[Evaluation on Surgical Robotic Pose Repeatability Based on Laser Tracking Measurement].
To provide accurate information for registration and safety evaluation of surgical robot, the pose repeatability measurement method was proposed. According to the terminal instrument of the master-slave surgical robot (such as high-frequency electric knife, ultrasonic knife), a suitable target ball fixture was designed. The node data at 10%, 50% and 100% rated speed were measured respectively. Through data analysis, the pose repeatability property of the tested samples at different speeds was obtained. It has high applicability and repeatability, and can meet the requirements of data traceability and registration testing.


Rapid On-Site Evaluation in Detection of Granulomas in the Mediastinal Lymph Nodes.
Rapid On-Site Evaluation (ROSE) of specimens collected by endobronchial ultrasound (EBUS)-guided-transbronchial needle aspiration (TBNA) ensures sample adequacy and triages subsequent biopsy procedures. EBUS-TBNA allows sampling of lymph nodes in granulomatous diseases; however, the ability of ROSE to predict the final diagnosis in this setting has not been well characterized. We performed a retrospective evaluation to study the utility of ROSE in the diagnosis of granulomatous diseases as well as to establish the procedure characteristics that would optimize the concordance between ROSE and final diagnosis. Charts of patients with a cytological diagnosis of granuloma by EBUS-TBNA between June 2008 and May 2013 were reviewed. Preliminary ROSE findings and final cytological diagnosis were compared. Patient demographics and procedure variables were assessed using mean (±SD). The variables collected were considered in a logistic regression analysis using concordance as the outcome. In our study, 255 procedures were performed to sample 625 lymph nodes that contained granulomas. An average of 2.4 (±1.2) lymph nodes were biopsied per procedure, with a mean size of 14.4 (±7.9) mm. The concordance between ROSE and the final diagnosis was 81.6%. The concordance rate was not impacted by needle size, lymph nodes size or station, number of stations biopsied, or passes per lymph node. The concordance did improve with the experience of the bronchoscopist (P < 0001). In this single-center study, there was a high concordance between ROSE and the final cytological diagnosis for mediastinal lymph nodes containing granulomas that were sampled by EBUS-TBNA. ROSE may serve to reduce procedure time, enhance sample triaging, and obviate the need for further invasive testing. The only variable associated with increased concordance was the experience of the operator.


Different Modular Organization Between Early Onset and Late Onset Depression: A Study Base on Granger Causality Analysis.
Background: Modular organization reflects the activity patterns of our brain. Different disease states may lead to different activity patterns and clinical features. Early onset depression (EOD) and late onset depression (LOD) share the same clinical symptoms, but have different treatment strategies and prognosis. Thus, explored the modular organization of EOD and LOD might help us understand their pathogenesis. Method: The study included 82 patients with late life depression (EOD 40, LOD 42) and 90 healthy controls. We evaluated the memory, executive function and processing speed and performed resting-stage functional MRI for all participants. We constructed a functional network based on Granger causality analysis and carried out modularity, normalized mutual information (NMI), Phi coefficient, within module degree z-score, and participation coefficient analyses for all the participants. Result: The Granger function network analysis suggested that the functional modularity was different among the three groups (P auc = 0.0300), and NMI analysis confirmed that the partition of EOD was different from that of LOD (P auc = 0.0190). Rh.10d.ROI (polar frontal cortex) and Rh.IPS1.ROI (dorsal stream visual cortex) were shown to be the potential specific nodes in the modular assignment according to the Phi coefficient (P = 0.0002, P fdr = 0.0744 & P = 0.0004, P fdr = 0.0744). Conclusion: This study reveal that the functional modularity and partition were different between EOD and LOD in Granger function network. These findings support the hypothesis that different pathological changes might exist in EOD and LOD.


Local Electronic Charge Transfer in the Helical Induction of Cis-Transoid Poly(4-carboxyphenyl)acetylene by Chiral Amines.
Understanding the phenomena that lead to the formation of a specific helicity in helical polymers remains a challenge even today. Various polymers have been shown to assume different helical screw-senses depending on different stimuli. Acid-base chiral amines, for example, can induce helical conformations on cis-transoid poly(4-carboxyphenyl)acetylene yielding high-intensity circular dichroism signals. There have been many experimental attempts to elucidate the driving forces involved, but the induction process remains unclear. Here, we investigate the mechanism of helical polymer formation by both Molecular Dynamics (MD) and Density Functional Theory (DFT) approaches. We find that DFT calculations and the dissociation energies between 4 monomer polymers and amines show a clear trend in the affinity of R and S conformers with clockwise and counterclockwise polymer screw-senses, respectively. The charge analysis revealed that the local charge transfer effect plays a crucial role that leads to the helical polymer-amine induction.


On the comparison of the strength of morphological integration across morphometric datasets.
Evolutionary morphologists frequently wish to understand the extent to which organisms are integrated, and whether the strength of morphological integration among subsets of phenotypic variables differ among taxa or other groups. However, comparisons of the strength of integration across datasets are difficult, in part because the summary measures that characterize these patterns (RV coefficient and rPLS ) are dependent both on sample size and on the number of variables. As a solution to this issue, we propose a standardized test statistic (a z-score) for measuring the degree of morphological integration between sets of variables. The approach is based on a partial least squares analysis of trait covariation, and its permutation-based sampling distribution. Under the null hypothesis of a random association of variables, the method displays a constant expected value and confidence intervals for datasets of differing sample sizes and variable number, thereby providing a consistent measure of integration suitable for comparisons across datasets. A two-sample test is also proposed to statistically determine whether levels of integration differ between datasets, and an empirical example examining cranial shape integration in Mediterranean wall lizards illustrates its use. Some extensions of the procedure are also discussed.


Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation.
The sinusoidal obstructive syndrome (SOS) is a complication that usually follows hematopoietic stem cell transplantation. It is also known as veno-occlusive disease, which is a rare complication of living donor liver transplantation (LDLT). Herein, we reported a 34 year-old female patient presenting SOS after LDLT. Its underlying cause was presumed to be associated with liver abscess and subsequent inferior vena cava stenosis. SOS led to graft failure, thus requiring retransplantation with a deceased donor liver graft. The underlying causes of SOS are complex pathologic entity with multifactorial etiology. It is likely that its multifactorial etiology includes a decrease of hepatic venous outflow that is caused by graft liver infection and inferior vena cava stenosis.


The Influence of Injected Volume on Discomfort During Administration of Digital Block.
Digital nerve block is associated with pain. In a search for methods to reduce the discomfort, we investigated how the volume of anaesthetic fluid influences pain during subcutaneous digital nerve block, and how it affects the success of the anaesthesia. A randomized blinded prospective study was performed on 36 healthy volunteers. The single injection subcutaneous digital block technique was used to anaesthetize the participants´ 4th digit on both hands. The same amount of lidocaine was used, but in two different volumes; 1 ml 2% lidocaine and 2ml 1% lidocaine. After each injection the participant was asked to estimate pain intensity on a visual analogue scale (VAS). The distribution of anaesthesia was then measured by using a Semmes-Weinstein 4.56 monofilament. Finally, participants gave a verbal assessment of which injection was least painful. In total, 72 blocks were performed. There were no statistically significant differences in pain intensity or preference between the two groups. Furthermore, the 1 ml injection gave poorer anaesthesia and had longer time to onset. Neither injection anaesthetized the dorsal aspect of the proximal phalanx. The two volumes cause the same degree of discomfort. Greater volume gives a greater area of distribution and more rapid onset of anaesthesia. It seems unreasonable to use a smaller volume of more concentrated anaesthetic when performing the subcutaneous technique.


Sex-related differences in the relationship between acceleromyographic adductor pollicis train-of-four ratio and clinical manifestations of residual neuromuscular block: a study in healthy volunteers during near steady-state infusion of mivacurium.
Studies in volunteers suggest that train-of-four (TOF) ratios >0.9 are needed to retain normal function of muscles involved in upper airway patency, swallowing, and vital capacity breathing. We determined if sex-related differences exist in the relationship between adductor pollicis (AP) TOF ratio and measures of neuromuscular function commonly used to assess recovery from neuromuscular block. In 10 males and 10 females, three steady-state levels of neuromuscular block were achieved with mivacurium infusions. TOF ratio was measured with acceleromyography at the AP. Hand grip strength and the ability to clench the teeth, raise the head >5 s, swallow, protrude the tongue, and open the eyes were tested at each stable block level and reconciled to uncorrected and normalized (pre-paralysis values) TOF measures. These relationships were compared between sexes. The ability to clench teeth and head raise >5 s was lost at a significantly greater TOF ratio in males than females. The percentage decrease in handgrip strength with decreasing TOF ratio was proportionally greater in males than females. Forty per cent of the males were unable to clench the teeth at an uncorrected TOF ratio >0.9. When TOF ratios were normalized, clinical functions showed no decrement at TOF ratio >0.9 in any volunteer. Sex-related differences exist in the relationship between AP TOF ratio and clinical measures of muscle function used to assess recovery from neuromuscular block. Normalization of AP TOF ratios is recommended because a non-normalized TOF ratio of 0.9 does not guarantee adequate reversal of neuromuscular block.


A case of morpheaform sarcoidosis.
Sarcoidosis is an idiopathic multisystem disease with various cutaneous presentations, and it is characterized by the presence of non-caseating granulomas in the affected organs. The specific manifestations are papules, plaques, nodules, ulcers and scar. We report here on a variant of sarcoidosis on a 71-year-old woman who showed an indurated plaque on the forearm. Her lesion's appearance was clinically similar to that of a morphea and the appearance of the lesion was unlike the commonly observed manifestations of sarcoidosis.


