Reconstruction of the decision-making process in assessing musculoskeletal chest pain: an exploratory study using recursive partitioning.
The purposes of this study were to identify the most important determinants from the patient history and clinical examination in diagnosing musculoskeletal chest pain (MSCP) in patients with acute noncardiac chest pain when supported by a structured protocol and to construct a decision tree for identification of MSCP in acute noncardiac chest pain. Consecutive patients with noncardiac chest pain (n = 302) recruited from an emergency cardiology department were assessed. Using data from self-report questionnaires, interviews, and clinical assessment, patient characteristics were associated with the MSCP diagnosis, and the decision-making process of the clinician was reconstructed using recursive procedures in the tradition of constructing Classification and Regression Trees. Thirty-eight percent of patients had MSCP. There was no single determinant that predicted the condition completely. However, many items with high associations could be identified, mainly with high negative predictive value. The decision-making process was reconstructed giving rise to a 5-step, linear decision tree without branches. Clinicians use a combination of indicators including systematic palpation of the spine and chest wall and items from the case history to diagnose MSCP. However, the high negative predictive values of the main determinants suggest that the MSCP diagnosis may be a diagnosis by exclusion.


Factors associated with preventive care practice among adults with diabetes.
Adherence to annual preventive care (foot, eye, and dental examinations) in this group of study participants with diabetes (n=253) was suboptimal. Participants were 2.6-5.8 times more likely to have a specific preventive care in the past 12 months if they were told to do so by a health care professional.


Fate of cyanobacteria in drinking water treatment plant lagoon supernatant and sludge.
In conventional water treatment processes, where the coagulation and flocculation steps are designed to remove particles from drinking water, cyanobacteria are also concentrated into the resultant sludge. As a consequence, cyanobacteria-laden sludge can act as a reservoir for metabolites such as taste and odour compounds and cyanotoxins. This can pose a significant risk to water quality where supernatant from the sludge treatment facility is returned to the inlet to the plant. In this study the complex processes that can take place in a sludge treatment lagoon were investigated. It was shown that cyanobacteria can proliferate in the conditions manifest in a sludge treatment lagoon, and that cyanobacteria can survive and produce metabolites for at least 10days in sludge. The major processes of metabolite release and degradation are very dependent on the physical, chemical and biological environment in the sludge treatment facility and it was not possible to accurately model the net effect. For the first time evidence is provided to suggest that there is a greater risk associated with recycling sludge supernatant than can be estimated from the raw water quality, as metabolite concentrations increased by up to 500% over several days after coagulation, attributed to increased metabolite production and/or cell proliferation in the sludge.


Ankylosing spondylitis: experience in surgical management of 21 patients.
Between 1976 and 1984, twenty-one patients with ankylosing spondylitis were treated surgically. Eight patients with rigid thoracic kyphosis underwent a two-stage combined procedure. The average correction was 36 degrees. Eight patients underwent a single-stage lumbar osteotomy with Harrington compression instrumentation. The average correction was 31 degrees. Five patients presented with stress fractures and back pain. All underwent combined anterior and posterior surgery. The average correction was 9 degrees. Two patients underwent anterior decompression for progressive paraplegia. Both showed improvement in neurologic function. At follow-up, all but one patient had improvement in pain and spinal alignment. There have been no deaths or persistent neurologic problems from these procedures.


Noninvasive evaluation of mid-left ventricular obstruction by two-dimensional and Doppler echocardiography and color flow Doppler echocardiography.
Three patients with midventricular obstruction resulting from three different pathophysiologic mechanisms and differing anatomic bases for the development of obstruction are presented. In the first patient, a membrane-like structure appeared to cause some fixed obstruction, but a superimposed dynamic component to the obstruction was also evident. Papillary muscle hypertrophy with approximation of the papillary muscles during systole was the mechanism in the second patient. In the third patient, apical infarction with hyperdynamic contraction of the mid- and basal portions of the myocardium appeared to be the pathophysiologic mechanism. Color flow Doppler echocardiography was particularly useful in localizing the site of obstruction and allowed further evaluations by pulsed and continuous-wave Doppler techniques to precisely determine pressure gradients.


Spontaneous regression of metastases from testicular tumours. A report of six cases from one centre.
In a review of the cases of testicular tumours treated at the Christie Hospital between 1961 and 1974 there are six cases with spontaneous regression of metastases, which are now reported. In this period, 827 cases of testicular tumour have been treated giving an incidence of spontaneous regression of 0.72%, which is considerably higher than previously reported. One of the cases appears to be pure seminoma; spontaneous regression of metastases from seminoma has not been reported previously.


Barrett's Esophagus: Diagnosis, Management, and Key Updates.
Barrett's esophagus (BE) is the precursor lesion for esophageal adenocarcinoma (EAC) development. Unfortunately, BE screening/surveillance has not provided the anticipated EAC reduction benefit. Noninvasive techniques are increasingly available or undergoing testing to screen for BE among those with/without known risk factors, and the use of artificial intelligence platforms to aid endoscopic screening and surveillance will likely become routine, minimizing missed cases or lesions. Management of high-grade dysplasia and intramucosal EAC is clear with endoscopic eradication therapy preferred to surgery. BE with low-grade dysplasia can be managed with removal of visible lesions combined with endoscopic eradication therapy or endoscopic surveillance at present.


Cryptococcal peritonitis in patients on peritoneal dialysis.
Peritonitis is an unusual complication of infections caused by Cryptococcus neoformans and has rarely been reported in patients with end-stage renal disease who are maintained on peritoneal dialysis. We report two patients on chronic peritoneal dialysis in whom the first known manifestation of cryptococcal infection was dialysate cultures positive for Cryptococcus neoformans. One patient was on prednisone for systemic lupus erythematosis. The other patient was severely malnourished with type I diabetes mellitus. Both patients were found to have cryptococcal meningitis. Both patients were treated with intravenous (IV) amphotericin B and removal of the dialysis catheter. Evaluation and care of peritoneal dialysis patients with cryptococcal peritonitis include serial cryptococcal cultures and antigen titers, investigation for cryptococcal meningitis, removal of the peritoneal dialysis catheter, and IV amphotericin B.


Solid renal masses: effectiveness and safety of image-guided percutaneous radiofrequency ablation.
With increasing emphasis on minimally invasive nephron-sparing techniques for treatment of renal tumors, image-guided percutaneous radiofrequency ablation (RFA) has emerged as a safe and effective method of tumor eradication that may be performed on an outpatient basis, with relatively low morbidity and mortality. This review addresses the clinical and technical considerations, risks, complications, and currently reported efficacy data pertaining to RFA of renal tumors, as well as the standardized approach to treatment and follow-up currently used in our practice.


Nucleoside phosphotransferase from yellow lupin seedling cotyledons.
Nucleoside phosphotransferase (nucleotide:3'-deoxynucleoside 5'-phosphotransferase, EC 18.104.22.168) from yellow lupin seedling cotyledons was purified and the active enzyme consists of a single polypeptide chain, Mr = 72 000 +/- 3000. In transphosphorylation, purine and pyrimidine nucleosides are good phosphate acceptors and 5'-nucleotides are effective phosphate donors. Among 2'- and 3'-nucleotides, only 3'-AMP and 3'-psi MP acted as phosphate donors, and p-nitrophenylphosphate appeared less active in this regard. The purine and pyrimidine bases inhibit transphosphorylation. The Km values determined for the inosine:5'-AMP pair were 400 micrometers for both the compounds. The enzyme showed optimum activity at pH 8.0 in mM Tris-HCl buffer. Antisulfhydryl reagents and EDTA did not affect enzyme activity.


Laparoscopic bowel resection for pediatric inflammatory bowel disease.
To compare 30-d outcomes between laparoscopic and open intestinal resection performed on pediatric patients with ulcerative colitis and Crohn disease. We identified all proctocolectomies performed on patients with ulcerative colitis and all intestinal resections with primary anastomosis performed on patients with Crohn disease in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric. We compared demographic, clinical, and 30-d outcome characteristics between patients who underwent an open or laparoscopic resection. Of the 140 patients with ulcerative colitis who underwent proctocolectomy, 103 (74%) were performed laparoscopically. Patients undergoing laparoscopic colectomy had shorter postoperative length of stay (LOS) and fewer incisional complications. On multivariate analysis, open versus laparoscopic proctocolectomy is not an independent predictor of postoperative LOS for patients with ulcerative colitis. Of the 188 patients with Crohn disease who underwent an intestinal resection, 122 (65%) underwent laparoscopic resection. In comparison with patients undergoing open resection, patients undergoing laparoscopic resection had similar rates of complications but a shorter postoperative LOS. For children with ulcerative colitis, laparoscopic proctocolectomy is not independently associated with a difference in postoperative LOS. In unadjusted analyses, laparoscopic bowel resections for children with Crohn disease may be associated with a shorter postoperative LOS compared with that of open procedures. Additional accrual of cases within the American College of Surgeons National Surgical Quality Improvement Program Pediatric will allow for risk-adjusted analyses of outcomes, including factors independently associated with incisional complications.


Abnormalities of serum proteins following thermal injury.
Suppressive factors were found to be present in serum and considered to be one of the causes of the suppression of body defences following thermal injury. The purpose of this study was to find out any abnormality of the postburn serum proteins by the comparison of burned and normal sera using immunoprecipitation in gel. The results of SDS-polyacrylamide gel electrophoresis, crossed immunoelectrophoresis, tandem crossed immunoelectrophoresis, and fused rocket immunoelectrophoresis showed that differing precipitation bands or peaks existed between burned and normal sera, and abnormal constituents with relatively low molecular weight were present in the burned serum.


Characterization, antioxidative and bifidogenic effects of polysaccharides from Pleurotus eryngii after heat treatments.
Polysaccharides were extracted from freeze-dried-, oven-dried- and boiling-treated Pleurotus eryngii (FDPEPS, ODPEPS and BTPEPS). Yield of FDPEPS and its total carbohydrates, total polysaccharides, reducing sugars, phenolics and protein content were higher than ODPEPS and BTPEPS. High performance liquid chromatography (HPLC) identified that FDPEPS, ODPEPS, and BTPEPS were composed of mannose (5.75%, 5.52%, 6.97%), glucose (88.90%, 89.31%, 87.68%) and galactose (5.34%, 5.17%, 5.35%). All three polysaccharides showed typical saccharic absorption bands in FT-IR. The FDPEPS showed the highest antioxidant activities in ferric reducing antioxidant power (FRAP), ABTS, superoxide anion and hydroxyl radical scavenging tests. Denser aggregates and larger serum pores were observed in confocal micrographs of soymilk added with ODPEPS. Viability of Bifidobacterium longum in soymilk added with polysaccharides was significantly higher (p<0.01) than those without polysaccharides during fermentation. Heat treatments applied before extraction affected the properties, composition and microstructures of FDPEPS, ODPEPS and BTPEPS.


