Retinal vascular resistance in arterial hypertension.
Retinal microcirculation represents an easily accessible, non-invasive, in-vivo possibility to assess early microvascular changes. In addition to the assessment of functional (e.g. retinal capillary flow, RCF) and retinal arteriolar structural parameters (e.g. wall-to-lumen-ratio, WLR) we now suggest a new parameter reflecting the resistance in small retinal arterioles (RVR). In 45 normotensive (NT) subjects and 123 patients with hypertension stage 1 (HT) we assessed RCF, WLR, arteriolar diameter, lumen diameter and wall cross section area in the retinal circulation by using scanning laser Doppler flowmetry (SLDF). Mean arterial pressure (MAP) was measured immediately before the SLDF measurement and retinal vascular resistance was calculated (RVR = MAP/RCF). In a separate study the test-retest reliability was determined in 6 volunteers from our clinical staff by assessing RVR three times within six weeks. The analysis of the volunteers revealed a coefficient of variation for RVR of 7.75 ± 2.11% and Cronbach´s alpha was 0.90. WLR, a marker of vascular remodeling did not differ between NT and HT. In contrast, RCF and inner diameter of the retinal arterioles (ID) were significantly lower (RCF: p = .045 and ID: p = .001) in the HT group than in the NT group and RVR was significantly higher in the HT group than in the NT group (p < .001). In both groups we found no correlation of RVR with age, but a significant correlation of RVR with WLR (NT: r = 0.34, p = .006; HT: r = 0.25, p = .01), indicating that the RVR reflects vascular remodeling in the retinal circulation. Our data showed an increased retinal vascular resistance in hypertensive patients compared to non-hypertensive patients prior to the occurrence of structural retinal vascular remodeling. The correlation between RVR and WLR indicates that RVR is a reliable, non-invasive and early-sensitive marker of vascular remodeling in early hypertension.


Family conflict in dementia: prodigal sons and black sheep.
To describe family conflict in cases of dementia referred to the Guardianship Tribunal of New South Wales, Australia. The file notes of 50 cases of family and systems conflict in cases of dementia presented to the Guardianship Tribunal were examined. Demographics, MMSE score, and type and severity of dementia were recorded. The documents and evidence presented to the Tribunal were coded and subjected to thematic analysis to identify the themes of the conflict, the protagonists and the position of the person with dementia with respect to the conflict. Family conflict was most commonly seen in mild to moderate dementia. Conflict occurred most frequently between siblings (with a group of siblings allied against a 'black sheep' member) and involved other systems such as service providers in 25% of cases. The person with dementia was usually involved in the conflict or in alliance with one or other of the family members in conflict, especially when paranoid ideation was fuelled by family members. Common themes included accusations of neglect, exploitation, lack of communication or sequestration of the person with dementia. No family had received family therapy prior to the application; conciliation during the hearing was successful in 30% of cases. Legal transactions such as Powers of Attorney were frequently made and frequently revoked by persons with dementia involved in family conflict. Dementia may be a great family divider, particularly when there are cracks in family solidarity. The understanding of family conflict in dementia has ramifications for both clinical and medico-legal practice. These findings may encourage family-centered interventions which address family dynamics and interpersonal conflict. They may also assist in capacity assessments of persons with dementia who change legal documents because of family conflict.


Photosynthetic Unit Size during the Synchronous Life Cycle of Scenedesmus.
Apparent size of the photosynthetic unit (chlorophyll/O(2) per flash) was estimated by O(2) yield of repetitive short flashes on cell samples taken at various times from a synchronized culture (14-hour light, 10-hour dark) of Scenedesmus obliquus. Unit size was essentially invariant (< 10% variation) with a mean value of 1750 chlorophyll/O(2) per flash. In contrast, the light-saturated photosynthetic rate per unit chlorophyll, or turnover rate of the photosynthetic unit, varied with the life cycle, rising 40% in the first three hours of the light period and decaying slowly thereafter. The results are taken as evidence that the metabolic machinery is subject to far greater control and adjustment than is the photochemical machinery.


Molecular subtyping within a single Salmonella typhimurium phage type, DT204c, with a PCR-generated probe for IS200.
We report primers and conditions for the generation by PCR of a probe for the DNA insertion element IS200. This probe was shown to be suitable for genotypic subtyping within a single phage type of Salmonella typhimurium. A collection of isolates of DT204c, a phage type implicated in the spread of multiple drug resistance in bovine animals and to man, was analyzed. Three IS200 profiles, corresponding to related chromosomal genotypes were characterized in DT204c. Molecular discrimination within a single phage type of S. typhimurium has general significance for genotypic typing, and for the definition of epidemiological clonality in Salmonella.


Investigation of the Transport Pathways Associated with Enhanced Brain Delivery of Peptide Drugs by Intranasal Coadministration with Penetratin.
We previously found that coadministering peptides and proteins with the cell-penetrating peptide L-penetratin intranasally significantly increased transport to the brain and enhanced pharmacological effects. The present study aimed to clarify the mechanisms of nose-to-brain drug delivery enhancement by L-penetratin coadministration. First, we compared the concentrations of Exendin-4 in plasma and brain after intranasal and subcutaneous administration and suggested that coadministration with L-penetratin facilitated the direct nose-to-brain transport of Exendin-4. Second, we demonstrated that L-penetratin did not stimulate the transport of Cy7-labeled Exendin-4 and insulin through the trigeminal nerves but shifted their distribution to the olfactory mucosal pathway. Third, we investigated the distribution of insulin into the deeper regions of the brain after delivery via the olfactory pathway and suggested that insulin had entered the olfactory bulb, bottom part of the brain, and perivascular space through the cerebrospinal fluid and had diffused throughout the brain. We further demonstrated that intranasally delivered insulin with L-penetratin specifically accumulated on the hippocampus neuronal cells. Thus, this study suggested that administrating peptide drugs intranasally with L-penetratin allows direct transport to the olfactory bulb, bottom part of the brain, and perivascular space of the cerebral artery. This technique also potentially allows targeting of specific brain areas.


Promoting a Culture of Civility in Nursing Learning Environments.
Incivility in nursing education imperils the well-being of both faculty and students, is damaging to professional relationships, and hinders the exchange of knowledge in nursing learning environments. Because supportive, respectful learning environments foster students' ability to flourish and reach their highest potential, it is essential that open dialogue and relationship building in nursing education are as valued as content taught. This study explored strategies for promoting a culture of civility in nursing learning environments. A 9-item survey was used to gather insights from nurses (n = 441) about how incivility could be managed or prevented in order to promote a culture of civility. The data revealed 2 major themes: personal action, and organization action. Nursing faculty, students, and schools/programs can promote civility in nursing learning environments through establishing a power balance, effective communication, self-reflection, setting clear expectations early, and instituting consequences for violating a culture of civility.


Extensive intracranial juvenile xanthogranulomas.
JXG is a disorder classified under histiocytosis. It usually affects children and commonly presents with skin lesions. Intracranial lesions are uncommon and usually solitary. We present the case of a child who had extensive intracranial involvement with multiple enhancing solid lesions in the cerebellum, brain stem, thalami, and bilateral cerebral hemispheres on MR imaging.


Quantitative proteome analysis of alveolar type-II cells reveals a connection of integrin receptor subunits beta 2/6 and WNT signaling.
Alveolar type-II cells (ATII cells) are lung progenitor cells responsible for regeneration of alveolar epithelium during homeostatic turnover and in response to injury. Characterization of ATII cells will have a profound impact on our understanding and treatment of lung disease. The identification of novel ATII cell-surface proteins can be used for sorting and enrichment of these cells for further characterization. Here we combined a high-resolution mass spectrometry-based membrane proteomic approach using lungs of the SILAC mice with an Affymetrix microarray-based transcriptome analysis of ATII cells. We identified 16 proteins that are enriched in the membrane fraction of ATII cells and whose genes are highly expressed in these cells. Interestingly, we confirmed our data for two of these genes, integrin beta 2 and 6 (Itgb2 and Itgb6), by qRT-PCR expression analysis and Western blot analysis of protein extracts. Moreover, flow cytometry and immunohistochemistry in adult lung revealed that ITGB2 and ITGB6 are present in subpopulations of surfactant-associated-protein-C-positive cells, suggesting the existence of different types of ATII cells. Furthermore, analysis of the Itgb2(-/-) mice showed that Itgb2 is required for proper WNT signaling regulation in the lung.


Development of a Method and Validation for the Quantitation of FruArg in Mice Plasma and Brain Tissue Using UPLC-MS/MS.
Aged garlic extract (AGE) is a popular nutritional supplement and is believed to promote health benefits by exhibiting antioxidant and anti-inflammatory activities and hypolipidemic and antiplatelet effects. We have previously identified N-α-(1-deoxy-d-fructos-1-yl)-l-arginine (FruArg) as a major contributor to the bioactivity of AGE in BV-2 microglial cells whereby it exerted a significant ability to attenuate lipopolysaccharide-induced neuroinflammatory responses and to regulate the Nrf2-mediated antioxidant response. Here, we report on a sensitive ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) protocol that was validated for the quantitation of FruArg in mouse plasma and brain tissue samples. Solid-phase extraction was used to separate FruArg from proteins and phospholipids present in the biological fluids. Results indicated that FruArg was readily absorbed into the blood circulation of mice after intraperitoneal injections. FruArg was reliably detected in the subregions of the brain tissue postinjection, indicating that it penetrates the blood-brain barrier in subnanomolar concentrations that are sufficient for its biological activity.


Chemistry at the protein-mineral interface in L-ferritin assists the assembly of a functional (μ3-oxo)Tris[(μ2-peroxo)] triiron(III) cluster.
X-ray structures of homopolymeric L-ferritin obtained by freezing protein crystals at increasing exposure times to a ferrous solution showed the progressive formation of a triiron cluster on the inner cage surface of each subunit. After 60 min exposure, a fully assembled (μ3-oxo)Tris[(μ2-peroxo)(μ2-glutamato-κO:κO')](glutamato-κO)(diaquo)triiron(III) anionic cluster appears in human L-ferritin. Glu60, Glu61, and Glu64 provide the anchoring of the cluster to the protein cage. Glu57 shuttles incoming iron ions toward the cluster. We observed a similar metallocluster in horse spleen L-ferritin, indicating that it represents a common feature of mammalian L-ferritins. The structures suggest a mechanism for iron mineral formation at the protein interface. The functional significance of the observed patch of carboxylate side chains and resulting metallocluster for biomineralization emerges from the lower iron oxidation rate measured in the E60AE61AE64A variant of human L-ferritin, leading to the proposal that the observed metallocluster corresponds to the suggested, but yet unobserved, nucleation site of L-ferritin.


