Prognostic factors in arthroplasty in the rheumatoid shoulder.
Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact.


Contemporary experience with laparoscopic partial nephrectomy.
We evaluated our contemporary outcomes with laparoscopic partial nephrectomy (LPN) for renal cortical neoplasms (RCN) by an experienced single surgeon in our last 100 consecutive patients. We reviewed a prospectively established database and identified 378 patients who underwent LPN for RCN. Data from the most recent 100 consecutive patients (June 2007 to August 2009) were evaluated for oncologic, functional, and recovery outcomes, and tumors were stratified by size. There were 57 men and 43 women. The mean tumor size was 2.8 cm (range 0.9-9.0 cm). The mean operative time was 132 minutes (range 95-350 minutes) and the mean blood loss was 175 mL (range 25-1000 mL). There were 13 (13%) complications. Seventy-seven tumors were ≤4 cm (group 1) and 23 tumors were >4 cm (group 2). The groups were similar in terms of demographics, perioperative data, and complications. The mean warm ischemia time in groups 1 and 2 were 25.9 and 29.5 minutes, respectively (P=.04). Overall, 79% of the tumors were malignant renal cell carcinoma variants with a positive margin rate of 2%. With a median follow-up of 8 months, there was 1 local recurrence. The median change between preoperative estimated glomerular filtration rate and 3 months' follow-up estimated glomerular filtration rate was 10.1 mL per minute per 1.73 m(2) (P>.001). LPN is a safe and effective treatment option for RCN. With extensive experience and a well-developed surgical technique, patient outcomes are improved and postoperative complications are reduced. LPN may be applied to more complex cases including larger and hilar tumors.


Uterine artery embolisation or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: a cost-utility analysis of the FEMME trial.
To assess the cost-effectiveness of uterine artery embolisation (UAE) and myomectomy for women with symptomatic uterine fibroids wishing to avoid hysterectomy. Economic evaluation alongside the FEMME randomised controlled trial. 29 UK hospitals. Premenopausal women who had symptomatic uterine fibroids amenable to UAE or myomectomy wishing to avoid hysterectomy. 254 women were randomised to UAE (127) and myomectomy (127). A within-trial cost-utility analysis was conducted from the perspective of the UK NHS. Quality-adjusted life years (QALYs) measured using the EuroQoL EQ-5D-3L, combined with costs to estimate cost-effectiveness over 2 and 4 years of follow-up. Over a 2-year time horizon, UAE was associated with higher mean costs (difference £645; 95% CI -1381 to 2580) and lower QALYs (difference -0.09; 95% CI -0.11 to -0.04) when compared with myomectomy. Similar results were observed over the 4-year time horizon. Thus, UAE was dominated by myomectomy. Results of the sensitivity analyses were consistent with the base case results for both years. Over 2 years, UAE was associated with higher costs (difference £456; 95% CI -1823 to 3164) and lower QALYs (difference -0.06; 95% CI -0.11 to -0.02). Myomectomy is a cost-effective option for the treatment of uterine fibroids. The differences in costs and QALYs are small. Women should be fully informed and have the option to choose between the two procedures. Fully informed women with uterine fibroids should have a choice between uterine artery embolisation or myomectomy.


Measurement of regional cerebral glucose uptake by magnetic resonance spin-lock imaging.
The regional uptake of glucose in rat brain in vivo was measured at high resolution using spin-lock magnetic resonance imaging after infusion of the glucose analogue 2-deoxy-d-glucose (2DG). Previous studies of glucose metabolism have used 13C-labeled 2DG and NMR spectroscopy, 18F-labeled fluorodeoxyglucose (FDG) and PET, or chemical exchange saturation transfer (CEST) MRI, all of which have practical limitations. Our goal was to explore the ability of spin-lock sequences to detect specific chemically-exchanging species in vivo and to compare the effects of 2DG in brain tissue on CEST images. Numerical simulations of R1p and CEST contrasts for a variety of sample parameters were performed to evaluate the potential specificity of each method for detecting the exchange contributions of 2DG. Experimental measurements were made in tissue phantoms and in rat brain in vivo which demonstrated the ability of spin-lock sequences for detecting 2DG. R1p contrast acquired with appropriate spin-lock sequences can isolate the contribution of exchanging protons in 2DG in vivo and appears to have better sensitivity and more specificity to 2DG-water exchange effects than CEST. Spin-lock imaging provides a novel approach to the detection and measurement of glucose uptake in brain in vivo.


Outbreak of respiratory syncytial virus subtype ON1 among children during COVID-19 pandemic in Southern Taiwan.
The regional respiratory syncytial virus (RSV) outbreak in southern Taiwan in late 2020 followed the surge of RSV cases in the national surveillance data and displayed distinct clinical features. This study investigated RSV epidemiology in the most recent five years and compared the clinical manifestations of this outbreak with non-outbreak period. Medical records of RSV-infected children at the National Cheng Kung University Hospital from January 2016 to December 2020 were retrospectively retrieved from hospital-based electronic medical database. Cases of RSV infection were identified by RSV antigen positive and/or RSV isolated from respiratory specimens. The demographic, clinical presentations, and laboratory data were recorded. The RSV isolates in 2020 was sequenced for phylogenetic analysis. Overall, 442 RSV-infected cases were retrieved and 42.1% (186 cases) clustered in late 2020. The 2020 outbreak started in September, peaked in November, and lasted for 3 months. 2020 RSV-infected children were older (2.3 ± 2.2 years vs. 1.0 ± 1.0 years), more likely to be diagnosed with bronchopneumonia (57.5% vs. 31.6%), but also had a lower hospitalization rate, shorter hospital stay, less oxygen use, and less respiratory distress than those in 2016-2019 (all p value < 0.05). The RSV isolates in 2020 belonged to RSV-A subtype ON1 but were phylogenetically distinct from the ON1 strains prevalent in Taiwan previously. The 2020 RSV outbreak was led by the novel RSV-A subtype ON1 variant with clinical manifestations distinct from previous years. Continuous surveillance of new emerging variants of respiratory viruses in the post-pandemic era is warranted.


Relationships between single nucleotide polymorphisms of antioxidant enzymes and disease.
The presence and progression of numerous diseases have been linked to deficiencies in antioxidant systems. The relationships between single nucleotide polymorphisms (SNPs) arising from specific antioxidant enzymes and diseases associated with elevated oxidative stress have been studied with the rationale that they may be useful in screening for diseases. The purpose of this narrative review is to analyse evidence from these studies. The antioxidant enzyme SNPs selected for analysis are based on those most frequently investigated in relation to diseases in humans: superoxide dismutase (SOD2) Ala16Val (80 studies), glutathione peroxidise (GPx1) Pro197Leu (24 studies) and catalase C-262T (22 studies). Although the majority of evidence supports associations between the SOD2 Ala16Val SNP and diseases such as breast, prostate and lung cancers, diabetes and cardiovascular disease, the presence of the SOD2 Ala16Val SNP confers only a small, clinically insignificant reduction (if any) in the risk of these diseases. Other diseases such as bladder cancer, liver disease, nervous system pathologies and asthma have not been consistently related to this SOD SNP genotype. The GPx1 Pro197Leu and catalase C-262T SNP genotypes have been associated with breast cancer, but only in a small number of studies. Thus, currently available evidence suggests antioxidant enzyme SNP genotypes are not useful for screening for diseases in humans.


Acute hyperinsulinemia increases neuropeptide Y concentrations in the hypothalamic arcuate nucleus of fasted rats.
Neuropeptide Y, a major hypothalamic peptide, stimulates feeding, insulin secretion and weight gain when injected intrahypothalamically. Hypothalamic NPY may be regulated by insulin availability at hypothalamic level, as its activity is apparently inhibited by intrahypothalamic insulin administration and is stimulated under insulin-deficient conditions. To determine the effects of acute physiological hyperinsulinemia, we measured regional hypothalamic NPY levels in rats during a hyperinsulinemic, euglycemic clamp. Seven male Wistar rats with implanted jugular cannulae, fasted for 24 h, were infused with insulin at 100 mU/h together with variable-rate glucose to maintain euglycemia (3.9 +/- 0.1 mmol/l), for 150 min. Controls were infused for the same period with polygeline vehicle alone (n = 8), and had blood glucose concentrations of 4.0 +/- 0.5 mmol/l. Insulin levels were 80.2 +/- 3.9 mU/l in insulin-infused rats and 15.2 +/- 1.4 mU/l in polygeline-treated controls (p < 0.001). NPY levels, measured by radioimmunoassay, were significantly higher in the arcuate nucleus/median eminence (ARC/ME) of hyperinsulinemic rats than in controls (4.8 +/- 1.2 vs 2.5 +/- 0.6 fmol/micrograms protein; p < 0.001), but were comparable with controls in 7 other hypothalamic regions. Acute physiological hyperinsulinemia therefore increases NPY levels selectively in the ARC/ME. Insulin could cause NPY accumulation in the ARC by blocking its transport to NPY-sensitive areas. This would be consistent with the suggestions that insulin inhibits hypothalamic NPY activity and also acts as a central satiety factor.


Climate and health concerns of Montana's public and environmental health professionals: a cross-sectional study.
Rural health professionals stand at the forefront of community response to climate change, but few studies have assessed their perceptions of the threat. Further, no previous study has compared the opinions of environmental to public health professionals or extensively analyzed the factors related to these experts' climate beliefs, risk perceptions, and issue prioritization. In conjunction with the Montana Climate Assessment's 2021 Special Report on Climate Change and Human Health, the 479 members of the Montana Public Health Association and Montana Environmental Health Association were surveyed during September-October 2019, with 39% completing the survey. We summarized descriptive data about their perceptions of local climate-related changes and their beliefs that global warming is happening, is mostly human-caused, is a risk to human health, and that their offices and others should take action. We also evaluated which sociodemographic and risk perception factors related to these climate beliefs, risk perceptions, and workplace issue prioritization. Health professionals in Montana, a politically conservative state, demonstrated high levels of awareness that global warming is happening, human-caused, and a threat to human health, well above reported rates of public concern. Eighty-eight percent said that global warming is occurring and 69% that it is mostly anthropogenic. Sixty-nine percent said that their own health was already affected by climate, and 86% said they were already seeing at least one climate change-related event in their communities. Seventy-two percent said that their departments should be preparing to deal with climate change's health effects, but just 30% said that it is currently happening. We found no statistically significant differences between Montana environmental health and public health professionals in regression models predicting climate beliefs, risk perception, and prioritization. As in studies of the public, political ideology and the observation of local climate-related changes were the strongest factors. Montana environmental and public health officials said that departmental action was needed on climate change, indicating the readiness of rural health professionals to take action. Further studies of health professionals in rural regions are warranted.


