An assessment of non-communicable diseases, diabetes, and related risk factors in the Republic of the Marshall Islands, Kwajelein Atoll, Ebeye Island: a systems perspective.
Non-communicable diseases (NCD) have been declared a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted on Ebeye Island of Kwajelein Atoll, Republic of the Marshall Islands (RMI) to describe the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); assess the system of service capacity and activities for service delivery, data collection, and reporting; and identify the key issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that impact the morbidity and mortality of the population. Population survey of the RMI show that 62.5% of the total population is overweight or obese with a dramatic increase from the 15-24 year old (10.6%) and the 25-64 year old (41.9%) age groups. The leading causes of death were septicemia, renal failure, pneumonia, cancer, and myocardial infarction. Other findings show gaps in the system of administrative, clinical, and support services to address these NCD. All health care in Ebeye is provided in one setting and there is collaboration, coordination, and communication among medical and health care providers. The Book of Protocols for the Kwajalein Atoll Health Care Bureau provides the guidelines, standards, and policy and procedures for the screening, diagnosis, and management of diabetes and other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified.


Effects of sevoflurane on cognitive deficit, motor function, and histopathology after cerebral ischemia in rats.
The volatile anesthetic sevoflurane exhibits neuroprotective properties when assessed for motor function and histopathology after cerebral ischemia in rats. Damage of hippocampal neurons after ischemia relates to a number of cognitive deficits that are not revealed by testing animals for motor function. Therefore, the present study evaluates cognitive and behavioral function as well as hippocampal damage in rats subjected to cerebral ischemia under sevoflurane compared with fentanyl/nitrous oxide (N(2)O)/O(2) anesthesia. Thirty-four rats were trained for 10 days using a hole-board test to detect changes in cognitive and behavioral function. Rats were randomly assigned to the following groups: (A) sham/fentanyl/N(2)O/O(2) (n=7); (B) ischemia/fentanyl/N(2)O/O(2) (n=10); (C) sham/2.0 vol% sevoflurane in O(2)/air (n=7); and (D) ischemia/2.0 vol% sevoflurane in O(2)/air (n=10). Cerebral ischemia was produced by unilateral common carotid artery occlusion combined with hemorrhagic hypotension (mean arterial blood pressure 40 mmHg for 45 min). Temperature, arterial blood gases, and pH were maintained constant. Cerebral blood flow was measured using laser-Doppler flowmetry. After surgery, cognitive and behavioral function was re-evaluated for 10 days. On day 11, the brains were removed for histopathologic evaluation (hematoxylin/eosin-staining). Cognitive testing revealed deficits in declarative and working memory in ischemic rats anesthetized with fentanyl/N(2)O. Rats anesthetized with sevoflurane during ischemia showed a significantly better outcome. Hippocampal damage was significantly worse with fentanyl/N(2)O. The present data add to previous investigations showing that sevoflurane prevents a deficit in cognitive function and histopathological damage induced by cerebral ischemia in rats.


[Telemetry EEG of parietal association cortex in heroin-induced CPP rats].
To determine the relationship between EEG changes of parietal association cortex (PtA) and drug-seeking behaviors of heroin-induced conditioned place preference (CPP) rats. Stereotaxic electrode was buried in the PtA of rats, which were then divided randomly into heroin-induced CPP group and operation-only control group. A CPP video system in combination with EEG wireless telemetry was used for recording PtA EEG and the behaviors of the rats-staying in black or white chamber of the video box; shuttling between black-white chambers or between white-black chambers. No significant difference in percentage of the telemetry EEG waves was found between the two groups of rats when they stayed in the black or white chambers. The heroin-induced CPP rats had increased percentage of delta waves (P < 0.05) on the right PtA and decreased percentage of beta and beta2 waves on both right and left PtA (P < 0.05) when they shuttled between two chambers. Compared with the operation-only controls, significant decrease in the percentage of delta waves on both left and right PtA and increase in theta, alpha and alpha1 waves were evident (P < 0.05) only when the heroin-induced CPP rats shuttled between white-black chambers. EEG changes on PtA of heroin-induced CPP rats differ between staying and shuttling states. Such changes may not be associated with drug-seeking behaviors.


Striped occipital cortex and intragyral hemorrhage: Novel magnetic resonance imaging markers for cerebral amyloid angiopathy.
To investigate whether a striped occipital cortex and intragyral hemorrhage, two markers recently detected on ultra-high-field 7-tesla-magnetic resonance imaging in hereditary cerebral amyloid angiopathy (CAA), also occur in sporadic CAA (sCAA) or non-sCAA intracerebral hemorrhage (ICH). We performed 7-tesla-magnetic resonance imaging in patients with probable sCAA and patients with non-sCAA-ICH. Striped occipital cortex (linear hypointense stripes perpendicular to the cortex) and intragyral hemorrhage (hemorrhage restricted to the juxtacortical white matter of one gyrus) were scored on T2*-weighted magnetic resonance imaging. We assessed the association between the markers, other CAA-magnetic resonance imaging markers and clinical features. We included 33 patients with sCAA (median age 70 years) and 29 patients with non-sCAA-ICH (median age 58 years). Striped occipital cortex was detected in one (3%) patient with severe sCAA. Five intragyral hemorrhages were found in four (12%) sCAA patients. The markers were absent in the non-sCAA-ICH group. Patients with intragyral hemorrhages had more lobar ICHs (median count 6.5 vs. 1.0), lobar microbleeds (median count >50 vs. 15), and lower median cognitive scores (Mini Mental State Exam: 20 vs. 28, Montreal Cognitive Assessment: 18 vs. 24) compared with patients with sCAA without intragyral hemorrhage. In 12 (36%) patients, sCAA diagnosis was changed to mixed-type small vessel disease due to deep bleeds previously unobserved on lower field-magnetic resonance imaging. Whereas a striped occipital cortex is rare in sCAA, 12% of patients with sCAA have intragyral hemorrhages. Intragyral hemorrhages seem to be related to advanced disease and their absence in patients with non-sCAA-ICH could suggest specificity for CAA.


Hybrid fluorocarbon-hydrocarbon CO2-philic surfactants. 2. formation and properties of water-in-CO2 microemulsions.
Hybrid fluorocarbon-hydrocarbon (F-H) sulfate surfactants are shown to be efficient stabilizers in water-in-CO2 (w/c) microemulsions. The chain structure and F-H ratio affect the regions of P-T phase stability and aggregation structure in these w/c phases. High-pressure near-infrared spectroscopy and small-angle neutron scattering measurements of microemulsified water provide evidence for the stabilization of w/c microemulsion droplets. The relative lengths of the two chains were found to influence the favored aggregation structure: for symmetric chain surfactants (F8H8, F7H7) spherical reverse micelles are present, but for asymmetric chain surfactants (F7H4, F8H4) extended cylinder aggregates form. These changes in aggregation are consistent with different surfactant packing parameters owing to the controlled variations in molecular structure. Furthermore, the general order of w/c phase transition pressures (F8H8 < F7H7 and F8H4 < F7H4) is in line with estimations of surfactant fractional free volume, as proposed by Johnston et al. (J. Phys. Chem. B 2004, 108, 1962-1966). Studies of adsorption at the poly(dimethylsiloxane)-water interface are shown to be valuable for assessing the CO2-philicity of new surfactants. All in all, the symmetric F8H8 and F7H7 analogues are seen to be the most efficient compounds from this class for applications in CO2.


Training military medics as civilian prehospital care providers in Southern Sudan.
To describe and evaluate a training program to teach civilian prehospital care to military medics in the Sudan People's Liberation Army (SPLA). Forty-one SPLA military personnel with variable prior medical experience participated in the course. Pre- and postintervention tests were used to evaluate participant knowledge and skill level, and test results were compared using paired t-tests. An intensive 40-hour course consisting of didactic teaching sessions, small-group discussions, and practical skill stations was completed during November 1997. Thirty-seven participants successfully completed the program. Four medics with significant prior experience were trained as teaching assistants. The pretest scores for the other 33 participants ranged from 25.0% to 75.0% (SD 12.4). The posttest scores ranged from 25.0% to 87.5% (SD 15.2), with a mean improvement in test scores of 35.0% (p < 0.0005). The most striking improvements were noted in the knowledge of subjects related to wound care, hemorrhage, and head trauma. A field medic training program in Southern Sudan was conducted utilizing an interactive training curriculum. This program may serve as an educational model to teach prehospital care principles in other areas of international conflict.


Photooxidative Destruction of Chloroplasts Leads to Reduced Expression of Peroxisomal NADH-Dependent Hydroxypyruvate Reductase in Developing Cucumber Cotyledons.
Photooxidative destruction of chloroplasts by exposure of norflurazon-treated cucumber (Cucumis sativus L.) seedlings to white light leads to reduced levels of the nuclear-encoded, peroxisomal enzyme hydroxypyruvate reductase. The partial reduction in hydroxypyruvate reductase activity under photooxidative conditions is accompanied by reductions in levels of hydroxypyruvate reductase protein and transcript. The low level of hydroxypyruvate reductase gene expression in the dark is not affected by norflurazon, and nonphotooxidizing far-red light is able to induce significant increases in hydroxypyruvate reductase expression even in the presence of norflurazon. We conclude that intact plastids are required for maximal expression of hydroxypyruvate reductase in the light and that the plastids affect hydroxypyruvate reductase gene expression at a pretranslational level.


Fate of Tableted Freeze-Dried siRNA Lipoplexes in Gastrointestinal Environment.
The incorporation of siRNA into nanocarriers is mandatory to facilitate its intracellular delivery, as siRNA itself cannot enter cells. However, the incorporation of these nanocarriers into oral, solid dosage forms and their fate in the gastrointestinal environment is yet to be explored. In the present work, the fate of, (i) naked siRNA, (ii) freshly prepared siRNA lipoplexes, and (iii) tableted siRNA lipoplexes, in simulated gastric and intestinal fluids was studied. The siRNA, either released from or protected within the lipoplexes, was quantified by gel electrophoresis and siRNA efficacy was assessed in cell transfection. The freshly prepared lipoplexes kept their siRNA load and transfection efficiency totally preserved during 1 h of incubation in simulated gastric fluid at 37 °C. However, in simulated intestinal fluid, despite no release of siRNA from lipoplexes after 6 h of incubation, gene silencing efficacy was dramatically decreased even after 1 h of exposure. The lipoplexes obtained from tablets efficiently protected siRNA in simulated gastric fluid, thus preserving the gene silencing efficacy, whereas their incubation in simulated intestinal fluid resulted in a marked siRNA release and decreased gene silencing efficacy. These results provided a detailed explanation for understanding the fate of siRNA in gastrointestinal conditions, when simply loaded in lipoplexes or formulated in the form of tablets.


