Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases.
Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape. This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy. Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth. Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.


Deciphering the dynamics of metal and antibiotic resistome profiles under different metal(loid) contamination levels.
Metal(loid) contaminations pose considerable threats to ecological security and public health, yet little is known about the dynamics of metal resistance genes (MRGs) and antibiotic resistance genes (ARGs) under different metal(loid) contamination levels. Here, we provided a systematic investigation of MRGs and ARGs in three zones (Zones I, II, and III) with different metal(loid) contamination levels across an abandoned sewage reservoir. More diverse MRGs and ARGs were detected from the high-contaminated Zone I and the moderate-contaminated Zone II, while the abundant MGEs (mobile genetic elements) potentially enhanced the horizontal gene transfer potential and the resistome diversity in Zone I. Particularly, resistome hosts represented by Thiobacillus, Ramlibacter, and Dyella were prevalent in Zone II, promoting the vertical gene transfer of MRGs and ARGs. The highest health risk of ARGs was predicted for Zone I (about 7.58% and 0.48% of ARGs classified into Rank I and Rank II, respectively), followed by Zone II (2.11% and 0%) and Zone III (0% and 0%). However, the ARGs co-occurring with MRGs might exhibit low proportions and low health risks (all were Rank IV) in the three zones. Overall, these findings uncovered the dynamic responses of resistomes and their hosts to different metal(loid) contamination levels, contributing to formulating accurate management and bioremediation countermeasures for various metal(loid) contaminated environments.


T cell engraftment in lymphoid tissues of human peripheral blood lymphocyte reconstituted SCID mice with or without prior activation of cells.
The reconstitution of severe combined immunodeficiency (SCID) mice with human PBL (Hu-PBL-SCID) was assessed using fresh unstimulated PBL and anti-CD3-stimulated PBL. Mice were reconstituted with PBL by intraperitoneal injection of 1-2.5 x 107 PBL in PBS; controls received PBS. Successful engraftment of human PBL in SCID mice was determined by measurement of human IgG in mouse sera, polymerase chain reaction (PCR) detection of human-specific HLA-DRbeta DNA in SCID periphery, and immunohistochemical staining of mouse tissues (spleen, lymph nodes, thymus, liver and lung) with antibodies specific for human CD45 and CD3. Human IgG was detected 1 week after reconstitution in sera of all animals that received at least 1 x 107 PBL and continued to increase for 8 weeks. Human-specific HLA-DRbeta DNA was detected in the majority of mice 3 weeks after reconstitution but not in controls. Moreover, immunohistochemical analysis of Hu-PBL-SCID mouse tissues revealed the presence of human CD45+ cells in all tissues examined. CD3+ T cell engraftment was observed in lymphoid tissues irrespective of whether PBL had been activated prior to transfer or not.


Determination of tributyltin and 4-hydroxybutyldibutyltin chlorides in seawater by liquid chromatography with atmospheric pressure chemical ionization-mass spectrometry.
A liquid chromatographic method is described for the simultaneous determination of tributyltin (TBT) and the hydroxylated intermediate 4-hydroxybutyldibutyltin (OHBuDBT). Separation was achieved in reverse phase mode on a cyanopropyl-bonded silica column under a gradient elution. Various organic solvents and additives were tested and the optimum composition of the mobile phase contained methanol, water, formic acid and tropolone as a complexing agent. Butyltin compounds were detected with an ion trap mass spectrometer interfaced to a liquid chromatograph with an atmospheric pressure chemical ionization source (LC-APCI-MS). Identification and fragmentation pattern of OHBuDBT chloride in full scan MS and MS/MS are reported for the first time using LC-APCI-MS. Gas chromatography-mass spectrometry (GC-MS) spectrum of the same compound is also reported for the first time for comparison purpose. This method allowed limits of detection (LOD) of 35 and 26 ng mL(-1) for TBT and OHBuDBT, respectively, based on successive injections of 10 microL of blank seawater extract. A liquid-liquid extraction procedure using n-hexane-ethyl acetate was developed for the simultaneous analysis of TBT and OHBuDBT chlorides in natural seawater and allowed average recoveries from 72 to 96% for the two compounds at three different spiking levels.


Portable remote Raman system for monitoring hydrocarbon, gas hydrates and explosives in the environment.
We report our initial efforts to use a small portable Raman system for stand-off detection and identification of various types of organic chemicals including benzene, toluene, ethyl benzene and xylenes (BTEX). Both fiber-optic (FO) coupled and a directly coupled f/2.2 spectrograph with the telescope have been developed and tested. A frequency-doubled Nd:YAG pulsed laser (20 Hz, 532 nm, 35 mJ/pulse) is used as the excitation source. The operational range of the FO coupled Raman system was tested to 66 m, and the directly coupled system was tested to a distance of 120 m. We have also measured remote Raman spectra of compressed methane gas and methane gas hydrate. The usefulness of the remote Raman system for identifying unknown compounds is demonstrated by measuring stand-off spectra of two plastic explosives, e.g. tri-amino tri-nitrobenzene (TATB) and beta-HMX at 10 m stand-off distance. The remote Raman system will be useful for terrestrial applications such as monitoring environmental pollution, in identifying unknown materials in public places in 10s or less, and for detecting hydrocarbon plumes and gas hydrates on planetary surfaces such as Mars.


Preimplantation prenatal diagnosis.
Preimplantation prenatal diagnosis refers to the application of molecular genetic techniques to the assessment of gametes before conception or to early embryos before implantation. Such techniques could allow couples at significant risk for a variety of known genetic diseases to use assisted reproductive technology in achieving pregnancies that are free of the genetic disorder in question. The techniques, their risks, benefits, limitations, and potential applications are described, and recent experiences with human pregnancies are reviewed.


[Anti-TNF biosimilars in chronic inflammatory bowel disease. What can rheumatologists learn from it?].
The expiry of the patent for tumor necrosis factor (TNF)-binding antibodies allowed the approval of biosimilars. Assessment and discussion of specific aspects of anti-TNF biosimilars in the therapy of inflammatory bowel diseases. Review and discussion of currently available literature. The use of TNF-binding antibodies differs between the therapy of rheumatoid disorders and inflammatory bowel diseases. Clinical proof of efficacy for biosimilars for infliximab has been achieved in rheumatoid diseases because activity indices are more stable than in inflammatory bowel diseases and require extrapolation. The TNF-binding antibodies, in particular infliximab, adalimumab and golimumab play a central role in the first-line therapy of inflammatory bowel diseases. The use of TNF-binding biosimilars for patients suffering from inflammatory bowel diseases is possible through extrapolation. Competition should not only drive a price reduction but also a better clinical profiling of anti-TNF therapy for patients with inflammatory bowel diseases. Missing information for "best use" include optimal strategies for dosing and timing for introduction during the course of Crohn's disease and ulcerative colitis.


A structured physical activity program in an adolescent population with overweight or obesity: a prospective interventional study.
Obesity is a significant health problem, with increasing involvement of young population worldwide. The aim of this study was to evaluate the effects of 2 different types of physical exercise (resistance vs. combined aerobic-resistance) on cardiovascular and anthropometric profile of a sample of sedentary adolescents with overweight and obesity. After undergoing clinical, cardiovascular and anthropometric-metabolic evaluation (T0), subjects with overweight and obesity were randomized to a 6-month resistance or combined aerobic-resistance training program. Clinical, cardiovascular and anthropometric-metabolic evaluations were repeated after 6 months of training (T1) and after 3 months of detraining (T2). Thirty adolescents with overweight/obesity were enrolled and 20 subjects completed training program. A significant improvement in body composition was detected after 6 months, with a reduction of body mass index (32.1 [30.5 to 34.4] vs. 31.1 [29.6 to 33.4] kg/m2, p = 0.02) and adipose tissue (45.5 [41.1 to 49.7] vs. 41.6 [37.0 to 49.2] kg, p < 0.01). A reduction in diastolic blood pressure (75.5 ± 8.9 vs. 68.2 ± 6.4 mm Hg, p = 0.02) and pulse wave velocity (5.7 [5.1 to 5.9] vs. 5.2 [4.7 to 5.7] m/s, p = 0.04) was also observed. Persistence of the effect on the most important parameters was observed also after detraining period. In conclusion, regular physical exercise induces positive metabolic and cardiovascular effects, persisting even after brief discontinuation. Novelty: Physical exercise induces positive effect on cardiovascular risk profile. Positive effects persist also after brief discontinuation. Physical exercise reduces early signs of autonomic disfunction.


Senior citizens' vitamin D supplements intake: evidence from Denmark.
Several public interventions have been designed in recent years to urge the intake of vitamin D supplements among the senior population to avoid the direct and indirect consequences associated with vitamin D deficiency. However, the effectiveness of these public campaigns remains quite limited. In an online survey, the current study investigates attitudes towards vitamin D supplements intake and associated behaviours in a representative sample of Danish senior citizens (N = 554) - that is, individuals aged 55 years and above. Approximately half of the sample reported taking vitamin D supplements in the preceding year. Furthermore, being male and having a positive perception of individuals' own health status increased the probability of being a non-user. Increasing confidence in the information provided by health authorities (such as medical doctors and pharmacies) is particularly critical for enhancing the likelihood of non-users to purchase vitamin D supplements. However, also encouraging the uptake of vitamin D supplements in specialized supermarkets with stands and promotions seems an appealing and practical solution to increase seniors' uptake of vitamin D supplements. The present study outlines the characteristics of senior Danish non-users of vitamin D supplements. Additionally, the research provides information on the strategies that could be applied by public organizations to foster vitamin D supplements intake among this target segment of the population. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.


Gender differences of venous thromboembolism risk after total hip and total knee arthroplasty: a meta-analysis.
We performed a meta-analysis to evaluate gender differences of venous thromboembolism (VTE) risk after total hip (THA) and total knee arthroplasty (TKA). We searched PubMed and Web of Knowledge from their beginning to 25 July 2015. Pooled odds ratio (OR) and 95 % confidence interval (CI) for VTE risk were calculated. Twenty studies with 7,892,585 patients were included in our study. The VTE incidence ranged from 0.27 to 61.0 %. The sex ratio (male/female) was 0.623 (3,016,648/4,839,785) in no VTE group versus 0.492 (11,926/24,226) in VTE group. The pooled OR was 1.184 (95 % CI 1.070-1.310; Z = 3.28, P = 0.001). The Begg's test (z = 1.46, P = 0.144) and the Egger's test (t = 0.58, P = 0.571), and the funnel plot suggested there was no significant publication bias. Sensitivity analysis by omitted a study with largest simple size showed the pooled OR was 1.166 (95 % CI 1.051-1.294; Z = 2.91, P = 0.004) by random-effects model. Meta-regression showed VTE risk was not related with THA and TKA incidence (t = 0.35, P = 0.732). Our meta-analysis showed female patients have slightly higher risk of VTE than male patients after THA and TKA.


