Elevated release of sCD40L from platelets of diabetic patients by thrombin, glucose and advanced glycation end products.
The pro-inflammatory CD40/CD40L dyad participates in atherogenesis. Plasma levels of the soluble ligand (sCD40L) predict cardiovascular events and are elevated in diabetic patients. This study compared CD40/CD40L surface expression on platelets and T lymphocytes of diabetic and control subjects, and tested whether glucose and advanced glycation end products (AGEs) stimulate sCD40L release. Constitutive and inducible surface expression of CD40/CD40L on platelets or T lymphocytes did not differ between diabetic patients (n = 9) and controls (n = 13). Platelets from diabetic patients contained higher intracellular CD40L than controls (p < 0.05) and thrombin stimulated greater platelet sCD40L release in diabetic patients (15.11 +/- 16.77 ng/ml) compared to controls (3.64 +/- 2.03 ng/ml; p < 0.05). Glucose and AGEs induced platelet sCD40L release and CD40L expression in mouse megakaryocytes. This study demonstrates elevated CD40L content and inducible release from platelets of diabetic patients, and identifies glucose and AGEs as potential triggers of expression and release accounting for the elevated sCD40L plasma levels in these patients.


Association between chromosome 9p21 variants and the ankle-brachial index identified by a meta-analysis of 21 genome-wide association studies.
Genetic determinants of peripheral arterial disease (PAD) remain largely unknown. To identify genetic variants associated with the ankle-brachial index (ABI), a noninvasive measure of PAD, we conducted a meta-analysis of genome-wide association study data from 21 population-based cohorts. Continuous ABI and PAD (ABI ≤0.9) phenotypes adjusted for age and sex were examined. Each study conducted genotyping and imputed data to the ≈2.5 million single nucleotide polymorphisms (SNPs) in HapMap. Linear and logistic regression models were used to test each SNP for association with ABI and PAD using additive genetic models. Study-specific data were combined using fixed effects inverse variance weighted meta-analyses. There were a total of 41 692 participants of European ancestry (≈60% women, mean ABI 1.02 to 1.19), including 3409 participants with PAD and with genome-wide association study data available. In the discovery meta-analysis, rs10757269 on chromosome 9 near CDKN2B had the strongest association with ABI (β=-0.006, P=2.46×10(-8)). We sought replication of the 6 strongest SNP associations in 5 population-based studies and 3 clinical samples (n=16 717). The association for rs10757269 strengthened in the combined discovery and replication analysis (P=2.65×10(-9)). No other SNP associations for ABI or PAD achieved genome-wide significance. However, 2 previously reported candidate genes for PAD and 1 SNP associated with coronary artery disease were associated with ABI: DAB21P (rs13290547, P=3.6×10(-5)), CYBA (rs3794624, P=6.3×10(-5)), and rs1122608 (LDLR, P=0.0026). Genome-wide association studies in more than 40 000 individuals identified 1 genome wide significant association on chromosome 9p21 with ABI. Two candidate genes for PAD and 1 SNP for coronary artery disease are associated with ABI.


An epidemiological study of sheep pox in Tunisia (2008-2017).
Sheep pox is a highly contagious disease causing significant economic losses on livestock farms, especially among young animals. Epidemiological analysis of retrospective data on sheep pox surveillance over ten years revealed the endemicity of the disease in Tunisia. Temporally, the prevalence of infected farms increased during the last five years analysed (2013-2017), despite control measures for the disease, which are based essentially on vaccination. Analysis of the seasonality of infection showed that most outbreaks occurred in autumn and winter. The geographical distribution and spatial analyses classified the governorate of Sidi Bouzid as the area most affected by sheep pox duringthe period of study. It was observed that vaccination coverage decreasedbelow the recommended value (80%) in the last four years (2013-2016).


[Follow-up of patients with differentiated thyroid cancer: determination of serum thyroglobulin in place of routine 131I scintigraphy?].
A comparison was conducted in patients with differentiated thyroid carcinoma still under 131I therapy (n = 18) between 2 mCi-131I scans, posttherapeutic scans and radioimmunologically measurable serum thyroglobulin (TG). All 3 parameters were positive in only 9 cases; among the other 9 patients TG appeared to be the better indicator (ratio 5:1) of residual tumour tissue than the 2 mCi-131I scan. In a second group of patients who had completed 131I therapy the 2 mCi scan and TG were compared (n = 21). Both indices were negative in 15 cases, whereas TG was positive in 6 patients in spite of a negative scan. TG generally remained within the clearly positive range also during T4 therapy. TG was highest in metastatic disease and practically uninfluenced by T4, i.e. by the endogenous TSH level. TG antibodies were found in 15% of cases, generally with low titres only; this did not interfere with TG determination as tumour marker. In summary, TG measurement appears to be superior to 2 mCi-131I scans for follow-up of cases with differentiated thyroid carcinoma.


Musashi-2 is a novel regulator of paclitaxel sensitivity in ovarian cancer cells.
As few prognostic markers and symptoms have been identified, ovarian cancer is typically diagnosed at an advanced stage, and a majority of patients will relapse and develop resistance to anticancer drugs such as paclitaxel. Musashi-2 (MSI2) is a regulator of gene translation and functions as an oncogenic protein and a marker of poor prognosis in various types of cancer. However, the biological and clinical significance of MSI2 in ovarian cancer remains unclear. Using a tissue microarray-based assay, we demonstrated that MSI2 was highly expressed in advanced, serous ovarian cancer tissues. In addition, MSI2-overexpressing ovarian cancer cells exhibited increased viability, proliferation and growth. We found that MSI2 was overexpressed in paclitaxel-resistant ovarian cancer SKOV3-TR cells but not in paclitaxel-sensitive cell lines. The loss of MSI2 expression in lentivirus-mediated stable MSI2 knockdown SKOV3-TR cells impaired paclitaxel resistance as determined using cell viability and apoptosis assays. In contrast, lentivirus-mediated MSI2 overexpression promoted the development of paclitaxel resistance in paclitaxel-sensitive ovarian cancer cells. The results of the present study are the first to demonstrate that MSI2 is a valuable marker of advanced, serous ovarian cancer and that MSI2 plays an important role in paclitaxel resistance.


Enzymes of carbohydrate metabolism in the developing rice grain.
The levels of reducing and nonreducing sugars, starch, soluble protein, and selected enzymes involved in the metabolism of sucrose, glucose-1-P, and glucose nucleotides were assayed in dehulled developing rice grains (Oryza sativa L. line IR1541-76-3) during the first 3 weeks after flowering. The level of reducing sugars in the grain was highest 5 to 6 days after flowering. The level of nonreducing sugars and the rate of starch accumulation were maximum 11 to 12 days after flowering, when the level of soluble protein was also the highest. The activities of bound and free invertase, sucrose-UDP and sucrose-ADP glucosyltransferases, hexokinase, phosphoglucomutase, nucleoside diphosphokinase, and UDP-glucose and ADP-glucose pyrophosphorylases were high throughout starch deposition, and were maximum, except for nucleoside diphosphokinase which did not increase in activity, between 8 and 18 days after flowering. Soluble primed phosphorylase and ADP glucose-alpha-glucosyltransferase (starch synthetase) were both present during starch accumulation. Phosphorylase activity was at least 2-fold that of soluble starch synthetase but the synthetase followed more closely the rate of starch accumulation in the grain. The activity of starch synthetase bound to the starch granule also increased progressively with increased starch content of the grain.


Role of GLP-1 induced glucagon suppression in type 2 diabetes mellitus.
This project consisted of two parts: a biochemical part and clinical studies. The overall aim was to elucidate the defective regulation of glucagon secretion in type 2 diabetes (T2DM). The aim in the biochemical part was to develop a glucagon ELISA by using C- and N-terminal antibodies generated in the laboratory. Much effort was put into this attempt; however, we were unsuccessful and had to use an alternative method in our attempt to characterize the paradoxical diabetic glucagon response further. By using Sep-Pac and HPLC separation methods, plasma from patients with T2DM known to have a defective suppression of glucagon was analyzed using three antibodies and RIA. In this way the hyperglucagonaemia was found to consist mainly of authentic glucagon, rather than abnormally processed forms. The first clinical study included ten healthy controls matched to ten patients with T2DM. The aim was to investigate if GLP-1 induced glucagon inhibition was dose dependent and if suppression was equally potent in healthy controls and T2DM patients. Further, we investigated if the potency of the inhibition depended on the prevailing plasma glucose (PG) level. All participants were investigated with increasing doses of GLP-1 administered as iv-infusions and saline (control) during a glycaemic clamp at fasting plasma glucose (FPG) levels. Patients were investigated on a third occasion with GLP-1 infusions after an over-night normalisation of PG using adjustable insulin infusions. From these experiments we were able to conclude that GLP-1-induced glucagon inhibition is dose-dependent, but surprisingly GLP-1 suppressed the alpha cell equally potently in patients and controls - and the suppression was independent of PG level. Therefore we concluded that the paradoxical glucagon response to orally ingested glucose is not caused by decreased potency of GLP-1 with respect to glucagon suppression. It may be due to the decreased secretion of this hormone reported in earlier studies. My second protocol aimed towards quantifying the glucose-lowering effect of GLP-1-induced glucagon inhibition seen in patients with T2DM. The glucose-lowering effect of GLP-1 is due to both insulin stimulation leading to peripheral glucose disposal and glucagon inhibition resulting in decreased stimulation of hepatic glucose production. With a five-day protocol including both glycaemic and pancreatic clamps in ten patients with T2DM we were able to isolate the contribution of glucagon suppression to the increased glucose turn-over seen during a GLP-1-glycaemic clamp, and interestingly it was equal to the known insulinotropic effect of GLP-1. Finally, we investigated patients with type 1 diabetes (T1DM) and no residual beta cell function with oral glucose tolerance test (OGTT) and isoglycaemic intravenous glucose infusion (IIGI) in order to evaluate any differences in glucagon response to glucose +/- gastri-intestinal (GI)-stimulation. Here we found that despite a perfectly normal inhibition of glucagon during the IIGI in the T1DM, they had a defective glucagon suppression in response to orally ingested glucose and a paradoxical secretion of glucagon was seen as in T2DM. Hereby, we proved that glucagon suppression in response to hyperglycaemia does not entirely depend on intra-islet insulin effects as has been suggested. Therefore we conclude that GI-tract factors rather than intraislet dysregulation explain the paradoxical glucagon response in patients with diabetes.


