Utility of immunoblotting for early diagnosis of toxoplasmosis seroconversion in pregnant women.
Congenital transmission of Toxoplasma gondii occurs mainly when a mother acquires the infection for the first time during pregnancy. It was recently shown that although early treatment of the primary infection during pregnancy has little or no impact on the fetomaternal transmission rate, it does reduce the incidence of sequelae in infected infants. Seroconversion is defined by the appearance of IgG. Commercial reagents continue to vary considerably in detecting low concentrations of antibodies, as during early seroconversion. We compared two routinely used immunoassays (IA) (Platelia and Elecsys Toxo IgG) and an indirect immunofluorescence assay (IIF) with a qualitative test based on immunoblot analysis (Toxo II IgG) (IB) to assess their abilities to diagnose seroconversion at its earliest stages. This prospective study was carried out between January and November 2010. It included 39 pregnant women with monthly follow-up who seroconverted during pregnancy. On first sera that were IgM positive but IgG negative (or equivocal) as detected by IA, IB diagnosed seroconversion twice as often as IIF (26/39 [66.7%] versus 13/39 [33.3%]; P < 0.001; χ(2) test). Serum samples were retaken 2 to 5 weeks later for the other 13 cases (IgG negative by IB on first serum). Seroconversion was demonstrated as follows: IB for 5 cases where IA remained negative or equivocal, IB and IIF for 5 cases where IA remained negative or equivocal, IA for 2 cases, and no method for 1 case (a third sample was necessary). In summary, IB permitted toxoplasmosis seroconversion diagnosis before other means in 92.3% of cases (36/39) and thus earlier therapeutic intervention.


Considerations on pharmacodynamics and pharmacokinetics: can everything be explained by the extent of drug binding to its receptor?
It is frequently assumed that pharmacological responses depend solely on the extent of drug binding to its receptor according to the occupational theory. It is therefore presumed that the intensity of the effect is determined by drug concentration at its receptor site, yielding a unique concentration-effect relationship. However, when dependence, abstinence, and tolerance phenomena occur, as well as for pharmacological responses in vivo that are modulated by homeostatic mechanisms, the rate of drug input shifts the concentration-effect relationship. Hence, such responses cannot be explained on the sole basis of the extent of drug binding to its receptor. Information on the cellular and molecular processes involved in the generation of abstinence, dependence, and tolerance will undoubtedly result in the development of pharmacodynamic models allowing a satisfactory explanation of drug effects modulated by these phenomena. Notwithstanding, integrative physiology concepts are required to develop pharmacokinetic-pharmacodynamic models allowing the description of drug effects in an intact organism. It is therefore important to emphasize that integrative physiology cannot be neglected in pharmacology teaching and research, but should be considered as an equally valuable tool as molecular biology and other biomedical disciplines for the understanding of pharmacological effects.


Structural characterization of pertussis toxin A subunit.
The relationship between the structure of the A subunit of pertussis toxin and its function was analyzed. Limited tryptic digestion of the A subunit converted the protein to two stable fragments (Mr = 20,000 and 18,000). Antibodies raised to synthetic peptides homologous to regions in the A subunit were used to map these fragments. Both fragments were shown to contain the NH2-terminal portion but not the COOH-terminal portion of the A subunit. While these fragments exhibited NAD glycohydrolase activity, they were unable to reassociate with the B oligomer of the toxin. Thus the COOH-terminal portion of the A subunit does not contain the residues which are required for the NAD glycohydrolase activity of the toxin. However, this region of the molecule may be important for maintaining the oligomeric structure of the toxin. These results suggest that the A subunit of pertussis toxin is similar in structure to the A subunit of cholera toxin. In addition, antibodies raised to a synthetic peptide identical to residues 6-17 of the A subunit of pertussis toxin will bind to the A subunit of cholera toxin.


Propagermanium Induces NK Cell Maturation and Tends to Prolong Overall Survival of Patients With Refractory Cancer.
Propagermanium (PG) inhibits the CCL2/CCR2 axis, and has been shown to function as an immune modulator. This study investigated its anti-tumor mechanism in patients with refractory cancers. Five healthy volunteers and 23 patients with refractory oral (n=8) or gastric (n=15) cancer received PG (30 mg/day). We performed flow cytometry (FCM) of peripheral blood mononuclear cells and in vitro killing assays. FCM revealed that CD16+/CD56Dim NK cells (i.e., mature, cytolytic subset) increased, and the apoptosis induction rate of cancer cells increased after PG administration. Among gastric cancer patients, median OS was 172.0 days. Two patients showed complete remission of lung or liver metastasis. Survival of patients with oral cancer also tended to be prolonged. PG induces NK cell maturation, and may potentiate anti-tumor activity.


The utility of International Society on Thrombosis and Haemostasis-Bleeding Assessment Tool and other bleeding questionnaires in assessing the bleeding phenotype in two platelet function defects.
The main objective of this study is to investigate the utility of International Society on Thrombosis and Haemostasis-Bleeding Assessment Tool (ISTH-BAT) in comparison with the condensed form of Molecular and Clinical Markers for the Diagnosis and Management of type 1 and WHO BATs, in assessing bleeding in two well known and clinically significant platelet function defects. Thirty-eight patients previously diagnosed with Glanzmann's thrombasthenia and 10 with Bernard-Soulier syndrome (BSS) were analyzed. Bleeding scores were significantly higher than that of controls using both electronic bleeding questionnaire (eBQ) and ISTH-BAT with no significant difference between both tools. ISTH-BAT had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 76.2%, 0.9 and 1. This was closely similar to eBQ. Both ISTH-BAT and eBQ are efficient in BSS and Glanzmann's thrombasthenia. However, given the ISTH recommendation, ISTH-BAT should be adopted. Larger study including other platelet defects will enhance its utility and support the integration of bleeding scores with standardized laboratory testing to allow for a universal diagnostic approach to patients with suspected bleeding disorders.


GLP‑1 improves palmitate‑induced insulin resistance in human skeletal muscle via SIRT1 activity.
The present study investigated whether glucagon like peptide‑1 (GLP‑1) improves glucose uptake through glucose transporter type 4 (GLUT4), mediated by the activation of sirtuin 1 (SIRT1), in skeletal muscle cells with palmitate induced‑insulin resistance. The levels of glucose uptake, GLUT4, protein kinase A (PKA), and cyclic adenosine monophosphate (cAMP) were determined in human skeletal muscle myotubes (HSMMs) exposed to palmitate and GLP‑1. Then, to determine whether PKA/cAMP were downstream signals of GLP‑1, a PKA inhibitor was used. To determine whether SIRT‑1 contributes to GLP‑1 action in HSMMs with palmitate‑induced insulin resistance, the levels of peroxisome proliferator‑activated receptor γ coactivator 1α (PGC1α) deacetylation and SIRT‑1 activity were assessed using a SIRT1 inhibitor and small interfering RNA (siRNA). The phosphorylation levels of protein kinase B (Akt) and insulin receptor substrate 1 (IRS‑1) as insulin signaling pathways, were assessed in GLP‑1‑treated HSMMs exposed to palmitate. The influence of SIRT1 on the GLP‑1‑induced activation of insulin signaling pathway was determined using a SIRT1 inhibitor. GLP‑1 restored the palmitate‑induced reductions in the levels of glucose uptake, GLUT4 mRNA, GLUT4 promoter activity, and GLUT4 protein in HSMMs. PKA and cAMP, as GLP‑1 downstream signals, played a role in this process. GLP‑1 increased the deacetylation levels of PGC1α, and stimulated SIRT1 in HSMMs. Moreover, the SIRT1 inhibitor and siRNA of SIRT1 suppressed the effect of GLP‑1 on GLUT4 expression in HSMMs exposed to palmitate. The SIRT1 inhibitor also prevented the GLP‑1‑induced phosphorylation of IRS‑1 and Akt in palmitate‑treated HSMMs. The present findings suggest that in palmitate‑induced insulin‑resistant HSMM, GLP‑1 activates SIRT1 through the PKA/cAMP pathway, which in turn enhances glucose uptake through GLUT4 and the insulin signaling pathway.


Fracture Risk in Women with Dysglycaemia: Assessing Effects of Baseline and Time-Varying Risk Factors.
Although individuals with diabetes appear to have a higher fracture risk compared to those without diabetes, fracture risk in impaired fasting glucose (IFG) has not been thoroughly explored. This study determined associations between glycaemia status and fracture risk. Women (n = 575, aged 50 + years) enrolled in the Geelong Osteoporosis Study, were followed from baseline (1993-1997), to date of first fracture, death or December 31, 2010, whichever occurred first (median 13.7 years, IQR 7.4-14.8). Hazard ratios (HRs) for any fracture (excluding fingers, toes, skull/face), as well as major osteoporotic fracture (MOF, clinical spine, hip, proximal humerus, wrist), in diabetes (n = 69), IFG (n = 250) and normoglycaemia (n = 256), were calculated using a Cox proportional hazards model. Normoglycaemia was set as the reference category. A Cox proportional hazards model with time-varying covariates was also used to assess change in baseline risk factors at the 10-year follow-up visit (2004-2008). During follow-up (6433 person-years), 162 women sustained any fracture and 104 had a MOF. Unadjusted fracture risk was higher in diabetes (HR 1.64; 95% CI 1.02-2.63) compared to normoglycaemia, but IFG and normoglycaemia had similar risk (HR 1.06; 95% CI 0.76-1.47). Age- and BMD-adjusted any-fracture risk in diabetes compared to normoglycaemia was greater (HR 1.59; 95% CI 0.98-2.58); IFG was similar to normoglycaemia (HR 1.01; 95% CI 0.72-1.41). For MOF, unadjusted and age- and BMD-adjusted fracture risk in IFG was similar to normoglycaemia HR 1.02; 95% CI 0.74-1.40 and HR 0.95; 95% CI 0.69-1.32, respectively, but diabetes was higher compared to normoglycaemia (unadjusted HR 1.64; 95% CI 1.04-2.60; adjusted HR 1.57; 95% CI 0.98-2.51). In the time-varying model, there was no difference between IFG in either the unadjusted or adjusted models, for both any fracture and MOF (p > 0.05). For diabetes, there was a significant difference between normoglycaemia in the adjusted model for any fracture (p = 0.046), but not for MOF (p = 0.103). An increased risk of fracture for women with diabetes was observed after accounting for time-varying risk factors. There was no difference in fracture risk detected for women with IFG.