Manganese-induced apoptosis through the ROS-activated JNK/FOXO3a signaling pathway in CTX cells, a model of rat astrocytes.
Manganese (Mn) is an essential trace element that maintains many normal physiological functions. However, multi-system disorders would occur once overexposure to Mn, especially neurotoxicity. Despite evidence demonstrating the critical role of ROS-activated JNK/FOXO3a signaling pathway in neuronal survival, the specific mechanisms by which it contributes to Mn-induced neurotoxicity are still unclear. The objectives of this study was to examine the modulation of the JNK/FOXO3a signaling pathway, which is activated by ROS, in Mn-induced apoptosis, using a rat brain astrocyte cell line (CTX cells). This study found that a dose-dependent decrease in cell viability of CTX cells was observed with 150, 200, 250, 300 μmol/L Mn. The results of apoptosis-related protein assay showed that Mn decreased the expression of anti-apoptotic protein Bcl-2 and enhanced the expression of apoptosis-related proteins like Bax and Cleaved-Caspase3. In addition, treatment with Mn resulted in elevated ROS levels and increased phosphorylation levels of JNK. Conversely, phosphorylation of nuclear transcription factors FOXO3a, which regulates expression of transcription factors including Bim and PUMA, was decreased. Depletion of ROS by N-acetyl-L-cysteine (NAC) and inhibition of the JNK pathway by SP600125 prevented Mn-induced JNK/FOXO3a pathway activation and, more importantly, the level of apoptosis was also significantly reduced. Confirmation of Mn-induced apoptosis in CTX cells through ROS generation and activation of the JNK/FOXO3a signaling pathway was the outcome of this study. These findings offer fresh insights into the neurotoxic mechanisms of Mn and therapeutic targets following Mn exposure.


MRI follow up of bilateral partial meniscal substitution with a demineralized bone block. A case report.
The case of a 60-year-old male is described, who presented in 2020 with a symptomatic degenerative bilateral posterior horn lesion of the medial meniscus. On MRI both lesions appeared identical as 60%-70% incomplete radial tears in the posterior horn of the medial meniscus with a flap tear component. The patient was arthroscopically treated with bilateral implantation of a demineralized bone block as a partial medial meniscus substitute. A complete isointense and homogenous signal was recorded after 16 weeks and 12 months on the right knee and after 12 weeks on the left knee, indicating a complete ingrowth and remodeling of the implant. KOOS and IKDC score improved from 81 and 66% presurgery to 94 and 93%, respectively, 6 months after the second partial medial meniscus substitution on the left knee.


Alpaca Field Behaviour When Cohabitating with Lambing Ewes.
A common strategy to reduce predator attack on livestock is the deployment of guardian alpacas. However, little research has been conducted on the behaviour of this species while housed with other livestock. This study monitored two male alpacas cohabitating with 180 lambing ewes in order to quantify field behaviour in two phases. Phase one assessed diurnal patterns of alpacas and lambing ewes using Global Navigation Satellite System (GNSS) collars recording data over 41 days, in combination with observational recordings. Phase two developed an alpaca behavioural ethogram through continuous observations from 05:30 to 19:30 h over a 3-day period. The two alpacas shared similar behaviours with commonality of distance travelled, and both species exhibited an increase in activity level based on speed between the times of 05:00 and 17:00 h. The GNSS data indicated that the alpacas flocked with the ewes at night sharing the same resting location, however, would spend time during the day on the outskirts of the paddock. Alpacas were observed to spend the majority of the observation period in two behavioural states: grazing (57%) and resting (27%). As a result of this study we were able to catalogue a range and frequency of field behaviours which alpacas exhibit while cohabitating with lambing ewes. However, further research is needed to determine in more detail how these behaviours correspond with the effectiveness of this species as a livestock guardian.


A novel handheld fluorescent microarray reader for point-of-care diagnostic.
A novel handheld optical sensor for quantification of fluorescent microarrays, the so-called portMD-113 has been developed. On the surface of a planar waveguide, the spots of different fluorescently labeled biological complexes are excited by the evanescent field of the guided light. The emitted fluorescence signals of the spots are independently and simultaneously detected applying our system, which consists of a pinehole array, a microlens array, an interference filter and a detector array. As it is demonstrated in comparative measurements, the detection limit of this sensor is close to that of commercial top microarray readers, e.g. of modern laser scanners, while it has remarkable and important advantages over them. Namely, the device comprises only a few low-cost, lightweight and small components without applying any moving or energy-intensive elements, which results in turn in a commercially competitive, handheld and compact design and in the possibility to be supplied simply by a battery or a personal computer. These advantageous properties open prospects e.g. for point-of-care medical checks, as well.


Afrezza (Insulin Human) Inhalation Powder: A New Inhaled Insulin for the Management Of Type-1 or Type-2 Diabetes Mellitus.
Afrezza (insulin human) inhalation powder: a new inhaled insulin for the management of type-1 or type-2 diabetes mellitus.


[Establishment of universal algorithms for commonly used kinship indices between two individuals].
To establish universal algorithms for commonly used kinship indices between two individuals. Based on the formulas of paternity index in duos(PID), full sibling index(FSI), half sibling index (HSI), avuncular index (AI), grandparental index (GI) and first cousin index (CI1st) deduced from ITO method, the common factors, 1 plus reciprocal of the frequency of the allele with identity by state between the two individuals, shared in these formulas were abstracted with induction method, following with reconstruction of these formulas with the common factor and the coefficient of relationship (r). A universal algorithm for PI(D), HSI, AI, GI and CI1st, was developed with the common factor and r value according to the heterozygosity of the two individuals. Meanwhile, a group of two formulas for FSI calculation was also established according to the individuals' heterozygosity. The universal algorithms for the 6 types of kinship indices are practical in corresponding kinship determination and the batch arithmetic operation with the universal algorithms can be easily programmed.


Comparison of efficacy and safety of minimally invasive procedures for 10-20 mm pediatric renal Stones-A bayesian network meta-analysis.
To assess the efficacy and safety of various minimally invasive procedures for 10-20 mm pediatric renal stones by Bayesian network meta-analysis (NWA). We searched clinical comparative trials published in Pubmed, Embase, Cochrane Library from inception to 12 April 2020. Two researchers evaluated the quality and extracted data individually. Data was analyzed using STATA and GEMYC R package. The overall network meta-analytic outcome of stone free rate (SFR) in a single session revealed that Retrograde Intrarenal Stone Surgery (RIRS), miniaturized percutaneous nephrolithotomy (mPCNL) and PCNL showed superiority to extracorporeal shockwave lithotripsy (ESWL). Statistical significance was not detected between any intervention from our pooled network analysis of complication rate. SMP was the most likely to ranking in first place to render stone free status, and it also showed the lowest risk possibility of complications. Mini-PCNL had longer operation time and hospitalization than ESWL. The global and loop inconsistency evaluation demonstrated a rather acceptable outcome apart from the comparisons of complication rate between two randomized control studies. Herein, the authors reviewed and explored the optimal management pattern for pediatric 10-20 mm renal stones. This NWA revealed RIRS and mPCNL could render higher SFR without increasing risk of complications compared with ESWL. Although SMP was deemed to be the best choice in our study, the limited source of study and sample size implied the results required to be further validated. In addition, there were still some problems requiring to be underlined for various surgical options. ESWL was inferior to RIRS, mPCNL and PCNL for 10-20 mm pediatric renal stones, among which SMP might be the most ideal option associated with the least possibility of complications and the highest probability of stone clearance.


Attenuation of Aβ25-35-induced parallel autophagic and apoptotic cell death by gypenoside XVII through the estrogen receptor-dependent activation of Nrf2/ARE pathways.
Amyloid-beta (Aβ) has a pivotal function in the pathogenesis of Alzheimer's disease. To investigate Aβ neurotoxicity, we used an in vitro model that involves Aβ25-35-induced cell death in the nerve growth factor-induced differentiation of PC12 cells. Aβ25-35 (20μM) treatment for 24h caused apoptotic cell death, as evidenced by significant cell viability reduction, LDH release, phosphatidylserine externalization, mitochondrial membrane potential disruption, cytochrome c release, caspase-3 activation, PARP cleavage, and DNA fragmentation in PC12 cells. Aβ25-35 treatment led to autophagic cell death, as evidenced by augmented GFP-LC3 puncta, conversion of LC3-I to LC3-II, and increased LC3-II/LC3-I ratio. Aβ25-35 treatment induced oxidative stress, as evidenced by intracellular ROS accumulation and increased production of mitochondrial superoxide, malondialdehyde, protein carbonyl, and 8-OHdG. Phytoestrogens have been proved to be protective against Aβ-induced neurotoxicity and regarded as relatively safe targets for AD drug development. Gypenoside XVII (GP-17) is a novel phytoestrogen isolated from Gynostemma pentaphyllum or Panax notoginseng. Pretreatment with GP-17 (10μM) for 12h increased estrogen response element reporter activity, activated PI3K/Akt pathways, inhibited GSK-3β, induced Nrf2 nuclear translocation, augmented antioxidant responsive element enhancer activity, upregulated heme oxygenase 1 (HO-1) expression and activity, and provided protective effects against Aβ25-35-induced neurotoxicity, including oxidative stress, apoptosis, and autophagic cell death. In conclusion, GP-17 conferred protection against Aβ25-35-induced neurotoxicity through estrogen receptor-dependent activation of PI3K/Akt pathways, inactivation of GSK-3β and activation of Nrf2/ARE/HO-1 pathways. This finding might provide novel insights into understanding the mechanism for neuroprotective effects of phytoestrogens or gypenosides.


