Essential components of physician health program monitoring for substance use disorder: A survey of participants 5 years post successful program completion.
Physician health programs (PHPs) have demonstrated efficacy, but their mechanism of influence is unclear. This study sought to identify essential components of PHP care management for substance use disorder (SUD), and to assess whether positive outcomes are sustained over time. Physicians with DSM-IV diagnoses of Substance Dependence and/or Substance Abuse who had successfully completed a PHP monitoring agreement at least 5 years before the study (N = 343) were identified as eligible. Of the 143 (42%) that could be reached by phone, 93% (n = 133; 86% male) completed the anonymous online survey. Virtually all PHP program components were rated as being at least "somewhat helpful" in promoting recovery, with the plurality of respondents rating almost all components as "extremely helpful." The top-rated components were: signing a PHP monitoring agreement, participation in the PHP, formal SUD treatment, and attending 12-step meetings, with each receiving a mean rating of at least 6.2 out of 7. Notably, 88% of respondents endorsed continued participation in 12-step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was "money well spent." Components of PHP monitoring were viewed as acceptable and helpful to physicians who completed the program, and outcomes were generally sustained over 5 years. More studies are needed to confirm these preliminary findings. This study documents the perceived cost-benefit of participation in a PHP among a small sample of program completers.


Impact of the acid flow rate on dentin erosion.
The study aimed to evaluate the erosive effects of acids flowing with different velocities and duration on dentin previously pre-treated with distilled water or human saliva. Bovine dentin surfaces were submitted to a 10 min demineralisation with hydrochloric or citric acid (pH 2.3, 37 degrees C) in an artificial mouth at flow rates of 3, 2.25, 1.5, 0.75 or 0.15 ml/min or in 30 ml of the respective acid without movement (each subgroup n=16 specimens). Prior to the demineralisation, half of the specimens of each group were either pre-treated with distilled water or human saliva for 120 min. After 2, 5 and 10 min demineralisation, profilometric traces of dentin loss were performed perpendicular to the direction of acid flow at three sites (A-C) with intervals of 500 microm. The first profile (A) was taken in a distance of 1.5 mm from the acid starting to flow over the sample. Thus, median dentin loss at each site was calculated and statistically analysed by five-way ANOVA. Dentin loss increased with increasing acid flow rate and demineralisation time and was higher for demineralisation with citric acid compared to hydrochloric acid. For given flow rates of 0.15 to 3 ml/min, measurement of dentin loss yielded highest values for site A and decreasing values for sites B and C. For all groups, no significant differences of dentin loss were observed between specimens pre-treated with distilled water or human saliva. Under the conditions of this study, both duration of demineralisation and acid flow rate but not pre-treatment with distilled water or saliva influence the extent of dentin erosion.


Post-arrest wide complex rhythm: What is the cause of death?
A 72-year-old man presented to the ED following witnessed cardiac arrest. After return of spontaneous circulation, an ECG was performed which demonstrated a wide complex rhythm with "shark fin" morphology. With careful examination it is possible to identify the J point and determine that the electrocardiogram (ECG) findings actually represent massive ST-elevation indicative of occlusion myocardial infarction (OMI). Initial troponin was undetectable. The patient underwent emergent cardiac catheterization and had a 100% proximal LAD occlusion that was successfully stented. The patient was discharged home neurologically intact several days later. This case highlights the importance of careful ECG interpretation and the limitations of troponin assays in the evaluation of acute coronary syndrome. Most importantly, we demonstrate how to evaluate for ST elevation in the context of a widened QRS complex.


The importance of clear margins in myxofibrosarcoma: Improving local control by means of staged resection and reconstruction.
Myxofibrosarcomas are associated with a locally infiltrative growth pattern, making a clear-margin resection margin challenging. This leads to high local recurrence rates. While immediate wound closure and adjuvant radiotherapy has been proposed to mitigate incomplete excisions, we present our experience treating myxofibrosarcomas with staged excisions until clear margins are obtained, prior to reconstruction. All patients with myxofibrosarcomas treated with a curative intent at our centre between 2009 and 2019 were identified. Patient demographics, tumour characteristics, number of resections, method of reconstruction, adjuvant therapy, complications, local recurrence rates, length of hospital stay and overall survival were assessed. 97 consecutive eligible patients were identified. Forty-six (47%) had positive margins reported following a first resection. The median number of resections required to obtain clear margins was two and the median time from first excision to definitive wound closure was 15 days. Local recurrence rate for the whole cohort was 14%. Patients who had staged resection until clear margins were obtained had a significantly lower rate of local recurrence compared to those who had positive margins at time of reconstruction (p-value = 0.001). The estimated 5-year disease-specific survival for the whole cohort was 93%. Obtaining clear margins in myxofibrosarcoma via staged resections was associated with lower local recurrence rates for patients who had an initial resection with positive margins. The outcomes of performing staged resections are equivalent to patients for whom a clear margin were obtained in the first instance.


Failure Mode and Effects Analysis (FMEA) for Immunogenicity of Therapeutic Proteins.
Biotherapeutic drugs made by cell-based systems are revolutionizing the practice of medicine. The next generation of biotherapeutics include recombinant proteins, monoclonal antibodies, viral vector expressed proteins, and cell therapies. Immunogenicity associated adverse events is one of the major risks for these biologics. Accurate and precise measurement of the immunogenicity of biologics is a critical component during all phases of drug development. We have utilized the principles of Failure Mode and Effects Analysis (FMEA) in performing assessment of risk of immunogenicity. The multi-dimensional approach involves: i) listing all the potential risks by likelihood of occurrence and severity as part of quality target product profile. ii) ascribing the causes by identifying the risks at each stage of development. iii) predicting the effects. iv) determining the risk mitigation strategy. v) implementing a monitoring process. vi) developing templates for data collection. vii) timely reporting and. viii) life cycle management. FMEA is a continuous process that works throughout the lifecycle of the product or the process and keeps on getting updated with new insights and knowledge.


Speech appliances in the treatment of phonological disorders.
Some individuals are unable to achieve correct production of the /r/ phoneme after receiving substantial amounts of treatment. Clark, Schwarz, and Blakeley (1993) developed a removable speech appliance that positions the tongue to produce the /r/ phoneme. Their results indicate that the appliance was successful with a large group of clients. The rationale and issues related to the use of speech appliances are discussed.


Management of canal stenosis with a transposition flap.
Stenosis of the external auditory canal is difficult to manage. Numerous surgical procedures have been advocated for its correction and all function to varying degrees, but repeat stenosis remains a problem. Our experience, with the use of a superiorly based preauricular transposition flap in combination with an endaural and postauricular approach in 5 patients, 8 ears, is presented. In 3 patients, 5 ears, the stenosis was congenital; in 1 patient, 1 ear, traumatic; and in 1 patient, 2 ears, secondary to chronic external otitis. With a follow-up of 1 to 9 years, the functional and cosmetic results have been satisfactory in all cases.


Restricted access to natural mother shifted endogenous rhythm of rat pups.
For further investigation of the role of rat dams in setting the phase of pups' endogenous circadian rhythm, periodic maternal deprivation experiments were performed. Access of intact original mothers to blinded pups was restricted to light phase (L-Suckling pups) or dark phase (D-suckling pups) under 12-12 h light-dark alternation throughout the nursing period. Free-running patterns of drinking and corticosterone rhythms were determined for 3 consecutive weeks after weaning. In each determination of the rhythm, water consumption and corticosterone levels were measured every 4 hr. Both rhythms were clearly observed in both L- and D-suckling pups. Acrophase of water intake rhythm at 5 weeks of age in L-suckling and D-suckling groups were 0758 h and 1954 h while those of corticosterone rhythm were 0143 h and 0948 h respectively. Reversed phase relationship of rhythms between L- and D-suckling groups were observed throughout the period examined. These results indicate that suckling can act as a Zeitgeber for the endogenous rhythm of pups.


Polymorphisms and functional differences in aryl hydrocarbon receptors (AhR) in Japanese field mice, Apodemus speciosus.
Dioxins, which are unintentionally generated toxic pollutants, exert a variety of adverse effects on organisms. The majority of these effects, which include teratogenesis, immunosuppression, tumor promotion, and endocrine disruption, are mediated through aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor. Genetic variations in AhR result in different survivability under exposure to dioxin contamination, which might affect the genetic structure of wildlife populations through differential susceptibility to dioxin exposure. The aim of this study was to clarify the polymorphisms of AhR in Japanese field mice, Apodemus speciosus, and their functional differences in order to develop a molecular indicator for dioxin sensitivity. Wild Japanese field mice had abundant polymorphisms in AhR coding region. Seventy-one single nucleotide polymorphisms, 27 of which occur amino acid substitutions, and consequently 49 alleles were identified in 63 individuals. In the functional analysis of AhR variants using transient reporter assays, a Gln to Arg mutation at amino acid 799 exhibited a significant decrease in the level of transactivational properties (p=0.015) which might modify the dioxin susceptibility of an individual.


[Genetic analysis and gene mapping of cold-induced seedling chlorosis in rice].
We found that the seedlings of indica rice cultivar Dular showed chlorosis but the seedlings of japonica rice cultivar Lemont remained green under natural low temperature in early spring. Using an F2 population of Lemont Dular, we found that the difference of cold tolerance at seedling stage between Dular and Lemont is controlled by a single major gene, with the chlorosis allele being recessive. We named the gene cisc(t). With the help of SSR markers, cisc(t) was mapped in a 5.5 cM interval between SSR markers RM257 and RM242 on chromosome 9.


Lifestyle of metabolically healthy obese individuals.
The aim of this study is to find factors associated with metabolic syndrome in obese individuals and thus offer guidance to stay metabolically healthy if obese. A cardiovascular screening programme performed in Finland during the years 2005-2007, identified 901 obese white individuals. Of them, 269 (30%) were metabolically healthy according to the Harmonization criteria of metabolic syndrome. In multivariate logistic regression analysis, male sex [odds ratio (OR) 1.44 (95% CI 1.01-2.07)], living alone [OR 1.77 (95% CI 1.18-2.65)], physical inactivity [OR 3.73 (95% CI 1.24-11.24)], and use of betablockers [OR 2.63 (95% CI 1.75-3.95)] were associated with metabolic syndrome. Even mild or occasional physical exercise is beneficial to health in obese individuals. Betablockers may not be the antihypertensive agents of choice when treating obese hypertensive individuals.


