MR 4D flow-derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction.
The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14. The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.


Controlling high-frequency collective electron dynamics via single-particle complexity.
We demonstrate, through experiment and theory, enhanced high-frequency current oscillations due to magnetically-induced conduction resonances in superlattices. Strong increase in the ac power originates from complex single-electron dynamics, characterized by abrupt resonant transitions between unbound and localized trajectories, which trigger and shape propagating charge domains. Our data demonstrate that external fields can tune the collective behavior of quantum particles by imprinting configurable patterns in the single-particle classical phase space.


Mediators explaining radical right voting patterns of Christians in Europe: Attitudes toward immigrants, values, or social capital?
Previous studies show that radical right parties in Europe receive relatively low levels of supports from Christian voters, despite that Christian value is highlighted in the European radical right agenda. However, the mechanism remains largely untested. The study investigates the factors underlying Christians voting or not voting for populist radical right parties across Europe, using Round 8 European Social Survey data. It is shown that there is no general relationship between Christian religiosity and radical right voting across European countries. In most countries, Christians are neither more nor less likely to vote for the radical right parties compared to the non-religious. When Christians are underrepresented in radical right supporters, it can hardly be explained by tolerance towards immigrants, pro-social values or social capital presumed to be fostered by Christian religion and church engagement. In some other cases, where Christians are more likely to vote for radical right parties, it is likely to be driven by anti-immigrant attitudes, authoritarian values and moral conservative values. In addition, Christians could have been more mobilizable for radical right parties due to their authoritarian and moral conservative values, which have not been fully capitalized. The study suggests that Christian religiosity does not serve as an "antidote" to the radical right. Tolerance towards immigrants, pro-social values or social capital are rarely the mechanisms driving European Christians away from supporting radical right parties.


Ifosfamide and continuous infusion etoposide in advanced adult soft tissue sarcoma. A Scandinavian Sarcoma Group Phase II Study.
The purpose of this study was to evaluate tumour response and toxicity to ifosfamide and continuous infusion etoposide in metastatic or locally advanced soft tissue sarcoma, with dose escalations under G-CSF (granulocyte colony-stimulating factor) support. Of 92 eligible patients (median age 51 years), 85% had tumours of high-grade malignancy and 82% had metastatic disease. Chemotherapy, the baseline dose, consisted of etoposide 600 mg/m2 as a 72 h infusion and ifosfamide 1500 mg/ m2/day for 3 days, followed by G-CSF support (VIG regimen). Stepwise 10% dose escalations were performed depending on haematological toxicity. For patients considered operable after induction chemotherapy, surgical resection of all identifiable residual tumour was attempted. Complete and partial response rates were 11% and 31%, for an overall response rate of 42% (95% CI 31-52%). Forty-eight per cent of courses were dose escalated by a median of 20%. Complete responders had significantly higher, and patients with progressive disease had significantly lower, dose levels than other patients. None of 20 patients with liver metastases responded despite high dose levels. Compared to a preceding pilot study, the addition of G-CSF led to significantly higher dose levels, improved schedule adherence and less haematological toxicity, but no apparent increase in response rate. In view of the modest dose of ifosfamide applied in this study, it is possible that the prolonged infusion of etoposide made a significant contribution to the regimen's antitumour activity, although this can only be determined definitively in a randomised study.


Solubilization and purification of rat pituitary gonadotropin-releasing hormone receptor.
Gonadotropin-releasing hormone (GnRH) receptors were solubilized from rat pituitary membrane preparations in an active form by using the zwitterionic detergent CHAPS (3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonic acid). The solubilized receptor exhibits high affinity, saturability, and specificity. The soluble supernatant retained 100% of the original binding activity when stored at 4 or -20 degrees C in the presence of 10% glycerol. The receptors were resolved into two components on the basis of chromatography on wheat germ agglutinin-agarose. Homogeneous receptor preparation was obtained by two cycles of affinity chromatography on immobilized avidin column coupled to [biotinyl-D-Lys6]GnRH. The overall recovery of the purified receptor was 4-10% of the initial activity in the CHAPS extract, and the calculated purification -fold was approximately 10,000 to 15,000. Analysis of iodinated purified GnRH receptors by autoradiography indicated the presence of two bands, Mr = 59,000 and 57,000. This was confirmed by photoaffinity labeling of the partially purified receptors and suggests that both components can specifically bind the hormone.


Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.
The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.


Mock surveys: a proactive approach to the accreditation visit.
Preparing for an accreditation visit is a challenge for the nurse manager. In this article, the authors describe the methods and tools developed to assist the Duke University Medical Center Gastrointestinal Endoscopy Unit in preparing for the Joint Commission on Accreditation of Healthcare Organizations review process.


Clinical pathological characteristics and survival of high-grade endometrioid carcinoma.
The molecular features of high-grade endometrioid carcinoma (HGEC) are more akin to nonendometrioid high-grade carcinoma (NEHC). This study aims to explore whether HGEC also has similar clinical pathology and prognosis similar to NEHC. Using the SEER database (Surveillance, Epidemiology, and End Results), a retrospective study of the clinical-pathological data and prognosis was carried out. (1) Compared with LGEC (low-grade endometrioid carcinoma), HGEC patients were older with larger tumor size and a higher proportion of stage III-IV disease. However, the young had a lower proportion of stage III-IV disease than NEHC. (2) Postoperative pathological examination revealed that the positive rate of peritoneal cytology, pelvic lymph nodes and para-aortic lymph nodes in HGEC were significantly higher than LGEC, but lower than NEHC. LGEC, HGEC, and NEHC, all showed distant organ metastases such as brain metastases, bone metastases, liver metastases, and lung metastases. Notably, the metastasis rates between HGEC and NEHC were not significantly different but were higher than LGEC. (3) The five-overall survival rates of LGEC, HGEC, and NEHC were 95.1%, 73.2%, and 54.8%, respectively. Notably, the survival rates decreased significantly in stage IV. There were no significant differences between HGEC and NEHC in stage IV (p = 0.665) and both were associated with worsened survival. Also, HGEC survival prognosis was similar to NEHC. HGEC presents mixed or overlapping clinical-pathological features of NEHC. Therefore, based on the unique pathological and prognostic features, HGEC could be classified as an intermediate between LGEC and NEHC.


[Adverse drug reactions profiles for abiraterone and enzalutamide: A pharmacovigilance descriptive analysis].
The aim of this study was to describe the profile of adverse drug reactions (ADRs) observed with abiraterone and enzalutamide, based on cases registered in the French regional pharmacovigilance centres to identify potential pharmacovigilance signals. We extracted from the French pharmacovigilance database all cases of ADRs or drug interactions involving abiraterone or enzalutamide from the time they market authorization date until December 31st, 2017. Signal detection results have been transmitted by the French Agency for Health Products (ANSM). The data were compared with those of the risk management plans for each drug and the literature. Among the 233 observations analyzed, nearly 62% involved abiraterone as a suspect drug and 38% involved enzalutamide; only 1 case involved both drugs. The ADRs profile is different between the drugs. Abiraterone is mostly associated with expected cardiac diseases (heart failure, and QT prolongation), expected with the drug. Also described, several cases of hepatotoxicity have been reported, however some cases with fatal outcome suggest that despite a follow-up of the liver function tests, it is difficult to anticipate this risk. Signals concerning acute renal failure and ischemic stroke have arisen. Enzalutamide is more particularly associated with various neurological disorders (convulsions, hallucinations, fatigue, and memory impairment) expected with the drug. While ischemic heart disease is also expected, signals of heart failure and atrial fibrillation have arisen. A potential hepatotoxicity of the molecule is discussed because of cases of cholestatic hepatitis. The analysis of the French pharmacovigilance database cases allows to confirm an expected and monitored risk profile in the risk management plan for both drugs. Several signals have arisen, some of which will be investigated through a pharmacoepidemiology study.


Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial.
Postoperative pain is the most distressing sequela of conventional hemorrhoidectomy. A modern alternative of circumferential mucosectomy has been proposed to reduce the pain in this procedure. This controlled trial included 80 patients with second to fourth degree hemorrhoidal disease operated on over a 2-year period. The patients were randomly allocated to undergo either the stapled Longo procedure (group 1) or Milligan-Morgan hemorrhoidectomy (group 2) under epidural anesthesia. The operating time, postoperative pain scores at 3, 6, 12, and 24 h, analgesic consumption, hospital stay, and complication rate were recorded. At follow-up the outcome and patient satisfaction were evaluated. The mean operating time in group 1 was shorter than in group 2, postoperative pain scores at all time points and the mean epidural morphine requirement was lower, and mean hospital stay was shorter. The complication rate did not differ (three cases of postoperative bleeding in group 1 and two cases in group. At follow-up no recurrence or complains were recorded except three cases of mild incontinence (one in group 1 and two in group 2). The patients in group 1 (95%) were more satisfied than in group 2 (89%). The Longo procedure is thus a simple, safe, and effective method that entails less postoperative pain, more satisfaction, and shorter hospital stay than the standard Milligan-Morgan hemorrhoidectomy.


The International Space Station as a microgravity research platform.
The International Space Station will provide a "World Class" environment for microgravity research. Ensuring this environment requires care in all aspects of its design. These aspects include consideration of the acceleration at near-orbit-tune-periods, such as gravity gradients and station drag, as well as controlling station structural dynamic modes, mechanical disturbances, and crew disturbances. Station designers must also ensure that the required acceleration environment is provided for long duration. The microgravity requirements placed on ISS will be reviewed, along with major considerations for achieving such an environment. Further, a description of the Space Station program strategy and implementation for meeting those requirements will be discussed.


Acute Respiratory Distress Syndrome.
Acute respiratory distress syndrome (ARDS) occurs in up to 10% of patients with respiratory failure admitted through the emergency department. Use of noninvasive respiratory support has proliferated in recent years; clinicians must understand the relative merits and risks of these technologies and know how to recognize signs of failure. The cornerstone of ARDS care of the mechanically ventilated patient is low-tidal volume ventilation based on ideal body weight. Adjunctive therapies, such as prone positioning and neuromuscular blockade, may have a role in the emergency department management of ARDS depending on patient and department characteristics.


