The psychological impact of the COVID-19 pandemic on people with multiple sclerosis.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that leads to neurological impairment and disability, mostly in young-aged people. Depression and anxiety are important associated mental disorders for people with MS (PwMS), which influence their life quality. During the COVID-19 pandemic, fear and stress levels enhanced dramatically for the general population, but mostly in progressive chronic pathologies such as MS. This study aimed to analyze the dynamic of psychological aspects in PwMS pre-pandemic and during pandemic, their connection with clinical outcomes, and with the coronavirus disease. We included 95 PwMS with relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS), who were first evaluated 4 years before the pandemic outbreak and the second time 2 years after. They completed a series of psychological tests for depression, anxiety, negative automatic thoughts, and stress: Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Endler Multidimensional Anxiety Scales (EMAS), Automatic Thoughts Questionnaire (ATQ). A neurologist evaluated the Expanded Disability Status Scale (EDSS) and a COVID-19 survey was completed by 78 patients. During the pandemic, depression was encountered in 9.47% of PwMS, only 1.05% with a severe form, and 6.3% with suicidal thoughts, while anxiety was more frequent (39% of cases). Compared to the pre-pandemic period, depression levels remained stable over time (p = 0.55), anxiety was reduced (p<0.001), and stress levels significantly increased (p = 0.001). Some social aspects, such as having sufficient income, reduced the risk for psychological comorbidities. There was a mild correlation between emotional well-being and neurological disability. Of all patients who responded to the survey, 53.84% had previous COVID-19 infections, no patient was hospitalized and 69.23% were vaccinated. There was no relationship between the COVID-19 infection and psychological test results. During the pandemic, in the MS population depression remained stable, anxiety decreased, and stress levels were enhanced compared to the pre-pandemic period. Psychiatric comorbidities were not influenced by the coronavirus infection.


Inhibitory effects of autologous hepatic tumor suspension on the development of liver cell carcinoma in rats.
Inoculation with a crude suspension prepared from autologous liver cell carcinoma inhibited the development of liver tumor in cirrhotic rats exposed to 3'-methyl-4-diethylaminoazobenzene (3'-Me-DAB). The suspension had also an inhibitory effect on the growth of tumor in rats bearing liver cell carcinoma. The results obtained suggest that a close relationship exists between tumor-associated antigens and onco-development.


PDE4 inhibitors: new xanthine analogues.
Novel xanthine analogues are described which are selective PDE4 inhibitors with improved therapeutic potential over theophylline.


Changes in the composition and activities of termite communities in relation to changing rainfall.
The foraging activities of termites were measured at nine sites distributed along a rainfall gradient in Tsavo National Park, Kenya. Dead wood disappearance (D, g m-2a-1) was mainly attributable to termites and was related to rainfall (R, mm a-1) by the equation [Formula: see text] Foraging activity was highest during rainy seasons and declined to low levels during the long dry season. The number of species increased with increasing rainfall while the importance of fungus growing Macrotermitinae declined.


The inhibition of phenolic biosynthesis in damaged and undamaged birch foliage and its effect on insect herbivores.
1. The leaves of Betula pendula Roth trees were damaged artificially, or by insect-grazing. Both induced an increase in phenolic levels in damaged leaves, larger in the case of insect attack.-2. Some of the damaged trees were sprayed with an inhibitor of phenolic biosynthesis, (aminoxy) acetic acid, which led to a reduction in phenolic levels in both undamaged and damaged leaves. Hence both the effects of damage per se and damage-induced changes in foliage phenolic levels on insect feeding preference could be examined using this technique.-3. Herbivore feeding preferences were assessed in the laboratory by comparing damaged and undamaged leaves, with or without phenolic inhibition, using caterpillars of a natural birch feeder, Apocheima pilosaria D. & S. (Lepidoptera: Geometridae) and a non-birch feeder, Spodoptera littoralis Boisduval (Lepidoptera: Noctuidae). Neither species showed any significant preferences and appeared indifferent to damage, irrespective of whether the trees had their damage-induced phenolic synthesis blocked.-4. The implications of these results for "induced defense" theory are discussed.


Evaluation of nested PCR assays for the detection of Legionella pneumophila in a wide range of aquatic samples.
To compare the sensitivities of two nested PCR assays for the detection of Legionella pneumophila to each other and to the plate counting technique (ISO 11731) in a wide range of aquatic samples. The nested PCR assay with the primer set LEG 225-LEG 858 revealed 56% of the 46 analysed aquatic samples as being positive for Legionella spp., while the primer set JFP-JRP yielded 98% positive samples. The detection was confirmed by sequencing the PCR products. These results are considerably higher than the result obtained with the plate counting technique (41%), indicating the higher sensitivity of PCR-based diagnostic methods. As the PCR assay with the LEG 225-LEG 858 primer set resulted in a lower number of positive samples, it is considered not sensitive enough for aquatic samples. Similar results for the respective primer sets were obtained for the detection of the species L. pneumophila, responsible for 90% of all human Legionella infections, in the aquatic samples analysed. Both microbial community analysis by PCR-denaturing gradient gel electrophoresis and the analysis of biotic and abiotic water quality parameters revealed no relation between L. pneumophila-positive and -negative samples and the physico-chemical and bacteriological characteristics of the aquatic samples. The results show the additional value of the PCR assay with the JFP-JRP primer set compared with the plate counting technique, as well as its applicability in a wide range of aquatic samples. This study shows the importance of comparing different primer sets for nested PCR assays for the detection of L. pneumophila in aquatic samples, as well as the lower sensitivity of the widely accepted plate counting technique (ISO 11731).


Variations in intrinsic breast cancer characteristics in screen-detected breast cancer patients aged between 45 and 69 and above the age of 70.
Increasing age is a well-recognized risk factor for breast cancer. With an increase in life expectancy of women, more older patients are diagnosed with breast cancer. This study aimed to identify the variations in breast cancer attributes and mortality in different age groups in New Zealand. This was a retrospective study of data from the Auckland Breast Cancer Register between 1 June 2000 and 28 February 2017. Patients who were diagnosed through Breast Screen were included. Group A included those aged between 45 and 69 years. Group B included individuals with an age of 70 years or above. From June 2000 to February 2017, a total of 6304 new cases of new breast cancer were diagnosed through Auckland Breast Screen, with 5788 patients in group A and 516 patients in group B. Group B was more likely to have the lower grade invasive cancers, with fewer grade 3 cancers. Oestrogen receptor positivity was more pronounced in group B, along with progesterone receptor positivity. Conversely, HER-2 receptor was less likely to be positive in group B. There was a significantly higher breast cancer-related mortality in group B (6.0% versus 2.7%). Mortality related to other causes was also much higher in group B as compared to that in group A (12.8% versus 2.5%). Women aged 70 years or above generally tend to have a more favourable type of breast cancer, with a lower tumour grade, oestrogen and progesterone receptor positivity, and lower rate of HER-2 overexpression.


Usefulness of frailty to predict short- and long-term outcomes in patients who have undergone major hepatectomy for perihilar cholangiocarcinoma.
The influence of frailty on outcomes after hepatectomy for perihilar cholangiocarcinoma (PHCC) remains unclear. This study aimed to investigate the impact of frailty on the incidence of postoperative complications and survival after major hepatectomy for PHCC. A total of 87 patients who had undergone surgery for PHCC between 2007 and 2020 were enrolled in this study. Frailty was scored retrospectively using the Clinical Frailty Scale (CFS). The survival and incidence of postoperative complications were compared based on the degree of frailty, and their risk factors were analyzed. The overall survival of the CFS score 1-2 group was significantly higher than that of the CFS score 3-7 group (P = .01). The survival benefit was especially observed in stage I or II PHCC. Furthermore, there were significant differences between the CFS score 1-3 group and the CFS score 4-7 group in the incidence of Clavien-Dindo classification grade ≥ IIIa (39.4% vs 70.6%; P = .03). Frailty was an independent risk factor for severe postoperative complications (odds ratio, 4.11; 95% confidence interval, 1.18-15.20; P = .03) and the incidence of systemic complications (P < .01). Frailty is a predictive factor for short- and long-term outcomes in patients who have undergone major hepatectomy for PHCC.


Interval out-patient female sterilization in Lagos.
Out-patient sterilization services were introduced by the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, Lagos, in September, 1981. This paper reviews the results of the first five years of its availability. There were 96 out-patient interval sterilizations, 47 were by the laparoscopic and 49 by the minilaparotomy procedures, representing 0.7% of maternities. Both local and general anaesthesia was used for the procedures. The patients' ages ranged from 28-52 years, all but three being above 31 years. Their parity ranged from 2-15 with between 2-10 living children. Only five patients had less than four children. 37.5% had used no contraception before. Termination of pregnancy was performed at the same time as tubal ligation in 12.5%, and 75% of these were secondary to contraceptive failure. Three patients had emergency laparotomy although in only one was it related to the sterilization procedure. Three patients were observed for 24 hours with no complications. Two patients were re-admitted after one week with pelvic peritonitis. The major complication rate was 3.1%. The failure rate was one per cent. There have been no requests for reversal. The results are compared with those of patients having puerperal sterilization during the same period, who totalled 2% of the maternities.


