A context analysis of student training records dating from the 1950/1960s: what were desirable and undesirable student nurse characteristics?
The aim of this study is to identify what were desirable and undesirable student nurse characteristics in the 1950/1960s and relate them to those who had successfully completed the programme and gained State Registration and those who had not. A further aim was to undertake comparisons with modern day values of what are viewed as desirable traits in nurses. In the 1950/1960s student nurses were hospital employees. Nurse training was based in hospital training schools and coordinated by sister tutors. Learning about nursing largely took place in clinical settings where there was limited supervision of student nurses by qualified nurses. Content analysis approaches were used whereby positive and negative comments related to successful and unsuccessful completers were identified. Data were extracted from individual training records relating to 641 student nurses. The records dated from 1955 to 1968. Clinical and training school reports were summarized by senior hospital figures such as the hospital matron. These reports were the focus of the analysis. Desirable student nurse traits identified in the analysis were being a 'nice person', who is kind, compassionate and attentive to patients, conscientious, bright and intelligent. Other values such as being hard-working, reliable and punctual reflect that the students studied were primarily employees. Amenable to discipline and unquestioningly obeying a doctor's order also were part of the conventions of the time. Most negative comments related to the unsuccessful completers. New insights into what was viewed as desirable and undesirable nursing characteristics in the 1950/1960s are identified. These insights have national and international relevance.


[New prognostic factors in the treatment of patients with stage-III Hodgkin's disease].
Our data are presented on evaluation of chemoradiotherapy of 365 patients with stage III Hodgkin's disease. Patients with stage IIIA tumors revealed the following significant differences of overall and relapse-free survival (p < or = 0.00001): 15-year overall survival (nodular sclerosis G1) - 95% vs.G2 - 45%; 15-year relapse-free survival: G1 - 86%, G2 - 32%. In stage IIIB group, overall survival (50%) was significantly lower as compared with 70%. Involvement foci significantly regressed by less than 75% (p = 0.044) after 2-4 cycles of preliminary combination chemotherapy. Our results suggest that differentiated criteria be used for prognosis of stage III Hodgkin's disease treatment.


Prenylated Chrysin Derivatives as Partial PPARγ Agonists with Adiponectin Secretion-Inducing Activity.
Decreased circulating adiponectin levels are associated with an increased risk of human metabolic diseases. The chemical-mediated upregulation of adiponectin biosynthesis has been proposed as a novel therapeutic approach to managing hypoadiponectinemia-associated diseases. In preliminary screening, the natural flavonoid chrysin (1) exhibited adiponectin secretion-inducing activity during adipogenesis in human bone marrow mesenchymal stem cells (hBM-MSCs). Here, we provide the 7-prenylated chrysin derivatives, chrysin 5-benzyl-7-prenylether compound 10 and chrysin 5,7-diprenylether compound 11, with the improved pharmacological profile compared with chrysin (1). Nuclear receptor binding and ligand-induced coactivator recruitment assays revealed that compounds 10 and 11 functioned as peroxisome proliferator-activated receptor (PPAR)γ partial agonists. These findings were supported by molecular docking simulation, followed by experimental validation. Notably, compound 11 showed PPARγ binding affinity as potent as that of the PPARγ agonists pioglitazone and telmisartan. This study presents a novel PPARγ partial agonist pharmacophore and suggests that prenylated chrysin derivatives have therapeutic potential in various human diseases associated with hypoadiponectinemia.


Cross-Sectional Study of the Prevalence of Cobalamin Deficiency and Vitamin B12 Supplementation Habits among Vegetarian and Vegan Children in the Czech Republic.
Vegetarian (VG) and vegan (VN) diets in childhood are of growing interest due to their perceived health and environmental benefits. Concerns remain due to the possible disruption of healthy growth and development of children because of the scarcity of evidence-based studies. Among the nutrients of special concern is vitamin B12. Therefore, the Czech Vegan Children Study (CAROTS) decided to examine the relationship between B12 metabolism parameters and B12 intake through diet and supplementation. We analyzed laboratory parameters within n = 79 VG, n = 69 VN, and n = 52 omnivores (OM) children (0−18 years old). There were no significant differences in levels of holotranscobalamin (aB12), folate, homocysteine (hcys), or mean corpuscular volume. However, there was a significant difference in levels of cyanocobalamin (B12) (p = 0.018), even though we identified only n = 1 VG and n = 2 VN children as B12 deficient. On the other hand, we identified n = 35 VG, n = 28 VN, and n = 9 OM children with vitamin B12 hypervitaminosis (p = 0.004). This finding was related to a high prevalence of over-supplementation in the group (mean dose for VG 178.19 ± 238.5 µg per day; VN 278.35 ± 394.63 µg per day). Additionally, we found a significant (p < 0.05) difference between B12, aB12, and hcys levels of supplemented vs. non-supplemented VG/VN children. This can show that the intake of vitamin B12 via diet in the VG group might not be sufficient. Secondly, we analyzed a relation between supplement use in pregnancy and breastfeeding and its impact on vitamin B12 levels of children aged 0−3 years. Out of n = 46 mothers, only n = 3 (e.g., 6.5%) were not supplemented at all. We have not identified any clinical manifestation of B12 deficiency and only n = 1 child with low serum cobalamin, a child who did not receive vitamin B12 supplementation and whose mother took only low doses of vitamin B12 (25/µg/day).To conclude, we did not observe any life-threatening or severe consequences of laboratory-stated vitamin B12 deficiency; thus, our group was well supplemented. On the other hand, we have identified many subjects with vitamin B12 hypervitaminosis of unknown impact on their health. Further research and new guidelines for B12 supplementation among VG and VN children are needed.


The relationship between cognitive engagement and better memory in midlife.
Engagement in cognitively stimulating work and activities may slow cognitive decline and dementia. We examined the individual and combined associations of four cognitive engagement indices (educational attainment, occupational complexity, social engagement, and cognitively stimulating leisure activities) with objective and subjective cognition. Middle-aged adults (n = 1864) enrolled in the Healthy Brain Project completed the Cogstate Brief Battery, the Cognitive Function Instrument, and self-report questionnaires of cognitive engagement. Educational attainment and leisure activity engagement were individually associated with memory performance. Participants were classified based on whether they rated highly in zero to four cognitive engagement indices. Compared to participants with no indices, participants with two or more indices performed moderately better on memory. Results suggest that greater variety of cognitive engagement across different areas of life is related to better memory in midlife. Possible explanation for this relationship may be increased opportunity for enhancing cognitive reserve, but further investigations are required.


Root endophyte differentially regulates plant response to NO3- and NH4+ nutrition by modulating N fluxes at the plant-fungal interface.
In the soil, plant roots associated with fungi often encounter uneven distribution of nitrate (NO3- )/ammonium (NH4+ ) patches, but the mechanism underlying N form-influenced plant-fungal interactions remains limited. We inoculated Arabidopsis with a root endophyte Phomopsis liquidambaris, and evaluated the effects of P. liquidambaris on plant performance under NO3- or NH4+ nutrition. Under NO3- nutrition, P. liquidambaris inoculation promoted seedling growth, whereas under NH4+ nutrition, P. liquidambaris suppressed seedling growth. Under high NH4+ conditions, fungus-colonized roots displayed increased NH4+ accumulation and NH4+ efflux, similar to the effect of ammonium stress caused by elevated NH4+ levels. Notably, this fungus excluded NH4+ during interactions with host roots, thereby leading to increased NH4+ levels at the plant-fungal interface under high NH4+ conditions. A nitrite reductase-deficient strain that excludes NO3- but absorbs NH4+ , decreased NH4+ levels in Arabidopsis shoots and rescued plant growth and nitrogen metabolism under high NH4+ levels. Transcriptomic analysis highlighted that P. liquidambaris had altered transcriptional responses associated with plant response to inorganic N forms. Our results demonstrate that fungus-regulated NO3- /NH4+ dynamics at the plant-fungal interface alters plant response to NO3- /NH4+ nutrition. This study highlights the essential functions of root endophytes in plant adaptation to soil nitrogen nutrients.


[Difficult reintubation during a Fantoni's tracheostomy resolved using a laryngeal mask].
We report the failure of a reintubation under direct laryngoscopy, during a percutaneous tracheostomy by Fantoni method. After the accidental per-procedural extubation and in front of an unpredicted difficult conventional endotracheal intubation, a laryngeal mask was used as an airway intubator conduit for the blind passage of the set's ventilation tube. This ventilation tube is a 40 cm long, 4 mm internal diameter special catheter with low pressure cuff, included into the TLT kit. The end of the procedure was uneventful.


Can the dextroenantiomer of the aromatase inhibitor fadrozole be useful for clinical investigation of aldosterone-synthase inhibition?
The beneficial effects of spironolactone, eplerenone, amiloride and potassium in preventing cardiovascular damage in various experimental models of salt-induced hypertension can be dissociated from blood pressure effects, and have drawn attention to the direct genomic and non-genomic actions of aldosterone at the level of the vessels, the heart and the kidneys. Exposure to endogenous aldosterone could be decreased by direct and specific aldosterone-synthase inhibition. FAD 286A, the dextroenantiomer of the aromatase inhibitor fadrozole, might be a first candidate to investigate in humans, the physiological impact and therapeutic properties of aldosterone-synthase inhibition, especially in various forms of primary aldosteronism.


Drug interactions between common illicit drugs and prescription therapies.
The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.


