Endurance exercise training. An effective therapeutic modality for hemodialysis patients.
These results demonstrate that some of the metabolic complications of chronic uremia treated with maintenance hemodialysis are related to the deterioration in physical fitness and strength that accompanies this chronic disease. Exercise training increased the physical work capacity, improved the lipid profile, normalized insulin sensitivity and glucose metabolism, and lowered the dose of antihypertensive medications required by some of the patients. These changes occurred in the absence of significant changes in diet or body weight. Furthermore, during an equivalent period of follow-up there was a significant deterioration in the lipid profiles of sedentary controls. Thus, exercise training has the potential to reduce the prevalence of many of the medical conditions thought to promote atherogenesis in hemodialysis patients. In addition, there was a significant improvement in the degree of anemia of the exercising patients. None of these metabolic and physiological changes could be attributed to factors related to changes in dialysis scheduling or technology, medications, or diets. Exercise training was associated with an improvement in the mood, level of depression, and psychosocial functioning of these patients; the sedentary controls either became more depressed or reduced their participation in pleasant, socially oriented activities. This raises the possibility that exercise training may have the potential to return some dialysis patients to a more normal social lifestyle, perhaps improving their socioeconomic status and reducing their dependency. These are extremely optimistic possibilities that could have far-reaching implications for the hemodialysis population. The dramatic improvements in lipid and glucose metabolism, hematologic function, blood pressure and work capacity in the exercising patients indicates that aerobic physical training is an effective therapeutic modality with a wide spectrum of effects on many pathologic processes previously thought to be a consequence of chronic uremia. Not only were there major biochemical changes as a result of exercise training, but the psychosocial functioning of these dialysis patients improved. Some of the physiologic changes, such as the increase in work capacity, greater strength and energy, and the rise in hematocrit, contributed to the psychological improvements, but in some patients accomplishing the goal itself (for most a 1-mile jog was the ultimate) seemed sufficient. There are a multitude of potential long-term benefits of exercise training programs for hemodialysis patients.(ABSTRACT TRUNCATED AT 400 WORDS)


Comparison of the single or double chest tube applications after pulmonary lobectomies.
Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. This study aimed to investigate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. This prospective randomised study included 100 consecutive patients who underwent lobectomy or bilobectomy for any pathological condition between May 2006 and November 2007. In the 50 patients in the 'single-tube group', only one 32F chest tube was inserted, and in the 50 patients in the 'double-tube group', two 32F chest tubes were inserted. Pre-, intra- and postoperative variables in both the groups were compared. The pre- and intraoperative characteristics of the patients were similar in both groups. The mean amount of drainage from chest tubes was 600+/-43.2cc in the single-tube group and 896+/-56.2cc in the double-tube group (p<0.001). The mean values of postoperative pain assessed on the visual analogue scale (VAS) in the early (second day) period were 4.28+/-0.21 in the single-tube group and 5.10+/-0.23 in the double-tube group (p=0.014). The VAS scores in the late (second week) period were 1.48+/-0.13 in the single-tube group and 2.00+/-0.17 in the double-tube group (p=0.01). All other related parameters were similar in both groups. Insertion of two chest tubes is not more effective than the insertion of a single chest tube after pulmonary lobectomy. Moreover, using a single tube is in fact more effective than using two tubes in that it causes less postoperative pain and less pleural fluid loss.


New electron-capture gas-liquid chromatographic method for the determination of mexiletine plasma levels in man.
A method for the determination of mexiletine in human plasma by gas-liquid chromatography with electron-capture detection is described. Plasma samples are extracted at pH 12 with dichloromethane after addition of the internal standard, the 2,4-methyl analogue of mexiletine. A derivative is obtained using heptafluorobutyric anhydride; according to gas chromatography-mass spectrometry it is a monoheptafluorobutyryl compound. The minimum detectable amount of mexiletine is 5 pg. Accurate determinations of human plasma levels were performed after oral or intravenous treatment.


Lamotrigine in spinal cord injury pain: a randomized controlled trial.
The objective was to investigate the effectiveness of lamotrigine for the treatment of spinal cord injury pain and clinical signs of neuronal hyperexcitability. Thirty patients with spinal cord injury (SCI) and at or below level neuropathic pain participated in a randomized double blind, placebo-controlled, crossover trial. A 1-week baseline period was followed by two treatment periods of 9 weeks duration with lamotrigine slowly increased to a maximum of 400 mg or placebo separated by a 2-week washout period. The primary outcome measure was the change in median pain score from baseline week to the last week of treatment. Secondary outcome measures included thresholds to standardized sensory stimuli using quantitative sensory testing. Twenty-two patients completed the trial. We found no statistically significant effect of lamotrigine as evaluated in the total sample. However, in patients with incomplete SCI, lamotrigine significantly reduced pain at or below SCI level. Patients with brush evoked allodynia and wind-up-like pain in the area of maximal pain were more likely to have a positive effect to lamotrigine than patients without these evoked pains (7 of 7 vs. 1 of 14). Lamotrigine was generally well tolerated. While this trial showed no significant effect on spontaneous and evoked pain in complete and incomplete spinal cord injury, lamotrigine reduced spontaneous pain in patients with incomplete spinal cord injury and evoked pain in the area of spontaneous pain.


Molecular mechanisms and cellular effects of glucocorticosteroids.
GCSs exert their anti-inflammatory effects through influencing multiple signal transduction pathways. Their most important action is switching off multiple activated inflammatory genes through inhibition of HAT and recruitment of HDAC2 activity to the inflammatory gene transcriptional complex. In addition, GCSs may activate several anti-inflammatory genes and increase the degradation of mRNA encoding certain inflammatory proteins. This broad array of actions may account for the striking effectiveness of GCSs in complex inflammatory diseases such as asthma and the difficulty in finding alternative anti-inflammatory drugs. There is now a better understanding of how the responsiveness to GCSs is reduced in patients who have severe asthma, who have asthma and smoke, and who have COPD. An important mechanism now emerging is a reduction in HDAC2 activity as a result of oxidative stress. These new insights into GCS action may lead to new approaches to treating inflammatory lung diseases and in particular to increasing effectiveness of steroids in situations where they are less effective.


Inhibitory effects of Ponciri Fructus on testosterone-induced benign prostatic hyperplasia in rats.
Benign prostatic hyperplasia (BPH) is non-cancerous condition of enlargement of the prostate, a common occurrence in older men. The immature fruits of Poncirus trifoliata (L.) Rafinesque (Rutaceae), Ponciri Fructus are widely used in traditional oriental medicine for the therapy of various diseases. However, little is known about the mechanism underlying the pathogenesis of BPH. In the present study, we investigated the protective effects of a Ponciri Fructus extract (PFE) on the development of BPH in a in a rat model of BPH induced by testosterone propionate (TP). Male Sprague Dawley rats were used as a model of BPH after its induction by daily subcutaneous injections of TP/corn oil, for a period of four weeks. PFE was administrated daily 1 h before TP/corn oil injection by oral gavage at a dose level of 200 mg/kg during the 4 weeks of TP/corn oil injections. All rats were sacrificed at the end of the experiment, we measured the relative prostate weight, the levels of testosterone and dihydrotestosterone (DHT), histological changes, activities of antioxidant enzymes (catalase, glutathione peroxidase, glutathione reductase, and superoxide dismutase), and expression of proliferating cell nuclear antigen (PCNA). In addition, we also measured the inhibition (%) of 5α-reductase in the prostatic tissue. Our findings indicate that PFE significantly inhibited the development of BPH; decreased the relative prostate weight, the level of testosterone and DHT in serum and prostatic tissue, prostatic hyperplasia, expression of PCNA, and increased the antioxidant enzymes. Moreover, PFE showed a weak inhibitory activity on 5α-reductase. These results suggest that PFE may be used as a therapeutic agent for BPH via antiproliferative and antioxidant effects.


Do attitudes toward disclosure in donor oocyte recipients predict the use of anonymous versus directed donation?
To compare the demographic and psychological characteristics of oocyte recipients and to determine whether the issue of disclosure about the use of a donor is a correlate of the decision to use an anonymous or directed donor. Cross-sectional study. University teaching hospital. Ninety consecutive recipients of donated oocytes (64 of whom used anonymous donors and 26 of whom used directed donors). Pretreatment psychosocial evaluation. Recipient opinions and attitudes regarding the choice of donor type and disclosure to others as determined through a semistructured interview. There were no statistically significant differences with regard to demographic characteristics between recipients who used anonymous and directed donors. There were statistically significant differences between the groups with regard to the issue of disclosure. Recipients who used directed donors were more likely to have told others about using an oocyte donor and were more likely to indicate that they intended to inform the child about the nature of his or her conception. Oocyte recipients who use known donors differ significantly from those who use anonymous donors with regard to the issue of disclosure to others. Further studies are needed to determine the causal direction of this relation.


An X-ray photoelectron spectroscopy study of the external surface of explanted microporous polyurethane vascular prostheses.
XPS has been used to examine the external surfaces of microporous polyurethane vascular prostheses implanted for up to 6 months in dogs. The phenomena of bilirubin absorption and physical degradation were investigated, using three different chemical washes to clean the prostheses. Very little evidence for chemical change was found, indicating a predominant role for the mechanical or biochemical ablation of degraded material.


Chaephilones A and B, Two New Azaphilone Derivatives Isolated from Chaetomium globosum.
Two new azaphilone derivatives, chaephilones A (1) and B (2), were isolated from the fungus Chaetomium globosum, together with four structurally related analogs 3 - 6. The structures of 1 and 2 were elucidated by comprehensive spectroscopic analyses including HR-ESI-MS and NMR. The known compounds were identified as chaetomugilin Q (3), chaetomugilin D (4), 11-epichaetomugilin A (5), and chaetomugilin S (6) by comparing their NMR data and optical rotation values with those reported. Compound 2 represents the first example of azaphilone with an open furan ring. Compounds 1 and 2 were evaluated for cytotoxic activities against five human cancer cell lines (HL-60, SMMC-7721, A-549, MCF-7, and SW480) by the MTS method.


