Application and expression of Toxoplasma gondii surface antigen 2 (SAG2) and rhoptry protein 2 (ROP2) from recombinant Escherichia coli strain.
The gene encoding surface antigen 2 (SAG2) or rhoptry protein 2 (ROP2) of Toxoplasma gondii was cloned into the plasmid pGEX-4T-1 and subsequently expressed in Escherichia coli as a glutathione-s-transferase (GST) fusion protein. The characteristics of purified GST-SAG2 or GST-ROP2 were analysed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analysis. The specific IgG of a panel of serum samples provided by the National Institute for the Control of Pharmaceutical and Biological Products were tested with commercial ELISA and the lateral flow immunoassay (LFIA) based on GST-SAG2, GST-ROP2 or GST-SAG2+ROP2. A total of 1096 sera and saliva samples from pregnant women were tested by GST-SAG2+ROP2-LFIA. In total, 20 T. gondii IgM positive sera (1.82%), 81 T. gondii IgG positive sera (7.4%) and 23 T. gondii IgA positive saliva (2.1%) were finally confirmed. The SAG2+ROP2 specific IgG and IFN-γ producing CD8+ T cells were induced in mice immunised with GST-SAG2+ROP2. The results indicate that GST-SAG2+ROP2 protein can be used as an antigen for diagnosing T. gondii infection and provide a strategy for development of subunit vaccines for protection against T. gondii infection.


Correlation between cardiopulmonary changes and severity of acute lung injury in dogs.
In an attempt to determine the physiologic parameters that best correlate with severity of lung edema (wet/dry [W/D] weight), we serially monitored multiple cardiopulmonary hemodynamics, airway pressure, and blood gases on both 100% oxygen and room air after graded infusions of oleic acid (OA) in dogs. We found significant increases in the intrapulmonary shunt fraction (Qsp/Qt), mean pulmonary arterial pressure (MPAP), pulmonary (PVR) and systemic vascular resistance (SVR), alveolar-arterial PO2 difference (P[A-a] O2), and peak airway pressure (Paw), but decreases in PaO2 and pH. These cardiopulmonary hemodynamic changes were similar to those found in adult respiratory distress syndrome (ARDS). This study showed that Qsp/Qt (r = .72, p less than .001), PaO2 (r = -.60, p less than .01), P(A-a)O2 (r = .55, p less than .01), pH (r = -.55, p less than .01), MPAP (r = .50, p less than .05) and Paw (r = .49, p less than .05) significantly correlated linearly with W/D. The significant correlation is not high enough clinically to predict the severity of acute permeability pulmonary edema considering only one parameter of cardiopulmonary hemodynamic change. Therefore, we propose the possible prediction of the severity of ARDS by considering all of the above hemodynamic changes together with Paw or dynamic compliance.


A maternal vaccine against group B Streptococcus: past, present, and future.
Group B Streptococcus (GBS) is a major cause of morbidity and mortality among neonates. Though there have been tremendous advances in prevention of invasive neonatal GBS disease through prophylactic antibiotic treatment of pregnant women, the incidence of neonatal disease has not changed significantly over the past several years. Vaccination of pregnant women is an important strategy that has the potential to improve further on existing protocols. In this review, we explore the history of the design of maternal GBS vaccines. We also discuss how recent applications of genomics and immunology to vaccine design promise to further enhance our ability to develop more effective vaccines against this important disease.


First evaluation of novel potential synergistic effects of glyphosate and arsenic mixture on Rhinella arenarum (Anura: Bufonidae) tadpoles.
The toxicity of glyphosate-based herbicide (GBH) and arsenite (As(III)) as individual toxicants and in mixture (50:50 v/v, GBH-As(III)) was determined in Rhinella arenarum tadpoles during acute (48 h) and chronic assays (22 days). In both types of assays, the levels of enzymatic activity [Acetylcholinesterase (AChE), Carboxylesterase (CbE), and Glutathione S-transferase (GST)] and the levels of thyroid hormones (triiodothyronine; T3 and thyroxine; T4) were examined. Additionally, the mitotic index (MI) of red blood cells (RBCs) and DNA damage index were calculated for the chronic assay. The results showed that the LC50 values at 48 h were 45.95 mg/L for GBH, 37.32 mg/L for As(III), and 30.31 mg/L for GBH-As(III) (with similar NOEC = 10 mg/L and LOEC = 20 mg/L between the three treatments). In the acute assay, Marking's additive index (S = 2.72) indicated synergistic toxicity for GBH-As(III). In larvae treated with GBH and As(III) at the NOEC-48h (10 mg/L), AChE activity increased by 36.25% and 33.05% respectively, CbE activity increased by 22.25% and 39.05 % respectively, and GST activity increased by 46.75% with the individual treatment with GBH and by 131.65 % with the GBH-As(III) mixture. Larvae exposed to the GBH-As(III) mixture also showed increased levels of T4 (25.67 %). In the chronic assay at NOEC-48h/8 (1.25 mg/L), As(III) and GBH-As(III) inhibited AChE activity (by 39.46 % and 35.65%, respectively), but did not alter CbE activity. In addition, As(III) highly increased (93.7 %) GST activity. GBH-As(III) increased T3 (97.34%) and T4 (540.93%) levels. Finally, GBH-As(III) increased the MI of RBCs and DNA damage. This study demonstrated strong synergistic toxicity of the GBH-As(III) mixture, negatively altering antioxidant systems and thyroid hormone levels, with consequences on RBC proliferation and DNA damage in treated R. arenarum tadpoles.


Intrathecal Rubella and RNA antibody synthesis in multiple sclerosis and progressive rubella panencephalitis.
The assay of serum and CSF rubella and RNA antibodies in 3 patients (2 multiple sclerosis and 1 progressive rubella panencephalitis) shows their predominant local (intrathecal) syntheses. This correlation suggests that RNA antibodies may be directed against the viral genome itself.


Meta-analysis of MMP9-562C/T and the risk of coronary heart disease.
Previous case-control studies have suggested that the -1562C/T and R279Q polymorphisms of the matrix metalloproteinase 9 gene (MMP9) are associated with coronary heart disease (CHD). However, other studies do not confirm these relationships. The objective is to assess these relationships using meta-analysis. Databases, including PubMed and ScienceDirect, were searched to access the genetic association studies. Then data were extracted. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated. Moreover, subgroup and sensitive analysis were performed. The meta-analysis of the -1562C/T polymorphism included 12 studies with 8,336 cases and 3,984 controls. The -1562T allele was significantly associated with CHD (OR 1.25, 95% CI 1.08-1.45, p = 0.004). There was heterogeneity among the 12 studies (I2 = 61%, p = 0.003). The overall results were consistent and were not changed substantially by the removal of any data set. The meta-analysis of the R279Q polymorphism, including 6 studies with 6,983 cases and 3,282 controls, showed that the R279Q polymorphism was not associated with CHD (p = 0.16). The synthesis of available evidence supports the fact that the MMP9 -1562C/T polymorphism is a risk factor for CHD.


Sensitivity to ether anesthesia and to gamma-rays in mutagen-sensitive strains of Drosophila melanogaster.
An ether-resistant strain of Drosophila melanogaster, Eth-29, has previously been found to be radiosensitive. Some mutagen-sensitive strains are known to be hypersensitive to X-rays in larvae. The correlation between sensitivities to ether anesthesia and to gamma-rays was examined in adult flies of 12 mutagen-sensitive strains and 6 control strains. A wide variation in sensitivities to ether anesthesia, gamma-ray knock-down and gamma-ray lethality was demonstrated. No correlation between DNA-repair capacity and ether sensitivity or gamma-ray knock-down sensitivity was shown. Only mei-9 and mus201, which are deficient in excision repair, as well as Eth-29 were found to be sensitive to gamma-ray lethality. These findings indicate that the targets for ether anesthesia, knock-down and lethality may be different. Lethality appears to be caused by DNA damage, while the other 2 endpoints appear not to be related to DNA damage.


Radon dynamic adsorption coefficients of two activated charcoals at different temperatures in nitrogen environment.
Profiting from their intrinsic low radioactivity, CarboACT and Saratech, the two kinds of activated charcoal, are commonly adopted in radon removal and radon enrichment process related to modern rare-event search experiments. For supporting CDEX collaboration on radon issue, a flow-through experimental system was established and radon dynamic adsorption coefficients (kα) of CarboACT and Saratech were systematically measured in N2 condition within the temperature range of -85 °C∼200 °C. The experimental results show that radon dynamic adsorption coefficients of CarboACT and Saratech increase exponentially with the decrease of temperature, and different elution curves of them were observed. Extrapolated to 77K, the kα-values of CarboACT and Saratech at liquid nitrogen temperature could be firstly estimated at 1.2 × 1013 (L/g) and 9.5 × 1011 (L/g), respectively. The overall image of the adsorption capacities of these two activated charcoals is valuable for rare-event search studies related to radon issue.


Biosynthesis and maintenance of GSH in primary astrocyte cultures: role of L-cystine and ascorbate.
We have studied the optimal conditions to maintain the astrocyte GSH levels under normal and oxidative stress conditions. The rate of GSH synthesis from L-methionine was statistically lower than from L-cystine or N-acetyl-cysteine in astrocytes treated with diethyl-maleate, which is a substrate of GSH S-transferases. This is in accordance with the fact that cystathionase activity was not detectable. The transport of L-cystine mediated by the Na(+)-independent system Xc- is the limiting step in GSH synthesis in astrocytes. Incubation with tert-butyl hydroperoxide (t-booH) reduced GSH concentration in astrocytes. This reduction was ameliorated in part by the addition of ascorbate or dehydroascorbate. When L-cystine and ascorbate were added together to the t-booH-treated astrocytes, the GSH concentration was indistinguishable from controls. Electron micrographs of astrocytes treated with t-booH showed an increased number of vacuoles and mitochondrial swelling. This was prevented by ascorbate and dehydroascorbate. The physiological implications of the availability of GSH precursors and ascorbate in the maintenance of GSH in astrocytes are discussed.


What does aducanumab treatment of Alzheimer's disease mean for research on vascular cognitive disorders?
•Controversial registration of aducanumab for Alzheimer's Disease•Aducanumab is the subject of post-licensing observational studies aiming to follow the effects of the drug•Given the high prevalence of cerebrovascular pathology it is important that these studies do not ignore vascular cognitive disorders•The studies may give detailed phenotyping data that may lead to knowledge of targets for treatments of patients with vascular cognitive disorders.


