A computational framework to empower probabilistic protein design.
The task of engineering a protein to perform a target biological function is known as protein design. A commonly used paradigm casts this functional design problem as a structural one, assuming a fixed backbone. In probabilistic protein design, positional amino acid probabilities are used to create a random library of sequences to be simultaneously screened for biological activity. Clearly, certain choices of probability distributions will be more successful in yielding functional sequences. However, since the number of sequences is exponential in protein length, computational optimization of the distribution is difficult. In this paper, we develop a computational framework for probabilistic protein design following the structural paradigm. We formulate the distribution of sequences for a structure using the Boltzmann distribution over their free energies. The corresponding probabilistic graphical model is constructed, and we apply belief propagation (BP) to calculate marginal amino acid probabilities. We test this method on a large structural dataset and demonstrate the superiority of BP over previous methods. Nevertheless, since the results obtained by BP are far from optimal, we thoroughly assess the paradigm using high-quality experimental data. We demonstrate that, for small scale sub-problems, BP attains identical results to those produced by exact inference on the paradigmatic model. However, quantitative analysis shows that the distributions predicted significantly differ from the experimental data. These findings, along with the excellent performance we observed using BP on the smaller problems, suggest potential shortcomings of the paradigm. We conclude with a discussion of how it may be improved in the future.


Treatment outcomes of the patients with early glottic cancer treated with initial radiotherapy and salvaged by conservative surgery.
This retrospective study analyzed the oncological and treatment outcomes of the patients with T1-T2N0 glottic cancer, who were treated with radiotherapy as initial treatment and salvaged by conservative surgery for radiation failure. Between May 1999 and December 2010, 115 patients with glottic laryngeal cancer were treated at Kobe University Hospital. At presentation, 54 patients had stage T1a disease, 26 had stage T1b disease and 35 had stage T2 disease. Seventy-nine patients were treated with conventional radiotherapy and 36 patients were treated with hyperfractionated radiotherapy as initial treatment. Median duration of follow-up was 61 months. Five-year local control rates of radiotherapy were 92% in T1a, 83% in T1b and 86% in T2. Of 12 patients who developed local recurrence, larynx was successfully preserved in 3 patients by laryngomicrosurgery, 7 patients by vertical partial laryngectomy and one patient by subtotal laryngectomy. Ultimate 5-year laryngeal preservation rate and local control rate of all cases were 99 and 100%, respectively. Present results suggest that initial treatment with radiotherapy salvaged by organ preservation surgery is an effective strategy for laryngeal preservation in the treatment of T1-T2N0 glottic laryngeal cancer.


Genetic correlation between heifer pregnancy and scrotal circumference measured at 15 and 18 months of age in Nellore cattle.
Data of pregnancy diagnosis from 24,945 Nellore heifers, raised under tropical conditions in Brazil and exposed to breeding at about 14 months of age, were analyzed simultaneously with 13,742 (analysis 1), 36,091 (analysis 2), 8,405 (analysis 3), and 8,405 (analysis 4) scrotal circumference (SC) records of contemporary young bulls in order to estimate heritability (h(2)) for yearling heifer pregnancy (HP) and for SC measured at around 15 (SC15) and 18 (SC18) months of age and to estimate genetic correlation between HP and SC15 (SC18). Heifer pregnancy was considered as a categorical trait, with the value 1 (success) assigned to heifers that were detected as pregnant by rectal palpation approximately 60 days after the end of a 90-day breeding season and the value 0 (failure) otherwise. In analyses 1 and 3, SC was measured at around 15 months of age and in analysis 2 and 4 it was measured at around 18 months of age. Only 8,848 animals from datasets 1 and 2 were common in both files, which means the same animals measured at different ages. Datasets used in analyses 3 and 4 included the same animals, measured at 15 and at 18 months of age, respectively. Heritability estimates for HP were similar in all analyses, with values ranging from 0.66 +/- 0.08 to 0.67 +/- 0.008. For SC15, the estimates were 0.57 +/- 0.05 in analysis 1 and 0.60 +/- 0.07 in analysis 3. For SC18, the estimates were 0.53 +/- 0.03 in analysis 2 and 0.64 +/- 0.06 in analysis 4. The estimates of genetic correlation between HP and SC15 were 0.15 +/- 0.10 in analysis 1 and 0.11 +/- 0.11 in analysis 3. For the correlation between HP and SC18, the values were 0.27 +/- 0.10 in analysis 2 and 0.16 +/- 0.11 in analysis 4. Based on standard errors and confidence intervals, the best heritability and genetic correlation estimates were obtained from analysis 2, which included more data and a better pedigree structure. Pearson correlation between HP and SC breeding values was similar to the genetic correlation estimates obtained from two-trait models, when all animals in the pedigree file were considered for its calculation. If only sires were considered for the calculation, Pearson correlation was higher but the pattern was the same as from two-trait analyses. The high heritability estimates obtained in the present study confirm that expected progeny difference (EPD) for HP can be used to select bulls for the production of precocious daughters and that the low genetic correlation between SC and HP indicates a greater efficacy of selection based on heifer pregnancy EPD than of selection based on scrotal circumference EPD. The results of the present study, although not conclusive, indicate that SC measured at around SC18 would have a higher genetic correlation with HP than would SC measured at around SC15.


Multiple Mycotic Aneurysms of the Abdominal Aorta Illustrated on MDCT Scanner.
Infective mycotic aneurysm of the aorta is a rare and life-threatening disease. A patient presenting with constitutional symptoms and pulsatile abdominal mass should raise a suspicion of mycotic aneurysm. Early detection of aortic mycotic lesions in such patients should play a key role in the treatment of aortic aneurysms. Multiple mycotic aneurysms of abdominal aorta in a young male are a rare manifestation of the disease. Multidetector computerized tomography (CT) is an essential tool in identifying the etiology, pathogenesis, protean manifestations of systemic tuberculosis, and ultimately deciding the course of treatment.


Sciatic nerve stiffness is not changed immediately after a slump neurodynamics technique.
Neurodynamics techniques aim to assess and improve neural mechanosensitivity. However, there is no in vivo evidence regarding the mechanical effects of these techniques in the nerve stiffness. This study examined the immediate effects of a slump neurodynamics technique in the sciatic nerve shear wave velocity (SWV. i.e. an index of stiffness) using ultrasound-based elastography. Fourteen healthy participants were included in this experiment. Sciatic SWV and ankle passive torque were measured during a passive ankle dorsiflexion motion (2°/s), before and immediately after 3 minutes of slump neurodynamics technique, randomly applied to one lower limb. The contralateral limb served as control. The slump intervention did not change the sciatic SWV (P=0.78), nor the dorsiflexion passive torque (P=0.14), throughout the ankle dorsiflexion motion. Excellent values of intra-rater repeatability (ICC=0.88, 0.68-0.96), and low values of standard error of measurement (0.59 m/s, 0.35-1.15m/s), were observed for the SWV measurements. The sciatic nerve stiffness of healthy participants did not change immediately after a slump neurodynamics technique, suggesting a compliance of the neural tissue to tensile loads. However, these results ought to be confirmed using other neurodynamics techniques and in other populations (e.g. peripheral neuropathies). III.


[Chinese medicinal materials industry during the 14th Five-Year Plan period: trends and development suggestions].
This study steps through the future perspectives and gives the development suggestions of Chinese medicinal materials(CMM) industry by presenting the characteristics and open problems during the 13 th Five-Year Plan period. The development of CMM industry presents the following trends:(1)the development of Dao-di herbs speeds up with the increasing demand for high-quality CMM;(2)the mismatch between supply and demand is aggravating, which presses for supply-side structural reform;(3)ecological planting will become the core mode of production and bolster rural revitalization;(4)the demand for CMM with both medical and edible values keeps growing, and the antibiotic-free feed policy brings significant opportunities;(5)the "Internet Plus CMM" wave emerges, which promotes the construction of traceability system. Finally, we put forward the following suggestions for the sustainable development of CMM industry:(1)optimizing the layout for the production of Dao-di herbs according to local conditions;(2)strengthening the commercialization of the seeds and the breeding, multiplication, and extension of CMM to accelerate the realization of specialized seed production, mechanized seed processing, localized variety layout, and county-based unified seed supply;(3)ensuring the safety of pesticide use and accelerating the registration of special pesticides;(4)promoting both theoretical and practical research on ecological production of CMM;(5)publicizing the demonstration and popularization of CMM traceability system. Overall, significant progress has been achieved in the CMM industry during the 13 th Five-Year Plan period, and this industry is in a critical stage of high-quality development, facing both challenges and opportunities.


The rationale of perioperative intraperitoneal chemotherapy in the treatment of peritoneal surface malignancies.
In summary, the use of perioperative intraperitoneal chemotherapy is a rational and scientifically sound treatment option for patients with peritoneal carcinomatosis. By delivering chemotherapeutic agents directly into the peritoneal cavity in the perioperative period, after cytoreductive procedures resulting in minimal residual tumor load, the cytotoxicity, efficacy, and safety of these agents can be maximized. The use of this treatment strategy in the intraoperative or perioperative period ensures that the efficacy of the chemotherapeutic agents is not reduced by limitations of abdominal compartmentalization and scarring. Treating patients under hyperthermic conditions may confer an additional benefit. Although the use of perioperative chemotherapy or hyperthermic intraperitoneal chemotherapy is not yet part of the standard of care for the treatment of advanced abdominal malignancies, both basic science and clinical investigations have confirmed the validity of these regimens. Further clinical studies in a cooperative group setting are necessary to prove the efficacy of perioperative intraperitoneal chemotherapy in both the treatment and prevention of peritoneal surface malignancy.


