The potential role of dentists in identifying patients' risk of experiencing coronary heart disease events.
A substantial proportion of people with risk factors for cardiovascular disease (CVD) are not identified before they develop clinical signs and symptoms. A multidisciplinary approach that includes a cardiovascular screening by oral health care providers can affect the identification of people at risk of experiencing cardiovascular events. The authors extracted data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 2001-2002 NHANES for people aged 40 to 85 years with no reported specific risk factors for coronary heart disease (CHD) and who had not seen a physician in the previous 12 months but had seen a dentist. They used these data to estimate the 10-year Framingham-based risk calculation scores for each subject to determine their global risk of experiencing acute CHD events. Eighteen percent of the male subjects had an increased 10-year global risk of experiencing a CHD event (> 10 percent risk score), 14.3 percent had a moderate, above-average risk score (> 10-< 20 percent), and an additional 4.3 percent had a high risk score (> or = 20 percent). Only one female subject had a risk score greater than 10 percent. When the authors extrapolated these results to the 2000 U.S. census data, they found that among men aged 40 to 85 years without reported risk factors who had not seen a physician but had seen a dentist in the previous 12 months, 332,262 had a greater than 10 to less than 20 percent risk of experiencing a CHD event, and 72,625 had a 20 percent or greater 10-year risk of experiencing a CHD event. Dentists can play an important role in identifying people in need of primary prevention strategies for CVD.


Meeting the needs of new-graduate nurse practitioners: a model to support transition.
The transition of newly graduated nurse practitioners (NPs) into practice can be challenging for the employer and the NPs. A new-graduate residency model for NPs along with evaluative criteria is presented from a primary care setting. Residency models are of benefit for new-graduate NPs to ease the transition to practice and promote patient care quality, and nurse retention, and satisfaction.


Identification of novel cerebellar developmental transcriptional regulators with motif activity analysis.
The work of the FANTOM5 Consortium has brought forth a new level of understanding of the regulation of gene transcription and the cellular processes involved in creating diversity of cell types. In this study, we extended the analysis of the FANTOM5 Cap Analysis of Gene Expression (CAGE) transcriptome data to focus on understanding the genetic regulators involved in mouse cerebellar development. We used the HeliScopeCAGE library sequencing on cerebellar samples over 8 embryonic and 4 early postnatal times. This study showcases temporal expression pattern changes during cerebellar development. Through a bioinformatics analysis that focused on transcription factors, their promoters and binding sites, we identified genes that appear as strong candidates for involvement in cerebellar development. We selected several candidate transcriptional regulators for validation experiments including qRT-PCR and shRNA transcript knockdown. We observed marked and reproducible developmental defects in Atf4, Rfx3, and Scrt2 knockdown embryos, which support the role of these genes in cerebellar development. The successful identification of these novel gene regulators in cerebellar development demonstrates that the FANTOM5 cerebellum time series is a high-quality transcriptome database for functional investigation of gene regulatory networks in cerebellar development.


Globin gene transfer for treatment of the beta-thalassemias and sickle cell disease.
The beta-thalassemias and sickle cell disease are severe congenital anemias that are caused by mutations that alter the production of the beta chain of hemoglobin. Allogeneic hematopoietic stem cell (HSC) transplantation is curative, but this therapeutic option is not available to the majority of patients. The transfer of a functional globin gene in autologous HCSs thus represents a highly attractive alternative treatment. This strategy, simple in principle, raises major challenges in terms of controlling the expression of the globin transgene, which ideally should be erythroid specific, differentiation-stage restricted, elevated, position independent, and sustained over time. Using lentiviral vectors, we have demonstrated that an optimised combination of proximal and distal transcriptional control elements permits lineage-specific, elevated expression of the beta-globin gene, resulting in therapeutic hemoglobin production and correction of anemia in beta-thalassemic mice. Several groups have now confirmed and extended these findings in various mouse models of severe hemoglobinopathies, thus generating enthusiasm for a genetic treatment based on globin gene transfer. Furthermore, globin vectors represent a general paradigm for the regulation of transgene function and the improvement of vector safety by restricting transgene expression to the differentiated progeny within a single lineage, thereby reducing the risk of activating oncogenes in hematopoietic progenitors. Here we review the principles underlying the genesis of regulated vectors for stem cell therapy.


Using online learning collaboratives to facilitate practice improvement for COPD: an ACPNet pilot study.
The purpose of this pilot study was to (1) understand the attitudes, knowledge, and beliefs of internists who manage patients with chronic obstructive pulmonary disease (COPD) and (2) evaluate the impact of a multifaceted approach to quality improvement (QI) work involving the management of COPD patients. This pilot study used a pre-post intervention design. The intervention included an online educational toolkit, QI coaching calls led by faculty, and the use of individual physician feedback reports to act as motivators for change. Data were collected using a practice pattern survey and a chart abstraction tool to identify discrepancies between perceived and actual care. Results from the pilot study showed a statistically significant improvement in quality indicators postintervention, suggesting a causal relationship with the multifaceted intervention. Discrepancies were identified between perceived and actual care in the areas of spirometry, pulse oximetry (exertion and resting), influenza and pneumococcal vaccinations, peak flow assessment, and inhaler use instruction.


Systemic anticoagulation considerations in chronic kidney disease.
Anticoagulation therapy is commonly required in patients with chronic kidney disease for treatment or prevention of thromboembolic disorders. Anticoagulant management plans can involve use of a single agent, or in some cases, a combination of agents to meet both short- and long-term goals. Systemic anticoagulation in the setting of renal insufficiency poses unique challenges secondary to renal failure-associated hypercoagulable conditions and increased risks for bleeding. Evidence supporting dosing regimens and monitoring approaches in the setting of severe renal impairment or hemodialysis is limited because this population is typically excluded in clinical trials. This review explores concepts of systemic anticoagulation in the chronic kidney disease setting with warfarin, unfractionated heparin, low-molecular-weight heparin, fondaparinux, direct thrombin inhibitors, and anticoagulants in advanced stages of development. Potential strategies for anticoagulant reversal are also briefly described.


[GLP-1 agonists: an overview].
GLP-1 agonists have been widely used in the therapy of type 2 diabetes due to their beneficial effects regarding weight loss and low risk of hypoglycemia. However, some safety concerns have been raised in view of possible detrimental effects to the pancreas. The future place of GLP-1 agonist in diabetes therapy will be determined by the current safety evaluation and data from studies investigating long-term effects.


Role of platelet-activating factor in reproduction: sperm function.
Since its discovery nearly thirty years ago, platelet-activating factor has emerged as one of the more important lipid mediators known. Platelet-activating factor (PAF; 1-O-alkyl-2-O-acetyl-sn-glycero-3-phosphorylcholine) exists endogenously as a mixture of molecular species with structural variants of the alkyl moiety. PAF is a novel potent signaling phospholipid that has unique pleiotropic biological properties in addition to platelet activation. PAF also plays a significant role in reproduction. PAF content in squirrel monkey sperm is significantly higher during the breeding season than the non-breeding season. PAF content in human sperm has a positive correlation with seminal parameters and pregnancy outcomes. High-fertility boars have significantly more PAF in their sperm than low-fertility boars. The enzymes (lyso-PAF-acetyltransferase and PAF-acetylhydrolase) necessary for PAF activation and deactivation are present in sperm. PAF-acetylhydrolase may act as a "decapacitation factor". Removal of this enzyme during capacitation may promote PAF synthesis increasing motility and fertilization. PAF also plays a significant role in the fertilization process, enhancing the fertilization rates of oocytes. Enhanced embryo development has also been reported in oocytes fertilized with PAF-treated sperm. PAF antagonists inhibit sperm motility, acrosome reaction, and fertilization, thus suggesting the presence of receptors for PAF. The PAF-receptor is present on sperm, with altered transcript levels and distribution patterns on abnormal cells. Whereas the exact mechanism of PAF in sperm function and reproduction is uncertain, its importance in normal fertility is substantial. The reproductive significance of PAF activity in sperm and fertility plus the role of PAF in the establishment of pregnancy requires further study.


Changes in Ultra-Processed Food Consumption and Lifestyle Behaviors Following COVID-19 Shelter-in-Place: A Retrospective Study.
Ultra-processed food (UPF) consumption poses a potential risk to public health and may be related to shelter-in-place orders. This study utilized the level of food processing as a lens by which to examine the relationships between diet, weight change, and lifestyle changes (including cooking, snacking, and sedentary activity) that occurred during regional shelter-in-place orders. This study used a cross-sectional, retrospective survey (n = 589) to assess baseline demographics, changes in lifestyle behaviors using a Likert scale, and changes in dietary behaviors using a modified food frequency questionnaire from mid-March to May 2020; data were collected in the California Bay Area from August to October 2020. Foods were categorized by level of processing (minimally processed, processed, and ultra-processed) using the NOVA scale. Stepwise multiple linear regression and univariate linear regression models were used to determine the associations between these factors. Increased snacking was positively associated with a change in the percent of the calories derived from UPF and weight gain (β = 1.0, p < 0.001; β = 0.8 kg, p < 0.001) and negatively associated with the share of MPF calories consumed (β = -0.9, p < 0.001). These relationships have public health implications as interventions designed around decreased snacking may positively impact diet and weight management and thereby mitigate negative health outcomes.


Therapeutic efficacy of mebendazole and artemisinin in different phases of trichinellosis: a comparative experimental study.
The present work aimed at studying the efficacy of mebendazole (MBZ) compared to artemisinin (ART) for the treatment of trichinellosis at various phases of infection. Seventy Swiss albino mice were orally infected by 300 Trichinella spiralis (T. spiralis) larvae. Mice were divided into infected untreated control group and infected groups treated with 50 mg kg-1 MBZ and 300 mg kg-1 ART for three and five consecutive days, respectively, at the enteral phase [2-4 days post infection (PI)], invasive phase (10-12 days PI) and encapsulated phase (28-30 days PI). All mice were sacrificed 35-42 days PI. MBZ and ART revealed a significant decrease in mean larval counts and increase of larval per cent reduction (LR %) when treatment was initiated during the enteral phase compared to the other phases. MBZ showed significantly higher LR % (99.7, 83.95 and 89.65%) than ART (80.58, 67.0 and 79.2%) when administered at the three infection phases. Histopathological study showed a decrease in the number of encysted larvae, their surrounding cellular infiltrates and increased regenerative muscles in all treated mice. In conclusion, ART possesses a substantial anthelmintic activity against T. spiralis infection in mice both at the enteral and encapsulated phases, yet, significantly lower than MBZ.


