Use of continuous infusion of clonidine for sedation in critically ill infants and children.
Adequate sedation and analgesia are required for critically ill children in order to minimize discomfort, reduce anxiety, and facilitate care. This is commonly achieved through a combination of opioids and benzodiazepines. Prolonged use of these agents is associated with tolerance and withdrawal. Clonidine as an adjunctive sedative agent may reduce sedation-related adverse events. Our first aim was to describe the indication for clonidine administration and its secondary effects in a mixed cohort of critically ill children. Our secondary aim was to measure the consumption of sedatives during two study periods: before and after the use of clonidine in our pediatric intensive care unit (PICU). This was a single-center study conducted in a tertiary PICU and encompassed retrospective chart review of patients who received clonidine between November 2013 and April 2015. We collected data on clonidine dosage, duration of administration, indication for the prescription, and potential side effects. We analyzed the total consumption of sedatives over 18 months, before and after the introduction of clonidine in our sedation protocol. A total of patients received clonidine, with a mean age of 2.2 ± 2.8 years. The primary reason for intensive care admission was respiratory failure (48%). The main indication for clonidine administration was increasing requirement for morphine and midazolam (60%). The mean duration of clonidine infusion was 9 ± 7.3 days. Bradycardia and hypotension occurred in five patients (11.6%) and nine patients (21%), respectively. These side effects did not result in any major intervention. Younger age was a risk factor for clonidine-associated bradycardia. We observed a significant decrease in morphine and midazolam consumption with clonidine as a comedication. Compared with the pre-study period, consumption decreased by 19.7% for morphine and by 59% for midazolam (calculated as milligram/admission). Continuous infusion of clonidine in critically ill children is safe and effective. Clonidine is a sedative-sparing agent and this can help reduce complications associated with prolonged use of opioids and benzodiazepines.


Oxytocin microinjected into the central amygdaloid nuclei exerts anti-aggressive effects in male rats.
We recently demonstrated that acute and chronic intracerebroventricular enhancement of brain OXT levels induces potent anti-aggressive and pro-social explorative effects during social challenges. However, the exact anatomical location in the brain where OXT exerts its action is still elusive. In the present study, we targeted two critical brain areas, i.e. the central amygdala (CeA) and the dorsal raphe (DR), both containing high levels of OXT receptors (OXTRs) and constituting important nodes of the neural circuitry related to aggression. Behavioral effects of local micro-infusion of OXT and OXTR antagonist, L368.899, (alone and combined) were evaluated in resident male rats during confrontations with an unfamiliar male intruder. Our results show that OXT microinjected into the CeA markedly reduced resident's offensive behavior and facilitated social exploration, without affecting other non-aggressive behaviors. The receptor specificity of the behavioral effects was verified when a micro-infusion of a selective OXTR antagonist nullified the changes. Pharmacological blockade of CeA OXTRs per se was without clear behavioral effects suggesting that endogenous OXT within the CeA does not play a major inhibitory role on offensiveness. Anatomical specificity was also supported by the absence of relevant behavioral effects when OXT was microinjected into more medial sub-regions of the amygdala. Likewise, within the DR neither OXT nor OXTR exerted significant effects on offensive aggression, while microinjection of the 5-HT1A autoreceptor agonist in this region significantly suppressed aggression. In conclusion, our results point at the CeA as an important brain site of action for the anti-aggressive and pro-social explorative effects induced by exogenous enhancement of brain OXT levels.


Posterior concave reconstruction with cage in the surgical treatment of complex lumbar deformity caused by lumbosacral hemivertebrae.
To identify the clinical and radiological outcomes in the coronal and sagittal planes after treatment of congenital complex lumbosacral hemivertebrae (LSHV) with or without posterior concave reconstruction. We retrospectively reviewed a consecutive series of patients with congenital LSHV deformities treated by posterior-only hemivertebra resection. The minimum follow-up was 2 years. The patients were divided into a concave-cage group and a non-cage group. The radiographic and clinical results were compared between the two groups. Forty patients were categorized into the cage group (n = 14) and non-cage group (n = 26). At the end of the propensity score matching analysis, 14 patients from the cage group were matched to 14 patients in the non-cage group. The lumbosacral curve and thoracolumbar/lumbar curve improved significantly in both groups at the final postoperative follow-up (P < 0.001), and the lumbosacral curve at the final follow-up was remarkably lower in the cage than non-cage group. The correction rates of the lumbosacral curve and thoracolumbar/lumbar curve were significantly higher in the cage than non-cage group. The lower lumbar lordosis improved significantly in both groups at the final postoperative follow-up (P < 0.05), and the lower lumbar lordosis at the final follow-up and its correction were remarkably higher in the cage than non-cage group (both P < 0.05). Posterior column reconstruction with insertion of a concave cage may achieve a higher correction rate of large lower lumbar lordosis and lumbosacral coronal deformity, attain better sagittal balance, and have fewer complications related to implant failure than posterior-only hemivertebra resection in patients with congenital LSHV.


Prevalence of dyslipidaemia in statin-treated patients in Ireland: Irish results of the DYSlipidaemia International Study (DYSIS).
Statins are proven to reduce cardiovascular risk; however, substantial risk remains in patients on statin therapy. Persisting dyslipidaemia is likely to play a contributory role. To assess the prevalence of persisting lipid abnormalities in patients treated with statins. DYSIS was a cross-sectional study of 22,063 patients in Europe and Canada. 900 Irish patients participated. All patients were ≥ 45 years and treated with statins for ≥ 3 months. Data were collected from the patients' records. ESC guidelines were used to classify risk and to define lipid levels. Mean age was 66.1 years with women representing 40.7%. 78.6% were high-risk patients; that is 53.9% with cardiovascular disease (CVD), 20.1% with diabetes and 15.9% with a SCORE risk ≥ 5%. Total cholesterol was not at goal in 34.4% of all patients. LDL-C was elevated in 30.8% of all patients and in 30% at high risk. Low HDL-C was found in 34.7% of high-risk patients compared to 16.9% of patients with an ESC score <5%. In diabetics without CVD, low HDL-C and elevated TGs were found in 46 and 44.3%, respectively. Despite statin therapy, a significant number of patients have persistent dyslipidaemia. While LDL-C targets are suboptimal in three out of ten patients, the prevalence of low HDL-C and high TGs in high-risk patients is greater than one in three. A more integrated approach to the treatment of patients with dyslipidaemia is warranted. Clinical trials are needed to assess the impact of therapies that raise HDL-C and lower elevated TGs.


A simple and effective scaffold for mouse hepatic stellate cell primary culture.
Scaffold-based culture is necessary for hepatic stellate cells (HSCs) because HSCs are promptly autoactivated under plastic conditions. Our research aims to investigate the potential and role of fibrin scaffold in reducing autoactivation, maintaining cell function, and extending the in vitro culture time of primary HSCs. HSCs were isolated from BALB/c mice and cultured on the surface of plastic, Matrigel, and fibrin gel. HSC's characteristics, including recovery, morphology, proliferation, lipid droplet (LD) storage, and activation were evaluated. Cell recovery was 86%, 80%, and 60% in fibrin, Matrigel, and plastic, respectively (P < 0.05). HSCs cultured on a plastic dish were autoactivated until day 7 with high proliferation, loss of cytoplasmic LD lipid droplets, and increased expression of activation markers, including alpha-smooth muscle actin (α-sma) and collagen type I. In contrast, these phenomena were reduced in Matrigel and fibrin-based cultures (P < 0.05). HSC culture in fibrin scaffold was associated with altered expression of cell adhesion molecules, including increased E-cadherin and inhibited N-cadherin. HSCs were more stellate-like in morphology in fibrin than in the Matrigel scaffold. Interestingly, fibrin-scaffold-embedded culture was able to maintain HSC quiescent state for up to 14 days in vitro. Fibrin gel could provide a potential scaffold for primary HSC culture while preserving cell function and extending primary HSC in vitro culture time.NEW & NOTEWORTHY Fibrin gel is appropriate for maintaining quiescence characteristics in primary culture of mouse hepatic stellate cells. Embedded culture of hepatic stellate cells in fibrin gel simulates in vivo cell morphology. Stiffness and adhesion molecules of fibrin gel play a crucial role in the hepatic stellate cell's primary culture.


The changing epidemiology of foodborne diseases.
The epidemiology of foodborne diseases in the United States have changed in recent decades as new pathogens have emerged, the food supply has changed, and the number of people with heightened susceptibility to foodborne diseases has increased. Emerging pathogens are those that have recently increased or are likely to increase within 2 decades. Emergency is often the consequence of changes in some aspect of the social environment. The global economy, for example, has facilitated the rapid transport of perishable foods, increasing the potential for exposure to foodborne pathogens from other parts of the world. Other factors altering foodborne disease patterns are the types of food that people eat, the sources of those foods, and the possible decline in public awareness of safe food preparation practices. Aging, extension of life expectancy for the chronically ill through medical technology, and the AIDS epidemic have increased the public health impact of foodborne diseases because they increase the proportion of the population susceptible to severe illness after infection with a foodborne pathogen. The evolving epidemiology of foodborne diseases must be monitored and understood to implement appropriate prevention technologies.


Transference neurosis in group psychotherapy: the concept and the reality.
The contribution of Durkin and Glatzer to examination of transferences and the therapeutic process emphasizes the nature of peer transferences that of are sufficient depth to resolve personality conflicts. In the past two decades additional emphasis on the totality of the treatment relationship and of self psychology has added to understanding elements in the transference and curative process. A clinical illustration provided by Durkin and Glatzer is reexamined in light of these advances.