Increased immunoexpression of trefoil factors in salivary gland tumors.
Very little is known about the role of trefoil factors (TFFs) in salivary gland tumors, and TFF immunoexpression has never been investigated in such tumors. The aim of this study was to evaluate TFF immunoexpression in benign and malignant salivary gland tumors. Benign (n = 25) and malignant (n = 25) salivary gland tumor specimens were included in this study, using mucocele (n = 25) specimens as a control group. Immunohistochemical staining was performed to evaluate the expression of TFFs (TFF1, TFF2, and TFF3) by semiquantitative means. Expression of TFF1, TFF2, and TFF3 was significantly increased in benign (p = 0.001, p = 0.005, p < 0.001, respectively) and malignant (p < 0.001, p < 0.001, p < 0.001, respectively) groups as compared with the control group. Patterns of co-expression between TFF1/TFF2, TFF2/TFF3, and TFF1/TFF3 were different among the three groups. The present study provided new information showing that all TFFs were significantly increased in benign and malignant salivary gland tumors, and overexpression of TFFs could be associated with neoplastic transformation in salivary gland tissues. Overexpression of TFFs may be useful as biomarkers in terms of differential diagnosis between salivary gland tumors and other oral neoplasms for which clinical manifestations are indistinguishable.


Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated with nepafenac.
To compare the incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated postoperatively with topical prednisolone and those treated with topical prednisolone and nepafenac 0.1% suspension (Nevanac). Edward S. Harkness Eye Institute of Columbia University, New York, New York, USA. This retrospective chart review was of consecutive patients who had phacoemulsification at a single institute and were given topical prednisolone alone or topical prednisolone and nepafenac to prevent cystoid macular edema. Data collection included preexisting ocular and systemic diseases, concurrent use of ocular and systemic medications, surgical technique, intraoperative and postoperative complications, follow-up visual and ocular assessments, and postoperative optical coherence tomography (OCT) assessment for macular edema. Postoperatively, 240 patients were treated with prednisolone and 210 patients, with prednisolone-nepafenac. Preoperatively, the 2 groups were demographically and clinically comparable in sex distribution (P = .8400), history of diabetes (P = .7267), hypertension or cardiac disease (P = .8690), and concurrent use of oral nonsteroidal anti-inflammatory drugs (P = .7303). Iris manipulation was done in 16 patients in the prednisolone-alone group and 10 patients in the prednisolone-nepafenac group (P = .3876). Capsule staining was done in 5 patients and 4 patients, respectively. All patients were followed for at least 1 month postoperatively. Visually significant pseudophakic macular edema was documented by OCT in 5 patients treated with prednisolone alone and in no patients treated with prednisolone and nepafenac (P = .0354). No significant intraoperative or postoperative complications were reported. Patients treated with topical prednisolone alone had a significantly higher incidence of visually significant pseudophakic macular edema after uneventful cataract surgery than those treated with topical prednisolone and nepafenac.


Mechanical ventilation and respiratory mechanics during equine anesthesia.
The mechanical ventilation of horses during anesthesia remains a crucial option for optimal anesthetic management, if the possible negative cardiovascular side effects are managed, because this species is prone to hypercapnia and hypoxemia. The combined use of capnography and pitot-based spirometry provide complementary information on ventilation and respiratory mechanics, respectively. This facilitates management of mechanical ventilation in conditions of changing respiratory system compliance (ie, laparoscopy) and when investigating new ventilatory strategies including alveolar recruitment maneuvers and optimization of positive expiratory pressure.


Prevalence and factors associated with ever had road traffic accidents among drivers in Hargeisa city, Somaliland, 2022.
Road traffic accidents (RTAs) are a major cause of morbidity in Somaliland. This study aimed to determine the prevalence and factors associated with traffic-related incidents in Hargeisa city. A cross-sectional study was conducted between January and March 2022, utilizing a mixed approach involving quantitative and qualitative research approaches. Key informant interviews were conducted with 15 government officials, and structured questionnaires were administered to 387 drivers. Cluster sampling and purposive sampling were employed to select drivers and government officials, respectively. Data collection was performed using the Kobo Collect application, followed by cleaning and analysis using IBM SPSS version 25. Descriptive statistics, binary logistic regression, and chi-square tests were utilized for data analysis. The findings revealed an increasing trend of RTAs in Somaliland over the past 11 years (2011-2021). Moreover, the prevalence of RTAs in the past two years alone was determined to be 28.17% (CI: 23.67, 32.63). Factors significantly associated with RTAs in the research area included the type of vehicle, particularly Minibus (AOR = 3.249, CI: 1.022, 10.322) and Vitz (AOR = 2.325, CI: 1.092, 5.494), encountering aggressive behavior from other drivers (AOR = 1.790, CI: 1.013, 3.162), vehicles less than 4 years (AOR = 0.446, CI: 0.258, 0.771), traffic law violations (AOR = 2.726, CI: 1.296, 5.735), and the presence of traffic campaigns (AOR = 0.465, CI: 0.236, 0.917). The study recommends increasing awareness of RTAs among drivers and pedestrians, regular vehicle maintenance checks, enforcement of traffic laws, and increased police presence in road management to reduce fatalities associated with RTAs.


Alveolar septal deposition of immunoglobulin and complement parallels pulmonary hemorrhage in a guinea pig model of severe pulmonary leptospirosis.
Human patients suffering from leptospirosis present with a diverse array of clinical manifestations, including the more severe and often fatal pulmonary form of the disease. The etiology of pulmonary hemorrhage is unclear. Isolates of Leptospira acquired from patients suffering from pulmonary hemorrhage were used to develop a guinea pig model of pulmonary hemorrhage. Gross findings post-infection confirmed extensive hemorrhage in the lungs and on peritoneal surfaces as the likely cause of death. Immunohistochemistry confirmed the presence of large numbers of leptospires in kidney, liver, intestinal tissues, and spleen, but few inflammatory cells were seen. In marked contrast, few leptospires were detected in infected hemorrhagic lung tissue. Blood chemistries and hematology did not reveal the etiology of the hemorrhage observed. There was no chemical or microscopic evidence for disseminated intravascular coagulation. To ascertain an immunopathologic role during disease, immunofluorescence was performed on infected lung tissues and confirmed the presence of IgM, IgG, IgA, and C3 along the alveolar basement membrane. This suggests that an autoimmune process may be the etiology of fatal pulmonary hemorrhage in leptospirosis.


Seq-ing the SINEs of central nervous system tumors in cerebrospinal fluid.
It is often challenging to distinguish cancerous from non-cancerous lesions in the brain using conventional diagnostic approaches. We introduce an analytic technique called Real-CSF (repetitive element aneuploidy sequencing in CSF) to detect cancers of the central nervous system from evaluation of DNA in the cerebrospinal fluid (CSF). Short interspersed nuclear elements (SINEs) are PCR amplified with a single primer pair, and the PCR products are evaluated by next-generation sequencing. Real-CSF assesses genome-wide copy-number alterations as well as focal amplifications of selected oncogenes. Real-CSF was applied to 280 CSF samples and correctly identified 67% of 184 cancerous and 96% of 96 non-cancerous brain lesions. CSF analysis was considerably more sensitive than standard-of-care cytology and plasma cell-free DNA analysis in the same patients. Real-CSF therefore has the capacity to be used in combination with other clinical, radiologic, and laboratory-based data to inform the diagnosis and management of patients with suspected cancers of the brain.


Impact of co-existence of PMQR genes and QRDR mutations on fluoroquinolones resistance in Enterobacteriaceae strains isolated from community and hospital acquired UTIs.
Fluoroquinolones are commonly recommended as treatment for urinary tract infections (UTIs). The development of resistance to these agents, particularly in gram-negative microorganisms complicates treatment of infections caused by these organisms. This study aimed to investigate antimicrobial resistance of different Enterobacteriaceae species isolated from hospital- acquired and community-acquired UTIs against fluoroquinolones and correlate its levels with the existing genetic mechanisms of resistance. A total of 440 Enterobacteriaceae isolates recovered from UTIs were tested for antimicrobial susceptibility. Plasmid-mediated quinolone resistance (PMQR) genes and mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were examined in quinolone-resistant strains. About (32.5%) of isolates were resistant to quinolones and (20.5%) were resistant to fluoroquinolones. All isolates with high and intermediate resistance phenotypes harbored one or more PMQR genes. QnrB was the most frequent gene (62.9%) of resistant isolates. Co-carriage of 2 PMQR genes was detected in isolates (46.9%) with high resistance to ciprofloxacin (CIP) (MICs > 128 μg/mL), while co-carriage of 3 PMQR genes was detected in (6.3%) of resistant isolates (MICs > 512 μg/mL). Carriage of one gene only was detected in intermediate resistance isolates (MICs of CIP = 1.5-2 μg/mL). Neither qnrA nor qnrC genes were detected. The mutation at code 83 of gyrA was the most frequent followed by Ser80-Ile in parC gene, while Asp-87 Asn mutation of gyrA gene was the least, where it was detected only in high resistant E. coli isolates (MIC ≥128 μg/mL). A double mutation in gyrA (Lys154Arg and Ser171Ala) was observed in high FQs resistant isolates (MIC of CIP < 128 μg/mL). FQs resistance is caused by interact between PMQR genes and mutations in both gyrA and parC genes while a mutation in one gene only can explain quinolone resistance. Accumulation of PMQR genes and QRDR mutations confers high resistance to FQs.


Characterization and application of monoclonal antibodies specific to West Nile virus envelope protein.
Recent epidemics of West Nile virus (WNV) around the world have been associated with significant rates of mortality and morbidity in humans. To develop standard WNV diagnostic tools that can differentiate WNV from Japanese encephalitis virus (JEV), four monoclonal antibodies (MAbs) specific to WNV envelope (E) protein were produced and characterized by isotyping, reactivity with denatured and native antigens, affinity assay, immunofluorescence assay (IFA), and epitope competition, as well as cross-reactivity with JEV. Two of the MAbs (6A11 and 4B3) showed stronger reactivity with E protein than the others (2F5 and 6H7) in Western blot analysis. 4B3 could bind with denatured antigen, as well as native antigens in indirect ELISA, flow cytometry analysis, and IFA; whereas 2F5 showed highest affinity with native antigen. 4B3 and 2F5 were therefore used to establish an antigen capture-ELISA (AC-ELISA) detection system. The sensitivity of this AC-ELISA was 3.95 TCID(50)/0.1 ml for WNV-infected cell culture supernatant. Notably, these MAbs showed no cross-reactivity with JEV, which suggests that they are useful for further development of highly sensitive, easy handling, and less time-consuming detection kits/tools in WNV surveillance in areas where JEV is epidemic.


Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma.
Discordant results exist about the role of human epidermal growth factor receptor 2 (HER2) overexpression and/or HER2 amplification in lung adenocarcinoma. We aimed to compare the performance of HercepTest and PATHWAY anti-HER2 (4B5) by correlating immunohistochemistry (IHC) results with silver in situ hybridization (SISH) in adenocarcinoma lung specimens. A total of 148 surgically resected adenocarcinoma lung specimens were included. HER2 overexpression was found in 7.4% patients for HercepTest Dako and in 2.7% patients for 4B5 antibody. The overall coincidence between these two types of antibodies equals 93.9%. The incidence of HER2 amplification in lung adenocarcinoma was 17.6%, of which in 2.7% of the cases high-grade amplification was present. HER2 amplification was present in 90.9% of patients with overexpression of HER2, obtained by using HercepTest Dako and 75% patients using 4B5 antibody. A significant correlation between overexpression of HER2 receptors obtained by HercepTest Dako and 4B5 antibody and HER2 amplification was shown. The research of the efficiency of targeted molecular therapies with an HER2 antibody may serve as a basis for the introduction of routine HER2 status determination in lung adenocarcinoma, dictating the need for the standardized protocol for HER2 status determination in such pathology.


Maintenance therapy with synthetic opioids and driving aptitude.
To assess the influence of methadone and buprenorphine maintenance treatment on the driving aptitude of opioid-dependent patients. Prospective, open label, outpatient maintenance, single-blind (investigator) study. Thirty opioid-dependent patients maintained on either methadone or buprenorphine were recruited from the drug-addiction outpatient clinic in Vienna. The traffic-relevant performance dimensions of the participants were assessed 22 h after receiving synthetic opioid maintenance therapy, by a series of seven tests constituting the Act & React Test System (ART) 2020 Standard test battery, developed by the Austrian Road Safety Board (ARSB). To test for additional consumption of illicit substances, blood and urine samples were taken at the beginning of the tests. The patient group only differed from control subjects in two of the ART 2020 Standard tests. During a task to test the subject's attention under monotonous circumstances (Q1 test), patients had a significantly greater number of reactions (p = 0.027) and a significantly higher percentage of incorrect reactions than control subjects. When driving in a dynamic environment (DR2 test) patients had a significantly longer mean decision time (p = 0.029) and mean reaction time (p = 0.009) compared with control subjects. Interestingly, when separated into treatment groups, the mean decision and reaction times of buprenorphine-maintained patients in the DR2 test did not differ from controls, whereas patients maintained on methadone showed significantly prolonged mean decision (p = 0.009) and reaction times (p = 0.004). In this same test, patients who had consumed additional illicit drugs had a longer mean reaction time compared with control subjects (p = 0.036). The synthetic opioid-maintained subjects investigated in the current study did not differ significantly in comparison to healthy controls in the majority of the ART 2020 Standard tests.


Can myomectomy be performed during pregnancy?
To evaluate the effectiveness, safety, complications and outcome of pregnancy after myomectomy performed during pregnancy. Five pregnant women with myomas requiring operation because of severe abdominal pain were included in the series at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine between October 1, 1996 and February 24, 2001. The patients were controlled with ultrasonography and cardiotocography every month up to 32 gestational weeks and then every 2 weeks. Cesarean section was performed on all patients at 37-40 weeks. Complications and fetoneonatal outcome were recorded. The mean age of the patients was 31.4 +/- 3.5 years. The mean parity was 1.4 +/- 1.6. The median gestational age at the time of myomectomy was 17.8 +/- 3.4 weeks. The mean size of the myomas was 14.0 +/- 3.8 cm. The main symptom of all patients was severe abdominal pain in spite of analgesic medication. The mean duration of the operation was 40.0 +/- 7.9 min. The mean blood loss was 280.0 +/- 83.6 ml. The mean number of myomas removed was 2.8 +/- 1.3. Myomectomy during pregnancy can be performed if necessary.


Subnanometer cobalt oxide clusters as selective low temperature oxidative dehydrogenation catalysts.
The discovery of more efficient, economical, and selective catalysts for oxidative dehydrogenation is of immense economic importance. However, the temperatures required for this reaction are typically high, often exceeding 400 °C. Herein, we report the discovery of subnanometer sized cobalt oxide clusters for oxidative dehydrogenation of cyclohexane that are active at lower temperatures than reported catalysts, while they can also eliminate the combustion channel. These results found for the two cluster sizes suggest other subnanometer size (CoO)x clusters will also be active at low temperatures. The high activity of the cobalt clusters can be understood on the basis of density functional studies that reveal highly active under-coordinated cobalt atoms in the clusters and show that the oxidized nature of the clusters substantially decreases the binding energy of the cyclohexene species which desorb from the cluster at low temperature.


Immunohistochemical detection and localization of somatostatin receptor subtypes in prostate tissue from patients with bladder outlet obstruction.
Scant information on the cellular distribution of the five somatostatin receptor (SSTR) subtypes in the normal prostate and in neoplasms of the prostate has been reported in very few studies in which techniques, such as in situ hybridization histochemistry, autoradiography, and more recently immunohistochemistry, have been applied. The aim of the study was to examine immunohistochemically the distribution and localization of these 5 subtypes in the various tissue components in normal prostate. The study was conducted in 14 surgical specimens of normal prostate tissue from adenomectomy specimens from patients with bladder outlet obstruction. The distribution and localization of the 5 somatostatin receptor (SSTR) subtypes was investigated with an immunohistochemical technique. Specificity of the antibodies against the 5 receptor subtypes was preliminarily investigated. Close to 90% of secretory cells showed a weak positivity in the cytoplasm, the proportion ranging from 86.3% (SSTR4) to 89.9% (SSTR5). Strong immunoreactivity was seen in a small proportion of cells, ranging from 0.8% (SSTR3) to 3.2% (SSTR1). For the subtypes 1 and 3 the greatest proportion of basal cells showed a moderate intensity (42.5 and 41.4%, respectively), strong immunoreactivity being observed only in 18.1 and 15.8% of cells, respectively. For the subtypes 2, 4 and 5, the majority of cells showed a weak intensity (72.3, 65.7 and 65.1%, respectively). Subtype 1 showed a strong immunoreactivity in the cytoplasm in 60% of the smooth muscle cells. With subtypes 2, 3 and 4 the greatest proportion of cells showed a weak intensity (63.4, 89.8 and 81.7%, respectively). With the subtype 5 the majority of cells (59.8%) were negative. Subtype 1 showed a strong immunoreactivity in the cytoplasm in 98.6% of the endothelial cells. With subtypes 3 and 4 the greatest proportion of cells showed a weak intensity (73.5 and 56.4%, respectively). With the subtype 2 and 5 the majority of cells were negative (59.1 and 50.7%, respectively).


The HbA/HbA2 ratio in newborns and its correlation with fetal maturity.
The relative amounts of HbF, HbA and HbA2 were determined in about 1000 newborns and their parents. In newborns the mean value of HbA2 was 0.27 +/- 0.02% and that of HbF 74.69 +/- 0.25%. The ratio HbA/HbA2 was estimated at different gestational ages and was found to range from 101 at 32 weeks gestation to 76 at 45 weeks, indicating that the relative amount of HbA2 increases with fetal maturation. The correlations between the levels of the different haemoglobins and various indexes of fetal maturation (gestational age, birth weight, crown-heel length and head circumference) are also given.


Assessment of premenstrual symptomatology: a re-evaluation of the predictive validity of self-report.
The predictive validity of subjects' self-reports of the severity of four groups of symptoms associated with the premenstrual syndrome (PMS) was assessed by canonical correlation of retrospective self-reports of usual symptom severities with prospectively obtained symptom severity scores from the next two cycles. Prospective scores from the second cycle were then correlated with retrospective recall scores obtained after the end of that cycle. A measure of inter-cycle variability was obtained by correlation between two consecutive sets of prospective scores. The symptoms studied were tension, depression, cognitive and physical ('water retention') symptoms. It was found that subjects' recall of a particular cycle predicted 72% of the variance in that cycle's prospective severity scores, indicating that the subjects correctly interpreted the severity of premenstrual symptoms and distinguished them from symptoms present in the follicular part of the cycle. Retrospective reports of usual PMS symptomatology predicted 21% of the variance in symptom scores in the next menstrual cycle and 12% of the variance in the following one. Despite this decrease, averaging the scores from the two prospective cycles improved the prediction to 23%. Prospective scores from one cycle predicted only 14% of the variance in prospective scores from the next, suggesting a high degree of inter-cycle variability. Women's self-reports of their usual PMS symptomatology reflect their experience more accurately than has been thought. The finding of marked inter-cycle variability suggests that arguments for the use of a single cycle of prospective data in PMS evaluation are fallacious and that retrospective self-report may be clinically useful and relatively valid.


Thermal and metabolic factors affecting bioaccumulation of triazine herbicides by rainbow trout (Oncorhynchus mykiss).
The bioaccumulation of the triazine herbicides terbutryn and terbuthylazine in rainbow trout was investigated at water temperatures of 4 degrees C, 10 degrees C, and 17 degrees C. The synergetic effect of water temperature and herbicide on fish liver detoxification metabolism was also studied by measuring liver ethoxyresorufin-O-deethylase (EROD) and UDP-glucuronosyltransferase (UDPGT) activities. The bioaccumulation of terbutryn increased significantly with increasing water temperature. However, temperature seemed to have no effect on the bioaccumulation of terbuthylazine. Both chemicals decreased the measured enzyme activities. Also, temperature effects were significant. In all tests the highest liver EROD activities were measured in fish exposed to a water temperature of 4 degrees C, and the activities decreased with increasing water temperature. The thermal effects on fish liver UDPGT activity differed between the herbicides. The highest activities at a water temperature of 4 degrees C were measured in fish exposed to terbutryn, whereas fish exposed to terbuthylazine had the highest liver UDPGT activities at 17 degrees C. Measuring liver detoxification metabolism together with bioaccumulation increases the understanding of bioaccumulation of chemicals in different environmental conditions.


