Deep Learning in Structure-Based Drug Design.
Computational methods play an increasingly important role in drug discovery. Structure-based drug design (SBDD), in particular, includes techniques that take into account the structure of the macromolecular target to predict compounds that are likely to establish optimal interactions with the binding site. The current interest in machine learning algorithms based on deep neural networks encouraged the application of deep learning to SBDD related problems. This chapter covers selected works in this active area of research.


Nonobstructive Diffuse Dilated Bowel Loops: Prenatal Diagnosis, Fetal Characteristics and Neonatal Outcomes.
The purpose of this study was to describe the characteristics and outcomes of fetuses with a diagnosis of nonobstructive diffuse dilated bowel loops. We conducted a retrospective study of all pregnancies with fetal diagnosis of nonobstructive diffuse dilated bowel loops over 14 years in a large tertiary referral center. Fetomaternal and neonatal characteristics and outcomes were assessed. Seven fetuses had sonograms showing diffuse dilated bowel loops; none of them had intestinal obstruction after labor. The median gestational age at diagnosis was 33 weeks 1 day (range, 27 weeks-34 weeks 1 day). The median gestational age at delivery was 34 weeks 1 day (range, 32 weeks 4 days-39 weeks 1 day). Four cases had premature rupture of membranes beyond 32 weeks. Four among the 7 had gastrointestinal manifestations. Three cases presented with hematochezia, which resolved with conservative treatment. One fetus had intractable diarrhea, had a diagnosis of rare microvillus inclusion disease, and died of sepsis after 92 days. Not a single case of Hirschsprung disease was observed in our group. Nonobstructive diffuse dilated bowel loops diagnosed in the second half of pregnancy are associated with premature rupture of membranes and premature labor. As neonatal gastrointestinal complications may be anticipated, prenatal parental counseling with a neonatologist and pediatric gastroenterologist should be conducted.


The anti-Parkinson drug, rasagiline, prevents apoptotic DNA damage induced by peroxynitrite in human dopaminergic neuroblastoma SH-SY5Y cells.
Clinical trials for treatment of Parkinson's disease suggest that (-)deprenyl (selegiline), an inhibitor of type B monoamine oxidase, may slow the disease progression. However, the mechanism underlying protection of nigral dopamine neurons by selegiline remains an enigma. Recently, rasagiline, (R)(+)-N-propargyl-1-aminoindan, was reported to be neuroprotective by in vivo and in vitro experiments, which is another selective irreversible inhibitor of type B monoamine oxidase and not metabolized into amphetamine-like derivatives as in the case of selegiline. In this paper, the mechanism of the neuroprotection was examined using human dopaminergic neuroblastoma SH-SY5Y cells against apoptosis induced by peroxynitrite generated from SIN-1. After treatment with SIN-1, the apoptotic DNA damage in the cells was quantified by a single cell gel electrophoresis (comet) assay and by staining with Hoechst 33342. Change in mitochondrial membrane potential, Deltapsim, was measured by use of a fluorescent indicator, JC-1. Rasagiline reduced apoptosis with much more potency than selegiline, and the protection required 20 min pre-incubation before SIN-1 treatment. The protection by rasagiline was proved to be due to stabilization of mitochondrial membrane potential against the collapse induced by SIN-1, whereas rasagiline did not scavenge peroxynitrite directly. The studies on structure-activity relationship showed that a propargylamine group and a hydrophobic group with an adequate intermediate space were required for the protection. These results suggest that rasagiline may protect declining neurons through its anti-apoptotic activity in neurodegenerative diseases.


Geriatric pain management. The anesthesiologist's perspective.
Geriatric patients have a unique physiology that makes their pain management problematic. This article reviews the issue of geriatric pain management from the perspective of the anesthesiologist. It looks at the main causes of geriatric chronic pain and emphasizes the different analgesic modalities available that can provide maximum relief and minimal potential side effects.


Effect of Prolonged Use of Dronedarone on Recurrence in Patients with Non-Paroxysmal Atrial Fibrillation After Radiofrequency Ablation (DORIS): Rationale and Design of a Randomized Multicenter, Double-Blinded Placebo-Controlled Trial.
Prolonged use of anti-arrhythmic drugs (AAD) beyond the post-ablation blanking period to maintain sinus rhythm has been adopted in clinical practice but without sufficient evidence. Dronedarone is an AAD valid for maintaining sinus rhythm with fewer side effects than other AAD for long-term use. We sought to investigate the effect of prolonged use of dronedarone on the recurrence of non-paroxysmal AF patients beyond 3 months within the first year after ablation. Non-paroxysmal AF patients will receive dronedarone for 3 months after radiofrequency ablation. Patients without drug side effects and atrial tachyarrhythmia (AT) recurrence will then be randomly divided into dronedarone and placebo groups and followed up until 1 year after ablation. The primary endpoint is the cumulative nonrecurrence rate post 3 months to 1 year after ablation. Patients will receive 7-day Holter monitoring (ECG patch) at 6, 9, and 12 months after ablation to evaluate AT recurrence. Secondary endpoints include dronedarone withdrawal due to side effects or intolerance of AT recurrence, time to the first recurrence, repeat ablation, electrical cardioversion, unscheduled emergency room visit, or re-hospitalization. This trial will evaluate whether prolonged use of dronedarone effectively reduces the recurrence rate after ablation in non-paroxysmal AF patients. The result of this trial will provide evidence for optimizing post-ablation anti-arrhythmic therapy. ClinicalTrials.gov ; NCT05655468, 19-December-2022.


Evaluation of a new image-enhanced endoscopic technology using band-limited light for detection of esophageal squamous cell carcinoma.
The aim of the present study was to evaluate the clinical utility of a new image-enhanced endoscopy (IEE) technology called optical enhancement imaging (OEI-1, -2, -3) by quantitatively evaluating diagnostic performance in superficial esophageal squamous cell carcinoma (SCC) in order to facilitate detection and characterization of gastrointestinal tumors. The study involved 10 esophageal SCC resected endoscopically at our hospital. Ex vivo observation of the boundary area between normal and SCC was done using each mode (white light image [WLI], OEI-1, OEI-2, and OEI-3) with and without magnification. The additional effect of OEI on WLI was evaluated by calculating the color difference (expressed as ΔE94 ) between SCC and normal epithelium, and that between the intraepithelial papillary capillary loop (IPCL) and inter-vascular background coloration (IVBC). Mean ΔE94 values between SCC and normal epithelium for WLI, OEI-1, OEI-2, and OEI-3 were 9.37 ± 4.64, 13.82 ± 4.46,13.26 ± 4.73, and 16.44 ± 4.83, respectively; the corresponding values between IPCL and IVBC were 17.57 ± 10.17, 29.32 ± 9.95, 25.41 ± 11.72, and 23.71 ± 11.58, respectively. Compared with WLI, all OEI exhibited significant additional effect on ΔE94 . Furthermore, we found significant additional effect of OEI-3 in observing SCC and normal epithelium, and of OEI-1 in observing IPCL and IVBC, compared with other OEI. These results suggest that OEI improves endoscopic detection and characterization of esophageal SCC compared with WLI. Moreover, the data indicate that OEI-3 is useful for detection and OEI-1 is useful for characterization of esophageal SCC.


Characterization of a laccase gene from the white-rot fungus Trametes versicolor and structural features of basidiomycete laccases.
A gene coding for the multi-copper phenol oxidase laccase has been isolated from the white-rot basidiomycete Trametes versicolor. The gene, which is preceded by a TATA box and a pyrimidine-rich region, is predicted to contain ten introns. The mature translation product, preceded by a 22-residue signal peptide, should consist of 498 residues. Comparisons with Edman degradation data of peptides from T. versicolor laccase strongly suggest that two disulfide bridges are formed by Cys-85/Cys-487 and Cys-117/Cys-205, respectively. The encoded protein contains five Cys, and the sequence surrounding the remaining Cys-452 is consistent with its involvement in the ligation of type-1 copper. Alignment of sequences indicates that T. versicolor laccase displays a Phe at the position corresponding to a residue (Met in ascorbate oxidase and azurin) considered important for the reduction potential of type-1 copper proteins.


Stand-alone cervical cages versus anterior cervical plate in 2-level cervical anterior interbody fusion patients: clinical outcomes and radiologic changes.
Retrospective study. To compare the efficacy of 2-level anterior cervical discectomy and fusion with cage alone (ACDF-CA) and with cage and plate construct (ACDF-CPC) with regard to clinical outcome and radiologic changes. The use of stand-alone cervical interbody cages in ACDF has become popular, but high subsidence rates have been reported in the literature. A total of 54 consecutive patients who underwent 2-level ACDF-CA or ACDF-CPC after suffering from cervical radiculopathy were divided into 2 groups: group A (n = 28) underwent ACDF-CA, group B (n = 26) underwent ACDF-CPC. Fusion rate, global and segmental kyphosis, disk height, and subsidence rate were assessed by radiolographs. Clinical outcomes were assessed using Robinson's criteria. Solid fusion was achieved in 96.43% (27/28) in group A and in 96.15% (25/26) in group B. Fusion segmental kyphosis of >5 degrees occurred in 14.29% (4/28) of group A and in 7.69% (2/26) of group B; however, there was no statistical difference between the 2 groups (P>0.05). Subsidence occurred in 35.71% (10/28) of group A as compared with 11.54% (3/26) of group B (P<0.05). Clinical outcomes were similar in the 2 treatment groups. The use of cage and plate construct in 2-level ACDF results in a shorter fusion duration and a lower subsidence rate than that of cage alone; however, there is no significant difference in the postoperative global and segmental alignment and clinical outcomes between groups.


Patients need to remain in treatment for PTSD to receive the full benefit.
Despite strong evidence to support trauma-focused treatment as the gold standard in treating PTSD, many studies report elevated drop-out rates. The study by Holmes et al. (2019) examines temporal patterns of treatment non-completion and reported individuals who improved at a greater rate attended all sessions. This commentary discusses some of the factors that contribute to premature termination, including treatment modality (e.g., exposure-based), barriers to care, treatment format, motivation, treatment resistance, and lack of multimodal assessments. Future investigations comparing individual differences in response to treatment would allow for the examination of characteristics that facilitate or impede treatment response.


