Dynamic imaging of the recycling endosomal network in macrophages.
Recycling endosomes (REs) form an extensive and complex network of subcompartmentalized vesicular and tubular elements that connect with the cell surface and other endosomes in macrophages. As surveillance and defense cells of the innate immune system, macrophages are highly dependent on REs for their active and voluminous cell surface turnover and endocytic, exocytic, and recycling of membrane and cargo. Here we set out three approaches for imaging and analyzing REs in macrophages, based on the expression of fluorescently labeled RE-associated proteins and the uptake of fluorescent cargo. Subcompartments of the REs are identified by co-expression and co-localization analysis of RE associated Rab GTPases. Transferrin is a well-known cargo marker as it recycles through REs and it is compared here to other cargo, revealing how different endocytic routes intersect with REs. We show how the movement of transferrin through REs can be modeled and quantified in live cells. Finally, since phagosomes are a signature organelle for macrophages, and REs fuse with the maturing phagosome, we show imaging of REs with phagosomes using a genetically encoded pH-sensitive SNARE-based probe. Together these approaches provide multiple ways to comprehensively analyze REs and the important roles they play in these immune cells and more broadly in other cell types.


Prediction of respective contribution of linear electron flow and PGR5-dependent cyclic electron flow to non-photochemical quenching induction.
In chloroplasts, regulated formation of the proton gradient across the thylakoid membrane (ΔpH) is important for controlling non-photochemical quenching (NPQ), which is crucial for plants to perform photosynthesis under fluctuating light conditions. The ΔpH is generated by two electron flows: the linear electron flow (LEF) and the cyclic electron flow (CEF). The Arabidopsis CEF mutant, pgr5, showed significantly lower NPQ values than those observed in WT, indicating that ΔpH, generated by the PGR5-dependent CEF, has a crucial role in controlling NPQ. However, the respective significance of LEF and CEF for ΔpH formation is largely unknown. Here we applied computer simulation to reproduce NPQ induction kinetics and estimate the respective contribution of LEF and PGR5-dependent CEF to the dynamics of ΔpH formation. The results indicate that the contribution of CEF to total ΔpH formation for induction of NPQ varies from 60-80%. The simulation also suggested a role of the PGR5-dependent CEF in accelerating electron transfer in the cytochrome b6f complex.


[The creeping post-operative hip joint empyema (author's transl)].
The case histories of 10 patients with chronic empyema of the hip joint following nailing of the femoral neck, respectively following intertrochanteric osteotomy are being described. With only a few exceptions their post-operative course showed no signs of infection. After an interval of between 5 weeks and 2 years their condition deteriorated rapidly. By the time the patients returned to hospital, usually, the joint was already destroyed or septic luxation had occurred. Because of their poor general condition only resection of the femoral head was possible. As an alternative to continuous suction drainage, the implantation of PMMA chains seems to have advantages.


The influence of morphology on geldanamycin production in submerged fermentations of Streptomyces hygroscopicus var. geldanus.
The diverse morphology of the filamentous organism Streptomyces hygroscopicus var. geldanus was characterised by image analysis under various environmental conditions. In the presence of surfactant compounds, a significant decrease in the mean pellet diameter was observed. Cell aggregation was also influenced by spore inoculum level, with high concentrations reducing pellet size. In addition, the dispersion of pellets was found to increase with the inclusion of glass beads to submerged shake-flask cultures. In all cases, production of the secondary metabolite geldanamycin was determined to be dependent on the morphological profile of the organism, with a concomitant increase of 88% in geldanamycin yield observed as the mean pellet diameter was reduced by 70%. Thus, to maximise the yield of geldanamycin, it is necessary to limit pellet formation in Streptomyces hygroscopicus var. geldanus to an appropriate size.


A combination of Tropaeolum majus herb and Armoracia rusticana root for the treatment of acute bronchitis.
Tropaeolum majus herb (nasturtium) and Armoracia rusticana root (horseradish) produce three different isothiocyanates as secondary metabolites, which exert antibacterial, anti-inflammatory, and immune-modulatory functions in humans. Combined in the medicinal product ANGOCIN® Anti-Infekt N, the two natural components demonstrated promising effects against acute bronchitis. A randomized, two-armed, placebo-controlled, double-blind, phase IV study revealed the healing fostering effect of the two herbal plant components METHODS: This study included 384 patients, with 195 in the treatment and 189 in the placebo group. The 'bronchitis severity score' (BSS) was utilized as primary endpoint. This score sums the ratings for five significant bronchitis symptoms, which are established at the patient's visits to the clinic. Compared to placebo intake, the group of patients treated with the phytomedicine showed statistically significant accelerated healing of bronchitis symptoms after three days of treatment, with reductions in coughing, mucous production, and chest pain. This beneficial effect persisted for the entire duration of treatment until day ten. In conclusion, a combination of Tropaeolum majus herb and Armoracia rusticana root promotes an elevated improvement of bronchitis symptomatology.


Neuroprotective activity of antazoline against neuronal damage induced by limbic status epilepticus.
Imidazoline drugs exert neuroprotective effects in cerebral ischaemia models. They also have effects against mouse cerebellar and striatal neuronal death induced by N-methyl-D-aspartate (NMDA) through the blockade of NMDA currents. Here, we investigated the effects of antazoline on NMDA toxicity and current in rat hippocampal neuronal cultures, and on an in vivo model of status epilepticus. In hippocampal cultures, antazoline (30 microM) decreased NMDA-mediated neurotoxicity and also blocked the NMDA current with voltage-dependent and fast-reversible action (inhibition by 85+/-3% at -60 mV). Status epilepticus was induced by injecting pilocarpine (200 nmol) directly into the right pyriform cortex of male adult rats. The rats then received immediately three consecutive i.p. injections at 30-min intervals of either PBS (control group) or antazoline at 10 mg/kg (low-dose group) or at 45 mg/kg (high-dose group). During the 6-h recording, status epilepticus lasted more than 200 min in all groups. In the high-dose group only, seizures completely ceased 1 h after the third injection of antazoline, then started again 1 h later. Rats were killed 1 week later, and Cresyl Violet-stained sections of their brain were analysed for damage quantification. On the ipsilateral side to the pilocarpine injection, pyriform cortex and hippocampal CA1 and CA3 areas were significantly protected in both antazoline-treated groups, whilst prepyriform and entorhinal cortices were only in the high-dose group. On the contralateral side to the pilocarpine injection, only the hippocampal CA3 area was significantly protected in the low-dose group, but all investigated structures were in the high-dose group. In conclusion, antazoline is a potent neuroprotective drug in different models of neuronal primary culture, as previously shown in striatal and cerebellar granule neurons [Neuropharmacology 39 (2000) 2244], and here in hippocampal neurons. Antazoline is also neuroprotective in vivo in the intra-pyriform pilocarpine-induced status epilepticus model.


Users of retail medications for opioid use disorders faced high out-of-pocket prescription spending in 2011-2017.
High out-of-pocket spending has been a barrier to treatment for the estimated 2.0 million Americans suffering from opioid use disorders (OUD). This paper provides national estimates of financial costs faced by the population receiving retail medications for OUD (MOUD). We used pooled annual data from the 2011-2017 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the civilian noninstitutionalized population in the United States. The sample includes individuals who reported filling a retail prescription for buprenorphine or naltrexone, the two most common medications available from retail pharmacies to treat OUD. The main outcome is out-of-pocket spending of retail MOUD prescriptions per fill and per person. Patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage is associated with reduced annual out-of-pocket MOUD expenditures between $316 and $328 per year. Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with OUD.


A systematic review of psychostimulant treatment of negative symptoms of schizophrenia: challenges and therapeutic opportunities.
Primary negative symptoms of schizophrenia (NSS) contribute heavily to functional disability and treatment of these symptoms continues to be a major unmet need even when the positive (psychotic) symptoms are controlled. The modified dopamine (DA) hypothesis posits that positive symptoms are associated with increased DA activity in the mesolimbic tract whereas NSS and cognitive symptoms are associated with decreased DA activity in the mesocortical (frontal) region. Several studies have reported improvement in NSS with DA agonist use, but with varying degrees of risk for triggering psychotic symptoms, especially in the absence of concurrent antipsychotic drug treatment. This article aims to examine older and newer evidence suggesting that psychostimulants may have a potential therapeutic role in the treatment of NSS together with a thorough review of the potential risks and benefits of psychostimulant administration in individuals with schizophrenia. A systematic search of relevant literature using electronic databases, reference lists, and data presented at recent meetings was conducted. Improvement of NSS after psychostimulant administration is reviewed both in challenge and treatment paradigms with various agents such as methylphenidate, amphetamine, and modafinil or armodafinil. The literature points to evidence that, used adjunctively, DA agonists may improve NSS without worsening of positive symptoms in selected patients who are stable and treated with effective antipsychotic medications. Several areas of inadequate study and limitations are identified including small study samples, single-site trials, varying rigor of bias control, the dose and the duration of adjunctive psychostimulant administration, and the potential for development of tolerance. Large, controlled clinical trials to further characterize effects of psychostimulants on NSS in carefully selected patients are warranted.


Hepatic parenchymal hemodynamics of cholangitis with portal trunk thrombus using contrast-enhanced ultrasonography with Sonazoid: delineation of so-called central and peripheral zonal differentiation by arrival-time parametric imaging.
We carried out contrast-enhanced ultrasonography using Sonazoid for a patient who had portal thrombosis due to choledocholith and cholangitis, and the video images were analyzed by an offline procedure using arrival-time parametric imaging. Colors were changed with the time course from red to orange, yellow, green, light blue, and blue, with the time the contrast agent reached the right hepatic artery as the starting point. The central part of the liver was primarily colored blue, and the peripheral part primarily yellowish-green. In other words, we confirmed the central and peripheral zonal differentiation observed in the arterial phase of dynamic computed tomography by color mapping image of arrival-time parametric imaging. Particularly, real-time changes in the hemodynamics of the hepatic parenchyma could be captured by color mapping image using arrival-time parametric imaging.


Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft.
Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft; subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patient's condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique.


Adaptive evolution of tight junction protein claudin-14 in echolocating whales.
Toothed whales and bats have independently evolved specialized ultrasonic hearing for echolocation. Recent findings have suggested that several genes including Prestin, Tmc1, Pjvk and KCNQ4 appear to have undergone molecular adaptations associated with the evolution of this ultrasonic hearing in mammals. Here we studied the hearing gene Cldn14, which encodes the claudin-14 protein and is a member of tight junction proteins that functions in the organ of Corti in the inner ear to maintain a cationic gradient between endolymph and perilymph. Particular mutations in human claudin-14 give rise to non-syndromic deafness, suggesting an essential role in hearing. Our results uncovered two bursts of positive selection, one in the ancestral branch of all toothed whales and a second in the branch leading to the delphinid, phocoenid and ziphiid whales. These two branches are the same as those previously reported to show positive selection in the Prestin gene. Furthermore, as with Prestin, the estimated hearing frequencies of whales significantly correlate with numbers of branch-wise non-synonymous substitutions in Cldn14, but not with synonymous changes. However, in contrast to Prestin, we found no evidence of positive selection in bats. Our findings from Cldn14, and comparisons with Prestin, strongly implicate multiple loci in the acquisition of echolocation in cetaceans, but also highlight possible differences in the evolutionary route to echolocation taken by whales and bats.


The significance of folic acid for epilepsy patients.
The following is a comprehensive review of the current understanding of the many important roles of folic acid in the health of patients with epilepsy. A review of past and current literature reveals that folic acid plays important roles in the areas of hematology, neurology, development, and reproduction. Also highlighted are new areas for exploration.


Dental disease patterns in methamphetamine users: Findings in a large urban sample.
The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface. Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease. On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance. MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive. The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.


Long-term neuroglobin expression of human astrocytes following brain trauma.
Neuroglobin (Ngb), a 17 kDa monomeric protein, was initially described as a vertebrate oxygen-binding heme protein in 2000 and detected in metabolically active organs or cells, like the brain, peripheral nervous system as well as certain endocrine cells. A large array of initial experimental work reported that Ngb displayed a neuron restricted expression pattern in mammalian brains. However, growing evidence indicated astrocytes may also express Ngb under pathological conditions. To address the question whether human astrocytes express Ngb under traumatic insults, we investigated Ngb immuno-reactivity in post-mortem human brain tissues that died of acute, sub-acute and chronic brain trauma, respectively. We observed astrocytic Ngb expression in sub-acute and chronic traumatic brains rather than acute traumatic brains. Strikingly, the Ngb immuno-reactive astrocytes were still strongly detectable in groups that died 12 months after brain trauma. Our findings may imply an unexplored role of Ngb in astrocytes and the involved mechanisms were suggested to be further characterized. Also, therapeutic application of Ngb or Ngb-inducible chemical compounds in neuro-genesis or astrocytic scar forming can be expected.


Transformation in Low-grade B-cell Neoplasms.
Low-grade B-cell leukemias/lymphomas are a diverse group of indolent lymphoproliferative disorders that are typically characterized by good patient outcomes and long life expectancies. A subset of cases, however, undergo histologic transformation to a higher-grade neoplasm, a transition associated with a more aggressive clinical course and poor survival. Transformation of follicular lymphoma to diffuse large B-cell lymphoma and Richter transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma are best characterized in the literature. This article reviews clinical and pathologic characteristics of these most common forms of transformation, with an emphasis on salient histologic, immunophenotypic, and genetic features.


Chondroitin sulfate zinc with antibacterial properties and anti-inflammatory effects for skin wound healing.
A chondroitin sulfate zinc (CSZn) complex was prepared by an ion-exchange method. The purified product was characterized by energy-dispersive X-ray spectroscopy, high-performance chromatography, elemental analysis, Fourier transform infrared spectroscopy, inductively coupled mass spectrometry, and nuclear magnetic resonance spectroscopy. The CSZn demonstrated antibacterial activity against Escherichia coli and Staphylococcus aureus and satisfied MTT cell viability (NIH3T3 fibroblasts) at ≤50 μg/mL. RT-PCR demonstrated significant promotion by CSZn of fibroblast growth factor beta (β-FGF), collagen III (COLIIIα1), vascular endothelial growth factor (VEGF) and reduction of cytokines IL-6, IL-1β & TNF-alpha. An in vivo rat full-thickness wound healing model demonstrated significant wound healing of CSZn relative to controls of saline treatment, zinc chloride treatment and chondroitin treatment. CSZn has demonstrated promising antibacterial and wound healing properties making it deserving of consideration for more advanced wound healing applications.


Evaluation of disease activity and damage in different subtypes of cutaneous lupus erythematosus using the CLASI.
The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a scoring system for patients with cutaneous lupus erythematosus (CLE) to assess disease activity and damage. Objective The aim of this study was to evaluate whether the CLASI is a useful instrument which reflects the different subtypes of CLE comparably well in each parameter. A total of 50 patients (42 female, 8 male) with different subtypes of CLE, including acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE) and LE tumidus (LET), from the Departments of Dermatology, University of Düsseldorf, Germany, and Danderyd Hospital, Stockholm, Sweden, were evaluated using the CLASI at one time point. The total CLASI activity score was significantly lower in patients with LET compared with ACLE (P<0.05) and CCLE (P<0.001), and the total CLASI damage score was significantly lower in patients with LET than with ACLE (P<0.05), SCLE (P<0.001) and CCLE (P<0.001). The erythema score and the scale/hypertrophy score were significantly lower in LET than in ACLE (P<0.05, both) and CCLE (P<0.05 and P < 0.001, respectively). The dyspigmentation score was lowest in patients with LET, differing significantly from ACLE (P<0.05), SCLE (P<0.05) and CCLE (P<0.001). The scarring/atrophy/panniculitis score was significantly higher in patients with CCLE in contrast to SCLE and LET (P<0.05 and P<0.001, respectively). These data characterize the CLASI as an overall useful instrument to analyse disease activity and damage in CLE. However, the CLASI does not give an accurate assessment of all disease subtypes; therefore, a revision of the CLASI with critical analysis of all parameters is recommended.


Metal concentrations and potential health risk in clam (Meretrix lyrata Sowerby 1851) tissues from East Java Coast, Indonesia.
The presence of Hg, Cu, Cr, Cd, Pb, and Zn in clam (Meretrix lyrata) from the East Java Coast (EJC), Indonesia, is reported in this study. Metal levels in clam whole tissues were Zn > Cu > Cr > Pb > Cd > Hg. Cr, Cd, and Pb levels in clam tissue surpassed the tolerated limit for eating and the provisional acceptable weekly intake (PTWI) at numerous places along the EJC. The target hazard quotients (THQs) for Cr, Cd, and Pb were greater than one in several locations, indicating that these metals could be harmful to consumers (particularly non-carcinogenic impacts). Eating clams from this area may be detrimental to human health. Furthermore, target cancer risk (TCR) values for Cr and Cd were greater than 10-4 in several locations, implying that Cr and Cd could cause cancer in people over the course of a lifetime of exposure.


[Assessment of health-related quality of life of sugarcane cutters in the pre-harvest and harvest periods].
To assess health-related quality of life in sugarcane cutters. Longitudinal study conducted in a sugar and ethanol plant located in the western region of the State of São Paulo (Southeastern Brazil) from April (pre-harvest) to October (harvest) 2010. A total of 44 sugarcane cutters, smokers and non-smokers, was evaluated in three periods: pre-harvest, at the end of the third month during harvest and at the end of harvest. Health-related quality of life was assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Analysis of variance for repeated measures and the Friedman test were performed to compare quality of life among the periods. To identify the frequency of workers whose score increased in the harvest periods compared to pre-harvest (positive responders), the Goodman test was used, considering the qualitative variables of the SF-36 domains. At the end of pre-harvest, 23% workers drop out of work; 27% were smokers. There was a significant decrease in the vitality domain at the end of harvest compared to pre-harvest. The dropouts presented higher score in the social aspect domain compared to the group that remained working. There was no difference in health-related quality of life between smokers and non-smokers. However, there was a higher percentage of positive responders among non-smokers in the physical, social and emotional domains in the third month of harvest and in the general health status and social domains at the end of harvest, compared to smokers. Health-related quality of life in sugarcane cutters was reduced after the harvest period in the vitality domain. The individuals who remained working during harvest are those with lower scores for social aspects, which demonstrates the need to promote health assistance policies for this specific population, particularly during sugar harvest.


The cardinal role of the phospholipase A(2)/cyclooxygenase-2/prostaglandin E synthase/prostaglandin E(2) (PCPP) axis in inflammostasis.
The process of inflammation is regulated in part by bioactive lipids of which prostaglandins/eicosanoids form an important class. We provide evidence that the phospholipase A(2)/cyclooxygenase-2/prostaglandin E synthase/prostaglandin E(2) (PCPP) axis is positioned at the core of a natural regulatory circuit controlling the initiation, magnitude, duration, and resolution of the inflammatory response. During the inflammatory phase, proinflammatory cytokine, chemokine and matrix destructive metalloprotease expression levels are moderated by the PCPP axis through the modulation of signaling pathways that control proinflammatory gene expression at transcriptional, post-transcriptional, and translational levels. The PCPP axis also contributes to the activation of lipid mediator class switching; this highly coordinated process results in the biosynthesis of lipoxins and resolvins that promote inflammatory resolution through a variety of cellular and molecular mechanisms. The PCPP axis activity is autoregulated by way of a positive feedback circuit involving PGE(2)-mediated, p38 MAPK-dependent stabilization of COX-2 mRNA and COX-2 catalytic potentiation via its limited proteolytic cleavage (e.g., Ca(2+)-activated calpains). In conclusion, through its fine temporal modulation of multiple signaling cassettes via EP1-EP4 GPCRs, PGE(2) influences the onset, course, magnitude, and duration of the inflammatory response and functions as a key feedback regulator of the cellular and molecular processes controlling inflammation.


