Identification of specific residues of human interleukin 2 that affect binding to the 70-kDa subunit (p70) of the interleukin 2 receptor.
Analogs of interleukin 2 containing defined amino acid substitutions and deletions were assayed for bioactivity and for competitive binding to the high-affinity human interleukin 2 receptor complex and its two component subunits, a 55-kDa subunit (p55 or TAC) and a 70-kDa subunit (p70). Substitution of Asp20 or deletion of Phe124 resulted in inactive analog proteins that were unable to interact with the high-affinity p55/p70 complex or the intermediate-affinity p70 subunit of the interleukin 2 receptor. These analogs, however, retained the capacity to compete for binding to the low-affinity p55 subunit. The presence of the carboxylic acid in the side chain of Asp20 was necessary for effective binding to the p70 protein. In contrast, substitution of Trp121 and Leu17 created analogs that were inactive in the bioassay and all three binding assays. The effects of these mutations on protein conformation were assessed by circular dichroism. These results demonstrate that specific residues in the NH2 and COOH termini of interleukin 2 are crucial for its structure and activity.


Antioxidant, Cytotoxic, and Antibacterial Activities of the Selected Tibetan Formulations Used in Gandaki Province, Nepal.
An open-ended and semistructured questionnaire was used for an ethnomedicinal survey of the Tibetan formulations practiced in four Tibetan refugee settlements in Gandaki Province, Nepal. Based on the ethnomedicinal survey data, commonly used nine formulations were selected (Aru-18, Basam, Dadue, Dashel, Mutik-25, Raab Ga Yangzin Tea, Serdok-11, Sugmel-10, and Yungwa-4) to test biological activities. Antioxidant activity was evaluated using the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical scavenging method. The cytotoxicity was examined by using the Allium cepa L. root tip meristem model. Similarly, the antibacterial effect was assessed by using well diffusion and broth dilution methods. An ethnomedicinal survey showed a total of 52 Tibetan formulations were generally used by respondents for common diseases such as stomach disorders, diabetes, and migraine. From the antioxidant activity test, Sugmel-10 showed the highest DPPH free-radical-scavenging activity (IC50 1.8 μg/ml) and Yungwa-4 showed the lowest activity (IC50 5.2 μg/ml). Also, from the cytotoxic activity, the A. cepa root meristem model exhibited significant dose- and time-dependent growth suppression in Basam, Dadue, Mutik-25, and Serdok-11 as compared with cyclophosphamide standard drug. Similarly, Basam showed a good antibacterial effect having MIC 20 mg/ml and MBC 100 mg/ml against Enterococci faecalis. Conclusion. Research showed that Tibetan people preferred Tibetan formulations for the treatment and mitigation of several diseases. The result of antioxidant, cytotoxic, and antibacterial activities experimentally justified the ethnomedicinal value of nine common formulations (Aru-18, Basam, Dadue, Dashel, Mutik-25, Raab Ga Yangzin Tea, Serdok-11, Sugmel-10, and Yungwa-4). To the best of our knowledge, this study was performed for the first time in Nepal. Results from this preliminary study open the door to the scientific world to perform extensive pharmacological studies for designing and developing new therapeutic agents.


Thymoma, myasthenia gravis, erythroblastopenic anemia and systemic lupus erythematosus in one patient.
A 50-year-old woman who initially had myasthenia gravis subsequently presented with thymoma, erythroblastopenic anemia and systemic lupus erythematosus during 17 years of follow-up. In a review of the literature no similar documented cases were found, although 14 patients were reported with three of the above diseases, two also having positive LE cell tests. An association of several autoimmune disorders in one patient may be more frequent than was previously believed.


Motor performance in hyperactive children treated with imipramine.
The effects of the tricyclic antidepressant imipramine were evaluated in a study of 9 children with Attention Deficit-Hyperactivity Disorder. The study was double-blind, placebo-controlled, with three drug conditions, low, medium, and high doses. The focus was on neuropsychological drug effects. Imipramine exerted negative dose-response effects on motor performance (motor speed, motor pursuit), while it improved hyperactive behavior and attention and raised the heart rate slightly.


The airway epithelial lining in guinea pigs is intact promptly after the mucosal crossing of a large amount of plasma exudate.
In the present study of anaesthetized guinea pigs, we have confirmed by chemical analyses that 10 min after topical mucosal provocation with capsaicin 0.4 nmol of platelet-activating factor 8 nmol plasma macromolecular tracers (FITC-dextran, molecular weight 156 kD, previously injected intravenously) have been significantly exuded into airway tissue and lumen. We have also examined the airway mucosa and the mucosal surface material using fluorescence, light, and electron microscopy. Thus we have demonstrated by histological techniques that promptly after the induction of large exudative responses plasma macromolecules are abundant in the lumen as well as in the lamina propria. Furthermore, the exudate is seen on the surface of a mucosa that has an intact epithelial lining. These observations are evidence in favour of the possibility that plasma exudation into the lumen is a first-line defense mechanism of the normal airway mucosa.


The role of the estrogen receptor in uterine epithelial proliferation and cytodifferentiation in neonatal mice.
We have examined the relationship between localization of estrogen receptor (ER) and selected cell responses induced by estrogen in the neonatal CD-1 mouse uterus. The following simultaneous staining techniques were used to determine whether only uterine epithelial cells with ER are capable of showing proliferative and secretory activities after estrogen treatment: 1) ER localization and [3H]thymidine incorporation using immunohistochemistry and autoradiography; and 2) immunohistochemical double staining of ER and an estrogen-induced secretory protein lactoferrin (LF). Uterine tissues from two strains (CD-1 and BALB/c) mice on day 4 of age showed detectable ER by immunostaining in both epithelial and stromal cells. Day 4 CD-1 mice received a single injection of diethylstilbestrol (DES; 20 micrograms/kg BW). The percentage of ER-immunostained uterine epithelial cells and the intensity of the staining rapidly increased from 6-36 h, indicating that estrogen stimulates the expression and detectability of ER during the course of hormone treatment. Twenty-eight and 81% of epithelial cells showed positive ER immunostaining 6 and 24 h, respectively, after the DES treatment. The intensity of ER-immunostained stromal cells, however, was slightly decreased by the treatment. DES administration elicited epithelial cell proliferation. Labeling indices of epithelial cells reached a maximum (approximately 44%) 12 h after an injection of DES, and a second small peak was recognized 24 h after the treatment. Labeling indices of positively ER-immunostained epithelial cells and those of negatively stained epithelial cells showed almost the same pattern for 6-18 h after treatment. The respective maximum values were 45% and 43%. When day 4 mice were given three daily injections of DES in saline and killed 12 and 24 h after the last injection, significant amounts of LF were recognized in the apical cytoplasm of the epithelial cells. The epithelial cells that showed LF immunostaining always exhibited ER immunostaining in the nuclei. These results suggest that exogenous estrogen elicits increased expression of ER, DNA synthesis, and cell proliferation in neonatal uterine epithelial cells associated with low levels of ER, while there was a direct relationship with the presence of ER in epithelial cells and the induction of LF.


What a maleless group can tell us about the constraints on female transfer in Thomas's langurs (Presbytis thomasi).
During a long-term study of wild Thomas's langurs (Presbytis thomasi), the adult male of one of the bisexual study groups, group M, suddenly disappeared. Just after the adult male's disappearance, the females of group M actively avoided other groups and sometimes formed subgroups. Infants were attacked by extra-group males and 1 infant disappeared. After about 2 months, the females initiated affiliative interactions with males of neighbouring groups. Aggressive interactions between females of group M and females of other groups were also observed. Females of group M did not leave their home range in spite of efforts by adult males to lead them away. After about 4.5 months, a former all-male band member joined group M. The coincidences of this case suggest that increased infanticide risk, increased food competition, loss of knowledge of the home range and loss of established social relationships could be important constraints on female transfer. A comparison with 5 other studies of 1-male groups in which the adult male disappeared showed that proximate factors, such as the presence of infants, the size of neighbouring groups and the presence of extra-group males, influence female decisions.


Conductive Photo-Activated Porphyrin-ZnO Nanostructured Gas Sensor Array.
Chemoresistors working at room temperature are attractive for low-consumption integrated sensors. Previous studies show that this feature can be obtained with photoconductive porphyrins-coated ZnO nanostructures. Furthermore, variations of the porphyrin molecular structure alter both the chemical sensitivity and the photoconductivity, and can be used to define the sensor characteristics. Based on these assumptions, we investigated the properties of an array of four sensors made of a layer of ZnO nanoparticles coated with porphyrins with the same molecular framework but different metal atoms. The array was tested with five volatile organic compounds (VOCs), each measured at different concentrations. Results confirm that the features of individual porphyrins influence the sensor behavior, and the differences among sensors are enough to enable the discrimination of volatile compounds disregarding their concentration.


Psychosocial intervention on procedure-related distress in children being treated for laceration repair.
Research has demonstrated that emergency department visits for injured children are highly stressful experiences, especially when they include a painful procedure. This pilot study explored the impact of an intervention, which included preparation and distraction on procedure-related distress in children treated for laceration repair in the emergency department. Distress and parent ratings of satisfaction were compared between children who received individualized preparation and distraction interventions for laceration repair provided by a child life specialist and children who received no intervention. Twenty-four subjects, aged 3 to 13 yr, were recruited from a pediatric emergency department within a university medical center. Patients receiving the intervention were provided with preprocedure age appropriate information relating to the laceration repair and distraction during the procedure. Results showed that children who received psychosocial intervention had lower observed distress behaviors during suturing compared with patients who did not receive the intervention. Results also showed that parents of patients who received the intervention perceived less distress in their children and rated their overall care significantly higher. These findings have significant implications for children's health care and supporting family needs when a child enters the emergency department.


