Reducing Opioid Prescribing Rates in Emergency Medicine.
Pain management is one of the most common reasons patients visit the emergency department. Understanding the contributions of emergency medicine-and specifically Ochsner Health System's emergency providers-to the opioid crisis is important. Benchmark prescribing data indicated that Ochsner Health System emergency medicine providers' opioid prescription rates were significantly higher than the national average in emergency medicine. Data relevant to visit and opioid prescription counts were extracted from the organization's electronic health record system. Opioid prescription rates were calculated for each provider. A data transparency project was initiated in which provider opioid prescription rates were unblinded and distributed among the provider group. Opioid prescription rates declined in aggregate for the emergency services from 22% to 14% during the 1-year project timeline. Some physicians demonstrated a 70% reduction in prescription rates. Importantly, patient satisfaction scores were not negatively impacted by declining opioid prescription rates. Provider performance transparency using unblinded and transparent data analytics can efficiently and significantly alter provider practice.


Monitoring Elite Soccer Players' External Loads Using Real-Time Data.
To assess the validity of measuring locomotor activities and PlayerLoad using real-time (RT) data collection during soccer training. Twenty-nine English soccer players participated. Each player wore the same MEMS device (Micromechanical Electrical Systems; S5, Optimeye; CatapultSports, Melbourne, Australia) during 21 training sessions (N = 331 data sets) in the 2015-16 and 2016-17 seasons. An RT receiver (TRX; Catapultsports, Melbourne, Australia) was used to collect the locomotor activities and PlayerLoad data in RT and compared with the postevent downloaded (PED) data. PlayerLoad and locomotor activities (total distance covered; total high-speed running distance covered, >5.5#x00A0;m/s; total sprinting distance covered, >7 m/s; maximum velocity) were analyzed. Correlations were near perfect for all variables analyzed (r = .98-1.00), with a varied level of noise between RT and PED also (0.3-9.7% coefficient of variation). Locomotor activities and PlayerLoad can use both RT and PED concurrently to quantify a player's physical output during a training session. Caution should be taken with higher-velocity-based locomotor activities during RT compared to PED.


[Ultrasonic and radiographic quantification of palmar angulation in metacarpal IV and V neck fractures].
Therapy of metacarpal neck fractures depending on radiographically measured palmar angulation is discussed controversially in the literature. Some authors describe normal hand function of malunited metacarpal neck fractures with a palmar angulation up to 70°; others define 30° as the uppermost limit to maintain normal hand function. However, the methods of measuring palmar angulation are not clearly defined. Here, we present a new method to measure palmar angulation using ultrasound. The aim of this prospective study is to compare the radiographic methods of measuring palmar angulation with the ultrasound method. 20 patients with a neck fracture of the metacarpals IV or V were treated either conservatively or operatively. 2 weeks after trauma or operation, an x-ray was performed. 2 examiners measured the palmar angulation on the oblique and lateral projections using 2 different methods (medullary canal and dorsal cortex methods). At the same time, the 2 examiners performed measurements of palmar angulation using ultrasound. The measurements obtained with the different methods as well as by the 2 examiners at 2 different terms were compared. Intra- and interobserver reliability of each method was calculated, and for the ultrasound method a test for accuracy of the measured angles was performed. Depending on the method of radiographic measurement and different x-ray projections, an average of up to 20.3° higher angles were determined as compared with the ultrasound method. The average deviation in angles measured within and between the 2 examiners was lower for the ultrasound method than for the radiographic methods, corresponding to a higher degree of intra- and interobserver reliability. The ultrasound method for measuring palmar angulation in metacarpal neck fractures is simple, and appears to be more precise in comparison to radiographic methods. An exactly lateral projection of the fractured metacarpal bone can be imaged without superposition and exposure to radiation. The question arises whether previous studies that suggested normal hand function with palmar angulation up to 70° might have been based on too high angle-readings due to the use of radiographic methods.


Benefits of 24-Week Exergame Intervention on Health-Related Quality of Life and Pain in Women with Fibromyalgia: A Single-Blind, Randomized Controlled Trial.
Objective: To evaluate the effects of 24-week exergame-based intervention on health-related quality of life (HRQoL) and pain in patients with fibromyalgia as well as to analyze the effectiveness of the intervention in subgroups of patients with different pain intensity levels. Design: Single-blinded, randomized controlled trial. Setting: University facilities Participants: Fifty-five women with fibromyalgia participated in the study. Intervention: The exercise group (EG) completed 24 weeks of exergames focused on mobility, postural control, upper and lower limbs coordination, aerobic fitness, and strength. A total of 120 minutes per week, divided into two sessions of 60 minutes, was completed. Main outcome measures: The Euroqol-5 Dimensions-5 Levels (EQ-5D-5L) was used to assess the HRQoL. In addition, pain intensity was measured using a visual analog scale (VAS). Results: Twenty-five out of 28 women allocated to the EG completed the intervention, which means an 89.29% of adherence. They were randomly divided into an exercise (age = 54.04 [8.45]) and a control group (52.72 [9.98]). Significant effects on the perceived health status and pain intensity (P < 0.05) were found. K-means clustering procedure revealed two groups with different response to the intervention. The respond group obtained significant effects of the exergame intervention in EQ-5D-5L, pain VAS, and VAS-EQ, compared with those who did not respond. Conclusions: Exergames could be a useful tool to improve perceived health status and pain intensity level in women with fibromyalgia with a reduced health-related quality of life.


Alternative surgical approach to treat aortic arch aneurysm after ascending aortic replacement with hybrid prosthesis.
We present a surgical technique to treat the distal aortic arch in patients who previously underwent ascending aortic replacement using the frozen elephant trunk. After debranching of the epiaortic vessels using a custom-made four-branch graft and systemic cooling, the extracorporeal circulation is interrupted, maintaining antegrade cerebral perfusion through the four-branch prosthesis. Then the "old" Dacron prosthesis, previously implanted for the ascending aortic replacement, is partially incised at its distal end, leaving a margin of prosthesis anastomosed to the native distal aorta, and the E-vita stent-graft is deployed under direct vision. Then the two margins of the "old" Dacron and the new Dacron E-vita prosthesis (Jotec Inc., Hechingen, Germany) are sutured together with one suture line to guarantee sealing and reconstruction of the aorta. This technique presents several advantages: the discrepancy between the graft size and the native aortic diameter is avoided, performing the anastomosis between two prosthetic materials with similar diameters is easier; there is no risk of tears in the diseased native aortic wall and related bleeding; and finally, it is easier to perform the anastomosis at the level of the ascending aorta rather than at the distal arch, especially when the disease of the aorta is extended to the descending segment.


Social capital and vulnerability from the family, neighborhood, school, and community perspectives.
This article reviews research and offers program examples for developing social capital in youth with a range of vulnerabilities: emotional, physical, social, and developmental. Protective factors provided by developing social capital at the individual level include access to support networks, transition to employment, and community connectedness. The authors feature approaches from the cooperative extension system, which links university and community resources, and identify exemplary programs that support social capital development by intervening with families, schools, neighborhoods, and communities.


Problems in the diagnosis and management of acute pancreatitis.
Despite the lack of precise knowledge as to its exact mechanism of causation, acute pancreatitis continues to engage the clinician's attention. The world medical literature is replete with publications on the subject and the numerous Australian studies attest to the continuing clinical interest (Hennessy, 1965; Bennett and Jepson, 1966; Kune, 1968; Barraclough and Coupland, 1972; Battersby and Chapuis, 1977 and Reid and Kune, 1978). The majority of these reviews concentrate on the supposed aetiology and clinical features of acute pancreatitis and cover well trodden ground. It is the purpose of this paper to review the problems in the diagnosis and management of acute pancreatitis in the light of present knowledge and to relate these to 494 patients with acute pancreatitis admitted to St Vincent's Hospital, Melbourne, during the period 1968 to 1979. The diagnosis of acute pancreatitis in these 494 cases was made at operation, autopsy or by the demonstration of an elevation in the serum amylase above 1200 International units (I.U.) per litre in patients with compatible symptoms and signs.


Comparative effects of wild type Stenotrophomonas maltophilia and its indole acetic acid-deficient mutants on wheat.
The present investigation evaluated the role of Stenotrophomonas maltophilia and its IAA-deficient mutant on soil health and plant growth under salinity stress in the presence of tryptophan. In the first phase, S. maltophilia isolated from roots of the halo- phytic herb, Cenchrus ciliaris was used as bio-inoculant on wheat grown in saline sodic soil. A field experiment was conducted at Soil Salinity Research Institute during 2010-2011. Treatments included seed inoculation with S. maltophilia with or without tryptophan; uninoculated untreated plants were taken as control. An aqueous solution of tryptophan was added to rhizosphere soil at 1 μg l(_1) after seed germination. Inoculation with S. maltophilia significantly increased soil organic matter, enhanced (20-30%) availability of P, K, Ca and NO3 -N and decreased Na content and electrical conductivity of rhizosphere soil. Plant height, fresh weight, proline and phytohormone content of leaves were increased 30-40% over the control. Activities of superoxide dismutase (SOD) and peroxidase (POD) were 40-50% higher than control. Addition of tryptophan further augmented (10-15%) growth parameters, whereas NO3 -N, P, K and Ca content, proline content and SOD and POD increased 20-30%. In a second phase, indoleacetic acid (IAA)-deficient mutants of S. maltophilia were constructed and evaluated for conversion of tryptophan to IAA at the University of Calgary, Canada, during 2013-2014. About 1800 trans-conjugants were constructed that were unable to produce IAA in the presence of tryptophan. The results suggest that tryptophan assisted S. maltophilia in the amelioration of salt stress, and that IAA played positive role in induction of salt tolerance.