Preliminary study on immunoscintigraphy of a murine lymphoma using technetium-99M labeled chicken antibody.
Radiolabeled antibodies generated against tumor-associated antigens are used for immunoscintigraphy to detect tumors and tumor metastases. Although successful tumor imaging has been achieved using trace-labeled murine monoclonal antibodies, such antibodies often lead to the development of human anti-murine antibodies (HAMA), which limit their subsequent administration for tumor imaging and therapy. It has been reported recently that chicken polyclonal antibodies have high affinity and specificity for the antigen against which they are raised and do not have any immunological cross-reactivity with HAMA. The present study deals with immunoscintigraphy of Dalton's lymphoma, an experimental tumor model using chicken antibodies generated against Dalton's lymphoma-associated antigen (DLAA) and labeled with technetium-99m ((99m)Tc). Scintigrams showed specific uptake of the radiolabel resulting in clear tumor images. The radioactivity uptake of the chicken anti-DLAA antibody was about twofold higher than that of the non-specific chicken antibody. The results demonstrate the potential of chicken antibody for in vivo radioimmunodetection and localization of tumors.


Absence of the trade-off between the size and number of offspring in the natterjack toad (Bufo calamita).
A trade-off between size and number of offspring was not found for females of similar sizes of the natterjack toad (Bufo calamita). Moreover, for large females, clutches with higher number of eggs had larger eggs as well. This suggests that larger females produce more numerous and larger eggs because they potentially have more energy available for reproduction. Egg size diminished allometrically with clutch size. Egg size, however, did not increase offspring fitness. Therefore, this allometric decrease may be considered a consequence of phylogenetic constraints rather than a result of optimizing selection.


Trioxsalen bath plus UVA effective and safe in the treatment of psoriasis.
Seventy-four patients with psoriasis were treated using a trioxsalen bath (50 mg/150 l of water) and long wave ultraviolet light (UVA) given in an ordinary PUVA-cabin. Good or excellent results were observed in 92% of the patients in the initial phase and in 63% during the maintenance treatment. Because of local side-effects the therapy was discontinued in two patients. One of them developed contact hypersensitivity to trioxsalen and the other developed blisters with such low doses of UVA that it was difficult to maintain the proper dose. The therapy was started with 0.28 J/cm2 of UVA and after an average of 18 treatments, when the average dose was 1.70 J/cm2, the patients were moved to maintenance treatment which took place at 1--4 week intervals. The therapy was well tolerated and cosmetically very acceptable. The final tan was even on all but the face, which remained untanned.


Characteristics and regulation of the expression on interleukin 1 receptors by murine Langerhans cells and keratinocytes.
There is increasing evidence that interleukin 1beta (IL-1beta), a product in murine epidermis of Langerhans cells (LC) exclusively, contributes to the initiation and regulation of LC migration in response to skin sensitization. The hypothesis is that IL-1beta induces the production by keratinocytes of tumour necrosis factor alpha (TNF-alpha) which acts in a paracrine fashion on LC to provide one signal for migration. In addition, it is believed that IL-1beta acts in an autocrine fashion on LC to provide a second, TNF-alpha-independent, signal for the initiation of this response. The viability of this hypothesis is dependent upon the availability of appropriate membrane receptors. We describe therefore experiments designed to investigate the IL-1 receptor (IL-1R) status of keratinocytes, LC and lymph node dendritic cells (DC). Flow cytometric analyses of epidermal cell suspensions revealed at least 60% of LC positive for the type I IL-1R (IL-1RI). In contrast, only a small proportion of keratinocytes displayed surface IL-1RI, although high intracellular expression of this receptor could be detected either by flow cytometric analysis of cells permeabilized with saponin or by immunofluorescence microscopy. Expression of the type II IL-1R (IL-1RII) was detected at relatively low levels on both LC and keratinocytes. Interestingly, DC isolated from the lymph nodes of sensitized mice displayed upregulated expression of IL-1RI and lower levels of IL-1RII compared to LC. The conclusion drawn is that the IL-1R phenotype of LC and keratinocytes under resting conditions is consistent with the proposed contribution of IL-1beta to LC migration. Furthermore, the regulation of IL-1R expression by epidermal cells and DC will undoubtedly influence the development of cutaneous immune responses.


A new magnesium sheet alloy with high tensile properties and room-temperature formability.
Lightweight sheet alloys with superior mechanical performance such as high strength, ductility and formability at room temperature (RT) are desirable for high volume automotive applications. However, ductility or formability of metallic alloys at RT are generally inversely related to strength, thereby making it difficult to optimize all three simultaneously. Here we design a new magnesium sheet alloy-ZAXME11100 (Mg-1.0Zn-1.0Al-0.5Ca-0.4Mn-0.2Ce, wt. pct.) via CALPHAD (CALculation of PHAse Diagram) modeling and experimental validation. This new sheet alloy offers an excellent RT formability with a high Index Erichsen (I.E.) value of 7.8 mm in a solution-treated condition (T4), due to its weak and split basal texture and fine grain structure. The new ZAXME 11100 alloy also shows a rapid age-hardening response during post-forming artificial aging treatment at 210 °C for 1 hour (T6), resulting in a significant increase of yield strength from 159 MPa (T4) to 270 MPa (T6). The excellent combination of T4 ductility (31%), T4 formability (7.8 mm) and T6 yield strength (270 MPa) in this new magnesium alloy is comparable to that of common 6xxx series aluminum sheet alloys. Thus, this new magnesium sheet alloy is highly attractive for sheet applications in automotive and other industries.


Teerakanchana's equation transcends over 12 other LDL-C quantification formulae in the North Indian population.
Over the last 3 decades, there has been a steady rise in global mortality due to cardiovascular diseases (CVDs). Therefore, timely diagnosis of CVDs is paramount. Low-Density Lipoprotein-cholesterol (LDL-C) in blood serum is one of the biomarkers for the risk assessment of CVDs, measured by direct assays and indirect approaches. The indirect method of LDL-C quantification by Friedewald's formula is more widely used in Indian clinical settings than direct assays due to its time and cost-effectiveness. However, its accuracy has been questioned for a long. We tried to find the formula that work in best agreement with the direct method. Lipid profiling was done following a direct homogenous method (LDL-C_M) and LDL-C was calculated by 13 formula. The LDL-C values were categorized into groups based on TG. All the formula were statistically correlated with LDL-C_M. Teerakanchana's formula has shown a strong positive correlation (r = 0.914) and good agreement M (Lin's CCC = 0.929, CI = 0.918-0.939) with LDL-C_M, followed by Vujovic's formula (r = 0.903, Lin's CCC = 0.925, CI = 0.912-0.936). Teerakanchana and Vujovic's formula may replace Friedewald to quantify LDL-C in the public health care settings of the North Indian population.


The Association between Laughter and Functional Dyspepsia in a Young Japanese Population.
The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population. This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire. The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)). In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.


Developmental study in the circadian clock of the golden hamster: a putative role of astrocytes.
The hypothalamic suprachiasmatic nuclei (SCN) house the circadian clock in the mammalian brain. A glial fibrillary acidic protein immunoreactivity (GFAP-ir) distribution rhythm has been observed in the SCN of adult Syrian hamster. The implication of astrocytes in photic entrainment was analyzed through developmental studies of the photic pathway and of SCN astrocytes appearance. Using anterograde tracing we studied the timing of penetration of the retinohypothalamic tract (RHT) fibers into the SCN. Using c-fos induction by light we followed the maturation of RHT synapses in the SCN. When RHT terminals reach the SCN, c-fos induction can be obtained. Using GFAP immunoreactivity we demonstrated that the number of astrocytes increased in parallel with RHT development from PN5 to PN15. At PN15, a time when pups can shift from maternal to photic entrainment, RHT terminals and GFAP-ir exhibit an adult-like pattern. One demonstrated role of astrocytes is to control extracellular glutamate concentration. Glutamate is the neurotransmitter released at RHT terminals; its content fluctuates according to a circadian rhythm within the SCN. Thus the present data tend to indicate that SCN astrocytes are participating in the circadian rhythm of SCN glutamate content.


Effects of decreased dietary salt intake on blood pressure in preschool children.
Salt-restricted preschool black children, 4 to 5 years of age, were found to have significantly lower diastolic and systolic blood pressures than a matched group on a regular diet. The one exception was the systolic readings for the group of female children; no significant difference between restricted and regular salt diets was found.


Smoking and ischemic stroke: a role for nicotine?
Cigarette smoking is a preventable risk factor for ischemic stroke. The mechanisms by which smoking contributes to stroke are poorly understood and the role of nicotine in this process is controversial. Although nicotine administered transdermally and orally does not appear to have as many associated health risks as do cigarettes, nicotine does have acute vasoactive and mitogenic effects on vascular tissues. Nicotine might alter the function of the blood-brain barrier and disrupt normal endothelial cell function. Some of the detrimental effects of nicotine are prevented by nicotinic acetylcholine receptor antagonists. However, recent studies indicate that nicotine might also interact with intracellular signaling pathways that are independent of acetylcholine receptors. In light of these recent developments, the impact of nicotine on cerebrovascular pathology should not be dismissed.


The use of Forane anesthesia for surface-induced deep hypothermia.
The effects of Forane anesthesia for deep surface hypothermia with 30 minutes of total circulatory occlusion were evaluated. With 100% O2 6 of 7 dogs developed motor disorders postoperatively, while 3 of 5 with 98% O2/2% CO2 and none with 95% O2/5% CO2 developed motor disorders. Cooling was uneventful except for 1 episode of ventricular fibrillation in the 5% CO2 group at 23 degrees C. Resuscitation was easy, but the early rewarming period was characterized by repeated episodes of ventricular fibrillation and delayed recovery of cardiac function, especially in the 100% O2 group. Blood lactate levels remained low during cooling and gradually increased during rewarming in all groups, with the highest levels in the 100% O2 group and the lowest in the 5% CO2 group. It is concluded that Forane can be used for surface hypothermia with 30 minutes' circulatory occlusion when administered in 95% O2/5% CO2. A Comparison of these results with previously reported series indicates that Forane is inferior to ether but may be superior to halothane for surface hypothermia.