[Central precocious puberty is associated with a high prevalence of organic disease].
The incidence of central precocious puberty (CPP) is lower in boys than in girls; however, the presence of organic disease is more common in boys. To investigate the percentage of CPP secondary to organic disease in boys and to analyze their clinical and biological characteristics at diagnosis, during follow-up, and at the end of therapy. Eight boys with a diagnosis of CPP treated with triptorelin every 28 days were included. Age, height in standard deviation (SD), body mass index (BMI) in SD, growth velocity in SD, bone age (Greulich and Pyle), predicted height (Bayle-Pinneau), and target height were analyzed. Testicular volume was measured (according to Prader standards) and peak lutein hormone (LH) values and testosterone levels were determined after gonadotropin-releasing hormone (GnRH) stimulus. Seventy-five percent of the patients with CPP had organic disease. After treatment with triptorelin, growth reduction significantly decreased. In contrast, no changes were seen in the difference between bone age and chronological age, due to the slight difference found at diagnosis. Likewise, during treatment, there was no LH peak and testosterone levels were lower than 0.5 ng/ml in response to GnRH stimulus. No changes were observed in weight or BMI. Three patients reached an adult height similar to their genetic height and their predicted height, as estimated by the Bayle-Pinneau method. 1. Among boys with CPP we found a substantial number of patients with organic disease. 2. Adult height after treatment with triptorelin can reach the normal range. 3. Determination of testosterone levels can be useful in the follow-up of these children during treatment.


Risk Factors of Submucosal or Lymphovascular Invasion in Early Gastric Cancer <2 cm.
Although prediction of submucosal (SM) or lymphovascular (LV) invasion is important before endoscopic resection of early gastric cancer (EGC), it can only be confirmed following endoscopic resection. After endoscopic resection, patients with SM or LV invasion may require additional surgery due to high risk of lymph node metastasis.We conducted a retrospective study to identify risk factors for SM or LV invasion before endoscopic submucosal dissection (ESD) of EGC. Between January 2009 and May 2014, we reviewed the data of patients with EGC who met the absolute indications for ESD before procedure: well and/or moderately differentiated adenocarcinomas, tumors ≤ 2 cm in length and absence of ulcer or ulcer-scar.During study period, a total of 308 lesions in 297 patients were included. SM or LV invasion was detected in 34 lesions (34/308, 11.0%). Multivariate analysis revealed that a moderately differentiated adenocarcinoma (odds ratio [OR] 4.157, P = 0.000) and location of the stomach (the upper and middle third; OR 3.100, P = 0.008) were significant risk factors for SM or LV invasion.Careful consideration of endoscopic treatment decision might be necessary for the patients with a moderately differentiated adenocarcinoma and EGC located on the upper and middle third of the stomach.


Standing up for your birth rights: An intersectional comparison of obstetric violence and birth positions between Quichua and Egyptian women.
Obstetric violence is a pervasive phenomenon in reproductive health across the world. Denial of the choice in birth position is a common form of obstetric violence as horizontal positions are non-evidence based, yet routinely imposed. This contributes to the cultural barriers to access reproductive health care. The present study compares women's experiences in childbirth from the Quichua and Egyptian communities, exploring the intersectional factors that contribute to obstetric violence and the adoption of preferred birth positions to offer recommendations on implementing respectful and rights-based reproductive care. Two independent scoping reviews have been carried out and subsequently compared. The intersectional approach revealed how gender, race, and class have a multiplicative effect on the denial of choice in birth position as a form of obstetric violence. This phenomenon exacerbates the pre-existing health disparities that disproportionately affect women, indigenous and racialized groups, and people living in poverty. Culturally competent, multilevel, and multidisciplinary interventions, strengthening of health systems, and community participation are essential to combat discrimination and guarantee birth rights. Allowing women to choose their birth position is a low-hanging fruit to challenge the complex issue of obstetric violence and ensure a rights-based approach to reproductive health.


[Efficacy of specific immunotherapy in children with seasonal allergic rhinitis and conjunctivitis, sensitized to grass pollen].
The aim of this study was the evaluation of efficacy of the specific immunotherapy using Pollinex for 3 years before the period of pollen dust in children with seasonal allergic rhinitis and conjunctivitis induced by grass pollen. The study was carried out in a group of 40 children aged 5-18 years, from the Outpatient Department of Immunology at the National Research Institute of Mother and Child. The children demonstrated clinical symptoms of seasonal allergic rhinitis with conjunctivitis and had a medical history typical for this disease. Diagnostic procedures including skin prick tests and estimation of specific IgE to grass pollen by Pharmacia - CAP system, gave positive results. The efficacy of therapy was monitored by a clinical score with 4-0 points, recording symptoms relating to intensity of rhinoedema, rhinorrhea, sneezing, itching, oedema, conjunctival congestion, pain and lacrimation. In the study group, 39 children (97%) with seasonal rhinitis and conjunctivitis treated by specific immunotherapy (Pollinex) improved. This was confirmed by a statistically significant difference. The results indicate that the specific immunotherapy is an effective treatment of seasonal allergic rhinitis with conjunctivitis in children sensitized to grass pollen.


In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases.
In-situ and microinvasive adenocarcinoma of the uterine cervix. A clinical, cytologic and histologic study of 14 cases. Am J Clin Pathol 64: 155-70, 1975. The clinicopathologic features of 14 cases of in-situ and microinvasive adenocarcinoma of the cervix, encountered during the period 1961-1974, form the basis of this report. Seven cases represent examples of in-situ and seven, microinvasive adenocarcinoma. Severe dysplasia and carcinoma in-situ of the squamous epithelium were coincidental finds in 12 patiients. Papanicolaou smears were abnormal in all 14 patients. In nine, malignant glandular cells were identified. Five smears contained both malignant squamous and glandular cells. The mean age of the 14 patients was 38.4 years. Thirteen patients had borne one to six children. Two were pregnant at the time of diagnosis, and four were on birth control medication. Thirteen of the patients underwent conization biopsy. Hysterectomy in one form or another was curative in all. The relatively infrequent occurrence of in-situ adenocarcinoma is probably due to the low incidence of cervical adenocarcinoma and to the fact that the lesion is focal and easily overlooked. Five of the cases in the present series were a chance finding in a review of 200 consecutive cone biopsies of the cervix. The resemblance of the in-situ lesions to carcinoma and the presence of morphologically similar glandular tissue adjacent to foci of microinvasion suggests that the in-situ lesion is the precursor of invasive adenocarcinoma of the cerivs.


Do animals have rights?
A right, unlike an interest, is a valid claim, or potential claim, made by a moral agent, under principles that govern both the claimant and the target of the claim. Animals cannot be the bearers of rights because the concept of rights is essentially human; it is rooted in and has force within a human moral world.


Equity, Diversity, and Inclusion moments to raise Equity, Diversity, and Inclusion literacy among physician leaders.
Previous research in our department on equity-deserving groups revealed that physician leaders could improve their understanding of barriers faced by physicians from these groups. We developed EDI Moments, a brief, recurring educational intervention, to raise the EDI literacy of physician leaders in our Department of Medicine. In addition to being considered a good use of time by attendees, EDI Moments have led to new processes and policies to improve EDI in our department. Teams that implement EDI Moments should leverage local EDI expertise and select topics suited for their audience's baseline knowledge.


Implications of statistical tests of variance and means.
The primary purpose of this paper is to illustrate that tests for the homogeneity of variance in the statistical analysis of clinical neuropsychological data may provide unique information. Specifically, tests of variance homogeneity are more sensitive to outliers than the more commonly used tests of group means. Moreover, when both a test of means and of variance are done and the results compared, the nature of the deficit within the sample can be interpreted with greater confidence.


Extracorporeal life support for adult cardiorespiratory failure.
Extracorporeal membrane oxygenation is routinely used for neonatal respiratory failure but is considered unsuccessful in adults based on old studies and old methods. We conducted a new phase 1 trial of modern extracorporeal life support (ECLS) in moribund adults with cardiorespiratory failure. Criteria for initiation of ECLS were 90% mortality risk despite maximal conventional care, good potential for recovery, age < 60 years, and no contraindication to anticoagulation. Vascular access for ECLS was performed by operative or percutaneous cannulation. Continuous systemic heparinization was used, maintaining whole blood activated clotting time between 160 to 180 seconds. Blood components were transfused as necessary. Lung management included low rate and low pressure ventilation with an inspired oxygen fraction 0.5 or less. Forty patients were treated with ECLS, 30 with primary respiratory failure and 10 with primary cardiac failure. Twenty-two patients recovered lung or heart function, and 18 patients survived and were discharged from the hospital (14 with respiratory failure and four with cardiac failure, overall survival 45%). The major complication of ECLS was bleeding. With modern techniques, ECLS can be lifesaving in adult cardiorespiratory failure when conventional therapy has failed.


In vitro studies of the synergism of piperacillin and netilmicin against blood culture isolates.
The purpose of this study was to evaluate the in vitro synergism between piperacillin and netilmicin against microorganisms isolated from Danish patients with septicemia and to examine the influence of inactivation of piperacillin among these bacteria on the synergy results. A total of 132 stains was examined: Escherichia coli 20, indole-positive Proteus 17, Klebsiella pneumoniae 18, Enterobacter cloacae 20, Pseudomonas aeruginosa 20, Staphylococcus aureus 20, and coagulase-negative staphylococci 17. Synergy testing was performed by checkerboard titration in microtiter trays. The ability of the strains to inactivate piperacillin was examined by the clover-leaf test. Synergism was found for 52% of the strains and partial synergism for 32%. Antagonism was not found. Of the piperacillin-resistant strains synergism could be demonstrated in 80% compared with 33% of the piperacillin-susceptible strains (p less than 0.001). No significant correlation was seen between the results of the synergy test and the results of the susceptibility test to netilmicin. The frequency of piperacillin inactivation according to the clover-leaf test was significantly higher among the strains with synergism than among all the others (p less than 0.02). The combination of piperacillin and netilmicin gave good results concerning the in vitro synergism. This synergism was probably sometimes caused by netilmicin disturbing the bacterial production of piperacillin-inactivating proteins.