[Soluble transferrin receptors and ferritin index in the diagnosis of iron deficiency in patients with spondyloarthritis and anemia].
To assess the diagnostic value of the detection of soluble transferrin receptors (sTfR) and ferritin index (sTfR/log Fer) in patients with spondyloarthritis (SpA) and anemia for the revealing absolute iron deficiency (ID). The study included 68 patients with SpA: median age 39 [34; 47] years, men: 38 (55.9%). Hemogram, C-reactive protein levels and ferrokinetics parameters were assessed, including sTfR testing by the method of quantitative enzyme-linked immunosorbent assay (Monobind Inc., USA). We also calculated sTfR/log Fer. Based on ferrokinetics parameters and C-reactive protein levels, chronic disease anemia (CDA), iron deficiency anemia (IDA), or their combination (CDA/IDA) were diagnosed. CDA was diagnosed in 16 patients, CDA/IDA in 32 patients, and 20 patients had no anemia. An increase in sTfR concentration in patients with CDA/IDA (1.7 [1.4; 2.2] mg/L) compared with patients with CDA (1.5 [1.1; 1.7] mg/L, p0.05) was revealed. sTfR/log Fer in patients with CDA/IDA (0.93 [0.82; 1.24]) was higher than in patients with CDA (0.64 [0.48; 0.75], p0.0001). When evaluating the ROC curves, it was found that sTfR levels 1.39 mg/L and sTfR/log Fer levels 0.83 indicate the presence of absolute ID. The area under the ROC curve for sTfR was 0.72 (95% confidence interval 0.600.82, p0.001), for sTfR/log Fer 0.85 (95% confidence interval 0.740.92, p0.001). The sensitivity and specificity of sTfR/log Fer (75 and 83%, respectively) were higher compared with sTfR (53 and 81%, respectively). In patients with SpA having CDA/IDA, sTfR and sTfR/log Fer are statistically significantly increased. The results obtained indicate the possibility of diagnosing ID by using these parameters.


Does aging differentially reduce heart rate variability related to respiration?
Segments of resting heart rate were submitted to spectral analysis in order to assess changes in spectral power with age. Different frequencies of heart rate variability have been related to vagal and sympathetic cardiac control. Data were from 56 male volunteers ranging in age between 18 and 65 years of age. Spectral results revealed that respiratory sinus arrhythmia declined less with age than lower (vasomotor) frequencies. Assessment of total (rather than relative) power at respiratory frequencies revealed the expected drop in power with age. Thus, the decline in heart rate variability with age may not be due predominantly to a decline in frequencies related to respiration.


The thermochemistry of group 15 tetrachloride anions.
Bond strengths for a series of Group 15 tetrachloride anions ACl4 (A = P, As, Sb, and Bi) have been determined by measuring thresholds for collision-induced dissociation of the anions in a flowing afterglow-tandem mass spectrometer. The central atoms in these systems have ten electrons, which violates the octet rule: the bond dissociation energies for ACl4- help to clarify the effect of the central atom on hypervalent bond strengths. The 0 K bond energies in kJ mol(-1) are D(Cl3A-CL-) = 90 +/- 7,115 +/- 7,161 +/- 8, and 154 +/- 15, respectively. Computational results using the B3LYP/LANL2DZpd level of theory are higher than the experimental bond energies. Calculations give a geometry for BiCl4 that is essentially tetrahedral rather than the see-saw observed for the other tetrachlorides. NBO calculations predict that the phosphorus and arsenic systems have 3C-4E bonds, while the antimony and bismuth systems are more ionic.


Male mice express spermatogenic cell-specific triosephosphate isomerase isozymes.
Triosephosphate isomerase 1 (TPI1) is a member of the glycolytic pathway, which is a critical source of energy for motility in mouse sperm. By immunoblotting, we detected two male, germ line-specific TPI1 bands (Mr 33,400 and 30,800) as well as the somatic-type band (Mr 27,700). Although all three bands were observed in spermatogenic cells, somatic-type TPI1 disappeared from sperm during epididymal maturation. In vitro dephosphorylation analysis suggested that the two male, germ line-specific TPI1 bands were not the result of phosphorylation of the 27,700 Mr TPI1 band. The Mr 33,400; 30,800; and 27,700 TPI1 bands corresponded to the respective sizes of the proteins predicted to use the first, second, and third possible initiation codons of the Tpi1 cDNA. We performed immunofluorescence on epididymal sperm and determined that TPI1 specifically localized in the principal piece. The antibody staining was stronger in cauda epididymal sperm than in caput epididymal sperm, a finding consistent with the identification of TPI1 as a cauda epididymal sperm-enriched protein. Immunofluorescence with sodium dodecyl sulfate (SDS)-insoluble flagellar accessory structures showed a strong TPI1 signal only in the principal piece, indicating that TPI1 is a component of the fibrous sheath. Northern blot hybridization detected longer Tpi1 transcripts (1.56 kb) in mouse testis, whereas somatic tissues had shorter transcripts (1.32 kb). As there is only one triosephosphate isomerase gene in the mouse genome, we conclude that the three variants we see in sperm result from the use of alternative translation start codons in spermatogenic cells.


[Effects of cryptotanshinone on proliferation and apoptosis of Hela cell line of cervical cancer].
To investigate the proliferation effects and apoptosis induction of cryptotanshinone on Hela cell line of cervical cancer. The MTT assay was used to detect the growth inhibition rates of Hela cells at 24, 48, 72 h which cultured with cryptotanshinone in different concentrations. The cell cycle distribution and apoptosis were measured by flow cytometry. The protein expressions of E6, p53 and p21 were studied by Western blot. The different concentrations (0.5-16 mg x L(-1)) of cryptotanshinone had cytotoxicity on Hela cells, which were clearly dose and time-dependent. The IC50 of 24, 48, 72 h were 17.8, 8.17, 6.55 mg x L(-1), respectively. Cells were treated with cryptotanshinone which had significant effects on cell cycle of Hela cell, and induced apoptosis. Western blot showed cryptotanshinone decreased expressions of HPV E6 and increased expressions of p53 and p21 proteins. Cryptotanshinone had significant cytotoic and radiosensitization effects on cervical cancer Hela cells. One of the mechanism may be that it might make significant G0/G1 phase arrest and induced apoptosis, a decrease in S phase, and restore the function of p53 to induce apoptosis in Hela cells to kill the tumor cell.


Gadolinium Deposition in the Brain in a Large Animal Model: Comparison of Linear and Macrocyclic Gadolinium-Based Contrast Agents.
Recent studies reported a signal intensity increase in the deep cerebellar nuclei (DCN) on magnetic resonance images caused by gadolinium deposition after the injection of gadolinium-based contrast agents (GBCAs). There is an ongoing debate if the propensity of a GBCA to deposit gadolinium is primarily determined by its class as either linear or macrocyclic. In the current study, we aimed to compare the amount and the distribution of retained gadolinium of linear and macrocyclic GBCAs in the DCN after a single injection at a dose comparable to a human patient's in a large animal model. Eighteen sheep were randomly assigned in 6 groups of 3 animals, which received a single injection of 0.1 mmol/kg body weight of either the macrocyclic GBCAs gadobutrol, gadoteridol, or gadoterate meglumine; the linear GBCAs gadobenate dimeglumine or gadodiamide; or saline. Animals were euthanized 10 weeks after injection. Local distribution and concentration of gadolinium and colocalization to other metals (iron, zinc, copper) in the DCN was assessed by laser ablation-inductively coupled plasma-mass spectrometry. Average gadolinium concentration for the macrocyclic GBCAs and the saline group was below the limit of quantification (5.7 ng/g tissue). In contrast, 14 (for gadobenate) and 27 (for gadodiamide) times more gadolinium than the limit of quantification was found for the linear GBCAs gadobenate (mean, 83 ng/g) or gadodiamide (mean, 155 ng/g brain tissue). Gadolinium distribution colocalized with other metals for linear GBCAs and a specific accumulation in the DCN was found. The current study supports the hypothesis that the amount of gadolinium deposited in the brain is primarily determined by its class as either macrocyclic or linear. The accumulation of gadolinium in the DCN for linear GBCAs explains the hyperintensities in the DCN found in previous patient studies with linear GBCAs.


Resonance frequency assessment of dental implant stability with various bone qualities: a numerical approach.
Resonance frequency analysis (RFA) has been used by several investigators to assess the boundary conditions of dental implants. The goal of the current study was to determine the vibrating behavior of a dental implant under various surrounding bone conditions. A 3D finite element (FE) model of a cylinder-type titanium implant was developed. In this model, the implant was embedded into a cubic section of bone. The model was first validated using a series of modal testing experiments. The effects of bony conditions on the resonance frequencies of the implant were computed with different bone types and bone densities. Our results show that the resonance frequency of the implant with type III surrounding bone decreased linearly (r = -0.996, P < 0.01) from 17.9 kHz (without loss in bone density) to 0.6 kHz (90% loss in bone density) when the bone densities were decreased. On the other hand, without bone loss, the highest resonance frequency value (36.1 kHz) was found when the implant was placed into type I surrounding bone. In contrast, the resonance frequency of the implant with type IV bone quality was found to be 9.9 kHz, which is almost four-fold less than that found in the type I model. These results suggest that RFA could serve as a non-invasive diagnostic tool for detecting the stability of dental implants during the healing stages and in subsequent routine follow-up care after treatment.


Tuberculosis peritonitis: diagnostic value of the ascitic/blood glucose ratio.
In a study of 25 consecutive patients presenting with ascites, the use of the ascitic/blood glucose ratio in assisting in the diagnosis of tuberculous peritonitis was investigated. In all 13 patients with histologically confirmed tuberculous peritonitis the ratio was less than 0.96, and in 10 patients with non-tuberculous ascites the ratio was greater than 0.96, this difference being statistically significant (P less than 0.001). In 2 patients with probable non-tuberculous ascites but with pulmonary tuberculosis the results were excluded from statistical analysis, as they had received anti-tuberculosis therapy in addition to their other treatment. The conclusion drawn from this study is that the ascitic/blood glucose ratio is a useful test in the differentiation of tuberculous peritonitis from ascites due to other causes.