Retrograde transport of sodium selenite and intracellular injection of micro-ruby: a combined method to describe the morphology of zinc-rich neurones.
Zinc is found in synaptic vesicles in a large number of glutamatergic systems. Its involvement in neurotransmission and neurological disorders has been suggested. There are methods for tracing these circuits, but they do not fill the dendritic tree. In this study, extracellular selenite injections in vivo were combined with intracellular injection of fluorochromes in fixed tissue to reveal the morphology of these zinc-rich neurones. Intraperitoneal and intracerebral injections of sodium selenite alone or intracerebral injections of selenite combined with bisbenzimide were made in the visual cortex of the rat in order to locate the somata of zinc-rich neurones. After 24 h of retrograde transport, animals were killed and fluorescent markers were injected intracellularly into fixed slices to show neuronal morphology: (a) Lucifer Yellow (LY) followed by biocytin, (b) LY coupled to biocytin or (c) micro-ruby (MR) (dextranamines bound to rhodamine and biotin). Double-labelled somata (selenite+fluorochrome) were plotted. Details of the dendritic morphology were then revealed by incubation in avidin-biotin complex and development in 3,3'-diaminobenzidine and H(2)O(2). Camera lucida drawings showed that zinc-rich neurones in layers II-III involved in cortico-cortical visual projections were typical pyramidal neurones. This technique is noteworthy for its analysis of the morphology (and connections) of zinc-rich neurones.


Glutathionylation of the iron superoxide dismutase from the psychrophilic eubacterium Pseudoalteromonas haloplanktis.
Our previous work showed that the adduct between beta-mercaptoethanol and the single cysteine residue (Cys57) in superoxide dismutase from the psychrophilic eubacterium Pseudoalteromonas haloplanktis (PhSOD) reduces the enzyme inactivation by peroxynitrite. In this work, immunoblotting experiments prove that peroxynitrite inactivation of PhSOD involves formation of nitrotyrosine residue(s). In order to study the role of Cys57 as a redox-sensor residue modifiable by cellular thiols, a recombinant PhSOD and two Cys57 mutants were produced and characterized. Recombinant and mutant enzymes share similar activity and peroxynitrite inactivation, but different reactivity towards three glutathione forms. Indeed, oxidized glutathione and S-nitrosoglutathione, but reduced glutathione, lead to S-glutathionylation of recombinant PhSOD. This new covalent modification for a Fe-SOD does not occur in both Cys57 mutants, thus indicating that its target is Cys57. Moreover, mass spectrometry analysis confirmed that S-glutathionylation of Cys57 takes place also with endogenous PhSOD. Formation of this mixed disulfide in PhSOD protects the enzyme from tyrosine nitration and peroxynitrite inactivation. PhSOD undergoes S-glutathionylation during its overproduction in E. coli cells and in a growing culture of P. haloplanktis. In both cases the extent of glutathionylated PhSOD is enhanced upon cell exposure to oxidative agents. We suggest that S-glutathionylation of PhSOD could represent a further cold-adaptation strategy to improve the antioxidant cellular defence mechanism.


Returning to productive activities: Perspectives of individuals with long-standing acquired brain injuries.
The primary objective of this study was to understand how intrinsic and extrinsic factors influence productive involvement over time. Given this relatively unexplored area of study, an interpretive research paradigm was incorporated using the grounded theory methodology. Six participants were recruited based on inclusion criteria. They had been living with a brain injury for an average of 14 years. The primary method of data collection was semi-structured interviews, which was supplemented by programme reports to enhance methodological triangulation. The results revealed that factors influencing involvement in productive activities over time were conceptually linked to learning about one's capacity. These factors involved: an opportunity to try, support and feedback from others, experimenting, and participants' appraisals of themselves. Recommendations for clinical practice include incorporating the postulates of the social cognitive theory in rehabilitation and moving from a deficits approach towards a strengths model of practice.


Identification of three isoforms for mitochondrial adenine nucleotide translocator in the pufferfish Takifugu rubripes.
Three adenine nucleotide translocator (ANT) genes were identified through in silico data mining of the Fugu genome database along with isolation of their corresponding cDNAs in vivo from the pufferfish (Takifugu rubripes). As a result of phylogenetic analysis, the ANT gene on scaffold_254 corresponded to mammalian ANT1, whereas both of those on scaffold_6 and scaffold_598 to mammalian ANT3. The ANT gene encoded by scaffold_6 was expressed ubiquitously in various tissues, whereas the ANT genes encoded by scaffold_254 and scaffold_598 were predominantly expressed in skeletal muscle and heart, respectively.


Effects of temporary clips on somatosensory evoked potentials in aneurysm surgery.
Changes in somatosensory evoked potentials (SEPs) were used to identify cerebral ischemia and to predict neurological outcome during the application of temporary clips in aneurysm surgery. SEPs were recorded intra-operatively in 76 patients with 79 aneurysms (8 in the posterior fossa). Twenty aneurysms ruptured during surgery, and 37 temporary clips were applied over an average of 8.1 minutes (range: 2-25 minutes). Of 17 cases with complete loss of potential, 14 were associated with temporary clips. Two losses were persistent with postoperative neurological deficit after 10 minutes of clipping. Six showed incomplete recovery after a mean loss of 19.2 minutes following clipping of 9.3 minutes, resulting in a new deficit in four patients. Despite complete recovery of potential in six patients after a 1 loss over 18.8 minutes following clipping of 10.7 minutes, four patients developed neurological deficits. The sensitivity of SEPs in determining permanent neurological deficits was 57%, and the was specificity 88%. The duration of temporary clipping was significantly shorter in patients without resulting new neurological deficit (Mann-Whitney Test; p < 0.01). The risk of a new deficit was 30.7% in cases where less than 8 minutes of clipping was performed, and the risk was 80.9% when clipping exceeded 8 minutes. The extent of recovery of potentials and the duration of SEP changes was strongly associated with the postoperative deficits (Kolmogorov-Smirnov Test, p = 0.009; p = 0.001, Mann-Whitney Test). Pathological p(ti)O2 measurements were obtained in 6 of 12 patients. In four patients, temporary occlusion was followed by a parallel alteration of SEPs and p(ti)O2 below 10 mmHg. There is no genuinely safe permissible occlusion time. Despite complete recovery of SEPs after a loss of potential, the patient may develop new deficits.


Retention of opioids and their glucuronides on a combined zwitterion and hydrophilic interaction stationary phase.
A stationary phase combining zwitterionic ion chromatography and hydrophilic interaction chromatography (ZIC-HILIC) from SeQuant was evaluated for the chromatography of some opiates and their polar metabolites. The effects of mobile phase constitution on retention and resolution were extensively evaluated. Different aspects of mobile phase constitution such as ion strength and type of buffer, type and amount of organic modifier and pH were examined. The selectivity and retention of the opiates compared to their glucuronides could be substantially altered with small changes of the mobile phase, especially when the type of buffer, i.e., formate or acetate and organic modifier, i.e., acetonitrile or methanol were changed. The retention on the ZIC-HILIC was dominated by hydrophilic interaction chromatography (HILIC) but considerable effects on the selectivity was observed, possibly caused by an ion exchange mechanism due to interactions with the charges on the stationary phase.


Biofidelity evaluation of WorldSID and ES-2re under side impact conditions with and without airbag.
This study evaluated the biofidelity of the WorldSID and the ES-2re under whole-body side impact conditions with and without a side airbag using the biomechanical cadaveric response data generated from 4.3m/s whole-body side impact tests. Impact forces, spinal kinematics, and chest deflections were considered in the biofidelity evaluation. Average responses and response corridors of PMHS were created using a time-alignment technique to reduce variability of the PMHS responses while maintaining the sum of the time shifts to be zero for each response. Biofidelity of the two dummies was compared using a correlation and analysis (CORA) method. The WorldSID demonstrated better biofidelity than the ES-2re in terms of CORA ratings in the conditions with airbag (0.53 vs. 0.46) and without an airbag (0.57 vs. 0.49). Lastly, the kinematic analysis of the two dummies indicated an overly compliant shoulder response of the WorldSID and excessive forward rotation of the ES-2re relative to the PMHS.


Maternal T cells promote placental growth and prevent spontaneous abortion.
Transplantation immunologists have long been intrigued by the natural allograft that results from normal mammalian pregnancy. Its general success contrasts with the rejection problems associated with most artifactual organ transplantation and raises intriguing questions concerning the nature of the mechanisms involved in that success. This area of research has recently taken on added momentum because it is now clear that immunological maneuvers can prevent recurrent spontaneous abortion in mice, horses and humans [1-3]. The purpose of this review is to discuss some of these recent developments, which lead to the surprising conclusion that maternal T cells, rather than being potentially detrimental to the fetal allograft, promote its growth and viability during normal pregnancy. This review will address these questions by considering: (a) the nature of the exposure of fetal alloantigens to the maternal circulation in the chimeric zone of the placenta; (b) the evidence for maternal immune recognition of the fetal alloantigens; and (c) the consequences of that recognition with respect to the prevention of spontaneous abortion. As in other areas of immunology the T cell emerges as the most important component of this immune recognition.


Isolated hypersomnia due to bilateral thalamic infarcts.
We describe a unique patient who developed hypersomnia as the sole presenting symptom of bilateral thalamic infarcts.


A review of techniques for the analysis of boron in the development of neutron capture therapy agents.
The resurgence of interest in neutron capture therapy, which uses boron-10 labelled compounds and neutron irradiation as a technique for the treatment of cancer, has been accompanied by the application of a new generation of techniques for the analysis and imaging of boron in biological matrices. In this review, a description is given of the requirements for boron neutron capture agents and the achievements to date of the analytical techniques.


Directly measured activation parameters for the ring expansions of cyclopropylhalocarbenes.
Activation parameters have been redetermined for the ring expansions of cyclopropylchlorocarbene and cyclopropylfluorocarbene; agreement between the experimental and computed activation parameters has been significantly improved.


