Ureterointestinal strictures following Bricker ileal conduit: management via a percutaneous approach.
Urinary diversion after radical cystectomy is commonly performed via an ileal conduit using the Bricker method. However, 4-8% of these cases are complicated with stricture formation at the ureterointestinal junction. Thus, this could eventually lead to hydronephrosis and kidney loss in neglected patients. Few data exist concerning the outcomes of patients with ureterointestinal junction strictures managed via a percutaneous approach and balloon dilatation of the stricture. The potential of managing these strictures, using a stent replacement strategy, was evaluated. A total of 14 patients (10 male, 4 female; age range 24-72 years) were enrolled in the study. Mean follow-up time was 30.9 months. Invasive bladder cancer was diagnosed in 11, neurogenic bladder in 2 and shrunk bladder after external beam radiation for prostate cancer in 1 patient. They were all managed by radical cystectomy followed by Bricker ileal conduit. In 6 cases, ureterointestinal strictures bilaterally were discovered, whereas unilateral (left-sided) strictures were noted to the remaining 8 patients. All strictures were managed via a percutaneous approach and balloon dilatation. A double J stent was placed at the end of the procedure and was regularly replaced after an interval of 3-6 months. A percutaneous nephrostomy was successfully placed in all patients. Double J stent insertion was possible in 18 of a total of 20 (90%) obstructed ureters. No major complications were observed in any of the cases while adequate renal function was preserved in all patients. Quality of life is not reported to be significantly compromised in any patient. Double J ureteral stent replacement is performed every 3-6 months in a retrograde fashion. One patient died in the follow-up period due to disease progression. Placement of a double J stent via a percutaneous approach seems to have offered a viable option in the management of ureterointestinal strictures in this patient population. In addition, periodical retrograde replacement of the stent probably does not constitute a factor compromising quality of life. However, further studies are required to justify these primary clinical data.


Optociliary shunt vessels in compressive optic neuropathy by the intracranial internal carotid artery.
To report a clinical case of optic nerve compression by supraclinoidal internal carotid artery associated with optociliary shunt vessels. A 78-year-old woman with the clinical triad of left visual loss, ipsilateral optic disc pallor, and retinochoroidal (optociliary) shunt vessels is reported. She complained of loss of vision in the left eye of 2 years'' duration. A diffuse depression of the visual field was found in the affected eye. Magnetic resonance imaging revealed left optic nerve compression by the supraclinoidal internal carotid artery. The occurrence of optociliary shunt vessels, visual loss, and optic atrophy is a nonspecific sign of chronic optic nerve compression and in some instances may be falsely localized.


How often should sitting and rising from a chair be evaluated in patients with Duchenne muscular dystrophy?
To determine how often sitting/rising from a chair should be assessed in Duchenne muscular dystrophy (DMD) patients to avoid redundant/missing data. Sitting/rising from a chair was evaluated in 26 DMD children (5-12 yrs), in three-month intervals, over twelve months, with the Functional Evaluation Scale (domain sitting/rising from a chair). Scores were compared by effect sizes (ES) and standardized response means (SRM) (responsiveness analysis). Sit-to-stand showed low-to-moderate responsiveness in three-month intervals (ES:0.23-0.32; SRM:0.36-0.68), moderate-to-high responsiveness in six-month intervals (ES:0.52-0.65; SRM:0.76-1.28), high responsiveness at nine-month (ES:0.84-0.91; SRM:1.26-1.64) and twelve-month intervals (ES:1.27; SRM:1.48). Stand-to-sit showed low responsiveness in three-month intervals (ES:0.26-0.49; SRM:0.37-0.42), moderate responsiveness in six-month intervals (ES:0.50-0.78; SRM:0.56-0.71), high responsiveness in nine-month (ES:0.94-1.00; SRM:0.84-1.02) and twelve-month intervals (ES:1.13; SRM:1.52). Six months or longer intervals for reassessment are indicated to evaluate sitting/standing from a chair in DMD patients.


Entropy-based optimization of wavelet spatial filters.
A new class of spatial filters for surface electromyographic (EMG) signal detection is proposed. These filters are based on the 2-D spatial wavelet decomposition of the surface EMG recorded with a grid of electrodes and inverse transformation after zeroing a subset of the transformation coefficients. The filter transfer function depends on the selected mother wavelet in the two spatial directions. Wavelet parameterization is proposed with the aim of signal-based optimization of the transfer function of the spatial filter. The optimization criterion was the minimization of the entropy of the time samples of the output signal. The optimized spatial filter is linear and space invariant. In simulated and experimental recordings, the optimized wavelet filter showed increased selectivity with respect to previously proposed filters. For example, in simulation, the ratio between the peak-to-peak amplitude of action potentials generated by motor units 20 degrees apart in the transversal direction was 8.58% (with monopolar recording), 2.47% (double differential), 2.59% (normal double differential), and 0.47% (optimized wavelet filter). In experimental recordings, the duration of the detected action potentials decreased from (mean +/- SD) 6.9 +/- 0.3 ms (monopolar recording), to 4.5 +/- 0.2 ms (normal double differential), 3.7 +/- 0.2 (double differential), and 3.0 +/- 0.1 ms (optimized wavelet filter). In conclusion, the new class of spatial filters with the proposed signal-based optimization of the transfer function allows better discrimination of individual motor unit activities in surface EMG recordings than it was previously possible.


Physiological attributes and transcriptomics analyses reveal the mechanism response of Helictotrichon virescens to low temperature stress.
Helictotrichon virescens is a perennial grass that is primarily distributed in high altitude areas of 2000 ~ 4500 m. It is widely cultivated in the Qinghai-Tibet Plateau of China, strongly resistant to cold, and an essential part of the wild herbs in this region. However, the molecular mechanism of the response of H. virescens to low temperature stress and the key regulatory genes for specific biological processes are poorly understood. Physiological and transcriptome analyses were used to study the cold stress response mechanism in H virescens. During the low temperature stress period, the content of chlorophyll a and b decreased more and more with the delay of the treatment time. Among them, the difference between the controls was not significant, and the difference between the control and the treatment was significant. At the same time, the expression of related differential genes was up-regulated during low temperature treatment. In addition, the plant circadian pathway is crucial for their response to cold stress. The expression of differentially expressed genes that encode LHY and HY5 were strongly up-regulated during cold stress. This study should help to fully understand how H. virescens responds to low temperatures. It answers pertinent questions in the response of perennial herbs to cold stress, i.e., how light and low temperature signals integrate to regulate plant circadian rhythms and Decrease of content of chlorophylls (which can be also accompanied with decrease of total quantity of reaction centers) leads to an increase in photosynthetic damage.


Cyp1a2 protects against reactive oxygen production in mouse liver microsomes.
H(2)O(2) production was evaluated in liver microsomes prepared from Cyp1a1/1a2(+/+) wild-type and Cyp1a1(-/-) and Cyp1a2(-/-) knockout mice pretreated with 5 microg dioxin (TCDD)/kg body wt or vehicle alone. NADPH-dependent H(2)O(2) production in TCDD-induced microsomes from wild-type mice was about one-third of that in noninduced microsomes. In Cyp1a2(-/-) mice, H(2)O(2) production was the same for induced and noninduced microsomes, with levels significantly higher than those in wild-type mice. Cyp1a1(-/-) microsomes displayed markedly lower levels of H(2)O(2) production in both induced and noninduced microsomes, compared with those in wild-type and Cyp1a2(-/-) microsomes. The CYP1A2 inhibitor furafylline in vitro exacerbated microsomal H(2)O(2) production proportional to the degree of CYP1A2 inhibition, and the CYP2E1 inhibitor diethyldithiocarbamate decreased H(2)O(2) production proportional to the degree of CYP2E1 inhibition. Microsomal H(2)O(2) production was strongly correlated to NADPH-stimulated production of thiobarbituric acid-reactive substances, as well as to decreases in microsomal membrane polarization anisotropy, indicative of peroxidation of unsaturated membrane lipids. Our results suggest that possibly acting as an "electron sink," CYP1A2 might decrease CYP2E1-and CYP1A1-mediated H(2)O(2) production and oxidative stress. In this regard, CYP1A2 may be considered an antioxidant enzyme.


Brief Report: Associations Between Self-Reported Paternal Relationships, Anger, Alcohol, and Intimate Partner Violence in a Prison Sample.
This study investigates the association between family relationships, anger, alcohol use, and self-reported intimate partner violence (IPV). Participants were 55 male prisoners who completed a survey about their family relationships, anger, alcohol use, and aggression. Exposure to parental IPV predicted rates of self-reported perpetration of IPV, suggesting the importance of understanding more about the developmental pathways to IPV if effective prevention, intervention, and assessment strategies are to be developed for use with this high-risk population.


Clinical progression of renal vein leiomyoma: A case report.
Vascular leiomyoma originating in the renal vein is a rare entity. Our case allowed us charting of progression of renal vein leiomyoma for 8-years' duration. Apart from intraluminous growth causing displacement of viscera, the leiomyoma did not show any aggressive behaviour. Eventually, removal of the tumour through nephrectomy provided complete symptomatic relief to our patient. A 75-year old female presented with an eight-year long history of severe pain in right flank. CT imaging revealed a mass arising from the right renal vein and a few hepatic tumours. The differentials included leiomyosarcoma, in view of hepatic lesions. Excision of the tumour was performed with radical nephrectomy. Immunohistopathological examination confirmed it to be a case of leiomyoma. Three months post-op, the patient reported complete pain relief and no adverse events, and there were no signs of recurrence. Vascular leiomyomas do not show any aggressive behaviour. However, their growth tends to displace the normal viscera, causing pressure effects that may give rise to intractable pain. Vascular obstruction affects GFR and renal function. In our patient, despite a long period of growth, the tumour did not show any malignant changes. Tumour excision through radical nephrectomy resulted in symptomatic improvement in our patient. Since imaging alone does not distinguish a leiomyoma from its malignant counterpart with certainty, surgical excision may be warranted in all the cases.


