Direct observation of hot-electron-enhanced thermoelectric effects in silicon nanodevices.
The study of thermoelectric behaviors in miniatured transistors is of fundamental importance for developing bottom-level thermal management. Recent experimental progress in nanothermetry has enabled studies of the microscopic temperature profiles of nanostructured metals, semiconductors, two-dimensional material, and molecular junctions. However, observations of thermoelectric (such as nonequilibrium Peltier and Thomson) effect in prevailing silicon (Si)-a critical step for on-chip refrigeration using Si itself-have not been addressed so far. Here, we carry out nanothermometric imaging of both electron temperature (Te) and lattice temperature (TL) of a Si nanoconstriction device and find obvious thermoelectric effect in the vicinity of the electron hotspots: When the electrical current passes through the nanoconstriction channel generating electron hotspots (with Te~1500 K being much higher than TL~320 K), prominent thermoelectric effect is directly visualized attributable to the extremely large electron temperature gradient (~1 K/nm). The quantitative measurement shows a distinctive third-power dependence of the observed thermoelectric on the electrical current, which is consistent with the theoretically predicted nonequilibrium thermoelectric effects. Our work suggests that the nonequilibrium hot carriers may be potentially utilized for enhancing the thermoelectric performance and therefore sheds new light on the nanoscale thermal management of post-Moore nanoelectronics.


Seasonality of low birthweight in indigenous Australians: an increase in pre-term birth or intrauterine growth retardation?
We have analysed birthweights of 4,508 Aboriginal and Torres Strait Islander livebirths in the Kimberley region of Western Australia from 1981-93. Mean birthweight varied significantly according to month of birth (F(11) = 2.57, p = 0.003) and low birthweight babies were more common during the wet season. A significant increase in the proportion of very low birthweight (VLBW) babies was observed during the wet season compared with the dry season (OR 2.73; 95% CI 2.3-3.67; p < 0.001); whereas babies weighing 1,500-2,499 g were not significantly more common during the wet season (OR 1.06; 95% CI 0.96-1.17; p = ns). The results indicate that adverse environmental conditions may be associated with increased risk of VLBW. Since newborns weighing less than 1500 g are very likely to be pre-term (< 37 weeks' gestation), the findings also suggest that seasonality of birthweight may be due to an increase in pre-term births rather than an increase in intrauterine growth retardation. Further research is required to identify the underlying causes of an increase in VLBW babies during the wet season.


Hernias: a frequent complication in children treated with continuous peritoneal dialysis.
The course of 93 children, treated with continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) over a total of 1,819 months, was evaluated retrospectively regarding hernia development. Thirty-seven patients (40%) developed 60 hernias (one per 30 patient-months), of which 36 were ventral, 7 umbilical, 14 inguinal, and 3 scrotal. Hernia occurrence was inversely correlated to patient's age and duration of CAPD/CCPD. The rate of hernia development was highest within the first 3 months following initiation of CAPD/CCPD with a subsequent rapid decrease. The dialysate inflow volume was not related to hernia development. The only complication due to the presence of a hernia was one episode of incarceration of the small bowel that required immediate surgical intervention. Surgical repair was the treatment performed in 75% of the cases. The remaining hernias were managed with volume reduction, conversion from CAPD to CCPD, or discontinuation of the daytime dialysate dwell in patients undergoing CCPD. Our observations suggest that hernia development is a frequent complication in children treated with CAPD/CCPD.


Lipid peroxidation in maternal and cord blood and protective mechanism against activated-oxygen toxicity in the blood.
Concentrations of a peroxidation product (malondialdehyde), fluorescent chromophores, lipofuscin-like fluorescent products, superoxide dismutase, catalase, glutathione peroxidase, and vitamin E in the maternal blood and the cord blood were determined and the results obtained were related to the estimation of lipid peroxidation and protective mechanism against uncontrolled oxidative processes in late pregnancy. Serum levels of fluorescent products were higher in the maternal blood than in the cord blood, indicating less frequent lipid peroxidation in the fetus than in the mother. In support of this assumption, the three protective enzymes and vitamin E were present in relatively lower concentrations in the cord blood. Sudden exposure of the newborn infant to a normobaric atmosphere after beginning breathing seems, therefore, to cause oxidation of red blood cell membrane, denaturation of the membrane, inducing hemoglobin breakdown, and consequently hemolysis.


Neural inflammation and the microglial response in diabetic retinopathy.
This chapter reviews the function of microglia and their potential roles in neural inflammation and pathological changes during diabetic retinopathy.


Serious psychological distress and cannabis use among pregnant women in the United States: Findings from the National Survey of Drug Use and Health, 2015-2018.
Cannabis use in pregnancy has been shown to be associated with a past diagnosis of mental health disorders. This study aimed to evaluate the association between serious psychological distress (SPD) and cannabis use in pregnant women in the United States. Using cross-sectional data from the 2015-2018 National Survey on Drug Use and Health (NSDUH), we compared likelihood of cannabis use among pregnant women who reported acute, recent or no SPD based on the Kessler K-6 Distress Scale. Weighted analyses were conducted to describe study population and differences in cannabis use patterns in women with SPD compared to those without. Multivariate logistic regression models were fit to determine whether the relationship between SPD and cannabis use differed by acute, recent or no SPD status. Our final study sample consisted of 2,277,425 pregnant women. In adjusted analyses, pregnant women with any SPD (acute or recent) had 3.1 (95% confidence interval: 2.1, 4.5) times the odds of being current cannabis users compared to pregnant women without SPD. Compared to those with no SPD, pregnant women adjusted with acute SPD had 3.9 (2.5, 6.1) the adjusted odds and recent SPD had 2.4 (1.3, 4.4) times the odds of being current cannabis users. Cannabis use rates in each trimester were significantly higher in women with SPD compared to women without. Women who report recent or acute SPD are significantly more likely to use cannabis during all trimesters of pregnancy than those who report no SPD.


An E-value analysis of potential unmeasured or residual confounding in systematic reviews of post-tuberculosis mortality, respiratory disease, and cardiovascular disease.
Unmeasured confounding poses a serious threat to observational studies of post-TB health outcomes. E-values have been recently proposed as a method to assess the magnitude of unmeasured confounding necessary to nullify, or to render non-significant, relative effect estimates from observational studies. We calculated E-values for both the risk ratio (RR) point estimates and their lower 95% confidence limits (LCL) from studies of post-TB mortality, respiratory disease, and cardiovascular disease (CVD) included in published systematic reviews within and across post-TB outcome domains. We also employed a meta-analytic E-value approach to estimate the proportion of unconfounded study RRs greater than 1.1 at different levels of unmeasured confounding. Across post-TB health outcome domains, we observed a median E-value of 5.59 (IQR = 3.19-7.35) for RRs, and 2.95 (IQR = 1.71-4.61) for LCLs. Post-TB mortality studies had higher median E-values (E-valueRR = 6.90 and E-valueLCL = 4.54) than studies of respiratory disease (E-valueRR = 5.59, E-valueLCL = 2.94) or CVD (E-valueRR = 3.90, E-valueLCL = 1.81). The E-value at which the estimated proportion of studies with unconfounded RRs greater than 1.1 would remain over 0.7 was 3.45 for post-TB mortality, 3.96 for post-TB respiratory disease, and 1.71 for post-TB CVD meta-analyses. Unmeasured confounding with an association of 2.95 or greater with both the exposure (TB) and outcome, on the risk ratio scale, could render most post-TB health studies' findings statistically non-significant. Post-TB mortality and respiratory disease studies had higher E-values than TB-CVD studies, indicating that either (a) TB-CVD studies may be more susceptible to unmeasured confounding bias, or (b) the true effect of TB on CVD is lower.


Insulin action and secretion independent of traditional risk factors predict new-onset type 2 diabetes in Iraqi and Swedish born citizens - The MEDIM cohort study.
Our aim was to study the incidence of type 2 diabetes in a population-based cohort of Swedish and Iraqi born individuals, focussing on traditional risk factors, insulin action, insulin secretion and ethnicity. The cohort consisted of 1164 Iraqi and 693 Swedish-born citizens. We investigated the association between new-onset type 2 diabetes and the predictors including lifestyle factors, metabolic risk markers, country of birth, insulin sensitivity and secretion assessed by Matsuda index with Cox regression. Eighty-nine individuals were diagnosed with type 2 diabetes with a mean follow-up of 7.5 years. Both lower insulin sensitivity (ISI, HR 0.02 [0.01-0.08]) as well as insulin secretion (CIR, HR 0.13 [0.07-0.24]) at baseline predicted type 2 diabetes onset, independent of traditional risk factors. Our results were not modified by country of birth. Regarding traditional risk factors, WHR (1.05 [1.00-1.09]), blood glucose (3.27 [2.35-4.55]), LDL/HDL (1.46 [1.20-1.78]) and diastolic blood pressure (1.04 [1.00-1.07]) predicted diabetes incidence in the full model. Both impaired insulin sensitivity index and corrected insulin response predicted type 2 diabetes onset, independent of traditional risk factors. We conclude that insulin secretion and action might be useful additional predictors for type 2 diabetes in populations of European and Middle Eastern ethnicities.


The perineuronal satellite oligodendrocyte. A role in remyelination.
Demyelination was induced in the superior cerebellar peduncles of weanling mice by the administration of Cuprizone. Remyelination occurred when the animals were replaced on a normal diet. Perineuronal satellite oligodendrocytes in the periventricular gray were clearly seen to be remyelinating axons. This study demonstrates for the first time the role of these cells in remyelination, and raises the possibility that they may be involved in normal myelination of the central nervous system.