DNA sequence of an amber replication mutant indicates that a 29 kd protein is the product of the F plasmid replication gene.
DNA sequencing shows that the mutational alteration resulting from an amber-suppressible replication-defective mutation of F plasmid is a single base pair change from C:G to T:A which yields an amber codon in the coding frame for a 29 kd polypeptide located in the minimal replication region. We thus identified the gene indispensable for F DNA replication as the coding frame which encodes a 29 kd polypeptide. We will designate this gene repA.


Biotransformation enzyme-dependent formation of micronucleus and multinuclei in cell line V79-hCYP2E1-hSULT1A1 by 2-nitropropane and N-nitrosodimethylamine.
V79-hCYP2E1-hSULT1A1, a V79-derived cell line co-expressing both human CYP2E1 and SULT1A1, has been constructed and efficiently used in detection of the mutagenic activities of a number of promutagens. 2-Nitropropane (2-NP) and N-nitrosodimethylamine (NDMA), both being hepatocarcinogenic to animals but inactive in standard genotoxicity assays in vitro, are activated to mutagenic metabolites by human SULT1A1 and CYP2E1, respectively. Nevertheless, little is known about the chromosomal effects of these two carcinogens. In the present study, we investigated the effects of 2-NP and NDMA on frequencies of micronucleated (F(mi)) and multinucleated cells (F(mu)) in V79-hCYP2E1-hSULT1A1 cells. The results showed induction of both F(mi) and F(mu) by 2-NP and NDMA individually, and this effect was completely suppressed by relatively specific inhibitor of SULT1A1 and CYP2E1, i.e., pentachlorophenol and 1-aminobenzotriazole, respectively. The F(mu)/F(mi) ratio in 2-NP groups was significantly higher than NDMA groups, probably indicating an aneugenic activity of 2-NP based on proposed F(mu)/F(mi) ratio as a simple index to discriminate aneugens from clastogens. The present study has established biotransformation enzyme-dependent formation of multinuclei and micronuclei induced by 2-NP and NDMA.


Technique of successful clinical double-lung transplantation.
Lung transplantation has become a successful method in the therapy for end-stage pulmonary disease. While single-lung transplantation provides benefit to patients with pulmonary fibrosis, bilateral lung transplants are required for septic or emphysematous lung disease. We describe the technique employed in 6 patients to transplant en bloc both lungs with the recipient heart left in place. The lungs are connected by a left atrial cuff, main pulmonary artery, and trachea. The completed implantation has a tracheal anastomosis securely wrapped in omentum, a left atrial anastomosis posterior to the heart, and a pulmonary artery anastomosis anteriorly. Airway ischemia resulted in the death of 1 patient. This procedure allows complete excision of all diseased pulmonary tissue, retention of the recipient's own heart, and separate excision of the donor heart for use in another recipient, thereby markedly increasing the supply of donor lungs for transplantation.


Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery.
Whether patients who subsequently develop early postoperative delirium have a genetic predisposition that renders them at risk for postoperative delirium has not been determined. The authors conducted a nested cohort study to include patients aged > or = 65 yr who were scheduled to undergo major noncardiac surgery requiring anesthesia. A structured interview was conducted preoperatively and for the first 2 days postoperatively to determine the presence of delirium, defined using the Confusion Assessment Method. Blood was drawn for measurement of the apolipoprotein genotypes. Bivariate tests of association were conducted between delirium and apolipoprotein genotypes and other potentially important risk factors. Variables that had significant bivariate association with postoperative delirium were entered in a forward multivariable logistic regression model. Of the 190 patients studied, 15.3% developed delirium on both days 1 and 2 after surgery. Forty-six patients (24.2%) had at least one copy of the apolipoprotein e4 allele. The presence of one copy of the e4 allele was associated with an increased risk of early postoperative delirium (28.3% vs. 11.1%; P = 0.005). Even after adjusting for covariates, patients with one copy of the e4 allele were still more likely to have an increased risk of early postoperative delirium (odds ratio, 3.64; 95% confidence interval, 1.51-8.77) compared with those without the e4 allele. Apolipoprotein e4 carrier status was associated with an increased risk for early postoperative delirium after controlling for known demographic and clinical risk factors. These results suggest that genetic predisposition plays a role and may interact with anesthetic/surgical factors contributing to the development of early postoperative delirium.


First-line cetuximab plus capecitabine in elderly patients with advanced colorectal cancer: clinical outcome and subgroup analysis according to KRAS status from a Spanish TTD Group Study.
Single-agent cetuximab is safe and active in elderly patients with advanced colorectal cancer (CRC). A cetuximab-capecitabine combination has not previously been tested in elderly patients with advanced CRC. Sixty-six patients with advanced CRC were treated with cetuximab as a 400 mg/m2 i.v. infusion followed by 250 mg/m2 i.v. weekly plus capecitabine at a dose of 1,250 mg/m2 every 12 hours. After the inclusion of 27 patients, the protocol was amended for safety reasons, reducing the dose of capecitabine to 1,000 mg/m2 every 12 hours. Thirty-nine additional patients were treated with the reduced dose of capecitabine. The overall response rate was 31.8%. KRAS status was determined in 58 patients (88%). Fourteen of 29 patients with wild-type KRAS tumors responded (48.3%; 95% confidence interval [CI], 29.4%-67.5%), compared with six of 29 patients with mutant KRAS tumors (20.7%; 95% CI, 8.0%-39.7%). The median progression-free survival (PFS) interval was 7.1 months. The median PFS interval for patients whose tumors were wild-type KRAS was significantly longer than for those with mutant KRAS tumors (8.4 months versus 6.0 months; p = .024). The high incidence of severe paronychia (29.6%) declined (7.7%) after capecitabine dose adjustment. Cetuximab plus capecitabine at a dose of 1,000 mg/m2 every 12 hours may be an alternative to more aggressive regimens in elderly patients with advanced wild-type KRAS CRC.


Prognostic significance of 18F-fluorodeoxyglucose positron emission tomography (PET)-based parameters in neoadjuvant chemoradiation treatment of esophageal carcinoma.
The purpose of the research was to study the prognostic value of tumor 18F-FDG PET-based parameters in neoadjuvant chemoradiation for patients with squamous esophageal carcinoma. Sixty patients received chemoradiation therapy followed by esophagectomy and two 18FDG-PET examinations at pre- and post-radiation therapy. PET-based metabolic-response parameters were calculated based on histopathologic response. Linear regression correlation and Cox proportional hazards models were used to determine prognostic value of all PET-based parameters with reference to overall survival. Sensitivity (88.2%) and specificity (86.5%) of a percentage decrease of SUVmax were better than other PET- based parameters for prediction of histopathologic response. Only percentage decrease of SUVmax and tumor length correlated with overall survival time (linear regression coefficient β: 0.704 and 0.684, P<0.05). The Cox proportional hazards model indicated higher hazard ratio (HR=0.897, P=0.002) with decrease of SUVmax compared with decrease of tumor size (HR=0.813, P=0.009). Decrease of SUVmax and tumor size are significant prognostic factors in chemoradiation of esophageal carcinoma.


A nonbacterial cause of post-traumatic soft-tissue gas.
A young male sustained a wound on the lateral aspect of the right thigh, presenting 24 hours later with subcutaneous crepitus over the thigh. He was systemically well, Gram stains and wound culture were negative. The cause was a sucking wound due to the valvelike action of the iliotibial band.


[Possibilities and trends in the development of new sensitizers for photodynamic therapy and fluorescence diagnosis of tumors].
The Photodynamic Therapy (PDT) is a new method in the treatment of tumors, which is highly effective in early stages of cancers. The efficacy of the therapy is mostly determined by the properties of the sensitizer used. On the basis of biophysical investigations and determination of photophysical parameters it is possible to suggest new potential photosensitizers. This approach allows a systematical research for new and more effective photosensitizers.


Occurrence of calcitonin gene-related peptide in the chicken amacrine cells.
The distribution of calcitonin gene-related peptide (CGRP)-like immunoreactivity (CGRPI) in the chicken retina was investigated by means of immunohistochemistry. CGRPI was localized in the stratified amacrine cells. The terminal branching pattern of these cells was different between the central and peripheral retinal regions. Flat-mount preparations revealed these CGRPI cells to be evenly distributed in the entire retina with surprisingly rich arborization.


Complex sclerosing lesions (radial scars) of the breast can be palpable.
Complex sclerosing lesion (CSL)/radial scar and carcinoma of breast can both present mammographically as stellate lesions. The mammographic features used to distinguish these two entities are reported as being unreliable. All reports to date indicate that CSLs are not palpable. Of the 54,407 women screened in the first 2 1/2 years of the Warwickshire, Solihull and Coventry Breast Screening Service, 24 histologically-proven CSLs were identified. This represents an incidence of 0.04%. In six (25%) of these patients a corresponding clinically-palpable abnormality was identified. We found no imaging or histological features that differentiated the palpable lesions from the impalpable lesions. It is important not to assume that a palpable stellate lesion is a carcinoma.


Effect of adjuvant tamoxifen therapy on thyroid function in postmenopausal women with breast cancer.
Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4) and total tri-iodothyronine (TT3) concentrations were measured in 45 postmenopausal breast cancer patients before adjuvant treatment with tamoxifen and at 3- and 6-month intervals. A significant increase in TSH (p = 0.002) at the end of 3 months and a subsequent decrease at the end of 6 months was noted. There were no significant changes in TT3 and FT4. We concluded that tamoxifen therapy in postmenopausal women may result in a reversible increase in TSH after 3 months.


