Psychiatric and behavioral problems in aggressive drivers.
Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.


POEMS: a case study of an Italian wine-producing firm.
Over the last decade, researchers paid much attention to concepts such as Design for Environment, Extended Producer Responsibility, Responsible Chain Management, and Eco-design. Many management tools and standards (such as EMAS, ISO 14001, LCA, EPD, Ecolabel) have been developed to support companies in the evaluation and management of their environmental performance and to pursue continual environmental improvement. The more recent development of the aforesaid fields looks at interorganizational environmental management. Such an approach can complement the more traditional intraorganizational corporate environmental management approaches and tools. A typical example of this new trend is the Product Oriented Environmental Management System (POEMS), which represents the natural evolution of the above-mentioned tools, combining the features of EMS, EPD and Ecolabel. Although the structure of the POEMS is still not standardized, many experimental applications have yet been carried out in Europe. In developing a POEMS, a company needs to determine all of the environmental impacts caused at all life-cycle stages of the product and, ideally, to reduce all of them through a continual commitment. The aim of the present study was to perform a survey of the developed POEMS models and to analyze their peculiarities and drawbacks in the application to Small and Medium Enterprises. A case study regarding an Italian winery company is presented. The study analyzes the structure and the activities of the examined firm, in order to estimate direct and indirect environmental impacts following a life-cycle approach. The chosen functional unit is a 0.75-L bottle of red wine. The article also suggests some solutions to improve the environmental performances of the firm's products.


Radiation-induced lymphopenia during chemoradiation therapy for non-small cell lung cancer is linked with age, lung V5, and XRCC1 rs25487 genotypes in lymphocytes.
We investigated clinical and genetic factors associated with severe radiation-induced lymphopenia (RIL) in a randomized clinical trial of photon vs. proton radiation, with chemotherapy, for non-small cell lung cancer. XRCC1 rs25487 was genotyped in lymphocytes from serial peripheral blood samples. Severe RIL was defined as absolute lymphocyte count (ALC) < 0.3 × 109 cells/L. Univariate and multivariate analyses were used to identify independent risk factors, which were then used to group patients for risk of severe RIL. Univariate analysis of the 178 patients in this analysis showed that older age, larger tumors, higher lung V5 and mean lung dose, and higher heart V5 and mean heart dose were associated with severe RIL during treatment (P < 0.05). The XRCC1 rs25487 AA genotype was also associated with increased risk of severe RIL during treatment (AA vs. others: hazard ratio [HR] = 1.665, 95% confidence interval [CI] 1.089-2.500, P = 0.018). Multivariate analyses showed that older age (HR = 1.031, 95% CI 1.009-1.054, P = 0.005), lung V5 (HR = 1.039, 95% CI 1.023-1.055, P < 0.0001), and AA genotype (AA vs. others, HR = 1.768, 95% CI 1.165-2.684, P = 0.007) were independently associated with higher incidence of severe RIL. These three risk factors (age ≥ 56 years, lung V5 ≥ 51% and XRCC1 rs25487 AA) distinguished patients at different risk of developing severe RIL (P < 0.0001). Age, lung V5 and XRCC1 rs25487 AA were all linked with risk of severe RIL. Our predictive risk model may be helpful for identifying patients at high risk of severe RIL so that treatment can be modified.


Chemical diversity in leaf and stem essential oils of Origanum vulgare L. and their effects on microbicidal activities.
Essential oils (EOs) from the stems and leaves of Origanum vulgare L. grown in Saudi Arabia and Jordan were analyzed by gas chromatography-mass spectrometry (GC-MS) and GC-flame ionization detector (FID) techniques on two different columns (polar and nonpolar). A detailed phytochemical analysis led to the identification of 153 constituents of these essential oils. Both Saudi and Jordanian plants are classified by chemotypes rich in cymyl-compounds. However, the Saudi Origanum contains carvacrol as the major component and is, thus, characterized as a carvacrol chemotype, while the Jordanian Origanum contains thymol as the major component, and, thus, it is classified as a thymol chemotype. In addition, the antimicrobial activities of the studied EOs and their major components, including carvacrol and thymol, were evaluated against various Gram-positive and Gram-negative microorganisms. All the tested compounds exhibited significant antimicrobial activity against all the tested bacteria. Among them, thymol demonstrated superior activity against all the tested organisms, followed by carvacrol. Moreover, results on oil composition and oil yield of O. vulgare L. from different parts of the world is compared in detail with the present outcomes.


Scanning electron microscopy of malignant gliomas. A comparative study of glioma cells in smear preparations and in tissue culture.
Smear preparations from 15 malignant gliomas, 2 metastatic carcinomas and from normal brain were examined by scanning electron microscopy. Tissue culture preparations from malignant gliomas were also studied. In the better differentiated areas of gliomas, the cells in smears were stellate with multiple long interweaving processes 0.25--1.3 micrometer in diameter which could be distinguished from myelinated nerve fibers (1.3--5 micrometer) and from fibrin (0.08--0.3 micrometer) by their thickness and arrangement in the tissue. The relationship of glial processes to blood vessels within the tumour was well demonstrated in smears. Metastatic carcinoma cells lacked the processes seen in glioma cell smears and did not show the same relationship to blood vessels. The more anaplastic glioma cells had fewer processes and ovoid cell bodies covered with surface ruffles and microvilli similar to the cell membrane projections in the nuclear regions of glioma cells in culture. The relationship of the surface morphology of glioma cells in smears to the known invasive nature of these tumours is discussed.


Evolving relationship of Nares Strait ice arches on sea ice along the Strait and the North Water, the Arctic's most productive polynya.
Nares Strait, the waterway that separates northwest Greenland from Ellesmere Island, is a major pathway along which sea ice leaves the Arctic, including the planet's oldest and thickest sea ice that is experiencing an accelerated loss. Ice arches that develop during the winter at the Strait's northern or southern terminus can remain stable for months at a time during which the transport of sea ice ceases. The Arctic's most productive polynya, the North Water (NOW) or Pikialasorsuaq (West Greenlandic for 'great upwelling') forms at the Strait's southern end. There is evidence that a warming climate and the concomitant thinning of Arctic sea ice is weakening the arches and it has been proposed that this may impact the stability of NOW and the complex ecosystem that it sustains. Here we employ a categorization of recent winters with respect to the presence or absence of ice arches to explore their impact on sea ice along the Strait and over the NOW. We find that winters during which a southern ice arch is absent are associated with a reduced and thinner ice cover along the Strait with ice conditions over the NOW similar to that during winters with a southern arch. In winters, without a southern arch, there is also an acceleration of the winds along the Strait that contributes to the presence of reduced ice cover. Ocean color remote sensing data suggests that current levels of primary productivity over the NOW are independent of the presence or absence of an ice arch. The results suggest more research is needed to assess the stability of the NOW, with respect to reduced ice cover and primary productivity, in a future where ice arches cease to form along Nares Strait.


HDT-1, a new synthetic compound, inhibits glutamate release in rat cerebral cortex nerve terminals (synaptosomes).
Excessive glutamate release has been proposed to be involved in the pathogenesis of several neurological diseases. In this study, we investigated the effect of HDT-1 (3, 4, 4a, 5, 8, 8a-hexahydro-6,7-dimethyl-4a-(phenylsulfonyl)- 2-tosylisoquinolin-1(2H)-one), a novel synthetic compound, on glutamate release in rat cerebrocortical nerve terminals and explored the possible mechanism. The release of glutamate was evoked by the K+ channel blocker 4-aminopyridine (4-AP) or the high external [K+] and measured by one-line enzyme-coupled fluorometric assay. We also determined the loci at which HDT-1 impinges on cerebrocortical nerve terminals by using membrane potentialsensitive dye to assay nerve terminal excitability and depolarization, and Ca2+ indicator Fura-2 to monitor Ca2+ influx. HDT-1 inhibited the release of glutamate evoked by 4-AP and KCl in a concentration-dependent manner. HDT-1 did not alter the resting synaptosomal membrane potential or 4-APevoked depolarization. Examination of the effect of HDT-1 on cytosolic [Ca2+] revealed that the diminution of glutamate release could be attributed to reduction in voltage-dependent Ca2+ influx. Consistent with this, the HDT-1-mediated inhibition of glutamate release was significantly prevented in synaptosomes pretreated with the N- and P/Q-type Ca2+ channel blocker omega-conotoxin MVIIC. In rat cerebrocortical nerve terminals, HDT-1 inhibits glutamate release through a reduction of voltage-dependent Ca2+ channel activity and subsequent decrease of Ca2+ influx into nerve terminals, rather than any upstream effect on nerve terminal excitability.


Phorbol ester effect in platelets, lymphocytes, and leukemic cells (HL-60) is associated with enhanced phosphorylation of class I HLA antigens. Coprecipitation of myosin light chain.
Phorbol-12-myristate-13-acetate (PMA) is a potent tumor promoter. However, the mechanism of its effect is still unknown. In the present study we use two dimensional gel electrophoresis to show that the PMA effect on platelets is associated with enhanced phosphorylation of a series of polypeptides at 44K which migrate close to but distinct from a previously reported 47K protein. We identified these proteins as the class I molecules of the human histocompatibility antigens (HLA A,B). We further demonstrate that the PMA effect is also associated with a dramatic phosphorylation of HLA antigens in HL-60 leukemic cells and in human lymphocytes, showing that an increase in phosphorylation of HLA antigens is intimately related to the signal of PMA in various cellular systems. Immunoprecipitation of HLA proteins resulted in coprecipitation of phosphorylated myosin light chain (20K). HLA antigens are transmembrane proteins which interact with cytoskeletal elements, probably via their intracellular region, which has been previously shown to be phosphorylated. It is suggested that phosphorylation of HLA membrane proteins may represent an important mechanism in the effects induced by PMA.