Bioreduction and biosorption of Cr(VI) by a novel Bacillus sp. CRB-B1 strain.
This study reported an efficient novel chromium reducing bacteria (Bacillus sp. CRB-B1) and investigated its removal mechanism. Bacillus sp. CRB-B1 could effectively reduce high level Cr(VI), under a wide range of shaking velocity (125-200 rpm), temperature (33-41 °C), pH (6-9). The co-existing ions Cd2+ and NO3- inhibited its Cr(VI) reduction capacity, while Cu2+ enhanced the reduction efficiency. In addition, Bacillus sp. CRB-B1 could reduce Cr(VI) using glucose and fructose as an electron donor. Micro-characterization analysis confirmed the Cr(VI) reduction and adsorption ability of Bacillus sp. CRB-B1. Cells degeneration result indicated that Cr(VI) removal was mainly bioreduction rather than biosorption. The cell-free suspension had a Cr(VI) removal rate of 68.5.%, which was significantly higher than that of cell-free extracts and cell debris, indicating Cr(VI) reduction mainly occurs extracellularly, and possibly mediated by extracellular reductase. The reduced Cr was mainly distributed in the extracellular suspension, and a small amount was accumulated in the cells. In conclusion, Bacillus sp. CRB-B1 was a highly efficient Cr(VI) reducing bacteria, which has potential in the remediation of Cr(VI)-containing water and soil.


Solution-based synthesis and low-temperature transport properties of CsBi4Te6.
The thermoelectric material CsBi(4)Te(6) was synthesized in nanometer thin flake-like form by a low temperature solvothermal approach. The crystals were then densified by spark plasma sintering (SPS), resulting in a polycrystalline specimen with layered and partially orientated grains. The orientation of the CsBi(4)Te(6) flakes reflects the anisotropic crystal structure of the material aided by the unidirectional pressure during SPS. Hall, resistivity, Seebeck coefficient, and thermal conductivity was measured on the polycrystalline specimen in evaluating the potential of this approach for thermoelectric applications.


Preventing and Managing Conflict of Interest in Nutrition Policy: Lessons for Alcohol Control Comment on "Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool".
Ralston et al present an analysis of policy actor responses to a draft World Health Organization (WHO) tool to prevent and manage conflicts of interest (COI) in nutrition policy. While the Ralston et al study is focussed explicitly on food and nutrition, the issues and concepts addressed are relevant also to alcohol policy debates and present an important opportunity for shared learning across unhealthy commodity industries in order to protect and improve population health. This commentary addresses the importance of understanding how alcohol policy actors - especially decision-makers - perceive COI in relation to alcohol industry engagement in policy. A better understanding of such perceptions may help to inform the development of guidelines to identify, manage and protect against risks associated with COI in alcohol policy.


Application of TLC for confirmation and screening of pesticide residues in fruits, vegetables, and cereal grains: Part 2. Repeatability and reproducibility of Rf and MDQ values.
This paper illustrates the effect of major factors influencing the reproducibility of thin layer chromatography (TLC) separation and detection under largely differing environmental and laboratory conditions. The optimum conditions for reproducibility and detection sensitivity was obtained on 20 x 20 cm layer in the retention factor (Rf) range of 0.2-0.7 by applying the sample in spots of 3-4 mm diameter at 2 cm from the edge of the plate. The reproducibility rapidly decreased below Rf = 0.2. Above Rf = 0.2 the within-laboratory reproducibility of 219 pesticides obtained in ethyl acetate silica gel elution system by several laboratories was typically below 10%. The among-laboratories reproducibility of the average retention factors was generally below 12%. The minimum detectable quantities (MDQ) of 219 pesticide residues were determined with nine detection methods. The MDQ values largely varied depending on the mode of detection. Bioassay methods enabled the detection down to 0.1-10 ng, while 20-100 ng could be achieved with the chemical reagents. Higher MDQ values are also reported in order to assist the identification of compounds potentially present. The between-laboratories reproducibility of MDQ values was typically 1-5 MDQmin.


[Diversity of hospital care for anorexia nervosa in psychiatry in France].
Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.


Intralymphatic interleukin-2 in combination with zidovudine for the therapy of patients with AIDS.
In a pilot study the safety and therapeutic effects of an immunostimulatory intralymphatic treatment with natural human interleukin-2 (IL-2) in combination with zidovudine were evaluated in nine patients with AIDS. Therapy with IL-2 consisted of one subcutaneous injection of 0.1 microgram/kg IL-2, followed by four intralymphatic IL-2 infusions of 0.1 microgram/kg each within a period of up to 15 days. Enlargement of lymph nodes was seen in six and a transient increase of CD4 cells in five out of nine persons in association with the IL-2 therapy. An increase of HIV p24-antigenemia was observed only in the two patients in whom zidovudine dosage had to be reduced because of side effects. Moderate clinical side effects occurred in eight of the nine patients. Four patients developed zidovudine associated anemia. Six participants showed a favourable course of disease with survival of 25 to 54 months (median 30 months) despite a previous diagnosis of manifest AIDS before IL-2 therapy. This pilot study demonstrates that a combination therapy with intralymphatic IL-2 and zidovudine can induce positive immunomodulatory effects, even in the presence of manifest AIDS. Further studies should explore the tolerability and effects of a prolonged therapy with IL-2 in combination with a more potent antiviral drug combination therapy.


Knowledge, Skills, and Practices of Triage among Emergency Nurses in Jordan.
The importance of knowledge, skills, and practices of nurses makes abridge for a higher quality of care provided to patients. This study purposed to assess the levels of knowledge, skills, and practices of patient triage among emergency nurses in Jordan. A cross-sectional, descriptive correlational, observational design was utilized to assess the levels of knowledge, skills, and practices of patients' triage among emergency nurses working in triage at emergency departments in Jordan. A convenience sample of 125 registered nurses were recruited from triage units of three health sectors in the middle region of Jordan; government, educational, and private. The findings revealed that 88.8% of nurses had sufficient knowledge of triage, 84.8% had moderate triage skills, and 88.8% demonstrated good triage practices. There was a statistically significant positive association between triage knowledge, emergency experience, and triage training course. A significant positive association was found between triage skills, emergency experience, triage experience, and triage training course. Also, triage practices had a significant positive association with triage experience and triage training course. It is necessary to develop nursing policies that consider triage as a baseline training program for all emergency nurses. Also, triage training programs should be conducted and take into consideration the associated factors to enhance emergency nurses' knowledge, skills, and practices of triage in order to improve quality of care and patients' outcomes.


Simplified microvascular clamps.
A simple method to produce an effective new pattern of microvascular clamp, which is easily assembled from inexpensive and widely available components, is presented.


Test-retest reliability and minimal detectable change for measures of wearable gait analysis system (G-Walk) in children with cerebral palsy.
Cerebral Palsy (CP) is the most frequent cause of physical disability in childhood. CP causes primary deficits such as impairments in muscle tone, muscle weakness, problems in selective motor control and secondary deficits such as contractures and deformities. These deficits lead to motor disorders during movement causing limitations in gait. Sixty percent of children with CP can walk independently despite these problems, however, they present with various gait abnormalities. Gait analysis is used in the quantitative assessment of gait disturbances providing functional diagnosis, assessment for treatment, planning, and monitoring of progress. G-Walk is a wearable sensor device which provides quantitative gait analysis via spatiotemporal parameters and pelvic girdle angles. In literature, there is no study investigating the reliability of the G-Walk in children with CP. The purpose of this study was to confirm the test-retest reliability of a commercially available body-worn sensor 'BTS G-WALK sensor system' for spatiotemporal gait parameters in children with CP. Fifty-four children with CP (mean age: 9.19 ± 3.49 years), Gross Motor Function Classification System (GMFCS) level I-II completed the test-retest protocol with 5 days between tests. The test-retest reliability was calculated using intra-class correlation coefficients (ICC). Minimal detectable changes were calculated using standard error measurements. According to the analysis, ICC varied from 0.799 to 0.977 in all of the gait parameters. The statistical analysis showed that all G-Walk parameters' measurements were found to have almost perfect test-retest reliability. The G-Walk was found to be reliable in gait parameters for children with CP between ages 5 and 15, in GMFCS level I-II. A gait analysis carried out with the G-Walk system is a reliable method to assess gait in children with CP in a clinical setting.


Nonvascularized autogenous bone graft for extensive phalangeal bone loss: case report.
A 47-year-old man, a fine woodworker, sustained extensive phalangeal and soft tissue loss of his dominant left long and index fingers in a table saw injury. We report the long-term clinical and radiographic outcomes of the patient following reconstruction with corticocancellous iliac crest bone grafts. Rarely described in recent literature, we believe that primary nonvascularized autogenous bone grafting for phalangeal reconstruction is a worthwhile alternative to amputation when the soft tissue envelope is satisfactory.


Lean-driven interventions, including a dedicated radiologist, improve diagnostic imaging turnaround time and radiology report time at the emergency department.
Emergency departments (EDs) worldwide face crowding, which negatively affects patient care. Diagnostic imaging plays a major role in management of ED patients and contributes to patients' length of stay at the ED. In this study, the impact of Lean-driven interventions on the imaging process at the ED was assessed. During a 6-month multimodal intervention period, Lean-driven interventions and a dedicated radiologist present at the ED were implemented during peak hours (12 a.m.-8 p.m.). Data concerning patient population, radiology department turnaround time (RDTT), radiology report time (RRT), and examination time (ET) for ED patients were compared with a control period of 6 months 1 year earlier. RDTT, RRT, and ET were significantly shorter in the intervention period compared with those in the control period. Median RDTT was respectively 36 min (interquartile range (IQR) 24-56) and 70 min (IQR 39-127), RRT 11 min (IQR 6-21) and 37 min (IQR 15-88), and ET 22 min (IQR 14-35) and 23 min (14-38). Lean-driven interventions on the imaging process at the ED significantly reduced RDTT, RRT, and ET.


Adjusting to your new job.
Having done the hard work in winning your new job, you might find fitting into a new environment to be just as demanding. Don't make the common mistake of focusing solely on work and getting results. You need to pay equal attention to nurturing good relationships with your new colleagues. Here are a few more hints to help ensure that you get off to the best possible start.