Effects of feeding on thermoregulatory behaviours and gut blood flow in white sturgeon (Acipenser transmontanus) using biotelemetry in combination with standard techniques.
The effects of thermoregulatory behaviours on gut blood flow in white sturgeon Acipenser transmontanus before and after feeding was studied using a blood flow biotelemetry system in combination with a temperature preference chamber. This is the first study to look at cardiovascular responses to feeding in white sturgeon, and also the first time behavioural tests in fish have been combined with recordings of cardiac output, heart rate, cardiac stroke volume and gut blood flow. The results showed strong correlations between gut blood flow and temperature choice after feeding (R(2)=0.88+/-0.03, 6-8 h postprandially and R(2)=0.89+/-0.04, 8-10 h postprandially) but not prior to feeding (R(2)=0.11+/-0.05). Feeding did not affect the actual temperature preference (18.4+/-0.7 degrees C before feeding, 18.1+/-0.7 degrees C, 6-8 h postprandially and 17.5+/-0.5 degrees C, 8-10 h postprandially). Fish instrumented with a blood flow biotelemetry device, and allowed to move freely in the water, had a significantly lower resting heart rate (37.3+/-0.26 beats min(-1)) compared with the control group that was traditionally instrumented with transit-time blood flow probes and kept in a confined area in accordance with the standard procedure (43.2+/-2.1 beats min(-1)). This study shows, for the first time in fish, the correlation between body temperature and gut blood flow during behavioural thermoregulation.


Two strong 5' splice sites and competing, suboptimal 3' splice sites involved in alternative splicing of human immunodeficiency virus type 1 RNA.
The human immunodeficiency virus type 1 (HIV-1) genome contains 20 exons that are alternatively spliced from 16 splice sites to generate more than 40 different mRNAs, including incompletely spliced and unspliced mRNAs. In contrast to avian retroviral RNA, which has a cis-acting element in gag that negatively regulates splicing (NRS), HIV-1 RNA did not have any NRS sequences in the gag or pol genes detectable by a splicing inhibition assay. However, this assay demonstrated that the HIV-1 first 5' splice site competed with a cellular 5' splice site, suggesting that HIV-1 may have some strong splice sites. To extend this observation, we used a splice site swapping strategy to determine the efficiency of 14 HIV-1 splice sites in human beta globin chimeras tested in transient transfection experiments. While the 1st HIV-1 5' splice site used in all spliced transcripts and the 4th 5' splice site used in most of the 2-kb transcripts were efficient, the other splice sites, including all the 3' splice sites, were less efficient, ranging in use from 25 to 60%. We propose that this range of splice site efficiencies contributes to the regulation of alternative splicing of HIV-1 mRNAs.


Lower extremity lymphocele development after saphenous vein harvesting.
Damage to the lymphatic vessels may occur after surgery on the greater saphenous vein. We describe the development of a lymphocele in a patient after saphenous vein harvesting for a coronary artery bypass graft. Treatment of these lymphoceles should initially be conservative, but if this approach fails, surgical excision should be performed and special attention paid to identifying and ligating the feeding lymphatic vessel.


Validation of the genital herpes treatment satisfaction questionnaire (GHerpTSQ) in status and change versions.
A new measure of treatment satisfaction (GHerpTSQ) for recurrent genital herpes simplex virus (HSV) was validated and used to evaluate two therapeutic strategies widely used for the management of HSV: episodic treatment, where individual herpes outbreaks are treated as they arise; suppressive therapy, where treatment is taken daily to prevent HSV outbreaks. Satisfaction with treatment is important since daily dosing with suppressive therapy is necessary in the absence of symptoms. A 12-item questionnaire was designed using a modified form of the Diabetes treatment satisfaction questionnaire (DTSQ). The psychometric properties of the GHerpTSQ were evaluated within a sample of 125 Canadians with a history of HSV (type 1, 2) infection participating in a 48 week randomised cross-over trial. Factor analysis suggested that the items can be analysed as two separate subscales corresponding to Control/effectiveness, and Convenience/lifestyle; the single item concerning side effects was retained for separate analysis. Forced one-factor analysis showed that the two subscales can be combined to obtain a total score relating to overall treatment satisfaction. The GHerpTSQ has good internal reliability, clear structure with little overlap of subscales and evidence of good sensitivity to changes in treatment.


Public health response to bioterrorism with Bacillus anthracis: coordinating public health laboratory, communication, and law enforcement.
In October 2001, public health departments across the United States were part of an intensive response to a bioterrorism event using anthrax spores delivered by mail. It is useful to examine this experience as an unscripted exercise of bioterrorism response capacity, more realistic than scenarios of planned exercises. The event particularly challenged public health laboratory and communications capacity, but it also tested surveillance and training capacity. The bioterrorism response demonstrated the importance of strong partnerships between the public health laboratory and emergency response agencies as well as medical providers and the usefulness of open, flexible communication strategies.


[[A projection system for future age-specific fertility rates]].
"This paper presents detailed description of a newly developed fertility projection system which was used in population projections for Japan, and population projections by prefectures, officially announced in September and November 1992 respectively. The system is based on a model of age-specific fertility rates by birth order, and it converts parameters which convey behavioral traits of cohort fertility into age-specific fertility rates of future years." (SUMMARY IN ENG)


Color Doppler imaging of basal cerebral arteries: normal reference values and clinical applications.
Transcranial color-coded duplex ultrasonography is a new diagnostic procedure allowing the visualization of major intracranial vessels. The purpose of this report is to describe this method and to evaluate its practical potential in the routine examination of basal cerebral arteries. The results from the examination of 96 patients are presented. By means of color coding of Doppler frequencies, the major intracranial vessels were identified by nature of their anatomic location with respect to the echogenic brainstem structures in all subjects. The average maximal systolic velocity was, in the middle cerebral artery, 108 +/- 15 cm/s; in the anterior cerebral artery, 96 +/- 15; in the posterior cerebral artery, 76 +/- 16; and in the basilar artery, 59 +/- 17 cm/s. The determination of the angle between the ultrasonic beam and the examined vessel improved the accuracy of flow velocity measurements in comparison with conventional transcranial Doppler ultrasonography. The exact measurement of blood flow velocity in several segments of the visualized vessel proved helpful in the assessment of pathologic findings, especially in differentiation between a stenosis of the intracranial vessel and a vasospasm.


Glaucoma in aphakia and pseudophakia after congenital cataract surgery.
Glaucoma is one of the most common causes of visual loss despite successful congenital cataract surgery. The overall incidence does not appear to have decreased with modern microsurgical techniques. The onset of glaucoma may be acute or insidious and notoriously refractory to treatment. Angle closure glaucoma may occur in the early postoperative period; but the most common type of glaucoma to develop after congenital cataract surgery is open angle glaucoma. Several risk factors have been identified and both chemical and mechanical theories have been proposed for its pathogenesis. Unlike children with congenital glaucoma, those with paediatric glaucoma following congenital cataract surgery are usually asymptomatic despite high intraocular pressure. They may require regular evaluation under anaesthesia, whenever there are any suspicious findings. Unlike congenital glaucoma, the first line of treatment for glaucoma in aphakia/pseudophakia may be medical. Traditional trabeculectomy in paediatric glaucoma following congenital cataract surgery has met with limited success. The addition of antimetabolites to trabeculectomy is known to inhibit fibrosis and enhance the success, but carries the lifelong risk of bleb-related endophthalmitis. Drainage implant surgery is a viable option to achieve longterm intraocular pressure control in this refractory group of patients. Cycloablative procedures may provide temporising treatment and should be reserved for patients with low visual potential. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. Further research is needed to understand the pathophysiology, prevention and treatment of this sight-threatening complication following successful cataract surgery in children.


Wrist-RoboHab: a robot for treatment and evaluation of brain injury patients.
This article, introduces a new haptic robot, wrist-RoboHab, for upper limb rehabilitation of post stroke, orthopedic and Parkinson patients., The robot is designed for hand movement therapy and could be used for both treatment and evaluation purposes in three operational states; forearm supination/pronation, wrist flexion/extension and ulnar/radial deviation. At first the mechanical design and control system are described. Then the results of a case study are demonstrated. Clinical results, showed an improvement in Fugle-Meyer, AROM, power and the biomechanical assessment of the spasticity in a chronic patient. Furthermore, it was approved that the robot can have a good interaction with both, patient and therapist.


Recombination nodules and axial equalization in the ZW pairs of the Peking duck and the guinea fowl.
The meiotic Z and W chromosomes of the Guinea fowl (Numida meleagris) and the Peking duck (Anas platyrhynchos) show features similar to those described previously for 3 species of Phasianidae: chicken, Japanese quail and bobwhite quail. Axial equalization in the gonosomes of the Peking duck involves lengthening of the W axis along with shortening of the Z axis. A single recombination nodule is constantly found in the synaptic, terminal region of the ZW pairs stained with phosphotungstic acid. The localization of this nodule is significantly different in these two species, but the length of synaptonemal complex harboring the nodules is not significantly different. Based on the phylogenetic distance between the observed species, the present data support the hypothesis that the presence of a pseudoautosomal region is a general property of ZW pairs in carinate birds.


Medicare program; Provider Reimbursement Review Board jurisdiction over challenge to apportionment of malpractice insurance costs--HCFA. Notice of HCFA ruling.
This notice announces a HCFA Ruling relating to the jurisdiction of the Provider Reimbursement Review Board (PRRB) over challenges to the application or validity of our regulations concerning apportionment of malpractice insurance costs under the Medicare program. A related HCFA Ruling, 86-2, was issued on this matter on July 2, 1986. this Ruling announces that providers may request consideration by PRRB of appeals where a Notice of Program Reimbursement (NPR) has not yet been issued.