Intracardiac myxomas: twenty-year echocardiographic experience with review of the literature.
We reviewed the echocardiograms of 35 patients with intracardiac myxomas. Patient data were combined from two geographically distant laboratories. No significant variations in the patient profiles were encountered. Most patients were white (33 of 35) with a mean age of 45 years. The diagnosis was suspected on clinical grounds alone in only six of 35 patients before the echocardiogram was done. M-mode recordings were the primary echocardiographic modality available in the first 16 patients, whereas two-dimensional studies were also done in the others. Continuous and pulsed wave Doppler echocardiography were added in eight of the most recent studies. In one patient color flow imaging from both transthoracic and esophageal approaches was possible to better visualize a large left atrial tumor. Thirty-three patients had solitary tumors (29 left atrial, three right atrial, and one left ventricular), and two had multiple tumors. The most characteristic finding, as expected, was the demonstration of abnormal mass echoes produced by the myxoma tissue. Several interesting features not previously emphasized in the literature included abnormal notching of the interventricular septum and posterior left ventricular wall probably produced by displacement from the larger mobile left atrial tumors dropping into the mitral sleeve. This was best appreciated by the M-mode recordings. In one patient with an associated atrial septal defect, movement of the tumor into the defect appeared to alter the expected downward displacement into the mitral orifice. In the patients who were studied by two-dimensional, Doppler, or color flow imaging, tumor movement was evidenced by abnormal frequency shifts, and dispersion of flow around the tumor mass was readily appreciated. Surgical removal was performed in all patients. Follow-up echocardiograms were done postoperatively ranging up to 17 years. Recurrent tumors occurred in two patients, both of whom had congenital myxomas. Echocardiography is proving to be an unparalleled tool in the diagnosis of intracardiac tumors.


Fabrication of magnetic molecularly imprinted polymers based on aptamers and β-cyclodextrin for synergistic recognition and separation of tetracycline.
Tetracycline is extensively used as an antibiotic in animal husbandry, and there arose an increase in antibiotic resistance genes in the environment, posing a threat to human health. Motivated by this, a magnetic molecularly imprinted material based on synergistic recognition (1 + 1>2) was constructed and coupled with high-performance liquid chromatography to detect ultra-trace tetracycline in complicated samples. In this case, the molecularly imprinted polymers were synthesized via a "one-pot" method and acted as recognition elements on the surface of silica-coated ferroferric oxide particles. Aptamers and β-cyclodextrin, as functional monomers, had a synergistic effect on the recognition of tetracycline and the synergistic recognition factor was 1.7. Meanwhile, the material exhibited high selectivity to tetracycline with an imprinting factor of 7.6. In addition, compared to being modified on the surface, the stability of the aptamers was effectively improved by cross-linking in the molecularly imprinted polymer framework. Relevant experimental conditions, such as buffers, concentration of magnesium ions and adsorption time, were optimized. As a result, the method showed a limit of detection of 1.0 μg L-1 and the linearity range of 0.005-0.5 mg L-1, as well as certain reproducibility and stability. Furthermore, when applied for the analysis of animal feed samples, a significant reduction of matrix interference was observed with satisfactory recoveries (85.0-111.5%), which emphasized the good accuracy and practicability of the established method. For these advantages, the proposed method represents a versatile and powerful tool for the separation and detection of small molecule compounds in complicated real samples.


Lymphoid neogenesis in chronic inflammatory diseases.
The frequent observation of organized lymphoid structures that resemble secondary lymphoid organs in tissues that are targeted by chronic inflammatory processes, such as autoimmunity and infection, has indicated that lymphoid neogenesis might have a role in maintaining immune responses against persistent antigens. In this Review, we discuss recent progress in several aspects of lymphoid neogenesis, focusing on the similarities with lymphoid tissue development, the mechanisms of induction, functional competence and pathophysiological significance. As more information on these issues becomes available, a better understanding of the role of lymphoid neogenesis in promoting chronic inflammation might eventually lead to new strategies to target immunopathological processes.


Circ_0021350 plays an oncogene role by regulating miR-1207-3p/PIK3R3 in glioblastoma.
Glioblastoma (GBM) is the most malignant glioma, with poor survival rates and prognosis. Several studies have reported the abnormal expression of circular RNAs (circRNAs) and their functions in the malignant biological behavior of GBM. However, such research is still in the preliminary stages, and further study is needed to confirm the therapeutic potential of circRNAs in GBM. RNA-seq was performed using four tumor tissues from patients with GBM and their adjacent non-tumor brain tissues to screen differentially expressed circRNAs. Fluorescence in situ hybridization assay was used to examine the location of circ_0021350 in glioma cells. In addition, a series of biological function assays were employed to verify the oncogenic role of circ_0021350 in GBM. Quantitative reverse transcription PCR was used to examine circular, micro- (miRNA), and messenger RNA (mRNA) levels. Furthermore, dual-luciferase reporter, RNA pull-down, and RNA binding protein immunoprecipitation assays were applied to verify the interaction between circ_0021350 and its downstream effectors. Circ_0021350 was significantly elevated in GBM tissues and glioma cells. Overexpression of circ_0021350 promoted glioma cell proliferation and metastatic ability; silencing of circ_0021350 had the opposite effect. Mechanistic analysis revealed that circ_0021350 sponged miR-1207-3p to regulate PIK3R3, whose overexpression reversed the reduction in the malignant biological behavior of glioma cells caused by silencing circ_0021350. Our findings suggest that circ_0021350 is an oncogenic circRNA in GBM, and the circ_0021350/miR-1207-3p/PIK3R3 axis may serve as a potential therapeutic target in GBM treatment.


Electrochemical mechanism of synchronous ammonia and nitrate removal based on multi-objective optimization by coupling random forest with genetic algorithm.
In this work, an electrochemical system was constructed for the simultaneous elimination of ammonia and nitrate using the prepared Ti foam/SnO2-Sb anode and a Cu foam cathode. The hybrid RF-GA method is proposed as a tool for the analysis and optimization of the simultaneous removal of ammonia and nitrate. The influence of independent variables including NaCl concentration, time, and current densities was studied. Results showed that the random forest (RF) model could successfully predict the behavior of electrochemical systems (R2 = 0.9751, RMSE = 0.4567 for the ammonia prediction model; R2 = 0.9772, RMSE = 0.0436 for the nitrate prediction model). The variable importance measures (VIM) analysis reveals that time has the maximum influence on the degradation rate of ammonia and nitrate. The RF model is used as an objective function for the genetic algorithm (GA) to determine the optimum conditions in combination with the calculated specific energy consumption. Based on the optimization results, the removal rates of ammonia and nitrate reach 94.4 % and 74.7 %, respectively, with a minimum specific energy consumption of 0.181 kwh·g-1. The electrochemical reaction mechanism of the composite pollutants in the Ti foam/SnO2-Sb and Cu foam electrode system is further elucidated. The results indicate that nitrate is reduced to nitrite, ammonia, or nitrogen gas at the cathode, accompanied by the mutual transformation of Cu(0), Cu(I), and Cu(II) on the Cu electrode. Ammonia is oxidized to nitrogen gas or nitrate at the anode. Ultimately, the nitrogen-containing composite pollutant is decomposed and discharged as nitrogen gas by cyclic redox reactions.


Research progress of trace components in sesame-aroma type of baijiu.
Baijiu is one of the traditional distilled liquor made from grains in China and occupies a vital position in China's food industry. In 2018, the total sales revenue of baijiu industry were reached 536.383 billion yuan, respectively. According to the aroma characteristics, baijiu is artificially divided into 12 aroma types. Especially, although sesame-aroma type of baijiu is widely recognized for a short time compared with strong-aroma and light-aroma type of baijiu, sesame-aroma type of baijiu is becoming more and more popular among consumers due to its unique roasted sesame aroma recently. With its unique aroma of roasted sesame (similar to roasted coffee), sesame-aroma type of baijiu has drawn the attention of consumers and researchers. The researches on the trace components in sesame-aroma type of baijiu and their influences on the aroma profile of sesame-aroma type of baijiu have been carried out gradually. This perspective mainly introduces the production process and development process of sesame-aroma type of baijiu, summarizes recent progress in the research on the trace components in sesame-aroma type of baijiu, especially for the influences of trace components on the aroma profile of sesame-aroma type of baijiu. It provides ideas for the research direction of sesame-aroma type of baijiu, and lays a foundation for the improvement of baijiu quality and the development of sesame-aroma type of baijiu in the future.


Blood cyclosporine concentrations in liver transplant recipients: assay method and influence of changed hepatic and renal function.
In 154 blood samples from adult and pediatric liver transplant recipients with variable degrees of hepatic and renal dysfunction, the specific monoclonal antibody-based Sandimmune RIA kit gave CsA results that were highly correlated with HPLC values. In contrast, assay of CsA levels with the PARIA in 213 samples showed values that varied between 1.8 and 18.8 times those determined by HPLC. In adults, the extent of this variation in the CsA HPLC/PARIA ratio was highly correlated with values of BIL and to a lesser extent with serum ALP; additionally, in children, correlations with AST and GGT were noted.


Myth-busting the provider-user relationship for digital sequence information.
The United Nations Convention on Biological Diversity (CBD) formally recognized the sovereign rights of nations over their biological diversity. Implicit within the treaty is the idea that mega-biodiverse countries will provide genetic resources and grant access to them and scientists in high-income countries will use these resources and share back benefits. However, little research has been conducted on how this framework is reflected in real-life scientific practice. Currently, parties to the CBD are debating whether digital sequence information (DSI) should be regulated under a new benefit-sharing framework. At this critical time point in the upcoming international negotiations, we test the fundamental hypothesis of provision and use of DSI by looking at the global patterns of access and use in scientific publications. Our data reject the provider-user relationship and suggest a far more complex information flow for DSI. Therefore, any new policy decisions on DSI should be aware of the high level of use of DSI across low- and middle-income countries and seek to preserve open access to this crucial common good.