An Improved Method for Developing Injury Risk Curves Using the Brier Metric Score.
Many injury metrics are routinely proposed from measured or derived quantities from biomechanical experiments using post mortem human subjects (PMHS). The existing literature did not provide guidance on deciding between parameters collected in an experiment that would be best to use for the development of human injury probability curves (HIPC). The objective of this study was to use the Brier Metric Score (BMS) to identify the most appropriate metric from an experiment that predicts injury outcomes. The Brier Metric Score assesses how well a metric predicts the outcome for a censored data point (a lower BMS is better). Survival analysis was then conducted with the selected metric and the best distribution was selected using Akaike information criterion (AIC). Confidence intervals (CIs) and the normalized confidence interval width (NCIS) were calculated for the injury probability curve. The testing and validation of the methods described were performed using biomechanics data in the open literature. The methods for the HIPC development procedure detailed herein have been rigorously tested and used in the generation of WIAMan HIPCs and Injury Assessment Reference Curves (IARCs) for the WIAMan ATD, but can also be used in other ATD or PMHS injury risk curve development.


Postoperative Outcomes After Staged Versus Coordinated Breast Surgery and Bilateral Salpingo-Oophorectomy.
The objective of this study was to compare postoperative complication rates and healthcare charges between patients who underwent coordinated versus staged breast surgery and bilateral salpingo-oophorectomy (BSO). The MarketScan administrative database was used to identify adult female patients with invasive breast cancer or BRCA1/BRCA2 mutations who underwent BSO and breast surgery (lumpectomy or mastectomy with or without reconstruction) between 2010 and 2015. Patients were assigned to the coordinated group if a breast operation and BSO were performed simultaneously or assigned to the staged group if BSO was performed separately. Primary outcomes were (1) incidence of 90-day postoperative complications and (2) 2-year aggregate perioperative healthcare charges. Fisher's exact tests, Wilcoxon rank-sum tests, and multivariable regression analyses were performed. Of the 4228 patients who underwent breast surgery and BSO, 412 (9.7%) were in the coordinated group and 3816 (90.3%) were in the staged group. The coordinated group had a higher incidence of postoperative complications (24.0% vs. 17.7%, p < 0.01), higher risk-adjusted odds of postoperative complications [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.06-1.76, p = 0.02], and similar aggregate healthcare charges before (median charges: $106,500 vs. $101,555, p = 0.96) and after risk-adjustment [incidence rate ratio (IRR) 1.00, 95% CI 0.93-1.07; p = 0.95]. In a subgroup analysis, incidence of postoperative complications (12.9% for coordinated operations vs. 11.7% for staged operation, p = 0.73) was similar in patients whose breast operation was a lumpectomy. While costs were similar, coordinating breast surgery with BSO was associated with more complications in patients who underwent mastectomy, but not in patients who underwent lumpectomy. These data should inform shared decision-making in high-risk patients.


Prediction of minor head injured patients using logistic regression and MLP neural network.
In this study it is aimed to assess the posttraumatic cerebral hemodynamia in minor head injured patients. Eighty patients with minor head injury (Group 1) evaluated in the early 8 h of posttraumatic period between July 2003 and February 2004. The control group (Group 2) has composed of 32 healthy people. Bilateral blood flow velocities of middle cerebral arteries (MCA) had measured using transtemporal technique while internal carotid arteries were evaluated by submandibular examination. Two different mathematical models such as the traditional statistical method on the basis of logistic regression and a multi-layer perceptron (MLP) neural network are used to classify the age, sex, velocitiy parameters of MCA, mean velocity of extracranial ICAs and V(MCA)/ V(ICA) ratios. The neural network was trained, cross-validated and tested with subject's transcranial Doppler signals. As a result of these classifications, we found the success rate of logistic regression, the success rate of MLP neural network is 88.2 and 89.1%, respectively. The classification results show that MLP neural network is offering the best results in the case of diagnosis.


Salazinic Acid-Derived Depsidones and Diphenylethers with α-Glucosidase Inhibitory Activity from the Lichen Parmotrema dilatatum.
Three new depsidones, parmosidones F - G (1 - 2), and 8'-O-methylsalazinic acid (3), and 3 new diphenylethers, parmetherines A - C (4 - 6), together with 2 known congeners were isolated from the whole thalli of Parmotrema dilatatum, a foliose chlorolichen. Their structures were unambiguously determined by extensive spectroscopic analyses and comparison with literature data. The isolated polyphenolics were assayed for their α-glucosidase inhibitory activities. Newly reported benzylated depsidones 1: and 2: in particular inhibited α-glucosidase with IC50 values of 2.2 and 4.3 µM, respectively, and are thus more potent than the positive control, acarbose.


VLDL substrate properties and efficiency of their metabolic transformation by LPL.
A study was made of the regulation of the triglyceride hydrolysis catalysed by LPL from bovine milk, by the apoproteins from human plasma VLDL. Both isolated apolipoproteins, and those found on the surface of plasma VLDL particles, were investigated. A concentration-dependent activating action of apo C-II on the hydrolysis of emulsified triolein, and uncompetitive inhibition of VLDL triglyceride hydrolysis by apo C-III were found. It is suggested that VLDL lipolysis might be controlled in vivo through the variation of the relative surface content of these enzymatic activity modulators.


Exploring drying kinetics and fate of nutrients in thermal digestion of solid organic waste.
Thermal digestion has emerged as a novel technique for the rapid treatment of solid organic waste (SOW). Dehydration mechanism and fate of nutrients during the thermal digestion of the SOW were explored. A series of experiments were carried out in a specially designed laboratory-scale dehydrator to determine its drying kinetics. The statistical analysis revealed that the diffusion model predicted the dehydration profile most accurately than other models. The effective moisture diffusivity coefficient depended on the temperature and varied from 2.81 × 10-08 m2/s to 8.68 × 10-08 m2/s at the tested temperature range. The activation energy required for complete dehydration was found to be 26.56 kJ/mol. The artificial neural network (ANN) model was found highly efficient (R2 - 0.983) in predicting the total drying time required for attaining equilibrium moisture content. The total N decreased from 2.2% to 1.81% due to evaporation of ammonical nitrogen, while the availability of P and K was increased from 0.38% to 0.43% and 1.47% to 1.75%, respectively when the temperature was increased from 110 °C to 170 °C. The thermal dehydration technique was found effective in digesting the organics and improving the bioavailability of the nutrients, which favours for its re-utilization in agriculture.


Bipolar disorder in primary care: Medication treatment by co-located psychiatrists versus primary care clinicians supported by psychiatrists.
To compare medication treatment of individuals with bipolar disorder in two primary care-based integrated care models. Participants were randomized to 12-months of treatment with direct care by co-located psychiatrists in primary care, or collaborative care (primary care clinicians supported by psychiatrists). Medication data at initial and last treatment visits were extracted from the clinical registry for 191 patients diagnosed with bipolar disorder. Participants receiving no medication treatment decreased from 28% to 11% (direct co-located) (χ2 = 10.9, p < .001) and 39% to 17% (collaborative care; χ2 = 16.9, p < .001). Last visit medication prescriptions for antipsychotic medication (approximately one-half of participants) increased significantly compared to initial visit and did not differ between arms. Anticonvulsant mood-stabilizing medication (approximately one-third of participants in both arms) was higher than lithium prescription (approximately 6% of participants) at last visit. Similar patterns of medication treatment were observed in participants with bipolar disorder receiving either direct care from psychiatrists, or medication treatment by primary care clinicians supported by psychiatrists.


Proton MR spectroscopy of the breast.
Magnetic resonance imaging (MRI) of the breast has emerged as a highly sensitive modality. In addition to morphologic and kinetic analysis obtained from contrast-enhanced breast MRI, functional information has been needed for diagnosis of breast disease. In vivo proton (hydrogen 1 [(1)H]) MR spectroscopy of the breast has demonstrated that choline (Cho) can be detected in breast cancers, whereas Cho is generally undetectable in normal breast tissue. Thus, breast MR spectroscopy has shown great promise as a way to differentiate between benign and malignant lesions and to gauge the effect of chemotherapeutic agents in patients with locally advanced breast cancer. Prior studies performed on 1.5-T MR imagers have reported sensitivities of 70-100% (average 89%; 149/168) and specificity of 67-100% (average 87%; 97/112) for breast MR spectroscopy. Moreover, the presence of a Cho peak in breast cancer may reflect the increased cell proliferation, with a decrease in this peak after treatment reflecting decreased viability of the tumor. With further development and the assessment of Cho quantity in the tumor, breast MR spectroscopy may be helpful in the elucidation of the biology of breast cancer.


Nomogram to Predict Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in Asian Population.
Symptomatic intracranial hemorrhage (sICH) is a serious hemorrhagic complication after intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients. Most existing predictive scoring systems were derived from Western countries. The objective of this study is to develop a nomogram to predict the possibility of sICH after IVT in Asian population. This retrospective cohort study included AIS patients treated with recombinant tissue plasminogen activator (rt-PA) in a tertiary hospital in Shenzhen, China, from January 2014 to December 2020. The endpoint was sICH within 36 hours of IVT treatment. Multivariable logistic regression was used to identify risk factors of sICH, and a predictive nomogram was developed. Area under the curve of receiver operating characteristic curves (AUC), calibration curve, and decision curve analyses were performed. The nomogram was validated by bootstrap resampling. Data on a total of 462 patients were collected, of whom 20 patients (4.3 %) developed sICH. In the multivariate logistic regression model, the National Institute of Health stroke scale scores (NIHSS) (odds ratio (OR), 1.14; 95 % confidence interval (CI), 1.06-1.23, P < 0.001), onset to treatment time (OTT) (OR, 1.02; 95 % CI, 1.01-1.03, P < 0.001), neutrophil to lymphocyte ratio (NLR) (OR, 1.22; 95 % CI, 1.09-1.35, P < 0.001), and cardioembolism (OR, 3.74; 95 % CI, 1.23-11.39, P = 0.020) were independent predictors for sICH and were used to construct a nomogram. Our nomogram exhibited favorable discrimination ability (AUC, 0.878; specificity, 87.35 %; and sensitivity, 73.81 %). Bootstrapping for 500 repetitions was performed to further validate the nomogram. The AUC of the bootstrap model was 0.877 (95 % CI: 0.823-0.922). The calibration curve exhibited good fit and calibration. The decision curve revealed good positive net benefits and clinical effects. The nomogram consisting of the predictors NIHSS, OTT, NLR, and cardioembolism could be used as an auxiliary tool to predict the individual risk of sICH in Chinese AIS patients after IVT. Further external verification among more diverse patient populations is needed to demonstrate the accuracy of the model's predictions.