ANXA1 affects murine hair follicle growth through EGF signaling pathway.
Annexin A1 (ANXA1), a calcium-dependent phospholipid binding protein expressed in animals, plants and microorganisms, participates in various cellular physiological activities. Previous proteomics analysis indicates that the level of ANXA1 in mice dorsal skin changes during hair growth cycle, we speculate that ANXA1 may play an important role in hair follicle (HF) development. Thus, Anxa1 knock-out (KO) and over-expression (OE) mice were constructed to test its function. Our results showed that in addition to the diameter of HF and hair shaft, ANXA1 could participate in hair growth by affecting the density of HF, and the proliferation of hair follicle stem cells (HFSCs). Meanwhile, molecular analysis showed that EGF signaling pathway is involved in the function of ANXA1. The expression of Anxa1 is negatively correlated with the levels of Egf, Notch1, Mkk7, and phosphorylated AKT1 and ERK/2 proteins. The levels of Egf, Notch1, Mkk7 and phosphorylation of AKT1 and ERK/2 increased in Anxa1 KO mice but decreased in Anxa1 OE mice. Taken together, our results suggested that ANXA1 could affect the hair growth by regulating the HFSCs proliferation through EGF signaling pathway.


A novel one-step microbial transformation of betulin to betulinic acid catalysed by Cunninghamella blakesleeana.
Betulinic acid and its derivatives are potential bioactive compounds present in nature. This study investigated the biotransformation of betulin to betulinic acid by Cunninghamella blakesleeana cells. LC-MS analysis demonstrated that betulin could be transformed into at least five products from cultured C. blakesleeana cells, among which betulinic acid was the most important. The presented method provides an attractive alternative approach to chemical synthesis, because is less time-consuming and more environmentally friendly. C. blakesleeana can transform betulin into potent derivatives with high pharmacological activities.


Comparison of the rate of aminoacylation of tRNA isolated from NMRI mouse liver with tRNA isolated from Krebs II ascites or mouse plasmacytoma cells.
A comparison of the initial rates of aminoacylation of tRNAs isolated from different sources for 17 amino acids was performed. tRNA was isolated from NMRI mouse liver (tRNA L) and from Krebs II ascites tumors (tRNA Asc), and aminoacyl-tRNA synthetases were prepared from the latter cells. The aminoacylation of tRNA Asc was 31-88% slower than the charging of tRNA L. In similar studies, tRNA from a mouse plasmacytoma tumor (tRNA Mt) and from suspension cultured cells of the same cell line (tRNA M) were compared to tRNA L in the aminoacylation reaction catalysed by synthetases isolated from tumor or suspension cultured cells. About half of the tRNAs (Mt or M) for the 17 amino acids tested differed in charging rate when compared to tRNA L, but the differences were not as great as those observed in the experiments where tRNA Asc and tRNA L were compared.


Long-term improvement of psoriasis patients' adherence to topical drugs: testing a patient-supporting intervention delivered by healthcare professionals.
Psoriasis affects 2-4% of the Western adult population and is a socio-economic burden for patients and society. Topical drugs are recommended as first-line treatment for mild-to-moderate psoriasis, but low adherence is a barrier to treatment success. Psoriasis patients require support, in order to improve their long-term use of topical drugs. The project aims to test whether a patient-supporting intervention delivered by dermatology nurses can reduce the severity of psoriasis, improve the use of topical drugs, and is cost-effective compared to standard procedure. The intervention consists of improved support delivered to patients by three experienced dermatology nurses, who will support patients on a regular basis by consultations with a focus on providing reminder systems, accountability, reinforcement, and building trust in the treatment. Each patient will be supported by the same dermatology nurse throughout the entire study period. The effect will be compared with standard procedure. The intervention will be tested in a randomized controlled trial during a 48-week period. A group of patients with moderate-to-severe psoriasis (psoriasis affecting ≥ 4% of the total body surface area) and 18-85 years of age who are prescribed topical treatment will be randomized to a non-intervention (n ≈ 57) or intervention group (n ≈ 57). Participants in both arms will be prescribed topical preparations containing corticosteroid and/or calcipotriol. The primary outcome will be a change in the severity of psoriasis, measured as reduction in the Lattice-System Physician's Global Assessment. Secondary outcomes will include changes in health-related quality of life (measured by disease specific and generic questionnaires), primary adherence (i.e., proportion of filled prescriptions), and secondary adherence by objective measure (rate of topical drug consumption (obtained by weighing medication packages) compared to estimated recommended consumption). A health economic evaluation is planned to run alongside the trial. Participants' total health costs will be estimated on the basis of health costs reported to the national health registries and costs spent on the intervention, after which a cost-utility and cost-effectiveness analysis will be carried out. If the intervention can reduce the severity of psoriasis in a significant manner and is economically favorable compared to standard treatment, there is potential for implementing the intervention in dermatology clinics. Clinicaltrials.gov NCT04220554 . Registered on January 7, 2020. Study results, either positive, negative, or inconclusive, will be published on www.clinicaltrials.gov . Trial registration no. with the Danish Regional Committee on Health Research Ethics, registration no. 72613.


[An analysis of a process for culturing Lactobacillus acidophilus using a method of spectroturbidimetry].
Changes in the spectrum of the opacity of biodispersions containing L. acidophilus at the stage of growth have been studied. The pronounced positive correlation between the opacity of dispersion and the titer of cells, determined by the method of ultimate dilutions, have been shown.


GPR55 in the brain and chronic neuropathic pain.
There is a clear need for novel and improved therapeutic strategies for alleviating chronic neuropathic pain, as well as a need for better understanding of brain mechanisms of neuropathic pain, which are less understood than spinal and peripheral mechanisms. The G protein-coupled receptor 55 (GPR55), is a lysophosphatidylinositol (LPI)-sensitive receptor that has also been involved in cannabinoid signaling. It is expressed throughout the central nervous system, including the periaqueductal gray (PAG), a brainstem area and key element of the descending pain control system. Behaviors, pharmacology, biochemistry tools, and stereotaxic microinjections were used to determine if GPR55 plays a role in pain control in a chronic constriction injury (CCI) neuropathic pain model in rats. It was found that the blockade of GPR55 action in the PAG can restore and drive a descending control system to mitigate neuropathic pain. Our data demonstrate that GPR55 play a role in the descending pain control system, and identify GPR55 at supraspinal level as a neuropathic pain brain mechanism.


The expert witness: understanding the rationale.
The origins of the use of expert witnesses to assist courts in helping understand the required conduct in determining the standard of care provides a basis for recognizing the consultant role sought in judicial proceedings. Both rules of evidence and court decisions have evolved in a manner that encourages the introduction of expert testimony while conditioning its use to avoid unfair bias. Trial court judges decide on permitting such testimony, while legal counsel is responsible for helping juries determine its importance and reliability. Certain types of restrictions and adverse consequences for misstatements exist but are subordinated to the trial process in most circumstances, a process that varies among different jurisdictions.


Role of nitric oxide pathway in the protection against lethal endotoxemia afforded by low doses of lipopolysaccharide.
Survival after lipopolysaccharide challenge (LD80, 20 mg.kg-1, i.p.) was significantly enhanced by previous treatment with a microdose of LPS (50 micrograms.kg-1, i.v.). When NG-monomethyl-L-arginine, a specific inhibitor of the formation of nitric oxide from L-arginine, was given 30 minutes before microdose, survival was significantly reduced. When we monitored the serum Tumor Necrosis Factor (TNF) levels in both groups a significant reduction of TNF level after the microdose was observed in mice previously treated with L-NMMA. The ability of L-NNMA to reduce TNF release was dose dependent.


[Gastric outlet stenosis (benign): definition, incidence, therapy?].
According to a strict definition of a benign gastric outlet obstruction i.e. delayed vomiting, changing of symptoms, weight loss and intraoperative test by Hegardilators (less than 14), 2.2% real stenoses among 619 operative treated duodenal ulcer patients were found. All patients were treated by SPV and digital dilatation of the stenosis through a gastrotomy. During up to a 10 year follow-up no reoperation was necessary. All patients showed Visick-classification of I and II. In conclusion SPV with digital dilatation showed good clinical results for patients with benign gastric outlet obstruction in long-term follow up.


The relationship between radiographic findings and patient-reported outcomes in adult hip dysplasia patients: A hospital cross-sectional study.
This study aimed to clarify the relationship of individual radiographic parameters and features with the patient-reported outcome measurements (PROMs) of patients with developmental dysplasia of the hip (DDH) in a hospital-referred cross-sectional analysis. This cross-sectional study included 108 Japanese DDH patients (female, n = 88; male, n = 20; mean age, 43.4 years). We recorded the CE angle, angle of Sharp, ARO, ADR, AHI, crossover sign, pistol grip deformity, and femoral head-neck ratio, which were measured on the AP view, and the α-angle, which was measured on the Lauenstein view. We also recorded cyst formation and osteophytes on either view. We used the Japanese Orthopaedic Association hip disease evaluation questionnaire (JHEQ) to assess the PROMs. The PROMs of patients with and without cysts or osteophytes and those of patients with or without cam or pincer deformity were compared. The relationships between specific PROMs and radiographic features were evaluated with a linear regression analysis and independent associations between PROMs and radiographic features were assessed with a multiple regression analysis using various independent variables. The JHEQ movement and mental values in patients with cyst formation were significantly lower in comparison to those in patients without cyst formation. The JHEQ subscale values did not differ according to the presence or absence of osteophytes, cam deformity or pincer deformity. The CE angle was found to be associated with the JHEQ movement score in the linear regression analysis. To identify radiographic features that were independently associated with each of the JHEQ subscale scores, we performed a multiple regression analysis with age, body mass index, sex and the number of affected hip joints (bilateral or unilateral) included as independent variables. The CE angle was found to be independently associated with JHEQ movement. The CE angle was independently associated with the JHEQ movement value.


Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients.
Retrospective comparison study of patients who had a delayed infection following a posterior spinal fusion and instrumentation (PSFI) for adolescent idiopathic scoliosis (AIS). To define risk factors for the development of delayed infections following PSFI for AIS by comparing those patients who developed this complication to a randomly selected group of patients who did not. Despite studies reporting the incidence and treatment of delayed infection following PSFI for AIS, there are no studies analyzing risk factors for its occurrence. All patients who required treatment for delayed infections following PSFI for AIS were identified (infection group, n = 36). A random selection of patients who did not develop a delayed infection (no infection, n = 90) was made in a ratio of 3:1 (no infection/infection). The 2 groups were compared using statistical methods. Parameters associated with the infection group included: presence of a significant medical history, surgeon, less surgical time, a more distal fusion level (16% infection rate with a thoracic LIV vs. 33% infection rate with a lumbar LIV), not using postoperative drains, and increased drainage when drains were used. Other factors associated with infection were use of a blood transfusion and when increasing units of transfusion were used. Multivariate logistic regression analysis identified 3 factors that remained statistically significant: 1) significant medical history, 2) receiving a blood transfusion, and 3) not using a postoperative drain. Factors that were not associated with delayed infection included body mass index, the number of anchor points used, use of allograft bone, and the total number of levels instrumented and antibiotic regimen. The occurrence of a delayed infection is most likely multifactorial and is related to a positive past medical history and the use of blood transfusions. Postoperative use of a drain may be important to avoid delayed infection.


Functional constipation in infants: a follow-up study.
Our objective of this study was to describe the clinical course of severe functional constipation in early childhood. Eligible patients were 47 children (60% boys; median age, 3.5 months) who had constipation in their first year of life. Follow-up data were obtained through a standardized questionnaire. Success was defined as a period of at least 4 weeks with > or =3 painless bowel movements per week. Six months after initial evaluation, 69% of the children were recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A duration of symptoms <3 months before referral correlated significantly with better outcome. We conclude that most infants with severe constipation evaluated at a tertiary center are recovered after 6 months. Early therapeutic intervention may beneficially contribute to the resolution of constipation.


Long-term maintenance following attainment of goal weight: a preliminary investigation.
The present study sought to determine whether the high relapse rates observed among subjects in fixed length behavioral-based weight loss programs would be lowered if subjects were allowed to continue in treatment until they had reached their desired weights. Five hundred seventeen (517) clients at a commercial weight-loss program were surveyed approximately 1 year posttreatment regarding their current weight status. Of the 267 subjects who responded to the mailed survey, it was found that 82% remained within 10% of their posttreatment weights at the time of the follow-up. Of particular interest was the fact that weight trends during the intervening year suggested subjects were actively and effectively calibrating their weight. It was concluded that the high relapse rates typical for this mode of treatment may be an artifact of premature treatment cessation and further investigation is indeed merited.


Production, bioprocess optimization and γ-irradiation of Penicillium polonicum, as a new Taxol producing endophyte from Ginko biloba.
Twenty-eight fungal endophytes were recovered from the different parts of Ginkgo biloba and screened for their Taxol producing potency. Among these isolates, Penicillium polonicum AUMC14487 was reported as the potent Taxol producer (90.53 μg/l). The chemical identity of the extracted Taxol was verified from the TLC, HPLC, NMR, EDX, and FTIR analyses. The extracted Taxol displayed a strong antiproliferative activity against HEPG2 (IC50 4.06 μM) and MCF7 (IC50 6.07 μM). The yield of Taxol by P. polonicum was optimized by nutritional optimization with the Response Surface Methodology (RSM) using Plackett-Burman and Central Composite Designs. In addition to nutritional optimization, the effect of γ-irradiation of the spores of P. polonicum on its Taxol producing potency was evaluated. The yield of Taxol by P. polonicum was increased via nutritional optimization by response surface methodology with Plackett-Burman and FCCD designs, and γ-irradiation by about 4.5 folds, comparing to the control culture. The yield of Taxol was increased by about 1.2 folds (401.2 μg/l) by γ -irradiation of the isolates at 0.5-0.75 kGy, comparing to the control cultures (332.2 μg/l). The highest Taxol yield was obtained by growing P. polonicum on modified Czapek's- Dox medium (sucrose 40.0 g/l, malt extract 20.0 g/l, peptone 2.0 g/l, K2PO4 2.0 g/l, KCl 1.0 g/l, NaNO3 2.0 g/l, MgSO4. 5H2O 1.0 g/l) of pH 7.0 at 30.0 °C for 7.0 days. From the FCCD design, sucrose, malt extract and incubation time being the highest significant variables medium components affecting the Taxol production by P. polonicum.


Drupin, a thrombin-like protease prompts platelet activation and aggregation through protease-activated receptors.
Hemostasis is a proteolytically regulated process that requires activation of platelets and the blood coagulation cascade upon vascular injury. Activated platelets create a thrombogenic environment and amplify the coagulation process. Plant latex proteases (PLPs) have been used as therapeutic components to treat various ailments by folk healers. One of the main applications of plant latices is to stop bleeding from minor injuries and to enhance wound healing activity. Although many studies have reported the pro-coagulant activities of PLPs, an in-depth investigation is required to understand the mechanism of action of PLPs on platelets. Here, the effect of PLPs on platelet aggregation was studied systematically to validate the observed pharmacological effect by folk healers. Among 29 latices from the Ficus genus tested, Ficus drupacea exhibited potent pro-coagulant and thrombin-like activity. Drupin, a thrombin-like cysteine protease responsible for platelet aggregation was purified from F. drupacea latex. Drupin exhibits pro-coagulant activity and reduces the bleeding time in mice tail. It induces platelet aggregation by activating mitogen-activated protein kinases and the nuclear factor-κB and PI3K/Akt signalling cascade, which, in turn, phosphorylats, cytosolic phospholipase A2 leading to the release of thromboxane A2 from the granules to activate the nearby platelets to aggregate. Furthermore, we investigated the involvement of protease-activated receptors in drupin-induced platelet aggregation using specific protease activated receptor 1 (PAR1) and PAR4 receptor antagonists. The results confirmed that the drupin-induced platelet aggregation was mediated by both PAR1 and PAR4, synergistically. Overall, drupin reduces the bleeding time by exerting pro-coagulant activity and induces platelet aggregation by activating the intracellular signalling cascade.


Inhibitory effect of phytoglycoprotein on tumor necrosis factor-alpha and interleukin-6 at initiation stage of colon cancer in 1,2-dimethylhydrazine-treated ICR mice.
This study was carried out to investigate the chemopreventive potentials of plant originated glycoprotein (UDN glycoprotein, 116 kDa) isolated from the stems of Ulmus davidiana Nakai (UDN) on aberrant crypt foci (ACF) formation in 1,2-dimethylhydrazine (DMH)-treated ICR mice. UDN glycoprotein was administered to mice at 0.01% and 0.02% levels for 5 weeks. The mice were treated with 20 mg/kg DMH twice a week for 2 weeks in presence of UDN glycoprotein and killed at week 6. We found that UDN glycoprotein has inhibitory effects on the frequency of colonic aberrant crypt foci (ACF), activation of colonic proliferating cell nuclear antigen (PCNA), and release of plasma lactate dehydrogenase (LDH) in DMH-treated mice. In addition, UDN glycoprotein has anti-oxidative effects on the formation of plasma thiobarbituric acid reactive substances (TBARS) and the production of plasma inducible nitric oxide (NO) in DMH-treated mouse. Also, 0.02% UDN glycoprotein suppressed the DNA binding activities of nuclear factor-kappa B (NF-kappaB) and activator protein-1 (AP-1), accompanying the inhibitions of its subunits (p50, p65, c-Jun, and c-Fos), pro-inflammatory proteins [inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2)], and pro-inflammatory cytokines [tumor necrosis factor (TNF)-alpha and interleukin (IL)-6] on DMH-stimulated ACF formation. On the basis of these results, we assume that UDN glycoprotein may be useful for colon cancer prevention at initiation stage.


Selective PEEP in acute bilateral lung disease. Effect on patients in the lateral posture.
Seven patients with acute respiratory failure due to diffuse and fairly uniform lung disease were studied during mechanical ventilation in the lateral decubital position with: (a) zero end-expiratory pressure (ZEEP) through a double-lumen oro-bronchial tube to permit a recording of the ventilation to each lung; (b) bilateral positive end-expiratory pressure (PEEP) of 1.2 kPa, with maintenance of ventilation distribution between lungs as observed during ZEEP; (c) selective PEEP of 1.2 kPa, applied to the dependent lung only, with ventilation as during ZEEP; and (d) conventional PEEP of 1.2 kPa applied to both lungs through a single-lumen tube, with free distribution of ventilation between the lungs. During ZEEP, 69% of ventilation was distributed to the non-dependent and 31% to the dependent lung; cardiac output was 6.51 X min-1, venous admixture (QS/QT) 40% and arterial oxygen tension (PaO2) 8.3 kPa. With bilateral PEEP, functional residual capacity (FRC) increased by 0.331, cardiac output was reduced to 5.11 X min-1 and venous admixture to 32%. PaO2 increased to 10.1 kPa. With selective PEEP the dependent lung FRC increased by 0.211 and the FRC of the non-dependent lung decreased by 0.081. Cardiac output increased to 6.11 X min-1, which was no longer significantly different from that during ZEEP. Venous admixture remained at the same level as with bilateral PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)


Opioid Use Patterns After Primary Total Knee Replacement.
Orthopedic surgeries are associated with the prescription of more narcotics than any other surgical specialty, particularly for total knee replacement (TKR) surgery. The authors examined controlled substance prescriptions following TKR surgery in a sample of 560 TKR patients. Results indicated that of all the 5164 prescriptions documented on the controlled substance monitoring database, 64% were for opioid medications. More than half of the patients received controlled substances from both the surgery site provider and a nonsurgery site provider in the year following surgery. The authors recommend that providers consider the possibility of outside prescribing when prescribing opioid analgesic.