Virtual Simulation of Intra-operative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis.
To create and pilot test a novel open abdominal aortic aneurysm (AAA) repair virtual simulation focused on intraoperative decision-making. To identify if the simulation replicated real-time intra-operative decision-making and discover how learners' respond to this type of simulation. An explanatory sequential mixed methods study. We developed a step-by-step outline of major intra-operative decision points within a standard open AAA repair. Perioperative and intraoperative decision-making trees were developed and coded into an online virtual simulation. The simulation was piloted. Quantitative data was collected from the simulation platform. We then performed a qualitative thematic analysis on feedback from interviewed participants. Four academic general and vascular surgical training programs across the US. Seventeen vascular and general surgery trainees and 6 vascular surgery faculty. Participants spent on average 27 minutes (range: 8-45 minutes) interacting with the interface. 93% of participants reported feeling they were making real intraoperative decisions. 85% said it added to their knowledge base. 96% requested additional simulations. 22 interviews were completed: 241 primary codes were collapsed into 21 parent codes, and 6 emerging themes identified. Themes included the benefit of how (1) "Virtual Learning Could Standardize the Training Experience"; how (2) "Dealing with the Unexpected" as a trainee is an important part of surgical education growth, and that this (3) "Choose Your Own Adventure" virtual format simulates this intraoperative growth experience. Participants requested a (4) "Looping Feature Feedback Diagram" for future simulation iterations and highlighted that (5) "Fancier is Not Necessarily More Educational." Finally, many trainees wondered about (6) "The Attending Impact" from the simulation: if faculty would notice a difference between trainees who did vs did not utilize the simulation for case preparation. Operative simulation training should focus on both technical skills and intra-operative decision-making, particularly "dealing with the unexpected." The learners' responses indicate that a low-fidelity, scalable, virtual platform can effectively deliver knowledge and allow for intra-operative decision-making practice in a remote learning environment.


Clinical Outcomes of the Flexor Carpi Ulnaris Turnover Flap for Posterior Elbow Soft Tissue Defects.
To report the clinical outcomes from 2 academic centers of the flexor carpi ulnaris (FCU) flap for coverage of posterior elbow soft tissue defects. We retrospectively reviewed 17 patients who underwent an FCU flap for posterior elbow wound reconstruction over an 8-year period at 2 academic centers. Outcome measures included visual analog score for pain; Disabilities of the Arm, Shoulder, and Hand score; Mayo Elbow Performance score; range of motion; wound healing; grip strength; and isokinetic dynamometry for wrist flexion. Wilcoxon signed-rank test was used to make side-to-side comparisons between the operative and nonsurgical extremities, and nonparametric statistical methods were used to analyze results. All wounds healed successfully without need for revision surgery. Average visual analog, Disabilities of the Arm, Shoulder, and Hand, and Mayo Elbow Performance scores in the operative elbow were 1.8, 34, and 86, respectively. Average elbow arc of motion was 11° to 140° with 70° forearm pronation and 73° forearm supination. Compared with the nonsurgical side, grip strength on the operated side was 97% and wrist flexion peak torque was 89%. The operative limb had an average wrist flexion fatigue of 7%, compared with 22% for the nonsurgical arm. Patients receiving an FCU flap had reliable healing, minimal pain, good functional outcomes, and no meaningful deficits in grip strength or wrist flexion strength. Therapeutic IV.


New thermoreversible liquid embolic agent for embolotherapy: technical report.
To evaluate potential feasibility of new liquid embolic agent, thermoreversible gelation polymer (TGP), for embolotherapy. TGP is a liquid polymer that was originally developed as a cell culture medium for tissue engineering. TGP becomes liquid at temperatures lower than the sol-gel transition temperature (TT) and becomes a gel at temperatures higher than the TT. The TT can be adjusted from 10 degrees C to 40 degrees C, allowing gelation at body temperature without solvent. The renal arteries in six swine were embolized with TGP. Angiographic evaluations were obtained 0, 3 h, and 14 days after embolization. The animals were sacrificed at day 14 after angiogram. All renal arteries were successfully embolized with TGP using cooling catheter. No acute and chronic clinical complication was observed. Follow-up angiogram demonstrated complete or near complete occlusion of renal arteries. No untoward inflammatory response was observed in acute and chronic specimen. This embolic material has potential feasibility to be used in the treatment of cerebral arteriovenous malformations, aneurysms, or hyper vascular tumors.


A time-of-flight method of measuring flow velocity by magnetic resonance imaging.
A new time-of-flight method for direct imaging of flow velocities by magnetic resonance is presented. The technique uses selective exciting and refocusing RF pulses to selectively affect planes oriented in orthogonal directions in space, with the region of excitation perpendicular to the flow and the refocusing region parallel to and including the flow. The positions of the sources of the resulting spin echoes are imaged, showing a displacement equal to the product of the velocity and the echo time. These images clearly show the profile of the velocity distribution, both in laminar and nonlaminar flows.


Altering polymerization temperature of antibiotic-laden cement can increase porosity and subsequent antibiotic elution.
To examine the role of polymerization temperature on the cement porosity and antibiotic elution to optimize antibiotic release from antibiotic-laden cement (ABLC). Elution profiles of vancomycin and tobramycin from ABLC discs prepared with low- and high-dose antibiotic dosages, cured at 8, 21, and 37 °C, and placed in phosphate buffered saline (PBS) at 37 °C were examined. Samples were collected at one, four, eight, 24, 72, 168, 336, and 1008 hours to calculate the quantity of antibiotic eluted. Porosity was determined by MicroCT analysis. ABLC porosity and antibiotic elution were increased up to five times the amount eluted from room temperature discs (p < 0.05). Low-dose ABLC group saw decreased but similar porosity at 8 °C and 21 °C compared to cement cured at 37 °C (p < 0.001). High-dose ABLC group porosities were all significantly different (p < 0.02). Altering the polymerization temperature of ABLC led to more porous constructs yielding increased antibiotic elution.


Metacognitions in proneness towards hallucinations and delusions.
The objectives of the present study were to examine the degree of co-existence of hallucinations and delusions in the nonclinical population. In addition, we wished to investigate the role of metacognitions in hallucinations and delusions. Finally, we explored the relative roles of positive and negative metacognitive beliefs in proneness to hallucinations and delusions. Three hundred and thirty-one nonclinical participants completed instruments assessing: hallucination-proneness (Launay-Slade Hallucinations Scale; LSHS), delusion-proneness (21-item version of the Peters et al. Delusions Inventory; PDI-21) and metacognitive beliefs (Meta-Cognitions Questionnaire; MCQ). Participants were successively grouped according to their scores on the LSHS and the PDI-21. Results revealed that hallucination-proneness was positively and significantly associated with delusion-proneness. Furthermore, hallucination-prone and delusion-prone participants scored significantly higher on some sub-scales of the MCQ compared to non-prone participants. Finally, multiple regression analysis revealed that positive and negative beliefs were good predictors of proneness towards hallucinations and delusions.


Neuroinflammatory responses in experimental and human stroke lesions.
Neuroinflammation has been suggested as an attractive treatment target in stroke, since it offers a broader therapeutic window in comparison to currently established thrombolytic approaches. Inflammatory cells of both the innate and the adaptive immune system have been identified in experimental as well as human stroke lesions. In animal models, various therapeutic strategies targeting neuroinflammation have shown beneficial effects, however, translation to human disease has so far been disappointing. Comparisons of the numerous experimental findings with until now rather limited human data reveal that despite similarities in the core signature of the inflammatory reaction, human stroke lacks clearly definable temporal and spatial sequences of lesion maturation that can be generalized and applied for a large patient population. Thus, in comparison with well-timed animal models with a clear succession of pathogenic mechanisms, precise and stage-dependent targeting of neuroinflammation in human stroke patients will be difficult to achieve. In addition, the contribution of different components of the innate and adaptive immune system quantitatively varies between humans and experimental animals and even between different modes of ischemia induction in animal models. Finally, human stroke lesions develop on a basis of age-dependent microglia pre-activation, which may have major impact on the further activation and functional differentiation of these cells. Knowledge about neuroinflammation in stroke patients, however, is currently limited and it has to be determined in future studies to what extent different causes of stroke and different co-morbidities in the patients result in distinct patterns of inflammation.


Identification of the cytochrome P450 isoenzymes involved in the metabolism of diazinon in the rat liver.
The metabolism of diazinon, an organo-phosphorothionate pesticide, to diazoxon and pyrimidinol has been studied in incubations with hepatic microsomes from control Sprague-Dawley (SD) rats or SD rats treated with different P450-specific inducers (phenobarbital, dexamethasone, beta-napthoflavone, and pyrazole). Results obtained indicate an involvement of CYP2C11, CYP3A2, and CYP2B1/2, whereas CYP2E1 and CYP1A1 do not contribute to the pesticide oxidative metabolism. Indeed, diazinon was metabolized by microsomes from control rats; among the inducers, phenobarbital and dexamethasone only increased the production of either metabolites, although to different extents. The production of the two metabolites is self-limiting, due to P450 inactivation; therefore, the inhibition of CYP-specific monooxygenase activities after diazinon preincubation has been used to selectively identify the competent CYPs in diazinon metabolism. Results indicate that, after diazinon preincubation, CYP3A2-catalyzed reactions (2beta- and 6beta-testosterone hydroxylation) are very efficiently inhibited; CYP2C11- and CYP2B1/2-catalyzed reactions (2alpha- and 16beta-testosterone hydroxylation, respectively) are weakly inhibited, while CYP2E1-, CYP2A1/2-, and CYP1A1/2-related activities were unaffected. Results obtained by using chemical inhibitors or antibodies selectively active against specific CYPs provide a direct evidence for the involvement of CYP2C11, CYP3A2, and CYP2B1/2, indicating that each of them contributed about 40-50% of the diazinon metabolism, in hepatic microsomes from untreated, phenobarbital-, and dexamethasone-treated rats, respectively. The higher diazoxon/pyrimidinol ratio observed after phenobarbital-treatment together with the significantly more effective inhibition toward diazoxon production exerted by metyrapone in microsomes from phenobarbital-treated rats supports the conclusion that CYP2B1/2 catalyze preferentially the production of diazoxon.


Vessels of intraocular malignant melanomas.
The vessel walls of six malignant choroidal melanomas were thin; only thin basal membranes and narrow endothelial linings could be observed with the electron microscope. The endothelium was even absent in some places. Tumor cells were released into the bloodstream through disruptions of the vessel walls in the epithelioid and spindle cell B type tumors.