Nicotinamide is a specific inhibitor of dark-operative protochlorophyllide oxidoreductase, a nitrogenase-like enzyme, from Rhodobacter capsulatus.
Dark-operative protochlorophyllide oxidoreductase (DPOR) is a nitrogenase-like enzyme consisting of two components, L-protein as a reductase component and NB-protein as a catalytic component. Elucidation of the crystal structures of NB-protein (Muraki et al., Nature 2010, 465: 110-114) has enabled us to study its reaction mechanism in combination with biochemical analysis. Here we demonstrate that nicotinamide (NA) inhibits DPOR activity by blocking the electron transfer from L-protein to NB-protein. A reaction scheme of DPOR, in which the binding of protochlorophyllide (Pchlide) to the NB-protein precedes the electron transfer from the L-protein, is proposed based on the NA effects.


Spatial Patterns of Inshore Marine Soundscapes.
Passive acoustic monitoring was employed to investigate spatial patterns of soundscapes within a marine reserve. High energy level broadband snaps dominated nearly all habitat soundscapes. Snaps, the principal acoustic feature of soundscapes, were primarily responsible for the observed spatial patterns, and soundscapes appeared to retain a level of compositional and configurational stability. In the presence of high-level broadband snaps, soundscape composition was more influenced by geographic location than habitat type. Future research should focus on investigating the spatial patterns of soundscapes across a wider range of coastal and offshore seascapes containing a variety of distinct ecosystems and habitats.


[Functional results in children with retinopathy of prematurity stage 4 and 5].
To investigate the structural and functional results in children with retinopathy of prematurity stage 4 and 5. 91 children with ROP stage 4 and 5 were observed by the authors in years 1990-1998. In all patients the clinical course of the disease, visual acuity and binocular vision were examined during follow-up. Most patients with ROP stage 4 and 5 are blind or practically blind, even the children in whom only stage 4a was diagnosed. Prognosis for vision in children with ROP stage 4 and 5 is poor and all methods of surgical treatment of retinal detachment should be performed in these children to safeguard some kind of useful vision in some patients.


Lower extremity muscle strength in 6- to 8-year-old children using hand-held dynamometry.
The purposes of the study were to establish isometric torque reference values for healthy 6- to 8-year-old children for 6 lower extremity muscles and determine the effects of gender, age, height, weight, and physical activity upon strength. A hand-held dynamometer was used to obtain force/torque values for 154 children. Age-referenced force/torque and cutoff values are provided for each muscle group. Torque increased with age and height for all muscles and with weight for all muscles except knee extensors. No gender differences were found. Children who participated in 3 or more hours per week in organized sports were stronger in 4 of 6 muscles; the number of hours spent in active play did not affect torque. This study provides hand-held dynamometer strength reference values to enable clinicians to determine if clients of the same age, height, and weight have muscle weakness.


Treatment outcomes of acute poptoperative infectious endophthalmitis.
Acute postoperative endophthalmitis is one of the most severe complications of modern ophthalmic procedures including cataract surgeries, vitrectomy and intravitreal injection (IVI). We evaluated the treatment outcomes of acute postoperative infectious endophthalmitis. In this retrospective study, we collected data from 82 patients with acute infectious endophthalmitis within 6 weeks after intraocular surgeries, including cataract surgeries, vitreoretinal surgeries, and IVI, from January 2010 to December 2019. We analyzed the pre-treatment, treatment-related and post-treatment factors that affected visual outcomes. The mean age was 67.65 ± 9.52 years, the proportion of male patients was 56.1%. The mean baseline vision was 1.92 (Snellen Equivalent SE], counting finger [CF]) ± 0.54 logarithm of the minimum angle of resolution (log MAR) and the mean final vision was 0.71 (SE, 39/200) ± 0.80 logMAR. Visual improvement was significant (P < 0.001). The pre-treatment factors affecting final visual outcomes were diabetes, hemodialysis, baseline vision, signs of vitreous opacity, and different surgeries before endophthalmitis; the treatment-related factors affecting visual outcomes were the choice factors between IVI of antibiotics alone and vitrectomy combined with IVI of antibiotics, and the injection numbers of antibiotics; post-treatment factors affecting visual outcomes were complications such as retinal detachment (RD), glaucoma and macular pucker. Furthermore, prior cataract surgery was associated with a better mean final vision of 0.57 (SE, 54/200) ± 0.67 logMAR while prior vitrectomy resulted in the worst mean final vision of 1.38 (SE, 21/500) ± 0.75 logMAR. The important factors that affected the final visual prognosis, included diabetes, hemodialysis, baseline vision, severity of vitritis, treatment strategies and complications. The treatment outcomes revealed better final vision in prior cataract surgery than vitrectomy.


Strong and Atmospherically Stable Dicationic Oxidative Dopant.
Increasing the doping level of semiconducting polymer using strong dopants is essential for achieving good electrical conductivity. As for p-dopant, raising the electron affinity of a neutral compound through the dense introduction of electron-withdrawing group has always been the predominant strategy to achieve strong dopant. However, this simple and intuitive strategy faces extendibility, accessibility, and stability issues for further development. Herein, the use of dicationic state of tetraaryl benzidine (TAB2+ ) in conjunction with bis(trifluoromethylsulfonyl)imide anion (TFSI- ) as a strong and atmospherically stable p-dopant (TAB-2TFSI), for which the concept is hinted from a rapid and spontaneous dimerization of radical cation dopant, is demonstrated. TAB-2TFSI possesses a large redox potential such that it would have deteriorated when in contact with H2 O. However, no trace of degradation after 1 year of storage under atmospheric conditions is observed. When doping the state-of-the-art semiconducting polymer with TAB-2TFSI, a high doping level together with significantly enhanced crystallinity is achieved which led to an electrical conductivity as high as 656 S cm-1 . The concept of utilizing charged molecule as a dopant is highly versatile and will potentially accelerate the development of a strong yet stable dopant.


Coffee consumption and abdominal aortic calcification among adults with and without hypertension, diabetes, and cardiovascular diseases.
This study was performed to investigate the effect of coffee consumption on abdominal aortic calcification (AAC) among adults with and without hypertension, diabetes, and cardiovascular diseases (CVD). A total of 2548 participants from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were included. Coffee consumption was obtained from 24-h dietary recalls. Dual-energy X-ray absorptiometry (DXA) was used to measure the severity of AAC. In the fully adjusted model, compared with non-drinkers, high coffee consumption (≥390 g/d) was associated with higher AAC scores among participants with hypertension (β = 0.72, 95% CI: 0.21-1.22), diabetes (β = 1.20, 95% CI: 0.35-2.05), and CVD (β = 2.03, 95% CI: 0.71-3.36). We did not observe such an association among participants without hypertension, diabetes, and CVD. Furthermore, decaffeinated coffee was not associated with AAC. In conclusion, patients with hypertension, diabetes, and CVD should focus on coffee consumption, especially caffeinated coffee, to reduce the burden of AAC.


Acquired ocular motor apraxia due to bilateral frontoparietal infarcts.
A case of acquired ocular motor apraxia in a 78-year-old man is reported. Disordered saccades and pursuit movements in the horizontal and vertical planes were recorded electro-oculographically. Magnetic resonance imaging showed bilateral border-zone infarcts, involving the frontal lobes and the superior part of the inferior parietal lobules.


Reduction of breast lymphoedema secondary to breast cancer: a randomised controlled exercise trial.
Breast lymphoedema can occur following surgical treatment for breast cancer. We investigated whether an exercise program reduced breast lymphoedema symptoms compared to a non-exercise control group. A single-blinded randomised controlled trial was conducted in which women with stable breast lymphoedema (n = 89) were randomised into an exercise (n = 41) or control (n = 47) group. The intervention comprised a 12-week combined aerobic and resistance training program, supervised weekly by an accredited exercise physiologist. All participants completed a weekly symptoms diary and were assessed monthly to ensure that there was no exacerbation of their lymphoedema. Changes in the breast were captured physically with ultrasound and bioimpedance spectroscopy and changes in symptoms were captured using European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer (BR23) and Lymphoedema Symptom Intensity and Distress questionnaires. The exercise group reported a greater reduction in breast-related symptoms than the control group, assessed by the EORTC BR23 breast symptom questions. Measures of extracellular fluid, assessed with bioimpedance spectroscopy ratio, decreased in the exercise group compared to the control group. No significant difference was detected in dermal thickness in the breast, assessed by ultrasound. Session attendance in the exercise sessions was high, with two musculoskeletal adverse events reported, but no exacerbations of lymphoedema observed. Combined resistance and aerobic exercise training is safe for women living with breast lymphoedema. Preliminary data suggest exercise training can reduce breast lymphoedema symptoms to a greater extent than usual care.


Systematic Review on the Cost-Effectiveness of Seasonal Influenza Vaccines in Older Adults.
Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults. This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity. A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ. The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.


The benefit of cisplatin-based polychemotherapy for adenocarcinoma of the lung. The Kyushu Lung Cancer Chemotherapy Study Group.
We studied the efficacy of cisplatin-based polychemotherapy for adenocarcinoma of the lung. A total of 136 patients were randomized for treatment with either cyclophosphamide, Adriamycin, cisplatin and mitomycin C (CAPM) or mitomycin C, cytosine arabinoside and tegafur (MCT). Radiation was given to the chests of patients at stage III. The differences in the response rate (35% in the CAPM arm and 13% in the MCT arm) were statistically significant (P less than 0.01). However, the significant difference was observed in stage-IV patients (CAPM, 33%; MCT, 4%; P less than 0.001) and not in stage-III patients (CAPM, 40%; MCT, 40%). The median period of survival was 9.5 months for the CAPM arm and 5.5 months for the MCT arm (P less than 0.035, Wilcoxon-Gehan test; P less than 0.1, log-rank test). Improved median survival for the CAPM regimen was demonstrated only by stage-IV patients (CAPM, 10 months; MCT, 5.5 months; P less than 0.025, Wilcoxon-Gehan test; P less than 0.05, log-rank test). The duration of the response, including PRs and NCs, was significantly different depending on the treatment, showing 5 months for the CAPM arm and 3 months for the MCT arm (P less than 0.05). The significant difference was also only observed in stage-IV patients. Myelosuppression was more severe with CAPM than with the MCT regimen. Nausea and vomiting were significantly increased in patients receiving the CAPM regimen. However, all toxicities were acceptable and there were no treatment-related deaths. We concluded that cisplatin-based chemotherapy, CAPM therapy, was of more benefit to patients with adenocarcinoma of the lung than MCT therapy.