Mechanisms of twinning. V. Conjoined twins, stem cells and the calcium model.
To examine the possible role of calcium in conjoined twinning. Conjoined (CJ) twins are an extreme example of monozygotic (MZ) twinning. Data were collected from various sources on factors to which gravidas who deliver CJ twins were exposed around the time of conception. A significant number of such women were subjected to environmental triggers. Of particular interest is increased CJ twinning following use of oral contraceptives. It is hypothesized that this resulted from prolonged ovulatory dysfunction in lightweight women. The incidence of uniovular twinning is inversely related to women's prepregnancy weights. These observations are consistent with the proposed general model of MZ twinning. Factors that induce calcium depression and delayed implantation encourage uniovular duplication in general and CJ twinning in particular.


Loss of BMP signaling mediated by BMPR1A in osteoblasts leads to differential bone phenotypes in mice depending on anatomical location of the bones.
Bone morphogenetic protein (BMP) signaling in osteoblasts plays critical roles in skeletal development and bone homeostasis. Our previous studies showed loss of function of BMPR1A, one of the type 1 receptors for BMPs, in osteoblasts results in increased trabecular bone mass in long bones due to an imbalance between bone formation and bone resorption. Decreased bone resorption was associated with an increased mature-to-immature collagen cross-link ratio and mineral-matrix ratios in the trabecular compartments, and increased tissue-level biomechanical properties. Here, we investigated the bone mass, bone composition and biomechanical properties of ribs and spines in the same genetically altered mouse line to compare outcomes by loss of BMPR1A functions in bones from different anatomic sites and developmental origins. Bone mass was significantly increased in both cortical and trabecular compartments of ribs with minimal to modest changes in compositions. While tissue-levels of biomechanical properties were not changed between control and mutant animals, whole bone levels of biomechanical properties were significantly increased in association with increased bone mass in the mutant ribs. For spines, mutant bones showed increased bone mass in both cortical and trabecular compartments with an increase of mineral content. These results emphasize the differential role of BMP signaling in osteoblasts in bones depending on their anatomical locations, functional loading requirements and developmental origin.


Seizure frequency in more than 180,000 treatment sessions with hyperbaric oxygen therapy - a single centre 20-year analysis.
Hyperbaric oxygen therapy (HBOT) involves the risk of central nervous system oxygen toxicity (CNS-OT), including seizures in patients breathing oxygen at pressures ≥ 2 atmospheres absolute. This study aimed to determine the seizure frequency and assess the clinical benefit of a 5-minute air-break (5´-AIRBK). Twenty-year (1999-2018) retrospective analysis of all consecutive treatments with HBOT. Medical records were reviewed to determine patient demographics, comorbidities, HBOT indications, and seizure characteristics and timing. Seizure frequency was compared before and after incorporating a 5´-AIRBK in the treatment protocol. Chi-square testing was performed using SPSS (version 24.0); P < 0.05 was accepted as statistically significant. We evaluated 188,335 HBOT sessions (74,255 before versus 114,080 after introducing a 5´-AIRBK). A total of 43 seizures were observed: 29 before and 14 after the 5´-AIRBK introduction (3.9 versus 1.2 per 10,000 treatments; P < 0.0001). Seizures occurred after a median of 57 (range 15-85) minutes following compression and after a median of 21 HBOT sessions (1-126). Patients experiencing seizures were undergoing treatment for: diabetic ulcer (n = 11); acute traumatic peripheral ischaemia (ATPI) (n = 6); non-diabetic ulcer (n = 5); sudden sensorineural hearing loss (n = 5); chronic refractory osteomyelitis (n = 5); radionecrosis (n = 3); necrotising fasciitis (NF) (n = 2); and haemorrhagic cystitis after allogeneic bone marrow transplantation (n = 1). ATPI and NF had a considerably higher relative frequency of seizures compared to other indications. A statistically significant lower seizure frequency was achieved with a 5´-AIRBK. Assessing and defining the appropriate patient/treatment profile can be useful to minimise the risk of CNS-OT.


Comparison of two different methods for performing combination analysis of force and posture risk factors in an epidemiological study.
This study aimed to introduce a method of simultaneous combination analysis of multiple exposure parameters for large epidemiological studies of work-related upper-extremity musculoskeletal disorders (MSD) and compare this analysis method with the conventionally used job-level combination analysis method when applied in exposure-response analysis of work-related upper-extremity MSD. Health outcome [carpal tunnel syndrome (CTS)] and physical exposure (forceful exertion and hand/wrist postures) data for 733 subjects were obtained from the baseline period of a 3-year work-related upper-extremity MSD study. Determinations of CTS cases were done based on a set of defined criteria. Physical exposure variables of several different types of forceful exertions and three different hand/wrist postures were collected onsite, processed, and analyzed using both a simultaneous combination and job-level combination analysis method. The commonly used job-level combination analysis method resulted in significantly different combination exposure distributions compared to the simultaneous combination analysis method, although the absolute differences were small. Both methods showed some significantly higher combined force-posture exposures among CTS cases than non-cases. The simultaneous combination method provides more realistic distribution information on combined exposure parameters compared to the job-level combination method that has been commonly used in epidemiological studies. The newly developed simultaneous combination analysis method needs to be used in larger scale work-related upper-extremity MSD epidemiological studies to test its predictive power compared to the job-level combination analysis method.


Ebselen and diphenyl diselenide change biochemical hepatic responses to overdosage with paracetamol.
The toxicity of paracetamol is largely related to its conversion to the reactive intermediate alkylating metabolite N-acetyl-para-benzo-quinoneimine (NAPQI). δ-Aminolevulinate dehydratase (δ-ALA-D) is a sulfhydril containing enzyme which is extremely sensitive to oxidizing and alkylating agents. In the present study, we examined whether acute treatment with paracetamol changes δ-ALA-D activity. The influence of two organochalcogenides with glutathione peroxidase-like activity, diphenyl diselenide [(PhSe)(2)] and ebselen was also assessed as potential protecting agents against paracetamol toxicity. Paracetamol (1200mg/kg for three days 4h after the injection of DMSO, diphenyl diselenide (100μmol/kg) or ebselen (100μmol/kg) caused an inhibition of about 40% (P < 0.01) in hepatic δ-ALA-D. Ebselen restored enzyme activity to control values. Non-protein-SH and ascorbic acid were diminished to 50% of control value by paracetamol, independent of chalcogenides treatment (all P values <0.05). In view of the fact that paracetamol caused a massive reduction in non-protein-SH and ascorbic acid, we realize that the protective effect of ebselen on δ-ALA-D activity is mediated by its thiol peroxidase-like activity or by a direct interaction with NAPQI and other reactive species formed during paracetamol metabolism.


Enhancing X-ray generation by electron-beam-laser interaction in an optical bragg structure.
We demonstrate that x-ray radiation emitted by relativistic electrons scattered by a counter-propagating laser pulse guided by an adequate Bragg structure surpasses by about 2 orders of magnitude the energy generated by a conventional free-space Gaussian-beam configuration, given the same e beam and injected laser power in both configurations.


The Use of Bruton's Tyrosine Kinase Inhibitors to Treat Allergic Disorders.
Studies show that inhibitors of Bruton's tyrosine kinase (BTKis), currently FDA-approved for the treatment of B cell malignancies, can prevent IgE-mediated reactions through broad inhibition of the FcεRI signaling pathway in human mast cells and basophils. This review will summarize recent data supporting the use of these drugs as novel therapies in various allergic disorders. Recent studies have shown that BTKis can prevent IgE-mediated degranulation and cytokine production in primary human mast cells and basophils. Two oral doses of the second-generation BTKi acalabrutinib can completely prevent moderate passive systemic anaphylaxis in humanized mice and even protect against death during severe anaphylaxis. Furthermore, two doses of ibrutinib can reduce or eliminate skin prick test responses to foods and aeroallergens in allergic subjects. BTKis in development also show efficacy in clinical trials for chronic urticaria. Unlike other therapies targeting IgE, such as omalizumab, BTKis appear to have rapid onset and transient effects, making them ideal candidates for intermittent use to prevent acute reactions such as IgE-mediated anaphylaxis. These studies suggest that BTKis may be capable of preventing IgE-mediated anaphylaxis, paving the way for future trials in food allergy and urticaria.


Fluorescent proteins for quantitative microscopy: important properties and practical evaluation.
More than 20 years after their discovery, fluorescent proteins (FPs) continue to be the subject of massive engineering efforts yielding continued improvements. Among these efforts are many aspects that should be of great interest to quantitative imaging users. With new variants frequently introduced into the research community, "tried and true" FPs that have been relied on for many years may now be due for upgrades to more modern variants. However, the dizzying array of FPs now available can make the initial act of narrowing down the potential choices an intimidating prospect. This chapter describes the FP properties that most strongly impact their performance in quantitative imaging experiments, along with their physical origins as they are currently understood. A workflow for evaluating a given FP in the researcher's chosen experimental system (e.g., a specific cell line) is described.


Risk of Rupture of Small Intracranial Aneurysms (≤5 mm) Among the Chinese Population.
We sought to develop a model to predict the risk of small intracranial aneurysm (SIA; ≤5 mm) rupture among Chinese adults and to compare the score predicted by our model with the PHASES (population, hypertension, age, size, earlier subarachnoid hemorrhage, aneurysm site) score. From August 2011 to June 2015, 366 patients with 394 SIAs were retrospectively evaluated and followed up for ≥5 years. The clinical characteristics of the patients were reviewed from their medical records, and the SIA features were evaluated from the imaging studies. The independent risk factors for SIA rupture were studied using multiple Cox proportional hazards regression analysis. The diagnostic value of the PHASES score for the prediction of SIA rupture was also calculated. Six SIAs in 6 different patients had ruptured during a mean follow-up of 6.4 years. An irregular shape (odds ratio [OR], 31.464), a high aspect ratio (OR, 40.573), and a high size ratio (OR, 20.541) increased the risk of rupture. The predictive score incorporated these three factors. The threshold was 1.5, and the area under the curve, sensitivity, and specificity were 0.986, 100%, and 94.6%, respectively. For the PHASES score, the area under the curve, sensitivity, and specificity were 0.702, 83.3%, and 62.1%, respectively. An irregular shape, a high aspect ratio, and a high size ratio were associated with SIA rupture in the Chinese population. Our predictive score is of great value in predicting the risk of SIA rupture.


