The spectrum of care for pediatric refugees and asylum seekers at a tertiary health care facility in Switzerland in 2015.
The aim of this retrospective study was to describe the epidemiology and spectrum of infections of admitted pediatric refugees and asylum seekers in a tertiary referral hospital in a high-income country in Europe. We identified recent refugees and asylum seekers < 18 years of age admitted to the University Children's Hospital in Basel, Switzerland, in 2015. A retrospective analysis was performed using electronic patient records. We identified 105 admissions in 93 patients with a median age of 5.7 (IQR 2.6-14.5) years. Eritrea, Syria, and Afghanistan were the most frequent countries of origin. The median duration of admission was 4 (IQR 2-6) days with infections and elective surgical interventions being the most common reason (54.8 and 16.1%, respectively). Most infections were airway, skin, and gastrointestinal in 46.4, 20.2, and 11.9%, respectively. The prevalence of tropical infections was 11.9%. The main pathogens identified were influenza A virus (13.8%), Staphylococcus aureus (10.3%), and rhino/enterovirus (10.3%). Previous medical non-infectious conditions were recorded in 13%. The study revealed a high burden of infections in admitted patients mostly caused by well-known pathogens prevalent also in the local population. Both tropical infections and pre-existing non-infectious conditions are also important in admitted patients. Better epidemiological data is required to optimize health care for this medically most vulnerable population in refugee crises. What is Known: • Pediatric refugees and asylum seekers are the most vulnerable population in refugee crises. • Data on health concerns and needs in this population is scarce. What is New: • This is one of the first studies on the epidemiology of pediatric refugees and asylum seekers treated as inpatients in a European high-income country. • The high burden of infections is mostly caused by well-known pathogens prevalent also in the local population.


DNA transitions induced by binding of PARP-1 to cruciform structures in supercoiled plasmids.
Poly(ADP-ribose)polymerase-1 (PARP-1) binds to single and double-stranded breaks in DNA, but less well known is its affinity for undamaged DNA. Previously, we have shown that PARP-1 also binds to the hairpin structures in DNA models. The mechanism underlying these interactions remains to be defined. We analyzed atomic force microscopy (AFM) images of complex of PARP-1 proteins with supercoiled plasmids containing cruciform structures. Using volume measurement analysis of molecules of PARP-1, we determined the numbers of PARP-1 molecules interacting with supercoiled DNA plasmids containing one cruciform structure. We also determined the extent of supercoiling of plasmids. Our observations show that PARP-1 binds to sequences that transition from B-DNA to cruciform structures. PARP-1 is present at the ends of hairpin arms, sites containing a 4-base single-stranded DNA. Furthermore, interaction of PARP-1 with supercoiled plasmids leads to a more relaxed plasmid-DNA conformation. Binding of PARP-1 to cruciform DNA offers insight into possible mechanisms underlying with changes in DNA conformation. These observations may offer insight into mechanisms involving DNA conformation related to process such as DNA repair and transcription.


A closer look at the nitrogen next door: 1H-15N NMR methods for glycosaminoglycan structural characterization.
Recently, experimental conditions were presented for the detection of the N-sulfoglucosamine (GlcNS) NHSO(3)(-) or sulfamate (1)H and (15)N NMR resonances of the pharmaceutically and biologically important glycosaminoglycan (GAG) heparin in aqueous solution. In the present work, we explore further the applicability of nitrogen-bound proton detection to provide structural information for GAGs. Compared to the detection of (15)N chemical shifts of aminosugars through long-range couplings using the IMPACT-HNMBC pulse sequence, the more sensitive two-dimensional (1)H-(15)N HSQC-TOCSY experiments provided additional structural data. The IMPACT-HNMBC experiment remains a powerful tool as demonstrated by the spectrum measured for the unsubstituted amine of 3-O-sulfoglucosamine (GlcN(3S)), which cannot be observed with the (1)H-(15)N HSQC-TOCSY experiment due to the fast exchange of the amino group protons with solvent. The (1)H-(15)N HSQC-TOCSY NMR spectrum reported for the mixture of model compounds GlcNS and N-acetylglucosamine (GlcNAc) demonstrate the broad utility of this approach. Measurements for the synthetic pentasaccharide drug Arixtra® (Fondaparinux sodium) in aqueous solution illustrate the power of this NMR pulse sequence for structural characterization of highly similar N-sulfoglucosamine residues in GAG-derived oligosaccharides.


Perioperative analgesia by erector spinae plane block in left ventricular assist implant.
In recent years, left ventricular assist devices have become an important element in the management of left ventricular failure refractory to pharmacological treatment. Their implantation (performed by left thoracotomy or sternotomy) generates significant perioperative pain, which can be managed with locoregional anaesthesia techniques. However, opinions vary on their use in cardiac surgery due to interference with the anticoagulant therapy required in these patients. The erector spinae plane block is an alternative to classic locoregional techniques. It does not produce hemodynamic alterations and does not interfere with antiplatelet and anticoagulant therapy, and is therefore an alternative to be considered in cardiac surgery. We present a case of left ventricular assist device implantation under this block prior to the surgical procedure and postoperative infusion through a catheter, obtaining satisfactory results in the management of perioperative pain.


Normal dopaminergic and serotonergic metabolites in cerebrospinal fluid and blood of restless legs syndrome patients.
Cerebrospinal fluid (CSF) and blood obtained from 22 untreated or scarcely treated patients with moderate to severe restless legs syndrome (RLS; mean age, 58.6 +/- 13 years) and 11 control subjects (mean age, 56.6 +/- 12.9 years) were investigated for biogenic amines between 6:00 and 8:00 PM. We did not find any significant differences in the CSF concentrations of homovanillic acid, 3-ortho- methyl-dopa, levodopa, 5-hydroxytryptophan, 5-hydroxyindoleacetic acid, tetrahydrobiopterin, dihydrobiopterin, 5-methyltetrahydrofolate, and neopterin. In addition, serotonin in whole blood and plasma activity of aromatic amino acid decarboxylase were all normal. Our results suggest that dopaminergic and serotonergic release is not substantially affected in RLS.


Expression of human hepatic genes in somatic cell hybrids.
Four diploid human cell types (lymphocytes, fibroblasts, amniotic fluid cells, and hepatocytes) were fused to mouse hepatoma cells, HH. HH synthesized and secreted several liver-specific gene products including albumin, transferrin, and alpha-fetoprotein. The resulting interspecific hybrids were compared to determine whether or not the pattern of human hepatic gene expression was similar when these various cells were fused with the mouse hepatoma line. The expression of six human hepatic genes was examined, including albumin, alpha-fetoprotein, ceruloplasmin, transferrin, alpha-1-antitrypsin, and haptoglobin. Albumin was most frequently expressed while alpha-fetoprotein was not detected in any of the hybrids studied. The patterns of expression of human serum proteins differed between the hybrid series. Hybrids derived from human fibroblasts produced primarily albumin, while those derived from lymphoblastoid cells and amniocytes had a higher frequency of clones secreting alpha-1-antitrypsin. The findings reported here suggest that the frequency of hybrid clones expressing human hepatic gene products and the array of proteins produced are influenced by the histogenetic state of the human parental cell type.


Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study.
As a noninvasive tool, myocardial deformation imaging may facilitate the early detection of cardiac dysfunction. However, normal reference ranges of myocardial strain and strain rate (SR) based on large-scale East Asian populations are still lacking. This study aimed to provide reference values of left ventricular (LV) and right ventricular (RV) strain and SR based on a large cohort of healthy Chinese adults using cardiovascular magnetic resonance (CMR) feature tracking (FT). Five hundred and sixty-six healthy Chinese adults (55.1% men) free of hypertension, diabetes, and obesity were included. On cine CMR, biventricular global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), and the peak radial, circumferential, and longitudinal systolic, and diastolic SRs (PSSRR, PSSRC, PSSRL, PDSRR, PDSRC, and PDSRL), and regional radial and circumferential strain at the basal, mid-cavity, and apical levels were measured. Associations of global and regional biventricular deformation indices with age and sex were investigated. Women demonstrated greater magnitudes of LV GRS (37.6 ± 6.1% vs. 32.1 ± 5.3%), GCS (- 20.7 ± 1.9% vs. - 18.8 ± 1.9%), GLS (- 17.8 ± 1.8% vs. - 15.6 ± 1.8%), RV GRS (25.1 ± 7.8% vs. 22.1 ± 6.7%), GCS (- 14.4 ± 3.6% vs. - 13.2 ± 3.2%), GLS (- 22.4 ± 5.2% vs. - 20.2 ± 4.6%), and biventricular peak systolic and diastolic SR in all three coordinate directions (all P < 0.05). For the LV, aging was associated with increasing amplitudes of GRS, GCS, and decreasing amplitudes of PDSRR, PDSRC, PDSRL (all P < 0.05). For the RV, aging was associated with an increase in the magnitudes of GRS, GCS, GLS, PSSRR, PSSRC, PSSRL, and a decrease in the magnitude of PDSRR, PDSRC (all P < 0.05). Biventricular radial and circumferential strain measurements at the basal, mid-cavity, and apical levels were all significantly related to age and sex in both sexes (all P < 0.05). We provide age- and sex-specific normal values of biventricular strain and SR based on a large sample of healthy Chinese adults with a broad age range. These results may be served as a reference standard for cardiac function assessment, especially for the Chinese population.


Preparation, characterization, and in vivo evaluation of glycyrrhetinic acid-mediated nano-drug delivery system co-loaded with syringopicroside and hydroxytyrosol.
This study aimed to create a glycyrrhetinic acid (GA)-mediated, multi-component, self-assembled nano-drug delivery system co-loaded with syringopicroside (S) and hydroxytyrosol (H) obtained from Syringa Linn by synthesizing a GA-polyethylene glycol-poly (lactic acid-co-glycolic acid) (GPP) nanoparticle delivery carrier to actively target the liver. The nanoparticles were optimized using the central composite design. Nanoparticle characterization, cytotoxicity, pharmacodynamics, and tissue distribution study were performed. The optimized SH-GPP nanoparticle was a white solid powder, which was safe and non-toxic. The particle size and Zeta potential of the nanoparticles were 101.5 ± 3.18 nm and -23.3 ± 0.82 mV, respectively. The polydispersity index value (PDI) was 0.190 ± 0.005; the particle size distribution was comparatively uniform. The average total encapsulation efficiency of the optimized SH-GPP nanoparticle was 50.26% ± 1.29%, and drug loading was 15.47% ± 0.39%. After S and H were arranged into nanoparticles, the proliferation inhibition of HepG2.2.15 cells was improved, and the aim of drug-loaded synergism between GPP and SH was achieved. The GA-mediated nanoparticles were better targeted, were retained longer in vivo, and had higher concentrations in the liver than the unmodified nanoparticles. These nanoparticles have the potential to be a new effective anti-hepatitis B treatment and have great research potential in clinical treatment.