Enhancing treatment of obesity by using a distracting mini-meal: a new approach to an old problem.
The management of obesity, apart from exercise, mainly involves a calorie restriction regimen. A pharmaceutical treatment is often used to improve patient compliance and diet effectiveness, although several side-effects have previously been described. To improve patient compliance and diet effectiveness without incurring unpleasant side-effects, we evaluated whether a distracting mini-meal can physiologically decrease the absorption of fats and carbohydrates. Two minutes before each of the three meals consumed daily, 32 obese patients were treated with a distracting mini-meal, 32 with metformin, and 32 with placebo. At baseline and after 1, 3, and 6 months of treatment, body weight, body mass index, waist circumference, fasting/post-prandial insulinaemia and glycaemia, homeostasis model assessment-index, triacylglycerols, and total cholesterol were evaluated. All patients showed good compliance. With the exception of post-prandial glycaemia, a significant reduction in all parameters was documented in every group, albeit the greater variation was observed in patients treated with a distracting mini-meal or metformin. No one showed noteworthy side-effects. Our study focuses on a distracting mini-meal that could become a useful tool in enhancing weight loss. The beneficial effect of a distracting meal on insulin resistance, glucose, and lipid metabolism suggest its possible use to prevent or mitigate obesity-related disorders.


Relationship between Preoperative ¹⁸F-Fluorodeoxyglucose Uptake and Epidermal Growth Factor Receptor Status in Primary Colorectal Cancer.
Both ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake and epidermal growth factor receptor (EGFR) status are prognostic variables of colorectal cancer (CRC). The aim of this study was to investigate a possible association between ¹⁸F-FDG uptake on preoperative positron emission tomography/computed tomography (PET/CT) and EGFR status in primary CRC. Records of 132 patients (66 men and 66 women; mean age=67.1±11.1 years) who underwent ¹⁸F-FDG PET/CT for CRC staging and subsequent bowel resection were reviewed. In primary lesions, ¹⁸F-FDG uptake was semiquantitatively evaluated in terms of maximum standardized uptake value (SUVmax), and EGFR status was determined by immunohistochemistry. Associations of clinicopathological parameters and EGFR status were analyzed by Pearson's chi-square test, multiple logistic regression, and receiver operating characteristic curves. Eighty-six patients (65.2%) showed EGFR expression. SUVmax was significantly lower in EGFR-negative tumors than in EGFR-expressing tumors (10.0±4.2 vs. 12.1±2.1; p=0.012). It was the only significant parameter correlated with EGFR expression (odds ratio=2.457; relative risk=2.013; p=0.038). At the SUVmax threshold of 7.5, the sensitivity and specificity for predicting EGFR expression were 84.9% and 40.4%, respectively (area under the curve=0.624; p=0.019). Preoperative ¹⁸F-FDG uptake is slightly correlated with EGFR status in primary CRC. Preoperative SUVmax of ¹⁸F-FDG may have a limited role in predicting EGFR expression in such tumors because of its poor specificity.


Assessment of metal bioavailability in sediments and bioaccumulation in edible bivalves, and phyto-remediation potential of mangrove plants in the tropical (Kali) estuary, India.
The bioavailability of metals (Fe, Mn, Zn, Cu, Co and Ni) in sediment cores (K-1, K-2, K-3 and K-4) and bioaccumulation in edible bivalves were studied to determine the toxicity of metals in the Kali Estuary, India. Enrichment Factor (EF) construed anthropogenic sources of Zn, Co and Ni, while Geo-accumulation Index (Igeo) revealed pollution of Zn and Ni based on total metal analysis. The Pollution Load Index (PLI >1) supported anthropogenic origin of metals in estuary. Metal speciation study indicated bioavailability of metals in sediments. The bioavailable Mn and Co equalled/exceeded the Apparent Effect Threshold (AET) limit (cores K-1, K-3 and K-4) and indicated toxicity to estuarine biota. The metals in Metetrix casta (Fe, Mn, Zn, Cu, and Ni), Saccostrea cucullata (Fe, Mn, Zn, Cu, Co and Ni) and Villorita cyprinoides (Fe, Mn, Zn, Cu, Co and Ni) exceeded the permissible bioaccumulation limit. Thus, revealed metal toxicity to bivalves and labelled them un-safe for human consumption. Translocation Factor (TF > 1) indicated the use of Kandelia candel in phyto-remediation of Fe, Zn, Cu, Co and Ni at station K-3, and Sonnaretia caseoloris in phyto-remediation of Fe, Zn and Ni at station K-4.


Neural actions of several substance P antagonists in the rat spinal cord.
Four substance P (SP) antagonists were tested on anaesthetized rats, by injecting 8 microgram amounts into the spinal cord (T8-T9), and by observing their effects on the hypothalamo-neurohypophysial responses to a presumably painful stimulus, the superfusion of the hepatic portal vein with 1 microM bradykinin. Only two antagonists, the new D-Pro4,D-Trp7,9,10,Val8-SP4-11 and D-Pro4,D-Trp7,9,10-SP4-11 were capable of inhibiting the responses by 50-60%, the former compound having 3 times less agonistic activity. The results suggest that substitution of the aromatic phenylalanine by the non-polar valine in position 8 may significantly improve the overall characteristics of neurally active SP antagonists.


Cancer from a biobehavioural and social epidemiological perspective.
Malignant neoplasm should not be viewed as a 'psychogenic' nor as a 'primarily organic' disease but as an interaction of various forces, in which psychosocial factors may play an important role. To understand the increase in neoplastic disease, which has taken place in this century, requires a theoretical framework including social, psychosocial and behavioural dimensions, as well as the endocrine and immunologic mechanisms acting as pathogenic pathways. Recent theoretical developments in health psychology and allied disciplines on coping behaviour and social support should be integrated into biomedical models of the aetiology, pathogenesis and clinical course of malignant neoplasia. Environmental stressors, as well as mediating variables at the cognitive, affective, behavioural and physiological levels of adaptation, are suggested as major components of a model of multidimensional pathology. A growing body of research on the role of psychosocial factors in adjustment to cancer and its treatment has contributed new insights into possible variables and causal mechanisms which may be relevant in the aetiology of the disease. Closeness to parents in childhood and the ability to form close interpersonal relationships in later adult life very possibly influence the ability of the individual to cope effectively with environmental stressors prior to neoplastic disease and with the considerable stresses of being a cancer patient subsequent to diagnosis and treatment. Pathogenic pathways for future investigation include mental health variables, such as self-esteem and sense of control, at the psychological level and immunity surveillance at the biological. An integration and cross-fertilization of current work in the aetiology of and adjustment to cancer is suggested linking psychosomatic and somatopsychic models.


Sydenham chorea in a12- year old Saudi girl.
Sydenham chorea (SC) is the most common acquired cause of chorea in children. (SC) is the neurological manifestation of rheumatic fever. Rheumatic fever is still reported in Saudi Arabia, although less frequently. According to modified Jones criteria, carditis and arthritis are the major manifestations of acute rheumatic fever (ARF) in children. SC is often seen in isolated form; however, it can occur in association with other clinical manifestations of ARF like carditis. It has been reported that silent, mild valvular regurgitation has been found in patients with pure chorea. SC is characterized by abnormal body movement, associated with behavioral changes. It is an autoimmune disease that occurs following an infection with Group A beta-haemolytic streptococcal infection that is prevalent in Saudi Arabia. Despite recent advances in child health care services, RF continues to occur in Saudi Arabia. We describe a 12-year-old Saudi girl with SC and clinically inaudible, but echocardiographically significant mild valvular regurgitation. The diagnosis of Sydenham chorea should be considered in young children with choreiform movements. Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of penicillin prophylaxis.


Implementation of Surprise Question Assessments using the Electronic Health Record in Older Adults with Advanced CKD.
The Surprise Question (SQ; "Would you be surprised if this patient died in the next 12 months?") is a validated prognostication tool for mortality and hospitalization among patients with advanced CKD. Barriers in clinical workflows have slowed SQ implementation in practice. The aims of this study were: (1) to evaluate implementation outcomes after the use of electronic health record (EHR) decision support to automate the collection of the SQ; and (2) to assess the prognostic utility of the SQ for mortality and hospitalization/emergency room (ER) visits. We developed and implemented a best practice alert (BPA) in the EHR to identify nephrology outpatients ≥60 years of age with an eGFR <30 ml/min per 1.73 m2. At appointment, the BPA prompted the physician to answer the SQ. We assessed the rate and timeliness of provider responses. We conducted a post-hoc open-ended survey to assess physician perceptions of SQ implementation. We assessed the SQ's prognostic utility in survival and time-to-hospital encounter (hospitalization/ER visit) analyses. Among 510 patients for whom the BPA triggered, 95 (19%) had the SQ completed by 16 physicians. Among those completed, nearly all (98%) were on appointment day, and 61 (64%) the first time the BPA fired. Providers answered "no" for 27 (28%) and "yes" for 68 (72%) patients. By 12 months, six (22%) "no" patients died; three (4%) "yes" patients died (hazard ratio [HR] 2.86, ref: yes, 95% CI, 1.06 to 7.69). About 35% of "no" patients and 32% of "yes" patients had a hospital encounter by 12 months (HR, 1.85, ref: yes, 95% CI, 0.93 to 3.69). Physicians noted (1) they had goals-of-care conversations unprompted; (2) EHR-based interventions alone for goals-of-care are ineffective; and (3) more robust engagement is necessary. We successfully integrated the SQ into the EHR to aid in clinical practice. Additional implementation efforts are needed to encourage further integration of the SQ in clinical practice.


Outcomes of acute heart failure patients managed in the emergency department.
Acute heart failure is a serious condition commonly seen in the emergency department (ED). The HEARTRISK6 Scale has been recently developed to identify the risk of poor outcomes but has not been tested. We sought to describe the management and outcomes of ED patients with acute heart failure and to evaluate the potential impact of the HEARTRISK6 Scale. We conducted a health records review of 300 consecutive acute heart failure patients presenting to two tertiary care EDs. Two evaluators abstracted clinical variables, ED management and treatment details, and patient outcomes using the electronic health records platform (EPIC) and attending physicians verified the data. The primary outcome measure was a short-term serious outcome, as shown in Results. In addition, the HEARTRISK6 score was calculated retrospectively. We included 300 patients with mean age of 78.5 years, 51.0% male, 56.3% arrival by ambulance, and 67.0% admitted to hospital. 25.3% experienced a short-term serious outcome 1) after admission (N = 201): non-invasive ventilation 14.9%, intubation 1.5%, major cardiac procedure 5.0%, myocardial infarction 2.0%, death 8.5%; 2) after ED discharge (N = 99): return to ED 21.2%, death 4.0%. Those initially admitted experienced a much higher proportion of serious outcomes compared to those discharged (29.9% vs. 16.2%). A HEARTRISK6 Scale cut-point score of ≥ 1 would have had a sensitivity of 91.0%, specificity 24.5%, and negative likelihood ratio 0.37 for short-term serious outcomes and suggested hospital admission for 80.7% of cases. There was a large range of severity of illness of acute heart failure patients and a wide variety of treatments were administered in the ED. Both admitted and discharged patients experienced a high proportion of poor outcomes. The HEARTRISK6 Scale showed a high sensitivity for short-term serious outcomes but with the potential to increase hospital admissions. Further validation of the HEARTRISK6 Scale is required before routine clinical use.


