Effect of pancreatectomy or adrenalectomy on the responses of rats to meal-feeding.
The effects of partial pancreatectomy or adrenalectomy and insulin or corticosterone replacement on the responses of rats to meal-feeding were studied. Partial pancreatectomy lowered glucose-6-phosphate dehydrogenase (G6PD) and malic enzyme (ME) activities and resulted in higher blood glucose levels. Partial pancreatectomy did not affect the ability of the animals to adapt to meal-feeding. Insulin supplementation of the pancreatectomized rats restored G6PD and ME activities to those observed in the intact animals and normalized the blood glucose levels in the ad libitum-fed rats. Adrenalectomy decresed the survival of rats subjected to meal-feeding. Eighty percent of the rats died when meal-fed a high glucose diet. Survival was improved when either a 66.5% starch diet or a 40.5% fat diet was substituted for the 66.5% glucose diet. Adrenalectomized meal-fed animals fed 66.5% glucose had higher G6PD and ME activities and higher liver lipid levels than both the adrenalectomized ad libitum-fed and the sham-operated meal-fed rats. Glucocorticoid supplementation lowered G6PD activity in the adrenalectomized meal-fed rats but had no effect on ME activity or liver lipid. Meal-fed adrenalectomized rats had lower liver and serum cholesterol levels than meal-fed intact rats and ad libitum-fed adrenalectomized rats. These cholesterol levels were increased with glucocorticoid supplementation. It was concluded that adaptation to meal-feeding involves an adrenal response to the periodic absence of dietary energy intake, and that the degree of involvement of this response is determined by the composition of the diet.


Regulation of the urinary excretion of endothelin in the rat.
The regulation of the urinary excretion of endothelin (UETV) and its clinical significance has not yet been established. The present study was designed to examine the effect of angiotensin II (A-II), arginine vasopressin (AVP), and nifedipine on UETV. Anesthetized Munich-Wistar rats were infused with low (50 ng/kg/min) and high (500 ng/kg/min) doses of A-II for 30 min. Both doses significantly increased UETV, from nondetectable (ND) levels to 155 +/- 54 (P < .03) and 450 +/- 86 fg/min (P < .001), respectively. This effect was accompanied by a significant increase in urine flow (UV), from 6 +/- 1 to 67 +/- 12 and 89 +/- 10 microL/min, and in mean arterial pressure (MAP), from 139 +/- 4 to 187 +/- 5 and 217 +/- 3 mm Hg. Infusions of A-II with its nonspecific antagonist, saralasin, resulted in a further increase in UETV to 647 +/- 126 and 782 +/- 117 fg/min (P < .002), respectively. However, infusion of A-II with its specific antagonist, losartan, completely blocked its stimulatory effect on UETV. Infusion of AVP, 10 or 100 mU/kg/h, produced increases in MAP, from 134 +/- 3 to 165 +/- 7 and 203 +/- 4 mm Hg, and in UV from 6 +/- 1 to 37 +/- 6 and 97 +/- 17 microL/min, comparable to A-II, but AVP did not have a marked effect on UETV.(ABSTRACT TRUNCATED AT 250 WORDS)


Long-term care of the patient with a tracheostomy.
An increasing number of technology-dependent patients are sent home for long-term home-management of stable chronic illness. With a patient who is going to undergo tracheotomy, patient-education (for the patient and his/her caregivers) should begin early (before the tracheostomy, if possible), should be individualized to the patient, and should include basic airway anatomy, medical justification for the tracheostomy, tube description and operation, signs and symptoms of respiratory and upper-airway distress, signs and symptoms of aspiration, suctioning technique, tracheostomy tube-cleaning and maintenance, stoma-site assessment and cleaning, cardiopulmonary resuscitation, emergency decannulation and reinsertion procedures, tube-change procedure, equipment-and-supply use and ordering procedures, and financial issues. There should be a scheduled follow-up plan with the attending physician. A combination of process-validation, through additional research, and expert consensus may be needed to standardize the long-term care of patients who undergo tracheostomy.


Management of the lateral neck in well differentiated thyroid cancer.
Lateral neck lymph node metastases in well differentiated thyroid cancer are common, ranging from 30% to 60%, with the majority of these foci identifiable only as microscopic deposits. A skilled ultrasound evaluation of the lymph nodes in the lateral neck is recommended for all patients presenting with newly diagnosed thyroid cancer undergoing surgical management. Ultrasound guided fine needle aspiration biopsy may be used to cytologically confirm suspected lateral neck nodal metastases prior to surgery. For patients with large volume nodal disease, extranodal extension, or multiple nodal metastases, computed tomography (CT) scan of the neck with contrast is an important additional imaging modality to accurately localize disease prior to surgery. Primary surgical management for lateral neck disease typically includes lateral neck dissection in conjunction with total thyroidectomy. Postoperative adjuvant radioactive iodine is typically recommended for patients with clinically evident nodal metastases, or for those with over 5 micrometastatic nodes. In the recurrent or persisting disease setting, complete surgical resection of local and regional disease remains the main treatment approach. However, sub-centimeter nodal disease may take an indolent course, and active surveillance may be a reasonable approach in selected clinical circumstances. Conversely, external beam radiation therapy (EBRT) may be considered for scenarios with unresectable disease, or microscopic residual disease following surgery in a clinically unfavorable setting. Two multi-kinase inhibitors (sorafenib and lenvatinib) are now FDA approved for treatment of RAI refractory thyroid cancer and now play an important role in the management of progressive, metastatic and surgically incurable disease.


Diagnostic yield of barium enema examination after incomplete colonoscopy.
To determine the diagnostic yield of barium enema examination for neoplastic lesions larger than 1 cm in diameter in the nonvisualized portion of the colon after incomplete colonoscopy. A review of computerized gastroenterology and radiology databases identified 355 patients who underwent incomplete colonoscopy; 158 (44.5%) underwent subsequent barium enema examination (125 double-contrast and 33 single-contrast barium enema examinations). The radiographic reports were reviewed and compared with the endoscopic reports by one author to identify neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy. Six such lesions were found. In all six cases, the images from the barium enema examinations were reviewed together by two authors to determine the size, location, and morphologic features (polypoid, ulcerated, or annular) of the lesions. Medical, endoscopic, and surgical records were subsequently reviewed by one author to determine whether these represented true- or false-positive radiographic findings. Barium enema examination depicted six possible lesions in the nonvisualized colon after incomplete colonoscopy; five were found to be true-positive radiographic findings, and one was found to be a false-positive finding. The five true-positive findings included two annular lesions (both adenocarcinomas) and three polypoid lesions (all tubulovillous adenomas, with high-grade dysplasia in one). Thus, neoplastic lesions larger than 1 cm were found on barium enema images in the nonvisualized colon in five (3.2%) of 158 patients after incomplete colonoscopy. Barium enema examination had a diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the nonvisualized colon after incomplete colonoscopy.


Penoscrotal swelling-an unusual occurrence in a patient with an anastomotic leak following ileostomy closure.
Diverting loop ileostomy is a frequently done procedure accompanying colorectal surgeries. Dreaded complication is anastomotic leak. Early identification of anastomotic leak and apt management is required for better outcomes. Most often leak presents with fever, abdominal pain, rigidity, fever and hemodynamic instability. We report a rare occurrence of penoscrotal oedema in a patient with anastomotic leak and spontaneously subsiding with drainage of leaked contents.


Multiplexed site-specific electrode functionalization for multitarget biosensors.
Multitarget biosensors hold great promise to improve point-of-care diagnostics as they enable simultaneous detection of different biomolecular markers. Multiplexed detection of different markers, like genes, proteins, or a combination of both, propels advancement in numerous fields such as genomics, medical diagnosis and therapy monitoring. The functionalization of these biosensors, however, necessitates patterned immobilization of different bioreceptors, which remains challenging and time-consuming. We demonstrate a simple method for the patterned multiplexing of bioreceptors on a multi-electrode chip. By using the lithographically defined electrodes for surface functionalization, additional patterning steps become obsolete. Using the electrodes for self-aligned immobilization provides a spatial resolution that is limited by the electrode patterning process and that cannot be easily obtained by alternative dispensing or coating techniques. Via electrochemical reduction of diazonium salts combined with click chemistry, we achieved site-specific immobilization of two different ssDNA probes side by side on a single chip. This method was experimentally verified by cyclic voltammetry (CV), Fourier transform infrared spectroscopy (ATR-FTIR) and X-ray photoelectron spectroscopy (XPS), and specific target recognition was visualized by fluorescence microscopy. The combination of the electroaddressability of electrografting with the chemoselectivity of click chemistry, offers a versatile platform for highly efficient site-specific functionalization of multitarget biosensors.


Tips to avoid nerve injury in elbow arthroscopy.
Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy.


Hearing loss: terminology and classification. Joint Committee of the American Speech-Language-Hearing Association and the Council on Education of the Deaf.
The following position statement and technical report were developed by the Joint Committee of the American Speech-Language-Hearing Association (ASHA) and the Council on Education of the Deaf (CED) and approved as Association policy by the ASHA Legislative Council in November 1997 (LC 6-97). CED member organizations are reviewing the document for approval in 1998. Joint Committee members responsible for the development of this document include (from ASHA) Joan Marttila, chair 1996-97; Linda Seestedt-Stanford, chair 1994-95; Evelyn Cherow, ex official; Donald Goldberg; Dawna Lewis; Leslie Ann McMillian; Jane Seaton; Alicia Stewart; and Larry Higdon, vice president for professional practices in audiology and monitoring vice president; and (from CED) Kathee Christensen; Steve Nover; Marilyn Sass-Lehrer; and Patrick Stone. This document supersedes ASHA policy: Definitions of Communication Disorders and Variations: Hearing Disorders section.


