The practice of traditional Korean medicine in Washington, D.C.
Therapeutic relationships between Korean immigrants and their hanui, traditional Korean professional physicians, and the role adaptation of these physicians in the United States are discussed. The professional practices of four hanui who work in the Washington, D.C., area are examined through case studies. Research methods included semi-structured interviews, participant observation, key informant interviews, and examination of documentary materials. In hanbang, the traditional Korean medical care system, illness is related to a disturbed state of ki, the cosmological vital energy. Symptoms are often interpreted in terms of a psychosocial base. Pathophysiology is usually illustrated in functional and holistic terms. Treatment modalities include acupuncture, herbal medicines, moxabustion, and cupping. Improvement is evaluated by the quality of pulse, the disappearance of symptoms, restoration of the appetite and of a healthy look and voice, and the return of the ability to function in everyday life. The therapeutic relationship between hanui and their clients is genuine, spontaneous, and harmonious. Clients actively enter into the clinical process by negotiating with hanui about treatment decisions. Hanui practicing in the United States modify their practices to meet their immigrant clients' expectations in relation to the impact of Western biomedicine. They may use some biomedical diagnostic techniques, offer traditional medicines in tablet form, and explain symptoms and treatment with reference to some biomedical terms. Koreans use both hanbang and Western biomedical treatments. However, clients who receive both types of therapy may experience conflicts because of the lack of cooperation between hanui and biomedical physicians.


The impact of short tandem repeat variation on gene expression.
Short tandem repeats (STRs) have been implicated in a variety of complex traits in humans. However, genome-wide studies of the effects of STRs on gene expression thus far have had limited power to detect associations and provide insights into putative mechanisms. Here, we leverage whole-genome sequencing and expression data for 17 tissues from the Genotype-Tissue Expression Project to identify more than 28,000 STRs for which repeat number is associated with expression of nearby genes (eSTRs). We use fine-mapping to quantify the probability that each eSTR is causal and characterize the top 1,400 fine-mapped eSTRs. We identify hundreds of eSTRs linked with published genome-wide association study signals and implicate specific eSTRs in complex traits, including height, schizophrenia, inflammatory bowel disease and intelligence. Overall, our results support the hypothesis that eSTRs contribute to a range of human phenotypes, and our data should serve as a valuable resource for future studies of complex traits.


Varus deformity in supracondylar fractures of the humerus in children.
Eighty cases of supracondylar fracture of the humerus at the elbow in children have been analysed. The post-reduction radiograph of the fracture was classified depending on the residual deformity present and related to the loss of carrying angle and cubitus varus deformity at the time of follow-up. Fifty-four percent of the displaced fractures showed a loss of carrying angle greater than 5 degrees, and of these 23 per cent developed cubitus varus deformity. Eighty-five per cent of those cases with a loss of carrying angle greater than 10 degrees showed either residual tilt or medial rotation on the post-reduction radiograph. All cases in which there was residual medial tilt after manipulation and 40 per cent of those with medial rotation on the post-reduction radiograph developed cubitus varus. In our series, there was no evidence of epiphyseal injury causing the deformity and in none of the cases was the deformity progressive. It is suggested that, in order to reduce the incidence of varus deformity in suprocondylar fractures, open reduction and internal fixation is indicated in those fractures in which tilt or medial rotation cannot be reduced by conservative means.


Field dependent study on the impact of co-evaporated multihits and ion pile-up for the apparent stoichiometric quantification of GaN and AlN.
For atom probe tomography, multihits and any associated ion pile-up are viewed as an "Achilles" heel when trying to establish accurate stoichiometric quantification. A significant reason for multihits and ion pile-up is credited to co-evaporation events. The impact is the underestimation of one or more elements present due to detector inadequacies when the field evaporated ions are spatially and temporally close. Nitride materials, especially GaN and AlN, have been shown to suffer a strong field dependent compositional bias, with N having the characteristics for being a species prone to ion pile-up. In this paper we have explored through field dependent measurements on GaN and AlN the associated impact of co-evaporated multihits and ion pile-up. To achieve this a normal CAMECA electrode along with a specially modified GRID electrode, which was designed to manipulate co-evaporated ions and hence ion pile-up, were employed. From our results and in-depth analysis, any co-evaporation and associated ion pile-up is found to be either very small, or not species dependent. Thus, ion pile-up cannot be attributed as the cause for the significant N underestimation observed in these materials.


Hamster circadian rhythms are phase-shifted by electrical stimulation of the geniculo-hypothalamic tract.
The suprachiasmatic nuclei (SCN) contain the major pacemaker for mammalian circadian rhythms. The SCN receive photic input both directly, via the retinohypothalamic tract (RHT), and indirectly, via the geniculohypothalamic tract (GHT), which originates in cells in the intergeniculate leaflet (IGL) and anterior portions of the ventral lateral geniculate nucleus (vLGN). We tested whether electrical stimulation of the GHT would induce phase shifts in wheel-running activity rhythms of Syrian hamsters housed in continuous darkness or continuous illumination. In both lighting conditions, electrical stimulation of the GHT induced mainly phase advances when given during the late subjective day and small phase delays when given during the late subjective night and early subjective day. Stimulation in the thalamus outside the GHT failed to produce similar phase shifts. Repeated daily stimulation had only a weak entraining effect on the activity rhythm. Activation of GHT neurons appears to influence the pacemaker for activity rhythms in a phase-dependent manner.


A prospective study of predictors of successful weight maintenance by women enrolled in community-based weight-loss programs.
Research is limited on the psychological predictors of successful long-term weight maintenance after weight loss. Therefore, the present study examined the individual contributions of body image, depression, and self-esteem to successful weight maintenance after a significant weight loss. Measures of depression, self-esteem, and body image were administered at baseline, three-, and twelve-months to 73 women enrolled in community- based weight loss programs. Significant predictors of weight maintenance included baseline self-classified weight, early (3 months) weight maintenance, later (12 months) change in perceptual body image, and the interaction between early and late change in body image avoidance. Classifying oneself as more overweight at baseline predicted less weight maintenance, while later discrepancies between current and realistic body size were positively associated with weight maintenance. Those who showed steady improvements in body image avoidance behavior were more likely to maintain weight loss. Baseline BMI, self-esteem, and depression did not predict 12-month weight maintenance. Further understanding how body image and related factors contribute to weight maintenance may inform development of more effective interventions to promote long-term weight maintenance.


Non-Globular Organic Ionic Plastic Crystal Containing a Crown-Ether Moiety - Tuning Its Behaviour Using Sodium Salts.
Organic ionic plastic crystals (OIPCs) are a class of soft materials showing positional order while still allowing orientational freedom. Due to their motional freedom in the solid state, they possess plasticity, non-flammability and high ionic conductivity. OIPC behavior is typically exhibited by 'simple' globular molecules allowing molecular rotation, whereas the interactions that govern the formation of OIPC phases in complex non-globular molecules are less understood. To better understand these interactions, a new family of non-globular OIPCs containing a 15-crown-5 ether moiety was synthetized and characterized. The 15C5BA molecule prepared does not exhibit the sought-after behavior because of its non-globular nature and strong intermolecular H-bonds that restrict orientational motion. However, the OIPC behavior was successfully obtained through complexation of the crown-ether moiety with sodium salts containing chaotropic anions. Those anions weaken the interactions between the molecules, allowing rotational freedom and tuning of the thermal and morphological properties of the OIPC.


Quantifying the conservation status and abundance trends of wildlife communities with detection-nondetection data.
Effective conservation requires understanding species' abundance patterns and demographic rates across space and time. Ideally, such knowledge should be available for whole communities because variation in species' dynamics can elucidate factors leading to biodiversity losses. However, collecting data to simultaneously estimate abundance and demographic rates of communities of species is often prohibitively time intensive and expensive. We developed a multispecies dynamic N-occupancy model to estimate unbiased, community-wide relative abundance and demographic rates. In this model, detection-nondetection data (e.g., repeated presence-absence surveys) are used to estimate species- and community-level parameters and the effects of environmental factors. To validate our model, we conducted a simulation study to determine how and when such an approach can be valuable and found that our multispecies model outperformed comparable single-species models in estimating abundance and demographic rates in many cases. Using data from a network of camera traps across tropical equatorial Africa, we then used our model to evaluate the statuses and trends of a forest-dwelling antelope community. We estimated relative abundance, rates of recruitment (i.e., reproduction and immigration), and apparent survival probabilities for each species' local population. The antelope community was fairly stable (although 17% of populations [species-park combinations] declined over the study period). Variation in apparent survival was linked more closely to differences among national parks than to individual species' life histories. The multispecies dynamic N-occupancy model requires only detection-nondetection data to evaluate the population dynamics of multiple sympatric species and can thus be a valuable tool for examining the reasons behind recent biodiversity loss.


miR-21 inhibitor sensitizes human OSCC cells to cisplatin.
miR-21 as a tumor oncogenic molecule has been reported. However, whether miR-21 can affect the sensitivity of oral squamous cell carcinoma (OSCC) cells to cisplatin remain unclear. The aim of this study is to evaluate the roles of miR-21 in the sensitivity of OSCC cells to cisplatin. RT-PCR assay was performed to detect the expression of miR-21 in 10 pairs of OSCC and noncancerous tissue samples. Then As-miR-21 oligonucleotides were used to down the miR-21 expression. Finally, the effects of miR-21 downregulation the sensitivity of OSCC cells (CA-27) to cisplatin in vitro were also detected. The level of miR-21 expression in OSCC tissues was significantly higher than that in corresponding noncancerous tissues. Down the expression of miR-21 could significantly inhibit growth and induce apoptosis of CA-27 cells. Moreover, downregulation of miR-21 could sensitize CA-27 cells to cisplatin possibly by increasing cisplatin induced apoptosis. This study demonstrated that combination of cisplatin application with miR-21 downregulation might be a potential strategy for the treatment of human OSCC.