Geometrically-controlled twist transitions in nematic cells.
We study geometrically controlled twist transitions of a nematic confined between a sinusoidal grating and a flat substrate. In these cells, the transition to the twisted state is driven by surface effects. We have identified the mechanisms responsible for the transition analytically and used exact numerical calculations to study the range of surface parameters where the twist instability occurs. Close to these values, the cell operates under minimal external fields or temperature variations.


Win-stay-lose-learn promotes cooperation in the prisoner's dilemma game with voluntary participation.
Voluntary participation, demonstrated to be a simple yet effective mechanism to promote persistent cooperative behavior, has been extensively studied. It has also been verified that the aspiration-based win-stay-lose-learn strategy updating rule promotes the evolution of cooperation. Inspired by this well-known fact, we combine the Win-Stay-Lose-Learn updating rule with voluntary participation: Players maintain their strategies when they are satisfied, or players attempt to imitate the strategy of one randomly chosen neighbor. We find that this mechanism maintains persistent cooperative behavior, even further promotes the evolution of cooperation under certain conditions.


K+ channels and metabolic inhibition in cardiac cells.
Metabolic inhibition, whether it is caused by ischemia or hypoxia, is characterized by an important net K+ outward movement. The nature of the currents involved remains a subject of discussion. Good candidates among the many representatives of the large K+ channel family are the ATP-dependent and the Nai-activated K+ channels. Arguments in favour of the ATP-dependent K+ channel will be presented and are based on: 1) the effect of oral antidiabetics on action potential duration during hypoxia; 2) an estimation of the proportion of channels that need to be activated; the channel itself can be activated at relatively high ATP concentrations, and 3) the rectifying properties of the activated current at the whole cell and single channel level. A Nai(+)-activated K+ current can be induced by intracellular dialysis with a solution containing a high Nai+ concentration. Induction is facilitated by simultaneous blockade of the Na+, K+ pump with ouabain or Ke(+)-free solution superfusion. The current shows marked outward rectifying properties. At the single channel level, the open probability was dependent on Nai+ and Na+, K+ pump activity. The channel showed inward rectification when Ki+ less than Ke+, but outward rectification when Ki+ greater than Ke+. The channel and the whole cell current showed similar blocking phenomena. The Nai(+)-activated K+ current may play an important role in action potential shortening during pump blockade and be responsible for a marked K+ loss in advanced ischemia.


[Development of composite deprivation index for Korea: the correlation with standardized mortality ratio].
The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.


[Clinical features of hepatitis-associated aplastic anemia in children].
To study the clinical features of hepatitis-associated aplastic anemia (HAAA) in children. The clinical data of the children with newly diagnosed HAAA from January 2007 to December 2008 were respectively studied, including clinical manifestations, and blood routine, bone marrow examination, viral serology and immune function results as well as treatment and prognosis. A total of 8 children were confirmed as HAAA, accounting for 4.9% in children with aplastic anemia. There were 7 males and 1 female. The median age was 7.5 years (range 4.4 to 10.3 years) at diagnosis. They had negative serologic results and the causes of hepatitis could not be identified. The median interval from hepatitis occurrence to blood cell reduction was 6 weeks. Three cases were diagnosed as severe aplastic anemia and 5 cases as very severe aplastic anemia. Severe T cell immune disorders were found in all 8 cases. The percentage of Ts cells increased and the percentage of Th cells decreased significantly in the 8 children with HAAA. Four children survived after immune suppress treatment, three children died within one month after diagnosis and one child required own discharge without treatment. HAAA is more frequent in male school children. The children with HAAA have severe T cell immune disorders, with a higher early death rate. Immune suppress treatment is effective.


Equipment selection in a DRG environment.
New equipment will continue to be purchased by the healthcare field. It is imperative that those who are considering equipment purchases keep in mind the various factors affecting our healthcare system today. With the increased cost of equipment and the increased risk that this equipment will not be financially successful, it is imperative that those purchasing the equipment be aware that successful adoption of equipment under the PPS will require that special consideration be given to the following: technologies, ability to enhance an integrated healthcare service, and its potential to serve as a cornerstone for a health service program.


Subcellular proteomics insights into Alzheimer's disease development.
Alzheimer's disease (AD), one of the most common dementias, is a neurodegenerative disease characterized by cognitive impairment and decreased judgment function. The expected number of AD patient is increasing in the context of the world's advancing medical care and increasing human life expectancy. Since current molecular mechanism studies on AD pathogenesis are incomplete, there is no specific and effective therapeutic agent. Mass spectrometry (MS)-based unbiased proteomics studies provide an effective and comprehensive approach. Many advances have been made in the study of the mechanism, diagnostic markers, and drug targets of AD using proteomics. This paper focus on subcellular level studies, reviews studies using proteomics to study AD-associated mitochondrial dysfunction, synaptic, and myelin damage, the protein composition of amyloid plaques (APs) and neurofibrillary tangles (NFTs), changes in tissue extracellular vehicles (EVs) and exosome proteome, and the protein changes in ribosomes and lysosomes. The methods of sample separation and preparation and proteomic analysis as well as the main findings of these studies are involved. The results of these proteomics studies provide insights into the pathogenesis of AD and provide theoretical resource and direction for future research in AD, helping to identify new biomarkers and drugs targets for AD.


Could Mesenchymal Stem Cell-Derived Exosomes Be a Therapeutic Option for Critically Ill COVID-19 Patients?
Coronavirus disease 2019 (COVID-19) is a pandemic viral disease originated in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severe form of the disease is often associated with acute respiratory distress syndrome (ARDS), and most critically ill patients require mechanical ventilation and support in intensive care units. A significant portion of COVID-19 patients also develop complications of the cardiovascular system, primarily acute myocardial injury, arrhythmia, or heart failure. To date, no specific antiviral therapy is available for patients with SARS-CoV-2 infection. Exosomes derived from mesenchymal stem cells (MSCs) are being explored for the management of a number of diseases that currently have limited or no therapeutic options, thanks to their anti-inflammatory, immunomodulatory, and pro-angiogenic properties. Here, we briefly introduce the pathogenesis of SARS-CoV-2 and its implications in the heart and lungs. Next, we describe some of the most significant clinical evidence of the successful use of MSC-derived exosomes in animal models of lung and heart injuries, which might strengthen our hypothesis in terms of their utility for also treating critically ill COVID-19 patients.


Duodenal transection in a battered child: a case report.
A case of severe duodenal injury following child abuse is presented. Perforating duodenal injuries are seldom seen after blunt abdominal trauma. A high energy force directed to the center of the upper abdomen may result in disruption of the duodenum. Early diagnosis and appropriate treatment are necessary to improve the outcome. Most children indeed are seen too late and in septic shock because of neglect.


Populations of carbonic acid isomers at 210 K from a fast two-electron reduced-density matrix theory.
Parametrization of the 2-electron reduced density matrix (2-RDM) rather than the many-electron wave function yields a new family of electronic-structure methods that are faster and more accurate than traditional coupled electron-pair methods including coupled cluster with single and double excitations. Deriving the parametrization from N-representability conditions generates a 2-RDM that captures significant correlation from triple and higher-order excitations at the cost of double excitations. We apply the parametric 2-RDM method to confirm recent experiments determining the relative thermodynamic populations of the cis-cis and cis-trans isomers of carbonic acid. In 2010 Bernard et al. showed by infrared spectroscopy that the populations of cis-cis and cis-trans isomers have a 10:1 ratio at 210 K. By use of the parametric 2-RDM method, we predict a 8:1 ratio at 210 K. Comparable ab initio methods overestimate the stability of the cis-cis isomer with 24:1 and 21:1 ratios. These 2-RDM-based methods promise to have significant applications throughout chemistry.


Temporal relationship between primary and motile ciliogenesis in airway epithelial cells.
Cilia are traditionally classified as motile or primary. Motile cilia are restricted to specific populations of well-differentiated epithelial cells, including those in the airway, brain ventricles, and oviducts. Primary cilia are nonmotile, solitary structures that are present in many cell types, and often have sensory functions such as in the retina and renal tubules. Primary cilia were also implicated in the regulation of fundamental processes in development. Rare depictions of primary cilia in embryonic airways led us to hypothesize that primary cilia in airway cells are temporally related to motile ciliogenesis. We identified primary cilia in undifferentiated, cultured airway epithelial cells from mice and humans and in developing lungs. The solitary cilia in the airways express proteins considered unique to primary cilia, including polycystin-1 and polycystin-2. A temporal analysis of airway epithelial cell differentiation showed that cells with primary cilia acquire markers of motile ciliogenesis, suggesting that motile ciliated cells originate from primary ciliated cells. Whereas motile ciliogenesis requires Foxj1, primary ciliogenesis does not, and the expression of Foxj1 was associated with a loss of primary cilia, just before the appearance of motile cilia. Primary cilia were not found in well-differentiated airway epithelial cells. However, after injury, they appear in the luminal layer of epithelium and in basal cells. The transient nature of primary cilia, together with the temporal and spatial patterns of expression in the development and repair of airway epithelium, suggests a critical role of primary cilia in determining outcomes during airway epithelial cell differentiation.