Multiple autoimmune manifestations in monoclonal gammopathy of undetermined significance and chronic lymphocytic leukemia.
In 18 cases of monoclonal gammopathy of undetermined significance, MGUS (monoclonal gammopathy of undetermined significance), admitted for diagnosed or suspected peripheral neuropathy, 11 patients showed other co-existing autoimmune manifestations. Two had POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-component, and skin symptoms), the others mainly endocrinopathy and polyclonal pseudolymphoma. There were 13 cases of sensorimotor neuropathy, two cases of neuritis, while neuropathy could not be confirmed in three cases. Compared with a retrospective review of autoimmunity in a randomly selected CLL (chronic lymphocytic leukemia) cohort of 115 patients, 13 out of 42 patients with clinical and/or laboratory features of autoimmunity showed co-expression of autoimmune signs, the dominating traits being Coombs positive AIHA (auto-immune hemolytic anemia), platelet autoantibodies, endocrinopathy mainly associated with the thyroid gland, serological and/or rheumatological symptoms, but only one case of sensorimotor neuropathy. Viewed from a current model of acquired autoimmunity it is perhaps not surprising that such autoimmunity is seen predominantly in patients with monoclonal gammopathy. Thus, a high concentration of cross-reacting polyreactive autoantibodies related to the M-component might be present in these patients. Furthermore, quantitative defects of the immunoglobulins including the hypogammaglobulinemia associated with M-components can presumably give rise to a defect of the anti-idiotypic network's regulation of natural autoantibodies and autoimmune manifestations in vivo. Such autoimmune manifestations, which are easily overlooked in CLL may call for additional treatment with immunosuppression and/or intravenous, polyclonal IgG.


Effects of acidified blanching water and pectinase enzyme pretreatments on physicochemical properties and antioxidant capacity of Carica papaya juice.
The high pectin content in papaya (Carica papaya) causes the juice extraction to be difficult and results in a low yield. This study aims to determine the effect of acidified blanching water and pectinase enzyme pretreatments on the yield, physicochemical properties, and antioxidant activities of the papaya juice. For acidified blanching treatment, papaya cubes (3 cm3 ) were blanched in water containing 0%, 0.5%, 1.5%, and 2.5% w/v citric acid at 95℃ for 2 min. For enzyme treatment, a pectinase enzyme (10, 20, and 30 ppm) was added to the homogenous papaya puree and incubated at 45℃ (200 rpm) for 60 min. The enzyme reaction was stopped by pasteurization at 74℃ for 2 min. The puree was filtered, and the juice was pasteurized at 74℃ for 7 min. All pretreated papaya juice were analyzed for physicochemical properties (color, clarity, viscosity, pH, total soluble solids [TSSs], total carotenoid content, total phenolic content [TPC], and total flavonoid content [TFC]), and antioxidant activities (2,2-diphenyl-1-picrylhydrazyl [DPPH] and ferric reducing antioxidant power [FRAP] assay). Both pretreatments improved the clarity of papaya juice, and was significantly greater after pretreatment with pectinase enzyme. The TPC and antioxidant activities of papaya juice were conserved and maintained by acidified blanching at 1.5% (w/v) citric acid. Increased concentrations of pectinase enzyme significantly reduced the TPC and total carotenoid content. Pretreatment with pectinase enzyme up to 20 ppm does not significantly reduce the TFC and antioxidant activities. Acidified blanching and pectinase enzyme pretreatments have an impact on extraction of papaya fruit juice while retaining the nutritional composition of the juice. PRACTICAL APPLICATION: Papaya (Carica papaya) is a fruit with great nutritional values but is highly perishable and prone to postharvest loss. Juice has become a more cost-effective and convenient option for preserving the fruit. However, since papaya is a pectin-rich fruit, the extraction of juice using mechanical pressing is difficult due to the bonding of juice to the pulp in the form of a jellied mass, which results in juice with low yield. Using acidified blanching and pectinase enzyme to clarify the juice not only increases the yield but also retains the nutrient composition of the juice.


[Fears of pregnant women if prenatal examination yields or does not yield any findings].
Besides a medical point of view, prenatal diagnosis also has psychological effects on the pregnant woman. We studied the state of anxiety before and after prenatal examination with unsuspicious and suspicious prenatal findings. In a consecutive sample of 332 pregnant women presenting between the 12th and 21st week of gestation for prenatal malformation scan (level three reference centre, Unit for Prenatal Medicine, Department of Obstetrics and Gynaecology, Medical University of Lübeck) we ascertained state and trait anxiety (Spielberger) before prenatal examination and state anxiety after prenatal examination with unsuspicious and suspicious findings. In the sample of N = 332 pregnant women prenatal examination showed a suspicious finding in 37 fetuses (11.1 %) and an unsuspicious finding in 295 fetuses (88.9 %). Before prenatal examination there is no difference (Mann-Whitney-Test, P = 0.286) between the group with negative results and the pregnant women with a positive result for the trait anxiety scale; however, there is a significant difference (Mann-Whitney-Test, P = 0.014*) for the scale of state anxiety. After prenatal examination the evaluation of the state anxiety questionnaire shows a significant (Mann-Whitney-Test, P = 0.000*) difference between pregnant women with an unsuspicious finding and pregnant women with a suspicious finding. State-anxiety is significantly reduced after examination if the prenatal scan is unsuspicious (Wilcoxon-Test, P = 0.000*), but there is no significant difference between pre-and post-examination anxiety if there is a positive finding (Wilcoxon-Test, P = 0.399). Evaluating aspects of anxiety as regards content, it can be demonstrated that before prenatal examination the pregnant women are just as much afraid of a malformation being detected as of it being missed. Suspecting or knowing about a malformation of the unborn means a complex process of coping and an intense psychosocial strain for a pregnant woman. Besides the fear of a detected malformation the pregnant women state equal fear of a malformation being missed. In contrast to this the immediate feedback of a negative finding during ultrasound examination leads to a significant reduction of anxiety and to an emotional relief for the pregnant woman.


Selection for the internal medicine residency programme in the Leiden region.
The selection and the professional training for a resident in internal medicine requires a great investment of time, training effort and money. Drop-outs are therefore considered a failure of the selection procedure. To evaluate our selection model and outcome of the training programme, we determined the drop-out rate at the Leiden University Medical Centre with its affiliated hospitals. Data were collected from all files that have been kept from 1988 onwards of all internists trained and registered in Leiden. These files contained the application forms, the assessments of the trainers and references and the specifications of the programme. Also the first employment as board-certified internist is registered. The drop-out percentage of the training programme was 8.5%. The drop-outs did not differ in study characteristics from those who successfully completed the programme. The reports from the training team members showed that the drop-outs were as suitable and motivated as the other candidates. During the training programme 8.5% of the residents moved to another university to complete their training as an internist. All board-certified internists who graduated at the Leiden University Medical Centre found a job. The efficacy of the selection procedure for trainee internists is more than 90%. There are no studies in the literature for a comparison of data.


Regulation of testicular steroid production in vitro by gonadotropins (GTH I and GTH II) and cyclic AMP in coho salmon (Oncorhynchus kisutch).
The ability of coho salmon gonadotropins GTH I and GTH II to stimulate testicular production of 11-ketotestosterone (11-KT) and 17 alpha,20 beta-dihydroxy-4- pregnen-3-one (17,20 beta-P) in vitro, as well as the involvement of cyclic AMP (cAMP) as a mediator of the actions of GTH I and GTH II, were investigated in maturing male coho salmon. Testicular tissue was incubated in the presence or absence of the test substances at 15 degrees. Both GTH I and GTH II stimulated the in vitro production of 11-KT and 17,20 beta-P in a concentration- and time-dependent manner. In testicular tissue at stage IV of spermatogenesis, GTH I and GTH II stimulated the in vitro production of steroids with similar potency. The steroidogenic activity of GTH I and GTH II appeared to be mediated, at least in part, by cAMP as indicated by the ability of dibutyryl cAMP and forskolin to mimic the steroidogenic actions of GTHs, and the similar ability of GTH I and GTH II to increase intracellular cAMP levels in the testicular tissue. The calcium ionophore A23187 stimulated basal but not GTH-stimulated production of steroids in vitro. In addition, differential effects of a protein kinase C inhibitor, H-7, on 11-KT and 17,20 beta-P production were found. Basal and GTH-stimulated production of 11-KT were inhibited by H-7; whereas basal and GTH-stimulated production of 17,20 beta-P were stimulated by H-7. These results suggest that protein kinase C may also be involved in the steroidogenic actions of GTH I and GTH II.


A modified-Delphi study of a framework to support the potential implementation of pharmacist prescribing.
There is an extensive evidence base of the effectiveness and safety of pharmacist prescribing around the globe. There is therefore potential to develop a framework to support the implementation in Qatar to achieve the National Vision 2030 of establishing a comprehensive world-class healthcare system by better utilisation of its healthcare workforce. To determine the levels of agreement amongst key stakeholders regarding a framework for the potential development and implementation of pharmacist prescribing in Qatar. A quantitative, consensus-based modified Delphi study involving stakeholders in Qatar with key strategic positions of health policy influence (directors of medicine/nursing/pharmacy, lead administrators, health-related academics, patient safety leads, professional regulators) was conducted. Delphi statements were developed from extensive literature reviews, semi-structured interviews, pharmacist prescribing frameworks implemented in other countries, and based on the Consolidated Framework for Implementation Research. The scope of the statements included definitions and scope of prescribing, education and training, and governance, were validated with eight specialists from UK and Qatar, and presented as an online Delphi. Consensus was set at 70% or higher agreement and less than 15% disagreement for each statement. Thirty-three experts agreed to participate in the Delphi, with a response rate of 94% for Round 1 and 91% for Round 2, at which point the Delphi stopped. Consensus was achieved for 38 out of 47 statements indicating that a collaborative prescribing model was preferred, and that experience and additional training were required along with robust governance. Consensus was not reached in relation to independent prescribing, prescribing controlled drugs, and ordering certain diagnostic/monitoring investigations (e.g. ECG, X-ray). High levels of agreement were attained for statements, which can constitute a framework for the development and implementation of pharmacist prescribing in Qatar. Further work is required to translate this framework into healthcare policy and practice.