Whole abdomen radiation for minimal residual epithelial ovarian carcinoma after surgical resection and maximal first-line chemotherapy.
Ten patients with Stage III epithelial ovarian received whole abdomen radiation therapy after extensive courses of chemotherapy and second or third laparotomies. All patients had less than 2-mm diameter residual disease. The major side effect was bone marrow suppression which led to decreased dose or field size in four patients. Five patients have recurred and three of these have died. Further treatment after recurrence was compromised by bone marrow suppression. While 40-50% of selected patients may respond to this approach, numerous alternatives are being explored that would not handicap further treatment to the same degree and may have equal response rates.


Cell-specific ablation in the testis: what have we learned?
Testicular development and function is the culmination of a complex process of autocrine, paracrine and endocrine interactions between multiple cell types. Dissecting this has classically involved the use of systemic treatments to perturb endocrine function, or more recently, transgenic models to knockout individual genes. However, targeting genes one at a time does not capture the more wide-ranging role of each cell type in its entirety. An often overlooked, but extremely powerful approach to elucidate cellular function is the use of cell ablation strategies, specifically removing one cellular population and examining the resultant impacts on development and function. Cell ablation studies reveal a more holistic overview of cell-cell interactions. This not only identifies important roles for the ablated cell type, which warrant further downstream study, but also, and importantly, reveals functions within the tissue that occur completely independently of the ablated cell type. To date, cell ablation studies in the testis have specifically removed germ cells, Leydig cells, macrophages and recently Sertoli cells. These studies have provided great leaps in understanding not possible via other approaches; as such, cell ablation represents an essential component in the researchers' tool-kit, and should be viewed as a complement to the more mainstream approaches to advancing our understanding of testis biology. In this review, we summarise the cell ablation models used in the testis, and discuss what each of these have taught us about testis development and function.


Interactions between pregnancy, obstructive sleep apnea, and gestational diabetes mellitus.
Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known. The objective of the study was to assess the relationship between pregnancy, OSA, and GDM. We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester. Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured. Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15-37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels. Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA.


Fluid intake and hydration status in obese vs normal weight children.
Little is known on the relationship between obesity and hydration levels in children. This study assessed whether and by which mechanisms hydration status differs between obese and non-obese children. Hydration levels of 86 obese and 89 normal weight children (age: 7-11 years) were compared. Hydration was measured as the average free water reserve (FWR=urine output/24 h minus the obligatory urine output [total 24 h excreted solutes/97th percentile of urine osmolality of children with adequate water intake, that is, 830 mOsm/kg]) over 2 days. Three days of weighed dietary and fluid intakes were recorded. Non-parametric tests were used to compare variables that were skewed and to assess which variables correlated with hydration. Variables mediating the different hydration levels of obese and normal weight children were assessed by co-variance analysis. Obese children were less hydrated than normal weight peers [FWR=median (IQR): 0.80 (-0.80-2.80) hg/day vs 2.10 (0.10-4.45) hg/day, P<0.02; 32% of obese children vs 20% of non-obese peers had negative FWR, P<0.001]. Body mass index (BMI) z-score (z-BMI) and water intake from fluids correlated with FWR (ρ=-0.18 and 0.45, respectively, both P<0.05). Water intake from fluids completely explained the different hydration between obese and normal weight children [FWR adjusted for water from fluids and z-BMI=2.44 (0.44) hg vs 2.10 (0.50) hg, P=NS; B coefficient of co-variation between FWR (hg/day) and water intake from fluids (hg/day)=0.47, P<0.001]. Obese children were less hydrated than normal weight ones because, taking into account their z-BMI, they drank less. Future prospective studies are needed to explore possible causal relationships between hydration and obesity.


Sleep and Technology in Early Childhood.
Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.


Ethoxy acetalated dextran-based nanocarriers accomplish efficient inhibition of leukotriene formation by a novel FLAP antagonist in human leukocytes and blood.
Leukotrienes are pro-inflammatory lipid mediators generated by 5-lipoxygenase aided by the 5-lipoxygenase-activating protein (FLAP). BRP-201, a novel benzimidazole-based FLAP antagonist, inhibits leukotriene biosynthesis in isolated leukocytes. However, like other FLAP antagonists, BRP-201 fails to effectively suppress leukotriene formation in blood, which limits its therapeutic value. Here, we describe the encapsulation of BRP-201 into poly(lactide-co-glycolide) (PLGA) and ethoxy acetalated dextran (Ace-DEX) nanoparticles (NPs), aiming to overcome these detrimental pharmacokinetic limitations and to enhance the bioactivity of BRP-201. NPs loaded with BRP-201 were produced via nanoprecipitation and the physicochemical properties of the NPs were analyzed in-depth using dynamic light scattering (size, dispersity, degradation), electrophoretic light scattering (effective charge), NP tracking analysis (size, dispersity), scanning electron microscopy (size and morphology), UV-VIS spectroscopy (drug loading), an analytical ultracentrifuge (drug release, degradation kinetics), and Raman spectroscopy (chemical attributes). Biological assays were performed to study cytotoxicity, cellular uptake, and efficiency of BRP-201-loaded NPs versus free BRP-201 to suppress leukotriene formation in primary human leukocytes and whole blood. Both PLGA- and Ace-DEX-based NPs were significantly more efficient to inhibit leukotriene formation in neutrophils versus free drug. Whole blood experiments revealed that encapsulation of BRP-201 into Ace-DEX NPs strongly increases its potency, especially upon pro-longed (≥ 5 h) incubations and upon lipopolysaccharide-challenge of blood. Finally, intravenous injection of BRP-201-loaded NPs significantly suppressed leukotriene levels in blood of mice in vivo. These results reveal the feasibility of our pharmacological approach using a novel FLAP antagonist encapsulated into Ace-DEX-based NPs with improved efficiency in blood to suppress leukotriene biosynthesis.


NIR light-propelled bullet-shaped carbon hollow nanomotors with controllable shell thickness for the enhanced dye removal.
Materials with asymmetric nanostructures have attracted tremendous research attention due to their unique structural characteristics, excellent physicochemical properties, and promising prospects. However, it is still difficult to design and fabricate bullet-shaped nanostructure due to its structural complexity. Herein, for the first time, we successfully constructed NIR light-propelled bullet-shaped hollow carbon nanomotors (BHCNs) with an open mouth on the bottom of nano-bullet for the enhanced dye removal, by employing bullet-shaped silica nanoparticles (B-SiO2 NPs) as a hard template. BHCNs were formed by the growth of polydopamine (PDA) layer on the heterogeneous surface of B-SiO2 NPs, followed by the carbonization of PDA and subsequent selective etching of SiO2. The shell thickness of BHCNs was able to be facilely controlled from ≈ 14 to 30 nm by tuning the added amount of dopamine. The combination of streamlined bullet-shaped nanostructure with good photothermal conversion efficiency of carbon materials facilitated the generation of asymmetric thermal gradient field around itself, thus driving the motion of BHCNs by self-thermophoresis. Noteworthily, the diffusion coefficient (De) and velocity of BCHNs with shell thickness of 15 nm (BHCNs-15) reached to 43.8 μm⋅cm-2 and 11.4 μm⋅s-1, respectively, under the illumination of 808 nm NIR laser with the power density of 1.5 W⋅cm-2. The NIR laser propulsion caused BCHNs-15 to enhance the removal efficiency (53.4% vs. 25.4%) of methylene blue (MB) as a typical dye because the faster velocity could produce the higher micromixing role between carbon adsorbent and MB. Such a smart design of the streamlined nanomotors may provide a promising potential in environmental treatment, biomedical and biosensing applications.


Role of endocavitary brachytherapy with or without chemotherapy in cancer of the nasopharynx.
We previously reported our preliminary experience with nasopharyngeal cancer boosted after 60-70 Gy external beam radiotherapy (EBRT) by fractionated endocavitary brachytherapy (ECBT) to cumulative doses of 78-82 Gy. As for Stage III-IVB disease, cisplatin (CDDP)-based neoadjuvant chemotherapy (CHT) was given. The aim of the present study was to define the role of ECBT more accurately. Ninety-one patients with primary nasopharyngeal cancer, staged according to the 1997 UICC/AJCC classification system, were treated between 1991 and 2000 with 60-70 Gy external beam radiotherapy and 11-18 Gy ECBT. Of the 91 patients, 21 were treated in conjunction with CHT and 70 without CHT. Tumors were subdivided into undifferentiated (UD) and well, moderately, and poorly differentiated (WMP-D) subtypes. Treatment results were analyzed for local control (LC), disease-free survival (DFS), freedom from distant metastasis, and overall survival (OS). A univariate and multivariate Cox regression analysis found stage, treatment period, age, and grade significant for LC, DFS, and OS. At 2 years, for Stage I-IIB (1st period, 1991-1996), the LC, DFS, and OS were 96%, 88%, and 80%, respectively, vs. 65%, 46%, and 52% for Stage III-IVB. For the 2nd treatment period (1996-2000; CHT for Stage III-IVB), the LC, DFS, and OS at 2 years was 100%, 90%, and 61% (Stage I-IIB), respectively, vs. 86%, 74%, and 66% (Stage III-IVB). Three prognostic groups (PGs) were constructed. For the 1991-1996 period, at 2 years, patients in the good PG (UD Stage I-IIB disease) had 100% LC and 92% OS; those in the intermediate PG (UD Stage III-IVB or WMP-D Stage I-IIB), had 94% LC and 71% OS; and those in the poor PG (WMP-D Stage III-IVB) had 47% LC and 40% OS. For the 1996-2000 period, at 2 years, the good PG had 100% LC and 88% OS; the intermediate PG had 100% LC and 64% OS; and the poor PG had 71% LC and 60% OS. For Stage I-IIB disease treated between 1991 and 2000, at 3 years, the LC and OS was 97% and 67%, respectively. The results with 77-81 Gy without CHT warrant EBRT combined with ECBT to remain our standard of care for Stage I-IIB disease. For N2-3 and/or T3-4 tumors, in addition to high doses of RT, neoadjuvant CHT was administered as of 1996. For the 1991-2000 period, at 3 years, the LC was 86% and the OS was 72% with CHT, with little extra morbidity; they were 68% and 35% without CHT. Because of better target coverage and sparing, T3-4 tumors are currently boosted by stereotactic RT to 81.2 Gy.