FAP positive fibroblasts induce immune checkpoint blockade resistance in colorectal cancer via promoting immunosuppression.
Immune checkpoint blockades that significantly prolonged survival of melanoma patients have been less effective on colorectal cancer (CRC) patients. Growing evidence suggested that fibroblast activation protein-alpha (FAP) on cancer associate fibroblasts (CAFs) has critical roles in regulating antitumor immune response by inducing tumor-promoting inflammation. In this study, we explored the roles of FAP in regulating the tumor immunity and immune checkpoint blockades resistance in CRC experimental systems. We found that CAFs with high FAP expression could induce immune checkpoint blockade resistance in CRC mouse model. Mechanistically, CAFs with high FAP expression promoted immunosuppression in the CRC tumor immune microenvironment by up-regulating CCL2 secretion, recruiting myeloid cells, and decreasing T-cell activity. In human CRC samples, FAP expression was proportional to myeloid cells number, but inversely related to T-cell number. High FAP expression also predicted poor survival of CRC patients. Taken together, our study suggested that high FAP expression in CAFs is one reason leading to immune checkpoint blockades resistance in CRC patients and FAP is an optional target for reversing immune checkpoint blockades resistance.


Ga-68 DOTATATE PET/CT and F-18 FDG PET/CT in the evaluation of low and intermediate versus high-grade neuroendocrine tumors.
We investigated the role of Ga-68 DOTATATE PET/CT in comparison to F-18 FDG PET/CT in patients with low and intermediate versus high-grade neuroendocrine tumors (NETs). We identified 81 patients who underwent Ga-68 DOTATATE PET/CT at our institution between May 2017 and December 2018 and met inclusion criteria of biopsy-proven NET with known Ki-67 index, histologic grade, or differentiation. Patients were divided into two groups. Control group included Ki-67 ≤20%, grade 1 or 2, or well-differentiated tumors. Experimental group included Ki-67 >20%, grade 3, or poorly-differentiated tumors. Mean age was 57 years, with 36 males and 45 females. Most common primary sites were small bowel, pancreas, and lung. Most common distant metastatic sites were liver and bone. In the control group (n = 67), median Ki-67 was 4% (range 1-30%). 55/67 (82.1%) DOTATATE and 6/11 (54.5%) FDG scans were positive (P = 0.04). Positive scans showed >10 lesions in 25/55 (45.5%) DOTATATE and 1/6 (16.7%) FDG scans (P = 0.18). 40/55 (72.7%) positive DOTATATE and 3/6 (50%) FDG scans showed distant disease (P = 0.25). In the experimental group (n = 14), median Ki-67 was 68% (range 25-95%). All 14 DOTATATE and all nine FDG scans were positive. Positive scans showed >10 lesions in 4/14 (28.6%) DOTATATE and 5/9 (55.6%) FDG scans (P = 0.20). 10/14 (71.4%) positive DOTATATE and 7/9 (77.8%) FDG scans showed distant disease (P = 0.74). All patients with high grade, poorly-differentiated NETs had positive DOTATATE PET/CTs. In these patients, DOTATATE PET/CT did not significantly differ from FDG PET/CT in identifying >10 lesions or distant disease.


Application of wood biochar in polluted soils stabilized the toxic metals and enhanced wheat (Triticum aestivum) growth and soil enzymatic activity.
Biochar is a stable carbonaceous by-product of pyrolysis and can be used for toxic metals (TMs) retention in polluted soil. Wheat (Triticum aestivum) was grown in three polluted soils collected from Chenzhou (CZ), Tongguan (TG) and Fengxian (FX), China. Wood biochar (WBC) was applied at 0, 0.5, 1.0 and 2.0% to each pot filled with 2 kg polluted soil. The results showed that WBC was efficient to alter soil pH and electrical conductivity (EC). The changes in soil pH and EC had a direct relationship with the immobilization and phytostabilization of TMs in the three soils. The bioavailable TMs (Zn, Pb, Cd, and Cu) were reduced in the soil after WBC amendments due to ion exchange, precipitates of metal-carbonates and metal-phosphates, and chemisorption on WBC surface. The reduction in the bioavailable TMs content also resulted in the diminution in TMs shoot uptake in wheat. Similarly, the TMs uptake in wheat root were also reduced as a result of WBC application. The reduction in bioavailable TMs and the release of essential nutrients and base cations from the WBC also increased the wheat shoot and root dry biomasses production. The application of WBC in polluted soil also improved soil health and the urease and β-glucosidase enzymes were also enhanced. The results concluded that WBC was efficient to reduce the bioavailability of TMs and shoot and root uptake, improved wheat dry biomasses production and soil enzymatic activities in industrial and smelter/mines polluted soils.


Escherichia coli Hfr-DNA degradation in endonuclease I-deficient minicells.
[3H]Thymidine (dThd)-labelled Hfr DNA was transferred by conjugation into Escherichia coli F- minicells harvested from an endonuclease I-deficient (endI-) strain and its iosgenic wild type (endI+) parent. The susceptibility of this DNA to attack by DNAase was examined. The kinetics of in vivo conversion of [3H]dThd-labelled DNA into acid soluble radioactivity was examined. This activity, attributed to exonuclease action was the same for both strains. Contribution of endonuclease I was measured by an analysis of changes in weight-average (Mw) and number-average (Mn) molecular weight distribution of DNA molecules recovered from minicells. Reduction in Mw was greater in the endI-strain. The ratio Mn/Mw changed drastically during the incubation period of endI- minicells, but remained unchanged in the endI+ strain. These experiments suggest that the presence of the endI- mutation in minicell-producing strain chi1268 leads to a greater loss in M2 of Hfr DNA conjugally transferred into the minicells.


Between a cough and a wheeze: dendritic cells at the nexus of tobacco smoke-induced allergic airway sensitization.
Exposure to cigarette smoke represents a major risk factor for the development of asthma. Enhanced sensitization toward allergens has been observed in humans and laboratory animals exposed to cigarette smoke. Pulmonary dendritic cells (DCs) are crucially involved in sensitization toward allergens and play an important role in the development of T helper (Th)2-mediated allergic airway inflammation. We propose the concept that aberrant DC activation forms the basis for the deviation of the lung's default tolerogenic response toward allergic inflammation when harmless antigens are concomittantly inhaled with tobacco smoke. This review will summarize evidence suggesting that tobacco smoke can achieve this effect by providing numerous triggers of innate immunity, which can profoundly modulate airway DC biology. Tobacco smoke can affect the airway DC network either directly or indirectly by causing the release of DC-targeted mediators from the pulmonary tissue environment, resulting in the induction of a Th2-oriented pathological immune response. A thorough knowledge of the molecular pathways involved may open the door to novel approaches in the treatment of asthma.


Genetic variation within and among infrapopulations of the marine digenetic trematode Lecithochirium fusiforme.
Allozyme markers were used to study genetic variation in Lecithochirium fusiforme within a natural population of Conger conger. Six of 16 enzyme-coding loci studied were found to be polymorphic. These loci were surveyed in 12 infrapopulations of adult flukes. High levels of genetic variation were detected (P = 0.375); Ho = 0.048; He = 0.085). However, the population did not conform to Hardy-Weinberg expectations, as it showed a significant deficit of heterozygotes. L. fusiforme also exhibited low differentiation between infrapopulations (FST = 0.064). Despite significant linkage disequilibrium at Pgm-1 and Pgm-2 (P < 0.05), mating system does not appear to be the principal reason for the deficit of heterozygotes detected, because some polymorphic loci were in Hardy-Weinberg equilibrium. Association between FIS and FST statistics suggests the existence of the Wahlund effect. However, all infrapopulations showed a strong deficit of heterozygotes for most polymorphic loci (FIS = 0.409). Detection of significant genetic differentiation among temporal samples and the existence of paratenic hosts in the life-cycle suggests the Wahlund effect, caused by the mixture of genetically distinct temporal samples in the infrapopulations. Occasional temporal gene flow also might explain the high estimated genetic polymorphism.


Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis.
This distillation of the peer-reviewed scientific literature on infection after cataract surgery summarizes background material on epidemiology, etiology, and pathogenesis, describes the roles of surgical technique and antibiotic prophylaxis in prevention, and discusses diagnostic and therapeutic interventions in cases of suspected endophthalmitis.


[Therapy of malignant hepatic tumors using percutaneous hot saline injections. Feasibility study and preliminary results].
To investigate the feasibility and the results of percutaneous hot saline injection therapy (PSIT) of liver tumors. Eight patients with hepatocellular carcinoma (11 nodules), 1 with cholangiocarcinoma and 1 with a metastasis from colon cancer underwent PSIT. The patients were selected according to variable criteria; thus, each patient was considered apart. A boiling saline solution was injected into the hepatic lesions through a needle like those commonly used for percutaneous ethanol injection (PEI). The results were assessed with US, CT, angiography, the measurement of tumor marker levels, the histopathologic examination of needle biopsy material, resected specimens, explanted liver material and follow-up. PSIT was more easily performed and altogether better accepted than PEI; in particular, pain immediately regressed upon infusion interruption. For this reason and for the atoxicity of the injected liquid, relatively large lesions could be treated with a greater volume per session and fewer sessions than with PEI. Treatment outcome was positive in all patients, except for the cholangiocarcinoma patient who required surgery. The only major complication was moderate peritoneal bleeding in a patient with severe coagulopathy. PSIT can be considered a useful tool for the local treatment of hepatic tumors. Its systematic use to treat hepatocellular carcinoma must be proceeded by further comparative studies with PEI.


Sixteenth Daniel C. Baker, Jr, memorial lecture. Surgical management of supraglottic cancer and its lymph node metastases in a conservative perspective.
Supraglottic laryngectomy combined with functional elective or curative neck dissection is a priceless contribution toward treatment of supraglottic cancer and its lymph node metastases. The history and background of this conservative approach is reviewed. Results related to staging are presented. Irradiation as a combined or alternative therapy is considered.


Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection.
The prognosis for patients with advanced gallbladder carcinoma is dismal despite aggressive surgical resection. The aim of this study is to determine useful prognostic factors for patients with gallbladder carcinoma following aggressive surgical resection. Medical records of 62 patients with gallbladder carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of clinicopathological factors on long-term survival. According to the UICC staging system, ten (16%), 11 (18%), eight (13%), 16 (25%), nine (15%), and eight patients (13%) were diagnosed with stages I, II, IIIA, IIIB, IVA, and IVB disease, respectively. Partial hepatectomy and pancreatoduodenectomy were performed for 43 (69%) and 11 (18%) patients, respectively. Overall survival rates of all 62 and 41 patients with UICC stages III and IV disease were 71% and 56% at 1 year, 48% and 23% at 3 years, and 48% and 23% at 5 years, respectively (median survival time, 15.8 and 12.7 months, respectively). Multivariate analysis revealed that independent prognostic factors included tumor differentiation (p = 0.006), hepatic invasion (p = 0.002), lymph node metastasis (p = 0.009), and surgical margin status (p = 0.002) for all patients, and adjuvant chemotherapy (p = 0.005), tumor differentiation (p = 0.008), hepatic invasion (p = 0.001), and surgical margin status (p = 0.022) for patients with UICC stages III and IV disease. R0 resection and adjuvant chemotherapy are significant prognostic factors in advanced gallbladder carcinoma and should be performed to improve survival.


Effect of tirzepatide on albuminuria levels and renal function in patients with type 2 diabetes mellitus: A systematic review and multilevel meta-analysis.
The present systematic review aimed to summarize the available evidence from published randomized controlled trials (RCTs) regarding the effect of tirzepatide on albuminuria levels and renal function in patients with type 2 diabetes mellitus. Medline (via PubMed), Cochrane Library and Scopus were searched until 20 October 2023. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled with a three-level mixed-effects meta-analysis. In total, 9533 participants from eight RCTs were analysed. All RCTs had a low risk of bias, according to the Cochrane Collaboration tool (RoB2). Tirzepatide was associated with a significantly greater reduction in urine albumin-to-creatinine ratio compared with controls [mean difference (MD) -26.9%; 95% confidence interval (CI) (-34.76, -19.04); p < .001; level of evidence (LoE) moderate]. This effect remained significant in participants with baseline urine albumin-to-creatinine ratio ≥30 mg/g [MD -41.42%; 95% CI (-54.38, -28.45); p < .001; LoE moderate]. Based on subgroup analysis, the comparative effect of tirzepatide was significant against placebo and the insulin regimen, whereas no difference was observed compared with semaglutide. The beneficial effect of tirzepatide on albuminuria levels remained significant across all investigated doses (5, 10 and 15 mg), showing a dose-response relationship. A neutral effect was observed on the estimated glomerular filtration rate [MD 0.39 ml/min/1.73m2 ; 95% CI (-0.64, 1.42); p = .46; LoE moderate]. Our findings suggest that tirzepatide probably leads to a significant reduction in albuminuria across all administered doses, while its use is associated with a neutral effect on creatinine clearance as a measure of renal function.


Recurrence rate with inferior conjunctival autograft transplantation compared with superior conjunctival autograft transplantation in pterygium surgery: a meta-analysis.
Conjunctival autograft transplantation from superior conjunctiva is often chosen to lower the postoperative recurrence rate for pterygium treatment. However, inferior conjunctival autograft (ICA) might be taken as an alternative surgery method, especially under certain conditions. Consequently, we designed this research to estimate and contrast the result of inferior conjunctival autograft and superior conjunctival autograft (SCA) on the postoperative recurrence rate. We searched through network database (PubMed, Embase and Cochrane Central Register of Controlled Trials) to choose suitable randomized controlled trials (RCTs). Based on Cochrane review methods, we evaluated eligibility and risk of bias of included studies. The primary measures included postoperative recurrence rate. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were assessed. RevMan 5.3 software was utilized to conduct statistical analysis. Four RCTs composed of a total of 438 eyes were included in this meta-analysis, with 234 eyes in the inferior conjunctival autograft group and 204 eyes in the superior conjunctival autograft group. Statistical meta-analysis revealed that the postoperative recurrence rate was similar between the two groups (RR = 0.77, 95% CI: 0.36 to 1.62, P = 0.49). Only two RCTs applied the postoperative pain scale and one of them did not provided adequate numbers. Our meta-analysis indicated that inferior autograft transplantation and superior autograft transplantation had a similar effect on postoperative recurrence rate. The inferior autograft group might have a less postoperative pain. Subsequent RCTs which have more patients participated and more outcomes are needed to confirm our conclusions in years to come.


Site-directed mutagenesis of the aspartokinase gene lysC and its characterization in Brevibacterium flavum.
Using overlap extension polymerase chain reaction (PCR), five transformants of Escherichia coli containing site-directed mutagenized lysC beta gene were generated and analysed. Exchange of C to A and C to T at nucleotide 1118 of the mutated lysC beta gene causes a substitution of serine301 in the wild-type enzyme for tyrosine301 and phenylalanine301 in the mutant enzymes, respectively. Enzyme assays showed that Brevibacterium flavum cells harbouring pSUMN18 with mutated lysC beta genes exhibited 16-20 fold lower specific activities of aspartokinase as compared to that of host containing wild-type lysC gene. The mutation introduced into lysC beta of B. flavum CCRC 18271 resulted in partial feedback-resistant aspartokinase activity.


Autosomal dominant retinitis pigmentosa: a new multi-allelic marker (D3S621) genetically linked to the disease locus (RP4).
We report the characterization of a new eight-allele microsatellite (D3S621) isolated from a human chromosome 3 library. Two-point and multi-locus genetic linkage analysis have shown D3S621 to co-segregate with the previously mapped RP4 (theta m = 0.12, Zm = 4.34) and with other genetic markers on the long arm of the chromosome, including D3S14 (R208) (theta m = 0.00, Zm = 15.10), D3S47 (C17) (theta m = 0.11, Zm = 4.95), Rho (theta m = 0.07, Zm = 1.37), D3S21 (L182) (theta m = 0.07, Zm = 2.40) and D3S19 (U1) (theta m = 0.13, Zm = 2.78). This highly informative marker, with a polymorphic information content of 0.78, should be of considerable value in the extension of linkage data for autosomal dominant retinitis pigmentosa with respect to locii on the long arm of chromosome 3.


Homing ability of adult cardinalfish is affected by elevated carbon dioxide.
The levels of carbon dioxide (CO(2)) predicted for the oceans by the end of this century have recently been shown to impair olfactory discrimination in larval fishes. However, whether this disruption extends to olfactory-mediated behaviour in adult fishes is unknown. In many fishes, adult survival and reproduction can be critically dependent upon navigation to home sites. We tested the effects that near-future levels of CO(2) (550, 700 or 950 ppm) have on the ability of adult five-lined cardinalfish, Cheilodipterus quinquelineatus, to home to their diurnal resting sites after nocturnal feeding. Cardinalfish exposed to elevated CO(2) exhibited impaired ability to distinguish between odours of home- versus foreign-site conspecifics in pair-wise choice experiments. A displacement experiment demonstrated that fish from all CO(2) treatments displayed a 22-31% reduction in homing success compared with control fish when released at 200 m from home sites. While CO(2)-exposed cardinalfish released directly back onto home sites exhibited similar site fidelity to control subjects, behaviour at home sites was affected, with CO(2)-exposed fish exhibiting increased activity levels and venturing further from shelter. This study demonstrates that the potential disruption of chemosensory mechanisms in fishes due to rising CO(2) levels in the ocean extend to critical adult behaviours.


Partial Coordination-Perturbed Bi-Copper Sites for Selective Electroreduction of CO2 to Hydrocarbons.
In the electrochemical CO2 reduction reaction (CO2 RR), it is challenging to develop a stable, well-defined catalyst model system that is able to examine the influence of the synergistic effect between adjacent catalytic active sites on the selective generation of C1 or C2 products. We have designed and synthesized a stable crystalline single-chain catalyst model system for electrochemical CO2 RR, which involves four homomorphic one-dimensional chain-like compounds (Cu-PzH, Cu-PzCl, Cu-PzBr, and Cu-PzI). The main structural difference of these four chains is the substituents of halogen atoms with different electronegativity on the Pz ligands. Consequently, different synergistic effects between bi-copper centers lead to changes in the faradic efficiency (FE CH 4 :FE C 2 H 4 ). This work provides a simple and stable crystalline single-chain model system for systematically studying the influence of coordination microenvironment on catalytically active centers in the CO2 RR.


Prepulse inhibition of the acoustic startle reflex impairment by 5-HT2A receptor activation in the inferior colliculus is prevented by GABAA receptor blockade in the pedunculopontine tegmental nucleus.
The relationship between serotonin dysfunction and schizophrenia commenced with the discovery of the effects of lysergic acid diethylamide (LSD) that has high affinity for 5-HT2A receptors. Activation of these receptors produces perceptual and behavioural changes such as illusions, visual hallucinations and locomotor hyperactivity. Using prepulse inhibition (PPI) of the acoustic startle, which is impaired in schizophrenia,we aimed to investigate:i) the existence of a direct and potentially inhibitory neural pathway between the inferior colliculus (IC) and the pedunculopontine tegmental nucleus (PPTg) involved in the mediation of PPI responses by a neural tract tracing procedure;ii) if the microinjection of the 5-HT2A receptors agonist DOI in IC would activate neurons in this structure and in the PPTg by a c-Fos protein immunohistochemistry study;iii) whether the deficits in PPI responses, observed after the administration of DOI in the IC, could be prevented by the concomitant microinjection of the GABAA receptor antagonist bicuculline in the PPTg.Male Wistar rats were used in this study. An IC-PPTg reciprocated neuronal pathway was identified by neurotracing. The number of c-Fos labelled cells was lower in the DOI group in IC and PPTg, suggesting that this decrease could be due to the high levels of GABA in both structures. The concomitant microinjections of bicuculline in PPTg and DOI in IC prevented the PPI deficit observed after the IC microinjection of DOI. Our findings suggest that IC 5-HT2A receptors may be at least partially involved in the regulation of inhibitory pathways mediating PPI response in IC and PPTg structures.