PARP1 Is a Prognostic Marker and Targets NFATc2 to Promote Carcinogenesis in Melanoma.
Background: Melanoma is the most lethal skin tumor. PARP1 plays an oncogenic role in tumors, but the mechanism of PARP1 in melanoma remains unclear. Explicating the functional mechanism of PARP1 might highlight new targets for improving the survival rate of melanoma patients. Methods: The expression level of PARP1 and its correlation with prognosis of melanoma were examined using the TCGA dataset, the GEO12391 dataset, and western blot analysis. The differentially expressed genes (DEGs) following PARP1 intervention were identified via microarray analyses. GSEA, GO, and KEGG pathway enrichment analyses of the DEGs were performed. Theses DEGs were also compared with PARP1-related DEGs in the GEO59455 dataset and correlation analyses were performed to identify the intersection of the two gene sets to identify PARP1 target genes. The regulatory relationship between PARP1 and its target gene NFATc2 was examined by Western blot analysis and RT-qPCR. A CCK8 assay was used to determine the biological role of PARP1 and its target, NFATc2, in melanoma. Results: We demonstrated that PARP1 was overexpressed in both melanoma tissues and melanoma cell lines, and that upregulated expression of PARP1 was associated with higher pathological stages and unfavorable prognosis of melanoma. Five genes (NFATc2, ITGAX, CYP26B1, SYT17, and VGF) were identified as PARP1 target genes, and NFATc2 expression was confirmed to be regulated by PARP1. A CCK8 assay showed that by down-regulating expression of PARP1 or NFATc2 that melanoma proliferation was inhibited. Conclusions: Taken together, the results of this study demonstrated that PARP1 expression is a prognostic marker and contributes to melanoma proliferation through the regulation of NFATc2.


Neurotoxicity of novel water-soluble contrast media for intrathecal application.
Novel nonionic contrast media were tested by injection into the subarachnoid space of the anterior fossae of guinea pigs, followed by EEG recording and histologic examination. Iopamidol was found to be more epileptogenic than metrizamide and P-297.


Complex organochlorine pesticide mixtures as determinant factor for breast cancer risk: a population-based case-control study in the Canary Islands (Spain).
All the relevant risk factors contributing to breast cancer etiology are not fully known. Exposure to organochlorine pesticides has been linked to an increased incidence of the disease, although not all data have been consistent. Most published studies evaluated the exposure to organochlorines individually, ignoring the potential effects exerted by the mixtures of chemicals. This population-based study was designed to evaluate the profile of mixtures of organochlorines detected in 103 healthy women and 121 women diagnosed with breast cancer from Gran Canaria Island, and the relation between the exposure to these compounds and breast cancer risk. The most prevalent mixture of organochlorines among healthy women was the combination of lindane and endrin, and this mixture was not detected in any affected women. Breast cancer patients presented more frequently a combination of aldrin, dichlorodiphenyldichloroethylene (DDE) and dichlorodiphenyldichloroethane (DDD), and this mixture was not found in any healthy woman. After adjusting for covariables, the risk of breast cancer was moderately associated with DDD (OR = 1.008, confidence interval 95% 1.001-1.015, p = 0.024). This study indicates that healthy women show a very different profile of organochlorine pesticide mixtures than breast cancer patients, suggesting that organochlorine pesticide mixtures could play a relevant role in breast cancer risk.


Tumour necrosis factor gene polymorphisms and childhood wheezing.
Tumour necrosis factor (TNF)-alpha is associated with childhood wheezing. A genetic predisposition to increased TNF-alpha production, influenced by single nucleotide gene polymorphisms, may be important. Frequencies of TNF-alpha-308G/A and lymphotoxin (LT)-alpha+252G/A polymorphisms were compared in 115 asthmatic children, 55 wheezy infants and 156 control school children from the UK. Genotype frequencies for the TNF-alpha-308 and LT-alpha+252 polymorphisms were significantly different from controls. Haplotype analysis showed that TNF-alpha-308G, LT-alpha+252A/TNF-alpha-308A, LT-alpha+252A was associated with a markedly increased risk for both asthma and infant wheezing. The TNF-alpha-308G, LT-alpha+252G/TNF-alpha-308G, LT-alpha+252A combination was protective for asthma and infant wheezing. These findings were confirmed by analysis of Caucasian data. Nasal TNF-alpha levels were measured in the infants during acute wheezing episodes and higher, but nonsignificant levels were produced in those with one or two LT-alpha+252A alleles. Unexpectedly, significantly lower nasal TNF-alpha levels were found in the presence of one or two TNF-alpha-308A alleles. TNF-alpha-308/LT-alpha+252 genotype combinations had a significant influence on nasal TNF-alpha levels. In conclusion, these findings may have implications for future early intervention studies by helping to identify infants at increased risk for wheezing and childhood asthma.


Acid-catalyzed isomerization of methyl 2-deoxy-D-arabino-hexosides: equilibria, kinetics and mechanism.
Four isomers of methyl 2-deoxy-D-arabino-hexosides were isolated by HPLC as chromatographically homogeneous compounds. The rates of pyranoside isomerization (alpha(p) and beta(p)) at 40 degrees C and of furanoside isomerization (alpha(f) and beta(f)) at 26 degrees C were determined. A mechanism has been suggested for transformations taking place during isomerization of methyl 2-deoxy-D-arabino-hexosides in methanolic solution catalyzed with hydrogen chloride.


Evaluation of image quality of personal ultrasound imager: Comparison with the conventional machine.
To determine if the image quality of a personal ultrasound imager (PUI) is as good as that of a conventional machine (CM). Ninety patients were studied by the same operator using both the PUI and CM. The quality of the B-mode images obtained from these patients was scored 0, 1 or 2, defined as poor, fair, or good, respectively. Liver-tumor vascularity depicted by power Doppler imaging (PDI) and directional PDI (DPDI) was classified as 0, no blood signal; 1, dot-like blood signal within the tumor; 2, mild blood-flow signal within the tumor; and 3, abundant blood-flow signal within the tumor. The mean score of PUI and CM B-mode image quality was 7.47±0.92 and 7.54±0.99 (mean±SD), respectively (p=0.531). On PDI, grade of vascularity of the liver tumors determined with the PUI was 4.44 and 4.68 in those determined with the CM (p=0.78). On DPDI, tumor vascularity was 3.12 when scored by the PUI and 4.29 when scored with the CM (p=0.03). The qualities of images acquired by the PUI and CM were significantly correlated. The quality of B-mode images acquired using the PUI and CM are statistically the same, and they share a similar ability to detect intratumoral blood-flow signals on PDI. Because of its extreme portability, the PUI is expected to become a valuable diagnostic tool in the clinic.


Time trends (1983-1999) for organochlorines and polybrominated diphenyl ethers in rainbow smelt (Osmerus mordax) from Lakes Michigan, Huron, and Superior, USA.
The U.S. Geological Service Great Lakes Science Center has archived rainbow smelt (Osmerus mordax) collected from the early 1980s to the present. These fish were collected to provide time- and site-dependent contaminant residue data needed by researchers and managers to fill critical data gaps regarding trends and behavior of persistent organic contaminants in the Great Lakes ecosystem. In the present study, data are presented for concentrations of several organochlorine (OC) contaminants in the archived smelt, including DDT, polychlorinated biphenyls (PCBs), toxaphene, and chlordanes in Lakes Michigan and Huron (MI, USA) and in Lake Superior (MN, USA). The trends for all the OCs were declining as a first-order decay over the sampled time series (1983/1985-1993/1999) with the exception of toxaphene in Lake Superior and PCBs at the Charlevoix/Little Traverse Bay site in Lake Michigan. Concentration of the emerging contaminant, polybrominated diphenyl ethers (PBDEs), also was traced from its apparent entry into this ecosystem in approximately 1980 until 1999. Time trends for the PBDEs were increasing exponentially at all sites, with concentration-doubling times varying from 1.58 to 2.94 years.


Engineering 3D graphene-like carbon-assembled layered double oxide for efficient microplastic removal in a wide pH range.
Microplastics (MPs) elimination is becoming an intractable environmental issue due to their nonbiodegradable nature and wide spreading,especially in the case of wastewater containing acid or alkaline effluent. To target the dilemma, this work rationally engineered a robust three-dimensional graphene-like carbon assembled layered double oxide material (defined as G@LDO) from hierarchical organic LDH (i.e., 3D OLDH) via a "precursor-calcination" strategy. In virtue of the mutually protection effect of graphene-like carbon (G) and LDO, the engineered G@LDO featured the preeminent acid and base resistance for polystyrene (PS, as representative of MPs) removal. Especially and importantly, the removal efficiency of PS was ≥ 80% at pH= 3-11, even nearly 60% PS was removed at pH= 1 and 13. The maximum adsorption ability of G@LDO for PS was estimated to be 209.39 mg/g by a Langmuir isotherm model, much superior to that of pure G, LDO, and 2D G@LDO. Furthermore, the removal pathway was analyzed by kinetic together with thermodynamic study, revealing that the PS removal on G@LDO was an exothermic reaction controlled by chemisorption. By systematical characterization and DFT calculation, the removal mechanism of PS was revealed to be hydrogen bond and complexation associated with LDH recovered from LDO and π-π conjunction from G. Notably, the existence of sulfure (S) in the carbon network was also identified as significant component in PS removal via p-π interaction. Overall, this work not only provides a effective candidate for microplastics removal in a wide applicable scope (especially acid/alkaline effluent), shedding light on environmental remediation, but also opens a new anvenue for the disposal of LDHs adsorbed organic in a high value-added manner.