Characterization of induced neural progenitors from skin fibroblasts by a novel combination of defined factors.
Recent reports have demonstrated that somatic cells can be directly converted to other differentiated cell types through ectopic expression of sets of transcription factors, directly avoiding the transition through a pluripotent state. Our previous experiments generated induced neural progenitor-like cells (iNPCs) by a novel combination of five transcription factors (Sox2, Brn2, TLX, Bmi1 and c-Myc). Here we demonstrated that the iNPCs not only possess NPC-specific marker genes, but also have qualities of primary brain-derived NPCs (WT-NPCs), including tripotent differentiation potential, mature neuron differentiation capability and synapse formation. Importantly, the mature neurons derived from iNPCs exhibit significant physiological properties, such as potassium channel activity and generation of action potential-like spikes. These results suggest that directly reprogrammed iNPCs closely resemble WT-NPCs, which may suggest an alternative strategy to overcome the restricted proliferative and lineage potential of induced neurons (iNCs) and broaden applications of cell therapy in the treatment of neurodegenerative disorders.


Structure of the mouse acidic amino acid decarboxylase GADL1.
Pyridoxal 5'-phosphate (PLP) is a ubiquitous cofactor in various enzyme classes, including PLP-dependent decarboxylases. A recently discovered member of this class is glutamic acid decarboxylase-like protein 1 (GADL1), which lacks the activity to decarboxylate glutamate to γ-aminobutyrate, despite its homology to glutamic acid decarboxylase. Among the acidic amino acid decarboxylases, GADL1 is most similar to cysteine sulfinic acid decarboxylase (CSAD), but the physiological function of GADL1 is unclear, although its expression pattern and activity suggest a role in neurotransmitter and neuroprotectant metabolism. The crystal structure of mouse GADL1 is described, together with a solution model based on small-angle X-ray scattering data. While the overall fold and the conformation of the bound PLP are similar to those in other PLP-dependent decarboxylases, GADL1 adopts a more loose conformation in solution, which might have functional relevance in ligand binding and catalysis. The structural data raise new questions about the compactness, flexibility and conformational dynamics of PLP-dependent decarboxylases, including GADL1.


Evolution and function of the sucrose-phosphate synthase gene families in wheat and other grasses.
Suc-phosphate synthase (SPS) is a key regulatory enzyme in the pathway of Suc biosynthesis and has been linked to quantitative trait loci controlling plant growth and yield. In dicotyledonous plants there are three SPS gene families: A, B, and C. Here we report the finding of five families of SPS genes in wheat (Triticum aestivum) and other monocotyledonous plants from the family Poaceae (grasses). Three of these form separate subfamilies within the previously described A, B, and C gene families, but the other two form a novel and distinctive D family, which on present evidence is only found in the Poaceae. The D-type SPS proteins lack the phosphorylation sites associated with 14-3-3 protein binding and osmotic stress activation, and the linker region between the N-terminal catalytic glucosyltransferase domain and the C-terminal Suc-phosphatase-like domain is 80 to 90 amino acid residues shorter than in the A, B, or C types. The D family appears to have arisen after the divergence of mono- and dicotyledonous plants, with a later duplication event resulting in the two D-type subfamilies. Each of the SPS gene families in wheat showed different, but overlapping, spatial and temporal expression patterns, and in most organs at least two different SPS genes are expressed. Analysis of expressed sequence tags indicated similar expression patterns to wheat for each SPS gene family in barley (Hordeum vulgare) but not in more distantly related grasses. We identified an expressed sequence tag from rice (Oryza sativa) that appears to be derived from an endogenous antisense SPS gene, and this might account for the apparently low level of expression of the related OsSPS11 sense gene, adding to the already extensive list of mechanisms for regulating the activity of SPS in plants.


Transition from initiation to promoter proximal pausing requires the CTD of RNA polymerase II.
The C-terminal domain (CTD) of mammalian RNA polymerase II consists of 52 repeats of the consensus hepta-peptide YSPTSPS, and links transcription to the processing of pre-mRNA. Although Pol II with a CTD shortened to five repeats (Pol II Delta5) is transcriptionally inactive on chromatin templates, it is not clear whether CTD is required for promoter recognition in vivo. Here, we demonstrate that in the context of chromatin, Pol II Delta5 can bind to the c-myc promoter with the same efficiency as wild type Pol II. However, Pol II Delta5 does not form a stable initiation complex, and does not transcribe promoter proximal sequences. Fluorescence recovery after photobleaching (FRAP) experiments with cells expressing enhanced green fluorescent protein (EGFP)-tagged Delta5 or wildtype Pol II revealed a single, highly mobile Pol II Delta5 fraction whereas wildtype Pol II yielded less mobile fractions. These data suggest that CTD is not required for promoter recognition, but rather for subsequent formation of a stable initiation complex and isomerization to an elongation competent complex.


Effects of acute verjuice consumption with a high-cholesterol diet on some biochemical risk factors of atherosclerosis in rabbits.
Metabolic changes in postprandial state particularly after fatty meals lead to atherosclerosis progression. Verjuice is an acidic juice made from unripe grape, commonly used as a popular ingredient in Iran. In this study the acute effects of verjuice intake on postprandial values of some biochemical atherosclerosis risk factors in rabbits fed high-cholesterol diets were investigated to see if it has is a possible protective role. Rabbits were allowed free access to diets containing: no cholesterol, 1% cholesterol, 1% cholesterol with 5 ml of verjuice, and 1% cholesterol with 10 ml of verjuice. C-reactive protein (CRP), malondialdehyde (MDA), nitrite, nitrate, glucose, LDL-cholesterol (LDL-C), oxidized-LDL (ox-LDL), total cholesterol (TC), apolipoprotein B (ApoB), triglyceride (TG), HDL-cholesterol (HDL-C), apolipoprotein A(ApoA), serum glutamic pyruvic transaminase (SGPT), serum glutamic oxaloacetate transaminase (SGOT), and fibrinogen levels were measured before and three hours after feeding these diets. Significant differences were observed in fibrinogen and glucose levels between the high-cholesterol diet with 5 and 10 ml verjuice and the high-cholesterol diet alone. Using 10 ml verjuice with the the high-cholesterol diet caused a significant reduction in ox-LDL, MDA, and nitrite compared with the high-cholesterol diet alone. No significant difference was found between the groups receiving verjuice and the high-cholesterol diet group in TC, HDL-C, TG, LDL-C, ApoA, ApoB, SGPT, SGOT, nitrate, or CRP. These results suggest that there might be an acute protective effect in the postprandial use of verjuice on some of the risk factors of atherosclerosis, particularly as an antioxidant.


Enhanced algal growth rate in a Taylor vortex reactor.
The rate of production of algal biomass in optically dense photobioreactors depends crucially on the temporal light exposure of microorganisms, which in turn is determined by fluid flow patterns and the quantity and spatial distribution of photosynthetically active radiation. In this report it is demonstrated that highly organized and robust toroidal flow structures known as Taylor vortices cause significant increases in the rate of biomass production, efficiency of light utilization, and CO2 uptake, and these effects become more pronounced at higher Reynolds numbers. In light of these findings and previously reported experiments using Taylor vortex flow to culture algae, it is argued that the flashing light effect, rather than mass transport effects, is responsible for the observed increases in the rate of photosynthesis.


Reducing complexity: a visualisation of multimorbidity by combining disease clusters and triads.
Multimorbidity is highly prevalent in the elderly and relates to many adverse outcomes, such as higher mortality, increased disability and functional decline. Many studies tried to reduce the heterogeneity of multimorbidity by identifying multimorbidity clusters or disease combinations, however, the internal structure of multimorbidity clusters and the linking between disease combinations and clusters are still unknown. The aim of this study was to depict which diseases were associated with each other on person-level within the clusters and which ones were responsible for overlapping multimorbidity clusters. The study analyses insurance claims data of the Gmünder ErsatzKasse from 2006 with 43,632 female and 54,987 male patients who were 65 years and older. The analyses are based on multimorbidity clusters from a previous study and combinations of three diseases ("triads") identified by observed/expected ratios ≥ 2 and prevalence rates ≥ 1%. In order to visualise a "disease network", an edgelist was extracted from these triads, which was analysed by network analysis and graphically linked to multimorbidity clusters. We found 57 relevant triads consisting of 31 chronic conditions with 200 disease associations ("edges") in females and 51 triads of 29 diseases with 174 edges in males. In the disease network, the cluster of cardiovascular and metabolic disorders comprised 12 of these conditions in females and 14 in males. The cluster of anxiety, depression, somatoform disorders, and pain consisted of 15 conditions in females and 12 in males. We were able to show which diseases were associated with each other in our data set, to which clusters the diseases were assigned, and which diseases were responsible for overlapping clusters. The disease with the highest number of associations, and the most important mediator between diseases, was chronic low back pain. In females, depression was also associated with many other diseases. We found a multitude of associations between disorders of the metabolic syndrome of which hypertension was the most central disease. The most prominent bridges were between the metabolic syndrome and musculoskeletal disorders. Guideline developers might find our approach useful as a basis for discussing which comorbidity should be addressed.


Molluscum Contagiosum of Cervix - A Case Report.
Molluscum Contagiosum (MC) is a common viral infection of skin caused by a double stranded DNA Pox virus affecting both adults and children. MC is primarily an infection of school-going children (one to five years), occasionally it affects adults and immunocompromised individuals. Transmission of virus occurs by direct contact with infected persons or contaminated objects. Most common sites are skin of face, trunk and extremities in children, genitals in adults and rarely palms, soles and mucous membranes. The occurrence of MC in genitals is lowest (3%). We present a case report of Molluscum Contagiosum of cervix which is a rare site; only one case has been reported in medical literature till date.


Subtype analysis of HTLV-1 in patients with HTLV-1 uveitis.
The hypothesis that HTLV-1 uveitis, a recently identified disease entity associated with human T-cell leukemia virus type I (HTLV-1), is caused by a specific subtype of the virus was tested. The nucleotide sequences of the long terminal repeat of HTLV-1 from five patients with HTLV-1 uveitis (HU) and four with adult T-cell leukemia were phylogenetically analyzed. Our results showed that both subtypes which had been identified in Japan were associated with HU, indicating that there was no difference in pathogenicity between these phylogenetic subtypes. One of the subtypes was more frequently isolated in Okinawa than in Kyushu, suggesting a bias in the prevalence of each subtype among the inhabitants of these two areas of Japan.


