[Regulation of intraocular pressure and haemodynamics in patients with severe polytrauma (author's transl)].
In 18 polytraumatized patients injuried by an accident, the intraocular pressure was measured and the aqueous humour production and regulatory capacity were determined by means of the perilimbal suction cup with simultaneous recording of haemodynamic parameters. The measurements were carried out 1. in the immediate acute stage, 2. in the period of circulatory recovery, and 3. under stable circulatory conditions. It became evident that the production of aqueous humour was suspended in the acute stage. With improving stabilization of the circulatory system, the aqueous humour minute volume and the regulatory capacity of the eye were raised. The cause of the reduction of both these parameters in the acute stage of a polytrauma has to be seen in an affection of the intraocular vascular nervous system in dependence of the general shock situation.


Gold(I)-Coumarin-Caffeine-Based Complexes as New Potential Anti-Inflammatory and Anticancer Trackable Agents.
Three new gold(I)-coumarin-based trackable therapeutic complexes and two non-trackable analogues have been synthesised and fully characterised. They all display anti-proliferative properties on several types of cancer cell lines, including those of colon, breast, and prostate. Two complexes displayed significant anti-inflammatory effects; one displayed pro-inflammatory behaviour; this highlights the impact of the position of the fluorophore on the caffeine scaffold. Additionally, the three coumarin derivatives could be visualised in vitro by two-photon microscopy.


Major changes in the 5' and 3' chromatin structure of sea urchin histone genes accompany their activation and inactivation in development.
The major histone gene repeat (h22) of the sea urchin Psammechinus miliaris is transiently expressed for several hours during early embryonic development. Several major alterations in chromatin structure coincide with changes in the pattern of early histone gene expression and are reversed later. During the early (128-cell) blastula stages when h22 DNA is maximally expressed, promoter regions of all five histone genes are sensitive to both micrococcal nuclease and DNAase I. Hypersensitivity to micrococcal nuclease remains the same throughout the early hours of development, but disappears abruptly at hatching blastula stage when transcription has completely ceased. Some sequences near the 3' end of active histone genes are very resistant to micrococcal nuclease cutting and map just downstream of the inverted DNA repeats essential for generating faithful 3' ends of histone mRNAs. These same histone DNA sequences are readily cut in free DNA or when histone genes are transcriptionally inactive.


A spin label study of myelin fluidity with normal and pathological peripheral nerves.
The myelin fluidity in peripheral nerves from normal subjects and patients with neuropathy has been studied. Nerve biopsies were made in subjects without neuropathy and in patients with Guillain-Barré, alcoholic or diabetic polyneuropathies and heredodegenerative diseases. The fluidity was studied using a stearic acid spin label with a nitroxide radical at C12 (12-doxylstearic acid) which was introduced by exchange between spin label-charged BSA and nerve myelin. Spectra was obtained with a VARIAN E 109 ESR spectrometer, at temperatures from 5 to 45 degrees C. The ultrastructure of biopsied nerves was also studied. The electron spin resonance (ESR) spectra were all typical of a partially immobilized nitroxide with a distance between outer hyperfine lines (2T//) of about 50 G, at room temperature. The curve 2T// against temperature shows two critical temperatures: 10 and 30 degrees C for all nerves. No correlation could be established between ultrastructure and fluidity of nerves. However, the myelin of nerves from diabetic patients showed a significant increase in viscosity. This physicochemical modification may represent an initial alteration of the myelin sheath, and demands further investigation. No modification of the myelin fluidity was observed in any of the other nerves studied.


Breaking through water-splitting bottlenecks over carbon nitride with fluorination.
Graphitic carbon nitride has long been considered incapable of splitting water molecules into hydrogen and oxygen without adding small molecule organics despite the fact that the visible-light response and proper band structure fulfills the proper energy requirements to evolve oxygen. Herein, through in-situ observations of a collective C = O bonding, we identify the long-hidden bottleneck of photocatalytic overall water splitting on a single-phased g-C3N4 catalyst via fluorination. As carbon sites are occupied with surface fluorine atoms, intermediate C=O bonding is vastly minimized on the surface and an order-of-magnitude improved H2 evolution rate compared to the pristine g-C3N4 catalyst and continuous O2 evolution is achieved. Density functional theory calculations suggest an optimized oxygen evolution reaction pathway on neighboring N atoms by C-F interaction, which effectively avoids the excessively strong C-O interaction or weak N-O interaction on the pristine g-C3N4.


Nickel allergy and osteomyelitis in a patient with metal osteosynthesis of a jaw fracture.
A 27-year-old female, after a fracture of the mandible treated with osteosynthesis and after a difficult extraction, developed osteomyelitis with fistulation and sequestration. Sequestrectomy and extraction of the teeth in the osteomyelitic area did not clear the patient of symptoms. A patch test to nickel turned out to be positive. After removal of the stainless steel cerclage in the mandible, clinical and radiographic changes returned to normal within 2 and 8 weeks, respectively. It is concluded that, whenever acute treatment does not take priority, patch tests comprising nickel, cobalt and chromium should be performed in patients who are candidates for metal osteosynthesis.


Involvement of tyrosine protein kinase in the initiation of flagellar movement in rainbow trout spermatozoa.
Initiation of flagellar motility in spermatozoa of the rainbow trout, Salmo gairdneri, is closely related to phosphorylation of a protein of molecular mass 15 kDa (Morisawa, M., and Hayashi, H. (1986) Biomed. Res. 6, 181-184). We have been able to solubilize the protein and its kinase and then construct an assay system in vitro for the phosphorylation of the 15-kDa protein. In vitro, the protein was phosphorylated in a cAMP-dependent manner. The phosphorylation absolutely required the presence of Mg2+ ions. at millimolar concentrations, but not of Ca2+ ions. The amino acid residue which was phosphorylated in the 15-kDa protein was tyrosine. The 15-kDa protein was purified to near homogeneity by affinity chromatography on a column of adenosine nucleotides conjugated to Eupergit and ion-exchange chromatography on DEAE-cellulose. The effects of synthetic inhibitors of protein kinase on the phosphorylation of the 15-kDa protein were also studied.


Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations.
In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.


The spread of COVID-19 in London: Network effects and optimal lockdowns.
We generalise a stochastic version of the workhorse SIR (Susceptible-Infectious-Removed) epidemiological model to account for spatial dynamics generated by network interactions. Using the London metropolitan area as a salient case study, we show that commuter network externalities account for about 42% of the propagation of COVID-19. We find that the UK lockdown measure reduced total propagation by 44%, with more than one third of the effect coming from the reduction in network externalities. Counterfactual analyses suggest that: (i) the lockdown was somehow late, but further delay would have had more extreme consequences; (ii) a targeted lockdown of a small number of highly connected geographic regions would have been equally effective, arguably with significantly lower economic costs; (iii) targeted lockdowns based on threshold number of cases are not effective, since they fail to account for network externalities.


Radiotherapy in the treatment of ovarian dysgerminomas.
Between 1969 and 1983 a total of 14 patients with ovarian dysgerminoma were treated at the Institute of Oncology and Radiotherapy, the Prince of Wales Hospital, Randwick. The case records of these patients have been reviewed for presenting symptoms, treatment given, and survival following treatment. Excluded from analysis are patients with mixed ovarian germ cell tumors (dysgerminoma and teratoma). Data includes three patients referred with recurrent or residual tumor after primary surgery. Ten patients remain alive (72%). All four patients who died had recurrent intra-abdominal tumor, with or without distant metastases at the time of death. Median duration of follow-up of living patients was 54 months. Survival of those dead ranged from 8 to 168 months following treatment. The place of radiotherapy in treatment is discussed.


Changes in the structure of the ligand or substitutions to AF2 residues in the estrogen receptor make independent contributions to coactivator sensitivity by SRC-1.
The estrogen receptor (ER) is a ligand-inducible transcription factor which depends, in part, upon the C-terminal activation function (AF2) in order to regulate the expression of target genes. AF2 residues fold into an amphipathic alpha-helix on helix 12 of the ER, with hydrophobic and acidic faces. It is believed that AF2 mediates the gene regulatory activities of ligand-activated ER by interacting with coactivator proteins. We have analyzed the contribution of acidic AF2 residues to the process of ER coactivation by the steroid receptor coactivator, SRC-1. In HeLa cells, SRC-1 coexpression was found to restore transcriptional potency to otherwise inert complexes of wild type ER and 4-hydroxyestratrien-17beta-ol. SRC-1 coexpression also enhanced transcriptional activity of reporter genes induced by an ER mutant with neutral replacements to acidic AF2 residues, in response to E2 or 4-hydroxyestratrien-17beta-ol. By contrast, ER complexes from ICI164,384-treated HeLa cells were both transcriptionally inactive and coactivator insensitive. It is concluded that changes to the structure of the ligand or substitutions to acidic residues in the AF2 region of the receptor contribute independently to the control of coactivator sensitivity in ER.


Variation of a variation: case report of attenuated familial adenomatous polyposis.
First described in 1988, attenuated familial adenomatous polyposis (AFAP) is a rare autosomal dominant precancerous condition of the gastrointestinal tract. Few reports have described adenocarcinomatous change in the gastroduodenal region thus far. We report a case of AFAP presenting with extensive gastric polyposis and ampullary adenocarcinoma in absence of a positive family history of gastrointestinal cancer and a novel mutation.


