, the HRP catalyzed condensation of 4ADNT and 2,4DANT to coniferyl alcohol, and the binding of 2,4DANT to lignocellulose with and without birnessite were also examined.


Racial comparisons of thyroid function and autoimmunity during pregnancy and the postpartum period.
To evaluate thyroid function and the prevalence of thyroid peroxidase (TPO) antibody and autoimmunity in African-American and white women during pregnancy and the postpartum period. Five hundred eighty-nine women were evaluated prospectively. Serum thyroid-stimulating hormone (TSH), free thyroxine (T4), and TPO, Ro, and La antibodies were obtained during pregnancy, at delivery, and postpartum. Levels of hCG were determined during pregnancy. Urinary iodine levels were evaluated in the third trimester in another group of women. All TPO antibody-positive patients were to be followed up at 3 and 6 months postpartum. African-American women had lower TSH values than white women at all times. Thyroid-stimulating hormone increased, and free T4 decreased from the first to third trimester of pregnancy for both groups. African Americans had higher hCG levels than whites in the first trimester but not in the third trimester. There was no difference in urine iodine excretion between African-American and white women. Finally, there was no difference in TPO antibody seropositivity between African-American and white women. Overall, 5 patients (0.8%) were diagnosed with subclinical hypothyroidism during pregnancy. Fluctuations in TSH and free T4 during pregnancy parallel reported obstetric values. African Americans demonstrated consistently lower TSH levels than whites. These differences were unexplained by racial differences in either TPO antibody seropositivity, iodine status, or chorionic gonadotropin levels.


Does pornography-blocking software block access to health information on the Internet?
The Internet has become an important tool for finding health information, especially among adolescents. Many computers have software designed to block access to Internet pornography. Because pornography-blocking software cannot perfectly discriminate between pornographic and nonpornographic Web sites, such products may block access to health information sites, particularly those related to sexuality. To quantify the extent to which pornography-blocking software used in schools and libraries limits access to health information Web sites. In a simulation of adolescent Internet searching, we compiled search results from 24 health information searches (n = 3206) and 6 pornography searches (n = 781). We then classified the content of each site as either health information (n = 2467), pornography (n = 516), or other (n = 1004). We also compiled a list of top teen health information sites (n = 586). We then tested 6 blocking products commonly used in schools and libraries and 1 blocking product used on home computers, each at 2 or 3 levels of blocking restrictiveness. Rates of health information and pornography blocking. At the least restrictive blocking setting, configured to block only pornography, the products blocked a mean of only 1.4% of health information sites. The differences between blocking products was small (range, 0.6%-2.3%). However, about 10% of health sites found using some search terms related to sexuality (eg, safe sex, condoms) and homosexuality (eg, gay) were blocked. The mean pornography blocking rate was 87% (range, 84%-90%). At moderate settings, the mean blocking rate was 5% for health information and 90% for pornography. At the most restrictive settings, health information blocking increased substantially (24%), but pornography blocking was only slightly higher (91%). Blocking settings have a greater impact than choice of blocking product on frequency of health information blocking. At their least restrictive settings, overblocking of general health information poses a relatively minor impediment. However, searches on some terms related to sexuality led to substantially more health information blocking. More restrictive blocking configurations blocked pornography only slightly more, but substantially increased blocking of health information sites.


Waiting time for rehabilitation services for children with physical disabilities.
Early rehabilitation may minimize disability and complications. However, children often wait a long time to gain admission to rehabilitation centres. To describe waiting times for paediatric physical and occupational therapy and to determine factors associated with these waiting times. The study was a prospective cohort design. Patients were followed from 1 January 1999 to 1 March 2000. All children with physical disabilities, aged 0-18 years, referred in 1999 from the Montreal Children's Hospital to paediatric rehabilitation centres. Data on date of referral, date of first appointment at the rehabilitation centre, age, gender, diagnosis, region and language were obtained from the rehabilitation transfer database. Primary family caregivers of children who were transferred to a rehabilitation facility participated in a telephone interview regarding their perceptions of the transfer process. There were 172 children referred to rehabilitation facilities. The mean age of the children was 2.5 years. Average waiting time was 157.4 days (SD 57.1) for occupational therapy and 129.4 days (SD 51.6) for physical therapy. Decreased waiting time was associated with living in the city as opposed to the suburbs (hazard ratio=1.77; 95% confidence interval=0.92-3.41) and inversely associated with age (hazard ratio=0.46; 95% confidence interval=0.34-0.62). Among the 41 primary family caregivers who participated in the survey, higher empowerment scores were associated with shorter waits for rehabilitation. Waiting time for rehabilitation services needs to be reduced. Empowered parents appear to manoeuvre within the system to reduce waiting times for their children.