Piceatannol protects against sepsis-induced myocardial dysfunction via direct inhibition of JAK2.
Sepsis-induced myocardial dysfunction (SIMD) represents one of the serious complications secondary to sepsis, which is a leading cause of the high mortality rate among septic cases. Subsequent cardiomyocyte apoptosis, together with the uncontrolled inflammatory response, has been suggested to be closely related to SIMD. Piceatannol (PIC) is verified with potent anti-apoptotic and anti-inflammatory effects, but its function and molecular mechanism in SIMD remain unknown so far. This study aimed to explore the potential role and mechanism of action of PIC in resisting SIMD. The interaction of PIC with JAK2 proteins was evaluated by molecular docking, molecular dynamics (MD) simulation and surface plasmon resonance imaging (SPRi). The cecal ligation and puncture-induced septicemia mice and the LPS-stimulated H9C2 cardiomyocytes were prepared as the models in vivo and in vitro, separately. Molecular docking showed that JAK2-PIC complex had the -8.279 kcal/mol binding energy. MD simulations showed that JAK2-PIC binding was stable. SPRi analysis also showed that PIC has a strong binding affinity to JAK2. PIC treatment significantly ameliorated the cardiac function, attenuated the sepsis-induced myocardial loss, and suppressed the myocardial inflammatory responses both in vivo and in vitro. Further detection revealed that PIC inhibited the activation of the JAK2/STAT3 signaling, which was tightly associated with apoptosis and inflammation. Importantly, pre-incubation with a JAK2 inhibitor (AG490) partially blocked the cardioprotective effects of PIC. Collectively, the findings demonstrated that PIC restored the impaired cardiac function by attenuating the sepsis-induced apoptosis and inflammation via suppressing the JAK2/STAT3 pathway both in septic mice and H9C2 cardiomyocytes.


Thirty years' experience of open-repair surgery for pectus excavatum: development of a metal-free procedure.
Throughout the history of surgery for pectus excavatum (PE), the Nuss procedure and open repair have been performed with many modifications, with most of these procedures using a metal bar. However, the use of a metal bar has several drawbacks. Thus, we aimed to develop a procedure that did not require a metal bar. Through our experience of 426 pediatric cases that underwent various procedures for open repair of PE at Nagoya City University, we arrived at the current procedure that we describe herein. We have evaluated this procedure by review of clinical results and deformity indices (Haller's, steepness, excavation volume, and asymmetry index). The latest and current procedure that supports the sternum with a bridge constructed by the 4th or 5th costal cartilages is associated with fewer complications, a lower re-operation rate, and striking improvement in the indices examined. Our current open-repair procedure that does not require a metal bar is recommended for correction of deformities of PE in children.


After a cold conditioning swim, UCP2-deficient mice are more able to defend against the cold than wild type mice.
Uncoupling protein 2 (UCP2) is widely distributed throughout the body including the brain, adipose tissue and skeletal muscles. In contrast to UCP1, UCP2 does not influence resting body temperature and UCP2-deficient (-/-) mice have normal thermoregulatory responses to a single exposure to cold ambient temperatures. Instead, UCP2-deficient mice are more anxious, exhibit anhedonia and have higher circulating corticosterone than wild type mice. To test the possible role of UCP2 in depressive behavior we exposed UCP2-deficient and wild type mice to a cold (26°C) forced swim and simultaneously measured rectal temperatures during and after the swim. The time that UCP2-deficient mice spent immobile did not differ from wild type mice and all mice floated more on day 2. However, UCP2-deficient mice were more able to defend against the decrease in body temperature during a second daily swim at 26°C than wild type mice (area under the curve for wild type mice: 247.0±6.4; for UCP2-deficient mice: 284.4±3.8, P<0.0001, Student's t test). The improved thermoregulation of wild type mice during a second swim at 26°C correlated with their greater immobility whereas defense against the warmth during a swim at 41°C correlated better with greater immobility of UCP2-deficient mice. Together these data indicate that while the lack of UCP2 has no acute effect on body temperature, UCP2 may inhibit rapid improvements in defense against cold, in contrast to UCP1, whose main function is to promote thermogenesis.


Use of a novel sealant film in head and neck surgery.
In head and neck surgery, sealant films represent a useful adjunct to ensure a reinforcement preventing leakages, dehiscence or oozing. The aim of this pilot study is to present the potential applications of a new sealant sheet in head and neck surgery, reporting outcomes, advantages and limitations. The sample included 32 patients, that underwent oncologic or elective surgery between January 2019 and January 2021 at the Cattinara Hospital in Trieste, Italy. Data regarding the patient, the surgical procedure and the postoperative course over hospitalization in terms of surgical complications were retrospectively collected. In this study, nor complication during the regular follow-up period occurred neither difficulties emerged in TP use in any head and neck subsites. In our experience, TP represented a valid aid in suture strengthening, easy to apply and suitable also for oncologic surgery in which the closure of some surgical defects may need a greater sealing effect.


Poly(ADP-ribose) polymerase inhibitor PJ34 protects against UVA-induced oxidative damage in corneal endothelium.
Fuchs endothelial corneal dystrophy (FECD) is one of the main causes for corneal endothelial blindness, which is characterized by the progressive decline of corneal endothelial cells. Poly (ADP-ribose) polymerase (PARP) was reported to be involved in cell death and apoptosis of several diseases. However, the role of PARP1 in the progression of FECD remains elusive. In the present study, we reported that UVA irradiation caused the corneal endothelial damage and corneal edema in mice, which was accompanied with the elevated activity of PARP1 and PAR. The PARP1 inhibitor PJ34 resolved the corneal edema and protected corneal endothelium from UVA-induced oxidative damage, mitochondrial dysfunction, and cell apoptosis. Mechanistically, PARP1 inhibition exerted its anti-apoptotic effects through downregulation of the phosphorylation levels of JNK1/2 and p38 MAPK and subsequently the increase of MKP-1. Our results suggest that PARP1 inhibition protects corneal endothelium from UVA-induced oxidative damage, which provides a potential alternative strategy for the therapy of FECD.


Current Practices and Considerations for Transcatheter Mitral Valve Implantation Based on Risk Stratification Among Patients with Mitral Valve Regurgitation.
Mitral Regurgitation (MR) is the most common form of severe valvular disease occurring in developed countries, being caused either primarily on its own or secondary to cardiac disease. Surgical intervention is required for the correction of MR, which could include the replacement or repair of the affected valve. Transcatheter Mitral Valve Replacement (TMVR) in selected patients is of increasing importance, especially after the success of Transcatheter Aortic Valve Replacement. TMVR can be divided into 3 types, that is, valve-in-valve for severe mitral valve disease, valve-in-ring for failed surgical repairs, and valve-in-mitral annular calcifications for mitral valvular disease with severe mitral annular calcifications and poor surgical criteria. The FDA approved Mitral valve-in-valve for patients with a high surgical risk in 2017, while valve-in-ring and valve-in-mitral annular calcifications are still currently under consideration. The SAPIEN M3 valve is relatively new with a trans-septal system, with a success rate of 86%, and no mortality in a 30-day outcome. The Cardiovalve is a bovine pericardium device that has a dual nitinol frame with a custom surgical design to facilitate TMVR. The AHEAD trial will evaluate whether the device is safe to use in a clinical setting and how effective it is for reducing MR in these patients. The trial consists of 30 patients in which the first 5 patients showed 100% technical success and a reduction of MR. This evolution of modern medicine has assisted in many different countries, including Pakistan where there is a higher prevalence of MR and hence, a greater need to apply TMVR in clinical practice.


Macrophage-bound C3 fragments as adhesion molecules modulate presentation of exogenous antigens.
The involvement of complement in the response to T cell dependent antigens is generally accepted, however the mechanism has not been clarified. We compared the T cell response in vitro, using antigen-pulsed macrophages from normal and genetically C3-deficient guinea pigs, and show, that C3-fragments fixed covalently to the surface of the antigen-presenting cells are involved in the triggering of responder T cells. Binding of guinea pig C3-specific mAb to oil-elicited, OVA- and PPD-pulsed macrophages of C3D guinea pigs is reduced compared to normal cells, while the expression of Ia antigens is the same. C3-like peptides can be immunoprecipitated only from the lysate of oil-elicited normal cells. These C3-fragments are fixed to the cell-membrane via ester-bonds, since they are released upon treatment with hydroxylamine. In comparison with normal cells, the antigen-presenting capacity of macrophages derived from C3D animals is strongly impaired in cultures containing 10% normal guinea pig serum. A further impairment is observed in cultures with 10% C3D guinea pig serum. Two of the tested C3-specific mAb inhibited antigen-induced T cell proliferation in a dose-dependent manner. Our data point to the importance of C3, as a bivalent molecule, having the capacity to facilitate the cooperation between the antigen-presenting cell and the responder T lymphocytes.


Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults.
This study presents longitudinal evidence on the trends and determinants of income-related inequities in general practitioner (GP), specialist, and any physician visits among older adults (aged 65+) in Canada. Using the Canadian National Population Health Survey between 1998/99 and 2010/11, random effect probit and negative binomial models were employed to model the probability of visit and the total number of visits, respectively. The concentration index-based horizontal inequity (HI) approach was used to measure income-related inequities in physician services. The decomposition technique was applied to explain the factors contributing to the observed inequities. The mobility index (MI) was also calculated to compare short-run and long-run estimates of inequities. The HI indices reveal significant pro-rich inequities in both the probability and the number of specialist visits. Inequities in the likelihood of GP visits and any physician visits were pro-rich but trivial in magnitude. The MI shows that upwardly income mobile individuals contribute to inequity in specialist visits in the long run. After income, education was the most important contributor to inequity in specialist visits, while unobserved heterogeneity explained most of the pro-rich inequity in the total number of GP and any physician visits. Although physician services are free at the point of the provision in Canada, this study demonstrates that poorer older adults utilized fewer specialist services than richer older adults for the same level of need. Specific policies are needed to ensure equity in specialist care use among the older adults in Canada.