Biological paradigms of molecular electronics.
Biological processors of information are shown to be paradigms of Molecular Electronics, suggesting the main features of systems for intelligent information processing at molecular level.


Retroesophageal right subclavian artery: a case report and review of the literature.
Variations of vessels arising from the aortic arch are numerous. One of the common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This is a report of a case of an adult male cadaver with a retroesophageal right subclavian artery. To highlight the significance of a retroesophageal right subclavian artery, especially its clinical and surgical implications. Is a report of a case of an anomalous vessel found during routine student dissection of the chest region in a male cadaver. The retroesophageal subclavian artery was seen originating as the last branch from the postero-lateral aspect of the thoracic aorta at the vertebral level T4. The heart was normal with no other vascular variations seen in this region. Anatomists and pathologists mainly encounter a retroesophageal right subclavian artery by chance and is usually described as asymptomatic, but several clinical conditions have been associated with its occurrence. This is a clear example of when knowledge of an anatomical variation is helpful in clinical practice.


miR-29b-3p suppresses the malignant biological behaviors of AML cells via inhibiting NF-κB and JAK/STAT signaling pathways by targeting HuR.
HuR/ELAVL1 (embryonic lethal abnormal vision 1) was a downstream target of miR-29b in some cancer cells. HuR protein exerts important prognostic effects of involving in the pathogenesis and development of acute myeloid leukemia (AML). This study aims to investigate the role of miR-29b-3p in biological behaviors of AML cells by targeting HuR and the involvement of the NF-κB and JAK/STAT signaling pathways. The expressions of HuR and miR-29b-3p in AML cells were determined using RT-qPCR and Western blot, and the association between them was analyzed using the Spearman method. Next, the target relationship between HuR and miR-29b-3p was predicted by biological information databases and verified by the dual-luciferase reporter gene assay. MTS, methyl cellulose, flow cytometry and transwell assay were employed to detect the cell proliferation, clone formation, cell cycle and apoptosis, invasion and migration respectively, the effect of miR-29b-3p targeted HuR on the biological behaviors of AML cells was explored after over- /down-expression of miR-29b-3p and rescue experiment. Then, immunofluorescence assay and western blot were employed to detect location expression and phosphorylation levels of NF-κB and JAK/STAT signaling pathways related molecules respectively. HuR was negatively correlated with miR-29b-3p, and was the downstream target of miR-29b-3p in AML cells. When miR-29b-3p was overexpressed in AML cells, HuR was down-regulated, accompanied by cell viability decreased, cell cycle arrest, apoptosis increased, invasion and migration weakened. Moreover, the opposite result appeared after miR-29b-3p was down-regulated. The rescue experiment showed that miR-29b-3p inhibitor could reverse the biological effect of HuR down-regulation in AML cells. Molecular pathway results showed that miR-29b-3p could inhibit p65 expression in nucleus and phosphorylation levels of p65, IκBα, STAT1, STAT3 and STAT5. miR-29b-3p can inhibit malignant biological behaviors of AML cells via the inactivation of the NF-κB and JAK/STAT signaling pathways by targeting HuR. miR-29b-3p and its target HuR can be used as a new potential molecular for AML treatment.


Chlorinated persistent organic pollutants in serum of New Zealand adults, 2011-2013.
A national survey was conducted in 2011-2013 to assess serum concentrations of persistent organic pollutants (POPs) in adult New Zealanders. Participants were randomly selected from the 2010 Electoral Roll within 64 demographic strata according to 4 age groups, 4 regions, 2 ethnic groups (Māori/non-Māori) and gender. Eligible subjects (n=734) donated up to 30ml of blood, after which serum was pooled (n=49) according to demographic strata prior to analysis by GC-HRMS. Associations between demographic variables (age, region, ethnicity, gender) and serum POPs were assessed using linear regression. The weighted geometric mean (GM) of PCDD/Fs was 5.3pg/g lipid toxic equivalents using the WHO 2005 toxic equivalence factors (TEQ05), which increased by age (3.2, 4.4, 4.8, and 8.1pg/g lipid for the 19-24, 25-34, 35-49, and 50-64year age groups, respectively). The weighted GM of dioxin-like PCBs was 1.4pg TEQ05/g lipid which also increased by age (0.82, 0.86, 1.4, and 2.3pg/g lipid for the same age groups, respectively). Of the detected OCPs, the highest concentration was observed for p,p'-DDE (weighted GM, 220ng/g lipid) followed by hexachlorobenzene (HCB; 7.3ng/g lipid), beta-HCH (7.0ng/g lipid), and dieldrin (4.7ng/g lipid). For most Cl-POPs, concentrations were lowest in the youngest age group, and were similar for men and women and Māori and non-Māori. Serum Cl-POPs were, on average, 50% lower than those measured 15years earlier in 1997. This survey provides evidence of declining serum concentrations of chlorinated POPs in the New Zealand adult population. Age was the most important determinant of POPs concentrations. Body burdens of PCDD/Fs and PCBs in New Zealand are relatively low by international comparison, while for OCPs they are similar or lower compared to those reported for other developed countries.


Otitis media as a presenting complaint in childhood immunodeficiency diseases.
Otitis media is one of the most common childhood infections and may result from a variety of underlying problems. Suspicion of immunodeficiency should increase when ear infections are frequent; suppurative; unresponsive to antibiotics; caused by unusual organisms; or seen in the context of other frequent infections, severe eczema, or failure to thrive. Humoral immune deficiencies, particularly with an inability to make antibody to encapsulated organisms, are the immunodeficiencies most likely to cause increased otitis media. Immune system evaluation should concentrate on humoral immunodeficiency disorders, but the presenting history and physical findings also should be considered when designing the work-up. Treating the underlying immune deficiency is usually necessary to adequately control the ear infections.


[Golimumab].
Golimumab is one of the TNF-inhibitors, having an efficacy and safety profile comparable to other TNF-inhibitors. In addition, golimumab is a fully human monoclonal antibody, has several unique features, such as neutralizing antibodies are difficult to generate. In clinical trials carried out in Japan, the efficacy and safety of administration of golimumab 100 mg every 4 weeks is shown, and golimumab blood concentration related to efficacy have been pointed out. From these, golimumab is considered a useful drug in every step of the treatment of rheumatoid arthritis. This section reviews the clinical trials of golimumab, and consider the useful use of golimumab.


Uric acid inhibits L-DOPA-CU(II) mediated DNA cleavage.
It has been proposed that considerable DNA damage may be caused by endogenous metabolites produced during the body's normal metabolic processes. We have previously shown that L-DOPA, in the presence of Cu(II) leads to oxidative DNA breakage in vitro. Uric acid is considered to be a naturally occuring antioxidant and is present in plasma at a relatively high concentration. In this paper we report that uric acid inhibits L-DOPA-Cu(II) mediated DNA cleavage at concentrations similar to or lower than those found in plasma. Xanthine, which is the structural analogue of uric acid is a more potent inhibitor of the reaction. Uric acid was also shown to directly quench the generation of hydroxyl radicals by L-DOPA-Cu(II). The results have been discussed in relation to the putative protective role of uric acid against endogenous DNA damage by oxygen radicals.


Keratinocyte carcinomas, area-level socioeconomic status and geographic remoteness in Tasmania: cross-sectional associations and temporal trends.
This article aims to examine cross-sectional associations and assess temporal trends in keratinocyte carcinoma (KC) incidence by area-level socioeconomic status (SES) and geographic remoteness in Tasmania, Australia. KCs-basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC)-registered by the Tasmanian Cancer Registry were assigned to area-level SES and remoteness area. Incidence rate ratios (2014-2018) were estimated using Poisson regression. Average annual percentage changes (2001-2018) were estimated using the Joinpoint Regression Program. BCC incidence increased with increasing area-level advantage (p value for trend <0.001), but no trend was found for SCC. SCC incidence was higher in rural than urban areas (p value <0.001), and BCC incidence was slightly lower in rural than urban areas for males (p value = 0.026), but not for females (p value = 0.381). BCC and SCC incidence increased between 2001 and the mid-2010s, when it peaked across most areas. Associations were found between BCC and higher area-level SES, and between SCC and geographic remoteness. The findings suggest differences in sun exposure behaviours, skin cancer awareness and access to services, or ascertainment bias. Efforts to control and deliver KC services in Tasmania should consider targeting populations with specific area-level characteristics.


Altered energetics and parasitism in juvenile northern pike (Esox lucius) inhabiting metal-mining contaminated lakes.
The objective of this study was to evaluate possible factors that could be contributing to altered bioenergetics of juvenile northern pike (Esox lucius) living in lakes receiving effluent from the Key Lake uranium mill in northern Saskatchewan, Canada. Although glycogen and triglycerides stores in liver and muscle were significantly greater in pike from exposure lakes compared to the reference, triglycerides stores of aquatic insects and spottail shiners that are prey items of juvenile pike showed no overall differences among lakes. Measures of parasitism, on the other hand, were negatively correlated with pike bioenergetics thereby reflecting a possible energetic cost of parasitism on reference lake fishes. The degree of infection, as measured by the abundance and biomass of intestinal parasites and the abundance of monogeneans on pike gills, was greatest in reference fishes and intermediate in low-exposure pike, whereas high-exposure fishes harbored no parasites.


