Polymorphisms in the beta2 adrenergic receptor and bronchodilator response, bronchial hyperresponsiveness, and rate of decline in lung function in smokers.
Non-specific bronchial hyperresponsiveness (NSBH) is a known predictor of accelerated rate of decline in lung function in smokers. Polymorphisms of the beta(2) adrenergic receptor (ADRB2) have previously been associated with NSBH and bronchodilator response (BDR) in asthmatics. Based on these associations, we hypothesised that ADRB2 polymorphisms would be associated with NSBH and BDR as well as an accelerated rate of decline in lung function among smokers. The prevalence of two ADRB2 polymorphisms, Arg16-->Gly and Gln27-->Glu, was examined in 587 smokers chosen from the NHLBI Lung Health Study for having the fastest (n=282) and slowest (n=305) 5 year rate of decline in forced expiratory volume in 1 second (FEV(1); mean DeltaFEV(1) -4.14 and +1.08% predicted/year, respectively). Contrary to our hypothesis, no ADRB2 allele or haplotype was associated with NSBH, BDR, or rate of decline in lung function. However, there was a significant negative association between heterozygosity at position 27 and a fast decline in lung function (adjusted odds ratio 0.56, 95% CI 0.40 to 0.78, p=0.0007). Heterozygosity at position 27 may be protective against an accelerated rate of decline in lung function. The polymorphism at position 16 does not contribute to the rate of decline in lung function, measures of NSBH, or BDR in smokers.


Molecular Insights into Endometrial Cancer in Mice.
Pluripotent, very small embryonic-like stem cells (VSELs) and the 'progenitors' endometrial stem cells (EnSCs) along with associated molecular changes in endometrial cancer, that developed seven months after neonatal exposure to estradiol in one of the sixty mice, were studied in the present study. Endocrine disruption affected both endometrium and myometrium, there was accumulation of endometrial fluid and significant hyperplasia. Disrupted endometrial-myometrial junction resulted in mobilization of myometrial cells into endometrium and epithelial and stromal cells into myometrium suggestive of adenomyosis. Markers specific for VSELs/ EnSCs (OCT-4, NANOG, SSEA-1, SCA-1, c-KIT) showed increased expression in uterine sections and marked upregulation of corresponding transcripts (Oct-4A, Oct-4, Sox-2, Nanog, Sca-1, c-Kit) was noted in RNA extracted from both uterine tissue and stem cells enriched from endometrial fluid. Hormonal receptors (ER-α, ER-β, PR, FSHR) were upregulated in both tumor sections and in endometrial fluid. ER-β and FSHR (Fshr3) expression was prominent suggesting a major role in endometrial cancer. Cancer cells showed global hypomethylation (reduced expression of 5-methyl cytosine), reduced expression of tumor suppressor gene (PTEN) and increased expression of cancer stem cells marker (CD166) which suggested dysregulation and aberrant oncogenic events. Increased expression of PCNA, Ki67, SOX-9 suggested excessive proliferation and hyperplasia which are predominant signs of endometrial cancer. Results suggest that VSELs increase in numbers and possibly transform into cancer stem cells (co-express CD166 and OCT-4) in endometrial cancer. Expression of OCT-4, CD133, ALDHA1 and CD166 in side-population cells from human endometrial cancer samples suggests a possible role of VSELs in human endometrial cancer as well.


Reiter's syndrome. Diagnosis and clinical features.
After a short review of the history of Reiter's diseases, new definitions of what is now called reactive arthritis are proposed. The best definition is based on a multiple-entry set of criteria validated by other members of the spondyloarthropathy group. This definition needs no reference to origin hypothesis and no exclusion criteria. The epidemiology of Reiter's syndrome is also discussed, and the problems due to previously imprecise definitions are emphasized. Clinical features are described and divided into four syndromes: peripheral arthritis, enthesopathic, pelvic and axial, and extramusculoskeletal syndromes; seven predictive factors of long-term evolution are proposed. Differential diagnosis is discussed within and without the spondyloarthropathy group.


Comparing combined laser iridoplasty and surgical iridectomy with trabeculectomy in treatment of refractory acute primary angle closure without significant cataract: a randomized controlled trial.
To compare the safety and efficacy of combined laser iridoplasty followed by surgical iridectomy (LI-SI) versus trabeculectomy in the management of medically unresponsive acute primary angle closure (APAC) with minimal cataract. This was a randomized controlled trial conducted among patients with medically unresponsive APAC without significant cataract. Study participants were randomized into: LI-SI or unaugmented trabeculectomy. Primary outcome of the study was the rate of post-operative surgical complications in the first 3 months after surgery. Secondary outcome assessed at 1 year was whether treatment was completely successful (IOP < 21 mmHg without IOP lowering drops), or partially successful (IOP < 21 mmHg with IOP lowering drops). Failure was defined as IOP ≥ 21 mmHg with IOP lowering drops. The study included 67 eyes of 67 patients (59 females/8 males = 7.4/1) who were randomized into 2 groups: LI-SI (Group 1, 37 eyes), and trabeculectomy (Group 2, 30 eyes). There was no statistical difference between the two groups at baseline. Overall, there were more post-operative complications in Group 1 versus Group 2 (45.9% versus 33.3% - p = 0.23), although all responded well to medical treatment and resolved without sequelae. Complete success was found in 97.1% (34/35 eyes) in Group 1 and 92.6% in group 2 (p = 0.19, Fisher's exact test). There was a higher rate of post-operative complications after LI-SI compared to trabeculectomy performed for medically unresponsive APAC with minimal cataract. Both procedures had similar surgical outcomes at 1 year.


Statistics of the LS-detector in the case of low counting efficiency.
In the case of high-quenched 3H and 63Ni sources a distinct incompatibility of theoretical and experimental detection efficiency in the triple liquid scintillation (LS) detector was observed (Appl. Radiat. Isot. 52 (2000) 643). The authors concluded, that the Poisson distribution does not properly describe the detection process, when less than one photoelectron is expected in one of the photomultipliers. Application of other distributions of photoelectrons, e.g. binomial, does not solve the observable problem of incompatibility. Measurements of a set of 55Fe sources have been performed with phototubes defocusing and grey filters for decreasing the counting efficiency of the TDCR detector. Differences between counting results of the 55Fe source and the light emitting diode (LED), simulating the scintillation source, excited by a pulse generator have been observed. Various distributions (Poisson, binomial and Polya) were used for the determination of the theoretical counting efficiency in both cases. The Poisson law gave a good result in the case of the LED but the Polya law had to be applied in the case of 55Fe. The results were independent of the scintillator volume. It seems that the validity of the Polya law in the case of LS-sources is related to the scintillator itself. Measurements of the 3H solution confirmed that conclusion.


An update on emerging immunological targets and their inhibitors in the treatment of psoriasis.
Psoriasis is a non-communicable, heterogeneous, autoimmune, inflammatory skin disease characterised by reddish, scaly plaques that grow over time. Psoriasis affects people in all countries with all age groups. The World Psoriasis Day organisation claims that out of 125 million people on this planet - Psoriasis affects about 2.5% to 3% of the population. The symptoms of psoriasis are unpredictable, and there are several external factors and associated comorbidities including psoriatic arthritis, renal failure, gastrointestinal disease, cardiovascular disease, stroke, obesity, diabetes, hypertension, mental disorders, cancer and a higher risk of death due to the systemic inflammation associated with the condition. In 2014, the WHA resolution identified that psoriasis is a severe non-communicable condition that affects both men and women. According to the declaration, several individuals suffer excessively from psoriasis all across the world as a result of inaccurate or delayed diagnosis, poor treatment solutions, minimal healthcare access, and social stigmatisation. Focusing on the function of cytokines and small-molecule inhibitors in the pathogenesis of disease could benefit the development of newer anti-psoriasis therapies. This is an updated comprehensive review that provides insight into the management of psoriasis with different therapeutic approaches and gives a brief idea about immunological signalling molecules that play a crucial part in the disease progression. We also highlighted the potential involvement of interleukins in the context of psoriasis, which may help the research community in its hunt for new treatments.


Spectral domain OCT features in type 2 macular telangiectasia (type 2 MacTel): its relevance with clinical staging and visual acuity.
To report spectral domain optical coherence tomography (SDOCT) imaging findings in type 2 macular telangiectasia (MacTel) and correlate them with clinical stages and visual acuity. This retrospective, cross-sectional study included type 2 MacTel cases who underwent SDOCT imaging with Spectralis machine. Macular SDOCT images were analysed. Imaging features were tested for correlation with different clinicals stages and visual acuity. 212 eyes of 108 type 2 MacTel patients were included. Hyperreflective middle retinal layer (87%) was the most frequently detected abnormality. This was followed by inner retinal cavities (49%), outward bending of inner retinal layers (35%), retinal pigment clumps (35%) and foveal contour irregularity (31%). Hyperreflective middle retinal layers (p < 0.001), inner (p = 0.032) and outer retinal (p = 0.002) cavities and internal limiting membrane drape (p = 0.031) were associated with poor vision in non-proliferative group and presence of retinal pigment clumps (p = 0.002), subretinal fluid (p = 0.037) and foveal contour irregularity (p < 0.001) were associated with poor vision in proliferative group. The described SDOCT features are practical for the diagnosis and staging in type 2 MacTel. Presence of hyperreflective middle retinal layers, hyporeflective inner and outer retinal cavities and internal limiting membrane drape were associated with poor vision in the non-proliferative group while retinal pigment clumps and subretinal neovascular membrane were associated with proliferative group and poor vision. Further long-term studies are required to describe the progressive and sequential changes on SDOCT.


[Lifestyle drugs in medicine].
Lifestyle drugs have become an important new group of medications, which are taken by healthy people to increase the individual well-being and quality of life. Nootropics, psychopharmaceuticals, hormones and "ecodrugs" are today the main groups. The wish for eternal youth, beauty and potency is central, and lifestyle medications are also requested to influence cosmetic findings, which are usually simply a result of the natural aging process. Lifestyle drugs seem to be harmless, but the physician must pay attention to possible abuse, side effects, risks and complications. Additionally, however, lifestyle drugs are also frequently used by patients suffering from emotional disorders such as somatoform disorders. Medicalization of physiological life is then expected to solve psychosocial problems, but without success. The use of lifestyle medications in somatoform disorders is contraindicated and psychotherapy or psychopharmacological treatment come first. With this overview article, we would like to make an update of new lifestyle drugs.


