Thyroid lymphoma: recent advances in diagnosis and optimal management strategies.
Primary thyroid lymphoma is rare, composing approximately 5% of all thyroid malignancies and less than 3% of all extranodal lymphomas. It typically presents as a rapidly enlarging goiter with associated compressive symptoms. Thyroid ultrasound and fine needle aspiration cytology, using flow cytometry and immunohistochemistry, remain the main modalities used to confirm the presence of lymphoma. The increasing use of an ultrasound-guided core biopsy to achieve an accurate diagnosis has further limited the role of surgery. An open surgical biopsy may still be required not only for definitive diagnosis but also to confirm the subtype of lymphoma. There are limited numbers of randomized or prospective trials to guide management, and controversy remains over optimal treatment. Treatment and prognosis of this disease can be dichotomized into two separate groups: pure mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL) or mixed subtypes. Early stage (stage IE) intrathyroidal MALT lymphomas typically have an indolent course and may be treated with single-modality surgery, radiotherapy, or a combination of both. DLBCLs are more aggressive, and survival outcomes are highest with multimodal therapy incorporating monoclonal antibodies, chemotherapy, and radiotherapy. The prognosis is generally excellent but can be varied because of the heterogeneous nature of thyroid lymphomas. The aim of this paper is to discuss the changes in diagnostic modalities and to focus on the recent alterations in the management of this rare disease, including targeted therapies as well as the more limited role of the endocrine surgeon.


Falciparum malaria in naturally infected human patients: X. Ultrastructural pathological alterations of renal glomeruli.
The ultrastructural pathological alteration of the renal glomeruli is described in nine patients with acute Plasmodium falciparum infection. Glomeruli were large and hypercellular with various types of blood cells in their capillary lumena. These were occasionally occluded with enlarged endothelial cells. Epithelial cells, or podocytes, were hypertrophied with extensively diffused foot processes fusion and numerous villous transformation, or appeared cedemalous filling the urinary space. The glomeruli basement membrane was irregular in thickness or focally missing. Mesangial cells were undergoing proliferation and contained electron-dense deposits. Subendothelial, "hump"-like deposits, similar to those previously described in immune complex nephritis, were detected in most cases; but the largest amount was found in the three youngest patients in whom parasitaemia levels were the highest. This study showed that the kidney may become the target damage mediated by immunopathologic mechanism, and the developed lesions may correspond, for certain extent, to membranoproliferative glomerulonephritis with abnormal deposits, during the acute infection with falciparum malaria. The amount and density of the immune complex deposit could be correlated with the degree of parasitaemia and, in return with the degree of glomerular immunopathological alterations.


Identifying dietary differences between Scotland and England: a rapid review of the literature.
Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England. A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted. Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders. Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities.


Pretibial myxedema is associated with polymorphism in exon 1 of CTLA-4 gene in patients with Graves' ophthalmopathy.
Cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) is a well-known molecule that regulates T cell activity, with polymorphisms at different regions of this gene having been associated with autoimmune conditions. Pretibial myxedema (PTM), also called Graves' dermopathy, is an autoimmune extrathyroidal manifestation of Graves' disease. We opted to investigate the relationship between three single nucleotide polymorphisms of the CTLA-4 gene (+49A/G, and -318C/T and -1147C/T) and PTM in Iranian patients with Graves' ophthalmopathy (GO). A total of 105 unrelated Iranian patients with GO from the outpatient endocrine clinic of a large university general hospital as well as 103 healthy controls were studied. The genomic DNA was extracted from venous blood samples by a salting out method, and the polymorphisms at +49, -318 and -1147 positions of the CTLA-4 gene were determined using the polymerase chain reaction-restriction fragment length polymorphism method. The GG genotype (OR = 6.000, 95% CI = 1.805-19.940, P = 0.005) and the G allele (OR = 2.653, 95% CI = 1.314-5.357, P = 0.009) at position +49 were significantly associated with PTM in the patient group. The same genotype and allele were also significantly more common among patients (with or without PTM) than controls. No significant association was found for the other two polymorphisms. In conclusion, the +49G allele is associated with increased risk of PTM in patients with GO. Studies with larger sample sizes are needed to confirm the results of the present study.


Dichotic listening to musical chords: background and preliminary data.
One test of dichotic listening utilizing nonverbal stimuli is included on the VA-CD Tonal and Speech Materials for Auditory Perceptual Assessment, Disc 1.0. It is a test using three tone complexes that meet the definition of musical chords. The dichotic chords were included as a complement to the three dichotic speech procedures on the VA disc because musical chords may depend on right hemisphere brain function in a manner at least related to the way speech depends on left hemisphere organization/activity. Normative data were obtained from 120 normal-hearing listeners at nine testing centers in the United States. The three tone chords were presented dichotically under two onset time conditions, simultaneous and 90-msec onset time stagger, and three presentation levels, 70, 80, and 90 dB SPL. In general, subjects could identify the dichotically presented chords about 60 percent of the time in each ear. In addition, onset time relationships and presentation levels did not greatly affect accuracy. Overall, subject performance was similar to that noted by others and at levels that should allow lesion effects to be sought.


Resection of Accessory Parotid Gland Tumors: A Multidisciplinary Feat and Review of Literature.
Accessory parotid lobe tumors are very rare. For any mass occupying the mid-cheek, tumors of the accessory parotid gland should be strongly suspected. These tumors are properly evaluated using ultrasonography, computed tomography, and fine needle aspiration cytology. Different surgical approaches are mentioned in the literature for the resection of these parotid lesions. These surgical approaches are often accompanied by the extracapsular dissection of the tumor. The extracapsular dissection of the tumor is an adequate technique to resect tumors of the accessory lobe of the parotid.


Plasmid-encoding extended-spectrum β-lactamase CTX-M-55 in a clinical Shigella sonnei strain, China.
To characterize a clinical Shigella sonnei strain harboring a conjugatable blaCTX-M-55-borne plasmid. S. sonnei strain #1081 was isolated from a dysentery patient in China. A CTX-M-55-encoding plasmid harbored in this strain was transformed to Escherichia coli, and then its complete nucleotide sequence was determined by next generation sequencing. The MIC values of bacterial strains were tested by using Vitec(®) 2 (Biomerieux, Marcy l'Etoile, France). Strain #1081 conferred the resistance to multiple beta-lactam antibiotics. blaCTX-M-55 was the only known antibiotic resistance gene and located in a 3090-bp ISEcp1-blaCTX-M-55-orf477 transposition unit carried by a conjugatable plasmid p1081-CTXM in #1081. The ISEcp1-mediated transposition provided a sole promoter, which was located adjacently upstream of the inverted repeat right element of ISEcp1, to drive the expression of CTX-M-55. Plasmid p1081-CTXM was a close variant of the IncI2-type plasmid pHN1122-1 that was harbored in a faecal E. coli strain recovered from a dog in China, indicating the potential transfer of CTX-M-55-encoding plasmids from faecal flora E. coli to human pathogen S. sonnei.


Palliative irradiation of brain metastases.
The records of 121 patients with brain metastases from a 3-year-period were reviewed. Radiation therapy was given to 113 patients, 80 per cent received 30 Gy in 2 weeks. Before irradiation 11 were operated upon. Significant neurologic improvement was obtained in 60 per cent of the irradiated cases. Recurrences, retreatment and the necessity of higher initial doses in selected cases are discussed.


Scratching behavior in spontaneous- or allergic contact-induced dermatitis in NC/Nga mice.
NC/Nga mice have pathological and behavioral features similar to those seen in human atopic dermatitis. There are two known dermatitis models in NC/Nga mice, one being spontaneous-induced dermatitis under conventional conditions and the other 2,4,6-trinitrochlorobenzene (TNCB)-induced allergic contact dermatitis. However, there are significant differences in time course on development of dermatitis. We studied the role of scratching behavior (sign of itch) on the development of dermatitis on spontaneous- and TNCB-induced dermatitis. We measured scratching counts, transepidermal water loss (TEWL), and skin inflammation score, under conventional conditions or by applying 5% TNCB once a week for 6 weeks in NC/Nga mice. In spontaneous-induced dermatitis, scratching counts increased with the passage of time. The scratching counts were significantly increased only 1 week after housing the mice under conventional conditions, but no changes were observed in cases of TNCB-induced dermatitis. In spontaneous-induced dermatitis, TEWL and skin-inflammation score were gradually increased, time-dependently. On the other hand, in TNCB-induced dermatitis, these dependent values rapidly increased and reached a maximum only after 24 h TNCB application. These data suggest that pathogenesis of spontaneous- and allergic contact-induced dermatitis was clearly different. It will be of major interest to identify the pruritic mediators causing profound scratching behavior and scratching-induced aggravation of inflammation in the spontaneous-induced dermatitis, as opposed to the inflammatory mediators that cause contact allergic dermatitis without major scratching.


A conceptual framework for evaluating the conceptualization, implementation and performance of transitional care programmes.
Developed health systems want to avoid unnecessary hospital admissions by addressing the needs of chronically ill older adults throughout acute episodes of illness. Transitional care (TC) is a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location, of which the main outcome of interest is avoiding hospital readmission. Implementation of TC is complex because it entails different actions to put multiple care components into practice, with various degrees of flexibility of adapting the intervention. Furthermore, the outcome involves behaviour change required by those delivering or receiving the intervention. Although there are examples of promising interventions, the possible variations in conceptualization and implementation present a real challenge for the adaptation of efficacious TC interventions from trial to 'real-world' settings. There is a lack of a theoretical basis or explicit logic model for why adapted interventions should work. This study provides conceptual approaches for the implementation and evaluation of TC programmes. It describes a framework of (1) conceptualization - with respect to the components in an intervention and the population of interest; (2) manner and context of implementation; and (3) evaluation - how these processes of implementation impact health outcomes.