Impact of chronic hypoxia on proximal pulmonary artery wave propagation and mechanical properties in rats.
Arterial stiffness and wave reflection are important components of the ventricular afterload. Therefore, we aimed to assess the arterial wave characteristics and mechanical properties of the proximal pulmonary arteries (PAs) in the hypoxic pulmonary hypertensive rat model. After 21 days in normoxic or hypoxic chambers (24 animals/group), animals underwent transthoracic echocardiography and PA catheterization with a dual-tipped pressure and Doppler flow sensor wire. Wave intensity analysis was performed. Artery rings obtained from the pulmonary trunk, right and left PAs, and aorta were subjected to a tensile test to rupture. Collagen and elastin content were determined. In hypoxic rats, proximal PA wall thickness, collagen content, tensile strength per unit collagen, maximal elastic modulus, and wall viscosity increased, whereas the elastin-to-collagen ratio and arterial distensibility decreased. Arterial pulse wave velocity was also increased, and the increase was more prominent in vivo than ex vivo. Wave intensity was similar in hypoxic and normoxic animals with negligible wave reflection. In contrast, the aortic maximal elastic modulus remained unchanged, whereas wall viscosity decreased. In conclusion, there was no evidence of altered arterial wave propagation in proximal PAs of hypoxic rats while the extracellular matrix protein composition was altered and collagen tensile strength increased. This was accompanied by altered mechanical properties in vivo and ex vivo. NEW & NOTEWORTHY In rats exposed to chronic hypoxia, we have shown that pulse wave velocity in the proximal pulmonary arteries increased and pressure dependence of the pulse wave velocity was steeper in vivo than ex vivo leading to a more prominent increase in vivo.


Wrestling game injuries among children in Dakar: a report on 172 cases.
The objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. It was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent's socioeconomic status, nature of the injury and location. Wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. Wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions' districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.


[Analysis of low-polarity constituents of Reniochalina sp. by gas chromatography-mass spectrometry].
The sponge of Reniochalina sp. was collected from China Yellow Sea. The specimen (dry weight 100 g) was repeatedly extracted with cyclohexane. The combined crude extract was then evaporated in vacuo, and the dark red residue (5 g) was subjected to a silica gel column for chromatographic separation using gradient mixtures of ethyl acetate and cyclohexane as eluents. The fraction eluted with ethyl acetate-cyclohexane (1:9, v/v) was repeatedly separated by preparative liquid chromatography (HiQ sil C18-10 column, 250 mm x 21.2 mm i.d. ) to afford sample B and sample C as dark red oil. These two low-polarity samples were analyzed by gas chromatography-mass spectrometry (GC-MS) equipped with an HP-5 column (30 m x 0.25 mm i.d.). The oven temperature was raised from 40 degrees C to 250 degrees C at 10 degrees C /min and kept at 250 degrees C for 70 min. Using GC-MS coupled with 1H-nuclear magnetic resonance (1H-NMR), 18 compounds including alkanes, alkenes, fatty acids, fatty acid esters, phthalic acid and phthalic esters, were identified. The results provide to be helpful for in taxonomy of Reniochalina.


[New therapeutic aspects in non-cicatricial alopecias].
We discuss the promising results of recent pharmacological and clinical studies on non-cicatricial alopecia: (1) The development of effective antiandrogens for topical application will provide some possibilities of 'causal' treatment of androgenetic alopecia in male patients. (2) Further investigations on patients treated with minoxidil may lead to new insight of the factors regulating the follicular functions. (3) Our preliminary experiences with the various therapeutic modes of alopecia areata, based on the autoimmune pathogenesis of this disease, supply the foundation for effective therapeutic regimens for practical use.


The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review.
The lumbodorsal fascia (LF) has been proposed to represent a possible source of idiopathic low back pain. In fact, histological studies have demonstrated the presence of nociceptive free nerve endings within the LF, which, furthermore, appear to exhibit morphological changes in patients with chronic low back pain. However, it is unclear how these characteristics relate to the aetiology of the pain. In vivo elicitation of back pain via experimental stimulation of the LF suggests that dorsal horn neurons react by increasing their excitability. Such sensitization of fascia-related dorsal horn neurons, in turn, could be related to microinjuries and/or inflammation in the LF. Despite available data point towards a significant role of the LF in low back pain, further studies are needed to better understand the involved neurophysiological dynamics.


Life events occurring before and after onset of depression in a Kenyan setting--any significance?
In a controlled study of life events in depressed patients in Kenya it was found that the rate of life events was higher in the depressed group in the 27 weeks preceding the onset of depression but with a sharp increase in the last 6-9 weeks before onset. It was also found that the depressed patients continued to experience independent life events after the onset of the depression. It is hypothesized that the continued occurrence of life events after the onset of depression is an incentive to seek help and, eventually, a psychiatric referral.


Essential energy space random walk via energy space metadynamics method to accelerate molecular dynamics simulations.
To overcome the possible pseudoergodicity problem, molecular dynamic simulation can be accelerated via the realization of an energy space random walk. To achieve this, a biased free energy function (BFEF) needs to be priori obtained. Although the quality of BFEF is essential for sampling efficiency, its generation is usually tedious and nontrivial. In this work, we present an energy space metadynamics algorithm to efficiently and robustly obtain BFEFs. Moreover, in order to deal with the associated diffusion sampling problem caused by the random walk in the total energy space, the idea in the original umbrella sampling method is generalized to be the random walk in the essential energy space, which only includes the energy terms determining the conformation of a region of interest. This essential energy space generalization allows the realization of efficient localized enhanced sampling and also offers the possibility of further sampling efficiency improvement when high frequency energy terms irrelevant to the target events are free of activation. The energy space metadynamics method and its generalization in the essential energy space for the molecular dynamics acceleration are demonstrated in the simulation of a pentanelike system, the blocked alanine dipeptide model, and the leucine model.


Real higher-order Weyl photonic crystal.
Higher-order Weyl semimetals are a family of recently predicted topological phases simultaneously showcasing unconventional properties derived from Weyl points, such as chiral anomaly, and multidimensional topological phenomena originating from higher-order topology. The higher-order Weyl semimetal phases, with their higher-order topology arising from quantized dipole or quadrupole bulk polarizations, have been demonstrated in phononics and circuits. Here, we experimentally discover a class of higher-order Weyl semimetal phase in a three-dimensional photonic crystal (PhC), exhibiting the concurrence of the surface and hinge Fermi arcs from the nonzero Chern number and the nontrivial generalized real Chern number, respectively, coined a real higher-order Weyl PhC. Notably, the projected two-dimensional subsystem with kz = 0 is a real Chern insulator, belonging to the Stiefel-Whitney class with real Bloch wavefunctions, which is distinguished fundamentally from the Chern class with complex Bloch wavefunctions. Our work offers an ideal photonic platform for exploring potential applications and material properties associated with the higher-order Weyl points and the Stiefel-Whitney class of topological phases.


[Sequential combination chemotherapy with vinblastine/bleomycin and adriamycin/cis-dichlorodiammineplatinum (II) in non-seminomatous testicular cancer. I. Results of a prospective randomized phase III-study with 71 patients with disseminated disease (stage IV) (author's transl)].
74 patients with disseminated non-seminomatous testicular cancer were randomly entered on a prospective sequential combination chemotherapy regimen with mandatory crossover, consisting of either vinblastine/bleomycin or adriamycin/cis-dichlorodiammineplatinum (II) (DDP) as initial therapy. Independent of the randomization the overall remission rate in 71 evaluable patients was 89% including 54% complete remissions. 35% of the patients remained disease-free at 2+ to 28+ months with a median of 12 months. By additional surgical removal of residual pulmonary metastases in two patients the complete remission rate was increased to 40/71 (56%), and the number of patients with no evidence of disease to 27/71 (38%). According to the life-table method the two-years survival rates were 63% for complete responders and 29% for all other patients, which was significantly lower. 53 patients (75%) were alive at 3 to 28 months with a median of 9 months. Additional advanced abdominal disease, initially elevated beta-HCG and LDH and extension of pulmonary disease were of significant negative influence on the prognosis. The evaluation of single chemotherapy courses revealed equal efficacy of both combinations. However, response to adriamycin/DDP occurred in 46% of the courses, when vinblastine/bleomycin had failed, while response to vinblastine/bleomycin occurred only in 21% of the courses when adriamycin/DDP had failed. Thus different patterns of cross-resistance between these alternative regimens may exist.


The genetics of black larva, an autosomal recessive lethal mutation located on chromosome 3 in the mosquito Anopheles albimanus.
A spontaneous autosomal recessive lethal mutation, black larva (bl), producing black pigmented larvae that die during the 4th larval instar has been discovered in the mosquito Anopheles albimanus Wiedemann. Genetic investigations using two Y-autosome translocations and a 3rd chromosome dominant marker, St indicate that bl is located on chromosome 3 at a distance of 15 map units from St.


Epidemiology and treatment of painful procedures in neonates in intensive care units.
Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain. To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates. Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.3 millions inhabitants) for the Epidemiology of Procedural Pain in Neonates (EPIPPAIN) study. Number of procedures considered painful or stressful by health personnel and corresponding analgesic therapy. The mean (SD) gestational age and intensive care unit stay were 33.0 (4.6) weeks and 8.4 (4.6) calendar days, respectively. Neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6%) painful and 18,556 (30.4%) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8%) for painful and 1180 (10.2%) for stressful procedures. Each neonate experienced a median of 115 (range, 4-613) procedures during the study period and 16 (range, 0-62) procedures per day of hospitalization. Of these, each neonate experienced a median of 75 (range, 3-364) painful procedures during the study period and 10 (range, 0-51) painful procedures per day of hospitalization. Of the 42,413 painful procedures, 2.1% were performed with pharmacological-only therapy; 18.2% with nonpharmacological-only interventions, 20.8% with pharmacological, nonpharmacological, or both types of therapy; and 79.2% without specific analgesia, and 34.2% were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons. Prematurity, category of procedure, parental presence, surgery, daytime, and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia. During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.