Treatment of inguinal hernia by lichtenstein technique: an open prospective study.
Treatment of inguinal hernia is still a challenge for the surgeon. The multitude of surgical techniques attests of the difficulty of choosing the best procedure. In the surgical B department of the Charles Nicolle Hospital we have chosen the Lichtenstein technique since 2008. The aim of this study was to evaluate the immediate and long-term results of this technique and to identify the predictive factors of recurrence. This open prospective study included all patients who underwent an elective inguinal hernia repair in the surgical B department of the Charles Nicolle Hospital between June 1st 2008 and December 31st 2009. These patients were regularly followed for at least three years. Hernia's recurrence was the primary study endpoint. Postoperative pain, wound complications, urinary complications were secondary endpoints. An univariate and multivariate analysis were performed to identify predictive factor of hernia recurrence. 256 men and eight women were involved in this study with a sex ratio to 32. The average age was 54 years, ranging from 18 to 85 years. we identified seven cases of recurrent hernia (2,6%) with a risk of recurrence at five years equal to 4.9%, 95%CI[4,5 - 5,3].Wound complications were present in 90 patients (34%), dominated by serums seen in 12.1% of cases. The scrotal edema was found in 32 patients (12%). Eight patients kept a postoperative pain after three years of follow-up (3%). The presence of coagulation disorders in pre-operative check-up ( OR 32.25, 95% CI [3.33- 333.3], p = 0.003) and the persistence of pain after one year of intervention ( OR 16.12,95% CI [2.68 -100], p = 0.01) were two predictive factors of hernia recurrence. The Lichtenstein technique remains the gold standard technique in the treatment of inguinal hernias by open surgery. It is a safe, simple, reproducible procedure with a low recurrence rate.


Effect of potato flour on quality and staling properties of wheat-potato flour bread.
To elucidate the impact of potato flour (PF) on quality changes and staling characteristics of the composite bread from wheat-potato flour (WPF), the physicochemical (specific volume, colority, sensory value, texture, and viscosity) properties, and staling (X-ray diffraction and water migration) properties of bread were investigated. The quality of composite bread was comparable to wheat bread when addition level of PF at 20%, but decreased when the addition level increased to 30% or more, and became unacceptable at 50%. A chewy mouthfeel and an elastic and none-crumbly texture were observed on composite bread, which had higher hardness than wheat bread, and could keep on both longer linear distance and higher linear force during compression test. It indicated that such new parameters other than hardness should be introduced to coordinate with the texture quality of composite bread. During storage, the higher addition level of PF significantly decreased crystallinity of composite bread and slowed water migration rate from the crumb to crust, suggesting that PF had antistaling effect on composite bread, which was further emphasized by the fact that the setback value of the WPF decreased with the increase of PF addition.


Allergenicity and cross-reactivity of pine pollen.
Pine pollen has long been considered a non-allergenic pollen. The large size of the grain and its low levels of proteins are the main reasons invoked to explain this low allergenicity. The aim of this study was to describe the main allergenic bands of Pinus radiata (PR) and its cross-reactivity with other pine species, other conifers and grass pollen. Sixty-five pine-pollen-allergic patients (51% also sensitized to grass pollen) were studied. Skin prick tests (SPT) to a battery of allergens including PR, Pinus pinea, Pinus sylvestris, Pinus nigra and Cupressus sempervirens pollens and specific IgE determination to PR and Pinus strobus were performed. IgE-immunoblotting to a PR extract and other pine pollens was also carried out. UniCAP inhibition and immunoblotting inhibition studies were performed to assess the cross-reactivity between different pollens. The SPTs were positive with all the pine pollen extracts tested in 69% of the patients. Specific IgE was positive to PR or P. strobus in 77% of the patients, and to Lolium perenne in 51%. Nine different allergenic bands were detected. The two main allergens were a 42 kDa band recognized by 85% of the patients and a band of approximately 6-8 kDa recognized by 40%. A high degree of cross-reactivity was observed between different pine pollen species, but not between pines and C. sempervirens pollen. A partial cross-reactivity could be seen between pine and grass pollens only in patients also sensitized to L. perenne. Pine pollen should be considered as a potential allergenic pollen especially where this pollen is abundant. The detection of a high number of patients that were monosensitized to pine pollen suggests the possibility of treating these patients with specific immunotherapy.


[Clinical and diagnostic aspects of coronary disease in diabetic patients].
Coronary heart disease in diabetic patients is more frequent than in non-diabetic patients, even without other associated risk factors. It is generally characterised by multi-vessel and distal lesions, associated with an increase incidence of moderate diffuse stenoses, endothelial dysfunction and intramyocardial microangiopathy. Diabetic patients present with a higher incidence of silent myocardial ischaemia (around 30%) than non-diabetic patients. The diagnosis of coronary artery disease has to be assessed mainly using non invasive techniques, particularly cardiac imaging with sensitising tests: thallium myocardial scintigraphy, echocardiography using exercise stress test or pharmacologically-induced stress (dipyridanole, dobutamide). The characteristics of these methods and their predictive values are described, and a step-by-step diagnosis approach is proposed.


The usefulness of stereotactic radiosurgery for radioresistant brain metastases.
We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology. Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS). The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma. The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.


Venous thrombosis causing arterial embolization to the same limb through a patent foramen ovale.
We describe a patient who presented with acute ischemia affecting the left lower limb. Because a transthoracic echocardiogram was abnormal, a transesophageal study was arranged. This demonstrated an atrial septal aneurysm and right-to-left shunting of contrast, raising the possibility of paradoxical embolism. The diagnosis was confirmed by contrast venography, which showed extensive thrombosis in the deep veins of the left thigh, and a ventilation-perfusion scan which was consistent with multiple pulmonary emboli. Among the lessons from this case was the finding that in patients with arterial embolism the likely origin of the embolus should be considered and, in the absence of common risk factors (atrial fibrillation, rheumatic heart disease, left ventricular dilatation, widespread atheroma), occult venous thrombosis and a right-to-left shunt should be sought. In this select group of patients, transesophageal echocardiography is significantly more sensitive than transthoracic study and should be the investigation of choice. Second, in the patient described in this report the clinical signs of deep venous thrombosis (DVT) were masked by the more prominent features of acute arterial ischemia. Without the incidental echocardiographic abnormality, it is likely that the important diagnoses of DVT, pulmonary embolism, and paradoxical embolism would not have been made.


Time-dependent changes of calbindin D-28K and parvalbumin immunoreactivity in the hippocampus of rats with streptozotocin-induced type 1 diabetes.
The hippocampus is affected by various stimuli that include hyperglycemia, depression, and ischemia. Calcium-binding proteins (CaBPs) have protective roles in the response to such stimuli. However, little is known about the expression of CaBPs under diabetic conditions. This study was conducted to examine alterations in the physiological parameters with type 1 diabetes induced with streptozotocin (STZ) as well as time-dependent changes in the expression of two CaBPs changes of were being evaluated. Rats treated with STZ (70 mg/kg) had high blood glucose levels (> 21.4 mmol/L) along with increased food intake and water consumption volumes compared to the sham controls. In contrast, body weight of the animals treated with STZ was significantly reduced compared to the sham group. CB-specific immunoreactivity was generally increased in the hippocampal CA1 region and granule cell layer of the dentate gyrus (DG) 2 weeks after STZ treatment, but decreased thereafter in these regions. In contrast, the number of PV-immunoreactive neurons and fibers was unchanged in the hippocampus and DG 2 weeks after STZ treatment. However, this number subsequently decreased over time. These results suggest that CB and PV expression is lowest 3 weeks after STZ administration, and these deficits lead to disturbances in calcium homeostasis.


Development of glycoprotein IIb-IIIa antagonists: translation of pharmacodynamic effects into clinical benefit.
This article will review the development of glycoprotein IIb-IIIa antagonists, with particular emphasis on the characteristics and pharmacodynamic studies of each agent that is available for clinical use. Abciximab is a Fab fragment of the 7E3 antibody that has high affinity and a slow rate of dissociation from glycoprotein IIb-IIIa. In contrast, the small molecules eptifibatide and tirofiban, have a much more rapid rate of dissociation, with an off time of 10 to 15 s. Accordingly, the circulating pool of abciximab is predominantly associated with platelets, whereas maintenance of a consistent concentration of tirofiban and eptifibatide in the blood is critical in order to achieve and sustain their inhibitory effects. The affinity of abciximab and tirofiban for glycoprotein IIb-IIIa are substantially greater than that of eptifibatide, necessitating maintenance of greater molar concentrations of eptifibatide in blood in order to achieve effective inhibition of the binding of fibrinogen to the activated conformer of glycoprotein IIb-IIIa.


Coagulation-Inspired Direct Fibrinogen Assay Using Plasmonic Nanoparticles Functionalized with Red Blood Cell Membranes.
The fast measurement of fibrinogen is essential in evaluating life-threatening sepsis and cardiovascular diseases. Here, we aim to utilize biomimetic plasmonic Au nanoparticles using red blood cell membranes (RBCM-AuNPs) and demonstrate nanoscale coagulation-inspired fibrinogen detection via cross-linking between RBCM-AuNPs. The proposed biomimetic RBCM-AuNPs are highly suitable for fibrinogen detection because hemagglutination, occurring in the presence of fibrinogen, induces a shift in the localized surface plasmon resonance of the NPs. Specifically, when the two ends of the fibrinogen protein are bound to receptors on separate RBCM-AuNPs, cross-linking of the RBCM-AuNPs occurs, yielding a corresponding plasmon shift within 10 min. This coagulation-inspired fibrinogen detection method, with a low sample volume, high selectivity, and high speed, could facilitate the diagnosis of sepsis and cardiovascular diseases.


Three-dimensional-Printed Malo Bridge: Digital Fixed Prosthesis for the Partially Edentulous Maxilla.
Screw-retained implant restorations have an advantage of predictable retention, retrievability, and lack of potentially retained subgingival cement. However, a few disadvantages exist such as need for precise placement of the implant for optimal and esthetic location of the screw access hole and obtaining passive fit. Malo bridge with customization of abutment can establish a precise patient's gingival architecture. It is the most esthetically advanced form of fixed prosthodontic rehabilitation for complete and partially edentulous patients. This prosthesis is combined with three-dimensional (3D)-printed computer-aided design and computer-aided manufacturing technology to gain the precise fit and added esthetics. It also has advantages such as elimination of screw access openings, makes it possible to remove and repair the fractured porcelain of the individual crown without removing the whole structure, excellent precision, avoids casting errors, light weight, reduced complexity of laboratory procedures, high definition of morphology, and time-consuming. This case report presents replacement of partially edentulous maxilla using 3D-printed Malo bridge.