Slender Sheath/Guiding Catheter Combination vs. Sheathless Guiding Catheter for Acute Coronary Syndrome: A Propensity-Matched Analysis of the Two Devices.
A Glidesheath slender (Terumo, Tokyo, Japan) and a sheathless Eaucath guiding catheter (Asahi Intecc, Nagoya, Japan) are two major slender devices utilized in percutaneous coronary intervention (PCI). This study aimed to investigate the differences in access-site complications between these devices in PCI for acute coronary syndrome (ACS). A total of 1108 consecutive patients who underwent transradial PCI for ACS were enrolled. Transradial PCI was performed using either a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group) or a 7.5-Fr sheathless guiding catheter (Sheathless group); 1 : 1 propensity score matching was performed, and 728 patients (364 in each group) were included in the propensity-matched population. In the matched patients, univariate analysis revealed that the Glidesheath group had less radial artery occlusion (RAO) at 30 days (Glidesheath: 1.4% vs. Sheathless: 4.1%, odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.91, p=0.039), whereas no significant between-group differences were observed in severe radial spasm (Glidesheath: 1.4% vs. Sheathless: 1.9%, OR = 0.71, 95% CI = 0.23-2.22, p=0.58) or access-site major bleeding (Glidesheath: 1.4% vs. Sheathless: 1.6%, OR = 0.83, 95% CI = 0.26-2.71, p=1.00). Multivariate analysis revealed that the choice for Glidesheath was significantly associated with less RAO (OR = 0.32, 95% CI = 0.11-0.93, p=0.036). In conclusion, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is obviously more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of RAO. The potential low risk of RAO in our findings supports the adoption of the 7-Fr Glidesheath slender sheath/7-Fr guiding catheter combination in transradial PCI for ACS.


Squamous Cell Carcinoma and Tattoo: A Man With a Tattoo-Associated Squamous Cell Carcinoma and Review of Benign Tumors, Lymphoid Conditions, and Malignant Neoplasms Occurring Within a Tattoo.
Tattoos, a common form of body adornment, have been associated with numerous cutaneous complications. These include not only benign neoplasms and malignant tumors but also lymphoid conditions occurring within the tattoo. Tattoo-associated dermatomyofibroma, epidermoid inclusion cyst, hemangioma, lipoma, milia, and pilomatricoma are benign lesions that have each only been described in one individual. However, there are only a few reports of persons with either dermatofibroma or seborrheic keratoses within their tattoo; also, benign nevi within a tattoo may be more common than the number of reported individuals. In contrast, there are multiple patients with tattoo-associated pseudoepitheliomatous hyperplasia. Lymphoid conditions that have been observed in a tattoo include single patients with either lymphomatoid papulosis or B-cell lymphoma; however, several individuals have been described with pseudolymphoma developing within their tattoo. Tattoo-associated cutaneous cancer predominantly includes individuals with squamous neoplasms (such as keratoacanthomas and squamous cell carcinomas) and malignant melanoma; however, basal cell carcinoma originating within a tattoo is not uncommon. A 57-year-old man is described who received a tattoo on his left forearm 35 years earlier; he subsequently developed a squamous cell carcinoma in the black tattoo ink. In contrast to the patient in this report, tattoo-associated squamous neoplasms usually develop within a median of four weeks after tattoo inoculation, touch-up, or laser-assisted removal. Also, in contrast to the reported patient, tattoo-associated squamous neoplasms are more commonly observed in red tattoos. However, malignant melanoma and basal cell carcinoma more frequently occur in black and darker-pigmented tattoos. In addition, dermatofibrosarcoma protuberans, cutaneous leiomyosarcoma, and invasive breast duct carcinoma cutaneous metastases have each been described to appear within a patient's tattoo. It remains to be determined whether tattoo inoculation or tattoo pigment, or both have an epidemiologic role in the subsequent development of benign, lymphoid, or malignant lesions within the tattoo. Several observations support either a direct or indirect role of tattooing as a contributing factor and tattoo pigment as a carcinogen in the etiology of tattoo-associated malignancies. Investigation into the possible relationship between tattoos and cancer development is in progress.


Perceived social environment and quality of life among people living with HIV/AIDS in northern Thailand.
Efforts have been made to improve the social environment of people living with HIV/AIDS (PLWHA) in Thailand but have not been assessed in terms of their quality of life (QOL). In this study, we preliminarily examined the relationship between PLWHA's perception of social environment and QOL. The participants of this study were 200 PLWHA who belonged to the self-help groups in Chiang Mai province, northern Thailand. We collected data in face-to-face interviews using a structured questionnaire. The QOL was measured using a Thai version of the Medical Outcomes Study HIV Health Survey. Those who perceived themselves as well accepted by the community, perceived health services accessible or someone's help available, tended to have better QOL in terms of mental health. Community acceptance was most significantly related to QOL. Stratified analyses revealed similar relationships between perceived social environment and QOL among symptomatic and non-symptomatic participants but the relationships appeared weaker among men than women. In sum, our preliminary findings suggest that supportive social environment, especially community acceptance, is important for mental aspects of PLWHA's QOL irrespective of the disease stages and for women who usually take on multiple roles in the Thai traditional family.


More beads, more peristaltic reserve, better outcomes: factors predicting postoperative dysphagia after magnetic sphincter augmentation.
Magnetic sphincter augmentation (MSA) offers a minimally invasive anti-reflux alternative to fundoplication for gastroesophageal reflux disease. The most common side effect of MSA is dysphagia, which may require dilation or even device removal. The incidence of dysphagia may be reduced by MSA sizing and preoperative motility studies. Multiple rapid swallows (MRS) is a provocative maneuver during high-resolution esophageal manometry (HRM) that assesses peristaltic reserve. We evaluated factors predicting development of dysphagia following MSA. A retrospective review of a prospectively maintained database identified patients undergoing MSA. Preoperative work-up included barium swallow, esophagogastroduodenoscopy, and esophageal manometry. Peristaltic augmentation was defined as a ratio > 1 of the distal contractile integral (DCI) following MRS and the mean DCI of the 10 baseline wet swallows during manometry. Demographics, MSA implant size, and postoperative symptom data were gathered on all patients. Sixty-eight patients underwent MSA. Mean age was 51.7 years, average BMI was 25.8 kg/m2. 15 (22.1%) of patients had severe dysphagia requiring endoscopic dilation. Peristaltic augmentation with MRS was significantly higher in patients without dysphagia (46.1% vs 6.3% p = 0.026). 33.3% of patients requiring dilatation exhibited complete absence of smooth muscle contraction following MRS (DCI = 0). The ratio of the DCI of MRS/wet swallows predicting dysphagia following MSA was 0.56. Patients with a small (12-14 beads) versus a larger MSA implant (15-17 beads) had a significantly higher rate of postoperative dysphagia (58.5% vs 30.0% p = 0.026). Adequate peristaltic reserve and larger device size correlate with decreased incidence of dysphagia following MSA implantation without compromising the anti-reflux barrier. Routine assessment of peristaltic reserve during preoperative HRM should be considered prior to MSA placement.


Effects of salbutamol, ipratropium bromide and disodium cromoglycate on breathlessness induced by exercise in normal subjects.
1 Healthy volunteers undertook submaximal graded exercise while objective measurements of cardio-respiratory function were made and breathlessness was assessed with serial visual analogue scales. 2 A useful and consistent relationship existed between breathlessness and ventilation for individual subjects. 3 Drugs were examined in this system to test whether they modified the relationship between ventilation and breathlessness such that less breathlessness occurred for a given level of ventilation. 4 Salbutamol, ipratropium bromide and disodium cromoglycate given by inhalation did not reduce breathlessness in healthy subjects during exercise.


Ghrelin-liposome interactions: characterization of liposomal formulations of an acylated 28-amino acid peptide using CE.
Ghrelin is a pharmacologically interesting peptide hormone due to its effects on appetite and metabolism. The cationic, octanoylated 28 amino acid peptide has a short biological half-life; thus, prolonged release formulations are of interest. Acylated peptides have been suggested to bind to or be incorporated into liposomes. Formulations based on neutral dipalmitoylphosphatidylcholine (DPPC) liposomes and phosphatidylcholine:cholesterol (70:30 mol%) liposomes, and negatively charged dipalmitoylphosphatidylcholine:dipalmitoylphosphatidylserine (DPPC:DPPS) (70:30 mol%) liposomes (2 mM total lipid concentration) were characterized using ACE. Pre-equilibrium CZE and frontal analysis CE methods circumventing capillary wall adsorption of the peptide and the liposomes and suitable for characterizing ghrelin-liposome interactions were developed. The cationic peptide exhibited low affinity (<10% bound) for DPPC and phosphatidylcholine:cholesterol (70:30 mol%) liposomes whereas electrostatic interactions caused a higher affinity for DPPC:DPPS (70:30 mol%) liposomes. Studies on desacyl ghrelin instead of ghrelin demonstrated the significance of the n-octanoyl side chain as an affinity providing moiety towards DPPC:DPPS liposomes (48 and 73% bound peptide, respectively). CE experiments showed that the binding was characterized by rapid dissociation kinetics.