1992: Parodi, Montefiore, and the first abdominal aortic aneurysm stent graft in the United States.
In 1990 Juan C. Parodi performed the first endovascular abdominal aortic aneurysm (AAA) repair in Buenos Aires. Two years later, in 1992, Parodi and Claudio Schonholz visited Montefiore Medical Center in New York to perform with us the first endovascular AAA repair to be done in the United States. Since then the Montefiore/Einstein vascular group has performed 1522 endovascular grafts in 674 patients for many types of vascular lesions using a variety of both surgeon-made and industry-made devices. The purpose of the present article is to describe the events that surrounded the performance of the first seminal endovascular AAA repair at our institution on November 23, 1992.


Studies on Mediterranean leishmaniasis: V.A. preliminary epidemiological survey of human leishmaniasis in Tuscany.
Leishmanin skin testing was performed on 1,285 people in the Tuscany region of Italy. In a known endemic area for leishmaniasis there was an increasing positivity with age, while in another area the curve was bell-shaped suggesting an interruption of transmission in the recent past. In all areas the positivity rate for males was higher than for females, but it was not possible to distinguish between areas of cutaneous and visceral disease.


Ranula and sarcoid granuloma of a sublingual gland.
A case is reported in which the treatment of the ranula consisted of dissection of the cystic wall along with excision of the sublingual gland of origin. The histological picture of the gland was consistent with sarcoidosis. Thereafter, all other examinations were negative for sarcoidosis. However, there remains the possibility that the lesion may be the precursor of widespread sarcoidosis which might occur in the future.


The association between thromboxane A2 receptor gene polymorphisms and the risk of cerebral infarction.
To explore the association between thromboxane A2 receptor (TXA2R) gene polymorphisms and the risk of cerebral infarction. We screened the relevant publications through the search engines in PubMed, Google Scholar, Embase, Web of Science, and China National Knowledge Infrastructure (the latest search update was performed on July 1, 2020). Gene-disease associations were measured using the estimation of OR (95 % CI) based on five genetic inheritance models. Totally three studies were included in this meta-analysis. TXA2R rs768963 polymorphism in homozygote comparison (OR = 1.86, 95 % CI: 1.35-2.56), heterozygote comparison (OR = 1.81, 95 % CI: 1.37-2.39), and dominant model (OR = 1.82, 95 % CI: 1.39-2.37) emerged as risk factors for cerebral infarction. Besides, an increased cerebral infarction risk was observed in the heterozygote comparison (OR = 1.39, 95 % CI: 1.03-1.88) for TXA2R rs2271875 polymorphism. None of the five models showed any association between TXA2R rs4523 polymorphism and cerebral infarction risk. In conclusion, this is the first meta-analysis verifying that TXA2R rs768963 polymorphism and TXA2R rs2271875 polymorphism may be associated with the risk of cerebral infarction.


Primary desmoplastic small round cell tumor of the kidney in a 7-year-old girl.
Desmoplastic small round cell tumor (DSRCT) is a rare pathologic entity that most frequently affects the peritoneal cavity and presents in adolescent boys. It often presents at an advanced stage and has a generally poor prognosis. We present an unusual case of DSRCT of the kidney presenting in a young girl. This is the first report of DSRCT of the kidney in the pediatric population, and it suggests that this condition should be a diagnostic consideration when assessing a child with a kidney mass.


High Rate of Return to Sporting Activity Among Overhead Athletes With Subpectoral Biceps Tenodesis for Type II SLAP Tear.
To evaluate the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tear in overhead athletes. All competitive elite athletes with type II SLAP tears undergoing biceps tenodesis by a single surgeon were isolated between 2007 and 2015. Exclusion criteria were applied to individuals not involved in overhead athletics, clinical follow-up <24 months, adjacent rotator cuff or labral repair, concomitant SLAP repair, and/or previous arthroscopic shoulder surgery. Patient-reported outcome measures included visual analog scale (VAS), Kerlan Jobe Orthopaedic Clinic shoulder score, and Single Assessment Numerical Assessment. Clinical and sporting outcomes were recorded using a sports-specific questionnaire. Of 22 identified patients, 16 competitive overhead athletes (72.7%; 11 men, 5 women) with a mean age of 21.0 years were available at mean 4.5-year follow-up. Baseball or softball comprised the majority of patients (n = 9; 56.3%), followed by gymnastics (n = 2), swimming (n = 2), and other sports (n = 3). At mean 4.1 months postoperatively, 13 patients (81.3%) returned to previous level of athletic activity, whereas 2 patients (12.5%) failed to return to sporting activity and 1 (6.3%) returned at a lower level of competition. VAS pain significantly decreased from an average of 4.4 preoperatively to 1.7 postoperatively (P = .002), and mean Single Assessment Numerical Assessment scores also demonstrated significant improvement (55.4-76.7; P = .008). Final mean Kerlan Jobe Orthopaedic Clinic score was 74.0 (standard deviation 25.9), including 2 patients with suboptimal outcomes due to persistent pain. There were no significant differences in mean forward flexion or rotation in either the adducted or throwing position (P > .05), although small, significant decreases in postoperative active abduction were noted (165° vs 155°; P = .003). In the current series of competitive overhead athletes, 81% of patients returned to previous level of play at an average of 4.1 months postoperatively after subpectoral biceps tenodesis for symptomatic SLAP tear. Athletes reliably experienced significant decreased activity-related pain with athletic function. IV, case series.


Ecotoxicological aspects related to the occurrence of emerging contaminants in the Dinaric karst aquifer of Jadro and Žrnovnica springs.
Karst aquifers are globally important source of drinking water and harbor specific ecosystems that are vulnerable to anthropogenic contamination. This paper provides insights into the occurrence and ecotoxicological characterization of 21 emerging contaminants (ECs) detected in the karst catchment of Jadro and Žrnovnica springs (Dinarides, Croatia). Karst springs used for water supply, surface water, and groundwater were sampled during seven campaigns. The ECs concentration levels ranged from 0.3 ng/L (tramadol in Jadro spring) to 372 ng/L (1H-benzotriazole in Cetina River). DEET was the most frequently detected ECs with an average concentration of around 50 ng/L in both surface water and groundwater. To prioritise detected ECs, their persistence (P), bioaccumulation (B), mobility (M) and toxicity (T) were assessed based on in silico strategy for PBT assessment and recently developed REACH PMT guidelines. PBT scores ranging below the threshold of 0.5, indicated non-PBT compounds of expected low concern. However, only 4 out of 21 detected ECs were not assessed as PMT/vPvM. Concerningly, 20 ECs were categorised as very mobile. Karst springs exhibited larger proportions of ECs meeting PMT/vPvM criteria than surface water. To characterise the contamination extent and estimate the incidence of adverse effects of detected ECs, a preliminary environmental risk assessment (ERA) was conducted. Most ECs posed no environmental risk with RQ values predominantly below 0.01. The total risk quotient RQsite accentuated Cetina River as having the highest risk compared to other sampling sites. This is the first study on ECs in Croatian karst, contributing to a growing need to understand the impacts of emerging contaminants in karst aquifers, which are still largely unexplored.


Dynamic Reactive Ionization with Cluster Secondary Ion Mass Spectrometry.
Gas cluster ion beams (GCIB) have been tuned to enhance secondary ion yields by doping small gas molecules such as CH4, CO2, and O2 into an Ar cluster projectile, Arn + (n = 1000–10,000) to form a mixed cluster. The 'tailored beam' has the potential to expand the application of secondary ion mass spectrometry for two- and three-dimensional molecular specific imaging. Here, we examine the possibility of further enhancing the ionization by doping HCl into the Ar cluster. Water deposited on the target surface facilitates the dissociation of HCl. This concerted effect, occurring only at the impact site of the cluster, arises since the HCl is chemically induced to ionize to H+ and Cl– , allowing improved protonation of neutral molecular species. This hypothesis is confirmed by depth profiling through a trehalose thin film exposed to D2O vapor, resulting in ~20-fold increase in protonated molecules. The results show that it is possible to dynamically maintain optimum ionization conditions during depth profiling by proper adjustment of the water vapor pressure. H–D exchange in the trehalose molecule M was monitored upon deposition of D2O on the target surface, leading to the observation of [Mn* + H]+ or [Mn* + D]+ ions, where n = 1–8 hydrogen atoms in the trehalose molecule M have been replaced by deuterium. In general, we discuss the role of surface chemistry and dynamic reactive ionization of organic molecules in increasing the secondary ion yield.


Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift. Electrocardiographic features and angiographic correlation.
Eighteen patients with a first AMI, who during the acute ischemic phase did not develop ST segment elevation, but only positive or peaked T waves, are described. Patients who do not develop ST segment elevation during evolving anterior AMI represent a subgroup with a high probability of total obstruction of the LAD artery with retrograde filling via collateral vessels and a small degree of left ventricular dysfunction. We assume that during the period of total obstruction there was preexisting adequate collateral circulation in order to prevent transmural ischemia, which explains the absence of ST segment elevation.


Simultaneous implantation of bilateral ureters into bladder acellular matrix graft after partial cystectomy in a porcine model.
What's known on the subject? and What does the study add? The process of bladder regeneration with a bladder acellular matrix graft (BAMG) is thought to be accelerated by administration of vascular endothelial growth factor into the host bladder. In the present study, we showed that simultaneous implantation of bilateral ureters into a BAMG after a partial cystectomy is reasonable and provides an increased opportunity to the bio-scaffold for communication with host tissues from which a blood supply and stem cells will be generated. • To evaluate if the implantation of bilateral ureters into a bladder acellular matrix graft (BAMG) at the time of its implantation would enhance bladder regeneration in a partial substitution BAMG. • Partial cystectomies were performed under general anaesthesia in 12 pigs, followed by augmentation with a BAMG. • Six (ureteric implantation group) also received simultaneous implantation of bilateral ureters into the BAMG, while the remaining six (control group) did not have ureteric implantation. • In both groups, bladder regeneration was evaluated using endoscopic and histopathological methods at 1, 2, 4, and 8 weeks after implantation. • At 1 week after BAMG implantation, there were significant inflammatory changes on the host bladder in both groups, while no significant endoscopic changes were seen on the BAMG luminal surfaces. • At 2 weeks, inflammatory changes were diminished and epithelialisation on the BMAG was identified, especially near the host bladder in both groups. • Similarly, epithelialisation on the BAMG near the implanted ureters was seen in the ureteric implantation group. • At 4 and 8 weeks, epithelialisation remained in progress in both groups, although it was more active and expansive in the ureteric implantation group. • In our porcine model, endoscopic and histopathological examinations showed that simultaneous implantation of bilateral ureters into a BAMG enhanced epithelialisation of the AMG. • This new approach using host ureters and bladder as a potential source of bladder regeneration may provide for rapid and complete regeneration of a bladder substitute.