Genetic resistance to a Marek's disease transplantable tumor cell line in chicken lines selected for different immunological characters.
The tumor incidence and mortality of Marek's disease (MD) were determined for 471 progeny from four pairs of lines two-way selected for different immunological characters: graft versus host reaction (GVHR) competence, IgG levels, antibody response to rabbit serum albumin (RSA), and anaphylactic shock to BSA. All chicks were inoculated at 1 wk of age with 1 to 2 x 10(6) viable cells of a MD lymphoblastoid cell line, MDCC-MSB1-41C (41 C). Tumor incidence differed significantly between the high (H) and low (L) lines of each GVHR-, IgG-, RSA-, or BSA-selected group. There were also significant differences in mortality rates between H and L lines of all selected groups. The IgG-H, BSA-H, and RSA-H lines were more resistant than their respective L lines. The H line of the GVHR-selected lines was more susceptible than the L line. Tumor regression could be detected only in the IgG- and RSA-selected lines. No definite correlation could be found between genetic resistance to 41C and genetic resistance to MD virus.


Iliac arteries: reanalysis of results of balloon angioplasty.
In this reanalysis of the 667 percutaneous transluminal balloon angioplasties (PTAs) of the iliac arteries, the variables that are predictive of early and late success were identified. For 82 iliac occlusions, the success rate at 1 month was 75.6% +/- 4.7 (mean +/- standard error). With exclusion of the 15 technical failures that were associated with one complication, the success rate at 1 month was 91.0% +/- 3.5 and at 3 years, 58.8% +/- 7.1. For PTA of an iliac occlusion at one site, the predicted 3-year success rate was 66%, whereas for PTA of an iliac occlusion with a tandem lesion, the success rate was 17%. For the 313 common iliac PTAs, the success rate at 1 month was 97.1% +/- 0.9; at 1 year, 81.1% +/- 2.3; at 2 years, 70.6% +/- 2.9; at 3 years, 67.8% +/- 3.0; at 4 years, 64.9% +/- 3.3; at 5 years, 60.2% +/- 4.0; and at 6 years, 52.0% +/- 5.7. There were no variables that were statistically predictive of late results. For the 209 external iliac PTAs, the predicted 3-year success rate was 57% for men and 34% for women. For 58 PTAs of both common and external iliac stenoses, the predicted 3-year success rate was 73% for patients with good runoff and 30% for those with poor runoff. Serious complications were recorded in 3.9% (26 of 667): Death occurred in 0.3%, operation was necessary in 1.0%, and hospital discharge was delayed in 2.6%.


Parkin regulates kainate receptors by interacting with the GluK2 subunit.
Although loss-of-function mutations in the PARK2 gene, the gene that encodes the protein parkin, cause autosomal recessive juvenile parkinsonism, the responsible molecular mechanisms remain unclear. Evidence suggests that a loss of parkin dysregulates excitatory synapses. Here we show that parkin interacts with the kainate receptor (KAR) GluK2 subunit and regulates KAR function. Loss of parkin function in primary cultured neurons causes GluK2 protein to accumulate in the plasma membrane, potentiates KAR currents and increases KAR-dependent excitotoxicity. Expression in the mouse brain of a parkin mutant causing autosomal recessive juvenile parkinsonism results in GluK2 protein accumulation and excitotoxicity. These findings show that parkin regulates KAR function in vitro and in vivo, and suggest that KAR upregulation may have a pathogenetic role in parkin-related autosomal recessive juvenile parkinsonism.


A thermodynamic analysis of the anaerobic oxidation of methane in marine sediments.
Anaerobic oxidation of methane (AOM) in anoxic marine sediments is a significant process in the global methane cycle, yet little is known about the role of bulk composition, temperature and pressure on the overall energetics of this process. To better understand the biogeochemistry of AOM, we have calculated and compared the energetics of a number of candidate reactions that microorganisms catalyse during the anaerobic oxidation of methane in (i) a coastal lagoon (Cape Lookout Bight, USA), (ii) the deep Black Sea, and (iii) a deep-sea hydrothermal system (Guaymas basin, Gulf of California). Depending on the metabolic pathway and the environment considered, the amount of energy available to the microorganisms varies from 0 to 184 kJ mol(-1). At each site, the reactions in which methane is either oxidized to HCO3(-), acetate or formate are generally only favoured under a narrow range of pressure, temperature and solution composition--particularly under low (10(-10 )m) hydrogen concentrations. In contrast, the reactions involving sulfate reduction with H2, formate and acetate as electron donors are nearly always thermodynamically favoured. Furthermore, the energetics of ATP synthesis was quantified per mole of methane oxidized. Depending on depth, between 0.4 and 0.6 mol of ATP (mol CH4(-1) was produced in the Black Sea sediments. The largest potential productivity of 0.7 mol of ATP (mol CH4(-1) was calculated for Guaymas Basin, while the lowest values were predicted at Cape Lookout Bight. The approach used in this study leads to a better understanding of the environmental controls on the energetics of AOM.


Effect of iontophoresis and penetration enhancers on transdermal absorption of metopimazine.
Metopimazine is an antiemetic drug already used by oral and rectal administration. It would be interesting to develop a new formulation for a transdermal administration. The objective of this study was to determine the influence of iontophoresis on the metopimazine transdermal absorption and the possible synergistic enhancement with chemical enhancers. Transdermal transport of metopimazine was studied in vitro in a Franz cell with pig skin according to the following protocol: 1h of iontophoresis followed by 7h of passive diffusion. Different current densities were applied: 0, 0.125, 0.25 and 0.5 mA/cm(2). Chemical enhancers used as solvent dilution were ethanol, propylene glycol and isopropyl myristate. Metopimazine was assayed by HPLC. Fourier transform infrared spectroscopy was used to determinate the interaction between chemical enhancers and stratum corneum. The iontophoresis has increased the percutaneous absorption of metopimazine and has decreased the lag time with 3.85+/-0.90 microg/(cm(2)h) and 1.9h for 0.5 mA/cm(2) and with 0.27+/-0.20 microg/(cm(2)h) and >8h for passive diffusion. Transdermal transport has been increased with current density and with isopropyl myristate and was not modified by ethanol or propylene glycol. Results indicated that iontophoresis is an effective method for transdermal administration of metopimazine.


Visibility: science and regulation.
The 1999 Regional Haze Rule provides a context for this review of visibility, the science that describes it, and the use of that science in regulatory guidance. The scientific basis for the 1999 regulation is adequate. The deciview metric that tracks progress is an imperfect but objective measure of what people see near the prevailing visual range. The definition of natural visibility conditions is adequate for current planning, but it will need to be refined as visibility improves. Emissions from other countries will set achievable levels above those produced by natural sources. Some natural events, notably dust storms and wildfires, are episodic and cannot be represented by annual average background values or emission estimates. Sulfur dioxide (SO2) emission reductions correspond with lower sulfate (SO4(2-)) concentrations and visibility improvements in the regions where these have occurred. Non-road emissions have been growing more rapidly than emissions from other sources, which have remained stable or decreased since 1970. Simpler models representing transport, limiting precursor pollutants, and gas-to-particle equilibrium should be used to understand where and when emission reductions will be effective, rather than large complex models that have insufficient input and validation measurements. Examples of model-based source attribution show large differences among estimates from various modeling systems and with ambient measurements.


Does Rubbing of Universal Adhesive Reduce the Negative Effect of Saliva on Adhesion?
To evaluate in vitro the effect of saliva contamination on bond strength of a universal adhesive applied with actively (with rubbing motion) and passively (without rubbing motion). A total of 144 bovine dentin samples were used, and the universal adhesive, Clearfil Universal Bond Quick, was either applied in accordance with the manufacturer's instructions (passive application) or applied with rubbing motion for 10 s (active application). These 2 groups were divided into 6 subgroups according to saliva contamination (n = 12): 1. control: etch-and-rinse (no saliva); 2. control: self-etch (no saliva); 3. etching/saliva/bonding; 4. etching/bonding/saliva; 5. saliva/bonding; 6. bonding/saliva. A resin composite, Filtek Ultimate, was filled into a polyethylene mold (0.9 mm diameter, 1.2 mm height) on the surfaces. Samples were subjected to microshear bond strength testing, and five specimens from each group were examined using SEM. Resin-dentin interfaces were also observed using transmission electron microscopy (TEM). All failure modes were determined using light microscopy. Statistical analyses were performed with two-way ANOVA, the Kruskall-Wallis test, and the Mann-Whitney U-test (p < 0.05). Active-application groups showed statistically significantly higher bond strengths than did passive groups, regardless of adhesive strategy and saliva contamination (p < 0.05). Application of Clearfil Universal Bond Quick in self-etch mode with rubbing motion improved the µSBS among control groups (p < 0.05). The active application did not make a significant difference among the active groups (p > 0.05), except in group 2. Groups 2 and 5 showed significantly higher µSBS than group 3 among the passive groups (p < 0.05). Rubbing the universal adhesives without any prior etching may increase the dentin bond strength. Following etching, passive application of the universal adhesive (without any additional rubbing motion) could affect the bonding to dentin in the presence of saliva.


Targeting the Pulmonary Microbiota to Fight against Respiratory Diseases.
The mucosal immune system of the respiratory tract possesses an effective "defense barrier" against the invading pathogenic microorganisms; therefore, the lungs of healthy organisms are considered to be sterile for a long time according to the strong pathogens-eliminating ability. The emergence of next-generation sequencing technology has accelerated the studies about the microbial communities and immune regulating functions of lung microbiota during the past two decades. The acquisition and maturation of respiratory microbiota during childhood are mainly determined by the birth mode, diet structure, environmental exposure and antibiotic usage. However, the formation and development of lung microbiota in early life might affect the occurrence of respiratory diseases throughout the whole life cycle. The interplay and crosstalk between the gut and lung can be realized by the direct exchange of microbial species through the lymph circulation, moreover, the bioactive metabolites produced by the gut microbiota and lung microbiota can be changed via blood circulation. Complicated interactions among the lung microbiota, the respiratory viruses, and the host immune system can regulate the immune homeostasis and affect the inflammatory response in the lung. Probiotics, prebiotics, functional foods and fecal microbiota transplantation can all be used to maintain the microbial homeostasis of intestinal microbiota and lung microbiota. Therefore, various kinds of interventions on manipulating the symbiotic microbiota might be explored as novel effective strategies to prevent and control respiratory diseases.