The Mental Status Expert (MSE): an expert system for scoring and interpreting the mental status examination.
The mental status examination is the most difficult and time-consuming portion of the neurological examination. A complete mental status examination requires the examiner to assess alertness, memory, language, praxis, gnosis, attention, and visual-spatial functions. Findings of the mental status need to be interpreted in terms of severity of deficits, nature of the deficits, likely etiology, and likely area of corresponding brain injury. The performance of an accurate, complete, and detailed mental status examination is a daunting task for the medical student or resident in training. Traditional mental status examinations show considerable inter-examiner variability for items administered and for interpretation of abnormalities. Even in academic settings, mental status examinations have little educational content.


Pathological complete response in younger and older breast cancer patients.
Pathologic complete response (pCR) after neoadjuvant systemic treatment for inoperable locally advanced breast cancer is defined as complete microscopic disappearance of invasive cancer in both the breast and axilla in the postoperative specimen. The aim of the study was to characterize the groups of younger (≤ 40 years old) and older (≥ 70 years old) breast cancer patients who achieved a pCR. One hundred thirty-eight consecutive patients aged between 30 and 78 years with locally advanced breast cancer, operated on after neoadjuvant systemic treatment between November 2007 and June 2010, were analyzed. In this group 9 women (6.5%) were 40 years of age or younger, and 12 patients (8.7%) were 70 years of age or older. In the younger group, pCR was achieved in 1 patient with triple negative, invasive ductal breast cancer, G3, BRCA 1 mutation, treated with cisplatin. A near pCR was achieved in 2 other patients, with triple negative, invasive ductal breast cancer, G3, treated with AT. The pCR in the breast was found in a HER2 positive patient. In older patients, pCR was achieved in 2 patients with triple negative, invasive ductal breast cancer, G3, treated with AT or FEC. Pathologic complete response in the axilla was achieved in 1 patient with triple negative, ductal carcinoma. The pCR rates were significantly higher in triple negative breast cancer in both groups (p = 0.047 and p = 0.018, respectively). Pathologic complete response was significantly associated with receptor- based subtypes in both young and old women.


A monoclonal antibody to brush border and passive Heymann nephritis.
An IgG2a monoclonal antibody (MoAb) reacting with the brush border of the renal proximal tubule and glomerular capillary wall was produced by fusion of NS1 myeloma cells with spleen cells from BALB/c mice immunized with renal brush border preparations from rat kidney cortex. This antibody reacts with a 90,000 mol. wt protein which can be isolated by immunoprecipitation of radiolabelled brush border or glomerular preparations and localized on these structures by immunoperoxidase electron microscopy, thus demonstrating the presence of common antigenic determinants. Survey of various organs showed that the MoAb reacted with the brush border of the gut, but also with antigens associated with the distal vascular system. In the liver antigenic determinants were located along the sinusoid walls but mainly on bile canaliculi. Specific glomerular binding could be demonstrated in vivo by immunofluorescence after an intravenous injection of 2 mg of antibody or by paired label methodology using tracer amounts. Kinetics however were dramatically different from those observed in classical passive Heymann nephritis since glomerular binding was transient during the first hours after injection. Binding was also found in tubular structures, as well as in lung, liver, spleen and heart. These results identify a well defined antigen-antibody system responsible for the formation of transient extramembranous glomerular deposits and may be relevant to some human cases of glomerulonephritis. They may also provide new models to study glomerular and tubular transfer of membrane bound antibodies.


Conversion of immune response patterns from high to low and low to high by an RNase-sensitive thymocyte extract.
In vitro immune responses to human serum albumin (HSA) and synthetic polypeptides (T,G)-A-L, and (H,G)-A-L, associated with the maturation IgG-forming plasma cells were studied in relation to thymic low molecular weight RNA. This RNA, from normal low-responder animals to these antigens, converted high-responder bone marrow cells to low responders, whereas RNA from high responders converted low-responder bone marrow cells to high responders. These changes of immune response patterns were observed not only in the combination of allogeneic mouse cells and RNA, but also in xenogeneic rat and mouse systems. Thymic RNA from low-responder animals had no suppressive activity to high-responder RNA, when both were added together to one dish with antigen. High doses (x 50) of low-responder thymic RNA stimulated the same immune response level as a regular amount of high-responder thymic RNA. Intact thymocytes derived from low-responder mice added together with high-responder thymic RNA did not suppress immune response of high-responder bone marrow cultures. Intact allogeneic thymocytes also induced the same response as allogeneic thymic RNA. These results indicate that humoral immune responses can be influenced by thymic RNA derived from normal animals.


Upregulation of miR-324-5p Inhibits Proliferation and Invasion of Colorectal Cancer Cells by Targeting ELAVL1.
Colorectal cancer (CRC) is a common clinical cancer that remains incurable in most cases. miRNAs are reported to play a part in the development of various tumors. In the present study, we found that miR-324-5p was downregulated in CRC cells, while ELAV (embryonic lethal, abnormal vision, Drosophila)-like protein 1 (ELAVL1) showed a higher expression. miR-324-5p transfection significantly inhibited the proliferation as well as invasion in both SW620 and SW480 cells. miR-324-5p mimic transfection markedly decreased the expression of ELAVL1. Luciferase reporter gene assay confirmed that ELAVL1 is a direct target of miR-324-5p. Furthermore, cancer invasion factors uPA, uPAR, and MMP-9 were found to drop significantly in miR-324-5p-transfected groups. To conclude, our findings indicate that miR-324-5p may play a suppressive role in colorectal cell viability and invasion, at least in part, through directly targeting ELAVL1. Therefore, miR-234-5p might function as a promising candidate for CRC treatment and deserves deeper research.


Abnormal Q waves in Wolff-Parkinson-White syndrome. Incidence and clinical significance.
Between January 1970 and January 1975 the diagnosis of Wolff-Parkinson-White syndrome was entertained in 44 patients. Thirty-one (70%) of these patients had negative sigma-deflections (Q waves) on one or more electrocardiographic leads, thereby simulating a pattern of myocardial infarction (Mi). Fifteen patients (34%) were initially referred with an erroneous diagnosis of Mi based on the presence of Q waves. In nine of these 15 patients, the referring diagnosis was Mi plus ventricular preexcitation; in six, the diagnosis of ventricular preexcitation was overlooked entirely. The incidence of misdiagnosis (34%) was exactly the same as that reportly by Wolff and White approximately 30 years ago. Erroneous diagnosis of Mi can be virtually eliminated by normalizing the QRS complex by premature stimulation of the atrium during the effective refractory period of the accessory pathway.


Contribution of benthic microalgae to the temporal variation in phytoplankton assemblages in a macrotidal system.
Suspended marine benthic microalgae in the water column reflect the close relationship between the benthic and pelagic components of coastal ecosystems. In this study, a 12-year phytoplankton time-series was used to investigate the contribution of benthic microalgae to the pelagic system at a site along the French-Atlantic coast. Furthermore, all taxa identified were allocated into different growth forms in order to study their seasonal patterns. The highest contribution of benthic microalgae was observed during the winter period, reaching up to 60% of the carbon biomass in the water column. The haptobenthic growth form showed the highest contribution in terms of biomass, dominant in the fall-winter period when the turbidity and the river flow were high. The epipelic growth form did not follow any seasonal pattern. The epiphytic diatom Licmophora was most commonly found during summer. As benthic microalgae were found in the water column throughout the year, the temporal variation detected in the structure of pelagic assemblages in a macrotidal ecosystem was partly derived from the differentiated contribution of several benthic growth forms.


High abundances of potentially active ammonia-oxidizing bacteria and archaea in oligotrophic, high-altitude lakes of the Sierra Nevada, California, USA.
Nitrification plays a central role in the nitrogen cycle by determining the oxidation state of nitrogen and its subsequent bioavailability and cycling. However, relatively little is known about the underlying ecology of the microbial communities that carry out nitrification in freshwater ecosystems--and particularly within high-altitude oligotrophic lakes, where nitrogen is frequently a limiting nutrient. We quantified ammonia-oxidizing archaea (AOA) and bacteria (AOB) in 9 high-altitude lakes (2289-3160 m) in the Sierra Nevada, California, USA, in relation to spatial and biogeochemical data. Based on their ammonia monooxygenase (amoA) genes, AOB and AOA were frequently detected. AOB were present in 88% of samples and were more abundant than AOA in all samples. Both groups showed >100 fold variation in abundance between different lakes, and were also variable through time within individual lakes. Nutrient concentrations (ammonium, nitrite, nitrate, and phosphate) were generally low but also varied across and within lakes, suggestive of active internal nutrient cycling; AOB abundance was significantly correlated with phosphate (r(2) = 0.32, p<0.1), whereas AOA abundance was inversely correlated with lake elevation (r(2) = 0.43, p<0.05). We also measured low rates of ammonia oxidation--indicating that AOB, AOA, or both, may be biogeochemically active in these oligotrophic ecosystems. Our data indicate that dynamic populations of AOB and AOA are found in oligotrophic, high-altitude, freshwater lakes.


The Fractal and GLCM Textural Parameters of Chromatin May Be Potential Biomarkers of Papillary Thyroid Carcinoma in Hashimoto's Thyroiditis Specimens.
Occasionally, Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) share similar nuclear features. The current study aims to quantify the differences between the investigated specimens of HT-associated PTC versus the HT alone, to reduce the subjective experience of an observer, by the use of fractal parameters as well as gray-level co-occurrence matrix (GLCM) textural parameters. We have analyzed 250 segmented nuclei per group (nn = 25 per patient and np = 10 patients per group) using the ImageJ software (NIH, Bethesda, MD, USA) as well as an in-house written code for the GLCM analysis. The mean values of parameters were calculated for each patient. The results demonstrated that the malignant cells from the HT-associated PTC specimens showed lower chromatin fractal dimension (p = 0.0321) and higher lacunarity (p = 0.0038) compared with the corresponding cells from the HT specimens. Also, there was a statistically significant difference between the investigated specimens, in the contrast, correlation, angular second moment, and homogeneity, of the GLCM corresponding to the visual texture of follicular cell chromatin. The differences in chromatin fractal and GLCM parameters could be integrated with other diagnostic methods for the improved evaluation of distinctive features of the HT-associated PTC versus the HT in cytology and surgical pathology specimens.


