The impact of combined iliac occlusive disease and aortic aneurysm on open surgical repair.
Severe aortoiliac occlusive disease is a relative contraindication for endovascular aneurysm repair, owing to an association with high stent graft-related complication and reintervention rates in this population. Open AAA repair requiring aortofemoral bypass (AFB), however, may represent a unique population with differing outcomes from standard open repair. We sought to compare the demographic and procedural characteristics, as well as outcomes of patients undergoing standard intra-abdominal repairs (STD) versus those requiring AFB. Using a prospectively maintained database, we retrospectively identified patients who underwent open AAA repair from 1994 to 2017. A total of 1087 consecutive cases were performed consisting of 981 STD (681 tube graft, 300 aortoiliac) and 106 AFB cases. Demographics, procedural data, postoperative complications, and long-term survival were analyzed. The AFB cohort had more women (39.0 vs 22.8%; P = .001) and higher rates of hypertension (81.1 vs 69.8%; P = .015), chronic obstructive pulmonary disease (28.3 vs 17.4%; P = .006), and smoking (50.9 vs 36%; P = .002). The AFB group had smaller mean aortic (5.22 vs 5.77 cm; P = .001) and graft (17.08 vs 18.2 mm; P = .001) diameters. Proximal clamp position and blood loss were equivalent, although total anesthesia time was longer (295 vs 234 minutes; P = .001) in the AFB cohort. Overall 30-day postoperative morbidity (38.7 vs 24.8%; P = .002) was higher in the AFB group. Specifically, postoperative renal insufficiency (8.2 vs 3.4%; P = .032), wound infection (5.7 vs 1.2%; P = .005), and hematoma/seroma (5.7 vs 1.2%; P = .003) were more likely. Hospital length of stay was longer for AFB (11.9 vs 9.9 days; P = .007). The 30-day mortality (0.9% AFB vs 1.8% STD; P = .50) and major morbidity (17 vs 11.5%; P = .10) did not differ. Reintervention rate within 30 days of the initial surgery (12.3 vs 4.6; P = .001) and overall (33 vs 18.9%; P = .001) was higher in the AFB group. Long-term survival was lower in the AFB group (5-year survival: 63.1% AFB vs 71.9% STD; hazard ratio 0.76, log-rank P = .047). Multivariate regression analysis identified age, comorbid conditions, and aneurysm characteristics-rather than repair type-as independent predictors of 30-day reintervention and mortality at 5 years. Patients requiring AFB for AAA owing to associated iliac occlusive disease have more preoperative comorbidities, postoperative complications, a longer length of stay, reintervention rates and shorter 5-year survival. Patient and aneurysm characteristics rather than surgical repair type appear to be responsible for these differences. Nevertheless, 30-day mortality and major morbidity were comparable, making AFB an attractive alternative to endovascular aneurysm repair in patients with advanced iliac occlusive disease.


Calcium absorption in man: some dosing recommendations.
The absorption of calcium involves a saturable (active) and a nonsaturable (passive) component. The work of several investigators indicates that an inverse relationship exists between calcium intake and absorption efficiency. Human calcium absorption data from the literature were analyzed using a model which included both an active and a passive absorption component. Simulations were provided to illustrate the suitability of this model, and another previously reported model, to fit the data and to estimate the absorption efficiency of calcium when using different dosing regimens. Comparisons of the values predicted in this study with some literature values are provided and some assumptions and potential limitations associated with the use of this method are discussed. The division of the daily dose into equal increments taken at equally spaced intervals over the course of the day is recommended as a useful procedure for increasing the absorption efficiency and efficacy of calcium.


Pharmacology Management in Improving Exercise Capacity of Patients with Fontan Circulation: A Systematic Review and Meta-analysis.
The Fontan procedure is currently the mainstay therapy for single functional ventricles. However, with prolonged follow-up duration, various complications have been observed that seriously influence the quality of life of patients. The aim of this meta-analysis is to compare the effectiveness of pharmacologic agents in improving exercise capacity in patients with Fontan circulation. This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and has been registered in the International Prospective Register for Systematic Reviews database with registration no. 282352. Quality assessments of the included studies were assessed using the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Twelve studies met the predetermined inclusion criteria and were included in this metaanalysis. This meta-analysis found that treatment with bosentan significantly improved New York Heart Association Functional Class (NYHA FC) in Fontan patients (standard mean difference - 0.59, 95% CI -0.94 - -0.25; P=0.0008; I2 = 1%). However, the use of bosentan (P=0.66) and sildenafil (P=0.13) did not show a significant improvement in the maximum rate of oxygen consumption (VO2 max). This meta-analysis shows that people with Fontan circulation may benefit from using bosentan as it decreases postexercise heart rate and improves NYHA FC and 6-minute walking test results. Therefore, indirectly improving exercise capacity. Nonetheless, considerable work is required to strengthen our knowledge in improving the exercise capacity of Fontan patients.


Genetic and pharmacological targeting of GSDMD ameliorates systemic inflammation in macrophage activation syndrome.
Macrophage activation syndrome (MAS), a potentially life-threatening complication of autoimmune/autoinflammatory diseases, is characterized by the excessive expansion and activation of macrophages and cytotoxic T lymphocytes in multiple organs. Most commonly, MAS occurs in patients with systemic juvenile idiopathic arthritis and in its adult equivalent, adult-onset Still's disease (AOSD). Gasdermin D (GSDMD) is a critical pore-forming effector protein that mediates pro-inflammatory cytokine secretion via releasing its N terminal fragments to form transmembrane pores. GSDMD has been implicated in various inflammatory diseases, however, its role in MAS remains elusive. Here, we unveiled that the serum levels of GSDMD-N were elevated in patients with AOSD compared to heathy controls. In addition, the emergence of MAS features in AOSD patients resulted in further elevation. The serum levels of GSDMD were positively correlated with ferritin and interleukin-18 (IL-18). Repeated toll-like receptor 9 stimulation with unmethylated cytosine-phosphate-guanine (CpG) induced MAS symptoms in wild-type mice, including body weight loss, pancytopenia and hepatosplenomegaly. Genetic deletion and pharmacological inhibition of GSDMD ameliorated MAS symptoms in mice with the concomitant reduction of splenic and hepatic macrophage infiltration and IL-18 production. Consistent with these in vivo results, bone marrow-derived macrophages obtained from GSDMD-/- mice or treated with GSDMD inhibitor disulfiram exhibited attenuated IL-18 expression after CpG stimulation. Collectively, our findings identified GSDMD as a novel marker for MAS complication and a promising target for MAS treatment.


Spatio-temporal morphology changes in and quenching effects on the 2D spreading dynamics of cell colonies in both plain and methylcellulose-containing culture media.
To deal with complex systems, microscopic and global approaches become of particular interest. Our previous results from the dynamics of large cell colonies indicated that their 2D front roughness dynamics is compatible with the standard Kardar-Parisi-Zhang (KPZ) or the quenched KPZ equations either in plain or methylcellulose (MC)-containing gel culture media, respectively. In both cases, the influence of a non-uniform distribution of the colony constituents was significant. These results encouraged us to investigate the overall dynamics of those systems considering the morphology and size, the duplication rate, and the motility of single cells. For this purpose, colonies with different cell populations (N) exhibiting quasi-circular and quasi-linear growth fronts in plain and MC-containing culture media are investigated. For small N, the average radial front velocity and its change with time depend on MC concentration. MC in the medium interferes with cell mitosis, contributes to the local enlargement of cells, and increases the distribution of spatio-temporal cell density heterogeneities. Colony spreading in MC-containing media proceeds under two main quenching effects, I and II; the former mainly depending on the culture medium composition and structure and the latter caused by the distribution of enlarged local cell domains. For large N, colony spreading occurs at constant velocity. The characteristics of cell motility, assessed by measuring their trajectories and the corresponding velocity field, reflect the effect of enlarged, slow-moving cells and the structure of the medium. Local average cell size distribution and individual cell motility data from plain and MC-containing media are qualitatively consistent with the predictions of both the extended cellular Potts models and the observed transition of the front roughness dynamics from a standard KPZ to a quenched KPZ. In this case, quenching effects I and II cooperate and give rise to the quenched-KPZ equation. Seemingly, these results show a possible way of linking the cellular Potts models and the 2D colony front roughness dynamics.


The formation of alpha-D-(1----3) branch linkages by a D-glucansucrase from Streptococcus mutans 6715 producing a soluble D-glucan.
An exocellular D- glucansucrase that synthesizes a water-soluble, alpha-D-(1----6)-linked D-glucan having a high proportion of alpha-D-(1----3) branches was purified from the culture broth of Streptococcus mutans 6715. The rate of incorporation of D-[14C]glucose from [14C]sucrose into D-glucan of high molecular weight by this enzyme was increased (stimulated) by the presence of exogenous Leuconostoc mesenteroides B- 512F dextran, and it was found that this dextran could act as an acceptor. A highly branched dextran, containing 45-50% of alpha-D-(1----3) branch linkages, did not stimulate the enzyme nearly so much as B- 512F dextran, which has a low degree (5%) of alpha-D-(1----3) branches. We interpret this as evidence that the stimulating effects of dextran are not due to priming. If they were, the more highly branched dextran should have produced the greatest stimulation per unit weight, because a much greater number of nonreducing-end, priming sites would be available. We show that the D- glucansucrase was capable of transferring D-glucosyl groups from sucrose to B- 512F dextran to form alpha-D-(1----3) branches, thereby rendering the dextran more resistant to hydrolysis by endodextranase . The presence of 1.6M ammonium sulfate caused the enzyme to synthesize a D-glucan having a much higher percentage of alpha-D-(1----3) linkages.


