Conversion surgery for initially unresectable extrahepatic biliary tract cancer.
Surgical resection is the only curative treatment for biliary tract cancers; however, most patients undergo palliative chemotherapy because they are contraindicated for surgery. Conversion surgery, a treatment strategy for downsizing chemotherapy and subsequent surgical resection, is feasible for initially unresectable biliary tract cancers following the introduction of effective chemotherapeutic agents. Patients initially diagnosed with unresectable biliary tract cancers, and treated with conversion surgery after palliative chemotherapy between 2013 and 2019, were reviewed retrospectively. Twelve patients underwent conversion surgery after palliative chemotherapy for initially unresectable biliary tract cancers. The final pathological diagnosis included six perihilar cholangiocarcinomas, four distal common bile duct cancers, and two gallbladder cancers. Different chemotherapy regimens were used, but all the patients were treated with gemcitabine at some point during their treatment. The median overall survival was 28 months, which was longer than that of patients treated with isolated palliative chemotherapy in previous studies. Conversion surgery represents a therapeutic alternative for specific cases of unresectable biliary tract cancers. Palliative chemotherapy for initially unresectable biliary tract cancers is recommended for downsizing the tumor and expanding the indications for surgery. Further studies and clinical trials are required to develop new and effective chemotherapeutic regimens.


Determinants of infant nutritional status in Dabat district, North Gondar, Ethiopia: A case control study.
Malnutrition is the top cause of global burden of disease, disability and mortality among infants. Over two-thirds of deaths of children globally occur during the first year of life (infancy). Malnutrition among infants is substantially high in Ethiopia. Therefore, this study is aimed to assess determinants of infant nutritional status. A community based nested case-control study was conducted from February to June 2013 in Dabat district. A total of 80 cases and 320 controls (1:4 ratios) were studied. Relevant data was extracted from the community based survey data set. Anthroplus software was used to identify cases and controls. Determinants of infant nutritional status were identified using multivariate analysis. Among the total of 80 cases and 320 controls, more than half (52.5%) of the cases and the controls (53.8%) were males and females, respectively. Breast Feeding (BF) was started immediately after birth in only 43.8% of the cases. Nearly 94% of the mothers of the cases had no breast feeding information as part of Ante Natal Care (ANC) follow up. Maternal age (AOR: 0.29; 95% CI: 0.11-0.76), having radio (AOR: 0.43; 95% CI: 0.22-0.82), lack of toilet facility (AOR: 2.24; 95% CI: 1.16-4.33), deprivation of colostrum (AOR: 1.76; 95% CI: 1.01-1.06) and method of complementary feeding (AOR: 2.82; 95% CI: 1.33-5.99) were associated with wasting. This study has found that inappropriate infant feeding; nutritional information gap and lack of toilet facility as significant predictors of malnutrition. Hence, joint interventions, including counseling of mothers about benefits of colostrum feeding and use of appropriate feeding method, toilet utilization and mass media such as radio possession, are needed to address the problem in Dabat district.


Untangling Polypharmacy in Older Adults.
Polypharmacy, the use of five or more medications at one time, is increasingly prevalent in older adults. The nurse's role in education, care coordination, communication, and regular medication recon- ciliation is vital to improve outcomes.


Do non-centro-symmetric linear X-Y-X molecules exist? The case for the (I)2Pi(u) state of CuCl2.
The potential energy surface of the low-lying excited state (I)(2)Pi(u) of CuCl(2) is constructed by using the ionization potential equation-of-motion coupled-cluster method and also the RASPT2 method with a large active space of 21 electrons in 17 orbitals to improve the results. It is found by the multiconfiguration calculation that this state has a barrier of 53 cm(-1) between two equivalent minima in which the linear molecule has a dipole moment. In our computations artifactual symmetry breaking is carefully avoided. Further refinement, including consideration of interaction between the two excited (2)Pi states, yields a somewhat higher barrier between 100 and 500 cm(-1). The mechanism of formation of the double-minimum potential is explained by the pseudo-Jahn-Teller effect theory. Computed spectroscopic constants are in good agreement with experimental ones.


Report of an unusual case of persistent bacteremia by Bartonella bacilliformis in a splenectomized patient.
We report a case of a 56-year-old man with a history of splenectomy for idiopathic thrombocytopenic purpura who developed persistent bacteremia in the acute phase of human bartonellosis. This patient did not develop hemolytic anemia. Only after several courses of antibiotic treatment was the infection eradicated. This is an unusual case of overwhelming post-splenectomy infection by Bartonella bacilliformis, which provides clinical evidence that the spleen is a critical effector organ of clearance of this infection as well as the effector organ of bartonellosis-associated hemolytic anemia.


Persistent and Recurrent Bacterial Bronchitis-A Paradigm Shift in Our Understanding of Chronic Respiratory Disease.
The recent recognition that the conducting airways are not "sterile" and that they have their own dynamic microbiome, together with the rapid advances in our understanding of microbial biofilms and their roles in the causation of respiratory diseases (such as chronic bronchitis, sinusitis, and chronic otitis media), permit us to update the "vicious circle" hypothesis of the causation of bronchiectasis. This proposes that chronic inflammation driven by persistent bacterial bronchitis (PBB) causes damage to both the epithelium, resulting in impaired mucociliary clearance, and to the airway wall, which eventually manifests as bronchiectasis. The link between a "chronic bronchitis" and a persistence of bacterial pathogens, such as non-typable Haemophilus influenzae, was first made more than 100 years ago, and its probable role in the causation of bronchiectasis was proposed soon afterward. The recognition that the "usual suspects" are adept at forming biofilms and hence are able to persist and dominate the normal dynamically changing "healthy microbiome" of the conducting airways provides an explanation for the chronic colonization of the bronchi and for the associated chronic neutrophil-dominated inflammation characteristic of a PBB. Understanding the complex interaction between the host and the microbial communities of the conducting airways in health and disease will be a key component in optimizing pulmonary health in the future.


Quaternary ammonium promoted ultra selective and sensitive fluorescence detection of fluoride ion in water and living cells.
Highly selective and sensitive fluorescent probes with a quaternary ammonium moiety have been rationally designed and developed for fast and sensitive fluorescence detection of fluoride ion (F(-) from NaF, not TBAF) in aqueous solution and living cells. With the sequestration effect of quaternary ammonium, the detection time was less than 2 min and the detection limit of fluoride ion was as low as 0.57 ppm that is among the lowest detection limits in aqueous solutions of many fluoride fluorescence probes in the literature.


Dissecting the Specificity of Adenosyl Sulfamate Inhibitors Targeting the Ubiquitin-Activating Enzyme.
Targeting the activating enzymes (E1) of ubiquitin (Ub) and ubiquitin-like modifiers (Ubls) has emerged as a promising anti-cancer strategy, possibly overcoming the ineffectiveness of proteasome inhibitors against solid tumors. Here, we report crystal structures of the yeast ubiquitin E1 (Uba1) with three adenosyl sulfamate inhibitors exhibiting different E1 specificities, which are all covalently linked to ubiquitin. The structures illustrate how the chemically diverse inhibitors are accommodated within the adenylation active site. When compared with the previously reported structures of various E1 enzymes, our structures provide the basis of the preferences of these inhibitors for different Ub/Ubl-activating enzymes. In vitro inhibition assays and molecular dynamics simulations validated the specificities of the inhibitors as deduced from the structures. Taken together, the structures establish a framework for the development of additional compounds targeting E1 enzymes, which will display higher potency and selectivity.


[Renewed medical education in Linkoping. Problem-based learning, basic science and public health intensified].
A complete undergraduate medical programme in Linköping started 1986. The curriculum was innovative applying problem-based learning, community-orientation, and multi-professional training. After almost 20 years, a revision is implemented to vitalise the original educational principles. A curriculum committee coordinates seven multi-disciplinary theme-groups, mainly based on organ systems, responsible for planning and implementation of their parts during the whole curriculum. Critical appraisal, professional development, and population health are strengthened. Problem based learning is improved by using web-based scenarios and information technology. Phase I (2 semesters) focuses on basic concepts in basic science in relevant contexts, and Phase II (3 semesters) on normal structure, pathophysiology, diagnostic methods, and treatment. Phase III starts with a semester for a student research project and an elective period. The following five semesters deal with clinical medicine in hospitals and health centres with clerkships in four week periods changing with two week theoretical blocks related to the themes.


Reaction phenotyping: advances in the experimental strategies used to characterize the contribution of drug-metabolizing enzymes.
During the process of drug discovery, the pharmaceutical industry is faced with numerous challenges. One challenge is the successful prediction of the major routes of human clearance of new medications. For compounds cleared by metabolism, accurate predictions help provide an early risk assessment of their potential to exhibit significant interpatient differences in pharmacokinetics via routes of metabolism catalyzed by functionally polymorphic enzymes and/or clinically significant metabolic drug-drug interactions. This review details the most recent and emerging in vitro strategies used by drug metabolism and pharmacokinetic scientists to better determine rates and routes of metabolic clearance and how to translate these parameters to estimate the amount these routes contribute to overall clearance, commonly referred to as fraction metabolized. The enzymes covered in this review include cytochrome P450s together with other enzymatic pathways whose involvement in metabolic clearance has become increasingly important as efforts to mitigate cytochrome P450 clearance are successful. Advances in the prediction of the fraction metabolized include newly developed methods to differentiate CYP3A4 from the polymorphic enzyme CYP3A5, scaling tools for UDP-glucuronosyltranferase, and estimation of fraction metabolized for substrates of aldehyde oxidase.


