Visualization of retrovirus budding with correlated light and electron microscopy.
We have used correlated scanning EM (SEM) and multiphoton fluorescence microscopy to visualize budding of virus-like particles (VLPs) of Rous sarcoma virus (RSV) and HIV type 1 (HIV-1). When the Gag structural protein was expressed alone as a GFP fusion, most budding particles appeared morphologically aberrant, but normal assembly could be rescued by coexpression of untagged Gag protein. Imaging of live cells allowed budding to be seen in real time as the disappearance of fluorescent spots from the dorsal cell surface. The disappearance of very bright spots containing clusters of VLPs often occurred in a stepwise fashion. Even after imaging times >1 h, only a minority of the spots disappeared, suggesting that some might be budding-incompetent complexes. On individual cells, we enumerated both the fluorescent puncta and the budding structures visible by SEM and compared these numbers for WT Gag proteins and for Gag proteins that were blocked at the last step in budding by a late domain mutation. For the mutant HIV-1 and RSV proteins, almost all of the fluorescent spots corresponded to budding structures. For WT RSV, the dorsal side of cells showed 3-fold more fluorescent spots than budding structures, suggesting that formation of the polymerized Gag shell precedes bulging out of the membrane. For WT HIV-1, most fluorescent spots corresponded with budding structures, consistent with the slower budding rate of this virus. Combining these two types of microscopy will allow innovative approaches for elucidating the mechanism of retrovirus budding.


Nonparametric Diagnostic Test for Conditional Logistic Regression.
The use of conditional logistic regression models to analyze matched case-control data has become standard in statistical analysis. However, methods to test the fit of these models has primarily focused on influential observations and the presence of outliers, while little attention has been given to the functional form of the covariates. In this paper we present methods to test the functional form of the covariates in the conditional logistic regression model, these methods are based on nonparametric smoothers. We assess the performance of the proposed methods via simulation studies and illustrate an example of their use on data from a community based intervention.


Acute reversible heart failure with highly active antiretroviral therapy.
Highly active antiretroviral therapy is effective in the management of AIDS. It has improved the prognosis of human immunodeficiency virus (HIV) infection. However, with increased survival, adverse effects from medications used in HIV treatment have become more apparent. Cardiac complications from HIV infection include arrhythmias, heart failure, and coronary artery disease. Heart failure in HIV disease may be related to the virus itself or to noninfectious reasons. The association of HIV medications with heart failure is controversial as patients with HIV disease often have multiple risk factors for developing heart failure. We present a case of acute onset heart failure in a patient with HIV, coronary artery disease, and hypertension who was recently started on antiretroviral therapy. There was complete resolution of heart failure after cessation of HIV medications. This case highlights the need to consider HIV medications as a cause of deterioration in cardiac function, even in the presence of other well-established risk factors for heart failure.


Oestrogen formation in genital and non-genital skin fibroblasts cultured from patients with hypospadias.
Hypospadias is the most common birth defect in males. In most cases the aetiology is unknown. Since penile development is androgen dependent and oestrogen can modify androgen action, we compared the formation of oestrogen in penile tissue from patients with hypospadias to those with normal penile development. Oestrogen formation was assessed in fibroblast monolayers grown from biopsies of genital and non-genital skin from 11 males with normal genital development (controls) and 18 males with severe hypospadias utilizing the incorporation of tritium into H2O resulting from the aromatization of 1 beta-3H-androstenedione. In paired fibroblast strains from genital and non-genital skin of nine males with hypospadias, oestrogen formation was significantly (P < 0.025) lower in non-genital skin. Rates of oestrogen formation were also higher in a subset of foreskins from subjects with hypospadias than in normal controls and the remaining hypospadias subjects. In addition, oestrogen formation in this subset of fibroblast strains from patients with hypospadias was markedly enhanced by incubation of intact monolayers with either cholera toxin or forskolin, agents known to stimulate cAMP formation. Oestrogen formation in the remaining cell strains (controls and hypospadias) was also enhanced in most instances by cholera toxin and forskolin, although to a much lower degree. Thus, we identified in the hypospadias group a subgroup of fibroblast strains in which unstimulated and stimulated oestrogen formation was markedly higher than in other strains examined. Since oestrogen can modify certain androgen effects within cells and since formation of the male genitalia during embryogenesis is mediated by androgens, elevated oestrogen formation in male genital tissue might be a causative factor of hypospadias in some instances.


Development of the US English version of the phenylketonuria - quality of life (PKU-QOL) questionnaire.
Phenylketonuria (PKU) is a rare genetic disorder caused by a defect in the metabolism of phenylalanine (PHE) resulting in elevated blood and brain PHE levels, and leading to cognitive, emotional, and psychosocial problems. The phenylketonuria - quality of life (PKU-QOL) questionnaire was the first self-administered disease-specific instrument developed to assess the impact of PKU and its treatment on the health-related quality of life (HRQL) of patients and their caregivers. Available in four versions (child, adolescent, adult and parent), the PKU-QOL was simultaneously developed and validated in seven countries [i.e., France, Germany, Italy, The Netherlands, Spain, Turkey and the United Kingdom (UK)]. The objectives of our study were to develop and linguistically validate the PKU-QOL questionnaire for use in the United States (US). The UK versions served as a basis for the development of the US English PKU-QOL questionnaire. The linguistic validation process consisted of 4 steps: 1) adaptation of the UK versions into US English by a translator native of US English and living in the US; 2) a clinician review; 3) cognitive interviews with patients and caregivers to test the appropriateness, understandability and clarity of the US translations; and 4) two proof-readings. The adaptation from UK to US English revealed the usual syntactic and idiomatic differences between the two languages, such as differences in: 1) Spelling, e.g., "dietician" (UK) vs. "dietitian" (US), or "mum" (UK) vs. "mom" (US); 2) Syntax or punctuation; and 3) Words/expressions use, e.g., "holidays" (UK) vs. "vacation" (US), or "biscuits" (UK) vs. "crackers" (US). The major issue was cultural, and consisted of using a different terminology to describe PKU treatment throughout the questionnaires. The clinician, with the patients and the caregivers, during the interviews suggested to replace "supplement and amino-acid mixture" or "supplements" with "medical formula." This wording was later changed to "medical food" to be consistent with the terminology used in current US published guidelines. The translation of the UK English PKU-QOL questionnaire into US English did not raise critical semantic and cultural issues. The PKU-QOL will be valuable for US healthcare providers in individualizing treatment and managing patients with PKU.


[Application of near-infrared spectroscopy technology in extraction and concentration process of Reduning injection].
To establish a rapid quantitative analysis method for the content of chlorogenic acid and solid content in the extraction liquid concentration process during the production of Reduning injection by using the near-infrared (NIR) spectroscopy, in order to reflect the concentration state in a real-time manner and really realize the quality control of concentrating process of the extraction and concentration process. The samples during the Jinqing extraction liquid concentration process were collected. After the removal of abnormal samples, the spectra pretreatment and the wave band selection, the quantitative calibration model between NIR spectra and chlorogenic acid HPLC analytical value and solid content was established by using PLS algorithm, and unknown samples were predicted. The correlation coefficients between the chlorogenic acid content and the solid content were respectively 0.992 1 and 0.994 0, and the correlation coefficients of the verification model were respectively 0.994 4 and 0.998 4, with the root mean square error of calibration (RMSEC) of 0.814 6 and 2.656 1 and the root mean square error of prediction (RMSEP) of 0.704 6 and 1.876 7 respectively, and the relative standard errors of predictions (RSEP) were 6.01% and 2.93% respectively. The method is simple, rapid, nondestructive, accurate and reliable, thus could be adopted for the fast monitoring of the chlorogenic acid content and the solid content during the concentration process of Reduning injection extraction liquid.


Enzyme-linked immunosorbent assay for the detection of Giardia lamblia in fecal specimens.
An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of Giardia lamblia in human feces. The assay could detect between 37 and 375 trophozoites from cultures and between 12.5 and 125 cysts purified from human stool. Stool specimens were positive by ELISA in 36 (92%) of 39 patients with giardiasis; negative specimens came from patients with low numbers of parasites in their stool. In 10 patients stools became negative by ELISA after successful treatment. Stool specimens were positive by ELISA in three (2%) of 128 patients without demonstrable Giardia organisms in their stools; one positive specimen was from a child with IgA deficiency and diarrhea who responded clinically to metronidazole. The ELISA is a simple, sensitive, and specific diagnostic test for G lamblia that will be useful in diagnosis, in follow-up treatment, and in large-scale studies directed at defining the epidemiology and pathophysiology of G lamblia infection.


iCVI-ARTMAP: Using Incremental Cluster Validity Indices and Adaptive Resonance Theory Reset Mechanism to Accelerate Validation and Achieve Multiprototype Unsupervised Representations.
This article presents an adaptive resonance theory predictive mapping (ARTMAP) model, which uses incremental cluster validity indices (iCVIs) to perform unsupervised learning, namely, iCVI-ARTMAP. Incorporating iCVIs to the decision-making and many-to-one mapping capabilities of this adaptive resonance theory (ART)-based model can improve the choices of clusters to which samples are incrementally assigned. These improvements are accomplished by intelligently performing the operations of swapping sample assignments between clusters, splitting and merging clusters, and caching the values of variables when iCVI values need to be recomputed. Using recursive formulations enables iCVI-ARTMAP to considerably reduce the computational burden associated with cluster validity index (CVI)-based offline clustering. In this work, six iCVI-ARTMAP variants were realized via the integration of one information-theoretic and five sum-of-squares-based iCVIs into fuzzy ARTMAP. With proper choice of iCVI, iCVI-ARTMAP either outperformed or performed comparably to three ART-based and four non-ART-based clustering algorithms in experiments using benchmark datasets of different natures. Naturally, the performance of iCVI-ARTMAP is subject to the selected iCVI and its suitability to the data at hand; fortunately, it is a general model in which other iCVIs can be easily embedded.