Systematic review of perchloroethylene and non-Hodgkin's lymphoma.
We conducted a systematic review of epidemiology studies that evaluated the association between perchloroethylene (PCE) and non-Hodgkin's lymphoma (NHL). This included an independent detailed assessment of a few critical aspects of study quality (i.e., study design, exposure measurement, exposure levels, and potential confounding), and a consideration of other aspects of quality less formally. Of the identified 18 cohort studies of 15 unique cohorts, 17 case-control studies of 14 unique population groups, and 3 ecological studies, none was high quality for all four critical quality elements and each study also had other major methodological study limitations. Reported risk estimates were mostly null, ranged widely from below to above 1, and often had extremely wide confidence intervals (CIs), indicating unstable risk estimates. In addition, there was no consistent evidence of dose-response. Overall, given the low quality of the available epidemiology studies, the evidence does not support an association between PCE exposure and NHL.


Zinc induced apoptosis in HEP-2 cancer cells: the role of oxidative stress and mitochondria.
Induction of apoptosis by zinc sulfate was investigated during 96 h exposure on the cancer Hep-2 cell line. During 48 h of exposure, zinc translocated into mitochondria and stimulated production of reactive oxygen species (ROS), affected cellular GSH management and induced moderate activation of p53 and dissipation of mitochondrial membrane potential. In Zn-exposed cells, mitochondria released cytochrome c and AIF, whose translocation to the cytoplasm or the nucleus coincided with the activation of apoptosis. The use of various pharmacological inhibitors inhibiting particular apoptotic targets (antioxidants such as N-acetyl-cysteine and coenzyme Q, the caspase inhibitors z-DEVD-fmk and z-VAD-fmk, cyclosporin A and bonkgrekic acid) proved that Zn acts both directly and indirectly on mitochondria and observed apoptosis is executed by caspase-dependent and caspase-independent pathways.


Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ.
The aim of this study was to assess the usefulness of the breast segmentectomy with rotation mammoplasty (BSRMP) in conserving therapy for an extensive ductal carcinoma in situ (DCIS) with or without an invasive component. Thirty-six women with DCIS visible as large area of microcalcifications distributed out of the retroareolar area regardless of the quadrant were studied prospectively. All the patients underwent BSRMP and axillary procedure (31 sentinel node biopsy, 5 axillary dissection) followed by radiotherapy. In each case, follow-up was carried out carefully and special effort was made to identify postoperative complications. Cosmetic result was judged 6 months after radiotherapy by the patient herself and two surgeons being rated as poor, mediocre, medium, good or excellent. Operation was completed without any difficulties in all the cases. Appropriate BSRMP was easily done after the skin marking. Regardless of the type of axillary approach, it was conveniently performed. Wound was healed by primary adhesion; skin or breast tissue necrosis did not develop. Neither haematoma nor surgical site infection was observed. In none of the patient, centralisation of the nipple-areola complex (NAC) was needed. Three patients (8.3%) with close margins (1 mm or less) successfully underwent subsequent re-excision. The scar did not result in any impairment of arm movement. Cosmetic outcome was evaluated by the women as excellent and good in 55 (87%) and 8 (13%) cases, respectively, while by the surgeons as excellent, good and medium in 52 (82%), 8 (13%), and 3 cases (5%), respectively. BSRMP is a simple and safe technique achieving good cosmetic results without NAC centralisation and giving the wide and easy access to axilla for both sentinel node biopsy and lymphadenectomy. It can be helpful in cases of extensive, radially spreading tumours (in particular DCIS or invasive cancers with intraductal component), eccentric lesions, or superficially located cancers when the neighbouring skin is excised. However, due to its limitations (long incision, difficult subsequent mastectomy, possibility of scar placement in the visible area of decollete), a careful patients' selection should be done. Further studies are needed to assess long-term cosmetic outcomes including delayed post-radiotherapy effects.


Retinal vessel diameters and their correlation with retinal nerve fiber layer thickness in patients with pseudoexfoliation syndrome.
To compare retinal artery-vein diameters (RAVDs) of patients with pseudoexfoliation (PSX) syndrome with healthy controls and investigate the correlations between retinal nerve fiber layer (RNFL) thickness parameters and RAVDs. Seventeen eyes with PSX and 17 eyes of age-matched controls were included in the study. All participants underwent routine ophthalmological examination, Humphrey visual field and RNFL examination by using Stratus OCT. Retinal images were obtained by using a retinal camera (Topcon 501X). RAVDs were measured from inferior nasal, inferior temporal, superior nasal and superior temporal arcuates by using IMAGEnet software. Superior, inferior, nasal, temporal and average RNFL thicknesses were recorded. RAVDs and RNFL parameters in groups and correlations were analyzed by Mann-Whitney U and Spearmann correlation tests. Only inferior quadrant and average RNFL thickness were detected thinner in the PSX group compared with control group (P=0.009, P=0.038, respectively). No statistically significant difference regarding RAVDs was found between two groups. RAVDs seems to be comparable in the PSX and control group. RNFL is thinner in the inferior quadrant in the PSX group. RNFL thickness and RAVDs show significant correlations in both groups. This correlation doesn't seem to be specific to PSX.


The efficacy of cognitive prosthetic technology for people with memory impairments: a systematic review and meta-analysis.
Technology can compensate for memory impairment. The efficacy of assistive technology for people with memory difficulties and the methodology of selected studies are assessed. A systematic search was performed and all studies that investigated the impact of technology on memory performance for adults with impaired memory resulting from acquired brain injury (ABI) or a degenerative disease were included. Two 10-point scales were used to compare each study to an ideally reported single case experimental design (SCED) study (SCED scale; Tate et al., 2008 ) or randomised control group study (PEDro-P scale; Maher, Sherrington, Herbert, Moseley, & Elkins, 2003 ). Thirty-two SCED (mean = 5.9 on the SCED scale) and 11 group studies (mean = 4.45 on the PEDro-P scale) were found. Baseline and intervention performance for each participant in the SCED studies was re-calculated using non-overlap of all pairs (Parker & Vannest, 2009 ) giving a mean score of 0.85 on a 0 to 1 scale (17 studies, n = 36). A meta-analysis of the efficacy of technology vs. control in seven group studies gave a large effect size (d = 1.27) (n = 147). It was concluded that prosthetic technology can improve performance on everyday tasks requiring memory. There is a specific need for investigations of technology for people with degenerative diseases.


A calibrated measuring tape accurately predicts tidal volumes from ulna length.
Low tidal volume ventilation improves outcomes in acute respiratory distress syndrome. Calculation of this volume requires knowledge of a patient's gender, and height, which may not be available in emergency admissions, and the subsequent application of a nomogram. The objective of this study was to test the accuracy of a calibrated measuring tape that reads in mL of tidal volume when the ulna is measured. The measuring tape was used to obtain an estimate of a subject's tidal volume from their ulna length, and standing height was then measured (reference method). A total of 100 healthy volunteers were included. Mean tidal volume was 450 mL for males and 372 mL for females when calculated from the height. Comparing tidal volumes from the tape with those from the reference method, Bland Altman analysis showed a bias of -10 mL (limits of agreement (2SD) -74 mL to 54 mL) for males and a bias of -36 mL (limits of agreement (2SD) -88 mL to 16 mL) for females. Predicted mean tidal volumes were 5.7 mL/kg (95% CI: 5.1-6.3 mL/kg) for males and 5.8 mL/kg (95% CI: 5.3-6.2 mL/kg) for females. Usage of a calibrated measuring tape produced accurate estimates of tidal volumes required for lung protective ventilation in healthy volunteers.


Interferons exhibit temporally distinct regulation of two bovine macrophage Fc receptors.
Interferon (IFN)-induced modulation of two distinct types of Fc receptors (FcR) on bovine bone marrow culture-derived macrophages was quantified by flow cytometry. We have established the presence of separate FcR for monomeric and aggregated IgG on these cells, equivalent to the FcRI and FcRII of mice, respectively. These two kinds of FcR differed in protease sensitivity, hierarchy of preferential binding of immunoglobulin sub-class, and cross-inhibition. Treatment of macrophages with either recombinant bovine IFN-gamma (rBoIFN gamma) or rBoIFN alpha I1 produced a dose-dependent increase in the expression of both types of FcR; however, expression of the FcR for aggregated IgG was increased a full 24 h prior to that for monomeric antibody. Further, expression of the FcRII-equivalent declined substantially by 48 h of IFN exposure, while the presence of the FcRI-equivalent receptor was still enhanced. Finally, low doses (1 unit/ml) of either rBoIFN gamma or rBoIFN alpha I1 failed to alter FcR expression, yet mixtures of IFNs at this concentration were able to potentiate FcR expression. This is the first time that a differential time course of induction of FcR types by IFNs and the effects of mixtures of IFNs on FcR expression has been described in any species.


Natural language word embeddings as a glimpse into healthcare language and associated mortality surrounding end of life.
To clarify real-world linguistic nuances around dying in hospital as well as inaccuracy in individual-level prognostication to support advance care planning and personalised discussions on limitation of life sustaining treatment (LST). Retrospective cross-sectional study of real-world clinical data. Secondary care, urban and suburban teaching hospitals. All inpatients in 12-month period from 1 October 2018 to 30 September 2019. Using unsupervised natural language processing, word embedding in latent space was used to generate phrase clusters with most similar semantic embeddings to 'Ceiling of Treatment' and their prognostication value. Word embeddings with most similarity to 'Ceiling of Treatment' clustered around phrases describing end-of-life care, ceiling of care and LST discussions. The phrases have differing prognostic profile with the highest 7-day mortality in the phrases most explicitly referring to end of life-'Withdrawal of care' (56.7%), 'terminal care/end of life care' (57.5%) and 'un-survivable' (57.6%). Vocabulary used at end-of-life discussions are diverse and has a range of associations to 7-day mortality. This highlights the importance of correct application of terminology during LST and end-of-life discussions.


Understanding the Probiotic Bacterial Responses Against Various Stresses in Food Matrix and Gastrointestinal Tract: A Review.
Probiotic bacteria are known to have ability to tolerate inhospitable conditions experienced during food preparation, food storage, and gastrointestinal tract of consumer. As probiotics are living cells, they are adversely affected by the harsh environment of the carrier matrix as well as low pH, bile salts, oxidative stress, osmotic pressure, and commensal microflora of the host. To overcome the unfavorable environments, many probiotics switch on the cell-mediated protection mechanisms, which helps them to survive, acclimatize and remain operational in the harsh circumstances. In this review, we provide comprehensive understanding on the different stresses experienced by the probiotic when added in carrier food as well as during human gastrointestinal tract transit. Under such situation how these health beneficial bacteria protect themselves by activation of several defense systems and get adapted to the lethal environments.