[Recommendations for the diagnosis and therapy of meningitis, Waterhouse-Friderichsen syndrome and encephalitis in childhood].
Representatives of the working group of "Neuropaediatrics" and "Infectology" like to present recommendations on diagnostics and treatment of infectious diseases on the CNS. Individual opinions can not be considered in recommendations always. Therefore we have to understand these recommendations in this way that individual decisions will not be restricted in special situations.


Benzimidazole - Schiff bases and their complexes: synthesis, anticancer activity and molecular modeling as Aurora kinase inhibitor.
A new series of Schiff bases containing benzіmidazole moiety 11-17 were synthesized by the reaction of 4-(1H-benzо[d]іmіdazоl-2-yl)anіline (1) with different aromatic aldehydes (4-10) via conventional heating and microwave irradiation methods. The structures of the novel Schiff bases were characterized by using different spectral data. Also, metal complexes 18-21 of compound 13 were synthesized, and their structure was confirmed by spectral measurements (IR, NMR, UV), molar conductivity, magnetic susceptibility and thermo-gravimetric analysis. The novel synthesized ligand 13 and its complexes 18-21 were tested for their in vitro antitumor activities towards breast, liver and lung cancer cell lines. Also, the acute toxicity of the prepared compounds 13 and 18-21 was determined in vivo. The results showed that the newly synthesized compounds 13 and 18-21 exhibited a significant activity against cancer, especially for complex 21, compared to standard drug doxorubicin. The molecular docking of complexes 20 and 21 has been also studied as Aurora kinase inhibitors.


Comparison of immunoglobulin G subclass concentrations in severe community-acquired pneumonia and severe pandemic 2009 influenza A (H1N1) infection.
We compared immunoglobulin G (IgG) subclasses in patients with severe noninfluenza community-acquired pneumonia (CAP) to those in patients with severe pandemic 2009 influenza (H1N1) virus infection. Low IgG1 and IgG2 levels occurred often in the CAP group; however, H1N1 patients had lower IgG1 and IgG2 levels (5.4 versus 3.3 g/liter [P = 0.008] and 2.5 versus 1.2 g/liter [P < 0.001], respectively). Low IgG2 levels may be specifically linked to severe H1N1; however, it is not clear whether this association is related to H1N1 or to other features of severity.


Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable?
Very few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon's point of view in this seriously affected patient group. A retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis. All 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied. Destructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.


The regulation of substrate utilization.
The factors which regulate the utilization of blood-borne substrates by mammalian tissues are discussed. These include the availability of the substrates, the blood flow to tissues, the permeability of cells to the substrate, the activities of initiating enzymes and the regulation of the metabolic pathway. These various factors are illustrated by specific examples. In addition, the methodology involved in measurement of substrate utilization by tissues is briefly outlined.


Multiplex High-Resolution Melting Assay for Simultaneous Identification of Molecular Markers Associated with Extended-Spectrum Cephalosporins and Azithromycin Resistance in Neisseria gonorrhoeae.
Antimicrobial resistance in Neisseria gonorrhoeae persists as a major public health concern globally. We developed and evaluated a multiplex assay that relied on high-resolution melting (HRM) technology as a rapid, simple, and cost-effective method for simultaneously detecting and identifying different molecular markers associated with extended-spectrum cephalosporins (ESCs) and azithromycin (AZM) resistance in N. gonorrhoeae. Forty-eight well-characterized N. gonorrhoeae clinical isolates were selected for initial assay establishment. The multiplex HRM assays were able to accurately identify different nucleotide variations of the antimicrobial resistance determinants related to ESCs and AZM resistance. Specificity and cross-reactivity were assessed by testing 15 nongonococcal strains. Then, the assay was validated on 218 archived DNA specimens that had been sequenced using whole-genome sequencing technology. Compared with whole-genome sequencing, these assays had a sensitivity of 98.6%, with a specificity of 99.2%. For further validation of the assay's performance, a total of 338 samples (156 clinical isolates and 182 clinical specimens) were screened using the multiplex HRM assay. The results showed good concordance with the results of PCR sequencing. Given its rapidity (within 90 minutes), ease of performing, and low cost (<$1.00 per sample), this method may be applied to large-scale epidemiologic programs for increasing surveillance of ESCs and AZM resistance in N. gonorrhoeae.


Primary vaginal adenocarcinoma of the intestinal type associated with adenosis.
Primary vaginal adenocarcinoma unrelated to intrauterine hormone exposure is very uncommon. We report a case of a 52-year-old woman who presented with primary vaginal adenocarcinoma that showed intestinal differentiation with prominent papillary formations and numerous papillary and villous features with prominent goblet cells. There was vaginal adenosis in the immediate vicinity of the tumor. To our knowledge, this is the first reported case of a primary vaginal adenocarcinoma of the intestinal type associated with adenosis in a patient unexposed to prenatal diethylstilbesterol.


An unusual case of microangiopathic haemolytic anaemia associated with enterohaemorrhagic Escherichia coli O113:H21 infection, a verocytotoxin-2/shiga toxin-2 producing serotype.
A case of microangiopathic haemolytic anaemia and thrombocytopaenia in a 79-year-old woman is presented. The case is unusual in that diarrhoeal symptoms were brief and symptoms of anaemia caused her to re-present to hospital 6 days after the diarrhoea had ceased. Enterohaemorrhagic Escherichia coli O113:H21 producing shiga toxin-2 was isolated from a faecal specimen. This serotype has been reported only a few times to be associated with serious disease. However, it is amongst the 20 most common serotypes carried in cattle and found in beef. This case also illustrates the importance of using shiga-toxin gene detection in faecal cultures (as opposed to cultural methods for detection of the O157:H7 serotype) as the recommended investigation of human disease for accurate epidemiology and attribution of cause.


Microglial activation induces neuronal death in Chandipura virus infection.
Neurotropic viruses induce neurodegeneration either directly by activating host death domains or indirectly through host immune response pathways. Chandipura Virus (CHPV) belonging to family Rhabdoviridae is ranked among the emerging pathogens of the Indian subcontinent. Previously we have reported that CHPV induces neurodegeneration albeit the root cause of this degeneration is still an open question. In this study we explored the role of microglia following CHPV infection. Phenotypic analysis of microglia through lectin and Iba-1 staining indicated cells were in an activated state post CHPV infection in cortical region of the infected mouse brain. Cytokine Bead Array (CBA) analysis revealed comparatively higher cytokine and chemokine levels in the same region. Increased level of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), Nitric Oxide (NO) and Reactive Oxygen species (ROS) in CHPV infected mouse brain indicated a strong inflammatory response to CHPV infection. Hence it was hypothesized through our analyses that this inflammatory response may stimulate the neuronal death following CHPV infection. In order to validate our hypothesis supernatant from CHPV infected microglial culture was used to infect neuronal cell line and primary neurons. This study confirmed the bystander killing of neurons due to activation of microglia post CHPV infection.


Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population.
Beta-thalassaemia minor and iron deficiency are the most common causes of microcytosis and/or hypochromasia. The present study evaluates the diagnostic reliability of different RBC indices and formulas, as well as our proposed formula, in the differentiation of the beta-thalassaemia minor from iron deficiency in Palestinian population. Complete blood count (CBC) parameters of 2196 certainly diagnosed (1272 beta-thalassaemia minor and 924 iron deficiency) samples were used to evaluate the following indices and formulas: Bessman index (RDW), Mentzer formula (MCV/RBC), England and Fraser formula (MCV - RBC - 5 x Hb- 3.4), Shine and Lal formula (MCV2 x MCH/100), Ehsani formula (MCV-10 x RBC), Srivastava formula (MCH/RBC), Green and King formula (MCV2 x RDW/Hb x 100), red distribution width index RDWI (RDW x MCV/RBC), RDW/RBC, as well as our formula (MCV-RBC -3 x Hb). For each index and formula, the receiver operative characteristic (ROC) curve was constructed to calculate the area under the curve (AUC), in addition, sensitivity, specificity, and likelihood ratios were calculated. No significant differences were reported between our formula, Green-King formula and the RDWI (P > 0.05) in discriminating beta-thalassaemia minor from iron deficiency (AUC = 0.914, 0.909 and 0.907 respectively). However, the three indices and formula showed the highest efficiencies and they were significantly (P < 0.05) better than the others in the discrimination efficiency . It was concluded that our formula, Green-King formula and the RDWI provided the highest reliabilities in differentiating beta-thalassaemia minor from iron deficiency in Palestinian population while Bessman index was poor and ineffective for that purpose.


Food-related Stroop interference in obese and normal-weight individuals: behavioral and electrophysiological indices.
The primary objective of the present study was to investigate differences in the attentional processing of food-related words in a Stroop task, as assessed by means of behavioral (reaction times) and electrophysiological (P200 and P300 amplitudes) indices, between obese and normal-weight individuals. Results revealed a P200 bias to food-related words in obese participants, which was not seen in normal-weight participants. This indicates that, in an early, automatic stage of information processing, obese participants already tend to engage more attention towards food-related stimuli than to neutral stimuli. With respect to reaction times and P300 scores, as alleged indices of more conscious maintained attention, a general food-related bias was observed, with no between-group differences. Further, in the obese group, significant positive correlations were observed between the food-related reaction time bias, food craving, and external eating, whereas in the normal-weight group, food craving scores correlated positively with P200/P300 amplitude biases. It can be concluded that obese individuals display an enhanced automatic, preconscious attentional processing of food-related stimuli, and this can be regarded as an initial expression of a greater responsiveness to food cues. In the current food-abundant environment, such a heightened food cue-responsiveness might contribute substantially to the tendency to overeat.


Priapism and neuroleptics: a case report.
We present a case of priapism caused by the alpha adrenoreceptor blocking action of a butyrophenone. The problem was solved surgically performing a cavernousspongiosum fistula.