Differential expression of calreticulin in developmental stages of Taenia solium.
Taenia solium, a cestode that causes neurocysticercosis and taeniasis in humans, has a complex life cycle. The adult tapeworm develops in the intestine of human beings and is also responsible for neurocysticercosis, which is caused by the metacestode or cysticercus that develops in the brain. Recently, we have cloned the coding region for T. solium calreticulin (TsCRT) as a functional Ca(2+)-binding protein. Calreticulin is a ubiquitous protein involved in cellular Ca2+ homeostasis and protein folding. These important functions affect several aspects of cell physiology. To explore the expression of TsCRT during the T. solium life cycle, we used a specific polyclonal antibody raised against recombinant TsCRT to localize this protein by immunolabeling techniques. In sections of cysticerci obtained from swine muscle, as well as of adult tapeworms obtained after infection of hamsters with cysticerci, TsCRT was preferentially localized in tegumentary and muscle cytons of the suckers and rostellum. In mature proglottids obtained from infected humans, positive staining was observed in spermatogonia, ovogonia, uterine epithelium, and cells of the vas deferens. In the gravid uterus, the morula and early stage embryos were highly positive to TsCRT. However, expression diminished as embryonic development progressed and was absent in fully developed oncospheres that were surrounded by an embryophore. A similar down regulation was observed during spermatogenesis. Although early spermatocytes showed a high expression of TsCRT, mature spermatozoa present in the vas deferens were completely negative. These data indicate that calreticulin expression is spatially and temporally regulated during development of T. solium, especially during germ cell development and embryogenesis. In addition, these original images illustrate, for the first time, these processes at a histological level.


Condoms, Culture, and Conviction: The Effect of Acculturation and Religiosity on Latina Condom Use during First Sex with New Partners.
Latinas in the United States are less likely than their non-Hispanic peers to use condoms. Previous research has identified acculturation and religiosity as two key determinants of Latina condom use, but results are inconsistent, impairing the translation of findings to practice. The current study examines these constructs together and addresses methodological concerns noted in the literature. Structural equation modeling performed on a nationally representative sample of Latinas indicated that intrinsic religiosity increased condom use whereas acculturation decreased condom use. Extrinsic religiosity indirectly increased condom use via intrinsic religiosity. Implications for practice and policy are discussed.


[Evaluation of language therapy in aphasia after stroke].
In 27 patients with aphasia and hemiparesis following strokes speech was tested before and after completion of sanatorium treatment. After three weeks of speech re-education aphasia improved in various degrees in 19 patients. The best results of logopedic treatment were obtained in patients with medium-grade or slight aphasia subjected to rehabilitation treatment during the first three months after stroke. Effective motor rehabilitation conducted parallelly with re-education exercises in early period after stroke has a favourable effect on advance in therapy and later resocialization of patients.


[Value of 1H-MRS on SCA3/MJD diagnosis and clinical course].
To investigate the value of proton magnetic resonance spectroscopy (1H-MRS) on the diagnosis of SCA3/MJD, and to calculate the correlation between 1H-MRS ratio and the clinical score. Methods: Sixteen patients with SCA3/MJD and 19 healthy volunteers were scanned with 1H-MRS. The data of N-acetyl aspartate, creatine, choline-containing compounds, myoinositol, NAA/Cr, Cho/Cr, and mI/Cr ratio were collected, which were grouped for comparative study. The onset patients with SCA3/MJD were evaluated with the International Cooperative Ataxia Rating Scale and Scale for the Assessment and Rating of Ataxia, the correlation between NAA/Cr, Cho/Cr or mI/Cr ratio and the clinical score was calculated. Results: The NAA/Cr in the pons and cerebellar dentate nucleus from the onset patients with SCA3/MJD was significantly reduced compared to that in the normal control group. The NAA/Cr in the cerebellar dentate nucleus of onset patients with SCA3/MJD was obviously correlated with ICARS. Conclusion: SCA3/MJD lesions are mainly located in the cerebellum and brainstem, where gray and white mater are also involved. The cerebellar dentate nucleus may be the earliest involved area. There is a correlation between the ICARS and the cerebellar lesion degree. The ICARS reflects the severity of clinical manifestations. 1H-MRS is useful in the diagnosis of SCA3/MJD.


Inhibition of miRNA-152-3p enhances diabetic wound repair via upregulation of PTEN.
Diabetic foot ulcer (DFU) is a major complication of diabetes in the elderly population. The aim of this study was to investigate the potential mechanism of DFU at the molecular level and explore a feasible therapy for it. Using data from the Gene Expression Omnibus (GEO) database, we found that phosphatase and tensin homolog (PTEN) is differentially expressed between diabetic patients and those without diabetes. We also found that PTEN expression is regulated by glucose stimulation. In addition, decreased function of human umbilical vein endothelial cells (HUVECs) was found to be associated with reduction of PTEN. We identified microRNA-152-3p (miR-152-3p) to be a putative upstream negative regulator of PTEN, and in vivo and in vitro results indicated that miR-152-3p antagonist could restore HUVEC function and accelerate wound repair. Thus, miR-152-3p-induced downregulation of PTEN appears responsible for the delayed wound healing in DFU, and miR-152-3p inhibition may effectively accelerate wound repair, thereby providing a potential target for DFU therapy.


Intracranial complications of sinusitis.
While once a significant risk of sinusitis, the incidence of intracranial complications has decreased remarkably since the advent of antibiotics. This article reviews the intracranial complications of chronic sinusitis, their incidence, clinical manifestations, radiographic evidence, and treatment options.


RIBOSOMAL-DNA, MITOCHONDRIAL-DNA, CHROMOSOMAL, AND ALLOZYMIC STUDIES ON A CONTACT ZONE IN THE POCKET GOPHER, GEOMYS.
We studied 75 individuals of the Plains pocket gopher, Geomys bursarius, from eastern New Mexico, where the subspecies major and knoxjonesi hybridize. Each individual was examined for chromosome number, ribosomal DNA, mitochondrial DNA, and three protein systems for which reference parental populations were fixed for alternative alleles. Twenty individuals were indistinguishable from parental major, 14 individuals were indistinguishable from parental knoxjonesi, and 41 individuals had genotypes composed of combinations of character states that distinguish the two parental types. The parental types appear to represent discrete genetic entities that have restricted introgression across a narrow hybrid zone (width approximately 3 km, using the 20/80 criterion). Parental types overlap in geographic distribution near the center of the zone, and changes in mitochondrial DNA and the five nuclear markers are concordant across the zone. It is probable that there is premating isolation between knoxjonesi males and major females. The frequencies of individuals with certain genotypic combinations within our sample imply differential reproductive success of certain genotypes. We propose that F1 's and highly heterozygous males are sterile and that hybrid females are less fertile than parental females. These postmating factors, along with premating isolation for one of the reciprocal crosses, probably account for the restriction of gene flow across the contact zone. The structure of the zone can be explained by the "dynamic equilibrium" model.


Neural plasticity and hemispatial neglect in stroke.
The ability to outline the world and our place in it characterises our humanity. Stroke or brain injury can alter this world-making capability temporarily or permanently. The stroke patient's world, once intelligible and practicable, is transformed into a confusing, unapproachable and hostile environment. The skills of intellect, sensation, awareness and movement, which are honed over the course of a lifetime and which so characterise our humanity are the very abilities most compromised by stroke. Stroke can rob people of the most basic way of interacting with the world. We will outline what is neglect and its mechanism in brain plasticity.


Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study.
Recent data from the medical literature indicates that cyclooxygenase-2 (COX-2) plays a key role in the production of vascular endothelial growth factor (VEGF), a glycoprotein that has the ability to increase the permeability of blood vessels and to induce angiogenesis. This study was undertaken to investigate the immunohistological co-expression of COX-2 and VEGF in inflamed human pulp, in conjunction with the expression of CD34, a transmembrane glycoprotein expressed in endothelial cells. Pulp tissue of extracted carious human third molars with a recent history of spontaneous pain were collected and processed for immunostaining of COX-2, VEGF, and CD34 using the biotin-streptoavidin method. Healthy pulp samples served as controls. COX-2 expression was not observed in healthy pulps, whereas all inflamed pulps demonstrated COX-2-expressing cells. Similarly, VEGF was not expressed in normal pulp tissue, but was strongly positive in inflamed pulps. CD34 was expressed in the endothelium of both normal and inflamed pulp tissues. Co-expression of COX-2 and VEGF in all consecutive sections of inflamed pulps could be suggestive of a possible release of VEGF via a COX-2-dependent pathway.


A Facile Way To Improve the Bioavailability of Nanomedicine Based on the Threshold Theory.
One of the most significant barriers to the clinical transformation of nanomedicines is low drug distribution in solid tumors due to quick clearance of nanomedicine after injection. Studies have revealed that the distribution of nanomedicine in tumor sites can be considerably improved when the number of nanoparticles supplied in a short period surpasses the threshold. Most routinely employed nanomaterials have dose-related safety concerns. To resolve this problem, we use highly biocompatible albumin to construct blank nanoparticles and doxorubicin loading nanoparticles. Under the guidance of the threshold theory, when the quantity of drug loading nanoparticles is constant, the drug delivery effectiveness improves with the addition of blank nanoparticles. This enhanced impact was verified both in vitro and in vivo. The area under the curve of the high dose group (19.5 × 1011) is 2.5 times higher than that of the low dose group (6.5 × 1011). In addition, the drug distribution of the high dose group at the tumor site was also improved by 1.5 times compared with the low dose group. The results of histopathological sections also showed that the administration of excess blank nanoparticles within 24 h has no damage to the animals. This study contributes to the clinical transition of nanomedicine by providing fresh ideas for anticancer nanomedicine research.


Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin's Lymphoma Study Group.
Long-term survivors of successfully treated Hodgkin's lymphoma (HL) are at risk for late complications. Among these, infertility for female patients is of major importance. The subject of this analysis is to evaluate the menstrual status after HL therapy. From 1994 to 1998, the German Hodgkin's Lymphoma Study Group conducted clinical trials for early-, intermediate-, and advanced-stage HL (trials HD7 to HD9) involving a total of 3,186 patients. A survey was carried out to evaluate the menstrual status after therapy. The following factors were assessed concerning their influence on amenorrhea: age, treatment, stage, and the use of oral contraceptives during chemotherapy. A total of 405 women aged younger than 40 years answered the study questions. After a median follow-up of 3.2 years, 51.4% of the women receiving eight cycles of dose-escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) had continuous amenorrhea. Amenorrhea was significantly more frequent after dose-escalated BEACOPP compared with doxorubicin, bleomycin, vinblastine, and dacarbazine; cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine, and dacarbazine; or standard BEACOPP (P = .0066). Amenorrhea after therapy was most pronounced in women with advanced-stage HL (P < .0001), in women older than 30 years at treatment (P = .0065), and in women who did not take oral contraceptives during chemotherapy (P = .0002). Most women who are treated for advanced-stage HL experience amenorrhea after therapy. Amenorrhea is significantly more frequent in women with advanced-stage HL receiving eight cycles of dose-escalated BEACOPP and in women older than 30 years at first treatment. Furthermore, the data show a statistical association between the use of oral contraceptives and return of menstrual cycle, which is subject to further investigation.


Growth inhibitory effect of the antibody to hematopoietic stem cell antigen CD34 in leukemic cell lines.
Growth-inhibitory and proapoptotic effects of the monoclonal antibody to CD34 molecule, clone 4H11, were tested in CD34+ leukemic cell lines (MOLM-9, JURL-MK1, HEL) and CD34- cell lines (PS-1, ML-2 and CTV-1). We have found that the monoclonal antibody to CD34 inhibited the proliferation and induced apoptosis of all CD34+ cell lines. We did not observe induction of differentiation by anti-CD34 antibody, but a growth arrest of cells in the G0/G1 phase of the cell cycle was detected in all the cell lines studied. Combinations of anti-CD34 antibody with both type I (alpha, beta) or type II (gamma) interferons did not enhance the effects on the cell growth or inhibition of cellular proliferation of the antibody alone. Our data suggest that the monoclonal antibody to CD34 molecule prepared from clone 4H11, after sufficient experimental and preclinical testing on laboratory animals, may provide a new basis for targeted antibody therapy of acute or chronic myeloid leukemia.


Impact of Educational Intervention in Reducing the Weight of School Bags in Selected School Children.
To assess the effectiveness of educational intervention to reduce the weight of school bags. The study design was one group pre- and posttest experimental Research design. Government Senior Secondary School Dhanas, Chandigarh, and Shri Guru Harkrishan Model Senior Secondary School Sector-38D, Chandigarh (A private school) between July and November 2018. Names of the schools can be avoided. Total 760 students from selected sections nursery to 10th class of school were enrolled in the study. At baseline and end line weight of children, school bags and its content were weighed using weighing scale. Length of bag strap, breath of bag, torso of children, and their shoulders size were measured by measuring tape. Bag carrying style, posture, etc., were observed by observation checklist. Interviewed children (5th to 10th class) were using Nordic musculoskeletal questionnaire for musculoskeletal system assessment. Educational intervention was provided to the children for one month to reduce weight of school bag by teaching in assembly and displaying the charts in school. (Use of softbound thin textbooks, breaking thin books in 2-3 thin softbound books, use lightweight bag, pencil box, lunch box, and water bottles. Pack bag as per timetable.). The result revealed that heavy school bags were carrying 69.7% children from government school and 80.2% from private school. Children carrying heavy bags reported musculoskeletal problems 5 times higher than their counterparts. After intervention, there was significant reduction in the weight of school bags (P < 0.001 as per paired t-test). Provide the weight of the bags before and after intervention in addition to the P value. Children carrying heavy bags were suffering from musculoskeletal problems. Intervention helped in reducing the weight of school bag.


Fluorescence microlymphography in chronic venous incompetence.
In severe chronic venous incompetence there is not only microangiography of the blood capillaries, but the superficial lymphatic skin capillaries at the medial ankle region are damaged also. The network visualized after subepidermal injection of FITC-dextran 150,000 is interrupted by obliterations or is even completely destroyed. In addition, lymphatic microangiopathy may be diagnosed by increased leakage of the dye out of the capillaries (enhanced permeability) and by phenomena of cutaneous reflux (parts of the network filling from deeper invisible channels). It is concluded that formation of indurated edema in chronic venous insufficiency arises at least in part from lymphatic microangiopathy.


Blinding the blinded - assessing the effectiveness of a sham treatment in a multiplace hyperbaric chamber trial.
Hyperbaric oxygen therapy (HBOT) is used for a variety of problem wounds as an adjunctive treatment. The therapeutic impact of adding HBOT to a wound-healing regimen in many cases remains unclear and an ongoing need exists for additional randomised controlled trials. Many of these clinical studies require a sham group of study participants. To date, there has not been any published research on the concealment of sham treatments in multiplace hyperbaric chambers. The aim of this pilot project was to validate the existing blinding procedures used at one hyperbaric facility. Sixty-six volunteer recreational scuba divers, who had not previously been exposed to compression in a hyperbaric chamber, were recruited through local dive shops. One group was pressurised to 203 kPa and the other was minimally pressurised to 121 kPa, the minimum pressure required to cause middle ear pressure changes. Both protocols implemented continuous, though subtle, pressure variations toward the attainment of the final target pressure. A nearly identical number of subjects in both the 203 kPa (n = 32) and 121 kPa (n = 34) groups believed they had undergone a treatment pressure to 203 kPa (72% versus 71%) indicating a similarity of perception between the two groups.


Prevalence and factors associated with the use of acupuncture and Chinese medicine: results of a nationally representative survey of 17161 Australian women.
Traditional Chinese Medicine has considerable public support in Australia and elsewhere around the world; the literature suggests Chinese medicine (CM) and acupuncture are particularly popular. To examine factors associated with CM/acupuncture use among young/middle-aged Australian women. This research formed part of the Australian Longitudinal Study on Women's Health (ALSWH), a population-based cohort study. Data were obtained from the 'young' (34-39 years; n=8010) and 'middle-aged' (62-67 years; n=9151) ALSWH cohorts, who completed survey 6 (in 2012) and survey 7 (in 2013), respectively. Outcome measures included use of CM and visits to an acupuncturist in the previous 12 months. Predictive factors included demographic characteristics, and measures of health status (diagnosed chronic medical conditions) and health service utilisation. Statistical analyses included bivariate χ2 tests, two proportions Z-tests and backward stepwise multiple logistic regression modelling. In total, 9.5% and 6.2% of women in the young and middle-aged cohorts, respectively, had consulted an acupuncturist, and 5.7% and 4.0%, respectively, had used CM. Young women with low iron levels and/or endometriosis were more likely to use CM and/or acupuncture. Middle-aged women with low iron levels and/or chronic fatigue syndrome (CFS) were more likely to use CM, while middle-aged women with arthritis and/or CFS were more likely to use acupuncture. Women with chronic conditions (including arthritis, low iron, CFS and endometriosis) were associated with higher odds of CM/acupuncture use. There is a need for further research to examine the potential benefits of CM/acupuncture for these chronic illnesses.


Treatment of obstructive sleep apnea with the Karwetzky oral appliance.
The aims of this retrospective study were to assess the effect of a Karwetzky mandibular protrusion appliance for treating patients with mild, moderate, and severe obstructive sleep apnea. Eighty-one of 116 patients (69.8%) suffering from obstructive sleep apnea were treated with an activator model according to Karwetzky. After 4 months (SD 4.0 months) treatment outcome was controlled by polysomnography. Therapeutic outcome depended on the severity of obstructive sleep apnea. The median apnea-hypopnea index decreased from 10.6 events/h (range 2.0-14.9) to 5.8 events/h (range 0.2-17.3, P<0.01) in the mild group, from 21.7 events/h (range 17.3-28.4) to 7.7 events/h (range 1.0-30.1, P<0.001) in the moderate group, and from 42.1 events/h (range 33.2-64.9) to 18.1 events/h (range 2.4-48.8, P<0.001) in the severe group. Sleep variables did not show consistent improvement except for a trend towards more REM sleep and slow-wave sleep. The numbers of retentive teeth did not statistically influence treatment efficacy. Comparing the pre- and post-treatment polysomnographic variables, it was found that the respiratory events rather than sleep stages were significantly reduced by the Karwetzky appliance investigated.


Cystic fibrosis and lens opacity.
Cystic fibrosis (CF) is a fairly common lethal genetic disease in whites, inherited via an autosomal recessive pattern. Several clinically evident anomalies of the eye such as xerophthalmia, papilledema, retinal alterations and optic neuropathy have been described. In the present study we investigated lens changes in 40 patients affected by CF, to relate the results to the stage of digestive insufficiency. Each patient underwent an accurate ocular examination including visual acuity, slit-lamp examination, and measurement of lens transparency with the Opacity Lens Meter 701. The results were compared with those of an age- and sex-matched control group. The comparison between the lens opacity values obtained in the CF patients and those measured in the control group showed a statistically significant difference; moreover, lens transparency was more decreased in patients with severe digestive insufficiency.


