The role of host organism, transcriptional switches and reporter mechanisms in the performance of Hg-induced biosensors.
The purpose of this study was to comprehensively compare the response of nine biosensors capable of being induced by Hg. Induction by Hg was based upon the insertion of merR, merB, zntA and zntR promoter genes. LuxCDABE or lucFF reporter genes expressed luminescence, and host organisms were Escherichia coli, Vibrio anguillarum and Pseudomonas fluorescens. The role of transcriptional switches, reporter mechanism and host organism was to be investigated. All biosensors were subjected to the same assay conditions. Sensors had their own individual growth characteristics and response to the doses of Hg tested. Maximum bioluminescence response was induced by concentrations of Hg between 2.5 nm and 5 microM. E. coli pRB28 was found to detect levels of Hg as low as 1.6 nm and yet was capable of operating in a concentration range of up to 12.5 microM. The response of the sensors demonstrated their suitability for analysis under environmentally relevant concentrations. The sensitivity of the sensors, the optimum range and the expediency of the assay could not be related to a single sensor trait. It may be concluded that biosensor performance is dependent on more than one of the single factors studied. The results show that comparative testing of sensors is an important step in evaluating the relevance and performance of biosensors prior to routine environmental application.


Dynamic breasts: a common complication following partial submuscular augmentation and its correction using the muscle-splitting biplane technique.
Dynamic breast deformity following partial submuscular augmentation is not uncommon. The complication is due primarily to the release of the pectoralis and the true incidence of this complication is not known. The submuscular biplane pocket is a new pocket and is used to correct dynamic breasts following augmentation mammaplasty in the partial submuscular plane. After the first submuscular biplane muscle-splitting augmentation mammaplasty in October 2005, the author has performed 58 secondary augmentation mammaplasties for various reasons. Of these, nine patients showed marked dynamic breast deformity following partial submuscular augmentation and the submuscular muscle-splitting biplane was used to correct this complication. Good to excellent results were achieved in all patients with complete elimination of the dynamic breast deformity. The submuscular biplane is a new and versatile pocket and is used to correct dynamic breast deformity seen following partial submuscular augmentation mammaplasty.


The domino effect: adolescent girls' response to human papillomavirus vaccination.
To examine the experience of fear, the fear response, and factors affecting fear in adolescents undergoing school-based human papillomavirus (HPV) vaccination. A purposive sampling strategy and qualitative methods, including observation and face-to-face interviews. Focus groups comprised adolescent girls who were involved in HPV vaccination in 2007 at schools in Sydney, New South Wales. Individual interviews were conducted with parents, teachers and vaccination nurses. Data from observing vaccination days at three schools and from interviewing 130 adolescents in 20 focus groups, 38 parents, 10 teachers and seven nurses were included in the analysis. All participants discussed the issue of fear and distress experienced by adolescent girls in relation to HPV vaccination. Observations corroborated the focus group and interview data. Our results indicated that fear was promoted by witnessing the fear reactions of peers; perceived judgement by peers; lack of information or misinformation; and being vaccinated later in the day. Fear was moderated by procedural factors, the support of peers, appropriate knowledge, and nurses' distraction techniques or approach. Fear also affected acceptance of HPV vaccination. Fear of HPV vaccination was a near universal experience among adolescents in the school setting and was often associated with significant distress that had an adverse impact on the vaccination process. School vaccination could be improved by proactively managing fear and distress.


Dose calculation of 3D printing lead shield covered by biocompatible silicone for electron beam therapy.
This study aims to calculate the dose delivered to the upstream surface of a biocompatible flexible absorber covering lead for electron beam treatment of skin and subcutaneous tumour lesions for head and neck. Silicone (Ecoflex™ 00-30, Smooth-On, Easton, PA, USA) was used to cover the lead to absorb backscattered electrons from lead. A 3D printer (Zortrax M300, Zortrax, Olsztyn, Poland) was used to fabricate the lead shield. Analytic calculation, simplified Monte Carlo (MC) simulation, and detailed MC simulation which includes a modeling of metal-oxide-semiconductor field-effect transistor (MOSFET) detector were performed to determine the electron backscatter factor (EBF) for 6 MeV and 9 MeV electron beams of a Varian iX Silhouette. MCNP6.2 was used to calculate the EBF and corresponding measurements were carried out by using MOSFET detectors. The EBF was experimentally measured by the ratio of dose at the upstream surface of the silicone to the same point without the presence of the lead shield. The results derived by all four methods agreed within 2.8% for 6 MeV and 3.4% for 9 MeV beams. In detailed MC simulations, for 6 MeV, dose to the surface of 7-mm-thick absorber was 103.7 [Formula: see text] 1.9% compared to dose maximum (Dmax) without lead. For 9 MeV, the dose to the surface of the 10-mm-thick absorber was 104.1 [Formula: see text] 2.1% compared to Dmax without lead. The simplified MC simulation was recommended for practical treatment planning due to its acceptable calculation accuracy and efficiency. The simplified MC simulation was completed within 20 min using parallel processing with 80 CPUs, while the detailed MC simulation required 40 h to be done. In this study, we outline the procedures to use the lead shield covered by silicone in clinical practice from fabrication to dose calculation.


G-CSF-induced evacuation of sinusoidal NK cells and the facilitation of liver regeneration in a partial hepatectomy.
Since liver regeneration after partial hepatectomy (PHx) is known to improve by pretreatment with recombinant human G-CSF (rhG-CSF), we investigated the mechanism by evaluating the distribution and activity of sinusoidal NK cells. F344 rats were treated with rhG-CSF (250 microg/kg/day) for 5 days before PHx. Pretreatment with rhG-CSF improved the serum ALT levels and DNA biosynthesis of the remnant liver tissues at 20 h after PHx. Notably, the rhG-CSF pretreatment decreased the number of NK cells in the liver determined by immunohistochemistry using anti-NKR-P1A mAb before and at 20 h after PHx with no significant change in the NK activity per cell base, while also increasing the number of NK cells in the peripheral blood detected by flow cytometry. The rhG-CSF induced a pre-PHx downregulation of the IL-12p70 protein levels, while also promoting the post-PHx reduction of the protein levels of IL-12p70 and IFN-gamma. Conversely, rhG-CSF had no effect on the pre-PHx mRNA levels or the PHx-induced upregulation of mRNA levels of TNF-alpha, IL-1beta, IL-6, TGF-beta, IL-10, HGF, and c-Met determined by real-time RT-PCR. These results strongly suggest that rhG-CSF-induced facilitation of liver regeneration is achieved by immunoregulation through the intrahepatic IL-12 downregulation and evacuation of sinusoidal NK cells.


RNA polymerase from phage SP01-infected and uninfected Bacillus subtilis.
A purification procedure for RNA polymerase from uninfected and phage SP01-infected Bacillus subtilis is presented. The RNA polymerase purified from B. subtilis 10 min after infection with wild type phage SP01 is resolved into two major fractions (B, C) and one minor fraction (A) by calf thymus DNA-cellulose chromatography. Fraction C is indistinguishable from RNA polymerase from uninfected cells with respect to transcription specificity (both before and after phosphocellulose chromatography). Fraction B yields, on subsequent phosphocellulose chromatography, an enzyme (B-P) whose properties distinguish it from the host RNA polymerase. Enzyme B-P preferentially transcribes SP01 DNA and selectively forms rapidly initiating complexes with SP01 DNA but not with heterologous DNA. The SP01 RNA synthesized by Enzyme B-P includes, as previously reported, a large proportion of asymmetrical middle viral RNA. Host RNA polymerase holoenzyme synthesizes asymmetrical early viral RNA, while host core polymerase synthesizes symmetrical RNA that is complementary to early, middle, and late in vivo viral RNA and contains a preponderance of antimessenger. The subunit composition of Enzyme B-P is identical to host core polymerase with respect to the beta,beta', and alpha subunits and two additional components of mr equals 9,500 and 11,000 that we observe in all preparations of RNA polymerase. In addition, Enzyme B-P has two subunits of mr equals 13,000 and 28,000, which are synthesized after phage infection. On heterologous template, Enzyme B-P and host core polymerase have comparable activities. On these templates, addition of host initiation factor, sigma, restores full activity to Enzyme B-P as well as to host core polymerase. Sigma also modifies the activity of Enzyme B-P on SP01 DNA, restoring some asymmetrical early RNA transcription while retaining some asymmetrical middle RNA transcription.


Type C Niemann-Pick disease. Abnormal metabolism of low density lipoprotein in homozygous and heterozygous fibroblasts.
The esterification of cholesterol derived from human low density lipoprotein (LDL) or fetal bovine serum (FBS) was deficient in cultured fibroblasts from subjects with heterozygous and homozygous type C Niemann-Pick (NPC) disease. Failure to significantly esterify LDL-derived cholesterol resulted in abnormal accumulation of predominantly unesterified cholesterol in homozygous NPC fibroblasts. Compared with normal and homozygous fibroblasts, heterozygous NPC fibroblasts synthesized intermediate levels of cholesteryl ester during the initial 6 h of incubation with LDL. The rate of cholesterol esterification in heterozygous cells was normal when measured over a 24-h period of incubation with LDL. In addition to demonstrating a defect in cholesterol esterification, homozygous NPC fibroblasts accumulated more total cholesterol when incubated with LDL or FBS than normal fibroblasts accumulated. When heterozygous NPC fibroblasts were incubated with LDL or FBS, cellular accumulation of cholesterol reached levels that were high-normal or intermediary between levels observed in normal and homozygous NPC fibroblasts. The partial expression of these metabolic errors in the heterozygous genotype relevantly links these errors to the primary mutation of this disorder.


Novel compound heterozygous mutations in the desert hedgehog (DHH) gene in cases of siblings with 46,XY disorders of sexual development.
Disorders of sex development (DSD) are congenital disorders in which the development of the chromosomal, gonadal, or anatomical sex is atypical. Mutations in various genes can impede gonadal development, hormone synthesis, or hormone function and cause DSD. Exome sequencing was performed for two siblings with 46,XY DSD. All mutations identified by exome sequencing were confirmed by Sanger sequencing. The 13-month-old younger sibling had a female appearance of the external genital with a clitoris that was assessed as Prader III and scored 2 in the external masculinization score evaluative test. The 16-year-old elder sibling had severe hypospadias. Exome sequencing revealed compound heterozygous mutations in exon 3 of DHH in the siblings with 46,XY DSD. The frameshift mutation (NM_021044.3: c.602delC) was derived from the father and was predicted to be deleterious. The (c.937G > T) substitution mutation was derived from the mother. Novel compound heterozygous mutations of DHH led to 46,XY DSD in two siblings. This study expands the phenotypic mutation spectra of DHH in patients with 46,XY DSD.