The latent membrane protein 1 (LMP1) encoded by Epstein-Barr virus induces expression of the putative oncogene Bcl-3 through activation of the nuclear factor-kappaB.
The Epstein-Barr virus (EBV)-encoded oncoprotein latent membrane protein 1 (LMP1) has an essential role in B-lymphocyte transformation by the virus and is expressed in certain EBV-associated tumors and lymphoproliferative disorders. By using the Flp-In/TREx-inducible expression system, we introduced LMP1 into two human cell lines, Jurkat and HEK-293, and found that in both of them the putative cellular oncogene Bcl-3 is rapidly induced following the expression of LMP1. Bcl-3 was also induced in Ramos cells after in vitro EBV infection and after transfection with an LMP1 expression vector. This LMP1-induced Bcl-3 expression is considered to be mediated by the transcription factor NF-kappaB, because (1) deletion of a critical NF-kappaB-binding site in the Bcl-3 promoter abolished its responsiveness to LMP1, (2) an IkappaB mutant that specifically inhibits NF-kappaB activity suppressed the LMP1-induced activation of the Bcl-3 promoter, and (3) an LMP1 mutant lacking its effector domain CTAR2, required for the activation of NF-kappaB, is severely impaired in its ability to induce Bcl-3. Western blot analyses showed that all EBV-infected and LMP1-expressing lymphoid cell lines express Bcl-3. These results suggest the possibility that Bcl-3 is involved in the pathogenesis of certain EBV-associated malignancies and lymphoproliferative disorders.


Streamlined determination of 3-O-methyldopa in dried blood spots: Prospective screening for aromatic l-amino-acid decarboxylase deficiency.
Aromatic L-amino-acid decarboxylase (AADC) deficiency diagnosis is often delayed by low disease awareness and specific laboratory examinations. We demonstrated that an elevated concentration of L-dopa metabolite 3-O-methyldopa (3-OMD) in dried blood spots could be integrated into a newborn screening program to detect AADC deficiency. DBS samples for amino acid and acylcarnitine analysis using NeoBase™2 reagents were also analyzed for the 3-OMD concentration using 13C6-phenylalanine as an internal standard. For samples exceeding the pre-defined cutoffs, an additional spot was punched from the original filter paper for second-tier 3-OMD measurement by high performance liquid chromatography (HPLC)-MS/MS assay. Newborns with a 3-OMD concentration exceeding 500 ng/mL were referred for confirmatory testing. From Feb. 2020 to Dec. 2022, 157,371 newborns were screened for AADC deficiency. Eight newborns exhibited an elevated 3-OMD concentration (839-5170 ng/mL). Among them, six newborns were confirmed to carry two pathogenic DDC variants, indicating an incidence of AADC deficiency of ∼1:26,000 (95% confidence interval: 1 in 12,021 to 1 in 57,228). During the follow-up period, all six patients developed typical symptoms of AADC deficiency. The screening for 3-OMD, a target for AADC deficiency, could be easily integrated into the existing newborn screening programs and facilitate the future application for early diagnosis and effective treatment.


Microcirculation dynamics in systemic vasculitis: evidence of impaired microvascular response regardless of cardiovascular risk factors.
Systemic vasculitides (SVs) are a highly inflammatory group of diseases characterized by significant cardiovascular (CV) mortality. Microvascular damage closely linked with accelerated atherosclerosis and thrombosis represents a core pathophysiological mechanism contributing to the excess CV risk of patients with SVs. Skin represents an easily accessible tissue facilitating non-invasive microvascular study. In this study we aimed to investigate microcirculation dynamics and associate them with disease-related factors in patients with SVs. We assessed skin microcirculation using laser speckle contrast imaging (LSCI) and vascular reactivity by the post-occlusive reactive hyperaemia (PORH) protocol in a meticulously selected group of patients with SVs without CV disease and compared them to controls, matched for age, sex, BMI and smoking status. Sixty individuals were included in the study, 30 patients and 30 controls. Patients with SVs presented a lower peak magnitude during reperfusion phase (median [interquartile range] 207 [60.1] vs 143.7 [41.0] laser speckle perfusion units, P < 0.001) and lower percentage cutaneous vascular conductance increase (mean (s.d.) 190.0 [49.6]% vs 149.6 [48.9]%, P = 0.002) as compared with controls. Importantly, microvascular damage was correlated with disease duration (P < 0.001, r = -0.563 and P < 0.001, r = 0.442, respectively). For the first time we have shown that patients with SVs exhibit impaired microvascular function and blunted reactivity after occlusion, as this was demonstrated by the LSCI technique. Therefore, skin microcirculation may be a useful, non-invasive method in patients with SVs for the early detection of microvascular dysfunction, which is closely related to the high CV risk that these patients bear.


Alignment changes after open-wedge high tibial osteotomy result in offloading in the patellofemoral joint: a SPECT/CT analysis.
The patellofemoral (PF) joint may be adversely affected by medial open-wedge high tibial osteotomy (OWHTO). This study aimed to evaluate the PF compartmental changes using combined single-photon emission computed tomography (SPECT) and conventional computed tomography (CT) after OWHTO to provide clinical guidance regarding the PF joint pressure and force. Patients with medial osteoarthritis and varus malalignment > 5° were treated using OWHTO. Patients with a minimum 2-year follow-up were included in the study. The patellar positions were evaluated based on the radiographic parameters. The changes in chondral lesions during second-look arthroscopic examination were evaluated, and the PF joint arthritis grade was recorded on patellar Merchant radiographs using Kellgren-Lawrence classification. The PF compartmental changes according to SPECT/CT analysis after OWHTO were evaluated in all patients. The scintigraphic uptake was graded on four scales. Patients were divided into improved and unimproved groups according to the PF compartmental grade using the SPECT/CT uptake grading system. At a mean follow-up period of 47.0 months (range 25-74 months), the mean mechanical femorotibial angle changed significantly from varus 6.3° (range 5-12°) to valgus 2.6° (range 0-8°); p < 0.001) postoperatively. The radiological parameters presenting patellar positions, including the tibial slope, patellar convergence angle, and lateral tilt angle, did not change significantly between the preoperative values and the 2-year follow-up values. The mean patellar height significantly decreased (0.07 ± 0.14, p = 0.001 according to the Blackburn-Peel index and 0.32 ± 0.23, p < 0.001 using the modified Insall-Salvati ratio). The average tibial tubercle to trochlear groove (TT-TG) distance significantly decreased from 14.1 to 12.2 mm (p < 0.001). The Q angle also significantly decreased from 9.8o to 7.7o (p = 0.008). Chondral lesions of the patella and trochlear groove revealed significant deterioration; at 2 years after OWHTO, the arthritic grades of the PF joints worsened significantly, as determined by radiography (p = 0.007). Scintigraphic uptake in the PF joint was significantly lower (from 2 to 1) at 2 years postoperatively compared to that immediately after the index operation (p < 0.001). Only 4 of 56 (7.1%) patients showed increased uptake. Comparison between the improved and unimproved groups according to scintigraphic uptake changes revealed that the changes in the cartilage status on the patellar undersurface and TT-TG distance were the most significant predictive factors of increased scintigraphic uptake in the PF joint after OWHTO. Alignment correction by OWHTO result in PF compartment offloading and should be considered when identifying the surgical indications for OWHTO. Therapeutic, Level IV.


Emerging Technology in Promoting Physical Activity and Health: Challenges and Opportunities.
Sedentary behavior has been identified as one of the major causes of many chronic diseases such as cardiovascular disease, stroke, cancer, type 2 diabetes, and obesity [...].


Surgical considerations in childhood end-stage renal disease.
This article provides a conceptual framework that is useful to the pediatrician who provides children with renal failure with care. Operative and perioperative consideration are emphasized.


Effectiveness and efficiency of platelet rich plasma in the treatment of diabetic ulcers.
"There is a growing body of evidence suggesting that wound healing in chronic diabetic foot ulcers is growth factor dependent, and that the therapeutic delivery of these growth factors to wounds topically, has the potential ability to accelerate wound healing in conjunction with conventional wound care". There is, however, confusion about the utility of platelet rich plasma because the studies that have evaluated them use a wide range of products (different platelet and leukocyte concentrations, different techniques and frequencies of application, very heterogeneous simple, and different endpoints) making almost impossible to compare data and draw conclusions. In this study, we have analyzed the different platelet rich plasma products from a new perspective: cost-efficiency. According to our data, we observe that platelet rich plasma is a cost-effective option that allows faster healing of ulcers, and that should be taken into account in patients with long evolution ulcers.


[Mental health of Guatemalan health care workers during the COVID-19 pandemic: baseline findings from the HEROES cohort studySaúde mental dos trabalhadores da saúde guatemaltecos durante a pandemia de COVID-19: constatações basais do estudo da coorte HEROES].
To assess the baseline prevalence of mental health conditions and associated exposures in a cohort of health care workers (HCWs) in Guatemala. We analyzed baseline information from the 2020 Web-based COVID-19 Health Care Workers Study (HEROES)-Guatemala. Outcomes included mental distress and depressive symptoms. Exposures included COVID-19 experiences, sociodemographic characteristics, and job characteristics. We used crude and adjusted Poisson regression models in our analyses. Of the 1801 HCWs who accepted to participate, 1522 (84.5%) completed the questionnaire; 1014 (66.8%) were women. Among the participants, 59.1% (95% confidence interval [CI] = 56.6, 61.5) screened positive for mental distress and 23% (95% CI = 20.9, 25.2) for moderate to severe depressive symptoms. COVID-19 experiences, sociodemographic characteristics, and job characteristics were associated with the study outcomes. Participants who were worried about COVID-19 infection were at higher risk of mental distress (relative risk [RR] = 1.47; 95% CI = 1.30, 1.66) and depressive symptoms (RR = 1.51; 95% CI = 1.17, 1.96). Similarly, the youngest participants were at elevated risk of mental distress (RR = 1.80; 95% CI = 1.24, 2.63) and depressive symptoms (OR = 4.58; 95% CI = 1.51, 13.87). Mental health conditions are highly prevalent among Guatemalan.


Severe exfoliative dermatitis associated with hand ischemia during cisplatin therapy.
Platinum is one of the most widely used agents in clinical oncology today. Serious toxic effects are well recognized. To our knowledge, the current report describes the first case of severe allergic exfoliative dermatitis associated with ischemia and necrosis of the hands in a patient who had received multiple doses of this agent. We postulate that the tissue damage was caused by vasospasm of small vessels from the initial injury triggered by platinum or its associated immune complexes. Platinum has become an integral part of combination chemotherapy for various solid tumors. Clinicians must recognize its toxic side effects and control them within tolerable limits.