Motion of a current-vortex sheet in the magnetic Kelvin-Helmholtz instability.
In this paper, we consider the Kelvin-Helmholtz instability in the magnetohydrodynamic flow. The motion of the interface is described by a current-vortex sheet. We examine the linear stability of the current-vortex sheet model and determine the growth rate of the interface. The interface is linearly stable for M_{A}<2 where M_{A} represents the Alfvén Mach number. It is found that the interface is linearly unstable in the limit of the critical Alfvén Mach number M_{A}=2, due to resonance of eigenvalues. We perform numerical simulations for the current-vortex sheet for both regimes of M_{A}<2 and M_{A}>2. The numerical results show the stabilizing effects of the magnetic field on the evolution of the current-vortex sheet when the magnetic field is sufficiently large. For the regime M_{A}<2, the sheet oscillates both longitudinally and transversely and the transverse surface wave is pronounced for a large M_{A}. Remarkably, the interface is nonlinearly unstable for M_{A}≈2, for M_{A}<2, which may be due to the propagation of surface waves. For the regime M_{A}>2, the roll-up of the spiral is weakened and the spiral is more pinched and stretched for smaller M_{A}. A comparison of the unstable evolutions of large and small values of M_{A} shows significant differences of the magnetic field and vortex sheet strength.


Satisfaction and convenience of using terpenoid-impregnated eyelid wipes and teaching method in people without blepharitis.
Demodex infestations cause blepharitis and are difficult to treat. Recently, a new type of eyelid wipes with terpenoids has been found effective. We aim to evaluate patient satisfaction after short-term use and compare two teaching modalities on the techniques of use. Eligible participants were taught to use eyelid wipes (Cliradex®) by either live or online video demonstration based on random allocation. Participants used the wipes twice daily for a week. All participants had prior evaluation of socioeconomic status, dry eye symptoms, and meibomian gland features. After 1 week, competence of use was assessed by participants showing their technique to the investigator, and a questionnaire on comfort, ease, and convenience of use was administered. Higher scores indicate greater satisfaction, and these levels are compared among the two teaching modalities using chi square. A total of 50 participants were recruited, with a mean age of 42±16 years, and 88% of the participants were females. Overall, median comfort level was 4.0 (range: 1-6), ease level was 5.0 (3-6), and convenience level was 5.0 (2-6). Median stinging was 2.0 (1-4), which corresponded to some but mild stinging. The median competence level was 4.0 (2-4), which corresponded to excellent competence. These satisfactory levels (ease, comfort, and convenience) experienced were not significantly associated with different socioeconomic indicators, that is, housing type, income, highest education level, and were not different between teaching methods (p>0.05). Short-term use of Cliradex eyelid wipes seems to be acceptable to most people. The teaching instructions before using these wipes were equally effective - whether live or online video demonstration was used.


[Metabolic disorders caused by blood transfusions].
Preserved stored blood undergoes metabolic changes depending on the duration of storage. These metabolic changes include a deprivation of 2,3-diphosphoglycerate (2,3-DPG), acidosis and hyperkalemia. The preservative contains citrate as an anticoagulant which binds the ionised serum calcium. 2,3-DPG depleted erythrocytes show a clearly elevated oxygen affinity. Following massive transfusion, these changes can also occur in the recipient. Under these conditions, patients with coronary artery disease show impaired heart function. Prejudicial changes concerning other vital systems have not yet been definitely proved. Acidosis, hypocalcemia and hyperkalemia can take place under massive transfusion. Normally the body's own compensatory mechanisms ensure sufficient recompensation; however, under hypothermia or shock these mechanisms can be impaired. Disturbances of the electrolyte and acid base system are safely detected by ECG and regularly performed acid base analysis.


[Comparative evaluation of the efficiency of transscleral diode laser cyclophotocoagulation during contact and contactless procedures: experimental morphological study].
To elucidate the extent to which contact and contactless procedures of diode laser transscleral cyclophotocoagulation (CPC) has a antihypertensive effect and a ocular tissue damaging effect, the authors have made a comparative assessment of the procedures to determine their preference. The study was conducted on an experimental material (5 Chinchilla rabbits (10 eyes)). The follow-up was 1 day to 6 months after laser interventions. The authors estimated the parameters of ocular hydrodynamics before and laser intervtntion throughout the follow-up and analyzed them with morphological changes kept in mind. The final antihypertensive effect of both contact and contactless procedures was virtually equal. However, less inflammatory changes and lower ocular damaging effect, and no additional medical manipulations for contactless diode laser CPC make it more preferable to contact CPC for clinical use.


HFE codon 63/282 (H63D/C282Y) dimorphism in German patients with genetic hemochromatosis.
Genetic hemochromatosis (GH) is closely associated with genes of the major histocompatibility complex (MHC) on chromosome 6. Recently, a candidate gene for GH, with structural similarities to MHC class I genes, designated HLA-H and presently named HFE, has been cloned. The HFE gene is localized telomeric to the MHC and several reports have indicated that the HFE gene is mutated in GH patients. In the present study we have analyzed the relationship of HFE gene variants and disease manifestation in GH patients and family members. Fifty-seven patients with GH, 73 family members and 153 healthy blood donors were studied for the amino acid dimorphism at codon 63 (His63Asp=H63D) and codon 282 (Cys282Tyr= C282Y) of the HFE gene. The codon 63 and 282 dimorphism were defined by PCR amplification of genomic DNA samples and restriction enzyme digestion using RsaI/SnaBI for C282Y and BclI/MboI for H63D. Ferritin, transferrin serum levels and total iron-binding capacity were determined prior to therapeutic intervention. The Tyr-282 substitution occurred in 53 (93%) of patients compared with 8 (5.2%) of controls (OR=169, P<0.0001). Fifty-one (90%) patients were Tyr-282 homozygous. In contrast, the Asp-63 substitution was present in 5 (8.8%) of the patients compared with 34 (22%) of controls (OR=0.39, P=NS) with none of the patients being homozygous. In Tyr-282 homozygous GH patients serum ferritin levels, transferrin saturation, liver iron and liver iron index were elevated significantly compared to Tyr-282-negative patients, whereas no difference was observed between Tyr/Cys-282 heterozygous and Tyr-282-negative patients.


[Merkel cell carcinoma of the nose].
Despite an increasing number of reports Merkel cell carcinoma still is a rare neoplasm. We therefore present the imaging feature of the case of Merkel cell carcinoma involving the nasal region in 65-year woman with lymphoma malignum lymphoplasmocytoides and its rapid progression with fast metastasis to lymph nodes. Surgery and adjuvant radiotherapy, chemotherapy appeared to provide optimal local control.


A case of recurrent swimming-induced pulmonary edema in a triathlete: the need for awareness.
This report discusses a rare case of a 55-year-old female triathlete who developed recurrent episodes of swimming-induced pulmonary edema (SIPE). She had two hospital admissions with pulmonary edema after developing breathlessness while swimming, including a near-drowning experience in an open water swim. With increasing popularity of triathlon and open water sports, this case highlights the importance of a greater awareness of SIPE among health professionals, event organizers, and athletes. This report explores the previous reported cases in triathletes and those who have suffered recurrent episodes. It is paramount that an accurate diagnosis is made as these individuals may be at an increased risk of future life-threatening episodes.


[Voltage-gated potassium channels and human neurological diseases].
Voltage-gated potassium channels (Kv) is the largest, most complex in potassium channel superfamily. It can be divided into Kv alpha subunit and auxiliary two groups. The roles of some Kv channels types, e.g. rapidly inactivating (A-Type channel) and muscarine sensitive channels (M-type channel) are beginning to be understood. They are prominent in nervous system, acting in delicate and accurate ways to control or modify many physiological and pathological functions including membrane excitability, neurotransmitter release, cell proliferation or degeneration, signal transduction in neuronal network. Many human neurological disease pathogenesis are found to be related to mutant of Kv-channels subunit or subtype, such as, learning and memory impairing, ataxia, epilepsy, deafness, etc.


[Histiocytosis X and sclerosing cholangitis].
The case of a seven-year-old with multifocal (type II) Langheran's cell histiocytosis since the age of two years is reported. Despite therapy, biliary cirrhosis with portal hypertension developed gradually. Histologic studies of liver biopsy specimens, computed tomography, and transhepatic cholangiography disclosed dilatation of the bile ducts, suggesting sclerosing cholangitis, a specific complication of Langherans' cell histiocytosis which precipitates the development of biliary cirrhosis.


COVID-19: Effects of Pandemic Related Restrictions on Physical Activity, Screen Time, and Mental Well-being in German adolescents.
Objective: To describe the impact of the COVID-19 pandemic-related restrictions (PR) in April and May 2020 on physical activity (PA), sedentary screen time (SST), and mental well-being (MWB) in German adolescents, and to analyze associations between these variables. Methods: The Münster District Government invited all secondary school students (aged 11-17) in the region to take part in the online survey that assessed PA, SST, and MWB. For data analysis, we calculated descriptive statistics and ran linear regression analysis. Results: 1,038 students (627 [60.4%] female; 14.18 [± 1.97] years) were included in the analysis. During the PR, a marked decline in overall PA (p < .001) and a significant increase (p < .001) in SST were observed. One-third of the students reported worrying more and being less satisfied with their lives since PR. A decrease in life satisfaction (ß = -.524, p < .001) as well as an increase in general worrying (ß = -.336, p = .015) were associated with a decrease in PA during PR. Conclusion: The results show that the restrictions led to a decrease in physical activity, which may have detrimental effects on the students' mental and physical health.