Effects of Different Molecular Weight Oxidized Dextran as Crosslinkers on Stability and Antioxidant Capacity of Curcumin-Loaded Nanoparticles.
Curcumin is a polyphenolic compound that has been widely investigated for its health benefits. However, the clinical relevance of curcumin is limited due to its low water solubility and inefficient absorption. Therefore, curcumin is often encapsulated in nanocarriers to improve its delivery and function. In this study, composite nanoparticles composed of stearic acid-modified chitosan (SA-CS) and sodium caseinate (NaCas) were formed using sodium periodate-oxidized dextran with different molecular weights as a crosslinking agent. The effects of oxidized dextran (Odex) with different molecular weights on the composite nanoparticles were compared. The optimal SA-CS/NaCas/Odex composite nanoparticle (NPO) was obtained using an Odex (150 kDa)-to-SA-CS mass ratio of 2:1. Its size, polydispersity index (PDI), and zeta potential (ZP) were 130.2 nm, 0.149, and 25.4 mV, respectively. The particles were highly stable in simulated gastric fluid (SGF) in vitro, and their size and PDI were 172.3 nm and 0.263, respectively. The encapsulation rate of NPO loaded with curcumin (Cur-NPO) was 93% under optimal ultrasonic conditions. Compared with free curcumin, the sustained release of Cur-NPO significantly reduced to 17.9%, and free-radical-scavenging ability improved to 78.7%. In general, the optimal prepared NPO exhibited good GI stability and has potential applications in the formulation of orally bioactive hydrophobic drugs.


The conserved methionines of the 1.3 S biotinyl subunit of transcarboxylase: effect of mutations on conformation and activity.
Transcarboxylase from Propionibacterium shermanii is a biotin-containing enzyme which catalyzes the reversible transfer of a carboxyl group from methylmalonyl-CoA to pyruvate. Transcarboxylase 26 S complexes consist of a central, hexameric 12 S subunit with 6 outer, 5 S subunits attached by 12 1.3 S biotinyl subunits. Each of the subunits has been cloned and expressed in Escherichia coli in active form. We have used the cloned genes in mutagenic studies of the structure-function interactions of these subunits. One particular target of our studies has been the evolutionarily conserved tetrapeptide Ala-Met-Bct-Met which surrounds the biotinyl lysine. We have investigated the properties of subunits containing leucine substitutions at each methionine (1.3 S M88L and 1.3 S M90L) by assaying their activity in the two partial reactions in which this subunit participates. Partial reaction assays demonstrate that leucine substitution at either position has a greater effect on the 12 S partial reaction than on the 5 S reaction and Met 88 is more significant catalytically than Met 90. To determine whether structural alterations in the 1.3 S mutants were responsible for the effects on activity, the conformations of these mutants were investigated. In vitro hydrolysis studies with trypsin and V8 protease demonstrated differences in the susceptibility of 1.3 S M88L relative to 1.3 S WT and 1.3 S M90L. Complexes of avidin with 1.3 S WT or mutant subunits, as monitored by fluorescence properties, indicated that the microenvironment of the biocytin of 1.3 S M88L was different from those of 1.3 S WT and 1.3 S M90L. By contrast, substrate binding (oxalacetate for 5 S and methylmalonyl-CoA for 12 S) was unaffected by any of the 1.3 S mutants. Taken together, these results indicate that the conserved tetrapeptide of the 1.3 S biotinyl subunit, particularly Met 88, is required to provide an essential conformation and proper binding properties for catalysis of the partial reactions and the overall reaction.


Flexibility accompanies commitment of memory CD4 lymphocytes derived from IL-4 locus-activated precursors.
Differentiation of T helper (Th) subset 2 effector lymphocytes is thought to foreclose on IFN-gamma gene expression. Using an IL-4 locus modified to detect transcriptional induction of this effector cytokine gene in developing Th2 cells, we show here that these cells contributed effectively to a long-term memory population. A memory CD4 subset formed efficiently from an activated population after transcriptional induction of the IL-4 locus and differentiation into an IL-4-producing subset with Th2 characteristics. Memory lymphocytes derived from Th2 cells with IL-4 locus activation remained committed to transcriptional competence of Th2 cytokine genes when reactivated and cultured under strong Th1-polarizing conditions. This commitment to transcriptional competence at Th2 cytokine gene loci upon recall activation indicates that linear differentiation is a substantial component of type 2 memory. Strikingly, however, descendants of the Th2 population could turn on IFN-gamma expression when reactivated after a quiescent period, revealing an unexpected flexibility allowing activation of the forbidden IFN-gamma gene after reactivation and growth.


Multifunctional Nanoparticles Loading with Docetaxel and GDC0941 for Reversing Multidrug Resistance Mediated by PI3K/Akt Signal Pathway.
The polylactic-co-glycolic acid polyethylene glycol conjugated with cell penetrating peptide R7 (PLGA-PEG-R7)/polysulfadimethoxine-folate nanoparticles loaded with docetaxel (DTX) and GDC0941 (R7/PSD-Fol NPs) were prepared to overcome multidrug resistance (MDR) and enhance the antitumor activity. First, polysulfadimethoxine-folate was synthesized to construct the R7/PSD-Fol NPs. The R7/PSD-Fol NPs were prepared with the abilities of effective entrapment and drug loading. Due to the pH-sensitive effect of PSD-folate, the releasing of DTX and GDC0941 from the R7/PSD-Fol NPs was lower in pH 7.4 buffer solution than that in pH 5.0 buffer solution. The half maximal inhibitory concentration (IC50) of MCF-7 and resistant to doxorubicin (MCF-7/Adr) cells illustrated the cytotoxicity of R7/PSD-Fol nanoparticles by using the MTT method. The uptake of R7/PSD-Fol NPs was visualized by using the fluorescence of Rh-123 to detect the targeting effect of folate on the surface of R7/PSD-Fol NPs. The results of the cell apoptosis and the depolarization of mitochondrial membrane potential (MMP) were adopted to show the cytotoxicity of the R7/PSD-Fol NPs on MCF-7/Adr cells. The Western blot revealed the inhibition of PI3K/Akt pathway in MCF-7/Adr cells induced by R7/PSD-Fol NPs. Finally, both in vivo distribution and in vivo antitumor showed the R7/PSD-Fol NPs displayed the better distribution at tumor site and the stronger suppression of tumor growth in the tumor bearing nude mice compared with control group. It was concluded that R7/PSD-Fol NPs loaded with DTX and GDC0941 could overcome MDR and enhance the antitumor effect further.


[Hydrogen water alleviates paraquat-induced lung fibroblast injury in vitro by enhancing Nrf2 expression].
To investigate the effects of hydrogen water on proliferation, differentiation, collagen secretion and Nrf2 expression in paraquat-induced human lung fibroblasts. In vitro cultured human lung fibroblasts (HFL1) exposed to 600 μmol/L paraquat (PQ) for 24 h were treated with hydrogen water with or without RNA interference of Nrf2 expression. The changes in the cell proliferation were examined using MTT assay, and the expressions of Col-I, Col-III, α-SMA and Nrf2 in the cells were detected using Western blotting, real-time quantitative PCR and immunofluorescence assay. The contents of SOD, CAT and GSH in the cells were determined with ELISA. Compared with the PQ-exposed cells, the cells with hydrogen water treatment showed significantly lowered expressions of Col-I, Col-III, and α-SMA. Interference of Nrf2 expression obviously attenuated the effect of hydrogen water on PQ-exposed cells. Hydrogen water treatment significantly increased the expression of Nrf2 and promoted the production of the antioxidants in PQ-exposed lung fibroblasts. Hydrogen water enhances Nrf2 expression to promote the proliferation and production of antioxidants and inhibit the differentiation and collagen secretion in PQ-exposed human lung fibroblasts in vitro.


[Hypopituitarism].
Hypopituitarism is usually caused by tumours of the hypothalamus-pituitary region, but may also arise as the consequence of pituitary inflammation, infiltration or hypoperfusion. Tumour mass reduction by surgical intervention or following drug treatment may improve pituitary function. However, neurosurgical tumour resection and radiation therapy may lead to a permanent manifestation of hypopituitarism. Diagnosis is established by endocrine testing, revealing the characteristic low serum concentrations of both peripheral hormone and associated regulatory hormone of pituitary origin. Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary (in order of frequency: growth hormone deficiency>secondary hypogonadism>secondary hypothyroidism>secondary adrenal failure). The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones (hydrocortisone, DHEA, thyroxine, testosterone or oestradiol, growth hormone). Quality of life is impaired in a considerable number of patients with hypopituitarism and mortality is increased, mostly due to cardiovascular and cerebrovascular causes, but also as a consequence of recurrent respiratory infections. Long-term care and monitoring of patients with hypopituitarism requires the experienced endocrinologist.


Sarcomere length and force changes in single tetanized from muscle fibers following quick changes in fiber length.
By use of an optical system, with which the beam of the first-order diffraction line of He-Ne laser light from a single frog skeletal muscle fiber was split by the wedge-shaped mirror to be focused on two photodiodes ( Haugen & Sten - Knudsen , 1976), small changes in sarcomere length (less than 1 A) could be recorded during quick fiber length changes (up to 1.2% of Lo, complete within 0.2-0.4 msec) applied at the plateau of isometric tetanus. Data were only obtained on fibers which showed typical sinusoidal sarcomere length changes in response to sinusoidal fiber length changes during tetanus with a linear relation between their magnitudes. Measurements of sarcomere length changes were made at various points along the fiber length. The interval between the onset of fiber length changes at one fiber end and that of force change recorded at the fixed fiber end was explained by the propagation of mechanical impulse at about 180 m/sec. In the case of quick releases, the onset of sarcomere shortening near the fixed fiber end tended to take place after that of force change, especially with long fibers, indicating that the drop in force during a quick release may not always be associated with sarcomere shortening along the entire fiber length. This implies that the force changes in response to rapid length changes may not give correct information about the cross-bridge properties. Irrespective of the point at which sarcomere shortening was recorded, it was always observed that the onset of quick force recovery occurred while sarcomere shortening was still in progress. Such a phenomenon can be simulated by a viscoelastic multi-segment model with series elasticity located in each segment.