Adsorption of indium by waste biomass of brown alga Ascophyllum nodosum.
The biosorption capacities of dried meal and a waste product from the processing for biostimulant extract of Ascophyllum nodosum were evaluated as candidates for low-cost, effective biomaterials for the recovery of indium(III). The use of indium has significantly grown in the last decade, because of its utilization in hi-tech. Two formats were evaluated as biosorbents: waste-biomass, a residue derived from the alkaline extraction of a commercial, biostimulant product, and natural-biomass which was harvested, dried and milled as a commercial, "kelp meal" product. Two systems have been evaluated: ideal system with indium only, and double metal-system with indium and iron, where two different levels of iron were investigated. For both systems, the indium biosorption by the brown algal biomass was found to be pH-dependent, with an optimum at pH3. In the ideal system, indium adsorption was higher (maximum adsorptions of 48 mg/g for the processed, waste biomass and 63 mg/g for the natural biomass), than in the double metal-system where the maximum adsorption was with iron at 0.07 g/L. Good values of indium adsorption were demonstrated in both the ideal and double systems: there was competition between the iron and indium ions for the binding sites available in the A. nodosum-derived materials. Data suggested that the processed, waste biomass of the algae, could be a good biosorbent for its indium absorption properties. This had the double advantages of both recovery of indium (high economic importance), and also definition of a virtuous circular economic innovative strategy, whereby a waste becomes a valuable resource.


Gender differences in antipsychotics prescribed to veterans with serious mental illness.
To examine gender differences in prescribing of antipsychotic medications (APMs) according to their liability for weight gain and other metabolic side effects. We identified 4510 patients with schizophrenia or bipolar disorders receiving usual care in a Veterans Affairs (VA) health care network in the U.S. mid-Atlantic region who initiated treatment with an APM between October 2006 and September 2011. We used multivariable logistic regression to examine gender differences in the likelihood of incident prescription of APMs with low versus medium/high metabolic risk, adjusting for fiscal year of prescribing and selected Veteran demographic, mental health and physical health characteristics. Overall, 58% of women were prescribed an APM with a low risk of metabolic side effects compared to 45% of men (P<.001). In multivariable analysis, women Veterans were 1.47 times as likely as men to be prescribed a low-metabolic-risk APM (95% confidence interval: 1.26-1.73, P<.001). Several demographic and clinical covariates were also independently related to prescribing of APMs by level of metabolic risk. The results may suggest that prescribing choices for APMs by VA mental health prescribers and female Veterans reflect a growing awareness of the potential adverse health consequences of these treatments in women.


Bladder cancer detection and surveillance: carcinoembryonic antigen as a monitor of neoplastic transformation.
Routine cytopathology of exfoliated urothelial cells will identify only 70% of patients with transitional cell carcinoma (TCC) because most well-differentiated bladder tumors are not detected. Carcinoembryonic antigen (CEA) was identified on urothelial cancer cells from 66% of patients with grade I TCC, 65% with grade II TCC, 65% with grade III TCC, and 80% of patients with CIS. Immunoperoxidase labelling of CEA can enhance the sensitivity of exfoliative cytology.


A clustering classification of catchment anthropogenic modification and relationships with floods.
Anthropogenic modifications at catchments scale may be reconducted primarily at soil sealing and streams culverting, even if important consequences result from roads density and, more in general, infrastructures as they cause landscape fragmentation, and agricultural areas extension. Their most important outcomes in terms of hydrologic balance are the decreasing time of concentration and the increasing flood risk at catchment scale. The research introduces a methodological approach to classify the degree of anthropogenic modifications at catchment scale: clustering techniques have been applied to 508 catchments in a high-risk flooding sector of the Mediterranean region. Then, flood data recorded in the study area in the 1900-2018 period have been compared to clustering classification, pointing out the relationships with soil sealing and hydrographical network culverting in the catchment. The analysis has been performed considering fourteen subsets of 8 descriptive parameters each that differ in the evaluation of culverting in the terminal part of the hydrographical network; the analysis has been conducted identifying the optimal number of descriptive parameters and the corresponding best number of clusters on quantitative basis. The results show that three classes clustering is the more appropriate from a computational point of view. That division looks coherent with the features of the studied basins and is well correlated with floods occurrence in the last 100 years. Finally, the proposed methodology of anthropogenic disturbance classification at catchment scale may be applied to other areas even adapting and implementing other descriptive parameters. Then, it may be used to support the planning of mitigation strategies in term of flood risk.


Hormonal and metabolic response to physical exercise, fasting and cold exposure in the rat. Effects on ketogenesis in isolated hepatocytes.
Four groups of rats were subjected to the following conditions: (1) 48 h fasting, (2) 48 h of 4 degrees C cold exposure, (3) 5 h treadmill running, (4) 48 h fasting with 4 degrees C cold exposure. The groups were compared to fed control rats in order to study hormonal and metabolic responses in blood and tissue samples. Isolated hepatocytes were used to evaluate the rate of ketogenesis. Decreases in liver glycogen and increases in blood free fatty acids (FFA) confirmed that glycogenolysis and lipolysis occur in these situations of metabolic stress. Increases in the glucagon/insulin plasma ratio were also noted. Plasma catecholamine levels were only enhanced after running and after cold exposure. Production of blood ketone bodies was stimulated more by running and by fasting than by cold exposure. The low ketone body production observed after cold exposure seems to be linked to increases liver glycogen levels and decreased FFA availability. Liver cells isolated after cold exposure exhibited higher ketogenesis than these isolated after running. This difference in ketogenic capacity could result both from the longer hormonal stimulation by high glucagon/insulin plasma ratios and from the metabolic state of the liver.


Effect of carbon nanotubes loading on the photocatalytic activity of BiSI/BiOI as a novel photocatalyst.
In this paper, a simple hydrothermal method is employed to synthesize BiSI/BiOI/CNT nanocomposite with enhanced photocatalytic activity. The properties of the prepared samples were studied using nitrogen adsorption-desorption isotherm, photoluminescence, X-ray diffraction analysis (XRD), field-emission scanning electron microscopy (FE-SEM), energy dispersive spectrometry (EDS), UV-vis diffuse reflectance spectroscopy (DRS), and electrochemical impedance spectroscopy (EIS). The loading amount of CNT had a significant influence on the photoactivity of the BiSI/BiOI/CNT composite. In this study, several BiSI/BiOI/CNT nanocomposite samples with various mass ratios of CNT were made-up for further investigation to scrutinize the influence of CNT content on the photocatalytic activity of the nanocomposite. Photocatalysis measurements revealed that 2% Wt of CNT possesses the highest photocatalytic activity in the visible light irradiation with 93.1% photodegradation of malachite green (MG) as a test dye. The enhanced photocatalytic performance can be due to the large surface area, excellent conductivity performance, and high absorption ability in the visible light region. The synergistic effect of the factors mentioned above makes BiSI/BiOI/CNT nanocomposite a high-performance photocatalyst under visible light irradiation. An appropriate reaction mechanism of dye photodegradation has suggested according to the result of active species trapping experiments.


Embolisation of the ophthalmic artery branches distal to its visual supply.
A study of the embryology and the anatomy of the ophthalmic artery shows that the branches to the important sensory structures arise proximal to the second intraorbital segment of the vessel. Damage to vision will be avoided if embolisation is restricted to vessels anterior to this "safety point", which is easily recognised on an angiogram. The ideal point of injection of emboli is even more distal and varies with the extent of the lesion and the material used. Three cases are described with vascular lesions supplied by the ophthalmic artery and embolised with Histoacryl.


Ten-week lifestyle changing program reduces several indicators for metabolic syndrome in overweight adults.
We aim to investigate the effectiveness of a 10-week lifestyle intervention focusing on physical activity and high fiber intake for reducing indicators for metabolic syndrome in overweight-obese individuals. A prospective study of 50 overweight (OW) adults (22 in the general educational group - G1; 28 in the high fiber nutrition group - G2) was performed. Both groups were offered dietary counseling and supervised exercise. Clinical, anthropometric, dietary and plasma biochemical tests were performed at baseline - time 0 (T0) and after 10 weeks - time 1 (T1). Both groups improved their dietary quality, but only G2 presented higher intake of fruit and vegetables (servings/day), higher plasma β-carotene levels and a 24% reduction of MetS incidence. Additionally G2 showed greater reductions in body fat (4%), and waist circumference (7%), obesity class III (2%) and obesity class II (14%) rate. Lifestyle intervention, including a high dietary fiber intake, improved healthy eating index and decreased body fat composition and plasma lipid concentrations leading to MetS incidence reduction.


Development of a cancer camp for adult Spanish-speaking survivors: lessons learned from Camp Alegria.
The serious psychosocial and emotional side effects of cancer and its treatment negatively affect the lives of breast cancer survivors. Camp Alegria, in 2005, was the first oncology camp offered to Latina breast cancer survivors. This 3-day camp (N = 58 women) provided a culturally and linguistically relevant program that empowered Spanish-speaking women diagnosed with breast cancer and gave them an opportunity to gain support from other cancer survivors facing similar challenges. Process evaluation results illustrate high satisfaction with the overall program, format, educational and recreational activities. This paper describes the camp development, experiences, and lessons learned.


Silymarin Protects Against Impaired Autophagy Associated with 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine-Induced Parkinsonism.
1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) exacerbates mitochondrial impairment and α-synuclein expression leading to Parkinsonism. Impaired mitochondria and over-expressed α-synuclein are degraded and eliminated via macroautophagy and chaperone-mediated autophagy. Owing to multiple properties, silymarin protects from oxidative stress-mediated cellular injury. However, its effect on MPTP-induced changes in autophagy is not yet known. The study aimed to decipher the effect of silymarin on MPTP-induced changes in autophagy. Male mice (20-25 g) were treated with silymarin (intraperitoneally, daily, 40 mg/kg) for 2 weeks. On day 7, a few animals were also administered with MPTP (intraperitoneally, 20 mg/kg, 4 injections at 2-h interval) along with vehicles. Striatal dopamine content was determined. Western blot analysis was done to assess α-synuclein, beclin-1, sequestosome, phosphorylated 5' adenosine monophosphate-activated protein kinase (p-AMPK), lysosome-associated membrane protein-2 (LAMP-2), heat shock cognate-70 (Hsc-70), LAMP-2A, phosphorylated unc-51-like autophagy activating kinase (p-Ulk1), and phosphorylated mechanistic target of rapamycin (p-mTOR) levels in the nigrostriatal tissue. Silymarin rescued from MPTP-induced increase in beclin-1, sequestosome, p-AMPK, and p-Ulk1 and decrease in LAMP-2, p-mTOR, and LAMP-2A levels. Silymarin defended against MPTP-induced increase in α-synuclein and reduction in dopamine content. The results demonstrate that silymarin protects against MPTP-induced changes in autophagy leading to Parkinsonism.