Distinct microbiome profiles and biofilms in Leishmania donovani-driven cutaneous leishmaniasis wounds.
The endemic strain of Leishmania donovani in Sri Lanka causes cutaneous leishmaniasis (CL) rather than more common visceral form. We have visualized biofilms and profiled the microbiome of lesions and unaffected skin in thirty-nine CL patients. Twenty-four lesions (61.5%) were biofilm-positive according to fluorescence in situ hybridization. Biopsies of biofilm-positive lesions were dominated by Pseudomonas, class Bacilli and Enterobacteriaceae and distinguished by significantly lower community evenness. Higher relative abundance of a class Bacilli OTU was detected in wound swabs versus contralateral skin. Wound swabs and biopsies had significantly distinct microbiome profiles and lower diversity compared to unaffected skin. Greater abundances of potentially pathogenic organisms were observed in wet ulcers, lesions with high parasite loads and large wounds. In summary, more than half of L. donovani associated CL wounds harboured biofilms and the wounds exhibited a distinct, less diverse, microbiome than unaffected skin.


Cerium Oxide Polishes Lithium Disilicate Glass Ceramic via a Chemical-Mechanical Process.
The aim of the present study was to evaluate the chemical-mechanical polishing (CMP) effect of cerium oxide (ceria [CeO2]) as an abrasive to polish lithium disilicate glass ceramic. For the polishing experiment, 22 lithium disilicate glass ceramic samples were prepared, polished with sandpaper using a polishing machine, their surface roughness (Ra) was measured using a profilometer, and they were randomly divided into two groups (n = 10). The samples were polished for 30 seconds with ceria paste with different ratios of deionized water:ceria by weight: 1:0.5 (C0.5) and 1:1 (C1) according to their group and the Ra values were determined. The Ra measurement was repeated after an additional 30 seconds of polishing until 120 seconds of polishing had been performed. The surface images of the postpolishing (120 seconds) samples were obtained using scanning electron microscopy (SEM) to evaluate the surface morphology. For the adsorption experiment, 10 lithium disilicate glass ceramic specimens were prepared and soaked in 50-mL deionized water. After 24 hours, the specimens were removed. Each liquid sample was divided in two halves. The first half was stored and ceria particles were added into the second half. After 24 hours, the solutions were filtered. The silicon concentration in the liquid samples was analyzed using inductively coupled plasma-optical emission spectrometry. The difference in mean Ra value between groups was analyzed using two-way repeated analysis of variance (ANOVA) and the difference in mean silica concentrations before and after adding ceria particles was analyzed using the paired t-test. A p-value of <0.05 was considered statistically significant. Ra decreased as the ratio of ceria and polishing time increased. The surface morphology of the samples analyzed by SEM corresponded with their Ra values. The mean silicon concentration after adding ceria particles was significantly decreased (p < 0.05). Using a ceria-polishing paste to polish lithium disilicate glass ceramic generates a significantly smoother surface compared with baseline roughness. Moreover, CeO2 has a mechanical action and chemical reaction with lithium disilicate glass ceramic. Therefore, it can be used as a CMP paste to create a smooth surface.


Rational Design of Multifunctional Dendritic Mesoporous Silica Nanoparticles to Load Curcumin and Enhance Efficacy for Breast Cancer Therapy.
Breast cancer is the primary reason for cancer-related death in women worldwide and the development of new formulations to treat breast cancer patients is crucial. Curcumin (Cur), a natural product, exerts promising anticancer activities against various cancer types. However, its therapeutic efficacy is hindered as a result of poor water solubility, instability, and low bioavailability. The aim of this work is to assess the curative effect of a novel nanoformulation, i.e., Cur-loaded and calcium-doped dendritic mesoporous silica nanoparticles modified with folic acid (Cur-Ca@DMSNs-FA) for breast cancer therapy. The results manifested that Cur-Ca@DMSNs-FA dispersed very well in aqueous solution, released Cur with a pH-responsible profile, and targeted efficiently to human breast cancer MCF-7 cells. Further investigations indicated that Cur-Ca@DMSNs-FA effectively inhibited cell proliferation, increased intracellular ROS generation, decreased mitochondrial membrane potential, and enhanced cell cycle retardation at G2/M phase, leading to a higher apoptosis rate in MCF-7 compared to free Cur. Moreover, the Western blotting analysis demonstrated that Cur-Ca@DMSNs-FA were more active than free Cur through suppression of PI3K/AKT/mTOR and Wnt/β-catenin signaling, and activation of the mitochondria-mediated apoptosis pathway. In addition, hemolysis assay showed that the Ca@DMSNs-FA exhibited good biocompatibility. Last, in vivo studies indicated that when Cur was encapsulated in Ca@DMSNs-FA, the Cur concentration in blood serum and tumor tissues was increased after 1 h intraperitoneal injection. In conclusion, Cur-Ca@DMSNs-FA might act as a potential anticancer drug formulation for breast cancer therapy.


Cardiovascular abnormalities in patients with a carcinoid syndrome.
Heart failure is an important reason for morbidity and mortality in patients with carcinoid. Carcinoid heart disease is caused by increased levels of circulating serotonin. Because carcinoids also produce catecholamines, we evaluated cardiovascular manifestations of autonomic dysfunction in patients with a carcinoid syndrome. Twenty patients with a midgut carcinoid, who had a carcinoid syndrome with a median duration of 72 months, and markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion were studied. Ten patients had no symptoms of heart failure, i.e. New York Heart Association (NYHA) functional class I, 6 had class II, and 4 class III heart failure. Transthoracic echocardiography (TTE) showed right-sided valvular abnormalities in 13 of 19 evaluable patients (mild n=8, severe n=5). Fourteen of the 20 patients (70%) had an elevated concentration of plasma N-terminal atrial natriuretic peptide (N-ANP), which correlated with NYHA class, TTE abnormalities, and increased urinary metanephrine excretion. Heart rate variability (HRV) parameters, in particular those associated with increased sympathetic activity (low frequency power, p=0.002 versus healthy individuals), were impaired but were independent of NYHA class and TTE findings and correlated with urinary metanephrine excretion (r=-0.49, p<0.05). In these 20 carcinoid patients with substantial secretory activity of the tumour, overt cardiac morphological changes were present in a minority of patients. However, N-ANP values and HRV profile were markedly abnormal, and related to enhanced urinary excretion of catecholamine and metabolites, suggesting autonomic derangement. These abnormalities possibly herald the development of more severe cardiac dysfunction and may be indicative of the need for preventive drug treatment.


Multiple cerebral aneurysms associated with atrial myxoma. A case report.
Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.


Recurrent hyponatremia in a young adult woman with anorexia nervosa and the effects of insufficient communication.
This is the case of an 18-year-old young adult woman with anorexia nervosa (AN) who presented to the emergency department with complications from AN and was found to be hyponatremic. The hyponatremia was prioritized and corrected with fluids on hospital day one. The consulting adolescent medicine team recommended the primary inpatient medical team initiate the malnutrition protocol. Nephrology recommended fluid restriction. Despite initiation of this protocol and emphasis on protocol adherence with the primary team, patient, and family, the hyponatremia recurred. Retrospectively, there were three factors that led to her recurrent hyponatremia: inconsistencies in protocol adherence across medical clinical providers, lack of knowledge regarding the importance of adherence to the malnutrition protocol, and suboptimal communication between medical clinical providers. A multidisciplinary team experienced in the care of patients with AN may enhance inpatient treatment of this condition. A multidisciplinary team experienced in AN will have a better understanding of the complexities of AN, skill in protocol implementation, understand the importance of protocol adherence, and be more likely to clearly communicate the plan of care to the patient/family. These skills can lead to improved care quality, decreased risk of adverse outcomes, and likely decreased medical costs.


Neurotizations by means of the cervical plexus in over 100 patients with from one to five root avulsions of the brachial plexus.
In the years 1982-1991, we treated over 100 patients with avulsion of from one to five roots in perinatal (n = 21) and traumatic (n = 81) lesions of the brachial plexus. Based on the clinical diagnosis and the surgical findings, we divided all operated patients into four groups: 1) avulsion of all roots or avulsions and disruption of the rest of the brachial plexus; 2) avulsion and disruption of one to four roots and preservation of some elements of the brachial plexus with fibrotic changes; 3) avulsion and disruption of one to three roots, with some elements showing no macroscopic changes; and 4) children with perinatal brachial plexus palsy. In cases of root avulsion, we performed neurotization from the cervical plexus, the accessory and intercostal nerves. In patients with one to three root avulsions, we have performed selective neurotization for 3 years. The best results were obtained in groups 3 and 4, but some improvement was also noted in the other groups.


The ubiquitin binding region of the Smurf HECT domain facilitates polyubiquitylation and binding of ubiquitylated substrates.
Mono- and polyubiquitylation of proteins are key steps in a wide range of biological processes. However, the molecular mechanisms that mediate these different events are poorly understood. Here, we employed NMR spectroscopy to map a non-covalent ubiquitin binding surface (UBS) on the Smurf ubiquitin ligase HECT domain. Analysis of mutants of the HECT UBS reveal that interfering with the UBS surface blocked Smurf-dependent degradation of its substrate RhoA in cells. In vitro analysis revealed that the UBS was not required for UbcH7-dependent charging of the HECT catalytic cysteine. Surprisingly, although the UBS was required for polyubiquitylation of both Smurf itself and the Smurf substrate RhoA, it was not required for monoubiquitylation. Furthermore, we show that mutating the UBS interfered with efficient binding of a monoubiquitylated form of RhoA to the Smurf HECT domain. Our findings suggest the UBS promotes polyubiquitylation by stabilizing ubiquitylated substrate binding to the HECT domain.


New long-term-care hospitals' performance after implementation of a prospective payment system.
Long-term-care hospitals (LTCHs) treat chronically ill patients who need treatment for extended lengths of time. Throughout the 21st century, the number of LTCHs in the United States has tended to increase. In this study, the authors evaluated the utilization and financial performance of new LTCHs after the implementation of Medicare's prospective payment system. In the 1st year of operation, new LTCHs relative to existing facilities had fewer occupied beds, shorter length of stay, and lower financial performance. In the 2nd year, the financial performance and utilization of the new facilities became comparable to those of existing facilities.