The impact of exercise modality and menstrual cycle phase on circulating cardiac troponin T.
It is unclear whether exercise modality (moderate-intensity continuous [MCE]; high-intensity interval [HIE]) and menstrual cycle phase (follicular [FP]; luteal [LP]), individually or in combination, mediate the commonly observed exercise-induced elevation in cardiac troponin T (cTnT). This study examines cTnT responses to MCE and HIE during both the FP and LP. Randomised crossover study. Seventeen healthy, eumenorrheic women completed four trials including MCE (60% VO2max steady-state cycling until 300kJ) and work-equivalent HIE (repeated 4-min cycling at 90% VO2max interspersed with 3-min rest) during both the FP and LP. The FP and LP were verified based on ovarian hormones. Serum cTnT was assessed using a high-sensitivity assay before, immediately after, and 1 (1HR), 3 (3HR) and 4 (4HR) hours after exercise. cTnT values were corrected for plasma volume changes. cTnT was significantly elevated (p<0.05) post-exercise in both MCE (at 3HR and 4HR) and HIE (at 1HR, 3HR and 4HR). No statistically significant difference (p>0.05) in peak post-exercise cTnT, which mostly occurred at 3HR, was seen among the four trials (median [range], ngl-1: 5.2 [1.7-18.1] after MCE during FP; 4.8 [1.7-24.9] after MCE during LP, 8.2 [3.9-24.8] after HIE during FP and 6.9 [1.7-23.1] after HIE during LP). A single 300kJ bout of both MCE or HIE resulted in a significant post-exercise increase in cTnT, with no differences in peak cTnT response between menstrual cycle phases or between exercise modes, but the cTnT elevation occurs slightly earlier after HIE.


Isolation, identification and quantitation of hydroxycinnamic acid conjugates, potential platform chemicals, in the leaves and stems of Miscanthus × giganteus using LC-ESI-MSn.
Miscanthus×giganteus is a source of platform chemicals and bioethanol through fermentation. Cinnamates in leaves and stems were analysed by LC-ESI-MS(n). Free phenols were extracted and separated chromatographically. More than 20 hydroxycinnamates were identified by UV and LC-ESI-MS(n). Comparative LC-MS studies on the leaf extract showed isomers of O-caffeoylquinic acid (3-CQA, 4-CQA and 5-CQA), O-feruloylquinic acid (3-FQA, 4-FQA and 5-FQA) and para-coumaroylquinic acid (3-pCoQA and 5-pCoQA). Excepting 3-pCoQA, all were also detected in stem. 5-CQA dominated in leaf; a mandelonitrile-caffeoylquinic acid dominated in stem. Three minor leaf components were distinguished by fragmentation patterns in a targetted MS(2) experiment as dicaffeoylquinic acid isomers. Others (M(r) 516) were tentatively identified as hexosylcaffeoyl-quinates. Three positional isomers of O-caffeoylshikimic acid were minor components. p-Hydroxybenzaldehyde was also a major component in stem. This is the first report of the hydroxycinnamic acid profile of leaves and stems of M.×giganteus.


A multicenter evaluation of safety of early extubation in liver transplant recipients.
Small single-institutional studies performed prior to the introduction of organ allocation using the Model for End-Stage Liver Disease (MELD) suggest that early airway extubation of liver transplant recipients is a safe practice. We designed a multicenter study to examine adverse events associated with early extubation in patients selected for liver transplantation using MELD score. A total of 7 institutions extubated all patients meeting study criteria and reported adverse events that occurred within 72 hours following surgery. Adverse events were uncommon: occurring in only 7.7% of 391 patients studied. Most adverse events were pulmonary or surgically related. Pulmonary complications were usually minor, requiring only an increase in ambient oxygen concentration. The majority of surgical adverse events required additional surgery. Analysis of a limited set of perioperative variables suggest that blood transfusions and technical factors were associated with an increased risk of adverse events. In conclusion, while early extubation appears to be safe under specified circumstances, there are performance differences between institutions that remain to be explained.


Lack of co-transmission of Rickettsia conorii and Ehrlichia canis in human beings in the south of France.
Ehrlichia canis is the agent of canine Ehrlichiosis, commonly known as canine tropical pancytopenia. This canine disease is frequent in our area, as is Mediterranean Spotted Fever in humans. Recently a few cases of human Ehrlichiosis have been described in the USA. The supposed vector of both diseases is Rhipicephalus sanguineus. In order to evaluate the co-transmission of these two diseases, we selected 498 human sera positive for R. conorii and tested them for Ehrlichia canis. None of them were positive, suggesting the lack of co-transmission of the diseases.


Confirmation of thalamosubthalamic projections by electron microscopic autoradiography.
Direct projections from the centre median-parafascicular complex (CM-Pf) to the subthalamic nucleus(STN) were confirmed by electron microscopic autoradiography. [3H]Leucine injections into the rat CM-Pf produced preferential labeling of Gray's type I boutons containing round vesicles in the ipsilateral STN. Further results strongly suggested the existence of some common CM-Pf projections to both the striatum and STN.


Accuracy of urine urobilinogen and bilirubin assays in predicting liver function test abnormalities.
Components of the dipstick urinalysis (urine urobilinogen and urine bilirubin) are often used by emergency physicians to screen for the need to obtain liver function tests in many clinical situations. A prospective observational study was conducted to evaluate the sensitivity, specificity, and predictive properties of spot urine bilirubin and urobilinogen assays in the emergency department as screening test for serum liver function test (LFT) abnormalities. Of 122 patients, abdominal pain was the indication for laboratory evaluation in 54%; jaundice and constitutional symptoms were the indication in 29%. Overall sensitivities for both urine assays were 70% to 74% for serum bilirubin, but 43% to 53% for other LFTs; specificities were 77% to 87% for both urine screens. Positive predictive values show that the urine assays were 83% to 86% reliable for detecting at least one LFT abnormality. Negative predictive values were 85% for both urine assays for serum bilirubin elevations, but lower for other LFTs. Urine urobilinogen has its greatest clinical utility as a screen when a normal/abnormal threshold of 2.0/4.0 mg/dL is used.


Acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, in an adult with intestinal malrotation: a case report.
Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd's procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis.


Teaching psychiatry in a low-income country during the COVID-19 pandemic: A hybrid collaborative psychiatry course.
Amoud University in Borama is located in the self-declared state of Somaliland, in the Horn of Africa. Past conflicts and resulting economic hardship have led to a lack of local academic psychiatry faculty and resources. Amoud has been for some years partnering with voluntary faculty in the United Kingdom to teach psychiatry to its medical students through in-person "teaching missions." This was recently led by a Borama-native psychiatry resident in Ethiopia. COVID-19 added further hardships due to restrictions to travel and in-person gatherings. These challenges also created the opportunity for the development of an innovative, international, hybrid (online onsite), self-sustaining partnership model which has been successful in improving psychiatry teaching for undergraduate students in 2020-2021 and will continue in 2021-2022. An international, 'online-connected' department of psychiatry comprising a primary care physician in Somaliland, three postgraduate trainees in Ethiopia and the United States, and three senior psychiatrists in the United Kingdom developed a local faculty-led, hybrid-delivered, dynamic curriculum (bedside teaching, in person and online lecturing) that adapted to the needs, resources, faith and culture of Somaliland. While 2020-2021 has been the pilot year for the program, the overall experience has been enriching for students and faculty, leading to valuable cross-cultural conversations with impact on teaching and research. While learning about Somalilanders' and trauma, the program leads, also the authors of this article, have identified ways to harness the resilience and faith of students to bring about improvements in global mental health.


Is Insurance Status Associated With Likelihood of Operative ACL Injury Treatment Compared With Nonoperative Treatment?
While many factors inform the choice of operative versus nonoperative treatment of injuries to the anterior cruciate ligament (ACL) of the knee, socioeconomic status influences this decision, as has been reported with other procedures. To identify any associations between insurance status and likelihood of operative treatment of ACL injuries. Cross-sectional study; Level of evidence, 3. The Nationwide Inpatient Sample database was queried using International Classification of Diseases, 9th Revision codes for ACL injuries and reconstruction from 2001 to 2013. Chi-square analysis was performed to determine significant predictors of operative intervention. Binary logistic regression was used to account for demographic and significant predictor variables. Results were recorded as odds ratios (ORs) and 95% CIs. Significance was defined as P < .05. A total of 32,541 patients with ACL injuries were included in the final analysis. Overall incidence of surgical reconstruction was 85.4% (n = 27,805). Multivariable regression revealed that nonprivate insurance types were associated with lower likelihoods of operative reconstruction compared with private insurance: the lowest likelihood of operation was seen in uninsured patients (OR, 0.31; P < .01), followed by Medicare (OR, 0.33; P < .01) and Medicaid (OR, 0.51; P < .01) patients. There was also a decreased likelihood of surgery for elderly (OR, 0.0 [for age ≥75 years]; P < .01) and Black patients (OR, 0.65; P < .01). An increased likelihood of surgery was seen with female patients (OR, 1.14; P < .01). Patients in the highest median household income quartile were more likely to undergo surgery than those in the lowest (OR, 1.36; P < .01). Compared with privately insured patients, patients with nonprivate insurance had lower likelihood of surgery. Furthermore, patients in higher income quartiles were more likely to undergo operative fixation. These findings may suggest a need for more precise treatment guidelines and studies that investigate causes of such differences.