Crossed renal ectopia and abdominal aortic aneurysm.
A case of crossed renal ectopia assoicated with abdominal aortic aneurysm is reported. This is believed to be the first known case of these entities occurring together. It is important for the urologist to be cognizant of the possibility of such an association so that appropriate surgical correction of the aneurysm may be carried out without undue delay. The importance of a preoperative intravenous pyelogram for all patients undergoing abdominal aortic aneurysm repair is stressed.


Mechanical environment associated with rotator cuff tears.
A simplified 2-dimensional finite element model was used to investigate the stress environment in the supraspinatus tendon. The extrafibrillar matrix and collagen fiber were modeled with fiber-reinforced composite elements. The stress was evaluated at humeroscapular elevation angles of 0 degree, 30 degrees, and 60 degrees. Two acromion conditions were simulated. In the first set of conditions there was no subacromial impingement. In the second set there was subacromial impingement of the bursal side. Impingement was simulated by producing a 1-mm indentation on the bursal surface, an indentation similar to the type of impingement associated with deltoid contraction. The results demonstrated that subacromial impingement generates high stress concentrations in and around the critical zone. Such high stress could initiate a tear; tears that result from stress point to an extrinsic mechanism. However, we found that high stress and potential tears caused by impingement may occur on the bursal side, the articular side, or within the tendon. This result is unaccounted for by traditional mechanical models in which only bursal-sided partial tears are initiated by subacromial impingement.


Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing, self-expandable fully covered metal stent for palliative biliary drainage.
In addition to the poor prognosis associated with pancreatic adenocarcinoma, it can also lead to several other conditions including obstructive jaundice that can affect a patient's quality of life. This is a major concern in non-operative patients where palliation is considered the main therapeutic goal. Traditionally, there are several ways to pursue palliative biliary drainage including endoscopic methods, a variety of surgical procedures, and percutaneous techniques. Generally, endoscopic methods such as endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stent placement are considered first-line therapies. Unfortunately, ERCP is not always possible due to several potential reasons. Although endoscopic ultrasound-guided biliary puncture has been well described for several years, there are limitations to its usefulness in biliary drainage, in part due to complication concerns. However, more recently a lumen-apposing, self-expandable fully covered metal stent has been employed for such situations. We describe two cases in which this type of stent was used in patients for palliative biliary drainage in pancreatic adenocarcinoma where standard ERCP was not feasible. In both cases, stent deployment was successful without immediate complications related to the procedure or the stent. Furthermore, the main goal of these therapies was palliation and in both cases the patient chose this procedure for quality of life reasons. In the future, randomized trials are needed to better define the long-term effectiveness and safety of these stents compared to more standard therapies.


Analyzing the cost-effectiveness of microvascular decompression and percutaneous radiofrequency rhizotomy for trigeminal neuralgia: the role of clinical classification.
Trigeminal neuralgia (TN) is a neuropathic pain that can be treated with microvascular decompression (MVD) or percutaneous radiofrequency rhizotomy (PRR) when medications fail. However, the cost-effectiveness of these interventions is uncertain, and it is unclear whether TN should be considered as a single entity for cost-effectiveness analysis. To address these issues, a prospective cohort study was conducted between 2017 and 2020, documenting Burchiel et al.'s clinical classification, pain-free survival, complications, and costs. Two models of quality-adjusted life years (QALYs) were calculated: pain-specific (PQALY) and pain-complication-specific (PCQALY), based on pain-free survival and complications data, followed by cost-effectiveness analysis. The study included 112 patients, of whom 70 underwent MVD and 42 underwent PRR. Our findings revealed that MVD was less cost-effective in the PCQALY model than PRR, but more cost-effective in the PQALY model and had an incremental cost-effectiveness ratio (ICER) that met the World Health Organization cost-effectiveness threshold in both models. Further clinical classification analysis showed that MVD was only cost-effective in type 1 TN patients, with an ICER of 0.9 and 1.3 times the GDP/capita, based on PQALY and PCQALY, respectively, meeting the cost-effectiveness criteria. Conversely, MVD was economically dominated by PRR for type 2 TN patients based on PQALY. These findings indicate that PRR may be more cost-effective for type 2 TN patients, while MVD remains the cost-effective option for type 1 TN patients. Our study highlights the importance of clinical classification and complication in determining the cost-effectiveness of MVD and PRR for refractory TN.


Higher 24-h Total Movement Activity Percentile Is Associated with Better Cognitive Performance in U.S. Older Adults.
This study aimed to assess the association of a wrist-worn, device-based metric of 24-h movement with cognitive function and subjective cognitive complaints among older adults, 60 yr and older. This is a cross-sectional analysis of the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycles. A wrist-worn ActiGraph GT3X+ accelerometer captured total 24-h movement activity, analyzed as Monitor-Independent Movement Summary units (MIMS-units), and quantified into placement based on an age- and sex-standardized percentile. Cognitive tests in the domains of memory, language/verbal fluency, and executive performance were administered. Test-specific cognitive z -scores were generated. Subjective cognitive complaints included perceived difficulty remembering and confusion/memory loss. The analytical sample included 2708 U.S. older adults (69.5 ± 0.2 yr, 55% female, 20.9% non-White). Multivariable linear regressions revealed those in quartiles 3 (50th-74th percentile) and 4 (≥75th percentile) for their age and sex had higher cognitive function z -scores across all domains compared with those in quartile 1. Logistic regressions demonstrated those in quartiles 3 and 4 also had lower odds of reporting difficulty remembering (adjusted odds ratio [AOR] = 0.52, 95% confidence interval [CI] = 0.31-0.89; AOR = 0.57, 95% CI = 0.37-0.88) and confusion/memory loss (AOR = 0.49, 95% CI = 0.27-0.91; AOR = 0.49, 95% CI = 0.27-0.98), respectively, compared with those in quartile 1. In a representative sample of U.S. older adults, higher cognitive functioning occurs among those that perform total 24-h movement activity at or above the 50th percentile for their age and sex. Future studies should consider movement behaviors across a 24-h period on cognitive health outcomes in older adults. More research exploring prospective associations of MIMS-units and time-use behaviors across midlife and older adulthood that may affect cognitive functioning across diverse populations is needed.


Chitinase from Thermomyces lanuginosus SSBP and its biotechnological applications.
Chitinases are ubiquitous class of extracellular enzymes, which have gained attention in the past few years due to their wide biotechnological applications. The effectiveness of conventional insecticides is increasingly compromised by the occurrence of resistance; thus, chitinase offers a potential alternative to the use of chemical fungicides. The thermostable enzymes from thermophilic microorganisms have numerous industrial, medical, environmental and biotechnological applications due to their high stability for temperature and pH. Thermomyces lanuginosus produced a large number of chitinases, of which chitinase I and II are successfully cloned and purified recently. Molecular dynamic simulations revealed that the stability of these enzymes are maintained even at higher temperature. In this review article we have focused on chitinases from different sources, mainly fungal chitinase of T. lanuginosus and its industrial application.


Charcoal bezoar. Small-bowel obstruction secondary to amitriptyline overdose therapy.
Nasogastric administration of activated charcoal is effective in decreasing the half-life of amitriptyline. A case is reported in which this therapy for amitriptyline overdose led to charcoal bezoar formation and small-bowel obstruction. Amitriptyline's atropinic side effects on the gut make this a possible complication in such patients.


Current concepts in pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia.
The t(9;22)(q34;q11) or Philadelphia chromosome creates a BCR-ABL1 fusion gene encoding for a chimeric BCR-ABL1 protein. It is present in 3-4% of pediatric acute lymphoblastic leukemia (Ph(+) ALL), and about 25% of adult ALL cases. Prior to the advent of tyrosine kinase inhibitors (TKI), Ph(+) ALL was associated with a very poor prognosis despite the use of intensive chemotherapy and frequently hematopoietic stem-cell transplantation (HSCT) in first remission. The development of TKIs revolutionized the therapy of Ph(+) ALL. Addition of the first generation ABL1 class TKI imatinib to intensive chemotherapy dramatically increased the survival for children with Ph(+) ALL and established that many patients can be cured without HSCT. In parallel, the mechanistic understanding of Ph(+) ALL expanded exponentially through careful mapping of pathways downstream of BCR-ABL1, the discovery of mutations in master regulators of B-cell development such as IKZF1 (Ikaros), PAX5, and early B-cell factor (EBF), the recognition of the complex clonal architecture of Ph(+) ALL, and the delineation of genomic, epigenetic, and signaling abnormalities contributing to relapse and resistance. Still, many important basic and clinical questions remain unanswered. Current clinical trials are testing second generation TKIs in patients with newly diagnosed Ph(+) ALL. Neither the optimal duration of therapy nor the optimal chemotherapy backbone are currently defined. The role of HSCT in first remission and post-transplant TKI therapy also require further study. In addition, it will be crucial to continue to dig deeper into understanding Ph(+) ALL at a mechanistic level, and translate findings into complementary targeted approaches. Expanding targeted therapies hold great promise to decrease toxicity and improve survival in this high-risk disease, which provides a paradigm for how targeted therapies can be incorporated into treatment of other high-risk leukemias.


Obesity and disease activity in juvenile idiopathic arthritis.
Children with physical disabilities may have an increased risk for obesity and obesity might be a risk factor for inflammatory arthritis. The aims of this study were: to determine the prevalence of obesity in children and adolescents with juvenile idiopathic arthritis (JIA), and to examine the association between obesity and disease activity in this population. A cross-sectional analysis of all patients with JIA attending a pediatric rheumatology clinic, between October 2009 and September 2010, was performed. A linear regression model was used to explore the association between obesity and disease activity in patients with JIA. A total of 154 subjects were included in the analysis; median age was 10.6 years, 61% were female, and 88% were white. Obesity was found in 18%, 12% were overweight, and 3% were underweight. There was no association between obesity and JADAS-27 (Juvenile Arthritis Disease Activity Score 27), physician's assessment of disease activity, parent's assessment of child's well-being, erythrocyte sedimentation rate, number of active joints, or C-reactive protein (p-value range 0.10 to 0.95). Although 18% of patients with JIA were obese, we did not find an association between obesity and disease activity. As obesity confers an additional health risk in children with arthritis, addressing this co-morbidity should be a health priority in patients with JIA. Future studies are necessary to further explore potential associations between obesity, development of JIA, and disease activity.