[THE ROLE OF COMPREHENSIVE CONSERVATIVE MANAGEMENT IN ELDERLY PATIENTS WITH END STAGE RENAL DISEASE].
The number of dialysis patients is consistently growing and the dialysis population is aging. Of all age groups of dialysis patients, the higher prevalence rate is in the elderly group (aged 75 years and older). The elderly patients have a high rate of comorbidities. Chronic dialysis treatment is expected to prolong survival. Older age and comorbidities are among the most powerful prognostic factors for survival on chronic dialysis. Observational studies found that after adjustment for age and comorbidities, dialysis treatment does not confer survival advantage when compared to conservative management in elderly patients with multiple comorbidities. Comprehensive conservative management is targeted for those patients who are not expected to benefit from chronic dialysis. The focus is on patients' preferences, specifically regarding issues of quality of life, and not necessarily on prolonging survival. For this process, shared decision-making is the recommended strategy. The rate of patients who opt for conservative management varies between countries. There is no data from Israel in this regard, but it is assumed that the conservative option is underutilized. There are different reasons for the current situation, factors that: depend on the caregivers' side, are patient dependent, relate to the health care system and available services and some cultural aspects. Addressing these gaps may require further collection of data, construction of needed services for conservative management and education of the caregivers and the patients.


[Duodenogastric reflux and chronic gastritis].
In a review of the literature it is considered a possible relation between duodenogastric reflux and chronic gastritis. Doubtless bile acids are able to break down mucosal barrier in an acute action. But it is not proven, that bile acids cause chronic gastritis in chronic action. Furthermore duodenogastric bile reflux is a frequent and physiological event. Therefore we can not accept the duodenogastric reflux as the cause of simple chronic gastritis. The expression "reflux gastritis" is not correct for each kind of chronic gastritis that is no auto-immune gastritis.


Behavioral, physiological and morphological correlates of parasite intensity in the wild Cururu toad (Rhinella icterica).
Large numbers of parasites are found in various organs of anuran amphibians, with parasite intensities thought to modulate the host's Darwinian fitness traits. Interaction between the anuran hosts and their multiple parasites should modulate the host's phenotypic characteristic, such as those associated with high energetic demand (such as calling effort and locomotor performance), energy balance (standard metabolic rate), and morphological plasticity (as indicated by organ masses). The present study investigated the impact of parasite intensities on the behavioral, physiological, and morphological traits of wild adult male Rhinella icterica (Anura: Bufonidae). We tested as to whether individuals with higher parasite intensities would present: 1) lower vocal calling effort in the field, as well as poorer locomotor performance and body-condition index; and 2) higher standard metabolic rates and internal organ masses. Measurements included: calling effort in the field; standard metabolic rate; locomotor performance; parasite intensity; internal organ masses (heart, liver, kidneys, intestines, stomach, lungs, hind limb muscle, and spleen); and the body-condition index. Results showed a negative association of parasite intensities with locomotor performance, and standard metabolic rate of R. icterica. A positive association between parasite intensities and relative organ masses (heart, intestines and kidneys) was also evident. Toads with higher pulmonary and intestinal parasites intensities also showed higher total parasite intensities.


Micromotion and friction evaluation of a novel surface architecture for improved primary fixation of cementless orthopaedic implants.
A new surface architecture (OsteoAnchor) for orthopaedic stem components has been developed, which incorporates a multitude of tiny anchor features for embedding into the bone during implantation. It was tested for its ability to provide improved primary fixation compared to existing surface coatings. Friction testing was performed on bovine trabecular bone. It was found that OsteoAnchor provided up to 76% greater resistance to transverse motion under simultaneous normal loading compared to the porous tantalum. Micromotion testing was performed on stem components implanted in cadaver ovine femurs. The micromotion amplitudes for the OsteoAnchor stem were significantly lower than for a corresponding plasma sprayed stem. These results demonstrate that OsteoAnchor has the potential to provide improved primary fixation for stem components in joint replacement operations.


Insights on eukaryotic translation initiation factor 5A (eIF5A) in the brain and aging.
Long-term memory, a persistent form of synaptic plasticity, requires translation of a subset of mRNA present in neuronal dendrites during a short and critical period through a mechanism not yet fully elucidated. Western blotting analysis revealed a high content of eukaryotic translation initiation factor 5A (eIF5A) in the brain of neonatal rats, a period of intense neurogenesis rate, differentiation and synaptic establishment, when compared to adult rats. Immunohistochemistry analysis revealed that eIF5A is present in the whole brain of adult rats showing a variable content among the cells from different areas (e.g. cortex, hippocampus and cerebellum). A high content of eIF5A in the soma and dendrites of Purkinje cells, key neurons in the control of motor long-term memory in the cerebellum, was observed. Detection of high eIF5A content was revealed in dendritic varicosities of Purkinje cells. Evidence is presented herein that a reduction of eIF5A content is associated to brain aging.


FTY720 modulates human oligodendrocyte progenitor process extension and survival.
FTY720, a sphingosine-1-phosphate (S1P) receptor agonist that crosses the blood-brain barrier, is a potential immuno-therapy for multiple sclerosis. Our objective was to assess the effect of FTY720 on process extension, differentiation, and survival of human oligodendrocyte progenitor cells (OPCs), and link the functional effects with S1P receptor expression and signaling. Functional assays and receptor expression studies were conducted on A2B5+ OPCs derived from the human fetal central nervous system. Cells were treated with physiologically relevant concentrations of the active phosphorylated form of FTY720. S1P receptor/signaling modulators were used to elucidate the basis of the FTY720-induced functional responses. Short-term (1 day) FTY720 treatment caused initial process retraction that was reversed by uncoupling S1P3 and 5 from their G protein using suramin, and with a Rho-kinase inhibitor H1152. Retraction was associated with RhoA-mediated cytoskeletal signaling and with inhibition of OPC differentiation into more mature phenotypes. Continued FTY720 treatment (2 days) induced process extension and enhanced cell survival associated with increased extracellular signal-regulated kinases 1 and 2 phosphorylation, mimicked with the S1P1-specific agonist SEW2871, but not reversed with suramin. Quantitative real-time polymerase chain reaction showed that FTY720 induced reciprocal and cyclic modulation of S1P1 and S1P5 messenger RNA levels. The observed initial downregulation of S1P5 and subsequently of S1P1 messenger RNA supports functional responses being mediated sequentially by S1P5- and later S1P1-associated signaling. FTY720 induces time-dependent modulation of S1P receptors on human OPCs with consequent functional responses that are directly relevant for the remyelination process.


Longitudinal Diffusion Tensor Imaging Resembles Patterns of Pathology Progression in Behavioral Variant Frontotemporal Dementia (bvFTD).
Objective: Recently, the characteristic longitudinal distribution pattern of the underlying phosphorylated TDP-43 (pTDP-43) pathology in the behavioral variant of frontotemporal dementia (bvFTD) excluding Pick's disease (PiD) across specific brain regions was described. The aim of the present study was to investigate whether in vivo investigations of bvFTD patients by use of diffusion tensor imaging (DTI) were consistent with these proposed patterns of progression. Methods: Sixty-two bvFTD patients and 47 controls underwent DTI in a multicenter study design. Of these, 49 bvFTD patients and 34 controls had a follow-up scan after ~12 months. Cross-sectional and longitudinal alterations were assessed by a two-fold analysis, i.e., voxelwise comparison of fractional anisotropy (FA) maps and a tract of interest-based (TOI) approach, which identifies tract structures that could be assigned to brain regions associated with disease progression. Results: Whole brain-based spatial statistics showed white matter alterations predominantly in the frontal lobes cross-sectionally and longitudinally. The TOIs of bvFTD neuroimaging stages 1 and 2 (uncinate fascicle-bvFTD pattern I; corticostriatal pathway-bvFTD pattern II) showed highly significant differences between bvFTD patients and controls. The corticospinal tract-associated TOI (bvFTD pattern III) did not differ between groups, whereas the differences in the optic radiation (bvFTD pattern IV) reached significance. The findings in the corticospinal tract were due to a "dichotomous" behavior of FA changes there. Conclusion: Longitudinal TOI analysis demonstrated a pattern of white matter pathways alterations consistent with patterns of pTDP-43 pathology.


Early clinical experience with CardioCard - a credit card-sized electronic patient record.
CardioCard is a CDROM of credit card size containing medical information on cardiac patients. Patient data acquired during hospital stay are stored in PDF format and secured by a password known to patients only. In a consecutive series of patients, we assessed acceptance and utility of this new information medium. A questionnaire was sent to all patients who had received CardioCard over a one-year period. The questionnaire was returned by 392 patients (73%). 44% of patients had the card with them all the time. The majority of patients (73%) considered the CardioCard useful (8% not useful, 19% no statement) and most (78%) would even agree to bear additional costs. Only 5% worried about data security. In contrast, 44% would be concerned of data transmission via internet. During an observation period of 6 (SD 3) months, data were accessed by 27% of patients and 12% of their physicians. The proportion of card users was lower among older patients: < or = 50 years (y), 39%; 51.60 y, 38%; 61.70 y, 26%; >70 y, 16% and particularly among older women: 61.70 y, 9%; >70 y, 5%. Technical problems during data access occurred in 34%, mostly due to incorrect handling. A majority of patients considered CardioCard as useful and safe. Lack of hardware equipment or insufficient computer knowledge, but not safety issues were the most important limitations. As patients expressed concerns regarding protection of privacy if data were accessible via internet, this would remain a strong limiting factor for online use.