Brief Report: The Feasibility and Effectiveness of an Advocacy Program for Latino Families of Children with Autism Spectrum Disorder.
Latino, Spanish-speaking families of children with autism spectrum disorder (ASD) face unique barriers in special education advocacy. Although advocacy programs are becoming more common in the United States, none of these programs target Latino families. This is a pilot study to examine the feasibility and effectiveness of an advocacy program for Latino families of children with ASD. Using a quasi-experimental design, 40 Latino family members of children with ASD participated in this study. Results demonstrated consistent attendance, low attrition, and high participant satisfaction. Intervention (versus control) group participants demonstrated significantly increased empowerment and special education knowledge, and stronger family-school partnerships. Findings provide preliminary support for advocacy programs for Latino families of children with ASD.


Rheumatoid factor by laser nephelometry and Waaler-Rose assay: prognostic value in patients with recent-onset rheumatoid arthritis.
To evaluate the prognostic value of rheumatoid factor (RF), detected in the Waaler-Rose agglutination assay and by nephelometry, in patients with recent-onset rheumatoid arthritis (RA). Consecutive patients with new-onset RA between 1993 and 1997 were followed for a median period of 4.7 years. Clinical data at baseline and drug use during the disease course were recorded. Outcome parameters studied were disease process, damage (erosions, joint surgery, extra-articular manifestations, and new co-morbidity), and death. Cut-off levels for RF were >40 IU/mL (nephelometry) and titres 1:160 (Waaler-Rose haemagglutination). RF tests were negative by both methods in 22% of RA patients (RF- group), while 33% were RF positive by nephelometry only (RF+ group) and 45% were positive by Waaler-Rose and nephelometry (RF++ group). Baseline clinical and laboratory findings as well as the number of subsequently used disease-modifying anti-rheumatic drugs (DMARDs), the number of patients starting and the time spent on steroid therapy were similar in the three RF groups. Odd ratios for death (n = 23), erosions (n = 62), and serious extra-articular disease manifestations (EAMs) (n = 13) as well as patient survival, erosion-free or surgery-free survival rates did not differ between the RF groups. Only rheumatoid nodules were more frequent in RF++ patients. The baseline presence of RF by either Waaler-Rose or nephelometry was not associated with differences in drug therapy, morbidity other than rheumatoid nodules, or mortality in RA patients in the first 5 years of disease. Being immunoglobulin M (IgM) RF positive thus had little impact on RA patient outcome.


An Integrated Multidimensional Resilience Index for urban areas prone to flash floods: Development and validation.
Resilience analysis is critical in developing flash flood risk reduction strategies in the context of global change and sustainable development. The most common method for assessing resilience is index-based. Nevertheless, the resulting indices typically fail to represent resilience's multidimensional character since they frequently disregard all involved dimensions (i.e., social, economic, environmental, physical, institutional, and cultural). Furthermore, regional resilience indices are rarely externally validated in urban areas prone to flash flooding because the required data are limited and flash flooding does not occur concurrently throughout the study region. This research developed and validated a regional Integrated Multidimensional Resilience Index (IMRI) in urban flash flood-prone areas to address the aforementioned knowledge gaps. The Monte Carlo method enabled internal validation of the IMRI following uncertainty and sensitivity analyses. Latent Class Cluster Analysis (LCCA) was used to characterize resilience, leveraging resulting regional spatial patterns. The findings obtained revealed that the most resilient urban areas have greater social and cultural resilience, while the least resilient urban areas should strengthen their social and institutional resilience. Validation results demonstrated a low bias between the IMRI scores and the control statistics derived from the Monte Carlo analysis as well as a higher than 80 % probability of not getting variations in the resilience categories, confirming the robustness of the IMRI. Through LCCA, five distinct regional spatial patterns of resilience were identified. The methodological approach deployed here enabled the identification of the underlying characteristics that determine the urban system's resilience to flash flooding, thereby supporting the formulation of resilience-building strategies for each dimension and urban area under consideration.


Laccase catalytic activity shielded by SiO2 nanostructured materials: an in vitro and in silico approach.
This study investigates the enhancement of enzymatic catalytic performance by immobilizing laccase on various nanostructured mesoporous silica materials (SBA-15, MCF, and MSU-F). The activity of immobilized laccase was evaluated under different hydrothermal, pH, and solvent conditions, with laccase@MSU-F showing a three-fold increase in stability. Laccase immobilized on these materials demonstrated stability in a pH range of 4.5 to 10.0, while free laccase was inactivated at pH higher than 7. Molecular dynamics simulations revealed that electrostatic interactions and protective confinement effects contribute to the improved stability of immobilized laccase. Overall, the findings suggest that nanomaterials can enhance the operational stability and recovery of enzymes.Communicated by Ramaswamy H. Sarma.


Effect of nifedipine on gastric emptying and gastrointestinal motility in man.
Nifedipine, a calcium-blocking agent, inhibits smooth muscle contractions in various organs including gastric muscle in vitro. Despite this, nifedipine has been found to have no effect on gastric emptying in man. We have investigated the effect of nifedipine on gastric emptying of liquids and solids and on gastrointestinal motility in six healthy subjects. For this, isotopic techniques and manometric methods were used. We confirm that nifedipine 30 mg per os does not modify gastric emptying of liquids or solids. By contrast, antral motility was significantly inhibited (P less than 0.05) and duodenal motility increased. These results could be interpreted as (1) gastroduodenal motility changes are not severe enough to alter emptying or (2) isotopic techniques are not sensitive enough to detect subtle changes in gastric emptying.


Generation and dispersion of chemical and biological gradients in a large-deep multi-basin lake (Lake Como, north Italy): The joint effect of external drivers and internal wave motions.
The formation of chemical and biological heterogeneity in lakes can be favored by physical and morphometric constrains. This study describes the results of four whole-lake field campaigns carried out in Lake Como (north Italy) during thermal stratification. The aim was to analyze the distribution of chemical-biological variables in a multi-basin lake as a result of internal and external physical drivers and constrains. Lake Como has a y-like shape encompassing three main sub-basins: northern, south-eastern, and south-western. Field data underlined: the presence of chemical-biological gradients between the south-western basin and the rest of the lake and the propagation of a fresher water-plume (formed by the two main northern inflows) into the northern basin and then into the south-western closed arm. The use of a three-dimensional hydrodynamic model showed a periodic movement of this plume that tends to enter the south-western basin first and then to return toward north, moving forward and back through the junction of the three arms. The entrance into the eastern basin, instead, occurs only secondarily. Wavelet transform analysis revealed common periodicity between the plume movement and the action of different external and internal lake-stressors, including: the discharge of the main inflow (period centered at 1, 3.3, and 6.5 day), the wind intensity (0.5 and 1 day) and the two main basin-scale internal wave motions: (3.3 day and 7.1 day). The periodic movement of the fresher water-plume enhances the water exchange and reduces the chemical-biological gradients between the western closed basin and the main lake, playing a crucial role in distributing both inorganic and organic materials at the lake basin-scale.


Role of inflammation markers in the prediction of weight gain and development of obesity in adults - A prospective study.
There is a growing body of literature confirming the association between inflammation and obesity. Recent research suggests that inflammation may play a role in weight gain. The aim of the study was to analyse whether serum inflammatory markers predict weight gain or development of obesity in a prospective study design. The baseline study (DILGOM 2007) consists of a population-based sample of 5024 Finnish men and women aged 25-75 years, of whom 3735 participated in the follow-up study in 2014. Baseline data collection included a questionnaire on health behaviour, physical examinations and blood samples including serum high-sensitivity C-Reactive Protein (hs-CRP), Interleukin-1 receptor antagonist (IL-1Ra), Interleukin-6 (IL-6), Tumor Necrosis Factor Alpha (TNF-alpha) and high molecular weight adiponectin (HMW adiponectin). Indicators of obesity were weight, body mass index (BMI), waist circumference and body fat percentage (% body fat). At baseline hs-CRP, IL-1Ra, IL-6, TNF-alpha and HMW adiponectin associated strongly (p < 0.0001) with obesity indicators. After adjustment for several potential predictors of obesity, hs-CRP and IL-1Ra associated inversely with changes in obesity indicators during the 7-year follow-up. These associations disappeared, however, after further adjustment for baseline BMI. Only HMW adiponectin retained a modest positive association with the change in weight (p = 0.008), in BMI (p = 0.007) and in waist circumference (p = 0.002). These findings suggest that the inflammatory markers, although highly associated with obesity, do not predict weight gain in an adult population. This could translate into inflammation being a result of obesity rather than a contributing factor to it.


Theoretical analysis of the stretched optical pulse ripple and novel chirped pulse retrieving algorithm.
Amplitude and phase ripples of an ultrafast chirped pulse complex envelope are considered. The formula that establishes the relation between the pulse complex envelope and its spectrum amplitude was theoretically derived for both cases of the ripple. Based on current results, a linearly chirped pulse can be retrieved using only a spectrum analyzer and Kerr nonlinear medium.


Null alleles of the fourth component of complement and HLA haplotypes in familial systemic lupus erythematosus.
Eight families (121 individuals) with two or more members affected with systemic lupus erythematosus (SLE) were analyzed for histocompatibility antigens (HLA-A, B, C, DR, MT, and MB) and complement antigens (C4A, C4B, and BF). These data were correlated with serological markers (antinuclear antibodies, single- and double-stranded anti-DNA, anti-SM, anti-nRNP, anti-Ro [SS-A], anti-La [SS-B], and biological false-positive tests for syphilis and clinical features. Fifteen members had SLE, and 19 had other immune diseases (subacute cutaneous lupus erythematosus, discoid lupus erythematosus, hypothyroidism, insulin-dependent diabetes mellitus, primary Sjogren's syndrome, immune thrombocytopenic purpura, rheumatoid arthritis, and multiple sclerosis). Twenty-three healthy relatives (seroreactors) had significant titers of circulating antibodies, as did 2 of 17 spouses. There was an increased frequency of null C4 alleles in those individuals with SLE (60%) and healthy relatives (50%) as compared with spouses (24%). Multivariate analysis showed a significant association between SLE and female sex (P =.006), whereas there was no significant association revealed between female sex and other immune diseases. Patients with SLE also had a higher frequency of either C4A or C4B null alleles (P = .01) than those with immune diseases. The C4A homozygous null phenotype was more common in SLE patients than in seroreactors (P = .02). There was a higher frequency of HLA-DR2 and DR3 in individuals with SLE than in those with immune disease (P = .08), seroreactors (P = .02) and normal relatives (P = .002). One totally C4-deficient patient with SLE was identified. These families demonstrate an important association between SLE and the C4 null allele and the HLA-DR2 and DR3. These risk factors, however, cannot account for the development of disease in all individuals.