Uniform and reproducible barrier layer removal of porous anodic alumina membrane.
A method for the fabrication of porous anodic alumina (PAA) membrane without bottom barrier layer on Al substrate is described. In this method, two-step anodizing followed by a barrier thinning process at the end of the second anodization was used to prepare wide range highly-ordered PAA membrane with a thin barrier layer. Finally, cathodic polarization and pore widening processes were combined to remove the barrier layer completely between the oxide film and Al substrate. Scanning electron microscope (SEM) was used to characterize the morphology and structure of the PAA membrane. From the SEM images, the PAA membrane prepared with the assistance of cathodic polarization showed more homogeneous pore diameters and pore wall quality than that made by pore widening only. In addition, the barrier layer was removed completely with 7.5 min of cathodic polarization and 70 min of pore widening without corrosion in the Al substrate. It was possible to control the pore diameter without any damage to the PAA template from 70 to 90 nm. The fabricated PAA template can be applied to the growth of ordered nanowires, nanorods, nanotubes, and similar structures.


A Comprehensive Comparison of Early-Onset and Average-Onset Colorectal Cancers.
The causative factors for the recent increase in early-onset colorectal cancer (EO-CRC) incidence are unknown. We sought to determine if early-onset disease is clinically or genomically distinct from average-onset colorectal cancer (AO-CRC). Clinical, histopathologic, and genomic characteristics of EO-CRC patients (2014-2019), divided into age 35 years and younger and 36-49 years at diagnosis, were compared with AO-CRC (50 years and older). Patients with mismatch repair deficient tumors, CRC-related hereditary syndromes, and inflammatory bowel disease were excluded from all but the germline analysis. All statistical tests were 2-sided. In total, 759 patients with EO-CRC (35 years, n = 151; 36-49 years, n = 608) and AO-CRC (n = 687) were included. Left-sided tumors (35 years and younger = 80.8%; 36-49 years = 83.7%; AO = 63.9%; P < .001 for both comparisons), rectal bleeding (35 years and younger = 41.1%; 36-49 years = 41.0%; AO = 25.9%; P = .001 and P < .001, respectively), and abdominal pain (35 years and younger = 37.1%; 36-49 years = 34.0%; AO = 26.8%; P = .01 and P = .005, respectively) were more common in EO-CRC. Among microsatellite stable tumors, we found no differences in histopathologic tumor characteristics. Initially, differences in TP53 and Receptor Tyrosine Kinase signaling pathway (RTK-RAS)alterations were noted by age. However, on multivariate analysis including somatic gene analysis and tumor sidedness, no statistically significant differences at the gene or pathway level were demonstrated. Among advanced microsatellite stable CRCs, chemotherapy response and survival were equivalent by age cohorts. Pathogenic germline variants were identified in 23.3% of patients 35 years and younger vs 14.1% of AO-CRC (P = .01). EO-CRCs are more commonly left-sided and present with rectal bleeding and abdominal pain but are otherwise clinically and genomically indistinguishable from AO-CRCs. Aggressive treatment regimens based solely on the age at CRC diagnosis are not warranted.


Evidence for M2 and M3 muscarinic receptor involvement in cholinergic excitatory junction potentials through synergistic activation of cation channels in the longitudinal muscle of mouse ileum.
Cholinergic nerve-mediated excitatory junction potentials (EJPs) in the longitudinal muscle of mouse ileum were characterized by using M2 or M3 muscarinic receptor-knockout (KO) mice and 1-[β-[3-(4-methoxyphenyl) propoxy]-4-methoxyphenethyl]-1H-imidazole hydrochloride (SK&F 96365) and pertussis toxin (PTX). EJPs evoked by electrical field stimulation (EFS) in wild-type preparations, initially determined to be cholinergic in origin using tetrodotoxin, atropine, and eserine, were profoundly depressed after SK&F 96365 treatment known to block muscarinic receptor-operated cation channels. A similar depression of the EJPs was also observed by PTX treatment, which is predicted to disrupt M2-mediated pathways linked to cation channel activation. In M2-KO mouse preparations, cholinergic EJPs were evoked by EFS with their relative amplitude of 20%-30% to the wild-type EJP and strongly inhibited by SK&F 96365. No cholinergic EJP was seen in M3-KO as well as M2/M3 double-KO preparations. The results suggest that the wild-type cholinergic EJP is not a simple mixture of M2 and M3 responses, but due to synergistic activation of cation channels by both M2 and M3 receptors in the murine ileal longitudinal muscle.


Taming turbulence in the complex Ginzburg-Landau equation.
Taming turbulence in the complex Ginzburg-Landau equation (CGLE) by using a global feedback control method and choosing traveling-wave solutions as our target state is investigated. The problem of optimal control for the smallest driving strength is studied by systematically comparing the stabilities of all traveling waves. Within the Benjamin-Feir-Newell unstable parameter region (c2<-c1 -1, a critical control curve is determined, which is located at c2=alphacbeta1 , with alpha approximately -4.0 and beta approximately -0.87. It characterizes the transition of chosen traveling-wave target state from long wavelength to short one. This finding is of great significance for taming turbulence in the CGLE and some other spatiotemporal systems as well.


Ruptured thoracic aortic dissection presenting as opacified left hemothorax.
Acute aortic dissections are uncommon, with a reported incidence of 2000 cases per year in the United States. Hemothorax is an unusual but well-described complication of ruptured thoracic aortic dissection. It usually occurs on the left and can be seen in both proximal and distal dissections. Chest radiographs (CXR) in thoracic aortic dissections often reveal a widened mediastinum or abnormal aortic silhouette, evident in 80%-90% of cases. However, CXR may be normal in about 12% of patients with aortic dissection. Clues that would indicate aortic dissection such as abnormal aortic silhouette and widened mediastinum may be obscured by an opacified hemothorax caused by rupture of a thoracic aortic dissection. A high index of suspicion is necessary to make a diagnosis of ruptured thoracic aortic dissection in a patient presenting with hemothorax. This is illustrated in the case described.


Impact of KIF6 Polymorphism rs20455 on Coronary Heart Disease Risk and Effectiveness of Statin Therapy in 100 Patients from Southern Iran.
The purpose of this study was to investigate the association between Trp719Arg (rs20455) and Coronary Heart Disease (CHD), and also Coronary Heart Disease reduction in individuals with this SNP during statin therapy in southern Iran. It has been shown that rs20455, which could affect the function of kinesin protein, is associated with Coronary Heart Disease and could be an effective factor for patients who take statin therapy. Patients and control individuals were genotyped for rs20455 Single Nucleotide Polymorphism (SNP) using ARMS PCR (Amplification Refractory Mutation System Polymerase Chain Reaction) and RFLP (Restriction Fragment Length Polymorphism) analysis. The effect of kinesin family member 6 (KIF6) on statin therapy was also examined among patients who had a history of one or two heart attacks. It was found that rs20455 had a significant association with Coronary Heart Disease (Odds Ratio [OR] 3.17, 95% Confidence Interval [CI] 1.68 to 5.98). In addition, statin therapy was more effective in rs20455 carriers than non-carriers, with 80% of the carriers showed positive response to this treatment. Trp 719Arg have an effect on development of Coronary Heart Disease but it is very useful for statin therapy. Overall, individuals with this Single Nucleotide Polymorphism can take statin therapy to prevent the catastrophic consequences of Coronary Heart Disease.


Volatile release from self-assembly structured emulsions: effect of monoglyceride content, oil content, and oil type.
Monoglycerides (MGs) can form self-assembled structures in emulsions, which can be used to control volatile release. In this study, initial headspace concentrations (C(initial)), maximum headspace concentrations (C(max)), release rates, and partition coefficients of propanol, diacetyl, hexanal, and limonene were determined in MG structured oil-in-water emulsions using dynamic and static headspace analyses. For all of the volatile compounds, C(initial) values above structured emulsions were significantly lower than those above unstructured emulsions and decreased with increasing MG contents (p < 0.05). However, volatiles had higher release rates in emulsions with higher MG contents. When oil content was reduced from 20 to 10%, C(initial) and C(max) increased for limonene and hexanal and decreased for propanol and diacetyl. When different oils were applied, both C(initial) and C(max) were significantly lower in medium-chain triglyceride emulsions than in soybean oil emulsions (p < 0.05). Static headspace analysis revealed that volatile compounds had significantly lower air-emulsion partition coefficients in the structured emulsions than in unstructured emulsions (p < 0.05). These results indicated that MG structured emulsions can be potentially used as delivery systems to modulate volatile release.


Nanoparticle distribution and temperature elevations in prostatic tumours in mice during magnetic nanoparticle hyperthermia.
Among a variety of hyperthermia methods, magnetic nanoparticle hyperthermia is a highly promising approach for its confined heating within the tumour. In this study we perform in vivo animal experiments on implanted prostatic tumours in mice to measure temperature distribution in the tumour during magnetic nanoparticle hyperthermia. Temperature elevations are induced by a commercially available ferrofluid injected via a single injection to the centre of the tumour, when the tumour is subject to an alternating magnetic field. Temperature mapping in the tumours during magnetic nanoparticle hyperthermia has demonstrated the feasibility of elevating tumour temperatures higher than 50°C using only 0.1 cm(3) ferrofluid injected in the tumour under a relatively low magnetic field (3 kA/m). Detailed 3-D nanoparticle concentration distribution is quantified using a high-resolution microCT imaging system. The calculated nanoparticle distribution volume based on the microCT scans is useful to analyse nanoparticle deposition in the tumours. Slower ferrofluid infusion rates result in smaller nanoparticle distribution volumes in the tumours. Nanoparticles are more confined in the vicinity of the injection site with slower infusion rates, causing higher temperature elevations in the tumours. The increase in the nanoparticle distribution volume in the tumour group after the heating from that in the tumour group without heating suggests possible nanoparticle re-distribution in the tumours during the heating.


Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial.
The objective of this randomized, controlled clinical trial was to compare the clinical and microbiological effects of pocket debridement using erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser with conventional debridement in maintenance patients. Fifteen patients, all smokers, having at least four teeth with residual probing depth (PD) ≥ 5 mm were recruited. Two pockets in two jaw quadrants were randomly assigned to subgingival debridement using an Er:YAG laser (test) or ultrasonic scaler/curette (control) at 3-month intervals. Relative attachment level (RAL), PD, bleeding on probing and dental plaque were recorded at baseline and at 6 and 12 months. Microbiological subgingival samples were taken at the same time points and analysed using a checkerboard DNA-DNA hybridization technique. A significant decrease in PD took place in both treatments from baseline to 12 months (p < 0.01). In the control, the mean initial PD decreased from 5.4 to 4.0 mm at 12 months. For the test, a similar decrease occurred. No significant between-treatment differences were shown at any time point. The mean RAL showed no overall significant inter- or intra-treatment differences (p > 0.05). No significant between-treatment differences were observed in subgingival microbiological composition or total pathogens. The results failed to support that an Er:YAG laser may be superior to conventional debridement in the treatment of smokers with recurring chronic inflammation. This appears to be the first time that repeated Er-YAG laser instrumentation has been compared with mechanical instrumentation of periodontal sites with recurring chronic inflammation over a clinically relevant time period.


A dose verification method for high-dose-rate brachytherapy treatment plans.
To evolve a fast dose verification method for high-dose-rate (HDR) brachytherapy treatment plans and to demonstrate its applicability in different clinical cases. We developed a software tool in VC++ for the Varisource HDR unit for HDR dosimetry plan verification using TG-43 parameters. HDR treatment dosimetry of a number clinical cases using Varisource was verified by comparison with the treatment planning system (TPS). A number of different types of clinical cases treated by Varisource were evaluated. TPS calculated dose values and verification code calculated dose values were found to agree to within 3% for most of the dose calculation points. We have validated with clinical cases a fast and independent dose verification method of the dosimetry at selected points for HDR brachytherapy treatments plan using TG-43 parameters. This can be used for the verification of the TPS calculated dose at various points. The code is written to work with Varisource, but it can conceivably be modified for other sources also by using the fitted constant of the respective source.


Endoscopic screening for malignancy in the gastric remnant: the clinical significance of dysplasia in gastric mucosa.
Five hundred and four asymptomatic patients in whom gastrectomy had been performed between 1931 and 1960 were investigated by endoscopy plus biopsy. Ten stump carcinomas were detected (1.98%). In five patients the tumour was limited to the mucosa and was not seen at endoscopy. In three patients with previously noted severe dysplasia intramucosal carcinoma was detected during follow up and in two the carcinoma was found at the site of the preceding severe dysplasia. True regression of severe dysplasia could not be shown. In 23 patients with previous mild or moderate dysplasia no progression was seen during follow up. Severe gastric dysplasia is a serious marker of malignancy demanding close follow up with repeated endoscopy and biopsy. The clinical significance of mild and moderate dysplasia remains unclear. Early detection of stump carcinoma is indeed possible. Physicians should rely not so much on the endoscopic appearance but on the results of multiple biopsies.


Permissive underfeeding.
Dietary manipulation may influence outcome after infection and injury by altering production of inflammatory mediators and disease activity. Restricted nutrient intake may have beneficial effects on life-span, development of degenerative disease, autoimmune processes, renal injury, susceptibility to infection, and survival rate after infection. Nutritional therapies that serve to maximize nitrogen balance may adversely affect the host response to injury, especially when given in excess of energy and protein needs. The optimal calorie/protein intake during different phases of critical illness remains to be established. However, a short period of restricted intake may be beneficial.


Effect of biofilm formation by clinical isolates of Helicobacter pylori on the efflux-mediated resistance to commonly used antibiotics.
To evaluate the role of biofilm formation on the resistance of Helicobacter pylori (H. pylori) to commonly prescribed antibiotics, the expression rates of resistance genes in biofilm-forming and planktonic cells were compared. A collection of 33 H. pylori isolates from children and adult patients with chronic infection were taken for the present study. The isolates were screened for biofilm formation ability, as well as for polymerase chain reaction (PCR) reaction with HP1165 and hp1165 efflux pump genes. Susceptibilities of the selected strains to antibiotic and differences between susceptibilities of planktonic and biofilm-forming cell populations were determined. Quantitative real-time PCR (qPCR) analysis was performed using 16S rRNA gene as a H. pylori-specific primer, and two efflux pumps-specific primers, hp1165 and hefA. The strains were resistant to amoxicillin, metronidazole, and erythromycin, except for one strain, but they were all susceptible to tetracycline. Minimum bactericidal concentrations of antibiotics in the biofilm-forming cells were significantly higher than those of planktonic cells. qPCR demonstrated that the expression of efflux pump genes was significantly higher in the biofilm-forming cells as compared to the planktonic ones. The present work demonstrated an association between H. pylori biofilm formation and decreased susceptibility to all the antibiotics tested. This decreased susceptibility to antibiotics was associated with enhanced functional activity of two efflux pumps: hp1165 and hefA.


Performance of Leadless Pacemaker in Japanese Patients vs. Rest of the World - Results From a Global Clinical Trial.
A global study designed to demonstrate the safety and efficacy of a transcatheter pacing system included 38 Japanese patients enrolled at 4 sites. Subgroup analysis to evaluate the performance of the leadless intracardiac transcatheter pacing system in Japanese patients was performed.Methods and Results:Safety and efficacy outcomes, patient and implant procedure characteristics, and patient and physician acceptability from the Japanese population were compared with those from outside Japan. Differences in patient characteristics, implant procedure characteristics and patient acceptability were observed. There were no major complications in Japanese patients and pacing thresholds remained low and stable throughout follow-up. There were no observable differences between Japanese patients and patients from outside Japan in the freedom from major complication rate at 12-months post-implant (100.0% vs. 95.7%, P=0.211) or physician acceptability. Although some differences in specific baseline characteristics, such as body size and pacing indication, and in implant procedure characteristics, including anticoagulation strategy and hospitalization period, were observed in the Japanese patients, transcatheter pacemaker performance was similar to that in the global trial. (Clinical Trial Registration: ClinicalTrials.gov ID NCT02004873.).


Discrepancy in perceived social support among typically developing siblings of youth with autism spectrum disorder.
Social support can buffer against stressors often associated with having family members with autism spectrum disorder. This study included 112 parents and typically developing siblings of children with autism spectrum disorder. Relations between self-reported typically developing sibling emotional and behavioral problems and discrepancy between social support frequency and importance were examined via polynomial regression with response surface analysis. Typically developing siblings who described social support as frequent and important reported relatively few problems. Typically developing siblings who reported social support as highly important but infrequent exhibited the highest emotional and behavioral difficulties. Thus, typically developing siblings with little support who view support as highly important may be particularly responsive to social support improvement efforts.


Factors Associated With Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis.
The aim of this meta-analysis is to assess the effect of different independent predictors on acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI). This meta-analysis adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive database search was conducted using PubMed, Web of Science, and Scopus for the period from January 1, 2015, to August 15, 2023. The following key terms were employed: "transcatheter aortic valve implantation" OR "transcatheter aortic valve replacement" AND "acute kidney injury" OR "acute renal failure." Our search was limited to studies published exclusively in the English language. The statistical analysis was conducted using RevMan version 5.4.1 (The Cochrane Collaboration). Estimates were presented as odds ratio (OR) with 95% confidence interval (CI) for categorical variables, while continuous variables were reported as mean difference (MD) with 95% CI. A total of 19 studies met the selection criteria and were included in the meta-analysis. The pooled incidence of AKI was reported as 20% (95% CI: 18-20%). Factors significantly associated with post-TAVI AKI encompass hypertension, chronic kidney disease (CKD), low estimated glomerular filtration rate (eGFR), high baseline creatinine levels, peripheral vascular disease (PVD), Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EUROscore) II, and the transfemoral surgical approach.


Maternal Obesity and Excessive Gestational Weight Gain Are Associated with Components of Child Cognition.
Maternal overweight and obesity affect two-thirds of women of childbearing age and may increase the risk of impaired child cognition. Our objective was to test the hypothesis that high/low gestational weight gain (GWG) and high/low prepregnancy BMI were associated with offspring intelligence quotient (IQ) and executive function at age 10. Mother-infant dyads (n = 763) enrolled in a birth cohort study were followed from early pregnancy to 10 y postpartum. IQ was assessed by trained examiners with the use of the Stanford Binet Intelligence Scale-4th edition. Executive function was assessed by the number of perseverative errors on the Wisconsin Card Sorting Test and time to complete Part B on the Trail Making Test. Self-reported total GWG was converted to gestational-age-standardized GWG z score. Multivariable linear regression and negative binomial regression were used to estimate independent and joint effects of GWG and BMI on outcomes while adjusting for covariates. At enrollment, the majority of women in the Maternal Health Practices and Child Development cohort were unmarried and unemployed, and more than one-half reported their race as black. The mean ± SD GWG z score was -0.5 ± 1.8, and 27% of women had a pregravid BMI ≥ 25. The median (IQR) number of perseverative errors was 23 (17, 29), the mean ± SD time on Part B was 103 ± 42.6 s, and 44% of children had a low average IQ (≤ 89). Maternal obesity was associated with 3.2 lower IQ points (95% CI: -5.6, -0.8) and a slower time to complete the executive function scale Part B (adjusted β: 12.7 s; 95% CI: 2.8, 23 s) compared with offspring of normal-weight mothers. Offspring of mothers whose GWG was >+1 SD, compared with -1 to +1 SD, performed 15 s slower on the executive function task (95% CI: 1.8, 28 s). There was no association between GWG z score and offspring composite IQ score (adjusted β: -0.32; 95% CI: -0.72, 0.10). Prepregnancy BMI did not modify these associations. Although GWG may be important for executive function, maternal BMI has a stronger relation than GWG to both offspring intelligence and executive function. Our findings contribute to evidence linking maternal obesity to long-term child outcomes.


Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling.
This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD. Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale. Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction. The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.


Psychiatry's Role in Improving the Physical Health of Patients With Serious Mental Illness: A Report From the American Psychiatric Association.
The American Psychiatric Association Integrated Care Workgroup recently convened an expert panel charged with addressing the role of psychiatry in improving the physical health of persons with serious mental illness. The group reviewed the peer-reviewed and gray literature and developed a set of recommendations grounded in this review. This column summarizes the panel's primary findings and recommendations to key stakeholders, including clinicians, health care organizations, researchers, and policy makers.


Neutrophil hyperactivation correlates with Alzheimer's disease progression.
Recent studies have underlined the effect of systemic inflammation on the pathophysiology of Alzheimer's disease (AD). Neutrophils are key components of early innate immunity and contribute to uncontrolled systemic inflammation if not tightly regulated. The aim of our study was to fully characterize human circulating neutrophils at different disease stages in AD. We analyzed neutrophil phenotypes and functions in 42 patients with AD (16 with mild cognitive impairment and 26 with dementia), and compared them to 22 age-matched healthy subjects. This study was performed directly in whole blood to avoid issues with data interpretation related to cell isolation procedures. Blood samples from AD patients with dementia revealed neutrophil hyperactivation associated with increased reactive oxygen species production and increased levels of intravascular neutrophil extravascular traps. The homeostasis of circulating neutrophils in these patients also changed: The ratio between the harmful hyperreactive CXCR4high /CD62Llow senescent and the CD16bright /CD62Ldim immunosuppressive neutrophil subsets rose in the later stage of the disease. These abnormalities were greater in fast-decliner than in slow-decliner patients. Our results indicate that the inflammatory properties of circulating neutrophils shift as the percentage of aged neutrophils expands in patients with AD-changes that may play an instrumental role in establishing systemic chronic inflammation. Most important, our data strongly suggest that the neutrophil phenotype may be associated with the rate of cognitive decline and may thus constitute an innovative and prognostic blood biomarker in patients with AD. Ann Neurol 2018;83:387-405.


Noise exposure and auditory thresholds of German airline pilots: a cross-sectional study.
The cockpit workplace of airline pilots is a noisy environment. This study examines the hearing thresholds of pilots with respect to ambient noise and communication sound. The hearing of 487 German pilots was analysed by audiometry in the frequency range of 125 Hz-16 kHz in varying age groups. Cockpit noise (free-field) data and communication sound (acoustic manikin) measurements were evaluated. The ambient noise levels in cockpits were found to be between 74 and 80 dB(A), and the sound pressure levels under the headset were found to be between 84 and 88 dB(A).The left-right threshold differences at 3, 4 and 6 kHz show evidence of impaired hearing at the left ear, which worsens by age.In the age groups <40/≥40 years the mean differences at 3 kHz are 2/3 dB, at 4 kHz 2/4 dB and at 6 kHz 1/6 dB.In the pilot group which used mostly the left ear for communication tasks (43 of 45 are in the older age group) the mean difference at 3 kHz is 6 dB, at 4 kHz 7 dB and at 6 kHz 10 dB. The pilots who used the headset only at the right ear also show worse hearing at the left ear of 2 dB at 3 kHz, 3 dB at 4 kHz and at 6 kHz. The frequency-corrected exposure levels under the headset are 7-11 dB(A) higher than the ambient noise with an averaged signal-to-noise ratio for communication of about 10 dB(A). The left ear seems to be more susceptible to hearing loss than the right ear. Active noise reduction systems allow for a reduced sound level for the communication signal below the upper exposure action value of 85 dB(A) and allow for a more relaxed working environment for pilots.


Polydatin Glycosides Improve Monocrotaline-Induced Pulmonary Hypertension Injury by Inhibiting Endothelial-To-Mesenchymal Transition.
Objective: To study the effect of polydatin on the injury of pulmonary arterial hypertension (PAH) induced by monocrotaline (MCT). Methods: SD rats were induced to develop PAH injury by a single subcutaneous injection of MCT (60 mg/kg). From the second day, rats in the administration group were orally given sildenafil (20 mg/kg) and polydatin (30 or 60 mg/kg) for 3 weeks. At the end of the experiment, right ventricular hypertrophy (RVH) index of SD rats was calculated, pathological damage was assessed by HE staining, transcription levels of target genes were detected by RT-PCR and Elisa, and expression levels of Endothelial-to-mesenchymal transition (EndMT) related proteins were detected by immunohistochemistry (IHC) and immunofluorescence (IF). Finally, molecular docking analysis was used to verify the interaction of polydatin on the main targets. Results: Polydatin could significantly restore the body function, reduce MCT-induced PAH injury, reduce serum biochemical indices; polydatin could effectively inhibit EndMT process by decreasing the expression of N-cadherin, β-catenin and vimentin; polydatin could down-regulate TAGLN expression and increase PECAM1 expression to reduce pulmonary vascular remodeling. The interaction between polydatin and EndMT target was confirmed by molecular docking operation. Conclusion: Pharmacological experiments combined with Combining molecular docking was first used to clarify that polydatin can reduce the pulmonary endothelial dysfunction and pulmonary vascular remodeling induced by MCT by inhibiting EndMT. The results of the study provide new ideas for the further treatment of PAH injury.


Charging changes contact composition in binary sphere packings.
Equal volume mixtures of small and large polytetrafluorethylene spheres are shaken in an atmosphere of controlled humidity which allows one to also control their tribocharging. We find that the contact numbers are charge dependent: As the charge density of the beads increases, the number of same-type contacts decreases and the number of opposite-type contacts increases. This change is not caused by a global segregation of the sample. Hence, tribocharging can be a way to tune the local composition of a granular material.


Multipoint Thomson scattering diagnostic for the Madison Symmetric Torus reversed-field pinch.
The multipoint Thomson scattering diagnostic on the Madison Symmetric Torus (MST) is now fully operational with 21 spatial points, which cover the entire minor radius. Four full electron temperature profiles can be obtained during each MST discharge, with a variable delay between each profile. This system overcomes challenges that arise from the unique machine design, location, and plasma characteristics of MST. The machine design limits the maximum porthole diameter to 11.4 cm, requiring a compact, re-entrant, seven element lens for scattered light collection. Limited space near MST necessitates a long beam path for the two Nd:YAG lasers requiring a remote beam line adjustment system to suppress drift in the beam position due to thermal expansion of the building. Due to the remote location of the laser head, substantial design effort was put into the creation of a set of safety interlocks for the laser system. The dynamic nature of MST plasmas and the wide range of operating space require a versatile scattered light detection system consisting of filter polychromators with temperature controlled avalanche photodiode detectors. We also implement an insertable integrating sphere, which travels along the laser beam path through the vacuum vessel, for the alignment of both the fiber optics and the lasers.


Work and Leprosy: women in their pains, struggles and toils.
To analyze the interference of leprosy in women's life regarding work and daily life activities. Exploratory qualitative study developed from semi-structured interviews and with the use of field diaries. The strategy of the organization of data was a thematic analysis of content and referential of the work process in health and gender. The themes presented are: "The leprosy pains", "Changes with the disease and adaptation at work and activities" and "Being a woman with leprosy". On them, we present the aspects that changed in women's life from the leprosy, especially regarding work and daily activities. Beyond physical limitation, there are impacts on social relations and above all on formal work, there may even be dismission. In women affected by leprosy, work and daily activities are directly affected; this deepens the social difficulties and requires attention of health professionals.


Roaming atoms and radicals: a new mechanism in molecular dissociation.
The detailed description of chemical reaction rates is embodied in transition state theory (TST), now recognized as one of the great achievements of theoretical chemistry. TST employs a series of simplifying assumptions about the dynamical behavior of molecules to predict reaction rates based on a solid foundation of quantum theory and statistical mechanics. The study of unimolecular decomposition has long served as a test bed for the various assumptions of TST, foremost among which is the very notion that reactions proceed via a single well-defined transition state. Recent high-resolution ion imaging studies of formaldehyde unimolecular decomposition, in combination with quasiclassical trajectory calculations from Bowman and coworkers, have shown compelling evidence, however, for a novel pathway in unimolecular decomposition that does not proceed via the conventional transition state geometry. This "roaming" mechanism involves near dissociation to radical products followed by intramolecular abstraction to give, instead, closed shell products. This phenomenon is significant for a number of reasons: it resists easy accommodation with TST, it gives rise to a distinct, highly internally excited product state distribution, and it is likely to be a common phenomenon. These imaging studies have provided detailed insight into both the roaming dynamics and their energy-dependent branching. The dynamics are dominated by the highly exoergic long-range abstraction of H from HCO by the "roaming" hydrogen atom. The energy-dependent branching may be understood by considering the roaming behavior as being descended from the radical dissociation; that is, it grows with excess energy relative to the conventional molecular dissociation because of the larger A-factor for the radical dissociation. Recent work from several groups has identified analogous behavior in other systems. This Account explores the roaming behavior identified in imaging studies of formaldehyde and considers its implications in light of recent results for other systems.