Fumigant Toxicity of Essential Oils from Basil and Spearmint Against Two Major Pyralid Pests of Stored Products.
The fumigant activity of essential oil vapors distilled from sweet basil Ocimum basilicum L. and spearmint Mentha spicata L. (Lamiaceae) were tested against two major stored products pests Ephestia kuehniella (Zeller) and Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae). Various oil doses (0.5, 2.5, 5, 50, 250, 500, 1,000, and 1,500 µl/liter air), for an exposure period of 24 h, were tested. The essential oils were subjected to gas chromatography-mass spectrometry analysis and revealed that the major compounds were for spearmint oil carvone (67.1%) and limonene (+1,8 cineole; 14.3%) and for basil oil linalool (45.9%), 1,8 cineole (16.7%) and eugenol (10.3%). Apart from a few exceptions, no significant differences in insecticidal action were observed between basil and spearmint oil. Both oils were highly effective against adult moths, given that notable mortality (>80%) was recorded after exposure to low doses such as 2.5 µl/liter. Noteworthy, egg mortality was also recorded, reaching 73-79% for basil and 56-60% for spearmint. Toxicity data indicated that larvae and pupae were the most tolerant stages in all cases. Larval mortality never exceeded 21 and 18%, for basil and spearmint, respectively, irrespective of moth species. Basil and spearmint oils displayed mortalities as high as 38 and 28% in pupae. Lethal doses (LD50 and LD99) values were estimated via probit analysis. Developmental stage proved to be a significant factor, whereas the effect of oil species on insect mortality was insignificant. With the exception of adult individuals, basil and spearmint oils did not show satisfactory overall insecticidal activity against E. kuehniella and P. interpunctella.


Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture.
This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.


Influence of Membrane Equivalent Weight and Reinforcement on Ionic Species Crossover in All-Vanadium Redox Flow Batteries.
One of the major sources of lost capacity in all-vanadium redox flow batteries (VRFBs) is the undesired transport (usually called crossover) of water and vanadium ions through the ion-exchange membrane. In this work, an experimental assessment of the impact of ion-exchange membrane properties on vanadium ion crossover and capacity decay of VRFBs has been performed. Two types of cationic membranes (non-reinforced and reinforced) with three equivalent weights of 800, 950 and 1100 g·mol-1 were investigated via a series of in situ performance and capacity decay tests along with ex situ vanadium crossover measurement and membrane characterization. For non-reinforced membranes, increasing the equivalent weight (EW) from 950 to 1100 g·mol-1 decreases the V(IV) permeability by ~30%, but increases the area-specific resistance (ASR) by ~16%. This increase in ASR and decrease in V(IV) permeability was accompanied by increased through-plane membrane swelling. Comparing the non-reinforced with reinforced membranes, membrane reinforcement increases ASR, but V(IV) permeability decreases. It was also shown that there exists a monotonic correlation between the discharge capacity decay over long-term cycling and V(IV) permeability values. Thus, V(IV) permeability is considered a representative diagnostic for assessing the overall performance of a particular ion-exchange membrane with respect to capacity fade in a VRFB.


Plasmapheresis for hemolytic crisis and impending acute liver failure in Wilson disease.
Wilsonian crisis is fatal unless copper removal is initiated early and liver transplantation is performed for patients that fulfill criteria for a poor outcome. We report a patient presenting with severe hemolysis and impending acute liver failure that made a rapid recovery with prompt initiation of plasmapheresis and chelation therapy. Rapid copper removal by plasmapheresis alleviated hemolysis and liver injury. A review of the literature was performed examining the use of plasmapheresis and albumin dialysis with continuous veno-venous hemodialysis or molecular adsorbents and recirculating system.


Clonality and phenotyping of canine lymphomas before chemotherapy and during remission using polymerase chain reaction (PCR) on lymph node cytologic smears and peripheral blood.
Polymerase chain reaction (PCR) assays for the immunoglobulin and T-cell receptor genes were utilized to determine phenotype and clonality from lymph node cytologic smears and peripheral blood lymphocytes from 10 dogs with lymphoma, before chemotherapy and during remission. Results were compared with those from 13 dogs with a cytologic diagnosis of lymph node hyperplasia. Clonality was identified in 7 of the lymphomas on the basis of either lymph node cytology or peripheral blood lymphocytes before treatment. No lymph node hyperplasia samples were clonal. In 6 of the dogs with lymphoma, clonality was demonstrated during clinical remission. Detection of PCR clonality during clinical remission is an effective means of identifying minimal residual disease in canine lymphoma and thus additional work is warranted to determine if molecular remission is prognostic or predictive for outcome in well-controlled and well-defined lymphoma subtypes.


Symptom relief after endoscopic sinus surgery: an outcomes-based study.
Previous studies of patients outcomes after sinus surgery have generally described only a summary measure of overall change in symptoms or health status. This paper describes an outcomes-based longitudinal study of sinus symptom prevalence among thirty-one patients treated with endoscopic surgery for chronic sinusitis. Patients completed structured data collection forms to quantify the prevalence of commonly experienced sinus-related symptoms during an eight-week period both before surgery and six months after undergoing sinus surgery. Significant decreases in nasal symptom prevalence (post-surgery versus pre-surgery) were noted for headaches, nasal drainage, nasal congestion, sinus infection, and breathing difficulties. In addition, the proportion of subjects who rated their current health as "better" compared to one year previously increased from 27% pre-surgery to 58% six months after sinus surgery. These findings aid in quantifying the magnitude of improvement experienced by sinus surgery patients and provide further evidence that endoscopic sinus surgery represents an effective treatment for chronic sinusitis.


Idiopathic Juvenile Osteoporosis: A Case Report.
Idiopathic Juvenile Osteoporosis (IJO) is a very rare disease, self restrictive and shows marked, spontaneous improvement during adolescence. The major clinical features were pain with difficulty walking, growth retardation, oral and dental abnormalities with radiographically porous bone structure. A 13-year-old male referred to paediatric dentistry clinic for toothache. The observations made with extra-intraoral clinic examination that one revealed short and skinny stature, diffuse caries in deciduous teeth, abraded lower incisor, deep bite and dysmorphic appearance in permanent incisor. This report emphasizes the recognized features of IJO as well as describes facio-dental findings that could aid in the diagnosis and management of these patients.


Homogeneous nucleation rate measurements in supersaturated water vapor.
The rate of homogeneous nucleation in supersaturated vapors of water was studied experimentally using a thermal diffusion cloud chamber. Helium was used as a carrier gas. Our study covers a range of nucleation rates from 3x10(-1) to 3x10(2) cm(-3) s(-1) at four isotherms: 290, 300, 310, and 320 K. The molecular content of critical clusters was estimated from the slopes of experimental data. The measured isothermal dependencies of nucleation rate of water on saturation ratio were compared with the prediction of the classical theory of homogeneous nucleation, the empirical prediction of Wolk et al. [J. Chem. Phys. 117, 10 (2002)], the scaled model of Hale [Phys. Rev. A 33, 4156 (1986)], and the former nucleation onset data.


Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study.
Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5mg/dl or ≥25%) after an acute coronary syndrome. From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups. Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0±11.8 years vs. 59.7±12.1 years; p=0.006), a higher proportion of women (44.8 vs. 17.6%; p<0.001), patients with a lower estimated glomerular filtration rate (76±25 vs. 86±27ml/min/1.73 m2; p=0.001), and patients who underwent fewer coronary angioplasties (p<0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113±92 vs. 169±103ml; p<0.001), including in diagnostic procedures (54±24 vs. 85±56ml; p<0.001) and diagnostic-therapeutic procedures (174±64 vs. 205±98ml; p=0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p<0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794-0.949; p=0.002). There were no differences in clinical endpoints between the groups. RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA.


A Biologically Interfaced Evolvable Organic Pattern Classifier.
Future brain-computer interfaces will require local and highly individualized signal processing of fully integrated electronic circuits within the nervous system and other living tissue. New devices will need to be developed that can receive data from a sensor array, process these data into meaningful information, and translate that information into a format that can be interpreted by living systems. Here, the first example of interfacing a hardware-based pattern classifier with a biological nerve is reported. The classifier implements the Widrow-Hoff learning algorithm on an array of evolvable organic electrochemical transistors (EOECTs). The EOECTs' channel conductance is modulated in situ by electropolymerizing the semiconductor material within the channel, allowing for low voltage operation, high reproducibility, and an improvement in state retention by two orders of magnitude over state-of-the-art OECT devices. The organic classifier is interfaced with a biological nerve using an organic electrochemical spiking neuron to translate the classifier's output to a simulated action potential. The latter is then used to stimulate muscle contraction selectively based on the input pattern, thus paving the way for the development of adaptive neural interfaces for closed-loop therapeutic systems.


Critical pathways: the next generation of outcomes tracking.
In summary, for each critical path you should have financial, quality, variance analysis, health-related quality of life and patient satisfaction outcome measures that should be reported as a package in a frequency established by the organization. These measures must complement the overall critical path program goals and objectives. The data must also be provided to the critical path teams to analyze and define where there may be opportunities for improvement. This puts the data analysis and responsibility of care processes into the hands of the clinicians where it belongs and not with administration. Administration provides the vehicles for the data; the clinicians provide the analysis.


Helping Mom Help Baby: Nutrition-Based Support for the Mother-Infant Dyad During Lactation.
Lactation and breastfeeding support the short- and long-term health of both mother and infant, yet the success of these processes depend upon individual and combined factors of the pair. Complications during pregnancy and delivery greatly affect the likelihood that a mother will be capable of breastfeeding for at least the recommended 6 months. Guidelines for women regarding postpartum diet and lifestyle management also fail to reflect the diversity of mother-infant pairs and their circumstances. In our analysis of the literature, we have identified a categorical deficit in modern scientific discourse regarding human lactation; namely, that postpartum involves full-body contribution of resources and thus requires the application of nutrition from a systemic perspective.