The morphology and origin of the skeletal muscle bundles associated with the human mustache.
The arrector pili muscle is a smooth muscle bundle that attaches to the bulge region of the hair follicle and extends to its superior attachment in the upper dermis or epidermis. However, the morphology and origin of the muscle associated with the human mustache is different, having a general smooth arrector pili muscle. The purpose of the present study was to identify the morphology of the muscle associated with the human mustache using three-dimensional reconstruction. The skin of the superior part of the upper lip region from human cadavers were fixed, processed using routine histological methods, serially sectioned at a thickness of 10 μm, and then stained with Masson's trichrome. The serial sections were reconstructed three-dimensionally using 'Reconstruct' software. The present study confirmed skeletal muscle fibers in this area, but they did not attach to the follicle of the human mustache. Although the follicle of the mustache was surrounded with some muscle fibers, they just ran obliquely to the skin surface from the deeper orbicularis oris muscle regardless of the follicle. There was no muscle associated with the human mustache. The voluntary or involuntary mobility of the human mustache has been lost evolutionally forever.


Masking ability of bleach-shade resin composites using the multilayering technique.
Evaluate the masking ability of bleach-shade resin composites applied by multilayering techniques over colored substrates. Disc-shaped specimens were fabricated from bleach-shade resin composites using different multilayering techniques. Substrates were produced in opaque ceramic discs simulating colored substrates (A2, A3, A3.5, C2, C3, C4) and a bleached tooth (0M1). Color coordinates were obtained using a reflectance spectrophotometer. Color difference was calculated by CIEDE2000 using coordinates of 0 M1 ceramic as standard reference. Data were analyzed by one-way ANOVA and Tukey's post-hoc test (p ≤ 0.05). Masking ability interpretation was based on perceptibility and acceptability thresholds. All combinations presented ΔE00 above the acceptable threshold (ΔE00 >1.8), ranging from 2.49 to 7.42, regardless of the restorative system, multilayering strategy or substrate color. Multilayering combinations placed over A2, A3 and A3.5 were moderately (1.8<ΔE00 ≤3.6) and clearly unacceptable (3.6<ΔE00 ≤5.4), combinations associated with C2, C3 and C4 were clearly unacceptable and, extremely unacceptable (ΔE00 >5.4). Lower ΔE00 was observed for combinations with 0.5 mm extra white enamel layer (2.49), or 1.0 mm white dentin layer (2.69), over A2 and A3.5 substrates. Lightness difference showed the greatest contribution to ΔE00 . Bleach-shade resin composite systems applied by the multilayering technique were not able to ensure effective masking ability. Bleach-shade resin composites applied with different combinations of the multilayering technique were not effective in masking colored substrates. Alternative strategies, techniques and dental materials should be explored to obtain acceptable masking.


Artificial intelligence for the real world of breast screening.
Breast cancer screening with mammography reduces mortality in the women who attend by detecting high risk cancer early. It is far from perfect with variations in both sensitivity for the detection of cancer and very wide variations in specificity, leading to unnecessary recalls and biopsies. Over the last 12 months several papers have reported on AI algorithms that perform as well as human readers on large well curated population data sets. The nature of the test sets, the way the gold standard has been calculated, the definition of a positive call, and the statistics used all influence the results. Historically retrospective studies have not predicted the real-life performance of radiologist plus machine. So, it is important to perform prospective studies before introducing Artificial intelligence into real world breast screening.


The normally silent sigma54 promoters upstream of the pilE genes of both Neisseria gonorrhoeae and Neisseria meningitidis are functional when transferred to Pseudomonas aeruginosa.
The pilE gene encodes the pilin subunit in Neisseria gonorrhoeae and Neisseria meningitidis. Transcriptional analysis of promoters upstream of pilE in N. gonorrhoeae has been described previously (Fyfe et al. (1995) J. Bacteriol. 177, 3781-3787). Transcription from the sigma54-dependent promoter P3 was detected in Pseudomonas aeruginosa. Here we show that this transcription is dependent on the P. aeruginosa transcriptional activator PilR, and a specific upstream sequence with a high degree of similarity to the PilR-binding site found upstream of the P. aeruginosa pilin gene. This implies there is an upstream activator site (UAS) present 5' of pilE. Sequencing upstream of the N. meningitidis MC58 c2 pilE gene shows this region to be very similar to that in N. gonorrhoeae. P3 and the UAS are conserved, although insertions were noted on either side of the UAS. Transcriptional analysis has shown that the N. meningitidis P3 promoter is used in P. aeruginosa, provided PilR and an upstream region that includes sequence similar to the UAS are present. Transcription from the N. meningitidis PpilE is stronger than from the N. gonorrhoeae equivalent. N. meningitidis uses the sigma70 promoter P1 to transcribe pilE.


Comparison of some modeling and control issues for a flexible two link manipulator.
The nonlinear dynamics of a flexible two link manipulator presents a challenging modeling and control problem with its lumped actuator dynamics coupled with distributed link dynamics. Issues related to modeling uncertainty and control robustness as well as a good understanding of the experimental issues are essential for advanced modeling and control for such systems. This paper reports some of the advanced modeling, control, and experimental issues for a flexible two link manipulator, including some novel approaches developed by the authors.


Bisphenol A prevents MCF-7 breast cell apoptosis via the inhibition of progesterone receptor transactivation.
2,2-Bis(4-hydroxyphenyl)propane (bisphenol A; BPA) is an environmental endocrine-disrupting chemical. It mimics the effects of estrogen at multiple levels by activating estrogen receptors (ERs); however, BPA also affects the proliferation of human breast cancer cells independent of ERs. Although BPA inhibits progesterone (P4) signaling, the toxicological significance of its effects remain unknown. Tripartite motif-containing 22 (TRIM22) has been identified as a P4-responsive and apoptosis-related gene. Nevertheless, it has not yet been established whether exogenous chemicals change TRIM22 gene levels. Therefore, the present study investigated the effects of BPA on P4 signaling and TRIM22 and TP53 expression in human breast carcinoma MCF-7 cells. In MCF-7 cells incubated with various concentrations of P4, TRIM22 messenger RNA (mRNA) levels increased in a dose-dependent manner. P4 induced apoptosis and decreased viability in MCF-7 cells. The knockdown of TRIM22 abolished P4-induced decreases in cell viability and P4-induced apoptosis. P4 increased TP53 mRNA expression and p53 knockdown decrease the basal level of TRIM22 and P4 increased TRIM22 mRNA expression independent of p53 expression. BPA attenuated P4-induced increases in the ratio of cell apoptosis in a concentration-dependent manner, and the P4-induced decreases in cell viability was abolished in the presence of 100 nM and higher BPA concentrations. Furthermore, BPA inhibited P4-induced TRIM22 and TP53 expression. In conclusion, BPA inhibited P4-induced apoptosis in MCF-7 cells via the inhibition of P4 receptor transactivation. TRIM22 gene has potential as a biomarker for investigating the disruption of P4 signaling by chemicals.


Vesiculobullous eruptions of the oral cavity.
The spectrum of vesiculobullous eruptions of the oral cavity is wide and rich, with different disease entities that encompass different etiologies, pathogenesis, clinical manifestations, treatment plans, and prognostic ends. Trying to present all these entities in a comprehensive fashion is challenging, but in this article, most of the important entities pertaining to this topic have been encompassed in a concise manner.


The evolution of an ambulatory nursing intensity system: measuring nursing workload in a day hospital setting.
To establish a methodology for developing a user-friendly, environmentally specific nursing intensity measurement tool. Nursing intensity measurement systems assess the demand for nursing care in a given setting and must adapt to changes in technology, patient populations, and treatment profiles. Nowhere is this more evident than in a clinical research setting where demands for nursing care are driven by changing patient populations and new biomedical research protocols. This article traces the extension of an adult oncology ambulatory nursing intensity system at the Clinical Center, National Institutes of Health, into 3 day hospitals: medical surgical, pediatrics, and hematology/oncology. A team of stakeholders including nurse managers, clinical nurse specialists, and senior clinical research nurses was assembled. Descriptions of clinical research care for each day hospital were developed and organized into 6 levels with their associated time frames. Descriptions were reviewed by 2 content specialists, and a content validity index quantified the extent of their agreement. A weighted kappa statistic was used to measure interrater reliability. A content validity index of .87 indicated a high level of agreement between specialists. The weighted kappa statistic was .80, demonstrating substantial agreement between 2 raters. This ambulatory nursing intensity tool proved to be adaptable to heterogeneous patient populations.


Effect of advanced/hybrid oxidation process involving ultrasonication and ultraviolet radiation (sonophotolysis) on anthocyanin stability: Degradation kinetics and mechanism.
The hybrid oxidation effect of ultrasonics (US) and ultraviolet light (UV-A) on Cyanidin-3-O-glucoside (C3G) stability were examined. For comparison, sonolysis and photolysis experiments were also conducted. The results showed that under hybrid sonophotolysis and sonolysis treatment, C3G degradation undergoes zero-order kinetics, while under photolysis, first-order degradation kinetic prevailed. The degradation rate increases with the increase in US power, with the lowest, was recorded as 0.70 μg/ml/h (14 W/L) and 0.77 μg/ml/h (28 W/L), and highest as 0.80 μg/ml/h (42 W/L). Similarly, the degradation ability of UV photolysis at 400 μW/cm2 was weak, which increased with increasing UV power (600 μW/cm2). Overall the sonophotolysis degradation rate was significantly higher than that of the individual effect. With the addition of gallic acid (GA), the degradation of C3G was found lower under sonophotolysis; thus, it could be used as a natural protective agent for C3G during food processing.