Self-crosslinked chitosan/κ-carrageenan-based biomimetic membranes to combat diabetic burn wound infections.
Diabetic wound infection often leads to compromised healing with frequent chances of sepsis, amputation and even death. Traditional patient care emphasized on early debridement and fluid resuscitation followed by intravenous antibiotics therapy. However, compromised vasculature often limit the systemic effect of antibiotics. Current study focused formulation of chitosan HCl, κ- carrageenan and PVA based physical cross-linked hydrogel membrane dressings loaded with cefotaxime sodium (CTX), for potential diabetic burn wound healing by adopting solvent casting method. Results of mechanical strength shows tensile strength and % elongation of 12.63 ± 0.25 and 48 ±3.05 respectively. Water vapor transmission rate (WVTR) depicts that despite of formulation KCP3 and KCP6, all hydrogel membranes have WVTR value in range of ideal dressing i.e., 2000-2500 g/m2/day. Whereas, all hydrogel membranes have oxygen permibility values more than 8.2 mg/ml. Bacterial penetration analysis confirms the barrier property of formulated membranes. Drug loaded hydrogel membrane showed control release up to 24 hr which provide protection against bacterial proliferation. Present study aims to constructs diabetic burn rat model which demonstrate that CTX loaded hydrogel membrane shown significantly rapid wound closure higher re-epithelization and numerous granulation tissue formation as compared to positive and negative control group. Conclusively, it is confirmed that formulated hydrogel membranes are beneficial and can be considered as a promising membrane dressing to treat diabetic burn wound.


Thyroid hormone affects the hydrolysis of inositol phospholipids in the rat hypothalamus.
We have attempted to elucidate the effect of thyroid hormone on phospholipase C-linked inositol phospholipid hydrolysis in the rat hypothalamus. Hypothalamic slices of each animal, euthyroid control, hypothyroid, and thyroxine (T4)-supplemented hypothyroid rats were labeled with [3H]myoinositol in the presence of 5 mM LiCl, and then incubated for 60 min in KHG buffer containing either vehicle or 1 mM ouabain, a Na-K ATPase inhibitor. Hypothyroidism caused a significant increase in both basal and ouabain-stimulated accumulation of [3H]inositol phosphate ([3H]IP) in hypothalamic slices, whereas supplement with T4 to hypothyroid rats resulted in a complete restoration of hypothalamic [3H]IP formation to the value of euthyroid control. The present results indicate that thyroid hormone affects phospholipase C-linked inositol phospholipid hydrolysis in the hypothalamus, suggesting that negative feedback action of thyroid hormone may occur at a post-receptor site in the hypothalamus.


Carbon, nutrient and metal controls on phytoplankton concentration and biodiversity in thermokarst lakes of latitudinal gradient from isolated to continuous permafrost.
Shallow thaw (thermokarst) lakes abundant in regions of permafrost-affected peatlands represent important sources of carbon dioxide and methane emission to the atmosphere, however the quantitative parameters of phytoplankton communities which control the C cycle in these lakes remain poorly known. This is especially true considering the roles of permafrost, hydrochemical composition of lakes, lake sizes and season as major governing factors on phytoplankton abundance and biodiversity. In this work, we quantified phytoplankton characteristics of 27 thermokarst lakes (sizes ranging from 115 m2 to 1.24 km2) sampled in spring, summer and autumn across a permafrost gradient (isolated, sporadic, discontinuous and continuous zone) in the Western Siberia Lowland (WSL). The biodiversity indices were highest during all seasons in lakes of the continuous permafrost zone and rather similar in lakes of isolated, sporadic and discontinuous permafrost zone. Considering all seasons and permafrost zones, the biomass and cell number of phytoplankton correlated with Dissolved Organic Carbon (DOC), phosphate, and some metal micro-nutrients (Ni, Zn). The strongest correlations were observed for Cyanophycea during summer, with pH, Ni, Cu, Zn, Sr, Ba (cell number) and Cu, Zn, Ba (biomass), and during autumn, with DOC, K, Cr, Cu, Zn, Ba, Cd, Pb (biomass). Using a substituting space for time approach for climate warming and permafrost thaw and suggesting a shift in permafrost boundaries northward, we foresee an increase in cell number and biomass in continuous permafrost zone in spring and summer, and a decrease in phytoplankton abundance in the discontinuous and sporadic permafrost zones. The biodiversity of phytoplankton in the continuous permafrost zone might decrease whereas in other zones, it may not exhibit any sizably change. However, in case of strong deepening of the active layer down to underlaying mineral horizons, and the release of some limiting nutrients (Si, P) due to enhanced connectivity of the lake with groundwater, the share of cyanobacteria and diatoms may increase.


Effects of microfluid in the veins of the deployable hindwings of the Asian ladybeetle on flight performance.
The deployable hindwings of certain coleopterans are their major flying components, and the veins supporting their hindwings play a significant role during flight; this knowledge is critical for designing bioinspired deployable micro air vehicles (MAVs). Therefore, the effects of microfluid (hemolymph) in the veins of beetle deployable hindwings are investigated in this paper. Microstructures are derived from hindwing cross sections and the nanomechanical properties of the hindwings and veins of the Asian ladybeetle Harmonia axyridis (Coleoptera: Coccinellidae). Based on these microstructures, three three-dimensional coupled models are established, including solid veins, hollow veins, and hollow veins filled with hemolymph. Then, the mechanical properties and vibration characteristics of the models are investigated. The torsional veins are affected more significantly by hemolymph when bending. This work will be helpful in designing new biomimetic deployable MAVs.


Online versus face-to-face metacognitive educational counseling program on anxiety and meta-worry in women with a history of miscarriage: A randomized clinical trial.
In the COVID-19 outbreak, women with a history of miscarriage need more mental health. Anxiety and meta-worry as consequences of miscarriage, besides concerns due to pregnancy during coronavirus, show the necessity of appropriate online and face-to-face educational counseling. This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus face-to-face method on anxiety and meta-worry in these women. In this randomized clinical trial, 80 women with a history of miscarriage, anxiety, and meta-worry referred to Imam Jafar Sadegh hospital (labor, women ward and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two groups (n = 20/each). The participants received 8-session metacognitive educational counseling package online or face-to-face. Data were collected by Beck Anxiety Inventory, Wellz meta-worry questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS software (Anova and Repeated measure statistic tests). Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91, P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93, P = 0.56); with fewer anxiety scores in the online group. Meta-worry in the 12th week (online group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta-worry scores in the online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27, P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85, P = 0.96); with less score of belief about worry in the online group. Online and face-to-face metacognitive educational counseling methods decreased anxiety, meta-worry, and belief about worry in women with miscarriage. But online educational counseling was more effective. Distance online counseling in COVID-19 can help the mental health of women with miscarriage.


Environmental factors in debromination activity of polybrominated diphenyl ethers by hepatic microsomes of freshwater fish.
Although the debromination of polybrominated diphenyl ethers (PBDEs) in fish species has been studied, environmental factors, such as chemical contamination and habitat temperature, have not been well understood. This study compared debromination of BDE209 by hepatic microsomes of wild and cultured fish. PBDE concentrations in muscle tissue were lower in cultured fish than in wild fish. Debromination activity was high in wild common carp, followed by cultured common carp, moderate in cultured ayu sweetfish, and low in two cultured fish (rainbow trout and cherry salmon) and wild Japanese sea bass. Although common carps have been known as the species which have higher debromination ability, there were differences between wild and cultured common carps. First, wild common carp debrominated much more BDE209 than cultured common carp. Second was debromination of BDE209 lasted 96 h in wild carp but only 24 h in cultured carp. Wild carp were collected from warm wastewater effluent with consistently high concentrations of micropollutants. Cultured carp were collected from colder clean waters. Therefore, environmental factors in debromination include contamination or ambient temperature. To investigate the effects of habitat environment on debromination of PBDEs, we collected wild carp in summer and winter at two different locations with similar PBDE contamination levels. Carp collected from the natural river in winter had the highest BDE99 debromination activity. Although the results indicated seasonal difference of debromination of BDE209, we could not confirm whether habitat temperature or physiological cycle of carp affected to debromination ability. Thus, further investigation such as in vivo experiment is required.


Increasing task demand by obstructing object recognition increases boundary extension.
Individuals consistently remember seeing wider-angle versions of previously viewed scenes than actually existed. The multi-source model of boundary extension (BE) suggests many sources of information contribute to this visual memory error. Color diagnosticity is known to affect object recognition with poorer recognition for atypically versus typically colored objects. Scenes with low-color diagnostic main objects and two versions of scenes with high-color diagnostic main objects (typically and atypically colored) were tested to determine if the reduced ability to identify the main object in a scene influences BE. Scenes were presented to one group of participants for 46 ms and another group for 250 ms. Each scene was followed by a mask and a request for a recognition response concerning the identity of the main object. The scene was then immediately presented again for testing and participants rated it as depicting a more close-up view, more wide-angle, or the same view as before. The study demonstrates that poorer encoding of main objects in scenes leads to increased BE, but trial-by-trial recognition accuracy had no relationship to BE magnitude. This finding provides further insight into the impact of task demand and main object recognition on BE.


Overexpression of lncRNA AFAP1-AS1 correlates with poor prognosis and promotes tumorigenesis in colorectal cancer.
Accumulating evidence has shown that long non-coding RNAs (lncRNAs) are emerging as key molecules in human malignancies. The lncRNA actin filament associated protein 1 antisense RNA1 (AFAP1-AS1) was recently found deregulated in several cancers. However, its expression pattern, clinical performance and functional roles in colorectal cancer (CRC) had not been addressed. In this study, we found that AFAP1-AS1 was aberrantly over-expressed in CRC tissues and closely correlated with tumor size, TNM stage and distant metastasis. Kaplan-Meier analysis indicated that patients with high level of AFAP1-AS1 expression had poorer overall survival (OS) and disease-free survival (DFS). Univariate and multivariable Cox regression analyses further identified that up-regulated AFAP1-AS1 might act as an independent prognostic factor for CRC patients. Moreover, AFAP1-AS1 depletion resulted in the inhibition of CRC cell proliferation and colony formation. In addition, AFAP1-AS1 knockdown induced G0/G1 cell cycle arrest in CRC cells. Taken together, our findings indicate that AFAP1-AS1 is significantly up-regulated in CRC, which may act as an oncogene and correlate with tumor malignant progression and poor prognosis of CRC. This study may shed a new light on better understanding the pathogenesis of CRC. Moreover, AFAP1-AS1 also may be a promising diagnostic and therapeutic target for this deadly disease.