A recurrent mutation in bone morphogenetic proteins-2-inducible kinase gene is associated with developmental dysplasia of the hip.
Developmental dysplasia of the hip (DDH) is a complex disorder of the hip joint affecting 1-5‰ of newborns. While genetic influence on DDH has been long known, DDH has not been ascribed to any specific genetic event. The present study reported on variants contributing to DDH susceptibility in a family with four individuals affected across three generations. Whole-exome sequencing was performed in three affected and two unaffected individuals of a pedigree with DDH. Candidate variants were confirmed by Sanger sequencing and then validated in available family members and 37 sporadic DDH patients. Two novel heterozygous, inframe mutations causing multi-nucleotide substitution polymorphisms (c.1432_1440delCAGCAGCAG corresponding with p.Gln478_480del and c.1440_1441insCAG corresponding with p.Gln480ins) in exon 11 of chromosome 4 in bone morphogenetic proteins-2-inducible kinase (BMP2K) were identified; these were found in members of the pedigree affected by DDH and in the unaffected grandmother of the proband, who was deemed to be the carrier of potential mutations, but not in the unaffected normal control saunt of the proband. These two variants shared the same genomic coordinate but with different types of mutation in BMP2K. BMP2K is known to be associated with bone and cartridge development and heterozygous mutations were found to be present in 4/4 (100%) of the affected family members, 4/15 (26.7%) of the unaffected family members and 0/7 (0%) of the unaffected unrelated family members. Genotyping of 37 unrelated, sporadic DDH patients showed that three cases were positive for the BMP2K c.1432_1440delCAGCAGCAG variants (8.12%). These findings provided strong evidence for the role of BMP2K variants in causing DDH and demonstrated that the combination of pedigree information and next-generation sequencing is an effective method for identifying pathogenic sites associated with DDH.


MicroRNA expression in serum samples of sulfur mustard veterans as a diagnostic gateway to improve care.
Sulfur mustard is a vesicant chemical warfare agent, which has been used during Iraq-Iran-war. Many veterans and civilians still suffer from long-term complications of sulfur mustard exposure, especially in their lung. Although the lung lesions of these patients are similar to Chronic Obstructive Pulmonary Disease (COPD), there are some differences due to different etiology and clinical care. Less is known on the molecular mechanism of sulfur mustard patients and specific treatment options. microRNAs are master regulators of many biological pathways and proofed to be stable surrogate markers in body fluids. Based on that microRNA expression for serum samples of sulfur mustard patients were examined, to establish specific microRNA patterns as a basis for diagnostic use and insight into affected molecular pathways. Patients were categorized based on their long-term complications into three groups and microRNA serum levels were measured. The differentially regulated microRNAs and their corresponding gene targets were identified. Cell cycle arrest, ageing and TGF-beta signaling pathways showed up to be the most deregulated pathways. The candidate microRNA miR-143-3p could be validated on all individual patients. In a ROC analysis miR-143-3p turned out to be a suitable diagnostic biomarker in the mild and severe categories of patients. Further microRNAs which might own a link to the biology of the sulfur mustard patients are miR-365a-3p, miR-200a-3p, miR-663a. miR-148a-3p, which showed up only in a validation study, might be linked to the airway complications of the sulfur mustard patients. All the other candidate microRNAs do not directly link to COPD phenotype or lung complications. In summary the microRNA screening study characterizes several molecular differences in-between the clinical categories of the sulfur mustard exposure groups and established some useful microRNA biomarkers. qPCR raw data is available via the Gene Expression Omnibus https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE110797.


Iron-Fur complex suppresses the expression of components of the cyclo-(Phe-Pro)-signaling regulatory pathway in Vibrio vulnificus.
In the human pathogen Vibrio vulnificus, the quorum-sensing (QS) signal molecule cyclo-(L-phenylalanine-L-proline) (cFP) plays a critical role in triggering a signaling pathway involving the components LeuO-vHUαβ-RpoS-KatG via the membrane signal receptor ToxR. In this study, we investigated the impact of iron on the expression of these signaling components. We found that the transcription of the membrane sensor protein ToxR was not significantly affected by Fur-iron. However, Fur-iron repressed the transcription of genes encoding all the downstream cytoplasmic components in this pathway by binding to the upstream regions of these genes. Consequently, the expression of genes regulated by the alternative sigma factor RpoS, as well as the resistance to hydrogen peroxide conferred by KatG, were repressed. Additionally, we observed that in Vibrio cholerae, genes dependent on ToxR showed higher expression levels in a fur-deletion mutant compared to the wild type. These findings indicate that iron, in association with Fur, represses virtually all the cytoplasmic components responsible for the ToxR-dependent cFP-signaling pathways in these two pathogenic Vibrio species. This study, along with our previous reports demonstrating the repression of components involved in AI-2 dependent QS signaling by Fur-iron, highlights the crucial role of iron in quorum-sensing regulation, which is closely associated with the pathogenicity of this human pathogen.


Validated capillary electrophoretic method for the analysis of ivermectin in plasma after intragastric administration in pigs and horses.
A capillary electrophoretic (CE) method has been developed for the determination of ivermectin (CAS 70288-86-7), a new generation drug with antiparasitic activity, in pig and horse plasma. The method was statistically validated for its linearity, accuracy, precision and selectivity. The linear range was from 1 to 30 ng mL(-1) with correlation coefficients greater than 0.999. The limit of detection was 0.3 ng mL(-1), while the quantitative limit was 1 ng mL(-1), using a 0.5 mL sample size. The validated procedure was used to determination of pharmacokinetic parameters of ivermectin after ingestion of 0.1 mg for pigs and 0.2 mg dose per kg body weight for horses, respectively. Studies were performed on a group of eight pigs and six horses. There were no significant differences between pigs and horses in any of the estimated pharmacokinetic parameters.


Protectin DX ameliorates palmitate-induced hepatic insulin resistance through AMPK/SIRT1-mediated modulation of fetuin-A and SeP expression.
The role as well as the molecular mechanisms of protectin DX (PDX) in the prevention of hepatic insulin resistance, a hallmark of type 2 diabetes, remains unknown. Therefore, the present study was designed to explore the direct impact of PDX on insulin resistance and to investigate the expression of fetuin-A and selenoprotein P (SeP), hepatokines that are involved in insulin signalling, in hepatocytes. Human serum levels of PDX as well as fetuin-A and SeP were determined by high-performance liquid chromatography (HPLC). Human primary hepatocytes were treated with palmitate and PDX. NF-κB phosphorylation as well as expression of insulin signalling associated genes and hepatokines were determined by Western blotting analysis. FOXO1 binding levels were measured by quantitative real-time PCR. Selected genes from candidate pathways were evaluated by small interfering (si) RNA-mediated gene suppression. Serum PDX levels were significantly (P < 0.05) downregulated, whereas serum fetuin-A and SeP levels were increased (P < 0.05) in obese subjects compared with healthy subjects. In in vitro experiments, PDX treatment increased AMP-activated protein kinase (AMPK) phosphorylation and SIRT1 expression and attenuated palmitate-induced fetuin-A and SeP expression and insulin resistance in hepatocytes. AMPK or SIRT1 siRNA mitigated the suppressive effects of PDX on palmitate-induced fetuin-A through NF-κB and SeP expression linked to FOXO1 and insulin resistance. Recombinant fetuin-A and SeP reversed the suppressive effects of fetuin-A and SeP expression on palmitate-mediated impairment of insulin signalling. The current finding provides novel insight into the underlying mechanism linking hepatokines to the pathogenesis of hepatic insulin resistance.


Coexisting infectious diseases on admission as a risk factor for mechanical ventilation in patients with Guillain-Barré syndrome.
The aim of this study was to investigate patient characteristics on admission to hospital that increase the risk of subsequent mechanical ventilation (MV) use for patients with Guillain-Barré syndrome (GBS). We extracted data from the Japanese Diagnosis Procedure Combination (DPC) database for 4132 GBS patients admitted to hospital. Clinical characteristics of GBS patients with and without MV were compared. Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of requirement for MV with coexisting infectious diseases, after adjustment for potential confounding variables, age, sex, hospital type, and ambulance transportation. In total, 281 patients required MV, and 493 patients had coexisting respiratory diseases on admission. After adjustment for covariates and stratification by coexisting respiratory diseases, multivariate logistic regression analysis revealed that coexisting cytomegaloviral (CMV) disease (OR 8.81; 95% CI, 2.34-33.1) and herpes simplex viral (HSV) infections (OR 4.83; 95% CI, 1.16-20.1) were significantly associated with the requirement for MV in the group without coexisting respiratory diseases. Our findings suggest that coexisting CMV and HSV infections on admission might be significantly associated with increased risk of respiratory failure in GBS patients.


Elevated renal perfusion pressure does not contribute to natriuresis induced by isotonic saline infusion in freely moving dogs.
The study was designed to determine to what extent moderate elevation of renal perfusion pressure (RPP) via the mechanism of 'pressure natriuresis' contributes to the natriuresis induced by acute i.v. saline loading. Nine Beagle dogs maintained on ample sodium intake (5.5 mmol (kg body mass)(-1) day(-1)) were chronically equipped with an aortic occluder to servocontrol RPP, a bladder catheter to measure renal function, and catheters for measurement of RPP and mean arterial blood pressure (MABP). A swivel system allowed free movement in the kennel during experiments. Isotonic saline loading (500 ml in 100 min) was studied as follows: with and without servocontrol of RPP, and these two protocols repeated in the presence of angiotensin-converting enzyme inhibition (ACEI, Enalapril, 2 mg (kg body mass)(-1)). Saline loading increased MABP by about 12 mmHg and sodium excretion from about 28 micromol min(-1) up to about 350 micromol min(-1). Without ACEI, servocontrol of RPP at 10% below control 24 h MABP slightly delayed the onset of the saline-induced natriuresis, but did not reduce peak sodium excretion or cumulative sodium excretion. The slight delay most probably resulted from pressure-controlled renin release because, with ACEI, servocontrol of RPP did not delay or reduce the saline-induced natriuresis. In conclusion, pressure natriuresis does not contribute to the natriuresis following acute saline loading.