Virtual planning in patients with frontal lobe lesions.
The VIrtual Planning Test (VIP) was developed to investigate the planning and organisational abilities of 25 patients with frontal lobe neurosurgical lesions, comparing their performance with 25 matched control subjects. The task, presented in the form of a board game, simulates planning and execution of a set of target activities that have to take place over a four day period, involving those that are either preparatory for a fictional "trip" abroad, or those that relate to the subject's current environment (context). The frontal lobe patients were impaired overall, tending to select inappropriate activities associated with their current context and showing greater impairment on subtasks requiring only one, rather than two, preparatory acts. The findings are discussed in terms of the validity of the VIP test in identifying executive functioning impairment and the degree to which the pattern of deficits are consistent with neuropsychological models of executive function.


Trichomonas vaginalis P16 Immunoreactivity in cervicovaginal Pap tests: a diagnostic pitfall.
Detection of p16 is emerging as a useful biomarker for Human Papillomavirus (HPV)-related dysplastic and malignant lesions of the cervix, and as such has potential application to cervicovaginal Papanicolaou (Pap) specimens. While evaluating p16 immunocytochemistry in our laboratory we observed one Pap test in which Trichomonas vaginalis stained positively for p16. We therefore proceeded to determine the frequency of T. vaginalis immunoreactivity for p16 in 10 consecutive, satisfactory, liquid-based Pap tests diagnosed as negative for intraepithelial lesion or malignancy in which T. vaginalis was present. For each case, a ThinPrep slide prepared from residual vial material was immunostained with p16. In an additional case, a prepared cell block was stained with p16. T. vaginalis were consistently p16 positive. We document, for the first time, p16 immunoreactivity of T. vaginalis that, on a Pap slide and cell block, may be morphologically misinterpreted as small dysplastic or malignant epithelial cells. The presence of this parasite in Pap tests may also potentially hinder the use of p16 as an adjunct to liquid-based cervical screening cytology.


Fibrosing mediastinitis: CT and MR findings.
The aim of this study is to present the computed tomography (CT) and magnetic resonance (MR) findings in three cases of fibrosing mediastinitis, probably secondary to tuberculosis. Two patients had diffuse involvement of the mediastinum and one patient presented with a posterior mediastinal mass. On CT, the patients with diffuse involvement showed infiltrating soft-tissue masses with multiple foci of dense calcifications. One of these lesions enhanced mildly with contrast and one did not enhance. On MR examination, diffuse masses were of heterogeneous, intermediate and low signal on T1-weighted images (n = 2) and were of homogeneous low signal (n = 1) or heterogeneous (n = 1) signal intensity on T2-weighted images. After administration of Gd-DTPA, these mediastinal masses showed heterogeneous enhancement. The posterior mediastinal mass showed homogeneous pronounced enhancement on CT and was homogeneous with intermediate T1 signal intensity and hypointense T2 signal intensity. The CT findings of an infiltrative or well-defined mediastinal mass with scattered calcifications should suggest the diagnosis of fibrosing mediastinitis in the appropriate clinical setting. Although the appearance of calcification on MR are not specific, this technique provides further information than CT especially in those cases in which the lesions appear noncalcified, because MR imaging revealed areas of low signal intensity characteristic of fibrous tissue.


Medical imaging of pulmonary disease in SARS-CoV-2-exposed non-human primates.
Chest X-ray (CXR), computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) are noninvasive imaging techniques widely used in human and veterinary pulmonary research and medicine. These techniques have recently been applied in studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-exposed non-human primates (NHPs) to complement virological assessments with meaningful translational readouts of lung disease. Our review of the literature indicates that medical imaging of SARS-CoV-2-exposed NHPs enables high-resolution qualitative and quantitative characterization of disease otherwise clinically invisible and potentially provides user-independent and unbiased evaluation of medical countermeasures (MCMs). However, we also found high variability in image acquisition and analysis protocols among studies. These findings uncover an urgent need to improve standardization and ensure direct comparability across studies.


Proceedings of the Third American Association of Oral and Maxillofacial Surgeons Anesthesia Patient Safety Conference.
The 3rd Anesthesia Patient Safety Conference of the American Association of Oral and Maxillofacial Surgeons was held at the Daniel M Laskin Institute for Oral and Maxillofacial Surgery Education and Innovation at American Association of Oral and Maxillofacial Surgeons headquarters in Rosemont, Illinois on June 6, 2022. The conference provided a platform to scrutinize collective errors, explore optimal practices, comprehend the concepts and principles of human complacency, assessing the system's capacity to handle deviations from the norm, and contemplate ideas and initiatives to enhance our practice model. These safety conferences are designed to foster collaborative, proactive conversations and understand best practices in safe delivery of anesthetic care to our patients.


Unveiling the correlation of Fe3O4 fractions upon the adsorption behavior of sulfamethoxazole on magnetic activated carbon.
Magnetic particles (MPs) assisted powdered activated carbon (PAC) is a promising composite material for adsorption removal of micropollutants. The fractional amount of Fe3O4 impacts the balance between adsorption capacity and magnetic property of magnetic activated carbons (MPACs), and therefore it affects the extent of sulfamethoxazole (SMX) removal. Here, five MPACs with different mass ratios of Fe3O4: PAC (1:1, 1:2, 1:4, 1:6, and 1:8) were prepared using a hydrothermal method and characterized by various spectroscopic methods. The spherical shaped MPs were monolayerly deposited on PAC with fewer pores blocked when the mass ratio of Fe3O4 was comparatively low (≤ 20%). MPAC6 (14.3 wt% of Fe3O4) had the best overall performance, with good Langmuir adsorption capacities for SMX (173.0 mg g-1) and excellent magnetic properties (9.0 emu g-1). Corresponding adsorption kinetics fitted well with the pseudo second-order kinetic model. The negative ΔG0 (-25.6 to -27.2 KJ mol-1) and ΔH0 (-9.14 KJ mol-1), and positive ΔS0 (0.55 KJ mol-1 K-1) properties indicated the spontaneous and exothermic nature of the adsorption process accompanied by an increase in entropy. The strong cation-assisted electron donor-acceptor and hydrophobic interactions were contributed to a high extent of SMX removal in the pH range of 2-4. Formation of negative charge-assisted H-bonds was responsible for the adsorption of hydrophilic SMX- on negatively charged MPAC6 in alkaline solution. Desorption and regeneration experiments showed SMX removal was still 92.3% in the 5th cycle. These findings give valuable insights into the interactions between SMX and MPACs and guide for choosing sustainable magnetic adsorbents for environmental applications.


Outcome of pregnancy in women with idiopathic thrombocytopenic purpura.
The obstetric management and haematological problems in 28 pregnancies of 23 mothers with idiopathic thrombocytopenic purpura (ITP) are analyzed. There was no maternal death and only 1 stillbirth occurred in the series. Ten infants were born by Caesarean section and 18 were delivered vaginally. Neonatal cord bloodplatelet counts showed thrombocytopenia in 12 infants, but in only 4 (14.3%) was the cord blood platelet count <50 x 10(9)/L. None of the 27 liveborn infants died, although 4 required supportive treatment with corticosteroids and IgG. No maternal characteristics could be used to predict the neonatal platelet count. These results are comparable with other studies reported in the literature. The rarity of poor neonatal outcome in mothers with ITP does not justify obstetric intervention solely on the basis of their platelet counts. The management of patients should be individualized and carefully planned.


The ecology of the web ofUloborus diversus (Araneae: Uloboridae).
The distribution ofUloborus diversus webs around pack rat nests on the desert near Cave Creek, Arizona, differences between webs there and in nearby residential Phoenix, and differences between the webs of large and small individuals indicate that these spiders select web sites and designs to minimize web damage by wind. The frequency of web construction decreased when spiders in captivity were exposed to wind or to relatively bright (5 Lamberts) nights. Observations of web sites on the desert revealed high rates of web-turnover and substantial frequencies of movements of spiders from one site to another. Much lower rates of web-turnover and spider movement occurred in less windy situations in the laboratory, and in suburban Phoenix. Partial web replacement and the extension of web construction over two nights are apparently methods used to improve catching ability of sheltered (longer lived) webs by extending their surface and/or tightening their mesh.


Changes in soil quality and below-ground carbon storage with conversion of traditional agricultural crop lands to bioenergy crop production.
Berm-isolated (0.5 ha) plots have been used since 1995 to quantify changes in soil and water quality with conversion from agricultural to bioenergy crops. Soil quality improvements, including increases in soil carbon storage, have occurred on sites planted to woody or herbaceous species, and no-till corn compared with tilled corn or cotton. Initial increases in soil carbon occurred within the upper 10 cm of the soil profile. Soil carbon on plantings of switchgrass, no-till corn, and sweetgum with a cover crop between the rows increased over the first 3 years. Soil carbon decreased by 6% on the sweetgum plantings without a cover crop and remained lower through the fifth growing season. Overall, the greatest increases in below ground carbon storage have occurred primarily within the upper 40 cm. Former land use, growth characteristics, management practices, and soil characteristics appear to be the primary factors determining the timing, depth. and extent of changes in soil carbon storage for bioenergy and no-till crops.


Morphology of immatures of the thelytokous ant, Monomorium triviale Wheeler (Formicidae: Myrmicinae: Solenopsidini) with descriptions of the extraordinary last-instar queen larvae.
The ant genus Monomorium is one of the most species-rich but taxonomically problematic groups in the hyperdiverse subfamily Myrmicinae. An East Asian species, M. triviale Wheeler, produces both reproductive queens and sterile workers via obligate thelytokous parthenogenesis. Here, we describe the immature forms of M. triviale based on light and scanning electron microscopy observations, with a note on the striking caste dimorphism in the last larval instar. The last-instar queen larvae were easily recognized by their large size, aphaenogastroid body shape, and rows of doorknob-like tubercles on the lateral and dorsal body surface. This type of queen-specific structure has not been found in ants in general, let alone congeneric species found in Japan. In stark contrast to the queen larvae, worker larvae showed a pheidoloid body shape and a body surface similar to other ants. The worker larvae were estimated to have three instars, consistent with previously described congeners. The pupae of both castes had no cocoon, a characteristic commonly described in other Myrmicinae species. In total, the developmental period from egg to adult worker averaged 59 days under 25C. We discuss possible functions of the tubercles of queen larvae based on previous studies.