The Role of Allograft Bone in Foot and Ankle Arthrodesis and High-Risk Fracture Management.
Allogenic bone graft has long been accepted as a standard of care in the surgical arthrodesis of the foot and ankle and treatment of certain high-risk, comminuted fracture types that have greater potential for delayed union or nonunion. It has been shown in multiple studies to be equivalent to autograft in regard to union rates without the morbidity associated with bone graft harvest. We present a retrospective study on the efficacy of an allogenic cancellous/periosteal cellular bone matrix with mesenchymal stem cells and angiogenic growth factors. The study includes a cohort of 41 procedures and 40 patients who underwent foot and ankle arthrodesis, fracture fixation, or a simultaneous combination of both. Radiographic consolidation of the fracture/fusion site was reviewed at regular intervals (first postoperative visit at 1 week and 4, 8, and 12 weeks and at regular intervals until healing was confirmed). Age, workmen's compensation insurance, diabetes, and nicotine use were evaluated as potential risk factors. Our retrospective study indicated that allograft bone has the potential to positively affect union rates in foot and ankle arthrodesis and certain high-risk fracture types that have potential for delayed union/nonunion. Levels of Evidence: Level IV.


The comparison of pulmonary functions in open versus laparoscopic cholecystectomy.
To examine respiratory functions of patients after open and laparoscopic cholecystectomy and to compare the advantages. Fifty five cases with cholelithiasis subjected to elective cholescystectomy were studied. The patients were divided into two groups. Open Cholecystectomy (OC) was performed on 27 cases (Group I), and Laparoscopic Cholecystectomy (LC) in 28 cases (Group II). Respiratory function tests were performed 24 hours before the operation and on the 1st and 6th day after surgery. Blood gas values and anaesthesia periods were recorded. Forced expiratuary volume in the 1st second (FEV1), forced vital capacity (FVC) and FEV1/FVC values were also noted. FEV1, FVC and FEV1/FVC values on first post-operative day in all cases were statistically lower than the preoperative values (p = 0.0001). Percentage changes of respiratory function test was calculated preoperatively and 1st postoperative day. The changes in both groups showed a significant decrease in FEV1, FVC and FEVI/FVC in Group I compared to Group II (p = 0.0001 in FEV1, p = 0.007 in FVC and p = 0.004 in FEV1/FVC). There was no significant difference in respiratory function tests evaluated on the 6th postoperative day and they had returned to normal values. There was no difference among preoperative and postoperative PaCO2, pH values in arteriel blood gas values in all cases (p = 0.355 p = 0,215). These parameters did not differ in both groups (p = 0.527, p = 0.591), There was a significant decrease in PaO2 and O2 saturation in all cases (p = 0.0001), but there was no significant difference when both groups were compared (p = 0.166, p = 0.678). The better results of pulmonary function tests in patients subjected to LC proves the advantage of the procedure over OC.


[Treatment of pseudomyxoma peritonei is developing].
In pseudomyxoma peritonei a mucinous tumor of the appendix spreads into the abdominal cavity. Cytologic picture of the tumor may be benign, malignant or intermediary. The symptoms were previously relieved by repeated resections of the tumor mass, whereby even the most benign form of the disease progressed slowly. A method has now emerged in which radical-aimed surgery is combined with intraperitoneal lavage with a warmed solution of a cytotoxic agent. This treatment is associated with a morbidity of 33 to 56% and a mortality of 0 to 18%. Controlled studies have not been carried out on the novel treatment.


Breast cancer cells have lower activating protein 1 transcription factor activity than normal mammary epithelial cells.
To determine whether normal breast cells have different levels of activating protein 1 (AP-1) expression and activation relative to breast cancer cells, we have compared the level of c-Jun and c-Fos expression and AP-1 activity in human mammary epithelial cells (HMECs) at different stages of transformation (normal proliferating HMECs, immortal HMECs, oncogene-transformed HMECs, and breast cancer cell lines). These studies demonstrated that normal and immortal HMECs have a high basal level of expression of cJun and cFos and higher AP-1 DNA-binding and transcriptional activating activities than do oncogene-transformed HMECs or human breast cancer cells, with a gradual decrease in AP-1 transactivating activity as cells progress through the carcinogenesis pathway (normal > immortal > oncogene-transformed > cancer cell lines). The AP-1 activity in normal or immortal cells was not modulated by growth factor supplementation or oncogene overexpression, as it is in breast cancer cells. However, the addition of suramin, a nonspecific growth factor antagonist, did inhibit AP-1 in these HMECs, suggesting that this high level of AP-1 present in normal HMECs may be due to autocrine stimulation of growth factor pathways. The differences in AP-1 activity in normal and malignant breast cells may indicate that normal cells are more dependent on AP-1-mediated signals for their growth than are breast cancer cells.


Speeding up SVM training in brain-computer interfaces.
Traditional Support Vector Machine (SVM) is widely used classification method for brain-computer interface (BCI). However, SVM has a high computational complexity. In this paper, Gaussian Mixture Model (GMM)-based training data reduction is proposed to reduce high computational complexity. The proposed method is configured as follows: First, wavelet-based combined feature vectors are applied for motor imagery electroencephalography (EEG) identification and principal component analysis (PCA) are used to reduce the dimension of feature vectors. Thereafter, the GMM is implemented to reduce training data sizes. Finally, a nonlinear SVM classifier is used to classify the reduced training data. The performance of the proposed method was evaluated using three different motor imagery datasets in terms of accuracy and training time. The results from the study indicate that the proposed method achieves high accuracy with faster computational time in motor imagery EEG classification.


Quantitation of angiogenesis in the chick chorioallantoic membrane model using fractal analysis.
Objective quantitation of new vascular growth in angiogenesis assays has been difficult to achieve. The aim of this study was to test the potential applicability of fractal geometry to objectively quantify angiogenesis in the chick chorioallantoic membrane (CAM). To accomplish this, vascular growth in normal (NC) and tumor grafted (TGC) CAM was compared. Samples of human tumors of various origins acquired from biopsy specimens were grafted to CAMs at Days 6-12 of incubation. Images of 6- to 16-day NC and 10- to 17-day TGC were acquired and the box-counting method was used to estimate fractal dimension (Df). Vascular density (rho v) was derived from box counts. For NC, Df and rho v increased steadily from Days 6 to 14, peaked, and began to decrease by Day 15. Results from TGC showed that Df and rho v surrounding tumor grafts varied from those of NC. Complexity and density indices were calculated as amount of change in Df and rho v between TGC and NC of the same age, respectively. Based on these indices, differences in the angiogenic response elicited by various tumors were readily detected. Our results suggest that differences in Df and rho v, in both the temporal and spatial senses, are accurate and repeatable measures of vascular growth and may be useful for objective quantitation of the angiogenic response.


A higher plant enzyme exhibiting broad acceptance of stereoisomers.
An arginase, purified from the leaf of the jack bean, Canavalia ensiformis, can effectively hydrolyze both l- and d-arginine. Arginases, examined from a number of other plant and animal sources, exhibit marked substrate stereospecificity and fail to catabolize d-arginine. In order to provide essential nitrogen, jack bean leaf arginase also catabolizes l-canavanine, an arginine analog that is a predominant nitrogen-storing metabolite of this legume. The ability of arginase to metabolize both stereoisomers of arginine may result from the requirement for this enzyme to exhibit limited substrate specificity in order to hydrolyze both arginine and canavanine.


Diurnal changes of arterial oxygen saturation and erythropoietin concentration in male and female highlanders.
In Caucasians and Native Americans living at altitude, hemoglobin mass is increased in spite of erythropoietin concentrations ([Epo]) not markedly differing from sea level values. We hypothesized that a nocturnal decrease of arterial oxygen saturation (SaO2) causes a temporary rise of [Epo] not detected by morning measurements. SaO2 (continuous, finger oximeter) and [Epo] (ELISA, every 4 h) were determined in young highlanders (altitude 2600 m) during 24 h of usual daily activity. In Series I (six male, nine female students), SaO2 fell during the night with the nadir occurring between 01:00 and 03:00; daily means (range 92.4-95.2%) were higher in females (+1.7%, P < 0.01). [Epo] showed opposite changes with zenith occurring at 04:00 without a sex difference. Mean daily values (22.9 ± 10.7SD U/L) were higher than values obtained at 08:00 (17.2 ± 9.5 U/L, P < 0.05). In Series II (seven females), only SaO2 was measured. During follicular and luteal phases, SaO2 variation was similar to Series I, but the rhythm was disturbed during menstruation. While daily [Epo] variations at sea level are not homogeneous, there is a diurnal variation at altitude following changes in SaO2 Larger hypoventilation-dependent decreases of alveolar PO2 decreases during the night probably cause a stronger reduction of SaO2 in highlanders compared to lowlanders. This variation might be enlarged by a diurnal fluctuation of Hb concentration. In spite of a lower [Hb], the higher SaO2 in women compared to men led to a similar arterial oxygen content, likely explaining the absence of differences in [Epo] between sexes.