Auranofin Enhances Sulforaphane-Mediated Apoptosis in Hepatocellular Carcinoma Hep3B Cells through Inactivation of the PI3K/Akt Signaling Pathway.
The thioredoxin (Trx) system plays critical roles in regulating intracellular redox levels and defending organisms against oxidative stress. Recent studies indicated that Trx reductase (TrxR) was overexpressed in various types of human cancer cells indicating that the Trx-TrxR system may be a potential target for anti-cancer drug development. This study investigated the synergistic effect of auranofin, a TrxR-specific inhibitor, on sulforaphane-mediated apoptotic cell death using Hep3B cells. The results showed that sulforaphane significantly enhanced auranofin-induced apoptosis by inhibiting TrxR activity and cell proliferation compared to either single treatment. The synergistic effect of sulforaphane and auranofin on apoptosis was evidenced by an increased annexin-V-positive cells and Sub-G1 cells. The induction of apoptosis by the combined treatment caused the loss of mitochondrial membrane potential (ΔΨm) and upregulation of Bax. In addition, the proteolytic activities of caspases (-3, -8, and -9) and the degradation of poly (ADP-ribose) polymerase, a substrate protein of activated caspase-3, were also higher in the combined treatment. Moreover, combined treatment induced excessive generation of reactive oxygen species (ROS). However, treatment with N-acetyl-L-cysteine, a ROS scavenger, reduced combined treatment-induced ROS production and apoptosis. Thereby, these results deduce that ROS played a pivotal role in apoptosis induced by auranofin and sulforaphane. Furthermore, apoptosis induced by auranofin and sulforaphane was significantly increased through inhibition of the phosphoinositide 3-kinase (PI3K)/Akt pathway. Taken together, the present study demonstrated that down-regulation of TrxR activity contributed to the synergistic effect of auranofin and sulforaphane on apoptosis through ROS production and inhibition of PI3K/Akt signaling pathway.


Bioethics for clinicians: 26. Assisted reproductive technologies.
Assisted reproductive technologies (ARTs) can be very helpful for certain patients, but ethical concerns have been raised about the inherent nature of specific techniques and the contexts in which many techniques are used. Physicians play important roles in supporting those who wish to become parents and in educating patients about impediments to fertilization and way to promote conception. We discuss various ethical issues surrounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. We examine the empirical evidence of the effectiveness of ARTs and suggest ways to approach ARTs in practice.


Evaluating the Measurement Properties of the Self-Assessment of Treatment Version II, Follow-Up Version, in Patients with Painful Diabetic Peripheral Neuropathy.
Background. The Self-Assessment of Treatment version II (SAT II) measures treatment-related improvements in pain and impacts and impressions of treatment in neuropathic pain patients. The measure has baseline and follow-up versions. This study assesses the measurement properties of the SAT II. Methods. Data from 369 painful diabetic peripheral neuropathy (PDPN) patients from a phase III trial assessing capsaicin 8% patch (Qutenza®) efficacy and safety were used in these analyses. Reliability, convergent validity, known-groups validity, and responsiveness (using the Brief Pain Inventory-Diabetic Neuropathy [BPI-DN] and Patient Global Impression of Change [PGIC]) analyses were conducted, and minimally important differences (MID) were estimated. Results. Exploratory factor analysis supported a one-factor solution for the six impact items. The SAT II has good internal consistency (Cronbach's alpha: 0.96) and test-retest reliability (intraclass correlation coefficients: 0.62-0.88). Assessment of convergent validity showed moderate to strong correlations with change in other study endpoints. Scores varied significantly by level of pain intensity and sleep interference (p < 0.05) defined by the BPI-DN. Responsiveness was shown based on the PGIC. MID estimates ranged from 1.2 to 2.4 (pain improvement) and 1.0 to 2.0 (impact scores). Conclusions. The SAT II is a reliable and valid measure for assessing treatment improvement in PDPN patients.


[Lung Metastasis from Alpha-Fetoprotein Resulting in Esophagogastric Junction Cancer-A Case Report].
A 51-year-old male underwent total gastrectomy for esophagogastric junction cancer(T3N0M0, Stage ⅡA). He was diagnosed with an alpha-fetoprotein(AFP) producing tumor and hepatoid adenocarcinoma. One month after radical surgery, computed tomography(CT) showed lung metastasis, and the patient's serum AFP level was high. He underwent chemotherapy( S-1 and wPTX/RAM)and eventually died 4 months after surgery.


How Fast Is Too Fast in Force-Probe Molecular Dynamics Simulations?
While molecular dynamics (MD) simulations are routinely used to interpret atomic force microscopy (AFM) experiments of protein unfolding, computational cost in MD simulations still mostly imposes a large difference in loading rates and time scales in this comparison. Loading rate dependencies of unfolding forces and mechanisms have been studied in depth in experiments, simulations, and theory. One potential additional implication of the larger MD pulling velocity that remains to be assessed is that regions of the proteins that are close to the point of force application will be under force earlier or under more force than more shielded regions, resulting in a bias of the protein unfolding sequence which is likely marginal at the slower AFM velocities. We here, for the first time, quantify the parameters of this bias using a model system of four tandem spectrin repeats (SRs) linked with long, flexible poly-glycine linkers. We subject the system to seven different pulling velocities ranging from 0.01 to 10 m/s and find that for the fastest velocities, down to 1 m/s, the outer domains preferentially unfold; in fact, at 10 m/s, this happened in 100 cases out of 100. On the basis of these data, and also through analyzing the amount of partial unfolding in the beginning of the simulations, we show that the bias is equivalent to an effective signal propagation of 5-100 m/s, which is about 2 orders of magnitude slower than the expected speed of sound. Our results can help in identifying and removing this bias from future simulations.


Experimental Infection of Sand Flies by Massilia Virus and Viral Transmission by Co-Feeding on Sugar Meal.
Background: Massilia virus (MASV) is a phlebovirus isolated from Phlebotomus perniciosus in various regions of southwestern Europe. It is closely related to human pathogens such as Toscana virus and sandfly fever Naples virus. The natural cycle of phleboviruses is poorly understood. Indeed, experimental studies demonstrate that transovarial and sexual transmission are not efficient enough for the maintenance of the virus in nature and to date there is no convincing evidence that a species of vertebrates is the reservoir of the virus. Here, we studied various transmission routes of MASV taking advantage of experimental colonies representing different species of sand flies. Methodology/Principal findings: In P. perniciosus, four sources of infection were compared: (i) Virus-seeded larval food to the first instar larvae (L1), or (ii) to the fourth instar larvae (L4), (iii) virus-seeded blood meal to adult females, and (iv) virus-seeded sugar meal to adults of both sexes. From 875 adults emerged from infected L1 and L4, only three were positive. In females infected by bloodmeal the infection rate was high before defecation, then it decreased drastically; MASV RNA was detected in only 5 out of 27 post-defecation. Surprisingly, the most efficient route of infection was observed after intake of virus-seeded sugar meal: 72% of females (79/110) and 52% of males (51/99) were found to be MASV RNA-positive. In addition, MASV-infected sandflies regurgitated virus particules into the sugar drop and MASV RNA was detectable in this drop for at least 24 h after regurgitation. MASV RNA was detected in about one third of the P. perniciosus exposed to this sugar drop contaminated by regurgitation. Sugar meal infection was also tested with six other species of sand flies. In males, there were no significant differences in infection rates when compared to P. perniciosus. In females, most species tested showed high infection rate at the beginning but then significant gradual decrease in infection rate during the experiment. Conclusions/Significance: We present the first description of arboviral infection of a dipteran vector using sugar meal. In all seven sand fly species tested, MASV was detected for two weeks post-infection. Our results showed that MASV can be transmitted between P. perniciosus either through co-feeding or via an infected sugar source such as plant sap. These newly described routes of horizontal transmission may play an important role in the circulation of phleboviruses in nature.


Rotation of the Ipsilateral Supraorbital Rim Around the Horizontal Axis in Unilateral Coronal Synostosis: A Craniometric Analysis of the Emergence Profile.
Unilateral coronal synostosis (UCS) results in well-defined dysmorphic changes including sphenoid malposition yielding posterior displacement of the supraorbital rim. Although variation in the ipsilateral supraorbital rim emergence profile has been suggested, it has not been previously investigated. The authors sought to characterize the emergence profile of the ipsilateral supraorbital rim in UCS through craniometric analysis. Thirty-five nonsyndromic UCS patients (0-18 months) with CT images obtained before operative intervention and 16 control patients (0-24 months, 32 orbits) were included. Craniometric measurements were performed to quantify the emergence profile of the ipsilateral supraorbital rim and locate the likely apex of rotation. The ipsilateral supraorbital rim was significantly rotated around the horizontal axis when measured in reference to the 0° vertical in UCS versus control patients by an average difference of 7.3° to 11.3° across age groups (P < 0.05). No significant effect modification was detected between age and UCS on ipsilateral supraorbital rim emergence profile (P > 0.05). Additional angles with vertices around the superior orbital circumference were then measured to locate the likely apex of rotation and revealed a significant decrease in the posterior orbital roof to 0° horizontal in UCS patients by an average of 9.3° to 22.1° in children under 1 year old (P < 0.01). Variation in the emergence profile of the ipsilateral supraorbital rim in UCS is quantified, and the apex of this rotation likely lies at the posterior orbital roof. The novel quantification and characterization of this deformity will better direct the operative approach and enable a more accurate correction.


Prevalence, Potential Predictors, and Genotype-Specific Prevalence of Human Papillomavirus Infection among Sexually Active Students in Japan.
We conducted a community-based study to evaluate genotype-specific prevalence of high-risk HPV (HR-HPV) and potential predictors of its presence in young, asymptomatic, female college students. Self-administered surveys and vaginal swabs for self collection were distributed to students of participating schools. A sufficient cellular component in cervical samples was verified by examining for the presence of human β-globin DNA by PCR. A total of 1,118 valid cervical samples were subjected to screening for HR-HPV infection with the Digene Hybrid Capture 2 assay, followed by identification of HPV genotypes with GENOSEARCH HPV31 kit. Logistic regression was used to adjust for confounding factors associated with HR-HPV positivity and the adjusted odds ratio (AOR) was calculated. The median age of recruited students was 20 years. Of the 1,118 women who provided valid cervical samples for testing, 770 had sexual intercourse in the past, of which 125 (16.2%) were positive for HR-HPV. Logistic regression analysis revealed that HR-HPV infection was associated with smoking history (AOR 2.13; 95% confidence interval [CI] 1.98 to 5.05; p < 0.01), total number of partners (AOR 4.72; 95% CI 1.97 to 11.32 if > 5 partners; p < 0.001), number of partners in the past 6 months (AOR 3.12; 95% CI 1.42 to 6.87; p < 0.01), improper use of condoms (AOR 2.21; 95% CI 1.25 to 3.90; p < 0.01), and chlamydia infection (AOR 2.61; 95% CI 1.28 to 5.34; p < 0.01). The most common HR-HPV genotype was type 52 (6.4%), followed by 16 (3.1%), 56 (3.0%), and 58 (2.6%). Compared with previous reports in East Asian coutries, the prevalence of HR-HPV infection among young, asymptomatic, female students before the nationwide use of vaccination in Japan was in the intermediate range. The most common HR-HPV genotypes were HPV 52, 16, 56, and 58.