Body Image Disorders and Anabolic Steroid Withdrawal Hypogonadism in Men.
Hypogonadism commonly occurs during withdrawal from anabolic-androgenic steroid (AAS) use, particularly when users have been taking AAS for prolonged periods. Mounting evidence now suggests that AAS-induced hypogonadism may persist for months or even years after last AAS use, and in some cases may be partially or completely irreversible. Treatment with human chorionic gonadotropin and clomiphene may help to restore hypothalamic-pituitary-testicular axis function, and these substances are widely used illicitly by AAS users at the end of a course of AAS as so-called postcycle therapy. Many endocrinologists still have only limited experience in diagnosing and treating AAS-induced hypogonadism.


Management of urinary calculous disease in patients with renal cysts: review of 12 years of experience in 18 patients.
During the last 12 years 18 patients with urinary calculi were found to have associated cystic renal disease. We herein describe the difficulties in diagnosing and in treating this group, which included patients with simple single renal cysts, multiple cysts of 1 or both kidneys and polycystic renal disease. Renal calculi may be caused by or perpetuated by renal cystic disease. After spontaneous passage or surgical removal renal calculi may recur as long as renal cysts continue to cause urinary stasis owing to obstruction and distortion of the renal calices. Superimposed renal infection may cause further difficulties in diagnosis and treatment. The timely removal of calculi and the relief of obstruction caused by the cysts and stones are emphasized. We further recommend the judicious use of antibiotics, correction of electrolyte disturbances and prolonged followup in an attempt to prevent future calculous disease.


The radiometric assay of microsomal UDP-glucuronyltransferase using 125I-labelled phenolphthalein.
A rapid and sensitive method is described for assaying UDP-glucuronyl-transferase (EC 126.96.36.199) activity. The substrate is the relatively apolar phenolphthalein, labelled with 125I on one of its two phenolic rings leaving a free hydroxyl group for glucuronidation. Extraction with ethyl acetate leaves the glucuronide in the aqueous reaction medium which is then counted. Less than 10 mug microsomal protein is required and the glucuronidation of 10 ng 125I-labelled phenolphthalein (0.03 nmoles) is easily detected.


Specific cleavage of reduced and S-carboxamidomethylated neurophysin II by the collagenase of Clostridium histolyticum.
Purified collagenase of Clostridium histolyticum was shown to cleave reduced and S-carboxamidomethylated bovine neurophysin between Cys-13 and Gly-14. The scission resulted in formation of two separable fragments: a smaller peptide arising from residues 1 through 13, and a larger peptide comprising the remainder of the residues of the protein. By dansylation procedures, the smaller peptide was shown to have amino-terminal alanine as expected from the sequence of neurophysin II, and the larger peptide had amino-terminal glycine as anticipated. These results show that collagenase indeed cleaves bovine neurophysin II in accord with the specificity postulated for that enzyme, i.e., scission between -X-Gly- in a sequence of -Pro-X-Gly-Pro-Y-. This result, obtained with a non-collagenous protein substrate, is further confirmation of the specificity of collagenase as established by its action on collagens and on synthetic oligopeptides.


Long-term low-dose amiodarone therapy in the management of ventricular and supraventricular tachyarrhythmias: efficacy and safety.
Amiodarone hydrochloride has been in use for two decades for the control of ventricular and supraventricular arrhythmias. Established and emerging evidence indicates that amiodarone has an antiarrhythmic efficacy superior to that of most other drugs. The study was undertaken to evaluate the efficacy and acceptability of low-dose amiodarone therapy in the long-term management of supraventricular and ventricular tachyarrhythmias. A total of 124 patients with symptomatic drug-refractory or life-threatening arrhythmias managed with low-dose oral amiodarone therapy over a 10-year period was analyzed retrospectively. Of these, 45 patients (36%) had ventricular arrhythmias, 52 (42%) had atrial arrhythmias, and 27 (22%) had atrioventricular reentry tachycardia. Loading doses of amiodarone 600 mg daily for 1 week were administered for supraventricular arrhythmias and 600-1200 mg daily for 2 weeks for ventricular arrhythmias. Maintenance daily doses were 194 +/- 48 and 206 +/- 55 mg, respectively. Mean treatment duration was 32 +/- 28 months, with 326.3 patient years of therapy. Of 39 patients with sustained ventricular tachyarrhythmias, the actuarial incidence of satisfactory arrhythmia control (absence of sudden cardiac death or nonfatal arrhythmia recurrence) was 78% at 1 year and 71% at 2 years. Satisfactory control of supraventricular arrhythmias (mean ventricular rate < 100/min with significant symptomatic improvement for sustained atrial arrhythmias and < 1 attack per year for paroxysmal atrial or atrioventricular arrhythmias) was achieved in 73, 65, and 62% of patients at 1, 2, and 3 years, respectively. The cumulative incidence of amiodarone-related adverse effects was 5.8 per 100 patient years, with drug withdrawal required in 12 patients (9.7%). Fifteen patients had thyroid dysfunction, 2 had hepatic toxicity, and 1 developed nonfatal pulmonary fibrosis. Overall, the incidence of successful use of amiodarone (satisfactory arrhythmia control and freedom from side effects) was 67, 59, and 53% at 1, 2, and 3 years, respectively. The results of this study suggest that the efficacy of low-dose amiodarone therapy in the management of serious ventricular and supraventricular arrhythmias would be similar to those achieved with higher doses, but with a much more acceptable side effect profile.


Multi-waveform Spinal Cord Stimulation with High Frequency Electromagnetic Coupled (HF-EMC) Powered Implanted Electrode Array and Receiver for the Treatment of Chronic Back and Leg Pain (SURF Study).
Novel externally powered spinal cord stimulation technology can be fully implanted when trialing the effectiveness of the therapy, since no percutaneous leads are needed, and the trial period lasted 30 days. Multiple tests of different stimulation modalities and parameters are possible, thus improving the chances that the therapy will lead to effective pain reduction. The objective of this study was to analyze the effectiveness of the Freedom Spinal Cord Stimulator System (Stimwave LLC, Pompano Beach, FL) for the treatment of failed back surgery syndrome due to postlaminectomy syndrome utilizing multiple waveforms. This was a prospective, single cohort study. Patients were enrolled and implanted with up to 2 permanent, 8-contact electrode arrays with receiver, controlled regularly during 6 months of follow-up after a one month trial period. Pain and overall improvement were evaluated at 3 months and 6 months following an initial one-month implanted trial period. A variety of frequency stimulation waveforms (tonic as well as subthreshold) at frequencies of 10 Hz to 1500 Hz* and 50 to 800 µs pulse width, were provided. (*Note: While 1500 Hz was utilized in the study, Stimwave Technologies is currently only permitted to provide spinal cord stimulation therapy at frequencies below 1500 Hz, therefore pulse rates used in this study are not commercially available on Stimwave Technologies' products). Endpoints evaluated included the Visual Analog Scale (VAS) for pain intensity, Oswestry Disability Index (ODI) for functionality, Patient Global Impression of Change (PGIC) for overall health improvement, and quality of life as measured by the European Quality of Life 5 Dimension questionnaire (EQ-5D-5L). Thirty-nine patients completed the study. At 6 months, the responder rate (? 50% reduction VAS for back pain) was 33/39 = 85%. Mean VAS for back pain decreased 62%. The mean ODI decreased 46% from 54 to 29.2, indicating a reduction from severe to moderate disability. The median satisfaction as measured with the PGIC was 6 out of 7. The mean EQ-5D-5L utility score increased from 0.54 to 0.75. At the 6-months endpoint, 44% (17/39) of patients preferred tonic stimulation with a back pain per protocol responder rate of 82%; 41% (16/39) preferred surge with a responder rate of 56%; and 15% (6/39) preferred high density, with a responder rate of 83%. Fifteen patients reported 28 adverse events. Migration of the electrode array (n = 10) was the adverse event most reported. Two serious adverse events related to infection were reported. This study had several limitations. Trial failures were excluded from the analysis, there was a small sample size, and there was a lack of blinding due to the suprathreshold nature of tonic stimulation. The study demonstrates that spinal cord stimulation with multiple stimulation patterns demonstrates clinical and functional efficacy when using an externally powered stimulation system.


Effect of environmental conditions and inoculum density on infection of guava fruits by Colletotrichum glososporioides.
The influence of environmental factors (temperature and humidity), inoculum density on infection by Colletotrichum glososporioides and development of anthracnose lesions were determined on uninjured, sand-injured and punctured fruits. The optical temperature for severe infection was 30 degrees C, whereas the disease incidence was less at 20 and 35 degrees C. Inoculated guavas that received 1-60 h of continuous free moisture developed lesions, but the disease was minimal (0-7%) after 1-6 h free moisture. Infection rates of uninjured, sand-injured and punctured fruits receiving 60 h of free moisture were 34, 70 and 100%, respectively. Disease incidence increased as inoculum density increased from 101 to 106 conidia/ml. In field conditions, the development of anthracnose lesions was greater on punctured guavas than on uninjured or sand-injured ones, in both rainy and winter seasons. In general, the number of lesions was highest in sand-injured fruits, followed by punctured and uninjured fruits. In rainy season the number of lesions on injured and uninjured fruits was greater than similarly treated guavas in winter.


Vdelta1 T cell receptor binds specifically to MHC I chain related A: molecular and biochemical evidences.
Human MHC class I chain-related A (MICA) is a tumor-associated antigen that can be recognized by Vdelta1 subset of tumor-infiltrating gammadelta T cells. We previously reported that immobilized recombinant MICA protein could induce the proliferation of tumor-infiltrating Vdelta1 gammadelta T cells in vitro. But there has been no direct evidence showing the engagement of gammadelta T cell receptors (TCR) of the induced cells with MICA. In the current investigation, we show that MICA induces specific cytolytic activity of the expanded gammadelta T cells. We expressed the coupled V domains from the MICA-induced T cells as a single polypeptide chain Vdelta Vgamma TCR (gammadelta scTCR). Such scTCR can specifically bind MICA of HeLa cells. Direct interaction of gammadelta scTCRs with in vitro expressed MICA was monitored using an IAsys biosensor. We found that the Vdelta1 scTCR can specifically bind to immobilized MICA molecule and MICA alpha1alpha2 domains are responsible for the binding reaction.