Novel regimen through combination of memantine and tea polyphenol for neuroprotection against brain excitotoxicity.
NMDA receptors are abundant, ubiquitously distributed throughout the brain, fundamental to excitatory neurotransmission, and critical for normal CNS function. However, excessive glutamate overstimulates NMDA receptors, leading to increased intracellular calcium and excitotoxicity. Mitochondrial dysfunction associated with loss of Ca(2+)homeostasis and enhanced cellular oxidative stress has long been recognized to play a major role in cell damage associated with excitotoxicity. In this experiment, we attempted to explore whether treatment with memantine (an NMDA receptor antagonist) and tea polyphenol (an antioxidant and anti-inflammatory agent), either alone or in combination, is effective in neuroprotection in a mouse excitotoxic injury model. Memantine (10 mg/kg/day), tea polyphenol (60 mg/kg/day), or a combination (memantine 5 mg/kg/day plus tea polyphenol 30 mg/kg/day) was administered by oral gavage for 2 consecutive days before causing excitotoxic injury. Mice received a 0.3-microL NMDA [335 mM (pH 7.2)] injection into the left striatum. Locomotor activity was assessed 24 hr before and after excitotoxic injury. Brain synaptosomes were harvested 24 hr after excitotoxic injury for assessment of Na(+), K(+)-ATPase and Mg(2+)-ATPase activity, reactive oxygen species production, mitochondrial membrane potential (Delta Psi m), mitochondrial reductase activity (MTT test), and Ca(2+)concentration. The results showed that treatment with memantine could significantly rescue mitochondrial function by attenuating the decreased mitochondrial membrane potential (Delta Psi m) and mitochondrial reductase activity in mouse excitotoxic injury. Treatment with tea polyphenol could significantly decrease the increased production of synaptosomal reactive oxygen species (ROS) and thus reduced the deteriorative ROS-sensitive Na(+), K(+)-ATPase and Mg(2+)-ATPase activity. However, neither memantine nor tea polyphenol alone could significantly improve the impaired locomotor activity unless treatment was combined. Combined treatment with memantine and tea polyphenol could significantly protect mice against excitotoxic injury by reducing the increased synaptosomal ROS production, attenuating the decreased Na(+), K(+)-ATPase and Mg(2+)-ATPase activity, the mitochondrial membrane potential (Delta Psi m), the mitochondrial reductase activity, and the increased synaptosomal Ca(2+)concentration. In addition, the impairment in locomotor activity was also significantly improved. Therefore, the combined treatment of memantine and tea polyphenol is more effective in neuroprotection than either memantine or tea polyphenol alone in mouse excitotoxic injury. These findings provide useful information about the potential application of memantine and tea polyphenols in preventing clinical excitotoxic injury such as brain trauma, brain ischemia, epilepsy, and Alzheimer's disease.


Lipid production for second generation biodiesel by the oleaginous yeast Rhodotorula graminis.
The increasing cost of vegetable oils is turning the use of microbial lipids into a competitive alternative for the production of biodiesel fuel. The oleaginous yeast Rhodotorula graminis is able to use a broad range of carbon sources for lipid production, and is able to resist some of the inhibitors commonly released during hydrolysis of lignocellulosic materials. Using undetoxified corn stover hydrolysate as substrate, the yeast achieved a lipid productivity and lipid content of 0.21 g/L/h and 34%w/w, respectively. The corresponding results with crude glycerol as carbon source were 0.15 g/L/h and 54%w/w, respectively. Therefore, R. graminis appears to be a suitable candidate for fermentation processes involving renewable resources.


Reversed-phase high-performance liquid chromatographic identification of lutein and zeaxanthin stereoisomers in bovine retina using a C30 bonded phase.
An efficient reversed-phase high-performance liquid chromatographic assay with ultraviolet detection at 450 nm for simultaneous determination of lutein and zeaxanthin stereoisomers in bovine retina is described. The procedure involves rapid and careful one-step hexane extraction of the carotenoids from the homogenized liquid and enrichment by on-line solid phase extraction on a polystyrene cartridge. The substances were eluted at a flow rate of 1 ml/min with acetone-water (85:15, v/v) on a C30 reversed-phase column. C30 phases exhibit superior shape selectivity for the separation of carotenoid stereoisomers compared with conventional C18 phases. For comparison a mixture of iodine-isomerized lutein and zeaxanthin standards was separated.


Mechanistic and therapeutic overview of glycosaminoglycans: the unsung heroes of biomolecular signaling.
Immune regulation is a complex biological signaling pathway in which several classes of biomolecules and small molecules play a complacent role to mediate this process. Glycoimmunology is a rapidly evolving research area that deals with the structure, binding interactions and immunological functions of glycans. Great deal of information regarding proteins and nucleic acids in molecular recognition events have been established owing to their well-established structural features and straight forward replication, transcription and translation principles. However considering the complexities of template free synthesis and structural heterogeneity, role of carbohydrates in immune regulation are still unsung to a large extent. In the current review, we illuminate the canonical structural features, emerging and significant pathophysiological functions of glycosaminoglycans (GAGs), the negatively charged linear carbohydrate molecules that are primarily present on all types of cell surfaces and extra cellular matrix. A snap shot of their association with protein counterparts of diversified protein families has been updated exclusively to provide mechanistic insights into their cellular signaling functions. Eventually, this review throws light on the recent biomedical/biotechnological advances of GAG based biomarkers, nutraceuticals, therapeutics, and nanocomposites for inflammatory, immune disorders and their invaluable contribution in tissue engineering.


A new ribonuclease from cobra venom (Naja naja) showing specificity towards cytidylic acid.
A ribonuclease was isolated and purified to homogeneity from cobra venom. The enzyme was found to be homogeneous on SDS and non-SDS polyacrylamide gel electrophoreses, and high performance liquid chromatography. The purified enzyme hydrolysed poly(rC), but not poly(rA), poly(rU), poly(rG), poly(rI), or poly(rI).poly(rC). The presence of magnesium was found to be an essential requirement for the nucleolytic activity of this enzyme.


Carotid artery resection and bypass for neck carcinoma.
Twenty-six patients were treated by carotid artery resection and vascular replacement for recurrent cancer of the neck. The incidence of postoperative neurologic sequelae was 7%. The absolute 12-month disease-free survival for metastatic squamous cell carcinoma was 25%. It is concluded that in selected patients, this aggressive surgical therapy is indicated.


Patient-Centered Insights: Using Health Care Complaints to Reveal Hot Spots and Blind Spots in Quality and Safety.
Policy Points: Health care complaints contain valuable data on quality and safety; however, there is no reliable method of analysis to unlock their potential. We demonstrate a method to analyze health care complaints that provides reliable insights on hot spots (where harm and near misses occur) and blind spots (before admissions, after discharge, systemic and low-level problems, and errors of omission). Systematic analysis of health care complaints can improve quality and safety by providing patient-centered insights that localize issues and shed light on difficult-to-monitor problems. The use of health care complaints to improve quality and safety has been limited by a lack of reliable analysis tools and uncertainty about the insights that can be obtained. The Healthcare Complaints Analysis Tool, which we developed, was used to analyze a benchmark national data set, conceptualize a systematic analysis, and identify the added value of complaint data. We analyzed 1,110 health care complaints from across England. "Hot spots" were identified by mapping reported harm and near misses onto stages of care and underlying problems. "Blind spots" concerning difficult-to-monitor aspects of care were analyzed by examining access and discharge problems, systemic problems, and errors of omission. The tool showed moderate to excellent reliability. There were 1.87 problems per complaint (32% clinical, 32% relationships, and 34% management). Twenty-three percent of problems entailed major or catastrophic harm, with significant regional variation (17%-31%). Hot spots of serious harm were safety problems during examination, quality problems on the ward, and institutional problems during admission and discharge. Near misses occurred at all stages of care, with patients and family members often being involved in error detection and recovery. Complaints shed light on 3 blind spots: (1) problems arising when entering and exiting the health care system; (2) systemic failures pertaining to multiple distributed and often low-level problems; and (3) errors of omission, especially failure to acknowledge and listen to patients raising concerns. The analysis of health care complaints reveals valuable and uniquely patient-centered insights on quality and safety. Hot spots of harm and near misses provide an alternative data source on adverse events and critical incidents. Analysis of entry-exit, systemic, and omission problems provides insight on blind spots that may otherwise be difficult to monitor. Benchmark data and analysis scripts are downloadable as supplementary files.


Contribution to stress X-ray visualization of the fibular ligaments.
To determine the extension of a lesion of the fibular ligament with customary techniques is a highly subjective matter, since it underlies personal evaluation criteria. These criteria determine the indication for surgery. Socalled fixation devices are now made available, to avoid a wide margin of errors and to provide a means of attaining standardized and reproducable findings, which facilitate clinical diagnosis. We examined the Scheuba-fixation device in terms of its diagnostic value. In routine application in the clinic the device has proven to be useful, helping to decide on the proper treatment, especially in borderline cases.


Endoaortic balloon occlusion versus transthoracic cross-clamp for totally endoscopic robotic mitral valve surgery: a retrospective cohort study.
Endoaortic balloon occlusion (EABO) and transthoracic cross-clamping have been shown to have comparable safety profiles for aortic occlusion in minimally invasive mitral valve surgery (MIMVS). However, few studies have focused exclusively on the totally endoscopic robotic approach. We sought to compare outcomes for patients undergoing totally endoscopic robotic mitral valve surgery with aortic occlusion via EABO and transthoracic clamping after a period where EABO was unavailable required us to use the transthoracic clamp. Retrospective review identified 113 patients who underwent robotic mitral valve surgery at our facility between 2019 and 2021 with EABO (n = 71) or transthoracic clamping (n = 42). Relevant data were extracted and compared. Preoperative characteristics were similar other than a higher rate of coronary artery disease [EABO: 69.0% (49/71) vs clamp: 45.2% (19/42), p = .02] and chronic lung disease [EABO: 38.0% (27/71) vs clamp: 9.5% (4/42), p < .01] in the EABO group. Median percutaneous cardiopulmonary bypass time, operative time, and cross-clamp time were comparable. Similar rates of postoperative bleeding complications were observed, and no aortic complications were observed. One patient in each group underwent conversion to an open approach. 30-day mortality and readmission rates were comparable. EABO and transthoracic clamp were associated with similar bleeding and aortic outcomes, and mortality and readmission rates were comparable at thirty days postoperatively. Our findings support the comparable safety of the two techniques, which is well documented in studies encompassing all MIMVS techniques, within the specific context of the totally endoscopic robotic approach.