Evaluating the Free Energies of Solvation and Electronic Structures of Lithium-Ion Battery Electrolytes.
Adaptive biasing force molecular dynamics simulations and density functional theory calculations were performed to understand the interaction of Li(+) with pure carbonates and ethylene carbonate (EC)-based binary mixtures. The most favorable Li carbonate cluster configurations obtained from molecular dynamics simulations were subjected to detailed structural and thermochemistry calculations on the basis of the M06-2X/6-311++G(d,p) level of theory. We report the ranking of these electrolytes on the basis of the free energies of Li-ion solvation in carbonates and EC-based mixtures. A strong local tetrahedral order involving four carbonates around the Li(+) was seen in the first solvation shell. Thermochemistry calculations revealed that the enthalpy of solvation and the Gibbs free energy of solvation of the Li(+) ion with carbonates are negative and suggested the ion-carbonate complexation process to be exothermic and spontaneous. Natural bond orbital analysis indicated that Li(+) interacts with the lone pairs of electrons on the carbonyl oxygen atom in the primary solvation sphere. These interactions lead to an increase in the carbonyl (C=O) bond lengths, as evidenced by a redshift in the vibrational frequencies [ν(C=O)] and a decrease in the electron density values at the C=O bond critical points in the primary solvation sphere. Quantum theory of atoms in molecules, localized molecular orbital energy decomposition analysis (LMO-EDA), and noncovalent interaction plots revealed the electrostatic nature of the Li(+) ion interactions with the carbonyl oxygen atoms in these complexes. On the basis of LMO-EDA, the strongest attractive interaction in these complexes was found to be the electrostatic interaction followed by polarization, dispersion, and exchange interactions. Overall, our calculations predicted EC and a binary mixture of EC/dimethyl carbonate to be appropriate electrolytes for Li-ion batteries, which complies with experiments and other theoretical results.


Tuning Lewis Acidity by a Transannular pπ -σ* Interaction between Boron and Silicon/Germanium Atoms Supported by a Cage-Shaped Framework.
Cage-shaped borates tethered by heavier Group 14 elements (Si or Ge) were synthesized. These possess an intramolecularly transannular pπ -σ* interaction between the boron center and the tethered Si/Ge atom, which allows the precise tuning of their Lewis acidity. The Lewis acidity was investigated by the ligand-exchange reaction rate and IR measurements with the help of theoretical calculation. The synthesized borates exhibited catalytic activity. This study demonstrated the effectiveness of the direct orbital perturbation of a metal center by space interaction during fine tuning of the Lewis acidity.


Protective Effect of Amino Acids on the Muscle Injury of Aerobics Athletes after Endurance Exercise Based on CT Images.
During the training process, the aerobics athletes gradually increase their technical movements, the appreciation of the movements has been gradually improved, and the injuries of the athletes themselves have also gradually become serious. Based on CT image analysis, we study the protective effect of amino acids on aerobics athletes' muscle injury after endurance exercise. There are three major substance metabolism disorders in patients with muscle sclerosis, which are mainly manifested as decreased glucose tolerance and insulin resistance. Some patients develop muscle-derived diabetes. At the same time, the synthesis of lipids such as cholesterol and apolipoproteins decreases, the production of ketone bodies increases and the body uses more ketones for energy. The BCAA/AAA factor refers to the branched-chain amino acid/aromatic amino acid (BCAA/AAA) value. In amino acid metabolism, plasma albumin decreased significantly, the ratio of amino acids was unbalanced, and BCAA/AAA decreased, which was more likely to induce muscular encephalopathy. Using computer tomography (CT) to study the protective effect of amino acids on muscle injury, 32 aerobics athletes were randomly divided into an intervention group (Ig) and a control group (CG), each with 16 people. After 64-slice spiral CT scanning of muscles and three-dimensional reconstruction, the intervention group and the control group participated in aerobic endurance training 3 weeks in advance to establish a muscle microinjury model. The intervention group took the preprepared BCAA, while the control group did not take it. After three weeks of training, there will be one hour and three hours of aerobics competition. We need to detect changes in blood glucose (BS), creatine kinase (SCK), lactate dehydrogenase (LD), alanine (ALA), and alanine aminotransferase (AA) before and after exercise and 1 hour after exercise and record AVS athletes' pain analysis table. We successfully established the muscle injury model, letting all athletes' VAS score in 6-8 points; after 1 hour of exercise, the measurement results were the same as those of 2 hours. Therefore, after endurance training, the blood glucose content of the intervention group gradually decreased and returned to the original level after 2 hours of exercise, while the control group was lower than the level of exercise after 2 hours of exercise; the content of alanine in the two groups decreased more after 2 hours of exercise; the results of serum creatine kinase in the intervention group were higher than those in the control group after exercise. In the intervention group, lactate dehydrogenase increased rapidly at 2 hours after exercise; the alanine aminotransferase in the intervention group increased after exercise, but there was no significant change in the control group. It is also concluded that the longer the exercise time and the more energy consumption, the more effective the branched-chain amino acids supplement will be. The obtained imaging data can provide a more intuitive and accurate basis for the scientific selection of athletes, and amino acids can promote the synthesis of hormones, accelerate the synthesis of proteins and other products, reduce the content of creatine kinase in the blood, and protect the rapid recovery of muscle damage.


[Elective splenectomy in adults - preparation, operation, and postoperative treatment].
Elective splenectomy in adults is often performed after failure of conservative treatment in patients with hematologic, neoplastic, or autoimmune disorders. The indication to perform a splenectomy should be discussed in an interdisciplinary team and the surgeon should not make the decision on his own. Laparoscopic splenectomy is nowadays established as the gold-standard treatment due to low morbidity and mortality and - compared to open surgery - lower postoperative pain, less intraoperative blood loss and shorter hospital stay. Every patient with planned splenectomy must undergo vaccination against pneumococci and meningococci at least two weeks prior to the operation, which helps reducing the risk of the "overwhelming post-splenectomy infection" (OPSI). Beside re-vaccination against pneumococci and meningococci during follow-up, every patient should be informed about the increased risk of infection, receive a personal post-splenectomy pass and emergency antibiotics in case of infection.


Effect of whole body vibration on lactate level recovery and heart rate recovery in rest after intense exercise.
In this paper, we investigated the recovery of the lactate level, muscular fatigue, and heart rate recovery (HRR) with respect to whole body vibration (WBV) during the rest stage after a gait exercise. A total of 24 healthy subjects with no medical history of exercise injury participated. The participants were divided into a training group with vibration during rest and a control group with the same conditions but without vibration. The subjects performed a gait exercise with a slope of 15% and velocity of 4 km/h to consume 450 kcal in 30 min. Then, they rested on a vibrating chair or on a chair without vibrations for 30 min. The vibration protocol consists of a frequency of 10 Hz and amplitude of 5 mm. To estimate the recovery effect, we measured the lactate levels in blood, spectral edge frequency (SEF) of MVIC, and HRR before, immediately after exercise, and after rest. The results showed that the lactate level in the training group decreased more (93.8%) than in the control group (32.8%). Also, HRR showed a similar trend with a recovery of 88.39% in the training group but 64.72% in the control group. We considered that whole-body vibrations during rest would help remove lactic acid by improving the level of lactic acid oxidation with stimulated blood vessels in the muscles and by helping to maintain blood flow. Also, WBV would lead to compensation to actively decrease the fast excess post-exercise oxygen consumption from blood circulation. We suggest that whole-body vibrations during rest can provide fast, efficient fatigue recovery as a cool down exercise for women, the elderly, and patients without other activity after intense exercise.


The NHS in crisis.
How serious is the situation in emergency departments? Figures for England showing how many patients were discharged, transferred or admitted within four hours in January were the worst on record, at 85.1%. Add to this very high attendances at emergency departments and admissions, and a growing number of 12-hour waits for a bed and this does look like an unprecedented crisis. There is also a large number of trusts declaring Opel 3 and 4 alerts (the new black and red alerts). Attendances at major A&Es increased by 5.5% from 2015 to 2016, and many hospitals and ambulance services reported their busiest-ever days in January this year.


Investigating the effect of dental implant materials with different densities on radiotherapy dose distribution using Monte-Carlo simulation and pencil beam convolution algorithm.
The aim of this study was to investigate the effect of dental implant materials with different physical densities on dose distribution for head and neck cancer radiotherapy planning. Titanium (Ti), Titanium alloy (Ti-6Al-4V), Zirconia (Y-TZP), Zirconium oxide (ZrO2), Alumina (Al2O3) and polyetheretherketone (PEEK) dental implant materials were used for determination of implant material effect on dose distribution. Dental implant effect was investigated by using pencil beam convolution (PBC) algorithm of Eclipse treatment planning systems (TPS) and Monte Carlo (MC) simulation technique. 6 MV photon beam of the Varian 2300 C/D linear accelerator was simulated by EGSnrc-based BEAMnrc MC code system. Reasonable consistency was determined for percentage depth dose (PDD) curves between MC simulation and water phantom measurements at 6.4 MeV initial electron energy. The consistency between modelled linear accelerator PDD curve calculations and water-phantom PDD measurements were compatible within 1 % range. The dose increase in front of the dental implant calculated by MC simulation is in the range of 0.4-20.2%. We found by MC and PBC calculations that the differences in dose increase in front of the dental implant materials is in the range of 0.1-17.2% and is dependent on the physical density of the dental implant. Dose increase for Zirconia was noted to be maximum while PEEK implant dose increase was minimum among the whole dental implant materials studied. This study revealed that the Eclipse TPS PBC algorithm could not accurately estimate the backscatter radiation from dental implant materials.


A novel mechanism for TNFR-associated factor 6-dependent CD40 signaling.
Members of the TNFR family play critical roles in the regulation of the immune system. One member of the family critical for efficient activation of T-dependent humoral immune responses is CD40, a cell surface protein expressed by B cells and other APC. The cytoplasmic domain of CD40 interacts with several members of the TNFR-associated factor (TRAF) family, which link CD40 to intracellular signaling pathways. TRAF2 and 6 appear to play particularly important roles in CD40 signaling. Previous studies suggest that the two molecules have certain overlapping roles in signaling, but that unique roles for each molecule also exist. To better define the roles of TRAF2 and TRAF6 in CD40 signaling, we used somatic cell gene targeting to generate TRAF-deficient mouse B cell lines. A20.2J cells deficient in TRAF6 exhibit marked defects in CD40-mediated JNK activation and the up-regulation of CD80. Our previous experiments with TRAF2-deficient B cell lines suggest that TRAF6 and TRAF2 may have redundant roles in CD40-mediated NF-kappaB activation. Consistent with this hypothesis, we found CD40-mediated activation of NF-kappaB intact in TRAF6-deficient cells and defective in cells lacking both TRAF2 and TRAF6. Interestingly, we found that TRAF6 mutants defective in CD40 binding were able to restore CD40-mediated JNK activation and CD80 up-regulation in TRAF6-deficient cells, indicating that TRAF6 may be able to contribute to certain CD40 signals without directly binding CD40.