Adhesive restoration of endodontically treated teeth--current research.
Restoring endodontically-treated teeth using adhesively cemented fibre posts is becoming popular in general practice. Clinical studies have been promising, however failures can occur, usually because of de-bonding of the post. Current research, aimed at identifying factors that could improve the adhesion of fibre posts, is described.


Absorption and metabolization of cytoprotective epicatechin thio conjugates in rats.
The epicatechin (EC) thio derivatives 4β-(S-cysteinyl)-epicatechin (Cys-EC) and 4β-(S-cysteaminyl)-epicatechin (Cya-EC) are compounds that may provide protection from oxidation via mechanisms involving either the flavonoid moiety or the nonphenolic cysteine or cysteamine part of the molecule. Because the metabolically modified molecules may be the actual active species, we estimated the absorption/metabolization of the thio derivatives through the small intestine in vitro and studied the body distribution of the compounds and their metabolites in rats. The analysis of the samples generated was done using a high-performance liquid chromatograph coupled to a UV detector and a tandem mass spectrometer. We show that Cya-EC follows the same phase II metabolization pattern as EC, whereas Cys-EC is transported with the intact catechol moiety through the small intestine and effectively metabolized systemically. We also found that Cya-EC generates Cys-EC in vivo, which provides evidence for a Cya-EC-mediated cytoprotective effect through cysteamine/cystine exchange with subsequent cysteine transport, ubiquitously throughout the organism.


Interrupted escape and the emergence of exponential relaxation.
A simple statistical theory of irreversible processes in a subsystem coupled to (or "interrupted" by) a stochastic bath is formulated. The theory does not explicitly invoke time scale separation that underlies the standard description of nonequilibrium phenomena and is intrinsic to the concept of quasiequilibrium in the canonical ensemble. Arbitrary statistics and speed of bath fluctuations are straightforwardly treated by the theory. Except in the case of an extremely slow, nonequilibrium bath, the ultimate statistics of interrupted escape are shown to be Poisson, which is solely a consequence of the stationary nature of interactions in a sufficiently dense system. In the limit of a fast bath, the corresponding relaxation rate is shown to equal the initial rate of decay, thus validating a wide class of Golden Rate type expressions at long times. This true exponentiality thus appears when the time scale separation takes place. The theory also applies to a number of specific phenomena including transport in a fluctuating or disordered medium, gated reactions, the line shape theory, and the quantum Zeno effect. The general nature of motional narrowing phenomena is demonstrated and related to the bath mediated slowing down of a decay process with a nearly deterministic uninterrupted escape probability. The corresponding survival probability is shown also to exhibit discernible oscillations around the exponential background. Mathematical tools necessary for using the theory in specific applications are exposed in some detail.


Meiofauna increases bacterial denitrification in marine sediments.
Denitrification is a critical process that can alleviate the effects of excessive nitrogen availability in aquatic ecosystems subject to eutrophication. An important part of denitrification occurs in benthic systems where bioturbation by meiofauna (invertebrates <1 mm) and its effect on element cycling are still not well understood. Here we study the quantitative impact of meiofauna populations of different abundance and diversity, in the presence and absence of macrofauna, on nitrate reduction, carbon mineralization and methane fluxes. In sediments with abundant and diverse meiofauna, denitrification is double that in sediments with low meiofauna, suggesting that meiofauna bioturbation has a stimulating effect on nitrifying and denitrifying bacteria. However, high meiofauna densities in the presence of bivalves do not stimulate denitrification, while dissimilatory nitrate reduction to ammonium rate and methane efflux are significantly enhanced. We demonstrate that the ecological interactions between meio-, macrofauna and bacteria are important in regulating nitrogen cycling in soft-sediment ecosystems.


Quality assurance feedback as a nursing management strategy.
Quality assurance and effective nurse management can be viewed as intersecting goals. Objective feedback derived from quality assurance data is a potentially powerful means of enhancing nurses' performance and job satisfaction. The use of automated information systems to provide such direct feedback offers the additional advantage of recognizing nurses as self-monitoring, self-correcting professionals. The need, opportunity, and challenge involved in meshing quality assurance with human resource management through computer-generated feedback are discussed in the context of the home health care setting.


Systems strategies to support cancer screening in U.S. primary care practice.
Although systems strategies are effective in improving health care delivery, little is known about their use for cancer screening in U.S. primary care practice. We assessed primary care physicians' (N = 2,475) use of systems strategies for breast, cervical, and colorectal cancer (CRC) screening in a national survey conducted in 2007. Systems strategies included patient and physician screening reminders, performance reports of screening rates, electronic medical records, implementation of in-practice guidelines, and use of nurse practitioners/physician assistants. We evaluated use of both patient and physician screening reminders with other strategies in separate models by screening type, adjusted for the effects of physician and practice characteristics with multivariate logistic regression. Fewer than 10% of physicians used a comprehensive set of systems strategies to support cancer screening; use was greater for mammography and Pap testing than for CRC screening. In adjusted analyses, performance reports of cancer screening rates, medical record type, and in-practice guidelines were associated with use of both patient and physician screening reminders for mammography, Pap testing, and CRC screening (P < 0.05). Despite evidence supporting use of systems strategies in primary care, few physicians report using a comprehensive set of strategies to support cancer screening. Current health policy initiatives underscore the importance of increased implementation of systems strategies in primary care to improve the use and quality of cancer screening in the United States.


Influence of rheological properties of human bronchial secretions on the ciliary beat frequency.
We studied the relations between the mucociliary beat frequency (MF) measured photometrically on the depleted frog palate and the rheological properties of sputum collected in patients with chronic obstructive pulmonary disease. MF was lower (p less than 0.001) with sputa (11.3 +/- 3.3 Hz) than with frog mucus (16.9 +/- 3.3 Hz) used as controls. The relative transport rate (Tr) of sputa was closely correlated (r = 0.81, p less than 0.001) to the relative MF. Significant correlations were observed between MF on the one hand and viscosity (r = -0.68, p less than 0.01), elastic modulus (r = -0.70, p less than 0.01) and spinability (r = +0.49, p less than 0.05) on the other. These results suggest that abnormalities in the rheological properties of bronchial secretions may impair the mucociliary transport rate by first decreasing the ciliary beat frequency.


Good news and bad news.
Current delivery systems for the Sapien XT valve for the native pulmonary valve are unacceptable stiff and poorly design for implantation in the pulmonary outflow tract. This report details improvisation of the Melody Ensemble for easier pulmonary outflow tract delivery of the Sapien XT valve. The unacceptable cost of the utilization of two delivery systems for valve implantation, requires industry development of an safe, effective delivery system appropriate for the pulmonary outflow tract.


Fluorouracil (5-FU)-induced Cardiomyopathy.
Fluorouracil (5-FU) is a pyrimidine analog widely used in oncology. It is mainly used in the treatment of solid tumors. It is also used along with radiotherapy because of its radiosensitizing properties. As with all chemotherapy drugs, 5-FU is associated with adverse effects. Cardiotoxicity is one of them. It can present in a variety of ways and, sometimes, it can be lethal too. The reported case is of a 42-year-old male who presented with atypical chest pain after the first dose of 5-FU and was finally diagnosed with 5-FU-induced cardiotoxicity. His cardiac function normalized after the withdrawal of the drug.


Long-term follow-up of maxillary incisors with severe apical root resorption.
The purpose of the study was to analyse the mobility of teeth with severe orthodontically induced root resorption, at follow-up several years after active treatment, and to evaluate mobility in relation to root length and alveolar bone support. Seventy-three maxillary incisors were examined in 20 patients, 10-15 years after active treatment in 13 patients (age 24-32 years) and 5-10 years after active treatment in seven patients (age 20-25 years). All had worn fixed or removable retainers; seven still had bonded twistflex retainers. Total root length and intra-alveolar root length were measured on intra-oral radiographs. Tooth mobility was assessed clinically according to Miller's Index (0-4) and the Periotest method. Crestal alveolar bone level, periodontal pocket depth, gingival, and plaque indices, occlusal contacts during occlusion and function, and dental wear were recorded. There was a significant correlation (P < 0.05) between tooth mobility, and total root length and intra-alveolar root length. No correlation was found between tooth mobility and retention with twistflex retainers. None of the variables for assessment of periodontal status, occlusion and function were related to total root length or tooth mobility. It is concluded that there is a risk of tooth mobility in a maxillary incisor that undergoes severe root resorption during orthodontic treatment, if the remaining total root length is < or = 9 mm. The risk is less if the remaining root length is > 9 mm. Follow-up of teeth with severe orthodontically induced root resorption is indicated.


Development and validation of AMANDA, a new algorithm for selecting highly relevant regions in Molecular Interaction Fields.
Descriptors based on Molecular Interaction Fields (MIF) are highly suitable for drug discovery, but their size (thousands of variables) often limits their application in practice. Here we describe a simple and fast computational method that extracts from a MIF a handful of highly informative points (hot spots) which summarize the most relevant information. The method was specifically developed for drug discovery, is fast, and does not require human supervision, being suitable for its application on very large series of compounds. The quality of the results has been tested by running the method on the ligand structure of a large number of ligand-receptor complexes and then comparing the position of the selected hot spots with actual atoms of the receptor. As an additional test, the hot spots obtained with the novel method were used to obtain GRIND-like molecular descriptors which were compared with the original GRIND. In both cases the results show that the novel method is highly suitable for describing ligand-receptor interactions and compares favorably with other state-of-the-art methods.


The effects of reading-writing direction on the asymmetry of space perception and directional tendencies: a comparison between French and Tunisian children.
We compared the influence of reading and writing habits on the asymmetry of space perception and the directional tendencies of French and Tunisian right-handers, aged 5, 7, and 9 years. By comparing two groups of children who use the opposite direction for writing (from left to right for French, from right to left for Arabic), before and after being taught to read in school, we evaluated the impact of writing direction on these asymmetries. A bisection task, a circle-drawing task, and a dot-filling task were used to assess spatial asymmetries and directional tendencies. On the bisection task, a group difference emerged at 9 years, with the French children bisecting the line to the left of the true centre, and the Tunisian children showing no bias. On the circle-drawing task, there was a group difference from 7 years on, as the French children, but not the Tunisian children, used increasing counterclockwise movements. Finally, on the dot-filling task performed with the right hand, the French children filled in significantly more dots when going from left to right from 7 years on, whereas Tunisian children filled in more dots when going from right to left. These results show the impact of basic tendencies in younger children (ipsilateral bias in line bisection, clockwise direction in circle drawing, outward tendency for horizontal displacement in dot filling), as well as the impact of writing direction on spatial asymmetries after learning to read. The results are also discussed in reference to the differences between the two languages, the closeness of the French direction of writing to spontaneous neural-based tendencies, and the influence of learning French at age 8 for the Tunisian children.