Efficient generation of neural-like cells from porcine ovarian putative stem cells - morphological characterization and evaluation of their electrophysiological properties.
Until recently, the mammalian ovary was considered to consist of fully differentiated tissues, but evidence for the presence of adult stem cells in this organ appeared. The differentiation potential of these cells, referred to as putative stem cells, is not well defined. Porcine ovarian putative stem cells (poPSCs) were immunomagnetically isolated from postnatal pig ovaries based on the presence of the SSEA-4 surface marker protein. First, they were cultured in the undifferentiated state. After the third passage, a novel 7-day culture method inducing their differentiation into neural-like cells by the addition of forskolin (FSK), retinoic acid (RA) and basic fibroblast growth factor (bFGF) to the culture medium was applied. After 7 days, poPSCs successfully differentiated into neural-like cells, as evidenced by neural morphology and the presence of the neuronal markers nestin, NeuN, and GFAP, as confirmed by immunofluorescence, western blot, and real-time PCR. Electrophysiological analysis of potassium and sodium channel activity (patch clamp) confirmed that they indeed differentiated into neurons. The plasticity of poPSCs offers an excellent opportunity, especially in the field of neuroscience, since they can differentiate into neurons or glial cells. Although poPSCs might not be pluripotent cells, they also escape the rigid classification framework of adult stem cells.


1-[2-(2,4-Dichloro-benz-yloxy)-2-(furan-2-yl)eth-yl]-1H-benzotriazole.
In the title compound, C(19)H(15)Cl(2)N(3)O(2), the benzotriazole ring system is approximately planar [maximum deviation = 0.018 (2) Å] and its mean plane is oriented at dihedral angles of 30.70 (5) and 87.38 (4)°, respectively, to the furan and benzene rings while the dihedral angle between furan and benzene rings is 74.46 (6)°. In the crystal, weak C-H⋯N hydrogen bonds link the mol-ecules into chains along the b axis. π-π stacking inter-actions between the parallel dichloro-benzene rings of adjacent mol-ecules [centroid-centroid distance = 3.6847 (9) Å] and weak C-H⋯π inter-actions are also observed.


Brief episode of ischemia activates protective genetic program in rat heart: a gene chip study.
Brief episodes of ischemia of 20 min or less have the potential to protect the heart. Such episodes are associated primarily with reversible ischemic injury yet they induce changes in gene expression. The purpose of the study was to determine whether activation of protective genes takes place within 4 h following a brief episode of ischemia that would mimic angina pectoris. Three groups of rats were studied. In the control (Ctrl) group, hearts were immediately excised following anesthesia; in the sham-operated (SO) group, opened-chest rats received 4 h and 20 min of no intervention; and in the group subjected to ischemia (SI) hearts received 20 min of proximal coronary occlusion followed by 4 h of reperfusion. Hearts from the SI group were divided into nonischemic (NI) and ischemic (Isc) areas. Changes in gene expression pattern were analyzed by using Affymetrix Gene Chips. Ischemia led to strong upregulation of mRNA transcripts for heat shock proteins 70, 27, 105, 86 and 40 kDa, vascular endothelial growth factor, brain-derived neurotrophic factor, plasminogen activator inhibitor-1, activating transcription factor 3, B-cell translocation gene 2, and growth arrest and DNA damage inducible 45 alpha protein compared to the NI tissue. The majority of mRNAs whose levels increased following brief ischemia were of a protective nature. Genetic reprogramming emerging during or following brief episodes of ischemia that simulate angina, can be characterized as protective in nature. Developing new therapeutic strategies aimed to promote this protective response represents a legitimate target for future research.


Achilles'heel of laparoscopic pancreatectomy: reconstruction of the remnant pancreas.
Laparoscopic pancreatic reconstruction is a challenging procedure and is considered the Achilles' heel of laparoscopic pancreatectomy. Multiple techniques of laparoscopic pancreatic reconstruction have been reported, but the optimal technique remains unclear. This paper provides a brief introduction to the developmental status and major related complications of laparoscopic pancreatic reconstruction. We reviewed all published literature on the technology of laparoscopic pancreatic reconstruction within the last 5 years and herein discuss the advantages and disadvantages of different reconstruction methods. We also discuss several details of different reconstruction techniques in terms of their significance to the operation and complications. No individual method of laparoscopic pancreatic reconstruction is considered optimal for all conditions. The reconstruction strategy should be based on the surgeon's proficiency with laparoscopic technology and the patient's individual risk factors. Personalized methods of pancreatic reconstruction may more effectively reduce morbidity and mortality.


Improvement of peripheral endothelial dysfunction by acute vitamin C application: different effects in patients with coronary artery disease, ischemic, and dilated cardiomyopathy.
Endothelial dysfunction has been described in patients with coronary artery disease (CAD) or chronic heart failure (CHF). Vitamin C administration leads to an improvement of endothelial function by reducing elevated levels of reactive oxygen species. It remains unclear, however, whether the degree of endothelial dysfunction caused by oxidative stress differs between CAD and CHF because of ischemic (ICM) or dilated cardiomyopathy (DCM). In patients with CAD (n = 9; left ventricular ejection fraction [LVEF], 64% +/- 3%), ICM (n = 9; LVEF, 25% +/- 4%), DCM (n = 9; LVEF, 25% +/- 3%), and healthy subjects (HS; n = 5; LVEF, 66% +/- 5%) a change in internal radial artery diameter in response to acetylcholine (Ach; 15 and 30 microg/min) was measured with high-resolution ultrasound scanning during a co-infusion of normal saline or vitamin C (25 mg/min). Ach-mediated vasodilation was blunted in patients with CHF (DCM, 90 +/- 20 microm; ICM, 86 +/- 20 microm) and patients with CAD (336 +/- 20 microm) as compared with HS (496 +/- 43 microm; P <.05 vs patients with DCM, ICM, CAD). Vitamin C co-infusion increased Ach-mediated vasodilation by 180 +/- 35 microm (to 270 +/- 30 microm) in DCM (P <.05 vs CAD, HS) and by 294 +/- 40 microm (to 380 +/- 20 microm) in ICM (P <.05 vs DCM, CAD, HS). In patients with CAD, vitamin C increased Ach-mediated vasodilation by 146 +/- 35 microm to normal values, whereas vascular diameter remained unchanged in HS (14 +/- 20 microm; P = not significant). Acute vitamin C administration restored peripheral endothelial function in patients with CAD to normal values, whereas endothelial function remained attenuated in CHF, in particular in patients with DCM. These results suggest that in patients with CHF, factors other than oxidative stress (eg, cytokines) contribute to the pathologic endothelial function.


The Latin American and Caribbean Counter-Mobilization Against the UN Food Systems Summit: Magdalena Ackermann in Conversation with Saúl Vicente and Sofía Monsalve.
What is the diagnosis of the main problems of the Latin American and Caribbean region, including the corporate capture of food systems? How did the regional counter-mobilization against the UN Food Systems Summit arise? What were the positions of the Latin American governments and regional organizations on the Summit? What is the common vision for overcoming corporate food systems? These are some of the questions that are discussed in this thought-provoking conversation with Sofía Monsalve and Saúl Vicente, in which they share their insights and experiences on the challenges of the Latin American region and the outcomes of the regional counter-mobilization against the UN Food Systems Summit.


In Situ Characterization of the Initial Effect of Water on Molecular Interactions at the Interface of Organic/Inorganic Hybrid Systems.
Probing initial interactions at the interface of hybrid systems under humid conditions has the potential to reveal the local chemical environment at solid/solid interfaces under real-world, technologically relevant conditions. Here, we show that ambient pressure X-ray photoelectron spectroscopy (APXPS) with a conventional X-ray source can be used to study the effects of water exposure on the interaction of a nanometer-thin polyacrylic acid (PAA) layer with a native aluminum oxide surface. The formation of a carboxylate ionic bond at the interface is characterized both with APXPS and in situ attenuated total reflectance Fourier transform infrared spectroscopy in the Kretschmann geometry (ATR-FTIR Kretschmann). When water is dosed in the APXPS chamber up to 5 Torr (~28% relative humidity), an increase in the amount of ionic bonds at the interface is observed. To confirm our APXPS interpretation, complementary ATR-FTIR Kretschmann experiments on a similar model system, which is exposed to an aqueous electrolyte, are conducted. These spectra demonstrate that water leads to an increased wet adhesion through increased ionic bond formation.


Pathogenesis of spondyloarthritis: insights from synovial membrane studies.
Here, we review histopathologic studies of the cellular and molecular pathways of spondyloarthritis (SpA) synovial inflammation. In contrast with lymphocytes, specific macrophage subsets and polymorphonuclear cells selectively increase in SpA synovitis, correlate with global disease activity, decrease rapidly upon effective treatment with tumor necrosis factor (TNF)-alpha blockers, and serve as valuable biomarkers for treatment response in SpA. Functionally, increased Toll-like receptor triggering may be responsible for the proinflammatory response of these cells. Therefore, we propose that an exaggerated response of the innate immune system in genetically susceptible patients rather than a classic, lymphocyte-mediated autoimmune process is involved in the pathogenesis of SpA.


Procalcitonin as an early marker of postoperative infectious complications.
Procalcitonin (PCT) is a new marker for severe infection that is supposed to have a useful role in the early detection of bacterial infection in the perioperative period. to test the hypothesis that PCT is useful as an early marker of postoperative infectious complications. Thirty-three patients were submitted to major abdominal interventions that comprehend an intestinal resection (mean age: 49.9+/-19.3 years; 19 males, 14 females). PCT was tested at 4 times: T1=preoperative; T2=6 hours after starting interventions; T3=24 hours after; T4=48 hours after. "t"-Student test and Pearson correlation. In the postoperative course 11 patients had infectious complications that were: 3 wound infections, 2 positive haemocolture, 1 pneumonia, 3 deep abdominal infections, 2 anastomotic dehiscences. In these patients only the 24 hours PCT assay at T3 was higher than in the other patients that had not complications (microgram/ml 4.74+/-3.8 vs 1.22+/-0.8; p<0.0001). The cut off value of 1 ng/ml has a sensibility of 70% and a specificity of 81%. PCT detection appear to be an important aid for early diagnosis of postoperative infectious complications when it is used with the other indexes.