Disposition of Misoprostol and Its Active Metabolite in Impaired Hepatic Function.
The pharmacokinetics of misoprostol and its active metabolite, misoprostol acid, was assessed in 17 healthy subjects and 17 subjects with various degrees of hepatic impairment. Before misoprostol administration, subjects underwent antipyrine and indocyanine green clearance studies to assess hepatic functional capacity. Subjects were administered 400 mcg of oral misoprostol in an open-label design. There was a lower antipyrine clearance in the group with hepatic disease as compared to normal volunteers (0.56 versus 0.80 ml min(minus sign1) kg(minus sign1), respectively, p = 0.022). There was no difference in indocyanine green clearance values between groups. The C(max), t(1/2)&bgr, and [Formula: see text] tended to be larger in the hepatic group; however, there was no statistical difference. Adverse events, mostly gastrointestinal in nature, occurred more often in the subjects with hepatic disease. These data suggest the pharmacokinetics of misoprostol may be altered in the presence of hepatic disease. However, because of significant interpatient variability, definitive dosing recommendations cannot be made. Further study in this area is needed.


Vertebral deformities identified by vertebral fracture assessment: associations with clinical characteristics and bone mineral density.
Whether vertebral fractures identified on radiographs are painful or not, they are associated with increased morbidity and mortality. Vertebral fractures on X-rays correlate with low bone mineral density (BMD) at the spine and hip in addition to several clinical characteristics. Evidence suggests that vertebral deformities detected by X-ray and by vertebral fracture assessment (VFA) show good agreement. We examined the relationship between VFA-detected vertebral deformities and patient characteristics as well as BMD by analyzing the records of 432 patients who had undergone dual-energy X-ray absorptiometry (DXA) scans with VFA. Patients' demographic data and T-scores were obtained from patient questionnaires and DXA scans. We categorized vertebral deformities by type and severity. Patients with vertebral deformities were significantly older and more likely to report a history of fracture after childhood. Significantly more estrogen use was reported in patients without deformity. Those with deformities had significantly lower T-scores at the femoral neck and total hip but not at the spine. Increased severity and number of deformities correlated with lower T-scores at the total hip and femoral neck but not the spine. In conclusion, vertebral deformities detected by VFA, like those on X-ray, correlate with both clinical characteristics and reduced bone mass at the hip. These relationships, in addition to rapid performance, convenience, and minimal radiation exposure, indicate VFA-detected vertebral deformities are a valuable adjunct in identifying patients in need of additional evaluation and treatment.


The prevalence and prognostic significance of KRAS mutation subtypes in lung adenocarcinomas from Chinese populations.
We performed this retrospective study to identify the prevalence of KRAS mutation in Chinese populations and make a comprehensive investigation of the clinicopathological features of KRAS mutation in these patients. Patients from 2007 to 2013 diagnosed with primary lung adeno-carcinoma who received a radical resection were examined for KRAS, EGFR, HER2, BRAF mutations, and ALK, RET, and ROS1 fusions. Clinicopathological features, including sex, age, tumor-lymph node-metastasis stage, tumor differentiation, smoking status, histological subtypes, and survival information were analyzed. KRAS mutation was detected in 113 of 1,368 patients. Nine different subtypes of KRAS mutation were identified in codon 12, codon 13, and codon 61. KRAS mutation was more frequently found in male patients and former/current smoker patients. Tumors with KRAS mutation had poorer differentiation. Invasive mucinous adenocarcinoma predominant and solid predominant subtypes were more frequent in KRAS mutant patients. No statistical significance was found in relapse-free survival or overall survival between patients with KRAS mutation and patients with other mutations. In Chinese populations, we identified KRAS mutation in 8.3% (113/1,368) of the patients with lung adenocarcinoma. KRAS mutation defines a molecular subset of lung adenocarcinoma with unique clinicopathological features.


Clinical outcomes of 200 colorectal endoscopic submucosal dissections.
Endoscopic submucosal dissection (ESD) is an outstanding endoscopic technique in which a colonic lesion can be resected en-bloc. However, the procedure requires a high level of skill and the procedure has yet to be standardized. At the present time, colorectal ESD is only permitted in Japanese institutions that have been certified for advanced medical treatments. We examined 200 cases of colorectal ESD that were performed in our hospital. Over time, it was found that there was a continuous improvement in the treatment outcomes along with advances in both the procedures and the peripheral equipment utilized. Current results suggest that the colorectal ESD procedure is relatively stable. To ensure colorectal ESD continues to be safe, indications for its use need to be more fully investigated and medical personnel must be trained to carefully perform the procedure.


Development of environmental biotechnology and control of emerging biological contaminants: the grand challenge for a sustainable future.
Viruses and bacteria are "Angels" that works in environmental biotechnologies for sustainable development and "Demons" that can compromise the quality of life.


Ordering-Dependent Hydrogen Evolution and Oxygen Reduction Electrocatalysis of High-Entropy Intermetallic Pt4 FeCoCuNi.
Disordered solid-solution high-entropy alloys have attracted wide research attention as robust electrocatalysts. In comparison, ordered high-entropy intermetallics have been hardly explored and the effects of the degree of chemical ordering on catalytic activity remain unknown. In this study, a series of multicomponent intermetallic Pt4 FeCoCuNi nanoparticles with tunable ordering degrees is fabricated. The transformation mechanism of the multicomponent nanoparticles from disordered structure into ordered structure is revealed at the single-particle level, and it agrees with macroscopic analysis by selected-area electron diffraction and X-ray diffraction. The electrocatalytic performance of Pt4 FeCoCuNi nanoparticles correlates well with their crystal structure and electronic structure. It is found that increasing the degree of ordering promotes electrocatalytic performance. The highly ordered Pt4 FeCoCuNi achieves the highest mass activities toward both acidic oxygen reduction reaction (ORR) and alkaline hydrogen evolution reaction (HER) which are 18.9-fold and 5.6-fold higher than those of commercial Pt/C, respectively. The experiment also shows that this catalyst demonstrates better long-term stability than both partially ordered and disordered Pt4 FeCoCuNi as well as Pt/C when subject to both HER and ORR. This ordering-dependent structure-property relationship provides insight into the rational design of catalysts and stimulates the exploration of many other multicomponent intermetallic alloys.


Prognostic Factors after Surgery for Salivary Gland Cancer; What Is New, and What Is Next?
Salivary gland cancers account approximately for 7% of all head and neck tumors [...].


Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance.
Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30° arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers.


Noninvasive radioelectric asymmetric conveyor brain stimulation treatment improves balance in individuals over 65 suffering from neurological diseases: pilot study.
In the elderly population, problems with walking and balance are very common. These problems seriously affect the quality of life of the elderly. When gait and balance problems are caused by neurological disease, these problems can be more serious and difficult to handle. The aim of this pilot study was to verify the effect of a noninvasive radioelectric conveyor asymmetric brain stimulation protocol, named neuropostural optimization (NPO), to improve balance in neurological elderly. Twelve patients suffering from various neurological diseases participated in this study. They were assessed with the Romberg test, which was performed on a computerized stabilometric platform before, immediately following, and 72 hours after NPO was used to improve balance. The results showed that a stabilization of balance was recorded in all subjects a few minutes after administration of NPO. This stabilization increased 72 hours after treatment. The results show that NPO could be a valuable therapeutic approach to improve sensory-motor strategies and neurological control of balance in elderly patients suffering from various neurological diseases.


A Conspectus of Cellular Mechanisms of Nitrosothiol Formation from Nitric Oxide.
Although chemical mechanisms for the formation of nitrosothiol from •NO have been studied extensively "in the test tube", surprisingly little is known regarding the mechanism(s) of how nitrosothiols are formed in vivo. This lack of understanding has hampered more general acceptance of the concept of cysteine nitrosothiol formation as a generally applicable, regulated, and functionally significant protein posttranslational modification (as opposed to multiple other •NO-induced thiol modifications). Here we provide a brief overview/summary of the cellular formation of nitrosothiols from •NO via two possible mechanisms involving oxygen or transition metals.


Using the past to contextualize anthropogenic impacts on the present and future distribution of an endemic Caribbean mammal.
Island species are difficult to conserve because they face the synergy of climate change, invasive species, deforestation, and increasing human population densities in areas where land mass is shrinking. The Caribbean island of Hispaniola presents particular challenges because of geopolitical complexities that span 2 countries and hinder coordinated management of species across the island. We employed species distribution modeling to evaluate the impacts of climatic change and anthropogenic activities on the distribution of an endemic mammal of conservation concern, the Hispaniolan solenodon (Solenodon paradoxus). We aggregated occurrence points for this poorly known species for the Last Glacial Maximum (LGM) and the present (1975-2016) based on museum collections, online biodiversity databases, and new field surveys. We quantified degree of overlap between periods and scenarios with Schoener's D. Through a conservation paleobiology lens, we found that over time humans played an increasing role in shaping the distribution of S. paradoxus, thus, providing a foundation for developing conservation strategies on appropriate spatiotemporal scales. Human population density was the single most important predictor of S. paradoxus occurrence. Densities >166 people/km2 corresponded to a near-zero probability of occurrence. Models that accounted for climate but not anthropogenic variables falsely identified suitable habitat in Haiti, where on-the-ground surveys confirm habitat is unavailable. Climate-only models also significantly overestimated the potential for habitat connectivity between isolated populations. Our work highlights that alternative fates for S. paradoxus in the Anthropocene exist across the political border between the Dominican Republic and Haiti due to the fundamentally different economic and political realities of each country. Relationships in the fossil record confirm that Hispaniola's sociopolitical boundary is not biologically significant but instead represents one imposed on the island's fauna in the past 500 years by colonial activity. Our approach reveals how a paleontological perspective can contribute to concrete management insights.