Use of the free jejunal loop to replace cervical oesophagus in an experiment.
The paper presents the results of experimental studies exploring the possibility to replace the cervical oesophagus with a free intestinal loop. The experiments were carried out in dogs and cervical oesophagus replacement was performed using a jejunal loop. Nutrition was provided by mesenteric vessels anastomosed by means of a microsurgical operative technique. The intestinal segment was subsequently used to replace the resected segment of the cervical oesophagus. The results of our experiments indicate this new operative technique can be used in clinical practice.


Marked alterations in circulating inflammatory cells during cardiomyopathy development in a magnesium-deficient rat model.
Rodents fed on a Mg-deficient (Mg-D) diet develop cardiomyopathic lesions, as well as other types of cardiovascular dysfunction. In the rat, inflammatory cell infiltration of the myocardium begins to occur by week 1, and the lesions develop extensively in the third and fourth weeks on the Mg-D diet. Although the aetiologic mechanisms of Mg-D cardiomyopathy are unknown, we have previously reported that once plasma Mg is markedly reduced, one of the earliest molecular markers of the pathophysiological process is elevation of plasma substance P, calcitonin gene-related peptide and prostaglandin E2, followed by histamine and the inflammatory cytokines (interleukin-1, interleukin-6, and tumor necrosis factor-alpha). In order to evaluate the potential role of specific circulating inflammatory cell subpopulations in the mechanisms underlying pathophysiological changes observed in Mg-deficiency-induced cardiomyopathy, we analysed these cells by flow cytochemistry. Leucocyte subpopulation pools increased progressively in the Mg-D rats. Elevated circulating levels of neutrophils and lymphocytes appeared to contribute to both the acute (week 1-2) and chronic phases (week 3-4) of the inflammatory responses; monocytes, eosinophils, basophils and large unstained cells which are lymphoid in stained smears, on the other hand, increased significantly in the third and fourth weeks and thus contributed to the chronic inflammatory phase. Changes in the circulating leucocyte subpopulations paralleled the chronological progression of the cardiomyopathic lesions, particularly in weeks 3 and 4. Since a pronounced neutrophilia preceded leucocyte infiltration and deposition within the myocardial tissue, modifications of the microvascular barrier may be a prerequisite for cardiomyopathy in this model of neurogenic inflammation.


Maternal and neonatal outcomes in advanced maternal age: a retrospective cohort study.
To describe the effect of extremely advanced maternal age (EAMA) on maternal/neonatal outcomes. This was a case-control study in which 127 women ≥40 years at the time of delivery out of 2853 singleton hospital deliveries in Ondokuz Mayis University between 1 January 2008 and 31 August 2010 constituted the study group. One hundred and twenty-seven else were chosen randomly out of 2412, 21-35 years old women, via a computer system as controls. Demographic features of 254 mothers and infants as well as maternal and neonatal complications were recorded. Mean maternal age was 41.5 ± 1.9 (40-49) years in EAMA group and 28.9 ± 4.2 (21-35) years in controls. Primigravidity was 19.6% in the EAMA group, whereas 37.8% in controls (p = 0.003). No difference was found between groups according to route of delivery, stillbirth, preterm birth, congenital abnormalities, gender of babies, NICU admission and respiratory problems (for all p > 0.05). A 5th min Apgar score <7 was more frequent in babies born to EAMA mothers compared to controls (9.8% versus 4.9%, p = 0.004). The present study shows that EAMA mothers and their offsprings have similar peri and neonatal risks compared to younger mothers, except lower 5th minute Apgar scores. We conclude that with good perinatal care, EAMA women and their babies can pass through the perinatal period with similar risks of younger women.


Immunomodulatory effect of cytosine-phosphate-guanosine (CpG)-oligonucleotides in nonasthmatic chronic rhinosinusitis: an explant model.
The use of cytosine-phosphate-guanosine-oligodeoxynucleotides (CpG-ODNs) or immunostimulatory sequences (ISSs) in the treatment of airway diseases is gaining interest. Binding of the CpG-ODN ligand to Toll-like receptor 9 (TLR9) triggers a shift from a Th2- to a Th1-type response in the target tissue. In this study, we explored the potential use of CpG-ODN to dampen the predominantly Th2-driven chronic inflammatory state in our cohort of patients. An in vitro explant model comprising of sinonasal tissue from patients with asthma (n = 12) and without asthma (n = 11) were stimulated with CpG-ODN or Staphylococcus aureus enterotoxin B (SEB) or CpG-ODN in combination with SEB for 48 hours. Ten of the 12 asthma patients had nasal polyps. RNA was extracted for multiplex real-time reverse transcription polymerase chain reaction analysis and the 2(-delta deltaC(T)) method used to determine interleukin (IL)-5, p35 IL-12, interferon (IFN) gamma, and TLR9 expression levels. CpG-ODN significantly reduced IL-5 mRNA expression in patients without asthma (p = 0.0379) but not in the asthma-associated group. SEB alone caused an increase in IL-5 levels that could be dampened when CpG-ODN was added in combination with SEB. Significant differences in mean IL-5 expression levels between the asthmatic and nonasthmatic categories were detected (Welch t-test; **p = 0.0041). Asthmatic and nonasthmatic patients present as two distinct categories as reflected by significant differences in their IL-5 response to CpG-ODN (F = 11.93; ***p = 0.0008), SEB (F = 41.34; *p = 0.0476) and CpG-ODN with SEB (F = 13.2; *p = 0.0114). In contrast, no significant differences were observed in the expression levels of IL-12, IFN-gamma, and TLR9. Localized application of CpG-ODN on its own or in combination with SEB may potentially reduce the expression of the proinflammatory cytokine IL-5 in nonasthmatic patients and may be further developed as an immunotherapeutic agent.


Atypical presentation of odontogenic pain.
Pain referral patterns in the head and neck regions can be complex and frustrating for practitioners to diagnose and treat. This clinical case report involves a patient who did not respond to initial medical treatment for headache pain. The pain was found to be referred from a carious and pulpally involved mandibular molar that interestingly responded normal to pulp vitality testing.


Myocardial preservation 1987: what is the state of the art?
The principles of myocardial preservation by hypothermic cardioplegia are: to induce cardiac arrest rapidly, to minimize energy requirements and prevent ischaemic damage during arrest, and to avoid reperfusion injury after arrest. These principles are put into practice by infusing an effective cold cardioplegic solution at the beginning of ischaemia and then every 20-30 min throughout ischaemia. Myocardial temperature should be maintained below 15 degrees C in all areas of the myocardium by topical cooling, efficient venous drainage and cardiac venting. The use of an oxygenated blood-based cardioplegic solution produces a modest improvement in myocardial recovery compared with a non-oxygenated crystalloid solution. During coronary reperfusion after arrest, ventricular distension should be avoided and coronary pressure should be sufficiently high to perfuse all areas of the myocardium, especially in patients with coronary stenoses. Developing areas in myocardial preservation include metabolic supplementation of the myocardium, the use of free radical scavengers, the prevention of atrial arrythmias and the use of coronary sinus cardioplegia. The increasing numbers of high risk patients presenting for surgery should stimulate the surgeon to adhere closely to the basic principles of myocardial preservation and to apply existing cardioplegic techniques meticulously. It should also challenge the investigator to increase basic understanding and improve methodology in this important area of cardiac surgery.


Graded global ischaemia and reperfusion of the isolated perfused rat heart: characterisation by 31P NMR spectroscopy of the extent of energy metabolism damage.
31P Nuclear Magnetic Resonance (NMR) spectroscopy was used, in combination with biochemical methods, to describe the persisting alterations in energy metabolism provoked by graded normothermic (37 degrees C) global ischaemia, and reperfusion in the isolated perfused rat heart. Graded global ischaemia was induced by adjusting the coronary flow to 0, 1.2, 2.8, or 6.5% of the spontaneous coronary flow in hearts perfused retrogradely under 100 cmH2O (9.807 kPa) perfusion pressure. The 24 min ischaemia was followed by 30 min reperfusion with spontaneous coronary flow. Other series of hearts were perfused with a glucose-free buffer, they were submitted to identical restrictions of coronary flow but for 9 min only with a reperfusion of 20 min. NMR spectra (3 min) were taken throughout the perfusion-ischaemia-reperfusion sequence and used to follow the time-changes in intracellular pH and in the intramyocardial levels of phosphate compounds. Hearts were freeze-clamped at the end of reperfusion to allow for biochemical measurements to be made. Analysis of the results was mainly focused on the energy state at the end of reperfusion. At the end of ischaemia, the extent of the decrease in intracellular pH and the changes in phosphate compound levels were sharply dependent on the degree of coronary flow restriction. In glucose-free perfused hearts, the intracellular acidosis was less than in the presence of glucose. At the end of reperfusion, three kinds of metabolic alterations could be distinguished: 1) those, such as the extent of rephosphorylation of creatine, which were undiscriminative of the acuteness of the previous ischaemia; 2) those, such as the degree of the persisting depletion in ATP (and in the sum of adenine nucleotides), which were directly correlated to the degree of restriction of ischaemic coronary flow; 3) and those which characterised only the most severe conditions of ischaemia, namely a persisting increase in myocardial inorganic phosphate content, a residual shift, albeit slight, of intracellular pH toward acidic values and a displacement of the adenylate charge below control value. The assumption is made that these latter indices can be used to differenciate between reversible and irreversible metabolic damage. An index, calculated from NMR data and correlating well with the adenylate charge, is proposed.


Knowledge discovery from patients' behavior via clustering-classification algorithms based on weighted eRFM and CLV model: An empirical study in public health care services.
The rapid growing of information technology (IT) motivates and makes competitive advantages in health care industry. Nowadays, many hospitals try to build a successful customer relationship management (CRM) to recognize target and potential patients, increase patient loyalty and satisfaction and finally maximize their profitability. Many hospitals have large data warehouses containing customer demographic and transactions information. Data mining techniques can be used to analyze this data and discover hidden knowledge of customers. This research develops an extended RFM model, namely RFML (added parameter: Length) based on health care services for a public sector hospital in Iran with the idea that there is contrast between patient and customer loyalty, to estimate customer life time value (CLV) for each patient. We used Two-step and K-means algorithms as clustering methods and Decision tree (CHAID) as classification technique to segment the patients to find out target, potential and loyal customers in order to implement strengthen CRM. Two approaches are used for classification: first, the result of clustering is considered as Decision attribute in classification process and second, the result of segmentation based on CLV value of patients (estimated by RFML) is considered as Decision attribute. Finally the results of CHAID algorithm show the significant hidden rules and identify existing patterns of hospital consumers.