Perspective and investments in health system strengthening of Gavi, the Vaccine Alliance: a content analysis of health system strengthening-specific funding.
This paper aimed to compare the health systems strengthening (HSS) framework of Gavi and WHO and to analyze resource allocation in HSS by Gavi. Among 76 countries which received HSS funding from Gavi from 2006 to 2013, summary reports of 44 countries and approved proposals of 10 countries were collected. After comparing the HSS framework of WHO and Gavi, each activity described in documents was categorized according to Gavi's framework and funding allocation was analyzed. Compared with WHO's HSS framework, Gavi's has a distinctive function within the building block 'Drugs, Equipment, Supplies, Facilities' and a distinctive function of 'providing incentive and bonuses' under the building block 'Human Resource/Performance Management'. Gavi has steadily invested 10% of their total budget on HSS, but 47% were allocated in these categories, whereas 78% were for activities arguably not covered by WHO's HSS framework. In Africa, 70% of Gavi's budget fell under 'Drugs, Equipment, Supplies, Facilities' and 92.8% were for activities arguably not deemed as HSS by WHO. Gavi's HSS support emphasized inputs with short-term measurable outcomes. Harmonization of the concept of HSS and collaboration between Gavi and multilateral international agencies, such as World Bank and WHO, are needed.


[Omphalopagus conjoined twins with successful surgical separation (author's transl)].
The authors present an observation of omphalopagus conjoined twins with successful separation. They comment on the etiopathogenic factors, obstetrical problems, investigation of the extent of the union and operative timing.


Structural basis for the ATP-induced isomerization of kinesin.
Kinesin superfamily proteins (KIFs) are microtubule-based molecular motors driven by the energy derived from the hydrolysis of ATP. Previous studies have revealed that the ATP binding step is crucial both for the power stroke to produce motility and for the inter-domain regulation of ATPase activity to guarantee the processive movement of dimeric KIFs. Here, we report the first crystal structure of KIF4 complexed with the non-hydrolyzable ATP analog, AMPPNP (adenylyl imidodiphosphate), at 1.7Å resolution. By combining our structure with previously solved KIF1A structures complexed with two ATP analogs, molecular snapshots during ATP binding reveal that the closure of the nucleotide-binding pocket during ATP binding is achieved by closure of the backdoor. Closure of the backdoor stabilizes two mobile regions, switch I and switch II, to generate the phosphate tube from which hydrolyzed phosphate is released. Through the stabilization of switch II, the local conformational change at the catalytic center is further relayed to the neck-linker element that fully docks to the catalytic core to produce the power stroke. Because the neck linker is a sole element that connects the partner heads in dimeric KIFs, this tight structural coordination between the catalytic center and neck linker enables inter-domain communication between the partner heads. This study also revealed the putative microtubule-binding site of KIF4, thus providing structural insights that describe the specific binding of KIF4 to the microtubule.


Side-chain length is important for shogaols in protecting neuronal cells from beta-amyloid insult.
Ten shogaols were synthesized to evaluate the importance of the side-chain length in protecting cells from betaA(1-42) insult using PC12 rat pheochromocytoma and IMR-32 human neuroblastoma cells. The compounds cell protectivity against betaA insult was demonstrated using 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) reduction assay. The efficacy of cell protection from betaA insult by these shogaols was shown to improve as the length of the side chain increase.


Robustness and accuracy evaluation of moisture prediction model for black tea withering process using hyperspectral imaging.
The rapid and non-destructive detection of moisture in withering leaves is an unsolved problem because the leaves are stacked together and have random orientation. To address this issue, this study aimed to establish more robust and accurate models. The performance of front side, back side and multi-region models were compared, and the front side model showed the worst transferability. Therefore, five effective wavelength (EW) selection algorithms were combined with a successive projection algorithm (SPA) to select EWs. It was found that the shuffled frog leaping algorithm (SFLA) combined with SPA was the best method for the front side model for moisture analyses. Based on the selected EWs, the extreme learning machine (ELM) became the model with the best self-verification result. Subsequently, moisture distribution maps of withering leaves were successfully generated. Considering the processing demand of withering leaves, local region models developed based on partial least squares and the SFLA-SPA method were applied to predict the moisture of withering leaves in the local and stacked region. The results showed that the RPD, Rcv and Rp values were above 1.6, 0.870 and 0.897, respectively. These results provide a useful reference for the non-destructive detection of moisture in withering leaves.


Prospective evaluation of IOTA logistic regression models LR1 and LR2 in comparison with subjective pattern recognition for diagnosis of ovarian cancer in an outpatient setting.
To determine whether International Ovarian Tumor Analysis (IOTA) logistic regression models LR1 and LR2 developed for the preoperative diagnosis of ovarian cancer could also be used to differentiate between benign and malignant adnexal tumors in the population of women attending gynecology outpatient clinics. This was a single-center prospective observational study of consecutive women attending our gynecological diagnostic outpatient unit, recruited between May 2009 and January 2012. All the women were first examined by a Level-II ultrasound operator. In those diagnosed with adnexal tumors, the IOTA-LR1/2 protocol was used to evaluate the masses. The LR1 and LR2 models were then used to assess the risk of malignancy. Subsequently, the women were also examined by a Level-III examiner, who used pattern recognition to differentiate between benign and malignant tumors. Women with an ultrasound diagnosis of malignancy were offered surgery, while asymptomatic women with presumed benign lesions were offered conservative management with a minimum follow-up of 12 months. The initial diagnosis was compared with two reference standards: histological findings and/or a comparative assessment of tumor morphology on follow-up ultrasound scans. All women for whom the tumor classification on follow-up changed from benign to malignant were offered surgery. In the final analysis, 489 women who had either or both of the reference standards were included. Their mean age was 50 years (range, 16-91 years) and 45% were postmenopausal. Of the included women, 342/489 (69.9%) had surgery and 147/489 (30.1%) were managed conservatively. The malignancy rate was 137/489 (28.0%). Overall, sensitivities of LR1 and LR2 for the diagnosis of malignancy were 97.1% (95% CI, 92.7-99.2%) and 94.9% (95% CI, 89.8-97.9%) and specificities were 77.3% (95% CI, 72.5-81.5%) and 76.7% (95% CI, 71.9-81.0%), respectively (P > 0.05). In comparison with pattern recognition (sensitivity 94.2% (95% CI, 88.8-97.4%), specificity 96.3% (95% CI, 93.8-98.0%)), the specificities of the IOTA models were significantly lower (P < 0.0001). A significantly higher number of women would have been offered surgery for suspected cancer if the women had been assessed using the IOTA models instead of pattern recognition (213/489 (43.6%) vs 142/489 (29.0%); P < 0.001). The IOTA models maintained their high sensitivity when used in an outpatient setting. Specificity was relatively low, which indicates that a significant proportion of the women would have been offered unnecessary surgery for suspected ovarian cancer. These findings show that the IOTA models could be used as a first-stage test to diagnose ovarian cancer in an outpatient setting, but a different second-stage test is required to minimize the number of false-positive findings. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.


Educational assortative mating and time use in the home.
This study examines the association between individuals' educational assortative mating and time spent on child care and housework. Focus is put on hypogamous couples, or couples in which wives have more education than their husbands. Relative resources and gender revolution frameworks are considered as contexts to explain why hypogamous couples may share their time differently than other couples. A series of ordinary least squares regressions with population and sampling weights are employed using American Time Use Survey data from 2003 to 2018. Three, separate analyses using relative education, gender, and all educational pairings as the independent variables of interest are presented with child care and housework as the dependent variables. The current findings show that men in hypogamous marriages perform about 10 min more of child care per day on average than their peers in hypergamous and homogamous marriages, and that this comes primarily from basic care activities. This accounts for approximately 43% of the difference between men and women in the average amount of time spent on child care. No clear pattern of significance is apparent comparing individuals' time spent on housework by relative education, suggesting that housework and child care have evolved differently in the context of gendered domestic responsibilities. Men in hypogamous marriages are more egalitarian in their sharing of child care. However, this is only true for couples in which men have at least a high school diploma and women are highly educated.


A fuzzy logic-based model for noise control at industrial workplaces.
Ergonomics is a broad science encompassing the wide variety of working conditions that can affect worker comfort and health, including factors such as lighting, noise, temperature, vibration, workstation design, tool design, machine design, etc. This paper describes noise-human response and a fuzzy logic model developed by comprehensive field studies on noise measurements (including atmospheric parameters) and control measures. The model has two subsystems constructed on noise reduction quantity in dB. The first subsystem of the fuzzy model depending on 549 linguistic rules comprises acoustical features of all materials used in any workplace. Totally 984 patterns were used, 503 patterns for model development and the rest 481 patterns for testing the model. The second subsystem deals with atmospheric parameter interactions with noise and has 52 linguistic rules. Similarly, 94 field patterns were obtained; 68 patterns were used for training stage of the model and the rest 26 patterns for testing the model. These rules were determined by taking into consideration formal standards, experiences of specialists and the measurements patterns. The results of the model were compared with various statistics (correlation coefficients, max-min, standard deviation, average and coefficient of skewness) and error modes (root mean square error and relative error). The correlation coefficients were significantly high, error modes were quite low and the other statistics were very close to the data. This statement indicates the validity of the model. Therefore, the model can be used for noise control in any workplace and helpful to the designer in planning stage of a workplace.


Acetylcholinesterase differentiation during myogenesis in early chick embryonic cells caused by an inducer RNA.
In the stage 4 chick blastoderm, an area located 0.6 mm posterior to Hensen's node, the post-nodal piece (PNP), consists of an undifferentiated population of cells, since the explants when cultivated in vitro in a variety of media do not develop into any histologically identifiable structures. However, addition of a specific low molecular weight RNA isolated from the 16-day-old chick embryonic heart promotes the appearance of a distinct mode of morphological and biochemical changes that is similar to that of embryonic cardiogenic process. The RNA-induced changes in the PNP also include a marked increase in acetylcholinesterase activity. The increase in enzymatic activity can be measured biochemically, as well as visualized histochemically.