Foot Dorsiflexion Velocity and Torque Variance Explained through Architectural and Electromyography Variables Comparing Elders and Stroke Survivors.
The objectives of this study are to analyze the relationship between electromyographic variables, tibialis anterior (TA) architecture, and functional variables (torque and kinematic variables) during maximal isometric and isotonic foot dorsiflexion (FD), and to compare the described relationship between stroke survivors (SS) and healthy elders (HE). Twenty-eight participants (14 SS and 14 HE) over 65 years old performed 3 maximal isometric and isotonic FDs parameterized by ultrasound, electromyography (EMG), inertial sensor, and load cell. Common variables (TA) include muscle thickness, pennation angle, muscle activation, and EMG area under the curve. Specific variables include torque for isometric FD, and velocity and displacement for isotonic FD. There are significant differences in all variables when comparing the 2 groups. Among these differences, all the outcome variables show higher values in the HE group than in the SS group. However, in the 2 dependent variables obtained during isometric FD (median and maximal torques), the independent variables can explain nearly 70% of the variability of the dependent variable, with values of 68.4%-71.9% for SS and 69.1%-70.2% for HE. Similar results were found during isotonic FD. Even though the TA of the SS group is capable of generating less force (isometric FD) and is slower (isotonic FD) than that of the HE group, the contribution of the independent variables (muscle activation, pennation angle,and muscle thickness) can explain the same proportion of variability of the dependent variables.


Spinal fusion in a patient with Fukuyama congenital muscular dystrophy.
Many studies have evaluated surgical treatments for spinal deformities in patients with neuromuscular disease. However, few reports have described patients with Fukuyama congenital muscular dystrophy (FCMD). A 13-year-old boy with FCMD was unable to sit for long periods or sleep in the supine position because of progressive scoliosis. His Cobb angle worsened from 27° to 41° in 5months. He underwent standard posterior spinal fusion and pedicle-screw-alone fixation from T5 to S1. Postoperatively, his Cobb angle improved from 41° to 25° without exacerbation for 2years. After the surgery, he was able to sit for longer periods without pain, and he and his family were satisfied with the efficacy of the spinal fusion. Some patients with mild FCMD can sit at the age of puberty, but progression to scoliosis is possible. Therefore, spinal fusion for progressive scoliosis in patients with FCMD should be considered.


Strategies to evaluate outcomes in long-COVID-19 and post-COVID survivors.
SARS-CoV-2 infection can impact the physical, cognitive, mental health of patients, especially in those recovered in intensive care units. Moreover, it was proved that the effects of the virus may persist for weeks or months. The term long-COVID or post-COVID syndrome is commonly used for indicating a variety of physical and psychological symptoms that continue after the resolution of the acute phase. This narrative review is aimed at providing an updated overview of the impact of physical, cognitive, and psychological health disorders in COVID-19 survivors, by summarizing the data already published in literature in the last year. Studies cited were found through PubMed searches. We also presented an overview of the post-COVID-19 health consequences on three important aspects: nutritional status, neurological disorders, and physical health. Moreover, to activate a correct health planning policy, a multidisciplinary approach for addressing the post- COVID-19 issue, has been proposed. Finally, the involvement of health professionals is necessary even after the pandemic, to reduce expected post-pandemic psychosocial responses and mental health disorders.


Changes in volume of trapped gas in the lungs during provoked asthma followed by beta-2 receptor stimulation.
The volume of trapped gas (VTG) that could be mobilized by maximal breaths at the end of a nitrogen washout to 2% N2 was measured in 11 subjects with a history of asthma before and after provocation with specific allergens. The change after salbutamol was also measured. VTG was found to be more specific and sensitive for demonstrating early bronchospasm than changes in FEV1, VC or nitrogen washout. Salbutamol relieved all symptoms of bronchospasm.


User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico.
To evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals. We conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study's independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals. The study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction. Patient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.


Involvement of microRNAs in breast cancer.
MicroRNAs regulate numerous aspects of normal and pathologic cellular processes, including cancer. Breast cancer is a heterogeneous form of cancer that is derived from mammary epithelial cells. This review discusses the involvement of microRNAs in the regulation of normal mammary epithelial stem cells, their differentiation into basal and luminal phenotypes, and their control of breast cancer stem cells, also referred to as tumor-initiating cells. In the second section, we summarize the findings of differential microRNA expression in normal versus breast tumor tissue and among the various subtypes of breast cancer (primarily luminal, basal-like, and HER2). In the third and fourth sections of the review, specific mRNA targets of microRNAs in breast cancer are discussed, including those encoding the estrogen receptor-alpha and epidermal growth factor receptor, as well as survival, tumor suppressor, and cell-cycle-related proteins. Finally, the involvement of microRNAs in the promotion and suppression of breast cancer metastasis is reviewed. The studies presented herein provide a rationale for the design of therapeutic agents that target specific microRNAs in the treatment of breast cancer. Hopefully, this review will provide an impetus for more studies on the role of microRNAs in the regulation of normal mammary gland development and function.


Care of children who have had surgery for congenital heart disease.
Children who have had surgical correction for congenital heart disease can present to the ED with an acute illness that could be associated with their cardiac lesion. There is no data available to summarize complications that could be associated with surgically corrected congenital heart disease. This work was undertaken to describe the common procedures used, list known complications of these procedures, and review general management principles in caring for the acutely ill child who has had heart surgery.


Interruption of the aortic arch: experience in 17 infants.
Between April, 1965, and August, 1982, 17 children ranging in age from 2 days to 4 years were identified as having interruption of the aortic arch and operated on at our institution. There were eight type A interruptions, eight type B interruptions, and one type C interruption. Associated intracardiac anomalies were present in all but 3 patients. These 3 children, who all had type A interruption, underwent repair by mobilization of the aorta and end-to-end reconstruction. The other 14 children had initial palliative operations. The 2 patients in Group 1 had type A interruption with associated ventricular septal defect (VSD), and underwent subclavian artery-aorta anastomosis. In Group 2, the palliative procedure consisted of placement of a Dacron tube graft in 1 patient with type A interruption and associated VSD, and placement of a polytetrafluoroethylene (PTFE) graft, division of the patent ductus arteriosus, and banding of the pulmonary arteries in 11 patients--2 with type A, 8 with type B, and 1 with type C interruption. Ten children (71%) survived initial palliation, 1 of the 2 in Group 1 and 9 of the 12 in Group 2. In Group 2, 5 children had interruption of the aortic arch (4, type B; 1, type C) with associated VSD; among the 4 who survived palliation, 3 subsequently have had successful closure of the VSD and 1 is awaiting closure. Among the patients who had palliative procedures, there are 6 long-term survivors (43%). In the total series, there are 9 long-term survivors (53%).(ABSTRACT TRUNCATED AT 250 WORDS)


Hydrothermal synthesis of TiO2 hollow microspheres for the photocatalytic degradation of 4-chloronitrobenzene.
TiO(2) hollow microspheres were synthesized by a simple hydrothermal method followed by calcination at different temperatures ranging from 400 to 800°C. The prepared samples were characterized by XRD, SEM, TEM, SAED, HRTEM, N(2) adsorption, and UV-vis spectroscopy. The photocatalytic activities of the hollow microspheres were evaluated by photocatalytic decomposition of 4-chloronitrobenzene (4-CNB). Results showed that the TiO(2) hollow microspheres, which had an average external diameter of 1.75 μm, were composed of numerous TiO(2) nanoparticles. Photocatalysis experiments indicated that the TiO(2) hollow microspheres calcined at 500°C exhibited the highest photocatalytic activity, which was nearly 2 and 1.5 times higher than that of the uncalcined sample and Degussa P25, respectively. The catalyst crystallinity, catalyst dosage and 4-CNB concentration were found to have a significant impact on the degradation efficiency whereas solution pH has relatively less effect. The removal of total organic carbon (TOC) and formation of chloride, nitrate (V) anions were monitored to follow the mineralization process of 4-CNB. In addition, it was demonstrated that these TiO(2) hollow microspheres could be recycled easily without decreasing their photocatalytic activities.


Reingestion of feces in rodents and its daily rhythmicity.
The ingestion of feces is widespread among rodent species and is an extensively employed component of the repertoire of feeding behaviors in some species. Coprophagy is thus a significant consideration in the nutrition and dietary ecology of many rodents. As certain fecal pellets pass from the anus, they are taken up directly into the mouth, chewed, and swallowed. The nocturnally active herbivorous kangaroo rat Dipodomys microps ingests about 1/4 of the feces it produces daily and the daily pattern of reingestion shows a consistent rhythm. For about 8 h of the daytime, during the non-foraging, resting phase of the day, D. microps reingests all fecal pellets produced; during the remainder of the day it leaves all feces produced. The reingested feces contain more nitrogen and water, and less inorganic ions than the non-reingested feces. The extent of reingestion varies among rodent species in relation to diet, and coprophagy is more important in the more herbivorous species. The granivorous kangaroo rat D. merriami ingests feces rarely. The herbivorous vole Microtus californicus ingests about 1/4 of its feces, as does D. microps. However, in contrast to D. microps, M. californicus shows a series of rhythmic, short-term (one to several hour duration) alternations between reingestion and non-reingestion during the course of the day and night. This pattern correlates with the pattern of foraging in M. californicus, which extends over both night and day.