SeqExpress: desktop analysis and visualization tool for gene expression experiments.
SeqExpress is a stand-alone desktop application for the identification of relevant genes within collections of microarray or SAGE experiments. A number of analysis, filtering and visualization tools are provided to aid in the selection of groups of genes. If R is installed then the application can use this to provide further analysis. SeqExpress is available at: http://www.seqexpress.com


Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up.
Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes. The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention. Of 160 subjects randomly assigned to groups, 29 (35.8%) in the control group (n = 81) and 30 (38.0%) in the intervention group (n = 79) were cognitively impaired at admission. The intervention group received geriatric consultation, continuous rehabilitation, and discharge planning. Subjects' cognitive function was measured using the mini mental state examination Taiwan version at admission, 6, 12, 18, and 24 months after discharge and analyzed using hierarchical generalized linear models. Patients who received the intervention program had 75% less likelihood of being cognitively impaired 6 months following discharge than those who received routine care (odds ratio = 0.25, p < 0.001). The difference between the control and intervention groups was small at admission, peaked at 18 months, and decreased from 18 to 24 months following discharge. Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan.


Hypoxia gene expression signatures as prognostic and predictive markers in head and neck radiotherapy.
Reliable methods for identification of hypoxia in radiotherapy-treated tumors have been a desirable aim in radiation oncology for decades. Hypoxia is a common feature of the microenvironment in solid tumors, and it is associated with increased aggressiveness, reduced therapeutic response, and a poorer clinical outcome. In head and neck squamous cell carcinomas, the negative effect of hypoxia on radiotherapeutic response can be counteracted and minimized by applying hypoxic modification to radiotherapy, which favors the clinical outcome after treatment. However, not all tumors are hypoxic, hence not all patients benefit from the addition of hypoxic modification. Therefore, predictive and clinically applicable methods for pretherapeutic hypoxic evaluation and categorization are needed. Hypoxia gene expression signatures are a developing strategy to approach this obstacle. This method has evolved along with the development of complementary DNA microarray analysis and classifies tumors in accordance to the expression of specific hypoxia-responsive genes in the tumor biopsy. Thus, tumors are classified and categorized in terms of the biological behavior to hypoxic conditions in the microenvironment. Until now, most of the developed hypoxia signatures have only been evaluated in terms of their prognostic impact; however, recently, a predictive impact for hypoxic modification of radiotherapy was verified. Here, we provide an overview of the hypoxic issue in radiotherapy and present the most promising hypoxia gene expression signatures developed to date.


Author Correction: Upconverting SrF2 nanoparticles doped with Yb3+/Ho3+, Yb3+/Er3+ and Yb3+/Tm3+ ions - optimisation of synthesis method, structural, spectroscopic and cytotoxicity studies.
An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Effect of Glycyrrhetic Acid Derivatives on Regulation of Thymocyte Volume.
We studied the effects of glycyrrhetinic acid (bioactive aglycone of glycyrrhizin) and its ester derivatives at positions C-3 and C-30 on the cell volume regulation in rat thymocytes under conditions of hypoosmotic stress. Native glycyrrhetinic acid completely suppressed this process with half-maximal concentration of 12.7±1.4 μM and Hill coefficient of 3.1±0.6. Formation of esters at C-3 (esters with the acetic, cinnamic and methoxi-cinnamic acid) and at C-30 (methyl ester) drastically decreased the inhibitory activity of the molecule, suggesting that intact hydroxyl group at C-3 and carboxyl group at C-30 are structurally important determinants of biological activity of glycyrrhetinic acid towards volume regulation of thymic lymphocytes.


A case of good management.
This paper reports an incident involving the exposure of eight employees who were handling a strain of Chlamydia in a production process. The report shows how a change of strain can alter the pathogenicity of the organism and how it is important to review handling precautions before any change of strain or procedure is undertaken.


[Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis].
Temporal cellulitis complicated by temporomandibular osteoarthritis and mandibular osteomyelitis is rare with the availability of antibiotics and the prevention of dental infections. A 56 year-old woman developed a jaw abscess during hospitalization in an intensive care unit following medical drug overdose. Repeatedly surgical drainage was performed guided by CT scans and multiple antibiotherapies. CT scan follow-up revealed temporomandibular arthritis with decrease of the joint space, synovitis, and subchondral cysts. Slow improvement was noted but limited mouth opening was persistent. This case illustrates the insidious evolution of an uncommon infection. It requires both expert clinical evaluation and an early MRI or CT scan investigation to determine the extension of the infection. Treatment is urgent because of the prognosis and is achieved by surgical drainage and adequate long-term antibiotherapy.


Hemostatic action of lotus leaf charcoal is probably due to transformation of flavonol aglycons from flavonol glycosides in traditional Chinses medicine.
Nelumbo nucifera Gaertn (lotus) leaves were empirically carbonized to enhance the hemostatic effect in traditional Chinese medicines. The mechanism of this application remains unclear. The present study aims at exploring the transformation of phytochemical compounds in lotus leaves after heating and figuring out the phytochemical mechanism of the application of charcoal hemostatic styptics. Raw lotus leaves were heated at 150 °C and 220 °C, respectively, and the transformation of the phytochemicals was studied. Flavonol glycosides in raw lotus leaves were found to be degraded to their corresponding aglycons in 150 °C lotus leaf charcoals (LLC) and the subsequent degradation products of aglycons in 220 °C LLC. 150 °C LLC exhibited the most desirable hemostatic effect in mice on reducing both bleeding time (BT) and clotting time (CT) by more than 30% as compared to the untreated group (P < 0.05). The extracts of 150 °C LLC were further separated by using different solvents. Ethyl acetate fraction which contained much flavonol aglycons displayed the most desirable hemostatic effect. On the contrary, petroleum ether fraction contains poor flavonoid and much alkaloid thus prolonged BT and CT. N-butanol extracts which contained only flavonol glycoside failed to shorten CT. In rats, quercetin (aglycon) standard promoted blood coagulation by shortening APTT (activated partial thromboplastin time) and increasing fibrinogen (P < 0.05). Hyperoside (glycoside) increased fibrinogen and platelet count (P < 0.05). Nuciferine was shown to prolong APTT and TT (thrombin time) and decrease fibrinogen (P > 0.05). Degradation of flavonoids and alkaloids in lotus leaves was suggested to enhance the hemostatic effect of LLC. Flavonol aglycons were found to be more effective on blood clotting compared with their corresponding glycosides. Nuciferine, a typical alkaloid in lotus leaves which was degraded in LLC showed anticoagulation effect in rats. The content of flavonoid aglycon can be regarded as a criterion to qualify LLC.


Prostate specific membrane antigen (PSMA) expression gives prostate cancer cells a growth advantage in a physiologically relevant folate environment in vitro.
Prostate specific membrane antigen (PSMA) expression is correlated with stage and grade of prostate cancer suggesting that it confers a growth advantage. We studied if PSMA folate hydrolase activity provides cells a growth advantage in a low folate (LF) micro-environment by hydrolyzing extracellular poly-gamma-glutamated folate to a form that cells can import. Proliferation of LNCaP and DU-145 cells was assessed in media containing low (LF), physiological (PF), or high (HF) folate with or without penta-gamma-glutamated folate and a PSMA specific folate hydrolase inhibitor, 2-(phosphonomethyl)-pentanedioic acid (2-PMPA). LNCaP cells, which express PSMA, and DU-145 cells, which do not, displayed decreased proliferation when grown in LF or PF compared to HF media. This reduction in proliferation was eliminated in LNCaP cells when penta-gamma-glutamated folate was added to the media. In the presence of penta-gamma-glutamated folic acid DU-145 cells displayed increased growth but this was still significantly lower than growth in HF medium. Addition of 2-PMPA attenuated the increased growth seen in LNCaP cells but had no effect on DU-145 cell growth. The folate hydrolase activity of PSMA may provide a growth advantage in LF and PF environments.


Writing for reflection: Radiography students' experiences with reflective journaling.
Reflective journaling is a widely recognised method of engaging in reflective practice, whereby individuals document their critical analysis of past experiences or actions, focusing on the implications and lessons learned for future application. In radiography and other healthcare professions, reflective practice is considered essential for professional development and should be cultivated during training. This study aimed to explore the experiences of senior radiography students in utilising the reflective journal as a clinical learning tool. This study employed a phenomenological research design, with the study participants being third and fourth-year radiography students. Data collection took place after the introduction of reflective journaling, with nineteen participants having utilised the reflective journal daily, for a minimum of eight months. Individual interviews were conducted after obtaining the participants' consent. The collected data were analysed using Atlas. ti (version 9.3), guided by the content analysis framework. The study revealed that participants experienced adaptation, characterised by reflective adaptation and process adaptation when utilising the reflective journal. Participants also encountered reflective barriers, including personal expression bias, inconsistent feedback, rumination overload, and impulsive practice dominance. The findings demonstrate the benefits of reflective journaling in promoting critical thinking and reflective practice among radiography students. It is therefore recommended that this practice be fully embraced as a standard clinical component. Additionally, the frequency of reflections should be reviewed to ensure effectiveness and consistent feedback should be provided to enhance skills development. The findings contribute further evidence to support the incorporation of reflective journaling in clinical training to promote critical thinking and reflective practice.


Parathyroid hormone related protein (PTHrP) in tumor progression.
Parathyroid hormone-related protein (PTHrP) is widely expressed in fetal and adult tissues and is a key regulator for cellular calcium transport and smooth muscle cell contractility, as well as a crucial control factor in cell proliferation, development and differentiation. PTHrP stimulates or inhibits apoptosis in an autocrine/paracrine and intracrine fashion, and is particularly important for hair follicle and bone development, mammary epithelial development and tooth eruption. PTHrP's dysregulated expression has traditionally been associated with oncogenic pathologies as the major causative agent of malignancy-associated hypercalcemia, but recent evidence revealed a driving role in skeletal metastasis progression. Here, we demonstrate that PTHrP is also closely involved in breast cancer initiation, growth and metastasis through mechanisms separate from its bone turnover action, and we suggest that PTHrP as a facilitator of oncogenes would be a novel target for therapeutic purposes.