N6-methyladenosine modification of circCUX1 confers radioresistance of hypopharyngeal squamous cell carcinoma through caspase1 pathway.
Hypopharyngeal squamous cell carcinoma (HPSCC) is one of the most common malignant tumors in otolaryngology head and neck surgery and is one of the worst prognostic malignant tumors. Endogenous circular RNA (circRNA) is more stable than mRNA, microRNA (miRNA), and long non-coding RNA (LncRNA) in exosomes, plasma, and urine, and participates in gene expression regulation to perform different functions. Therefore, circRNA is expected to become a biomarker and therapy target for many tumors. However, the expression and function of circRNA regulated by N6-methyladenosine (m6A) are still unclear in HNSCC. In this study, we demonstrated that a specific circRNA, circCUX1, was upregulated in HPSCC patients who are resistant to radiotherapy and predicts poor survival outcome. We further found that methyltransferase like 3 (METTL3) mediated the m6A methylation of circCUX1 and stabilizes its expression. Knockdown circCUX1 promotes the sensitivity of hypopharyngeal cancer cells to radiotherapy. In addition, circCUX1 binds to Caspase1 and inhibits its expression, resulting in a decrease in the release of inflammatory factors, thereby developing tolerance to radiotherapy. Our findings indicate that circCUX1 is a potential therapeutic target for radiotherapy tolerance in HPSCC patients.


The effects of oral taurine administration on behavior and hippocampal signal transduction in rats.
Taurine, 2-aminoethylsulfonic acid, is one of the most abundant amino acids in the brain. It has various important physiological functions as a neuromodulator and antioxidant. Taurine is expected to be involved in depression; however, knowledge regarding its function in relation to depression is limited. In this study, we attempted to elucidate the effects of oral taurine administration on antidepressant-like behaviors in rats and depression-related signal transduction in the hippocampus. In behavioral tests, rats fed a high taurine (HT: 45.0 mmol/kg taurine) diet for 4 weeks (HT4w) showed decreased immobility in the forced swim test (FS) compared to controls. However, rats fed a low taurine (LT: 22.5 mmol/kg taurine) diet for 4 weeks or an HT diet for 2 weeks (HT2w) did not show a significant difference in FS compared to controls. In biochemical analyses, the expression of glutamic acid decarboxylase (GAD) 65 and GAD67 in the hippocampus was not affected by taurine administration. However, the phosphorylation levels of extracellular signal-regulated kinase1/2 (ERK1/2), protein kinase B (Akt), glycogen synthase kinase3 beta (GSK3β) and cAMP response element-binding protein (CREB) were increased in the hippocampus of HT4w and HT2w rats. Phospho-calcium/calmodulin-dependent protein kinase II (CaMKII) was increased in the hippocampus of HT4w rats only. Moreover, no significant changes in these molecules were observed in the hippocampus of rats fed an HT diet for 1 day. In conclusion, our findings suggest that taurine has an antidepressant-like effect and an ability to change depression-related signaling cascades in the hippocampus.


Norursane-type triterpenoids from Rosmarinus officinalis and their anti-inflammatory activity evaluation.
Five norursane-type triterpenoids, including three novel of 3β-28-norursa-12,17,19,21-tetraene-3-ol (1), 3β-28-norursa-12,20(30)-dien-3-ol (2) and 3β-28-norursa-12,16,20(30)-triene-3-ol (3), as well as two known 3β-28-norursa-17,19,21-trien-3-ol (4) and 3β-28-norursa-12-ene-3-ol (5) were isolated from the ethyl acetate dissolved fraction of the ethanol extract from Rosmarinus officinalis. Their structures were elucidated by HR-ESI-MS, IR, 1D- and 2D-NMR spectroscopic methods. Compounds 1-5 exhibited significant inhibitory effect on NO production in LPS-activated RAW264.7 cells, and compounds 2, 3 and 5 shown better anti-inflammatory activity.


The role of plasma kinin in functional vasodilatation in the pancreas.
1. Freshly collected pancreatic juice of the cat contained active kinin-forming enzyme (kallikrein) and, in addition, an active kininase.2. In response to successive doses of secretin, the kinin-forming activity of pancreatic juice fell off considerably. It was restored by pancreozymin.3. Stimulation of the dorsal vagus nerve caused an increase in venous outflow from the pancreas which was greater and more consistently seen when the splanchnic nerves had been sectioned.4. Intravenous injection of highly purified secretin usually had no effect on the outflow, whereas pancreozymin increased it up to 5 times.5. When the pancreas was perfused with oxygenated Locke solution, the effluent contained some kinin-forming enzyme when the gland was at rest. The enzyme activity did not increase when secretin was added to the perfusing fluid, but when acetylcholine or pancreozymin was added, the activity rose about fourfold.6. These results are discussed in relation to the theory that plasma kinins play a prominent role in the functional vasodilatation of glandular tissues.


Pyogenic granuloma following treatment of verruca vulgaris with cryotherapy and Duoplant.
We report an unusual case of pyogenic granuloma that appeared after the application of liquid nitrogen and 27 percent salicylic acid (Duoplant, Stiefel Inc.) to a verruca vulgaris. Only two cases of pyogenic granuloma following cryotherapy appear in the literature and pyogenic granuloma as a complication of salicylic acid application has not been documented.


Random mutagenesis of an essential Candida albicans gene.
A method for the analysis of Candida albicans gene function, which involves random mutagenesis of the open reading frame, is described. This method is especially suited for the study of essential and multi-functional genes, with several advantages over regulatable promoters more commonly used to study essential gene function. These advantages include expression from the endogenous promoter, which should yield a more appropriate transcript expression and abrogate the need for shifts in carbon or amino acid sources necessary with the use of regulatable promoters. Furthermore, there is potential for isolating individual functions of multi-functional genes. To verify this experimental approach, we randomly mutated the essential C. albicans gene, BMH1. The resulting "pool" of putative mutant alleles was then introduced into a BMH1/bmh1Delta strain of C. albicans, such that only the mutagenized BMH1 sequences could be expressed. Transformants were screened for rapamycin sensitivity, defects in filamentation on M199 agar, and growth at 42 degrees C. In this way, we identified six non-lethal mutant alleles of BMH1 with altered amino acid sequences. Further phenotypic analysis of these mutant strains enabled us to segregate individual functions of C. albicans BMH1. The relative merits of Escherichia coli versus PCR-mediated mutagenesis are discussed.


Recapturing public health sciences for HIV/AIDS in China.
In recent years, human immunodeficiency virus (HIV) has spread from high-risk groups to the general population in China. Scientific interpretation of HIV figures, prevalence and proportion vs. incidence is displayed to correctly guide politicians and lay people in understanding the situation. Although behaviour-focused studies have been conducted in China, many have focused on 'scientific' issues, with limited attention given to human dimensions or contexts. An evidence-based public health approach, with strict evaluation in terms of cost-effectiveness and behavioural outcomes, needs to be developed, together with activity to encourage decentralization and community engagement of programmes. Policies and strategies on HIV prevention and control need to be mindful of Chinese culture and reality, including the expansion of screening and surveillance.


Hyperintense areas in the cisternal segments of the cranial nerves: a magnetic resonance imaging study.
The study aimed to explore hyperintense areas in the cisternal segments of the cranial nerves using magnetic resonance imaging (MRI). Seventy outpatients underwent thin-sliced, coronal constructive interference steady-state (CISS) sequence and sagittal T2-weighted MRI following conventional MRI examination. With the coronal CISS sequence, hyperintense areas were located in the central parts of the olfactory bulbs in 65.7% of patients. For the intracranial optic nerve and optic chiasm, hyperintense areas were detected in 98.6% of the CISS sequences and 100% of the T2-weighted images. In the optic tract, hyperintense areas were detected in 51.4% of cases. In 35% of the patients who underwent the CISS sequence, the intracranial optic nerves were considerably compressed by the internal carotid and anterior cerebral arteries, with hyperintense areas similar to those in patients without vascular compression. Hyperintense areas of the cisternal segments of the oculomotor nerve and trigeminal root were identified in 52.9% and 87.1% of the patients, respectively. The hyperintense areas found within the cisternal segments of the cranial nerves delineated on the coronal CISS sequence and sagittal T2-weighted imaging may indicate the intracranial part of the glymphatic pathway through the cranial nerves. The cranial nerves may function as part of the glymphatic pathway.


#Supercorp kissed…or did they?: lesbian fandom and queerbaiting.
The Supercorp fandom refers to the platonic friendship between Kara Danvers, aka Supergirl, and her friend Lena Luthor. The term 'Supercorp' refers to an implied - yet unexplored - queer relationship created by fans of the DC/CW show Supergirl. Imagined relationships, referred to by fandoms (groups of fans) as 'shipping, tackle the unexplored chemistry between two characters who are not romantically linked. Supergirl's screenwriters were notorious for placing Kara and Lena in heteronormative relationship scenarios, effectively queerbaiting (or covert courting) the audience by suggesting a romantic relationship never explored on-screen. On November 11, 2021, fans had fun by doctoring photos of the series finale and 'showing' Kara and Lena kissing. Fans created an alternate reality where two women publicly expressed their love. Deprived of a queer 'happy ending', Supergirl fans gaslit the DC fandom (and beyond), leading many to question the reality of their initial viewing experience. The fans were gaslighting the world into questioning whether the footage was authentic. The fandom rallied in solidarity by crafting the 'reality' they wanted. Using a lens informed by psychoanalytic theory and fan studies research, this paper examines how the Supercorp fandom used the liminal space of broadcast time zones to reclaim a queer narrative which they were denied. This paper contributes to the advancement of lesbian studies by shining a light on the efforts of a marginalized segment of fandom and examining the trauma caused by queer coding - and queerbaiting - in service to a heteronormative agenda.


Capacity Trajectory in the Context of Dementia: A Case of Exercising Rights in Troubled Civil Life.
For years, Common law and Civil Code have determined the legal age as majority which defines adulthood, giving a presumption of legal capacity to adults. At this age, all adults are presumed to be capable of making their own decisions, protecting their interests and exercising the rights they enjoy in the acts of their civil life. This legal presumption of capacity structures the life-course of adults and allows them to act and make decisions either in daily life or for exceptional civil acts, for instance, marriage. Domestic laws, including French laws, do provide for certain exceptions, especially for persons suffering from disease or disabilities. The use of substitutive decision-making, or "coercive legal" measures, is increasing. At the same time, these legal substitutive decision-making measures have encountered challenges. The cornerstone Article of International Convention on the Rights of Persons with Disabilities (CRPD) reaffirms the exigence of equal recognition of all persons before the law with equal capacity. The interpretation of this article 12 is subject to considerable controversy. The controversy around CRPD and the paradox between the normative evolution of fundamental rights and the increasing uses of legal substitutive decision-making measures in social practices raise questions about the place of this legal presumption of capacity. In this article, we wish to tackle this controversy by starting with situations where the daily capacity to exercise one's rights becomes an issue for the professional or family circle. What happens when persons seem unable to understand the consequences of their actions or when they behave incomprehensibly according to their close ones? When should others around the person worry about the person's ability to take care of oneself? What happens when a person's ways of functioning change? Is it an indication that his or her state of health is experiencing changes? That the person's needs have evolved? What does this imply for family and friends, especially in terms of actions or substitute decisions? Using the core notion of "capacity trajectory," this article intends to empirically shed light on how rights and legal capacity are exercised in situations of vulnerability. We wish to demonstrate that the presumption of capacity requires certain "conditions of capacity" in practice.