Precision Medicine in Type 1 Diabetes.
Type 1 diabetes is a complex, chronic disease in which the insulin-producing beta cells in the pancreas are sufficiently altered or impaired to result in requirement of exogenous insulin for survival. The development of type 1 diabetes is thought to be an autoimmune process, in which an environmental (unknown) trigger initiates a T cell-mediated immune response in genetically susceptible individuals. The presence of islet autoantibodies in the blood are signs of type 1 diabetes development, and risk of progressing to clinical type 1 diabetes is correlated with the presence of multiple islet autoantibodies. Currently, a "staging" model of type 1 diabetes proposes discrete components consisting of normal blood glucose but at least two islet autoantibodies (Stage 1), abnormal blood glucose with at least two islet autoantibodies (Stage 2), and clinical diagnosis (Stage 3). While these stages may, in fact, not be discrete and vary by individual, the format suggests important applications of precision medicine to diagnosis, prevention, prognosis, treatment and monitoring. In this paper, applications of precision medicine in type 1 diabetes are discussed, with both opportunities and barriers to global implementation highlighted. Several groups have implemented components of precision medicine, yet the integration of the necessary steps to achieve both short- and long-term solutions will need to involve researchers, patients, families, and healthcare providers to fully impact and reduce the burden of type 1 diabetes.


Attentional and processing skills following traumatic brain injury in early childhood.
Attentional deficits are common following TBI in adults. This study examined whether these skills are also vulnerable following early childhood injury, when such skills are rapidly developing. This study investigated attention 30 months post-TBI in pre-schoolers (n=56) and age-matched controls (n=26). TBI children were divided into mild, moderate and severe injury groups. Pre-injury data were collected at time of injury. Assessment of attention included the Continuous Performance Test, Wechsler Intelligence Scale and Personality Inventory for Children. Severe TBI was associated with reduced accuracy and slowed processing, particularly on complex motor responses. Sustained attention was more intact. Parental reports indicate internalized behavioural problems and somatic complaints. Young children with severe TBI are at risk for severe, persisting attentional impairments. Children with mild and moderate TBI show better outcome, with pre-injury behaviour and age also predictive of attentional skills at 30 months post-injury.


Characterization of molecules mediating cell-cell communication in human cardiac valve interstitial cells.
Cell-cell interactions and adhesion determine cellular architectural organization, proliferation, signaling, differentiation, and death. We have identified the molecular components of different cell-cell junctions in human valve interstitial cells (ICs) both in situ and in culture. ICs were isolated, cultured, and phenotyped for cell surface and cytoplasmic markers by flow cytometry and immunocytochemistry. Western blotting was used to identify and quantify the molecular components of these cell-cell junctions in human valve ICs and compared with expression in smooth muscle and fibroblast cell types. N-cadherin and desmoglein were weakly detected on a low percentage of ICs, and the other classical cadherins were not detected. alpha- and beta-catenin, but not gamma-catenin, were expressed at equivalent levels by all valve ICs. Valve ICs did not express connexin-32 and -40; however, connexin-26 and -43 were equally expressed by a low percentage of ICs, demonstrating cell surface and cytoplasmic expression ,and connexin-45 was weakly expressed. The other cell types also expressed N-cadherin, alpha- and beta-catenin, desmoglein and connexin-43. The expression of these junctional molecules was predominantly by valve ICs on the inflow side of the valves. Human valve ICs have the ability to communicate with other valve ICs and mediate cell-cell adhesion via N-cadherin, connexin-26 and -43, and desmoglein. The junctions between valve ICs could support an interconnecting and coordinated cellular unit capable of controlling the functionality of the valve.


Electrophysiological and pharmacological responses of chronically denervated lower esophageal sphincter of the opossum.
Achalasia is characterized by loss of myenteric neurons and incomplete relaxation of the lower esophageal sphincter (LES). The aim of this study was to develop an achalasia model in the opossum using the surfactant benzyldimethyltetradecylammonium chloride (BAC). This study further characterizes the achalasia model. BAC or saline was injected circumferentially into the LES of 14 adult opossums. Eight months after injection, manometry, isolated muscle bath studies, electrical field stimulation, and histochemical analysis were performed. Manometrically, the LES of BAC-treated opossums showed higher pressures (38.7 +/- 12 mm Hg vs. 17 +/- 3.0 mm Hg) and reduced esophageal body contraction amplitudes (4.2 +/- 3 mm Hg vs. 27.4 +/- 12 mm Hg). Isolated muscle strips challenged with carbachol and sodium nitroprusside contracted and relaxed similarly to controls. Electrical field stimulation failed to induce relaxation in BAC-treated tissue but did induce contraction. Contractile responses were markedly reduced by tetrodotoxin and atropine in BAC-treated animals and controls. An altered nitric oxide system was shown by the lack of response to L-arginine and N omega-nitro-L-arginine. Histology showed loss of myenteric neurons and increased cholinergic nerve bundles. Loss of NO inhibitory myenteric neurons markedly reduces the relaxation of the LES, and histology and pharmacological responses suggest a proliferation of cholinergic nerves into the LES contributing to the static elevated pressures of the amyenteric LES.


Identification and validation of ferroptosis-related genes in lipopolysaccharide-induced acute lung injury.
Emerging evidence reveals the important role of ferroptosis in the pathophysiological process of acute lung injury (ALI). We aimed to identify and validate the potential ferroptosis-related genes of ALI through bioinformatics analysis and experimental validation. Murine ALI model was established via intratracheal instillation with LPS and confirmed by H&E staining and transmission electronic microscopy (TEM). RNA sequencing (RNA-seq) was used to screen differentially expressed genes (DEGs) between control and ALI model mice. The potential differentially expressed ferroptosis-related genes of ALI were identified using the limma R package. Gene Ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, gene set enrichment analysis (GSEA), and protein-protein interactions (PPI) were applied for the differentially expressed ferroptosis-related genes. CIBERSORT tool was used to conduct immune cell infiltration analysis. Finally, protein expressions and RNA expression of ferroptosis DEGs were validated in vivo and in vitro by western blots and RT-qPCR. Among 5009 DEGs, a total of 86 differentially expressed ferroptosis-related genes (45 up-regulated genes and 41 down-regulated genes) were identified in the lungs between control and ALI. GSEA analysis showed that the genes enriched were mainly involved in response to molecule of bacterial origin and fatty acid metabolic process. The GO and KEGG enrichment analysis indicated that the top 40 ferroptosis DEGs were mainly enriched in reactive oxygen species metabolic process, HIF-1signaling pathway, lipid and atherosclerosis, and ferroptosis. The PPI results and Spearman correlation analysis suggested that these ferroptosis-related genes interacted with each other. Immune infiltration analysis confirmed that ferroptosis DEGs were closely related to immune response. Consistent with the RNA-seq data, the western blot and RT-qPCR unveiled increased mRNA expressions of Cxcl2, Il-6, Il-1β, and Tnfα, and protein expressions of FTH1, TLR4 as well as decreased ACSL3 in LPS-induced ALI. In vitro, the upregulated mRNA levels of CXCL2, IL-6, SLC2A1, FTH1, TNFAIP3, and downregulated NQO1 and CAV1 in LPS-stimulated BEAS-2B and A549 cells were verified. We identified 86 potential ferroptosis-related genes of LPS-induced ALI through RNA-seq. Several pivotal ferroptosis-related genes involved in lipid metabolism and iron metabolism were implicated in ALI. This study may be helpful to expand our understanding of ALI and provide some potential targets to counteract ferroptosis in ALI.


Expression and functional role of BK channels in chronically injured spinal cord white matter.
Spinal cord injury (SCI) causes neuronal death, demyelination of surviving axons, and altered ion channel functioning, resulting in impaired axonal conduction. The large-conductance, voltage and Ca(2+)-activated K(+) (BK or Maxi K(+)) channels contribute to the repolarization phase of action potentials. Therefore, they may play a significant role in regulating axonal conduction in SCI. In this paper, using combined electrophysiological and molecular approaches, we tested the hypothesis that the deficit in axonal conduction in chronic SCI is partially due to the activation of axonal BK channels. BK channels were found to be expressed in spinal cord white matter axons. These channels are not sensitive to BK channel blocker iberiotoxin in uninjured cords, likely reflecting their juxtaparanodal localization. After chronic injury, BK channels were exposed due to axonal demyelination at the injured site and their activation was found to depend on calcium influx, likely through N-type voltage-dependent calcium channels. Activation of BK channels introduced a reduction in the size of the compound action potentials (CAPs) and in axonal response to high frequency stimulation (HFS). Administration of BK channel blocker iberiotoxin significantly enhanced axonal conduction in the injured cords. Thus, pharmacological targeting of axonal BK channels may provide a therapeutic strategy for the treatment of chronic SCI, by restoring conduction to the remaining functional axons.


The hemodynamic effects of ventricular pacing with and without atrioventricular synchrony in patients with normal and diminished left ventricular function.
The relative hemodynamic effects of heart rate, inotropic state, and atrioventricular (AV) synchrony during ventricular pacing were evaluated in 10 patients with normal left ventricular ejection fraction (LVEF) (0.66 +/- 0.07, mean S.D.) and in eight patients with a diminished LVEF (0.34 +/- 0.18). Hemodynamics were measured at AV intervals of 130, 0, and -130 msec during ventricular pacing at a baseline rate that was 10 pulses/min greater than the resting heart rate, at 130 pulses/min alone, and at 130 pulses/min during continuous intravenous infusion of dobutamine. During baseline ventricular pacing and during ventricular pacing at 130 pulses/min with and without dobutamine, both groups of patients had a significant decrease in cardiac index, stroke volume index, and stroke work index when the AV pacing interval was decreased from 130 to 0 msec. The observed decrease in these three hemodynamic variables was similar when patients with diminished LVEF were compared to patients with normal LVEF. No further significant decrease in cardiac index, stroke volume index, and stroke work index occurred in either group when the AV interval was changed from 0 to -130 msec during baseline ventricular pacing or during ventricular pacing at 130 with and without dobutamine. Beneficial hemodynamic effects occur during ventricular pacing when AV synchrony is maintained at resting heart rates and during increases in heart rate and inotropic state in patients with normal and diminished LVEF.


How does sepsis promote thrombosis in microvascular anastomoses?
This study on 100 rats, divided into five equal groups, has shown that chronic distant sepsis promotes occlusion of microvascular anastomoses to a significantly greater extent than aseptic inflammation, transient bacteraemia and even local infection. This may be related to the significant increase in the number of platelets in the group with distant sepsis.


Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration.
To evaluate whether severe carotid stenosis and related hemodynamics impairment may increase the risk of cognitive deterioration in asymptomatic subjects. A total of 210 subjects with unilateral asymptomatic severe carotid stenosis and 109 healthy controls were included and prospectively evaluated for a 36-month period. At entry, demographics, vascular risk profile, and pharmacologic treatments were defined. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index (BHI) test. Cognitive status was evaluated with the Mini-Mental State Examination (MMSE) at entry and at the end of the follow-up period. Cognitive deterioration was defined as a decrease in the MMSE score of 3 points or more during the overall follow-up period. Subjects with carotid stenosis showed an increased probability of developing cognitive deterioration compared with the group without stenosis (odds ratio [OR] 4.16 [95% confidence interval (CI) 1.89-9.11]; p < 0.001). The presence of an impaired BHI ipsilateral to the stenosis was associated with an increased incidence of reduction in cognitive performance (OR 14.66 [95% CI 7.51-28.59]; p < 0.001). Our findings show that the presence of a severe carotid stenosis influences cognitive deterioration over a 36-month period in asymptomatic subjects. An associated hemodynamic impairment significantly increases the risk. Evaluation of functional consequences of carotid stenosis may offer the opportunity to select a group with an increased risk of developing cognitive impairment from subjects with asymptomatic severe carotid stenosis.


Sequential study of lesion development in experimental haemophilus pleuropneumonia.
Recently weaned pigs were infected aerogenically with Haemophilus (Actinobacillus) pleuropneumoniae, serotype 5. At three, six, 12, and 18 hours and one, two, four and seven days after exposure to haemophili a pair of animals were killed and necropsied. Pulmonary oedema with multifocal petechial haemorrhages and a diffuse neutrophilic bronchiolitis and alveolitis were observed at three and six hours after infection. Focal areas of coagulative necrosis developed in areas of intense suppuration at 12 and 18 hours after infection. At one and two days after infection, necrotic areas were surrounded by dense bands of degenerating leucocytes and contained unidentifiable round and elongated cells characteristic of this disease. In subacute lesions a thick layer of granulation tissue formed around the outer margin of developing abscesses. Most of the round and elongated cells in alveolar exudates could not be identified by enzyme histochemistry or electron microscopic examination. Neutrophils in various stages of degeneration and deterioration provided strong evidence that some of the cells were of this type. These findings suggest that neutrophils may play an early and significant role in development of lesions.


Differential enhancement of interferon-gamma-induced MHC class II expression of HEp-2 cells by 1,25-dihydroxyvitamin D3.
Interferon-gamma (IFN-gamma) induces the expression of MHC class II antigens on non-lymphoid cells. In this study we investigated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), the most active metabolite of vitamin D3, on the IFN-gamma-induced expression of MHC class II antigens on HEp-2 cells. We found that 1,25(OH)2D3 enhanced the IFN-gamma-induced expression of HLA-DR on these cells. Differential effects on the MHC class II antigens HLA-DR, -DQ and -DP were also observed.


Correction to: Common Pediatric Medical Emergencies in Office Practice.
The published online version contains an inadvertent error. On page 8, under the heading "Approach to a Child with Trauma" there is a box with "Primary Survey & Resuscitation".


Scleroderma renal crisis and ovarian hyperstimulation syndrome related to the use of clomiphene in a patient with scleroderma.
This paper presented a 28-year-old female with systemic sclerosis who developed scleroderma renal crisis and ovarian hyperstimulation syndrome following clomiphene administration. Urgent therapy including angiotensin-converting enzyme (ACE) inhibitors and supportive care resulted in regression and eventually resolution of all the clinical and laboratory symptoms. Although scleroderma renal crisis is a fatal complication of high-dose corticosteroids, rarely is this seen with the use of ACE inhibitors. This case report aimed to investigate the potential capacity of the selective oestrogen receptor modulator clomiphene to induce scleroderma renal crisis as well as corticosteroids.


Factors associated with nosocomial pneumonia in hospitalized individuals.
To identify factors associated with nosocomial pneumonia in individuals admitted to a public hospital in Feira de Santana, Bahia. This case control study was carried out in 211 adult individuals (46 cases and 165 controls), of a mean age of 41 years, treated at clinical wards, surgical wards or the adult intensive care unit of Cleriston Andrade General Hospital in Feira de Santana. The cases comprised individuals who developed respiratory tract infections (nosocomial pneumonia) after hospital admission. The controls consisted of patients without nosocomial pneumonia. Information on socioeconomic status, medical history, lifestyle and oral hygiene habits was obtained through interviews. The medical records were checked to verify subjects' health status and the diagnosis of pneumonia. A clinical oral examination was performed by a trained dental surgeon. Odds ratio (OR) was estimated in the bivariate analysis as an association measurement, along with the respective 95% confidence interval through the Mantel-Haenszel method. The frequency of nosocomial pneumonia in the sample was 21.8%. The occurrence of hypertension was higher and hospital stay duration was longer in the cases than in controls (p ≤ 0.05). Lack of dental floss and mouthwash use were higher in the controls (p = 0.01). The findings indicate that arterial hypertension, length of hospital stay of five days and lack of dental floss and mouthwash use are factors likely associated with nosocomial pneumonia, suggesting that these factors should be targeted for effective prevention.


Graphdiyne: from Preparation to Biomedical Applications.
Graphdiyne(GDY) is a kind of two-dimensional carbon nanomaterial with specific configurations of sp and sp 2 carbon atoms. The key progress in the preparation and application of GDY is bringing carbon materials to a brand-new level. Here, the various properties and structures of GDY are introduced, including the existing strategies for the preparation and modification of GDY. In particular, GDY has gradually emerged in the field of life sciences with its unique properties and performance, therefore, the development of biomedical applications of GDY is further summarized. Finally, the challenges of GDY toward future biomedical applications are discussed.


Nerve growth factor influences neurobehavioral development of newborn mice.
Thirty-six male pups of the CD-1 outbred strain received from postnatal day 2 to day 10 a daily subcutaneous injection of either highly purified murine Nerve Growth Factor (NGF; 5 mg/kg), cytochrome c (5 mg/kg), or saline solution. NGF-treated pups showed a slight, but significant, reduction in body weight gain and a concomitant acceleration in the appearance of early signs of neurobehavioral maturation such as righting reflex, cliff aversion, and response to tactile stimulation of the perioral area. Other responses, including the ultrasonic vocalization pattern on day 7, were unaffected or affected to a lesser extent.


ITCH deficiency clinical phenotype expansion and mitochondrial dysfunction.
Autoimmune Disease, Multisystem, with Facial Dysmorphism (ADMFD) is an autosomal recessive disorder due to pathogenic variants in the ITCH gene. It is characterized by failure to thrive, dysmorphic facial features, developmental delay, and systemic autoimmunity that can manifest variably with autoimmune hepatitis, thyroiditis, and enteropathy, among other organ manifestations. It was originally described in 10 consanguineous Old Order Amish patients, and more recently in two patients of White British and Black German ethnicities. While the role of ITCH protein in apoptosis and inflammation has previously been characterized, a defect in cellular bioenergetics has not yet been reported in ITCH deficiency. Here we present a Caucasian female originally evaluated for possible mitochondrial respiratory chain deficiency, who ultimately was found to have two novel variants in ITCH with absence of ITCH protein in patient derived fibroblasts. Clinical studies of patient muscle showed mitochondrial DNA copy number of 57% compared to controls. Functional studies in skin fibroblasts revealed decreased activity of mitochondrial fatty acid oxidation and oxidative phosphorylation, and decreased overall ATP production. Our findings confirm mitochondrial energy dysfunction in a patient with ITCH deficiency offering the opportunity to assess alternative therapeutic options.


Risk factors predicting cervical spine fracture on CT in craniocervical trauma - retrospective study.
The study identifies risk factors predicting cervical spine fracture on CT based on information in the referral form. All patients aged over 18 years with a CT scan of the head and cervical spine completed at the University Hospital Brno in the year 2019 to exclude any fresh trauma were included in the retrospective study. The analyzed potential risk factors included gender, age over 65 years, unconsciousness or impaired consciousness, mechanism of injury, paresthesia or plegia suspected to be associated with trauma, cervical spine pain, other neurological symptomatology, presence of cervical collar, presence of intracranial hemorrhage on head CT, and presence of skull fracture on head CT. In total, a cervical or upper thoracic spine fracture was described in 51 of 1177 patients (4.3%). Statistically significant risk factors for cervical spine fracture on CT scan were identified as mechanism of injury similar to car accident or jumping into water (OR 2.52; p=0.004), pain of the cervical spine (OR 1.81; p.


Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in childhood.
Two patients, a 5 year old boy with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms despite appropriate pharmacologic therapy and an 11 year old girl with symptoms of tiredness and peak instantaneous LVOT gradient of 80 and 90 mmHg respectively were considered for radiofrequency catheter septal ablation, to relieve the left ventricular outflow tract obstruction. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions was placed in the hypertrophied septum, commencing distally in the ventricle and proceeding towards the aortic valve, taking care to stay away from the His bundle. The procedure was deemed to be completed when the entire extent of the hypertrophied septum had been treated. In the boy the procedure was complicated by two episodes of ventricular fibrillation, requiring DC cardioversion, but without any neurologic sequelae. The peak to peak gradient between left ventricle and aorta was 50 mmHg and 60 mmHg respectively pre-ablation, and remained unchanged immediately after. Both patients were discharged from the hospital 48 hours later. Serial measurement of serum Troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography at 7 days and at 6 weeks post-ablation respectively confirmed a beneficial hemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. In young children, in whom alcohol induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.