Reduction in Osteoarthritis Risk After Treatment With Ticagrelor Compared to Clopidogrel: A Propensity Score-Matching Analysis.
Osteoarthritis (OA) is a common cause of joint pain and disability, and effective treatments are lacking. Extracellular adenosine has antiinflammatory effects and can prevent and treat OA in animal models. Ticagrelor and clopidogrel are both used in patients with coronary artery disease, but only ticagrelor increases extracellular adenosine levels. This study was undertaken to determine whether treatment with ticagrelor was associated with a lower risk of OA. We conducted a 1:2 propensity score-matching analysis using data from 2011-2017 in the Optum Clinformatics Data Mart. Patients who had received either ticagrelor or clopidogrel for ≥90 days were included in our study, and patients with a prior diagnosis of OA or inflammatory arthritis were excluded. OA was identified using International Classification of Diseases codes. The primary outcome was the time to diagnosis of OA after treatment with ticagrelor versus clopidogrel. Our propensity score-matched cohort consisted of 7,007 ticagrelor-treated patients and 14,014 clopidogrel-treated patients, with a median number of days receiving treatment of 287 and 284, respectively. For both groups, the mean age was 64 years, and 73% of the patients were male. Multivariate Cox regression analysis estimated a hazard ratio for developing OA of 0.71 (95% confidence interval 0.64-0.79) (P < 0.001) after treatment with ticagrelor compared to clopidogrel. Treatment with ticagrelor was associated with a 29% lower risk of developing OA compared to treatment with clopidogrel over 5 years of follow-up. We hypothesize that the reduction in OA seen in patients who received ticagrelor may in part be due to increased extracellular adenosine levels.


Ethical issues associated with solid organ transplantation and substance use: a scoping review.
While solid organ transplantation for patients with substance use issues has attracted ethical discussion, a typology of the ethics themes has not been articulated in the literature. We conducted a scoping review of peer-reviewed literature on solid organ transplantation and substance use published between January 1997 and April 2016. We aimed to identify and develop a typology of the main ethical themes discussed in this literature and to identify gaps worthy of future research. Seventy articles met inclusion criteria and underwent inductive content analysis. Four main ethical themes were identified: (1) personal responsibility; (2) utility; (3) moral character; and (4) fairness. Each theme had multiple sub-themes and there was substantial overlap between themes. This scoping review identified a disproportionate emphasis in the literature regarding personal responsibility, which was referenced by each of the other themes, and a narrow focus on alcohol and liver. We recommend future research further investigate these connections between ethical themes and focus on ethical issues associated with transplants from organ groups other than liver for patients who use substances other than alcohol.


Pseudovacuoles--immobilized by high-pressure freezing--are associated with blebbing in walker carcinosarcoma cells.
By applying high pressure freezing and freeze-substitution, we observed large inclusions of homogeneous appearance in the front of locomoting Walker carcinosarcoma cells that have not been described earlier. Live cell imaging revealed that these inclusions were poor in lipids and nucleic acids but had a high lysine (and hence protein) content. Usually one such structure 2-5 mum in size was present at the front of motile Walker cells, predominantly in the immediate vicinity of newly forming blebs. By correlating the lysine-rich areas in fixed and embedded cells with electron microscopic pictures, inclusions could be assigned to confined, faintly stained cytoplasmic areas that lacked a surrounding membrane; they were therefore called pseudovacuoles. After high-pressure freezing and freeze substitution, pseudovacuoles appeared to be filled with 20 nm large electron-transparent patches surrounded by 12 and 15 nm large particles. The heat shock protein Hsp90 was identified by peptide sequencing as a major fluorescent band on SDS-PAGE of lysine-labelled Walker cell extracts. By immunofluorescence, Hsp90 was found to be enriched in pseudovacuoles. Colocalization of the lysine with a potassium-specific dye in living cells revealed that pseudovacuoles act as K+ stores in the vicinity of forming blebs. We propose that pseudovacuoles might support blebbing by locally regulating the intracellular hydrostatic pressure.


Renal parenchymal neurilemoma: a rare and unusual kidney tumor.
We report a case of a neurilemoma arising from the renal parenchyma. Renal neurilemoma is an extremely rare tumor, with only 5 cases previously reported. Because so little is known of its natural history and potential for malignancy we recommend radical nephrectomy as the treatment of choice.


[Several estimations of the solutions of the system of differential equations describing electron transfer processes].
Some inequalities are deduced in relation to probabilities of the states of molecules-carriers complex. The existing hierarchy for velocity constants in electron transfer chains permits the application of deduced inequalities both for the simplification of the initial equation system, and for different evaluations, as for example for determining the maximum velocity of electron transport through the complex, for determing the number of electrons in the complex etc.


Skin Graft Techniques.
Management of extensive lower extremity soft tissue and skin loss can be a very difficult to achieve by any surgeon. There can be several associated comorbidities that need to be considered and addressed with these patients. The approach is multifactorial and requires commitment from both the surgeon as well as the patient. There are several protocols that have been formulated throughout the literature addressing soft tissue and skin coverage of the limbs. This article provides a review of the literature and describes the evaluation, harvesting, transplantation, and management of skin grafting techniques to the lower extremities.


FIR haplodeficiency promotes splicing to pyruvate kinase M2 in mice thymic lymphoma tissues revealed by six-plex tandem mass tag quantitative proteomic analysis.
The switch of pyruvate kinase (PK) M1 to PKM2 is pivotal for glucose metabolism in cancers. The PKM1/M2 shift is controlled by the alternative splicing of two mutually exclusive exons in the PKM gene. PKM1 is expressed in differentiated tissues, whereas PKM2 is expressed in cancer tissues. This study revealed that the haplodeficiency of FUSE-binding protein (FBP)-interacting repressor (FIR), a transcriptional repressor of the c-myc gene, contributed to the splicing of PKM1 to PKM2 in mice thymic lymphoma and/or T-cell type acute lymphoblastic leukemia (T-ALL) using six-plex tandem mass tag (TMT) quantitative proteomic analysis. TMT revealed 648 proteins that were up- or downregulated in mice thymic lymphoma tissues compared with wild type mouse. These proteins included transcription factors and proteins involved in DNA damage repair, DNA replication, T-cell activation/proliferation, apoptosis, etc. Among them, PKM2 protein, but not PKM1, was upregulated in the thymic lymphoma as well as T-ALL. Using qRT-PCR, we revealed that the activation of PKM2 mRNA was higher in thymic lymphoma cells of FIR+/-TP53-/- mice than that in control lymphocytes of FIR+/+TP53-/- sorted by flow cytometry. FIR knockdown by siRNA suppressed hnRNPA1 expression in HeLa cells. These results indicated that FIR haplodeficiency contributes the alternative splicing of PKM1 to PKM2 by partly inhibiting hnRNPA1 expression in the thymic lymphoma cells prior to T-ALL. Taken together, our findings suggest that FIR and its related spliceosomes are potential therapeutic targets for cancers, including T-ALL.


Polyglactin 910 suture in urinary tract.
Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract.


Relationship between psychological ownership of the nursing profession and turnover intention: A correlational survey among Taiwanese nurses.
The aim of this study is to examine the relationship between psychological ownership of the nursing profession and turnover intention. There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated. This study adopted a cross-sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical centre in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self-Efficacy Scale and developed Having a Place Scale. Psychological ownership comprises three dimensions: self-efficacy, nurse identity and 'having a place' in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self-efficacy and 'having a place' are negatively related to nurses' intention to leave a hospital (r = -.23 and -.31, p < .001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r = -.38, p < .001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r = .76, p < .001). The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace. Nurse managers can enhance nurses' self-efficacy and sense of 'having a place' to retain nurses in hospitals, while enhancing nurse identity to retain nurses in the profession.


Peptidoglycan fine structure of the radiotolerant bacterium Deinococcus radiodurans Sark.
Peptidoglycan from Deinococcus radiodurans was analyzed by high-performance liquid chromatography and mass spectrometry. The monomeric subunit was: N-acetylglucosamine-N-acetylmuramic acid-L-Ala-D-Glu-(gamma)-L-Orn-[(delta)Gly-Gly]-D-Ala-D-Ala. Cross-linkage was mediated by (Gly)2 bridges, and glycan strands were terminated in (1-->6)anhydro-muramic acid residues. Structural relations with the phylogenetically close Thermus thermophilus are discussed.


Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management.
111 pregnancies complicated with premature rupture of the membranes (PROM) at a gestational age between 20 and 34 weeks, were observed prospectively with expectant management. Median duration of the latency period was 7 (0-109) days. The duration of the latency period was inversely related to the gestational age at PROM. Intra-uterine death ensued in 9.9% of the pregnancies. Clinical chorioamnionitis ensued in 12.6% of the pregnancies. Eight (7.6%) neonates developed sepsis. None of the babies died as a consequence of sepsis alone. Of the 43 (41.0%) neonates who developed idiopathic respiratory distress syndrome (IRDS), 8 (7.6%) babies died. The perinatal mortality rate was 18.6%. The study seems to justify the expectant management of PROM pregnancies of less than 34 weeks of gestation.


Flow cytometric DNA ploidy defines patients with poor prognosis in node-negative breast cancer.
Flow cytometric DNA analysis was performed on fine-needle aspirates from frozen tumour biopsies from 421 node-negative, non-adjuvantly-treated breast-cancer patients with a median observation time of 6.75 years. Among premenopausal patients (n = 175), those having at least one DNA "hypoploid" subpopulation defined as DNA index (DI) < 0.96 or 1.44 < or = 1.92 (n = 81) were characterized by early recurrences (log-rank p = 0.05), Wilcoxon p = 0.007), poor overall survival (OS) (p < 0.001) and poor survival after recurrence (p < 0.001). In the postmenopausal group (n = 246), there were no significant difference among 7 different DI classes regarding either recurrence-free survival (RFS) or OS. S-phase fraction (SPF), divided into quartiles, predicted OS in premenopausal patients only (p = 0.02). Conventional multivariate Cox analysis of OS in the premenopausal group revealed hypoploidy to be the only independent prognostic factor involving a relative risk (RR) of 22.8. Age < or = 40 years was of marginal significance, whereas SPF, histological grade (WHO), oestrogen and progesterone receptor (PgR) content, tumour size and number of lymph nodes removed were excluded from the model. Application of the conventional Cox model to the premenopausal group regarding RFS was found inappropriate due to lack of proportionality of the hazards of hypoploidy due to lack of proportionately of the hazards of hypoploidy, SPF and histological grade. However, introduction of time-dependent co-variates using 2 years as cut-off level showed hypoploidy with a RR of 3.52 and age < or = 40 years with a RR of 3.28 to be independent prognostic factors. In the postmenopausal group, the conventional Cox model identified the number of lymph nodes removed to be the only independent prognostic factor regarding RFS as well as OS, whereas SPF < 9% (lowest quartile) was of marginal significance in RFS analysis. Hypoploidy was correlated to high SPF, low PgR content and low differentiation, indicating that hypoploid tumours proliferate rapidly and hormone-independently. These patients may therefore benefit from adjuvant chemotherapy administered while tumour burden and risk of drug resistance are still low.