Essential hypertension in black and white subjects. Hemodynamic findings and fluid volume state.
Systemic hemodynamics (cardiac output, intraarterial pressure, total peripheral resistance) and intravascular volume (plasma volume and red cell mass) were measured in a population of 126 black and white patients, 51 with borderline hypertension and 75 with established essential hypertension. The findings were compared with those in 29 age-matched normotensive control subjects of both races. The white patients with established hypertension demonstrated a faster heart rate than the black patients (less than 0.05); this difference was more pronounced during upright tilt (p less than 0.02). No significant difference in cardiac index, total peripheral resistance, plasma volume or total blood volume was found between the two racial populations. Cardiac index correlated directly with plasma and total blood volume in black patients (r = 0.32, p less than 0.05) and white patients (r = 0.35, p less than 0.001) as well as in the whole study population (r = 0.36, p less than 0.001). The regression lines were similar in the two races. Further, a negative correlation was observed between the total peripheral resistance and plasma volume (r = -0.31, p less than 0.001) or total blood volume (r = -0.34, p less than 0.001), and it was similar in both races (blacks r = -0.48, p less than 0.01; whites r = -0.25, p less than 0.05). Age correlated significantly with total peripheral resistance in the white patients (r = 0.35, p less than 0.001) and in the total study population (r = 0.28, p less than 0.001). We conclude that, for every given age or level of arterial pressure, systemic hemodynamics are similar for the black and white patients with essential hypertension. These data, therefore, do not support the clinical impression that basic pathophysiology and hypertensive vascular disease are different in the black patient with essential hypertension.


Noradrenergic stimulation increases fear memory expression.
Fear responses are typically not limited to the actual threatening stimulus but generalize to other stimuli resembling the threatening stimulus. Although this fear generalization is generally adaptive, fear overgeneralization is maladaptive and assumed to contribute to anxiety disorders. Despite the clinical relevance of fear (over)generalization, how the extent of fear generalization is modulated remains not well understood. Based on the known effects of stress on learning and memory, we tested here the impact of major stress mediators, glucocorticoids and noradrenergic arousal, on fear generalization. In a laboratory-based, placebo-controlled, double-blind, between-subject design, 125 healthy participants first underwent a fear conditioning procedure. About 24 h later, participants received orally either a placebo, hydrocortisone, the α2-adrenoceptor antagonist yohimbine, leading to increased noradrenergic stimulation, or both drugs before a test of fear generalization. Skin conductance responses as well as explicit rating data revealed that yohimbine intake led to enhanced fear memory expression, i.e. an enhanced responding to the CS+ but not to stimuli resembling the CS+. Moreover, neither enhanced safety learning nor a mere enhancement of perceptual discrimination ability could explain this result. In contrast to yohimbine, hydrocortisone had no significant effect on fear memory. These findings suggest that noradrenergic arousal strengthens fear memory expression and have important implications for mental disorders in which the overgeneralization of conditioned fear is prominent.


Extradural thoracic spinal cord compression: unusual initial presentation of post-transplant lymphoproliferative disorder.
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid-organ transplantation. We report a lung transplant recipient presenting with lower limb weakness as a result of extradural cord compression from PTLD. Diagnosis was made by laminectomy of T-3 with partial removal of the epidural mass. Further treatment consisted of chemoradiotherapy. The patient recovered completely. To our knowledge, this is the first reported case of PTLD presenting with signs and symptoms of spinal cord compression. The differential diagnosis of spinal cord compression in a patient who has had a transplant should include primary presentation of PTLD.


Placental imbalance of Th1- and Th2-type cytokines in preeclampsia.
To characterize the changes in the level of T helper 1 (Th1)- [interleukin (IL)-2 and tumor necrosis factor (TNF)-alpha] and Th2-type cytokine (IL-10) and the ratios of Th1/Th2 (IL-2/IL-10 and TNF-alpha/IL-10) in placentae from women with preeclampsia and women with gestational hypertension. Placental levels of IL-2, TNF-alpha, and IL-10 were determined with radioimmunoassay and Th1/Th2 ratios (IL-2/IL-10 and TNF-alpha/IL-10) calculated in the placentae from 22 women with preeclampsia, 15 women with gestational hypertension, and 32 normal term pregnant women. Although preeclampsia had the trend of the increase in the placental levels of IL-2 and TNF-alpha and the trend of the decrease in placental IL-10, there were not significant difference in placental levels of IL-2, IL-10, and TNF-alpha among preeclampsia, gestational hypertension, and normal pregnancy (P > 0.05 for all). Placental ratios of IL-2/IL-10 and TNF-alpha/IL-10 were significantly higher in preeclampsia than in normal pregnancy (P = 0.035 and P = 0.005, respectively). No differences of Th1/Th2 ratios were found between preeclampsia and gestational hypertension and between gestational hypertension and normal pregnancy (P > 0.05 for all). Alterations of placental balances of cytokines with Th1 predominance were demonstrated in preeclampsia. These associations may offer insights into the pathogenesis of preeclampsia.


A clinical, genetic and echocardiographic study of hypertrophic cardiomyopathy in a large family.
To confirm recent reports on the incidence of human lymphocyte antigens (HLA) in familial hypertrophic cardiomyopathy and to better define the genetic patterns found in these patients. A large family (31 members, 18M, 13F, age range 6-80 years) with a high incidence of hypertrophic cardiomyopathy was screened for HLA, dermatoglyphic patterns and blood subtyping. Our finding show variable expression of the disease and reduced penetrance. No linkage between the disease-causing gene and HLA loci could be demonstrated in the family. There was no specific haplotype which present in all affected individuals and missing in all controls. Haplotype A2 B18 was the most commonly encountered in affected individuals but was absent in IV 3 and present in a few controls. No linkage was found between the disease-responsible gene and the blood groups. Finally, no typical pattern emerged from the dermatoglyphic studies. The genetic assessment of this family, in agreement with other European studies, showed no clear correlation between hypertrophic cardiomyopathy and blood groups ABO, Rh, Lewis, Duffy and was unable to show atypical or unusual dermatoglyphic patterns.


Mechanism of microbial dissolution and oxidation of antimony in stibnite under ambient conditions.
In this study, we demonstrate that a bacterial isolate Paraccocus versutus XT0.6 from the Xikuangshan antimony mine, the world largest antimony deposit, is capable of stibnite dissolution, oxidation of Sb(III), and formation of secondary Sb(V) bearing mineral. The isolate could oxidize dissolved Sb(III) aerobically and anaerobically. It was able to dissolve Sb(III) in solid minerals, which was subsequently oxidized to Sb(V) completely. Part of Sb(V) was scavenged by the formation of secondary Sb(V)-bearing mineral mopungite [NaSb(OH)6] in the biotic experiments. In contrast, Sb(III) released from mineral/rocks was only partially oxidized to Sb(V) and no secondary Sb-bearing mineral was formed in abiotic controls. These results demonstrated that microbial processes involved in the mobilization, oxidation, and transformation of antimony in minerals/rocks under ambient environmental conditions and offer new insights in biogeochemistry of Sb at mining areas.


Breast Cancer in Very Young Patients in a Spanish Cohort: Age as an Independent Bad Prognostic Indicator.
Breast cancer (BC) in very young women (BCVY) is more aggressive than in older women. The purpose of this study was to evaluate the relevance of a range of clinico-pathological factors in the prognosis of BCVY patients. We retrospectively analyzed 258 patients diagnosed with BCVY at our hospital from 1998 to 2014; the control group comprised 101 older patients with BC. We correlated clinicopathological factors, treatments, relapse and exitus with age and with previously published miRNA expression data. We identified some significant differences in risk factors between BCVY and older patients. The age at menarche, number of pregnancies, and age at first pregnancy were lower in the BCVY group and had a greater probability of recurrence and death in all cases. Lymph node-positive patients in the BCVY group are associated with a worse prognosis (P = .02), an immunohistochemical HER2+ subtype, and disease relapse (P = .03). Moreover, there was a shorter time between diagnosis and first relapse in BCVY patients compared with controls, and they were more likely to die from the disease (P = .002). Finally, from our panel of miRNAs deregulated in BC, reduced miR-30c expression was associated with more aggressive BC in very young patients, lower overall survival, and with axillary lymph node metastases. Patient age and axillary lymph node status post-surgery are independent and significant predictors of distant disease-free survival, local recurrence-free survival, and overall survival. The HER2+ subtype and lower miR-30c expression are related to poor prognosis in lymph node-positive young BC patients.


Causes of elder abuse: caregiver stress versus problem relatives.
Elderly abuse victims and a nonabused control group were compared to test the widely accepted proposition that such abuse results from the burden and stress placed on those caring for infirm and dependent elderly people. The study found substantially more support for the idea that abuse is associated with personality problems of the caregiver.


Application of physical exercise therapies in breast cancer survivors and their effects on the inflammatory profile: A narrative review.
One of the adverse effects of cancer treatments is the exacerbation of inflammation, which generates numerous limitations and contributes to the development of several comorbidities and the recurrence of cancer itself. Physical exercise (PE) has been proposed as an efficient complementary strategy to combat the inflammatory effects of oncological treatments and to prevent the development of comorbidities, but its adequate application in breast cancer survivors (BCS) requires the establishment of consensuses and practical recommendations. This study aimed to review the randomized controlled trials that evaluated the influence of PE in the inflammatory profile of BCS. The search for articles published between 1999 and 2020 was done in PsycINFO, PubMed, Cochrane, Science Direct, and Scopus databases. Current knowledge reveals the effectiveness of PE in the functional independence and health of BCS. Evidence of the capacity of PE to improve the inflammatory profile and the immune response in BCS has also been described. However, the heterogeneity of the studies regarding structural training variables, types of exercise, stages of intervention, and severity of the disease, still do not allow the establishment of precise guidelines for the prescription and progression of exercise to improve the inflammatory process in BCS. . This review suggests a possible strategy to be used in the assessment, training prescription, and rehabilitation of BCS, to support the development of new studies and the work of exercise professionals in the prescription and application of physical training to improve health and inflammatory status in BCS.


Metagenomic analysis of oral plaques and aortic valve tissues reveals oral bacteria associated with aortic stenosis.
Bacteria derived from the oral cavity enter the bloodstream and cause the onset of various systemic diseases, including heart valve disease. However, information on the oral bacteria involved in aortic stenosis is limited. We comprehensively analyzed the microbiota in aortic valve tissues collected from aortic stenosis patients using metagenomic sequencing and investigated the relationships between the valve microbiota, the oral microbiota, and oral cavity conditions. Metagenomic analysis revealed the presence of 629 bacterial species in five oral plaques and 15 aortic valve clinical specimens. Patients were classified into two groups (A and B) according to their aortic valve microbiota composition using principal coordinate analysis. Examination of the oral conditions of the patients showed no difference in the decayed/missing/filled teeth index. Bacteria in group B tend to be associated with severe disease, and the number of bacteria on the dorsum of the tongue and the positive rate of bleeding during probing were significantly higher in this group than in group A. The pathophysiology of aortic stenosis may be related to the presence of oral bacteria such as Streptococcus oralis and Streptococcus sanguinis following bacteremia. Systemic inflammation in severe periodontitis may be driven by the oral microbiota, supporting the indirect (inflammatory) association between oral bacteria and aortic stenosis. Appropriate oral hygiene management may contribute to the prevention and treatment of aortic stenosis.