Interaction of apolipoprotein E gene polymorphisms on miscarriage risk in black and white American women.
To evaluate whether [1] apolipoprotein E (APOE) polymorphisms can differentially regulate miscarriage risk and [2] whether this genotype effect could also be modulated by the race within populations. Data were derived from the Coronary Artery Risk Development in Young Adults (CARDIA), a longitudinal study with black and white participants from four U.S. Not applicable. Women without miscarriages (controls) and women who miscarried at least once (cases). None. A group of women (n = 1,372) successfully followed for 25 years and with their APOE alleles identified were analyzed for miscarriage risk throughout their reproductive life. Additionally, a larger longitudinal analysis encompassing all the participants who had their APOE characterized (n = 2,140) was also performed for the association between APOE and miscarriage risk. In white women followed up for 25 years, the odds ratio for miscarriage associated with APOE*2 allele presence was 1.61 (95% confidence interval, 1.04-2.50) compared with APOE*33 carriers. This was a race-dependent phenomenon as no associations between APOE alleles and miscarriage was observed in black women. Likewise, Cox regression analysis showed that cumulative miscarriage risk in white women was 37.2% in the APOE*2 carriers compared with 27.8% and 24.8% in APOE*33 and APOE*4 carriers, respectively. With APOE*33 as the reference, the age-adjusted hazard ratio associated with carrying the APOE*2 allele was 1.47 (95 confidence interval, 1.06-2.05). This variable miscarriage risk, produced by an interaction between genotype and race, may reconcile, at least partially, the conflicting reports of the association of APOE and miscarriage risk.


Sun awareness and sun protection practices in Malta.
Concern regarding the rising incidence of melanoma and non-melanoma skin cancers in Malta has led to the organization of annual campaigns since the early 1990s. These aim to inform the public of the dangers of sun exposure and to promote sun protection. To help guide future campaigns, a survey was carried out to evaluate current sun protection measures among the Maltese people and to assess their level of knowledge regarding harmful effects of the sun on the skin. A total of 559 pedestrians were interviewed in the main street of the capital city of Malta in the summer of 1999. Self-reported rates of regular sunscreen and hat use in adults exposed to the spring/summer sun between 10.00 h and 15.00 h were 51% and 32%, respectively, for leisure activities, and 25% and 37%, respectively, for outdoor work. Men reported using sunscreen less often than women during both leisure and work. The fairer-skinned outdoor workers actually reported making less use of a sunscreen and/or hat than their darker counterparts, and rates of sunscreen and/or hat use during leisure and work were not found to increase with the amount of time spent in the sun. Almost 75% of sunscreen users were using a sun protection factor of at least 15. Parents reported much higher rates of regular sunscreen and hat use by their young children than by themselves, with 87% of children under 12 years of age reported to be using sunscreen and 78% reported to be wearing a hat. The great majority knew that injudicious sun exposure is associated with skin cancer and skin ageing, but 48% were still regarding a suntan achieved without skin burning as 'healthy' The mass media was by far considered to be the main source of information for the general public regarding effects of the sun on the skin. The positive impact of past campaigns can be seen in the high reported rates of sun protection in children. However, much remains to be done with adults in order to change their attitude about a 'healthy suntan' and to convince them that it is worthwhile to protect themselves from the sun.


Esophageal intubation in the management of perforated esophagus with stricture.
Insertion of a Celestin tube was employed in the treatment of 5 elderly patients who sustained perforations of the thoracic or abdominal esophagus during dilation of benign or malignant strictures. Two perforations treated within 24 hours were closed by direct suture in addition to intubation. There was a delay of 24 to 48 hours between the occurrence of the perforation and treatment in the other 3 cases. Only 1 of the latter patients subsequently developed pleural effusion, and this responded to drainage. One patient died 3 weeks after intubation; there was no evidence to suggest continued leakage through the perforation. The Celestin tube appears to be effective in sealing off esophageal perforations while healing occurs and merits consideration in the management of esophageal perforations associated with stricture in elderly patients when more radical treatment is not envisaged.


Toxicological evaluation of a novel cooling compound: 2-(4-methylphenoxy)-N-(1H-pyrazol-3-yl)-N-(2-thienylmethyl)acetamide.
A toxicological evaluation of a novel cooling agent, 2-(4-methylphenoxy)-N-(1H-pyrazol-3-yl)-N-(2-thienylmethyl) acetamide (S2227; CAS 1374760-95-8), was completed for the purpose of assessing its safety for use in food and beverage applications. S2227 undergoes rapid oxidative metabolism in vitro, and in rat and dog pharmacokinetic studies is rapidly converted to its component carboxylic acid and secondary amine. S2227 was not found to be mutagenic or clastogenic in vitro, and did not induce micronuclei in polychromatic erythrocytes in vivo. The secondary amine hydrolysis product, N-(2-thienylmethyl)-1H-pyrazol-3-amine (M179), was also evaluated for genotoxicity. In subchronic oral toxicity studies in rats, the no-observed-adverse-effect-level (NOAEL) for S2227 was 100 mg/kg/day (highest dose tested) when administered by oral gavage for 90 consecutive days. Furthermore, S2227 demonstrated a lack of maternal toxicity, as well as adverse effects on fetal morphology at the highest dose tested, providing a NOAEL of 1000 mg/kg/day for both maternal toxicity and embryo/fetal development when administered orally during gestation to pregnant rats.


The impact of COVID-19 on elective and trauma spine service in a district general hospital.
The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software. Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020. We recommend following steps can be helpful to deal with similar situations or new pandemics in future:24 hours on-call spine service during the pandemic.Clinical criteria in place to prioritize urgent spinal cases.Pre-screening spine patients before elective operating.Start of separate specialist trauma list for patients needing urgent surgeries. This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations.Cite this article: Bone Joint Open 2020;1-6:281-286.


Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study.
Although patient's health status before ICU admission is the most important predictor for long-term outcomes, it is often not taken into account, potentially overestimating the attributable effects of critical illness. Studies that did assess the pre-ICU health status often included specific patient groups or assessed one specific health domain. Our aim was to explore patient's physical, mental, and cognitive functioning, as well as their quality of life before ICU admission. Baseline data were used from the longitudinal prospective MONITOR-IC cohort study. ICUs of four Dutch hospitals. Adult ICU survivors (n = 2,467) admitted between July 2016 and December 2018. None. Patients, or their proxy, rated their level of frailty (Clinical Frailty Scale), fatigue (Checklist Individual Strength-8), anxiety and depression (Hospital Anxiety and Depression Scale), cognitive functioning (Cognitive Failure Questionnaire-14), and quality of life (Short Form-36) before ICU admission. Unplanned patients rated their pre-ICU health status retrospectively after ICU admission. Before ICU admission, 13% of all patients was frail, 65% suffered from fatigue, 28% and 26% from symptoms of anxiety and depression, respectively, and 6% from cognitive problems. Unplanned patients were significantly more frail and depressed. Patients with a poor pre-ICU health status were more often likely to be female, older, lower educated, divorced or widowed, living in a healthcare facility, and suffering from a chronic condition. In an era with increasing attention for health problems after ICU admission, the results of this study indicate that a part of the ICU survivors already experience serious impairments in their physical, mental, and cognitive functioning before ICU admission. Substantial differences were seen between patient subgroups. These findings underline the importance of accounting for pre-ICU health status when studying long-term outcomes.


High prevalence of hepatitis B viral DNA in cirrhotic patients without surface antigen.
The diagnosis of liver diseases induced by hepatitis B virus (HBV) is supported by the detection of HBV surface antigen (HBsAg) in serum. The present study aimed to investigate the presence of HBV deoxyribonucleic acid (DNA) in patients with liver cirrhosis using a polymerase chain reaction (PCR) based on primers derived from the pre-S1 and pre-core regions. HBsAg was detected in 10 of 48 patients (21%), total anti-hepatitis B core antigen (HBc) antibodies in 54%, anti-hepatitis B e antigen (HBeAg) in 14.6%, anti-HBc immunoglobulin M in 8%, and anti-HBs in 26%; none had detectable HBeAg. HBV DNA was detected in 73% of the cirrhotic patients. All cirrhotic patients with HBsAg also had HBV DNA; HBV DNA was detected in 64.5% of those without HBsAg. We conclude that the clearance of HBsAg does not necessarily indicate termination of viraemia in patients with liver cirrhosis and the detection of HBV DNA using a PCR based on primers from the pre-S1 and pre-core regions should be included in the diagnosis of HBV infection.


Polar bears make little use of terrestrial food webs: evidence from stable-carbon isotope analysis.
The mean stable-carbon isotope ratios (δ13C) for polar bear (Ursus maritimus) tissues (bone collagen -15.7‰, muscle -17.7‰, fat -24.7‰) were close to those of the same tissues from ringed seals (Phoca hispida) (-16.2‰, -18.1‰, and -26.1‰, respectively), which feed exclusively from the marine food chain. The δ13C values for 4 species of fruits to which polar bears have access when on land in summer ranged from -27.8 to -26.2‰, typical of terrestrial plants in the Arctic. An animal's δ13C signature reflects closely the δ13C signature of it's food. Accordingly, the amount of food that polar bears consume from terrestrial food webs appears negligible, even though some bears spend 1/3 or more of each year on land during the seasons of greatest primary productivity.


A switch-on xanthene-triphenylamine based fluorescent and colorimetric sensor for the detection of ultra-trace Hg2+ in food samples and living cells.
A novel colorimetric and fluorescent "switch-on" probe based on xanthene-triphenylamine was developed for detection of Hg2+, which threatens public health, food safety and the environment. The probe displayed superior colorimetric and fluorescent selectivity/sensitivity toward Hg2+ over a series of metal ions via Hg2+-triggered deprotection reaction. Hg2+ induced a ∼18-fold enhancement in emission intensity of probe TXS with yellow fluorescence (λem = 558 nm) and led to distinct color transition from light yellow to blue or yellow under daylight depending on solvent mixture. Detection parameters were optimized and examined for the influence that they exerted on the detection which involved the usage of the Box-Behnken design methodology. The sensing pathway was also examined theoretically by DFT and TD-DFT calculations. The probe was successfully utilized for the detection of Hg2+ in several food and water samples with good recoveries. Cell imaging studies demonstrated that the probe was suitable for Hg2+ detection in live cells.