Selection of new lactic acid bacteria strains bearing probiotic features from mucosal microbiota of healthy calves: Looking for immunobiotics through in vitro and in vivo approaches for immunoprophylaxis applications.
From the birth, since their mucosal microbiota and immune system are not fully developed, newborn calves are susceptible to several mucosal pathogenic microorganisms. Operating through humoral and non-humoral mechanisms in the host, several lactic acid bacteria strains bearing probiotic features are often employed in livestock as food supplement, improving animal production performance, promoting health and reducing the severity of mucosal infections. Accordingly, we isolated, species-level identified and screened for their probiotic potentials seventy lactic acid bacteria strains from upper airway, vaginal and intestinal mucosa of healthy calves. Based on in vitro approaches, we selected three strains: Lactobacillus fermentum V3B-08 isolated from upper airway mucosa, Weissella hellenica V1V-30 isolated from vaginal mucosa and Lactobacillus farciminis B4F-06 isolated from intestinal mucosa were used to mono-colonize germ-free mice in the same site in which these strains were isolated, aiming to characterize their immunomodulatory features. These strains were able to colonize germ-free mice mucosa and trigger sIgA synthesis at a local level, in addition to stimulating, in different ways, adaptive immune responses at a systemic level.


Phylogeny and evolution of infectious bursal disease virus circulating in Turkish broiler flocks.
The emergence of new infectious bursal disease virus (IBDV) variants can threaten poultry health and production all over the world causing significant economic losses. Therefore, this study was performed to determine IBDV molecular epidemilogy, VP2 gene variation, and corresponding pathological lesions in IBDV infected chickens in Turkey. For this, 1855 bursa of Fabricius samples were collected from 371 vaccinated broiler flocks. Atrophia and haemorrhages were seen in the bursa Fabricius of very virulent IBDV (vvIBDV) infected chickens. Partial VP2 gene was sequenced and phylogenetic, recombination, and evolutionary analyses were performed. 1548 (83.5%) out of 1855 of bursa of Fabricius samples were IBDV positive and 1525 of those could be sequenced. The recombination analysis did not detect occurrence of any recombination event among the Turkish strains. Among 1525 sequenced samples, 1380 of them were found to be classical strains. Among 1380 classical strains, 1317 were similar to IBDV 2512, 11 to Faragher 52/70, 40 to 228 E, and 12 to Lukert strain. Out of 1525 reverse transcriptase ploymerase chain reaction positive samples, 144 of them were found to be similar to vvIBDV-VP2 gene reported to GenBank previously. The phylogenetic tree performed on a broad sequence dataset demonstrated grouping of vvIBDV Turkish strains in three different clusters, including sequences collected also from Iraq and Kuwait (Cluster 1), Indian (Cluster 2), and a distinct Turkish-only cluster (Cluster 3). The evolutionary rate estimation on branches/clades including Turkish strain mirrored the expected one for RNA viruses and no significant differences were found among different considered branches. In conclusion, results of this study indicate that vvIBDV strains similar to those circulating in various countries in the Middle East are present and undergoing evolution in chickens from Turkish broiler flocks. This point needs to be taken into account in planning adequate control strategies.


Intern year in a developing country amidst COVID-19.
It was the middle of March when we were two weeks into our clinical rotation and just started to get the hang of the new hospital. When one morning after reaching the hospital and finishing our patient rounds and notes, we received a frantic message from our co-rotator, mentioning all clinical rotations for MD students have been suspended due to COVID-19, according to the new AMA guidelines. We immediately booked our flight tickets and flew back to Mumbai.


Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment.
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.


Structure-activity relationships of the intramolecular disulfide bonds in coprisin, a defensin from the dung beetle.
Defensins, which are small cationic molecules produced by organisms as part of their innate immune response, share a common structural scaffold that is stabilized by three disulfide bridges. Coprisin is a 43-amino acid defensin-like peptide from Copris tripartitus. Here, we report the intramolecular disulfide connectivity of cysteine-rich coprisin, and show that it is the same as in other insect defensins. The disulfide bond pairings of coprisin were determined by combining the enzymatic cleavage and mass analysis. We found that the loss of any single disulfide bond in coprisin eliminated all antibacterial, but not antifungal, activity. Circular dichroism (CD) analysis showed that two disulfide bonds, Cys20-Cys39 and Cys24-Cys41, stabilize coprisin's α-helical region. Moreover, a BLAST search against UniProtKB database revealed that coprisin's α-helical region is highly homologous to those of other insect defensins.


Enzyme-catalyzed change of antioxidants content and antioxidant activity of asparagus juice.
A pectolytic enzyme preparation from Aspergillus niger (pectinase AN) decreased most rutin content and antioxidant activity of asparagus juice. To investigate the mechanism of such loss, we analyzed several possible related enzyme activities in pectinase AN. We found that the activity of pectinase AN to oxidize guaiacol had no significant difference with or without the presence of H2O2; thus it was laccase activity, not peroxidase (PO) activity, that pectinase AN contained. We did not find any polyphenol oxidase (PPO) activity in pectinase AN. Laccase in pectinase AN could be the major cause of loss of rutin and antioxidant activity of asparagus juice. When most laccase activity of pectinase AN was inactivated after heating at 70 degrees C for 1.5 min and incubated with asparagus juice, the loss rate of rutin was only 9% of that treated with unheated pectinase AN, and the antioxidant activity was even increased. Rhamnosidase activity was detected in pectinase AN and can change rutin in asparagus juice to quercetin-3-glucoside, which has higher antioxidant activity than rutin. This may explain the increase of antioxidant activity of asparagus juice treated with heated pectinase AN that still contained some rhamnosidase activity. The discovery of our research is helpful to produce juice with high antioxidant activity and high health benefits in the juice industry.


Reactive Epstein-Barr virus-related polyclonal lymphoproliferative disorder in a patient with AIDS.
Reactivation of Epstein-Barr virus infection and polyclonal expansion of lymphocytes is well-documented in solid organ and hematopoietic stem cell transplant recipients and is considered a potential precursor to lymphoma. We report an analogous case of posttransplantation polyclonal lymphoproliferative disorder in a patient with human immunodeficiency virus infection who was successfully treated with antiretroviral therapy.


Bringing Radiation Exposures and Associated Health Risks into Perspective-Development of an App.
The NATO HFM 291 research task group (RTG) on "Ionizing Radiation Bioeffects and Countermeasures" represents a group of scientists from military and civilian academic and scientific institutions primarily working in the field of radiobiology. Among other tasks, the RTG intends to extend their work on risk estimation and communication to bridge the gap in appropriate judgment of health risks given a certain radiation exposure. The group has no explicit psychological background but an expertise in radiobiology and risk assessment. The group believes that, as one of the essential first steps in risk communication, it is required to put radiation risk into perspective. Radiation risk requires a weight in comparison to already-known risks. What we envision is to Compare Radiation exposure-associated health Risks (CRRis App) with daily life health risks caused by other common exposures such as cigarette smoking, driving a car, etc. Within this paper, we provide (1) an overview of health risks after radiation exposure, (2) an explanation of the task and concept of an envisioned CRRis App, (3) an overview of existing software tools related to this issue, (4) a summary of inputs and discussions with experts in the field of radiation protection and risk communication during the ConRad conference, and finally, (5) identification of the next steps in the development of the App.


[Mycobacteria in swimming pool water and the meaning of microbiological conventional indicators].
Monitoring program of hygienic quality water in twelve public swimming pools was performed. Legally required microbiological indicator parameters of safety for gastrointestinal illness were measured besides the analyses of Pseudomonas spp. and Staphylococcus spp. prevalence, frequency of recovery and number of nontuberculous mycobacteria. We detected positive samples for coliforms at lower rate (29.3%) than Pseudomonas (75.5%), Staphylococcus spp. (46%) and Mycobacteria (59.4%). We pointed out statistically significant correlation (r=0.67 p=0.0001) between Mycobacteria and Pseudomonas so we think that the latter might be a good predictive marker. As 82% of samples had free chlorine residual within the limits stated by Italian Laws, the efficacy of chlorination to prevent risk of infectious diseases transmission by route other than gastroenteric was discussed. A revision of both the sanitary significance of conventional microbial parameters and the related regulations appears necessary.


Pregnancy-related Hand and Wrist Problems.
Hand and wrist disorders are common during pregnancy. Most of these problems develop during the third trimester when hormonal changes, fluid retention, and weight gain are maximum. This review study aimed to discuss pregnancy-related hand and wrist problems, and provide an overview of their pathology, clinical presentations, clinical examinations, and treatment options. Pregnancy-related carpal tunnel syndrome and De Quervain disease are among the most encountered disorders; however, neuralgic amyotrophy, pyogenic granuloma in hand, ligamentous laxity of the joints, arthralgia, and exacerbation of hand and wrist arthritis are among other reported disorders during pregnancy. Pregnancy-related hand and wrist problems may remain undertreated and reduce pregnant females' quality of life. Non-surgical treatments are usually effective for pregnancy-related hand and wrist problems. In general, pregnancy-related hand and wrist problems have a good prognosis and usually resolve after childbirth.


Women and Tobacco Use: Discrepancy in the Knowledge, Belief and Behavior towards Tobacco Consumption among Urban and Rural Women in Chhattisgarh, Central India.
Tobacco consumption has become pandemic, and is estimated to have killed 100 million people in the 20th century worldwide. Some 700,000 out of 5.4 million deaths due to tobacco use were from India. The era of global modernization has led to an increase in the involvement of women in tobacco consumption in the low income and middle-income countries. Tobacco consumption by females is known to have grave consequences. To assess: (1) the tobacco use among urban and rural women; (2) the discrepancy in the knowledge, belief and behavior towards tobacco consumption among urban and rural women in Durg-Bhilai Metropolitan, Chhattisgarh, Central India. The study population consisted of 2,000 18-25 year old young women from Durg-Bhilai Metropolitan, Chhattisgarh, Central India, from both urban and rural areas. Data were collected using a pretested, anonymous, extensive face to face interview by a female investigator to assess the tobacco use among women and the discrepancy in the knowledge, belief and behavior towards tobacco consumption among urban and rural individuals. The prevalence of tobacco use was found to be 47.2%. Tobacco consumption among rural women was 54.4% and in urban women was 40%. The majority of the women from urban areas (62.8%) were smokers whilst rural women (77.4%) showed preponderance toward smokeless tobacco use. Urban women had a better knowledge and attitude towards harms from tobacco and its use than the rural women. Women in rural areas had higher odds (1.335) of developing tobacco habit than the urban women. Increased tobacco use by women poses very severe hazards to their health, maternal and child health, and their family health and economic well-being. Due to the remarkably complex Indian picture of female tobacco use, an immediate and compulsory implementation of tobacco control policies laid down by the WHO FCTC is the need of the hour.