[Neuropsychological status of patients with low and moderate carotid artery stenoses after the coronary artery bypass surgery].
The purpose of the study was a comparative evaluation of a neurological and neuropsychological status of patients with and without carotid artery stenoses less than 50% after coronary artery bypass grafting. The study involved 65 patients divided into two groups: the first group included 35 patients (mean age 56.2±5.7 years) without carotid artery stenoses, the second group included 30 patients (56.8±5.5 years) with the presence of carotid artery stenoses. Initially, all patients had comparable clinical parameters. Before surgery, the high frequency of asthenic, vestibulopathic and vestibular-atactic syndromes was observed in patients with the presence of low and moderate stenoses of carotid arteries compared to patients without stenoses. After coronary artery bypass grafting, the neurological status of patients became worse in both groups. Patients with the presence of low and moderate stenoses of carotid arteries performed worse on neuropsychological tests one month after surgery.


iGepros: an integrated gene and protein annotation server for biological nature exploration.
In the post-genomic era, transcriptomics and proteomics provide important information to understand the genomes. With fast development of high-throughput technology, more and more transcriptomics and proteomics data are generated at an unprecedented rate. Therefore, requirement of software to annotate those omics data and explore their biological nature arises. In the past decade, some pioneer works were presented to address this issue, but limitations still exist. Fox example, some of these tools offer command line only, which is not suitable for those users with little or no experience in programming. Besides, some tools don't support large scale gene and protein analysis. To overcome these limitations, an integrated gene and protein annotation server named iGepros has been developed. The server provides user-friendly interfaces and detailed on-line examples, so most researchers even those with little or no programming experience can use it smoothly. Moreover, the server provides many functionalities to compare transcriptomics and proteomics data. Especially, the server is constructed under a model-view-control framework, which makes it easy to incorporate more functions to the server in the future. In this paper, we present a server with powerful capability not only for gene and protein functional annotation, but also for transcriptomics and proteomics data comparison. Researchers can survey biological characters behind gene and protein datasets and accelerate their investigation of transcriptome and proteome by applying the server. The server is publicly available at http://www.biosino.org/iGepros/.


[Simulator-based modular human factor training in anesthesiology. Concept and results of the module "Communication and Team Cooperation"].
Human factors (HF) play a major role in crisis development and management and simulator training can help to train HF aspects. We developed a modular training concept with psychological intensive briefing. The aim of the study was to see whether learning and transfer in the treatment group (TG) with the module "communication and team-cooperation" differed from that in the control group (CG) without psychological briefing ("anaesthesia crisis resource management type course"). A total of 34 residents (TG: n=20, CG: n=14) managed 1 out of 3 scenarios and communication patterns and management were evaluated using video recordings. A questionnaire was answered at the end of the course and 2 months later participants were asked for lessons learnt and behavioral changes. Good communication and medical management showed a significant correlation (r=0.57, p=0.001). The TG showed greater initiative ( p=0.001) and came more often in conflict with the surgeon ( p=0.06). The TG also reported more behavioral changes than the CG 2 months later. The reported benefit of the simulation was training for rare events in the CG, whereas in the TG it was issues of communication and cooperation ( p=0.001). A training concept with psychological intensive briefing may enhance the transfer of HF aspects more than classical ACRM.


Internal Acoustic Meatus Localization During Anterior Petrosectomy: A Novel Technique.
Anterior petrosectomy demands localization of the internal auditory canal (IAC) for safe bone drilling and maximum exposure. Various techniques have been described in the literature, each with shortcomings. We propose a new technique to localize the internal acoustic meatus (IAM) using more consistent anatomical landmarks. The study was done in three phases. In phase-I (radiological), computed tomography scan heads of fifty patients (100 sides) were analyzed. Arcuate eminence-Greater Superficial Petrosal Nerve bifurcation angle(Garcia-Ibanez technique), Arcuate eminence-IAC angle(Fisch technique) and a new angle formed between foramen ovale (FO) and foramen spinosum (FS) line, and FS and IAM line (FO-FS-IAM angle) was measured. The mean, standard deviation, and variance were calculated. In phase-II (cadaveric), the FO-FS-IAM angle was measured on five (10 sides) dry skulls. In phase-III (clinical), the IAM was localized using the FO-FS-IAM angle in 13 patients. The mean angle between arcuate eminence and Greater Superficial Petrosal Nerve (Garcia-Ibanez technique) was 126.20 ± 11.63°(range 106-156) with a variance of 135.20. The mean bifurcation angle was 63 ± 5.81°(range 53-78). By the Fisch technique, the mean arcuate-IAM angle was 73.5 ± 11.70°(range 51-105) with a variance of 137.18. By our technique, the mean FO-FS-IAM angle was 94.72 ± 5.89°(range 84-108). The variance was 34.73. The mean FO-FS-IAM angle on dry skulls was identical (95 ± 1.97°) to our radiological measurements. This angle was reproduced reliably in clinical cases for localizing the IAM during anterior petrosectomy. The FO-FS-IAM angle variance was much lower than the analogous angles measured by Garcia-Ibanez and Fisch techniques, making it a more reliable and effective tool for localizing the IAM.


Kinetics of folding and association of differently glycosylated variants of invertase from Saccharomyces cerevisiae.
A core-glycosylated form of the dimeric enzyme invertase has been isolated from secretion mutants of Saccharomyces cerevisiae blocked in transport to the Golgi apparatus. This glycosylation variant corresponds to the form that folds and associates during biosynthesis of the protein in vivo. In the present work, its largely homogeneous subunit size and well-defined quaternary structure were utilized to characterize the folding and association pathway of this highly glycosylated protein in comparison with the nonglycosylated cytoplasmic and the high-mannose-glycosylated periplasmic forms of the same enzyme encoded by the suc2 gene. Renaturation of core-glycosylated invertase upon dilution from guanidinium-chloride solutions follows a unibimolecular reaction scheme with consecutive first-order subunit folding and second-order association reactions. The rate constant of the rate-limiting step of subunit folding, as detected by fluorescence increase, is k1 = 1.6 +/- 0.4 x 10(-3) s-1 at 20 degrees C; it is characterized by an activation enthalpy of delta H++ = 65 kJ/mol. The reaction is not catalyzed by peptidyl-prolyl cis-trans isomerase of the cyclophilin type. Reactivation of the enzyme depends on protein concentration and coincides with subunit association, as monitored by size-exclusion high-pressure liquid chromatography. The association rate constant, estimated by numerical simulation of reactivation kinetics, increases from 5 x 10(3) M-1 s-1 to 7 x 10(4) M-1 s-1 between 5 and 30 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)


Risk factors for mortality in symptomatic hyperlactatemia among HIV-infected patients receiving antiretroviral therapy in a resource-limited setting.
To determine the mortality rate and risk factors after experiencing symptomatic hyperlactatemia in HIV-infected patients receiving antiretroviral therapy (ART). A retrospective cohort study was conducted among patients who were diagnosed with symptomatic hyperlactatemia (lactate >2.5mmol/l) between January 2004 and April 2006. All patients were followed until 3 months after the diagnosis. One hundred and twenty-five patients were included in the study. The mean+/-standard deviation (SD) age was 39.9+/-10.1 years and body weight was 58.2+/-16.9kg; 60.8% were male. Symptomatic hyperlactatemia in 114 (91.2%) was associated with receiving d4T, in five (4.0%) with d4T+ddI, in four (3.2%) with ZDV+ddI, and in two (1.6%) with ddI (d4T, stavudine; ddI, didanosine; ZDV, zidovudine). The median duration of ART was 13 months. Nine (7.2%) patients died. Patients who died had a higher mean lactate level (8.0 vs. 5.1mmol/l) and mean alanine aminotransferase (ALT; 164 vs. 48U/l) at the time of diagnosis when compared to those who survived (p<0.05). Patients who died had a lower mean weight than those who survived (48 vs. 59kg, p=0.008). By logistic regression, mortality was associated with patients whose body weight was <45kg (p=0.014, odds ratio (OR) 9.090, 95% confidence interval (CI) 1.575-52.632) and whose serum lactate was >10mmol/l (p=0.004, OR 20.372, 95% CI 2.610-159.001). The mortality rate of symptomatic hyperlactatemia among HIV-infected patients receiving ART is substantial. Almost all patients received d4T. Patients who have a low body weight and high serum lactate level are at a higher risk of mortality.


Average sound speed estimation using speckle analysis of medical ultrasound data.
Most ultrasound imaging systems assume a pre-determined sound propagation speed for imaging. However, a mismatch between assumed and real sound speeds can lead to spatial shift and defocus of ultrasound image, which may limit the applicability of ultrasound imaging. The estimation of real sound speed is important for improving positioning accuracy and focus quality of ultrasound image. A novel method using speckle analysis of ultrasound image is proposed for average sound speed estimation. Firstly, dynamic receive beam forming technology is employed to form ultrasound images. These ultrasound images are formed by same pre-beam formed radio frequency data but using different assumed sound speeds. Secondly, an improved speckle analysis method is proposed to evaluate focus quality of these ultrasound images. Thirdly, an iteration strategy is employed to locate the desired sound speed that corresponds to the best focus quality image. For quantitative evaluation, a group of ultrasound data with 20 different structure patterns is simulated. The comparison of estimated and simulated sound speeds shows speed estimation errors to be -0.7 ± 2.54 m/s and -1.30 ± 5.15 m/s for ultrasound data obtained by 128- and 64-active individual elements linear arrays, respectively. Furthermore, we validate our method via phantom experiments. The sound speed estimation error is -1.52 ± 8.81 m/s. Quantitative evaluation proves that proposed method can estimate average sound speed accurately using single transducer with single scan.


First record of a Takayama bloom in Haizhou Bay in response to dissolved organic nitrogen and phosphorus.
Since 1990s, harmful algal blooms (HABs) of Kareniaceae, primarily caused by species of Karenia and Karlodinium and rarely by Takayama species, have been substantially increasing in frequency and duration in the coastal waters of China. In this study, we recorded a bloom of high abundance of T. acrotrocha in the Haizhou Bay, the Yellow Sea in September 2020, which is the first record of a Takayama bloom in the temperate coastal waters of China. We found that high concentrations of DON and DOP accelerated the proliferation of T. acrotrocha in the Haizhou Bay. Intensive mariculture, and terrestrial nitrogen and phosphorus input may be responsible for the eutrophication in the Haizhou Bay featuring high concentrations of DON and DOP, and high DIN/DIP ratios. The results suggested that, under ocean warming, the HABs of Kareniaceae are becoming increasingly dominant in eutrophic temperate coasts with intensive mariculture activities.