Inhibition of cAMP accumulation by intracellular calcium mobilization in C6-2B cells stably transfected with substance K receptor cDNA.
C6-2B rat glioma cells were stably transfected with substance K receptor cDNA and used to study interactions between cAMP and Ca2+ signaling pathways. Activation of the newly expressed receptors by substance K increased the intracellular free Ca2+ concentration, as monitored by single-cell fura-2 imaging, and markedly inhibited agonist-stimulated cAMP accumulation. Blockade of intracellular Ca2+ mobilization abolished the substance K receptor-mediated inhibition of isoproterenol-induced cAMP production. Phosphodiesterase inhibitors, down-regulation or inhibition of protein kinase C, and pertussis toxin failed to prevent substance K-induced inhibition of agonist-stimulated cAMP accumulation. An increased intracellular Ca2+ concentration caused by either calcium ionophores or activation of endogenous bradykinin receptors was found to markedly reduce cAMP production in wild-type cells. These results demonstrate that elevated intracellular Ca2+ concentration can negatively modulate agonist-stimulated adenylate cyclase activity in C6-2B glioma cells.


Preoperative Angiotensin-converting enzyme inhibitors and acute kidney injury after coronary artery bypass grafting.
Angiotensin-converting enzyme (ACE) inhibitors confer renal protection in different clinical settings. No final conclusions are available on the renal benefits of ACE inhibitors after coronary artery bypass grafting (CABG). Because ACE inhibitors decrease glomerular perfusion pressure, they may exacerbate kidney injury during cardiopulmonary bypass (CPB)-related hypoperfusion. We evaluated the effect of preoperative ACE inhibitors on acute kidney injury (AKI) after CABG. A propensity score-based analysis of 536 patients undergoing CABG on CPB was performed, among which 281 received ACE inhibitors preoperatively. Patients with preoperative end-stage renal failure requiring dialysis were excluded. Postoperative AKI was defined as 50% or more decrease in the glomerular filtration rate from preoperative or postoperative mechanical renal support. After CABG, AKI developed in 49 patients (9.1%), and 23 (4.2%) required dialysis. The incidence of AKI was 6.4% in patients who received preoperative ACE inhibitors and 12.2% in patients who did not (p = 0.02). The incidence of AKI requiring dialysis was 2.4% in the treatment group and 6.3% in controls (p = 0.03). After adjusting for propensity score and covariates, preoperative ACE inhibitors were found to reduce the incidence of postoperative AKI (odds ratio, 0.48; 95% confidence interval, 0.23 to 0.77; p = 0.04). Other independent predictors were age, preoperative glomerular filtration rate, left ventricular ejection fraction of less than 0.35, preoperative use of intraaortic balloon pump, emergency operation, and CPB time. Preoperative ACE inhibitors are associated with a reduced rate of AKI after on-pump CABG surgery.


Ischemic preconditioning protects hepatocytes via reactive oxygen species derived from Kupffer cells in rats.
Hepatic ischemic preconditioning decreases sinusoidal endothelial cell injury and Kupffer cell activation after cold ischemia/reperfusion, leading to improved survival of liver transplant recipients in rats. Ischemic preconditioning also protects livers against warm ischemia/reperfusion injury, in which hepatocyte injury is remarkable. We aimed to determine whether ischemic preconditioning directly protects hepatocytes and to elucidate its mechanisms. Rats were injected with gadolinium chloride to deplete Kupffer cells or with N -acetyl- l -cysteine, superoxide dismutase, or catalase to scavenge reactive oxygen species. Livers were then preconditioned by 10 minutes of ischemia and 10 minutes of reperfusion. Subsequently, livers were subjected to 40 minutes of warm ischemia and 60 minutes of reperfusion in vivo or in a liver perfusion system. In other rats, livers were preconditioned by H(2)O(2) perfusion instead of ischemia. In the other experiments, livers were perfused with nitro blue tetrazolium to detect reactive oxygen species formation. Ischemic preconditioning decreased injury in hepatocytes, but not in sinusoidal endothelial cells. Kupffer cell depletion itself did not change hepatocyte injury after ischemia/reperfusion, indicating no contribution of Kupffer cells to ischemia/reperfusion injury. However, Kupffer cell depletion reversed hepatoprotection by ischemic preconditioning. Reactive oxygen species formation occurred in Kupffer cells after ischemic preconditioning. Scavenging of reactive oxygen species reversed the effect of ischemic preconditioning, and H(2)O(2) preconditioning mimicked ischemic preconditioning. Ischemic preconditioning directly protected hepatocytes after warm ischemia/reperfusion, which is not via suppression of changes in sinusoidal cells as in cold ischemia/reperfusion injury. This hepatocyte protection was mediated by reactive oxygen species produced by Kupffer cells.


Immunolocalization of CRES (Cystatin-related epididymal spermatogenic) protein in the acrosomes of mouse spermatozoa.
The CRES (cystatin-related epididymal spermatogenic) protein is a member of the cystatin superfamily of cysteine protease inhibitors and exhibits highly restricted expression in the reproductive tract. We have previously shown that CRES protein is present in elongating spermatids in the testis and is synthesized and secreted by the proximal caput epididymal epithelium. The presence of CRES protein in developing germ cells and in the luminal fluid surrounding maturing spermatozoa prompted us to examine whether CRES protein is associated with spermatozoa. In the studies presented, indirect immunofluorescence, immunogold electron microscopy, and Western blot analysis demonstrated that CRES protein is localized in sperm acrosomes and is released during the acrosome reaction. Interestingly, while the 19- and 14-kDa CRES proteins were present in testicular and proximal caput epididymal spermatozoa, the 14-kDa CRES protein was the predominant form present in mid-caput to cauda epididymal spermatozoa. Furthermore, following the ionophore-induced acrosome reaction, CRES protein localization was similar to that of proacrosin/acrosin in that it was detected in the soluble fraction as well as associated with the acrosome-reacted spermatozoa. The presence of CRES protein in the sperm acrosome, a site of high hydrolytic and proteolytic activity, suggests that CRES may play a role in the regulation of intraacrosomal protein processing or may be involved in fertilization.


Task Force I: methodological aspects of blood pressure measurement.
To reach a consensus on important methodological aspects of blood pressure measurement. A Task Force on the methodological aspects of blood pressure measurement wrote this review after the Eighth International Consensus Conference on Blood Pressure Monitoring, in Sendai, Japan (28-31 October 2001). This consensus paper is based on the papers presented by Task Force I and on the discussion sessions, and is therefore representative of a broad spectrum of expert opinion. Consensus was reached on the following five issues: (1) there is an urgent need for a simplified protocol for the validation of blood pressure measuring devices; (2) there is a need for a means of updating the "state of the market" for validated devices so that users can have easy access to this information; (3) new devices must be validated independently, and existing devices that have not been validated must be reappraised; (4) manufacturers should confirm when new models use algorithms which have been validated previously; (5) the Food and Drug Administration now accepts that when ambulatory blood pressure measurement is used in clinical short-term trials in which side-effects are not being assessed, a placebo arm is not required.


[Sleep Disorders and Autonomic Nervous System Dysfunction].
Parasympathetic nervous system activity dominates during non-rapid eye movement (REM) sleep, whereas the sympathetic nervous system is dominant during REM sleep. The balance between the sympathetic and parasympathetic nervous systems reduces the heart rate and blood pressure during non-REM sleep and increases these parameters during REM sleep and wakefulness. Heart rate variability analysis, a non-invasive method of autonomic nervous system analysis, may be useful in screening for obstructive sleep apnea and also to predict orthostatic hypotension secondary to autonomic disturbances in patients with REM sleep behavior disorder.


Enhancing patient safety through a standardized model of physiologic monitoring.
The use of physiologic monitoring (e.g., cardiac monitoring) as an important component in providing safe patient care has escalated over the past two decades. It enables the clinician to detect physiologic changes in the patient's condition before they become clinically significant, thus allowing anticipation and prevention of adverse events. Issues and concerns regarding physiologic monitoring were raised throughout the London Health Sciences Centre (LHSC) leading to the approval of a project to develop a policy and guidelines for its use: the focus being standardization of processes and patient safety improvements. This article describes the underlying issues, the execution and results of the project, and its impact on patient safety within LHSC.


Fatal disopyramide intoxication from suicidal/accidental overdose.
Disopyramide is an oral antiarrhythmic drug which reduces conduction velocity, prolongs duration of action potential and the effective refractory period, and exerts vagolytic properties. The drug is usually well absorbed orally. The principal use of the drug is to suppress ventricular extrasystoles with usual oral dosage of 100 to 200 mg every 6 h, until blood levels of 2 to 4 micrograms/mL are attained. The use of the drug for suicide is uncommon as it is a prescription drug. Two cases of fatal disopyramide intoxication seen at the Los Angeles County Medical Examiner's Office will be discussed followed by a review of the literature of fatal suicidal disopyramide overdose. Case 1 was a 31-year-old male pharmacist with known history of depression and no history of heart disease. His decomposed remains were found with a suicide note and with several disopyramide tablets. At autopsy the blood level for disopyramide was 146 micrograms/mL. Case 2 is a 40-year-old male with history of alcoholism and prior suicidal attempts who regularly took disopyramide to control ventricular arrhythmias. He apparently ingested 36 100-mg tablets of disopyramide before his final collapse. At autopsy his blood level of disopyramide was 63 micrograms/mL.


Isolated corpus callosal infarction secondary to pericallosal artery disease presenting as alien hand syndrome.
Two patients are described with the callosal type of alien hand syndrome. Both presented with abnormal feelings in the left upper limb and intermanual conflict without clinical evidence of callosal apraxia or frontal lobe dysfunction such as motor deficit or reflexive grasping. Imaging studies disclosed subacute infarction in the body and splenium of the corpus callosum due to pericallosal artery disease. These patients were unique in their presentation as a callosal type of alien hand syndrome secondary to ischaemic stroke.


Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization.
An effective and viable hemostatic agent is important for stopping bleeding during surgery. However, it is difficult to achieve hemostasis at uneven or deep bleeding sites using a gelatin sponge. A flowable hemostatic agent has therefore been developed by processing and improving gelatin sponge, to address bleeding under these conditions. In this study, we evaluated the efficacy, safety, and physical and chemical properties of this flowable hemostatic agent in various experiments. We examined its efficacy for stopping bleeding in a rabbit model of liver abrasion in vivo, and compared its efficacy in dynamic coagulation and erythrocyte aggregation tests with gelatin sponge in vitro. We also investigated its safety in rat histocompatibility and acute systemic toxicity tests in mice in vivo, and in hemolysis tests in vitro, to determine if the flowable hemostatic agent induced any pathological reactions or adverse events. In terms of its physical and chemical properties, we analyzed the morphology and chemical bonds of the flowable hemostatic agent by optical and electron microscopy and infrared spectroscopy, and its absorbency and density. The flowable hemostatic agent resulted in a shorter mean bleeding time, less bleeding, greater likelihood of successful hemostasis, and reduced clotting time compared with gelatin sponge. The flowable agent produced some changes in physical morphology, but no pathological changes or undesirable outcomes were detected. This flowable topical hemostatic agent thus provides a safe and more effective hemostatic method than gelatin sponge, and more promising results for intraoperative hemostasis, especially on uneven or deep bleeding surfaces.


Needle-aspiration lung biopsy: a comprehensive approach to complication reduction.
Complications in needle-aspiration lung biopsy are often related to technique. A step-by-step discussion of lung biopsy focusing on complication reduction is presented. Preparation, needle selection, biopsy approach, needle manipulations, sampling, postprocedure care, and complication management are discussed in detail.


The possible adverse effects of intramuscular botulinum toxin injections and their management.
In the last two decades or so the intramuscular administration of botulinum toxin type A, and more recently type B, has become an established first line treatment of many neurological and other medical disorders. So far, the toxin has been used mainly by experienced researchers and clinicians with extensive knowledge of its mode of action and potential adverse effects. However, in the foreseeable future it is likely that this treatment will be provided by more medical practitioners and in different clinical settings, especially as the range of its clinical indications increases. Botulinum toxin, in therapeutic doses, is a remarkably safe drug with relatively few adverse effects. The commonest adverse effects are muscle weakness, fatigue, flu-like symptoms, a dry mouth, dizziness and a skin rash. Nonetheless, serious adverse events may occur, albeit rarely, and it is imperative that prescribers of this treatment are thoroughly familiar with its potential risks. The purpose of this article is to review the possible adverse effects of botulinum toxin intramuscular injections, to describe the factors that might predispose to them and to summarise the strategies for their prevention and treatment.


[Subsequent psychological effects].
In connection with the concept of temporality and psychic causality, the notion of deferred action plays a significant role in Freud's thinking. Early experiences, impressions and recollections are later revised in the light of new experience and thus subsequently given a meaning that they did not originally have. The author's main concern here is to show that psychoanalysis of such a strictly hermeneutic nature--regarding the past entirely in terms of the present and projecting a whole system of new meanings onto it which the patient finds immediately convincing--is unable to satisfy the rigorous scientific standards implicit in Freud's approach to causal explanation and will thus necessarily fail to identify the actual past causes of present illness. Kerz-Rühling's article is a call for a more empirically oriented form of psychoanalysis de-potentiating empathy and understanding in counter-transference and reinstating the inductive method of establishing causes.


The biology of pediatric acute megakaryoblastic leukemia.
Acute megakaryoblastic leukemia (AMKL) comprises between 4% and 15% of newly diagnosed pediatric acute myeloid leukemia patients. AMKL in children with Down syndrome (DS) is characterized by a founding GATA1 mutation that cooperates with trisomy 21, followed by the acquisition of additional somatic mutations. In contrast, non-DS-AMKL is characterized by chimeric oncogenes consisting of genes known to play a role in normal hematopoiesis. CBFA2T3-GLIS2 is the most frequent chimeric oncogene identified to date in this subset of patients and confers a poor prognosis.


Good vibrations: cross-frequency coupling in the human nucleus accumbens during reward processing.
The nucleus accumbens is critical for reward-guided learning and decision-making. It is thought to "gate" the flow of a diverse range of information (e.g., rewarding, aversive, and novel events) from limbic afferents to basal ganglia outputs. Gating and information encoding may be achieved via cross-frequency coupling, in which bursts of high-frequency activity occur preferentially during specific phases of slower oscillations. We examined whether the human nucleus accumbens engages such a mechanism by recording electrophysiological activity directly from the accumbens of human patients undergoing deep brain stimulation surgery. Oscillatory activity in the gamma (40-80 Hz) frequency range was synchronized with the phase of simultaneous alpha (8-12 Hz) waves. Further, losing and winning small amounts of money elicited relatively increased gamma oscillation power prior to and following alpha troughs, respectively. Gamma-alpha synchronization may reflect an electrophysiological gating mechanism in the human nucleus accumbens, and the phase differences in gamma-alpha coupling may reflect a reward information coding scheme similar to phase coding.


Assessing Mothers' Parenting Stress: Differences Between One- and Two-Child Families in China.
This study aimed to investigate mothers' parenting stress and explore its relationship with associated demographic variables in two-child families involving preschool children. A sample of 621 two-child families and a comparison group of 319 one-child families from China participated in the study; the children were aged between 3 and 7. The results showed that (1) mothers of two-child families had higher parenting stress than those of one-child families; (2) within the two-child families, demographic variables, such as birth order, gender combination, and the age gap were found to have significant effects on maternal stress levels; and (3) in two-child families, families with an income of less than 3000 yuan had significantly higher maternal stress than families with an income of more than 6000 yuan.


The decrease of lasalocid residue in the edible tissues by silymarin supplementation of chicken diet.
Widespread use of coccidiostats, in spite of beneficial control of protozoan infections in poultry, implies a risk of residues in edible tissues, and there is increasing interest in the development of strategies for prevention of veterinary drugs residue in food-producing animals. The aim of this study is assigned to clarify the impact of silymarin addendum in the diet on lasalocid concentration in the liver and breast muscles from the broiler. Four groups of chickens received a feed with lasalocid at levels between 75 and 200 mg kg-1. Other four groups received a feed with lasalocid (75-200 mg kg-1) plus silymarin. Significant differences of lasalocid concentrations between the liver and breast muscles were observed. Moreover, the chickens from the groups supplemented with silymarin shown significant decreases of lasalocid concentrations in the analysed tissues. The herbal substance did not counteract the ionophore in the treatment of coccidiosis and did not change biochemical parameters of blood. These findings suggest that silymarin might be used in chicken feeding in order to reduce the risk from lasalocid contamination of the broiler edible tissues.


Regulation of proinflammatory cytokines in human lung epithelial cells infected with Mycoplasma pneumoniae.
Mycoplasma pneumoniae is a small bacterium without a cell wall that causes tracheobronchitis and atypical pneumonia in humans. It has also been associated with chronic conditions, such as arthritis, and extrapulmonary complications, such as encephalitis. Although the interaction of mycoplasmas with respiratory epithelial cells is a critical early phase of pathogenesis, little is known about the cascade of events initiated by infection of respiratory epithelial cells by mycoplasmas. Previous studies have shown that M. pneumoniae can induce proinflammatory cytokines in several different study systems including cultured murine and human monocytes. In this study, we demonstrate that M. pneumoniae infection also induces proinflammatory cytokine expression in A549 human lung carcinoma cells. Infection of A549 cells resulted in increased levels of interleukin-8 (IL-8) and tumor necrosis factor alpha mRNA, and both proteins were secreted into culture medium. IL-1 beta mRNA also increased after infection and IL-1 beta protein was synthesized, but it remained intracellular. In contrast, levels of IL-6 and gamma interferon mRNA and protein remained unchanged or undetectable. Using protease digestion and antibody blocking methods, we found that M. pneumoniae cytoadherence is important for the induction of cytokines. On the other hand, while M. pneumoniae protein synthesis and DNA synthesis do not appear to be prerequisites for the induction of cytokine gene expression, A549 cellular de novo protein synthesis is responsible for the increased cytokine protein levels. These results suggest a novel role for lung epithelial cells in the pathogenesis of M. pneumoniae infection and provide a better understanding of M. pneumoniae pathology at the cellular level.


Kv1 potassium channel complexes in vivo require Kvbeta2 subunits in dorsal spinal neurons.
Whereas Kvbeta2 subunits modulate potassium current properties carried by Kv1 channel complexes in heterologous systems, little is known about the contributions of Kvbeta2 subunits to native potassium channel function. Using antisense approaches and in situ recordings from Xenopus embryo spinal cord neurons, we tested the in vivo roles of Kvbeta2 subunits in modulation of voltage-dependent potassium current (IKv). We focused on 1) two different populations of dorsal spinal neurons that express both Kvbeta2 and Kv1 alpha-subunit genes and 2) the 24- and 48-h developmental period, during which IKv undergoes developmental regulation. At both 24 and 48 h, antisense methods produced efficient knock-down of both Kvbeta2 protein and IKv. At both times, dominant negative suppression of Kv1 channels also eliminated IKv, indicating that Kv1 channels require Kvbeta2 subunits to function in dorsal spinal neurons. Even though Kv1 channels determined the IKv values of both dorsal neuron types, comparisons of their IKv properties revealed important differences at both developmental stages. The latter results support the notion that different Kv1 alpha-subunits and/or posttranslational modifications underlie the IKv values of the two dorsal neuron types. Overall, the results demonstrate that Kvbeta2 subunits function in vivo as obligatory subunits of Kv1 channels in at least two neuron types and two different developmental stages.


The dengue threat to the United States.
Over the past 3 decades, dengue has spread rapidly and has emerged as one of the world's most common mosquitoborne viral diseases. Although often found in tropical and semitropical areas, dengue is capable of being transmitted in temperate climates as well. Dengue is currently endemic to Mexico, most other Latin American countries, and parts of the Caribbean, and it has the potential to become reestablished as an endemic disease in the United States. In fact, sustained transmission of dengue has occurred in Florida within the past year. Conditions exist in the U.S. that could facilitate sustained dengue transmission, including environmental factors, competent mosquito vectors, limited vector and dengue surveillance, increased domestic outdoor daytime activities in warmer months, and low public awareness of the disease. If dengue were to be reestablished in the U.S., it could have significant medical, public health, and economic consequences for the country. The impact of dengue as a public health threat could be lessened through enhanced awareness and reporting of cases, increased support for vector surveillance and control programs, and a greater focus on vaccine development.