Defining a staged-based process for economic and financial evaluations of mHealth programs.
Mobile and wireless technology for health (mHealth) has the potential to improve health outcomes by addressing critical health systems constraints that impede coverage, utilization, and effectiveness of health services. To date, few mHealth programs have been implemented at scale and there remains a paucity of evidence on their effectiveness and value for money. This paper aims to improve understanding among mHealth program managers and key stakeholders of how to select methods for economic evaluation (comparative analysis for determining value for money) and financial evaluation (determination of the cost of implementing an intervention, estimation of costs for sustaining or expanding an intervention, and assessment of its affordability). We outline a 6 stage-based process for selecting and integrating economic and financial evaluation methods into the monitoring and evaluation of mHealth solutions including (1) defining the program strategy and linkages with key outcomes, (2) assessment of effectiveness, (3) full economic evaluation or partial evaluation, (4) sub-group analyses, (5) estimating resource requirements for expansion, (6) affordability assessment and identification of models for financial sustainability. While application of these stages optimally occurs linearly, finite resources, limited technical expertise, and the timing of evaluation initiation may impede this. We recommend that analysts prioritize economic and financial evaluation methods based on programmatic linkages with health outcomes; alignment with an mHealth solution's broader stage of maturity and stage of evaluation; overarching monitoring and evaluation activities; stakeholder evidence needs; time point of initiation; and available resources for evaluations.


Ultrasonographic assessment of ambulatory venous pressure in superficial venous incompetence.
In spite of its invasiveness, measurement of ambulatory venous pressure (AVP) is widely considered the gold standard measurement of venous function. We studied a technique for noninvasive ultrasonographic AVP determination in superficial venous incompetence. A linear relationship between venous pressure (measured by echo-guided venous puncture) and diameter (measured by transverse axis duplex imaging) was preliminarily demonstrated with multiple measurements in different conditions (supine, sitting, standing, and Trendelenburg positions, after exercise with and without cuff occlusion) in a saphenous tract at the thigh of 82 limbs in which reflux had been previously demonstrated. Then AVP was measured in another group of 44 patients who had demonstrated superficial venous incompetence, both with and without proximal occlusion, using again the same invasive method and a new noninvasive technique. The latter technique consisted in the construction of a linear diameter/pressure curve obtained after saphenous diameter (by high-resolution sonography) and noninvasive pressure (using hydrostatic values) determinations in the sitting and standing positions. Further measurement of saphenous diameter after standardized exercise permits extrapolation of the AVP values from the curve. Linear regression analysis demonstrates that (1) beginning from 20 mm Hg, the pressure/diameter relationship of the incompetent greater saphenous vein is linear; and (2) AVP values derived invasively and noninvasively are significantly correlated (r = 0.7347 and p < 0.0001 for AVP derived without occlusion; r = 0.7270 and p < 0.0001 for values recorded with occlusion). The proposed technique appears able to reliably assess noninvasively AVP values in superficial venous incompetence. In addition, it can be performed with equipment that is widely used for vascular investigations.


Non-suicidal self-injury disorder in a community sample of adults.
Non-suicidal self-injury (NSSI) Disorder has been included in DSM-5 for the first time as a disorder requiring further research. The present study investigated DSM-5 criteria for NSSI Disorder in a community sample of adults and provided an initial investigation of differences between those with and without a diagnosis of NSSI Disorder and NSSI history. Participants over the age of 18 (N=548) completed an online survey using Amazon׳s MTurk. A lifetime history of NSSI was reported by 23% of the sample. Nearly 3% of the total sample and 11.2% of those with an NSSI history met criteria for NSSI Disorder. Those with NSSI Disorder were similar to participants with an NSSI history who did not meet criteria for the disorder on NSSI frequency and methods, and age of NSSI onset, use of coping strategies, and borderline symptoms, but they differed on automatic reinforcement of the behavior and reported interference with functioning. Endorsement of specific NSSI Disorder criteria, potential implications for the diagnosis, and avenues for future research are discussed.


Effects of phosphorus and sulfur on yield and nutrient uptake of wheat (Triticum aestivum L.) on Vertisols, North Central, Ethiopia.
Deficiency of phosphorus (P) and sulfur (S) is increasingly being reported in soils of Ethiopia. While some studies have shown significant response of wheat to P and S application, information on the response of wheat to P and S application interactively is conspicuously lacking. In this regard, we evaluated the response of wheat to P and S application interactively in the study area. A field experiment was conducted at two locations to determine the effects of P and S, on yield, uptake and P, S use efficiency of bread wheat. A factorial combination of four levels of P (0,11,22 and 44 kg h-1) and three levels S (0, 15 and 30 kg ha-1) laid out in Randomized Complete Block Design with three replications. Results revealed that interacted application of P and S at 22 and 15 kg ha-1 respectively increased grain yield of wheat by 40.1 % over control. The corresponding increase with straw was 53.4 % over control. Wheat yield obtained with combined application of P and S greater than single application of P or S indicating synergistic between them. The maximum grain N (56.3 kg ha-1), P (12.8 kg ha-1) and S (4.2 kg ha-1) uptakes were obtained due to combined application of P and S at 22 P and 15 S kg ha-1. Agronomic efficiencies of P and S decreased as the rates of P and S application increased. Combined fertilization of S and P is necessary in the study district and 15 kg S combined with 22 kg P ha-1 produced the highest yield. Thus, this treatment is found to be recommended for bread wheat production in Vertisols of the district. While, partial budget analysis result revealed that, combination of 22P and 15S kg ha-1 produced the highest MMR (54.9 %) and thus, this treatment is found to be economically feasible treatment for bread wheat production in study area of the district. We recommend further experiments on different combination of P with S in different agro-ecologies and soil types are required for confirmation of results and the residual effect of P and S on the following crop is needed to study the long-term effect of P and S.


Patient Acceptance of Routine Serial Postoperative Endoscopy Following Low Anterior Resection (LAR) and Its Ability to Detect Biomarkers in Anastomotic Lavage Fluid.
Various reports have now established that postoperative endoscopy to examine and intervene in the process of anastomotic healing is both feasible and safe. Here we present our preliminary experience with serial postoperative endoscopy to determine its feasibility, patient acceptance and the ability to obtain and the utility of perianastomotic material for molecular analysis. Patients undergoing LAR with ileostomy for rectal cancer were recruited for study to undergo routine serial endoscopic surveillance (SES) at three time points during the course of LAR: intraoperatively, before discharge (postoperative day 3-7) and at follow-up (postoperative day 10-28). At each endoscopy, images were captured, anastomotic tissues were lavaged and lavage fluid was retrieved. Fluid samples were analyzed using proteomics, zymography, ELISA and bacteria via 16S rRNA gene amplicon sequencing and culture of collagenolytic strains. SES is feasible and acceptable to this limited set of patients following LAR. Biologic analysis of perianastomotic fluids was able to detect the presence of proteins, microbiota and inflammatory mediators previously identified at anastomotic sites in animals with pathologic healing. SES can be implemented in patients undergoing LAR with a high degree of patient compliance and capture of biologic information and imaging. Application of this approach has the potential to uncover, for the first time, the natural history of normal versus pathologic anastomotic healing in patients undergoing anastomotic surgery.


Is multiple sclerosis a length-dependent central axonopathy? The case for therapeutic lag and the asynchronous progressive MS hypotheses.
Trials of anti-inflammatory therapies in non-relapsing progressive multiple sclerosis (MS) have been stubbornly negative except recently for an anti-CD20 therapy in primary progressive MS and a S1P modulator siponimod in secondary progressive MS. We argue that this might be because trials have been too short and have focused on assessing neuronal pathways, with insufficient reserve capacity, as the core component of the primary outcome. Delayed neuroaxonal degeneration primed by prior inflammation is not expected to respond to disease-modifying therapies targeting MS-specific mechanisms. However, anti-inflammatory therapies may modify these damaged pathways, but with a therapeutic lag that may take years to manifest. Based on these observations we propose that clinically apparent neurodegenerative components of progressive MS may occur in a length-dependent manner and asynchronously. If this hypothesis is confirmed it may have major implications for the future design of progressive MS trials.


Racial and Ethnic Diversity in SARS-CoV-2 Vaccine Clinical Trials Conducted in the United States.
Evidence shows that White and non-Hispanic individuals are overrepresented in clinical trials. The development of new vaccines and drugs, however, necessitates that clinical research trials include representative participants, particularly in light of evidence showing that underrepresented minorities may have a different response to certain medications and vaccines. Racial and ethnic disparities among clinical trials are multilayered and complex, and this requires action. The results of this study indicate that significant racial and ethnic disparities consistently exist among the most recent early SARS-CoV-2 vaccine clinical trials as compared to the pandemic H1N1 vaccine clinical trials of 2009. New strategies, policies, training programs, and reforms are required to address these disparities among clinical trials.


Developing a district level supportive supervision framework for community health workers through co-production in South Africa.
One of the key challenges of community health worker (CHW) programmes across the globe is inadequate supervision. Evidence on effective approaches to CHW supervision is limited and intervention research has up to now focused primarily on outcomes and less on intervention development processes. This paper reports on participatory and iterative research on the supervision of CHWs, conducted in several phases and culminating in a co-produced district level supportive supervision framework for Ward Based Outreach Teams in a South African district. Drawing on a conceptual framework of domains of co-production, the paper reflects on the implications of the research process adopted for participants, generation of research knowledge and recommendations for practice, as well as lessons for research on the supervision of CHWs. Through the research process, participants reflected and engaged meaningfully, honestly and productively across hierarchies, and were able to forge new, dialogic relationships. The iterative, back forth feedback, involving a core group of participants across phases, enabled additions and validations, and informed further data collection. The culmination of the process was consensus on the key issues facing the programme and the generation of a set of recommendations for a local, context-specific framework of supportive supervision. The process of engagement, relationships built and consensus forged proved to be more significant than the framework itself. The co-production approach can enable local impact of research findings by providing a bottom-up collaborative platform of active participation, iterative feedback, knowledge generation and mutual learning that can complement guidance and frameworks from above. Although time consuming and not without its limitations, this approach to research has much to offer in advancing understanding of CHW supervision.