Multi-level validation of the German physical activity self-efficacy scale in a sample of female sixth-graders.
The majority of children and adolescents are insufficiently physically active. Self-efficacy is considered one of the most important determinants of physical activity (PA). The purpose of this study was to validate the German version of the physical activity self-efficacy scale by means of a multi-level approach. Factorial validity, internal consistency and criterion validity were examined for the individual and the class level. The final sample comprised 454 female sixth-graders of 33 classes. To examine the factorial validity of the translated 8-item scale, a multi-level confirmatory factor analysis was conducted with the lavaan package in R. Internal consistency was estimated with the alpha function of the psych package. Criterion validity was examined by correlating self-efficacy with moderate-to-vigorous physical activity (MVPA) assessed with accelerometers. In contrast to previous validation studies, a unidimensional structure of the scale was not supported. Instead, two highly correlated (rindividual = .87; rclass = .69) but distinct latent factors, representing PA self-efficacy and social support from family and friends, were differentiated on both the individual and class level. The best overall fit exhibited a multi-level 1 × 1-model, including only the six items measuring PA self-efficacy (χ2 = 32.10, CFI = .986, TLI = .976, RMSEA = .059, SRMR = .035). Internal consistencies for the complete 8-item scale and the 6-item scale were good on the individual level and excellent on the class level. For the two items measuring social support, Cronbach's alpha was low on the individual and excellent on the class level. Weak relations between self-efficacy and MVPA were found for the individual level, strong associations were found for the class level. The validation speaks for the use of the abridged 6-item scale, which allows for a unidimensional assessment of PA self-efficacy. Generally, the results support the relevance of a multi-level approach, which not only differentiates between self-efficacy on the individual level and on the class level but also between the respective implications regarding reliability and criterion validity on both levels. Thereby, this study offers a rigorously validated scale and further illustrates possible consequences of the usual neglect of group-level variance in scale validation.


Depressive Symptoms among Older Jordanian Patients with Cancer Undergoing Treatment.
To date, predictive and risk factors for depression among older patients with cancer have not been adequately studied in the Middle Eastern countries including Jordan. Therefore, this study aimed to assess the levels of depressive symptoms, anxiety, and hope among older Jordanian patients with cancer aged 60 years and over who are currently undergoing treatment, and to identify the relationship between selected factors (socio-demographic, treatment, and psychological) and depressive symptoms. A cross-sectional design was conducted on a convenience sample consisting of 150 patients with cancer from one of the biggest governmental hospitals in Jordan. The findings revealed that almost 34% and 27% of the patients experienced anxiety and depression and had a moderate level of hope. Correlating factors with depression were age, duration of treatment, hope, anxiety, educational level, and health insurance. However, low duration of treatment, high anxiety, and low hope were the significant predictors of high depression. Understanding the risk factors correlated with depression could help develop early interventions to enhance the psychological consequences for patients with cancer at risk for depression. Health-care providers need to develop psychological care for older patients with cancer and interventions directed at minimizing depression. Also, nurses should focus on providing holistic care including physical, social, psychological, and spiritual dimensions. Depression care should be an important part of the comprehensive treatment care plan for older patients undergoing cancer treatment.


Effect of heating temperature on the sintering characteristics of sewage sludge ash.
This study investigated and analyzed the effects of the heating temperature on the properties of the sintered sewage sludge ash. The results indicated that the water absorption rate of the sintered sewage sludge ash samples decreased when the firing temperature was increased from 800 to 900 degrees C. When the heating temperature reached 1000 degrees C, the absorption rate decreased significantly. The bulk density of the sewage sludge ash samples increased by 2.3g/cm3 when the heating temperature was increased from 900 to 1000 degrees C, indicating that the densification was affected by heating. The porosity of the sintered sewage sludge ash samples ranged from 36% to 39% when the heating temperature ranged from 600 to 900 degrees C. The least porosity occurred at 1000 degrees C; the sintered samples were well densified. When the temperature was between 900 and 1000 degrees C, the strength appeared to increase significantly, reaching 2040 kgf/cm2, implying an advance in densification due to sintering. The SEM observations were in general agreement with the trends shown by the density data.


Function of the hypothalamo-pituitary-adrenocortical system during ontogenesis in rats with inherited stress-induced arterial hypertension.
The functional activity of the hypothalamo-pituitary-adrenocortical system (HPAS) during the development of rats with inherited stress-induced arterial hypertension (HSIAH rats) was compared with that in normotensive Wistar rats. In rats aged 2, 3, 4, 6, 8, 10, 12, and 18 weeks, competitive protein binding assays were used to estimate peripheral blood plasma corticosterone levels at rest and after 1 h of restricted mobility in mesh cylinders. Basal corticosterone levels and HPAS responses to stress were lower during ontogenesis in hypertensive rats than in Wistar rats of the same age. The exception was rats aged four weeks, when HSIAH rats started to develop hypertension and their HPAS was more sensitive to emotional stress than was the case in Wistar rats, this being associated with the greater reaction of the adrenals to ACTH. Decreased reactions of the HPAS to emotional stress in adult HSIAH rats is not associated with loss of adrenal ACTH sensitivity.


Endothelium-dependent vasodilation of peripheral conduit arteries in patients with heart failure.
Endothelium-dependent vasodilation of peripheral resistance vessels is abnormal in patients with heart failure, but there are little in vivo data on endothelium-dependent vasodilation of peripheral conduit vessels. This study assessed endothelium-dependent vasodilation of forearm conduit and resistance vessels in normal subjects and patients with heart failure. The effects of intraarterial endothelium-dependent and endothelium-independent vasodilators on both forearm conduit (brachial artery) and resistance vessels were assessed in 9 patients with New York Heart Association class II-III heart failure and 11 normal subjects of similar age. Brachial artery diameter was measured by two-dimensional, moderate-frequency (8 MHz) ultrasound, and forearm blood flow was measured by strain gauge plethysmography. The endothelium-dependent vasodilator, methacholine (0.3 and 1.5 micrograms/min), increased brachial artery diameter by 7.6 +/- 1.3% and 12.2 +/- 1.5% in normal subjects as compared to 6.9 +/- 2.1% and 10.4 +/- 2.4% in patients with heart failure (P = NS, normal vs heart failure). The endothelium-independent vasodilator, nitroglycerin (0.15 microgram), also produced similar increases in brachial artery diameter in the two groups (8.2 +/- 1.3% in normal subjects vs 11.1 +/- 1.4% in patients with heart failure, P = NS). In contrast, forearm blood flow responses to methacholine were significantly (P < .05) greater in normal subjects (4.1 +/- 0.5 and 9.2 +/- 1.4 mL/min/100 mL forearm volume) than in patients with heart failure (2.0 +/- 0.8 and 5.1 +/- 1.3 mL/min/100 mL forearm volume). Forearm blood flow responses to the endothelium-independent vasodilator, sodium nitroprusside, were similar between the two groups. This study suggests that endothelium-dependent and endothelium-independent vasodilation of the brachial artery is not impaired in patients with class II-III heart failure. This finding contrasts with abnormal endothelium-dependent vasodilation of forearm resistance vessels. These data suggest that there are regional differences in endothelial function in patients with heart failure.


Sex differences in visual information processing following right cerebrovascular accidents.
This study examined whether males and females who had sustained right CVA's but did not show gross asymmetries in processing left- and right-sided visual information would demonstrate visual hemiimperception when tested with more demanding evaluation procedures. Testing involved tasks of reaction time, oral reading and searching for embedded words and figures. Males and females differed in their response patterns for tasks involving searching for embedded target stimuli; specifically, males required greater lengths of time to locate stimuli in left hemispace, while females showed no such pattern of results. This suggests that closer attention must be paid to screening procedures used to detect hemispatial visual imperceptions, particularly among males.


Simulation-assisted design of microfluidic sample traps for optimal trapping and culture of non-adherent single cells, tissues, and spheroids.
This work focuses on modelling design and operation of "microfluidic sample traps" (MSTs). MSTs regroup a widely used class of microdevices that incorporate wells, recesses or chambers adjacent to a channel to individually trap, culture and/or release submicroliter 3D tissue samples ranging from simple cell aggregates and spheroids, to ex vivo tissue samples and other submillimetre-scale tissue models. Numerous MST designs employing various trapping mechanisms have been proposed in the literature, spurring the development of 3D tissue models for drug discovery and personalized medicine. Yet, there lacks a general framework to optimize trapping stability, trapping time, shear stress, and sample metabolism. Herein, the effects of hydrodynamics and diffusion-reaction on tissue viability and device operation are investigated using analytical and finite element methods with systematic parametric sweeps over independent design variables chosen to correspond to the four design degrees of freedom. Combining different results, we show that, for a spherical tissue of diameter d < 500 μm, the simplest, closest to optimal trap shape is a cube of dimensions w equal to twice the tissue diameter: w = 2d. Furthermore, to sustain tissues without perfusion, available medium volume per trap needs to be 100× the tissue volume to ensure optimal metabolism for at least 24 hours.


Development of a medical-psychiatric program within the private sector. Potential problems and strategies for their resolution.
Recent reports regarding the development of combined medical-psychiatric units have primarily involved units operated under the auspices of academic medical centers. Almost no published information is available regarding the fiscal, administrative, or clinical feasibility of operating such programs within the context of the private community hospital setting. This article outlines the organization and development of such a private unit and discusses the various medical, administrative, political, and financial considerations that must be evaluated in planning for the successful operation of medical-psychiatric units within the private sector.


The interaction role of obesity and pubertal timing on the psychosocial adjustment of adolescent girls: longitudinal data.
The objective of the study was to verify the hypothesis that obesity is associated with pubertal timing, as both factors interact to predict psychosocial adjustment problems in girls. We selected 811 girls who had participated in a longitudinal study on a representative sample of French Canadian children from 1986 to 1997. Only data collected between 1993 and 1996 were analyzed. We classified the participants into three weight categories (normal, overweight, and obese) and pubertal timing (early, on-time, or late-maturing) and compared their internalized and externalized problem behavior and conflict as well as their socioeconomic status. We found that (1) early and late-maturing girls are more at risk of being overweight during the whole period of pubertal development as demonstrated by the increasing rate of obesity in these two groups between 11 and 13 y old, and (2) there was an interaction effect between pubertal timing and obesity in predicting problem behavior and conflict. Overweight and obese girls who developed faster or slower than their peers displayed more adjustment problems at 11 and 12 y old. At 13 y old, obesity predicted adjustment problems separately without regard to pubertal timing. Our results suggest that puberty timing is a risk factor for obesity and that both pubertal timing and being overweight predict adjustment problems during all the courses of pubertal development, supporting partially our hypothesis. Programs and interventions must take into account these two factors and adolescents should be monitored throughout all the periods of pubertal development.