Internal consistency of the Seasonal Pattern Assessment Questionnaire (SPAQ).
We examined the consistency reliability of the widely used Seasonal Pattern Assessment Questionnaire (SPAQ). In total, 587 questionnaires from a random sample of the general population were analysed. The 6 items of the Seasonality Scale Index (SSI) correlated fairly well, and consequently this scale proved to have a high internal consistency (alpha = 0.82). Items from the SSI that measure seasonal variations in sleep and weight were consistent with other SPAQ scales that also measure these dimensions. Since the questionnaires analysed were from an epidemiological study, the high consistency reliability shows that the symptoms probed for by the SSI, tend to cluster in susceptible individuals in the general population.


Peri-operative considerations for sedation-analgesia during cataract surgery: a narrative review.
Cataract surgery is usually of short duration and is associated with minimal pain when employing topical or regional anaesthesia. Patient education regarding the peri-operative process may help alleviate anxiety and avoid the need for sedation. However, sedation may be required, and we discuss the various options. Many consider that pre-operative fasting is necessary due to the risk of aspiration but fasting may not be required if minimal sedation is administered. If the use of sedatives, hypnotics or analgesics is required, then their associated adverse events should be considered.


The in situ near-total pancreatectomy (LIVOCADO procedure) for end-staged chronic pancreatitis.
Total pancreatectomy for severe pain in end-stage chronic pancreatitis may be the only option, but with vascular involvement, this is usually too high risk and/or technically not feasible. The purpose of the study was to present the clinical outcomes of a novel procedure in severe chronic pancreatitis complicated by uncontrollable pain and vascular involvement. We describe an in situ near-total pancreatectomy that avoids peripancreatic vascular dissection (Livocado procedure) and report on surgical and clinical outcomes. The Livocado procedure was carried out on 18 (3.9%) of 465 patients undergoing surgery for chronic pancreatitis. There were 13 men and 5 women with a median (IQR) age of 48.5 (42.4-57) years and weight of 60.7 (58.0-75.0) kg. All had severe pain and vascular involvement; 17 had pancreatic parenchymal calcification; the median (IQR) oral morphine equivalent dose requirement was 86 (33-195) mg/day. The median (IQR) maximal pain scores were 9 (9-10); the average pain score was 6 (IQR 4-7). There was no peri-operative or 90-day mortality. At a median (IQR) follow-up of 32.5 (21-45.75) months, both maximal and average pain scores were significantly improved post-operatively, and at 12 months, two-thirds of patients were completely pain free. Six (33%) patients had employment pre-operatively versus 13 (72%) post-operatively (p = 0.01). The Livocado procedure was safe and carried out successfully in patients with chronic pancreatitis with vascular involvement where other procedures would be contraindicated. Perioperative outcomes, post-operative pain scores, and employment rehabilitation were comparable with other procedures carried out in patients without vascular involvement.


Clinical Effects of BNT162b2 Vaccine on the Short-Term Course of Chronic Spontaneous Urticaria Patients.
The clinical effects of Pfizer-BioNTech coronavirus disease 2019 (COVID-19; BNT162b2) vaccine on the clinical course of chronic spontaneous urticaria (CSU) is unclear. To evaluate the clinical effects of BNT162b2 vaccine on the clinical course of CSU. In this study, 90 CSU patients vaccinated with one or two repeated doses of BNT162b2 vaccine were included. Urticaria Activity Score over 28 days (UAS28), Urticaria Control Test (UCT), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and Medication Scores (MSs) were obtained before the vaccination, 28 days after the first and, if available, after the second dose of BNT162b2 vaccine. The demographic, clinical, and laboratory features were compared between the subjects with exacerbated (group A) and non-exacerbated (group B) disease activity. Among the 90 study participants, 14 (15.5%) experienced exacerbations in their urticarial activity after the first or repeated doses of BNT162b2 vaccinations. The demographic, clinical, and laboratory features were similar between the exacerbated and non-exacerbated CSU patients. However, the rate of adverse reactions within 48 hours, such as hives, injection site reactions and wheals lasting <1 hour, were significantly higher in group A than in group B (P = 0.004, P < 0.001, P = 0.001, P = 0.018). BNT162b2 vaccination caused an exacerbation in 15.5% of CSU patients during the short-term follow-up. The long-term evaluation can be informative about the lasting effects of BNT162b2 vaccine on the clinical course of CSU patients.


Three-dimensional-printed individualized porous implants: A new "implant-bone" interface fusion concept for large bone defect treatment.
Bone defect repairs are based on bone graft fusion or replacement. Current large bone defect treatments are inadequate and lack of reliable technology. Therefore, we aimed to investigate a simple technique using three-dimensional (3D)-printed individualized porous implants without any bone grafts, osteoinductive agents, or surface biofunctionalization to treat large bone defects, and systematically study its long-term therapeutic effects and osseointegration characteristics. Twenty-six patients with large bone defects caused by tumor, infection, or trauma received treatment with individualized porous implants; among them, three typical cases underwent a detailed study. Additionally, a large segmental femur defect sheep model was used to study the osseointegration characteristics. Immediate and long-term biomechanical stability was achieved, and the animal study revealed that the bone grew into the pores with gradual remodeling, resulting in a long-term mechanically stable implant-bone complex. Advantages of 3D-printed microporous implants for the repair of bone defects included 1) that the stabilization devices were immediately designed and constructed to achieve early postoperative mobility, and 2) that osseointegration between the host bone and implants was achieved without bone grafting. Our osseointegration method, in which the "implant-bone" interface fusion concept was used instead of "bone-bone" fusion, subverts the traditional idea of osseointegration.


The potential of telemedicine for dermatological care of pediatric patients in Germany.
Skin diseases are a common reason for consultations in pediatric practice. The present study aims to characterize the dermatological requests of resident pediatric specialists using teledermatology in Germany. This analysis of consultation requests, submitted by pediatricians to a designated pediatric dermatologist via a telemedical consultation system (PädExpert) using the store-and-forward technology, was performed between February 2021 and December 2021. The study analysis included 504 telemedical consultation requests. The mean age of the patients was 6.5 ± 5.0 years with 45.5% of the patients being female. Telemedicine was useful in providing a definite diagnosis in 88.3%. The diagnoses were most frequently assigned to the group of infectious skin diseases (28.8%). Referral to a dermatologist was recommended in 11.5%. The requests were answered on the same day in 63.8% of the cases. The study data shows the great potential of teledermatology to improve access for children with skin diseases to specialized dermatological care. Another advantage is its function as a triage instrument. Since most cases could be managed by teledermatology only, it is possible to reduce the need for an in-person visit to the dermatologist, thus saving resources.


Combining exome/genome sequencing with data repository analysis reveals novel gene-disease associations for a wide range of genetic disorders.
Within this study, we aimed to discover novel gene-disease associations in patients with no genetic diagnosis after exome/genome sequencing (ES/GS). We followed two approaches: (1) a patient-centered approach, which after routine diagnostic analysis systematically interrogates variants in genes not yet associated to human diseases; and (2) a gene variant centered approach. For the latter, we focused on de novo variants in patients that presented with neurodevelopmental delay (NDD) and/or intellectual disability (ID), which are the most common reasons for genetic testing referrals. Gene-disease association was assessed using our data repository that combines ES/GS data and Human Phenotype Ontology terms from over 33,000 patients. We propose six novel gene-disease associations based on 38 patients with variants in the BLOC1S1, IPO8, MMP15, PLK1, RAP1GDS1, and ZNF699 genes. Furthermore, our results support causality of 31 additional candidate genes that had little published evidence and no registered OMIM phenotype (56 patients). The phenotypes included syndromic/nonsyndromic NDD/ID, oral-facial-digital syndrome, cardiomyopathies, malformation syndrome, short stature, skeletal dysplasia, and ciliary dyskinesia. Our results demonstrate the value of data repositories which combine clinical and genetic data for discovering and confirming gene-disease associations. Genetic laboratories should be encouraged to pursue such analyses for the benefit of undiagnosed patients and their families.


Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in Turkish cohort.
To evaluate the results and recurrence rates of external and endonasal dacryocystorhinostomy (DCR) surgery in patients with primary acquired nasolacrimal duct obstruction (PANDO) in Turkish Cohort. Medical records were reviewed in all patients who underwent surgery for PANDO between January 2010 and September 2014 in a tertiary university hospital retrospectively. The patients were followed up on the first day, first month, third month and sixth month postoperatively. Lacrimal drainage system and recurrence rates were recorded. This study was conducted in 81 patients, 27 of whom were men (33.3%) and 54 were women (66.7%). The mean follow-up time was 30.13±16.42 months (range 6-62 months). The mean age was 50.51±12.47 years (range 16 to 77 years). External DCR was used in 44 (66.7%) of the cases and endonasal DCR was used in 37 (45.7%) of the cases. Surgical results of DCR were divided into three groups based on the integrity and openness of the lacrimal drainage pathway in all PANDO patients. Operation success rates of these data revealed that 45 (55.6%) cases were recorded as successful, 20 (24.7%) of the cases were accepted as partially successful and 16 (19.8%) of the cases were deemed as unsuccessful. Based on these data, surgical success rates were found in 38 (86.4%) patients in external DCR and 27 (73%) patients in endonasal DCR. Surgical failure rates were six (13.6%) in external DCR and 10 (27%) in endonasal DCR. There was no statistically significant difference between success rates and recurrences in both groups (p>0.05). Endoscopic DCR produced simple, minimally invasive and preferable results compared to external DCR in the Turkish population. Although the success of external DCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.