Maternal pregnancy loss, birth characteristics, and childhood leukemia (United States).
The authors evaluated the relation between maternal pregnancy loss, birth characteristics, and childhood leukemia in the Northern California Childhood Leukemia Study. Incident cases of childhood leukemia (age 0-14 years) were rapidly ascertained, and controls were randomly selected from birth records and individually matched to cases. A total of 366 cases [313 acute lymphoblastic leukemia (ALL) and 53 acute myeloid leukemia (AML)] and 460 controls were included in this analysis. The biological mothers of all subjects provided detailed reproductive history and birth characteristics of the index children during a personal interview. Odds ratio (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. Data on maternal pregnancy loss and birth characteristics were also available from the birth certificates of 96.3% of all subjects. History of miscarriage was associated with a significantly increased risk of AML (OR = 2.94, 95% CI: 1.03, 8.34), but not ALL. Neither birth weight, birth order, or parental ages appeared to be an important predictor of the risk of ALL or AML. A comparison between data from two different sources (interview versus birth certificate) indicated good reproducibility and offered some evidence against recall bias. Maternal history of miscarriage is associated with an increased risk of childhood AML.


Paris saponin VII enhanced the sensitivity of HepG2/ADR cells to ADR via modulation of PI3K/AKT/MAPK signaling pathway.
To find the effect of Paris saponin VII (PS VII)-mediated PI3K/AKT/MAPK signaling pathway on the sensitivity of ADR-resistant HepG2 cell (HepG2/ADR) cells to ADR. The proliferation inhibitory rates were detected by using MTT assay. Flow cytometry was employed to examine the intracellular accumulation of ADR. The expressions of drug-resistant genes (P-gp, MRP and BCRP) were detected by qRT-PCR, cell apoptosis by Annexin-V-FITC/PI staining, and the expressions of drug-resistance-related proteins, apoptosis-related proteins, and PI3K/AKT/MAPK pathway-related proteins were determined by Western blotting. HepG2/ADR and HepG2 cells treated with PS VII (0.88, 1.32, 1.98, and 2.97 μM) for 48 hours showed increased proliferation inhibitory rate in a dose-dependent manner. HepG2/ADR cells treated PS VII (0.88, 1.32, 1.98 μM) for 48 hours showed decreased IC50 of ADR. Compared with HepG2/ADR cells treated with ADR (5 nM), those treated with PS VII (≤1.98 μM) and ADR (5 nM) showed enhanced ADR accumulation, decreased drug-resistant gene expressions, increased cell apoptosis with unregulated Bax and cleaved caspase-3 and downregulated Bcl-2, as well as the inhibition of PI3K/AKT/MAPK pathway. Moreover, the combination of ADR (5 nM), PS VII (1.98 μM), and LY294002 (PI3K/AKT inhibitor, 20 μM)/SB203580 (P38 inhibitor, 20 μM) for 48 hours could further decreased the HepG2/ADR cell viability, but induced cell apoptosis, accompanying with the decreased expressions of drug-resistant genes. PS VII could downregulate the expressions of drug-resistance genes, increase intracellular accumulation of ADR, promote cell apoptosis, and enhance the sensitivity of HepG2/ADR cells to ADR via PI3K/AKT/MAPK.


Reversal of multidrug resistance by tropane alkaloids from the stems of Erythroxylum rotundifolium.
Six tropane alkaloid esters were isolated from the stems of Erythroxylum rotundifolium. The structures of three new tropane esters, 7beta-hydroxy-6beta-(3,4,5-trimethoxybenzoyloxy)-3alpha-(E)-(3,4,5-trimethoxycinnamoyloxy)tropane (1), 6beta-benzoyloxy-3alpha-(Z)-(3,4,5-trimethoxycinnamoyloxy)tropane (2), and (-)-6beta-benzoyloxy-3alpha-hydroxytropane (3), were established by spectroscopic techniques. When alkaloids 1-6 were evaluated against a panel of human cancer cell lines, the new compound 6beta-benzoyloxy-3alpha-(Z)-(3,4,5-trimethoxycinnamoyloxy)tropane (2) and three known compounds, 6beta-benzoyloxy-3alpha-(3,4,5-trimethoxycinnamoyloxy)tropane (4), 6beta-benzoyloxy-3alpha-(E)-(3,4,5-trimethoxycinnamoyloxy)tropane-7beta-ol (5), and 7beta-acetoxy-6beta-benzoyloxy-3alpha-(E)-(3,4,5-trimethoxycinnamoyloxy)tropane (6), demonstrated greatest activity with multidrug-resistant oral epidermoid carcinoma (KB-V1) cells incubated in the presence of vinblastine. Thus, tropane esters of this type can reverse the multidrug-resistance phenotype, presumably by interacting with P-glycoprotein.


Past and future impacts of land-use changes on ecosystem services in Austria.
Environmental and socio-economic developments induce land-use changes with potentially negative impacts on human well-being. To counteract undesired developments, a profound understanding of the complex relationships between drivers, land use, and ecosystem services is needed. Yet, national studies examining extended time periods are still rare. Based on the Special Report on land use, land management and climate change by the Austrian Panel on Climate Change (APCC), we use the Driver-Pressure-State-Impact-Response (DPSIR) framework to (1) identify the main drivers of land-use change, (2) describe past and future land-use changes in Austria between 1950 and 2100, (3) report related impacts on ecosystem services, and (4) discuss management responses. Our findings indicate that socio-economic drivers (e.g., economic growth, political systems, and technological developments) have influenced past land-use changes the most. The intensification of agricultural land use and urban sprawl have primarily led to declining ecosystem services in the lowlands. In mountain regions, the abandonment of mountain grassland has prompted a shift from provisioning to regulating services. However, simulations indicate that accelerating climate change will surpass socio-economic drivers in significance towards the end of this century, particularly in intensively used agricultural areas. Although climate change-induced impacts on ecosystem services remain uncertain, it can be expected that the range of land-use management options will be restricted in the future. Consequently, policymaking should prioritize the development of integrated land-use planning to safeguard ecosystem services, accounting for future environmental and socio-economic uncertainties.


Characterization of bacteriophage vB_KleM_KB2 possessing high control ability to pathogenic Klebsiella pneumoniae.
Klebsiella pneumoniae is a widespread pathogen of several human diseases. The emergence of multidrug-resistant K. pneumoniae makes the treatment of these diseases a significant challenge. The application of bacteriophages is a potential approach for dealing with the emergence of multidrug-resistant pathogenic bacteria. This study isolates a novel bacteriophage vB_KleM_KB2 that infects the multidrug-resistant clinical isolates of K. pneumoniae. The bacteriophage exhibits a short latent period of 10 min, and can effectively lyse the bacterium within 60 min. Notably, the bacteriophage can completely inhibit the growth of the host bacterium at the initial concentration of 107 CFU/mL with a low multiplicity of infection of 0.001, which proves its high lytic activity. Furthermore, the bacteriophage shows high environmental tolerances, which can facilitate the practical application of the bacteriophage. Analysis of the bacteriophage genome shows that the bacteriophage possesses a novel genome sequence and can represent a new bacteriophage genus. Considering the high lytic activity, short latent period, high stability, and novel genetic background, bacteriophage vB_KleM_KB2 enriches the bacteriophage library and provides a new alternative for controlling the diseases caused by multidrug-resistant pathogenic K. pneumoniae.


Rumination prospectively predicts executive functioning impairments in adolescents.
The current study tested the resource allocation hypothesis, examining whether baseline rumination or depressive symptom levels prospectively predicted deficits in executive functioning in an adolescent sample. The alternative to this hypothesis was also evaluated by testing whether lower initial levels of executive functioning predicted increases in rumination or depressive symptoms at follow-up. A community sample of 200 adolescents (ages 12-13) completed measures of depressive symptoms, rumination, and executive functioning at baseline and at a follow-up session approximately 15 months later. Adolescents with higher levels of baseline rumination displayed decreases in selective attention and attentional switching at follow-up. Rumination did not predict changes in working memory or sustained and divided attention. Depressive symptoms were not found to predict significant changes in executive functioning scores at follow-up. Baseline executive functioning was not associated with change in rumination or depression over time. Findings partially support the resource allocation hypothesis that engaging in ruminative thoughts consumes cognitive resources that would otherwise be allocated towards difficult tests of executive functioning. Support was not found for the alternative hypothesis that lower levels of initial executive functioning would predict increased rumination or depressive symptoms at follow-up. Our study is the first to find support for the resource allocation hypothesis using a longitudinal design and an adolescent sample. Findings highlight the potentially detrimental effects of rumination on executive functioning during early adolescence.


Economic evaluation of elective cesarean versus vaginal delivery on cost of future pelvic floor disorders in the United States.
To analyze the cost impact of cesarean versus vaginal delivery in the United States on the development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). We compared average cost of delivery method to the lifetime risk and cost of pelvic floor disorders (PFDs) in women < 65 years. Costs of maternal care, obtained from the MarketScan® database, included those incurred at delivery and 3 months post-partum. Future costs of PFDs included those incurred after delivery up to 65 years. Previously reported data on the prevalence of POP and SUI following cesarean and vaginal delivery was used to calculate attributable risk. An incremental cost of illness model was used to estimate costs for SUI. Direct surgical and ambulatory care costs were used to determine cost of POP. Average estimated cost was $7089 for vaginal delivery and $9905 for cesarean delivery. The absolute risks for SUI and POP were estimated as 7% and 5%, respectively, following cesarean delivery, and 13% and 14%, respectively, following vaginal delivery. For SUI, average direct cost was $5642, indirect cost was $4208, and personal cost was $750. Average direct cost of POP surgery was $4658, and nonsurgical cost was $2220. The potential savings for reduced prevalence of SUI and POP in women who underwent cesarean delivery is estimated at $1255, but they incur an additional $2816 maternal care cost over vaginal delivery. Although elective cesarean is associated with reduced prevalence of PFDs, the increased initial cost of cesarean delivery does not offset future cost savings.