Anti-pancreatic immunity. In vitro studies of cellular and humoral immune reactions directed toward pancreatic islets.
It has been suggested that the immune system may be responsible for the destruction of insulin secreting cells in some types of diabetes. In order to test this hypothesis, we studied the consequences of immune-mediated reactions on the function of pancreatic islet cells in vitro. A model was set up in vitro where mouse pancreatic islet cells are exposed to human lymphocytes or sera + complement then stimulated for the release of insulin or glucagon. A selective inhibition of insulin secretion, but not of glucagon secretion, was observed in the presence of lymphocytes from 37 out of 40 insulin-dependent diabetic (IDD) patients and in the presence of sera (+ complement) from 22 out of 40. Lymphocytes were found inhibitory in almost all patients in both groups, with and without associated autoimmune diseases. In contrast, inhibitory sera were observed almost only in patients with associated autoimmune diseases or recent onset diabetes. The selective inhibition of insulin secretion, but not of glucagon secretion, suggests that lymphocytes or sera may be involved in a destructive process of insulin secreting cells in vivo. This cell-mediated effect depends on direct T lymphocyte cytotoxicity, rather than antibody-dependent cell cytotoxicity, as suggested by the lack of any effect of aggregated immunoglobulins on the reaction. In contrast, when C57BL/6 mice were immunized by mastocytoma cells from a DBA2 strain, their lymphocytes and sera blocked both secretions of insulin and glucagon when incubated in vitro with DBA2 islet cells. This non-selective inhibition may be due to anti-H2 immunity, rather than immunity directed against insulin secreting cells.


Parathyroid hormone-related protein: a regulated calcium-mobilizing product of the mammary gland.
Parathyroid hormone-related protein shares similarities in sequence and function with the endocrine hormone, parathyroid hormone. However, unlike parathyroid hormone, a product of the parathyroid glands, parathyroid hormone-related protein has a wide distribution in tissues, including the mammary gland. Although during pregnancy the expression of parathyroid hormone-related protein in the mammary gland is low, following birth, protein levels rise sharply in the gland in response to elevations in serum prolactin. Large amounts of parathyroid hormone-related protein are secreted into milk, suggesting a possible role in the neonate. Transient phosphaturia and elevations of parathyroid hormone-related protein in mammary vein plasma support a possible endocrine function for parathyroid hormone-related protein during lactation. Recent evidence suggests a local function for parathyroid hormone-related protein in the lactating mammary gland, and evidence exists that parathyroid hormone-related protein stimulates calcium secretion by the goat mammary gland. Parathyroid hormone-related protein, a putative vasodilator, is produced by the external nutrient vasculature of the mammary gland, and levels within this tissue are regulated during lactation. Infusion of parathyroid hormone-related protein into the ovine mammary artery increases gland blood flow, suggesting a role for the protein in modulation of mammary gland hemodynamics. Regulation of parathyroid hormone-related protein synthesis by the lactating gland, together with the protein's actions on regional blood flow and calcium secretion, support an important function in the mammary gland during lactogenesis.


Asymmetric synthesis of new chiral beta-amino acid derivatives by Mannich-type reactions of chiral N-sulfinyl imidates with N-tosyl aldimines.
New chiral beta-(sulfonylamino)sulfinylimidates are synthesized in high overall yield and excellent diastereomeric excess via highly anti-selective Mannich-type reactions of chiral N-tert-butanesulfinyl imidates with N-tosyl aldimines. Deprotection of the beta-(sulfonylamino)sulfinylimidates gave access to enantiopure imidate hydrochlorides in high yields, as useful intermediates for an easy transformation to new chiral beta-sulfonylamino amides upon simple heating in chloroform. Hydrolysis of the imidate hydrochlorides afforded the corresponding chiral beta-sulfonylamino esters with >98% ee as new chiral beta-amino acid derivatives.


Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?
Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien-Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of "white-out" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.


A liberal arts education as preparation for medical school: how is it valued? How do graduates perform?
This study examines the utility of a liberal arts education on medical students' preparation and performance. Data included a survey of admission committee members, a preadmission survey of two cohorts of students, and academic performance and extracurricular involvement during medical school. Some admission committee members perceived applicants with liberal arts backgrounds to have certain advantages. These students preferred "discussing issues," and showed an initial preference for the practice of psychiatry. Despite entering with lower total grade-point average and being less involved in extracurricular activities, they were more likely to receive formal commendation and be elected to Alpha Omega Alpha. Although similarities outweigh differences, students with liberal arts backgrounds may benefit from an educational breadth well-suited for practicing the "art of medicine."


[Relationship between syndrome differentiation and blood total fibrinolytic activity, superoxide dismutase and albumin in nephrosis syndrome].
Relationship between the Syndrome Differentiation and total fibrinolytic activity (TFA), superoxide dismutase (SOD), serum albumin (Alb) was observed in 118 pediatric patients with nephrosis syndrome. The results suggested that there was significant difference between Damp-Heat type and Spleen Deficiency type in terms of blood TFA, SOD and serum Alb. Very significant positive correlation was found between serum Alb and TFA, P < 0.01. The level of TFA in pediatric patients with edema was significantly lower than that in normal children, the more the degree of edema, the more the level of TFA activity. It was shown that there would be possibility to find intrinsic connection between Syndrome Differentiation and laboratory findings.


Mechanistic Insight into the Abiotic Interactions of Selenate and Selenite with Natural Organic Matter.
Natural organic matter (NOM) decreases the selenium (Se) mobility in soil and sediment. Biotic dissimilatory reduction of selenate and selenite and assimilation of the reduced Se species into biomolecules are thought to be primarily responsible for this decreased Se mobility. However, the possibility of Se immobilization due to the abiotic interaction of Se species with NOM is still poorly understood. Equilibrating selenate and selenite with a model NOM (Pahokee peat soil), followed by X-ray absorption spectroscopic analysis, this study shows that the NOM can abiotically reduce highly mobile selenate into relatively less mobile selenite. NOM can sorb Se species, especially selenite, considerably. Preloading of the NOM with Fe(III) increases the sorption of selenite and selenate by several orders of magnitude. Modeling of the Se and Fe K-edge EXAFS data revealed that Se species are sorbed to NOM due to indirect complexation with the organically complexed Fe(O,OH)6 octahedra through the corner- (2C) and edge-sharing (1E) and direct complexation with the oxygen-containing functional groups of the NOM. This study concludes that the abiotic reduction and complexation of the Se species with NOM can be the additional or alternative route of Se immobilization in the NOM-rich soil and sediment.


Molecular characterisation of birch bark tar by headspace solid-phase microextraction gas chromatography-mass spectrometry: a new way for identifying archaeological glues.
To develop an analytical methodology, as non-destructive as possible, suitable for the identification of natural substances from archaeological origin, we studied the potentiality of solid-phase microextraction (SPME) for analysing birch bark tar, an adhesive commonly used during ancient times. First of all, birch bark tars were produced by a controlled heating of birch bark. The two kinds of samples obtained using different processes of fabrication, one at liquid state, the second one at solid state, were then analysed by headspace HS-SPME-GC-MS. Different conditions of sample treatment were tested (two different fibre coatings, various times and temperatures of extraction) in order to suggest optimal conditions for the analysis of birch bark tar. Both samples were shown to be rich in volatile organic components. Two main groups of constituents, namely phenolic compounds issued from lignin or tannin known to be present in bark and sesquiterpenoid hydrocarbons, secondary metabolites largely distributed in the plant kingdom, were detected for the first time in birch bark tar. HS-SPME-GC-MS appears thus to be a very efficient method for investigating the volatiles emitted by plant tars and could be further used for the study of birch bark tar samples issued from archaeological context.


Correlations of alcohol consumption with related covariates and heritability estimates in older adult males over a 14- to 18-year period: the NHLBI Twin Study.
Consistent maximum-likelihood heritability estimates of consumption of alcoholic beverages were observed at three separate times during a 14- to 18-year period in adult twin males initially aged 42-56 years in 1969-1973. Log transformation of the average number of drinks/week of the returnees to all three examinations was examined relative to potential covariates representing both antecedents of drinking alcohol and consequences of alcohol consumption. Significant relationships were noted for 38 of the covariates at one or more of the separate examinations, including positive correlations with smoking, coffee consumption, high-density lipoprotein cholesterol, mean corpuscular volume, systolic blood pressure, uric acid and behavioral measures, and negative correlations with blood urea nitrogen, red blood cell count, tea consumption, and tricep skinfolds. Analysis of the average alcohol consumption adjusted for nine independent covariates selected from multiple stepwise regression resulted in a modest decline in maximum-likelihood heritability estimates compared with unadjusted data, but little difference from heritability estimates obtained when abstainers from alcohol (no alcoholic beverages consumed at all three examinations) were excluded. The most striking effect of omitting abstainers from alcohol was the decline in the intraclass correlations in dizygotic twins. Bivariate analyses of alcohol and individual covariates revealed the phenotypic correlation between alcohol consumption and a measure of hostility was primarily environmental, that for high-density lipoprotein, smoking and coffee drinking with alcohol was primarily genetic, and the phenotypic correlation between alcohol consumption and mean corpuscular volume had both significant genetic and environmental correlations.(ABSTRACT TRUNCATED AT 250 WORDS)


The development and validation of a new interprofessional team approach evaluation scale.
A team approach in health care involves an interprofessional approach to patient care. We wanted to develop and validate a tool that would evaluate the interprofessional team approach to patients of a family medicine team. We performed a descriptive study in three consecutive phases: a literature review, consensus development panels, and a cross-sectional validation study. Three rounds of consensus development panels were carried out in order to evaluate and adapt the initial scale. The cross-sectional study was carried out in all Slovenian family medicine practices, each invited 10 consecutive patients. In the quantitative study, 3,292 patients participated (a 50.7% response rate), of which 1,810 (55.0%) were women. The mean age of the sample was 53.1 ± 1.2 years. The final Cronbach's alpha was 0.901. A factor analysis of the 9-item scale put forward two factors (Team Approach and Person-Centred approach) which explained 68.6% of the variance. This study provided a new scale for the evaluation of patient satisfaction with the interprofessional family medicine team from the patients' point of view. It opened the question of family medicine team competencies and pointed towards the need to develop a family medicine interprofessional team competency framework and a comprehensive tool for its assessment.