Suicidal tendencies as a complication of light therapy for seasonal affective disorder: a report of three cases.
Suicidality in seasonal affective disorder (SAD) subjects treated with bright light therapy seems to be a rare phenomenon. We report on three SAD patients with predominant atypical symptoms who presented for treatment in our clinic for SAD. Two suffered from bipolar disorder, one from recurrent major depressive disorder. All subjects were drug-free and treated with bright light therapy as a monotherapy for the first time. Treatment response was assessed weekly by standardized rating instruments, using the Hamilton Rating Scale for Depression (HAM-D) and the HAM-D-SAD addendum for assessment of atypical symptoms. Within the first week after beginning bright light therapy, two subjects attempted suicide. The third patient developed suicidal thoughts that were so acute and overwhelming that we had to discontinue bright light therapy and start with psychopharmacologic treatment in an inpatient setting. It is suggested that bright light-induced amelioration of drive and mood can be dissociated as can be the case in the "critical time" of antidepressant therapy. The authors believe the collection of prevalence data on suicide and SAD would be worthwhile.


Glioblastoma with tumor-to-tumor metastasis from lung adenocarcinoma.
Glioblastoma is a tumor with widely variable morphology. It may rarely show pseudoepithelial components or true epithelial differentiation. Metastasis to glioblastomas have been previously reported, but were unsupported by immunohistochemical or molecular analyses. Herein we describe a glioblastoma with carcinomatous foci in a patient with no past clinical history of tumors outside the central nervous system. The carcinomatous foci expressed epithelial, but not glial markers. Therefore, whole-body imaging was carried out to verify the presence of carcinoma. A lung mass was biopsied and it resulted as primary lung adenocarcinoma. Carcinomatous foci of glioblastoma and lung adenocarcinoma had the same KRAS mutation which was absent in glial areas of the glioblastoma. Thus, glioblastoma with tumor-to-tumor metastasis was diagnosed. This case demonstrates that, albeit rare, metastases to glioblastoma may occur, and they should be considered in the differential diagnosis of glioblastoma with carcinomatous foci. Even when the past clinical history is negative, the presence of carcinoma should be investigated to rule out glioblastoma with tumor-to-tumor metastasis.


Bioavailability of dietary minerals to humans: the stable isotope approach.
A number of minerals contained in foods are essential nutrients for humans, animals, and/or plants. While most vitamins are very well absorbed, most essential minerals are not. Usual absorption of minerals ranges from less than 1% to over 90%. The bioavailability of dietary minerals must be considered when determining whether the diet contains enough, too little, or too much. By using stable isotope tracers as labels, the metabolic fate of minerals in a specific day's diet, a specific meal, or a food can be distinguished from minerals from other sources and followed. A number of mass spectrometric methods have been used to measure stable isotopes. Magnetic sector, thermal ionization mass spectrometry (TIMS) is used routinely in our laboratory to study bioavailability of Zn, Cu, and Fe. Other mass spectrometric methods that are less precise, but useful for many applications requiring isotopic determinations include quadrupole TIMS, inductively coupled plasma mass spectrometry (ICP/MS), and fast atom bombardment mass spectrometry (FAB/MS). One of the major advantages of stable isotope studies is that multiple isotopes of the same mineral can be used simultaneously and multiple minerals can be studied simultaneously. The use of stable isotopes for studies of bioavailability of minerals in foods has gained widespread interest in recent years. The approach is expected to be applied to an increasing number of food science and nutrition problems in the future.


The network of transcription factors that underlie the CD4 versus CD8 lineage decision.
Virtually all mature T cells are CD4(+)CD8(-) or CD4(-)CD8(+) and this not only is their most important surface-phenotype distinction but also has crucial functional consequences for the entire immune response. Both subsets arise from double-positive thymocytes, and much has been learned about the molecular events that govern this lineage bifurcation process. As detailed in this review, the signaling pathways and specific molecules that control this process are now being discovered. In particular, the transcription factors ThPOK (T-helper inducing POZ-Kruppel factor) and Runx3 have emerged as the crucial regulators of helper lineage commitment and the cytotoxic lineage, respectively. This article describes their antagonistic interaction that is an important mechanism of the lineage specification, as well as the hierarchy and importance of several other transcription factors and cytokine signals in the network of pathways that govern thymocyte helper/cytotoxic lineage commitment.


Olive phenols preserve lamin B1 expression reducing cGAS/STING/NFκB-mediated SASP in ionizing radiation-induced senescence.
Senescence occurs upon critical telomere shortening, or following DNA damage, oncogenic activation, hypoxia and oxidative stress, overall referred to stress-induced premature senescence (SIPS). In response to DNA damage, senescent cells release cytoplasmic chromatin fragments (CCFs), and express an altered secretome, the senescence-associated secretory phenotype (SASP), which contributes to generate a pro-inflammatory and pro-tumoral extracellular milieu. Polyphenols have gained significant attention owing to their anti-inflammatory and anti-tumour activities. Here, we studied the effect of oleuropein aglycone (OLE) and hydroxytyrosol (HT) on DNA damage, CCF appearance and SASP in a model of irradiation-induced senescence. Neonatal human dermal fibroblasts (NHDFs) were γ-irradiated and incubated with OLE, 5 µM and HT, 1 µM. Cell growth and senescence-associated (SA)-β-Gal-staining were used as senescence markers. DNA damage was evaluated by Comet assay, lamin B1 expression, release of CCFs, cyclic GMP-AMP Synthase (cGAS) activation. IL-6, IL-8, MCP-1 and RANTES were measured by ELISA assay. Our results showed that OLE and HT exerted a protective effect on 8 Gy irradiation-induced senescence, preserving lamin B1 expression and reducing cGAS/STING/NFκB-mediated SASP. The ability of OLE and HT to mitigate DNA damage, senescence status and the related SASP in normal cells can be exploited to improve the efficacy and safety of cancer radiotherapy.


Comparative Validation of Polyp Detection Methods in Video Colonoscopy: Results From the MICCAI 2015 Endoscopic Vision Challenge.
Colonoscopy is the gold standard for colon cancer screening though some polyps are still missed, thus preventing early disease detection and treatment. Several computational systems have been proposed to assist polyp detection during colonoscopy but so far without consistent evaluation. The lack of publicly available annotated databases has made it difficult to compare methods and to assess if they achieve performance levels acceptable for clinical use. The Automatic Polyp Detection sub-challenge, conducted as part of the Endoscopic Vision Challenge (http://endovis.grand-challenge.org) at the international conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) in 2015, was an effort to address this need. In this paper, we report the results of this comparative evaluation of polyp detection methods, as well as describe additional experiments to further explore differences between methods. We define performance metrics and provide evaluation databases that allow comparison of multiple methodologies. Results show that convolutional neural networks are the state of the art. Nevertheless, it is also demonstrated that combining different methodologies can lead to an improved overall performance.


The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups.
Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.


The relationship between body mass index (weight status) and hypertension in a cohort of elementary school students: a retrospective longitudinal study.
This study longitudinally investigated the relationship between childhood body mass index and hypertension in a cohort of 4th-grade students. Students who were overweight or at risk for overweight when in the 1st grade were over 4 times more likely to be overweight or at-risk-for overweight in the 4th grade than were students who were not overweight or not at risk for overweight when in the 1st grade. Students who were overweight or at risk for overweight when in the 1st grade were approximately 3 times more likely to be hypertensive or prehypertensive in the 4th grade than were students who were not overweight or not at risk for overweight when in the 1st grade.


The Mechanism Study of Common Flavonoids on Antiglioma Based on Network Pharmacology and Molecular Docking.
Glioma is the most common primary intracranial tumor in adult patients. Among them, glioblastoma is a highly malignant one with a poor prognosis. Flavonoids are a class of phenolic compounds widely distributed in plants and have many biological functions, such as anti-inflammatory, antioxidant, antiaging, and anticancer. Nowadays, flavonoids have been applied to the therapy of glioma; however, the molecular mechanism underlying the therapeutic effects has not been fully elaborated. This study was carried out to explore the mechanism of selected active flavonoid compounds in treating glioma using network pharmacology and molecular docking approaches. Active ingredients and associated targets of flavonoids were acquired by using the Traditional Chinese Medicine Database and Analysis Platform (TCMSP) and Swiss TargetPrediction platform. Genes related to glioma were obtained from the GeneCards and DisGeNET databases. The intersection targets between flavonoid targets and glioma-related genes were used to construct protein-protein interaction (PPI) network via the STRING database, and the results were analyzed by Cytoscape software. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed and displayed by utilizing the Metascape portal and clusterProfiler R package. Molecular docking was carried out by iGEMDOCK and SwissDock, and the results were visually displayed by UCSF Chimera software. Eighty-four active flavonoid compounds and 258 targets overlapped between flavonoid targets and glioma-related genes were achieved. PPI network revealed potential therapeutic targets, such as AKT1, EGFR, VEGFA, MAPK3, and CASP3, based on their node degree. GO and KEGG analyses showed that core targets were mainly enriched in the PI3K-Akt signaling pathway. Molecular docking simulation indicated that potential glioma-related targets-MAPK1 and HSP90AA1 were bounded more firmly with epigallocatechin-3-gallate (EGCG) than with quercetin. The findings of this study indicated that selected active flavonoid compounds might play therapeutic roles in glioma mainly through the PI3K-Akt signaling pathway. Moreover, EGCG had the potential antiglioma activity by targeting MAPK1 and HSP90AA1.


