Evaluation of light-curing units in rural and urban areas.
To evaluate the distribution of light-curing units (LCU) used in an urban area (Riyadh) and a rural area (Kharj) of Saudi Arabia, and to compare their irradiance values. The study involved three dental centers in urban areas and two in rural areas, all of which were parts of a single healthcare institution providing dental services. The light outputs (power mW) from 140 LCUs were measured by laboratory-grade spectrometry, and the irradiance (mW/cm(2)) was calculated from the tip area of each LCU. The minimum acceptable irradiance outputs for the quartz-tungsten-halogen (QTH) and light-emitting diode (LED) units were set at 300 and 600 mW/cm(2), respectively. The ages of these units and the protocol used to light-cure the resins were also determined. The total number of LCUs was 140, 112 (78%) in urban areas, and 28 (22%) in rural areas. In rural areas, only 7 of the 22 (32%) QTH units delivered irradiances greater than 300 mW/cm(2) and were therefore considered clinically acceptable, whereas 4 of the 6 (66.7%) LED units delivered values greater than 600 mW/cm(2). In urban centers, 43 of 61 (70.5%) LED units and 25 of 61 (49%) QTH units were considered clinically acceptable. Irradiance values for both QTH (P < 0.01) and LED (P < 0.05) units were significantly better in urban than in rural areas. Urban areas had a greater distribution of LCUs than rural areas. Overall, irradiance values were significantly higher in urban areas.


A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia.
Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.


Evaluation of the protective efficacy of a spatial repellent to reduce malaria incidence in children in Mali compared to placebo: study protocol for a cluster-randomized double-blinded control trial (the AEGIS program).
Spatial repellents have been widely used for the prevention of mosquito bites but their efficacy in reducing mosquito-borne diseases has never been evaluated in Africa. Additionally, spatial repellents have the potential of being critical tools in the prevention of mosquito-borne diseases in contexts where typical vectors control efforts such as insecticide-treated nets (ITNs) and indoor residual spray (IRS) are inaccessible or underutilized such as among displaced populations or in emergency relief settings. To address this knowledge gap, Kolondieba District, Sikasso Region, Mali was selected as a site to estimate the impact of the Mosquito Shield™, a spatial repellent that incorporates transfluthrin on a plastic sheet, on malaria-related outcomes. Over the past decade, the Region of Sikasso, Health districts of Kadiolo, Yorosso, and Kolondieba have remained among the most afflicted, characterized by an annual parasite incidence of more than 116 cases per 1000 population [1] and a Plasmodium falciparum prevalence rate of 29.7% [2]. Cluster-randomized, placebo-controlled, double-blinded clinical trial, whereby children ≥ 6 months to < 10 years old will be enrolled and followed to determine the time to malaria infection with monthly blood samples for microscopic diagnosis. A total of 1920 subjects (HHs) will be enrolled in 60 clusters (30 spatial repellent, 30 placebo). Malaria incidence will be estimated and compared to demonstrate and quantify the protective efficacy (PE) of a spatial repellent, in reducing malaria infection. Monthly mosquito collections using CDC light traps will be conducted to determine if there are entomological correlates of spatial repellent efficacy that may be useful for the evaluation of new spatial repellents. Quarterly human landing catches (HLC) will assess the behavioral effects of the intervention. Findings will serve as an efficacy trial of spatial repellent products for sub-Saharan Africa. Findings will be submitted to the World Health Organization Vector Control Advisory Group (WHO VCAG) for assessment of whether spatial repellents have "public health value." Entomological outcomes will also be measured as proxies of malaria transmission to help develop guidelines for the evaluation of future spatial repellent products. ClinicalTrials.gov NCT04795648 . Registered on March 12, 2021.


The Use of the OverStitch for Bariatric Weight Loss in Europe.
Technological advances have permitted minimally invasive treatment of many gastrointestinal diseases. With the advent of endoscopic full-thickness suturing, it has become possible to replicate some of the surgical procedures. Endoluminal bariatric procedures to remodel and reduce the gastric volume similar to surgery is evolving as a treatment option for obesity. Some of these methods also have been extended to treat weight regain after gastric bypass surgery. There is a steep learning curve to gaining proficiency with different endoscopic gastric remodeling or gastroplasty techniques. This article describes a simplified technique of endoscopic sleeve gastroplasty using the OverStitch suturing device.


Inhaled Milrinone After Left Ventricular Assist Device Implantation.
Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P = .017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.


Effects of silver nanoparticles on denitrification and anammox in sediments of hypertrophic and mesotrophic lakes.
The abundant production and wide usage of silver nanoparticles (Ag NPs) inevitably lead to their release into aquatic ecosystems. However, it is still unclear about how Ag NPs influence denitrification and anammox (DA) in freshwater sediments. To address this, the sediments of hypertrophic and mesotrophic lakes were exposed to 0.5 and 50 mg/L Ag NPs under anaerobic conditions for 7 days to explore the effects of Ag NPs on environmental variables, including redox potential (Eh), pH, organic matter (OM) and acid volatile sulfide (AVS), and the resulting influence on DA. Experimental results indicated that NO3--N and NH4+-N levels were increased by the low (p > 0.05) and high doses of Ag NPs (p < 0.05) in comparison with the non-Ag control, revealing an inhibitive impact on DA. The level of total nitrogen (TN) was notably increased by the low and high doses of Ag NPs (p < 0.05), perhaps due to inhibited enzyme activity and corresponding encoding gene abundance, which were related to generating gaseous nitrogen such as N2O and N2. In addition, environmental factor Eh was significantly raised by Ag NPs (p < 0.05), further inhibiting DA. Moreover, the quantitative analysis unveiled that denitrifying and anammox bacteria in hypertrophic lakes evinced a stronger resistance to Ag NPs toxicity than those in mesotrophic lakes. Overall, our study revealed that short-term exposure to Ag NPs could inhibit DA in sediments. These findings provide an understanding enabling evaluation and prediction of the environmental risks of Ag NPs in freshwater lakes.