[Immune mechanisms involved in the development and eradication of anti-factor VIII alloantibodies in hemophilia].
Hemophilia A is an X-linked hereditary bleeding disorder caused by a congenital deficiency in blood coagulation factor VIII (FVIII). Therapy to prevent or treat bleeding is replacement of FVIII. The most significant complication of treatment in patients with hemophilia A is the development of alloantibodies that inhibit FVIII activity, termed inhibitors. In the presence of inhibitors, replacement of the missing clotting factor with FVIII preparations becomes less effective. Once replacement therapy is ineffective, morbidity increases. It remains unsolved to prevent inhibitor formation. The only strategy is long-term administration of a large quantity of FVIII in an attempt to eradicate the inhibitors through immune tolerance. However, little is known about the mechanisms involved in the induction of tolerance. This review will focus on the current understanding of why inhibitors develop and can be eradicated. The development of inhibitors by intravenous infusions of FVIII without adjuvant poses an intriguing challenge to immunologists.


Short-term effects of topical levobunolol on the human retinal circulation.
The effect of topical levobunolol HCl 0.5% on the retinal circulation was studied on 15 normal volunteers aged 21-54 years (32 +/- 10 years). In a double-masked, randomised design, one eye of each subject received a drop of levobunolol HCl 0.5% (LEV) and the fellow eye received a drop of artificial tears (TEAR). Leucocyte velocity (VBFS) and density in the retinal macular microcirculation were measured by the blue-field simulation technique. Venous diameter (D), maximum erythrocyte velocity (Vmax) and volumetric blood flow rate (Q) were measured in a major temporal vein by laser Doppler velocimetry and monochromatic fundus photography. The following average changes from baseline were observed 2 hours after treatment: heart rate, -4.6 +/- 8.3% (p = 0.04); intraocular pressure, -31.7 +/- 10.6% (p = 0.0001); and perfusion pressure, 15.4 +/- 14.4% (p = 0.02) in LEV eyes; no statistically significant changes in IOP and perfusion pressure were seen in TEAR eyes. When each eye was compared with its own baseline, there were no significant changes in VBFS, density, D, Vmax and Q in LEV eyes. In TEAR eyes, there were no significant changes in VBFS, density, Vmax and Q, but a significant change in D (-1.8 +/- 2.6%; p = 0.02) was observed. A significant average percentage increase in Q of 10.9 +/- 19.2% (paired t-test between the change after LEV and the change after TEAR, p = 0.044) was seen in LEV eyes when compared with TEAR eyes. Twelve of the 15 subjects demonstrated a relative increase in Q in the LEV eyes in comparison with the TEAR eyes, while 3 subjects showed the opposite. A significant difference in the effect of levobunolol between the two eyes was detected, even though there was no statistically significant effect when each eye was compared with its baseline.


Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management.
Incidental durotomy (ID) can occur in up to 14% of all lumbar spine surgeries. The risk of this complication is markedly higher among elderly patients with advanced spinal pathology. In addition, revision cases and other more invasive procedures increase the risk of ID. When unrepaired, IDs can increase the risk of developing meningitis and can lead to the formation of cerebrospinal fluid fistulas and pseudomeningoceles. Intraoperative recognition and repair are essential to ID management, although repair techniques vary considerably. Although primary suture repair is considered the "benchmark," indirect repair alone has shown comparable outcomes. Given the concern for infection after ID, many have indicated for prolonged prophylactic antibiotic regimens. However, there is little clinical evidence that this is necessary after adequate repair. The addition of subfascial drains have been shown to promote wound healing and early ambulation, whereas no consensus on duration of indwelling drains exists and such management is largely case dependent. Early ambulation after surgery has not shown to be associated with increased risk of further ID complications and decreases rehabilitation time, length of stay, and risk of venous thromboembolism. However, there remains a role for conservation mobilization protocols in more severe cases where notable symptoms are observed.


What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications?
Body mass index (BMI) cutoffs are commonly utilized to decide whether to offer obese patients elective total hip arthroplasty (THA). However, weight loss goals may be unachievable for many, and some patients are thereby denied complication-free surgery. The purpose of this study was to assess the impact of varying BMI cutoffs on the rates of complication-free surgery after THA. Patients undergoing THA between 2015 and 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Common Procedural Terminology code 27130. BMI and rates of 30-day complications were collected. BMI cutoffs of 30, 35, 40, 45, and 50 kg/m2 were applied to model the incidence of complications if THA would have been allowed to proceed based on BMI. A total of 192,394 patients underwent THA, and 13,970 (7%) of them had a BMI ≥40 kg/m2. With a BMI cutoff of 40 kg/m2, 178,424 (92.7%) patients would have proceeded with THA. From this set, 170,296 (95.4%) would experience complication-free surgery, and 11.8% of complications would be prevented. THA would proceed for 191,217 (99.3%) patients at a BMI cutoff of 50 kg/m2, of which 182,123 (95.2%) would not experience a complication, and 1.3% of complications would be prevented. Using 35 kg/m2 as the BMI cutoff would prevent 28.6% of complications and permit 75.9% of complication-free surgeries to proceed. Lower BMI cutoffs for THA can result in fewer complications although they will consequentially limit access to complication-free THA. Consideration of risks of obesity in THA may be best considered as part of a holistic assessment and shared decision-making when deciding on goals for weight reduction.


Predicting length of stay in psychiatry.
Diagnostic Related Groups (DRGs) and Healthcare Resource Groups (HRGs) do not predict accurately length of stay or resources needed for treatment in psychiatry. This preliminary study assessed the relative contribution of severity of illness, in combination with other variables, in predicting length of stay. Data were analysed on 115 consecutive admissions to a district psychiatric in-patient unit to assess the variables which most accurately predict length of stay. The variables included demographic data, diagnosis, clinical, social and behavioural measures. For initial admission, diagnosis of neurosis predicted shortest stay, but diagnosis alone accounted for only 14.6% of the variation in length of stay. Addition of Social Behaviour Scale score, living alone and specific psychiatric symptoms significantly increased the predictive value (adjusted R2 = 36.6%). Addition of variables available at discharge (use of ECT, major tranquillizers and antidepressants) significantly increased the adjusted R2 to 49.0%. Prediction of total length of hospitalization over a 12-month period, from the date of initial admission, indicated that mania predicted the longest stay and addition of other variables meant that only 18.9% of length of stay was predicted. If these results are borne out in a large study, they indicate that diagnostic or health related groups (DRGs) are only likely to be useful in psychiatry if they include more detailed social, clinical and behavioural variables.


[Combined renal and pancreas transplantation as treatment for chronic renal insufficiency of diabetic origin: a series of 50 consecutive transplantations].
The aim of this study was to report the results of 50 transplantations of kidney and pancreas performed in the same surgical centre for chronic renal insufficiency of patients with insulino-dependent diabetes. From 1989 to 1999, 50 pancreatic transplantations were consecutively performed, 48 combined with a kidney transplantation and two in patients having a functioning kidney graft. The whole pancreas was transplanted in the right iliac fossa through an extraperitoneal approach with duodeno-vesical bypass of exocrine secretion. The kidney was transplanted in the left iliac fossa through a different extraperitoneal approach. Immunosuppression protocol included Azathioprine replaced by Mycophenolate Mofetil since 1996, associated with corticotherapy and Ciclosporine replaced by FK 506 since 1997. Recipients were 32 women and 18 men (mean age: 37 +/- 5 years) treated by insulinotherapy since 23 +/- 6 years and receiving 35 +/- 10 insulin units per day. Peptide C was 0.33 +/- 0.35 mg/mL and serum creatinin 726 +/- 260 mumol/L. One patient died on d10 from pulmonary artery thrombosis due to unknown drepanocytosis. The most frequent postoperative complications were leakage of duodeno-vesical anastomosis (n = 9) decreasing in frequency with experience, reoperated with preservation of the pancreatic graft in all cases and venous thrombosis of the pancreatic graft (n = 5) with a definitive loss of function. Secondary deaths occurred at 24, 36, 48, 50, 72 months with functioning grafts in two patients. With a mean 5-year follow-up, 44 patients were alive (88% of the whole series), 34 of them with two functional grafts (68% of the whole series) Sixteen pancreas grafts were lost: three by death of the patients, eight from surgical complications, four by rejection and one by transplantectomy of a functional graft. Combined kidney and pancreas transplantation is now very efficient in the treatment of diabetic renal insufficiency. Total pancreas transplantation through an extraperitoneal approach seems to be the safest method. A very strict selection of both donors and recipients is necessary.


Feature Fusion Based SVM Classifier for Protein Subcellular Localization Prediction.
For the importance of protein subcellular localization in different branches of life science and drug discovery, researchers have focused their attentions on protein subcellular localization prediction. Effective representation of features from protein sequences plays a most vital role in protein subcellular localization prediction specially in case of machine learning techniques. Single feature representation-like pseudo amino acid composition (PseAAC), physiochemical property models (PPM), and amino acid index distribution (AAID) contains insufficient information from protein sequences. To deal with such problems, we have proposed two feature fusion representations, AAIDPAAC and PPMPAAC, to work with Support Vector Machine classifiers, which fused PseAAC with PPM and AAID accordingly. We have evaluated the performance for both single and fused feature representation of a Gram-negative bacterial dataset. We have got at least 3% more actual accuracy by AAIDPAAC and 2% more locative accuracy by PPMPAAC than single feature representation.