Modulation of the spatial distribution of crystallizable emulsifiers in Pickering double emulsions.
The unique role of the spatial distribution of crystallizable emulsifiers in regulating the structure and properties of double emulsions has been gradually recognized. Herein, we utilized crystallizable monoglycerides of different carbon chain length (GMS/GMP/GML) to "structuring" the intermediate oil phase of double emulsions during a two-stage emulsification process followed by a cooling treatment. A ternary eigenvector (I, M, E) based on the numerical processing of polarization images was invented to quantitatively characterize the distribution pattern of monoglycerides. Crystallization kinetics analysis and dissipative particle dynamic simulation were then employed to reveal the regulatory mechanism for the site-specific interface distribution behavior. Results suggested that the distribution pattern of monoglycerides could be pricesly tuned as the internal interface-, external interface- or oil-phase dominated one in double emulsions. The surface activity as well as crystallization rates of monoglycerides dominated the interfacial distribution kinetics, and the cooling gradient along the interface region further regulated their interfacial distribution potential. Specificly, shorter crystallization time (t1/2) made GMP molecules rapidly solidified in oil phase, leading to the oil phase domninate crystallization (0, M, 0), whereas, slow crystallization rate rendered GML and GMS with sufficient time to diffuse to the interface, thus forming interfacial crystals ((I, 0, 0) and (0, 0, E)). The sensitivity of GML to cooling gradient along the interface region led to its preferential external interface distribution under cooling treatment. The presented study explored novel strategies that can be used in characterizing and manipulating the distribution pattern of crystallizable emulsifiers in multi-interface emulsion systems.


Trustworthiness perception at zero acquaintance: Consensus, accuracy, and prejudice.
Research on trustworthiness perception from faces has unfolded in a way that is strikingly reminiscent of Jussim's narrative in his 2012 book. Jussim's analysis warns us against overemphasizing evidence about prejudice over evidence about accuracy, when both are scant; and reminds us to hold all accounts to the same standards, whether they call on societal biases or true signals.


Management of progressive genu varum in a patient with Dyggve-Melchior-Clausen syndrome.
We describe the orthopaedic management of progressive genu varum in a child who manifested the full phenotypic characterization of Dyggve-Melchior-Clausen syndrome.


Risk for Obstructive Sleep Apnea by Berlin Questionnaire, but not daytime sleepiness, is associated with resistant hypertension: a case-control study.
Obstructive Sleep Apnea Syndrome (OSAS) is a risk factor for resistant hypertension. Overnight polysomnography and portable sleep monitors are not generally available and questionnaires may be useful for screening OSAS. In a case-control study, we investigate the association between resistant hypertension and sleep disorders evaluated by the Berlin Questionnaire and Epworth Sleepiness Scale (ESS). Cases were 63 patients with resistant hypertension (either systolic blood pressure (BP) > or =140 mm Hg or diastolic BP > or =90 mm Hg using at least three BP-lowering drugs, including a diuretic). Controls were 63 patients with controlled BP under drug treatment. All the patients were submitted to ambulatory BP monitoring and level III polysomnography by means of a portable monitor. The prevalence of high risk in the Berlin Questionnaire and high score in the ESS (>10) was compared between the groups. Diagnostic performance for OSAS of both questionnaires was calculated. The prevalence of high score in ESS was 44% in both groups. There was a higher prevalence of high risk for OSAS in Berlin Questionnaire in the cases group (78% vs. 48%; P < 0.001). In a logistic regression model, high risk for OSAS in Berlin Questionnaire was independently associated with resistant hypertension (odds ratio 4.1; confidence interval 95% 1.80-9.31; P < 0.01). Sensitivity and specificity for the diagnosis of OSAS was 85.5% (75.3-92.0%) and 65.0% (52.0-76.0%), respectively. High risk for OSAS assessed by the Berlin Questionnaire is highly prevalent and associated with resistant hypertension. This questionnaire may be used as screening for OSAS in patients with this clinical condition.


The elusive "hunger protein": an appetite-stimulatory factor that is overabundant in human obesity.
Paradoxically, most if not all previously known appetite-stimulatory hormones are downregulated in human obesity, reflecting failing homeostatic circuitries. Recently, we discovered that acyl-coenzyme-A binding protein/diazepam-binding inhibitor (ACBP/DBI) acts as a lipogenic and appetite stimulator, when systemically injected into mice. ACBP/DBI plasma levels are also elevated in obese subjects, supporting the notion that it may represent the elusive "hunger protein" that explains overeating in human obesity.


Radiation Exposure to the Surgeon and Patient During a Fluoroscopic Procedure: How High Is the Exposure Dose? A Cadaveric Study.
Using fresh cadavers, real-time dosimeters were used to estimate the radiation exposure dose from C-arm fluoroscopy to surgeons, medical staff, and patients during various procedures. The aim of this study was to evaluate the radiation exposure dose from C-arm fluoroscopy, which is used to generate real-time images of the human body, under a variety of conditions and in different areas. Awareness of the harmful effects of long-term low-dose radiation is rising. There are no all-inclusive reports evaluating the radiation exposure dose to medical staff associated with fluoroscopic procedures that can accurately simulate the real clinical situation. Seven fresh cadavers were irradiated for 1, 3, and 5 minutes with C-arm fluoroscopy. The x-ray source was positioned under the table, over the table, and laterally. Radiation exposure doses were measured at different simulated areas such as the center area, and the surgeon's hand or thyroid gland. There were significant differences in the radiation exposure dose under different conditions and for different irradiated areas. The risk of direct and scatter radiation exposure was the greatest with the lateral position, which increased by more than 200 times and more than 30 times, respectively, compared with that from a position under the table. Direct radiation was attenuated to less than one-hundredth after passing through the body of the cadaver. All radiation exposure doses were positively correlated with total exposure time. Our study revealed the direct and scatter radiation exposure dose from C-arm fluoroscopy to different areas under a variety of conditions when fluoroscopy is used to generate real-time images of the human body. Our results serve as a guide for medical staff to understand the risk of radiation exposure during each fluoroscopic procedure. Medical staff, especially surgeons, should consider how to protect themselves and reduce radiation exposure by using appropriate shielding. 4.


Where and when are portion sizes larger in young children? An analysis of eating occasion size among 1·5-5-year-olds in the UK National Diet and Nutrition Survey (2008-2017).
To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance. Cross-sectional. Data from parent-reported 4-d food diaries in the UK National Diet and Nutrition Survey (2008-2017) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n 48 419 occasions) and between children (n 1962) for all eating occasions. Eating contexts: location, eating companion, watching TV, and sitting at a table and individual characteristics: age, gender, ethnicity and parental socio-economic status were explored as potential correlates of eating occasion size. Children aged 1·5-5 years. Median eating occasion size was 657 kJ (IQR 356, 1117). Eating occasion size variation was primarily attributed (90 %) to differences between eating occasions. Most (73 %) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377 kJ larger than at home. Eating occasions sitting at a table, v. not, were 197 kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes. Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.


The effects of stress on eyewitness memory: A survey of memory experts and laypeople.
This survey examined lay and expert beliefs about statements concerning stress effects on (eyewitness) memory. Thirty-seven eyewitness memory experts, 36 fundamental memory experts, and 109 laypeople endorsed, opposed, or selected don't know responses for a range of statements relating to the effects of stress at encoding and retrieval. We examined proportions in each group and differences between groups (eyewitness memory experts vs. fundamental memory experts; experts vs. laypeople) for endorsements (agree vs. disagree) and selections (don't know vs. agree/disagree). High proportions of experts from both research fields agreed that very high levels of stress impair the accuracy of eyewitness testimony. A majority of fundamental experts, but not eyewitness experts, endorsed the idea that stress experienced during encoding can enhance memory. Responses to statements regarding moderating factors such as stressor severity and detail type provided further insight into this discrepancy. Eyewitness memory experts more frequently selected the don't know option for neuroscientific statements regarding stress effects on memory than fundamental memory experts, although don't know selections were substantial among both expert groups. Laypeople's responses to eight of the statements differed statistically from expert answers on topics such as memory in children, in professionals such as police officers, for faces and short crimes, and the existence of repression, providing insight into possible 'commonsense' beliefs on stress effects on memory. Our findings capture the current state of knowledge about stress effects on memory as reflected by sample of experts and laypeople, and highlight areas where further research and consensus would be valuable.


Characterization of low-glycosylated forms of soluble human urokinase receptor expressed in Drosophila Schneider 2 cells after deletion of glycosylation-sites.
The urokinase-type plasminogen activator receptor (uPAR) is a glycolipid-anchored membrane protein that is thought to play an active role during cancer cell invasion and metastasis. We have expressed a truncated soluble form of human uPAR using its native signal peptide in stably transfected Drosophila Schneider 2 (S2) cells. This recombinant product, denoted suPAR (residues 1-283), is secreted in high quantities in serum-free medium and can be isolated in very high purity. Characterization by SDS-PAGE and mass spectrometry reveals that suPAR produced in this system carries a uniform glycosylation composed of biantennary carbohydrates. In contrast, suPAR produced in stably transfected Chinese hamster ovary (CHO) cells carries predominantly complex-type glycosylation and exhibits in addition a site-specific microheterogeneity of the individual N-linked carbohydrates. Measurement of binding kinetics for the interaction with uPA by surface plasmon resonance reveals that S2-produced suPAR exhibits binding properties similar to those of suPAR produced by CHO cells. By site-directed mutagenesis we have furthermore removed the five potential N-linked glycosylation-sites either individually or in various combinations and studied the effect thereof on secretion and ligand-binding. Only suPAR completely deprived of N-linked glycosylation exhibits an impaired level of secretion. All the other mutants showed comparable secretion levels and retained the ligand-binding properties of suPAR-wt. In conclusion, stable expression of suPAR in Drosophila S2 cells offers a convenient and attractive method for the large scale production of homogeneous preparations of several uPAR mutants, which may be required for future attempts to solve the three-dimensional structure of uPAR by X-ray crystallography.