Characteristics of alpha-Amylase during Germination of Two High-Sugar Sweet Corn Cultivars of Zea mays L.
The role of the scutellum and the aleurone in alpha-amylase production in the high-sugar sweet corn cultivars Illini X-tra Sweet (shrunken-2, sh2) and Illinois 677a (sugary, sugary enhancer; su se) was compared to that in the starchy (Su) hybrid Funks G4646 with the use of alpha-amylase enzyme assays, isoelectric focusing, electron microscopy, and laser scanning confocal microscopy. The scutellum of Illinois 677a had low levels of alpha-amylase activity compared to that of Funks G4646 through 10 days after imbibition, and the aleurone of Illini X-tra Sweet had negligible activity. On the isoelectric focusing gels, the Illinois 677a scutellum had fewer alpha-amylase isozymes at 7 days compared to the Funks G4646 scutellum. The Illini X-tra Sweet aleurone had no alpha-amylase isozymes. Funks G4646 scutellar epithelial and aleurone cells contained abundant rough endoplasmic reticulum, polysomes, and dictyosomes at 5 and 7 days, respectively. The scutellar epithelial cells of Illinois 677a contained fewer of these structures by 5 days, and the Illini X-tra Sweet aleurone contained mostly lipid bodies through 7 days. Few cytoplasmic membranes and little RNA were detected with laser scanning confocal microscopy in the Illini X-tra Sweet aleurone compared to Funks G4646 at 7 days. These data suggest that the scutellum of Illinois 677a and the aleurone of Illini X-tra Sweet have impaired abilities to produce alpha-amylase.


Efficacy of interpersonal therapy-group format adapted to post-traumatic stress disorder: an open-label add-on trial.
Post-traumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the "gold-standard" therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, approved earlier by the UNIFESP Ethics Review Board, they received a semi-structured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a PTSD diagnosis according to DSM-IV criteria. Other instruments were administered, and patients completed out self-report instruments at baseline, and endpoint to evaluate clinical outcomes. Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials.


A Systematic Review and Meta-Analysis of the Accuracy of in VivoReflectance Confocal Microscopy for the Diagnosis of Primary Basal Cell Carcinoma.
Basal cell carcinoma (BCC) is the most common cancer worldwide and its incidence is constantly rising. Early diagnosis and treatment can significantly reduce patient morbidity and healthcare costs. The value of reflectance confocal microscopy (RCM) in non-melanoma skin cancer diagnosis is still under debate. This systematic review and meta-analysis were conducted to assess the diagnostic accuracy of RCM in primary BCC. PubMed, Google Scholar, Scopus, and Web of Science databases were searched up to July 05, 2019, to collect articles concerning primary BCC diagnosis through RCM. The studies' methodological quality was assessed by the QUADAS-2 tool. The meta-analysis was conducted using Stata 13.0, RevMan 5.0, and MetaDisc 1.4 software. We included 15 studies totaling a number of 4163 lesions. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87-0.95; I2= 85.27%) and 0.93 (95% CI, 0.85-0.97; I2= 94.61%), the pooled positive and negative likelihood ratios were 13.51 (95% CI, 5.8-31.37; I2= 91.01%) and 0.08 (95% CI, 0.05-0.14; I2= 84.83%), and the pooled diagnostic odds ratio was 160.31 (95% CI, 64.73-397.02; I2=71%). Despite the heterogeneity and risk of bias, this study demonstrates that RCM, through its high sensitivity and specificity, may have a significant clinical impact on the diagnosis of primary BCC.


Characterization of prostaglandin-F2 alpha-binding sites on rat hepatocyte plasma membranes.
Prostaglandin (PG) F2 alpha has previously been shown to increase glucose output from perfused livers and isolated hepatocytes, where it stimulated glycogen phosphorylase via an inositol-trisphosphate-dependent signal pathway. In this study, PGF2 alpha binding sites on hepatocyte plasma membranes, that might represent the putative receptor, were characterized. Binding studies could not be performed with intact hepatocytes, because PGF2 alpha accumulated within the cells even at 4 degrees C. The intracellular accumulation was an order of magnitude higher than binding to plasma membranes. Purified hepatocyte plasma membranes had a high-affinity/low-capacity and a low-affinity/high-capacity binding site for PGF2 alpha. The respective binding constants for the high-affinity site were Kd = 3 nM and Bmax = 6 fmol/mg membrane protein, and for the low-affinity site Kd = 426 nM and Bmax = 245 fmol/mg membrane protein. Specific PGF2 alpha binding to the low-affinity site, but not to the high-affinity site, could be enhanced most potently by GTP[gamma S] followed by GDP[beta S] and GTP, but not by ATP[gamma S] or GMP. PGF2 alpha competed most potently with [3H]PGF2 alpha for specific binding to hepatocyte plasma membranes, followed by PGD2 and PGE2. Since the low-affinity PGF2 alpha-binding site had a Kd in the concentration range in which PG had previously been shown to be half-maximally active, and since this binding site showed a sensitivity to GTP, it is concluded that it might represent the receptor involved in the PGF2 alpha signal chain in hepatocytes. A biological function of the high-affinity site is currently not known.


Determination of the gamma G/gamma A ratio in homozygous beta-thalassemic patients among a Lebanese population.
The gamma G/gamma A ratio was determined on 50 cord blood samples from normal newborns and in 28 beta-thalassemia homozygotes among the Lebanese population, using electrophoresis on acrylamide-bisacrylamide gels containing Triton X-100, urea, and 2-mercapto-ethanol. 2-Mercapto-ethanol was found to be the most effective reducer, giving good resolution and a clean background. As the concentration of Triton X-100 was critical in this study, a concentration of 500 microliters of Triton X-100/25 ml of reaction mixture was found to be optimal. In our 50 cord blood samples, the mean total Hb was 20 g/dl, with a range of 12-26. The mean fetal Hb (HbF) level was 64%, and the range 50-90%. The mean value for gamma G/gamma G + gamma A was 0.75. All beta-homozygotes had an elevated HbF, ranging from 7.7-99.3%, and their mean gamma G/gamma G + gamma A was 0.64. Only two out of 28 had gamma G/gamma G + gamma A ratio of 0.5; in the rest it was 0.60 or greater. This may be due to the greater resistance of erythrocytes with higher HbF and higher gamma G/gamma A destruction.


One-pot synthesis of asymmetric annulated bis(pyrrole)s.
Condensation of activated functionalized pyrroles with acetone results in asymmetric bis(pyrrole)s, formed via ring annulation. The methodology is somewhat general and can be applied to a variety of ketones, as well as to a range of pyrrolic substrates that do not bear electron-withdrawing groups directly adjacent to the pyrrole ring.


Molecular Docking as a Therapeutic Approach for Targeting Cancer Stem Cell Metabolic Processes.
Cancer stem cells (CSCs) are subpopulation of cells which have been demonstrated in a variety of cancer models and involved in cancer initiation, progression, and development. Indeed, CSCs which seem to form a small percentage of tumor cells, display resembling characteristics to natural stem cells such as self-renewal, survival, differentiation, proliferation, and quiescence. Moreover, they have some characteristics that eventually can demonstrate the heterogeneity of cancer cells and tumor progression. On the other hand, another aspect of CSCs that has been recognized as a central concern facing cancer patients is resistance to mainstays of cancer treatment such as chemotherapy and radiation. Owing to these details and the stated stemness capabilities, these immature progenitors of cancerous cells can constantly persist after different therapies and cause tumor regrowth or metastasis. Further, in both normal development and malignancy, cellular metabolism and stemness are intricately linked and CSCs dominant metabolic phenotype changes across tumor entities, patients, and tumor subclones. Hence, CSCs can be determined as one of the factors that correlate to the failure of common therapeutic approaches in cancer treatment. In this context, researchers are searching out new alternative or complementary therapies such as targeted methods to fight against cancer. Molecular docking is one of the computational modeling methods that has a new promise in cancer cell targeting through drug designing and discovering programs. In a simple definition, molecular docking methods are used to determine the metabolic interaction between two molecules and find the best orientation of a ligand to its molecular target with minimal free energy in the formation of a stable complex. As a comprehensive approach, this computational drug design method can be thought more cost-effective and time-saving compare to other conventional methods in cancer treatment. In addition, increasing productivity and quality in pharmaceutical research can be another advantage of this molecular modeling method. Therefore, in recent years, it can be concluded that molecular docking can be considered as one of the novel strategies at the forefront of the cancer battle via targeting cancer stem cell metabolic processes.


Evaluation of the Residual Disinfection Effects of Commonly Used Skin Disinfectants against Viruses: An Innovative Contact Transmission Control Method.
Lasting disinfection effects, that is, the residual disinfection effects (RDEs), of skin-coated disinfectants have rarely been considered for infection control owing to the challenges involved in the accurate evaluation of RDEs. In this study, we constructed a new skin evaluation model and determined the RDEs of existing disinfectants against viruses. Our results showed that ethanol and isopropanol had no RDE, whereas povidone-iodine, chlorhexidine gluconate, and benzalkonium chloride (BAC) exhibited RDEs, with 10% povidone-iodine and 0.2% BAC showing particularly strong RDEs. The RDE of 0.2% BAC was strong enough to reduce the median survival times of severe acute respiratory syndrome coronavirus-2, human coronavirus-OC43, and influenza virus from 670 to 5.2, 1300 to 12, and 120 to 4.2 min, respectively. Additionally, this strong RDE was maintained even 4 h after coating the skin. Clinical data also showed that the strong RDE of 0.2% BAC was maintained for more than 2 h. Thus, applying disinfectants with strong RDEs on the skin correlates with a reduction in virus survival time and appears to create a skin surface environment that is not conducive to virus survival. A prolonged reduction in virus survival decreases the contact transmission risk, thereby enabling stronger infection control.


Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics.
Previous studies have demonstrated an association between malnutrition and poor outcomes. The primary objective of this study was to explore the difference in the composite end point of readmission rate or mortality rate between hospitalized veterans with and without malnutrition. This was a retrospective chart review comparing veterans with malnutrition based on a modified version of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus characteristics that used 5 of the 6 clinical characteristics to a matched control group of nonmalnourished veterans based on age, admitting service, and date of admission who were admitted between August 1, 2012, and December 1, 2014. Data were extracted from the medical record. Multivariate analysis was used to identify predictors of outcomes. In total, 404 patients were included in the final analysis. All end points were found to be statistically significant. The malnourished group was more likely to meet the composite end point (odds ratio [OR], 5.3), more likely to be readmitted within 30 days (OR, 3.4), more likely to die within 90 days of discharge (OR, 5.5), and more likely to have a length of stay >7 days (OR, 4.3) compared with the nonmalnourished group. Length of stay was significantly longer in the malnourished group, 9.80 (11.5) vs 4.38 (4.5) days. Malnutrition was an independent risk factor for readmission within 30 days or death within 90 days of discharge. Malnourished patients had higher rates of readmission, higher mortality rates, and longer lengths of stay and were more likely to be discharged to nursing homes.


Association between high-sensitivity cardiac troponin T and future cardiovascular incidence in a general Japanese population: results from the Tohoku medical megabank project.
Purpose: Elevation of high-sensitivity cardiac troponin T (hs-cTnT) is associated with an increased risk of cardiovascular disease (CVD). This study determined whether hs-cTnT was detectable with N-terminal pro-b-type natriuretic peptide (NT-proBNP) and related to CV risk factors in a general Japanese population. Materials and methods: The Tohoku Medical Megabank Organization pooled individual participant data for a population-based cohort study in the Iwate prefecture (n = 30,193, age = 60.2 ± 11.5 year). Results: Hs-cTnT levels were higher in participants with hypertension, diabetes mellitus than in participants without these conditions (all ps < 0.001). Logistic regression analysis demonstrated that NT-proBNP was strongly associated with elevation of hs-cTnT (OR = 3.35, 95% CI = 2.90-3.89, p < 0.001). The receiver operating characteristic curve analysis showed that hs-cTnT was one of useful biomarker for the differentiation of high risk for CVD (the Suita score ≥ 56) from a general population. Logistic regression analysis demonstrated hs-cTnT levels were related to the CVD high risk group (OR = 2.67, 95% CI = 2.28-3.14, p < 0.001). Conclusions: Hs-cTnT levels are associated with elevation of NT-proBNP and high Suita score, which suggests that elevated hs-cTnT is related to subclinical myocardial damage and indicates CV risk.


Multidrug-Resistant CTX-M and CMY-2 Producing Escherichia coli Isolated from Healthy Household Dogs from the Great Metropolitan Area, Costa Rica.
Objective: This study aimed to determine the prevalence of fecal carriage of antibiotic-resistant Escherichia coli of healthy household dogs with an emphasis on extended-spectrum β-lactamases (ESBL), AmpC-type β-lactamases and resistance to quinolones. Materials and Methods: Rectal swabs were collected from 74 dogs without any clinical evidence of gastrointestinal disease. Samples were cultured on MacConkey agar plates and MacConkey supplemented with 2 μg/mL cefotaxime or 5 μg/mL ciprofloxacin. Isolates were identified with Vitek 2 Compact and susceptibility testing performed by Kirby Bauer disk diffusion method. Minimal inhibitory concentration (MIC) was done on isolates resistant to cefotaxime, ciprofloxacin, and nalidixic acid. PCR amplification was performed to detect CTX-M and CMY-2. Isolates positive for CTX-M and/or CMY-2 were selected for whole-genome sequencing. Results: Multiresistance was detected in 56% of the isolates. A high percentage of resistance was detected for cefazolin (63%), ampicillin (54%), streptomycin (49%), nalidixic acid (42%) and tetracycline (38%). The MIC50 and MIC90 for isolates resistant to cefotaxime (24%) was determined as 16 and >250 μg/mL, respectively; for ciprofloxacin (18%), 125 and 250 μg/mL, respectively. ESBL (CTX-M type) and AmpC (CMY-2 type) were detected in 6 (7.1%) and 14 (19%) of the isolates, respectively. Whole-genome sequence analysis showed high genetic diversity in most of the isolates and a large variety of resistance mechanisms, including mobile genetic elements. Conclusion: The frequency of multidrug-resistant E. coli is worrying, mainly because of the presence of many isolates producing ESBL and AmpC β-lactamases. Based on the "One Health" concept, considering the relationships between animals, humans, and the environment, these data support the notion that companion animals are important reservoirs of multidrug-resistant bacteria.


The effect of traffic noise on cognitive performance with regard to personality traits: A laboratory experiment study.
Exposure to traffic noise could play an important part in inducing psychological disorders which in turn can affect individuals' cognitive and mental performance. The aim of this study was to determine the effect of traffic noise exposure on the cognitive performance with regard to subjects' personality traits. Sixty students with normal hearing and vision took part in this experimental study. In order to simulate the traffic noise condition of Tehran, the noise from several busy streets was first carefully recorded. Later on, the subjects were exposed to this recorded noise in an anechoic chamber. Also, the NEO-five factor inventory questionnaire and the continuous performance test were used to assess personality traits and cognitive performance of participants respectively. The results showed that the cognitive features of the study, such as reaction time and the number of commission/omission errors in continuous performance testing increased significantly after exposure to the traffic noise (p < 0.05), and among the personality traits, only the neuroticism has a significant correlation with response time in the continuous performance tests (p < 0.05). Apart from the effect of traffic noise on cognitive function, the findings of this study confirmed that Neuroticism (one of the personality traits) also significantly affect the cognitive performance of individuals when they are exposed to traffic noise in laboratory conditions.


The adsorption and activation of NO on silver clusters with sizes up to one nanometer: interactions dominated by electron transfer from silver to NO.
The adsorption and activation of NO on microsilver species provide the foundation to understand the mechanism of NO removing reactions on silver based catalysts. However, the diversiform of the geometrical structures and electronic properties of microsilver species in condensed phases has posed considerable challenges for exploring these interactions. We study the reactions of NO with bare silver clusters Agn(±) (7-69) in the gas phase using a continuous flow reactor running at low temperatures. Evidence for NO unit adsorption, the formation of (NO)2 and the reduction of NO is observed on different cluster sizes. The kinetic rates of initial NO unit adsorption are closely related to silver clusters' global electronic properties. The low electron binding energy and the unpaired electron of a silver cluster favor the adsorption and activation of NO. In particular, the clusters with one less electron than those of closing electron shells are generally inert and the sizes having one more electron outside these shells are generally quite reactive. These observations depict a general figure of interactions between NO and microsilver species, in which electron transfer from silver to NO dominates.


Congenital malformations in Assam.
To determine the annual incidence of congenital malformations in Assam and to analyze the data. Data regarding babies born with congenital malformations in the state of Assam during the year 2006 were obtained through questionnaires and analyzed. The results were compared with similar Indian data. The overall incidence of congenital malformation was 0.08%. This was considerably lower than similar published data from other states. Five hundred and eleven babies were born with congenital malformations, with 421 (82.4%) having major malformations. Males were affected more than females, 334 (65.4%) vs. 177 (34.6%). The gastrointestinal and genitourinary systems accounted for 26% and 25.8%, respectively. Malformation involving the central nervous system was more common in certain ethnic groups. The incidence of malformations in certain systems was at variance with the data from other states.


The path to EHR.
All signs are pointing to electronic health records (EHRs). President Bush included a statement in his 2004 State of the Union address on the need for computerizing health records.


Intelligent difficulty scoring and assistance system for endoscopic extraction of common bile duct stones based on deep learning: multicenter study.
The study aimed to construct an intelligent difficulty scoring and assistance system (DSAS) for endoscopic retrograde cholangiopancreatography (ERCP) treatment of common bile duct (CBD) stones. 1954 cholangiograms were collected from three hospitals for training and testing the DSAS. The D-LinkNet34 and U-Net were adopted to segment the CBD, stones, and duodenoscope. Based on the segmentation results, the stone size, distal CBD diameter, distal CBD arm, and distal CBD angulation were estimated. The performance of segmentation and estimation was assessed by mean intersection over union (mIoU) and average relative error. A technical difficulty scoring scale, which was used for assessing the technical difficulty of CBD stone removal, was developed and validated. We also analyzed the relationship between scores evaluated by the DSAS and clinical indicators including stone clearance rate and need for endoscopic papillary large-balloon dilation (EPLBD) and lithotripsy. The mIoU values of the stone, CBD, and duodenoscope segmentation were 68.35 %, 86.42 %, and 95.85 %, respectively. The estimation performance of the DSAS was superior to nonexpert endoscopists. In addition, the technical difficulty scoring performance of the DSAS was more consistent with expert endoscopists than two nonexpert endoscopists. A DSAS assessment score ≥ 2 was correlated with lower stone clearance rates and more frequent EPLBD. An intelligent DSAS based on deep learning was developed. The DSAS could assist endoscopists by automatically scoring the technical difficulty of CBD stone extraction, and guiding the choice of therapeutic approach and appropriate accessories during ERCP.


Practices and health perception of preparation of Brassica vegetables: translating survey data to technological and nutritional implications.
Food preparation practices are known to have large nutritional implications on the final product. This article describes survey data on preparation practices of Brassica vegetables and the translation of these data into technological and nutritional implications using knowledge on the mechanisms of changes in the content of phytochemicals. The survey on preparation practices was performed with food service establishments (n = 123) and households (n = 477) in Semarang, Indonesia, and assessed the food handlers' perception of the health benefits of these vegetables. Boiling and stir-frying are the most frequently applied techniques to prepare Brassicas. The respondents perceive that steaming, boiling, and stir-frying result in vegetables with a high health benefit. White cabbage and choysum are the most frequently prepared Brassicas. However, broccoli is perceived as the healthiest. The consequences of the various applied preparation techniques on the content of alleged health promoting phytochemicals (glucosinolates) in dishes containing Brassica vegetables are discussed.