From hospitalization to grief: meanings parents assign to their relationships with pediatric oncology professional.
To understand the meanings assigned by bereaved parents to their relationships with healthcare professionals during the end-of-life hospitalization of their child. Qualitative-interpretative study based on hermeneutics. Data were collected from interviews with parents who were grieving the death of a child with cancer in the hospital and participant observation in an oncology ward. Deductive thematic analysis for data interpretation ensued. The experience of parents is the sum of all relationships during treatment. Therefore, meanings form a tangle of interrelated senses built not only in the interaction with these professionals, but also with the child and with grief itself. In relationships with professionals, meanings related to the memories of the child, negative emotions and regret were identified. The experiences and meanings of grief are shaped by the social processes and interactions experienced by the family in the hospital. The relationship with the professionals represents part of the support in coping with the grief after the child's death in the hospital, due to the perpetuity of the love shown for the child as a possible legacy in the legitimacy of the experienced interactions.


Improving English language skills through learning Mathematic contents: From the expertise reversal effect perspective.
Previous research in the field of content and language integrated learning (CLIL) has not yet comprehensively investigated the interaction between learners' expertise and the instructional effectiveness. Taking cognitive load theory as the theoretical framework, a study was conducted to investigate the expertise reversal effect on learning English and mathematics simultaneously: whether an integrated approach (i.e. learning both English and mathematics simultaneously) could facilitate the acquisition of mathematic skills and English linguistic skills as a foreign language more effectively and efficiently than a separated learning approach (i.e. learning Mathematics and English separately). The materials for the integrated learning approach were in English-only, and the materials for the separated learning approach were in English-and-Chinese. Both sets of materials were given as reading content for teaching mathematic skills and English as a foreign language. The study adopted a 2 (language expertise: low vs. high) × 2 (instruction: integrated vs. separated) between-subject factorial design with instructional approaches and learners' expertise in English as independent variables, the learning performance in Mathematics and English with the cognitive load ratings as the dependent variables. Sixty-five Year-10 students with lower expertise in English and 56 Year-2 college students with higher expertise in English in China were recruited and allocated to two instructional conditions respectively. An expertise reversal effect was confirmed: the English and mathematics integrated learning approach was more effective for higher expertise learners while the English and mathematics separated learning condition was more beneficial for lower expertise learners.


Motion sense sensitivity of the ankle is abnormal and correlated with motor performance in children with and without a probable developmental coordination disorder.
This study systematically examined ankle motion sense sensitivity and its relation to motor functions in children with and without a probable developmental coordination disorder (pDCD). Seventy-two children aged 10-11 years were recruited, including thirty-six children with pDCD and 36 age- and sex-matched typically developing (TD) children. Children placed their dominant foot on a passive ankle motion apparatus that induced plantar flexion of the ankle under nine constant velocities ranging between 0.15 and 1.35°/s. The adjusted movement detection time (ADT) to passive ankle motion was obtained to measure ankle motion sense sensitivity. The results showed that, in comparison to that in the TD group, ankle ADT was significantly increased by 22-59% for the range of velocities in the pDCD group. A correlation analysis showed that mean ADTs were significantly correlated with the manual dexterity (r = -0.33, p = 0.005) and balance (r = -0.24, p = 0.046) scores on the Movement Assessment Battery for Children (MABC-2) in the combined group. Similar correlations were found between the ADTs and the manual dexterity (r = -0.37, p = 0.028) and total motor (r = -0.34, p = 0.047) scores in the TD group. This study documents that ankle motion sense sensitivity to passive foot motion is reduced and is likely to contribute to poor motor performance in children with and without pDCD.


Generation of High-Affinity Molecularly Imprinted Nanoparticles for Protein Recognition via a Solid-Phase Synthesis Protocol.
Molecularly imprinted polymers are leading technology in the development of protein biomimetics. This chapter describes the protocol for the synthesis of protein imprinted nanoparticles. These materials exhibit exceptional affinity (into the nM/pM range) and selectivity for their target template. The nanoparticles can be developed for a wide range of targets, while exhibiting excellent robustness, solubility, and flexibility in use. They are finding use in the creation of drug delivery vectors and sensing and recognition assays.


Stimulation of oxygen consumption at the cytochrome A3 level inhibits aldosterone biosynthesis from 18-hydroxycorticosterone.
A mitochondrial preparation from duck adrenal gland was used, under aerobic conditions, to show that the oxygen requirement for the last step of aldosterone biosynthesis (transformation of 18-hydroxycorticosterone into aldosterone) is at the cytochrome P-450 level only. Vitamin C and tetramethyl-p-phenylene-diamine (TMPD) were used to increase oxygen consumption at the cytochrome a3 level, thereby decreasing its availability to cytochrome P-450. The vitamin C plus TMPD system acts as an 'oxygen trap'. Results show that despite reducing equivalents provided by L-malate, vitamin C plus TMPD strongly inhibits aldosterone biosynthesis from 18-hydroxycorticosterone (89%). Moreover, we used KCN in order to block oxygen consumption, even in the presence of vitamin C plus TMPD. Under these conditions, the inhibition of aldosterone biosynthesis from 18-hydroxycorticosterone is reduced by 51%. The reversal of this inhibition by KCN was evident but only partial. According to polarographic and electron microscopy studies, the reversal of inhibition can only be explained by an increased availability of oxygen at the cytochrome P-450 level. Experiments performed under aerobic conditions, without a nitrogen atmosphere, show that oxygen is required in the transformation of 18-hydroxycorticosterone into aldosterone, at the cytochrome P-450 level. This suggests that a classical hydroxylating mechanism is involved.


Preventing Medication Nonadherence of Youth (13-24 Years) With HIV Initiating Antiretroviral Therapy.
The objective of this study was to evaluate the feasibility and acceptability of a dynamic, behavioral intervention to optimize medication adherence of adolescents and young adults (AYAs) with HIV newly initiating highly active antiretroviral therapy (HAART) and explore its efficacy on adherence and disease outcomes. The two-arm randomized controlled trial piloted a brief, individualized intervention designed for direct integration into standard clinical care. In total, 32 AYAs with a confirmed HIV diagnosis, reportedly horizontally acquired, and recommended to initiate HAART completed a two-week placebo trial before HAART initiation and were subsequently randomized to standard of care or the individualized intervention. Adherence and disease outcomes were measured over the first six months of HAART. Results supported the primary study aim regarding feasibility (recruitment = 89%, attendance = 81%-100%, intervention exercise completion = 100%) and acceptability (average favorable response = 89%). Data also supported the positive effect of the intervention on select HAART adherence measures and disease outcomes. Adherence (by pharmacy refill) declined in both groups; however, adherence declined more slowly in the intervention group versus standard of care (p < .001). In addition, 100% of participants receiving the intervention obtained an undetectable viral load by 3 months and maintained an undetectable viral load at 6 months (vs. 68.8% standard of care). This is one of the first interventions to target adherence for AYAs with HIV newly initiating HAART and designed for delivery in existing clinical care settings. Future research will help confirm efficacy and the potential utility of the intervention in promoting HAART adherence from medication initiation and preventing the decrease in adherence often observed over time.


Effectiveness of secondary prevention in metalworkers with work-related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study.
In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs). To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS). Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.


Attitudes toward and Perceptions of Educational Needs for End-of-Life Care among Health Professions Students: A Cross-Sectional Study in China.
To provide effective end-of-life care education for health professions students, it is important to understand students' views of death in addition to their perceptions of educational needs and preferences. However, there is a lack of studies addressing interindividual variability in perceptions of end-of-life care educational needs among health professions students. This study aimed to identify latent profiles of perceptions of end-of-life care educational needs among health professions students and examine whether the demographic characteristics, death-related events, death attitude, and death anxiety differed by need subgroup. Through convenience sampling, health professions students from three universities in China were recruited between March 2020 and June 2020. Data were collected using a demographic information and death-related experience questionnaire, the End-of-Life Care Curriculum Needs Questionnaire, the End-of-Life Care Educational Needs Questionnaire, the Death Attitudes Profile-Revised, and the Templer's Death Anxiety Scale. A total of 1048 students completed the survey. Two classes of perceptions of end-of-life care educational needs were identified: approximately 29.80% of students belonged to a medium-need group class (1), and 70.20% belonged to a high-need group class (2). Being female and having knowledge of end-of-life care significantly increased the probability of membership in class 2. Students with the two latent profiles reported having varied curriculum needs. In addition, a positive attitude toward death and low death anxiety increased the probability of membership in class 1. Two classes of perceptions of end-of-life care educational needs were identified, and these classes were significantly associated with sex and death-related knowledge (P < 0.05). Interindividual variability should be considered in the future development of end-of-care curricula.


Shoulder-related donor site morbidity after delayed breast reconstruction with pedicled flaps from the back: An open label randomized controlled clinical trial.
This randomized controlled trial (RCT) investigates differences in shoulder-related morbidity after delayed breast reconstruction by either a latissimus dorsi (LD) flap or a thoracodorsal artery perforater (TAP) flap. In accordance with the CONSORT guidelines, we included women for unilateral delayed breast reconstruction. Patients were randomized to reconstruction by either of the two flaps. Shoulder-function was assessed at baseline and at 3, 6 and 12 months after surgery. The primary endpoint was patient-reported shoulder-related pain. A further objective assessment by the Constant Shoulder Score (CSS) was included as secondary endpoints. A total of 50 women were enrolled over a two-year period and allocated to reconstruction, with 25 patients in each group. Patient-reported shoulder-related pain was significantly lower in the TAP group at 12 months after surgery when adjusting for pain at baseline: OR = 0.05 95%CI(0.005-0.51), p-value = 0.011. The estimated effect on the total CSS at 12 months, when applying the TAP flap instead of the LD flap and adjusting for the baseline score, was 6.2 points with 95%CI(0.5-12.0), p-value 0.033. The TAP flap seems to have a statistically significant positive effect on pain and activity in daily life (ADL), while there were no significant effect on range of motion and strength after one year. Patient reconstructed by the TAP flap are less likely to experience shoulder-related pain and have a better shoulder-function one year after the reconstruction. Harvest of the LD flap carries a higher risk of shoulder-function impairment, chronic pain and reduced ADL.