Surgical management of spinal metastases of thymic carcinoma: A case report and literature review.
Metastatic thymic carcinoma in the spine is a rare disease with no standard curative managements yet. The objective of this study is to report a very rare case of spinal metastases of thymic carcinoma successfully operated by combination of instrumentation and cement augmentation together with adjuvant treatment. The management of these unique cases has yet to be well-documented. A 57-year-old man presented with a 6-month history of continuous and progressive back pain. The patient, who had been diagnosed of thymic carcinoma (stage IV B) for 3 years, received surgical treatment of median sternotomy thymectomy, followed by 3 cycles of chemotherapy and 12 cycles of radiotherapy. Magnetic resonance imaging (MRI) of spine showed spinal cord compression secondary to the epidural component of the T4 mass, with increased metastatic marrow infiltration of the left T4 vetebral body, which presented as a solid tumor. Post-operative pathology confirmed the diagnosis of spinal metastases of thymic carcinoma. The patient underwent exploratory surgery, circumferential spinal cord decompression, cement augmentation and a stabilization procedure via a posterior approach. The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month follow-up visit. There were no other complications associated with the operation during the follow-up period. Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Metastatic thymic carcinoma of the spine, although rare, should be part of the differential diagnosis when the patient has a history of thymic carcinoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymic carcinoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.


[Apple-peel jejunal atresia. Nutritional management].
Apple-peel jejunal atresia is a rare digestive tract congenital defect often accompanied with a short gut. Two cases managed by a three-stage medical and surgical approach are reported. A protein hydrolysate-jejunal secretion mixture was drip-fed through the distal ileostomy to stimulate trophicity of the distal gut.


Are Executive Functions Deficits in Early-Onset Chronic Schizophrenia More Severe than in Adult-Onset Chronic Schizophrenia?
The research on the age of schizophrenia onset and cognitive impairments leads to contradictory conclusions. It is still unknown whether neurocognitive deficits in early-onset schizophrenia (EOS) are more intense than adulthood-onset schizophrenia (AOS). The study aimed to examine specific aspects of the executive functions of chronic outpatients with different ages of schizophrenia onset. Two clinical groups (EOS and AOS) consisted of 60 chronic outpatients with schizophrenia recruited from the community-based support system. The executive functions were measured with the Wisconsin Card Sorting Test (WCST), Trail Making Test A&B (TMT A&B), verbal fluency task (VFT), and the N-back test. Obtained results were compared to control groups consisting of 40 healthy subjects, matched with age, sex, and years of education, respectively. There were no differences in various aspects of executive dysfunctions between EOS and AOS outpatients. The outpatients in general, had lower scores than healthy controls regardless of their age of symptom onset. The most important finding suggests that some cognitive domains (visual working memory and processing speed) in presented schizophrenia patients were similar to those in healthy controls.Despite the demographic differences, both clinical groups present the same level of executive functioning. In addition, similar to the healthy participants, the outpatients had no problems in working memory and processing speed. These observations suggest that EOS might not be associated with more severe cognitive deterioration. Moreover, the stabilization or improvement of their functioning might be linked with long-term psycho-social rehabilitation and modern pharmacotherapy.


The use of remotely sensed environmental parameters for spatial and temporal schistosomiasis prediction across climate zones in Ghana.
Schistosomiasis control in sub-Saharan Africa is enacted primarily through preventive chemotherapy. Predictive models can play an important role in filling knowledge gaps in the distribution of the disease and help guide the allocation of limited resources. Previous modeling approaches have used localized cross-sectional survey data and environmental data typically collected at a discrete point in time. In this analysis, 8 years (2008-2015) of monthly schistosomiasis cases reported into Ghana's national surveillance system were used to assess temporal and spatial relationships between disease rates and three remotely sensed environmental variables: land surface temperature (LST), normalized difference vegetation index (NDVI), and accumulated precipitation (AP). Furthermore, the analysis was stratified by three major and nine minor climate zones, defined using a new climate classification method. Results showed a downward trend in reported disease rates (~ 1% per month) for all climate zones. Seasonality was present in the north with two peaks (March and September), and in the middle of the country with a single peak (July). Lowest disease rates were observed in December/January across climate zones. Seasonal patterns in the environmental variables and their associations with reported schistosomiasis infection rates varied across climate zones. Precipitation consistently demonstrated a positive association with disease outcome, with a 1-cm increase in rainfall contributing a 0.3-1.6% increase in monthly reported schistosomiasis infection rates. Generally, surveillance of neglected tropical diseases (NTDs) in low-income countries continues to suffer from data quality issues. However, with systematic improvements, our approach demonstrates a way for health departments to use routine surveillance data in combination with publicly available remote sensing data to analyze disease patterns with wide geographic coverage and varying levels of spatial and temporal aggregation.


Modulation of 1-[beta-D-arabinofuranosyl] cytosine-induced apoptosis in human myeloid leukemia cells by staurosporine and other pharmacological inhibitors of protein kinase C.
We have examined the effects of both nonspecific and highly selective pharmacological inhibitors of protein kinase C (PKC) on the capacity of a 6-h exposure to 1-[beta-D-arabinofuranosyl]cytosine (ara-C; 10 microM) to induce apoptotic DNA fragmentation and cell death in the human myeloid leukemia cell lines HL-60 and U937. Staurosporine, a highly potent, nonspecific inhibitor of PKC (20-50 nM), uniquely potentiated ara-C-related degradation of DNA to oligonucleosomal fragments in both cell lines (i.e., 2- to 3-fold), but was ineffective when given alone at these concentrations. In contrast, co-administration of the nonspecific PKC inhibitor H7 and two highly selective PKC inhibitors, calphostin C and chelerythrine, also increased the extent of DNA fragmentation observed in ara-C-treated cells, but these effects were evident only at inhibitor concentrations that were by themselves sufficient to induce DNA damage. Agarose gel electrophoresis demonstrated that cells co-exposed to staurosporine and ara-C exhibited considerably more pronounced internucleosomal DNA cleavage than did cells exposed to ara-C alone; moreover, this effect was suppressed by Zn2+ (1 mM) and the permeant Ca2+ chelator BAPTA-AM (50 microM). Potentiation of ara-C-related DNA fragmentation by subeffective concentrations of staurosporine was accompanied by a pronounced increase in the morphological features characteristic of apoptosis. A synergistic interaction between staurosporine and ara-C with respect to inhibition of clonogenicity in both HL-60 and U937 cells was demonstrated by median dose-effect analysis. The actions of staurosporine did not result from enhanced ara-C metabolism, as preincubation of cells with concentrations of this agent that potentiated ara-C actions (e.g., 20-50 nM) did not increase intracellular levels of the lethal metabolite ara-CTP. Lastly, preexposure of HL-60 and U937 cells to staurosporine did not block ara-C-mediated upregulation of c-jun, an oncogene whose increased expression has been temporally associated with ara-C-induced apoptosis. Together, these findings indicate that staurosporine exhibits a unique pattern of potentiation of ara-C-related apoptosis in human myeloid leukemias, and provide a rationale for exploring the antileukemic potential of this combination regimen.


Atmospheric CO2 and VPD alter the diel oscillation of leaf elongation in perennial ryegrass: compensation of hydraulic limitation by stored-growth.
We explored the effects of atmospheric CO2 concentration (Ca ) and vapor pressure deficit (VPD) on putative mechanisms controlling leaf elongation in perennial ryegrass. Plants were grown in stands at a Ca of 200, 400 or 800 μmol mol-1 combined with high (1.17 kPa) or low (0.59 kPa) VPD during the 16 h-day in well-watered conditions with reduced nitrogen supply. We measured day : night-variation of leaf elongation rate (LERday : LERnight ), final leaf length and width, epidermal cell number and length, stomatal conductance, transpiration, leaf water potential and water-soluble carbohydrates and osmotic potential in the leaf growth-and-differentiation zone (LGDZ). Daily mean LER or morphometric parameters did not differ between treatments, but LERnight strongly exceeded LERday , particularly at low Ca and high VPD. Across treatments LERday was negatively related to transpiration (R2 = 0.75) and leaf water potential (R2 = 0.81), while LERnight was independent of leaf water potential or turgor. Enhancement of LERnight over LERday was proportional to the turgor-change between day and night (R2 = 0.93). LGDZ sugar concentration was high throughout diel cycles, providing no evidence of source limitation in any treatment. Our data indicate a mechanism of diel cycling between daytime hydraulic and night-time stored-growth controls of LER, buffering Ca and daytime VPD effects on leaf elongation.


[How to manage obesity in the general practitioner's office ?]
The prevalence of obesity continues to increase and only a change in behavior can lead to a reduction in weight and an improvement of the cardio-metabolic profile. The general practitioner plays an important role in preventing excess weight and in identifying patients at risk. He is often on the front line to provide hygiene- dietetic advice and long-term support. The purpose of this article is to give the primary care physician some guidelines from reception at the office to referral to a specialist center if necessary.


Outcome of patients with early breast cancer receiving nitrogen-containing bisphosphonates: a comparative analysis from the Metropolitan Detroit Cancer Surveillance System.
Preclinical data suggest that bisphosphonates exhibit antitumor activity. However, clinical studies indicated conflicting results. In this study, we compared the overall survival (OS) of postmenopausal patients with nonmetastatic invasive breast cancer who received any of the second-generation nitrogen-containing bisphosphonates for osteopenia or osteoporosis, with the survival of those who did not. We conducted a retrospective study at the Wayne State University/Karmanos Cancer institute (KCI) in Detroit, Michigan and extracted data from the Metropolitan Detroit Cancer Surveillance System (MDCSS), a Surveillance, Epidemiology and End Results (SEER) registry. Patients > 50 years of age with stage I, II, or III invasive breast cancer between the years 2000 through 2003 were included. Information regarding medications was extracted from the patients' medical records. A total of 696 women with stage I-III breast cancer were included. Ninety-seven women (14%) used nitrogen-containing bisphosphonates. The difference in OS between bisphosphonate users and nonusers was not statistically significant (P = .32) at 3 years. After adjusting for differences between the groups in age, stage of disease, hormone receptor status, endocrine therapy, vitamin D, and calcium use, there was a marginally significant (P = .07) difference in survival; bisphosphonate users had poorer survival than nonusers. Our results indicate that the use of nitrogen-containing bisphosphonates is not associated with improved OS in patients with nonmetastatic breast cancer, even after adjusting for known prognostic factors, but with a marginally worse OS. Further research is awaited to clarify the role of bisphosphonates in the adjuvant setting.