Pelvic packing and angio-embolization after blunt pelvic trauma: a retrospective 18-year analysis.
Treatment of pelvic trauma related hemorrhage is challenging and remains controversial. In hemodynamically unstable patients suspected for massive bleeding, pre-peritoneal packing (PPP) with temporary external fixation (EF) and subsequent trans-arterial embolization (TAE) can be performed in order to control bleeding. In hemodynamically stable patients suspected for minor to moderate bleeding, primary TAE with EF may be performed. The goal of this study was to determine effectiveness and safety of both strategies. Retrospectively, patients that received treatment for pelvic trauma-related hemorrhage at two level 1 trauma centers located in the United States between January 2001 and January 2019 were evaluated. Both centers advocate subsequent TAE in addition to PPP and EF in hemodynamically unstable patients, and primary TAE in stable patients. Demographic and clinical data was collected and mortality, ischemic and infectious complications were determined. In total, 135 patients met the inclusion criteria. Of these, 61 hemodynamically unstable patients suspected for massive pelvic bleeding underwent primary PPP (45%) and 74 stable patients suspected for minor/moderate bleeding underwent primary TAE (55%). In total, 37/61 primary PPP patients underwent EF (61%) and 48 underwent adjunct TAE (79%), performed bilaterally in 77% and unselective by use of gelfoam in 72% of cases. Primary TAE patients received embolization bilaterally in 49% and unselective in 35% of cases. Exsanguination-related deaths were found in 7/61 primary PPP patients (11%). There were none among the primary TAE patients. Potentially ischemic in-hospital complications, of which one could be considered severe (gluteal necrosis), occurred more in patients that received bilateral unselective TAE compared to all other TAE patients (p=0.02). Primary TAE appears to be an effective and safe adjunct for (minor) pelvic hemorrhage in hemodynamically stable patients. Primary PPP followed by EF and adjunct bilateral unselective TAE with gelfoam appears effective for those suspected of massive pelvic bleeding. This unselective embolization approach using gelfoam might be related to (ischemic) complications. When considering the amount and severity of complications and the severity of pelvic trauma, these might not outweigh the benefit of fast hemorrhage control.


Interception of photosynthetically active radiation by cacti of different morphology.
Ribbing, orientation of cladodes, and variations in stem height were examined theoretically and in the field to see whether the morphology of various cacti could be interpreted as adaptations for intercepting photosynthetically active radiation (PAR). The total daytime PAR incident on different parts of the stem was related to the nocturnal increase in tissue acidity of these Crassulacean acid metabolism plants. The acidity change was 90% saturated for a total daytime PAR of about 22 mol m-2, which indicates that the vertical stems of cacti are often light-limited in the desert.PAR interception by a cactus with ribs of various depths was simulated. Ribbing led to more surface area but a lower PAR per unit area, so net carbon gain was little influenced.Although the cladodes of Opuntia basilaris Engelm. and Bigel. var. basilaris were randomly oriented, those of another platyopuntia, O. chlorotica Engelm. and Bigel, preferentially faced northsouth. Compared to facing east-west, cladodes facing N-S would receive 52% more PAR at the winter solstice, a time when water is generally available and overheating is not a problem in the Mojave desert habitat of O. chlorotica.The maximum height of Stenocereus gummosus (Engelm.) Gibs. & Horak varied from 0.7 m in northern Baja California (31°52'N) to 4.1 m at 23°47'N. Stem height was positively correlated (r 2=0.93) with the height of the surrounding vegetation and negatively correlated (r 2=0.91) with the PAR 1 m above the ground. The great plasticity in stem height permits S. gummosus to obtain sufficient PAR in the presence of subtropical trees in the southern part of its range and yet expend less biomass to reach unobstructed PAR in the northern part of its range, where the surrounding vegetation is much shorter.


Compartment-specific expression of plasminogen activator inhibitor-1 correlates with severity/outcome of murine polymicrobial sepsis.
Plasminogen activator inhibitor type 1 (PAI-1) co-induces septic coagulopathy. We aimed to characterize spatiotemporal PAI-1 gene/protein changes occurring in acute sepsis and tested whether PAI-1 fluctuations correlate with sepsis severity and early outcome. Female mice underwent cecal ligation and puncture (CLP) in three experiments. I: mild (23 G needle) CLP to compare circulating PAI-1 to its organ gene expression within 0-24h. II: mild or severe (17 G) CLP to asses differences in PAI-1 organ-specific expression and in coagulation/fibrinolysis. III: moderate (18 G) CLP to characterize circulating PAI-1 in survivors (SUR), and to retrospectively compare it to dying (DIE) mice. In mild sepsis, the trajectory of circulating PAI-1 (1089 ng/ml peak at 24h) was identical to PAI-1 gene expression in the left cranial vena cava (LCVC; 39-fold peak at 24h). PAI-1 expression rise was immediate (60-fold at 6h) and sustained in the liver, but marginal in the kidney, lungs and heart. Body temperature decrease correlated with the PAI-1 expression increase in the liver (rho = -0.79), and blood (protein, rho = -0.53). Regardless of severity, PAI-1 gene expression remained unaltered except the LCVC where it was >3-fold higher in 17G (vs. 23 G). Severe sepsis extended activated partial thromboplastin/pro-thrombin time and increased circulating PAI-1, while antithrombin and fibrinogen decreased at 6 and/or 24h (vs. 23 G). Within 24h of death, circulating PAI-1 in DIE was >3-fold higher versus SUR. Polymicrobial sepsis caused a gradual circulating PAI-1 release and highly variable gene expression response pattern in organs. Only circulating PAI-1 and PAI-1 expression in the LCVC correlated with response severity and/or outcome.


Complete genome sequence of DU_RP_II, a novel Ralstonia solanacearum phage of the family Podoviridae.
DU_RP_II, a bacteriophage of the family Podoviridae, which lyses Ralstonia solanacearum, was isolated from a diseased plant sample, and its genome was completely sequenced. The genome was found to be 42,091 base pairs long and to be a circular double-stranded DNA with a GC content of 62.17% and 38 predicted coding sequences. The phage showed homology to the RSK1 phage in four coding sequences, but it was concluded that the phage differed from previously reported Ralstonia phages based on the results of both morphology and bioinformatics analysis. This suggests that the phage DU_RP_II is a new member of the family Podoviridae.


Use of Dactylopius coccus Costa (Hemiptera: Coccoidea) pigments in the detection of larvae and pupae of Plutella xylostella (L.) (Lepidoptera: Yponomeutidae).
Carmines obtained from the dye of Dactylopius coccus Costa (Hemiptera: Coccoidea) were used for the detection of larvae and pupae of Plutella xylostella (L.) (Lepidoptera: Yponomeutidae) in broccoli inflorescences. Larvae were dyed with carmine II and red cochineal, while the majority of the dyes, with the exception of carmine III and the aqueous extract, were suitable to dye pupae. In the broccoli lumps exposed to the dyes, only the verge of the stems were actually dyed, right in the position where the incision took place, an appropriate characteristic for implementing this technique for commercial use.


Interaction between hydrogen peroxide and titanium: a possible role in the biocompatibility of titanium.
Hydroxyl radicals formed from hydrogen peroxide during an inflammatory response are potent agents for cellular deterioration. The behaviour of implanted material in terms of its ability to sustain or stop free radical formation may be therefore very important. In vitro studies of titanium which is known to be biocompatible and osseointegrates into human bone were carried out. In our model studies, the production of free radicals from H2O2 at Ti and TiO2 surfaces was measured by spin trapping techniques. Our findings suggest that there is no sustained hydroxyl radical production at a titanium (oxide) surface. We propose that this is due to the quenching of the Fenton reaction through both trapping and oxidation of superoxide radicals in a TiOOH adduct.


The foraging kinetics of ground ant communities in different mexican coffee agroecosystems.
Foraging efficiency was studied by measuring the rate of tuna fish bait discovery by ants in unshaded and two types of shaded coffee systems. We also investigated the effect of weed biomass upon ant foraging efficiency. We found that the rate of discovery was faster in the coffee system with no shade than in systems with shade trees. The rate of discovery in the two types of shade systems (monospecific and polyspecific shade) was similar. Differences in the foraging rate between systems seem to be related to the composition of the ground ant community in each of the systems, and to cumulative factors such as plant diversity, microclimate and interspecific competition. No correlation was found between weed biomass and ant foraging efficiency. The results of this study support the idea of manipulating agroecosystem plant and structural diversity in order to enhance pest regulation by ants.