Analysis, occurrence, and potential sensory significance of five polyfunctional mercaptans in white wines.
A previously developed analytical method has been improved, validated and adapted for the analysis of 2-furfurylthiol (FFT), 4-methyl-4-mercapto-2-pentanone (MP), 3-mercaptohexyl acetate (MHA), 3-mercaptohexanol (MH) and benzylmercaptan (BM) in 136 white wines from different parts of the world. The overall uncertainty of the determinations was found to be around 20%, which was considered satisfactory given the low levels at which these compounds are found. The levels ranged from the method detection limits (0.5; 0.6; 2.0; 8.0 and 0.5 ng/L for FFT, MP, MHA, MH and BM, respectively) to 225; 87.9; 591; 7255 and 131 ng/L, which implies that nearly all of them can reach more than 100 Odor Units in some wines. The levels are significantly linked to both the grape variety (with the exception of FFT) and to the origin (in the case of Sauvignon Blanc samples), however, the range of variation within groups are so large that clear clusters could not be observed. Different sensory tests carried out on white wine models showed that all these compounds, even at low concentration, play an outstanding role on the aroma of wine, contributing to fruity, fresh and green notes. In some wines they are at concentrations high enough to act as genuine impact compounds.


NLRP3 deletion protects from hyperoxia-induced acute lung injury.
Inspiration of a high concentration of oxygen, a therapy for acute lung injury (ALI), could unexpectedly lead to reactive oxygen species (ROS) production and hyperoxia-induced acute lung injury (HALI). Nucleotide-binding domain and leucine-rich repeat PYD-containing protein 3 (NLRP3) senses the ROS, triggering inflammasome activation and interleukin-1β (IL-1β) production and secretion. However, the role of NLRP3 inflammasome in HALI is unclear. The main aim of this study is to determine the effect of NLRP3 gene deletion on inflammatory response and lung epithelial cell death. Wild-type (WT) and NLRP3(-/-) mice were exposed to 100% O2 for 48-72 h. Bronchoalveolar lavage fluid and lung tissues were examined for proinflammatory cytokine production and lung inflammation. Hyperoxia-induced lung pathological score was suppressed in NLRP3(-/-) mice compared with WT mice. Hyperoxia-induced recruitment of inflammatory cells and elevation of IL-1β, TNFα, macrophage inflammatory protein-2, and monocyte chemoattractant protein-1 were attenuated in NLRP3(-/-) mice. NLRP3 deletion decreased lung epithelial cell death and caspase-3 levels and a suppressed NF-κB levels compared with WT controls. Taken together, this research demonstrates for the first time that NLRP3-deficient mice have suppressed inflammatory response and blunted lung epithelial cell apoptosis to HALI.


Association of obesity, diabetes, serum lipids and blood pressure regulates insulin action.
Insulin resistance is present in patients with Type 2 diabetes mellitus as well as in obese patients without diabetes. The aim of our study was to compare insulin action in diabetic and control persons with or without obesity and to evaluate the influence of serum cholesterol, serum triglyceride and blood pressure on metabolic variables of insulin action. We examined 42 Type 2 diabetic patients and 41 control persons with body mass index (BMI) from 21.1 to 64.5 kg x m(-2), and 33 to 71 years old. The isoglycemic hyperinsulinemic clamp technique was performed at an insulin infusion rate of 1 mU x kg(-1) x min(-1) during 120 min. We evaluated the metabolic clearance rate of glucose (MCR(G), ml x kg(-1) x min(-1)) as the most important indicator of insulin action by isoglycemic clamp. The Pearson's correlation and multiple regression models were used to compare studied factors with the insulin action. We found following predictors of insulin resistance expressed in the relationship with MCR(G): BMI (r = -0.68, p<0.001), plasma glucose concentration (r = -0.66, p<0.001), cholesterol (r=-0.55, p<0.001), triglycerides (r = -0.54, p<0.001) and mean blood pressure (r = -0.38, p<0.01). From the multiple regression analysis we conclude that obesity may have even greater influence on the insulin action than diabetes mellitus itself.


Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital.
For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.


Two Orders of Magnitude Variation of Diffusion-Enhanced Förster Resonance Energy Transfer in Polypeptide Chains.
A flexible peptide chain displays structural and dynamic properties that correspond to its folding and biological activity. These properties are mirrored in intrachain site-to-site distances and diffusion coefficients of mutual site-to-site motion. Both distance distribution and diffusion determine the extent of Förster resonance energy transfer (FRET) between two sites labeled with a FRET donor and acceptor. The relatively large Förster radii of traditional FRET methods (R₀ > 20 Å) lead to a fairly low contribution of diffusion. We introduced short-distance FRET (sdFRET) where Dbo, an asparagine residue conjugated to 2,3-diazabicyclo[2.2.2]octane, acts as acceptor paired with donors, such as naphtylalanine (NAla), tryptophan, 5-l-fluorotryptophan, or tyrosine. The Förster radii are always close to 10 Å, which makes sdFRET highly sensitive to diffusional motion. We recently found indications that the FRET enhancement caused by diffusion depends symmetrically on the product of the radiative fluorescence lifetime of the donor and the diffusion coefficient. In this study, we varied this product by two orders of magnitude, using both donors of different lifetime, NAla and FTrp, as well as a varying viscogen concentration, to corroborate this statement. We demonstrate the consequences of this relationship in evaluating the impact of viscogenic coadditives on peptide dimensions.


Postprandial low-grade inflammation does not specifically require TLR4 activation in the rat.
Toll-like receptor 4 (TLR4), an innate immune receptor, is suspected to play a key role in the postprandial inflammation that is induced by a high-fat meal rich in saturated fatty acids (SFA). Our objective was to test this hypothesis by using a specific competitive inhibitor of TLR4 (INH) vs vehicle (VEH) administered immediately before a high-SFA meal in rats. First, in a cross-over kinetic study of 12 rats receiving INH and VEH i.v. 10 min before the test meal, we measured plasma inflammatory and vascular markers for 6 h. Then, in 20 rats, 3 h after INH or VEH followed by the test meal (parallel study), we measured the mRNA level of a set of cytokines (Il1-β, Il-6, Tnfα, Mcp-1, Pai-1), and of Tlr4 and Tlr2 in the adipose tissue and the liver, and that of adhesion molecules (Icam-1 and Vcam-1) in the aorta. Plasma IL-6 and PAI-1 increased >4-fold at 3-4 h after test-meals, very similarly after INH as compared to VEH. The expression of TLR2 and of all measured cytokine genes in the adipose tissue was dramatically higher after INH (vs VEH). In the liver, gene expression of Il1-β, Tnfα, Mcp-1 and Tlr2, was also higher after INH, though more moderately, whereas that of Il-6 and Pai-1 was similar between groups. INH did not affect mRNA level of Icam-1 and Vcam-1 in the aorta. TLR4 activation is not specifically required to mediate systemic postprandial inflammation and we propose that TLR2 and TLR4 exert a dual and interdependent mediation of the postprandial inflammatory response, at least in the adipose tissue.


[Clinical usefulness and psychometric properties of the Cambridge Behavioural Inventory].
An important area in neuropsychological assessment is that of psychological and behavioural symptoms. The Cambridge Behavioural Inventory (CBI) is a self-report measure aimed at relatives which takes account of a wide range of behavioural symptoms that may occur during the course of neurological diseases. The main objective of the study is to test the clinical usefulness of its Spanish adaptation. The CBI was completed by 215 members of kin of patients referred from neurology and psychiatry services. The CBI profiles of four groups of patients were compared, these being grouped according to their main clinical characteristics, psychometric data, imaging tests and the clinical judgement of the professional requesting the neuropsychological study. Most of the scales (10 out of 13) of the CBI yielded acceptable internal consistency values, and the memory and attention/orientation scales showed high correlations with objective measures of memory and time orientation. The CBI profiles of the groups of patients with different conditions (organic memory disorder, functional memory disorder, behavioural variant of frontotemporal dementia and Alzheimer's disease) were consistent with their main features. The CBI is a psychometrically reliable instrument with adequate convergent and discriminant validity that can be useful in the process of neuropsychological assessment. It can provide relevant information not only about cognitive functioning and the functional capabilities, but also about the behavioural and psychological symptoms of patients with cognitive disorders.


[Therapeutic efficacy of vaginal administration of bromocryptin in patients with hyperprolactinemia].
Oral bromoergocriptine (BEC) is currently the treatment of choice in women with hyperprolactinemia secondary to a prolactinoma. However, undesirable side effects (of variable type and intensity) are frequently present in these women due to both local irritation and to a direct effect upon the central nervous system. The present work was undertaken as a pilot study to assess the therapeutic effectiveness of vaginally administered BEC and to corroborate if the side effects are less frequent and of minor intensity when compared to oral BEC. Initially, 16 women were included, but two of them did not accept to continue in the study; thus, a total of 14 women with hyperprolactinemia (> or = 40 ng/ml) were divided in two groups: Group A encompassed five women, aged 27 to 36 years old, two with normal menstrual cycles and three with oligomenorrhea; all had primary or secondary sterility during 3 to 12 years and galactorrhea from 6 months to 3 years; in only one patient a brain computerized axial tomography (CAT) was performed which showed the existence of a macroprolactinoma. All received oral BEC (2.5-5 mg/day, except one patient with 10 mg/day). Group B included nine women, aged 26 to 36 years old, four had normal menstrual cycles and five had oligomenorrhea; all had primary or secondary sterility during the last 2 to 7 years and eight out of nine, also had galactorrhea during 1 to 8 years; in four of them a CAT was performed showing a pituitary microadenoma.(ABSTRACT TRUNCATED AT 250 WORDS)


The British Abortion Act (1967) and the interests of the foetus.
This article examines ethical issues on the rights and interests of the unborn foetus, an issue that remains highly contentious. Furthermore, it attempts to investigate how well the British legislation fits with the foetus and pregnant woman's rights and interests. "Pro-life" and "pro-choice" groups have provided extensive arguments for and against. One important theoretical issue rests on whether foetuses are human beings in the moral sense, in which all human beings have full and equal moral rights. What constitutes personhood is a matter of moral decision and is not one of scientific fact and thus it consists of all persons, rather than all genetically human entities. It is persons who invent moral rights and who are capable of respecting them. Legislators in Britain have sidestepped the ethical debate on abortion by opting for the pragmatic course of permitting abortion in a limited range of circumstances and thus the Abortion Act 1967 has failed to address the status of the foetus, or indeed the rights of any of the parties concerned. Thus, although the Act supports the interests of the foetus capable of free existence by lowering the foetal age to 24 weeks after which termination is not permissible, the legislators have accepted that the rights of the woman outweigh those of the foetus and if a woman's own life or health is in danger then even a late abortion is the best choice.