Assessment of Salivary Flow Rate and pH Among Areca Nut Chewers and Oral Submucous Fibrosis Subjects: A Comparative Study.
To assess and compare the salivary flow rate (SFR) and salivary pH among areca nut chewers, oral submucous fibrosis (OSMF) patients and apparently healthy individuals. A comparative study was conducted to assess and compare the SFR and pH among 135 outpatients (45 areca nut chewers + 45 OSMF + 45 control) at The Oxford Dental College and Research Hospital, Bangalore, India. Subjects were interviewed using structural proforma and Modified Schirmer strips and pH paper were implemented for assessing SFR and pH respectively. Statistical analysis was done using IBM SPSS ver. 21.0 software. A statistically significant increase in SFR (35.7 mm at 3rd minutes) among areca nut group and a decrease in SFR among OSMF group (23.4 mm at 3rd minutes) when compared to apparently healthy subjects (30.7 mm at 3rd minutes). The mean pH among areca nut, OSMF and control groups was 6.76, 6.82, and 6.74 respectively with no statistical significance. The observation and findings of the study clearly showed hypersalivation among areca nut group and hyposalivation among OSMF group, with no significant change in salivary pH when compared to healthy subjects.


Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis.
Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.


Novel pathogenic variant in LMNA gene identified in a six-generation family causing atrial cardiomyopathy and associated right atrial conduction arrhythmias.
To characterize the cardiac phenotype associated with the novel pathogenic variant (c.1526del) of LMNA gene, which we identified in a large, six-generation family. A family tree was constructed. The clinical data of living and deceased family members were collected. DNA samples from 7 family members were analyzed for LMNA mutations using whole-exome high-throughput sequencing technology. The clinical presentation of pathogenic variant carriers was evaluated. In this six-generation family (n = 67), one member experienced sudden death at the age of 40-years-old. Three pathogenic variant carriers were identified to possess a novel heterozygous deletion mutation in LMNA gene (HGVS: NM_170707.4, c.1526del) located at exon 9 of LMNA chr1:156137145, which creates a premature translational stop signal (p.Pro509Leufs*39) in the LMNA gene and results in an mutant lamin A protein product. The main symptoms of the pathogenic variant carriers were palpitation, fatigue, and syncope, which typically occurred around 20-years-old. AV-conduction block and non-sustained ventricular tachycardia were the first signs of disease and would rapidly progress to atrial standstill around 30-years-old. Significant right atrial enlargement and bicuspid aortic valve malformation was also commonly seen in patients who carried this pathogenic variant. The pathogenic variant of c.1526del p.P509Lfs*39 was a frameshift deletion located at exon 9 of LMNA chr1:156137145 and causes severe right atrial enlargement, sick sinus syndrome, atrial standstill, ventricular tachycardia, and bicuspid aortic valve malformation. Our findings expand the phenotypic spectrum of novel LMNA gene mutations.


On the genus Habrobathynella Schminke, 1973 (Crustacea, Malacostraca, Bathynellacea), with description of three new species from India.
The genus Habrobathynella Schminke, 1973 contains 16 species, 2 from Madagascar and 14 from the peninsular India. This is a remarkably species-rich genus when compared to the three other genera of the family Parabathynellidae known from India: Atopobathynella Schminke, 1973 (5 spp.), Chilibathynella Noodt, 1964 (1 sp.), and Parvulobathynella Schminke, 1973 (3 spp.). This paper provides a monographic treatment of Habrobathynella together with a detailed illustrated account of three new cavernicolous species, viz. Habrobathynella bose n. sp., Habrobathynella ernstmayr n. sp. and Habrobathynella raman n. sp., from the States of Andhra Pradesh and Telangana, India. For each of the already described species, the following details are provided: reference to original description, diagnosis, type data, type locality, distribution, ecology, co-occurrence with other species and remarks on taxonomic affinity. Distribution maps and a dichotomous key for identification of all species in Habrobathynella are provided. We also include a brief note on the biogeography and conservation status of the Indian bathynellaceans.


Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control.
Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves). The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program. Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed. Publication of trial results is anticipated in late 2016. Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual dates may be incorrect or unknown. The inclusion of ultrasound in areas where ultrasound capacity does not previously exist requires a significant investment of time and resources. Such investment ensures appropriate training, high quality images, and accurate dating pregnancies. We outline our ultrasound training, image acquisition, quality control, and dating protocols in detail. Clinicaltrials.gov NCT01335490; http://clinicaltrials.gov/ct2/show/NCT01335490 (Archived by WebCite at http://www.webcitation.org/6UbERJNO6).


In vivo-like nearest neighbor parameters improve prediction of fractional RNA base-pairing in cells.
We conducted a thermodynamic analysis of RNA stability in Eco80 artificial cytoplasm, which mimics in vivo conditions, and compared it to transcriptome-wide probing of mRNA. Eco80 contains 80% of Escherichia coli metabolites, with biological concentrations of metal ions, including 2 mM free Mg2+ and 29 mM metabolite-chelated Mg2+. Fluorescence-detected binding isotherms (FDBI) were used to conduct a thermodynamic analysis of 24 RNA helices and found that these helices, which have an average stability of -12.3 kcal/mol, are less stable by ΔΔGo37 ∼1 kcal/mol. The FDBI data was used to determine a set of Watson-Crick free energy nearest neighbor parameters (NNPs), which revealed that Eco80 reduces the stability of three NNPs. This information was used to adjust the NN model using the RNAstructure package. The in vivo-like adjustments have minimal effects on the prediction of RNA secondary structures determined in vitro and in silico, but markedly improve prediction of fractional RNA base pairing in E. coli, as benchmarked with our in vivo DMS and EDC RNA chemical probing data. In summary, our thermodynamic and chemical probing analyses of RNA helices indicate that RNA secondary structures are less stable in cells than in artificially stable in vitro buffer conditions.


Bioactive Self-Regulated Liquified Microcompartments to Bioengineer Bone-Like Microtissues.
Designing a microenvironment that drives autonomous stromal cell differentiation toward osteogenesis while recapitulating the complexity of bone tissue remains challenging. In the current study, bone-like microtissues are created using electrohydrodynamic atomization to form two distinct liquefied microcapsules (mCAPs): i) hydroxypyridinone (HOPO)-modified gelatin (GH mCAPs, 7.5% w/v), and ii) HOPO-modified gelatin and dopamine-modified gelatin (GH+GD mCAPs, 7.5%+1.5% w/v). The ability of HOPO to coordinate with iron ions at physiological pH allows the formation of a semipermeable micro-hydrogel shell. In turn, the dopamine affinity for calcium ions sets a bioactive milieu for bone-like microtissues. After 21 days post encapsulation, GH and GH+GD mCAPs potentiate autonomous osteogenic differentiation of mesenchymal stem cells accompanied by collagen type-I gene upregulation, increased alkaline phosphatase (ALP) expression, and formation of mineralized extracellular matrix. However, the GH+GD mCAPs show higher levels of osteogenic markers starting on day 14, translating into a more advanced and organized mineralized matrix. The GH+GD system also shows upregulation of the receptor activator of nuclear factor kappa-B ligand (RANK-L) gene, enabling the autonomous osteoclastic differentiation of monocytes. These catechol-based mCAPs offer a promising approach to designing multifunctional and autonomous bone-like microtissues to study in vitro bone-related processes at the cell-tissue interface, angiogenesis, and osteoclastogenesis.


Groundwater Pollution Sources Apportionment in the Ghaen Plain, Iran.
Although Iran's Ghaen Plain provides saffron to much of the world, no regional groundwater quality (GQ) assessment has yet been undertaken. Given the region's potential for saltwater intrusion and heavy metal contamination, it is important to assess the GQ and determine its main probable source of pollution (MPSP). Such knowledge would allow for informed mitigation or elimination of the potential adverse health effects of this groundwater through its use as drinking water, or indirectly as a result of the consumption of groundwater-irrigated crops. Total dissolved solids, sodium, and chloride in the water of the majority of 16 wells sampled within the region exceeded World Health Organization and Iranian permissible standards for drinking water. The groundwater proved to only be suitable for irrigating salt tolerant crops under good drainage conditions. Due to the precipitation of calcium carbonate in the water supply facilities, the water from all wells was deemed unsuitable for industrial purposes. Heavy metal pollution and contamination indices showed no groundwater contamination. Analysis of ionic ratios and the application of principal components analysis indicated the MPSP to be saltwater intrusion, with the geology subtending the plain, and to a lesser extent, anthropogenic activities. Reducing groundwater withdrawals, particularly those for agricultural production by using high performance irrigation methods could reduce saltwater intrusion and improve GQ in the Ghaen Plain.


Effect of Polydeoxyribonucleotide Injection in a Patient With Carpal Tunnel Syndrome.
Ultrasound-guided corticosteroid injection into the carpal tunnel is widely performed for the management of carpal tunnel syndrome. However, this injection may worsen the condition in patients with type 2 diabetes mellitus. Polydeoxyribonucleotide was recently recognized as a substitute for corticosteroid because of its anti-inflammatory effects. A 41-yr-old woman with type 2 diabetes mellitus was admitted to our rehabilitation clinic with a 1-mo history of numbness and tingling in her right hand and first three fingers tips. She declined corticosteroid treatment because of a previous episode of uncontrolled blood glucose levels after corticosteroid injection. Therefore, ultrasound-guided polydeoxyribonucleotide injections into the carpal tunnel were carried out. At the 6-mo follow-up, the patient demonstrated an improvement in the carpal tunnel syndrome symptoms without any complications. Thus, polydeoxyribonucleotide injections into the carpal tunnel can be an alternative to corticosteroid injections for carpal tunnel syndrome if there are limitations because of adverse effects of the latter.