Patterns of use of recombinant zoster vaccine among commercially-insured immunocompetent and immunocompromised adults 50-64 years old in the United States.
The Centers for Disease Control and Prevention (CDC) recommends recombinant zoster vaccination (RZV) for adults ≥ 50 years to prevent herpes zoster (HZ) and its sequelae. Initially, no distinct recommendation was made for immunocompromised adults, who experience higher HZ rates and more severe outcomes. We characterized receipt of first RZV dose (initiation) and both doses (completion) over time, and the impact of immune function on RZV uptake among adults aged 50-64 years in the United States. We identified RZV claims from the IBM MarketScan database between 1/1/2018 and 12/31/2019. We characterized immunocompromised enrollees as having malignancy, HIV, solid organ transplant, primary immunosuppression, or medication-induced immunosuppression using inpatient, outpatient, and prescription claims in the 6 months prior to study start. We evaluated patterns of vaccine uptake by demographic and healthcare access characteristics and immune status. The cumulative incidence of RZV initiation during the study period was 10.0%. Incidence increased with age and number of medical office visits, and was higher among women, urban residents, high-deductible insurance beneficiaries, and those who were immunocompromised compared to immunocompetent. Among immunocompromised adults, RZV initiation was highest among those with HIV and primary immunodeficiencies. Of those who initiated RZV, 89.5% received both doses. RZV completion was highest among those who received the first dose at a pharmacy. Most enrollees (88.6%) who completed RZV vaccination did so within the recommended dosing schedule. RZV uptake was low in the two years since the CDC recommendation, and differed by demographic, healthcare access, and clinical characteristics. Initiation rates were higher among immunocompromised adults compared to immunocompetent adults, despite no CDC recommendation for vaccination in these groups during the study period. The CDC has since recommended RZV for immunocompromised individuals, and our findings may inform efforts to increase RZV uptake in individuals at higher risk of severe disease.


Hybridization between different strains of Schistosoma intercalatum Fisher, 1934 from Cameroun and Zaïre.
The offspring from hybridization experiments between Schistosoma intercalatum, Cameroun (intermediate host Bulinus forskalii) and S. intercalatum, Zaïre (intermediate host B. globosus) was investigated. Reciprocal crosses between the two forms were performed. F1- and F2-miracidia developed in both parental intermediate hosts. The minimum prepatent period was 24 days at 26 degrees C, an average of the prepatent periods for the two parental strains. The total cercariae production per 100 exposed snails decreased sharply from 121 000 for the parental strain from Cameroun in B. forskalii to 21 000 and 5000 from the F1- and F2-generations, respectively. The figures for S. intercalatum, Zaïre in B. globosus were 270 000, 134 000 and 3000, respectively. F1- and F2-generations were from the cross between males from Cameroun and females from Zaïre. The viablility of the four cross-breeding experiments carried out (two with each combinations of the parental strains) were low. It was only possible to obtain F2-cercariae. No miracidia were hatched from eggs produced by the F2-gerneation.


Zebrafish Larvae as an Experimental Model of Cryptococcal Meningitis.
This chapter provides guidance for introducing Cryptococcus neoformans into the zebrafish larvae model system to establish a CNS infection phenotype that mimics cryptococcal meningitis as seen in humans. The method outlines techniques for visualizing different stages of pathology development, from initial to severe infection profiles. The chapter provides tips for real time visualization of the interactions between the pathogen and different aspects of the CNS anatomy and immune system.


Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera.
We clarified the configuration of the mediastinal lymphatics, focusing on the last intercalated lymph node and the direct drainage vessel to the thoracic duct, based on recent anatomical findings. We macroscopically observed the lymphatics during dissections of 205 cadavers in combination with routine histology. We also review the results of injection by other researchers. Efferent vessels draining directly into the thoracic duct or venous angle were frequently found in the following node groups: the right paratracheal node group corresponding to the last intercalated node in 98% of cadavers (201); the brachiocephalic angle node group in 85% of cadavers (174); the right recurrent nerve group in 46% (94); the left superior phrenic node group in 73% (150); the node group at the origin of the left common carotid artery (the preaortico-carotid node) in 37% (76); the pretracheal node group in 25% (51) and the left tracheobronchial node group in 36% (74). Last intercalated nodes appeared common for multiple drainage routes or regional lymphatics. These results were mostly consistent with injection studies by Riquet et al. Direct lymphatic drainage from the esophagus to the thoracic duct was observed in 19% of cadavers (39). Direct lymphatic drainage of lung segments to distant mediastinal nodes is also reviewed. The sentinel node concept is discussed in relation to the above observations. We hypothesize that the most critical sentinel node, if such usage is allowed, is situated as a guard for a limited specific route and for a common drainage route. We term it the "common terminal node".


Vulnerability to sleep-related affective disturbances? A closer look at dysfunctional beliefs and attitudes about sleep as a moderator of daily sleep-affect associations in young people.
Sleep and affect are closely related. Whether modifiable cognitive factors moderate this association is unclear. This study examined whether Dysfunctional Beliefs and Attitudes about Sleep moderate the impact of sleep on next-day affect in young people. Four hundred and sixty-eight young people (205 adolescents, 54.1% female, M ± SDage=16.92 ± 0.87; 263 emerging adults, 71.9% female, M±SDage=21.29 ± 1.73) self-reported sleep and affect, and wore an actigraph for 7-28 days, providing >5000 daily observations. Linear mixed-effects models tested whether Dysfunctional Beliefs and Attitudes about Sleep moderated daily associations between self-reported and actigraphic sleep duration, sleep efficiency, and next-day affect on between- and within-person levels. Both valence (positive/negative) and arousal (high/low) dimensions of affect were examined. Covariates included age, sex, race/ethnicity, day of week, and previous-day affect. Dysfunctional Beliefs and Attitudes about Sleep significantly moderated sleep and high arousal positive affect associations on between- but not within-person levels. Individuals with higher Dysfunctional Beliefs and Attitudes about Sleep (+1 SD) and lower average sleep duration (actigraphic: p = .020; self-reported: p = .047) and efficiency (actigraphic: p = .047) had significantly lower levels of high arousal positive affect. After adjusting for multiple comparisons, Dysfunctional Beliefs and Attitudes about Sleep did not moderate relationships between sleep duration and low arousal positive affect (p ≥ .340). Young people with more unhelpful beliefs about sleep and shorter, or poorer, sleep may experience dampened levels of high arousal positive affect. DBAS may constitute a modifiable factor increasing affective vulnerability on a global but not day-to-day level. Intervention studies are needed to determine if changing Dysfunctional Beliefs and Attitudes about Sleep may reduce sleep-related affect disturbances in young people.


Species distribution and community organization in a Nebraska Sandhills mixed prairie as influenced by plant/soil-water relationships.
Plant and soil water relationships in a typical nebraska Sandhills prairie were examined to 1) explain the observed distribution patterns of several dominant grasses along a topographic gradient, and 2) show how spatial and temporal variations in soil moisture are critical to community organization on a sandy substrate. An experimental transect encompassing the major community and soil types along a steep, west-facing vegetated dune was established. Maximum available water was shown to be significantly higher in the fine textured surface soils of the lowland sites than the coarse textured sands of the dune sites. Seasonal (1979) patterns of available soil moisture of the sampling sites on the transect showed that in the upper elevation dune sands, moisture was available in the entire profile with surface depletions not occurring until mid to late summer. In contrast, moisture in the surface 60-80 cm in the fine textured lowland soils was exhausted by early to mid-summer with the entire profile nearly dry by late summer. Deep-rooted, C4 species, Andropogon hallii and Calamovilfa longifolia which are common on upper, coarser sandy soils showed significantly greater water stress on fine textured soils than on dune sands. C3, shallowrooted species, Agropyron smithii, Stipa comata, and Koeleria cristata always experienced lower mid-day and predawn leaf water potentials than the C4 species. The C3 species, with the exception of Koeleria are most abundant on finer textured soils that provide substantial moisture during their peak activity in the spring. It appears that the C4 species show more conservative water use patterns than the C3 species as significantly lower leaf conductances in the C4's were measured when soil water was abundant. The C3 species appear to be opportunistic with available water and rapidly deplete surface soil moisture as a result of high transpiration rates. These data suggest that the temporal and spatial distribution of available water along this gradient controls species distribution according to rooting morphology, photosynthetic physiology, and water deficits, incurred by transpirational losses. Competitive interactions between species that utilize soil moisture differently may be an important factor in community organization.


Rho-kinase inhibition prevents the progression of diabetic nephropathy by downregulating hypoxia-inducible factor 1α.
The small GTPase Rho and its effector Rho-kinase are involved in the pathogenesis of diabetic nephropathy. Accumulating evidence shows that hypoxia-inducible factor-1α (HIF-1α) is a key regulator of renal sclerosis under diabetic conditions. However, the interactions of Rho-kinase and HIF-1α in the development of renal dysfunction have not been defined. Here, we assessed whether Rho-kinase blockade attenuates HIF-1α induction and the subsequent fibrotic response using type 2 diabetic mice and cultured mesangial cells. Fasudil, a Rho-kinase inhibitor, reduced urinary albumin excretion, mesangial matrix expansion, and the expression of fibrotic mediators in db/db mice. Mechanistically, HIF-1α accumulation and the expression of its target genes that contribute to diabetic glomerulosclerosis were also prevented by fasudil in the renal cortex. In mesangial cells, Rho/Rho-kinase signaling was activated under hypoxic conditions. Further in vitro studies showed that pharmacological and genetic inhibition of Rho-kinase promoted proteasomal HIF-1α degradation, which subsequently suppressed HIF-1-dependent profibrotic gene expression by upregulation of prolyl hydroxylase 2. Thus, we found a previously unrecognized renoprotective mechanism for the effects of Rho-kinase inhibition and this could be a potential therapeutic target for the treatment of diabetic nephropathy.