[Results after osteosynthesis of extraarticular proximal phalangeal fractures].
The aim of the study was to retrospectively present and analyse the functional results of surgically treated extraarticular fractures of the proximal phalanx.From 1/2005-4/2008 we operated on 49 patients with 52 closed, extraarticular fractures of the proximal phalanx of the long fingers with either pins, screws or plates. 30 patients were male, 19 were female, the mean age was 35 years. Open fractures, fractures of the thumb and those with injuries to neurovascular structures or tendons were excluded. Postoperative physiotherapy was started on day 1 after surgery. Postoperative finger function and complications were analysed based on the total active motion (TAM) regarding the Belsky score and the classification of Page and Stern. In addition, patients were contacted by phone in 4/2009 to verify the subjective functional results at the end of the observation period.Three different operative procedures were employed: internal fixation by Kirschner wires (n=25), and open fixation by screws (n=8) or plates (n=19). The entire treatment period amounted to 12 (4-28) weeks, the observation time was 33 (11-50) months. Two patients, both after plate osteosynthesis, had to be reoperated because of functional deficits due to adhesions. In both a tenolysis and removal of the plate was performed. The functional result was excellent in 20 of 25 patients treated by Kirschner wires, in seven of the eight in the screw-fixation group and in 13 of the 19 patients treated by plate ostheosynthesis (TAM > 240°); the result was judged fair in 1 after plate osteosynthesis (TAM 215°). The remaining 11 patients showed a good outcome with a TAM between 220° and 239°. These favourable results remained subjectively stable at the end of the observation period, when all patients could be contacted by phone.Osteosynthesis by kirschner wires, screws and plates for closed extraarticular fractures of the proximal phalanx of the long fingers gives good to excellent results with few complications.


Factors influencing serum albumin in dialysis patients.
Hypoalbuminemia is a major risk factor for morbidity and mortality in dialysis patients. The proximate cause of hypoalbuminemia is probably responsible for these events, and not the hypoalbuminemia itself. Because protein-calorie malnutrition decreases albumin synthesis, hypoalbuminemia has been attributed to poor nutritional intake resulting from underdialysis. However, serum albumin (Salb) level is determined by several other factors: plasma volume expansion, albumin redistribution, exogenous loss, increased fractional catabolic rate (FCR), and decreased synthesis. Decreased albumin synthesis is primarily responsible for hypoalbuminemia in hemodialysis (HD) patients. Studies of a smaller number of peritoneal dialysis (PD) patients suggest exogenous albumin loss and volume expansion as contributing mechanisms. However, both malnutrition and inflammation suppress albumin synthesis. As the adequacy of dialysis has improved, recent studies are unable to show any relation between dialysis adequacy and Salb level. Further, Salb level appears to be a poor marker of nutritional status in dialysis patients when compared with other measures of nutrition, such as subjective global assessment score, anthropometry, and dietary intake. Instead, cytokines and positive acute-phase reactants, produced in response to inflammation, have been identified as important contributors to hypoalbuminemia in dialysis patients. These markers correlate with hypoalbuminemia and supercede Salb level in predicting mortality. Multivariate analysis identifies markers of inflammation and nutritional status as independent predictors of hypoalbuminemia in HD patients and markers of inflammation and peritoneal albumin loss as independent predictors in PD patients. However, the acute-phase response and malnutrition are closely interrelated, because inflammatory mediators also suppress appetite, increase muscle catabolism, and result in progressive cachexia. Future studies should focus on elucidating the inflammatory stimuli and the complex interaction between the acute-phase response and nutritional status.


Biomechanics and Orthotic Treatment of the Adult Acquired Flatfoot.
The adult acquired flatfoot deformity resulting from posterior tibial tendon dysfunction is the result of rupture of the posterior tibial tendon as well as key ligaments of the ankle and hindfoot. Kinematic studies have verified certain levels of deformity causing hindfoot eversion, lowering of the medial longitudinal arch and forefoot abduction. The condition is progressive and left untreated will cause significant disability. Bracing with ankle-foot orthoses has shown promising results in arresting progression of deformity and avoiding debilitating surgery. Various types of ankle-foot orthoses have been studied in terms of effects on gait as well as efficacy in treatment.


Effective virtual screening protocol for CYP2C9 ligands using a screening site constructed from flurbiprofen and S-warfarin pockets.
An effective virtual screening protocol was developed against an extended active site of CYP2C9, which was derived from X-ray structures complexed with flubiprofen and S-warfarin. Virtual screening has been effectively supported by our structure-based pharmacophore model. Importance of hot residues identified by mutation data and structural analysis was first estimated in an enrichment study. Key role of Arg108 and Phe114 in ligand binding was also underlined. Our screening protocol successfully identified 76% of known CYP2C9 ligands in the top 1% of the ranked database resulting 76-fold enrichment relative to random situation. Relevance of the protocol was further confirmed in selectivity studies, when 89% of CYP2C9 ligands were retrieved from a mixture of CYP2C9 and CYP2C8 ligands, while only 22% of CYP2C8 ligands were found applying the structure-based pharmacophore constraints. Moderate discrimination of CYP2C9 ligands from CYP2C18 and CYP2C19 ligands could also be achieved extending the application domain of our virtual screening protocol for the entire CYP2C family. Our findings further demonstrate the existence of an active site comprising of at least two binding pockets and strengthens the need of involvement of protein flexibility in virtual screening.


Bronchial atresia: a recognizable entity in the pediatric age group.
Bronchial atresia, a congenital lesion that develops after the 16th wk of fetal life, may be more common than previously believed, and this probably explains some cases of so-called congenital lobar emphysema. It may produce symptoms of pulmonary infection, wheezing, and respiratory distress severe enough to justify elective resection of that part of the lung distal to the atresia. The roentgenographic features that make this a recognizable entity are the following: (1) There is localized hyperinflation of lung in a segmental or lobar distribution, with a circular or oval parahilar radiodensity. Bronchography will demonstrate that there is no filling of the bronchus supplying this part of the lung. (2) The occasional neonate with this condition may present with an intrathoracic mass suggesting retained fetal lung fluid in lobar distribution. Bronchography will demonstrate that there is no filling of the bronchus to that part of the lung. (3) A plug of desquamated tissue and mucus in the cyst-like bronchus just distal to the point of atresia appears to be an unvarying component of the syndrome. It most commonly presents as a round or oval density, but in some cases it may be shaped like a rod or tree and rarely contains an air-fluid level.


Inferior vena cava pseudothrombus in computed tomography using a contrast medium power injector: a potential pitfall.
Of 276 patients undergoing CT using a power injector to deliver contrast material, 71 (26%) demonstrated a pseudothrombus in the suprarenal inferior vena cava. This occurs much more commonly than in patients injected by hand and is a potential pitfall in interpreting these scans.


Selective inhibition of the platelet phosphoinositide 3-kinase p110beta as promising new strategy for platelet protection during extracorporeal circulation.
Extracorporeal circulation (ECC) is used in cardiac surgery for cardiopulmonary bypass as well as in ventricular assist devices and for extracorporeal membrane oxygenation. Blood contact with the artificial surface and shear stress of ECC activates platelets and leukocytes resulting in a coagulopathy and proinflammatory events. Blockers of the platelet glycoprotein (GP) IIb/IIIa (CD41/CD61) can protect platelet function during ECC, a phenomenon called "platelet anaesthesia", but may be involved in post-ECC bleeding. We hypothesized that the new selective phosphoinositide 3-kinase p110beta inhibitor TGX-221 that inhibits shear-induced platelet activation without prolonging the bleeding time in vivo may also protect platelet function during ECC. Heparinized blood of healthy volunteers (n = 6) was treated in vitro with either the GP IIb/IIIa blocker tirofiban, TGX-221 or as control and circulated in an ECC model. Before and after 30 minutes circulation CD41 expression on the ECC-tubing as measure for platelet-ECC binding and generation of the platelet activation marker beta-thromboglobulin were determined using ELISA. Platelet aggregation and platelet-granulocyte binding were analysed in flow cytometry. After log-transforming the data statistical evaluation was performed using multifactor ANOVA in combination with Tukey's HSD test (global alpha = 5%). Tirofiban and TGX-221 inhibited platelet-ECC interaction, platelet aggregation and platelet-granulocyte binding. Tirofiban also inhibited ECC-induced beta-thromboglobulin release. The observed inhibition of platelet-ECC interaction and platelet activation by tirofiban contributes to explain the mechanism of "platelet anaesthesia". TGX-221 represents a promising alternative to GP IIb/IIIa blockade and should be further investigated for use during ECC in vivo.


Multiple complexes in human spermatocytes.
Multiple complexes develop during metaphase I in normal human spermatocytes. Usually they form two separate bodies about 1 micron in diameter, composed of tripartite units and a denser matrix. The tripartite units are structurally identical to the components of the central space of synaptonemal complexes (SCs). Formation of the multiple complexes occurs by shedding of SC fragments from a few chromosomal regions at prometaphase I. The combined total length of central elements in each multiple complex is 1 to 3 micron. Multiple complexes remain as cytoplasmic, perinuclear bodies during telophase I and interphase of spermatocytes II, but they were not observed during or after the second meiotic division. Although multiple complexes are initially located in the spindle, they do not show microtubular attachments and seem to be passively moved towards the periphery.


Connexons and cell adhesion: a romantic phase.
Recent evidence indicates, that gap junction forming proteins do not only contribute to intercellular communication (Kanno and Saffitz in Cardiovasc Pathol 10:169-177, 2001; Saez et al. in Physiol Rev 83:1359-1400, 2003), ion homeostasis and volume control (Goldberg et al. in J Biol Chem 277:36725-36730, 2002; Saez et al. in Physiol Rev 83:1359-1400, 2003). They also serve biological functions in a mechanical sense, supporting adherent connections between neighbouring cells of epithelial and non-epithelial tissues (Clair et al. in Exp Cell Res 314:1250-1265, 2008; Shaw et al. in Cell 128:547-560, 2007), where they stabilize migratory pathways in the developing central nervous system (Elias et al. in Nature 448:901-907, 2007; Malatesta et al. in Development 127:5253-5263, 2000; Noctor et al. in Nature 409:714-720, 2001; Rakic in Brain Res 33:471-476, 1971; J Comp Neurol 145:61-83 1972; Science 241:170-176, 1988), or mediate polarized movements and directionality of neural crest cells during organogenesis (Kirby and Waldo in Circ Res 77:211-215, 1995; Xu et al. in Development 133:3629-3639, 2006). Since, most data describing adhesive properties of gap junctions delt with connexin 43 (Cx43) (Beardslee et al. in Circ Res 83:629-635, 1998), we will focus our brief review on this isoform.