Successful use of pessary for uterine prolapse after pelvic trauma in a nulliparous young female: A case report.
To date, sporadic studies have shown that a relationship exists between delayed pelvic organ prolapse (POP) and pelvic trauma, and these cases have all been managed with surgical procedures. A 29-year-old, nulliparous (Gravida 0) woman without sexual experience was referred to our gynecology outpatient clinic, complaining of a protruding vaginal mass 5 years after a traffic accident (hit by a truck when she was walking) that caused serious multiple injuries. Stage 2 cystocele, stage 3 uterine prolapse, and stage 2 rectocele, pelvic trauma history. The woman was successfully managed with the Gellhorn size 2 pessary use. The short-term effect of pessary use was significant improvement. This is the first case report of the successful use of a pessary for POP after pelvic trauma in a nulliparous young female.


Topical tamoxifen in the therapy of cutaneous leishmaniasis.
The aims of the present work were to test the effect of tamoxifen administered topically and the therapeutic efficacy of tamoxifen and pentavalent antimonial combinations in an experimental model of cutaneous leishmaniasis. BALB/c mice infected with a luciferase expressing line of Leishmania amazonensis were treated with topical tamoxifen in two different formulations (ethanol or oil-free cream) as monotherapy or in co-administration with pentavalent antimonial. Treatment efficacy was evaluated by lesion size and parasite burden, quantified through luminescence, at the end of treatment and 4 weeks later. Topical tamoxifen, formulated in ethanol or as a cream, was shown to be effective. The interaction between tamoxifen and pentavalent antimonial was additive in vitro. Treatment with combined schemes containing tamoxifen and pentavalent antimonial was effective in reducing lesion size and parasite burden. Co-administration of tamoxifen and pentavalent antimonial was superior to monotherapy with antimonial.


Phylogenetic relationships among Bombycinae (Lepidoptera, Bombycoidea, and Bombycidae) based on mitochondrial genomes.
The subfamily Bombycinae Latreille, [1802] is an important silk-producing group, including well-known economical insects. Although there are many studies on the development of these economic insects, the relationships between genera/species of this subfamily are still unclear. Two data sets of mitochondrial genomes, 13 protein-coding genes (13PCGs) and 13PCGs-AA, were used to estimate phylogenetic relationships based on the maximum likelihood and Bayesian inference methods. The results strongly support the subfamily Bombycinae as a monophyletic group divided into two clades.


Evaluation of the utility of Liebowitz Social Anxiety Scale and Barratt Impulsiveness Scale in the diagnosis of social anxiety, impulsivity and depression.
Often mental disorders are serious problems concerning psychological well-being. They require comprehensive and specialized psychiatric and psychological help, but there are no public methods of controlling your mental state. The aim of study was the evaluation of the utility of Liebowitz Social Anxiety Scale and Barratt Impulsiveness Scale in the diagnosis of social anxiety, impulsivity and depression. The study included 85 persons. The study group had 34 patients treated in an open ward of the Department of Psychiatry and Psychotherapy of Medical University of Silesia in Katowice. The control group included 51 persons without mental disorders. Three self-rating questionnaires were used: Beck Depression Inventory, Barratt Impulsiveness Scale and Liebowitz Social Anxiety Scale. Statistica v10 Statsoft software was used for statistical analysis. The analyzed groups had significant differences in terms of Beck Scale (U Mann-Whitney test p=0.000001). Average score in study group: 22.94±12.50; in control group: 7.15±6.44. Groups had significant differences in terms of Liebowitz Scale (U test Mann-Whitney test, p=0.000164). Average score in the study group: 60.41±30.30; in control group: 35.01±23.94. Groups had significant differences in terms of Barratt Scale (t-student test p=0.000601). Average in study group: 66.35±9,49; in control group: 59.54±7.87. Significant positive correlation was observed between the results of Beck Scale and Liebowitz Scale (r=0.64465). Correlation was not observed between the results of the Liebowitz and Barrat (r=0.12091 and Beck and Barrat (r=0.21482). The intensity of the Liebowitz Social Anxiety Scale is directly proportional to the severity of depression according to the Beck Depression Inventory. The degree of impulsivity by Barrat Impulsiveness Scale does not correlate with the level of depression according to Beck Depression Inventory. The analyzed scales are relevant in the diagnosis of mental disorders.


[Dosimetric and qualitative evaluations of the use of rhodium filtration in mammography].
The value of rhodium filtration in mammography was compared with that of conventional molybdenum; dosimetric and qualitative tests were performed on a phantom and in vivo on informed and consenting patients. Phantom dosimetric tests confirmed a dose reduction with rhodium filtration changing according to thickness and primary beam energy. With rhodium filtration the dose decreased by 40% on the average topping 67% in breasts thicker than 6.5 cm. No significant differences were observed between rhodium and molybdenum filtration in clinical and phantom qualitative tests. Four radiologists--three of them in double blind--studied 29 mammograms repeated in the same technical setting and expressed a very slight preference for molybdenum also in thick and dense breasts. The slight preference was not based on higher diagnostic yield and therefore clinically irrelevant. Preferences appeared to be subjective, differing from one radiologist to another. In conclusion, the authors suggest the use of rhodium filtration in thick breasts because of the lower administered dose and of shorter exposure time with direct magnification.


Parental Fitness Questioned on the Grounds of Narcolepsy: Presentation of Two Cases.
We report two cases of fathers whose parental fitness was questioned during divorce and custody litigation because of narcolepsy type 2 and type 1, respectively. These cases highlighted both the existence of a narcolepsy-related stigma and the need to involve sleep experts in custody assessments when concerns about the parental fitness are related to a sleep disorder, expanding the field of interest of the growing "sleep forensics."


Perceived racial discrimination and risk of uterine leiomyomata.
The incidence of uterine leiomyomata (fibroids, myomas) is 2-3 times higher in black women than white women. Black women also report higher levels of racial discrimination. We evaluated the hypothesis that greater exposure to racism increases myoma risk in black women. Data were derived from the Black Women's Health Study, a prospective cohort study of US black women age 21-69 years in 1995. In 1997, women reported on "everyday" and "lifetime" experiences of racism. From 1997 through 2003, we followed 22,002 premenopausal women to assess the association between self-reported racism and risk of myomas. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. During 107,127 person-years of follow-up, 3440 new cases of uterine myomas confirmed by ultrasound (n = 2774) or surgery (n = 666) were reported. All IRRs for "lifetime" and "everyday" experiences of racism were above 1.0. Using a summary variable that averaged the responses from 5 "everyday" racism items, multivariable IRRs comparing quartiles 2, 3, and 4 to quintile 1 (lowest) were 1.16 (95% CI = 1.04-1.29), 1.19 (1.06-1.32), and 1.27 (1.14-1.43), respectively. Multivariable IRRs comparing women who reported 1, 2, or 3 lifetime occurrences of major discrimination (ie, job, housing, or police) relative to those who reported none were 1.04 (0.96-1.13), 1.17 (1.07-1.28), and 1.24 (1.10-1.39), respectively. Results did not vary according to case definition (ultrasound vs. surgery) or health care utilization. Associations were weaker among foreign-born women and among women with higher coping skills. Perceived racism was associated with an increased risk of uterine myomas in US-born black women.


Four-year incidence of allergic sensitization among schoolchildren in a community where allergy to cat and dog dominates sensitization: report from the Obstructive Lung Disease in Northern Sweden Study Group.
Exposure to high levels of cat allergen might prevent sensitization. We sought to measure the incidence of allergic sensitization among schoolchildren living in a dust mite- and cockroach-free environment and the associated risk factors. In 1996, a longitudinal cohort was established in northern Sweden, including 2454 children aged 7 to 8 years. Children were skin tested, and the testing was repeated 4 years later. Questionnaires were completed yearly. Participation was 88% both in 1996 and 2000. The prevalence of positive skin test results increased from 20.6% at age 7 and 8 years to 30.4% at age 11 and 12 years, a cumulative incidence of 13.8%, and was significantly higher among boys. The incidence was highest for cat (6.0%), timothy grass (5.9%), dog (4.9%), and birch (3.6%). A family history of allergy was the major risk factor for both a positive skin test response at age 7 and 8 years (odds ratio [OR], 1.69; 95% CI, 1.36-2.10) and for development of a positive skin test response over the next 4 years (OR, 1.67; 95% CI, 1.23-2.28). A significant inverse association between cat and dog ownership and the prevalence of type 1 allergy was found, particularly for those children who had lived with a cat both before age 7 and 8 years and during the next 4 years (OR, 0.44; 95% CI, 0.31-0.61). A similar pattern, although not significant, was found for incident cases. The high incidence of type 1 allergy at this age was similar to reports from communities with mite and cockroach allergen. Despite cat and dog being the most common allergens of sensitization, keeping these animals at home was not associated with an increased risk for sensitization.


Superparamagnetic iron oxide nanoparticle micelles stabilized by recombinant oleosin for targeted magnetic resonance imaging.
Recombinant surfactants present a new platform for stabilizing and targeting nanoparticle imaging agents. Superparamagnetic iron oxide nanoparticle-loaded micelles for MRI contrast are stabilized by an engineered variant of the naturally occurring protein oleosin and targeted using a Her2/neu affibody-oleosin fusion. The recombinant oleosin platform allows simple targeting and the ability to easily swap the ligand for numerous targets.