Estrogen receptor interaction with immobilized metals: differential molecular recognition of Zn2+, Cu2+ and Ni2+ and separation of receptor isoforms.
We have utilized iminodiacetate (IDA) gels with immobilized Zn2+, Cu2+ and Ni2+ ions to evaluate the metal binding properties of uterine estrogen receptor proteins. Soluble (cytosol) receptors labeled with [3H]estradiol were analyzed by immobilized metal affinity chromatography (IMAC) before as well as after (1) 3 M urea-induced transformation to the DNA-binding form, and (2) limited trypsin digestion to separate the steroid- and DNA-binding domains. Imidazole (2-200 mM) affinity elution and pH-dependent (pH 7-3.6) elution techniques were both evaluated and found to resolve several receptor isoforms differentially in both the presence and absence of 3 M urea. Individual receptor forms exhibited various affinities for immobilized Zn2+, Cu2+ and Ni2+ ions, but all intact receptor forms were strongly adsorbed to each of the immobilized metals (Ni2+ greater than Cu2+ much greater than Zn2+) at neutral pH. Generally, similar results were obtained with IDA-Cu2+ and IDA-Ni2+ in the absence of urea. Receptors were tightly bound and not eluted before 100 mM imidazole or pH 3.6. Different results were obtained using IDA-Zn2+; at least four receptor isoforms were resolved on IDA-Zn2+. Receptor-metal interaction heterogeneity and affinity for IDA-Zn2+ and IDA-Cu2+, but not IDA-Ni2+, were substantially decreased in the presence of 3 M urea. The receptor isoforms identified and separated by IDA-Zn2+ chromatography were not separable using high-performance size-exclusion chromatography, density gradient centrifugation, chromatofocusing or DNA-affinity chromatography. The affinity of trypsin-generated (mero)receptor forms for each of the immobilized metals was decreased relative to that of intact receptor. High-affinity metal-binding sites were mapped to the DNA-binding domain, but at least one of the metal-binding sites is located on the steroid-binding domain. Recovery of all receptor forms from the immobilized metal ion columns was routinely above 90%. These results demonstrate the differential utility of various immobilized metals to characterize and separate individual receptor isoforms and domain structures. Receptor-metal interactions warrant further investigation to establish their effects on receptor structure/function relationships. In addition to the biological implications, recognition of estrogen receptor proteins as metal-binding proteins suggests new and potentially powerful receptor immobilization and purification regimes previously unexplored by those in this field.


Pentoxifylline-Induced Apoptosis in Chronic Lymphocytic Leukemia: New Insights into Molecular Mechanism.
Chronic lymphocytic leukemia (CLL) is an indolent B-lineage neoplasm, characterized by clonal expansion of CD5 positive B cells with constitutive activation of survival pathways including NF-kB. Pentoxifylline, a xanthine-derivative compound indicated for the treatment of microvascular disturbancies, has been suggested to have anti-proliferative and anti-metastatic activities in various types of cancer. In the present study we extend these data showing one of the potential molecular mechanisms through which Pentoxifylline may promote apoptosis in CLL clonal lymphocytes. Peripheral blood mononuclear cells were isolated from 15 CLL patients 0 RAI stage and 15 healthy volunteers and treated for 24 and 48 hours with Pentoxifylline. Apoptosis induction was evaluated through Annexin V and TUNEL assays. Mitochondrial membrane potential depolarization analysis, active Caspase-3 assay, reactive oxygen species generation and Western Blot were assessed to further investigate the alterations induced by Pentoxifylline. We observed a statistically significant occurrence of apoptosis, DNA fragmentation and active Caspase-3 in lymphocytes from CLL patients compared to healthy volunteers after 48 hours of Pentoxifylline treatment. To clarify the molecular mechanism of the drug, we also evaluated the expression levels of NF-kB/p65 and its related proteins. In treated CLL cells, NF-kB/p65 was significantly decreased in comparison to normal cells, whereas we observed a less marked reduction of Bcl-2 expression. The treatment also induced a decrease of Mcl-1 in CLL cells with a greater down-regulation of the anti-apoptotic alternatively spliced isoform. These findings showed that Pentoxifylline induced apoptosis in leukemic cells through a molecular mechanism that involves the NF-kB signaling.


C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery.
The relationship between C-reactive protein (CRP) levels and prolonged intensive care unit (ICU) length of stay (LoS) has not been well defined. To explore the association between CRP levels at ICU admission and prolonged ICU LoS in gastrointestinal cancer (GC) patients after major surgery. A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (≥ 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions. A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00-2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS (P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31-1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39-4.24, P = 0.002) for CRP levels higher than 2.6. Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.


Concomitant medications and immune checkpoint inhibitor therapy for cancer: causation or association?
The majority of cancer patients assume concomitant medications for the treatment of cancer-related symptoms or co-morbidities. As immune checkpoint inhibitors expand in the treatment of a widening range of malignancies, drug-drug interactions have become an area of increasing interest due to the potential for some concomitant medications to exert immune-modulatory effects and influence outcomes from immunotherapy. Here, we review the evidence supporting this association across selected drug classes including antibiotics, proton pump inhibitors, metformin, and opioids.


The subnuclear distribution of substance P, cholecystokinin, vasoactive intestinal peptide, somatostatin, leu-enkephalin, dopamine-beta-hydroxylase, and serotonin in the rat interpeduncular nucleus.
The distribution of immunofluorescent somata and processes within the interpeduncular nucleus (IPN) containing substance P (SP), cholecystokinin (CCK), vasoactive intestinal peptide (VIP), somatostatin (SST), leu-enkephalin (L-ENK), dopamine beta hydroxylase (DBH), and serotonin (5HT) was examined in male rats treated with colchicine 48 hours prior to perfusion. Serial sections were examined for immunofluorescence and variations in the density of fluorescence rated 1 + (sparse) to 4 + (dense). The rostral subnucleus contained SP, SST, and L-ENK-positive somata and processes. Substance P and VIP processes were present throughout the rostral subnucleus but were concentrated in two ovoid areas located dorsally in the caudal region of this subnucleus. Cholecystokinin and L-ENK processes surrounded these ovoid areas. The entire width of the central subnucleus was crossed by SP and L-ENK processes oriented horizontally in narrow bands. Substance P processes were also aligned into vertical columns adjacent to the lateral margins of the central subnucleus. Leu-enkephalin and 5HT processes were distributed throughout this subnucleus, while VIP processes were present only caudally. Dopamine beta hydroxylase processes were evenly distributed but were restricted from the vertical columns laterally. The intermediate subnuclei contained a sparse density of SP and 5HT processes that were present in proximity to the major blood vessels penetrating this subnucleus. Only DBH processes were evenly distributed. The lateral subnuclei contained a dense concentration of SP processes. The medial edges of this subnucleus were distinguished by VIP, CCK, L-ENK, and 5HT processes. The dorsal subnucleus contained 5HT, L-ENK, and SST-positive somata and processes. Substance P, VIP, CCK, and DBH processes were also present. Dorsal-lateral subnuclei contained SP, SST, L-ENK, and DBH processes. Interstitial subnuclei contained SP, CCK, L-ENK, 5HT, and DBH processes. This study demonstrates that perikarya and processes containing peptides and monoamines are distributed within subnuclei of IPN in a topographic and heterogeneous pattern. New features of IPN organization are revealed.


[Chronic widespread pain and tender points in low back pain: a population-based study].
Clinical observation suggests a frequent coincidence of back pain (BP) and fibromyalgia (FMA). Based on data from a population survey on back pain we studied the hypothesis of FMA being a frequent underlying condition of BP. We additionally studied the association of the severity of back pain and both chronic widespread musculoskeletal pain and active tender points. Data from a regional two-stage survey on urban German residents (aged 25-74 years) of Luebeck/Northern Germany (N=3969) were reanalyzed. The survey combined a postal questionnaire screening with a subsequent medical-psychological examination. Only subjects with back pain on the day of filling in the questionnaire were invited (n = 875). The response and participation rates were 82% and 73%, respectively. The severity of back pain was graded according to Kohlmann and Raspe (1994; based on pain severity and disability). In assessing widespread pain and tender points and classifying FMA-cases, we followed the criteria of the American College of Rheumatology (Wolfe et al. 1990). Standardized psychometric scales were used to measure general health status, bodily complaints, depressiveness, and catastrophizing cognitions. In Luebeck, the overall point prevalence of back pain reached 39%. Among those invited and examined we found 27%, 25%, and 19% with back pain grade 1, 2 or 3, respectively. 29% reported no back pain on the day of examination. 12.6% of probands with actual back pain reported chronic widespread pain. The number of active tender points showed a significant and relevant association with back pain grade and was additionally correlated with all indicators of somatic and psychological distress. Our data do not support the hypothesis of FMA as a frequent underlying condition of BP. We found, however, a close correlation between BP grade (and amount of distress) and tender points count. More severe forms of BP imply an increasing allodynia/hyperalgesia, itself being associated with a higher amount of somatic and psychological distress (Chronic severe) back pain seems to be more than simply pain in the back.


Research progress on the source, production, and anti-cancer mechanisms of paclitaxel.
Paclitaxel, a tetracyclic diterpenoid compounds, was firstly isolated from the bark of the Pacific yew trees. Currently, as a low toxicity, high efficiency, and broad-spectrum natural anti-cancer drug, paclitaxel has been widely used against ovarian cancer, breast cancer, uterine cancer, and other cancers. As the matter of fact, natural paclitaxel from Taxus species has been proved to be environmentally unsustainable and economically unfeasible. For this reason, researchers from all over the world are devoted to searching for new ways of obtaining paclitaxel. At present, other methods, including artificial cultivation of Taxus plants, microbial fermentation, chemical synthesis, tissue and cell culture have been sought and developed subsequently. Meanwhile, the biosynthesis of paclitaxel is also an extremely attractive method. Unlike other anti-cancer drugs, paclitaxel has its unique anti-cancer mechanisms. Here, the source, production, and anti-cancer mechanisms of paclitaxel were summarized and reviewed, which can provide theoretical basis and reference for further research on the production, anti-cancer mechanisms and utilization of paclitaxel.


Intra-articular calcaneal fractures: computed tomographic analysis.
Computed tomography (CT) analysis of 21 intra-articular calcaneal fractures categorized according to the Essex-Lopresti classification revealed the following distribution: joint depression-type 57%, comminuted type 43%, tongue-type 0%. The posterior calcaneal facet was fractured and/or depressed in 100% of the cases while the medial facet was involved in only 25% of the cases. CT proved superior to plain films by consistently demonstrating additional fracture components within each major category suggesting subclassifications which have potential prognostic value. CT allowed more expeditious handling of acutely injured patients, and improved preoperative planning, postoperative follow-up, and detailed analysis of causes for chronic residual pain. CT further identified significant soft tissue injuries such as peroneal tendon displacement which cannot be delineated on plain films.


