Medicaid Expansion: A Tale of Two Governors.
This is a study of why two seemingly similar governors made divergent decisions on expanding Medicaid under the Patient Protection and Affordable Care Act (ACA). Performing a case study of Governors John Kasich (OH) and Scott Walker (WI), I explore the roles played by electoral pressures, political party, governor's ideology, the state's policy heritage, stakeholder advocacy, and the economy in each governor's decision about whether to expand Medicaid. Electoral pressure was the most significant factor for both governors. I demonstrate that even Walker succumbed to state electoral pressures and expanded Medicaid, albeit in a manner unique to Wisconsin. He did this despite his emphatic national rhetoric rejecting Obamacare and expansion. Additionally, existing state political institutions drove each governor to decide in a manner unique to his state: previous Medicaid decisions in Wisconsin and direct democracy in Ohio provided additional pressures and divergent starting points. The remaining factors served less as a driving force behind the decision and more as a frame to justify the decision ex post facto. Case studies allow for a more complex view of how political pressures fit together; differences can be explained and expanded, and an enhanced understanding of political processes can be gleaned.


The Psychometric Properties of an Arabic version of the PedsQL Multidimensional Fatigue Scale Tested for Children with Cancer.
Fatigue is considered to be one of the most reported symptoms experienced by children with cancer. A major aim of this study was to develop an Arabic version of the Pediatric Quality of Life (PedsQL) Multidimensional Fatigue Scale (child report) and to test its psychometric proprieties for the assessment of fatigue in Arabic children with cancer. The PedsQL Multidimensional Fatigue Scale (Arabic version) and the PedsQL TM 4.0 Generic Core scale (existing Arabic version) were completed by 70 Jordanian children with cancer. Cronbach's alpha coefficients were found to be 0.90 for the total PedsQL Multidimensional Fatigue Scale (Arabic version), 0.94 for the general fatigue subscale, 0.67 for the sleep/rest fatigue subscale, and 0.87 for the cognitive fatigue subscale. The PedsQL Multidimensional Fatigue Scale scores correlated significantly with the PedsQL TM 4.0 Generic Core scale and demonstrated good construct validity. The results demonstrate excellent reliability and good validity of the PedsQL Multidimensional Fatigue Scale (Arabic version) for children with cancer. This is the first validated scale that assesses fatigue in Arabic children with cancer. The English scale has been used with several pediatric clinical populations, so this Arabic version may be equally useful beyond the field of cancer.


Identification of an apoplastic protein involved in the initial phase of salt stress response in rice root by two-dimensional electrophoresis.
The apoplast of plant cells, which carries out multiple functions in plant metabolism and signaling, is not only a barrier but also the linker between the environment and the protoplast. To investigate the role of apoplastic proteins in the salt stress response, 10-d-old rice (Oryza sativa) plants were treated with 200 mM NaCl for 1, 3, or 6 h, and the soluble apoplast proteins were extracted for differential analysis compared with untreated controls using two-dimensional electrophoresis. Ten protein spots that increased or decreased significantly in abundance were identified by mass spectrometry. These proteins included some well-known biotic and abiotic stress-related proteins. Among them, an apoplastic protein, with extracellular domain-like cysteine-rich motifs (DUF26), O. sativa root meander curling (OsRMC), has shown drastically increased abundance in response to salt stress during the initial phase. OsRMC RNA interference transgenic rice has been generated to assess the function of OsRMC in the salt stress response. The results show that knocking down the expression level of OsRMC in transgenic rice led to insensitive seed germination, enhanced growth inhibition, and improved salt stress tolerance to NaCl than in untransgenic plants. These results indicate that plant apoplastic proteins may have important roles in the plant salt stress response.


Perioperative Management of Painful Phantom Limb Syndrome: A Narrative Review and Clinical Management Proposal.
Painful Phantom Limb Syndrome (PPLS) occurs in 50 to 80% of patients undergoing amputation, having a great impact on quality of life, productivity and psychosocial sphere. The objective of this review is to summarize the pharmacological and non-pharmacological strategies, surgical optimization, and provide a multidisciplinary approach aimed at reducing the incidence of chronic pain associated with PPLS in patients undergoing limb amputation. A narrative review was carried out using Medline, Pubmed, Proquest, LILACS and Cochrane, searching for articles between 2000 and 2021. Articles describing the epidemiology, pathophysiological considerations, and current treatments were selected after a screening process. A multidisciplinary and multimodal approach is required in PPLS, and should include the use of regional techniques, and adjuvants such as NSAIDs, ketamine, lidocaine and gabapentinoids. In addition, an evaluation and continuous management of risk factors for chronic pain in conjunction with the surgical team is necessary. The current literature does not support that a single technique is effective inthe prevention of PPLS. However, adequate acute pain control, rehabilitation and early restoration of the body scheme under a multidisciplinary and multimodal approach have shown benefit in the acute setting.


CD90 Marks a Mesenchymal Program in Human Thymic Epithelial Cells In Vitro and In Vivo.
Thymic epithelium is critical for the structural integrity of the thymus and for T cell development. Within the fully formed thymus, large numbers of hematopoietic cells shape the thymic epithelium into a scaffold-like structure which bears little similarity to classical epithelial layers, such as those observed in the skin, intestine or pancreas. Here, we show that human thymic epithelial cells (TECs) possess an epithelial identity that also incorporates the expression of mesenchymal cell associated genes, whose expression levels vary between medullary and cortical TECs (m/cTECs). Using pluripotent stem cell (PSC) differentiation systems, we identified a unique population of cells that co-expressed the master TEC transcription factor FOXN1, as well as the epithelial associated marker EPCAM and the mesenchymal associated gene CD90. Using the same serum free culture conditions, we also observed co-expression of EPCAM and CD90 on cultured TECs derived from neonatal human thymus in vitro. Single cell RNA-sequencing revealed these cultured TECs possessed an immature mTEC phenotype and expressed epithelial and mesenchymal associated genes, such as EPCAM, CLDN4, CD90 and COL1A1. Importantly, flow cytometry and single cell RNA-sequencing analysis further confirmed the presence of an EPCAM+CD90+ population in the CD45- fraction of neonatal human thymic stromal cells in vivo. Using the human thymus cell atlas, we found that cTECs displayed more pronounced mesenchymal characteristics than mTECs during embryonic development. Collectively, these results suggest human TECs possess a hybrid gene expression program comprising both epithelial and mesenchymal elements, and provide a basis for the further exploration of thymus development from primary tissues and from the in vitro differentiation of PSCs.


Cochrane corner: interventions to prevent hearing loss caused by noise at work.
This Cochrane Corner features "Interventions to prevent hearing loss caused by noise at work", published in 2017. The aim of this Cochrane Review was to find out if hearing loss caused by noise at work is being prevented by current interventions. Tikka et al. identified 29 studies that studied the effect of preventive measures. One study evaluated legislation to reduce noise exposure, eleven studies evaluated effects of personal hearing protection devices and 17 studies evaluated effects of hearing loss prevention programmes (HLPPs). There was some very low-quality evidence that implementation of stricter legislation can reduce noise levels in workplaces and moderate-quality evidence that training of proper insertion of earplugs significantly reduces noise exposure at short-term follow-up. This Cochrane review has identified specific strategies that have shown effectiveness in reducing workplace noise, such as the implementation of stricter legislation and the need for training in the proper use of earplugs and earmuffs to reduce noise exposure to safe levels. The overall quality of evidence for the effectiveness of HLPPs in preventing hearing loss was very low, there was limited follow-up of participants receiving training for insertion of earplugs and no controlled studies examining engineering controls to reduce workplace noise.


Restriction of translation of capped mRNA in vitro as a model for poliovirus-induced inhibition of host cell protein synthesis: relationship to p220 cleavage.
Poliovirus infection of HeLa cells results in a rapid inhibition of host protein synthesis by a mechanism that does not affect the translation of poliovirus RNA. It has been suggested that this virus-induced translational control results from inactivation of the cap-binding protein complex, and it has been shown that the 220-kilodalton component(s) (p220) of the cap-binding protein complex is cleaved in infected HeLa cells to form antigenically related polypeptides of 100 to 130 kilodaltons. We have previously described an activity in infected cells that specifically restricts translation of capped mRNA in rabbit reticulocyte lysates. Here, we describe further refinements and characterization of restriction assay. We determined that the assay is a good in vitro model for study of host cell shutoff by several criteria: (i) translation was inhibited in both instances at the step involving mRNA binding to ribosomes; (ii) translation of capped mRNA was specifically inhibited, whereas translation of poliovirus RNA was not; (iii) restriction activity appeared in infected cells with kinetics which parallel host cell shutoff; and (iv) restriction activity, like the specific inhibition of host translation, appeared in cells infected in the presence of guanidine-HCl. The restricting activity was partially purified from poliovirus-infected cells and was compared with the virus-induced p220 cleavage activity. Both activities copurified through numerous cell fractionation and biochemical fractionation procedures. However, specific restriction of capped mRNA translation in reticulocyte lysates occurred without complete cleavage of the endogenous p220.