Treatment of urethral syndrome with triamcinolone acetonide.
A new method for the treatment of the urethral syndrome is presented. Therapy involves the submucosal injection of triamcinolone acetonide around Skene's glands to decrease inflammation and scarring. It is a simple office procedure, while all other therapeutic modalities are surgical.


Brazilian society of surgical oncology: Guidelines for the surgical treatment of mid-low rectal cancer.
Colorectal cancer (CRC) is the third leading cause of cancer in North America, Western Europe, and Brazil, and represents an important public health problem. It is estimated that approximately 30% of all the CRC cases correspond to tumors located in the rectum, requiring complex multidisciplinary treatment. In an effort to provide surgeons who treat rectal cancer with the most current information based on the best evidence in the literature, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guidelines for rectal cancer treatment that is focused on the main topics related to daily clinical practice. The SBCO developed the present guidelines to provide recommendations on the main topics related to the treatment of mid-low rectal cancer based on current scientific evidence. Between May and June 2021, 11 experts in CRC surgery met to develop the guidelines for the treatment of mid-low rectal cancer. A total of 22 relevant topics were disseminated among the participants. The methodological quality of a final list with 221 sources was evaluated, all the evidence was examined and revised, and the treatment guideline was formulated by the 11-expert committee. To reach a final consensus, all the topics were reviewed via a videoconference meeting that was attended by all 11 of the experts. The prepared guidelines contained 22 topics considered to be highly relevant in the treatment of mid-low rectal cancer, covering subjects related to the tests required for staging, surgical technique-related aspects, recommended measures to reduce surgical complications, neoadjuvant strategies, and nonoperative treatments. In addition, a checklist was proposed to summarize the important information and offer an updated tool to assist surgeons who treat rectal cancer provide the best care to their patients. These guidelines summarize concisely the recommendations based on the most current scientific evidence on the most relevant aspects of the treatment of mid-low rectal cancer and are a practical guide that can help surgeons who treat rectal cancer make the best therapeutic decision.


Mn-based catalysts for sulfate radical-based advanced oxidation processes: A review.
Sulfate radical-based advanced oxidation processes (AOPs) have drawn increasing attention during the past two decades, and Mn-based materials have been proven to be effective catalysts for activating peroxymonosulfate (PMS) and peroxydisulfate (PDS) to degrade many contaminants. This article presents a comprehensive review of various Mn-based materials to activate PMS and PDS. The activation mechanisms of different Mn-based catalysts (i.e., Mn oxides MnOx, MnOx hybrids, and MnOx‑carbonaceous material composites) were first summarized and discussed in detail. Besides the commonly reported free radicals (SO4-• and •OH), non-radical mechanisms such as singlet oxygen and direct electron transfer have also been discovered for selected materials. The effects of pH, inorganic ions, natural organic matter (NOM), dissolved oxygen content, temperature, and the crystallinity of the materials on the catalytic reactivity were also discussed. Then, important instrumentations and technologies employed to characterize Mn-based materials and to understand the reaction mechanisms were concisely summarized. Three common overlooks in the experimental designs for examining the PMS/PDS-MnOx systems were also discussed. Finally, future research directions were suggested to further improve the technology and to provide a guidance to develop cost-effective Mn-based materials to activate PMS/PDS.


3-(9H-Carbazol-9-yl)propan-1-ol.
In the title compound, C(15)H(15)NO, the dihedral angle between the benzene rings is 2.25 (2)°. The C-C-C-O atoms of the propanol side chain are in a gauche conformation [torsion angle = -60.5 (2)°]. In the crystal, O-H⋯O hydrogen bonds link the mol-ecules into C(2) chains propagating in [100]. The O-bonded H atom is disordered over two sites of equal occupancy.


A machine learning based sentient multimedia framework to increase safety at work.
In the last few decades, we have witnessed an increasing focus on safety in the workplace. ICT has always played a leading role in this context. One ICT sector that is increasingly important in ensuring safety at work is the Internet of Things and, in particular, the new architectures referring to it, such as SIoT, MIoT and Sentient Multimedia Systems. All these architectures handle huge amounts of data to extract predictive and prescriptive information. For this purpose, they often make use of Machine Learning. In this paper, we propose a framework that uses both Sentient Multimedia Systems and Machine Learning to support safety in the workplace. After the general presentation of the framework, we describe its specialization to a particular case, i.e., fall detection. As for this application scenario, we describe a Machine Learning based wearable device for fall detection that we designed, built and tested. Moreover, we illustrate a safety coordination platform for monitoring the work environment, activating alarms in case of falls, and sending appropriate advices to help workers involved in falls.


Dysbindin gene (DTNBP1) and schizophrenia in Korean population.
Dysbindin gene (DTNBP1) has been consistently reported to be associated with schizophrenia. However data from East Asian population has been sparse and inconsistent till today. This study tried to replicate the genetic association of DTNBP1 with schizophrenia in a large Korean sample, as well as analyzing the association of DTNBP1 with clinical variables. Nine hundred and eight (908) patients with schizophrenia and 601 controls were investigated. The high-throughput genotyping method using pyrosequencer (Biotage AB, Sweden) was used for genotyping 4 SNPs (rs3213207, rs1011313, rs760761, and rs2619522). Haplotype analyses revealed a significant association with schizophrenia (P < 0.0001) with the haplotypes A-C-C-C and A-C-T-A having an eminent protective effect toward schizophrenia. The major contribution to the difference in the haplotype distribution between patients and the controls was the rs760761 (C/T) and rs2619522 (A/C) haplotypes (P < 0.0001). No association of DTNBP1 with other clinical variables was found. In conclusion, the present study suggests a possible protective effect of rare DTNBP1 variants in schizophrenia, although subsequent studies in different ethnic groups are warranted.


Fibrosis or Necrosis in Resected Lymph Node Indicate Metastasis Before Chemoradiotherapy in Lung Cancer Patients.
The histological features of lymph nodes (LNs) treated by chemoradiotherapy (CRT) in non-small cell lung cancer (NSCLC) have not been well studied. The purpose of this study was to evaluate the histological findings of LNs affected by CRT. Among 107 clinically N2 NSCLC patients who underwent induction CRT followed by surgery from 1999 to 2017, 24 patients who received pathological evaluation of mediastinal LN before CRT were enrolled in this study. Postoperatively, we histologically reviewed all resected LNs (n=117) of the station evaluated before CRT. Fibrosis and/or necrosis were observed in all investigated LN stations. Histological observation of fibrosis and/or necrosis in the resected LNs after CRT indicated the presence of LN metastasis before CRT. The metastatic LNs that responded to CRT showed specific histological features, which enabled us to know the accurate clinical stage of the patient even though cancer cells were not found in the post-treated LNs.


Botryosphaeran, [(1 → 3)(1 → 6)-β-D-glucan], induces apoptosis-like death in promastigotes of Leishmania amazonensis, and exerts a leishmanicidal effect on infected macrophages by activating NF-kB and producing pro-inflammatory molecules.
Leishmaniasis is an infectious-parasitic disease caused by the protozoan Leishmania spp. The available treatments are based upon expensive drugs bearing adverse side-effects. The search for new therapeutic alternatives that present a more effective action without causing adverse effects to the patient is therefore important. The objective of this study was to evaluate the in vitro effect of botryosphaeran, a (1 → 3)(1 → 6)-β-D-glucan, on the promastigote and intracellular amastigote forms of Leishmania amazonensis. The direct activity of botryosphaeran on promastigote forms was evaluated in vitro and inhibited proliferation, the IC50 7 μg/mL in 48 h was calculated. After 48 h treatment, botryosphaeran induced nitric oxide production (NO), caused mitochondrial membrane hyperpolarization, increased reactive oxygen species (ROS), and accumulation of lipid vesicles in promastigotes, resulting in apoptosis, necrosis and autophagy, and was accompanied by morphological and ultrastructural changes. The range of concentrations used did not alter the viability of peritoneal macrophages from BALB/c mice and erythrocytes of sheep. Botryosphaeran was able to reduce the number of infected macrophages and the number of amastigotes per macrophage at 12.5 μg/mL (50.75% ± 6.48), 25 μg/mL (55.66% ± 3.93) and 50 μg/mL (72.9% ± 6.98), and IC50 9.3 μg/mL (±0.66) for intracellular amastigotes forms. The leishmanicidal effect was due to activation of NF-κB and promoted an increase in pro-inflammatory cytokines (TNF-α and IL-6), iNOS and microbial-derived ROS and NO, in addition to decreasing the levels of SOD. Based upon the data obtained, we infer that botryosphaeran exerted an active leishmanicidal and immunomodulatory effect, acting on promastigotes through autophagic, apoptotic and necrosis processes, and in the intracellular amastigote form, through the action of ROS and NO.


Microparticles of polyvinyl alcohol for nasal delivery. I. Generation by spray-drying and spray-desolvation.
Spray-drying and spray-desolvation are described for the generation of polyvinyl alcohol microparticles intended for nasal administration. The spray-dried microparticles of polyvinyl alcohol were of an appropriate size distribution but consisted of hollow spheres, which made them unsuitable for nasal delivery, as rapid clearance and a varied deposition pattern would be expected. Microparticles were also produced by spraying polyvinyl alcohol (average molecular weight of 14,000) solution (12.5%, w/v) at 0.332 ml/min onto the surface of acetone (spray-desolvation). These microparticles were solid collapsed spheres with the desired size for nasal deposition (10-200 microns). This method can be applied to encapsulation of drugs that are heat labile such as peptides and proteins.