Formation of 3,3'-diiodothyronine and 3',5',3-triiodothyronine (reverse T3) in thyroid glands of rats and in enzymatically iodinated thyroglobulin.
It was observed in the present investigation that labeled thyroxine (T4) comprised less than 2% of the total 131I in the thyroids of severely iodine-deficient rats labeled with 131I for 18-24 h, a much lower value than had previously been reported for iodine-deficient rats. This low value was attributable to two factors: 1) the use of a diet low enough in iodine content to produce extreme iodine deficiency, and 2) the use of a paper chromatography system that successfully separates T4 from the minor iodothyronines, 3,3'-diiodothyronine (T2) and 3',5',3-triiodothyronine (reverse T3; T3'). Formation of the minor iodothyronines, while low, becomes appreciable in relation to T4 formation in severe iodine deficiency. In the present study, the formation of labeled T2 was significant only in iodine deficiency, and the highest values were observed in the most severely iodine-deficient rats. In the latter, labeled monoiodotyrosine (MIT) comprised approximately 60% of the total 131I in the thyroid, and the increased formation of T2 could be attributed to the increased probability of coupling between two molecules of MIT. The formation of labeled T3', on the other hand, was significant in thyroids from both iodine-deficient and iodine-sufficient rats. Similarly, in thyroglobulin iodinated in vitro with thyroid peroxidase to varying levels of iodination, the formation of T2 was evident only at lower levels of iodination, whereas the formation of T3' was significant at all levels of iodination. The comparison of relative T3' and T4 formation in enzymatically iodinated thyroglobulin with corresponding values reported for the intermolecular (DIHPPA) model for T4 formation, indicates that the peroxidase model system simulates much more closely the relative formation of T3' and T4 seen in vivo.


Variation in hospital inpatient prices across small geographic areas.
To examine whether market competition may influence the difference in the inpatient price per discharge between public (Medicare) and private payers across small geographic areas. Retrospective multivariate analysis. Data came from the 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs) in 162 counties from 6 states where an HCUP price-to-charge ratio (PCR) was available. The SIDs were linked with the Area Resource File, American Hospital Association Annual Survey Database, and US Census Bureau data files. Hospital inpatient prices were estimated by applying the HCUP PCR to total hospital charges. Payer-specific price comparisons were made for all discharges, an acute condition (acute myocardial infarction), and an elective condition (knee arthroplasty). Ordinary least squares models were used to examine the effect of market competition on the inpatient price per discharge by payer. Greater geographic variation was found in the inpatient price per discharge among private than public payers for most hospital services. Hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. Hospitals charged significantly higher prices to private than public payers. Because the payment policies from Medicare ultimately affect private payers, public policy efforts that take into consideration market-based approaches or payment reform may help to reduce price variations.


The role of effector cells and antiserum in the inhibition of cell-mediated cytotoxicity of allogeneic tumor cells.
Previous experiments in this laboratory demonstrated a progressive decrease in cell-mediated cytotoxicity (CMC) against allogeneic tumor cells by immune spleen cells from mice repeatedly immunized with those tumor cells. In the present study, immune spleen cells, obtained at specified intervals during the course of multiple immunizations of BALB/c mice with EL-4 lymphoma cells, were tested for CMC against EL-4 target cells pretreated with anti-EL-4 serum which had been obtained from singly or repeatedly immunized animals. Cytolysis of EL-4 cells was measured by a 51Cr-release assay. The results indicate that blocking of CMC in an allogeneic tumor model may occur by two pathways. First, antigen or antigen-antibody complexes present in the immunized animal may bind in vivo to the antigen receptor sites of of sensitized effector cells that are used in the in vitro CMC assay, thereby blocking their interaction with tumor cells. Second, immune serum that is added to the in vitro CMC assay may contain highly avid antibodies, as well as antigen-antibody complexes, that bind to tumor cells and thereby block interaction with sensitized effector cells. The identification of these elements may be of prognostic significance in certain clinical situations.


Recent advances in the management of variceal bleeding.
Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients. It represents a medical emergency and is associated with a high morbidity and mortality. In those who survive the initial bleeding event, the risks of further bleeding and other decompensated events remain high. The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage. Liver cirrhosis is a multi-staged pathological process and we are moving away from a one-size-fits-all therapeutic approach. Instead there is an increasing recognition that a more nuanced approach will yield optimal survival for patients. This approach seeks to risk stratify patients according to their disease stage. The exact type and timing of treatment offered can then be varied to suit individual patients. At the same time, the toolbox of available therapy is expanding and there is a continual stream of emerging evidence to support the use of endoscopic and pharmacological therapies. In this review, we present a summary of the treatment options for a variety of different clinical scenarios and for when there is failure to control bleeding. We have conducted a detailed literature review and presented up-to-date evidence from either primary randomized-controlled trials or meta-analyses that support current treatment algorithms.


Histone methylases as novel drug targets: developing inhibitors of EZH2.
Post-translational modifications of histones (so-called epigenetic modifications) play a major role in transcriptional control and normal development, and are tightly regulated. Disruption of their control is a frequent event in disease. In particular, the methylation of lysine 27 on histone H3 (H3K27), induced by the methylase EZH2, emerges as a key control of gene expression and a major regulator of cell physiology. The identification of driver mutations in EZH2 has already led to new prognostic and therapeutic advances, and new classes of potent and specific inhibitors for EZH2 show promising results in preclinical trials. This review examines the roles of histone lysine methylases and demethylases in cells and focuses on the recent knowledge and developments about EZH2.


The association between occupational secondhand smoke exposure and life satisfaction among adults in the European Union.
Despite existing legislation, a large proportion of the European Union (EU) population is exposed to occupational secondhand smoke (SHS). The aim of this study was to explore associations between occupational exposure to SHS and self-reported life satisfaction. We analysed data collected through the Eurobarometer survey (wave 82.4) from n = 11,788 individuals working in indoor spaces. The sample was representative of the population of the 28 EU member states. We fitted a multilevel logistic regression model adjusting for smoking, age, gender, occupation, area of residence, education, difficulty paying bills, marital status and social class. 27.5% of those working indoors reported at least some occupational exposure to SHS. People exposed to occupational SHS were less likely to report that they were satisfied with the life they lead (adjusted Odds Ratio = 0.72, 95% Confidence Interval: 0.60-0.87). The effect of occupational exposure on life satisfaction did not differ by smoking status, with all interaction terms between smoking status and occupational exposure to SHS not statistically significant. Exposure to SHS at the workplace does not only have negative consequences on physical health, but it can also impact life satisfaction of smokers and non-smokers. Our findings highlight the need for stricter enforcement of smokefree environments at the workplace in the EU.


The role of percutaneous renal biopsy in the diagnosis and management of renal diseases in children.
We undertook a retrospective study to determine the proportion of patients in whom diagnostic and therapeutic changes were made as a result of renal biopsy. From April 1992 to March 1997, 111 renal biopsies were performed on 109 children aged 11 months to 18 years at our hospital. Adequate renal tissue was obtained in 106 cases (95.3%). Gross hematuria was observed in 12 cases (10.8%). Perirenal hematoma was found in 8 cases (7.2%) by ultrasound. A scoring system was designed to assess if diagnosis and therapy are affected as a result of renal biopsy. For diagnosis, the score was 0 when no additional information was obtained; 1 when the diagnosis was confirmed or ruled out; and 2 when the diagnosis was changed after biopsy or the pathologic findings provided a definite prognosis. For therapy, the score was 0 when the management was not changed after biopsy; 1 when the clinical diagnosis was confirmed and yielded a change in management; and 2 when the diagnosis and management were changed after biopsy. We found the benefit score for diagnosis was 0 in 2 (1.9%) of the 106 biopsied cases; 1 in 78 (73.6%), and 2 in 26 (24.5%). The benefit score for therapy was 0 in 62 (58.5%); 1 in 24 (22.6%); and 2 in 20 (18.9%). Therapeutic change always occurred in the biopsied patients with steroid resistant nephrotic syndrome and systemic diseases with renal involvement, and occasionally occurred in frequent relapsing nephrotic syndrome, steroid dependent nephrotic syndrome and asymptomatic proteinuria plus hematuria. It never occurred in patients with acute or chronic renal failure and hematuria. We conclude that renal biopsy is a safe and efficient procedure in pediatric patients. It can markedly change diagnosis and therapy, and can increase the likelihood for a more rational management of children with renal disease.