Origin of colossal ionic conductivity in oxide multilayers: interface induced sublattice disorder.
Oxide ionic conductors typically operate at high temperatures, which limits their usefulness. Colossal room-temperature ionic conductivity was recently discovered in multilayers of yttria-stabilized zirconia (YSZ) and SrTiO3. Here we report density-functional calculations that trace the origin of the effect to a combination of lattice-mismatch strain and O-sublattice incompatibility. Strain alone in bulk YSZ enhances O mobility at high temperatures by inducing extreme O disorder. In multilayer structures, O-sublattice incompatibility causes the same extreme disorder at room temperature.


Disparities in illicit drug use and disability status among a nationally representative sample of U.S. college students.
The number of students with disabilities attending postsecondary institutions is increasing. However, research on substance use among this population is limited. This study examined disparities in the prevalence of illicit drug use and drug use disorders among college students with disabilities and their counterparts without disabilities. Data from the 2017 National Survey on Drug Use and Health were analyzed. We estimated prevalence and odds of disability, illicit drug use, and illicit drug dependence or abuse in a subsample of college students (n = 6,189). A majority of college students reporting a disability had a cognitive limitation. Students with any disability had a higher prevalence of illicit drug use and significantly higher odds of ever use of illicit drugs (AOR = 1.47; 95% CI 1.20-1.79). Compared to their peers with no disabilities, they were more likely to have misused any psychotherapeutic in the past year (AOR = 1.38; 95% CI 1.08-1.76), and had nearly twice the odds of misusing prescription pain relievers in the past month (AOR = 1.97; 95% CI 1.11-3.49). Additionally, students with disabilities had three times the odds of meeting criteria for past-year dependence or abuse of any illicit drug (AOR = 3.01; 95% CI 2.06-4.40). This study documented a higher prevalence of drug use and drug use disorders among college students with disabilities compared to their nondisabled peers. Understanding the risk factors for substance use in this population is critical for developing effective prevention and treatment strategies.


Migration of ventriculoperitoneal shunt into the heart--case report.
A 76-year-old man underwent ventriculoperitoneal shunting for hydrocephalus after subarachnoid hemorrhage. Eighteen days after the shunt operation, fluoroscopy revealed the peritoneal catheter in the heart. Three-dimensional computed tomography demonstrated penetration of the catheter into the internal jugular vein. Under local anesthesia, part of the peritoneal catheter was pulled out through the cervical incision and cut off. The ends of the peritoneal catheter were connected so that the distal end was settled in the right atrium of the heart under fluoroscopic visualization. The migration of the peritoneal catheter into the heart presumably occurred because the subcutaneous wire guide of the shunt catheter perforated the internal jugular vein and the catheter was drawn into the heart through the internal jugular vein by the negative pressure of the vein and thoracic cavity.


Identifying the Factors Contributing to the Severity of Truck-Involved Crashes in Shanghai River-Crossing Tunnel.
The impact that trucks have on crash severity has long been a concern in crash analysis literature. Furthermore, if a truck crash happens in a tunnel, this would result in more serious casualties due to closure and the complexity of the tunnel. However, no studies have been reported to analyze traffic crashes that happened in tunnels and develop crash databases and statistical models to explore the influence of contributing factors on tunnel truck crashes. This paper summarizes a study that aims to examine the impact of risk factors such as driver factor, environmental factor, vehicle factor, and tunnel factor on truck crashes injury propensity based on tunnel crashes data obtained from Shanghai, China. An ordered logit model was developed to analyze injury crashes and property damage only crashes. The driver factor, environmental factor, vehicle factor, and tunnel factor were explored to identify the relationship between these factors and crashes and the severity of crashes. Results show that increased injury severity is associated with driver factors, such as male drivers, older drivers, fatigue driving, drunkenness, safety belt used improperly, and unfamiliarity with vehicles. Late night (00:00-06:59) and afternoon rushing hours (16:30-18:59), weekdays, snow or icy road conditions, combination truck, overload, and single vehicle were also found to significantly increase the probability of injury severity. In addition, tunnel factors including two lanes, high speed limits (≥80 km/h), zone 3, extra-long tunnels (over 3000 m) are also significantly associated with a higher risk of severe injury. So, the gender, age of driver, mid-night to dawn and afternoon peak hours, weekdays, snowy or icy road conditions, the interior zone of a tunnel, the combination truck, overloaded trucks, and extra-long tunnels are associated with higher crash severity. Identification of these contributing factors for tunnel truck crashes can provide valuable information to help with new and improved tunnel safety control measures.


Prevalence of a New Variant OXA-204 and OXA-48 Carbapenemases Plasmids Encoded in Klebsiella pneumoniae Clinical Isolates in Tunisia.
Carbapenemase-producing Klebsiella pneumoniae strains have emerged as a major problem for healthcare systems. The aim of this study was to determine the role and diversity of plasmids harboring carbapenemases encoding genes from a collection of K. pneumoniae isolates recovered between July 2011 and January 2012, with decreased susceptibility to carbapenems. Imipenem (IPM), ertapenem (ETP), meropenem (MEM), and doripenem (DOR) minimum inhibitory concentrations (MICs) were determined by E-test. Carbapenemase production was detected with the modified Hodge test. β-Lactamases encoding genes were amplified by PCR and sequenced. Plasmid incompatibility groups harbored by carbapenemases producers were investigated using the PCR-based replicon typing method and the clonal relationship of the isolates was investigated by pulse filed electrophoresis. IMP, ertapenem, meropenem, and doripenem MICs ranged between 0.25 and 16 mg/L. Carbapenemase activity was detected in 14 isolates. Two carbapenemases were identified: OXA-48 in 13 isolates and a new variant OXA-204 in 1 isolate, in combination with extended-spectrum β-lactamases, CTX-M-1, CTX-M-9, CTX-M-14, CTX-M-15, and VEB-8. One isolate produced CMY-2. OXA-48 and the new variant OXA-204 were confirmed as transferable plasmid encoded. The carbapenemase-producing K. pneumoniae harbored plasmids of the A/C, LVPK, and L/M replicon types. Thirteen different pulso types were observed. Three pairs of isolates showed a clonal relatedness. This diversity in β-lactamases, in pulso types and in plasmid content, shows the ability of OXA-type carbapenemase to disseminate. This is worrying for the control of the increase in antibiotic resistance frequency and necessitates that continuous investigations in the clinical setting remain a high priority to clarify the contribution of antimicrobial use into multiresistance bacterial dissemination.


Macropolyhedral boron-containing cluster chemistry. Ligand-induced two-electron variations of intercluster bonding intimacy. Structures of nineteen-vertex [(eta5-C5Me5)HIrB18H19(PMe2Ph)] and the related carbene complex [(eta5-C5Me5)HIrB18H19[C(NHMe)2]].
Addition of PMe2Ph to fused-cluster syn-[(eta5-C5Me5)IrB18H20] 1 to give [(eta5-C5Me5)HIrB18H19(PMe2Ph)] 3 entails a diminution in the degree of intimacy of the intercluster fusion, rather than retention of inter-subcluster binding intimacy and a nido-->arachno conversion of the character of either of the subclusters. Reaction with MeNC gives [(eta5-C5Me5)HIrB18H19[C(NHMe)2]] 4 which has a similar structure, but with the ligand now being the carbene [:C(NHMe)2], resulting from a reductive assembly reaction involving two MeNC residues and the loss of a carbon atom.


Form follows function: structural and catalytic variation in the class a flavoprotein monooxygenases.
Flavoprotein monooxygenases (FPMOs) exhibit an array of mechanistic solutions to a common chemical objective; the monooxygenation of a target substrate. Each FPMO efficiently couples reduction of a flavin cofactor by NAD(P)H to oxygenation of the target substrate via a (hydro)peroxyflavin intermediate. This purpose of this review is to describe in detail the Class A flavoprotein hydroxylases (FPMO) in the context of the other FPMO classes (B-F). Both one and two component FPMOs are found in nature. Two-component enzymes require, in addition to the monooxygenase, the involvement of a reductase that first catalyzes the reduction of the flavin by NAD(P)H. The Class A and B FPMOs are single-component and manage to orchestrate the same net reaction within a single peptide. The Class A enzymes have, by some considerable margin, the most complete research record. These enzymes use choreographed movements of the flavin ring that facilitate access of the organic substrates to the active site, provide a means for interaction of NADPH with the flavin, offer a mechanism to sequester the dioxygen reduction chemistry from solvent and a means to release the product. The majority of the discrete catalytic events of the catalytic cycle can be observed directly in exquisite detail using spectrophotometric kinetic methods and many of the key mechanistic conclusions are further supported by structural data. This review attempts to compile each of the key observations made for both paradigm and newly discovered examples of Class A FPMOs into a complete catalytic description of one enzymatic turnover.


Highly thermostable exopolysaccharide produced by the moderately halophilic bacterium isolated from a man-made young salt lake in Romania.
Halophilic bacterial strains isolated from a man-made salt lake in Romania produce a specific exopolysaccharide. This product is synthesized under both static and stirring conditions, and the yield of this exoploysaccharide depends on the composition of the culture medium. The highest amount of polymer was obtained in the presence of casamino acids and yeast extract, under stirring conditions. This polymer has high thermostability, with a melting point at 207 degrees C. The melting process is associated with the thermal degradation of the compound. This polymer is characterized by maximum absorbtion at 260 nm and fluorescence emission at 530 nm. The FT-IR analysis of the polymer revealed the presence of a saccharide structure and of amine and sulfate groups throughout the sugar backbone.


The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study.
Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Experts' opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth.