Skin diseases associated with Malassezia species in humans. Clinical features and diagnostic criteria.
Malassezia yeasts not only cause the well known pityriasis versicolor and folliculitis, but also play an important role in other skin diseases, including seborrheic dermatitis and atopic dermatitis. The presence of Malassezia yeasts may be confirmed by direct microscopic examination and cultures of skin scrapings. In pityriasis versicolor the direct microscopic examination is the rapidest and surest test for confirming the clinical diagnosis. The preparation will show a cluster of globose budding spores with thick or double wall and short hyphae. For detecting Malassezia in the other diseases the cultures is preferable. Culture is useful both for confirming the clinical diagnosis and for epidemiological investigations. The identification of the Malassezia species is not easy. The microscopic observation of the colony direct towards the identification of Malassezia species, but it is not enough to identify the colonies definitely. Several biochemical tests are necessary for a precise identification, such as catalase reaction, growth on media without lipid sources, ability to utilize hydrophilic emulsifiers as sole lipid source, esculin test, tryptophan test.


Imaging circulating cells and lymphoid tissues with iron oxide nanoparticles.
The use of nanometer-sized iron oxide nanoparticles and micron-sized iron oxide particles as magnetic resonance (MR) contrast agents has garnered a high degree of interest in diverse areas of biology and medicine. Applications such as cell tracking, molecular imaging, gene detection, and lymphography are being explored to provide insight into disease mechanisms, monitor therapeutic efficacy, and facilitate diagnostic imaging. What makes iron oxide so appealing is a number of favorable properties including high detectability by MR, biodegradability and low toxicity. Here we describe the recent progress on the use of magnetic nanoparticles in imaging circulating cells and lymphoid tissues. The study of the lymph system and the biodistribution of various circulating immune cells is important in the diagnosis, prognosis, and treatment of a wide range of diseases and is expected to have a profound effect on patient outcome.


Utility of the Modified Wisconsin Card Sorting Test in neuropsychological assessment.
Nelson's (1976) Modified Wisconsin Card Sorting Test (MCST) was evaluated and the utility of the conventional criterion and new threshold scores for identifying patients with frontal lobe disorder assessed. Measures of perseveration and other indices of performance on the MCST were not found to discriminate between patients with frontal and non-frontal lobe lesions, using either the conventional criterion or new threshold scores. In addition there were no significant differences between left- and right-sided lesioned patients. However, the task was found to have high specificity (98.7 per cent) and good sensitivity (45.6 per cent) to lesions irrespective of site indicating that it may be a useful screening test. The present findings are consistent with recent research with the original Wisconsin Test, that suggests that card-sorting performance may not be as differentially sensitive to frontal lobe disorder as has been thought hitherto.


Evaluation of a pharmacist-managed telephone lipid clinic at a Veterans Affairs Medical Center.
Heart disease is one of the leading causes of death and disability in the US, with dyslipidemia being a significant risk factor. Pharmacist-managed lipid clinics have been shown to be effective in lowering low-density lipoprotein cholesterol (LDL-C) values in the veteran population. In addition, telephone-managed clinics are known to be an effective method to manage anticoagulation therapy. This type of appointment is very convenient; it reduces travel and waiting times, costs, and potential no-show rates. To assess changes in LDL-C levels from baseline to follow-up and number of patients attaining LDL-C goals during enrollment in the pharmacist-managed telephone lipid clinic (PMTLC). A retrospective chart review was conducted on all patients enrolled in the clinic who had follow-up laboratory data available. Baseline LDL-C values were compared with values obtained at follow-up. Patients' total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) values were also collected and analyzed for improvement. The agents used, number of antidyslipidemic medications, and the incidence of adverse drug reactions prior to and during clinic enrollment were also collected. Patients in the PMTLC had a mean +/- SD reduction in LDL-C of 44.3 +/- 45.2 mg/dL (p < 0.001). In addition, 10 (28%) patients achieved the LDL-C goal (p = 0.002). Mean reductions in TC and TG levels were 44 mg/dL (18%) and 14.6 mg/dL (8%), respectively. There was no significant change in HDL-C levels. The PMTLC at the Erie, PA, Veterans Affairs Medical Center demonstrated statistically significant reduction in patients' LDL-C levels and increase in the number of patients attaining LDL-C goal.


LDLR promotes growth and invasion in renal cell carcinoma and activates the EGFR pathway.
Previous studies identified an association of low-density lipoprotein (LDL) levels and LDL receptor (LDLR) with renal cell carcinoma (RCC) development. This study investigated the expression and roles of LDLR in RCC. LDLR expression was examined in clear cell RCC (ccRCC) and adjacent normal kidney tissues, and its clinicopathological significance was analyzed. The role of LDLR in RCC cell proliferation, cell cycle, and invasion were assessed in RCC cells with LDLR stable knockdown. LDLR expression was higher in ccRCC tissues than in normal kidney tissues and increased with RCC progression. LDLR knockdown in RCC cells inhibited cell growth, migration and invasion, and induced G1/S cell cycle arrest. We identified an interaction between LDLR and EGFR, and EGFR signaling protein expression was reduced after LDLR knockdown. Our findings reveal that LDLR plays an important role in RCC carcinogenesis, suggesting that LDL and LDLR might be potential targets for therapeutic intervention in RCC.


Biogenic Silver Nanoparticles: What We Know and What Do We Need to Know?
Nanobiotechnology is considered to be one of the fastest emerging fields. It is still a relatively new and exciting area of research with considerable potential for development. Among the inorganic nanomaterials, biogenically synthesized silver nanoparticles (bio-AgNPs) have been frequently used due to their unique physicochemical properties that result not only from their shape and size but also from surface coatings of natural origin. These properties determine antibacterial, antifungal, antiprotozoal, anticancer, anti-inflammatory, and many more activities of bio-AgNPs. This review provides the current state of knowledge on the methods and mechanisms of biogenic synthesis of silver nanoparticles as well as their potential applications in different fields such as medicine, food, agriculture, and industries.


The ferredoxin-thioredoxin reductase variable subunit gene from Anacystis nidulans.
The ferredoxin-thioredoxin reductase variable subunit gene of Anacystis nidulans was cloned, and its nucleotide sequence was determined. A single-copy 219-bp open reading frame encoded a protein of 73 amino acid residues, with a calculated Mr of 8,400. The monocistronic transcripts were represented in a 400-base and a less abundant 300-base mRNA form.


Variable association between Chlamydophila psittaci infection and ocular adnexal lymphomas: methodological biases or true geographical variations?
Since the first publication in 2004, a large number of reports have raised the question of an association between ocular adnexal lymphoma and Chlamydia psittaci. The results of this scientific debate, however, remain controversial. The primary objective of this paper was therefore to raise important questions concerning the interpretation of the different and heterogeneous data on the association between Chlamydophila psittaci and ocular adnexal lymphoma, namely the impact of the methodology used and the epidemiological variability of seroprevalence of C. psittaci antibodies. This paper also provides some methodological suggestions for future studies in the field of chlamydia-lymphoma associations.


Effectiveness of board game activities for reducing depression among older adults in adult day care centers of Taiwan: a quasi-experimental study.
Depression is common in older adults and is associated with an increased risk of cognitive impairment. To clarify the possible roles of board game use in psychosomatic health promotion, this study evaluated the effects of board game activities in reducing depression in older adults. This was a quasi-experimental study. Purposive sampling was used to select 150 participants aged 65 years and above with intact mental functions who were currently residing in adult day care centers. Seventy-five participants who participated in 12 sessions of selected board game activities were assigned to the experimental group, and 75 participants who adhered to their ordinary activities were allocated to the control group. Structured questionnaires were used for data collection. The board game activities showed promising effects on the depression levels of the investigated older adults living in adult day care centers. Therefore, one possible beneficial effect of board game activities may be reduced depression in older adults. The results of this study provide support for the mediating role of board game activities in the mental health of long-term care elders. Incorporating board game activities into social work may help to make it more diverse and innovative.


Acculturation, sexual behaviour, risk and knowledge in Vietnamese men living in metropolitan Sydney.
To describe the relationship between acculturation, sexual risk and sexually transmissible infections (STIs) and blood borne viruses (BBVs) knowledge among Vietnamese men living in inner Sydney and to compare this prevalence with national data. Telephone interviews were completed with a random sample of Vietnamese men, selected from the electronic phone book using a list of common Vietnamese surnames. Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. There was an association between lower acculturation scores and having more than 10 lifetime sexual partners, more than 50 lifetime sexual partners, never using a condom, ever or recently having commercial sex, ever having an STI, being hepatitis B carriers or ever being imprisoned. There is an association between acculturation and many aspects of sexual behaviour.


[Autonomic Dysfunction in Lewy Body Disease].
Lewy body disease is a clinicopathological entity that includes Parkinson's disease, dementia with Lewy bodies, and pure autonomic failure with Lewy bodies, all of which are characterized by varied degrees of autonomic dysfunction. Research in animal models has shown transmission of α-synuclein from peripheral autonomic nerves to the central nervous system via the autonomic nervous system, and the autonomic nervous system plays an important role in the study of Lewy body disease. This paper outlines the pathophysiology, characteristics, and treatment of typical autonomic dysfunction in patients with Lewy body disease.


A randomized Phase I pharmacokinetic trial comparing the potential biosimilar trastuzumab (SIBP-01) with the reference product (Herceptin®) in healthy Chinese male volunteers.
This study aimed to evaluate the bioequivalence, safety, tolerability and immunogenicity of the biosimilar trastuzumab (SIBP-01) compared to Herceptin®. In this Phase I randomized double-blind parallel-group trial, 100 healthy male volunteers were randomized in a1:1 ratio to receive a single 6 mg•kg-1 intravenous dose of SIBP-01 or Herceptin®. Serum concentrationswere analyzed using a validated ELISA. The two groups had similar baseline characteristics. The geometric mean ratios (90% CI) of Cmax, AUC0-t and AUCinf between the trial group and the reference group were 93.55%-104.27%, 91.98%-102.35% and 91.88%-102.34%, respectively; the geometric mean ratios (90% CI) of AUC0-t and AUCinf in the sensitivity analysis were 92.29%-102.63% and 91.81%-102.16%, respectively. These values were within the prespecified equivalence margins, establishing the bioequivalence of SIBP-1 and Herceptin®. AEs were similar across all subjects in the SIBP-01 and Herceptin® arms, with treatment-related AEs reported by 72.00% and 80.00%, respectively. In each group, there was one AE that caused a subject to discontinue the study. Trastuzumab (Herceptin®) is significantly more effective than chemotherapy in reducing exacerbations and tumor cell growth, and its adverse events are far lower than chemotherapy. Herceptin®is very expensive for most patients in China. The protein molecular primary structure of the biosimilar trastuzumab (SIBP-01) is consistent with Herceptin®, with highly similar high level structure, biologocal activity and purity.But there are few studies comparing the bioequivalence of SIBP-01 and Herceptin® in healthy subjects and cancer patients 2. This study showed the PK similarity of SIBP-01 to Herceptin®. SIBP-01 was safe and well tolerated in healthy male volunteers, with no significant differences from the reference drug in safety or immunogenicity 4.