Describing chlorophenol sorption on variable-charge soil using the triple-layer model.
The sorption of 2,4-dichlorophenol, 2,4,6-trichlorophenol, and pentachlorophenol by a variable-charge soil from southern Chile was studied in a series of batch experiments. The chlorophenol sorption behavior was evaluated as a function of pH (pH range 4-8) at two different ionic strengths, 0.01 and 0.1 M KCl (25 degrees C). Chlorophenol sorption depended on pH and a downward shift in the soil PZC was observed with increasing chlorophenol concentration. Chlorophenol sorption decreased with increasing pH, suggesting that the undissociated species is sorbed more readily and that electrostatic repulsion may inhibit partitioning as pH increases. Data from the sorption experiments were fitted by the triple-layer model, in which monodentate outer- and inner-sphere complexes were formed between deprotonated organic molecules and active sites on the variable-charge soil.


A novel model based on qAnti-HBc and conventional biomarkers for identifying significant liver injury among CHB patients with ALT ≤ ULN.
Antiviral therapy is not routinely recommended for CHB patients with ALT ≤ ULN (CHB-NALT), based on current international guidelines. However, it is debatable if antiviral treatment should be offered for CHB-NALT patients, because significant liver injury is observed from liver biopsy of some CHB-NALT patients. Quantification of anti-HBc (qAnti-HBc) can predict antiviral response in CHB patients, while its role in CHB-NALT patients remains to be explored. To determine if it is reliable that the novel non-invasive model based mainly on qAnti-HBc and other conventional biomarkers for providing objective value among CHB-NALT patients with antiviral therapy, in direct comparison with liver biopsy. 542 or 110 liver biopsied CHB-NALT patients from 2015 to 2020 or in 2021 were included in training set or validation set. Circulating IL-1β, IL-2, IL-4, IL-12p70, IL-17, TNF and IFNα were determined in the training set. A non-invasive model was developed based on qAnti-HBc and other conventional biomarkers. Among 423/542 (78%) patients with significant liver injury in the training set, 47% were in grey-zone. Circulating IL-1β, IL-12p70, IL-17 in the CHB-NALT patients with liver injury was significantly higher than these without liver injury in the training set (p < 0.01). No significant difference of IL-1β, IL-12p70, IL-17 was observed between CHB-NALT patients with significant liver injury and active CHB with elevated ALT in the training set. There was inverse correlation between liver injury grades and IFNα, IL-4, or IL-2 in these patients (p < 0.05). Serum qAnti-HBc level was significantly higher with CHB-NALT patients with liver injury than these without in the training set (P < 0.01). ALT/ULN, AST, PLT and qAnti-HBc were identified as independent predictors for significant liver injury. Furthermore, our current model demonstrated a good performance in predicting significant liver injury, i.e. AUROCs of 0.95 or 0.86 in training set or validation set. The model cut-off value for anti-viral therapy at ≥1.471. qAnti-HBc appears to be well correlated with the hepatic damage, in direct comparison with liver biopsy from CHB-NALT patients. The novel model developed seems to be reliable for predicting liver injury in CHB-NALT patients. Such model also provides objective value for decision making of antiviral therapy.


The relationship between social anxiety disorder and alcohol use disorders: a critical review.
Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.


Global stakeholder perspectives of home birth: a systematic scoping review.
Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders' perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders' perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.


Activating alleles of JAK3 in acute megakaryoblastic leukemia.
Tyrosine kinases are aberrantly activated in numerous malignancies, including acute myeloid leukemia (AML). To identify tyrosine kinases activated in AML, we developed a screening strategy that rapidly identifies tyrosine-phosphorylated proteins using mass spectrometry. This allowed the identification of an activating mutation (A572V) in the JAK3 pseudokinase domain in the acute megakaryoblastic leukemia (AMKL) cell line CMK. Subsequent analysis identified two additional JAK3 alleles, V722I and P132T, in AMKL patients. JAK3(A572V), JAK3(V722I), and JAK3(P132T) each transform Ba/F3 cells to factor-independent growth, and JAK3(A572V) confers features of megakaryoblastic leukemia in a murine model. These findings illustrate the biological importance of gain-of-function JAK3 mutations in leukemogenesis and demonstrate the utility of proteomic approaches to identifying clinically relevant mutations.


Decolorization and biosorption for Congo red by system rice hull- Schizophyllum sp. F17 under solid-state condition in a continuous flow packed-bed bioreactor.
Synthetic dyes are important chemical pollutants from various industries. This work developed an efficient and relatively simple continuous decolorization system rice hull-Schizophyllum sp. F17 under solid-state condition in a packed-bed bioreactor, for decolorizing Congo red. In the decolorization system, two decolorization mechanisms exist, one is decolorization by Schizophyllum sp. F17, the other is biosorption by rice hull. The decolorization efficiency was greatly affected by dye concentration and hydraulic retention time (HRT), which were quantificationally analyzed and optimized through response surface methodology (RSM). A 2(2) full factorial central composite design (CCD) was performed, and three second order polynomial models were generated to describe the effects of dye concentration and HRT on total decolorization (R2=0.902), decolorization by Schizophyllum sp. F17 (R2=0.866) and biosorption by rice hull (R2=0.890). Response surface contour plots were constructed to show the individual and cumulative effects of dye concentration and HRT, and the optimum values. A maximum total decolorization 89.71% and maximum decolorization by Schizophyllum sp. F17 60.44% was achieved at dye concentration 142.63mg/L, HRT 41h, and dye concentration 110.7mg/L, HRT 29.4h, respectively. Meanwhile, the role of manganese peroxidase (MnP) in the decolorizaion process was investigated. This study proved the feasibility of continuous mode for decolorizing synthetic dyes by white-rot fungi in solid-state fermentation bioreactors.


An enhancement approach of fluorescence signatures in excitation emission matrixes for water contaminant analysis.
Three-dimensional fluorescence spectroscopy has been widely used for the analysis of water contaminants. However, the problems of weak signals and overlapping fluorescence peaks remain unresolved. In this work, we studied the impact of absorption on the spectral shape of fluorescence and found that it is a major cause of overlapping peaks and weak signals. An approach is proposed to purify fluorescent signals and enhance fluorescence signatures based on the theory of fluorescence quantum yield. Using this theory, the problems of noise amplification and singularity points were identified, and an optimization algorithm was proposed related to Wiener filtering. For practical application to multiple compounds, three overlapping cases were discussed theoretically. The effectiveness of this procedure in subsequent parallel factor analysis was assessed and compared with original data by conducting experiments with six typical compounds and real water samples. The results indicate that overlapping along the excitation wavelength axis can be reduced despite the existence of multiple compounds, and the sensitivity of weak fluorescent signals can be significantly improved. The proposed method can enhance fluorescence signatures for the separation and analysis of fluorescent components in water contaminants.


What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements.
In order to measure the effectiveness of interventions claiming to improve adherence in diabetes, valid measurement of adherence is necessary. Any measurement must first be based on a definition. This study aimed to identify and categorize definitions and measurements of adherence in living with diabetes, from a review of the literature. Publications were identified from the medline database. Adherence, compliance and concordance were used as terms in the search algorithm, along with diabetes, diabetes mellitus and treatment. Two hundred and ninety-three papers were identified. Abstracts of these papers were read by two researchers independently. Two hundred and thirty-nine papers did not contain definitions or measures of adherence and were discarded. Of the remaining 54 papers, 26 included definitions and 46 described measurements of adherence. Definitions and measurements fell into five categories: coincidence of behaviour with professional advice, relationship as part of the process of care, outcome and process targets, taking the medication as prescribed and others. No single definition of adherence emerged. Many authors did not provide definitions of adherence. Glycated haemoglobin was the most common measurement of adherence, although this can raise problems. Research which claims to show an intervention has, or has not, improved adherence must be interpreted cautiously. Interventions which appear to fail may actually succeed in aspects of adherence which were not defined or measured in the study. Clinicians and researchers could use clear definitions and measurements, such as the ones presented in this review.


Life events and hippocampal volume in first-episode major depression.
There are many studies on life events in depression and also several studies examining brain structural changes in the hippocampus of depressed patients. However, only few studies have focused on the association of life events and hippocampal volume in depression. The hypothesis of a significant negative association between life events and hippocampal volumes in first episode depression was examined. 28 in-patients with a first episode of major depression were examined with high-resolution magnetic resonance imaging measuring hippocampal volumes. The precourse of depression was assessed with the Interview for the Retrospective Assessment of the Onset and Course of Schizophrenia and Other Psychoses (IRAOS) and life events by using the Munich Interview for the Assessment of Life Events and Conditions (MEL). A significant negative correlation between major life events three month before the onset of depression and the left hippocampal volume was found for male patients. In female patients no significant association between major life events and hippocampal volumes could be found. The results support the hypothesis that the hippocampus plays a crucial role in the pathogenesis of major depression in the early phase of the disorder particularly for male patients.


Genetic heterogeneity and predominance of blaCTX-M -15 in cefotaxime-resistant Enterobacteriaceae isolates colonizing hospitalized children in Tunisia.
Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have emerged as important nosocomial pathogens. Community infections by these organisms have been also reported and were associated with previous intestinal colonization. We aimed to characterize cefotaxime-resistant Enterobacteriaceae (CTX-R-En) isolated from hospitalized children in a Tunisian paediatric ward. Seventy CTX-R-En isolates were collected from 227 rectal swabs from hospitalized children in a paediatric ward. Antimicrobial susceptibility testing was determined according to the EUCAST guidelines. Isolates were characterized by polymerase chain reaction (PCR, genes encoding: ESBLs, pAmpC, carbapenemases, plasmid-mediated quinolone resistance, virulence factors in Escherichia coli and Klebsiella pneumoniae isolates, occurrence of classes 1 and 2 integrons, phylogenetic groups of E. coli isolates, ERIC-PCR and PCR-based replicon typing) and conjugal transfer experiments. In total, 65 out of 227 (28·6%) hospitalized children were colonized with CTX-M-R-En, and 70 isolates were identified. Isolates were 59 ESBL-, 7 plasmidic-AmpC (pAmpC)-, 3 ESBL+pAmpC-, and one ESBL+carbapenemase producers. The following bla genes were identified: blaCTX-M-15 (n = 54), blaCTX-M-1 (n = 5), blaCTX-M-9 (n = 2), blaCTX-M-13 (n = 1) and blaCTX-M-14 (n = 1), blaCMY-2 (n = 5), blaCMY-4 (n = 4), blaACC-1 (n = 1) and blaOXA-48 (n = 1). Our results showed that hospitalized children were colonized with various CTX-R-En-producing several beta-lactamase enzymes.