A Micro Bubble Structure Based Fabry-Perot Optical Fiber Strain Sensor with High Sensitivity and Low-Cost Characteristics.
A high-sensitivity, low-cost, ultrathin, hollow fiber micro bubble structure was proposed; such a bubble can be used to develop a high-sensitivity strain sensor based on a Fabry-Perot interferometer (FPI). The micro bubble is fabricated at the fiber tip by splicing a glass tube to a single mode fiber (SMF) and then the glass tube is filled with gas in order to expand and form a micro bubble. The sensitivity of the strain sensor with a cavity length of about 155 μm and a bubble wall thickness of about 6 μm was measured to be up to 8.14 pm/μϵ.


Toxicity and antidiabetic activity of ethanolic extract of Sphagneticola trilobata (L.) Pruski flower in rats.
Plants are the source of medication for preventive, curative, protective or promotive purposes. Medicinal plants are an important source for generating of novel phytomedicine. They provide profound therapeutic benefits, more affordable treatments, effectiveness, less side effects and relatively low cost or less expensive and globally competitive. Using plant derived medicine is also relatively safe compared to synthetic medicines. Many plants have proved to successfully aid in the treatment of ailments including Sphagneticola triolobata (L.) Pruski. This study was therefore, designed to investigate acute and subacute toxicities, antidiabetic activity and also antioxidant activity of flower extract from S. triolobata (L.) Pruski. This research investigates the toxicity and antidiabetic activity of Sphagnelicola trilobata (L.) Pruski flower ethanolic extract in rats. Acute toxicity was determined by a single oral administration of S. trilobata extract of 1500, 2000, and 2500 mg/kg body weight; and subacute toxicity by oral administration every two days for 14 days. Signs of toxicity and mortality were observed during 24 h and for 14 days. Hematological values and blood chemistry were also characterized. The antidiabetic activity was examined by orally administering S. trilobata extract of 250 mg/kg body weight to streptozotocin-induced diabetic rats on a daily basis for eight weeks; and the body weight, blood glucose, serum insulin, and lipid profiles were determined. The antioxidant activity of the extract was assessed by 1, 1-diphenyl-2-picryl-hydrazyl free radical scavenging assay. The results demonstrated a median lethal dose (LD50) greater than 2500 mg/kg since there was no sign of toxicity and mortality in acute and subacute toxicity testing. The high LD50 indicated that S. trilobata flower ethanolic extract is safe for treatment of diabetes. There was no significant change in the body weight, hematological values, and blood chemistry of treated rats, compared with the control group. The diabetes-induced rats showed a significant reduction in blood glucose and triglyceride (p < 0.05). Meanwhile, the antioxidant activity of S. trilobata extract was lower than that of standard ascorbic acid.


[How to differentiate COVID-19 pneumonia from heart failure? A case report].
We report the case of a 64-year-old patient with a history of coronary artery disease and severe left ventricular dysfunction ischemic requiring medical therapy only admitted for dyspnea. The association of heart failure with COVID-19 pneumonia is discussed. The distinction between these two pathologies is based on a set of clinical, biological and radiological arguments.


Value of microarray allergen assay in the management of eosinophilic oesophagitis.
Eosinophilic oesophagitis (EoE) is a disorder characterised by oesophageal dysfunction and, histologically, by eosinophilic inflammation. Although treatment, which includes dilatations, oral corticosteroids and restrictive diets, is often effective, choosing the foods to be eliminated from the diet is difficult. Component resolved diagnostic by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process. We studied 67 patients with EoE, diagnosed clinically and histologically by endoscopic biopsy. CRD analysis with microarray technology was carried out in the 67 EoE patients, 50 patients with pollen allergy without digestive symptoms, and 50 healthy controls. Allergies were not detected by microarray in only seven of the 67 patients with EoE. Controls with pollen allergy showed sensitisation to different groups of pollen proteins without significant differences. In EoE patients with response to some allergens, the predominant allergens were grasses group 1 and, in particular, nCyn d 1 (Cynodon dactylon) or Bermuda grass pollen in 59.5%, followed by lipid transfer proteins (LTP) of peach (19.40%), hazelnut (17.91%) and Artemisia (19.40%). In patients with EoE, sensitisation to plant foods and pollen is important. The proteins most frequently involved are nCyn d 1 and lipid transfer proteins, hazelnuts and walnuts. After one year of an array-guided exclusion diet and pollen-specific immunotherapy in the case of high levels of response, patients with EoE showed preliminary significant improvements.


Heterotopic ossification after total ankle replacement: The role of prosthesis alignment.
The aetiology of heterotopic ossifications (HO) after total ankle arthroplasty (TAR) remains controversial. The aim of the study was to evaluate the prevalence and localisation of HO and the effect of alignment. 88 TARs with a series of radiological controls and follow-up of 36 months were evaluated. Frontal and sagittal alignment parameters (alfa and beta angle defined by Hintermann) and tibial coverage were evaluated. The prevalence and grading of HO increased over time, mostly in the posterior gutter. Varus alignment correlated with HO increase in the ventral and lateral gutters the first year. A dorsally located rotational centre correlated with total HO growth and HO in the posterior gutter. These correlations were not detected after 3 years, as HO were seen in all prostheses, regardless of alignment. HO grow over time with a prevalence up to 100% after 3 years. TAR alignment correlates with gutter-specific HO formation within the first year.


Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes.
The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes. 615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care. Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r=0.28, p<0.001) and access to healthy foods (r=-0.16, p=0.003) were significantly associated with self-care behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07, p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods (r=-0.20, p<0.001) remained significantly associated with self-care behaviors χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0). This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.


A case report of thyroid cancer showing a remarkable effect of gefitinib.
Thyroid cancer is a common type of cancer. The most radical treatment for this type of tumor is surgical removal. Gefitinib disrupts the EGFR kinase activity. This report describes a patient with thyroid cancer who demonstrated a complete response to gefitinib. The patient was a 56-year-old woman. She had been treated for lung cancer. The lung cancer had initially disappeared following chemoradiotherapy. However, a few months later, a distant metastasis was detected on the opposite lung field. Thyroid cancer was then incidentally observed when these lesions were examined. Fine needle aspiration cytology of the thyroid tumor with ultrasonography (US) showed papillary carcinoma. Finally, all of the lesions were treated with gefitinib. Gefitinib demonstrated a remarkable effect on both the thyroid and lung lesions. The CT showed a complete resolution of the masses in the lung, neck and thyroid. The present report suggests that treatment with gefitinib is therefore an effective option for thyroid papillary carcinoma.


MELAS: a mitochondrial encephalomyopathy syndrome.
MELAS, a syndrome characterized by Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like episodes, is one of a group of diseases known as mitochondrial encephalopathies. These genetically-transmitted diseases result in metabolic abnormalities associated with mitochondrial dysfunction, which contribute to neuronal destruction. Clinical manifestations include dementia, seizures, muscle weakness and stroke-like episodes. Accurate diagnosis is difficult to make and effective treatment is nonexistent at this time. The focus of care is supportive and the nurse's role centers on identification of deficits and maintenance of existing function.


Comparison of the anti-diabetic and nephroprotective activities of vitamin E, metformin, and Nigella sativa oil on kidney in experimental diabetic rats.
In this study, we aimed to evaluate and compare the nephroprotective and possible anti-diabetic effects of vitamin E, metformin, and Nigella sativa. Thirty male Wistar Albino rats were randomly divided into control, experimental diabetes (DM), vitamin E + DM, Metformin + DM, and N. sativa + DM. For experimental diabetes induction, IP 45 mg/kg streptozotocin was administered. Rats in vitamin E + DM, Metformin + DM, and N. sativa + DM received 100 mg/kg vitamin E, 100 mg/kg metformin, and 2.5 ml/kg N. sativa oil for 56 days. After the experiment, all animals were sacrificed, and blood and kidney samples were collected. The blood urea level of the DM group was significantly higher (P<0.01) than the control group. Urea levels in vitamin E, metformin, and N. sativa groups were similar to the control group (P>0.05) but significantly different from the DM group (P<0.01). Bax, caspase-3, and caspase-9 immunopositivity intensity were quite low in the control group, and similar to the N. sativa group (P>0.05). Bcl-2 immunopositivity density was highest in the N. sativa group, similar to the control group in terms of percentile area (P>0.05). When all three treatment methods were compared in terms of their effectiveness in alleviating DM and DN, it was determined that the most successful result was obtained with N. sativa oil.


[Current view on the pathogenesis of immune-mediated inflammatory diseases associated with ocular manifestations].
This literature review discusses the new concept of pathogenesis of systemic immune-mediated inflammatory diseases (IMIDs), presents their classification and analyzes their association with ocular manifestations.


Melanocortin 1 receptor variants, pigmentation, and skin cancer susceptibility.
The melanocortin 1 receptor is a key regulator of variation in normal human pigmentation. Genetic variants of this receptor cause red hair and fair skin, and several case-control studies have demonstrated that these genetic variants increase the risk of skin cancer development in humans. The mechanism whereby the risks of skin cancer are increased is not entirely clear, and may be because of a combination of effects on pigmentation and non-pigmentary pathways.


A systematic review of frailty education programs for health care professionals.
To identify and examine the reported effectiveness of education programs for health professionals on frailty. A systematic review was conducted of articles published up to June 2021, examining the evaluation of frailty training or education programs targeting health professionals/students. The participant demographics, program content and structure, effectiveness assessment methodology and outcomes, as well as participant feedback, were recorded with narrative synthesis of results. There were nine programs that have evaluated training of health professionals in frailty. These programs varied with respect to intensity, duration, and delivery modality, and targeted a range of health professionals and students. The programs were well-received and found to be effective in increasing frailty knowledge and self-perceived competence in frailty assessment. Common features of successful programs included having multidisciplinary participants, delivering a clinically tailored program and using flexible teaching modalities. Of note, many programs assessed self-perceived efficacy rather than objective changes in patient outcomes. Despite increasing attention on frailty in clinical practice, this systematic review found that there continues to be limited reporting of frailty training programs.


