Blood spinal cord barrier disruption recovers in patients with degenerative cervical myelopathy after surgical decompression: a prospective cohort study.
The pathophysiology of degenerative cervical myelopathy (DCM) is characterized by chronic compression-induced damage to the spinal cord leading to secondary harm such as disruption of the blood spinal cord barrier (BSCB). It is therefore the purpose of this study to analyze BSCB disruption in pre- and postoperative DCM patients and to correlate those with the clinical status and postoperative outcome. This prospectively controlled cohort included 50 DCM patients (21 female; 29 male; mean age: 62.9 ± 11.2 years). As neurological healthy controls, 52 (17 female; 35 male; mean age 61.8 ± 17.3 years) patients with thoracic abdominal aortic aneurysm (TAAA) and indication for open surgery were included. All patients underwent a neurological examination and DCM-associated scores (Neck Disability Index, modified Japanese Orthopaedic Association Score) were assessed. To evaluate the BSCB status, blood and cerebrospinal fluid (CSF) samples (lumbar puncture or CSF drainage) were taken preoperatively and in 15 DCM patients postoperatively (4 female; 11 male; mean age: 64.7 ± 11.1 years). Regarding BSCB disruption, CSF and blood serum were examined for albumin, immunoglobulin (Ig) G, IgA and IgM. Quotients for CSF/serum were standardized and calculated according to Reiber diagnostic criteria. Significantly increased preoperative CSF/serum quotients were found in DCM patients as compared to control patients: AlbuminQ (p < .001), IgAQ (p < .001) and IgGQ (p < .001). IgMQ showed no significant difference (T = - 1.15, p = .255). After surgical decompression, neurological symptoms improved in DCM patients, as shown by a significantly higher postoperative mJOA compared to the preoperative score (p = .001). This neurological improvement was accompanied by a significant change in postoperative CSF/serum quotients for Albumin (p = .005) and IgG (p = .004) with a trend of a weak correlation between CSF markers and neurological recovery. This study further substantiates the previous findings, that a BSCB disruption in DCM patients is evident. Interestingly, surgical decompression appears to be accompanied by neurological improvement and a reduction of CSF/serum quotients, implying a BSCB recovery. We found a weak association between BSCB recovery and neurological improvement. A BSCB disruption might be a key pathomechanism in DCM patients, which could be relevant to treatment and clinical recovery.


Analysis of expressed sequence tags from biodiesel plant Jatropha curcas embryos at different developmental stages.
Jatropha curcas is considered a potential biodiesel feedstock plant whose seeds contain up to 40% oil. However, little is currently known about the seed biology of Jatropha. Therefore, it would be valuable to understand the mechanisms of development and lipid metabolism in Jatropha seeds. In the present study, three cDNA libraries were constructed with mRNA from Jatropha embryos at different stages of seed development. A total of 9844 expressed sequence tags (ESTs) were produced from these libraries, from which 1070 contigs and 3595 singletons were obtained. One hundred and seven unigenes were found to be differentially expressed in the three cDNA libraries of Jatropha embryos, indicating that these genes may play key roles in seed development. We have identified 59 and 61 unigenes that might be involved in the development and lipid metabolism in Jatropha seeds, respectively. Some of these genes may also play important roles in embryogenesis, morphogenesis, defense response and adaptive mechanisms in plants.


Surgical excision of a broad-based left atrial myxoma: report of a case.
We report herein the case of a 72-year-old woman who underwent successful resection of an unusual type of broad-based left atrial myxoma. The tumor, which was attached to the fossa ovalis and anterior wall of the left atrium posterior to the aorta, was resected en bloc with the interatrial septum and the affected free wall of the left atrium. The defect in the left atrium and atrial septum was then reconstructed with an equine pericardial patch. To our knowledge, this type of cardiac myxoma, with a base extending from the septum to the atrial wall, has not been previously reported.


Human hepatocyte transplantation for acute liver failure: state of the art and analysis of cell sources.
Liver transplantation is the only treatment available for acute liver failure. However, mortality rates remain high because of the shortage of donor organs. Indeed up to 20% of patients with acute liver failure may survive without transplantation. In the last two decades, research has focused on the development of alternative or supportive measures to deal with acute liver failure; one of the most studied is hepatocyte transplantation, because it is thought that the function of the liver can only be replaced with a biological substrate characterized by functioning liver cells. Hepatocyte transplantation has been successful in many animal models of acute liver failure, although only several clinical attempts have been made in humans with encouraging but not yet convincing results, mainly because of the lack of a reliable source of live liver cells. Allogenic and xenogenic fresh or cryopreserved hepatocytes have been tested. Recent research has focused on fetal hepatocytes and progenitor liver cells of both hepatic and bone marrow origin. The ability to preserve and bank human hepatocytes would allow pooling of cells from multiple donors to increase the numbers for transplantation. The development of a reliable and large-scale available source of live liver cells would probably have a major impact on the introduction of hepatocyte transplantation in clinical practice.


On texture, form, and fixational eye movements.
Recent studies show that small movements of the eye that occur during fixation are controlled in the brain by similar neural mechanisms as large eye movements. Information theory has been successful in explaining many properties of large eye movements. Could it also help us understand the smaller eye movements that are much more difficult to study experimentally? Here I describe new predictions for how small amplitude fixational eye movements should be modulated by visual context in order to improve visual perception. In particular, the amplitude of fixational eye movements is predicted to differ when localizing edges defined by changes in texture or luminance.


Achromatic and chromatic contrast discrimination in patients with type 2 diabetes.
Effects of type 2 diabetes on achromatic and chromatic contrast sensitivity (CS) are still controversial. In this study, we aimed to investigate CS in patients without diabetic retinopathy (no-DR) and in those with non-proliferative DR (NPDR) and proliferative DR (PDR) using psychophysical methods with transient and sustained achromatic stimuli and color patches. Achromatic CS was measured with the pulsed pedestal (PP) paradigm (7, 12, and 19 cd/m2) and pedestal-△-pedestal (P-△-P) paradigm (11.4, 18, and 28.5 cd/m2). A chromatic discrimination paradigm that assesses protan, deutan, and tritan color vision was adopted. Forty-two patients (no-DR n = 24, NPDR n = 12, PDR = 6; male n = 22, mean age = 58.1 y/o) and 38 controls (male n = 18, mean age = 53.4 y/o) participated. In patients, mean thresholds were higher than in controls and linear trends were significant in most conditions. For the PP paradigm, differences were significant in the PDR and NPDR groups in the 7 and 12 cd/m2 condition. For the P-△-P paradigm, differences were only significant in the PDR group in the 11 cd/m2 condition. Chromatic contrast loss was significant in the PDR group along the protan, deutan and tritan axes. The results suggest independent involvements of achromatic and chromatic CS in diabetic patients.


Thermosensitivity of dorsal raphe neurons in vitro.
Thermosensitivity of raphe neurons was studied in tissue slices of rat brainstems (400-500 micron). Measurement of activity of single cells in the dorsal raphe region of the slices revealed that the majority of neurons (89%) were sensitive to changes in temperature. Over the range 34 to 42 degrees C, 3 classes of thermosensitive cells were found: warm (61%), cold (15%) and biphasic type cells (13%). Many dorsal raphe neurons may be intrinsically temperature sensitive and may serve as extrahypothalamic thermodetector components in the integrative process of central thermoregulation.


A label-free biosensor for DNA detection based on ligand-responsive G-quadruplex formation.
A facile and label-free assay with label-free molecular beacons (MBs) and fluorescent dye N-methyl mesoporphyrin IX (NMM) was developed for the detection of specific single-stranded DNA sequences. It was demonstrated by a reverse transcription oligonucleotide sequence (target DNA, 20 bases) of RNA fragment of human immunodeficiency virus (HIV) as model systems. In the absence of target DNA, the MBs were in the stem-closed form, the G-quadruplex structure could not form and the fluorescence signal of NMM was very low. In the presence of target DNA the MBs turned "Off" to "On", thus promoting the formation of G-quadruplex which could greatly enhance the fluorescence of NMM. This biosensor was simple in design, fast in operation, and more convenient and promising than other methods. It took less than 30 min to finish and its detection limit was 1.4 nM. No sophisticated experimental techniques or chemical modification for DNA sequences were required. This new approach could be widely applied to sensitive and selective nucleic acids detection.


An illustration of variable precision rough set theory: the gender classification of the European barn swallow (Hirundo rustica).
This paper introduces a new technique in the investigation of object classification and illustrates the potential use of this technique for the analysis of a range of biological data, using avian morphometric data as an example. The nascent variable precision rough sets (VPRS) model is introduced and compared with the decision tree method ID3 (through a 'leave n out' approach), using the same dataset of morphometric measures of European barn swallows (Hirundo rustica) and assessing the accuracy of gender classification based on these measures. The results demonstrate that the VPRS model, allied with the use of a modern method of discretization of data, is comparable with the more traditional non-parametric ID3 decision tree method. We show that, particularly in small samples, the VPRS model can improve classification and to a lesser extent prediction aspects over ID3. Furthermore, through the 'leave n out' approach, some indication can be produced of the relative importance of the different morphometric measures used in this problem. In this case we suggest that VPRS has advantages over ID3, as it intelligently uses more of the morphometric data available for the data classification, whilst placing less emphasis on variables with low reliability. In biological terms, the results suggest that the gender of swallows can be determined with reasonable accuracy from morphometric data and highlight the most important variables in this process. We suggest that both analysis techniques are potentially useful for the analysis of a range of different types of biological datasets, and that VPRS in particular has potential for application to a range of biological circumstances.


Impact of increasing Ultraviolet-B (UV-B) radiation on photosynthetic processes.
Increased UV-B radiation on the earth's surface due to depletion of stratospheric ozone layer is one of the changes of current climate-change pattern. The deleterious effects of UV-B radiation on photosynthesis and photosynthetic productivity of plants are reviewed. Perusal of relevant literature reveals that UV-B radiation inflicts damage to the photosynthetic apparatus of green plants at multiple sites. The sites of damage include oxygen evolving complex, D1/D2 reaction center proteins and other components on the donor and acceptor sides of PS II. The radiation inactivates light harvesting complex II and alters gene expression for synthesis of PS II reaction center proteins. Mn cluster of water oxidation complex is the most important primary target of UV-B stress whereas D1 and D2 proteins, quinone molecules and cytochrome b are the subsequent targets of UV-B. In addition, photosynthetic carbon reduction is also sensitive to UV-B radiation which has a direct effect on the activity and content of Rubisco. Some indirect effects of UV-B radiation include changes in photosynthetic pigments, stomatal conductance and leaf and canopy morphology. The failure of protective mechanisms makes PS II further vulnerable to the UV-B radiation. Reactive oxygen species are involved in UV-B induced responses in plants, both as signaling and damaging agents. Exclusion of ambient UV components under field conditions results in the enhancement of the rate of photosynthesis, PS II efficiency and subsequently increases the biomass accumulation and crop yield. It is concluded that predicted future increase in UV-B irradiation will have significant impact on the photosynthetic efficiency and the productivity of higher plants.