[Clinical study on jianfei pill in preventing and treating recurrence of infantile asthma].
Further explore on preventing and treating recurrence of infantile asthma with TCM method and its mechanism. Using Jianfei Pill (JFP) which was prepared according to the therapeutic principle of strengthening the body resistance to consolidate the constitution and promoting blood circulation to remove obstruction in the channels in treating 56 patients suffering from asthma. Their pulmonary functions were observed. A total effective rate of 91.1% was shown in JFP group, which was higher than that of the control group (60%), P < 0.01. In comparison with the control group, the level of serum IgA, IgG and E-rosette ascend significantly (P < 0.01). The wave amplitude of pulmonary impedance rheogram and right heart index (HI) also increased significantly (P < 0.01), while pulmonary arterial pressure (PPA) and pulmonary vascular resistance (PVR) dropped markedly (P < 0.01). JFP might work by means of enhancing the immune function and improving the pulmonary microcirculation to control chronic bronchial inflammation and reduce its reactivity to prevent the relapse of asthma.


Short Symptom Duration Is Associated With Superior Outcomes in Patients Undergoing Primary Hip Arthroscopy: A Systematic Review.
To evaluate the effect of duration of preoperative hip pain symptoms on outcomes in patients undergoing primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome. A systematic review of the literature was conducted with the following key words: "hip arthroscopy," "outcomes," "femoroacetabular impingement," "duration," "symptoms," "time," "delay," "earlier," and "timing" was performed in PubMed and Cochrane in May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for this review. When available, article information including the author, study type, study period, and follow-up, demographics, preoperative duration of symptoms, surgical outcome tools, and secondary surgeries were recorded. Six studies including 3,298 hips were included in this systematic review. Five studies had a minimum of 2 years' follow-up, and 1 study had a minimum of 5 years' follow-up. Femoroacetabular impingement (including subtypes cam and pincer impingement) was a surgical indication in all 6 studies and the most common indication for surgery. All 6 studies reported patient-reported outcome scores. All studies conducted statistical analyses comparing the duration of symptoms' effect on outcomes and found superior outcomes in patients with shorter duration of symptoms before hip arthroscopy. In 3 studies, modified Harris Hip Score, Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sports-Specific Subscale, and visual analog scale for satisfaction ranged from 79.1-82.6, 86.3-88.4, 75-75.5. and 75.3-82.5, respectively, in cohorts with <2-year duration of symptoms, compared with 72-77.7, 79.6-84, 65.0-66.7, and 69.7-75.3 in >2-year cohort. Similarly, in one study, the <2-year duration group was reported to have a conversion to total hip arthroplasty rate of 0.6% and an overall secondary surgery rate of 0.9%, whereas the >2-year duration group had a conversion to total hip arthroplasty rate of 6.4% and an overall secondary surgery rate of 10.1%. Patients with hip pain symptoms of less than 2 years before arthroscopic treatment of femoroacetabular impingement syndrome have better outcomes than those patients who had a longer duration of symptoms. However, significant improvements can still be expected regardless of time between onset of symptoms and surgery. Level IV, systematic review of Level III and Level IV studies.


Resolution of hydronephrosis after pyeloplasty in children.
There is still a lack of knowledge regarding the natural course of resolution of hydronephrosis after pyeloplasty, and no consensus exists on how resolution of hydronephrosis is defined or when resolution is expected to occur. To determine when resolution of hydronephrosis occurs following pyeloplasty, by type of obstruction and by surgical approach. This retrospective study included 125 children age <15 years treated with pyeloplasty and followed for two years with repeated ultrasound and MAG3 scan. Children with single kidneys, bilateral disease, and without hydronephrosis were excluded. Children with re-interventions were excluded in the evaluation of hydronephrosis but not in terms of success rate. Outcomes time to resolution of hydronephrosis (Anterior-Posterior diameter (APD) <10 mm or >50% reduction of APD) and 2-year success rate. Exposure was surgical approach and type of obstruction (intrinsic/extrinsic). Survival analysis was performed, adjusting for age, gender, year, laterality, preoperative renal function on MAG3, calyces dilatation and APD in the multivariable analysis. At 12 months and 24 months follow-up, 90% and 93% had reached resolution, respectively. All children with persistent dilatation had improved drainage and stable or improved function on MAG3. There was no difference in time to resolution of hydronephrosis between open versus robotic-assisted laparoscopic surgery (adjusted HR 0.90, [0.54-1.52], p = 0.70), nor between different types of obstruction (aHR 0.84 [0.53-1.34], p = 0.47). Eight children had re-intervention, all identified within 3 months after primary surgery, and four had a postoperative drop on MAG3, giving a total success rate of 91% (121/135). The vast majority of cases resolve and do so within 12 months from surgery. Since the improvement of hydronephrosis seems small between the first and second year after surgery, the value of follow-up beyond 12 months could be questioned. Based on the present study and previous literature we would recommend that children with persisting dilatation should continue their follow-up with ultrasound beyond 12 months. Children with complete resolution of their hydronephrosis at 12 months do not likely benefit from further follow-up. The same follow-up protocol should be applied, regardless of whether the obstruction is intrinsic or extrinsic in nature, or the surgery is performed with open or robotic-assisted approach. Overall, the definition of resolution of hydronephrosis varies in the literature and have impact on the results and may compromise comparisons. Surgical approach or type of obstruction does not seem to affect time to resolution of hydronephrosis after pyeloplasty in children. Follow-up with ultrasound beyond 12 months does not seem to benefit children with complete resolution.


Effects of cages, plant age and mechanical clipping on plantain chemistry.
In plant-insect herbivore field studies, effects of cages, plant age, and mechanical clipping on host plant chemistry are often postulated but not well documented. We examined the effects of cages (for the purpose of restraining insects on experimental plots), plant age over the course of the experiment and mechanical clipping on plantain (Plantago lanceolata) chemistry. Leaf age affected the concentrations of nitrogen and iridoid glycosides (IGs; specifically aucubin and catalpol), with higher levels in newer leaves. Caged plants had higher levels of IGs and lower concentrations of nitrogen than uncaged plants. The IG concentrations were greater in new leaves of caged plants than uncaged plants, whereas the concentrations in mature leaves were unaffected by caging. Plants that were 5 weeks older had higher levels of IGs and lower nitrogen than plants harvested 5 weeks earlier. Comparison of three studies suggested that over the summer IG concentrations increase during dry years but decrease during wet years. Plants with above-ground parts clipped and then allowed to regrow for five weeks had similar concentrations of IGs and nitrogen compared to control plants; but the regrowth plants had a lower catalpol to total IG ratio. We conclude that cages and time can have significant positive effects on iridoid glycoside concentrations and significant negative effects on leaf nitrogen concentration. But our results also indicate that the direction and magnitude of the effects of cages, time and mechanical damage are not easily predicted. Therefore, it is advisable to determine and/or control for such effects in field experiments on plant-insect interactions.


Inhibition of epoxide hydrolases and glutathione S-transferases by 2-, 3-, and 4-substituted derivatives of 4'-phenylchalcone and its oxide.
4'-Phenylchalcones, chalcone oxides, and related compounds were synthesized and tested as inhibitors of cytosolic epoxide hydrolase, microsomal epoxide hydrolase, and glutathione S-transferases from mouse and rat liver. Several compounds were more potent inhibitors of the cytosolic epoxide hydrolase than the parent 4'-phenylchalcone oxide while large substituents in the 4- and especially the 2-position caused a reduction in inhibition. The chalcone oxides showed selectivity as inhibitors of the cytosolic epoxide hydrolase acting on trans-stilbene oxide, while chalcones were inhibitors of cytosolic glutathione S-transferase acting on cis-stilbene oxide. Data are consistent with the hypothesis that much of the inhibition of the glutathione S-transferase is caused by the glutathione conjugate of the chalcone.


Prospective assessment of patient-rated symptoms following whole brain radiotherapy for brain metastases.
To prospectively assess patient-rated symptoms in patients with brain metastases treated with whole brain radiotherapy, these patients were asked to rate their symptoms on the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8, and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a scale of 0-10 (0=absence of symptom and 10=worst possible symptom). Patients with a language barrier or significant cognitive impairment were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and P < 0.01 was considered statistically significant. One hundred seventy patients (102 female and 68 male) were included between January 1999 and January 2002. Their median age was 66 years (range 33-84) and the median Karnofsky performance score (KPS) at baseline was 60 (range 20-90). The most common primary cancer sites were lung (99; 58%), breast (32; 19%), gastrointestinal (16; 9%), unknown (14; 8%) and others (9; 6%). One-third had significant weight loss (> or =10% over the last 6 months). All patients were prescribed dexamethasone at varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions, 7 (4%); and others, 25 (15%). The baseline mean +/- SD for ESAS scores were: pain 2.4 +/- 2.8, fatigue 5.3 +/- 2.8, nausea 1.3 +/- 2.2, depression 2.8 +/- 2.7, anxiety 3.6 +/- 3.0, drowsiness 3.5 +/- 2.9, appetite 3.0 +/- 3.2, sense of well-being 3.8 +/- 2.7, and shortness of breath 2.3 +/- 2.5. For the entire cohort, after the delivery of palliative radiotherapy for brain metastases, there were statistically significant deteriorations in the mean differences from the baseline for the following ESAS domains: fatigue 1.0 to 1.8; drowsiness 1.2 to 1.8; and appetite 2.2 to 2.4. The data demonstrate that certain parameters of quality of life worsen after whole brain radiotherapy.