Outpatient treatment engagement after suicidal attempt: A multisite prospective study.
After suicidal attempt, the rate of specialized out treatment engagement (SOTE) does not exceed 30-50%. We designed a multisite prospective naturalistic study, in order to investigate predictive factors of SOTE after emergency department discharge among 107 suicidal attempters without current psychiatric ambulatory care. Both bivariate and multivariate analyses highlighted that booking an appointment with a mental health professional before discharge was significantly associated with higher SOTE rate. Psychiatric caregivers of emergency departments should be informed that this approach is a simple, fast way to improve SOTE among this population.


Epithelial cell processes in the development of the secondary palate in the mouse.
Ultrastructural studies of palatal shelves of Tuck A mice embryos aged 12.25-14.25 days show discontinuities of the epithelial basement membrane traversed by epithelial cell processes before the onset of midline degenerative changes.


Analysis of the GH content within archived dried blood spots of newborn screening cards from children diagnosed with growth hormone deficiency after the neonatal period.
It is unknown whether GH secretion of children with growth hormone deficiency (GHD) is already diminished at birth. We aimed to determine the GH content within archived dried blood spots of newborn screening cards from children diagnosed with GHD at childhood. At our hospital, all children with the diagnosis of GHD and an actual age <10years were identified. For 16 patients (mean age, 7.4years; range, 1.0-9.7), screening cards were available. The archived dried blood from the first 48 to 96h of life was eluated in buffer of a highly sensitive hGH-ELISA to measure the GH content. Reference values were calculated based on 600 anonymous newborn screening cards of different ages. Median GH content within the archived dried blood spots of the reference had declined by 30% during the first year and by further 35% during the next 8.5years of storage. After correction for time of storage, four out of the 16 archived dried blood spots of the GHD children contained low amounts of GH (≤5th percentile). Diminished GH secretion at birth was absent in isolated GHD, but associated with multiple pituitary hormone deficiency (MPHD) (P=0.0013), ectopic neurohypophysis (P=0.0013), lower GH test peak values (P=0.02) and higher weight at diagnosis (P=0.015). Children with isolated GHD have normal GH secretory capacity during the first week of life while the majority of children with MPHD and pituitary malformation were GH deficient immediately after birth.


Contraindications and complications to thoracoscopy.
Contraindications to thoracoscopy are mostly only relative. Complications are rare if the technical conditions are fulfilled.


The views and experiences of people with type 2 diabetes being cared for by their community pharmacist: a cross-sectional patient survey.
Community pharmacists are highly accessible healthcare providers and studies in several countries have demonstrated a role for community pharmacists in delivering enhanced care to people with type 2 diabetes. The aim of this study is to evaluate the views and experiences of people with type 2 diabetes attending community pharmacies in Ireland. A 13-item questionnaire, anchored on a 5-point Likert scale, was used. The study took place in seven pharmacies in the Munster region of Ireland. Participants were people attending a participating pharmacy who had type 2 diabetes and were aged ≥ 18 years. The questionnaire was answered by 125 people with type 2 diabetes. Mean age of participants was 65.7 ± 12.4 years and 59.2% were male. The statement "I am totally satisfied with my visit to this pharmacist", was the item that participants most frequently agreed with (agree/strongly agree = 99.2%, mean score 4.9 ± 0.4). Over 80% of participants agreed or strongly agreed with the statement "It is easier to get to see the pharmacist than the doctor", (mean score 4.3 ± 1.1). In this population, people with type 2 diabetes were highly satisfied with the care provided to them by their community pharmacist. These data support the implementation of enhanced community pharmacy services for people with type 2 diabetes in Ireland.


Auditory illusion analogous to Baldwin illusion redux.
Two tones, differing only in duration, were used to define an interval. The perceived midpoint of the interval was displaced towards the tone of longer duration.


Successful explantation of a ventricular assist device following fulminant influenza type A-associated myocarditis.
We report a case of fulminant myocarditis associated with refractory ventricular fibrillation following influenza A infection. Histologic examination was consistent with myocarditis and serology confirmed the viral etiology. The patient was supported with biventricular assist devices for 20 days during which her refractory ventricular fibrillation resolved spontaneously. This is the first documented case of resolution of prolonged ventricular fibrillation while on a ventricular assist device. This case suggests those patients with fulminant viral myocarditis and refractory ventricular arrhythmias may be supported successfully with ventricular assist devices until myocardial recovery takes place.


Survey of infection in orthopedic postoperative and their causative agents: a prospective study.
to evaluate the cases of wound infections in orthopedic postoperative period. postoperative patients who developed infection during the period from November 2012 to November 2013 were studied. Secretions were collected during surgery using sterile swabs, and sent for microbiological analysis. during the period analyzed, 38 surgical procedures progressed to infection. The type of surgery presenting the largest number of infections was osteosynthesis, in 36 (94.7%) patients. Among the materials used, 18 (36%) surgeries that used external fixator were infected, and 17 (34%) using plate. The species of bacteria that caused the largest number of infections were Staphylococcus aureus, infecting 16 (43.9%) patients, followed by Acinetobacter baumannii, which infected four (10.5%) patients. Regarding the resistance profile of Gram-positive strains to antibiotics, 100% of Staphylococcus aureus strains were susceptible to vancomycin and 31.3%, to ceftriaxone. As for the Gram-negative bacteria, 100% of Acinetobacter baumannii strains were resistant to ceftriaxone, gentamicin and imipenem. infection control in the postoperative period is necessary, using antibiotics correctly and consciously, avoiding resistance of bacterial agents.


Microbiological dataset of rural drinking water supplies in Zahedan, Iran.
The residual chlorine and microbial quality of drinking water in the Zahedan villages by a number of1221 samples from all 168 villages were collected between 2014-2015. Then the samples were evaluated using 9-tube fermentation methods and portable chlorine method test. Based on the microbial coliform and fecal coliform indices, the data indicated that the maximum and minimum controlling of the bacteria in the distribution network were in the winter (90.62%) and autumn (85.56%), respectively. Also in the reservoirs, the maximum and minimum controlling of the bacteria were in winter (93.49%) and autumn (87.35%), respectively. The residual chlorine was prepared in almost all of seasons.


Characteristics of non-small-cell lung cancer with interstitial pneumonia: variation in cancer location, histopathology, and frequency of postoperative acute exacerbations in interstitial pneumonia.
Non-small-cell lung cancer (NSCLC) has been reported to develop in patients with interstitial pneumonia (IP); however, clinical, radiological, and pathological features remain to be elucidated. We retrieved the records of 120 consecutive NSCLC patients associated with IP who underwent surgery at Toranomon Hospital between June 2011 and May 2017. We classified the patients into three groups according to NSCLC location using high-resolution computed tomography: group A, within a fibrotic shadow and/or at the interface of a fibrotic shadow and normal lung; group B, within emphysematous tissue and/or at the interface of emphysematous tissue and normal lung; and group C, within normal lung. In 64 patients, programmed death ligand-1 (PD-L1) status was assessed with immunohistostaining. Most of the patients (89; 70%) were classified as group A. This group tended to have squamous cell carcinoma with the usual interstitial pneumonia (UIP). These cancers were located mainly in the lower lobes and seven of the eight postoperative acute exacerbations (pAE) of IP developed in this group. NSCLC in the group B were mainly squamous cell carcinomas located in the upper lobes. No patient with PD-L1 negative was classified into group B. None of the patients in group C showed UIP. and most of the cancers were adenocarcinoma. The frequency of epidermal growth factor receptor mutation-positive NSCLC was the highest in this group. The three groups each showed characteristic features in terms of tumor location, histopathology, PD-L1 expression, and frequency of pAEof IP.


Overview of the practices of on-farm emergency slaughter of cattle in the Nordic countries.
On farm mortality is an increasing problem in cattle production systems in the Nordic countries. It represents an economic loss to the farmer and raises questions of sustainability, food waste and animal welfare. On-farm emergency slaughter (OFES) represents, in some situations, an opportunity for a farmer to salvage some of the economic value from an animal that cannot be transported to a slaughterhouse. The basis of the regulation of OFES in the Nordic countries originates largely from legislation from the European Union. However, this review has found that the availability and practice of OFES in the Nordic countries differs considerably. For example, in Norway 4.2% of all cattle slaughter is OFES, whilst in Iceland OFES has never been recorded. National food safety authorities have issued differing regulations and guidelines regarding the suitability of sick and injured animals for OFES. This review shows there is a paucity of data regarding the incidence and reasons for the use of OFES of cattle in the Nordic countries and points out the need for more investigation into this area to improve veterinary education, consumer protection and animal welfare.


Characterization of COVID-19 outbreaks in three nursing homes during the first wave in Berlin, Germany.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) belongs to the coronavirus family and is characterized by its high transmission competence. Elderly COVID-19 patients are at significantly higher risk of severe course of disease and death. Therefore, outbreaks in nursing homes are particularly challenging for facility managers and health authorities. Here, we report three outbreaks of COVID-19 related to nursing homes (NH01.a, NH02 and NH03) with almost 1000 affected individuals during the first COVID-19 wave in Berlin, Germany. The occurrence of cases and the measures taken were analyzed retrospectively. In all three outbreaks, the index persons were nursing home employees or volunteers. Measures taken were quarantine of contacts, close-meshed tests, separation of the affected housing unit, suspension of admission, ban on visiting, and equipping staff with personal protective equipment, of which there was a shortage in Germany at the beginning of the pandemic. A court-ordered quarantine became necessary for three residents of NH01.a due to cognitive disabilities. In total, 61 persons were tested positive for SARS-CoV-2 in NH01.a, ten persons in NH02, and sixteen persons in NH03. Seventeen patients (27.9%) of NH01.a and three patients (18.8%) of NH03 were referred to hospital. Of all confirmed cases, thirteen (21.3%) related to NH01.a and four (25.0%) related to NH03 died as a result of the infection. Besides one 82 year old volunteer, all deceased persons were residents aged between 66 and 98. Our results emphasize the importance of a previously developed containment and cluster strategy for nursing homes. Due to the particular vulnerability of the residents, immediate action, close cooperation and communication between the facility management, residents, visitors and the health authorities are essential in the case of confirmed COVID-19 cases in healthcare facilities.