Mechanical stress induces bone formation in the maxillary sinus in a short-term mouse model.
Clinicians occasionally face the challenge of moving a tooth through the maxillary sinus. The objective of this study was to evaluate tissue remodeling during tooth movement into the maxillary sinus, more specifically as regards to bone formation. The maxillary first molar of 20 male mice was moved toward the palatal side by a nickel-titanium super elastic wire for 1 to 14 days, and the bone remodeling around the root was evaluated using histomorphometry and immunodetection of bone-restricted Ifitm-like (Bril) protein, a novel marker of active bone formation. When mechanical stress was applied to the tooth, the periodontal ligament on the palatal side was immediately compressed to approximately half of its original width by the tipping movement of the tooth. At the same time, osteoblasts deposited new bone on the wall of the maxillary sinus prior to bone resorption by osteoclasts on the periodontal side, as evidenced by the high level of expression of Bril at this site. As a result of these sequential processes, bone on the sinus side maintained a consistent thickness during the entire observation period. No root resorption was observed. Bone formation on the surface of the maxillary sinus was evoked by mechanotransduction of mechanical stress applied to a tooth over a 2-week period, and was induced ahead of bone resorption on the periodontal ligament side. Mechanical stress can be exploited to induce bone formation in the maxillary sinus so that teeth can be moved into the sinus without losing bone or causing root damage.


Identification of a novel ENG gene mutation (c.1550_1551dupTG, p.S518*) in a Chinese family with hereditary hemorrhagic telangiectasia.
It is very important to diagnose Hereditary hemorrhagic telangiectasia (HHT) early through appropriate screening and preventive treatment of a patient and their affected family members. This study aimed to report on a case of a Chinese family with heterozygous ENG-related HHT. Gene mutations were identified by whole-exome sequencing and physical examination were conducted to reveal the clinical symptoms. Physical examination revealed symptomatic anaemia, coagulation system disorder and multiple red or pink spots reflecting telangiectases on the eyelids, tongue, palate and nasal cavity. Nine other affected relatives were identified in examining his family tree, among which three family members had died due to nose bleeding and one member presented symptomatic anaemia requiring blood transfusions. A novel heterozygous variation c.1550_1551dupTG (p.S518*) in ENG gene was identified. The patient and his daughter were confirmed to have heterozygous ENG-related HHT and the novel ENG heterozygous variant may play an important role on the severe symptoms of HHT. However, further case follow-up and functional studies should be conducted to confirm these mechanismal hypotheses.


Effect of zinc supplementation on zinc status, copper status and cellular immunity in elderly patients with diabetes mellitus.
This preliminary study was to investigate the effects of zinc supplementation on Zn status, Cu status, serum macrominerals and lymphocyte subsets in elderly diabetic patients. The results of Zn supplementation can correct plasma Zn levels to normal values. However, this treatment did not affect the cellular Zn, copper status and serum macrominerals. Enhancement of the percentage of CD4 cells was observed after Zn therapy but had no effect on the percentage of CD8 cells and CD4/CD8 ratios. Our finding implicated that zinc supplementation might be useful to enhance the immune status in these patients.


Wolbachia and its influence on the pathology and immunology of Dirofilaria immitis infection.
Since the definitive identification in 1995 of the bacterial endosymbiont Wolbachia that resides in different tissues of the filarial worm Dirofilaria immitis, there has been increasing interest to understand whether and what role it plays in the pathogenesis of and immune response to heartworm infection. The present study evaluated the effects of treatments on lung pathology in 20 beagle dogs experimentally infected with D. immitis. Dogs in Group 1 were treated with doxycycline (10 mg/kg/day) orally from weeks 0-6, 10-12, 16-18, 22-26, and 28-34. Dogs in Group 2 served as infected, non-treated controls. Dogs in Group 3 were given doxycycline as described for Group 1 combined with weekly oral doses of ivermectin (6 mcg/kg) for 34 weeks and intramuscular (IM) melarsomine (2.5 mg/kg) at week 24, followed by two additional melarsomine injections 24h apart 1 month later. Group 4 received only melarsomine as described for Group 3. Lung lesion criteria, scored by two independent blinded pathologists, included perivascular inflammation and endothelial proliferation. Doxycycline treatment alone had no effect on lesion scores, whereas the combination of doxycycline and ivermectin resulted in less severe perivascular inflammation. All lungs were evaluated for positive immunostaining for the Wolbachia surface protein (WSP). Control dogs showed numerous thrombi, intense perivascular and interstitial inflammation and, occasionally, positive staining for WSP. Interestingly, dogs receiving doxycycline/ivermectin/melarsomine showed significantly less severe arterial lesions and the virtual absence of thrombi.


Artificial neural networks improve the prediction of Kt/V, follow-up dietary protein intake and hypotension risk in haemodialysis patients.
Artificial neural networks (ANN) represent a promising alternative to classical statistical and mathematical methods to solve multidimensional non-linear problems. The aim of the study was to compare the performance of ANN in predicting the dialysis quality (Kt/V), the follow-up dietary protein intake and the risk of intradialytic hypotension in haemodialysis patients with that predicted by experienced nephrologists. A combined retrospective and prospective observational study was performed in two Swiss dialysis units (80 chronic haemodialysis patients, 480 monthly clinical observations and biochemical test results). Using mathematical models based on linear and logistic regressions as background, ANN were built and then prospectively compared with the ability of six experienced nephrologists to predict the Kt/V and the follow-up protein catabolic rate (PCR) and to detect a Kt/V < 1.30, a follow-up PCR < 1.00 g/kg/day and the occurrence of hypotension. ANN compared with nephrologists gave a more accurate correlation between estimated and calculated Kt/V and follow-up PCR (P<0.001). The same superiority of ANN was also seen in the ability to detect a Kt/V < 1.30, a follow-up PCR < 1.00 g/kg/day and the occurrence of hypotension expressed as a percentage of correct answers, sensitivity, specificity and predictivity. The use of ANN significantly improves the ability of experienced nephrologists to estimate the Kt/V and the follow-up PCR and to detect a Kt/V < 1.30, a follow-up PCR < 1.00 g/kg/day and the occurrence of intradialytic hypotension.


Halo pin positioning in the temporal bone; parameters for safe halo gravity traction.
Halo gravity traction (HGT) is increasingly used pre-operatively in the treatment of children with complex spinal deformities. However, the design of the current halo crowns is not optimal for that purpose. To prevent pin loosening and to avoid visual scars, fixation to the temporal area would be preferable. This study aims to determine whether this area could be safe for positioning HGT pins. A custom made traction setup plus three human cadaver skulls were used to determine the most optimal pin location, the resistance to migration and the load to failure on the temporal bone. A custom-made spring-loaded pin with an adjustable axial force was used. For the migration experiment, this pin was positioned at 10 predefined anatomical areas in the temporal region of adult cadaver skulls, with different predefined axial forces. Subsequently traction force was applied and increased until migration occurred. For the load-to-failure experiment, the pin was positioned on the most applicable temporal location on both sides of the skull. The most optimal position was identified as just antero-cranial to the auricle. The resistance to migration was clearly related to the axial tightening force. With an axial force of only 100 N, which corresponds to a torque of 0.06 Nm (0.5 in-lb), a vertical traction force of at least 200 N was needed for pin migration. A tightening force of 200 N (torque 0.2 Nm or 2 in-lb) was sufficient to resist migration at the maximal applied force of 360 N for all but one of the pins. The load-to-failure experiment showed a failure range of 780-1270 N axial force, which was not obviously related to skull thickness. The temporal bone area of adult skulls allows axial tightening forces that are well above those needed for HGT in children. The generally applied torque of 0.5 Nm (4 in-lb) which corresponds to about 350 N axial force, appeared well below the failure load of these skulls and much higher than needed for firm fixation.


[Commentary on "Traumatic stress disorder patients on the burn unit: noninvasive treatments and medication"].
It must be emphasized that the psychological management of patients with severe burn injuries always represents a major challenge that can never be carried out according to a general scheme but must in every case be adapted to the individual requirements and available options.


Comprehensive proteome analysis of mouse liver by ampholyte-free liquid-phase isoelectric focusing.
In this study, ampholyte-free liquid-phase IEF (LIEF) was combined with narrow pH range 2-DE and SDS-PAGE RP-HPLC for comprehensive analysis of mouse liver proteome. Because LIEF prefractionation was able to reduce the complexity of the sample and enhance the loading capacity of IEF strips, the number of visible protein spots on subsequent 2-DE gels was significantly increased. A total of 6271 protein spots were detected after integrating five narrow pH range 2-DE gels following LIEF prefractionation into a single virtual 2-DE gel. Furthermore, the pH 3-5 LIEF fraction and the unfractionated sample were separated by pH 3-6 2-DE and identified by MALDI-TOF/TOF MS, respectively. In parallel, the pH 3-5 LIEF fraction was also analyzed by SDS-PAGE RP-HPLC MS/MS. LIEF-2-DE and LIEF-HPLC could obviously improve the separation efficiency and the confidence of protein identification, which identified a higher number of low-abundance proteins and proteins with extreme physicochemical characteristics or post-translational modifications compared to conventional 2-DE method. Furthermore, there were 207 proteins newly identified in mouse liver in comparison with previously reported large-scale datasets. It was observed that the combination of LIEF-2-DE and LIEF-HPLC was effective in promoting MS-based liver proteome profiling and could be applied on similar complex tissue samples.