Neonatal, lethal noncompaction of the left ventricular myocardium is allelic with Barth syndrome.
Loss-of-function mutations in the G4.5 gene have been shown to cause Barth syndrome (BTHS), an X-linked disorder characterized by cardiac and skeletal myopathy, short stature, and neutropenia. We recently reported a family with a severe X-linked cardiomyopathy described as isolated noncompaction of the left ventricular myocardium (INVM). Other findings associated with BTHS (skeletal myopathy, neutropenia, growth retardation, elevated urinary organic acids, and mitochondrial abnormalities) were either absent or inconsistent. A linkage study of the X chromosome localized INVM to the Xq28 region near the BTHS locus, suggesting that these disorders are allelic. We screened the G4.5 gene for mutations in this family with SSCP and direct sequencing and found a novel glycine-to-arginine substitution at position 197. This position is conserved in a homologous Caenorhabditis elegans protein. We conclude that INVM is a severe allelic variant of BTHS with a specific effect on the heart. This finding provides further structure-function information about the G4.5 gene product and has implications for unexplained cases of severe infantile hypertrophic cardiomyopathy in males.


Recent Progress in the Application of Hydroxyapatite for the Adsorption of Heavy Metals from Water Matrices.
Wastewater treatment remains a critical issue globally, despite various technological advancements and breakthroughs. The study of different materials and technologies gained new valences in the last years, in order to obtain cheap and efficient processes, to obtain a cleaner environment for future generations. In this context, the present review paper presents the new achievements in the materials domain with highlights on apatitic materials used for decontamination of water loaded with heavy metals. The main goal of this review is to present the adsorptive removal of heavy metals using hydroxyapatite-based adsorbents, offering a general overview regarding the recent progress in this particular area. Developing the current review, an attempt has been made to give appropriate recognition to the most recent data regarding the synthesis methods and targeted pollutants, including important information regarding the synthesis methods and precursors, morphological characteristics of the adsorbent materials and effectiveness of processes.


Detection of a cardiac mass by [18F]FDG-PET/CT: a rare case.
Intra-cardiac masses present an important problem in cardiology. The differential diagnoses includes tumours, which may be primary (benign or malignant) or metastatic, and infected mural thrombi.Myxomas, sarcomas, breast, lung and renal cancer represent the commonest causes of primary benign, malignant and metastatic intra-cardiac masses, respectively.Recent studies have shown that cardiac involvement in malignant lymphoma is common but under-investigated.Diagnostic imaging techniques for detection of cardiac masses include echocardiography, CT and MRI, with echocardiography having the highest sensitivity. We propose that 18-F-PET/CT may play an important role in the detection and evaluation of intra-cardiac masses.


Sperm binding to hyaluronan is an excellent predictor of Nili-Ravi buffalo bull fertility.
This study reports the first evaluation of sperm hyaluronan binding assay (HBA) for predicting the fertility of Nili-Ravi buffalo bulls in relation to standard parameters of sperm quality. Cryopreserved semen doses of low (n = 6), medium (n = 3) and high fertility (n = 8) bulls based on their respective return rates were used. Significantly, more spermatozoa bound to hyaluronan from the most fertile bulls (57.15% ± 1.44) compared with medium (42.46% ± 1.08) and low fertility bulls (29.70% ± 0.78). A strongly positive correlation (r = .824, p < .01) was found between HBA and fertility that predicts a 67.9% variability (r2 = .679, p < .01) in fertility. HBA was also strongly positively correlated with sperm viability (r = .679, p < .01) followed by their live/dead ratio (r = .637, p < .01), uncapacitated spermatozoa (r = .631, p < .01), normal apical ridge (r = .459, p < .01), motility (r = .434, p < .01), mature spermatozoa with low residual histones (r = .364, p < .01), high plasma membrane integrity (r = .316, p < .01) and nonfragmented DNA levels (r = .236, p < .05). It was negatively correlated with spermatozoa having reacted acrosome (r = -.654, p < .01). A fertility model built using a combination of sperm HBA and either sperm livability or viability predicts, respectively, 86.1% (r2 = .861, p < .01) and 85.9% (r2 = .859, p < .01) variability in buffalo bull fertility. In conclusion, sperm HBA may prove to be a single robust predictor of Nili-Ravi buffalo bull fertility.


Synthesis of the EFG Framework of Tamulamides A and B.
Synthesis of the fused polycyclic ether motif comprising the EFG rings of the marine ladder polyethers tamulamides A and B has been achieved via two different etherification strategies. Ultimately, a reductive etherification approach proved most successful due to tolerance of the G ring substitution and provided the EFG 6,7,6 ring system in 58% yield.


Understanding the priorities in life beyond the first year after stroke: Qualitative findings and non-participant observations of stroke survivors and service providers.
ABSTRACTLong-term unmet health needs are associated with a lower quality of life in stroke survivors. Survivors' priorities in living their lives and health professionals' recognition influence survivors' perceptions of their needs. From the perspectives of survivors and service providers, this study investigated survivors' long-term priorities for continuing their lives after stroke. A qualitative study was conducted with a convenience sample of 40 stroke survivors and a purposive sample of 11 providers who had worked with survivors for more than five years and were currently managers of community-based stroke care services or leaders of volunteer groups. Following the survivors' interviews, non-participant observations of a random day's activities were conducted. Data were transcribed verbatim. Survivors' and providers' data were analyzed separately and then together thematically. Five themes emerged: healing the mind in order to move forward, optimizing adaptations and maintaining physical function, living a safe and cost-effective life, returning to work, and giving back to society. Community-based services can be improved to offer more at-home, technology-supported psychological and self-management interventions, barrier-free and one-stop services, and opportunities for employment and volunteering. It would be worthwhile to invest in conducting public education to promote social inclusion and strengthening collaboration between academic and community organizations.


GCH1 mutation and clinical study of Chinese patients with dopa-responsive dystonia.
Dopa-responsive dystonia (DRD) is typically caused by heterozygous mutations in GTP cyclohydrolase 1 gene (GCH1). Our aim was to investigate the clinical and genetic features of Chinese DRD patients. We analyzed a cohort of Chinese DRD patients' clinical data. Mutation of the GCH1 gene was screened by direct sequencing. Additionally, multiplex ligation-dependent probe amplification (MLPA) assay targeting the GCH1 and the TH gene to evaluate large exon deletion or duplicate mutation of the genes were performed in point mutation-negative patients. Ten sporadic DRD patients and two pedigrees including six patients were included in the study. The onset age ranged from 3 to 15 years old. All patients initially presented with walking problems due to lower limb dystonia. The delay between onset and diagnosis ranged from 1 to 42 years old. The symptoms were completely or near-completely abolished with low dose levodopa treatment (dosages ranged from 25 mg to 400 mg/day). Direct sequencing in 14 patients found two known mutations (Gly203Arg in exon 5 in four unrelated patients and Met102Lys in exon 1 in one patient) and one new mutation (Thr186Ile mutation in exon 5 in two unrelated pedigrees). A heterozygous exon 2 deletion in the GCH1 gene was found in one of three point mutation-negative patients by MLPA analysis. Our clinical findings in DRD patients were consistent with other studies. GCH1 gene mutations were quite common in Chinese patients. MPLA should be performed in routine deletion analysis of GCH1 in point mutation-negative DRD patients.


Effect of pursed-lip breathing and forward trunk lean positions on regional chest wall volume and ventilatory pattern in older adults: An observational study.
Pursed-lip breathing (PLB) and forward trunk lean posture (FTLP) are commonly used to relieve dyspnea and improve ventilation in a rehabilitation program. However, their effect on chest wall volumes and movements in older adults without chronic obstructive pulmonary disease has never been investigated. This observational study aimed to identify the effect of combined PLB and FTLP on total and regional chest wall volumes, ventilatory pattern, and thoracoabdominal movement using in older adults. It was hypothesized that the combined PLB with FTLP would result in the highest chest wall volumes among the experimental tasks. Twenty older adults performed 2 breathing patterns of quiet breathing (QB) and PLB during a seated upright (UP) position and FTLP. An optoelectronic plethysmography system was used to capture the chest wall movements during the 4 experimental tasks. Tidal volume (VT) was separated into pulmonary ribcage, abdominal ribcage, and abdomen volume. The changes in anterior-posterior (AP) and medial-lateral (ML) chest wall diameters at 3 levels were measured and used to identify chest wall mechanics to improve chest wall volumes. The PLB significantly improved ventilation and chest wall volumes than the QB (P < .05). VT of pulmonary ribcage, VT of abdominal ribcage, and VT were significantly higher during the PLB + UP (P < .05) and during the PLB + FTLP (P < .01) as compared to those of QB performed in similar body positions. However, there was no significant in total and regional lung volumes between the PLB + UP and the PLB + FTLP. The AP diameter changes at the angle of Louis and xiphoid levels were greater during the PLB + UP than the QB + UP and the QB + FTLP (P < .01). The AP diameter changes at the umbilical level and the ML diameter changes at the xiphoid level were significantly larger during the PLB + FTLP than the QB + FTLP and the QB + UP (P < .05). The ML diameter changes at the umbilical level were significantly greater during the PLB + FTLP than the QB + UP (P < .05). However, no significant difference in the relative regional chest wall volumes and phase angle among the experimental tasks (P > .05). In conclusion, a combined PLB performed in an FTLP or UP sitting could be used as a strategy to improve chest wall volumes and ventilation in older adults.


Community assessment: an innovative approach.
Conducting a community health assessment and analysis is an essential skill for baccalaureate nursing students. Repetitive assignments in the same locale can negatively affect the community, students, and instructors. The authors discuss how a distant community can be successfully used for skill development by utilizing the Internet, communicating with key informants via telephone, and reading resource materials collected from the area. Key elements are prior visitation to the community by the instructor and collaboration with the university reference librarian.