Intrauterine herpes simplex virus infection. Hydranencephaly and a nonvesicular rash in an infant.
Herpes simplex virus (HSV) infection in a pregnant woman may have profound adverse effects on the fetus or neonate. A rare congenital syndrome has been associated with intrauterine infection with HSV. An infant with the congenital herpes syndrome is described, the characteristic clinical and laboratory features associated with this syndrome are summarized, and other possible manifestations of herpes virus infection in the newborn are reviewed.


Caspase-4 mediates cytoplasmic accumulation of TDP-43 in the primate brains.
The cytoplasmic accumulation of the nuclear TAR DNA-binding protein 43 (TDP-43) is a pathologic hallmark in amyotrophic lateral sclerosis, frontotemporal lobar degeneration, and other neurological disorders. However, most transgenic TDP-43 rodent models show predominant nuclear distribution of TDP-43 in the brain. By expressing mutant TDP-43 (M337V) in the brains of rhesus monkeys and mice, we verified that mutant TDP-43 is distributed in the cytoplasm of the monkey brain and that the majority of mutant TDP-43 remains in the nuclei of the mouse brain. The primate-specific caspase-4, but not mouse homologue caspase-11, could remove the NLS-containing N-terminal domain and generate fragmented TDP-43 that accumulates in the cytoplasm. Moreover, increased expression of caspase-4 in the monkey brain promotes the cytoplasmic accumulation of endogenous TDP-43, and suppressing caspase-4 reduces the cytoplasmic distribution of endogenous TDP-43 in cultured human neural cells. Our findings suggest that primate-specific caspase-4-mediated cleavage of TDP-43 accounts for its cytoplasmic mislocalization in the primate brains and may serve as a potential therapeutic target.


Extranodal natural killer/T-cell lymphoma from skin or soft tissue: suggestion of treatment from multinational retrospective analysis.
Clinical features and outcomes of extranodal natural killer/T-cell lymphoma (ENKL) arising from extranasal sites are not fully understood. The purpose of this study was to study the prognosis and treatment outcome of skin/soft tissue primary ENKL. This multicenter retrospective study included 48 patients with skin/soft tissue primary ENKL diagnosed from 1993 to 2010. Patients with Ann Arbor stage I, T1-2N0M0 by International Society for Cutaneous Lymphomas-European Organization of Research and Treatment of Cancer TNM (tumour-node-metastasis) stage, International prognostic index score of 0-1, and a Korean prognostic index (KPI) score of 0-1 were associated with better survival. Four of five patients with T1-2N0M0 disease achieved complete response with radiation alone. In disseminated disease, only 6 of 13 patients responded to anthracycline-containing chemotherapy, and all the two patients receiving SMILE showed response. In conclusion, we identified the prognostic value of KPI, and we suggest a treatment recommendation according to the TNM (tumour-node-metastasis) stage. Radiotherapy with/without chemotherapy seemed to be optimal in localized disease. In advanced stages, a more aggressive treatment regimen with newer agents should be sought.


Practice and expectations regarding simulation for residents in obstetrics and gynecology.
Simulation now has an important role in theoretical and practical aspects of medical education and training. We performed an epidemiological, observational, multicenter study based on nationwide data collection. French obstetrics and gynecologic residents were invited to complete an anonymous survey. We received 305 answers. The most frequently offered gynecology sessions were laparoscopy on pelvitrainer (76%) and pelvic ultrasound (60%) while the most frequently offered obstetric sessions were breech delivery (61%), shoulder dystocia (62%) and postpartum hemorrhage (68%) managements. Regarding session frequency, 29.1% of residents thought that one session per month would be ideal. Two hundred and sixty three residents (96%) considered that simulation-training sessions were beneficial. One hundred and thirty-six residents (49%) had an opportunity to repeat sessions and a majority of them (96%) found a daily benefit following a training simulation session. Simulation programs were extremely popular among the surveyed residents. To improve OBGYN resident training, simulation should be an integral part of residency programs.


Influence of resveratrol on oxidative stress resistance and life span in Caenorhabditis elegans.
Resveratrol (3,5,4'-trihydroxy-trans-stilbene), a polyphenol from red wine, has been reported to be beneficial in cases of ageing-related cardiovascular and neurodegenerative diseases owing to its property to reduce oxidative stress. Previous studies on the longevity promoting effect of resveratrol have been partly inconclusive, therefore we set out to investigate whether resveratrol at least promoted longevity in Caenorhabditis elegans under acute oxidative stress conditions. C. elegans was cultured under standard conditions with or without resveratrol. After exposure to juglone-induced acute oxidative stress, the survival rate and hsp-16.2::GFP expression were measured. The influence of resveratrol on life span was recorded also under oxidative stress induced by high glucose concentrations in the growth medium. No extension of the normal life span of C. elegans was observed either in liquid or solid growth media containing different concentrations of resveratrol. However, resveratrol alleviated juglone-induced lethal oxidative stress, and significantly prolonged the life span of C. elegans under conditions of acute oxidative damage and oxidative stress caused by high concentrations of glucose. Resveratrol, as an antioxidant, ameliorated oxidative stress in vivo but did not extend the life span of C. elegans under normal conditions. However, resveratrol did extend life span under conditions of oxidative stress.


Voxelwise encoding models of body stimuli reveal a representational gradient from low-level visual features to postural features in occipitotemporal cortex.
Previous research on body representation in the brain has focused on category-specific representation, using fMRI to investigate the response pattern to body stimuli in occipitotemporal cortex. But the central question of the specific computations involved in body selective regions has not been addressed so far. This study used ultra-high field fMRI and banded ridge regression to investigate the computational mechanisms of coding body images, by comparing the performance of three encoding models in predicting brain activity in occipitotemporal cortex and specifically in the extrastriate body area (EBA). Our results indicate that bodies are encoded in occipitotemporal cortex and in the EBA according to a combination of low-level visual features and postural features.


Hospital morbidity and mortality after myocardial revascularisation surgery: current changes in risk factors.
To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary bypass surgery, the data of 514 myocardial revascularisation procedures performed consecutively between January 1991 and December 1992 were analysed; 73.2% of the patients had associated diseases and 59.3% had suffered one or more previous myocardial infarctions. The mean ejection fraction of the population as a whole was 52.2 +/- 13. In 10.5% of the cases there was severe left ventricular (LV) function impairment with a mean ejection fraction (EF) of 30.2 +/- 4.4 (range 20-35). A major preoperative complication occurred in 8.2% of the entire population and 68.8% of the patients undergoing emergency surgery. Surgery was elective in 72.7% of the cases, urgent in 15.4% and emergency in 11.9%. Hospital mortality was 4.1% (CL 3.2-4.9). In the group of electively operated patients, mortality was 2.7% (CL 1.8-3.5), with no statistically significant difference (P = 0.943) from the mortality observed in the patients undergoing urgent surgery [2.5% (CL 0.8-4.1)]. The mortality in both groups was statistically different (P = 0.0001 and P = 0.008) from that of the patients undergoing emergency surgery [14.7% (CL 10.1-18.9)]. Perioperative acute myocardial infarction occurred in 5.4% of the patients (CL 4.4-6.4), in three cases resulting in death [10.7% (CL 4.8-15.8)]. Fourteen of the acute myocardial infarctions (AMI) occurred in the 42 patients undergoing emergency surgery for acute coronary occlusion (33.3%). A percentage of 18.7% of the 493 surviving patients suffered a postoperative complication.(ABSTRACT TRUNCATED AT 250 WORDS)


Nanosystems of plant-based pigments and its relationship with oxidative stress.
Plant-based pigments are widely present in nature, they are classified depending on their chemical structure as tetrapyrroles, carotenoids, polyphenolic compounds, and alkaloids and are extensively used in medicine, food industry, clothes, and others. Recently they have been investigated due to their role in the areas of food processing, food safety and quality, packaging, and nutrition. Many studies indicate a relationship between bioactive pigments and Non-Communicable Diseases derived from oxidative stress. Their biological applications can help in preventing oxidative injuries in the cell caused by oxygen and nitrogen reactive species. Those pigments are easily degraded by light, oxygen, temperature, pH conditions, among others. Nanotechnology offers the possibility to protect bioactive ingredients and increase its bioavailability after oral administration. Safety to humans (mainly evaluated from toxicity data) is the first concern for these products. In the present work, we present a comprehensive outlook of the most important plant-based pigments used as food colorants, the principal nanotechnology systems prepared with them, and the relationship of these compounds with the oxidative stress and related Non-Communicable Disease.


