Acute vertebral fracture after spinal fusion: a case report illustrating the added value of single-source dual-energy computed tomography to magnetic resonance imaging in a patient with spinal Instrumentation.
Magnetic resonance imaging (MRI) is degraded by metal-implant-induced artifacts when used for the diagnostic assessment of vertebral compression fractures in patients with instrumented spinal fusion. Dual-energy computed tomography (DECT) offers a promising supplementary imaging tool in these patients. This case report describes an 85-year-old woman who presented with a suspected acute vertebral fracture after long posterior lumbar interbody fusion. This is the first report of a vertebral fracture that showed bone marrow edema on DECT; however, edema was missed by an MRI STIR sequence owing to metal artifacts. Bone marrow assessment using DECT is less susceptible to metal artifacts than MRI, resulting in improved visualization of vertebral edema in the vicinity of fused vertebral bodies.


Direct capillary electrophoresis analysis of basic and acidic drugs from microliter volume of human body fluids after liquid-phase microextraction through nano-fibrous membrane.
In the present work, a disposable microextraction device with a polyamide 6 nano-fibrous supported liquid membrane (SLM) is employed for the pretreatment of minute volumes of biological fluids. The device is placed in a sample vial for an at-line coupling to a commercial capillary electrophoresis instrument with UV-Vis detection (CE-UV) and injections are performed fully automatically from the free acceptor solution above the SLM with no contact between the capillary and the membrane. Up to 4-fold enrichment of model basic (nortriptyline, haloperidol, loperamide, and papaverine) and acidic (ibuprofen, naproxen, ketoprofen, and diclofenac) drugs is achieved by optimizing the ratio of the donor to the acceptor solution volumes (16 to 4 μL, respectively). The actual setup enables SLM extractions from less than a drop of sample and is suitable for pretreatment of scarce human body fluids. Two unique methods are reported for efficient clean-up and enrichment of the basic and acidic drugs from capillary blood (formed as dried blood spot), serum, and urine samples, which enable their determination at therapeutic and/or toxic levels. The hyphenation of the SLM extraction with CE-UV analysis provides good repeatability (RSD, 2.4-14.9%), linearity (r2, 0.988-1.000), sensitivity (LOD, 0.017-0.22 mg L-1), and extraction recovery (ER, 20-106%) at short extraction times (10 min) and with minimum consumption of samples and reagents. Graphical abstract.


Peripheral neuropathy with nucleoside antiretrovirals: risk factors, incidence and management.
Distal symmetrical peripheral neuropathy is a common adverse experience in persons with HIV infection. This condition, which presents as a pain, numbness. burning and/or dysaethesia initially in the feet, is often multi-factorial in its origin. Nucleoside analogue reverse transcriptase inhibitors represent an important contributor to peripheral neuropathy. Specifically, around 10% of patients receiving stavudine or zalcitabine and 1 to 2% of didanosine recipients may have to discontinue therapy with these agents due to neuropathy. Prompt withdrawal of these therapies enables gradual resolution of signs and symptoms in most patients, although a period of symptom intensification may occur shortly after withdrawal. Risk factors for developing peripheral neuropathy during nucleoside analogue therapy include low CD4+ cell count (<100 cells/mm3), a prior history of an AIDS defining illness or neoplasm, a history of peripheral neuropathy, use of other neurotoxic agents including high alcohol (ethanol) consumption and nutritional deficiencies such as low serum hydroxocobalamin levels. Thus, patients at increased risk of peripheral neuropathy should potentially avoid the use of the neurotoxic nucleoside analogues or be more carefully monitored during therapy. Management of this problem includes patient education. prompt withdrawal of the likely causative agent (giving consideration not to leave the patient on a sub-optimal therapy regimen) and simple analgesia. with augmentation with tricyclic antidepressants or anticonvulsant agents when pain is severe. New agents that may assist in managing this condition include levacecarnine (acetyl-L-carnitine) and nerve growth factors such as recombinant human nerve growth factor.


Neurorehabilitation of stroke.
Despite ongoing improvements in the acute treatment of cerebrovascular diseases and organization of stroke services, many stroke survivors are in need of neurorehabilitation, as more than two-thirds show persisting neurologic deficits. While early elements of neurorehabilitation are already taking place on the stroke unit, after the acute treatment, the patient with relevant neurologic deficits usually takes part in an organized inpatient multidisciplinary rehabilitation program and eventually continues with therapies in an ambulatory setting afterwards. A specialized multidisciplinary neurorehabilitation team with structured organization and processes provides a multimodal, intense treatment program for stroke patients which is adapted in detail to the individual goals of rehabilitation. There are many parallels between postlesional neuroplasticity (relearning) and learning in the development of individuals as well as task learning of healthy persons. One key principle of neurorehabilitation is the repetitive creation of specific learning situations to promote mechanisms of neural plasticity in stroke recovery. There is evidence of achieving a better outcome of neurorehabilitation with early initiation of treatment, high intensity, with specific goals and active therapies, and the coordinated work and multimodality of a specialized team. In this context, interdisciplinary goal-setting and regular assessments of the patient are important. Furthermore, several further potential enhancers of neural plasticity, e.g., peripheral and brain stimulation techniques, pharmacological augmentation, and use of robotics, are under evaluation.


[Effect of verapamil on cerebral circulation].
Acute experiments were conducted on anesthetized cats; verapamil in a dose of 0.05, 0.1, 0.5, and 1 mg/kg, injected intravenously, caused a reduction of the tone of the cerebral vessels and of the general arterial pressure. Changes in the volume velocity of the cerebral circulation were phasic in character and depended on the tone of the cerebral vessels and the arterial pressure level. The circulation increased more in the cerebral cortex than in the reticular formation; PO2 correlated with the circulation in the cerebral cortex. The diameter of the pial arteries became greater both in case of the intravascular verapramil administration and its local application. The block of beta-adrenoceptors, M-cholinoreceptors, histamine receptors and preliminary administration of the sympatholytic failed to eliminate the vasodilatory action of verapamil. It is supposed that vasodilation was myotropic in character, and was possible connected with the electrolyte metabolism.


Retracted: An Annealing Model Analysis and Research on the In of Community Public Sports on Economic Development.
[This retracts the article DOI: 10.1155/2022/3129638.].


Infection of the maternal-fetal interface and vertical transmission following low-dose inoculation of pregnant rhesus macaques (Macaca mulatta) with an African-lineage Zika virus.
Congenital Zika virus (ZIKV) infection can result in birth defects, including malformations in the fetal brain and visual system. There are two distinct genetic lineages of ZIKV: African and Asian. Asian-lineage ZIKVs have been associated with adverse pregnancy outcomes in humans; however, recent evidence from experimental models suggests that African-lineage viruses can also be vertically transmitted and cause fetal harm. To evaluate the pathway of vertical transmission of African-lineage ZIKV, we inoculated nine pregnant rhesus macaques (Macaca mulatta) subcutaneously with 44 plaque-forming units of a ZIKV strain from Senegal, (ZIKV-DAK). Dams were inoculated either at gestational day 30 or 45. Following maternal inoculation, pregnancies were surgically terminated seven or 14 days later and fetal and maternal-fetal interface tissues were collected and evaluated. Infection in the dams was evaluated via plasma viremia and neutralizing antibody titers pre- and post- ZIKV inoculation. All dams became productively infected and developed strong neutralizing antibody responses. ZIKV RNA was detected in maternal-fetal interface tissues (placenta, decidua, and fetal membranes) by RT-qPCR and in situ hybridization. In situ hybridization detected ZIKV predominantly in the decidua and revealed that the fetal membranes may play a role in ZIKV vertical transmission. Infectious ZIKV was detected in the amniotic fluid of three pregnancies and one fetus had ZIKV RNA detected in multiple tissues. No significant pathology was observed in any fetus; and ZIKV did not have a substantial effect on the placenta. This study demonstrates that a very low dose of African-lineage ZIKV can be vertically transmitted to the macaque fetus during pregnancy. The low inoculating dose used in this study suggests a low minimal infectious dose for rhesus macaques. Vertical transmission with a low dose in macaques further supports the high epidemic potential of African ZIKV strains.


Patterns of chromosomal imbalances in parathyroid carcinomas.
In this study we have characterized chromosomal imbalances in a panel of 29 parathyroid carcinomas using comparative genomic hybridization (CGH). The most frequently detected imbalances were losses of 1p and 13q that were seen in >40% of the cases. The commonly occurring regions of loss were assigned to 1p21-p22 (41%), 13q14-q31 (41%), 9p21-pter (28%), 6q22-q24 (24%), and 4q24 (21%), whereas gains preferentially involved 19p (45%), Xc-q13 (28%), 9q33-qter (24%), 1q31-q32 (21%) and 16p (21%). The distribution of CGH alterations supports the idea of a progression of genetic events in the development of parathyroid carcinoma, where gains of Xq and 1q would represent relatively early events that are followed by loss of 13q, 9p, and 1p, and by gain of 19p. A sex-dependent distribution was also evident for two of the common alterations with preferential gain of 1q in female cases and of Xq in male cases. When the CGH profiles for the 29 carcinomas were compared with our previously published results for sporadic parathyroid adenomas, highly significant differences were revealed. Loss of 1p, 4q, and 13q as well as gains of 1q, 9q, 16p, 19p and Xq were significantly more common in the carcinomas than in the adenomas. In contrast, loss of the 11q13 region, which is the most common CGH abnormality in sporadic adenomas, was not detected in any of the carcinomas. Taken together, the findings identify several candidate locations for tumor suppressor genes and oncogenes that are potentially involved in parathyroid carcinogenesis.


An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial).
Economic evidence for vitiligo treatments is absent. To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.