Optimized SEEG-guided three-dimensional radiofrequency thermocoagulation for insular epilepsy.
The high risk of resection surgery for drug-resistant insular epilepsy has driven interest in new treatment techniques. Stereo-electroencephalography-guided three-dimensional radiofrequency thermocoagulation (SEEG-3D RFTC) offers an alternative option. Herein, we present the detailed protocol and investigation of the efficacy and safety of a preliminary observational study. From February 2017 to April 2021, ten patients diagnosed with insular epilepsy were enrolled in the study. They underwent implantation of a combination of SEEG electrodes to form a high-density focal stereo-array in insula, including oblique electrodes through the long axis of insula and orthogonal electrodes to widely cover the medial and lateral insula. SEEG-3D RFTC was performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. Surgical procedures were well tolerated, with no related long-term complications. Seizure-free outcome was achieved in seven patients (70%), including ILAE I in four and ILAE II in three. Two other (20%) patients had rare seizures (ILAE III). One (10%) patient experienced an ILAE IV outcome (follow-up = 12--63 months). The responder rate (including ILAE I-IV) was 100%. The optimized SEEG-3D RFTC is an effective and safe option for the treatment of drug-resistant insular epilepsy.


Right ventricular hypertrophy is associated with cardiovascular events in hypertrophic cardiomyopathy: evidence from study with magnetic resonance imaging.
Although left ventricular (LV) morphology and function have been well studied in hypertrophic cardiomyopathy (HCM), few data exist regarding the right ventricle. Accordingly, we studied right ventricular (RV) morphology and function and their effect on cardiovascular events in HCM using cardiac magnetic resonance (CMR) imaging. This retrospective study included 106 HCM patients (age 61.6 ± 14.5 years) examined using CMR imaging during January 2008 to September 2014. RV hypertrophy (RVH) was defined as RV maximal wall thickness > 5 mm. RVH was observed in 30 of the 106 patients (RVH group), with the remaining 76 patients assigned to the non-RVH group. The RVH group had higher brain natriuretic peptide levels (461.6 ± 699.8 pg/mL vs. 225.3 ± 254.5 pg/mL; P = 0.01) and also showed a reduced RV end-diastolic volume index (43.4 ± 16.0 mL/m2 vs. 56.6±15.2 mL/m2; P = 0.0001), in keeping with a greater LV mass index (109.1 ± 24.9 g/m2 vs. 78.6 ± 23.0 g/m2; P < 0.0001). The RVH group was prominently associated with RV late gadolinium enhancement compared with the non-RVH group (33.3% vs. 0%; P < 0.0001). After CMR imaging, 15 patients developed cardiovascular events that included admission for heart failure, ventricular tachyarrhythmia/fibrillation, stroke, and sudden cardiac death. Cox proportional hazard analysis revealed that RVH was an independent predictor of the occurrence of cardiovascular events after adjustments by sex, age, LV mass index, LV ejection fraction, and LV outflow tract obstruction (hazard ratio, 5.42; 95% confidence interval, 1.16-25.3; P = 0.03). These results suggest that HCM patients with RVH on CMR images have a greater incidence of cardiovascular events than non-RVH patients. Further work is needed to confirm this observation and assess its clinical importance.


[Hormonal evaluation in the diagnosis of obesity associated with "primary empty sella"].
To determine whether obesity associated with "primary empty sella" (PES) had a characteristic hormonal pattern, we evaluated the hormonal profile in 24 simple obese and 19 obese-PES women. The latter group showed a significant delta-GH and LH impaired levels as well as plasma beta-EP significantly higher. Hence, the beta-EP measurement could be used to predict the hormonal response in these women.


Detection of HIV-1 RNA in two consecutive blood donations screened negative for HIV antibodies.
An unusual serological pattern of HIV-1 seroconversion in a blood donor is described. The seroconversion panel was used to investigate the sensitivity of existing screening assays. A volunteer blood donor who had given blood 79 times was diagnosed anti-HIV-1-antibody-positive. The heteroduplex mobility assay identified a subtype B HIV-1 strain. The frozen plasmas from the last four blood donations had been kept at -30 degrees C. They were thawed and aliquoted for subsequent testing. The last two blood donations contained HIV-1 RNA, 2,800 copies/ml (October 26) and 170 copies/ml (November 23). Weak anti-p24 antibodies were detected by Western blot in the October 26 sample, and a clear p24 reactivity along with a faint gp160 reactivity was observed on November 23. HIV p24 antigen was undetectable in both samples. Out of 13 screening assays, only 6 gave positive results on the November sample and 7 negative results which were obtained by 1 competitive enzyme immunoassay (EIA) and 6 of the 9 sandwich EIAs. Most sandwich EIAs gave prolonged false-negative results in the present case. p24 antigen testing was negative and would not have reduced the risk of HIV transmission.


Community attitudes to mental illness in New Zealand twenty-two years on.
Three propositions about attitudes to mental illness derived from Nunnally (Popular Conceptions of Mental Health. Holt, Rinehart & Winston, New York, 1961) were examined with the semantic differential technique as it was used originally by Olmsted and Ordway (Final Report to National Institutes of Mental Health, 1963). Attitudes were compared between several studies using the same measures, that ranged over 22 years from 1962 to 1984. The results were remarkably consistent across all studies, indicating that the community had persistently negative attitudes towards the mentally ill and was no more likely today to want to play a major role in the care of the mentally ill than was the case more than 20 years ago. As a consequence it appears that there will need to be substantial and permanent attitude change, of a kind fleetingly observed over the period of the study, before the professional care of the mentally ill in the community may be expected to have maximum impact.


Preservation of biomarkers immunoreactivity on cytospins protected with polyethylene glycol.
The aim of this retrospective study was to evaluate the preservation of biomarkers immunoreactivity on cytospins protected with polyethylene glycol (PEG). In two independent cytopathology laboratories, immunocytochemical reactions were retrospectively evaluated on methanol-fixed and PEG-protected cytospins stored at room temperature (RT) for different time periods and compared with immunocytochemical reactions on corresponding baseline methanol-fixed cytospins. Semi-quantitatively assessed immunoreactivity, using scores from 0 to 3, was considered reduced if two sequential scores were lowered by at least one point. Immunocytochemical reactions for 40 biomarkers with membrane (10), cytoplasmic (22) and nuclear (8) localisation were performed on 921 slides prepared from 183 cytological samples. For the majority of biomarkers (29/37, 78%), immunoreactivity on PEG-protected cytospins stored at RT remained unchanged in the first 12 months. Immunoreactivity for GFAP, p40 and hepatocyte antigen was monitored and remained unchanged for 1, 8 and 7 months, respectively. Partial or complete loss of immunoreactivity on PEG-protected cytospins stored for less than 12 months was found on a single sample out of the total evaluated for CD3 (1/7), CD30 (1/4), CD45 (1/10), CK5/6 (1/7), MelanA (1/7) and vimentin (1/7), while more frequent changes of immunoreactivity were found for Ki67 (4/7) and p63 (2/7). Immunoreactivity on cytospins protected with PEG and stored at RT is well-preserved for at least 12 months for the majority of biomarkers.


The role of the microbiome in diabetes mellitus.
The microbiome is greatly significant for immune system development and homeostasis. Dysbiosis in gut microbial composition and function is linked to immune responses and the development of metabolic diseases, including diabetes mellitus (DM). However, skin microbiome changes in diabetic patients and their role in DM are poorly elucidated. In this review, we summarize recent findings about the association between the gut and skin microbiota and DM, highlighting their roles in the proinflammatory status of DM. Moreover, although there is evidence that the connection between the gut and skin causes the same activated innate immune response, additional studies are needed to explore the mechanism. These findings might inform future DM prevention, diagnosis and treatment.


Experimental study on the single basin solar still integrated with shell and spiral finned tube latent heat storage system enhanced by copper oxide nanoparticles.
In this work, a latent heat storage system was designed, installed, and tested when it was integrated with a single basin solar still. The latent heat storage system is a shell and spiral finned tubes, where 20 kg of a paraffin-CuO nanocomposite with a weight fraction concentration of 1% was poured into the shell while hot water from the solar collector was being pumped through the spiral finned tubes. In order to identify the effect of implementing the storage system on the performance of the solar still, two experiments were conducted, with and without storage, under approximatelysimilar weather conditions. The proposed design of the storage system succeeded to overcome all challenges associated with using paraffin wax as storage material with the solar still. The obtained results revealed that an improvement in fresh water daily productivity of 4.54% was achieved when the storage system was integrated with the solar still. The economic analysis showed that the cost per 1 L of fresh water was 0.25 $/L when the storage unit was used. This high cost will be significantly reduced when a large-scale system is installed.