Characterization of GPCRs in extracellular vesicle (EV).
Extracellular vesicle (EV) are tiny membranous vesicles usually <500nm in size that recently emerged as a new paradigm in human intercellular signaling. EVs have shown a promising role in development of diagnostic markers in many pathophysiological disorders. The presence of chemosensory and therapeutically relevant G protein-coupled receptors (GPCRs) on EV membranes is poorly characterized. Here, we compare different methods including ultracentrifugation and polymer-charge-based separation to isolate EVs from cell culture media and human saliva. The presence of bitter taste GPCRs (T2R4 and T2R38) and a class A GPCR angiotensin II type 1 receptor on these EVs was characterized by qPCR, ELISA, and immunotransmission electron microscopy.


[Treatment for intracranial aneurysms].
Aneurysm rupture is suspected in case of sudden, intense headache, sometimes associated with nausea or vomiting, focal neurologic deficit or loss of consciousness. Aneurysm rupture is a diagnostic and therapeutic emergency that has to be managed in highly specialized centers. Ruptured aneurysms have to be treated in emergency to avoid rebleeding. Endovascular approach is the first line treatment. The indications for treatment of unruptured have to be discussed according to several factors including patient's age, aneurysm size and location. Follow-up examinations are needed after aneurysm treatment (CTA, MRA, DSA). According to aneurysm risk factors, patients with aneurysms have to stop smoking and their blood pressure should be controlled on a regular basis and treated if needed.


Is equipoise a useful concept to justify randomised controlled trials in the cultural context of Pakistan? A survey of clinicians in relation to a trial of talking therapy for young people who self-harm.
Clinical equipoise, also defined as the uncertainty principle, is considered essential when recruiting subjects to a clinical trial. However, equipoise is threatened when clinicians are influenced by their own preferences. Little research has investigated equipoise in the context of trial recruitment. This cross-sectional survey sought clinicians' views (operationalised as 11 statements relating to treatments offered in a trial of a psychological intervention for young people) about equipoise and individual treatment preferences in the context of moral justification for recruiting young people at risk of self-harm or suicide to a randomised controlled trial (RCT) to evaluate the Youth Culturally Adapted Manual Assisted Psychological Intervention (Y-CMAP) in Pakistan. We compared the views of clinicians involved in Y-CMAP RCT recruitment to those of a sample of clinicians not involved in trial recruitment but treating similar patients, comparing their sociodemographic characteristics and the proportions of those in each group agreeing with each statement. There was a response rate of 96% (75/78). Findings showed that, during trial recruitment and before the RCT results were known, the majority of all responding clinicians (73.3%) considered Y-CMAP to be an effective treatment for young people at risk of self-harm or suicide. Although there was an acknowledgement of individual preferences for the intervention, there was near consensus (90%) on the need to conduct an RCT for reaching an evidence-based decision. However, there were no significant differences in the proportion of recruiting clinicians reporting a treatment preference for Y-CMAP than non-recruiting clinicians (31 (88.6%) versus 36 (90%), p = 0.566). A significantly higher proportion of non-recruiting clinicians (87.5%) as compared to (48.5%) in the trial (p = 0.000) stated that there may be other treatments that may be equally good for the patients, seemingly undermining a preference for the intervention. Those reporting a treatment preference also acknowledged that there was nothing on which this preference was based, however confident they felt about them, thus accepting clinical equipoise as ethical justification for conducting the RCT. There was a significant group difference in views that treatment overall is better as a result of young patients' participation in the Y-CMAP trial (p = 0.015) (i.e. more clinicians not involved in the trial agreed with this statement). Similarly, more clinicians not involved in the trial agreed on the perceived availability of other treatment options that were good for young people at risk of self-harm (p < 0.05). The paper highlights that clinicians in Pakistan accept the notion of clinical equipoise as an ethical justification for patient participation in RCTs. The need for conducting RCTs to generate evidence base and to reduce bias was considered important by the clinical community.


[Sarcoma of the spleen with MDM2 expression].
Primary sarcomas and sarcoma metastases are a rarity in the spleen. We report on the case of a 69-year-old male patient presenting with unclear abdominal symptoms and computed tomography (CT) revealed a tumor mass in the spleen. Histologically the tumor mass predominantly showed features of a spindle cell sarcoma with lymphoid infiltrates. The expression and amplification of MDM2 could be demonstrated by means of immunohistochemistry and fluorescence in situ hybridization (FISH). Furthermore, staging examinations did not reveal indications of any other primary tumors. These preliminary findings were suggestive of a dedifferentiated liposarcoma; however, in the further diagnostic work-up the tumor showed strong expression of CD21 and CD23 and was ultimately diagnosed as a follicular dendritic cell sarcoma (FDCS). The case emphasizes that MDM2 expression represents a possible pitfall in the diagnosis of spindle cell tumors. The differential diagnostic distinction between FDCS and a dedifferentiated liposarcoma is discussed.


Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder.
Urinary norepinephrine and epinephrine levels (microgram/day) were measured at two-week intervals during the course of hospitalization in the following patient groups: post-traumatic stress disorder (PTSD); major depressive disorder (MDD); bipolar I, manic (BP); paranoid schizophrenia (PS); and undifferentiated schizophrenia (US). The mean norepinephrine level during hospitalization was significantly higher in PTSD (76 +/- 10.4 micrograms/day) than in BP (60.6 +/- 8.4 micrograms/day), MDD (41.2 +/- 4.7 micrograms/day), PS (33.4 +/- 4.9 micrograms/day) and US (34.3 +/- 5.9 micrograms/day) groups, according to Duncan's multiple range test, (F(4,39) = 6.94, p less than 0.0003). The norepinephrine elevations in the PTSD group were sustained throughout hospitalization. The only other group to show mean levels in this range was the BP group in the first sample after hospital admission. This finding supports prior psychophysiological studies indicating increased sympathetic nervous system activity in PTSD patients. The mean epinephrine level during hospitalization was also significantly higher in PTSD (22.7 +/- 2.4 micrograms/day) than in MDD (13.6 +/- 1.7 micrograms/day), PS (14.7 +/- 2.4 micrograms/day), and US (18.9 +/- 1.8 micrograms/day), but not higher than in BP (21.5 +/- 2.7 micrograms/day). The relationship of epinephrine levels among diagnostic groups was sustained throughout hospitalization. It appears likely that the main underlying mechanisms for elevations of both hormones are psychological, but further work will be required to establish the exact nature of these mechanisms.


DNA segregation: putting chromosomes in their place.
Recent studies provide evidence that bacterial chromosomes are replicated by an enzyme factory, the replisome, located at a fixed position at the center of the cell; the fixed replisome could be a major factor in determining chromosome order in the cell, and may provide the force that drives chromosome segregation.


The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes.
In the United States, there continue to be significant racial/ethnic disparities in preterm birth (PTB) rates, infant mortality, and fetal mortality rates. One potential mediator of these disparities is social determinants of health, including individual socioeconomic factors; community factors such as crime, poverty, housing, and the racial/ethnic makeup of the community; and the physical environment. Previous work has identified statistically significant associations between each of these factors and adverse pregnancy outcomes. However, there are recent studies that provide new, innovative insights into this subject, including adding social determinant data to population-based datasets; exploring multiple constructs in their analysis; and examining environmental factors. The objective of this review will be to examine this recent research on the association of each of these sets of social determinants on racial/ethnic disparities PTB, infant mortality, and fetal mortality to highlight potential areas for targeted intervention to reduce these differences.


Differential treatment effects of two anchorage systems for rapid maxillary expansion: a retrospective cephalometric study.
The purpose of this study was to compare cephalometric changes resulting from treatment with two appliances for rapid maxillary expansion: (1) a strictly tooth-borne appliance and (2) a combined tooth- and bone-borne appliance. Pre- and posttreatment lateral cephalograms of 100 patients were analyzed by cephalometry. Of these patients, 50 were treated with strictly tooth-borne and another 50 with combined tooth- and bone-borne appliances. Mean pretreatment age was 13.04 ± 4.82 years, and mean treatment duration was 7.12 ± 2.37 months. To identify any implications for clinical therapy, additional subgroups were formed based on the pretreatment cephalometric findings for skeletal Class I (0° < ANB ≤ 4°) or Class III (ANB ≤0°). Paired t-tests were used for intragroup and analysis of variance (ANOVA) for intergroup comparisons. Results were considered statistically significant at p ≤ 0.05. Both appliance types resulted in significant cephalometric changes in the maxilla and mandible. Compared to the strictly tooth-borne appliances, the combined tooth- and bone-borne appliances were found to cause more pronounced advancement of the maxilla (SNA angle) notably among the Class III patients. Hybrid (combined tooth- and bone-borne) appliances for rapid maxillary expansion might be preferable in the treatment of skeletal Class III patients, since they possibly exert a more pronounced skeletal effect on the sagittal position of the maxilla.


The effect of music as an intervention for post-stroke depression: A systematic review and meta-analysis.
The clinical application of music therapy and research into its use and effectiveness are common in Western countries. The physiological role of this type of therapy is to stimulate the central nervous system through music, which may have a sedative, analgesic effect, and reduce negative emotions. Previous studies have confirmed that music can be effective for a range of psychological disorders, including post-stroke depression (PSD). There is, however, a lack of systematic evaluation of its effectiveness, and variability in sample size and in the quality of research has detracted from the persuasiveness of findings. Based on PRISMA 2020, articles on music therapy intervention in post-stroke depression were identified through the Web of Science, PubMed, EMBASE, CNKI, Weipu, and Wanfang databases. The retrieval time was taken from the establishment of the database to October 18, 2022. Two researchers conducted a stringent evaluation of the quality of the articles and extracted the data. They then used RevMan5.3 software for meta-analysis. Twenty articles were listed, involving 1625 patients. Meta-analysis results showed that music therapy could lower scores on the Hamilton Depression Rating Scale (HDRS/Ham-D), the National Institutes of Health stroke scale and self-rated depression scale for patients with PSD. Music therapy was also shown to improve the Barthel Index for Activities of Daily Living and treatment efficacy of PSD patients. However, music therapy did not reduce the incidence of adverse reactions in PSD patients. Music therapy has benefits in improving HDRS/Ham-D score and symptoms of PSD patients, and could be more widely applied.