[Impact of neutrophil-to-lymphocyte ratio on the prognosis of patients with locally advanced colorectal cancer].
To investigate the impact of neutrophil-to-lymphocyte ratio(NLR) on the prognosis of patients with locally advanced colorectal cancer (LACRC). Clinicopathological data of 684 patients with stage II(-III( CRC undergoing radical resection at Shanghai Ruijin Hospital from January 2008 to December 2010 were analyzed retrospectively. NLR was calculated from neutrophil and lymphocyte counts on routine blood tests prior to surgery. The optimal cutoff value of NLR for predicting 5-year overall survival (OS) was determined through receiver operating characteristic (ROC) curve analysis. According to the cut-off value, patients were divided into high NLR and low NLR groups. Clinicopathological characteristics and prognosis were compared between two groups. Univariate and multivariate analyses were performed with Cox proportional hazards model to evaluate the impact of clinical factors on prognosis. A total of 396 male and 288 female patients were included in the study, with a median age of 62 years(range 21-92).Among these patients, 335 had rectal cancers and 349 had colonic cancers; 328 were TNM stage II( and 356 were stage III(. The end of follow-up was January 2016. ROC curve showed that the optimal cut-off value of NLR was 3.0, then patients were divided into low NLR group (NLR≤3.0, n=481) and high NLR group (NLR>3.0, n=203). Compared with low NLR group, the high NLR group was more likely to be older (median 64 vs. 61, t=-2.412, P=0.016), presented higher ratio of colonic cancer [66.0%(134/203) vs. 44.7%(215/481), χ2=25.945, P=0.000] and stage III( tumor [60.1%(122/203) vs. 48.6%(234/481), χ2=7.499, P=0.007], but lower ratio of first-degree relative cancer history [8.9%(18/203) vs. 15.6%(75/481); χ2=5.496, P=0.020]. However, no significant differences were observed between two groups in gender, smoking and drinking history, tumor differentiation grade, vessel invasion and nerve invasion (all P>0.05). The median follow-up time was 67 months (range 3-92), and the 5-year OS rates of high NLR and low NLR group were 59.6% and 73.2% respectively, with significant difference (P=0.001). Cox multivariate analysis revealed that age >65 years (HR=2.07, 95%CI=1.59-2.70, P=0.000), no first-degree relative cancer history (HR=2.01, 95%CI=1.23-3.28, P=0.005), poor differentiation grade (HR=1.65, 95%CI=1.26-2.15, P=0.000), positive vessel or nerve invasion (HR=1.92, 95%CI=1.35-2.71, P=0.000), high TNM stage(HR=2.10, 95%CI=1.59-2.77, P=0.000) and preoperative NLR>3.0(HR=1.51, 95%CI=1.14-2.00, P=0.004) were independent risk factors of prognosis for patients with LACRC. Preoperative NLR can influence the prognosis of patients with LACRC receiving radical surgery. High NLR is associated with poor prognosis.


Struggling to Eat to Survive Cancer-Lived Experiences of Eating Among Adolescents and Young Adults Undergoing High-Emetogenic Chemotherapy.
Purpose: The purpose of this study was to provide in-depth understanding of adolescents' and young adults' (AYAs') lived experiences of eating when they are at home between high-emetogenic chemotherapy sessions. Methods: The study was guided by van Manen's hermeneutic-phenomenological methodology. Eligible AYAs were 15-29 years old, diagnosed with either oncological or hematological cancer, treated with high-emetogenic chemotherapy, and Danish speaking. AYAs were recruited from three university hospital departments. Data were collected using semi-structured in-depth interviews. Results: Thirteen AYAs, aged 17-29 years, participated in the interviews via telephone or face-to-face in their homes. The essential meaning of the phenomenon of eating can be characterized by the overarching theme "Struggling to eat to survive" and unfolded through the following three themes: "Cooperating with a deceiving body", "Capturing moments of eating opportunities", and "Being loved and cared for at home". Conclusions: Struggling to eat was essential for survival and a fundamental existential challenge that required reflection and consciousness. AYAs experienced their deceiving bodies as a major concern, which challenged their ability to eat and forced them to develop strategies to capture moments of eating opportunities. AYAs kept hold of doing "something" themselves to maintain the slightest control of their own lives and thereby assist clinical outcomes and cure. However, AYAs had to struggle with food and start viewing food as a friend, not an enemy.


Impact of vaginal-rectal ultrasound examinations with covered and low-level disinfected transducers on infectious transmissions in france.
The risk of cross-infection from shared ultrasound probes in endorectal and vaginal ultrasonography due to low-level disinfection (LLD) is difficult to estimate because potential infections are also sexually transmitted diseases, and route of contamination is often difficult to establish. In France, the widely used standard for prevention of infections is through the use of probe covers and LLD of the ultrasound transducer by disinfectant wipes. We performed an in silico simulation based on a systematic review to estimate the number of patients infected after endorectal or vaginal ultrasonography examination using LLD for probes. We performed a stochastic Monte Carlo computer simulation to produce hypothetical cohorts for a population of 4 million annual ultrasound examinations performed in France, and we estimated the number of infected patients for human immunodeficiency virus (HIV), herpes simplex virus, hepatitis B virus, hepatitis C virus, human papilloma virus, cytomegalovirus, and Chlamydia trachomatis. Modeling parameters were estimated by meta-analysis when possible. The probability of infection from a contaminated probe ranged from 1% to 6%, depending on the pathogen. For cases of HIV infection, this would result in approximately 60 infected patients per year. For other common viral infections, the number of new cases ranged from 1,600 to 15,000 per year that could be attributable directly to ultrasound and LLD procedures. Our simulation results showed that, despite cumulative use of probe cover and LLD, there were still some cases of de novo infection that may be attributable to ultrasound procedures. These cases are preventable by reviewing the currently used LLD and/or upgrading LLD to high-level disinfection, as recommended by the US Centers for Disease Control and Prevention.


Perioperative care of the newborns with CHDs in the time of COVID-19.
Coronavirus disease 2019 (COVID-19), caused by a novel betacoronavirus (SARS-CoV-2), has led to an unexpected outbreak affecting people of all ages. The first data showed that COVID-19 could cause severe pulmonary disease, cardiac injury, and death in adults, especially the elderly and those with concomitant diseases. Currently, it was demonstrated that severe COVID-19 may also develop in neonatal age, although rarely. Newborns with CHD are known to be at high risk for increased morbidity from viral lower respiratory tract infections because of underlying anatomical cardiac lesions. There are limited data on the implications of COVID-19 on patients with cardiovascular disease, especially for those with CHD. Herein, we aimed to summarise the COVID-19-specific perioperative management issues for newborns with CHD by combining available data from the perspectives of neonatology and paediatric cardiovascular surgery.


Changes in third molar position after Class II subdivision malocclusion treatment with asymmetric extractions.
This study aimed to assess the changes in third molars angulation and their available space after Class II subdivision malocclusion treatment with asymmetric premolar extractions. The sample consisted of 37 patients (17 male, 20 female and mean age 13.18 ± 1.99 years) in group 1 (Type 1 Class II subdivision) and 25 (10 male, 15 female, mean age 13.56 ± 2.46 years) in group 2 (Type 2 Class II subdivision). In group 1, extractions were performed in the two maxillary quadrants and in the Class I mandibular quadrant. In group 2, extraction was performed in the Class II maxillary quadrant. Panoramic radiographs were used to evaluate third molar angulations and their available space pre- and post-treatment. Radiographic measurements were performed with Dolphin® Imaging 11.9. Paired t tests were used for intragroup comparison between stages and sides. In Type 1, there were similar improvements in third molar angulations and increases in the space available on the extraction quadrants in the maxillary arch. In the mandibular arch, there was significantly greater improvement in angulation and greater space availability in the extraction quadrant after treatment. In Type 2, there was significantly greater improvement in angulation and available space for the maxillary third molar on the extraction quadrant. In the mandibular arch, there was a similar improvement in the available space for the third molars. After treatment, both groups presented better angulation and significantly greater space for third molar eruptions on the extraction quadrants, when compared to the homologous non-extraction quadrants.


Long-standing effect of cholecystectomy in patients with metabolic-associated fatty liver disease.
The role of cholecystectomy as a risk factor in patients with metabolic-associated fatty liver disease (MAFLD) remains unclear. This study aimed to investigate if long-standing cholecystectomy is associated with advanced liver fibrosis and cirrhosis in patients with recently diagnosed MAFLD. A retrospective observational study was performed in four hospitals in Mexico including patients with recently diagnosed MAFLD and a history of cholecystectomy. Subjects were divided into those with cholecystectomy ≥6 months before MAFLD diagnosis (ChBM), and those with cholecystectomy at the time of MAFLD diagnosis (ChAM). Odds ratios (OR) for the association of advanced liver fibrosis and cirrhosis with the timing of cholecystectomy were calculated. Mean age of 211 participants was 49.06 ± 15.12 years and the majority were female (72.5%). Patients from the ChBM (n = 70) group were significantly older (53.14 vs. 47.03 years; P = 0.003), had higher BMI (30.54 vs. 28.52 kg/m2; P = 0.011) and lower platelet count (236.23 vs. 266.72 × 103/µL; P = 0.046) compared with patients from ChAM group (n = 141). In multivariable-adjusted analysis, age (OR = 2.37; P = 0.024), dyslipidemia (OR = 4.28; P = 0.005) and severe liver fibrosis (OR = 4.68; P = 0.0) were independent risk factors associated with long-standing cholecystectomy. Patients with long-standing cholecystectomy (≥6 months) are at increased risk of severe liver fibrosis and cirrhosis at the time of MAFLD diagnosis compared to those with recently done cholecystectomy. Advanced age (>50 years) and dyslipidemia are also commonly found in these subjects.


Experimental evaluation and early clinical results of a new low-profile bileaflet aortic valve.
We performed an experimental and clinical evaluation of a new low-profile bileaflet aortic valve (Regent, St. Jude Medical Inc., St. Paul, MN, U.S.A.). Common valve sizes were experimentally tested for leakage volume, pressure drop, and transvalvular hemodynamics using a pulse duplicator. Thirty patients (mean age 60 +/- 7 years, predominant valve stenosis n = 25) received the Regent prosthesis for initial clinical evaluation. In vitro evaluation revealed equivalent leakage volumes, larger performance indices (0.552 versus 0.513), and lower pressure drops in comparison to SJM hemodynamic plus valve controls. Clinically, 21 mm (n = 9), 23 mm (n = 12), and 25 mm (n = 9) valves were implanted with no significant perioperative complications. Echocardiography revealed low transvalvular flow velocities (2.2 +/- 0.4 m/s) and low pressure gradients (20 +/- 6 mm Hg) postoperatively and at 6 months follow-up. In vitro testing and early clinical results are promising; however, long-term performance has to be proven.