Quantum phases of matter on a 256-atom programmable quantum simulator.
Motivated by far-reaching applications ranging from quantum simulations of complex processes in physics and chemistry to quantum information processing1, a broad effort is currently underway to build large-scale programmable quantum systems. Such systems provide insights into strongly correlated quantum matter2-6, while at the same time enabling new methods for computation7-10 and metrology11. Here we demonstrate a programmable quantum simulator based on deterministically prepared two-dimensional arrays of neutral atoms, featuring strong interactions controlled by coherent atomic excitation into Rydberg states12. Using this approach, we realize a quantum spin model with tunable interactions for system sizes ranging from 64 to 256 qubits. We benchmark the system by characterizing high-fidelity antiferromagnetically ordered states and demonstrating quantum critical dynamics consistent with an Ising quantum phase transition in (2 + 1) dimensions13. We then create and study several new quantum phases that arise from the interplay between interactions and coherent laser excitation14, experimentally map the phase diagram and investigate the role of quantum fluctuations. Offering a new lens into the study of complex quantum matter, these observations pave the way for investigations of exotic quantum phases, non-equilibrium entanglement dynamics and hardware-efficient realization of quantum algorithms.


Respiratory Syncytial Virus Infection Rates with Limited Use of Palivizumab for Infants Born at 29 to 31+6/7 Weeks Gestational Age.
Immunoprophylaxis with palivizumab can reduce respiratory syncytial virus (RSV) infections and hospitalizations. Criteria in British Columbia limit the use of palivizumab to infants born at 29 to 31+6/7 weeks gestational age, which differ from guidelines of the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society (CPS). To determine whether the limited use of palivizumab affected the frequency of hospital visits by RSV-positive infants (termed "RSV-positive hospital visits") who received approval for palivizumab and those who met the AAP/CPS criteria but did not receive approval for palivizumab. Data sets were generated for the period May 1, 2008, to April 30, 2011, to identify infants with gestational age of 29 to 31+6/7 weeks who were born in or transferred to the Fraser Health authority, RSV-positive results for infants less than 12 months of age who had visited Fraser Health sites and BC Children's Hospital, and palivizumab approvals. Infants were matched across these 3 data sets through their personal health numbers. The study included 359 infants born at 29 to 31+6/7 weeks, of whom 297 met the AAP/CPS criteria. However, only 46 of these 297 received approval for palivizumab according to the BC criteria. Sixteen (4.5%) of the 359 infants had RSV-positive hospital visits during the RSV season (November through March). Of the 46 infants who received approval for palivizumab, 2 (4.3%) had RSV-positive hospital visits, and of the 251 who met the AAP/CPS criteria but did not receive palivizumab approval, 14 (5.6%) had RSV-positive hospital visits. Of the 359 infants, 6 (1.7%) had RSV-positive results while admitted to the neonatal intensive care unit, and 10 (2.8%) tested positive for RSV during a subsequent hospital visit. The frequency of RSV-positive hospital visits did not differ between infants who received and those who did not receive approval for palivizumab in the Fraser Health authority. Limited use of palivizumab for RSV prophylaxis led to reasonable rates of RSV-positive hospital visits in the study population.


Differences between cell lines of uterine cervical glassy cell carcinoma and large cell nonkeratinizing squamous cell carcinoma.
Cell lines were established from two uterine cervical cancers, a glassy cell carcinoma (GCC) and a large cell nonkeratinizing squamous cell carcinoma (LCSC), and studied by a variety of techniques, including histology, chromosome analysis, heterotransplantation and tumor marker analyses. There were radical differences in the morphology, heterotransplantability, production of tumor markers, etc., between the cultures of these morphologically similar cancers. The LCSC line (HKMUS) consisted of polygonal and round cells containing tonofilaments; these cells discharged tumor antigen-4 (TA-4) into the conditioned media. HKMUS was heterotransplantable into the subcutis of nude mice to form LCSC. On the other hand, the GCC line (HOKUG) consisted of round or spindle-shaped cells. HOKUG was easily transplanted into the subcutis or intraabdominal cavity of nude mice and metastasized easily. It discharged TA-4, carbohydrate antigen 125 (CA125) and neuron-specific enolase (NSE) into the conditioned media. The histologic picture of GCC revealed numerous blood vessels and a rapid proliferation of the cells. GCC, which is considered to be a mixed carcinoma having the characteristics of both squamous carcinoma and adenocarcinoma, seems to be a cancer of unpredictable prognosis as compared to LCSC, possibly due to its rapid proliferation and easy metastasis, leading to peritonitis carcinomatosa.


Photodynamic treatment with anionic nanoclays containing curcumin on human triple-negative breast cancer cells: Cellular and biochemical studies.
Photodynamic treatment is a minimally invasive and clinically approved procedure for eliminating selected malignant cells with activation of a photosensitizer agent at a specific light. Little is known, however, about the phototoxic properties of curcumin, as a natural phenolic compound, against different types of cancers. It is generally accepted that cellular damage occurs during photo treatment. There is a limitation in using of curcumin as a drug due to its low solubility, but nanoparticles such as anionic nanoclays or layered double hydroxide (LDH) could overcome it. The aim of this study was to investigate cellular responses to curcumin-LDH nanoparticles after photodynamic treatment of MDA-MB-231 human breast cancer cells. For this purpose, the MDA-MB-231 human breast cancer cell line treated with curcumin-LDH nanoparticle and then irradiated (photodynamic treatment). After irradiation, lactate dehydrogenase assay, clonogenic cell survival, cell death mechanisms such as autophagy and apoptosis were determined. Cell cycle distribution after photodynamic therapy (PDT) and also intracellular reactive oxygen species (ROS) generation were measured. The result showed that curcumin-LDH-PDT has a cytotoxic and antiprolifrative effect on MDA-MB-231 human breast cancer cells. Curcumin-LDH-PDT induced autophagy, apoptosis, and G0/G1 cell cycle arrest in human breast cancer cell line. Intracellular ROS increased in MDA-MB-231 cancer cell line after treatment with curcumin-LDH along with irradiation. The results suggest that curcumin-LDH nanoparticle could be considered as a novel approach in the photodynamic treatment of breast cancer.


Effect of handling intensity at the time of transport for slaughter on physiological response and carcass characteristics in beef cattle fed ractopamine hydrochloride.
The effects of handling intensity on the physiological response and carcass characteristics of feedlot cattle fed ractopamine hydrochloride were evaluated at the time of transport to slaughter. Eighty steers (BW = 668 ± 36 kg) representing 10 lots of similar breed, frame size, and degree of finish were blocked by lot, stratified by weight, and randomly assigned to 1 of 2 handling intensities (HI) over a 1,600 m dirt alley course: 1) low-stress handling (LSH) or 2) high-stress handling (HSH). For the LSH treatment, 4 penmates were kept at a walk with the use of a lead rider. For the HSH treatment, 4 penmates were kept at a minimum of a trot and received 2 applications of an electric prod (approximately 1 s per impulse) at 2 separate instances: first in the alley before post-handling sampling, and again during loading for transportation to the abattoir. Behavioral observations and physical indicators of stress were recorded a minimum of 1 h before handling (baseline), immediately after handling (POSTHAND), and while in lairage after a 200 km transport to the abattoir. Vital parameters were recorded at baseline and POSTHAND. Venous blood samples were collected via jugular venipuncture at baseline and POSTHAND, and mixed arterial and venous blood samples were collected during exsanguination at slaughter. Muscle tremors tended to be more prevalent in HSH cattle at POSTHAND ( = 0.10). The HSH cattle tended to have greater POSTHAND heart rate ( = 0.08); however, there was no effect of HI on POSTHAND respiration rate or rectal temperature ( 0.34). The HSH cattle had greater lactate, epinephrine, norepinephrine, cortisol, and glucose concentrations at POSTHAND ( ≤ 0.02). Additionally, HSH cattle had lower POSTHAND blood pH, bicarbonate, base excess, and partial pressure carbon dioxide ( < 0.0001). Bicarbonate concentrations were greater in HSH cattle at slaughter ( = 0.05); however, there were no differences between HI treatments for the remaining blood variables ( 0.11). Concentrations of stress hormones and CK were significantly greater at slaughter relative to baseline and POSTHAND for both LSH and HSH cattle ( < 0.001). These findings suggest cattle trotted without a lead rider develop metabolic acidosis, and illustrate the importance of low-stress handling at the time of transport for slaughter. Further research is warranted to develop strategies to mitigate stress at the time of transport and ensure the welfare of beef cattle presented to abattoirs.


Present status of immediate loading of oral implants.
Several conditions must be present to obtain implant integration and long-term clinical success when using the one-stage implant placement procedure with immediate loading. These conditions include (1) primary stability, (2) sufficient bone quality, and (3) elimination of micromovement of the implant before osseous integration is complete. This report presents the results of research on immediate loading using a new and innovative implant design, Ankylos. The author reviewed clinical studies of immediate loaading or oral implants, including two treatment options, removable overdentures and fixed reconstructions. Animal studies have demonstrated that successful osseointegration of Ankylos implants can occur (Figure 2D) when implants are placed and loaded immediately in the presence of some specific conditions. The histological findings involving implants that were placed in humans and immediately loaded showed no fibrous tissue formation (encapsulation). The bone-to-implant contact (osseointegration) was found to be excellent between the immediately-loaded implants and the surrounding alveolar bone. The Ankylos implant system with its progressive thread design successfully promotes primary, clinical stability at the time of implant placement. Several animal studies have shown that in implant restorations placed in similar areas of poor bone quality (ie, maxilla and the posterior part of the mandible), the concept of immediate loading can result in long-term clinical success, when loading forces are controlled. Immobilization of the implants and soft diet recommendations that reduce micromovement at the bone-to-implant interface will improve long-term clinical success. In summary, the Ankylos implant is well designed for one-stage placement with immediate loading, as well as for two-stage treatment protocols. Both clinical protocols will result in long-term clinical survival.