Architectural flexibility in lambda site-specific recombination: three alternate conformations channel the attL site into three distinct pathways.
In the phage lambda life cycle, the Integrase (Int) protein carries out recombination between two different sets of DNA substrates: attP and attB in integration, attL and attR in excision. In each case, the partners are very different in structure from each other and the recombination reaction between them is effectively irreversible. For comparison, we have studied the recombination mediated by Int between two identical attL sites. Both in vitro and in vivo, recombination between two attL sites can be mediated inefficiently by Int alone. But, while IHF can stimulate recombination 5-10-fold in vivo (to the level of excision and integration), this stimulation is not observed under standard conditions in vitro. We find that IHF can stimulate the in vitro recombination between two attLs that are modified to be defective in one of the high affinity binding sites for Int, P'1. With such substrates, the efficiency of IHF-stimulated recombination is comparable to that seen in vivo. The requirements for this reaction distinguish it from other lambda recombination pathways, as does the performance of several mutant Int proteins. Recombination of attL sites on intracellular plasmids suggests that this pathway is effective in vivo, but that some unknown factor or condition permits it to operate on wild-type as well as mutated attL sites. The recombination pathway described in this work apparently uses a unique attL architecture, one which requires bending by IHF and is inhibited by Int bound at the P'1 site. In addition to demonstrating the architectural flexibility of the lambda system, this pathway should be a valuable resource for separating the basic requirements of strand exchange chemistry from the features which impart directionality.


Perfect duet: Dual recombinases improve genetic resolution.
As a powerful genetic tool, site-specific recombinases (SSRs) have been widely used in genomic manipulation to elucidate cell fate plasticity in vivo, advancing research in stem cell and regeneration medicine. However, the low resolution of conventional single-recombinase-mediated lineage tracing strategies, which rely heavily on the specificity of one marker gene, has led to controversial conclusions in many scientific questions. Therefore, different SSRs systems are combined to improve the accuracy of lineage tracing. Here we review the recent advances in dual-recombinase-mediated genetic approaches, including the development of novel genetic recombination technologies and their applications in cell differentiation, proliferation, and genetic manipulation. In comparison with the single-recombinase system, we also discuss the advantages of dual-genetic strategies in solving scientific issues as well as their technical limitations.


Investigating the neural basis of cognitive control dysfunction in mood disorders.
Dysfunction of cognitive control is a feature of both bipolar disorder (BP) and major depression (MDD) and persists through to remission. However, it is unknown whether these disorders are characterized by common or distinct disruptions of cognitive control function and its neural basis. We investigated this gap in knowledge in asymptomatic BP and MDD participants, interpreted within a framework of normative function. Participants underwent fMRI scans engaging cognitive control through a working memory task and completed a cognitive battery evaluating performance across multiple subdomains of cognitive control, including attention, impulsivity, processing speed, executive function, and memory. Analysis was performed in two stages: (i) cognitive control-related brain activation and deactivation were correlated with cognitive control performance in 115 healthy controls (HCs), then, (ii) significantly correlated regions from (i) were compared between 25 asymptomatic BP, 25 remitted MDD, and with 25 different HCs, matched for age and gender. Impulsivity and executive function performance were significantly worse in BP compared to both MDD and HCs. Both BP and MDD had significantly poorer memory performance compared to HCs. Greater deactivation of the medial prefrontal cortex (MPFC) during the fMRI task was associated with better executive function in healthy controls. Significantly less deactivation in this region was present in both BP and MDD compared to HCs. Failure to deactivate the MPFC, a key region of the default mode network, during working memory processing is a shared neural feature present in both bipolar and major depression and could be a source of common cognitive dysfunction.


Pathways for Novel Epidemiology: Plant-Pollinator-Pathogen Networks and Global Change.
Multiple global change pressures, and their interplay, cause plant-pollinator extinctions and modify species assemblages and interactions. This may alter the risks of pathogen host shifts, intra- or interspecific pathogen spread, and emergence of novel population or community epidemics. Flowers are hubs for pathogen transmission. Consequently, the structure of plant-pollinator interaction networks may be pivotal in pathogen host shifts and modulating disease dynamics. Traits of plants, pollinators, and pathogens may also govern the interspecific spread of pathogens. Pathogen spillover-spillback between managed and wild pollinators risks driving the evolution of virulence and community epidemics. Understanding this interplay between host-pathogen dynamics and global change will be crucial to predicting impacts on pollinators and pollination underpinning ecosystems and human wellbeing.


Functional chitosan/glycidyl methacrylate-based cryogels for efficient removal of cationic and anionic dyes and antibacterial applications.
In this study, we constructed a novel family of chitosan-based cryogels with antibacterial activity to treat different types of dye wastewater. Glycidyl methacrylate (GMA) cross-linked chitosan (CS) cryogels functionalized with negatively and positively molecules were prepared via thermo-crosslinking and freeze-drying methods. These chitosan-based cryogels present a well-defined three-dimensional microporous network structure with ultra-light and high porosity, and have high water absorption ability. For CS/GMA/SMA cryogels, 71.20% of Cationic Yellow X-8GL (CY) can be removed, and the process kinetics well corresponded to the Pseudo-second order model and Freundlich model. The quantity and percent of Reactive Yellow B-4RFN (RY) removal by CS/GMA/DMC cryogel reached at 224.6 mg/g and 96.11%, which closely fitted the Pseudo-second order model and Dubinin-Radushkevich isotherm. Furthermore, the chitosan-based cryogels showed antibacterial efficacies against E. coli and S. aureus. The prepared chitosan-based cryogels with adsorption and antibacterial properties have great potential for the remediation of dyeing wastewater.


Long-distance romantic relationships among college students: Prevalence, correlates, and dynamics in a campus probability survey.
To determine the prevalence of long-distance relationships (LDRs) among college students and explore how relationship dynamics differed between LDRs and geographically close relationships (GCRs). Data were from romantically involved students (N = 2075) who participated in the 2020 College Sexual Health Survey. Students completed an online survey in which they reported their current romantic relationship status, if they were in a long-distance relationship, and relationship dynamics (happiness, commitment, and conflict). Overall, 34.2% of romantically involved students were in LDRs, which were more common for first-year students, students in longer duration relationships, dating relationships, and Hispanic, Asian, and multiracial students. LDRs were less common for older students. Based on χ2 tests, relationship happiness, commitment, and conflict did not differ based on LDR status. As LDRs are common, providing students with resources focused on navigating LDRs may help them manage their romantic relationships.


Clinical presentation and imaging characteristics of occult lung cancer associated ischemic stroke.
We investigated the clinical and imaging characteristics of initial and recurrent strokes in patients with occult lung cancer associated ischemic stroke (OLCA-stroke). A retrospective review of all ischemic stroke patients with occult lung cancer in the absence of conventional stroke etiologies between 2005 and 2013 was conducted. We compared the initial and recurrent lesion patterns on diffusion-weighted MRI in patients with OLCA-stroke, with respect to vascular territory involved, number and size of lesions, clinical presentation, cancer subtypes, recurrences and fatalities, and outcome of survivors. Thirteen patients with confirmed OLCA-stroke were identified. All had elevated D-dimer levels, six had central lung cancer and seven had peripheral lung cancer. Eight (62%) had adenocarcinoma, and nine (69%) had metastasis. Ten (77%) patients had multiple lesions in multiple vascular territories. Twelve (92%) patients suffered recurrent strokes. Multiple small and large disseminated lesions in multiple vascular territories were more frequent in recurrent strokes in comparison with initial strokes. The middle cerebral artery was most frequently involved in recurrent strokes, followed by the posterior circulation territory and anterior cerebral artery, which were of similar frequency as initial strokes. Overall, 58% of patients had their first recurrent stroke within the first month, and 69% had a poor outcome, especially for those with multiple recurrent strokes and metastases. Occult cancer should be considered in the setting of multiple and recurrent embolic strokes within the short term in the absence of conventional stroke etiologies. The severity of malignancy and cancer treatments and stroke influenced the recurrences and outcome.


Kinesin family member 18B activates mTORC1 signaling via actin gamma 1 to promote the recurrence of human hepatocellular carcinoma.
The mechanistic target of rapamycin complex 1 (mTORC1) signaling pathway is frequently reported to be hyperactivated in hepatocellular carcinoma (HCC) and contributes to HCC recurrence. However, the underlying regulatory mechanisms of mTORC1 signaling in HCC are not fully understood. In the present study, we found that the expression of kinesin family member 18B (KIF18B) was positively correlated with mTORC1 signaling in HCC, and the upregulation of KIF18B and p-mTOR was associated with a poor prognosis and HCC recurrence. Utilizing in vitro and in vivo assays, we showed that KIF18B promoted HCC cell proliferation and migration through activating mTORC1 signaling. Mechanistically, we identified Actin gamma 1 (γ-Actin) as a binding partner of KIF18B. KIF18B and γ-Actin synergistically modulated lysosome positioning, promoted mTORC1 translocation to lysosome membrane, and prohibited p70 S6K from entering lysosomes for degradation, which finally led to the enhancement of mTORC1 signaling transduction. Moreover, we found that KIF18B was a direct target of Forkhead box M1, which explains the potential mechanism of KIF18B overexpression in HCC. Our study highlights the potential of KIF18B as a therapeutic target for the treatment of HCC.