Evaluation and predictive value of IgE responses toward a comprehensive panel of house dust mite allergens using a new multiplex assay: a real-life experience on an Italian population.
Background. House dust mites (HDM) are among the most important allergen sources worldwide, representing a major cause of perennial allergic rhinitis and asthma. Aim. To evaluate the prevalence of IgE responses towards a comprehensive panel of HDM allergens and to evaluate the implications of molecular sensitization profiles on respiratory symptoms. Methods. 155 consecutive HDM-allergic patients (mean age: 27.5 years; range: 1-62; female: 63), 86 affected by rhinitis and 68 by asthma, were enrolled. Specific IgE reactivity to Der f 1, Der p 1, Der f 2, Der p 2, Der p 5, Der p 7, Der p 10, Der p 11, Der p 20, Der p 21 and Der p 23 was tested in patients' sera using the last version of the multiparametric assay Allergy Explorer (ALEX). Results. In all, major and minor allergens were positive, respectively, in 96.8% and 50.9% of the patients. Prevalence and IgE levels of Der f 1, Der f 2, Der p 1 and Der p 20 were significantly higher in asthmatic patients (p less than 0.05), whereas subjects negative for minor allergens resulted more frequently suffering from rhinitis (p = 0.0001). Asthmatic patients had IgE reactivity to a larger number of HDM allergens (mean 5.4; SD ± 2.3) than patients with only rhinitis (mean 4.2; SD ± 2.5) (p = 0.003), whereas no differences in the number of HDM positive molecules and in the specific IgE levels were found among different ages. Conclusions. This study confirms that the assessment of IgE to a comprehensive panel of HDM allergens defines different serological reactivity profiles that seem associated with different clinical presentations.


Relationship among guanine nucleotide exchange, GTP hydrolysis, and transforming potential of mutated ras proteins.
The effect of a series of mutations on the transforming potential of normal human rasH has been compared with their effects on GTPase and guanine nucleotide exchange rates of p21. The mutation Val-146 resulted in partial activation of transforming potential which could be attributed to a greater than 1,000-fold-increased rate of nucleotide exchange in the absence of an effect on GTPase. In contrast, the more modest enhancement of exchange rate (approximately 100-fold) which resulted from the mutation Met-14 did not affect biological activity. The partially activating mutation Thr-59 was found to result in both a 5-fold reduction in GTPase and a 10-fold increase in nucleotide exchange. However, the nontransforming mutant Ile-59 displayed a comparable decrease in GTPase without an effect on nucleotide exchange. The activating effect of the Thr-59 mutation may thus represent a combined effect of reduced GTPase and increased exchange. Similarly, the strongly activating mutation Leu-61 resulted in a fivefold increase in nucleotide exchange in addition to decreased GTPase, whereas weakly activating mutations at position 61 (Trp and Pro) resulted only in decreased GTPase without affecting nucleotide exchange rates. Finally, combining the two mutations Met-14 and Ile-59, which alone had no effect on biological activity, yielded a double mutant with a 20-fold increased transforming potential, demonstrating a synergistic effect of these two mutations. Overall, these results indicate that large increases in nucleotide exchange can activate ras transforming potential in the absence of decreased GTPase and that relatively modest increases in nucleotide exchange can act synergistically with decreased GTPase to contribute to ras activation.


Heterogeneity of distribution pattern at the electron microscopic level of heparan sulfate in various basement membranes.
Using the high-iron diamine thiocarbohydrazide silver proteinate (HID-TCH-SP) staining technique and enzymatic digestion, we investigated the ultrastructural distribution pattern of heparan sulfate side chains of heparan sulfate proteoglycan (HSPG) in various basement membranes (nerve, capillary, oral epithelial, muscle, and dental basement membranes). Four different distribution patterns of stain deposits were identified as heparan sulfate on the basis of enzymatic degradation by heparitinase. In some basement membranes associated with tooth germs and oral epithelium, HID-TCH-SP stain deposits were regularly located at both sides of the lamina densa, but few were observed in the lamina densa itself. In nerve, muscle, and capillary basement membranes, the stain deposits were localized at the external side of the lamina densa adjacent to the underlying connective tissue, but were not found in the laminae lucida and densa. In the internal basal lamina of junctional epithelium of gingiva, the stain deposits were detected mainly in the lamina lucida region. Finally, in some dental and oral epithelial basement membranes, the stain deposits were randomly distributed throughout both laminae lucida and densa. Thus, the present study demonstrated distinct differences in heparan sulfate distribution pattern among various basement membranes, suggesting their architectural heterogeneity.


The origin of syncytial muscle fibres in the myotomes of Xenopus laevis--a revision.
During the early stages of myogenesis in X. laevis, the primary myoblasts (of mesodermal origin) differentiate simultaneously, in each myotome, into mononucleate myotubes. At later stages mesenchymal cells appear in intermyotomal fissures and then in the myotomes between myotubes and contribute to the formation ofsyncytial muscle fibres. The pathway of mesenchymals cell during myogenesis was described in X laevis by monitoring the incorporation of 3H-thymidine. 3H-thymidine was incorporated in the nuclei of mesenchymal cells in intermyotomal fissures of younger myotomes and then in those of older myotomes between the myotubes revealing the proliferation of mesenchymal cells. As expected, nuclei of differentiating mononucleate myotubes did not incorporate 3H-thymidine. At later stages of myogenesis the myotubes were found to contain two classes of nuclei: large nuclei of the primary myoblasts (of myotomal origin) and smaller nuclei originating from secondary myoblasts ofmesenchymal origin. TEM and autoradiographic analyses confirm that mulinucleate myotubes in X. laevis arise through fusion of secondary myoblasts with mononucleate myotubes.


Tumour Budding Is an Independent Predictive Factor of Cutaneous Squamous-cell Carcinoma Aggressiveness.
Tumour budding (TB), i.e. the presence of groups of ≤5 tumour cells ahead of the invasive tumour front, is a pathological feature associated with an aggressive outcome in several cancer types. The aim of this study was to assess the value of TB as an independent prognostic factor of cutaneous squamous cell carcinomas (cSCC). We studied 25 cases of aggressive cSCC (defined as tumours that developed local recurrences and/or metastases after adequate excision) and 27 cases of non-aggressive cSCC. TB was expressed as the mean number of tumour buds in 5 adjacent high-power fields (HPF). Statistical analysis showed that TB is an independent predictive factor of cSCC aggressiveness. When the cut-off value of 0.8 buds/HPF was considered, the positive and negative predictive values for cSCC aggressiveness reached 77.3% and 75.0%, respectively. As with other cancer types, TB appears to be a new independent pathological factor of aggressiveness of cSCC, providing a new tool to predict cSCC outcome, similar to other already established features associated with an adverse outcome (such as tumour size).


Effects of H2-receptor antagonists on matrix metalloproteinases in rat gastric tissues with acetic acid-induced ulcer.
To investigate the destructive process of connective tissues in gastric ulcer, both collagenolytic and gelatinolytic activities were examined in the homogenates of rat acetic acid-induced gastric ulcer, a typical model of chronic ulcer. Gelatinolytic activity in the ulcerous lesion was significantly higher than that in the normal tissue. However, collagenase was not detected in both normal and ulcerated tissues either by the enzyme assay or by the immunoblotting. By gelatin-gel-zymographic analyses, the gelatinolytic activity was found to be composed of a number of species, mainly 60-, 72- and 92-kDa, all of which were inhibited by ethylenediaminetetraacetic acid. Among the induced matrix metalloproteinases, one crossreacted with a sheep anti-(rabbit prostromelysin)antibody. Thus, in chronic gastric ulcer, it is likely that several metalloproteinases participate in degradation of connective tissue matrices including components of basement membranes. The elevated levels of gelatinolytic activities in the ulcerous tissues and ulcer index were significantly suppressed by treating the animals with famotidine or a new H2-receptor antagonist, 3-amino-4-[4-[4-(1-piperidinomethyl)-2-pyridyloxy]-cis-2- butenylamino]-3-cyclobutene-1,2-dione hydrochloride (IT-066).


Cercarial elastase is encoded by a functionally conserved gene family across multiple species of schistosomes.
Water borne cercaria(ae) of the trematode genus Schistosoma rapidly penetrate host skin. A single serine protease activity, cercarial elastase, is deposited in advance of the invading parasite by holocytosis of vesicles from ten large acetabular gland cells. Cercarial elastase activity is a composite of multiple isoforms. Genes coding for the isoforms can be divided into two classes by amino acid and promoter sequence homology. Two of the five genes identified in Schistosoma mansoni account for over 90% of the activity and protein released. The remaining genes produce little protein or are silent. Positional scanning synthetic combinatorial substrate libraries demonstrate that the two major isoforms have similar substrate specificities and are, therefore, isoenzymes. The closely related Schistosoma hematobium and the distantly related Schistosomatium douthitti also contain multiple orthologous cercarial elastase genes suggesting that gene duplication may have occurred after speciation in Schistosoma evolution and that this duplication has been conserved.


Ketoacidosis at onset of type 1 diabetes is a predictor of long-term glycemic control.
Few studies have evaluated the impact of diabetic ketoacidosis (DKA) at diabetes onset on long-term glycemic control in patients with type 1 diabetes (T1D). We aimed to determine any differences in long-term glycemic control between children/adolescents with T1D presenting with DKA at diabetes onset and those without. This retrospective study comprised 335 patients diagnosed with T1D from September 2007 to December 2012, among which 132 (39.4%) presented with DKA. Variables compared between patients with DKA at onset and those without: yearly hemoglobin A1c (HbA1c) levels, daily insulin dose, yearly rates of severe hypoglycemia and DKA, percent of patients achieving target HbA1c levels. After the first year of diabetes, the mean daily insulin dose and HbA1c level were significantly higher in the group with DKA at onset (0.74 ± 0.26 vs 0.69 ± 0.27 units/kg/d, P = .049, and 7.85 ± 1.13% vs 7.49 ± 0.94%, P = .01, respectively), despite similarity of therapy (multiple daily injections or continuous subcutaneous insulin infusion), with a similar but not statistically significant trend subsequently. Mean HbA1c since onset was significantly higher in the DKA group (8.08 ± 0.95% vs 7.86 ± 0.95%, P = .025). A significantly higher percentage of patients in the group without DKA at onset achieved a mean level of HbA1c since onset within glycemic targets (32% vs 20.5%, P = .02). In the DKA group, the frequency of subsequent DKA episodes per diabetes years was significantly higher (P = .042). DKA at diagnosis was associated with less favorable long-term glycemic control as assessed by HbA1c and the rate of DKA episodes. T1D patients presenting with DKA may therefore need stricter treatment and tight follow-up.