Cellulose-binding domains: cellulose associated-defensive sensing partners?
The cellulose-binding domains (CBDs) in the Phytophthora cellulose-binding elicitor lectin (CBEL) are potent elicitors of plant defence responses. Induction of defence has also been reported in various cellulose-deficient mutants of Arabidopsis thaliana. Based on these observations, we propose a model linking cellulose alteration to defence induction. This integrates the fast increase in cytosolic calcium recorded in response to CBEL, mechano-stimulated calcium uptake mechanisms, and proteins that interact functionally with the cellulose synthase complex. In this context, CBDs emerge as new tools to decipher the signalling cascades that result from cell wall-cellulose perturbations.


Diagnosis of thyroid micronodules on ultrasound using a deep convolutional neural network.
To assess the performance of deep convolutional neural network (CNN) to discriminate malignant and benign thyroid nodules < 10 mm in size and compare the diagnostic performance of CNN with those of radiologists. Computer-aided diagnosis was implemented with CNN and trained using ultrasound (US) images of 13,560 nodules ≥ 10 mm in size. Between March 2016 and February 2018, US images of nodules < 10 mm were retrospectively collected at the same institution. All nodules were confirmed as malignant or benign from aspirate cytology or surgical histology. Diagnostic performances of CNN and radiologists were assessed and compared for area under curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Subgroup analyses were performed based on nodule size with a cut-off value of 5 mm. Categorization performances of CNN and radiologists were also compared. A total of 370 nodules from 362 consecutive patients were assessed. CNN showed higher negative predictive value (35.3% vs. 22.6%, P = 0.048) and AUC (0.66 vs. 0.57, P = 0.04) than radiologists. CNN also showed better categorization performance than radiologists. In the subgroup of nodules ≤ 5 mm, CNN showed higher AUC (0.63 vs. 0.51, P = 0.08) and specificity (68.2% vs. 9.1%, P < 0.001) than radiologists. Convolutional neural network trained with thyroid nodules ≥ 10 mm in size showed overall better diagnostic performance than radiologists in the diagnosis and categorization of thyroid nodules < 10 mm, especially in nodules ≤ 5 mm.


Analyzing the influence of PEG molecular weight on the separation of PEGylated gold nanoparticles by asymmetric-flow field-flow fractionation.
Polyethylene glycol (PEG) is an important tool for increasing the biocompatibility of nanoparticle therapeutics. Understanding how these potential nanomedicines will react after they have been introduced into the bloodstream is a critical component of the preclinical evaluation process. Hence, it is paramount that better methods for separating, characterizing, and analyzing these complex and polydisperse formulations are developed. We present a method for separating nominal 30-nm gold nanoparticles coated with various molecular weight PEG moieties that uses only phosphate-buffered saline as the mobile phase, without the need for stabilizing surfactants. The optimized asymmetric-flow field-flow fractionation technique using in-line multiangle light scattering, dynamic light scattering, refractive index, and UV-vis detectors allowed successful separation and detection of a mixture of nanoparticles coated with 2-, 5-, 10-, and 20-kDa PEG. The particles coated with the larger PEG species (10 and 20 kDa) were eluted at times significantly earlier than predicted by field-flow fractionation theory. This was attributed to a lower-density PEG shell for the higher molecular weight PEGylated nanoparticles, which allows a more fluid PEG surface that can be greater influenced by external forces. Hence, the apparent particle hydrodynamic size may fluctuate significantly depending on the overall density of the stabilizing surface coating when an external force is applied. This has considerable implications for PEGylated nanoparticles intended for in vivo application, as nanoparticle size is important for determining circulation times, accumulation sites, and routes of excretion, and highlights the importance and value of the use of secondary size detectors when one is working with complex samples in asymmetric-flow field-flow fractionation.


COVID-19 associated kidney impairment in adult: Qualitative and quantitative analyses with non-enhanced CT on admission.
To qualitatively and quantitatively assess kidney imapairment in adults with COVID-19 by analysing imaging features on non-enhanced CT (NECT) and possible correlation between renal parenchymal attenuation (RPA) and serum creatinine (SCr) levels on admission. This study was approved by the local institutional ethics committee. A total of 82 patients with COVID-19 admitted from 10/1/2020∼15/3/2020 were enrolled. RPA and perinephric fat stranding (PFS) were evaluated on NECT imaging. According to the presence of PFS, the patients were divided into two groups: Group A, 38 patients with PFS, and Group B, 44 patients without PFS. Clinical data, including age, gender, clinical classification, SCr levels, and RPA on NECT were analysed. The RPA and SCr of the two groups with COVID-19 were analysed to determine possible difference and correlation. Eighty subjects with no kidney diseases were randomly selected as control group to determine the RPA of normal kidney performed on the same CT scanner. Mean age, male to female ratio, number of severe and critical cases, and SCr of Group A were higher than those of Group B. Both mean RPA of Group A and Group B were lower than that of control. Mean RPA of Group A was even lower than that of Group B. A significant weak negative linear correlation between RPA on NECT and SCr in COVID-19 was indicated. Decrease in RPA on NECT was observed in patients with COVID-19 and a weak linear negative correlation with SCr levels was found. The presence of PFS suggested more severe renal impairment in COVID-19. RPA measurements and PFS could be useful in quantitative and qualitative evaluation of COVID-19 associated renal impairment on admission.


Degeneration of two of nine types of synapses in the putamen after center median coagulation in the cat.
The cat putamen contains the identical nine types of synapses and the same proportion of axo-dendritic (or axo-somatic) synapses as described for the fundus striati. However, type III (cortico-striatal) (31:16%) and type V Caxon-callateral) (13:1%) occur much more frequently and type I (nigro-striatal) much less frequently (14:34%) in the putamen than in the fundus striati. Of the axo-spinous synapses only type IV, with densely arranged small round vesicles and interrrupted, asymmetric contact, shows a dark degeneration after center median lesions, mainly in the parvocellular part. Of the six axo-dendritic (or axo-somatic) synapses, only type VII, with densely packed small round vesicles and asymmmetric contact, is degenerated after the same lesion in the center median nucleus. However, after such lesions type VII synapses are much more frequently degenerated in the putamen than those of type IV.


Analysis of the plasmids of Escherichia coli O148:H28 from travellers with diarrhea.
98 Escherichia coli strains of serotype O148:H28 isolated from diarrheal patients from 10 Asian countries and Mexico at Osaka Airport Quarantine were analyzed for enterotoxigenicity and plasmid profile. They were classified into three groups. The first group contained 44 strains that were non-enterotoxigenic and carried 3.9 kb and 50 kb non-enterotoxin plasmids. The second group contained 9 strains that produced LT and ST. They carried a 45 kb enterotoxin plasmid, and 4.6 kb and 9.2 kb non-enterotoxin plasmids. The third group contained 45 strains that produced ST. They carried a 40 kb enterotoxin plasmid, and non-enterotoxin plasmids other than 3.9 kb, 4.6 kb, 9.2 kb and 50 kb. Southern blot hybridization demonstrated that all the non-enterotoxin or enterotoxin plasmids carried by the strains of the same group were identical or similar. These results suggested that the 98 E. coli strains with O148:H28 serotype were derived from three clones, and that the individual strains among each group were derived from a single clonal strain.


Antitumor activity of satraplatin in cisplatin-resistant oral squamous cell carcinoma cells.
The aim of the current study was to identify the antitumor activity of satraplatin in paired cisplatin (CDDP)-resistant oral squamous cell carcinoma (OSCC) cell line and its parental cell line. CDDP-resistant (KB-R) cells and parental cells (KB) pair were used. Viability was assessed using the MTT and clonogenic assay. Real-time polymerase chain reaction (PCR), glutathione (GSH) assay, and flow cytometric analysis were used for further assessment. KB-R cells did not show cross-resistance to satraplatin. The expression status of almost all transporters was upregulated in the KB-R cells. There was no difference in the GSH levels between the KB and KB-R cells. Flow cytometric analysis indicated that with satraplatin the G2/M phase was arrested in the KB-R cells. KB-R cells contain enriched side population cells. These data suggested that satraplatin has antitumor activity against the CDDP-resistant OSCC cells. The mechanism of cross-resistance to platinum agents seems to be multifactorial.


Detailed insights in adsorption process of heavy metals on tire wear particles.
Road traffic induced tire wear particles (TWP) attracted widespread attention due to their potential environmental impact. Here, the adsorption process of heavy metals like Pb2+ and Cd2+ on tire wear particles produced by filing (TWP-f) is studied to elucidate the underlying kinetics and thermodynamics. This work includes voltammetric experiments to investigate the concentration and temperature dependency of the adsorption. The adsorption kinetics in buffer solution spiked with heavy metals follows a pseudo-second-order rate equation involving rate-controlling boundary layer adsorption and a side-by-side intraparticle diffusion process. Meanwhile, the adsorption tendencies under the studied conditions for TWP-f were Pb2+ > Cd2+. The equilibrium adsorption data were modulated by the Langmuir, Freundlich, and Dubinin-Radushkevich (DR) isotherms. Both the Freundlich and DR isotherms were found to be feasible for describing the adsorption on TWP-f. The adsorption energy obtained from the DR isotherm is 1.6 kJ mol-1 for Pb2+ and 2 kJ mol-1 for Cd2+, indicating physisorption as the dominating force. According to the Freundlich isotherm, multilayer adsorption is proposed. The thermodynamic parameters show that the adsorption of Pb2+ and Cd2+ is endergonic. Due to small Gibbs enthalpy values near the thermodynamic equilibrium, the adsorption process is mainly dependent on the ambient conditions. So, close-to-nature experiments were conducted to verify the received results. Therefore, tire and road wear particles including road sediments (TRWP+RS) were added to prefiltered freshwater samples of the river Freiberger Mulde (having naturally elevated trace element concentrations). The adsorption kinetics were investigated by ICP-MS/MS emphasizing the pseudo-second-order rate equation. Moreover, it is suggested that the tire wear particles in the TRWP+RS sample are majorly responsible for the adsorption of at least Cd2+.