Amphipathic alpha-helical peptide, HP (2-20), and its analogues derived from Helicobacter pylori: pore formation mechanism in various lipid compositions.
In a previous study, we determined that HP(2-20) (residues 2-20 of parental HP derived from the N-terminus of Helicobacter pylori Ribosomal Protein L1) and its analogue, HPA3, exhibit broad-spectrum antimicrobial activity. The primary objective of the present study was to gain insight into the relevant mechanisms of action using analogues of HP(2-20) together with model liposomes of various lipid compositions and electron microscopy. We determined that these analogues, HPA3 and HPA3NT3, exert potent antibacterial effects in low-salt buffer and antifungal activity against chitin-containing fungi, while having little or no hemolytic activity or cytotoxicity against mammalian cell lines. Our examination of the interaction of HP(2-20) and its analogues with liposomes showed that the peptides disturb both neutral and negatively-charged membranes, as demonstrated by the release of encapsulated fluorescent markers. The release of fluorescent markers induced by HP(2-20) and its analogues was inversely related to marker size. The pore created by HP(2-20) shows that the radius is approximately 1.8 nm, whereas HPA3, HPA3NT3, and melittin have apparent radii between 3.3 and 4.8 nm. Finally, as shown by electron microscopy, the liposomes and various microbial cells treated with HPA3 and HPA3NT3 showed oligomerization and blebbing similar to that seen with melittin, while HP(2-20) exhibited flabbiness. These results suggest that HP(2-20) may exert its antibiotic effects through a small pore (about 1.8 nm), whereas HPA3 and HPA3NT3 formed pores of a size consistent with those formed by melittin.


Juvenile amaurotic idiocy (neuronal ceroid lipofuscinosis) and lymphocyte fingerprint profiles.
Lymphocytes from 3 children with a form of juvenile amaurotic idiocy (characterized by retinal blindness, progressive dementia, and extrapyramidal motor disturbance) were studied by electron microscopy. Numerous fingerprint profiles (FP) were found in vacuolated lymphocytes from all 3 patients and an asymptomatic younger sibling of 1 patient who subsequently became symptomatic. We propose that the combination of this clinical picture and vacuolated lymphocytes with FP is sufficiently distinctive for clinical and research purposes until the biochemical defect is discovered. Wider utilization of ultrastructural study of lymphocytes should increase the number of children diagnosed and allow detection of asymptomatic patients.


Cardiac Magnetic Resonance Imaging Versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement: A Randomized, Open-Label, Noninferiority Trial.
Computed tomography (CT) is recommended for guiding transcatheter aortic valve replacement (TAVR). However, a sizable proportion of TAVR candidates have chronic kidney disease, in whom the use of iodinated contrast media is a limitation. Cardiac magnetic resonance imaging (CMR) is a promising alternative, but randomized data comparing the effectiveness of CMR-guided versus CT-guided TAVR are lacking. An investigator-initiated, prospective, randomized, open-label, noninferiority trial was conducted at 2 Austrian heart centers. Patients evaluated for TAVR according to the inclusion criteria (severe symptomatic aortic stenosis) and exclusion criteria (contraindication to CMR, CT, or TAVR, a life expectancy <1 year, or chronic kidney disease level 4 or 5) were randomized (1:1) to undergo CMR or CT guiding. The primary outcome was defined according to the Valve Academic Research Consortium-2 definition of implantation success at discharge, including absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance. Noninferiority was assessed using a hybrid modified intention-to-treat/per-protocol approach on the basis of an absolute risk difference margin of 9%. Between September 11, 2017, and December 16, 2022, 380 candidates for TAVR were randomized to CMR-guided (191 patients) or CT-guided (189 patients) TAVR planning. Of these, 138 patients (72.3%) in the CMR-guided group and 129 patients (68.3%) in the CT-guided group eventually underwent TAVR (modified intention-to-treat cohort). Of these 267, 19 patients had protocol deviations, resulting in a per-protocol cohort of 248 patients (121 CMR-guided, 127 CT-guided). In the modified intention-to-treat cohort, implantation success was achieved in 129 patients (93.5%) in the CMR group and in 117 patients (90.7%) in the CT group (between-group difference, 2.8% [90% CI, -2.7% to 8.2%]; P<0.01 for noninferiority). In the per-protocol cohort (n=248), the between-group difference was 2.0% (90% CI, -3.8% to 7.8%; P<0.01 for noninferiority). CMR-guided TAVR was noninferior to CT-guided TAVR in terms of device implantation success. CMR can therefore be considered as an alternative for TAVR planning. URL: https://www. gov; Unique identifier: NCT03831087.


Stability of tryptophan during food processing and storage. 2. A comparison of methods used for the measurement of tryptophan losses in processed foods.
Tryptophan losses in stored milk powders and in different model systems representing the major reactions of food proteins during processing and storage were determined using four different chemical methods and in a rat assay. Similar tryptophan values were obtained by the three chemical methods which included high pressure liquid chromatography (HPLC) after sodium hydroxide hydrolysis, colorimetric reaction with p-dimethylamino-benzaldehyde (p-DAB) after barium hydroxide hydrolysis, and fluorescence of the Norharman derivative after NaOH hydrolysis. Tryptophan losses in the treated proteins as measured by the alkaline-hydrolysis methods were generally smaller than those determined by the rat assay. Good agreement however was obtained when the chemical value was multiplied by the true nitrogen digestibility. Determination of tryptophan by reaction with p-DAB after papain (EC 18.104.22.168) digestion gave lower values in the processed proteins than the other chemical methods or the rat assay. A method using alkaline-hydrolysis is recommended, preferably combined with HPLC-measurement of the liberated tryptophan.


Upper limb function of individuals hospitalized in intensive care: A 6-month cohort study.
Impaired physical function is a common complication in intensive care unit (ICU) patients. However, specific upper limb (UL) function is still poorly studied in this population. To evaluate UL function at discharge and after a 6-month follow-up of individuals hospitalized in the ICU. This was a longitudinal prospective 6-month multicentre cohort study with forty-six individuals hospitalized in the ICU undergoing mechanical ventilation for ≥ 48 h (ICU Group) and forty-six healthy individuals matched by sex, age, and socioeconomic status (control Group). The primary outcomes were measurements of UL disability using the Jebsen-Taylor Hand Function Test (JTT) and the Nine Hole Peg Test (NHPT). Secondary outcomes were physical function (Barthel index), muscle strength (Medical Research Council scale and hand grip strength), and quality of life (EuroQol-5 Dimension). All measurements were assessed after ICU discharge and at a 6-month follow-up. The JTT performance time in the ICU group after discharge was worse than that in the control group [121 s (86-165) vs. 54 s (49-61), median (IQR), p<0,001] and was reduced after 6 months [62 s (54-81), p<0,01]. The NHPT performance time at discharge in the ICU group was worse than that in the controls [39 s (33-59) vs. 21 s (20-23), p<0,001] and was reduced after 6 months of follow-up [24 s (21-27), p<0,01]. Physical function, muscle strength and quality of life were reduced after ICU discharge. Individuals hospitalized in the ICU presented with reduced UL function at discharge and at the 6-month follow-up.


Hypophosphite cross-linked starch succinate/chitosan membranes as alternative for packaging and pharmaceutical application.
The growing industrial demand for valuable biomaterials contributes to modifying readily available starch to give it the desired functional properties. The advantage of the reported studies was the modification of starch with succinic acid via sodium hypophosphite as a cross-linker. The cross-linked structure was confirmed with Raman, ATR-FTIR, 13C and 31P CP-MAS NMR spectroscopies. In the next step, the phosphonated starch succinate/chitosan materials were prepared for application in food packaging and coatings. The most desirable features for such employment were achieved, such as a low water vapour permeability through the membranes (~2 %) and accelerated biodegradability compared to starch film attributes. Significant differences in these properties resulting from the time of synthesis and the quantitative composition of the films were verified. The longer synthesis time of composites affected the better mechanical properties (Elongation at break, εb =~91-94 %, and Young's Modulus, E = 140-160 MPa). Thermal parameters (including FTIR analysis of gaseous products evolved during the thermal decomposition) were confirmed. The changes in ordering behaviour (crystallinity degree, Xc) determined with XRD varied from 23 % (for the starch film) to 10-21 % (starch in composites). Obtained biodegradable starch-based materials may constitute an attractive ecological alternative for plastics.


Snoring effects on the baroreflex: an animal model.
Baroreflex sensitivity (BRS) is reduced in humans during snoring, however the mechanisms are unknown. We used an anaesthetised rabbit induced snoring (IS) model, to test: (1) whether IS was associated with reduced BRS; and (2) if snoring related vibration transmission to peri-carotid tissues influenced BRS levels. BRS was quantified using the spontaneous sequence technique. During IS, BRS fell by 40%, without any associated change in blood pressure (BP) but accompanied by an increase in heart rate (HR). Direct application of a snore frequency and intensity matched vibratory stimulus to the peri-carotid tissues of non-snoring tracheostomised rabbits had no effect on BRS, HR or BP. In conclusion, IS induced depression of BRS is likely mediated via a HR driven change in BRS operating point that is unrelated to snoring-related vibration transmission to carotid baroreceptors. The anaesthetised IS rabbit provides a model in which mechanistic interactions between snoring and BRS can be further explored.


Hand in hand: patient and employee satisfaction.
When you make your hospital the kind of place where employees can do their best work, you create an environment that attracts patients.