Erythromycin suppresses nuclear factor-kappaB and activator protein-1 activation in human bronchial epithelial cells.
Erythromycin (EM), and related 14-member macrolide antibiotics, has attracted attention for its effectiveness in airway diseases including diffuse panbronchiolitis and sinobronchial syndrome. However, its molecular mechanisms remain unknown. We evaluated the effects of EM on activation of several transcription factors, including nuclear factor-kappaB (NF-kappaB) and activator protein-1 (AP-1) in human bronchial epithelial cell line BET-1A, which are known to regulate the expression of many proinflammatory cytokines and chemokines such as interleukin-8 (IL-8). BET-1A cells were cultured with hormonally defined Ham's F12 medium, and were stimulated by phorbol myristate acetate (PMA). EM suppressed mRNA expression as well as the release of IL-8 at therapeutic and noncytotoxic concentrations (% inhibition of IL-8 protein release: 42.2 +/- 5.5%, at 10(-6) M). Furthermore, electrophoretic mobility shift assays revealed that EM inhibited the activations of NF-kappaB and AP-1 induced by PMA in BET-1A cells. These data indicate that EM has inhibitory effects not only on the mRNA expression and release of IL-8, but also on the activation of transcription factors NF-kappaB and AP-1. Our findings support the concept that the recruitment of neutrophils in airway diseases may be regulated by NF-kappaB and AP-1.


Maternal and fetal influences on uterine and conceptus development in the cow: I. Growth of tissues of the gravid uterus.
Objectives of this study were to evaluate maternal and fetal influences on development of gravid uterine tissues of cows. Brahman cows with Brahman or Charolais fetuses and Charolais cows with Brahman or Charolais fetuses were used. Cows were killed 232 +/- .5 or 271 +/- .7 d after mating. The gravid uterus of each cow was weighed and dissected into its component parts. Weights of the fetus, fetal membranes, cotyledons, caruncles, and uterus were recorded as were weights of the fetal liver, heart, kidneys, spleen, lungs, stomach complex, intestines, and semitendinosus muscle. Ribonucleic acid, DNA, and protein concentrations in caruncles, cotyledons, liver, heart, kidney, and semitendinosus muscle were determined. Data were analyzed by analysis of variance; breed of cow (C), breed of fetus (F), day of gestation (D), and all interactions were included in the model as fixed effects. Fetal weights were influenced (P less than .003) by C, F, D, and C x D and tended (P = .07) to be influenced by C X F X D. Weight, RNA, DNA, and protein contents of selected fetal tissues followed similar patterns of significance. Thus, both maternal and fetal genotype influenced fetal growth. Greater influences of the maternal system and interrelationships between maternal and fetal systems were observed at the latter stage of gestation. Placentomal (caruncle + cotyledon) weights were greater for Charolais than for Brahman cows (P less than .02) or fetuses (P less than .001) and were greater (P less than .01) at 271 than at 232 d. Caruncular weights followed similar patterns; however, fetal genotype was the only significant source of variation in cotyledonary weight, RNA, DNA, or protein content.(ABSTRACT TRUNCATED AT 250 WORDS)


Ethosomes and organogels for cutaneous administration of crocin.
The present study describes the production and characterization of phosphatidylcholine based ethosomes and organogels, as percutaneous delivery systems for crocin. Crocin presence did not influence ethosome morphology, while the drug slightly increased ethosome mean diameter. Importantly, the poor chemical stability of crocin has been found to be long controlled by organogel. To investigate the performance of phosphatidylcholine lipid formulations as crocin delivery system, in vivo studies, based on tape stripping and skin reflectance spectrophotometry, were performed. Tape stripping results suggested a rapid initial penetration of crocin exerted by the organogel, probably due to a strong interaction between the peculiar supramolecular aggregation structure of phospholipids in the vehicle and the lipids present in the stratum corneum and a higher maintenance of crocin concentration in the case of ethosomes, possibly because of the formation of a crocin depot in the stratum corneum. Skin reflectance spectrophotometry data indicated that both vehicles promoted the penetration of crocin through the skin, with a more rapid anti-inflammatory effect exploited by ethosomes, attributed to an ethanol pronounced penetration enhancer effect and to the carrier system as a whole.