Cloning of Amb a I (antigen E), the major allergen family of short ragweed pollen.
To determine the structure of Amb a I (previously called antigen E), the major allergen from short ragweed, cDNA from pollen was cloned into lambda gt11 and lambda gt10. One of the three distinct clones isolated from the lambda gt11 library by screening with anti-denatured Amb a I antibodies was used to screen both libraries for other Amb a I sequences. Multiple clones were isolated and sequenced and proved to be highly homologous but nonidentical. The clones could be divided into three groups based on sequence similarity, and in accordance with the International Union of Immunological Societies-approved nomenclature (Marsh, D. G., Goodfriend, L., King, T. P., Lowenstein, H., and Platts-Mills, T. A. E. (1986) Bull. WHO 64, 767-770) they have been designated Amb a I.1, Amb a I.2, and Amb a I.3. Clones within a group have greater than 99% identity, and similarity among groups is 85-90% at the nucleotide level. The amino acid sequence of four peptides (isolated from antigen E obtained from the Research Resources Branch of the National Institutes of Health) containing 132 amino acids was identical to one of the clones (Amb a I.1). The presence of multiple naturally occurring isoelectric forms of Amb a I was demonstrated by two-dimensional gel electrophoresis and Western blotting. Southern blot analysis demonstrates the presence of multiple Amb a I-related sequences in the ragweed genome. Amb a I is therefore not a single molecule but rather a family of closely related proteins.


Homocysteine thiolactone-induced hyperhomocysteinemia does not alter concentrations of cholesterol and SREBP-2 target gene mRNAS in rats.
The present rat study was conducted to test whether hyper-homocysteinemia induced by dietary homocysteine (Hcy) alters the cholesterol concentration in plasma and tissue and the gene expression of genes involved in cholesterol biosynthesis and uptake. Therefore, rats were fed 100 or 200 mg Hcy per kilogram body mass per day (Hcy100 group and Hcy200 group, respectively) as dl-homocysteine thiolactone, or an Hcy-free diet, which served as control, over 14 days. Rats from the Hcy100 group and the Hcy200 group had higher plasma Hcy concentrations (34.4 +/- 4.6 and 69.4 +/- 11.5 microM, respectively) than rats fed an Hcy-free diet (9.5 +/- 1.7 microM). The concentration of Hcy in liver was 2.6 and 3.8 times higher, and in small intestine was 2.6 and 5.1 times higher, in the Hcy100 group and the Hcy200 group, respectively, than in control rats (P < 0.05). The concentrations of cholesterol in plasma, lipoproteins, liver, and small intestine and the relative mRNA concentrations of sterol regulatory element-binding protein 2 (SREBP-2), 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, and low-density lipoprotein (LDL) receptor in liver and small intestine were not influenced by dl-homocysteine thiolactone supplementation. In conclusion, in view of the experimental conditions used here, increased plasma and tissue concentrations of Hcy do not alter cholesterol metabolism of liver and intestine.


Dietary Manipulation of Amino Acids for Cancer Therapy.
Cancer cells cannot proliferate and survive unless they obtain sufficient levels of the 20 proteinogenic amino acids (AAs). Unlike normal cells, cancer cells have genetic and metabolic alterations that may limit their capacity to obtain adequate levels of the 20 AAs in challenging metabolic environments. However, since normal diets provide all AAs at relatively constant levels and ratios, these potentially lethal genetic and metabolic defects are eventually harmless to cancer cells. If we temporarily replace the normal diet of cancer patients with artificial diets in which the levels of specific AAs are manipulated, cancer cells may be unable to proliferate and survive. This article reviews in vivo studies that have evaluated the antitumor activity of diets restricted in or supplemented with the 20 proteinogenic AAs, individually and in combination. It also reviews our recent studies that show that manipulating the levels of several AAs simultaneously can lead to marked survival improvements in mice with metastatic cancers.


[Kidney cancer metastasis to the adrenal gland. Role of adrenalectomy].
We analysed case records of 2507 patients with renal cell carcinoma treated in the department of onco-urology of Cancer Research Center (Moscow). 1939 of them underwent nephrectomy between 1971 and 1999. The overall incidence of adrenal metastases according to CT and histological findings was 4.7%. Synchronous metastases occurred in 90 and metachronous ones in 30 patients. Radical nephrectomy with adrenalectomy was performed in 18 out of 90 patients with synchronous metastases, palliative nephrectomy in 20 and 52 patients were not considered for surgery. Among 18 patients who underwent complete surgical resection, 12(66%) had either lymph node involvement or distant metastases. A microscopic metastasis was found on histological examination only in 1 patient with normal CT scan and macroscopically intact adrenal on intraoperative assessment. Mean survival after radical nephrectomy with adrenalectomy in 6 patients with solitary lesions was 57 months compared to the longest survival of 31 months in patients with widespread disease. Solitary metachronous ipsilateral and contralateral adrenal involvement was present in 7 patients. The average interval between nephrectomy and appearance of adrenal metastasis in this group was 73 months. One patient was lost for follow-up and one died of adrenal deficiency 4.3 months after adrenalectomy. One patient underwent a consecutive removal of brain and lung metastases 33 and 38 months following adrenalectomy while the remaining 4 were alive in 15, 16, 26 and 34 months with no evidence of the disease. Thus, ipsilateral adrenalectomy is obligatory only in patients with severe disease as shown by CT scan or at nephrectomy. About one-third of the patients will benefit from the surgery. Adrenalectomy should be performed in case of obvious adrenal involvement. The aggressive surgical approach is justified in solitary metachronous adrenal involvement because of long-term survival expected in some of such patients.


The roles of toxin A and toxin B in Clostridium difficile infection: insights from the gnotobiotic piglet model.
We recently published our findings indicating that anti-TcdB antibodies were effective as treatment for C. difficile infection, but that anti-TcdA actually worsened prognosis in the gnotobiotic piglet model. To further investigate the roles of the two toxins, we administered purified toxins separately or together, systemically, to piglets and found that both toxins, either alone or together, are able to elicit severe lesions systemically and are also able to cross into the gut lumen and cause large intestinal lesions typical of infection. We also found that anti-TcdA administered before systemic challenge with TcdA again did not protect from development of disease, but, in this case, did not appear to worsen prognosis. Further work is still needed, but these findings add to the growing knowledge regarding the roles of the C. difficile toxins.


Early abdominal aortic graft infection due to Propionibacterium acnes: a case report and review of the literature.
Propionibacterium acnes is a member of the human microbiota that has been recently associated with late-onset infections of indwelling devices, especially shoulder prosthesis. Aortic graft infection are rare events with significant morbidity and mortality. Here, we describe the case of an abdominal aortic graft infection due to P. acnes with an unusual early onset. A review of the recent English language literature has been added.


Radiation-induced root surface caries restored with glass-ionomer cement placed in conventional and ART cavity preparations: results at two years.
There are no published studies comparing the clinical performances of more-viscous glass-ionomer cement (GIC) restorations when placed using conventional and atraumatic restorative treatment (ART) cavity preparation methods to restore root surface caries. One dentist used encapsulated Fuji IX GP and Ketac-Molar to restore 72 conventional and 74 ART cavity preparations for 15 patients who had received cervicofacial radiation therapy. Two assessors evaluated the restorations at six, 12, and 24 months for retention, marginal defects and surface wear, and recurrent caries. After two years, the cumulative restoration successes were 65.2 per cent for the conventional and 66.2 per cent for the ART cavity preparations, without statistical or clinical significance (P > 0.50). Restoration dislodgement accounted for 82.8 per cent and marginal defects for 17.2 per cent of all failures. There were no instances of unsatisfactory restoration wear or recurrent caries observed. Teeth with three or more restored cervical surfaces accounted for 79.3 per cent of all failures (P < 0.0001). For root surface caries restored with GIC, the use of hand instruments only with the ART method was an equally effective alternative to conventional rotary instrumentation for cavity preparation. Larger restorations had higher failures, usually from dislodgement.


Advances in brachytherapy.
During the past 15 years, permanent seed brachytherapy for prostate cancer has advanced significantly in all areas, including patient selection, treatment planning, technique, and technology (eg, seeds stranded in Vicryl suture). These improvements have made transperineal seed implantation an accurate and practical treatment option for men with low-, intermediate-, and high-risk disease. Because of the evidence that the various treatment options for prostate cancer are likely to be equally successful in terms of long-term cancer control, continuing efforts focus on enhancing the quality of life of implant patients.


A simple method to establish an efficient medium suitable for potato regeneration.
Potato (Solanum tuberosum) is one of the important crop plants, and many potato cultivars consist of a tetraploid genome with high heterozygosity. The techniques of transformation and genome editing require plant regeneration. However, no efficient regeneration method has been established except for some specific cultivars, such as 'Sayaka'. In general, it is necessary to determine the adequate concentrations of auxin and cytokinin for plant regeneration. We established an efficient method using a 24-well microplate that easily enabled determination of the concentrations of these plant growth regulators suitable for shoot regeneration. Using this method, the optimal concentrations of these factors were analyzed for two representative potato cultivars, 'Sayaka' and 'Konafubuki'. This analysis revealed there was a large difference in the optimal concentrations between them. Based on this result, a specialized medium for the efficient regeneration of 'Konafubuki' cultivars was proposed. This assay method was also applied for determination of hygromycin sensitivity of these potato cultivars, and it was observed that 'Konafubuki' was rather sensitive to hygromycin. These findings suggested that the selection of a 'Konafubuki' transformant could be achieved using a medium containing a lower amount of hygromycin than that used for 'Sayaka'.