Transganglionic degenerative atrophy in the substantia gelatinosa of the spinal cord after peripheral nerve transection in rhesus monkeys.
The effect of sciatic nerve transection on its centrally located terminals in the spinal cord was analyzed by electron microscopy in adult rhesus monkeys one and three months following lesion. Although the peripheral and intermediate portions of the dorsal roots, where the axons are enveloped by Schwann cells were normal, their central portion and their terminals in the substantia gelatinosa were remarkably altered. Transganglionic degenerative atrophy (TDA) is characterized by three distinct types of electron-microscopic alterations. The first type exhibits a conspicuous electron density of the terminal and pre-terminal axoplasm. Importantly, shrinkage replaces fragmentation and glial engulfement of the terminal seen in the course of Wallerian degeneration. The second type is characterized by the disappearance of synaptic vesicles from the terminals. The third type of TDA consists of intricate labyrinthine structures, composed of flattened profiles of axonal, dendritic and glial elements. The complex and diverse cellular changes that occur in the upper dorsal horn following peripheral nerve injury may provide the structural basis of plasticity of the primary nociceptive system.


Micro-invasive breast carcinoma with granulomatous stromal response.
Two cases of micro-invasive breast carcinoma with granuloma formation associated with invasive foci are presented. This is an unusual feature which may aid in the recognition of stromal micro-invasion. Micro-invasive carcinomas are defined as predominantly non-invasive tumours in which there are one or more foci of infiltration, none measuring more than 1 mm in maximum diameter.


Mac-2-Binding Protein Glycosylation Isomer as a Novel Predictor of Hepatocellular Carcinoma Recurrence in Patients with Hepatitis C Virus Eradication.
Hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) can recur even after achievement of a sustained virologic response (SVR). Mac-2-binding protein glycosylation isomer (M2BPGi) is a newly identified biomarker correlated with liver fibrosis. This study aimed to clarify outcomes for patients with an SVR and to assess the prognostic value of M2BPGi. This single-center retrospective study analyzed patients who underwent surgical resection for primary HCV-related HCC between 2008 and 2018. The study enrolled 81 patients whose M2BPGi could be evaluated after an SVR. The relationship between liver fibrosis-related factors and scores (including M2BPGi) and HCC recurrence, was evaluated. Of the 81 patients, 57 (70.4%) with HCV-related HCC obtained an SVR, whereas 24 patients (29.6%) did not. The patients with an SVR had a significantly more favorable recurrence-free survival (RFS) than the patients with no SVR (P < 0.0001, log-rank). Among the SVR groups, M2BPGi predicted a shorter RFS after hepatic resection with a higher degree of accuracy than other markers and scores in the SVR group. The high-M2BPGi group had worse liver function, RFS, and overall survival (OS) (P = 0.0014 and 0.0006, log-rank, respectively). In the multivariate analysis, high M2BPGi was significantly associated with worse RFS and OS. Even after achievement of an SVR, the risk of HCC recurrence cannot be eliminated. Measurement of M2BPGi after an SVR can be applied for risk stratification in the assessment of patients with HCV-related HCC.


Inflammatory bowel disease and thromboembolic events: a c'lot to learn.
Inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations including arterial and venous thromboembolism. Research evidences that IBD patients have about a 2- to 3-fold increase in the risk of venous thromboembolism when compared with the general population. We intended to evaluate the coagulation parameters and the prevalence of thromboembolic events (TE) in IBD patients. It was also our aim to investigate the correlation between coagulation parameters and disease phenotype and activity in this population. This single center prospective observational study was performed between November 2016 and April 2020. The cohort included patients with 18 years of age or older, diagnosed with IBD and followed at a gastroenterology consultation, during a follow-up period of 36 months. Patients were evaluated in terms of IBD type, extent and disease behavior, clinical scores of IBD activity, medication, smoking history, family and personal history of TE, coagulation parameters, fecal calprotectin levels, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hospitalization due to TE, IBD-related hospitalization or surgery, pregnancy, or diagnosis of malignancy. The study included 149 IBD patients (67 males and 82 females). Coagulation parameters were similar in CD and UC patients and only plasminogen was increased in CD patients [97.4 (17.0) versus 91.6 (13.3), p = 0.035], when comparing with UC patients. The determined values were in the range of the reference values described in literature for the standard population. During the follow-up period, none of the patients experienced a TE that demanded hospitalization. In our study, acquired and inherited risk factors for TE and changes in coagulation parameters did not show to influence prothrombotic predisposition in IBD patients. As such, the clinical relevance of measuring coagulation parameters in this population is questionable. NCT05162339 (ClinicalTrials.gov ID).


Step-and-Repeat Nanoimprint-, Photo- and Laser Lithography from One Customised CNC Machine.
The conversion of a computer numerical control machine into a nanoimprint step-and-repeat tool with additional laser- and photolithography capacity is documented here. All three processes, each demonstrated on a variety of photoresists, are performed successfully and analysed so as to enable the reader to relate their known lithography process(es) to the findings. Using the converted tool, 1 cm(2) of nanopattern may be exposed in 6 s, over 3300 times faster than the electron beam equivalent. Nanoimprint tools are commercially available, but these can cost around 1000 times more than this customised computer numerical control (CNC) machine. The converted equipment facilitates rapid production and large area micro- and nanoscale research on small grants, ultimately enabling faster and more diverse growth in this field of science. In comparison to commercial tools, this converted CNC also boasts capacity to handle larger substrates, temperature control and active force control, up to ten times more curing dose and compactness. Actual devices are fabricated using the machine including an expanded nanotopographic array and microfluidic PDMS Y-channel mixers.


Identification and enumeration of Microcystis using a sandwich hybridization assay.
Based on sequence analyses of phycocyanin intergenic spacers (PC-IGS) from Microcystis, Anabaena, Aphanizomenon, and Planktothrix (Oscillatoria) strains, a genus-specific probe pair TF/TR was designed, and a sandwich hybridization assay was established to quantitatively detect Microcystis. Through BLAST and cyanobacterial culture tests, TF/TR was demonstrated to be specific for Microcystis. A calibration curve for the sandwich hybridization assay was established, and the lowest detected concentration was 100 cell/ml. Laboratory and field samples were analyzed with both sandwich hybridization assay and microscopy. The biotic and abiotic components of the samples were of little disturbance to the sandwich hybridization assay. The results showed no distinct difference between the two methods. In this study, a sandwich hybridization assay was established to detect Microcystis, providing an alternative to traditional microscopic, morphology-based methods.


Novel molecularly imprinted aerogels: Preparation, characterization, and application in selective separation for oleanolic acid in lingonberry.
An oleanolic acid (OA) surface molecularly imprinted polymer silylated porous composite aerogels (OA-MIP@Si-PC-aerogels) adsorbent material was successfully prepared and characterized. The material not only has a great selectivity for the target molecule OA but also has other noteworthy qualities including high stability, excellent repeatability, and a sizable adsorption capacity. via cellulose and sodium alginate as the main materials, the carrier Si-PC-aerogels were made through ionic cross-linking, chemical cross-linking, and silylation procedures. By adopting a surface molecular imprinting approach on Si-PC-aerogels, OA-MIP@Si-PC-aerogels were effectively created utilizing OA as the template molecule and MAA as the functional monomer. Due to the presence of a specific imprinted layer on the aerogel surface, the adsorption capacity of OA-MIP@Si-PC-aerogels for OA could reach 66.20 mg g-1. OA-MIP@Si-PC-aerogels could achieve a 68.86% yield of OA from the extracts of lingonberry (Vaccinium Vitis-Idaea L.). The adsorption capacity remained at 90% after five consecutive adsorption-desorption cycles. HepG2 cells were exposed to OA that was effectively enriched with OA-MIP@Si-PC-aerogels in lingonberry (Vaccinium Vitis-Idaea L.) fruit homogenates. This OA significantly inhibited the growth of HepG2 cells in vitro. It further demonstrated that OA-MIP@Si-PC-aerogels could efficiently target OA enrichment and separation with good recovery.


[Barriers to antenatal women with severe maternal morbidity in Antioquia, Colombia].
This study seeks to describe the barriers to access to antenatal care in women with severe maternal morbidity, treated at a hospital in the city of Medellin, Colombia in 2017. Qualitative, ethnographic study using the ethnonursing approach proposed by Leininger, and Spradley's ethnographic interview. Women with severe maternal morbidity consider that the health system does not guarantee access to health for them and their unborn children. It is concluded that the health system, to which the women included in the study are entitled, is not available, which conditions non-attendance to prenatal care programs.


Effects of Vitamin D Supplementation in Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.
There are some evidence that Vitamin D supplementation may be beneficial for patients with irritable bowel syndrome (IBS). The aim of this study was to evaluate the effects of Vitamin D supplementation on symptoms and quality of life (QOL) in patients with IBS. In a randomized, double-blind, placebo-controlled clinical trial, 116 patients with IBS were supplemented weekly with either a pearl of 50,000 IU Vitamin D or an identical pearl of placebo containing medium chain triglyceride for 6 weeks. Mean age of patients was 42.24 ± 12.26, and 40.06 ± 13.37 in Vitamin D and placebo groups, respectively. Dietary intakes were similar between and within groups. Serum concentration of 25-hydroxy Vitamin D increased significantly from 21.10 ± 5.23 to 36.43 ± 12.34 in the Vitamin D group (P < 0.001), while it was not significantly different before and after the trial in placebo group. The IBS symptoms severity scores (SSSs), disease-specific QOL, and total score were evaluated at weeks 0 and 6. IBS-SSS, IBS-QOL, and the total score were improved significantly more in Vitamin D group in comparison to the placebo group (P < 0.05). This study indicates that Vitamin D therapy can improve the severity of symptoms and QOL in patients with IBS; however, the long-term effects remained to be elucidated. Trial registration at IRCT: IRCT201402234010N11 IRB Number: 116/3976.