Modified stochastic medium prediction model for the deformation response of concealed underground stations under existing pipelines.
The underground pipeline network in the city is so intertwined that the concealed excavation of a metro station inevitably leads to a series of underground pipelines, causing settlement deformation and further risk of leakage. The existing theoretical methods for analysing settlement deformation are mostly for circular chambers, whereas metro stations have a nearly square cross-sectional form and different construction methods are very different, which have a greater impact on the deformation of the overlying pipelines. In this paper, based on the random medium theory and Peck's formula, the improved random medium model for predicting ground deformation is modified, the correction coefficients λ and η for the influence of different construction methods are proposed, the prediction model of underground pipeline deformation under different construction methods is obtained, and the numerical models of four work methods commonly used in urban tunnel construction: pillar hole method, side hole method, middle hole method and Pile-Beam-Arch (PBA) method are constructed through simulation, and the mathematical analysis software was used to fit the results to the model and obtain the range of correction coefficients λ and η for each of the four methods, and the accuracy and applicability of the theoretical model was verified by combining with actual engineering cases. The influence on the overlying pipes is in descending order: side hole method, pillar hole method, middle hole method and PBA method. The theoretical model provided in this paper for predicting the deformation of pipes in any overlying strata of the tunnel is well suited to the actual project and has a high degree of correlation with the measured results.


Characterization of γ-aminobutyric acid metabolism and oxidative damage in wheat (Triticum aestivum L.) seedlings under salt and osmotic stress.
The molecular response of plants to abiotic stresses has been considered a process mainly involved in the modulation of transcriptional activity of stress-related genes. Nevertheless, recent findings have suggested new layers of regulation and complexity. Upstream molecular mechanisms are involved in the plant response to abiotic stress. Plants gain resistance to abiotic stress by reprogramming metabolism and gene expression. GABA is proposed to be a signaling molecule involved in nitrogen metabolism, regulating the cytosolic pH, and protection against oxidative damage in response to various abiotic stresses. The aim of our study was to examine the role of the GABA shunt pathway-specific response in five wheat (Triticum aestivum L.) cultivars (Hurani 75, Sham I, Acsad 65, Um Qayes and Nodsieh) to salt and osmotic stress in terms of seed germination, seedling growth, oxidative damage (malondialdehyde (MDA) accumulation), and characterization of the glutamate decarboxylse gene (GAD) m-RNA level were determined using RT-PCR techniques. Our data showed a marked increase in GABA, MDA and GAD m-RNA levels under salt and osmotic stress in the five wheat cultivars. Um Qayes cultivar showed the highest germination percentage, GABA accumulation, and MDA level under salt and osmotic stresses. The marked increase in GAD gene expression explains the high accumulation of the GABA level under both stresses. Our results indicated that the GABA shunt is a key signaling and metabolic pathway that allows wheat to adapt to salt and osmotic stress. Based on our data, the Um Qayes wheat cultivar is the cultivar most recommended to be grown in soil with high salt and osmotic contents.


Altered protein binding of disopyramide in plasma from patients with cancer and with inflammatory disease.
Protein binding of disopyramide (D) was studied in eight patients with cancer, seven with inflammatory diseases, and seven healthy subjects. Plasma samples containing concentrations of 0.2-12.0 micrograms/ml were ultrafiltered, and the free fractions were measured with fluorescence polarization immunoassay. The mean free fractions at D concentrations ranging from 1.0 to 6.0 micrograms/ml were significantly less in patients with cancer (p less than 0.01) and those with inflammatory diseases (p less than 0.05) than in healthy subjects. Patients with cancer had a greater (p less than 0.05) D binding than those with inflammatory diseases. A multiple regression analysis revealed a significant contribution of plasma alpha 1-acid glycoprotein (AAG) (r = -0.79, p less than 0.01), but not of albumin (r = -0.096), to the overall variability in D binding at 3.0 micrograms/ml. The mean capacity constant in the two patient groups was similar, but significantly (p less than 0.01) greater than in the healthy group. Nonspecific D binding was greater in cancer patients (p less than 0.01) compared to the other two groups. Our results suggest that (a) therapeutic range of D measured as total drug concentration in patients with cancer and with inflammatory diseases would be greater than previously thought, and (b) unidentified component(s) (other than AAG and albumin) might contribute to the greater D binding in cancer patients compared to other study groups.


Tinnitus and patterns of hearing loss.
Tinnitus is strongly linked with the presence of damaged hearing. However, it is not known why tinnitus afflicts only some, and not all, hearing-impaired listeners. One possibility is that tinnitus patients have specific inner ear damage that triggers tinnitus. In this study, differences in cochlear function inferred from psychophysical measures were measured between hearing-impaired listeners with tinnitus and hearing-impaired listeners without tinnitus. Despite having similar average hearing loss, tinnitus patients were observed to have better frequency selectivity and compression than those without tinnitus. The results suggest that the presence of subjective tinnitus may not be strongly associated to outer hair cell impairment, at least where hearing impairment is evident. The results also show a different average pattern of hearing impairment amongst the tinnitus patients, consistent with the suggestion that inner hair cell dysfunction with subsequent reduced auditory innervation is a possible trigger of tinnitus.


Mucinous adenocarcinoma in perianal fistula in Crohn's disease: Case report and literature review.
Crohn's disease (CD) is a chronic bowel disease that, due to exacerbated inflammation, can lead to complications such as the development of perianal fistulas. The development of mucinous adenocarcinoma in perianal fistulas in patients with CD is rare and, consequently, few reports exist in the literature. We report the case of a 71-year-old man diagnosed 22 years ago with CD with perineal involvement, who came with complaints of intense perianal pain, a gluteal mass, and local bleeding. Tomography of his abdomen showed an expansive, heterogeneous, and solid perianal mass on the right, with interspersed necrotic/liquefied areas and possible mucinous content. The patient was referred to the surgery department for an incisional biopsy, which confirmed mucinous adenocarcinoma. The patient underwent extra levator abdominoperineal rectal resection (APR) with partial prostatectomy. Perineal mucinous adenocarcinoma arising in a fistula associated with CD is very rare. Since the symptoms overlap, early diagnosis of malignancy is difficult. Histological analysis is the gold standard for its diagnosis. Surgical resection through APR is well-established and, despite being a complex procedure with potential complications, tends to have good results. However, the locoregional and inguinal lymph node involvement was related to a worse progression in this case. The diagnostic hypothesis of mucinous adenocarcinoma should be suspected in CD patients who present long-term perineal involvement with fistulas. Biopsies and imaging exams should be performed to aid the diagnosis of the condition and thus contribute to the surgical plan.


Lead intoxication: a summary of the clinical presentation among Thai patients.
Lead is an important toxic metal found in industrial communities. Due to the industrialization in the recent decade in Thailand, lead intoxication as a toxicant-related disorder becomes a new public health problem. A retrospective study on clinical presentation of hospitalized patients with diagnosis of lead intoxication during year 1990-1999 in King Chulalongkorn Memorial hospital, the largest Thai Red Cross Society Hospital, was performed. All 14 cases diagnosed with lead intoxication were identified in our series. Average age of the subjects was 25.55 +/- 21.93 years old. Male predominance was detected in our series (male:female = 12:2). Two main groups of subjects as; (1) childhood aged below 10 years old (male:female = 4:2) and (2) adult aged between 24 and 60 years old (n = 8, all male), can be identified. For the first group, the clinical presentations were convulsion (n = 3), unexplained anemia (n = 1), attention deficit (n = 1) and asymptomatic (n = 1), respectively. All of the subjects in this group presented the history of living at the old battery plant area. Five of the six cases came from the same village. For the second group, the clinical presentations were unexplained abdominal pain (n = 5), chronic renal failure (n = 1), unexplained anemia (n = 1) and asymptomatic (n = 1), respectively. Most of the subjects (75%) in this group presented the history of working in the battery plant for more than 10 years. Another case presented the history of gunshot and residual bullet in the bone marrow. The other one left is an interesting case with the history of prolonged usage of ritual pill and holy paper incineration. Like other studies, battery plant had strong relation with the lead intoxication. Although the total identified cases are rather few, there may be more undetected asymptomatic lead intoxication cases in the community. Specific control of lead resulted from battery plant and monitoring of the workers as public health strategies are still recommended.


Collagen organization in wound healing after myocardial injury.
Our understanding of what constitutes "normal" collagen organization in wound healing after myocardial injury and how such organization is achieved is still in its infancy. However, once this knowledge has been obtained, it may suggest methods of enhancing or even optimizing healing, and thus provide us with the possibility of modifying the structural problems responsible for infarct expansion and rupture.


Partnering with Insurers in Caring for the Most Vulnerable Youth with Diabetes: NICH as an Integrator.
In this review, we outline barriers to appropriately caring for high-risk youth with diabetes and discuss efforts in partnering with insurers through Alternative Payment Models to achieve the Triple Aim (improved health, improved care, and reduced costs) for this population. Current approaches in caring for youth with diabetes who evidence a high degree of social complexity are woefully ineffective. These youth are vulnerable to repeat diabetic ketoacidosis episodes, poor glycemic control, and excessive utilization of healthcare resources. To effectively pursue the Triple Aim, an "integrator" (i.e., an entity that accepts responsibility for all components of the Triple Aim for a specified population) must be identified; however, this does not fit into current fee-for-service models. Integrators for youth with diabetes are limited, but early examples of integrator efforts are promising. We present one successful "integrator," Novel Interventions in Children's Healthcare (NICH), and detail this program's efforts in partnering with insurers to serve high-risk youth with diabetes.


The survival pattern in male breast cancer. An analysis of 1429 patients from the Nordic countries.
A joint Nordic study was conducted to elucidate the survival pattern in male breast cancer by means of regression analysis of annual relative survival rates. A total of 1429 (98.4%) of all patients diagnosed during a 25-year to 30-year period and reported to the Nordic cancer registries were available for follow-up through 1982. The relative survival rate was lower in older patients; the relative excess risk of dying (from breast cancer) during the first 5 years of observation, calculated by multiple regression modelling, increased in a regular fashion more than three-fold from patients younger than 40 years at diagnosis to those aged 80 years or older. Significantly lower rates were found among males in Denmark and Finland, the relative excess risks of dying (compared with Sweden) being 1.39 (1.06-1.80) and 1.73 (1.22-2.45), respectively, during the first 5 years. The authors concluded first that important differences exist between male and female patients with breast cancer in the relation between survival and age at diagnosis, and secondly that a later stage at presentation or national differences in the natural history are the most likely explanations for the worse prognosis in Denmark and Finland.