Laparoscopic sacral colpopexy and other procedures for prolapse.
The repair of pelvic support defects is a demanding task. Irrespective of the route or repair chosen by the surgeon, sound surgical judgement, complete understanding of pelvic anatomy and the mechanisms involved in pelvic organ prolapse, and expertise in pelvic surgery are required if successful outcomes are to be expected. Laparoscopic surgery offers a substitute for conventional open abdominal surgery which, in our hospital, now has a record of low complication rates, speedy discharge and recovery times with outcomes that are equal to those achieved by conventional abdominal surgery. This type of surgery is no more difficult to perform than open abdominal surgery. However, it demands the same rigorous training and a very significant amount of time and dedicated effort to learn. The pelvic surgeon who desires to practise this form of advanced laparoscopic surgery must accept these facts. Obviously, more cases and long-term follow-up are needed for meaningful statistical analysis. Randomized prospective trials are greatly preferred, however, it is difficult for the laparoscopic surgeon to carry out such studies when the majority of patients are referred specifically for the laparoscopic route. Good sound statistical data are now becoming available concerning some essential components of the procedure such as laparoscopic knot and suture strengths. It seems very reasonable to conclude that, based on early experience with laparoscopic pelvic reconstruction, the future of this approach is bright.


Increasing Dietary alpha-linolenic acid enhances tissue levels of long-chain n-3 PUFA when linoleic acid intake is low in hamsters.
We tested whether feeding hamsters diets varying in alpha-linolenic acid (ALA) content and low in linoleic acid (LA) could increase the tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) to the same extent as a fish oil-supplemented diet. For 5 weeks, 60 hamsters were fed 1 of the following 5 diets containing 2% of total dietary energy (TE) as LA and either 0.5% (diet A), 1% (diets B and E), 2% (diet C), or 4% (diet D) ALA of TE, so that the ratio of LA/ALA was 4:1, 2:1, 1:1, or 1:2. Diet E was supplemented with fish oil at the level of 0.2% of total energy intake. At the end of the study, overnight-fasted hamsters were sacrificed, and blood and tissues were collected. Tissue levels of ALA, EPA, DPA, and DHA rose in proportion to the increase in the dietary ALA level (p < 0.01); however, the levels of DHA reached a plateau at ALA intakes above 1% (p < 0.01). These changes were accompanied by decreases in arachidonic acid with or without increases in LA levels (p < 0.01). Hamsters fed diet D had similar or higher EPA, DPA, and DHA tissue levels to those fed diet E (p < 0.01). In hamsters, diets containing 4% energy as ALA and 2% energy as LA can increase the tissue levels of EPA, DPA, and DHA to the same extent as feeding 0.2% energy as fish oil.


Physical activity prevents alterations in mitochondrial ultrastructure and glucometabolic parameters in a high-sugar diet model.
Endurance exercise is a remarkable intervention for the treatment of many diseases. Mitochondrial changes on skeletal muscle are likely important for many of the benefits provided by exercise. In this study, we aimed to evaluate the effects that a regular physical activity (swimming without workload) has on mitochondrial morphological alterations and glucometabolic parameters induced by a high-sugar diet (HSD). Weaned male Wistar rats fed with a standard diet or a HSD (68% carbohydrate) were subjected to 60 minutes of regular physical activity by swimming (without workload) for four- (20 sessions) or eight-week (40 sessions) periods. After training, animals were euthanized and the sera, adipose tissues, and skeletal muscles were collected for further analysis. The HSD increased body weight after an 8-week period; it also increased the fat pads and the adipose index, resulting in glucose intolerance and insulin resistance (IR). Transmission electron microscopy showed an increase in alterations of mitochondrial ultrastructure in the gastrocnemius muscle, as well as a decrease in superoxide dismutase (SOD) activity, and an increase in protein carbonylation. Regular physical activity partially reverted these alterations in rats fed a HSD, preventing mitochondrial morphological alterations and IR. Moreover, we observed a decrease in Pgc1α expression (qPCR analysis) in STD-EXE group and a less pronounced reduction in HSD-EXE group after an 8-week period. Thus, regular physical activity (swimming without workload) in rats fed a HSD can prevent mitochondrial dysfunction and IR, highlighting the crucial role for physical activity on metabolic homeostasis.


Decolonizing personality assessment and honoring indigenous voices: a critical examination of the MMPI-2.
Utilizing a mixed methods approach located between constructivist-interpretivist and critical-ideological research paradigms (Ponterotto, 2005), the current study builds upon previous research (Pace et al., 2006) that investigated the cultural validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 in its use with American Indians. Thirty items from MMPI-2 scales F, 1, 6, 8, and 9 were identified via item analysis as reflecting significant differences in endorsement rates between an American Indian sample and the MMPI-2 normative group. Semistructured interviews focused on these 30 items were conducted with 13 American Indian participants from an Eastern Woodlands Nation in Oklahoma. Interviews were audio recorded, transcribed, and then coded for themes using a qualitative coding analysis. Nine themes emerged: core belief system, experiences of racism and discrimination, conflicting epistemologies, living in two worlds, community connectedness, responsibility and accountability to the community, traditional knowledge, stories as traditional knowledge, and language and historic loss. Results of the current study demonstrate how the MMPI-2 may pathologize Indigenous worldviews, knowledge, beliefs, and behaviors rather than accurately assess psychopathology. Implications for practice and future research are addressed.


Individual changes in visual performance in non-demented Parkinson's disease patients: a 1-year follow-up study.
Cognitive deficits in Parkinson's disease (PD) are heterogeneous entities, and the cognitive status fluctuates over time. However, individual changes in longitudinal cognitive performance in PD are not fully understood. We evaluated three visual indices (visuoperception, visuoconstruction, and visuospatial ability) and four cognitive domains (attention/working memory, executive function, memory, and language) at baseline (Time1) and at 1-year follow-up (Time2) in 36 patients with PD and 32 healthy controls (HCs). To explore the magnitude and frequency of cognitive changes, we analyzed data using the simple difference method and the standardized regression-based method. We also explored the correlations between changes in test scores and several clinical predictors, using logistic regression analysis. At 1 year, patients with PD showed higher rates of change in scores on several cognitive tests, especially the Incomplete Letters test of visuoperception, compared to HCs. After adjusting for demographic variables, the visuoperceptual change was 61.1% overall, with the largest effect size. The changes in scores of visuoperception correlated with those of memory (r = 0.672, p < 0.001), language (r = 0.389, p < 0.05), and visuospatial ability (r = 0.379, p < 0.05). The severity of olfactory disturbance, the MDS-UPDRS Part I score, and younger PD onset predicted the significant changes observed in the Incomplete Letters test scores. Visuoperception changed more in non-demented PD patients than in HCs at 1-year follow-up. The changes in visuoperception could relate to involvement of the ventral occipitotemporal pathway, the more widespread temporal lobe, and brain reserve in PD.


Price and health policy in Sweden--a critical review.
Price policies for alcoholic beverages have been used as a means of implementing health policy in Sweden since the mid 1950s. The importance of using price policy for other commodities like tobacco and food has occasionally been suggested, but so far never implemented. Actually, during the last two decades, the prices of tobacco and certain foods in Sweden have supported unhealthy behaviour. Consumer prices have increased more than average for healthy products like fish, and less than average for tobacco. This article critically reviews the development of price policy as a means of implementing health policy in Sweden. What has happened? What has not happened? Why? What are the potential effects of price policy? What about future prospects and possible consequences of Swedish integration into European Economic Community? For example, a harmonisation of taxes would entail a significant fall of Swedish alcohol prices of about 50%. This would probably lead to a 25% increase in alcohol consumption accompanied by an increased prevalence of alcohol-related problems in Sweden.


Redefining diagnostic symptoms of depression using Rasch analysis: testing an item bank suitable for DSM-V and computer adaptive testing.
We aimed to redefine the optimal self-report symptoms of depression suitable for creation of an item bank that could be used in computer adaptive testing or to develop a simplified screening tool for DSM-V. Four hundred subjects (200 patients with primary depression and 200 non-depressed subjects), living in Iraqi Kurdistan were interviewed. The Mini International Neuropsychiatric Interview (MINI) was used to define the presence of major depression (DSM-IV criteria). We examined symptoms of depression using four well-known scales delivered in Kurdish. The Partial Credit Model was applied to each instrument. Common-item equating was subsequently used to create an item bank and differential item functioning (DIF) explored for known subgroups. A symptom level Rasch analysis reduced the original 45 items to 24 items of the original after the exclusion of 21 misfitting items. A further six items (CESD13 and CESD17, HADS-D4, HADS-D5 and HADS-D7, and CDSS3 and CDSS4) were removed due to misfit as the items were added together to form the item bank, and two items were subsequently removed following the DIF analysis by diagnosis (CESD20 and CDSS9, both of which were harder to endorse for women). Therefore the remaining optimal item bank consisted of 17 items and produced an area under the curve (AUC) of 0.987. Using a bank restricted to the optimal nine items revealed only minor loss of accuracy (AUC = 0.989, sensitivity 96%, specificity 95%). Finally, when restricted to only four items accuracy was still high (AUC was still 0.976; sensitivity 93%, specificity 96%). An item bank of 17 items may be useful in computer adaptive testing and nine or even four items may be used to develop a simplified screening tool for DSM-V major depressive disorder (MDD). Further examination of this item bank should be conducted in different cultural settings.


An unusual case of Aspergillus endocarditis in a kidney transplant recipient.
The incidence of aspergillosis in kidney transplant recipients is low and most commonly occurs in the early posttransplantation period. We report an unusual case of a 52-year-old female patient with Aspergillus endocarditis as a late complication after kidney transplantation, presumably spread from a necrosis in the gut, associated with previous cytomegalovirus colitis. As complications, the patient experienced septic embolization into the coronary and pulmonary arteries, and an infarction of the right parietal cortex and insula. The patient died as a result of global heart failure after a 10-day course of antimycotic therapy with amphotericin B plus 5-flucytosine during surgical valve replacement.