UMSARS Versus Laryngoscopy-Based Assessment of Dysphagia.
Multiple System Atrophy (MSA) dysphagia is routinely assessed by the Unified Multiple System Atrophy Rating Scale (UMSARS) part I-item 2. To compare the UMSARS part I-item 2 with an ear/nose/throat (ENT) expert physician assessment. We retrospectively analyzed the data of MSA patients who underwent an ENT assessment (nasofibroscopic and radioscopic exam) and an annual UMSARS assessment. Deglutition Handicap Index (DHI) and pulmonary/nutrition complications were collected. Seventy-five MSA patients were included. The ENT assessment revealed more severe dysphagia compared to the UMSARS part I-item 2 score (P = 0.003). A higher proportion of patients with impaired protective mechanisms showed severe UMSARS-based dysphagia (P = 0.005). Patients with choking and oral/pharyngeal transit defects and nutritional complications were equally distributed across UMSARS part I-item 2 scores. Worse UMSARS part I-item 2 scores had worse DHI scores. The UMSARS-based assessment of dysphagia does not capture key aspects of pharyngo-laryngeal dysfunction reflecting swallowing efficiency.


Fat fractions from high-resolution 3D radial Dixon MRI for predicting metastatic axillary lymph nodes in breast cancer patients.
To assess diagnostic performance of fat fractions (FF) from high-resolution 3D radial Dixon MRI for differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer patients. High-resolution 3D radial Dixon MRI was prospectively performed on 1.5 T in 70 biopsy-verified breast cancer patients. 35 patients were available for analysis with histopathologic and imaging data. FF images were calculated as fat / in-phase. Two radiologists measured lymph node FF and assessed morphological features in one ipsilateral and one contralateral lymph node in consensus. Diagnostic performance of lymph node FF and morphological criteria were compared using histopathology as reference. 22 patients had metastatic axillary lymph nodes. Mean lymph node FF were 0.20 ± 0.073, 0.31 ± 0.079, and 0.34 ± 0.15 (metastatic, non-metastatic ipsi- and non-metastatic contralateral lymph nodes, respectively). Metastatic lymph node FF were significantly lower than non-metastatic ipsi- (p < 0.001) and contralateral lymph nodes (p < 0.001). Area under the receiver operating characteristics curve for lymph node FF was 0.80 compared to 0.76 for morphological criteria (p = 0.29). Lymph node FF yielded sensitivity 0.91, specificity 0.69, positive predictive value (PPV) 0.83, and negative predictive value (NPV) 0.82, while morphological criteria yielded sensitivity 0.91, specificity 0.62, PPV 0.80, and NPV 0.80 (p = 0.71). Combining lymph node FF and morphological criteria increased diagnostic performance with sensitivity 1.00, specificity 0.67, PPV 0.86, NPV 1.00, and AUC 0.83. Lymph node FF from high-resolution 3D Dixon images are a promising quantitative indicator of metastases in axillary lymph nodes.


Inhibition of interleukin-1alpha-induced cartilage oligomeric matrix protein degradation in bovine articular cartilage by matrix metalloproteinase inhibitors: potential role for matrix metalloproteinases in the generation of cartilage oligomeric matrix protein fragments in arthritic synovial fluid.
To determine whether matrix metalloproteinases (MMPs) degrade cartilage oligomeric matrix protein (COMP) to produce fragments similar to those found in synovial fluid (SF) from patients with arthritis. COMP fragments were generated in vitro by treating (a) bovine articular cartilage with interleukin-1alpha (IL-1alpha), (b) purified bovine COMP with MMPs, and (c) articular cartilage with MMPs. The fragments generated in each case were analyzed by Western blot, using an antibody to the C-terminal heptadecapeptide of COMP. IL-1alpha stimulation of cartilage resulted in a fragmentation of COMP, which was inhibited by MMP inhibitors CGS 27023A and BB-94. Isolated, recombinant MMPs rapidly degraded purified COMP, as well as COMP residing in cartilage. Several COMP fragments produced in vitro had similar electrophoretic mobility to those in SF of patients with arthritis. MMPs may contribute to the COMP fragments found in vivo. Quantitation of MMP-specific fragments may be useful in the evaluation of MMP inhibitors in patients with arthritis.


Like an empowering micro-home: A qualitative study of women's experience of giving birth in water.
To describe women´s experiences and perceptions of giving birth in water. A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made. One city-located hospital in Stockholm, offering waterbirth to low risk women. 20 women, 12 primiparas and 8 multiparas, aged 27-39. The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant". The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women. This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.


Hepatocellular carcinoma with atrial tumor thrombus presenting as myxoma: Resection under cardiopulmonary bypass.
Surgical resection for Hepatocellular carcinoma (HCC) with atrial tumor thrombus is a rare life saving procedure. A case of left lateral segment liver tumor (HCC) with atrial tumor thrombus resected with use of cardio-pulmonary bypass is presented.


Application of the concept synthetic lethality toward anticancer therapy: a promise fulfilled?
Back in 1997, a suggestion to apply the concept of synthetic lethality towards the development of selective, less toxic, cancer drugs and anticancer targets, was brought forward. The availability of large scale synthetic, low-molecular-weight chemical libraries seemed to lend itself to the concept. Human/mouse genome-wide siRNAs and shRNA-expressing libraries allowing high throughput screening for target genes synergistic lethal with defined human cancer aberrations, also raised high hopes of a soon to be established selective therapy. Sixteen years later, the major experimental aspects relating to the implementation of this more focused approach to cancer drug discovery, is briefly and critically reviewed.


The effect of pulsed expansion of subfascially placed expanders on the extent and duration of mitosis in the capsule and rat integument.
This study investigated the mitotic activity in the subdermally induced capsule and the epithelium surrounding tissue expanders maintained by pulsed expansions. Tissue expanders were placed into the fascial plane beneath the panniculus muscle of the rat and expanded sequentially. The volume in the expander was rapidly increased to a constant level and maintained for 48 hours; this was followed by a total decrease of volume for 48 hours. The procedure was repeated with volumes of 20, 30, and 40 mL. At the conclusion of each cycle of expander inflation, a group of rats was killed, and biopsy specimens of the induced capsule and epithelium were obtained. The developing capsule exhibited a significant increase in the mitotic index in the layers adjacent to the expander. The highest mitotic index was obtained with an inflation of 30 mL. These observations suggest that cellular proliferation, growth, and development of the extracellular matrix in the induced subdermal capsule can be sustained by pulsed volume changes in the expander.


Adaptation of an evidence-based intervention for Appalachian women: new STEPS (Strength Through Education, Physical fitness and Support) for breast health.
Appalachia is characterized by a high prevalence of individual-level risks for breast cancer, including physical inactivity and postmenopausal obesity. The availability of local, evidence-based programs to improve physical fitness is limited. We adapted an evidence-based intervention, StrongWomen, to improve physical fitness and increase breast cancer knowledge among women 40 years and older in Appalachian Pennsylvania. Utilizing a multi-site, community-based design, we tested the adapted 12-week, supervised program-New STEPS (Strength Through Education, Physical fitness and Support)-among 139 women. The completion rate was 67.6 %. Pre/post scores improved for each of six fitness assessments (P<0.01). We found differences in overall fitness by study site (P<0.001), but no differences by age (P=0.13) or by previous breast cancer diagnosis (P=0.73). New STEPS is an adapted, evidence-based program that can improve physical fitness and breast cancer awareness among women in Appalachian Pennsylvania. New STEPS may help fill a void in local fitness programs for Appalachian women at risk for breast cancer or breast cancer recurrence.


Balloon dilatation of a porcine bioprosthetic valve in aortic position.
We describe a case of percutaneous balloon valvoplasty of a stenotic Hancock bioprosthesis in aortic position. The procedure reduced the peak systolic gradient from 110 to 25 mm Hg. The calculated area of the orifice increased from 0.59 to 1.07 cm2. A cineaortogram performed after the procedure showed trivial aortic regurgitation and the subsequent immediate course was uneventful. The mechanism of dilatation and the risks of the procedure are discussed.


A wearable headset for monitoring electromyography responses within spinal surgery.
This research examines an approach for enhancing the efficiency of spinal surgery utilising the technological capabilities and design functionalities of wearable headsets, in this case Google Glass. The aim was to improve the efficiency of the selective dorsal rhizotomy neurosurgical procedure initially through the use of Glass via an innovative approach to information design for an intraoperative monitoring display. Utilising primary and secondary research methods the development of a new electromyography response display for a wearable headset was undertaken. Testing proved that Glass was fit for purpose and that the new intraoperative monitor design provided an example platform for the innovative intraoperative monitoring display; however, alternative wearable headsets such as the Microsoft HoloLens could also be equally viable. The new display design combined with the appropriate wearable technology could greatly benefit the selective dorsal rhizotomy procedure.


Pain referred to teeth as the sole discomfort in undiagnosed mediastinal lymphoma: report of case.
The role of routine medical examination in dental diagnosis is described in a report of case involving a young, seemingly healthy patient whose only symptom, pain in the mandibular left molars, proved a manifestation of a malignant mediastinal lymphoma.


Cytology and hormonal receptors in breast cancer.
Even in advanced tumors of the breast, it may be interesting to know the steroid receptor status (RS) for therapeutic and prognostic purposes. When, for clinical reasons, surgical biopsy is not advisable, a morphologic technique may be attempted on cytological material. In the past few years, we have employed the cytochemical method described by Lee (RSf) on cytological material obtained from 31 primary and 34 secondary tumors; adequate material and follow-up were available in 42 cases. Patients with positive results (strong and diffuse fluorescence of neoplastic cells) usually had better prognosis and longer disease-free interval and total duration of disease. The majority of patients responded to endocrine manipulation. In contrast, weak positivity or negative results were associated with a poorer prognosis. If these results are confirmed in larger series of cases and for longer periods of observation, the morphological evaluation of RS on cytological material could significantly contribute to the management of breast cancer patients.