Blood protein polymorphisms in the donkey (Equus asinus).
Transferrin, albumin, 6-phosphogluconate dehydrogenase and vitamin D-binding protein polymorphisms were detected in 242 feral and domesticated Australian donkeys by polyacrylamide gel electrophoresis, starch gel electrophoresis, autoradiography, immunoblotting with specific antisera and activity staining. All four TF and two ALB variants were donkey specific while only one of the PGD variants was donkey specific. The two GC variants were electrophoretically identical to the Equus caballus F and S proteins. Available evidence suggested that the TF, ALB, PGD and GC systems are controlled by co-dominant alleles with frequencies of the most common alleles of each system being 0.831, 0.946, 0.957 and 0.861 respectively. Glucose phosphate isomerase and plasminogen were monomorphic in the Australian population of donkeys.


Monitoring HIV-1 Assembly in Living Cells: Insights from Dynamic and Single Molecule Microscopy.
The HIV-1 assembly process is a multi-complex mechanism that takes place at the host cell plasma membrane. It requires a spatio-temporal coordination of events to end up with a full mature and infectious virus. The molecular mechanisms of HIV-1 assembly have been extensively studied during the past decades, in order to dissect the respective roles of the structural and non-structural viral proteins of the viral RNA genome and of some host cell factors. Nevertheless, the time course of HIV-1 assembly was observed in living cells only a decade ago. The very recent revolution of optical microscopy, combining high speed and high spatial resolution, in addition to improved fluorescent tags for proteins, now permits study of HIV-1 assembly at the single molecule level within living cells. In this review, after a short description of these new approaches, we will discuss how HIV-1 assembly at the cell plasma membrane has been revisited using advanced super resolution microscopy techniques and how it can bridge the study of viral assembly from the single molecule to the entire host cell.


Fatigue responses in exercise under control of VO2.
To examine the fatigue response during an exhaustive heavy exercise performed under control of oxygen uptake (email@example.com (2)Delta50) or power output (SS@pDelta50), eleven trained male subjects performed an incremental test to determine the peak of the oxygen uptake value (V.O (2peak)) and lactate threshold and two exhaustive steady-state cycling exercises at the intermediate value between the lactate threshold and V.O (2peak) (firstname.lastname@example.com (2)Delta50 and SS@pDelta50). The control of V.O (2) induced an oscillation of the power output, which lowered the average power output (276 +/- 47 vs. 315 +/- 40 W, p = 0.004) and cancelled the slow component of oxygen kinetics. However, all subjects reached maximal cardiac output (CO) and heart rate (HR) values which were sustained almost two times longer in firstname.lastname@example.com (2)Delta50 compared to SS@pDelta50 (979 +/- 854 vs. 475 +/- 236 s, p = 0.046 for CO and 1050 +/- 890 vs. 513 +/- 288 s, p = 0.037 for HR). Furthermore, SS@pDelta50 elicited V.O (2peak) but not firstname.lastname@example.com (2)Delta50 (4963 +/- 434 vs. 4723 +/- 460 mL . min (-1), p = 0.026). Finally, the time spent at the maximal CO and HR values is correlated with time to exhaustion at V.O (2)Delta50. In conclusion, the cause of fatigue does not seem to have the same origin during exhaustive supra-lactate threshold exercise under control of V.O (2) (V.O (2)Delta50) compared to constant power output (pDelta50), while both elicit the maximal HR and CO values.


Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction.
We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.


The relationship between outdoor activity and health in older adults using GPS.
Physical activity (PA) provides health benefits in older adults. Research suggests that exposure to nature and time spent outdoors may also have effects on health. Older adults are the least active segment of our population, and are likely to spend less time outdoors than other age groups. The relationship between time spent in PA, outdoor time, and various health outcomes was assessed for 117 older adults living in retirement communities. Participants wore an accelerometer and GPS device for 7 days. They also completed assessments of physical, cognitive, and emotional functioning. Analyses of variance were employed with a main and interaction effect tested for ±30 min PA and outdoor time. Significant differences were found for those who spent >30 min in PA or outdoors for depressive symptoms, fear of falling, and self-reported functioning. Time to complete a 400 m walk was significantly different by PA time only. QoL and cognitive functioning scores were not significantly different. The interactions were also not significant. This study is one of the first to demonstrate the feasibility of using accelerometer and GPS data concurrently to assess PA location in older adults. Future analyses will shed light on potential causal relationships and could inform guidelines for outdoor activity.


Internal conversion and intersystem crossing dynamics of uracil upon double thionation: a time-resolved photoelectron spectroscopy study in the gas phase.
The photophysical properties of 2,4-dithiouracil (2,4-DTU) in the gas phase are studied by time-resolved photoelectron spectroscopy (TRPES) with three different excitation wavelengths in direct extension of previous work on uracil (U), 2-thiouracil (2-TU) and 4-thiouracil (4-TU). Non-radiative deactivation in the canonical nucleobases like uracil mainly occurs via internal conversion (IC) along singlet excited states, although intersystem crossing (ISC) to a long-lived triplet state was confirmed to play a minor role. In thionated uracils, ISC to the triplet state becomes ultrafast and highly efficient with a quantum yield near unity; however, the lifetime of the triplet state is strongly dependent on the position of the sulfur atom. In 2-TU, ISC back to the ground state occurs within a few hundred picoseconds, whereas the population remains trapped in the lowest triplet state in the case of 4-TU. Upon doubling the degree of thionation, ISC remains highly efficient and dominates the photophysics of 2,4-DTU. However, several low-lying excited states contribute to competing IC and ISC pathways and a complex deactivation mechanism, which is evaluated here based on TRPES measurements and discussed in the context of the singly thionated uracils.


Links between the concentrations of gaseous pollutants measured in different regions of Estonia.
The factors that determine the concentrations of air pollutants (NO, NO2, SO2, O3), measured in 8 monitoring stations (4 rural background, 3 urban, and 1 industrial) in Estonia, are studied applying the factor analysis. The factor analysis reveals remarkable impact of COVID-19 lockdown, effects caused by dramatic decrease in oil-shale based energy production in Estonia provoked by new socio-economic conditions such as elevated price for CO2 emission quota, differences between rural and urban stations, maritime-continental difference for NO2 and ozone, and specific industrial impact in case of SO2. The multiple regression analysis to predict the ozone concentration in one rural background station at Tahkuse was performed, based on the ozone concentrations measured in other stations and the concentrations of NO, NO2, and CO2, recorded in the same station. It was found that the ozone concentration at Tahkuse is rather well predictable (determination coefficient, i.e., correlation coefficient squared, R 2 = 0.714), using only the concentrations from another rural station at Saarejärve that is about 110 km away from Tahkuse. Adding all the available data into the list of regression analysis arguments, the model predictability is improved moderately (determination coefficient R 2 = 0.795). Large model residuals above all tend to occur with the values measured and predicted at summer nights. Surprisingly, neither NO nor NO2 concentration measured in the Tahkuse station did appear a good predictor for ozone (R 2 = 0.02 and 0.05, respectively), possibly long-range transport of ozone (that has also experienced NO and/or NO2 influence during transport) overrides the local effects of NO and/or NO2.


Genome-wide identification and gene expression profiling of ubiquitin ligases for endoplasmic reticulum protein degradation.
Endoplasmic reticulum (ER)-associated degradation (ERAD) is a mechanism by which unfolded proteins that accumulate in the ER are transported to the cytosol for ubiquitin-proteasome-mediated degradation. Ubiquitin ligases (E3s) are a group of enzymes responsible for substrate selectivity and ubiquitin chain formation. The purpose of this study was to identify novel E3s involved in ERAD. Thirty-seven candidate genes were selected by searches for proteins with RING-finger motifs and transmembrane regions, which are the major features of ERAD E3s. We performed gene expression profiling for the identified E3s in human and mouse tissues. Several genes were specifically or selectively expressed in both tissues; the expression of four genes (RNFT1, RNF185, CGRRF1 and RNF19B) was significantly upregulated by ER stress. To determine the involvement of the ER stress-responsive genes in ERAD, we investigated their ER localisation, in vitro autoubiquitination activity and ER stress resistance. All were partially localised to the ER, whereas CGRRF1 did not possess E3 activity. RNFT1 and RNF185, but not CGRRF1 and RNF19B, exhibited significant resistance to ER stressor in an E3 activity-dependent manner. Thus, these genes are possible candidates for ERAD E3s.