Blood-building foods in contemporary Chinese populations.
According to ancient Chinese medicine, "weak blood" is a yin condition that occurs during growth, pregnancy, the postpartum period, and old age. Treatment requires use of special foods that are "yang" in nature. This article investigated the use of such blood-building foods in seven contemporary Chinese populations throughout the world. Analysis of questionnaires from 379 respondents indicated that high-protein foods, such as pork liver and other meats, were recommended most often. Although these and other foods recommended were primarily yang, only 8.1% of respondents considered weak blood a "yin" condition. Comparison of 717 responses concerning foods that should be used to treat weak blood showed more similarities than differences between Chinese populations in different parts of the world. Strong adherence to cultural practices was also evident. Self-diagnosis and self-prescription are common modes of treating symptoms in the Chinese and other cultures. Knowledge of beneficial food-related health practices can enable practitioners to counsel their clients more effectively and to develop bilingual educational materials that incorporate familiar cultural practices.


Distinct interaction of versican/PG-M with hyaluronan and link protein.
The proteoglycan aggregate is the major structural component of the cartilage matrix, comprising hyaluronan (HA), link protein (LP), and a large chondroitin sulfate (CS) proteoglycan, aggrecan. Here, we found that another member of aggrecan family, versican, biochemically binds to both HA and LP. Functional analyses of recombinant looped domains (subdomains) A, B, and B' of the N-terminal G1 domain revealed that the B-B' segment of versican is adequate for binding to HA and LP, whereas A and B-B' of aggrecan bound to LP and HA, respectively. BIAcore trade mark analyses showed that the A subdomain of versican G1 enhances HA binding but has a negligible effect on LP binding. Overlay sensorgrams demonstrated that versican G1 or its B-B' segment forms a complex with both HA and LP. We generated a molecular model of the B-B' segment, in which a deletion and an insertion of B' and B are critical for stable structure and HA binding. These results provide important insights into the mechanisms of formation of the proteoglycan aggregate and HA binding of molecules containing the link module.


Biological adhesion in seagrasses: The role of substrate roughness in Posidonia oceanica (L.) Delile seedling anchorage via adhesive root hairs.
Seagrasses are marine flowering plants that developed several adaptive traits for living in submerged waters. Among this group, Posidonia oceanica (L.) Delile is the dominant species of the Mediterranean Sea, forming persistent meadows that provide valuable ecosystem services to human communities. P. oceanica seedlings can anchor to rocky substrates through adhesive root hairs. Here we investigate, for the first time, the bioadhesion process in seagrasses. Seedlings were grown on substrates provided with different roughness in order to identify mechanisms involved in the adhesion process. Root anchorage strength was measured through a peel test and hair morphology at different micro-roughness was analysed by electron and fluorescence microscopy. Maximum anchorage strength was recorded at roughness levels between 3 and 26 μm, while on finer (0.3) and coarser (52, 162 μm) roughness attachment was weaker. No attachment was obtained on smooth surfaces. Accordingly, root hair tip morphology strongly responded to the substrate. Morphological adaptation of the root hairs to surface topography and mechanical interlocking into the micro-roughness of the substrate appear the main mechanisms responsible for bioadhesion in the system under study. Substrate roughness at the scale of microns and tens of microns is pivotal for P. oceanica seedling attachment to take place. These findings contribute to identification of features of optimal microsite for P. oceanica seedling settlement and to the development of novel approaches to seagrass restoration that take advantage of species' key life history traits.


Does the pulvinar-LP complex contribute to motor programming?
Extracellular unit recording studies in the pulvinar lateral posterior complex (Pul-LP) of behaving monkeys have shown a response property not previously reported. In monkeys performing aimed arm reaching movements towards frontally located targets some cells showed a change in activity beginning 495 +/- 84 ms before the onset of the reaching movement. This change in frequency precedes that observed in primary motor and parietal posterior cortex for reaching movements. These findings seem to indicate the involvement of the Pul-LP in motor functions and suggest its possible contribution to motor programming.


Massive mediastinal hemorrhage following treatment of hyperthyroidism with radioactive iodine.
A case of superior mediastinal hemorrhage is described which was caused by necrosis of retrosternal thyroid tissue, following treatment with radioactive iodine.


Enrollment Matters: The Reality of Disparity and Pursuit of Equity in Clinical Trials.
Disparities in clinical trial enrollment persist, fortified by the foundation and historical ideologies undergirding clinical cancer research. The scientific community has an ethical responsibility to seize the current moment to deconstruct and reconstruct these paradigms for more equitable research.


[In vitro gene transfection into rabbit articular chondrocytes mediated by recombinant adeno-associated virus vector].
To investigate the in vitro efficiency of recombinant adeno-associated virus (rAAV2) vector-mediated gene transfection into the rabbit articular chondrocytes. Articular chondrocytes were isolated from New Zealand rabbits, cultured, and transfected with rAAV2 containing enhanced green fluorescent protein (eGFP) gene at different values multiplicity of infection (MOI). Successful transfection of chondrocytes was confirmed by detection of recombinant enhanced green fluorescent protein using inverted fluorescence microscopy. The transfection efficiency was determined using the fluorescence-activated cell sorter. A maximum level of 4.76% was set as the background autofluorescence in live, uninfected chondrocytes. The percentage of eGFP-positive chondrocytes increased in a vector dose-dependent manner. When the MOI value was <1 x 10(5) v.g./cell the transfection rate was positively linearly correlated with the dose. However, the MOI > 10(5) v.g./cell did not markedly increase the transfection rate. The greatest population of eGFP-expressing cells was 97.7% and the highest mean fluorescence intensity was 17.4 7 days after transfection. EGFP gene expression remained high until 56 days after transfection. The in vitro efficiency of rAAV2 vector-mediated eGFP gene transfection into rabbit articular chondrocytes was high. The eGFP expression can be maintained for a rather long time. EGFP gene is an ideal tracer for chondrocytes transduction.


Pneumomediastinum and pneumothorax during emergency tracheotomy under spontaneous ventilation: Macklin meets Müeller?
Potentially serious complications associated to emergency tracheotomy continue being a matter of concern. We review the pathogenesis of gas leakage in this setting and discuss about the possible mechanisms involved in its cause. We present two cases of pneumomediastinum, subcutaneous emphysema and pneumothorax in the context of emergency tracheotomy under spontaneous ventilation, finally resolved by chest drainage. The combination of overly negative pleural pressures due to extreme inspiratory efforts in the context of an almost completely obstructed airway together with over-pressurized alveoli because of gaseous entrapment secondary to serious expiratory obstruction appears to be the most plausible primary cause of air leaks in our patients. Understanding the underlying mechanisms evolved in its production will help clinicians to suspect and diagnose this phenomenon.


Melatonin alleviates arsenite toxicity by decreasing the arsenic accumulation in cell protoplasts and increasing the antioxidant capacity in rice.
Arsenic (As) is a common environmental pollutant that seriously interferes with the normal growth of organisms. There is an urgent need to take environment-safe and efficient strategies to mitigate As toxicity. Melatonin (MT) is a pleiotropic molecule that regulates plant growth and organ development and alleviates heavy metal stresses. The experiment aims to explore the mechanism of MT in reducing arsenite toxicity by hydroponic rice seedlings. The results showed that MT application reduced the As content in rice roots and shoots by 26.4% and 37.5%, respectively, and mainly decreased As content in the soluble fractions of the rice root cell. MT application also increased the As content of chelated-soluble pectin and alkali-soluble pectin in the cell wall by 14.7% and 74.4%, respectively. It promoted the generation of the functional group of the root cell walls by the FTIR analysis, indicating that MT may promote the fixation of As on the cell wall. Meanwhile, MT contributed to scavenging excess H2O2, reducing MDA content, and maintaining normal morphology of root cells by stimulating SOD, POD and CAT activities and increasing the level of GSH. The research deepens our understanding of how MT participates in maintaining redox homeostasis in rice cells, reducing As toxicity, and decreasing As concentration in rice seedlings, thereby providing more possibilities for reducing As accumulation in rice.


Capsule neural tensor networks with multi-aspect information for Few-shot Knowledge Graph Completion.
Few-shot Knowledge Graph Completion (FKGC) has recently attracted significant research interest due to its ability to expand few-shot relation coverage in Knowledge Graphs. Prevailing FKGC approaches focus on exploiting the one-hop neighbor information of entities to enhance few-shot relation embedding. However, these methods select one-hop neighbors randomly and neglect the rich multi-aspect information of entities. Although some methods have attempted to leverage Long Short-Term Memory (LSTM) to learn few-shot relation embedding, they are sensitive to the input order. To address these limitations, we propose the Capsule Neural Tensor Networks with Multi-Aspect Information approach (short for InforMix-FKGC). InforMix-FKGC employs a one-hop neighbor selection strategy based on how valuable they are and encodes multi-aspect information of entities, including one-hop neighbors, attributes and literal description. Then, a capsule network is responsible for integrating the support set and deriving few-shot relation embedding. Moreover, a neural tensor network is used to match the query set with the support set. In this way, InforMix-FKGC can learn few-shot relation embedding more precisely so as to enhance the accuracy of FKGC. Extensive experiments on the NELL-One and Wiki-One datasets demonstrate that InforMix-FKGC significantly outperforms ten state-of-the-art methods in terms of Mean Reciprocal Rank and Hits@K.


Trace-level detection of sulfonamide antibiotics using quaternary ammonium polymeric ionic liquid-based effervescence-enhanced dispersive solid-phase extraction followed by LC-DAD analysis in environmental waters.
Conventional ionic liquids possess several disadvantages, such as high viscosity, difficult sampling/retrieval, and great loss in aqueous solution, limiting their wide applications in the pretreatment field. To solve these drawbacks, we synthesized a quaternary ammonium polymeric ionic liquid (PIL) and pressed it into an effervescent tablet for developing an effervescence-enhanced dispersive solid-phase extraction method (QAP-EDSE). The pressed effervescent tablet was composed of PIL as an extractant, tartaric acid as an acidic source, NaHCO3 as an alkaline source, and water-soluble starch as a filler, respectively. Under the CO2-driven dispersion, the QAP-EDSE method integrated rapid enrichment, extraction, and dispersion into one synchronous step. Employing the one-factor-at-a-time approach, several important variables were optimized as follows: 200 mg of P[VBTHEA]Cl as sorbent, 400 μL of acetone as elution solvent, 5 min of elution, solution pH 9.0, and 1 : 1.25 molar ratio of alkaline to acidic sources. Combining LC-DAD analysis, this proposed approach offered the limits of detection as low as 0.11-0.31 μg L-1 and satisfactory recoveries of 81.40-102.62% for five sulfonamides (SAs) in environmental waters. The lower relative standard deviations (1.9-6.7%) evidenced the higher intraday and interday experimental precision by this method. Overall, the newly developed method is environmentally benign, time-saving, and easy to operate with low detection limit and high recovery and thus shows excellent prospects in the trace-level detection of SAs in environmental waters.