Physical, Thermal Transport, and Compressive Properties of Epoxy Composite Filled with Graphitic- and Ceramic-Based Thermally Conductive Nanofillers.
Epoxy polymer composites embedded with thermally conductive nanofillers play an important role in the thermal management of polymer microelectronic packages, since they can provide thermal conduction properties with electrically insulating properties. An epoxy composite system filled with graphitic-based fillers; multi-walled carbon nanotubes (MWCNTs), graphene nanoplatelets (GNPs) and ceramic-based filler; silicon carbide nanoparticles (SiCs) was investigated as a form of thermal-effective reinforcement for epoxy matrices. The epoxy composites were fabricated using a simple fabrication method, which included ultrasonication and planetary centrifugal mixing. The effect of graphite-based and ceramic-based fillers on the thermal conductivity was measured by the transient plane source method, while the glass transition temperature of the fully cured samples was studied by differential scanning calorimetry. Thermal gravimetric analysis was adopted to study the thermal stability of the samples, and the compressive properties of different filler loadings (1-5 vol.%) were also discussed. The glass temperatures and thermal stabilities of the epoxy system were increased when incorporated with the graphite- and ceramic-based fillers. These results can be correlated with the thermal conductivity of the samples, which was found to increase with the increase in the filler loadings, except for the epoxy/SiCs composites. The thermal conductivity of the composites increased to 0.4 W/mK with 5 vol.% of MWCNTs, which is a 100% improvement over pure epoxy. The GNPs, SiCs, and MWCNTs showed uniform dispersion in the epoxy matrix and well-established thermally conductive pathways.


The Apgar cycle: a new view of a familiar scoring system.
Apgar scores are universally recorded, but they should no longer be used to guide resuscitation; thus, some authorities have suggested that the scores should be abandoned. However, the physiological relationships underlying the elements of the Apgar scoring system can be conceptualised as a cycle, wherein the five functions are linked by cardiorespiratory reflexes and metabolically supported by the oxygen pathway. Respiratory effort represents both the main input into the system and its functional output (sustained respirations). The progressive deterioration of functions during asphyxia, and their recovery during resuscitation, are readily understood within the sequence. This depiction helps in learning concepts such as primary and secondary apnoea and bradycardia. The visual model harmonises the pedagogical and practical values of the Apgar scoring system, by placing the rapid assessment of respirations, heart rate and colour during neonatal resuscitation (as taught in the Neonatal Resuscitation Program) in its broader physiological context. The understanding imparted by the Apgar cycle may directly enhance patient care during resuscitation, apart from the attribution of numerical scores.


Depression, perceived disability and unemployment are associated with reduced life satisfaction in anorexia nervosa.
Life satisfaction is a core aspect of an individual's wellbeing and describes the subjective assessment of their quality of life. Reduced life satisfaction is frequently reported in anorexia nervosa (AN), but the factors contributing to this are still unclear. This study sought to extend previous work by examining 12 potential correlates of AN life satisfaction. One hundred and five female AN patients were administered questionnaires assessing life satisfaction, depression, anxiety, stress, employment status, marital status, body mass index, eating disorder symptomatology, perceived disability and readiness for change. A stepwise linear regression revealed that only depression, perceived disability and employment status were significantly associated with AN life satisfaction. The findings thus highlight prevailing mood and personal functioning as critical foci for clinical management strategies in people with AN. Addressing depressive symptoms and perceived disability while bettering employment prospects could facilitate improved AN life satisfaction.