Comparative Phloem mobility of nickel in nonsenescent plants.
(63)Ni was applied to nonsenescent source leaves and found to be transported to sink tissues in pea (Pisum sativum L.) and geranium plants (Pelargonium zonale L.). The comparative mobilities (percent tracer transported out of source leaf /% (86)Rb transported) for (63)Ni in peas was 2.12 and in geranium 0.25. The value for the phloem mobile (86)Rb was 1.00. By contrast, the comparative mobility of (45)Ca, which is relatively immobile in the phloem, was low (0.05 in peas, 0.00 in geranium). Interruption of the phloem pathway between source and sink leaves by steam girdling almost completely inhibited (63)Ni accumulation in the sink leaves of both species. We conclude that Ni is transported from nonsenescent source leaves to sink tissues via the phloem of leguminous and nonleguminous plants.


Three-dimensional kinematics of wheelchair propulsion.
A three-dimensional (3-D) biomechanical model was used to determine upper extremity kinematics of 16 male subjects with low-level paraplegia while performing wheelchair propulsion (WCP). A six-camera VICON motion analysis system was used to acquire the coordinate data of ten anatomic markers. Joint axes for the wrist and elbow were defined along with the planes of motion for the upper arm (humerus) and trunk. The group's mean and standard deviation profiles were graphed for eight of the nine rotations measured during WCP. Variability in the intercycle and intersubject movement patterns were calculated using the root mean square standard deviation (RMS sigma) and the coefficient of variation (CV). Motion pattern similarities were quantified using the coefficient of multiple correlation (CMC). The intercycle (Nc > or = 6) motion patterns of individual subjects were highly consistent, similar, and repeatable during WCP. This was confirmed by low CVc values (3-31%), high CMCc values (0.724-0.996) and RMS sigma c values below 3.2 degrees. For the group, mean values of the propulsion velocity, cadence, and propulsion cycle duration were 89.7 m/min, 66.1 pushes/min, and 0.96 s, respectively. Humeral plane and rotation showed large excursions (76.1-81.6 degrees), while trunk lean and forearm carrying angle displayed relatively small ranges of motion (5.5-10.9 degrees). The intersubject (N3 = 16) motion patterns were less similar compared to individual intercycle patterns. This was evidenced by higher CVc values (12-128%) and lower CMC3 values (0.418-0.935). Intersubject humeral patterns were the most consistent while trunk lean was the least consistent. Intersubject root mean square standard deviations (RMS sigma c) were more than three times the corresponding intercycle values for all nine rotations.


Factors Important in Determining the Heat Process Value, FT, for Low-Acid Canned Foods 1.
In this monograph an attempt is made to put into perspective several factors that impinge on the heat process value, FT. In the heat processing of low-acid canned foods (LACF), there are three specific types of final product spoilage that concern the food microbiologist and the food manufacturer. These three areas are discussed in some detail. The order to follow in the design of LACF and endpoint values are suggested. Use of descriptive and numerical terms for the endpoint of the LACF heat preservation process is discussed. The origin of the term, "commercial sterility," is reviewed; reasons for replacing this term (in the future) with a specification are presented. The several faces of the widely-used heat process value, FT, are examined. The use of a safety factor to take care of unknown processing conditions is proposed. Suggested safety factors are listed. The classical research of Esty and Meyer on resistance of Clostridium botulinum is reviewed and interpreted using the simple logarithmic model. The often-quoted but poorly-understood term, 12D, is discussed.


Effects of dimethyl sulfoxide on apolipoprotein A-I in the human hepatoma cell line, HepG2.
Exposure of HepG2 cells to 1% (v/v) dimethyl sulfoxide (DMSO), an effective free radical scavenger, for 24 h resulted in a 2-fold increase in the levels of apolipoprotein (apo) A-I mRNA and secreted protein, with no significant change in apoA-II, apoB, and apoE mRNA and protein levels. The induction of apoA-I was accompanied by a 50% increase in secreted HDL. Nuclear run-off assays indicated that the transcription rate of the apoA-I gene was also increased 2-fold in DMSO-treated cells. Consistent with nuclear run-off assays, transient transfection experiments, using a series of pGL2-derived luciferase reporter constructs containing the human apoA-I proximal promoter, demonstrated that DMSO treatment increased apoA-I promoter activity 2-fold. We have identified a potential 'antioxidant response element' (ARE) in the apoA-I promoter that may be responsible for the increase in apoA-I transcriptional activity by DMSO. Gel mobility shift assays with an apoA-I-ARE revealed increased levels of a specific protein-DNA complex that formed with nuclear extracts from DMSO-treated cells. The formation of this complex is sequence specific as determined by DNA competition studies. When a copy of the ARE was inserted upstream of the SV40 promoter in a luciferase reporter plasmid, a significant 2-fold induction in luciferase activity was observed in HepG2 cells in the presence of DMSO. In contrast, a plasmid containing a mutated apoA-I-ARE did not confer responsiveness to DMSO treatment. Furthermore, pGL2 (apoA-I-250 mutant ARE), in which point mutations eliminated the ARE in the apoA-I promoter, showed no increase in luciferase activity in response to DMSO. These results implicate protein-DNA interactions at the antioxidant response element region in the transcriptional induction of human apoA-I gene expression by DMSO.


Risk of perinatal transmission with treatment combinations of intrapartum and newborn zidovudine monotherapy.
To determine perinatal transmission rates when zidovudine (ZDV) was given either to mothers after labor had begun, to their infants postnatally, or both. Woman-infant pairs who received intrapartum and newborn ZDV therapy between January 1, 1992, and July 1, 1998, were considered. A medical record review identified female subjects known to be HIV-infected. All women who were given treatment with any antiretroviral drug before the onset of labor were excluded. All women satisfying eligibility criteria were enrolled. Nonparametric tests were used for analysis. The transmission rate of the study population was compared with rates reported for mother-infant pairs in the United States who did not receive ZDV. Administration of ZDV therapy after onset of labor resulted in a transmission rate of 11.9% (n = 59; 95% confidence interval [CI], 4.9 to 22.9). The overall perinatal transmission rate among women who received ZDV therapy after the onset of labor among sites in New York City was 6.3% (n = 32; CI, 0.8 to 20.8) compared with 18.5% (n = 27; CI, 6.3 to 38.0) among other sites. Administration of intrapartum therapy alone (n = 9), intrapartum plus newborn therapy (n = 37), and newborn therapy alone (n = 13) resulted in transmission rates of 11.1% (CI, 0.3 to 48.2), 13.5% (CI, 4.5 to 28.8), and 7.7% (CI, 0.2 to 36.0), respectively. The transmission rates reported here are lower than rates reported when antiretroviral therapy was not administered.


A retrospective analysis of commonly prescribed medications and the risk of developing breast cancer related lymphedema.
Breast cancer related lymphedema (BCRL) is a common complication of current breast cancer treatment modalities, significantly lowering quality of life for these patients and often leading to recurrent infections. Here, based on pre-clinical literature, we aim to retrospectively evaluate the risks of prescribed medications on BCRL development. All post-operative breast cancer patients who received radiotherapy from 2005-2013 at Massachusetts General Hospital and developed lymphedema(n=115) were included in the analysis. Comparable patients without lymphedema(n=230) were randomly selected as control. The following classes of medications were analyzed: NSAIDs, corticosteroids, angiotensin system inhibitors, calcium channel blockers and hormonal therapy. Known risk factors for lymphedema development were included as variables, including BMI, age at diagnosis, type of surgery, number of lymph nodes removed and radiation therapy. Outcomes were BCRL development and lymphedema severity. Similarly, to previous studies, we found that an increase in BMI increases the risk of BCRL(p=0.006) and axillary lymph node dissection has a higher risk of developing BCRL compared to sentinel lymph node biopsy(p=0.045). None of the drugs studied increased the risk of BCRL development or lymphedema severity. However, lymphedema severity was positively correlated with the number of lymph nodes removed(p=0.034). We found that anti-inflammatory drugs, anti-hypertensive drugs and hormonal therapy taken during the year postoperatively do not increase the risk of BCRL development or lymphedema severity in breast cancer patients. While others have demonstrated that the number of lymph nodes removed during surgery increases the risk of BCRL, we found it also correlates to lymphedema severity.


Acetylcholine Attenuated TNF-α-Induced Apoptosis in H9c2 Cells: Role of Calpain and the p38-MAPK Pathway.
Previous studies have shown that inflammation is associated with excessive activation of calpains. Acetylcholine (ACh) has been reported to inhibit pro-inflammatory cytokine release and protect against cardiomyocyte injury. However, there is no direct evidence regarding whether ACh can regulate calpains to exert cardioprotection. To this end, we investigated the effect of ACh on tumour necrosis factor alpha (TNF-α)-induced cardiomyocyte injury and further explored the underlying mechanism. Flow cytometry and transmission electron microscopy were performed to evaluate apoptosis and cellular ultrastructure. Western blotting was performed to assess changes in protein expression. siRNA was employed to silence specific proteins. TNF-α treatment increased the expression of cleaved caspase-3, calpain-1 and p38-mitogen-activated protein kinase (p38- MAPK). The calpain inhibitor PD150606 and the p38-MAPK inhibitor SB203580 inhibited apoptosis induced by TNF-α. Moreover, SB203580 decreased the expression and activity of calpain-1, possibly related to the up-regulation of calpastatin. ACh significantly inhibited TNF-α-induced cell apoptosis, as evidenced by decreases in caspase-3 cleavage, p38-MAPK phosphorylation, and calpain-1 expression and activity as well as increases in calpastatin expression. These beneficial effects of ACh were abolished by atropine or M2AChR siRNA. Our results suggest that ACh ameliorated TNF-α-induced calpain activation by decreasing p38-MAPK phosphorylation and enhancing calpastatin expression, indicating that calpain may be an important link between inflammatory factors and myocardial cell apoptosis.