Bullying victimization, physical inactivity and sedentary behavior among children and adolescents: a meta-analysis.
Physical activity and sedentary behavior are related with psycho-social variables among youth, however its relationship with bullying victimization is unclear. The aim of the study was to clarify the associations between physical activity and sedentary behaviors with bullying victimization among children and adolescents. Two independent authors searched in four databases. The studies were selected/included only if participants were children and/or adolescents and the relationship between physical activity and/or sedentary behavior with bullying victimization was reported. Random-effects meta-analyses were used. A total of 18 cross-sectional studies (including 386,740 children and adolescents, 51.8% females) were reviewed. Our study found that not meeting the physical activity guidelines (Odds Ratio [OR] = 1.14, 95% confidence interval [CI], 1.04 to 1.23) and excessive sedentary behavior (i.e., 2 h per day or more of screen time) (OR = 1.21, 95% CI, 1.14 to 1.28) were associated with 14 and 21% higher bullying victimization, respectively. Consistent associations were also found when we analyzed specific forms of bullying for sedentary behavior, including traditional and cyberbullying. The present study establishes the first quantitative framework for understanding the influence of physical activity and sedentary behavior on bullying victimization, and lays the groundwork for future studies and interventions aimed to its promotion. CRD42018099388 .


Egg-box model-based gelation of alginate and pectin: A review.
Alginate and pectin are emblematic natural polyuronates that have been widely used in food, cosmetics and medicine. Ca-dependent gelation is one of their most important functional properties. The gelation mechanisms of alginate and pectin, known as egg-box model, were believed to be basically the same, because their Ca-binding sites show a mirror symmetric conformation. However, studies have found that the formation and the structure of egg-box dimmers between alginate and pectin were different. Very few studies have reviewed those differences. Therefore, this study was proposed to first summarize the intrinsic and extrinsic factors that can influence the gelation of alginate and pectin. The differences in the effect of these factors on the gelation of alginate and pectin were then discussed. Meanwhile, the similarity and difference in their gelation mechanism was also summarized. The knowledge gained in this review would provide useful information for the practical applications of alginate and pectin.


Hyperlipoproteinemia and multifocal neurologic dysfunction in systemic lupus erythematosus.
Two patients with systemic lupus erythematosus, including one with neuropathologic findings, had recurrent multifocal neurologic dysfunction and hyperlipoproteinemia. The lipoprotein disturbances were complex and variable over time. Deficient lipoprotein lipase was found in both patients and appeared to be related temporally to neurologic deterioration. One of these patients had neurologic disease and lipoprotein abnormalities 2 1/2 years before SLE could be documented serologically. These studies suggest that lipoprotein lipase deficiency may be a marker for the endothelial disorder causing cerebral vasculopathy in SLE.


Dog liver glucose-6-phosphate dehydrogenase: purification and kinetic properties.
Glucose-6-phosphate dehydrogenase (G6PD) catalyses the first step of the pentose phosphate pathway which generates NADPH for anabolic pathways and protection systems in liver. G6PD was purified from dog liver with a specific activity of 130 U x mg(-1) and a yield of 18%. PAGE showed two bands on protein staining; only the slower moving band had G6PD activity. The observation of one band on SDS/PAGE with M(r) of 52.5 kDa suggested the faster moving band on native protein staining was the monomeric form of the enzyme. Dog liver G6PD had a pH optimum of 7.8. The activation energy, activation enthalpy, and Q10, for the enzymatic reaction were calculated to be 8.96, 8.34 kcal x mol(-1), and 1.62, respectively.The enzyme obeyed "Rapid Equilibrium Random Bi Bi" kinetic model with Km values of 122 +/- 18 microM for glucose-6-phosphate (G6P) and 10 +/- 1 microM for NADP. G6P and 2-deoxyglucose-6-phosphate were used with catalytic efficiencies (kcat/Km) of 1.86 x 10(6) and 5.55 x 10(6) M(-1) x s(-1), respectively. The intrinsic Km value for 2-deoxyglucose-6-phosphate was 24 +/- 4mM. Deamino-NADP (d-NADP) could replace NADP as coenzyme. With G6P as cosubstrate, Km d-ANADP was 23 +/- 3mM; Km for G6P remained the same as with NADP as coenzyme (122 +/- 18 microM). The catalytic efficiencies of NADP and d-ANADP (G6P as substrate) were 2.28 x 10(7) and 6.76 x 10(6) M(-1) x s(-1), respectively. Dog liver G6PD was inhibited competitively by NADPH (K(i)=12.0 +/- 7.0 microM). Low K(i) indicates tight enzyme:NADPH binding and the importance of NADPH in the regulation of the pentose phosphate pathway.


Public health emergency operations centres in Africa: a cross-sectional study assessing the implementation status of core components and areas for improvement, December 2021.
To assess implementation status of public health emergency operations centres (PHEOCs) in all countries in Africa. Cross-sectional. Fifty-four national PHEOC focal points in Africa responded to an online survey between May and November 2021. Included variables aimed to assess capacities for each of the four PHEOC core components. To assess the PHEOCs' functionality, criteria were defined from among the collected variables by expert consensus based on PHEOC operations' prioritisation. We report results of the descriptive analysis, including frequencies of proportions. A total of 51 (93%) African countries responded to the survey. Among these, 41 (80%) have established a PHEOC. Twelve (29%) of these met 80% or more of the minimum requirements and were classified as fully functional. Twelve (29%) and 17 (41%) PHEOCs that met 60%-79% and below 60% the minimum requirements were classified as functional and partially functional, respectively. Countries in Africa made considerable progress in setting up and improving functioning of PHEOCs. One-third of the responding countries with a PHEOC have one fulfilling at least 80% of the minimum requirements to operate the critical emergency functions. There are still several African countries that either do not have a PHEOC or whose PHEOCs only partially meet these minimal requirements. This calls for significant collaboration across all stakeholders to establish functional PHEOCs in Africa.


Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series.
Bevacizumab (Avastin) is a monoclonal antibody which targets all isoforms of vascular endothelial growth factor A. Its potent anti-angiogenic effects have been shown to cause regression of neovascularization in proliferative diabetic retinopathy. The aim of this study is to investigate the role of Avastin as an adjunct to vitrectomy in the management of severe diabetic eye disease. Sixteen patients (18 eyes) with severe proliferative diabetic retinopathy were recruited into the study. All eyes underwent a single intravitreal injection of bevacizumab 1.25 mg in 0.05 mL prior to vitrectomy surgery for the management of tractional retinal detachment or vitreous haemorrhage due to severe proliferative diabetic retinopathy. At 3 months, seven eyes had visual acuities which were better than baseline, four were unchanged and seven were worse. At 6 months, 14 eyes had visual acuities better than baseline, one was unchanged and three were worse. Seven of the 18 eyes (38.8%) had postoperative rebleeds, six of which required surgical washout. Avastin improved the ease of the surgery in these complex eyes and the early results are encouraging. We have found it to be particularly useful in diabetic eyes with traction detachments of short duration in which there is still active neovascularization.


The physiological cost of restricted weight bearing.
To identify the energy cost of placing restrictions on weight bearing status. Measurement of the Physiological cost index (PCI) for 11 healthy volunteers carrying out three types of mobilisation over a 100 m course in a physiology laboratory: normal walking fully weight bearing (FWB); non-weight bearing (NWB) and feather touch weight bearing (FTWB). NWB and FTWB were performed using a walking frame for support. FTWB was defined as mobilisation with the foot flat, as in normal gait, but with less than 100 N force generated through the limb. Both NWB and FTWB developed significantly greater PCI than normal walking. There was no physiological cost benefit of FTWB over NWB, p=0.67, but FTWB was perceived by all participants to be less tiring. Restricting weight bearing status significantly increases energy expenditure; the PCI. FTWB may be a more tolerable form of restricted weight bearing, although the PCI does not reflect this perception. These findings should be borne in mind when recommending such restrictions in clinical practice and encouraging a patient to mobilise early and effectively.


[Mauvais contrôle des facteurs de risque cardiovasculaire modifiables chez les patients congolais en phase aiguë et séquellaire d'un accident vasculaire cérébral : Une étude transversale].
To assess the level of the control of the cardiovascular risk factors in patients with a history of stroke in the Democratic Republic of the Congo. The level of the control of arterial hypertension, diabetes mellitus, and dyslipidemias was analyzed in two hundred and seventy-four (274) patients followed for stroke. Among 188 patients with a prior diagnosis of arterial hypertension, only 100 (53.2%) were treated, 27 (27.0%) had their blood pressure well controlled [12.3% in acute stroke vs. 46.5% in sequelae phase; p = 0.0002]. Among 42 (71.2%) diabetics treated, 23 (63.9%) had glycaemia levels > 200 mg/dl, 60.0% in acute phase and 83.3% in sequelae phase (p = 0.28). Finally, 87.0% of the patients had a non-HDL-C > 85 mg/dl. This study shows a poor control of modifiable cardiovascular risk factors in patients with very high cardiovascular risk due to stroke. There is a need for an effective program to combat non-communicable diseases in our environment.