Inhibition of phosphorylation of the mitochondrial 34 kDa protein. A unique effect of vanadium ions?
We have shown previously that vanadate stimulates overall endogenous phosphorylation of proteins in subcellular particulate fractions. In brain mitochondria there is a single peptide band of Mr (approx.) 34 kDa, phosphorylation of which is inhibited rather than stimulated by both vanadate and vanadyl ions. Here, further characterization of this unique effect of vanadium ions is reported. Phosphorylation of the 34 kDa protein proceeds in the Triton X-100 extracts of mitochondria. The P-labeled 34 kDa band was recovered from TCA sediments of endogenously phosphorylated mitochondria. Acid lability of the phosphate linkage suggests a bond of P-N type. Phosphorylation of the 34 kDa protein is highly sensitive to Mg2+, while Mn2+ is a less potent activator. The results provide further evidence for existence of a protein occurring exclusively in mitochondria, the phosphorylation of which is selectively modified by both vanadate anion and vanadyl cation in a way differing from those hitherto described.


Chronic chorioamnionitis: a clinicopathologic and immunohistochemical study.
Lymphocytic inflammation of the fetal membranes is unusual and has been termed chronic chorioamnionitis. We report the clinicopathologic and immunohistochemical findings in 31 placentas with chronic chorioamnionitis. The most common histopathologic association was chronic villitis of unknown etiology, which was identified in 22 (71%) of the 31 placentas. The severity of the chronic villitis did not correlate with the severity of chronic chorioamnionitis. Additional placental findings included chronic intervillositis in two, fetal vessel thrombosis in five, hemorrhagic endovasculitis in four, decidual chronic vasculitis in three, and atherosis in one. Maternal history included pregnancy-induced hypertension in six and diabetes in one. Twelve infants were preterm, and five had intrauterine growth retardation. There was no neonatal sepsis or death. Immunohistochemical staining in areas of chronic chorioamnionitis showed CD3+ and CD8+ cells present in moderate numbers, and CD4+ cells in smaller numbers. CD20+ and CD56+ cells were rare or absent. Chronic chorioamnionitis is commonly associated with chronic villitis of unknown etiology, shares similar clinical associations, and may have a related cause, possibly immunologic.


POEMS syndrome: A rare cause of ascites and pelvic effusion.
POEMS syndrome is a rare clonal plasma cell disease associated with multisystem involvement. We reported a case of 48-year-old woman with large volume of exudative ascites with an increased level of λ-light chain and hepatosplenomegaly. The patient was treated with thalidomide and dexamethasone and showed a good clinical response.


Author Correction: Text-mined dataset of inorganic materials synthesis recipes.
An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Achieving high-rate partial nitritation with aerobic granular sludge at low temperatures.
Partial nitritation is necessary for the implementation of the mainstream anammox (anaerobic ammonium oxidation) process in wastewater treatment plants. However, the difficulty in outcompeting nitrite-oxidizing bacteria (NOB) at mainstream conditions hinders the performance of partial nitritation. The present work aimed to develop a high-rate partial nitritation process for low-ammonium wastewater treatment at low temperatures by seeding aerobic granules. Experimental results suggested that both stratified structure of nitrifiers developed in the granules and sufficient residual ammonium concentration (18-35 mg N L-1) in the bulk liquid contributed to efficient NOB repression. With the hydraulic retention time progressively shortened from 1.0 to 0.17 h, the influent nitrogen loading rate of the partial nitritation process reached 6.8 ± 0.4 kg N m-3 d-1 even at 10-15 °C. The high concentration (7.5 gVSS L-1) and activity (0.48 g N g-1 VSS d-1 at 11 °C) of granular sludge made the reactor possess an overcapacity evaluated by the ratio between the actual ammonium oxidation rate of the granules and their maximum potential. The overcapacity helped the reactor to face the adverse effect of decreasing temperatures. Overall, this work indicated the great potential of applying aerobic granules to achieve high-rate partial nitritation at mainstream conditions. Moreover, anammox bacteria with a relative abundance of 2.8% was also identified in the partial nitritation granules at the end of this study, suggesting that the granules provided a habitable niche for anammox bacteria growth. Note that these results cannot fully relate to the treatment of real domestic/municipal wastewater, they are a source of important information increasing the knowledge about low temperature partial nitrification.


Nano zero-valent iron loaded corn-straw biochar for efficient removal of hexavalent chromium: remediation performance and interfacial chemical behaviour.
To improve the poor stability of nano zero-valent iron (nZVI), corn-straw biochar (BC) was used as a support for the synthesis of composites of nZVI-biochar (nZVI/BC) in different mass ratios. After a thorough characterization, the obtained nZVI/BC composite was used to remove hexavalent chromium [Cr(vi)] in an aquatic system under varying conditions including composite amount, Cr(vi) concentration, and pH. The obtained results show that the treatment efficiency varied in the following order: nZVI-BC (1 : 3) > nZVI-BC (1 : 5) > nZVI alone > BC alone. This order indicates the higher efficiency of composite material and the positive effect of nZVI content in the composite. Similarly, the composite dosage and Cr(vi) concentration had significant effects on the removal performance and 2 g L-1 and 6 g L-1 were considered to be the optimum dose at a Cr(vi) concentration of 20 mg L-1 and 100 mg L-1, respectively. The removal efficiency was maximum (100%) at pH 2 whereas solution pH increased significantly after the reaction (from 2 to 4.13). The removal kinetics of Cr(vi) was described by a pseudo-second-order model which indicated that the removal process was mainly controlled by the rate of chemical adsorption. The thermodynamics was more in line with the Freundlich model which indicated that the removal was multi-molecular layer adsorption. TEM-EDS, XRD, and XPS were applied to characterize the crystal lattice and structural changes of the material to specify the interfacial chemical behaviour on the agent surface. These techniques demonstrate that the underlying mechanisms of Cr(vi) removal include adsorption, chemical reduction-oxidation reaction, and co-precipitation on the surface of the nZVI-BC composite. The results indicated that the corn-straw BC as a carrier material highly improved Cr(vi) removal performance of nZVI and offered better utilization of the corn straw.


Do corticosteroids prevent postherpetic neuralgia? A review of the evidence.
A short course of corticosteroids is frequently used in herpes zoster to prevent postherpetic neuralgia. To clarify the evidence behind this routine practice, we reviewed the three randomized controlled trials on this subject. Although in all three similar dosages of corticosteroids (40 mg to 60 mg prednisone daily for 2 to 4 weeks) were used, deficiencies in reported clinical characteristics of study subjects, the potential for bias in the ascertainment of pain duration, and the inability to exclude type II error make it impossible to determine whether or not this practice is effective. More research on this subject is needed, with greater attention to good study methodology.


Alar Rim Deformities.
The alar rim plays an important role in nasal harmony. Alar rim flaws are common following the initial rhinoplasty. Classification of the deformities helps with diagnosis and successful surgical correction. Diagnosis of the deformity requires careful observation of the computerized or life-sized photographs. Techniques for treatment of these deformities can easily be learned with attention to detail.


In vivo imaging of clock gene expression in multiple tissues of freely moving mice.
Clock genes are expressed throughout the body, although how they oscillate in unrestrained animals is not known. Here, we show an in vivo imaging technique that enables long-term simultaneous imaging of multiple tissues. We use dual-focal 3D tracking and signal-intensity calibration to follow gene expression in a target area. We measure circadian rhythms of clock genes in the olfactory bulb, right and left ears and cortices, and the skin. In addition, the kinetic relationship between gene expression and physiological responses to experimental cues is monitored. Under stable conditions gene expression is in phase in all tissues. In response to a long-duration light pulse, the olfactory bulb shifts faster than other tissues. In Cry1(-/-) Cry2(-/-) arrhythmic mice circadian oscillation is absent in all tissues. Thus, our system successfully tracks circadian rhythms in clock genes in multiple tissues in unrestrained mice.


Is discectomy effective for treating low back pain in patients with lumbar disc herniation and Modic changes? A systematic review and meta-analysis of cohort studies.
Previous low-quality evidence has suggested preoperative Modic changes (MC) showed a trend toward less improvement in low back pain in patients with lumbar disc herniation (LDH) undergoing discectomy. However, a recent meta-analysis concluded that the presence of preoperative MC did not significantly impact clinical outcomes following lumbar discectomy. To compare low back pain and functional outcomes of patients after discectomy for LDH with preoperative MC. Systematic review and meta-analysis of cohort studies. This comprehensive systematic review and meta-analysis used English-language articles identified through searches using Pubmed, Web of Science, Embase, and Cochrane library until August 2022. The included studies identified publications that concentrated on the patients suffering from LDH with different preoperative MCs treated by discectomy. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were the two main metrics to evaluate outcomes. A series of 2,299 LDH patients with a definitive type of MC were included in four retrospective and five prospective studies. Overall, there is moderate to high quality evidence suggesting no significant difference between normal and MC groups for pain outcomes as well as normal and Modic type 2 groups in terms of pain or functional outcomes at one or two-year follow up. There are less functional outcomes in LDH patients with preoperative MC compared with no MC at 2-year follow up and showed no significant difference at 1-year follow-up. However, above all results may due to heterogeneity. Subgroup analysis revealed that only Modic type 1 showed statistically lower functional scores (mean difference in ODI scores range from 0 to 100) compared with Modic type 2 or compared with no MC at 2-year follow-up and showed no significant difference at 1-year follow-up (MC1 vs. MC0, p=.24, MD= -2.70; 95% CI, -7.15 to 1.76 for 1-year;p<.00001, MD= -7.92; 95% CI, -11.19 to -4.66 for 2 years. MC1 vs. MC2, p=.58, MD= -1.29; 95% CI, -5.83 to 3.25 for 1-year;p<.0001, MD= -6.77; 95% CI, -9.94 to -3.61 for 2 years). These data suggest LDH patients with or without preoperative MCs show a similar improvement of low back pain at 1 and 2-year follow-up and functional scores after discectomy at one-year follow-up. LDH patients with preoperative Modic type 1 are associated with worse functional status after discectomy at 2-year follow-up. However, high-quality randomized controlled trials and prospective cohort studies which focus on analyzing the risk and confounding factors are lacking.