Serum uric acid level negatively correlated with the prevalence of clopidogrel low response in patients undergoing antiplatelet treatment with aspirin and clopidogrel.
It has been reported that elevated serum uric acid (SUA) is related to inflammation and potentially to platelet hyper-reactivity. However, the relationship between elevated SUA and residual platelet reactivity is uncertain in patients on dual antiplatelet treatment (DAPT) with aspirin and clopidogrel. A cross-sectional cohort study was conducted on 2569 patients undergoing DAPT with aspirin and clopidogrel. Patients' SUA levels, residual platelet aggregation, routine blood tests and clinical characteristics were recorded. The relationship between SUA level and residual platelet aggregation was assessed by correlation analysis, and the relationship between SUA level and the prevalence of clopidogrel low response (CLR) was assessed by multivariate logistic regression analysis. Adenosine diphosphate (ADP) induced platelet aggregation (PLADP) was higher in normal-SUA group than that in hyperuricemia group [30(21, 40) % vs. 27(19, 39) %, p = 0.032]. No significant difference was found for arachidonic acid (AA) induced platelet aggregation (PLAA) between the two groups [4(2, 5) % vs. 3(2, 5) %, p = 0.557]. The correlation between SUA and PLADP was statistically significant(r = -0.115, p < 0.001), while that between SUA and PLAA was non-significant (r = -0.012, p = 0.643). Using the multivariate logistic regression analysis, higher SUA concentration was associated with a decreased risk of clopidogrel low response (CLR) (OR [95%CI] = 0.997 [0.995-0.999], p = 0.001). This is the largest study to date showing that in patients receiving DAPT with aspirin and clopidogrel, SUA is independently and negatively associated with the prevalence of clopidogrel low response. URL: http://www.clinicaltrials.gov Unique Identifier: NCT01955200.


Advocating for Mental Health Nursing Care Education Using a Flipped Classroom.
Educators are challenged to meet the needs of all student learning styles. Nursing educators care deeply about student perceptions, but understand the need for critical thinking in student learning outcomes. The need for mental health nursing care touches every nursing specialty. The concepts are abstract and complex, with many unknowns concerning the mind. The flipped classroom (FC) provides an opportunity for students to explore the concepts prior to classroom learning. This article describes an initiative to integrate an FC approach with a population of baccalaureate nursing students over the course of five semesters.


[Opportunistic microbial infections and their importance in general pathology].
Opportunist germs are commensal bacteria or fungi of the skin and mucosae or saprophytes of the external media, which become virulent when general or local resistance of the organism is lowered. Under the influence of favouring factors, mainly certain drugs, infections due to opportunist germs are becoming more and more frequent, mainly in hospitals, constant or occasional contact of man with these bacteria make diagnosis and prophylaxis of their infections difficult.


Polyclonal antibodies against malondialdehyde-modified proteins: characterization and application in study of in vitro lipid peroxidation of cellular membranes.
In order to develop an immunofluorescent technique able to detect the cellular damage induced by lipid peroxidation, we produced rabbit polyclonal antibodies (AbAIP) against malondialdehyde (MDA)-modified lysozyme. These antibodies specifically recognized all the MDA-treated proteins tested, but not native proteins or proteins treated by other aldehydes. Moreover, we showed by an enzyme-linked immunosorbent assay (ELISA) that the amount of immunoreactive protein in MDA-treated erythrocytes was proportional to the concentration of MDA added, suggesting that this ELISA measurement may represent a quantitative determination of peroxidative protein alterations. In addition, when coupled to an indirect fluorochrome antibody conjugate [fluorescein isothiocyanate (FITC)], these antibodies permitted precise localization of the modified proteins within the membranes of peroxidized cells.


The coevolution of Euphydryas chalcedona butterflies and their larval host plants : III. Oviposition behavior and host plant quality.
Oviposition host preference of the checkerspot butterfly, Euphydryas chalcedona, was examined in relation to the nutritional qualities of two regularly-used larval host plants. In many coastal-California colonies, E. chalcedona larvae feed primarily on a common drought-deciduous shrub, Diplacus aurantiacus, but also use an herbaceous perennial, Scrophularia californica. Diplacus has been shown to be nutritionally inferior to Scrophularia, however, Diplacus may be a more persistant resource in ecological and evolutionary time. In both greenhouse and field trials, butterflies strongly preferred to oviposit on Scrophularia, but would oviposit on Diplacus if Scrophularia was not available. Host preference of adults was not related to their larval feeding experience. In trials testing the effects of sun and shade on oviposition behavior, E. chalcedona preferred to oviposit on hosts in sun. Scrophularia often occurs in shadier habitats than Diplacus and Scrophularia plants placed in shade were accepted more often than Diplacus plants placed in the shade. Host use by E. chalcedona butterflies appears to reflect a trade-off between nutritional quality and resource relability.


Cattle-FRETS71, a novel fluorogenic substrate with broad applicability for characterizing ADAMTS13 properties and function.
Current ADAMTS13 activity assays are important for diagnosing thrombotic thrombocytopenic purpura (TTP) but are unreliable to assay ADAMTS13 activity in animal models. The Cattle-FRETS71 assay is capable of detecting ADAMTS13 activity in plasma from multiple animal species, making it a potentially useful reagent at all stages of clinical research. The performance of Cattle-FRETS71 in TTP diagnosis is not yet known. We evaluated the performance of the Cattle-FRETS71 substrate against the human FRETS-rVWF71 and the FRETS-VWF73 commercial substrates in human plasma and serum samples to validate its utility in diagnosing TTP in patients. Internal validation was performed using heparinized plasma samples (n = 81). External validation was a blinded study using serum samples from the Oklahoma TTP Registry (n = 118, collected 2004-2014) that had been initially assayed by FRETS-VWF73 within 1 year of collection. Additional validation was performed with citrated plasma samples with variable ADAMTS13 activities (n = 32) that were analyzed by FRETS-VWF73. There was an excellent correlation (r = 0.94) between Cattle-FRETS71 and FRETS-rVWF71 for assayed heparinized plasma samples (n = 81). Assay results between Cattle-FRETS71 and FRETS-VWF73 of Oklahoma TTP Registry serum samples (n = 118) and citrated plasma samples (n = 32) were comparably good (r = 0.81 and r = 0.85, respectively). The Cattle-FRETS71 assay is comparable with other assays in quantifying ADAMTS13 activity in human plasma collected from patients with documented or suspected TTP. The versatility of Cattle-FRETS71, combined with its specificity and sensitivity, makes it a useful tool for the standardization of ADAMTS13 activity across basic and clinical research paradigms.


Correction: Lange et al. Performance of a Piezoelectric Energy Harvesting System for an Energy-Autonomous Instrumented Total Hip Replacement: Experimental and Numerical Evaluation. Materials 2021, 14, 5151.
The authors wish to make the following corrections to their paper [...].


Hand preference and proficiency and cerebral speech dominance determined by the carotid amytal test.
Epileptic patients whose speech dominance had been determined with the carotid amytal test were given tests of hand preference, strength, and dexterity. A Discriminant Function Analysis applied to the data correctly identified the side of speech representation in 89.5% of the sample.


Calcium ions in the presence of exogenous phosphatidylserine interfere with GABA diffusion through the Deiters' neuron membrane.
Diffusion of GABA through the plasma membrane of GABA-acceptive neurons might be a mechanism of importance for the termination of its synaptic action. In the present investigation we studied the effects of phosphatidylserine (PS) (10(-4)-10(-3) M), Ca2+ 2 mM and PS + 2 mM Ca2+ on such a process. The method involved the use of single microdissected Deiters' membranes which were put between two small microchambers in order to study the passage of GABA across the membrane. The results show that whereas PS and Ca2+ by themselves have no effect on such a process, PS + 2 mM CaCl2 give a significant, although slight, inhibition. The hypothesis that Calcium ion + PS effect is due to a disturbance of the interaction between GABA and endogenous PS molecules of the membrane is discussed.


The effects of person-related and environmental factors on consumers' decision-making in agri-food markets: The case of olive oils.
Refined olive oil (ROO) and extra virgin olive oil (EVOO) categories are different products with respect to their objective quality. Nevertheless, this quality gap is not reflected in the purchase behaviour of consumers in Spain, which is the main producer country worldwide. On the basis of economic theory, the price gap could be a part of the explanation; however, the objective price gap between EVOO and ROO has been on average around €0.40 kg-1 since the 2007/2008 crop year in Spain. Therefore, this paper contributes to a more in-depth understanding of those factors, besides price, affecting consumers' decision-making process in olive oil markets. We examine how consumers build their purchase preferences towards two products - namely EVOO and ROO-based on their evaluative judgements shaped by person-related and environmental factors. In doing so, a theoretical model is proposed and an empirical application in southern Spain is presented, using variance-based structural equation modelling (SEM) by means of partial least squares path modelling (PLS). The results show how attitude towards EVOO and ROO play a key role in explaining both EVOO and ROO consumption. In addition, taste preferences are shown to have an overriding moderator effect on the relationship between attitude towards ROO and consumption. Negative anticipated consequences regarding EVOO are core to shape consumers' attitude towards ROO and also influence attitude towards the own product. Meanwhile, healthy shopping habits affect mainly attitude towards EVOO and the perceived value of private brands influences attitude towards ROO.