Intrahepatic Portosystemic Shunt via the Right Adrenal Vein in an Asymptomatic Cirrhotic Patient.
Intrahepatic Portosystemic Shunts (PSSs) draining to the Inferior Vena Cava (IVC) via the right adrenal vein has been reported as very rare, and all the patients who have been recorded have had hepatic encephalopathy. Here, we present a patient with intrahepatic PSS via the right adrenal vein diagnosed incidentally without encephalopathy. A 51-year-old patient, who was diagnosed with chronic liver parenchyma disease and a suspecting nodule on the ultrasound was examined by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). A 4 cm in diameter Hepatocellular Carcinoma (HCC) was detected. In addition to HCC, an abnormal shunt between the right posterior portal vein and the IVC via the right adrenal vein was also detected. To the best of our knowledge, this is the first case with intrahepatic PSS via the right adrenal vein diagnosed incidentally in the absence of encephalopathy and the fourth case with this abnormal shunt in English literature. Intrahepatic PSS via the right adrenal vein is rare. It may be asymptomatic at the time of diagnosis but has the potential to cause various problems, later on, especially hepatic encephalopathy. The radiologist must be aware of this abnormal shunt.


Perinatal BPA exposure demasculinizes males in measures of affect but has no effect on water maze learning in adulthood.
Bisphenol A (BPA) is an endocrine disrupting agent that can alter the normal gonadal steroid-sensitive sexual differentiation of the brain and behavior. While reproductive behavior and physiology are known to be altered by perinatal exposure to this compound, less is known about BPA's effects on sex differences in learning and measures of affect. In order to evaluate the effects of perinatal BPA treatment on learning and affect in adulthood, we exposed rats to one of five doses of BPA through gestation and lactation then examined adult behavior in the Morris Water Maze (MWM), the Elevated Plus Maze (EPM) and the Forced Swim Test (FST). No effect of BPA was observed in the MWM, but on both the EPM and FST, low doses (5 μg/kg) of BPA eliminated sex differences found between controls; furthermore, a non-monotonic dose-response observed in previous studies was confirmed for these tasks. Overall, our study adds to the growing data suggesting that BPA interferes with the normal development of affective behaviors in a non-linear, dose-dependent manner.


Mediation of vascular endothelial proliferation by factors in fetal bovine retinal extracts and serum.
The effect of fetal bovine retinal extract (FBR) and dialyzed fetal bovine serum (FBS) on in vitro proliferation of vascular endothelial cells was studied. Quantitatively, FBR, both dialyzable and nondialyzable, and dialyzed FBS exhibited a synergism in bringing about an enhanced proliferation of vascular endothelial cells. Assays on selected samples using both aortic and retinal vascular endothelial cells yielded similar results. In the absence of dialyzed FBS, FBR had only a negligible stimulatory effect. When compared at a protein concentration of 3 mg ml-1, dialyzed FBS elicited vascular endothelial proliferation at a rate only 25% that of FBS (not dialyzed). However, under experimental conditions using 3 mg ml-1 of dialyzed FBS and 0.5 mg ml-1 of dialyzed retinal extract, a six-fold increase in the activity of vascular endothelial proliferation was demonstrated. The observed synergistic effect was dependent on the concentrations of both dialyzed FBS and FBR. The observed synergism rules out the possibility that the stimulatory effect of FBR was due to blood contamination in sample preparation. Qualitatively, major components of dialyzed FBS and dialyzed FBR that exerted a synergistic effect on the stimulation of vascular endothelial proliferation were isolated by permeation chromatography using Sephadex G-100, with Mr estimated at 150 000 and 80 000, respectively. One minor component in FBS and one in FBR were also present.


Extensive hookworm-related cutaneous larva migrans in Norwegian travellers to the tropics.
Hookworm-related cutaneous larva migrans is a common dermatosis in travellers to the tropics and typically presents as one or a few migrating serpiginous lesions on the lower extremities or buttocks. We present two Norwegian holidaymakers who developed extensive disease after returning from Brazil and Tanzania, respectively. Both patients responded to the treatment with ivermectin.


Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance.
The aim of this study was to report the CT evolution and clinical significance of HCA after intra-arterial mechanical thrombectomy (revascularization by using retrievers and/or other mechanical devices without concomitant delivery of intra-arterial thrombolytics) in our patients. These lesions are common after intra-arterial thrombolysis, being considered a negative prognostic sign. Their significance after pure mechanical thrombectomy remains unknown. Forty-eight patients were treated with mechanical thrombectomy by using retrievable stents between April 2010 and February 2011. All patients underwent initial (first 24 hours) and follow-up (48-72 hours) nonenhanced CT. We retrospectively analyzed the clinical and radiologic data of the patients with HCA and compared them with controls. Fifteen of 48 patients presented with HCA. The site of occlusion was the MCA in 7 patients, both the extra- and intracranial segments of the ICA in 6, and the intracranial ICA in 2. In 7 patients, previous intravenous thrombolysis was administered. Complete recanalization (TICI 3) was achieved in 12 patients, and incomplete recanalization (TICI 2b), in 3. The location of HCA was the subarachnoid space in 6 patients, the brain parenchyma in 4 patients, and both in 5 patients. The HCA were asymptomatic in all patients. There was no statistical difference in final NIHSS score reduction (NIHSS pretreatment-NIHSS at discharge) between patients and controls. In our series, HCA are common after mechanical thrombectomy but do not carry an increased risk of symptomatic hemorrhage or negative prognosis. These data might be related to the high rate of recanalization and the absence of intra-arterial thrombolytics.


Immunosurveillance and melanoma.
There is considerable indirect and some direct evidence that immune mechanisms can play an important role in controlling the growth of melanoma. In mice, melanoma can be prevented with vaccines. Consequently, even though naturally occurring immunosurveillance may not be sufficiently potent to prevent melanoma, it is possible that the prophylactic augmentation of immunity to melanoma with vaccines may eventually permit this cancer to be prevented in humans.


Biomarker concordance between molecular stereotactic biopsy and open surgical specimens in gliomas.
To compare 1p/19q codeletion, MGMT promoter methylation, and IDH mutation status in stereotactic biopsy and open craniotomy specimens. The latest WHO classification of gliomas requires assessment of the expression of molecular markers. Samples can be obtained for molecular assays via open craniotomy or molecular stereotactic biopsy (MSB). However, there is uncertainty as to whether MSB is representative of the entire tumour, and therefore how reliable it is for treatment planning. We examined 11 patients diagnosed with brain tumours suspicious of glioma who underwent open craniotomy after stereotactic biopsy and in whom multiple biomarkers were assessed in both sets of samples by methylation-specific multiplex ligation-dependent probe amplification. Institutional Review Board ethical approval was granted (KB 694/2018). The initial histopathological grade as determined by stereotactic biopsy was the same as in the samples obtained by open surgery. Further, the marker profile used here was valid in both high- and low-grade gliomas. MSB is a reliable way to obtain material for precision medicine approaches.


Lower amputation rate after fasciotomy by straight midline incision technique for a 22,900-V electrical injury to the upper extremities.
The purpose of this study is to compare the major amputation rate following two different fasciotomy techniques, conventional versus straight midline, in patients with high-voltage arc burn injury by electric currents of 22,900V to the upper extremities. A retrospective analysis of 230 patients (270 burned upper limbs) who underwent fasciotomy after high-voltage electrical injuries between 1996 and 2007 was performed. The patients were divided into two groups according to the fasciotomy method used. From 1996 to 2002, 158 patients (184 limbs) underwent conventional fasciotomy by Green's volar-ulnar incision (conventional fasciotomy group). From 2003 to 2007, 72 patients (86 limbs) underwent fasciotomy using a straight midline curved incision (midline fasciotomy group). The patients were also divided into two groups based on whether the fasciotomy procedure was performed early or late. Patients who underwent fasciotomies <8h after injury were classified as early, while those who underwent it >8h after injury were classified as late. Major amputation rates were compared between two fasciotomy methods and analyzed following fasciotomy timing. The midline fasciotomy group had a significantly lower major amputation rate (33.7%) than the conventional fasciotomy group (59.2%) (p<0.001). A subsequently decreased major amputation rate of 27.8% was observed in the early fasciotomy subgroup of the midline fasciotomy group (p=0.025). Early fasciotomy remarkably reduced the major amputation rate after high-voltage arc injury; in the setting of minimized vascular exposure after fasciotomy, a midline straight incision could ensure that various types of reconstructive microsurgical procedures and primary skin closures can be used to save limbs.


Peptidergic regulation of thymocyte differentiation, proliferation, and apoptosis during aging of the thymus.
The effects of T-31, AB-17, and AB-9 peptides on old (passage 8) thymocyte culture were studied. Only AB-9 peptide exhibited a complex geroprotective effect on thymocytes during their aging. Peptide AB-9 stimulated proliferative activity and differentiation of thymocytes and inhibited their apoptosis.


The (Null) Effects of Happiness on Affective Polarization, Conspiracy Endorsement, and Deep Fake Recognition: Evidence from Five Survey Experiments in Three Countries.
Affective polarization is a key concern in America and other democracies. Although past evidence suggests some ways to minimize it, there are no easily applicable interventions that have been found to work in the increasingly polarized climate. This project examines whether irrelevant factors, or incidental happiness more specifically, have the power to reduce affective polarization (i.e., misattribution of affect or "carryover effect"). On the flip side, happiness can minimize systematic processing, thus enhancing beliefs in conspiracy theories and impeding individual ability to recognize deep fakes. Three preregistered survey experiments in the US, Poland, and the Netherlands (total N = 3611) induced happiness in three distinct ways. Happiness had no effects on affective polarization toward political outgroups and hostility toward various divisive social groups, and also on endorsement of conspiracy theories and beliefs that a deep fake was real. Two additional studies in the US and Poland (total N = 2220), also induced anger and anxiety, confirming that all these incidental emotions had null effects. These findings, which emerged uniformly in three different countries, among different partisan and ideological groups, and for those for whom the inductions were differently effective, underscore the stability of outgroup attitudes in contemporary America and other countries. The online version contains supplementary material available at 10.1007/s11109-021-09701-1.