Detection of Possible Symmetries in Vascular Networks by Computer-Assisted Image Analysis.
The possible forms that vascular networks may assume are significantly constrained by complex demands in terms of efficient delivery of oxygen and resources throughout the entire body. Because of these constraints the search for systematic patterns in the structural features of vascular networks and of their correlation with physiological needs and pathological conditions (such as tumor angiogenesis) represents an important line of morphological research. In this context, symmetry properties of vascular trees received limited attention, although symmetry is a widespread phenomenon, visible in all forms and scales in natural environments, and represents a significant information to describe a shape. In the present chapter three, image analysis-based methods allowing for the detection of possible symmetry features exhibited by vascular trees will be detailed and discussed.


Complications and Mortality in Octogenarians Undergoing Lumbopelvic Fixation.
Advancements in modern medicine have led to longer life expectancy. Literature on spinopelvic fixation in elderly patients is limited. We investigated morbidity and mortality in octogenarians who underwent spinopelvic fixation. A retrospective chart review was conducted of patients who underwent spinopelvic fixation from January 2014 through December 2018 at a single institution. Patients were grouped into the octogenarian group (OG), 80-89 years old, and comparison group (CG), 40-50 years old. Demographics; pathology; Charlson Comorbidity Index; Hounsfield units; surgery details; and clinical data including complications, intensive care unit and length of hospital stay, and mortality were collected and compared. Inclusion criteria were met by 26 patients (OG: n = 14; CG: n = 12). Diagnoses in the OG were deformity (42.9%), pseudarthrosis (35.7%), fracture (7.1%), infection (7.1%), and tumor (7.1%). The only significant differences in baseline patient characteristics were that Charlson Comorbidity Index was significantly higher in the OG (6.0 ± 1.4) compared with the CG (1.1 ± 1.0) (P < 0.001) and the OG had lower Hounsfield units (P < 0.001), indicating poorer bone quality. More patients in the CG underwent staged and anterior approaches compared with the OG (P = 0.031). Major and minor complication rates were 57.1% and 42.9%, respectively, in the OG (P = 0.98) and 25% and 25% in the CG (P = 0.34). Mortality rate was 14.3%. With an aging population, the number of patients requiring spinopelvic fixation will continue to grow. Spine surgeons must carefully weigh benefits and risks in patients with multiple comorbidities.


Clinical effect of meso-tetrahydroxyphenylchlorine based photodynamic therapy in recurrent carcinoma of the ovary: preliminary results.
This article addresses the use of meso-tetrahydroxyphenylchlorin-based photodynamic therapy (m-THPC-PDT) to treat recurrent gynaecologic malignancies of the ovary. Photodynamic therapy is an experimental approach in the treatment of neoplasms and results indicate it is a highly tissue selective, relatively simple intervention with few side effects, therefore reducing the overall burden on the patient. Of the three patients involved in the initial study, two were treated solely with photodynamic therapy by laparoscopy, and one underwent additional palliative debulking surgery of metastatic tumours. After a post-operative period of more than two years all three women remained free of relapses.


Impending rupture of a blunt trauma-induced left ventricular aneurysm: report of a case.
Most left ventricular true aneurysms that occur secondary to blunt trauma gradually become symptomatic as they enlarge, which validates conservative management as a reasonable initial course of action. We report a case of impending rupture of a left ventricular true aneurysm that showed rapid expansion within a few weeks. A 17-year-old youth was involved in a head-on collision into a car while riding a motorcycle. He underwent repair of a ruptured jejunum and internal fixation of a fractured femur; 28 days after the accident, he was transferred to another hospital for rehabilitation. His chest X-ray just before the transfer was normal. He was re-admitted to our hospital 58 days after the accident complaining of anterior chest pain and dyspnea. Echocardiography showed impending rupture of a left ventricular aneurysm. We performed emergency open repair of a left ventricular true aneurysm with a very thin wall. We report this case to show that even a true aneurysm of the left ventricle should be carefully monitored from the early stage, considering the possibility of rupture.


Extragonadal teratocarcinoma derived from embryonal stem cells in chimaeric mice.
Three tumours which arose in two (one male and one hermaphrodite) out of 63 chimaeric mice resulting from injection of E14TG2a embryo stem (ES) cells into host blastocysts have been investigated. All of the tumours appeared within the first 3 weeks after birth. The tumour in the male chimaera and one of the tumours in the hermaphrodite were in the perigenital region but were extragonadal. The third, smaller tumour in the hermaphrodite was on the caecum. The perigenital tumour in the male chimaera was a teratocarcinoma with a wide variety of differentiated tissues, including non-pigmented retina, as well as nests of undifferentiated embryonal carcinoma (EC) cells with high levels of alkaline phosphatase activity. The perigenital tumour in the hermaphrodite was a teratoma, less differentiated and with no evidence of EC cells. Glucose phosphate isomerase isozyme analysis indicated that both perigenital tumours were predominantly of the injected ES cell rather than the host blastocyst type. The possible origins of these tumours, which are the first reported to have arisen from ES cells in chimaeric mice, are discussed.


Cerebral blood flow response to changes in arterial carbon dioxide tension during hypothermic cardiopulmonary bypass in children.
We examined the relationship of changes in partial pressure of carbon dioxide on cerebral blood flow responsiveness in 20 pediatric patients undergoing hypothermic cardiopulmonary bypass. Cerebral blood flow was measured during steady-state hypothermic cardiopulmonary bypass with the use of xenon 133 clearance methodology at two different arterial carbon dioxide tensions. During these measurements there was no significant change in mean arterial pressure, nasopharyngeal temperature, pump flow rate, or hematocrit value. Cerebral blood flow was found to be significantly greater at higher arterial carbon dioxide tensions (p less than 0.01), so that for every millimeter of mercury rise in arterial carbon dioxide tension there was a 1.2 ml.100 gm-1.min-1 increase in cerebral blood flow. Two factors, deep hypothermia (18 degrees to 22 degrees C) and reduced age (less than 1 year), diminished the effect carbon dioxide had on cerebral blood flow responsiveness but did not eliminate it. We conclude that cerebral blood flow remains responsive to changes in arterial carbon dioxide tension during hypothermic cardiopulmonary bypass in infants and children; that is, increasing arterial carbon dioxide tension will independently increase cerebral blood flow.


A regional analysis of suicide: the USA vs Sri Lanka.
A regional analysis of suicide rates in the districts of Sri Lanka was carried out, and the results compared to an earlier regional analysis of suicide rates in the states of the USA. Some common results were identified, such as the correlation between suicide rates and interregion migration and the birth rate which were positive in both countries. The importance of simultaneous study of two or more nations in identifying generalizable findings was stressed.


Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD.
Aerobic exercise training is a recognized approach for improving functional capacity in COPD. People with greater disease severity often have difficulty achieving higher aerobic exercise training intensity. The effects of resistance training prior to aerobic training were examined to determine if this sequential approach was associated with greater gains in functional status than aerobic training alone or concurrent aerobic and resistance training. Patients were randomized to: 1) sequential resistance then aerobic training (RT-then-AT) (8 weeks resistance training followed by 8 weeks aerobic exercise training), 2) control group (CE-then-AT + RT) (8 weeks of 'sham' training followed by 8 weeks concurrent aerobic and resistance training), 3) control group (CE-then-AT) (8 weeks 'sham' training followed by 8 weeks aerobic training). Outcomes were assessed at study entry, after week 8, and after week 16: aerobic exercise performance; muscle strength and endurance. 75 patients completed training: FEV1 %pred 40 ± 10, V˙O(2peak) %predicted, 71 ± 22, fat-free mass index 19.5 ± 3.1. RT-then-AT had greater acquisition of peripheral muscle endurance than CE-then-AT + RT and CE-then-AT, but improvements in aerobic exercise performance were similar. Improvements in muscle strength were similar between RT-then-AT and CE-then-AT + RT. Sarcopenia was associated with poorer attendance, and lower aerobic and resistance training volumes. Although the sequential approach to resistance and aerobic training yielded a greater increase in muscle endurance and higher resistance training volume compared to concurrent resistance and aerobic training, other training outcomes were similar between the two groups, thus the sequential approach is not clearly superior to the concurrent approach in severe COPD. ClinicalTrials.gov Identifier: NCT01058213.


'Nesting' and 'Matrescence' as distinctive features of a free-standing birth centre in the UK.
To explore the culture, beliefs, values, customs and practices around the birth process within a free-standing birth centre (FSBC). Ethnography. A birth centre situated in the midlands of England. Women attending the centre, midwives and maternity-care assistants (MCAs) working at the centre. Women in the study seemed to invoke intuitive nesting-related behaviours in their assessment of the suitability of the birth centre. In addition, the birth centre staff's focus on creating the right ambience for birth may also emanate from nesting concerns. Birth-centre staff assisted women through the 'becoming mother' transition, which is conceptualised as 'matrescent' care. The birth-centre environment elicited nesting-like behaviours from both women and staff. This formed part of a nurturing orientation that was conceptualised as 'matrescent' (becoming mother) care. 'Matrescence' does not seem to be grounded in clinical skills but is relationally mediated. Nesting-like behaviours and 'matrescent' care in this context challenge maternity services to review traditional conceptualisations of safety and traditional expressions of clinical intrapartum care.


Taxonomic relationships of Thiobacillus halophilus, T. aquaesulis, and other species of Thiobacillus, as determined using 16S rDNA sequencing.
Total base sequences of the 16S rRNA genes of Thiobacillus halophilus and Thiobacillus aquaesulis show that these bacteria fall into the gamma- and beta-subdivisions, respectively of the Proteobacteria. The closest relative of T. halophilus is Thiobacillus hydrothermalis (with 98.7% similarity), and the closest relative of T. aquaesulis is Thiobacillus thioparus (93.2% similarity). Physiological properties and mol% G+C content of their DNA serve to confirm that these four organisms are all distinct species. It is reiterated that the species currently assigned to the genus Thiobacillus are clearly so diverse that they need reclassification into several genera. The type species, T. thioparus, is unequivocally placed in the beta-subdivision of the Proteobacteria, thus requiring that the use of the genus name Thiobacillus be restricted to the chemolithoautotrophic species falling into that group. T. aquaesulis and T. thioparus may thus be regarded as true species of Thiobacillus. The relatively large number of obligately chemolithoautotrophic Thiobacillus species falling in the gamma-subdivision of the Proteobacteria need further study in order to assess the case for reclassification into one or more new or different genera.