Efficacy of imidacloprid/permethrin and fipronil/(S)-methoprene combinations against Haemaphysalis longicornis ticks evaluated under in vitro and in vivo conditions.
Haemaphysalis longicornis is one of the most important ticks infesting a wide range of mammals including dogs in Japan. H. longicornis is recorded to be a vector of, for example, Babesia gibsoni. It was the aim of the study presented here to evaluate the efficacy of imidacloprid/permethrin and fipronil/(S)-methoprene against larval, nymphal and adult stages of H. longicornis under in vitro as well as in vivo conditions. In the in vitro part of the study, ticks showed avoidance behaviour to imidacloprid/permethrin-treated filter papers. The onset of acaricidal efficacy in the imidacloprid/permethrin group was recorded earlier than in the fipronil/(S)-methoprene group. In the in vivo experiment three beagles per group were treated with either imidacloprid/permethrin, fipronil/(S)-methoprene or left untreated. Each dog was infested with 30 adult female H. longicornis. Ticks were place on a shaved area of skin of the treated dogs and behaviour of the ticks was recorded as before. After 3 h all ticks were removed and placed in Petri dishes. Ticks were further examined until day 4 post-treatment (p.t.). All ticks recovered from the untreated dogs survived. At 4 h p.t. (1 h post-removal) 40 of the 90 ticks exposed to the imidacloprid/permethrin treatment and 25 of the 90 ticks in the fipronil/(S)-methoprene-treated group were found dead. At day 1 p.t., 61 ticks in the imidacloprid/permethrin- and 81 ticks in the fipronil/(S)-methoprene-treated group were recorded dead. At the final examination day 4 p.t., all 90 ticks were found dead in the imidacloprid/permethrin group, while five ticks remained alive in the fipronil/(S)-methoprene group.


De novo sequencing, characterization, and comparison of inflorescence transcriptomes of Cornus canadensis and C. florida (Cornaceae).
Transcriptome sequencing analysis is a powerful tool in molecular genetics and evolutionary biology. Here we report the results of de novo 454 sequencing, characterization, and comparison of inflorescence transcriptomes of two closely related dogwood species, Cornus canadensis and C. florida (Cornaceae). Our goals were to build a preliminary source of genome sequence data, and to identify genes potentially expressed differentially between the inflorescence transcriptomes for these important horticultural species. The sequencing of cDNAs from inflorescence buds of C. canadensis (cc) and C. florida (cf), and normalized cDNAs from leaves of C. canadensis resulted in 251799 (ccBud), 96245 (ccLeaf) and 114648 (cfBud) raw reads, respectively. The de novo assembly of the high quality (HQ) reads resulted in 36088, 17802 and 21210 unigenes for ccBud, ccLeaf and cfBud. A reference transcriptome for C. canadensis was built by assembling HQ reads of ccBud and ccLeaf, containing 40884 unigenes. Reference mapping and comparative analyses found 10926 sequences were putatively specific to ccBud, and 6979 putatively specific to cfBud. Putative differentially expressed genes between ccBud and cfBud that are related to flower development and/or stress response were identified among 7718 shared sequences by ccBud and cfBud. Bi-directional BLAST found 87 (41.83% of 208) of Arabidopsis genes related to inflorescence development had putative orthologs in the dogwood transcriptomes. Comparisons of the shared sequences by ccBud and cfBud yielded 65931 high quality SNPs between two species. The twenty unigenes with the most SNPs are listed as potential genetic markers for evolutionary studies. The data provide an important, although preliminary, information platform for functional genomics and evolutionary developmental biology in Cornus. The study identified putative candidates potentially involved in the genetic regulation of inflorescence evolution and/or disease resistance in dogwoods for future analyses. Results of the study also provide markers useful for dogwood phylogenomic studies.


Identification and interaction analysis of key genes and microRNAs in hepatocellular carcinoma by bioinformatics analysis.
Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide. However, present studies of its multiple gene interaction and cellular pathways still could not explain the initiation and development of HCC perfectly. To find the key genes and miRNAs as well as their potential molecular mechanisms in HCC, microarray data GSE22058, GSE25097, and GSE57958 were analyzed. The microarray datasets GSE22058, GSE25097, and GSE57958, including mRNA and miRNA profiles, were downloaded from the GEO database and were analyzed using GEO2R. Functional and pathway enrichment analyses were performed using the DAVID database, and the protein-protein interaction (PPI) network was constructed using the Cytoscape software. Finally, miRDB was applied to predict the targets of the differentially expressed miRNAs (DEMs). A total of 115 differentially expressed genes (DEGs) were found in HCC, including 52 up-regulated genes and 63 down-regulated genes. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses from DAVID showed that up-regulated genes were significantly enriched in chromosome segregation and cell division, while the down-regulated genes were mainly involved in complement activation, protein activation cascades, carboxylic acid metabolic processes, oxoacid metabolic processes, and the immune response. From the PPI network, the 18 nodes with the highest degree were screened as hub genes. Among them, ESR1 was found to have close interactions with FOXO1, CXCL12, and GNAO1. In addition, a total of 64 DEMs were identified, which included 58 up-regulated miRNAs and 6 down-regulated miRNAs. ESR1 was potentially targeted by five miRNAs, including hsa-mir-18a and hsa-mir-221. The roles of DEMs like hsa-mir-221 in HCC through interactions with DEGs such as ESR1 and CXCL12 may provide new clues for the diagnosis and treatment of HCC patients.


Sequence-selective targeting of duplex DNA by peptide nucleic acids.
Sequence-selective gene targeting constitutes an attractive drug-discovery approach for genetic therapy, with the aim of reducing or enhancing the activity of specific genes at the transcriptional level, or as part of a methodology for targeted gene repair. The pseudopeptide DNA mimic peptide nucleic acid (PNA) can recognize duplex DNA with high sequence specificity and affinity in triplex, duplex and double-duplex invasive modes or non-invasive triplex modes. Novel PNA modification has improved the affinity for DNA recognition via duplex invasion, double-duplex invasion and triplex recognition considerably. Such modifications have also resulted in new approaches to targeted gene repair and sequence-selective double-strand cleavage of genomic DNA.


Caprine enteritis associated with Yersinia pseudotuberculosis infection.
Yersiniosis was prevalent among a caprine herd during the late autumn of 2003 in Iwate Prefecture, Japan. The disease affected 29 of about 100 lactating goats, but not dried or nonparous goats, mature male goats or kids. Four animals died within an epidemic period of 20 days. Affected animals developed decreased milk production with subsequent watery diarrhea, neutrophilia with increased band forms and multiple microabscesses characteristic of yersiniosis in the intestinal mucosa from the jejunum to caecum as well as in the mesenteric lymph nodes. Y. pseudotuberculosis serotype III was isolated from intestinal contents and mesenteric lymph nodes. The organism was also cultured from clinically normal dried animals. The outbreak might have been precipitated by multiple stress factors, such as lactation, cold weather, Corynebacterium pseudotuberculosis infection resulting in abscess formation and tapeworm and coccidium parasitisms.


Upregulation of SPRR3 promotes colorectal tumorigenesis.
Hereditary colorectal cancer develops through a series of well-defined genetic and histological changes. However, elucidation of the canonical pathway based on hereditary colorectal cancer has not provided a clear explanation of the molecular mechanisms of sporadic colorectal cancer. To identify the alterative pathways involved in sporadic colorectal tumorigenesis, we performed gene expression analysis in patients with sporadic colorectal tumors. A comparison analysis of gene expression profiles revealed a pattern of upregulation of small proline rich repeat protein 3 (SPRR3) in tumor samples. SPRR3 has previously been reported to be downregulated in esophageal cancer. However, in the present study, we observed that SPRR3 was strongly upregulated in 31 of 35 samples of sporadic colorectal tumors (88%). We also determined that overexpression of SPRR3 not only accelerates colorectal cancer cell proliferation but also is associated with lymphovascular invasion in colorectal cancer. Moreover, AKT was activated and p53 levels were decreased in cells that overexpressed SPRR3. In contrast to the pattern seen in esophageal cancer, these results suggest that increased expression of SPRR3 is involved in colorectal tumorigenesis.


[The pulsed Doppler echo of the internal mammary artery].
In this study the authors discuss the results obtained using pulsed Doppler to evaluate internal mammary artery blood flow velocity in normal, dysplastic and neoplastic breasts. The following parameters were evaluated: percentage of artery localization, vessel diameter, and blood flow velocity. One hundred and seventy-five patients were examined by pulsed Doppler US and mammography in the same sitting. US evaluation of the internal mammary artery was possible in 156 cases. These patients were divided into 3 groups according to Wolfe's classification: normal (38 patients), dysplastic (74 patients) and neoplastic (44 patients). The mean blood flow velocity was estimated in each group; a significant difference was observed between normal (11.8 +/- 6 cm/s) and dysplastic (22.5 +/- 11 cm/s) patients. As for neoplastic patients, similar values were observed in benign (20.6 +/- 9 cm/s) and malignant (25.8 +/- 11 cm/s) lesions. Benign and malignant lesions were distinguished also according to Wolfe's parameters. In the patients with malignant lesions and normal breasts there was an increase in blood flow velocity--which was not observed in dysplastic breasts. In benign lesions in normal or dysplastic breasts, the blood flow velocity was similar to that observed in the respective group of nonpathologic breasts.


COVID-19 pandemic: a time for collaboration and a unified global health front.
Coronavirus disease 2019 has, in the span of weeks, immobilized entire countries and mobilized leading institutions worldwide in a race towards treatments and preventions. Although several solutions such as telemedicine and online education platforms have been implemented to reduce human contact and further transmission, countries need to favour collectivism both within and beyond their borders. Inspired by experiences of previous outbreaks such as SARS in 2003 and Ebola in 2014-2015, global solidarity is a must in order to prevent further morbidity and mortality. Examples in leadership and collaborations ranging from research funds from the Bill and Melinda Gates Foundation to mask donations by the Jack Ma Foundation should be celebrated as examples to follow. Open communication and transparency will be crucial in monitoring the evolution of the disease in the global effort of flattening the curve. This crisis will challenge the integrity and fuel innovation of health systems worldwide, whilst posing a new quality chasm that warrants increased recognition.