Does high memory load kick task-irrelevant information out of visual working memory?
The limited capacity of visual working memory (VWM) requires the existence of an efficient information selection mechanism. While it has been shown that under low VWM load, an irrelevant simple feature can be processed, its fate under high load (e.g., six objects) remains unclear. We explored this issue by probing the "irrelevant-change distracting effect," in which the change of a stored irrelevant feature affects performance. Simple colored shapes were used as stimuli, with color as the target. Using a whole-probe method (presenting six objects in both the memory and test arrays), in Experiment 1 we found that a change to one of the six shapes led to a significant distracting effect. Using a partial-probe method (presenting the probe either at the screen center or at a location selected from the memory array), in Experiment 2 we showed the distracting effect again. These results suggest that irrelevant simple features can be stored into VWM, regardless of memory load.


Characterization of Na+/H+ exchange in sheep rumen epithelial cells kept in primary culture.
The study aimed at testing whether Na+/H+ exchange activity is maintained during isolation and cultivation of rumen epithelial cells (REC) and whether Na+/H+ exchange is altered during proliferation and differentiation. REC were isolated from sheep rumen epithelium by fractional trypsinization and further cultivated for up to 21 days. Characteristics of Na+ uptake into cultured REC were the same as previously described for the Na+/H+ exchange in the intact rumen epithelium. Na+ uptake was increased by intracellular acidification and was inhibited by high doses of amiloride. Amiloride inhibited 3H-thymidine incorporation into REC at concentrations similar to those found for the inhibition of Na+ uptake. Fetal calf serum, a growth factor, stimulated amiloride-sensitive Na+ uptake. We therefore conclude that cultured rumen epithelial cells express Na+/H+ exchange and that the activity of the exchange is at least correlated to the intensity of proliferation.


A new look at liming as an approach to accelerate recovery from acidic deposition effects.
Acidic deposition caused by fossil fuel combustion has degraded aquatic and terrestrial ecosystems in North America for over four decades. The only management option other than emissions reductions for combating the effects of acidic deposition has been the application of lime to neutralize acidity after it has been deposited on the landscape. For this reason, liming has been a part of acid rain science from the beginning. However, continued declines in acidic deposition have led to partial recovery of surface water chemistry, and the start of soil recovery. Liming is therefore no longer needed to prevent further damage, so the question becomes whether liming would be useful for accelerating recovery of systems where improvement has lagged. As more is learned about recovering ecosystems, it has become clear that recovery rates vary with watershed characteristics and among ecosystem components. Lakes appear to show the strongest recovery, but recovery in streams is sluggish and recovery of soils appears to be in the early stages. The method in which lime is applied is therefore critical in achieving the goal of accelerated recovery. Application of lime to a watershed provides the advantage of increasing Ca availability and reducing or preventing mobilization of toxic Al, an outcome that is beneficial to both terrestrial and aquatic ecosystems. However, the goal should not be complete neutralization of soil acidity, which is naturally produced. Liming of naturally acidic areas such as wetlands should also be avoided to prevent damage to indigenous species that rely on an acidic environment.


Laparoscopic radical cystectomy with orthotopic ileal neobladder in the female: report of 14 cases.
Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder in female patients with bladder carcinoma. From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4 - 5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope. The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively. Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hysterectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation. LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is required to confirm the neobladder function and oncological outcomes.


One-year follow-up study of patients with enterochromaffin-like cell carcinoids after treatment with octreotide long-acting release.
In a one-year study of 5 patients with chronic atrophic gastritis (CAG), pernicious anaemia (PA), hypergastrinaemia and enterochromaffin-like (ECL) cell tumours, the somatostatin analogue octreotide LAR (long-acting release) in a dose of 20 mg given intramuscularly at monthly intervals had an antiproliferative effect on the ECL cells. The aim of the present study was to follow neuroendocrine (NE) markers in the blood and macroscopic and histopathological changes in the stomach during a 12-month follow-up after discontinuation of octreotide LAR treatment. Five patients underwent upper gastrointestinal endoscopy at 6 and 12 months' follow-up after octreotide LAR treatment. Biopsies from flat, oxyntic mucosa and from tumours were obtained. Sections were stained with haematoxylin-erythrosin and immunostained for the NE cell marker chromogranin A (CgA). Serum gastrin and CgA were measured every 3 months. The number of visible tumours was unchanged (7) at 12 months' follow-up. One lesion showed carcinoid tumour and the others various degrees of linear and micronodular NE hyperplasia. At the same time-point, biopsies from flat, oxyntic mucosa showed a slightly (non-significant) elevated number of CgA immunoreactive (IR) cells. Serum gastrin increased from 186+/-50 pM (mean+/-SEM) to 603+/-109 pM (normal < 40 pM); p<0.05, and serum CgA increased non-significantly from 25+/-2 ng/ml (normal < 30 ng/ml) to 61+/-11 ng/ml. During follow-up, slightly elevated levels of serum CgA and CgA IR cells in the oxyntic mucosa, without significant recurrence of ECL cell carcinoids, were observed.


Determination of the chemical components and phospholipids of velvet antler using UPLC/QTOF-MS coupled with UNIFI software.
Velvet antler, which exhibits immune and growth enhancing effects, is commonly used in a variety of Asian health care products, but its complex components remain unknown. The current study analyzed extracts using ultra-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry in the MSE mode. Automated detection and data filtering were performed using UNIFI software and peaks were compared with a proprietary scientific library (Traditional Medicine Library; TML). The results obtained using different data processing parameters (including 3D peak detection, target by mass and fragment identification) were evaluated against 87 compounds comprising 1 lignan, 30 terpenoids (including 20 triterpenes), 39 steroids, 8 alkaloids, 4 organic acids and 5 esters in the TML. Using a screening method with a mass accuracy cutoff of ±2 mDa, a retention time cutoff of ±0.2 min, a minimum response threshold of 1,000 counts and an average of 10 false detects per sample analysis, 16 phospholipids were identified in the extracts of velvet antler, three of which were quantified. The results demonstrated that there was 1.07±0.02 µg/g of 1-myristoyl-sn-glycero-3-phosphocholine, 7.05±0.52 ng/g of 1,2-dimyristoyl-sn-glycero-3-phosphocholine and 18.81±0.55 ng/g of 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine in velvet antler. The current study successfully identified certain components of velvet antler. Furthermore, the results may provide an experimental basis for further pharmacological and clinical study.


Pharmacodynamics of a novel designer natriuretic peptide, CD-NP, in a first-in-human clinical trial in healthy subjects.
CD-NP is a novel chimeric natriuretic peptide (NP) consisting of the 22-amino-acid (AA) human C-type natriuretic peptide (CNP), a venodilating peptide with limited renal actions and minimal effects on blood pressure, and the 15-AA C-terminus of Dendroaspis NP (DNP). The rationale for the design of CD-NP was to enhance the renal actions of CNP, the ligand for natriuretic peptide receptor-B, but without inducing excessive hypotension. Here we report the first-in-human studies for CD-NP, which represent the first successful clinical testing of a chimeric NP demonstrating in normal human volunteers that CD-NP possesses cyclic guanosine monophosphate-activating, natriuretic, and aldosterone-suppressing properties without inducing excessive hypotension, laying the foundation for additional studies on this first-in-class new cardiovascular therapeutic in human heart failure, which are now underway worldwide.


Expression of lipoprotein lipase mRNA and secretion in macrophages isolated from human atherosclerotic aorta.
The expression of lipoprotein lipase (LPL) mRNA and the LPL activity were studied in macrophages (CD14 positive) from human atherosclerotic tissue. Macrophages were isolated after collagenase digestion by immunomagnetic isolation. About 90% of the cells were foam cells with oil red O positive lipid droplets. To analyze the mRNA expression, PCR with specific primers for LPL was used. Arterial macrophages were analyzed directly after isolation and the data showed low expression of LPL mRNA when compared with monocyte-derived macrophages. To induce the expression of LPL mRNA in macrophages, PMA was used. When incubating arterial macrophages with PMA for 24 h we could not detect any increase in LPL mRNA levels. Similarly, the cells secreted very small amounts of LPL even after PMA stimulation. In conclusion, these studies show a very low expression of LPL mRNA in the CD14-positive macrophage-derived foam cells isolated from human atherosclerotic tissue. These data suggest that the CD14-positive cells are a subpopulation of foam cells that express low levels of lipoprotein lipase, and the lipid content could be a major factor for downregulation of LPL. However, the cells were isolated from advanced atherosclerotic lesions, and these findings may not reflect the situation in early fatty streaks.


Smoking stage relations to peer, school and parental factors among secondary school students in Kinta, Perak.
To identify the prevalence of different stages of smoking and differences in associated risk factors. Thos longitudinal study started in February 2011 and the subjects were 2552 form one students aged between twelve to thirteen years of from 15 government secondary schools of Kinta, Perak. Data on demographic, parental, school and peer factors were collected using a self-administered questionnaire. We examined the effects of peer, school and parental factors on the five stages of smoking; never smokers, susceptible never smokers, experimenters, current smokers and ex-smokers, at baseline. In the sample, 19.3% were susceptible never smokers, 5.5% were current smokers 6% were experimenters and 3.1% were ex-smokers. Gender, ethnicity, best friends' smoking status, high peer pressure, higher number of relatives who smoked and parental monitoring were found to be associated with smoking stages. Presence of parent-teen conflict was only associated with susceptible never smokers and experimenters whereas absence of home discussion on smoking hazards was associated with susceptible never smokers and current smokers. We identified variations in the factors associated with the different stages of smoking. Our results highlight that anti-smoking strategies should be tailored according to the different smoking stages.