Environmental Susceptibility of the Sperm Epigenome During Windows of Male Germ Cell Development.
Male germ cells require multiple epigenetic reprogramming events during their lifespan to achieve reproductive capacity. An emerging body of compelling data demonstrates that environmental exposures can be embodied within the developing male germ cell as epigenetic marks. In turn, these epigenetic marks can impart information at fertilization to affect the trajectory of offspring health and development. While it is recognized that in utero epigenetic reprogramming of male germ cells is a particularly susceptible window to environmental exposures, other such windows exist during germ cell development. The objective of this review is to discuss epigenetic reprogramming events during male germ cell development and to provide supporting evidence from animal and human studies that during specific periods of development, germ cells are susceptible to environmentally induced epigenetic errors. Moving forward, the nascent field of sperm epigenetics research is likely to advance our understanding of paternal environmental determinants of offspring health and development.


Stereotactic Body Radiotherapy (SBRT) for primary and recurrent head and neck tumors.
Stereotactic Body Radiotherapy (SBRT) is increasingly used to treat a variety of head and neck tumors as a result of its highly conformal dose distributions and stereotactic spatial accuracy in delivery. Our experience and other previous reports have shown that SBRT is technically feasible, well-tolerated and compares favorably to other alternatives of salvage therapy in the management of patients with recurrent and/or previously irradiated head and neck cancers. Furthermore, it has the advantage of a shorter treatment schedule, greater compliance, and safe delivery in the outpatient setting. This affords an opportunity to introduce SBRT as a definitive treatment in select patients. This review presents an overview of the use of SBRT for managing head and neck tumors by highlighting the existing indications and the expanding role of SBRT in managing these patients.


The road-map for establishment of a prognostic molecular marker panel in glioma using liquid biopsy: current status and future directions.
Gliomas are primary intracranial tumors with defined molecular markers available for precise diagnosis. The prognosis of glioma is bleak as there is an overlook of the dynamic crosstalk between tumor cells and components of the microenvironment. Herein, different phases of gliomagenesis are presented with reference to the role and involvement of secreted proteomic markers at various stages of tumor initiation and development. The secreted markers of inflammatory response, namely interleukin-6, tumor necrosis factor-α, interferon-ϒ, and kynurenine, proliferation markers human telomerase reverse transcriptase and microtubule-associated-protein-Tau, and stemness marker human-mobility-group-AThook-1 are involved in glial tumor initiation and growth. Further, hypoxia and angiogenic factors, heat-shock-protein-70, endothelial-growth-factor-receptor-1 and vascular endothelial growth factor play a major role in promoting vascularization and tumor volume expansion. Eventually, molecules such as matrix-metalloprotease-7 and intercellular adhesion molecule-1 contribute to the degradation and remodeling of the extracellular matrix, ultimately leading to glioma progression. Our study delineates the roadmap to develop and evaluate a non-invasive panel of secreted biomarkers using liquid biopsy for precisely evaluating disease progression, to accomplish a clinical translation.


Impact of immunohistochemistry-based subtyping of GATA3, CK20, CK5/6, and CK14 expression on survival after radical cystectomy for muscle-invasive bladder cancer.
Molecular subtyping of muscle-invasive bladder cancer (MIBC) predicts disease progression and treatment response. However, standard subtyping based on transcriptomic analysis is relatively expensive. This study tried to use immunohistochemistry (IHC) to subtype MIBC based on GATA3, CK20, CK5/6, and CK14 protein expression. The IHC-based subtypes in MIBC subtypes were classified as luminal (GATA3+ CK5/6-, 38.6%), basal (GATA3-CK5/6+, 12.9%), mixed (GATA3+ CK5/6+, 37.9%), and double-negative (GATA3-CK5/6-, 10.6%) in 132 MIBC patients. All individual markers and clinicopathological parameters were analyzed against treatment outcomes after radical cystectomy. The mean patient age was 65.6 years, and the male to female ratio was 6.8:1. Positive IHC expression of GATA3, CK20, CK5/6, and CK14 were 80.3%, 50.8%, 42.4%, and 28.0%, respectively. Only GATA3 and CK5/6 were significantly associated with survival outcome (p values = 0.004 and 0.02). The mixed subtype was significantly better in 5-year OS at 42.8%, whereas the double-negative subtype had the worst prognosis (5-year OS 7.14%). The double-negative subtype had a hazard ratio of 3.29 (95% CI 1.71-6.32). Subtyping using GATA3 and CK5/6 was applicable in MIBCs, and patients with the double-negative subtype were at the highest risk and may require more intensive therapy.


Docetaxel-induced radiation recall dermatitis : A case report and literature review.
Radiation recall dermatitis (RRD) refers to an acute inflammatory skin reaction appearing on a previously irradiated area following the systemic administration of a reaction-triggering agent. Despite various hypotheses, the pathomechanism of RRD appears complex and is still not fully understood. In addition, no clinical guidelines exist concerning whether drug treatment should be continued upon manifestation of an associated radiation recall phenomenon. We present the case of a patient with docetaxel-induced RRD, which was successfully treated with topical steroids and systemic antihistamines; re-challenge to docetaxel did result in very mild remanifestation of skin reactions.


Combined mechanism of refractory shock in primary cardiac lymphoma: a rare dilemma.
Primary cardiac lymphoma is very rare, and usually manifests after the fifth decade of life. The lack of typical manifestations makes it difficult to diagnose at an early stage that can be discovered only by echocardiography. The location of the tumour often results in cardiac compromise, which prevents the delivery of potentially curative therapies. Clinical presentations may depend on flow obstruction, infiltration of adjacent tissues, tumour embolisation, and atrioventricular (AV) disturbances. We report a rare case of primary cardiac lymphoma that presented with clinical signs of shock from two distinct mechanisms. The first mechanism was intermittent complete AV block that was caused by disruption of the electrical conduction system from tumour infiltration in addition to direct mechanical compression of the atrioventricular node by the tumour. The second mechanism, subtotal RV inflow obstruction from the bulky mass contributed to compromising venous return, which played a major role of refractory shock in this case.


Should We Use Genetic Scores in the Determination of Treatment Strategies to Control Dyslipidemias?
Conventional risk stratification algorithms that rely on age, clustered phenotypic traits, and biomarkers under-recognize the sizeable subgroup of individuals at high polygenic risk for atherosclerotic cardiovascular disease (ASCVD). This review provides perspective on the promising role of genetic testing in cardiovascular prevention through the lens of lipid metabolism. Recent advances in cardiovascular genetics identified a number of common and rare variants affecting ASCVD risk. This genetic susceptibility can be assessed by polygenic risk scores (PRS) which quantify risk conferred by the cumulative impact of common variants. This results in a normally distributed spectrum of risk for coronary artery disease that is present at birth and amplifies the effects of modifiable risk factors including lipids. Polygenic risk is a significant determinant of ASCVD risk that is below the discrimination level of conventional guideline-based clinical frameworks. Genetic risk scores thus hold potential to refine phenotypic screening in cardiovascular prevention, identify subsets of the population that might derive particular benefit from early lifestyle and pharmaceutical interventions, and guide treatment eligibility. This might pave the way to personalized prevention aimed at reducing the unacceptable global burden of ASCVD.


[The effect of adenosine and its derivatives on the dynamics of delayed activity and the calmodulin level in various structures of the brain].
The adenosine and A1-adenosine receptor agonists produced shifts of DC potential and decreased the calmodulin levels in the animal hypothalamus.


Genetic and structural analysis of the ColE1 Rop (Rom) protein.
Repressor of primer (Rop) is a small dimeric protein that participates in the mechanism that controls the copy number of plasmid of the ColE1 family by increasing the affinity between two complementary RNAs. The Rop dimer is a bundle of four tightly packed alpha-helices that are held together by hydrophobic interactions. We have systematically altered, by site directed mutagenesis, most of the solvent exposed amino acids of the Rop bundle and we have identified the alterations that cause a decrease of the activity of the regulatory molecule. We conclude that Rop folding is rather insensitive to amino acid substitutions and to other mutations as drastic as deletions and insertions. Looking along the 2-fold symmetry axis the amino acid side chains whose alterations affect the function of Rop are all located on one side of the molecule. Furthermore they are clustered at the extremities of the alpha-helix bundle, the only exception being the aromatic ring of Phe-14.


Toward a new generation of vaginal pessaries via 3D-printing: Concomitant mechanical support and drug delivery.
To improve patient adherence, vaginal pessaries - polymeric structures providing mechanical support to treat stress urinary incontinence (SUI) - greatly benefit from 3D-printing through customization of their mechanics, e.g. infill modifications. However, currently only limited polymers provide both flawless printability and controlled drug release. The current study closes this gap by exploring 3D-printing, more specifically fused filament fabrication, of pharmaceutical grade thermoplastic polyurethanes (TPU) of different hardness and hydrophilicity into complex pessary structures. Next to the pessary mechanics, drug incorporation into such a device was addressed for the first time. Mechanically, the soft hydrophobic TPU was the most promising candidate for pessary customization, as pessaries made thereof covered a broad range of the key mechanical parameter, while allowing self-insertion. From the drug release point of view, the hydrophobic TPUs were superior over the hydrophilic one, as the release levels of the model drug acyclovir were closer to the target value. Summarizing, the fabrication of TPU-based pessaries via 3D-printing is an innovative strategy to create a customized pessary combination product that simultaneously provides mechanical support and pharmacological therapy.