Completion and determinants of a continuum of care in maternal health services in Benishangul Gumuz region: A prospective follow-up study.
The provision of a continuum of care to women throughout pregnancy, labor, and after delivery has become a fundamental strategy for improving maternal and neonatal health. A better understanding of where the gaps are in seeking care along the pathway and what factors contribute to the gaps is required for successful program implementation. Hence, this study was targeted to determine the status and determinant factors of the completion rate of a continuum of care in maternal health services. A prospective follow-up study was conducted among 2,198 sampled pregnant women and followed for 11 months in Benishangul-Gumuz region. A multistage clustered sampling technique was employed to select the study participants. Data were collected via face-to-face interviews using a pretested, semi-structured questionnaire, and logbook registry. Collected data were edited, cleaned, and analyzed using STATA software. The multilevel regression model was used to examine the effects of individual- and community-level factors and expressed as AOR with 95% CI. The completion rate of a continuum of care via visit-based, content-based, and space dimensions was 33.1, 20, and 37.2%, respectively. The enabling factors were having information on maternal health services (AOR = 2.25; 95% CI: 1.11-4.55), iron and folic acid supplementation (AOR = 2.58; 95% CI: 1.37-4.86), tetanus toxoid vaccination during pregnancy (AOR = 2.21; 95% CI: 1.39-3.52), having pregnant-related problems (AOR = 2.1; 95% CI: 1.15-3.71), dry and stimulate newborn (AOR = 2.61; 95% CI: 1.42-4.77), appropriate cord care (AOR = 2.01; 95% CI: 1.07-3.79), and immunizing newborn (AOR = 6.9; 95% CI: 3.79-12.59), whereas risk factors were ever having a stillbirth (AOR = 0.52; 95% CI: 0.32-0.85) and delay of 1st ANC initiation at 4-6 months of pregnancy (AOR = 0.45; 95% CI: 0.3-0.68). The completion rates via visit-based, content-based, and space dimensions were low. Different determinant factors which have a programmatically important implication were identified. Thus, interventions should focus on increasing women's awareness and improving the availability and accessibility of the whole packages of maternal health services to facilitate the completion rate.


DNA sequence dependence of closely opposed cyclobutyl pyrimidine dimers induced by UV radiation.
Treatment of UV-irradiated DNAs with Micrococcus luteus pyrimidine dimer-DNA glycosylase results in the formation of double-strand breaks due to cleavage at closely opposed pyrimidine dimers. To determine if the induction of closely opposed dimers is significantly affected by DNA nucleotide sequence, end-labeled DNA fragments of known nucleotide sequence were UV irradiated, incubated with pyrimidine dimer-DNA glycosylase, and analyzed by electrophoresis through nondenaturing polyacrylamide gels. Distinct bands of increased electrophoretic mobility were observed, indicating that bifilar cleavage had occurred with greater probability at specific sites in each DNA sequence. In vitro enzymatic photoreactivation of dimers prior to treatment with pyrimidine dimer-DNA glycosylase prevented the appearance of bands. DNA sequence analysis revealed the presence of closely opposed runs of pyrimidines at sites of more frequent bifilar cleavage. Our results indicate that the induction of closely opposed dimers occurs with greater probability at specific sites in DNA sequences and that such sites are characterized by the presence of closely opposed pyrimidine runs.


Diagnostic Flow Cytometry in the Era of Targeted Therapies: Lessons from Therapeutic Monoclonal Antibodies and Chimeric Antigen Receptor T-cell Adoptive Immunotherapy.
Therapeutic monoclonal antibodies (therapeutic mAb) and adoptive immunotherapy have become increasingly more common in the treatment of hematolymphoid neoplasms, with practical implications for diagnostic flow cytometry. Their use can reduce the sensitivity of flow cytometry for populations of interest owing to downregulation/loss of the target antigen, competition for the target antigen, or lineage switch. Expanded flow panels, marker redundancy, and exhaustive gating strategies can overcome this limitation. Therapeutic mAb have been reported to cause pseudo-light chain restriction, and awareness of this potential artifact is key. Established guidelines do not yet exist for antigen expression by flow cytometry for therapeutic purposes.


Radiation Therapy Without Anesthesia for a 2-Year-Old Child Using Audio-Visual Assisted Therapeutic Ambience in Radiation Therapy (AVATAR).
Radiation therapy (RT) is essential to managing many pediatric malignancies but can provoke anxiety, fear, and discomfort for children owing to prolonged treatment time, extended course, and restrictive immobilization. Patients younger than 10 years frequently require daily general anesthesia (GA), which is resource intensive, expensive, potentially toxic, and anxiety and fear provoking. Audio-Visual Assisted Therapeutic Ambience in Radiation Therapy (AVATAR), a video streaming device, has been proposed as an alternative to anesthesia in patients aged 3 to 10 years. A pilot study evaluating the efficacy of this novel innovation is accruing, but patients younger than 3 years are ineligible. We simulated a 2-year-old with stage IV Wilms tumor for bilateral whole-lung and left-flank irradiation without GA. Using AVATAR, we attempted to deliver RT to this patient without sedation. Patient anxiety at the time of simulation and at the beginning, middle, and end of the treatment course was characterized using the validated Modified Yale Preoperative Anxiety Score (mYPAS) measurement tool. Although the patient tolerated computed tomography simulation without GA or AVATAR use, his mYPAS of 14 out of 18 indicated significant anxiety. Using AVATAR, all treatments were delivered without GA; his mYPASs were 5 and 4 (the lowest possible) and 4 at the first, midcourse, and final treatments, indicating no significant anxiety and a decrease from the pre-AVATAR baseline. Without GA, the time to deliver RT decreased by 66% from 90 to 30 minutes. We describe an expanded, previously unreported indication for AVATAR by demonstrating the feasibility of this approach to reduce or omit anesthesia in appropriate younger patients currently excluded from ongoing trials. The financial and quality-of-life benefits (including decreased stress, anxiety, toxic effects, cost, and appointment time) of AVATAR use may be extendable to a younger patient population than previously thought. In older children, prospective validation is ongoing, but additional study in patients younger than 3 years is needed.


Distribution of rotavirus G and P genotypes approximately two years following the introduction of rotavirus vaccines in South Korea.
Genotyping of human rotaviruses was performed on 299 (40.1%) rotavirus-positive samples obtained from 745 children with acute diarrhea in three provinces in South Korea between March 2008 and February 2010, approximately 2 years following the introduction of the RotaTeq (September 2007) and Rotarix (July 2008). The most prevalent G genotypes were G1 (51.5%), followed by G3 (24.0%), G4 (15.4%), G9 (6.4%), and G2 (4.7%). The predominant types of P genotypes were P[8] (72.6%), followed by P[6] (19.1%) and P[4] (6.0%). The phylogenetic analyses of the VP7 genes of G9 strains revealed they were highly identical and belonged in lineage III. This study highlights the consistency of the predominant G1 genotype and slightly higher predominance of the identical G9 strains over the G2 genotype.


Characteristics of circulating megakaryocyte progenitors (CFU-MK) in patients with primary myelofibrosis.
Characteristics of circulating CFU-MK and the effect of serum and plasma on CFU-MK growth were studied in 14 patients with primary myelofibrosis (MF) using short- and long-term culture methods. The number of CFU-MK in short-term cultures was significantly increased in the non-splenectomized patient group (p less than 0.01). Without added PHA-LCM and normal serum, spontaneous colony formation was found in 9 out of 10 patients. In long-term blood cultures from 6 MF patients, 3 untreated patients formed confluent adherent layers and produced in suspension an equal number or an even greater number of nucleated cells, megakaryocytes and CFU-MK than those obtained in long-term bone marrow culture from normal individuals. 2 splenectomized patients showed neither an increased numbers of CFU-MK nor the capacity to develop an adherent layer. The serum and plasma of MF patients failed to stimulate megakaryocyte colony formation by normal bone marrow in a normal fashion. These findings indicate a megakaryocytopoietic abnormality, and a central role of the spleen in extramedullary haematopoiesis in MF.


Analysis of the Pathogenicity and Phylogeny of Colletotrichum Species Associated with Brown Blight of Tea (Camellia sinensis) in Taiwan.
Brown blight, a destructive foliar disease of tea, has become a highly limiting factor for tea cultivation in Taiwan. To understand the population composition of the causal agents (Colletotrichum spp.), the fungal diversity in the main tea-growing regions all over Taiwan was surveyed from 2017 to 2019. A collection of 139 Colletotrichum isolates was obtained from 14 tea cultivars in 86 tea plantations. Phylogenic analysis using the ribosomal internal transcribed spacer, glutamine synthetase gene, Apn2-Mat1-2 intergenic spacer, β-tubulin, actin, calmodulin, and glyceraldehyde-3-phosphate dehydrogenase genes together with morphological characterization revealed three species associated with brown blight of tea; namely, Colletotrichum camelliae (95.6% of all isolates), C. fructicola (3.7%), and C. aenigma (0.7%). This is the first report of C. aenigma in Taiwan. The optimal growth temperatures were 25°C for C. camelliae and 25 and 30°C for C. fructicola and C. aenigma. Although C. fructicola and C. aenigma were more adapted to high temperature, C. camelliae was the most pathogenic across different temperatures. Regardless of whether spore suspensions or mycelial discs were used, significantly larger lesions and higher disease incidences were observed for wounded than for nonwounded inoculation and for the third and fourth leaves than for the fifth leaves. Wounded inoculation of detached third and fourth tea leaves with mycelial discs was found to be a reliable and efficient method for assessing the pathogenicity of Colletotrichum spp. within 4 days. Preventive application of fungicides or biocontrol agents immediately after tea pruning and at a young leaf stage would help control the disease.


A new predictive tool consolidating CURB-65 with procalcitonin and albumin to assess short-term mortality in hospitalized elderly patients with infectious disease: A retrospective study of a patient cohort.
Hospitalized elderly patients are often at risk of life-threatening infectious diseases such as pneumonia and urinary tract infection, thus diagnostic tools for bacterial infections are demanded. We developed a new predictive tool consolidating modified CURB-65, procalcitonin (PCT) and albumin (Alb). This is a retrospective study. Modified CURB-65 (mCURB-65) score, PCT, Alb, and various cardiovascular/respiratory/renal functions were measured. Survival analyses were conducted to assess 30-days mortality of elderly patients using mCURB-65 score, PCT and Alb. The consolidated scores were compared with the number of patients died. There were 445 elderly patients included. Kaplan-Meier survival curves showed significant differences between the high and low groups of mCURB-65, PCT and Alb (log-rank test, P < .001). Cox proportional regression showed that the hazard ratios (95% confidence intervals) for high mCURB-65, high Alb, and high PCT were all significant, 1.95 (1.24-3.05), 0.50 (0.32-0.77), and 2.09 (1.32-3.31), respectively. The consolidated scores showed tendency of increase with proportion of the number of patients died. The consolidated score consisted of mCURB-65, PCT and Alb can be a useful tool to predict short-term mortality of the hospitalized elderly patients with infectious disease.


