Parasomnias. Things that go thump in the night.
General practitioners are well versed with patients presenting to the surgery with sleep symptoms, however, the approach to evaluating these symptoms is often haphazard. Insomnia is the commonest presenting complaint. Sleep apnoea, although readily treatable, carries with it significant morbidity and mortality. This article aims to highlight those disorders that occur infrequently during the night but which interrupt sleep--the parasomnias. Knowledge of the spectrum of parasomnias and their symptoms usually allows a reasonably accurate clinical diagnosis and the assistance of a sleep physician or sleep laboratory is not often required. Parasomnias may be classified by the sleep phase during which they occur. Nonrapid eye movement (NREM) parasomnias are most likely to occur during the first episode of stages 3 and 4 of NREM sleep (slow wave sleep) which is approximately one hour after sleep onset. Rapid eye movement (REM) sleep density is usually greatest in the last few hours of sleep, therefore REM sleep parasomnias are most likely to occur during this time.


Cognitive Bias Modification: Past Perspectives, Current Findings, and Future Applications.
Research conducted within the general paradigm of cognitive bias modification (CBM) reveals that emotional biases in attention, interpretation, and memory are not merely associated with emotional disorders but contribute to them. After briefly describing research on both emotional biases and their modification, the authors examine similarities between CBM paradigms and older experimental paradigms used in research on learning and memory. The techniques and goals of CBM research are compared with other approaches to understanding cognition-emotion interactions. From a functional perspective, the CBM tradition reminds us to use experimental tools to evaluate assumptions about clinical phenomena and, more generally, about causal relationships between cognitive processing and emotion.


Management of retained foreign bodies and rectal sexual trauma.
Little is written in medical or nursing literature about the incidence or management of rectal foreign bodies or rectal sexual trauma. Circumstantial evidence suggests that this rare problem is becoming more common. This article discusses the incidence, methods and treatment options for patients with this problem, and the nurse's role in ensuring they are cared for in a sensitive manner.


The need for evidence-based health policy to address health care variations.
Medicare policy making now deals mostly with price-setting issues. However, as Warren Buffet has noted: "Price is what you pay. Value is what you get." Victor Fuchs's studies raise fundamental issues for a value-oriented Medicare program. Florida offers one of many regional patterns of Medicare mortality that are not yet adequately explained. Valued-oriented, evidence-based Medicare policies would target opportunities to improve population health and would foster greater use of evidence-based medicine.


Exome sequencing and functional analyses revealed CETN1 variants leads to impaired cell division and male fertility.
Human spermatogenesis requires an orchestrated expression of numerous genes in various germ cell subtypes. Therefore, the genetic landscape of male infertility is highly complex. Known genetic factors alone account for at least 15% of male infertility. However, ~40% of infertile men remain undiagnosed and are classified as idiopathic infertile men. We performed exome sequencing in 47 idiopathic infertile men (discovery cohort), followed by replication study (40 variants in 33 genes) in 844 infertile men and 709 controls using Sequenom MassARRAY® based genotyping. We report 17 variants in twelve genes that comprise both previously reported (DNAH8, DNAH17, FISP2 and SPEF2) and novel candidate genes (BRDT, CETN1, CATSPERD, GMCL1, SPATA6, TSSK4, TSKS and ZNF318) for male infertility. The latter have a strong biological nexus to human spermatogenesis and their respective mouse knockouts are concordant with human phenotypes. One candidate gene CETN1, identified in this study, was sequenced in another independent cohort of 840 infertile and 689 fertile men. Further, CETN1 variants were functionally characterized using biophysical and cell biology approaches. We demonstrate that CETN1 variant- p.Met72Thr leads to multipolar cells, fragmented nuclei during mitosis leading to cell death and show significantly perturbed ciliary disassembly dynamics. Whereas CETN1-5' UTR variant; rs367716858 leads to loss of a methylation site and increased reporter gene expression in vitro. We report a total of eight novel candidate genes identified by exome sequencing, which may have diagnostic relevance and can contribute to improved diagnostic workup and clinical management of male infertility.


Intentional replantation of periodontally compromised hopeless tooth.
Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. Even single tooth mal-alignment makes the patient to approach a dentist. Intentional replantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors agree that it should be reserved as the last resort to save a tooth after other procedures have failed or would likely to fail. The main reason of failure in replanted teeth is root resorption, specifically ankylosis or replacement resorption. Although the success rate is not always high, intentional replantation may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Here is case report of a patient desiring alignment of malpositioned periodontally involved anterior single tooth due to various causes treated by intentional replantation.


Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy.
To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.


Reconfigurable optical interleaver modules with tunable wavelength transfer matrix function using polymer photonics lightwave circuits.
A transparent reconfigurable optical interleaver module composed of cascaded AWGs-based wavelength-channel-selector/interleaver monolithically integrated with multimode interference (MMI) variable optical attenuators (VOAs) and Mach-Zehnder interferometer (MZI) switch arrays was designed and fabricated using polymer photonic lightwave circuits. Highly fluorinated photopolymer and grafting modified organic-inorganic hybrid material were synthesized as the waveguide core and caldding, respectively. Thermo-optic (TO) tunable wavelength transfer matrix (WTM) function of the module can be achieved for optical routing network. The one-chip transmission loss is ~ 6 dB and crosstalk is less than ~25 dB for transverse-magnetic (TM) mode. The crosstalk and extinction ratio of the MMI VOAs were measured as -15.2 dB and 17.5 dB with driving current 8 mA, respectively. The modulation depth of the TO switches is obtained as ~18.2 dB with 2.2 V bias. Proposed novel interleaver module could be well suited for DWDM optical communication systems.


Evaluation of vaginal cysts and masses by 3-dimensional endovaginal and endoanal sonography.
The purpose of this pictorial essay is to describe the utility of 3-dimensional endovaginal and endoanal sonography in the assessment of vulvovaginal cysts and masses. It is accepted that compared with transabdominal pelvic sonography, transvaginal end-fire sonography provides improved resolution for visualization of female reproductive organs with fewer artifacts. To visualize the structures that are located in or lateral to the vaginal canal, side-fire 3-dimensional endovaginal or endoanal sonography can be used. This special technique has the advantage of maintaining the spatial anatomic relationship of any abnormality in the vagina.


Cigarette smoking by adolescent females: implications for health and behavior.
Cigarette smoking rates among teenage females have risen progressively since 1968 until surpassing teenage males in 1979. Psychosocial factors underlying the initiation of smoking include peer pressure, adult role modeling and prosmoking messages in advertising, with smoking potentially representing a desired set of personality characteristics. Regular smoking leads to the development of a dependence process, with cessation often difficult to achieve and maintain. Preventing smoking onset is a responsibility of health professionals and educators. Social psychological approaches teaching social skills and techniques for resisting smoking have been effective in reducing rates of initiation in JHS experimental programs.


Effect of capsule 'UB03' containing potential probiotic strains for the treatment of patients with irritable bowel syndrome.
The objective of this research was to study the efficacy and safety of capsule 'UB03' to treat patients with Irritable Bowel Syndrome (IBS). Thirty patients with Rome II IBS were assigned to receive capsule 'UB03' (10 billion lyophilised bacteria and yeast/capsule produced by Unique Biotech Limited, India) twice daily for 90 days. Assessment of IBS was carried out according with Rome II criteria and their severity for 90 days of treatment with an interval of 30 days. Complete haemogram, serum glutamic pyruvic transaminase, serum creatinine were performed as a part of safety evaluation at the time of inclusion and after 90 days of treatment. There was significant improvement in frequency of defecation (23%), consistency of stool, abdominal discomfort, bloating and flatulence. However, there was no significant change in abdominal pain and mucus in stool. This trial demonstrates that the consumption of capsule 'UB03' containing potential probiotic strains is found to be effective and safe for the treatment of patients with IBS.


Obesity paradox on outcome in atrial fibrillation maintained even considering the prognostic influence of biomarkers: insights from the ARISTOTLE trial.
We investigated the association between obesity and biomarkers indicating cardiac or renal dysfunction or inflammation and their interaction with obesity and outcomes. A total of 14 753 patients in the Apixaban for Reduction In STroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial provided plasma samples at randomisation to apixaban or warfarin. Median follow-up was 1.9 years. Body Mass Index (BMI) was measured at baseline and categorised as normal, 18.5-25 kg/m2; overweight, >25 to <30 kg/m2; and obese, ≥30 kg/m2. We analysed the biomarkers high-sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), growth differentiation factor-15 (GDF-15), troponin T and N-terminal B-type natriuretic peptide (NT-pro-BNP). Outcomes included stroke/systemic embolism (SE), myocardial infarction (MI), composite (stroke/SE, MI, or all-cause mortality), all-cause and cardiac mortality, and major bleeding. Compared with normal BMI, obese patients had significantly higher levels of hs-CRP and IL-6 and lower levels of GDF-15, troponin T and NT-pro-BNP. In multivariable analyses, higher compared with normal BMI was associated with a lower risk of all-cause mortality (overweight: HR 0.73 (95% CI 0.63 to 0.86); obese: 0.67 (0.56 to 0.80), p<0.0001), cardiac death (overweight: HR 0.74 (95% CI 0.60 to 0.93); obese: 0.71 (0.56 to 0.92), p=0.01) and composite endpoint (overweight: 0.80 (0.70 to 0.92); obese: 0.72 (0.62 to 0.84), p<0.0001). Regardless of biomarkers indicating inflammation or cardiac or renal dysfunction, obesity was independently associated with an improved survival in anticoagulated patients with AF. NCT00412984.