Cesarean section and the risk of pediatric Crohn's disease.
Crohn's disease (CD) could involve an inappropriate immune response against normal bowel flora. Disrupted or atypical patterns of microbial bowel colonization may impair development of homeostasis between gut flora and the immune system. Perinatal microbial exposures may be particularly important in stimulating intestinal immune recognition. As birth by cesarean section is thought to represent an atypical pattern of early bowel colonization, we examined its association with pediatric CD. Some 1536 patients diagnosed with pediatric CD and 15,439 controls matched by delivery unit, week of birth, sex, and born between 1973 and 2006 were identified through Swedish registers. The association of birth by cesarean section with pediatric CD was examined using conditional logistic regression, with stratification by sex and adjustment for parental socioeconomic index and maternal infections during pregnancy. Birth by cesarean section is associated with a modestly increased risk for pediatric CD among boys (odds ratio [OR] = 1.25, 95% confidence interval [CI] 1.01-1.54) but not girls, (OR = 0.99, 95% CI 0.76-1.29) and elective cesarean section is associated with a modest increased risk for the entire population (OR = 1.36, 95% CI 1.02-1.80). This study does not suggest that the delivery procedure should be altered, but the findings may be of etiological significance in CD, indicating a potential role for perinatal exposures associated with delivery mode. Although the sex difference may have arisen by chance, the modestly increased CD risk for boys delivered by cesarean section is consistent with sex-specific differences in susceptibility to some exposures.


Erythrocyte protoporphyrin concentrations in clinically normal cats and cats with lead toxicity.
Erythrocyte protoporphyrin (EPP) and blood lead concentrations were determined in 91 clinically healthy cats living in the inner suburban area of Sydney, Australia. The mean EPP concentration was 223.4 +/- 186.1 micrograms litre-1 whole blood and the mean blood lead concentration 0.62 +/- 0.25 mumol litre-1. EPP concentrations were also monitored in three cats with confirmed lead toxicity--at the time of diagnosis and one week and one month after chelation therapy with calcium EDTA. EPP concentrations were elevated in two cats and within the normal range in the third cat at the time of diagnosis. EPP concentration were higher in two cats one week after treatment than at the time of diagnosis. One month after chelation therapy, EPP concentrations were normal in two cats but still substantially elevated in the third cat although its blood lead concentration had returned to normal and all clinical signs of lead toxicity had resolved. It was determined that the predominant form of protoporphyrin present in cats with lead toxicity was zinc protoporphyrin. The EPP assay may have limited value in the diagnosis of acute lead toxicity and in monitoring the success of chelation therapy in cats.


Hydrogel composite of lanthanum and Halorubrum ejinoor sp. cell lysate as an adsorbing material.
Although halophilic archaea are rich in natural environments, their biotechnological applications are not as prevalent as those of other extremophiles, such as thermophiles and alkaliphiles. This study presents an simple method to prepare a hydrogel composite using crude cell lysate of a halophilic archaea, Halorubrum ejinoor sp. (H.e.) which was isolated from a saline lake in Inner Mongolia, China. Furthermore, formation mechanism and potential applications of the hydrogel as an adsorbing material are discussed. Halorubrum ejinoor sp. (H.e.) cell lysate was firstly prepared by adding pure water onto the H.e. cell pellet, followed by a short incubation at 60 °C. The cell lysate was injected into different metal ion (or H+) solutions to obtain the hydrogel composite. It was observed that H+, Fe3+, La3+, Cu2+, and Ca2+ induced gelation of the cell lysate, while Fe2+, Co2+, Ni2+, Mg2+, Na+, and K+ did not. DNA and extracellular polysaccharides (EPS) in the H.e. cell lysate were found to be responsible for the gelation reaction. These results suggest that DNA and EPS should be crosslinked by metal ions (or H+) and form a networked structure in which the metal ion (or H+) serves as an anchor point. Potential application of the hydrogel as an adsorbing material was explored using La3+-induced H.e. hydrogel composite. The hydrogel composite can adsorb the fluoride, phosphate and DNA-binding carcinogenic agents, such as acridine orange. The simplicity and cost effectiveness of the preparation method might make H.e. hydrogel a promising adsorbing material. This work is expected to expand the technical applications of haloarchaea.


The genetics of common variation affecting platelet development, function and pharmaceutical targeting.
Common variant effects on human platelet function and response to anti-platelet treatment have traditionally been studied using candidate gene approaches involving a limited number of variants and genes. These studies have often been undertaken in clinically defined cohorts. More recently, studies have applied genome-wide scans in larger population samples than prior candidate studies, in some cases scanning relatively healthy individuals. These studies demonstrate synergy with some prior candidate gene findings (e.g., GP6, ADRA2A) but also uncover novel loci involved in platelet function. Here, I summarise findings on common genetic variation influencing platelet development, function and therapeutics. Taken together, candidate gene and genome-wide studies begin to account for common variation in platelet function and provide information that may ultimately be useful in pharmacogenetic applications in the clinic. More than 50 loci have been identified with consistent associations with platelet phenotypes in ≥ 2 populations. Several variants are under further study in clinical trials relating to anti-platelet therapies. In order to have useful clinical applications, variants must have large effects on a modifiable outcome. Regardless of clinical applications, studies of common genetic influences, even of small effect, offer additional insights into platelet biology including the importance of intracellular signalling and novel receptors. Understanding of common platelet-related genetics remains behind parallel fields (e.g., lipids, blood pressure) due to challenges in phenotype ascertainment. Further work is necessary to discover and characterise loci for platelet function, and to assess whether these loci contribute to disease aetiologies or response to therapeutics.


[Wellness spaces for hospital staff at Confluence hospitals].
The mobilization and commitment of hospital staff in the fight against the COVID-19 epidemic have been remarkable since the beginning of this unprecedented health crisis. To support the teams of the Confluence Hospitals, the management has set up relaxation areas for the professionals.


Negative Incentives for Noninstitutional Births Are Associated With a Higher Rate of Facility-Based Births in the Eastern Visaya Region, Philippines.
In the Philippines, the "no home-birthing policy" implemented in 2008 has encouraged local governments to endorse ordinances that prohibit noninstitutional deliveries (NIDs). The Philippines' social insurance scheme has also enabled them to provide incentive payments to women who deliver at birthing facilities (BFs). This study evaluated whether these positive and/or negative incentives were associated with an increased facility-based delivery (FBD) rate and examined challenges in implementing those incentive measures in the Eastern Visaya Region of the Philippines. Cross-sectional data were collected regarding delivery locations during 2017, and barangay-level data were collected regarding positive and negative incentives and the characteristics of 4,371 barangays in the region. Multivariate logistic regression analysis, using "ordinance with nonmonetary sanction" as the reference category, indicated that no ordinance to prohibit NIDs was significantly associated with a lower FBD rate (odds ratio [OR]: 0.90, P=.013), and ordinance with low cash penalty (OR: 1.37, P<.001) and high cash penalty (OR: 2.52, P<.001) had higher FBD rates. Positive incentives were not associated with FBD rates (OR: 1.02, P=.563). The FBD rate was also significantly associated with urban barangay status (OR: 1.45, P<.001), availability of a vehicle (OR: 3.19, P<.001), availability of public transportation to a government BF (OR: 1.25, P<.001), and distance to the most accessible government BF (OR: 0.89, P<.001). Substantial proportions of barangays had no vehicles available for transportation (34.1%) or no available vehicles and no public transportation to a government BF (5.5%). Although negative incentives for NIDs could motivate pregnant women to seek FBD, local governments in the Philippines should be aware of barriers that limit access to government BFs in underserved barangays before introducing those negative incentives. Above all, barangay-level investments in making a vehicle for transporting pregnant women might help address these barriers and increase the FBD rate.


Identifying the cutoff score for the PCL-R scale (psychopathy checklist-revised) in a Brazilian forensic population.
This study introduces a Portuguese-language version of psychopathy checklist-revised (PCL-R) [Harv. Mental Health Lett. 12 (1995) 4] in the Brazilian penitentiary system. Hare's scale is used extensively in many other countries. In a forensic population sample of 56 male subjects classified as psychopaths and non-psychopaths [Manual for the Hare Psychopathy Checklist-Revised, Multi-Health System, Toronto, 1991], 33 correlated to global personality disorder (GPD) and 23 to partial personality disorder (PPD), respectively, subtypes of antisocial personality disorder [Manual for the Hare Psychopathy Checklist-Revised, Multi-Health System, Toronto, 1991]. Subjects were evaluated through psychiatric and neurological examinations, review of judicial records, Rorschach and PCL-R. A control group of 30 subjects without criminological or psychiatric history was also evaluated with the same instruments. PCL-R validation and identification of cutoff score for Psychopathy (GPD group) was assessed through the concurrent use of the Rorschach. PCL-R cutoff score for the Brazilian population was set at 23. Sensitivity was determined at 84.8%, and reliability was high (Kappa index = 0.87). GPD individuals were characterized as clearly psychopathic according to PCL-R criteria while PPD individuals can only be considered mildly psychopathic, with better chance of rehabilitation.


VANGUARD®crLyme: A next generation Lyme disease vaccine that prevents B. burgdorferi infection in dogs.
Lyme disease, a public health threat of significance to both veterinary and human medicine, is caused by the tick (Ixodes) transmitted spirochete, Borreliella burgdorferi. Here we report on the immunogenicity and efficacy of VANGUARD®crLyme (Zoetis), the most recent canine Lyme disease vaccine to be approved by the United States Department of Agriculture. VANGUARD®crLyme is a subunit vaccine consisting of outer surface protein A (OspA) and a recombinant outer surface protein C (OspC) based-chimeric epitope protein (chimeritope) that consists of at least 14 different linear epitopes derived from diverse OspC proteins. The combination of OspA and the OspC chimeritope (Ch14) in the vaccine formulation allows for the development of humoral immune responses that work synergistically to target spirochetes in both ticks and in mammals. Immunogenicity was assessed in purpose-bred dogs. A two-dose vaccination protocol resulted in high antibody titers to OspA and Ch14 and vaccinal antibody reacted with 25 different recombinant OspC variants. Efficacy was demonstrated using an Ixodes scapularis -purpose bred dog challenge model. Vaccination with VANGUARD®crLyme provided protection against infection and prevented the development of clinical manifestations and histopathological changes associated with Lyme disease.


Hemorrhage from esophageal varices after placement of the LeVeen shunt.
Transient bleeding from esophageal varices was noted in a patient with alcoholic cirrhosis and a patent end-to-side portacaval shunt after placement of a LeVeen shunt for unmanageable ascites. Pressure measurements of the portal systemic gradient, obtained at the time of bleeding and 12 days later, suggest that the variceal hemorrhage was induced by the rapid infusion of ascitic fluid into the systemic circulation. Principles of management for variceal hemorrhage after LeVeen shunt placement are discussed.