Monitoring of multimodality evoked potentials during open heart surgery under hypothermia.
Multimodality evoked responses (ERs) were monitored in 16 adults who had cardiac surgery under cardiopulmonary bypass and moderate hypothermia (19-25 degrees C). Cooling affected all sensory ERs by progressively increasing the latencies of the major components. The effect was more profound on the later than on the earlier ER components. Visual evoked responses (VERs) were most inconsistent and always disappeared at temperatures below 25 degrees C. The later components of the long latency somatosensory evoked responses (SERs) also attenuated or disappeared rather early during hypothermia. On the other hand, short latency SERs were more resistant to the effects of hypothermia. They were always recordable at temperatures of 25 degrees C or above; and usually persisted even at temperatures between 20 and 25 degrees C. Brain-stem auditory evoked responses (BAERs) were consistently present at temperatures above 25 degrees C, wave V was recordable in majority between 20 and 25 degrees C. All sensory ERs disappeared with severe hypothermia (20 degrees C or less) except the components generated more peripherally such as N10 of the short latency SERs. We feel that BAERs and short latency SERs may serve as useful intraoperative monitors of brain function during hypothermia.


Entanglement of bosonic modes through an engineered exchange interaction.
Quantum computation presents a powerful new paradigm for information processing. A robust universal quantum computer can be realized with any well controlled quantum system, but a successful platform will ultimately require the combination of highly coherent, error-correctable quantum elements with at least one entangling operation between them1,2. Quantum information stored in a continuous-variable system-for example, a harmonic oscillator-can take advantage of hardware-efficient quantum error correction protocols that encode information in the large available Hilbert space of each element3-5. However, such encoded states typically have no controllable direct couplings, making deterministic entangling operations between them particularly challenging. Here we develop an efficient implementation of the exponential-SWAP operation6 and present its experimental realization between bosonic qubits stored in two superconducting microwave cavities. This engineered operation is analogous to the exchange interaction between discrete spin systems, but acts within any encoded subspace of the continuous-variable modes. Based on a control rotation, the operation produces a coherent superposition of identity and SWAP operations between arbitrary states of two harmonic oscillator modes and can be used to enact a deterministic entangling gate within quantum error correction codes. These results provide a valuable building block for universal quantum computation using bosonic modes.


Early-onset tolerance in rat global cerebral ischemia induced by a mitochondrial inhibitor.
It was studied whether a subtoxic dose of the mitochondrial neurotoxin, 3-nitropropionic acid (3-NPA), can initiate early-onset tolerance induction for subsequent ischemic injury. Wistar rats were pretreated for 3 h by intraperitoneal 3-NPA (20 mg/kg body weight; n=13) or solvent (n=12). Fifteen minutes global cerebral ischemia was induced by bilateral carotid artery occlusion and hypobaric hypotension. rCBF and tissue hemoglobin oxygen saturation were measured by laser Doppler scanning and a microspectrophotometric method. Ischemic insult and brain temperature were identical in both groups. Body weight and neurological scores recovered in the pretreated group but further deteriorated in the non-treated group (P<0.05). Quantitative histology demonstrated a better neuronal density in neocortex and hippocampal CA2, CA3, and CA4 of pretreated animals (P<0.05).


Portable and cost-effective pixel super-resolution on-chip microscope for telemedicine applications.
We report a field-portable lensless on-chip microscope with a lateral resolution of <1 μm and a large field-of-view of ~24 mm(2). This microscope is based on digital in-line holography and a pixel super-resolution algorithm to process multiple lensfree holograms and obtain a single high-resolution hologram. In its compact and cost-effective design, we utilize 23 light emitting diodes butt-coupled to 23 multi-mode optical fibers, and a simple optical filter, with no moving parts. Weighing only ~95 grams, we demonstrate the performance of this field-portable microscope by imaging various objects including human malaria parasites in thin blood smears.


[Molecular identification of non-tuberculous mycobacteria].
Nontuberculous mycobacteria can be saprophytic, pathogenic or opportunistic. The most common diseases produced by these microorganisms are the post-surgical infections due to anesthetic procedures, infections associated with catheters, disseminated cutaneous diseases and pulmonary and central nervous system diseases that especially affect HIV patients. Identification of the nontuberculous mycobacteria can take several weeks and even then, differentiation of complex members is not possible. The PCR-restriction analysis (PRA) technique was evaluated as a method for genotypic identification of nontuberculous mycobacteria isolated of clinical samples located in the culture collection of the Instituto Nacional de Salud (National Institute of Health), Bogotá, Colombia. Seventy clinical isolates of nontuberculous mycobacteria stored in 50% glycerol at -70 degrees C were identified by phenotypic techniques. The genotypic identification was made using the PCR-restriction analysis (PRA) using the restriction enzymes BstEII and HseIII, the restriction products were visualized on gels of agarose to 3%, and the concordance between the methodologies was evaluated. A matching of 100% was obtained in the identification of Mycobacterium terrae, M. szulgai, M. avium, M. chelonae and M. scrofulaceum, the matching between M. fortuitum species, M. abscessus, M. gordonae and M. intracellulare varied from 44 to 89%; there was no concurrence in the identification of species M. flavescens and M. malmoense. PRA provided a fast, inexpensive and accurate alternative for the identification of nontuberculous mycobacteria that permited the differentiation among species of a complex and determining the subtype of each species sample.


Effects of ACNU, a water-soluble nitrosourea derivative, on survival and cell kinetics of cultured HeLa S3 cells.
Effects of a water-soluble nitrosourea, 1(4-aminomethylpyrimidine-5yl)methyl-3-(2-chloroethyl)-3-nit rosourea hydrochloride (ACNU) was investigated on cultured HeLa S3 cells with regard to their lethality and cell progression through the cell cycle. The survival curve of exponentially growing cells exposed to increasing concentrations of the drug for 1 hr was characterized by a threshold type of response (Do = 7.0 micrograms/ml X 1 hr, Dq 3.5 micrograms/ml X 1 hr). Throughout the cell cycle, ACNU exerted its main killing effect on cells in the G1 and G2 + M phases, whereas cells in S were resistant to the drug. The change in their age-response was due to the Do value of the dose-survival curve rather than the Dq. Effects of cell progression were also examined at a low concentration of ACNU (5.0 micrograms/ml), which allowed 80% of treated cells to survive. Delayed transit was observed in the S phase, and more markedly in the G2 + M phase. The magnitude of these perturbations depended on the position of the cell cycle at which the drug was administered. Cells treated in the G1 and early S phases showed a much longer duration of S and G2 + M phases than cells treated in mid-S phase. Cells treated in the late S and G2 phases could normally pass through mitosis, but were subsequently blocked in the G2 phase following a prolonged S phase in the next cell cycle. These studies revealed that there seems to be some positive relationship of the effect of ACNU on cell progression and cell killing throughout the cell cycle.


Realism-based assessment of the efficacy of potassium peroxymonosulphate on Stenotrophomonas maltophilia biofilm control.
The potential of pentapotassium bis(peroxymonosulphate) bis(sulphate) (OXONE) to control biofilms in drinking water distribution systems (DWDS) was evaluated and compared to chlorine disinfection. Mature biofilms of drinking water (DW)-isolated Stenotrophomonas maltophilia were formed using a simulated DWDS with a rotating cylinder reactor (RCR). After 30 min of exposure, OXONE at 10 × minimum bactericidal concentration (MBC) caused a significant 4 log reduction of biofilm culturability in comparison to the unexposed biofilms and a decrease in the number of non-damaged cells below the detection limit (4.8 log cells/cm2). The effects of free chlorine were restricted to approximately 1 log reduction in both biofilm culturability and non-damaged cells. OXONE in synthetic tap water (STW) at 25 ºC was more stable over 40 days than free chlorine in the same conditions. OXONE solution exhibited a disinfectant decrease of about 10% of the initial concentration during the first 9 days, and after this time the values remained stable. Whereas possible reaction of chlorine with inorganic and organic substances in STW contributed to free chlorine depletion of approximately 48% of the initial concentration. Electron paramagnetic resonance (EPR) spectroscopy studies confirmed the presence of singlet oxygen and other free radicals during S. maltophilia disinfection with OXONE. Overall, OXONE constitutes a relevant alternative to conventional DW disinfection for effective biofilm control in DWDS.


Current Trends in Artificial Intelligence Application for Endourology and Robotic Surgery.
With the advent of electronic medical records and digitalization of health care over the past 2 decades, artificial intelligence (AI) has emerged as an enabling tool to manage complex datasets and deliver streamlined data-driven patient care. AI algorithms have the ability to extract meaningful signal from complex datasets through an iterative process akin to human learning. Through advancements over the past decade in deep learning, AI-driven innovations have accelerated applications in health care. Herein, the authors explore the development of these emerging AI technologies, focusing on the application of AI to endourology and robotic surgery.


The Inhibitory Effect of Ojeoksan on Early and Advanced Atherosclerosis.
Atherosclerosis is closely related to vascular dysfunction and hypertension. Ojeoksan (OJS), originally recorded in an ancient Korean medicinal book named "Donguibogam", is a well-known, blended herbal formula. This study was carried out to investigate the beneficial effects of OJS on atherosclerosis in vitro and in vivo. Western-diet-fed apolipoprotein-E gene-deficient mice (ApoE -/-) were used for this study for 16 weeks, and their vascular dysfunction and inflammation were analyzed. OJS-treated ApoE -/- mice showed lowered blood pressure and glucose levels. The levels of metabolic parameters with hyperlipidemia attenuated following OJS administration. Hematoxylin and eosin (H&E) staining revealed that treatment with OJS reduced atherosclerotic lesions. OJS also suppressed the expression of adhesion molecules and matrix metalloproteinases (MMPs) compared to Western-diet-fed ApoE -/- mice and tumor necrosis factor-alpha (TNF-α)-stimulated human umbilical vein endothelial cells (HUVECs). Expression levels of MicroRNAs (miRNA)-10a, -126 3p were increased in OJS-fed ApoE -/- mice. OJS significantly increased the phosphorylation of endothelial nitric oxide synthase (eNOS) and protein kinase B (Akt), which are involved in nitric oxide (NO) production. OJS also regulated eNOS coupling by increasing the expression of endothelial GTP Cyclohydrolase-1 (GTPCH). Taken together, OJS has a protective effect on vascular inflammation via eNOS coupling-mediated NO production and might be a potential therapeutic agent for both early and advanced atherosclerosis.