[Digital guidelines of the twenty-first century : Requirements for the structured development, application and evaluation of medical knowledge].
Until now, clinical guidelines have been understood as generalized representations of clinical knowledge that, based on best available evidence, show the requirements for patient care in specific patient situations. This expert opinion article is intended to discuss how digital guidelines should be designed and which requirements must be met for the structured development, application and evaluation of such guidelines. The digitalization of guidelines must take into account the transformation of analogue text-based guideline information into formats that enable human-machine interaction via user interfaces, that show physicians the requirements for guideline-compliant patient care and that also enable machine storage, machine execution and machine processing of patient data.


Simulating various levels of clinical challenge in the assessment of clinical procedure competence.
Immersive simulation is increasingly used for competency assessment of emergency physicians. This group's concept of hybrid simulation (HS) (combining simulated patients and part-task trainers (a simulator that simulates a limited component of a clinical procedure) to create a multimodal clinical context) requires clinicians to integrate technical and nontechnical skills in a holistic clinical performance for assessment. It also offers the potential to provide authentic simulation of a given clinical procedure across multiple levels of challenge. The aims of this study are to systematically design and validate 2 patient-focused HS scenarios (each combining a simulated patient with a part-task simulator) for assessment of the management of a commonly encountered problem in an emergency department (ED) at different levels of clinical challenge, and to explore the effect of level of challenge of the HS scenario on physicians' performance. A simple (HS1) and a complex (HS2) HS scenario (based on the management of a patient with a traumatic skin laceration within the ED) was developed according to expert opinion through cognitive task analysis. Interns and emergency medicine residents (stratified into expert and novice groups according to experience) were recruited to participate in both scenarios. Participants were randomized to perform either the HS1 or HS2 scenario first. Participants completed a questionnaire for face validity (realism of simulation) and content validity (comprehensiveness of simulation). Performances were assessed by 2 independent raters using validated rating tools modified to the needs of this study: the Modified Objective Structured Assessment of Technical Skills-Task Specific Checklist, the Objective Structured Assessment of Technical Skills-Global Rating Score, and the Direct Observation of Procedural Skills. Ten novice and 10 expert clinicians completed both scenarios. Mean face and content validity ratings were high for both HS1 (mean 4.4 [SD 0.52] and 4.2 [SD 0.48], respectively) and HS2 scenarios (mean 4.5 [SD 0.35] and 4.3 [SD 0.43], respectively). In HS1, no difference was found between experts' and novices' Modified Objective Structured Assessment of Technical Skills-Task Specific Checklist, Objective Structured Assessment of Technical Skills-Global Rating Score, and Direct Observation of Procedural Skills ratings. Experts performed significantly better than novices in HS2 in terms of the 3 tools' ratings. Novices' Modified Objective Structured Assessment of Technical Skills-Task Specific Checklist and Direct Observation of Procedural Skills ratings were significantly worse in HS2 compared with HS1, but no difference was found with the Objective Structured Assessment of Technical Skills-Global Rating Score. No statistical difference was found in experts' Modified Objective Structured Assessment of Technical Skills-Task Specific Checklist, Objective Structured Assessment of Technical Skills-Global Rating Score, and Direct Observation of Procedural Skills ratings between HS2 and HS1 scenarios. Recreating clinical challenge is an important consideration in the design of simulation-based assessment of procedural skills of clinicians. In this study, we have demonstrated a systematic approach to developing HS scenarios, which may be able to recreate various levels of clinical challenge for purpose of assessment of procedural skills.


A new parameter for the diagnosis of hemorrhagic shock: jugular index.
The purpose of this study is to investigate whether there are any significant changes in the diameter and the area of the internal jugular vein (IJV) during the hemorrhagic shock. Healthy volunteers donating blood were included in the study. Arterial blood pressure, pulse rate, anteroposterior (AP) and transverse diameter, and area measurements of the IJV during inspiration and expiration were performed on the volunteers before and after 450 mL of blood donation. A total of 35 volunteers were enrolled in the study. The IJV prehemorrhagic AP diameters during inspiration and expiration were 4.9 ± 2.2 and 7.9 ± 3.1 mm, and the posthemorrhagic values were 2.7 ± 1.6 and 6.6 ± 3.1 mm (respectively, P < .001 and P = .007). The jugular index-AP was 36% ± 15% before hemorrhage and 58% ± 17% after hemorrhage (P < .001). The IJV areas during inspiration and expiration were 0.40 ± 0.28 and 0.81 ± 0.51 cm(2) before hemorrhage and were 0.14 ± 0.15 and 0.61 ± 0.47 cm(2) after hemorrhage (for both, P < .001). The jugular index-area was found as 47% ± 18% before hemorrhage and as 73% ± 18% after hemorrhage (P < .001). We believe that measurement of the IJV and the jugular index is a reliable indicator of class 1 hemorrhagic shock. It may be used as a part of focused abdominal sonography for trauma in clinical practice.


Effects of tributyltin at concentrations below ambient levels in seawater on Caprella danilevskii (Crustacea: Amphipoda: Caprellidae).
Hatched juveniles of Caprella danilevskii (Crustacea: Amphipoda) were exposed to one of two concentrations of tributyltin (TBT) (1.1 and 10.7 ng TBTL(-1)) for 49 d at 20 degrees C. These concentrations are near or below ambient levels in seawater. In both treatments and control, the survival rate was 100% at maturation, and >85% at the end of the experiments. Females reached maturation at 20 (median) to 21.5d at instar VII, and repeated spawning 4-5 times during the experiment. The total number of juveniles per female decreased significantly from 39.5 in the control to 24.5 and 17.5 in 1.1 ng L(-1) and 10.7 ng L(-1) treatments, respectively. An earlier study reported that as the TBT concentration in seawater increased from a 0-10 ng L(-1) regime to a 10-20 ng L(-1) regime, the number of stations where Caprella spp. could be collected decreased along the coast of the Seto Inland Sea, of Japan. Thus, the present study indicates the possibility that the extremely low concentration of TBT measured in Japanese waters after 2000 lead to a reduction in reproductive success of Caprella spp.


Orbital apex syndrome due to trigeminal perineural spread of sinonasal leprosy: a case report.
Leprosy is a granulomatous disease primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, but also significantly involving sinonasal cavities and cranial nerves. It continues to be a significant public health problem, and despite multidrug therapy, it can still cause significant morbidity. The awareness of cranial nerve, intracranial and orbital apex involvement as in our case is important for appropriate treatment measures.


Treatment response in recent-onset heart failure with reduced ejection fraction: non-ischaemic vs. ischaemic aetiology.
In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non-ischaemic than in ischaemic aetiology. Infrequent diagnostic work-up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short-term response to initiated guideline-directed medical treatment (GDMT) in recent-onset HFrEF of non-ischaemic (non-IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. Patients hospitalized with recent-onset HFrEF [left ventricular ejection fraction (LVEF) < 40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (± ≥10 unit change in LVEF, ± ≥30% change in N-terminal pro-B-type natriuretic peptide, and ± ≥1 point change in New York Heart Association functional class) during 28 weeks of follow-up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non-IHF (n = 203) vs. IHF (n = 114), patients were younger (mean age 61.0 vs. 69.4 years, P < 0.001) with lower mean LVEF (26% vs. 31%, P < 0.001), but with similar male predominance (70.4% vs. 75.4%, P = 0.363). For non-IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P < 0.001) and improved (74.2% vs. 43.9%, P < 0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51-5.74; P = 0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18-0.65; P < 0.001). In cases without previous IHD or new-onset myocardial infarction (n = 261), a decision for coronary investigation was made in 69.0%. In recent-onset HFrEF, patients with non-IHF responded better to GDMT than patients with IHF. Almost one-third of patients selected for follow-up at HF clinics were never investigated for IHD.


Stinging Insect Allergens.
Hymenoptera venom allergy is one of the common causes of anaphylaxis. However, when physicians make the diagnosis of Hymenoptera venom allergy, the history of being stung is not always consistent with the results of venom-specific IgE. With the development of component-resolved diagnosis, it is possible to accurately localize an allergic reaction to certain sensitized proteins. This paper reviewed the studies that have addressed the identified allergenicity and cross-reactivity of Hymenoptera venom allergens accepted by the WHO/IUIS Nomenclature Sub-committee, the componentresolved diagnosis of Hymenoptera venom allergy and its predictive values for the efficacy and safety of venom immunotherapy. Also special attention was paid to the spread of Hymenoptera venom allergy in Asian countries.


Effects of straw and biochar amendment on hydrological fluxes of dissolved organic carbon in a subtropical montane agricultural landscape.
Straw and biochar amendments have been shown to increase soil organic carbon (SOC) stocks in arable land; however, their effects on hydrological fluxes of dissolved organic carbon (DOC), which may offset the benefits of C sequestration amounts remain uncertain. Therefore, we conducted a three-year field study that included four treatments (CK, control with no fertilizer; NPK, synthetic N fertilizer; RSDNPK, synthetic N fertilizer plus crop residues; BCNPK, synthetic N fertilizer plus biochar of crop straw) to investigate the effects of straw and biochar amendment on DOC losses through hydrological pathways of overland flow and interflow from a wheat-maize rotation system in the subtropical montane agricultural landscape. We detected substantial intra- and inter-annual variations in runoff discharge, DOC concentration, and DOC fluxes for both overland flow and interflow pathways, which were primarily attributed to variations in rainfall amount and intensity. On average, the DOC concentrations for interflow (2.98 mg C L-1) were comparable with those for overland flow (2.71 mg C L-1) throughout the three-year experiment. However, average annual DOC fluxes for interflow were approximately 2.60 times greater than those for overland flow, which probably related to higher runoff discharges of interflow than overland flow. Compared to the control, on average, the N fertilization treatments significantly decreased the annual DOC fluxes of overland flow and significantly increased annual DOC fluxes of interflow. Relative to the application of synthetic N fertilizer only, on average, crop straw amendment practice significantly increased annual DOC fluxes of interflow by 28.7%, while decreasing annual DOC fluxes of overland flow by 12.0%; in contrast, biochar amendment practice decreased annual DOC fluxes of interflow by 25.3% while increasing annual DOC fluxes of overland flow by 44.6%. Overall, considering both overland flow and interflow, crop straw amendment significantly increased hydrological DOC fluxes, whereas biochar had no significant effects on hydrological DOC fluxes throughout the three-year experiment. We conclude that crop straw incorporation strategies that aim to increase SOC stocks may enhance hydrological losses of DOC, thereby in turn offsetting its benefits in the subtropical montane agricultural landscapes.