Automated Device for Asynchronous Extraction of RNA, DNA, or Protein Biomarkers from Surrogate Patient Samples.
Many biomarker-based diagnostic methods are inhibited by nontarget molecules in patient samples, necessitating biomarker extraction before detection. We have developed a simple device that purifies RNA, DNA, or protein biomarkers from complex biological samples without robotics or fluid pumping. The device design is based on functionalized magnetic beads, which capture biomarkers and remove background biomolecules by magnetically transferring the beads through processing solutions arrayed within small-diameter tubing. The process was automated by wrapping the tubing around a disc-like cassette and rotating it past a magnet using a programmable motor. This device recovered biomarkers at ~80% of the operator-dependent extraction method published previously. The device was validated by extracting biomarkers from a panel of surrogate patient samples containing clinically relevant concentrations of (1) influenza A RNA in nasal swabs, (2) Escherichia coli DNA in urine, (3) Mycobacterium tuberculosis DNA in sputum, and (4) Plasmodium falciparum protein and DNA in blood. The device successfully extracted each biomarker type from samples representing low levels of clinically relevant infectivity (i.e., 7.3 copies/µL of influenza A RNA, 405 copies/µL of E. coli DNA, 0.22 copies/µL of TB DNA, 167 copies/µL of malaria parasite DNA, and 2.7 pM of malaria parasite protein).


Memristor in a Reservoir System-Experimental Evidence for High-Level Computing and Neuromorphic Behavior of PbI2.
Lead halides in an asymmetric layered structure form memristive devices which are controlled by the electronic structure of the PbX2|metal interface. In this paper, we explain the mechanism that stands behind the I- V pinched hysteresis loop of the device and shortly present its synaptic-like plasticity (spike-timing-dependent plasticity and spike-rate-dependent plasticity) and nonvolatile memory effects. This memristive element was incorporated into a reservoir system, in particular, the echo-state network with delayed feedback, which exhibits brain-like recurrent behavior and demonstrates metaplasticity as one of the available learning mechanisms. It can serve as a classification system that classifies input signals according to their amplitude.


[Use of systolic times and electrocardiography for the evaluation of left ventricle involvement in aortic valve diseases].
75 patients suffering from aortic valvulopathy without signs of left ventricular insufficiency have been examined. Left ventricular function is studied by determining systolic times with polygraphic examination (Q-S2, LVET and PEP). The ECG findings were assessed with a myocardial hypertrophy criterion based on a point-score system. Finally, the time of total carotidogram ascent, the 1/2 T and the distance between Q wave and acme of the systolic murmur (Q-acme) were measured. It is concluded that: 1) The most meaningful increases in LVET are associated with the most evident shortenings in PEP only in the phase of the disease in which left ventricular hypertrophy is at its height. 2) The delay in systolic wave ascent should be considered indicative of the functional haemodynamic importance of aortic stenosis, whereas the earliness or otherwise of systolic murmur acme is an expression of the anatomic extent of the stenosis in question.


Wear resistance of first-generation highly cross-linked annealed polyethylene in cementless total hip arthroplasty is maintained 20 years after surgery.
The aim of this study was to evaluate the performance of first-generation annealed highly cross-linked polyethylene (HXLPE) in cementless total hip arthroplasty (THA). We retrospectively evaluated 29 patients (35 hips) who underwent THA between December 2000 and February 2002. The survival rate was estimated using the Kaplan-Meier method. Hip joint function was evaluated using the Japanese Orthopaedic Association (JOA) score. Two-dimensional polyethylene wear was estimated using Martell's Hip Analysis Suite. We calculated the wear rates between years 1 and 5, 5 and 10, 10 and 15, and 15 and final follow-up. The mean follow-up period was 19.1 years (SD 0.6; 17.3 to 20.1). The 19-year overall survival rate with the end point of all-cause revision was 97.0% (95% confidence interval (CI) 91 to 100). The mean JOA score improved from 43.2 (SD 10.6; 30 to 76) before surgery to 90.2 (SD 6.4; 76 to 98) at the final follow-up (p < 0.001). There was no osteolysis or loosening of the acetabular or femoral components. The overall steady-state wear rate was 0.013 mm/year (SD 0.012). There was no hip with a steady-state wear rate of > 0.1 mm/year. There was no significant difference in wear rates for each period. We found no significant correlation between the wear rate and age, body weight, BMI, or cup inclination. First-generation annealed HXLPE shows excellent wear resistance and no acceleration of wear for approximately 20 years, with low all-cause revision rates. Cite this article: Bone Joint J 2022;104-B(2):200-205.


What type of valve replacement should be used in patients with endocarditis?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in patients undergoing a surgery for endocarditis is a biological valve or mechanical valve superior for achieving long-term low rates of reinfection?' Altogether more than 41 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Out of the studies that include statistical comparisons, in mechanical valve replacement the average endocarditis recurrence rate ranged from approximately 3 to 9% and in biological valves from approximately 7 to 29%. Out of the studies that specifically compared the outcomes of the two valves, 50% concluded there to be no significant difference when separated from other risk factors and 50% recommended a mechanical valve for lower recurrence and higher survival rates. The Euro Heart Survey found that 63% of valve replacements were mechanical, due to young age (90%) and physician preference (75%) and only 21% bioprosthetic. Current guidelines from American College of Cardiology/American Heart Association (ACC/AHA) recommend a mechanical valve in patients <65 years old and a bioprosthetic valve if >65, without risk factors for thromboembolism, but this is based on class II evidence (conflicting evidence or opinion). These guidelines are not specific to patients with infective endocarditis, so it is vital to review the literature related to this. Three of the studies in the search specify that for patients under 60-65 years old, a mechanical valve has greater benefit, but this was not found to be true for the over 65 years. It can be concluded that for patients under 65 years old, a mechanical valve may offer greater freedom from reoperation and increased long-term survival when compared to a bioprosthetic valve (assuming no other co-morbidities), although this divide is narrowing with the use of newer generation bioprosthetic valves and has to be off-set against potential bleeding risks. For patients over 65 years, other important variants need to be considered including patient choice, correct protocols of antibiotics and radical debridement.


The New York City Beacons: rebuilding communities of support in urban neighborhoods.
Established in 1991 in New York City and now operating in at least seven other cities, Beacons are designed to rebuild communities of support for children and youth in urban neighborhoods. The Beacon framework is based on research findings and practitioner experience indicating that programs taking a youth development approach are more effective than those focused on "fixing" specific youth problems. Successful Beacon programs provide positive ways to meet young people's need for safety, a sense of belonging, and mastery; they also provide opportunities for decision making and contributing to others. There are currently eighty Beacons in New York City, serving about 140,000 youth and adults annually. Beacons have been replicated in several parts of the country, including Denver, Minneapolis, Oakland, Palm Beach County, Philadelphia, San Francisco, and Savannah. The Youth Development Institute of the Fund for the City of New York provides technical assistance and training to Beacons in New York City and in all seven replication sites.


Use of standardized assessment instruments in couple therapy: the role of attitudes and professional factors.
The study examined therapeutic approach, professional affiliation, training, seniority, and work setting as predictors of attitudes toward standardized instruments and their use in couple therapy. Data were gathered from 163 certified marriage and family therapists in Israel. Results showed that 27.6% of marital therapists used standardized instruments for assessment. More positive attitudes toward standardized instruments were associated with the extent of training in their use and with a structural-strategic approach. Logistic regression analysis indicated that positive attitudes, training, and work setting best predict the application of standardized assessment instruments. Reasons for the relative lack of use of standardized assessment instruments are discussed. It is recommended that more training in assessment instruments be included in marriage and family therapy training.


[Psychometric studies of performance deficits in acute schizophrenic patients with special reference to gender].
19 male and 18 female schizophrenic inpatients were examined on cognitive, motor and sensorimotor performance and visual and speech related intellectual ability at the beginning and end of a therapeutic period of 4 weeks on the average. Speed of sensorimotor reaction time revealed a higher performance level with regard to male as compared to female patients. Reverse effects could be demonstrated with respect to precise motor reactions (pegboard). Starting at a higher level of performance female had an important decrease. Considering speed of unprecise movements (tapping) and tremor-parameter (steadiness) impairment of performance occurred in time course for both male and female. Especially simple tasks demanding speed to solve the problem and left-handed requirement are solved in a lower degree indicating impaired reception of information and hemispheric hyperactivation.


Adherence to a predominantly Mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a South Eastern European population.
Our aim was to assess the association of a Mediterranean diet and gastroesophageal reflux disease among adult men and women in Albania, a former communist country in South Eastern Europe with a predominantly Muslim population. A cross-sectional study was conducted in 2012, which included a population-based sample of 817 individuals (≥18 years) residing in Tirana, the Albanian capital (333 men; overall mean age: 50.2 ± 18.7 years; overall response rate: 82%). Assessment of gastroesophageal reflux disease was based on Montreal definition. Participants were interviewed about their dietary patterns, which in the analysis was dichotomized into: predominantly Mediterranean (frequent consumption of composite/traditional dishes, fresh fruit and vegetables, olive oil, and fish) versus largely non-Mediterranean (frequent consumption of red meat, fried food, sweets, and junk/fast food). Logistic regression was used to assess the association of gastroesophageal reflux disease with the dietary patterns. Irrespective of demographic and socioeconomic characteristics and lifestyle factors including eating habits (meal regularity, eating rate, and meal-to-sleep interval), employment of a non-Mediterranean diet was positively related to gastroesophageal reflux disease risk (fully adjusted odds ratio = 2.3, 95% confidence interval = 1.2-4.5). Our findings point to a beneficial effect of a Mediterranean diet in the occurrence of gastroesophageal reflux disease in transitional Albania. Findings from this study should be confirmed and expanded further in prospective studies in Albania and in other Mediterranean countries.


Similarity of the oral microbiota of pre-school children with that of their caregivers in a population-based study.
This study evaluated the similarity between the oral microbiota of young children and that of their adult caregivers. Oral samples from children (174 dentate and 18 pre-dentate) aged 6-36 months and their caregivers in Saipan were assayed using a DNA probe assay. Many species including Streptococcus mutans, Streptococcus sobrinus, Actinomyces species, Campylobacter rectus, Fusobacterium nucleatum, Prevotella intermedia, and Porphyromonas gingivalis were detected in dentate and pre-dentate children, whereas Bacteroides forsythus was detected only in dentate children. A higher percentage of children were positive for the detection of an individual species if the caregiver was also positive. There were significant relative risks of species detection between dentate children and their caregivers. By logistic regression, there were significant positive associations between species detection in caregiver and in child, but not between species detection and child age or maternal education level. In conclusion, dental pathogens were detected in young, including pre-dentate, children. The microbial profiles of children were strongly associated with the microbiota of their caregivers.