The effect of incremental positive end-expiratory pressure on right ventricular hemodynamics and ejection fraction.
The effects of incremental positive end-expiratory pressure (PEEP) on right ventricular (RV) function were evaluated in 36 (n = 36) ventilated patients. Positive end-expiratory pressure was increased from 0 (baseline) to 20 cm H2O in 5-cm H2O increments and RV hemodynamics and thermally derived right ventricular ejection fraction (RVEF), right ventricular end-diastolic volume index (RVEDVI), and right ventricular end-systolic volume index (RVESVI) were computed. Right ventricular contractility was determined from the analysis of RV systolic pressure-volume relations. Right ventricular ejection fraction declined from 42 +/- 8% at baseline to 30 +/- 9% at 20 cm H2O PEEP. Right ventricular end-diastolic volume index declined between 0 and 5 cm H2O PEEP (103 +/- 42 to 92 +/- 34 ml.m-2) and then increased to 113 +/- 40 at 20 cm H2O PEEP. Right ventricular end-systolic volume index increased from 60 +/- 31 ml.m-2 at baseline to 79 +/- 34 ml.m-2 at 20 cm H2O PEEP. The slope (E) of the relation of RV peak systolic pressure to RV end-systolic volume index decreased from 0.26 mm Hg.m2.ml-1 between PEEP of 0-15 cm H2O to 0.05 mm Hg.m2.m-1 at PEEP greater than 15 cm H2O. It is concluded that low levels of PEEP have a predominant preload reducing effect on the RV. Above 15 cm H2O PEEP, RV volumes increase and E decreases, consistent with increased RV afterload and a decline in RV contractility.


Potential impact of new oral anticoagulants on the management of atrial fibrillation-related stroke in primary care.
Anticoagulant prophylaxis with vitamin K antagonists (such as warfarin) is effective in reducing the risk of stroke in patients with atrial fibrillation (AF). New oral anticoagulants have emerged as potential alternatives to traditional oral agents. The purpose of this review was to summarise the effectiveness and safety of rivaroxaban, dabigatran and apixaban in stroke prevention in patients with AF in phase III trials, evaluate their cost-effectiveness and consider the implications for primary care. A literature search was performed between 2007 and 2012, selecting all phase III trials (ROCKET AF, RE-LY and ARISTOTLE) of new oral anticoagulants and relevant cost-benefit studies. Evidence shows that all three agents are at least as effective as warfarin in the prevention of stroke and systemic emboli, with similar safety profiles. Cost-benefit studies of rivaroxaban and dabigatran further confirm their potential use as alternatives to warfarin in clinical practice. These observations may allow stratification of the general practice AF population, to help prioritise which patients may benefit from receiving a new oral anticoagulant. The clinical and economic benefits of the new oral anticoagulants, along with appropriate risk stratification, may enable a higher number of patients with AF to receive effective and convenient prophylaxis for stroke prevention.


Language lateralization development in children with autism: insights from the late field magnetoencephalogram.
Left hemisphere dominance represents the typical language lateralization profile for the majority of neurologically healthy, right-handed individuals. We investigated hemispheric dominance for language in language-impaired children with autism and typically developing controls to investigate the hypothesis that atypical functional specialization for language represents one component of developmental language impairment in autism. Late field magnetoencephalography (MEG) recordings were used to calculate a hemispheric Lateralization Index from the neuromagnetic activity evoked by passive auditory presentation of vowel stimuli. Results indicate that children with autism and typically developing children follow opposite maturational trajectories in language lateralization; while leftward lateralization (i.e. left hemisphere dominance) emerged from bilaterally symmetric neuronal activation as age increased in our sample of typically developing children, rightward lateralization emerged from bilaterally symmetric activity as age increased in our sample of children with autism.


Electrical termination of tachyarrhythmias by discrete pulses.
Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. The ability of discrete stimuli to terminate an arrhythmia depends on the timing of the stimulus, the distance from the site of reentry where the stimulus is applied, the electrophysiologic properties of the myocardium between the site of stimulation and the site of reentry, and the size of the reentrant circuit. Modes of pacing used to terminate tachycardia have included single or multiple timed extrastimuli, overdrive pacing, burst pacing and competitive asynchronous (underdrive) pacing. Patient-triggered devices that deliver asynchronous pacing stimuli are routinely available. Newer devices have been developed that automatically sense the onset of tachycardia and respond with pacing stimuli. These devices have been highly effective in selected patients with supraventricular tachycardia. The seriousness of occasional pacing-induced acceleration of ventricular tachycardia or conversion to ventricular fibrillation has limited the application of these devices in patients with ventricular arrhythmias. Pre-implantation electrophysiologic studies are necessary to document arrhythmia mechanisms and to determine the feasibility of various pacing modalities in treating the tachycardia. The potential for complicating arrhythmias (atrial fibrillation/flutter or ventricular fibrillation) must also be tested. Future devices designed for terminating tachycardias with discrete pulses should be capable of being programmed to respond with one or more of the various modalities available. These devices should automatically and reliably sense both tachycardia onset and termination, and should adjust their responses appropriately if initial stimulation sequences fail to terminate the arrhythmia.


Construction and implantation of a cannula system for repeated injections into localized regions of the rat brain.
The construction and method of implantation of a brain cannula for chronic use in rats is described. All the components of the cannula system are easily made from stainless steel tubing and no machined parts are required. The use of a metal key eliminates the need for tapped holes during implantation. Although little time is required to prepare each animal the system remains firmly fixed to the skull and allows injections to be made accurately into selected brain areas.


PLZF and the (pro)renin receptor.
For many years, angiotensin II with its respective receptors was considered to be the only effector molecule within the renin-angiotensin system. Nevertheless, several studies indicated that renin (the enzyme catalyzing the generation of angiotensin I) and its enzymatically inactive precursor prorenin may have an angiotensin-II-independent (patho)physiological significance. In 2002, a specific (pro)renin receptor ((P)RR)) which increases the enzymatic activity of its ligands and induces an intrinsic activity upon ligand binding has been published. Recently, our group has demonstrated a novel (P)RR signal transduction pathway involving direct protein-protein interaction between the (P)RR and the transcription factor promyelocytic zinc finger protein (PLZF) and the nuclear translocation of PLZF upon renin stimulation. Downstream effects of (P)RR activation by renin included repression of the (P)RR itself and induction of the p85alpha subunit of the phosphatidylinositol-3 kinase (PI3K-p85alpha) as well as an increase in proliferation and a decrease in apoptotic activity. Various animal models demonstrated that inhibition of prorenin binding to the (P)RR can prevent or even abolish the development of cardiac fibrosis and diabetic nephropathy via angiotensin-II-independent mechanisms. Additional studies that verify these remarkable findings are needed. Moreover, the potency of aliskiren (the first orally active renin inhibitor in the market) to interfere with a putatively detrimental binding of (pro)renin to the (P)RR is of particular interest and has to be elucidated.


Characterization of the Gly45Asp variant of human cytochrome P450 1A1 using recombinant expression.
Cytochrome P450 1A1 (CYP1A1) is a heme-containing enzyme involved in metabolism of xenobiotics. CYP1A1 containing a Gly45Asp substitution has not yet been characterized. Escherichia coli expressing the Gly45Asp variant, as well as the purified variant protein, had lower CYP (i.e., holoenzyme) contents than their wild-type (WT) equivalents. The purified variant protein had reduced heme contents compared with their WT equivalents. Enhanced supplementation of a heme precursor during culture did not increase CYP content in E. coli expressing the variant, but did for the WT. Substitution of Gly45 with other residues, especially those having large side chains, decreased CYP contents of E. coli expressing the variants to a considerable extent. A 3D structure of CYP1A1 indicates that Gly45, along with other residues of the PR region, interacts with Arg77 of β- strand 1-1, which indirectly interacts with heme. Substitution analyses suggest the importance of residues of the PR region and Arg77 in holoenzyme expression. E. coli membrane and mammalian microsomes expressing the Gly45Asp variant, as well as the purified variant protein, had reduced ethoxyresorufin O-dealkylation activities, compared with the WT equivalents. These findings suggest the Gly45Asp substitution results in a structural disturbance of CYP1A1, reducing its holoenzyme formation and catalytic activity.


Neonatal repetitive maternal separation causes long-lasting alterations in various neurotrophic factor expression in the cerebral cortex of rats.
This study was carried out to examine the effects of early postnatal maternal separation stress on the development of the cerebral cortex with respect to time-dependent fluctuations of neurotrophic factor ligand and receptor expression. Wistar rats were separated from their mothers for 3h per day during postnatal days (PND) 10 to 15. The cerebral cortex was analyzed by real-time RT-PCR for the evaluation of the expression of mRNA for brain-derived neurotrophic factor (BDNF), TrkB, insulin-like growth factor-1 (IGF-1), and type 1 IGF receptor (IGF-1R) on PND16, 20, 30, and 60. The expression of these neurotrophic factor ligands and receptors in the cerebral cortex was enhanced on PND16 and PND20, and then it returned to baseline levels on PND30. By PND60, however, the expression levels were attenuated. The important implication of this study is the persistent abnormal fluctuation of neurotrophic factor expression for a prolonged period, triggered even after the brain growth spurt. Given that neurotrophic factors play important roles in brain development, it can be speculated that the altered expression of these factors induced by maternal separation may interrupt normal brain development and ultimately lead to functional disruption. However, the possibility of such changes leading to various functional disruptions and the underlying mechanisms involved require further study.


Chondrosarcoma of the cervical vertebra: a case report.
A rare case of cervical chondrosarcoma is presented and its clinical behavior and treatment modalities are discussed.