Evaluation of the expanding spectrum of sertraline against uncommon fungal pathogens.
The emergence of non-Aspergillus mold pathogens has increased notoriously in the last decades with serious health consequences. The options of treatment for these microorganisms often resistant to a wide variety of antifungals is limited. Sertraline is an antidepressant with in vitro and in vivo antifungal properties which has been recently studied as an adjuvant in the treatment of invasive infections. In this study, we evaluated the in vitro interaction of sertraline with voriconazole and amphotericin B against Lomentospora prolificans, Scedosporium spp., Fusarium spp., Paecilomyces spp., Alternaria spp. and Curvularia spp. The minimum inhibitory concentration and minimum fungicidal concentration for sertraline were in the range of 8-32 μg/mL. Sertraline showed antifungal capacity against all fungi tested and synergism in combination with amphotericin B against some strains of Lomentospora prolificans, Scedosporium apiospermum and Alternaria alternata, antagonism with voriconazole against Purpureocillium lilacinum and indifference in both combinations for most of the other strains tested. These results suggest a potential role of sertraline as an adjuvant in the treatment of some of these serious mycoses.


A randomized controlled trial of chest compression only CPR for older adults-a pilot study.
Older people are trained infrequently in cardiopulmonary resuscitation (CPR), yet are more likely to witness a cardiac arrest. Older people who are CPR trained perform CPR when witnessing a cardiac arrest. To assess whether elderly adults (>55 years) who receive chest-compression only cardiopulmonary resuscitation (CC-CPR) training display equivalent skill retention rates compared with those who receive traditional CPR instruction. We also identified factors associated with 3 months skill retention at 3 months in both groups. Older adults in a suburban hospital Older Adult Services program were invited to participate in an experimental CPR course. The 2 h course was modelled after the AHA Friends and Family course, and used one of two standardized video scenarios. Seventy four subjects were randomized to CC-CPR (n=36) or traditional CPR (n=38) training. Participation consisted of initial training, followed by a 3 months return videotaped assessment. Three months skill competence was assessed either by consensus between two video evaluators, or the on-site evaluator. Chi square and Kappa tests were used for analysis, and unadjusted odds ratios and 95% confidence intervals are reported. Skill retention assessments were completed on 29 (81%) CC-CPR and 26 (68%) CPR trainees. Subjects were elderly (71.5+/-6.69 years), and had a high rate of previous CPR training (58.0%). Groups were similar in demographic characteristics. After training, participants exhibited high rates of perceived competence (86.4%), although the overall 3 months skill retention was low (43.6%). CC-CPR training resulted in equivalent skill retention rates as compared with traditional CPR training (51.7 vs. 44.4%; P=0.586). No participant factors were associated with skill retention, including age, previous CPR training, education level, medical history, or perceived physical ability to perform. We identified low rates of CPR skill retention in this elderly population. CC-CPR instruction was associated with equivalent skill retention rates compared with traditional CPR instruction. No demographic factors were associated with successful skill retention.


Using digital humanities and linguistics to help with terrorism investigations.
This article seeks to offer a response to the digital transformation of forensic science by employing a tool-based linguistic analysis, integrated into the paradigm of digital humanities. It is a way to scientifically model the analysis of digital texts using digital methods. Computer science comes in support of linguistic skills in order to deal with investigative situations and help analyze criminal acts. It presents a case report thanks to the analysis of a corpus made up of 23 texts relating to criminal acts related to suspected terrorist groups with links to the far left. The goal is to help investigators by providing results which can help find stylistic similarities or exclusions between texts and thus potentially between the authors of those texts, offering authors profiling hypothsesis that may be included in the investigation process. While linguistics alone cannot solve such cases, a better understanding of language data, including topics, style and grammar, bring additional clues that can be very useful information in the investigation of crimes (linguists can "translate" information to investigators, so that it can be integrated to the investigation). Digital tools provide a form of objectification since they are based on statistical calculations which reveal regularities that are otherwise invisible to the naked eye. These tools, when used properly in investigations, can prove invaluable in extracting "clues" from the linguistic "traces" that make up texts.


Ultrastructural localization of N-acetylaspartylglutamate in synaptic vesicles of retinal neurons.
Localization of N-acetylaspartylglutamate (NAAG) in a variety of central and peripheral neurons, as well as its receptor-mediated activation of membrane conductance have led to speculation that this peptide has a role in chemical neurotransmission. We previously identified NAAG in retinal neurons of several species, including the grass frog, and now have determined its ultrastructural distribution within the plexiform layers of this amphibian retina. NAAG immunoreactivity was localized within vesicles in synaptic endings of presumptive amacrine and bipolar neurons in the inner plexiform layer. Additionally, the peptide was present in vesicles within ribbon synapses in the outer plexiform layer, a result suggestive of release from photoreceptor cells. These data support the hypothesis that NAAG is secreted at points of synaptic contact between neurons, including retinal amacrine, bipolar and photoreceptor cells.


Comparison of respondents and nonrespondents in an osteoporosis study.
We attempted to enroll an age-stratified random sample of Rochester, Minnesota women > or = 30 years of age in a population-based prospective study of the determinants of bone loss. Using the resources of the Rochester Epidemiology Project, 541 women were contacted and 305 agreed to participate. Of 236 nonrespondents, 38 were ineligible and 198 refused to participate resulting in a 61% response rate for eligible subjects. We reviewed community medical records for respondents and nonrespondents (including ineligibles) to determine whether the two groups differed with regard to variables that might be important in osteoporosis research. There was little difference between respondents and nonrespondents for a history of cigarette smoking, hyperthyroidism, thyroidectomy, or age-related fractures. Respondents survived better, were less likely to be obese or have renal failure, and more likely to have had an oophorectomy and consume alcohol (P < 0.01). These data suggest that nonrespondents were less healthy than respondents.


There's something in the air.
A 20-year-old woman presented with bilateral constant positive visual phenomenon since she was 9 years old. The symptoms had been worsening and becoming more intrusive in the last 3 years. Recently she has also had a migrainous episode. All ophthalmic and neurological investigations were normal. Her symptoms met the diagnostic criteria for visual snow. The diagnosis was explained, and the patient was reassured. Ophthalmologists and neurologists need to be aware of this condition to avoid over investigation and worsening of patient anxiety.


Acute occlusion of the left renal artery manifested by hypertensive crisis.
Because the signs and symptoms of acute renal artery occlusion mimic those of many more common diseases, prompt diagnosis is aided by an awareness that an occlusive renovascular event may have occurred. No routine, noninvasive laboratory test can confirm the diagnosis. Renal arteriography is the procedure of choice after excretory urograms have ruled out an obstructive uropathy. Early assessment of kidney viability is important. The endpoints of emergency treatment are to decrease symptoms, decrease diastolic blood pressure to less than or equal to 105 mm Hg, and to maintain urine output at greater than 50 mL/h. Restoration of a lower blood pressure must not be so prompt that renal perfusion decreases too rapidly. Definitive surgical treatment versus medical management of the renal artery occlusion remains a controversial topic. Where surgery is not feasible, medical management consists of streptokinase acutely followed by heparin and then chronic coumarin therapy.


Purification and properties of rabbit liver phosphorylase phosphatase.
A procedure for the purification of rabbit liver phosphorylase phosphatase is described. The specific activity of the preparation is 2,100 units/mg of protein, representing a 25,000-fold purification. During the initial steps of the purification a large activation of enzyme activity was observed. The molecular weight of the purified enzyme was estimated by Sephadex G-75 chromatography to be 35,000, and by sucrose density ultracentrifugation to be 34,000 (2.9 S). On Na dodecyl-SO4 polyacrylamide disc gel electrophoresis a single component with a molecular weight of 34,000 was observed. The pH optimum is 6.9 to 7.4, and the Km for rabbit muscle phosphorylase alpha is 2 muM. The same procedure is also applicable to the extensive purification of phosphorylase phosphatase from rabbit muscle.


Vaginal administration of a single dose of 16, 16 dimethyl prostaglandin E2 p-benzaldehyde semicarbazone ester for pre-operative cervical dilatation in first trimester nulliparae.
A single pessary containing 0-5 mg 16, 16 dimethyl prostaglandin E2 p-benzaldehyde semicarbazone ester was used for cervical dilatation prior to vacuum aspiration in 124 first trimester nulliparae. Five hours after prostaglandin administration the cervix had dilated to 8 mm or more in 87 patients (70 per cent). The uterus was evacuated in these patients without mechanical dilatation of the cervix. In the remaining 37 patients the cervix had become soft and dilated 5 to 7 mm and further mechanical dilatation could be carried out easily. Side effects were minor and included vomiting in two patients, diarrhoea in one and transient pyrexia in two patients. There were no complications and no damage to the cervix or uterus during evacuation.


The contribution of metabolic parameters of FDG PET/CT prior and during therapy of adult patients with lymphomas.
Lymphomas are the most common hematological malignancies and are further distinguished in Hodgkin lymphoma (HL) and non-Hodgkin (NHL). For staging purposes and for assessing response to treatment, the Lugano classification is currently used, both for HL and NHL patients, whereas for the assessment of prognosis, several prognostic systems exist, such as the international prognostic index (IPI) and revised-IPI for diffuse large B cell lymphomas, follicular lymphoma IPI (FLIPI)-1 and 2 for follicular lymphomas, and the international prognostic score for advanced HL. The aim of this systematic review was to determine the significance of the metabolic FDG PET/CT parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in monitoring therapeutic interventions and prognostic outcome of patients with HL and NHL. We performed a systematic search on the literature and selection of articles concerning treatment evaluation, response and survival in association with MTV and TLG in patients with lymphomas. Our review documented that in most studies, baseline MTV and TLG were predictive of treatment response, progression-free survival (PFS) and overall survival (OS) for both HL and NHL patients. There were conflicting results for the value of interim determination of MTV and TLG. Our conclusion was that combination of baseline MTV and TLG parameters with prognostic scoring systems, such as IPI, or FLIPI-1 and -2, will add additional predictive power for response and prognosis in lymphoma patients.