Extension of long cellular processes of hepatic stellate cells cultured on extracellular type I collagen gel by microtubule assembly: observation utilizing time-lapse video-microscopy.
Hepatic stellate cells cultured on or in freshly prepared type I collagen gel as a substratum were induced to elongate long cellular processes. The extension of the cellular processes was monitored by using video-enhanced optical microscopy. The cellular processes seemed to extend along the extracellular type I collagen fibers. Once extended cellular processes after overnight culture on type I collagen gel were retracted by cytoskeleton degradation with colchicine or cytochalasin B. The cellular processes were also retracted by treatment with protein kinase inhibitor, herbimycin A or staurosporin, or with phosphatidylinositol 3-kinase inhibitor, wortmannin. The effects of colchicine, herbimycin A, staurosporin, or wortmannin were drastic, and the cells were finally changed to a round shape within a few hours, as seen also after cold-treatment at 4 degrees C. Cytochalasin B also time-dependently retracted the extended cellular processes. These results indicated that the cultured stellate cells were induced to elongate cellular processes by cell surface binding to type I collagen fibrils, followed by protein or phosphatidylinositol phosphorylation and finally F-actin and microtubule assembly. Extended long cellular processes seem to reflect the in vivo structure of hepatic stellate cells, and molecular mechanism for the extension and maintenance of cellular processes was proposed.


Left-behind children in rural China experience higher levels of anxiety and poorer living conditions.
The number of rural Chinese parents who leave their children with family members to work in the cities has increased dramatically over the last decade. This study compared the social anxiety of left-behind children (LBC) and children not left behind (non-LBC). We investigated 1694 LBC and 1223 non-LBC, aged seven to 17 years, in a Chinese province using a structured questionnaire that included questions about socio-demographic characteristics, social anxiety, family function, quality of life, neglect and physical abuse. LBC displayed higher social anxiety scores, more neglect, lower parental educational level, lower quality of life, lower family function and lower prevalence of physical abuse than non-LBC. Multiple linear regression models showed that higher Social Anxiety Scales for Children (SASC) scores in LBC were clearly associated with lower quality of life, poorer family function, physical abuse, being female, having more siblings and minorities. In non-LBC, they were associated with lower quality of life, poorer family function, neglect, being female and physical abuse. LBC have a relatively higher level of social anxiety and poorer living conditions than non-LBC, and there are differences in social anxiety, and its relevant factors, between the two groups.


Bioterrorism vs. health security--crafting a plan of preparedness.
Bioterrorism, once a subject of fantasy and speculation, has become all too real in a world turned upside down by the September 11, 2001. series of events. An essential, but as yet unanswered, question has become a crucial topic for discussion on the nightly news and in living rooms across the United States: How much of a terrorist threat do we face, and what must be done to control its potential for mass destruction? This article seeks to both answer this question and explore proper plans of preparedness for the eventuality of the unthinkable.


CFTR chloride channel is a molecular target of the natural cancer preventive agent resveratrol.
The naturally occurring polyphenol compound resveratrol (RES) has been receiving wide attention because of its variety of health benefits and favourable biological activities. Previous studies have shown that RES could induce intestinal chloride secretion in mouse jejunum and stimulate cAMP-dependent Cl- secretion in T84, primary cultured murine nasal septal and human sinonasal epithelial cells, but the precise molecular target is not clear. We therefore tested the hypothesis that RES may stimulate the activity of cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel. Using cell-based fluorescent assays, transepithelial short-circuit current measurements and excised inside-out patch-clamp analysis; we found that RES dose-dependently potentiate CFTR Cl- channel activities, which was reversed by CFTR inhibitors CFTR(inh)-172 and GlyH101. Transepithelial Cl- secretion by CFTR-expressing FRT cells was stimulated by RES with half maximal concentration -80 microM. Intracellular cAMP content was not elevated by RES in FRT cells. Excised inside-out patch-clamp analysis indicated that RES significantly increased the chloride currents of CFTR. In ex vivo studies, RES stimulated the transmucosal chloride current of rat colon by short-circuit current assay. These data suggested that CFTR is a molecular target of RES. Our findings add a new molecular target to RES, and RES may represent a novel class of therapeutic lead compounds in treating CFTR-related diseases including CF and habitual constipation.


Graphics processing units-accelerated adaptive nonlocal means filter for denoising three-dimensional Monte Carlo photon transport simulations.
The Monte Carlo (MC) method is widely recognized as the gold standard for modeling light propagation inside turbid media. Due to the stochastic nature of this method, MC simulations suffer from inherent stochastic noise. Launching large numbers of photons can reduce noise but results in significantly greater computation times, even with graphics processing units (GPU)-based acceleration. We develop a GPU-accelerated adaptive nonlocal means (ANLM) filter to denoise MC simulation outputs. This filter can effectively suppress the spatially varying stochastic noise present in low-photon MC simulations and improve the image signal-to-noise ratio (SNR) by over 5 dB. This is equivalent to the SNR improvement of running nearly 3.5 × more photons. We validate this denoising approach using both homogeneous and heterogeneous domains at various photon counts. The ability to preserve rapid optical fluence changes is also demonstrated using domains with inclusions. We demonstrate that this GPU-ANLM filter can shorten simulation runtimes in most photon counts and domain settings even combined with our highly accelerated GPU MC simulations. We also compare this GPU-ANLM filter with the CPU version and report a threefold to fourfold speedup. The developed GPU-ANLM filter not only can enhance three-dimensional MC photon simulation results but also be a valuable tool for noise reduction in other volumetric images such as MRI and CT scans.


[A case of adenocarcinoma arising in female urethral diverticulum].
An 81-year-old woman was admitted with a chief complaint of bloody discharge from the urethra. On physical examination an elastic-soft mass was palpable beneath the anterior vaginal wall. Magnetic resonance imaging and computed tomographic scan revealed the mass around the urethra. Transvaginal needle biopsy was performed and the histopathologic finding was adenocarcinoma. The tumor was excised with the uterus, the ovary and the anterior vaginal wall. The macroscopic appearance suggested that the tumor arose in the urethral diverticulum. She had intravesical recurrence at 8 months after the operation, and partial cystectomy was performed. However there was recurrence again, and radical cystectomy was performed finally. We review 81 cases of urethral diverticular carcinoma in the literature.


Parallelizing a molecular dynamics algorithm on a multiprocessor workstation using OpenMP.
The atomistic molecular dynamics program YASP has been parallelized for shared-memory computer architectures. Parallelization was restricted to the most CPU-time-consuming parts: neighbor-list construction, calculation of nonbonded, angle and dihedral forces, and constraints. Most of the sequential FORTRAN code was kept; parallel constructs were inserted as compiler directives using the OpenMP standard. Only in the case of the neighbor list did the data structure have to be changed. The parallel code achieves a useful speedup over the sequential version for systems of several thousand atoms and above. On an IBM Regatta p690+, the throughput increases with the number of processors up to a maximum of 12-16 processors depending on the characteristics of the simulated systems. On dual-processor Xeon systems, the speedup is about 1.7.


[Dry pars plana capsulotomy and anterior vitrectomy using 25-gauge vitrectomy system during children cataract surgery].
To describe the initial surgical experience and report the safety and feasibility of dry pars plana capsulotomy and anterior vitrectomy using a 25-gauge vitrectomy system in pediatric cataract surgery. This was a prospective case series study. After anterior continuous curvilinear capsulorhexis (ACCC) and phacoemulsification with intraocular lens (IOL) implantation in the capsule for all patients, a pars plana capsulotomy and anterior vitrectomy was performed with a 25-gauge vitrectomy system using a dry technique in 40 eyes of 30 children with cataracts. All procedures were uneventful and all IOLs were implanted in the capsular bag. No intraoperative complications were noted attributable to the small-gauge instruments. The average follow-up period was eight months (range, 4 to 30). Postoperative intraocular pressure remained stable in most cases, except two eyes (5%) with transient hypotony during the first day after surgery. The postoperative inflammatory response was mild. Ultrasound biomicroscopy showed complete healing of the sclerotomy at four weeks after surgery. No posterior synechia, posterior capsule opacification, IOL capture, vitreous prolapse, choroidal detachment or retinal detachment was observed throughout the follow-up period. Dry pars plana capsulotomy and anterior vitrectomy using a 25-gauge vitrectomy system is safe and effective for the management of posterior lens capsules and anterior vitreous in pediatric cataract surgery. Prospective and comparative study is recommended to evaluate this procedure and traditional method.


Command vs. market in China's energy intensity reduction strategies: Firm-level evidence.
China has significantly reduced the energy consumption for per unit of GDP by using both command-and-controls or market-based strategies. This paper examines empirically the relative effectiveness and efficiency of command-and-control strategy (energy reduction target) vs. market-based strategy (electricity price). We find that (1) electricity price was similarly effective in reducing electricity intensity across firms, but government targets were more effective for firms that were more technologically outdated and energy intensive; and (2) government targets led to expenditures that were not useful in reducing energy intensity, suggesting inefficiency associated with targets. Despite the Chinese governments' capacities and resources in directing and influencing enterprises, market-based approaches might still be more effective and efficient than command-and-control ones to reduce energy intensity.


Genetic analysis of the RAB39B gene in Chinese Han patients with Parkinson's disease.
Parkinson's disease (PD) is a common neurodegenerative disorder of complex etiology. Mounting evidence indicates that genetic abnormalities play an important role in the pathogenesis of PD. To date, at least 20 genetic loci and 15 disease-causing genes for parkinsonism have been identified, as well as some susceptibility genes conferring risk to PD. More recently, mutations in the RAB39B gene (RAB39B, member RAS oncogene family) have been reported to cause X-linked intellectual disability and early-onset PD with α-synuclein pathology. To evaluate whether variants in the RAB39B gene are related to PD in Chinese Han population, we conducted genetic analysis of the RAB39B gene in 502 patients with PD from Mainland China. No pathogenic mutation or variant was identified in the coding region or exon-intron boundaries of the gene. Our results suggest that mutation(s) in the coding region of the RAB39B gene plays little or no role in the development of PD in Chinese population.