Acute Adverse Effects of Vaccines Against SARS-COV-2.
Introduction The global struggle against the impact of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) on physical and mental health and on economic and social aspects of human life continues even after two and a half years have passed since the emergence of this virus. The development of vaccines was a milestone. By June 2022, billions of people have been vaccinated against the deadly virus. However, like any other vaccine, the various vaccines against coronavirus disease 2019 (COVID-19) also cause a variety of adverse effects. Therefore this study aimed to determine the different acute side effects experienced after receiving the vaccines and correlating them with some socio-demographic and biomedical factors. Methodology This cross-sectional study has a sample size of 467. Study participants were recruited after fulfilling inclusion and exclusion criteria. After gaining approval from the Ethical Review Board (ERB) of CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan, an online questionnaire was distributed via social media. The survey questionnaire had a series of questions regarding the socio-demographic and biomedical characteristics of the participants, as well as the type of vaccine they got, followed by questions about the development of adverse effects after each dose (first and second). Data were statistically analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The analysis was carried out in a confidence range of 95%, and a p-value<0.05 was considered statistically significant. Results Sinopharm (76.0%) was the most frequently received vaccine. Adverse events were reported more after the first dose (79.7%) than in the second (67.2%) (p value 0.001). The reported adverse events after either dose were of mild intensity (p<0.05). None of the individuals reported serious adverse events or hospitalization after getting the shots. Females, younger age groups, and individuals with BMI in the underweight category were more prone to developing symptoms and experiencing difficulty doing routine work after getting the doses. The associations were statistically significant (p<0.05). Blood group (A,B,0,AB), past COVID-19 history, and smoking status were not positively associated with the appearance of symptoms after either dose or with inconvenience doing daily work post-vaccination. Conclusion The vaccines developed against COVID-19 offer benefits that outweigh the few mild adverse effects experienced. None of these symptoms is severe enough to stop an individual from doing routine work or result in morbidity or mortality. Therefore, people should avoid any hesitancy towards getting vaccinated to get past this pandemic.


Strap Muscle Type I Thyroplasty After Gore-Tex Implant Extrusion: Case Report and Literature Review.
To discuss the presentation and management techniques of implant extrusion following type I thyroplasty and to illustrate the potential of strap muscle for augmentation following implant removal. We report a unique case of a patient with late Gore-Tex implant extrusion after type I thyroplasty treated with removal and autologous strap muscle graft for augmentation. A 41-year-old female nearly 3.5 years status post Gore-Tex type I thyroplasty for left vocal fold paralysis presented for evaluation of dysphonia. Upon flexible laryngoscopy, erythema, edema, and granulation tissue were identified at the left vocal fold and ventricle. The patient subsequently underwent removal of her implant. Intraoperatively, a free portion of sternothyroid muscle was dissected free and placed into the paraglottic space. One month following surgery, the patient reported an improvement in her Voice Handicap Index (VHI) score from 40 to 0. In addition, no major complications were observed and complete glottic closure was achieved. Nine months postsurgery, she continued to function well with a VHI score of 0. At 50 months postop, the patient still reports a VHI score of 0. Implant extrusion is a rare complication of type I thyroplasty usually occurring in the first few months after surgery and more commonly presenting in females. Current management options consist of observation or augmentation with autologous fat or vocal fold injection following implant removal. This is the first report of a successful strap muscle free graft revision thyroplasty following implant extrusion. The patient's excellent long-term outcome highlights the potential of strap muscle augmentation as a feasible management option for implant extrusion.


[The role of multispiral computed tomographic coronarography].
The aim of the study was to assess the use of multispiral computed tomographic coronarography (MSCT-CG) in comparison with conventional coronary angiography. Overall 62 patients aged 45-72 years were examined, the MSCT-CG was conducted in 38 patients. The sensitivity of MSCT-CG was 92%, the specificity - 91,2%, in comparison with the CAG. The prognostic value of negative test was 95,7%, the prognostic value of positive test was 84%, overall accuracy was counted up to 91,5%. Though, the MSCT-CG showed certain overestimation in calculating the stenosis degree and, thus, false positive results, in cases with calcined atherosclerotic plaques. Main advantages of MSCT-CG were: non-invasiveness, possibility of vessel lumen, arterial wall and structure of the plaque assessment.


Unusual presentation of jejunal hemangioma on Tc-99m pertechnetate scan with single-photon emission computerized tomography-computed tomography.
Small bowel hemangioma is a rare benign tumor in the pediatric population. The usual presentation of these tumors is melena, anemia, or hematochezia. Our case demonstrates the usefulness of Meckel's/Tc-99m pertechnetate scan with single-photon emission computerized tomography/computerized tomography in diagnosing a vascular lesion in the small bowel in a child presenting with melena, unresponsive to medical management. We present a case of incidentally detected jejunal hemangioma during Tc-99m pertechnetate scintigraphy which would help the nuclear medicine physician and surgeon, to be cognizant of this atypical presentation in their clinical practice.


Deletion of integrin alpha 1 by homologous recombination permits normal murine development but gives rise to a specific deficit in cell adhesion.
Integrin alpha 1 is a receptor for laminin and collagen which is expressed widely and dynamically in embryogenesis and has been implicated in various developmental processes including establishment of the placenta and formation of the central and peripheral nervous system. In the adult it is the sole collagen receptor in smooth muscle and liver and is thought to be important for the stability of these tissues. We have generated a null allele of the alpha 1 gene in the germline of mice by homologous recombination in embryonic stem cells. Mice homozygous for the mutation are viable and fertile and have no overt phenotype, demonstrating that the molecule is not required for development. Embryonic fibroblasts derived from mutant animals are unable to spread on or migrate into substrata of collagen IV and are deficient in spreading on and migrating into laminin. Further in vitro analysis of cell spreading and migration suggests that alpha 1 beta 1 is not required for binding to collagen I and implicates a third receptor, possibly integrin alpha 3 beta 1, in collagen I binding.


Review of ivermectin in scabies.
Currently available topical medications for scabies are messy and need prolonged application. This leads to poor patient adherence. Emerging drug resistance to topical scabicides has made eradication of scabies difficult. Availability of an effective oral scabicidal agent, ivermectin (Ivm), opens a new era in the management of scabies. This review summarizes the published literature on the use of ivermectin in the treatment of scabies. A single oral dose of ivermectin of 200 mg/kg body weight is very effective in the treatment of human scabies. A second dose 7-10 days later substantially improves the cure rate. This suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite. Endemic and epidemic scabies in institutions are better treated with Ivm. Crusted scabies ideally should be treated with a combination of Ivm and topical scabicides. Other standard measures and precautions should be taken. Additional controlled studies using a higher single oral dose or using parenteral or topical forms of Ivm are needed. The safety of Ivm in children less than 5 years old and in pregnant women has to be established. The U.S. FDA has not yet approved the drug for the treatment of human scabies.


Risk factors for ≥high-grade anal intraepithelial lesions in MSM living with HIV and the response to topical and surgical treatments.
The objective of this study in MSM living with HIV was to determine the incidence of HSIL and ASCC, related factors, and the response to treatment. Data were gathered in 405 consecutive HIV-infected MSM (May 2010-December 2018) at baseline and annually on: sexual behavior, anal cytology, and HPV PCR and/or high-resolution anoscopy results. They could choose mucosectomy with electric scalpel (from May 2010) or self-administration of 5% imiquimod 3 times weekly for 16 weeks (from November 2013). A multivariate logistic regression model was developed for ≥HSIL-related factors using a step-wise approach to select variables, with a significance level of 0.05 for entry and 0.10 for exit, applying the Hosmer-Lemeshow test to assess the goodness of fit. The study included 405 patients with a mean age of 36.2 years; 56.7% had bachelor´s degree, and 52.8% were smokers. They had a mean of 1 (IQR 1-7) sexual partner in the previous 12 months, median time since HIV diagnosis of 2 years, and mean CD4 nadir of 367.9 cells/uL; 86.7% were receiving ART, the mean CD4 level was 689.6 cells/uL, mean CD4/CD8 ratio was 0.77, and 85.9% of patients were undetectable. Incidence rates were 30.86/1,000 patient-years for ≥high squamous intraepithelial lesion (HSIL) and 81.22/100,000 for anal squamous cell carcinoma (ASCC). The ≥HSIL incidence significantly decreased from 42.9% (9/21) in 2010 to 4.1% (10/254) in 2018 (p = 0.034). ≥HSIL risk factors were infection with HPV 11 (OR 3.81; 95%CI 1.76-8.24), HPV 16 (OR 2.69, 95%CI 1.22-5.99), HPV 18 (OR 2.73, 95%CI 1.01-7.36), HPV 53 (OR 2.97, 95%CI 1.002-8.79); HPV 61 (OR 11.88, 95%CI 3.67-38.53); HPV 68 (OR 2.44, CI 95% 1.03-5.8); low CD4 nadir (OR1.002; 95%CI 1-1.004) and history of AIDS (OR 2.373, CI 95% 1.009-5.577). Among HSIL-positive patients, the response rate was higher after imiquimod than after surgical excision (96.7% vs 73.3%, p = 0.009) and there were fewer re-treatments (2.7% vs 23.4%, p = 0.02) and adverse events (2.7% vs 100%, p = 0.046); none developed ASCC. HSIL screening and treatment programs reduce the incidence of HSIL, which is related to chronic HPV infection and poor immunological status. Self-administration of 5% imiquimod as first-line treatment of HSIL is more effective than surgery in HIV+ MSM.


Burnout and psychiatrists: what do we know and where to from here?
Medicine in most parts of the world is becoming a stressful profession. Psychiatrists represent a high-risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work-related stress. There are reports that entrants in the profession of psychiatrists are decreasing globally. Conceptual issues related to burnout are explored and factors contributing to burnout in psychiatrists are reviewed. Methodologically sound studies are needed to help us understand positive aspects of psychiatry as a profession and the environment psychiatrists work in. Effective treatment programmes for burnout are also needed not only to reduce suffering but also to retain psychiatrists in the profession.