Comparison of infection risks and clinical outcomes in patients with and without SARS-CoV-2 lung infection under renin-angiotensin-aldosterone system blockade: Systematic review and meta-analysis.
Angiotensin-converting enzyme-2 (ACE2) is the receptor for SARS-CoV-2. Animal studies suggest that renin-angiotensin-aldosterone system (RAAS) blockers might increase the expression of ACE2 and potentially increase the risk of SARS-CoV-2 infection. The effect of ACE inhibitor (ACEI) treatment on the pneumonia incidence in non-COVID-19 patients (25 studies, 330 780 patients) was associated with a 26% reduction of pneumonia risk (odds ratio [OR]: 0.74, P < .001). Pneumonia-related death cases in ACEI-treated non-COVID-19 patients were reduced by 27% (OR: 0.73, P = .004). However, angiotensin II receptor blockers (ARB) treatment (10 studies, 275 621 non-COVID-19 patients) did not alter pneumonia risk in patients. Pneumonia-related death cases in ARB-treated non-COVID-19 patients was analysed only in 1 study and was significantly reduced (OR, 0.47; 95% confidence interval, 0.30 to 0.72). Results from 11 studies (8.4 million patients) showed that the risk of getting infected with the SARS-CoV-2 virus was reduced by 13% (OR: 0.87, P = .014) in patients treated with ACEI, whereas analysis from 10 studies (8.4 million patients) treated with ARBs showed no effect (OR, 0.92, P = .354). Results from 34 studies in 67 644 COVID-19 patients showed that RAAS blockade reduces all-cause mortality by 24% (OR = 0.76, P = .04). ACEIs reduce the risk of getting infected with the SARS-CoV-2 virus. Blocking the RAAS may decrease all-cause mortality in COVID-19 patients. ACEIs also reduce the risk of non-COVID pneumonia. All-cause mortality due to non-COVID pneumonia is reduced by ACEI and potentially by ARBs.


Effect of Hematocrit and Erythrocyte Density on Intraoperative Blood Loss in Hemophilia A Patients During Total Knee Arthroplasty.
Intraoperative blood loss during total knee arthroplasty in patients with hemophilia varies over a wide range (from 300 to 3000 ml). The reasons have not been clarified yet. We studied the dependence of intraoperative blood loss during total knee arthroplasty in patients with hemophilia A on hematocrit and mean erythrocyte density. Intraoperational blood loss ≥1000 ml was observed in patients with hematocrit <38.5%. In patients with hematocrit >38.5% this parameter depended on the mean erythrocyte density: in patients with increased erythrocyte density, the risk of intraoperational blood loss ≥1000 ml was higher. The increase in erythrocyte density can serve as an indicator of pathological processes, including the processes modulating hemostasis. It can also be assumed that erythrocytes with higher density change blood flow, which affects platelet adhesion to the damaged endothelium. Hematocrit below the threshold level and mean density of erythrocytes above the normal level can be regarded as risk factor for increased intraoperational blood loss.


Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer?
It remains controversial whether video-assisted thoracoscopic surgery (VATS) major pulmonary resection (VMPR) with systematic node dissection (SND) is a feasible approach for clinical N0 and pathological N2 non-small cell lung cancer (cN0-pN2 NSCLC). We compared the clinical outcome of patients who underwent VMPR with SND for cN0-pN2 NSCLC with the outcome of patients who underwent MPR with SND by thoracotomy. We conducted this study to determine the feasibility of VMPR for cN0 and pN2 NSCLC patients and intraoperative node staging by node sampling. Between 1997 and 2006, 770 patients underwent MPR with SND for NSCLC, wherein 450 patients had VMPR and 320 were subjected to open thoracotomy. There were 673 clinical N0 patients. Among them, we retrospectively reviewed 69 patients (10.3%) with cN0-pN2 NSCLC of which the greatest tumor dimension ranged from 20 to 50mm. These patients were divided into two groups: 37 patients under group V, who underwent VMPR, and 32 patients under group T, who underwent MPR by thoracotomy, for cN0-pN2 NSCLC. The majority of the patients underwent postoperative chemotherapy. There were no differences between the two groups regarding preoperative data or the number of nodes dissected. The rate of nodal metastasis (number of metastatic nodes/number of dissected nodes) was similar between the two groups (group V vs group T, 0.24 vs 0.24 in total nodes dissected, 0.24 vs 0.23 in mediastinal nodes dissected). The 3-year and 5-year recurrence-free survivals were similar (60.9% vs 49.6% and 60.9% vs 49.6%), as well. Most of the pattern of recurrence was due to remote metastasis. In like manner, the 3-year and 5-year survivals were similar (67.6% vs 57.7% and 45.4% vs 41.1%). This study demonstrates that VMPR with SND is a feasible surgical therapy for cN0-pN2 NSCLC without loss of curability. It is unnecessary to convert the VATS approach to thoracotomy in order to do SND even if pN2 disease is revealed during VMPR.


It serves you right. Hassle-free health care builds loyalty, volume--and the bottom line.
Zero barriers to care, zero waiting times: Tough as those targets sound, today's stars of customer service are scoring direct hits. "It's not a change in the services that are delivered," says one patient satisfaction pro. "It's a change in the way they're being delivered."


Effect of an integrated maternal health intervention on skilled provider's care for maternal health in remote rural areas of Bangladesh: a pre and post study.
An integrated maternal health intervention in a rural sub district of Bangladesh focused on the training and deployment of a required number of Community Based Skilled Birth Attendants (CSBAs). The aim of the study was to assess the effect of the intervention on use of skilled provider care during pregnancy, delivery and after delivery. The effect compared the skilled providers care in low performing areas with high and medium performing areas through pre-and post-intervention surveys. The post-intervention survey was conducted two years after the completion of the intervention. Village clusters, with populations of approximately 3000, were randomly assigned to the surveys. Mothers who had delivered within the 6 months prior to the surveys, were recruited for the structured interviews. Logistic regression was conducted to compare the effect. Majority of mothers in the low performing areas belonged to a poor economic quintile. The level of skilled attendance for 4+ Antenatal Care (ANC) and delivery increased sharply from baseline to endline survey in low performing areas (ANC: 1.6% to 15.3%, p < 0.0001; skilled birth attendant at delivery: 12.6% to 38.3%, p < 0.0001). Less than 1% of the women received Post Natal Care (PNC) from a skilled provider prior to the intervention, and this proportion increased to 20% at the end of the intervention. Adjusted odds showed that the intervention had an effect on the individual performing area on use of skilled provider care during ANC, delivery and PNC. The increase of 4+ ANC from skilled providers and skilled birth attendants during delivery in the low performing areas due to the integrated maternal health intervention was significant relative to the increase in the high performing areas [4+ ANC from skilled providers - OR: 3.8 (1.9-7.6); skilled birth attendants - OR: 2.8 (2.1-3.8)]. An integrated maternal health care intervention focused on deployment of a required number of CSBAs increased the opportunity for underprivileged women to benefit from skilled providers care during their pregnancy. This integrated intervention might improve the maternal health in developing countries where home delivery with unskilled attendants is common.


Optimization and validation of a high performance liquid chromatography method for the simultaneous determination of vitamins A and E in human serum using monolithic column and diode-array detection.
In this study a novel, simple and rapid reversed-phase high performance liquid chromatography (HPLC) procedure for simultaneous determination of vitamins A and E (retinol and alpha-tocopherol) in blood serum has been developed and validated using monolithic column and diode-array detection (DAD). The monolithic column Chromolith Performance RP-18e (100 mm x 4.6 mm) was operated at ambient temperature. One hundred percent methanol at flow rate 2.5 ml min(-1) was used as a mobile phase. Detection of both compounds was performed with diode-array detector, retinol was monitored at 325 nm and alpha-tocopherol at 295 nm. The linear dependence between peak area and concentration ranged from 0.25 to 10.00 micromol l(-1) for retinol and 0.5-50.0 micromol l(-1) for alpha-tocopherol. The limit of detection (LOD) for retinol was 0.02 micromol l(-1) and limit of quantification (LOQ) was 0.07 micromol l(-1). The limit of detection (LOD) for alpha-tocopherol was 0.1 micromol l(-1) and limit of quantification (LOQ) was 0.3 micromol l(-1). Retinol was eluted in 0.8 min and alpha-tocopherol in 1.4 min. The simultaneous analysis of vitamin A and E can be achieved in less than 2 min. The implementation of monolithic column Chromolith Performance shortens the time of analysis of both vitamins four times in comparison with using traditional particulate column Pecosphere C18 (150 mm x 4.6 mm), 5 microm. This fact may play an important role for routine clinical analysis of biological samples.


Subcellular fractionation of tissue culture cells.
Subcellular fractionation has two major steps, (1) the homogenization of the cells and (2) the subsequent separation of the organelles. The homogenization step is discussed with reference to the problems encountered using tissue culture cells. Promising techniques for the isolation of specific compartments are illustrated using the isolation of the endosomal compartment as the example.


Income inequality not gender inequality positively covaries with female sexualization on social media.
Publicly displayed, sexualized depictions of women have proliferated, enabled by new communication technologies, including the internet and mobile devices. These depictions are often claimed to be outcomes of a culture of gender inequality and female oppression, but, paradoxically, recent rises in sexualization are most notable in societies that have made strong progress toward gender parity. Few empirical tests of the relation between gender inequality and sexualization exist, and there are even fewer tests of alternative hypotheses. We examined aggregate patterns in 68,562 sexualized self-portrait photographs ("sexy selfies") shared publicly on Twitter and Instagram and their association with city-, county-, and cross-national indicators of gender inequality. We then investigated the association between sexy-selfie prevalence and income inequality, positing that sexualization-a marker of high female competition-is greater in environments in which incomes are unequal and people are preoccupied with relative social standing. Among 5,567 US cities and 1,622 US counties, areas with relatively more sexy selfies were more economically unequal but not more gender oppressive. A complementary pattern emerged cross-nationally (113 nations): Income inequality positively covaried with sexy-selfie prevalence, particularly within more developed nations. To externally validate our findings, we investigated and confirmed that economically unequal (but not gender-oppressive) areas in the United States also had greater aggregate sales in goods and services related to female physical appearance enhancement (beauty salons and women's clothing). Here, we provide an empirical understanding of what female sexualization reflects in societies and why it proliferates.