Heritability and linkage analysis of personality in bipolar disorder.
The many attempts that have been made to identify genes for bipolar disorder (BD) have met with limited success, which may reflect an inadequacy of diagnosis as an informative and biologically relevant phenotype for genetic studies. Here we have explored aspects of personality as quantitative phenotypes for bipolar disorder through the use of the Temperament and Character Inventory (TCI), which assesses personality in seven dimensions. Four temperament dimensions are assessed: novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (PS). Three character dimensions are also included: self-directedness (SD), cooperativeness (CO), and self-transcendence (ST). We compared personality scores between diagnostic groups and assessed heritability in a sample of 101 families collected for genetic studies of BD. A genome-wide SNP linkage analysis was then performed in the subset of 51 families for which genetic data was available. Significant group differences were observed between BD subjects, their first-degree relatives, and independent controls for all but RD and PS, and all but HA and RD were found to be significantly heritable in this sample. Linkage analysis of the heritable dimensions produced several suggestive linkage peaks for NS (chromosomes 7q21 and 10p15), PS (chromosomes 6q16, 12p13, and 19p13), and SD (chromosomes 4q35, 8q24, and 18q12). The relatively small size of our linkage sample likely limited our ability to reach genome-wide significance in this study. While not genome-wide significant, these results suggest that aspects of personality may prove useful in the identification of genes underlying BD susceptibility.


[Ten year experience in kidney transplantation in patients undergoing peritoneal dialysis (1996-2006)].
Kidney transplantation is nowadays considered the most sophisticated method of treatment of chronic terminal renal insufficiency. The advancement in surgical technique and the use of new immunosuppressive medications provide a longer survival period of both the patient and the graft. The objective of this paper is a retrospective presentation of the ten-year monitoring of kidney transplantation in patients undergoing peritoneal dialysis performed at the Military Medical Academy. During that period, 32 patients underwent the transplantation (18 men and 14 women of the average age of 32.48+/-2.1). The total of 34 transplantations were performed, out of which 2 were retransplantations. Patient monitoring period was 7-92 months. The immunosuppressive therapy was quadrupled in 17 (50%) patients and tripled in 17 (50%) of them. The loss of the graft in the early period following the transplantation occurred in 5 (15.6%) patients due to trombosis a. renalis, out of whom two were retransplantation cases. Registered surgical vascular complications included 5 (15.6%) bleeding, 4 (12.5%) hematomes and 6 (18.7%) lymfocells. Delayed graft function occurred in 5 (14.7%) and acute rejection in 7 (20.5%) patients while the disease reccured in 2 patients. As for the complications, rejection without the loss of graft was registered in 4 (12.5%) pts, ureter stenosis in 3 (8.82%) pts, bacterial infections in 4 (12.5%) pts and reactivation of CMV infections in 9 (26.4%) pts. Our patients are observed for the maintenance of stable medium volume of serum creatinine (which is 123.6 +/-10.2 umol/l in the early stage and 133.24+/-11.1 umol/l in the end of the monitoring period as well as the medium volume of clearence creatinine (which is 64.80+/-3.5 ml/min at the early phase of monitoring period and 69.47+/-3.3 ml/min. in the end). Our group of renal transplantation patients, undergoing peritoneal dialysis was with stable renal function registered through the monitoring period.


Imaging of a case of atrioventricular septal defect: The added value of using the third dimension in echocardiography.
The role of 3D echocardiography has been increasing in the management of patients with congenital heart disease (CHD), particularly in pre-surgical planning, catheter-guided interventions, and functional assessment of the heart.


Adverse childhood experiences and postpartum depression in bipolar disorder.
Women are particularly vulnerable to recurrence of bipolar disorder (BD) following childbirth. Risk of postpartum psychosis (PP) is especially high, but postpartum depression (PPD) is also common. Adverse childhood experiences (ACEs) have not been associated with PP, but have been associated with PPD in non-bipolar samples. The relationship between ACEs and PPD within BD remains to be investigated. Here, we examined this association in a large, well-defined sample of women with BD. Participants were 575 parous women with DSM-IV BD. Lifetime psychopathology, including perinatal, was assessed via semi-structured interview and case-notes. ACEs, assessed via self-report and case-notes, were compared between women with lifetime PPD (n = 368) and those without a lifetime history of perinatal mood episodes (n = 207). In univariate analysis exposure to 3 or more ACEs, and to childhood abuse specifically, was significantly associated with PPD (p = 0.026 and 0.041 respectively), but this did not remain significant after adjusting for lifetime number of episodes of depression and parity. Post-hoc analysis revealed more frequent episodes of depression to be associated with both a history of 3 or more ACEs and of childhood abuse. Limited range of ACEs assessed and potential recall bias. Increased frequency of ACEs and particularly childhood abuse was associated with more frequent lifetime episodes of depression, but not specifically episodes with postpartum onset. Understanding factors that mediate the pathway between ACEs and PPD in BD has implications for risk prediction of PPD.


Estimating the population level impact of a gonococcal vaccine candidate: Predictions from a simple mathematical model.
Neisseria gonorrhoeae cross-protection was suggested in a New Zealand meningitis B vaccine. We modeled the potential impact of similar vaccines on gonorrhea prevalence in heterosexuals in the United States. Our mathematical model incorporated infection, behavior, and vaccination dynamics. Approximate Bayesian Computation calibrated our model to US prevalence. Primary analyses assumed New Zealand vaccine characteristics: 30% efficacy and 2-year duration of protection. We estimated impact under two vaccine coverages (20%, 50%). Reduction in gonorrhea prevalence ranged from 4.8 to 39.4%, depending on vaccine coverage. Vaccine impact was correlated with both size of the highly sexually active subpopulation and sexual mixing between high and low activity subpopulations. A meningitis vaccine providing low efficacy cross-protection against gonorrhea acquisition and short duration of protection could result in a large reduction in gonorrhea prevalence in the United States. Potential dual protective effects can be considered when making vaccine recommendations.


Spinal cord injury medicine. 2. Medical complications after spinal cord injury: Identification and management.
This is a self-directed learning module that reviews medical complications associated with spinal cord injury (SCI). It is part of a chapter on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of common medical complications that impact rehabilitation and long-term follow-up for individuals with SCI. Issues addressed include the rehabilitation approach to SCI individuals with pressure ulcers, unilateral lower-extremity swelling (deep venous thrombosis, heterotopic ossification, fractures), along with the pathophysiology, assessment, and treatment of spasticity, autonomic dysreflexia, orthostatic hypotension, and pain. To describe diagnostic and treatment approaches for medical complications common to individuals with SCI.


Sublingual salivary gland tumors: clinicopathologic study of six cases.
The aim of this study was to assess the clinical and histologic features of 6 cases of sublingual salivary gland tumors treated in a single institution. The clinical data were obtained from the medical records, and the histopathologic slides were reviewed. Four cases were adenoid cystic carcinoma (ACC) and 2 were mucoepidermoid carcinoma (MEC). Most cases were clinically staged as T3N0M0. Histologically, 3 cases of ACC were of the cribriform subtype and 1 was tubular. One MEC was classified as intermediate and 1 as high grade of malignancy. After surgical treatment, 3 patients (2 MEC and 1 ACC) did not show tumoral recurrence after a mean time of 162 months of follow-up (ranging from 120 to 216 months). Sublingual salivary gland tumors are very rare and most are malignant; in our series, 3 cases of ACC had poor prognosis but the patients with MEC were considered cured of the disease.


My future self: Young children's ability to anticipate and explain future states.
Two experiments examine preschool-aged children's ability to anticipate physiological states of the self. One hundred and eight 3-, 4-, and 5-year-olds were presented with stories and pictorial scenes designed to evoke thought about future states such as thirst, cold, and hunger. They were asked to imagine themselves in these scenarios and to choose one item from a set of three that they would need. Only one of the items could be used to address the future state. In both experiments, developmental differences were obtained for correct item choices and types of verbal explanations. In Experiment 2, the performance of the 3- and 4-year-olds was negatively affected by introducing items that were semantically associated with the scenarios but did not address the future state, whereas the 5-year-olds' performance was not. Results are discussed with respect to children's understanding of the future, theory of mind, and inhibitory control skills.


End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates.
Candidates with fulminant hepatic failure (Status-1A) receive the highest priority for liver transplantation (LT) in the United States. However, no studies have compared wait-list mortality risk among end-stage liver disease (ESLD) candidates with high Model for End-Stage Liver Disease (MELD) scores to those listed as Status-1A. We aimed to determine if there are MELD scores for ESLD candidates at which their wait-list mortality risk is higher than that of Status-1A, and to identify the factors predicting wait-list mortality among those who are Status-1A. Data were obtained from the Scientific Registry of Transplant Recipients for adult LT candidates (n = 52,459) listed between September 1, 2001, and December 31, 2007. Candidates listed for repeat LT as Status-1 A were excluded. Starting from the date of wait listing, candidates were followed for 14 days or until the earliest occurrence of death, transplant, or granting of an exception MELD score. ESLD candidates were categorized by MELD score, with a separate category for those with calculated MELD > 40. We compared wait-list mortality between each MELD category and Status-1A (reference) using time-dependent Cox regression. ESLD candidates with MELD > 40 had almost twice the wait-list mortality risk of Status-1A candidates, with a covariate-adjusted hazard ratio of HR = 1.96 (P = 0.004). There was no difference in wait-list mortality risk for candidates with MELD 36-40 and Status-1A, whereas candidates with MELD < 36 had significantly lower mortality risk than Status-1A candidates. MELD score did not significantly predict wait-list mortality among Status-1A candidates (P = 0.18). Among Status-1A candidates with acetaminophen toxicity, MELD was a significant predictor of wait-list mortality (P < 0.0009). Posttransplant survival was similar for Status-1A and ESLD candidates with MELD > 20 (P = 0.6). Candidates with MELD > 40 have significantly higher wait-list mortality and similar posttransplant survival as candidates who are Status-1A, and therefore, should be assigned higher priority than Status-1A for allocation. Because ESLD candidates with MELD 36-40 and Status-1A have similar wait-list mortality risk and posttransplant survival, these candidates should be assigned similar rather than sequential priority for deceased donor LT.