Heat-shock proteins and juvenile chronic arthritis.
Heat-shock proteins are a category of proteins that are synthesized under stressful conditions (such as increased temperatures) both by prokaryotic and eukaryotic cells. Heat-shock proteins are a major target of the immune response and thus can be considered dominant antigens. Under physiological circumstances the response to heat-shock proteins is considered to play a role in the overall defence against bacterial infections. An aberrant immune response against heat-shock proteins may lead to autoimmunity, as illustrated by adjuvant arthritis in Lewis rats. Current evidence also points towards a role of T cell immunity against heat-shock proteins in the development of human autoimmune diseases such as juvenile chronic arthritis.


The total protein concentration of gingival crevicular fluid. Variation with sampling time and gingival inflammation.
The total protein concentration of gingival crevicular fluid (GCF), sampled repeatedly over a 10-min period with the minimum of physical irritation to the sulcus, was evaluated in a group of 32 healthy adolescents. The mean concentration of the 1st sample was comparable to that of normal tissue fluids and lymph, irrespective of the state of inflammation of the sample site. However, during repeated sampling, the values rose to resemble serum protein levels, except at those sites with no clinically detectable inflammation. Gel electrophoretic analysis confirmed the increasing proportion of serum-derived molecules in the more proteinaceous GCF samples. The results demonstrate the extreme sensitivity of the gingival vasculature to GCF sampling and consequently the need for accurate standardisation of GCF collection protocols. This will apply particularly when compositional data is to be normalised with respect to the total protein content or when the levels of a serum constituent are being examined.


Perceived stigma and community integration among clients of assertive community treatment.
Facilitating the integration of persons with psychiatric disabilities is an important goal of community programs. In addition to limitations such as inadequate housing, poverty, and unemployment, a common barrier to community adjustment identified by people with psychiatric disabilities is their perception of being stigmatized. This study examined the relationships between perceived stigma and community integration in 95 clients of assertive community treatment (ACT) teams, using sequential multiple regression procedures. Findings indicate that despite their physical presence in the community and the intensive support they receive, ACT clients believe other community members will reject them. Moreover, this perception appears to interfere with their sense of belonging, particularly among those who also perceive less social support and who have greater psychosocial skill deficits. In the context of the present study, global self-esteem did not mediate this relationship. In addition to community focused antistigma campaigns, stigma-related issues should also be addressed with ACT clients themselves.


Elemental distribution in developing rice grains and the effect of flag-leaf arsenate exposure.
We measured the bulk grain concentrations of arsenic (As), along with rubidium (Rb) and strontium (Sr) as indicators of phloem and xylem transport respectively, in rice (Oryza sativa cv. Italica Carolina) pulsed with arsenate at two exposure levels for 5 day periods at progressively later stages of grain fill, between anthesis and maturity, through the cut flag leaf. We compared these to unexposed (negative) controls and positive controls; pulsed with dimethylarsinic acid (DMA). We collected elemental maps of As and micronutrient elements (Fe, Zn, Mn, Cu and Ni) from developing grains of rice. Exposures were either 25 or 100 μg/ml arsenate (As(V)) at various stages of grain development, compared to 25 μg/ml dimethylarsinic acid (DMA); the most efficiently transported As species identified in rice. We used the spatial distribution of arsenic in the grain to infer the presence of As transporters. By exposing grains through the flag leaf rather than via the roots, we were able to measure arsenic transport into the grain during filling under controlled conditions. Exposure to 100 μg/ml As(V) resulted in widespread As localization in both embryo and endosperm, especially in grains exposed to As at later stages of panicle development. This suggests loss of selective transport, likely to be the result of As toxicity. At 25 μg/ml As(V), As colocalized with Mn in the ovular vascular trace (OVT). Exposure to either As(V) or DMA reduced grain Fe, an effect more pronounced when exposure occurred earlier in grain development. The abundance of Cu and Zn were also reduced by As. Arsenic exposure later in grain development caused higher grain As concentrations, indicating the existence of As transporters whose efficiency increases during grain fill. We conclude that localization of As in the grain is a product of both As species and exposure concentration, and that high As(V) translocation from the flag leaf can result in high As concentrations in the endosperm.


Impulsive and Self-Regulatory Processes in Risky Driving Among Young People: A Dual Process Model.
The present study empirically examined a novel dual process model of self-reported aberrant driving behavior in young and novice drivers that incorporates both impulsive and self-regulatory processes. Four hundred and nine participants aged 18-25 years (M age = 21.18 years, SD = 2.12; 65.5% females) completed online questionnaires on impulsivity, normlessness, sensation seeking, emotion and self-regulation, and attitudes toward driving safety. Path analysis showed that motor impulsivity was associated with self-reported driving violations, errors, and lapses, whereas sensation seeking was uniquely directly associated with self-reported errors. Non-planning impulsivity, normlessness and sensation seeking had significant indirect effects on self-reported errors, via self-regulation. Finally, motor impulsivity and normlessness had a significant indirect effect on self-reported violations, errors and lapses, via attitudes to driving safety. Based on our findings we suggest that a dual-process approach is relevant to the study of aberrant driving behavior in young and novice drivers, and the results of the present study have important implications for initiatives to promote driving safety in this population.


Fever alters characteristics of sleep in rats.
This study examined the effects of a fungal infection on body temperature (Tb) and sleep states. Tb and sleep were recorded in male rats for 24 hr after a saline injection and 48 hr after a subcutaneous injection of live brewer's yeast, at ambient temperatures (Ta's) of 20 degrees and 30 degrees C. Peak fevers of 1.6-3.1 degrees C occurred within 6-10 hr at both Ta's. The rats remained febrile for the next 12-24 hr. For the first 24 hr postyeast, amounts of SWS increased by 19 +/- 3% at 20 degrees C and 12 +/- 2% at 30 degrees C. Specifically, SWS was significantly increased from hr 5-8 (lights-on) and 13-24 (lights-off) at 20 degrees, and from hr 5-8 and 17-24 at 30 degrees C. Ta did not affect the changes in Tb or the changes in SWS after either saline or yeast. Duration of REMS varied with Ta after saline. After yeast, REMS increased by 21 +/- 12% at 20 degrees and decreased by 28 +/- 6% at 30 degrees C, with the net result that REMS at the two Ta's was equal during the fever. Furthermore, while the rats were febrile the normal diurnal variation in REMS was eliminated. Sleep and Tb returned to control values during the second fever day. These results suggest that an activated immune system both increases SWS and overrides the diurnal and thermoregulatory modulations of REMS.


Characterization of columnar aerosol over a background site in Central Asia.
Ground-based observational characterization of atmosphere aerosols over Central Asia is very limited. This study investigated the columnar aerosol characteristics over Issyk-Kul, Kyrgyzstan, a background site in Central Asia using the long-term (∼14 years: August 2007-November 2021) data acquired with the Cimel sunphotometer. The mean aerosol optical depth (AOD) and Ångström exponent (AE) during the observation period were 0.14 ± 0.10 and 1.19 ± 0.41, respectively. Both AOD and AE varied across seasons, with highest AOD in spring (0.17 ± 0.17). Regarding the aerosol types, clean continental aerosols were dominant type (65%), followed by mixed aerosols (∼19%), clean marine aerosols (∼14%), dust (0.8%), and urban/industrial and biomass burning aerosol (0.7%). The aerosol volume size distribution was bimodal indicating the influence of both anthropogenic and natural aerosols with clear dominance of coarse mode during the spring season. Mainly dust and mixed aerosols were present during high aerosol episodes while the coarse mode aerosol volume concentration was 7.5 (strong episodes) and ∼19 (extreme episodes) times higher than the whole period average. Aerosol over this background sites were from local and regional sources with some contribution of long-range transport.


POCT Accreditation ISO 15189 and ISO 22870: Making the Point.
ISO 22870 lists specific requirements for the quality and competence of point-of-care testing (POCT), which are intended for medical laboratories in conjunction with ISO 15189. POCT characteristics include the availability of a large number of devices 24 h/day, a variety of analytical methods, clinical settings inside and outside the hospital, and general non-laboratory staff. ISO 22870 accreditation for adequate POCT management therefore poses a challenge for laboratory medicine, which is charged with leading and coordinating POCT with a multidisciplinary committee. La Paz University Hospital has a complex multitest and multisite network that has been accredited since 2017. In our experience, the particularly crucial areas for POCT accreditation are method performance verification, internal and external quality assurance, staff training and competency, and continuous improvement. ISO 22870 and ISO 15189 accreditation have led us to improve numerous areas regarding the total testing process and, consequently, our patients' results.


Basics of laboratory statistics.
The strict monitoring of examinations and evaluation of newer methods or instruments is a daily routine in clinical laboratory. The automated analyzers accumulate an enormous amount of data from patients' examinations and quality control procedures. This laboratory data is meaningless if it does not generate the information that we can extend to the population of our interest. In an analytical work, the most important operation is the comparison of data, to quantify accuracy and precision and to generate meaningful explanation for clinician and patients queries. Most of the information needed in the regular laboratory work can be obtained with the use of simple convenient statistical tools. This article describes the basics of laboratory statistics, the knowledge of which answers about the application of quality control in laboratory, accuracy and diagnostic power of our examinations, variability in reports, comparison of different methods and derivation of a biological reference interval for an analyte.