Long-Term Stroke Risk Prediction in Patients With Atrial Fibrillation: Comparison of the ABC-Stroke and CHA2DS2-VASc Scores.
The ABC-stroke score (age, biomarkers [N-terminal fragment B-type natriuretic peptide, high-sensitivity troponin], and clinical history [prior stroke/transient ischemic attack]) was proposed to predict stroke in atrial fibrillation (AF). This score was derived/validated in 2 clinical trial cohorts in which patients with AF were highly selected and carefully followed-up. However, the median follow-up was 1.9 years in the trial cohort; therefore, its long-term predictive performance remains uncertain. This study aimed to compare the long-term predictive performances of the ABC-stroke and CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores in a cohort of anticoagulated patients with AF. We recruited 1125 consecutive patients with AF who were stable on vitamin K antagonists and followed-up for a median of 6.5 years. ABC-stroke and CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores were calculated and compared. Median CHA2DS2-VASc and ABC-stroke scores were 4 (interquartile range 3-5) and 9.1 (interquartile range 7.3-11.3), respectively. There were 114 ischemic strokes (1.55% per year) at 6.5 years. The C-index of ABC-stroke at 3.5 years was significantly higher than CHA2DS2-VASc (0.663 versus 0.600, P=0.046), but both C-indexes were nonsignificantly different at 6.5 years. Integrated discrimination improvement showed a small improvement (<2%) in sensitivity at 3.5 and 6.5 years with ABC-stroke. For ABC-stroke, net reclassification improvement was nonsignificantly different at 3.5 years, and showed a negative reclassification at 6.5 years compared with CHA2DS2-VASc. Decision curve analyses did not show a marked improvement in clinical usefulness of the ABC-stroke score over the CHA2DS2-VASc score. In anticoagulated patients with AF followed-up over a long-term period, the novel ABC-stroke score does not offer significantly better predictive performance compared with the CHA2DS2-VASc score.


Electro-Fenton and Induced Electro-Fenton as Versatile Wastewater Treatment Processes for Decontamination and Nutrient Removal without Byproduct Formation.
It is a long-pursued goal to develop electrified water treatment technology that can remove contaminants without byproduct formation. This study unveiled the overlooked multifunctionality of electro-Fenton (EF) and induced EF (I-EF) processes to remove organics, pathogens, and phosphate in one step without halogenated byproduct formation. The EF and I-EF processes used a sacrificial anode or an induced electrode to generate Fe2+ to activate H2O2 produced from a gas diffusion cathode fed by naturally diffused air. We used experimental and kinetic modeling approaches to illustrate that the •OH generation and radical speciation during EF were not impacted by chloride. More importantly, reactive chlorine species were quenched by H2O2, which eliminated the formation of halogenated byproducts. When applied in treating septic wastewater, the EF process removed >80% COD, >50% carbamazepine (as representative trace organics), and >99% phosphate at a low energy consumption of 0.37 Wh/L. The EF process also demonstrated broad-spectrum disinfection activities in removing and inactivating Escherichia coli, Enterococcus durans, and model viruses MS2 and Phi6. In contrast to electrochemical oxidation (EO) that yielded mg/L level byproducts to achieve the same degree of treatment, EF did not generate byproducts (chlorate, perchlorate, trihalomethanes, and haloacetic acids). The I-EF carried over all the advantages of EF and exhibited even faster kinetics in disinfection and carbamazepine removal with 50-80% less sludge production. Last, using septic wastewater treatment as a technical niche, we demonstrated that iron sludge formation is predictable and manageable, clearing roadblocks toward on-site water treatment applications.


Zinc Transport Differs in Rat Spermatogenic Cell Types and Is Affected by Treatment with Cyclophosphamide.
Adequate zinc levels are required for proper cellular functions and for male germ cell development. Zinc transport is accomplished by two families of zinc transporters, the ZIPs and the ZnTs, that increase and decrease cytosolic zinc levels, respectively. However, very little is known about zinc transport in the testis. Furthermore, whether cytotoxic agents such as cyclophosphamide (CPA), a known male germ cell toxicant, can affect zinc transport and homeostasis is unknown. We examined zinc transporter expression and zinc transport in pachytene spermatocytes (PS) and round spermatids (RS) in a normal state and after exposure to CPA. We observed differences in the expression of members of the ZnT and ZIP families in purified populations of PS and RS. We also observed that RS accumulate more zinc over time than PS. The expression of many zinc binding genes was altered after CPA treatment. Interestingly, we found that the expression levels of ZIP5 and ZIP14 were increased in PS from animals treated daily with 6 mg/kg CPA for 4 wk but not in RS. This up-regulation led to an increase in zinc uptake in PS but not in RS from treated animals compared to controls. These data suggest that CPA treatment may alter zinc homeostasis in male germ cells leading to an increased need for zinc. Altered zinc homeostasis may disrupt proper germ cell development and contribute to infertility and effects on progeny.


Outcomes of total thyroidectomy with therapeutic central and lateral neck dissection with a single dose of radioiodine in the treatment of regionally advanced papillary thyroid cancer and effects on serum thyroglobulin.
Achieving an undetectable serum thyroglobulin (Tg) level (<1.0 ng/mL) after surgical and radioiodine treatment for papillary thyroid cancer (PTC) is associated with low recurrence rates and has been termed biochemical remission. This study aimed to determine the effectiveness of total thyroidectomy with therapeutic central and lateral neck dissection for regionally advanced (T1-4bN1bM0) PTC with regard to posttreatment Tg levels. This is a single-institution retrospective cohort study of patients with regionally advanced PTC initially treated with total thyroidectomy and therapeutic levels 2-7 neck dissection from 2002 to 2012. Pathologic findings, complications, serum Tg levels, and outcomes were analyzed. Sixty-one patients were initially treated with total thyroidectomy and therapeutic central and lateral neck dissection for PTC involving the lateral cervical nodes (N1b). The median number of lymph nodes excised and positive was 27 (range 5-112) and 9 (range 1-67), respectively. Extranodal extension occurred in 48 %. Radioiodine was administered after surgery with a median total dose of 150 mCi (range 30-244 mCi). Recurrent or persistent cervical disease occurred in 8 (13 %) and 3 (5 %) patients, respectively, and required additional radioiodine treatment in 2 and reoperative neck dissection in 10. Three patients developed new distant metastasis, and 1 died during the median follow-up of 20 months (range 1-109 months). Undetectable unstimulated Tg (<1.0 ng/mL) without clinically detectable recurrence was experienced in 68 % of patients with initial treatment. Biochemical remission can be experienced in most patients presenting with regionally advanced PTC with total thyroidectomy and compartment based therapeutic neck dissection followed by a single dose of radioiodine.


Hypoxia disrupts proteostasis in Caenorhabditis elegans.
Oxygen is fundamentally important for cell metabolism, and as a consequence, O₂ deprivation (hypoxia) can impair many essential physiological processes. Here, we show that an active response to hypoxia disrupts cellular proteostasis - the coordination of protein synthesis, quality control, and degradation that maintains the functionality of the proteome. We have discovered that specific hypoxic conditions enhance the aggregation and toxicity of aggregation-prone proteins that are associated with neurodegenerative diseases. Our data indicate this is an active response to hypoxia, rather than a passive consequence of energy limitation. This response to hypoxia is partially antagonized by the conserved hypoxia-inducible transcription factor, hif-1. We further demonstrate that exposure to hydrogen sulfide (H₂S) protects animals from hypoxia-induced disruption of proteostasis. H₂S has been shown to protect against hypoxic damage in mammals and extends lifespan in nematodes. Remarkably, our data also show that H₂S can reverse detrimental effects of hypoxia on proteostasis. Our data indicate that the protective effects of H₂S in hypoxia are mechanistically distinct from the effect of H₂S to increase lifespan and thermotolerance, suggesting that control of proteostasis and aging can be dissociated. Together, our studies reveal a novel effect of the hypoxia response in animals and provide a foundation to understand how the integrated proteostasis network is integrated with this stress response pathway.


Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography.
Cross-sectional. This study evaluates finger flexion and extension strengthening exercises using elastic resistance in chronic stroke patients. Eighteen stroke patients (mean age: 56.8 ± 7.6 years) with hemiparesis performed 3 consecutive repetitions of finger flexion and extension, using 3 different elastic resistance levels (easy, moderate, and hard). Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor digitorum (ED) muscles and normalized to the maximal electromyography of the non-paretic arm. Maximal grip strength was 39.2 (standard deviation: 12.5) and 7.8 kg (standard deviation: 9.4) in the nonparetic and paretic hand, respectively. For the paretic hand, muscle activity was higher during finger flexion exercise than during finger extension exercise for both ED (30% [95% confidence interval {CI}: 19-40] vs 15% [95% CI: 5-25] and FDS (37% [95% CI: 27-48] vs 24% [95% CI: 13-35]). For the musculature of both the FDS and ED, no dose-response association was observed for resistance and muscle activity during the flexion exercise (P > .05). The finger flexion exercise showed higher muscle activity in both the flexor and extensor musculature of the forearm than the finger extension exercise. Furthermore, greater resistance did not result in higher muscle activity during the finger flexion exercise. The present results suggest that the finger flexion exercise should be the preferred strengthening exercise to achieve high levels of muscle activity in both flexor and extensor forearm muscles in chronic stroke patients. The finger extension exercise may be performed with emphasis on improving neuromuscular control. 4b.


Prognostic factors among 185 adults with newly diagnosed advanced Hodgkin's disease treated with alternating potentially noncross-resistant chemotherapy and intermediate-dose radiation therapy.
The initial promising results with alternating chemotherapy regimens (mechlorethamine, vincristine, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine [MOPP/ABVD]; lomustine, melphalan, and vindesine [CAD] plus MOPP plus ABV) combined with intermediate-dose radiation therapy (RT) have been sustained with further follow-up; 82.2% of patients (152 of 185) achieved a complete remission (CR), and overall survival is 71.7% +/- 4.4% at 8 years (median follow-up is 55 months among the survivors). No statistically significant differences were found in CR percentage, CR duration, or survival between stages IIB, IIIB, and IV patients. For that reason, stepwise Cox regression analyses to identify the important prognostic factors were performed on overall survival, tumor mortality, freedom from disease progression, and survival following disease progression. Pretreatment characteristics were also tested for association with the probability of achieving CR, CR duration, and death due to other causes. Characteristics that were consistently associated with an independently unfavorable prognosis were low hematocrit, high serum lactic acid dehydrogenase (LDH), age more than 45 years, inguinal node involvement, mediastinal mass greater than .45 of the thoracic diameter, and bone marrow involvement. Patients with two or more unfavorable characteristics were much more likely to fail treatment (median survival, 62.4 months) than those with none or only one unfavorable factor (greater than 95% survival). This striking difference between the low- and high-risk groups remained even if the comparison was restricted to patients less than or equal to 45 years of age. These results provide a basis for selecting the young patients at high risk of failure for more intensive initial treatment with either autologous bone marrow rescue or hematopoietic growth factors.