The role of protein tyrosine kinases in CYP1A1 induction by omeprazole and thiabendazole in rat hepatocytes.
Benzimidazoles compounds like omeprazole (OME) and thiabendazole (TBZ) mediate CYP1A1 induction differently from classical aryl hydrocarbon receptor (AhR) ligands, 3-methylcholanthrene (3-MC) and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). To clarify the involvement of an intracellular signal pathway in CYP1A1 induction by OME and TBZ, the TBZ, OME and 3-MC signal-transducing pathways were compared by using specific protein tyrosine kinase inhibitors in primary culture of rat hepatocytes. The effect of OME and TBZ (75-250 microM) on cytochrome P450 1A1 (CYP1A1) expression was therefore studied in primary cultures of rat hepatocytes after 24 h, 48 h and 72 h of exposure. Both compounds provoked a dose- and time-dependent increase in CYP1A1 (EROD activity, protein and mRNA levels), but OME was less effective at all the concentrations and times tested. The mechanism of benzimidazole-mediated induction of CYP1A1 was investigated by comparison with 3-MC, a prototypical AhR ligand. As expected, OME and TBZ were unable to displace [(3)H]-TCDD from its binding sites to the AhR in competitive binding studies. Moreover, classic tyrosine kinase inhibitor herbimycin A (HA) inhibited the two benzimidazoles-mediated CYP1A1 inductions, but only partially inhibited the 3-MC-mediated one. Another two tyrosine kinase inhibitors, Lavendustin A (LA) and genistein (GEN), had no effect on CYP1A1 induction by benzimidazoles and 3-MC. These results are consistent with the implication of a tyrosine kinase, most probably the Src tyrosine kinase, in the mechanism of CYP1A1 induction in rat hepatocytes.


Roles of Staphylococcus aureus and sensitization to staphylococcal enterotoxin in bronchiectasis.
Staphylococcus aureus (S. aureus) is an inducer of mucosal type 2 immune response. To test the hypothesis that airway colonization with S. aureus may reflect allergic predisposition with staphylococcal enterotoxin (SE) sensitization in bronchiectasis, we retrospectively examined the association between SE sensitization and S. aureus and Pseudomonas aeruginosa (P. aeruginosa) in sputum of patients with bronchiectasis (n = 35). Overall, 14 (40%) patients with bronchiectasis were sensitized to either staphylococcal enterotoxin A (SEA) or staphylococcal enterotoxin B (SEB). SEA sensitization was more frequently observed in patients with sputum S. aureus than those without it. Patients with sputum S. aureus but without P. aeruginosa exhibited the highest SEA sensitization frequency and serum total IgE levels. Patients with both S. aureus and P. aeruginosa exhibited the highest blood eosinophils. In conclusion, S. aureus in the lower airway may indicate an allergic predisposition with SE sensitization and blood eosinophilia in bronchiectasis.


Adult-derived pluripotent stem cells.
The global incidence of spinal cord injury (SCI) is 15-40 cases per million people, with the socioeconomic and healthcare costs amounting to nearly $10 billion per annum in the USA alone. Despite substantial advances in medical care and surgical technology, many patients with SCI still experience significant long-term neurologic disability. Cellular transplantation offers a promising therapy to address the multifactorial nature of SCI in both the subacute and chronic phase of the injury to promote central nervous system repair and regeneration and to augment existing therapies. Adult-derived stem cells are the least ethically challenging stem cells but, until recently, a major hurdle has been inducing pluripotency to generate the required neural lineages. Improved generation and transfection techniques, combined with positive experimental outcomes in SCI models, suggest that adult-derived induced pluripotent stem cells could be a genuine alternative to embryonic stem cells for clinical treatments. For translation from bench to bedside, the efficacy of induced pluripotent stem cell-derived neural stem and progenitor cells in suitable SCI models needs to be validated further and backed up with rigorous early-stage clinical trials.


Quantitative analysis of the lipidomes of the influenza virus envelope and MDCK cell apical membrane.
The influenza virus (IFV) acquires its envelope by budding from host cell plasma membranes. Using quantitative shotgun mass spectrometry, we determined the lipidomes of the host Madin-Darby canine kidney cell, its apical membrane, and the IFV budding from it. We found the apical membrane to be enriched in sphingolipids (SPs) and cholesterol, whereas glycerophospholipids were reduced, and storage lipids were depleted compared with the whole-cell membranes. The virus membrane exhibited a further enrichment of SPs and cholesterol compared with the donor membrane at the expense of phosphatidylcholines. Our data are consistent with and extend existing models of membrane raft-based biogenesis of the apical membrane and IFV envelope.


Comparative performance study of different sample introduction techniques for rapid and precise selenium isotope ratio determination using multi-collector inductively coupled plasma mass spectrometry (MC-ICP/MS).
The analytical performance of five sample introduction systems, a cross flow nebulizer spray chamber, two different solvent desolvation systems, a multi-mode sample introduction system (MSIS), and a hydride generation (LI2) system were compared for the determination of Se isotope ratio measurements using multi-collector inductively coupled plasma mass spectrometry (MC-ICP/MS). The optimal operating parameters for obtaining the highest Se signal-to-noise (S/N) ratios and isotope ratio precision for each sample introduction were determined. The hydride generation (LI2) system was identified as the most suitable sample introduction method yielding maximum sensitivity and precision for Se isotope ratio measurement. It provided five times higher S/N ratios for all Se isotopes compared to the MSIS, 20 times the S/N ratios of both desolvation units, and 100 times the S/N ratios produced by the conventional spray chamber sample introduction method. The internal precision achieved for the (78)Se/(82)Se ratio at 100 ng mL(-1) Se with the spray chamber, two desolvation, MSIS, and the LI2 systems coupled to MC-ICP/MS was 150, 125, 114, 13, and 7 ppm, respectively. Instrument mass bias factors (K) were calculated using an exponential law correction function. Among the five studied sample introduction systems the LI2 showed the lowest mass bias of -0.0265 and the desolvation system showed the largest bias with -0.0321.


Cloning, expression and chromosome localization of porcine adiponectin and adiponectin receptors genes.
Adiponectin is a cytokine secreted specifically by adipocytes that has been proposed to enhance insulin sensitivity and prevent atherosclerosis. Adiponectin receptors (adipoR1 and adipoR2) are recently found in mice which act as receptors for globular and full-length adiponectin to mediate the fatty-acid oxidation and glucose uptake in muscle and liver. The primary goal of this study was to examine chromosome localization of porcine adiponectin and adiponectin receptors and the gene expression pattern in various tissues of pigs of the three genes. Radiation hybrid mapping demonstrated that porcine adiponectin, adipoR1 and adipoR2 were located to chromosome13q36-41, 10p11 and 5q25, in the regions that were syntenic to the homologs of human genes, respectively. Semi-quantitative RT-PCR showed that porcine adiponectin mRNA was specifically expressed in adipose tissue and porcine adipoR1 and adipoR2 mRNA were ubiquitously expressed in many tissues except brain. Comparison to adipoR2 mRNA which was highly expressed in liver, heart, kidney, adipose tissues and lung, adipoR1 mRNA was expressed at relatively high levels in porcine muscle, leukocytes and epididymis. Our data provide basic molecular information useful for the further investigation on the function of the three genes.


Different cellular targets for Cu- and Fe-catalyzed oxidation observed using a Cu-compatible thiobarbituric acid assay.
The widely used thiobarbituric acid (TBA) assay for oxidative damage to biomolecules fails in Cu2(+)-containing solutions due to the formation of a cloudy precipitate. The chelation of Cu2+ ions with EDTA or Chelex was investigated. Both prevented precipitate formation, but only Chelex allowed proper color development in the TBA assay. The Chelex modified assay could be adapted to a variety of systems, and was applied to the detection of Cu2+/ascorbate dependent deoxyribose breakdown and oxidative damage in erythrocyte ghosts, lysates and whole cells. Using this method, it was shown that Cu2+/ascorbate caused membrane damage in ghosts but not in whole red blood cells (RBC). Fe3+/ascorbate, on the other hand, caused formation of TBA-reactive products even in whole RBC. When Cu2+ and Fe3+ were presented to isolated hemoglobin as their 1:1 nitrilotriacetate complexes, the protein bound 10-12 cupric ions per molecule, but no ferric ions. It is suggested that oxidative damage catalyzed by copper or iron ions has different cellular targets, determined by the different binding properties of the two metals to various cellular components.


Antigenic variation in foot-and-mouth disease: studies based on the virus neutralization reaction.
The neutralization reaction is the most appropriate in vitro reference test system for assessing intratypic antigenic variation as it involves the antigenic determinants responsible for virus strain specificity and evoking protective antibody. Antigenic relationships determined in different neutralization test systems were independent of the system used and were assumed to truly reflect antigenic variation. The two-dimensional microneutralization test was found to be appropriate for foot and mouth disease (FMD) virus strain differentiation. To minimize test to test variation, comparisons are performed as matched pairs. The pooled variance of the test system is used to assess the significance of the relationships obtained. Antisera from convalescent animals were less specific than those from vaccinates. Serum quality seemed less critical for the virus neutralization than the complement fixation reaction. A system for FMD virus strain differentiation based on the use of the virus neutralization reaction taking into account the statistical and biological significance of observed r values is recommended.


Basilar artery occlusion in a young patient with Wegener's granulomatosis.
Stroke is an uncommon sequela of Wegener's granulomatosis, resulting primarily from vasculitic infiltration of small to medium-sized vessels. We describe a young patient with Wegener's granulomatosis and basilar artery occlusion. A 26-year-old man with histopathologically confirmed Wegener's granulomatosis suffered a brain stem stroke 24 hours after open lung biopsy. Angiography revealed midbasilar artery occlusion. Patients with Wegener's granulomatosis may experience premature large cerebral vessel occlusion. Putative etiologies in our patient include vasculitis, postoperative hypercoagulability, and/or intraoperative neck positioning leading to embolization.


Combination chemotherapy with docetaxel, vinorelbine and cisplatin as first-line treatment of advanced non-small-cell lung cancer: a multicenter phase II study of the Greek Cooperative Group for Lung Cancer.
Vinorelbine, docetaxel and cisplatin have documented single-agent activity in non-small-cell lung cancer (NSCLC); a multicenter phase II trial was initiated in order to evaluate the tolerance and efficacy of their combination. A total of 24 chemotherapy-naive patients with measurable stage IIIB or IV NSCLC and performance status (PS; WHO) 0-2 entered the study. Vinorelbine (20 mg/m2 i.v.) was given on days 1 and 15, cisplatin (60 mg/m2) on day 1, and docetaxel (100 mg/m2) on day 16, in cycles of 28 days. Recombinant human granulocyte colony-stimulating factor (150 microg/m2 s.c.) was administered prophylactically from day 17 to day 27. One pathological complete (4%) and six partial responses (25%) were documented (overall response 29%; 95% CI 11.6-49.2%). A total of five patients (21%) had stable and 12 (50%) progressive disease. The median duration of response was 28 weeks and the median time to tumor progression 36 weeks; the median survival was 20 weeks. Grade 3-4 neutropenia occurred in 16 patients (67%) while 13 of them (54%) developed febrile neutropenia. Grade 4 mucositis occurred in two patients (8%) and one of them also presented grade 4 diarrhea. There were four treatment-related deaths: two from sepsis, one from massive hemoptysis due to a pulmonary abscess and one from acute myocardial ischemia 7 days post-chemotherapy. In conclusion, the high incidence of neutropenic episodes and treatment-related deaths led to an early discontinuation of patient enrollment. This combination, in the schedule and the doses used, could not be recommended for off protocol treatment of patients with advanced NSCLC.