Draft genomic and transcriptome resources for marine chelicerate Tachypleus tridentatus.
Chinese horseshoe crabs (Tachypleus tridentatus), ancient marine arthropods dating back to the mid-Palaeozoic Era, have provided valuable resources for the detection of bacterial or fungal contamination. However, excessive exploitation for the amoebocyte lysate of Tachypleus has dramatically decreased the population of the Chinese horseshoe crabs. Thus, we present sequencing, assembly and annotation of T. tridentatus, with the hope of understanding the genomic feature of the living fossil and assisting scientists with the protection of this endangered species. The final genome contained a total size of 1.943 Gb, covering 90.23% of the estimated genome size. The transcriptome of three larval stages was constructed to investigate the candidate gene involved in the larval development and validate annotation. The completeness of the genome and gene models was estimated by BUSCO, reaching 96.2% and 95.4%, respectively. The synonymous substitution distribution of paralogues revealed that T. tridentatus had undergone two rounds of whole-genome duplication. All genomic and transcriptome data have been deposited in public databases, ready to be used by researchers working on horseshoe crabs.


Deficiencies of copper and a compound with ion-exchange characteristics of pyridinoline in skin from patients with abdominal aortic aneurysms.
A spontaneously aneurysm-prone mouse has a mutation on the X chromosome, which results in an abnormality of copper metabolism. A deficiency of the copper metalloenzyme, lysyl oxidase, results in a deficiency of lysyl-derived cross-linkages in collagen and elastin. Homology of the X chromosome suggests that this model may be relevant to the human abdominal aortic aneurysm (AAA). The present studies on skin from eight AAA patients suggest that copper deficiency occurs in humans, by comparison to skin of paired control subjects with atherosclerotic occlusive disease of the aorta. The lysyl-derived cross-linkage pyridinoline (or some compound with similar ion exchange elution characteristics) is also deficient in patients with AAA; while there is an excess of one of the cross-linkage precursors, hydroxylysine. In addition, the fluorescent properties of hydrolysates of skin from the patients with AAA differ from those of the controls, suggesting that simple biochemical markers might be defined on the basis of these differences in the future. These experiments support the hypothesis that the mouse model is relevant to the disease as it occurs in humans.


A morphometric study of nuclei, nucleoli and nuclear bodies in goitres and papillary thyroid carcinomas.
Significant positive correlations were found between the nuclear surface-to-volume ratio and the volumetric density of nucleoli, as well as between the volumetric density of nucleoli and the volumetric and numerical densities of complex nuclear bodies in goitres and papillary thyroid carcinomas.


Characterization of tRNA expression profiles in large offspring syndrome.
Assisted Reproductive Technologies (ART) use can increase the risk of congenital overgrowth syndromes, such as large offspring syndrome (LOS) in ruminants. Epigenetic variations are known to influence gene expression and differentially methylated regions (DMRs) were previously determined to be associated with LOS in cattle. We observed DMRs overlapping tRNA clusters which could affect tRNA abundance and be associated with tissue specificity or overgrowth. Variations in tRNA expression have been identified in several disease pathways suggesting an important role in the regulation of biological processes. Understanding the role of tRNA expression in cattle offers an opportunity to reveal mechanisms of regulation at the translational level. We analyzed tRNA expression in the skeletal muscle and liver tissues of day 105 artificial insemination-conceived, ART-conceived with a normal body weight, and ART-conceived bovine fetuses with a body weight above the 97th percentile compared to Control-AI. Despite the centrality of tRNAs to translation, in silico predictions have revealed dramatic differences in the number of tRNA genes between humans and cattle (597 vs 1,659). Consistent with reports in human, only a fraction of predicted tRNA genes are expressed. We detected the expression of 474 and 487 bovine tRNA genes in the muscle and liver with the remainder being unexpressed. 193 and 198 unique tRNA sequences were expressed in all treatment groups within muscle and liver respectively. In addition, an average of 193 tRNA sequences were expressed within the same treatment group in different tissues. Some tRNA isodecoders were differentially expressed between treatment groups. In the skeletal muscle and liver, we categorized 11 tRNA isoacceptors with undetected expression as well as an isodecoder that was unexpressed in the liver (SerGGA). Our results identified variation in the proportion of tRNA gene copies expressed between tissues and differences in the highest contributing tRNA anticodon within an amino acid family due to treatment and tissue type. Out of all amino acid families, roughly half of the most highly expressed tRNA isoacceptors correlated to their most frequent codon in the bovine genome. Although the number of bovine tRNA genes is nearly triple of that of the tRNA genes in human, there is a shared occurrence of transcriptionally inactive tRNA genes in both species. We detected differential expression of tRNA genes as well as tissue- and treatment- specific tRNA transcripts with unique sequence variations that could modulate translation during protein homeostasis or cellular stress, and give rise to regulatory products targeting genes related to overgrowth in the skeletal muscle and/or tumor development in the liver of LOS individuals. While the absence of certain isodecoders may be relieved by wobble base pairing, missing tRNA species could increase the likelihood of mistranslation or mRNA degradation.


The embolization of vascular malformations of the spinal cord with low-viscosity silicone rubber.
Development of the low-viscosity silicone rubber has made possible the successful embolization and complete obliteration of 9 out of 11 vascular malformations of the spinal cord treated with this material. The procedure is particularly useful in patients where the malformation is fed by a limited number of posterior radicular feeders without any supply from the anterior spinal artery. One patient with a supply from the anterior spinal artery. One patient with a supply from both anterior and posterior feeders was successfully embolized after a temporary occlusion of the anterior spinal radicular feeder. Seven patients out of 11 embolized with silicone rubber showed a clinical improvement of their signs and symptoms.


Polymerase chain reaction for the differentiation of Mycobacterium intracellulare and Mycobacterium avium.
Polymerase chain reaction (PCR) amplification was performed using DNA purified from 15 mycobacterial type strains and from 21 specimens isolated from patients suspected to have non-tuberculous mycobacterial diseases. Using a primer set of MTB1-MTB2, 11 specimens out of 21 were Mycobacterium avium and 8 were M. intracellulare, which were verified by the Gen Probe Rapid Diagnostic System for the M. avium complex (MAC). One of the remaining 2 specimens which did not hybridize with the probe for the MAC was identified as M. kansasii and the other was not specifically identified by the conventional culture method. PCR amplification, using a primer set of TB1-TB3, was also performed for the specific identification of M. tuberculosis complex.


Intracranial leiomyosarcoma: a neuro-oncological consequence of acquired immunodeficiency syndrome.
Leiomyosarcoma has recently been identified as an AIDS-related tumor, usually occurring in children in the chest or abdomen. We describe a case of intracranial leiomyosarcoma in an adult with AIDS. An enhancing mass adjacent to the right occipital cortical surface was diagnosed during a work-up for left arm weakness. Imaging characteristics were suggestive of a malignant neoplasm versus meningioma. The patient had a craniotomy for total excision of the lesion. Pathology showed a leiomyosarcoma. Metastatic work-up was negative. The patient refused radiation therapy, but is well without evidence of recurrence at 8 months follow-up. The differential diagnosis for intracranial lesions in AIDS should be expanded to include leiomyosarcoma. Surgical resection of the lesion is recommended.


Cartilage protective and anti-analgesic effects of ALM16 on monosodium iodoacetate induced osteoarthritis in rats.
Osteoarthritis (OA) is an age-related joint disease with characteristics that involve the progressive degradation of articular cartilage and resulting chronic pain. Previously, we reported that Astragalus membranaceus and Lithospermum erythrorhizon showed significant anti-inflammatory and anti-osteoarthritis activities. The objective of this study was to examine the protective effects of ALM16, a new herbal mixture (7:3) of ethanol extracts of A. membranaceus and L. erythrorhizon, against OA in in vitro and in vivo models. The levels of matrix metalloproteinase (MMP)-1, -3 and - 13 and glycosaminoglycan (GAG) in interleukin (IL)-1β or ALM16 treated SW1353 cells were determined using an enzyme-linked immunosorbent and quantitative kit, respectively. In vivo, the anti-analgesic and anti-inflammatory activities of ALM16 were assessed via the acetic acid-induced writhing response and in a carrageenan-induced paw edema model in ICR mice, respectively. In addition, the chondroprotective effects of ALM16 were analyzed using a single-intra-articular injection of monosodium iodoacetate (MIA) in the right knee joint of Wister/ST rat. All samples were orally administered daily for 2 weeks starting 1 week after the MIA injection. The paw withdrawal threshold (PWT) in MIA-injected rats was measured by the von Frey test using the up-down method. Histopathological changes of the cartilage in OA rats were analyzed by hematoxylin and eosin (H&E) staining. ALM16 remarkably reduced the GAG degradation and MMP levels in IL-1β treated SW1353 cells. ALM16 markedly decreased the thickness of the paw edema and writhing response in a dose-dependent manner in mice. In the MIA-induced OA rat model, ALM16 significantly reduced the PWT compared to the control group. In particular, from histological observations, ALM16 showed clear improvement of OA lesions, such as the loss of necrotic chondrocytes and cartilage erosion of more than 200 mg/kg b.w., comparable to or better than a positive drug control (JOINS™, 200 mg/kg) in the cartilage of MIA-OA rats. Our results demonstrate that ALM16 has a strong chondroprotective effect against the OA model in vitro and in vivo, likely attributed to its anti-inflammatory activity and inhibition of MMP production.


Myelin-associated glycoprotein (MAG) distribution in human central nervous tissue studied immunocytochemically with monoclonal antibody.
Recent biochemical data show that myelin-associated glycoprotein (MAG) is the antigen for a monoclonal antibody found in sera of patients with IgM paraproteinemia and neuropathy (Braun et al. 1982). Immunoreactivity of this antibody with CNS has not been described. To study this, monoclonal anti-MAG was used in the avidin-biotin-peroxidase complex method (Hsu et al. 1981) to immunostain paraffin and epon sections of human CNS. Well characterized polyclonal MAG antiserum (Quarles et al. 1981) was employed in comparison tests. In paraffin sections of developing CNS, both monoclonal and polyclonal MAG antisera stained oligodendroglia and myelin. In adult CNS, periaxonal regions of myelin sheaths were immunostained in paraffin sections and semithin epon sections treated with monoclonal and polyclonal anti-MAG. In electron-microscopic experiments that included milder pretreatment of epon thin sections and more precise reaction product localization, entire thickness of myelin sheaths were immunostained. Thus, in electron micrographs, monoclonal and polyclonal anti-MAG immunoreactivity also have the same localization. In other electron-microscopic experiments, the same reaction product localization was observed with antiserum to myelin basic protein (MBP), a known constituent of compact myelin. Thus, results with this monoclonal anti-MAG provide important new evidence to support the localization of MAG in compact CNS myelin. Our data also suggest that monoclonal antibodies against MAG will be useful in studies of the pathogenesis of multiple sclerosis and other demyelinating diseases.