Sacral Pressure Ulcer in Leriche Syndrome: A Case Report.
We experienced a case of a sacral pressure ulcer complicated with Leriche syndrome, an aortoiliac artery occlusion that has not been previously reported. In this case, the abdominal aorta below the bifurcation of the renal arteries into the bilateral common iliac arteries was occluded, and wound healing was delayed. Therefore, endovascular treatment was used for managing this condition, and wound healing was accelerated. Then, reconstructive surgery with a local flap was performed, and wound healing was achieved. In the case of delayed healing of buttock pressure ulcers, it is important to evaluate the blood flow in the iliac artery as well as the infection and nutritional status of the wound. In addition, after endovascular treatment, blood flow in the local flap is a matter of concern. If the wound healing is good, and imaging confirms that there is no restenosis at the endovascular treatment site and the perforator of the flap, reconstructive surgery can be performed safely.


Treating melancholia at home: theoretical wisdom and grim reality in the career of E.C. Seguin.
E.C. Seguin was one of the early, influential 19th-century neurologists who participated in the development of neurology as a specialty in the United States. Born in France, but raised from early childhood in the United States, Seguin published widely, developed a high-profile New York City practice, and was named Clinical Professor of Diseases of the Mind and Nervous System at the College of Physicians and Surgeons (New York) in 1874. Typical of the era, he studied neurologic disorders, but also several conditions that today would be considered in the realm of psychiatry. One of his seminal papers was titled "The treatment of mild cases of melancholia at home" (1876). Contrary to the widespread practice of isolating patients in either rest homes or asylums, Seguin introduced and formalized treatment of depression within the household. Against this academic backdrop, Seguin returned home on October 31, 1882, to discover that his own wife, afflicted with long-standing depression and treated at home, had committed suicide after murdering their 3 children. The grim dichotomy between the confidently written paper and the reality of the treatment failure is a neurologic lesson in humility regarding diseases and their unpredictable outcomes.


Genetic variants of human urea transporter-2 are associated with metabolic syndrome in Asian population.
A previous study has reported that the Ile227 and Ala357 genetic variants of human urea transporter-2 (HUT2) were associated with blood pressure in males in Asian population. In this study, we aimed to investigate five known HUT2 genetic variants with metabolic syndrome (MetS) and its related traits in the Stanford Asia-Pacific Program for Hypertension and Insulin Resistance (SAPPHIRe) study cohort. Five HUT2 single nucleotide polymorphisms (SNPs) were selected and genotyped among 1791 subjects in the SAPPHIRe study cohort. We first computed allele frequency and performed Hardy-Weinberg equilibrium (HWE) test in controls for each SNP. Next, we tested genotype associations with metabolic syndrome using multiple generalized estimating equations (GEE) models with covariate adjustment. Furthermore, multi-marker and multi-trait association tests were carried out using FBAT program. To account for multiple testing, Bonferroni correction was applied in this study. Among those 5 HUT2 SNPs, SNPs 1, 2 and 3 were significantly associated with MetS in the total sample and females, separately (9×10(-4)≤p≤0.04), but only the association between SNP 1 and MetS in females remained statistically significant after Bonferroni correction. When testing 5 SNPs simultaneously, significant associations were found with triglycerides (TG) (p=0.04). Likewise, significant multi-trait association (combining the data of waist circumference, TG, high density lipoprotein (HDL) cholesterol and fasting glucose together) was found with SNP 2 (p=0.04), but both results of multi-maker and multi-trait associations did not remain significant after multiple testing correction. The results have provided evidence that the HUT2 gene may play a certain role in developing MetS and its related traits in Asian population. Further investigation of the HUT2 gene influencing MetS and its related traits will be warranted.


Military physician recruitment and retention: a survey of students at the Uniformed Services University of the Health Sciences.
Recent strategies employed in response to military physician recruitment shortfalls have consisted of increasing financial incentives for students in the Health Professions Scholarship Program (HPSP) while offering no increased incentive for attendance at the Uniformed Services University of the Health Sciences (USUHS). To gauge the impact of these incentive increases on the decision of medical students to attend USUHS, a prospective e-mail survey of current USUHS medical students was conducted. The survey was distributed to 674 USUHS medical students from all four class years, of which 41% responded. Students were asked to prioritize incentives and disincentives for military service and USUHS, as well as respond to whether recent incentives applied solely to the HPSP would have affected their decision to attend USUHS. Data were assessed using a weighted scale with responses ranked highest receiving a score of 3, responses ranked second receiving a weighted score of 2, and those ranked third receiving a weighted score of 1. The total weighted sum for each question response across the respondent population was then tallied in aggregate and assigned a weighted score to identify factors consistently ranked highest among the students. Patriotic duty and serving uniformed personnel were ranked most appealing about military service. Combat and deployment considerations were ranked least appealing about military service. Also of note, numerous survey comment box responses highlighted the perceived advantages of pooling resources between the two programs to benefit military medical student recruitment and training. Survey results suggested that current enhanced financial incentives and shorter service obligation offered by the HPSP make attendance of USUHS less appealing for current USUHS students and may negatively impact recruitment and retention of USUHS medical officers. Commensurate incentives such as promotion and credit for time in service while attending USUHS were identified by current USUHS medical students as a possible means of improving USUHS appeal.


A place for everything and everything in its place: spatial organization of individuals on nests of the primitively eusocial wasp Ropalidia marginata.
Non-random space use is common among animals across taxa and habitats. Social insects often use space non-randomly, outside as well as inside their nests. While such non-random space use outside the nest may improve foraging efficiency, inside the nest, it is often associated with the efficient division of labour. Non-random space use by adults on their nests has been hypothesized to result from dyadic dominance interactions, non-random distribution of tasks, differential activity levels, workers avoiding their queens or prophylactic avoidance of disease spread. These hypotheses are generally derived from species in which the tasks of the workers are themselves non-randomly distributed on the nest. Here, we study the primitively eusocial wasp Ropalidia marginata, in which tasks are not distributed non-randomly, and show that 62.4% ± 16.2% of the adults nevertheless use space on their nest non-randomly. In this species, we find that non-random space use may help optimizing nutritional exchange between individuals while prophylactically minimizing disease spread among nest-mates. We did not find evidence for the roles of dominance interactions, activity levels or location of larvae in non-random space use. Spatial organization appears to be a mechanism of minimizing the costs and maximizing the benefits of social life.


Development of new methods in organic synthesis and their applications to the synthesis of biologically interesting natural products.
2,6-Dimethyl-9-Aryl-9-phosphabicyclo[3.3.1]nonanes (9-PBN and 9-NapBN) and the chiral diaminophosphine oxides (DIAPHOXs) derived from aspartic acid have been introduced as useful ligands and preligands, respectively, for transition metal-catalyzed asymmetric synthesis. anti-Selective asymmetric hydrogenation of α-amino-β-ketoesters using Ru-, Rh-, Ir-, and Ni-catalysts through dynamic kinetic resolution have been developed for the first time, producing efficiently important anti β-hydroxy-α-amino acids. The total synthesis of several biologically active natural products was achieved by use of the transition metal-catalyzed reaction using DIAPHOX, anti-selective asymmetric hydrogenation, and reactions developed by us. Synthesis of tangutorine, an antitumor indole alkaloid, has been enantioselectively achieved for the first time. Enantioselective synthesis of a martinelline chiral core was accomplished using the asymmetric tandem Michael-Aldol reaction as a key step developed by us. This synthesis represents the formal total synthesis of martinelline and martinellic acid. Papuamide B was synthesized through the elucidation of unknown stereostructures by using the anti-selective asymmetric hydrogenation and reactions developed by us.


Ulnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians.
Peripheral nerve lesions are sometimes associated with focal dystonia. We diagnosed ulnar neuropathy in 28 of 73 (40%) cases of occupational cramp in musicians. Focal slowing of ulnar conduction across the elbow was identified in 15 of 19 (79%) patients using the near nerve technique and in 5 of 17 (29%) patients using surface recording. Ulnar neuropathy was present in 24 of 31 (77%) cases with flexion dystonia of the fourth and fifth digits and only 4 of the remaining 42 (10%) cases with other patterns of focal dystonia. Focal dystonia improved in 13 of 14 patients whose ulnar neuropathy improved and appeared or worsened in 2 patients following ulnar nerve injury. These data, together with our recent observation of a dystonic pattern of antagonist bursting in patients with isolated ulnar neuropathy (Muscle Nerve 1995, 18:606-611), suggest that ulnar neuropathy may initiate or sustain a specific dystonia, flexion of the fourth and fifth digits, by inducing a central disorder of motor control.


Disulfide mutants of barnase. II: Changes in structure and local stability identified by hydrogen exchange.
The hydrogen exchange behaviour of two stabilised disulfide mutants of barnase has been examined using NMR H/2H exchange measurements. The choice of experimental conditions is crucial in experiments to study the effects of mutations on local and global stability and dynamic behaviour of proteins. If exchange conditions allow both local and global unfolding events to be examined, then a comparison of three proteins (two mutants and wild-type) allows the effect of a mutation on the folded state to be ascribed to specific increases or decreases in local stability. This method was used to examine the effect of an introduced crosslink on the folded state of two different disulfide mutants of barnase, and the results are related to structural studies. It is found that disulfide bonds can stabilise or destabilise local structures as well as having an effect upon global stability. The effects of the mutations on exchange rate constants of protons are compared with the effects on the structure upon the introduction of the disulfide bonds. In the protein with a disulfide bond between residues 43 and 80, some local exchange rate constants are higher, reflecting local destabilisation at the site of the disulfide bond, associated with small structural rearrangements. In the protein with a disulfide bond between residues 85 and 102, amide protons of the adjacent loop are protected to a considerable extent. This is not associated with a structural rearrangement yet indicates that this disulfide bond has an effect on the stability of this loop.