Multidrug resistant P-glycoprotein positive L1210/VCR cells are also cross-resistant to cisplatin via a mechanism distinct from P-glycoprotein-mediated drug efflux activity.
P-glycoprotein (P-gp, a drug transporter found in the plasma membrane)-mediated multidrug resistance of leukemia cells represents a real obstacle in the effective chemotherapeutic treatment of leukemia. While cisplatin (CisPt) is known to be a substance that is untransportable by P-gp, P-gp positive cells were often found to be resistant to CisPt. The aim of the current paper is to study this phenomenon using P-gp positive mouse leukemia cells L1210/VCR in which the overexpression of P-gp was induced by its ability to adapt to growth on vincristine (VCR). L1210/VCR cells are also resistant to CisPt. However, resistance to this substance could not be reversed by addition of the known P-gp inhibitor verapamil. CisPt induced more pronounced entry into apoptosis, as measured using the annexin V/propidium iodide kit, in sensitive L1210 cells than in resistant L1210/VCR cells. In addition, CisPt induced an increase in the proportion of L1210 cells that were in the g2 phase of the cell cycle when compared to L1210/VCR cells, as measured by staining with propidium iodide. Similarly, a higher release of cytochrome c from the mitochondria to the cytosol was induced by CisPt treatment in L1210 than in L1210/VCR cells. While similar levels of Bax and Bcl-2 proteins were observed in sensitive and resistant cells, CisPt induced a more pronounced decrease of the Bcl-2 levels in L1210 cells than in L1210/VCR cells. Consistent with this observation, CisPt induced a larger decrease of the Bcl-2 content in the Bcl-2:Bax heterooligomer in L1210 cells than in L1210/VCR cells. Moreover, CisPt induced a similar apoptotic DNA fragmentation pattern in both resistant and sensitive cells. All of the above observations indicated that L1210/VCR cells are also resistant to CisPt and that this resistance is related to the differences in the regulatory mechanisms responsible for CisPt-induced apoptosis in L1210/VCR cells without any contribution from the drug efflux activity of P-gp.


Tax reform for low-wage workers.
As a result of the recent implementation of work-oriented antipoverty programs, more welfare recipients can be expected to be working in low-wage jobs. With these jobs there is little hope that these workers' incomes will rise above the poverty level. One way to help support these low-wage workers is through tax reform. Although low-wage workers pay little or no federal tax, they still pay high payroll and local taxes. To help such workers keep more of their earnings, refundable taxes like earned income tax credit and child refund taxes should be expanded, and sales taxes on food should be eliminated.


Interlaboratory comparison of measurements of the spectral irradiance from fluorescent and incandescent lamps: a report.
A comparison of spectroradiometric measurements has been completed for the wavelength region from 300 nm to 800 nm. The measurement procedures and results obtained in eighteen laboratories are described. The results are considerably better than those in earlier comparisons. Conclusions regarding procedures to be avoided are given. Without special precautions 45 degrees illumination on the diffuse receiver may cause serious errors. Normal illumination on a plane or a spherical receiver is better. The power in the spectral lines was inaccurately measured by Rössler's method.


Venous Thromboembolism Due to Oral Contraceptive Intake and Spending Nights in a Vehicle -A Case from the 2016 Kumamoto Earthquakes.
A 40-year-old woman experiencing sudden dyspnea went to her personal doctor for advice. She was previously diagnosed with endometriosis and prescribed oral contraceptives for treatment. During earthquakes, she spent 7 nights sleeping in a vehicle. The patient had swelling and pain in her left leg and high D-dimer concentration levels. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the left lower extremity. She was diagnosed with pulmonary thromboembolism (PTE), and anticoagulation therapy was initiated. This present case is the first report of PTE attributed to the use of oral contraceptives after earthquakes.


Properties of 500Hz air- and bone-conducted vestibular evoked myogenic potentials (VEMPs) in superior canal dehiscence.
To compare threshold and amplitude properties for air- (AC) and mastoid bone-conducted (BC) cervical (cVEMP) and ocular (oVEMP) vestibular evoked myogenic potentials in superior canal dehiscence (SCD). Thirteen patients (53±14yrs) clinically diagnosed with SCD were tested using AC 500Hz sound and BC 500Hz transmastoid vibration. Baseline intensities of 135dBpSPL and 138dBpFL respectively were used and reduced until the response amplitudes were less than 2.5 standard deviations of the prestimulus baseline mean. SCD VEMP amplitudes, response gradients and threshold parameters for the initial peaks for the cVEMP (ipsilateral) and the oVEMP (contralateral) were compared with results for normal subjects over a range of intensities. Despite higher amplitudes, reflex gradients against intensity for AC and BC cVEMPs were significantly less in SCD than normals (P≪0.001) while AC and BC oVEMP gradients were not significantly different between the groups. Abnormally low thresholds for AC 500Hz were present for 85% of cVEMPs and 62% of oVEMPs. Abnormally low BC 500Hz thresholds were seen for 33% of cVEMPs and 83% of oVEMPs. Amplitudes for AC 500Hz were compared over the 135-105dBpSPL intensity range. The cVEMP showed more pathologically large amplitude responses with the lower stimulus intensities (135dBpSPL: 5%, 105dBpSPL: 100%) whereas the oVEMP demonstrated high rates of amplitude increases for all intensities (129-111dBpSPL: 92%). The pattern of pathologically large amplitudes evoked by BC 500Hz was similar for both reflexes such that both cVEMPs and oVEMPs showed maximum prevalence of abnormally large responses around 117dBpFL (cVEMP: 58%, oVEMP: 83%). In SCD, both AC and BC evoked cVEMPs show evidence of saturation but this is not evident for oVEMPs. Both cVEMPs and oVEMPs show frequent abnormalities of amplitudes and thresholds in SCD compared to normal subjects but the sensitivities differed between measures. Previous evidence of saturation of cVEMP responses in SCD was confirmed. For diagnosis, AC cVEMP amplitudes at 105dBpSPL or AC-evoked oVEMP amplitudes both have over 90% sensitivity in separating SCD from normal responses.


Using confidence assessment to explore physiotherapists, dieticians, speech pathologists and occupational therapists knowledge of medicines.
Medicines are the largest single intervention provided to patients on admission to hospital. Adverse effects of medicines may decrease the ability of patients to participate in clinical interventions from physiotherapists, dietitians, speech pathologists and occupational therapists (PDSOs), which in turn impacts on quality of care and length of hospital stay. PDSOs receive medicines education as part of their undergraduate degree but little education once commencing practice. Pharmacists' possess significant knowledge about medicines and are well placed to educate PDSOs about medicines which may benefit their interventions. This study used certainty- based scoring to evaluate an interprofessional workshop addressing medicines safety information for PDSOs. Scoping interviews established baseline knowledge. Interview data was then used to formulate the workshop and case study. Knowledge was assessed using a pre and post quiz including a certainty- based score. A two-hour pilot workshop attracted thirty-three attendees from the PDSO professions. A trend towards more correct answers and increased certainty they were correct was observed from pre to post quiz. This style of workshop measures PDSOs knowledge of, and competence with, medicines. The assessment for competence is an important consideration with increasing numbers of medicines and complexity of patients potentially increasing risk of adverse events.


Influence of hyaluronic acid on bacterial and fungal species, including clinically relevant opportunistic pathogens.
Hyaluronic acid (HA) has several clinical applications (aesthetic surgery, dermatology, orthopaedics and ophtalmology). Following recent evidence, suggesting antimicrobial and antiviral properties for HA, we investigated its effects on 15 ATCC strains, representative of clinically relevant bacterial and fungal species. The in vitro system employed allowed to assess optical density of broth cultures as a measure of microbial load in a time-dependent manner. The results showed that different microbial species and, sometimes, different strains belonging to the same species, are differently affected by HA. In particular, staphylococci, enterococci, Streptococcus mutans, two Escherichia coli strains, Pseudomonas aeruginosa, Candida glabrata and C. parapsilosis displayed a HA dose-dependent growth inhibition; no HA effects were detected in E. coli ATCC 13768 and C. albicans; S. sanguinis was favoured by the highest HA dose. Therefore, the influence of HA on bacteria and fungi warrants further studies aimed at better establishing its relevance in clinical applications.


Luteinized thecoma with sclerosing peritonitis.
Clement and colleagues recently described a group of six patients who had spindle cell proliferations of the ovary resembling luteinized thecomas. A fatal case of extensive sclerosing peritonitis associated with an identical ovarian proliferation is reported. In addition, several other cases in the literature that almost certainly represent the same disease entity have been identified. To our knowledge, this report increases the number of cases to 13. The extensive peritoneal disease along with the high mitotic activity of the ovarian tumor resulted in the diagnosis of peritoneal dissemination of an ovarian cancer in some cases, including the one currently described. Awareness of this newly described condition, which may be more common than previously thought, may help prevent further misdiagnosis.


Cost Utility of Schlemm's Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System.
Hydrus microstent (HMS) implantation at the time of cataract surgery appears to be cost-effective in mild-to-moderate glaucoma. However, long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness. The aim was to assess the societal cost-utility to the US Medicare system of implanting HMS with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma. Markov model cohort of patients with mild-to-moderate open-angle glaucoma and visually significant cataract. Patients received HMS during cataract surgery versus cataract surgery alone, in a deterministic model over a 2-year horizon using TreeAge software. Both arms received additional ocular hypotensive agents to control intraocular pressure. Treatment effect of HMS was measured as mean number of ocular hypotensive medications and intraocular pressure, which directly impacted transition probabilities. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. One-way sensitivity and probabilistic sensitivity analyses were conducted on device efficacy and longer time horizons. At 2 years, HMS with cataract surgery in mild glaucoma had an incremental cost-utility ratio of USD 38,346.43 per utility gained, compared with cataract surgery alone. Probabilistic sensitivity analysis was cost-effective in 61.4% of iterations for HMS+cataract surgery. The probability of side-effects with eye drops, utility decrement with side-effects, cost of the HMS and real-world efficacy rate had the greatest impact on model outcomes. HMS must be 85.60% as effective as published data to maintain cost-effectiveness at a willingness-to-pay threshold of USD 50,000. The incremental cost-utility ratio of HMS with cataract surgery in moderate glaucoma was USD 42,895.38. HMS implantation during cataract surgery appears to be cost-effective for patients with mild-to-moderate glaucoma. Nevertheless, more long-term safety and efficacy data are required.