Pure cultures for synthetic culture development: Next level municipal waste treatment for polyhydroxyalkanoates production.
Polyhydroxyalkanoates (PHAs), as bio-based plastics, promise a transition from petroleum products to green and sustainable alternatives. However, their commercial production is yet impeded by high production costs. In this study, we assessed synthetic culture in mono and co-culture modes for bacterial PHA production. It was demonstrated that volatile fatty acids (VFAs) derived from food waste and primary sludge are cheap carbon sources for maintaining high production yields in the synthetic cultures. The maximum obtained PHA was 77.54 ± 5.67% of cell dried weight (CDW) (1.723 g/L) from Cupriavidus necator and 54.9 ± 3.66% of CDW (1.088 g/L) from Burkholderia cepacia. The acquired results are comparable to those in literature using sugar substrates. Comparatively, lower PHA productions were obtained from the co-cultivations ranging between 36-45 CDW% (0.39-0.48 g/L). Meanwhile, the 3-hydroxyvalerate content in the biopolymers were increased up to 21%.


Challenges and Therapeutic Opportunities of Autophagy in Cancer Therapy.
Autophagy is a physiological cellular process that is crucial for development and can occurs in response to nutrient deprivation or metabolic disorders. Interestingly, autophagy plays a dual role in cancer cells-while in some situations, it has a cytoprotective effect that causes chemotherapy resistance, in others, it has a cytotoxic effect in which some compounds induce autophagy-mediated cell death. In this review, we summarize strategies aimed at autophagy for the treatment of cancer, including studies of drugs that can modulate autophagy-mediated resistance, and/or drugs that cause autophagy-mediated cancer cell death. In addition, the role of autophagy in the biology of cancer stem cells has also been discussed.


[Study of human psychophysiological features during in-depth occupational counseling].
The paper considers a complex of methods used in diagnostic psychophysiological studies in consulting practice by using a computer "Psychomat" complex.


Lower education is an associated factor with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis?
To analyze if socioeconomic characteristics as lower education and lower family income are associated factors with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis (KOA). This cross-sectional study included 140 participants aged 40 years or older with KOA grades II and III. Based on the Pain Catastrophizing Scale (PCS) and the Tampa Scale of Kinesiophobia (TSK), four groups were identified: non-catastrophic/non-kinesiophobic (NC/NK), non-catastrophic/non-kinesiophobic (NC/K), catastrophic/non-kinesiophobic (C/NK), and catastrophic/kinesiophobic (C/K). Pain intensity was measured using the visual analog scale (VAS). The 30-s chair stand test was performed to access physical function. Sociodemographic characteristics included age, sex, years of formal education (0 to 11 and > 11), and family income (up to 2 minimum wages and > 2). Multinomial regression analysis adjusted for age, radiographic severity, physical function, and pain intensity was used to determine the association between lower education and lower family income with the combination of pain catastrophizing and kinesiophobia. Only lower education was independently associated with the combination of pain catastrophizing and kinesiophobia (OR = 3.96 CI 95% 1.01-15.51). Lower education but not lower family income was an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. Thus, physician and physical therapist must pay attention on this important socioeconomic characteristic while conducting the treatment, since specific strategies of approach could be necessary for those patients. Key points • Lower education is an important associated factor with the combination of pain catastrophizing and kinesiophobia in individuals with knee osteoarthritis. • Physician and physical therapist must pay attention on patients schooling while conducting the treatment.


Long-term changes in the inversion chromosomal polymorphism: Drosophila subobscura population from Rasht (north of Iran).
Drosophila subobscura is characterized by a rich chromosomal polymorphism for inversions. Many inversions are adaptive to global warming and can be classified as 'warm' or 'cold' adapted. However, most studies were carried out from European populations located in the central area of the species distribution or from American colonizing populations. For this reason, we aimed to analyse the isolated and marginal Rasht population, located in the Hyrcanian forests area (Iran). The chromosomal polymorphism for inversions was compared with the previous Rasht samples (Rasht I and II) obtained 57 years ago. This polymorphism has changed based on the inversion composition and frequencies. Interestingly, the polymorphism for inversions was scarce and similar to that of Madeira, an isolated Atlantic island. Likely, this similarity is a consequence of the marginal location and isolation of the Rasht population. Also, the chromosomal thermal index (CTI) was 0.445, showing a significant increase over those from Rasht I (0.184) and II (0.210). All these observations were in agreement with the global warming expectations. Moreover, the CTI was also computed for Russian Caucasus and Turkish populations collected more than 40 years ago to better understand the adaptive potential of D. subobscura and to study the similarity between populations of different geographic areas. In summary, the inversions of D. subobscura also changed in marginal and isolated populations in agreement with the global warming expectations, and an open question is to know where is the threshold for this evolutionary change.


Risk analysis of Leksell Gamma Knife Model C with automatic positioning system.
This study was conducted to evaluate the decrease in risk from misadministration of the new Leksell Gamma Knife Model C with Automatic Positioning System compared with previous models. Elekta Instruments, A.B. of Stockholm has introduced a new computer-controlled Leksell Gamma Knife Model C which uses motor-driven trunnions to reposition the patient between isocenters (shots) without human intervention. Previous models required the operators to manually set coordinates from a printed list, permitting opportunities for coordinate transposition, incorrect helmet size, incorrect treatment times, missing shots, or repeated shots. A risk analysis was conducted between craniotomy involving hospital admission and outpatient Gamma Knife radiosurgery. A report of the Institute of Medicine of the National Academies dated November 29, 1999 estimated that medical errors kill between 44,000 and 98,000 people each year in the United States. Another report from the National Nosocomial Infections Surveillance System estimates that 2.1 million nosocomial infections occur annually in the United States in acute care hospitals alone, with 31 million total admissions. All medical procedures have attendant risks of morbidity and possibly mortality. Each patient should be counseled as to the risk of adverse effects as well as the likelihood of good results for alternative treatment strategies. This paper seeks to fill a gap in the existing medical literature, which has a paucity of data involving risk estimates for stereotactic radiosurgery.


Coronary aneurysms in infants and young children with acute febrile mucocutaneous lymph node syndrome.
In 1967, Kawasaki, in Japan, first described a new syndrome affecting infants and young children-an acute, febrile illness with mucocutaneous involvement associated with swelling of cervical lymph nodes. The prognosis is usually good but recently it has become evident that 1-2 percent of the patients die suddenly from acute heart failure. Infantile polyarteritis (nodosa-like arteritis) accompained by coronary aneurysm and thrombosis has been noted in postmortem examinations. Twenty patients surviving the illness were examined by coronary angiography; 12 of the 20 had abnormal coronary angiograms; seven patients had coronary aneurysms. Complete regression of the coronary aneurysms was proved in two patients at subsequent angiography. One patient developed mitral regurgitation as a result of papillary muscle dysfunction. One had a coronary aneurysm without symptoms two years after the onset of illness.


Applications of Transcranial Magnetic Stimulation for Understanding and Treating Dystonia.
Transcranial magnetic stimulation (TMS)-based studies have led to an advanced understanding of the pathophysiology of dystonia. This narrative review summarizes the TMS data contributed to the literature so far. Many studies have shown that increased motor cortex excitability, excessive sensorimotor plasticity, and abnormal sensorimotor integration are the core pathophysiological substrates for dystonia. However, an increasing body of evidence supports a more widespread network dysfunction involving many other brain regions. Repetitive TMS pulses (rTMS) in dystonia have therapeutic potential as they can induce local and network-wide effects through modulation of excitability and plasticity. The bulk of rTMS studies has targeted the premotor cortex with some promising results in focal hand dystonia. Some studies have targeted the cerebellum for cervical dystonia and the anterior cingulate cortex for blepharospasm. We believe that therapeutic potential could be leveraged better when rTMS is implemented in conjunction with standard-of-care pharmacological treatments. However, due to several limitations in the studies conducted to date, including small samples, heterogeneous populations, variability in the target sites, and inconsistencies in the study design and control arm, it is hard to draw a definite conclusion. Further studies are warranted to determine optimal targets and protocols yielding the most beneficial outcomes that will translate into meaningful clinical changes.


Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events: A Post Hoc Analysis of SOLOIST-WHF.
Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days. The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization. The main endpoint of interest was cardiovascular death or HF-related event (HF hospitalization or urgent care visit) occurring within 90 and 30 days after discharge for the index WHF hospitalization. Treatment comparisons were by proportional hazards models, generating HRs, 95% CIs, and P values. Of 1,222 randomized patients, 596 received study drug on or before their date of discharge. Sotagliflozin reduced the main endpoint at 90 days after discharge (HR: 0.54 [95% CI: 0.35-0.82]; P = 0.004) and at 30 days (HR: 0.49 [95% CI: 0.27-0.91]; P = 0.023) and all-cause mortality at 90 days (HR: 0.39 [95% CI: 0.17-0.88]; P = 0.024). In subgroup analyses, sotagliflozin reduced the 90-day main endpoint regardless of sex, age, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or mineralocorticoid receptor agonist use. Sotagliflozin was well-tolerated but with slightly higher rates of diarrhea and volume-related events than placebo. Starting sotagliflozin before discharge in patients with type 2 diabetes hospitalized for WHF significantly decreased cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter treatment before discharge.


The language of pain: affective descriptors of pain are a better predictor of psychological disturbance than pattern of sensory and affective descriptors.
The language used by chronic benign pain patients to characterize their pain complaint was analyzed to determine the best predictor of psychiatric disturbance. Using the 78 adjectives provided by the McGill Pain Questionnaire, the number of affective descriptors used was the best predictor of psychiatric disturbance. Addition of sensory descriptors either to augment the total number of descriptors used (magnitude) or as a pattern of sensory greater than affective or sensory less than affective failed to increase predictive strength.


Supporting Families and Providers When Suicide Occurs.
Death by suicide has increased in the United States. Experts have identified risk factors that may identify those at risk. It is understood that depression is one of the major risk factor. The families and community are the secondary victims when a suicide attempt or completion is made, and they are at risk for complicated grief. Recently, our team was consulted for the case of a young woman with a catastrophic suicide attempt.