[Intermediate experiment and mechanism analysis of flue gas desulfurization technology by circulating fluidized bed].
A new Circulating Fluidized Bed was designed for intermediate experiment of flue gas desulphurization, in which the flue gas flow rate was 3500 m3/h. By using it, the basic experiments were carried out to study the influence of Ca/S and supersaturated temperature on desulphurization efficiency and the effect of the recycling solid particle in the sulfur removal column on desulphurization performance. The results showed when Ca/S = 1.2, the desulphurization efficiency was increased by 15% through the recycle of solid particle; the gas velocity inside the bed could be designed higher. The mechanism analysis were also studied and the method to increase effective resident time was introduced.


Combinatorial biosynthesis of cyclic lipopeptide antibiotics: a model for synthetic biology to accelerate the evolution of secondary metabolite biosynthetic pathways.
Nonribosomal peptide synthetases (NRPSs) are giant multi-enzymes that carry out sequencial assembly line couplings of amino acids to generate linear or cyclic peptides. NRPSs are composed of repeating enzyme domains with modular organization to activate and couple specific amino acids in a particular order. From a synthetic biology perspective, they can be considered as peptide assembly machines composed of devices to couple fatty acids to l-amino acids, l-amino acids to l-amino acids, and d-amino acids to l-amino acids. The coupling devices are composed of specific parts that contain two or more enzyme domains that can be exchanged combinatorially to generate novel peptide assembly machines to produce novel peptides. The potent lipopeptide antibiotics daptomycin and A54145E have identical cyclic depsipeptide ring structures and stereochemistry but have divergent amino acid sequences. As their biosynthetic gene clusters are derived from an ancient ancestral lipopetide pathway, these lipopeptides provided an attractive model to develop combinatorial biosynthesis to generate antibiotics superior to daptomycin. These studies on combinatorial biosynthesis have helped generate guidelines for the successful assembly of NRPS parts and devices that can be used to generate novel lipopeptide structures and have established a basis for future synthetic biology studies to further develop combinatorial biosynthesis as a robust approach to natural product drug discovery.


A coated wire-type lead(II) ion-selective electrode based on a phosphorylated calix[4]arene derivative.
The preparation of a lead-selective electrode based on 5,11,17,23-tetra-tert-butyl-25,26,27,28-tetrakis-(diphenylphosphinoylmethoxy)calix[4]arene (1) as an ionophore is reported. The plasticized PVC membrane containing 30% PVC, 57% ortho-nitrophenyloctylether (NPOE), 4% sodium tetraphenylborate (NaTPB) and 9% ionophore 1 was directly coated on a graphite electrode. It exhibits a nearly Nernstian slope of 28.0 +/- 0.2 mV decade(-1) over a concentration range of 1 x 10(-5) - 1 x 10(-2) mol dm(-3) with a detection limit of 1.4 x 10(-6) mol dm(-3). The response time of the electrode was found to be ca. 17 s. The potential of the sensor was independent of the pH variation in the range 3.5 - 5.0. The selectivity of the electrode performance towards lead ions over Th4+, La3+, Sm3+, Dy3+, Y3+, Ca2+, Sr2+, Cd2+, Mn2+, Zn2+, Ni2+, Co2+, NH4+ Ag+, Li+, Na+ and K+ ions was investigated. The prepared electrode was used successfully as an indicator electrode for a potentiometric titration of a lead solution using a standard solution of EDTA. The applicability of the sensor for Pb2+ measurements in various synthetic water samples spiked with lead nitrate was also checked.


Tracking perinatal infection: is it safe to launder your scrubs at home?
This descriptive pilot study was conducted during 1991 and 1992 to determine the effect of wearing home-laundered scrub clothing in labor and delivery on the perinatal infection rate. Unit meetings were conducted to instruct the 68 participating employees to launder their scrub clothing in an automatic washing machine, and to dry them in an automatic dryer on a hot setting. Statistics, including total births and cesarean births, were gathered, including all cesarean births during the years of 1991 and 1992 at the two study sites. Infection rates were monitored by the infection control department and reported frequently to the infection control committee and the medical and nursing staff. Employees were surveyed to assess their satisfaction after purchasing and wearing their own scrub clothing. The method for determining the perinatal infection rate in this study was based on the National Nosocomial Infections Surveillance System, which combines exogenous and endogenous factors when assessing the rate of wound infections(6). The method for monitoring the newborn infection rate in this study was outbreak surveillance. Home-laundered scrub clothing can be worn safely in labor and delivery units, including the operating rooms contained in those units. This practice can reduce costs without increasing surgical wound infection rates.


Systemic bioavailability of ocularly applied 1% atropine eyedrops.
To investigate the pharmacological basis of systemic effects of atropine eyedrops, we estimated the bioavailability of ophthalmic 1% atropine solution in healthy volunteers. In a randomized crossover study we administered 0.3 mg atropine either intravenously or ocularly to six healthy volunteers. The plasma concentrations of the biologically active atropine enantiomer, 1-hyoscyamine, were determined using a muscarinic cholinoceptor binding assay. The mean area under the curve from zero to infinitum (AUC0-infinity) for 1-hyoscyamine was 1.862+/-0.580 microg/L x hr after intravenous, and 1.092+/-0.381 microl/L x hr after ocular administration (mean+/-sd, n=6), respectively. The mean bioavailability was 63.5+/-28.6% (mean+/-SD, n=6; min 19%, max 95%). Large interindividual differences characterized the absorption and elimination phases of 1-hyoscyamine kinetics. The terminal half-life (t1/2beta) of 1-hyoscyamine in plasma was not affected by the route of drug administration. The systemic bioavailability of 1-hyoscyamine was considerable and may explain the systemic anticholinergic side effects reported in association with the clinical use of atropine eyedrops.


Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure.
Although joint-preserving surgery for intermediate ankle osteoarthritis has been reported to be effective, failures of supramalleolar osteotomy and plafond-plasty can occur because of persistent malalignment of the distal tibia and incongruent ankle mortise. We introduce a novel opening wedge distal tibial osteotomy procedure (mortise-plasty) with rigid plate fixation combined with synthetic bone wedges. We performed 27 mortise-plasties in 25 patients with varus ankle osteoarthritis and instability. Six males (24%) and 19 females (76%), with a mean age of 63 (range 28 to 79) years, were followed up for a mean of 27.3 (range 14 to 45) months. The mean preoperative visual analog scale score, American Orthopaedic Foot and Ankle Society score, and Takakura ankle scale score were 7.4 (range 5.4 to 10), 58.7 (range 18 to 84), and 55.9 (range 29 to 88), respectively. These scores improved significantly to 2.1 (range 0 to 6.5), 89.3 (range 67 to 100), and 84.7 (range 55 to 100) postoperatively (p < .001). The mean preoperative tibial-anterior surface angle and talar tilt angle were 84.9° (range 78° to 90°) and 8.3° (range 3° to 21°), respectively. At the most recent follow-up visit, the corresponding values were 95.0° (range 82° to 99°) and 1.8° (range 0° to 8°), respectively (p < .001). Computed tomography scans indicated that the ankle mortise narrowed by approximately 1.8 mm and the tibial plafond was lowered after osteotomy. No patients underwent lateral ligament reconstruction, ankle joint replacement, or arthrodesis. Mortise-plasty osteotomy corrects the intra-articular and extra-articular deformities simultaneously and provides good clinical and radiographic outcomes for patients with varus ankle osteoarthritis and instability.


Partial purification and characterization of human 5-methylcytosine-DNA glycosylase.
The molecular mechanisms by which DNA 5-methylcytosine content is modulated are incompletely understood. Reduction of DNA 5-methylcytosine content has been correlated with the transition from hyperplasia to adenoma in the genesis of human adenocarcinoma of the colon. 5-methylcytosine-DNA glycosylase removes 5-methylcytosine from DNA as a free base, but its involvement in this process is unknown. The 5-methylcytosine-DNA glycosylase activity in HeLa nuclear extracts has been partially purified, with a 460-fold enrichment, and characterized. This activity is specific for 5-methylcytosine at CpG sites in fully methylated DNA; hemimethylated DNA is not a significant substrate. DNA containing unmethylated cytosines is not cleaved by the enzyme. There is an absolute requirement for Mg2+ ions for the activity, which is inhibited by EDTA. This 5-methylcytosine-DNA glycosylase activity could be involved in carcinogenesis, transcription, replication, differentiation and development through resultant DNA hypomethylation following enzymatic removal of 5-methylcytosine from DNA.


Grape proanthocyanidin-induced intestinal bloom of Akkermansia muciniphila is dependent on its baseline abundance and precedes activation of host genes related to metabolic health.
We previously showed that C57BL/6J mice fed high-fat diet (HFD) supplemented with 1% grape polyphenols (GP) for 12 weeks developed a bloom of Akkermansia muciniphila with attenuated metabolic syndrome symptoms. Here we investigated early timing of GP-induced effects and the responsible class of grape polyphenols. Mice were fed HFD, low-fat diet (LFD) or formulations supplemented with GP (HFD-GP, LFD-GP) for 14 days. Mice fed HFD-GP, but not LFD-GP, showed improved oral glucose tolerance compared to controls. A. muciniphila bloom occurred earlier in mice fed LFD-GP than HFD-GP; however, timing was dependent on baseline A. muciniphila levels rather than dietary fat. Mice gavaged for 10 days with GP extract (GPE) or grape proanthocyanidins (PACs), each delivering 360 mg PACs/kg body weight, induced a bloom of fecal and cecal A. muciniphila, the rate of which depended on initial A. muciniphila abundance. Grape PACs were sufficient to induce a bloom of A. muciniphila independent of specific intestinal gene expression changes. Gut microbial community analysis and in vitro inhibition of A. muciniphila by GPE or PACs suggest that the A. muciniphila bloom in vivo occurs via indirect mechanisms.


The DNA site utilized by bacteriophage P22 for initiation of DNA packaging.
Virion proteins recognize their cognate nucleic acid for encapsidation into virions through recognition of a specific nucleotide sequence contained within that nucleic acid. Viruses like bacteriophage P22, which have partially circularly permuted, double-stranded virion DNAs, encapsidate DNA through processive series of packaging events in which DNA is recognized for packaging only once at the beginning of the series. Thus a single DNA recognition event programmes the encapsidation of multiple virion chromosomes. The protein product of P22 gene 3, a terminase component, is thought to be responsible for this recognition. The site on the P22 genome that is recognized by the gene 3 protein to initiate packaging series is called the pac site. We report here a strategy for assaying pac site activity in vivo, and the utilization of this system to identify and characterize the site genetically. It is an asymmetric site that spans 22 basepairs and is located near the centre of P22 gene 3.