Variables affecting the accuracy of stereotactic localization using computerized tomography.
Stereotactic localization using computerized tomography (CT) is increasingly employed to guide neurosurgical procedures in crucial areas of the brain such as the brain stem. This technique allows the surgeon to resect a lesion in its entirety while sparing critical areas of the brain. Thus, the parameters used for scanning should be selected for maximum accuracy. While the small pixel size of CT scanners suggests a high degree of precision in localization, there have been few systematic studies of this accuracy. The authors have studied the amount of error in localization created by variables such as CT scan thickness, interscan spacing, size of lesion, and method of computation when using the Brown-Roberts-Wells (BRW) stereotactic system. Over 1000 CT scans were made of a phantom composed of spheres of differing diameter and location. The CT slice thickness was varied from 1.5 to 5.0 mm, and interscan spacing was varied from 0.5 to 3.0 mm. The coordinates of the center of the spheres were calculated independently using the laptop computer supplied with the unit and also by a stereotactic computer which automatically calculates the center of the fiducials. The actual BRW coordinates of the sphere center were obtained using the phantom base and were then compared to the computer-calculated coordinates to determine error in localization. Variables with a significant effect on error included the scan thickness, interscan spacing, and sphere size. The mean error decreased 23% as the scan thickness decreased from 5.0 to 1.5 mm and 45% as the interscan spacing decreased from 3.0 to 0.5 mm. Mean error was greatest for the smallest sphere sizes. The two computational methods did not differ in error. This study suggests that, for critical areas of the brain or for small lesions, a scan thickness of 1.5 mm and interscan spacing of 0.5 mm should be employed.


The risks and benefits of therapy with aldosterone receptor antagonist therapy.
Spironolacotone and eplerenone are mineralocorticoid-blocking agents. These compounds block both the epithelial and non-epithelial actions of aldosterone with the latter assuming increasing clinical importance. Spironolactone and eplerenone both effectively reduce blood pressure either as mono- or add-on therapy; moreover, they each offer survival benefits in diverse circumstances of heart failure and the potential for renal protection in proteinuric chronic kidney disease. However, as the use of mineralocorticoid-blocking agents has increased the hazards inherent to use of such drugs has become more apparent. Whereas; the endocrine side-effects of spironolactone are in most cases little more than a cosmetic annoyance the potassium-sparing effects of both spironolactone and eplerenone can prove fatal if sufficient degrees of hyperkalemia develop. However, for most patients the risk of developing hyperkalemia in and of itself should not discourage the sensible clinician from bringing these compounds into play. Hyperkalemia should always be considered as a possibility in any patient receiving one or the other of these medications. As such, steps should be taken to lessen the likelihood of its occurring if therapy is being contemplated with agents in this class.


Off-Pump Coronary Artery Bypass Grafting and Stroke-Exploratory Analysis of the GOPCABE Trial and Methodological Considerations.
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump CABG) may reduce severe adverse events including stroke. In the German Off-Pump Coronary Artery Bypass Grafting in Elderly patients trial, the rate of major adverse cardiovascular events was compared in 2,394 elderly (≥ 75 years) patients undergoing CABG with (on-pump) or without (off-pump) cardiopulmonary bypass. This exploratory post-hoc analysis investigated the impact of surgical aortic manipulation on the rate of stroke. There was no significant difference in the rate of stroke within 30 days after surgery between both groups (off-pump: 2.2%; on-pump: 2.7%; odds ratio [OR]: 0.83 [0.5-1.38]; p = 0.47). Within the off-pump group, different degrees of aortic manipulation did not lead to significant different stroke rates (tangential clamping: 2.3%; OR 0.86 [0.46-1.60]; clampless device: 1.8%; OR 0.67 [0.26-1.75]; no aortic manipulation: 2.4%; OR 0.88 [0.37-2.14]). An aggregate analysis including more than 10,000 patients out of the four recent major trials also yielded comparable stroke rates for on- and off-pump CABG (off-pump: 1.4%; on-pump: 1.7%; OR 0.87 [0.64-1.20]). Within recent prospective randomized multicenter trials off-pump CABG did not result in lower stroke rates. The possible intrinsic benefit of off-pump CABG may be offset by the complexity of the operative therapy as well as the multiple pathomechanisms involved in perioperative stroke.


Correlation between Neck Circumference and Other Anthropometric Measurements in Eight Latin American Countries. Results from ELANS Study.
Neck circumference (NC) is being used to identify the risk of chronic diseases. There is a high prevalence of overweight and obesity in Latin America, and neck circumference is a simple and practical measurement to assess this, especially in primary health centers. We analyzed the correlation between the NC anthropometric indicator and other anthropometric measurements such as BMI and waist circumference (WC) in eight Latin American cities. We applied Pearson's correlation to identify the correlate NC with the other anthropometric variables stratified by sex; the sensitivity (Se) and specificity (Sp) by sex were evaluated according to the cut-off established with the Youden Index. The strongest correlations between NC and WC were found when stratified by sex (women: r = 0.71; men: r = 0.69, respectively) followed by the correlation between NC and BMI (r = 0.65, both sex). NC cut-off points of 39.0 cm in men and 32.9 cm in women identified those individuals with an increased WC and 39.8 and 33.7 cm, respectively, for a substantial increase in WC. For BMI ≥ 25.0 kg/m2 for men, the cut-off point was 37.5 cm, and for women, it was 33.1 cm, and for BMI ≥ 30 kg/m2, the cut-off points were 39.2 and 34.2 cm, for men and women, respectively. Conclusion: NC proved to be a useful, practical, and inexpensive tool that can be used to identify, evaluate, and monitor overweight and obese individuals.


[Total body hyperthermia and continuous hyperthermic peritoneal perfusion as an adjuvant therapy in advanced gastric cancer].
Between September 1986 and July 1989, adjuvant hyperthermic therapy, consisting of either total body hyperthermia (TBHT) or continuous hyperthermic peritoneal perfusion (CHPP), was given to a total of 41 patients immediately following gastric resection for cancer. TBHT was performed in 1 curative- and 11 noncurative-gastrectomized patients (1 stage III and 11 stage IV), and CHPP in 18 curative- and 11 noncurative-gastrectomized patients (6 stage I/II, 10 stage III and 13 stage IV). For TBHT, the blood was warmed and maintained at 42 degrees C for 3 hours by means of a V-V bypass connected to an extracorporeal heater-pumping system. When the hyperthermic condition was established, anti-cancer drugs were administered intravenously. In CHPP, 46 degrees C saline containing anti-cancer drugs were infused at a constant rate through a tube placed at the Douglas fossa. The perfusate was drained out through another tube positioned at an uppermost part of the abdominal cavity. The hyperthermic condition was monitored by measuring the outflow temperature. Complications encountered were bone marrow depression, liver damage and pyrexia, and were more frequently experienced by the TBHT patients. Patients under 65 years of age who had had an absolute noncurative gastrectomy but with TBHT survived significantly longer than those without TBHT. When the patients who had undergone gastrectomy with CHPP for a cancer of more than se penetration were compared with those without CHPP, there was no significant difference in survival found between these two populations. This unsatisfactory result could be partly attributable to difficult maintenance of appropriate (sufficiently high) and constant perfusate temperature.


Evolution of practice patterns in the management of acute respiratory distress syndrome: A secondary analysis of two successive randomized controlled trials.
We sought to examine changes in acute respiratory distress syndrome (ARDS) management over a 12-year period of two successive randomized trials. Analyses included baseline data, from eligible patients, prior to influence of trial protocols, and daily study data, from randomized patients, of variables not determined by trial protocols. Mixed linear regressions examined changes in practice year-on-year. A total of 2376 patients met the inclusion criteria. Over the 12-year period, baseline tidal volume index decreased (9.0 to 7.0 ml/kg, p < 0.001), plateau pressures decreased (30.8 to 29.0 cmH2O, p < 0.05), and baseline positive end-expiratory pressures increased (10.8 to 13.2 cmH2O, p < 0.001). Volume-controlled ventilation declined from 29.4 to 14.0% (p < 0.01). Use of corticosteroids increased (baseline: 7.7 to 30.3%; on study: 32.6 to 61.2%; both p < 0.001), as did neuromuscular blockade (baseline: 12.3 to 24.5%; on study: 55.5 to 70.0%; both p < 0.01). Inhaled nitric oxide use increased (24.9 to 65.8%, p < 0.05). We observed no significant change in prone positioning (16.2 to 18.9%, p = 0.70). Clear trends were apparent in tidal volume, airway pressures, ventilator modes, adjuncts and rescue therapies. With the exception of prone positioning, and outside the context of rescue therapy, these trends appear consistent with the evolving literature on ARDS management.


Fourteen-day PET/CT imaging to monitor drug combination activity in treated individuals with tuberculosis.
Early bactericidal activity studies monitor daily sputum bacterial counts in individuals with tuberculosis (TB) for 14 days during experimental drug treatment. The rate of change in sputum bacterial load over time provides an informative, but imperfect, estimate of drug activity and is considered a critical step in development of new TB drugs. In this clinical study, 160 participants with TB received isoniazid, pyrazinamide, or rifampicin, components of first-line chemotherapy, and moxifloxacin individually and in combination. In addition to standard bacterial enumeration in sputum, participants underwent 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography and computerized tomography ([18F]FDG-PET/CT) at the beginning and end of the 14-day drug treatment. Quantitating radiological responses to drug treatment provided comparative single and combination drug activity measures across lung lesion types that correlated more closely with established clinical outcomes when combined with sputum enumeration compared to sputum enumeration alone. Rifampicin and rifampicin-containing drug combinations were most effective in reducing both lung lesion volume measured by CT imaging and lesion-associated inflammation measured by PET imaging. Moxifloxacin was not superior to rifampicin in any measure by PET/CT imaging, consistent with its performance in recent phase 3 clinical trials. PET/CT imaging revealed synergy between isoniazid and pyrazinamide and demonstrated that the activity of pyrazinamide was limited to lung lesion, showing the highest FDG uptake during the first 2 weeks of drug treatment. [18F]FDG-PET/CT imaging may be useful for measuring the activity of single drugs and drug combinations during evaluation of potential new TB drug regimens before phase 3 trials.