The anti-CD2 monoclonal antibody BTI-322 generates unresponsiveness by activation-associated T cell depletion.
The antihuman CD2 MoAb BTI-322 (Lo-CD2a) effectively inhibits T cell responses in vitro to allogeneic cells, which is followed by unresponsiveness to the original stimulator in secondary stimulation. We studied the xenogeneic human antiporcine mixed lymphocyte reaction (MLR), and utilized anti-T cell receptor (TCR) Vbeta family antibody-induced cell proliferation to determine the specificity and mechanism. BTI-322 and its humanized version, MEDI-507, effectively inhibited the primary xenogeneic MLR. After suboptimal primary stimulation using lower numbers of xenogeneic stimulator cells, the unresponsiveness in secondary culture was apparent only for xenogeneic stimulator cells of the original SLA haplotype, and not for third-party stimulators or allogeneic cells. The inhibition of primary MLR was not observed for nylon-wool-purified T cells, but was seen after reconstitution of purified T cells with monocytes. Similarly, anti-Vbeta family-specific stimulation showed family-specific unresponsiveness in secondary culture. This required the presence of the whole BTI-322 molecule: a F(ab')2 fragment was not effective. T cells of a distinct Vbeta family were depleted after stimulation with an anti-Vbeta family-specific antibody and BTI-322. We conclude that the inhibition by BTI-322 of a primary xenogeneic MLR or the response to an anti-TCR Vbeta antibody is associated with unresponsiveness upon restimulation, due to activation-associated cell depletion. In this process, the interaction between monocytes and the Fc part of the antibody is involved. This unique characteristic of BTI-322 suggests the potential of the antibody for tolerance induction in vivo, besides the potential use as a T cell depleting agent.


Maternal anxiety and neural responses to infant faces.
Women may be especially vulnerable to anxiety during the postpartum period and early infancy. However, little is known regarding the potential impact of maternal anxiety on the neural processing of infant-relevant information. In this ERP study, 47 recent mothers viewed neutral and distressed infant faces, concurrent with EEG collection. We examined the N170 as a perceptual marker of face processing and the late positive potential (LPP) as an index of engagement with stimulus processing. Mothers also completed the Spielberger State-Trait Anxiety Inventory. While the N170 was unaffected by infant affect and anxiety levels, the LPP was greater in amplitude for distressed vs. neutral faces. Moreover, the degree of LPP amplitude elicited by neutral infant faces was positively correlated with state anxiety. There were no associations between anxiety and the LPP elicited by distressed infant faces. We employed self-report measures of state and trait anxiety symptomatology and including diagnostic classification of anxiety disorders will be important in future research. These results indicate that recent mothers with higher levels of state anxiety may be more engaged with processing neutral infant cues.


Structural mechanisms for regulation of GSDMB pore-forming activity.
Cytotoxic lymphocyte-derived granzyme A (GZMA) cleaves GSDMB, a gasdermin-family pore-forming protein1,2, to trigger target cell pyroptosis3. GSDMB and the charter gasdermin family member GSDMD4,5 have been inconsistently reported to be degraded by the Shigella flexneri ubiquitin-ligase virulence factor IpaH7.8 (refs. 6,7). Whether and how IpaH7.8 targets both gasdermins is undefined, and the pyroptosis function of GSDMB has even been questioned recently6,8. Here we report the crystal structure of the IpaH7.8-GSDMB complex, which shows how IpaH7.8 recognizes the GSDMB pore-forming domain. We clarify that IpaH7.8 targets human (but not mouse) GSDMD through a similar mechanism. The structure of full-length GSDMB suggests stronger autoinhibition than in other gasdermins9,10. GSDMB has multiple splicing isoforms that are equally targeted by IpaH7.8 but exhibit contrasting pyroptotic activities. Presence of exon 6 in the isoforms dictates the pore-forming, pyroptotic activity in GSDMB. We determine the cryo-electron microscopy structure of the 27-fold-symmetric GSDMB pore and depict conformational changes that drive pore formation. The structure uncovers an essential role for exon-6-derived elements in pore assembly, explaining pyroptosis deficiency in the non-canonical splicing isoform used in recent studies6,8. Different cancer cell lines have markedly different isoform compositions, correlating with the onset and extent of pyroptosis following GZMA stimulation. Our study illustrates fine regulation of GSDMB pore-forming activity by pathogenic bacteria and mRNA splicing and defines the underlying structural mechanisms.


Palladium Single Atoms on TiO2 as a Photocatalytic Sensing Platform for Analyzing the Organophosphorus Pesticide Chlorpyrifos.
Traditional methods for analyzing organophosphorus pesticide chlorpyrifos, usually require the tedious sample pretreatment and sophisticated bio-interfaces, leading to the difficulty for real-time analysis. Herein, we use palladium single-atom (PdSA)/TiO2 as a photocatalytic sensing platform to directly detect chlorpyrifos with high sensitivity and selectivity. PdSA/TiO2 , prepared by an in situ photocatalytic reduction of PdCl42- on the TiO2 , shows much higher photocatalytic activity (10 mol g-1 h-1 ) for hydrogen evolution reaction than Pd nanoparticles (1.95 mol g-1 h-1 ), and excellent stability. In the presence of chlorpyrifos, the photocatalytic activity of PdSA/TiO2 decreases. Through this inhibition effect the platform can realize a detection limit for chlorpyrifos of 0.01 ng mL-1 , much lower than the maximum residue limit (10 ppb) permitted by the U.S. Environmental Protection Agency.


Physiological effects and brain protection by hypothermia and cerebrolysin after moderate forebrain ischemia in rats.
The "therapeutic window" of neuroprotective intervention due to hypoxic-ischemic brain injuries are initial disturbances of the neuronal function in regions of only moderate decrease of local cerebral blood flow (ICBF). Because of limited effects of single therapeutic principles therapeutic combinations should be tested. Neuroprotective effects of mild hypothermia and the nootropic drug Cerebrolysin (Cerebrolysin, EBEWE, Austria) on ICBF and development of brain edema were used. Four groups of adult Wistar rats (untreated and Cerebrolysin treated animals with 35 degrees C and 37 degrees C rectal temperature) were subjected to moderate forebrain ischemia by permanent bilateral carotid artery ligation for 6 h. The ICBF was measured continuously in the frontal and the occipital cortex by a 2-channel Laser Doppler flowmeter. The ECoG was derived from 4 ECoG leads above the frontal and occipital cortex and quantified by spectral analysis. Six hours after the onset of ischemia, the function of the blood-brain barrier to proteins was determined by staining with Evans Blue, the animals were sacrificed and the brain water content was estimated by gravimetry. Permanent bilateral carotid artery ligation led to an abrupt ICBF reduction to between 40-50% of baseline levels. Within a few minutes, however, the ICBF increased again to 50-80% of the baseline. The reduced spectral band power of the ECoG was correlated with the decreased ICBF values (p < 0.05) that indirectly indicated changes in the energy state of the neurons (p < 0.05). Changes in the ECoG appeared only with a delay of approximately 4 sec after the onset of ICBF reduction. Six hours after the onset of ischemia, a cytotoxic brain edema was shown in the frontoparietal cortex and hippocampus. Reducing the temperature by 2 degrees C diminished the decrease in ICBF between 10 min and 2 h after the onset of ischemia (p < 0.05). This effect was noted in the frontal but not in the occipital cortex. Furthermore, mild hypothermia prevented the loss of ECoG spectral power in the beta, alpha and theta bands (p < 0.05) as well as the development of cytotoxic brain edema. Cerebrolysin prevented the development of brain edema, too, both under normo- and hypothermic conditions. The ICBF was restored to higher levels in the occipital cortex in comparison both to the normothermic Cerebrolysin treated and hypothermic untreated rats (p < 0.05). This effect of Cerebrolysin was associated with only slight changes in ECoG, indicating that the neuronal activity state and the energy supply was obviously not decisively influenced. In conclusion, moderate ICBF reduction in rats to about 50-80% of baseline values was detectable in the ECoG by using spectral analysis. This reduction led to the development of cytotoxic brain edema in rats within 6 h. Thus, hypothermia prevents the development of cytotoxic brain edema. Cerebrolysin enhanced the effects of hypothermia on ICBF reduction and on the development of brain edema.


Outcomes of a Colorectal Enhanced Recovery After Surgery Protocol Modified for a Diverse and Urban Community.
Enhanced recovery after surgery (ERAS) colorectal programs have been shown to improve the length of stay (LOS) without increasing hospital resource utilization at academic centers worldwide. A multidisciplinary ERAS protocol that includes preoperative, intraoperative, and postoperative management guidelines was recently implemented at our urban, racially diverse, and academically affiliated community hospital. A delivery option was provided to reduce barriers to care. Given our unique patient population, the objective of our study was to determine if improvements in outcomes were reproducible in our hospital. This is a retrospective study of patients undergoing elective colectomy at New York-Presbyterian Queens Hospital between January 1, 2015, and December 31, 2020. Patient outcomes were compared between surgeries performed under standard practice (all colectomies prior to April 2017) and those performed after the implementation of the ERAS protocol. Demographic and perioperative data were abstracted from a prospectively derived database used to submit data to the National Surgical Quality Improvement Program. Additional data were obtained from chart review. Six hundred five elective colectomies were performed by 12 surgeons (range 1-228 cases) during the study period. Of these, 22 were performed open (41% followed ERAS), 467 were performed laparoscopically (57% followed ERAS), and 116 were performed robotically (74% followed ERAS). The average patient age was 64 y. Of which, 55% were male; 34% were Asian, 27% were non-Hispanic Caucasian, 27% were Hispanic, and 11% were Black or African American (all P-values > 0.05 for ERAS versus non-ERAS). Average duration of procedure was longer in the ERAS group (262 min versus 243 min, P = 0.04), although when stratified by procedure type, this relationship held true only for laparoscopic procedures. Hospital LOS was significantly shorter in the ERAS group (4.3 versus 5.4 d, P < 0.001) and this relationship held true for procedures performed both laparoscopically (4.2 versus 5.3 d, P = 0.01) and robotically (4.1 versus 5.1 d, P = 0.04). Of the ERAS group, patients who opted for delivery of ERAS components (n = 205) had the shortest LOS when compared to patients who picked up components (n = 91) or opted out of ERAS (n = 309) (4.1 versus 4.4 versus 5.2 d, P = 0.003). No significant differences were found for 30-d mortality, 30-d readmission, wound infection, or other postoperative complications (all P-values > 0.05). Implementation of an ERAS protocol in an urban, diverse, academically affiliated community hospital is associated with reductions in LOS for colectomies performed both laparoscopically and robotically. Facilitating ERAS compliance with a delivery option was also associated with improvements in hospital LOS. Preoperative nutrition supplementation was not associated with outcomes. No differences in mortality, readmission rates, or rates of postoperative complications were found.