Continuity of Care During COVID-19 Lockdown: A Survey on Stakeholders' Experience With Telerehabilitation.
Objective: To explore professionals', adult patients', and children's caregivers' perception and satisfaction with telerehabilitation during COVID-19 lockdown. Design: An observational transversal study on a web-based survey was conducted in order to explore participants' perception and satisfaction of telerehabilitation during COVID-19 lockdown. Setting: The study was conducted at our Outpatient Neurorehabilitation Service. Subjects: All rehabilitation professionals, adult patients, and children's caregivers who accepted telerehabilitation were recruited. Interventions: Participants had to respond to the Client Satisfaction Questionnaire-8 and to a purpose-built questionnaire on their perception and satisfaction of the service provided. Main Measures: Data were analyzed by qualitative statistics and logistic regression models. Results: All 144 caregivers, 25 adult patients, and 50 professionals reported a medium-high level of perception and a high level of satisfaction. Results showed a correlation among caregivers of children aged 0-3 and feeling overwhelmed with remote care (OR = 3.27), a low perception of telerehabilitation for enhancing goals (OR = 6.51), and a high perception of feeling helped in organizing daily activity (OR = 2.96). For caregivers of children aged over 6 years, changes in the therapy plan were related to a low perception of feeling in line with the in-person therapy (OR = 2.61 and OR = 9.61) and a low satisfaction (OR = 5.54 and OR = 4.97). Changes in therapy were related to concern (OR = 4.20). Caregivers under 40 and professionals showed a high probability to perceive telerehabilitation as supportive (OR = 2.27 and OR = 5.68). Level of experience with remote media was shown to influence perception and satisfaction. Interpretation: Telerehabilitation can be a useful practice both during a health emergency and in addition to in-presence therapy.


A study on visual evoked responses in children with chronic renal failure.
Nervous involvement is frequent in patients with renal failure. Early recognition of the condition by electrophysiological tests may provide means for protective measures before irreversible damage of nervous system (NS) structures takes place. This study has two objectives: (1) examining whether pattern-reversal visual evoked potential (PR-VEP) studies may provide information relating to possible subclinical NS involvement in pediatric patients with chronic renal failure (CRF) and (2) looking for a possible relationship between serum parathormone (PTH) and creatinine levels and PR-VEP parameters. PR-VEP recordings at low spatial frequencies were performed and peak-to-peak amplitudes and latencies of the P100 component were measured in 19 neurologically asymptomatic children with CRF, 15 of whom were on continuous ambulatory peritoneal dialysis (CAPD) and four on hemodialysis (HD). A similar procedure was applied to 29 healthy, age- and sex-matched, subjects. Patients were sub-grouped according to the serum PTH and creatinine levels. Student's-t and one-way ANOVA tests were used for comparisons within patient and control groups and sub-groups relating to serum PTH and creatinine levels. We did not demonstrate any statistically significant differences in PR-VEP parameters in patients vs. controls. PR-VEP amplitudes were higher in patients with low serum creatinine levels as compared to group with high creatinine values and to controls. No other relationship was found between PR-VEP parameters and serum PTH and creatinine levels in this pediatric population. Young patients with CRF and under dialysis do not necessarily show pathologic alterations in PR-VEPs when they are neurologically intact. This fact suggests that either PR-VEPs are not sensitive enough to detect clinically silent NS involvements in such patients, or it could be related to positive effects of the currently improving standards in the management of dialysis and supportive nutrition. Additional factors such as the age of the patient during examination, the latency between dialysis and visual evoked potential (VEP) assessment, or the selected check size may have some impact on the results and justify further studies.


Deletion of an essential gene in Escherichia coli by site-specific recombination with linear DNA fragments.
Deletion of an essential gene in Escherichia coli was accomplished by transformation of linear DNA fragments that have a Kanr gene segment flanked by sequences homologous to closely spaced regions on the E. coli chromosome. Selection for a double crossover within homologous sequences can effectively delete an entire gene. Cell viability is maintained by provision of the essential gene on a plasmid with a temperature-sensitive replicon, resulting in cells which have a temperature-sensitive phenotype.


Management of residual penile curvature after penile prosthesis placement.
Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.


Processing of the Precursors for the Light-Harvesting Chlorophyll-Binding Proteins of Photosystem II and Photosystem I during Import and in an Organelle-Free Assay.
We have investigated whether the precursors for the light-harvesting chlorophyll a/b binding proteins (LHCP) of photosystems II and I (PSII and PSI) are cleavable substrates in an organelle-free reaction, and have compared the products with those obtained during in vitro import into chloroplasts. Representatives from the tomato (Lycopersicon esculentum) LHCP family were analyzed. The precursor for LHCP type I of PSII (pLHCPII-1), encoded by the tomato gene Cab3C, was cleaved at only one site in the organelle-free assay, but two sites were recognized during import, analogous to our earlier results with a wheat precursor for LHCPII-1. The relative abundance of the two peptides produced was investigated during import of pLHCPII-1 into chloroplasts isolated from plants greened for 2 or 24 hours. In contrast to pLHCPII-1, the precursors for LHCP type II and III of PSI were cleaved in both assays, giving rise to a single peptide. The precursor for LHCP type I of PSI, encoded by gene Cab6A, yielded two peptides of 23.5 and 21.5 kilodaltons during import, whereas in the organelle-free assay only the 23.5 kilodalton peptide was found. N-terminal sequence analysis of this radiolabeled peptide has tentatively identified the site cleaved in the organelle-free assay between met40 and ser41 of the precursor.


Genetic bases of arrhythmogenic right ventricular Cardiomyopathy.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disease in which the pathological substrate is a fibro-fatty replacement of the right ventricular myocardium. The major clinical features are different types of arrhythmias with a left branch block pattern. ARVC shows autosomal dominant inheritance with incomplete penetrance. Recessive forms were also described, although in association with skin disorders.Ten genetic loci have been discovered so far and mutations were reported in five different genes. ARVD1 was associated with regulatory mutations of transforming growth factor beta-3 (TGFβ3), whereas ARVD2, characterized by effort-induced polymorphic arrhythmias, was associated with mutations in cardiac ryanodine receptor-2 (RYR2). All other mutations identified to date have been detected in genes encoding desmosomal proteins: plakoglobin (JUP) which causes Naxos disease (a recessive form of ARVC associated with palmoplantar keratosis and woolly hair); desmoplakin (DSP) which causes the autosomal dominant ARVD8 and plakophilin-2 (PKP2) involved in ARVD9. Desmosomes are important cell-to-cell adhesion junctions predominantly found in epidermis and heart; they are believed to couple cytoskeletal elements to plasma membrane in cell-to-cell or cell-to-substrate adhesions.


Caelestines A-D, brominated quinolinecarboxylic acids from the Australian ascidian Aplidium caelestis.
Four new brominated natural products, caelestines A-D (1-4), have been isolated from the Australian ascidian Aplidium caelestis. The structures of 1-4 were determined by analysis of their NMR and MS data. This is the first report of brominated quinolinecarboxylic acids from nature. Compound 1 has been previously synthesized but not spectroscopically characterized. Compounds 1-4 were tested against three mammalian cell lines (MCF-7, NFF, and MM96L) and a panel of microbial strains and showed only minor cytotoxicity.


Combinational Anti-tumor Effects of Chemicals from Paeonia lutea Leaf Extract in Oral Squamous Cell Carcinoma Cells.
We identified chemical components that exhibited antitumor activity against oral squamous cell carcinoma (OSCC) cells and examined their effective concentrations and additive and/or synergistic effects in combinational usage on the proliferation, apoptosis and cell cycle of OSCC cells. Using high-performance liquid chromatography, nuclear magnetic resonance spectroscopy and electrospray ionization-mass spectrometry, we identified the main chemical components of the methanol extracts from Paeonia lutea. We investigated the pharmaceutical effects of those components on the proliferation, apoptosis, and cell cycle of an OSCC cell line, SAS, using the tetrazolium salt 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) and caspase assays, as well as flow cytometry cell cycle analysis. We also examined the effects of those components on the mitogen-activated protein kinase signal transduction pathway by western blotting. Finally, the effects on normal human epidermal keratinocyte cells were also examined in similar experiments. Three chemicals have been identified in P. lutea leaves using high performance liquid chromatography: gallic acid methyl ester (GAME), pentagalloyl glucose (PGG) and paeoniflorin (PF). Both GAME and PGG significantly suppressed cell proliferation, and their combined effects were synergistic, while the effect of PF was minimal. However, those chemicals did not induce apoptosis. Cell cycle and western blotting analysis showed that the suppressive effects on cell proliferation resulted from G2 arrest and the suppression of phosphorylation of Akt/PKB. No effect was identified on normal human epidermal keratinocyte cells. These results indicate that GAME and PGG are the main chemical components of P. lutea leaves that have potential anti-cancer therapeutic effects.


Production of beta-carotene by a mutant of Rhodotorula glutinis.
Wild strains of Rhodotorula glutinis and R. rubra were investigated concerning their carotenoid production, proportion of beta-carotene and cell mass yield. R. glutinis NCIM 3353 produced 2.2 mg carotenoid/l in 72 h; and the amount of beta-carotene was 14% (w/w) of the total carotenoid content (17 microg/g cell dry weight). It was subjected to mutagenesis using UV radiation for strain improvement. Out of 2,051 isolates screened, the yellow coloured mutant 32 produced 120-fold more beta-carotene (2,048 microg/g cell dry weight) than the parent culture in 36 h, which was 82% (w/w) of the total carotenoid content. Mutant 32 was grown on different carbon and nitrogen sources. The best yield of beta-carotene (33+/-3 mg/l) was obtained when glucose and yeast extract were supplied as carbon and nitrogen sources, respectively. Divalent cation salts further increased the total carotenoid content (66+/-2 mg/l) with beta-carotene as the major component (55+/-2%, w/w).