Subsurface microstructure of metal-on-metal hip joints and its relationship to wear particle generation.
To control and minimize wear of metal-on-metal hip joints it is essential to understand the mechanisms of debris generation. In vivo, mainly nanosize globular and needle-shaped particles are found. These can neither stem from the action of abrasion nor from tribochemical reactions. In this study the acting wear mechanisms have been first identified on the surface by means of scanning electron microscopy (SEM). Afterwards, the microstructures of the subsurface regions of explants have been investigated using a transmission electron microscope (TEM). Observation of the subsurface gave additional insight about the microstructural changes of cobalt-base alloys subjected to wear. At some distance from the surface, a network of stacking faults and hexagonal epsilon-martensite was found strengthening the bulk material. This microstructure changed into a nanocrystalline type moving closer towards the surface. A comparison of in vivo debris size and grain size of the surface suggests that the globular wear particles result from torn off nanocrystals, while the needle shaped particles are generated by fractured epsilon-martensite. Identified cracks, propagating through the nanocrystalline layer, further support these findings. Thus, it is suggested that the dominating mechanism of particle generation for metal-on-metal joints is surface fatigue within a nanocrystalline surface layer.


[Biological and clinical significance of acute phase proteins with particular emphasis on the role of C-reactive protein].
The acute phase response is a non-specific, early phenomenon, in which the concentration of a number of plasma proteins is increased following most forms of tissue injury, bacterial infection, inflammation, malignant neoplasia and surgical procedures. These plasma proteins are collectively termed acute-phase proteins. Their most important role is to restore the homeostasis of human organism. C-reactive protein (CRP) regarding his dynamic reaction, is one of the best non-specific biochemical indicators of most disorders. The multiple quantitative measurement of CRP is usefull in the diagnosis, differentiation, the assessment of treatment effectiveness and patient's prognosis, additionally to other clinical parameters.


Combination syndrome in relation to osseointegrated implant-supported overdentures: a survey.
Thirteen patients who had worn a maxillary conventional denture and mandibular osseointegrated implant-supported overdenture for at least 3 years were evaluated for subjective assessment of fit of the maxillary denture, occlusal integrity, and the status of the anterior maxillary residual ridge. The findings of this study support the view that this combination of prostheses can result in perceived loosening of the maxillary denture, loss of posterior occlusion, increased anterior occlusal pressure, and anterior maxillary bone loss, similar to the effects seen in Combination Syndrome. It is therefore important to ensure that where an implant-supported mandibular overdenture is planned for the edentulous patient, some form of stabilisation of the maxillary arch is also considered.


Estrogen receptor 1 gene expression and its combination with estrogen receptor 2 or aromatase expression predicts survival in non-small cell lung cancer.
The biological roles of estrogen receptor 1 (ERS1), estrogen receptor 2 (ERS2), and aromatase (CYP19A1) genes in the development of non-small cell lung cancer (NSCLC) is unclear, as is the use of their expression as a prognostic factor. The aim of this study was to investigate the prognostic value of estrogen receptors and aromatase mRNA expression, along with aromatase protein concentration, in resected NSCLC patients. Tumor and non-tumor lung tissue samples were analyzed for the mRNA expression of ERS1, ERS2 and CYP19A1 by RT-PCR. Aromatase concentration was measured with an ELISA. A total of 96 patients were included. ERS1 expression was significantly higher in non-tumor tissue than in tumor samples. Two gene expression categories were created for each gene (and protein): high and low. ERS1 high category showed increased overall survival (OS) when compared to the low expression category. Aromatase protein concentration was significantly higher in tumor samples. Higher ERS1 expression in tumor tissues was related to longer overall survival. The analysis of gene expression combinations provides evidence for longer OS when both ERS1 and ERS2 are highly expressed. ESR1, alone or in combination with ERS2 or CYP19A1, is the most determining prognostic factor within the analyzed 3 genes. It seems that ERS1 can play a role in NSCLC prognosis, alone or in combination with other genes such as ERS2 or Cyp19a1. ERS2 in combination with aromatase concentration could have a similar function.


Geropsychiatry in long-term care: a nurse-centered approach.
High prevalence rates of psychiatric disorders and disruptive behaviors in nursing home residents create the need for structured programs of psychiatric consultation and teaching in the long-term care setting. Over 40 months, 473 residents were evaluated by a psychiatric consultation-liaison clinical nurse specialist; 100 of these cases were reviewed in detail. Apparent depression was the most common reason for referral, and depressive and adjustment disorders were the most common diagnostic conclusions of the consultation team. Behavioral complications of dementia were also frequently diagnosed. Treatment recommendations usually included the development of a behavioral management plan, but the institution of psychotropic medications, usually antidepressants, was indicated in about one-fifth of the 100 cases. Treatment interventions were effective in the majority of cases. About one-half of the problems prompting referral were within the expertise of the nurse specialist and did not require the direct involvement of the geropsychiatrist. This nurse-centered consultation model proved effective, well accepted, and easy to implement.


Accuracy of percutaneous soft-tissue interventions using a multi-axis, C-arm CT system and 3D laser guidance.
Purpose of this phantom study was to compare the accuracy of needle placement using a multi-axis, C-arm-based, flat-panel, cone-beam computed tomography system (CBCT guidance) with that under multi-detector computed tomography guidance (MDCT guidance). In an abdominal phantom, eight lesions (six lesions in the liver and two in the renal pelvises, respectively) were each punctured in-plane and off-plane with a 20G needle under CBCT and MDCT guidance. Access paths were initially defined and reproduced identically on the two systems. In total, 32 interventions were conducted. CBCT and MDCT guidance was compared prospectively with respect to technical success, accuracy, and overall procedural time. All 32 interventions were technically successful in that it was possible to hit the respective lesion in each procedure. When comparing the accuracy of MDCT to CBCT guidance there was no significant difference in absolute, angular, and longitudinal deviation for either in- or off-plane interventions. Overall procedural duration was significantly longer under CBCT guidance for in-plane interventions (888 vs 527s, p=0.00005), whereas, for off-plane procedures there was no significant difference between CBCT and MDCT guidance (920 vs 701s, p=0.08). Off-plane interventions took significantly longer than in-plane interventions under MDCT guidance (701 vs 527s, p=0.03), whereas under CBCT guidance no significant difference could be found between off- and in-plane procedures (920 vs. 888s, p=0.2). In this phantom study, we could show that percutaneous soft-tissue interventions under CBCT guidance can be conducted with an accuracy comparable to that under MDCT guidance. Although overall procedural duration is in general shorter using MDCT guidance, CBCT-guided interventions offer the advantage of more degrees of freedom, which is of particular importance for off-plane procedures.


Ischemic stroke in the vertebrobasilar system. Risk factors, etiology, and localization.
To investigate and determine the clinical findings, lesions, risk factors, and variety of etiology in Turkish patients suffering from vertebrobasilar ischemia. The clinical, radiological, and prognostic features of patients with ischemic stroke in the vertebrobasilar system (VBS) are not homogeneous. The mechanism, localization, and severity of the vascular lesions and the presence of coexisting vascular risk factors influence the prognosis. The study included 134 patients with ischemic strokes in the VBS that were evaluated according to age, gender, clinical findings, risk factors, lesion localization, echocardiography, Doppler sonography, and cervical magnetic resonance angiography at Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey between 1998-2002. Hypertension, heart disease, smoking, diabetes mellitus, and hyperlipidemia were the most commonly observed risk factors. While infratentorial involvement was seen at a higher ratio (75.4%), acute multi-infarcts appearing simultaneously were mostly localized in the thalamus and the brain stem (18.7%). Large and small vessel disease incidences have been found in 32.8% and 20.1% of the patients. Cardioembolism with an incidence rate of 41.8% was the most frequent etiological cause in VBS ischemia. No significant meaning has been developed with age and gender as compared to the relationship between localization and etiological subgroups. The most common risk factors were hypertension and cardiac diseases, and the most common localization of the infarcts was the infratentorial region. The cerebellum was seen as the most coexisting localization with all multiple infarcts. Cardioembolism accounted for the largest etiological group in all localizations and in multiple infarcts.


Are Intertrochanteric Fractures Evolving? Trends in the Elderly Population over a 10-Year Period.
Intramedullary devices for the fixation of intertrochanteric fractures are increasing in usage and popularity. This reflects either a shift in adoption of new technology or intertrochanteric fractures becoming more complex or unstable. This trend was observed in our institution, hence we set out to investigate if this was concordant with an associated change in the demographics of the patients or in the morphology of the intertrochanteric fracture pattern over a 10-year period. This is a retrospective cross-sectional comparison undertaken for the first 100 consecutive elderly patients with intertrochanteric fractures admitted to our tertiary institution over 3 yearly intervals, in each of the years 2004, 2007, 2010, and 2013. Fractures were radiologically classified via the Evans and AO classifications. Patient demographics such as age, ethnicity, and comorbidities and surgical data including time, type of fixation, time to surgery, and length of stay were collected via case note reviews to identify possible trends. The overall mean age was 80.5 years, with no statistically significant trend among age, sex, ethnicity, and comorbidities over the 10-year period. The main finding was a rise in the proportion of unstable intertrochanteric fractures. The proportion of such fractures was 30% in 2004, 42% in 2007, 47% in 2010, and 62% in 2013 (p < 0.001). Patients admitted for intertrochanteric fractures also experienced a shorter hospital length of stay and an increasing trend towards early fracture fixation (p < 0.001), with a greater usage of intramedullary nails in the treatment of such fractures (p < 0.001). Intertrochanteric fractures in elderly patients have evolved into more complex fractures over the past ten years, despite there being no change in the age of the patients over the same duration. This increasing proportion of unstable intertrochanteric fractures has brought about a greater tendency to fix these fractures with intramedullary implants.