[Epidermal growth factor (EGF) in tears in excimer laser photorefractive keratectomy. Responsible for postoperative refraction and "haze"?].
Corneal wound healing is of critical importance for the postoperative outcome of excimer laser PRK. Wound healing is a complex biological process that is well characterised at the microscopic level, but its regulation is poorly understood at the molecular level. Among various cytokines, epidermal growth factor (EGF) plays an important role in superficial wound healing. The synthesis of EGF varies individually; therefore, by determining the EGF concentration in the tear fluid, patients with increased wound healing activity might be traced. In this study we measured the EGF concentration pre- and postoperatively in the tear fluid of 50 eyes using a ELISA test. The preoperative refraction was between -2.00 and -10.00 dioptres. The maximum follow-up was 6 months. Preoperatively, in all eyes the EGF concentration in the tear fluid was between 0.2 and 1.7 ng/ml. In contrast, 1 week postoperatively, these values increased (0.21-22.50 ng/ml); 4 weeks postoperatively, the EGF concentration was in all eyes back to preoperative levels. In eyes with high EGF tear fluid concentration 1 week after surgery, refraction at 6 months was outside the intended correction of +/- 1.0 D. We could not find any correlation between EGF concentration and "corneal haze". EGF may play an important role in postoperative wound healing after excimer laser PRK. Investigations concerning a pharmaceutical control of EGF should be undertaken.


Peripheral arterial disease in non-diabetics: don't miss vasculopathy of specific etiology--non atherosclerotic (VSE-NA) in young patients.
To find out the proportion of non-diabetic peripheral arterial disease (PAD) attributable to systemic connective tissue diseases (CTD) or thrombophillic states as etiology and to identify clinical and laboratory features that would point towards systemic disease other than atherosclerosis. We studied the etiology of PAD in 45 non-diabetic patients in a tertiary health care center in Mumbai prospectively from January 2004- December '07. History, clinical examination haemogram, routine biochemistry, lipid profile, serological tests for connective tissue diseases and vasculitis, tests for prothrombotic state, vascular Doppler and 2D echo were performed in all cases. Angiography, CT scan and biopsy were done wherever necessary. We classified etiology of PAD as Gr I] Possibly Atherosclerosis OR Idiopathic, Gr II] Vasculopathy of specific etiology--Non Atherosclerotic (VSE-NA): this included patients with CTD and thrombophillic states. We tried to identify clinical and laboratory features, that would differentiate VSE-NA (Gr II)from the other group (Gr I). There were 24 females, 21 males, age 18 to 70 years (average 45). Sixteen patients presented with UE (upper extremity) gangrene, 22 with LE (lower extremity) gangrene and 7 with both UE and LE gangrene. VSE-NA was detected in 44.4% of patients, 28.9% were possibly due to atherosclerosis and 26.6% were idiopathic. In VSE-NA group, 28.9% were due to CTD and vasculitis and 15.6% due to thrombophillias (2 APLA, 4 hyperhomocysteinaemia, 1 hyperviscosity due to multiple myeloma). In the CTD and vasculitis group (N = 13), 9 (20%) were due to vasculitis (5 ANCA-associated vasculitis and 4 ANCA negative vasculitis. Out of 31 surgical referrals, 38.7% were VSE-NA whereas 57.14% of 14 medical patients were attributed to VSE-NA. Younger age of onset (< 41 yr), fever, weight loss, multiple limb involvement, anemia, high ESR, abnormal urine routine- proteinuria and RBCs all point towards a systemic connective tissue disorder. High index of suspicion, detailed investigations to detect VSE-NA in non-diabetic patients with PAD is important, as all these conditions have specific treatment.


Visualization of Cancer and Cardiovascular Disease Co-Occurrence With Network Methods.
Cancer and cardiovascular disease (CVD) are common causes of morbidity and mortality, and measurement and interpretation of their co-occurrence rate have important implications for public health and patient care. Here, we present the raw and adjusted co-occurrence rates of cancer and CVD in the overall population by using a visually intuitive network approach. By using baseline survey and linked health outcome data from 490,842 individuals age 40 to 69 years from the UK Biobank, we recorded diagnoses between 1997 and 2014 of specific cancers and specific CVDs ascertained through hospital claims. We measured raw and adjusted rates of CVD for the following groups: individuals with Hodgkin or non-Hodgkin lymphoma, lung and trachea cancer, uterus cancer, colorectal cancer, prostate cancer, breast cancer, or no recorded diagnosed cancer during this time period. Analysis accounted for age, sex, and behavioral risk factors, without regard to the order of occurrence of cancer and CVD. A significantly increased rate of CVD was found in patients with multiple types of cancers, including Hodgkin and non-Hodgkin lymphoma and lung and trachea, uterus, colorectal, and breast cancer, compared with patients without cancer by using age and sex-adjusted models. Increased co-occurrence for many CVD categories remained after correction for behavioral risk factors. Construction of co-occurrence networks highlighted heart failure as a shared CVD diagnosis across multiple cancer types, including breast cancer, lung cancer, non-Hodgkin lymphoma, and colorectal cancer. Smoking, physical activity, and other lifestyle factors accounted for some but not all of the increased co-occurrence for many of the CVD diagnoses. Increased co-occurrence of several common CVD conditions is seen widely across multiple malignancies, and shared diagnoses, such as heart failure, were highlighted by using network methods.


Synthetic studies on (+)-manzamine A: stereoselective synthesis of the tetracyclic core framework.
The stereoselective synthesis of the tetracyclic intermediate 3 for (+)-manzamine A (1) has been achieved. The key features of this stereoselective synthesis of 3 are the Rh-catalyzed asymmetric hydrogenation and a diastereoselective intermolecular Diels-Alder reaction. The 8-membered ring is efficiently constructed utilizing our Ns-strategy.


Ten ways HMOs have changed during the 1990s.
The same forces that encouraged the expansion of managed care also brought about change in health maintenance organizations (HMOs). Using data from annual surveys of the Association of American Health Plans and other sources, this paper examines ten major changes in the HMO industry during the 1990s, including the growth of for-profit plans and the relative decline of nonprofits; the shift from vertically integrated group/staff models to virtually integrated individual practice associations/network models; industry consolidation through mergers and acquisitions; increased patient cost sharing; and the shift to capitation payment of primary care physicians. Current research is unable to show whether these changes have led to improved quality of care or patient satisfaction.


Corticosteroids therapy in pediatric acute respiratory distress syndrome.
The use of corticosteroids in acute lung injury and acute respiratory distress syndrome is one of the most controversial issues in the literature. However, acute lung injury/acute respiratory distress syndrome studies are restricted to adults, despite the widespread use of corticosteroid for hyper-reactive respiratory airway diseases in children. This review aimed to describe experimental and clinical evidence for corticosteroid therapy in acute lung injury/acute respiratory distress syndrome and to point out the risks and benefits of its use in pediatrics. For this purpose, an extensive review of the literature was performed from 1980 to 2010 including both experimental and clinical papers, as well as reviews and meta-analysis, using Medline, Cochrane Central Register of Controlled Trials, Cochrane database of systematic reviews, SciELO, Lilacs and Bireme databases. The search terms were: acute lung injury, acute respiratory distress syndrome, steroids, child, clinical trials, meta-analyses, reviews, and case reports. Most studies showed that the corticosteroids-induced down-regulation of systemic inflammatory response is associated with oxygenation improvement, reduction of multiple organ dysfunctions, mechanical ventilation time, and intensive care units length of stay. Based on the literature, the authors suggest early and prolonged methylprednisolone administration for acute lung injury/acute respiratory distress syndrome, using continuous 1 mg/kg/day infusion to prevent glycemic variability, associated with strict infection surveillance. In addition, they recommend some diagnostic parameters, interventions and choices of endpoint variables to be adjusted to improve pediatric trials feasibility. Therefore, more research is required to establish the safety and efficacy of methylprednisolone in pediatric patients with acute lung injury/acute respiratory distress syndrome , as well as to determine the best parameters for monitoring steroid side effects and outcomes.


Report of workshop on traffic, health, and infrastructure planning.
Recent air pollutant measurement data document unique aspects of the air pollution mixture near roadways, and an expanding body of epidemiological data suggests increased risks for exacerbation of asthma and other respiratory diseases, premature mortality, and certain cancers and birth outcomes from air pollution exposures in populations residing in relatively close proximity to roadways. The Workshop on Traffic, Health, and Infrastructure Planning, held in February 2004, was convened to provide a forum for interdisciplinary discussion of motor vehicle emissions, exposures and potential health effects related to proximity to motor vehicle traffic. This report summarizes the workshop discussions and findings regarding the current science on this issue, identifies planning and policy issues related to localized motor vehicle emissions and health concerns, and provides recommendations for future research and policy directions.


68Ga-Pentixafor PET/CT Imaging of Chemokine Receptor CXCR4 in Chronic Infection of the Bone: First Insights.
Because of its role in infection and inflammatory processes, the chemokine receptor CXCR4 might be a potent target in imaging of infectious and inflammatory diseases. The aim of this pilot study was to determine whether the CXCR4 ligand 68Ga-pentixafor is suitable for imaging chronic infection of the bone. Methods: The study comprised 14 patients with suspected infection of the skeleton who underwent 68Ga-pentixafor PET/CT between April 2015 and February 2017 in our facility. 68Ga-pentixafor PET/CT results were retrospectively evaluated against a histologic, bacteriologic, and clinical standard. The results were also compared with available bone scintigraphy, white blood cell scintigraphy, and 18F-FDG PET/CT results. Results:68Ga-pentixafor PET/CT was positive in 9 of 14 patients. Diagnoses included osteitis or osteomyelitis of peripheral bone, osteomyelitis of the maxilla, and infected endoprostheses. Target-to-background ratios were 5.1-15 (mean, 8.7). Eight of 9 cases were true-positive as confirmed by pathology, bacteriology, or clinical observation. All negative cases were confirmed as true-negative by other imaging modalities and follow-up. Conclusion: Imaging of CXCR4 expression with 68Ga-pentixafor PET/CT appears suitable for diagnosing chronic infection of the skeleton. The findings of this study reveal a possible diagnostic gain in suspected chronic infections that are difficult to diagnose by other imaging modalities.


Gender differences in dually-diagnosed clients receiving chemical dependency treatment.
This article considers gender differences among 97 clients with dual diagnoses of severe mental illness and chemical dependency (46 male and 51 female). Comparisons are made at the time of their admission to an inpatient chemical dependency treatment program and at follow-up in cases where data are available. Many of the findings at time of admission are consistent with the few studies that have compared men and women with co-occurring mental and substance use disorders. For example, the women were more likely to have experienced emotional, physical, or sexual abuse, and they reported being charged with fewer types of crimes. Most differences at admission concerned psychiatric problems and family/social relations. Women reported that they were more bothered by their psychiatric symptoms and their family/social relations, but they also reported more happiness and closeness in some relationships. The women also said they had more relatives with alcohol, drug, and especially psychiatric, problems. At follow-up, gender differences in the family/social and psychiatric domains persisted. Findings suggest that men and women with dual diagnoses might benefit from different emphases in treatment programs.