Characterization of the complete chloroplast genome of Achnatherum pekinense (Poaceae), a widespread weed.
Achnatherum pekinense belongs to Poaceae. The complete chloroplast genome of A. pekinense was reported in this study. The chloroplast genome was 137,837 bp in size with a canonical quadripartite structure, including two inverted repeat regions (IR) of 21,635 bp for each, a large single-copy (LSC) region of 81,787 bp in length, and a small single-copy (SSC) region of 12,780 bp in length. The overall guanine-cytosine (GC) content of this chloroplast genome was 38.8%, and the corresponding values of the LSC, SSC, and IR regions were 36.9%, 33.1%, and 44.1%, respectively. A total of 113 unique genes were annotated in this chloroplast genome, including four rRNA genes, 31 tRNA genes, and 78 protein-coding genes. The phylogenetic analysis showed that A. pekinense was clustered with A. inebrians.


Placebo effect in patients with irritable bowel syndrome.
The placebo effect has evolved from being considered a nuisance factor in clinical research to a hot topic of scientific investigation. New research findings show that a placebo has real psychobiological and biological effects that are attributable to the overall therapeutic context. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that shows a significant placebo response of around 40–50% among different clinical trials.A positive patient-practitioner relationship can enhance the placebo effect in IBS patients.Emerging literature using functional brain imaging has started to document the neuronal changes associated with the placebo phenomenon in IBS patients, showing aberrant neural network during visceral placebo analgesia when compared to controls. Further promotion and integration of laboratory and clinical research are encouraged to advance the understanding of placebo mechanisms in IBS patients.


[The heart and the mountains].
In a normal subject, exposure to high altitude is accompanied by a diminution in performance that is proportional to the hypoxia. In order to advise a cardiac patient who is contemplating undertaking a physical activity in the mountains and wishes to avoid taking any unnecessary risks in an environment that can quickly become very hostile, it is important to have a recent evaluation of the cardiopathy, and some appreciation of the expected problems linked to the activity and the location. Certain pathologies are absolute contraindications to high altitude, such as pulmonary arterial hypertension, thrombo-embolic disease, and unstable cardiac disease. The majority of stable cardiopathies allow some modified activity. The role of the cardiologist is to evaluate the patient's functional capacity, to calculate the effect of altitude on this capacity, and to postulate whether the reserve will be sufficient to cope with the expected demand.


Histologic Osseointegration Level Comparing Titanium and Zirconia Dental Implants: Meta-analysis of Preclinical Studies.
Purpose: To assess the literature comparing histologic levels of osseointegration for titanium vs zirconia dental implants. Materials and Methods: This systematic review was conducted following the PRISMA guidelines and was registered in PROSPERO (CRD42021236781). Electronic and manual searches were carried out through the PubMed/MEDLINE, PubMed Central, and Embase databases with a platform-specific search strategy combining controlled terms (MeSH and Emtree) and text words. The articles were selected by two independent investigators who evaluated the articles based on the criteria for eligibility. Results: A total of 17 articles were included. All were preclinical studies. The populations included dogs (27.55%), minipigs (14.28%), rats (14.28%), and rabbits (43.89%); and the implantation site varied among the mandible (36.82%), maxilla (9.04%), tibia (17.64%), skull (10.70%), and femur (25.80%). A total of 370 titanium (Ti) implants and 537 zirconia (Zr) implants were evaluated. The average osseointegration (% bone-to-implant contact) for Zr was 55.51% (17.6% to 89.09%), and for Ti was 58.50% (23.2% to 87.85%). There was no statistical difference between studies at the 2-month follow-up (P = .672), but this difference was significant at 1 and 3 months (P < .001). Conclusions: Within the limitations of this review, Zr implants had a similar level of osseointegration compared to Ti implants. Nonetheless, because these findings are based on preclinical research, all data must be carefully examined.


[Exploring the mechanism of rhizoma coptidis in treating type II diabetes mellitus based on metabolomics by gas chromatography-mass spectrometry].
Metabolomics was used to explore the mechanism of Rhizoma coptidis in treating type II diabetes mellitus. The rat model of type II diabetes mellitus was constructed by an injection of streptozocin (40 mg/kg), along with diets of fat emulsion. The rats were divided into four groups, the control group, the model group, the Rhizoma coptidis group (10 g/kg) and the metformin group (0.08 g/kg). After the treatment for 30 d, blood samples were collected to test biomedical indexes, and 24 h urine samples were collected for the metabolomics experiment. In the Rhizoma coptidis group, fasting blood glucose (FBG), total cholesterol (TC) and total plasma triglycerides (TG) were significantly decreased by 59.26%, 58.66% and 42.18%, respectively, compared with those in the model group. Based on gas chromatography-mass spectrometry, a urinary metabolomics method was used to study the mechanism of Rhizoma coptidis in treating diabetes mellitus. Based on the principal component analysis, it was found that the model group and control group were separated into two different clusters. The Rhizoma coptidis group was located between the model group and the control group, closer to the control group. Twelve significantly changed metabolites of diabetes mellitus were detected and identified, including 4-methyl phenol, benzoic acid, aminomalonic acid, and so on. After diabetic rats were administered with Rhizoma coptidis, 7 metabolites were significantly changed, and L-ascorbic acid and aminomalonic acid which related with the oxidative stress were significantly regulated to normal. The pharmacological results showed that Rhizoma coptidis could display anti-hyperglycemic and anti-hyperlipidemic effects. The Rhizoma coptidis had antioxidation function in preventing the occurrence of complications with diabetes mellitus to some extent. The work illustrates that the metabolomics method is a useful tool to study the treatment mechanism of traditional Chinese medicine.


Prevalence of IgE-mediated allergy to latex in hospital nursing staff.
IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract. IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.


Contrasting hydraulic strategies in two tropical lianas and their host trees.
Tropical liana abundance has been increasing over the past 40 yr, which has been associated with reduced rainfall. The proposed mechanism allowing lianas to thrive in dry conditions is deeper root systems than co-occurring trees, although we know very little about the fundamental hydraulic physiology of lianas. To test the hypothesis that two abundant liana species would physiologically outperform their host tree under reduced water availability, we measured rooting depth, hydraulic properties, plant water status, and leaf gas exchange during the dry season in a seasonally dry tropical forest. We also used a model to compare water use by one of the liana species and the host tree during drought. All species measured were shallowly rooted. The liana species were more vulnerable to embolism than host trees and experienced water potentials that were predicted to result in substantial hydraulic losses in both leaves and stems. Water potentials measured in host trees were not negative enough to result in significant hydraulic losses. Model results predicted the liana to have greater gas exchange than its host tree during drought and nondrought conditions. The host tree species had a more conservative strategy for maintenance of the soil-to-leaf hydraulic pathway than the lianas it supported. The two liana species experienced embolism in stems and leaves, based on vulnerability curves and water potentials. These emboli were presumably repaired before the next morning. However, in the host tree species, reduced stomatal conductance prevented leaf or stem embolism.


DNA synthesis and mitosis in erythropoietic cells.
Studies of newt (Triturus or Diemictylus viridescens) erythropoietic cells showed that DNA synthesis and mitosis normally occur throughout most of the developmental process. Mitotic divisions were found in all immature precursor stages from the proerythroblast to the highly hemoglobinized reticulocyte. Mitoses were absent in mature erythrocytes. Radioautographic examination of thymidine-(3)H incorporation into DNA revealed that all erythroid cells except the mature erythrocyte were labeled. Microphotometric measurements of Feulgen-stained smears showed that all immature stages were undergoing DNA synthesis whereas the mature erythrocyte was inactive. The results obtained from three independent methods clearly demonstrate that (a) no loss of DNA or of chromosomes occurs during erythrocytic development and (b) highly hemoglobinized and, therefore, well-differentiated cells normally do undergo DNA synthesis and mitosis.


Pubertal timing, sex hormone levels, and associations between early life adversity and accelerated development amongst 11-year-old children of parents with schizophrenia or bipolar disorder and controls: The Danish high risk and Resilience study via 11.
Children of parents with severe mental illness have several known risk factors for altered pubertal timing. Pubertal timing is important for children's physical and emotional development. We aimed to examine pubertal timing and associations between pubertal timing, early life adversity and child problem behavior including psychiatric diagnoses among children of parents with schizophrenia or bipolar disorder and controls. Self-reported Tanner stage (mean age 11.9, range 10.87-12.67), sex hormone levels, home environment, placement out of home, and problem behavior including psychiatric diagnoses of children at familial high-risk (FHR) of schizophrenia (FHR-SZ), bipolar disorder (FHR-BP) and population-based controls (PBC) were assessed. A total of 465 children participated in the study (Tanner assessment N = 417, sex hormones N = 293). Assessed with self-reported Tanner, no difference in pubertal timing was found between groups (p = 0.09). Hormone levels did not differ between groups except for inhibin B (mean (SD) = 55.86 (29.13) pg/mL for FHR-SZ girls vs 84.98 (47.98) pg/mL) for PBC girls (p < 0.001)) and for follicle stimulating hormone (FSH) (mean (SD) = 5.82 (1.45) U/L for FHR-BP girls vs 4.54 (1.68) U/L for PBC girls (p < 0.001)). FHR children who were placed out of home (17 children, 3.8% of participants) had higher Tanner stages than those living at home (p < 0.001). Timing was not associated with level of problem behavior or psychiatric diagnoses. FHR children did not differ from controls in pubertal timing. Early life adversity assessed as placement out of home may be associated with accelerated pubertal timing among children of parents with schizophrenia or bipolar disorder.


Lymphadenopathy and granulomas: benignancy of malignancy and differential diagnosis with endobronchial ultrasound-transbronchial needle biopsy 19G needle fine-needle aspiration biopsy.
Endobronchial ultrasound (EBUS) is a very useful tool for the diagnosis of lymphadenopathy of the mediastinum. Nowadays, EBUS can substitute video-assisted thoracic surgery when a 19G needle is used. Several studies have provided data for efficient diagnosis not only for lung cancer, but for also sarcoidosis, tuberculosis and lymphoma. We present five cases of EBUS-transbronchial needle biopsy 19G needle used for the diagnosis of mediastinum lymphadenopathy. We present not only the pathological diagnosis, but also the steps for the differential clinical and pathological differential diagnosis for sarcoidosis, tuberculosis, cancer metastasis, respiratory infection and lymphoma.