The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review.
Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU. Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022. Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary. After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized. After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (n = 17) or only nurses (n = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (n = 4), warning devices (n = 3), multicomponent programs (n = 15), and architectural redesign (n = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels. Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.


A global analysis of developmentally regulated genes in Myxococcus xanthus.
Tn5 lac is a transposon that fuses the transcription of lacZ to exogenous promoters. We generated 2374 Tn5 lac insertion-containing strains of Myxococcus xanthus, a soil bacterium that undergoes multicellular development which culminates in the formation of spores. Thirty-six strains were identified that specifically increase beta-galactosidase expression at some particular time during development and these expression times range from minutes after starvation initiates development to 24 hr, when sporulation begins. Different maximum levels of beta-galactosidase expression were also observed and the maximum for many strains that begin beta-galactosidase expression late in development was observed only if spores were disrupted. Seven of the 36 strains display mild to severe defects in aggregation and/or sporulation, as did an additional five strains whose beta-galactosidase expression was not developmentally regulated. Restriction maps of the DNA adjacent to the Tn5 lac insertions that are developmentally regulated and/or cause developmental defects show that most of the 41 insertions are in different regions of the Myxococcus genome. The developmentally regulated Tn5 lac insertions described here provide a set of at least 29 new developmental markers for Myxococcus.


Defect structure in heteroepitaxial semipolar (1122) (Ga, Al)N.
The defect structures in semipolar (1122)-GaN, AlN layers grown on m-sapphire by metal organic vapor phase epitaxy (MOVPE) and molecular beam epitaxy (MBE) are characterized by transmission electron microscopy. The epitaxial relationships are identified as [1010](GaN) || [1120]sap and [1213](GaN) || [0001]sap. Defects are identified as mostly partial dislocations, I1-basal and prismatic stacking faults. The density of dislocations is of the order of 5.5 × 10(9) cm(-2). They are Frank-Shockley partial dislocations with b = 1/6<2023> (90%), Shockley partial dislocations with b = 1/3<1010> (8%) and perfect dislocations of a-type with b = 1/3<1120> (2%). This is in contrast with the growth in c- or a-orientations, where the large majority of extended defects consists of perfect dislocations. Upon MBE regrowth of GaN on MOVPE GaN, no additional defects are generated, although the defects in the substrate propagate through the overgrown layer. However, in the case of MBE deposition of AlN on MOVPE GaN, new threading dislocations of the type b = 1/3<1123> are generated taking stepped and curved structures along their lines.


Mucin at solution/air and solid/solution interfaces.
In this paper the surface activity of protein mucin at solution/air interface has been studied. The experiments of the adsorbed protein at solution/air interface have been carried out with a range of protein concentrations at a defined pH. The adsorption of the protein to solid surfaces and the degree of hydrophobicity at solid/solution interface of mucin have been evaluated at different pH and in the presence of Hofmeister electrolyte. The results from these studies have been further substantiated by surface potential measurements of mucin covered surface on stainless steel. Quartz crystal microbalance (QCM) has been used to follow the protein adsorption kinetics from solution to solid surface. The results from these measurements show that the adsorption behavior has a remarkable dependence on the degree of maximum coverage and is almost independent of the ionic strength. Other characteristic features such as maximum adsorption values at the protein isoelectric point (IEP4.7) and low-affinity isotherms that showed surface saturation even under unfavorable electrostatic conditions have been observed. The amount of mucin adsorbed in the presence of electrolytes has been estimated using electron spectroscopy for chemical analysis (ESCA). The study clearly shows that there exists an inverse relationship between the hydrophobicity and surface tension of the protein and also on the hydrated radius of Hofmeister electrolyte used.


Susceptibility patterns of Candida species recovered from Canadian intensive care units.
The objective of this study was to determine the speciation and susceptibility patterns of Candida species recovered from Canadian intensive care units (ICUs) during a 1-day point-prevalence study on fungal colonization/infection in Canadian ICUs. Blood, urine, respiratory tract, rectal, and wound fungal cultures were performed for 357 patients present at any time during a single-day 24-hour period in 35 Canadian ICUs. Comparative in vitro activities of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, micafungin, anidulafungin, and aminocandin were determined. Four hundred fifteen yeasts (409 Candida species and 6 non-Candida yeasts) were recovered. Almost 50% of the patients were found to have positive respiratory tract or rectal cultures. Candida albicans accounted for 72% of the Candida species isolated, followed by Candida glabrata (16%), Candida tropicalis (5%), Candida parapsilosis (3%), Candida krusei (2%), and other Candida species or nonspeciated isolates (2%). Minimum inhibitory concentrations (milligrams per liter) at which 90% of the strains were inhibited were 0.06 for micafungin as well as anidulafungin, 0.12 for voriconazole, 0.25 for itraconazole, posaconazole, as well as aminocandin, 1 for amphotericin B, and 4 for fluconazole. Only 4% of the isolates were resistant to fluconazole and/or itraconazole. Candida albicans is the predominant species colonizing Canadian ICU patients. Overall, the triazoles, both older and new compounds, and the echinocandins have excellent in vitro antifungal activities against Candida species recovered from Canadian ICUs patients.


[Needs of health insurers regarding surgery for the aged in Germany].
The increasing proportion of elderly persons presents one of the most urgent problems to European societies and has a decisive effect on social insurance systems. Costs are rising rapidly due to longer life and the falling number of births. Health care is especially hard-hit because of medical progress and growing numbers of procedures during old age. Despite these problems, the German health care system is still effective. In contrast to neighboring European states, there are neither waiting lists nor rationing of services. With respect to financing, future developments cannot be predicted. Planning scenarios taking enormously higher costs into account often result in demands for rationing, which the German health insurance companies do not accept. This study examines economic figures from the largest German health insurer and attempts to draw a picture of future health care for old people. New possibilities for prevention and resourcing and the need for rationing are discussed. The first, promising projects in these respects have already been started, with the aim of better health and quality of life for the elderly.


Development of the Condensed Heuristic Academic Research Model (CHARM) framework for short-term nursing research groups.
The norms by which nursing education and research have been conducted are changing More nursing schools are offering online and blended online/face-to-face programs with a shift in research from individual endeavors to a team-based approach. The changing landscape of nursing education and research requires more planning and adherence to schedules and timelines. A framework outlining efficient means to approach team-based nursing research in the academic setting that is reflective of the emerging blended environment is needed. This paper discusses the development of the Condensed Heuristic Academic Research Model (CHARM) framework and shares the experiences of one research team's use of the model in completing a five-component research project in one academic semester. Employment of the framework facilitates the development of time-management, scholarship, mentorship, and collaborative skills for emerging nurse resarchers, current scientists, and faculty members. The CHARM framework is a model that addresses the needs of emerging and experienced nurse researchers and fits well within the new digital and in-person environment of nursing research and education.


Solvation of potassium cation in helium clusters: Density functional theory versus pairwise method.
Microsolvation of a cation in helium quantum solvent is an attractive phenomenon leading generally to the formation of a strongly packed structure known as 'Snowball' feature. Here, the lowest energy structures and the relative stability of the solvated potassium cation K+ in helium clusters K+Hen up to the size n = 20 are investigated employing Density Functional Theory (DFT) and pairwise methods. The DFT calculations showed that M05-2X/6-311++G (3df, 2p) level of theory can reproduce properly the experimental data of K+He diatomic potential, whereas, in the pairwise method, the Basin-Hopping Monte Carlo (BHMC) algorithm was applied for the global optimization. The remarkable differences in the lowest energy structures computed in the frame of both methods are shown for K+He11 and K+He12 clusters. The BHMC optimization converged to an icosahedral geometry for n = 12, corresponding to the highest value of the binding energy per atom. For both methods, we have concluded that the first solvation shell is completed at the size n = 15, despite the maximum packing structure obtained at n = 17. Finally, the stability of the potassium doped helium cluster is discussed based on the Density Of States (DOS) curves.


Emerging technologies for CTC detection based on depletion of normal cells.
Properly conducted, an enrichment step can improve selectivity, sensitivity, yield, and most importantly, significantly reduce the time needed to isolate rare circulating tumor cells (CTCs). The enrichment process can be broadly categorized as positive selection versus negative depletion, or in some cases, a combination of both. We have developed a negative depletion CTC enrichment strategy that relies on the removal of normal cells using immunomagnetic separation in the blood of cancer patients. This method is based on the combination of magnetic and fluid forces in an axial, laminar flow in long cylinders placed in quadrupole magnets. Using this technology, we have successfully isolated CTCs from patients with breast carcinoma and squamous cell carcinoma of the head and neck. In contrast to a positive selection methodology, this approach provides an unbiased characterization of these cells, including markers associated with epithelial mesenchymal transition.


Retrospective review of consecutive cases of paediatric complex pain in a New South Wales tertiary children's hospital.
Prior to July 2013, a solo medical specialist provided a pain management service 1.5-2 days/week to children and young people aged 0-19 years, and their families at John Hunter Children's Hospital, Newcastle, NSW. A new multidisciplinary children's complex pain team now continues that service. This study aimed to identify the demographic and clinical characteristics of children, young people and their families referred to a paediatric pain specialist in the 5.5 years prior to the establishment of a multidisciplinary service and to quantify anecdotal observations, determine service priorities and identify clinical improvement opportunities. A retrospective review of the medical records of all new patients seen between January 2008 and June 2013 was conducted. Data sets for patient demographics, clinical characteristics, service outputs and disposition at discharge were determined prior to data extraction. A total of 114 children and young people aged between 7 days and 18 years (mean ± SD = 12.54 ± 3.6 years) were consecutively referred to the service. Many demographics are consistent with those previously reported; however, the number of children who identified as being of Aboriginal origin (11%), with rare diseases (28%), new diagnoses made (47%), child protection reports submitted (14%) and psychological morbidity in children (58%) and caregivers (38%) are new findings in the context of pain management and serve as indicators of the complex service needs of these patients and their families. The complexities encountered in this small cohort provide an indication of the time investment needed to understand and manage complex paediatric pain, especially in the contexts of complex families, time-poor general practitioners and under-resourced communities.