[A case of drug induced interstitial pneumonitis after gemcitabine treatment for pancreatic carcinoma].
A 67-year-old male with pancreatic cancer(cStage IVb)was given gemcitabine on days 1, 8 and 15, and this was repeated on 29 days at dose of 800 mg/m(2) in outpatient clinic. After 2 courses, he suffered from dyspnea and fever. Laboratory examination showed that the serum levels of white cell count, C-reactive protein, lactate dehydrogenase and KL-6 were elevated. Chest X-ray and CT revealed diffuse bilateral interstitial infiltrates. He was diagnosed with drug induced interstitial pneumonia due to gemcitabine. Corticosteroid therapy consisting of methylprednisolone(1,000 mg/day)for three days followed by prednisolone was effective and he was discharged on the 29th day after admission. Gemcitabine is an anti-cancer agent of first-line chemotherapy for patient with pancreatic carcinoma. Acute pulmonary toxicity induced by gemcitabine could lead to severe complication. We should consider the possibility of drug induced interstitial pneumonitis duringg emcitabine therapy.


Control and characterization of cyclopentene unimolecular dissociation on Si(100) with scanning tunneling microscopy.
Dissociation of individual cyclopentene molecules on the Si(100) surface is induced and investigated using cryogenic ultrahigh vacuum scanning tunneling microscopy (STM). Using a secondary feedback loop during elevated tunneling current and sample biasing conditions, the cyclopentene dissociation products are isolated and then characterized with atomic-scale spatial resolution. Using multibias STM and density functional theory, the cyclopentene dissociation products are shown to consist of a C(5)H(7) fragment and an individual H atom. The C(5)H(7) fragment contains a C=C double bond and is bound to the Si(100) surface via a single Si-C covalent bond, while the individual H atom can be induced to hop between two sites on a single silicon dimer with the STM tip. This study shows that the use of feedback control during STM-induced single molecule reactions allows transient reaction products to be captured and thus more thoroughly studied. While demonstrated here for cyclopentene on Si(100), this feedback-controlled approach can likely be applied to a wide array of chemical reactions on semiconductor surfaces.


[Four case reports of sarcoma combined with carcinoma].
We report 4 cases of double cancer, combined sarcoma and carcinoma. Case 1 was a 50-year-old woman, had a malignant fibrous histiocytoma in the leg and an advanced gastric carcinoma. The soft tissue sarcoma was resected and the gastric carcinoma was treated with chemotherapy. She died from pulmonary metastasis from the sarcoma. Case 2 was a 72-year-old woman with a liposarcoma in the leg and a thyroid carcinoma. Both tumors were resected, however, she died from pulmonary metastasis from the carcinoma. Case 3 was a 65-year-old man with a liposarcoma in the buttock and lung carcinoma. Both tumors were resected and he is alive and disease-free. Case 4 was a 47-year-old man with spindle cell sarcoma of the tibia and a rectal carcinoma. Both tumors were treated surgically, but he died from pulmonary metastasis from the sarcoma. We suggest that the combination of sarcoma and carcinoma is very rare and that the prognosis in these cases is very poor.


Characterization of a DsbA family protein reveals its crucial role in oxidative stress tolerance of Listeria monocytogenes.
The adaption and tolerance to various environmental stresses are the fundamental factors for the widespread existence of Listeria monocytogenes. Anti-oxidative stress is the critical mechanism for the survival and pathogenesis of L. monocytogenes. The thioredoxin (Trx) and glutaredoxin (Grx) systems are known to contribute to the anti-oxidative stress of L. monocytogenes, but whether the Dsb system has similar roles remains unknown. This study demonstrated that the DsbA family protein Lmo1059 of L. monocytogenes participates in bacterial oxidative stress tolerance, with Cys36 as the key amino acid of its catalytic activity and anti-oxidative stress ability. It is worth noting that Lmo1059 was involved in the invading and cell-to-cell spread of L. monocytogenes. This study lays a foundation for further understanding the specific mechanisms of oxidative cysteine repair and antioxidant stress regulation of L. monocytogenes, which contributes to an in-depth understanding of the environmental adaptation mechanisms for foodborne bacterial pathogens.


Contrasting genetic diversity between Planchonella obovata sensu lato (Sapotaceae) on old continental and young oceanic island populations in Japan.
Genetic diversity of plant populations on islands is likely to be influenced by characteristics such as island origin (oceanic or continental) and their age, size, and distance to continental landmasses. In Japan, Planchonella obovata sensu lato which is found on both continental and oceanic islands of varying age, size, and distance to East Asian continental areas-is an ideal system in which to investigate the factors influencing genetic diversity of island plant species. In this study, we examined the genetic diversity of P. obovata s.l. populations, in the context of the species population genetic structure, demography, and between island migration, from 668 individuals, 28 populations and 14 islands including both continental (the Yaeyama Islands) and oceanic islands (the Daito, Bonin, and Volcano Islands) using 11 microsatellite markers. The Yaeyama and Volcano Islands respectively had the highest and lowest genetic diversity, and island origin and age significantly affected genetic diversity. Clustering analysis revealed that populations were grouped into Bonin, Volcano, and Yaeyama + Daito groups. However, Bonin and Volcano groups were distinct despite the relatively short geographical distance between them. Approximate Bayesian Computation analysis suggested that the population size was stable in Bonin and Yaeyama + Daito groups, whereas population reduction occurred in Volcano group, and migration between groups were very limited. Younger oceanic islands showed lower genetic diversity, probably due to limited gene flow and a lack of time to accumulate unique alleles. Genetic structure was generally consistent with the geographic pattern of the islands, but in Volcano, a limited number of founders and limited gene flow among islands are likely to have caused the large genetic divergence observed.


Ultralarge Virtual Screening Identifies SARS-CoV-2 Main Protease Inhibitors with Broad-Spectrum Activity against Coronaviruses.
Drugs targeting SARS-CoV-2 could have saved millions of lives during the COVID-19 pandemic, and it is now crucial to develop inhibitors of coronavirus replication in preparation for future outbreaks. We explored two virtual screening strategies to find inhibitors of the SARS-CoV-2 main protease in ultralarge chemical libraries. First, structure-based docking was used to screen a diverse library of 235 million virtual compounds against the active site. One hundred top-ranked compounds were tested in binding and enzymatic assays. Second, a fragment discovered by crystallographic screening was optimized guided by docking of millions of elaborated molecules and experimental testing of 93 compounds. Three inhibitors were identified in the first library screen, and five of the selected fragment elaborations showed inhibitory effects. Crystal structures of target-inhibitor complexes confirmed docking predictions and guided hit-to-lead optimization, resulting in a noncovalent main protease inhibitor with nanomolar affinity, a promising in vitro pharmacokinetic profile, and broad-spectrum antiviral effect in infected cells.


Candida albicans Berthout, 1923: hydrolases activity and own method of digestive tract strains biotyping.
112 strains of Candida albicans were isolated from oral cavity and ontocenoses of the upper digestive tract (endoscopy) of children (age: 5-17) with gastrointestinal disorders. Axenic strains were differentiated with API 20C AUX and API ZYM tests (bioMérieux). Then enzymograms and biotypes were determined for all the strains based on the activity of 19 hydrolases. The highest activity was noted for: e2 - phosphatase alcaline, e6 - leucine arylamidase, e11 - phosphatase acid, e5 - lipase (c14); e7 - valine arylamidase, e12 - naphtol-AS-BI-phosphohydrolase, e16 - alpha-glucosidase and e18 - N-acetyl-beta-glucosamidase, and the latter four were used for biotyping procedures. Our own system was based on the mathematical binominal distribution formula (1 : 4 : 6 : 4 : 1): all "+"; one "-", three "+"; two "-", two "+"; three "-", one "+"; all "-". We have found the following biotypes: A (16.1 +/- 3.5%), B1 (2.7 +/- 2.53%), B3 (8.0 +/- 2.5%), B4 (22.3 +/- 3.9%), C2 (1.8 +/- 1.3%), C3 (7.1 +/- 2.4%), C6 (30.4 +/- 4.3%), D, (11.6 +/- 3.0%).


Solubility Difference between Pectic Fractions from Creeping Fig Seeds.
Crude water-extracted pectin (WEP) isolated from creeping fig seeds were mainly fractionated into WEP-0.3 and WEP-0.4 fractions. Fractions were confirmed to be nonstarch, nonreducing sugars, nonpolyphenols and protein-unbounded acidic polysaccharides. Interestingly, a significant difference in solubility was found between WEP-0.3 (higher solubility than WEP) and WEP-0.4 (remarkably insoluble), which was consistent with the amorphous and porous sponge-like structure of WEP-0.3 as well as the crystalline and dense rod-like state of WEP-0.4. However, the result of the FT-IR spectra was contradicted by the solubility of WEP-0.4, which possessed the lowest degree of methoxylation and ought to possess the highest solubility. Through mineral analysis, a considerably high content of Ca2+ was found in WEP-0.4, suggesting that the low solubility of WEP-0.4 was probably attributable to the formation of microgels during dialysis. Therefore, metal divalent cations in the dialysate were suggested to be depleted for the dialysis of low methoxyl pectin.