A solar light driven dual photoelectrode photocatalytic fuel cell (PFC) for simultaneous wastewater treatment and electricity generation.
In this paper, a novel dual heterojunction Photocatalytic Fuel Cell (PFC) system based on BiVO4/TiO2 nanotubes/FTO photoanode and ZnO/CuO nanowires/FTO photocathode has been designed. Compared with the electrodes in PFCs reported in earlier literatures, the proposed heterojunction not only enhances the visible light absorption but also offers a higher photoconversion efficiency. In addition, the nanostructured heterojunction owns a large surface area that ensures a large amount of active sites for organics degradation. The performance of the PFC base on the dual photoelectrodes was also studied herein. The results indicated that the PFC in ths paper exhibits a superior performance and its JV(max) reached 0.116 mw cm(-2), which is higher than that in most of reported PFCs with a Pt-free photocathode. When hazardous organic compounds such as methyl orange, Congo red and methylene blue were decomposed, the degradation rates obtained is to be 76%, 83%, and 90% respectively after 80 mins reaction. The proposed heterojunction photoelectrodes provided great potential for cost-effective and high-efficiency organic pollutants degradation and electricity generation in a PFC system.


Repeated haloperidol treatment decreases sigma(1) receptor binding but does not affect its mRNA levels in the guinea pig or rat brain.
The effects of chronic treatment with haloperidol on sigma (sigma) receptors were investigated across brain regions and species. The regional distribution of [3H](+)-pentazocine binding to sigma(1) receptor was similar between the guinea pig and rat brains. The highest level of binding was detected in the brain stem and lowest in the striatum and hippocampus. The regional distribution of [3H]1, 3-di (2-tolyl) guanidine ([3H]DTG) binding in the presence of 100 nM (+)-pentazocine to sigma(2) receptor was similar to that of the [3H](+)-pentazocine binding in the guinea pig brain, while in the rat brain high levels of [3H]DTG binding were detected in the cortex, frontal cortex and cerebellum. The intraperitoneal administration of 2 mg/kg of haloperidol to guinea pig and rats once a day for 21 days produced inhibition of [3H](+)-pentazocine binding but did not affect [3H]DTG binding to sigma(2) receptors in any brain region examined. The effects of haloperidol on [3H](+)-penazocine binding in the rat were much weaker than those in the guinea pig. The regional distribution of the level of sigma(1) receptor mRNA determined by the ribonuclease protection assay was similar to that of the [3H](+)-pentazocine binding activity, except in the cortex and cerebellum where the levels of sigma(1) receptor mRNA were low in guinea pig and rat. Treatment with haloperidol did not affect the levels of sigma(1) receptor mRNA in any brain region in either species. These findings suggested that the sigma receptors differentially distributed in brain regions are down regulated by treatment with haloperidol across sigma receptor subtypes and animal species without changing the transcriptional activity of the sigma(1) receptor. The mechanisms by which sigma receptors could be differently regulated in vivo by chronic treatment with haloperidol in different species may contribute to the therapeutic efficacy of haloperidol.


lnc-MAP3K13-7:1 Inhibits Ovarian GC Proliferation in PCOS via DNMT1 Downregulation-Mediated CDKN1A Promoter Hypomethylation.
Polycystic ovary syndrome (PCOS) is an endocrine-related disease and global cause of infertility that is associated with abnormal folliculogenesis. Inhibited granulosa cell (GC) proliferation is recognized as a key factor that underlies aberrant follicle maturation. Many epigenetic landscape modifications have been characterized in PCOS patients. However, the epigenetic regulation pathways in follicular dysplasia are not completely understood. In this study, we reported a novel mechanism of DNA hypomethylation induced by long non-coding RNAs (lncRNAs) and its function in cell cycle progression. We observed that lnc-MAP3K13-7:1 was highly expressed in GCs from patients with PCOS, with concomitant global DNA hypomethylation, decreased DNA methyltransferase 1 (DNMT1) expression, and increased cyclin-dependent kinase inhibitor 1A (CDKN1A, p21) expression. In KGN cells, lnc-MAP3K13-7:1 overexpression resulted in cell cycle arrest in the G0/G1 phase, as well as the molecular inhibition and genetic silencing of DNMT1. Mechanistically, lnc-MAP3K13-7:1 inhibited DNMT1 expression by acting as a protein-binding scaffold and inducing ubiquitin-mediated DNMT1 protein degradation. Moreover, DNMT1-dependent CDKN1A promoter hypomethylation increased CDKN1A transcription, resulting in attenuated GC growth. Our work uncovered a novel and essential mechanism through which lnc-MAP3K13-7:1-dependent DNMT1 inhibition regulates CDKN1A/p21 expression and inhibits GC proliferation.


Photocatalytic antimicrobial activity of thin surface films of TiO(2), CuO and TiO (2)/CuO dual layers on Escherichia coli and bacteriophage T4.
TiO(2)-coated surfaces are increasingly studied for their ability to inactivate microorganisms. The activity of glass coated with thin films of TiO(2), CuO and hybrid CuO/TiO(2) prepared by atmospheric Chemical Vapour Deposition (Ap-CVD) and TiO(2) prepared by a sol-gel process was investigated using the inactivation of bacteriophage T4 as a model for inactivation of viruses. The chemical oxidising activity was also determined by measuring stearic acid oxidation. The results showed that the rate of inactivation of bacteriophage T4 increased with increasing chemical oxidising activity with the maximum rate obtained on highly active sol-gel preparations. However, these were delicate and easily damaged unlike the Ap-CVD coatings. Inactivation rates were highest on CuO and CuO/TiO(2) which had the lowest chemical oxidising activities. The inactivation of T4 was higher than that of Escherichia coli on low activity surfaces. The combination of photocatalysis and toxicity of copper acted synergistically to inactivate bacteriophage T4 and retained some self-cleaning activity. The presence of phosphate ions slowed inactivation but NaCl had no effect. The results show that TiO(2)/CuO coated surfaces are highly antiviral and may have applications in the food and healthcare industries.


Exploring the utility of self-determination theory in complex interventions in multimorbidity: A qualitative analysis of patient experiences of the CARE Plus intervention.
CARE Plus is a primary-care-based complex intervention for patients with multimorbidity living in areas of high socioeconomic deprivation. This study explores patients' experience of the intervention and whether self-determination theory is useful to understand reported impacts. Thematic analysis of semistructured interviews of 14 participants conducted during a randomised controlled trial of CARE Plus. Improvement in wellbeing in daily lives following CARE Plus was estimated from participants' accounts of their experiences of the intervention. Participants valued the CARE Plus consultations irrespective of perceived improvements. Six participants reported changes in wellbeing that improved daily life, three reported slight improvement (not impacting daily life) and five no improvement. Evidence of satisfaction of the three major self-determination theory psychological needs - relatedness, competence and autonomy - was prominent in the accounts of those experiencing improved wellbeing in daily life; this group also spoke in ways congruent with more self-determined motivational regulation. These changes were not evident in those with little or no improvement in wellbeing. This study suggests self-determination theory has utility in understanding the impact of CARE Plus on patients and may be a useful theory to inform development of future interventions to improve outcomes for patients with multimorbidity.


Detection of coronary artery disease from the normal resting ECG using nonlinear mathematical transformation.
In order to enhance subtle changes not apparent in resting ECGs by conventional criteria, a computerized signal processing technique, biopotential coordinate transformation (BCT), has been developed to increase the physician's perceptibility of CAD in seemingly "normal" resting ECGs. ECGs initially read as normal then can be tested with this process to predict the presence or absence of CAD. A blinded, retrospective study of 93 Caucasian patients with normal ECGs was performed using coronary angiography as the test standard. The BCT process identified the presence or absence of CAD with an 84.3% sensitivity and 81.8% specificity in 62 men. Similarly, a 76.2% sensitivity and 80% specificity was obtained for 31 women. These results suggest that the BCT process may provide the emergency physician with a noninvasive screening test for the detection of CAD in patients with apparently normal resting ECGs. Further studies are necessary for process refinement and verification.


Antibacterial and Anticancer Properties of Microbispora sp., AL22: An Endophyte of Alpinia galanga (L.) Willd.
Background and Objective: The AL22 strain was isolated from the rhizosphere soil of Alpinia galanga (L.) Willd (Zingiberaceae) and identified as Microbispora sp., by analysing its morphology, chemotaxonomy and 16S rDNA sequence. Previous studies demonstrated the bactericidal effects of its crude extract against Bacillus cereus, Bacillus subtilis, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. The present study aimed to isolate the major compounds and evaluate their biological properties. Materials and Methods: Silica gel column chromatography and thin-layer chromatography were used for the purification and identification of 3,4-dihydro-lactucin (compound 1) and umbelliferone (compound 2) by NMR and mass spectrometry, respectively. Antibacterial and anticancer activities were carried out. Results: The bioassay studies illustrated that compound 1 had antibacterial activity against gram-positive bacteria, with its minimum inhibitory concentration and minimum bactericidal concentration of 16-32 and 64-128 μg mL1, respectively. The crude extract and purified compounds showed weak cytotoxic activity on the L929 and Vero cells with IC50 values >512.00 μg mL1. The cytotoxicity of compound 1 was observed in the MDA-MB-231 and HeLa cells with IC50 values of 37.62 and 75.34 μg mL1, respectively, while its IC50 value against the HepG2 cells was 456.67 μg mL1. Conclusion: These findings showed that compound 1 of Microbispora sp., AL22 exhibited antibacterial and anticancer activities. Extensive studies on 3,4-dihydro-lactucin could lead to the development of beneficial approaches for managing bacterial infections and cancer.


Solitary calcaneal metastasis as the first sign of gastric cancer. A case report.
A case of gastric adenocarcinoma is reported where the first symptom was a solitary calcaneal metastasis. The metastastic symptoms occurred in previously fractured bone, one year before the onset of gastric symptoms. This history is rare and the eight cases found in the literature where gastric cancer has started with solitary bone metastasis are reviewed.


Corneal iron line following LASIK with epithelial ingrowth.
To report a new corneal iron line following keratorefractive surgery. Case report and review of the literature. A 51-year-old man developed epithelial ingrowth after otherwise uneventful LASIK surgery. The patient, satisfied with an uncorrected visual acuity of 20/25 and otherwise asymptomatic, declined to have his flap relifted to treat the ingrowth. Six months postoperatively a corneal iron line was noted at the leading edge of the epithelial ingrowth. Vision remained stable. : Epithelial iron lines have been reported with a number of conditions, including post-refractive procedures. This is the first report of an iron line associated with epithelial ingrowth following LASIK.