Interhemispheric links in brain stimulation reward.
The MFB substrate of self-stimulation (SS) has generally been viewed as a unilateral system. We re-examined this belief with pairs of moveable SS electrodes placed bilaterally in the MFB. Rats barpressed for trains of single or twin cathodal pulses of fixed intensity and width and of variable frequency. The first (C) and second (T) pulse of each pair was delivered through the left and right electrode or inversely. C-T intervals ranging from 0.2 to 5.0 ms were tested. The frequency of C pulses required for criterial bar-pressing was used to plot the stimulation efficacy (SE), as a function of the C-T interval and pulse presentation order. The electrodes were subsequently moved and the same procedure repeated for more ventral sites. With some pairs of contralateral hypothalamic (H) sites, the SE was independent of the C-T interval. However, with other pairs of contralateral H sites, the SE increased with C-T interval in a manner resembling a collision effect, with the important exception that no conduction time (CT) was apparent in the data. The absence of CT excludes the presence of a genuine collision effect. When one pulse was sent to the H and another to the contralateral ventral tegmentum (VT), the H-VT curve rose always earlier than the VT-H curve, thus resembling a transynaptic collision effect. However, the C-T interval at which the VT-H curve began rising (always 1.0 ms or less) fails to support the contention that the electrodes activated fibers separated by a synapse. Finally, a typical collision effect was noted with ipsilateral H-VT electrode placements, confirming the presence of direct linkage between ipsilateral MFB sites. Computer-generated data based on two parsimonious assumptions were found to match the empirical results. These assumptions were that each electrode activated a different branch of the same reward neuron and that conduction failure occurred at the branchpoint. The model, which posits that a large number of MFB reward neurons send branches to the other hemisphere, is testable and makes clear-cut predictions about the effects of lesions. In a preliminary test, we recorded the H and contralateral VT threshold frequencies before and after lesioning the H. The H threshold increased more when using small pulse current and remained constant throughout the 4-week testing period. The VT threshold was elevated more for intermediate pulse current and kept increasing with time.(ABSTRACT TRUNCATED AT 250 WORDS)


Regulation of the anorectic drug recognition site during glucoprivic feeding.
The acute effects of 2-deoxy-D-glucose (2-DG)-induced glucoprivic feeding on the anorectic drug recognition site and Na+K(+)-ATPase in the brain were examined in adult rats and in lean and genetically obese mice. The marked hyperglycemia and the induction of feeding caused by the administration of 2-DG to satiated rats and lean mice were associated with significant increases in Na+K(+)-ATPase activity, and in [3H]ouabain binding and [3H]mazindol binding to the anorectic drug recognition site in hypothalamic membranes. Basal and 2-DG-stimulated levels of blood glucose were significantly correlated to the levels of hypothalamic [3H]ouabain (r = + .91, p less than 0.01) and [3H]mazindol (r = + .87, p less than 0.01) binding. A significant correlation (r = .74, p less than 0.05) was also observed between [3H]mazindol binding and [3H]ouabain binding supporting the hypothesis that these hypothalamic binding sites are functionally coupled in their response to circulating glucose. Following the intracerebroventricular (ICV) administration of the diabetogenic drug alloxan, 2-DG did not stimulate feeding or increase [3H]mazindol and [3H]ouabain binding sites in the hypothalamic paraventricular area. Since 2-DG still caused hyperglycemia in alloxan-treated rats, alloxan-induced inactivation of glucoreceptor mechanisms led to an uncoupling of the anorectic drug recognition site from a hypothalamic glucostat. In genetically obese mice (ob/ob), 2-DG also could not induce feeding or increase hypothalamic [3H]ouabain or [3H]mazindol binding, despite a significant hyperglycemic response. In contrast, 2-DG did increase feeding and the binding of [3H]ouabain and [3H]mazindol to the hypothalamus of lean littermates.(ABSTRACT TRUNCATED AT 250 WORDS)


Association of high-risk coronary atherosclerosis at CCTA with clinical and circulating biomarkers: Insight from CAPIRE study.
High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA. A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0-1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features. 528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively). Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.


Culture of marrow stromal cells derived from bone marrow specimens formed at fracture site of human long bone.
To study the process of the internal callus formation, we cultivated marrow stromal cells derived from bone marrow specimens formed at fracture sites of human long bone in alpha-modified Eagle's medium containing 10% fetal calf serum. After 2 weeks of culture, the cells formed two types of colonies; one consisted of spindle cells, and the other comprised of polygonal cells. The two types of colonies were separated and cultured further. The spindle and polygonal cells proliferated to confluence within 3 weeks and after 4 weeks, respectively, after the separation. Both the spindle and polygonal cells showed on the plasma membrane moderate intensity of staining reaction of alkaline phosphatase (ALPase) activity before the period of confluence and strong intensity during the period of confluence. Then, the spindle cells did not produce calcified matrix, but detached from the dish after 6-8 weeks of culture. In the colonies of polygonal cells, however, dense nodules were formed after 9 weeks of culture, which became visible to the naked eye as white aggregates after 11-12 weeks. Electron microscopic studies on the polygonal cells demonstrated matrix vesicles in the intercellular ground substance after 6 weeks of culture, and electron-dense needle-like crystals on the matrix vesicles after 8-10 weeks of culture. On the basis of infrared spectroscopic analysis, the aggregates were composed of hydroxyapatite. Thus, stromal cells derived from bone marrow specimens formed at fracture site of human long bone differentiated to spindle and polygonal cells containing high ALPase activity (a marker for osteogenic capacity) during culture, and the polygonal cells but not spindle cells produced the calcified matrix.


Growth-stimulating effect of lipoproteins on human arterial smooth-muscle cells and lung fibroblasts is due to apo B-containing lipoproteins, type LDL and VLDL, and requires LDL receptors.
Excessive growth of the arterial smooth muscle is essential for the development of atherosclerosis and leads to arterial insufficiency in several other conditions. It is therefore important to elucidate the mechanisms that regulate the growth of the human arterial smooth-muscle cell, SMC. Like other untransformed cells, SMC require plasma for sustained growth in vitro. As found in an earlier study most of the material in plasma which stimulates SMC growth is related to the lipoproteins (LP), and is widespread among LP of different density classes. In the present study we investigated whether the growth-stimulating activity might be more specifically related to certain lipoproteins defined by criteria other than density or particle size. Activity was assayed using human SMC and human lung fibroblasts as both a change of culture size and DNA synthesis. The growth-stimulating activity was confined to apo B-containing LP, as defined by their strong affinity to heparin-Sepharose, electrophoretic beta-mobility, the presence of apo B and the absolute requirement of low density lipoprotein (LDL) receptors for the growth-stimulating effect to appear. It was strongly potentiated by PDGF-BB. A much higher level of LDL was required to initiate synthesis of DNA in SMC than in fibroblasts but at optimal LDL concentration the degree of activation was similar for both cell types. Apo B-containing LP are very powerfully related to atherosclerosis. As intimal thickening is a primary change in atherogenesis, the growth-stimulating effect of them may be of direct pathogenetic importance.


Effects of some divalent cations on synaptic transmission in frog spinal neurones.
1. Synaptic transmission between dorsal root afferents and motoneurones was studied in the isolated and hemisected spinal cord of frogs, using intracellular and extracellular recording techniques, and ionic substitutions of divalent cations in the bathing fluid. 2. Delayed components of excitatory post-synaptic potentials (e.p.s.p.s) evoked in motoneurones by dorsal root supramaximal stimuli, as well as the Ca2+-dependent slow after-hyperpolarization which follows antidromic spikes, were reversibly blocked by superfusing the cords with 'Ca2+-free' media containing Co2+ (4 mM) or Mg2+ (6-10 mM). However, short latency e.p.s.p.s persisted in these media for more than 8 hr. 3. The minimum synaptic delay of the Co2+ and Mg2+, resistant e.p.s.p.s, measured from the peak negativity of the extracellularly recorded presynaptic spike to the onset of the e.p.s.p., was 0.3 msec at 10 +/- 1 degrees C. 4. The Co2+, Mg2+-resistant e.p.s.p.s were graded, and could be elicited by stimulation of segmental or adjacent roots. Those evoked by each of two adjacent roots showed linear summation when the roots were stimulated simultaneously. 5. The Co2+, Mg2+-resistant e.p.s.p.s decreased in amplitude at stimulating frequencies between 10 and 100 Hz, and with paired stimuli at intervals shorter than 20-40 msec. These reductions in amplitude were paralleled by decreases in amplitude of the presynaptic population spike. 6. Solutions free of divalent ions, containing EGTA (2 mM) abolished the Co2+, Mg2+-resistant e.p.s.p.s. They remained blocked for a variable time after returning to Ca2+-free Ringer containing Mg2+ (8 mM). Their continued abolition at this stage is probably not due to changes in electrical properties of motoneuronal membranes. Eventually, the Mg2+-resistant e.p.s.p.s started recovering in the Ca2+-free Ringer containing Mg2+. The time of onset of this recovery depended on the duration of exposure to EGTA. 7. Sr2+ (2-11 mM), although less effective than Ca2+, restored the composite e.p.s.p.s evoked by dorsal root supramaximal stimuli, as well as the Ca2+-dependent slow after-hyperpolarization of the motoneurone. The composite e.p.s.p.s could not be restored with Ba2+ (2-10 mM). 8. The results suggest that the Co2+, Mg2+-resistant e.p.s.p is generated by electrical coupling between some afferent fibres (probably primary afferents) and motoneurones. The after-effects of EGTA treatments probably reflect uncoupling of electrotonic junctions. In contrast, the delayed components of the composite e.p.s.p.s are generated through chemical synapses whose divalent cation requirement is similar to that of the neuromuscular junction.


GP Surgeons' Experiences of Training in British Columbia and Alberta: A Case Study of Enhanced Skills for Rural Primary Care providers.
There has been a steady erosion of family physicians with enhanced surgical skills providing care for rural residents. This has been largely due to the lack of formal training avenues and continuing medical education (CME) opportunities afforded to those interested, and attrition of those currently practicing. A qualitative study was undertaken using an exploratory policy framework to guide the collection of in-depth interview data on GP surgeons' training experiences. A purposive sample of GP surgeons currently practicing in rural BC and Alberta communities yielded interviews with 62 participants in person and an additional 8 by telephone. Interviews were audio recorded and transcribed then subjected to a process analysis. Participants thematically identified motivations for acquiring advanced skills training, resources required (primarily in the area of solid mentorship), the most efficacious context for a training program (structured), and differences in mentorship between obstetricians and general surgeons. Mentors and role models were the most salient influencing factor in the trajectory of training for the participants in this study. Mentorship between specialists and generalists was constrained at times by inter-professional tensions and was accomplished more successfully within a curriculum-based, structured environment as opposed to a learner-responsive training environment.