A novel synthetic Piper amide derivative NED-180 inhibits hyperpigmentation by activating the PI3K and ERK pathways and by regulating Ca2+ influx via TRPM1 channels.
Piper amides have a characteristic, unsaturated amide group and exhibit diverse biological activities, including proliferation and differentiation of melanocytes, although the molecular mechanisms underlying its antimelanogenesis effect remain unknown. We screened a selected chemical library of newly synthesized Piper amide derivatives and identified (E)-3-(4-(tert-butyl)phenyl)-N-(2,3-dihydrobenzo[b][1,4]dioxin-6-yl)acrylamide (NED-180) as one of the most potent compounds in suppressing melanogenesis. In murine melan-a melanocytes, NED-180 downregulated the expression of melanogenic regulatory proteins including tyrosinase, Tyrp1, Dct, and MITF. PI3K/Akt-dependent phosphorylation of GSK3β by NED-180 decreases MITF phosphorylation and inhibits melanogenesis without any effects on cytotoxicity and proliferation. Furthermore, topical application of NED-180 significantly ameliorated UVB-induced skin hyperpigmentation in guinea pigs. Interestingly, data obtained using calcium imaging techniques suggested that NED-180 reduced the TPA-induced activation of TRPM1 (melastatin), which could explain the NED-180-induced inhibition of melanogenesis. All things taken together, NED-180 triggers activation of multiple pathways, such as PI3K and ERK, and inhibits TRPM1/TRPV1, leading to inhibition of melanogenesis.


Interface evaluation after manual and ultrasonic insertion of standardized class I inlays using composite resin materials of different viscosity.
The aim of the present study was to investigate the effect of manual and ultrasonic insertion of standardized class I inlays (Cerana) using three composite resin materials of different viscosity (Tetric Flow, Tetric, and Tetric Ceram) on time to seat inlays, film thickness, and filler distribution within the materials. In a preliminary test, mean loads for manual and ultrasonic insertion were measured using the high viscosity composite resin material (Tetric Ceram). These loads were then applied with all composite resin materials to evaluate the times required to seat the inlays. In addition, film thickness was assessed using scanning electron microscopy, and filler distribution (wt% silicon, barium, ytterbium) was monitored using energy-dispersive spectroscopy. Ultrasonic insertion significantly reduced mean load applied to seat inlays (6.4+/-1.4 N; mean+/-SD) as compared to manual insertion (18.9+/-3.1 N; p < 0.001). Using an ultrasonic device, times for insertion values were significantly lower in the high and medium viscosity composite resin material groups compared to manual insertion (p < 0.05). The widest film thickness was recorded for the high viscosity composite resin material in combination with manual insertion (p < 0.05). However, when ultrasound was applied, there was no difference in film thickness between the three materials at any levels. Furthermore, the analysis of filler distribution revealed no significant differences between groups. Highly filled viscous composite resin materials may be used in combination with the ultrasonic insertion technique without untoward effects on film thickness or filler distribution.


Nitrogen and carbon dynamics in C3 and C4 estuarine marsh plants grown under elevated CO2 in situ.
Carbon dioxide concentrations were elevated in three estuarine communities for an entire growing season. Open top chambers were used to raise CO2 concentrations ca. 336 ppm above ambient in monospecific communities of Scirpus olneyi (C3) and Spartina patens (C4), and a mixed community of S. olneyi, S. patens and Distichlis spicata (C4). Nitrogen and carbon concentration (% wt) of aboveground tissue was followed throughout growth and senescence. Green shoot %N was reduced and %C was unchanged under elevated CO2 in S. olneyi. This resulted in a 20%-40% increase in tissue C/N ratio. There was no effect of CO2 on either C4 species. Maximum aboveground N (g/m2) was unchanged in S. olneyi, indicating that increased productivity under elevated CO2 was dependent on reallocation of stored N. There was no change in the N recovery efficiency of S. olneyi in pure stand and a decrease in the mixed community. Litter C/N ratio was not affected by elevated CO2 suggesting that decomposition and N mineralization rates will also remain unchanged. Continued growth responses to elevated CO2 could, however, be limited by the ability of S. olneyi to increase the total aboveground N pool.


Development and validation of a nomogram for esophagogastric variceal bleeding in liver cirrhosis: A cohort study in 1099 cases.
Esophagogastric variceal bleeding (EVB) is a catastrophic complication of decompensated liver cirrhosis. We aimed to establish a nomogram based on noninvasive clinical and imaging variables to predict the risk of EVB. The cut-off value of each variable was determined through univariate regression analysis. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to determine the risk factors and establish predictive models. The nomogram was established and validated using the calibration discrimination across different groups. Six indicators, including platelet count, hemoglobin, albumin to globulin ratio, fasting blood glucose, serum chloride, and computed tomography portal vein diameter (CTPD), were found to be related to the risk of EVB. Two models, with or without CTPD, were established and compared. Model 1 with CTPD had better discrimination than model 2 with C-index of 0.893 (95% confidence interval [CI] 0.872-0.915) and 0.862 (95% CI 0.837-0.887) in the primary cohort, respectively (Z = 2.027, P = 0.043). While the C-index of the two models in the validation cohort was 0.878 (95% CI 0.838-0.919) and 0.810 (95% CI 0.757-0.863). Moreover, the clinical decision analysis curve and clinical impact curve showed that these models might confer a significant net benefit on patients and provide a reference threshold for clinicians. A nomogram using routine clinical indicators was established to predict the risk of EVB in patients with liver cirrhosis, which was verified in an independent cohort and demonstrated a great consistency.


A microanalytical protein assay using laser densitometry.
Protein content of a wide variety of sample types may be determined by adsorption of microliter samples onto nitrocellulose, followed by amido black staining and laser densitometry. The method is quite rapid, sensitive, and selective, and dispenses with precipitation and transfer steps.


Prophylactic ankle bracing.
Many choices are available to athletes seeking an ankle support. The time-honored tradition of ankle taping with adhesive tape does offer protection against ankle sprains during activity. Laced stabilizers offer an equal or possibly greater amount of support, are less costly and easier to apply, and can be retightened frequently during activity. The physician should become familiar with one of these two methods and choose one based on availability and feasibility in the community. The air stirrup may be indicated for patients with a history of ankle injury who are undergoing a graduated rehabilitation program. Nevertheless, the air stirrup has not been shown to provide significantly greater inversion restriction than taping or lace-on braces and is not recommended as a first-line method of support for individuals with no history of recent ankle sprain. High-top shoes are better when the ankle is taped, although low-top shoes are better when a laced stabilizer is worn. Elastic guards help reduce ankle edema but do not provide ankle stability.


A multicenter validation of an active contour-based left ventricular analysis technique.
Quantitative analysis of functional cardiac magnetic resonance (MR) images has been limited by the lack of well-validated, semiautomatic, methods for rapid analysis. We describe the evaluation of a DICOM-compatible PC-based parallel-processing tool, for cardiac magnetic resonance analysis (CAMRA), which supports semiautomatic image mensuration using an active contour model-based algorithm. The CAMRA software was used to analyze data from 12 patients in a multicenter acquisition and analysis trial to compare semiautomatic contour detection with manual planimetry of the left ventricular endocardium from short-axis, breath-held, cine gradient-echo images. There was excellent agreement between the manual and semiautomatic measurements of global left ventricular function, with no significant (P = 0.32) difference in the determination of ejection fraction (-0.9 +/- 3.1% [mean difference +/- 1 standard deviation]). There was no significant interobserver difference in the semiautomatically measured ejection fraction. Additionally, a single observer completed the analysis on data from 30 patients and found no significant (P = 0.05) difference in the determination of ejection fraction (-1.3 +/- 3.5% [mean difference +/- 1 standard deviation]). The CAMRA software demonstrates the capability for the reproducible evaluation of global left ventricular function in cardiac patients, with adequate interobserver reproducibility for use in multicenter trials.


Mechano-signaling via Piezo1 prevents activation and p53-mediated senescence of muscle stem cells.
Skeletal muscle stem cells (MuSCs), also called satellite cells, are instrumental for postnatal muscle growth and skeletal muscle regeneration. Numerous signaling cascades regulate the fate of MuSCs during muscle regeneration but the molecular mechanism by which MuSCs sense mechanical stimuli remain unclear. Here, we describe that Piezo1, a mechanosensitive ion channel, keeps MuSCs in a quiescent state and prevents senescence. Absence of Piezo1 induces precocious activation of MuSCs, attenuates proliferation, and impairs differentiation, essentially abolishing efficient skeletal muscle regeneration and replenishment of the MuSC pool. Furthermore, we discovered that inactivation of Piezo1 results in compensatory up-regulation of T-type voltage-gated Ca2+ channels, leading to increased Ca2+ influx, which strongly induces NOX4 expression via cPKC. Elevated NOX4 expression in Piezo1-deficient MuSCs increases ROS levels and DNA damage, causing P53-dependent cellular senescence and cell death. The importance of the P53/P21-axis for mediating Piezo1-dependent cellular defects was confirmed by pharmacological inhibition of P53 in Piezo1-deficient mice, which abrogates increased senescence of muscle cells and normalizes muscle regeneration. Our findings uncover an essential role of Piezo1-mediated mechano-signaling in MuSCs for maintaining quiescence and preventing senescence. Reduced mechano-signaling due to decreased physical activity during aging may contribute to the increase of senescent cells and the decline of MuSC numbers in geriatric mice and humans.