Improving homework performance among children with ADHD: A randomized clinical trial.
Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. (PsycINFO Database Record


Suicide in HIV-infected individuals and the general population in Switzerland, 1988-2008.
High rates of suicide have been described in HIV-infected patients, but it is unclear to what extent the introduction of highly active antiretroviral therapy (HAART) has affected suicide rates. The authors examined time trends and predictors of suicide in the pre-HAART (1988-1995) and HAART (1996-2008) eras in HIV-infected patients and the general population in Switzerland. The authors analyzed data from the Swiss HIV Cohort Study and the Swiss National Cohort, a longitudinal study of mortality in the Swiss general population. The authors calculated standardized mortality ratios comparing HIV-infected patients with the general population and used Poisson regression to identify risk factors for suicide. From 1988 to 2008, 15,275 patients were followed in the Swiss HIV Cohort Study for a median duration of 4.7 years. Of these, 150 died by suicide (rate 158.4 per 100,000 person-years). In men, standardized mortality ratios declined from 13.7 (95% CI=11.0-17.0) in the pre-HAART era to 3.5 (95% CI=2.5-4.8) in the late HAART era. In women, ratios declined from 11.6 (95% CI=6.4-20.9) to 5.7 (95% CI=3.2-10.3). In both periods, suicide rates tended to be higher in older patients, in men, in injection drug users, and in patients with advanced clinical stage of HIV illness. An increase in CD4 cell counts was associated with a reduced risk of suicide. Suicide rates decreased significantly with the introduction of HAART, but they remain above the rate observed in the general population, and risk factors for suicide remain similar. HIV-infected patients remain an important target group for suicide prevention.


Energy production from biomass (Part 1): Overview of biomass.
The use of renewable energy sources is becoming increasingly necessary, if we are to achieve the changes required to address the impacts of global warming. Biomass is the most common form of renewable energy, widely used in the third world but until recently, less so in the Western world. Latterly much attention has been focused on identifying suitable biomass species, which can provide high-energy outputs, to replace conventional fossil fuel energy sources. The type of biomass required is largely determined by the energy conversion process and the form in which the energy is required. In the first of three papers, the background to biomass production (in a European climate) and plant properties is examined. In the second paper, energy conversion technologies are reviewed, with emphasis on the production of a gaseous fuel to supplement the gas derived from the landfilling of organic wastes (landfill gas) and used in gas engines to generate electricity. The potential of a restored landfill site to act as a biomass source, providing fuel to supplement landfill gas-fuelled power stations, is examined, together with a comparison of the economics of power production from purpose-grown biomass versus waste-biomass. The third paper considers particular gasification technologies and their potential for biomass gasification.


Assessing the expenditure distribution of animal health surveillance: the case of Great Britain.
Animal health surveillance in Great Britain (GB) is conducted through public and private initiatives, yet there is no consolidated information on these activities and their outcomes. We developed an inventory of livestock health surveillance programmes in GB to identify gaps in resource use and potential synergies that could be exploited. The inventory contained details of 36 livestock surveillance activities active in 2011. Data were collected by questionnaire and interviews. Livestock health surveillance funding was found to be unevenly distributed between species: the vast majority (approximately 94 per cent) was spent on cattle diseases (tuberculosis surveillance accounted for most of this expenditure), with 2 per cent on pigs, 2 per cent on sheep/goats, 1 per cent on poultry, and 1 per cent on antimicrobial resistance surveillance across all species. Consequently, surveillance efforts in GB appears heavily skewed towards regions with high cattle densities, particularly high-prevalence tuberculosis areas such as the southwest. The contribution of private schemes to surveillance funding was hard to quantify due to limited access to data, but was estimated to be about 10 per cent. There is scope to better understand the benefits of surveillance, enhance data sharing, clarify costs and identify who pays and who gains. Health surveillance should be considered within the sharing of responsibilities for disease control.


Effect of diets supplemented with different levels of manganese, zinc, and copper from their organic or inorganic sources on egg production and quality characteristics in laying hens.
This experiment was conducted to evaluate the effect of zinc, manganese, and copper sources (inorganic vs. organic) in the diet on laying performance and eggshell quality characteristics. One hundred and eighty Hy-Line W-36 layers at 38 weeks of age were allocated to 36-layer cages of five hens each. Each six cages were randomly assigned to one of the six experimental diets fed from 38 to 53 week of age. In three experimental treatments, the basal diet was supplemented with 65-75-7 or 65-75-7 or 40-40-7 mg/kg of Zn, Mn, and Cu, respectively, from their oxide or sulfate sources. Three other groups were fed diets supplemented with 20-20-3.5 or 40-40-7.5 or 60-60-10.5 mg/kg of organic forms of Zn, Mn, and Cu, respectively. Dietary treatments significantly did affect feed intake (P < 0.001), feed conversion ratio (P < 0.001) and percentage of broken eggs (P < 0.05). Substitution of Zn and Mn oxides (65 and 75 mg kg(-1), respectively) with equal amounts of their sulfate forms significantly improved feed intake, feed conversion ratio, percentage of broken eggs, and Haugh Unit (P < 0.05). In addition, laying hens maintained their performance when substitution of Zn and Mn oxides and Cu sulfate (65, 75, and 7 mg kg(-1), respectively) reduced up to 20, 20, and 3.5 mg kg(-1) by amino acid complexes of the microelements. The results showed that a corn-soybean diet supplemented with the organic forms of Zn, Mn, and Cu at a dosage 50% to 75% lower than NRC recommendation is sufficient to maintain laying performance and can improve eggshell and albumen qualities of the egg in laying hens.