Increased radiation dose to overweight and obese patients from radiographic examinations.
To estimate the increase in effective radiation dose from diagnostic x-rays for overweight and obese adult patients, as compared with the effective dose for lean reference phantoms. Relative effective radiation doses (E/E(0)) for the acquisition of chest and abdominal radiographs were calculated by using Monte Carlo computer simulations of effective doses delivered to adult phantoms with (E) and without (E(0)) subcutaneous adipose tissue added to the torso for five fat distributions. Total (anterior plus posterior) fat thicknesses ranged from 0 to 38 cm. For 30 cm of additional fat, E/E(0) values for 120-kVp chest and 80-kVp abdomen radiographs ranged from approximately 2 to 31 and 2 to 83 for male patients, respectively, and from 2 to 45 and 2 to 76 for female patients, respectively, depending on the type of fat distribution and patient orientation in the x-ray beam (anteroposterior or posteroanterior). Orienting the patient such that the thinnest fat layer was facing away from the x-ray tube minimized E/E(0), which was well approximated by using the formula E/E(0) = [B(t)/B(0)] x exp(kt(DF)), where B(t) and B(0) are the antiscatter grid Bucky factors for patient thicknesses of t and t = 20 cm, respectively; k, a constant; and t(DF), the distal (beam exit) fat layer thickness. Reductions in E/E(0) reached 14% and 20% for the thickest phantoms when x-ray tube voltages were increased by 10 and 20 kVp, respectively, for abdominal radiography in the male phantom. Effective doses from radiographic examinations in the extremely obese can exceed 100 mSv from only a small number of abdominal examinations and should be minimized to the extent possible and monitored. Exponential dose increases for increased subcutaneous fat thicknesses can be reduced substantially by positioning the patient so that the thinnest fat layer (anterior or posterior) is closest to the image receptor. Increasing the tube voltage also reduces the dose-but to a much smaller extent.


Molecular vibrations at a liquid-liquid interface observed by fourth-order Raman spectroscopy.
Interface-selective, Raman-based observation of molecular vibrations is demonstrated at a liquid-liquid interface. An aqueous solution of oxazine 170 dye interfaced with hexadecane is irradiated with pump and probe light pulses of 630-nm wavelengths in 17-fs width. The ultrashort pulses are broadened due to group velocity dispersion when traveling through the hexadecane layer. The dispersion is optically corrected to give an optimized instrumental response. The pump pulse induces a vibrational coherence of the dye via impulsive stimulated Raman scattering. The probe pulse generates second-harmonic light at the interface. The efficiency of the generation is modulated as a function of the pump-probe delay by the coherently excited molecules. Fourier transformation of the modulated efficiency presents the frequency spectrum of the vibrations. Five bands are recognized at 534, 557, 593, 619, and 683 cm(-1). The pump-and-probe process induces a fourth-order optical response that is forbidden in a centrosymmetric media. The contribution of an undesired, cascaded optical process is quantitatively considered and excluded.


α-Selective Lysine Ligation and Application in Chemical Synthesis of Interferon Gamma.
A traceless β-mercaptan-assisted α-selective ligation of N-terminal lysine-containing peptides has been developed. In this ligation-desulfurization-based protocol, the ε-amine of lysine is free of protection, thus improving the overall synthetic efficiency and avoiding harsh reactions in preparing large peptides and proteins. The applicability of this methodology has been demonstrated in the synthesis of an acid-labile therapeutic protein, interferon gamma, and the anticancer activity of synthetic protein has also been evaluated.


Elevated Thyroid Autoantibodies Aggravate Stroke Severity in Euthyroidism with Acute Ischemic Stroke.
Studies have indicated that immune reactions contribute to endothelial dysfunction and atherosclerosis. It is unclear whether thyroid dysfunction or elevated thyroid autoantibodies are associated with atherosclerosis. Therefore, we investigated the influence of thyroid autoimmunity related to elevated thyroid autoantibodies on functional outcome in euthyroidism with acute ischemic stroke (AIS). All patients with AIS underwent tests for thyroid function and thyroid antibodies (thyroid peroxidase antibody and thyroglobulin autoantibody). We divided the patients suffering from euthyroidism and AIS into positive thyroid autoantibody and negative thyroid autoantibody groups. Demographic profiles, risk factors, and functional outcomes were compared between the two groups. Out of the total 422 patients, 50 (11.8%) were included in the positive thyroid autoantibody group. The National Institutes of Health Stroke Scale (NIHSS) score at admission and discharge was higher in the positive thyroid autoantibody group than the negative thyroid autoantibody group (P < 0.05). In addition, there was significant difference in the mortality during hospitalizations between the two groups (P < 0.01). This study showed that thyroid autoantibodies aggravate stroke severity in euthyroidism with AIS. We speculate that vascular damage related to thyroid autoimmunity may aggravate the increased risk of unfavorable outcomes, independent of thyroid function.


Catalytically active lead(ii)-imidazolium coordination assemblies with diversified lead(ii) coordination geometries.
Five Pb(ii)-imidazolium carboxylate coordination assemblies with novel structural motifs were derived from the reaction between the corresponding flexible, semi flexible or rigid imidazolium carboxylic acid ligands and lead nitrate. The imidazolium linker present in these molecules likely plays a triple role such as the counter ion to balance the metal charge, the ligand being an integral part of the final product and the catalyst facilitating carbon-carbon bond formation reaction. These lead-imidazolium coordination assemblies exhibit, variable chemical and thermal stabilities, as well as catalytic activity. These newly prepared catalysts are highly active towards benzoin condensation reactions with good functional group tolerance.


Steroid-Responsive Post-Traumatic Persistent Neutrophilic Meningitis.
Post-traumatic meningitis is a potentially fatal condition that presents as a diagnostic and therapeutic challenge. The vast majority of post-traumatic meningitides are caused by infectious pathogens, most commonly multi-drug-resistant (MDR) bacterial pathogens. However, aseptic meningitis occurs less frequently due to tissue response to injury or stimulation by noninfectious agents, such as blood breakdown products or chemicals. Here, we present a case of post-traumatic persistent neutrophilic meningitis who was found to be steroid responsive. Diagnostic evaluation in our patient did not reveal any infectious pathogen, and the patient did not respond to broad-spectrum antimicrobial treatment. We suggest that physicians who treat patients with post-traumatic meningitis should consider steroid-responsive post-traumatic persistent neutrophilic meningitis (SPNM) in the list of differential diagnosis particularly when no infectious etiology is found and the patient does not respond to empirical antimicrobial treatment. Brain injury-induced immune dysregulation causing exaggerated inflammatory reaction might play a role in the pathogenesis of SPNM; however, further neuropathological studies are absolutely necessary to evaluate and characterize trauma-induced immune dysregulation.


Engineering Auger recombination in colloidal quantum dots via dielectric screening.
Auger recombination is the main non-radiative decay pathway for multi-carrier states of colloidal quantum dots, which affects performance of most of their optical and optoelectronic applications. Outstanding single-exciton properties of CdSe/CdS core/shell quantum dots enable us to simultaneously study the two basic types of Auger recombination channels-negative trion and positive trion channels. Though Auger rates of positive trion are regarded to be much faster than that of negative trion for II-VI quantum dots in literature, our experiments find the two rates can be inverted for certain core/shell geometries. This is confirmed by theoretical calculations as a result of geometry-dependent dielectric screening. By varying the core/shell geometry, both types of Auger rates can be independently tuned for ~ 1 order of magnitude. Experimental and theoretical findings shed new light on designing quantum dots with necessary Auger recombination characteristics for high-power light-emitting-diodes, lasers, single-molecular tracking, super-resolution microscope, and advanced quantum light sources.


Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type 1 diabetes: meta-analysis of randomised controlled trials.
To assess the efficacy and safety of dual sodium glucose cotransporter (SGLT) 1/2 inhibitor sotagliflozin in type 1 diabetes mellitus. Meta-analysis of randomised controlled trials. Medline; Cochrane Library; Embase; international meeting abstracts; international and national clinical trial registries; and websites of US, European, and Japanese regulatory authorities, up to 10 January 2019. Randomised controlled trials evaluating the effect of sotagliflozin versus active comparators or placebo on glycaemic and non-glycaemic outcomes and on adverse events in type 1 diabetes in participants older than 18. Three reviewers extracted data for study characteristics, outcomes of interest, and risk of bias and summarised strength of evidence using the grading of recommendations assessment, development, and evaluation approach. Main outcomes were pooled using random effects models. Of 739 records identified, six randomised placebo controlled trials (n=3238, duration 4-52 weeks) were included. Sotagliflozin reduced levels of glycated haemoglobin (HbA1c; weighted mean difference -0.34% (95% confidence interval -0.41% to -0.27%), P<0.001); fasting plasma glucose (-16.98 mg/dL, -22.1 to -11.9; 1 mg/dL=0.0555 mmol/L) and two hour-postprandial plasma glucose (-39.2 mg/dL, -50.4 to -28.1); and daily total, basal, and bolus insulin dose (-8.99%, -10.93% to -7.05%; -8.03%, -10.14% to -5.93%; -9.14%, -12.17% to -6.12%; respectively). Sotagliflozin improved time in range (weighted mean difference 9.73%, 6.66% to 12.81%) and other continuous glucose monitoring parameters, and reduced body weight (-3.54%, -3.98% to -3.09%), systolic blood pressure (-3.85 mm Hg, -4.76 to -2.93), and albuminuria (albumin:creatinine ratio -14.57 mg/g, -26.87 to -2.28). Sotagliflozin reduced hypoglycaemia (weighted mean difference -9.09 events per patient year, -13.82 to -4.36) and severe hypoglycaemia (relative risk 0.69, 0.49 to 0.98). However, the drug increased the risk of ketoacidosis (relative risk 3.93, 1.94 to 7.96), genital tract infections (3.12, 2.14 to 4.54), diarrhoea (1.50, 1.08 to 2.10), and volume depletion events (2.19, 1.10 to 4.36). Initial HbA1c and basal insulin dose adjustment were associated with the risk of diabetic ketoacidosis. A sotagliflozin dose of 400 mg/day was associated with a greater improvement in most glycaemic and non-glycaemic outcomes than the 200 mg/day dose, without increasing the risk of adverse events. The quality of evidence was high to moderate for most outcomes, but low for major adverse cardiovascular events and all cause death. The relatively short duration of trials prevented assessment of long term outcomes. In type 1 diabetes, sotagliflozin improves glycaemic and non-glycaemic outcomes and reduces hypoglycaemia rate and severe hypoglycaemia. The risk of diabetic ketoacidosis could be minimised by appropriate patient selection and down-titration of the basal insulin dose.


Acetaminophen overdose with fetal demise.
A case of fetal demise and maternal recovery after acetaminophen overdose is presented, to our knowledge the first reported. Fetal liver and maternal serum concentrations indicate overdose to be the cause of fetal death. Maternal disseminated intravascular coagulation (DIC) may have been related to maternal acetaminophen-induced liver disease alone or to a combination of liver disease and the presence of a dead fetus.