The synergistic action of two chitinases from Vibrio harveyi on chitin degradation.
In this study, two chitinases (VhChit2 and VhChit6) from Vibrio harveyi possessed specific activity of 36.5 and 20.8 U/mg, respectively. Structure analysis indicates that their amino acid composition of active sites is similar, but the substrate binding cleft of VhChit2 is deeper than that of VhChit6. They were shown to have a synergistic effect on chitin degradation, and the optimized degree of synergy and the degradation ratio of chitin reached 1.75 and 23.6 %, respectively. The saturated adsorption capacity of VhChit2 and VhChit6 adsorbed in 1 g of chitin was 48.5 and 33.4 mg. It was found that VhChit2 and VhChit6 had different adsorption sites on chitin, making more enzymes absorbed by chitin. Furthermore, the combined use of VhChit2 and VhChit6 increased their binding force of chitinases with the substrate. The synergistic action of VhChit2 and VhChit6 may be attributed to their different adsorption sites on chitin and the increased binding force with chitin.


The development and validation of a simple antigen detection ELISA for Plasmodium falciparum malaria.
A double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) is described for the detection of Plasmodium falciparum antigen. The test is based on an immunoglobulin (Ig) M capture monoclonal antibody on the solid phase and an IgG monoclonal antibody conjugated to peroxidase. The simple test takes about 2.5 h to complete and, because it uses whole blood with no prior treatment, it is possible to process batches of 50-100 samples simultaneously. The test is specific to P.falciparum and has a sensitivity close to that usually achieved with Giemsa-stained blood films. The reagents employed are stable at refrigerator temperatures for over 6 months, and as the test is compatible with human immunodeficiency virus and hepatitis B surface antigen ELISAs it could be suitable for blood transfusion screening.


Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma.
There are limitations in using only radiological criteria to evaluate treatment outcomes in hepatocellular carcinoma (HCC). α-fetoprotein (AFP) is regarded as an indicator of tumour activity in HCC. We present a novel correlation between AFP response and survival outcome in patients treated with localized concurrent chemoradiotherapy (CCRT). From 2005 to 2008, 187 locally advanced HCC patients underwent localized CCRT (external beam radiotherapy at 45 Gy over 5 weeks plus a concurrent hepatic arterial infusion of 5-fluorouracil during the first/fifth week), followed by repetitive hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil and cisplatin. Among them, 149 with an elevated baseline AFP level (>20 ng/ml) were finally studied. AFP response was defined as >50% decrease from baseline, 1 month after the completion of localized CCRT. Patients' characteristics were as follows: median age (52 years); Child-Pugh class A/B (n=137/12 respectively); and portal vein thrombosis (n=118). AFP responders (101 patients) had better objective responses than AFP non-responders (48 patients) after CCRT (44.5 vs. 12.5%; P<0.001) and subsequent HAIC (51.5 vs. 16.7%; P<0.001). Both median progression-free survival (PFS, 8.1 vs. 3.9 months; P<0.001) and overall survival (OS, 13.3 vs. 5.9 months; P<0.001) were longer in AFP responders than AFP non-responders. In multivariate analysis, AFP response and objective response were independent factors affecting PFS and OS. Furthermore, AFP non-responders were more likely to have extrahepatic metastasis within 6 months of treatments initiation than AFP responders (59.5 vs. 25.9%; P<0.001). Early AFP response may be useful not only in predicting prognosis and treatment response but also in establishing optimized treatment plans for HCC.


Role of EUS in the early detection of small pancreatic cancer.
The prognosis of pancreatic cancer is extremely poor as a result of the difficulty in early detection of small pancreatic cancer and the intractable nature of appropriate anti-cancer therapies. Computed tomography (CT) is generally used for initial screening, but imaging sensitivities are generally insufficient to detect small masses. Endoscopic ultrasonography (EUS), in contrast, exhibits higher sensitivity than other imaging modalities for the detection of pancreatic cancers, because of the high resolution of images. The goal of this study was to evaluate the role of EUS in the early detection of small pancreatic cancer. We retrospectively reviewed the Gifu University Hospital EUS database (November 2007 to October 2010), and extracted the data of patients whose aim was to confirm the presence or absence of pancreatic cancer subsequent to no tumor detection by abdominal CT. In a 3 year period, 132 patients underwent EUS to confirm the presence or absence of small pancreatic cancer. All patients had previously tested negative for pancreatic mass using abdominal CT, but had showed pancreatic cancer risk factors, including increased serum carcinoembryonic antigen and/or CA 19-9 (n = 106), serum amylase (n = 38), and/or mild to moderate dilation of the main pancreatic duct as determined by imaging (n = 88). EUS detected pancreatic mass in three of these patients. The masses in all three patients were minute (≤10 mm) and their presence was correlated with the detection of mild dilation of the main pancreatic duct in earlier CT scans. Increase of tumor markers was observed in two patients and hyperamylasemia and aggravation of diabetes were observed in one patient. EUS is strongly recommended for early detection of small pancreatic cancer in patients in whom the dilation of the main pancreatic duct was detected in previous imaging tests, with or without increase of pancreatic enzymes or tumor markers.


Effect of the incorporation of lignin microparticles on the properties of the thermoplastic starch/pectin blend obtained by extrusion.
The present study aimed to produce thermoplastic starch films with different concentrations of thermoplastic pectin and the addition of 4% lignin microparticles as a reinforcing and active agent. The pectin improved the modulus of elasticity, and decreased the elongation at break. In addition, it improved the UV light protection to 100% at 320 nm and 95.9% at 400 nm. The incorporation of lignin microparticles improved the thermal stability of the blends made with 25% and 50% thermoplastic pectin when compared to the pectin-free blends. The blend with 25% thermoplastic pectin led to an increase of 75.8% and 34% in elongation at break and deformation of the films, respectively. This blend also improved the UV light protection to 100% due to its dark brown color. Regarding the permeability properties, the films with 25% and 50% thermoplastic pectin showed lower oxygen permeability (48% and 65%) and an increase in the antioxidant activities from 2.7% to 71.08% and 4.1% to 79.28%, respectively. Thus, the polymer blend with 25% thermoplastic pectin with the incorporation of lignin microparticles proved to be a good alternative for use in foods sensitive to the effects of oxygen and UV light.


Simultaneous quantitative determination of five alkaloids in Catharanthus roseus by HPLC-ESI-MS/MS.
To establish a method to simultaneously determine the main five alkaloids of Catharanthus roseus for trace samples, a high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS) analysis method was developed. The five Catharanthus alkaloids, vinblastine, vincristine, vinleurosine, vindoline, and catharanthine were chromatographically separated on a C18 HPLC column. The mobile phase was methanol-15 nmol·L(-1) ammonium acetate containing 0.02% formic acid (65 : 35, V/V). The quantification of these alkaloids was based on the Multiple Reaction Monitoring (MRM) mode. This method was validated, and the results achieved the aims of the study. The intra- and inter-day precision and accuracy of the five alkaloids were within 1.2%-11.5% (RSD%) and -10.9%-10.5% (RE%). The recovery rates of the five alkaloids of samples were from 79.9% to 91.5%. The five analytes were stable at room temperature for 2 h, at 4 °C for 12 h, and at -20 °C for two weeks. The developed method was applied successfully to determine the content of the five alkaloids in three plant parts of three batches of C. roseus with a minute amount collected from three regions of China. The HPLC-ESI-MS/MS method can be used for the simultaneous determination of five important alkaloids in trace C. roseus samples.


Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery.
To compare the impact of two different types of mitral valve surgery on health-related quality of life, we conducted a retrospective study comparing modified totally endoscopic mitral valve surgery with median sternotomy mitral valve surgery. A total of 163 patients who underwent mitral valve surgery at our institution between January 1, 2019 and December 31, 2019 were enrolled. For these 163 patients, mitral valve surgery was performed using either a modified totally endoscopic approach or median sternotomy approach. We used the numerical rating scale and the Scar Cosmesis Assessment and Rating Scale to measure pain intensity and the aesthetic appearance of the surgical incision and used the MOS 36-item Short-Form Health Survey to assess health-related quality of life. Seventy-eight patients underwent the modified totally endoscopic mitral valve surgery, and eighty-five patients underwent the median sternotomy mitral valve surgery. The two groups of patients were similar in terms of demographics and echocardiography findings. The number of bioprosthetic valve replacements performed was significantly higher in the totally endoscopic group than in the median sternotomy group (p = 0.04), whereas the subvalvular apparatus was less preserved in only 33 cases in the totally endoscopic group (p = 0.01). The rate of postoperative adverse events was similar between the two groups. The pain was mild and aesthetic appearance was significantly better in the totally endoscopic approach group than in the sternotomy approach group. Significant differences in the scores for the bodily pain and mental health subscales of the MOS 36-item Short-Form Health Survey were found between the two groups. Compared with median sternotomy mitral valve surgery, totally endoscopic mitral valve surgery has an equally good treatment effect, improving patient's health-related quality of life with a better cosmetic appearance and a lower pain intensity. Our study suggested that the totally endoscopic approach is superior to the median sternotomy approach in terms of pain intensity, aesthetic appearance and health-related quality of life.


Cognitive demands and mental workload: A filed study of the mining control room operators.
Cognitive demand and mental workload assessment are essential for the optimal interaction of human-machine systems. The aim of this study was to investigate the cognitive demands and mental workload as well as the relationship between them among the mining control room operators. This cross-sectional study was performed on 63 control room operators of a large mining plant located in Iran. Cognitive demands and mental workload were assessed using cognitive task analysis (CTA) and NASA Task Load Index (NASA-TLX), respectively and the analysis was performed using SPSS version 21. Independent samples T-test, Mann-Whitney U test and multivariate linear regression were used for data analysis. Twelve cognitive demands were extracted after observing the tasks and conducting semi-structured interviews with the control room staff. The mean scores of total cognitive demands and MWL were 6.60 and 72.89, respectively, and these two indicators showed a positive and significant correlation (r = 0.286; P = 0.023). The participants' demographic characteristics such as age, education, and work experience did not affect mental workload, but the two cognitive demands (memory and defect detection) affected MWL. High cognitive demands and mental workload indicate poor interaction between humans and machines. Due to the effect of memory load and defect detection on mental workload, it is recommended to assign cognitive tasks based on memory and defect detection to the machine to reduce the mental workload and improve human-machine interaction.