Long-term sequelae and management following anterior cruciate ligament injury.
This article discusses a case in which a patient who sustained an anterior cruciate ligament (ACL) injury returned with anterior knee pain in the same knee approximately 20 years later. He underwent reconstruction at the time of the injury and had a revision reconstruction performed 10 years later. The case highlights the long-term consequences of ACL injury and subsequent reconstruction for the knee joint, as this patient has developed anterior knee pain during his mid-40s. Additionally, non-operative management of knee osteoarthritis is discussed.


Genetic dissection of chromosome substitution lines of cotton to discover novel Gossypium barbadense L. alleles for improvement of agronomic traits.
We recently released a set of 17 chromosome substitution (CS-B) lines (2n = 52) that contain Gossypium barbadense L. doubled-haploid line '3-79' germplasm systematically introgressed into the Upland inbred 'TM-1' of G. hirsutum (L.). TM-1 yields much more than 3-79, but cotton from the latter has superior fiber properties. To explore the use of these quasi-isogenic lines in studying gene interactions, we created a partial diallel among six CS-B lines and the inbred TM-1, and characterized their descendents for lint percentage, boll weight, seedcotton yield and lint yield across four environments. Phenotypic data on the traits were analyzed according to the ADAA genetic model to detect significant additive, dominance, and additive-by-additive epistasis effects at the chromosome and chromosome-by-chromosome levels of CS-B lines. For example, line 3-79 had the lowest boll weight, seedcotton yield and lint yield, but CS-B22Lo homozygous dominance genetic effects on seedcotton and lint yield were nearly four times those of TM-1, and its hybrids with TM-1 had the highest additive-by-additive epistatic effects on seedcotton and lint yield. CS-B14sh, 17, 22Lo and 25 produced positive homozygous dominance effects on lint yield, whereas doubly heterozygous combinations of CS-B14sh with CS-B17, 22Lo and 25 produced negative dominance effects, suggesting that epistatic effects between genes in these chromosomes strongly affect lint yield. The results underscore the opportunities to systematically identify genomic regions harboring genes that impart agronomically significant effects via epistatic interactions. The chromosome-by-chromosome approach significantly complements other strategies to detect and quantify epistatic interaction effects, and the quasi-isogenic nature of families and lines from CS-B intermatings will facilitate high-resolution localization, development of markers for selection and map-assisted identification of genes involved in strong epistatic effects.


Resolution of Graves' disease after renal transplantation.
We report a case of an adolescent boy with Down's syndrome and ESRD on hemodialysis who developed mild Graves' disease that was not amenable to radioablation, surgery, or ATDs. After 14 months of observation without resolution of Graves' disease, he successfully received a DDRT with a steroid minimization protocol. Thymoglobulin and a three-day course of steroids were used for induction and he was started on tacrolimus, MMF, and pravastatin for maintenance transplant immunosuppression. One month after transplantation, all biochemical markers and antibody profiling for Graves' disease had resolved and remain normal one yr later.


Cyr61 activates retinal cells and prolongs photoreceptor survival in rd1 mouse model of retinitis pigmentosa.
Subretinal injections with glial cell line-derived neurotrophic factor (GDNF) rescue morphology as well as function of rod cells in mouse and rat animal models of retinitis pigmentosa. At the same time, it is postulated that this effect is indirect, mediated by activation of retinal Müller glial (RMG) cells. Here, we show that Cyr61/CCN1, one of the secreted proteins up-regulated in primary RMG after glial cell line-derived neurotrophic factor stimulation, provides neuroprotective and pro-survival capacities: Recombinant Cyr61 significantly reduced photoreceptor (PR) cells death in organotypic cultures of Pde6b(rd1) retinas. To identify stimulated pathways in the retina, we treated Pde6b(rd1) retinal explants with Cyr61 and observed an overall increase in activated Erk1/2 and Stat3 signalling molecules characterized by activation-site-specific phosphorylation. To identify Cyr61 retinal target cells, we isolated primary porcine PR, RMG and retinal pigment epithelium (RPE) cells and exposed them separately to Cyr61. Here, RMG as well as RPE cells responded with induced phosphorylation of Erk1/2, Stat3 and Akt. In PR, no increase in phosphorylation in any of the studied proteins was detected, suggesting an indirect neuroprotective effect of Cyr61. Cyr61 may thus act as an endogenous pro-survival factor for PR, contributing to the complex repertoire of neuroprotective activities generated by RMG and RPE cells. We propose the following model of Cyr61 neuroprotection within the retina: Cyr61 stimulates retinal Müller glial (RMG) and retinal pigment epithelium (RPE) cells and activates PI3K/Akt, mitogen-activated protein kinase(MAPK)/Erk and Janus kinase(JAK)/Stat-signalling pathways in these cells. Phosphorylated Stat3 and Erk1/2 presumably translocate to the nucleus, induce transcriptional changes, which increase secretion of neuroprotective agents that protect photoreceptors (PR) from mutation-induced death.


Ophthalmic admissions in a tertiary hospital in Nigeria.
Hospitalization for eye care is required for different reasons. The pattern of admissions into the ophthalmic wards of a sub-urban tertiary hospital was studied. Records of patients admitted into the Ophthalmology wards of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife from January 2004 to December 2007 were reviewed and the age, sex, duration of admission and diagnosis recorded. Data was analyzed with SPSS version 13 and statistical significance inferred at P<0.05. Of the 523 patients admitted, 60.2% were males while 39.8% were females (P<0.0001); the male preponderance becomes less prominent with increasing age (P=0.001). The duration of admission ranged between 2 and 24 days with a mean of 2.86+/- 1.95 days and 63% were admitted for 3 days. The main indications for admission were cataract (58.3%), ocular trauma (14.3%) and glaucoma (13.4%). Eye injuries were more common among children and young adults while cataract and glaucoma were the leading indications in the middle aged and elderly. Cataract, trauma and glaucoma were the leading indications for ophthalmic hospitalization. Human and infrastructural development of the ophthalmology unit should lay emphasis on the more prevalent needs to enhance effective and efficient management of these diseases.


Effect of intracameral lidocaine anesthesia on the anterior segment of rabbit eyes.
To evaluate the effect of intracameral anesthesia on the anterior segment of rabbit eyes using chinese-made lidocaine. The study comprised eight eyes of four white rabbits which were divided into three groups according to the concentration of the lidocaine given. They are 0.5%, 1%, 2% lidocaine groups and balanced salt solution (BSS) control group. Each group contained two eyes. After 0.5 ml of the anesthetic agent was injected into the anterior chamber and retained there for ten minutes, the rabbits were executed and the eye balls were enucleated. Pathological examinations of the anterior segment, including cornea, iris and ciliary body, were carried out immediately. The pathological study revealed no abnormal findings in lidocaine 0.5% and 1% groups compared with the control group, where as in the lidocaine 2% group, much abnormal pathological change was found, including the shrinkage of corneal endothelium, stroma edema of iris and ciliary body. Using intracameral anesthesia of high concentration of chinese-made lidocaine would run a risk of damaging the anterior segment of rabbit eye. But at the low concentration usually used in cataract surgery, no adverse effect was found.


Dimer linkage structure in retroviruses: models that include both duplex and quadruplex domains.
Genome of all known retroviruses consists of two identical molecules of RNA, which are non-covalently linked. The most stable contact site between two RNA molecules is located near their 5' ends. The molecular interactions in the dimer linkage structure (DLS) in mature virions are currently unknown. Recently we suggested that the dimer linkage structure in human immunodeficiency virus 1 (HIV-1) contains both duplex and quadruplex domains and proposed a model of DLS in HIV-1Mal (Central African virus). In this paper we showed that similar models can be also built for HIV- 1Lai, a representative of the North-American and European viruses. One of the double-stranded domains in the model structures represents either an extended duplex formed by different pathways (through base pair melting and subsequent reannealing or by a recombination mechanism) or kissing loop complex. The quadruplexes contain both G- and mixed tetrads, for example, G.C.G.C or A.U.A.U. Phylogenetic analysis of 350 isolates from NCBI database showed that similar models of DLS are predictable practically for all HIV-1 isolates surveyed. A model of dimer linkage structure in Moloney murine sarcoma virus (MuSV) is also presented. The structure includes a duplex formed by the palindromic sequences and several quadruplexes.


Determinants of immunological responsiveness in recurrent spontaneous abortion.
A defined group of 20 women suffering recurrent spontaneous abortions of unknown etiology was studied for determinants relevant to immune responsiveness. A low prevalence of serum anti-CMV antibodies (35%; cf, 65% in controls)--but not anti-herpes-simplex-virus or Epstein-Barr virus antibodies--was noted. Only two (10%) of these women had lymphocytotoxic antibodies following their repeated pregnancies; low titer anti-sperm antibody was present in two other of these women. Whereas there was no significantly increased sharing of HLA-A or -B antigens within these couples compared with controls, there was an increased incidence of apparent HLA-B antigen homozygosity in the women. These data indicate a degree of immunological nonresponsiveness both to cytomegalovirus and to cell-surface alloantigens in habitually aborting women and, together with MLC data, provide further evidence that immunogenetic events may be relevant to reproductive success.


Kinetic and pharmacological studies on estazolam in mice and man.
After i.v. and oral doses of estazolam (5 mg/kg) to mice, the drug was rapidly cleared with a beta half-life (t1/2 beta) of 0.7 h. The active metabolite, 1-oxo-estazolam, was present in traces in mouse plasma and brain. Its elimination t1/2 (beta), determined after i.v. injection of 1-oxo-estazolam (5 mg/kg) to mice, was similar to that of the parent drug in both plasma and brain. After a single oral dose of estazolam (4 mg) to four human volunteers the drug was rapidly absorbed and reached maximum plasma concentrations in one to three hours. Elimination t1/2 of estazolam in humans was 19 h. The metabolite was undetectable in human plasma after either single or multiple doses of estazolam. These results, together with the finding that 1-oxo-estazolam was less effective than estazolam, in terms of ED50 and brain concentrations necessary to antagonize leptazol convulsions and disrupt rota-rod performance in mice, indicate that the metabolite does not contribute significantly to the pharmacological effects of its parent drug.