Results from a retrospective analysis of colonoscopies for Inflammatory bowel disease and colorectal cancer in a Lebanese tertiary care centre.
Inflammatory bowel diseases (IBDs) and colorectal cancer have an increased impact on the Lebanese population's morbidity and mortality. This study evaluated the situation of IBD and colorectal cancer at a tertiary hospital centre in Lebanon. 1007 patients underwent colonoscopy over a period of 12 months by qualified physicians. 91 patients were excluded from the study. Biopsy results were divided into normal versus abnormal colonic tissue. The abnormal section was further subdivided into number of polyps, IBD, dysplasia and cancer. Out of 916 individuals included, 61 cases of Crohn's colitis (CC) (6.7%) and 24 cases of ulcerative colitis (UC) (2.7%) were identified. A total of 92 cases of colorectal cancer (10.04%) were also identified. There was a slight male predominance in both groups of IBD without any statistical significance. One statistical significance was reported in favour to age<50 years in both IBD groups with a mean age of 37.9±9.7 years and 34.4±6.4 years for CC and UC, respectively. The incidence of granuloma in the CC group was 8.9% without any correlation compared with age or gender. No correlation was made between colorectal cancer and the existence of any IBD type. The data showed that age >50 years and male gender significantly correlate with an increased incidence of precancerous and cancerous polyps in the colon. They significantly correlate with adenocarcinoma. The estimated incidence of colorectal cancer, CC and UC was 54.1, 35.8 and 14.1 per 100 000, respectively, with a denominator of 169 959 patients per year. Within the limitations of this study, the incidence of colorectal cancer and IBD falls in the high range compared with similar European and American studies. Our data are biased because of the tertiary centre setting but they can be considered as base for further investigations.


Kinetic resolution of racemic 2,3-allenoates by organocatalytic asymmetric 1,3-dipolar cycloaddition.
The kinetic resolution of racemic 2,3-allenoates was realized via 1,3-dipolar cycloaddition by using a bisphosphoric acid catalyst, affording the optically active 2,3-allenoates and 3-methylenepyrrolidine derivatives in high yields and enantioselectivities.


Survival Outcomes of Patients With Breast Cancer Diagnosed Using Vacuum-Assisted Biopsy: A Nationwide Study From the Korean Breast Cancer Society.
Breast cancer is mainly diagnosed using core needle biopsy (CNB), although other biopsy methods, including vacuum-assisted biopsy (VAB), may also be used. We compared differences in clinical characteristics and prognoses of patients with breast cancer according to biopsy methods used for diagnosis. A total of 98,457 patients who underwent various biopsy methods (CNB, fine-needle aspiration [FNA], VAB, and excisional biopsy) for diagnosing breast cancer were recruited. Using CNB as a reference, related clinicopathological factors and prognostic differences between biopsy methods were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society Registration System. The associations between biopsy methods and clinicopathological factors were compared using multinomial logistic regression analysis, and the prognoses of patients undergoing the different biopsy methods, as breast cancer-specific survival (BCSS) and overall survival (OS), were compared using the Kaplan-Meier method and Cox proportional hazard model. Univariate and multivariate analyses showed that unlike FNA, both VAB and excisional biopsy were significantly associated with tumor size, palpability, tumor stage, and histologic grade as relatively good prognostic factors compared to CNB. In particular, VAB showed lower odds ratios for these factors than excisional biopsy. In the univariate analysis, the prognosis of patients undergoing VAB was better than that of those undergoing CNB with respect to BCSS (hazard ratio [HR], 0.188, p < 0.001) and OS (HR, 0.359; p < 0.001). However, in the multivariate analysis, there were no significant prognostic differences from CNB in both BCSS and OS; differences were only evident for FNA. In this study, we showed that the characteristics of breast cancer differed according to various biopsy methods. Although VAB is not a standard method for breast cancer diagnosis, it showed no prognostic differences to CNB.


Validity of [123I]beta-CIT SPECT in detecting MDMA-induced serotonergic neurotoxicity.
Recent [123I]beta-CIT single-photon emission computed tomography (SPECT) studies revealed decreased serotonin transporters (SERT) density in the brain of humans with a history of MDMA ("Ecstasy") use. However, [123I]beta-CIT SPECT has until now not been validated as a method for detecting such serotonergic lesions. Therefore, the present study was undertaken. Following baseline [123I]beta-CIT SPECT scans, a rhesus monkey was treated with MDMA (5 mg/kg, s.c. twice daily for 4 consecutive days). SPECT studies 4, 10, and 31 days after MDMA treatment revealed decreases in [123I]beta-CIT binding ratios in the SERT-rich brain region studied (hypothalamic/midbrain region), with SERT density reduced by 39% in this brain region 31 days after treatment. Data obtained with SPECT studies correlated well with SERT density determined with autoradiography after sacrifice of the animal (-34%). In addition, ex vivo [123I]beta-CIT binding studies in rats 1 week after treatment with neurotoxic doses of MDMA (20 mg/kg s.c. twice daily for 4 consecutive days) revealed significant reductions in [123I]beta-CIT binding in SERT-rich regions (including the hypothalamus) when compared to saline-treated rats. The combined results of these studies indicate that SPECT imaging of SERT with [123I]beta-CIT can detect changes in SERT density secondary to MDMA-induced neurotoxicity in the hypothalamic/midbrain region, and possibly other brain regions.


Thrombin-antithrombin complex and alpha-plasmin inhibitor-plasmin complex levels in singleton and twin pregnancies.
Thrombin-antithrombin complex (TAT) is a sensitive marker for thrombin formation, and alpha2-plasmin inhibitor-plasmin complex (PIC) is a marker for fibrinolysis. Previous studies have shown that blood coagulation and fibrinolysis are activated in normal pregnancies. Thus, the present study examined changes in TAT and PIC levels during the course of singleton and twin pregnancies and compared these markers between the two pregnant groups. The subjects were 148 pregnant women, of whom 84 were women carrying single fetuses and 64 were women with twin fetuses. Their average gestational age at entry was 10, 20, 30 and 38 weeks of gestation in singleton pregnancies and 10, 20, 30 and 35 weeks in twin pregnancies. Peripheral blood was collected, and plasma was separated after centrifugation and then stored at -20 degrees C. The TAT levels increased significantly with the progression of pregnancy in both pregnant groups, whereas the PIC levels increased significantly only in singleton pregnancies between 30 and 38 weeks of gestation. The TAT levels were significantly higher in twin pregnancies than in singleton pregnancies. The PIC levels were significantly lower in twin pregnancies than in singleton pregnancies at 35-38 weeks. Thrombin formation might be enhanced with the progression of pregnancy in both pregnant groups. This enhancement might be more intensified in twin pregnancies. Fibrinolysis might increase only in singleton pregnancies from 30 to 38 weeks of gestation. Fibrinolysis might be less intensified in twin pregnancies than in singleton pregnancies only at 35-38 weeks.


Infertility management in women with polycystic ovary syndrome: a review.
Polycystic ovary syndrome is the most common endocrine disorder in women and a major cause of anovulatory infertility. Various medical options are used, alone or in combination, to treat subfertility associated with polycystic ovary syndrome. This narrative review was conducted to provide an update and summarize the available evidence on the management of polycystic ovary syndrome related infertility. A wide literature search was performed and preferably randomized controlled trials and systematic reviews were included. Management is often centered on lifestyle changes. Pharmacological ovulation induction is the next step, with recommended use of letrozole, clomiphene citrate or gonadotropins. When it fails, assisted reproductive technologies or laparoscopic ovarian drilling are frequently advised. Combination treatment with metformin is often recommended. More recent alternative and adjunctive treatments have been suggested, like inositol, vitamin D, bariatric surgery and acupuncture, but further research is needed for recommendation.


Utility of intraperitoneal administration as a route of AAV serotype 5 vector-mediated neonatal gene transfer.
Gene transfer into a fetus or neonate can be a fundamental approach for treating genetic diseases, particularly disorders that have irreversible manifestations in adulthood. Although the potential utility of this technique has been suggested, the advantages of neonatal gene transfer have not been widely investigated. Here, we tested the usefulness of neonatal gene transfer using adeno-associated virus (AAV) vectors by comparing the administration routes and vector doses. To determine the optimal administration route, neonates were subjected to intravenous (i.v.) or intraperitoneal (i.p.) injections of AAV5-based vectors encoding the human coagulation factor IX (hfIX) gene, and the dose response was examined. To determine the distribution of transgene expression, vectors encoding lacZ or luciferase (luc) genes were used and assessed by X-gal staining and in vivo imaging, respectively. After the observation period, the vector distribution across tissues was quantified. The factor IX concentration was higher in i.p.-injected mice than in i.v.-injected mice. All transgenes administered by i.p. injection were more efficiently expressed in neonates than in adults. The expression was confined to the peritoneal tissue. Interestingly, a sex-related difference was observed in transgene expression in adults, whereas this difference was not apparent in neonates. AAV vector administration to neonates using the i.p. route was clearly advantageous in obtaining robust transgene expression. Vector genomes and transgene expression were observed mainly in the peritoneal tissue. These findings indicate the advantages of neonatal gene therapy and would help in designing strategies for gene therapy using AAV vectors.