Standardized Pathology Report for Breast Cancer.
Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of 'standard data elements,' 'conditional data elements,' and a biomarker report form. The 'standard data elements' consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the 'conditional data elements.' In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.


Bone marrow magnetic resonance studies in childhood leukemia. Evaluation of osteonecrosis.
In 25 patients under treatment or during follow-up for acute lymphoblastic leukemia magnetic resonance imaging (MRI) of both knees was compared to history and physical examination to detect osteonecrosis. Results of MRI were classified as: O, normal bone marrow (BM); 1, diffuse decrease in signal intensity; 2, circumscript lesions. Patients clinically suspected of osteonecrosis had a statistically significant increased incidence of Type 2 lesions. Three patients with a BM relapse also showed Type 2 lesions. Circumscript lesions of the epiphyses were seen exclusively in the four patients with clinical suspicion of osteonecrosis during BM remission and this may be a MR finding strongly indicative of osteonecrosis. Patients with Type 2 lesions during BM remission had received systemic chemotherapy for a statistically significant longer period than the other patients. Using MRI findings we suspect that at least four patients suffered osteonecrosis due to chemotherapy. MRI is a promising means of detecting this disorder.


Pneumomediastinum following Crystal Use: A Report of Two Cases.
Crystal is a synthetic substance with an increasing rate of abuse. It may cause patients to present to the emergency department because of its acute complications. We depict two cases of pneumomediastinum following inhalation of crystal. Both cases had used crystal for recreational purposes. In one case, a young man presenting to the ED with the retrosternal chest pain and neck pain was diagnosed to have pneumomediastinum and pneumopericardium. The other patient presenting with dyspnea and chest pain was shown to have collection of air within mediastinum. Both patients underwent a series of diagnostic evaluations and, after a course of observation, were discharged without a surgical intervention. Patients with chest pain following inhalation of crystal may suffer from this complication.


Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types.
In parallel to the detection of new neuronal autoantibodies, the diagnosis of non-infectious limbic encephalitis has risen. Given that cerebral imaging studies show highly variable results, the present retrospective study investigates imaging findings in association with autoantibody type. An institutional database search identified 18 patients with non-infectious limbic encephalitis who had undergone [18F] fluorodeoxyglucose positron emission tomography (FDG-PET). Sixteen of these patients also underwent magnetic resonance imaging (MRI). MRI and FDG-PET images were categorized as follows: normal (0); mesiotemporal abnormality (1); normal mesiotemporal finding but otherwise abnormal (2). Neuronal autoantibodies were determined in serum and/or CSF. Autoantibodies were grouped according to the cellular localization of their target antigen: antibodies against surface antibodies (i.e., VGKC, NMDAR): 9; antibodies against intracellular antigens (i.e., Hu, Ri, GAD): 4; no autoantibodies: 5. The fraction of abnormal scans was lower for MRI (10/16) than for FDG-PET (14/18). There was a significant association between PET findings and autoantibody type: All patients with autoantibodies against intracellular antigens showed mesiotemporal findings on FDG-PET. In turn, only 2/9 patients with autoantibodies against surface antigens displayed mesiotemporal hypermetabolism. In the remaining seven patients, four scans were rated as normal and three only showed findings outside the mesiotemporal region. A similar association was found using MRI, although this did not reach statistical significance. Autoantibody type was found to be associated with FDG-PET and, to a lesser extent, with MRI imaging results. Our observations may explain the heterogeneity of imaging data in LE and based on in vivo findings support the assumption of different patho mechanisms underlying LE due to antibodies against surface and intracellular antigens, respectively.


99mTc-labelled compounds prepared with sodium dithionite as reducing agent.
The paper deals with the applications of Na2S2O4 as reducing agent in the preparation of 99mTc-labelled compounds. The reduction of pertechnetate can advantageously be carried out in neutral solutions of pH 7. Using this procedure, DTPA, HEDSPA, MDP, gluconate, citrate and trypsin were successfully labelled. In HEDSPA and MDP labelling, a high as cumulation of 99mTc in rat bones (50%) was obtained. In gluconate labelling, under various reaction temperatures, two types of complexes were prepared. Complex I shows a 99mTc biodistribution which is comparable with the kidney diagnosticum 99mTc-Sn-gluconate (24% of 99mTc in kidneys). Complex II, on the other hand, exhibited a reduced affinity of 99mTc to kidneys (2.2%) which, however, increases in bone to 15.4%. The experimental results indicated that Tc(V) is bound in Complex I. In technetium complexing no "mixed complex" is formed technetium being complexed directly by chelate-forming groups on the labelled compound.


CYP24A1-induced vitamin D insufficiency promotes breast cancer growth.
Vitamin D plays a critical role in tissue homeostasis by regulating the expression of genes affecting cell proliferation, differentiation, and apoptosis. The vitamin D 24-hydroxylase CYP24A1 functions in vitamin D target tissues to degrade the hormonal form of vitamin D. Existing knowledge regarding dysregulated CYP24A1 expression supports its candidacy as a putative oncogene. Here, we found that the suppression of constitutive CYP24A1 expression conferred target cells with increased susceptibility to apoptosis and consequently inhibited anchorage-independent growth in breast carcinoma cells. In addition, suppression of vitamin D metabolism following knockdown of CYP24A1 significantly reduced tumor growth in vivo. These data provide substantial evidence for a pro-survival and stimulatory oncogenic effect of CYP24A1 in breast carcinoma cells.


MRI of pulmonary airspace disease: experimental model and preliminary clinical results.
To evaluate the potential of MRI for differentiating the various causes of pulmonary consolidation, 16 patients with known airspace diseases were imaged, and T1 and T2 values were determined. Substantial overlap was encountered between different diagnostic groups of T1 and T2 mapping, although alveolar proteinosis was notable for its low T1 value. In addition, a gelatin phantom simulating consolidation with varying degrees of residual aeration was constructed and tested, demonstrating that the degree of aeration did not influence the T1 and T2 values measured.


Infiltrating aggressive epitheliosis of the temporal bone: a newly described disease entity.
Two patients with a highly destructive histologic nondysplastic squamous epithelial lesion of the temporal bone are described. Both tumors were characterized by the production of copious amounts of keratin material which progressively extended in the temporal bone, surrounding bony structures, soft tissue and intracranially, with concomitant functional disorders. Only small amounts of epithelial cells were found. CT scanning revealed extensive and progressive destruction of the temporal bone, skull base in both patients, clivus and arch of atlas in one patient, besides intracranial and intracerebellar abscess formation. Despite extensive surgical therapy, the disorder was unmanageable. Histology showed a normal squamous epithelial basal cell layer with remarkable acanthosis and extensive hyperkeratosis. Material obtained at autopsy demonstrated intracerebellar extension of keratin material in one patient and in the hemicerebellectomy specimen of the other patient. To our knowledge, this disease entity has not been reported before.


Electronic Properties of Bilayer Graphene Strongly Coupled to Interlayer Stacking and an External Electric Field.
Bilayer graphene (BLG) with a tunable band gap appears interesting as an alternative to graphene for practical applications; thus, its transport properties are being actively pursued. Using density functional theory and perturbation analysis, we investigated, under an external electric field, the electronic properties of BLG in various stackings relevant to recently observed complex structures. We established the first phase diagram summarizing the stacking-dependent gap openings of BLG for a given field. We further identified high-density midgap states, localized on grain boundaries, even under a strong field, which can considerably reduce the overall transport gap.


Forskolin-induced organoid swelling is associated with long-term cystic fibrosis disease progression.
Cystic fibrosis (CF) is a monogenic life-shortening disease associated with highly variable individual disease progression which is difficult to predict. Here we assessed the association of forskolin-induced swelling (FIS) of patient-derived organoids with long-term CF disease progression in multiple organs and compared FIS with the golden standard biomarker sweat chloride concentration (SCC). We retrieved 9-year longitudinal clinical data from the Dutch CF Registry of 173 people with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Individual CFTR function was defined by FIS, measured as the relative size increase of intestinal organoids after stimulation with 0.8 µM forskolin, quantified as area under the curve (AUC). We used linear mixed-effect models and multivariable logistic regression to estimate the association of FIS with long-term forced expiratory volume in 1 s % predicted (FEV1pp) decline and development of pancreatic insufficiency, CF-related liver disease and diabetes. Within these models, FIS was compared with SCC. FIS was strongly associated with longitudinal changes of lung function, with an estimated difference in annual FEV1pp decline of 0.32% (95% CI 0.11-0.54%; p=0.004) per 1000-point change in AUC. Moreover, increasing FIS levels were associated with lower odds of developing pancreatic insufficiency (adjusted OR 0.18, 95% CI 0.07-0.46; p<0.001), CF-related liver disease (adjusted OR 0.18, 95% CI 0.06-0.54; p=0.002) and diabetes (adjusted OR 0.34, 95% CI 0.12-0.97; p=0.044). These associations were absent for SCC. This study exemplifies the prognostic value of a patient-derived organoid-based biomarker within a clinical setting, which is especially important for people carrying rare CFTR mutations with unclear clinical consequences.


Geographic and birth cohort associations of Kaposi's sarcoma among homosexual men in Canada.
The authors conducted an analysis of all 677 cases of Kaposi's sarcoma among the 3,047 cases of acquired immunodeficiency syndrome diagnosed in homosexual/bisexual men in Canada between 1980 and 1989. The proportion with Kaposi's sarcoma declined from 32.2% during 1980-1985 to 15.0% in 1989. The proportion with Kaposi's sarcoma was significantly higher in primary epidemic centers (Vancouver, Toronto, and Montreal) and in men in the 1945-1954 birth cohort independent of year of diagnosis. These data are consistent with an environmental cofactor for Kaposi's sarcoma which is likely to be a sexually transmitted agent.