Diabetes and depression were not associated in Venezuelan adults: The EVESCAM study, a national cross-sectional sample.
Evidence suggests that depression is more common in patients with diabetes than in the general population. However, contradictory results expose controversy in this association. To evaluate the relationship between diabetes and depression in a national sample of Venezuelan adults. The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,454 adults from July 2014 to January 2017 (response rate of 77.3%). Diabetes was defined using fasting blood glucose and a 2-hour oral glucose tolerance test. Depressive symptoms were determined using the Hospital Anxiety and Depression Scale. 3255 subjects were assessed. Depressive symptom score was different between genders and among age groups (p<0.001), and similar in those subjects with or without diabetes (p=0.899). Depressive symptoms prevalence was higher in women than in men and increased with age (p<0.05), but was similar in those with and without diabetes (p=0.215). Using a multivariate regression analysis model, the association of depressive symptoms and diabetes remains non-significant after adjusting for age and gender (Odds ratio=0.98; 95% Confidence Intervals 0.95 - 1.02, p=0.504). Diabetes and depression were not associated in a large sample of Venezuelan adults.


Impaired T-cell response to mRNA vaccination heralds risk of COVID-19 in long-term allogeneic hematopoietic stem cell transplantation survivors.
Not available.


Healthy in a crummy world: Implications of primal world beliefs for health psychology.
Aaron Beck's insight-that beliefs about one's self, future, and environment shape behavior-had major implications for health psychology research and practice. Yet, beliefs about one's environment have remained relatively understudied. A recent comprehensive empirically-driven effort has led to the identification of 26 primal world beliefs, or primals, (e.g., the world is: harmless vs. threatening, stable vs. fragile, just vs. unjust, meaningful vs. meaningless, improvable vs. too hard to improve, beautiful vs. ugly). Primals have been theorized to influence many outcomes of interest to different psychological subdisciplines, and a psychometrically rigorous effort has developed a Primals Inventory to measure them. In this brief report, we aim to introduce primals' potential implications for health psychology research and practice. After summarizing primals' theorized general function, we illustrate their connection to health processes and outcomes via five illustrative hypotheses. These hypotheses concern how primals might influence (a) the cardiotoxic stress axis; (b) conserved transcriptional response to adversity gene expression patterns; (c) health behaviors; (d) treatment effectiveness; and (e) risk of developing chronic diseases. Further research on primals in relation to health processes and outcomes might lead to new avenues of scientific inquiry and innovative methods of improving the trajectory of our society's health and well-being.


Impact of integrated family planning and HIV care services on contraceptive use and pregnancy outcomes: a retrospective cohort study.
To determine the impact of routine care (RC) and integrated family planning (IFP) and HIV care service on family planning (FP) uptake and pregnancy outcomes. Retrospective cohort study conducted between October 10, 2005, and February 28, 2009. United States Agency for International Development-Academic Model Providing Access To Healthcare (USAID-AMPATH) in western Kenya. Records of adult HIV-infected women. Integration of FP into one of the care teams. PRIMARY OUTCOMES MEASURES: Incidence of FP methods and pregnancy. Four thousand thirty-one women (1453 IFP; 2578 RC) were eligible. Among the IFP group, there was a 16.7% increase (P < 0.001) [95% confidence interval (CI): 13.2% to 20.2%] in incidence of condom use, 12.9% increase (P < 0.001) (95% CI: 9.4% to 16.4%) in incidence of FP use including condoms, 3.8% reduction (P < 0.001) (95% CI: 1.9% to 5.6%) in incidence of FP use excluding condoms, and 0.1% increase (P = 0.9) (95% CI: -1.9% to 2.1%) in incidence of pregnancies. The attributable risk of the incidence rate per 100 person-years of IFP and RC for new condom use was 16.4 (95% CI: 11.9 to 21.0), new FP use including condoms was 13.5 (95% CI: 8.7 to 18.3), new FP use excluding condoms was -3.0 (95% CI: -4.6 to -1.4) and new cases of pregnancies was 1.2 (95% CI: -0.6 to 3.0). Integrating FP services into HIV care significantly increased the use of modern FP methods but no impact on pregnancy incidence. HIV programs need to consider integrating FP into their program structure.


Previous maternal chemotherapy by cyclophosphamide (Cp) causes numerical chromosome abnormalities in preimplantation mouse embryos.
This study investigated the consequences of maternal cyclophosphamide treatment on fertilization rate, development and chromosomal integrity of embryos. It also evaluated efficiency of two methods of classic and metaphase induction for chromosomes assessment. Two different groups of NMRI mice 2-3 weeks and 6-7 weeks were injected intraperitonealy with 75 mg cyclophosphamide/kg. Six weeks later, oocytes were recovered, fertilized and incubated for 3 days in 5% CO(2) in air. Eight to 10 cell stage embryos were subjected to chromosomal study. Cyclophosphamide in both experimental groups reduced the oocyte fertilization rate and in the 6-7 weeks group it was significantly lower compared with control group (P<0.01). Also there was a reduction in 8-cell stage embryos formation from 48 to 72 h post-fertilization in both treated groups (P<0.05). Aneuploidy increased in the treatment groups compared with controls, which in the older group was significant (P<0.001). The success rate of the classic method to analyze metaphase plates was 30.1% and the success rate of heterokaryons formation with analyzable chromosomes was 67.8% in the metaphase induction method. In regards to the adverse effects of cyclophosphamide on fertilization rate, embryo development and chromosomal integrity of the mouse embryos, using Preimplantation Genetic Diagnosis in addition to Assisted Reproductive Technique is suggested.


Prediction of hydrogenated group IV-V hexagonal binary monolayers.
Group IV and V monolayers are very crucial 2D materials for their high carrier mobilities, tunable band gaps, and optical linear dichroism. Very recently, a novel group IV-V binary compound, [Formula: see text], has been synthesized on silicon substrate, and has shown very interesting electronic properties. Further investigations have revealed that the monolayer would be stable in freestanding form by hydrogenation. Inspired by this, by means of first-principles calculations, we systematically predict and investigate eight counterparts of [Formula: see text], namely [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]. The cohesive energies, phonon dispersions, and AIMD calculations show that, similar to [Formula: see text], all of these freestanding monolayers are stable in hydrogenated form. These hydrogenated monolayers are semiconductors with wide band gaps, which are favorable for opto-electronic purposes. The [Formula: see text] and [Formula: see text] structures possess indirect and direct band gaps, respectively. They represent very interesting optical characteristics, such as good absorption in the visible region and linear dichroism, which are crucial for solar cell and beam-splitting devices, respectively. Finally, the [Formula: see text] and [Formula: see text] monolayers have suitable band gaps and band edge positions for photocatalytic water splitting. Summarily, our investigations offer very interesting and promising properties for this family of binary compounds. We hope that our predictions open ways to new experimental studies and fabrication of suitable 2D materials for next generation opto-electronic and photocatalytic devices.


Factors associated with outcomes and response to therapy in patients with infiltrative hepatocellular carcinoma.
Infiltrative hepatocellular carcinoma (iHCC) is characterized by its indistinct borders and lack of a typical pattern of contrast enhancement. There are few published data on iHCC. We assessed outcomes, effects of treatment, and prognostic factors in a large cohort of patients with iHCC. We analyzed data from 155 patients (median age, 60 years; 79% male; median level of α-fetoprotein, 347 ng/mL; median Model for End-Stage Liver Disease score, 13) with iHCC, on the basis of contrast-enhanced computed tomography or magnetic resonance imaging, from 2002-2010 at the University of California, San Francisco Medical Center. All imaging study results were independently reviewed by 2 investigators. Most of the patients had tumors of Barcelona Clinic Liver Cancer stage C (70%) or D (22%). The median maximum tumor diameter was 11.3 cm; 41% of lesions were hypovascular, 82% had macrovascular invasion, and 52% had extrahepatic metastases. Median survival was 4.0 months, and rates of survival at 6 and 12 months were 30% and 10%, respectively. On multivariate analysis, predictors of 6-month mortality were Child-Pugh class B or C cirrhosis; lack of tumor-directed therapy with chemoembolization (transarterial chemoembolization), radiofrequency ablation, or sorafenib; α-fetoprotein level >1000 ng/mL; female sex; Model for End-Stage Liver Disease score; and maximum tumor diameter. The percentages of patients surviving 6 and 12 months were 17% and 2% for those who received no therapy (n = 109), 73% and 36% for those who received sorafenib (n = 11), and 45% and 17% for those who received transarterial chemoembolization (n = 18) (all P values <.01). Infiltrative HCC is a radiographically distinct and advanced form of hepatocellular carcinoma with a poor prognosis. Therapy with transarterial chemoembolization or sorafenib appears to prolong survival and requires further investigation.


Medication with calcium hydroxide improved marginal adaptation of mineral trioxide aggregate apical barrier.
The purpose of this study was to evaluate the effect of calcium hydroxide premedication on the marginal adaptation of the mineral trioxide aggregate (MTA) apical barrier. Forty single-rooted teeth were prepared and apically resorbed using sulfuric acid for 4 days. Teeth were allocated into two groups according to whether calcium hydroxide was placed in the canals for 1 week (medicated group) or not (nonmedicated group) before placing a 4-mm MTA apical plug in the canals. The roots were mounted on aluminum stubs, the root apex was viewed from the top under scanning electron microscopy, and the maximum distance between MTA and the surrounding dentin was measured. The mean gap widths in the medicated and nonmedicated groups were 70.2 μm and 130.0 μm, respectively (p < 0.05). Calcium hydroxide treatment improves marginal adaptation of the MTA apical plug.


Comparison of metabolic risk factors in patients with recurrent urolithiasis stratified according to age and gender.
Little is known regarding the metabolic features associated with aging and gender in urolithiais patients. We compared the metabolic characteristics among 3 generations (young, middle-aged and old) with recurrent calcium-containing urinary stones. One hundred and eighty-one patients with recurrent calcium-containing stones, including 71 patients aged </=45 years (group 1), 71 patients aged 46-60 years (group 2) and 39 patients aged >/=61 years (group 3), were investigated by metabolic evaluation. The frequencies of metabolic abnormalities, the value of each urinary constituent and the supersaturation index (AP(CaOx) index) were compared among subgroups of the 3 generations, containing both males and females. The number of metabolic abnormalities was the greatest in group 1, followed by group 2 and group 3. Hyperoxaluria was the most common abnormality in each group. Group 1 females showed a lower frequency of hypocitraturia than group 3 females. This was the only characteristic that showed a significant difference between the groups. Urinary calcium excretion was significantly greater in group 1 than in group 3. Urinary citrate excretion and the AP(CaOx) index were significantly higher in group 1 than in group 3 in females. Male patients had a significantly higher number of metabolic abnormalities than female patients, especially in group 1. Multiple metabolic abnormalities, particularly a high calcium excretion appear to be crucial factors in the development and recurrence of urolithiasis in young patients. Low urinary citrate excretion could play an important role in the occurrence of urolithiasis in elderly females.