Probiotic supplementation alleviates absence seizures and anxiety- and depression-like behavior in WAG/Rij rat by increasing neurotrophic factors and decreasing proinflammatory cytokines.
Epilepsy is one of the most common chronic brain disorders that affect millions of people worldwide. In the present study, we investigated the effects of probiotic supplementation on absence epilepsy and anxiety-and depression-like behavior in WAG/Rij rats. Fourteen male WAG/Rij rats (absence-epileptic) and seven male Wistar rats (nonepileptic) were used. The effects of probiotic VSL#3 (12.86 bn living bacteria/kg/day for 30 day/gavage) on absence seizures, and related psychiatric comorbidities were evaluated in WAG/Rij rats. Anxiety-like behavior was evaluated by the open-field test and depression-like behavior by the forced swimming test. In addition, the brain tissues of rats were evaluated histopathologically for nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], SRY sex-determining region Y-box 2 [SOX2] and biochemically for nitric oxide [NO], tumor necrosis factor-alpha [TNF-α] ,and Interleukin-6 [IL-6]. Compared to Wistar rats, WAG/Rij rats exhibited anxiety- and depression-like behavior, and had lower BDNF, NGF and SOX2 immunoreactivity, and higher TNF-α, IL-6 levels in brain tissue. VSL#3 supplementation reduced the duration and number of spike-wave discharges (SWDs) and exhibited anxiolytic or anti-depressive effect. VSL#3 supplement also increased the NGF immunoreactivity while decreasing IL-6, TNF-α and NO levels in WAG/Rij rat brain. The findings of the present study showed that neurotrophins, SOX2 deficiency, and pro-inflammatory cytokines may play a role in the pathogenesis of absence epilepsy. Our data support the hypothesis that the probiotics have anti-inflammatory effect. The present study is the first to show the positive effects of probiotic bacteria on absence seizures and anxiety- and depression-like behavior.


Clinical and histological features and therapeutic strategies for IgA nephropathy.
Chronic glomerulonephritis is the second most common reason, after diabetic nephropathy, for initiation of dialysis in Japan and IgA nephropathy (IgAN) is the most prevalent form of chronic glomerulonephritis. In the half century since IgAN was initially reported, our understanding of the long-term prognosis, clinical and histological features, pathogenesis of onset and progression, risk factors for progression, and appropriate treatment under different clinical and histological conditions, has steadily increased. Strong experimental and clinical evidence, the Clinical Practice Guidelines for IgA Nephropathy in Japan, the Oxford Classification, and the Kidney Disease Improving Global Outcomes guidelines have all contributed to the appropriate treatment of IgAN. Several intensive therapies, such as tonsillectomy, steroid therapy, and their combinations, can result in clinical remission, and prevent the progression to end stage renal disease (ESRD). However, some IgAN patients still progress to ESRD even when treated with intensive therapies. In this review, we discuss the clinical and histological features of IgAN, focusing primarily on our previous reports, and our opinions on therapeutic strategies for IgAN.


Optical intersubband transitions and femtosecond dynamics in Ag/Fe(100) quantum wells.
The optical intersubband transitions and femtosecond dynamics of electrons in quantum well states in Ag/Fe(100) are investigated by interferometric time-resolved two-photon photoemission. The quantum well wave functions and transition probabilities are evaluated from the two-photon photoemission resonance energies and intensities using an extended phase accumulation model. Direct femtosecond pump-probe correlation measurements elucidate the importance of interfaces in confined structures.


Smoking-related DNA adducts: 32P-postlabeling analysis of 7-methylguanine in human bronchial and lymphocyte DNA.
7-methylguanine DNA adducts were determined in macroscopically normal bronchial specimens and peripheral blood lymphocytes of 20 patients undergoing pulmonary surgery. A recently developed 32P-postlabeling assay was applied with anion exchange chromatography as an adduct enrichment method. The material consisted of 13 smokers and 7 non-smokers. The mean bronchial 7-methylguanine levels of 11 smokers and 6 non-smokers were 17.3 and 4.7 adducts/10(7) nucleotides. In lymphocyte DNA, the respective mean levels were 11.5 and 2.3 adducts/10(7) nucleotides. The bronchial DNA adduct levels in smokers were statistically higher than those in non-smokers. Among 5 smokers, for whom both bronchial and lymphocyte DNA was available, 7-methylguanine levels correlated in the two tissues (r = 0.77).


Differences in the clinical course of acute massive and submassive pulmonary embolism.
Acute massive or submassive pulmonary embolism (PE) has high mortality, but the clinical course according to the location of onset (ie, in-hospital or out-of-hospital) is unknown. In the present study 56 consecutive patients with acute massive or submassive PE were studied retrospectively and a comparison made of the clinical characteristics, and outcomes between in-hospital onset (Group A) and out-of-hospital onset (Group B). Patients in Group A (n=28) had more frequent comorbidities with hemodynamic instability (54% vs 4%, p<0.0001) and temporary risk factors (93% vs 11%, p<0.0001), whereas patients in Group B (n=28) had a longer duration of symptoms (median: 5.5 days vs 0.5 day; p<0.0001), and had higher systolic pulmonary artery pressure (63+/-17 mmHg vs 46+/-12 mmHg, p=0.0006). Although in-hospital mortality did not differ between the 2 groups, the recurrence rate was higher in Group B (23% vs 0%, p=0.03). Patients who had in-hospital onset of PE had mostly temporary risk factors, unstable hemodynamics and a lower recurrence rate compared with the cases of out-of-hospital onset. In cases of in-hospital onset, prompt diagnosis and suitable treatment is needed to prevent fatalities and cases of out-of-hospital onset should be followed carefully for recurrence.


Cell cycle-dependent phosphorylation of IQGAP is involved in assembly and stability of the contractile ring in fission yeast.
Cytokinesis is the final step in cell division and is driven by the constriction of the medial actomyosin-based contractile ring (CR) in many eukaryotic cells. In the fission yeast Schizosaccharomyces pombe, the IQGAP-like protein Rng2 is required for assembly and constriction of the CR, and specifically interacts with actin filaments (F-actin) in the CR after anaphase. However, the mechanism that timely activates Rng2 has not yet been elucidated. We herein tested the hypothesis that the cytokinetic function of Rng2 is regulated by phosphorylation by examining phenotypes of a series of non-phosphorylatable and phosphomimetic rng2 mutant strains. In phosphomimetic mutant cells, F-actin in the CR was unstable. Genetic analyses indicated that phosphorylated Rng2 was involved in CR assembly in cooperation with myosin-II, whereas the phosphomimetic mutation attenuated the localization of Rng2 to CR F-actin. The present results suggest that Rng2 is phosphorylated during CR assembly and then dephosphorylated, which enhances the interaction between Rng2 and CR F-actin to stabilize the ring, thereby ensuring secure cytokinesis.


The secretin gene: evolutionary history, alternative splicing, and developmental regulation.
The gene encoding the hormone secretin has been isolated and structurally characterized. The transcriptional unit is divided into four exons spanning 813 nucleotides. Comparison of the rat secretin gene to the other members of the glucagon-secretin gene family reveals that similarities are restricted to the exons encoding the biologically active peptides. Analysis of RNA from porcine intestine indicates that at least two transcripts are generated from the porcine secretin gene as a result of differential splicing. The longer and more abundant transcript appears to be identical to a previously isolated cDNA, which encodes a precursor that includes a 72-amino acid C-terminal extension peptide. The shorter transcript does not contain the third exon and, as a result, encodes only 44 residues beyond the C terminus of secretin. The amino acid sequence deduced from the shorter transcript is identical to a precursor form of secretin recently isolated from porcine duodenum [Gafvelin, G., Jornvall, H. & Mutt, V. (1990) Proc. Natl. Acad. Sci. USA 87, 6781-6785]. Developmental studies reveal that both secretin mRNA and peptide levels in the intestine are highest just before birth, prior to the onset of gastric acid secretion and feeding. This observation implies that secretin biosynthesis in developing animals is controlled independently of the principal factors known to regulate secretin release in adult animals.


Varicella serology in institutional exposure management.
A resident of a large facility for developmentally disabled persons developed chickenpox, exposing the other residents on his unit prior to diagnosis. Only 4 of the 20 exposed had previous histories. Indirect fluorescent antibody (IFA) testing for varicella-zoster antibodies done on the day the index patient was diagnosed demonstrated protective antibody levels in 18 of 21 residents. These residents returned to habilitative activities earlier than anticipated, maintaining program continuity. We suggest that varicella immunity might be more common in this population than supposed. Cost analysis of laboratory screening versus providing additional staffing during isolation supports screening in similar circumstances.


Lessons from Health Transformation in Turkey: Leadership and Challenges.
Abstract-Universal Health Coverage (UHC) is a feasible but difficult goal. It requires an outcome-oriented transformation program plus the strong commitment and leadership of high-level politicians. It also necessitates attention to context and receptivity to change, which are crucial for strategy development and delivery. Any health minister should acknowledge that it is very difficult to achieve success without public support, which also translates into support for the prime minister or president of the country. It is possible to achieve major improvements to health system performance in a relatively short period of time under the right conditions. Turkey made remarkable progress in health status, patient satisfaction and financial risk protection with its ten-year Health Transformation Program. Based on Turkey's transf-ormational experience, nine guiding principles are proposed. These principles are invaluable to transformational leadership and overcoming challenges: assuring deep commitment to bring change, using a two-pronged action approach, gaining the public's support as a shield, developing a comprehensive program, achieving a balance between the public and private sectors, obtaining and sustaining the financial protection of citizens, learning from mistakes, not being blinded by short-term success, and focusing on outcomes.


[Determination of two stilbene glycoside in five processed products of Rheum palamatum].
To compare of the contents of two stilbene glycoside in five processed products of Rheum palamatum. The contents of trans-3, 5, 4'-trihydroxystilbene-4'-O-beta-D-glucopyranoside (a) and trans-3, 5, 4'-trihydroxystilbene-4'-Obeta-D-(6"-O-galloyl)-glucopyranoside (b) were determined by HPLC analysis at 35 degrees C with methanol-1% acetic acid as mobile phase, the wavelengths were set at 280, 300 nm, the flow rate was 1.0 mL x min(-1). The two components could be detected in five processed products, and their contents were more close in the no-parched pieces, the vinegar roasts pieces and the wine roast pieces. However, the contents reduced significantly in other two kinds of pieces which were lower than 80 percent of no-parched pieces. High temperature may result in a significant reduction on glycoside in the pieces of rhubarb, and we have received similar results from determination of other glycoside compounds. Further analysis and comparison with the content of their corresponding aglycones, can provide a scientific basis to explain the variation of the material basis in the processed products of rhubarb.