Association of a sex-related difference of Strongyloides stercoralis-specific IgG4 antibody titer with the efficacy of treatment of strongyloidiasis.
It is difficult to completely eradicate strongyloidiasis, a human intestinal nematode infection with Strongyloides stercoralis with drugs, especially in males. To find host factors involved in the response to treatment, patients infected with S. stercoralis were examined for S. stercoralis-specific antibody titers and the effect of treatment with albendazole on these titers were determined. The cure rate was slightly but not significantly lower in males than in females (P = 0.108). However, a significantly higher titer of S. stercoralis-specific IgG4 antibody was observed in males than in females (P = 0.0097), and the S. stercoralis-specific IgG4 antibody titer was significantly higher in the male non-cured group than in the cured group (P = 0.035). These results suggest that elevation of the S. stercoralis-specific IgG4 antibody titer is associated with resistance to treatment of S. stercoralis infection, especially in males.


[Efficacy of intrahepatic arterial chemotherapy to prevent recurrence of residual liver in metastatic liver cancer patients after hepatectomy].
Five-year overall survival rates in 17 cases who underwent the hepatectomy for metastatic liver cancer from digestive tract averaged 43%. Postoperative intrahepatic arterial infusion in combination with Farmorubicin and 5-FU was performed in 9 cases (i.a group). Survival and recurrence rate on cases (i.a group) were compared with that of 8 cases without chemotherapy (control group). The 5-year survival rate was superior in the i.a group to that in the control group. There was no residual liver recurrence in the i.a group, but two cases had recurrence in the residual liver in the control group. These results suggest that the post-hepatectomized intrahepatic arterial infusion of anticancer drugs is useful to prevent recurrence in the residual liver and may prolong the survival time of patients with metastatic liver cancer from GI tract.


Fusarium Tri8 encodes a trichothecene C-3 esterase.
Mutant strains of Fusarium graminearum Z3639 produced by disruption of Tri8 were altered in their ability to biosynthesize 15-acetyldeoxynivalenol and instead accumulated 3,15-diacetyldeoxynivalenol, 7,8-dihydroxycalonectrin, and calonectrin. Fusarium sporotrichioides NRRL3299 Tri8 mutant strains accumulated 3-acetyl T-2 toxin, 3-acetyl neosolaniol, and 3,4,15-triacetoxyscirpenol rather than T-2 toxin, neosolaniol, and 4,15-diacetoxyscirpenol. The accumulation of these C-3-acetylated compounds suggests that Tri8 encodes an esterase responsible for deacetylation at C-3. This gene function was confirmed by cell-free enzyme assays and feeding experiments with yeast expressing Tri8. Previous studies have shown that Tri101 encodes a C-3 transacetylase that acts as a self-protection or resistance factor during biosynthesis and that the presence of a free C-3 hydroxyl group is a key component of Fusarium trichothecene phytotoxicity. Since Tri8 encodes the esterase that removes the C-3 protecting group, it may be considered a toxicity factor.


Mycobacterium tuberculosis: an emerging disease of free-ranging wildlife.
Expansion of ecotourism-based industries, changes in land-use practices, and escalating competition for resources have increased contact between free-ranging wildlife and humans. Although human presence in wildlife areas may provide an important economic benefit through ecotourism, exposure to human pathogens may represent a health risk for wildlife. This report is the first to document introduction of a primary human pathogen into free-ranging wildlife. We describe outbreaks of Mycobacterium tuberculosis, a human pathogen, in free-ranging banded mongooses (Mungos mungo) in Botswana and suricates (Suricata suricatta) in South Africa. Wildlife managers and scientists must address the potential threat that humans pose to the health of free-ranging wildlife.


One year experience of Achromobacter bacteremia at a tertiary care hospital in Northern India.
Achromobacter is a Gram-negative, motile, obligate aerobic and non-fermentative bacterium. It is an emerging pathogen in the hospital environment as it is frequently found in various solutions. Information about the incidence and risk factors of Achromobacter bacteremia from India is limited. We conducted this study to identify the risk factors and underlying conditions predisposing to bacteremia by Achromobacter spp. and analyse the antibiotic resistance pattern of the isolates. We performed a retrospective observational study where automated blood cultures positive for Achromobacter spp. were assessed for clinical characteristics and antibiotic susceptibility patterns from January 2022 to December 2022 in the microbiology laboratory of a tertiary care centre in Northern India. A total of 14 cases (14/2435, 0.57 %) of Achromobacter spp. were identified from bloodstream infections in one year. The mean age of the patients was 37.59±23.17 years with a male predominance (8/14, 57.1 %). All patients were managed on intravenous antibiotics and intravenous access as peripheral line catheters and only 5(5/14, 35.7 %) patients were managed on central line catheters. The isolates were found highly susceptible to ticarcillin-clavulanic acid (14/14, 100.0 %) followed by fluoroquinolones (12/14, 85.72 %) and trimethoprim-sulphamethoxazole (12/14, 85.72 %). Only 57.14 % (8/14, 57.14 %) of the patients were susceptible to piperacillin-tazobactam. The all-cause 40 day mortality was observed in 35.7 % (5/14, 35.7 %) with two deaths that were directly attributable to sepsis. This study provides insight into the incidence of Achromobacter bacteremia at our centre and the necessary antibiotic therapy to combat it.


[Study of the contamination by dermatophytes of a population of small wild mammals in Alsace].
Mature fruit-bodies of Coprinus congregatus grown on modified Bille-Hansen medium were obtained with concentrations of glucose ranging from 5 to 40 g/l and asparagine from 0 to 4 g/l; the carbon/nitrogen ratio varying from 13 to 100. When the ratio C/N is too high (above 100), no visible primordium is formed; when this ratio is under 13, numerous primordia are produced, but they never reach maturity. A positive correlation exists between the C2/N ratio and the time required for producing mature fruit-bodies. The best yield for basidiocarps production is reached when the C/N ratio value is around 30 and glucose concentrations range from 10 to 20 g/l.


Aspiration biopsy cytology and special stains.
Histochemical methods play a vital role in the histology laboratory. The application of histochemistry to aspiration biopsy cytology (ABC) has shown equal promise in the demonstration of distinctive intracytoplasmic and extracytoplasmic substances. In our examination of more than 8,000 fine needle aspirates, we have found that certain histochemical studies may be of special diagnostic importance. These include mucicarmine, periodic acid-Schiff, oil red O, Fontana-Masson argentaffin and Gomori's iron stains. With the exception of the oil red O stain for neutral lipids (alcohol soluble), each may be applied to the destained smear initially prepared according to the method of Papanicolaou. Modifications of these histologic stains have been made to suit the "rapid service" motto of our busy cytology laboratory.


Lipid and lipoprotein reference values from 133,450 Dutch Lifelines participants: Age- and gender-specific baseline lipid values and percentiles.
Lipids and lipoproteins are recognized as the most important modifiable risk factors for cardiovascular disease. Although reference values for the major lipoproteins, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and triglycerides, have been collected in numerous studies and cohorts, complete contemporary percentile-based reference values are underreported. We set out to provide such reference lipid data using a large contemporary population-based cohort study. Lifelines is a cross-sectional population-based Dutch cohort study. We analyzed 133,540 adult fasting participants without cardiovascular disease and without lipid-lowering drug use. Lipid levels were directly measured and selected percentiles of all lipid parameters were calculated. Friedewald LDL-C estimation was calculated as well. From 20 till 49 years of age, men were found to exhibit a steep 64% increase of LDL-C (median +54 mg/dL), while triglyceride levels increased almost two-fold. In women, LDL-C levels did not change from 18 till 35 years, followed by a steep 42% increase till 59 years (median +42 mg/dL). In contrast to men, triglycerides were stable in ageing women. Overall, Friedewald LDL-C levels are lower compared with the direct measurement, especially with increasing triglyceride levels. This observational study highlights striking gender- and age-related differences in plasma lipid profiles. The given reference ranges of plasma lipids can assist in early identification of individuals with hypocholesterolemia and hypercholesterolemia, especially familial hypercholesterolemia. These reference ranges are available for physicians and patients at www.my-cholesterol.care/.


Characteristics and Outcome of Patients With AIDS in Dutch ICUs Between 1997 and 2014.
Knowledge on characteristics and outcome of ICU patients with AIDS is highly limited. We aimed to determine the main reasons for admission and outcome in ICU patients with AIDS and trends over time therein. A retrospective study within the Dutch National Intensive Care Evaluation registry. Dutch ICUs. We used data collected between 1997 and 2014. Characteristics of patients with AIDS were compared with ICU patients without AIDS, matched for age, sex, admission type, and admission year. Joinpoint regression analysis was applied to study trends over time. None. We included 1,127 patients with AIDS and 4,479 matched controls. The main admission diagnoses of patients with AIDS were respiratory infection (28.6%) and sepsis (16.9%), which were less common in controls (7.7% and 7.5%, respectively; both p < 0.0001). Patients with AIDS had increased severity of illness and in-hospital mortality (28.2% vs 17.8%; p < 0.0001) compared with controls, which was associated with a higher rate of infections at admission in patients with AIDS (58.4% vs 25.5%). Over time, the proportion of patients with AIDS admitted with an infection decreased (75% in 1999 to 56% in 2013). Mortality declined in patients with AIDS (39% in 1999 to 16% in 2013), both in patients with or without an infection. Mortality also declined in matched controls without AIDS, but to a lesser extent. Infections are still the main reason for ICU admission in patients with AIDS, but their prevalence is declining. Outcome of patients with AIDS continued to improve during a time of widespread availability of combination antiretroviral therapy, and mortality is reaching levels similar to ICU patients without AIDS.