A Review of Clinical Radioprotection and Chemoprotection for Oral Mucositis.
The first tenet of medicine, "primum non nocere" or "first, do no harm", is not always compatible with oncological interventions e.g., chemotherapy, targeted therapy and radiation, since they commonly result in significant toxicities. One of the more frequent and serious treatment-induced toxicities is mucositis and particularly oral mucositis (OM) described as inflammation, atrophy and breakdown of the mucosa or lining of the oral cavity. The sequelae of oral mucositis (OM), which include pain, odynodysphagia, dysgeusia, decreased oral intake and systemic infection, frequently require treatment delays, interruptions and discontinuations that not only negatively impact quality of life but also tumor control and survivorship. One potential strategy to reduce or prevent the development of mucositis, for which no effective therapies exist only best supportive empirical care measures, is the administration of agents referred to as radioprotectors and/or chemoprotectors, which are intended to differentially protect normal but not malignant tissue from cytotoxicity. This limited-scope review briefly summarizes the incidence, pathogenesis, symptoms and impact on patients of OM as well as the background and mechanisms of four clinical stage radioprotectors/chemoprotectors, amifostine, palifermin, GC4419 and RRx-001, with the proven or theoretical potential to minimize the development of mucositis particularly in the treatment of head and neck cancers.


Analytic description of nanowires II: morphing of regular cross sections for zincblende- and diamond-structures to match arbitrary shapes.
Setting out from our recent publication [König & Smith (2021). Acta Cryst. B77, 861], we extend our analytic description of the regular cross sections of zincblende- and diamond-structure nanowires (NWires) by introducing cross section morphing to arbitrary convex shapes featuring linear interfaces as encountered in experiment. To this end, we provide add-on terms to the existing number series with their respective running indices for zinc-blende- (zb-) and diamond-structure NWire cross sections. Such add-on terms to all variables yield the required flexibility for cross section morphing, with main variables presented by the number of NWire atoms NWire(dWire[i]), bonds between NWire atoms Nbnd(dWire[i]) and interface bonds NIF(dWire[i]). Other basic geometric variables, such as the specific length of interface facets, as well as widths, heights and total area of the cross section, are given as well. The cross sections refer to the six high-symmetry zb NWires with low-index faceting frequently occurring in the bottom-up and top-down approaches of NWire processing. The fundamental insights into NWire structures revealed here offer a universal gauge and thus enable major advancements in data interpretation and the understanding of all zb- and diamond-structure-based NWires with arbitrary convex cross sections. We corroborate this statement with an exact description of irregular Si NWire cross sections and irregular InGaAs/GaAs core-shell NWire cross sections, where a radially changing unit-cell parameter can be included.


[Comparison Clinical Data and Results of Mathematical Modeling in Radiofrequency Ablation of Permanent Atrial Fibrillation: Cardioversion Might Be the Final Stage in the Combined Treatment].
to compare the theoretical possibility of permanent atrial fibrillation (AF) elimination (on the model of the 6-wave re-entry) result.


Total Percutaneous Revascularization of the Hand to Treat Refractory Digital Ischemia in Advanced Systemic Sclerosis.
We present the case of a young woman with systemic sclerosis (SSc) and refractory digital ulceration who was successfully treated with percutaneous revascularization of chronically occluded ulnar and radial arteries. To our knowledge, this is the first detailed report of limb salvage in SSc-induced hand ischemia in which contemporary endovascular techniques were used. (Level of Difficulty: Advanced.).


Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives.
Electronic cigarettes (e-cigs) have experienced a rapid growth in popularity but little is known about how they are used. The aim of this study was to identify the e-cig products used by experienced e-cig users, their pattern of e-cig use and the impact on tobacco use. Face-to-face survey of 104 experienced e-cig users. Of all the e-cig users, 78% had not used any tobacco in the prior 30 days. They had previously smoked an average of 25 cigarettes per day, and had tried to quit smoking an average of nine times before they started using e-cigs. Two-thirds had previously tried to quit smoking using an FDA-approved smoking cessation medication. The majority of the sample had used e-cigs daily for at least a year. Three quarters started using e-cigs with the intention of quitting smoking and almost all felt that the e-cig had helped them to succeed in quitting smoking. Two-thirds used e-cig liquid with a medium to high concentration of nicotine (13 mg +). Only 8% were using the most widely sold types of cigarette-sized e-cigs that are typically powered by a single 3.7 volt battery. Instead most used e-cigs designed to enable the atomizer to more consistently achieve a hotter more intense vapour. Until we have more evidence on the safety and efficacy of e-cigs for smoking cessation, smokers should be advised to use proven treatments (e.g. counselling and FDA-approved medicines). However, for those who have successfully switched to e-cigs, the priority should be staying off cigarettes, rather than quitting e-cigs.


Replication of cytomegalovirus in human epitheloid diploid cell line.
Human diploid BAMB cells with epitheloid morphology, which had been derived from amniotic fluid cells, were capable of supporting the replication of human cytomegalovirus (CMV), without prior treatment of the cells with halogenated pyrimidines. The growth of this virus in BAMB cells and in human diploid fibroblastoid (LEP) cells was compared in parallel tests. Virus replication was slower and less efficient in the former than in the latter system. The most characteristic morphological feature of the CMV-infected BAMB cells was the formation of multinucleated giant cells which frequently contained more than a hundred nuclei; such cells were not seen in LEP cultures. The development of ultrastructural changes was slower in BAMB cells than in LEP cells. The additional most marked differences concerned the place of viral envelopment and the production of cytoplasmic dense bodies. While in LEP cells most nucleocapsids were enveloped from the inner leaflet of the nuclear membrane, in the other system a great majority of the particles acquired their envelopes by budding into vacuoles. Cytoplasmic dense bodies were rare in infected LEP cells but very frequent in BAMB cells. Budding of these structures into vacuoles was also observed.


Long Noncoding RNA UCA1 Overexpression Is Associated with Poor Prognosis in Digestive System Malignancies: A Meta-analysis.
Long noncoding RNA (lncRNA) urothelial carcinoma associated 1 (UCA1) has been reported to be highly expressed in many kinds of cancers. This meta-analysis summarized its potential prognostic value in digestive system malignancies. A meta-analysis was performed through a comprehensive search in PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese National Knowledge Infrastructure (CNKI) for suitable articles on the prognostic impact of UCA1 in digestive system malignancies from inception to June 27, 2019. Pooled hazard ratios (HRs) with 95% confidence interval (95%CI) were calculated to summarize the effect. Sixteen studies were included in the study, with a total of 1504 patients. A significant association was observed between UCA1 abundance and poor overall survival (OS), and shorter disease-free survival (DFS) for patients with digestive system malignancies, with pooled HR of 2.07 (95%CI: 1.74-2.47), and of 2.50 (95%CI: 1.62-3.86). Subgroup analysis and sensitivity analysis suggested the reliability of our findings. It is suggested that UCA1 abundance may serve as a reliable predictive factor for poor prognosis in patients with digestive system malignancies.


Role of Endoscopic Ultrasound in Detecting Pancreatic Cancer Missed on Cross-Sectional Imaging in Patients Presenting with Pancreatitis: A Retrospective Review.
Pancreatic cancer is the fourth leading cause of cancer-related death in the USA. Early detection of pancreatic cancer may help improve patient survival. It has been hypothesized that acute idiopathic or chronic pancreatitis is associated with an increased risk of pancreatic cancer; however, these conditions may also represent an early manifestation of pancreatic cancer, rather than just being risk factors. Endoscopic ultrasound (EUS) is a sensitive diagnostic modality for the detection of small, early-stage pancreatic tumors. The aim of this study was to evaluate the diagnostic yield of EUS for pancreatic cancer in patients with acute idiopathic or chronic pancreatitis when cross-sectional imaging (CT and/or MRI) was negative for a mass lesion in the pancreas. This study was an IRB-approved retrospective chart review conducted for the period of August 2005 to September 2018. Any patient presenting with acute idiopathic or chronic pancreatitis with a CT and/or MRI imaging negative for a pancreatic mass lesion that underwent an EUS during the study period was selected for inclusion. A retrospective review was performed to evaluate the outcomes of patients who had pancreatic cancer diagnosed from an EUS-FNA (fine needle aspiration) sample. Data were collected on patient demographics and clinical characteristics, inclusive of specific post-diagnosis treatment course. An "event rate" was calculated and is defined as the number of positive pancreatic cancer diagnoses on EUS-FNA from all patients presenting with acute idiopathic or chronic pancreatitis who underwent an EUS examination following a CT and/or MRI study negative for pancreatic mass lesion. A total of 565 patients met inclusion criteria, with 30 cases of confirmed pancreatic cancer diagnosed with EUS-FNA from this group. The event rate for EUS diagnosis of pancreatic cancer was 5.3%. The majority of patients (52.0%) diagnosed with cancer were stages I-II. Endoscopic ultrasound should be a routine part of the diagnostic algorithm when evaluating a patient with acute idiopathic or chronic pancreatitis of unclear etiology, particularly when cross-sectional imaging is negative for a mass lesion and clinical suspicion is high for neoplasia. Further prospective studies are needed to evaluate the role of EUS in this setting.


A randomized controlled trial of two diets enriched with protein or fat in patients with type 2 diabetes treated with dapagliflozin.
Sodium-glucose cotranspsorter-2 (SGLT2) inhibitors (SGLT2i) involve loss of skeletal muscle mass, potentially leading to inadequate HbA1c reduction in type 2 diabetes (T2DM), since muscle mass is related to insulin sensitivity. The benefit of protein-enriched diet for improving HbA1c in SGLT2i-treated T2DM patients remains unclear. We conducted a multicenter, double-blind, randomized, controlled, investigator-initiated clinical trial. 130 T2DM patients treated with dapagliflozin (5 mg) were randomized to isoenergic protein-rich formula diet (P-FD) or fat-rich FD (F-FD) (1:1 allocation) to replace one of three meals/day for 24 weeks. Primary outcome was change in HbA1c. Secondary outcomes were changes in serum insulin, body composition and other metabolic parameters. Although HbA1c decreased significantly in both groups [mean (95% confidence interval) - 0.7% (- 0.9 to - 0.5) in P-FD, - 0.6% (- 0.8 to - 0.5) in F-FD], change in HbA1c was not significantly different between the two groups (P = 0.4474). Fasting insulin and body fat mass decreased, while HDL-cholesterol increased significantly in P-FD, and these changes were significantly greater compared with F-FD (all, P < 0.05). In T2DM treated with dapagliflozin, protein-enriched diet does not contribute to HbA1c reduction, although it decreases serum insulin and body fat mass, and increases HDL-cholesterol compared with fat-enriched diet with identical calories and carbohydrate ratio.