Characterization of the neuroimmune protein F5: localization to the dendrites and perikarya of mature neurons and the basal aspect of choroid plexus epithelial cells.
F5 was identified originally as an interleukin-2-regulated gene in L2 cells, a murine helper T-lymphocyte clone. In adult mouse, F5 mRNA was expressed at a modest level in lymphoid tissues, at a high level in mature neurons in the nervous system, but not in other tissues. Although the F5 sequence is highly conserved over evolution, the function of the F5 protein is unknown. In the present studies, the putative F5 protein-coding region was translated in vitro using a reticulocyte lysate system and in Escherichia coli, yielding a protein with the predicted molecular weight of 42 kDa. Polyclonal rabbit anti-F5 antibody was generated against a synthetic peptide corresponding to the C-terminus of the F5 protein. This antibody specifically recognized recombinant F5 protein. Western blot studies demonstrated a strongly-reactive 42-kDa band and a faint 39-kDa band in extracts of adult mouse brain regions, the levels of which paralleled F5 mRNA expression. Immunoperoxidase studies of adult mouse brain demonstrated F5 immunoreactivity in neuronal perikarya and dendrites but not axons. Neurons expressing the highest levels of F5 protein corresponded to those with the highest levels of F5 mRNA. Choroid plexus epithelial cells also exhibited strong reactivity localized to their basal aspect. These observations suggest that the F5 protein, expression of which appears to be regulated predominantly at the RNA level, may be involved in the maintenance of the functional or anatomic polarity of neurons and choroid plexus epithelial cells.


Structural basis of karyotype heterogeneity in Giardia lamblia.
The molecular karyotype of a series of Giardia lamblia isolates representing the two major genotypes (Groups 1 and 3) was generated by assigning 13 genetic markers to chromosomes separated by pulsed-field gel electrophoresis. The co-localization identified five linked groups of genetic markers in Group 1 isolates. For each of the five linkage groups, there were up to four size variants that hybridized with the same genetic markers. Long range physical maps of the regions flanking the low copy number genetic markers indicated that these size variants were homologous chromosomes. The linkage groups were similar in Group 1 and 3 isolates. The core of each chromosome was stable while the subtelomeres were variable. The location of the ribosomal DNA repeats was variable among the different isolates and they were found in the subtelomeric regions of any of the five linkage groups. The data suggest a functional ploidy of at least four. Hypervariable subtelomeric regions of homologous chromosomes provide the structural basis of the chromosome size heterogeneity that is characteristic of G. lamblia.


Some problems with particularism.
Particularists maintain that conspiracy theories are to be assessed individually, while generalists hold that conspiracy theories may be assessed as a class. This paper seeks to clarify the nature and importance of the debate between particularism and generalism, while offering an argument for a version of generalism. I begin by considering three approaches to the definition of conspiracy theory, and offer reason to prefer an approach that defines conspiracy theories in opposition to the claims of epistemic authorities. I argue that particularists rely on an untenably broad definition of conspiracy theory. Then, I argue that particularism and its counterpart are best understood as constellations of theses, rather than a pair of incompatible theses. While some particularist theses are highly plausible, I argue that one important particularist thesis is false. The argument for this conclusion draws on the history of false conspiracy theories. I then defend this conclusion against a pair of potential objections.


On the Reactions of Thiols, Sulfenic Acids, and Sulfinic Acids with Hydrogen Peroxide.
The reaction of thiols with H2 O2 is central to many processes essential to life, from protein folding to redox signaling. The initial products are assumed to be sulfenic acids, but their observation, and the kinetic and mechanistic characterization of their subsequent reactions, has proven challenging. The introduction of a 9-fluorotriptycene substituent enabled the use of 19 F NMR to directly monitor the reaction of a thiol with H2 O2 to yield a sulfenic acid, and its subsequent oxidation to sulfinic and sulfonic acids. The oxidations are specific base catalyzed, as revealed by the lack of isotope effects and the dependence of the kinetics on pH but not buffer concentration.


A severe transfusion reaction associated with anti-EnaTS in a patient with an abnormal alpha-like red cell sialoglycoprotein.
A 71-year-old woman (Ped) received 3 units of red cells (RBCs), compatible by the indirect antiglobulin test but strongly (4+) incompatible by direct agglutination at 37 degrees C. The next day, her plasma hemoglobin was 1252 mg percent and the direct antiglobulin test (DAT) was weakly positive (IgG and C3). Less than 5 percent of the transfused cells could be detected 48 hours posttransfusion. Her clinical condition deteriorated and renal failure developed. The patient died of pulmonary embolism. Her serum contained a strong (4+) IgM agglutinin and a weakly reactive (microscopically positive) IgG antibody, with anti-EnaTS specificity. EnaFS and EnaTS antigens were severely depressed or absent from the patient's RBCs; the ficin-resistant Ena antigen (EnaFR) appeared to be present. Pretransfusion RBC sialic acid level was 53 +/- 2 percent of normal. The patient's RBC membranes were shown to contain sialoglycoproteins beta and delta by sodium dodecyl sulphate polyacrylamide gel electrophoresis with periodic acid Schiff's base staining, with weak staining of components in the regions corresponding to alpha, alpha 2 and alpha delta. The nature of these components was not identified, but their presence suggested that the patient's RBCs expressed a previously undescribed sialoglycoprotein alpha variant.


[Environmental pollution and allergy: immunological mechanisms].
Airborne pollutants, both particulate and gaseous, represent a major environmental factor promoting allergic sensitization and disease expression. These adverse effects of particulate matter are highly dependent upon the nature and size of the particles, their content of chemicals and metals, and the subject's genetic makeup. Diesel exhaust and gases, in particular ozone, have been shown to exacerbate cellular inflammation and to act as mucosal adjuvants to skew the immune response to inhaled antigens toward a Th2-like phenotype. Growing evidence suggests that mechanisms of pollutant-induced amplification of the allergic reaction depend on oxidative stress that is under the control of susceptibility genes, as well as epigenetic mechanisms.


Aneurysm of the profunda femoris artery.
A case of profunda femoris artery aneurysm is presented. It is particularly unusual in that it is associated with anomalous vascularity, which may be of interest in the repair of ruptured lesions.


Brevinin-2GHk, a Peptide Derived from the Skin of Fejervarya limnocharis, Inhibits Zika Virus Infection by Disrupting Viral Integrity.
Several years have passed since the Zika virus (ZIKV) pandemic reoccurred in 2015-2016. However, there is still a lack of proved protective vaccines or effective drugs against ZIKV. The peptide brevinin-2GHk (BR2GK), pertaining to the brevinin-2 family of antimicrobial peptides, has been reported to exhibit only weak antibacterial activity, and its antiviral effects have not been investigated. Thus, we analyzed the effect of BR2GK on ZIKV infection. BR2GK showed significant inhibitory activity in the early and middle stages of ZIKV infection, with negligible cytotoxicity. Furthermore, BR2GK was suggested to bind with ZIKV E protein and disrupt the integrity of the envelope, thus directly inactivating ZIKV. In addition, BR2GK can also penetrate the cell membrane, which may contribute to inhibition of the middle stage of ZIKV infection. BR2GK blocked ZIKV E protein expression with an IC50 of 3.408 ± 0.738 μΜ. In summary, BR2GK was found to be a multi-functional candidate and a potential lead compound for further development of anti-ZIKV drugs.


[Occurrence of Cryptosporidium sp in fecal samples of children less than 10 years old with clinical indication of Rotavirus].
The presence of oocysts of Cryptosporidium sp was investigated in 485 fecal samples of children with clinical indication of Rotavirus. No significant differences were observed between Cryptosporidium sp. and rotavirus occurrence and fecal consistency. Cryptosporidium sp also should be performed in the laboratory diagnosis of diarrheic episodes in children.


Immunization of baboons with attenuated schistosomula of Schistosoma haematobium: levels of protection induced by immunization with larvae irradiated with 20 and 60 krad.
We have shown previously that baboons (Papio anubis) develop high levels (greater than 80%) of protection against challenge infection following immunization with Schistosoma haematobium cercariae irradiated with 20 krad. In the present study baboons were immunized with schistosomula irradiated with either 20 krad or 60 krad, with variations in the timing and number of larvae comprising each vaccination. Baboons immunized 2 or 3 times with schistosomula irradiated with 20 krad were significantly more protected (85-90%) against challenge infection than baboons similarly immunized with larvae receiving 60 krad (56-50% protection). Baboons immunized with schistosomula irradiated with 20 krad were better protected against challenge infection at 8 weeks after immunization than at 28 weeks after immunization. Protection was manifest by a reduction in worm numbers, tissue and excreta egg counts, gross pathology and, to a lesser extent, by stability of body weight and haematological indices following challenge. Enzyme-linked immunosorbent assay (ELISA) results of selected baboon sera showed few differences related to irradiation dose alone, but titres were higher in baboons receiving booster immunizations, and there was a significant correlation between titres immediately preceding challenge and the degree of resistance. Examination of responses to individual schistosomular surface antigens by immunoprecipitation and sodium dodecyl sulphate-polyacrylamide gel electrophoresis showed no correlation between the pattern of antigens recognized and resistance status. As with the ELISA assay, an anamnestic response was detected after vaccination, while the amount of antibody present declined markedly with increasing time after individual immunizations.


Double aortic arch diagnosed in a 44-year-old woman with recurring respiratory infections.
Complete vascular rings are originated because of the persistence of the fourth aortic arches, which surround the trachea and esophagus partially or completely, compressing them. The most common type of complete vascular ring is the double aortic arch. Symptoms usually appear in the first months of life, and are provoked by esophageal and tracheal compression. The diagnosis is usually made through the chest X-ray and the esophagogram in patients with dysphagia. We present a case in which the diagnosis of a double aortic arch was made in adulthood, suspected through a spirometry test and a chest X-ray.