Elucidating the Rimosamide-Detoxin Natural Product Families and Their Biosynthesis Using Metabolite/Gene Cluster Correlations.
As microbial genome sequencing becomes more widespread, the capacity of microorganisms to produce an immense number of metabolites has come into better view. Utilizing a metabolite/gene cluster correlation platform, the biosynthetic origins of a new family of natural products, the rimosamides, were discovered. The rimosamides were identified in Streptomyces rimosus and associated with their NRPS/PKS-type gene cluster based upon their high frequency of co-occurrence across 179 strains of actinobacteria. This also led to the discovery of the related detoxin gene cluster. The core of each of these families of natural products contains a depsipeptide bond at the point of bifurcation in their unusual branched structures, the origins of which are definitively assigned to nonlinear biosynthetic pathways via heterologous expression in Streptomyces lividans. The rimosamides were found to antagonize the antibiotic activity of blasticidin S against Bacillus cereus.


[The small lung nodule: dealing with a frequent radiological finding].
Small pulmonary nodules less than 10 mm in size are frequently found by multidetector CT in high-risk patients. The risk of malignancy is rather low. The individual cancer risk, the radiological appearance and the presence or absence of growth are guides towards the indication for invasive procedures. A risk adjusted algorithm should avoid unnecessary invasive procedures without missing a lung cancer.


Effects of diabetes duration and glycemic control on free radicals in children with type 1 diabetes mellitus.
Parameters of lipid peroxidation, protein oxidation, and antioxidant defense systems were measured in blood samples from 47 children with type 1 diabetes mellitus and from 51 healthy controls, matched for age and sex. In the diabetic children, chemiluminescent assay of plasma superoxide anion gave photoemission (counts x 10(3), mean +/- SD) of 674 +/- 412, which were significantly higher than those in the controls (452 +/- 185; p <0.05). Plasma vitamin A levels in the diabetic children (243 +/- 90 microg/dl) were also higher than those in the controls (207 +/- 59 microg/dl, p <0.05). In a subgroup of 24 diabetic children with blood HbA1C levels >or=8.5%, plasma lipoperoxide (LPO) and vitamin E levels were higher (p <0.05) than those in 23 diabetic children with blood HbA1C levels <8.5%. In a subgroup of 26 children with diabetes duration >or=5 yr, plasma LPO levels were higher (p <0.05) than those in 21 children with diabetes duration <5 yr. These findings confirm the presence of oxidant stress in children with type 1 diabetes mellitus and demonstrate that certain indices of oxidant stress are influenced by the duration of diabetes and by the efficacy of glycemic control. These observations suggest that supportive therapy aimed at oxidative stress may help to prevent clinical complications in children with type 1 diabetes mellitus.


A non-randomized clinical control trial of Harrison mirror image methods for correcting trunk list (lateral translations of the thoracic cage) in patients with chronic low back pain.
Spinal trunk list is a common occurrence in clinical practice, but few conservative methods of spinal rehabilitation have been reported. This study is a non-randomized clinical control trial of 63 consecutive retrospective subjects undergoing spinal rehabilitation and 23 prospective volunteer controls. All subjects presented with lateral thoracic-cage-translation posture (trunk list) and chronic low back pain. Initial and follow-up numerical pain rating scales (NRS) and AP lumbar radiographs were obtained after a mean of 11.5 weeks of care (average of 36 visits) for the treatment group and after a mean of 37.5 weeks for the control group. The radiographs were digitized and analyzed for a horizontal displacement of T12 from the second sacral tubercle, verticality of the lumbar spine at the sacral base, and any dextro/levo angle at mid-lumbar spine. Treatment subjects received the Harrison mirror image postural correction methods, which included an opposite trunk-list exercise and a new method of opposite trunk-list traction. Control subjects did not receive spinal rehabilitation therapy, but rather self-managed their back pain. For the treatment group, there were statistically significant improvements (approximately 50%) in all radiographic measurements and a decrease in pain intensity (NRS: 3.0 to 0.8). For the control group, no significant radiographic and NRS differences were found, except in trunk-list displacement of T12 to S1, worsened by 2.4 mm. Mirror image (opposite posture) postural corrective exercises and a new method of trunk-list traction resulted in 50% reduction in trunk list and were associated with nearly resolved pain intensity in this patient population. The findings warrant further study in the conservative treatment of chronic low back pain and spinal disorders.


Macrodystrophia lipomatosa with syndactyly.
Macrodystrophia lipomatosa (MDL) is a rare form of congenital localized gigantism characterized by hypertrophy of all mesenchymal tissues of the affected digits, with particular overgrowth of fat. Syndactyly is a rare association. We report a case of MDL associated with syndactyly affecting the hand. We describe the characteristic radiographic and MRI findings that distinguish the abnormality from other causes of localized gigantism.


A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study.
In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.


Beneficial effects of a non-protein diet on renal function of rats exposed to ischemic and nephrotoxic insults.
We investigated the effects of a non-protein diet on renal recovery in rats following 45-minute renal ischemia and mercuric chloride (3 mg/kg BW:S.C.) poisoning. The rats were fed a non-protein diet for one week before the renal insults. Renal functions were measured 24 hours after renal ischemia or 6 hours after mercuric chloride administration. In the ischemia investigation, the glomerular filtration rate (GFR), the renal plasma flow rate (RPFR) and the percent fractional sodium excretion (%FENa) of rats fed a regular diet (19.6% protein) were 25 +/- 7 microliters/min/g KW, 0.19 +/- 0.1 ml/min/g KW and 14.8 +/- 2.0, respectively. These values in the rats fed a non-protein diet showed better recovery, returning to a GFR of 114 +/- 32 microliters/min/g KW, an RPFR of 0.37 +/- 0.1 ml/min/g KW, and a %FENa of 2.43 +/- 0.6, respectively (p < 0.05). Furthermore, the seven-day survival rate was improved from 17% in the regular diet group to 100% in the non-protein diet group. In the mercuric chloride investigation, the renal functions in rats on a regular diet were shown by a GFR of 461 +/- 51 microliters/min/g KW, an RPFR of 1.91 +/- 0.2 ml/min/g KW, and a %FENa of 2.22 +/- 0.5. One-week feeding with a non-protein diet ameliorated the decrease in renal function, resulting in a GFR of 604 +/- 84 microliters/min/g KW, an RPFR of 2.15 +/- 0.5 ml/min/g KW, and a %FENa of 2.20 +/- 0.6. Consequently, there was a distinct beneficial effect on the survival of these rats.(ABSTRACT TRUNCATED AT 250 WORDS)


Hickman-Broviac catheter use in cancer patients.
Seventy-nine patients who had Hickman-Broviac (H-B) catheters inserted over a 1-year period were studied. There were 52 patients in the hematological group and 27 patients in the solid tumor group. Complications associated with the H-B catheters were infection and venous thrombosis, with infection being more common. Nine patients experienced local infection, ten had local infection with bacteremia, and 14 had severe infection, respectively. Infectious complications were more prevalent in the hematological group; 13 of the 14 severe infections were found in patients with hematological disorders. Severe infection was more common in patients with two catheters in place as compared to those with only one catheter (P less than 0.05). In particular, the presence of two catheters significantly increased the risk of infection in hematological patients. The risk of infection may be reduced by using only one catheter with either a single or double lumen.


Note-taking format and difficulty impact learning from instructor-provided lecture notes.
The method students use to take notes impacts how they process lecture information. The current experiment examined how the format and amount of content included in instructor-provided notes affect learning. Undergraduate students listened to a brief audio-recorded science lecture that emphasised independent facts, while using one of four note-taking guides. These guides varied in their format (outline notes, cloze notes) and level of difficulty (less-difficult, more-difficult). Outline notes included a partially complete organisational framework, promoting knowledge of relationships among concepts. Cloze notes included all lecture content with select words missing, encouraging processing of specific details. Metacognitive ratings and an objective cognitive load measure confirmed that outline note-taking was the most difficult method. However, outline notes led to higher performance than cloze notes on free recall and inference questions, and equal performance on verbatim questions. These benefits were greatest in the more-difficult outline notes condition, when less information was provided. These findings are consistent with the material-appropriate difficulty framework. Increasing note-taking difficulty was desirable, but only when the activity elicited semantic processing that complemented the type of processing afforded by the learning material.


Activated biochar derived from spent Auricularia auricula substrate for the efficient adsorption of cationic azo dyes from single and binary adsorptive systems.
In this study, spent Auricularia auricula substrate (AS)-derived biochar (ASBCs) and activated biochar with NaOH (A-ASBC) were evaluated for the adsorption of cationic azo dyes, including methylene blue (MB), rhodamine B (RB), and crystal violet (CV), from single and binary adsorptive systems. A-ASBC showed a higher maximum adsorption capacity for these dyes (MB: 53.62 mg·g-1, RB: 32.33 mg·g-1, CV: 735.73 mg·g-1) than ASBCs in a single system because it had a greater specific surface area and more oxygen containing-functional groups on the surface. The adsorption process of the three dyes onto the adsorbents was in good agreement with the Freundlich adsorption isotherm and fit the pseudo-second-order kinetic model, which revealed sorbate polymolecular layer formation over the adsorbent surface and the involvement of chemisorption. The adsorption mechanism showed that the adsorption of three dyes on adsorbents could be postulated as a multistep process with extraordinary affinity-induced adsorption in terms of both physisorption and chemisorption. In the binary adsorptive system, the results showed that all MB, RB, and CV had antagonistic/competitive effects on each other's adsorption (QBinary/QSingle < 1). Furthermore, a phytotoxic assay affirmed the effectiveness of the adsorbent in adsorbing dye species from aqueous solutions using Brassica pekinensis L. seeds as the model. Therefore, activated biochar prepared from AS can be used as a potentially economical and effective adsorbent for treating printing and dyeing wastewater.