Development of a short questionnaire to identify the risk of nonadherence to antibiotic treatment.
Nonadherence to the prescribed antibiotic treatment is a widespread problem, affecting not only individual patients, but also public health. As measures to predict it are still lacking, we aimed to design an instrument to identify nonadherence risk in short-term antibiotic therapies. Patient adherence was assessed by pill count and an extensive set of standardized questions, newly developed according to the five-dimension adherence model proposed by the World Health Organization. It combined previously validated questionnaires and original questions adapted from our exploratory survey. The extensive set was analyzed prospectively in adult patients treated with antibiotics in outpatient settings. The number of items was reduced stepwise keeping as many of five factor subgroups as possible. The items were dichotomized as positive (indicating nonadherence risk) or negative. One third (32%) of the respondents (N = 122) did not adhere to the prescribed antibiotic regimen. The extensive set of questions was reduced to a short questionnaire. It consisted of four items independently associated with nonadherence (P < 0.05) and covered three of the five analyzed factor subgroups: healthcare-related factor (consultations about medicines), therapy-related factor (complexity of treatment), and patient-related factors (forgetfulness, health behavior). The sum of 0-1 positive answers indicated an adherent patient, and 2-4 a risky patient. Such a differential approach led to relatively good sensitivity, specificity, and total predictive value (80%, 82%, and 81%, respectively) in our sample. The short measure representing the multiple factor subgroups was developed to identify nonadherence to antibiotic treatment with acceptable levels of sensitivity, specificity, and predictive values. It could be valuable for healthcare professionals, especially in primary healthcare. Considering limitations of the study (medium sample size, justification of patient's responses, no re-test), future studies could continue investigations on the validity and elaboration of this instrument in larger samples.


Conflicting notions of research ethics. The mutually challenging traditions of social scientists and medical researchers.
Tensions over ethics in research occasionally arise when anthropologists and other social scientists study health services in medical institutions. In order to resolve this type of conflict, and to facilitate mutual learning rather than mutual recrimination, we describe two general categories of research ethics framing: those of anthropology and those of medicine. The latter, we propose, has tended to focus on protection of the individual through preservation of autonomy-principally expressed through the requirement of informed consent-whereas the former has attended more to political implications. After providing few examples of concrete conflicts, we outline four issues that characterise the occasional clashes between social scientists and medical staff, and which deserve further consideration: (1) a discrepancy in the way anthropologists perceive patients and medical staff; (2) ambiguity concerning the role of medical staff in anthropological research; (3) impediments to informed consent in qualitative research projects; and (4) property rights in data. Our contention is that enhanced dialogue could serve to invigorate the ethical debate in both traditions.


Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review and Meta-Analysis.
To evaluate the efficacy of topical corticosteroids in managing acute radiation dermatitis (RD) in female breast cancer patients. MEDLINE, EMBASE, CINAHL, CENTRAL, ScienceDirect, Google Scholar and Clinicaltrials.gov were searched up to and including March 2017 to identify Randomised Controlled Trials (RCTs) assessing topical corticosteroids for the management and prevention of acute RD. Ten RCTs (919 participants) were identified. Meta-analysis, including results for 845 participants, demonstrated significant benefits of topical corticosteroids in preventing the incidence of wet desquamation (OR: 0.29; 95%CI: 0.19-0.45; p<0.0001) and reducing the mean RD score (SMD: -0.47, 95%CI: -0.61 - -0.33, p<0.00001). Topical corticosteroids impacted on the incidence of wet desquamation and the average RD score observed in female breast cancer patients. The use of topical corticosteroids can reduce pruritus in participants and improve quality of life.


Echocardiographic observations in opiate addicts with active infective endocarditis. Frequency of involvement of the various values and comparison of echocardiographic features of right- and left-sided cardiac valve endocarditis.
Echocardiographic observations are described in 25 opiate addicts with active infective endocarditis involving apparently previously normal valves. Infective endocarditis was isolated to the tricuspid valve in 11 patients, involved both right- (tricuspid valve) and left-sided valves in 7 and was isolated to the left-sided valves in 7 (mitral valve in 6). Twenty patients (80%) had tricuspid valve regurgitation, 12 had mitral regurgitation, 3 had aortic regurgitation and none had pulmonary valve regurgitation. Considering the 75 cardiac valves (excluding the pulmonary) in the 25 patients, echocardiographic abnormalities consistent with active infective endocarditis were detected in 26 (74%) of the 35 clinically incompetent valves but in none of the 40 competent valves. Comparison of the 20 incompetent tricuspid valves with the 12 incompetent mitral valves indicated that (1) the echocardiogram was less sensitive in detecting tricuspid valve lesions, (2) rupture of tricuspid valve chordae tendineae was absent or not detectable, and (3) tricuspid valve vegetations tended to be larger.


Use of murine embryonic stem cells in embryotoxicity assays: the embryonic stem cell test.
The embryonic stem cell test (EST) takes advantage of the potential of murine embryonic stem (ES) cells to differentiate in culture to test embryotoxicity in vitro. The EST represents a scientifically validated in vitro system for the classification of compounds according to their teratogenic potential based on the morphological analysis of beating cardiomyocytes in embryoid body outgrowths compared to cytotoxic effects on murine ES cells and differentiated 3T3 fibroblasts. Through a number of prevalidation and validation studies, the EST has been demonstrated to be a reliable alternative method for embryotoxicity testing based on the most important mechanisms in embryotoxicity-cytotoxicity and differentiation--as well as on differences in sensitivity between differentiated and embryonic tissues. Improvements of the EST protocol using flow cytometry analysis showed that differential expression of sarcomeric myosin heavy chain and alpha-actinin proteins quantified under the influence of a test compound is a useful marker for detecting potential teratogenicity. The in vitro embryotoxicity test described in this chapter is rapid, simple, and sensitive and can be usefully employed as a component of the risk/hazard assessment process.


Therapeutic effect of sleep deprivation in patients with premenstrual syndrome.
Eight of 10 women with premenstrual depression responded to one night's total sleep deprivation and maintained their improvement after a night of recovery sleep. In responders, subsequent late-night partial sleep deprivation was more effective than early-night deprivation.


[Place of the splanchnic nerves in the pathogenesis of shock due to retroperitoneal hematoma (author's transl)].
The clinical picture of retroperitoneal hematoma includes usually a state of shock. The author's experiment implies that the splanchnic nerves are directly involved in the pathogenesis of this fall in blood pressure. Simple therapeutic implications result from this.


Reduced thalamic volume observed across different subgroups of autism spectrum disorders.
We measured the thalamic volumes of 38 subjects with autism spectrum disorders (ASD), including autism, Asperger's disorder, and pervasive developmental disorder not otherwise specified, and 16 matched healthy controls. Thalamic volume in all ASD subgroups was significantly smaller compared with volume in the control subjects.


Can we use high precision metal isotope analysis to improve our understanding of cancer?
High precision natural isotope analyses are widely used in geosciences to trace elemental transport pathways. The use of this analytical tool is increasing in nutritional and disease-related research. In recent months, a number of groups have shown the potential this technique has in providing new observations for various cancers when applied to trace metal metabolism. The deconvolution of isotopic signatures, however, relies on mathematical models and geochemical data, which are not representative of the system under investigation. In addition to relevant biochemical studies of protein-metal isotopic interactions, technological development both in terms of sample throughput and detection sensitivity of these elements is now needed to translate this novel approach into a mainstream analytical tool. Following this, essential background healthy population studies must be performed, alongside observational, cross-sectional disease-based studies. Only then can the sensitivity and specificity of isotopic analyses be tested alongside currently employed methods, and important questions such as the influence of cancer heterogeneity and disease stage on isotopic signatures be addressed.


Epidemiological trend and age-period-cohort effects on cardiovascular disease mortality and disability-adjusted life years attributable to dietary risks and high body mass index at the regional and country level across China and Pakistan.
Modifiable risk factors are major drivers of cardiovascular disease (CVD). We aimed to determine the epidemiological trend and age-period-cohort effects on CVD burden attributable to dietary risks and high body mass index (BMI) across China and Pakistan from 1990 to 2019. Data on the all-ages and age-specific CVD burden, age-standardized CVD mortality and disability-adjusted life years (DALYs) rates were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analysis was conducted to find temporal trends and age-period-cohort (APC) modeling was used to estimate age, period, and cohort effects on CVD burden. Between 1990 and 2019, the all-ages CVD burden attributable to dietary risks and high BMI increased by ~2-3-fold in China and by 3-5-fold in Pakistan. The diet-related CVD age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate significantly decreased in China but increased in Pakistan. Both countries showed a marked increasing trend of CVD ASMR and the age-standardized DALYs rate attributable to high BMI. Taiwan in China showed a remarkable reduction in CVD burden. However, in Pakistan, all regions observed a significantly increasing trend of CVD burden attributable to modifiable risk factors. A higher risk ratio of premature CVD mortality (<70 years) was observed among Chinese attributable to high BMI and among Pakistani attributable to dietary risks. In China, early birth cohorts showed a higher risk ratio and recent birth cohorts experienced a lower risk ratio of CVD burden compared with Pakistan. In conclusion, dietary risks and high BMI caused a huge CVD burden across China and Pakistan.


Facile synthesis of chlorella-derived autogenous N-doped porous biochar for adsorption on tetracycline.
In this study, an autogenous N-doped biochar derived from Chlorella (CVAC) was prepared with NaOH as activator at 800 °C. The surface structural properties of CVAC and the adsorption performance of CVAC on tetracycline (TC) under different adsorption variables were analyzed and investigated using different characterization methods. The results showed that the specific surface area of CVAC was 491.16 m2 g-1 and the adsorption process was in accordance with Freundlich model and pseudo-second-order kinetic model. The maximum adsorption capacity of TC was 310.696 mg g-1 at pH 9 and 50 °C, and it was mainly physical adsorption. Furthermore, the cyclic adsorption-desorption behavior of CVAC using ethanol as eluent was evaluated and the feasibility of its long-term application was explored. CVAC also showed good cyclic performance. The variation of ΔG° and ΔH° confirmed that the adsorption of TC by CVAC was a spontaneous heat absorption process.