The impact of a sleep hygiene intervention on residents of a private residential facility for individuals with co-occurring mental health and substance use disorders: results of a pilot study.
An increasing number of Americans are experiencing sleep problems. There is evidence of a complex, bidirectional relationship between sleep disorders, substance abuse, and mental health symptoms. Institutional settings have been shown to elicit sleep problems as well. This pilot study was conducted with 28 patients in private, residential, dual-diagnosis treatment for addiction and mental health disorders. Upon admission, consenting patients were administered the Addiction Severity Index to assess pretreatment substance use and mental health symptoms. Patients followed a normal course of treatment as well as participated in a nightly sleep hygiene group that included relaxation suggestions. Evaluations with the Addiction Severity Index were completed again 30 days after discharge from treatment. Significant improvements in some substance use patterns as well as mental health symptoms were noted. Although results cannot be directly attributed to the use of a sleep hygiene group, this pilot study lays the foundation for future investigations of interventions supporting sleep in the dual-diagnosis population.


sLRP1 (Soluble Low-Density Lipoprotein Receptor-Related Protein 1): A Novel Biomarker for P2Y12 (P2Y Purinoceptor 12) Receptor Expression in Atherosclerotic Plaques.
Recent studies suggest that the P2Y12 (P2Y purinoceptor 12) receptor of vascular smooth muscle cells in atherosclerotic plaques aggravates atherosclerosis, and P2Y12 receptor inhibitors such as CDL (clopidogrel) may effectively treat atherosclerosis. It is imperative to identify an effective biomarker for reflecting the P2Y12 receptor expression on vascular smooth muscle cells in plaques. Approach and Results: We found that there was a positive correlation between the level of circulating sLRP1 (soluble low-density lipoprotein receptor-related protein 1) and the number of LRP1+ α-SMA+ (α-smooth muscle actin), P2Y12+, or P2Y12+ LRP1+ cells in plaques from apoE-/- mice fed a high-fat diet. Furthermore, activation of the P2Y12 receptor increased the expression and shedding of LRP1 in vascular smooth muscle cells by inhibiting cAMP (3'-5'-cyclic adenosine monophosphate)/PKA (protein kinase A)/SREBP-2 (sterol regulatory element binding transcription factor 2). Conversely, genetic knockdown or pharmacological inhibition of the P2Y12 receptor had the opposite effects. Additionally, CDL decreased the number of lesional LRP1+ α-SMA+ cells and the levels of circulating sLRP1 by activating cAMP/PKA/SREBP-2 in apoE-/- mice fed a high-fat diet. Our study suggests that sLRP1 may be a biomarker that reflects the P2Y12 receptor level in plaques and has the potential to be an indicator for administering P2Y12 receptor inhibitors for patients with atherosclerosis.


Studies on the glomerular filtration barrier and on the urinary excretion of basement membrane glycoproteins during the accelerated model of nephrotoxic serum nephritis.
A proliferative glomerulonephritis was induced in rats preimmunised with rabbit IgG by injecting a sub-nephrotoxic dose of rabbit anti-rat GBM IgG. All the rats developed a severe proteinuria within 2-5 days after the injection of anti-GBM IgG. At the same time, many mononuclear phagocytes infiltrated the glomeruli, the colloidal iron staining of the glomerular filtration barrier was altered, and the urinary excretion of laminin and of neutral proteinase strongly increased. However, the pattern and intensity of staining of different collagenous and non-collagenous BM glycoproteins were not modified, as shown by indirect immunofluorescence microscopy. The existence of a direct significant correlation between the proteinuria and the laminin urinary excretion, and between the latter and the urinary neutral proteinase activity suggests that lysosomal proteinase of mononuclear phagocytes may be involved in the damage of the GBM during the course of this experimental glomerulonephritis.


Computed tomography-based COVID-19 triage through a deep neural network using mask-weighted global average pooling.
There is an urgent need to find an effective and accurate method for triaging coronavirus disease 2019 (COVID-19) patients from millions or billions of people. Therefore, this study aimed to develop a novel deep-learning approach for COVID-19 triage based on chest computed tomography (CT) images, including normal, pneumonia, and COVID-19 cases. A total of 2,809 chest CT scans (1,105 COVID-19, 854 normal, and 850 non-3COVID-19 pneumonia cases) were acquired for this study and classified into the training set (n = 2,329) and test set (n = 480). A U-net-based convolutional neural network was used for lung segmentation, and a mask-weighted global average pooling (GAP) method was proposed for the deep neural network to improve the performance of COVID-19 classification between COVID-19 and normal or common pneumonia cases. The results for lung segmentation reached a dice value of 96.5% on 30 independent CT scans. The performance of the mask-weighted GAP method achieved the COVID-19 triage with a sensitivity of 96.5% and specificity of 87.8% using the testing dataset. The mask-weighted GAP method demonstrated 0.9% and 2% improvements in sensitivity and specificity, respectively, compared with the normal GAP. In addition, fusion images between the CT images and the highlighted area from the deep learning model using the Grad-CAM method, indicating the lesion region detected using the deep learning method, were drawn and could also be confirmed by radiologists. This study proposed a mask-weighted GAP-based deep learning method and obtained promising results for COVID-19 triage based on chest CT images. Furthermore, it can be considered a convenient tool to assist doctors in diagnosing COVID-19.


GW10, a member of P450 subfamily regulates grain size and grain number in rice.
A quantitative trait locus GW10 is located on Chromosome 10 by map-based cloning, which encodes a P450 Subfamily protein. The GW10 regulates grain size and grain number in rice involved in the BR pathway. Grain size and grain number play extremely important roles in rice grain yield. Here, we identify GW10, which encodes a P450 subfamily protein and controls grain size and grain number by using Lemont (tropical japonica) as donor parent and HJX74 (indica) as recipient parent. The GW10 locus was mapped into a 14.6 kb region in HJX74 genomic on the long arm of chromosome 10. Lower expression of the gw10 in panicle is contributed to the shorter and narrower rice grain, and the increased number of grains per panicle. In contrast, overexpression of GW10 is contributed to longer and wider rice grain. Furthermore, the higher expression levels of some of the brassinosteroid (BR) biosynthesis and response genes are associated with the NIL-GW10. The sensitivity of the leaf angle to exogenous BR in NIL-GW10 is lower than that in NIL-gw10 and in the KO-GW10, which implied that the GW10 should involve in the brassinosteroid-mediated regulation of rice grain size and grain number.


Etomidate unmasks intraadrenal regulation of steroidogenesis and proliferation in adrenal cortical cell lines.
To characterize intraadrenal adaptations for inhibition of cortisol synthesis, we analyzed the effects of etomidate (ETO) on steroid hormone secretion and expression of key regulators of steroidogenesis and proliferation in human NCI-h295 adrenocortical cancer cells. Etomidate potently blocked 11beta-hydroxylase (CYP11B1), aldosterone synthase (CYP11B2), and side chain cleavage enzyme (CYP11A1). This inhibition of steroidogenesis was associated with increased expression of steroidogenic acute regulatory protein (StAR), and CYP11A1 and 17alpha-hydroxylase/17, 20-lyase (CYP17A1) protein levels, but not of the respective mRNA levels. Promoter activity of CYP11A1 and melanocortin 2 receptor (MC2R) was not increased by etomidate in treated cells compared to controls. The increase in protein levels was partially reversed by cycloheximide suggesting post-transcriptional mechanisms but also protein stabilization as underlying cause. Furthermore, ETO exhibited antiproliferative activity paralleled by a decrease in phosphorylation of MEK and ERK1, 2. In summary, ETO exhibits pleiotropic effects on adrenal function in vitro. Inhibition of steroidogenesis is followed by increased levels of steroidogenic key proteins and reduced proliferation. These changes reflect adaptations to maintain steroidogenesis at the cost of adrenal proliferation.


Utility of platelet-rich plasma for treatment of striae distensae: A current exploration.
Platelet-rich plasma (PRP) has recently become a popular treatment for various skin conditions, including striae distensae, acne scars, traumatic scars, hair regrowth, and cutaneous rejuvenation. Although PRP has been utilized in orthopedics for many years, its recent entry into dermatology has been met with controversy. While the recent research has generally been limited and is often contradictory, this has differed from the persuasive marketing campaigns targeting patients and consumers. Aesthetic practitioners should be knowledgeable with the available evidence for PRP in the treatment of striae distensae. Here, we review the pertinent literature and offer additional insights.


First-passage distributions in a collective model of anomalous diffusion with tunable exponent.
We consider a model system in which anomalous diffusion is generated by superposition of underlying linear modes with a broad range of relaxation times. In the language of Gaussian polymers, our model corresponds to Rouse (Fourier) modes whose friction coefficients scale as wave number to the power 2-z. A single (tagged) monomer then executes subdiffusion over a broad range of time scales, and its mean square displacement increases as t(alpha) with alpha = 1/z. To demonstrate nontrivial aspects of the model, we numerically study the absorption of the tagged particle in one dimension near an absorbing boundary or in the interval between two such boundaries. We obtain absorption probability densities as a function of time, as well as the position-dependent distribution for unabsorbed particles, at several values of alpha. Each of these properties has features characterized by exponents that depend on alpha. Characteristic distributions found for different values of alpha have similar qualitative features, but are not simply related quantitatively. Comparison of the motion of translocation coordinate of a polymer moving through a pore in a membrane with the diffusing tagged monomer with identical alpha also reveals quantitative differences.


FeCl2-promoted cleavage of the unactivated C-C bond of alkylarenes and polystyrene: direct synthesis of arylamines.
Ironing it out: an efficient and convenient nitrogenation strategy involving C-C bond cleavage for the straightforward synthesis of versatile arylamines is presented. Various alkyl azides and alkylarenes, including the common industrial by-product cumene, react using this protocol. Moreover, this method provides a potential strategy for the degradation of polystyrene.


Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams-Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years.
Williams-Beuren syndrome (WBS) is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient's malocclusion. The patient's mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course.