Influence of Oxygen on the Thermal Decomposition Properties of C4F7N-N2-O2 as an Eco-Friendly Gas Insulating Medium.
The C4F7N (fluorinated nitrile) gas mixture has been recognized as the most potential substitute gas to SF6 used in gas-insulated equipment. In this paper, we explored the thermal stability and decomposition properties of the C4F7N-N2-O2 gas mixture. The influence mechanism of oxygen content and temperature on the byproduct generation was obtained and analyzed. It was found that thermal decomposition of the C4F7N-N2-O2 gas mixture mainly produces CO, C3F6, C3F8, CF3CN, (CN)2, and COF2. The addition of oxygen could accelerate the decomposition of C4F7N. The content of C3F6 and (CN)2 decreases, while the yield of CF4, CO, C3F8, and COF2 increases with the oxygen content. Thermal decomposition of the C4F7N-N2-O2 gas mixture at temperatures lower than 425 °C results from the interaction between C4F7N and the metal heating element, while the bond cleavage reactions occur at higher temperature. As for engineering application, the oxygen added in the 6%C4F7N-94%N2 gas mixture should not exceed 6% to avoid the negative effect of oxygen on the thermal stability of C4F7N.


Candida sepsis in surgical patients.
Candidemia in critically ill patients is a significant source of mortality. To identify perioperative risk factors accounting for patient death, we performed a retrospective study of 46 surgical patients with fungemia during the period from 1981 to 1990. Twenty patients survived (43%), and 26 died (57%). Mortality was associated with age older than 46 (p < 0.02, unpaired Student's t-test) and concomitant renal failure, hepatic failure, postoperative shock, or adult respiratory distress syndrome (p < 0.0001, p < 0.0001, and p < 0.05, respectively, chi 2 test). Survival was not influenced by the presence of diabetes, chronic obstructive pulmonary disease, gastrointestinal hemorrhage, pneumonia, alcohol consumption, steroid use, or enteral/parental nutrition. Bacterial speticemia developed in 26 patients (11 lived, 15 died) and typically preceded or was concomitant with the onset of fungal sepsis (88%). Candida albicans was the fungal species most commonly isolated from blood cultures (30 of 46). Its was cultured from other sites in addition to blood in 30 patients. Candidemia carries a higher risk of mortality in older patients and in those with multiple organ dysfunction. Other immunocompromised conditions such as diabetes and steroid use did not increase mortality. These findings suggest that the pathogenicity of Candida sepsis is not solely related to opportunistic superinfections but may reflect failure of other host defense mechanisms. Moreover, the frequent occurrence of bacterial septicemia prior to the development of Candida sepsis further emphasizes the importance of fungal surveillance cultures to detect early fungal colonization in the critically ill.


Pharmacokinetics of gestagens: some problems.
Various approaches to studying the pharmacokinetics of gestagens and the factors that influence derivation of the parameters are described with levonorgestrel used as an example. Published studies of the pharmacokinetics of levonorgestrel are reviewed, and new information is presented regarding intra- and intersubject variation. Differences between various formulations of levonorgestrel are apparent when the formulations are compared in the same subjects. There is also a marked difference in the parameters when derived under single-dose or steady-state conditions. The role of sex hormone-binding globulin in the metabolism of levonorgestrel is questioned. Large intra- and inter-subject variations in the parameters exist, and a subject may show a large month-to-month variation when one levonorgestrel formulation is used and smaller variations when another formulation is used. This wide variability in the pharmacokinetic parameters, problems that arise in the derivation and interpretation of the parameters, the biologic significance of most of these parameters, and their lack of correlation with pharmacodynamic responses severely limit the usefulness of pharmacokinetic studies of the gestagens.


Soft lens extended wear affects epithelial barrier function.
To explore the impact of eye closure and soft contact lens extended wear (SCLEW) on epithelial permeability to fluorescein (Pdc). A prospective cohort study. Thirty-one noncontact lens (CL) wearers participated. The effects of eye closure on Pdc were evaluated by comparing morning (AM) and afternoon (PM) measurements on non-CL subjects. The effects of SCLEW on Pdc were determined by measuring Pdc before beginning SCLEW and then after 2, 4, and 12 weeks of SCLEW. Pdc measured in the morning versus the afternoon and before versus after SCLEW was examined. Analyses of Pdc were done using the natural logarithm (ln). The mean +/- standard error (SE) ln(Pdc) measured in the AM versus PM on 16 non-CL wearers did not differ significantly (-2.56+/-0.16 vs. -2.69+/-0.15, respectively; P = 0.46). In contrast, the mean +/- SE ln(Pdc) in 15 subjects after 2 (-1.73+/-0.183, P < 0.001), 4 (- 1.59+/-0.188, P < 0.001), and 12 weeks (-1.99+/-0.206, P = 0.02) of SCLEW was substantially greater than that measured before lens wear (-2.42+/-0.159 ln(nm/sec)). Interestingly, the mean+/-SE ln(Pdc) measured in the afternoon on seven subjects after 13 weeks of SCLEW was similar to their average baseline ln(Pdc) (-2.62+/-0.27 vs. -2.52+/-0.243, respectively; P = 0.54). Further analysis showed that Pdc was highest in the morning and decreased approximately 12.5%/hour (P < 0.001) during the day. Sleeping without CLs does not appear to alter Pdc; however, 2 weeks of SCLEW caused a 99% increase in permeability without observable changes by slit-lamp examination. Increases in Pdc appear greatest in the morning after SCLEW and then decrease exponentially during the day. Whether changes in Pdc will predict CL-associated keratopathy needs further study.


Getting effective intervention to individuals exposed to traumatic stress: Dosage, delivery, packaging, and profiles.
There is strong evidence for the efficacy of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD). However, treatment non-completion remains a considerable problem. Of concern with a high dropout rate is that Holmes et al. (2019) found that clients who attended more sessions improved at a greater rate and clients who completed all 12 sessions had the best outcomes. In addition to dropping out of treatment, there are a number of issues related to getting effective intervention to those exposed to traumatic stress. This commentary will discuss dosage and early treatment responders, delivery and packaging, and the need to go beyond diagnosis to build from the findings of Holmes et al. to foster the delivery of effective treatment.


Absolute configuration reassignment of nectamazin A: Implications to related neolignans.
The ability of nature to produce structurally complex molecules makes the determination of the absolute configuration of natural products a challenging task. Although extensive NMR analysis generally allows for the reliable assignment of relative configurations, the assignments of absolute stereochemistry are commonly performed by empirical comparisons of optical rotation (OR) and/or electronic circular dichroism (ECD) data obtained for related molecules. Such an approach, however, may lead to misassignments and consequent error propagations. Herein, we present the case of the bicyclo(3.2.1)octane neolignan named (+)-nectamazin A. This compound was first reported in 2009 from Nectandra amazonum Nees. (Lauraceae) and had its absolute configuration determined as 7R,8S,3'S,4'R,5'S by means of experimental ECD spectroscopy. Our chemical studies on Ocotea aciphylla (Lauraceae) led to the isolation of (+)-nectamazin A. The extensive analysis of OR, ECD, and vibrational CD data aided by quantum chemical calculations, however, indicated (+)-nectamazin A to have the 7S,8R,3'R,4'S,5'R absolute configuration, in conflict with the configuration reported in the literature. The cause of the original incorrect assignment of (+)-nectamazin A derives from the direct comparison of experimental OR and ECD data obtained for structurally related molecules with different chromophoric systems. As an alternative, VCD spectroscopy is presented as a more reliable and sensitive technique to stereochemical investigations of bicyclo(3.2.1)octane neolignans.


Depression, anxiety, and performance status among the women with metastatic breast cancer receiving palliative care in Bangladesh: A cross sectional study.
Advanced breast cancer patients suffer from various psychological issues including depression and anxiety. This study aims to explore these psychological issues and their relationship with the performance status. This cross-sectional study was conducted among 95 patients with metastatic breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire along with Hospital Depression and Anxiety Scale. The performance status of the patients was determined by the Eastern Cooperative Oncology Group (ECOG) performance scale. The association between different variables were assessed by χ 2 test and Fisher Exact test. Mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), muslim (92.6%) and homemakers (82.1%). More than half (52.6%) of the patients were evaluated having ECOG performance status grade II. Four out of ten (44.2%) patients had moderate to severely anxiety, and almost one-third (36.9%) patients were suffering from moderate to severe depression. The patients with high educational status were found to have less depression. In addition, patients faring better on ECOG performance scale (Grade 0 to I) had significantly (p < 0.05) less depression and anxiety. Depression and anxiety are one of the major psychological sufferings among the women with metastatic breast cancers. All women suffering from breast cancer should be routinely screened and assessed for phychological distress and ensure early intervention.


Development and Characterization of Natural Chromite Coating on Metal Substrate Using the Plasma Spray Process.
Natural materials are gaining interest as coating feedstock because their "quality to cost" ratio is better and they are more environmentally friendly than most of the synthetic ceramics. They give sufficient protection to metal surfaces against harsh conditions such as corrosion, wear, and high temperature. In the current study, chromite mineral was beneficiated and reduced to two different sizes to be used as feedstock material for thermal spray coating. Powders were upgraded by gravity and magnetic separation, respectively, and thermally sprayed onto mild steel samples by using atmospheric plasma spray (APS) equipment. Morphology, structure, phases, elemental distribution of chromite powder, and coatings were studied using field emission scanning electron microscopy, X-ray diffraction, X-ray fluorescence spectroscopy, and energy-dispersive X-ray spectroscopy. Tribological properties of APS chromite coatings were investigated by using a ball-on-disk tribometer, and corrosion resistance properties were evaluated by carrying out potentiodynamic polarization testing in 3.5% NaCl solution. It is observed that the coating has better wear and corrosion resistance and is worn by abrasive wear that includes scratching and particles pull out. Coating efficiency, surface morphology, and microhardness of the coating developed by fine powder were better than those of coarse powder coating.