Complementary roles of sonography and magnetic resonance imaging in the assessment of fetal urinary tract anomalies.
The purpose of our study was to determine whether fetal magnetic resonance imaging (MRI) provides additional information that might affect the obstetric management of pregnancies complicated by sonographically diagnosed fetal urinary tract anomalies. Fetal MRI and sonography were used to study 39 women with suspected fetal urinary tract anomalies in the second and third trimesters of pregnancy. In 24 of 39 cases (61%), fetal MRI confirmed the sonographic diagnosis. In 14 cases (36%), fetal MRI modified the initial sonographic diagnosis and counseling but did not change obstetric management. In 1 case (3%), the addition of fetal MRI resulted in a substantial change in the management of the pregnancy. During the second and third trimesters of pregnancy, fetal MRI showed fetal urinary tract anomalies in excellent anatomic detail. Fetal MRI is a useful complementary tool in the assessment of sonographically diagnosed fetal urinary tract anomalies. In a small percentage of cases, it can have a substantial impact on obstetric management.


The validation of 'universal' PMI methods for the estimation of time since death in temperate Australian climates.
Forensic anthropologists have traditionally relied on their knowledge and experience of the decomposition stages to make an assessment of the time since death. However, recently new and empirical methods have been developed in various regions worldwide that propose to estimate the post-mortem interval (PMI) based on the observed decomposition changes alongside important taphonomic variables. Yet despite these methods being predominantly geographic specific, a number of methods have suggested they are effective universally and it is these 'universal' methods that have been inadequately test in Australia. The current study evaluated the accuracy of two of these methods in an Australian context, specifically the Greater Western Sydney region. The protocol developed by Megyesi et al. (2005) [1] was investigated because it is commonly cited in the literature and the PMI formula created by Vass (2011) [2] was also investigated because of its 'universal' claim. Between December 2014 and March 2016, two experimental trials were undertaken during the Australian summer seasons. Sixteen adult pig carcasses were left to decompose undisturbed on a soil surface common throughout the Western Sydney region and the Megyesi et al. (2005) [1] and Vass (2011) [2] methods were applied to the remains during this period. The results showed the Megyesi et al. (2005) [1] method overestimated the known PMI of remains, whereas the Vass (2011) [2] formula underestimated the time since death of the remains in these trials. The inaccuracy may be attributed to the constants which make up the variables in these formulas and they may not reflect the values of these variables in the Western Sydney region.


Monitoring after childhood cancer--an update for GPs.
The majority of children treated for a cancer will be long term survivors, with the potential to develop specific treatment related adverse health outcomes. This article describes the late effects of treatments for childhood cancer, and makes recommendations about appropriate surveillance. With appropriate primary care input, long term morbidity and mortality for childhood cancer survivors can be reduced.


Fatty acid synthetase, malic enzyme and other NADP+ binding dehydrogenases have similar antigenic determinant(s) at the NADPH binding domain.
Rabbit IgG prepared against malic enzyme inhibits pigeon liver fatty acid synthetase activity. By screening a number of polyclonal antibodies raised to several dehydrogenases, we have discovered that there is a direct relationship between this cross-reactivity and the existence of a common structural domain whose function is the binding of NADP+/NADPH. The presence of NADP+/NADPH in small concentrations protects against this immunoinhibition, thereby indicating a competitive binding of nucleotide and site-specific antibody at the antigenic domain. These data provide further support for the existence of an antigenic domain in the NADPH binding region of dehydrogenases which is responsible for the production of NADPH site-specific antibodies in polyclonal antisera.


The prognostic significance in Goodpasture's disease of specificity, titre and affinity of anti-glomerular-basement-membrane antibodies.
The nephrotoxic potential of anti-glomerular-basement-membrane (GBM) antibodies has been demonstrated in numerous animal experiments. However, it is not known to what extent the properties of circulating anti-GBM antibodies in human disease reflect the severity of the disease and predict the outcome. Clinical data were collected for 79 Swedish patients for whom a positive result had previously been obtained with anti-GBM ELISA. In stored sera from the patients, we measured antibody concentration, specificity and affinity together with antineutrophil cytoplasmic antibodies and alpha(1)-antitrypsin phenotype. Six months after diagnosis, 27 (34%) were dead, 32 (41%) were on dialysis treatment and only 20 (25%) were alive with a functioning native kidney. The best predictor for renal survival was renal function at diagnosis. In patients who were not dialysis dependent at diagnosis however, renal survival was associated with a lower concentration of anti-GBM antibodies, a lower proportion of antibodies specific for the immunodominant epitope and the histological severity of the renal lesion. The only factor that correlated with patient survival was age. Immunochemical properties of autoantibodies do not affect patient survival in anti-GBM disease but seem to be a factor in renal survival in patients detected before renal damage is too advanced.


In vivo dynamics of GFRα1-positive spermatogonia stimulated by GDNF signals using a bead transplantation assay.
In mouse testes, spermatogonial stem cells (SSCs), a subpopulation of GFRα1 (GDNF family receptor-α1)-positive spermatogonia, are widely distributed along the convoluted seminiferous tubules. The proliferation and differentiation of the SSCs are regulated in part by local expression of GDNF (glial cell-derived neurotorphic factor), one of major niche factors for SSCs. However, the in vivo dynamics of the GDNF-stimulated GFRα1-positive spermatogonia remains unclear. Here, we developed a simple method for transplanting DiI-labeled and GDNF-soaked beads into the mouse testicular interstitium. By using this method, we examined the dynamics of GFRα1-positive spermatogonia in the tubular walls close to the transplanted GDNF-soaked beads. The bead-derived GDNF signals were able to induce the stratified aggregate formation of GFRα1-positive undifferentiated spermatogonia by day 3 post-transplantation. Each aggregate consisted of tightly compacted Asingle and marginal Apaired-Aaligned GFRα1-positive spermatogonia and was surrounded by Aaligned GFRα1-negative spermatogonia at more advanced stages. These data not only provide in vivo evidence for the inductive roles of GDNF in forming a rapid aggregation of GFRα1-positive spermatogonia but also indicate the usefulness of this in vivo assay system of various growth factors for the stem/progenitor spermatogonia in mammalian spermatogenesis.


Effects of aminophylline on the threshold for initiating ventricular fibrillation during respiratory failure.
Cardiac arrhythmias have frequently been reported in association with respiratory failure. The possible additive role of pharmacologic agents in precipitating cardiac disturbances in patients with respiratory failure has only recently been emphasized. The effects of aminophylline on the ventricular fibrillation threshold during normal acid-base conditions and during respiratory failure were studied in anesthetized open chest dogs. The ventricular fibrillation threshold was measured by passing a gated train of 12 constant current pulses through the ventricular myocardium during the vulnerable period of the cardiac cycle. During the infusion of aminophylline, the ventricular fibrillation threshold was reduced by 30 to 40 percent of the control when pH and partial pressures of oxygen (PO2) and carbon dioxide (CO2) were kept within normal limits. When respiratory failure was produced by hypoventilation (pH 7.05 to 7.25; PC02 70 to 100 mm Hg: P02 20 to 40 mm Hg), infusion of aminophylline resulted in an even greater decrease in ventricular fibrillation threshold to 60 percent of the control level. These experiments suggest that although many factors may contribute to the increased incidence of ventricular arrhythmias in respiratory failure, pharmacologic agents, particularly aminophylline, may play a significant role.


The GPI1 homologue from Plasmodium falciparum complements a Saccharomyces cerevisiae GPI1 anchoring mutant.
Glycosylphosphatidylinositol (GPI) represents an important anchoring molecule for cell surface proteins. The first step in its synthesis is the transfer of N-acetylglucosamine (GlcNAc) from UDP-N-acetylglucosamine to phosphatidylinositol (PI). This chemically simple step is genetically complex because three or four genes are required in both yeast (GPI1, GPI2 and GPI3) and mammals (GPI1, PIG A, PIG H and PIG C), respectively. Here, we report cloning of a Plasmodium falciparum (P. falciparum) homologue of GPI1 (PfGPI1). Analysis showed that P. falciparum Gpi1p is somewhat more similar to the yeast proteins than human Gpi1p, showing 26 and 20% amino acid sequence identity with the Saccharomyces cerevisiae and Homo sapiens proteins, respectively. Multiple sequence alignment demonstrates also that the C-terminal half GPI1 proteins is much better conserved than the N-terminal half. The P. falciparum Gpi1p has a calculated molecular weight of 65 kDa and a predicted potential tyrosine phosphorylation site. The potential tyrosine phosphorylation site seems to occur in all other known Gpi1 proteins. Like the other GPI1 proteins, the predictive software revealed the absence of targeting signals such as organelle transit peptides, DNA binding sites, or N-terminal secretory signals. Hydrophobicity plots revealed multiple hydrophobic regions that could function as transmembrane segments. The cloned P. falciparum GPI1 gene complemented a gpi1 yeast mutant.


Scanning electron microscopic studies of the hyaloid vascular system in newborn mice exposed to O2 and CO2.
It has been suggested that the tunica vasculosa lentis of newborn mice undergoes vasoproliferation after oxygen exposure and might be used as an experimental model for intraocular neovascularization. A scanning electron microscopic technique which provides visualization of the entire hyaloid vascular system was used to study its response in mice exposed to various gas mixtures (70% O2/30% N2, 10% CO2/90% air, 10% CO2/70% O2/20% N2). Marked differences were found between hyaloid regression in gas exposed mice compared to air control mice, but no evidence of neovascularization was found in any group. The data support the possibility that changes in the hyaloid may be the consequence of the hydrostatic coupling which exists between this atrophic, possibly flow-resistant vasculature and the developing retinal vasculature whose blood flow characteristics are significantly altered by exposure to CO2 and O2.


alpha-Galactosylceramide-loaded, antigen-expressing B cells prime a wide spectrum of antitumor immunity.
Most of the current tumor vaccines successfully elicit strong protection against tumor but offer little therapeutic effect against existing tumors, highlighting the need for a more effective vaccine strategy. Vaccination with tumor antigen-presenting cells can induce antitumor immune responses. We have previously shown that NKT-licensed B cells prime cytotoxic T lymphocytes (CTLs) with epitope peptide and generate prophylactic/therapeutic antitumor effects. To extend our B cell vaccine approach to the whole antigen, and to overcome the MHC restriction, we used a nonreplicating adenovirus to transduce B cells with antigenic gene. Primary B cells transduced with an adenovirus-encoding truncated Her-2/neu (AdHM) efficiently expressed Her-2/neu. Compared with the moderate antitumor activity induced by vaccination with adenovirus-transduced B cells (B/AdHM), vaccination with alpha-galactosylceramide-loaded B/AdHM (B/AdHM/alpha GalCer) induced significantly stronger antitumor immunity, especially in the tumor-bearing mice. The depletion study showed that CD4(+), CD8(+) and NK cells were all necessary for the therapeutic immunity. Confirming the results of the depletion study, B/AdHM/alpha GalCer vaccination induced cytotoxic NK cell responses but B/AdHM did not. Vaccination with B/AdHM/alpha GalCer generated Her-2/neu-specific antibodies more efficiently than B/AdHM immunization. More importantly, B/AdHM/alpha GalCer could prime Her-2/neu-specific cytotoxic T cells more efficiently and durably than B/AdHM. CD4(+) cells appeared to be necessary for the induction of antibody and CTL responses. Our results demonstrate that, with the help of NKT cells, antigen-transduced B cells efficiently induce innate immunity as well as a wide range of adaptive immunity against the tumor, suggesting that they could be used to develop a novel cellular vaccine.