A factor mixture model approach to elaborating on offender mental health classification with the MMPI-2-RF.
A large proportion of prison inmates suffer from mental illnesses or severe personality disorders; therefore, offender classification is a worthwhile endeavor both for efficiently allocating mental health treatment resources and security risk classification. This study sought to elaborate on offender classification by using an advanced statistical technique, factor mixture modeling, which capitalizes on the strengths of both latent trait analysis and latent class analysis. A sample consisting of 616 male and 194 female prison inmates was used for this purpose. The MMPI-2-RF Restructured Clinical (RC) scales were used to elaborate on a variety of latent trait, latent class, and factor mixture models. A 3-factor, 5-class mixture model was deemed optimal in this sample. Remaining MMPI-2-RF scales as well as scores on external criterion measures relevant to externalizing psychopathology were used to further elaborate on the utility of the resulting latent classes. These analyses indicated that 3 of the 5 classes were predominantly different expressions of externalizing personality proclivities, whereas the remaining 2 indicated inmates with substantial internalizing or thought-disordered characteristics. Implications of these findings are discussed.


Mg storage properties of hollow copper selenide nanocubes.
Rechargeable Mg batteries are thought to be suitable for scalable energy-storage applications because of their high safety and low cost. However, the bivalent Mg2+ cations suffer from sluggish solid-state diffusion kinetics. Herein, a hollow morphological approach is introduced to design copper selenide cathodes for rechargeable Mg batteries. Hollow Cu2-xSe nanocubes are fabricated via a solution reaction and their Mg-storage properties are investigated in comparison to simple nanoparticles. The hollow structures accommodate the volume change during magnesiation/demagnesiation and maintain material integrity, and thus a remarkable cycling stability of over 200 cycles is achieved. A kinetic study demonstrates that a hollow structure favors solid-phase Mg2+ diffusion, and therefore the hollow Cu2-xSe nanocubes exhibit a high capacity of 250 mA h g-1 at 100 mA g-1 as well as a superior rate capability. Mechanism investigation indicates that Cu2-xSe experiences a structure conversion during which a phase transformation occurs. This work develops a facile method for the preparation of hollow copper selenides and highlights the advantages of hollow structures in the design of high-performance Mg-storage materials.


Exploiting peptide nanostructures to construct functional artificial ion channels.
Natural ion channel proteins possess remarkable properties that researchers could exploit to develop nanochemotherapeutics and diagnostic devices. Unfortunately, the poor stability, limited availability, and complexity of these structures have precluded their use in practical devices. One solution to these limitations is to develop simpler molecular systems through chemical synthesis that mimic the salient properties of artificial ion channels. Inspired by natural channel proteins, our group has developed a family of peptide nanostructures thatcreate channels for ions by aligning crown ethers on top of each other when they adopt an α-helical conformation. Advantages to this crown ether/peptide framework approach include the ease of synthesis, the predictability of their conformations, and the ability to fine-tune and engineer their properties. We have synthesized these structures using solid phase methods from artificial crown ether amino acids made from L-DOPA. Circular dichroism and FTIR spectroscopy studies in different media confirmed that the nanostructures adopt the predicted α-helical conformation. Fluorescence studies verified the crown ether stacking arrangement. We confirmed the channel activity by single-channel measurements using a modified patch-clamp technique, planar lipid bilayer (PLB) assays, and various vesicle experiments. From the results, we estimate that a 6 Å distance between two relays is ideal for sodium cation transport, but relatively efficient ion transport can still occur with an 11 Å distance between two crown ethers. Biophysical studies demonstrated that peptide channels operate as monomers in an equilibrium between adsorption at the surface and an active, transmembrane orientation. Toward practical applications of these systems, we have prepared channel analogs that bear a biotin moiety, and we have used them as nanotransducers successfully to detect avidin. Analogs of channel peptide nanostructures showed cytotoxicity against breast and leukemia cancer cells. Overall, we have prepared well-defined nanostructures with designed properties, demonstrated their transport abilities, and described their mechanism of action. We have also illustrated the advantages and the versatility of polypeptides for the construction of functional nanoscale artificial ion channels.


[Comparison the applications of tracheal intubation with GlideScope video laryngoscope and Macintosh direct laryngoscope in snoring patients].
To compare the efficacy and safety of applications of GlideScope video laryngoscope (GSVL) and Macintosh direct laryngoscope (MDLS) during endotracheal intubation under general anesthesia of abdominal snoring surgeries. Forty patients ranged from American Society of Anesthesiologists I to II scheduled for snoring surgery under general anesthesia with endotracheal intubation were randomly divided into GSVL group and MDLS group (20 cases in each group), After traditional induction, endotracheal intubation (ETT) performed by GSVL or MDLS. Glottic exposure, the time of endotracheal intubation(from mask ventilation ending to successful intubation), the times of tracheal intubation operation were recorded in both groups. The mean artery pressure(MAP), heart rate(HR) were monitored before induction (basic value T0), before tracheal intubation (T1), after tracheal intubation (T2), 1 min after tracheal intubation (T3), 3 mins after tracheal intubation (T4). The glottic exposure of GSVL group is superior to that of MDLS group. There was no significant difference in the time of tracheal intubation between MDLS group (27 +/- 11)s and GSVL group (26 +/- 11)s (P < 0.05). Compared with T0, MAP of T1 was lower in two groups (P < 0.05), while HR were similar both in two groups (P > 0.05). MAP of T2 and T3 increased and HR became faster (P < 0.05). MAP of T4 declined, but HR still increased (P < 0.05). Between the two groups, there was no significant difference of MAP or HR (P > 0.05). Compared with MDLS,the GSVL is of benefit to improve the glottic exposure in endotracheal intubation to the snoring patients,so as to improve the success rate of tracheal intubation. But there is no obvious advantages via GSVL in preventing hemodynamic reaction during tracheal intubation.


[Effect of acupuncture at three acupoints of eye on Bell palsy].
To probe the effect of acupuncture at three acupoints of eye on Bell palsy. Seventy-six cases were randomly divided into a routine acupuncture group and a Yan three needling group, 38 cases in each group. The routine acupuncture group were treated with electroacupuncture (EA) at routinely selected acupoints including Yifeng (TE 17), Dicang (ST 4), etc. and the Yan three needling group were treated by EA at the routinely selected acupoints combined with acupuncture at three acupoints of eye including Jingming (BL 1), Shangming, Chengqi (ST 1). The intensity on 0.05 ms in the intensity/time (I/t) curve for frontal ventral fronto-occipital muscle and orbicular muscle of mouth at the affected side was used for assessment criteria of course of disease, and frontal ventral fronto-occipital muscle restoring the raising eyebrow action and orbicular muscle of mouth restoring to House-Brackmann grade I and II were regarded as the therapeutic time limit. Routine EA treatment combined with acupuncture at the 3 acupoints of eye could significantly increase clinical therapeutic effect on Bell palsy with a cured rate of 89.5%, which was better than 65.8% in the routine acupuncture group (P<0.05), and the therapeutic cycle was shorted. Acupuncture at the 3 acupoints of eye can significantly improve Bell palsy and promote recovery of functions of facial nerves.


Evaluation of the Relative Ureide Content of Xylem Sap as an Indicator of N(2) Fixation in Soybeans: GREENHOUSE STUDIES.
The use of the relative ureide content of xylem sap [(ureide-N/total N) x 100] as an indicator of N(2) fixation in soybeans (Merr.) was examined under greenhouse conditions. Acetylene treatments to inhibit N(2) fixation were imposed upon the root systems of plants totally dependent upon N(2) fixation as their source of N and of plants dependent upon both N(2) fixation and uptake of exogenous nitrate. Significant decreases in the total N concentration of xylem sap from plants of the former type were observed, but no significant decrease was observed in the total N concentration of sap from the latter type of plants. In both types of plants, acetylene treatment caused significant decreases in the relative ureide content of xylem sap. The results provided further support for a link between the presence of ureides in the xylem and the occurrence of N(2) fixation in soybeans. The relative ureide content of xylem sap from plants totally dependent upon N(2) fixation was shown to be insensitive to changes in the exudation rate and total N concentration of xylem sap brought about by diurnal changes in environmental factors. There was little evidence of soybean cultivars or nodulating strains affecting the relative ureide content of xylem sap. ;Ransom' soybeans nodulated with Rhizobium japonicum strain USDA 110 were grown under conditions to obtain plants exhibiting a wide range of dependency upon N(2) fixation. The relative ureide content of xylem sap was shown to indicate reliably the N(2) fixation of these plants during vegetative growth using a (15)N method to measure N(2) fixation activity. The use of the relative ureide content of xylem sap for quantification of N(2) fixation in soybeans should be evaluated further.


The recovery mosaic: older women's lived experiences after a myocardial infarction.
The purpose of this study was to examine the experience of recovery in women 65 years of age and older during initial recovery from acute myocardial infarction. The study was designed with Heideggerian phenomenology, purposive sampling, and unstructured interactive interviews. Data were analyzed with interpretive processes of hermeneutics. The study was set in a Canadian metropolitan teaching hospital and in patient homes. Seven women who had had a first time myocardial infarction were recruited. Age ranged from 67 to 86 years (mean, 74 years). Analysis revealed that recovery for these women was highly contextual and consisted of life experience resembling a mosaic, in which the women described how they "created a new picture for themselves." The data were clustered into 4 substantive themes that included: life is scattered; trying to make sense of it; learning to live with it; and getting settled. The older women in this study underestimated their susceptibility to acute myocardial infarction, were avid planners and coordinators of their recovery, equated the loss of the homemaker role to job loss, used their ability to socialize as an indicator of the recovery progress, and lacked support to perform household duties, such as laundry, and those women with fewer symptoms "cheated" in relation to activity and diet. These findings may serve as a basis for the development of healthcare strategies reflective of older women's recovery.


Safety and effectiveness of a new saline filled testicular prosthesis.
Testicular prostheses have been used for 50 years to replace missing or removed testes. In 1995 the manufacture of the silicone gel filled testis prosthesis in the United States was discontinued because of concern about the safety profiles of other implants. We assessed the safety and effectiveness of a new, saline filled implant for testicular replacement. This open label, multicenter, prospective, case controlled clinical trial was done at 18 American tertiary referral centers. Adult and pediatric male patients missing 1 or 2 testes and without evidence of active malignancy or rheumatological disease were enrolled. All patients underwent formal rheumatological and urological evaluation prior to and after prosthesis placement. Main outcome measures were prosthesis safety assessed by adverse events and effectiveness assessed by changes in testis dimension. Secondary outcome measures were quality of life assessments with 3 validated instruments. All patients were followed a minimum of 1 year in this 5-year study. Postoperative adverse events observed in 19% of 149 patients included device related discomfort or pain in 3%, scrotal edema in 1.3%, infection in 1.3%, extrusion in 2.6%, deflation in 0.7% and pulmonary emboli in 0.7%. No patient reported rheumatological symptoms at 1 year. Testis dimensions were significantly increased in patients missing a testis at baseline (p <0.001). Subjective assessment of testicular appearance was significantly improved (p <0.001) and scores were stable or significantly improved in 2 of 3 quality of life instruments. At short-term followup a new, saline filled testis prosthesis appears safe and well tolerated. Importantly validated self-esteem measures also suggest improvement in quality of life after prosthesis placement.