Spreading versus biomass production by colonies of the fish pathogen Flavobacterium psychrophilum: role of the nutrient concentration.
Colonies of the fish pathogen Flavobacterium psychrophilum have gliding motility in media with low agar concentrations. Although gliding motility, particularly in Flavobacterium johnsoniae, has been well-studied, little is known about its regulation by environmental factors. The work described here shows that the ability of F. psychrophilum to spread over surfaces depends on nutrient availability. In fact, as the nutrient contents of the medium decreased, spreading was favored and the diameter of the colonies increased. Macroscopy examination revealed modifications in colony morphology as nutrient depletion increased: from a dense and defined colony to the formation of microcolonies inside a general colony structure. Additionally, colony expansion dynamics and population density across the colony radius varied inversely with bacterial biomass production. Motility was an immediate response when bacteria were transferred from a rich to a more diluted medium. Our results suggest that, when nutrients are limiting, F. psychrophilum activates a specific growth mode that enables it to colonize surfaces by means of gliding motility. The use of diluted media allowed the differentiation, among previously isolated F. psychrophilum non-gliding mutants, of those completely unable to glide and those with only partially impaired gliding ability.


[Effect of irradiation power on the mechanical properties of laser-welded titanium joints.].
To make an clinical implication for the use of laser welding pure titanium,this study investigate the effect of irradiation power on the mechanical properties of laser-welded joints. The pure titanium tensile test and three-point bending test rods were laser-welded with different irradiation power. Then the tensile rods were tested for the ultimate tensile strength (UTS), and the bending rods for the ultimate bending strength (UBS). The tensile fracture surface was examined by scanning electron microscopy (SEM). Metallurgical analysis was also performed on polished longitudinal sectioned samples. A small portion of the central area in group 1.4 kW was not joined. ANOVA showed no significant difference of OTS and VBS between group 1.6 kW and group 1.8 kW at the 0.05 level. SEM examination and metallurgical analysis showed that there were defects such as pores and cracks in the welding zone; and as the irradiation power increased, there were more pores and cracks. The increase in laser irradiation power cannot increase melting depth significantly.


A specialized mitochondrial molecular chaperone system: a role in formation of Fe/S centers.
Mitochondria contain a specialized system of molecular chaperones that plays a critical role in the biogenesis of Fe/S centers. This Hsp70:J-protein system shows many similarities to the system found in bacteria, but the precise role of neither chaperone system has been defined. However, evidence to date suggests an interaction with the scaffold protein on which a transient Fe/S center is assembled, and thus implies a role in either assembly of the center or its transfer to recipient proteins.


Tumefactive acute disseminated encephalomyelitis complicating human swine influenza (H1N1).
This report illustrates an adult patient presenting with tumefactive acute disseminated encephalomyelitis complicating human swine influenza. Its presentation, diagnosis, investigation findings, course, and response to treatment are discussed herein.


The filopodium: a stable structure with highly regulated repetitive cycles of elongation and persistence depending on the actin cross-linker fascin.
The ability of mammalian cells to adhere and to migrate is an essential prerequisite to form higher organisms. Early migratory events include substrate sensing, adhesion formation, actin bundle assembly and force generation. Latest research revealed that filopodia are important not only for sensing the substrate but for all of the aforementioned highly regulated processes. However, the exact regulatory mechanisms are still barely understood. Here, we demonstrate that filopodia of human keratinocytes exhibit distinct cycles of repetitive elongation and persistence. A single filopodium thereby is able to initiate the formation of several stable adhesions. Every single filopodial cycle is characterized by an elongation phase, followed by a stabilization time and in many cases a persistence phase. The whole process is strongly connected to the velocity of the lamellipodial leading edge, characterized by a similar phase behavior with a slight time shift compared to filopodia and a different velocity. Most importantly, re-growth of existing filopodia is induced at a sharply defined distance between the filopodial tip and the lamellipodial leading edge. On the molecular level this re-growth is preceded by a strong filopodial reduction of the actin bundling protein fascin. This reduction is achieved by a switch to actin polymerization without fascin incorporation at the filopodial tip and therefore subsequent out-transport of the cross-linker by actin retrograde flow.


Three-dimensional slice cultures from murine fetal gut for investigations of the enteric nervous system.
Three-dimensional intestinal cultures offer new possibilities for the examination of growth potential, analysis of time specific gene expression, and spatial cellular arrangement of enteric nervous system in an organotypical environment. We present an easy to produce in vitro model of the enteric nervous system for analysis and manipulation of cellular differentiation processes. Slice cultures of murine fetal colon were cultured on membrane inserts for up to 2 weeks without loss of autonomous contractility. After slice preparation, cultured tissue reorganized within the first days in vitro. Afterward, the culture possessed more than 35 cell layers, including high prismatic epithelial cells, smooth muscle cells, glial cells, and neurons analyzed by immunohistochemistry. The contraction frequency of intestinal slice culture could be modulated by the neurotransmitter serotonin and the sodium channel blocker tetrodotoxin. Coculture experiments with cultured neurospheres isolated from enhanced green fluorescent protein (eGFP) transgenic mice demonstrated that differentiating eGFP-positive neurons were integrated into the intestinal tissue culture. This slice culture model of enteric nervous system proved to be useful for studying cell-cell interactions, cellular signaling, and cell differentiation processes in a three-dimensional cell arrangement.


[Guangdong official on planned parenthood rumors].
Certain rumors have been rife in some parts of Guangdong with regard to the planned parenthood policies. As a result a few of the masses have harbored doubts about the policy of the Central Committee and State Council on advocating that each couple has only 1 child. This has affected the launching of planned parenthood work. A station reporter has therefore visited a responsible person of the provincial People's Government's planned parenthood office. The responsible person pointed out: At present there is all kinds of talk in some places. Some people say that it was wrong to advocate that a couple have only 1 child. Some say that theentral Committee and State Council have advocated having 2 children. Some have even said that the Central Committee has issued a document stipulating that those who have taken out single-child certificates can have a 2nd child as long as they surrender all their premiums, and so on and so forth. There is no basis at all for these notions. There is no change in the party and state policy that a couple should have only 1 child. The current population policy of the party and state is: universal advocation of having only 1 child, strict control over the birth of a 2nd, and resolute prohibition of the birth of a 3rd. If certain of the masses encounter actual difficulties that need to be taken care of in accordance with the policies on controlling the birth of a 2nd child, they can be allowed to have a 2nd child. For instance, if the 1st child is deformed and cannot grow into a normal laborer, the couple will be allowed to have a 2nd child. However, only a very few people encounter these actual difficulties. The responsible person said: For a couple to have only 1 child is the best method of solving China's present special population problem.


Profound but Transient Changes in the Inflammatory Milieu of the Blood During Autologous Hematopoietic Stem Cell Transplantation.
Little is known about the inflammatory milieu in the blood during autologous hematopoietic stem cell transplantation (AHSCT) and how it is affected by the stem cell mobilization, collection, and reinfusion and conditioning regimen. In this study, we analyzed 92 proteins connected to inflammation at 10 time points during and after AHSCT in 16 patients with multiple sclerosis (MS). Serum from 29 patients with newly diagnosed MS and 15 healthy controls were included for comparative analysis. There were no significant differences in inflammatory serum protein levels between patients with newly diagnosed MS and healthy controls, but 29 out of 73 detectable proteins were significantly altered between at least 2 adjacent sampling time points during AHSCT. The predominant changes occurred after the conditioning regimen had been administered, whereas stem cell mobilization, collection, and reinfusion appeared to have less impact. Two distinct response patterns could be discerned, likely representing loss of basal cytokine production and homeostasis. The analyzed serum proteins gradually returned to baseline levels after treatment, with no remaining differences at 3 months after AHSCT. We conclude that treatment with AHSCT has a major but transient impact on the inflammatory milieu of peripheral blood.


[Renin-angiotensin-aldosterone system in hypertension patients who have had a cerebral stroke].
The study of the renin activity and aldosterone concentrations in the blood plasma has revealed activation of the renin-angiotensin-aldosterone system (RAAS) in patients with stage III essential hypertension and a history of 1-3-year-old cerebral stroke. Middle-aged patients demonstrated high activity of renin and high levels of aldosterone whereas elderly patients presented a moderate rise in renin activity and elevated aldosterone levels. The data obtained indicate a decrease in the endocrine function of the kidneys in elderly hypertensive patients with a history of cerebral stroke. The authors revealed a considerable hypersecretion of aldosterone in the presence of a moderate elevation of plasma renin activity in patients with the cerebral form of stage II essential hypertension at the height of the crisis. It is suggested that aldosterone hypersecretion in elderly patients with stage III essential hypertension and residual manifestations of cerebral circulation impairment is pathogenetically important.


Precise in situ tuning of the critical current of a superconducting nanowire using high bias voltage pulses.
We present a method for in situ tuning of the critical current (or switching current) and critical temperature of a superconducting MoGe nanowire using high bias voltage pulses. Our main finding is that as the pulse voltage is increased, the nanowire demonstrates a reduction, a minimum and then an enhancement of the switching current and critical temperature. Using controlled pulsing, the switching current of a superconducting nanowire can be set exactly to a desired value. These results correlate with in situ transmission electron microscope imaging where an initially amorphous nanowire transforms into a single crystal nanowire by high bias voltage pulses. We compare our transport measurements to a thermally activated model of Little's phase slips in nanowires.