[Effect of continuous gamma-radiation at low doses on clonogenic hemopoietic (CFU-S) and stromal (CFU-F) bone marrow cells ].
We studied the effects of low doses of continuous gamma-irradiation (Co60, 10 days, mean daily dose power 1.5-2.0 mGy, total dose 15 mGy) on hemopoietic and stromal progenitor cells of murine bone marrow. The content of hemopoietic clonogenic cells representing a "younger" (CFU-S-11) and more "mature" (CFU-S-7) categories in the compartment of stem cells was determined in the bone marrow. The state of bone marrow stroma was estimated by the method of in vitro cloning according to the number of progenitor cells that form colonies of fibroblasts (CFU-F) and by the method of ectopic transplantation according to the capacity of stroma of organizing and building new hemopoietic territories. Continuous gamma-irradiation at low doses, that were by one order of magnitude lower than those inducing hermesis, exerted a stimulating effect on both hemopoietic (CFU-S) and stromal (CFU-F) progenitor cells. The number of CFU-S in the compartment of stem cells of the bone marrow markedly increased and they formed larger hemopoietic territories but these cells appeared to create a qualitatively different microenvironment, which stimulated the proliferation of CFU-S.


Cervical cytology screening in Vietnamese asylum seekers in a Hong Kong detention center. Population demographics and historical perspectives.
To provide a brief review of the history and demographics of the Vietnamese asylum-seeking population in Hong Kong and their possible effects on the initiation of a cervical cytology screening program at a Hong Kong detention center. Analysis of case histories, questionnaires and interviews with women in a detention center identified demographic features related to Pap smear history, knowledge of the Pap test, age at first intercourse and cigarette smoking status among women aged 17 years and over. Analysis of Pap smear uptake following initiation of a screening program was undertaken. Of the 1,171 women in the detention center who were eligible for a Pap smear, 536 (45.8%) actually obtained one, although enrollment, which was strong at the initial offering, slowed considerably as the program progressed. None of the women had had a Pap smear prior to leaving Vietnam. Knowledge of the utility and risk status criteria for Pap testing was very limited. The majority (77.9%) of the subjects started sexual activity after age 20 years, and three (0.6%) smoked. There were four (0.2%) abnormal smears identified among those tested. Convincing evidence was obtained that the Pap test was not widely used in Vietnam among the asylum-seeking population, and its role in preventing cervical cancer was not well known to the women studied. The initial strong uptake of the Pap smear was not maintained. That may be attributable to psychosocial factors associated with detention under harsh conditions and trauma associated with fleeing Vietnam.


Magnetism at the Interface of Magnetic Oxide and Nonmagnetic Semiconductor Quantum Dots.
Engineering interfaces specifically in quantum dot (QD) heterostructures provide several prospects for developing multifunctional building block materials. Precise control over internal structure by chemical synthesis offers a combination of different properties in QDs and allows us to study their fundamental properties, depending on their structure. Herein, we studied the interface of magnetic/nonmagnetic Fe3O4/CdS QD heterostructures. In this work, we demonstrate the decrease in the size of the magnetic core due to annealing at high temperature by the decrease in saturation magnetization and blocking temperature. Furthermore, surprisingly, in a prominently optically active and magnetically inactive material such as CdS, we observe the presence of substantial exchange bias in spite of the nonmagnetic nature of CdS QDs. The presence of exchange bias was proven by the increase in magnetic anisotropy as well as the presence of exchange bias field (HE) during the field-cooled magnetic measurements. This exchange coupling was eventually traced to the in situ formation of a thin antiferromagnetic FeS layer at the interface. This is verified by the study of Fe local structure using X-ray absorption fine structure spectroscopy, demonstrating the importance of interface engineering in QDs.


Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia.
Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.


Anisakiasis, an underestimated infection: effect on intestinal permeability of Anisakis simplex-sensitized patients.
Anisakis simplex is a parasite that, if present in uncooked and contaminated saltwater fish, can invade the human gut. Two different clinical situations are recognized: the first, known as a gastrointestinal disease, varying from an asymptomatic episode to vomiting and diarrhea, and the second, classified as an adverse reaction to food, characterized by a wide spectrum of allergic reactions like rhinitis, conjunctivitis, or even anaphylaxis causing hypotension and/or shock. The intestinal epithelium, the major defense system against external molecules, represents an open gate for toxins and allergens if its protective function is compromised. Previous data have demonstrated a strict relationship between an altered intestinal permeability (I.P.) and worsening of the clinical manifestations in patients with adverse reactions to the food. In this article we evaluated the sensitization to A. simplex among patients who referred clinical symptoms of allergy. All subjects underwent commonly used alimentary skin prick test for food allergens, to which Ani s1, an A. simplex allergen, was added. In addition, in A. simplex-sensitized subjects, I.P. was determined upon their enrolment to the study (time 0) and after 6 months of consuming a raw fish-free diet (time 6). Five hundred and forty subjects were screened, and 170 had a positive skin prick test, 87 (51.2%) of whom were positive to Ani s1. Increased I.P. was evidenced in A. simplex-sensitized subjects with worse clinical symptoms, which receded after 6 months' elimination of raw seafood. With our data we demonstrated that the alimentary habit to eat raw fish represents a high risk for the integrity of the intestinal mucosa, and we suggest that this pathological situation may constitute an ideal, under-estimated, open gate for molecules that predispose to other, more important pathologies.


Lipid Nanoparticles: A Novel Gene Delivery Technique for Clinical Application.
Lipid nanoparticles (LNPs) are an emerging vehicle for gene delivery that accommodate both nucleic acid and protein. Based on the experience of therapeutic liposomes, current LNPs have been developed based on the chemistry of lipids and RNA and on the biology of human disease. LNPs have been used for the development of Onpattro, an siRNA drug for transthyretin-mediated amyloidosis, in 2018. The subsequent outbreak of COVID-19 required a vaccine for its suppression. LNP-based vaccine production received much attention for this and resulted in great success. In this review, the essential technology of LNP gene delivery has been described according to the chemistry for LNP production and biology for its clinical application.


The making of an endocrinologist in India: Life and times at Institute of Post Graduate Medical Education and Research Calcutta.
Endocrinology is relatively one of the newer super-specialties of internal medicine. Following higher secondary schooling, it takes anywhere between 13 and 18 years to become a super-specialist in India, which holds true for endocrinology also. This article intends to highlight the life and the journey of making an endocrinologist in India, through personal experiences, focusing on Institute of Post Graduate Medical Education and Research (IPGMER) Calcutta, the largest super-specialty teaching hospital and research institute of Eastern India. In general, there is lack of adequate exposure to endocrinology during the Bachelor of Medicine, Bachelor of Surgery and MD Internal Medicine Training in India. Pre-Doctorate of Medicine (DM) senior residency goes a long way in developing an orientation for endocrinology. Endocrinology DM entrance examinations are usually a rigorous intimidating affair. Endocrinology training at IPGMER was a heady mix of managing huge number of patients with diverse endocrinopathies, laboratory work, academic presentations, and clinical research. The support and back up provided by the entire faculty enhanced the learning process. As I look back, the 3 years of DM residency flew by like the wink of the eye. The journey of endocrinology is the journey of a lifetime.


[Development of novel methodology for rapid conjugated oligosaccharide synthesis].
Glycosylation is one of the most important post-translation modifications of proteins, which affects biological activities by way of controlling higher order structure. Recently, the novel structure of glycoprotein, namely C-glycosyl protein was identified in various proteins. The first total synthesis of the naturally occurring C-glycosyl amino acid and peptide was achieved. The mannose and tryptophan moiety was connected via ring opening reaction of epoxide by lithiated indole derivative. After functional group conversion and deprotection, the glyco-amino acid was synthesized in a concise and stereoselective manner. To develop the rapid oligosaccharide construction methodology, the soluble polymer supported oligosaccharide was investigated. Due to high polarity of polymer support, the purification of PEG bound compound is achieved quite easily. The real-time monitoring of the glycosylation reaction was performed by MALDI-TOF MS, whereas the deprotection reaction of chloroacetyl group was performed by color test using (p-nitrobenzyl) pyridine. The purification of PEG bound compound which has chloroacetyl group, is achieved by capture-release strategy by use of resin bound cysteine derivative. By combination of these methodologies and novel linker, tetrasaccharides were synthesized.


Role of protease-activated receptors in the vascular system.
Thrombin is one of the key molecules involved in the development of vascular diseases. Thrombin does not only serve as a coagulation factor, but it also exerts cellular effects by activating protease (proteinase)-activated receptors (PARs), a family of seven-transmembrane G protein-coupled receptors. This study focused on the role of PARs in the vascular system. Among the four members so far identified, PAR-1 and PAR-2 were found to play an important role in the vascular system, while the functional roles of PAR-3 and PAR-4 appear to be mostly limited to platelets. The endothelial cells play a primary role in mediating the vascular effects of PARs under physiological conditions, while PARs of the smooth muscle cells can be induced under pathological conditions, and therefore play a more pathophysiological role. PAR-1 and PAR-2 mediate various vascular effects including regulation of vascular tone, proliferation and hypertrophy of smooth muscle and angiogenesis. Since proteases are activated under pathological conditions such as hemorrhage, tissue damage, and inflammation, PARs are suggested to play a critical role in the development of functional and structural abnormality in the vascular lesion. Understanding the functional role of PARs in the vascular system can thus help in the development of new strategies for the prevention and therapy of vascular diseases.