Evaluation of Therapeutic Effectiveness of Prescribed Medications in Patients with Type 2 Diabetes Mellitus: Findings from a Tertiary Care Hospital, Lahore, Pakistan.
The present study was aimed to highlight the current prescribing pattern of oral hypoglycemia in type 2 diabetes mellitus and to evaluate the therapeutic effectiveness of these therapeutic categories in achieving target glycemic control. This is a prospective, cross-sectional, observational study of 6 months' duration conducted in a tertiary care hospital of Lahore, Pakistan. The current research recruited 145 patients presented in diabetes management center of a tertiary care hospital in Lahore, Pakistan. Mean age of the participants was 50.2 (± 8.5) years. Out of the 145 patients, 63% were females and 37% were males. Most patients were diagnosed to have diabetes within the past 5 years. Diabetes-induced neuropathy was the most common complication (71.7%) among the patients. A large proportion of these patients (70.3%) were also suffering from other comorbidities among which the most common one is hypertension. The average number of prescribed medications was 1.31. Metformin was prescribed to a majority of patients (64%) as monotherapy while 28.96% received combination therapy. Mean glycated hemoglobin (HBA1c) before and after 3 months of treatment was 8.5 (± 2.3) and 8.04 (± 2.1), respectively. Inferential statistics show a strong association between HBA1c and life style modifications and adherence to medication therapy (P = 0.05). However, the correlation between HBA1c and Morisky score and duration of disease was inverse and weak (P = 0.6, 0.4). The t-test values show a small difference between HBA1c values before and after 3 months (t = 0.440 and 0.466, respectively). Optimization of medication regimen and continuous patient education regarding life style modification and adherence to medication therapy are necessitated to bring HBA1c values near to target.


Molecular epidemiology of extraintestinal pathogenic (uropathogenic) Escherichia coli.
Molecular epidemiological analyses of extraintestinal pathogenic Escherichia coli (ExPEC), which are also called "uropathogenic E. coli" since they are the principle pathogens in urinary tract infection, involve structured observations of E. coli as they occur in the wild. Careful selection of subjects and use of appropriate methods for genotyping and statistical analysis are required for optimal results. Molecular epidemiological studies have helped to clarify the host-pathogen relationships, phylogenetic background, reservoirs, and transmission pathways of ExPEC, to assess potential vaccine candidates, and to delineate areas for further study. Ongoing discovery of new putative virulence factors (VFs), increasing awareness of the importance of VF expression and molecular variants of VFs, and growing appreciation of transmission as an important contributor to ExPEC infections provide abundant stimulus for future molecular epidemiological studies. Published by Elsevier GmbH.


Imido-P(v) trianion supported enantiopure neutral tetrahedral Pd(ii) cages.
Charge-neutral chiral hosts are attractive due to their ability to recognize a wide range of guest functionalities and support enantioselective processes. However, reports on such charge-neutral cages are very scarce in the literature. Here, we report an enantiomeric pair of tetrahedral Pd(ii) cages built from chiral tris(imido)phosphate trianions and oxalate linkers, which exhibit enantioselective separation capabilities for epichlorohydrin, β-butyrolactone, and 3-methyl- and 3-ethyl cyclopentanone.


Benthic protists: the under-charted majority.
Marine protist diversity inventories have largely focused on planktonic environments, while benthic protists have received relatively little attention. We therefore hypothesize that current diversity surveys have only skimmed the surface of protist diversity in marine sediments, which may harbor greater diversity than planktonic environments. We tested this by analyzing sequences of the hypervariable V4 18S rRNA from benthic and planktonic protist communities sampled in European coastal regions. Despite a similar number of OTUs in both realms, richness estimations indicated that we recovered at least 70% of the diversity in planktonic protist communities, but only 33% in benthic communities. There was also little overlap of OTUs between planktonic and benthic communities, as well as between separate benthic communities. We argue that these patterns reflect the heterogeneity and diversity of benthic habitats. A comparison of all OTUs against the Protist Ribosomal Reference database showed that a higher proportion of benthic than planktonic protist diversity is missing from public databases; similar results were obtained by comparing all OTUs against environmental references from NCBI's Short Read Archive. We suggest that the benthic realm may therefore be the world's largest reservoir of marine protist diversity, with most taxa at present undescribed.


MoS2/ZnO-Heterostructures-Based Label-Free, Visible-Light-Excited Photoelectrochemical Sensor for Sensitive and Selective Determination of Synthetic Antioxidant Propyl Gallate.
Propyl gallate (PG) as one of the important synthetic antioxidants is widely used in the prevention of oxidative deterioration of oils during processing and storage. Determination of PG has received extensive concern because of its possible toxic effects on human health. Herein, we report a photoelectrochemical (PEC) sensor based on ZnO nanorods and MoS2 flakes with a vertically constructed p-n heterojunction. In this system, the n-type ZnO and p-type MoS2 heterostructures exhibited much better optoelectronic behaviors than their individual materials. Under an open circuit potential (zero potential) and visible light excitation (470 nm), the PEC sensor exhibited extraordinary response for PG determination, as well as excellent anti-inference properties and good reproducibility. The PEC sensor showed a wide linear range from 1.25 × 10-7 to 1.47 × 10-3 mol L-1 with a detection limit as low as 1.2 × 10-8 mol L-1. MoS2/ZnO heterostructure with proper band level between MoS2 and ZnO could make the photogenerated electrons and holes separated more easily, which eventually results in great improvement of sensitivity. On the other hand, formation of a five membered chelating ring structure of Zn(II) with adjacent oxygen atoms of PG played significant roles for selective detection of PG. Moreover, the PEC sensor was successfully used for PG analysis in different samples of edible oils. It demonstrated the ability and reliability of the MoS2/ZnO-based PEC sensor for PG detection in real samples, which is beneficial for food quality monitoring and reducing the risk of overuse of PG in foods.


Error-related brain activity dissociates hoarding disorder from obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is associated with an abnormally large error-related negativity (ERN), an electrophysiological measure of error monitoring in response to performance errors, but it is unclear if hoarding disorder (HD) also shows this abnormality. This study aimed to determine whether the neurophysiological mechanisms underlying error monitoring are similarly compromised in HD and OCD. We used a visual flanker task to assess ERN in response to performance errors in 14 individuals with HD, 27 with OCD, 10 with HD+OCD, and 45 healthy controls (HC). Age-corrected performance and ERN amplitudes were examined using analyses of variance and planned pairwise group comparisons. A main effect of hoarding on ERN (p = 0.031) was observed, indicating ERN amplitudes were attenuated in HD relative to non-HD subjects. A group × age interaction effect on ERN was also evident. In HD-positive subjects, ERN amplitude deficits were significantly greater in younger individuals (r = -0.479, p = 0.018), whereas there were no significant ERN changes with increasing age in OCD and HC participants. The reduced ERN in HD relative to OCD and HC provides evidence that HD is neurobiologically distinct from OCD, and suggests that deficient error monitoring may be a core pathophysiological feature of HD. This effect was particularly prominent in younger HD participants, further suggesting that deficient error monitoring manifests most strongly early in the illness course and/or in individuals with a relatively early illness onset.


Impairment of exercise tolerance due to broxyquinoline-brobenzoxaldine combination.
A case report of impaired exercise tolerance during administration of broxyquinoline-brobenzoxaldine combination in therapeutic doses is presented. The first author of this paper, a 28-year-old healthy male, volunteered as a subject for a prospective study on the neurotoxicity of halogenated hydroxyquinolines and took a course of broxyquinoline-brobenzoxaldine combination. The author, who is a karate enthusiast, observed impairment of exercise tolerance during the course of treatment with the drugs. A challenge course of treatment with the same drugs in the same doses produced similar effects. Since halogenated hydroxyquinolines are still used widely in many countries, such an adverse effect would be of practical relevance, particularly in asymptomatic cyst-passers of Entamoeba histolytica whose occupations involve physical labour.


The gene amyE(TV1) codes for a nonglucogenic alpha-amylase from Thermoactinomyces vulgaris 94-2A in Bacillus subtilis.
We isolated the gene amyE(TV1) from Thermoactinomyces vulgaris 94-2A encoding a nonglucogenic alpha-amylase (AmyTV1). A chromosomal DNA fragment of 2,247 bp contained an open reading frame of 483 codons, which was expressed in Escherichia coli and Bacillus subtilis. The deduced amino acid sequence of the AmyTV1 protein was confirmed by sequencing of several peptides derived from the enzyme isolated from a T. vulgaris 94-2A culture. The amino acid sequence was aligned with several known alpha-amylase sequences. We found 83% homology with the 48-kDa alpha-amylase part of the Bacillus polymyxa beta-alpha-amylase polyprotein and 50% homology with Taka amylase A of Aspergillus oryzae but only 45% homology with another T. vulgaris amylase (neopullulanase, TVA II) recently cloned from strain R-47. The putative promoter region was characterized with primer extension and deletion experiments and by expression studies with B. subtilis. Multiple promoter sites (P3, P2, and P1) were found; P1 alone drives about 1/10 of the AmyTV1 expression directed by the native tandem configuration P3P2P1. The expression levels in B. subtilis could be enhanced by fusion of the amyE(TV1) coding region to the promoter of the Bacillus amyloliquefaciens alpha-amylase gene.


The implications of genetic diversity for nutrient requirements: the case of folate.
"The existence of chemical individuality follows of necessity from that of chemical specificity, but we should expect the differences between individuals to be still more subtle and difficult of detection. Indications of their existence are seen, even in man,... in the quantitative differences in those portions of the end products of metabolism which are endogenous and are not affected by diet.... Even those idiosyncracies with regard to... articles of food which are summed up in the proverbial saying that what is one's man meat is another man's poison, presumably have a chemical basis."