Evaluation of gamma radiation-induced DNA damage in Aedes aegypti using the comet assay.
The study was undertaken to evaluate gamma radiation-induced DNA damage in Aedes aegypti. The comet assay was employed to demonstrate the extent of DNA damage produced in adult male A. aegypti exposed to seven different doses of gamma radiation, ranging from 1 Gy to 50 Gy. DNA damage was measured as the percentage of comet tail DNA. A significant linear increase in DNA damage was observed in all samples; the extent of damage being proportional to the dose of gamma radiation the organism received, except in those treated with 1 Gy. The highest amount of DNA damage was noticed at 1 h postirradiation, which decreased gradually with time, that is, at 3, 6 and 12 h postirradiation. This may indicate repair of the damaged DNA and/or loss of heavily damaged cells as the postirradiation time increased. The comet assay serves as a sensitive and rapid technique to detect gamma radiation-induced DNA damage in A. aegypti. This could be used as a potential biomarker for environmental risk assessment.


Effects of dietary supplementation of alfalfa meal on growth performance, carcass characteristics, meat and egg quality, and intestinal microbiota in Beijing-you chicken.
This study was conducted to investigate the effects of alfalfa meal supplementation on growth performance, carcass characteristics, meat and egg quality, and intestinal microbiota in chickens. A total of 600 healthy 20-wk female Beijing-you chickens (a local Chinese chicken breed) were selected and randomly assigned into 4 dietary treatments: 0, 5, 8, and 10% alfalfa meal supplementation. Chickens were raised in a free-range system for 56 d. Microbiota inhabiting 3 different intestinal sections (duodenum, ileum, and cecum) was determined using high-throughput sequencing. The results showed that chickens given alfalfa meal had lower (P < 0.05) feed conversion ratio, mortality, abdominal fat yield, and yolk cholesterol content, and higher (P < 0.05) breast muscle contents of inosine monophosphate, total amino acids, essential amino acids, non-essential amino acids, delicious amino acids, yolk protein, albumen protein, and yolk color compared to those given no alfalfa meal. The Lactobacillus was the dominant genus in both duodenum and ileum, while the microbiota in cecum was mainly composed of the Bacteroides. Although small changes in the dominant intestinal microbiota of chickens fed with or without alfalfa meal were observed, supplementation of alfalfa meal tended to stimulate the proliferation of beneficial bacteria, such as the Lactobacillus and Bacteroides, and inhibit potential pathogens, including the Clostridium. Therefore, dietary supplementation of alfalfa meal was feasible to Beijing-you chickens raised in a free-range system, and 10% was recommended as the relatively optimal level.