Silencing the cochaperone CDC37 destabilizes kinase clients and sensitizes cancer cells to HSP90 inhibitors.
The cochaperone CDC37 promotes the association of HSP90 with the protein kinase subset of client proteins to maintain their stability and signalling functions. HSP90 inhibitors induce depletion of clients, which include several oncogenic kinases. We hypothesized that the targeting of CDC37 using siRNAs would compromise the maturation of these clients and increase the sensitivity of cancer cells to HSP90 inhibitors. Here, we show that silencing of CDC37 in human colon cancer cells diminished the association of kinase clients with HSP90 and reduced levels of the clients ERBB2, CRAF, CDK4 and CDK6, as well as phosphorylated AKT. CDC37 silencing promoted the proteasome-mediated degradation of kinase clients, suggesting a degradation pathway independent from HSP90 binding. Decreased cell signalling through kinase clients was also demonstrated by reduced phosphorylation of downstream substrates and colon cancer cell proliferation was subsequently reduced by the inhibition of the G1/S-phase transition. Furthermore, combining CDC37 silencing with the HSP90 inhibitor 17-AAG induced more extensive and sustained depletion of kinase clients and potentiated cell cycle arrest and apoptosis. These results support an essential role for CDC37 in concert with HSP90 in maintaining oncogenic protein kinase clients and endorse the therapeutic potential of targeting CDC37 in cancer.


Let-7b promotes alpaca hair growth via transcriptional repression of TGFβR I.
The young male alpaca ear and the back skins were used to investigate the effect of transforming growth factor receptor-β I (TGFβR I) on alpaca hair follicles and hair growth. The expression level and location of TGFβR I in alpaca ear and dorsal skin were detected through real-time quantitative PCR (RT-PCR) and paraffin section immunohistochemical technique (ICC-P). The results shown TGFβR I was lower expression in back skin compared to ear skin and the mean density of the positive reaction in ear skin was significantly higher than back skin. The targeted relationship with let-7b was detected using the dual-luciferase reporter vector of TGFβR I, which showed a significant target relationship between let-7b and TGFβR I. After transfection with let-7b eukaryotic expression vector, the relative mRNA expression of TGFβR I in alpaca skin fibroblasts did not differ, while the relative protein level was significantly decreased. In summary, a higher TGFβR I expression level in the ear skin suggests that TGFβR I may inhibit coat hair elongation. Further studies showed TGFβR I protein was downregulated by let-7b through transcriptional repression.


Impact of Emergency Department Tele-intake on Left Without Being Seen and Throughput Metrics.
More than 2 million patients present to a U.S. emergency department (ED) annually and leave without being seen (LWBS) due to delays in initiating care. We evaluated whether tele-intake at the time of presentation would reduce LWBS rates and ED throughput measures. We conducted a before-and-after study at an urban community hospital. The intervention was use of a tele-intake physician to triage patients from 11 am to 6 pm, 7 days per week. Tele-intake providers performed a triage history and physical examination, documented findings, and initiated orders in the medical record. We assessed the impact of this program using the domains of the National Quality Forum framework evaluating access, provider experience, and effectiveness of care. The main outcome was 24-hour LWBS rate. Secondary outcomes were overall door to provider and door to disposition times, left without treatment complete (LWTC), left against medical advice (AMA), left without treatment (LWOT), and physician experience. We compared the 6-month tele-intake period to the same period from the prior year (October 1 to April 1, 2017 vs. 2016). Additionally, we conducted a survey of our physicians to assess their experience with the program. Total ED volume was similar in the before and after periods (19,892 patients vs. 19,646 patients). The 24-hour LWBS rate was reduced from 2.30% (95% confidence interval [CI] = 2.0% to 2.5%) to 1.69% (95% CI = 1.51% to 1.87%; p < 0.001). Overall door to provider time decreased (median = 19 [interquartile range {IQR} = 9 to 38] minutes vs. 16.2 [IQR = 7.8 to 34.3] minutes; p < 0.001), but ED length of stay for all patients (defined as door in to door out time for all patients) minimally increased (median = 184 [IQR = 100 to 292] minutes vs. 184.3 [IQR = 104.4 to 300] minutes; p < 0.001). There was an increase in door to discharge times (median = 146 [IQR = 83 to 231] minutes vs. 148 [IQR = 88.2 to 233.6] minutes; p < 0.001) and door to admit times (median = 330 [IQR = 253 to 432] minutes vs. 357.6 [IQR = 260.3 to 514.5] minutes; p < 0.001). We saw an increase in LWTC (0.59% [95% CI = 0.49% to 0.70%] vs. 1.1% [95% CI = 0.9% to 1.2%]; p < 0.001), but no change in AMA (1.4% [95% CI = 1.2% to 1.6%] vs. 1.6% [95% CI = 1.4% to 1.78%]; p = 0.21) or LWOT (4.3% [95% CI = 4.1% to 4.6%] vs. 4.4% [95% CI = 4.1% to 4.7%]; p = 0.7). Tele-intake providers thought tele-intake added value (12/15, 80%) and allowed them to effectively address medical problems (14/15, 95%), but only (10/15, 67%) thought that it was as good as in-person triage. Of the receiving physicians, most agreed with statements that tele-intake did not interfere with care (19/22, 86%), helped complement care (19/21, 90%), and gave the patient a better experience (19/22, 86%). Remote tele-intake provided in an urban community hospital ED reduced LWBS and time to provider but increased LWTC rates and had no impact on LWOT.


Diffuse large B cell lymphoma presenting as Horner's syndrome in a patient diagnosed with neurofibromatosis type 1: a case report and review of the literature.
Horner's syndrome has a variety of etiologies ranging from benign to serious life-threatening conditions and has been infrequently reported as a presenting symptom of patients with lymphoid neoplasms. Only one case of Burkitt's lymphoma presenting with toothache, paresthesia, and Horner's syndrome has been described and no case reports of diffuse large B-cell lymphoma as the etiology of Horner's syndrome currently exist in the literature. In addition, lymphoid neoplasms have rarely been reported to occur in patients with neurofibromatosis type 1 despite an increased risk of many types of cancer in such cases. A 28-year-old Thai man presented with a progressively enlarged left supraclavicular mass together with a significant weight loss and night sweating for four months. He also noticed hoarseness and ptosis of his left eye associated with double vision for two months. Physical examination revealed large supraclavicular lymphadenopathy and Horner's syndrome (ptosis, miosis, and anhydrosis) on the left side of his face. A large mediastinal mass was clearly detected by chest X-ray and computed tomography and subsequent lymph node biopsy provided a diagnosis of diffuse large B-cell lymphoma. Interestingly, the patient was also definitely diagnosed with neurofibromatosis type 1 from multiple café au lait macules, axillary freckles, three neurofibromas, multiple Lisch nodules, and a history of affected family members. He subsequently received chemotherapy with a good response. Twenty-seven cases of various types of lymphoid neoplasms previously reported to occur in neurofibromatosis type 1 patients were also extracted from the literature. All cases were non-Hodgkin lymphoma and the major subtype was T-cell. Only nine cases were B-cell lymphoma. The majority of cases were young with a median age at lymphoma diagnosis of 9.4 years (range 1.1 to 77 years). Two-thirds of the cases were boys or men. Other concomitant malignancies were brain tumor, colorectal cancer, pheochromocytoma, and acute lymphoblastic leukemia. We describe for the first time a case of diffuse large B-cell lymphoma that occurred in a neurofibromatosis type 1 patient with Horner's syndrome. Horner's syndrome can be an initial manifestation of diffuse large B-cell lymphoma. Patients who present with a classical triad of Horner's syndrome should always be fully investigated for lymphomatous involvement, especially in the thorax. The exact molecular mechanism for diffuse large B-cell lymphoma development in neurofibromatosis type 1 cases remains to be elucidated.


Effects of automated teller machine service quality on customer satisfaction: Evidence from commercial bank of Ethiopia.
The banking industry has seen the emergence of numerous service delivery channels, automated teller machines (ATMs), telephone banking, and online banking. Global financial systems and mature competition have been compelled to research the importance of consumer satisfaction. Thus, this study aimed to examine the effects of automated teller machine service quality on customer satisfaction in commercial banks of Ethiopia in the Afar regional state, Northeast Ethiopia. To this end, cross-sectional data were collected through a questionnaire from a sample of three hundred forty-six (346) ATM users selected from Semera-logia City, Asyaita, and Awash Town. To identify the dimensions of automated teller machine service quality and their relationship with customer satisfaction, confirmatory factor analysis and structural equation modeling (SEM)) through SPSS and AMOS 23.0 data analysis software were used. The findings indicate that convenience, reliability, ease of use, fulfillment, and security/privacy of ATM service quality dimensions are positively and significantly associated with customer satisfaction. The results of this study can help banks' management improve the quality of their ATM services to increase overall customer satisfaction. To ensure continued customer satisfaction, banks are encouraged to make the ATM service more convenient, reliable, user-friendly, secure, and fulfilling. They should also constantly update and differentiate their ATM service quality aspects to build a competitive advantage and boost their profitability.


Flutrimazole 1% dermal cream in the treatment of dermatomycoses: a multicentre, double-blind, randomized, comparative clinical trial with bifonazole 1% cream. Efficacy of flutrimazole 1% dermal cream in dermatomycoses. Catalan Flutrimazole Study Group.
Flutrimazole is a new imidazole derivate. Its antifungal activity has been demonstrated in in vivo and in vitro studies to be comparable to that of clotrimazole and higher than bifonazole. To compare the efficacy and tolerability of flutrimazole cream 1% with a reference drug, bifonazole, in the treatment of dermatomycoses, eligible for topical treatment exclusively. A multicentre, double-blind, randomized, parallel-group clinical trial was conducted. Patients with clinically and mycologically (KHO and/or culture) diagnosed fungal infection of the skin were included in this study and were randomized into two treatment groups: 1% flutrimazole or 1% bifonazole, applied to the affected area (target lesion) once a day. The principal criterion of efficacy, 'cure', was based on clinical and mycological assessment. Four hundred and forty-nine patients were included in the study (228 flutrimazole, 221 bifonazole). 'Intention-to-treat' analysis of the data showed a difference between the treatments in terms of the rate of cure (clinical and mycological) after 4 weeks: 73% in the flutrimazole group and 65% in the bifonazole group (p = 0.05). From a safety point of view, flutrimazole and bifonazole were well tolerated, and the overall incidence of adverse effects (mainly mild local effects like irritation or burning sensation) was 5%. One percent flutrimazole applied topically once a day in the treatment of fungal infections of the skin presents a better efficacy than bifonazole and a good tolerability.


Live-cell imaging of chromatin contacts opens a new window into chromatin dynamics.
Our understanding of the organization of the chromatin fiber within the cell nucleus has made great progress in the last few years. High-resolution techniques based on next-generation sequencing as well as optical imaging that can investigate chromatin conformations down to the single cell level have revealed that chromatin structure is highly heterogeneous at the level of the individual allele. While TAD boundaries and enhancer-promoter pairs emerge as hotspots of 3D proximity, the spatiotemporal dynamics of these different types of chromatin contacts remain largely unexplored. Investigation of chromatin contacts in live single cells is necessary to close this knowledge gap and further enhance the current models of 3D genome organization and enhancer-promoter communication. In this review, we first discuss the potential of single locus labeling to study architectural and enhancer-promoter contacts and provide an overview of the available single locus labeling techniques such as FROS, TALE, CRISPR-dCas9 and ANCHOR, and discuss the latest developments and applications of these systems.