Effect of dietary supplementation of omega-3 polyunsaturated fatty acid (PUFA) rich fish oil on reproductive performance of the goat (Capra hircus).
Dietary supplementation of n-3 PUFA decreases the luteolytic PGF2α and improves the pregnancy rate in the dairy cow. However, its effect in the goat is not known. Accordingly, we studied the effect of supplementation of n-3 PUFA rich Fish oil (FO) on different reproductive events in the goat. Cycling goats (n = 30) were divided into two equal groups and fed an isocaloric and isonitrogenous diet supplemented with either FO (TRT; n = 15) or palm oil (PO) (CON; n = 15) @ 0.6 mL/kg body weight for 72 days during the breeding season. Estrus synchronization was done on day 25 and 36 of supplementation using two PG regimen and the goats in estrus were bred. Mean interval from PGF2α administration to the onset of estrus was 12 h longer (P < 0.05) in the TRT group than that of CON. The number of preovulatory follicles (POF) and ovulation rate was significantly higher in FO supplemented goats (P < 0.05) by 39.64 and 41.35%, respectively. Though the corpus luteum diameter was significantly higher (P < 0.05) on day 5, 8 and 11 post-breeding in the TRT group, mean serum progesterone (P4) did not differ significantly (P > 0.05). Mean concentration of serum estradiol (E2) was significantly (P < 0.01) lower in the FO supplemented group during day 0-60 post-breeding which could be due to significantly low serum cholesterol (P < 0.01). Though the serum concentration of PGF2α metabolite (PGFM) and PGE2 metabolite (PGEM) in the pregnant goats was significantly (P < 0.05) lower in the TRT group on day 16 and 17 post-breeding, the ratio of PGEM to PGFM remained unaffected suggesting a favourable effect of FO supplementation on the early pregnancy. The number of embryos, twinning rate and kidding rate were high in FO supplemented group though it was non-significant. However, gestation length, birth weight of kids and neonatal behaviour were comparable between the groups (P > 0.05). In conclusion, supplementation of n-3 PUFA rich FO significantly increased the number of POF and ovulation rate with numerical increase in the kidding rate. Further, it decreased the serum E2 and PGFM during the critical window of pregnancy recognition in the doe.


Label-Free Electrochemical Aptasensor for Sensitive Detection of Malachite Green Based on AuNPs/MWCNTs@TiO2 Nanocomposites.
This study proposes a label-free aptamer biosensor for the sensitive detection of malachite green(MG) using gold nanoparticles/multi-walled carbon nanotubes @ titanium dioxide(AuNPs/MWCNTs@TiO2). The nanocomposite provides a large surface area and good electrical conductivity, improving current transfer and acting as a platform for aptamer immobilization. The aptamer and the complementary chain(cDNA) are paired by base complementary to form the recognition element and fixed on the AuNPs by sulfhydryl group, which was modified on the cDNA. Since DNA is negatively charged, the redox probe in the electrolyte is less exposed to the electrode surface under the repulsion of the negative charge, resulting in a low-electrical signal level. When MG is present, the aptamer is detached from the cDNA and binds to MG, the DNA on the electrode surface is reduced, and the rejection of the redox probe is weakened, which leads to an enhanced electrical signal and enables the detection of MG concentration by measuring the change in the electrical signal. Under the best experimental conditions, the sensor demonstrates a good linear relationship for the detection of MG from 0.01 to 1000 ng/mL, the limit of detection (LOD)is 8.68 pg/mL. This sensor is stable, specific, and reproducible, allowing for the detection of various small-molecule pollutants by changing the aptamer, providing an effective method for detecting small-molecule pollutants.


Transcriptome profiling of anti-müllerian hormone treated preantral/small antral mouse ovary follicles.
The predisposition for the initiation of folliculogenesis in mammals including humans is programmed to start at fetal life and continues until reproductive capacity. The follicles grow from a pool of primordial follicles which retain the major functions in the entire reproductive life of a female. Anti-müllerian hormone (AMH), a glycoprotein belonging to the transforming growth factor-beta family, has an inhibitory effect on ovarian follicle development. The key regulatory target genes in primordial follicle development are of paramount importance in reproductive biology of female. A systems biology method was used to find regulatory genes performing critical role in primordial follicle development. A complete in-depth bioinformatics analysis was performed to investigate the changes in transcriptome of preantral to small antral mouse follicles treated for 12 h and 24 h with two different concentrations; 50 and 200 ng/ml of AMH, and thereby identify candidate genes in time and concentration manner. Firstly, we found differentially expressed genes that were time and concentration dependent in response to AMH. The network analysis of these differentially expressed genes provided new candidate genes and pathways associated with inhibitory action of AMH on the primordial follicle development. To further emphasize the function of AMH, the key identified genes' protein-protein docking was analyzed and found the intracellular and extracellular protein-protein interaction. This study elucidates one of the novel mechanisms of AMH involvement in inhibition of ovarian follicle development which may lead to prolong productive life in female.


Tactical and surgical techniques issues in the surgical treatment of incisional hernias.
Within five years, between 2006 and 2011, a total of 368 incisional hernias have been operated in the Surgery Clinic 1, University Emergency Hospital Bucharest. The study followed the morphological and biological parameters, associated pathology, tactics and surgical technique used and postoperative morbidity. The average age of patients was 61.75 years, female sex was predominant (81.25%), and incisional hernias were large and giant in a percentage of 73.37%. Locations were predominantly median (83.42%). Recurrent incisional hernias and multiple relapsed hernias represented 25.54%. Associated pathology was dominated by obesity (51,09%) and cardiovascular disease (37,77%). We have used both methods of tissue procedures (22.83%), and the prosthetic procedures (77.17%). Prosthetic techniques, retro muscle fitting mesh in the rectus abdominis muscle sheath (Rives-Stoppa technique), fitting ov er the fascia and tissue replacement techniques were performed. Immediate postoperative morbidity was represented by seroma (14.13%), prolonged postoperative ileus (8.69%), prolonged hematic drainage (6.52%), and hematoma (1.9%). Late postoperative morbidity was given by granulomas (5.7%) and recurrence of incisional hernias (4.34%). Good and very good results were obtained in the 89.96% of the operated cases.


The role of antihypertensive polar renomedullary lipid in the pathogenesis of hypertension.
One-0-hexadecyl-2-0-acetyl-sn-glycero-3-phosphorylcholine (HAGPC), a component of semisynthetic antihypertensive polar renomedullary lipid (APRL) reported by Muirhead et al. in chemically treated rabbit renomedullary lipid had a strong hypotensive action, a cardiosuppressing action and an apparent anti-norepinephrine action. 3-(N-n-octadecylcarbamoyloxy)-2-methoxypropyl-2-thiazolio ethyl phosphate significantly inhibited the hypotensive action of HAGPC, whereas the hypotensive activities of prostaglandin I2, prostaglandin E2, bradykinin, histamine and acetylcholine were not affected by this drug. The blood pressure of rats with established hypertension produced by clipping one renal artery and contralateral nephrectomy normally decreases rapidly after unclipping the renal artery, but the initial rapid decrease was significantly inhibited by an intravenous infusion of 3-(N-n-octadecylcarbamoyloxy)-2-methoxypropyl-2-thiazolio ethyl phosphate. This shows that endogenous 1-alkyl-2-acetyl-sn-glycero-3-phosphorylcholine participates in the rapid decrease of blood pressure after unclipping the renal artery in one-kidney, one clip hypertensive rats.


Effect of 5-haplotype of dysbindin gene (DTNBP1) polymorphisms for the susceptibility to bipolar I disorder.
We investigated a possible association between dysbindin gene (DTNBP1) variants and bipolar I disorder (BID). Five SNPs within DTNBP1 (rs3213207, rs1011313, rs2005976, rs760761, and rs2619522) were genotyped for 151 patients with BID and 478 controls. We observed a significant protective association of the haplotype A-C-G-T-A (all SNPs, P = 0.00016) and particularly G-T-A (the last three SNP, P = 0.00007) within DTNBP1 variants investigated. Single marker and subgroup (e.g., psychotic features, age at onset, family history, etc.) analyses showed no significant association. Although the association was due to a small number of subjects, specific DTNBP1 haplotypes, previously associated with schizophrenia, may be also associated with BID. Adequately powered studies from different ethnicities will be necessary to confirm our findings.


Identification of Core Gene Biomarkers in Patients with Diabetic Cardiomyopathy.
Diabetic cardiomyopathy (DCM) is a disorder of the myocardium in diabetic patients, which is one of the critical complications of diabetes giving rise to an increased mortality. However, the underlying mechanisms of DCM remain incompletely understood presently. This study was designed to screen the potential molecules and pathways implicated with DCM. GSE26887 involving 5 control individuals and 7 DCM patients was selected from the GEO database to identify the differentially expressed genes (DEGs). DAVID was applied to perform gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. A protein-protein interaction (PPI) network was also constructed to visualize the interactions among these DEGs. To further validate significant genes and pathways, quantitative real-time PCR (qPCR) and Western blot were performed. A total of 236 DEGs were captured, including 134 upregulated and 102 downregulated genes. GO, KEGG, and the PPI network disclosed that inflammation, immune disorders, metabolic disturbance, and mitochondrial dysfunction were significantly enriched in the development of DCM. Notably, IL6 was an upregulated hub gene with the highest connectivity degree, suggesting that it may interact with a great many molecules and pathways. Meanwhile, SOCS3 was also one of the top 15 hub genes in the PPI network. Herein, we detected the protein level of STAT3 and SOCS3 in a mouse model with DCM. Western blot results showed that the protein level of SOCS3 was significantly lower while phosphorylated-STAT3 (P-STAT3) was activated in mice with DCM. In vitro results also uncovered the similar alterations of SOCS3 and P-STAT3 in cardiomyocytes and cardiac fibroblasts induced by high glucose (HG). However, overexpression of SOCS3 could significantly reverse HG-induced cardiomyocyte hypertrophy and collagen synthesis of cardiac fibroblasts. Taken together, our analysis unveiled potential biomarkers and molecular mechanisms in DCM, which could be helpful to the diagnosis and treatment of DCM.


Fetal station at the time of labour arrest and risk of caesarean delivery.
This study aimed to determine whether an unengaged vertex in nulliparous women experiencing active phase labour-arrest increased the caesarean delivery risk. We selected a retrospective cohort of 393 patients. Of these, the presenting part was unengaged in 307, and engaged in 86. Compared with the engaged vertex, unengaged vertex significantly increased the risk of caesarean delivery (27% vrs 7%, P < 0.001, with the risk increased 5 fold [Odds ratio 4.94, confidence intervals 2.08, 11.76]. The risk remains significant after adjusting for confounding variables on multiple logistic regression [adjusted OR 4.71, CI 1.99, 11.01]. However, the degree of unengagement did not significantly affect caesarean rate. (39% at -3 station, 39% at -2 station, and 33% at -1 station; P = 0.577). While an unengaged vertex significantly increased the caesarean delivery rate, the degree of unengagement did not, and the eventual vaginal delivery rate (73%) is high and should prevent hasty recourse to caesarean delivery.