The function of EHD2 in endocytosis and defense signaling is affected by SUMO.
Post-translational modification of target proteins by the small ubiquitin-like modifier protein (SUMO) regulates many cellular processes. SUMOylation has been shown to regulate cellular localization and function of a variety of proteins, in some cases affecting nuclear import or export. We have previously characterized two EHDs (EH domain containing proteins) in Arabidospis and showed their involvement in plant endocytosis. AtEHD2 has an inhibitory effect on endocytosis of transferrin, FM-4-64, and the leucine rich repeat receptor like protein LeEix2, an effect that requires and intact coiled-coil domain. Inhibition of endocytosis of LeEix2 by EHD2 is effective in inhibiting defense responses mediated by the LeEix2 receptor in response to its ligand EIX. In the present work we demonstrate that SUMOylation of EHD2 appears to be required for EHD2-induced inhibition of LeEix2 endocytosis. Indeed, we found that a mutant form of EHD2, possessing a defective SUMOylation site, has an increased nuclear abundance, can no longer be SUMOylated and is no longer effective in inhibiting LeEix2 endocytosis or defense signaling in response to EIX.


An unexpected difficult laryngoscopy.
A case of unexpected difficult laryngoscopy in a patient with gross hydrocephalus and generalized hypertonus is described. The 30-month-old girl had no antecedent history of such difficulty, having had two recent uneventful anaesthetics. We suggest that the reason for our inability to open the patient's mouth was a result of contracture of the temporalis muscle. The patient was managed using a laryngeal mask airway with controlled ventilation.


Pyrimidinergic Receptor Activation Controls Toxoplasma gondii Infection in Macrophages.
Infection by the protozoan parasite Toxoplasma gondii is highly prevalent worldwide and may have serious clinical manifestations in immunocompromised patients. T. gondii is an obligate intracellular parasite that infects almost any cell type in mammalian hosts, including immune cells. The immune cells express purinergic P2 receptors in their membrane--subdivided into P2Y and P2X subfamilies--whose activation is important for infection control. Here, we examined the effect of treatment with UTP and UDP in mouse peritoneal macrophages infected with T. gondii tachyzoites. Treatment with these nucleotides reduced parasitic load by 90%, but did not increase the levels of the inflammatory mediators NO and ROS, nor did it modulate host cell death by apoptosis or necrosis. On the other hand, UTP and UDP treatments induced early egress of tachyzoites from infected macrophages, in a Ca2+-dependent manner, as shown by scanning electron microscopy analysis, and videomicroscopy. In subsequent infections, prematurely egressed parasites had reduced infectivity, and could neither replicate nor inhibit the fusion of lysosomes to the parasitophorous vacuole. The use of selective agonists and antagonists of the receptor subtypes P2Y2 and P2Y4 and P2Y6 showed that premature parasite egress may be mediated by the activation of these receptor subtypes. Our results suggest that the activity of P2Y host cell receptors controls T. gondii infection in macrophages, highlighting the importance of pyrimidinergic signaling for innate immune system response against infection. Finally the P2Y receptors should be considered as new target for the development of drugs against T. gondii infection.


Efficacy and renal effects of enalapril therapy for hypertensive patients with chronic renal insufficiency.
The antihypertensive efficacy and renal effects of enalapril maleate therapy were evaluated in 13 hypertensive patients with chronic renal failure. Enalapril was administered as follows: alone; added to furosemide, clonidine hydrochloride, or atenolol; or in combination with any of the aforementioned drugs. Three patients did not complete the study; uncontrolled hypertension was the cause in two of these patients. In the remaining ten patients, short-term (mean +/- SD, 63 +/- 9 days) enalapril maleate therapy decreased the patient's seated blood pressure from 161/98 +/- 19/8 to 130/80 +/- 13/7 mm Hg. Furosemide was administered to eight patients; the dose of concomitant sympatholytic therapy was decreased in five of five patients. Serum potassium concentration increased from 4.1 +/- 0.3 to 4.5 +/- 0.3 mmol/L. Levels of urinary total protein excretion decreased from 2.23 +/- 2.05 to 1.08 +/- 1.45 g/d. Renal function (creatinine clearance, 0.58 +/- 0.21 mL/s) did not change from baseline. During long-term therapy, the rate of progression of renal insufficiency seemed to slacken in three of four patients with diabetic nephropathy. Thus enalapril can reduce blood pressure and proteinuria in hypertensive patients with chronic renal insufficiency. The possibility that enalapril can slow the progression of diabetic nephropathy remains to be confirmed by future studies.


Dual projection generalized sidelobe canceller based on mixed signal subspace for ultrasound imaging.
In this paper, we propose a dual projection generalized sidelobe canceller (DPGSC) based on mixed subspace (MS) for ultrasound imaging, which aims to improve the speckle signal-noise-ratio (sSNR) and decrease the dark-region artifacts. A mixed signal subspace based on the correlation between the desired steering vector and the eigenvectors is constructed to further optimize the desired steering vector and the final weight vector. The simulated and experimental results show that the proposed method can greatly improve the speckle uniformity. In the geabr_0 experiment, the standard deviation of background and sSNR of MS-DPGSC can be improved by 48.07% and 58.49% more than those of eigenspace-based generalized sidelobe canceller (ESGSC). Furthermore, for a hyperechoic target, the maximal improvement of contrast ratio is 95.29%. In terms of anechoic cyst, the contrast-to-noise ratio of MS-DPGSC is increased by 123.08% than that of ESGSC. The rat mammary tumor experimental data show that the proposed method has better comprehensive imaging effect than traditional generalized sidelobe cancellers and ESGSCs.


Enhancement by lanthanide of general anesthetic-induced GABAA-receptor current in rat septal cholinergic neurons in culture.
1. Actions of lanthanide ions were examined on general anesthetic-induced currents mediated by the activation of gamma-aminobutyric acid-A receptors (GABAARs) in rat septal cholinergic neurons in primary culture, by means of a whole cell voltage-clamp technique. 2. La3+ enhanced a pentobarbital sodium (500 microM)-induced GABAAR current in a reversible and dose-dependent manner (median effective concentration = 15.7 microM; Hill coefficient = 1.58; 89% increase by 100 microM La3+). This action was independent of holding potentials (-34-26 mV), and was due to an increase in the apparent affinity for pentobarbital (295% increase with 100 microM La3+). 3. The action of La3+ on pentobarbital current was mimicked particularly by other lanthanide ions (Ce3+, Nd3+, Gd3+, Tb3+, Er3+, and Yb3+) and by Y3+ among a number of multivalent cations. There was no correlation between the potentiated proportions by lanthanide ions and their crystal ionic radii. 4. La3+ (100 microM) also augmented a GABAAR response evoked by either alpha-chloralose (500 microM), 2,6-diisopropylphenol (50 microM), or 3-alpha-hydroxy-5-alpha-pregnane-11,20-dione (20 microM) (144, 80, and 153% increase, respectively). 5. We suggest that the GABAAR channels on septal neurons are endowed with a novel "lanthanide site" whose activation results in a positive allosteric interaction with a binding site of the general anesthetics that is involved in a direct activation of GABAAR channels without any added exogenous GABA.


Microbial Electrosynthesis and Anaerobic Fermentation: An Economic Evaluation for Acetic Acid Production from CO2 and CO.
Microbial electrosynthesis (MES) and anaerobic fermentation (AF) are two biological processes capable of reducing CO2, CO, and water into acetic acid, an essential industrial reagent. In this study, we evaluated investment and production costs of acetic acid via MES and AF, and compared them to industrial chemical processes: methanol carbonylation and ethane direct oxidation. Production and investment costs were found high-priced for MES (1.44 £/kg, 1770 £/t) and AF (4.14 £/kg, 1598 £/t) because of variable and fixed costs and low production yields (100 t/y) compared to methanol carbonylation (0.26 £/kg, 261 £/t) and ethane direct oxidation (0.11 £/kg, 258 £/t). However, integrating AF with MES would reduce the release of CO2, double production rates (200 t/y), and decrease investment costs by 9% (1366 £/t). This resulted into setting the production costs at 0.24 £/kg which is currently market competitive (0.48 £/kg). This economically feasible bioprocess produced molar flow rates of 4550 mol per day from MES and AF independently. Our findings offer a bright opportunity toward the use and scale-up of MES and AF for an economically viable acetic acid production process.


Evaluation of Patients' Adverse Events During Contact Isolation for Vancomycin-Resistant Enterococci Using a Matched Cohort Study With Propensity Score.
Although contact isolation has been widely recommended for multidrug-resistant organisms, contact isolation has raised some concerns that it may bring unintended patient harms. To compare adverse events between a contact isolation group with vancomycin-resistant Enterococcus (VRE) and a matched comparison group using a relatively large data set from full electronic medical records (EMR) and propensity score-matching methods. This retrospective, matched cohort study was conducted at Seoul National University Bundang Hospital (SNUBH) in Korea, a tertiary, university-affiliated hospital that has 1337 inpatient beds. Participants included a total of 98 529 hospitalized adult patients (aged ≥18 years) during 2015 to 2017. Contact isolation in a single or shared double room. As adverse contact isolation-related outcomes, falls and pressure ulcers were included. All relevant EMR data were extracted from the SNUBH clinical data warehouse. Risk factors for adverse events were included in the propensity score model based on literature reviews, such as Braden scale score and Hendrich II fall risk score. A fine stratification and weighting (FSW) and a 1:10 nearest neighbor (NN) propensity score matching as a sensitivity analysis were adopted to compare adverse events between the 2 groups for the observation period from the study entry date and the exit date. Time-to-event analyses with a Cox proportional hazard model were conducted in December 2021. For comparison of outcomes in wards, 177 patients (mean [SD] age, 67.38 [14.12] years; 98 [55.4%] female) with VRE and 93 022 patients (mean [SD] age, 56.44 [16.88] years; 49 462 [53.2%] female) without VRE were included and no difference was found in basic characteristics from the FSW (VRE contact isolation [n = 172] vs comparison [n = 69 434]) as well as from the 1:10 NN (VRE contact isolation [n = 168] vs comparison [n = 1650]). Among 177 patients with VRE contact isolation, 8 pressure ulcers and 3 falls occurred during their hospital stays; incidence rates of adverse events were 2.5 and 0.9 per 1000 patient-days, respectively (pressure ulcer incidence rate from the FSW: 2.53 per 1000 patient-days [95% CI, 1.09-4.99 per 1000 patient-days]; pressure ulcer incidence rate from the 1:10 NN: 2.54 per 1000 patient-days [95% CI, 1.10-5.01 per 1000 patient-days]; fall incidence rate from the FSW: 0.87 per 1000 patient-days [95% CI, 0.18-2.54 per 1000 patient-days]; fall incidence rate from the 1:10 NN: 0.87 per 1000 patient-days [95% CI, 0.18-2.55 per 1000 patient-days]). The hazard ratios for adverse events showed no statistically significant differences for both groups: 1.42 (95% CI, 0.67-2.99) for pressure ulcer and 0.66 (95% CI, 0.20-2.13) for fall from the FSW. In this cohort study, no association was found between the likelihood of adverse events and contact isolation using propensity score-matching methods and closely related covariates for adverse events.