Laser in situ keratomileusis for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser.
To evaluate the safety, efficacy, predictability, and visual results of laser in situ keratomileusis (LASIK) using the Bausch & Lomb Technolas(R) 217 scanning-spot laser for the treatment of myopia and compound myopic astigmatism. Stanford Eye Laser Center, Stanford, California, USA. In a prospective study, 110 eyes of 58 patients with a mean spherical equivalent (SE) of -4.87 diopters (D) +/- 2.5 (SD) (range -1.0 to -11.4 D) had LASIK for myopia and compound myopic astigmatism using the Technolas 217 scanning-spot laser. The primary outcome variables included preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), achieved versus attempted correction, vector analysis of astigmatism, and complications. One hundred ten eyes were available for analysis at 3 months. The mean SE refraction was reduced 95% (mean -0.23 +/- 0.4 D), and astigmatism was reduced 70% (mean 0.28 +/- 0.3 D). One day postoperatively, 100% of eyes had a UCVA of 20/40 or better, 96% had 20/25 or better, 77% had 20/20 or better, and 39% had 20/15 or better. At the 3-month examination, 100% of eyes had a UCVA of 20/40 or better, 95% had 20/25 or better, 83% had 20/20 or better, and 48% had 20/15 or better. Ninety percent of eyes were within +/-0.5 D of emmetropia. No eye lost 2 or more lines of BSCVA. The Technolas 217 scanning-spot laser produced excellent postoperative UCVA and BSCVA. It was predictable, safe, and effective for the treatment of myopia and compound myopic astigmatism. Long-term follow-up is needed to assess the stability of the procedure.


Assessment of Facial Morphologic Features in Patients With Congenital Adrenal Hyperplasia Using Deep Learning.
Congenital adrenal hyperplasia (CAH) is the most common primary adrenal insufficiency in children, involving excess androgens secondary to disrupted steroidogenesis as early as the seventh gestational week of life. Although structural brain abnormalities are seen in CAH, little is known about facial morphology. To investigate differences in facial morphologic features between patients with CAH and control individuals with use of machine learning. This cross-sectional study was performed at a pediatric tertiary center in Southern California, from November 2017 to December 2019. Patients younger than 30 years with a biochemical diagnosis of classical CAH due to 21-hydroxylase deficiency and otherwise healthy controls were recruited from the clinic, and face images were acquired. Additional controls were selected from public face image data sets. The main outcome was prediction of CAH, as performed by machine learning (linear discriminant analysis, random forests, deep neural networks). Handcrafted features and learned representations were studied for CAH score prediction, and deformation analysis of facial landmarks and regionwise analyses were performed. A 6-fold cross-validation strategy was used to avoid overfitting and bias. The study included 102 patients with CAH (62 [60.8%] female; mean [SD] age, 11.6 [7.1] years) and 59 controls (30 [50.8%] female; mean [SD] age, 9.0 [5.2] years) from the clinic and 85 controls (48 [60%] female; age, <29 years) from face databases. With use of deep neural networks, a mean (SD) AUC of 92% (3%) was found for accurately predicting CAH over 6 folds. With use of classical machine learning and handcrafted facial features, mean (SD) AUCs of 86% (5%) in linear discriminant analysis and 83% (3%) in random forests were obtained for predicting CAH over 6 folds. There was a deviation of facial features between groups using deformation fields generated from facial landmark templates. Regionwise analysis and class activation maps (deep learning of regions) revealed that the nose and upper face were most contributory (mean [SD] AUC: 69% [17%] and 71% [13%], respectively). The findings suggest that facial morphologic features in patients with CAH is distinct and that deep learning can discover subtle facial features to predict CAH. Longitudinal study of facial morphology as a phenotypic biomarker may help expand understanding of adverse lifespan outcomes for patients with CAH.


Modulation of GITR for cancer immunotherapy.
Modulation of co-inhibitory and co-stimulatory receptors of the immune system has become a promising new approach for immunotherapy of cancer. With the recent FDA approval of CTLA-4 blockade serving as an important proof of principal, many new targets are now being translated into the clinic. Preclinical research has demonstrated that targeting glucocorticoid-induced tumor necrosis factor (TNF) receptor related gene (GITR), a member of TNF receptor superfamily, by agonist antibodies or natural ligand, can serve as an effective anti-tumor therapy. In this review, we will cover this research and the rationale that has led to initiation of two phase 1 clinical trials targeting GITR as a new immunotherapeutic approach for cancer.


Effects of melatonin on lipid peroxidation and anti-oxidant enzyme activity in rats with experimentally induced hyperthyroidism.
1. The present study was designed to investigate the effects of high-dose melatonin on lipid peroxidation and anti-oxidant enzyme activity in rats with experimentally induced hyperthyroidism. 2. Twenty-four albino male rats, weighing 240-260 g, were randomly allotted into one of three experimental groups (control, hyperthyroid and hyperthyroid + melatonin treatment), with each group containing eight animals. Hyperthyroidism was induced by a daily with i.p. injection of 200 microg l-thyroxine for 30 days. In addition to l-thyroxin treatment, rats in the hyperthyroid + melatonin treatment group were also given daily i.p. injections of 10 mg/kg melatonin on the last 10 days of l-thyroxine treatment. Control animals received injections of an equivalent volume of saline solution. Rats received the last injection 24 h before being killed. 3. At the end of the experiment, rats in all three groups were fasted for 12 h and killed by cardiac puncture under ether anaesthesia. Blood samples were taken for the determination of malondialdehyde (MDA), glutathione (GSH) and superoxide dismutase (SOD) levels and concentrations of tri-iodothyronine (T(3)) and thyroxine (T(4)). 4. It was found that MDA and SOD levels and concentrations of T(3) and T(4) were higher and the GSH level was lower in rats with hyperthyroidism compared with controls. Melatonin treatment decreased the elevated MDA and SOD levels and increased the lowered GSH level to control levels in rats with hyperthyroidism, but did not ameliorate the concentrations of T(3) and T(4). 5. It was concluded that high-dose melatonin treatment may decrease the hyperthyroidism-induced disturbances of lipid peroxidation and anti-oxidant enzyme activity and oxidative damage.


Clonal relationship between human and avian ciprofloxacin-resistant Escherichia coli isolates in North-Eastern Algeria.
The objectives of this study were to determine rates, patterns, and mechanisms of antibiotic resistance, and to assess connections between chicken commensal, human commensal, and pathogenic ciprofloxacin-resistant Escherichia coli isolates. All E. coli isolates collected from chickens, their farmers, and patients in the Constantine region (North-east Algeria) were analyzed for bla and plasmid-mediated quinolone resistance (PMQR) gene contents, phylogroups, Rep-PCR profiles, and multilocus sequence types. A high prevalence of resistance to fluoroquinolones (51.4 % to ciprofloxacin) was recorded in avian isolates. Of these, 22.2 % carried the aac(6')-Ib-cr gene, whereas lower resistance levels to these antibiotics were recorded in chicken farmers' isolates. None of the commensal isolates harbored the qnr, qepA, or oqxAB genes. One human pathogenic isolate was ertapenem-resistant and harbored the bla OXA-48 gene, 84 showed an extended-spectrum β-lactamase phenotype, with bla CTX-M-15 gene prevalent in 87.2 % of them. Seventy isolates were resistant to fluoroquinolones, with aac(6')-Ib-cr present in 72.8 %, qnrB in 5.7 %, and qnrS in 10 %. Three Rep-PCR profiles were common to chicken commensal and human pathogenic isolates (phylogroups D and B1; ST21, ST48, and ST471 respectively); one was found in both chicken and chicken-farmer commensal strains (D; ST108), while another profile was identified in a chicken-farmer commensal strain and a human pathogenic one (B1; ST19). These findings suggest clonal and epidemiologic links between chicken and human ciprofloxacin-resistant E. coli isolates and the important role that poultry may play in the epidemiology of human E. coli infections in the Constantine region.


Gamma oscillations by synaptic inhibition in a homogeneous medium model of hippocampal interneurons.
Population of interacting inhibitory hippocampal neurons is described by a continuous model. The explicit equation for the frequency of synchronized neural firing and the condition for its stability are obtained. The results of their numerical solution are in quantitative agreement with the data of Wang and Buzsáki, 1996 (J. Neurosci. 16, 6402-6413).


Postoperative permanent pressure alopecia.
A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.


Serum thrombopoietin levels in relation to disease status in patients with immune thrombocytopenic purpura.
Pre- and post-treatment serum thrombopoietin (TPO) concentration was measured in 35 patients with immune thrombocytopenic purpura (ITP). Mean post-treatment levels were significantly lower (P = 0.02) than pretreatment and not different for treatment modality. No significant correlation between pre- or post-treatment TPO and platelet counts was demonstrable (R = -0.325, P = 0.056 and R = -0.227, P = 0.190 respectively). In patients with very low platelet counts (< or =20 x 10(9)/l), pretreatment serum TPO was significantly higher than in patients with higher counts (P = 0.033). The logarithm of the platelet turnover rate, measured in 15 patients, correlated with pretreatment TPO levels (R = 0.64). These findings suggest a contributory role for TPO in the mechanism of ITP.


CRISPR-mediated Ophthalmic Genome Surgery.
Clustered regularly interspaced short palindromic repeats (CRISPR) is a genome engineering system with great potential for clinical applications due to its versatility and programmability. This review highlights the development and use of CRISPR-mediated ophthalmic genome surgery in recent years. Diverse CRISPR techniques are in development to target a wide array of ophthalmic conditions, including inherited and acquired conditions. Preclinical disease modeling and recent successes in gene editing suggest potential efficacy of CRISPR as a therapeutic for inherited conditions. In particular, the treatment of Leber congenital amaurosis with CRISPR-mediated genome surgery is expected to reach clinical trials in the near future. Treatment options for inherited retinal dystrophies are currently limited. CRISPR-mediated genome surgery methods may be able to address this unmet need in the future.