[Oral anticoagulants: new horizons].
Anticoagulation is at the dawn of a new era. Dominated for a long time by heparins and vitamin K antagonists, the anticoagulant arsenal is growing up. With a direct and reversible action targeting specifically thrombin (IIa) or factor Xa, these new synthetic agents, given orally, have large therapeutic windows and predictable pharmacokinetics. Their properties allow them to avoid tight monitoring improving patient comfort and security. Pharmacological studies are promising. Regarding some indications, these new drugs seem better than "classical" anticoagulants either in efficacy or in security terms. However, they increase the hemorrhagic risk and particularly in fragile populations like elderly patients or with renal insufficiency. Only few assays are available in the laboratory to evaluate their effects and no antidote is currently on the market. The way to new anticoagulant therapies is now open. In the future, specific indications of vitamin K antagonists, heparins and these new molecules will have to be determined.


Higher fibrinogen level is independently linked with the presence and severity of new-onset coronary atherosclerosis among Han Chinese population.
Fibrinogen is a coagulation/inflammatory biomarker strongly associated with atherogenesis. However, no data is currently available regarding the association of fibrinogen level with the presence and severity of new-onset coronary atherosclerosis assessed by Gensini score (GS), particularly in Han Chinese with a large sample size. We studied 2288 consecutive, new-onset subjects undergoing coronary angiography with angina-like chest pain. Clinical and laboratory data were collected. Coronary stenotic lesions were considered to be the incidence of coronary atherosclerosis. The severity of coronary stenosis was determined by the GS system. Data indicated that patients with high GS had significantly elevated fibrinogen level (p<0.001). The prevalence and severity of coronary atherosclerosis were dramatically increased according to fibrinogen tertiles. Spearman correlation analysis revealed a positive association between fibrinogen level and GS (r = 0.138, p<0.001). Multivariate logistic regression analysis demonstrated that plasma fibrinogen level was independently associated with high GS (OR = 1.275, 95% CI 1.082-1.502, p = 0.004) after adjusting for potential confounders. Moreover, fibrinogen level was also independently related to the presence of coronary atherosclerosis (fibrinogen tertile 2: OR = 1.192, 95% CI 0.889-1.598, p = 0.241; tertile 3: OR = 2.003, 95% CI 1.383-2.903, p <0.001) and high GS (fibrinogen tertile 2: OR = 1.079, 95% CI 0.833-1.397, p = 0.565; tertile 3: OR = 1.524, 95% CI 1.155-2.011, p = 0.003) in a dose-dependent manner. Receiver-operating characteristic curve analysis showed that the best fibrinogen cut-off value for predicting the severity of coronary stenosis was 3.21 g/L. Higher fibrinogen level is independently linked with the presence and severity of new-onset coronary atherosclerosis in Han Chinese population.


The comparison between superparamagnetic and ferromagnetic iron oxide nanoparticles for cancer nanotherapy in the magnetic resonance system.
The paper aims to compare zeta potentials, magnetic properties, electron spin resonance, photoluminescence (PL) spectra and antitumor effect of magneto-mechano-chemically synthesized magneto-sensitive nanocomplexes loaded with the anticancer drug doxorubicin (DOXO) during nanotherapy of Walker-256 carcinosarcoma carried out by a magnetic resonance system. Diamagnetic DOXO acquired the properties of a paramagnetic substance after synthesis. MNC comprising superparamagnetic nanoparticles (NP) and DOXO had different g-factors, zeta potentials, a lower saturation magnetic moment, area of the hysteresis loop, and a higher coercivity compared to similar MNC with ferromagnetic NP. The main PL peak of MNC spectrum was defined by DOXO at 598 nm. MNC composed of superparamagnetic NP and DOXO showed a lower standard deviation of the normal PL spectral distribution than MNC based on ferromagnetic NP in relation to conventional DOXO. MNC containing superparamagnetic NP responded to resonance conditions leading to a more pronounced antitumor effect compared to MNC with ferromagnetic NP in the course of magnetic nanotherapy for Walker-256 carcinosarcoma bearing animals (temperature inside the tumor did not exceed 40 °C). Therefore, these findings are associated with differences in chemotherapeutic effect between MNC due to a different surface charge and conformational changes in DOXO molecules during its magnetoelectric interaction with single- and multidomain NP.


Periodic Catatonia: Long-term Treatment With Lamotrigine: A Case Report.
Periodic catatonia is a rare form of catatonia, characterized by episodes occurring in a cyclic pattern with clinical features of combined stupor and excitement, with intervals of remission. Although periodic catatonia is not common, it is an urgent condition, requiring hospitalization for evaluation and treatment. The management of periodic catatonia is quite challenging, mainly because of the unknown pathophysiological mechanisms involved in the onset of this clinical entity, which are less clear than in other forms of catatonia. Although positive trials of several medications in the acute phase of periodic catatonia have been published, available literature concerning the prevention of recurrent catatonic episodes is scarce. Here, we present the case of a patient with periodic catatonia in which long-term treatment with lamotrigine appears to have acted prophylactically in reducing the occurrence and severity of new catatonic episodes. A better understanding of the mechanisms involved in the pathophysiology of periodic catatonia and increasing psychiatrists' and physicians' awareness of the presentation of this clinical entity could be of benefit in shedding light on the most appropriate treatment approach. However, further clinical studies are needed before any firm recommendations can be made.


Rare Esophageal Migration of AXIOS Stent Used for Walled-off Pancreatic Necrosis Drainage.
The AXIOS stent (Boston Scientific, Marlborough, MA) is a novel lumen-apposing self-expandable metallic stent designed for enteric drainage of nonadherent lumens. Efficacy and safety of using the AXIOS stent for pancreatic fluid drainage have been consistently shown in several studies. Although it is less common with this novel stent, stent migration still may happen. We present a case of AXIOS stent migration into the esophagus.


Intercostal artery pseudoaneurysm: a rare complication of transaortic transcatheter aortic valve implantation.
In this case report, we present an 86-year old patient with an intercostal pseudoaneurysm after transaortic transcatheter aortic valve implantation (TAVI). This new technique of a transaortic approach is considered a possible alternative to the more usual transfemoral, trans-subclavian or transapical access site, mainly in patients with extensive peripheral arterial disease. A mini-thoracotomy or mini-sternotomy is needed to access the ascending aorta. The patient presented with a painless but progressive pulsatile mass right parasternally, 3 months after the procedure. An intercostal pseudoaneurysm was diagnosed with duplex examination and chest CT. Successful treatment with an ultrasound-guided injection of thrombin resulted in a complete obliteration of the pseudoaneurysm. Only nine reported cases of intercostal pseudoaneurysms have been reported worldwide, and this is the first case in a patient who underwent a transaortic TAVI. Since the transaortic access is used more frequently, it is important to report on possible complications of this new technique.


Intraperitoneal cytosine arabinoside therapy in ovarian carcinoma.
Previous pharmacokinetic modeling has suggested that cytosine arabinoside (ara-C) may be an ideal agent for peritoneal administration in the treatment of intraabdominal neoplasms. In vitro drug sensitivity testing with clonogenic assays demonstrated sensitivity to the high concentrations of ara-C potentially achievable by intraperitoneal (IP) administration in five of nine patients with ovarian carcinoma. The kinetics of IP ara-C were then studied in three patients, and a 2 to 3 log concentration gradient was observed between the peritoneal compartment and plasma. Subsequently, the clinical efficacy of IP ara-C given for a five-day course every four weeks was evaluated in 10 patients with ovarian carcinoma who had failed systemic chemotherapy. Chemical peritonitis did not occur and systemic toxicity was minimal. Two patients were rendered free of disease and are alive without disease 14+ and 15+ months since therapy was discontinued. These results demonstrate that there is a very large pharmacologic advantage to the IP route of administration for ara-C, that ara-C is active against advanced ovarian carcinoma, and that the IP route of administration permits the cytokinetically rational use of very long durations of exposure for this cell-cycle phase-specific agent.


Bevacizumab Versus Ranibizumab in the Treatment of Macular Edema Due to Retinal Vein Occlusion: 6-Month Results of the CRAVE Study.
To compare efficacy of monthly treatment with bevacizumab or ranibizumab for macular edema due to retinal vein occlusion. Randomized, multicenter, comparative trial (ClinicalTrials.gov identifier: NCT01428388). Participants were randomized 1:1 to receive monthly treatment with bevacizumab or ranibizumab. The primary outcome was change in central foveal thickness at 6 months compared to baseline. The trial randomized 98 patients to treatment with bevacizumab or ranibizumab. At 6 months, there were no differences in change in central foveal thickness between groups (bevacizumab: mean reduction of 212.6 µm, 95% confidence interval [CI], -288.3 to -137.0; ranibizumab: mean reduction of 243.8 µm, 95% CI, -309.6 to -178.0; P=.72, analysis of variance [ANOVA]). Both groups showed similar functional outcomes (bevacizumab: 0.33 logMAR gain, 95% CI, -0.47 to -0.18; ranibizumab: 0.34 logMAR gain, 95% CI, -0.45 to -0.23; P=.38, ANOVA). In the treatment of retinal vein occlusion, bevacizumab and ranibizumab have similar effects on reducing macular thickness and improving visual acuity.


Phagocytic activity of macrophages and microglial cells during the course of acute and chronic relapsing experimental autoimmune encephalomyelitis.
The ED1 monoclonal antibody recognizes an antigen in lysosomal membranes of phagocytes. The expression of this antigen in cells increases during phagocytic activity. Here we describe the expression of ED1-immunoreactivity during the various stages of both acute (monophasic) and chronic relapsing experimental autoimmune encephalomyelitis (EAE) in the Lewis rat. During the first attack of acute and chronic relapsing EAE, ED1-immunoreactivity was present in macrophages and in cells which displayed morphologic features of activated microglial cells (i.e., cells with thick short processes). At the ultrastructural level these cells were seen to contain phagocytosed myelin structures in lysosomes. ED1-immunoreactivity in these cells was present in the cytoplasm near lysosomes. During the remission phase of acute EAE and the relapse phase of chronic relapsing EAE, ED1-positive cells with dendritic morphology not only were present in or nearby lesions, but were also found at sites distant from lesions throughout large parts of the brain. These cells had a morphology comparable to microglial cells in normal brain. A major difference between animals which were in remission and animals which on day 25 were suffering from a relapse, was that the latter showed the presence of lesions with darkly stained round ED1-positive macrophages and activated microglial cells. These results indicate that during a relapse, newly recruited blood-borne macrophages infiltrate the brain and, together with activated lymphocytes and microglial cells, recommence a new demyelination process.


Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding.
In response to a low number of Baby-Friendly-designated hospitals in the United States, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation. The intervention period lasted from July 2012 to August 2014. During that period, data on process indicators aligned with the Ten Steps to Successful Breastfeeding and outcome measures (overall and exclusively related to breastfeeding) were collected. In addition, data on the Baby-Friendly designation were collected after the end of the intervention through April 2016. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing. By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson's r [235]: 0.80; P < .01). Overall breastfeeding increased from 79% to 83% (t = 1.93; P = .057), and exclusive breastfeeding increased from 39% to 61% (t = 9.72; P < .001). A nationwide initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding.


Ultrasound in the detection of adrenal tumours.
An analysis was made of the ultrasound (US) findings in 110 patients with proven or ultrasonographically suspected adrenal tumours. A total of 212 glands were imaged, 117 of which contained a tumour. The diagnosis was confirmed histologically in 50 cases and by imaging and follow-up in 162 cases. Normal glands were visualized ultrasonically in 27 out of 40 glands on the right and 5 out of 55 on the left. US detected 55 out of 59 primary adrenal tumours and 49 out of 58 secondary tumours, showing a sensitivity of 89%. In 13 tumours ultrasonography gave a false negative result, and in 13 cases a false positive one. Benign or primary malignant tumours and metastases could not be differentiated on the basis of echo-structure, but a large heterogeneous tumour in a patient with no known extra-adrenal malignancy is probably a primary malignant adrenal tumour.


Hyperaesthesia following genital herpes: a case report.
We report an adult female patient who presented with sacral radiculopathy as incapacitating dysthesias following primary genital herpes simplex, which later recurred. Despite use of systemic antiviral treatment, the painful syndrome in our patient persisted. The success in treatment was seen only after the addition of amitriptyline hydrochloride. The case is being presented here for its rare manifestation and novel use of amitriptyline hydrochloride.


Healthy deliveries from biopsied human embryos.
Preimplantation genetic diagnosis was performed in 122 embryos obtained by IVF from 11 patients carriers of haemophilia, Duchenne's muscular dystrophy, Barth's syndrome, cystic fibrosis, Pelizaeus-Merzbacher syndrome or Rett's syndrome. After multiplex polymerase chain reaction (PCR) or fluorescence in situ hybridization (FISH) analysis with multiple probes, 28 embryos diagnosed as not affected were replaced. Of these, eight implanted (28%) and produced three ongoing pregnancies, three deliveries of four babies and a biochemical pregnancy. However, one case screened for cystic fibrosis was misdiagnosed and the pregnancy was terminated. In order to evaluate the efficiency of multiplex PCR, 55 non-replaced embryos were reassessed by PCR or by FISH. Identical results were obtained in all cases. However, one embryo which had only X-chromosome specific amplification by PCR was found to be XO in all its cells by FISH. Although multiplex PCR is demonstrated to be reliable for sexing of human embryos, FISH has the additional advantages of supplying ploidy assessment while not being affected by contamination.


Revisited: Therapeutic and toxic blood concentrations of more than 1100 drugs and other xenobiotics.
In order to assess the significance of drug/substance levels measured in intensive care medicine and clinical and forensic toxicology as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. We revisited and expanded our 2012 compilation of therapeutic and toxic plasma concentration ranges as well as half-lives of now more than 1100 drugs and other xenobiotics.Data have been abstracted from original papers, text books, and previous compilations and have been completed with data collected in our own forensic and clinical toxicology laboratories. We compiled the data presented in the table and the corresponding annotations over the past 30+ years. A previous compilation was completely double-checked, revised, and updated, if necessary. In addition, more than 200 substances, especially drugs who have been introduced since 2012 to the market as well as illegal drugs and other xenobiotics which became known to cause intoxications were added. We carefully referenced all data. Moreover, the annotations providing details were updated and revised, when necessary.For more than 1100 drugs and other xenobiotics, therapeutic ("normal") and, if data was available, toxic, and comatose-fatal plasma/blood concentrations as well as elimination half-lives were compiled in a table.In case of intoxications, the blood concentration of the substance and/or metabolite better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications as well as to support forensic and clinical expert opinions.


Anion-Driven C-F Bond Activation of Trifluoromethyl N-Aryl Hydrazones: Application to the Synthesis of 1,3,4-Oxadiazoles.
The CF3 group attached to N-aryl hydrazone could be activated upon treatment with a suitable base, thus serving as an excellent C1 unit for the assembly of a series of 1,3,4-oxadiazoles by reaction with hydrazides. The transformation is proposed to proceed via the intermediate formation of a gem-difluorinated azoalkene. Furthermore, this reaction features simple conditions and a broad substrate scope with respect to both trifluoromethyl N-aryl hydrazones and hydrazides.


The Leader-Clinician Advocate in Advancing Student Clinical Learning.
The visionary, think-ahead leader realizes a responsibility to ensure that a steady pipeline of qualified professionals exists. In the settings where they lead, academic partnerships can ensure that students are socialized and adequately prepared for existing and emerging job roles. Concept-based learning, NCLEX-RN test plans, and 12 strategies to ensure leader-clinician engagement with students are presented. J Contin Educ Nurs. 2017;48(3):99-101.


A new species of endophytic Balansia from Veracruz, Mexico.
A new graminicolous species of Clavicipitaceae, Balansia brunnans sp. nov., has been found to infect Panicum xalapénse. Staining of living host tissues indicates the presence of intercellular endophytic mycelium. Stromata develop just below the nodes on the culms. Balansia brunnans is comparable to Balansia aristidae, B. discoidea, B. gaduae, B. nigricans, and B. strangulans in development of stromata on culms and possession of an endophytic mycelial stage. Among the differences between Balansia brunnans and other comparable species is that it possesses a brown perithecial stroma, whereas comparable species have black perithecial stromata. A key is provided to distinguish B. brunnans from similar species.


Extracardiac features of heart failure: catecholamines and hormonal changes.
Congestive heart failure is a very complex clinical syndrome characterized by a number of important extracardiac features. In an attempt to maintain circulatory homeostasis, there is activation of a number of vasopressor/Na+ retentive forces. Plasma levels of angiotensin, norepinephrine and vasopressin rise, likely contributing to heightened peripheral resistance and antidiuresis. These forces appear to be offset to some extent by vasodilator/Na+ excretion activity in the form of increased prostaglandins, atrial natriuretic factor, and dopamine. There is a complex interplay between these neurohumoral systems in heart failure which is just beginning to be understood.


Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy.
We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4-8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.


What can psychoanalysts learn from the development of literary theory?
It is no accident that literary theorists and academicians have become very interested in psychoanalysis. There is a remarkable parallel between the development of literary theory from its origins to the present day and the development of psychoanalysis from the time of Freud to now. The same concerns that have troubled critics of art and literature about how to go about evaluating an artwork are the ones most controversial today in the field of psychoanalysis. The questions, for example, of whether beauty resides in the work of art or in the mind of the audience and its parallel in psychoanalysis, whether the material produced by the patient is essentially from the patient or the product of an interaction between patient and analyst, or even whether it is ever possible to interpret any patient material or artwork all the way down to some basic qualities remain unanswered and polemical today.


Density and potential profiles of non-neutral electron plasmas in a magnetic mirror field.
Low-energy non-neutral electron plasmas were confined with an electrostatic potential and a magnetic mirror field of the mirror ratio up to 5. Using a conventional phosphor screen and the unique multiring trap, both radial and axial density profiles of plasmas were measured. With the present experimental parameters, it was confirmed that a plasma density increased at higher field with an electrostatic confinement and that it decreased at higher field with a magnetic mirror confinement. The electrostatic potentials along the magnetic field were estimated with computer simulations.


Occurrence in Monia rectirostris (Cladocera: Daphnidae) of a parasite morphologically similar to Pasteuria ramosa (Metchnikoff, 1888).
Pasteuria ramosa, a bacterial parasite of the cladocerans Daphnia pulex and D. magna, was described by Metchnikoff in 1888. Because the organism could not be cultured, it was subsequently lost. However, the original illustrations and descriptions of the life cycle of P. ramosa are similar to a bacterial spore parasite of nematodes (BSPN) that was recently described in Meloidogyne. As a result of these similarities, a search for P. ramosa was initiated. An organism resembling P. ramosa was found infecting Moina rectirostris, a member of the Daphnidae and a new host for the bacterium. Photomicrographs and scanning electron micrographs of the parasite indicated that the morphology of this organism was similar to the descriptions and illustrations presented by Metchnikoff. Morphological features of this newly described parasite also indicated that the bacterium is similar to the BSPN.