The prognostic significance of acute phase proteins in patients with inoperable squamous cell carcinoma of the bronchus.
In 95 patients with inoperable squamous cell carcinoma of the bronchus, nine potential serum "markers" were analysed for their prognostic significance. Lactate dehydrogenase, alpha 1 HS-glycoprotein, ferritin, carcino-embryonic antigen and immunoglobulin E did not prove to be useful as prognostic indices. The erythrocyte sedimentation rate and the acute phase proteins alpha 1 acid glycoprotein, C-reactive protein and prealbumin were correlated with survival. After taking the performance status and tumour stage into account, C-reactive protein still proved to be a strong prognosticator. The clinical relevance of the acute phase proteins signifying a so-called "biochemical status" next to the "clinical status" is discussed.


Cone monochromacy and a reversed Purkinje shift in the gerbil.
Retinal spectral sensitivity of the gerbil (Meriones unguiculatus) shows that this animal has a unique photoreceptor complement: there is only a single class of cone and the spectrum for these receptors is peak shifted toward the short wavelengths relative to the spectra obtained from rods.


Pharmacokinetics and Bioequivalence of 2 Azithromycin Tablet Formulations: A Randomized, Open-Label, 2-Stage Crossover Study in Healthy Volunteers.
The current study aimed to assess the bioequivalence of a new branded azithromycin with the reference formulation. An open-label, randomized, 2-stage, crossover study design was implemented involving 77 healthy volunteers under fasting conditions. Each volunteer received a single dose of 250-mg azithromycin tablets test and reference formulations separated by a 21-day washout period. Twenty-two samples were collected at pre-dose and until 72 hours post-dose. Azithromycin concentrations were analyzed using a high-performance liquid chromatography-mass spectrometry validated method following a solid-phase plasma extraction. Noncompartmental analysis was carried out to estimate the pharmacokinetic parameters, which were compared between the test and reference products using a multivariate analysis of variance. The difference between Cmax and AUC0-72 of the test and reference formulation was not significant. The 94.1% confidence intervals of ln-transformed Cmax and AUC0-72 of azithromycin were within the bioequivalence acceptance limits of 80%-125%, therefore it can be concluded that the tested formulation is bioequivalent to the reference formulation.


LUBAC and NF-κB trigger a nuclear response from mitochondria.
Mitochondria are key signaling hubs for innate immune responses. In this issue, Wu et al (2022) report that remodeling of the outer mitochondrial membrane by the linear ubiquiting chain assembly complex (LUBAC) facilitates transport of activated NF-κB to the nucleus in response to TNF signaling.


Poly[bis-[μ2-4,4'-bis-(imidazol-1-ylmeth-yl)biphenyl-κ2 N:N']di-chlorido-nickel(II)].
In the title compound, [NiCl2(C20H18N4)2] n , the Ni2+ cation is situated on an inversion center and is coordinated by two chloride ions and four imidazole N atoms of four different 4,4'-bis-[(1H-imidazol-1-yl)meth-yl]-1,1'-biphenyl (BIMB), forming a slightly distorted octa-hedral geometry. Each BIMB ligand adopts a linear linker to connect Ni2+ ions, forming a two-dimensional layer with an sql network. In the crystal, neighboring layers repeat in an ABAB stacking mode, and weak inter-molecular C-H⋯Cl hydrogen bonds between alternate layers lead to a three-dimensional, twofold inter-penetrated, supra-molecular framework with a pcu topology net.


Cross talk between the upstream exon-intron junction and Prp2 facilitates splicing of non-consensus introns.
Splicing of mRNA precursors is essential in the regulation of gene expression. U2AF65 recognizes the poly-pyrimidine tract and helps in the recognition of the branch point. Inactivation of fission yeast U2AF65 (Prp2) blocks splicing of most, but not all, pre-mRNAs, for reasons that are not understood. Here, we have determined genome-wide the splicing efficiency of fission yeast cells as they progress into synchronous meiosis in the presence or absence of functional Prp2. Our data indicate that in addition to the splicing elements at the 3' end of any intron, the nucleotides immediately upstream the intron will determine whether Prp2 is required or dispensable for splicing. By changing those nucleotides in any given intron, we regulate its Prp2 dependency. Our results suggest a model in which Prp2 is required for the coordinated recognition of both intronic ends, placing Prp2 as a key regulatory element in the determination of the exon-intron boundaries.


Structural analysis of a set of socioeconomic indexes as an aid in defining the socioeconomic level of a family: results from an italian multicentric survey.
The study of possible associations between social and health factors was one of the purposes of the multicentric Italian survey of perinatal preventive medicine. To get a concise and coherent social indicator, which could be useful to this study, we explored the socioeconomic information systematically collected on the parents of 12,058 babies born in 1973-1975 in four centres (Trieste, Milan, Parma and Bari), which reflect some of the heterogeneous aspects of Italy. The Correspondence analysis indicated that the seven considered indexes, concerning both parents' education levels and occupations, dwelling quality and the length of father's residence in the area in which the baby was born, were highly and similarly correlated in each centre. The Dynamic cluster analysis enabled us to bring together the socioeconomic profiles of the families into six classes, on the basis of their similarities, which depend only upon the multivariate distribution of the seven categorical variables under study. Therefore, the attained classification not only is independent of whatever score is assigned to the socioeconomic categories but also allows for the strong interactions between the variables and exploits all the available information. Our six classes were found to be rather similar to the six socioeconomic groups (S.E.G.) of the U.K. Registrar General and to show some resemblance to certain social groups defined by other classifications adopted in obstetric and pediatric field. The socioeconomic indicator constructed here should enable us to find out how much, in different areas of Italy, the social classes may account for inequalities in health conditions and care of the mother and her baby.


Ornamental roses for conservation of leafcutter bee pollinators.
Pollinator conservation is a global priority. Efforts are taken to restore pollinators by improving flower resources, a crucial driver of pollinator diversity and population growth. It helped gardening and landscaping supply chains, which introduced lists of bee-friendly plants and bee hotels, yet, desirable results seem distant. One shortcoming of the present schemes is that they lack a cohesive planning for nesting opportunities and nesting provisions for wild solitary bees, the crucial pollinators of crop and wild plants. We tested whether the world's popular ornamental plant, rose (Rosa chinensis Jacq.)-a hitherto unlisted bee-friendly plant-can aid in conserving leafcutter bees, which require fresh leaves for constructing nest cells. We surveyed 2360 rose plants in 136 sites in rural and urban places and lowlands and highlands of south (8°N-12°N) and northeastern India (26°N-27°N) for the characteristic notches the bees leave on foraged leaves. We reared brood constructed with rose and non-rose leaves to examine the brood success rate. About a quarter of all the roses surveyed had the notches of leafcutter bees on the leaves. However, the proportion of cut roses varied considerably among sites. Bees used roses much higher in urban areas and lowlands than in rural areas and highlands. The selection of plants was negatively associated with pesticide application. The brood success rate was 100% for the brood that was constructed by the leaves of rose and non-rose plants. Rose flowers do not support bees, but rose leaves indeed do. We recommend rose plants in leafcutter bee conservation and restoration schemes, particularly in urban environment.


Canine distemper, a re-emerging morbillivirus with complex neuropathogenic mechanisms.
Paramyxoviruses are responsible for a wide variety of diseases both in humans and in animals. Common to many paramyxoviruses is the fact that they can cause neurological symptoms in their final host. Newly discovered paramyxoviruses, such as the Hendra and Nipah viruses, show the same pattern of pathogenesis as that of the paramyxoviruses already known. Canine distemper virus (CDV) is a well-studied member of the genus Morbillivirus. Study of the neuropathogenesis of CDV might give insight into disease mechanisms and suggest approaches for the prevention of other recently discovered paramyxovirus infections.


DNA Barcoding Identification of Kadsurae Caulis and Spatholobi Caulis Based on Internal Transcribed Spacer 2 Region and Secondary Structure Prediction.
Kadsurae Caulis and Spatholobi Caulis have very similar Chinese names. Their commodities were hard to distinguish because their stems were very alike after dried and processed. These two herbal drugs were often mixed in clinical use. Authenticity assurance is crucial for quality control of herbal drugs. Therefore, it is essential to establish a method for identifying the two herbs. In this paper, we used the DNA barcoding technology, based on the internal transcribed spacer 2 (ITS2) regions, to differentiate Kadsurae Caulis and Spatholobi Caulis. The ITS2 of these two herbs were very different. They were successfully differentiated using the DNA barcoding technique. DNA barcoding was a promising and reliable tool for the identification of medicinal plants. It can be a powerful complementary method for traditional authentication. The internal transcribed spacer 2 (ITS2) regions between Kadsurae Caulis and Spatholobi Caulis varied considerably, totally 139 variable sitesSample 1 was not Kadsurae Caulis as it labeled, but it should be Spatholobi Caulis in fact based on ITS2 regionThe secondary structure can also separate Kadsurae Caulis and Spatholobi Caulis effectivelyDNA barcoding provided an accurate and strong prove to identify these two herbs. Abbreviations used: CTAB: hexadecyltrimethylammonium bromide, DNA: deoxyribonucleic acid, ITS2:internal transcribed spacer 2, PCR: polymerase chain reaction.


[Vascular malformations of the posterior fossa with otorhinolaryngological symptoms (author's transl)].
Aneurysms, angiomas and arterio-venous fistulas of the posterior fossa are neurosurgical problems. However, if these malformations produce symptoms like deafness, tinnitus, vertigo or nystagmus otorhinolaryngologists are involved. Pathogenetic factors are either the local pressure of the malformation or reduction of cerebral or pontine blood supply. The otorhinological, neurological and diagnostical problems of these malformations are presented. Special emphasis is applied to the operative procedures.