Kainic acid: enduring alterations in cerebellar morphology and in cerebral catecholamine and GABA concentrations after cerebellar injection in the rat.
Kainic acid injected locally in the vermian cortex produces a focal lesion with severe cellular loss. Microscopic changes in 3-week-old preparations are given for both central and peripheral segments. Biochemical studies indicate that norepinephrine, dopamine and gamma-aminobutyric acid (gaba) concentrations in the forebrain are consistently higher on the side of the lesion and remain elevated for at least 3 weeks. It is postulated that disinhibition of cerebellar activity traversing the uncrossed pathway from cerebellar nuclei to catecholamine cell bodies was a major mechanism causing increased catecholamine metabolism in the ipsilateral forebrain.


Determination of metal ion contents of two antiemetic clays use in Geophagy.
Nausea is usually associated with early to late stages of pregnancy. Geophagy-deliberate consumption of soil is a common method of managing gravidae-induced discomfort. To control nausea, pregnant women in Nigeria commonly eat baked clay called "Eko" and another type of clay that induces buccal constriction called "Omumu". The metal contents in Eko and Omumu, digested under different pH conditions (acidic, alkaline and neutral), were investigated using Inductively Coupled Plasma Optical Emission Spectroscopy (ICPS-OES). We identified and quantitate the elements present and speculate on their potential impact on maternal and fetal health upon gestational exposure beyond the acceptable exposure levels and the Millennium Contaminant Level Goals (MCLG) set by the United States Environmental Protection Agency (USEPA). Specifically, our result indicates unacceptably high levels of aluminum in Eko and Omumu (>10-fold greater than the highest desirable levels set by the USEPA). The aluminum concentrations were influenced by the pH condition in which the samples were digested. Dietary exposure to aluminum at such high levels may be deleterious to maternal health and fetal development. Therefore consumption of Eko and Omumu as an antidote to reduce nausea during pregnancy should be discouraged. Future studies are planned to investigate specific impacts on fetal and maternal health and likely teratogenicity in rodent models.


Prone positioning in acute respiratory distress syndrome.
The ultimate efficacy of prone positioning in ARDS is difficult to evaluate because of heterogeneous study populations, the variances in the duration of the prone position, and the small sample sizes used in most studies. Prone positioning offers an easy, readily available treatment option for refractory hypoxemia. Although there is a rationale supporting the hypothesis that prone ventilation could reduce the mortality of ARDS patients, currently there are insufficient clinical data to support this hypothesis.


Synergistic effect of CART (cocaine- and amphetamine-regulated transcript) peptide and cholecystokinin on food intake regulation in lean mice.
CART (cocaine- and amphetamine-regulated transcript) peptide and cholecystokinin (CCK) are neuromodulators involved in feeding behavior. This study is based on previously found synergistic effect of leptin and CCK on food intake and our hypothesis on a co-operation of the CART peptide and CCK in food intake regulation and Fos activation in their common targets, the nucleus tractus solitarii of the brainstem (NTS), the paraventricular nucleus (PVN), and the dorsomedial nucleus (DMH) of the hypothalamus. In fasted C57BL/6 mice, the anorexigenic effect of CART(61-102) in the doses of 0.1 or 0.5 microg/mouse was significantly enhanced by low doses of CCK-8 of 0.4 or 4 microg/kg, while 1 mg/kg dose of CCK-A receptor antagonist devazepide blocked the effect of CART(61-102) on food intake. After simultaneous administration of 0.1 microg/mouse CART(61-102) and of 4 microg/kg of CCK-8, the number of Fos-positive neurons in NTS, PVN, and DMH was significantly higher than after administration of each particular peptide. Besides, CART(61-102) and CCK-8 showed an additive effect on inhibition of the locomotor activity of mice in an open field test. The synergistic and long-lasting effect of the CART peptide and CCK on food intake and their additive effect on Fos immunoreactivity in their common targets suggest a co-operative action of CART peptide and CCK which could be related to synergistic effect of leptin on CCK satiety.


Modeling neocortical areas with a modular neural network.
The modular organization of neocortex has been speculated to have a role in the operation of memory retrieval. By introducing two modifications in the model considered by O'Kane and Treves (1992a, J. Phys. A: Math. Gen.), we have been able to increase the storage load limit and to destabilize the memory-glass states that marred the memory operation of the original model. The two modifications, a sparse rather than complete activation of cortical modules and a correlation between the patterns of activation and the underlying connectivity, are both consistent with available evidence.


Comparative proteomic analysis of two divergent strains provides insights into thermotolerance mechanisms of Ganoderma lingzhi.
Heat stress (HS) is a major abiotic factor influencing fungal growth and metabolism. However, the genetic basis of thermotolerance in Ganoderma lingzhi (G. lingzhi) remains largely unknown. In this study, we investigated the thermotolerance capacities of 21 G. lingzhi strains and screened the thermo-tolerant (S566) and heat-sensitive (Z381) strains. The mycelia of S566 and Z381 were collected and subjected to a tandem mass tag (TMT)-based proteome assay. We identified 1493 differentially expressed proteins (DEPs), with 376 and 395 DEPs specific to the heat-tolerant and heat-susceptible genotypes, respectively. In the heat-tolerant genotype, upregulated proteins were linked to stimulus regulation and response. Proteins related to oxidative phosphorylation, glycosylphosphatidylinositol-anchor biosynthesis, and cell wall macromolecule metabolism were downregulated in susceptible genotypes. After HS, the mycelial growth of the heat-sensitive Z381 strain was inhibited, and mitochondrial cristae and cell wall integrity of this strain were severely impaired, suggesting that HS may inhibit mycelial growth of Z381 by damaging the cell wall and mitochondrial structure. Furthermore, thermotolerance-related regulatory pathways were explored by analyzing the protein-protein interaction network of DEPs considered to participate in the controlling the thermotolerance capacity. This study provides insights into G. lingzhi thermotolerance mechanisms and a basis for breeding a thermotolerant germplasm bank for G. lingzhi and other fungi.


Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score.
Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units. We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC. Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/- 0.297 (p < 0.001) after validation in the VC. Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.


Proteomic Analysis on Sequential Samples of Cystic Fluid Obtained from Human Brain Tumors.
Cystic formation in human primary brain tumors is a relatively rare event whose incidence varies widely according to the histotype of the tumor. Composition of the cystic fluid has mostly been characterized in samples collected at the time of tumor resection and no indications of the evolution of cystic content are available. We characterized the evolution of the proteome of cystic fluid using a bottom-up proteomic approach on sequential samples obtained from secretory meningioma (SM), cystic schwannoma (CS) and cystic high-grade glioma (CG). We identified 1008 different proteins; 74 of these proteins were found at least once in the cystic fluid of all tumors. The most abundant proteins common to all tumors studied derived from plasma, with the exception of prostaglandin D2 synthase, which is a marker of cerebrospinal fluid origin. Overall, the protein composition of cystic fluid obtained at different times from the same tumor remained stable. After the identification of differentially expressed proteins (DEPs) and the protein-protein interaction network analysis, we identified the presence of tumor-specific pathways that may help to characterize tumor-host interactions. Our results suggest that plasma proteins leaking from local blood-brain barrier disruption are important contributors to cyst fluid formation, but cerebrospinal fluid (CSF) and the tumor itself also contribute to the cystic fluid proteome and, in some cases, as with immunoglobulin G, shows tumor-specific variations that cannot be simply explained by differences in vessel permeability or blood contamination.


The aquatic carnivorous plant Aldrovanda vesiculosa (Droseraceae) exhibits altered developmental stages in male gametophyte.
Aldrovanda vesiculosa (Droseraceae) is a rare aquatic carnivorous plant, distributed in Europe, Asia, Africa, and Australia. Aldrovanda populations can flower prolifically under favourable conditions, but seed set is very limited. We studied the structure of Aldrovanda pollen collected from flowers in different developmental stages (opened and non-opened anthers) from both European and Australian populations to elucidate pollination traits and the basis of poor seed set on the basis of microscopic observation of pollen and anther structure. Microscopic analyses of Aldrovanda pollen showed that this plant has pollen arranged in tetrads like other species in the Droseraceae family. In hydrated pollen, cytoplasmic protrusions originate from pores located along the equatorial wall of monads, and can develop into pollen tubes. Interestingly, pollen development from microspores occurs in open anthers, suggesting a delay of the developmental stages. In addition, pollen development displays altered sperm cell formation and precocious pollen germination. Precocious germination may characterize recalcitrant pollen, which naturally do not undergo dehydration before anthesis and remain partially hydrated, particularly in aquatic and wetland plants. These alterations of male gametophyte development could affect fertilization processes, and be the reason for the low reproductive capability of Aldrovanda observed both in the field and in cultures. Generally, reduced pollen longevity and very quick germination are considered an adaptation to aquatic or wet environments.