Long-term prognostic significance of neoangiogenesis in breast carcinomas: comparison of Tie-2/Tek, CD105, and CD31 immunocytochemical expression.
The immunocytochemical detection of Tie-2/Tek, CD105, and CD31 was assessed in a large series (n = 905) of breast carcinomas on frozen sections. Results were correlated with patients' long-term outcome (median, 11.7 years) to define the respective prognostic significance of these markers. Univariate (Kaplan-Meier) analysis demonstrated that higher expression of CD31 (P = 0.032), CD105 (P = 0.001), and Tie-2/Tek (P = 0.025) correlated with poorer survival. However, only greater CD105 expression could significantly (P = 0.035) identify node-negative patients with poorer survival. Moreover, in multivariate analysis, CD105 and Tie-2/Tek, but not CD31, expression proved to be independent significant prognostic indicators. Marked expression of CD31 (P = 0.024), CD105 (P = 0.001), and Tie-2/Tek (P = 0.01) also correlated with higher risk of metastases in node-negative patients. It is concluded that CD105 immunoexpression in breast carcinomas is an independent prognostic indicator in node-negative patients, better in terms of overall survival than Tie-2/Tek and CD31. Also, Tie-2/Tek expression proved more sensitive than CD31 expression in terms of prognostic significance. Compared with CD31, CD105 and Tie-2/Tek have more clinical relevance for patient monitoring and also can serve as targets for specific therapy, such as CD105 immunotoxins or Tie-2/Tek pathway blockade, as recently suggested in experimental studies.


Effect of leukocyte hydrolases on bacteria XVI. Activation by leukocyte factors and cationic substances of autolytic enzymes in Staphylococcus aureus: modulation by anionic polyelectrolytes in relation to survival of bacteria in inflammatory exudates.
The mechanisms involved in the activation of autolytic enzymes in Staphylococcus aureus, by leukocyte extracts, cationic proteins, phospholipase A2, amines, and membrane-damaging agents was studied in a resting cell system as well as by growing staphylococci. The bacteria were labeled with [14C]N-acetylglucosamine and were subjected to a variety of agents either in 0.1 M acetate buffer, pH 5.0, or in phosphate buffer, pH 7.4. While intact log-phase cultures were found to undergo partial autolysis at pH 5.0 and almost complete lysis at pH 7.4, both heat-killed bacteria and bacterial cell walls were completely resistant to autolysis in buffers. Autolysis at pH 5.0 can be further activated by leukocyte extracts, nuclear histone, crystalline ribonuclease, egg-white and human lysozyme, phospholipase A2, as well as by spermine, spermidine, and polymyxins B and E. The addition of viable log-phase bacteria to radiolabeled heat-killed staphylococci or to radiolabeled cell walls which had been cleaned off autolytic enzymes resulted in degradation of the radiolabeled targets. The data suggest that the various inducers of autolysin activation caused leakage of autolytic enzymes from the intact bacteria which attacked the depolymerized the bacterial cell walls. Anionic polyelectrolytes like heparin, dextran sulfate, suramine, polyglutamic acid, and liquid (polyanethole sulfonic acid) markedly inhibited both spontaneous and induced lysis. Staphylococci which had grown in the presence of anionic polyelectrolytes became highly resistant to lysis triggered by any of the inducers of autolysis. Since inflammatory exudates are known to be rich in anionic polyelectrolytes, it is suggested that the prolonged survival of intact bacterial cells in such a milieu may be due to the inactivation of autolytic enzymes. It is also postulated that the degradation of certain bacterial species following phagocytosis or extracellular degradation may not be the result of the action of hydrolytic enzymes but rather the result of activation by leukocyte factors of autolytic enzymes which lead to bacteriolysis.


Aloe gel-base food products: Chemical, toxicological, and regulatory aspects.
Aloe products are increasingly valued as ingredients in food supplements and flavoring agents. In early March 2020, the European Commission drafted a ban on the use of Aloe products that contain hydroxyanthracene derivatives (HADs) in food, following the opinion on concerns about the toxicity of vegetable extracts containing HADs carried out by the European Food Safety Authority (EFSA). Aloe gel preparation is characterized by minimal amounts of HADs, only present as contaminants during extraction, compared to other sold Aloe preparations such as Aloe latex and Aloe whole leaf extract. This review provides a comprehensive account of the toxicological aspects of Aloe gel, and briefly discusses the chemical profile of other Aloe preparations. Unlike these other preparations, pure Aloe gel shows no toxic effects. However, further toxicological studies remain necessary to establish the maximum permissible limit of HAD contaminants in Aloe gel, considering daily doses and maximum duration of treatments. Finally, officially validated analytical methods for determination of HADs are required, in the form of tools for use by Companies and Competent Authorities to ensure the absence of HAD contamination in raw materials or in finished products.


Antimycobacterial, cytotoxic, and anti-inflammatory activities of Artemisialudoviciana.
A third part of the world population has been exposed to the pathogen Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB). TB is a deadly disease, and its treatment has been hampered because of the lack of new antibiotics or the development of new antimycobacterial agents against this pathogen. The situation is aggravated because of the appearance of multidrug-resistant strains. In Mexican traditional medicine, records showed Artemisia ludoviciana for the treatment of TB. Thus, the combination of antibiotics and plant extracts might represent new antimycobacterial agents as an attractive alternative. The biological activities of ethanol extract obtained from A. ludoviciana were evaluated for its antimycobacterial activities using an M. tuberculosis clinical isolate. Also, the toxicity of the extracts was assessed ex vivo and in vivo using the human-derived macrophages cell line (THP-1) and the Artemia spp. model, respectively. Lastly, the inflammatory response of macrophages exposed to the extracts was also evaluated. The ethanol extract of A. ludoviciana showed antimycobacterial activity with a MIC of 250 μg/mL against a clinical strain of M. tuberculosis. Ex vivo cytotoxicity using the THP-1 cell line incubated with the ethanol extract showed an IC50 of 20 μg/mL. On the other hand, the Artemia model's toxicity test showed moderate toxicity when the A. ludoviciana extract was tested with LC50 of 195.64 μg/mL. Analysis of the inflammatory response of THP-1 cells exposed to the same extract showed no increase in secreted interleukine-6 and -10. Also, no effect was observed in the pro-inflammatory tumor necrosis factor-α cytokine level. Moreover, a chemical profile of the extracts identified achillin as the major component in the ethanol extract, along with other minor components such as thujone and stigmasterol. We showed that the ethanol extract of A. ludoviciana possessed antimycobacterial activity and could potentially be used to supplement the antibiotic treatment of TB.


Thin-layer chromatographic determination of procainamide and N-acetylprocainamide in human serum and urine at single-dose levels.
Thin-layer chromatographic methods were applied for bioavailability studies of procainamide in serum and urine. Detection of the parent compound and the major metabolite was performed in the ultraviolet range at 275 nm. Using 100-microliter samples, detection limits were 60 ng of procainamide-HCl per ml serum and 7 micrograms/ml urine, and 60 ng of N-acetylprocainamide-HCl per ml serum and 5 micrograms/ml urine. Advantages over previous methods are discussed. From serum and urine data of five volunteers, the bioavailability of procainamide from a 250-mg dragee preparation compared with an intravenous dose was verified. Pharmacokinetic data were computed using one-compartment open models. Results corresponded well with values previously published.


A clinico-pathologic study of crescentic glomerulonephritis in 50 children. A report of the Southwest Pediatric Nephrology Study Group.
In this study, we have evaluated 50 children (30 girls and 20 boys; mean age, 10.1 years) with a variety of renal diseases in whom renal biopsy specimens showed crescents in greater than or equal to 50% of glomeruli. Initial clinical features included edema in 61%; hypertension in 51%; gross hematuria in 73%; 3 to 4+ proteinuria in 78%; and severely decreased GFR (less than 30 ml/min/1.73 m2) in 66%. When the total number of patients was divided into those with 50 to 79% crescents (N = 18) and those with 80 to 100% crescents (N = 32), no significant difference in outcome could be demonstrated, with endstage renal disease (ESRD) being seen in 44 and 52% of the two groups, respectively. Pathologic features associated with a poor prognosis included predominance of large crescents (P = 0.004) or fibrous crescents (P = 0.03); increased frequency of gaps in Bowman's capsule (P = 0.004); global glomerular sclerosis (P = 0.05); glomerular IgM (P = 0.003); interstitial fibrosis (P = 0.03); and tubular atrophy (P = 0.04). At followup, GFR was normal in all patients with poststreptococcal GN, but low in 60% of patients with other conditions. The study permits the following conclusions: (1) Approximately 50% of children with crescents in 50% or more glomeruli progress to ESRD; (2) a poor prognosis is associated with (a) a high percentage of large crescents, (b) increased frequency of gaps in Bowman's capsule, and (c) evidence of chronic histologic changes, but not with the percentage of crescents per se; and (3) the underlying type of glomerulonephritis is considered a helpful prognostic indicator.(ABSTRACT TRUNCATED AT 250 WORDS)


Subdural empyema associated with an apparent regional hyperperfusion (luxury perfusion).
A patient with a subdural empyema demonstrated a late arterial "blush" during a 99mTc-pertechnetate cerebral dynamic flow study which "washed out" in the delayed images. Cerebral arteriography and subsequent autopsy documented inflammatory tissue surrounding the empyema, resulting in this scintigraphic pattern.


The effects of catecholamines and adrenoceptor blocking drugs on the canine peripheral lymph flow.
Blood flow through the femoral artery, lymph flow in a lymphatic vessel in the femoral triangle and metatarsal distal venous pressure were measured simultaneously in a canine moving hind limb. 2. Low intra-arterial doses of adrenaline and noradrenaline increased lymph flow even in the presence of marked arterial vasoconstriction. In contrast, isoprenaline increased arterial blood flow without affecting lymph flow rate. 3. Phenoxybenzamine, dihydroergotoxine, and nicergoline did not inhibit the lymphatic flow increase induced by adrenaline at doses active on arterial or venous vascular alpha-adrenoceptors. 4. Propranolol given intra-arterially into animals pretreated with alpha-adrenoceptor blocking agents restored the vasoconstrictor effect of adrenaline (reversal of adrenaline reversal).