Multifunctionality of matrix protein in the replication and pathogenesis of Newcastle disease virus: A review.
As an important structural protein in virion morphogenesis, the matrix (M) protein of Newcastle disease virus (NDV) is demonstrated to be a nuclear-cytoplasmic trafficking protein and plays essential roles in viral assembly and budding. In recent years, increasing lines of evidence have indicated that the M protein has obvious influence on the pathotypes of NDV, and the interaction of M protein with cellular proteins is also closely associated with the replication and pathogenicity of NDV. Although substantial progress has been made in the past 40 years towards understanding the structure and function of NDV M protein, the available information is scattered. Therefore, this review article summarizes and updates the research progress on the structural feature, virulence and pathotype correlation, and nucleocytoplasmic transport mechanism of NDV M protein, as well as the functions of M protein and cellular protein interactions in M's intracellular localization, viral RNA synthesis and transcription, viral protein synthesis, viral immune evasion, and viral budding and release, which will provide an in-depth understanding of the biological functions of M protein in the replication and pathogenesis of NDV, and also contribute to the development of effective antiviral strategies aiming at blocking the early or late steps of NDV lifecycles.


The acidosis of chronic renal failure.
The acidosis of chronic renal failure is not due to bicarbonate wastage per se; rather, bicarbonate reabsorption per nephron is markedly enhanced. The ability to lower the urine pH is preserved. While overall ammonium production may be decreased in chronic renal failure, both ammonium production and excretion are markedly increased when expressed per remaining nephron. Titratable acid excretion in chronic renal failure is essentially maximal, owing to the effect of parathyroid hormone on phosphate excretion by the kidney. Thus, it appears that the acidosis of chronic renal failure is solely the consequence of the reduction in functional renal mass. Extrarenal buffering may contribute substantially to the maintenance of a near normal acid-base status in patients with marked reduction in glomerular filtration rate. That homeostasis is so well preserved until glomerular filtration rate falls to approximately 10 per cent of normal is remarkable; the price, however, may be considerable. Prolonged acidosis may magnify the tendency of renal failure to cause osteodystrophy. An obvious treatment for the acidosis of renal failure is exogenous alkali therapy. Most clinicians withhold alkali therapy until the bicarbonate concentration falls below 20 mEq per L. If the acidosis cannot be safely corrected with exogenous therapy, dialysis should be initiated.


The Impact of Blue Light Cystoscopy on the Diagnosis and Treatment of Bladder Cancer.
Photodynamic diagnostic technique with blue light cystoscopy (BLC) takes advantage of the preferential uptake and accumulation of protoporphyrins in neoplastic tissue which emit a red fluorescence when illuminated with blue light (360-450 nm wavelengths). This allows enhanced visualization of small papillary tumors and flat carcinoma in situ lesions that might have been missed on white light cystoscopy (WLC). There is compelling evidence that the ability of BLC to detect these additional tumors translates into improved recurrence rates compared to WLC. However, the impact of BLC with regard to progression rates and in patients who are managed with intravesical therapy is not yet known. Further work is required to optimize the integration of BLC into clinical practice, but the future for BLC appears promising.


Reliability of the Welling scale (WS1) for rating temporal bone dissection performance.
To determine the inter- and intrarater reliability of using a new scale (Welling scale) for resident evaluation of temporal bone dissection performance. Prospective, double-blinded, randomized trial. Twelve residents in otolaryngology (postgraduate year [PGY] 2-5) drilled 26 temporal bones (21 cadaveric, 5 plastic) with the objective to perform a complete mastoidectomy with facial recess approach. These bones were then rated using the Welling scale by six independent raters on two separate occasions (4-6 wk apart). Raters were blinded to PGY year. The Kappa statistic was calculated for inter- and intrarater reliability. Intrarater agreement was high for all raters, ranging from kappa = 0.65 to 0.72 (all P < .001), whereas the interrater agreement scores were more moderate (range, kappa = 0.49-0.64; all P < .01). The Welling scale can be used reliably to assess temporal bone dissection performance where performance is measured by assessment of end product (mastoidectomy with facial recess approach).


Rapid formation of myometrial gap junctions during parturition in the unilaterally implanted rat uterus.
In uterine smooth muscles, gap junction plaques rapidly form during the final stages of gestation. To investigate the related mechanisms, regional differences in myometrial gap junction development in rat uterus were examined quantitatively during delivery, using thin-section and freeze-fracture techniques in combination with light- and electron microscopy. Examination of implanted and nonimplanted horns in the unilaterally ligated rat bicornuate uteri, revealed no differences in the occurrence of gap junction plaques, but after 2 to 4 pups had been delivered, the contracted segments contained more gap junction plaques than did noncontracted segments examined immediately before delivery. In all segments, gap junctions were found more frequently in the circular muscle layers than in the longitudinal muscle layers. Gap junctions ranged in size from 0.002 micron 2 to 0.52 micron 2, but two-thirds were less than 0.1 micron 2. The frequency of small gap junction plaques (less than 0.1 micron 2) was higher in the noncontracted segment. These results suggest that gap junctions are dynamic structures, and that their formation is controlled not only by general hormonal factors, possibly involved in gap junction increases in the myometrium before delivery, but also by local factors, possibly related to the contraction, that may accelerate an increase in gap junction formation during delivery.


The 'hollow cylinder' protein of erythrocyte membranes.
The 'hollow cylinder' protein (Harris, J.R. (1968) Biochim. Biophys. Acta 150, 534-537) has been purified from human erythrocyte membranes. The molecular weight of the native protein, as determined by analytical ultracentrifugation, was found to be 747,000. By means of sodium dodecyl sulphate gel electrophoresis, the purified protein was shown to be composed of three different low molecular weight polypeptides of average molecular weight 25,000. This study provides convincing evidence that the spectrin tetramer is not responsible for the characteristic electron microscopic appearance of the hollow cylinder protein.


[Psoriasis and inflammatory bowel diseases].
Psoriasis and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) are among the immune-mediated inflammatory diseases. This group includes approximately 80 disorders, some of which can at times be associated in a single patient. In psoriasis, Crohn's disease may be observed slightly more frequently, but ulcerative colitis and celiac disease are also an issue. The underlying relations between these disorders comprise: i) genetic data obtained by genome-wide association studies that show the involvement of shared predisposing loci and/or genes, for example, in innate immunity; ii) immunological data: these disorders share inflammation effector mechanisms, particularly the activation pathway of Th17 lymphocytes, which explains the efficacy of anti-TNF antibodies and anti-IL-12/23; and iii) environmental co-factors such as smoking, possibly certain food proteins (gliadin, etc.), and bacterial infections that are probably decisive elements in the genesis of these diseases.


Hemodynamic effects of laparoscopic surgery in term and preterm infants with cardiac anomalies.
The aim of this study was to clarify whether cardiac anomalies are a reasonable contraindication to laparoscopic surgery in infants. Between January 2004 and January 2013, 131 term and preterm infants with cardiac anomalies underwent laparoscopic surgery within the first 6 months of life. In this retrospective study type of cardiac anomaly, performed operative procedure, operative time, intraabdominal pressure and postoperative complications were evaluated. Over this 9-year period, 80 preterm and 51 term infants underwent different complex and even long-lasting laparoscopic procedures. Median operative time was 67 min with a median intraabdominal pressure of 13 mmHg. Cardiac anomalies ranged from persistent foramen ovale, atrium septal defect to ventricular septal defect and tetralogy of Fallot. In the postoperative course hemodynamic impairment was noted in three infants (2.3 %). Only one of them presented cardiorespiratory instability. In this study different laparoscopic procedures could be performed in numerous infants with cardiac anomalies. Due to the inhomogeneity of this group of patients and individual combinations of heart defects with or without hemodynamic relevance, preoperative evaluation by a firm pediatric cardiologist is crucial. Prospective studies are necessary to further clarify the use of laparoscopic surgery in this distinct group of patients.


Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials.
Shared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations. We selected cancer-related US studies from the Cochrane 2014 review of PtDAs and added RCTs meeting Cochrane criteria from searches of PubMed, CINAHL, PsycINFO (January 2010 to December 2013); and reference lists. Two reviewers independently screened titles/abstracts; three reviewers independently screened full text articles, performed data extraction and assessed: 1) inclusion of participants based on seven indicators of social disadvantage (limited education; female gender; uninsured or Medicaid status; non-U.S. nativity; non-White race or Hispanic ethnicity; limited English proficiency; low-literacy), and 2) attention to social disadvantage in the development or evaluation of PtDAs. Twenty-three of 39 eligible RCTs included participants from at least one disadvantaged subgroup, most frequently racial/ethnic minorities or individuals with limited education and/or low-literacy. Seventeen studies discussed strategies and lessons learned in attending to the needs of disadvantaged social groups in PtDA development; 14 studies targeted disadvantaged groups or addressed subgroup differences in PtDA evaluation. The diversity of the US population is represented in a majority of cancer-related PtDA RCTs, but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients' participation in SDM. More detailed attention to the comprehensive range of social factors that determine cancer risk, variations in care and outcomes is needed in the development and evaluation of PtDAs for disadvantaged populations. Registered 24 October 2014 in PROSPERO International prospective register of systematic reviews ( CRD42014014470 ).