[Methods for the determination of psycho-social performance within the scope of a model for objectivizing biological age].
With the help of experimental findings of a randomized study concerning the dynamics of ageing of a reference population (365 persons of either sex between 18 and 73 years) the authors adopt a principal attitude to methodical questions in objectifying the biological ageing. It is above all demonstrated, if and in how far the psycho-sociometric methods used in a gerontological complex method developed for this purpose meet certain methodical requirements (objectifity, reliability, validity) and are effective from the practical and clinical point of view. On principle it is referred to the necessity of a sex-different interpretation of findings concerning the dynamics of ageing and to the possibilities and borderlines, to attract them for a total assessment of the performance. The clinical model demonstrated for objectifying the biological ageing of man opens a wide field of theoretical and practical possibilities to gain recognitions on dynamics and influencibility of human ageing.


[Anesthetic management of a boy with 7 q trisomy syndrome].
A 5-year-old boy with 7 q trisomy received general anesthesia for tracheostomy. He was born with multiple morphological malformations including anomalies of ears, eyes, face and vertebral, accompanying difficulty in tracheal intubation. At first we inserted a laryngoscope under awake condition to estimate the difficulty in intubation. Then, we performed intubation under sevoflurane-N2O-O2 anesthesia. After intubation, there was no problem during the operation. A child with chromosome abnormality has multiple malformations and we should be ready for possible difficulties.


A high-resolution anthropomorphic voxel-based tomographic phantom for proton therapy of the eye.
Proton therapy is increasingly used in medical treatments for cancer patients due to the sharp dose conformity offered by the characteristic Bragg peak. Proton beam interactions with the eye will be simulated using the MCNPX Monte Carlo code and available nuclear cross-section data to calculate the dose distribution in the eye gel and surrounding organs. A high-resolution eye model will be employed using a 3D geometrical voxel-based anthropomorphic head phantom obtained from the Visible Human Project (female data). Manual segmentation of the eye, carried out by the Medical Physics group at the University of Surrey resulted in 15 identified structures. This work emphasizes the use of a realistic phantom for accurately predicting dose deposition by protons.


Increased phosphorylation of a membrane protein consequent to amygdaloid kindling.
The phosphorylation of both particulate and soluble proteins in the amygdala was examined in electrically kindled rats. In animals receiving electrical stimulation in the left amygdala for 5-6 days that displayed electrical after-discharges but no motor seizures, no changes were observed in the phosphorylation of either particulate or soluble proteins. In animals stimulated for 20-21 days where major motor seizures were produced, the phosphorylation of a protein having a molecular weight of 45,000 ( 45K ) was markedly increased. The phosphorylation of this protein was increased in both the right (unstimulated) and left (stimulated) amygdala. Major motor seizures induced by electroconvulsive shocks, however, did not alter phosphorylation of this protein. Phosphorylation of the 45K protein was stimulated by calcium and calmodulin. The 45K protein is a major phosphoprotein of amygdala, representing 3.2% of the total particulate phosphoproteins in control animals and 7.4% in the kindled animals. In the presence of calcium-calmodulin, 16.2% of net protein phosphorylation was accounted for by the 45K protein.


The Seasonal Divergence in the Weakening Relationship between Interannual Temperature Changes and Northern Boreal Vegetation Activity.
The response of boreal vegetation to global warming has shown a weakening trend over the last three decades. However, in previous studies, models of vegetation activity responses to temperature change have often only considered changes in the mean daily temperature (Tmean), with the diurnal temperature range (DTR) being neglected. The goal of this study was to evaluate the temporal trends of the relationships between two temperature factors (Tmean and DTR) and the vegetation activity across the boreal regions on both annual and seasonal timescales, by simultaneously employing satellite and climate datasets. We found that the interannual partial correlation between the growing season (GS) NDVI and Tmean (RNDVI-Tmean) has shown a significant decreasing trend over the last 34 years. At the seasonal scale, the RNDVI-Tmean showed a significant upward trend in the spring, while in the summer and autumn, the RNDVI-Tmean exhibited a significant downward trend. The temporal trend characteristics of the partial correlation between the NDVI and DTR (RNDVI-DTR), at both the GS and seasonal scales, were fully consistent with the RNDVI-Tmean. The area with a significant decrease in the GS RNDVI-Tmean and RNDVI-DTR accounted for approximately 44.4% and 41.2% of the boreal region with the 17-year moving window, respectively. In stark contrast, the area exhibiting a significant increasing trend in the GS RNDVI-Tmean and RNDVI-DTR accounted for only approximately 22.3% and 25.8% of the boreal region with the 17-year moving window, respectively. With respect to the seasonal patterns of the RNDVI-Tmean and RNDVI-DTR, the area with a significant upward trend in the spring was greater than that with a significant downward trend. Nevertheless, more areas had a significant downward trend in the RNDVI-Tmean and RNDVI-DTR in summer and autumn than a significant upward trend. Overall, our research reveals a weakening trend in the impact of temperature on the vegetation activity in the boreal regions and contributes to a deeper understanding of the vegetation response to global warming.


Superiority of infectivity-based over particle-based methods for quantitation of drug resistant HIV-1 as inocula for cell cultures.
Performance of phenotypic assays and replication capacity assays require normalization of virus input. Therefore, quantitation of HIV-1 in supernatants to inoculate cell cultures is an important step. Since the gold standard for the determination of infectivity, the tissue culture infectious dose 50% (TCID50) is time-consuming, several other methods are in use. This study evaluated methods for the quantitation of drug resistant viruses in cell culture supernatants. The compared methods were based on the detection of viral structural components like genomic RNA or p24 antigen (CA-p24) (particle-based), the determination of reverse transcriptase (RT) activity, and methods based on the detection of viral infectivity like LTR-induced beta-galactosidase (beta-gal) activity and the TCID50 (infectivity-based). Significant correlations were observed between beta-gal activity and TCID50, and between CA-p24 and viral RNA. RT activity did not correlate with any other method. However, RT activity correlated significantly with infectivity when non-resistant subtype-B isolates were analyzed. In contrast to viral infectivity, CA-p24 exhibited a long half life and accumulated in cell culture, resulting in decreasing ratios of infectious virions to CA-p24 over time. As a consequence, relative replication capacities of drug resistant viruses were only determined reliably if the input virus was normalized according to infectivity. In conclusion, RT activity seems to be feasible for non-resistant subtype-B viruses but may be of limited use for non-B subtypes and for drug resistant viruses. Methods determining infectivity are most suitable for quantitation of cell culture inocula, whereas particle-based assays are more appropriate for quantitation of virus production during an experiment.


Preferred antibiotics for treatment of acute otitis media: comparison of practicing pediatricians, general practitioners, and otolaryngologists.
The antibiotic preferences of 2,190 pediatricians (peds) 360 general practitioners (GPs), and 273 otolaryngologists (ENTs) in the United States and concurrence with treatment guideline recommendations for acute otitis media (AOM) for suspected drug-resistant Streptococcus pneumoniae (DRSP) and beta-lactamase-producing Haemophilus influenzae before and after an educational workshop were compared. Peds and GPs preferred amoxicillin/clavulanate high-dose, whereas ENTs preferred higher generation cephalosporins. Before the workshop, endorsement of guideline-recommended antibiotics for treatment of AOM caused by DRSP by Peds, GPs, and ENTs was 80%, 75%, and 78%, respectively, and for Haemophilus influenzae was 73%, 63%, and 84%, respectively. After the workshop concurrence with AOM guideline recommendations for DRSP increased to 96%, 95%, and 97% and for H. influenzae increased to 93%, 94%, and 96% for Peds, GPs, and ENTs, respectively (p<0.0001 for all comparisons). Peds, GPs, and ENTs select appropriate antibiotics for AOM 63-84% of the time. After instruction that provides the rationale for guideline-recommended agents based on pharmacokinetics/pharmacodynamics and double tympanocentesis trials, endorsement of recommended antibiotics significantly improved to >90%.


A hybrid molecularly imprinted polymer coated quantum dot nanocomposite optosensor for highly sensitive and selective determination of salbutamol in animal feeds and meat samples.
A hybrid molecularly imprinted polymer (MIP)-coated quantum dot (QD) nanocomposite was synthesized and applied as a fluorescence probe for the highly sensitive and selective determination of salbutamol. The hybrid MIP-coated QD nanocomposite was synthesized via a copolymerization process in the presence of thioglycolic acid capped CdTe QDs with salbutamol as a template, 3-aminopropyltriethoxysilane as the functional monomer, and tetraethyl orthosilicate as a cross-linker. The optimum molar ratio of template, monomer, and cross-linker was 1:6:20. The fluorescence intensity of the hybrid MIP-coated QDs was efficiently quenched after salbutamol rebound to the recognition sites, as a result of charge transfer from QDs to salbutamol. The synthesized hybrid MIP-coated QD nanocomposite showed high sensitivity and good selectivity toward salbutamol. Under the optimal recognition conditions, the fluorescence intensity was quenched linearly with increasing concentration of salbutamol in the range from 0.10 to 25.0 μg L-1, with a detection limit of 0.034 μg L-1. The hybrid optosensor developed was successfully applied in the determination of salbutamol in animal feeds and meat samples. Satisfactory recoveries were obtained in the range from 85% to 98%, with a standard deviation of less than 8%. Furthermore, the accuracy of the hybrid MIP-coated QD nanocomposite was investigated by comparison with a conventional high-performance liquid chromatography method, with the results obtained with two methods agreeing well with each other. The advantages of this sensing method are simplicity, rapidity, cost-effectiveness, high sensitivity, and good selectivity. Graphical Abstract The synthesis of hybrid MIP-coated QDs nanocomposite.