Myelodysplastic syndrome: a study of prognostic factors.
Forty-three patients with myelodysplastic syndrome (MDS) were retrospectively analyzed for its prognostic factors. We evaluated the relationship of the clinical, biochemical, and hematological data, as well as colony-forming unit myeloid (CFU-C) culture, Bournemouth score, modified Bournemouth score, and modified Dutcher score to the prognosis. The median age was 65 years. Eighteen patients had refractory anemia (RA), 4 had refractory anemia with ringed sideroblasts (RARS), 15 had refractory anemia with excess blasts (RAEB), 2 had refractory anemia with excess blasts in transformation (RAEB-t), and 4 had chronic myelomonocytic leukemia (CMMoL). The median survival of all patients was 482 days. The median survival for each subtype was as follows: RA, 628 days; CMMoL, 350 days; RAEB, 240 days; RAEB-t, 90 days. For RARS, no data have yet been obtained, because only one out of 4 patients with RARS has died. We subdivided all patients into two groups: one group included patients with RA or RARS and the other group included patients with RAEB, RAEB-t or CMMoL. The former group had a median survival of 677 days and the latter group 240 days, p = 0.0035. In the former group, 3 out of 22 patients (13.6%) developed acute myeloid leukemia (AML), as compared to 8 out of 21 patients (38.1%) in the latter group, p = 0.0661. Twenty-five of the 43 patients died: 10 from AML and 15 from infection and/or bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)


Foreskin length in uncircumcised men is associated with subpreputial wetness.
This study was performed to identify possible factors associated with penile wetness, defined as the observation of a diffuse homogenous film of moisture on the surface of the glans and coronal sulcus, in men attending a sexually transmitted infection clinic. Genital examination was undertaken in 422 uncircumcised men and any degree of subpreputial wetness observed was recorded. The degree of visibility of the urinary meatus on direct inspection was also assessed. Subjects were asked whether they retracted the foreskin while urinating and how long since they had last passed urine. Penile wetness was observed in 13.0% of the men and was more common in those whose foreskin covered the urinary meatus on direct inspection (17.4% vs. 4.9%) and those with balanitis (33.3%). On multivariate analysis, penile wetness was independently associated with balanitis, non-specific urethritis/chlamydia, reporting sex with another man and having a visible urinary meatus on direct inspection. Penile wetness was not associated with retracting the foreskin while passing urine or duration since last passed urine. Men with a foreskin covering the urinary meatus on direct observation should be advised about the benefits of good genital hygiene if penile wetness was observed.


Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials.
Objective This study was performed to determine whether the results of prevailing in vivo and in vitro studies offer a reliable model for investigation of medication-related osteonecrosis of the jaw (MRONJ). Methods Embase, Medline, and the Cochrane Library were searched for articles published from September 2003 to June 2017 involving experimental approaches to the pathogenesis of MRONJ. In vivo and in vitro trials were analyzed with respect to the scientific question, study design, methodology, and results. Results Of 139 studies, 87, 46, and 6 conducted in vivo, in vitro, and both in vivo and in vitro experiments, respectively. Rats, mice, dogs, minipigs, sheep, and rabbits were the preferred animal models used. Osteoblasts, osteoclasts, fibroblasts, keratinocytes, macrophages, and human umbilical vein endothelial cells were the preferred cell types. Zoledronate, alendronate, ibandronate, and risedronate were the most frequent bisphosphonates used. MRONJ was most reliably induced in minipigs because of the close relationship with human bone physiology. In vitro studies showed that reduced viability, growth, and migration of cells in the bone and soft tissues were causative for MRONJ. Other than exposed jawbone after tooth extraction, no reliable cofactors were found. Conclusion The minipig is the most suitable animal model for MRONJ.


[Changes of hard tissues in patients with functional and skeletal Angel Class Ⅲ malocclusion after FRⅢ appliance treatment].
To compare changes of hard tissues before and after treatment of functional and skeletal Angle Class Ⅲ malocclusion with FRⅢ appliance. Thirty patients with functional and skeletal Angel Class Ⅲ malocclusion were selected and treated with FRⅢ appliance. SPSS 22.0 software package was performed for statistical analysis. After treatment, there was no significant difference in SNA, S-Ptm, ANS-Ptm and Go-Po (P>0.05). ANB, ANS-Me, ANS-Me /N-Me were increased significantly (P<0.01). SNB, L1-NB, L1-MP were decreased significantly (P<0.05). MP-FH, Y axis, U1-NA, U1-NA (mm), U1-SN were increased significantly (P<0.05). After FRⅢ appliance treatment of Angel Class Ⅲ malocclusion, the position of mandible may rotate clockwise downward and backward, with retrusion of the lower incisors and protrusion of the upper incisors.


New insights on the sister lineage of percomorph fishes with an anchored hybrid enrichment dataset.
Percomorph fishes represent over 17,100 species, including several model organisms and species of economic importance. Despite continuous advances in the resolution of the percomorph Tree of Life, resolution of the sister lineage to Percomorpha remains inconsistent but restricted to a small number of candidate lineages. Here we use an anchored hybrid enrichment (AHE) dataset of 132 loci with over 99,000 base pairs to identify the sister lineage of percomorph fishes. Initial analyses of this dataset failed to recover a strongly supported sister clade to Percomorpha, however, scrutiny of the AHE dataset revealed a bias towards high GC content at fast-evolving codon partitions (GC bias). By combining several existing approaches aimed at mitigating the impacts of convergence in GC bias, including RY coding and analyses of amino acids, we consistently recovered a strongly supported clade comprised of Holocentridae (squirrelfishes), Berycidae (Alfonsinos), Melamphaidae (bigscale fishes), Cetomimidae (flabby whalefishes), and Rondeletiidae (redmouth whalefishes) as the sister lineage to Percomorpha. Additionally, implementing phylogenetic informativeness (PI) based metrics as a filtration method yielded this same topology, suggesting PI based approaches will preferentially filter these fast-evolving regions and act in a manner consistent with other phylogenetic approaches aimed at mitigating GC bias. Our results provide a new perspective on a key issue for studies investigating the evolutionary history of more than one quarter of all living species of vertebrates.


Closed tube loop-mediated isothermal amplification assay for rapid detection of hepatitis B virus in human blood.
Recently, many studies have demonstrated the significant advantages of loop-mediated isothermal amplification (LAMP) based methods over serological tests and PCR for rapid detection of microbial pathogens. Here, a rapid LAMP assay was developed to detect the hepatitis B virus (HBV) from DNA, and particularly, blood samples from infected patients using a commercially available master mix and portable real-time fluorometer. The final optimized fluorescence-based LAMP assay provided significant amplification time of less than 15 minutes compared with over 1 hour for PCR and an opened tube LAMP system described previously. Results indicated that fluorescence-based LAMP assay was more sensitive than PCR as a rapid, sensitive, efficient, and highly reliable approach for rapid detection of HBV.


Representation of medical informatics in the wikipedia and its perspectives.
A wiki is a technique for collaborative development of documents on the web. The Wikipedia is a comprehensive free online encyclopaedia based on this technique which has gained increasing popularity and quality. This paper's work explored the representation of Medical Informatics in the Wikipedia by a search of specific and less specific terms used in Medical Informatics and shows the potential uses of wikis and the Wikipedia for the specialty. Test entries into the Wikipedia showed that the practical use of the so-called WikiMedia software is convenient. Yet Medical Informatics is not represented sufficiently since a number of important topics is missing. The Medical Informatics communities should consider a more systematic use of these techniques for disseminating knowledge about the specialty for the public as well as for internal and educational purposes.


Role of GPER in estrogen-dependent nitric oxide formation and vasodilation.
Estrogens are potent regulators of vasomotor tone, yet underlying receptor- and ligand-specific signaling pathways remain poorly characterized. The primary physiological estrogen 17β-estradiol (E2), a non-selective agonist of classical nuclear estrogen receptors (ERα and ERβ) as well as the G protein-coupled estrogen receptor (GPER), stimulates formation of the vasodilator nitric oxide (NO) in endothelial cells. Here, we studied the contribution of GPER signaling in E2-dependent activation of endothelial NO formation and subsequent vasodilation. Employing E2 and the GPER-selective agonist G-1, we investigated eNOS phosphorylation and NO formation in human endothelial cells, and endothelium-dependent vasodilation in the aortae of wild-type and Gper-deficient mice. Both E2 and G-1 induced phosphorylation of eNOS at the activation site Ser1177 to similar extents. Endothelial NO production to E2 was comparable to that of G-1, and was substantially reduced after pharmacological inhibition of GPER. Similarly, the clinically used ER-targeting drugs 4OH-tamoxifen, raloxifene, and ICI182,780 (faslodex, fulvestrant™) induced NO formation in part via GPER. We identified c-Src, EGFR, PI3K and ERK signaling pathways to be involved in GPER-dependent NO formation. In line with activation of NO formation in cells, E2 and G-1 induced equally potent vasodilation in the aorta of wild-type mice. Gper deletion completely abrogated the vasodilator response to G-1, while reducing the response to E2 by ∼50%. These findings indicate that a substantial portion of E2-induced endothelium-dependent vasodilation and NO formation is mediated by GPER. Thus, selective targeting of vascular GPER may be a suitable approach to activate the endothelial NO pathway, possibly leading to reduced vasomotor tone and inhibition of atherosclerotic vascular disease.


Assisted reproduction versus spontaneous conception: a comparison of the developmental outcomes in twins.
The use of assisted reproductive technology is increasing rapidly. Research, although sparse, has resulted in inconsistent findings as to the developmental prognosis for infants conceived by assisted reproductive techniques such as in vitro fertilization and the use of fertility drugs. In the present study, the authors compared twins who were spontaneously conceived with those who were conceived through assisted reproductive technology. The authors found differences in birth weight and gestational age. Infants conceived by assisted reproductive technology fared worse than did those who were spontaneously conceived. The authors found no differences between the groups in mental development at 24 months of age, but they found evidence of differences in physical development. Implications of the findings are discussed.


Ovariectomy decreases the mRNA levels of transforming growth factor-beta 1 and increases the mRNA levels of osteocalcin in rat bone in vivo.
Estrogen depletion causes postmenopausal osteoporosis. Here we report that steady state mRNA levels of transforming growth factor-beta 1 (TGF-beta 1) and osteocalcin in bone persistently decreased and increased, respectively, in vivo in estrogen-depleted rats after ovariectomy (OVX). 21 female Wistar rats (7-month-old) were randomized and underwent OVX or sham-operation, total RNA was extracted from tibiae and assessed by Northern blot analysis. OVX induced 70-80% decrease in TGF-beta 1 mRNA levels and 2- to 3-fold increase in mRNA levels of osteocalcin compared with controls three weeks after surgery. These changes persisted up to twelve weeks post-operation. OVX caused 15% reduction in femoral bone mineral density and 2-fold elevation in serum osteocalcin levels as early as two weeks post-operation. Moreover, estrogen depletion resulted in marked decrease and increase, respectively, in steady state mRNA levels of TGF-beta 1 and osteocalcin in vitro in osteoblastic rat osteosarcoma cells, ROS 17/2.8. Our results provide the first in vivo evidence that expression of TGF-beta and osteocalcin in bone is reciprocally regulated at the transcriptional level in estrogen deficient OVX rats and suggests that TGF-beta 1 may play a role in estrogen-dependent maintenance of normal bone density.