Smoking and secondary ACL rupture are detrimental to knee health post ACL injury-a Bayesian analysis.
To identify potential prognostic factors for patient-reported outcomes in an Icelandic cohort of ACL injured subjects. All knee MRI reports written in Iceland between the years 2001 to 2011 were read to identify individuals with a possible ACL injury. These individuals were contacted and asked to complete an online questionnaire regarding their injury and current knee related health. The questionnaire collected information on years since surgery, injury circumstance, brace use, physiotherapy, ACL surgery, second ACL injury and current smoking status. In addition, the baseline status of their meniscii were assessed from the original MRI report and medical records were used to identify any subsequent, non-ACL surgery. The patient-reported Knee Osteoarthritis and Injury Outcome Score (KOOS) was used assess current knee related health. A Bayesian proportional odds model was used to assess the effect of all potential prognostic factors above as well as age and sex on KOOS outcomes. A total of 408 subjects completed the questionnaire indicating that they did rupture their ACL. The following variables were associated with worse outcomes across all KOOS subscales: having a subsequent arthroscopy, reinjury to your ACL, and smoking. Having physiotherapy for 9 months was associated with worse KOOS pain scores than having 6 months of physiotherapy. Conversely KOOS pain score tended to be higher if you injured your knee during sports. Reinjuring your ACL, smoking and having subsequent (non-ACLR) surgery predict your knee related health following an ACL injury. Strategies should be implemented to reduce the risk of secondary ACL injury, and patients should be strongly advised not to smoke.


Well connected: pharmacy education and the humanities.
Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of what patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients' problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences.


Current aspects of organoid technology for biomaterial toxicity analysis.
Organoids provide us an opportunity to understand how diseases affect cellular physiology, human tissues or organs. They are indespensible tools for biomaterial toxicity analysis, drug discovery and regenerative medicine.


Intrathecal anti-tetanus serum (ATS) and parenteral betamethasone in the treatment of tetanus.
217 cases of tetanus admitted to Christian Medical College and Brown Memorial Hospital, Ludhiana, from June 1977 to April 1980 were studied. Three treatment regimes were used during this period. The addition of intrathecal horse antitetanus serum (ATS) (Group II) to the routine treatment (Group I) reduced the mortality from 63% to 53% but this was not statistically significant. Following a further addition of parenteral betamethasone to the regimen (Group III) the mortality decreased to 27% which was significantly lower than in Groups I and II. A similar trend in mortality was demonstrated when the severe cases were analysed separately. Groups I and III were comparable in terms of various prognostic factors and the nursing care received but Group II had a higher incidence of unfavourable prognostic factors, which may have obscured the benefit of intrathecal ATS. The combination of parenteral betamethasone and intrathecal ATS seems to be beneficial in the treatment of tetanus.


Morphological appearance of low-level echoes in the gallbladder. Interpretation with microscopic biliary analysis and clinical correlation.
A total of 743 patients affected by various gastrointestinal disorders were examined by ultrasound. The presence in the gallbladder bile of low-level echoes (LLE) was observed in 56 (7.5%). Twenty-six of these patients had surgery: 24 underwent cholecystectomy for important biliary-like painful symptomatology, and 2 had cephalopancreatectomy for pancreatic head carcinoma. Both macro- and microscopic controls of the bile were carried out in all 26 patients. In 20 cases, only microscopic cholesterol crystals and calcium bilirubinate granules were observed in the bile. The microscopic evidence of these crystals was associated in four cases with macroscopic evidence of so-called "biliary sludge" and in four cases with macroscopic evidence of highly viscous bile. In the other 6 cases these crystals were associated with the presence of cholesterol stones. The authors consider that the observation of LLE in the gallbladder bile is an important index of the presence of cholesterol crystals and/or calcium bilirubinate granules. These LLE can assume polymorphic aspects, described by the authors, which may simulate other pathologies and lead to incorrect echographic diagnosis. The high incidence of LLE in an alithiasic population (5.1%), together with the elevated frequency, according to the authors, of association of these echoes with a painful biliary-like symptomatology (52.6%), underlines the diagnostic importance of an accurate ultrasound investigation in this type of pathology.


Generation of a monoclonal antibody against Mycoplasma spp. following accidental contamination during production of a monoclonal antibody against Lawsonia intracellularis.
This report describes Mycoplasma contamination of Lawsonia intracellularis cultures that led to the unintended acquisition of a monoclonal antibody against Mycoplasma spp. during the attempted generation of a monoclonal antibody against L. intracellularis.


Cranial autonomic symptoms in migraine: characteristics and comparison with cluster headache.
Cranial autonomic symptoms (CAS) are distinguishing features of trigeminal autonomic cephalalgias, of which cluster headache (CH) is the most common, but they can occur in patients with migraine. For migraine with strictly unilateral headache, the presence of CAS might cause diagnostic confusion with CH. Characteristics of CAS in migraine and comparisons with those in CH have rarely been reported. This study prospectively recruited consecutive patients with migraine and CH treated at a headache clinic. Six CAS items were surveyed, including: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, eyelid oedema and forehead/facial sweating. The CAS characteristics recorded included: laterality, intensity, time sequence and consistency with headache attacks. A total of 786 migraine patients (625 women/161 men, mean age 40 (13) years) and 98 CH patients (11 women/87 men, mean age 36 (11) years) were recruited. The prevalence of > or =1 CAS in migraine patients was 56% and did not differ among migraine subtypes. Except for forehead/facial sweating, the features of the other CAS differed between patients with migraine and CH: CAS in migraine tended to be bilateral (OR 5.8-23.8 among different CAS), be unrestricted to the headache sides (OR 5.0-20.4), appear with mild to moderate intensity (OR 1.7-7.7) and be inconsistent with headache attacks (OR 2.8-6.7). CAS were present in half of our migraine patients and the clinical features may help differentiate migraine from CH.


Changes in cardiac metabolism, perfusion, ECG and plasma catecholamines during increased intracranial pressure in the pig.
The effects of graded elevations of intracranial pressure (ICP) on cardiac metabolism, blood flow and electrophysiology, and plasma catecholamines were studied in eight open-chest pigs. ICP was consecutively elevated from 15 +/- 3 mmHg in the control state to 40 +/- 4, 84 +/- 4 and 152 +/- 11 mmHg. Mean arterial blood pressure and heart rate were significantly increased at the two highest ICP levels. Cardiac oxygen uptake was also increased from 2.9 +/- 0.4 ml X min-1 to a maximum of 7.1 +/- 2.0 ml X min-1, and coronary sinus blood flow increased from 49 +/- 7 to 131 +/- 35 ml X min-1 at the highest ICP level. The transmyocardial blood flow distribution was unchanged, as determined by the microspheres technique. Arterial plasma catecholamine concentrations were significantly elevated at the two highest ICP levels, but noradrenaline overflow from the heart did not increase. The high arterial adrenaline concentrations (51 +/- 25 nmol X 1(-1) at the highest ICP level) may be responsible for the cardiac stimulation seen in these experiments. No signs of ischaemia, as judged by myocardial lactate production or the relative flow distribution to the endocardium were observed. Changes in the T-wave morphology appeared in the subendocardial ECG at all ICP levels, the changes being more prominent with increasing ICP levels. It is concluded that the increase in circulating catecholamine levels, adrenaline in particular, together with an elevation of afterload cause an increase of myocardial work, which may explain the T-wave changes in the ECG which are observed upon rapid elevation of intracranial pressure.


Spleen-left kidney ratio and liver-right kidney ratio: novel measures of normal liver, spleen, and kidney dimensions in Southwestern Nigerian children.
Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased. This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20. The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337). The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.


Towards the cloning of genes underlying murine QTLs.
Many quantitative trait loci (QTLs), including those for ethanol-related traits, have been mapped in the mouse. In light of rapidly developing tools and resources, we briefly review the strategy for identifying the genes underlying these QTLs. We note that positional cloning will soon be a matter of testing candidate genes rather than discovering genes; therefore, we describe a "congenic test" to support that a candidate gene is indeed a QTL. Considering the rapid development of congenics and mutants, we also identify four areas of investigation-phenotypes, ethanol specificity, environment, and gene interactions-that might be exploited during the course of positional cloning to gain insights into QTL pathways. In particular, we note that multiple mutants of nearly every major neurotransmitter pathway have now been made. These mutants are not only useful for phenotypic tests, but also could be used to conduct "gene dependence" tests of QTLs. We also consider potential applications for the very recently developed ability to clone mice.


Prevalence, incidence and survival outcomes of cardiac sarcoidosis in the South Island, New Zealand.
Cardiac sarcoidosis (CS) is an important cause of mortality in patients with sarcoidosis. The aim of this retrospective cohort study was to characterize the prevalence, incidence, clinical features and outcomes of CS in the southern region of New Zealand. 45 patients were identified: 23 fulfilling international classification criteria, 9 fulfilling physician consensus criteria, and 13 classified as possible CS. As of June 2021, 26 patients were living and domiciled in the Canterbury district; estimated point prevalence was 4.43 cases per 100,000 people. The average annual incidence was 0.24 cases per 100,000 people between 2016 and 2020. We estimated a 5.14% frequency of CS in patients with sarcoidosis. Median age at presentation was 56 years (range 31-72). Common presentations included heart failure, heart block and life threatening ventricular and supraventricular arrhythmias. Electrocardiogram abnormalities were found in 93.3% and cardiac MRI was often relied upon by physicians for diagnosis. The 10-year survival was 94% (95% CI 78-99%). Our study provides further insight into the epidemiology of CS. In this retrospective cohort the frequency of CS amongst patients with sarcoidosis was estimated at 5%, whilst the estimated point prevalence of the disease was twice that of a contemporary report from the Northern hemisphere. The 10-year survival was similar to contemporaneous reports from other developed countries.


Validating a measure of motivational climate in health science courses.
The aim of the study was to examine the validity evidence for the 19-item form of the MUSIC Model of Academic Motivation Inventory (College Student version) within health science schools in three different countries. The MUSIC Inventory includes five scales that assess the motivational climate by measuring students' perceptions related to five separate constructs: empowerment, usefulness, success, interest, and caring. The 26-item form of the MUSIC Inventory has been validated for use with undergraduate students and with students in professional schools, including students at a veterinary medicine school, a pharmacy school, and a medical school. A 19-item form of the MUSIC Inventory has also been validated for use with undergraduate students, but it has not yet been validated for use with medical school students. The purpose of this study was to provide validity evidence for the use of the 19-item form in heath science schools in three different countries to determine if this version is acceptable for use in different cultures. If validated, this shorter form of the MUSIC Inventory would provide more differentiation between the Interest and Usefulness scales and could reduce respondent fatigue. Cook et al's [1] practical guidelines were followed to implement Kane's [2] validity framework as a means to examine the evidence of validity through scoring inferences, generalization inferences, and extrapolation inferences. Students (n = 667) in health science schools within three countries were surveyed. The results produced evidence to support all five hypotheses related to scoring, generalization, and extrapolation inferences. Scores from the 19-item form of the MUSIC Inventory are valid for use in health science courses within professional schools in different countries. Therefore, the MUSIC Inventory can be used in these schools to assess students' perceptions of the motivational climate.