Pay for Performance: Are Hospitals Becoming More Efficient in Improving Their Patient Experience?
The Centers for Medicare & Medicaid Services (CMS) changed the way hospitals interact with patients when it implemented a pay-for-performance (P4P) system. Under this system, a financial reward or penalty is based in part on measures of patient experience. The program seeks to reward healthcare providers who expand their focus from solely delivering a highly technical set of services that improves the patient's health to creating an atmosphere that makes hospitalization more humane and respectful of patients' values and preferences. Refocusing priorities requires capital investment in more "patient-friendly" facilities or funding staff training programs. This study seeks to determine whether a relationship exists between inpatient costs and the score for "overall rating of hospital" (ORH) on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) hospital version survey. Second, if a relationship exists, the study examines how that relationship changed during the time of CMS' implementation of its P4P program. The study's findings suggest that higher-cost hospitals have higher levels of positive patient experiences, after controlling for other variables. Importantly, the research findings indicate that hospitals are becoming more efficient in delivering care associated with higher levels of patient experience, coinciding with implementation of the P4P program.


The Association between Platelet Distribution Width and Stroke in Atrial Fibrillation Patients.
To explore the association between platelet distribution width (PDW) and stroke in atrial fibrillation (AF) patients. This study included 150 AF patients who were divided into stroke and non-stroke groups. Multivariate logistic regression analysis and area under the receiver operating characteristic curve were performed. Among the 150 patients, 50 and 100 were grouped into the stroke and non-stroke groups, respectively. There were significant differences in systolic blood pressure, total cholesterol, C-reactive protein, and PDW between the groups (P<0.05). Multiple logistic regression analysis showed that PDW (OR: 1.56, P=0.002) was a risk factor for stroke. PDW was an important risk factor for stroke in AF patients, suggesting it has the potential to be a new biomarker for predicting stroke.


Production of enzymes by Paenibacillus chitinolyticus and Paenibacillus ehimensis to obtain chitooligosaccharides.
Obtaining oligosaccharides from chitosan has been the focus of several studies in the pharmaceutical, chemical, food, and medical areas, due to their functional properties. Here, we evaluated the production potential of biologically functional chitooligosaccharides using enzymes extracts produced by Paenibacillus chitinolyticus and Paenibacillus ehimensis. After 48 h of fermentation, these microorganisms were able to produce chitosanases, which generated oligomers with a degree of polymerization between dimers and hexamers. The maximum conversion of chitosan to oligomers was 99.2 %, achieved after 12 h incubation of chitosan with enzymes produced by P. ehimensis. The chitooligosaccharides generated were capable of scavenging the 2,2-diphenyl-1-picrylhydrazyl radical, reaching a maximum scavenging rate of 61 and 39 % when produced with P. ehimensis and P. chitinolyticus enzymes, respectively. The use of these enzymes in the crude form could facilitate their use in industrial applications.


Magnetic resonance imaging of endothelial adhesion molecules in mouse atherosclerosis using dual-targeted microparticles of iron oxide.
Microparticles of iron oxide (MPIO) distort magnetic field creating marked contrast effects far exceeding their physical size. We hypothesized that antibody-conjugated MPIO would enable magnetic resonance imaging (MRI) of endothelial cell adhesion molecules in mouse atherosclerosis. MPIO (4.5 microm) were conjugated to monoclonal antibodies against vascular cell adhesion molecule-1 (VCAM-MPIO) or P-selectin (P-selectin-MPIO). In vitro, VCAM-MPIO bound, in dose-dependent manner, to tumor necrosis factor (TNF)-alpha stimulated sEND-1 endothelial cells, as quantified by light microscopy (R2=0.94, P=0.03) and by MRI (R2=0.98, P=0.01). VCAM-MPIO binding was blocked by preincubation with soluble VCAM-1. To mimic leukocyte binding, MPIO targeting both VCAM-1 and P-selectin were administered in apolipoprotein E-/- mice. By light microscopy, dual-targeted MPIO binding to endothelium overlying aortic root atherosclerosis was 5- to 7-fold more than P-selectin-MPIO (P<0.05) or VCAM-MPIO (P<0.01) alone. Dual-targeted MPIO, injected intravenously in vivo bound aortic root endothelium and were quantifiable by MRI ex vivo (3.5-fold increase versus control; P<0.01). MPIO were well-tolerated in vivo, with sequestration in the spleen after 24 hours. Dual-ligand MPIO bound to endothelium over atherosclerosis in vivo, under flow conditions. MPIO may provide a functional MRI probe for detecting endothelial-specific markers in a range of vascular pathologies.


Sociomics! Using the IssueCrawler to map, monitor and engage with the global proteomics research network.
We invite comment upon an experiment to locate proteomics on the WWW using a software tool called the IssueCrawler. We call our research "sociomics" because, like the bioscience omics, it is a semi-automated, computerised approach to the global analysis of data, whose computerised results can be integrated towards the development of a new "systems sociology" approach to the study of society. Our findings are that proteomics on the web is a scale-free network whose nodes display considerable "dynamic range".


Heart failure symptom monitoring and response training.
The purpose of this study was to test the efficacy of a heart failure (HF) training program on patients' ability to recognize and respond to changes in HF symptoms. The primary aim was to compare event-free survival at 90 days. A total of 99 HF patients randomized to the HF symptom training intervention or usual care completed instruments about self-care (Self-Care of HF Index) and at baseline and 3 months. Demographic, clinical, and comorbidity data were collected by interview and chart review. Time to first event (death or a HF-related hospitalization) was tracked by electronic records and patient interview. The sample was predominately male (67.7%), elderly (67.7 yrs ± 12.1) and Caucasian (88.9%). The intervention group reported more events but the difference was not significantly different (χ(2) = 1.18, p = 0.26). There was no difference in survival time between groups (χ(2) = 1.53, p = 0.216). In paired t-tests, the intervention group had significantly improved self-care maintenance, management and confidence scores (all p < 0.01). The usual care group had significantly improved self-care maintenance and management (both p < 0.01). Improvements in self-care maintenance and confidence were higher in the intervention group compared with usual care (18.0 vs. 12.9 points). HF symptom awareness training appeared to have an early but not sustained benefit resulting in no difference in 90-day event-free survival. However, larger improvement in self-care maintenance and confidence scores in the intervention group compared to usual care is promising. Embedding meaningful symptom monitoring strategies in self-care maintenance interventions requires further investigation.


A green-based approach for noninvasive skin rejuvenation: Potential application of hyaluronic acid.
Gradually, loss of skin elasticity and elastic properties occurs after 30 years of age and will be associated with several changes, including creating wrinkles, skin laxity (sagging skin), and skin blemishes. In general, people all over the world are looking for ways to keep their facial skin young over time. There are several strategies to skin rejuvenate, including invasive and non-invasive methods. However, invasive methods have less popularity than non-invasive methods due to their need for specialist physicians (medical expertise), localized neuropathic pains for patients, the prevalence and incidence of skin infections, and high-cost clinical services. In the meantime, skin hydration is one of the simplest non-invasive methods for skin rejuvenation, and HA, with anti-aging and skin collagen-stimulating properties, has been introduced as a natural skin moisturizing agent. Therefore, since this composition maintains facial skin moisture and radiance, and improves its elasticity, it has always been considered by experts and specialist physicians. On the other hand, due to its lipophilic properties, hydrophilic macromolecules containing HA cannot pass through the stratum corneum. However, they have temporary and superficial softening effects on the skin. Hence, some nanocarriers have been suggested to overcome this problem and develop the properties and positive influences of HA on skin rejuvenation. Therefore, the present study aimed to introduce some new non-invasive approaches in facial skin rejuvenation, including applying liposomes, niosomes, ethosomes, and ionic liquids, to transport HA into the inner and deeper layers of the skin, including Dermis. In this review article, we examine non-invasive methods using nanoparticles to deliver HA to the epidermis and dermis of the skin for skin rejuvenation.


[Surgical correction of congenital bilateral dislocations of the extensor tendons of the thumb].
A congenital bilateral thumb-contracture due to dislocation of both extensor tendons over the metacarpophalangeal joint was treated in a fourteen-year-old boy. Intraoperatively the extensor tendons were shifted to a dorsal position and restrained over the center of the metacarpophalangeal joint of the thumb. By this method the previously useless thumbs were given normal function and cosmetic appearance. This congenital anomaly could not be classified as any known syndrome.


Bicycle and motorcycle wheel spoke injury in children.
To review bicycle and motorcycle wheel spoke injuries around the foot and ankle in 24 children. Medical records of 12 boys and 12 girls aged 2 to 11 (mean, 5.3) years who presented with an isolated posterior heel injury caused by wheel spokes of a motorcycle (n=9) or bicycle (n=15) were reviewed. All 9 motorcycle injury patients and 8 of 15 bicycle injury patients had lacerations. The remaining 7 bicycle injury patients had abrasions and developed skin necrosis and ulcerations, with 5 requiring debridement. The most common site of laceration was the posterolateral heel; 7 of these patients had deep soft tissue injury, and in 5 the Achilles tendon was partially cut or completely severed. The mean number of operations was 2.2 in the motorcycle group and 1.3 in the bicycle group. Seven patients with severe skin loss required skin grafting or flap surgery for wound coverage. The mean time from injury to definitive treatment was 8.2 days. The mean length of hospital stay was 18.4 days in the motorcycle group and 8.1 days in the bicycle group. Delayed definitive treatment was associated with more operations (r=0.499, p=0.013) and longer hospital stay (r=0.567, p=0.004). Wheel spoke injuries may result in severe soft tissue damage and bony trauma. Poor prognostic factors included high-energy injury, contamination and infection, and delayed treatment.