Anatomy of the intervertebral foramen.
The intervertebral foramen serves as the doorway between the spinal canal and periphery. It lies between the pedicles of neighboring vertebrae at all levels in the spine. A number of categorization schemes have been attempted to describe the boundaries of the intervertebral foramen. No uniform agreement has been made on which classification best describes this area. Studies of the nerve root canals have clearly noted variations in the angle of take-off from the thecal sac, length of the nerve root, and placement of the dorsal root ganglion from different lumbar levels. The nerve root canal receives a dual blood supply from central and peripheral sources. The dorsal root ganglion also has a dual vascular supply that aids in preventing damage to this vital foraminal structure. The presence of ligamentous structures within the foramen has been demonstrated by a number of recent studies. These ligaments serve a protective and organizational role for the neurovascular structures of the foramen. A thorough knowledge of the intervertebral foramen will allow the understanding of the pathological and degenerative changes that cause compression or injury to these foraminal structures.


bHLH-Orange Transcription Factors in Development and Cancer.
Basic helix-loop-helix (bHLH) proteins are a large superfamily of transcription factors that play critical roles in many physiological processes including cellular differentiation, cell cycle arrest and apoptosis. Based on structural and phylogenetic analysis, mammalian bHLH-Orange (bHLH-O) proteins, which constitute the repressor family of bHLH factors, can be grouped into four subfamilies: Hes, Hey, Helt and Stra13/Dec. In addition to the bHLH domain that mediates DNA-binding and protein dimerization, all members of this family are characterized by a distinctive motif called the "Orange domain" which is present exclusively in these factors. Genetic studies using targeted mutagenesis in mice have revealed essential roles for many bHLH-O genes in embryonic development, cell fate decisions, differentiation of a number of cell types and in apoptosis. Furthermore, growing evidence of crosstalk between bHLH-O proteins with the tumor suppressors p53 and hypoxia-inducible factor, have started to shed light on their possible roles in oncogenesis. Consistently, deregulated expression of several bHLH-O factors is associated with various human cancers. Here, we review the structure and biological functions of bHLH-O factors, and discuss recent studies that suggest a potential role for these factors in tumorigenesis and tumor progression.


Tubulovesicular structures--the ultrastructural hallmark for transmissible spongiform encephalopathies or prion diseases.
Tubulovesicular structures (particles--TVS) are the only ultrastructural marker for all transmissible spongiform encephalopathies (TSEs) or prion disease as seen by thin section electron microscopy. The latter is stressed as opposed to negative-staining techniques. TVS are spheres or short rods of approximately 27-35 nm in diameter. What is particularly interesting, this size of TVS is also the size of filter cut-off as judged from ultrafiltration studies and the size of the smallest infectious unit as recently estaimated. TVS have been found in all naturally occurring and experimentally induced TSEs, including variant Creutzfeldt-Jakob disease and human familial TSEs--fatal familial insomnia and Gerstmann-Sträussler-Scheinker disease. In longitudinal studies, the number of neuronal processes containing TVS correlates roughly with the incubation period and with infectivity. Hence, they are readily found in hamsters infected with the 263K strain of scrapie but it is very difficult to find them in human TSEs where titre is lower. The composition of TVS is unknown but they are not composed of PrP. Their consistent presence in all TSEs suggests the role at least of TSE pathogenesis.


Long-term potentiation of inhibitory circuits and synapses in the central nervous system.
Glycinergic inhibition evoked disynaptically in the teleost Mauthner cell by stimulation of the contralateral eighth nerve exhibits long-term potentiation following classical tetanization of that pathway. This enhancement occurs at the synapses between primary afferents onto second-order interneurons and the connections between these inhibitory cells and the Mauthner neuron. The evidence for modifications of glycinergic transmission is that the slope of the relation between the presynaptic volley and the synaptic conductance can be greater after the tetanus. This increase in gain is still manifest after pharmacological block of potentiation at the excitatory synapse with glutamate antagonists. Inhibitory long-term potentiation is induced by tetani weaker than those required for enhancement of the monosynaptic excitation of the other (ipsilateral) Mauthner cell. Thus, in vivo learning can alter the balance between excitation and inhibition within a network by modifying one or both of them.


Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way.
To assess the effect of sub-specialty prenatal care provided to high-risk obstetrical patients in a community perinatal center as a function of whether consultation and referral to a Maternal-Fetal Medicine (MFM) sub-specialist was at the discretion of the generalist, required by the insurance carrier, or by patient choice. Demographics, management, and perinatal outcomes for high-risk patients managed exclusively by MFM were compared with those managed by generalists who were later referred to MFM after problems arose. Despite similar demographics, high-risk patients managed exclusively by a single MFM had less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores (1.3% vs. 5.5%, p < 0.001), and lower perinatal mortality rates (8.0/1000 vs. 47.6/1000, p < 0.001) than those referred at a later date. In this setting, earlier MFM care resulted in better outcomes. These data suggest that the 'gatekeeper' model of generalist to MFM might be better the other way around.


Cervical traction in the home.
The indications for and contraindications to cervical traction are discussed. The social and economic advantages to be obtained from carrying out such treatment at home are obvious. A special technique is described which does not make use of weights and in which traction is applied in a position of flexion rather than of extension.


Updates in Anthracycline-Mediated Cardiotoxicity.
Cardiotoxicity is one of the main adverse effects of chemotheraphy, affecting the completion of cancer therapies and the short- and long-term quality of life. Anthracyclines are currently used to treat many cancers, including the various forms of leukemia, lymphoma, melanoma, uterine, breast, and gastric cancers. World Health Organization registered anthracyclines in the list of essential medicines. However, anthracyclines display a major cardiotoxicity that can ultimately culminate in congestive heart failure. Taking into account the growing rate of cancer survivorship, the clinical significance of anthracycline cardiotoxicity is an emerging medical issue. In this review, we focus on the key progenitor cells and cardiac cells (cardiomyocytes, fibroblasts, and vascular cells), focusing on the signaling pathways involved in cellular damage, and the clinical biomarkers in anthracycline-mediated cardiotoxicity.


Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index.
Obesity is a growing epidemic among university students, and the high levels of stress reported by this population could contribute to this issue. Singular relationships between perceived stress; engagement in restrained, uncontrolled, and emotional eating; sleep; dietary risk; and body mass index (BMI) have been reported in the current body of literature; however, these constructs interact with each other, and the complex relationships among them are infrequently examined. Therefore, the aim of the present study was to explore the complex relationships between these constructs using mediation and moderation analyses stratified by gender. A cross-sectional study, enrolling university students from the United States (U.S.), the Netherlands, South Korea, Malaysia, Ireland, Ghana, and China, was conducted between October 2020 and January 2021 during the COVID-19 pandemic. Perceived stress; maladaptive eating behaviors including restrained, uncontrolled, and emotional eating; sleep duration and quality; dietary risk; and BMI were assessed using validated questionnaires, which were distributed through an online platform. A total of 1392 students completed the online survey (379 male, 973 female, and 40 who self-identified as "other"). Uncontrolled and emotional eating mediated the relationship between perceived stress and dietary risk for both males and females; higher sleep quality weakened this relationship among female students but not males. Emotional eating mediated the relationship between perceived stress and BMI for both males and females, but higher sleep quality weakened this relationship only among females. Our findings suggest that students in higher education are likely to benefit from interventions to reduce uncontrolled and emotional eating. Programs that improve sleep quality, especially during highly stressful periods, may be helpful.


Pathogenesis of chronic Chagas cardiomyopathy: the role of coronary microvascular derangements.
There is ample experimental and clinical evidence of functional and structural microvascular abnormalities occurring in patients with Chagas cardiomyopathy, possibly due to the inflammatory process and/or autonomic disturbances caused by Trypanosoma cruzi infection. Those microvascular derangements are likely to constitute at least an ancillary factor that potentiates and amplifies the chronic inflammation in myocardial tissue. It is possible to devise appropriate therapeutic interventions aimed at reverting or slowing the progression of the microvascular abnormalities to positively affect the natural history of Chagas cardiomyopathy.


Job strain or healthy work: a question of task design.
Objectively evaluated task requirements were used to classify jobs causing high strain, low strain, and jobs conducive to personal development. Effects of these job characteristics on psychophysiological outcomes were tested in 241 employees by using 24-hr ambulatory assessment of blood pressure (BP), heart rate, and mood. Self-reports about job characteristics showed that employees working in jobs conducive to personal development perceived the highest job demands and decision latitude. They also showed a healthy cardiovascular behavior with increased diastolic BP at work and its strong unwinding at night. Although self-reports about job characteristics did not differ between low- and high-strain jobs, employees exposed to high-strain jobs had higher systolic and diastolic BP during work and more often a disturbed relaxation ability.


The efficacy and safety of intra-articular injection of triamcinolone acetonide versus triamcinolone hexacetonide for treatment of juvenile idiopathic arthritis.
Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. Intra-articular corticosteroids joint injection (IAJI), with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA), is an effective additional treatment for oligo and polyarticular JIA. Previous studies have shown the benefits of TH over TA; however, TA is still used in many pediatric rheumatology centers. Our unit has experience with both regimens, and therefore we aimed to compare the efficacy and safety of TA versus TH for JIA patients. Chart review of JIA patients who were randomly (based on drug availability) treated with TA or TH IAJI during 2010-2019. Primary outcomes for efficacy were defined as full recovery from arthritis one month after IAJI and a relapse rate of arthritis 3 months after IAJI. Primary outcome for safety was defined as the occurrence of adverse events (AEs) during the follow up period after IAJI. Overall, 292 joints of 102 JIA patients were treated (138 TA/154 TH joints). Complete recovery after one month was documented in 107 (69.6%) of TA treated joints and 96 (69.5%) of TH treated joints (P = 0.232). However, rate of relapse after 3 months was significantly higher for TA treated joints (27 (20.1%) vs. 13 (8.8%), respectively, P < 0.01). No AEs were documented except minor scars at four joint injection sites. The recovery from arthritis was similar (~ 70%) with both regimens, however relapse rate was more than double in TA as compared to TH injected joints. These findings are important due to a contemporary shortage of TH in the US market.