Lower extremity joint coupling during running: a current update.
The relationship between lower extremity mechanics and injury is not well understood. However, joint coupling studies are beginning to emerge, which may lend further insight into running biomechanics. To provide a current review of the research examining lower extremity joint coupling in running. There are various techniques utilized to measure joint coupling, including joint timing, rearfoot eversion/tibial internal rotation ratios, continuous relative phase calculations, and vector coding. The study of joint coupling is of particular interest as it may pertain to running injuries. There is some evidence that joint coupling may be altered with orthotics and/or with footwear. Most studies have included a relatively small sample size and larger scale studies are needed to quantify normal ranges for many of the coupling measures. In addition, prospective studies are needed to clarify the relationship to injury. It is hoped that this update will serve as a review of the current state of thought regarding lower extremity joint coupling during running. As greater insight into the role of joint coupling in injuries is gained, more optimal intervention and prevention strategies can be developed to minimize injury risk.


Fatigue-induced changes in knee-extensor torque complexity and muscle metabolic rate are dependent on joint angle.
Joint angle is a significant determinant of neuromuscular and metabolic function. We tested the hypothesis that previously reported correlations between knee-extensor torque complexity and metabolic rate ([Formula: see text]) would be conserved at reduced joint angles (i.e. shorter muscle lengths). Eleven participants performed intermittent isometric knee-extensor contractions at 50% maximum voluntary torque for 30 min or until task failure (whichever occurred sooner) at joint angles of 30º, 60º and 90º of flexion (0º = extension). Torque and surface EMG were sampled continuously. Complexity and fractal scaling of torque were quantified using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. [Formula: see text] was determined using near-infrared spectroscopy. Time to task failure/end increased as joint angle decreased (P < 0.001). Over time, complexity decreased at 90º and 60º (decreased ApEn, increased DFA α, both P < 0.001), but not 30º. [Formula: see text] increased at all joint angles (P < 0.001), though the magnitude of this increase was lower at 30º compared to 60º and 90º (both P < 0.01). There were significant correlations between torque complexity and [Formula: see text] at 90º (ApEn, r = - 0.60, P = 0.049) and 60º (ApEn, r = - 0.64, P = 0.035; DFA α, ρ = 0.68, P = 0.015). The lack of correlation between [Formula: see text] and complexity at 30º was likely due to low relative task demands, given the similar kinetics of [Formula: see text] and torque complexity. An inverse correlation between [Formula: see text] and knee-extensor torque complexity occurs during high-intensity contractions at intermediate, but not short, muscle lengths.


Real-life adherence to subcutaneous immunotherapy: What has changed in the era of the COVID-19 pandemic.
Allergen immunotherapy (AIT) must be continued for 3 years, to achieve a long-term modifying effect. Adherence is a key to ensure effectiveness. The objective of this study was, first of all, to evaluate the adherence with subcutaneous immunotherapy (SCIT) and to identify the main causes of SCIT withdrawal in real-life practice in our clinic. Secondly, we also aimed to investigate to what extent the COVID-19 pandemic altered our SCIT receiving patients' treatment adherence behaviors and the factors that affected their decisions. Retrospective analysis of the medical records of patients ages ≥18 years, who had started SCIT in January 2014 or later until September 2020 in our department for the diagnosis of allergic rhinitis, allergic asthma or venom allergy, were included in the study. Adherence was determined as the accomplishment of 3 years of SCIT. A total of 124 patients (72 female [58.1%]; median age, 35 [19-77] years) were included. The adherence rate to SCIT in our tertiary center's real-life setting was 56.25% with a follow-up duration of 3 years before COVID-19 pandemic. Dose modification, defined as reducing patient's planned SCIT dose due to a systemic allergic/large local reaction or missed injection, and its frequency, which is the number of dose adjustments done throughout the SCIT, was found to be the only factor related to nonadherence. But with the pandemic only in 6 months, among 63 patients receiving SCIT, 15 patients (23.81%) dropped out, and the most common reason was fear of being infected with COVID-19 virus during receiving SCIT in hospital (93.33%). The only independent predictor of drop-out during the COVID-19 pandemic was short duration of AIT (p = 0.012). When we compare the dropped-out cases before and after the start of pandemic, AIT duration was significantly shorter in pandemic period (p = 0.005). Adherence rate to SCIT in our real-world setting study was 56.25% before the COVID-19 pandemic. Our results indicated that patients requiring dose modification were more prone to be non-adherent. Approximately one quarter of patients dropped-out with the start of pandemic, almost all due to fear of being infected during receiving SCIT in hospital. Since short SCIT follow-up time was found to be the only risk factor for drop-out during the COVID-19 pandemic, we believe that patients who are in the early phases of their treatment should be observed more closely and their concerns should be answered by their doctors.


Relative Contribution of Windbreak, Copper Sprays, and Leafminer Control for Citrus Canker Management and Prevention of Crop Loss in Sweet Orange Trees.
The management of citrus canker, caused by Xanthomonas citri subsp. citri, has been widely studied in endemic areas because of the importance of the disease in several citrus-producing countries. A set of control measures is well established, but no study has investigated the efficiency of each measure individually and their combination for disease suppression. This study comprised a 3-year field study to assess the relative contribution of three measures for the control of citrus canker and reduction of crop losses. Windbreak (Wb), copper sprays (Cu), and leafminer control (Lc) were assessed in eight different combinations in a split-split plot design. The orchard was composed of 'Valencia' sweet orange trees grafted onto 'Rangpur' lime. Casuarina cunninghamiana trees were used as Wb. Cu and Lc sprays were performed every 21 days throughout the year. Individually, Cu showed the highest contribution for canker control, followed by Wb. Lc had no effect on reducing citrus canker. Wb+Cu showed the highest efficiency for control of the disease. This combination reduced the incidence of diseased trees by approximately 60%, and the incidence of diseased leaves and fruit by ≥90% and increased the yield in 2.0- to 2.6-fold in comparison with the unmanaged plots. Cu sprays were important for reducing disease incidence and crop losses, whereas Wb had an additional contribution in minimizing the incidence of cankered, non-marketable fruit. The results indicated that the adoption of these measures of control may depend on the characteristics of the orchard and destination of the production.


How Hubei fought the virus.
Doctors on the front line in the Chinese province where the coronavirus outbreak started tell Donna Lu about their experiences treating covid-19.


A review on occurrence, characteristics, toxicology and treatment of nanoplastic waste in the environment.
Nanoplastics (NPs) have showed hotspot of discussion in recent years due to their impact in environment as a futuristic major pollutant in water, soil and air. In this correspondence review on the occurrence of nanoplastics and its effect at the environment as a waste have been overviewed and assimilated. It has the direct or indirect effect on aquatic and terrestrial geographical living beings due to its toxicity. The review revealed the major lacking in the field of analysis, database of contaminant quantity and legislative support to essential eradication on the existing imminent pollutant effects. A brief discussion about properties and characters of nanoplastics has been done. The environment exposed with macroplastics, microplastics and nanoplastics has abundantly contaminated the ecosystem surrounding it. Recent studies reveal that the major health effect by nanosize particles has mainly induced toxicity to the aquatic and terrestrial animals when compared to microsize particles and macrosize particles. The drastic effects and its toxicity in living ecosystem due to nanoplastics have been shown. The occurring waste is supposed to manage from environment by treating before entering into environment. The degradation methods for treatment of nanoplastics have been discussed in this review work.


Individual and community-level risk factors of women's acceptance of intimate partner violence in Ethiopia: multilevel analysis of 2011 Ethiopian Demographic Health Survey.
The prevalence of Intimate partner violence (IPV) is higher in societies with higher acceptance of norms that support IPV. In Ethiopia, the proportion of women's acceptance of IPV was 69%, posing a central challenge in preventing IPV. The main objective of this study was to assess the individual and community-level factors associated with women's acceptance of IPV. Two-level mixed-effects logistic regression was applied to the 2011 Ethiopia Demographic and Health Survey data. A total of 16,366 women nested in the 596 clusters were included in the analysis. The acceptability of the IPV was estimated to be 69%. Among the individual-level factors: women's education with secondary and above (AOR = 0.38; 95% CI 0.29-0.52), partner's education secondary and above (AOR = 0.71; 95% CI 0.54-0.82), women aged 35-49 years (AOR = 0.67; 95% CI 0.54-0.82), fully empowered in household level decision making (AOR = 0.67; 95% CI0.54-0.81), literate (AOR = 0.76; 95% CI 0.62-0.92), and perceived existence of law that prevents IPV (AOR = 0.56; 95% CI 0.50-0.63) were significantly associated with women's acceptance of IPV. Similarly, rural residence (AOR = 1.93; 95% CI 1.53-2.43) and living in the State region (AOR = 2.37; 95% CI 1.81-3.10) were significantly associated with the women's acceptance of IPV among the community-level factors. Both individual and community-level factors were significant risk factors for the acceptability of intimate partner violence. Women's education, women's age, women's empowerment, partner education level, perceived existence of the law, and literacy were among individual factors. State region and residence were among community-level risk factors significantly associated women's acceptance of IPV.


Renal transplantation outcome in selected recipients with IgA nephropathy as native disease: a bicentric study.
IgA nephropathy (IgAN) is the causative disease of at most 10% of patients on dialysis and waiting for kidney transplantation. The disease can recur on the graft and it is important to know the exact impact of such recurrence on overall results of transplantation in this subgroup of young recipients. This is a retrospective study done in two closed centers over three decades with a final number of 142 recipients (111 men; median age of 42.2 years at surgery) with biopsy-proven IgAN among 1979 transplanted patients (7.2%). The mean follow-up time was 6.6 years. Recurrence was defined clinically as proteinuria over 1 g/day ± haematuria and associated with ≥1+ IgA mesangial deposits on the graft biopsy. We used Cox regression and Kaplan-Meier survival curves to study the event. Patient survival was excellent: 92% at 10 y; graft survival was 53% at 10y and similar to other recipients. The clinico-pathological (full) recurrence (CPR) was observed overall in 25 cases (17.6%) leading to graft loss in 10 cases (7%). The cumulative rate at 10 y of full recurrence and graft loss due to CPR was 21% and 13% respectively. We could not demonstrate any major influence of immunosuppression (induction or maintenance) or other factors on full recurrence. In addition, 10.5% of recipients disclosed only pathological recurrence without significant clinical consequences. Despite significant prevalence of full recurrence after grafting, the overall good results observed still validate renal transplantation in this subgroup of IgAN recipients.