Cyclosporin C is the main antifungal compound produced by Acremonium luzulae.
A strain of Acremonium luzulae (Fuckel) W. Gams was selected in screening new microorganisms for biological control of fruit postharvest diseases, especially gray and blue mold diseases on apples and strawberries. This strain manifests a very strong activity against a large number of phytopathogenic fungi. In this work, the product responsible for this antifungal activity was isolated from modified Sabouraud dextrose broth cultures of A. luzulae. It was purified to homogeneity by reverse-phase column chromatography. On the basis of UV, infrared, and 1H and 13C nuclear magnetic resonance spectra, mass spectral analysis, and the amino acid composition of the acid hydrolysates, the antibiotic was determined to be cyclosporin C. Cyclosporin C showed a broad-spectrum activity against filamentous phytopathogenic fungi but no activity against bacteria or yeasts. Its antifungal activity is only fungistatic. In contrast to Tolypocladium inflatum, another cyclosporin-producing strain, A. luzulae, did not produce additional cyclosporins. This was confirmed by in vivo-directed biosynthesis.


Intradiploic epidermoid cyst of the orbital roof: a case report.
Intradiploic epidermoid cysts are uncommon in the orbital walls and typically present with chronic headaches. We present the unusual presentation of a 46-year-old man where a long-standing intradiploic mass of the orbital roof led to acute onset of pain and mechanical ptosis. Computed tomography and magnetic resonance imaging revealed an intradiploic cystic mass within the orbital roof. The cystic mass was extirpated and histological examination confirmed the diagnosis of an epidermoid cyst. This case illustrates the potential of long-standing intradiploic epidermoid cysts in producing an acute presentation.


The Efficacy of Hyaluronidase in Early Surgery of Nasal Bone Fracture.
A nasal bone fracture is one of the most common facial injuries and is often treated by closed reduction. Typically, 2 to 3 weeks are needed for patients to return to daily life because the operation is performed after swelling around the fracture site is reduced. This study aimed to investigate that hyaluronidase injection could reduce swelling, perform early operation and return to daily life accelerated.From January 2017 to December 2017, 181 patients with nasal bone fracture were analyzed. 60 patients underwent hyaluronidase injection and massage to reduce edema, then performed surgery within 2 to 4 days. The remaining patients were treated conservatively (massage alone); they then underwent surgery. Ultrasonography was used to measure changes in skin thickness, and the treatment duration, outcome, and patient satisfaction were compared.The duration from injury to surgery was short in the early operation group, and the period of recovery and return to ordinary life was significantly shorter than in the conventional group. The difference in skin thickness after hyaluronidase injection and massage was 0.8 mm in the early operation group; there was no significant difference in the conventional group. There was no statistically significant difference in satisfaction between the 2 groups, but the mean satisfaction was higher in the early operation group.In patients with nasal bone fracture after facial trauma, hyaluronidase injection, and massage led to reduced edema. This might improve patient satisfaction by allowing earlier operation and earlier return to daily life.


Automated versus manual audit in the emergency department.
The purpose of this paper is to compare data collected by automated form processing with manual data collection for clinical indicators (CIs) in paediatric emergency medicine. Paediatric patients presenting with croup, asthma, bronchiolitis, head injury and gastroenteritis in August 2006 were identified by ICD 9 coding and a traditional manual audit was performed by two data collectors. Data were collected on a total of 16 CIs for these five illnesses. Manual audit data were then compared to information collected for this same patient population using TELEform, an automated forms processing (AFP) system that had been employed for over two years. Teleform data were only available for 24 patients compared to information for 127 patients identified by ICD 9 coding and manual audit. Teleform data overestimated compliance with clinical guidelines by 17 percent giving an overall departmental agreement with CIs of 90.6 percent compared to 73.5 percent in the manual audit. Additionally, manual audit demonstrated that when the clinical guideline was incorporated into the clinical record, compliance was 92.5 percent compared to 51.3 percent when it was not. This single center study demonstrates that data collected by AFP such as TELEform, overestimate emergency department performance regarding CIs compliance. Departments that use automated data collection tools need to establish relationships between such data and data collected via more traditional auditing methods.


Recurrent HERV-H-mediated 3q13.2-q13.31 deletions cause a syndrome of hypotonia and motor, language, and cognitive delays.
We describe the molecular and clinical characterization of nine individuals with recurrent, 3.4-Mb, de novo deletions of 3q13.2-q13.31 detected by chromosomal microarray analysis. All individuals have hypotonia and language and motor delays; they variably express mild to moderate cognitive delays (8/9), abnormal behavior (7/9), and autism spectrum disorders (3/9). Common facial features include downslanting palpebral fissures with epicanthal folds, a slightly bulbous nose, and relative macrocephaly. Twenty-eight genes map to the deleted region, including four strong candidate genes, DRD3, ZBTB20, GAP43, and BOC, with important roles in neural and/or muscular development. Analysis of the breakpoint regions based on array data revealed directly oriented human endogenous retrovirus (HERV-H) elements of ~5 kb in size and of >95% DNA sequence identity flanking the deletion. Subsequent DNA sequencing revealed different deletion breakpoints and suggested nonallelic homologous recombination (NAHR) between HERV-H elements as a mechanism of deletion formation, analogous to HERV-I-flanked and NAHR-mediated AZFa deletions. We propose that similar HERV elements may also mediate other recurrent deletion and duplication events on a genome-wide scale. Observation of rare recurrent chromosomal events such as these deletions helps to further the understanding of mechanisms behind naturally occurring variation in the human genome and its contribution to genetic disease.


Evidence for functional immaturity of the ornithine-urea cycle in very-low-birth-weight infants.
In a randomized, prospective study the response of serum urea concentration to different protein intakes was studied in two groups of preterm infants with different gestational ages on the 8th and the 21st day of life. 16 very-low-birth-weight (VLBW) infants (GA: 29-31 weeks) and 17 low-birth-weight (LBW) infants (GA: 31-33 weeks) were fed either with fresh human milk or with fortified human milk. The protein intake varied between 2.1 and 3.3 g/kg/day. On the 8th day of life the VLBW infants did not respond to higher protein intakes by increased serum urea concentrations, although a clear correlation was found between protein intake and serum alpha-amino-nitrogen concentrations in these infants. The more mature LBW infants responded to a high protein intake by increased serum urea concentrations on the 8th day of life. On the 21st day of life protein intake correlated to both serum urea and alpha-amino-nitrogen concentrations in all infants studied. These findings are consistent with a somewhat limited capacity of the immature infant for expansion of urea production for some time after birth. This immaturity should be considered when metabolic responses to protein intake are studied and evaluated in such infants.


Protein Tyrosine Phosphatase Receptor Type G (PTPRG) Controls Fibroblast Growth Factor Receptor (FGFR) 1 Activity and Influences Sensitivity to FGFR Kinase Inhibitors.
Recently, FGFR1 was found to be overexpressed in osteosarcoma and represents an important target for precision medicine. However, because targeted cancer therapy based on FGFR inhibitors has so far been less efficient than expected, a detailed understanding of the target is important. We have here applied proximity-dependent biotin labeling combined with label-free quantitative mass spectrometry to identify determinants of FGFR1 activity in an osteosarcoma cell line. Many known FGFR interactors were identified (e.g. FRS2, PLCG1, RSK2, SRC), but the data also suggested novel determinants. A strong hit in our screen was the tyrosine phosphatase PTPRG. We show that PTPRG and FGFR1 interact and colocalize at the plasma membrane where PTPRG directly dephosphorylates activated FGFR1. We further show that osteosarcoma cell lines depleted for PTPRG display increased FGFR activity and are hypersensitive to stimulation by FGF1. In addition, PTPRG depletion elevated cell growth and negatively affected the efficacy of FGFR kinase inhibitors. Thus, PTPRG may have future clinical relevance by being a predictor of outcome after FGFR inhibitor treatment.


A comparison of standard vs. breakaway bases: an analysis of a preventative intervention for softball and baseball foot and ankle injuries.
More than 40 million individuals participate in organized baseball and softball leagues in the United States every year. Unfortunately, it has also been estimated by the Consumer Product Safety Commission that softball and baseball are the two main sports leading to emergency-room visits in the United States. A previous field study has determined that the utilization of breakaway bases has the potential of preventing 96% of sliding injuries, thereby preventing 1.7 million injuries a year in the United States with a savings of $2 billion a year in health care costs. It is the purpose of this study to analyze and compare the potential attenuating capabilities of various types of bases. We found the force at the ankle upon impact when compared to the standard base revealed all breakaway bases reduced the force of impact to a statistically significant level. The force at the foot upon impact when compared to the standard base revealed all breakaway bases reduced the force at variable levels, with the Rogers bases having the only statistically significant reduction. However, the force delivered to the tibia/fibula was increased with the Stay Down and Mag-Net large bases as compared to the standard stationary base. The moments of inversion/eversion and dorsiflexion/plantar flexion upon impact, when compared to the standard base, revealed all safety bases were reduced to a statistically significant level. We conclude breakaway bases reduce the force of impact and moments to a statistically significant level and confirm previous field studies. Though there is a difference among the breakaway bases themselves, they should be used on all fields.