Methylatable Signaling Helix Coordinated Inhibitory Receiver Domain in Sensor Kinase Modulates Environmental Stress Response in Bacillus Cereus.
σB, an alternative transcription factor, controls the response of the cell to a variety of environmental stresses in Bacillus cereus. Previously, we reported that RsbM negatively regulates σB through the methylation of RsbK, a hybrid sensor kinase, on a signaling helix (S-helix). However, RsbK comprises a C-terminal receiver (REC) domain whose function remains unclear. In this study, deletion of the C-terminal REC domain of RsbK resulted in high constitutive σB expression independent of environmental stimuli. Thus, the REC domain may serve as an inhibitory element. Mutagenic substitution was employed to modify the putative phospho-acceptor residue D827 in the REC domain of RsbK. The expression of RsbKD827N and RsbKD827E exhibited high constitutive σB, indicating that D827, if phosphorylatable, possibly participates in σB regulation. Bacterial two-hybrid analyses demonstrated that RsbK forms a homodimer and the REC domain interacts mainly with the histidine kinase (HK) domain and partly with the S-helix. In particular, co-expression of RsbM strengthens the interaction between the REC domain and the S-helix. Consistently, our structural model predicts a significant interaction between the HK and REC domains of the RsbK intradimer. Here, we demonstrated that coordinated the methylatable S-helix and the REC domain of RsbK is functionally required to modulate σB-mediated stress response in B. cereus and maybe ubiquitous in microorganisms encoded RsbK-type sensor kinases.


Problems in self-management of analgesics after outpatient shoulder surgery.
Surgical outpatients are instructed in the use of analgesics post-operatively, but many fail to obtain adequate pain control at home. This study describes how the medication taken related to the prescribed medication and to pain intensity to improve recommendations of drug choice and scheduling. Also, we describe which errors occurred to suggest improvements in patient education and adherence. Data were extracted from a study of dexamethasone in day-case arthroscopic shoulder surgery. Patients were recommended paracetamol 1 g four times daily and as needed: ibuprofen 600 mg up to 1,800 mg daily and morphine 10 mg up to 60 mg daily. Patients reported pain intensity and analgesic use until the third post-operative day. A total of 75 patients were available for analysis, and 33 patients (44%) reported an average pain intensity less-than 3 (by numerical rating scale 0-10) during the first three days. Paracetamol was taken as recommended by less-than 50%, and adherence was poorer in patients with higher average pain scores. The maximal daily dose was exceeded for paracetamol (n = 7) and ibuprofen (n = 14) due to too many daily doses or medication of other brand names or strengths than the patients were used to. In total, 32 patients had rescue doses between midnight and 6 a.m. Intolerance was seen for paracetamol (n = 1), ibuprofen (n = 7) and opioid (n = 2). Problems in analgesic use after outpatient surgery include undertreatment, poor compliance, overdosage, nightly breakthrough pain and poor tolerance due to side effects. Interventional studies should target these areas. none. not relevant.


Prostaglandins and the anti-inflammatory activities of aspirin and sodium salicylate.
Acetylsalicylic acid (aspirin) and sodium salicylate are equally effective in reducing the swelling in the carrageenan-induced paw test and the accumulation of leucocytes into the inflammatory exudate produced by the subcutaneous implantation of polyvinyl sponges in the rat. Aspirin but not sodium salicylate caused a significant reduction in the potentiation of paw oedema found after the concurrent administration of carrageenan and arachidonic acid. Some implications of these findings are discussed.


Sustainable Design of Urban Rooftop Food-Energy-Land Nexus.
Urban rooftop functional design offers a promising option to enable multi-function urban land-use to deliver multiple ecosystem services, e.g., food production by rooftop agriculture and energy supply by installing photovoltaic (PV) panels. To identify the best rooftop utilization strategy considering multiple decision criteria and understand the impact of rooftop solution on the design of urban energy systems, we propose a whole system modeling framework that integrates biogeochemical simulation and multi-objective energy system optimization. We apply the framework to evaluate three rooftop agriculture options, namely, basic rooftop farming, unconditioned greenhouse, and conditioned greenhouse, and one rooftop energy supply option, i.e., PV panels, for an urban energy eco-design case in Shanghai, China. Enabling rooftop agriculture options brings more flexibility to the design and operation of energy systems. PV panels provide cost-optimal solutions, whereas conditioned greenhouse potentially delivers environmentally sustainable land-use by contributing to climate regulation ecosystem services.


Physicochemical, Sensory and Nutritional Properties of Foods Affected by Processing and Storage.
Due to their chemical composition and physicochemical characteristics, most foods are very perishable and are easily altered by physical, chemical and biological agents [...].


Determination of musk compounds in sewage treatment plant sludge samples by solid-phase microextraction.
Headspace solid-phase microextraction, followed by GC-MS analysis is presented as a suitable technique for the determination of musk compounds in sewage treatment plant sludge. Five polycyclic musks (celestolide, phantolide, traseolide, galaxolide and tonalide) and four nitro musks (musk xylene, musk moskene, musk tibetene and musk ketone) were considered in the optimisation of the analytical method. The influence of extraction temperature, fibre coating, agitation, pH and salting out on the efficiency of the extraction along with the extraction kinetics were studied. An extraction temperature of 100 degrees C and sampling the headspace over the stirred sludge sample using polydimethylsiloxane -divinylbenzene as fibre coating lead to effective extraction. The method proposed is very simple and yields high sensitivity, good linearity and repeatability for all the analytes with limits of detection at the sub-ng/g level. The total analysis time, including extraction and GC analysis, was only 40 min, and no manipulation of the sample was required.


General anesthesia.
The general anesthetic course has been made acceptably safe with the development of modern anesthetic agents and techniques and increased capabilities for monitoring patient organ systems. Each area of surgery has features unique to its specialty. Consideration of these aspects when planning an anesthetic and surgical course, as well as the importance of the team effort, cannot be overemphasized.


A systematic review of acupuncture for sleep quality in people with insomnia.
Acupuncture is widely used in Asia and increasingly in Western countries. We performed a systematic review and meta-analysis to examine the effects of acupuncture for insomnia. We identified randomized controlled trials from English and Chinese databases. Data were extracted using a predefined form and analysed using RevMan 5.2. We included studies that compared acupuncture to sham/placebo, standard pharmacotherapy or cognitive behavioral therapy. Risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome was sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). A total of 30 studies involving 2363 participants were included. Acupuncture point combinations included the use of at least one of the recommended points for insomnia, HT7, GV20, SP6. Pharmacotherapy control was used in 27 studies and sham/placebo in three studies. Cognitive behavioral therapy was not used in any of the studies. Pharmacotherapies in all studies were benzodiazepine receptor agonists, except for one that used an antidepressant. Acupuncture was superior to sham/placebo in terms of PSQI (MD -0.79, 95% CI -1.38, -0.19, I(2)=49%). Acupuncture was also more effective than pharmacotherapy (MD -2.76, 95% CI -3.67, -1.85, I(2)=94%). Most studies were at risk of bias. Some mild adverse events were reported but they were not causally related to the acupuncture treatments. Acupuncture compared to sham/placebo and pharmacotherapy showed statistically significant results. However, the evidence is limited by bias in the included studies and heterogeneity. Well-designed studies are needed to confirm the results identified in this review.


Stratification of patients with lysosomal acid lipase deficiency by enzyme activity in dried blood spots.
Lysosomal acid lipase deficiency (LAL-D) is a phenotypic continuum between the severe Wolman disease and the attenuated cholesteryl ester storage disease (CESD). To study if the amount of residual LAL enzymatic activity in dried blood spots (DBS) correlates with the LAL-D disease severity. DBS from Wolman and CESD patients, LAL-D carriers, and presumably unaffected random newborns were acquired. LAL enzymatic activity in DBS were measured using a novel, highly specific LAL substrate. Patients with Wolman disease displayed significantly lower LAL enzymatic activity compared to CESD patients. This was not observed with the traditional assay in which a non-specific substrate was used together with an LAL-specific inhibitor. The new LAL enzymatic activity assay using the specific substrate offers an improved biochemical genetics method for the diagnosis of LAL-D in symptomatic patients and more importantly, for the prognosis of asymptomatic patients who test positive in population-wide LAL-D newborn screening.


Changes in mediobasal hypothalamic dopamine and GABA release: a possible mechanism underlying taurine-induced prolactin secretion.
Taurine (Tau), a putative inhibitory amino acid neurotransmitter, has been shown to stimulate prolactin (PRL) release. Using ovariectomized, estrogen-replaced adult rats we investigated initially the effect of this amino acid, injected by different routes, on PRL secretion in vivo. Tau (100-500 mg/kg) had no effect on PRL release when given i.p.; 15 min after i.c.v. injection of Tau (3 mumoles), a significant increase in serum PRL levels was observed (78 +/- 9 ng/ml over basal levels, p < 0.01 vs. controls). In vitro (cultured anterior pituitary cells) PRL release was not affected by a 5 h incubation with Tau (10(-3)-10(-8) M). Basal dopamine (DA) or gamma-aminobutyric acid (GABA) output from superfused mediobasal hypothalamic fragments (MBH) was not affected by Tau (10(-3) M or 10(-5) M). However, during stimulation with KCl (50 mM), Tau (10(-3) M) significantly lowered DA release, and increased GABA output. It is concluded that Tau acts at a central level to increase PRL secretion, most probably by modulating the hypothalamic release of neurotransmitters controlling lactotroph function.


Silver staining, immunofluorescence, and immunoelectron microscopic localization of nucleolar phosphoproteins B23 and C23.
Nucleolar organizer region (NOR)-specific silver staining and immunolocalization of nucleolar phosphoproteins B23 and C23 were compared in Novikoff hepatoma ascites cells. Silver staining and protein C23 immunostaining were both localized in the fibrillar shell surrounding the fibrillar center and in the fibrillar center. During mitosis, silver staining and protein C23 were localized at the NORs. Therefore, protein C23 and the silver-staining protein both seem to be associated with rDNA-containing structures (Mirre and Stahl 1981). A comparison of toluidine blue staining specific for RNA and B23 immunostaining demonstrated that protein B23 was associated with RNA-containing regions of the nucleolus and was absent from the fibrillar centers. Localization of these proteins and their functions are discussed in relation to the organization of the nucleolus.