QTL analysis of ergot resistance in sorghum.
Sorghum ergot, caused predominantly by Claviceps africana Frederickson, Mantle, de Milliano, is a significant threat to the sorghum industry worldwide. The objectives of this study were firstly, to identify molecular markers linked to ergot resistance and to two pollen traits, pollen quantity (PQ) and pollen viability (PV), and secondly, to assess the relationship between the two pollen traits and ergot resistance in sorghum. A genetic linkage map of sorghum RIL population R931945-2-2 x IS 8525 (resistance source) was constructed using 303 markers including 36 SSR, 117 AFLP , 148 DArT and two morphological trait loci. Composite interval mapping identified nine, five, and four QTL linked to molecular markers for percentage ergot infection (PCERGOT), PQ and PV, respectively, at a LOD >2.0. Co-location/linkage of QTL were identified on four chromosomes while other QTL for the three traits mapped independently, indicating that both pollen and non pollen-based mechanisms of ergot resistance were operating in this sorghum population. Of the nine QTL identified for PCERGOT, five were identified using the overall data set while four were specific to the group data sets defined by temperature and humidity. QTL identified on SBI-02 and SBI-06 were further validated in additional populations. This is the first report of QTL associated with ergot resistance in sorghum. The markers reported herein could be used for marker-assisted selection for this important disease of sorghum.


Elective coronary stent implantation in cardiogenic shock complicating acute myocardial infarction: in-hospital and six-month clinical and angiographic results.
Effective treatment of patients with acute myocardial infarction and cardiogenic shock depends on restoring persistent patency of the infarct-related artery. Coronary stenting, reducing abrupt or delayed closure related to dissection and suboptimal result, may improve PTCA results in cardiogenic shock. Eighteen patients (14 males and 4 females, mean age 59 +/- 7 years), referred to catheterization laboratory for acute myocardial infarction and shock, had elective stent implantation during 14 primary and 4 rescue PTCA. Time delay between shock onset and PTCA was 4.1 +/- 3 hr (range, 30 min to 12 hr). The IRA was LAD in seven patients (38%), LCx in two (11%), and RCA in eight (45%). One patient (5.%) had distal LMCA occlusion. Stent deployment was successful in 100% of patients and resulted in TIMI 3 flow in 13 (72%) patients. In 13 (72%) cases, cardiogenic shock gradually resolved and the patients were discharged alive. Five patients (28%) died because of irreversible hemodynamic deterioration without evidence of reinfarction. At 6-month follow-up, all the discharged patients were alive and no patient had reinfarction or recurrent angina. Heart transplant was required in one patient 5 months after stenting because of refractory congestive heart failure. Angiography demonstrated patency of all the coronary arteries treated, with TIMI 3 flow in all patients. Stent restenosis rate was 30%, and target lesion revascularization with CABG or re-PTCA was not required in any case. LV function improved from 39% +/- 15% to 51% +/- 15% (P < 0.01). Elective coronary stenting is an effective treatment for acute myocardial infarction complicated by cardiogenic shock and may improve acute and long-term survival.


'Real-motion' cells in visual area V2 of behaving macaque monkeys.
Extracellular recordings were made in area V2 of behaving macaque monkeys. Neurons were classified into three groups: non-oriented cells, oriented cells with antagonistic areas and oriented cells without antagonistic areas in their receptive field. All neurons were tested with standard visual stimulations in order to assess whether they gave different responses to the movement of a stimulus and to the movement of its retinal image alone, when the stimulus was motionless and the animal voluntarily moved its eyes. To do this, neuronal responses obtained when a moving stimulus swept a stationary receptive field (during steady fixation) and when a moving receptive field swept a stationary stimulus (during tracking eye movements), were compared. The receptive field stimulation at retinal level was physically the same in both cases, but only in the first was there actual movement of the visual stimulus. Control trials, where the monkeys performed tracking eye movements without any intentional receptive field stimulation, were also carried out. Out of a total of 263 neurons isolated in the central 10 deg representation of area V2, 101 were fully studied with the visual stimulation described above. Most of these (83/101; 82%) gave about the same response to the two situations. About 14% (14/101) gave a good response to stimulus movements during steady fixation and a very weak one to retinal image displacements of stationary stimuli during visual tracking. We have called neurons of this type "real-motion cells" (cf. Galletti et al. 1984). None of the non-oriented cells was a real-motion one, while about an equal percentage of real-motion cells was found among the oriented cells with and without antagonistic areas. Finally, we found only 4 neurons which showed behaviour opposite to that of real-motion cells, i.e. they showed a better response to displacement of the retinal image of stationary stimuli than to actual movement of stimuli. We suggest that real-motion cells might contribute to correctly evaluating movement in the visual field in spite of eye movements and that they might allow recognition of the movement of an object even if it moves across a non-patterned visual background. Present data on area V2, together with similar results observed in area V1 (Galletti et al. 1984; Battaglini et al. 1986), support the view that these two cortical areas analyse the movement in a parallel fashion along with many other characteristics of the visual stimulus.


Facile synthesis of pH-responsive sodium alginate/carboxymethyl chitosan hydrogel beads promoted by hydrogen bond.
In this work, a novel synthesis strategy of sodium alginate/carboxymethyl chitosan hydrogel beads promoted by hydrogen bond was described. The beads were prepared by dropping the blends of two polymers into the citric acid solution. Besides hydrogen bonding, electrostatic interactions were also involved in the formation of the hydrogel beads. The thermal stability experiments revealed that the more the content of carboxymethyl chitosan, the better the thermal stability of the beads. The beads exhibited excellent pH sensitivity, pH reversibility, and lactoferrin loading capacity. The swelling ratio of the bead and its protein releasing profile was pH-dependent, which could prevent premature protein release in the gastric environment. Also, the circular dichroism results demonstrated that lactoferrin could maintain its structure during the loading and releasing process. The obtained results revealed that the hydrogel beads prepared in this work could be used as a potential protein carrier for oral delivery.


Tnpo3 controls splicing of the pre-mRNA encoding the canonical TCR α chain of iNKT cells.
Unconventional T cells, such as innate natural killer T cells (iNKT) cells, are an important part of vertebrate immune defences. iNKT recognise glycolipids through a T cell receptor (TCR) that is composed of a semi-invariant TCR α chain, paired with a restricted set of TCR β chains. Here, we show that splicing of the cognate Trav11-Traj18-Trac pre-mRNA encoding the characteristic Vα14Jα18 variable region of this semi-invariant TCR depends on the presence of Tnpo3. The Tnpo3 gene encodes a nuclear transporter of the β-karyopherin family whose cargo includes various splice regulators. The block of iNKT cell development in the absence of Tnpo3 can be overcome by transgenic provision of a rearranged Trav11-Traj18-Trac cDNA, indicating that Tnpo3 deficiency does not interfere with the development of iNKT cells per se. Our study thus identifies a role for Tnpo3 in regulating the splicing of the pre-mRNA encoding the cognate TCRα chain of iNKT cells.


Chronic infections and atherosclerosis/thrombosis.
An emerging pathophysiologic paradigm implicates chronic inflammation in the initiation, progression, and destabilization of atherosclerotic vascular disease. Various potential contributors to the inflammatory response in the vessel wall include atherogenic lipids, mechanical stress and injury, hypertension and angiotensin II, cigarette smoking, immune response to neoantigens, and chronic infections with viruses and or bacteria (Table 1). The potential link between chronic infection and atherosclerosis/thrombosis is under extensive investigation in several laboratories around the world. Although indirect evidence and experimental data tend to support this link, definitive proof is still lacking. If such a link is eventually proven to be causal in nature, it will provide a novel target for preventive and therapeutic strategies (anti-infective drugs, vaccines, etc.) against a common disease that is the leading killer of people in Western nations. Results of ongoing, large-scale clinical trials are eagerly awaited.


Prediction of non-sentinel lymph node metastasis in early breast cancer by assessing total tumoral load in the sentinel lymph node by molecular assay.
The one-step nucleic acid amplification (OSNA) is a molecular procedure that yields a semiquantitative result for detection of nodal metastasis. Size of metastasis in the sentinel lymph node (SLN) by conventional histology has been described as a predictive factor for additional axillary metastasis. The objective of this study is to quantify intraoperatively the total tumoral load (TTL) in the positive SLNs assessed by OSNA and to determine whether this TTL predicts non-SLN metastasis in patients with clinically node negative early stage breast cancer. 306 patients with cT1-3N0 invasive breast cancer who had undergone intraoperative SLN evaluation by OSNA were included. TTL was defined as the addition of CK19 mRNA copies of each positive SLN (copies/μL). TTL was a predictive factor of additional non-SLN metastasis in the complete axillary lymph node dissection (cALND) (OR, 1.67; 95% CI, 1.18-2.35). In the multivariate analysis, the TTL was a predictor of non-SLN metastasis in HR positive patients (OR, 1.69; 95% CI, 1.19-2.41). In our cohort of patients, with a TTL ≤1.2 × 10(5) copies/μL, there was a specificity of 85.3% and negative predictive value (NPV) of 80%. If we consider only the HR positive patients, with a TTL ≤5 × 10(5) copies/μL there was a specificity of 86.7% and NPV of 83.7%. TTL assessed by OSNA assay predicts for additional non-SLN metastasis and this intraoperative tool can help guiding decisions on performing a cALND in breast cancer patients.


Paddy soil geochemistry, uptake of trace elements by rice grains (Oryza sativa) and resulting health risks in the Mekong River Delta, Vietnam.
Soil geochemistry and phytoavailable trace elements were investigated in 80 paddy soil samples and corresponding rice grains from the Mekong River Delta in Vietnam. Soil parameters like Fe-, Al-, and Mn-phases, organic matter, and pH-value determine element concentrations in soil and affect their transfer into rice grains. Arsenic exceeded the allowed limit for Vietnamese agricultural soils in 11% of the samples, presumably caused by natural processes. Lead surpassed the limit in one soil sample. Other toxic elements were close to their natural concentrations and far below allowable limits for agricultural soil. There was no clear correlation of trace element concentrations in soils with those in corresponding grains, even if the different soil parameters and the large pH-range between 3.7 and 6.8 were considered. To assess health risks of critical elements in rice, the thresholds of tolerable upper intake level for total food and drinking water (UL) and of permissible maximum concentration (MC) for rice grains were evaluated. Surprisingly, rice grains grown on non- or low-polluted soils can surpass the upper limits. According to the UL concept, 12% of the grains exceeded the UL of As, 29% that of Cd, and 27% that of Pb for each gender. According to the MC concept, 5% of the rice grains exceeded the MC of inorganic As for adults and 38% that for young children. 24% of the grains surpassed the MC of Pb, while Cd in all grains was below the MC. The differing results of the UL and MC approaches show an urgent need for revision and harmonization concerning As, Cd, and Pb limits, especially regarding countries with high rice consumption.