Adjuvants for human vaccines.
Rational selection of individual adjuvants can often be made on the basis of innate molecular interactions of the foreign molecules with pattern recognition receptors such as Toll-like receptors. For example, monophosphoryl lipid A, a family of endotoxic TLR4 agonist molecules from bacteria, has recently been formulated with liposomes, oil emulsions, or aluminum salts for several vaccines. Combinations of antigens and adjuvants with particulate lipid or oil components may reveal unique properties of immune potency or efficacy, but these can sometimes be exhibited differently in rodents when compared to nonhuman primates or humans. New adjuvants, formulations, microinjection devices, and skin delivery techniques for transcutaneous immunization demonstrate that adjuvant systems can include combinations of strategies and delivery mechanisms for uniquely formulated antigens and adjuvants.


Long-term Natural History of Atrophy in Eyes with Choroideremia-A Systematic Review and Meta-analysis of Individual-Level Data.
To conduct a systematic review and meta-analysis of the natural history of atrophy secondary to choroideremia (CHM). A sensitive and reliable anatomic measure to monitor disease progression is needed in treatment trials for CHM. However, the long-term natural history of the residual retinal pigment epithelium (RPE) is unclear, with reported RPE area decline rates varying widely among patients. We searched in 7 literature databases up through July 17, 2019, to identify studies that assessed the residual RPE area in untreated eyes with CHM using fundus autofluorescence (FAF). We sought individual-eye data and investigated the RPE decline pattern using 3 models: the area linear model (ALM), radius linear model (RLM), and area exponential model (AEM), in which the area, radius, and log-transformed area of RPE change linearly with time, respectively. To account for different eyes' entry times into the studies, we added a horizontal translation factor to each dataset. The RPE decline rate was estimated using a 2-stage random-effects meta-analysis. We assessed the risk of bias using the Quality In Prognosis Studies tool. Of 807 articles screened, we included 9 articles containing cross-sectional data (257 eyes) from 6 studies and longitudinal data (229 visits from 68 eyes) from 5 studies. The residual RPE area followed a trend of exponential decay as a function of patient age. After the introduction of horizontal translation factors to longitudinal datasets of individual eyes, the datasets fit along a straight line in the AEM over nearly 60 years (r2 = 0.997). The decline rate of log-transformed RPE area was 0.050 (95% confidence interval, 0.046-0.055) log(mm2)/year and was independent of the baseline RPE area (r = -0.18; P = 0.15) and age (r = 0.06; P = 0.63). In contrast, the decline rates of the area and effective radius of residual RPE strongly correlated with the baseline RPE area (r = 0.90 and 0.61, respectively; P < 0.001). The loss of residual RPE area in untreated eyes with CHM follows the AEM over approximately 60 years. Log-transformed residual RPE area measured by FAF can serve as an anatomic endpoint to monitor CHM.


Creation of a chemotherapy-induced nausea/vomiting dashboard to improve outcomes for pediatric cancer patients.
Two of the most common acute side effects of chemotherapy are nausea and vomiting. Nausea and vomiting impact quality of life, nutritional status, and ability to tolerate further chemotherapy. Parents of pediatric oncology patients rank nausea as one of the most bothersome treatment-related symptoms. Utilizing Quality Improvement methodology, we developed a dashboard interface to facilitate extraction of data from the electronic medical record (EMR), which is presented via a visual display that summarizes the type of chemotherapy and antiemetic medications, use of as needed medications, and number of episodes of emesis. This dashboard interface allows for rapid and efficient identification of patients whose antiemetic regimen is mismatched for the emetogenicity of ordered chemotherapy, thus providing a timely opportunity to modify the antiemetic regimen based on published guidelines before administration of chemotherapy drugs. It also allows measurement of the effectiveness of the antiemetic regimen in terms of the number of break through emesis and the need for as needed medications. A novel CINV dashboard was created, which visually conveys complex information about antiemetics, chemotherapy emetogenicity, as needed medications, and breakthrough vomiting for inpatient pediatric oncology patients.


Biochemical responses of Lemna minor experimentally exposed to cadmium and zinc.
The effects of 5 μM cadmium (Cd), a non-essential toxic element and 25 and 50 μM zinc (Zn), an essential micronutrient, were investigated in aquatic plant Lemna minor L. after 4 and 7 days of exposure to each metal alone or to their combinations. Both metals showed tendency to accumulate with time, but when present in combination, they reduced uptake of each other. Cd treatment increased the lipid peroxidation and protein oxidation indicating appearance of oxidative stress. However, Zn supplementation in either concentration reduced values of both parameters, while exposure to Zn alone resulted in elevated level of lipid peroxidation and protein oxidation but only on the 7th day. Enhanced DNA damage, which was found on the 4th day in plants treated with Cd alone or in combination with Zn, was reduced on the 7th day in combined treatments. Higher catalase activity obtained in all treated plants on the 4th day of experiment was reduced in Zn-treated plants, but remained high in plants exposed to Cd alone or in combination with Zn after 7 days. Cd exposure resulted in higher peroxidase activity, while Zn addition prominently reduced peroxidase activity in the plants subjected to Cd stress. In conclusion, Cd induced more pronounced oxidative stress and DNA damage than Zn in applied concentrations. Combined treatments showed lower values of oxidative stress parameters--lipid peroxidation, protein oxidation and peroxidase activity as well as lower DNA damage, which indicates alleviating effect of Zn on oxidative stress in Cd-treated plants.


Temporal factors in the discrimination of coherent motion.
When observers view the relative movements of a pair of bars defined by the difference of spatial Gaussian functions (DOGs), they can accurately discriminate coherent movements over a range of temporal frequencies and temporal asynchronies. Of particular interest is the fact that performance accuracy is maintained even when the two bars differ in spatial-frequency content and contrast. On each trial, observers viewed two brief presentation intervals in which a pair of vertically oriented DOGs moved randomly back and forth within a restricted range. During one observation interval, both elements moved in the same direction and by the same magnitude (correlated), and in the other interval, the movements were independent (uncorrelated). Temporal asynchronies were introduced by delaying the displacement of the right bar relative to that of the left bar in each interval. Observers were able to discriminate correlated versus uncorrelated movements up to a 45-60-msec temporal delay between the two elements' relative displacements. If motion processing is accomplished by mechanisms operating over multiple spatial and temporal scales, the visual system's tolerance of temporal delays among correlated signals may facilitate their space-time integration, thereby capitalizing on the perceptual utility of coherent-motion information for image segmentation and interpolating surface structure from the movements of spatially separated features.


Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods.
The use of titanium alloy (Ti) rods is frequently associated with rod fracture after spinal fixation. To address this issue, cobalt chrome (CoCr) rods, which are advantageous because of their greater strength and resistance to fatigue relative to Ti rods, have been introduced. The purpose of the present study was to compare radiographic outcomes after the use of Ti versus CoCr rods in a matched cohort of patients undergoing posterior spinal fusion for treatment of spinal instability. We retrospectively reviewed data from patients who had undergone spinal fusion involving more than 3 levels at a single institution between 2004 and 2015. Patients were matched for age, diagnosis, 3-column osteotomy, levels fused, and T score. Fifty patients with Ti rods were identified and appropriately matched to 50 consecutive patients with CoCr rods. The distributions of age at surgery, sex, diagnosis, 3-column osteotomy, levels fused, number of patients with previous surgical procedures, and T score did not significantly differ between the 2 groups. However, there were significant differences in length of follow-up (CoCr, 25.0 vs. Ti, 28.5 months; P < 0.001), fusion rate (CoCr, 45 [90%] vs. Ti, 33 [66%]; P = 0.004), occurrence of rod breakage (CoCr, 0 vs. T, 8 [16%]; P = 0.006), and junctional kyphosis (CoCr, 24 [46%] vs. Ti, 9 [18%]; P = 0.003). Our findings indicate that the use of CoCr rods is effective in ensuring stability of the posterior spinal construct and accomplishment of spinal fusion. Furthermore, our results indicate that junctional kyphosis may occur more frequently in CoCr systems than in Ti systems.


The menstrual cycle and the well being of women.
The concept of premenstrual syndrome (PMS) is considered and found wanting. The problems which are presented under the heading of PMS, however, are important and need better understanding A three factor model to account for such problems is presented. The three factors are (i) menstruation, problems with which may influence mood and well being premenstrually as well as during menstruation; (ii) the timing factor, linked to the normal hormonal cycle and producing cyclical variability in certain aspects of central nervous system (CNS) function; and (iii) the vulnerability factor, which is not a function of the menstrual cycle, but which involves other characteristics which result in some women reacting to the first two factors adversely. Evidence is presented that the mood changes which commonly occur perimenstrually are linked to cycle-related alterations in serotonergic activity in the CNS, and premenstrual food craving may be a marker of such alterations. The term 'menstrual cycle related problems' is offered as a preferable alternative to 'premenstrual syndrome'.