Catalytic Depolymerization of Waste Polyolefins by Induction Heating: Selective Alkane/Alkene Production.
Low- and high-density polyethylene (LDPE/HDPE) have been selectively depolymerized, without added H2, to C2-C20 + alkanes/alkenes via energy-efficient radio frequency induction heating, coupled with dual-functional heterogeneous Fe3O4 and Ni- or Pt-based catalysts. Fe3O4 was used to locally generate heat when exposed to magnetic fields. Initial results indicate that zeolite-based Ni catalysts are more selective to light olefins, while Ni supported on ceria catalysts are more selective to C7-C14 alkanes/alkenes. LDPE conversions up to 94% were obtained with minimal aromatic, coke, or methane formation which are typically observed with thermal heating. Two depolymerization mechanisms, a reverse Cossee-Arlman mechanism or a random cleavage process, were proposed to account for the different selectivities. The depolymerization process was also tested on commercial LDPE (grocery bags), polystyrene, and virgin HDPE using the Ni on Fe3O4 catalyst, with the LDPE resulting in similar product conversion (∼48%) and selectivity as for virgin LDPE.


Significance of abnormal blood pressure response during exercise-induced myocardial dysfunction after recent acute myocardial infarction.
The relation between exercise left ventricular ejection fraction and blood pressure (BP) responses after an acute myocardial infarction (AMI) was investigated. Twenty-eight to 37 days after an uncomplicated AMI, 224 consecutive patients underwent exercise radionuclide angiography in the 40 degrees semisupine position. In 180 patients (group A, 80%), BP increased more than 5 mm Hg every stage; in 44 patients, BP responses were abnormal; in 33 (group B, 15%), BP did not increase during 2 stages; in 11 (group C, 5%), it decreased more than 5 mm Hg after an initial increase. Ejection fraction did not differ significantly among the 3 groups at rest (51 +/- 13 in group A, 50 +/- 18 in group B, 47 +/- 13 in group C [difference not significant]) or at peak exercise (51 +/- 16% in group A, 46 +/- 19% in group B, and 43 +/- 16% in group C, [difference not significant]). Exercise-induced left ventricular failure or hemodynamic decompensation occurred in 22 patients. In these patients, ejection fraction at rest was 44 +/- 19% and decreased to 35 +/- 16% (p less than 0.05) with exercise. Only 9 of these patients (41%) had abnormal BP responses, with the other 13 (59%) showing a normal BP responses. The The 35 patients with abnormal BP responses in the absence of hemodynamic decompensation were asymptomatic, terminating exercise because of fatigue. The ejection fraction at rest and during exercise in these patients was similar to that in patients with normal BP responses.(ABSTRACT TRUNCATED AT 250 WORDS)


Magnetic resonance imaging of normal bone marrow.
The appearance in magnetic resonance imaging (MRI) of the bones depends, to a large extent, on the unmineralized content of the bone cavities. Because yellow marrow contains a large number of fat protons and red marrow a significant number of water protons, MRI offers the opportunity to map the distribution of red and yellow marrow. In addition, red marrow MR appearance varies according to the relative proportion of fat and nonfat cells. Variations in the composition of red marrow and its distribution among normal subjects, mainly in relation to age and sex, contribute to creating a wide spectrum in bone MR appearance, which must be known in order to avoid confusion with bone marrow abnormalities.


Impact of failed mechanical reperfusion in patients with acute myocardial infarction treated with primary angioplasty.
Percutaneous coronary intervention is not successful in all patients whose acute myocardial infarction is controlled with primary angioplasty, and, after an initial successful procedure, reperfusion is not always sustained due to subacute (stent) thrombosis. In a studied population that had acute myocardial infarction, failed mechanical reperfusion occurred in 108 patients (6.9%). Killip's class >I at admission, a left anterior descending artery as the infarct-related vessel, or a preprocedural Thrombolysis In Myocardial Infarction grade 0 or 1 flow was an independent predictor of failed reperfusion. Outcome after successful early and sustained mechanical reperfusion is excellent. Failure of the initial procedure and reocclusion of the infarct-related vessel are important determinants of adverse outcome.


Changes in plasma thrombospondin-1 concentrations following acute intracerebral hemorrhage.
Angiogenesis is a fundamental process for brain development and repair. Thrombospondin-1 is the first identified endogenous angiogenesis inhibitor. Its expression in rat brain is upregulated after intracerebral hemorrhage (ICH). We determined whether plasma thrombospondin-1 concentrations are associated with injury severity and prognosis in ICH patients. This observational, prospective study recruited 110 patients and 110 age- and gender-matched healthy controls. Blood samples were collected from the patients at admission and from the healthy controls at study entry to measure plasma thrombospondin-1 concentrations. The endpoints included 1-week mortality, 6-month mortality, 6-month overall survival and 6-month unfavorable outcome (modified Rankin Scale score >2). Plasma thrombospondin-1 concentrations were markedly higher in patients than in healthy controls. Thrombospondin-1 was an independent predictive factor for all endpoints and plasma thrombospondin-1 concentrations were highly associated with injury severity reflected by hematoma volume and National Institutes of Health Stroke Scale score. Under receiver operating characteristic curves, plasma thrombospondin-1 concentrations had similar predictive values compared with hematoma volume and National Institutes of Health Stroke Scale score. Increased plasma thrombospondin-1 concentrations following ICH are independently associated with injury severity and short-term and long-term clinical outcomes.


Depression and codependency in women.
Seven million American women are depressed, and 40 million Americans, primarily women, have been labeled as codependent. This study aimed to identify the prevalence of codependency in women undergoing treatment for depression, examine the relationship between codependency and depression, and determine which of the symptoms of codependency are most highly predictive of depression scores. Depression and codependency were measured in a sample of 105 depressed women by using the Beck Depression Inventory and the Codependency Assessment Tool. Descriptive statistics, Pearson's Product Moment Correlation, and multiple regression were used for analysis. Of these depressed women, 36% were moderately to severely codependent. Depression and codependency were strongly related, with the significant gamma = .92 (P < .001). Of the codependency subscales, Low Self-Worth and Hiding Self correlate most strongly with depression; Other Focus/Self-Neglect added the least-independent--explanatory power. Thus, future research should be directed toward the relationship of codependency to power, alienation of self, and personality disorders.


The effect of chronic ethanol consumption on the fine structure of the CA1 stratum oriens in short-sleep and long-sleep mice: short-term and long-term exposure.
The effect of chronic ethanol administration on the fine structure of the hippocampal CA1 stratum oriens was examined in two lines of mice selectively bred for their differential sensitivity to acute ethanol exposure (long-sleep, LS and short-sleep, SS mice). Two experiments were performed. In the first experiment, mice received a liquid diet for 3 weeks with the final amount of ethanol being 35% ethanol-derived calories. In the second experiment, mice received 23.5% ethanol-derived calories for 3 months. Quantitative electron microscopy of the dendritic spines and synaptic appositions in the stratum oriens of CA1 revealed an interaction between diet and line of mice, but only in the 3-month exposure condition. This difference was due to a significant decrease in the density of spines and synaptic appositions in the LS mice receiving ethanol. Additionally, baseline differences between lines indicate that the lines are differing in the density of spine synapses in the absence of ethanol treatment. The possible interaction between acute sensitivity to ethanol and differences in fine structure are examined.


Involvement of corticotrophin-releasing hormone and corticosteroid receptors in the brain-pituitary-gill of tilapia during the course of seawater acclimation.
The mRNA expression of genes for corticotrophin-releasing hormone (CRH) and the hormone receptors CRH-receptor/CRH-R, glucocorticoid receptor 1/2 (GR1/2) and mineralocorticoid receptor (MR) was studied in the brain, pituitary and gill of tilapia (Oreochromis mossambibus) during salinity and handling stress by real-time quantitative-polymerase chain reaction analysis. The results indicated that the transcripts of CRH and CRH-R were increased in the forebrain, midbrain and gill, whereas elevated hypothalamic CRH mRNA suppressed the CRH-R mRNA in the pituitary in seawater (SW) fish. The levels of plasma osmolality and cortisol were significantly increased in SW compared to freshwater fish. The up-regulation of GR1, GR2, MR and α-NKA (Na(+) /K(+) -ATPase) transcripts in SW fish provided evidence that cortisol responds to stress and involves ion-base regulation via the GR1, GR2 and MR receptors in the gill. These data suggest that GR1, GR2 and MR have a pivotal role in the brain and gill. GR1, GR2 and MR expression may be dependent on CRH and cortisol expression in the brain and gill. In addition, we performed in situ hybridisation analysis to localise and differentiate the CRH, CRH-R, GR1, GR2 and MR transcripts in the brain of FW- and SW-acute acclimated tilapia during salinity stress. In almost all transcripts, the hybridisation signal was significantly abundant in the SW-acute acclimated tilapia brain, especially in the dorsal ventral cephalon, dorsal nucleus preopticus pars magnocellularis and dorsal nucleus preopticus pars parvocellularis. Salinity stress induced differential and specific responses in the gill and brain compared to handling stress.


Negative chronotropic action of cyclic AMP on the fetal rat heart in organ culture.
Dibutyryl cyclic AMP and cyclic AMP in a DMSO medium were administered to the fetal rat heart in organ culture. Changes in heart rate were observed. Dibutyryl cyclic AMP in concentrations of 5 X 10(-5) M and 1 X 10(-4) M produced significant negative chronotropism. At a concentration of 1 X 10(-3) M, cyclic AMP in a 3% or 0.5% DMSO medium produced significant negative chronotropism. These data were compared with other studies. The negative chronotropic action of cyclic AMP and its dibutyryl derivative are evidence against the involvement of cyclic AMP in positive cardiac chronotropism.


The reaction of acetaldehyde with brain microtubular proteins: formation of stable adducts and inhibition of polymerization.
Stable adducts were formed by treatment of bovine brain microtubular proteins (MTP) with acetaldehyde, followed by gel filtration to remove excess acetaldehyde. The extent of stable adduct formation was determined using [14C]acetaldehyde and was correlated with acetaldehyde concentration and reaction time. Significant inhibition of MTP polymerization was observed at adduct concentrations of 0.6 mol acetaldehyde/mol tubulin dimer. The data suggest that repeated exposure of MTP to low concentrations of acetaldehyde, as would occur in the brain and other tissues of alcoholics, may inhibit MTP polymerization with neurological consequences.