Circulating tumor DNA (ctDNA) in adjuvant therapy of early stage colon cancer: current status and future perspectives.
This article reviews the current knowledge on circulating tumor DNA (ctDNA) in early stage colon cancer and ongoing trials on ctDNA-guided treatment in the adjuvant setting. A literature search of Pubmed was performed to identify studies on ctDNA in early stage colon cancer and neoadjuvant or adjuvant treatment. For ongoing trials, we searched clinicaltrials.gov and the Australian New Zealand Clinical Trials Registry (ANZCTR). Several studies show that ctDNA is a strong predictor for recurrence and survival after surgery and adjuvant chemotherapy. The specificity of this marker is extremely high, and the sensitivity is increasing with the development of technology. Recurrences can be detected very early and the analysis can potentially be used to guide neoadjuvant and adjuvant treatment. Ongoing and planned studies are now looking into escalation and de-escalation of therapy according to ctDNA-status after surgery. Serial measurement of ctDNA shows great promise as a marker for both prognosis and response to treatment in early colon cancer. Future studies will show whether we can use this analysis for tailoring treatment for patients in the adjuvant and neoadjuvant setting. With improved technology, ctDNA has the potential of becoming a 'game-changer' in the treatment of early stage colon cancers.


Tornado disaster--Illinois, 1990.
On August 28, 1990, from 3:15 to 3:45 p.m., the strongest tornado in northern Illinois in greater than 20 years struck the towns of Plainfield, Crest Hill, and Joliet in Will County. As a result of the storm's impact phase, 302 persons were injured (28 fatally). This report summarizes an investigation of injuries and deaths that resulted from the tornado's impact.


Pilot of a Low-Cost Elementary School Handwashing Intervention in Bangladesh: Acceptability, Feasibility, and Potential for Sustainability.
Schoolchildren frequently transmit respiratory and gastrointestinal infections because of dense person-to-person contact in schools. We piloted a low-cost handwashing intervention among elementary schoolchildren in Bangladesh. We trained teachers to lead behavior change communication sessions using flipcharts to encourage students' handwashing before eating, after defecating, and after cleaning school toilets; provided handwashing stations (reservoirs with taps and stool + basin + soapy water solution [mix of 30 gm detergent with 1.5 L water] + pump top bottle with steel holder); and formed hygiene committees for maintenance and covering the recurrent cost of detergent. We evaluated intervention acceptability, feasibility, and potential for sustainability at 1 and 14 months after the intervention. At baseline, of 300 before eating events, no one washed hands with soap, and 99.7% (299) did not wash hands at all as soap was unavailable. Out of 269 after toileting events, 0.7% (2) washed hands with soap, and 88% (237) did not wash hands. After 4 weeks of the intervention, 45% (87/195 before eating events), 83% (155/186 after toileting events), and 100% (15/15 after cleaning toilet events) washed both hands with soapy water as children found it accessible, low cost, and child friendly. After 14 months, 9.4% (55/586 before eating events) and 37% (172/465 after toileting events) washed both hands with soapy water for health benefits. The intervention was acceptable and feasible; it overcame limited access to soap and water and was affordable as schools covered the recurrent costs of detergent. Further research should explore long-term habit adoption and impact on health and attendance.


Outcomes of aortic coarctation surgical treatment in adults.
The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes. From January 1987 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients. Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis. Surgical treatment of aortic coarctation, even in adult patients, is an efficient therapeutic choice, regardless of the applied surgical technique, with low morbidity and mortality. It reduces efficiently the arterial pressure levels in both immediate and mid-term follow-up.


Hallucinations arising in the context of torn attachment, traumatic childhood and tapeworms.
The aim of this paper is to describe the processes underlying psychotic symptoms in an adolescent who presented to our service at the age of 15 years. A teenage female presented having experienced her early childhood in a war-torn third-world country, during which time her mother died, and she suffered worm infestation, neglect and trauma, before being adopted by a family in a developed country, where she lived for several years prior to relocating to Australia. The presenting complaints included longstanding anxiety, depressive and dissociative symptoms, with subsequent behavioural problems and learning difficulties. More recently, she had developed auditory hallucinations, and the antipsychotic she had been taking was beneficial. An MRI of the brain demonstrated lesions in keeping with healed parasitic disease (neurocysticercosis). The patient's hallucinations are discussed in the context of the relationship between a traumatic childhood and psychosis, and neurocysticercosis. Within months of her presentation, the hallucinations resolved as her step-mother became more available. Her antipsychotic medication is being carefully decreased, and the patient is engaging in psychological therapies to deal with her past trauma and disrupted attachment.


On the tactical significance of game situations in anticipating ball trajectories in tennis.
It is hypothesized that live playing situations preceding an opponent's strokes in tennis have sufficient significance to provide expert players with anticipative cues to estimate accurately the spatiotemporal characteristics of oncoming ball trajectories. Seven participants (all expert tennis players) had to watch two players opposed in high, moderate, and low tactical significance situations terminated by a stroke delivered by one of the two players in the direction of the participants. The participants' vision was occluded 100 ms after the stroke, and they had to indicate the zone reached by the ball at the moment of its rebound. Results showed that the essential anticipative information is contained in the view of the opponent's stroke movements, whatever the tactical significance of the situation.


Solid Phase Deposition Pattern Concerning Formation Oil in YD 7 Reservoir of Tarim Oilfield and Its Application: A Case Study.
Yudong (YD) 7 reservoir in the Yingmaili area of Tarim Oilfield is one of the key areas of oil and gas exploration in the Tarim Basin. However, due to the serious plugging problem caused by solid phase precipitation particles such as wax and paraffin, it is necessary to study the well flow phase behavior and solid phase precipitation law of typical high-production wells in this block to obtain the phase enveloping line and provide theoretical support for preventing solid phase precipitation of formation crude oil. In this study, the PVT tester and the self-designed microscopic solid deposition tester are used to obtain the phase enveloping line of formation crude oil, and the change law of the "gas-liquid-solid" phase behavior when the formation crude oil changes with temperature and pressure is observed. The morphological process of solid precipitation is recorded and analyzed through a microscopic visualization window. Finally, the solid phase precipitation point of formation crude oil is verified using a laser solid phase deposition tester. The experimental results show that under atmospheric pressure, the solid phase precipitation temperature point of surface crude oil is 34.05 °C, the maximum instantaneous precipitation is 0.01178%, and the maximum cumulative precipitation is 8.34%. The solid phase precipitation point of formation crude oil changes under different temperatures and pressures. Under different pressures and temperatures, it shows multiphase changes such as liquid-solid, liquid phase, gas-liquid-solid, gas-liquid, and gas phases. Limited by equipment, we can only observe the first four phase behaviors in the laboratory. In the process of solid phase precipitation, formation crude oil shows a fine needle shape at the initial stage and finally adhesions and aggregations in the form of an increasing crystal nucleus as the center, thus blocking the formation or wellbore. Combined with the analysis of production data, it can be seen that there is a solid precipitation problem in well YD 702 over 1200 m in the wellbore and the solid phase precipitation problem from the wellbore to the surface pipeline. This study provides theoretical support for preventing solid phase precipitation in the YD 7 reservoir and provides a reference for other oil fields with solid phase precipitation blocking problems.


Consumer focus can spur group practice turnaround.
Many healthcare organizations have lost money on their employed group practices. The solution to this dilemma is not necessarily divestment of the group practices. Instead, some healthcare organizations should view their physicians as an asset. Healthcare organizations and physicians need to develop a new framework for their relationship to optimize their competitive advantage. Three guiding principles that will help accomplish this objective are to recast the healthcare organization-physician relationship to focus on the consumer, reconfigure the economic model to exceed consumer demands, and restructure the group practice to encourage fiscal and service excellence. In developing a new relationship framework, the stakeholders need to define the group practice's mission, strategic direction, composition, infrastructure, compensation model, and structure.


Lung surfactants.
The pharmacology, clinical efficacy, and cost considerations of exogenous lung surfactants are reviewed. Exogenous pulmonary surfactants, along with advancements in ventilatory care, have significantly reduced the incidence of respiratory distress syndrome (RDS) and its related complications in infants. The following exogenous surfactants are approved for the prophylaxis and treatment (rescue) of neonatal RDS: beractant, a modified natural surfactant; calfactant and poractant, both natural surfactants; and colfosceril, a synthetic surfactant that is not currently available in the United States. Lucinactant, a synthetic surfactant, is under investigation and received approvable status from the Food and Drug Administration in February 2005. The surfactants are delivered directly to their site of action, and only small amounts reach the systemic circulation. Bioavailability to the distal airways and alveoli depends on the method of delivery, the stage and severity of pulmonary disease, and the properties of the particular surfactant. According to data from clinical trials, the use of exogenous surfactant therapy for rescue within the first two hours of life appears to be as efficacious as prophylaxis in most premature infants. Comparative trials of surfactants have proven the efficacy of both synthetic and natural surfactants in the prevention and treatment of RDS. However, these trials have universally demonstrated greater reduction in the immediate need for ventilator support in infants who receive natural surfactants. Natural preparations cause less pneumothorax, bronchopulmonary dysplasia, and mortality compared with synthetic preparations. Synthetic agents offer the potential advantages of an unlimited supply with consistent pharmaceutical quality and no risk of transmitting infectious disease or causing immunologic sensitization.


The Availability of Neutral Cyan, Green, Blue and Purple Colors from Simple D⁻A Type Polymers with Commercially Available Thiophene Derivatives as the Donor Units.
In this paper, the Stille coupling reaction was used to prepare four donor⁻acceptor⁻donor (D⁻A⁻D) type monomers. For this purpose, 2,3-bis(4-methoxyphenyl) quinoxaline was used as the acceptor unit, and thiophene derivatives (3,4-ethylenedioxythiophene, or EDOT; 3-methoxythiophene, or MOTh; 3-methylthiophene, or MTh; and thiophene, or Th) were used as the donor units. The monomers were polymerized to the corresponding polymers by the cyclic voltammetry (CV) or potentiostatic method. The band gaps and the adsorption profiles of the polymers were finely tuned with the incorporation of the different thiophene units. All four polymers have low band gaps, and switched between the colored neutral states and the highly transmissive oxidized state. We were successfully able to obtain the valuable neutral colors of cyan, green, blue, and violet for the polymers employing EDOT, MOTh, MTh, and Th as the donor unit, respectively. Furthermore, electrochromic kinetic investigations showed that all four polymers displayed excellent optical contrasts (ΔT%), fast switching times, high coloration efficiencies, and robust stabilities, indicating that these four polymers are probably promising choices for developing electrochromic devices.