Resveratrol inhibits type II phosphatidylinositol 4-kinase: a key component in pathways of phosphoinositide turn over.
Resveratrol has anti-inflammatory, cardio protective and cancer chemopreventive properties. The molecular targets for resveratrol in early signaling cascades are not well understood. Resveratrol inhibits type II PtdIns 4-kinase but not PtdIns 3-kinase activity in vitro. Resveratrol directly binds to the enzyme with a Kd of 7.2 microM. Kinetic studies show that resveratrol competes with PtdIns binding. Inhibition of PtdIns 4-kinase activity by resveratrol/phenylarsine oxide reduces Jurkat cell adhesion to matrigel/fibronectin coated surfaces, suggesting a role for type II PtdIns 4-kinase in lymphocyte infiltration to the sites of inflammation.


Binder free cobalt iron phosphate thin films as efficient electrocatalysts for overall water splitting.
Designing nanostructure based robust catalyst for the electrochemical water splitting is the great task in the energy conversion field to accomplish high electrical conductivity, low overpotential and long lasting activity. Herein, the electrochemical overall water splitting is reported by using the hydrothermally synthesized binder free cobalt iron phosphate thin films on low cost stainless steel substrates as a conducting backbone for the first time. The effect of composition ratio variation of cobalt and iron was studied on the structural, compositional, morphological, and surface electronic properties by conducting various characterizations which results in amorphous hydrous cobalt iron phosphate having mesoporosity. The as synthesized cobalt iron phosphate having composition ratio (50:50 of Co:Fe) exhibits excellent electrochemical OER and HER catalytic water splitting performance. Best performing electrode exhibits smallest overpotentials of 251.9 mV and 55.5 mV for OER and HER respectively at 10 mA/cm2 current density. To split water molecule into the H2 and O2 by overall water splitting in same alkaline medium, the potential of 1.75 V was required after long duration (100 h) catalysis. Overall analysis confirms the cobalt iron phosphate thin films are outstanding and robust for the hydrogen production as clean renewable energy source.


A machine learning-derived echocardiographic algorithm identifies people at risk of heart failure with distinct cardiac structure, function, and response to spironolactone: Findings from the HOMAGE trial.
An echocardiographic algorithm derived by machine learning (e'VM) characterizes pre-clinical individuals with different cardiac structure and function, biomarkers, and long-term risk of heart failure (HF). Our aim was the external validation of the e'VM algorithm and to explore whether it may identify subgroups who benefit from spironolactone. The HOMAGE (Heart OMics in AGEing) trial enrolled participants at high risk of developing HF randomly assigned to spironolactone or placebo over 9 months. The e'VM algorithm was applied to 416 participants (mean age 74 ± 7 years, 25% women) with available echocardiographic variables (i.e. e' mean, left ventricular end-diastolic volume and mass indexed by body surface area [LVMi]). The effects of spironolactone on changes in echocardiographic and biomarker variables were assessed across e'VM phenotypes. A majority (>80%) had either a 'diastolic changes' (D), or 'diastolic changes with structural remodelling' (D/S) phenotype. The D/S phenotype had the highest LVMi, left atrial volume, E/e', natriuretic peptide and troponin levels (all p < 0.05). Spironolactone significantly reduced E/e' and B-type natriuretic peptide (BNP) levels in the D/S phenotype (p < 0.01), but not in other phenotypes (p > 0.10; pinteraction <0.05 for both). These interactions were not observed when considering guideline-recommended echocardiographic structural and functional abnormalities. The magnitude of effects of spironolactone on LVMi, left atrial volume and a type I collagen marker was numerically higher in the D/S phenotype than the D phenotype but the interaction test did not reach significance. In the HOMAGE trial, the e'VM algorithm identified echocardiographic phenotypes with distinct responses to spironolactone as assessed by changes in E/e' and BNP.


Characterization and expression analysis of immune-related genes in the red swamp crayfish, Procambarus clarkii in response to lipopolysaccharide challenge.
To learn more about red swamp crayfish related genes in response to bacterial infections, we investigated immune-related genes induced by lipopolysaccharide (LPS) in the hepatopancreas using high-throughput sequencing method. In present the study, a total of 55,107 unigenes were identified, with an average length of 678 bp. A total of 2215 differentially expressed genes (DEGs) were found, including 669 up-regulated genes and 1546 down-regulated genes. The result of Gene ontology (GO) analysis revealed that 3017 DEGs were enriched in 19 biological process subcategories, 17 cellular component subcategories and 15 molecular function subcategories. The top 20 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways showed that "ribosome" was the most abundant group, which had 34 DEGs. KEGG enrichment analysis identified several immune response pathways. Real-time quantitative reverse transcription-PCR (qRT-PCR) results exhibited that several immune responsive genes were greatly up-regulated following LPS stimulation as observed in the results of high-throughput sequencing. Overall, this study provides new insight into the immune defense mechanisms of P. clarkii against LPS infection.


Parental Conflicts and Posttraumatic Stress of Children in High-Conflict Divorce Families.
Parental conflicts consistently predict negative outcomes for children. Research suggests that children from high-conflict divorces (HCD) may also experience post-traumatic stress symptoms (PTSS), yet little is known about the association between parental conflicts in HCD families and child PTSS. We investigated this association, hypothesizing that parental conflicts would predict child PTSS. We also tested the moderating role of interparental contact frequency, hypothesizing that frequent contact would intensify the association between parental conflicts and child PTSS. This study was part of an observational study on the outcomes of No Kids in the Middle (NKM), a multi-family group intervention for HCD families. A total of 107 children from 68 families participated in the study with at least one parent. We used pre- (T1) and post-intervention (T2) data. Research questions were addressed cross-sectionally, using regression analyses to predict PTSS at T1, and longitudinally, using a correlated change (T1 to T2) model. The cross-sectional findings suggested that mother- and child-reported conflicts, but not father-reported conflicts, were related to the severity of child PTSS. Longitudinally, we found that change in father-reported conflicts, but not change in child- or mother-reported conflicts, were related to change in child PTSS. The estimated associations for the different informants were not significantly different from one another. The frequency of contact between ex-partners did not moderate the relationship between parental conflicts and child PTSS. We conclude that there is a positive association between parental conflicts and child PTSS in HCD families independent of who reports on the conflicts. The online version contains supplementary material available at 10.1007/s40653-021-00410-9.


Spinal fluid lysozyme in the diagnosis of central nervous system tumours.
C.S.F. lysozyme concentrations were determined in 24 normal subjects and 14 patients with a variety of neurologic diseases. We found absent or very low activity (below 0-5 mg/ml, in 4 out of 24) in normal individuals. Patients with tumours and other neurological diseases had high lysozyme activity in C.S.F. Our findings suggest that lysozyme is not an accurate indicator of the presence of neoplastic disease as suggested by other investigators.


Genetic characteristics of an amikacin-resistant Brucella abortus strain first isolated from Marmota himalayana.
Brucella spp. are facultative intracellular pathogens that can persistently colonize animal host cells and cause zoonotic brucellosis. Brucellosis affects public health and safety and even affects economic development. Our lab found that a Brucella strain isolated from Marmota himalayana exhibited amikacin resistance. To annotate and analyze the potential resistance genes in this strain, we utilized sequencing platforms in this study and cloned potential resistance genes. The findings showed that the isolated strain belonged to B. abortus biovar 1 and was similar to B. abortus 2308. The isolate had amikacin resistance genes encoding aminoglycoside 3'-phosphotransferase. Based on the results of genome analysis, the isolated strain may have obtained amikacin resistance genes from Salmonella spp. through Tn3 family transposons. Notably, this study establishes a foundation for further research on the resistance mechanism of Brucella spp. and provides data that may be useful for the prevention and control of drug-resistant Brucella strains.


Identification of subunits of bovine heart cytochrome oxidase.
Purified lipid-depleted cytochrome oxidase, at purity of 12--14 nmol heme a per mg protein, has been shown to contain seven non-identical subunits in the ratio of unity. Their molucular weights on polyacrylamide gel are, in thousands, 40, 21, 14.8, 13.5, 11.6, 9.5, and 7.6 from gel electrophoresis after dissociation in sodium dodecyl sulfate and beta-mercaptoethanol. The molar ratio is determined by the amino acid composition of each subunit obtained from direct hydrolysis of the stained polyacrylamide gel slices. The amino acid composition of the isolated subunits I and II determined by regular hydrolysis method is found practically the same as that from direct hydrolysis of gel slices. The heme-associated polypeptides are identified with subunits of molecular weights of 40.10(3) and 11.6.10(3). One of the two coppers associated with the polypeptide of molecular weight of 21 000. The second copper may be associated with heme in the subunit of 40.10(3). Evidence of the existence of interpolypeptide disulfide linkages is presented.


Shifting the LDL-receptor paradigm in familial hypercholesterolemia: novel insights from recent kinetic studies of apolipoprotein B-100 metabolism.
Familial hypercholesterolemia (FH) is a dominantly inherited disorder associated with elevated plasma cholesterol concentrations and premature cardiovascular disease. In addition to impaired low density lipoprotein (LDL) receptor-mediated clearance of low density lipoproteins in FH, evidence from in vitro and in vivo studies suggests that hepatic oversecretion of apoB may contribute to the hypercholesterolemia. The proposed association between apoB secretion and FH may, however, be a function of the class of LDL receptor defect. Hepatic cholesterol pools appear to regulate apoB secretion and LDL receptor activity. Therefore, therapeutic regulation of cholesterogenesis in FH may have the dual effect of reducing hepatic apoB secretion and upregulating the LDL receptor. These effects may also be genetically determined.