Streptomyces herbaceus sp. nov., Streptomyces incanus sp. nov. and Streptomyces pratens sp. nov., isolated from the soil of a hay meadow.
The taxonomic positions of three streptomycetes isolated from a soil sample from a hay meadow were determined using a polyphasic approach. The isolates had chemical and morphological properties typical of the genus Streptomyces and, in phylogenetic analyses based on 16S rRNA gene sequences, formed a distinct subclade that was most closely related to the Streptomyces prasinus subclade. DNA-DNA relatedness studies showed that the novel strains belonged to three different genomic species. The novel strains could be distinguished from one another and from the type strains of the species classified in the S. prasinus subclade using a combination of genotypic and phenotypic properties. On the basis of these data, it is proposed that the novel strains be assigned to the genus Streptomyces as Streptomyces herbaceus sp. nov., Streptomyces incanus sp. nov. and Streptomyces pratens sp. nov., with BK119(T) ( = KACC 21001(T) = CGMCC 4.5797(T)), BK128(T) ( = KACC 21002(T) = CGMCC 4.5799(T)) and BK138(T) ( = KACC 20904(T) = CGMCC 4.5800(T)) as the respective type strains.


Smoking, alcohol and lipoprotein metabolism.
Daily smoking and use of alcohol have a many-fold influence on lipid metabolism. The relations between HDL-cholesterol, alcohol use and smoking are well known. During recent years, the influence of smoking on postprandial lipid and glucose metabolism, and on insulin sensitivity in particular, has gained increasing attention. In addition, new data have emerged about the oxidative properties of alcohol use and smoking. As life habits tend to show clustering, isolating mechanisms responsible for the lipid changes induced by smoking or alcohol per se is difficult and is one factor causing contradiction in this study area.


Kisspeptin-GPR54 signaling in mouse NO-synthesizing neurons participates in the hypothalamic control of ovulation.
Reproduction is controlled in the brain by a neural network that drives the secretion of gonadotropin-releasing hormone (GnRH). Various permissive homeostatic signals must be integrated to achieve ovulation in mammals. However, the neural events controlling the timely activation of GnRH neurons are not completely understood. Here we show that kisspeptin, a potent activator of GnRH neuronal activity, directly communicates with neurons that synthesize the gaseous transmitter nitric oxide (NO) in the preoptic region to coordinate the progression of the ovarian cycle. Using a transgenic Gpr54-null IRES-LacZ knock-in mouse model, we demonstrate that neurons containing neuronal NO synthase (nNOS), which are morphologically associated with kisspeptin fibers, express the kisspeptin receptor GPR54 in the preoptic region, but not in the tuberal region of the hypothalamus. The activation of kisspeptin signaling in preoptic neurons promotes the activation of nNOS through its phosphorylation on serine 1412 via the AKT pathway and mimics the positive feedback effects of estrogens. Finally, we show that while NO release restrains the reproductive axis at stages of the ovarian cycle during which estrogens exert their inhibitory feedback, it is required for the kisspeptin-dependent preovulatory activation of GnRH neurons. Thus, interactions between kisspeptin and nNOS neurons may play a central role in regulating the hypothalamic-pituitary-gonadal axis in vivo.


TGFβ signalling acts as a molecular brake of myoblast fusion.
Fusion of nascent myoblasts to pre-existing myofibres is critical for skeletal muscle growth and repair. The vast majority of molecules known to regulate myoblast fusion are necessary in this process. Here, we uncover, through high-throughput in vitro assays and in vivo studies in the chicken embryo, that TGFβ (SMAD2/3-dependent) signalling acts specifically and uniquely as a molecular brake on muscle fusion. While constitutive activation of the pathway arrests fusion, its inhibition leads to a striking over-fusion phenotype. This dynamic control of TGFβ signalling in the embryonic muscle relies on a receptor complementation mechanism, prompted by the merging of myoblasts with myofibres, each carrying one component of the heterodimer receptor complex. The competence of myofibres to fuse is likely restored through endocytic degradation of activated receptors. Altogether, this study shows that muscle fusion relies on TGFβ signalling to regulate its pace.


Psychosocial cardiovascular risks--on the double loads in women.
The author discusses gender differences in the psychosocial correlates of cardiovascular risk. A moderate amount of overtime work was associated with a decreased risk of myocardial infarction in men but a corresponding increased risk in women. The reason for this difference may be the double role (home and paid work) of women. Emotional states in diaries differed between men and women in the same occupations, and these differences seemed to some extent to be occupation specific.


Traumatic rupture of gastric pull-up after apparent mild thoracic trauma: a case report and literature review.
While elderly patients account for only 10-12% of all trauma victims, they consume 25% of trauma-related health care resources, with higher rates of mortality and complication. Presently described is the case of an elderly patient who presented to the emergency department (ED) following mild thoracic trauma, with previous history of gastric pull-up surgery. The patient had consulted another facility 48 hours earlier and was prescribed analgesia and x-ray follow-up for a mechanical fall and pain in the lower rib cage. At arrival, the patient complained of increasing dyspnea and pain at the right hemithorax. X-ray showed right hemithorax effusion, and contrast computed tomography (CT) demonstrated a large amount of contrast filling the pleural space and a relatively small point of gastric pull-up rupture in the stomach. The patient was referred to the cardiothoracic unit, but was unresponsive upon arrival and died. The aim of the present report was to raise the index of clinical suspicion of traumatic rupture of the gastric pull-up following traumatic chest injury, and to affirm that contrast CT should be the gold standard for diagnosis.


A bicistronic therapeutic retroviral vector enables sorting of transduced CD34+ cells and corrects the enzyme deficiency in cells from Gaucher patients.
Corrective gene transfer for therapeutic intervention in metabolic and hematopoietic disorders has been hampered by the relatively inefficient transduction of human hematopoietic stem cells. To overcome this, a bicistronic recombinant retrovirus has been generated that delivers both a therapeutic glucocerebrosidase (GC) cDNA for the treatment of Gaucher disease, and a small murine cell surface antigen (heat-stable antigen [HSA]) as a selectable marker. An amphotropic retroviral-producing cell clone was created, and filtered supernatant was used to transduce NIH 3T3 cells. Sorting of transduced cells by flow cytometry enabled separation into populations based on cell surface fluorescence intensity derived from the expressed HSA. Significant increases in GC enzyme activity were seen for the transduced and especially the transduced and sorted cells. Similarly, increases in GC specific activity were seen in transduced and sorted skin fibroblasts from a patient with Gaucher disease. To streamline future transfer and sorting protocols for hematopoietic cells, transformed B-cell lines from Gaucher patients were created. Type I B cells were transduced and sorted, and large increases in GC specific activity occurred with concomitant increases in integrated retroviral copy numbers. In addition, toward the goal of using this selectable approach for corrective gene transfer to bone marrow stem cells, CD34+ cells were isolated from normal BM donors, transduced, and sorted based on cell surface expression of HSA. Proviral DNA was detected in approximately 40% of clonogenic progenitor colonies derived from unsorted, transduced CD34+ cells, demonstrating the high titer of the vector. However, after sorting, 100% of the colonies had the corrective GC cDNA, demonstrating the efficiency of this selective system for human hematopoietic progenitors. It is expected that strategies based on this approach will allow sorting of transduced cells of many types before implantation of transduced cells to animals or patients. This vector system may also be used to simplify manipulations and studies on retroviral-mediated gene delivery in vitro and for in vivo models.


A Mild Two-Step Synthesis of Structurally Valuable Indole-Fused Derivatives.
A mild two-step synthetic approach for the preparation of structurally valuable indolo[3',2':4,5]pyrrolo[3,2,1-kl]phenothiazines has been developed. In this work, cyclohexanone was used as the key bridge to connect the indole and phenothiazine frameworks to construct a structurally valuable indole-fused derivative. The present protocol achieved the cascade construction of multiple C-hetero bonds, affording a convenient approach access to hexacyclic-fused system that contained both indole and phenothiazine, two privileged skeletons.


Optical nonlinearities in non-peripherally substituted pyridyloxy phthalocyanines: a combined effect of symmetry, ring-strain and demetallation.
The optical nonlinearities of six non-peripherally-substituted pyridyloxy phthalocyanines have been studied at 532 nm using a nanosecond Z-scan technique in a dimethyl sulphoxide solution. Ring-strain effects and the absence of a metal center were found to greatly reduce the inherent high nonlinearities expected of some of these phthalocyanine complexes. Of the six molecules investigated, 1(4),8(11),15(18),22(25)-tetrakis-(2-pyridyloxy)phthalocyaninato lead(II) 3, 1(4),8(11),15(18),22(25)-tetrakis-(2-pyridyloxy)phthalocyanine 5, and 1(4),8(11),15(18),22(25)-tetrakis-(4-pyridyloxy)phthalocyanine 6 were found to exhibit negligible nonlinear optical behavior, due to either the absence of asymmetry or central metal and/or the presence of a ring-strain effect. A two-photon absorption process was found to be the major contributor to the observed reverse saturable absorption (RSA) in 1(4),8(11),15(18),22(25)-tetrakis-(4-pyridyloxy)phthalocyaninato lead(II) 4, 1(4)-mono-(2-pyridyloxy)phthalocyaninato lead(II) 7, and 1(4)-mono-(4-pyridyloxy)phthalocyaninato lead(II) 8, with large two-photon absorption cross-section, high hyperpolarizability and high third-order susceptibility values in the range of 4.53 × 10(-43)-5.33 × 10(-42) cm(4) s per photon, 1.61 × 10(-28)-1.89 × 10(-27) esu and 9.73 × 10(-12)-7.05 × 10(-11) esu respectively.


A comparative study of the ribosomal RNA operons of Streptomyces coelicolor A3(2) and sequence analysis of rrnA.
S. coelicolor A3(2) contains six ribosomal RNA operons. Here we describe the cloning of rrnA, rrnC and rrnE, thereby completing the cloning of all operons. Southern hybridisation of genomic DNA with a heterologous probe from the E.coli rrnB 16S rRNA gene showed differences in hybridisation among the six rRNA operon-containing bands. The nucleotide sequence of the 16S rRNA gene and the upstream region of rrnA was determined and compared with the corresponding sequence of rrnD, showing that the 16S rRNA genes are 99% identical. Substantial differences were found, however, in the upstream regions corresponding to the P1 and P2 promoters of rrnD. Southern analysis showed that some of the other rRNA operons of S.coelicolor A3(2) also differed in this part of the upstream region.