[Risk reduction and drug use in detention: study about the detainees of Liancourt Penitentiary].
The prison population is drug users. Recent debates around the provision of devices to reduce the risks associated with drug use (syringe exchange programs and snort kit) lead us to question local practices of the prison population. An anonymous questionnaire was offered to the prison population of the Liancourt penitentiary. The questions addressed the use of drugs before and during incarceration, knowledge of HIV and B and C hepatitis status, taking an opiate substitution treatment and advice on the implementation of syringe exchange programs and snort kit. A percentage of 54.4 of the prisoners responded to the questionnaire. An amount of 60.1 % of respondents consumed at least one drug before incarceration and 43.6 % of respondents consumed at least one drug during their incarceration. Cannabis was the most consumed drug before and during incarceration. Barely half of respondents reported knowing their HIV and hepatitis B and C status. Over 10 % of respondents said they were interesting in establishing needle exchange programs or snort kit. The prison concentrate drug users and is not a repressive tool of efficient risk reduction. The strategies implemented by the medical unit of Liancourt prison require adaptations that warrant development of health resources. Then, only new tools to reduce risks associated with drug use can be established.


Ophthalmic considerations in cleft lip and palate patients.
Cleft lip and palate (CL and P) represents the second most frequently occurring congenital deformity after clubfoot deformity. CL and P could be associated with many other structural abnormalities of the adjacent vital structures of the face. In this study, an attempt was made to identify the abnormalities of the ocular structures seen in patients with isolated CL and P as well as in those with syndromic CL and P. Of the 322 patients with cleft lip and palate screened, 27 (8.3%) had ocular abnormalities. Totally 47 ocular defects were identified in 27 patients. Abnormalities of the eyelid were the commonest accounting for 22% of the total defects (11/47), which includes symblepharon, ectropion, lid colobomas, euryblepharon and ptosis. Second commonest abnormality was squint 8/47 (17%) followed by orbital defects 8/47 (17%) (Telecanthus and Hypertelorism). Abnormalities of the nasolacrimal apparatus 3/47 (6%), refractive errors 7/47 (15%), dermoids 4/47 (6%), cataract 2/47 (4%) and retinal colobomas 2/47 (4%) constituted the rest. Thus, children with cleft lip and palate should be assessed as soon as possible after birth by a multidisciplinary team involving the Pediatrician, Ophthalmologist and specialists from Maxillofacial, ENT and Plastic surgery. The medical problems in this group of children are global and therefore, should not be looked at in isolation.


Abortion caused by electrical current.
A case of electrical accident in a pregnant woman at 9 weeks of gestation is described. No fetal heart activity was noted immediately after the injury, and spontaneous abortion occurred two days later.


Congenital nasal pyriform aperture stenosis associated with central diabetes insipidus.
We describe a child who has central diabetes insipidus associated with congenital nasal pyriform aperture stenosis without any apparent anterior pituitary dysfunction. This association further strengthens the concept that congenital nasal pyriform aperture stenosis may be a microform of holoprosencephaly.


Comparative Efficacy and Safety of Conservative Care for Pregnancy-Related Low Back Pain: A Systematic Review and Network Meta-analysis.
More than one-half of pregnant women experience pregnancy-related low back pain (LBP). Pregnancy-related LBP greatly affects activities of daily life, and although many interventions have been proposed, the optimal treatment for pregnancy-related LBP remains unclear. The purpose of this study was to compare conservative care strategies on their efficacy and safety for women with pregnancy-related LBP through systematic review with pairwise meta-analysis and network meta-analysis. MEDLINE, Embase, the Cochrane Library, AMED, CINAHL, PEDro, PsycINFO, and ClinicalTrials.gov were searched from inception to November 2019. Randomized controlled trials and observational controlled studies were included without restriction to language, sample size, or duration of follow-up. Two independent investigators extracted the data and assessed the risk of bias. The quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation. Twenty-three studies were included in the qualitative synthesis (18 randomized controlled trials were included in the network meta-analysis). For women with LBP during pregnancy, progressive muscle relaxation therapy (mean difference = -3.96; 95% CI = -7.19 to -0.74; moderate-quality evidence) and Kinesio Taping (mean difference = -3.71; 95% CI = -6.55 to -0.87; low-quality evidence) reduced pain intensity (Visual Analog Scale, range = 0 to 10) compared with placebo. Moderate-quality evidence suggested that transcutaneous electrical nerve stimulation improved physical function (mean difference = -6.33; 95% CI = -10.61 to -2.05; Roland Morris Disability Questionnaire, range = 0-24) compared with placebo. For patients with LBP during pregnancy, progressive muscle relaxation therapy and Kinesio Taping may help to decrease pain, and transcutaneous electrical nerve stimulation may improve physical function. This review helps fill the gap in evidence regarding optimal treatment for pregnancy-related LBP. If you have LBP during pregnancy, your physical therapist has evidence to support the use of progressive muscle relaxation therapy and Kinesio Taping to help decrease pain and the use of transcutaneous electrical nerve stimulation to help improve physical function.


The multitaskers of the brain: Glial responses to viral infections and associated post-infectious neurologic sequelae.
Many viral infections cause acute and chronic neurologic diseases which can lead to degeneration of cortical functions. While neurotropic viruses that gain access to the central nervous system (CNS) may induce brain injury directly via infection of neurons or their supporting cells, they also alter brain function via indirect neuroimmune mechanisms that may disrupt the blood-brain barrier (BBB), eliminate synapses, and generate neurotoxic astrocytes and microglia that prevent recovery of neuronal circuits. Non-neuroinvasive, neurovirulent viruses may also trigger aberrant responses in glial cells, including those that interfere with motor and sensory behaviors, encoding of memories and executive function. Increasing evidence from human and animal studies indicate that neuroprotective antiviral responses that amplify levels of innate immune molecules dysregulate normal neuroimmune processes, even in the absence of neuroinvasion, which may persist after virus is cleared. In this review, we discuss how select emerging and re-emerging RNA viruses induce neuroimmunologic responses that lead to dysfunction of higher order processes including visuospatial recognition, learning and memory, and motor control. Identifying therapeutic targets that return the neuroimmune system to homeostasis is critical for preventing virus-induced neurodegenerative disorders.


Association of online health information seeking behavior with levels of knowledge about palliative care among older adults.
This study examined the knowledge, misconceptions, and predictors of palliative care among older adults using nationally representative data. A cross-sectional analysis was conducted with 1,390 respondents (≥ 50 years) from cycle 2 of the 2018 Health Information National Trends Survey (HINTS). Overall, 63.53% of older adults reported that they had never heard of palliative care. Among those who reported knowledgeable about palliative care, 33.33% thought palliative care is the same as hospice, and 41.42% automatically linked palliative care to death. Ordered logistic regression analysis revealed that online health information seeking behavior is a significant predictor of the level of knowledge about palliative care among older adults. Older adults who utilized the internet for health information were 2.16 (p < .001) times more likely to report being knowledgeable about palliative care than non-internet users. Findings from this study indicate that public health education efforts are needed to increase palliative care knowledge among older adults and the internet may be the key to improving health literacy in palliative care for them.


Phenotyping asthma, rhinitis and eczema in MeDALL population-based birth cohorts: an allergic comorbidity cluster.
Asthma, rhinitis and eczema often co-occur in children, but their interrelationships at the population level have been poorly addressed. We assessed co-occurrence of childhood asthma, rhinitis and eczema using unsupervised statistical techniques. We included 17 209 children at 4 years and 14 585 at 8 years from seven European population-based birth cohorts (MeDALL project). At each age period, children were grouped, using partitioning cluster analysis, according to the distribution of 23 variables covering symptoms 'ever' and 'in the last 12 months', doctor diagnosis, age of onset and treatments of asthma, rhinitis and eczema; immunoglobulin E sensitization; weight; and height. We tested the sensitivity of our estimates to subject and variable selections, and to different statistical approaches, including latent class analysis and self-organizing maps. Two groups were identified as the optimal way to cluster the data at both age periods and in all sensitivity analyses. The first (reference) group at 4 and 8 years (including 70% and 79% of children, respectively) was characterized by a low prevalence of symptoms and sensitization, whereas the second (symptomatic) group exhibited more frequent symptoms and sensitization. Ninety-nine percentage of children with comorbidities (co-occurrence of asthma, rhinitis and/or eczema) were included in the symptomatic group at both ages. The children's characteristics in both groups were consistent in all sensitivity analyses. At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster. Future research including time-repeated assessments and biological data will help understanding the interrelationships between these diseases.


Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography.
Lung cancer screening programmes using chest X-ray and sputum cytology are routinely performed in Japan; however, the efficacy is insufficient. Screening using low-dose computed tomography (CT) is a more effective approach and has the potential to detect the disease more accurately. A total of 7183 low-dose CT screening tests for 4689 participants and 36 085 chest X-ray screening tests for 13 381 participants were conducted between August 1998 and May 2002. Sensitivity and specificity of lung cancer screening were calculated by both the detection method and the incidence method by linkage of the screening database and the Cancer Registry database. The preclinical detectable phase was assumed to be 1 year. Sensitivity and specificity by the detection method were 88.9 and 92.6% for low-dose CT and 78.3 and 97.0% for chest X-ray, respectively. Sensitivity of low-dose CT by the incidence method was 79.5%, whereas that of chest X-ray was 86.5%. Lung cancer screening using low-dose CT resulted in higher sensitivity and lower specificity than traditional screening according to the detection method. However, sensitivity by the incidence method was not as high as this. These findings demonstrate the potential for overdiagnosis in CT screening-detected cases.