Preclinical evaluation of SPECT imaging with 131I-labeled monoclonal antibody SZ39 in nude mice bearing human glioma xenografts.
The imaging characteristics of monoclonal antibody SZ39 against glioma were evaluated in glioma-bearing nude mice. Monoclonal antibody SZ39 is a murine IgG2a that reacts with a glycoprotein epitope (molecular weight 180,000), a human glioma-associated membrane antigen. Monoclonal antibody SZ39 was labeled with 131I using a modified chloramine T method. Each glioma-bearing nude mouse was given 50 microCi/40 micrograms of the experimental agent, 131I-labeled monoclonal antibody, or 50 microCi/46 micrograms of a control agent, 131I-labeled monoclonal antibody C50, an antibody against colon cancer. Single-photon emission computed tomography (SPECT) was performed every 24 hours in the first week after administration. Glioma-bearing nude mice were killed in groups of 3 at 24 hours and daily up to 72 hours. The ratio of radioactivity uptake in glioma to normal organs was calculated. After administration of the labeled SZ39, glioma was visualized with SPECT on days 1 to 7, particularly at 72 hours. There was no accumulation of radioactivity in glioma with the labeled C50 antibody. All glioma-organ ratios increased with time. At 72 hours, the ratio of glioma to brain was 22.46 and of the other organs was 2.64 on average. SZ39 had a relatively low endocytosis rate and was favorable for 131I labeling. These characteristics were helpful to reduce free 131I in the blood and reduce the uptake by other organs. The results suggest that 131I-labeled SZ39 selectively accumulates in glioma, representing a potential strategy for SPECT imaging of these lesions.


[Lung cancer screening with low dose CT requires careful consideration].
Results from the American National Lung Screening Trial (NLST) show a significant reduction in lung cancer and all-cause mortality in a high risk population screened with annual low-dose CT. Handling of pulmonary nodules, false positive tests, overdiagnosis, psychosocial consequences and cost-efficiency etc. are all aspects that require careful consideration. This paper gives an overview of the current knowledge on these issues. Before a recommendation can be made, we need an overall evaluation of both the benefits and harms in CT screening for lung cancer.


Application of CGEAN's Research Priorities: PhD, DNP Scholarship.
The Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEAN's Delphi study.


[Recurrent dislocation of the patella--arthroscopic therapy].
The authors present results of the surgical treatment of the recurring patella dislocation. They use the surgical technique of medial percutaneous raphe by absorbable PDS suture and lateral release with arthroscopis assistance. The operation was performed for recurring dislocation in 19 cases in 16 patients. Three patients underwent a surgery on both knees. The average age of patients was 22 years (range, 14-29 years). The average period after the surgery was 22 months (range, 12-45 months). Minimal number of dislocations prior to operation was 3, maximal more than 20. The surgical technique consists in medial raphe by percutaneously inserted absorbable PDS suture with arthroscopic assistance and in performing a lateral release in the "closed manner" under the check of the arthroscope. After-care consists in the application of a rigid orthesis which is starting from the first postoperative day removed for physiotherapy by CPM. After two weeks a hinged orthesis is used with a gradual increase of the range of motion. After 6 weeks the patient starts full weightbearing without any fixation. The authors evaluated the results of the operation after Bentley. They also followed the duration of turniquet of the operated on limb, the duration of hospitalization and the period necessary for the achievement of the full range of motion. Radiograph was used for the determination of the shape of patella after Baumgartl and Wiberg, the angle of the femoral sulcus, the height of patella after the Insall-Salvati index and lateral shift of patella. Arthroscopic examination focused on the evaluation of the patellar and femoral chondromalacy and its classification after Outerbridge. Clinically, Q angle was measured, the axis of the limb, anxiosity test was made and the presence of crepitation was checked. Ninety per cent of the patients evaluated the condition after the surgery as very good or good, twice as poor. In one patient there occurred one recurrence of dislocation after the surgery. In the second patient after the surgery pain aggravated in connection with a severe degenerative damage of the femoropatellar joint. Neither avascular necrosis of the patella nor any more extensive bleeding was encountered. There was no infectious complication in the group of patients. Chondral lesion was recorded in 80% of patients. The degree of the damage increased with the number of dislocations. A frequent complication was a recurring knee effusion with the necessity of its evacuation. The relation between the number of dislocations and the final outcome of the surgery was proved. No patient with the number of dislocations 10 and more was evaluated as excellent. AS release and medial raphe is a surgical technique which brings very good and good results in a high number of patients. Independently performed raphe or release do not have comparable good results in the therapy of recurring dislocation. The authors' results do not differ from data in specialised literature. Arthroscopically performed lateral release and medial raphe by percutaneously inserted suture and with AS assistance has a number of unquestionable benefits. The performance is associated with only minimum complications. It reduces the duration of hospitalization, immobilization of the limb, duration of physiotherapy as well as the total duration of the incapacity to work. The cosmetic result is good. It is possible to operate on also on young patients prior to the final ossification in the area of the tibial tubercle. A prerequisite of a good result is an accurate performance of the operation and subsequent physical therapy. Contraindications include marked degenerative changes in the femoropatellar joint, instability of the knee, patella dislocation in TKR. Q angle exceeding 30 degrees and valgus deformity of the limb exceeding 15 degrees. A high number of dislocations and the resulting more severe damage to the cartilage reduce the potential for achieving excellent results.


[Current status of antibiotic resistance of pyelonephritis causing pathogens].
The article gives the analysis of frequent clinical situations arising in empiric therapy of pyelonephritis alone and accompanied with other severe diseases such as decompensated diabetes mellitus, chronic renal insufficiency, HIV infection. The choice of antibacterial drugs for empiric therapy of pyelonephritis is based on the results of the tests for antibiotic resistance of pyelonephritis causing agents, pharmacokinetic and pharmacodynamic studies. Present-day standards and recommendations of leading centers of pyelonephritis empiric therapy are reviewed.


[Cycle dependent expression of the gene coding for B2mRNA].
The relative contents of individual tissue specific RNA B2mRNAx was studied in the population of nuclear and poly(A)+ cytoplasmic RNA from the livers of intact, falsely operated and having suffered the partial liver resection rats. Dot-hybridization technique was used to study this transcript containing the transcribed copy of the B2 repetitive genetic element of rats. The expression of the gene coding for B2mRNAx takes place at the lower level in the liver induced to proliferation as compared with the one in the liver of intact animals. It is changed reproducibly in antiphase with the c-fos RNA and with major inclinations at the moments of cellular phases switch.


Decoration of Vertically Aligned Carbon Nanotubes with Semiconductor Nanoparticles Using Atomic Layer Deposition.
Vertically aligned carbon nanotubes (VACNTs or "CNT forest") were decorated with semiconductor particles (TiO₂ and ZnO) by atomic layer deposition (ALD). Both the structure and morphology of the components were systematically studied using scanning (SEM) and high resolution transmission electron microscopy (HRTEM), energy-dispersive X-ray spectroscopy (EDX), Raman spectroscopy, and X-ray diffraction (XRD) methods. Characterization results revealed that the decoration was successful in the whole bulk of VACNTs. The effect of a follow-up heat treatment was also investigated and its effect on the structure was proved. It was attested that atomic layer deposition is a suitable technique for the fabrication of semiconductor/vertically aligned carbon nanotubes composites. Regarding their technological importance, we hope that semiconductor/CNT forest nanocomposites find potential application in the near future.


The medial cord to musculocutaneous (MCMc) nerve transfer: a new method to reanimate elbow flexion after C5-C6-C7-(C8) avulsive injuries of the brachial plexus--technique and results.
The aim of this paper is to report on our ample experience with the medial cord to musculocutaneous (MCMc) nerve transfer. The MCMc technique is a new type of neurotization which is able to reanimate the elbow flexion in multilevel avulsive injuries of the brachial plexus provided that at least the T1 root is intact. A series of 180 consecutive patients, divided into four classes according to the quality of hand function, is available for a long-term follow-up after brachial plexus surgery. The patients enrolled for the study have in common a brachial plexus palsy showing multiple cervical root avulsive injuries at two (C5-C6), three (C5-C6-C7) and four (C5-C6-C7-C8) levels. The reinnervation of the musculocutaneous nerve is obtained via an end-to-end transfer from two donor fascicles located in the medial cord. The selected fascicles are those directed principally to the flexor carpi radialis, ulnaris and, to a lesser degree, the flexor digitorum profundus. Under normal anatomic conditions, they are located in the medial cord, and their site corresponds to the inverted V-shaped bifurcation between the internal contribution of the median nerve and the ulnar nerve. The technique has no failure and no complications when the hand shows a normal wrist and finger flexion and a normal intrinsic function. In case of suboptimal conditions of the hand, the technique has proved technically more challenging, but still with 67% satisfactory results. In the four-root avulsive injuries, however, this method shows its limitations and an alternative strategy should be preferred when possible. EMG analysis shows a reinnervation in both the biceps and the brachialis muscles, explaining the high quality of the observed results. Moreover, this technique theoretically offers the possibility of a "second attempt" at a more distal level in case of failure of the first surgery. This procedure is quick, safe, extremely effective and easily feasible by an experienced plexus surgeon. The ideal candidate is a patient harbouring a C5-C6 avulsive injury of the upper brachial plexus with a normally functioning hand.


Colchicine myoneuropathy in chronic renal failure patients with gout.
Colchicine myoneuropathy is a rare and often underdiagnosed disease. It often presents as painless subacute muscle weakness. We present a case of painful colchicine myoneuropathy in a 76-year-old man with chronic renal failure and gout. Published work about clinical presentations of colchicine myoneuropathy in gouty arthritis patients are reviewed. During the previous year, the patient had a drug regimen of colchicine 0.5 mg three times per day for a 3 day course each month. He developed bilateral lower leg weakness and severe myalgia. His serum creatinine level was 680.7 micromol/L and creatinine kinase was 959 IU/L on admission. Laboratory findings included decreasing amplitude of motor and sensory nerve conduction velocity and an electromyogram showed small amplitude, short duration polyphasic waves over the right biceps. A muscle biopsy disclosed vacuolar changes in the cytoplasm. These results all supported a diagnosis of colchicine myoneuropathy. After cessation of colchicine, the creatinine kinase level decreased approximately 50% in 6 days, myalgia subsided and his muscle weakness improved gradually over the next 2 weeks.