Cyclo-oxygenase-2 inhibitors suppress epithelial cell kinetics and delay gastric wound healing in rats.
The present study examined the effects of NS-398, a specific cyclo-oxygenase-2 inhibitor, on gastric mucosal cell kinetics and gastric wound healing following acid-induced injury. Male Sprague-Dawley rats were fasted for 24 h and then 0.6 mol/L hydrochloric acid (HCl; 1 mL) was administered into the stomach; NS-398 or indomethacin was administered to the animals 10 min after the acid. Levels of constitutive cyclo-oxygenase (COX-1) and mitogen-inducible cyclo-oxygenase (COX-2) in the gastric mucosa were analysed using western blotting and immunohistochemical staining. The grade of the lesion was assessed using planimetry and histological examination, including immunohistochemistry for proliferating cell nuclear antigen (PCNA). Although there was strong expression of COX-1, there was minimal expression of COX-2 in the gastric mucosa. Expression of COX-2 was enhanced mainly in surface epithelial cells and neck cells following HCl administration. Gastric mucosal ulcers and erosions healed within 48 h, during which time the proliferative zone expanded in the control animals. Indomethacin and NS-398 suppressed the expansion of the proliferative zone and delayed the healing of the gastric injury. The present study demonstrated that cyclo-oxygenase-2 inhibitors delay gastric wound healing by suppressing expansion of the mucosal proliferative zone. These results provide evidence that cyclo-oxygenase-2 has an important role in gastric mucosal regeneration.


The impact of short-duration precipitation events over the historic Cauvery basin: a study on altered water resource patterns and associated threats.
The Cauvery Delta, the 'Rice Bowl' of India follows a time-tested cultivation pattern over several irrigation zones. However, in this era of the Anthropocene, it is now well-established that short-duration, intense precipitation episodes will batter the flood plains year after year. The purpose of this first study is thus to quantify the impacts that such episodes may have on the floodplains of the Cauvery Delta and the concomitant threats to the historic Kallanai Dam. Precipitation events during the North-East monsoon period are driven not just by warm rain microphysics but also by large frozen hydrometeors falling from deep clouds causing undesirable flooding over the region to the extent of 66%. Additionally, from an assessment of the velocity heads and the floodwater depths, this study projects a heightened vulnerability. The total extent of submergence along riverbanks and other flow paths was estimated to be 145.98 [Formula: see text] out of which 65.14% of the submerged area is agricultural land. The most important conceptual advance established in this paper is that sub-zones in major watersheds that are currently safe will get inundated in the RCP8.5 warming scenario in 2050.


Satisfaction of Nigerian patients with health services: a protocol for a systematic review.
Patient-based assessment of health services is becoming popular in measuring the standard of care. Both quantitative and qualitative methods are available. Patient satisfaction surveys are commonly used to record the experiences of patients in hospitals, whereas qualitative designs (e.g., interviews and focus group discussions) are used less frequently. To date, there has been no systematic review published devoted to patient satisfaction with health services in Nigeria. We aim to (1) systematically analyze relevant quantitative studies to pinpoint excellent procedures in measuring patient satisfaction with health services, (2) to investigate if a reference method (gold standard method) exists, and (3) to identify relevant topics which are recognized by patients as important for the delivery of a high-quality health service in Nigeria. Searches of eight electronic journal databases, including MEDLINE, EMBASE, CINAHL, PsycINFO, AJOL, CDSR, DARE, and HTA will be conducted to identify studies assessing patient satisfaction with health services in Nigeria. The searches will be supported by manual searches in reference lists of relevant primary studies and systematic reviews. The review will be limited to studies published since 2007. After a stepwise screening process by two reviewers, data from included studies will be extracted and reviewed. The COSMIN RoB checklist will be used to critically appraise included studies. We will carry out an extensive data synthesis to answer the review questions. The intended systematic review will provide information on how the satisfaction of patients with health services has earlier been described and assessed in Nigerian studies. It will establish if a gold standard method exists and synthesize information on topics which might be of special interest to patients. Review findings will enrich the debate on patient-centered care and overall performance of health quality standards in Nigeria. PROSPERO CRD42018108140.


Epigenetic inhibition of nuclear receptor small heterodimer partner is associated with and regulates hepatocellular carcinoma growth.
Aberrant hypermethylation of promoter regions in cytosine-guanine dinucleotides (CpG) islands has been shown to be associated with transcriptional silencing of tumor-suppressor genes in many cancers. This study evaluated the methylation profile and the tumor-suppressive function of the small heterodimer partner (SHP, NR0B2) in the development of human hepatocellular carcinoma (HCC). Human HCC pathologic specimens and cell lines were used as model systems in this study. The expression of SHP is diminished in HCC pathologic specimens and cell lines by epigenetic silencing owing to SHP promoter hypermethylation. In vitro methylation decreased SHP promoter transactivation and nuclear receptor LRH-1 binding, an event that was reversed by demethylation. Overexpression of SHP inhibited HCC foci formation, arrested HCC tumor growth in xenografted nude mice, and increased the sensitivity of HCC cells to apoptotic stimuli. Further analysis of a total of 19 normal liver and 57 HCC specimens showed that down-regulation of SHP gene expression may be a common denominator of HCC. We propose that SHP functions as a novel tumor suppressor in the development of HCC. These findings provide new insight into the molecular mechanisms leading to this common cancer and may have both diagnostic and therapeutic applications.


A consensus approach to wound care in epidermolysis bullosa.
Wound care is the cornerstone of treatment for patients with epidermolysis bullosa (EB); however, there are currently no guidelines to help practitioners care for these patients. The objective of this study was to generate a list of recommendations that will enable practitioners to better care for patients with EB. An expert panel generated a list of recommendations based on the best evidence available. The recommendations were translated into a survey, and sent to other EB experts to generate consensus using an online-based modified Delphi method. The list was refined and grouped into themes and specific recommendations. There were 15 respondents (45% response rate), with significant experience in the EB field (>10 years [67%]). Respondents included physicians (67%), nurses (17%), and allied health professionals (7%). There was more than 85% agreement for all the proposed items. These were further refined and grouped into 5 main themes (assessment and management of factors that impair healing, patient-centered concerns, local wound care, development of an individualized care plan, and organizational support) and 17 specific recommendations. There is a paucity of scientific evidence with most recommendations based on expert opinion. These recommendations will provide practitioners with a framework for caring for these patients. Additional scientific research including effectiveness studies for everyday practice and expert consensus, may further refine these recommendations.


Effects of miRNAs in exosomes derived from α-synuclein overexpressing SH-SY5Y cells on autophagy and inflammation of microglia.
Our previous study has revealed that GFP-α-synuclein overexpressing SH-SY5Y cells-derived exosomes (GFP-SNCA Exo) decrease autophagy in microglia via their load of miRNAs. However, it is unclear whether GFP-SNCA Exo can affect microglial inflammation via modulation of autophagy. In order to investigate the effects of miRNAs carried by GFP-SNCA Exo on autophagy and inflammation of microglia. SH-SY5Y cells were transfected with lentivirus expressing α-synuclein and then their exosomes were collected. Western blot and laser confocal images showed that α-synuclein transferred between SH-SY5Y cells and microglia through exosomes. Differentially expressed miRNAs between GFP-SNCA Exo and the vector exosomes were detected by microarray analysis. After bioinformatics analysis of the differentially expressed miRNAs, we found that their target genes were enriched in the MAPK and autophagy-associated signaling pathway. The expression of P62, p-JNK/JNK, and p-ERK/ERK and the release of IL-6 significantly increased whereas LC3 II/I decreased in microglia exposed to GFP-SNCA Exo for 48 h when compared to the control group. But rapamycin could reverse the increasing expression of p-JNK/JNK, p-ERK/ERK and the release of IL-6 induced by GFP-SNCA Exo. Dual immunofluorescence staining for LC3B and LAMP1 showed that the fluorescence density of LC3B decreased and the fluorescence of LC3B and LAMP1 were not co-located in microglia after 48 h co-culture with GFP-SNCA Exo compared with the control group, which indicated that these exosomes decreased autophagy and impaired the autophagy flux in recipient microglia. Taken together, our results indicate that GFP-SNCA Exo activate the MAPK signaling pathway and inflammation by decreasing autophagy in microglia.


DNA-free RNA isolation protocols for Arabidopsis thaliana, including seeds and siliques.
High throughput applications of the reverse transcriptase quantitative PCR (RT-qPCR) for quantification of gene expression demand straightforward procedures to isolate and analyze a considerable number of DNA-free RNA samples. Published protocols are labour intensive, use toxic organic chemicals and need a DNase digestion once pure RNAs have been isolated. In addition, for some tissues, the amount of starting material may be limiting. The convenience of commercial kits is often prohibitive when handling large number of samples. We have established protocols to isolate DNA-free RNA from Arabidopsis thaliana tissues ready for RT-qPCR applications. Simple non-toxic buffers were used for RNA isolation from Arabidopsis tissues with the exception of seeds and siliques, which required the use of organic extractions. The protocols were designed to minimize the number of steps, labour time and the amount of starting tissue to as little as 10-20 mg without affecting RNA quality. In both protocols genomic DNA (gDNA) can be efficiently removed from RNA samples before the final alcohol precipitation step, saving extra purification steps before cDNA synthesis. The expression kinetics of previously characterized genes confirmed the robustness of the procedures. Here, we present two protocols to isolate DNA-free RNA from Arabidopsis tissues ready for RT-qPCR applications that significantly improve existing ones by reducing labour time and the use of organic extractions. Accessibility to these protocols is ensured by its simplicity and the low cost of the materials used.


Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy.
The prevalence of missed polyps in patients with inadequate bowel preparation on screening colonoscopy is unknown. To determine the prevalence of missed adenomas in average-risk patients presenting for screening colonoscopy who are found to have inadequate bowel preparation. Retrospective chart review. Endoscopy and pathology reports were examined to determine the characteristics of polyps. Data from repeat colonoscopies were collected through 2010. Outpatient endoscopy center at an academic medical center. This study involved patients who underwent outpatient average-risk screening colonoscopy between 2004 and 2009 documented to have inadequate bowel preparation and who had colonoscopy to the cecum. Initial adenoma detection rate and adenoma detection rate on follow-up examination. Inadequate bowel preparation was reported on 373 patients, with an initial adenoma detection rate of 25.7%. Of 133 patients who underwent repeat colonoscopy, 33.8% had at least 1 adenoma detected, and 18.0% had high-risk states detected (≥ 3 adenomas, 1 adenoma ≥ 1 cm, or any adenoma with villous features or high-grade dysplasia). Per-adenoma miss rate was 47.9%. Among patients with at least 1 adenoma on repeat colonoscopy, 31.1% had no polyps on initial colonoscopy; mean time between colonoscopies was 340 days. Among patients with high-risk states, 25.0% had no polyps seen on initial colonoscopy; mean time between colonoscopies was 271 days. Retrospective design. Adenomas and high-risk lesions were frequently detected on repeat colonoscopy in patients with inadequate bowel preparation on initial screening colonoscopy, suggesting that these lesions were likely missed on initial colonoscopy.


A method for detecting carcinogenic organic chemicals using mammalian cells in culture.
A method for testing organic chemicals for their carcinogenic potential is described. Baby hamster kidney cells (BHK-21/C1 13) were exposed to different doses of test compound in liquid tissue culture medium containing rat liver post-mitochondrial supernatant and cofactors (S-9 mix) to aid metabolism, but without serum. Survival of cells following exposure to the compound was assessed by cloning in liquid growth medium. Transformation was assessed by colony growth in semi-solid agar. The dose-response curve for survival was used to determine the LC50 of the compound. A dose-response curve for transformation was constructed and a 5-fold increase in transformation frequency at the LC50 was regarded as a positive test result. The method may also be used for testing gaseous compounds. Cells grown in monolayers and overlaid with serum-free medium and S-9 mix were exposed to vinyl chloride gas mixed with air. After exposure, the treated cells were trypsinized, resuspended in growth medium, and survival and transformation assays performed. The methods described are illustrated by examples taken from an evaluation study using 120 compounds and found to be more than 90% accurate in distinguishing between carcinogens and non-carcinogens.


Multidetector row computed tomography in bowel obstruction. Part 1. Small bowel obstruction.
Multidetector row computed tomography (MDCT) has the potential to provide high-resolution multiplanar imaging that can help in accurate diagnosis of small bowel obstruction. Reformatted multiplanar images can increase diagnostic confidence in identifying transition points causing obstruction and also allow accurate delineation of various pathological conditions. Accurate and early diagnosis of complications associated with small bowel obstruction can also help in the clinical management of patients. In appropriate clinical scenarios MDCT angiograms may also be performed. Furthermore the rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of common and unusual diseases causing small bowel obstruction as revealed on MDCT.


Negative pressure therapy stimulates healing of critical-size calvarial defects in rabbits.
Negative pressure therapy (NPT) is the controlled application of subatmospheric pressure to wounds. It has been shown to stimulate healing across a broad spectrum of soft-tissue wounds, at least in part from the application of mechanical stress on cells and tissues in the wound environment. This study tests the hypothesis that application of NPT to cranial critical-size defects (CSD) in skeletally mature rabbits leads to osseous healing. NPT was delivered 1, 4, 6 or 10 days over CSD-containing calcium phosphate scaffolds placed in contact with intact dura. At 12 weeks after defect creation, NPT groups exhibited significantly greater defect bridging and bone within the scaffolds (P<0.01). Increasing duration of NPT did not result in a greater amount of bone within the scaffolds, but did increase the amount of bone distributed in the upper half of the scaffolds. Appearance of tissue within defects immediately following the removal of NPT at day 6 suggests alternating regions of dural compression and distention indicative of cell stretching. Dura and adjacent tissue were composed of multiple cell layers that extended up into the scaffolds, lining struts and populating pore spaces. An extracellular matrix densely populated with cells and capillaries, as well as larger vessels, infiltrated pores of NPT-treated scaffolds, while scattered spindle-shaped cells and sparse stroma are present within pores of control scaffolds. This rabbit model data suggest that NPT activates within mature dura a natural healing cascade that results in osseous tissue formation without the addition of exogenous factors or progenitor cells.


How to adapt orthodontic treatment for a patient with a general pathology? Review of the literature based on six scenarios that challenge the practitioner
The democratization of access to orthodontic treatments and the development of orthodontics in adults lead more and more practitioners to take care of patients with various general pathologies. The aim of this literature review was to specify the recommendations governing orthodontic treatment in six specific situations: diabetes, patient at risk of endocarditis, haemophilia, osteopetrosis, epidermolysis bullosa and treatment with growth hormone. A review of the literature was carried out according to the PRISMA method from the PubMed database. The keywords used were, for diabetes: diabetic, diabetus mellitus, for infective endocarditis: endocarditis, for hemophilia : hemophilia, bleeding disorder, for the use of growth hormone: growth hormone, for epidermolysis bullosa: epidermolysis bullosa and for osteopetrosis: osteopetrosis, associated with the request « orthodontic » or « tooth movement ». None of these situations constituted an absolute contraindication to orthodontic treatment. However, if surgical procedures with potential for complications were necessary, a compromise should then be discussed in order to provide the best benefit/risk balance for patients.


Capturing Chromosome Conformation.
The genome is organized in 3D topology-associated domains to ensure proper gene transcriptional processes. The chromosome conformation capture (3C) is an affordable method to investigate local chromatin structure and dynamics in cells and tissue. Herein I describe an easy to design and a cost-effective protocol.


IL-15-high-responder developing NK cells bearing Ly49 receptors in IL-15-/- mice.
In mice lacking IL-15, NK cell development is arrested at immature stages, providing an opportunity to investigate the earliest developing NK cells that would respond to IL-15. We show in this study that immature NK cells were present in the spleen as well as bone marrow (BM) and contained IL-15-high-responder cells. Thus, mature NK cells were generated more efficiently from IL-15(-/-) than from control donor cells in radiation BM chimeras, and the rate of IL-15-induced cell division in vitro was higher in NK cells in the spleen and BM from IL-15(-/-) mice than in those from wild-type mice. Phenotypically, NK cells developed in IL-15(-/-) mice up to the minor but discrete CD11b(-)CD27(+)DX5(hi)CD51(dull)CD127(dull)CD122(hi) stage, which contained the majority of Ly49G2(+) and D(+) NK cells both in the spleen and BM. Even among wild-type splenic NK cells, IL-15-induced proliferation was most prominent in CD11b(-)DX5(hi) cells. Notably, IL-15-mediated preferential expansion (but not conversion from Ly49(-) cells) of Ly49(+) NK cells was observed in vitro only for NK cells in the spleen. These observations indicated the uneven distribution of NK cells of different developing stages with variable IL-15 responsiveness in these lymphoid organs. Immature NK cells in the spleen may contribute, as auxiliaries to those in BM, to the mature NK cell compartment through IL-15-driven extramarrow expansion under steady-state or inflammatory conditions.


Combination of biological pretreatment with NaOH/Urea pretreatment at cold temperature to enhance enzymatic hydrolysis of rice straw.
A stepwise pretreatment of combination of bacterial treatment with NaOH/Urea (NU) treatment was conducted to enhance enzymatic hydrolysis of rice straw (RS). The results showed that the composition of RS changed significantly, the lignin and hemicellulose decreased while cellulose increased. The biological treatment with a bacterium Sphingobacterium sp. LD-1 achieved mild conditions for the sequential NU treatment, reducing the concentration of the NU solution from 7%/12% to 4%/6% and increasing the temperature from -20°C to -10°C. The saccharification of rice straw co-treated with bacterium Sphingobacterium sp. LD-1 and 4%/6% NU at -10°C resulted in 1.396-fold and 1.372-fold increase of reducing sugar and glucose yield respectively than that of sole NU treatment.


Inhibition of salvage pathway enzymes by adenine arabinoside 5'-monophosphate (ara-AMP).
The effect of 9-beta-arabinofuranosyladenine 5'-monophosphate (ara-AMP) on the purine salvage pathway has been studied. On a dose-dependent basis ara-AMP inhibits the incorporation of adenine-8-14C into nucleotides in intact erythrocytes. The partially purified enzymes of the purine salvage pathway, the adenine phosphoribosyltransferase and the 5'-phosphoribosyl-1-pyrophosphate (PP-ribose-P) synthetase, but not the hypoxanthine-guanine phosphoribosyltransferase, are inhibited by ara-AMP in a non-competitive manner. The possible adverse drug interactions which might occur by the simultaneous use of ara-AMP and other antimetabolites are discussed.


Preparation of hydroxypropyl starch/polyvinyl alcohol composite nanofibers films and improvement of hydrophobic properties.
Starch-derived edible films have great potential as biodegradable food packaging and biomedical materials, in this study, we adopted a green method to prepare starch-based composite electrospun nanofibers films. The hydroxypropyl starches (HPS) were prepared to improve native starch solubility and properties, and a series of blend solutions were prepared with different HPS/polyvinyl alcohol (PVA) weight ratios. The comparison of the properties of HPS/PVA (HPA) nanofibers with different amylose contents were evaluated, and the fibers fabricated from hydroxypropyl high amylose starch (HP-HAS) had more continuous and homogeneous morphologies compared to the other starch fibers, it was also found that the addition of HP-HAS in the film has better mechanical properties than pure PVA film. Thus, to improve the hydrophobicity of the film, the HP-HAS/PVA (HPA(H)) nanofiber was selected for the hydrophobic study by the citric acid (CA) treatment. The hydrophobic surface was formed on the HPA(H) film by CA self-assembled coating with a water contact angle changed from 30.95° up to 100.74°. This study successfully prepared the modified starch/PVA composite nanofibers and established a simple method of self-assembled hydrophobic modification to improve water stability. Therefore, this green strategy is an alternative candidate in further study for food packaging and relative areas.