Correction: NG2 antigen is involved in leukemia invasiveness and central nervous system infiltration in MLL-rearranged infant B-ALL.
The original version of this Article contained an error in the spelling of the author Juan Carlos Rodriguez-Manzaneque, which was incorrectly given as J Carlos Rodríguez-Manzaneque. This has now been corrected in both the PDF and HTML versions of the Article.


Scaling of biological community structure: a systems approach to community complexity.
Local community dynamics are determined by the interaction of environmental variation and the biotic properties of communities. This interaction occurs on many spatial and temporal scales, hence the expectation is that community dynamics will be complex. Previous theoretical approaches to communities have assumed linear, near equilibrium dynamics. An alternative approach suggests that community dynamics are the result of the balance between energy use by the community and its tendency to move towards thermodynamic equilibrium, in this case extinction of all species in the community. Because this balance will be imprecise, community dynamics should be oscillatory. Furthermore, because energy use by a community can be broken down into a hierarchical set of processes occurring on different time scales, community dynamics should reflect multiple periodicities. The above theoretical treatment suggests that since community dynamics are scaled, a hierarchical observational approach should help resolve important aspects of community structure. This approach of scaling community observations provides a technique for evaluation of community responses to environmental change, including human induced perturbations. A thermodynamic approach to community dynamics can also provide the basis for new theoretical and empricial discoveries about biological communities.


Increased plasma interleukin-1 activity in women after ovulation.
The polypeptide interleukin-1 mediates many host responses to infection and inflammation. A method was developed for studying interleukin-1 levels in human plasma from febrile patients. Interleukin-1 activity was also consistently found in plasma samples from women in the luteal phase of their menstrual cycle. This activity was neutralized by a specific antiserum to human interleukin-1 and was low in plasma from healthy men and preovulatory women. Thus interleukin-1 appears to have a role in normal physiological conditions as well as in disease states.


Four-locus gene interaction between IL13, IL4, FCER1B, and ADRB2 for asthma in Chinese Han children.
IL13, IL4, IL4RA, FCER1B, and ADRB2 are important inflammatory genes associated with immunoglobulin E levels. This study attempts to determine whether there are gene-gene interactions in the five genes among asthmatic children of Chinese Han nationality. Nine single-nucleotide polymorphisms (SNPs) in the five genes were genotyped in 1,000 asthmatic children and 1,000 healthy controls using TaqMan real-time quantitative polymerase chain reaction. Multifactor-dimensionality reduction method was applied for the analysis. A four-way gene-gene interaction model consisting of IL13 rs20541, IL4 rs2243250, ADRB2 rs1042713, and FCER1B rs569108 was chosen as the optimal one for determining asthma susceptibility (testing balanced accuracy = 0.6089, cross-validation consistency = 10/10, P = 6.98E-05). Each of the four SNPs was identified to have an independent association with childhood asthma (G allele of rs20541, odds ratio (OR) = 1.24, P = 1.23E-03; T allele of rs2243250, OR = 1.25, P = 3.81E-03; A allele of rs1042713, OR = 1.29, P = 6.75E-05; G allele of rs569108, OR = 1.27, P = 3.86E-03). Individuals homozygous for the risk alleles at all the four loci (rs20541 GG, rs2243250 TT, rs1042713 AA, and rs569108 GG) had a significantly higher risk of asthma compared with those without any risk homozygotes (OR = 13.55, P = 4.28E-03), and also greater than those with less than four risk homozygotes (OR = 10.09, P = 6.51E-03). Our results suggest that IL13 rs20541, IL4 rs2243250, ADRB2 rs1042713, and FCER1B rs569108, four SNPs with significant sole effect on asthma, interact to confer a higher risk for the disease in Chinese Han children.


Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use.
To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems. An ecological study and a cohort study. Two medical surgical intensive care units (ICUs) in inner Brazil. Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed. In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the "carbapenem pressure," described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models. The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02-0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001-1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam). Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population ("herd effect"-like) impact of antimicrobial use in the ICUs.


Immunofluorescence of hepatitis A virus antigen in chimpanzees.
Chimpanzee liver biopsies and necropsy tissues were examined by immunofluorescence for hepatitis A virus antigen. Results further indicate that the liver may be the sole site of replication for the virus.


The effects of starvation and re-feeding on growth and swimming performance of juvenile black carp (Mylopharyngodon piceus).
We investigated the effects of starvation and re-feeding on growth and swimming performance and their relationship in juvenile black carp (Mylopharyngodon piceus). We measured the specific growth rate (SGR), resting metabolic rate (RMR) and constant acceleration test speed (U CAT, the maximum swimming speed at exhaustion by constant acceleration test with 0.1667 cm s(-2) rate) in a treatment group (21 days of starvation then 21 days of re-feeding) and control group (routine feeding) (n = 20). Starvation resulted in a 17 % decrease in body mass of black carp (P < 0.05). After 21 days of re-feeding, body mass was greater than that of pre-starvation but still less than that of the control group at 42 days. During the re-feeding phase, the SGR of the treatment group was higher than that of the control group (P < 0.05). Starvation resulted in a significant decrease in the RMR and U CAT. After 21 days of re-feeding, both the RMR and U CAT recovered to the pre-starvation levels. In the control group, individual juvenile black carp displayed strong repeatability of the RMR and U CAT across the measurement periods (P ≤ 0.002). In the treatment group, RMR showed significant repeatability between pre-starvation and re-feeding (P = 0.007), but not between pre-starvation and starvation or between starvation and re-feeding. U CAT showed significant repeatability between pre-starvation and starvation (P = 0.006) and between pre-starvation and re-feeding (P = 0.001), but not between starvation and re-feeding. No correlation or only a weak correlation was found between any two variables of RMR, U CAT and SGR, whereas the increment of the U CAT (ΔU CAT) was negatively correlated with that of SGR during the starvation phase (r = -0.581, n = 20, P = 0.007) and re-feeding phase (r = -0.568, n = 20, P = 0.009). This suggested that within individual black carp, there is a trade-off between growth and maintenance (or development) of swimming performance under food-limited conditions.


Minimal threshold for stimulating catheters.
A patient undergoing total knee replacement was fitted with a stimulating femoral catheter for postoperative analgesia. After the catheter was secured to the skin, the minimal stimulatory threshold was verified again and found to be extremely low (0.00-0.01 mA; pulse width, 0.1 ms). However, in spite of this situation, no paresthesia or pain was experienced by the patient. Use of the catheter resulted in satisfactory analgesia with no complications noted during the hospital stay or at follow-up three months later. When the nerve stimulator was sent to our biomedical engineering department to verify the accuracy of its current output, it was found to be functioning adequately. Neurostimulation is a complex phenomenon that is far from being completely understood. On the basis of this single report, we cannot recommend the routine use of a threshold inferior to 0.2 mA for neural electrolocation. However, we do not advocate the requirement of strict numerical thresholds either. Further research is needed to understand the relationship linking stimulatory threshold and distance between needle (or catheter) tip and nerve.


Prevention of IL-1 signaling attenuates airway hyperresponsiveness and inflammation in a murine model of toluene diisocyanate-induced asthma.
IL-1 is a pleotropic cytokine that has been shown to play a prominent role in asthma induced by large-molecular-weight proteins. Increased IL-1 immunostaining in the submucosa of patients with toluene diisocyanate (TDI)-induced asthma has also been observed, suggesting that this cytokine might also be important in asthma associated with low-molecular-weight chemicals. We sought to determine the role of IL-1 signaling in airway reactivity and inflammation by using a murine model of TDI-induced asthma. C57BL/6 mice were exposed to TDI by means of vapor inhalation (20 ppb; 4 hours per day, 5 days per week, for 6 weeks) and then challenged 2 weeks later by inhalation with 20 ppb TDI vapor for 1 hour. Sensitized-challenged mice showed increased airway hyperresponsiveness (AHR), increased levels of TDI-specific IgG1 antibodies, airway epithelial thickening, inflammation consisting of infiltrating lymphocytes and eosinophils, and increased mRNA expression of IL-4, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 in the lung. Prevention of IL-1 signaling through deletion of the IL-1 receptor type I or administration of neutralizing antibodies to both IL-1beta and IL-1alpha abrogated the development of TDI-induced asthma. A partial reduction in AHR and TDI-specific IgG1 levels was observed in mice administered anti-IL-1beta, whereas anti-IL-1alpha had no effect on either parameter. Antibodies to IL-1beta or IL-1alpha alone blocked airway inflammation and the expression of IL-4 and adhesion molecules in the lung. These results suggest that IL-1 signaling is critical for AHR and airway inflammation, with IL-1beta and IL-1alpha having unique and overlapping roles in TDI-induced occupational asthma.


Construction of acetyl-CoA and DBAT hybrid metabolic pathway for acetylation of 10-deacetylbaccatin III to baccatin III.
10-Deacetylbaccatin III (10-DAB) C10 acetylation is an indispensable procedure for Taxol semi-synthesis, which often requires harsh conditions. 10-Deacetylbaccatin III-10-β-O-acetyltransferase (DBAT) catalyzes the acetylation but acetyl-CoA supply remains a key limiting factor. Here we refactored the innate biosynthetic pathway of acetyl-CoA in Escherichia coli and obtained a chassis with acetyl-CoA productivity over three times higher than that of the host cell. Then, we constructed a microbial cell factory by introducing DBAT gene into this chassis for efficiently converting 10-DAB into baccatin III. We found that baccatin III could be efficiently deacetylated into 10-DAB by DBAT with CoASH and K+ under alkaline condition. Thus, we fed acetic acid to the engineered strain both for serving as a substrate of acetyl-CoA biosynthesis and for alleviating the deacetylation of baccatin III. The fermentation conditions were optimized and the baccatin III titers reached 2, 3 and 4.6 g/L, respectively, in a 3-L bioreactor culture when 2, 3 and 6 g/L of 10-DAB were supplied. Our study provides an environment-friendly approach for the large scale 10-DAB acetylation without addition of acetyl-CoA in the industrial Taxol semi-synthesis. The finding of DBAT deacetylase activity may broaden its application in the structural modification of pharmaceutically important lead compounds.