The Plasmodium falciparum Vps4 homolog mediates multivesicular body formation.
Members of the apicomplexan family of parasites contain morphologically unique secretory organelles termed rhoptries that are essential for host cell invasion. Rhoptries contain internal membranes, and thus resemble multivesicular bodies. To determine whether multivesicular body endosomal intermediates are formed in Apicomplexa, we used the Plasmodium falciparum homolog of the class E gene, Vps4, as a probe. Endogenous P. falciparum Vps4 (PfVps4) localized to the cytoplasm of P. falciparum trophozoites, and transgenic PfVps4 localized to the cytosol in P. falciparum, in the related parasite Toxoplasma gondii and in COS cells. When mutated to block ATP hydrolysis, transiently expressed PfVps4 localized instead to large vesicular structures in P. falciparum. The same construct, and another mutant blocked in ATP binding, generated large cholesterol-enriched multivesicular bodies in both COS cells and T. gondii. Mutant PfVps4 structures in T. gondii co-localized with markers for early endosomes. These results demonstrate a conservation of Vps4 function across wide phylogenetic boundaries, and indicate that endosomal multivesicular bodies form in both P. falciparum and T. gondii.


Depletion-induced shape and size selection of gold nanoparticles.
For nanoparticle-based technologies, efficient and rapid approaches that yield particles of high purity with a specific shape and size are critical to optimize the nanostructure-dependent optical, electrical, and magnetic properties, and not bias conclusions due to the existence of impurities. Notwithstanding the continual improvement of chemical methods for shaped nanoparticle synthesis, byproducts are inevitable. Separation of these impurities may be achieved, albeit inefficiently, through repeated centrifugation steps only when the sedimentation coefficient of the species shows sufficient contrast. We demonstrate a robust and efficient procedure of shape and size selection of Au nanoparticles (NPs) through the formation of reversible flocculates by surfactant micelle induced depletion interaction. Au NP flocculates form at a critical surfactant micelle molar concentration, C(m)* where the number of surfactant micelles is sufficient to induce an attractive potential energy between the Au NPs. Since the magnitude of this potential depends on the interparticle contact area of Au NPs, separation is achieved even for the NPs of the same mass with different shape by tuning the surfactant concentration and extracting flocculates from the sediment by centrifugation or gravitational sedimentation. The refined NPs are redispersed by subsequently decreasing the surfactant concentration to reduce the effective attractive potential. These concepts provide a robust method to improve the quality of large scale synthetic approaches of a diverse array of NPs, as well as fine-tune interparticle interactions for directed assembly, both crucial challenges to the continual realization of the broad technological potential of monodispersed NPs.


[Relationship between lifestyle and dietary habits and the occurrence of squamous cell carcinoma in different subsites of the esophagus].
To elucidate the association between lifestyle and dietary factors and esophageal squamous cell carcinoma( ESCC) in three different sections of the esophagus. From January 2010 to December 2016, a hospital-based case-control study was conducted, and a total of 550 patients with ESCC and gender and age( ±3 age) frequency-matched 550 cancer-free control subjects were recruited in this study. Odds ratios( ORs) and their corresponding 95% confidence intervals( CIs) were calculated by using unconditional binary or multinomial logistic regression. Multiple correspondence analysis( MCA) was applied to illustrate the influence of the risk factors on different sections of the esophagus. Tea drinking was associated with lower risk of upper( Ut) and lower thoracic( Lt) ESCC( OR = 0. 40, 95% CI 0. 22-0. 73; OR= 0. 50, 95% CI 0. 31-0. 81; for Ut and Lt, respectively), and lower intake of vegetables increased the risk of Ut and Lt ESCC( OR = 3. 93, 95% CI 1. 61-9. 61; OR =2. 68, 95% CI 1. 30-5. 53; for Ut and Lt, respectively). Intake of hot food, hard food and lower intake of fruits were associated with an elevated risk of the ESCC in all subsites( P<0. 05). The strength of association between drinking and ESCC was lower in middle thoracic( Mt) compared with the Lt ESCC( OR = 0. 58, 95% CI 0. 35-0. 98). Moreover, this reduction of association strength were also found in eating hot food( OR = 0. 45, 95%CI 0. 27-0. 76) and lower intake of vegetables( Ut OR = 0. 44, 95% CI 0. 20-0. 99). However, the association between lower intake of fruits and the Mt ESCC risk was stronger compared with Lt ESCC( OR = 1. 66, 95% CI 1. 08-2. 55). In additional, the association between lower intake of fruits and the Ut ESCC risk was stronger compared with Mt ESCC. Joint category plot of MCA also identified the heterogeneous associations between risk factors and different sections of the esophagus. Differences in risk factors of ESCC in different subsites, intake of hot food, hard food, and lower intake of vegetables were common risk factors for three subsites of ESCC.


DNA binding and gel electrophoresis studies of a copper (II) complex containing mixed aliphatic and aromatic dinitrogen ligands.
The interaction of a novel mixed ligand copper (II) complex, [Cu(N-N)(L)(EtOH)](NO(3))(2) . 2H(2)O, in which N-N indicates 2,9-dimethyl-1,10-phenanthroline and L indicates N,N-dimethyltrimethylenediamine with calf thymus DNA was investigated by absorption, circular dichroism, voltammetric, and viscosimetric techniques. The absorption spectra of the complex with calf thymus DNA showed a marked hypochromism in the pi --> pi* and metal to ligand charge transfer (MLCT) transitions, with no obvious red shift attributed to a partial intercalation. The intrinsic binding constant (K(b)) was determined as 2 x 10(5) M(-1). There was slight to appreciable changes in the relative viscosity of DNA, which is consistent with enhanced hydrophobic interaction of the methyl-substituted phen ring and partial intercalation mode of binding. Electrochemical studies showed a decrease in the peak current, which is ascribed to the strong binding between Cu (II) complex and DNA. The fluorescence spectral characteristics showed that the Cu (II) complex is able to displace the methylene blue bound to DNA, but not as complete as intercalative molecules. It is remarkable that this mixed ligand complex, in contrast to [Cu(2,9-dmp)(2)](+) (2,9-dmp = 2,9-dimethyl-1,10-phenanthroline), which fails to cleave DNA, has ability to cleave the supercoiled plasmid DNA.


A Density Functional Theory Study of the Hydrogen Absorption in High Entropy Alloy TiZrHfMoNb.
The high entropy alloy is promising for hydrogen storage, especially in regard to its adjustable hydrogen storage properties. Despite several experimental investigations, there still lacks a detailed atomic-level understanding of the hydrogenation process. In this study, based on first-principles calculations, the hydrogen behaviors and microstructural evolution in high entropy alloy TiZrHfMoNb during the hydrogen absorption are investigated systematically. At low hydrogen content, hydrogen atoms prefer to occupy the octahedral interstitial sites of the BCC phase, which is different from that in BCC pure metals; when the hydrogen content reaches 1.08 wt %, the BCC TiZrHfMoNb hydrides transform into FCC phase, and hydrogen atoms are more favorable to occupy the tetrahedral interstitial sites. Further radial distribution function (RDF) analysis indicates that the enhanced disorder of <hydrogen-hydrogen> bonds and decreased lattice distortion of the metal structure destabilize the BCC TiZrHfMoNb hydride and eventually induce the BCC → FCC phase transformation, which is quite different from that in conventional alloys; the difference originates from the severe lattice distortion in high entropy alloy. The phonon spectra of different TiZrHfMoNb hydrides show that the hydride with a H/M ratio of 2 dynamically has a stable lattice, corresponding to a hydrogen storage capacity of 1.94 wt %. The present study demonstrates that the high entropy alloys have unique hydrogen absorption ability, which may advance the related experimental and theoretical studies.


Reviewing the nursing students' views toward OSCE test.
One of the essential components of learning and educational program is evaluation or examination. There are various methods for evaluating clinical skills among which objective structured clinical examination (OSCE) has been recognized as the most reliable method for evaluation of the clinical skills. This was a one-step single-group descriptive study which was conducted through a researcher-made questionnaire. Results indicated that the view of most of the students in OSCE test has been good in terms of equipment and facilities with relative frequency of 59.2 percent, conditions of holding the examination with relative frequency of 50.9% and total test with relative frequency of 55.1%; in terms of physical environment, students' view was moderate with relative frequency of 469%. The results of the study showed that appropriateness of physical environment and equipment and facilities to hold OSCE can directly be involved in enhancing the quality of this test.


Stress-induced synthesis of phosphatidylinositol 3-phosphate in mycobacteria.
Phosphoinositides play key roles in regulating membrane dynamics and intracellular signaling in eukaryotic cells. However, comparable lipid-based signaling pathways have not been identified in bacteria. Here we show that Mycobacterium smegmatis and other Actinomycetes bacteria can synthesize the phosphoinositide, phosphatidylinositol 3-phosphate (PI3P). This lipid was transiently labeled with [(3)H]inositol. Sensitivity of the purified lipid to alkaline phosphatase, headgroup analysis by high-pressure liquid chromatography, and mass spectrometry demonstrated that it had the structure 1,2-[tuberculostearoyl, octadecenoyl]-sn-glycero 3-phosphoinositol 3-phosphate. Synthesis of PI3P was elevated by salt stress but not by exposure to high concentrations of non-ionic solutes. Synthesis of PI3P in a cell-free system was stimulated by the synthesis of CDP-diacylglycerol, a lipid substrate for phosphatidylinositol (PI) biosynthesis, suggesting that efficient cell-free PI3P synthesis is dependent on de novo PI synthesis. In vitro experiments further indicated that the rapid turnover of this lipid was mediated, at least in part, by a vanadate-sensitive phosphatase. This is the first example of de novo synthesis of PI3P in bacteria, and the transient synthesis in response to environmental stimuli suggests that some bacteria may have evolved similar lipid-mediated signaling pathways to those observed in eukaryotic cells.