Solvation structure of the halides from x-ray absorption spectroscopy.
Three-dimensional models for the aqueous solvation structures of chloride, bromide, and iodide are reported. K-edge extended X-ray absorption fine structure (EXAFS) and Minuit X-ray absorption near edge (MXAN) analyses found well-defined single shell solvation spheres for bromide and iodide. However, dissolved chloride proved structurally distinct, with two solvation shells needed to explain its strikingly different X-ray absorption near edge structure (XANES) spectrum. Final solvation models were as follows: iodide, 8 water molecules at 3.60 ± 0.13 Å and bromide, 8 water molecules at 3.40 ± 0.14 Å, while chloride solvation included 7 water molecules at 3.15 ± 0.10 Å, and a second shell of 7 water molecules at 4.14 ± 0.30 Å. Each of the three derived solvation shells is approximately uniformly disposed about the halides, with no global asymmetry. Time-dependent density functional theory calculations simulating the chloride XANES spectra following from alternative solvation spheres revealed surprising sensitivity of the electronic state to 6-, 7-, or 8-coordination, implying a strongly bounded phase space for the correct structure during an MXAN fit. MXAN analysis further showed that the asymmetric solvation predicted from molecular dynamics simulations using halide polarization can play no significant part in bulk solvation. Classical molecular dynamics used to explore chloride solvation found a 7-water solvation shell at 3.12 (-0.04/+0.3) Å, supporting the experimental result. These experiments provide the first fully three-dimensional structures presenting to atomic resolution the aqueous solvation spheres of the larger halide ions.


E6020, a synthetic TLR4 agonist, accelerates myelin debris clearance, Schwann cell infiltration, and remyelination in the rat spinal cord.
Oligodendrocyte progenitor cells (OPCs) are present throughout the adult brain and spinal cord and can replace oligodendrocytes lost to injury, aging, or disease. Their differentiation, however, is inhibited by myelin debris, making clearance of this debris an important step for cellular repair following demyelination. In models of peripheral nerve injury, TLR4 activation by lipopolysaccharide (LPS) promotes macrophage phagocytosis of debris. Here we tested whether the novel synthetic TLR4 agonist E6020, a Lipid A mimetic, promotes myelin debris clearance and remyelination in spinal cord white matter following lysolecithin-induced demyelination. In vitro, E6020 induced TLR4-dependent cytokine expression (TNFα, IL1β, IL-6) and NF-κB signaling, albeit at ∼10-fold reduced potency compared to LPS. Microinjection of E6020 into the intact rat spinal cord gray/white matter border induced macrophage activation, OPC proliferation, and robust oligodendrogenesis, similar to what we described previously using an intraspinal LPS microinjection model. Finally, a single co-injection of E6020 with lysolecithin into spinal cord white matter increased axon sparing, accelerated myelin debris clearance, enhanced Schwann cell infiltration into demyelinated lesions, and increased the number of remyelinated axons. In vitro assays confirmed that direct stimulation of macrophages by E6020 stimulates myelin phagocytosis. These data implicate TLR4 signaling in promoting repair after CNS demyelination, likely by stimulating phagocytic activity of macrophages, sparing axons, recruiting myelinating cells, and promoting remyelination. This work furthers our understanding of immune-myelin interactions and identifies a novel synthetic TLR4 agonist as a potential therapeutic avenue for white matter demyelinating conditions such as spinal cord injury and multiple sclerosis.


Properties of zero-lag long-range synchronization via dynamical relaying.
In 2006 Fischer et al. reported the phenomenon of zero-lag long-range isochronous synchronization via dynamical relaying in systems with delay [Phys. Rev. Lett. 97, 123902 (2006)]. They reported that when one has two coupled systems A and C, with delay between them, then the introduction of a third coupled element B between A and C will allow them to synchronize even in regions of the parameter space where this was not possible without the presence of B. Here we studied this phenomenon in detail in coupled Rössler oscillators and found that this happens in three different ways, that is, we verified that when there is feedback between A and B this kind of synchronization can happen via antiphase or in-phase synchronization depending on the delay value. The third case occurs via anticipating synchronization and is found when B drives A and C without getting feedback from them. We found similar phenomena in coupled Kuramoto oscillators, which present periodic orbits only and this allowed us to perform analytical calculations. Finally, we studied coupled logistic maps and identify the region where zero-lag long-range synchronization is possible as the region characterized by a negative transversal Lyapunov exponent.


Characterization of a slow cholinergic post-synaptic potential recorded in vitro from rat hippocampal pyramidal cells.
Intracellular recording from CA1 pyramidal cells in the hippocampal slice preparation was used to compare the action of exogenously applied acetylcholine (ACh) and cholinomimetics to the effect of electrically stimulating sites in the slice known to contain cholinergic fibres. ACh depolarized pyramidal cells with an associated increase in input resistance, blocked a calcium-activated potassium conductance (GK(Ca], and blocked accommodation of action potential discharge. All of these actions were blocked by the muscarinic antagonist, atropine. Repetitive electrical stimulation of stratum (s.) oriens evoked a series of fast excitatory post-synaptic potentials (e.p.s.p.s) followed by an inhibitory post-synaptic potential. These potentials were followed by a slow e.p.s.p. that lasted 20-30 s. The slow e.p.s.p. was selectively enhanced by eserine and blocked by atropine. Ionophoretic application of ACh closely mimicked the time course of the slow e.p.s.p. The slow e.p.s.p. was blocked by tetrodotoxin and cadmium, indicating that it was dependent on propagated action potentials and on calcium. Considerably higher stimulus strengths were needed to elicit a slow e.p.s.p. than to elicit the earlier synaptic potentials. The size of the slow e.p.s.p. was markedly increased by repetitive stimulation. Stimulation of the alveus, s. oriens, s. pyramidale and fimbria all evoked a slow e.p.s.p., while stimulation of s. radiatum was relatively ineffective. The input resistance of the cell increased during the slow e.p.s.p. Hyperpolarizing the cell decreased the size of the slow e.p.s.p. and at membrane potentials of -70 mV or greater, little response was recorded. Stimulation of s. oriens blocked GK(Ca) and accommodation of action potential discharge. These effects, which could be seen in the absence of any change in membrane potential, were enhanced by eserine and blocked by atropine. The present electrophysiological results establish that CA1 pyramidal cells receive a cholinergic input and demonstrate that this input can dramatically alter the firing properties of these neurones for tens of seconds in the absence of any marked effect on membrane potential. Such an action contrasts with previously characterized synaptic potentials in this region of the brain.


[Glycyrrhizinic acid modulates the immunity of MRL/lpr mice and related mechanism].
Objective To investigate the immunological effect of glycyrrhizic acid (GA) on MRL/lpr mice and its underlying mechanism. Methods The research included 10 wild type C57BL/6 mice and 40 MRL/lpr mice. MRL/lpr mice were randomly assigned to four groups: MRL/lpr control, MRL/lpr treated with dexamethasone (1.5 mg/kg), MRL/lpr treated with GA (20 mg/kg) and GA (40 mg/kg), 10 mice in each group. The serum levels of interleukin 4 (IL-4) and interferon-γ (IFN-γ) were tested by ELISA. The ratio of Th1/Th2 cell subsets in spleen was analyzed by flow cytometry. The protein levels of GATA-binding protein 3 (GATA3), T-bet, p-JAK3, JAK3, phosphorylated signal transducer and activator of transcription 3 (p-STAT3), STAT3, p-NF-κBp65, NF-κBp65, p-IκBα, IκBα in spleen were detected by Western blot analysis. Results GA decreased serum levels of IL-4 and increased IFN-γ, modulated the balance of Th1/Th2 cell subsets in spleen markedly. GA inhibited the protein levels of GATA3, p-JAK3, p-STAT3, p-NF-κB, p-IκBα and increased T-bet protein in MRL/lpr mice. Conclusion Administration of GA can ameliorate the immune function in MRL/lpr mice.


[Hemorrhage in the vitreous and retinal venous loop in a diabetic subject].
A vitrectomy was performed in a diabetic patient because of unilateral vitreous hemorrhage, which persisted for six months. There was only background retinopathy in the other eye. In the operated eye, no proliferative retinopathy was found. During surgery a partial posterior vitreous detachment was noted with persistent vitreoretinal attachment to the superotemporal vascular arcade. Postoperative fundus examination and fluorescein angiography showed background retinopathy and the presence of a venous loop involving the superotemporal vein. Histologic description of venous loops with vitreoretinal adhesion was recently reported and it was suggested that this could lead to vitreous hemorrhage even in absence of severe proliferative retinopathy. To our knowledge, there is no previous report of diabetic vitreous hemorrhage probably due to a venous loop with vitreoretinal attachment.


A small-scale comparison of Iceland scallop size distributions obtained from a camera based autonomous underwater vehicle and dredge survey.
An approach is developed to estimate size of Iceland scallop shells from AUV photos. A small-scale camera based AUV survey of Iceland scallops was conducted at a defined site off West Iceland. Prior to height estimation of the identified shells, the distortions introduced by the vehicle orientation and the camera lens were corrected. The average AUV pitch and roll was 1.3 and 2.3 deg that resulted in <2% error in ground distance rendering these effects negligible. A quadratic polynomial model was identified for lens distortion correction. This model successfully predicted a theoretical grid from a frame photographed underwater, representing the inherent lens distortion. The predicted shell heights were scaled for the distance from the bottom at which the photos were taken. This approach was validated by height estimation of scallops of known sizes. An underestimation of approximately 0.5 cm was seen, which could be attributed to pixel error, where each pixel represented 0.24 x 0.27 cm. After correcting for this difference the estimated heights ranged from 3.8-9.3 cm. A comparison of the height-distribution from a small-scale dredge survey carried out in the vicinity showed non-overlapping peaks in size distribution, with scallops of a broader size range visible in the AUV survey. Further investigations are necessary to evaluate any underlying bias and to validate how representative these surveys are of the true population. The low resolution images made identification of smaller scallops difficult. Overall, the observations of very few small scallops in both surveys could be attributed to low recruitment levels in the recent years due to the known scallop parasite outbreak in the region.


The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence.
Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P < 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P < 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of >40 is a significant cutoff point for predicting therapy nonadherence (P < 0.011 and P < 0.004, respectively). Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk.