A content analysis of the Meaningful Use clinical summary: do clinical summaries promote patient engagement?
This study analyzed Meaningful Use (MU) clinical summaries (CS) given to 100 older adults (⩾ 65) from 10 family physicians in an urban primary care practice. In the United States, MU was designed to promote and enhance patient engagement in hospitals and clinics across the country, providing financial incentives to physicians attesting to the Meaningful Use of a certified Electronic Health Record by meeting a series of measures and objectives. The CS is intended to support patient and family engagement by communicating elements discussed during the clinical encounter including an updated medication list, problem list, and plan of care (POC). Despite the $27.7 billion spent distributing MU payments to more than 418,000 Eligible Professionals in ambulatory care to date, there is little discussion in the scholarly literature supporting the use of the CS to facilitate patient engagement. Ten CS were accessed from each of 10 family physicians during a regular practice week. Directed content analysis and descriptive statistics were used to evaluate the summaries. Key variables of analysis included diagnoses, medications, plan of care content, availability, completeness, health literacy, format, and readability. CS contained an average of 5.2 diagnoses and 10 medications. Summaries contained vital signs (98%), lab results (9%), smoking status (88%), professional care team members (4%), follow-up appointments (46%), and POC (67%); 37% of CS were judged to be incomplete. Readability scores indicated that a university education was required to understand the CS. CS support patient engagement by supplying information that supports behavior change and self-management, however barriers to patient engagement exist, including (a) access, (b) poor document readability, and


Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?: Dissection by Layers and a Description of Its Superficial and Deep Layers.
No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure. To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics. Descriptive laboratory study. Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90° of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis. The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers. This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL. This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.


Testosterone supplementation in male obese Zucker rats reduces body weight and improves insulin sensitivity but increases blood pressure.
Androgen levels are lower in obese men as compared with normal weight individuals. However, there are no safety data regarding the chronic use of androgen supplements in middle-aged men. The present study was undertaken to determine the cardiovascular and metabolic effects of chronic (10 weeks) testosterone treatment in male obese Zucker rats, starting at 22 weeks of age, when testosterone levels were significantly decreased. Testosterone supplements increased plasma levels, 10-fold in both obese Zucker rats and lean Zucker rats. In obese Zucker rats, testosterone supplements reduced body weight, plasma insulin, and cholesterol levels and improved the oral glucose tolerance test. None of these parameters were affected in lean Zucker rats. Mean arterial pressure was significantly increased in obese Zucker rats but not lean Zucker rats. Testosterone supplements increased proteinuria and accelerated renal injury in lean Zucker rats only. Thus, treatment of obese men with chronic testosterone supplements should be done with careful monitoring of blood pressure.


Comparison of diagnostic techniques for detection of Giardia duodenalis in dogs and cats.
An evaluation of currently available in-clinic diagnostic tests for Giardia duodenalis infection of dogs and cats has not been performed. In addition, there is discordance among published diagnostic comparisons. The absence of a true gold standard for detecting Giardia duodenalis also complicates diagnostic evaluations. To evaluate diagnostic tests commercially available in the United States for detecting Giardia duodenalis in dogs and cats, in comparison to a widely used reference test, the direct immunofluorescent assay (IFA), and also to compare the results of 2 methods of analysis: comparison of diagnostic tests to a reference test (IFA) and Bayesian analysis. Fecal samples from a convenience sample of 388 cats and dogs located in Colorado, Oklahoma, and Virginia. Fecal samples were tested for Giardia duodenalis by zinc sulfate centrifugal fecal flotation and 4 different commercial diagnostic immunoassays. Results were analyzed via Bayesian analysis and by comparison to the IFA as the reference test. Sensitivity and specificity by comparison to IFA was ≥82% and ≥90%, respectively, for all diagnostic tests in dogs and cats. When analyzed via Bayesian analysis, sensitivity and specificity were ≥83% and ≥95%, respectively. When ZnSO4 centrifugal fecal flotation results were combined with immunoassay results, there was no longer a significant difference between the sensitivities of the commercial in-clinic immunoassays. The Bayesian analysis validates using IFA as the reference test. Differences in commercial in-clinic immunoassay sensitivities can be mitigated when the results are combined with ZnSO4 centrifugal fecal flotation results.


C-terminal sequences can inhibit the insertion of membrane proteins into the endoplasmic reticulum of Saccharomyces cerevisiae.
We have constructed three gene fusions that encode portions of a membrane protein, arginine permease, fused to a reporter domain, the cytoplasmic enzyme histidinol dehydrogenase (HD), located at the C-terminal end. These fusion proteins contain at least one of the internal signal sequences of arginine permease. When the fusion proteins were expressed in Saccharomyces cerevisiae and inserted into the endoplasmic reticulum (ER), two of the fusion proteins placed HD on the luminal side of the ER membrane, but only when a piece of DNA encoding a spacer protein segment was inserted into the fusion joint. The third fusion protein, with or without the spacer included, placed HD on the cytoplasmic side of the membrane. These results suggest that (i) sequences C-terminal to the internal signal sequence can inhibit membrane insertion and (ii) HD requires a preceding spacer segment to be translocated across the ER membrane.


Two new cantilever-type polyoxometalates constructed from {Mo(2)O(4)}(2+) fragments and diphosphonates.
Two new cantilever-type polyoxometalates Na(5)(NH(4)){V(IV)[(Mo(2)O(6))CH(3)C(O)(PO(3))(2)](2)}.13H(2)O (1) and (NH(4))(4){V(IV)[(Mo(2)O(6))NH(3)CH(2)CH(2)CH(2)C(O)(PO(3))(2)](2)}.6H(2)O (2) have been synthesized and characterized by IR spectroscopy, UV-visible spectroscopy, elemental analysis, TG analysis, XPS, (31)P NMR and single-crystal X-ray diffraction. The structure analysis reveals that the diphosphonate, hydroxyethylidene diphosphonic acid and alendronic acid as the scaffolds, have been grafted on the "S"-shaped polyoxoanions and respectively. The alkyl groups of the diphosphonates like arms hanged on the polyoxoanions form the cantilever-type polyoxometalates.


A review of the species of the tribe Chorosomatini of China (Hemiptera: Heteroptera: Rhopalidae).
Species of the tribe Chorosomatini (Hemiptera: Heteroptera: Rhopalidae: Rhopalinae) occurring in China are reviewed. Type materials of three species described from China, so far of uncertain identities, are re-examined and documented, and taxonomic changes are accordingly proposed. The following synonymies, suspected but not explicitly proposed by previous authors, are confirmed and explicitly proposed: Agraphopus lethierryi Stål, 1872 = A. yunnanus Hsiao, 1965; Leptoceraea viridis Jakovlev, 1873 = L. granulosa Hsiao, 1965; Chorosoma macilentum Stål, 1858 = Ch. brevicolle Hsiao, 1964. Faunistic records of other species of the tribe are provided, and several misidentifications in the previous literature are corrected; Ch. gracile Josifov, 1968, and Ch. schillingii (Schilling, 1829) are recorded for the first time from China. A checklist of the species and subspecies of Chorosomatini occurring in China, with a review of their distribution, and a key for their identification, are provided.


Comparative study of surface electromyography of masticatory muscles in patients with different types of bruxism.
Bruxism is a rhythmic masticatory muscle activity that occurs involuntarily in a non-physiologically functional state. There is a lack of research classifying the functional status of masticatory muscles in patients with different mandibular movement types (centric clenching or eccentric grinding) of bruxism. To assess the differences of the masticatory muscle activity in patients with different types of bruxism. A total of 21 subjects with centric bruxism (CB) and 21 subjects with eccentric bruxism (ECB) were screened from college students according to a questionnaire and their tooth wear features. Sixteen subjects with no bruxism were also recruited. The surface electromyography (EMG) signals of the temporalis anterior (TA) and superficial masseter muscle (MM) were measured in different mandibular positions and during the chewing task. The EMG amplitude and chewing cycle duration parameters were then analyzed. The CB group showed fewer muscle maximal motor units, with the MM being more pronounced, a higher proportion of muscle contractions to be recruited for the same load of chewing activity, and a longer chewing cycle. The ECB group showed more TA maximal motor units and higher MM activity on the non-working side in unilateral chewing. CB mainly affects the MM, and patients with CB show reduced masticatory muscle contraction efficiency and chewing cycle efficiency. ECB mainly affects the TA, and patients with ECB show enhanced contraction of non-functional lateral muscle bundles.


[Medical treatment of inflammatory intestinal diseases].
What possible treatments are there for inflammatory intestinal diseases, and on what scientific grounds do we treat these patients? A survey shows that the considerable decline in mortality which has occurred as regards ulcerous colitis ensued rather via trial and error than as a result of regular clinical tests.


Synthesis of Ketones and Esters from Heteroatom-Functionalized Alkenes by Cobalt-Mediated Hydrogen Atom Transfer.
Cobalt bis(acetylacetonate) is shown to mediate hydrogen atom transfer to a broad range of functionalized alkenes; in situ oxidation of the resulting alkylradical intermediates, followed by hydrolysis, provides expedient access to ketones and esters. By modification of the alcohol solvent, different alkyl ester products may be obtained. The method is compatible with a number of functional groups including alkenyl halides, sulfides, triflates, and phosphonates and provides a mild and practical alternative to the Tamao-Fleming oxidation of vinylsilanes and the Arndt-Eistert homologation.