In vivo motion of femoral condyles during weight-bearing flexion after anterior cruciate ligament rupture using biplane radiography.
The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key PointsThree-dimensional tibiofemoral kinematics and femoral condylar motion in ACL-deficient knees during upright weight-bearing flexion were measured using biplane radiography with the geometric center axis.ACL deficiency caused posterior subluxation of the lateral condyle with excess external femoral rotation at early flexion positions.On flexion from 15° to 60°, the lateral condyle moved slightly posteriorly in ACL deficiency leading to reduced extent of external femoral rotation.


A review of the literature considering the role of mental health nurses in assertive outreach.
A review of the literature considering the role of mental health nurses in assertive outreach Assertive outreach teams are a central component of the UK government vision for Mental Health. The general aim of such services is to engage with clients who for one reason or another lose contact with traditional services and require a more flexible approach to care. Researchers and the Government recognize that nurses who work within Assertive Outreach need specialist skills, knowledge and personal attributes to carry out their work. A comprehensive review of the literature was carried out via computer search engines, an Internet search and a hand search of pertinent references. Two screens were applied to the literature to make sure only the highest quality information was evaluated. The results of the literature search were presented in tabular format and three key themes were identified as being important for mental health nurses working in assertive outreach services. These themes were clinical knowledge and skills, successful outcomes for assertive outreach services and personal attributes of practitioners. Multidisciplinary working within assertive outreach services allows for some of the ethical dilemmas to be resolved. However, the competing demands placed on nurses, including risk assessment verses engagement, may lead to high stress levels and burnout. Research studies highlight that without experienced and knowledgeable staff the provision of an assertive outreach model is in jeopardy. The Government and service providers need to ensure that practitioners within assertive outreach services receive sufficient training, managerial and clinical supervision, in order to do the best for a very challenging and chaotic client group.


Morphological and pathological response in primary systemic therapy of patients with breast cancer and the prediction of disease free survival: a single center observational study.
To identify breast cancer subtypes likely to respond to primary systemic therapy (PST or neoadjuvant therapy) and to assess the accuracy of physical examination (PE) and breast ultrasonography (US) in evaluating and predicting residual size of breast carcinoma following PST. 116 patients who received at least two cycles of PST between 1998 and 2009 were selected from a prospectively collected clinical database. Radiological assessment was done by mammography and US. Prior to PST, tumors were subclassified according to core biopsy (NCB) and/or fine-needle aspiration-based immunohistochemical profiles of NCB. Pathological response rates were assessed following the surgeries by using Chevallier classification. Tumor measurements by PE and US were obtained before and after PST. Different clinical measurements were compared with histological findings. Disease-free survival (DFS) was assessed. Pathological complete remission (pCR=Chevallier I/II) was observed in 25 patients (21.5%), 44% of whom had triple negative histology, 28% Her2 positive and 76% had high-grade tumor. Of 116 patients, 24 received taxane-based PST, 48 combined taxane + anthracycline treatment, 8 trastuzumab combinations, 21 anthracycline-based treatments, and 15 other treatments. In the taxane treated group, the pCR rate was 30%, in the taxane + anthracycline group 25%, in the anthracycline group 9.5%, and in trastuzumab group 37.5%. After PST, PE and US were both significantly associated with pathology (P<0.001 and P=0.004, respectively). Concerning OS, significant difference was observed between the Chevallier III and IV group (P=0.031) in favor of Chevallier III group. In the pCR group, fewer events were observed during the follow-up period. Our results show that even limited, routinely used immunohistochemical profiling of tumors can predict the likelihood of pCR to PST: patients with triple negative and Her2-positive cancers are more likely to achieve pCR to PST. Also, PE is better correlated with pathological findings than US.


Seasonal variation in biomass and carbohydrate partitioning of understory sugar maple (Acer saccharum) and yellow birch (Betula alleghaniensis) seedlings.
We investigated seasonal patterns of biomass and carbohydrate partitioning in relation to shoot growth phenology in two age classes of sugar maple (Acer saccharum Marsh.) and yellow birch (Betula alleghaniensis Britt.) seedlings growing in the understory of a partially harvested forest. The high root:shoot biomass ratio and carbohydrate concentration of sugar maple are characteristic of species with truncated growth patterns (i.e., cessation of aboveground shoot growth early in the growing season), a conservative growth strategy and high shade tolerance. The low root:shoot biomass ratio and carbohydrate concentration of yellow birch are characteristic of species with continuous growth patterns, an opportunistic growth strategy and low shade tolerance. In both species, starch represented up to 95% of total nonstructural carbohydrates and was mainly found in the roots. Contrary to our hypothesis, interspecific differences in shoot growth phenology (i.e., continuous versus truncated) did not result in differences in seasonal patterns of carbohydrate partitioning. Our results help explain the niche differentiation between sugar maple and yellow birch in temperate, deciduous understory forests.


Electromagnetic field strength levels surrounding electronic article surveillance (EAS) systems.
Electronic article surveillance (EAS) is used in many applications throughout the world to prevent theft. EAS systems produce electromagnetic (EM) energy around exits to create an EM interrogation zone through which protected items must pass before leaving the establishment. Specially designed EAS tags are attached to these items and must either be deactivated or removed prior to passing through the EAS EM interrogation zone to prevent the alarm from sounding. Recent reports in the scientific literature have noted the possibility that EM energy transmitted by EAS systems may interfere with the proper operation of sensitive electronic medical devices. The Food and Drug Administration has the regulatory responsibility to ensure the safety and effectiveness of medical devices. Because of the possibility of electromagnetic interference (EMI) between EAS systems and electronic medical devices, in situ measurements of the electric and magnetic fields were made around various types of EAS systems. Field strength levels were measured around four types of EAS systems: audio frequency magnetic, pulsed magnetic resonant, radio frequency, and microwave. Field strengths from these EAS systems varied with magnetic fields as high as 1073.6 Am(-1) (in close proximity to the audio frequency magnetic EAS system towers), and electric fields up to 23.8 Vm(-1) (in close proximity to the microwave EAS system towers). Medical devices are only required to withstand 3 Vm(-1) by the International Electrotechnical Commission's current medical device standards. The modulation scheme of the signal transmitted by some types of EAS systems (especially the pulsed magnetic resonant) has been shown to be more likely to cause EMI with electronic medical devices. This study complements other work in the field by attaching specific characteristics to EAS transmitted EM energy. The quantitative data could be used to relate medical device EMI with specific field strength levels and signal waveforms. This is one of several efforts being made by the FDA, the electronic medical device industry and the EAS industry to mitigate the potential for EMI between EAS and medical devices.


Projecting extended optical traps with shape-phase holography.
We describe a method for projecting single-beam optical traps whose potential energy wells are extended along one-dimensional curves. This technique exploits shape-phase holography in which computer-generated phase-only diffractive optical elements are used to implement complex and amplitude-only holograms. The resulting optical traps can have specified intensity and phase profiles along their lengths and can extend along curves in three dimensions. We demonstrate the extended traps' operation and characterize their potential energy profiles through digital video microscopy of trapped colloidal spheres.


Eversion vs conventional carotid endarterectomy: a systematic review.
to determine whether eversion carotid endarterectomy (CEA) was safe and more effective than conventional CEA. controlled trials comparing eversion vs conventional technique for CEA were identified from the Cochrane Stroke Review Group database plus additional hand searching. Researchers were contacted to identify additional published and unpublished studies. Randomised and pseudorandomised trials comparing eversion to conventional techniques in patients undergoing CEA were examined. Outcomes included stroke and death, carotid restenosis/occlusion, and local complications. five trials were included comprising 2465 patients and 2590 arteries. There were no significant differences in the rate of perioperative stroke or death (1.7% vs 2.6%, odds ratio [OR] 0.44, 95% confidence interval [CI] 0.10-1.82) and stroke during follow-up (1.4% vs 1.7%; OR: 0.84; 95% CI: 0.43-1.64) between eversion and conventional CEA techniques. Eversion CEA was associated with a significantly lower rate of restenosis >50% during follow-up (2.5% vs 5.2%, OR: 0.48, 95% CI: 0.32-0.72). There were no statistically significant differences in local complications between the eversion and conventional group. When eversion procedures were compared with patch procedures only, non-significant differences were found in primary outcomes. eversion CEA may be associated with low risk of arterial occlusion and restenosis. However, numbers are too small to definitively assess the benefits and disadvantages of eversion CEA. Reduced restenosis rates did not appear to be associated with clinical benefit in terms of reduced stroke risk, either perioperatively or later. Until further evidence is available, the choice of the CEA technique should be based on the experience and familiarity of the individual surgeon.