A Retrospective Review of Conjunctival Melanoma Presentation, Treatment, and Outcome and an Investigation of Features Associated With BRAF Mutations.
Large studies investigating clinical presentation and treatment in primary conjunctival melanoma (CM) are rare. Clinicopathological characteristics of BRAF-mutated CM have not been studied thoroughly. To determine the associations of clinicopathological tumor features and treatment with local recurrence, metastasis, and mortality and to determine the association of BRAF mutations with these features. Population-based cohort study at the Eye Pathology Institute, Copenhagen, Denmark. Participants included 139 patients with primary CM in Denmark from January 1, 1960, to December 31, 2012. For BRAF analysis, all patients with available formalin-fixed, paraffin-embedded tumor samples from January 1, 1994, to December 31, 2012, were included. BRAF mutations, local recurrence, regional and distant metastasis, melanoma-related mortality, and all-cause mortality were examined. A poor prognosis of tumors involving the extrabulbar conjunctiva and adjacent tissue structures was confirmed in multivariable Cox proportional hazards regression models. Patients undergoing incisional biopsy more frequently developed metastasis (hazard ratio [HR], 2.46; 95% CI, 1.08-5.58; P = .03). Excision without adjuvant treatment was associated with local recurrence (HR, 1.97; 95% CI, 0.11-3.48; P = .02), metastatic disease (HR, 2.51; 95% CI, 1.07-5.91; P = .03), and all-cause mortality (HR, 1.80; 95% CI, 1.05-3.08; P = .03). BRAF mutations were identified in 19 of 47 primary CMs (40.4%) and were more frequent in younger patients (P = .005), less frequent in the extrabulbar conjunctiva (P = .05), more frequently classified as T1 tumors (P = .03), and rarely manifested with primary acquired melanosis (P = .001) or with a uniformly pigmented lesion (P = .006). Distant metastases developed in 6 of 19 BRAF-mutated CMs (31.6%) as opposed to 1 of 28 BRAF wild-type CMs (3.6%). No definitive association with distant metastasis was seen in multivariable Cox proportional hazards regression models. Incisional biopsy and excision without adjuvant therapy were associated with a poor outcome in patients with CM. Extrabulbar location was also associated with a poor outcome in multivariable analysis. BRAF-mutated CMs were frequent in younger patients and were rare in tumors involving the extrabulbar conjunctiva. Despite a more favorable location, BRAF-mutated tumors may be associated with more frequent distant metastasis.


Accelerated healing of full-thickness burns by the use of high-voltage pulsed galvanic stimulation in the pig.
An experimental study was designed using domestic pigs to evaluate the effect of high-voltage pulsed galvanic stimulation (HVPGS) on the rate of healing of full-thickness thermal burns. Twenty animals were used in the study; each one received two standardized burns over the paravertebral region. In half of the animals, HVPGS was performed daily for the study period. One of the burn wounds in each pig was used to evaluate wound contraction by measuring the wound surface weekly for four weeks. The second burn wound had weekly tissue biopsies to evaluate fibroblast population. The data showed a significantly faster rate of wound contraction (p less than 0.001) and a higher fibroblast response (p less than 0.001) in the HVPGS group when compared with controls.


Randomized trial of hypnosis as a pain and symptom management strategy in adults with sickle cell disease.
Sickle cell disease (SCD) is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality), anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. ClinicalTrials.gov: NCT00393250.


Transformation characteristics of organic pollutants in Fered-Fenton process for dry-spun acrylic fiber wastewater treatment.
The Fered-Fenton process using Ti sheet as cathode and RuO2/Ti as anode was employed for the pretreatment of dry-spun acrylic fiber manufacturing wastewater. The effects of feeding mode and concentration of H2O2 on chemical oxygen demand (COD) removal efficiency as well as the biodegradability variation during the Fered-Fenton process were investigated. The feeding mode of H2O2 had significant influence on COD removal efficiency: the removal efficiency was 44.8% if all the 60.0 mM H2O2 was fed at once, while it could reach 54.1% if the total H2O2 was divided into six portions and fed six times. The biochemical oxygen demand/COD ratio increased from 0.29 to above 0.68 after 180 min treatment. The transformation characteristics of organic pollutants during the Fered-Fenton process were evaluated by using gas chromatography-mass spectrometry (GC-MS), Fourier transform infrared spectroscopy (FTIR) and fluorescence excitation-emission matrix (EEM) spectroscopy. Most of the refractory organic pollutants with aromatic structure or large molecular weight were decomposed during the Fered-Fenton process.


Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre.
In eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis. All members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick's four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes. A total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times). Implementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.


Systemic Delivery of Free Chitosan Accelerates Femur Fracture Healing in Rats.
Chitosan-containing compounds have been shown to be suitable for bone replacement, but few studies demonstrate the impact of the chitosan as a free drug on the fracture.In this study, we aimed to evaluate possible effects of free chitosan on fracture healing. Thirty adult male Sprague-Dawley rats with a mean body weight of 205 g (range from 200g to 210g) were randomly and equally divided into two groups. Standardized femur fractures were created in all rats. Treatments were administered intraperitoneally twice weekly at 1 mg chitosan per injection and the controls were administered physiological saline. The site of the fracture was compared with the control group at 1, 2 and 4 weeks after surgery (n=5 in each group). The weight, activity and reaction of the rats were observed at all the timepoints. Anterior-posterior radiographs and micro-CT scans of all fractures were taken after surgery, and the parameters included: the volume of callus that was calculated using the Perkins volume formula, BV/TV, BV, BMD of cortical bone, cortical thickness, and cortical number at the fracture sites. After sacrifice, fractured femurs from rats were dissected and carefully cleaned of muscle around the fracture callus to preserve callus integrity. Sections were stained with haematoxylin and eosin for histological evaluation of healing. Radiological (X-ray and micro-CT) evaluation showed that fracture healing of the experimental group was better than control group at the second week and fourth week. Histological evaluation revealed fracture healing of the experimental group was better than control group at the same time. There was no statistically significant difference in fracture healing between the two groups at the first week. Systemic delivery of free chitosan can accelerate the bone healing process in rat femur fracture at the early-middle stage.


A case of haemoptysis in a girl with Noonan syndrome.
Noonan syndrome (NS) is an autosomal dominant condition affecting 1 in 2 000 live births. It is characterised by distinctive physical features, congenital heart disease and multiple other comorbidities including haematological abnormalities. Haemoptysis is the expectoration of blood originating from the lower respiratory tract. It is uncommon in children but can be life threatening.Perfusion of the lower respiratory system arises from the pulmonary arterial circulation and the bronchial circulation, or bleeding may arise from either. In children, the most common causes of haemoptysis are respiratory tract infections, aspirated foreign bodies and bronchiectasis. We present a 7-year-old girl with recurrent haemoptysis.


Empathy-Related Responses to Depicted People in Art Works.
Existing theories of empathic response to visual art works postulate the primacy of automatic embodied reaction to images based on mirror neuron mechanisms. Arguing for a more inclusive concept of empathy-related response and integrating four distinct bodies of literature, we discuss contextual, and personal factors which modulate empathic response to depicted people. We then present an integrative model of empathy-related responses to depicted people in art works. The model assumes that a response to empathy-eliciting figural artworks engages the dynamic interaction of two mutually interlinked sets of processes: socio-affective/cognitive processing, related to the person perception, and esthetic processing, primarily concerned with esthetic appreciation and judgment and attention to non-social aspects of the image. The model predicts that the specific pattern of interaction between empathy-related and esthetic processing is co-determined by several sets of factors: (i) the viewer's individual characteristics, (ii) the context variables (which include various modes of priming by narratives and other images), (iii) multidimensional features of the image, and (iv) aspects of a viewer's response. Finally we propose that the model is implemented by the interaction of functionally connected brain networks involved in socio-cognitive and esthetic processing.


Incompetent great saphenous veins treated with endovenous 1,320-nm laser: results for 71 legs and morphologic evolvement study.
Endovenous lasers with various wavelengths have been utilized with good outcomes in treating leg varicose veins. The natural history and evolution of treated veins after endovenous procedures, however, have seldom been addressed. This study determines the efficacy vein ablation and serial venous morphologic evolution of incompetent great saphenous veins (GSVs) after endovenous 1,320-nm laser treatment. Fifty patients with symptomatic varicose veins secondary to GSV insufficiency treated with 1,320-nm endovenous laser ablation were enrolled. The treated varicose veins in each limb were mapped and sized before laser treatment. Vein wall diameters were measured with duplex ultrasound at follow-up visits. Seventy-one limbs in 50 patients were enrolled. During the mean 13.1-month follow-up, closure of GSVs was observed in 94% of limbs (67/71). Vein diameters at 3 cm below saphenofemoral junction level were reduced to 81% at 2 days, 75% at 1 month, 48% at 3 months, and 39% at 5 months. Average mean duration for treated GSVs to narrow as fibrotic cords (internal diameter,<2.5 mm) was 5.8 months. The endovenous 1,320-nm laser ablation procedures have excellent efficacy in treating incompetent GSVs. This excellent shrinkage behavior may be the basis for nice long-term results of patients treated with 1,320-nm Cooltouch endovenous laser.


A statistical evaluation of the literature regarding the associations among alcoholism, drug abuse, and antisocial personality disorder.
Prior literature suggested an association among alcoholism, drug abuse, and antisocial personality disorder. A meta-analysis of inferential studies bearing on these associations was performed on 40 studies. Results demonstrated that each diagnosis in the triad had a significant positive association with each of the other two. Possible common etiologies of the diagnoses were discussed. Presence of one of the three diagnoses suggests that consideration of the other two is advisable. Finally, interrelationships among the diagnoses may explain treatment results common to several of the diagnoses.