Cyclophosphamide-induced disruption of umami taste functions and taste epithelium.
Clinical studies have reported taste dysfunctions developing in patients undergoing chemotherapy. This adverse side effect is a major concern for the doctors and patients because disrupted taste can reduce appetite, cause malnutrition, delay recovery, and affect quality of life. Cyclophosphamide (CYP) is a common atenoplastic drug used during chemotherapy and is thought to affect taste through learned tasted aversions. This study asked whether CYP also alters umami taste sensory functions and disrupts taste epithelium of mice. Behavioral tests focused on taste acuity, assessed by the ability of mice to discriminate between the taste qualities of two umami substances, monosodium glutamate (MSG) and inosine 5'-monophosphate (IMP), and taste sensitivity, assessed by detection thresholds of MSG and IMP, after an IP injection (75 mg/kg) of CYP. The behavioral results revealed a two-phase disturbance in taste acuity and loss of sensitivity, the first phase occurring within 2-4 days after injection and the second occurring 9-12 days after injection. The number of fungiform papillae (with and without pores) decreased immediately after injection and did not begin to recover until 12 days after injection. Circumvallate taste buds began to show disturbances by 8 days after injection and evidence of recovery beginning 12 days after injection. Von Ebner glands were smaller and secreted less saliva 4 days postinjection but not later. These findings suggest the initial behavioral deficits may be because of cytotoxic effects of the drug on taste sensory tissues, whereas the second phase may be because of a disturbance of the taste cell replacement cycle.


[Gastric volvulus in children: five case reports].
Gastric volvulus is an abnormal rotation of all or a part of the stomach around one of its axes. It is a rare cause of intestinal obstruction in children. This anomaly can be primary, due to abnormalities of the gastric ligaments, or secondary to other congenital malformations. We report on the cases of five children treated between January 1994 and December 2011, four boys and one girl, with a medium age of 7 months. Diagnosis was based on clinical features, particularly in the upper gastrointestinal Rx contrast study, which confirmed the diagnosis. Four out of the five children underwent laparoscopic surgery with fixation of the stomach. A diaphragmatic hernia was associated in one case. Antireflux surgery was performed in three cases, and a diaphragmatic defect was closed in one case. The follow-up was uneventful after a medium period of 7 years. good knowledge of this anomaly is the guarantee of early diagnosis and optimum treatment to ameliorate the prognosis.


Stress-related disorders and subsequent cancer risk and mortality: a population-based and sibling-controlled cohort study in Sweden.
Prior research has suggested a potential role of psychological stress on cancer development while the role of familial factors on this association is underexplored. We conducted a nationwide cohort study including 167,836 individuals with a first-onset stress-related disorder (including post-traumatic stress disorder, acute stress reaction, adjustment disorder and other stress reactions) diagnosed between 1981 and 2016 in Sweden (i.e., exposed patients), 1,631,801 birth year- and sex-matched unexposed individuals, and 179,209 unaffected full siblings of the exposed patients. Cox models were used to estimate the hazard ratios (HRs) of newly diagnosed cancer and cancer-related death, beyond 1 year after diagnosis of stress-related disorders. We further examined the potential mediation roles of behavior-related morbidities in the associations of stress-related disorders with smoking or alcohol-related cancer incidence and mortality. We found modestly elevated risks of cancer incidence and mortality among exposed patients compared with matched unexposed individuals (incidence: HR = 1.03, 95% CI 1.01-1.06; mortality: HR = 1.13, 95% CI 1.07-1.18), while not when comparing with full siblings (incidence: HR = 1.03, 95% CI 0.99-1.08; mortality: HR = 1.09, 95% CI 1.00-1.19). Similarly, the suggested elevations in incidence and mortality of individual cancer sites (or groups) in the population-based comparison attenuated towards null in the between-sibling comparison. The risk elevations for smoking or alcohol-related cancers in the population-based comparison (incidence: HR = 1.18, 95% CI 1.11-1.24; mortality: HR = 1.20, 95% CI 1.12-1.29) were partially mediated by alcohol-related morbidities during follow-up. Collectively, our findings suggest that the association between stress-related disorders and cancer risk and mortality is largely explained by familial factors, including shared behavioral hazards.


An analysis of prognostic factors after percutaneous endoscopic gastrostomy placement in Japanese patients with amyotrophic lateral sclerosis.
A percutaneous endoscopic gastrostomy (PEG) is an useful intervention for feeding of amyotrophic lateral sclerosis (ALS) patients who have lost oral intake function. The aim of this study was to investigate the risk factors for early death and the survival after PEG placement. A total of 102 ALS patients who underwent PEG placement were enrolled in this study. Patients were divided into two groups; the poor prognosis group included patients who died or needed permanent mechanical ventilation within 30days after PEG placement, and the good prognosis group included patients who did not meet the criteria of the poor prognosis group. Clinical characteristics, respiratory function, and nutritional parameters were compared for the two groups to assess the correlations between clinical and laboratory variables and early death after PEG placement. Multivariate analysis between two groups revealed that higher arterial carbon dioxide pressure (PaCO2) and aphagia before PEG placement were significantly associated with the poor prognosis group. Multivariate analysis for survival also revealed that higher PaCO2 and shorter duration from onset to PEG placement were significantly associated with shorter survival after PEG placement. In conclusion, respiratory and nutritional parameters are revealed to be important prognostic factors for ALS patients who undergo PEG placement.


Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit.
We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System (TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study; sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.


Characteristics of Clostridioides difficile colonization in Ilamian children.
The increasing colonization with Clostridioides difficile in paediatric hospitalized population is a well known event; however, its prevalence in Iranian children has not effectively been identified yet. The objective of this study was to determine the intestinal-carriage rates of C. difficile and molecular characterization of C. difficile in the Ilamian pediatric population from May 22, 2018, until September 22, 2018. Eighty samples were obtained from 40 children aged <5 years, at day 0 of their hospitalization (N=40 samples), to determine community-associated colonization, and then at day 5 days after hospitalization (N=40 samples), to determine healthcare associated colonization. The stool samples were examined for C. difficile, and isolated strains were evaluated for production of Clostridial toxins A/B and molecular characterizations. The colonization rates of C. difficile and toxigenic C. difficile were 10% (8/80) and 3.75% (3/80), respectively. Based on the age group, the intestinal-carriage rates of C. difficile were 37.5, 50, and 12.5% in children ≤ 1, 1-3, and 3-5 years old, respectively. Our findings have revealed eight distinct ribotypes. Our findings have revealed eight distinct ribotypes of C. difficile isolates. Three out of 8 (37.5%) of C. difficile isolates were considered as community-associated colonization and belonged to ribotypes 7, 8, and 9. Conclusion. Our findings suggest the need of confirmation by further epidemiological studies in Iranian children. Given that the 37.5% of cases observed were community-associated, estimates of the incidence of C. difficile infections, that include only hospitalized children, may largely underestimate the burden of disease in children.


Case report: unusual dental morphology in a child with ankyloblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome.
Anomalies of dental anatomy are common in the ectodermal dysplasia syndromes. These anomalies, when found in combination with dental caries, can pose a restorative challenge for the paediatric dentist. Modification of traditional techniques and approaches may help the practitioner provide a successful treatment outcome. A 3 years and 11 months old girl with a diagnosis of ankyloblepharon-ectodermal dysplasiacleft lip/palate (AEC) syndrome was referred for treatment to a specialist paediatric dental service. Her abnormal dental anatomy, hypodontia and dental caries formed a triad of challenges for the team. Under general anaesthesia, her dentition was restored using a combination of restorative approaches and techniques, including the placement of both composite resin and preformed metal crown restorations. At 18-month followup, the family had successfully implemented good home care and dietary practices, and the local dental service had instituted a preventive programme consisting of regular examination, advice and fluoride varnish placement. The restorations remained intact and no further caries was detected. At 24-month follow-up, the first permanent molars were partially erupted, and displayed unusually deep fissures. There was also a degree of ectopic eruption of the first permanent molars, and possibly of one of the maxillary permanent incisors. Dental care for children with AEC syndrome is optimised by early intervention, good home care and regular professional review. Dental care providers should be aware of the possibility of complex dental anatomy, and bear this in mind should it become necessary to formulate a restorative treatment plan.


Update on the evaluation and treatment of osteogenesis imperfecta.
Osteogenesis imperfecta (OI) is a heritable bone fragility disorder that presents with a wide clinical phenotype spectrum: from perinatal lethality and severe deformities to very mild forms without fractures. Most cases of OI are due to autosomal dominant mutations of the type I collagen genes. A multidisciplinary approach with rehabilitation, orthopedic surgery, and consideration of medical therapy with bisphosphonates underpins current management. Greater understanding of the pathogenesis of OI may lead to novel, therapeutic approaches to help improve clinical symptoms of children with OI in the future.


Interleukin-6 and depressive symptom severity in response to physical exercise.
Elevated IL-6 has been implicated in depression. The anti-inflammatory effects of exercise may be associated with its clinical efficacy for depression. We determined if serum IL-6 levels were altered by 12 weeks of physical exercise, and if IL-6 levels were associated with baseline depression severity and change in depression severity in response to exercise. Data from 116 adults (42.7±11.5y) with mild-to-moderate depression (Patient Health Questionnaire >9) who participated in the physical exercise arm of the Regassa RCT (www.regassa.se) were analyzed. Participants were requested to complete three 60-min exercise sessions weekly for 12 weeks. Blood samples were provided at baseline and post-intervention following an overnight fast and were analyzed for serum levels of IL-6 using ELISA. IL-6 values were logarithm-transformed. Higher baseline serum IL-6 levels were significantly associated with reduced depression severity after exercise. Reduced IL-6 levels following exercise were significantly associated with parallel reductions in depression severity. These findings are consistent with a previously reported association between reduced serum IL-1β levels and reduced depression severity following 12 weeks of physical exercise in 105 depressed adults. Findings support associations between IL-6, depressive symptoms, and exercise response, and provide support for the plausible involvement of IL-6 in the antidepressive effect of exercise.