Excessive Sensory Stimulation during Development Alters Neural Plasticity and Vulnerability to Cocaine in Mice.
Early life experiences affect the formation of neuronal networks, which can have a profound impact on brain function and behavior later in life. Previous work has shown that mice exposed to excessive sensory stimulation during development are hyperactive and novelty seeking, and display impaired cognition compared with controls. In this study, we addressed the issue of whether excessive sensory stimulation during development could alter behaviors related to addiction and underlying circuitry in CD-1 mice. We found that the reinforcing properties of cocaine were significantly enhanced in mice exposed to excessive sensory stimulation. Moreover, although these mice displayed hyperactivity that became more pronounced over time, they showed impaired persistence of cocaine-induced locomotor sensitization. These behavioral effects were associated with alterations in glutamatergic transmission in the nucleus accumbens and amygdala. Together, these findings suggest that excessive sensory stimulation in early life significantly alters drug reward and the neural circuits that regulate addiction and attention deficit hyperactivity. These observations highlight the consequences of early life experiences and may have important implications for children growing up in today's complex technological environment.


Development and Validation of HPLC and HPTLC Methods for Estimation of Glabridin in Extracts of Glycyrrhiza glabra.
Glabridin is a major bioactive phytoconstituent of licorice. This work discusses the development and validation of HPLC and HPTLC methods for analysis of glabridin in licorice. The HPLC separation was performed using a Purospher STAR RP-18e column (5 μm silica particle size, 250 mm × 4.6 mm inner diameter) with gradient elution of 0.2% acetic acid in water-acetonitrile. The flow rate was 1 mL/min. Quantification was performed at a detection wavelength of 280 nm. HTPLC separation was performed on precoated silica gel 60 F254 aluminum plate (10 × 10 cm, 250 μm thickness). A linear ascending development was done using a mobile phase of hexane-ethyl acetate-chloroform (5 + 4 + 3, v/v/v). After development, the plates were scanned at 285 nm. Both of the methods provided good separation of glabridin from other constituents of licorice extract. The methods were validated as per ICH guidelines. Comparison by Student t-test showed that there was a statistically insignificant difference between the mean glabridin content estimated by both methods at 95% confidence interval. The glabridin content in licorice extract was 3.90% by HPLC and 3.79% by HPTLC.


The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study.
Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia. The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients. The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed. Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation. This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.


Simultaneous relaxometry and morphometry of human brain structures with 3D magnetic resonance fingerprinting: a multicenter, multiplatform, multifield-strength study.
Relaxation times and morphological information are fundamental magnetic resonance imaging-derived metrics of the human brain that reflect the status of the underlying tissue. Magnetic resonance fingerprinting (MRF) enables simultaneous acquisition of T1 and T2 maps inherently aligned to the anatomy, allowing whole-brain relaxometry and morphometry in a single scan. In this study, we revealed the feasibility of 3D MRF for simultaneous brain structure-wise morphometry and relaxometry. Comprehensive test-retest scan analyses using five 1.5-T and three 3.0-T systems from a single vendor including different scanner types across 3 institutions demonstrated that 3D MRF-derived morphological information and relaxation times are highly repeatable at both 1.5 T and 3.0 T. Regional cortical thickness and subcortical volume values showed high agreement and low bias across different field strengths. The ability to acquire a set of regional T1, T2, thickness, and volume measurements of neuroanatomical structures with high repeatability and reproducibility facilitates the ability of longitudinal multicenter imaging studies to quantitatively monitor changes associated with underlying pathologies, disease progression, and treatments.


Characterization of dextran-producing Weissella strains isolated from sourdoughs and evidence of constitutive dextransucrase expression.
The study of exopolysaccharide production by heterofermentative sourdough lactic acid bacteria has shown that Weissella strains isolated from sourdoughs produce linear dextrans containing α-(1→6) glucose residues with few α-(1→3) linkages from sucrose. In this study, several dextran-producing strains, Weissella cibaria and Weissella confusa, isolated from sourdough, were characterized according to carbohydrate fermentation, repetitive element-PCR fingerprinting using (GTG)(5) primers and glucansucrase activity (soluble or cell-associated). This study reports, for the first time, the characterization of dextransucrase from Weissella strains using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and in situ polymer production (after incubation with sucrose) from enzymatic fractions harvested from both sucrose and glucose culture media. Results demonstrate that dextransucrase activity was mainly soluble and associated with a constitutive 180-kDa protein. In addition, microsequencing of the active dextransucrase from W. cibaria LBAE-K39 allowed the design of specific primers that could detect the presence of glucansucrase encoding genes similar to GTFKg3 of Lactobacillus fermentum Kg3 and to DSRWC of W. cibaria CMU. This study hence indicates that sourdough Weissella strains synthesize original dextransucrase.


Hexaphenylbenzenes as potential acetylene sponges.
Acetylene sponges can be created by taking advantage of the nonplanar geometry of hexaphenylbenzenes and the special capacity of the central aromatic ring to engage in C(sp)-H...pi interactions reinforced by secondary C(sp(2))-H...pi interactions, as revealed by X-ray crystallographic studies and DFT calculations.


Growth hormone in short, slowly growing children and those with Turner's syndrome.
Results of an aborted placebo controlled trial of treatment with human pituitary growth hormone in children with Turner's syndrome and short, slowly growing children are reported. One child in each group had a considerable reduction in growth rate standard deviation score while taking growth hormone. The remaining eight patients with Turner's syndrome and 10 short, slowly growing patients who received growth hormone showed mean rises in growth rate of greater than two standard deviation scores. Neither placebo group showed a mean increase in growth rate standard deviation score. These differences were significant.


Juxtapapillary chorioretinitis in neurosyphilis. A case report.
A case of neurosyphilis is described. The presenting symptoms were reduced vision and pain around the left eye. The examination revealed a juxtapapillary chorioretinitis and neurosyphilis with elevated total protein (0.84 g/l) and pleocytosis (250 cells X 10(6)/l) in the cerebrospinal fluid (CFS). Four months after treatment with penicillin for 10 days and prednisolone for 5 weeks, the ophthalmological signs had disappeared. There was no pleocytosis (4 cells X 10(6)/l), and the total protein content in CSF was almost normal (0.52 g/l). Treatment with 6 mill (IU) penicillin G intravenously every 6 h resulted in a concentration in serum and spinal fluid higher than the generally accepted treponemacidal level.


Neurofeedback Modulation of the Sound-induced Flash Illusion Using Parietal Cortex Alpha Oscillations Reveals Dependency on Prior Multisensory Congruency.
Spontaneous neural oscillations are key predictors of perceptual decisions to bind multisensory signals into a unified percept. Research links decreased alpha power in the posterior cortices to attention and audiovisual binding in the sound-induced flash illusion (SIFI) paradigm. This suggests that controlling alpha oscillations would be a way of controlling audiovisual binding. In the present feasibility study we used MEG-neurofeedback to train one group of subjects to increase left/right and another to increase right/left alpha power ratios in the parietal cortex. We tested for changes in audiovisual binding in a SIFI paradigm where flashes appeared in both hemifields. Results showed that the neurofeedback induced a significant asymmetry in alpha power for the left/right group, not seen for the right/left group. Corresponding asymmetry changes in audiovisual binding in illusion trials (with 2, 3, and 4 beeps paired with 1 flash) were not apparent. Exploratory analyses showed that neurofeedback training effects were present for illusion trials with the lowest numeric disparity (i.e., 2 beeps and 1 flash trials) only if the previous trial had high congruency (2 beeps and 2 flashes). Our data suggest that the relation between parietal alpha power (an index of attention) and its effect on audiovisual binding is dependent on the learned causal structure in the previous stimulus. The present results suggests that low alpha power biases observers towards audiovisual binding when they have learned that audiovisual signals originate from a common origin, consistent with a Bayesian causal inference account of multisensory perception.


Normal life expectancy and thrombosis-free survival in aspirin treated essential thrombocythemia.
Focusing on platelet-mediated erythromelalgia as a specific, presenting, and single sign of essential thrombocythemia (ET) we were able to define the characteristic peripheral blood and bone marrow findings in ET patients. From 1974 to 1986 we treated 20 symptomatic ET patients with microvascular circulation disturbances including erythromelalgia (N = 18), atypical or typical transient ischemic attacks (N = 6), or acute coronary ischemic syndrome (N = 3) with aspirin and one course of busulfan. The mean platelet counts before and after busulfan treatment were 1,009 (range 545-1,525) and 241 (range 159-315) x 10(9)/L, respectively. After induction of a complete remission, treatment with busulfan and aspirin was discontinued until symptoms returned. All 20 patients remained asymptomatic as long as ET was in maintained remission (platelet < 350 x 10(9)/L) for 4 to 61 (mean 36) months. Eight patients became symptomatic and 4 patients remained asymptomatic at relapse of ET after a follow-up period of 19 to 61 and 31 to 46 months, respectively. Platelet counts at time of symptomatic relapse in the 8 patients were 410, 450, 490, 500, 515, 545, 548, and 635 x 10(9)/L and at time of asymptomatic relapse in 4 ET patients 577, 600, 648, and 725 x 10(9)/L. Based on these observations, since 1986 we followed the strategy to treat ET patients with aspirin as long as the platelet count was between 400 and 1,000 up to 1,250 x 10(9)/L. Clear indications to reduce the platelet count were bleeding, aspirin side effects, and platelets counts above 1500 x 10(9)/L. This nonleukemogenic or least toxic approach in ET is the rationale behind the normal life expectancy and subsequent thrombosis-free survival in 68 ET patients after a mean follow-up period of 6.2 years.


Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course.
The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course.