Alterations in the epidermis of the carp, Labeo rohita (Cyprinidae: Cypriniformes), infected by the bacteria, Aeromonas hydrophila: A scanning electron microscopic, histopathological and immunohistochemical investigation.
This study was carried out to comprehend the pathogenicity of the bacteria in the epidermis of Labeo rohita inoculated with Aeromonas hydrophila. Alterations in the histopathology of the epidermis were examined using scanning electron microscopy, light microscopy and the localization of iNOS and caspase 3 + ve cells by means of immunohistochemical methods. Skin samples obtained from infected fish at different intervals 2, 4, 6, 8 and 10 days showed significant changes in the cellular components of the epidermis. Epithelial cells often appeared hypertrophied with fragmented and loosely arranged microridges, and in the process of exfoliation. Mucous goblet cells increased significantly in density. Club cells showed degenerative changes, often with simultaneous confluence of adjacent cells and release of their contents. Increase in density of iNOS and caspase 3 + ve cells indicates inflammatory response and apoptosis. This study could provide valuable information on the pathogenesis of the disease, and disease outbreaks in farmed fish. Further, it could provide useful guidelines for fish farmers to take preventive measures for the control of the disease.


Effects of dietary protein, fat and beta-carotene levels on beta-carotene absorption in rats.
It is important that the factors influencing functional carotenoid absorption be made clear. The effect of rat diets containing different combinations of dietary protein, fat, and beta-carotene levels on beta-carotene absorption was evaluated. In the mid-level beta-carotene diet groups (1.8 mg beta-carotene/100 g diet), the retinol content in the liver and the ratio of the liver retinol content to the beta-carotene intake (namely, retinol accumulation rate) were both greater in the mid-level dietary protein groups (20 g protein/100 g diet) than in lower dietary protein groups (5 g protein/100 g diet), but were not affected by dietary fat level (10 g or 2 g fat/100 g diet). The liver beta-carotene content and its accumulation rate were lower in the mid-level dietary fat groups (10 g fat/100 g diet). beta-carotene 15,15'-dioxygenase (CDO) activity in the small intestine increased in the mid-level dietary protein groups, which resulted in an increase in the content of liver retinol converted from dietary beta-carotene. With respect to the mid-level dietary fat groups, the fecal beta-carotene excretion rate (%) increased. The low beta-carotene diet groups (0.006 mg beta-carotene/100 g diet) showed a higher serum retinol accumulation rate, CDO activity, and liver beta-carotene accumulation rate than the mid-level beta-carotene diet groups. These results suggest the marked effect of protein, fat, and beta-carotene level in diets on the absorption and metabolism of beta-carotene.


Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data.
Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.


Heart block during bacterial endocarditis: a review of the literature and guidelines for surgical intervention.
The management of patients with bacterial endocarditis complicated by atrioventricular block is based on uncontrolled data, mostly from retrospective surgical and autopsy series. It is difficult to advance broad recommendations on the basis of such a biased population. Nevertheless, it is the firm opinion of many experienced clinicians that heart block developing as the result of aortic endocarditis signals myocardial abscess formation, and thereby is an indication for early surgery. I present a patient with aortic and mitral endocarditis in whom first degree heart block developed and then disappeared over five days; she was successfully managed with medical therapy alone. This case illustrates that some patients with endocarditis and heart block will not require surgery. In this setting, I propose the following guidelines in selecting patients for operation: 1) the observed appearance or progression of heart block; 2) the presence of aortic valve involvement; 3) the persistence of heart block, despite at least one week of optimal antibiotics; and 4) the elimination of other potential causes of conduction abnormalities.


Becoming a vaccine champion: evidence-based interventions to address the challenges of vaccination.
The incidence, prevalence, morbidity and mortality rates of vaccine-preventable diseases have decreased drastically since the advent of modern vaccination by Edward Jenner at the end of the 18th century. In recent years, however, a growing number of parents have been refusing or delaying vaccination for their children for socioeconomical, medical, religious and/or philosophical reasons. This has resulted in a loss of herd immunity that has caused a resurgence of many infectious diseases. This article describes evidence-based methods by which a pediatric clinic can become a vaccine champion by aiming at vaccination rates of 100 percent. This goal can be attained by a team effort that addresses the challenges of vaccination by using every visit as a chance to vaccinate, educate, address the fears and the concerns of the parents and provide articles and other written documentations on the benefits and side effects of vaccines. A standardized system that identifies and tracks patients who need vaccines is also essential to find those who are seldom brought to medical attention. A consistent and systematic use of these evidence-based methods by a dedicated staff is essential to attain vaccination rates close to 100 percent.


Bacterial vaginosis: a comprehensive review.
In summary, bacterial vaginosis infections are very common, easy to diagnose, and usually quite simple to treat. Rarely are symptoms dramatic, and often the woman is unaware of the presence of this infection. Partners should be treated, and thorough health education should be provided to both patient and partner. Further research is needed to develop safer, equally effective treatments for this infection. Currently metronidazole is the drug of choice, except in pregnant women. Possible serious problems may result from untreated bacterial vaginosis infections; therefore, routine treatment to resolve this infection is recommended. Preventative measures should always be reviewed with each patient and regular check-ups are recommended, especially for sexually active individuals.


Fampridine response in MS patients with gait impairment in a real-world setting: Need for new response criteria?
The primary objective of this real-world study was to describe the response to fampridine and changes of gait parameters in multiple sclerosis (MS) patients' walking disability (Expanded Disability Status Scale (EDSS): 4-7) after treatment with fampridine for 2 weeks as recommended by the European Medicines Agency (EMA) and compare it with the overall physician's judgement. A total of 211 adult MS patients were analyzed using a multimodal gait assessment including the timed 25-foot walk test (T25FW), 2-minute walking test (2-MWT), 12-item Multiple Sclerosis Walking Scale (MSWS-12), the GAITRite electronic walkway system, and the patients' clinical global impression (CGI). Multimodal gait assessment was compared with the clinician's impression of overall improvement after 2 weeks. In total, 189 subjects were included, of which 133 (70.37%) were responders to fampridine (RF), according to physician's judgement. Looking at independent multimodal gait assessment, RFs showed improvement of 12.60% in the T25FW, 19.25% in the 2-MWT, 21.12% in the MSWS-12, and 6.54% in their Functional Ambulation Profile (FAP) score. The combination of the T25FW and the MSWS-12 would offer the best sensitivity and specificity for determining response to fampridine according to both neurologists' and patients' classification. This study provides new information on the use of fampridine in a real-world setting with a large patient sample on the potential benefit of using more definitive responder criteria to fampridine for the clinical setting.


Two-year evaluation of restorations of a packable composite placed in UK general dental practices.
The aim of this study was to assess the clinical performance at two years of 100 Solitaire 2 restorations placed in five United Kingdom dental practices by members of a practice-based research group. Restorations were assessed after two years by a trained evaluator and the dental practitioner who had placed the material, for anatomic form, marginal adaptation, surface roughness, gingival condition and the presence or absence of secondary caries. In addition, the patients completed a questionnaire requesting details of the comfort and performance of the Solitaire 2 restoration(s). A total of 88 (58 Class II and 30 Class I) restorations of Solitaire 2 placed in 49 patients (mean age 43 years) were assessed. Twelve restorations could not be evaluated because of patient unavailability for the dates of the examinations. Two Class II restorations (2%) had failed by the time of the two-year evaluation and the remaining 86 restorations were found to be intact with no secondary caries. A high percentage of optimal scores were recorded for anatomic form and surface roughness. The colour match of two restorations (2%) was recorded as an obvious mismatch, but otherwise no unacceptable scores were recorded. After two years of clinical service a high proportion (96%) of the Solitaire 2 restorations that were available for re-examination, placed in general dental practice settings, were found to be performing satisfactorily.


C. elegans as a model in developmental neurotoxicology.
Due to many advantages Caenorhabditis elegans (C. elegans) has become a preferred model of choice in many fields, including neurodevelopmental toxicity studies. This review discusses the benefits of using C. elegans as an alternative to mammalian systems and gives examples of the uses of the nematode in evaluating the effects of major known neurodevelopmental toxins, including manganese, mercury, lead, fluoride, arsenic and organophosphorus pesticides. Reviewed data indicates numerous similarities with mammals in response to these toxins. Thus, C. elegans studies have the potential to predict possible effects of developmental neurotoxicants in higher animals, and may be used to identify new molecular pathways behind neurodevelopmental disruptions, as well as new toxicants.


Comparison between simple release and Z-plasty of retinaculum for de Quervain's disease: a retrospective study.
We compared two surgical procedures for de Quervain's disease that was not responsive to conservative treatment. Group A (simple release) consisted of 38 patients and group B (Z-plasty of the retinaculum) included 36 patients. The visual analogue scale score and the Disabilities of the Arm, Shoulder and Hand Score improved significantly after surgery; there were no statistical differences in outcome between the two groups. In group A, one patient required reoperation, two had subluxations of extensor tendons and two had temporary loss of sensation in the area of the radial nerve. In group B, two patients had temporary loss of sensation. The mean time to resolution of pain at the operative site was significantly shorter in group B. Both simple release and Z-plasty were effective surgical methods. Z-plasty allowed earlier return to activities of daily living but there was no statistical difference between the two groups in incidence of complication. Level of evidence: IV.