Phosphorylation-mediated 14-3-3 protein binding regulates the function of the rho-specific guanine nucleotide exchange factor (RhoGEF) Syx.
Syx is a Rho-specific guanine nucleotide exchange factor (GEF) that localizes at cell-cell junctions and promotes junction stability by activating RhoA and the downstream effector Diaphanous homolog 1 (Dia1). Previously, we identified several molecules, including 14-3-3 proteins, as Syx-interacting partners. In the present study, we show that 14-3-3 isoforms interact with Syx at both its N- and C-terminal regions in a phosphorylation-dependent manner. We identify the protein kinase D-mediated phosphorylation of serine 92 on Syx, and additional phosphorylation at serine 938, as critical sites for 14-3-3 association. Our data indicate that the binding of 14-3-3 proteins inhibits the GEF activity of Syx. Furthermore, we show that phosphorylation-deficient, 14-3-3-uncoupled Syx exhibits increased junctional targeting and increased GEF activity, resulting in the strengthening of the circumferential junctional actin ring in Madin-Darby canine kidney cells. These findings reveal a novel means of regulating junctional Syx localization and function by phosphorylation-induced 14-3-3 binding and further support the importance of Syx function in maintaining stable cell-cell contacts.


Changes in the management of infrarenal abdominal aortic aneurysm disease in Sweden.
Treatment of abdominal aortic aneurysm (AAA) has changed over time, with endovascular repair (EVAR) being the main technical revolution. This study assessed the effect of this change on outcome on a national basis over a 17-year interval. Primary infrarenal AAA repairs in Swedish residents aged 50 years and older, in the Swedish Vascular Registry (Swedvasc) 1994-2010, were analysed. The rate per 100,000 population, patient characteristics, operative technique and outcome were assessed for the intervals 1994-1999, 2000-2005 and 2006-2010. Some 11,336 intact aneurysm repairs were performed. The overall rate per 100,000 increased (18.4 in 1994-1999, 19.4 in 2000-2005 and 24.0 in 2006-2010; P < 0.001), most noticeably among older people (18 per cent increase among those aged 50-64 years, P = 0.004; 27 per cent in 65-79-year-olds, P < 0.001; 128 per cent in those aged at least 80 years, P < 0.001). The use of EVAR increased rapidly after 2005 (rate: 0.6 in 1994-1999, 4.4 in 2000-2005 and 11.8 in 2006-2010; P < 0.001). The 30-day mortality rate decreased after open repair (4.7, 3.4 and 2.7 per cent respectively; P < 0.001), but was stable after EVAR (2.6, 2.2 and 1.6 per cent; P = 0.227). Some 4972 ruptured aneurysm (rAAA) repairs were performed. The rate decreased after 2005 (9.3 in 1993-1999, 9.3 in 2000-2005 and 8·4 in 2006-2010; P = 0.006). The use of EVAR for rAAA increased over time (rate: 0, 0.5 and 1.6 respectively; P < 0.001), whereas open repair decreased (9.3, 8.8 and 6.8; P < 0.001). Thirty-day mortality decreased over time (38.3, 32.8 and 28.4 per cent; P < 0.001). The introduction of EVAR has been associated with an increased number of intact AAA repairs, which has accelerated recently, whereas the rate of rAAA repair has started to decline. Simultaneously, outcomes have improved.


Ultrafast electron diffraction from nanophotonic waveforms via dynamical Aharonov-Bohm phases.
Electron interferometry via phase-contrast microscopy, holography, or picodiffraction can provide a direct visualization of the static electric and magnetic fields inside or around a material at subatomic precision, but understanding the electromagnetic origin of light-matter interaction requires time resolution as well. Here, we demonstrate that pump-probe electron diffraction with all-optically compressed electron pulses can capture dynamic electromagnetic potentials in a nanophotonic material with sub-light-cycle time resolution via centrosymmetry-violating Bragg spot dynamics. The origin of this effect is a sizable quantum mechanical phase shift that the electron de Broglie wave obtains from the oscillating electromagnetic potentials within less than 1 fs. Coherent electron imaging and scattering can therefore reveal the electromagnetic foundations of light-matter interaction on the level of the cycles of light.


Chronic hemodynamic effects after radiofrequency catheter ablation of frequent monomorphic ventricular premature beats.
Radiofrequency catheter ablation (RFCA) of severely symptomatic monomorphic ventricular premature beats (VPBs) is reported to be a safe and effective treatment option. However, the chronic hemodynamic effects of these VPBs have not been precisely evaluated. We sought to investigate chronic effects after decreasing the number of VPBs by RFCA. A total of 47 patients who had no underlying heart disease and frequent monomorphic VPBs, consisting of more than 10,000 beats per day (24,194 +/- 12,516 beats per day), were enrolled. Patients were treated with RFCA and followed up over 6 months as outpatients. Echocardiography and serum B-type natriuretic peptide (BNP) level were repeatedly checked before and after RFCA. In 38 patients, whose VPBs were dramatically decreased to less than 1,000 beats per day by successful RFCA, left ventricular (LV) end-diastolic dimension (LVEDd) and end-systolic dimension (LVESd) measured by echocardiography decreased significantly (LVEDd: 50 +/- 5 to 48 +/- 5 mm, P < 0.01; LVESd: 33 +/- 7 to 30 +/- 6 mm, P < 0.01) in association with improvement of BNP level (39.9 +/- 34.1 to 16.8 +/- 10.3 pg/mL, P = 0.0001). In nine patients, whose VPBs were treated unsuccessfully by RFCA or that recurred, LV dimensions and BNP level did not change during the follow-up period. Significant improvement in LV dimensions and serum BNP level appeared to indicate that RFCA of VPBs ameliorated occult cardiac dysfunction induced by frequent VPBs.


Assessment of physical activity in older Belgian adults: validity and reliability of an adapted interview version of the long International Physical Activity Questionnaire (IPAQ-L).
Adequate monitoring of older adults' physical activity (PA) is essential to develop effective health promotion programs. The present study examined criterion validity and test-retest reliability of the long International Physical Activity Questionnaire (IPAQ-L), adapted for Belgian, community-dwelling older adults (65 y and older). Participants (n = 434) completed the last seven days version of IPAQ-L, modified for the Belgian population of community-dwelling older adults. This elderly-adapted version of IPAQ-L combined vigorous and moderate activities, and questions on gait speed and recreational cycling were added. Furthermore, participants wore an ActiGraph GT3X(+) accelerometer for at least five days. Criterion validity was determined by comparing self-reported weekly minutes of moderate-to-vigorous physical activity (MVPA) and weekly minutes of total PA with accelerometer data, defined by two different cut points (Freedson vs. Copeland). To examine test-retest reliability, a subsample of 29 participants completed IPAQ-L for a second time within a ten day interval. IPAQ-L showed moderate criterion validity for measuring weekly minutes of MVPA and total PA (Spearman's ρ range 0.33-0.40). However, plots on agreement between self-reported and accelerometer PA showed a systematic over-reporting of IPAQ-L for MVPA. In contrast, plots indicated that IPAQ-L under-estimated levels of total PA, however, this under-estimation of total PA was substantially lower than the observed over-reporting of MVPA. Test-retest reliability was moderate-to-good for work-related PA, domestic PA, MVPA and total PA (ICC range 0.52-0.81), but poorer for transportation and recreational PA (ICC 0.44 and 0.43, respectively). Criterion validity results suggest that IPAQ-L is more valid to measure older adults' weekly minutes of total PA than weekly MVPA minutes. Moreover, results might imply that content validity of IPAQ-L can be improved if specific light-intensity PA items are incorporated into IPAQ-L. Test-retest reliability of IPAQ-L was moderate to good, except for weekly minutes of transportation and recreational PA, probably due to week-to-week variability of these behaviors.


Accelerometer-Measured Versus Self-Reported Physical Activity Levels and Sedentary Behavior in Women Before and 9 Months After Roux-en-Y Gastric Bypass.
Roux-en-Y gastric bypass (RYGB) patients report significant pre- to post-surgery increases in physical activity (PA). Conversely, objectively assessed PA does not increase after RYGB. The aim of the study was to compare self-reported and accelerometer-measured changes in moderate-to-vigorous PA (MVPA) and exercise from pre- to post-surgery, in women undergoing RYGB. Forty-three women with an average pre-surgery body mass index of 39.2 kg/m2 (SD 3.1) were recruited at Swedish hospitals. PA was measured by the Actigraph GT3X+ and by a previously validated short PA questionnaire, at home visits 3 months before and 9 months after surgery, thus limiting seasonal effects. Self-reported time spent in exercise increased with 75 % and time spent in MVPA increased with 51 %, whereas accelerometer-assessed time spent in exercise increased with 0.9 % and time spent in MVPA increased with 2.1 %, from before to after surgery. Correlations comparing accelerometers with the questionnaire were 0.35 (P = 0.02) for MVPA and 0.13 (P = 0.4) for exercise before RYGB and 0.52 (P ≤ 0.001) for MVPA and 0.12 (P = 0.4) for exercise after RYGB. Pre- to post-RYGB surgery increases in self-reported PA were not confirmed by accelerometer-measured PA. Thus, health care workers should use objective measures of PA in patients undergoing RYGB, in order to assess whether patients achieve sufficient levels of PA.


Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children.
The prevalence of childhood eczema is increasing in many countries. Epidemiological studies, however, say little of its association to outdoor air pollution and climate factors. We conducted a nationwide survey of middle-school students in Taiwan from 1995 to 1996. The 12-month prevalence of eczema was compared with air monitoring station data of temperature, relative humidity, and criteria air pollutants. A total of 317,926 children attended schools located within 2 km of 55 stations. Prevalence rates of recurrent eczema were 2.4 and 2.3% in boys and girls, respectively, with prevalence rates of flexural eczema 1.7% in both sexes. After adjustment for possible confounders, flexural eczema was found to be associated with traffic-related air pollutants, including nitrogen oxides and carbon monoxide. Recurrent eczema was associated with traffic-related air pollution only in girls. There were no associations for the highest monthly means of temperature, whereas the annual means and the lowest monthly means of temperature were negatively related to flexural eczema, but only in girls. The lowest monthly mean relative humidity was positively related to eczema. The results suggest that air pollution and climatic factors, which showed stronger associations in girls than boys, may affect the prevalence of childhood eczema.