The emergence of human population genetics and narratives about the formation of the Brazilian nation (1950-1960).
This paper discusses the emergence of human population genetics in Brazil in the decades following World War II, and pays particular attention to narratives about the formation of the Brazilian nation. We analyze the institutionalization of this branch of genetics in the 1950s and 1960s, and look at research on the characteristics of the population of Brazil, which made use of new explanatory models of evolutionary dynamics. These developments were greatly influenced by the activities of the Rockefeller Foundation and by the presence of North American geneticists in Brazil, especially Theodosius Dobzhansky. One of the main points of this paper is to show that explanations of Brazilian human genetic diversity constructed in the mid-twentieth century closely followed interpretations that had been produced since the end of the nineteenth century, in which notions of 'racial mixing' played a central role. Even as population genetics was conditioned by nationalist concerns that had long marked Brazilian history, we argue that its emergence and institutionalization was closely associated with global, post-World War II socio-political contexts, especially with regards to modernization projects and growing scientific internationalization.


Endovascular therapy of ascending thoracic aorta.
We describe the endovascular treatment given to a patient who, after surgery on the ascending thoracic aorta due to acute type A dissection (Bentall's procedure), developed a pseudoaneurysm 12 cm in diameter of the ascending aorta at the brachiocephalic trunk. Firstly, an extra-anatomical carotid-carotid bypass was performed, which was followed by endovascular treatment, excluding the aortic arch from the origin of both coronary arteries to the origin of the left common carotid artery, occluding the brachiocephalic trunk. For accurate placement of the endoprosthesis, the device was released after cardiac arrest with adenosine.


Characterization of a recombinant 10-linoleic acid hydratase from Lactiplantibacillus plantarum ZS2058 and biosynthesis of 10- hydroxy-cis-12-octadecenoic acid.
10-Hydroxy-cis-12-octadecenoic acid (10-HOE, 10-OH C18:1), an emerging functional fatty acid, has anti-fungal and anti-inflammatory effects. 10-HOE is synthesized by bacterial 10-linoleic acid hydratase (10-LHT) with linoleic acid as the substate. However, the characterization of 10-LHT and its targeted synthesis of 10-HOE have been rarely reported. In this study, the recombinant 10-LHT from Lactiplantibacillus plantarum ZS2058 was characterized, and the biocatalysis of 10-HOE using crude enzyme was optimized. The recombinant 10-LHT catalyzed the conversion of linoleic acid (C18:2) to 10-HOE as identified using gas chromatography-mass spectrometry (GC-MS). It showed a molecular weight of about 70 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and was a flavin adenine dinucleotide (FAD)-dependent enzyme. The activity of 10-LHT was optimal at pH 6.5 and 25 °C, and it was pH-stable but thermo-sensitive. The optimal condition for the 10-HOE biosynthesis using crude enzyme was 5 g L-1 linoleic acid (C18:2), 148.0 U mL-1 10-LHT, 0.05 mmol L-1 FAD, 2% methanol and 100 mmol L-1 sodium chloride at 25 °C and pH 6.5. A conversion yield of 47.8 ± 1.5% and the corresponding 10-HOE concentration of 2.4 ± 0.1 g L-1 were achieved at 48 h under the optimal reaction conditions. This work achieved the highest conversion yield of 10-HOE with the highest substrate concentration, and provides some useful information for the industrial production of 10-HOE. © 2021 Society of Chemical Industry.


Importance of Anatomy Education on Electrotherapy Lectures in Physiotherapy and Rehabilitation Curricula: Student Perceptions of a Foundation University.
Student opinions are important to improve the physiotherapy and rehabilitation curriculum, and to maintain the quality of education. This study aimed to evaluate the students' perception levels related to anatomy education in terms of electrotherapy lectures. Third and fourth-year physiotherapy students (61 female, 43 male) have voluntarily participated in this study. The data were obtained by a survey, which consists of 29 closed-ended (15 Likert-type questions) questions. The average age was 21.82 ± 1.62 years. The grade point average of the participants, which is based on the 4-point scale, is 2.33 ± 0.44 points. There was no difference between the genders in terms of the grade point averages (p = 0.78). Students stated that the anatomy knowledge of the musculoskeletal system is extremely important in terms of electrotherapy lectures. This is followed by the nervous system and the circulatory system, respectively. They also stated that they need more anatomy knowledge during motor point stimulation applications (50%), and less anatomy knowledge during ultrasound applications (15.38%). In the results of Likert-type survey, first and second highest scores were pertained to "I need anatomy knowledge when inserting electrodes" and "The knowledge which is obtained from anatomy lectures affect to the motor nerve stimulations" (1.42 ± 0.67 and 1.40 ± 0.66, respectively, p < 0.05) and the least score was pertained to "I need to look at my anatomy notes before the electrotherapy exams" (0.41 ± 0.88, p < 0.05). The results from this study help to enhance our conceptual understanding of students' perception levels of anatomy education importance in terms of electrotherapy lectures.


A novel portable smart phone sensing platform based on a supramolecular fluorescence probe for quick visual quantitative detection of picric acid.
Picric acid (PA) is a lethal explosive substance that is easily soluble in water and harmful to the environment. Here, a supramolecular polymer material BTPY@Q[8] with aggregation induced emission (AIE) was prepared by supramolecular self-assembly of cucurbit uril (Q[8]) and 1,3,5-tris[4-(pyridin-4-yl) phenyl] benzene derivative (BTPY), which exhibited aggregation-induced fluorescence enhancement. To this supramolecular self-assembly, the addition of a number of nitrophenols was found to have no obvious effect on the fluorescence, however on addition of PA, the fluorescence intensity underwent a dramatic quench. For PA, BTPY@Q[8] had sensitive specificity and effective selectivity. Based on this, a quick and simple on-site visual PA fluorescence quantitative detection platform was developed using smart phones, and the platform was used to monitor temperature. Machine learning (ML) is a popular pattern recognition technology, which can accurately predict the results from data. Therefore, ML has much more potential for analyzing and improving sensing data than the widely used statistical pattern recognition method. In the field of analytical science, the sensing platform offers a reliable method for the quantitative detection of PA that can be applied to other analytes or micropollutant screening.


[Hepatitis C].
HCV carriers are supposed to me 100,000,000 worldwide. 5-15% of subjects are infected via haemotransfusion and another significant amount via intravenous drugs; nevertheless in the major part of subjects the via of transmission remains unclear. HCV causes long-term infectious in the host because of its high frequency of mutations. Mutations origin multiple mutants, called quasi-species, who have distinct immunological features and can so easily escape host immune response. Chronic HCV infection leads to cirrhosis in 5-10 years and to a possible hepatocarcinoma in 15-20 years. Nevertheless, it remains unclear why some patients undergo a slight clinical course, while others experience an aggressive one (exitus in less than 5 years). Alpha-interferon (alpha-IFN) is at date the only drug of proven efficacy in HCV chronic hepatitis, even if HCV eradication is a rare event. The goal to obtain is to standardize doses and duration of the treatment.


Relating isobolograms to response surfaces.
The interaction index, isobologram and the appropriate contour of constant response of a dose response surface each offer essentially equivalent information regarding departures from additivity in a chemical combination. The benefit of relating the interaction index and isobolograms to a contour of a fitted dose response surface is that departures from additivity can be related to parameters of a statistical model. This permits an assessment of the statistical significance of the parameters and conclusions regarding the nature of departures from additivity which account for the variability inherent in the experiments used to generate the data. Relationships between statistical models and experimental designs can be exploited to yield economical designs for studying chemical combinations.


Immunogenicity and reactogenicity of new multivalent pneumococcal vaccines.
In a study conducted in two phases at one month's interval, 22 healthy adult volunteers received a tetravalent (1, 3, 4, 12F) polysaccharide pneumococcal vaccine; 21 other subjects received another tetravalent (14, 18C, 19F, 23F) vaccine and 25 received a pentadecavalent vaccine (1, 3, 4, 6A, 7F, 8, 9N, 11A, 12F, 14, 15F, 18C, 19F, 23F). Placebo was given under single blind conditions to eleven subjects in the first phase of the study and to 24 subjects in the second phase of the study. The vaccines were well tolerated giving rise to transient local reactions in a small proportion of subjects. Results obtained indicate that all 15 polysaccharides are satisfactorily immunogenic. Results so far obtained can be described as encouraging. Further studies to investigate the reactogenicity and immungenicity of multivalent pneumococcal polysaccharide vaccines with a greater number of serotypes are under way.


Cognitive restraint directed at carbohydrates in individuals on low-carb diet with binge eating: the role of guilt about food cravings.
To evaluate whether the carbohydrate-restricted diet leads to higher levels of food cravings in individuals with binge eating. A total of 146 individuals with binge eating participated in the Low-Carb Diet Group (n=48) and Control Group (n=98). The Binge Eating Scale, Hay's questionnaire, Food Cravings Questionnaire - Trait and State, Cognitive restraint subscale and its adapted version for the cognitive restraint toward carbohydrates, were used as measures. Parametric tests were used for comparison between groups (Student's t test), and Pearson's correlation test to verify correlations between variables of interest. No differences were found between groups with and without diet concerning the level of binge eating or food craving total score. The differences found were the higher levels of cognitive restraint (p=0.01), cognitive restraint for carbohydrates (p=0.01) and subscales of 'guilt about food craving' (p=0.04) in the Low-Carb Diet Group. Individuals with binge eating and a history of low-carb diet have greater cognitive restraint toward carbohydrates and association with altered eating attitudes (guilt about food craving).