In vivo staining test with methylene blue for bladder cancer.
An in vivo staining test with 0.2 per cent methylene blue was applied to 129 patients with bladder tumor and 16 patients with chronic cystitis within a 6-year interval. Although normal mucosa did not pick up the stain nonpapillary in situ and microinvasive carcinomas did so frequently. Moderate dysplasia was stained in about half of the patients. The intensity of the stain in papillary tumors was correlated with the histologic anaplasia (grade). Grade 1 tumors were stained poorly or unstained in 86 per cent of the tests, whereas grades 2 and 3 tumors picked up the stain in 74 and 96 per cent of the tests, respectively. Even a tiny tumor, if poorly differentiated, was identified easily by the blue stain. The histologic anaplasia of tumors could be assessed roughly according to the intensity of the stain. However, chronic cystitis occasionally took up the stain, especially in cases of marked inflammatory infiltrate a deep stain was recognized. To differentiate nonpapillary early cancer from chronic cystitis the addition of a cytologic examination may be necessary.


Effect of berberine and bicyclol on Chinese patients with nonalcoholic fatty liver disease: a retrospective study.
To compare the effect of berberine and bicyclol on patients with nonalcoholic fatty liver disease (NAFLD). Chinese nonalcoholic and non-viral hepatitis patients with a hepatic lipid content > 13% and nonalcoholic fatty liver disease activity score (NAS) ≥ 2 were treated with 500 mg berberine thrice daily, together with dietary modification (low-fat diet) and Tai Chi exercise for 4 months (BT cohort; n = 112), or 25 mg bicyclol thrice daily plus dietary modification and Tai Chi exercise for 4 months (CT cohort, n = 145), or dietary modification and Tai Chi exercise for 4 months (DT cohort, n = 128). Patients in the BT and the CT cohorts had improved anthropometric measurements (weight, height, body mass index, and waist-to-hip ratio), biochemical parameters (blood sugar, lipid profile, and liver functions tests), liver/spleen computed tomography findings, and liver biopsy results after 4 months of intervention (p < 0.05 for all). Bicyclol decreased the NAS in the CT cohort to a significantly greater degree than berberine in the BT cohort (p < 0.0001, q = 3.879). Patients in the DT cohort had reduced body mass index and waist-to-hip ratio (p < 0.05 for both). During the 4-month intervention, patients in the BT cohort had abdominal distension, mild diarrhea, constipation, nausea, and dyspepsia; patients in the CT cohort had dizziness and abdominal distension. Berberine or bicyclol plus dietary modification and Tai Chi exercise could control NAFLD without serious adverse effects. Dietary modification and Tai Chi exercise alone for 4 months are insufficient for the management of NAFLD. It is possible to reduce body weight by administering berberine or bicyclol.


Emergency department utilization: a comparative analysis of older-adults, old and old-old patients.
A comparative analysis of Emergency Department (ED) utilization by 2936 older-adults, old, and old-old patients was conducted in the only hospital available for residents of a vast geographical region. All patients (45+) who arrived at the ED during the first week of every even month from September 1986 to August 1987 were selected for the study. No significant differences were found among the three groups with regard to sociodemographic characteristics other than age. Data showed that the old-old use the ED approximately twice as much as the old and the older-adults; they also use the ED more often than the two other groups during the winter season. These two findings indicate the utility of viewing the old-old not only as a part of the elderly population, but also as a unique risk group. Hospitalization rates present a different pattern: they double in each age group moving from the youngest to the oldest. Complaints of an internal medicine nature are more often presented by the two groups of the elderly in comparison to the older-adults, and are followed by more frequent hospitalizations in internal medicine wards. Such findings have practical implications, and should be taken into consideration by policymakers.


No need to use both Disabilities of the Arm, Shoulder and Hand and Constant-Murley score in studies of midshaft clavicular fractures.
Background and purpose - Most newer randomized studies examining plate fixation and nonoperative treatment of midshaft clavicular fractures utilize both Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley score (CS) in the evaluation of patient outcomes. Compared with DASH, the use of CS requires on-site trained personnel and patient visits to obtain the score. The use of both DASH and CS should provide extra value compared with the use of a single functional outcome score; if this value is not provided, the combined use is not necessary. We evaluated the agreement between DASH and CS in patients with displaced midshaft clavicular fractures.Patients and methods - We used prospectively collected data from 146 patients enrolled in a randomized study comparing operative and nonoperative treatment of midshaft clavicular fractures. We determined correlation between DASH and CS at all follow-up points and calculated mean bias in the Bland-Altman plot.Results - We found moderate to high correlation (from 0.82 at 6 weeks' follow-up to 0.58 at 1-year follow-up) between DASH and CS score, and a small bias (2.21 [95% CI 0.22-4.20]) in the Bland-Altman plot.Interpretation - In patients with displaced midshaft clavicular fractures DASH and CS measures the same degree of disability. Unless specifically studying strength and range of motion, we recommend the sole use of DASH as it would eliminate potential observer-induced bias along with removing the economic and logistic burden of obtaining CS without compromising the value of the collected data.


Relationship between different physiological processes of Tomato seedlings exposed to acid mine water Uncovered using correlation analysis.
This study was conducted to assess the correlation between growth response, phytoaccumulation factor of different tissues, and elemental composition in tomato seedlings exposed to acid mine water (AMW). In pairwise correlation determinations values of plant height, stem diameter, seed germination indices (radicle length, final germination percentage (FGP), emergency rate index (ERI), vigour index (VI), germination percentage (G%) and germination rate index (GRI)) and the elemental compositions (Cd, Cr, Cu, Ni and Zn) in the different plant tissues, root (root accumulation factor = RAF), stem (stem translocation factor = STF) and leaves (leaf translocation factor = LTF) were selected for the relationship determinations. Pearson correlation coefficients were calculated and revealed the relationships between the paired parameters. The study concluded that the strongly correlated physiological parameters were jointly co-ordinated in tomato seedlings exposed to AMW.


Unexpected diagnosis of metastatic breast carcinoma in an endomyocardial biopsy done for cardiac allograft rejection evaluation.
We report a case of a 75-year-old female post orthotopic heart transplantation, who presented to the emergency department with a six-week history of shortness of breath, hand tremor and ultimately delirium. She had lobular breast carcinoma more than 5 years prior to her heart transplant, treated by lumpectomy followed by anthracycline based chemotherapy. The reason for her heart transplant was heart failure that was suspected to be from anthracycline cardiomyopathy, however, her explanted heart actually showed cardiac sarcoidosis. She was placed on long-term immunosuppression with tacrolimus, mycophenolate mofetil and prednisone. Two years after her heart transplant, she underwent bilateral mastectomies for recurrent breast cancer. Her neurological workup, including brain imaging (CT, MRI, LP and EEG) did not show any structural abnormalities, ischemia, mass or neurosarcoidosis as cause for delirium. Tacrolimus was held due to renal dysfunction and hemolytic anemia, and then she developed signs of right heart failure so an endomyocardial biopsy was carried out for suspected allograft rejection. The biopsy did not show any evidence of cellular or antibody medicated rejection; however, it demonstrated infiltration by bland appearing cells with signet ring morphology cells many of which showed intracytoplasmic mucin. The cells were strongly positive with cytokeratins AE1/3, CK7 and mammaglobin. The morphology and immunoprofile were consistent with metastatic lobular breast carcinoma and this was thought to be the cause of her clinical presentation with delirium, hemolytic anemia and renal dysfunction as a paraneoplastic syndrome.


Histopathologic approach to the surgical lung biopsy in interstitial lung disease.
Interpretation of lung biopsy specimens is an integral part in the diagnosis of interstitial lung disease (ILD). The process of evaluating a surgical lung biopsy for disease involves answering several questions. Unlike much of surgical pathology of neoplastic lung disease, arriving at the correct diagnosis in nonneoplastic lung disease often requires correlation with clinical and radiologic findings. The topic of ILD or diffuse infiltrative lung disease covers several hundred entities. This article is meant to be a launching point in the clinician's approach to the histologic evaluation of lung disease.


Psychotic Disorders in the Elderly: Diagnosis, Epidemiology, and Treatment.
This review covers the latest advances in our understanding of psychosis in the elderly population with respect to diagnosis, epidemiology, and treatment. Major topics of discussion include late life psychiatric disorders such as schizophrenia, schizoaffective disorder, and delusional disorder as well as dementia-related psychosis. Clinical differences between early-onset and late-onset disorders are reviewed in terms of prevalence, symptomatology, and approach to treatment. Newly revised research and clinical criteria for dementia-related psychosis are referenced. The evidence base for emerging therapies including citalopram and pimavanserin in relation to conventional therapies such as atypical antipsychotics are discussed..


Young adults' experiences with flexitarianism: The 4Cs.
Meat reduction has important implications for public health and the environment. With people more likely to reduce their meat consumption than eliminate it completely, there is increased interest in flexitarian (reduced meat) diets. Young adults in particular are transitioning towards a flexitarian diet, yet there is very little research on this crucial sub-set of the population. In this research, 23 interviews are conducted with young adults aged 18-35 in New Zealand to explore their lived experiences (i.e., motivations, strategies and barriers) towards flexitarianism. The research finds young adults are encouraged to transition towards flexitarianism due to increased control, through a transition away from home which is enabled through cooking strategies, social support and experimentation. Young flexitarians are motivated to reduce meat consumption due to concern about various individual (health, variety, price, reduce social unease) and altruistic (environment and ethics) motivations. Continued meat consumption is mainly driven by a need to compromise at social gatherings, and due to positive associations with variety, nutrients and fullness as well as taste due to cravings. The findings have several implications for social marketing and public health, particularly around supportive social settings, seeing flexitarianism as a 'not all or nothing approach' (one does not have to be a full vegetarian or a meat eater, but can instead be something in between), positive emotions such as pride associated with meat reduction, and that documentaries and social networks are key triggers for meat reduction.