Binding mode transitions of Escherichia coli single strand binding protein-single-stranded DNA complexes. Cation, anion, pH, and binding density effects.
We have extended our investigations of the multiple binding modes that form between the Escherichia coli single strand binding (SSB) protein and single-stranded DNA (Lohman, T. M. & Overman, L. B. (1985) J. Biol. Chem. 260, 3594-3603; Bujalowski, W. & Lohman, T. M. (1986) Biochemistry 25, 7799-7802) by examining the effects of anions, pH, BaCl2, and protein binding density on the transitions among these binding modes. "Reverse" titrations that monitor the quenching of the intrinsic tryptophan fluorescence of the SSB protein upon addition of poly(dT) have been used to measure the apparent site size of the complex at 25 degrees C in pH 8.1 and 6.9 as a function of NaF, NaCl, NaBr, and MgCl2 concentrations. Under all conditions in which "reverse" titrations were performed, we observe three distinct binding modes with site sizes of 35 +/- 2, 56 +/- 3, and 65 +/- 3 nucleotides/SSB tetramer; however, the transitions among the three binding modes are strongly dependent upon both the cation and anion valence, type, and concentration as well as the pH. A net uptake of both cations and anions accompanies the transitions from the (SSB)35 to the (SSB)56 binding mode at pH 6.9, whereas at pH 8.1 this transition is anion-independent, and only a net uptake of cations occurs. The transition from the (SSB)56 to the (SSB)65 binding mode is dependent upon both cations and anions at both pH 6.9 and 8.1 (25 degrees C), and a net uptake of both cations and anions accompanies this transition. We have also examined the transitions by monitoring the change in the sedimentation coefficient of the SSB protein-poly(dT) complex as a function of MgCl2 concentration (20 degrees C, pH 8.1) and observe an increase in s20,w, which coincides with the increase in apparent site size of the complex, as measured by fluorescence titrations. The frictional coefficient of the complex decreases by a factor of two in progressing from the (SSB)35 to the (SSB)65 binding mode, indicating a progressive compaction of the complex throughout the transition. The transition between the (SSB)35 and the (SSB)56 complex is dependent on the protein binding density, with the lower site size (SSB)35 complex favored at higher binding density. These results indicate that the transitions among the various SSB protein-single-stranded DNA binding modes are complex processes that depend on a number of solution variables that are thermodynamically linked.(ABSTRACT TRUNCATED AT 400 WORDS)


Sonographic prediction of successful embryonic implantation in in-vitro fertilization and embryo transfer cycle procedures, using a multi-parameter approach.
The success of in vitro fertilization and embryo transfer (IVF-ET) cycles depend on maternal age, embryo quality and uterine receptivity. Prediction of embryonic implantation prior to IVF has become crucial in counseling patients due to the cost of failed procedure, in terms of huge financial expenditure, time taken for the procedure, associated health risks and psychological effects following unfulfilled expectation. The objective of this study was therefore to develop a scoring protocol and consequently, a predictive model for a successful embryonic implantation in IVF-ET cycles using maternal demographic, endometrial, ovarian, and hormonal parameters as tools for clinical decision and patient counseling. The body mass index (BMI), age, endometrial pattern and thickness, antral follicle count, (AFC) and anti-Mullerian hormone (AMH) concentration of 295 women between the ages of 18-45 years were evaluated prior to IVF- ET at a fertility clinic in Lagos, Nigeria. The AFC, endometrial pattern and thickness were determined sonographically and the AMH assayed, using ELISA test kits. Multiple regression analysis was used to determine the contribution of each parameter to the likelihood of a successful implantation, and a 4 point rating scale was developed based on the relative contribution of each parameter. Scores were then assigned based on the strength of each predictor variable to implantation rates. Eighteen women that conceived had a full score of 20, while five that failed to conceive scored below 9. Chi square test indicated that endometrial pattern, thickness, age, AFC and AMH are highly significant in predicting embryonic implantation at IVF, while BMI was insignificant (r = -1.831, p = 0.094). The prediction model demonstrated a positive correlation between the cumulative score and implantation rate. The use of the scoring system could provide a guide to clinicians to predict the success rate of each IVF-ET procedure prior to commencement of treatment. The availability of this prediction model provides a counselling tool for physicians to IVF clients which ensures improved confidences level and reduced disappointments from failures in successful implantation and embryonic transfer including its associated financial costs and health risks.


Prohibitin is required for Ras-induced Raf-MEK-ERK activation and epithelial cell migration.
Ras proteins control the signalling pathways that are responsible for normal growth and malignant transformation. Raf protein kinases are direct Ras effector proteins that initiate the mitogen-activated protein kinase (MAPK) cascade, which mediates diverse biological functions such as cell growth, survival and differentiation. Here we show that prohibitin, a ubiquitously expressed and evolutionarily conserved protein is indispensable for the activation of the Raf-MEK-ERK pathway by Ras. The membrane targeting and activation of C-Raf by Ras needs prohibitin in vivo. In addition, direct interaction with prohibitin is required for C-Raf activation. C-Raf kinase fails to interact with the active Ras induced by epidermal growth factor in the absence of prohibitin. Moreover, in prohibitin-deficient cells the adhesion complex proteins cadherin and beta-catenin relocalize to the plasma membrane and thereby stabilize adherens junctions. Our data show an unexpected role of prohibitin in the activation of the Ras-Raf signalling pathway and in modulating epithelial cell adhesion and migration.


Periarticular needle-based therapies can cause periprosthetic knee infections.
Periarticular needle-based therapies such as dry needling, acupuncture, and genicular nerve radiofrequency ablation are becoming more popular for treatment of knee osteoarthritis. These therapies are also being used after total knee arthroplasty for persistent postoperative pain. Although limited published evidence exists for the risk of periprosthetic joint infection after these procedures, we describe one case of periprosthetic joint infection developing shortly after dry needling and another case developing shortly after genicular nerve blocks. We present details of these 2 cases along with a review of the literature regarding the use of periarticular needle-based therapies after total knee arthroplasty.


A prospective video-based observational and analytical approach to evaluate management during brain tumour surgery at a university hospital.
The operating room (OR) is a high-risk complex setting, where patient safety relies on the coordinated efforts of multiple team members. However, little attention has been paid to evaluating the strategies employed by OR practitioners to prevent and correct incidents that inevitably occur during surgery. Therefore, we were prompted to investigate human factor (HF) engineering methods that have been used in an innovative way in order to systematically observe and analyze the management of incidents in the neurosurgical OR of a French university hospital. A technical case report illustrates our approach that associates the following procedures: the recording of OR team member activities and behaviour by video cameras and direct observation of a HF researcher, with the description and the explicit demonstration of safety related procedures in self- and cross-confrontation interviews of OR team members. This technical report emphasizes complementary aspects of clinical performance related to safety skills. Moreover, individual and team performances rely on complementary abilities that associate practical knowledge, skills, and attitudes, which are engaged at various degrees to prevent and manage incidents. This report also enlightens new quality-improvement opportunities as well as further objectives for future studies.


The activated protein C-mediated enhancement of tissue-type plasminogen activator-induced fibrinolysis in a cell-free system.
The effect of human activated protein C (APC) on fibrinolysis was studied in a cell-free system by continuously monitoring the thrombin-induced formation and subsequent tissue-type plasminogen activator-induced degradation of fibrin. In systems comprising dialyzed human plasma, APC shortens the time for lysis to occur in a concentration-dependent, saturable manner. Half-maximal activity occurs at an APC concentration of 10 nM. The effect is mediated by enhanced plasminogen activation and is dependent upon ionized calcium. The effect is lost when plasma adsorbed with barium citrate is utilized in place of unadsorbed plasma. The effect can be reconstituted, however, from components recovered from the barium citrate precipitate. Fractionation of the barium citrate adsorbable proteins with polyethylene glycol (PEG) provides two fractions, one of which is obtained by precipitation at 5% PEG, and the other of which is obtained from the 5% PEG supernatant by further precipitation at 40% PEG. The latter fraction contains Factor X and presumably the other vitamin K-dependent clotting factors. Both of these fractions together, but neither of them alone, fully reconstitute barium-adsorbed plasma, such that APC-enhanced fibrinolysis occurs as in non-adsorbed plasma. These fractions also are sufficient to provide for an APC effect in a system in which purified plasminogen and fibrinogen are used in place of barium citrate-adsorbed plasma. Thus, an effect of APC on tissue-type plasminogen activator-induced fibrinolysis exists which is Ca2(+)-dependent and requires two or more, as yet unidentified, components that can be precipitated from human plasma by barium citrate.


Digitalis-sensitive Na+, K+-ATPase: lack of a direct catecholamine-mediated stimulation in bovine myocardial tissue.
It has been documented that biogenic amines can stimulate Na+, K+-ATPase from various tissue preparations. However, it is unclear whether or not this stimulation occurs in myocardial tissues. We have evaluated possible catecholamine stimulation of purified Na+, K+- ATPase preparations utilizing a bovine ventricular microsomal preparation. We have studied the dose response of the enzyme to ouabain and digitoxigenin in the presence and absence of propranolol and norepinephrine. Our results indicate that propranolol increases the sensitivity of Na+, K+-ATPase to inhibition by digitalis, and that stimulation of Na+, K+-ATPase in bovine myocardium is not mediated via an adrenergic mechanism. In addition, our results indicate that in myocardial tissue, both stereoisomers of propranolol produce a direct nonspecific membrane effect which can modify Na+, K+-ATPase activity.


L-DOPA biotransformation: correlations of dosage, erythrocyte catechol O-methyltransferase and platelet SULT1A3 activities with metabolic pathways in Parkinsonian patients.
The objectives of this study were to determine (1) the effects of dose and drug absorption on pathways of biotransformation of L-DOPA in Parkinsonian patients treated with Sinemet, and (2) the extent to which genetically-determined variations in the activities of erythrocyte catechol O-methyltransferase and/or platelet phenol sulfotransferase might be reflected in individual differences in L-DOPA metabolism. In the 19 patients studied, there were negative correlations between dosage or absorption and extent of O-methylation and of sulfation of L-DOPA or its metabolites. Levels of activity for erythrocyte COMT were also reflected in individual variation in the metabolism of L-DOPA. In contrast, differences in platelet phenol sulfotransferase were not reflected in differences in sulfation of L-DOPA or of its metabolites. If such a relationship did exist, it might have been obscured by the effects of high dosage of L-DOPA, effects which might have resulted from a deficiency of the sulfation cosubstrate 3'-phosphoadenosine 5'-phosphosulfate in patients taking higher doses of drug.