Animal models of pain: progress and challenges.
Many are frustrated with the lack of translational progress in the pain field, in which huge gains in basic science knowledge obtained using animal models have not led to the development of many new clinically effective compounds. A careful re-examination of animal models of pain is therefore warranted. Pain researchers now have at their disposal a much wider range of mutant animals to study, assays that more closely resemble clinical pain states, and dependent measures beyond simple reflexive withdrawal. However, the complexity of the phenomenon of pain has made it difficult to assess the true value of these advances. In addition, pain studies are importantly affected by a wide range of modulatory factors, including sex, genotype and social communication, all of which must be taken into account when using an animal model.


Effects of social isolation and the time of day on testosterone levels in plasma of C57BL/6By and BALB/cBy mice.
Adult male C57BL/6By and BALB/cBy mice were housed either in large groups (20 per cage) or individually, and levels of plasma testosterone were measured in samples taken in the morning (9 to 10 A.M.) and in the evening (9 to 10 P.M.). No significant strain differences were found in testosterone levels, but the mean testis weight was significantly higher in the BALB/cBy strain. Two-way analysis of variances of pooled plasma testosterone data showed that social isolation of males results in a significant increase in A.M. (but not P.M.) testosterone concentrations and increased testis weight in both strains. Our results suggest that differential housing of a social species can affect testicular function. Since testicular function can also be influenced by the time of day, the question is raised whether the expression of circadian variation in plasma testosterone level is dependent on population density.


Prophylactic effect of lafutidine against the adverse reaction induced in rat stomach by repeated administration of 5-fluorouracil.
We examined the prophylactic effect of lafutidine, a histamine H2 receptor antagonist, on the morphological and functional derangement of the rat stomach after the administration of 5-fluorouracil (5-FU) in the absence or presence of taurocholate Na (TC). Rats were given 5-FU p. o. once daily for 5 days. After 18 hr fasting, the animals were given omeprazole to inhibit acid secretion. Under urethane anesthesia, the stomach was mounted on an ex-vivo chamber, perfused with 100 mM HCl, and both the transmucosal potential difference (PD) and gastric mucosal blood flow (GMBF) were simultaneously measured before and after exposure of the mucosa to 20 mM TC for 30 min. The 5-FU treatment lowered the basal PD with a decrease in the mucosal height and caused few haemorrhagic lesions in the stomach when perfused with 100 mM HCl for 2 hr. The 5-FU treatment had no influence on the reduced PD response caused by TC, but significantly impaired the increase in GMBF after exposure to TC, resulting a marked aggravation of gastric lesions. Lafutidine, given together with 5-FU for 5 days, significantly antagonized the deleterious effect of 5-FU on the basal PD and the GMBF response to TC, and prevented the aggravation of gastric lesions. These effects of lafutidine were not mimicked by cimetidine and disappeared due to the chemical ablation of capsaicin-sensitive afferent neurons. We conclude that 1) 5-FU treatment caused the morphological and functional derangement of the stomach and increased the mucosal vulnerability against acid, and 2) lafutidine prevents such changes caused by 5-FU treatment, probably mediated through capsaicin-sensitive afferent neurons.


[Digital technology and nursing practice, opportunities and disparities between hospital and community care].
While the use of digital technology has developed in nursing practice in the hospital setting, this movement is late to arrive in homecare. Structural factors can explain these disparities, which are also due to insufficient training of private practice professionals and the fact that digital tools are not always suited to their mode of practice. However, there are adapted and innovative solutions, such as platforms for the organisation of homecare.


Understanding the Life, Pain, and Barriers to Physical Activity in Korean Patients with Panic Disorder: Photovoice Inquiry.
This study attempted to understand the life, pain, and barriers to physical activity in the daily life of patients with panic disorder (PD). It aimed to provide specific evidence to promote physical activity for patients, suggesting that suitable physical activity strategies for patients with PD would be of value. Seven patients were invited to participate in a photovoice study. Photovoice is one example of participatory action research. This study inductively identified two main themes: the life and pain of patients with PD and perceived barriers to participate in physical activity by patients with panic disorder. Based on a specific understanding of the population, this study attempted to provide evidence why patients with panic disorder need appropriate physical-activity-promoting strategies.


Study of V1a vasopressin receptor gene single nucleotide polymorphisms in platelet vasopressin responsiveness.
There is a significant heterogeneity among individuals in terms of platelet aggregation response to arginine vasopressin (AVP). The aim of this study was to evaluate whether four single nucleotide polymorphisms (SNPs) in the promoter region of vasopressin V1a receptor gene (V1aR) could be used as genetic markers for divergent platelet aggregation response to AVP. Seventeen of 33 subjects showed more than 60% of maximum platelet aggregation and were classified as responders. Sixteen were classified as nonresponders because they had less than 30% aggregation. In a preliminary study, V1aR gene sequences were determined in two responders and two nonresponders. We found four SNPs in the promoter region of the V1aR gene: -6951G/A, -4112A/T, -3860T/C, and -242C/T. In all 33 subjects the genotypes of four SNPs were determined using either polymerase chain reaction (PCR) with allele-specific primers or PCR followed by restriction-fragment length polymorphism (RFLP). There were no differences in the AVP-induced aggregation between the subjects with and without variant alleles of each four SNPs. The genotype frequencies of four SNPs of V1aR were almost identical between AVP responders and nonresponders. These results suggest that the four SNPs in the promoter region of the V1aR gene may not be useful as genetic markers for platelet aggregation heterogeneity.


Early non-specific modulation of corticospinal excitability during action observation.
Activity of the primary motor cortex (M1) during action observation is thought to reflect motor resonance. Here, we conducted three studies using transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) of the first dorsal interosseus muscle (FDI) during action observation to determine: (i) the time course of M1 corticospinal excitability during the observation of a simple finger movement; (ii) the specificity of M1 modulation in terms of type of movement and muscle; and (iii) the relationship between M1 activity and measures of empathy and autistic traits. In a first study, we administered single-pulse TMS at 30-ms intervals during the observation of simple finger movements. Results showed enhanced corticospinal excitability occurring between 60 and 90 ms after movement onset. In a second experiment, TMS-induced MEPs were recorded from the FDI and abductor digiti minimi muscles while pulses were delivered 90 ms after movement onset during observation of simple finger movement and dot movement. Increased corticospinal excitability was restricted to finger movement and was present in both muscles. Finally, in an exploratory experiment, single-pulse TMS was administered at 30, 90 and 150 ms after movement onset, and participants were asked to complete the Empathy Quotient (EQ) and the Autism Spectrum Quotient (AQ). Correlational analysis revealed a significant link between motor facilitation at 90 ms and the EQ and AQ scores. These results suggest that corticospinal excitability modulation seen at M1 during action observation is the result of a rapid and crude automatic process, which may be related to social functioning.


Molecular identification of ovine Theileria species by a new PCR-RFLP method.
Theileria spp. infect wild and domestic ruminants in the tropical and subtropical regions of the world. Two species, T. lestoquardi and T. ovis, are suspected to cause ovine theileriosis in Iran. The epidemiological aspects of ovine theileriosis in Iran are poorly understood, and further investigations by sensitive and precise techniques are required. In this study, the use of a nested PCR for amplification of a fragment of the 18S ribosomal DNA from virtually all species of Theileria is described. For differentiation of various Theileria spp. a RFLP assay was developed as a diagnostic tool enabling direct, concurrent, highly specific and sensitive identification of Theileria spp. The sensitivity of the nested PCR for Theileria species was 10(-5)% parasitemia. Restriction fragment length polymorphism (RFLP) of the PCR products allowed differentiation between three different Theileria species (T. annulata, T. lestoquardi and T. ovis) and seems to be useful for differentiation of other species such as T. separata and Theileria spp. china. From 100 field blood samples obtained from sheep in East and South-East Iran, 56% were positive for Theileria spp. by nested-PCR compared with 21% by microscopic examination. Out of 56 positive samples, 12.5% (7/56) were positive for T. ovis and 87/5% (49/56) were positive for T. lestoquardi. This is the first report in which T. ovis has been detected in Iran using molecular identification techniques.


Does omeprazole improve asthma-control in poorly-controlled asthmatic children with gastro-esophageal reflux.
The role of gastro-esophageal reflux disease (GERD) in poorly controlled asthma is often mentioned, but published studies have presented discordant results. Our main objective was to assess the effectiveness of GERD treatment in controlling asthma in children. We conducted a prospective study including poorly controlled asthmatic children aged 4 to 16 years. We checked the presence of acid reflux using pH monitoring. Patients with GERD were randomized into two groups; one received omeprazole for 6 months and the control group was not treated. The outcome was the score of the children asthma control test at the end of 6 months. The acid suppression was checked at the end of treatment with pH monitoring. After treatment, children with persistent acid reflux received high PPI doses and therefore were reevaluated 6 months later. We included 102 children with poorly controlled asthma among which 59 (57.8%) had acid reflux. Gastroesophageal reflux (GER) was significantly more common in boys (p = 0.04). Treatment with omeprazole in sufficient doses improved the control of asthma in 5 children out of 6 (84.8 vs 11.5; p<.0001). Three factors appeared to be statistically associated with asthma control improvement after PPI therapy: male sex (p=.04), normal birth weight (p=.05) and a positive Prick-test (p=.05). These factors were not confirmed or were not sufficiently precise in multivariate analysis. The likelihood of a causal relationship between acid reflux and asthma, difficult to highlight with pH monitoring, was poor. This study confirmed the high prevalence of GER in poorly controlled asthmatic children and showed the possible benefit of an efficient GER treatment in improving asthma control.


Colonoscopy or barium enema for population colorectal cancer screening?
There is good evidence from faecal occult blood testing trials that detection and removal of non-advanced colorectal neoplasms can achieve a reduction in colorectal cancer mortality. Both colonoscopy and barium enema have potential advantages and disadvantages if implemented for population screening. The relative merits of each are discussed.


Sinogenic brain abscess complicating pregnancy.
Cerebral abscess is an extremely rare complication of pregnancy. We report a case of a patient at 36 weeks of gestation presenting with severe headache, confusion, and seizures after starting treatment for sinusitis. Imaging revealed a left temporal lobe abscess, which was treated with broad-spectrum antibiotics. Neurologic deterioration in a gravida with sinusitis suggests secondary sinogenic intracranial suppurative complications.