Vulvar carcinoma with 0.5 mm of invasion and associated inguinal lymph node metastasis.
A case of vulvar carcinoma with 0.5 mm of invasion treated by radical wide local excision only, which later developed ipsilateral inguinal lymph node recurrence, is presented. This represents the least amount of invasion reported resulting in inguinal lymph node metastasis. Review of the literature of stage I vulvar carcinoma with less than 1 mm of invasion indicates that this phenomenon occurs in only 1.6% of all patients who have undergone inguinal lymphadenectomy. Although this represents the second report of ipsilateral inguinal nodal metastasis associated with less than 1 mm of invasion, we continue to perform radical wide local excision without ipsilateral inguinal lymphadenectomy until more cases demonstrate a higher incidence of lymph node involvement.


Nodal monocytoid B-cell lymphoma (nodal marginal-zone B-cell lymphoma).
Benign monocytoid B cells are seen in lymph nodes in different types of lymphadenitis and they occur in the form of clusters within and around sinuses and in the interfollicular areas, but rarely completely surround benign follicles to produce a marginal-zone pattern. The cytologic hallmark of these cells is the presence of abundant pale to clear cytoplasm; these cells usually are of medium size, and they have a rather bland-appearing, irregular nuclei with inconspicuous nucleoli. Malignant monocytoid B-cell proliferations in a lymph node have been classified as monocytoid B-cell lymphomas (MBCL), which are now called nodal marginal-zone B-cell lymphoma (MZL) in the World Health Organization (WHO) classification. In the recently published clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma, 25 of 1,378 cases (1.8%) were classified as primary MZL, whereas four times as many cases (105 or 7.6%) were classified as low-grade mucosa-associated lymphoid tissue (MALT)-type lymphoma. Transformation to large-cell lymphoma at the time of diagnosis was seen in five of 25 (20%) cases of nodal MZL and in 32 of 105 (30%) cases of MALT-type lymphoma. Comparison of the clinical findings at presentation and the survival results indicate that nodal MZL is more aggressive clinically than low-grade MALT-type lymphoma. For example, patients with nodal MZL had a significantly higher incidence of advanced-stage disease, including peripheral and paraaortic lymphadenopathy, than those with MALT-type lymphoma. Moreover, patients with nodal MZL had lower 5-year overall survival and failure-free survival than patients with MALT type lymphoma. When analysis was restricted to those patients with zero to three adverse risk factors in the International Prognostic Index, patients with nodal MZL still had a significantly lower overall and failure-free survival at 5 years than patients with MALT-type lymphoma. We conclude that nodal MZL is a distinctive disease entity and is similar to other low-grade nodal lymphomas, such as the follicular or small lymphocytic lymphomas, but different than MALT-type lymphoma.


Intrathymic T cell differentiation in radiation bone marrow chimeras and its role in T cell emigration to the spleen. An immunohistochemical study.
Immunohistochemical studies were made on the regeneration of T cells of host- and donor-type in the thymus and spleen of radiation bone marrow chimeras by using B10- and B10.BR-Thy-1 congenic mice. Both the thymic cortex and the medulla were first repopulated with thymocytes of irradiated host origin, restoring the normal histologic appearance by days 11 to 14, regardless of the H-2 compatibility between the donor and the host. In Thy-1 congenic chimeras, thymocytes of donor bone marrow origin, less than 100 cells in one thymic lobe, were first recognized at day 7, when the thymus involuted to the smallest size after the irradiation. The thymocytes of donor-type then proliferated exponentially, showing a slightly faster rate when higher doses of bone marrow cells were used for reconstitution, reaching a level of 100 million by day 17 and completely replacing the cortical thymocytes of host origin by day 21. The replacement of cortical thymocytes started from the subcapsular layer in a sporadic manner. The replacement of medullary thymocytes from host- to donor-type occurred gradually between days 21 and 35, after the replacement in the cortex was completed. In the spleen, about 1 million survived cells were recovered at day 3 after the irradiation, and approximately 60% of them were shown to be host-type T cells that were observed in the white pulp areas. The host-type T cells in the spleen increased gradually after day 10, due to the influx of host-type T cells from the regenerating thymus. Thus a pronounced increase of T cells of host-type was immunohistochemically observed in the splenic white pulp between days 21 and 28, when thymocytes of host-type were present mainly in the thymic medulla. These host-type T cells were shown to persist in the spleen for a long time, as long as 420 days after the treatment. Phenotypically, they were predominantly Lyt-1+2+ when examined at day 28, but 5 mo later, they were about 50% Lyt-1+2+ and 50% Lyt-1+2-. Donor-type T cells in the spleen began to appear at about day 14 in chimeras that were transplanted with a larger dose of bone marrow cells, whereas this was slightly delayed in those grafted with a smaller dose of bone marrow cells, starting at about day 28.(ABSTRACT TRUNCATED AT 400 WORDS)


Wavelet images and Chou's pseudo amino acid composition for protein classification.
The last decade has seen an explosion in the collection of protein data. To actualize the potential offered by this wealth of data, it is important to develop machine systems capable of classifying and extracting features from proteins. Reliable machine systems for protein classification offer many benefits, including the promise of finding novel drugs and vaccines. In developing our system, we analyze and compare several feature extraction methods used in protein classification that are based on the calculation of texture descriptors starting from a wavelet representation of the protein. We then feed these texture-based representations of the protein into an Adaboost ensemble of neural network or a support vector machine classifier. In addition, we perform experiments that combine our feature extraction methods with a standard method that is based on the Chou's pseudo amino acid composition. Using several datasets, we show that our best approach outperforms standard methods. The Matlab code of the proposed protein descriptors is available at http://bias.csr.unibo.it/nanni/wave.rar .


[An example of metastasis to the iliopsoas muscle from sigmoid colon cancer].
Even though skeletal muscle, making up about 40% of body weight, is the largest organ in the human body, metastasis from malignant lesions is rare. Among reports of metastasis, those involving the iliopsoas muscle are numerous but few reports involve resection. Reported here is one example we experienced where metastasis developed in the iliopsoas muscle following colectomy, resection was then made possible by radiotherapy and chemotherapy. The case involved a 71-year- old male in which a Hartmann procedure was performed for sigmoid colon cancer. The pathology was Type 3 (8 × 7 cm, adenocarcinoma( mod), ss or more, ly1, v1, n0, ow(-), aw or ew(+), stage II). Upon additional sampling, thermal degredation of neoplastic cells was shown and outpatient oral UFT was performed. Five years following surgery, lymphoadenopathy was noted in the area of the left iliac artery upon US and CT. PET showed a probable metastasis to the left iliopsoas muscle. Early esophageal and stomach cancer were diagnosed by GFT. The esophageal cancer was located 30-32 cm from the incisors, unstained, Borrmann type 1, penetrating deeper than the muscularis propria. Biopsy revealed a diagnosis of tubular adenocarcinoma. ESD was performed for the esophageal cancer and one month later, a total gastrectomy D1+β was performed. During surgery, the iliopsoas muscle tumor was determined to be large and impossible to resect. Radiotherapy of 10MV X-ray, 8 fields, 65-70 Gy/26 times for 6 . 5 weeks was performed for residual tumor but had no effect on tumor size. Fifteen courses of FOLFOX+bevacizumab were then performed. The tumor was markedly reduced in size, unidentifiable upon CT but showed slight uptake on PET and resection of the suspected residual tumor was performed. Histologically, atypical cells were shown in scarred muscle and connective tissue, however, degradation by chemotherapy was high. Residual tumor at resection margins was found, findings consistent with metastasis form sigmoid colon cancer. Taking into account the age and condition of the patient following surgery, chemotherapy was changed to S-1. Currently, 5 months after resection, there has been no recurrence.


Novel Cooperative Automatic Modulation Classification Using Vectorized Soft Decision Fusion for Wireless Sensor Networks.
Cooperative automatic modulation classification (CAMC) using a swarm of sensors is intriguing nowadays as it would be much more robust than the conventional single-sensing-node automatic modulation classification (AMC) method. We propose a novel robust CAMC approach using vectorized soft decision fusion in this work. In each sensing node, the local Hamming distances between the graph features acquired from the unknown target signal and the training modulation candidate signals are calculated and transmitted to the fusion center (FC). Then, the global CAMC decision is made by the indirect vote which is translated from each sensing node's Hamming-distance sequence. The simulation results demonstrate that, when the signal-to-noise ratio (SNR) was given by η ≥ 0dB, our proposed new CAMC scheme's correct classification probability Pcc could reach up close to 100%. On the other hand, our proposed new CAMC scheme could significantly outperform the single-node graph-based AMC technique and the existing decision-level CAMC method in terms of recognition accuracy, especially in the low-SNR regime.


Adenocarcinoma arising from an ectopic pancreas in the stomach.
Ectopic pancreas is rare, being found in between 0.6 % and 15 % at autopsy. Heterotopic pancreas is usually an asymptomatic condition which is found incidentally at surgery or at autopsy. Occasionally, significant symptoms arise from complications, such as recurrent upper gastrointestinal bleeding, biliary or intestinal obstruction, or malignant degeneration. Malignant change is very rare. We report a case of malignant change (adenocarcinoma) in an ectopic pancreas in the stomach. In the literature, there are eight reported cases of malignant change in ectopic gastric pancreas. The prognosis in the other reported cases is unknown, but in our patient, the tumor was confined to the muscle of the stomach and there was no lymph node invasion.