Human calcanei from the Middle Pleistocene site of Sima de los Huesos (Sierra de Atapuerca, Burgos, Spain).
The existence of calcanei in the fossil record prior to modern humans and Neandertals is very scarce. This skeletal element is fundamental to understanding the evolution of the morphology of the foot in human evolution. Here we present and metrically and comparatively describe 29 calcaneus remains from the Middle Pleistocene site of Sima de los Huesos (SH) (Sierra de Atapuerca, Burgos, Spain). These calcanei belong to 15 individuals (nine adults, two adolescents and four immature individuals). The metric and morphological differences in the calcanei among Middle and Late Pleistocene hominins tend to be subtle. However, the calcanei from SH are broad and robust with large articular surfaces and most significantly, exhibit a very projected sustentaculum tali. A biomechanical and phylogenetic interpretation is proffered to explain the observed morphology of these calcanei. It has been possible to propose tentative sex assignments for the SH calcanei based on size, using methods similar to those used to establish sex from the talus bones from SH. The estimation of stature based on the calcaneus provides a mean of 175.3 cm for males and 160.6 for females, which is similar to that obtained using other skeletal parts from the site. In sum, the SH calcanei are robust with a proportionally long tubercle and a projected sustentaculum tali, which are traits shared by Neandertals.


Peri-Urethral and Anterior Vaginal Wall Masses: Does Radiological Imaging Change the Predicted Diagnosis?
This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions. This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis. A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses. Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis. Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.


Assessment of trace elements directly from archived total suspended particulate filters by laser ablation ICP-MS: A case study of South Carolina.
Exposure to particulate air pollution is one of the greatest environmental risk factors for adverse human health outcomes. However, the constituents that may be responsible for such adverse health effects have not been fully studied. Total suspended particulates filters collected every 6 days in 2011 from three South Carolina locations were used in this case study. An inductively coupled plasma mass spectrometer interfaced with a laser ablation system (LA-ICP-MS) was used to directly analyze 41 inorganic elemental species on air pollution filters. Then, machine learning and multivariate statistical methods was employed to identify combinatorial patterns in the data and classify sites based on their elemental composition. Forty-one elements were assessed and 33 were used in subsequent analysis. Correlations between United States Environmental Protection Agency (US EPA)'s chemical analysis dataset and data from the current study revealed significant associations between 7/15 elements with enough variation for comparison (r between 0.28 to 0.66, p<0.05). Subsequent multivariate analyses revealed four distinct patterns in the distribution of elements by sample location throughout the year. The different airborne elements may need to be assessed to understand combinations of elements which occur together over space and/or time. Such information can be helpful in planning effective counter measures and strategies to control particulate air pollution.


Experimental energy improvement of a special design heat exchanger-based hybrid solar collector for a photovoltaic module square surface.
Solar cells convert a part of the solar irradiance into electrical energy, and the remaining produces heat, which can be converted as a thermal energy accumulated in the module. This conversion depends on the solar cells temperature. Since conversion efficiency is very low, 5-20%, this investigation proposes an optimal combination of a photovoltaic module with a specially designed heat exchanger in order to improve the conversion energy efficiency. So, an experimental prototype of a photovoltaic thermal collector, with a special heat exchanger design for a PV module square surface is built and tested outdoor. The system is constituted of a PV module with square surface and a heat exchanger with a copper tube, in a spiral form. In order to assess the effect of the exchanger design on hybrid system performance, a comparison with a traditional photovoltaic module is done. During the experimental tests, various parameters were measured, such as solar irradiance, ambient temperature, coolant inlet/outlet temperature and surface temperature of the device. Based on the obtained results, it has been found that the use of the new PVT decreases the PV cells temperature in the order of 20°C. A consequence of that shows that the electrical power increases, by 6 W; moreover, the electrical energy efficiency goes from 7.93 to 9.65%, while the thermal energy efficiency of the PVT reaches 74.3%. The overall energy efficiency for the same system achieved was 84 %. Therefore, the energy loss is minimized, reaching 16%.


Home Surgical Skill Training Resources for Obstetrics and Gynecology Trainees During a Pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has created a unique educational circumstance in which medical students, residents, and fellows find themselves with a gap in their surgical training. We reviewed the literature, and nine categories of resources were identified that may benefit trainees in preventing skill decay: laparoscopic box trainers, virtual reality trainers, homemade simulation models, video games, online surgical simulations, webinars, surgical videos, smartphone applications, and hobbies including mental imagery. We report data regarding effectiveness, limitations, skills incorporated, cost, accessibility, and feasibility. Although the cost and accessibility of these resources vary, they all may be considered in the design of remote surgical training curricula during this unprecedented time of the COVID-19 pandemic.


Risk factors and prediction models for bronchiolitis obliterans after severe adenoviral pneumonia.
Severe adenoviral pneumonia (SAP) can cause post-infectious bronchiolitis obliterans (PIBO) in children. We aimed to investigate the relevant risk factors for PIBO and develop a predictive nomogram for PIBO in children with SAP. This prospective study analysed the clinical data of hospitalised children with SAP and categorised them into the PIBO and non-PIBO groups. Least absolute shrinkage and selection operator (LASSO) regressions were applied to variables that exhibited significant intergroup differences. Logistic regression was adopted to analyse the risk factors for PIBO. Additionally, a nomogram was constructed, and its effectiveness was assessed using calibration curves, C-index, and decision curve analysis. A total of 148 hospitalised children with SAP were collected in this study. Among them, 112 achieved favourable recovery, whereas 36 developed PIBO. Multivariable regression after variable selection via LASSO revealed that aged < 1 year (OR, 2.38, 95% CI, 0.82-6.77), admission to PICU (OR, 24.40, 95% CI, 7.16-105.00), long duration of fever (OR, 1.16, 95% CI, 1.04-1.31), and bilateral lung infection (OR, 8.78, 95% CI, 1.32-195.00) were major risk factors for PIBO. The nomogram model included the four risk factors: The C-index of the model was 0.85 (95% CI, 0.71-0.99), and the area under the curve was 0.85 (95% CI, 0.78-0.92). The model showed good calibration with the Hosmer-Lemeshow test (χ2 = 8.52, P = 0.38) and was useful in clinical settings with decision curve analysis. Age < 1 year, PICU admission, long fever duration, and bilateral lung infection are independent risk factors for PIBO in children with SAP. The nomogram model may aid clinicians in the early diagnosis and intervention of PIBO. • Adenoviruses are the most common pathogens associated with PIBO. • Wheezing, tachypnoea, hypoxemia, and mechanical ventilation are the risk factors for PIBO. • Age < 1 year, admission to PICU, long duration of fever days, and bilateral lung infection are independent risk factors for PIBO in children with SAP. • A prediction model presented as a nomogram may help clinicians in the early diagnosis and intervention of PIBO.


Exploring changes in cigar smoking patterns and motivations to quit cigars among black young adults in the time of COVID-19.
The COVID-19 pandemic has disproportionately impacted the Black/African American communities in the U.S. The objective of this study is to understand the change in cigar smoking patterns and motivations to quit cigars during the COVID-19 pandemic among Black young adult cigar smokers. During May-June 2020, in-depth telephone interviews were conducted to investigate cigar (i.e., large cigars, cigarillos, filtered cigars, and blunts) smoking behaviors during the pandemic among self-identified, non-Hispanic Black/African American young adult cigar smokers (n = 40; ages 21-29). Interviews were audio-recorded, transcribed verbatim, and coded separately by three coders. Thematic analysis was used to assess thematic patterns arising from the interviews. Most participants reported smoking cigarillos and blunts in higher frequency and quantity to cope with COVID-19-induced stress, anxiety, loneliness, and boredom due to economic losses and physical isolation. Some also reported contextual changes in cigarillo and blunt smoking, including smoking around the clock, smoking immediately after waking up, and smoking an entire cigarillo or blunt in one setting. Very few participants reported motivations to quit cigars during the pandemic. Perceiving higher risks of progressed COVID-19 outcomes did not prompt participants' increased motivations for quitting cigars. Black young adults in this study increasingly smoked cigarillos and blunts during the COVID-19 pandemic, mainly attributed to daily life stressors. Participants did not have increased motivations for quitting cigars to reduce COVID-19-related risks. Promoting contextually appropriate healthy coping and cigar smoking cessation may minimize COVID-19-related health consequences of cigar smoking and reduce health disparities among Black young adults.


Verification of IMRT dose calculations using AAA and PBC algorithms in dose buildup regions.
The purpose of this comparative study was to test the accuracy of anisotropic analytical algorithm (AAA) and pencil beam convolution (PBC) algorithms of Eclipse treatment planning system (TPS) for dose calculations in the low- and high-dose buildup regions. AAA and PBC algorithms were used to create two intensity-modulated radiotherapy (IMRT) plans of the same optimal fluence generated from a clinically simulated oropharynx case in an in-house fabricated head and neck phantom. The TPS computed buildup doses were compared with the corresponding measured doses in the phantom using thermoluminescence dosimeters (TLD 100). Analysis of dose distribution calculated using PBC and AAA shows an increase in gamma value in the dose buildup region indicating large dose deviation. For the surface areas of 1, 50 and 100 cm2, PBC overestimates doses as compared to AAA calculated value in the range of 1.34%-3.62% at 0.6 cm depth, 1.74%-2.96% at 0.4 cm depth, and 1.96%-4.06% at 0.2 cm depth, respectively. In high-dose buildup region, AAA calculated doses were lower by an average of -7.56% (SD = 4.73%), while PBC was overestimated by 3.75% (SD = 5.70%) as compared to TLD measured doses at 0.2 cm depth. However, at 0.4 and 0.6 cm depth, PBC overestimated TLD measured doses by 5.84% (SD = 4.38%) and 2.40% (SD = 4.63%), respectively, while AAA underestimated the TLD measured doses by -0.82% (SD = 4.24%) and -1.10% (SD = 4.14%) at the same respective depth. In low-dose buildup region, both AAA and PBC overestimated the TLD measured doses at all depths except -2.05% (SD = 10.21%) by AAA at 0.2 cm depth. The differences between AAA and PBC at all depths were statistically significant (p < 0.05) in high-dose buildup region, whereas it is not statistically significant in low-dose buildup region. In conclusion, AAA calculated the dose more accurately than PBC in clinically important high-dose buildup region at 0.4 cm and 0.6 cm depths. The use of an orfit cast increases the dose buildup effect, and this buildup effect decreases with depth.