Effect of aspirin and heparin on random skin flap survival in rats.
Aspirin and heparin are commonly given to patients undergoing microvascular procedures to increase flap survival and patency, yet there is scant information concerning the effect these flaps have on nonmicrovascular flaps. The objective was to obtain baseline values concerning the effect of aspirin and heparin on the viability of standardized flap tissues. One hundred rats were divided into five groups receiving high-dose aspirin, low-dose aspirin, high-dose aspirin in combination with heparin, and heparin alone and the final group were controls. The viability of the tissue was measured at 1 week by fluorescein fluorescence. There was significant improvement in flap survival in the high-dose aspirin and high-dose aspirin combination groups. It appears that high-dose aspirin increases survival of ischemic flap tissue irrespective of the presence of microvascular anastomosis and may be of clinical benefit in all flap surgery. The authors have indicated no significant interest with commercial supporters.


Biomimetic piezoelectric quartz crystal sensor with chloramphenicol-imprinted polymer sensing layer.
The measurement of banned antibiotic like chloramphenicol is significant for customer protection and safety. The presence of residual antibiotics in foods and food products of animal origin could pose as health hazards and affect food quality for global acceptance. In this study, the potential of a chloramphenicol sensor based on molecularly imprinted polymer (MIP) coupled with a piezoelectric quartz crystal was explored. The MIP was prepared by precipitation polymerization at 60 °C. Methacrylic acid was used as monomer, trimethylolpropane trimethacrylate (TRIM) as crosslinker, and chloramphenicol as the template. Template removal on the resulting polymer was done by extraction using methanol-acetic acid. Characterization of the MIP and NIP were conducted by spectroscopic and microscopic methods. These further supported the imprinting and rebinding process of chloramphenicol to the polymer matrix. The chloramphenicol sensor was devised by spin-coating onto one side of the 10 MHz AT-cut quartz crystal the MIP suspension in polyvinylchloride-tetrahydrofuran (6:2:1 w/w/v) solution. Optimization of sensor response was performed by varying the type of cross-linker, amount of MIP sensing layer, curing time, and pH. The sensor exhibited good sensitivity of about 73 Hz/log (conc., µg mL(-1)) and good repeatability (rsd<10%). A linear relationship (r(2)=0.9901) between frequency shift and chloramphenicol concentration in the range of 1×10(-6) up to 1×10(-1) µg/mL was obtained. The sensor response was highly selective to chloramphenicol than with other compounds of similar chemical structures. Acceptable percent recovery was obtained for real sample analysis using the sensor. The proposed sensor could be a promising low cost and highly sensitive approach for residual chloramphenicol quantification in food products.


Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade?
We compared hemiarthroplasty (HA) and total shoulder replacement (TSR) for the treatment of osteoarthritis at minimum of 10 years from primary arthroplasty. Thirty-three patients (13 HA and 20 TSR) were intraoperatively randomized to HA or TSR after glenoid exposure and were assessed to a minimum of 10 years postoperatively. Apart from those who died, no patients were lost to follow-up. At 6 months and 1 year, the TSR patients had less pain than the HA patients (P < .05), and this became more apparent at 2 years postoperatively (P < .02). There were no statistically significant differences between the groups at 10 years with respect to pain, function, and daily activities. No patients in the HA group rated their shoulders as pain-free at 10 years; however, 42% of the surviving TSR patients rated their shoulders as pain-free at 10 years. Four HA patients were revised to TSR due to severe pain secondary to glenoid erosion. Two shoulders in the TSR group have been revised. Nine of the 13 HA patients (69%) and 18 of the 20 TSR patients (90%) remained in situ at death or at the 10-year review. TSR has advantages over HA with respect to pain and function at 2 years, and there has not been a reversal of the outcomes on longer follow-up. This longer-term review does not support the contention that HA will avoid later TSR complications, and in particular, an unacceptable rate of glenoid component failure.


The Cooperative Lifestyle Intervention Program-II (CLIP-II): design and methods.
A complication of cardiovascular disease (CVD) and the metabolic syndrome (MetS) among older adults is loss of mobility. The American Heart Association has identified weight management as a core component of secondary prevention programs for CVD and is an important risk factor for physical disability. The American Society for Nutrition and the Obesity Society have highlighted the need for long-term randomized clinical trials to evaluate the independent and additive effects of diet-induced weight loss (WL) and physical activity in older persons on outcomes such as mobility, muscle function, and obesity related diseases. Here we describe the rationale, design, and methods of a translational study, the Cooperative Lifestyle Intervention Program-II (CLIP-II). CLIP-II will randomize 252 obese, older adults with CVD or MetS to a weight loss only treatment (WL), aerobic exercise training (AT)+WL, or resistance exercise training (RT)+WL for 18 months. The dual primary outcomes are mobility and knee extensor strength. The interventions will be delivered by YMCA community partners with our staff as trainers and advisers. This study will provide the first large scale trial to evaluate the effects of diet-induced WL on mobility in obese, older adults with CVD or MetS as compared to WL combined with two different modes of physical activity (AT and RT). Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and RT+WL on muscle strength.


Socio-economic status and major trauma in a Scandinavian urban city: A population-based case-control study.
Epidemiological studies of patients with major trauma, including both hospitalized and immediately deceased whom are undergoing medico-legal autopsy, are very rare. We studied the incidence and mortality of major trauma in all 10 districts in the Scandinavian city of Malmö, Sweden, and the association between socio-economic status and major trauma. Major trauma was defined as a New Injury Severity Score > 15, or a lethal outcome due to trauma. Cases with a registration address in Malmö between 1 January 2011 and 31 December 2013 were identified from the red trauma alarm list in the hospital and the autopsy register in the Forensic Department. Statistics Sweden matched each case with four randomly selected age-, gender- and district-matched controls. Social assistance within the household, level of education, income and capital income were compared. We identified 117 cases (80 men and 37 women) with a median age of 48.0 years (IQR 28.5-65.0). The incidence of major trauma in Malmö was 12.7 (95% CI 10.4-15.0) per 100,000 person-years; and 69 died due to major trauma, with 8.4 (95% CI 6.4-10.4) per 1000 deaths. Lower income (p = 0.024), no income (OR 1.6; 95% CI 1.0-2.4; p = 0.037) and social assistance (OR 2.3; 95% CI 1.3-4.1; p = 0.003) were associated with major trauma. The level of education was not found to be related to major trauma (p = 0.47). Low income and social assistance within the household were associated with major trauma in the city of Malmö, but not the level of education; in this age-, gender- and district-matched case-control study of major trauma.


Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.
Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.


A statistical model investigating the prevalence of tuberculosis in New York City using counting processes with two change-points.
We considered a Bayesian analysis for the prevalence of tuberculosis cases in New York City from 1970 to 2000. This counting dataset presented two change-points during this period. We modelled this counting dataset considering non-homogeneous Poisson processes in the presence of the two-change points. A Bayesian analysis for the data is considered using Markov chain Monte Carlo methods. Simulated Gibbs samples for the parameters of interest were obtained using WinBugs software.


COL6A1 mutation leading to Bethlem myopathy with recurrent hematuria: a case report.
Collagen VI-related myopathies are a spectrum of muscular diseases with features of muscle weakness and atrophy, multiple contractures of joints, distal hyperextensibility, severe respiratory dysfunction and cutaneous alterations, attributable to mutations in the COL6A1, COL6A2, and COL6A3 genes. However, no case of collagen VI mutations with hematuria has been reported. We report a 14-year-old boy who had both Bethlem myopathy and recurrent hematuria and who carried a known de novo COL6A1 missense mutation c.877G > A (p.G293R). The patient was a 14-year-old boy presenting with muscle weakness from 3 years of age without any family history. Six months before admission, he developed recurrent gross hematuria, three bouts in total, with the presence of blood clots in the urine. Next-generation sequencing of his whole-exome was performed. The result of sequencing revealed a de novo heterozygous G-to-A nucleotide substitution at position 877 in exon 10 of the COL6A1 gene. After treatment, the hematuria healed, but the muscle weakness failed to improve. Hematuria in Bethlem myopathy can be caused by COL6 mutations, which may be related to the aberrant connection between collagen VI and collagen IV.


Feature selection for global tropospheric ozone prediction based on the BO-XGBoost-RFE algorithm.
Ozone is one of the most important air pollutants, with significant impacts on human health, regional air quality and ecosystems. In this study, we use geographic information and environmental information of the monitoring site of 5577 regions in the world from 2010 to 2014 as feature input to predict the long-term average ozone concentration of the site. A Bayesian optimization-based XGBoost-RFE feature selection model BO-XGBoost-RFE is proposed, and a variety of machine learning algorithms are used to predict ozone concentration based on the optimal feature subset. Since the selection of the underlying model hyperparameters is involved in the recursive feature selection process, different hyperparameter combinations will lead to differences in the feature subsets selected by the model, so that the feature subsets obtained by the model may not be optimal solutions. We combine the Bayesian optimization algorithm to adjust the parameters of recursive feature elimination based on XGBoost to obtain the optimal parameter combination and the optimal feature subset under the parameter combination. Experiments on long-term ozone concentration prediction on a global scale show that the prediction accuracy of the model after Bayesian optimized XGBoost-RFE feature selection is higher than that based on all features and on feature selection with Pearson correlation. Among the four prediction models, random forest obtained the highest prediction accuracy. The XGBoost prediction model achieved the greatest improvement in accuracy.


Understanding the Process of Procedural Sedation for Orthopedic Injuries in the Pediatric Emergency Department.
To establish a procedural sedation (PS) time line for patients in the pediatric emergency department (PED) with orthopedic injuries. Retrospective review of patients requiring PS for orthopedic injuries. Process times were collected. Ten percent of encounters were co-reviewed. Interrater reliability and descriptive statistics were calculated. A total of 189 patients were included. Co-abstracted data demonstrated excellent agreement. The median time to PS and length of stay (LOS) were 214 (interquartile range [IQR]: 160-282) and 320 (IQR: 257-402) minutes, respectively. Patients with orthopedic injuries requiring PS experience prolonged PED visits. Interventions should target safely reducing the time to PS and LOS.