Renal pathology in diabetes mellitus.
The key change in diabetic glomerulopathy is accumulation of extracellular material. Basement membrane thickening and matrix expansion develop concomitantly. In insulin-dependent diabetic patients persistent microalbuminuria is associated with an early stage of glomerulopathy. Albuminuria in non-insulin-dependent patients does not always reflect glomerulopathy. Renal and glomerular hypertrophy in the early stages of insulin-dependent diabetes mellitus is unlikely to play a dominant role in the development of glomerulopathy. Loss of capillary surface, closely associated with loss of glomerular function, is only partly explained by mesangial expansion--glomerular occlusion plays an important role. Possible mechanisms of albuminuria are qualitative changes of the basement membrane, eg, loss of proteoglycans and excess glycosylation; epithelial cell changes; new vessel formation; remodeling of glomerular structures; and impeded function of juxtaglomerular arterioles. The interplay among abnormalities in individual compartments of the diabetic kidney should be explored.


Prevalence of diabetes mellitus in north-western Tanzania.
The prevalence of diabetes mellitus in 3,145 Tanzanian Africans living in three different areas of the country was studied. Fasting capillary blood glucose concentrations were measured by Dextrometer and if the levels were greater than or equal to 5.5 mmol/l an oral glucose tolerance test was performed. When using the 1980 WHO criteria [8] for diagnosis, the overall diabetic prevalence was 0.7%. Prevalence increased with age, and in the population greater than or equal to 20 years of age it was 1.6%. In a rural area inhabitated by the Haya tribe, the prevalence in the population aged greater than or equal to 20 years was 2.5%, and in a similar area populated by the Sukuma tribe it was 0.5%. In the urban area of Mwanza town it was 1.9%. Obesity was seen in 3.7% of the population and in 9.1% of the diabetic subjects. Sixty-eight percent of the diabetic patients were female compared with 53% in the general population. None of the diabetic patients discovered had any symptoms. Thus, the overall prevalence of diabetes in Tanzania is rather low but shows geographical variability and is strongly associated with age.


Comparing the antifibrotic effect on the liver of Telmisartan and Pentoxifylline, in a Wistar rat experimental model.
Chronic liver diseases are characterized by higher or lower changes of the liver lobe architecture (parenchymatous and vacuolar), the accumulation of inflammatory and collagen infiltrates, mainly in the Kiernan spaces and a progressive evolution to liver cirrhosis. Despite the progresses made in knowing the mechanisms of liver fibrosis and the development of some antiviral drugs with a high potential, that can induce fibrosis regression, there still continues to exist the need for a specific antifibrotic treatment. In our study, we used four groups of Wistar rats: a reference group and three groups that received 40% carbon tetrachloride (CCl4), intraperitoneally, twice a week, for four weeks; after one week since starting the administration of CCl4, one of the three groups received, through oral gavage, Telmisartan (TS) 8 mg÷kg, and another received Pentoxifylline (PTX) 20 mg÷kg, dissolved in saline solution, for four weeks. The antifibrotic action of the two drugs was analyzed by evaluating the histopathological and immunohistochemical changes of hepatocytes, hepatic stellate cells (Ito cells) and macrophages (Kupffer cells). The study highlighted that in the group treated with TS, the process of fibrillogenesis was significantly reduced, in comparison to the group treated with PTX and with the reference group.


Thyroid Predictors of Postpartum Mood Disorders.
Postpartum mood disorders (PMD) are currently among the leading causes of maternal postpartum morbidity and mortality. PMD include the conditions of postpartum blues (PB), postpartum depression (PPD), and postpartum psychosis. The pathogenesis of PMDs are ambiguous, and there are no reliable prenatal predictive markers despite current research efforts. Even though reliable indicators have not been found, leading ideas suggest an etiology of hormonal fluctuations. Although thyroid markers have long been linked to psychiatric disorders such as major depressive disorder (MDD), how they correlate with PMDs is still unclear. This study aimed to evaluate the pathophysiological link between thyroid function, PMDs, and the usefulness of thyroid markers as indicators of their occurrence and severity. The methodology consisted of a narrative literature review. Several inclusion and exclusion criteria were used to filter the results of literature searches in PubMed. Studies were included if they discussed any marker related to thyroid endocrinology in relation to the incidence or pathophysiology of any PMD. Both primary and secondary analyses were included. The permissive inclusion criteria were used due to the relative scarcity of research on the topic and the ambiguous pathophysiology of PMD. The results demonstrated the potential utility of thyroid autoimmunity as a predictor of late-onset PPD. Hypothyroidism, low euthyroid hormone levels, and the presence of thyroid autoantibodies were correlated with increased incidence of PPD and late postpartum depressive symptoms, past the timeline of PB. Most notably a rapid postpartum drop in cortisol level may precipitate thyroid autoimmunity in anti-thyroid peroxidase (TPO) antibody positive women, which could eventually produce a hypothyroid phase associated with depressive symptoms. There was insufficient evidence to suggest a relationship with postpartum psychosis. In conclusion, the exact pathophysiological mechanisms of PMDs remain ambiguous, but TPO-antibodies in the third trimester may be a predictor of late PPD.


Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers.
Complications from diabetic foot ulcers often lead to increased patient morbidity. Much debate still ensues concerning surgical versus conservative management of neuropathic diabetic foot ulcerations. The present study assessed and compared the efficacy of metatarsal head resection and medical approach in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads. In a retrospective cohort study, 24 consecutive neuropathic diabetic foot ulcers in the lower area of the metatarsal heads that had undergone metatarsal head resection were included as the operative group. For the control group, we included 25 similar ulcers that were scheduled for medical therapy. With respect to postoperative complications, wound healing occurred earlier in the operative group, and the recurrence rate was inversely greater in the medical treatment group. Also, the hospitalization rate was significantly greater in the medical treatment group. Overall, the long-term complication rate was lower in the operative than in the medical treatment group. Also, the infection rate was greater in the medical treatment group than in the operative group. Comparing early and late clinical outcomes of metatarsal head resection surgery and medical treatment showed complete superiority for the surgical approach, and metatarsal head resection is more completely cost beneficial than the medical approach.


New approaches to primary brain tumor treatment.
Primary brain tumors represent over 100 different tumor types with widely divergent biologies and clinical outcomes, but these neoplasms frequently pose similar challenges to neuro-oncologists. Malignant gliomas are the most common type of primary intrinsic brain tumor in adults and remain extremely lethal. Current standard-of-care therapies for these cancers include surgery, radiation and palliative cytotoxics, which have significant side-effects and limited efficacy. Advances in our understanding of the molecular underpinnings of cancer have led to targeted molecular therapies that may permit improvement in therapeutic efficacy and reduced toxicity; these therapies, however, still face many challenges. Signal transduction pathways that are inappropriately regulated in brain cancers include growth factors and their receptors (e.g. epidermal growth factor receptor, vascular endothelial growth factor receptor and platelet-derived growth factor receptor), which regulate cellular interactions with the microenvironment and intracellular oncogenic pathways. Low-molecular-weight inhibitors have been developed to target many kinases and may have advantages in terms of delivery. Monoclonal antibodies may have greater specificity, but face delivery restrictions. Preferential tumor delivery of chemotherapies, conjugated toxins and radioisotopes has been achieved through convection-enhanced delivery, intratumoral implants and intra-arterial infusion. Despite these advances, few molecularly targeted therapies have demonstrated significant antineoplastic activity for a broad range of patients, possibly due to tumor and patient heterogeneity. Improved functional neuropathology and imaging may permit identification of patient subgroups for which clinical responses may be enriched. It is probable, however, that targeted therapies will be most effective in combination either with one another or with cytotoxic therapies. In this study, we review the current state of new therapies for malignant gliomas.


X-linked hypophosphataemia in South Africa.
To investigate the pattern of clinical presentation in a series of South African subjects with X-linked hypophosphataemia (XLH) with particular reference to ethnic differences in presentation and inheritance, and to determine the perceptions and psychosocial problems associated with the disease. The clinical details of 50 subjects were collected from their records as well as from examining those currently attending the clinics held at Chris Hani Baragwanath Hospital and the National Health Laboratory Services in Johannesburg. There were 17 males and 33 females in the study. The psychosocial part of the study involved interviews with 20 parents and 7 subjects (aged 16 years or more). Thirty-one of the subjects were black, 17 white and 2 Indian. The mean age of clinical onset was 2.02 years (range 0.25 - 10 years). Fifty-four per cent of the cases were apparently sporadic. The prevalence of sporadic mutations was 64% among the black subjects and 41% among the white subjects. No differences were found in either clinical or biochemical presentation between genders or ethnic groups, despite an apparently higher sporadic presentation in the black children. The study also showed that this disorder had not only affected family life but also the lives of the subjects and their interpersonal relationships. The hereditary nature of the condition was not clear to most parents even after having attended the clinic for many years. South African subjects with XLH have similar features to those reported in other studies but there is a higher prevalence of sporadic mutations in the black subjects. Better counselling services are needed to improve the understanding of this condition among parents of affected children.