Untangling metabolic and spatial interactions of stress tolerance in plants. 2. Accelerated method for measuring and predicting stress tolerance. Can we unravel the mysteries of the interactions between photosynthesis and respiration?
A simple method using the O(2) electrode that allows examination of the response of respiration and photosynthesis in leaf slices or algae to anoxia and high light under different temperatures useful for the examination of the interactions among photosynthesis, photorespiration, and respiration is described. The method provides a quantifiable assessment of stress tolerance that also permits us to examine fundamental biochemically and genetically related responses involved in stress tolerance and the cooperation among organelles. Additionally, we demonstrated a role for compounds, such as NO(-)(3) and oxaloacetate, as protective agents against photoinhibition, and we examined the role of dark adaptation in the activation of photosynthesis and NO(-)(3)-dependent O(2) oxygen evolution. A physiological and ecological role of a dark period (night) in stress tolerance is presented. Utilizing the method to follow changes in such metabolic activities as protein synthesis, protein conformation states, enzymes activity, carbon metabolism, and gene expression at different points during the treatments will be educational.


A DFT investigation into the effects of As-doping on the electronic structure and electrochemical activity of pyrite (FeS2).
Pyrite (FeS2) is a semiconductor mineral with electronic structural properties that are heavily influenced by trace elements in its composition. It has been demonstrated experimentally that the reduction of Fe3+ ions is significantly enhanced in the presence of trace arsenic (As) atoms in FeS2. Using density functional theory calculations, we compare the geometric and electronic structural properties of pure and As-doped (110) pyrite surfaces. The interaction of the Fe3+ ion, a common oxidant of sulfides in acidic solution and acid mine drainage, with the aforementioned surfaces is thoroughly investigated. The findings reveal that the addition of an As atom alters the electronic structure of pyrite and decreases its band gap. The adsorption energy of the Fe3+ ion on As-doped pyrite is greater than that on pure pyrite. The calculated Gibbs free energy changes show that the reduction of Fe3+ to Fe2+ ion on the As-modified surface is thermodynamically more favorable than on pure pyrite.


The burden of implementation: A mixed methods study on barriers to an ICU follow-up program.
It has been suggested that ICU follow-up clinics can offer support for ICU survivors and their relatives. However, implementation of such clinics can be challenging. We explored the barriers to implementation of an ICU follow-up program from the healthcare providers' perspective. This was a mixed methods study with a triangulation design conducted over the 7-month pilot period of an ICU follow-up program. The quantitative analysis showed that two main tasks within the program took the most time to be completed: training and tracking. Training new healthcare professionals to acquire the necessary competences for the follow-up clinic was the most time-consuming task [30 min (IQR 13-56)]. Tracking patients, which consists of keeping records of a patient during the hospital stay and when discharged, was the second most time-consuming task [15 min (IQR 10-20)]. We recorded 291 items of qualitative data from the 12 team members who participated. The qualitative analysis identified three domains that were crucial barriers for program implementation: Luhr et al. (2019) [1] organization (37.1%), Máca et al. (2017) [2] engagement (38.5%), and (Gayat et al., 2018 [3]) resources (24%). In agreement with the quantitative data, training and tracking were perceived by participants as laborious tasks and key barriers to implementation of the ICU follow-up program. Despite the expectation that resources would be the most important barrier, they were not considered as such by our participants being only mentioned in 13.4% of our qualitative reports; when mentioned, this barrier was related mostly to insufficient numbers of staff members. Awareness of those barriers can help healthcare providers and ICU managers in developing strategies adapted to overcome constraints, thus facilitating the implementation process.


Report highlights lack of progress by some trusts in special measures.
SIX TRUSTS in England that must remain in special measures for another six months have nurse shortages and inadequate leadership that threaten public safety.


The miR-1224-5p/TNS4/EGFR axis inhibits tumour progression in oesophageal squamous cell carcinoma.
Oesophageal squamous cell carcinoma (ESCC) is a common and aggressive malignancy. Although many molecular alterations have been observed in ESCC, the mechanisms underlying the development and progression of this disease remain unclear. In the present study, miR-1224-5p was identified to be downregulated in ESCC tissues compared to normal tissues, and its low expression was correlated with shorter survival time in patients. In vitro experiments showed that miR-1224-5p inhibited the proliferation, colony formation, migration and invasion of ESCC cells. Mechanistic investigation revealed that miR-1224-5p directly targeted TNS4 and inhibited its expression, which led to the inactivation of EGFR-EFNA1/EPHA2-VEGFA (vascular endothelial growth factor A) signalling. Experiments in vivo confirmed the suppressive effect of miR-1224-5p on oesophageal cancer cells. By immunohistochemistry analysis of ESCC specimens, we found that TNS4 expression was positively correlated with that of VEGFA, and was significantly associated with lymph node metastasis and shorter survival time in patients. Together, our data suggest that miR-1224-5p downregulation is a frequent alteration in ESCC that promotes cell proliferation, migration, invasion and tumour growth by activating the EGFR-EFNA1/EPHA2-VEGFA signalling pathway via inhibition of TNS4 expression. Decreased miR-1224-5p and elevated TNS4 are unfavourable prognostic factors for ESCC patients.


Synthesis of Imidazole-Based [30]Heptaphyrin and Stable Figure-Eight [60]Tetradecaphyrins via [5 + 2] Condensations in One Pot.
Derived from a Pd-catalyzed oxidative C-H/C-H coupling reaction, two giant imidazole-based [60]tetradecaphyrins adopting stable figure-eight geometry together with one [30]heptaphyrin are obtained by [5 + 2] MacDonald condensations in one pot. The directional imidazole is believed to play a vital role for the diverse cyclization and conformation stabilization.


Nano copper oxide catalyzed synthesis of symmetrical diaryl sulfides under ligand free conditions.
Potassium thiocyanate acts as an efficient sulfur surrogate in C-S cross-coupling reactions mediated by recyclable copper oxide nanoparticles under ligand free conditions. This protocol avoids foul smelling thiols, for the synthesis of a variety of symmetrical diaryl sulfides, via the cross-coupling of different aryl halides with potassium thiocyanate, affording corresponding products in moderate to excellent yields.


Scanning electron microscopic evaluation of the skin surface after ultrasound exposure.
Transdermal drug-delivery systems have become widely accepted clinically for the administration of several systemic drugs. Recently, research on ultrasound irradiation to facilitate the penetration of drugs through the skin have been reported. The present study investigated the morphological changes induced in skin after ultrasound irradiation to hairless mouse skin and human skin. Hairless mice and human skin were immersed in an ultrasound irradiation water tank. Ultrasound was delivered for a duration of 5 min. Ultrasound frequency of 48 kHz was generated at an intensity of 0.5 W/cm2. The surface of the skin was observed with scanning electron microscopy for comparison with skin samples unexposed to ultrasound energy. For hairless mouse exposed to ultrasound, the cells of the stratum corneum of the skin surface were almost completely removed. The polygonal cells of the stratum spinosum and basal cells were exposed. In addition, large craterlike pores with a diameter of 100 microns were formed sporadically in some of the skin samples. In contrast, the surface of human skin exposed to ultrasound showed only slight removal of keratinocytes around the hair follicles. The removal of the stratum corneum and other alterations in hairless mouse and human skin by ultrasound may explain the enhancement of transdermal drug penetration. The effect on human skin was relatively minor compared with that on hairless mouse skin.


Omeprazole. Overview and opinion.
Omeprazole, a substituted benzimidazole, is a specific inhibitor of the enzyme H+/K(+)-ATPase, which is found on the secretory surface of the parietal cell. This enzyme, the "proton pump," catalyzes the final step in acid secretion. Omeprazole is a powerful inhibitor of gastric acid secretion. At the time of writing, omeprazole has been licensed in the United States for the treatment of severe grades of gastroesophageal reflux disease (GERD) as well as GERD unresponsive to treatment with currently available agents, and for the treatment of Zollinger-Ellison syndrome and other gastric hypersecretory states. Most recently, it has been recommended by the FDA advisory committee for approval as first-line therapy in duodenal ulcer disease.


Early reduced dopaminergic tone mediated by D3 receptor and dopamine transporter in absence epileptogenesis.
In Genetic Absence Epilepsy Rats From Strasbourg (GAERSs), epileptogenesis takes place during brain maturation and correlates with increased mRNA expression of D3 dopamine receptors (D3R). Whether these alterations are the consequence of seizure repetition or contribute to the development of epilepsy remains to be clarified. Here, we addressed the involvement of the dopaminergic system in epilepsy onset in GAERSs. Experiments were performed using rats at different stages of brain maturation from three strains according to their increasing propensity to develop absence seizures: nonepileptic control rats (NECs), Wistar Hannover rats, and GAERSs. Changes in dopaminergic neurotransmission were investigated using different behavioral and neurochemical approaches: autoradiography of D3R and dopamine transporter, single photon emission computed tomographic imaging, acute and chronic drug effects on seizure recordings (dopaminergic agonists and antagonists), quinpirole-induced yawns and dopamine synaptosomal uptake, microdialysis, brain tissue monoamines, and brain-derived neurotrophic factor quantification. Autoradiography revealed an increased expression of D3R in 14-day-old GAERSs, before absence seizure onset, that persists in adulthood, as compared to age-matched NECs. This was confirmed by increased yawns, a marker of D3R activity, and increased seizures when animals were injected with quinpirole at low doses to activate D3R. We also observed a concomitant increase in the expression and activity of the dopamine transporter in GAERSs before seizure onset, consistent with both lowered dopamine basal level and increased phasic responses. Our data show that the dopaminergic system is persistently altered in GAERSs, which may contribute not only to behavioral comorbidities but also as an etiopathogenic factor in the development of epilepsy. The data suggest that an imbalanced dopaminergic tone may contribute to absence epilepsy development and seizure onset, as its reversion by a chronic treatment with a dopamine stabilizer significantly suppressed epileptogenesis. Our data suggest a potential new target for antiepileptic therapies and/or improvement of quality of life of epileptic patients.


RhoGAP: the next big thing for small mice?
The size of an organism is determined by the number and size of its constituent cells. The insulin/IGF-1 signaling systems have been long recognized to play a critical role in the determination of body size. Now the generation of mice deficient for a RhoGAP suggests that this small G protein might also regulate the growth of animals.