Lipoprotein lipase activity in adipose tissue and skeletal muscle of runners: relation to serum lipoproteins.
Physically well-trained people generally have lower VLDL-triglyceride and higher HDL-cholesterol levels than sedentary subjects. To examine the underlying mechanisms of this lipoprotein pattern, we measured the lipoprotein lipase (LPL) activity in needle biopsy specimens of adipose tissue and skeletal muscle of competitive runners and of body weight-matched, physically less-active controls. The active sportsmen were either sprinters, whose training program consisted mainly of athletics of short duration or long distance runners undergoing a strenuous endurance exercise program. In sprinters (all males) the serum lipid and lipoprotein concentrations did not differ significantly from those of controls and the mean LPL activities in muscle and adipose tissue were also similar in these two groups. The long distance runners (both sexes), on the other hand, had higher means levels of HDL-cholesterol than the respective controls. The LPL-activity of both adipose tissue (p less than 0.05) and skeletal muscle (p less than 0.01) was significantly higher in male long distance runners than in control males. Female runners had higher muscle LPL activity than controls (p less than 0.01) but in adipose tissue the difference in LPL activity was not significant. Rough estimates calculated for LPL activity present in whole body adipose tissue and skeletal muscle indicated that total LPL activity was 2.3 times higher in male long distance runners and 1.5 times higher in female long distance runners than in the respective controls. In combined groups of male runners and controls, there was a highly significant positive correlation between the serum HDL-cholesterol level and the LPL activity of adipose tissue expressed per tissue weight (r = +0.72, p less than 0.001) or per whole body fat (r = +0.62, p less than 0.001). The group means of HDL-cholesterol and adipose tissue LPL activity in the five cohorts studied (male sprinters, distance runners and controls and female distance runners and controls) were also positively correlated (r = +0.94). It is concluded that endurance training is associated with an adaptive increase of LPL activity not only in skeletal muscle but also in adipose tissue. These changes are not observed in sprinters who are trained by exercises of shorter duration. The high HDL-cholesterol levels of physically well-trained people are probably accounted for, at least partly, by the increased LPL activity and the concomitant rapid turnover or triglyceride-rich lipoproteins.


Complete Genome Sequences of Four African Horse Sickness Virus Strains from a Commercial Tetravalent Live Attenuated Vaccine.
This is a report of the complete genome sequences of plaque-selected isolates of each of the four virus strains included in a South African commercial tetravalent African horse sickness attenuated live virus vaccine.


Health coaching by medical assistants improves patients' chronic care experience.
We sought to test the hypothesis that training medical assistants to provide health coaching would improve patients' experience of care received and overall satisfaction with their clinic. Randomized controlled trial. Low-income English- or Spanish-speaking patients aged 18 to 75 years with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were randomized to receive either a health coach or usual care for 12 months. Patient care experience was measured using the Patient Assessment of Chronic Illness Care (PACIC) scale at baseline and at 12 months. Patient overall satisfaction with the clinic was assessed with a single item asking if they would recommend the clinic to a friend or family member. PACIC and satisfaction scores were compared between study arms using generalized estimating equations to account for clustering at the clinician level. PACIC scores were available from baseline and at 12 months on 366 (76%) of the 441 patients randomized. At baseline, patients receiving health coaching were similar to those in the usual care group with respect to demographic and other characteristics, including mean PACIC scores (3.00 vs 3.06) and the percent who would "definitely recommend" their clinic (73% and 73%, respectively). At 12 months, coached patients had a significantly higher mean PACIC score (3.82 vs 3.13; P < .001) and were more likely to report they would definitely recommend their clinic (85% vs 73%; P = .002). Using medical assistants trained in health coaching significantly improved the quality of care that low-income patients with poorly controlled chronic disease reported receiving from their healthcare team.


C1-2 instability from os odontoideum mimicking intramedullary spinal cord tumor.
Os odontoideum is a common cause of atlantoaxial instability in the pediatric population. The authors present the cases of 2 patients whose initial clinical presentation and MR imaging findings were suggestive of an intramedullary neoplasm, but whose ultimate diagnosis was determined to be cervical spine instability and cord injury due to os odontoideum.


[Development and functional verification of CAR-T cells targeting CLL-1].
Objective: To explore the development of a CAR-T cells targeting CLL-1 and verify its function. Methods: The expression levels of CLL-1 targets in cell lines and primary cells were detected by flow cytometry. A CLL-1 CAR vector was constructed, and the corresponding lentivirus was prepared. After infection and activation of T cells, CAR-T cells targeting CLL-1 were produced and their function was verified in vitro and in vivo. Results: CLL-1 was expressed in acute myeloid leukemia (AML) cell lines and primary AML cells. The transduction rate of the prepared CAR T cells was 77.82%. In AML cell lines and AML primary cells, CLL-1-targeting CAR-T cells significantly and specifically killed CLL-1-expressing cells. Compared to untransduced T cells, CAR-T cells killed target cells and secreted inflammatory cytokines, such as interleukin-6 and interferon-γ, at significantly higher levels (P<0.001) . In an in vivo human xenograft mouse model of AML, CLL-1 CAR-T cells also exhibited potent antileukemic activity and induced prolonged mouse survival compared with untransduced T cells [not reached vs 22 days (95%CI 19-24 days) , P=0.002]. Conclusion: CAR-T cells targeting CLL-1 have been successfully produced and have excellent functions.


Prediction of early (30-day) and late (30-90-day) mortality after radical cystectomy in a comprehensive cancer centre over two decades.
Radical cystectomy (RC) is associated with substantial postoperative mortality. In this study, we analyzed early (30-day; 30 M) and late (30-90-day; 30-90 M) mortality after RC in a Dutch tertiary referral center and determined factors associated with 30 M, 30-90 M and 90-day mortality (90 M). We identified 823 patients who underwent RC for bladder cancer in the Netherlands Cancer Institute between 1997 and 2017. Predictive factors for mortality were analyzed to identify patients with a higher mortality risk. Multivariate logistic regression analysis was performed to examine the influence of patient, surgical and histopathological variables on 30 M, 30-90 M and 90 M. Thirty-day mortality was 1.9% and 90 M was 6.0%. Multivariable analysis showed that age (OR 1.08, 95% CI 1.01-1.1, p = 0.002) and ASA 3-4 (OR 3.57, 95% CI 1.25-10.16, p = 0.002) were significant predictors of 30 M while higher ASA score (OR 2.9, 95% CI 1.31-6.5, p = 0.009) and higher pathological T stage (OR 8.8, 95% CI 1.9-40.4, p = 0.005) were associated with 30-90 M. Risk of 90 M was increased in patients with ASA 3-4 (OR 2.4, 95% CI 1.2-4.9, p = 0.01), pT3-4 (OR 3.1, 95% CI 1.27-7.57, p = 0.01) and positive LNs (OR 2.5, 95% CI 1.25-4.98, p = 0.009). Patient-related factors predicted 30 M whereas both patient-related and cancer-related factors predicted 30-90 M. This suggests that patient mix, i.e. patient- vs. cancer-related factors for 30 M and 30-90 M, should be taken into account if mortality rates are to be compared between hospitals.


Active and Healthy Families: A Randomized Controlled Trial of a Culturally Tailored Obesity Intervention for Latino Children.
There is a critical need for culturally relevant interventions to address obesity among Latino children, who have a greater risk of obesity and diabetes than non-Hispanic white children. To test the impact of a family-centered, culturally tailored obesity intervention delivered through group medical appointments on body mass index (BMI) and other measures of cardiovascular risk among Latino children. In a randomized controlled trial, 55 parent-child dyads were assigned to Active and Healthy Families (AHF) or a usual care wait-list control condition. Dyads were eligible if they spoke Spanish and if the child received care in a federally qualified health center, was aged 5 to 12 years, had a BMI in the 85th percentile or higher, and had not participated in AHF. The 10-week AHF intervention included biweekly group sessions delivered by a registered dietitian, physician, and promotora triad. Sessions covered topics such as parenting, screen time, healthy beverages, physical activity, and stress due to immigration. Child BMI (kg/m(2)) decreased (-0.50) in the AHF group and increased (+0.32) in the control group, yielding an adjusted difference in change of -0.78 (95% confidence interval [CI] -1.28, -0.27). Children assigned to AHF also exhibited relative improvements over controls in BMI z score (-0.10; 95% CI -0.19, -0.02) and triglycerides (-26.8 mg/dL; 95% CI -50.1, -3.6), but no significant between-group differences were observed for blood pressure or other fasting blood measures. AHF resulted in reductions in child BMI, BMI z score, and triglycerides. AHF, which was designed for low-income Latino families, has potential to reduce health disparities, but future studies are needed to determine long-term impact.


Neutral degradates of chloroacetamide herbicides: occurrence in drinking water and removal during conventional water treatment.
Treated drinking water samples from 12 water utilities in the Midwestern United States were collected during Fall 2003 and Spring 2004 and were analyzed for selected neutral degradates of chloroacetamide herbicides, along with related compounds. Target analytes included 20 neutral chloroacetamide degradates, six ionic chloroacetamide degradates, four parent chloroacetamide herbicides, three triazine herbicides, and two neutral triazine degradates. In the fall samples, 17 of 20 neutral chloroacetamide degradates were detected in the finished drinking water, while 19 of 20 neutral chloroacetamide degradates were detected in the spring. Median concentrations for the neutral chloroacetamide degradates were approximately 2-60ng/L during both sampling periods. Concentrations measured in the fall samples of treated water were nearly the same as those measured in source waters, despite the variety of treatment trains employed. Significant removals (average of 40% for all compounds) were only found in the spring samples at those utilities that employed activated carbon.


Fluorescence spectra in lung with porphyrin injection.
The fluorescence emission spectra from human bronchial mucosa and tumors, before and after injection of dihematoporphyrin ether/ester, have been measured with an optical multichannel analyzer from 500 to 750 nm. Fluorescence was excited with a violet krypton ion laser (average wavelength 410 nm). The autofluorescence spectra decrease monotonically with increasing wavelength except for a small broad peak near 600 nm. The spectra from tumor sites, after injection of the fluorescent porphyrin, exhibit the characteristic fluorescence emission at 630 and 690 nm, added to the autofluorescence spectrum. The spectra from control or nontumor sites are similar but the magnitude of the component due to the injected porphyrin is smaller than at a tumor site. The magnitude ratio of tumor to control site fluorescence depends on concentration of the porphyrin, tumor thickness, and time after injection. Autofluorescence degrades contrast and thus makes very thin tumors difficult to image. Subtraction of the autofluorescence background is desirable.


The influence of the graft monocytes in the outcome of allogeneic bone marrow transplantation.
The influence of graft monocytes on graft-versus-host disease (GVHD) has not yet been established in clinical trials. To understand this association better, we evaluated the influence of bone marrow graft monocytes aiming to analyze, primarily, the correlation with acute GVHD and chronic GVHD and, secondarily, the correlation with engraftment and survival.