Monitoring Caenorhabditis elegans molting in a conventional luminometer.
Molting is an essential developmental process in Caenorhabditis elegans. However, the study of molting in the worm has been limited by the lack of automated techniques that allow monitoring the process in a simple way. In 2015, Olmedo et al. published an automated method to monitor the timing of each larval stage and molt in C. elegans using bioluminescence. This new method has greatly contributed to the study of molting in this organism but requires the use of a high-sensitivity luminometer, which many laboratories do not have. We have adapted the method to a conventional luminometer, so that it can be used by most laboratories that work with C. elegans and do not have high-sensitivity equipment.•A customization of a method to study molting in C. elegans using a conventional luminometer instead of a high-sensitivity one.•This adaptation allows most laboratories to use their routine luminometers to study molting in C. elegans.•Although the use of a high-sensitivity luminometer, as proposed by Olmedo et al., remains the gold standard for studying molting, this adaptation is suitable for studying significant differences in molting and the duration of larval stages between different strains of C. elegans.


Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients.
Delirium is a risk factor for dementia in cognitively intact patients. Whether an episode of delirium accelerates cognitive decline in patients with known dementia, is less explored. This is a prospective follow-up study of 287 hip fracture patients with pre-fracture cognitive impairment. During the hospitalization, the patients were screened daily for delirium using the Confusion Assessment Method. Pre-fracture cognitive impairment was defined as a score of 3.44 or higher on the pre-fracture Informant Questionnaire on Cognitive Decline in the Elderly Short Form (IQCODE-SF). At follow-up after 4-6 months, the caregivers rated cognitive changes emerging after the fracture using the IQCODE-SF, and the patients were tested with the Mini Mental State Examination (MMSE). A sub-group of the patients had a pre-fracture MMSE score which was used to calculate the yearly decline on the MMSE in patients with and without delirium. 201 of the 287 patients developed delirium in the acute phase. In linear regression analysis, delirium was a significant and independent predictor of a more prominent cognitive decline at follow-up measured by the IQCODE-SF questionnaire (p=0.002). Among patients having a pre-fracture MMSE score, the patients developing delirium had a median (IQR) yearly decline of 2.4 points (1.1-3.9), compared to 1.0 points (0-1.9) in the group without delirium (p=0.001, Mann-Whitney test). Hip fracture patients with pre-fracture dementia run a higher risk of developing delirium. Delirium superimposed on dementia is a significant predictor of an accelerated further cognitive decline.


A role for ultrasound in the fabrication of carbohydrate-supported nanomaterials.
Nowadays, sonication is a well-known technique for the fabrication and surface modification of nanomaterials with various sizes, shapes, and chemical and physical properties. In addition to conducting catalyst-mediated chemical reactions and enhancing medicinal properties, such as antibacterial and antifungal activities, nanoparticles made from biodegradable and biocompatible carbohydrate coatings and glycosidic frameworks offer exciting opportunities for the development of biomaterials, optical sensors, packaging materials, agricultural products, and food. This review article discusses the synthesis of carbohydrate-coated nanoparticles by ultrasound radiation as well as the many applications of these nanoparticles.


1H NMR for quantifying sulfide trapping efficiency by using 1,3,5-tris(2-hydroxyethyl)-1,3,5-triazinane.
Hydrogen sulfide (H2S) is an extremely toxic colourless gas; it is corrosive and denser than air. It usually happens in oil and natural gas fields, refineries, coal mines, and in some industrial effluent treatment systems. This work presents an alternative method of monitoring and quantifying H2S trapping efficiency by using 1,3,5-tris(2-hydroxyethyl)-1,3,5-triazinane as a sequestering agent, and sodium sulfide as a source of sulfide ion, through (1)H NMR spectroscopy. The results proved that the reaction occurs very quickly at 20 °C at pH 7 and 10. 3,5-di(2-hydroxyethyl)-1,3,5-thiodiazinane and 5-(2-hydroxyethyl)-1,3,5-dithiozinane were observed and quantified; it was evidenced that (1)H NMR spectroscopy can be applied as a fast and effective method to quantify H2S trapping efficiency.


[Outpatient surgery in urology from the perspective of the Professional Association of German Urologists (BvDU): what works well, what needs improvement?]
The numbers of outpatient surgical procedures in Germany have been stagnating for decades. The Outpatient Surgery Contract (AOP-Vertrag §115 b SGB V, new version), anchored in the Medical Service of the German Statutory Health Insurance Reform Act (MDK-Reformgesetz) aims to increase the numbers of outpatient surgical procedures such that they approach those of other European countries. The umbrella organisation of the German health insurance funds, the German Hospital Society (DKG e.V.) and the National Association of Statutory Health Insurance Physicians (KBV) have ordered an expert opinion from the Institute of Health and Social Sciences (IGES). This assessment has been available since 1 April 2022.


Reconstruction of hard and soft tissue maxillofacial defects.
Reconstruction of maxillofacial composite defects is a technically demanding and time-demanding process. It also requires a prolonged treatment course, a team approach, and meticulous planning that is prosthetic and esthetically driven. The use of vascularized flap reconstruction, dental implants, and computer-aided technology and advances in maxillofacial prosthetics has contributed immensely toward the goal of fully reconstructing victims of large avulsive wounds. Further advances in technology, surgical training, and maxillofacial prosthodontics will undoubtedly aid in minimizing the number of surgical interventions and maximize the final functional and esthetic results of these patients.


Potential of oil-based formulations of Beauveria bassiana to control Triatoma infestans.
The in vitro development of Beauveria bassiana conidia was monitored when immersed in six concentrations of seven non-ionic (MP 6400, MP 600, Renex 60, Renex 95, Span 80, Tween 20 and Tween 80) and three anionic (DOS 75, Hostapaval BVQ 9 and Surfax 220) surfactants and 11 vegetable oils (linseed, soybean, groundnut, rapeseed, thistle, sunflower, olive, sesame, corn, castor, and babassu). The influence of the oils on the settling behavior of Triatoma infestans nymphs and the activity of an oil-water formulation of the fungus against this vector under laboratory and simulated field conditions were also determined. With exception of DOS 75 and Surfax 220 germination of conidia on complete medium was >98% at 24 h after exposure to surfactants up to 10%. Elevated rates of germination (>25%) were observed in 10% corn, thistle and linseed oil 8 days after incubation. Pure oils had a significant repellent effect to T. infestans. Repellency decreased generally at 10% of the oil and some oils showed some attractiveness for nymphs when tested at 1%. Nymphs were highly susceptible to oil-water formulated conidia, even at unfavorable moisture for extra-tegumental development of the fungus on the insect cuticle.


Oncogenous osteomalacia: a case study.
A case of oncogenous osteomalacia due to a fibrosarcoma of the maxilla is reported, with a 19 year course before treatment. Metabolic studies of calcium and phosphorus were performed 3 and 19 years after the first symptomology. There was a negative balance for both phosphorus and calcium with low serum levels of 1,25-dihydroxyvitamin D which were corrected by resection of the tumor. Portions of the tumor were cultured and the supernatant did not affect phosphorus transport by a proximal tubule kidney cell line. Other portions were injected into athymic nude mice where they resulted in hypophosphatemia and phosphaturia, thus confirming the endocrine nature of the oncogenous osteomalacia factor.


Metals promote sequences of the reverse Krebs cycle.
The reverse tricarboxylic acid (rTCA) cycle (also known as the reverse Krebs cycle) is a central anabolic biochemical pathway whose origins are proposed to trace back to geochemistry, long before the advent of enzymes, RNA or cells, and whose imprint remains intimately embedded in the structure of core metabolism. If it existed, a primordial version of the rTCA cycle would necessarily have been catalysed by naturally occurring minerals at the earliest stage of the transition from geochemistry to biochemistry. Here, we report non-enzymatic promotion of multiple reactions of the rTCA cycle in consecutive sequence, whereby 6 of its 11 reactions were promoted by Zn2+, Cr3+ and Fe0 in an acidic aqueous solution. Two distinct three-reaction sequences were achieved under a common set of conditions. Selectivity was observed for reduction reactions producing rTCA cycle intermediates compared with those leading off-cycle. Reductive amination of ketoacids to furnish amino acids was observed under similar conditions. The emerging reaction network supports the feasibility of primitive anabolism in an acidic, metal-rich reducing environment.


[A simple apparatus to check ventilation and respiration (author's transl)].
A simple device is described which gives visible and audible warning of interruption of ventilation, whether artificial or spontaneous. A thermistor is incorporated in an adaptor placed between the Y-piece and the endotracheal tube. It responds to a change in temperature before the tube via an electronic system that makes two small green bulbs glow. The sound signal is given 6 seconds after the last optical signal of the bulbs.


Structural studies on proteoglycan catabolism in rabbit articular cartilage explant cultures.
Mature rabbit articular cartilage cultures have been used to study the catabolism of aggregating proteoglycan monomers in normal cartilage. During the first 4 days of culture, about 40% of monomers are degraded and lose the ability to bind to hyaluronate. The non-aggregating products (NAgg-PG) have been isolated and compared structurally and immunologically to aggregating monomers (Agg-PG) purified from fresh tissue. The results show that: (1) NAgg-PG are smaller, more heterogeneous in size and have a lower protein/glycosaminoglycan ratio than Agg-PG. (2) NAgg-PG and Agg-PG have a very similar chondroitin sulfate/keratan sulfate ratio. (3) NAgg-PG have 25-50% lower disulfide content than Agg-PG. (4) NAgg-PG have only about 20% of the reactivity of Agg-PG towards a monoclonal antibody (12-20/1-C-6) specific for the hyaluronate binding region of the core protein. These results provide further evidence that proteoglycan catabolism in cartilage explants involves proteolysis of core protein resulting in separation of the hyaluronate binding region from the glycosaminoglycan-rich regions.


[Comparison of trace elements in muli before and after processing].
Determination and comparison of 34 kinds of trace elements in 5 samples of muli before and after processing have been conducted by ICP-AES. The result shows that all the elements have changed in contents.