Serum urea and total cholesterol independently predict re-hospitalisation with a cardiac-related event following an acute ST-elevation myocardial infarction.
Although elevated serum urea and low serum sodium have been shown to be associated with increased short-term (30-day) mortality following an ST-elevation myocardial infarction (STEMI), little is known about the role of these biochemical markers as predictors of intermediate-term (1-year) re-hospitalisation. Case notes of 90 consecutively admitted patients discharged with a primary diagnosis of an STEMI were retrospectively investigated. Baseline parameters were recorded and patients' clinical course following hospital discharge was carefully reviewed up to 1-year post-STEMI. Multivariate logistic regression analysis was performed to determine the independent association between baseline parameters and 1-year re-hospitalisation. The mean age of the patients was 62.8+/-1.38 years. Thirty patients (33.3%) were re-hospitalised for cardiac-related events and three patients (3.3%) died within 1 year of index STEMI. Using stepwise regression analysis, after adjusting for all independent variables, admission total cholesterol (p=0.013) and urea (p=0.04) were found to be the only significant independent predictors of re-hospitalisation or death. Admission serum sodium was non-significant (p=0.065), but only just. For each mmol/L increase in total cholesterol, a patient was 2.18 times more likely to be re-hospitalised, while for each mmol/L increase in serum urea, a patient was 1.32 times more likely to be re-hospitalised or die. When data were categorised based on high urea (> 7 mmol/L), high total cholesterol (> 5.0 mmol/L) and low sodium (< 135 mmol/L) at admission, none of these variables showed any significant increased risk of re-hospitalisation or death. This suggests that these biochemical parameters were continuously associated with risk of re-hospitalisation through the whole range of serum concentrations. In this retrospective study, independent predictors of 1-year re-hospitalisation following an STEMI include high serum urea, raised cholesterol levels and, possibly, reduced sodium levels. These simple biomarkers can be included in patients' risk stratification when following post-STEMI patients in out-patient clinics.


Higher rates of first episode psychosis in immigrants admitted in inpatient unit at southwest Spain.
We present data on the incidence of admissions for first episode psychosis in a region of southern Spain. All consecutive cases of admissions to the psychiatric hospitalization unit due to psychosis were selected. The incidence rates for first episode psychosis among immigrants and non-immigrants between two years were calculated. Incidence rate ratio of first episode of psychosis was higher in immigrants (IRR 5.95 95% CI 3.8-9.3 p<0.001) and also in individuals from Sub-Saharan Africa (IRR: 30.09 95% CI:16.2-55.8 p<0.001). The results reflect the risk that immigrants have a greater risk of being hospitalized than non-immigrants.


Quantitative assessment of impaired postevacuation brain re-expansion in bilateral chronic subdural haematoma: possible mechanism of the higher recurrence rate.
Recurrence of chronic subdural haematoma (CSDH) occurs in up to 30% of patients. The rate of recurrence is higher in bilateral versus unilateral CSDH and the reason for this has not been fully elucidated. There are few quantitative studies of temporal changes in brain re-expansion after haematoma evacuation. The aim of this study is to use a simple volumetric image analysis method to quantify temporal changes of postoperative brain re-expansion in unilateral and bilateral CSDH. We reviewed computed tomography (CT) scans of 20 consecutive patients (16 men, 4 women; median age, 73.5 years) with CSDH (unilateral, n=10; bilateral, n=10) who underwent surgery (burr hole drainage on one or both sides) at our institutions during the period from June 2006 to August 2008. Haematoma volume was quantified preoperatively and on postoperative days 14 and 30 by computer-based image analysis (PACS Web 1000 System) of CT scans. We then calculated the brain re-expansion rate (BRR) for postoperative days 14 and 30. Haematoma volume remained significantly higher (p<0.001) in bilateral versus unilateral CSDHs at both postoperative time points, and the BRR was significantly greater (p<0.001) in unilateral versus bilateral CSDH at both time points. Results of this quantitative analysis provide definitive evidence for a poor BRR in bilateral compared to unilateral CSDH. This impairment may result in shifting of the brain and shearing of blood vessels, resulting in a higher recurrence rate.


Estimation of errors in determining intrathoracic blood volume using the single transpulmonary thermal dilution technique in hypovolemic shock.
The transpulmonary thermal dilution technique has been widely adopted for monitoring cardiac preload and extravascular lung water in critically ill patients. This method assumes intrathoracic blood volume (ITBV) to be a fixed proportion of global end-diastolic volume (GEDV). This study determines the relation between GEDV and ITBV under normovolemic and hypovolemic conditions and quantifies the errors in estimating ITBV. Nineteen pigs allocated to control (n = 9) and shock (n = 10) groups were studied. Shock was maintained for 60 min followed by volume resuscitation. The dual dye-thermal dilution technique was used to measure GEDV and ITBV (ITBVm) at baseline (time 0), shock phase (30 and 90 min), and after resuscitation (150 min). The regression equations estimated from paired GEDV and ITBVm measurements under normovolemic and hypovolemic conditions were used to estimate ITBV from the corresponding GEDV, and the estimation errors were quantified. A more simplified equation, used in a commercially available clinical monitor (ITBV = 1.25 x GEDV), was then used to estimate ITBV. The regression equation in the control group was ITBVm = 1.21 x GEDV + 99 (r = 0.89, P < 0.0001) and in the shock group at 30 and 90 min was ITBVm = 1.45 x GEDV + 0.6 (r = 0.95, P < 0.0001). The 95% confidence interval for the y-intercept was relatively wide, ranging from 31 to 168 and -47 to 49, respectively, for the two equations. The equation estimated in the control group led to overestimation of ITBV and a significant (P < 0.05) increase in errors in the shock group at 30 and 90 min. Errors in estimating ITBV using the simplified commercial algorithm were less than 15% under normovolemic and hypovolemic conditions. The linear relation between GEDV and ITBV is maintained in hypovolemic shock. Even though the relation between GEDV and ITBV is influenced by circulatory volume and cardiac output, the mean errors in predicting ITBV were small and within clinically tolerable limits.


How Coronavirus Restrictions Adopted by Governments Affected World Religious Groups: A Review.
The coronavirus pandemic has significantly affected the operation of the world's faith communities. The first reaction of different confessions to the introduction of corresponding restrictive measures was quite variable-it ranged from understanding and assisting the authorities to disobedience and deliberate violation of the quarantine regime. Today, religious precepts, values, and attitudes continue to exert an enormous influence on the behavioral patterns and public perception of the imposed COVID-19-related restrictions. In light of this, the present article aimed to study the effect of COVID-19 on religious communities' response to the pandemic progress to determine what tools of public influence can be used by secular authorities and religious leaders to counter the global viral threats. To achieve this goal, faith communities' reactions to restrictive measures adopted by the governments in relation to religious services and gatherings were analyzed. The study findings suggest that information campaigns launched by the secular authorities to prevent COVID-19 spread cannot offset the need for collective worshipping for a long time even under the possibility of being infected. Notwithstanding the fact that most modern world countries are secular and realize the freedom of religion or belief, this study calls for further discussion on the feasibility of additional regulations for religious communities in the context of the virus's active transmission. Along with this, it puts forward an offer for religious leaders to conduct more comprehensive explanatory work with believers concerning the pandemic issues from the perspective of religious dogmas. The research question concerns a review of academic research regarding the assessment of how secular authorities interacted with religious authorities in the context of the most common religions and churches and how much this changed the behavior of believers.


Sodium dependence of the nerve growth factor--regulated hexose uptake in chick embryo ganglionic cells.
Embryonic dorsal root ganglionic cells, when incubated in vitro in the absence of nerve growth factor (NGF) undergo a general metabolic degeneration which is preceded by certain changes in permeation properties. Previous studies demonstrated that NGF can rapidly modulate permeation properties which regulate the availability to the cell of an important energy source, glucose. Hexose uptake was determined by measuring the ability of the cells to accumulate [3H]labeled 2-deoxy-D-glucose. The work reported here shows that the NGF-dependent portion (about one-third) of the total specific hexose uptake was also dependent on the presence of Na+, with the apparent uptake constant (Kt) for deoxyglucose varying inversely with an external Na+ concentration of 70-140 mM; Vmax was unaffected in this range. Preincubation of ganglionic cells with 10 mM ouabain for 15-60 min, followed by a pulse with [3H]-deoxyglucose, also resulted in 50-95% reduction of the NGF-sensitive uptake. A similar pretreatment of cells with veratridine gave a 25-50% reduction in uptake. The NGF-controlled hexose uptake was also energy dependent, being diminished 50-95% after a 30-90 min preincubation with 2 mM 2,4-dinitrophenol. Uptake activities for other substrates (alpha-aminoisobutyric acid, uridine) which exhibited NGF regulation were likewise Na+-sensitive. These results indicate that availability of major energy substrates to NGF-dependent dorsal root ganglionic neurons is controlled by sodium gradients across their membranes. It is conceivable that NGF provides for maintenance and development of its target neurons by acting on such sodium gradients and, consequently, regulating the intake of essential nutrients.


Infection control guidelines for optometrists 2007.
Information from peer-reviewed articles, guidelines from professional societies and manufacturers' instructions were considered to determine the risk factors in optometric practice and to make recommendations for disinfection, sterilisation and reprocessing of instrumentation and other equipment used in practice and measures for personal protection. Wherever possible, all practitioners should adopt measures to decrease the risk of transmission of infection, such as single use instruments/equipment, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for infected or immuno-suppressed individuals.


Post-translational covalent assembly of CAR and synNotch receptors for programmable antigen targeting.
Chimeric antigen receptors (CARs) and synthetic Notch (synNotch) receptors are engineered cell-surface receptors that sense a target antigen and respond by activating T cell receptor signaling or a customized gene program, respectively. Here, to expand the targeting capabilities of these receptors, we develop "universal" receptor systems for which receptor specificity can be directed post-translationally via covalent attachment of a co-administered antibody bearing a benzylguanine (BG) motif. A SNAPtag self-labeling enzyme is genetically fused to the receptor and reacts with BG-conjugated antibodies for covalent assembly, programming antigen recognition. We demonstrate that activation of SNAP-CAR and SNAP-synNotch receptors can be successfully targeted by clinically relevant BG-conjugated antibodies, including anti-tumor activity of SNAP-CAR T cells in vivo in a human tumor xenograft mouse model. Finally, we develop a mathematical model to better define the parameters affecting universal receptor signaling. SNAP receptors provide a powerful strategy to post-translationally reprogram the targeting specificity of engineered cells.