Monolithic Flexible Supercapacitors Integrated into Single Sheets of Paper and Membrane via Vapor Printing.
A novel approach to fabricate supercapacitors (SCs) via vapor printing, specifically oxidative chemical vapor deposition (oCVD), is demonstrated. Compared to stacking multiple layers into a SC, this method enables the monolithic integration of all components into a single-sheet substrate, minimizing the inactive materials and eliminating the possibility of multilayer delamination. Electrodes comprised of pseudocapacitive material, poly(3,4-ethylenedioxythiophene) (PEDOT), are deposited into both sides of a sheet of flexible porous substrate. The film deposition and patterning are achieved in a single step. The oCVD PEDOT penetrates partially into the porous substrate from both surfaces, while leaving the interior of the substrate serving as a separator. Near the surface, the PEDOT coating conforms to the substrate's structure without blocking the pores, resembling the substrate's intrinsic morphology with high surface area. The porously structured PEDOT coating, paired with in situ ion gel electrolyte synthesis, gives enhanced electrode-electrolyte interfaces. The monolithic device demonstrates high volumetric capacitance (11.3 F cm-3 ), energy density (2.98 mWh cm-3 ), and power density (0.42 W cm-3 ). These outstanding performance metrics are attributed to the large loading of active materials, minimization of inactive materials, and good electrode-electrolyte interfaces. SC arrays can be printed on a single substrate without the use of wire interconnects.


Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction.
A substantial subset of patients after myocardial infarction (MI) discontinue pivotal medication early after discharge. In particular, cessation of antiplatelet treatment may lead to catastrophic ischemic events. Thus, adherence to prescribed medication in patients after MI is an issue of medical and social concern. The aim of the study was to evaluate the level of adherence to treatment using a newly developed scale in patients after MI treated with percutaneous coronary intervention. A single-center, prospective, observational cohort clinical study with a 6-month follow-up was performed. Patients with physical or cognitive impairment, prisoners, soldiers, and family members and coworkers of the researchers were excluded from the study. The impact of selected sociodemographic and clinical factors on adherence was evaluated in 221 patients (63 women and 158 men) aged 30 to 91 years. The results obtained with the Adherence in Chronic Diseases Scale (ACDS) ranged from 7 to 28 points; with the average and median scored being 23.35 and 24, respectively. The ACDS score reflects the level of adherence to prescribed medication. The high ACDS scores (>26 points) were obtained in 59 (26.7%) patients, intermediate scores (21-26 points) in 110 (49.8%) and low scores (<21 points) in 52 subjects (23.5%). Acute coronary syndrome (re-ACS) occurred in 18 (8.1%) patients during the follow-up period. The high-level adherence (ACDS score >26 points) was found in 11.1% of patients with re-ACS vs 28.4% of the remaining ones (P=0.1). Lower scores (mean ± standard deviation) in re-ACS patients were found for items 2 and 3 of the ACDS: 3.11±0.68 vs 3.45±0.73 (P=0.02) and 3.28±0.89 vs 3.64±0.64 (P=0.04), respectively. Age and previous MI were found to be independent factors influencing adherence assessed with the ACDS.


AL-aided AMC in a multi-user white-light OFDMA VLC system over a light-diffusing fiber loop.
To develop an adaptive modulation scheme for flexible high-speed multi-user visible light communication (VLC), automatic modulation classification (AMC) is adopted for monitoring the modulation formats of different subcarrier groups. An AMC scheme based on a joint convolutional neural network (CNN), active learning (AL), and data augmentation (DA) is demonstrated over an orthogonal frequency division multiplexing access (OFDMA) VLC system. The configuration of the diffuse white-light VLC system is combined with a pair integrated transceiver module, a light-diffusing fiber (LDF), and a wireless channel, which can provide white-light illumination and ubiquitous access. Within the forward error correction (FEC) threshold, the data rates of the white-light VLC links can reach 325.5 Mbps with a bit error rate (BER) of 2.163 × 10-3. An experiment with two-user access via the proposed VLC link with an unequal bandwidth allocation was demonstrated. The performance of the AL-aided CNN AMC scheme also shows a classification accuracy rate of 95.48% for the constellation diagrams of different subcarriers of the OFDMA signal over 240 training samples and faster convergence than a CNN-based AMC.


Comparison of thoracic epidural pressure in the sitting and lateral decubitus positions.
The hanging drop technique identifies the epidural space using the negative pressure of this space. Although the hanging drop technique is popular at the thoracic level, there is still controversy on the negative epidural pressure at this level. The authors hypothesized that the epidural pressure is more consistently negative in the sitting position than in the lateral decubitus position at the thoracic level. This study compared the epidural pressures of 28 awake patients in the sitting (sitting group, n = 14) or lateral decubitus (lateral group, n = 14) position. The T5-T6 epidural pressure was measured using a closed pressure measurement system connected to a Tuohy needle. All of the thoracic epidural pressures in the sitting group were negative (median, -5 mmHg; range, -18 to -1; mean, -7.2; SD, 6.3), in contrast to the lateral group (median, 5 mmHg; range, -4 to 13; mean, 5.1; SD, 4.4). The thoracic epidural pressure in the sitting group was significantly lower than in the lateral group (P < 0.001). The thoracic epidural pressure is more negative in the sitting position than in the lateral decubitus position. These results suggest that the patient should be sitting when the hanging drop technique is used to identify the epidural space.


Configurational temperature in active matter. II. Quantifying the deviation from thermal equilibrium.
This paper proposes using the configurational temperature T_{conf} for quantifying how far an active-matter system is from thermal equilibrium. We measure this "distance" by the ratio of the systemic temperature T_{s} to T_{conf}, where T_{s} is the canonical-ensemble temperature for which the average potential energy is equal to that of the active-matter system. T_{conf} is "local" in the sense that it is the average of a function, which depends only on how the potential energy varies in the vicinity of a given configuration. In contrast, T_{s} is a global quantity. The quantity T_{s}/T_{conf} is straightforward to evaluate in a computer simulation; equilibrium simulations in conjunction with a single steady-state active-matter configuration are enough to determine T_{s}/T_{conf}. We validate the suggestion that T_{s}/T_{conf} quantifies the deviation from thermal equilibrium by data for the radial distribution function of the 3D Kob-Andersen and 2D Yukawa active-matter models with active Ornstein-Uhlenbeck and active Brownian Particle dynamics. Moreover, we show that T_{s}/T_{conf}, structure, and dynamics of the homogeneous phase are all approximately invariant along the motility-induced phase separation boundary in the phase diagram of the 2D Yukawa model. The measure T_{s}/T_{conf} is not limited to active matter and can be used for quantifying how far any system involving a potential-energy function, e.g., a driven Hamiltonian system, is from thermal equilibrium.


Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study.
IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs). Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/: 619, m/f: 317/302, mean age at presentation: 38.3 years, average disease duration: 11.2 years; Crohn's disease/CD/: 254, m/f: 125/129, mean age at presentation: 32.5 years, average disease duration: 9.2 years). Intestinal, extraintestinal signs and laboratory tests were monitored regularly. Any alteration suggesting an EIMs was investigated by a specialist. A total of 21.3% of patients with IBD had EIM (UC: 15.0%, CD: 36.6%). Age at presentation did not affect the likelihood of EIM. Prevalence of EIMs was higher in women and in CD, ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC. In UC there was an increased tendency of EIM in patients with a more extensive disease. Joint complications were more frequent in CD (22.4% vs UC 10.2%, P<0.01). In UC positive family history increased the risk of joint complications (OR:3.63). In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028). PSC was present in 1.6% in UC and 0.8% in CD. Dermatological complications were present in 3.8% in UC and 10.2% in CD, the rate of ocular complications was around 3% in both diseases. Rare complications were glomerulonephritis, autoimmune hemolytic anaemia and celiac disease. Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries. The high number of EIM supports a role for complex follow-up in these patients.


[Collagen powder: hydrocolloidal dressings. Their effectiveness in radiodermatitis].
The authors analyze the effectiveness of a collagen cicatrizant powder for use in treating radiodermatitis compared with extra fine hydrocolloidal dressings by evaluating skin lesions according to the Radiation Therapy Oncology Group (RTOG) intensity scale. As the same time, the authors evaluate the patient's opinion regarding the treatment he/she receives. This study was carried out in the Valladolid University Clinical Hospital's Department of Radiotherapy. This study showed that the Catrix brand dressing is more effective than hydrocolloidal dressings as a treatment of lesions caused by radiodermatitis. Both the nursing personnel and patients involved in this study rated this Catrix product higher than those hydrocolloidal dressings products tested.


[Lemierre's syndrome following peritonsillar abscess].
Lemierre's syndrome is a rare but serious condition, characterized by disseminated infection with Fusobacterium necrophorum, most often originating from the oropharynx. Thrombophlebitis of the internal jugular vein and septic embolisms to various organs is the typical clinical picture. We describe a 16-year-old man with peritonsillar abscess who developed abscesses in lungs, liver and spleen. The patient was admitted to the ICU and treated with surgical drainage of infectious foci, antibiotics and anticoagulant therapy. After six weeks of antibiotic treatment the patient was discharged with no sequelae.


Did I make the grade? Ethical issues in psychosocial screening of children for adoptive placement.
This article suggests that psychological evaluations as a "screen for normalcy" with a view to adoption are a breach of the child's right to psychological integrity and privacy under international human rights law. A foreseeable outcome of such psychological screens, especially for the older foster child who has experienced multiple placements, is an unreliable mental health diagnosis. Normal, albeit maladaptive, potentially modifiable coping strategies arising in the context of family disruption come after the psychological screen to be labeled as an indicator of mental disorder. This, in turn, may inappropriately interfere with the child's adoption prospects. It is suggested that psychological screens for normalcy of preadoptive children represent a misuse both of psychology and psychiatry for they are motivated more by the needs and interests of social institutions involved in the adoption process rather than those of the child.


Advances in pediatric oncology MRI.
Refined stratification of disease is thought to result in better survival from childhood malignant disease while minimizing the adverse effects of anticancer therapies. There is a potential for magnetic resonance imaging (MRI) to contribute to such stratification by improved tissue characterization, anatomical depiction, staging, and assessment of early treatment response. Recent advances in pediatric MRI outside the central nervous system (CNS) are reviewed in this context. The focus is on new applications for conventional MRI and on clinical implementation of tissue-specific and quantitative techniques. This area is largely unexplored, and potential directions for research are indicated.