An Overview of the Cardiorespiratory Hypothesis and Its Potential Contribution to the Care of Neurodegenerative Disease in Africa.
One hypothesis that could explain the beneficial effects of physical exercise on cognitive function is the cardiorespiratory hypothesis. This hypothesis proposes that improved cognitive functioning may be in part a result of the physiological processes that occur after physical exercise such as: Increased cerebral perfusion and regional cerebral blood flow. These processes ensure increased oxygenation and glucose transportation to the brain, which together can improve cognitive function. The objective of this narrative review is to examine the contribution of this hypothesis in the care of African older adults with neurodegenerative conditions (i.e., dementia (Alzheimer's disease)) or with mild cognitive impairments. Although studies in developed countries have examined people of African descent (i.e., with African Americans), only the limited findings presented in this review reflect how these conditions are also important for the African continent. This review revealed that no studies have examined the effects of cardiorespiratory fitness on neurodegenerative disease in Africa. African nations, like many other developing countries, have an aging population that is growing and will face an increased risk of neurodegenerative declines. It is therefore imperative that new research projects be developed to explore the role of the cardiorespiratory fitness in neurodegenerative disease prevention in African nations.


Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease.
A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute interior wall myocardial infarction (MI) cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermole, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery (RCA) in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross sectional study carried out at the department of cardiology and cardiac catheterization at Jiinnah Hospital, Lahore from April 2008 to September 2008. A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. Out of 60 patients, 29 (48.4%) had the culprit lesion in proximal, 23 (38.5%) in mid and 8 (13.4%) in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion.


[Management of difficult cases of biliary lithiasis].
To assess that insertion of a biliary endoprosthesis is a safe and effective treatment in patients with retained common bile duct stones (CBDS). Before 1974, surgical exploration including cholecystectomy with choledochotomy was the only effective treatment for CBDS. However, morbi-mortality increases rapidly in the elderly and is over 10% in patients over 65, particularly if other serious medical conditions are present. Endoscopic sphincterectomy is now an established procedure, with a success rate of about 90%, complications are relatively rare, and mortality is about 1%. However, the size and number of the stones, the appearance of the terminal bile duct and presence of peripapillary diverticulum influence the outcome. At the present time technique of fragmenting the stones using intracorporeal electrohydraulic, extracorporeal shock waves or laser lithotripsy would be seen to be an attractive alternative approach. Endoprosthesis insertion is a safe, effective and cheap treatment in CBDS. 40 patients with unextractable CBDS were studied and treated with endoscopic stenting. Four patients were lost for follow-up. The remaining patients comprised 29 females and 7 males, with a mean age of 67 years. Four patients underwent surgical treatment for post-sphincterotomy haemorrhage (1 patient), internal endoprosthesis migration (1 patient) and peripapillary diverticulum (2 patients). In 7 high-risk patients with large CBDS, recurrent obstructive jaundice was successfully treated by replacing the endoprosthesis. In 6 of them we added medical treatment with ursodeoxycholic acid and after 24 months follow-up, the stones disappeared. In 13 patients the endoprosthesis were inserted temporally, and in a second approach we removed the CBDS by mechanical lithotripsy. The remaining 12 patients were still alive without symptoms after a follow-up of 24 months. On the basis of these findings we therefore concluded that endoscopic insertion of a biliary endoprosthesis is a safe and effective treatment for CBDS in patients in whom endoscopic sphincterotomy and attemps to remove the stones are not successful.


Morphology, Rheological and Mechanical Properties of Isotropic and Anisotropic PP/rPET/GnP Nanocomposite Samples.
The effect of graphene nanoplatelets (GnPs) on the morphology, rheological, and mechanical properties of isotropic and anisotropic polypropylene (PP)/recycled polyethylene terephthalate (rPET)-based nanocomposite are reported. All the samples were prepared by melt mixing. PP/rPET and PP/rPET/GnP isotropic sheets were prepared by compression molding, whereas the anisotropic fibers were spun using a drawing module of a capillary viscometer. The results obtained showed that the viscosity of the blend is reduced by the presence of GnP due to the lubricating effect of the graphene platelets. However, the Cox-Merz rule is not respected. Compared to the PP/rPET blend, the GnP led to a slight increase in the elastic modulus. However, it causes a slight decrease in elongation at break. Morphological analysis revealed a poor adhesion between the PP and PET phases. Moreover, GnPs distribute around the droplets of the PET phase with a honey-like appearance. Finally, the effect of the orientation on both systems gives rise not only to fibers with higher modulus values, but also with high deformability and a fibrillar morphology of the dispersed PET phase. A fragile-ductile transition driven by the orientation was observed in both systems.


Elective staged proctocolectomy and living donor liver transplantation for colon cancer with sclerosing cholangitis-related ulcerative colitis: a case report.
Primary sclerosing cholangitis (PSC) is a well-known complication of ulcerative colitis (UC), but it is rare to encounter patients requiring both living donor liver transplantation (LDLT) and proctocolectomy. We report a case of elective two-stage surgery involving proctocolectomy performed after LDLT for a patient with early colon cancer concurrent with PSC-related UC. To our knowledge, this is the first report of concurrent cancer successfully treated with both LDLT and proctocolectomy. A 32-year-old Japanese man with colon cancer associated with UC underwent restorative proctocolectomy at 3 months after living donor liver transplantation (LDLT) for PSC. He was diagnosed with PSC and UC when he was a teenager. Conservative therapy was initiated to treat both PSC and UC. He had experienced recurrent cholangitis for years; therefore, a biliary stent was placed endoscopically. However, his liver function progressively deteriorated. Colonoscopic surveillance revealed early colon cancer; hence, surgical treatment was considered. PSC progressed to cirrhosis and portal hypertension; hence, LDLT was performed before restorative proctocolectomy. Three months after LDLT, we performed restorative proctocolectomy with ileal pouch-anal anastomosis. The postoperative course was uneventful. The patient was well, with good liver and bowel functions and without tumor recurrence, more than 1 year after proctocolectomy. With strict patient selection and careful patient management and follow-up, elective proctocolectomy may be performed safely and effectively after LDLT for concurrent early colon cancer with PSC-related UC. There are no previous reports of the use of both LDLT and proctocolectomy for the successful treatment of PSC-related UC and concurrent cancer.


What interventions should pharmacists employ to impact health practitioners' prescribing practices?
To determine which interventions are effective in influencing health practitioners' prescribing practices and explore differences in intervention complexity, setting, sustainability, cost effectiveness, and impact on patient outcomes. A systematic search for English-language systematic reviews was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature, EMBASE, and the Cochrane Library from the date of inception to July 2005 using search terms in accordance with Cochrane recommendations. Included reviews were required to clearly report a search strategy, inclusion/exclusion criteria, literature assessment criteria, and methods for synthesizing or summarizing information and references. Two reviewers independently identified studies for inclusion, assessed study quality, and extracted relevant information. Interventions were classified as consistently effective, inconsistently effective, and effectiveness uncertain. Thirty-four of 4585 titles reviewed met the inclusion criteria. Quality scores ranged from 70% to 100%. Consistently effective interventions included reminders (manual and computerized), audit and feedback, educational outreach visits, organizational strategies, and patient-mediated interventions. Inconsistently effective interventions included computer decision support systems and educational meetings. Multi-faceted interventions were consistently shown to be more efficacious than single interventions. Limited data precluded exploration of the effects of interventions in different settings, sustainability of effect, cost effectiveness, and patient clinical outcomes. Interventions that are most effective for impacting prescribing practice include audit and feedback, reminders, educational outreach visits, and patient-mediated interventions. To maximize impact, pharmacists' efforts to positively impact prescribing practices should focus on these intervention types rather than relying primarily on passive didactics or dissemination of guidelines.


The mechanism of interaction of sodium dodecyl sulfate with elastic fibers.
Sodium dodecyl sulfate (SDS), an anionic hydrophobic ligand, is known to alter the mechanical properties of elastic fibers. In order to analyze the mechanism of the alteration, two forms of fibrous elastins, "solid" and "powder" elastins, which consisted of fascicular elastic fibers and single or oligomeric elastic fibers, respectively, were prepared from bovine aorta, and the interactions of SDS with these elastins in the presence and absence of 0.15 M NaCl were studied. The solid elastin was able to retain 1.2- to 1.4-fold larger amounts of SDS than the powder elastin under both conditions, and both elastins retained 1.2-fold or larger amounts of SDS in the presence of NaCl than in its absence. Whereas both elastins released the retained SDS gradually on repeated washing with an SDS-free buffer, the release rates from the solid elastin, especially the rate in the presence of NaCl, were much smaller than those from the powder elastin, and the solid elastin retained approximately 40% of the bound SDS under conditions where the powder elastin lost most of its SDS. The SDS-binding capacities of both elastins were significantly lower than those of soluble kappa-elastin and serum albumin, which bound SDS homogeneously on the polypeptide chains. When the washed SDS-bound solid elastin was incubated with methylene blue and examined under a microscope, most of the methylene blue-SDS complex was located at the interfiber spaces of the elastic fibers. These results suggest that SDS alters the mechanical properties of elastic fibers by binding to the interfiber spaces and surfaces of the fibers rather than by binding to the internal polypeptide chains.


Segmental action of aldosterone on water and electrolyte transport across rabbit colon in vivo.
Water and electrolyte transport (Na, K, Cl) and the electrical potential difference were investigated simultaneously in five segments of rabbit colon in vivo, under control conditions and under the influence of aldosterone. A dialysis method was used. The solution was designed to mimic the electrolyte concentration of the lumen, and to simulate normal in vivo conditions. Under in vivo conditions (imposed gradients), marked segmental differences in water and electrolyte transport were present. The proximal colon secreted sodium and absorbed potassium, whereas the distal colon absorbed sodium and secreted potassium. Chloride was secreted in all segments. Aldosterone stimulated water and NaCl absorption in the proximal colon by an electroneutral mechanism, whereas in the distal colon a stimulation of electrogenic Na-absorption occurred. The results demonstrate the role of aldosterone in regulating rabbit colonic electrolyte transport. A uniform hormonal stimulation causes qualitatively and quantitatively different effects in the various segments.