Comparative cytotoxic and antitumoral effects of ellipticine derivatives on mouse L 1210 leukemia.
Twelve derivatives of the antitumoral alkaloid ellipticine (E) and ellipticinium were assayed in vitro on cultured L 1210 cells. These drugs possess varying abilities to decrease the cell growth rate in a 1--1000-fold range. Some of them have a highly cytotoxic effect in the 10(-8)--10(-6) M range. Non-specific intracellular damages are produced: multilobation of nuclei, occurrence of numerous lipid granules, diminution of the size and increase in the number of mitochondrial profiles and several modifications of the internal architecture of mitochondria. 2-Methyl-9-hydroxyellipticinium (2-CH3-9-OHE) was submitted to a bioassay; it inactivates the tumorigenic potency of the cells exposed to it, when they are grafted back into mice in the same dose range which reduces in vitro the growth rate of the cells. A fairly good correlation holds between the in vitro and in vivo (antitumor effect) assays, offering a possible prescreening test for a cheaper and rapid evaluation of chemotherapeutic activity of these compounds. The results stress again the importance of the 9-hydroxy substitution in these series for improving the anticancer efficiency. The nature of the biochemical target of E and derivatives is discussed according to our data.


The effect of healthcare policy signals on patients' perceived value, trust and intention to use services offered by a healthcare provider.
Capitation is a healthcare reimbursement scheme in which a healthcare provider equitable access to funding for services and greater flexibility and budgeting. The objectives of the study are to investigate the effect of capitation signaling on patients' perceived value and trust and on their use intention. This study was a scenario-based survey to examine interaction design, including capitation policy information and value-added health services information, which act as a combination of to test the hypotheses using signaling theory. Subject may receive the information about health services, information about a capitation policy, both of these two signals, or neither of them. The results of this study show that signal capitation policy and value-added health service information positively affects patients' perceived value, but not patients' trust. When a patient receives a signal either capitation policy information or value-added health service information, their perceived value, trust, and use intention are significantly higher than those who receive neither signal. We suggest that high-quality healthcare institutions should consider distinguishing themselves from other low-quality providers by signaling information and allocate resources on value-added health services to enhance patients' awareness of healthy behavior and benefit from implementing a capitation payment scheme. This research contributes to healthcare stakeholders, especially policymakers and service providers, in terms of how best to engage with patients.


miRNA‑342 suppresses renal interstitial fibrosis in diabetic nephropathy by targeting SOX6.
Diabetic kidney disease (DKD) is one of the major microvascular complications in patients with type 1 and/or type 2 diabetes, the first cause of end‑stage renal disease (ESRD) in several countries and regions. However, the pathogenesis of DKD and the mechanisms through which it leads to ESRD remain unknown. Thus, in this study, we aimed to elucidate some of these mechanisms. The expression of microRNA (miRNA or miR)‑342‑3p and SRY‑box 6 (SOX6) in the renal tissues of mice with DKD and mouse renal mesangial cells (MCs) was determined by RT‑qPCR and western blot analysis. The diabetic kidney environment was established using high‑glucose medium. SOX6 was verified as a target gene of miR‑342‑3p by dual‑luciferase activity assay. In addition, western blot analysis was employed to determine the changes in the levels of several biomarkers of fibrosis [transforming growth factor (TGF)‑β1, fibronectin (FN), collagen IV (referred to as C‑IV) and phosphatase and tensin homolog (PTEN)]. Compared with THE control mice, the expression of miR‑342‑3p in the kidney tissues of mice with DKD was downregulated, whereas that of SOX6 was upregulated. The same phenomenon was observed in the MCs cultured in high‑glucose medium. Subsequently, miR‑342‑3p inhibited SOX6 expression, promoted cell proliferation and inhibited the apoptosis of MCs. Moreover, the overexpression of miR‑342‑3p suppressed high glucose‑induced renal interstitial fibrosis. In addition, it was found that miR‑342‑3p inhibited SOX6 expression by binding to the 3'‑UTR of SOX6. On the whole, the findings of this study demonstrate that miR‑342‑3p suppresses the progression of DKD by inducing the degradation of SOX6. Thus, the miR‑342‑3p/SOX6 axis may serve as a novel therapeutic target in the treatment of DKD.


Propofol induces excessive vasodilation of aortic rings by inhibiting protein kinase Cβ2 and θ in spontaneously hypertensive rats.
Exaggerated hypotension following administration of propofol is strongly predicted in patients with hypertension. Increased PKCs play a crucial role in regulating vascular tone. We studied whether propofol induces vasodilation by inhibiting increased PKC activity in spontaneously hypertensive rats (SHRs) and, if so, whether contractile Ca2+ sensitization pathways and filamentous-globular (F/G) actin dynamics were involved. Rings of thoracic aorta, denuded of endothelium, from normotensive Wistar-Kyoto (WKY) rats and SHR were prepared for functional studies. Expression and activity of PKCs in vascular smooth muscle (VSM) cells were determined by Western blot analysis and elisa respectively. Phosphorylation of the key proteins in PKC Ca2+ sensitization pathways was also examined. Actin polymerization was evaluated by differential centrifugation to probe G- and F-actin content. Basal expression and activity of PKCβ2 and PKCθ were increased in aortic VSMs of SHR, compared with those from WKY rats. Vasorelaxation of SHR aortas by propofol was markedly attenuated by LY333531 (a specific PKCβ inhibitor) or the PKCθ pseudo-substrate inhibitor. Furthermore, noradrenaline-enhanced phosphorylation, and the translocation of PKCβ2 and PKCθ, was inhibited by propofol, with decreased actin polymerization and PKCβ2-mediated Ca2+ sensitization pathway in SHR aortas. Propofol suppressed increased PKCβ2 and PKCθ activity, which was partly responsible for exaggerated vasodilation in SHR. This suppression results in inhibition of actin polymerization, as well as that of the PKCβ2- but not PKCθ-mediated, Ca2+ sensitization pathway. These data provide a novel explanation for the unwanted side effects of propofol.


Postpartum intentions on contraception use and method choice among breastfeeding women attending a university hospital in Ohio: a cross-sectional study.
Few postpartum women use effective contraception and those who use less effective methods have increased rates of unintended pregnancy. Little is known about postpartum contraception intentions among breastfeeding women. Our objectives were to measure the extent of prenatal contraceptive counseling, to assess contraceptive intentions, and to identify correlates of both among postpartum women who were planning to breastfeed. We conducted a cross-sectional study using a convenience sample of 100 breastfeeding women before their discharge following delivery at a large university hospital in 2015. We used logistic regression to assess three outcomes of interest: not intending to use contraception before 6 months postpartum, reporting receiving counseling on postpartum contraception during prenatal care, and considering the effects of contraception methods on the breastfeeding mother-infant dyad when choosing a postpartum contraception method. Most women (91%) intended to use contraception. Prior history of no contraception use was the sole factor related to not intending to use contraception. The most commonly cited reason for the intended choice of contraceptive method was convenience (35%). Few women (21%) reported considering the effects of contraception methods on the breastfeeding dyad when choosing a postpartum contraception method. Nearly half of women reported never discussing postpartum contraception options with their healthcare provider during prenatal care. In the multivariate analysis, receiving public assistance was the only factor that remained statistically significantly associated with reporting having received contraception counseling during prenatal care. Although most women intended to use contraception, they did not appear to have received adequate prenatal counseling on postpartum contraception.


Artesunate Protects LPS-Induced Acute Lung Injury by Inhibiting TLR4 Expression and Inducing Nrf2 Activation.
Artesunate, a derivative of artemisinin, has been reported to have anti-inflammatory property. However, few studies showed the protective effects of artesunate on lung injury. In this study, we aimed to investigate the effects of artesunate on LPS-induced lung injury in mice. The mice were treated with artesunate 1 h before or after LPS treatment. The effects of artesunate on lung MPO activity and malondialdehyde (MDA) content were detected. The lung wet/dry radio and the numbers of inflammatory cells in BALF were also measured. ELISA was used to evaluate the levels of TNF-α, IL-1β, and IL-6 in BALF. Western blot analysis was adapted to detect TLR4 and Nrf2 signaling pathways. The results showed that artesunate protected against LPS-induced ALI by decreasing the numbers of inflammatory cells, lung edema, MPO activity, and MDA content. Furthermore, artesunate significantly inhibited the levels of TNF-α, IL-1β, and IL-6. Artesunate also inhibited LPS-induced IL-6 and IL-8 production in the A549 cells. In addition, artesunate dose-dependently suppressed LPS-induced TLR4 expression and NF-κB activation. The expression of Nrf2 and HO-1 were also up-regulated by artesunate. The data suggest that artesunate possesses anti-inflammatory and anti-oxidant properties against LPS-induced ALI via inhibiting TLR4 signaling pathway and activating Nrf2 signaling pathway.


Structure determination of Cryptococcus neoformans serotype A-variant glucuronoxylomannan by 13C-n.m.r. spectroscopy.
A series of polysaccharides was derived by physical and chemical methods from an antigenic, O-acetyl-containing, glucuronoxylomannan (GXM), isolated from the growth medium of Cryptococcus neoformans (CDC B2550) serotype A-variant having composition ratios of Man:Xyl:GlcA:OAc = 10:4:3:6. 13C-N.m.r. spectra of derivatives provided new structural evidence for GXM. Treatment of GXM with Li in ethylenediamine gave a xylomannan (XM, with Man:Xyl = 5:2). Smith degradation of XM gave a mannan (M). Ultrasonic treatment of GXM gave GXM-sonicated (GXMS). Treatment of GXM with 3-(3-dimethylaminopropyl)-1-ethylcarbodiimide.HCl and then with NaBH4 gave reduced GXMS (RGXMS), or with aq. trifluoroacetic acid gave partially acid-hydrolyzed GXMS. Periodate oxidation of GXM and NaBH4 reduction of the product gave a polyalcohol-mannan (PM). Treatment of GXMS, RGXMS, and PM with NH4OH at pH 11 gave the respective O-deacetylated analogs. Comparison among the 13C-n.m.r. spectra of GXM, the various derivatives, and reference monosaccharides allowed the following conclusions: M is (1----3)-alpha-D-mannopyranan; XM consists of the M backbone with 91% of the Xyl on nonadjacent Man residues as 2-O-beta-D-Xylp substituents and with 9% as 4-O-D-Xylp substituents on other Man residues. GXM consists of the XM structure, but with non-D-xylosylated Man residues substituted with 2-O-beta-D-GlcpA substituents and with 6-O-acetyl groups distributed approximately equally on Man residues that have other substituents and those that have none. The molecular mechanics program MM2 was used to estimate the relative energies of anomeric orientations of the typical glycosidic linkage in M. The results suggest that 6'-OH----O-2 H-bonding is significant in the minimal-energy orientation of M, with phi = -36 degrees and psi = 51 degrees, and that two other glycosidic orientations may be important in the 2-O- or 6-O-substituted derivatives of M.