Accidental falls among community-dwelling older adults: improving the identification process of persons at risk by nursing staff.
Elderly persons living in the community are a heterogeneous population. Among them, the screening of persons at risk of falling is still a matter of debate. The aim of this analysis was to improve the identification process of elderly persons living in the community at risk for falling by nursing staff of community- based services. A secondary analysis was performed with the data from a prospective non-randomized interventional trial. The study included 268 community-dwelling older adults (mean age of 82 years, 81.3% female) from Ulm and Neu-Ulm with a followup period of 12 months. Fall risk indicators were extracted from the nursing assessment and analysis with crude odds ratios revealed the following risk indicators for falls: assistance when transferring, bathing and climbing a flight of stairs as well as fall history. Afterwards, fall risk indicators were selected by backward elimination in a multiple logistic regression. Variable selection identified a positive fall history and the need for assistance when bathing as important risk indicators. These two risk indicators could be used as a screening tool, which would be easy to perform by nursing staff in their daily work. This screening test defined as more than one fall in the last 12 months or bathing assistance, the first ADL to be affected in the disablement process, has a sensitivity of 85.3% and a specificity of 42.1%.


Mineral Oil Aspiration Related Juvenile Idiopathic Arthritis.
We describe the development of rheumatoid factor-positive migratory polyarthritis in a 5-year-old male who had been administered bidaily oral mineral oil as a laxative since birth. Minor respiratory symptoms, radiographic and bronchoscopic findings were consistent with chronic lipoid pneumonia. We speculate that immune sensitization to mineral oil promoted the clinical syndrome of juvenile idiopathic arthritis.


Development of a Lumbar Extradural Arachnoid Cyst Associated with a Lumbar Catheter of Lumboperitoneal Shunt: A Case Report.
A 78-year-old man, who had undergone lumboperitoneal shunt (LPS) placement for idiopathic normal-pressure hydrocephalus eight years prior, presented with intermittent claudication, lower back pain, and radicular pain on the inside of the right thigh. Magnetic resonance imaging (MRI) revealed an extradural arachnoid cyst (EDAC) above the lumbar catheter of the LPS. The EDAC compressed the spinal dural sac and cauda equina toward the anterior side at level L3/4, triggering his clinical manifestations. The LPS was removed and simultaneously converted into a ventriculoperitoneal shunt (VPS), which immediately improved the neurological deficits. Postoperative MRI showed shrinkage of the cyst and restoration of the compressed cauda equina. Spinal EDAC is a rare entity resulting from arachnoid membrane herniation due to a small defect in the dura mater. This is the first report showing that symptomatic EDAC can be accompanied by the lumbar catheter of the LPS and that a mere conversion from LPS to VPS or ventriculoatrial shunt might be sufficient to shrink LPS-related EDAC without invasive lumbar surgeries.


Pathology services: market overview. Fulton, Longshore & Associates, Inc.
The study reported in this issue of DRG Monitor focuses on services provided by Directors of Pathology and was designed to characterize those services and to develop criteria to assist hospitals in assessing the appropriateness of their professional staffing in Pathology.


Detection of antibodies to varicella-zoster virus proteins in sera from the elderly.
Sera from 40 elderly individuals ranging in age from 60 to 94 years were tested for the presence of antibodies to varicella-zoster virus (VZV)-specific proteins. Sodium dodecylsulfate polyacrylamide gel electrophoresis analysis of lysates of VZV-infected BSC-1 cells labeled with either [35S]methionine or [3H]mannose and immunoprecipitated with human sera revealed the variable presence of VZV-specific antibodies to four VZV glycoproteins (gpI, gpII, gpIII, and gpIV), and three nonglycosylated proteins (155, 140, 32 kilodaltons, kDa). The predominant antibody response in the sera from the elderly was to VZV gpII and the 155-kDa species. In addition, some sera from elderly individuals without an identifiable history of varicella or zoster contained antibodies to VZV proteins, suggesting a possible subclinical infection in these patients. Finally a history of zoster in the elderly was significantly correlated (p = 0.02) with the presence of antibody to gpIV.


[Surgical outcomes of different approaches for mesial temporal lobe gliomas].
To analyze the surgical outcomes of different approaches for mesial temporal lobe gliomas. Microsurgery was performed via trans-sylvian, trans-temporal, or subtemporal approaches on 62 patients with mesial temporal lobe gliomas, 33 with localized tumors within the mesial temporal structures (type A), 19 in anterior portion (type A1), and 14 extending to posterior portion (type A2); 19 patients with multicompartmental tumors involving the mesial temporal lobe, insular lobe, and posterior frontorbital gurus (type B); 14 patients with tumors involving the temporal pole and lateral areas of the temporal horn (type C); and 6 patients with tumors infiltrating the brain stem, basal nuclei and thalamus (type D). Trans-sylvian approach was performed in 25 cases of which total tumor removal was achieved in 14 cases, subtotal removal in 6 cases, and gross removal in 5 cases. Primary visual deficits worsened after surgery in 5 cases. Trans-temporal approach was used in 23 cases of which total tumor resection was achieved in 15 cases, subtotal resection in 5 cases, and gross resection in 3 cases. Primary visual deficits worsened after surgery in 5 cases. Four patients in which preoperative vision were good presented with visual deficits postoperatively. Subtemporal approach was used in 14 cases of which total tumor removal was achieved in 10 cases, and subtotal removal in 4 cases. All 14 patients did not develop worsened vision after surgery. Trans-sylvian and subtemporal approaches can reduce possible harm to parenchyma and optic radiation, whereas approaches to the temporal horn through the superior and middle temporal gyri will induce damage to parenchyma and optic radiation.


3-Methyl-1,5-diphenyl-4,5-dihydro-1H-pyrazole.
In the title compound, C16H16N2, the dihydro-pyrazole ring adopts a shallow envelope conformation, with the C atom bearing the phenyl group displaced by 0.298 (2) Å from the other atoms (r.m.s. deviation = 0.015 Å). The dihedral angles between the four near coplanar atoms of the central ring and the N- and C-bonded phenyl groups are 13.49 (13) and 82.22 (16)°, respectively.


Clinical experience with the words-in-noise test on 3430 veterans: comparisons with pure-tone thresholds and word recognition in quiet.
Since the 1940s, measures of pure-tone sensitivity and speech recognition in quiet have been vital components of the audiologic evaluation. Although early investigators urged that speech recognition in noise also should be a component of the audiologic evaluation, only recently has this suggestion started to become a reality. This report focuses on the Words-in-Noise (WIN) Test, which evaluates word recognition in multitalker babble at seven signal-to-noise ratios and uses the 50% correct point (in dB SNR) calculated with the Spearman-Kärber equation as the primary metric. The WIN was developed and validated in a series of 12 laboratory studies. The current study examined the effectiveness of the WIN materials for measuring the word-recognition performance of patients in a typical clinical setting. To examine the relations among three audiometric measures including pure-tone thresholds, word-recognition performances in quiet, and word-recognition performances in multitalker babble for veterans seeking remediation for their hearing loss. Retrospective, descriptive. The participants were 3430 veterans who for the most part were evaluated consecutively in the Audiology Clinic at the VA Medical Center, Mountain Home, Tennessee. The mean age was 62.3 yr (SD = 12.8 yr). The data were collected in the course of a 60 min routine audiologic evaluation. A history, otoscopy, and aural-acoustic immittance measures also were included in the clinic protocol but were not evaluated in this report. Overall, the 1000-8000 Hz thresholds were significantly lower (better) in the right ear (RE) than in the left ear (LE). There was a direct relation between age and the pure-tone thresholds, with greater change across age in the high frequencies than in the low frequencies. Notched audiograms at 4000 Hz were observed in at least one ear in 41% of the participants with more unilateral than bilateral notches. Normal pure-tone thresholds (≤20 dB HL) were obtained from 6% of the participants. Maximum performance on the Northwestern University Auditory Test No. 6 (NU-6) in quiet was ≥90% correct by 50% of the participants, with an additional 20% performing at ≥80% correct; the RE performed 1-3% better than the LE. Of the 3291 who completed the WIN on both ears, only 7% exhibited normal performance (50% correct point of ≤6 dB SNR). Overall, WIN performance was significantly better in the RE (mean = 13.3 dB SNR) than in the LE (mean = 13.8 dB SNR). Recognition performance on both the NU-6 and the WIN decreased as a function of both pure-tone hearing loss and age. There was a stronger relation between the high-frequency pure-tone average (1000, 2000, and 4000 Hz) and the WIN than between the pure-tone average (500, 1000, and 2000 Hz) and the WIN. The results on the WIN from both the previous laboratory studies and the current clinical study indicate that the WIN is an appropriate clinic instrument to assess word-recognition performance in background noise. Recognition performance on a speech-in-quiet task does not predict performance on a speech-in-noise task, as the two tasks reflect different domains of auditory function. Experience with the WIN indicates that word-in-noise tasks should be considered the "stress test" for auditory function.


[Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community].
This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors. The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors. The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p =.003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029). This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.


Noninvasive determination of pulmonary artery wedge pressure: comparative analysis of pulsed Doppler echocardiography and right heart catheterization.
To compare left ventricular filling variables as derived by transmitral pulsed Doppler echocardiography (tpDE) and hemodynamic variables as assessed at right heart catheterization (RHC), 104 ICU patients (64 male, 40 female) aged 26 to 73 yr (mean 54.6 +/- 10.3) without valvular heart disease were examined. Simultaneously with RHC, transmitral flow velocity profiles were obtained by tpDE, and the ratio of the velocity-time integrals of late diastolic active (A wave) and early diastolic passive inflow into the left ventricle (E wave) was calculated (A/E ratio). Invasively determined pulmonary capillary wedge pressure (WP) ranged from 3 to 36 mm Hg (median 13.35, 5%/95% 6/31 mm Hg). Linear regression analysis showed a highly significant correlation between the A/E ratio and WP (r = .98, p less than .001, standard error of the estimate [SEE] = 0.10). The A/E ratio also correlated with other hemodynamic variables such as cardiac output (r = -.68, p less than .001, SEE = 0.33), cardiac index (r = -.74, p less than .001, SEE = 0.31), and stroke volume index (r = -.68, p less than .001, SEE = 0.34). The interobserver agreement (derived by intraclass correlation analysis between two examiners) on the A/E ratio was high (r = .95, p less than .001, n = 26). We conclude that WP can be accurately determined noninvasively by tpDE. For the assessment of systolic ventricular function, tpDE is of limited diagnostic value.