Open fire exposure increases the risk of pregnancy loss in South Asia.
Interactions between climate change and anthropogenic activities result in increasing numbers of open fires, which have been shown to harm maternal health. However, few studies have examined the association between open fire and pregnancy loss. We conduct a self-comparison case-control study including 24,876 mothers from South Asia, the region with the heaviest pregnancy-loss burden in the world. Exposure is assessed using a chemical transport model as the concentrations of fire-sourced PM2.5 (i.e., fire PM2.5). The adjusted odds ratio (OR) of pregnancy loss for a 1-μg/m3 increment in averaged concentration of fire PM2.5 during pregnancy is estimated as 1.051 (95% confidence intervals [CI]: 1.035, 1.067). Because fire PM2.5 is more strongly linked with pregnancy loss than non-fire PM2.5 (OR: 1.014; 95% CI: 1.011, 1.016), it contributes to a non-neglectable fraction (13%) of PM2.5-associated pregnancy loss. Here, we show maternal health is threaten by gestational exposure to fire smoke in South Asia.


Does cardiac catheterization laboratory activation by electrocardiography machine auto-interpretation reduce door-to-balloon time?
In an attempt to begin ST-segment elevation myocardial infarction (STEMI) treatment more quickly (referred to as door-to-balloon [DTB] time) by minimizing preventable delays in electrocardiogram (ECG) interpretation, cardiac catheterization laboratory (CCL) activation was changed from activation by the emergency physician (code heart I) to activation by a single page if the ECG is interpreted as STEMI by the ECG machine (ECG machine auto-interpretation) (code heart II). We sought to determine the impact of ECG machine auto-interpretation on CCL activation. The study period was from June 2010 to May 2012 (from June to November 2011, code heart I; from December 2011 to May 2012, code heart II). All patients aged 18 years or older who were diagnosed with STEMI were evaluated for enrollment. Patients who experienced the code heart system were also included. Door-to-balloon time before and after code heart system were compared with a retrospective chart review. In addition, to determine the appropriateness of the activation, we compared coronary angiography performance rate and percentage of STEMI between code heart I and II. After the code heart system, the mean DTB time was significantly decreased (before, 96.51 ± 65.60 minutes; after, 65.40 ± 26.40 minutes; P = .043). The STEMI diagnosis and the coronary angiography performance rates were significantly lower in the code heart II group than in the code heart I group without difference in DTB time. Cardiac catheterization laboratory activation by ECG machine auto-interpretation does not reduce DTB time and often unnecessarily activates the code heart system compared with emergency physician-initiated activation. This system therefore decreases the appropriateness of CCL activation.


Haemorrhagic shock secondary to a diffuse ulcerative enteritis after Ipilimumab and Nivolumab treatment for metastatic melanoma: a case report.
We provide a unique case of haemorrhagic shock complicating a corticosteroid-resistant diffuse ulcerative enteritis in a patient treated with a combination of an anti cytotoxic T-lymphocyte antigen-4 (CTLA4) and an anti programmed cell death protein 1 (PD-1) for metastatic melanoma. Immunotherapy has changed the perspective for the management of patients with metastatic melanoma but are also responsible for digestive complications mainly represented by immunomediated colitis. Digestive bleeding is common in patients with extensive colonic lesions but has never been described in enteritis independent of colitis. The patient with acute intestinal obstruction related ileitis without evidence of stricture on imaging and then had a gastro-intestinal bleed. In the absence of haemorrhagic lesions on upper gastrointestinal endoscopy, colonoscopy and computed tomography (CT) angiography, a surgical exploration with enteroscopy was performed. This revealed an extensive ulcerated jejunoileitis, with active bleeding, within a Meckel's diverticulum. Management included resection of the Meckel diverticulum with a transient double barrel ileostomy. Two infliximab infusions were given due to persistent bleeding. We observed a dramatic improvement after infliximab treatment with complete cessation of bleeding and no further need for transfusions. A complete mucosal healing has been achieved on enteroscopy at 3 months with disappearance of histological inflammatory lesions. This observation suggests that infliximab represents a therapeutic option in severe enteritis and may be as effective as in more moderate immune-mediated enterocolitis.


Risk prediction tools in surgical oncology.
Healthcare has increasingly focused on patient engagement and shared decision-making. Decision aids can promote engagement and shared decision making by providing patients and their providers with care options and outcomes. This article discusses decision aids for surgical oncology patients. Topics include: short-term risk prediction following surgery, long-term risk prediction of survival and recurrence, the combination of short- and long-term risk prediction to help guide treatment choice, and decision aid usability, transparency, and accessibility.


The mechanistic basis of chromotherapy: Current knowledge and future perspectives.
Chromotherapy is a method of treatment that uses wavelengths in the visible region for curing different diseases and medical conditions. Recent advances in photobiology and the speciality of Photobiomodulation are uncovering the cellular and molecular effects of visible range electromagnetic radiation. We discuss the reported effects of visible range radiation on cells (in vitro and in vivo) and the attempted explanations of the underlying processes with regard to therapeutic effects. Some of the important advances in this area are reviewed, especially the effects of visible light on bacteria, enzymes and the use of visible light for wound healing and treatment of psychiatric diseases for the purpose of explaining the therapeutic implications of chromotherapy. We highlight the correlation of wavelengths used between recently uncovered mechanisms of photobiology and conventional chromotherapy. The elucidation of mechanisms of the cellular and molecular interaction of light will help in deciphering the scientific background of chromotherapy and will help in the application of this alternative therapeutic treatment to many other diseases.


Lack of HIV infection among truck drivers in Iran using rapid HIV test.
The aim of this study was to evaluate the prevalence of HIV infection in Iranian long distance truck drivers using rapid HIV test. The study included 400 consecutive participants in Bazargan city, north-west of Iran in the late 2008 and the early 2009. No HIV infection was observed among these long distance truck drivers. Although results of this study is plausible compared to other similar studies, repeated surveys are necessary to know the trend of HIV infection in truckers in Iran.


Vinyl substituted triphenylamine based turn-off fluorescent probe for selective and sensitive detection of mercury (II) in water and live cells.
Here, we report vinyl substituted triphenylamine (TPA-alk) fluorescent probe for the rapid and efficient detection of mercury ion (Hg2+) in water and biological environment. TPA-alk detects Hg2+ selectively over a wide range of competitive metal ions with a blue shift of 43 nm in the UV absorbance spectrum. The detection limit is found to be 0.146 µM (29.2 ppb) with high selectivity over a wide range of competitive metal ions. DFT study explains the blue shift in the UV-vis absorption band of the optical probe upon the addition of Hg2+. Cell viability assay illustrates that the probe is biocompatible and it has low cytotoxicity even at its higher concentration. Cell imaging studies demonstrate the efficiency of the TPA-alk probe for the micromolar detection of mercury (II) in live BMG1 cells.


[Amino acid transport by membrane vesicles of virally transformed and nontransformed cells: effects of sodium gradient and cell density].
Mixed membrane vesicle populations composed of plasma membrane and endoplasmic reticulum were prepared from Balb/c 3T3 and simian virus 40-transformed Balb/c 3T3 mouse fibroblasts. The initial rates of uptake of L-leucine and alpha-aminoisobutyric acid by these vesicles were stimulated by a NaCl gradient (external greater than internal). Cation specificity for stimulation of L-leucine uptake was Na+ greater than Li+ greater than K+. NaSCN was as effective as NaCl. Stimulation of uptake of both amino acids by a NaCl gradient was twice as great in vesicles from transformed as compared to non-transformed cells. The NaCl gradient produced transient accumulation of both L-leucine and alpha-aminoisobutyric acid to twice the equilibrium level in vesicles from transformed cells. No such "overshoot" was observed in vesicles from nontransformed cells. In vesicles from the contact-inhibitable Balb/c 3T3 cells, transport of alpha-aminoisobutyric acid, but non L-leucine, exhibited a density-dependent decrease in Na+ gradient induced stimulation, from 248% for sub-confluent to 109% with confluent cells. No density-related changes in uptake were noted with vesicles from the transformed cells. These studies suggest that variation in amino acid uptake associated with viral transformation may be related, at least in part, to alterations in Na+ permeability of the surface membrane.


Impact of sodium silicate on lead release and colloid size distributions in drinking water.
Sodium silicates have been used in drinking water treatment for decades as sequestrants and corrosion inhibitors. For the latter purpose they are poorly understood, which presents a potential public health risk. We investigated a common sodium silicate formulation as a treatment for lead release and compared it to orthophosphate, a well-established lead corrosion control treatment. We also compared the size distributions of colloids generated in silicate and orthophosphate-treated systems using field flow fractionation with multielement detection. At a moderate dose of 24 mg SiO2/L, sodium silicate yielded a median lead release of 398 µg/L, while orthophosphate yielded 67 µg Pb/L. At an elevated dose of 48 mg SiO2/L, sodium silicate dispersed corrosion scale in cast iron pipe sections and lead service lines, resulting in a substantial release of colloidal iron and lead. In the silicate-treated system, a silicon-rich coating occurred at the lead-water interface, but lead carbonate remained the major corrosion product and appeared to control lead levels. These data suggest that, as a corrosion control treatment for lead, sodium silicate is inferior to orthophosphate in circumneutral pH water with low alkalinity. And, as with polyphosphate, excess silicate can be highly detrimental to controlling lead release.