Schistosoma japonicum: immunological characterization and detection of circulating polysaccharide antigens from adult worms.
The antigenic constituents of a trichloroacetic acid (TCA)-soluble fraction of adult Schistosoma japonicum were studied with immunoelectrophoresis, and compared with those of Schistosoma mansoni. Eight TCA-soluble antigens of S. japonicum were demonstrated, five of which showed immunological identity with S. mansoni antigens. Of the eight antigens, five antigens with anodic motility were found as circulating antigens in S. japonicum-infected hamster and rabbit sera; the major circulating antigen was the circulating anodic antigen (CAA). Two other antigens, with cathodic motility, including the circulating cathodic antigen (CCA), were demonstrable as circulating antigens in S. mansoni infections, but not in S. japonicum infections. Most of the circulating antigens were shown to be gut-associated. Only one antigen, line 2, which was not demonstrable as circulating antigen and which was present in the parenchyma of the worms, was found to be specific for S. japonicum. Using an ELISA for the detection of CAA in the sera of S. japonicum-infected rabbits, a lower detection level of 100 ng CAA/ml serum was achieved. Moreover, at 7-8 weeks after infection, a direct relationship between worm burden and CAA level was demonstrated.


Global prevalence of self-harm during the COVID-19 pandemic: a systematic review and meta-analysis.
COVID-19 and its transmission mitigation measures have caused widespread mental health problems. Previous studies have suggested that psychological, economic, behavioral, and psychosocial problems associated with the COVID-19 pandemic may lead to a rise in self-harm. However, little is known about the prevalence of self-harm worldwide during COVID-19. Therefore, a quantitative synthesis is needed to reach an overall conclusion regarding the prevalence of self-harm during the pandemic. By using permutations of COVID-19, self-harm or relevant search terms, we searched the following electronic databases from November 2019 to January 2022: Web of Science, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure (CNKI), Wanfang Database and systematically reviewed the evidence according to MOOSE guidelines. We employed Cochran's chi-squared test (Cochran's Q), I2test and subgroup analysis to assess and address the heterogeneity. Sensitivity analysis was conducted by eliminating each included study individually and then combining the effects. Sixteen studies that met the inclusion and exclusion criteria were identified, with sample sizes ranging from 228 to 49,227. The methodological quality of the included studies was mostly at the medium level. By using a random effect model, the pooled prevalence of self-harm was 15.8% (95% CI 13.3-18.3). Based on subgroup analysis, the following characteristics of the included studies were more likely to have a higher prevalence of self-harm: studies conducted in Asia or prior to July 2020, cross-sectional studies, samples recruited in hospitals or schools, adolescents, females, the purpose of self-harm (NSSI), mental symptoms and restriction experiences. We provided the first meta-analytic estimated prevalence of self-harm based on a large sample from different countries and populations. The prevalence of self-harm during COVID-19 was not encouraging and requires attention and intervention. Further high-quality and prospective research are needed in order to determine the prevalence of self-harm with greater accuracy because to the clear heterogeneity across the included studies. In addition, this study also provides new directions for future research, including the identification of high-risk groups for self-harm, the formulation and implementation of prevention and intervention programs, and the long-term impact of COVID-19 on self-harm.


Measuring experiences of facility-based care for pregnant women and newborns: a scoping review.
Access to high-quality, person-centred care during pregnancy and childbirth is a global priority. Positive experience of care is key in particular, because it is both a fundamental right and can influence health outcomes and future healthcare utilisation. Despite its importance for accountability and action, systematic guidance on measuring experience of care is limited. We conducted a scoping review of published literature to identify measures/instruments for experience of facility-based pregnancy and childbirth (abortion, antenatal, intrapartum, postnatal and newborn) care. We systematically searched five bibliographic databases from 1 January 2007 through 1 February 2019. Using a predefined evidence template, we extracted data on study design, data collection method, study population and care type as reported in primary quantitative articles. We report results narratively. We retrieved 16 528 unique citations, including 171 eligible articles representing, 157 unique instruments and 144 unique parent instruments across 56 countries. Half of the articles (90/171) did not use a validated instrument. While 82% (n=141) of articles reported on labour and childbirth care, only one reported on early pregnancy/abortion care. The most commonly reported sub-domains of user experience were communication (84%, 132/157) and respect and dignity (71%, 111/157). The primary purpose of most papers was measurement (70%, 119/171), largely through cross-sectional surveys. There are alarming gaps in measurement of user experience for abortion, antenatal, postnatal and newborn care, including lack of validated instruments to measure the effects of interventions and policies on user experience. This review was registered and published on PROSPERO (CRD42017070867). PROSPERO is an international database of prospectively registered systematic reviews in health and social care.


Effects of ischemia on the function and structure of the cat carotid body.
Interrupting the blood supply to the carotid body by ligating arteries of its vascular peduncle altered the chemoreceptive properties of the carotid nerve and produced structural changes in parenchymal (glomus and sustentacular) cells. The onset of ischemia was marked by an increase in the discharge of both A (myelinated) and C (unmyelinated) sensory fibers followed by depression and finally by receptor silence. The discharge of A-fibers disappeared after 30-50 min and that of C-fibers after 60-90 min. During ischemia of 15-60 min duration the threshold to pharmacological (NaCN, ACh) and 'natural' (hypoxic) stimuli progressively increased and was accompanied by reversible changes in the structure of parenchymal cells and nerve endings. Ischemia for 2 h or longer produced irreversible functional damage and disappearance of glomus and sustentacular cells from the carotid body. Following ischemic injury, nerve fibers regenerated and all responded to mechanical stimuli but only a few were stimulated by natural or pharmacological agents. Thus, parenchymal cells of the carotid body appear to be most important in transduction by allowing sensory fibers to respond to chemical stimuli.


Real-time sentinel lymph node biopsy guidance using combined ultrasound, photoacoustic, fluorescence imaging: in vivo proof-of-principle and validation with nodal obstruction.
Precise sentinel lymph node (SLN) identification is crucial not only for accurate diagnosis of micro-metastases at an early stage of cancer progression but also for reducing the number of SLN biopsies (SLNB) to minimize their severe side effects. Furthermore, it is desirable that an SLNB guidance should be as safe as possible in routine clinical use. Although there are currently various SLNB guidance methods for pre-operative or intra-operative assessment, none are ideal. We propose a real-time SLNB guidance method using contrast-enhanced tri-modal images (i.e., ultrasound, photoacoustic, and fluorescence) acquired by a recently developed hand-held tri-modal probe. The major advantage of tri-modal imaging is demonstrated here through an in vivo study of the technically-difficult case of nodal obstruction that frequently leads to false-negative results in patients. The results in a tumor model in rabbits and normal controls showed that tri-modal imaging is capable of clearly identifying obstructed SLNs and of indicating their metastatic involvement. Based on these findings, we propose an SLNB protocol to help surgeons take full advantage of the complementary information obtained from tri-modal imaging, including for pre-operative localization, intra-operative biopsy guidance and post-operative analysis.


Fissurectomy as a treatment for anal fissures in children.
Anal fissures, characterised by painful defecation and rectal bleeding, are common in both children and infants. A significant proportion are resistant to simple laxative therapy, and no simple surgical treatment has been described which does not risk compromising sphincteric function. This study reports the initial experience of fissurectomy as a treatment of this condition. Over a 36 month period, 37 children with an anal fissure were treated by fissurectomy. There were 14 boys and 23 girls, with an age range of 17 weeks to 12 years. Fissurectomy was performed under general anaesthetic, with additional caudal anaesthesia. Stay sutures were used to avoid the need for an anal retractor, thereby preventing stretching of the internal anal sphincter. Of the 37 operations, 36 (97%) were performed as day cases and all children were discharged on laxative therapy. At review, 6 weeks postoperatively, 30 (81%) were asymptomatic. Six (16%) patients were symptomatic; however, 4 of these had failed to comply with the postoperative laxative regimen. One patient failed follow-up. Fissurectomy is a successful treatment for anal fissures, when combined with postoperative laxative therapy. As dilatation of the internal anal sphincter is not involved, the risk of iatrogenic faecal incontinence is obviated.


Esophageal foreign body sensation: a rare presentation of angioedema.
Angioedema remains a rare but potentially life-threatening complication of angiotensin-converting enzyme (ACE) inhibitor use. Most presentations involve edema of the tongue or oral pharynx. However, in recent years, a visceral form involving the gastrointestinal tract also has been described. We present the case of a rare presentation of esophageal and retropharyngeal edema related to ACE inhibitor use. A review of ACE inhibitor-related angioedema is also presented.


Fibromuscular dysplasia and thrombosed aneurysm of the popliteal artery in a child.
A case is reported of bilateral congenital popliteal aneurysms in a 10-year-old girl. Spontaneous thrombosis of the left aneurysm resulted in acute ischemia of the left leg below the knee, and the aneurysm was bypassed with an autogenous saphenous vein graft. Elective resection of the right aneurysm revealed fibromuscular dysplasia, of the medial hyperplasia type, as the cause of the aneurysm. One year after operation, the grafts remained patent, and the patient was asymptomatic.


Hypolipidemic effects of S-methylmethionine (vitamin U) using various experimental procedures.
Hypolipidemic effects of S-methylmethionine (MMSC) were compared with clofibrate in 3 experimental procedures. In results, the characteristic effect of MMSC is discussed from therapeutic viewpoint.


Proinflammatory and "resiliency" proteins in the CSF of patients with major depression.
A number of studies have shown that elevated levels of inflammatory cytokines may promote depression and suicidal ideation and that neuroprotective peptides may decrease the response to stress and depression. In this study, cerebrospinal fluid (CSF) levels of three inflammatory cytokines (IL-1, IL-6, and tumor necrosis factor α (TNFα)) and two putative "resiliency" neuropeptides (brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY)) were compared between patients with depression and healthy controls. Eighteen patients with major depression and 25 healthy controls underwent a lumbar puncture; CSF samples were withdrawn and assayed for IL-1, IL-6, TNFα, BDNF, and NPY levels. Patients with depression were then entered into an 8-week treatment protocol and had repeated lumbar puncture procedures post-treatment. Contrary to prediction, we found that at baseline depressed patients had higher CSF NPY concentration compared to the normal comparison group. Within the depressed patients, we found several statistically significant correlations between elevated CSF cytokine levels and clinical severity. Despite the small sample size, given the challenges in obtaining CSF from patients with depression these data are of interest in confirming some aspects of the inflammatory hypothesis of depression.