The Correlation Between Parental Perceptions and Readiness to Change with Participation in a Pediatric Obesity Program Serving a Predominantly Black Urban Community: A Retrospective Cohort Study.
This study assessed whether maternal BMI and perceptions about weight and reported level of readiness to change was correlated with compliance to a pediatric lifestyle modification program targeting a hard-to-reach urban population with a high prevalence of severe obesity. The Parental Readiness Questionnaire (PRQ) was administered to the child's mother at program entry. The PRQ consisted of forty-seven multiple-choice and 10-point Likert scale questions regarding family demographics, exercise and eating habits, attitudes about health, body image, and weight, and the desire to improve nutrition and physical activity. Analysis was performed on PRQs of participants to compare parental perceptions and readiness for change with compliance to program requirements. Analysis was conducted on 596 questionnaires and compliance was categorized into three groups based on attendance to follow-up visits. Significant differences were found between short-term and long-term follow-up groups in regards to parental perception of one's health as well as the health, weight, and body image of their child. Differences were found in perceptions of one's own weight and body image as well as the health of one's self and child between the group with a maternal BMI < 35 and the group with a maternal BMI ≥ 35. A lower maternal BMI was associated with a better perception of one's own weight, body image, and health, as well as the health of the child. Positive parental perceptions on weight were correlated with improved compliance to a pediatric lifestyle modification program.


Unexpected unrelated umbilical cord blood stem cell engraft in two patients with severe aplastic anemia that received immunosuppressive treatment: A case report and literature review.
Severe aplastic anemia (SAA) is a life-threatening bone marrow disorder. Bone marrow transplantation is the primary therapy for SAA; however, its efficacy is limited by numerous factors, including lack of histocompatible sibling donor, patient age and graft-versus-host-disease (GVHD) following transplantation. Immunosuppressive treatment (IST) is the first procedure developed for patients without a sibling donor. Our previous study reported that patients administered enhanced IST, in addition to a regime of unrelated umbilical cord blood (UCB) transfusion, exhibited higher efficiency and a reduced rate of relapse. Therefore, the present study reported the cases of 2 patients that received enhanced IST plus unrelated UCB transfusion. These patients exhibited complete hematological recovery with an increased rate of mixed chimerism and demonstrated no signs of GVHD or relapse during the 2-year follow-up period. Thus, enhanced immunosuppressive treatment (low-dose cyclophosphamide and antithymocyte globulin) combined with UCB transfusion may be an effective treatment for patients with SAA.


Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution.
Global health interest has grown among medical students over the past 20 years, and most medical schools offer global health opportunities. Studies suggest that completing global health electives during medical school may increase the likelihood of working with underserved populations in a clinical or research capacity. This study aimed to assess the association of global electives in medical school on subsequently working in global health and with underserved populations in the United States (U.S.), additionally considering students' interests and experiences prior to medical school. We also examined whether respondents perceived benefits gained from global electives. We surveyed medical school graduates (classes of 2011-2015) from a large public medical school in the U.S. to describe current practice settings and previous global health experience. We evaluated work, volunteer, and educational experiences preceding medical school, socioeconomic status, race and ethnicity using American Medical College Application Service (AMCAS) data. We assessed the association between students' backgrounds, completing global health electives in medical school and current work in global health or with underserved populations in the U.S. In the 5 to 8 years post-graduation, 78% of 161 respondents reported work, research, or teaching with a focus on global or underserved U.S. Completing a global health elective during medical school (p = 0.0002) or during residency (p = 0.06) were positively associated with currently working with underserved populations in the U.S. and pre-medical school experiences were marginally associated (p = 0.1). Adjusting for pre-medical school experiences, completing a global health elective during medical school was associated with a 22% greater prevalence of working with an underserved population. Perceived benefits from global electives included improved cultural awareness, language skills, public health and research skills, and ability to practice in technology-limited settings. Medical school graduates who participated in global electives as students were more likely than their peers to pursue careers with underserved populations, independent of experiences prior to medical school. We hypothesize that by offering global health experiences, medical schools can enhance the interests and skills of graduates that will make them more likely and better prepared to work with underserved populations in the U.S. and abroad.


Synchronous early-stage endometrial and ovarian cancer.
To explore the clinicopathologic findings and oncological outcome of early-stage synchronous endometrial and ovarian malignancies. A retrospective study of 93 women with synchronous stage I ovarian and stage I-II endometrial cancer treated between December 1981 and August 2005 in the gynecologic oncology department of San Gerardo Hospital, Italy. Fifty-one percent of the ovarian tumors were stage Ia and 71% of the endometrial cancers had minimal myometrial invasion. Endometrioid histology and grade 2 disease were prevalent in both sites. Hyperplasia and endometriosis coexisted in 71% and 22% of endometrial and ovarian cancers, respectively. The actuarial 5-year disease-free and overall survival rates were 83% and 96%, respectively. The incidence of synchronous endometrial and ovarian cancer is not negligible, especially among young women. Synchronous cancers show very favorable pathologic features and have an excellent oncologic outcome. Adjuvant therapy should be tailored according to surgical staging and histology.


Performance demonstration of a hybrid Compton camera with an active pinhole for wide-band X-ray and gamma-ray imaging.
X-ray and gamma-ray imaging are technologies with several applications in nuclear medicine, homeland security, and high-energy astrophysics. However, it is generally difficult to realize simultaneous wide-band imaging ranging from a few tens of keV to MeV because different interactions between photons and the detector material occur, depending on the photon energies. For instance, photoabsorption occurs below 100 keV, whereas Compton scattering dominates above a few hundreds of keV. Moreover, radioactive sources generally emit both X-ray and gamma-ray photons. In this study, we develop a "hybrid" Compton camera that can simultaneously achieve X-ray and gamma-ray imaging by combining features of "Compton" and "pinhole" cameras in a single detector system. Similar to conventional Compton cameras, the detector consists of two layers of scintillator arrays with the forward layer acting as a scatterer for high-energy photons (> 200 keV) and an active pinhole for low-energy photons (< 200 keV). The experimental results on the performance of the hybrid camera were consistent with those from the Geant4 simulation. We simultaneously imaged [Formula: see text]Am (60 keV) and [Formula: see text]Cs (662 keV) in the same field of view, achieving an angular resolution of 10[Formula: see text] (FWHM) for both sources. In addition, imaging of [Formula: see text]At was conducted for the application in future nuclear medicine, particularly radionuclide therapy. The initial demonstrative images of the [Formula: see text]At phantom were reconstructed using the pinhole mode (using 79 keV) and Compton mode (using 570 keV), exhibiting significant similarities in source-position localization. We also verified that a mouse injected with 1 MBq of [Formula: see text]At can be imaged via pinhole-mode measurement in an hour.


Kaleidoscopes of reality.
This article addresses the broad context of shifting definitions of how knowledge and reality can be described, including the transition from positivism to postpositivism in the 20th century. It provides an exploration of ways of knowing, from ancient Greek and yogic traditions to Barbara Carper's Fundamental Patterns of Knowing in Nursing (1978). It examines three reported components of modern care (intuition, cultural knowing, and spirituality) which are simultaneously present and absent in nursing. It concludes with an imaginative exploration of how nursing might be changed by transdisciplinary scholarship and education, new knowledge creation through interactive online communities, and the emergence of collective wisdom.


[Malformation syndromes in the spanish literature: The first descriptions].
Malformation or dysmorphic syndromes are conditions that are defined by the combination of a set of major and minor malformations that generally have a genetic origin. We investigated the early Spanish descriptions of a large number of sydromes. We started the study from the definition in a classic treatise on the subject. Among the 60 selected syndromes studied, at least two articles of each syndrome among those published in Spain and for the first time were listed in the Spanish Medical Index. For years prior to 1970, it expanded The search was expanded to PubMed, for the years before 1970. We collected 64 articles that referred to 58 syndromes. Four articles were written during the first half of the twentieth century. Almost half of the works (n=30) appeared in the 1970's. The papers were published in ten Spanish pediatric, nine Spanish non-pediatric, three pediatric non-Spanish and two non-Spanish non-pediatric Journals. The Journals with the most articles published were Anales de Pediatría y Revista Española de Pediatría. The hospitals where the articles originate more often were Hospital La Paz, Madrid and Hospital Clinic, Barcelona. The rest of the works were written in 30 pediatric hospitals and two more in non-Spanish hospitals. The number of authors increased with the passage of time. Although there were potential limitations, we have identified what may be the first descriptions of 58 syndromes, among the 60 chosen initially.


Phase I trial of concomitant vinorelbine, cisplatin, and pelvic irradiation in cervical carcinoma and other advanced pelvic malignancies.
To determine the maximum tolerated dose (MTD) of vinorelbine in combination with weekly cisplatin and pelvic radiation therapy (RT). Eligible patients included those with bulky or locally advanced cervical cancer. Women with other advanced gynecologic malignancies were also eligible. All patients received cisplatin 40 mg/m(-2)/week (maximum dose, 70 mg) during pelvic RT. Vinorelbine was administered on the same day as cisplatin at a starting dose of 10 mg/m(-2)/week and escalated in 5 mg/m(-2)/week increments. Dose-limiting toxicity (DLT) was defined as: grade 3-4 non-hematologic toxicity, grade 4 hematologic toxicity, or any toxicity which required > or =1 week delay in RT or an omission of >1 dose of chemotherapy. Between April 2001 and September 2002, 12 women with pelvic malignancies (11 cervical, 1 recurrent ovarian) were enrolled. Cohorts of 3, 6, and 3 patients were treated at 10, 15, and 20 mg/m(-2)/week dose levels of vinorelbine. At the 20 mg/m2 level, DLT was observed. Two of three patients missed >1 cycle of chemotherapy secondary to predominantly hematologic toxicity. One patient at the 20 mg level developed a creatinine clearance <50 ml/min and missed 1 dose of cisplatin. Another developed transient grade 3 diarrhea. No grade 4 toxicities were observed. The MTD of vinorelbine in combination with cisplatin and pelvic RT in patients with cervical cancer is 15 mg/m(-2)/week.