The reproductive strategy of the gregarious parasitoid, Pteromalus puparum (Hymenoptera: Pteromalidae) : 3. Superparasitism in a field population.
Pteromalus puparum is a gregarious parasitoid of lepidopterous pupae. To determine in which phase of a host outbreak superparasitism occurs, field investigations were carried out on seasonal prevalence of the host, Papilio xuhtus, and parasitism by P. puparum in a citrus grove in Fukuoka, Japan in 1974. Host pupation occurred from May to November and the parasitoid attacked the host throughout this period. Pupal density increased rapidly after mid-August and the percentage parasitism decreased during this period. A high level of parasitism was attained after one or more parasitoid generations in mid-September. The superparasitism was observed after mid-September when the parasitoid attained extremely high density, and resulted in an increase in the proportion of males, high mortality, and a decrease in the size of the progeny.


Ultramobile Surgical Set for Austere Damage Control Surgery.
The authors describe an equipment list for an ultramobile, surgeon-carried equipment set that is specifically designed for missions that require the extremes of constraints on personnel and resources conducted outside the ring of golden hour access to damage control surgery (DCS) capabilities.


Body mass index is related to unsuccessful puncture attempts and failure to axillary vein cannulation during ultrasound-guided cardiac electronic device implantation.
Ultrasound (US)-guided axillary vein cannulation is effective and safe during cardiac implantable electronic devices (CIEDs). It is a reasonable alternative to other techniques in order to shorten procedural time and decrease perioperative complications. However, in this context, the short-axis (out-of-plane) visualization to guide the vein puncture is the most used technique. The aim of our study is to describe a single-center experience with the US long-axis (in-plane) technique defining predictors of unsuccessful puncture attempts and failure to axillary vein cannulation in a cohort of patients undergoing CIEDs procedures. From November 2017 to June 2019, consecutive patients undergoing CIEDs procedures were enrolled in the study. US-guided long axis (in-plane) view to guide axillary vein cannulation was used in all subjects. Unsuccessful puncture attempts (UAs) and complete failures to cannulate the vein were collected for each procedure. All patients were evaluated on a daily basis until hospital discharge and at 1-month follow up visit. Among 119 subjects (M: F = 75:44), mean age was 79 ± 9 years, mean BMI 25.7 ± 4.3 kg/m2, and mean BSA 1.74 ± 0.4 m2. We placed 95 pacemakers (32 single-, 61 dual-, and 2 triple-chamber) and 20 ICDs (7 single, 6 dual, 7 triple chambers). An upgrade from dual-chamber to triple-chamber device was carried out with the addition of a new lead in 3 patients. During a system revision, one new electrode was implanted. The overall leads inserted were 204. There were 33 initial unsuccessful attempts in 22/119 patients. US-guided axillary access was finally successful in 94.9% of patients (113/119). In the other cases (6/119), cephalic vein was isolated or blinded subclavian puncture was performed. Interestingly, at univariate analysis, an increasing BMI and BSA, male sex, and anticoagulant therapy were predictors of unsuccessful attempts or failure to cannulate the vein with US. Among those subjects, the multivariate logistic regression showed significant correlations only between BMI and unsuccessful attempts: odds ratio (OR) = 1.16, p = 0.009 [95% CI = 1.04-1.31], and BMI with failure to cannulate the vein: OR = 1.21, p = 0.03 [95%CI = 1.01-1.45]. The receiver operating characteristic (ROC) curves individuated the best BMI value cutoff point at 27 kg/m2 (area under the curve [AUC]: 68.6%) having a sensitivity of 63.6% and a specificity of 66.5% for unsuccessful puncture attempts; a BMI value of 28 kg/m2 (AUC 74.9%) had a sensitivity of 66.7% and a specificity of 66.7% for failure to cannulate the vein with the US-guided approach. Axillary vein long-axis (in-plane) US-guided cannulation during CIEDs implantation is characterized by a high success rate (94.9%). An elevated BMI is significantly related to unsuccessful puncture attempts or failure to cannulation. The higher is the BMI, the more are the chances to have difficult vein puncture or cannulation failure and to switch from US-guided approach to another technique.


Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing.
The purpose of this study was to evaluate the clinical outcomes and meniscus healing after arthroscopic repair of horizontal-cleavage meniscus tears, compared with vertical-longitudinal meniscus tears. This was a retrospective review of a consecutive series of 52 meniscal repairs for horizontal-cleavage tears (n = 27) or vertical-longitudinal tears (n = 25); the groups were compared with respect to clinical symptoms and meniscal healing. Arthroscopic meniscal repair was performed using the inside-out technique with a marrow-stimulating technique. Clinical symptoms were evaluated using the Lysholm score and Knee injury and osteoarthritis outcome score (KOOS). Meniscus healing was evaluated by MRI. The mean follow-up periods were 35.4 ± 8.9 months in the horizontal-cleavage tear group and 39.8 ± 8.3 months in the vertical-longitudinal tear group. There were no significant differences in Lysholm score and KOOS, including each subscale, between the horizontal-cleavage tear- and vertical-longitudinal tear-groups at the final follow-up. At the final follow-up, MRI meniscus grades 0 and 1 were significantly more frequent in the vertical-longitudinal tear-group than in the horizontal-cleavage tear-group, while grade 3 was significantly more frequent in the horizontal-cleavage tear group than in the vertical-longitudinal tear group (p < 0.0001). Although meniscus healing of horizontal-cleavage tears may be poor, arthroscopic repair should be considered for horizontal-cleavage tears because it does provide good clinical outcomes. IV.


Randomised controlled trials for the prevention of cognitive decline or dementia: A systematic review.
Dementia prevention research has progressed rapidly in recent years, with publication of several large lifestyle intervention trials, and renewed interest in pharmacological interventions, notably for individuals with Alzheimer's disease biomarkers, warranting an updated review of results and methodology. We identified 112 completed trials testing the efficacy of single-domain pharmacological (n = 33, 29%), nutritional (n = 27, 24%), physical activity (n = 18, 16%) and cognitive stimulation (n = 13, 12%), or multidomain (n = 22, 20%) interventions on incident dementia, or a relevant intermediate marker (e.g. cognitive function, biomarkers or dementia risk scores) in people without dementia. The earliest trials tested pharmacological interventions or nutritional supplements, but lifestyle interventions predominated in the last decade. In total, 21 (19%) trials demonstrated a clear beneficial effect on the pre-specified primary outcome (or all co-primary outcomes), but only two (10%) were large-scale (testing blood pressure lowering (Syst-Eur) or multidomain (FINGER) interventions on incident dementia and cognitive change in cognitive function, respectively). Of the 116 ongoing trials, 40% (n = 46) are testing multidomain interventions. Recent methodological shifts concern target populations, primary outcome measures, and intervention design, but study design remains constant (parallel group randomised controlled trial). Future trials may consider using adaptive trials or interventions, and more targeted approaches, since certain interventions may be more effective in certain subgroups of the population, and at specific times in the life-course. Efforts should also be made to increase the representativeness and diversity of prevention trial populations.


Immunogenicity of a Haemophilus influenzae type b-tetanus conjugate vaccine when administered separately or in combined vaccines for primary immunization in two consecutive national schedules in Turkey.
In Turkey, the Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (Hib) was replaced by the combined diphtheria-tetanus-acellular pertussis and inactivated polio vaccine (DTaP-IPV/Hib) in 2008. This shift to the new schedule created different cohorts of vaccinated children as a consequence of the different schedules used. We evaluated the immunogenicity of the Hib vaccine in infants vaccinated with these different schedules. Three groups of children were evaluated: group 1 comprised 145 infants vaccinated with diphtheria, tetanus, and whole cell pertussis (DTwP), oral polio vaccine (OPV), and Hib vaccines simultaneously at separate sites; group 2 comprised 204 infants vaccinated with the DTaP-IPV/Hib combined vaccine; group 3 comprised 100 infants vaccinated with a mixed schedule of DTwP, OPV, and Hib for the first one or two doses, followed by DTaP-IPV/Hib vaccine to complete the series. Anti-polyribosylribitol phosphate (anti-PRP) titers ≥0.15μg/ml were similar in groups 1, 2, and 3. However, in group 1, who received all the vaccines at separate sites, ≥ l.0μg/ml long-lasting antibody titers and anti-PRP geometric mean titers were higher (p=0.001). This study showed that even one dose administered in combination with other vaccines in a primary series decreased the level of anti-PRP.


Observation of magnetic level repulsion in Fe6:Li molecular antiferromagnetic rings.
Heat capacity (C), magnetic torque, and proton NMR relaxation rate (1/T(1)) measurements were performed on Fe6:Li single crystals in order to study the crossings between S = 0 and S = 1 and between S = 1 and S = 2 magnetic states of the molecular rings, at magnetic fields B(c1) = 11.7 T and B(c2) = 22.4 T, respectively. C vs B data at 0.78 K show that the energy gap between two states remains finite at B(c)'s (Delta(1)/k(B) = 0.86 K and Delta(2)/k(B) = 2.36 K) thus proving that levels repel each other. The large Delta(1) value may also explain the anomalously large width of the peak in 1/T(1) vs B, around B(c1). This anticrossing, unexpected in a centrosymmetric system, requires a revision of the Hamiltonian.


Abdominal computed tomography in teratoma of the testis: its accuracy in stage I disease and an assessment of the distribution of retroperitoneal lymph-node metastases in other stages of the disease.
One hundred and one patients with Stage I teratoma of the testis have had an abdomino-pelvic computed tomography (CT) scan. These patients have been followed up for a minimum of 18 months and only eight patients have relapsed in the abdomen alone. The abdomino-pelvic CT scan has a negative predictive value of 92%. In those shown by CT to have retroperitoneal lymphadenopathy, the distribution of disease correlates closely with that reported in the literature following retroperitoneal lymphadenectomy. The CT scan provides information about the amount of tumour present and this influences treatment. Computed tomography is the imaging modality of choice for staging patients with teratoma of the testis and invasive techniques do not appear to be justified.


Congenital absence of the common bile duct: A rare anomaly of extrahepatic biliary tract.
Congenital absence of the common bile duct (CBD) is an extremely rare developmental anomaly with right and left hepatic ducts draining directly into the gallbladder (GB). Other synonyms for this clinical condition are "cholecystohepatic ducts", "transverse lie of the GB" or "interposition of the GB". The potential for iatrogenic injury is high, because of either inadvertent division or ligation of the ducts. Diagnosis is mostly made intraoperatively, and needs some form of biliary reconstruction. Herein, we are reporting a case of congenital absence of the CBD in a 36-year-old lady that was detected intraoperatively.