Reported frequency of domestic violence: cross sectional survey of women attending general practice.
To determine exposure to violence by a partner or spouse among women attending general practice and its association with respondents' demographic and personal characteristics; frequency of inquiry about violence by general practitioners; and women's views on routine questioning about domestic violence by general practitioners. Cross sectional, self administered, anonymous survey. 22 volunteer Irish general practices. 1871 women attending general practice. Proportion who had experienced domestic violence, severity of such violence, and context in which violence occurred. Of the 1692 women who had ever had a sexual relationship, 651 (39%, 95% confidence interval 36% to 41%) had experienced violent behaviour by a partner. 78/651 (12%) women reported that their doctor had asked about domestic violence. 298/651 (46%, 42% to 50%) women had been injured, 60 (20%) of whom reported that their doctor had asked about domestic violence. 1304/1692 (77%, 77% to 80%) were in favour of routine inquiry about domestic violence by their usual general practitioner. 1170 women (69%) reported controlling behaviour by their partner and 475 (28%) reported feeling afraid of their previous or current partner. Women who reported domestic violence were 32 times more likely to be afraid of their partner than women who did not report such violence. Almost two fifths of women had experienced domestic violence but few recalled being asked about it. Most women favoured routine questioning by their practitioner about such violence. Asking women about fear of their partner and controlling behaviour may be a useful way of identifying those who have experienced domestic violence.


Combination approaches to combat multidrug-resistant bacteria.
The increasing prevalence of infections caused by multidrug-resistant bacteria is a global health problem that has been exacerbated by the dearth of novel classes of antibiotics entering the clinic over the past 40 years. Herein, we describe recent developments toward combination therapies for the treatment of multidrug-resistant bacterial infections. These efforts include antibiotic-antibiotic combinations, and the development of adjuvants that either directly target resistance mechanisms such as the inhibition of β-lactamase enzymes, or indirectly target resistance by interfering with bacterial signaling pathways such as two-component systems (TCSs). We also discuss screening of libraries of previously approved drugs to identify nonobvious antimicrobial adjuvants.


Alterations in monoamines level in discrete brain regions and other peripheral tissues in young and adult male rats during experimental hyperthyroidism.
The present study was conducted to investigate the effect of experimentally-induced hyperthyroidism on dopamine (DA), norepinephrine (NE) and serotonin (5-HT) levels in different brain regions as well as in blood plasma, cardiac muscle and adrenal gland of young and adult male albino rats (60 rats of each age). Hyperthyroidism was induced by daily s.c. injection of L-thyroxine (L-T4, 500 μg/kg body wt.) for 21 consecutive days. Induction of hyperthyroidism caused a significant elevation in DA and 5-HT levels in most of the tissues studied of both young and adult animals after 7, 14, and 21 days. NE content significantly decreased after 21 days in most of the brain regions examined and after 14 and 21 days in blood plasma of young rats following hyperthyroidism. In adult rats, NE content decreased after 14 and 21 days in cardiac muscle and after 21 days only in adrenal gland. It may be suggested that the changes in monoamines level induced by hyperthyroidism may be due to disturbance in the synthesis, turnover and release of these amines through the neurons impairment or may attributed to an alteration pattern of their synthesis and/or degradative enzymes or changes in the sensitivity of their receptors.


Inhibition of platelet-activating factor binding to human platelets by calcium channel blockers.
Calcium channel blockers may impair cell activation either by inhibiting calcium influx or by inhibiting agonist binding. Because of this dual action of calcium channel blockers and because of the close relationship between calcium influx and platelet-activating factor (PAF) binding to platelets the current studies examined the effect of calcium channel blockers on PAF binding to washed human platelets. Diltiazem and verapamil inhibited aggregation by PAF in a dose-dependent manner with 50% inhibition at 2.8 +/- 1.4 X 10(-5) M diltiazem (mean +/- SD, n = 5) and 4.2 +/- 2.0 X 10(-5) M verapamil. Both channel blockers also inhibited PAF binding in a dose-dependent manner with 50% inhibition at 4.7 +/- 2.5 X 10(-5) M diltiazem and 6.3 +/- 1.2 X 10(-5) M verapamil. Analysis of the mechanisms of inhibition of binding indicate both competitive and non-competitive effects of the channel blockers. Scatchard analysis of PAF binding in the presence of different fixed concentrations of either diltiazem or verapamil revealed that these agents both increased PAF receptor number and decreased the receptor binding affinity. Lineweaver-Burke analysis of the same data revealed a family of lines which intersect to the right of the ordinate. The channel blockers also dissociated previously-bound PAF from platelets. The current studies indicate that calcium channel blockers inhibit platelet activation by PAF by more than one mechanism and suggest that the PAF receptor may be closely associated with calcium channels.


Dose-dependent suppression of the high alcohol intake of chronically intoxicated rats by Ca-acetyl homotaurinate.
The effect of taurine derivative, Ca-acetyl homotaurinate, on voluntary alcohol intake was investigated in ethanol-dependent and naive rats. A high 24 hr oral intake of a 10% ethyl alcohol solution (9-10 g/kg) was exhibited by rats following 15 days of intragastric infusions of ethanol (7-8 g/kg/day). In four groups, rats were IG injected by short pulses of isotonic saline or a daily dose of 200, 300 and 450 mg/kg respectively, distributed over six daily infusions during alternating 8 hr presentations of ethanol solution and water. Compared to their respective basal intakes during the first two days of injection, the rats demonstrated a dose-dependent 50 to 70% reduction in alcohol consumption with drug treatment. This suppression effect was specific to the ethanol solution and persisted during 4 days of post-treatment observation. In ethanol-naive rats similarly tested and drinking half the amount of alcohol drunk by their ethanol-dependent counterparts, only the highest dose of drug (450 mg/kg) significantly suppressed their alcohol intake. It is suggested that Ca-acetyl homotaurinate interacts with CNS mechanisms involved in the ethanol tolerance-dependence state, underlying an enhanced reinforcing property of ethanol oral intake. Opioid receptors could be the targets in this action.


A Theoretical Perspective to Decipher the Origin of High Hydrogen Storage Capacity in Mn(II) Metal-Organic Framework.
Herein, we report a detailed periodic DFT investigation of Mn(II)-based [(Mn4 Cl)3 (BTT)8 ]3- (BTT3- =1,3,5-benzenetristetrazolate) metal-organic framework (MOF) to explore various hydrogen binding pockets, nature of MOF…H2 interactions, magnetic coupling and, H2 uptake capacity. Earlier experiments found an uptake capacity of 6.9 wt % of H2, with the heat of adsorption estimated to be ∼10 kJ/mol, which is one among the highest for any MOFs reported. Our calculations unveil different binding sites with computed binding energy varying from -6 to -15 kJ/mol. The binding of H2 at the Mn2+ site is found to be the strongest (site I), with H2 found to bind Mn2+ ion in a η2 fashion with a distance of 2.27 Å and binding energy of -15.4 kJ/mol. The bonding analysis performed using NBO and AIM reveal a strong donation of σ (H2 ) to the dz 2 orbital of the Mn2+ ion responsible for such large binding energy. The other binding pockets, such as -Cl (site II) and BTT ligands (site III and IV) were found to be weaker, with the binding energy decreasing in the order I>II>III>IV. The average binding energy computed for these four sites put together is 9.6 kJ/mol, which is in excellent agreement with the experimental value of ∼10 kJ/mol. We have expanded our calculations to compute binding energy for multiple sites simultaneously, and in this model, the binding energy per site was found to decrease as we increased the number of H2 molecules suggesting electronic and steric factors controlling the overall uptake capacity. The calculated adsorption isotherm using the GCMC method reproduces the experimental observations. Further, the magnetic coupling computed for the unbound MOF reveals moderate ferromagnetic and strong antiferromagnetic coupling within the tetrameric {Mn4 } unit leading to a three-up-one-down spin configuration as the ground state. These were then coupled ferromagnetically to other tetrameric units in the MOF network. The magnetic coupling was found to alter only marginally upon gas binding, suggesting that both exchange interaction and the spin-states are unlikely to play a role in the H2 uptake. This is contrary to the O2 uptake studied lately, where strong dependence on exchange-coupling/spin state was witnessed, suggesting exchange-coupling/magnetic field dependent binding as a viable route for gas separation.


Lifespan extension in Caenorhabditis elegans by oxyresveratrol supplementation in hyper-branched cyclodextrin-based nanosponges.
In this work, the increase of the Caenorhabditis elegans (C. elegans) lifespan extension using hyper-branched cyclodextrin-based nanosponges (CD-NS) complexing oxyresveratrol (OXY), and the possible inhibition of C. elegans phosphodiesterase type 4 (PDE4) were evaluated. The titration displacement of fluorescein was used to calculate the apparent complexation constant (KF) between CD-NS and OXY. Moreover, PDE4 was expressed in E. coli, purified and refolded in presence of cyclodextrins (CDs) to study its possible inhibition as pharmacological target of OXY. The apparent activity was characterized and the inhibitory effect of OXY on PDE4 displayed a competitive in vitro inhibition corroborated in silico. A maximum increase of the in vivo life expectancy of about 9.6% of using OXY/CD-NS complexes in comparison with the control was obtained, in contrast to the 6.5% obtained with free OXY. No effect on lifespan or toxicity with CD-NS alone was found. These results as a whole represent new opportunities to use OXY and CD-NS in lifespan products.


Enhanced removal of P(V), Mo(VI) and W(VI) generated oxyanions using Fe-MOF as adsorbent from hydrometallurgical waste liquid: Exploring the influence of ionic polymerization.
Environmentally hazardous P(V), Mo(VI) and W(VI) generated oxyanions exist widely in the waste liquid of nonferrous hydrometallurgy. In this work, Fe-MOF material was simply prepared via solvothermal synthesis and then used as an adsorbent to remove P(V), Mo(VI) and W(VI) oxyanions from hydrometallurgical waste liquid. Several important parameters, including solution pH, oxyanion concentration, contact time, adsorbent amount, temperature and coexistent heavy metal ions, were systematically investigated. The results demonstrate that adsorption process was almost pH-independent over a broad range of pH 3.0-10.0. The adsorption efficiency was strongly associated with the chemical species of oxyanions. The higher polymerisation degree of oxyanions was more favourable for removal efficiency. Additionally, the maximum removal efficiencies for P(V), Mo(VI) and W(VI) oxyanions under optimum conditions were approximately 100%. Furthermore, the adsorption kinetics and isotherms of oxyanions on the adsorbent separately belonged to the pseudo-second-order and Langmuir isotherm models. XPS analysis revealed that inner-sphere complexation played a dominant role in the adsorption removal process. Fe-MOFs with pH-independent properties, abundant binding sites and high stability are prospective adsorbents for treating waste liquids in the hydrometallurgical industry.