In silico prediction of peptide-MHC binding affinity using SVRMHC.
The binding between peptide epitopes and major histocompatibility complex (MHC) proteins is a major event in the cellular immune response. Accurate prediction of the binding between short peptides and class I or class II MHC molecules is an important task in immunoinformatics. SVRMHC which is a novel method to model peptide-MHC binding affinities based on support rector machine regression (SVR) is described in this chapter. SVRMHC is among a small handful of quantitative modeling methods that make predictions about precise binding affinities between a peptide and an MHC molecule. As a kernel-based learning method, SVRMHC has rendered models with demonstrated appealing performance in the practice of modeling peptide-MHC binding.


Evaluation of the esophagogastric junction using high resolution manometry and esophageal pressure topography.
The assessment of the esophagogastric junction (EGJ) is the most challenging aspect of clinical esophageal manometry. Although conventional manometric systems can be optimized toward interrogating specific aspects of the EGJ, they are too limited in recording channels and/or fidelity for a comprehensive assessment. The technological advantages inherent in high resolution manometry (HRM) with esophageal pressure topography (EPT) analysis substantially change this equation providing a technology sufficiently robust to dynamically record the contractile activity within the EGJ with both good fidelity and good spatial resolution. This review is an update on our understanding of the application of HRM and EPT to the analysis of EGJ function. With respect to sphincter relaxation, the integrated relaxation pressure (IRP) has proven to be a robust metric in differentiating intact from impaired EGJ relaxation. In the process, it revealed that impaired EGJ relaxation could occur not only in the setting of achalasia but also with other causes of EGJ outflow obstruction including hiatus hernia. The morphological description of the EGJ by EPT has also revealed not only a spectrum of abnormality ranging from an intact sphincter to overt herniation, but also the surprise finding of spontaneous conversion among sphincter configurations, emphasizing its dynamic nature. With respect to barrier function, preliminary data have refocused on the crural diaphragm as a key-differentiating feature between preserved and compromised function. Finally, although the accomplishments summarized above are substantial, much work remains to fully exploit the potential of EPT in the clinical characterization of the EGJ.


Uptake and oxidation of acetaldehyde by intact human erythrocytes.
Human erythrocytes were examined for acetaldehyde-oxidizing capacity of intact cells, in comparison with its uptake under various conditions. The oxidation was found to be predominant over other possible acetaldehyde-metabolizing pathways, particularly with low concentrations of acetaldehyde. Further investigation using three media which differed in the initial pyruvate level showed an independence of acetaldehyde oxidation rate up to the high cellular lactate/pyruvate concentration ratio. The apparent non-oxidative acetaldehyde uptake obtained by subtraction of oxidation from the total uptake, was reduced when pretreating the erythrocytes with pyridoxal but not with pyridoxal 5'-phosphate. Though N-ethylmaleimide also inhibited the non-oxidative uptake, another sulfhydryl blocking reagent, p-chloromercuribenzoate was without effect. Thus, in addition to the oxidation, acetaldehyde may be involved in a reaction such as binding to the red cell components, as the minor metabolizing pathway in the erythrocytes.


Imaging techniques for evaluating bone microarchitecture.
At present, fracture risk prediction in the individual patient relies chiefly on bone mineral density (BMD) measurements. However, many lines of evidence indicate that the decreased bone strength characteristic of osteoporosis is dependent not only on BMD, but also on other factors, most notably bone microarchitecture. Here, we review available tools for characterizing trabecular microarchitecture (in terms of morphology, topology, and texture) and for obtaining 2D and 3D images (using radiography, computed tomography, and magnetic resonance imaging). Bone microarchitecture imaging is a noninvasive method that may improve fracture risk prediction in the individual patient, shed light on the pathophysiology of osteoporosis, and help to monitor the effects of treatments. Among the various methods available to date, magnetic resonance imaging has the advantage of involving no radiation exposure, although its limited availability restricts its usefulness for studying vast populations. Regardless of the methods selected to assess bone microarchitecture, there is a need for validated standardized parameters capable of improving fracture risk prediction in longitudinal studies.


Probabilistic diagnosis of normal pressure hydrocephalus and other treatable cerebral lesions in dementia.
Clinical profiles of dementia patients, differing with respect to age, presence of gait abnormalities and urinary incontinence are discussed. Epidemiological data, subjective probabilities and clinical reasoning are used to predict a treatable cerebral lesion, i.e., an intracranial space occupying lesion or normal pressure hydrocephalus (NPH). Our calculations help in distinguishing clinically between demented patients who are, and who are not likely to benefit from computed tomography (CT) investigation for treatable lesions and, eventually, from cerebrospinal fluid shunting for NPH. Utility calculations show that shunting can be recommended only for a patient with the full triad of symptoms of NPH, and CT evidence of NPH, when no other prognostic information is available. Future clinical research should address the long-term prognosis of (treated) NPH patients, and the mortality of shunting, because these two factors are critical to the shunting decision.


Catheter-based intracoronary myocardial adenoviral gene delivery: importance of intraluminal seal and infusion flow rate.
Although percutaneous, adenoviral-mediated intracoronary gene delivery to the heart has been demonstrated in some species, consistent and safe methodology is needed before clinical applicability is possible. In this study, we examine the effects of altering intracoronary flow rate and obtaining an adequate seal between the catheter and the coronary lumen on successful cardiac gene delivery and myocardial injury in both piglets and adult rabbits. To study the efficacy of in vivo myocardial gene transfer, we utilized adenoviral vectors containing either the beta(2)-adrenergic receptor or beta-galactosidase. The left circumflex coronary artery of piglets and the right coronary artery of rabbits were catheterized under fluoroscopic guidance and adenovirus solutions were injected using varying flow rates with or without balloon inflation. Successful transgene delivery to the heart was determined approximately 1 week after coronary infusions. Histologic analysis was also performed in all animals to determine the extent of myocardial injury. Our results indicate that efficient and reproducible cardiac transgene expression utilizing intracoronary delivery is dependent upon the infusion flow rate and, in larger animals, requires an intraluminal seal. Excessive flow rate is associated with greater myocardial injury. Thus, conditions can be established and controlled to improve future investigational and clinical application of catheter-based intracoronary myocardial gene therapy.


Growth-inhibiting effect of tumor necrosis factor on human umbilical vein endothelial cells is enhanced with advancing age in vitro.
We have examined the effects of in vitro aging on the growth capacity of human umbilical vein endothelial cells (HUVECs) under the influence of tumor necrosis factor (TNF) with or without interferon-gamma (IFN-gamma). The growth and colony-forming abilities of control cells were impaired with advancing age in vitro, especially at later stages (more than 70-80% of life span completed). It was found that treatment with TNF inhibited growth and colony-forming efficiency at any in vitro age. The effects of TNF were shown to increase with increasing in vitro age, as reflected by a more pronounced increase in doubling times, a decrease in saturation density, and a reduction in colony-forming efficiency. However, the characteristics of TNF receptors, including the dissociation constant, and the number of TNF-binding sites per cell-surface area remained rather constant. The effect of TNF was augmented by IFN-gamma at a dose that alone affected growth and colony formation only slightly. The augmentation by IFN-gamma was also found to depend on in vitro age; the synergy with TNF in the deterioration of colony-forming ability was observed only in "aged" cells. These results suggest that the intrinsic responsiveness of HUVECs to growth-inhibiting factors, as well as to growth-stimulating factors, changes during aging in vitro.


Spheroid culture as a tool for creating 3D complex tissues.
3D cell culture methods confer a high degree of clinical and biological relevance to in vitro models. This is specifically the case with the spheroid culture, where a small aggregate of cells grows free of foreign materials. In spheroid cultures, cells secrete the extracellular matrix (ECM) in which they reside, and they can interact with cells from their original microenvironment. The value of spheroid cultures is increasing quickly due to novel microfabricated platforms amenable to high-throughput screening (HTS) and advances in cell culture. Here, we review new possibilities that combine the strengths of spheroid culture with new microenvironment fabrication methods that allow for the creation of large numbers of highly reproducible, complex tissues.


[Screening for coronary artery disease (CAD) in asymptomatic diabetics. How to and in whom to screen?].
Screening for coronary artery disease (CAD) in the asymptomatic diabetic patient is controversial with respect to both patient selection and rational choice of screening methods. Epidemiological studies in the real world and improved knowledge on risk markers have changed the criteria that help refine global risk stratification in a patient population that is per se high risk. Over the past years, it is likely that we have been overestimating the risk when using the classical risk factors. This review highlights the role of novel risk markers in the global assessment of diabetic patients, and identifies the best diagnostic approaches to select those patients who might benefit most from revascularization procedures or more aggressive treatment goals, despite the absence of symptoms. Factors such as the presence of kidney disease, cardiovascular autonomic neuropathy or atherosclerotic disease in other arterial territories, may exponentially increase the risk of poor outcomes in diabetic patients. With the aim of rationalizing the use of diagnostic procedures, we propose a sequential approach that combines anatomic and functional data with the coronary calcium score. This approach may serve as a filter to select patients for further assessment with more expensive and less available tests so as to optimize the cost-benefit ratio of screening.


Arabidopsis thaliana MTP1 is a Zn transporter in the vacuolar membrane which mediates Zn detoxification and drives leaf Zn accumulation.
The Arabidopsis thaliana metal tolerance protein 1 (MTP1) of the cation diffusion facilitator family of membrane transport proteins can mediate the detoxification of Zn in Arabidopsis and yeast. Xenopus laevis oocytes expressing AtMTP1 accumulate more Zn than oocytes expressing the AtMTP1(D94A) mutant or water-injected oocytes. An AtMTP1-GFP fusion protein localizes to the vacuolar membrane in root and leaf cells. The analysis of Arabidopsis transformed with a promoter-GUS construct suggests that AtMTP1 is not produced throughout the plant, but primarily in the subpopulation of dividing, differentiating and expanding cells. RNA interference-mediated silencing of AtMTP1 causes Zn hypersensitivity and a reduction in Zn concentrations in vegetative plant tissues.