Development of an ICF-based core set of activities and participation for patients with mental disorders: an approach based upon data.
To use data and patient involvement to identify categories within the International Classification of Functioning, Disability and Health (ICF) component activities and participation relevant for patients with affective, somatoform, anxiety and adjustment disorders. The first step was to identify systematically, outcome instruments used in randomized controlled trials, to relate item content to the ICF. Then four patient focus group discussions (n = 21 participants) were conducted, and finally an expert panel (n = 11 participants) was used to identify the most relevant categories in therapy settings. Focus groups: inpatient psychotherapy patients. Expert panel: clinicians, stakeholders, patient representative. In the literature search, 313 measures were identified, which included 1562 meaningful concepts (separate content units). These were allocated to ICF categories that were validated and complemented in focus groups and by an expert panel. The resulting core set includes 27 categories related to the nine chapters of the ICF component activities and participation. A core set of items, set within the World Health Organization ICF and relevant to the treatment of people with affective, somatoform, anxiety and adjustment disorders, has been developed based on existing evidence.


Prevalence of tetracycline and rabies virus antibody in raccoons, skunks, and foxes following aerial distribution of V-RG baits to control raccoon rabies in Ontario, Canada.
More than 3.6 million baits containing a recombinant vaccinia virus-rabies glycoprotein (V-RG) oral rabies vaccine were aerially or hand-distributed during 1999-2006 in an approximate 4,000-9,000 km(2) area of eastern Ontario, Canada, as part of a multitactic approach to control the raccoon variant of rabies. The efficacy of the program was assessed through the collection and testing of > 6,900 animals for bait acceptance and rabies virus-specific antibodies. Raccoon acceptance of rabies vaccine baits was significantly greater (71-83% ) in areas baited at a density of 150 baits/km(2) compared to areas baited at 75 baits/km(2) (26-58% ), and more raccoons consumed vaccine baits in areas baited with a flight line spacing of 0.75 km (45.3% [321/708]) than with a spacing of 1.5 km (33.8% [108/320]). In addition, greater numbers of raccoons consumed vaccine baits during a drop in September (52.7% [213/404]) as opposed to a June bait drop (34.6% [216/624]). Seropositivity rates for raccoons ranged between 7% and 28% in areas baited at 75/km(2) and 10% to 27% in areas baited at 150/km(2) with statistical differences varying among years and treatments. The last case of raccoon-variant rabies reported in Ontario was in September 2005. The control of raccoon rabies in Ontario has resulted in an estimated $6M to $10 M Cdn annual savings in rabies-associated costs.


Association of blood lipids with coronary artery plaque among Saudi patients referred to computed tomography.
Blood lipids are strong risk factors for the progression of atherosclerotic plaques. However, data on gender-specific associations are limited. To examine gender-specific associations of coronary plaque with blood lipids among a large sample of Saudi patients without CAD. Retrospective cross-sectional study was conducted among adult patients referred to (64 multidetector spiral) computed tomography (CT) for standard indications at the Prince Sultan Cardiac Centre (Riyadh, Saudi Arabia) between July 2007 and December 2017. Those with pre-existing CAD were excluded. Plaques were determined based on quantification of coronary calcium and Coronary CT angiography. A total 2421 patients (1498 males and 923 females) were included. The prevalence of any plaque was 36.6% with higher burden in males than females (41.3% versus 28.9%, p < 0.001). Approximately 78.9% of all plaques were calcified. Blood lipids (mmol/L) were 4.75 ± 1.14 for total cholesterol, 2.90 ± 0.96 for LDL cholesterol, 1.20 ± 0.36 for HDL cholesterol, and 1.64 ± 1.09 for triglycerides. Males had significantly higher triglycerides and lower HDL cholesterol compared with females. In adjusted models in males and all patients, soft and/or calcified plaques were significantly associated with lower HDL cholesterol and higher triglycerides. In females, the only significant association was between soft plaques and higher triglycerides. Middle-aged patients without clinical CAD in Saudi Arabia have a high burden of plaques, specially calcified ones. The findings may impact the use of lipid lowering mediations, by underscoring the importance of assessing the risk of CAD in patients without clinical CAD even in case of lack of coronary calcification.


Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics.
Rapid maxillary expansion is known to improve nasal airway ventilation. However, it is difficult to precisely evaluate this improvement with conventional methods. The purpose of this longitudinal study was to use computational fluid dynamics to estimate the effect of rapid maxillary expansion. Twenty-three subjects (9 boys, 14 girls; mean ages, 9.74 ± 1.29 years before rapid maxillary expansion and 10.87 ± 1.18 years after rapid maxillary expansion) who required rapid maxillary expansion as part of their orthodontic treatment had cone-beam computed tomography images taken before and after rapid maxillary expansion. The computed tomography data were used to reconstruct the 3-dimensional shape of the nasal cavity. Two measures of nasal airflow function (pressure and velocity) were simulated by using computational fluid dynamics. The pressure after rapid maxillary expansion (80.55 Pa) was significantly lower than before rapid maxillary expansion (147.70 Pa), and the velocity after rapid maxillary expansion (9.63 m/sec) was slower than before rapid maxillary expansion (13.46 m/sec). Improvement of nasal airway ventilation by rapid maxillary expansion was detected by computational fluid dynamics.


The significance of micro-lymphatic invasion and pathological Gleason score in prostate cancer patients with pathologically organ-confined disease and negative surgical margins after robot-assisted radical prostatectomy.
The development process of recurrence in prostate cancer patients with pathologically organ-confined (pT2) disease and negative surgical margins is unclear. The aim of the present study was to determine factors associated with the development of biochemical recurrence following robot-assisted radical prostatectomy among those prostate cancer patients. We retrospectively reviewed the data of patients who underwent robot-assisted radical prostatectomy without neoadjuvant endocrine therapy. We evaluated prognostic factors in 1096 prostate cancer patients with pT2 disease and negative surgical margins. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for biochemical recurrence. Of the 1096 patients, 55 experienced biochemical recurrence during the follow-up period. The 5-year biochemical recurrence-free survival rate for patients with pT2 and negative surgical margins was 91.8%. On univariate analysis, clinical stage, biopsy Gleason score, percent of positive core, pathological Gleason score, and the presence of micro-lymphatic invasion were significantly associated with biochemical recurrence. On a multivariate analysis, the presence of micro-lymphatic invasion and a pathological Gleason score ≥ 4 + 3 were significant prognostic factors for biochemical recurrence. Based on these factors, we developed a risk stratification model. The biochemical recurrence-free survival rate differed significantly among the risk groups. The prognosis of prostate cancer patients with pT2 disease and negative surgical margins is favorable. However, patients with the presence of micro-lymphatic invasion and a pathological Gleason score ≥ 4 + 3 tend to experience biochemical recurrence more often after surgery. Therefore, careful follow-up might be necessary for those patients.


[Influence of adaptation to supercooling on the fatty acid composition of rat tissue lipids].
Adaptation to supercooling produces a considerable effect on composition and quantitative content of certain fatty acids in all the studied tissues. In lipids of the myocardium and skeletal muscles adaptation causes an increase in the content of unsaturated fatty acids in particular of polyenic ones. In lipids of the lungs, vice versa, the content of saturated fatty acids increases, chiefly due to palmitic acids. In lipids of the liver a ratio of certain unsaturated fatty acids changes noticeably: the content of monoenic acids rises but the content of polyenic acids is more than 5 times as low.


Ependymoblastoma: a histological, immunohistological and ultrastructural study of five cases.
Five ependymoblastomas were studied by means of routine histological techniques, immunohistology and electron microscopy. The tumours were characterized histologically by medium sized, poorly differentiated cells with round or oval nuclei frequently in mitosis and by ependymoblastic rosettes. Reactions for cytokeratin and neurofilament were negative and tubular material positive for glial fibrillary acidic protein was scanty. All five tumors demonstrated positivity for vimentin and S-100 protein. Electron microscopy showed poorly differentiated cells with high nucleo-cytoplasmic ratio and scanty cytoplasmic organelles. Sparse rosettes were present and the cells were united by junctional complexes. Frequent rudimentary or incomplete cilia, a few basal bodies and a few short intercellular glial-like filaments were seen. Features differentiating ependymomas and anaplastic ependymomas from ependymoblastomas are discussed and the need for a definite category separating ependymoblastomas from the former tumours is emphasized.


Use of soybean oil to modulate the gel properties of soybean protein isolation-wheat gluten composite with or without CaCl2.
Plant protein is widely used in the study of animal protein substitutes and healthy sustainable products. The gel properties are crucial for the production of plant protein foods. Therefore, the present study investigated the use of soybean oil to modulate the gel properties of soybean protein isolation-wheat gluten composite with or without CaCl2 . Oil droplets filled protein network pores under the addition of soybean oil (1-2%). This resulted in an enhanced gel hardness and water holding capacity. Further addition of soybean oil (3-4%), oil droplets and some protein-oil compounds increased the distance between the protein molecule chain. The results of Fourier transform infrared spectroscopy and intermolecular interaction also showed that the disulfide bond and β-sheet ratio decreased in the gel system, which damaged the overall structure of the gel network. Compared with the addition of 0 m CaCl2 , salt ion reduced the electrostatic repulsion between proteins, and local protein cross-linking was more intense at 0.005 m CaCl2 concentration. In the present study, structural properties and rheological analysis showed that the overall strength of the gel was weakened after the addition of CaCl2 . The presence of appropriate amount of soybean oil can fill the gel pores and improve the texture properties and network structure of soy protein isolate-wheat gluten (SPI-WG) composite gel. Excessive soybean oil may hinder protein-protein interaction and adversely affect protein gel. In addition, the presence or absence of CaCl2 significantly affected the gelling properties of SPI-WG composite protein gels. © 2023 Society of Chemical Industry.