Oxaliplatin-induced acute thrombocytopenia: a case report and review of the literature.
We herein report the case of a 77-year-old woman who developed acute thrombocytopenia during the 23rd cycle of modified FOLFOX therapy. She developed a hypersensitivity reaction with nasal bleeding. The chemotherapy infusion was immediately discontinued. The patient's symptoms resolved with discontinuation of chemotherapy and the administration of supportive therapy. A complete blood count showed severe thrombocytopenia, and oxaliplatin-induced thrombocytopenia was diagnosed. The patient was admitted to the hospital, and the thrombocytopenia was corrected with a platelet transfusion followed by prednisolone. She was discharged after one week without requiring additional platelet transfusions. With the widespread use of oxaliplatin, the risk of oxaliplatin-induced acute thrombocytopenia should be considered an acute onset hematological emergency.


Borderline personality symptomatology and compliance with general health care among internal medicine outpatients.
The extant literature on borderline personality disorder (BPD) and compliance with mental health treatment contains conflicting findings. However, among those individuals with this type of personality dysfunction, reduced compliance with mental health treatment appears to be the predominant theme. To our knowledge, the relationship between BPD and compliance with general health care has not been studied. In addition, there is no prior study in this area examining a primary care population. Using a cross-sectional survey methodology among a sample of internal medicine outpatients (N = 261), we assessed borderline personality symptoms with two self-report measures and general health care compliance or adherence with four self-report measures. With the exception of on-time arrival for doctor appointments, the remaining compliance variables demonstrated statistically significant relationships at the p < 0.01-0.001 levels, with borderline personality symptoms predicting reduced compliance (i.e., conscientiousness with medical treatment, regular dental check-ups, timely completion of laboratory work, following doctor's exercise and nutrition instructions, remembering to take medications, and Medical Outcomes Study General Adherence Score). Compared with participants without borderline personality symptoms, those participants with such symptoms in this study evidenced lower general health care compliance.


Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study.
Thoracoscopic lobectomy has been widely performed on patients with early-stage lung cancer; meanwhile indications of thoracoscopic segmentectomy have not been clearly defined due to technical difficulties and unclear oncological outcomes. The aim of this study was to compare early and late outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy. Between January 2005 and December 2013, 100 thoracoscopic segmentectomies and 1049 thoracoscopic lobectomies were performed on patients with lung cancer in our institute. Preoperative clinical parameters including gender, age, tumour size, pathological stage, histology and forced expiratory volume in 1 s (FEV1) were used for propensity score matching. After propensity score matching, 94 thoracoscopic segmentectomies and 94 lobectomies were selected and compared. Thoracoscopic segmentectomies were performed on patients with normal lung function (mean FEV1 = 101.6 ± 24.1%), small-sized tumour (mean diameter 1.7 ± 1.0 cm), early-stage cancer (Stage I 93.7%) and predominant adenocarcinoma (81.9%). The lobectomy group had similar clinical features with the segmentectomy group. Most commonly performed procedures were left upper lobe upper division segmentectomy (19%) and right lower lobe superior segmentectomy (17%). Segmentectomies were performed in all lobes except the right middle lobe. There were no differences between segmentectomy and lobectomy in terms of operation time (166.3 ± 54.7 min vs 181.1 ± 85.2 min, P = 0.47) and hospital stay (6.2 ± 5.2 days vs 7.1 ± 7.1 days, P = 0.31). Incidence of postoperative complications was non-significantly higher in the lobectomy group (17.2 vs 10.6%, P = 0.1), and postoperative mortality rates were also non-significantly higher in the segmentectomy group (1.1 vs 2.1%, P = 0.56). Postoperative FEV1 decrease was non-significantly lower in the segmentectomy group (8.9 ± 10.8 vs 11.0 ± 13.1, P = 0.36). The 3-year overall survival and recurrence-free survival was not different between the two groups (94 and 87% in the segmentectomy group and 96 and 94% in the lobectomy group, P = 0.62 and P = 0.69, respectively). Thoracoscopic segmentectomy could achieve equal short-term surgical results and long-term oncological outcomes compared with thoracoscopic lobectomy.


Fate mapping and scRNA sequencing reveal origin and diversity of lymph node stromal precursors.
Lymph node (LN) stromal cells play a crucial role in LN development and in supporting adaptive immune responses. However, their origin, differentiation pathways, and transcriptional programs are still elusive. Here, we used lineage-tracing approaches and single-cell transcriptome analyses to determine origin, transcriptional profile, and composition of LN stromal and endothelial progenitors. Our results showed that all major stromal cell subsets and a large proportion of blood endothelial cells originate from embryonic Hoxb6+ progenitors of the lateral plate mesoderm (LPM), whereas lymphatic endothelial cells arise from Pax3+ progenitors of the paraxial mesoderm (PXM). Single-cell RNA sequencing revealed the existence of different Cd34+ and Cxcl13+ stromal cell subsets and showed that embryonic LNs contain proliferating progenitors possibly representing the amplifying populations for terminally differentiated cells. Taken together, our work identifies the earliest embryonic sources of LN stromal and endothelial cells and demonstrates that stromal diversity begins already during LN development.


Molecular mechanisms involved in DNA repair, in gene rearrangement and in gene amplification may be considered as an integrated system in maintaining cellular homeostasis and cell survival.
In procaryotic and also in eucaryotic cells, several systems for repairing the DNA damage have been discovered. The mechanism and genetic control of DNA excision-repair and SOS have been extensively studied. These repair processes help prevent lesions from interfering with DNA functions or from converting into permanent mutations that cause cellular malfunctioning and cell death, which in higher organisms contribute to malignancy. However, other molecular systems can be identified which contribute to the maintenance of homeostasis and the survival of the cell. The system that maintains the DNA superstructure is one of these while gene amplification allows the cell to become resistant to a particular environmental change and survive in the presence of chemical compounds like drugs. Our purpose was to group in a major system the molecular systems which, until now, have always been considered as separate entities. The common basis of all these systems is the capacity to maintain genetic information or to permit the survival of the cell. The system, called the "Cell Survival Molecular System" (CSMS), is composed of several well known molecular systems, such as DNA repair, which are able to restore the DNA structure and genetic mechanisms. Moreover, the Cell Survival Molecular System may also give a selective advantage to the cell so that it can grow in a hazardous environment. Following on from this, the relationship between CSMS and cancer will be discussed. The development and the progression of the cancer may be the result of the growth of an "adapted cell". This may adapt to, or resist, a new or changed environment. In addition, genetic defects can occur in CSMS and these will probably give an impaired function to some systems in CSMS. These defects could be associated with inherited or familiar cancer.


Wasting and lipodystrophy in patients infected with HIV: a practical approach in clinical practice.
The care of patients who have HIV infection must address multiple medical, psychological, and socioeconomic factors. Because of the time constraints of a typical 15-minute office visit, important issues may be overlooked unless the physician has a clear concept of priorities and a clear method of tracking information. Although the medical aspects--viral control--must take priority, the psychological and social consequences of the illness must not be ignored. Nutritional evaluation and counseling must be addressed because nutritional disturbances often adversely affect the general health of patients who are infected with HIV. Important nutritional complications of HIV infection are the syndromes of wasting and lipodystrophy. However, the onset of wasting may not be heralded by a change in the patient's weight. In patients who have AIDS, the mechanism leading to a loss of skeletal muscle mass has not been identified. HIV-related lipodystrophy consists of accumulation of fat in the subcutaneous tissues of the lower trunk, abdominal viscera, and dorsocervical region with loss of fat from the upper and lower extremities, buttocks, and face. Lipodystrophy in association with HIV infection is not the same as the wasting syndrome of protein-energy malnutrition. An early sign of lipodystrophy is facial wasting. The treatment of the nutritional complications of HIV infection includes exercise; nutritional counseling; and in selected patients, androgenic hormones, anabolic steroid hormones, and human growth hormone.


The Emerging Role of Nanotechnology in Cell and Organ Transplantation.
Transplantation is often the only choice many patients have when suffering from end-stage organ failure. Although the quality of life improves after transplantation, challenges, such as organ shortages, necessary immunosuppression with associated complications, and chronic graft rejection, limit its wide clinical application. Nanotechnology has emerged in the past 2 decades as a field with the potential to satisfy clinical needs in the area of targeted and sustained drug delivery, noninvasive imaging, and tissue engineering. In this article, we provide an overview of popular nanotechnologies and a summary of the current and potential uses of nanotechnology in cell and organ transplantation.


Pigmented squamous cell carcinoma.
Although dendritic, melanin-containing melanocytes can be seen in a variety of epithelial neoplasms, only 0.01% to 7% of all squamous cell carcinomas (SCC) are pigmented. Furthermore, most reported cases have occurred in the oral and ocular mucosa, with relatively few cases reported to originate in the skin. Herein we report a case of a 61-year-old Caucasian male who presented with a large blue-black nodule on his left cheek, clinically suspicious for a melanoma; however, histological evaluation revealed an acantholytic pigmented squamous cell carcinoma. Previous cases are reviewed and the clinical and histological differential diagnoses are discussed.