The self-tuning controller: comparison with human performance in the control of arterial pressure.
A self-tuning controller was implemented for the automated infusion of sodium nitroprusside to lower mean arterial pressure in anesthetized dogs. The system incorporated a recursive least-squares parameter identifier and a modified minimum-variance controller. The onset delay was estimated on-line, the performance criterion included the cost of control, and requested step-changes were automatically translated into five successive smaller steps to reduce overshoot. The performance of the system in lowering mean arterial pressure was quantitatively compared with that of a well-trained anesthesiologist. In 10 runs in four animals, the automated system performed as well as the physician who devoted 100% of his attention to the task. Since the stability of the self-tuning controller cannot be guaranteed, such a system should be operated only in the presence of appropriate supervisory algorithms.


The antioxidant function of the p53 tumor suppressor.
It is widely accepted that the p53 tumor suppressor restricts abnormal cells by induction of growth arrest or by triggering apoptosis. Here we show that, in addition, p53 protects the genome from oxidation by reactive oxygen species (ROS), a major cause of DNA damage and genetic instability. In the absence of severe stresses, relatively low levels of p53 are sufficient for upregulation of several genes with antioxidant products, which is associated with a decrease in intracellular ROS. Downregulation of p53 results in excessive oxidation of DNA, increased mutation rate and karyotype instability, which are prevented by incubation with the antioxidant N-acetylcysteine (NAC). Dietary supplementation with NAC prevented frequent lymphomas characteristic of Trp53-knockout mice, and slowed the growth of lung cancer xenografts deficient in p53. Our results provide a new paradigm for a nonrestrictive tumor suppressor function of p53 and highlight the potential importance of antioxidants in the prophylaxis and treatment of cancer.


Association of iron metabolism markers, socioeconomic and lifestyle factors with endometriosis: A cross-sectional study.
Evidence on the link between iron metabolism markers and endometriosis is limited. We aimed to investigate the associations of iron metabolism markers, including serum ferritin level and transferrin saturation, with endometriosis. This study involved 6551 participants from the National Health and Nutrition Examination Survey (NHANES). Univariable and multivariable logistic regression analyses were used to examine the linear relationships between iron metabolism markers and endometriosis. Furthermore, restricted cubic splines were used to identify the non-linear dose-response associations. Univariable analysis showed that the factors associated with endometriosis included age, race, education level, and smoking status. In multivariable model, compared with lowest quartile, highest quartile of serum ferritin level was positively associated with endometriosis (OR: 2.11, 95% confidence intervals [CI]: 1.31, 3.40, P = 0.004), and third quartile of transferrin saturation positively associated with endometriosis (OR: 1.55, 95% CI: 1.05, 2.29, P = 0.033). The restricted cubic splines showed the non-linear (inverted U-shape) associations between serum ferritin level and transferrin saturation and endometriosis (all P for non-linear<0.01), indicating that the ORs of endometriosis increased with serum ferritin level and transferrin saturation up to the turning point and thereafter the ORs of endometriosis did not significantly increase with the increasing serum ferritin and transferrin saturation. Our findings suggests that serum ferritin level and transferrin saturation were positively associated with endometriosis. Serum ferritin and transferrin saturation may be an important marker for endometriosis. Future prospective and longitudinal studies are necessary to better understand these findings.


The interface of toxicology and tissue culture and reflections on the carnation test.
The convergence of an imperative for expanded testing of chemicals before they are released into the environment and the maturation of tissue culture as an important tool for biomedical research, has led to the development of in vitro methods for toxicological evaluation. Of the several facets of the interface -- screening, mechanisms, personnel monitoring, and risk assessment -- screening has the broadest interface. The success which has been achieved to date stems from a recognition of the limitations as well as the attributes of in vitro research, extensive validation of specific tests (especially for mutagenesis and carcinogenesis), and the use of test batteries rather than single tests.


A powerful approach for association analysis incorporating imprinting effects.
For a diallelic marker locus, the transmission disequilibrium test (TDT) is a simple and powerful design for genetic studies. The TDT was originally proposed for use in families with both parents available (complete nuclear families) and has further been extended to 1-TDT for use in families with only one of the parents available (incomplete nuclear families). Currently, the increasing interest of the influence of parental imprinting on heritability indicates the importance of incorporating imprinting effects into the mapping of association variants. In this article, we extend the TDT-type statistics to incorporate imprinting effects and develop a series of new test statistics in a general two-stage framework for association studies. Our test statistics enjoy the nature of family-based designs that need no assumption of Hardy-Weinberg equilibrium. Also, the proposed methods accommodate complete and incomplete nuclear families with one or more affected children. In the simulation study, we verify the validity of the proposed test statistics under various scenarios, and compare the powers of the proposed statistics with some existing test statistics. It is shown that our methods greatly improve the power for detecting association in the presence of imprinting effects. We further demonstrate the advantage of our methods by the application of the proposed test statistics to a rheumatoid arthritis dataset. email@example.com Supplementary data are available at Bioinformatics online.


Changes in the activities of dihydroxyacetone phosphate and glycerol-3-phosphate acyltransferases in rat liver under various conditions.
Activities of enzymes relating to the acyl dihydroxyacetone phosphate (acyl DHAP) pathway were determined in rat liver under conditions known to elevate the peroxisomal beta-oxidation activity. In fasted and streptozotocin-induced diabetic rats, DHAP acyltransferase activity showed a small but significant increase, though the activities of glycerol-3-phosphate (GP) acyltransferase and alkyl DHAP synthase were not changed. After 2 weeks, feeding of 20% partially hydrogenated marine oil, the activity of DHAP acyltransferase also increased to 140% of the control. The feeding of 0.25% clofibrate and 2% di(2-ethylhexyl)phthalate (DEHP) increased the activities of both DHAP and GP acyltransferases by 2- to 3-fold, whereas alkyl DHAP synthase activity decreased under the same conditions. A fractionation study showed that the increases in the activities of DHAP acyltransferase and acyl/alkyl DHAP reductase in the liver of rats treated with DEHP occurred mainly in peroxisomes and microsomes, respectively. The phospholipid contents per mg protein of the isolated hepatic peroxisomes from rats were as follows (percent of the control): fasting, 62%; diabetic, 69%; high fat-diet, 89%; clofibrate-treated, 126%; DEHP-treated, 119%. These results suggest that glycerophospholipid metabolism might also be controlled by peroxisomal enzymes under physiological and pathological conditions.


Essential ingredients for rational drug design.
This short review focuses on three aspects of rational drug design that we consider of utmost importance: the conformation of small molecules in solid form, the conformation of small molecules in solution and lesser studied interactions in protein-ligand complexes. Using examples from recent literature, we will illustrate these different aspects and how they have contributed to the discovery of potent modulators.


San Francisco pedestrian injury surveillance: mapping, under-reporting, and injury severity in police and hospital records.
Police reports of severely injured pedestrians help identify hazardous traffic areas in San Francisco, but they under-report non-fatal collisions. We set out to: identify injured pedestrians who were missing from police collision reports, see what biases exist in injury reporting and assess the utility of broad categories of police severe injury (including fatal) for mapping and analysis. We linked data on injured pedestrians from police collision reports listed in the Statewide Integrated Traffic Reporting System (SWITRS, n = 1991) with records of pedestrians treated at San Francisco General Hospital (SFGH, n = 1323) for 2000 and 2001. Data were analyzed using bivariate statistics, logistic regression and mapping. : We found that police collision reports underestimated the number of injured pedestrians by 21% (531/2442). Pedestrians treated at SFGH who were African-American were less likely then whites (odds ratio = 0.55, p-value < or= 0.01), and females were more likely than males (odds ratio = 1.5, p-value < or = 0.01) to have a police collision report. Over 70% of pedestrians deemed by the police to have a severe injury received treatment at SFGH, regardless of the collision's distance from SFGH. The sensitivity of a police-designated severe injury (including fatal) was 69% and the specificity was 89% when compared with a known SFGH assessment. But, sensitivity declined when we included pedestrians without a SFGH record. Though collision reports have demonstrated limitations, broad categories of police severity may be sensitive enough to map locations where numerous severe injuries occur, for timely countermeasure selection.


Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders?
The objective of this study is to determine whether achievement of the Maternal and Child Health Bureau core outcome ease of use of health services differs between children with developmental disabilities, mental health conditions and physical disorders. We analyzed data from the 2005 National Survey of Children with Special Health Care Needs. Children with special health care needs were classified into 4 health condition groups: developmental disabilities (DD), mental health conditions (MH), physical disorders (PD) and multiple conditions. The outcome measure was 'difficulty using services'. We conducted bivariate and multivariate analyses to determine the associations between the health condition groups and the outcome. Of the CSHCN included in the study, 2.6% had DD, 12.9% had MH, 49.9% had PD and 34.6% belonged to multiple conditions group. Four percent of CSHCN with PD, 17% of those with DD, 13% of those with MH and 20% of those in the multiple conditions group had difficulty using services. In multivariate analyses, CSHCN with DD had 2.3 times and MH conditions had 2.6 times the odds of having difficulty using services compared to those with PD. Existing programs for CSHCN should be evaluated for the adequacy of services provided to children with DD and MH. Future studies should evaluate how developmental disabilities and mental health policies affect navigating the health care system for this population.


Targetted phototherapy with sensitizer-monoclonal antibody conjugate and light.
Photodynamic therapy (PDT) was performed in vitro and in vivo using monoclonal antibody conjugated to hematoporphyrin (HP). The antibody (45-2D9) recognized a cell surface glycoprotein on cells derived from NIH 3T3 cells which were transformed with the ras oncogene (45-342). Radionuclide imaging with either In111 or I125 chelated to 45-2D9 or the isotype identical (IgG1) antibody MOPPC-21 revealed selectivity of 45-2D9 for 45-342 flank tumours in nude mice, and minimal targetting for a 45-342 clone which did not express the cell surface glycoprotein. The 45-2D9-HP conjugate resulted in selective killing of the 45-342 line compared with the parent line in vitro. At HP concentrations of 76 micrograms ml-1, the 45-2D9-HP conjugate resulted in significantly more long-term cures of PDT treated flank tumours compared with free HP at the same concentration. 45-2D9 alone had no effect on tumour growth. The antibody-HP conjugate resulted in significantly less local toxicity compared with standard Photofrin II PDT, and also achieved a greater number of long-term cures. This 'photoimmunotherapy' demonstrates the ability to treat established tumours with greater efficacy and decreased morbidity, probably due to specific sensitizer targetting which allows normal surrounding tissue to be spared upon illumination.