Gradient enhanced spectroscopy.
This paper provides a brief overview of the personal recollections of the authors regarding their contributions to the introduction of shielded gradient technology into NMR spectroscopy during the late 1980s and early 1990s. It provides some background into early probe design and details some of the early technical progress with the use of shielded magnetic field gradients for coherence selection in high resolution NMR and describes the developments at General Electric, the National Institutes of Health, Georgetown University and Johns Hopkins University School of Medicine that ultimately led to this technology becoming commonplace in modern NMR spectroscopy. Most of this early technical work was published in the Journal of Magnetic Resonance.


Increased choroidal thickness is not a disease progression marker in keratoconus.
The recent findings of increased Choroidal Thickness (CT) in Keratoconus (KC) patients raised the question of whether CT could be an indicator of progressive KC. To test this hypothesis, we evaluated and compared the choroidal profile in progressive and non-progressive KC. We ran a cross-sectional observational study in 76 patients diagnosed with KC, age 14-30, to assess KC progression. Progression was defined as when at least two of the studied variables confirmed progression (Kmax, Km, PachyMin, D-Index, Astig, K2, 3 mm PCR). Included patients performed a Spectralis Optical Coherence Tomography (OCT) with enhanced depth image (EDI) technology to evaluate choroidal profile. Choroidal measurements were taken subfoveally and at 500 µm intervals from the fovea, in 7 different locations, and compared between groups. Multivariate linear regression analyses were also performed to assess the influence of CT in KC progression. Thirty-six eyes (47.4%) were classified as KC progressors. The mean subfoveal CT observed in the total sample was 382.0 (± 97.0) μm. The comparison between groups (progressive and non-progressive KC) showed no differences in the locations evaluated (mean subfoveal CT difference between groups was 2.4 μm, p = 0.915). In the multivariate analysis CT seems not be influenced by KC progression (B = 6.72 μm, 95% CI - 40.09 to 53.53, p = 0.775). Assessment of choroidal profile does not appear to be a useful tool to differentiate progressive and non-progressive KC. Further research is needed in order to better understand the role of choroid in KC.


Mother father deaf: the heritage of difference.
Almost 90% of the children born to life-long profoundly deaf parents are hearing. Within this extraordinary family setting, hearing children of deaf parents are exposed to and interact with two differing cultural, social and linguistic systems: that of their deaf parents and the Deaf community, and that of hearing peers and adults. The present paper focuses on cultural identity and affiliation of hearing children of deaf parents--a population whose lives incorporate the paradox of being culturally 'Deaf' and yet functionally hearing. Data reported here are primarily based on interviews and life histories with 150 adult hearing children of deaf parents throughout the United States. The informants in this study provide an opportunity to explore the parameters and norms of Deaf culture as it contrasts and conflicts with those of Hearing culture.


Immune response and cytokine production following immunization with experimental herpes simplex virus 1 (HSV-1) vaccines.
Balb/c mice were immunized with the recombinant fusion protein gD1/313 (FpgD1/313 representing the ectodomain of HSV-1 gD), with the non-pathogenic ANGpath gE-del virus, with the plasmid pcDNA3.1-gD expressing full-length gD1 and with the recombinant immediate early (IE) HSV-1 protein ICP27. Specific antibodies against these antigens (as detected by ELISA) reached high titers with the exception of the DNA vaccine. High-grade protection against challenge with the virulent strain SC16 was found following immunization with the pcDNA3.1-gD plasmid and with the gE-del virus. Medium grade, but satisfactory protection developed after immunization with the FpgD1/313 and minimum grade protection was seen upon immunization with the IE/ICP27 polypeptide. A considerable response of peripheral blood cells (PBL) and splenocytes in the lymphocyte transformation test (LTT) was found in mice immunized with FpgD1/313, with the pcDNA3.1-gD plasmid and with the live ANGpathgE-del virus. For lymphocyte stimulation in vitro, the FpgD1/313 antigen was less effective than the purified gD1/313 polypeptide (cleaved off from the fusion protein); both proteins elicited higher proliferation at the 5 microg per 0.1 mL dose than at the 1 microg per 0.1 mL dose. The secretion of Th type 1 (TNF, IFN-gamma and IL-2) and Th type 2 (IL-4 and IL-6) cytokines was tested in the medium fluid of purified PBL and splenocyte cultures; their absolute values were expressed in relative indexes. The PBL from FpgD1/313 immunized mice showed increased secretion of both T(H)1 (TNF) as well as T(H)2 (IL-4) cytokines (7-10-fold, respectively). Splenocytes from FpgD1/313 immunized mice showed a significant (23-fold) increase in IL-4 production.


Metabolic syndrome and impaired health-related quality of life and in non-Hispanic White, non-Hispanic Blacks and Mexican-American Adults.
We examined the relationship between metabolic syndrome (MetS) and impaired health-related quality of life (HRQoL) in non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and Mexican-Americans (MA). Data (n=5170) from 2009-2010 NHANES were used. Subjects perceived poor overall health (POH), poor physical health (PPH), and poor mental health (PMH) status in the past 30 days were used as indices of impaired HRQoL. Race/ethnic-specific associations between MetS and indices of HRQoL were determined using prevalence odds ratios (POR) from logistic regression models. Statistical adjustments were made for age, sex, education, marital status, income and smoking. Rates of POH, PPH and PMH in the past 30 days increased linearly with increased number of components of MetS in NHW, NHB and MA. MetS was associated with increased odds of PPH in NHW (POR=2.34; 95% CI=1.73-3.17) and MA (POR=1.65; 95% CI=1.09-2.50); increased odds of PPH in NHW (POR=1.65; 95% CI=1.18-2.31), NHB (POR=1.83; 95% CI=1.01-3.35), and MA (POR=1.67; 95% CI=1.09-2.83); and increased odds of PMH in NHW (POR=1.50; 95% CI=1.08-2.08), NHB (POR=2.28; 95% CI=1.29-4.01), and MA (POR=1.44; 95% CI=0.80-2.59). Upon adjustment for other independent variables, smoking and lack of education were found associated with increased odds of impaired HRQoL. MetS is associated with POH, PPH, and PMH in American adults. From clinical standpoint, this study further suggests that HRQoL should be considered in the management of subjects with MetS. Robust public health programs designed to reduce the prevalence of MetS may help in reducing impaired HRQoL, including POH, PPH, and PMH in American adults who have MetS.


Biological monitoring of smoke exposure among wildland firefighters: a pilot study comparing urinary methoxyphenols with personal exposures to carbon monoxide, particular matter, and levoglucosan.
Urinary methoxyphenols (MPs) have been proposed as biomarkers of woodsmoke exposure. However, few field studies have been undertaken to evaluate the relationship between woodsmoke exposure and urinary MP concentrations. We conducted a pilot study at the US Forest Service-Savannah River Site, in which carbon monoxide (CO), levoglucosan (LG), and particulate matter (PM(2.5)) exposures were measured in wildland firefighters on prescribed burn days. Pre- and post-shift urine samples were collected from each subject, and cross-shift changes in creatinine-corrected urinary MP concentrations were calculated. Correlations between exposure measures and creatine-adjusted urinary MP concentrations were explored, and regression models were developed relating changes in urinary MP concentrations to measured exposure levels. Full-shift measurements were made on 13 firefighters over 20 work shifts in winter 2004 at the US Forest Service Savannah River site, a National Environmental Research Park. The average workshift length across the 20 measured shifts was 701+/-95 min. LG and CO exposures were significantly correlated for samples where the filter measurement captured at least 60% of the work shift (16 samples), as well as for the smaller set of full-shift exposure samples (n=9). PM(2.5) and CO exposures were not significantly correlated, and LG and PM(2.5) exposures were only significantly correlated for samples representing at least 60% of the work shift. Creatinine-corrected urinary concentrations for 20 of the 22 MPs showed cross-shift increases, with 14 of these changes showing statistical significance. Individual and summed creatinine-adjusted guaiacol urinary MPs were highly associated with CO (and, to a lesser degree, LG) exposure levels, and random-effects regression models including CO and LG exposure levels explained up to 80% of the variance in cross-shift changes in summed creatinine-adjusted guaiacol urinary MP concentrations. Although limited by the small sample size, this pilot study demonstrates that urinary MP concentrations may be effective biomarkers of occupational exposure to wood smoke among wildland firefighters.


[Neuroendocrine tumors of the colon - management guidelines (recommended by The Polish Network of Neuroendocrine Tumors)].
The neuroendocrine tumors (NET) of the colon are rare with a rising incidence due to an increased number of diagnostic examination including screening colonoscopy. According to distinct prognosis and treatment these tumors are classified as colonic or rectal NET. This paper provides the consensus guidelines for management of patients with these neoplasms recommended by the Polish Neuroendocrine Tumor Network Group. Furthermore the epidemiology and clinical presentation are described.


5-aminolevulinic acid photodynamic therapy for extensive oral leukoplakia with concomitant oral submucous fibrosis: A case report.
Oral leukoplakia and oral submucous fibrosis are potentially malignant disorders of the oral cavity, with high rates of recurrence and malignant transformation. Notably, the malignant transformation rate of oral leukoplakia with concomitant oral submucous fibrosis is significantly higher than that of oral submucous fibrosis or oral leukoplakia alone. However, the management of these conditions is not well defined. Photodynamic therapy is a minimally invasive treatment modality that effectively targets oral potentially malignant disorders, such as oral leukoplakia, erythroleucoplakia, and verrucous hyperplasia, with the advantages of being repeatable and leaving no scarring. We report the case of a 42-year-old man with concomitant oral leukoplakia and oral submucous fibrosis almost involving the entire right buccal mucosa, who underwent six sessions of topical 5-aminolevulinic acid-mediated photodynamic therapy. Photodynamic therapy successfully eradicated whitish plaques and improved mouth opening without any adverse effects. Although photodynamic therapy failed to completely reverse the pathological changes, grading of epithelial dysplasia did not progress and clinical recurrence was not found during the 10-month follow-up. In conclusion, topical 5-aminolevulinic acid-mediated photodynamic therapy appears safe and has excellent clinical efficacy against oral leukoplakia-concomitant oral submucous fibrosis, but long-term follow-up is necessary.