Acacetin inhibits VEGF expression, tumor angiogenesis and growth through AKT/HIF-1α pathway.
Acacetin (5,7-dihydroxy-4'-methoxyflavone) is a flavone compound, some of which have anti-cancerous effects. Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis and tumor growth. In this study, we found that acacetin decreased the steady level of VEGF mRNA level and inhibited VEGF transcriptional activation. To further determine the potential mechanism of acacetin in inhibiting VEGF expression, we showed that acacetin inhibited HIF-1α expression and AKT activation. Over-expression of HIF-1α or AKT restored acacetin-decreasing VEGF transcriptional activation, indicating that AKT and HIF-1 are the essential downstream targets of acacetin for inhibiting VEGF expression in the cells. Moreover, acacetin significantly inhibited ovarian cancer cell-induced angiogenesis and tumor growth in vivo through inhibiting HIF-1α and VEGF expression. Acacetin did not change HIF-1α mRNA level, but inhibited HIF-1α protein level through increasing its degradation and decreasing its stability. These results indicate that acacetin may be a useful natural compound for ovarian cancer prevention and treatment.


Visual field loss in primary gaze and reading gaze due to acquired blepharoptosis and visual field improvement following ptosis surgery.
Acquired blepharoptosis has been associated with loss of the superior visual field (SVF) in primary gaze. Because many patients with acquired blepharoptosis complained of difficulty reading or performing other visual functions in reading gaze, a prospective study was undertaken to determine if acquired blepharoptosis was the cause of these visual dysfunctions. Preoperative and postoperative SVFs were tested in primary gaze and reading gaze in 19 patients with unilateral or bilateral acquired blepharoptosis totaling 30 eyes. Preoperative testing revealed a marked loss of the SVF in both primary gaze and reading gaze. All patients underwent levator aponeurosis defect repair. Postoperative results showed a significant improvement in both primary and reading gaze SVFs. Therefore, patients with good visual acuity complaining of difficulty reading or carrying out other visual functions in reading gaze should be examined for the presence of acquired blepharoptosis. Blepharoptosis repair can be expected to improve the SVF in both primary gaze and reading gaze.


Idaho judge rebuffs abortion funding rule.
In a 3-page ruling on July 11, Ada County District Court Judge Duff McKee chastised Idaho officials for issuing new Medicaid regulations limiting abortion coverage to the same extent as an earlier rule found unconstitutional by the court. Judge McKee opened his order by calling the new rule "a blatant and ill-concealed attempt to maintain the status quo." Invalidating the prohibition on Medicaid coverage for low-income women's abortions except when two physicians certify that continued pregnancy will result in "grave, long-lasting physical damage," Judge McKee reiterated his holding that such a measure violates the Idaho Constitution. On February 1, Judge McKee held that the state Constitution provides broader protection for the right of privacy than the federal Constitution. The court indicated that the initial Medicaid regulation conflicted with a constitutional guarantee of neutrality, which requires Idaho to be evenhanded when subsidizing the exercise of a constitutionally protected right. Plaintiffs in Roe v. Harris--represented by ACLU Reproductive Freedom Project's Louise Melling, Planned Parenthood Federation's Carole Chervin, and cooperating attorney Newal Squyres--challenged the new regulation in early July. The lawsuit was originally filed in August of 1993. An Idaho statute, which was challenged but upheld, provides Medicaid funding when two physicians certify that it is necessary to save the woman's life or health, or when a court determines the pregnancy resulted from rape or incest.


Exercise Tolerance in Patients With Idiopathic Pulmonary Fibrosis, Effect of Supplemental Oxy-Gen.
Exercise tolerance in patients with idiopathic pulmonary fibrosis IPF is mainly limited by mechanical constrain of ventilation and high physiologic dead space. Oxygen enriched gas inhalation seems to increase ventilatory efficiency by reduction of dead space to tidal volume ratio (VD/VT) which probably mirrors improved pulmonary capillary flow and leads to longer physical tolerance at lower level of minute ventilation. The effect is noticeable at FIO2 that can be delivered in rehabilitation purposes or daily living activities.


Complications of permanent cardiac pacing in patients with persistent left superior vena cava.
Persistent left superior vena cava (PLSVC) is present in about 0.3-0.5% of the general population and in about 12% of patients with other abnormalities. This congenital anomaly is usually asymptomatic and does not cause any physiological problems. However, it may become a significant problem in multiple clinical situations. Various complications related to PLVSC are encountered in anesthesiological, nephrological, oncological and cardiological procedures. The presence of PLSVC is usually incidentally detected during placement of pacemaker (PM), implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) leads. Technical difficulties during lead positioning (especially ventricular leads) are commonly known and often described in the literature. The purpose of the present study was to evaluate the specific methods used for implantation of increasingly complicated pacing systems, finding an optimal strategy in patients with PLSVC, especially with electrotherapy complications. We performed a single-center retrospective analysis of 11 patients (7 women and 4 men, mean age 60.4 ± 13 years) with PLSVC hospitalized in single Cardiology Department between 2000 and 2012. The clinical characteristic, indications for PM/ICD/CRT implantation, technique of implantation and complications were evaluated. In PLSVC patients, different indications for pacing or resynchronization therapy were represented: sick sinus syndrome (SSS) in 4 patients, 3rd degree atrio-ventricular (AV) block in 4 patients, dilated cardiomyopathy with left bundle branch block in 2 patients, dilated cardiomyopathy and non-sustained ventricular tachycardia episodes in 1 patient. In patients no. 1, 3, 4 and 10 the complications necessitated the change of leads or type of pacing. Transvenous lead extraction was successfully performed in patient no. 1 and 10 with re-implantation of new leads via PLSVC in patient no. 1 and via right superior vena cava in patient no. 10. Patient no. 3 received an additional ventricular lead via PLSVC because of 2nd degree AV block (formerly atrial lead implanted due to SSS). In patient no. 4 with left atrial pacing (lead in coronary sinus), prosthetic mitral valve replacement was combined with epicardial ventricular lead placement. Patients no. 2 and 7 received a CRT device, without technical problems in patient no. 7, whereas in patient no. 2 due to difficulties with left ventricular lead positioning a hybrid approach to epicardial lead pacing was used. In patient no. 8 an ICD was implanted with difficulty in placing defibrillator lead. Patient no. 5 received 2 atrial leads via PLSVC with successful biatrial pacing; patient no. 6 with the necessity of DDD pacing had a (ventricular) lead for left atrial pacing and a typical right ventricular lead. In patients no. 9 and 11 typical DDD pacing was used with contralateral placement of the leads due to anatomical and technical differences. After 12 years of follow-up the survival is 90.9%. Late electrotherapy complications have developed only in patient no. 8 (problems with the defibrillator lead). Patients with PLSVC are a very heterogeneous group with different indications for pacing, therefore individualization of therapy is required. Technical complications connected with pacing of the right heart chambers are commonly known, hence transvenous left atrial or left ventricular lead implantation should be attempted. In case of difficulties in transvenous positioning of the lead, a hybrid or isolated cardiac surgery technique should be considered. Because of the increasing number of electrotherapy complications, these problems are also present in PLSVC patients. Transvenous lead extraction with re-implantation of a pacing system has not been reported yet. For this reason a thorough evaluation of the venous system is required in PLSVC patients before intervention.


Nanomaterial and Aptamer-Based Sensing: Target Binding versus Target Adsorption Illustrated by the Detection of Adenosine and ATP on Metal Oxides and Graphene Oxide.
Target molecule-induced desorption of aptamer probes from nanomaterials has been a very popular sensing method, taking advantage of the fluorescence quenching or catalytic activity of nanomaterials for signal generation. While it is generally conceived that aptamers desorb due to binding to target molecules, in this work, we examined the effect of competitive target adsorption. From five metal oxide nanoparticles including CeO2, ZnO, NiO, Fe3O4, and TiO2, only ATP was able to induce desorption of its aptamer. Adenosine could not, even though it had an even higher affinity than ATP to the aptamer. The same conclusion was also observed with a random DNA that cannot bind ATP, indicating that the desorption of DNA was due to competitive adsorption of ATP instead of aptamer binding. On graphene oxide, however, adenosine produced slightly more aptamer desorption than ATP under most of the conditions, and this can be partially attributed to the weaker interaction of negatively charged ATP with negatively charged graphene oxide. For such surface-based biosensors, it is recommended that a nonaptamer control DNA be tested side-by-side to ensure the sensing mechanism to be related to aptamer binding instead of target adsorption.


[Recommendations for the Prevention, Diagnostics and Therapy of Addiction Disorders in the Elderly].
Recommendations for the Prevention, Diagnostics and Therapy of Addiction Disorders in the Elderly Abstract. Although the chronic consumption of alcohol and sedatives, and increasingly opioids, represents a major problem in old age with consequential damage for those affected, little attention has been paid to the substance abuse disorders in old age. The aim of the present recommendations, a collaboration work of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP), Swiss Nurses Association (SBK) and Swiss Society of Addiction Medicine (SSAM), is to summarize the current state of knowledge in prevention, diagnostics and therapy of substance abuse disorders in old age for an interprofessional clinical team. They are intended to help strengthen prevention and early diagnosis, and consciously emphasize psychotherapy and nursing intervention options.


Relationships between the Transition of the Physical Phase of Membrane Lipids and Photosynthetic Parameters in Anacystis nidulans and Lettuce and Spinach Chloroplasts.
The transition of the physical phase of lipids in membrane fragments of a blue-green alga Anacystis nidulans was studied by a spin labeling technique. The maximum hyperfine splitting of the electron spin resonance spectrum of the N-oxyl-4', 4'-dimethyloxazolidine derivative of 5-ketostearic acid plotted against the reciprocal of the absolute temperature gave a discontinuity point that was characteristic of a transition of the physical phase of the hydrocarbon region of membrane lipids. The phase transition appeared at approximately 13 or 24 C in the organisms grown at 28 or 38 C, respectively.The temperature dependence curve of chlorophyll a fluorescence in intact cells, membrane fragments, and extracted lipids of Anacystis cells suspended in a buffer solution showed that the fluorescence yield became maximum near the phase transition temperatures. These findings suggest that chlorophyll a in the thylakoid membrane works as a native fluorescence probe for the detection of phase transition.The temperature dependence of photosynthetic electron transport reactions was studied by measuring the oxidoreductive reactions of P700 and by measuring O(2) evolution. Each of the Arrhenius plots of the reaction rates was composed of two straight lines with a break near the phase transition temperatures. The activation energy was always lower above than below the transition temperatures. It is proposed to explain these phenomena that a reaction involving plastoquinone is influenced by the physical state of membrane lipids.The shift between the pigment state 1 and state 2 measured by fluorescence transients also showed a characteristic break in the Arrhenius plots near the phase transition temperatures; below the transition temperatures the shift almost disappeared. This suggests that the configurational change of the thylakoid membrane related to the state 1 and state 2 shift is dependent on the physical state of membrane lipids. In the chloroplasts of lettuce and spinach, on the other hand, there was no break in the Arrhenius plot of the electron transport reactions or of Mg(2+)-induced changes of chlorophyll a fluorescence.It is suggested that the transitions of the hyperfine splitting of the ESR signal, electron transport, and the configurational change, as well as the appearance of the maximum of chlorophyll a fluorescence, in the thylakoid membranes of Anacystis nidulans are all related to the transition of the physical phase of membrane lipids between the liquid crystalline state and the mixed liquid crystal-solid state.