Interferon-λ rs12979860 genotype association with liver fibrosis in chronic hepatitis C (CHC) patients in the Pakistani population.
Risk and progression of liver fibrosis and cirrhosis in chronic hepatitis C (CHC) patients is significantly influenced by host genetic factors in a polygenic manner. The rs12979860 genetic polymorphism in the interferon-λ3-interferon-λ4 (IFNL3-IFNL4) region has been found to be a major determinant of hepatic inflammatory and fibrotic progression in CHC patients of mainly Caucasian origin; however, it is not known if this association applies to other ethnicities, including Pakistani CHC patients. Here, we genotyped IFNL3-IFNL4 rs12979860 genetic variants in a sample set of 502 Pakistani patients with CHC and used logistic regression analysis to determine its association with the risk and progression of HCV-related fibrosis and cirrhosis. We demonstrate that the rs12979860 major (CC) genotype, despite not determining the risk of stage-specific hepatic fibrosis independently, is associated with a marginally significant risk of liver cirrhosis (OR: 1.64, p = 0.049) after an adjustment for age, gender, body mass index, HCV viral load, and liver enzymes. In a subgroup of CHC patients with sustained ALT levels of <60 IU/L, a more pronounced impact of the IFNL3-IFNL4 rs12979860 major (CC) genotype on advanced liver fibrosis (OR: 4.99, p = 0.017) and cirrhosis (OR: 3.34, p = 0.005) was seen. The present study suggests that IFNL3-IFNL4 rs12979860 polymorphism may also be a significant predictor of hepatic fibrosis and cirrhosis in Pakistani CHC patients, especially in those with normal or near-normal liver enzyme levels.


Molecular characterization of Escherichia coli isolated from milk samples with regard to virulence factors and antibiotic resistance.
Raw milk is considered an essential source of nutrition during all stages of human life because it offers a valuable supply of protein and minerals. Importantly, milk is considered a good media for the growth and contamination of many pathogenic bacteria, especially food-borne pathogens such as Escherichia coli. Thus, the objective of this study was to characterize E. coli and detect its virulence factors and antibiotic resistance from raw milk samples. Raw milk samples (n=100) were collected from different localities in Qena, Egypt, and investigated for the presence of E. coli using different biochemical tests, IMViC tests, serotyping to detect somatic antigen type, and molecularly by polymerase chain reaction (PCR) tests. The presence of different virulence and antimicrobial genes (hly, eae, stx1, stx2, blaTEM, tetA(A), and tetB genes) in E. coli isolates was evaluated using PCR. The results demonstrated that 10 out of 100 milk samples were contaminated with E. coli. Depending on serology, the isolates were classified as O114 (one isolate), O27 (two isolates), O111 (one isolate), O125 (two isolates), and untypeable (five isolates) E. coli. The sequencing of partially amplified 16S rRNA of the untypeable isolates resulted in one isolate, which was initially misidentified as untypeable E. coli but later proved as Enterobacter hormaechei. Moreover, antibacterial susceptibility analysis revealed that nearly all isolates were resistant to more than 3 families of antibiotics, particularly to b-lactams, clindamycin, and rifampin. PCR results demonstrated that all E. coli isolates showed an accurate amplicon for the blaTEM and tetA(A) genes, four isolates harbored eae gene, other four harbored tetB gene, and only one isolate exhibited a positive stx2 gene. Our study explored vital methods for identifying E. coli as a harmful pathogen of raw milk using 16S rRNA sequencing, phylogenetic analysis, and detection of virulence factors and antibiotic-resistant genes.


Overview and research agenda arising from the 7th World Workshop on Oral Health and Disease in AIDS.
The Research Agenda generated by the 7th World Workshop on Oral Health and Disease in AIDS (WW7) is delivered in this paper. Panels of international experts presided over nine workshops that constituted the conference held in November 2014 in Hyderabad, India. The main goal of the Workshop was to bring together clinician and scientists interested in the subject to debate with world-wide perspectives current issues related to the oral manifestations in HIV/AIDS. The workshops were structured around three themes; basic science, clinical/translational science and social science and were attended by 135 participants from 31 countries. The research questions debated at the workshops are presented in nine consensus papers published in this issue and are summarised in this paper along with an outline of the identified research needs in the field.


Field studies on the susceptibility of housefly to certain insecticides in nine Egyptian governorates.
Standard WHO test methods were used to determine the susceptibility of field population of housefly to four organophosphorous and two pyrethroid insecticides. Field population flies collected from nine governorates, Giza, Faiyoum, Suez, Behaira, Menoufia, Sharkia, Kafr El-Sheikh, Assiut and Aswan. The results indicated that, all tested insecticides were very effective on flies collected, from Sharkia, Kafr El-Sheikh and Aswan, but there was an evidence of increased vigor tolerance among those collected from Kafr El-Sheikh for bioresmethrin and tolerance for diazinon in Aswan. In Assiut, flies exhibited high sensitivity to diazinon, deltamethrin and bromophos while malathion was the least effective adulticide. Resistance to malathion, diazinon, fenthion and bioresmethrin was noticed in varying degrees at all governorates. The highest average resistance ratio was recorded for malathion in Behaira (55.3 folds) and in Suez (26 folds). Resistance was also more pronounced in Menoulia for diazinon (23.3 folds). As for bioresmethrin an apparent increase in the resistance ratio was detected in Suez (25 folds). In Giza. houseflies were resistant to fenthion (14.5 folds). Regarding the difference between the six insecticides used, deltamethrin was the most potent insecticide in all governorates.


Effect of different ethanolic concentrations on antioxidant properties and cytoprotective activities of Platostoma palustre Blume.
The objective of this study was to evaluate the antioxidant activities of Mesona procumbens ethanolic extracts (MPEEs) which displayed variable antioxidant levels with different ethanolic concentrations. Compared to MPEEs with 20, 40 and 80% ethanol, the 60% MPEE exhibited a higher total phenol content (TPC), total flavonoid content (TFC), 1,1-diphenyl-2-picryl hydrazyl (DPPH)- and 2,2-azino-bis-(3-ethyl benzothiazoline-6-sulphonic acid (ABTS)-scavenging activities, reducing power, protection of Raw 264.7 mouse macrophages against H2O2-induced damage, and inhibition of reactive oxygen species (ROS) induced by 2,2-azobis(2-amidino propane) dihidrochloride (AAPH). IC50 values of DPPH and ABTS radicals by MPEEs were highly and significantly associated with TPCs and TFCs. The most significant protective effect against oxidative DNA damage was also found to be the 60% MPEE at a concentration of 3.6 mg/mL. In addition, the cell viability test showed that none of the MPEEs had any cell toxicity up to a concentration of 250 μg/mL. The 60% MPEE exhibited higher in vitro and ex vivo antioxidant activities, possessed a protective capability for the biological membrane system, and can be used as a functional ingredient representing a potential source of natural antioxidants to prevent and treat oxidative stress-related disorders.


Functional properties of subsets of T lymphocytes defined by specific antigens.
Heteroantisera raised to the acute lymphocytic T (ALL) cell line HSB2 and to Sézary cells react with distinct subpopulations of T lymphocytes. Each antiserum reacts with a different T cell antigen and defines a distinct subpopulation that represents approximately 50% of peripheral blood T lymphocytes. The anti-HSB2-positive subpopulation contained suppressor cells for pokeweed mitogen-dependent immunoglobin (Ig) synthesis whereas the anti-Sézary cell serum-positive population included helper cells for Ig synthesis and mixed lymphocyte responder cells.


Very rapid virologic response and early HCV response kinetics, as quick measures to compare efficacy and guide a personalized response-guided therapy.
This is the second and final report for our study designed to compare two generic sofosbuvir products for the degree and speed of virologic response to a dual anti-hepatitis C virus (HCV) treatment protocol. We aimed to test the applicability of the early virus response kinetics and the very rapid virologic response (vRVR) rate as quick outcome measures for accelerated comparative efficacy studies and as a foundation for a personalized response-guided therapy. Fifty eligible chronic HCV patients were randomized to either one of two generic sofosbuvir products (Gratisovir or Grateziano) at a daily dose of one 400 mg tablet plus a weight-based ribavirin dose. Data were compared between the groups for early virus response kinetics and vRVR rates in relation to the rates of final sustained virologic response at week 12 posttreatment (SVR12). The Log10 transformed virus load (Log polymerase chain reaction) curves showed fairly similar rapid decline during the first 2 weeks, with no significant difference between the groups at four analysis points throughout the study by repeated-measures factorial analysis of variance test (P=0.48). The SVR12 rates were 96% (95% confidence interval, 79.6%-99.9%) in Gratisovir group (24/25) and 95.7% (95% confidence interval, 78%-99.9%) in Grateziano group (22/23). There was no statistically significant difference found by exact test (P>0.999). There was a significant association between the vRVR and the SVR12, with 100% positive predictive value (38/38 of those who had vRVR, achieved a final SVR12) and 82.6% sensitivity (among the total 46 with SVR12, 38 were having vRVR). We can conclude from our study that the early HCV response kinetics and the vRVR rates could be used as sensitive quick markers for efficacy (with a very high positive predictive value for SVR12), based on our accelerated comparative efficacy research model. This might open the way for new models of accelerated equivalence efficacy studies along with the bioequivalence kinetics studies to test a generic drug against a reference. Also, the early response kinetics and the vRVR might be used as qualifiers for a personalized course of treatment. This could shorten unnecessarily long treatment courses in rapid responders and might help to avoid relapses in slow responders.


Are there useful CT features to differentiate renal cell carcinoma from lipid-poor renal angiomyolipoma?
This study was an attempt to identify key CT features that can potentially be used to differentiate between lipid-poor renal angiomyolipoma and renal cell carcinoma (RCC). We conducted an analysis of patients who received nephrectomy or renal biopsy from 2002 to 2011 with suspected RCC. We included tumors smaller than 7 cm with a completed three-phase CT examination. A radiologist and a urology fellow, blinded to histopathologic diagnosis, recorded the imaging findings by consensus and compared the values for each parameter between lipid-poor angiomyolipoma, RCC subtypes, and RCC as a group. Multivariate logistic regression analysis was performed for each univariate significant feature. The sample in our study consisted of 132 patients with 135 renal tumors, including 51 men (age range, 26-84 years; mean age, 57 years) and 81 women (age range, 29-91 years; mean age, 57 years). These tumors included 33 lipid-poor angiomyolipomas, 54 clear-cell RCC, 31 chromophobe RCC, and 17 papillary RCC. Multivariate analysis revealed four significant parameters for differentiating RCC as a group from lipid-poor angiomyolipoma (angular interface, p = 0.023; hypodense rim, p = 0.045; homogeneity, p = 0.005; unenhanced attenuation > 38.5 HU, p < 0.001), five for clear-cell RCC, two for chromophobe RCC, and one for papillary RCC. Lipid-poor angiomyolipoma and clear-cell RCC showed early strong enhancement and a washout pattern, whereas chromophobe RCC and papillary RCC showed gradual enhancement over time. Specific CT features can potentially be used to differentiate lipid-poor renal angiomyolipoma from renal cell carcinoma.