Co-morbidity in rheumatoid arthritis.
Rheumatoid arthritis (RA) affects approximately 0.5-1% of the population and imposes substantial societal costs including an increased risk of work-related disability and accelerated mortality. It is increasingly clear that RA-related co-morbidities, including cardiovascular disease (CVD), infection, osteoporosis, lymphoproliferative malignancy, and peptic ulcer disease, serve as major determinants of disease-associated outcome. In this review, the impact of these select co-morbidities on RA outcome is discussed. In addition, this review explores potential mechanisms underlying their association with RA, the possible iatrogenic role of agents used to treat the disease, and measures aimed at both prevention and treatment of disease-specific co-morbidity.


Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution.
The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.


Efficacy of ondansetron in prophylaxis of postoperative nausea and vomiting in patients following infratentorial surgery: a placebo-controlled prospective double-blind study.
In a prospective double blind placebo-controlled study, 45 patients scheduled for infratentorial surgery were randomly allocated into two groups. Five patients were later excluded from the study because of various reasons. Out of 40 analyzable patients, 20 received IV Ondansetron (4 mg), whereas the other 20 received the matching placebo approximately 1 hour before the skin closure. After conclusion of surgery and tracheal extubation, all patients were monitored in the recovery room for post operative nausea and vomiting (PONV) for 48 hours. The incidence of PONV within the first 24 hours was found to be 50% and 10% in the placebo and ondansetron groups, respectively (p<0.05). After 24 hours, however, both groups were comparable in relation to the incidence of emesis. Rescue antiemetic (RAE) was required in nine (45%) patients in the placebo group and in two (10%) patients in the Ondansetron group (p<0.05). A significantly higher number of patients remained sedated postoperatively in the Ondansetron group than in the placebo group (p<0.05). One patient in the Ondansetron group had protracted diarrhea for 48 hours postoperatively. These results indicate that administration of IV Ondansetron (4 mg) 1 hour before skin closure effectively reduces PONV after infratentorial surgery, and does not have significant adverse effects.


Nursing outcomes for Brazilian pediatric patients hospitalized with deficient diversional activity.
To validate the content of nursing outcomes for pediatric patients hospitalized with a nursing diagnosis of deficient diversional activity. The nursing outcomes were evaluated by expert nurses from a Brazilian hospital; the nurses used a Likert-type scale. We considered those that had a weighted average of ≥0.80 as valid outcomes. Eight (57.14%) nursing outcomes and 54 (45.38%) indicators were validated. The study suggests that nursing outcomes validated by the experts are pertinent for Brazilian pediatric patients hospitalized and diagnosed with deficient diversional activity. Nursing Outcomes Classification is a viable alternative for the assessment of nursing care outcomes. Further studies should investigate the applicability of these data in clinical practice.


Parliamentarians take the initiative on HIV/AIDS.
In 1999 UNAIDS and the Inter-Parliamentary Union jointly published the Handbook for Legislators on HIV/AIDS, Law and Human Rights. This section describes initiatives taken by parliamentarians to promote legal and policy responses to the HIV/AIDS epidemic which respect human rights.


Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in 'Utstein' style.
The purpose of this study was to describe the chain of survival in Amsterdam and its surroundings and to suggest areas for improvement. To ensure accurate data, collection was made by research personnel during the resuscitation, according to the Utstein recommendations. Between June 1, 1995 and August 1, 1997 all consecutive cardiac arrests were registered. Patient characteristics, resuscitation characteristics and time intervals were analyzed in relation to survival. From the 1046 arrests with a cardiac etiology and where resuscitation was attempted, 918 cases were not witnessed by EMS personnel. The analysis focussed on these 918 patients of whom 686 (75%) died during resuscitation, 148 (16%) died during hospital admission and 84 patients (9%) survived to hospital discharge. Patient and resuscitation characteristics associated with survival were: age, VF as initial rhythm, witnessed arrest and bystander CPR. EMS arrival time was significantly shorter for survivors (median 9 min) compared to non-survivors (median 11 min). In 151 cases the police was also alerted and arrived 5 min (median) earlier than EMS personnel. Using the OPC/CPC good functional health was observed in 50% of the survivors and moderate performance in 29%. All links in the chain of survival must be strengthened, but equipping the police with semi-automatic defibrillators may be the most useful intervention to improve survival.


Mobilization of community resources to work with abusive and neglectful families: community organization in New York State.
This article describes the community organization experience of the Family Life Development Center at Cornell University in connection with the federally financed Resource Center on Child Abuse and Neglect which it has operated since 1975. Early on, the Center decided to concentrate its efforts on organizing local task forces on child abuse and neglect which would work at the community level to improve services for families and children afflicted with the problem. As a result, over 50 such groups were organized and they have stimulated creation of over 100 new services including Parents Anonymous chapters, parent aides, multidisciplinary teams and parenting education projects. In short, the local community organization approach enabled a small state level staff to stimulate a major mobilization of resources for child abuse and neglect at the community level throughout the state. The process began with several "trial and error" experiences in rural New York. This led to technical assistance in task force formation for a dozen more counties and finally to regional workshops on task force organizations. The process culminated with formation of a statewide federation of the local groups. The Center is now implementing the approach in New Jersey, Puerto Rico and the Virgin Islands.


A simple and economical method for the manual construction of frozen tissue arrays.
Tissue microarray has been developed to enable multiple cores of tissue in one or more new paraffin blocks. Currently, almost all tissue microarrays are made by coring cylindrical tissues from formalin-fixed and paraffin-embedded tissues. The disadvantages of formalin-fixed and paraffin-embedded tissues include the poor preservation of antigenicity of certain proteins and mRNA degradation induced by the fixation and embedding process. However, frozen tissue array construction presents technical difficulties, and tissue array devices are expensive, particularly for small- and medium-sized laboratories. We describe a simple manual method for producing well-aligned tissue arrays by a capsule freeze method that allows us to successfully perform hematoxylin-eosin and immunohistochemical stain. All 120 tissue samples were collected and constructed into blocks by this capsule freeze method. The capsules were not affected during the sectioning process, and the capsule material always disappeared during the aqueous steps of the stain processing. The frozen tissue arrays were smoothly sectioned without the use of a tape transfer system and immunohistochemical study was performed with satisfactory results. This alternative method can be applied in any laboratory, and is both simple and economical.


Hydrodynamics of concentrated proteoglycan solutions.
The dynamics of water transport in proteoglycan compartments has been studied in relation to osmotic flow (proteoglycan diffusion) and hydraulic permeability (proteoglycan sedimentation) in concentrated solutions of proteoglycan subunit and native proteoglycan aggregate isolated from Swarm rat chondrosarcoma. A central parameter that describes the kinetics of both types of water movement is the hydrodynamic frictional coefficient of water with proteoglycan. The frictional coefficient is markedly concentration dependent, increasing with increasing concentration, and highlights important structural features and types of organization of the proteoglycans in concentrated solutions. These include the requirements that proteoglycans in the extracellular matrix not to be immobilized but to have translational diffusive mobility and concentration gradients to be osmotically active, that chondroitin sulfate segmental mobility describing translational motion largely determines osmotic flow and hydraulic permeability of the proteoglycans, and that the proteoglycans exhibit an enhanced ability to resist flow as compared to other macromolecules. Additional dynamic studies suggest the formation of transient super-aggregate structures may occur at high concentrations which endows the proteoglycan subunit hydrodynamic properties similar to proteoglycan aggregate.


Improved tropane alkaloid production and changes in gene expression in hairy root cultures of two Hyoscyamus species elicited by silicon dioxide nanoparticles.
Species of Hyoscyamus are rich sources of medicinally important tropane alkaloids, which have anticholinergic, antispasmodic and sedative effects and are competitive inhibitors of acetylcholine. The application of nanotechnology and nanomaterials for elicitation is rapidly expanding and recent research indicates that silicon dioxide nanoparticles (SiO2 NPs) can be used as an efficient elicitor to increase the production of hyoscyamine and scopolamine in Hyoscyamus species. Thus, in this work, the effect of SiO2 NPs (0, 25, 50, 100 and 200 mg L-1) with two treatment times (24 and 48 h) on the growth rate, total phenol and flavonoid content (TPC, TFC), antioxidant enzyme activity, tropane alkaloid yield and pmt (putrescine N-methyltransferase) and h6h (hyoscyamine 6<beta>-hydroxylase) gene expression levels in hairy roots of two Hyoscyamus species (H. reticulatus and H. pusillus) was investigated. The highest TPC and TFC accumulation was obtained in H. reticulatus elicited by SiO2 NPs (100 and 200 mg L-1), respectively, at 24 h of treatment. High-performance liquid chromatography (HPLC) revealed the highest amount of hyoscyamine (140.15 μg g-1 FW) and scopolamine (67.71 μg g-1 FW) accumulated in H. reticulatus transformed roots treated with 100 mg L-1 SiO2 NPs at 24 h, with a respective increase of 1212% and 272% compared to non-treated roots. In H. pusillus, the highest hyoscyamine (7.42 μg g-1 FW) and scopolamine (15.56 μg g-1 FW) production (about 82% and 241% higher, respectively, compared to the lowest amounts) was achieved with 25 and 100 mg L-1 SiO2 NPs, respectively, at 48 h of treatment. Semi-quantitative RT-PCR analysis determined the highest expression level of pmt and h6h genes in H. reticulatus transformed roots supplemented with 100 mg L-1 SiO2 NPs.


Photosynthetic system II: racial differentiation in Typha latifolia.
The rate of reduction of 2,6-dichlorophenol-indophenol by illuminated chloroplasts isolated from ecological races of Typha latifolia was negatively correlated with length of growing season at the site of origin. Efficiency of the photochemical apparatus for this reaction was twice as high in a high-altitude population from Wyoming as in a maritime population from California.