Analysis of Kytococcus sedentarius Strain Isolated from a Dehumidifier Operating in a University Lecture Theatre: Systems for Aerobic Respiration, Resisting Osmotic Stress, and Sensing Nitric Oxide.
A strain of Kytococcus sedentarius was isolated from a dehumidifier operating in a university lecture theatre. Genome analysis and phenotypic characterisation showed that this strain, K. sedentarius MBB13, was a moderately halotolerant aerobe with a branched aerobic electron transport chain and genes that could contribute to erythromycin resistance. The major compatible solute was glycine betaine, with ectoine and proline being deployed at higher osmolarities. Actinobacteria possess multiple WhiB-like (Wbl) regulatory proteins, and K. sedentarius MBB13 has four (WhiB1, WhiB2, WhiB3, and WhiB7). Wbls are iron-sulfur proteins that regulate gene expression through interactions with RNA polymerase sigma factors and/or other regulatory proteins. Bacterial two-hybrid analyses suggested that WhiB1 and WhiB2, but not WhiB3 and WhiB7, interact with the C-terminal domain of the major sigma factor, σA; no interaction was detected between any of the Wbl proteins and the only alternative sigma factors, σB, σH, or σJ. The interaction between σA and WhiB1 or WhiB2 was disrupted in a heterologous system under growth conditions that produce nitric oxide and the iron-sulfur clusters of the isolated WhiB1 and WhiB2 proteins reacted with nitric oxide. Thus, K. sedentarius strain exhibits the major phenotypic characteristics of the type strain and a comprehensive examination of the interactions between its four Wbl proteins and four sigma factors suggested that the Wbl proteins all operate through interaction with σA.


[Torsion of the spleen].
The authors describe, a case of torsion of the splenic hilum complicated with a Salmonella typhimurium infection in a child aged 14 months. The existence of a defect of the spleen fixation to the parietal peritoneum, the wandering spleen, that occurs during foetal life is responsible for this situation. The etiology of this entity as well as its clinical presentation and differential diagnosis are analysed. the therapeutic indications os splenectomy and splenopexy are discussed.


MicroRNA-363-3p suppresses anoikis resistance in human papillary thyroid carcinoma via targeting integrin alpha 6.
MicroRNAs are highly conserved endogenous small noncoding RNAs and demonstrated to play important roles in the metastatic cascade of papillary thyroid carcinoma (PTC), including the process of anoikis resistance. In this study, the correlation between miRNA-363-3p (miR-363-3p) expression and PTC metastasis was analyzed based on clinical data, and the effect and related mechanism of miR-363-3p on anoikis resistance in B-CPAP cells were further investigated. First, miR-363-3p was found to be down-regulated in PTC tissue, which was correlated with the advanced clinical stage and lymph node (LN) metastasis. Then, functional study revealed that miR-363-3p was also down-regulated in B-CPAP cells compared with that in thyroid epithelial Nthy-ori3-1 cells, and miR-363-3p transfection could suppress anoikis resistance of B-CPAP cells. Finally, integrin alpha 6 (ITGA6) was validated as the target gene of miR-363-3p, and restoration of ITGA6 expression attenuated miR-363-3p's inhibitory effect on anoikis resistance in B-CPAP cells. These findings contribute to understand the role of miR-363-3p in the metastatic cascade of PTC and suggest the potential clinical value of miR-363-3p for the prevention of PTC metastasis.


Application of blind source separation to real-time dissolution dynamic nuclear polarization.
The use of a blind source separation (BSS) algorithm is demonstrated for the analysis of time series of nuclear magnetic resonance (NMR) spectra. This type of data is obtained commonly from experiments, where analytes are hyperpolarized using dissolution dynamic nuclear polarization (D-DNP), both in in vivo and in vitro contexts. High signal gains in D-DNP enable rapid measurement of data sets characterizing the time evolution of chemical or metabolic processes. BSS is based on an algorithm that can be applied to separate the different components contributing to the NMR signal and determine the time dependence of the signals from these components. This algorithm requires minimal prior knowledge of the data, notably, no reference spectra need to be provided, and can therefore be applied rapidly. In a time-resolved measurement of the enzymatic conversion of hyperpolarized oxaloacetate to malate, the two signal components are separated into computed source spectra that closely resemble the spectra of the individual compounds. An improvement in the signal-to-noise ratio of the computed source spectra is found compared to the original spectra, presumably resulting from the presence of each signal more than once in the time series. The reconstruction of the original spectra yields the time evolution of the contributions from the two sources, which also corresponds closely to the time evolution of integrated signal intensities from the original spectra. BSS may therefore be an approach for the efficient identification of components and estimation of kinetics in D-DNP experiments, which can be applied at a high level of automation.


[Penicher: an manuscript addendum to his pharmacopoeia of 1695 on the copy of Pharmacy College Library].
Penicher's pharmacopeia (1695) was part of the Library of the "College de Pharmacie". The inventory of this Library was done in 1780 and is kept by the Library of the BIU Santé, Paris-Descartes University in Paris that digitized it recently. This copy contains handwritten texts that complete the original edition. The first main addition, at the beginning of the document, is three recipes of drugs, in Latin, one of them being well known at the early 18th century, the vulnerary balm of Leonardo Fioraventi (1517-1588), that is also known as Fioraventi's alcoholate. This product will still be present in the French Codex until 1949. The Penicher' book also includes, at the end, three handwritten pages in French which represent the equipment of apothecaries. These drawings are very close to the ones of Charas' Pharmacopeia. One can think that these additions are from the second part of the 18th century, but before the gift of the pharmacopeia to the College de Pharmacie by Fourcy en 1765. The author is unknown but he is probably one of the predecessor of Fourcy in Pharmacie de l'Ours (Bear's pharmacy). This gift done by Fourcy when joining the Community of Parisians pharmacists did not prevent the fact that Fourcy was sentenced by his colleagues pharmacists, a few years later, for the sales of "Chinese specialties" that someone called Jean-Daniel Smith, a physician installed in Paris, asked him to prepare.


[Usefulness of thickness of the pelvic floor muscle as a predictor for urinary incontinence after radical prostatectomy].
A total of 49 patients were enrolled in this study. Voiding symptoms were investigated on medical records at 3 and 6 months after retropubic retrograde radical prostatectomy. Incontinence was defined as any involuntary urine leakage. First, clinical and surgical factors were analyzed in continent and incontinent patients. Then, the thickness of the pelvic diaphragm and the levator ani of 38 patients were measured on a monitor using a preoperative magnetic resonance image. The differences between these factors and the continent status were analyzed. Incontinence was noted in 57 and 29% of the patients at 3 and 6 months, respectively. There were significant differences in the thickness of the pelvic diaphragm on sagittal images between the continent and incontinent groups at both 3 and 6 months postoperatively (p = 0.006 and p = 0.02, respectively). There were no differences on other factors. The pelvic diaphragm thickness may be a predictive factor of post-prostatectomy incontinence. The data suggested that patients having a thin pelvic diaphragm might not be expected to achieve earlier recovery of continence after radical prostatectomy.


Lexical and syntactic errors in translation by Italian/English bilinguals.
Translation is recognized as a specific linguistic ability in bilinguals. Yet, we know little about what factors influence translation ability, especially at the sentence level. In this study, adults were asked to translate sentences from English (L2) into Italian (L1). We hypothesized that (1) adults with later age of arrival in Canada would perform better in translating into their native language than adults with earlier age of arrival, and therefore earlier L2 acquisition and (2) adults with higher use of L1 would perform better than adults with low use. Participants (N = 70) formed 4 groups based on their age of arrival in Canada (AoA) and their reported use of Italian. The translated sentences were scored for syntactic and lexical correctness, and for the number of omitted words. There were significant AoA group effects: late arrival in Canada was associated with better performance. There were no effects for reported frequency of use of Italian Both self-ratings and native Italian listener ratings of the translated sentences correlated highly with number of correct sentences.


Ordered FePdCu nanoisland arrays made by templated solid-state dewetting.
Ordered FePdCu nanoisland arrays were formed by annealing at 600 °C, which caused solid state dewetting of [Cu/Fe/Pd] multilayers deposited on self-assembled SiO2 nanospheres with a size of 100 nm. A single FePdCu island was formed on the top of each SiO2 nanosphere. The structure of the obtained system was studied by x-ray diffraction (XRD), while its magnetic properties were studied by SQUID magnetometry. A partially ordered L10 alloy appeared in the annealed films, leading to magnetic hardening of the material. The paper presents the influence of the patterning on the system properties. It is shown that templated dewetting is a method providing nanoislands with well-controlled sizes and positions. The role of copper admixture in controlling the structural and magnetic properties is also discussed.


Health Care Practitioners' Perspectives on Deprescribing Anticholinergic and Sedative Medications in Older Adults.
Anticholinergic and sedative (ACh-Sed) medications are commonly prescribed for older adults and are associated with adverse events. (1) To investigate perspectives of health care practitioners (HCPs) surrounding deprescribing (withdrawal) of ACh-Sed medications in older adults; (2) to assess HCPs' perspectives on the design and implementation of a report on a patient's exposure to ACh-Sed medications using the Drug Burden Index (DBI) pharmacological tool. This was a qualitative study using focus groups with purposive samples of accredited pharmacists (APs), general practitioners (GPs), and specialist physicians (SPs). Participants were also asked to comment on a sample DBI report of a hypothetical patient and its potential role in practice. The discussions were audiorecorded, transcribed verbatim, and thematically analyzed to derive conceptual domains. QSR NVivo Version 10 was used for data management. Several barriers and enablers to deprescribing ACh-Sed medications in older adults were identified. The most noteworthy barrier to deprescribing related to devolving responsibility. Predominantly, APs expressed frustration surrounding disregard by GPs of their recommendations to deprescribe medications. GPs expressed that deprescribing should be conducted by SPs and vice versa. The DBI report supported and addressed some of the identified barriers to deprescribing ACh-Sed medications in older adults. The HCPs also identified several opportunities and considerations for implementing the DBI report in practice, mainly highlighting that ACh-Sed medications are not the only high-risk medications for older people. Although HCPs recognize the harms associated with ACh-Sed medication use, they devolve prescribing and management responsibility to other groups of HCPs.