Nanomonitors: electrical immunoassays for protein biomarker profiling.
The objective of this research is to develop a 'point-of-care' device for early disease diagnosis through protein biomarker characterization. Here, we present label-free, high sensitivity detection of proteins with the use of electrical immunoassays that we call nanomonitors. The basis of the detection principle lies in the formation of an electrical double layer and its perturbations caused by proteins trapped in a nanoporous alumina membrane over a microelectrode array platform. High sensitivity and rapid detection of study protein biomarkers for cardiovascular diseases, C-reactive protein (CRP) and myeloperoxidase (MPO) in pure and clinical samples through label-free electrical detection were achieved. CRP and MPO were detected in pure solutions with a lower detection limit of 200 pg/ml and 500 pg/ml, respectively. These two study proteins were also detected from multiplexed samples containing a mixture of both proteins as well as human serum samples. The performance parameters of the nanomonitors, such as speed of detection on the order of minutes, volume of reagents of a few microliters and low cost per assay are comparable to traditional assay methods, such as ELISA. In addition, nanomonitors also provide the advantages of being a label-free technique with large linear dynamic range of detection and a significant reduction in the size of assay, thus making it an ideal candidate for a clinical diagnostic 'lab-on-a-chip' device for protein biomarker profiling and hence early disease diagnosis.


Herbal compounds for rheumatoid arthritis: Literatures review and cheminformatics prediction.
Rheumatoid arthritis (RA) is a systemic disease characterized by autoimmunity, joint inflammation, and cartilage destruction, which affects 0.5-1% of the population. Many compounds from herbal medicines show the potentials to treat RA. On this basis, the compounds with good pharmacokinetic behaviors and drug-likeness properties will be further studied and developed. Therefore, the herbal compounds with anti-RA activities were reviewed in this paper, and the cheminformatics tools were used to predict their drug-likeness properties and pharmacokinetic parameters. A total of 90 herbal compounds were analyzed, which were reported to be effective on RA models through anti-inflammation, chondroprotection, immunoregulation, antiangiogenesis, and antioxidation. Most of the herbal compounds have good drug-likeness properties. Most of the compounds can be an alternative and valuable source for anti-RA drug discovery.


The effects of prometryne on subchronically treated mice evaluated by SCGE assay.
Prometryne is a methylthio-s-triazine herbicide used to control annual broadleaf and grass weeds in many cultivated plants. Significant traces are documented in environment, mainly water, soil and plants used for human and domestic animal nutrition. Data on the toxic effects of prometryne and other methylthio-s-triazine have scorcely been published. The goal of this study was to investigate if prometryne, applied orally, could induce DNA damage in mouse leukocytes, in subchronical in vivo experimental design. Three different doses of prometryne were applied per os repeatedly every 48 hours. After the 7th dose (day 14) and the 14th dose (day 28) blood leucocytes were analyzed by alkaline Single Cell Gel Electrophoresis (Comet) assay. The results of three different comet parameters showed general increase in Olive tail moment, tail length and tail intensity values in treated groups of animals. The increase in measured values was almost proportional to the dose received and the time of exposure. We conclude that prometryne or its metabolic residues have the potential to induce processes that cause genotoxic effects on leukocytes on mice in in vivo repeated exposure.


[Papillary fibroelastoma of the aortic valve. Sudden death caused by an uncommon tumor of the heart].
We describe a very rare tumor of the heart with a pendulous papillary fibroelastoma of the aortic valve, obstructing the ostium of the LCA - resulting in the sudden death of a healthy 40-year-old man. Acute severe ischemia was registered in the ECG a few minutes before death - corresponding especially to the myocardial regions perfused by the LCA. There is no doubt from the post mortem findings that the sudden death of this patient was caused by occlusion of the left coronary ostium by the pendulous papillary fibroelastoma.


[Correlation between a blood pressure variability-based scoring system and target organ damage in patients with hypertension].
To investigate the relationship between a blood pressure variability (BPV)-based scoring system (BPVSS) and the target organ damage in patients with hypertension. We selected 95 consecutive inpatients with essential hypertension admitted between January and June, 2015 in the Department of Cardiology of Guangzhou General Hospital of Guangzhou Military Command. The BPV indices were analyzed for their correlation with the parameters of target organ damage (IVSd, LVPWd, baPWV_L/R, and IMT_L/R). The patients with a BPVSS of 3.9 or higher (control, 43 cases) and those with a lower BPVSS (observation group, 52 cases) were compared for differences in IVSd, LVPWd, baPWV_L/R, IMT_L/R and the proportion of carotid plaques. Similar with the traditional BPV indices, BPVSS was negatively correlated with IMT_L/R (r=-0.278/-0.324, P<0.05). BPVSS was also negatively correlated with IVSd (r=-0.241), LVPWd (r=-0.223), and baPWV_L/R (r=-0.468/-0.373) (P<0.05). IVSd, LVPWd, baPWV_L/R and IMT_L/R were all significantly higher in the observation group than in the control group (t=2.307, 2.516, 3.250/2.790, and 2.372/3.425, respectively; P<0.05). The proportion of carotid plaques in the observation group was significantly higher than that in the control group (Χ(2)=27.833, P<0.001). BPVSS indicates the severity of target organ damage in patients with hypertension. A greater BPV is correlated with a lower BPVSS score and more severe damages of the heart and blood vessels.


Alpha lipoic acid supplementation improved antioxidant enzyme activities in hemodialysis patients.
Background: Cardiovascular disease (CVD) is the main cause of death in hemodialysis (HD) patients and oxidative stress is an important risk factor for CVD. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) are primary antioxidant enzymes in human cells acting against toxic reactive oxygen species (ROS) and their reduced activity may contribute to oxidative disorders in HD patients. Alpha lipoic acid (ALA) as a potent strong antioxidant may affect these enzymes. Objective: We examined the effects of ALA supplementation on antioxidant enzyme activities in HD patients. Method: In this double-blinded, randomized clinical trial, 63 HD patients (43 males and 20 females; age range: 22-79 years) were assigned into the ALA group (n: 31), receiving a daily dose of ALA (600 mg), or a control group (n: 32), receiving placebo for 8 weeks. Body mass index (BMI), antioxidant enzymes, albumin (Alb) and hemoglobin (Hb) were determined before and after intervention. Results: At baseline, the mean blood activities of SOD, GPx, and CAT in ALA group were 1032±366, 18.9±5.09 and 191±82.7 U/gHb which increased at the end of study to 1149±502, 19.1±7.19 and 208±86.6 U/gHb respectively. However, only the increase of SOD was statistically significant in comparison with placebo group (P = 0.04). The mean levels of Alb, Hb, weight and BMI were not significantly changed in study groups (P>0.05). Conclusion: ALA may be beneficial for HD patients by increasing the activity of antioxidant enzymes; however, further studies are needed to achieve precise results.


Normal coronary flow reserve after arterial switch operation for transposition of the great arteries: an intracoronary Doppler guidewire study.
Recent studies performed with positron emission tomography have suggested that coronary flow reserve (CFR) is moderately to severely reduced after the arterial switch operation (ASO). These findings are of great concern but have not been confirmed by other methods. Eleven symptom-free children were studied between 4 and 11 (median 6.0) years after the ASO. Flow velocity in the left anterior descending (LAD) and right coronary arteries (RCA) was measured with a 0.014-inch Doppler FloWire (Cardiometrics) before and after intracoronary injection of adenosine (0.5 microg/kg) and nitroglycerin (5 microg/kg). CFR was defined as the ratio of hyperemic to basal average peak velocity (APV). The median (range) CFR in the LAD was 3.7 (3.0 to 4.8) and 3.4 (2.9 to 4.8) in the RCA. The increase in APV after intracoronary injection of nitroglycerin was 300% (240% to 420%) in the LAD and 260% (190% to 460%) in the RCA. APV at rest was 15.0 (14.0 to 21.0) cm/s in the LAD and 16.0 (9.6 to 30.0) cm/s in the RCA. A linear relation was found between right ventricular systolic pressure and resting APV in the RCA (r=0.77, P=0.0056), and between resting APV and CFR (r=-0.61, P<0.05) in the RCA. The CFR and coronary vasoreactivity to nitroglycerin in children treated for transposition of the great arteries with the ASO was within normal limits. Increased right ventricular pressure and myocardial hypertrophy can cause increased resting coronary flow velocity in the RCA and affect CFR negatively.


Laryngeal involvement in rheumatoid arthritis. A clinical, laryngoscopic, and computerized tomographic study.
Laryngeal involvement was evaluated in 45 patients with moderately severe rheumatoid arthritis (RA). RA duration and severity, prior laryngeal symptoms, and abnormalities detected by concurrent indirect laryngoscopy (IL) and computerized tomography (CT) were noted and correlated with changes of basilar interstitial fibrosis (BPF) found by chest radiograph. Thirty-two percent had abnormalities detected by IL, 54% had abnormalities by CT, and 36% had BPF on chest radiographs. Comparison of these groups revealed: only two symptoms (sore throat and difficulty during inspiration) were predictive of abnormalities detected by IL; no symptoms predicted abnormalities on percentage of RA patients even in the absence of symptoms; IL tends to detect mucosal and gross functional abnormalities while CT detects structural lesions; BPF shown on chest radiographs in RA patients does not appear to be correlated with cricoarytenoid arthritis as defined by IL and CT.