Supraventricular tachycardia in infants, children and adolescents: diagnosis, and pharmacological and interventional therapy.
Supraventricular tachycardia is the most frequent form of symptomatic tachydysrhythmia in children. Neonates and infants with paroxysmal supraventricular tachycardias generally present with signs of acute congestive heart failure. In school-aged children and adolescents, palpitations are the leading symptom. Chronic-permanent tachycardia results in a secondary form of dilated cardiomyopathy. Therapy for episodes of tachycardia depends on the individual situation. In severe haemodynamic compromise, or if ventricular tachycardia is suspected, tachycardia should immediately be terminated by external cardioversion during deep sedation. Vagal manoeuvres are effective in patients with atrioventricular reentrant tachycardias. Adenosine is the drug of first choice in any age group for tachycardias involving the atrioventricular node; its advantages include short half-life and minimal or absent negative inotropic effects. Adenosine may also be used in patients with wide QRS complex tachycardia. Intravenous verapamil is contraindicated in neonates and infants because of the high risk of electromechanical dissociation. In older children (>5 years) and adolescents, verapamil may be administered with the same restrictions as in adult patients (wide QRS complex tachycardia, significant haemodynamic compromise). Spontaneous cessation of tachycardia can be expected in most neonates and infants during the first year of life. Prophylactic pharmacological treatment in this age group is advisable because recognition of tachycardia is often delayed until the occurrence of symptoms. Withdrawal of drug treatment should be attempted around the end of the first year. However, in older children, spontaneous cessation of tachycardia is rare. Prophylactic drug therapy is performed on an empirical basis. Digoxin may be administered in all forms of supraventricular tachycardia in which the atrioventricular node is involved, except in patients with pre-excitation syndrome aged >1 year. In patients with atrioventricular reentrant tachycardia, class IC drugs such as flecainide and propafenone are effective. Sotalol is also effective in atrioventricular reentrant tachycardia, as well as in primary atrial tachycardia. Although amiodarone has the highest antiarrhythmic potential, it should be used with caution because of its high rate of adverse effects. In school-aged children and adolescents, radiofrequency catheter ablation of the anatomical substrate is an attractive alternative to drug therapy, with a rate of permanent cessation of the tachycardia of up to 90%. Despite the clear advantages of this procedure, it should be performed only with unquestionable indication; the long term morphological and electrophysiological sequelae on the growing atrial and ventricular myocardium are still unknown.


Association of Antidepressants With Recurrent, Injurious and Unexplained Falls is Not Explained by Reduced Gait Speed.
To examine if antidepressants at baseline are associated with falls and syncope over 4 years follow-up and if any observed associations are explained by baseline gait speed. Longitudinal study (three waves). The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study. Two thousand ninety-three community-dwelling adults aged ≥60 years. Antidepressants (ATC code "N06A") were identified. Recurrent falls (≥2 falls), injurious falls (requiring medical attention), unexplained falls, and syncope were reported at either Wave 2 or 3. Usual gait speed was the mean of two walks on a 4.88 m GAITRite walkway. Poisson regression analysis was used to examine associations between baseline antidepressant use and future falls adjusting for sociodemographics, physical, cognitive and mental health, and finally, gait speed. Compared to non-antidepressant users, those on antidepressants at baseline were more likely to report all types of falls (24.8-40.7% versus 9.8-18%) at follow-up. Antidepressants at baseline were independently associated with injurious falls (incidence risk ratio: 1.58, 95% confidence interval: 1.21, 2.06, z = 3.38, p = 0.001, df = 32) and unexplained falls (incidence risk ratio: 1.49, 95% confidence interval: 1.04, 2.15, z = 2.17, p = 0.030, df = 32) independent of all covariates including gait speed. There was little evidence to support the hypothesis that gait would (partly) explain any observed associations between baseline use of antidepressants and future falls. The underlying mechanisms of the observed relationships may be related to depression, vascular pathology, or direct effects of antidepressants. Clinicians should identify the best treatment option for an individual based on existing risk factors for outcomes such as falls.


Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project.
The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.


Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience.
The Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device. We collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated. The 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA. Percutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.


Perceived skin tone discrimination and psychotic experiences among Black Americans: Findings from the National Survey of American Life.
Black Americans face significant discrimination, which has been linked to risk for psychotic experiences. However, fewer studies have examined whether perceived skin tone discrimination is associated with psychotic experiences. Drawing data from the National Survey of American Life (NSAL), we used multivariable logistic regression to examine the associations between perceived skin tone discrimination (from Blacks and Whites) and psychotic experiences, adjusting for sociodemographic covariates, common mental disorders, and major discriminatory events. In bivariate regression models, a one-unit increase in frequency of perceived skin tone discrimination from Blacks was associated with a 24% increase in odds of having any lifetime psychotic experience (AOR: 1.24; 95% CI: 1.11-1.38). A one-unit increase in frequency of perceived skin tone discrimination from Whites was associated with an 18% increase in odds of having any lifetime psychotic experience (AOR: 1.18; 95% CI: 1.03-1.34). When examining perceived skin tone discrimination from Blacks and Whites in the same models, only perceived skin tone discrimination from Blacks was significantly associated with lifetime psychotic experiences, adjusting for sociodemographic characteristics, common metal disorders, and major discriminatory events. Perceived skin tone discrimination was associated with lifetime hallucinatory experiences, but not lifetime delusional ideation. A significant portion of the Black population reported skin tone discrimination from Blacks and Whites, which is related to lifetime psychotic experiences. Future longitudinal and qualitative studies can elaborate on these findings and further contextualize skin tone discrimination and its health effects.


Coexisting Extra-Medullary Manifestation of Chronic Myelomonocytic Leukemia and Follicular Lymphoma: What's Between Neoplastic Follicles Matters.
We illustrate a rare case of coexisting extramedullary manifestation of CMML and new onset follicular lymphoma within the same core-needle biopsy of a lymph node. We discuss the differences between extramedullary hematopoiesis and extramedullary manifestation of myeloid neoplasms. We also highlight the importance of generous tissue sampling and thorough examination of nodal tissue in the setting of an established myeloid neoplasm to avoid missing rare but possible nodal involvement.


Ex vivo dissection increases lymph node yield in oesophagogastric cancer.
Retrieval and analysis of an adequate number of lymph nodes is critical for accurate staging of oesophageal and gastric cancer. Higher total node counts reported by pathologists are associated with improved survival. A prospective study was undertaken to understand the factors contributing to variability in lymph node counts after oesophagogastric cancer resections and to determine whether a novel strategy of ex vivo dissection of resected specimens into nodal stations improves node counts reported by pathologists. The study involved 88 patients with potentially curable oesophagogastric cancer undergoing radical resection. Lymph node counts were obtained from pathology reports and analysed in relation to multiple variables including the introduction of ex vivo dissection of nodal stations in theatre. Higher lymph node counts were obtained with ex vivo dissection of nodal stations (median 19 versus 8, P < 0.01). Node counts also varied significantly with the reporting pathologist (median range 4 to 48, P = 0.02) which was independent of the level of experience of the pathologist (P = 0.67). Node counts were not affected by patient age (P = 0.26), gender (P = 0.50), operative approach (P = 0.50) or neoadjuvant therapy (P = 0.83). Specimen handling is a significant factor in determining lymph node yield following radical oesophageal and gastric cancer resections. Ex vivo dissection of resected specimens into nodal stations improves node counts without alterations to surgical techniques. Ex vivo dissection should be considered routine.


Subtotal Resection for the Symptom Relief of a Fatal and Aggressive Primary Cardiac Liposarcoma: A Case Report.
Primary cardiac liposarcoma is a rare malignant soft tissue lesion, but there are still no diagnosis and treatment guidelines for this disease. This is the case report of a 59-year-old male with cardiac liposarcoma infiltrating the mitral valve and the left atrium. He achieved satisfactory symptom relief with subtotal resection.


Low serum insulin-like growth factor-I (IGF-I) level is associated with increased risk of vascular dementia.
Insulin-like growth factor-I (IGF-I) is important for the adult brain, but little is known of the role of IGF-I in Alzheimeŕs disease (AD) or vascular dementia (VaD). A prospective study of 342 patients with subjective or objective mild cognitive impairment recruited at a single memory clinic. We determined whether serum IGF-I concentrations at baseline were associated with the risk of all-cause dementia, AD, or VaD. Patients developing mixed forms of AD and VaD were defined as suffering from VaD. The statistical analyses included Cox proportional hazards regression analysis. During the follow-up (mean 3.6 years), 95 (28%) of the patients developed all-cause dementia [AD, n=37 (11%) and VaD, n=42 (12%)]. Low as well as high serum IGF-I (quartile 1 or 4 vs. quartiles 2-3) did not associate with all-cause dementia [crude hazard ratio (HR) 1.30, 95% confidence interval (CI): 0.81-2.08 and crude HR 1.05, 95% CI: 0.63-1.75, respectively] or AD (crude HR 0.79, 95% CI: 0.35-1.79 and crude HR 0.94, 95% CI: 0.43-2.06, respectively]. In contrast, low serum IGF-I concentrations were associated with increased risk of VaD (quartile 1 vs. quartiles 2-3, crude HR 2.22, 95% CI: 1.13-4.36). The latter association remained significant also after adjustment for multiple covariates. In a memory clinic population, low serum IGF-I was a risk marker for subsequent VaD whereas low IGF-I did not associate with the risk of AD. High serum IGF-I was not related to the risk of conversion to dementia.