Copper-Catalyzed Decarboxylative/Click Cascade Reaction: Regioselective Assembly of 5-Selenotriazole Anticancer Agents.
A simple and efficient Cu-catalyzed decarboxylative/click reaction for the preparation of 1,4-disubstituted 5-arylselanyl-1,2,3-triazoles from propiolic acids, diselenides, and azides has been developed. The mechanistic study revealed that the intermolecular AAC reaction of an alkynyl selenium intermediate occurred. The resulting multisubstituted 5-seleno-1,2,3-triazoles were tested for in vitro anticancer activity by MTT assay, and compounds 4f, 4h, and 4p showed potent cancer cell-growth inhibition activities.


Expression and activity of cell cycle regulators during proliferation and programmed cell death in the mammary gland.
In the mammary gland distinct phases of proliferation, differentiation and programmed cell death of epithelial cells occur at defined stages of development. Here we show that the expression and activity of cell cycle regulators during normal and preneoplastic proliferation and programmed cell death are remarkably similar. In all cases we found elevated levels of a protein kinase A activity and of transcription factor AP-1, cFos and JunD being the major components of the AP-1 DNA binding complex. A correlation between cFos and JunD expression and chromosomal DNA fragmentation during programmed cell death was observed. Several genes associated with G1, including cyclin D1, D2 and D3 and c-fos, c-jun, junB, JunD, c-myc and p53, are induced in proliferating and in apoptotic mouse mammary tissue. Whereas the expression of these genes correlated with active proliferation of epithelial cells in terminal end buds during puberty, very little proliferation or DNA synthesis, but, instead, extensive apoptosis of epithelial cells, was observed during involution. Our results suggest that a G1-like state is associated with programmed cell death of mammary epithelial cells in vivo and that apoptosis occurs without S-phase induction.


Unexplained recurrent fever: when is autoinflammation the explanation?
Recurrent fever can be the sole or leading manifestation of a variety of diseases including malignancies, autoimmune diseases and infections. Because the differential diagnoses are manifold, no formal guidelines for the approach of patients with recurrent fever exists. The newly recognized group of autoinflammatory diseases are often accompanied by repetitive fever attacks. As these episodes are frequently associated by a variety of divergent presentations, the differentiation of other causes for febrile illnesses can be difficult. In this article, we first review disease entities, which frequently present with the symptom of recurrent fever. In a next step, we summarize their characteristic pattern of disease presentation. Finally, we analyse key features of autoinflammatory diseases, which are helpful to distinguish this group of diseases from the other causes of recurrent fever. Recognizing these symptom patterns can provide the crucial clues and, thus, lead to the initiation of targeted specific diagnostic tests and therapies.


A relationship between functional age and health status in female subjects.
A multiple regression equation was used to predict age from seven clinical variables in 1080 apparently well female subjects. A multiple correlation coefficient of R = 0.77 was achieved by five of the variables: timed forced expiratory volume, systolic blood pressure, plasma urea nitrogen, cholesterol, and alkaline phosphatase. On the basis of selection by medical questionnaire responses and other objective criteria, 9% of the subjects were nonsmokers and healthier than the rest. These selected subjects showed a significant reduction in preducted age. Within this group, subjective perception of health was associated with differences in predicted age: poor health with an increase and good health with a decrease in functional age. This study of functional age was based on the healthiest segment of the population in order to minimize the effect of overt pathological processes on the aging rate. An association has been demonstrated between health impairment and predicted age as a measure of the aging rate.


An Appraisal of Using Opioids in Patients with Opioid Use Disorder.
Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the United States. Opioid analgesics are efficient first-line pain relievers for acute and chronic lower-extremity pain syndrome. Perioperative pain management strategies have been proposed using opioid stewardship, but there are few standardized protocols to guide podiatric medical providers treating patients with OUD. First, we describe the pharmacology of therapeutic agents used as medications for addiction treatment for OUD and substance use disorder (SUD). Second, we offer criteria for selecting acute pain and perioperative management in patients with OUD and SUD per current medical literature. Finally, we review the literature applying opioid stewardship in the context of prescribing opioid analgesics in the presence of OUD and SUD. Three hypothetical clinical scenarios grounded in clinical-based literature are described with congruent data and founded guidelines. The first and second scenarios describe acute pain and perioperative management in patients with OUD receiving methadone and buprenorphine-naloxone, respectively. The third scenario describes acute pain and perioperative management in a patient with SUD receiving intravenous naltrexone. We hope that the lower-extremity specialist will appreciate that thoughtful management of acute perioperative pain among patients who receive medications for addiction treatment for OUD is critically important given the risks of destabilization during the perioperative period. The literature reveals the lack of rigorous evidence on acute pain management in patients who receive medication for OUD; however, some clinical evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes.


Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis.
Electronic-based (e-based) lifestyle interventions provide potential and cost-effective delivery of remote interventions for overweight and obese perinatal women. To date, no meta-analysis has reported the efficacy of maternal and neonatal outcomes. Seven electronic databases were searched from inception up to July 13, 2016, including the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed and Scopus. Among the 1,145 studies retrieved, 14 randomized controlled trials were selected among 17 publications. The Cochrane risk of bias tool was used to appraise the quality assessment. The meta-analyses demonstrated a significant result for limiting gestational weight gain, losing postnatal weight in 1-2 months, increasing self-reported moderate and vigorous physical activity and reducing caloric intake using diet-related software. Our review shows that an e-based lifestyle intervention is an acceptable approach. The findings reveal the variability in intervention methods and provide limited conclusive evidence. Thus, future studies should examine the efficacy and essential components as well as the various approaches using optimal portions of in-person and phone sessions. Further evaluations comparing the effectiveness of different e-based lifestyle intervention approaches toward activity-related and diet-related outcomes are necessary.


Unclassified sclerosing bone dysplasia with osteopathia striata, cranial sclerosis, metaphyseal undermodeling, and bone fragility.
Sclerosing bone dysplasias are diagnosed on the basis of a characteristic pattern of osteosclerosis and clinical manifestations; in many of them, cause and pathogenesis are still unknown. A 33-year-old man had five fractures of the humerus, tibiae, and femur as a result of mild traumatic incidents that occurred between the ages of 18 and 33 years as well as a remnant of rib fractures without apparent trauma on radiographs. His height was 158 cm (-2.2 SD). Radiographic evaluation showed cranial sclerosis, longitudinal striations in the metaphyses of the femur and tibia, fan-like striation in the ilium, metaphyseal widening in the femur and tibia, and sclerosis of the ribs. The blood chemistry findings, including serum calcium, phosphorus, and alkaline phosphatase, were normal. Biopsy from the ilium showed thick trabeculae composed of woven bone. The coexistence of osteopathia striata, cranial sclerosis, metaphyseal undermodeling, and bone fragility has not been recognized previously. Our case appears to represent a new form of sclerosing bone dysplasia.


Comparative Efficacy of Chitosan, Pectin Based Mesalamine Colon Targeted Drug Delivery Systems on TNBS-induced IBD Model Rats.
A number of natural polymer-based drug delivery systems targeting the colon are reported for different applications. Most of the research is based on the class of natural polymers such as polysaccharides. This study compares the anti-inflammatory effect of different polysaccharide based tablets on IBD when a drug carrier is targeted to the colon as matrix and coated systems. The TNBS induced IBD Wistar rats were used as a model for the study. The microscopic and macroscopic parameters were studied in detail. Almost all the important IBD parameters were reported in this work. The results demonstrated that the polysaccharides are efficient in carrying the drugs to the colon. Reduction in the level of ulcer index (UI), Myeloperoxidase (MPO), and Malondialdehyde MDA, confirmed the inhibitory activity on the development of Reactive oxygen species (ROS). The increased level of Tumor necrosis factor (TNFα) an expression of colonic inducible nitric oxide synthase (iNOS) was lowered in treatments as compared to TNBS control. The different polymer-based mesalamine (DPBM) confirmed the efficient anti- inflammatory activity on IBD induced rats. The increased level of glutathione (GSH), and superoxide dismutase (SOD) also confirmed the effective anti-inflammatory effect. A significant decrease in the ulcer score and ulcer area was reported. The investigation revealed that chitosan is superior to pectin in IBD treatment likewise polysaccharide-based matrix systems are superior to the coated system.


"La manie d'ecrire": psychology, auto-observation, and case history.
This essay examines the modern psychiatric case study as a scientific method and as a genre of writing about the self. As psychological discourse became a privileged language of selfhood at the fin de siècle, the penultimate signifier of the self came to be found in the realm of sexuality, in the particular contours of an individual's sexual desire. The investigative tool used to uncover these secrets of identity was the case history. This article concerns an influential project of sexual research based on "auto-observations"-autobiographical patient narratives-conducted by Dr. Georges Saint-Paul, who published under the inverted pseudonym "Laupts." The article focuses on the central autobiography of his collection, the "roman d'un inverti," and related sexological literature to suggest how this emphasis on patient stories in psychiatric writing engendered new narrative possibilities for doctors and patients alike. Putting patient stories at the center of psychiatric investigation created a new relationship between patient and doctor, observation and diagnosis, subject and discourse. The tools of psychological observation simultaneously placed a subject's confession more firmly at the center of the investigation and made it more open to interpretation by nonspecialists. Rather than simply confirming the authority of the trained observer, the story of Laupts's enquête suggests that the method actually authorized inquiry by others.