Diesel exhaust particulate emissions and in vitro toxicity from Euro 3 and Euro 6 vehicles.
Incomplete combustion processes in diesel engines produce particulate matter (PM) that significantly contributes to air pollution. Currently, there remains a knowledge gap in relation to the physical and chemical characteristics and also the biological reactivity of the PM emitted from old- and new-generation diesel vehicles. In this study, the emissions from a Euro 3 diesel vehicle were compared to those from a Euro 6 car during the regeneration of a diesel particulate filter (DPF). Different driving cycles were used to collect two types of diesel exhaust particles (DEPs). The particle size distribution was monitored using an engine exhaust particle sizer spectrometer and an electrical low-pressure impactor. Although the Euro 6 vehicle emitted particulates only during DPF regeneration that primarily occurs for a few minutes at high speeds, such emissions are characterized by a higher number of ultrafine particles (<0.1 μm) compared to those from the Euro 3 diesel vehicle. The emitted particles possess different characteristics. For example, Euro 6 DEPs exhibit a lower PAH content than do Euro 3 samples; however, they are enriched in metals that were poorly detected or undetected in Euro 3 emissions. The biological effects of the two DEPs were investigated in human bronchial BEAS-2B cells exposed to 50 μg/mL of PM (corresponding to 5.2 μg/cm2), and the results revealed that Euro 3 DEPs activated the typical inflammatory and pro-carcinogenic pathways induced by combustion-derived particles, while Euro 6 DEPs were less effective in regard to activating such biological responses. Although further investigations are required, it is evident that the different in vitro effects elicited by Euro 3 and Euro 6 DEPs can be correlated with the variable chemical compositions (metals and PAHs) of the emitted particles that play a pivotal role in the inflammatory and carcinogenic potential of airborne PM.


Influence of buried hydrogen-bonding groups within monolayer films on gas-surface energy exchange and accommodation.
Self-assembled monolayers (SAMs) of carbonyl-containing alkanethiols on gold are employed to explore the influence of hydrogen-bonding interactions on gas-surface energy exchange and accommodation. H-bonding, COOH-terminated SAMs are found to produce more impulsive scattering and less thermal accommodation than non-H-bonding, COOCH3-terminated monolayers. For carbamate-functionalized SAMs of the form Au/S(CH2)16OCONH(CH2)(n-1)CH3, impulsive scattering decreases and accommodation increases as the H-bonding group is positioned farther below the terminal CH3.


Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients.
Identifying the sites of obstruction of the upper airway in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is paramount for surgical planning. The aim of this study is to compare wake physical exam findings to the ones obtained during drug-induced sedation endoscopy (DISE) in the diagnosis of severe collapse of the upper airway in OSAHS patients. A retrospective chart review of OSAHS patients who underwent DISE at our institution during the 2006-2010 period was conducted. All the patients had previously undergone a physical examination that included modified Mallampati index (MMI), the Müller maneuver (MM), and the Friedman staging system. Level and severity of airway collapse were evaluated. A severe collapse was attributed to obstructions equal or greater than 75 % of the airway. A total of 138 patients were included in the study. The incidence of severe airway collapse was compared between DISE and MM; at retropalatal level, no significant difference was found. At retrolingual level, 69 % of patients had severe collapse with DISE in comparison to a 28 % with the MM (p < 0.05). No relationship was found either with the MMI or with the Friedman staging system when compared to the incidence of severe retrolingual collapse diagnosed by DISE. Concordance was low between awake and DISE exploration in both retropalatal and retroglossal level. The Müller maneuver underestimates tongue base severe obstruction diagnosis when compared to that obtained after DISE in OSAHS patients. The wake patient exploration does not accurately correlate to DISE exploration.


Treat to target strategy in early rheumatoid arthritis versus routine care - A comparative clinical practice study.
To assess the 2-year effect on disease activity and health-related quality of life (HRQoL) of implementing a clinical practice treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA). Patients in the Norwegian Very Early Arthritis Cohort 2.0 (NOR-VEAC 2.0), included 2010-2015, were treated according to T2T principles with visits at baseline, 3, 6, 9, 12 months, then every 6 months plus monthly visits until DAS28 <2.6. These patients were compared to a pre-T2T cohort of patients included in the Norwegian Disease Modifying Anti-Rheumatic Drug (NOR-DMARD) register 2006-2009. Both groups had a clinical diagnosis of RA (≤1 year) and were DMARD naïve. Disease activity and HRQoL outcomes were analysed, and the primary outcome was SDAI remission (≤3.3) at 2years. The T2T cohort included 293 patients (mean (SD) age 54 (13) years, 66% females, disease duration median (25,75 perc) 98 (57,164) days) and the routine care cohort 392 patients (age 54 (13) years, 68% females, 4 (0,30) days since diagnosis). At 2years, the proportion of patients achieving SDAI remission was 46% in the T2T cohort compared to 31% in the routine care cohort. EQ-5D was similar at baseline, but differed significantly between groups at 2years (median (25,75 perc) 0.77 (0.69, 0.85) vs 0.73 (0.59, 0.80), p < 0.001). Methotrexate monotherapy was the dominant DMARD regimen used to achieve SDAI remission in both cohorts. Higher remission rates and better HRQoL were achieved in patients following a T2T strategy in clinical practice compared to routine care.


Cryptococcosis of the colon resembling Crohn's disease in a patient with the hyperimmunoglobulinemia E-recurrent infection (Job's) syndrome.
A 29-yr-old woman presenting with granulomatous colitis and a chronic perirectal abscess was found to have localized cryptococcosis associated with the hyperimmunoglobulinemia E-recurrent infection (Job's) syndrome. Similarity to previous cases of esophageal cryptococcosis and ileocecal histoplasmosis suggests an association between the hyperimmunoglobulinemia E-recurrent infection syndrome and localized fungal infections of the alimentary tract. To our knowledge, this is the first well-documented case of cryptococcosis confined to the colon and perirectal tissues.


A Novel Graphic Medicine Curriculum for Resident Physicians: Boosting Empathy and Communication through Comics.
Curricular design that addresses residency physician competencies in communication skills and professionalism remains a challenge. Graphic Medicine (GM) uses comics, a medium combining text and images, to communicate healthcare concepts. Narrative Medicine, in undergraduate medical education, has limited reported usage in Graduate Medical Education (GME). Given the time constraints and intensity of GME, we hypothesized that comics as a form of narrative medicine would be an efficient medium to engage residents.The authors created a novel curriculum to promote effective communication and professionalism, focusing on empathy, compassion and cultural competency. A four-week curriculum was delivered in a neurology residency program. Excerpts from non-fiction graphic memoirs about neurological conditions were read, discussed, and paired with prompt-driven drawing exercises. Qualitative surveys were used to assess acceptability of comics, usefulness of comics to convey patient illness experience, and perception of patient needs for physician-patient communication.Ninety-seven percent of residents reported the sessions were a good use of their time. Residents identified new symptoms of neurologic disorders, articulated patient communication needs, and expressed increased empathy after participation. Residents participated in drawing exercises, but these were not formally analyzed. Graphic medicine is a well received format that may build communication skills and increase empathy.


Review and perspective on bioinformatics tools using machine learning and deep learning for predicting antiviral peptides.
Viruses constitute a constant threat to global health and have caused millions of human and animal deaths throughout human history. Despite advances in the discovery of antiviral compounds that help fight these pathogens, finding a solution to this problem continues to be a task that consumes time and financial resources. Currently, artificial intelligence (AI) has revolutionized many areas of the biological sciences, making it possible to decipher patterns in amino acid sequences that encode different functions and activities. Within the field of AI, machine learning, and deep learning algorithms have been used to discover antimicrobial peptides. Due to their effectiveness and specificity, antimicrobial peptides (AMPs) hold excellent promise for treating various infections caused by pathogens. Antiviral peptides (AVPs) are a specific type of AMPs that have activity against certain viruses. Unlike the research focused on the development of tools and methods for the prediction of antimicrobial peptides, those related to the prediction of AVPs are still scarce. Given the significance of AVPs as potential pharmaceutical options for human and animal health and the ongoing AI revolution, we have reviewed and summarized the current machine learning and deep learning-based tools and methods available for predicting these types of peptides.


Intraperitoneal tuberculosis abscess: A rare form of tuberculosis.
Tuberculosis is related to high rate of morbidity and mortality worldwide. Extra-pulmonary forms are increasing in incidence. The diagnosis of extrapulmonary locations, especially abdominal, is often difficult because the clinical and biological signs are not specific, leading to a delay in diagnosis and treatment. The intraperitoneal tuberculosis abscess is a particular radio-clinical entity, due to its atypical and confusing symptomatology. We report the case of a 36-year-old female patient who had a peritoneal tuberculosis abscess manifested by diffuse abdominal pain in a febrile context.


Incidence of donor renal fibromuscular dysplasia: does it justify routine angiography?
The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fifty-nine patients completed the donor evaluation process and underwent DSA. Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.


[Augmentation with antibiotic-impregnated spacers in sepsis revision surgery].
The development of antibiotic-impregnated polymethyl methacrylate (PMMA) spacers is based on clinical experience and the use of antibiotic-loaded PMMA beads in septic bone surgery as well as antibiotic-loaded bone cement in arthroplasty beginning in the 1970s. In the meantime hand-formed and prefabricated spacers are implanted in cases of sepsis to achieve high local antibiotic concentrations and bactericidal effects to eradicate the infection. Preformed spacers with gentamicin are commercially available and furthermore, clindamycin-loaded PMMA bone cement can also be used. In principle, all thermostable antibiotics can be mixed with PMMA cement. Spacers permit bridging of bone defects originating from trauma or septic bone segment resection. After joint resection spacers allow a certain degree of articulation and inhibit shortening of the extremity which has a positive effect on the soft tissue covering and its perfusion. The functional outcome after secondary arthroplasty is better if a spacer has been implanted compared to long-term immobilization without spacers. Nevertheless, spacers can also cause serious complications, such as dislocations and fractures. Antibiotic-loaded spacers have therefore widened the therapeutic options in sepsis surgery.