Early and mid-term outcomes of total repair of tetralogy of Fallot through a right subaxillary thoracotomy.
We aimed to investigate the safety, feasibility and early and mid-term outcomes of total repair of elective tetralogy of Fallot through a right subaxillary thoracotomy. Between May 2010 and September 2015, a retrospective review of patients with elective tetralogy of Fallot undergoing primary repair through a right subaxillary thoracotomy was performed. This study included 47 patients [27 males, 20 females; the mean age of 1.7 ± 1.5 years (ranging from 3 to 106 months); body weight of 9.7 ± 2.8 kg (ranging from 5 to 16 kg); McGoon ratio ≥1.5]. The ventricular septal defects were approached through a right atriotomy in 30 patients, a right ventriculotomy in 8 patients and the combination of a right atriotomy and ventriculotomy in 9 patients. Transannular and non-transannular patches were used in 20 and 27 patients, respectively. There was 1 operative death (2.1%), and the others recovered uneventfully. The median cardiopulmonary bypass and aortic cross-clamping times was 79 ± 20.8 (45-136) and 50 ± 15.7 (25-94) min, respectively. The mechanical ventilation time, length of intensive care unit and postoperative hospital stay were 0.9 ± 0.6, 2.6 ± 1.1 and 10.7 ± 2.7 days, respectively. The main complications involved low cardiac output syndrome in 5 patients, arrhythmia in 6 patients, pulmonary infection in 4 patients, small residual shunt in 2 patients, mild residual right ventricular outflow tract obstruction in 2 patients, mild tricuspid regurgitation in 3 patients and atelectasis in 1 patient. The mean follow-up time was 82 ± 22.0 months, and no late deaths occurred during the follow-up. One (2.1%) patient received reintervention for residual significant pulmonary artery stenosis. That was in addition to 2 (4.3%) patients having mild residual right ventricular outflow tract, 1 (2.1%) patient with moderate tricuspid regurgitation and 3 (6.4%) patients with moderate pulmonary valve regurgitation to be followed up. The right subaxillary thoracotomy, providing a safe and feasible alternative, can be performed with a low mortality rate and satisfactory early and mid-term outcomes for total repair of elective tetralogy of Fallot.


Functional characterization of the developmental genes asm2, asm3, and spt3 required for fruiting body formation in the filamentous ascomycete Sordaria macrospora.
The formation of fruiting bodies is one of the most complex developmental processes in filamentous ascomycetes. It requires the development of sexual structures that give rise to meiosporangia (asci) and meiotic spores (ascospores) as well as surrounding structures for protection and dispersal of the spores. Previous studies have shown that these developmental processes are accompanied by significant changes of the transcriptome, and comparative transcriptomics of different fungi as well as the analysis of transcriptome changes in developmental mutants have aided in the identification of differentially regulated genes that are themselves involved in regulating fruiting body development. In previous analyses, we used transcriptomics to identify the genes asm2 and spt3, which result in developmental phenotypes when deleted in Sordaria macrospora. In this study, we identified another gene, asm3, required for fruiting body formation, and performed transcriptomics analyses of Δasm2, Δasm3, and Δspt3. Deletion of spt3, which encodes a subunit of the SAGA complex, results in a block at an early stage of development and drastic changes in the transcriptome. Deletion mutants of asm2 and asm3 are able to form fruiting bodies, but have defects in ascospore maturation. Transcriptomics analysis of fruiting bodies revealed a large overlap in differentially regulated genes in Δasm2 and Δasm3 compared to the wild type. Analysis of nuclear distribution during ascus development showed that both mutants undergo meiosis and postmeiotic divisions, suggesting that the transcriptomic and morphological changes might be related to defects in the morphogenesis of structural features of the developing asci and ascospores.


Impact of ant control technologies on insecticide runoff and efficacy.
Insecticides are commonly used for ant control around residential homes, but post-treatment runoff may contribute to contamination of surface water in urban watersheds. This study represents the first instance where runoff of insecticides was directly measured after applications around single family residences. During 2007, houses were treated with bifenthrin or fipronil sprays following standard practices. During 2008, pin stream applicators, spray-free zones and restricting sprays to the house foundation were considered as management options. During 2007, the resulting runoff from the bifenthrin spray in the irrigation water had a mean concentration of 14.9 microg L(-1) at 1 week post-treatment and 2.5 microg L(-1) at 8 weeks, both high enough to be toxic to sensitive aquatic organisms. In comparison, treatments with bifenthrin granules resulted in no detectable concentrations in the runoff water after 8 weeks. The mean concentration for fipronil used as a perimeter spray was 4.2 microg L(-1) at 1 week post-treatment and 0.01 microg L(-1) at 8 weeks, with the first value also suggesting a potential for causing acute aquatic toxicity to sensitive organisms. During 2008, insecticide runoff was reduced by using spray-free zones and pin stream perimeter applications. It is shown that insecticide runoff from individual home treatments for ants can be measured and used to improve techniques that minimize runoff. The pin stream application and applications limited to the house foundation should be further evaluated for their potential to reduce pesticide runoff from residential homes.