Timing of delivery and pregnancy outcomes among laboring nulliparous women.
The objective of the study was to compare pregnancy outcomes by completed week of gestation after 39 weeks with outcomes at 39 weeks. Secondary analysis of a multicenter trial of fetal pulse oximetry in spontaneously laboring or induced nulliparous women at a gestation of 36 weeks or longer. Maternal outcomes included a composite (treated uterine atony, blood transfusion, and peripartum infections) and cesarean delivery. Neonatal outcomes included a composite of death, neonatal respiratory and other morbidities, and neonatal intensive care unit admission. Among the 4086 women studied, the risks of the composite maternal outcome (P value for trend < .001), cesarean delivery (P < .001), and composite neonatal outcome (P = .047) increased with increasing gestational age from 39 to 41 or more completed weeks. Adjusted odds ratios (95% confidence interval) for 40 and 41 or more weeks, respectively, compared with 39 weeks were 1.29 (1.03-1.64) and 2.05 (1.60-2.64) for composite maternal outcome, 1.28 (1.05-1.57) and 1.75 (1.41-2.16) for cesarean delivery, and 1.25 (0.86-1.83) and 1.37 (0.90-2.09) for composite neonatal outcome. Risks of maternal morbidity and cesarean delivery but not neonatal morbidity increased significantly beyond 39 weeks.


Recovery of oil from palm oil mill effluent using polypropylene micro/nanofiber.
Residual palm oil that goes into the river untreated can become detrimental to the environment. Residual oil discharge during milling process into palm oil mill effluent (POME) is unavoidable. About 1 wt% of residual oil in POME causes major problems to the mills, in terms of environment, wastewater treatment and economy losses. This paper reports the recovery of residual oil from POME by adsorption on polypropylene micro/nanofiber (PP-MNF) and desorption of oil by hands pressing, and oil extraction from the PP-MNF using solvent and supercritical-CO2 extraction techniques. The characterization of the PP-MNF and the quality of oil extracted were analyzed using analytical instruments. The reusability of the PP-MNF was also investigated. The experimental results showed the adsorption capacity of the PP-MNF was 28.65 g of oil/g of PP-MNF on average using refined palm oil, whilst recovery of oil from POME was 10.93 g of oil/g of PP-MNF. The extraction yield of oil from PP-MNF using hand pressing was 89.62%. The extraction of residual oil from the pressed PP-MNF showed comparable yield between solvent and supercritical CO2 techniques. The quality of recovered oil was similar with the quality of the crude oil, and no trace of polypropylene contamination was detected in the oil recovered. The PP-MNF showed no significant physical change after the extraction process. In conclusion, the PP-MNF has great potential to be used commercially in residual oil recovery from POME.


Isolation of embryonic hematopoietic niche cells by flow cytometry and laser capture microdissection.
Hematopoietic stem cells (HSCs) can differentiate into several types of hematopoietic cells, such as erythrocytes, megakaryocytes, lymphocytes, neutrophils, or macrophages, and also undergo self-renewal to sustain hematopoiesis throughout an organism's lifetime. HSCs emerge and expand during mouse embryogenesis. HSC regulation is governed by two types of activity: intrinsic activity programmed primarily by cell autonomous gene expression, and extrinsic factors, which originate from the so-called niche cells surrounding HSCs. Previously, we reported that endothelial niche cells regulate HSC generation at aorta-gonad-mesonephros region and placenta, and that hepatoblastic niche cells regulate HSC differentiation in mouse embryonic liver. In the course of those studies, we employed immunohistochemistry, flow cytometry, and the laser capture microdissection system to assess embryonic regulation of the mouse hematopoietic niche.


Foliar-applied magnesium nanoparticles modulate drought stress through changes in physio-biochemical attributes and essential oil profile of yarrow (Achillea millefolium L.).
Nanoparticles (NPs) are an emerging tool for mitigating environmental stresses. Although beneficial roles of NPs have been reported in some plants, there is little data on magnesium (Mg)-NPs in alleviating drought stress. Therefore, the field experiment was conducted to study changes in biochemical attributes and essential oil (EO) compositions of yarrow (Achillea millefolium L.) plants under drought stress and Mg-NPs in 2016 and 2017. Irrigation regimes were used in two levels as well-watered (irrigation intervals of 7 days) and drought stress (irrigation intervals of 14 days) conditions, and Mg-NPs were sprayed on leaves in four levels (0, 0.1, 0.3, and 0.5 g L-1). The results showed drought stress led to increased electrolyte leakage (EL), proline, carotenoid, anthocyanin, and total flavonoid content (TFC). However, flowers yield and EO yield were lower in plants exposed to drought stress as compared to well-watered conditions. The 0.3 and 0.5 g L-1 Mg-NPs were more effective in alleviating drought stress by enhancing these traits. Heat map results showed that EL and TSS represented the high variability upon different treatments. The GC and GC/MS results represented that α-pinene (8.60-12.20%), 1,8-cineol (9.03-14.02%), camphor (6.84-9.80%), α-bisabolol (8.54-18.81%), chamazulene (14.23-22.50%), and caryophyllene oxide (7.20-9.80%) were the min EO constitutes of yarrow plants. Totally, drought decreased monopertens but increased sesquiterpenes of EO. To sum up, foliar applied Mg-NPs in a range of 0.3-0.5 g L-1 can be recommended as effective tool to improve plant yield through changes in biochemical attributes of yarrow plants.


Functional effects of local thyroid hormone administration after sciatic nerve injury in rats.
This study investigates potential functional effects of thyroid hormone (T3) on peripheral nerve regeneration in rats. Forty adult male Lewis rats were included in this study. After complete transection of the right sciatic nerve, the gap between the stumps was bridged with a silicone tube. In the first experimental group (group A, n = 12), T3 solution was used to fill the tube, whereas a sterile buffer solution was used in nontreated rats, (group B, n = 12). Additionally, sham operation with surgical incision and mobilization of the sciatic nerve without any other intervention was performed (group C, n = 10). In a few animals, alpha-segment of the nerve was excised and the stumps were reversed to exclude the possibility of regeneration (group D, n = 6). The process of peripheral nerve regeneration was assessed by functional indices at 3, 6, 9, 13, and 17 weeks postoperatively. Mid-stance angle, at the ankle, measured in degrees, was used as a kinematic index and the withdrawal reflex (measured in grams of applied force) was used to evaluate the return of sensory function. Kinematic indexes were not different between the groups A and B at all time points of the evaluation. Sensory function was significantly different in T3-treated animals compared with buffer-treated control group (x vs. y, P = 0.031) at 9 weeks. Thereafter, sensory function was comparable between groups. In conclusion, T3 seems to accelerate the return of sensory function after complete transection of the sciatic nerves in Lewis rats without a significant effect on motor nerve recovery.


Effect of dietary fish oil supplementation on fever and cytokine production in human volunteers.
The effect of dietary fish oil supplementation on acute phase responses to intramuscular injection of typhoid vaccine, and in vitro cytokine production, was investigated in human volunteers. Half of the subjects supplemented their normal diet with 4.5 g/day of fish oil for 6-8 weeks. Injection of typhoid vaccine in unsupplemented subjects caused an increase in white cell count, resting heart rate, metabolic rate, oxygen consumption, and oral temperature. Fish oil supplementation inhibited the tachycardia and attenuated the maximal increases in oral temperature and metabolic rate following typhoid vaccine. However, interpretation of these latter results were complicated by similarly attenuated responses in saline-injected subjects. The in vitro production of interleukin-1 and interleukin-6 from whole blood was suppressed by fish oil supplementation, however, production of tumor necrosis factor alpha was not significantly altered. Fish oil supplementation may therefore provide a non-pharmacological approach of attenuating several of the responses associated with injury and infection and this may be related to reduced cytokine (IL-1 and IL-6) production.


[Interaction of steroids with human serum albumin by spin echo technique and paramagnetic sound methods].
The rate of water proton relaxation of the solutions of human serum albumin (HSA) modified by different spin labels has been investigated by spin echo technique. The rate of proton relaxation in the presence of the labeled HSA is higher than that in water solutions of spin labels. The proton relaxation data of the protein solutions can be explained by local properties of the water, bound with the protein (in the regions of spin labels) which seem to resemble those of water-glycerol solutions. The rate of proton relaxation was decreased in the presence of steroids that can be explained by a decrease of the local microviscosity of the water-protein matrix due to interaction of steroids with HSA.


NMR spectroscopy: structure elucidation of cycloelatanene A: a natural product case study.
The structure elucidation of new secondary metabolites derived from marine and terrestrial sources is frequently a challenging task. The hurdles include the ability to isolate stable secondary metabolites of sufficient purity that are often present in <0.5 % of the dry weight of the sample. This usually involves a minimum of several chromatographic purification steps. The second issue is the stability of the compound isolated. It must always be assumed when dealing with the isolation of natural products that the compound may rapidly degrade during and/or after the isolation, due to sensitivity to light, air oxidation, and/or temperature. In this way, precautions need to be taken, as much as possible to avoid any such chemical inter-conversions and/or degradations. Immediately after purification, the next step is to rapidly acquire all analytical spectroscopic data in order to complete the characterization of the isolated secondary metabolite(s), prior to any possible decomposition. The final hurdle in this multiple step process, especially in the acquisition of the NMR spectroscopic and other analytical data (mass spectra, infrared and ultra-violet spectra, optical rotation, etc.), is to assemble the structural moieties/units in an effort to complete the structure elucidation. Often ambiguity with the elucidation of the final structure remains when structural fragments identified are difficult to piece together on the basis of the HMBC NMR correlations or when the relative configuration cannot be unequivocally identified on the basis of NOE NMR enhancements observed. Herein, we describe the methodology used to carry out the structure elucidation of a new C16 chamigrene, cycloelatanene A (5) which was isolated from the southern Australian marine alga Laurencia elata (Rhodomelaceae). The general approach and principles used in the structure determination of this compound can be applied to the structure elucidation of other small molecular weight compounds derived from either natural or synthetic sources.


A Case Report of Coronavirus Disease 2019 Presenting with Tremors and Gait Disturbance.
Neurologic symptoms present as significant complications of coronavirus disease 2019 (COVID-19) infection. This report describes a novel manifestation of tremors triggered by severe acute respiratory syndrome coronavirus 2 infection. We describe a case of a 46-year-old man with COVID-19 infection complicated by a bilateral intention tremor and wide-based gait. Although neurological manifestations have been reported related to COVID-19, tremulousness has not yet been described. Considering the evolving diversity of neurologic manifestations in this infection, emergency physicians should be vigilant of possible COVID-19 infection in patients presenting with unexplained neurologic symptoms.