A monovalent attenuated serotype 2 bluetongue virus vaccine confers homologous protection in sheep.
An outbreak of bluetongue caused by bluetongue virus serotype 2 virus in certain Mediterranean countries during 1999/2000, presented an opportunity to produce a monovalent type 2 vaccine. Since no data have been published previously on the protection conferred by the current live attenuated bluetongue vaccine strains used in the polyvalent vaccine, a challenge experiment was performed to determine the degree of homologous protection induced by the type 2 vaccine strain. The standard vaccine dose of 5 x 10(4) pfu of vaccine conferred 99.7% protection against clinical disease and no viraemia was detected in the vaccinates.


Mycobacterium tuberculosis infection in a corticosteroid-treated rheumatic disease patient population.
To investigate the incidence and risk factors of Mycobacterium tuberculosis infection in longterm corticosteroid treated rheumatic disease patients. We assessed retrospectively the incidence of active tuberculosis and its risk factors in 269 rheumatic disease patients treated with moderate to high doses of corticosteroid for an evaluation period representing 1,035 corticosteroid years of therapy. The mean daily dose of steroid was 18.7 mg prednisolone and the mean daily dose during the first year of treatment was 20.4 mg prednisolone. 21 of these patients developed active tuberculosis resulting in an incidence rate of 20/1,000 patient-years. Cumulative and mean daily steroid doses during the follow-up period and during the first year of treatment, and a history of steroid pulse therapy were significantly correlated with the development of tuberculosis. A past history of tuberculosis, initial chest P-A abnormality, the starting dose of steroid, a history of more than 30 mg/day of prednisolone for more than one month, and a history of cytotoxic therapy were not related to the development of tuberculosis. The incidence of active tuberculosis is increased in rheumatic patients on moderate-to-high dose steroid treatment. Its risk factors are the cumulative and mean daily steroid doses during the follow-up period and during the first year of steroid treatment, and a history of steroid pulse therapy.


[Thalidomide for the treatment of recurrent gastrointestinal blood loss due to intestinal angiodysplasias].
Two female patients, 86 and 80 years of age, had been treated with blood transfusions for several years and several months, respectively, due to iron-deficiency anaemia caused by gastrointestinal blood loss. Angiodysplasias were detected and subsequently coagulated in the course of repeated gastroscopies and colonoscopies. Due to the failure of this treatment, treatment with thalidomide was started. Thereafter, the gastrointestinal bleeding stopped and there was no longer any need for blood transfusions. Treatment with thalidomide seems an effective therapy for patients with frequently recurring gastrointestinal blood loss due to angiodysplasias who no longer tolerate conventional and invasive procedures due to their physical condition.


Lipid monolayer-coated solid surfaces do not perturb the lateral motion and distribution of C3b receptors on neutrophils.
We have used epifluorescence and photobleaching techniques to study the lateral distribution and motion of fluorescein-conjugated Fab fragments of anti-C3b receptor antibody bound to human neutrophils when the cells rest on various solid supports (microscope slides or cover slips). Supports composed of quartz, glass, or alkylated glass induced cellular adhesion, spreading, and an extensive lateral redistribution of C3b receptors (but not HLA antigens). The neutrophil C3b receptors become patchy, and the patches apparently undergo nonrandom translational motion. Many patches are found on the upper surfaces of the cells removed from the region of cell membrane-glass contact. In contrast, neutrophils supported by lipid monolayer-coated glass do not adhere or spread, and the C3b receptor remains uniform and diffuses freely (D approximately equal to 2 X 10(-10) cm2/s).


Does osteopenia warrant treatment?
The progressive loss of bone mass that leads to osteoporosis in postmenopausal women is known to result in substantial morbidity and mortality. Underdiagnosed and undertreated, osteoporosis jeopardizes the health of an estimated 8 million American women 50 years of age or older who are at high risk for hip, vertebral, and other fractures. Because osteopenia is generally a subclinical condition that results in a lower fracture rate than osteoporosis, its potential impact is more difficult to recognize, although it is nearly three times more prevalent than osteoporosis. The question arises as to whether osteopenia should be diagnosed and treated before it transitions into osteoporosis. Because the number of postmenopausal women is projected to increase substantially in the near future and the number of postmenopausal women who will or who have discontinued their use of hormone therapy has increased sharply, the consequences of failing to identify and treat women at increased fracture risk are considerable. Moreover, the rate of bone loss in the first year after discontinuation of hormone therapy is especially rapid and similar to the rate that occurs early after menopause. Accordingly, fracture risk is substantially increased at this time in relation to the magnitude of bone loss. The goal of nonpharmacologic and pharmacologic therapy is to prevent the first fracture in any woman at risk for fracture. Initiation of antiresorptive therapy known to provide rapid efficacy can be particularly important in achieving the treatment goal in appropriate osteopenic women.


Regulation of GTP cyclohydrolase I gene transcription by basic region leucine zipper transcription factors.
Tetrahydrobiopterin is an essential cofactor for the phenylalanine, tyrosine and tryptophan hydroxylases, and the family of nitric oxide synthases. The initial and rate-limiting enzyme in the biosynthesis of tetrahydrobiopterin is GTP cyclohydrolase I. The proximal promoter of the human GTP cyclohydrolase I gene contains the sequence motif 5'-TGACGCGA-3', resembling a cAMP response element (CRE). The objective of this study was to analyze the regulation of GTP cyclohydrolase I gene transcription by basic region leucine zipper (bZIP) transcription factors. A constitutively active mutant of the cAMP response element binding (CREB) protein strongly stimulated GTP cyclohydrolase I promoter activity, indicating that the CRE in the context of the GTP cyclohydrolase I gene is functional. Likewise, GTP cyclohydrolase I promoter/luciferase gene transcription was stimulated following nuclear expression of the catalytic subunit of cAMP-dependent protein kinase. Constitutively active mutants of activating transcription factor 2 (ATF2) and c-Jun additionally stimulated GTP cyclohydrolase I promoter activity, but to a lesser extent than the constitutively active CREB mutant. The fact that stress-activated protein kinases target the GTP cyclohydrolase I gene was corroborated by expression experiments involving p38 and MEKK1 protein kinases. We conclude that signaling pathways involving either the cAMP-dependent protein kinase or stress-activated protein kinases converge to the GTP cyclohydrolase I gene. Hence, enzymatic reactions that require tetrahydrobiopterin as cofactor are therefore indirectly controlled by signaling cascades involving the signal-responsive transcription factors CREB, c-Jun, and ATF2.


Characterization of human peroxisomal membrane proteins.
The peroxisomal membrane appears to play a crucial role in transporting proteins into the organelle. Some human genetic disorders involving peroxisome biogenesis, such as Zellweger syndrome, may be caused by genetic defects of the import machinery located in the peroxisomal membrane. In order to characterize the proteins of the human peroxisomal membrane, we isolated peroxisomes from human liver. We obtained their membranes using various procedures and analyzed their proteins by SDS-polyacrylamide gel electrophoresis and silver staining. We compared the protein composition of peroxisomal membranes with membranes derived from mitochondria and microsomes. The main peroxisomal membrane proteins (PMPs) have apparent molecular masses of 147, 112, 95, 87, 81, 79, 74, 69(70), 53-52 (double band), 47, 45, 43, 37, 31, 28, 22, and 17 kDa. The following PMPs of 147, 112, 79, 69(70), 53-52 (double band), 47, 43, 31, 28, 22, and 17 kDa fit the criteria for integral membrane proteins. We then produced rabbit polyclonal and mouse monoclonal antibodies that recognized some human PMPs. One of these antibodies detected mainly PMP43. We used this antiserum to evaluate the presence and subcellular distribution of the PMP43 in fibroblasts derived from patients affected by Zellweger syndrome. These results represent new information about the protein composition of the human peroxisomal membrane and provide biological tools for further characterization of the human PMPs and their genes in normal and pathological conditions.


Some embryological aspects of cholinergic innervation in the cardiovascular system--a close association with the subintestinal circulatory channel.
A series of our studies on the dog venous system revealed that cholinergic excitatory innervation was localized in a group of veins: the portal, mesenteric, and hepatic veins and the middle segment of the inferior vena cava. Our studies on pharmacological responsiveness of dog veins also revealed that they could be divided into two groups: the visceral and somatic parts, and the cholinergic excitatory innervation localized to the visceral part. Considering these results and some relevant literature, a hypothesis is proposed on the classification of muscles of the cardiovascular system and some embryological aspects of the parasympathetic cholinergic innervation in the circulatory system are discussed. The embryonic circulatory system of vertebrates can be divided into two parts: somatic and visceral. The body of an embryo is regarded as a double tube and vessels of the visceral part and the heart belong to the inner tube. The muscle of these vessels and the heart are derived from visceral mesoderm, either the coelomic epithelium or mesenchymal cells, in common with muscle of the digestive tube; and thus the parasympathetic cholinergic nerves innervating the muscle of the digestive tube also distribute to these vessels and the heart. The heart and vascular muscles in the visceral part are structures developed early in the course of evolution in invertebrates. Their primary function is to propel the body fluid, and the chief structure containing them is the subintestinal circulatory channel (ventral aorta - heart - subintestinal vein). They exhibit spontaneous, rhythmic activity, showing characteristics of a single unit muscle, and receive parasympathetic cholinergic innervation. On the other hand, the vascular muscles in the somatic part are endothelium-associated muscles developed anew in the vertebrate; do not contract spontaneously, being classified as a multiunit muscle; and lack parasympathetic cholinergic innervation.