Projections from the 17/18 visual area transition zone to the ipsilateral visual field representation in the cat superior colliculus.
We demonstrate by retrograde tracing methods that the transition zone between visual cortical areas 17 and 18--where a representation of the ipsilateral visual field (IVF) has been described--projects to the IVF representation in the ipsilateral superior colliculus. The stratum griseum superficiale is the target of this retinotopically organized cortical projection to the rostral part of the superior colliculus.


Smart Diagnosis of Urinary Tract Infections: is Artificial Intelligence the Fast-Lane Solution?
Artificial intelligence (AI) can significantly improve physicians' workflow when examining patients with UTI. However, most contemporary reviews are focused on examining the usage of AI with a restricted quantity of data, analyzing only a subset of AI algorithms, or performing narrative work without analyzing all dedicated studies. Given the preceding, the goal of this work was to conduct a mini-review to determine the current state of AI-based systems as a support in UTI diagnosis. There are sufficient publications to comprehend the potential applications of artificial intelligence in the diagnosis of UTIs. Existing research in this field, in general, publishes performance metrics that are exemplary. However, upon closer inspection, many of the available publications are burdened with flaws associated with the improper use of artificial intelligence, such as the use of a small number of samples, their lack of heterogeneity, and the absence of external validation. AI-based models cannot be classified as full-fledged physician assistants in diagnosing UTIs due to the fact that these limitations and flaws represent only a portion of all potential obstacles. Instead, such studies should be evaluated as exploratory, with a focus on the importance of future work that complies with all rules governing the use of AI. AI algorithms have demonstrated their potential for UTI diagnosis. However, further studies utilizing large, heterogeneous, prospectively collected datasets, as well as external validations, are required to define the actual clinical workflow value of artificial intelligence.


A continuous process for biodiesel production in a fixed bed reactor packed with cation-exchange resin as heterogeneous catalyst.
Continuous esterification of free fatty acids (FFA) from acidified oil with methanol was carried out with NKC-9 cation-exchange resin in a fixed bed reactor with an internal diameter of 25 mm and a height of 450 mm to produce biodiesel. The results showed that the FFA conversion increased with increases in methanol/oil mass ratio, reaction temperature and catalyst bed height, whereas decreased with increases in initial water content in feedstock and feed flow rate. The FFA conversion kept over 98.0% during 500 h of continuous esterification processes under 2.8:1 methanol to oleic acid mass ratio, 44.0 cm catalyst bed height, 0.62 ml/min feed flow rate and 65°C reaction temperature, showing a much high conversion and operational stability. Furthermore, the loss of sulfonic acid groups from NKC-9 resin into the production was not found during continuous esterification. In sum, NKC-9 resin shows the potential commercial applications to esterification of FFA.


Interindividual variability in response to protein and fish oil supplementation in older adults: a randomized controlled trial.
Precision nutrition is highly topical. However, no studies have explored the interindividual variability in response to nutrition interventions for sarcopenia. The purpose of this study was to determine the magnitude of interindividual variability in response to two nutrition supplementation interventions for sarcopenia and metabolic health, after accounting for sources of variability not attributable to supplementation. A 24 week, randomized, double-blind, placebo-controlled trial tested the impact of leucine-enriched protein (LEU-PRO), LEU-PRO plus long-chain n-3 PUFA (LEU-PRO+n-3) or control (CON) supplementation in older adults (n = 83, 71 ± 6 years) at risk of sarcopenia. To estimate the true interindividual variability in response to supplementation (free of the variability due to measurement error and within-subject variation), the standard deviation of individual responses (SDR ) was computed and compared with the minimally clinically important difference (MCID) for appendicular lean mass (ALM), leg strength, timed up-and-go (TUG), and serum triacylglycerol (TG) concentration. Clinically meaningful interindividual variability in response to supplementation was deemed to be present when the SDR positively exceeded the MCID. The probability that individual responses were clinically meaningful, and the phenotypic, dietary, and behavioural determinants of response to supplementation were examined. The SDR was below the MCID for ALM (LEU-PRO: -0.12 kg [90% CI: -0.38, 0.35], LEU-PRO+n-3: -0.32 kg [-0.45, 0.03], MCID: 0.21 kg), TUG (LEU-PRO: 0.58 s [0.18, 0.80], LEU-PRO+n-3: 0.73 s [0.41, 0.95], MCID: 0.9 s) and TG (LEU-PRO: -0.38 mmol/L [-0.80, 0.25], LEU-PRO+n-3: -0.44 mmol/L [-0.63, 0.06], MCID: 0.1 mmol/L), indicating no meaningful interindividual variability in response to either supplement. The SDR exceeded the MCID (19 Nm) for strength in response to LEU-PRO (25 Nm [-29, 45]) and LEU-PRO+n-3 (23 Nm [-29, 43]) supplementation but the effect was uncertain, evidenced by wide confidence intervals. In the next stage of analysis, similar proportions of participant responses were identified as very likely, likely, possibly, unlikely, and very unlikely to represent clinically meaningful improvements across the LEU-PRO, LEU-PRO+n-3, and CON groups (P > 0.05). Baseline LC n-3 PUFA status, habitual protein intake, and numerous other phenotypic and behavioural factors were not determinants of response to LEU-PRO or LEU-PRO+n-3 supplementation. Applying a novel, robust methodological approach to precision nutrition, we show that there was minimal interindividual variability in changes in ALM, muscle function, and TG in response to LEU-PRO and LEU-PRO+n-3 supplementation in older adults at risk of sarcopenia.


[Changes in the kidney in a case of neurofibromatosis (author's transl)].
In a case of an 18-yr-old girl with generalized neurofibromatosis there was an unilateral hydronephrosis due to polypoid neurofibromas in the ureter and urinary bladder. In the kidney were interstitial neurofibromas, a great number of dysontogenetic adenomas and also neurofibromatosis of the vessels.


Transoral endoscopic vestibular approach Sistrunk procedure: First reported case series.
Standard of care for management of thyroglossal duct cysts (TGDCs) is a Sistrunk procedure performed through a transcervical incision. We describe the first series of Sistrunk procedures performed through a transoral endoscopic vestibular approach, eliminating a visible external scar. The transoral endoscopic vestibular approach to the Sistrunk (TEVAS) was performed in patients with TGDCs meeting inclusion criteria who desired a scarless approach. Six patients (five females and one male) underwent TEVAS, with a mean age of 38 years (range 16-56 years) and a mean TGDC size of 1.8 cm (range 1.1-2.4 cm). Mean operative time was approximately 5 h (range 2-8 h). There were no surgical complications or recurrences. For appropriately selected patients, the TEVAS is an alternative to open neck surgery that provides improved cosmesis while maintaining successful resection outcomes. More data on outcomes including complications and recurrences are needed as additional case information is collected.


Extracellular vesicles in urological malignancies.
Extracellular vesicles (EVs) are small lipid bound structures released from cells containing bioactive cargoes. Both the type of cargo and amount loaded varies compared to that of the parent cell. The characterisation of EVs in cancers of the male urogenital tract has identified several cargoes with promising diagnostic and disease monitoring potential. EVs released by cancers of the male urogenital tract promote cell-to-cell communication, migration, cancer progression and manipulate the immune system promoting metastasis by evading the immune response. Their use as diagnostic biomarkers represents a new area of screening and disease detection, potentially reducing the need for invasive biopsies. Many validated EV cargoes have been found to have superior sensitivity and specificity than current diagnostic tools currently in use. The use of EVs to improve disease monitoring and develop novel therapeutics will enable clinicians to individualise patient management in the exciting era of personalised medicine.


Formation of deposits on the surfaces of superheaters and economisers of MSW incinerator plants.
Mineralogical and chemical investigations of deposits from superheaters and economisers from a MSWI plant in Mannheim, Germany, lead to a classification system which provides information about the most critical parameters leading to fouling and corrosion. With the help of this classification system parameters like the geometry of boilers and the waste input can be changed in order to prolong run times between revisions and enhance energy efficiency of MSWI plants.


Interleukin 6 destabilizes atherosclerotic plaques by downregulating prolyl-4-hydroxylase α1 via a mitogen-activated protein kinase and c-Jun pathway.
Interleukin 6 (IL-6) is a pivotal cytokine that regulates extracellular matrix metabolism by ameliorating the modification of collagen content, important in fibrous caps of atherosclerotic plaque. Prolyl-4-hydroxylase α1 (P4Hα1) is a key intracellular enzyme required for synthesis of collagen in animals. We investigated the relationship of IL-6 and P4Hα1 in atherosclerosis-prone mice and human aortic smooth muscle cells (HASMCs). Apolipoprotein E (ApoE)-/- mice were fed a high-fat diet and a perivascular constrictive silica collar was placed on the right common carotid artery to induce atherosclerotic lesions, then mice were divided into two groups for transfection with empty lentivirus or IL-6 lentivirus. HASMCs were transfected with small interfering RNA or treated with recombinant human IL-6. IL-6 significantly downregulated collagen, P4Hα1 and smooth muscle cell contents in atherosclerotic mouse arteries. Macrophage and lipid contents in the atherosclerotic area were significantly increased with IL-6 treatment. IL-6 significantly downregulated P4Hα1 expression in HASMCs through an RAF-MEK1/2-ERK1/2 mitogen-activated protein kinase (MAPK) pathway, and c-Jun was involved in the process. Our findings highlight IL-6 destabilize atherosclerotic plaques in mice by downregulating P4Hα1 via an RAF-MEK1/2-ERK1/2 MAPK and c-Jun pathway.


Brain morphologic characteristics of cirrhotic alcoholics and cirrhotic nonalcoholics: an MRI study.
Cirrhotic alcoholics, cirrhotic nonalcoholics, and normal controls were compared on planimetric and subjective ratings of the MRI of the brain. The results indicated that the cirrhotic alcoholics exhibited more gross pathology than the nonalcoholic cirrhotics on ratings of frontal, parietal, and cerebellar atrophy; however, these groups were more similar to each other than they were different on planimetric measurements. The results are discussed in terms of the etiology and localization of the neuropathologic sequelae found commonly among alcoholics.