One-pot solvothermal synthesis of uniform layer-by-layer self-assembled ultrathin hexagonal Gd2O2S nanoplates and luminescent properties from single doped Eu3+ and codoped Er3+, Yb3+.
Uniform Gd(2)O(2)S flower-like nano-assemblies were prepared through one-pot mild solvothermal synthesis. The parallel nanoplates are the building blocks, ∼3 nm in thickness and 20-30 in diameter. Ethanediamine, the main solvent, plays an important role in dissolving a large amount of sulphur and producing active S(2-) ions, which results in the direct formation of Gd(2)O(2)S. Oleylamine, the capping agent, controls the growth of the plate-like structure. Under UV excitation, the Gd(2)O(2)S:Eu(3+) nano-phosphor shows good red luminescence with a main emission peak at 627 nm. Under 980 nm laser excitation, Gd(2)O(2)S:xYb(3+),1%Er(3+) nano-phosphors exhibit a tuneable emission, shifting from greenish-yellow to orange-yellow, with increasing Yb(3+) content.


Tobacco "chippers"--individual differences in tobacco dependence.
This study explores the behavior of tobacco "chippers"--very light smokers who regularly use tobacco without developing dependence. Eighteen chippers (CHs) who averaged a maximum of five cigarettes per day, but who smoked at least 4 days per week, were compared to 29 dependent smokers (DSs). Laboratory data showed that CHs inhale cigarette smoke and are exposed to nicotine. In both experimental and retrospective self-report data, CHs showed no signs of tobacco withdrawal when abstinent. CHs also differed from DSs in their pattern of smoking: their smoking was less linked with mood states. However, the hypothesis that they were "social" smokers was contradicted. CHs also differed on psychosocial variables relevant to a stress-coping model of smoking: they reported less stress, better coping, and more social support, but these differences were small. Although the two groups were demographically similar, smoking behavior differences between CHs and DSs were long-standing: the two groups differed in their responses to initial smoking and in their family histories of smoking and cessation. CHs' smoking behavior challenges classical theories of dependence; further research is needed on the factors that may protect CHs from addiction.


Changes in cognitive distortions and affectivity levels in adolescent depression after acute phase fluoxetine treatment.
It is supposed that both antidepressants and psychotherapies work in a manner consistent with cognitive theories of depression when changing negative affective and cognitive distortions. This study evaluated changes in cognitive distortions (i.e. systematic misinterpretations of new information) and affectivity in adolescent major depressive disorder (MDD) after acute phase treatment with fluoxetine. Twenty-five adolescents (mean age 15.10 years (SD = 1.19); 17 (68%) females) with MDD receiving fluoxetine were followed for 8 weeks. Clinician rating scales of MDD and self-reports of cognitive distortions and affectivity were completed before and after the treatment. Seven (28%) adolescents showed significant improvement in cognitive distortions, 11 (44%) showed a significant decrease in negative affect, and 15 (60%) showed a significant increase in positive affect. The responders to fluoxetine had significantly decreased level of negative affect (62.5%) and an increased level in positive affect (81.2%) compared to non-responders, whereas there were no differences between the two regarding changes in cognitive distortions. Treatment with fluoxetine over 8 weeks led to reductions in cognitive distortions, with decreased negative and increased positive affect in adolescents with MDD. Improvements in affectivity levels closely corresponded to reductions in depressive symptoms and were greater than improvements in cognitive distortions.


Successful treatment of early ischemic contracture in the upper arm caused by traumatic haematoma through surgical muscle release and continuous passive motion: Case report.
Compartment syndrome is a condition that occurs when there is an increase in pressure within a muscle compartment, leading to a decrease in blood flow to the muscles and nerves within that compartment. If left untreated, this can lead to ischemic contracture, which is a late sequelae of compartment syndrome that occurs when there is sustained ischemic damage to the muscles. Timely diagnosis and treatment are critical in reducing the extent of permanent changes within muscle and nerve tissue. No previously published studies have reported on the treatment of early ischemic contracture resulting from traumatic haematoma in the upper arm. We present an exceptional case involving a 17-year-old male who developed this condition following a collision during a basketball game, resulting in a haematoma with severe pain, tightness and restricted range of motion in the affected arm. He was treated through surgical intervention involving surgical muscle release, haematoma evacuation and continuous passive motion (CPM) postoperatively to restore the range of motion and improve overall function with complete recovery at the 27-month follow-up.


[Problems in the characterization of autoantibodies in patients' sera by microfluorometry as exemplified by antimitochondrial antibodies].
Attention is called to various problems of subjective differentiation of fluorescence patterns for demonstrating autoantibodies by the indirect immunofluorescent technique. For the objective measurement of the fluorescent intensity, the main problem is the dependence of the measuring results upon the thickness of the tissue sections. The determination of the relationships of the fluorescent intensity in one preparation is independent on the thickness of the section. Using 25 patient sera with antimitochondrial antibodies, it could be shown that the relationship of the fluorescent intensity of various positively reacting tissue areas is not constant, but changes considerably depending on the concentration of the autoantibody in the test solution. Thus, differentiation of subgroups of antimitochondrial antibodies cannot be made using one serum dilution.


Impact of maternal income on the risk of gestational diabetes mellitus in primiparous women.
Findings concerning the impact of socio-economic status on the risk of gestational diabetes mellitus (GDM) are inconclusive and little is known about the simultaneous impact of income and educational attainment on the risk of GDM. This study aims to assess the impact of maternal prepregnancy income in combination with traditional GDM risk factors on the incidence of GDM in primiparous women. This is an observational cohort study including 5962 Finnish women aged ≥ 20 years from the city of Vantaa, Finland, who delivered for the first time between 2009 and 2015, excluding women with pre-existing diabetes mellitus. The Finnish Medical Birth Register, Finnish Tax Administration, Statistics Finland, Social Insurance Institution of Finland and patient healthcare records provided data for the study. We divided the study population according to five maternal income levels and four educational attainment levels. Incidence of GDM decreased with increasing income level in primiparous women (P < 0.001 for linearity, adjusted for smoking, age, BMI and cohabiting status). In an adjusted two-way model, the relationship was significant for both income (P = 0.007) and education (P = 0.039), but there was no interaction between income and education (P = 0.52). There was an inverse relationship between both maternal prepregnancy taxable income and educational attainment, and the risk of GDM in primiparous Finnish women.


[Recurrent multi-focal cerebral stroke complicating Libman-Sacks endocarditis in a young woman with systemic lupus erythromatosus].
Systemic lupus erythromatosus is often associated with an antiphospholipid syndrome (APS). A high prevalence of valvular heart disease in APS leads to increased risk of embolic events, particularly cerebrovascular. We present a patient with cerebral infarction, with positive lupus anticoagulant, anticardiolipin antibodies and factor V Leiden mutation. Echocardiographic examination revealed mitral valve anterior leaflet thickening and verrucous vegetations consistent with Libman-Sacks endocarditis, which is commonly associated with APS.


Mixed epithelial and stromal tumor (MEST) in a young adult male: A case report and literature review.
A MEST is a rare renal tumor, with stromal as well as epithelial components. It is predominantly benign and local recurrence is not very common. In the majority of the cases, it occurs in females. Its occurrence in a young male makes it a rarity. A 24 years old male presented at SIUT with the complaint of left flank pain on and off for one month. CT scan showed soft tissue density mass in left renal pelvis extending from mid-pole calyces to pelviuretric junction, leading to obstruction and ultimately mild uropathy. We found a partially obstructing staghorn calculus with asymmetrical cortical thinning. Left Robot-Assisted Nephro-ureterectomy plus excision of bladder cuff was planned in which 3 × 4 cm mass involving the left renal pelvis was excised. To date, there is no radiologic evidence of disease recurrence. MEST in young adults is an extremely rare tumor. They have been referred to by many alternate synonyms including 'adult mesoblastic nephroma' and 'cystic nephroma' with 'ovarian' or 'cellular' type stroma. Majority of patients with MEST present, with hematuria, abdominal pain, palpable flank mass, recurrent urinary tract infections. Similarly, our patient presented initially with nonspecific pain in the left flank region. Majority of cases in the literature presented with the tumor in benign stage, with localized spread, and without recurrence. Mixed epithelial and stromal tumors (MEST) of the kidney are distinct entities of benign kidney tumors. MEST in young males is a very rare entity, and a small number of cases exist. Histopathology plays a very cardinal role in diagnosis, and overall the disease has a promising outcome with conservative surgery.


Early onset of efficacy with erenumab for migraine prevention in Japanese patients: Analysis of two randomized, double-blind, placebo-controlled studies.
In two 24-week migraine prevention studies in Japan, erenumab was associated with significantly greater reductions in migraine frequency versus placebo over Weeks 13-24 (primary endpoint). This post hoc analysis evaluated the onset of efficacy within the first 4 weeks after the initiation of erenumab from the 24-week double-blind periods of these studies. Placebo-adjusted differences in least squares mean (LSM) change from baseline in weekly migraine days (WMD) were assessed weekly in each study and by migraine type (episodic (EM]/chronic [CM]) (Study 20170609). A total of 407 patients from Study 20120309 (70 mg: N = 135; 140 mg: N = 136; placebo: N = 136) and 261 patients from Study 20170609 ([EM] 70 mg: N = 78; placebo: N = 81; [CM] 70 mg: N = 52; placebo: N = 50) were included. For Study 20120309, onset of efficacy was observed as early as Week 1 in favor of erenumab versus placebo. Placebo-adjusted differences in LSM (95% confidence interval [CI]) change from baseline in WMD at Week 1 were -0.38 (-0.71 to -0.05; p = .022) and -0.49 (-0.82 to -0.16; p = .004) in favor of erenumab 70 and 140 mg, respectively. For Study 20170609, significant placebo-adjusted differences were observed with erenumab 70 mg at Week 1 in patients with EM (LSM [95% CI]: -0.55 [-0.97 to -0.12; p = .012]), and at Week 2 in patients with CM (LSM [95% CI]: -0.81 [-1.53 to -0.09; p = .028]) and for the overall population (LSM [95% CI]: -0.71 [-1.09 to -0.33; p < .001]). Erenumab treatment significantly reduced WMD compared with placebo. Onset of erenumab efficacy occurred as early as Week 1 in patients with migraine.