[The mechanism of the chronic supraventricular tachycardia: an intracavitary electrophysiological study (author's transl)].
Chronic Supraventricular Tachycardia (CST) or Chronic Atrial Tachycardia is a relatively rare arrhythmia. Because of very poor number of cases studied with electrophysiologic techniques its mechanism is still debated. Three cases of CST, one of persistent type and two of repetitive type, are reported. His bundle electrogram, high and low right atrial electrograms and atrial stimulation were performed in every case, ventricular stimulation in only one case. The Amiodarone, Pindolol, Verapamil and vagal manoeuvres effects were evaluated in all cases. The site of origin of tachycardia, atrial in cases 1 and 3 and junctional in case 2, was estabished by atrial map. The electrophysiologic findings suggested the presence of an ectopic focus in cases 1 and 3 and of an AV nodal re-entry circuit in case 2. Our results and those of the literature indicate that the site and the mechanism of CST, as in paroxysmal supraventricular tachycardia, is not univocal. Their electrophysiologic evaluation by means of endocavitary techniques can allow a more satisfactory therapeutic approach.


Appropriateness of Abdominal Aortic Aneurysm Screening With Ultrasound: Potential Cost Savings With Guideline Adherence and Review of Prior Imaging.
To assess the appropriateness of abdominal aortic aneurysm (AAA) screening with ultrasound (US) and potential cost savings by adhering to guidelines and reviewing prior imaging. Screening aortic US performed in Nova Scotia from January 1 to April 30, 2019, were reviewed. Patient sex, age, risk factors, and study result (negative, <2.5 cm; ectatic, 2.5-2.9 cm; positive for AAA, ≥3 cm) were recorded. Previous imaging tests were reviewed for the presence/absence of aortic ectasia or aneurysm. Appropriateness was based on the Canadian Task Force on Preventive Health Care (CTFPHC) and the Canadian Society of Vascular Surgery (CSVS) guidelines. The number of potentially averted US, subsequent missed positive findings, and cost savings (over the 4-month period) were calculated according to: 1) each guideline; and 2) each guideline combined with review of imaging done 0 to 5 years and 0 to 10 years previously. There were 17 (4.6%) of 369 ectatic aortas and 18 (4.9%) of 369 AAAs. The number of potentially averted examinations, missed ectatic aortas, missed AAAs, and cost savings were as follows, respectively: CTFPHC, 222 (60.2%) of 369, 8, 7, and CAD$20 501.70; CSVS, 117 (31.7%) of 369, 4, 2, and CAD$10 804.95. The model that would yield the greatest cost savings and fewest missed positive findings was the combination of CSVS guidelines with review of prior imaging within 5 years; this would avert 189 (51.2%) of 369 examinations, save CAD$17 454.15 over 4 months, and miss only 2 AAAs and 2 ectatic aortas. Over half of aortic US screening tests can be safely averted by adhering to CSVS guidelines and reviewing imaging performed within 5 years.


Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions.
Female Genital Mutilation and Cutting (FGM/C) is an act of gender-based violence (GBV) and a global public health issue with well-documented adverse outcomes. With the rise in global migration, there is an increasing prevalence of FGM/C among Arab diaspora living in the West and Global South. What remains unclear is how to reduce the practice. This study was designed to identify interventions exerting an effect on reducing the practice of FGM/C. A systematic review of peer-reviewed articles was conducted on interventions targeting individuals and/or the broader community to prevent FGM/C within the Arab League and its diaspora, up to December 2021. Databases searched included PubMed, Medline, Web of Science, PsycINFO, EMBASE, CINAHL, BIOSIS, ASSIA and Scopus. Quality assessment used the Mixed Methods Appraisal Tool (MMAT) 2018. Twelve of 896 studies met the inclusion criteria. Eight interventions relied entirely on education with short-term gains but unchanged practices. Three interventions used social marketing and mixed media. Only one study took a multi-sectoral approach. At a macro level, opportunities to reduce or to end the practice of FGM/C exist through legislation, policy, a public health approach grounded in gender equality and human rights. Using multi-sectoral actions that consider the social context and challenge social norms at macro, meso and micro levels appears more effective than individual-level interventions. Promoting advocacy and developing supportive environments to reduce GBV, enhance gender equality and empower communities is crucial for interventions to succeed and achieve the Sustainable Development Goal target of FGM/C abandonment by 2030.


Automatic digital analysis of the EMG during standardized flexion and extension of the foot.
An analysis was made of parameters of the EMG contraction pattern of the soleus and the tibialis anterior muscle in normal test subjects. Constant isometric contractions were consecutively executed with both muscles during 60 sec under standardized conditions. The EMG was derived with surface electrodes, then converted analogue to digital and analyzed with the aid of a PDP 8/I computer. Values measured were tension, integrated amplitude, peak-to-peak amplitude and number of peaks. The fluctuations in tension exerted (coefficient of variation) were more marked in the tibialis anterior than in the soleus muscle. The difference between males and females in tension exerted was different for different muscles. The EMG pattern showed significant intermuscular differences, as did the fatigue phenomena. One of the causes is the ratio between tonic and phasic motor units. The same applies to intermuscular differences in fatiguability. Different muscles may dominant in different individuals. The above observations can explain the great range of variation in normal values. Comparative clinical studies will require a cataloguing of normal values for all muscles. This study can contribute to this.


Radio frequency electrode system for optical lesion size estimation in functional neurosurgery.
Radiofrequency (RF) lesioning in the human brain is one possible surgical therapy for severe pain as well as movement disorders. One obstacle for a safer lesioning procedure is the lack of size monitoring. The aim of this study was to investigate if changes in laser Doppler or intensity signals could be used as markers for size estimation during experimental RF lesioning. A 2 mm in diameter monopolar RF electrode was equipped with optical fibers and connected to a digital laser Doppler system. The optical RF electrode's performance was equal to a standard RF electrode with the same dimensions. An albumin solution with scatterers was used to evaluate the intensity and laser Doppler signal changes during lesioning at 70, 80, and 90 degrees C. Significant signal changes were found for these three different clot sizes, represented by the temperatures (p<0.05, n=10). The volume, width, and length of the created coagulations were correlated to the intensity signal changes (r=0.88, n=30, p<0.0001) and to the perfusion signal changes (r=0.81, n=30, p<0.0001). Both static and Doppler-shifted light can be used to follow the lesioning procedure as well as being used for lesion size estimation during experimental RF lesioning.


Executive function in children with prenatal cocaine exposure (12-15years).
Prenatal exposure to cocaine (PCE) may alter areas of the brain dense with monoamine receptors such as the prefrontal cortex and negatively affect cognitive processes implicated in executive function (EF). This study investigated the effects of PCE on EF at 12 and 15years. EF was examined in 189 PCE and 183 non-cocaine exposed (NCE) children who were primarily African American and of low socioeconomic status. Caregivers rated their child on the Behavior Rating Inventory of Executive Function (BRIEF) at ages 12 and 15. The BRIEF includes two summary scales and eight subscales: Behavioral Regulation Index (BRI) (Inhibit, Shift, and Emotion) and Metacognition Index (MI) (Monitor, Working Memory, Plan/Organize, Organization of Materials and Task Completion). Two additional measures were included at age 15 (BRIEF Self-Report and the CANTAB Stockings of Cambridge (SOC)). Girls with PCE were perceived by caregivers to have more behavioral regulation problems at age 12 (p<0.005) and more metacognitive problems at age 12 (p<0.003) than NCE females, but there was no association for males. PCE girls improved in behavioral regulation (p<0.05) and metacognition (p<0.04) from 12 to 15years compared to NCE girls based on caregiver report. By self-report PCE was associated with problems of inhibition (p<0.006). Girls with PCE performed more poorly on number of moves to complete the SOC, requiring planning and problem solving, than NCE girls. Prenatally cocaine exposed girls were perceived by caregivers as having problems of behavioral regulation, and by self-report, inhibitory control problems. Girls with PCE also performed more poorly on a task of planning and problem solving at age 15 which corresponded to caregiver report at age 12. Early assessment and remediation of these weaknesses in girls may improve school performance and behavior associated with poor EF.


Clinical exome sequencing reports: current informatics practice and future opportunities.
The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes.


"It is about how the net looks": a qualitative study of perceptions and practices related to mosquito net care and repair in two districts in eastern Uganda.
Prolonging net durability has important implications for reducing both malaria transmission and the frequency of net replacement. Protective behaviour, such as net care and repair, offers promise for improving net integrity and durability. Given the potential cost-savings and public health benefit associated with extending the useful life of long-lasting insecticidal nets (LLINs), prevention and mitigation of damage will become ever more critical to ensuring adequate net coverage at the population level. A qualitative assessment was conducted in two districts in central eastern Uganda in September 2013. Data on household net care and repair behaviour, attitudes and practices were collected from 30 respondents through in-depth interviews (IDIs), observations, photos, and video to gather an in-depth understanding of these behaviours. Net damage was common and the most cited causes were children and rodents. Responses revealed strong social norms about net cleanliness and aesthetics, and strong expectations that others should care for and repair their own nets. Respondents were receptive and able to repair nets, though longer-term repair methods, such as sewing and patching, were not as commonly reported or observed. Self-reported behaviour was not always consistent with observed or demonstrated behaviour, revealing potential misconceptions and the need for clear and consistent net care and repair messaging. Respondents considered both aesthetics and malaria protection important when deciding whether, when, and how to care for and repair nets. BCC should continue to emphasize the importance of maintaining net integrity for malaria prevention purposes as well as for maintaining aesthetic appeal. Additional research is needed, particularly surrounding washing, drying, daily storage routines, and gender roles in care and repair, in order to understand the complexity of these behaviours, and refine existing or develop new behaviour change communication (BCC) messages for net care and repair.