On being a pathologist: Maria Dąbska--the woman behind the eponym, a pioneer in pathology.
There is only one cancer to our knowledge named in honor of its female describer, the Dąbska tumor. Maria Dąbska was a brave hero of the Warsaw Resurrection of 1944 who survived deportation to Germany to graduate from medical school in Gdańsk and pursue a career in pathology, for which her research on the Dąbska tumor, breast cancer, sweat gland tumors, keratoacanthoma, soft tissue sarcomas, bone pathology, parachordoma, melanoma, and other entities remains salient. Working behind the Iron Curtain, she nevertheless achieved international recognition, yet few today are cognizant of her and her accomplishments. This vibrant distinguished professor is celebrating her 90th birthday.


Serum cholesterol, body mass index and smoking status do not predict long-term cognitive impairment in elderly stroke patients.
Older stroke survivors are at risk of long-term cognitive impairment, which is associated with a number of modifiable and non-modifiable factors. We aimed to assess the association between the modifiable risk factors, serum cholesterol, low density lipoprotein, high density lipoprotein, serum triglycerides, body mass index (BMI) and smoking status on cognitive function, while controlling for the non-modifiable factors, acute functional impairment, diabetes status and age. A cross-sectional study from a metropolitan university hospital in Sweden involving older adults (n = 149). Assessments occurred at 20 months post-stroke, using the Mini Mental State Examination and serum blood levels of cholesterol, low density lipoprotein, high density lipoprotein and serum triglycerides. Hierarchical linear regression showed that only acute functional impairment significantly contributed to long-term cognitive impairment in stroke survivors. Only 12% of the sample showed healthy cholesterol levels while the remaining patients showed borderline or high cholesterol levels. In terms of BMI, only 2% of the sample were underweight, 38% were within healthy range and 26% were overweight/obese. Only eight women and four men were smokers, therefore our sample of smokers was likely too small to detect any differences between smokers and non-smokers in regard to cognitive outcomes. Serum cholesterol, low density lipoprotein, high density lipoprotein, serum triglycerides, BMI or smoking status did not influence cognitive outcomes in older stroke surviving individuals. These findings suggest that modification of these factors may not influence cognitive outcomes in stroke-surviving individuals however should be interpreted as preliminary given limitations in the current study.


Association of Neighborhood-Level Material Deprivation with Adverse Outcomes and Processes of Care Among Patients with Heart Failure in a Single-Payer Healthcare System: A Population-Based Cohort Study.
We studied the association between neighborhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure (HF) patients in a universal healthcare system. In a population-based retrospective study (2007-2019), we examined the association of material deprivation with one-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years. Among 395,763 patients (median age 76 [IQR 66-84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (P≤0.001). Younger residents (age ≤65 years) of the most versus least deprived neighborhoods had higher hazards of all-cause death (HR 1.19 [95%CI, 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 [95%CI, 1.19-1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95%CI, 1.08-1.14]) and cardiovascular hospitalization (HR 1.13 [95%CI, 1.09-1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all P<0.001), while the most deprived of younger ages were less likely to undergo ICD/CRT-P implantation (P=0.023), compared to the least deprived. Patients with newly-diagnosed HF residing in the most deprived neighborhoods had worse outcomes and reduced access to care than those less deprived. This article is protected by copyright. All rights reserved.


Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants.
To determine whether thickening of infant formula feedings with rice cereal increases coughing, we studied 25 infants from birth to 6 months of age, referred for evaluation of gastroesophageal reflux. Coughing was blindly quantified after each of a pair of isocaloric meals (one thickened and one unthickened). Coughing was more frequent after thickened feedings than after unthickened feedings.


Vaccines for COVID-19: learning from ten phase II trials to inform clinical and public health vaccination programmes.
Public health professionals and clinicians, in many countries, are immersed in the ongoing and upcoming vaccination programmes for COVID-19. Published information from vaccine trials is complex. There are important and helpful insights about the nature of the available and forthcoming vaccines, immune responses and side-effects from phase II trials. We have systematically summarised information from 10 such trials on the nature of the vaccines, exclusions from the trials, immunological effects and side-effects. Some important information within these trial reports is not available in the phase III trial articles, so a complete picture requires examination of phase II and phase III trials for each vaccine. We recommend our systematic approach for the examination of other upcoming COVID-19 vaccine phase II and III trials.


Choice of the replacement fluid during large volume plasma-exchange.
The replacement fluid used during therapeutic large volume plasma-exchange can be seen as an important factor influencing the result of such treatment. The choice includes fluids such as electrolyte solutions, gelatin, hydroxyethyl-starch, albumin and fresh frozen plasma. By evaluating the pathophysiology of the underlying disease, it is possible to choose between merely replacing the removed volume by non-protein fluids or rather to introduce plasma protein components into the patient's circulation by substituting with purified or enriched proteins such as albumin, clotting factors, antithrombin III or fresh frozen plasma. This paper analyzes the rationale for the choice of the appropriate replacement fluid taking into account pathophysiologic, pharmacologic and logistic criteria.


Cell cycle analysis by flow cytometry: principles and applications.
Numerous flow cytometric analyses are based on DNA content studies. We have considered firstly monoparametric cell cycle analyses, which only take DNA content into account, but are sometimes of limited interest. Then, we have presented multiparametric analyses, which can be used to improve cycle phase identification by taking simultaneously into account DNA and other cellular components, or by considering some events occurring during cell cycle. Finally, we have discussed monoparametric and multiparametric cell cycle analysis interest in various application fields, particularly in pharmacology, toxicology, tumoral pathology and higher plant system studies.


Administrative database research infrequently used validated diagnostic or procedural codes.
Administrative database research (ADR) frequently uses codes to identify diagnoses or procedures. The association of these codes with the condition it represents must be measured to gauge misclassification in the study. Measure the proportion of ADR studies using diagnostic or procedural codes that measured or referenced code accuracy. Random sample of 150 MEDLINE-cited ADR studies stratified by year of publication. The proportion of ADR studies using codes to define patient cohorts, exposures, or outcomes that measured or referenced code accuracy and Bayesian estimates for probability of disease given code operating characteristics were measured. One hundred fifteen ADR studies (76.7% [95% confidence interval (CI), 69.3-82.8]) used codes. Of these studies, only 14 (12.1% [7.3-19.5]) measured or referenced the association of the code with the entity it supposedly represented. This proportion did not vary by year of publication but was significantly higher in journals with greater impact factors. Of five studies reporting code sensitivity and specificity, the estimated probability of code-related condition in code-positive patients was less than 50% in two. In ADR, diagnostic and procedural codes are commonly used but infrequently validated. People with a code frequently do not have the condition it represents.


Opportunities and barriers for implementation of integrated TB and HIV care in lower level health units: experiences from a rural western Ugandan district.
As countries with a high burden of TB and HIV roll out integrated TB/HIV care, there is need to assess possibility of lower level health units treating TB to provide integrated TB/HIV care. To determine barriers and opportunities for provision of integrated TB/HIV care in lower level health units offering TB treatment in Mbarara district, Uganda. Conducted key informant interviews, interviewed health workers and observed services offered. 22 health units were assessed and 88 health workers were interviewed. Of the 18 health units mandated to offer laboratory services, 55.6% and 38.9% were able to offer rapid HIV-testing and ZN staining respectively. Understaffing, lack of capacity to diagnose HIV and TB, lack of guidelines to inform care options of TB/HIV co-infected patients and insufficient knowledge and skills among health workers towards provision of integrated TB/HIV care were mentioned as barriers to provision of integrated TB/HIV services. To offer integrated TB/HIV services at lower level health units currently offering TB stand alone services, there is need to address gaps in knowledge and skills among health workers, laboratory diagnostics, staffing levels, medical supplies and infrastructure.


The Efficacy of Liposomal Bupivacaine for Opioid and Pain Reduction: A Systematic Review of Randomized Clinical Trials.
Background The opioid crisis has prompted surgeons to search for alternative postoperative methods of analgesia. Liposomal bupivacaine is a long-acting local anesthetic formulation used for pain, potentially reducing opioid use. Evaluation of liposomal bupivacaine as a viable alternative for pain management is needed. The objective was to assess the efficacy of randomized clinical trials (RCTs) of liposomal bupivacaine in postoperative pain management and opioid consumption. Material and Methods The authors extracted RCTs comparing liposomal bupivacaine versus placebo or active comparators for postoperative pain or opioid reduction from PubMED/MEDLINE, Cochrane Library, and ClinicalTrials.gov. Exclusion criteria included nonhuman studies, non-RCTs, pooled studies, and inability to access full text. The following variables were abstracted: surgical specialty, number of subjects, pain and opioid outcomes, and authors' financial conflicts of interest. Results We identified 77 published RCTs, of which 63 studies with a total of 6770 subjects met inclusion criteria. Liposomal bupivacaine did not demonstrate significant pain relief compared to placebo or active agents in 74.58% of RCTs. Of the studies evaluating narcotic use, liposomal bupivacaine did not show a reduction in opioid consumption in 85.71% of RCTs. Liposomal bupivacaine, when compared to standard bupivacaine or another active agent, yielded no reduction in opioid use in 83.33% and 100.00% of studies, respectively. Clinical trials with a financial conflict of interest relating to the manufacturer of liposomal bupivacaine were significantly more likely to show pain relief (OR: 14.31 [95% CI, 2.8, 73.10], P = 0.0001) and decreased opioid consumption (OR: 12.35 [95% CI 1.40, 109.07], P = 0.0237). Of the 265 unpublished RCTs on ClinicalTrials.gov, 47.54% were withdrawn, terminated, suspended, or completed without study results available. Conclusions The efficacy of liposomal bupivacaine for providing superior postoperative pain control relative to placebo or another active agent is not supported by a majority of RCTs. Underreporting of trial results and bias due to underlying financial relationships amongst authors are two major concerns that should be considered when evaluating the available evidence.


Autocannibalization of sensate and denervated rat groin flaps.
The extent to which rats self-mutilate was studied in 30 Sprague-Dawley rats. The experiment tested unilateral and bilateral sensate and denervated groin flaps, with statistically significant results obtained between the bilateral groups.