ICD implantation and arrhythmia-free survival in patients with depressed LV function following surgery for valvular heart disease.
Although prophylactic implantable cardioverter-defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit. We followed 17 patients (14 men/three women, age 62 +/- 13 years, left ventricular ejection fraction [LVEF] 29 +/- 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T-wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow-up and vital status was determined using the National Death Index. There were no differences between the groups in overall survival (P = 0.24) or arrhythmia-free survival (P = 0.38), and the 2-year arrhythmia-free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia-free survival (P = 0.51). Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia-free survival as patients with ischemic cardiomyopathy.


Light inhibition of mitochondrial respiration in a mutant of Chlamydomonas reinhardtii devoid of ribulose-1,5-bisphosphate carboxylase/oxygenase activity.
The effect of light on mitochondrial respiration has been investigated in Chlamydomonas reinhardtii rcl-u-1-10-6C, a mutant devoid of ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) activity. No CO2 uptake was observed in the light, confirming that there was no Rubisco activity, but the CO2 evolution rate was diminished by 65 to 80%. This inhibition was ascribable to a decrease in the tricarboxylic acid cycle (Krebs cycle) activity. At the same time, O2 evolution associated with stimulation of the O2 uptake appears. Darkness or addition of DCMU fully reversed the effect of light, indicating that the inhibitory process is linked to photosystem activities. Levels of pyridine nucleotides (NAD(H) and NADP(H)) and adenine nucleotides (ATP and ADP), the most probable mediators of the interaction between photosynthesis and respiration, were measured in dark and in light. During a dark to light transition the level of NADPH increased significantly whereas the NAD(H) pool remained almost fully oxidized. The level of ADP was always extremely low. These results suggest that the inhibition of Krebs cycle activity is due to a competition for cytosolic ADP between chloroplastic photophosphorylations and oxidative phosphorylations.


Preparation and characterization of multi-walled carbon nanotube/hydroxyapatite nanocomposite film dip coated on Ti-6Al-4V by sol-gel method for biomedical applications: an in vitro study.
In the present research, the introduction of multi-walled carbon nanotubes (MWCNTs) into the hydroxyapatite (HA) matrix and dip coating of nanocomposite on titanium alloy (Ti-6Al-4V) plate was conducted in order to improve the performance of the HA-coated implant via the sol-gel method. The structural characterization and electron microscopy results confirmed well crystallized HA-MWCNT coating and homogenous dispersion of carbon nanotubes in the ceramic matrix at temperatures as low as 500 °C. The evaluation of the mechanical properties of HA and HA/MWCNT composite coatings with different weight percentages of MWCNTs showed that the addition of low concentrations of MWCNTs (0.5 and 1 wt.%) had improved effect on the mechanical properties of nanocomposite coatings. Moreover, this in vitro study ascertained the biocompatibility of the prepared sol-gel-derived HA/MWCNT composite coatings.


CRISPR/Cas9-Based Engineering of the Epigenome.
Determining causal relationships between distinct chromatin features and gene expression, and ultimately cell behavior, remains a major challenge. Recent developments in targetable epigenome-editing tools enable us to assign direct transcriptional and functional consequences to locus-specific chromatin modifications. This Protocol Review discusses the unprecedented opportunity that CRISPR/Cas9 technology offers for investigating and manipulating the epigenome to facilitate further understanding of stem cell biology and engineering of stem cells for therapeutic applications. We also provide technical considerations for standardization and further improvement of the CRISPR/Cas9-based tools to engineer the epigenome.


[Dietary literacy questionaire for school-age children's daily diet providers and its reliability and validity].
Development of dietary literacy questionnaire for school-age children's diet providers and evaluation of its reliability and validity. Based on the main theoretical basis of dietary literacy definition, a pool of dietary literacy questionnaires for school-age children's daily diet providers was prepared by expert group discussion through the Delphi method. The initial scale was formed by method such as expert panel discussions. A stratified cluster sampling method was used to investigate the daily dietary providers of 1137 urban and rural children in Hefei in November 2018. The t-test and Pearson correlation coefficient were used to analyze the decision value, correlation analysis and internal consistency analysis. The structural equation model was constructed to evaluate the structural validity of the questionnaire. One week after the interval, 90 school-age children's daily diet providers using random sampling were retested, and the test-retest reliability was analyzed. The reliability of the questionnaire was evaluated using Cronbach'α, Guttman coefficient, and structural validity. Further analysis of the differences in the educational level of children's diet providers and the scores of urban and rural questionnaires. A total of 1043 valid questionnaires were returned. 894(85. 7%) were children's parents and 128(12. 3%) were children's grandparents or maternal grandparents. After expert group discussion, the questionnaire preliminarily identified four first-level indicators to provide attitudes, actions, skills and environment for daily dietary providers about children's meals. The average authority coefficient of experts was 0. 87. The study finally retained 30 items, including the four dimensions of attitudes, actions, skills and environment provided by the daily diet providers of school-age children to the children's diet. The cumulative variance contribution rate was 52. 470%. The Cronbach' α coefficient of the questionnaire was 0. 874, the split-half reliability was 0. 813, and the test-retest reliability was 0. 878. Structural equation model fitting index: χ~2/df=2. 28, RMSEA=0. 042, NFI=0. 841, GFI=0. 927, AGFI=0. 912, RFI=0. 821, IFI=0. 904, TLI=0. 891, CFI=0. 903. In addition, the differences in scores of different education levels, urban and rural questionnaires and different dietary behaviors of children were statistically significant(P<0. 05), and the questionnaires had good discriminant validity. The reliability and validity of the dietary literacy questionnaire for school-age children's daily diet providers is good, and it can provide reference for evaluating the dietary quality of school-age children's dietary providers.


Effects of trigeminal ganglion stimulation on the central auditory system.
A projection from the trigeminal ganglion to the ventral cochlear nucleus (VCN) of the guinea pig was recently described. The synaptic terminals of this projection terminate in the granule and magnocellular regions of the VCN. Stimulation of this projection has been shown to result in activation of neurons of the ventral cochlear nucleus. We investigated the effect of electrically stimulating the trigeminal ganglion on the central auditory system activity using 2-deoxyglucose (2-DG) autoradiographic techniques. Electrical stimuli were applied to the left trigeminal ganglion as bipolar pulses, 100 micros per phase, at intervals of 200 ms and an amplitude of 100 microA. Negative control animals were not stimulated. A positive control animal was stimulated in the left ear using a 1 kHz tone burst with 200 ms duration and an amplitude of 80 dB SPL. 2-DG was administered by intramuscular injection. Following a 1 h incorporation period, animals were sacrificed, the brains rapidly harvested, and prepared for autoradiography using standard techniques. Autoradiographs were analyzed using computer-assisted video densitometry to determine film optical density in the central auditory regions of interest. The cerebellum was also sampled as a gray matter indifferent intra-brain control region. Results showed systematic and significant differences between 2-DG uptake in the cochlear nucleus and higher auditory centers between control and stimulated animals. Trigeminally stimulated animals showed significantly higher uptake than unstimulated animals in all auditory centers examined, especially ipsilateral to the stimulation site. The activation pattern differs qualitatively from that seen with sound stimulation in that mainly contralateral pathways are activated with sound stimulation. These results demonstrate that a projection from the predominantly somatosensory trigeminal ganglion can influence the activity of central auditory neurons in a manner distinct from acoustic stimulation, suggesting activation of non-classical auditory pathways.


An Exercise Counseling Intervention in Minority Adults With Heart Failure.
The primary aim of this study was to assess the feasibility of an exercise counseling intervention for adults of diverse race/ethnicity with heart failure (HF) and to assess its potential for improving overall physical activity, functional capacity, and HF self-care. This study was a quasi-experimental, prospective, longitudinal cohort design. Twenty adults were enrolled and completed the 6-minute walk and standardized instruments, followed by exercise counseling using motivational interviewing. Each received an accelerometer, hand weights, and a diary to record self-care behaviors. Participants were followed via phone for 12 weeks to collect step-counts, review symptoms, and plan the following week's step goal. Results indicate that this intervention was feasible for most participants and resulted in improvements in physical activity, functional capacity, and self-care behaviors. Brief exercise counseling may be an appropriate option to improve outcomes for stable patients with HF and may be tailored to fit different settings.


A simple combined Ag-I/RHG technique for human metaphase chromosomes.
A combination of the Ag-I staining method of the human nucleolus organizer regions (NORs) with an RHG banding method is described. This technique gives a reliable identification of each of the Ag + NOR acrocentric chromosomes. Its probable chemical nature is discussed.


Student's perspective of success in a postbaccalaureate program.
To identify contributors to the success of students in medical school that graduate from a 1-year postbaccalaureate bridge program. In 2010, using rigorous qualitative methodology, the principal investigator interviewed a random sample of 15 (23%) of current and past graduates of The Florida State University College of Medicine Bridge program. The investigators recorded and transcribed the interviews, utilized consensual qualitative research methodology to analyze the data, and identified an overarching theoretical construct. Content analysis of all 15 interviews yielded 73 themes, which were grouped into 6 broad categories/domains: The Florida State University College of Medicine Bridge Program attributes, personal attributes, proof of competence, support systems, exposure to medical programs, and faith/religion. Postbaccalaureate programs prepare students for success in medical school. The Florida State University College of Medicine Bridge Program has been particularly successful in identifying and educating students who demonstrated promise upon application, despite noncompetitive grades and Medical College Admission Test scores. The authors identify the characteristics and individual experiences of the students and program that relate to success.


A comparison of a new whole body scanner with a large crystal scanning camera in whole body imaging.
Physical parameters and the clinical experience obtained in one year with a new whole body scanning system are presented. Advantages and disadvantages of this system are described in comparison with a large crystal scanning camera. The whole body scanner has two detectors each an array of ten crystals with a large area (700 cm2 per head) able to scan a surface of 60 X 193 cm. The information is formed in a 160 by 512 point matrix and stored on a floppy disc. X-ray or polaroid film output is available. Whole body bone scans (both A.P. and P.A.) with excellent resolution are obtained in less than 25 min. The relative sensitivity and resolution of both imaging systems was studied using line and plane source phantoms and clinical material. Taking into account the different physical parameters of the systems an attempt at a practical comparison of scans is made in terms of time, sensitivity, resolution and image quality.