Relationship between Cardiovascular Risk Score and Traditional and Nontraditional Cardiometabolic Parameters in Obese Adolescent Girls.
Since the cardiovascular (CV) risk score in the young population, children and adolescents, is underestimated, especially in developing countries such as Montenegro, where a strong interaction exists between the genetically conditioned CV risk and environmental factors, the purpose of this study was to estimate CV risk in apparently healthy adolescent girls. Moreover, we aimed to test some new, emerging CV risk factors and their interaction with the traditional ones, such as obesity. Precisely, we aimed to assess the impact of low bilirubin levels, as a routine biochemical parameter, as an additional risk factor for atherosclerotic disease in the adult phase. Forty-five obese adolescent girls (mean age 17.8±1.22 years) and forty-five age- and sex-matched normal weight controls, all nonsmokers, were included. Anthropometric and biochemical parameters were measured. Cardiovascular Risk Score (CVRS) was calculated by adding the points for each risk factor (e.g. sex, HDL-c, non-HDL-c, blood pressure and fasting glycemia). A significant positive relationship between CVRS and ALT, hsCRP and TG/HDL-c, but an opposite relationship between CVRS and total bilirubin were found (P<0.001). Multiple linear regression analysis showed that higher waist circumference (WC) and LDL-c, but lower HDL-c were independent predictors of lower bilirubin values (adjusted R2=0.603, P<0.001). Obese adolescent girls are at an increased risk of cardiovascular disease late in life. In addition to the traditional risk factors, total bilirubin may have the potential to discriminate between low and higher risk for cardiovascular disturbances in healthy adolescent girls.


Characteristics and outcomes of gastroduodenal ulcer bleeding: a single-centre experience in Lithuania.
Despite the optimal use of combined endoscopic haemostasis and pharmacologic control of acid secretion in the stomach, mortality in patients with peptic ulcer bleeding (PUB) has remained constant. Recent data has shown that the majority of patients with PUB die of non-bleeding-related causes. To provide an overview of our experience of PUB management, with emphasis on the effect of age, gender, comorbidities, and drug use on the characteristics and outcomes of gastroduodenal ulcer bleeding. We retrospectively reviewed the medical records of all patients admitted with the primary diagnosis of acute, chronic or unspecified gastric and/or duodenal ulcer with haemorrhage during 2008-2012. Two hundred and nineteen patients were identified. 46.6% of patients were ≥ 65 years old (elderly) and 53.4% were < 65 years old (young). The young patients were more likely to have duodenal ulcers and liver failure at admission. Previous use of medications was more regularly observed in gastric ulcer patients than in duodenal ulcer patients. Rebleeding occurred in 43 (19.6%) patients and death in 5 (2.3%) patients. Increased risk of mortality in our patients was associated with age ≥ 65 years (RR = 2.21; 95% CI: 1.90-2.56; p = 0.021). Management of peptic ulcer bleeding should aim at reducing the risk of multiorgan failure and cardiopulmonary death instead of focusing merely on successful haemostasis.


Can the computer replace the adult for storybook reading? A meta-analysis on the effects of multimedia stories as compared to sharing print stories with an adult.
The present meta-analysis challenges the notion that young children necessarily need adult scaffolding in order to understand a narrative story and learn words as long as they encounter optimally designed multimedia stories. Including 29 studies and 1272 children, multimedia stories were found more beneficial than encounters with traditional story materials that did not include the help of an adult for story comprehension (g+ = 0.40, k = 18) as well as vocabulary (g+ = 0.30, k = 11). However, no significant differences were found between the learning outcomes of multimedia stories and sharing traditional print-like stories with an adult. It is concluded that multimedia features like animated illustrations, background music and sound effects provide similar scaffolding of story comprehension and word learning as an adult.


Misremembering pictured objects: people of all ages demonstrate the boundary extension illusion.
In the boundary extension illusion, subjects recollect more of a photographed scene than was originally shown. In this study, first- and fifth-grade children, young adult college students, and older adults studied 4 one-object or 4 two-object picture stimuli for 15 s each. Immediately after each visual scene was shown, the subjects drew it from memory inside a rectangle that was the same size as the previous picture. This study demonstrated that all age groups, from young children to older adults, were susceptible to the boundary extension illusion. This finding is discussed in terms of Intraub's perceptual schema hypothesis and Johnson's source-monitoring hypothesis.


Characterization of phosphate-solubilizing fluorescent pseudomonads from the rhizosphere of seabuckthorn growing in the cold deserts of Himalayas.
Isolation and characterization of fluorescent pseudomonads with high phosphate-solubilizing ability is reported from the alkaline and calcium-rich soils with low P availability in the cold desert region of Lahaul and Spiti in the trans-Himalayas of India. Of 216 phosphate-solubilizing isolates, 12 exhibiting high solubilization of tricalcium phosphate (TCP) in NBRIP liquid culture were identified as Pseudomonas trivialis, P. poae, P. fluorescens, and Pseudomonas spp. on the basis of phenotypic features, whole-cell fatty acids methyl ester (FAME) profiles, and 16S rDNA sequencing. These isolates also showed relatively high solubilization of North Carolina rock phosphate (NCRP) in comparison to the solubilization of Mussoorie rock phosphate (MRP) and Udaipur rock phosphate (URP). The solubilization of phosphate substrates by P. trivialis and P. poae is reported for the first time.


Repeat sleeve gastrectomy: optimization of outcomes by modifying the indications and technique.
Few series are available concerning repeat sleeve gastrectomy (re-SG), and series have reported contradictory results concerning morbidity rates, with limited data concerning weight loss. Evaluate the short- and medium-term outcomes of re-SG. University hospital, France, public practice. Between June 2007 and March 2016, all patients undergoing re-SG (n = 46 patients) were included. Re-SG was proposed for patients with insufficient excess weight loss (EWL) (≤50%) or renewed weight gain with excessively high residual gastric volume (>250 mL and/or large gastric pouch). The primary efficacy endpoint was the overall complication rate of re-SG. The secondary efficacy endpoints were operative data, evaluation of weight loss, and correction of co-morbidities, risk factors for gastric leak (GL), by comparing 2 periods (period 1, January 2004-December 2013: blue/green or purple staplers without reinforcement; period 2, after December 2013: black staplers with reinforcement) and comparison of weight loss according to the indication for re-SG. The re-SG group consisted of 46 patients (35 women, mean age: 47.5 yr). The mean body mass index (BMI) before SG was 47.2 kg/m² (35-63.6). The mean time interval between SG and re-SG was 73 months (11-106). The BMI before re-SG was 41.2 kg/m² (29-54.7). Indications for surgery were insufficient weight loss in 25 patients (54.3%) and weight regain in 21 patients (45.7%). A large gastric pouch was visible in 4 patients (8.6%). The mean operating time was 97.6 minutes (45-220). One death (2.1%) and 7 complications (15.2%) were observed. The mean length of hospital stay was 3.6 days (1-30). At last follow-up, mean BMI was 32.1 kg/m2 (20.3-41.3) and mean EWL was 62.3% (18-127.2). When analyzing risk factors for GL, residual gastric volume between 250 and 350 mL was associated with a higher GL rate compared with a volume ≥350 mL, and re-SG performed during period 1 was associated with a higher GL rate than re-SG performed during period 2 (17.4% versus 0%; P = .13). Re-SG performed for weight regain was associated with a significantly higher additional weight loss compared with re-SG performed for insufficient weight loss (mean additional EWL of 45.9%; P = .06). Re-SG is feasible, but it requires adaptation of the surgical procedure to decrease complications. Results on weight loss are acceptable, but the best indications for re-SG were a gastric volume>350 mL and in the case of weight regain with the exception of technical failure of the primary SG.


Enhancing a Somatic Maturity Prediction Model.
Assessing biological maturity in studies of children is challenging. Sex-specific regression equations developed using anthropometric measures are widely used to predict somatic maturity. However, prediction accuracy was not established in external samples. Thus, we aimed to evaluate the fit of these equations, assess for overfitting (adjusting as necessary), and calibrate using external samples. We evaluated potential overfitting using the original Pediatric Bone Mineral Accrual Study (PBMAS; 79 boys and 72 girls; 7.5-17.5 yr). We assessed change in R and standard error of the estimate (SEE) with the addition of predictor variables. We determined the effect of within-subject correlation using cluster-robust variance and fivefold random splitting followed by forward-stepwise regression. We used dominant predictors from these splits to assess predictive abilities of various models. We calibrated using participants from the Healthy Bones Study III (HBS-III; 42 boys and 39 girls; 8.9-18.9 yr) and Harpenden Growth Study (HGS; 38 boys and 32 girls; 6.5-19.1 yr). Change in R and SEE was negligible when later predictors were added during step-by-step refitting of the original equations, suggesting overfitting. After redevelopment, new models included age × sitting height for boys (R, 0.91; SEE, 0.51) and age × height for girls (R, 0.90; SEE, 0.52). These models calibrated well in external samples; HBS boys: b0, 0.04 (0.05); b1, 0.98 (0.03); RMSE, 0.89; HBS girls: b0, 0.35 (0.04); b1, 1.01 (0.02); RMSE, 0.65; HGS boys: b0, -0.20 (0.02); b1, 1.02 (0.01); RMSE, 0.85; HGS girls: b0, -0.02 (0.03); b1, 0.97 (0.02); RMSE, 0.70; where b0 equals calibration intercept (standard error (SE)) and b1 equals calibration slope (SE), and RMSE equals root mean squared error (of prediction). We subsequently developed an age × height alternate for boys, allowing for predictions without sitting height. Our equations provided good fits in external samples and provide an alternative to commonly used models. Original prediction equations were simplified with no meaningful increase in estimation error.


The Expanding Pathogenic Role of Insulin Resistance in Human Disease.
The December 2011 issue of Diabetic Medicine celebrated the outstanding personal contributions of the renowned clinical scientist Prof. Sir Harold Himsworth in characterizing impaired insulin action in relation to phenotypes of diabetes. The commissioned articles in the special issue of the journal were assembled in recognition of the publication in 1936 of a landmark paper in which Himsworth summarized his innovative research, to which much of our current understanding of insulin resistance can be readily traced. The collection of invited articles that marked the 75th anniversary of the Lancet publication provided a state-of-the-art summary from internationally renowned investigators of what has become an increasingly diverse field reaching into myriad aspects of clinical medicine. This article is protected by copyright. All rights reserved.