The effects of syntactic structure on letter detection in adjacent function words.
In the present study, we examined letter detection in very frequent function-word sequences. It has been claimed that such sequences are processed in a unitized manner, thus preempting access to their constituent letters. In contrast, we showed that letter detection in the words for and the (1) was no more difficult when the words appeared in adjacent locations in a sentence (familiar) than when they appeared apart (less familiar sequence) and (2) was contingent upon the words' syntactic roles within the phrase. Thus, letter detection in for was easier when the sequence was separated by a clause boundary than when the words were part of the same clause. The advantage derived from clause separation was strongest when a comma divided clauses. These results challenge the unitization account of the "missing-letter" effect in common phrases and support a position where this phenomenon is seen to reflect the extraction of phrase structure during reading.


Cholestasis in immature newborn infants: is parenteral alimentation responsible?
This report is a response to the suggestion, first raised in The Journal in 1971, 1 that intravenous alimentation may be responsible for intrahepatic cholestasis in premature infants. Nine of 15 premature infants (30 weeks' gestation or less, birth weight up to 1,250 gm) who survived at least five days and were autopsied were found to have cholestasis. The most severe hepatic pathology was found in the infants whose nutrition was poorest and whose livers were smallest. Both groups had a variety of other clinical problems, especially respiratory distress, intracranial hemorrhage, and infection; it was the first of these that prevented oral feeding in most instances. No correlation was found between treatment with intravenous FreAmine and/or Intralipid and the presence of cholestasis. None of the affected patients, however, could sustain oral or nasogastric feedings during the first seventeen days of life, whereas all surviving patients without cholestasis were able to feed orally within eight days. Fasting later in the course had no effect. Therefore, early fasting, rather than parenteral supplementation, may contribute to impaired hepatobiliary function in the small premature infant.


LncRNA SLC16A1-AS1 is upregulated in hepatocellular carcinoma and predicts poor survival.
Long non-coding RNAs (LncRNAs) are broadly transcribed in the genome of human and animals, they play critical roles in cellular process, and participate in the progression of multiple diseases, including cancer. SLC16A1-AS1 is a tumor suppressive lncRNA in lung cancer. This study aimed to investigate the involvement of lncRNA SLC16A1-AS1 in hepatocellular carcinoma (HCC). A total of 64 HCC patients were subjected to biopsy to obtain paired HCC and non-tumor tissues. Expression of SLC16A1-AS1 and miR-141 in paired tissues was determined by RT-qPCR. Correlations were analyzed by linear regression. Overexpression of SLC16A1-AS1 and miR-141 were achieved in HCC cells to explore the interactions between them. The methylation of the gene encoding miR-141 in HCC cells was detected by methylation-specific PCR (MSP). CCK-8 assay was performed for cell proliferation assay. SLC16A1-AS1 was upregulated in HCC and its high expression levels predicted poor survival of HCC patients. Expression levels of miR-141 were lower in HCC patients and were inversely correlated with the expression levels of SLC16A1-AS1. In HCC cells, overexpression of SLC16A1-AS1 led to downregulation of miR-141, while overexpression of miR-141 did not regulate the expression of SLC16A1-AS1. In addition, overexpression of SLC16A1-AS1 led to increased methylation of miR-141. And overexpression of SLC16A1-AS1 attenuated the inhibitory effects of miR-141 on HCC cell proliferation. SLC16A1-AS1 is upregulated in HCC and predicts poor survival. In addition, SLC16A1-AS1 may downregulate miR-141 through methylation to promote cancer cell proliferation.


The role of VATS in the removal of intrathoracic foreign bodies - a systematic review.
To date, no systematic review or meta-analysis study has been conducted regarding the use of video-assisted thoracoscopic surgery (VATS) in the removal of intrathoracic foreign bodies (FB). This systematic review aims to evaluate the feasibility of VATS in the removal of intrathoracic FBs. PubMed/MEDLINE, CINAHL, Web of Science, EMBASE, and Cochrane Library databases were systematically searched to identify reports published up to April 1, 2022. The initial systematic search revealed a total of 208 papers, of which only 54 studies reporting 71 cases were included in this systematic review. Among the patients, 46 (64.8%) were male, 22 (31%) were female, and 3 (4.2%) were unknown. The mean age was 34.5 ± 24.3 years (1 day to 98 years). The patients were of 3 etiologic groups: iatrogenic (31, 43.7%), traumatic (28, 39.4%), and accidental (9, 12.7%). Most of the patients were emergency cases (27, 38%). The most frequently used imaging modalities to diagnose these foreign bodies were X-ray (46, 64.8%), followed by computed tomography (44, 62%), and ultrasonography (16, 22.5%). About 43% of all the foreign bodies were therapeutic equipment. The pleural cavity had the highest involvement (36.8%), followed by the lung parenchyma (14.6%) and thoracic cavity (13.2%). Regardless of the number of access ports, all the patients had a good clinical outcome. VATS is a safe and effective method for the removal of intrathoracic FBs from various thoracic sites that are associated with a good clinical outcome - in both elective and emergency cases.


Chromosome aberrations and prognosis in preleukaemia.
24 patients with preleukaemia were cytogenetically studied by the G-banding staining technique. All patients developed later frank acute non-lymphocytic leukaemia and died. 13 patients had a completely normal karyotype (NN-patients) with a median survival time of 8 months. 6 patients had both normal and abnormal metaphases (AN-patients) with a median survival time of 18.5 months, while 5 patients had abnormal metaphases only (AA-patients) with a median survival time of 3 months.


Clinical review: DHEA replacement for postmenopausal women.
It has been proposed that because dehydroepiandrosterone (DHEA) and its sulfate, DHEAS, are important precursors for estrogen and androgen production, treatment with DHEA is a physiologically based strategy for the alleviation of hormone deficiency symptoms in postmenopausal women. We have summarized the physiology of DHEA in women and reviewed the findings from randomized controlled trials (RCT) of the effects of DHEA therapy in postmenopausal women with normal adrenal function. We reviewed the medical literature for key papers investigating DHEA physiology and RCT of the use of DHEA in postmenopausal women through November 2010. The focus was on sexual function, well-being, metabolic parameters, and cognition as study endpoints. Although cross-sectional studies have indicated a link between low DHEA levels and impaired sexual function, well-being, and cognitive performance in postmenopausal women, placebo-controlled RCT do not show benefits of oral DHEA for any of these outcomes or favorable effects on lipids and carbohydrate metabolism. Taken together, findings from this review of the published literature of studies do not support the use of DHEA in postmenopausal women at this time.


Potential for altering rheumatoid arthritis outcome.
The potential for disproportionately altering outcome in the early stages of rheumatoid arthritis (RA) was first hypothesized in the early 1990s. This window of opportunity hypothesis for therapeutic intervention in RA is based on the existence of a time frame within which there is a potential for a greater response to therapy, resulting in sustained benefits or, perhaps most important, a chance of cure. Given the persistent, progressive, damaging, inflammatory nature of RA, this approach to altering outcome in the early stages seems attractive.


Clinical Characteristics of Dermatomyositis with Interstitial Lung Disease: A Retrospective Case-Control Study.
Interstitial lung disease (ILD) is a common complication of dermatomyositis (DM) and one of the main risk factors for poor prognosis in DM patients. The aim of this study was to reveal the clinical characteristics of DM patients with ILD. Clinical data from the Second Affiliated Hospital of Soochow University were used to conduct a retrospective case-control study. Univariate and multivariate logistic regression analysis were performed to identify risk factors for ILD in DM. A total of 78 DM patients were included in this study, including 38 DM patients with ILD and 40 DM patients without ILD. Compared with patients without ILD, patients with ILD were older (59.6 vs. 51.2 years, P = 0.004), and had higher rates of clinically amyopathic DM (CADM) (45 vs. 20%, P = 0.019), Gottron's papules (76 vs. 53%, P = 0.028), mechanic's hands (13 vs. 0%, P = 0.018), myocardial involvement (29 vs. 8%, P = 0.014), and higher positive rates of anti-SSA/Ro52 (74 vs. 20%, P < 0.001) and anti-melanoma differentiation-associated gene-5 (MDA5) (24 vs. 8%, P = 0.048) antibodies, while albumin (ALB) (34.5 vs. 38.0 g/l, P = 0.006), prognostic nutritional index (PNI) (40.3 vs. 44.7, P = 0.013), the rates of muscle weakness (45 vs. 73%, P = 0.013) and heliotrope rash (50 vs. 80%, P = 0.005) were lower. In addition, the five patients who died were all DM patients with ILD (13 vs. 0%, P = 0.018). Multivariate logistic regression showed that old age (odds ratio [OR] = 1.119, 95% confidence interval [CI] = 1.028-1.217, P = 0.009), Gottron's papules (OR = 8.302, 95% CI = 1.275-54.064, P = 0.027) and anti-SSA/Ro52 (OR = 24.320, 95% CI = 4.102-144.204, P < 0.001) were independent risk factors for ILD in DM. DM patients with ILD usually present with older age, higher rates of CADM, Gottron's papules, mechanic's hands, myocardial involvement, higher positive rates of anti-MDA5 and anti-SSA/Ro52 antibodies, lower ALB, PNI, and lower rates of muscle weakness and heliotrope rash. Old age, Gottron's papules, and anti-SSA/Ro52 were independent risk factors for ILD in DM.


Peripheral targets influence sensory-motor connectivity in the neonatal spinal cord: sciatic nerve axotomy in Bax-deficient mice.
In neonatal animals, peripheral nerve axotomy induces cell death in the corresponding dorsal root ganglion neurons and motoneurons, indicating that trophic interactions between these neurons and their targets control neuronal survival at this age. However, axotomy-induced cell death masks the role of peripheral tissues in regulating the central connections between these neurons in neonates. Since we have shown in Bax-deficient mice (Bax-/-) that transection of the sciatic nerve at postnatal day (P) 0 rarely induced apoptosis in motoneurons, we examined whether peripheral nerve axotomy eliminates synaptic connections between group Ia afferents and motoneurons in Bax-/-. After the axotomy, we observed in P7 Bax-/- that many axons survived in the fourth lumber (L4) dorsal root and that primary afferent projections to L4 motor pools also remained. Sciatic nerve stimulation evoked synaptic responses in L4 ventral roots in these mice although the amplitudes were considerably smaller and the onset latencies longer compared with the controls. Our results suggest that the monosynaptic connection between group Ia afferents and motoneurons is morphologically and functionally preserved following axotomy. Peripheral tissues may modulate synaptic connectivity but do not contribute to the maintenance of primary afferent projections in the stretch reflex pathway at an immature stage.