Plasmid Sequence and Availability for an Improved Clostridioides difficile CRISPR-Cas9 Mutagenesis System.
A two-plasmid mutagenesis system for Clostridioides difficile is described that improves ease of use and efficiency in creating site-directed mutations. pJB06 contains a xylose-inducible cas9 gene, while the second plasmid (pJB07) encodes the corresponding guide RNA (gRNA) and regions of homology for repair of the introduced double-stranded DNA (dsDNA) breaks, both of which are replaceable via restriction digest.


Gorlin syndrome: two unusual cases of recurrent, bilateral, multinodular, calcified ovarian fibromas with conservative surgical treatment.
Gynecologically, NBCCS is variously associated (14%-75% cases) to typically bilateral, multinodular, calcified, ovarian fibromas. We report 2 rare cases of unusually recurrent bilateral ovarian fibromas treated with conservative surgery. Preservation of the normal ovarian tissue is always recommended, even though there is the risk of recurrences, given the benign nature of the lesions and the young age of patients.


Molecular cloning, expression analysis and characterization of peroxiredoxin during WSSV infection in shrimp Fenneropenaeus indicus.
Innate immunity is the first line of defense in shrimps against invading pathogenic microorganisms. Peroxiredoxins (PRX) are the family of antioxidant proteins that play a crucial role in reduction of oxidative stress in host during viral infection. Peroxiredoxin from Fenneropenaeus indicus was identified, cloned and expressed in prokaryotic expression system. The Fi-PRX protein consists of two conserved Cys residues and belongs to typical 2-cys PRX family. The phylogenetic analysis revealed a close evolutionary relatedness of Fi-PRX with the PRX from Drosophila melanogaster PRX1 and distant origin with PRX sequences from other shrimp isolates Fenneropenaeus chinensis, Litopenaeus vannamei and Penaeus japonicus. Fi-PRX transcripts are constitutively expressed in hemocytes and tissues (gills, heart and muscle) and down regulated during 12 h, 24 h and 48 h of WSSV challenged shrimps. Fi-PRX protein levels correlated well with the corresponding levels of Fi-PRX transcripts in hemocytes and tissues of WSSV challenged shrimps. Recombinant Fi-PRX reduces insulin only in the presence of DTT suggesting that the antioxidant function of the protein is thiol dependent. These findings suggest that antioxidant activity of Fi-PRX play a significant role in neutralization of excessive free radicals and ROS generated during viral invasion.


Verrucous carcinoma of the larynx--a misnomer.
A serie of our observations of so-called "verrucous carcinomas" of the larynx show that these peculiar lesions do not develop true infiltrating growths or metastases, and do not fulfill the criteria of a true carcinoma. Our experiences indicate that these cases can be treated successfully by repeated endoscopic resections. We have found that no aggressive radical treatment - either by surgery or irradiation - is necessary in managing these lesions. Although the etiology of "Ackerman's tumor" of the larynx is still uncertain, we suggest that the lesions develop as the result of a virus infection and propose again the term "verrucous acanthosis" instead of verrucous carcinoma for this disease.


Comparison and imputation-aided integration of five commercial platforms for targeted DNA methylome analysis.
Targeted bisulfite sequencing (TBS) has become the method of choice for the cost-effective, targeted analysis of the human methylome at base-pair resolution. In this study, we benchmarked five commercially available TBS platforms-three hybridization capture-based (Agilent, Roche and Illumina) and two reduced-representation-based (Diagenode and NuGen)-across 11 samples. Two samples were also compared with whole-genome DNA methylation sequencing with the Illumina and Oxford Nanopore platforms. We assessed workflow complexity, on/off-target performance, coverage, accuracy and reproducibility. Although all platforms produced robust and reproducible data, major differences in the number and identity of the CpG sites covered make it difficult to compare datasets generated on different platforms. To overcome this limitation, we applied imputation and show that it improves interoperability from an average of 10.35% (0.8 million) to 97% (7.6 million) common CpG sites. Our study provides guidance on which TBS platform to use for different methylome features and offers an imputation-based harmonization solution that allows comparative, integrative analysis.


Antimicrobial 1,3,4-trisubstituted-1,2,3-triazolium salts.
A series of 1,3,4-trisubstituted-1,2,3-triazolium bromide salts were prepared by efficient two-step sequences of azide-alkyne cycloaddition and benzylic substitution. The antimicrobial activity of each triazolium salt and correlating triazole precursor was evaluated using a minimum inhibitory concentration (MIC) assay. MIC activities as low as 1 µM against Gram-positive bacteria, 8 µM against Gram-negative bacteria and 4 µM against fungi were observed for salt analogs, while neutral triazoles were inactive. Analogs representing selective and broad-spectrum antimicrobial activity were each identified. MIC structure-activity relationships observed within this motif indicate that the presence of cationic charge and balance of overall hydrophobicity are strongly impactful, while benzyl vs. aryl substituent identity and variation of substituent regiochemistry are not.


The epidemiology of cancer of the uterine cervix in Canada: 1931 to 1984.
Canadian patterns of morbidity and death from malignancies of the uterine cervix have been examined for the periods 1970 to 1980 and 1931 to 1984, respectively. Age-standardized morbidity and mortality rates have declined significantly during these periods (p = 0.0041 and 0.0001, respectively). The decline in age-standardized morbidity rates is attributable to significant declines in age-specific morbidity rates for five of the eight age groups studied (p less than 0.035), with the most notable decline observed for women aged 55 to 64 years (1.8 fewer new cases per 100,000 population per year). Four of the eight age groups studied reveal significant declines in age-specific mortality rates (p less than 0.0005). However, mortality rates for women aged 85+ years have demonstrated significant increases (p less than 0.03).


Confidence in predicted position error explains saccadic decisions during pursuit.
A fundamental problem in motor control is the coordination of complementary movement types to achieve a common goal. As a common example, humans view moving objects through coordinated pursuit and saccadic eye movements. Pursuit is initiated and continuously controlled by retinal image velocity. During pursuit, eye position may lag behind the target. This can be compensated by the discrete execution of a catch-up saccade. The decision to trigger a saccade is influenced by both position and velocity errors, and the timing of saccades can be highly variable. The observed distributions of saccade frequency and trigger time remain poorly understood, and this decision process remains imprecisely quantified. Here, we propose a predictive, probabilistic model explaining the decision to trigger saccades during pursuit to foveate moving targets. In this model, expected position error and its associated uncertainty are predicted through Bayesian inference across noisy, delayed sensory observations (Kalman filtering). This probabilistic prediction is used to estimate the confidence that a saccade is needed (quantified through log-probability ratio), triggering a saccade upon accumulating to a fixed threshold. The model qualitatively explains behavioral observations on the frequency and trigger time distributions of saccades during pursuit over a range of target motion trajectories. Furthermore, this model makes novel predictions that saccade decisions are highly sensitive to uncertainty for small predicted position errors, but this influence diminishes as the magnitude of predicted position error increases. We suggest that this predictive, confidence-based decision-making strategy represents a fundamental principle for the probabilistic neural control of coordinated movements.NEW & NOTEWORTHY This is the first stochastic dynamical systems model of pursuit-saccade coordination accounting for noise and delays in the sensorimotor system. The model uses Bayesian inference to predictively estimate visual motion, triggering saccades when confidence in predicted position error accumulates to a threshold. This model explains saccade frequency and trigger time distributions across target trajectories and makes novel predictions about the influence of sensory uncertainty in saccade decisions during pursuit.


Burnout and associated factors among healthcare workers in acute care settings at a tertiary teaching hospital in Tanzania: An analytical cross-sectional study.
Healthcare worker burnout has been linked to increased patient safety risk, low work professionalism, and low satisfaction with the care encounter. This study aimed to find the prevalence and factors associated with burnout among healthcare workers in acute care settings at a national referral hospital in Tanzania. An analytical cross-sectional study was performed at a national referral hospital in Tanzania. Healthcare workers at the departments of Emergency Medicine, Intensive Care Unit, and Anesthesia at Muhimbili National Hospital were recruited from January 2021 to March 2021. A two-part questionnaire adopted from the Maslach Burnout Inventory (MBI) and MBI-Human Services Survey tool were administered to measure burnout. Categorical variables were summarized using frequencies and percentages, and variables were compared using logistic regression. A total of 174 healthcare workers were issued questionnaires to participate in the study. With a response rate of 78%, 135 healthcare workers were included in the study, 43.7% were from the intensive care unit; the majority were female (63.7%), and assistant nursing officers (42%). The prevalence of burnout among participants was 62%, with 90.4% of participants showing a high level of emotional exhaustion. A longer duration of a single-day shift was associated with increased burnout among work-related factors (p < 0.001). Fewer night-time sleeping hours, tobacco use, and lack of regular exercise were significantly associated with increased burnout among social-related factors (p < 0.001). The study showed an alarmingly high prevalence of burnout among healthcare workers in the acute care setting of Muhimbili National Hospital. Personal well-being and participation in wellness programs have been associated with a reduced prevalence of burnout. The hospital should address the issue of burnout among its healthcare workers. This also calls for immediate action, necessitating further studies at the regional and national levels to ascertain the burden and causes of burnout in this setting.


Lepromatous leprosy masquerading as disseminated tuberculosis.
A patients with disseminated leprosy is described. A 57 year old man from Cuba presented with fever and pancytopenia. Bone marrow aspirate showed numerous acid-fast bacilli and a liver biopsy specimen contained multiple granulomas. The patient was considered to have tuberculosis and was treated with isoniazid and rifampin, with initial clinical improvement, only to have the fever recur and to show deterioration in hematologic and hepatic function. Failure to grow M. tuberculosis suggested a diagnosis of leprosy which was proved by skin biopsy. How lepromatous leprosy can masquerade as disseminated tuberculosis is discussed.