EIF5A2 enhances stemness of epithelial ovarian cancer cells via a E2F1/KLF4 axis.
Ovarian cancer stem cells (OCSC), endowed with tumor-initiating and self-renewal capacity, would account not only for the tumor growth, the peritoneal metastasis, and the relapse, but also for the acquisition of chemotherapy resistance. Nevertheless, figuring out their phenotypical and functional traits has proven quite challenging, mainly because of the heterogeneity of ovarian cancer. A deeper understanding of OCSC mechanisms will shed light on the development of the disease. Therefore, we aim to explore it for the design of innovative treatment regimens which aim at the eradication of ovarian cancer through the elimination of the CSC component. In this study, immunohistochemistry assay and western blot assay were used to detect protein expression in the primary tumor and peritoneal multi-cellular aggregates/spheroids (MCAs/MCSs). OCSCs induced from cell line SKOV3 and HO-8910 were enriched in a serum-free medium (SFM). The effect of EIF5A2 on CSC-like properties was detected by sphere-forming assays, re-differentiation assays, quantitative real-time polymerase chain reaction, western blotting, flow cytometry, cell viability assays, immunofluorescence staining, and in vivo xenograft experiments. RNA-sequencing (RNA-seq) was used to reveal the mechanism by which EIF5A2 positively modulates the stem-like properties of ovarian cancer cells. Expression of EIF5A2 was significantly higher in peritoneal MCAs/MCSs compared to matched primary tumors, and EIF5A2 was also unregulated in ovarian cancer cell line-derived spheroids. Knockdown of EIF5A2 reduced the expression of the stem-related markers (ALDH1A1 and OCT-4), inhibited self-renewal ability, improved the sensitivity to chemotherapeutic drugs, and inhibited tumorigenesis in vivo. Mechanistic studies revealed that EIF5A2 knockdown reduced the expression of KLF4, which could partially rescue stem-like properties abolished by EIF5A2 knockdown or strengthened by EIF5A2 overexpression, through the transcription factor E2F1, which directly bind to KLF4 promoter. Our results imply that EIF5A2 positively regulates stemness in ovarian cancer cells via E2F1/KLF4 pathway and may serve as a potential target in CSCs-targeted therapy for ovarian cancer.


Competition and dispersal delays in patchy environments.
Dispersal delays are introduced into a competition model for two species that disperse among n identical patches. The model is formulated as a system of integro-differential equations with an arbitrary distribution of dispersal times between patches. By identifying steady states and analyzing local stability, conditions for competitive exclusion, coexistence or extinction are determined in terms of the system parameters. These are confirmed by numerical simulations with a delta function distribution, showing that all solutions approach a steady state and that high dispersal is generally a disadvantage to a species. However, if the two species have identical local dynamics, then small dispersal rates (with certain parameter restrictions) can be an advantage to the dispersing species. If the number of species is increased to three, then oscillatory coexistence with dispersal delay is possible.


[Treatment of floating knee injury in children with elastic intramedullary nail].
To observe the clinical effect of elastic intramedullary nail in minimally invasive treatment of floating knee injury in children. From January 2009 to September 2017, 11 children with floating knee injury were treated with one-off open reduction and elastic intramedullary nail or external fixator fixation, including 7 males and 4 females, aged 5.0 to 11.0 years, with an average age of 8.3 years. The treatment results were evaluated according to karlstrom's standard. Eleven patients were followed up for 8 to 48 months, with an average of 28 months. All the fractures healed at one time, and there were no complications such as nonunion, malunion and serious dysfunction of knee joint. The length of the affected limb in 2 cases was 1.2 to 1.5 cm longer than that in the opposite side without shortening. According to Karlstrom scoring standard, 8 cases were excellent, 1 case was good and 2 cases were middle. Elastic intramedullary nail minimally invasive treatment of floating knee injury in children is a safe and effective treatment, which can effectively reduce the fracture and promote bone healing, which is conducive to early functional recovery.


Collapse of highly charged polyelectrolytes triggered by attractive dipole-dipole and correlation-induced electrostatic interactions.
In the first part of the paper, we study the collapse of flexible highly charged polyelectrolyte chains induced by attractive dipole-dipole interactions. The latter emerge due to the formation of dipoles between the chain monomers and counterions condensed on the polyelectrolyte from solution. Using the statistics of slightly perturbed Gaussian polymers, we obtain the scaling relations for the chain dimensions as a function of polyelectrolyte linear charge density in the limit of compacting chains. The results are in good agreement with the outcomes of recent molecular dynamics simulations of the collapse of flexible polyelectrolytes in the presence of explicit counterions. In the second part, we analyze the results of molecular dynamics simulations for the complex formation by two highly charged polyelectrolyte chains carrying opposite charges. We use the scaling arguments based on the picture of complexation of electrostatic blobs in order to rationalize the size of the complexes of two polyelectrolyte chains in the collapsed state. Similar scaling relation for the complex size was recently obtained in computer simulations of complexation of diblock polyampholytes and was described theoretically on the basis of similar electrostatic blob concepts. We also analyze the density of complexes formed and polyelectrolyte linear charge densities required for the onset onto the collapse as a function of interaction strength between the monomers. In both parts of the paper, we overview the scaling relationships obtained for similar systems with alternating charges from other theoretical approaches.


Best Laboratory Practices Regarding POCT in Different Settings (Hospital and Outside the Hospital).
Point-of-care testing is proliferating at an alarming rate as technological improvements in miniaturization coupled with the need for rapid diagnostics drive the market globally. This review highlights best laboratory practices that must be communicated to the diverse group of people employing POC testing in their respective settings both inside and outside the hospital setting so that reliable results can be obtained.


Social media and mobile apps for health promotion in Australian Indigenous populations: scoping review.
Health promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited. The study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit? We conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas. The review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects. Although social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects.


Natural history studies for the preliminary evaluation of Larinus filiformis (Coleoptera: Curculionidae) as a prospective biological control agent of yellow starthistle.
We studied the life history, geographic distribution, behavior, and ecology of Larinus filiformis Petri (Coleoptera: Curculionidae) in its native range to determine whether it is worthy of further evaluation as a classical biological control agent of yellow starthistle, Centaurea solstitialis (Asteraceae: Cardueae). Larinus filiformis occurs in Armenia, Azerbaijan, Turkey, and Bulgaria and has been reared only from C. solstitialis. At field sites in central and eastern Turkey, adults were well synchronized with the plant, being active from mid-May to late July and ovipositing in capitula (flowerheads) of C. solstitialis from mid-June to mid-July. Larvae destroy all the seeds in a capitulum. The insect is univoltine in Turkey, and adults hibernate from mid-September to mid-May. In the spring, before adults begin ovipositing, they feed on the immature flower buds of C. solstitialis, causing them to die. The weevil destroyed 25-75% of capitula at natural field sites, depending on the sample date. Preliminary host specificity experiments on adult feeding indicate that the weevil seems to be restricted to a relatively small number of plants within the Cardueae. Approximately 57% of larvae or pupae collected late in the summer were parasitized by hymenopterans [Bracon urinator, B. tshitsherini (Braconidae) and Exeristes roborator (Ichneumonidae), Aprostocetus sp. (Eulophidae), and unidentified species of Eurytomidae and Ormyridae]. This weevil may be a better choice than the other capitula insects already established in the United States, particularly in colder parts of the plant's range.


[Simple cysts of the testis in children. Apropos of 2 cases].
Reporting two cases of simple testicular cysts in children, the authors analyse these rare benign tumors (9 other cases in literature). The cystic dilatation first affect the rete testis, it can be partial (simple cyst) or extensive (multicystic dysplasia). The primitive perturbation would affect the mesonephrotic formations, with a defect of junction between the two different embryologic formations of the testicle and its excretor system. These tumors are revealed by a large isolated testicle, histology only makes the diagnosis. Despite their benignity, simple orchidectomy is the save treatment; enucleation is justified only when the opposite testicle is also injured.


Titanium mesh and pedicled buccal fat pad for the reconstruction of maxillary defect: case report.
Pedicled buccal fat pad (PBFP) has been used for the reconstruction of small-sized maxillary defects but cannot be used without hard tissue support on the defect larger than 4 cm × 4 cm × 3 cm. A 64-year-old man had a history of squamous cell carcinoma of the left maxilla. After removal of the posterior maxilla, a complex bone defect (size, 5 cm × 4 cm × 3 cm) was immediately reconstructed using PBFP combined with a titanium mesh. A pinpoint fistula was found in the left palatal region 1 month after the surgery and was treated with a palatal sliding flap. There were no further complications during the follow-up. The present technique demonstrated that PBFP combined with a titanium mesh could be used for the reconstruction of complex maxillary defect (size, 5 cm × 4 cm × 3 cm) without additional bone graft.


[Nursing handover: an observational study at the inpatient wards - cardiothoracic department].
The handover has relevant implications in terms of patient safety. An effective handover requires the use of a standardized and shared communication tool. This observational study explored the nursing handover at shift change in order to detect eventual omissions. Furthermore, it investigated the quality perceived by the nurses involved. At each shift change, an external observer detected the referred and omitted information by the delivering nurse, through the use of a direct observational grid (modified ISBAR). The percentage of the omitted information was calculated excluding any unforeseen information, not linked to the patient care pathway and detected through the consultation of the nursing record. The quality perceived by the nurses involved was investigated through the use of the Handoff CEX tool. The data was processed through a descriptive and inferential statistical analysis. 256 handovers were observed and 256 nursing records were reviewed. The omissions were detected in 43.17% of the cases. The results highlight a propensity for a prospective approach. A high statistical significance emerges in relation to the modality of handover, the type of patient, the nurse/patients ratio and the number of interruptions. Referring to the perceived quality, 40 Handoff CEX evaluation forms were completed. The results show a more than satisfactory perception. However, the thematic analysis highlights scarcely detailed and dispersive handovers as well as the difficulty to focus on the information to deliver. According to the findings of this research, it is necessary to implement a standardized tool which supports the handover process.