Effect of growth temperature and temperature shifts on spinach leaf morphology and photosynthesis.
The growth kinetics of spinach plants (Spinacia oleracea L. cv Savoy) grown at 5 degrees C or 16 degrees C were determined to allow us to compare leaf tissues of the same developmental stage rather than chronological age. The second leaf pairs reached full expansion at a plant age of 32 and 92 days for the 16 degrees C and 5 degrees C plants, respectively. Growth at 5 degrees C resulted in an increased leaf area, dry weight, dry weight per area, and leaf thickness. Despite these changes, pigment content and composition, room temperature in vivo fluorescence, and apparent quantum yield and light-saturated rates of CO(2) exchange or O(2) evolution were not affected by the growth temperature. Furthermore, 5 degrees C expanded leaves were found to be more resistant to photoinhibition at 5 degrees C than were 16 degrees C expanded leaves. Thus, it is concluded that spinach grown at low temperature is not stressed. However, shifting spinach leaves from 5 degrees C to 16 degrees C or from 16 degrees C to 5 degrees C for 12 days after full leaf expansion had occurred resulted in a 20 to 25% reduction in apparent quantum yields and 50 to 60% reduction in light saturated rates of both CO(2) exchange and O(2) evolution. This was not accompanied by a change in the pigment content or composition or in the room temperature in vivo fluorescence. It appears that leaf aging during the temperature shift period can account for the reduction in photosynthesis. Comparison of cold-hardened and non-hardened winter rye (Secale cereale L. cv Muskateer) with spinach by in vivo fluorescence indicated that rye is more sensitive to both short term and longer duration temperature shifts than is spinach. Thus, susceptibility to an abrupt temperature shift appears to be species dependent.


An improved endoscopic variceal ligation for esophageal and solitary gastric varices--three-O-band-shooter.
We have reported a 16.0 mm long new type of instrument with the inner diameter of inner cylinder of 10.3 mm for endoscopic variceal ligation which could shoot 3 elastic O bands continuously in short period of time without removing the endoscope. The suction volume of new instrument is larger than that of the Stiegmann's ligator. We performed endoscopic variceal ligation (EVL) in 17 cases of the esophageal varix and 8 cases of the solitary gastric varix. EVL was performed as prophylaxis as all the cases. The esophageal varices were eliminated in all the cases after ulcer formation. The procedure was performed one time in 15 cases and two times in the remaining 2 cases. Three patients died one to hepatic failure during the follow-up period between 4 and 16 months. Six and twelve months cumulative recurrence rates were 30% and 48% respectively. On the other hand all the gastric varices disappeared after one sitting of the treatment. There was one variceal recurrence during the follow-up period. Computed tomography and/or arterioportography performed before had showed patent gastro-renal shunt in five cases. No change in the shunt was observed after the treatment. No serious complications due to EVL was encountered in all the cases. Therefore, it is thought that this method can be used for the treatment of not only esophageal varices but also gastric varices.


Mediterranean diet pyramid: a proposal for Italian people.
Bread was a staple in the traditional Mediterranean diet of the early 1960s, as well as nowadays; however, it was a stone ground sourdough bread in Nicotera and probably in the Greek cohorts of the Seven Countries Study. In the present review, the nutritional characteristics of this food are analyzed in relation to its protective effects on coronary heart disease, metabolic diseases and cancer. According to our traditions, cultural heritage and scientific evidence, we propose that only cereal foods with low glycemic index (GI) and rich in fiber have to be placed at the base of the Mediterranean diet pyramid, whereas refined grains and high GI starchy foods have to be sited at the top.


In vivo oxygen, temperature and pH dynamics in the female reproductive tract and their importance in human conception: a systematic review.
Despite advances in ART, implantation and pregnancy rates per embryo transfer still remain low. IVF laboratories strive to ensure that the process of handling gametes in vitro closely mimics the in vivo environment. However, there remains a lack of knowledge regarding the in vivo regulation and dynamic variation in biophysical parameters such as oxygen concentration, pH and temperature within the reproductive tract. To undertake a systematic review of the current understanding of the physico-chemical parameters of oxygen tension (pO2), pH and temperature within the female reproductive tract, and their potential implications in clinical and pathological processes related to fertility and those pertaining to limited reproductive capacity. A comprehensive literature search was performed using electronic databases including Medline, Embase, Cochrane Library and Pubmed to identify original and review articles addressing the biophysical parameters (pO2, pH and temperature) in the female reproductive tract of any species. The search included all studies published between 1946 and November 2015. Search terms included 'oxygen', 'pH', 'hydrogen ion concentration', 'acid base' and others terms. We also used special features and truncations to identify synonyms and broaden the search. Studies were excluded if they only assessed embryo culture conditions, fetal acid-base status, oxidative stress, outcomes of pregnancy and measurements of these parameters in non-reproductive organs. Our search generated 18 685 records and 60 articles were included. pO2 within the female reproductive tract shows cyclical variation and minute-to-minute oscillations, which may be influenced by uterine contractility, hormones, the autonomic system, cardiac pulsatility, and myometrial and smooth muscle integrity. Fine balanced control of pO2 and avoidance of overwhelming oxidative stress is crucial for embryogenesis and implantation. The pH in the female reproductive tract is graduated, with lowest pH in the vagina (~pH 4.42) increasing toward the Fallopian tubes (FTs) (~pH 7.94), reflecting variation in the site-specific microbiome and acid-base buffering at the tissue/cellular level. The temperature variation in humans is cyclical by day and month. In humans, it is biphasic, increasing in the luteal phase; with the caudal region of the oviduct 1-2 degrees cooler than the cranial portion. Temperature variation is influenced by hormones, density of pelvic/uterine vascular beds and effectiveness of heat exchange locally, crucial for sperm motility and embryo development. We have identified significant deficiencies and inconsistencies in the methods used to assess these biophysical factors within the reproductive tract. We have suggested that the technological solutions including the development of methods and models for real time, in vivo recordings of biophysical parameters. The notion of 'back to nature' in assisted conception suggested 20 years ago has yet to be translated into clinical practice. While the findings from this systematic review do not provide evidence to change current in vitro protocols, it highlights our current inability to assess the in vivo reproductive tract environment in real time. Data made available through future development of sensing technology in utero may help to provide new insights into how best to optimize the in vitro embryo environment and allow for more precise and personalized fertility treatment.


Fertility preservation for pediatric male cancer patients: illustrating contemporary and future options; a case report.
The main aim of current pediatric male fertility preservation programs is storing spermatogonia stem cell (SSC) prior to starting cancer treatment. From July 1st, 2014 to May 1st, 2020; 170 patients have been recruited in Wake Forest Testicular Tissue Banking Program. The existence of multiple testis biopsies in different time points and detailed histological analyses of a unique cancer patient, provided an educational opportunity to investigate testis condition in different phases of cancer management. A pediatric male cancer patient with B-cell acute lymphoblastic leukemia (ALL) had multiple testicular leukemia recurrences and went through several testicular biopsies, to identify leukemic infiltration as well as considering fertility preservation. Infiltration of leukemia cells into both testes was identified. Neither elongated spermatid nor sperm were detected, but germ cells including SSC, spermatocyte and round spermatid could be identified in the stored tissue even after initial cancer treatment. Different germ cells were identified by hematoxylin and eosin (H&E) staining and specific immunohistochemical (IHC) markers including PGP9.5/UCHL1 or MAGE-A4 (spermatogonia), SYCP3 (spermatocyte) and PRM1 (round spermatid). This emphasizes the importance of offering testicular biopsy to pediatric cancer patients at risk of infertility regardless to the stage of cancer treatment, although earlier biopsy is preferred. Promising research on in vitro spermatogenesis and auto-transplantation support the practice of SSC preservation. In addition, finding and storing round spermatids isolated from testicular biopsy provides a currently available option of round spermatid injection (ROSI). Given the complexity of managing cancer while considering fertility preservation, a multidisciplinary collaboration is important to achieve optimal overall outcomes.


Management of cardiovascular risk in diabetic patients: evolution or revolution?
Diabetes is associated with a marked increase in the risk of cardiovascular disease. Epidemiological evidence shows that hyperglycemia, hypertension and disorders of both lipid and thrombosis are involved in the etiology of cardiovascular disease in diabetes. Intervention trials on each of such factors have demonstrated a favourable effect in terms of reduction of cardiovascular disease, suggesting that even in diabetic patients in whom blood glucose levels are adequately controlled, other cardiovascular risk factors, such as hyperlipidemia, hypertension and prothrombotic state, should be aggressively treated. The need for an aggressive treatment has been recently underscored by the UKPDS (United Kingdom Prospective Diabetes Study) researchers who suggest that "polypharmacy" is now needed for the prevention of diabetic complications, implying that this approach requires an adequate control of all cardiovascular risk factors even using associations of drugs for each of them. A thorough application of these concepts might appear difficult in particular when the resource cost is considered. However, it has been shown that blood glucose, blood pressure and serum lipid control are advantageous in diabetic patients not only in terms of cost/benefit ratio but also in terms of quality of life. In the present article, we will briefly review this evidence and discuss the ethical and socioeconomic concerns that may subsequently rise.