Phospholipid alterations in canine cardiac sarcoplasmic reticulum induced by an acid-active phospholipase C.
Phospholipid alterations and phospholipase activities were studied in a preparation of canine cardiac sarcoplasmic reticulum (SR) known to contain lysosomes. Incubation of SR at pH 5.0 (37 degrees C) resulted in a loss in total lipid phosphorus which was maximal (10%) by 30 min. whereas a modest increase in lipid phosphorus occurred during incubation at pH 7.0. The content of phospholipid phosphorus was decreased (8.6-19.0%) in sphingomyelin, phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine when SR was incubated at pH 5.0; however phosphatidic acid increased 14% relative to control. Lysophospholipids were not detected. Liposomes of 1-acyl 2-[1 14C]-linoleoyl-sn-glycero-3-phosphoryl-ethanolamine (14C-PE) were hydrolyzed by SR at pH 5.0 to yield radiolabelled diglyceride (18.1 nmol/hr mg protein) and free fatty acid (8.3 nmol/hr mg protein). SR-mediated diglyceride production at pH 5.0, but not free fatty acid release, was markedly potentiated when 14C-PE was peroxidized by preincubation at pH 5.0 for 3-24 hours at 37 degrees C. After 24 hours of preincubation at pH 5.0 the specific activity of SR-mediated diglyceride production was 188% of control. A comparable increase in diglyceride production occurred when 14C-PE was peroxidized at pH 7.0 and hydrolyzed by SR at pH 5.0. No increase in enzymatic activity occurred when liposomes were both preincubated and assayed at pH 7.0. When 14C-PE was exposed to air at pH 5.0 or 7.0 more polar radiolabelled derivatives were formed as determined by thin layer chromatography. Up to twice as much polar lipid was formed at pH 5.0 compared to pH 7.0.(ABSTRACT TRUNCATED AT 250 WORDS)


Combination of thoracic epidural analgesia with patient-controlled intravenous analgesia versus traditional thoracic epidural analgesia for postoperative analgesia and early recovery of laparotomy: a prospective single-centre, randomized controlled trial.
Thoracic epidural analgesia (TEA) has always been the first choice for postoperative pain treatment, but associated complications and contraindications may limit its use. Our study put forward a new analgesic strategy that combines TEA with patient controlled intravenous analgesia (PCIA) to optimize TEA. Patients undergoing laparotomy were enrolled in this prospective randomized study. Patients were randomized to one of two groups: TEA/PCIA group and TEA group. Patients in TEA/PCIA group received TEA in the day of surgery and the first postoperative day and PCIA continued to use until the third postoperative day. Patients in TEA group received TEA for three days postoperatively. Visual analogue scale (VSA) pain scores at rest and on movement at 6, 24,48,72 h after surgery were recorded. In addition, the incidence of inadequate analgesia, adverse events, time to first mobilization, time to pass first flatus, time of oral intake recovery, time of urinary catheter removal, postoperative length of hospital stay, cumulative opioid consumption, and the overall cost were compared between the two groups. We examined VAS pain scores using repeated measures analysis of variance; P < 0.05 was considered as statistically significant. Eighty-six patients were analysed (TEA/PCIA = 44, TEA = 42). The mean VAS pain scores at rest and on movement in TEA/PCIA group were lower than TEA group, with a significant difference on movement and 48 h postoperatively (P < 0.05). The time to first mobilization and pass first flatus were shorter in TEA/PCIA group (P < 0.05). Other measurement showed no statistically significant differences. The combination of TEA with PCIA for patients undergoing laparotomy, can enhance postoperative pain control and facilitate early recovery without increasing the incidence of adverse effects and overall cost of hospitalization. Chinese Clinical Trial Registry( www.chictr.org.cn ), ChiCTR 1,800,020,308, 13 December 2018.


A case of eruptive milia.
A 68-year-old woman presented with a 10-year history of multiple milia on her scalp. Spontaneous eruptive milia are uncommon and the term describes cases that are more extensive in number and distribution than would be expected in primary milia.


The Erlanger Microlightguide Photometer: a new concept for monitoring intracapillary oxygen supply of tissue--first results and a review of the physiological basis.
The local oxygen supply to the skin immediately before and after withdrawal of blood was appraised in 18 healthy test subjects by measuring the intracapillary hemoglobin oxygenation (HbO2). The investigation was carried out with the Erlanger Microlightguide Photometer (EMPHO). EMPHO measurements are based on the registration of tissue remission spectra from which the HbO2 values are calculated using the Kubelka-Munk theory. The results show that global parameters do not reflect the supply of oxygen to the tissue; for example, in hypovolemia, the physiological response to the pathophysiological stimulus is centralization. This is manifested at a very early stage in the skin, before the oxygen supply to other organs (e.g., liver, kidney, gut) is affected. The disturbance of the local cutaneous oxygen supply is reflected in a change in the intracapillary hemoglobin oxygenation of the skin. Hence, one might consider measurements of the local oxygen supply to the skin as an early indicator for centralization.


Low-frequency high-definition power Doppler in visualizing and defining fetal pulmonary venous connections.
The use of low-frequency high-definition power Doppler in assessing and defining pulmonary venous connections was investigated. Study A included 260 fetuses at gestational ages ranging from 18 to 36 weeks. Pulmonary veins were assessed by performing two-dimensional B-mode imaging, color Doppler flow imaging (CDFI), and low-frequency high-definition power Doppler. A score of 1 was assigned if one pulmonary vein was visualized, 2 if two pulmonary veins were visualized, 3 if three pulmonary veins were visualized, and 4 if four pulmonary veins were visualized. The detection rate between Exam-1 and Exam-2 (intra-observer variability) and between Exam-1 and Exam-3 (inter-observer variability) was compared. In study B, five cases with abnormal pulmonary venous connection were diagnosed and compared to their anatomical examination. In study A, there was a significant difference between CDFI and low-frequency high-definition power Doppler for the four pulmonary veins observed (P < 0.05). The detection rate of each pulmonary vein when employing low-frequency high-definition power Doppler was higher than that when employing two-dimensional B-mode imaging or CDFI. There was no significant difference between the intra- and inter-observer variabilities using low-frequency high-definition power Doppler display of pulmonary veins (P > 0.05). The coefficient correlation between Exam-1 and Exam-2 was 0.844, and the coefficient correlation between Exam-1 and Exam-3 was 0.821. In study B, one case of total anomalous pulmonary venous return and four cases of partial anomalous pulmonary venous return were diagnosed by low-frequency high-definition power Doppler and confirmed by autopsy. The assessment of pulmonary venous connections by low-frequency high-definition power Doppler is advantageous. Pulmonary venous anatomy can and should be monitored during fetal heart examination.


Towards multiscale modeling of influenza infection.
Aided by recent advances in computational power, algorithms, and higher fidelity data, increasingly detailed theoretical models of infection with influenza A virus are being developed. We review single scale models as they describe influenza infection from intracellular to global scales, and, in particular, we consider those models that capture details specific to influenza and can be used to link different scales. We discuss the few multiscale models of influenza infection that have been developed in this emerging field. In addition to discussing modeling approaches, we also survey biological data on influenza infection and transmission that is relevant for constructing influenza infection models. We envision that, in the future, multiscale models that capitalize on technical advances in experimental biology and high performance computing could be used to describe the large spatial scale epidemiology of influenza infection, evolution of the virus, and transmission between hosts more accurately.


PCNU and recurrent childhood brain tumors.
PCNU, the latest nitrosourea analogue to be subjected to clinical trials, held promise as a superior chemotherapy agent for brain tumors because of more favorable biochemical and cytotoxic characteristics in laboratory studies. Thirty-nine children with a variety of recurrent primary CNS tumors, all of whom had evaluable disease, participated in a phase II PCNU trial. Their mean age was 9.7 (3-20) years. PCNU was administered as a 2 hour intravenous infusion in one of 2 dose schedules at 6-7 week intervals; 100-125 mg/m2 for minimally treated patients and 70-90 mg/m2 for heavily treated patients. Response was assessed after 2 courses of chemotherapy after attempting to taper the steroid dose. The overall objective response rate was 18% (7/39) for a mean of 5.9 months (2+ -12). Only partial responses were observed. Disease-specific responses rates were: brainstem glioma--18% (3/17); cerebral glioma--27% (3/12); ependymoma--1/1; and primitive neuroectodermal tumors--(0/9) including 5 medulloblastomas, 2 pineoblastomas and 3 cerebral primitive neuroectodermal tumors. Toxicity was primarily hematologic and clinically significant thrombocytopenia (less than 50,000 mm3) was encountered in 30/38 (79%) patient trials. Modest activity of PCNU in recurrent childhood gliomas is confirmed. Our response rates, using objective CT criteria, are somewhat lower than those reported for BCNU and CCNU. Because of comparable hematologic toxicity and efficacy, intravenous PCNU does not appear to offer a clinical advantage to existing nitrosoureas for children with recurrent brain tumors using a 2 hour intravenous infusion schedule.


An electrospun triphasic nanofibrous scaffold for bone tissue engineering.
A nanofibrous triphasic scaffold was electrospun from a mixture of polycaprolactone (PCL), type-I collagen and hydroxyapatite nanoparticles (nano-HA) with a mixture dry weight ratio of 50/30/20, respectively. Scaffolds were characterized by evaluating fiber morphology and chemical composition, dispersion of HA particles and nanoindentation. Scanning electron microscopy revealed fibers with an average diameter of 180 +/- 50 nm, which coincides well with the collagen fiber bundle diameter characteristic of the native extracellular matrix of bone. The triphasic fibers, stained with calcein and imaged with confocal microscopy, show a uniform dispersion of apatite particles throughout their length with minor agglomeration. Scaffold fibers of triphasic (50/30/20), collagen/nano-HA (80/20), PCL/nano-HA (80/20), pure PCL and pure collagen were each pressure consolidated into non-porous pellets for evaluation by transmission electron microscopy and nanoindentation. While the majority of apatite particles are uniformly dispersed having an average size of 30 nm, agglomerated particles as large as a few microns are sparsely distributed. Nanoindentation of the pressure-consolidated scaffolds showed a range of Young's modulus (0.50-3.9 GPa), with increasing average modulus in the order of (PCL < PCL/nano-HA < collagen < triphasic < collagen/nano-HA). The modulus data emphasize the importance of collagen and its interaction with other components in affecting mechanical properties of osteoconductive scaffolds.


In situ synchrotron X-ray diffraction investigation of the evolution of a PbO₂/PbSO₄ surface layer on a copper electrowinning Pb anode in a novel electrochemical flow cell. Corrigendum.
Figures 7 and 8 of the article by Clancy et al. [(2015), J. Synchrotron Rad. 22, 366-375] are corrected.


Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option.
Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome. Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment. The mean subjective international Knee Documentation Committee score (IKDC score) at two years follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at two years duration. The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.