Normal stimulated growth hormone secretion but low peripheral levels of insulin-like growth factor I in prepubertal children with insulin-dependent diabetes mellitus.
The hypothalamo-pituitary-insulin-like growth factor I (IGF-I) axis was studied in 24 prepubertal children with insulin-dependent diabetes mellitus (IDDM) and 12 non-diabetic children. There were no significant differences between the diabetic and control subjects in basal concentrations of immunoreactive growth hormone releasing hormone (ir-GHRH), growth hormone (GH) or stimulated GH levels, but after exercise ir-GHRH concentrations were higher in the diabetic children. Peripheral IGF-I levels were significantly lower in the diabetic children, and even lower in those with poor metabolic control. A positive correlation was found between IGF-I levels and circulating free insulin concentrations in the diabetic subjects (r = 0.49, p < 0.05). These observations suggest that the GH response to physiological stimulation is normal in prepubertal diabetic children. Exercise-induced GH response may not be mediated by GHRH. IGF-I levels were reduced in prepubertal children with IDDM and even more so in subjects with poor metabolic control. This may be a consequence of transitory hypoinsulineamia, emphasizing the importance of adequate insulinization to facilitate optimal growth in children and adolescents with IDDM.


Three-dimensional ultrasound in margin evaluation for breast tumor excision using Mammotome.
Sonographic evidence of tumor removal by Mammotome excision does not confirm histological clearance. The operator finds it hard to determine if a malignant tumor has been fully removed, leaving a safe margin in the direction of each border; that is, the spatial orientation during tumor retrieval is not well-established by naked eye under sonographic guidance. We propose a computational imaging process to extract reasonable tumor contour in pre- and postoperative data sets for sonographic guidance so that Mammotome excision can help the operator to evaluate the surgical outcome. There were five tumors in the study, including three benign and two malignant. The lesion of interest was delineated after 2-D examination was completed, then it was analyzed with 3-D breast ultrasound (US). To give a reference point for correlations between pre- and postoperative images, we used a marker tape pasted on the skin within the transducer scanning area and then the preoperative 3-D US images were obtained. Subsequently, 2-D breast US was applied during Mammotome operation. After the Mammotome procedures were finished, the postoperative 3-D US images were obtained; thus, we gained two different data sets of 3-D US images that were used for later analysis for evaluating the extension of postoperative margin status. From the results, the safe margin was not satisfactory in all directions, because the minimum differences measured by the proposed algorithm were not large enough in all five cases, and this was proved from two malignant mastectomy specimens. The experimental results representing this inadequate Mammotome excision can be visualized through the computer aid. The comparison of tumor contour and excision margin may possibly be used for small malignant tumors in the future to improve the breast-conserving surgery.


Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery.
Motor evoked potentials (MEPs) changes might be caused to the non-surgically induced factors during cervical spinal surgery. Therefore, control MEPs recorded cranially to the exit of the C5 root are highly recommendable in cervical spinal surgery. We studied whether corticobulbar MEPs (C-MEPs) from tongue muscle could be used as a control MEPs in cervical spinal surgery. Twenty-five consecutive cervical spinal surgeries were analyzed. Stimulation of motor area for tongue was done by subcutaneous electrodes placed at C3/C4 (10-20 EEG System), and recording was done from both sides of tongue. C-MEPs were recorded successfully 24 out of the 25 (96%) tested patients. Forty-six out of fifty MEPs (92%) from tongue muscles were monitorable from the baseline. In two patients, we could obtain only unilateral C-MEPs. Mean MEPs latencies obtained from the left and right side of the tongue were 11.5 ± 1 ms and 11.5 ± 0.8 ms, respectively. Monitoring C-MEPs from tongue muscles might be useful control in cervical spinal surgery. They were easily elicited and relatively free from phenomenon of peripheral stimulation of the hypoglossal nerves. This is first study to identify the usefulness of C-MEPs as a control of cervical spinal surgery.


Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark.
When children are given opportunities to talk about their existential and spiritual concerns and needs, different health risks related to parents' illness and death may be reduced. The existential and spiritual care and conversations provided during parents' and close grandparents' cancer illness are insufficient. This article presents a practical and theoretical perspective on how to care for the existential and spiritual needs of children at three different age stages. Data from a research project guided the process of synthesizing the theoretical aspects with the practical. The theoretical perspective comprises Majbrit Guldin's theory of children's age-related grief reactions and James Fowler's three stages about children's spiritual and cognitive development. The empirical study is based on qualitative interviews with 16 children or close grandchildren of cancer patients at hospice. The theoretical and practical perspective function as a guide for existential and spiritual care and conversation with children at three different ages. The preschool child needs adults to support their growing spirituality and help them show, express, and understand their feelings. The school-aged child needs adults who listen to and acknowledge the child's understandings, experiences, and feelings as well as challenge their rigid thinking. The young adult needs adults who are willing to be there for them physically, mentally, socially, and spiritually in a genuine relationship. The perspective might function well for nurses and other health professionals as it is generic and addresses barriers for communication with children found in different healthcare contexts.


On the stability of stigmatization: the case of ex-homosexual males.
We undertook to empirically identify variables that influence the stigmatization of ex-homosexuals by analyzing the relationship between stigmatization and seven variables held to influence negative attitudes toward members of other ex-deviant groups: the stigmatizer's age, highest achieved educational level, amount of interaction the stigmatizer has had with an ex-homosexual, degree of effectiveness attributed to treatment in changing the homosexual to a heterosexual orientation, degree of responsibility that the stigmatizer attributes to ex-homosexuals for their prior homosexual behavior, degree of dangerousness attributed to ex-homosexuals, and degree of seriousness attributed to homosexuality. Analysis of data obtained by questionnaire from 281 respondents showed that the variable most strongly related to stigmatization of ex-homosexuals was the degree of dangerousness attributed to them. There was a profound direct relationship between these variables. Further, educational level, belief in the effectiveness of treatment, and amount of interaction of ex-homosexuals were inversely related to stigmatization, while degree of seriousness attributed to homosexuality was directly related to stigmatization. Respondents' tendency to stigmatize was not found to be related to age or to their attribution of responsibility to the ex-homosexual for his previous sexual orientation.


Is there a dose response relationship for clodronate in the treatment of tumour induced hypercalcaemia?
Eighty-six patients with tumour induced hypercalcaemia were randomised to 600, 900, 1200 or 1500 mg of intravenous clodronate, according to post hydration serum calcium levels. Sixty-seven were evaluable for response. The overall response rate was 49.3% (95% CI: 36.8-61.8) with no significant difference in response rates, i.e. achievement of normocalcaemia at days 6-9 (corrected serum calcium < or =2.6 mmol l(-1)) across all groups.


Impact of a two-arm educational program for improving diabetes care in primary care centres.
Improvement of the quality of diabetes care is essential for reducing diabetes complications. Nevertheless, compliance with diabetes clinical practice recommendations is inadequate in primary care. The aim of this study was to assess the impact of diabetes education, when directed simultaneously to both diabetes care providers and patients, on the frequency of performance of relevant laboratory tests and improvement of metabolic control. A three-step educational program was applied at 45 community clinics of a health-managed organisation comprising 175 health care providers and 16,275 diabetic patients. At the end of a 2-year period, the proportion of diabetic patients with HbA1c tested at least once a year rose from 60 to 85%. The percentage of patients with HbA1c <7% rose from 38 to 50%, whereas the percentage with HbA1c >8.5% decreased from 27 to 19%. The number of patients visiting an eye clinic at least once yearly rose from 55 to 65% and of those undergoing microalbumin testing from 27 to 37%. There was a 20% increase in the number of patients with low-density lipoprotein cholesterol measurements. Our study demonstrates the efficacy of diabetes education when directed simultaneously to health care providers and diabetic patients. The improvement in quality of care induced by such intervention can translate into better metabolic control and, ultimately, the prevention of diabetes complications.


Interictal epileptiform discharges on electroencephalography in children with methylenetetrahydrofolate reductase (MTHFR) polymorphisms.
Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme involved in folate metabolism. MTHFR C677T and A1298C polymorphisms are best-defined variants of MTHFR that were reported to be associated with epilepsy development. The aim of the study was to determine the incidence of interictal epileptiform discharges on electroencephalography (EEG) in asymptomatic children with C677T and A1298C polymorphisms who had no history of seizure. Children with MTHFR C677T or A1298C polymorphisms who had normal neurological examination without a history of seizure were included in the study. Blood samples for serum folate, vitamin B12, and homocysteine levels were analyzed. Sleep and awake electroencephalograms (EEG) were recorded. A total of 102 children (50 girls and 52 boys) with a mean age of 59.4 ± 58.7 months were included in the study. Interictal epileptiform EEG discharges were detected in 3 children (2.9%). There was no increase in the prevalence of interictal epileptiform discharges in seizure-free and asymptomatic children with MTHFR C677T and A1298C polymorphisms.


Immunomodulating activity of RU 41740: in vitro and in vivo studies on human lymphocytes.
A group of institutionalized elderly subjects, selected on the basis of their skin hypoergy and displaying different kinds of T and B lymphocyte impairments has been chosen as a model to verify the in vivo immunopotentiating activity of RU 41740 on human lymphocytes. Oral treatment with the drug was able to: restore or improve the cutaneous delayed hypersensitivity to recall antigens; significantly increase the blastigenetic response to mitogenic and submitogenic doses of PHA and PWM and improve the in vitro PWM-induced synthesis of IgG and IgM. The immunopharmacological activity of RU 41740 appeared to persist three months after the end of therapy, without any direct stimulating activity on the peripheral blood lymphocytes. The in vitro results seem to suggest that peripheral lymphocytes are not directly influenced by the drug.