Base composition studies on transfer RNA from normal and regenerating rat liver.
The base composition of bulk tRNA isolated from regenerating rat liver, 12, 18, 24 and 30 h after partial hepatectomy, was determined by a 3H derivative method. Only a few minor statistically significant changes (2--11%), as compared to sham-operated liver, were found at 18, 24 and 30 h after hepatectomy. These included a reduction in the amounts of adenosine and 3-(3-amino-3-carboxypropyl)-uridine, and an increase in the amounts of 1-methyl-adenosine, 1-methylguanosine, 3-methylcytidine and pseudouridine. Similarly, when the base composition of tRNA fractions from control and 24-h regenerating rat liver, partially purified by one-dimensional polyacrylamide gel electrophoresis, was determined, no gross differences were observed. These results suggest that the process of liver regeneration is not accompanied by a gross alteration of the modification pattern of tRNA.


Impact of Right Ventricular Pacing in Patients With TAVR Undergoing Permanent Pacemaker Implantation.
Long-term right ventricular pacing (VP) has been related to negative left ventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients. The aim of the PACE-TAVI registry is to evaluate the association of high percentage of VP with adverse outcomes in patients with pacemaker implantation after TAVR. PACE-TAVI is an international multicenter registry of all consecutive TAVR patients who underwent permanent pacemaker implantation for conduction disturbances in the first 30 days after the procedure. Patients were divided into 2 subgroups according to the percentage of VP (<40% vs ≥40%) at pacemaker interrogation. The primary endpoint was the composite of cardiovascular mortality or hospitalization for HF. A total of 377 patients were enrolled, 158 with VP <40% and 219 with VP ≥40%. After multivariable adjustment, VP ≥40% was associated with a higher incidence of the primary endpoint (HR: 2.76; 95% CI: 1.39-5.51; P = 0.004), first HF hospitalization (HR: 3.37; 95% CI: 1.50-7.54; P = 0.003), and cardiovascular death (HR: 3.77; 95% CI: 1.02-13.88; P = 0.04), while the incidence of all-cause death was not significantly different (HR: 2.17; 95% CI: 0.80-5.90; P = 0.13). Patients with VP ≥ 40% showed a higher New York Heart Association functional class both at 1 year (P = 0.009) and at last available follow-up (P = 0.04) and a nonsignificant reduction of left ventricular ejection fraction (P = 0.18) on 1-year echocardiography, while patients with VP <40% showed significant improvement (P = 0.009). In TAVR patients undergoing permanent pacemaker implantation, a high percentage of right VP at follow-up is associated with an increased risk for cardiovascular death and HF hospitalization. These findings suggest the opportunity to minimize right VP through dedicated algorithms in post-TAVR patients without complete atrioventricular block and to evaluate a more physiological VP modality in patients with persistent complete atrioventricular block.


Cloning and characterization of thioredoxin peroxidases from Trichinella spiralis.
The intracellular parasitic nematode, Trichinella spiralis, can initiate a high level of oxidative stress, especially during rapid growth and generative propagation phases. Thioredoxin peroxidases (TPXs) protect helminths against oxidative stress, but none has been identified in T. spiralis. Here, 3 members of the TPX family were cloned from T. spiralis muscle larvae (ML). The lengths of TsTPX ORFs were 747bp, 588bp and 594bp, respectively, and the deduced proteins predicted to contain AhpC-TSA and 1-cys Prx_C domains. Interestingly, qRT-PCR data showed that TsTPX genes were expressed in all three developmental stages of T. spiralis. The TsTPX2 and TsTPX3 genes were up-regulated in day 3 adults (Ad3) compared with newborn larvae (NBL) and ML (P<0.05); expression levels of the TsTPX1 gene in ML were higher compared with Ad3 and NBL amounts (P<0.05). After prokaryotic expression, the reactivity of rTsTPX proteins was assessed by Western-blotting: only rTsTPX1 was specifically recognized by T. spiralis infection sera from pigs. Enzyme catalytic experiments showed that rTsTPX proteins could deoxidize H2O2 in the presence of DTT, with the catalytic ability increasing with protein concentration and time.


Phosphinates as new electrophilic partners for cross-coupling reactions.
The use of enol phosphinates as electrophiles for cross-coupling reactions has been explored. Both boronic acids (Suzuki-Miyaura reaction) and stannanes (Stille reaction) couple efficiently with lactam derived phosphinates.


Orthochromatic and metachromatic staining reactions by pyronin Y on Epon semithin sections.
Semithin sections from glutaraldehyde-fixed, Epon-embedded tissues were stained by aqueous solutions of pyronin Y at increasing concentrations (from 10(-6) to 10(-3) mol). Mucopolysaccharide containing structures (e.g. mucin) were found stained in orange, meanwhile the chromatin and remaining tissue components appeared in a bright pink-red color. Cytophotometric measurements showed that a metachromatic shift occurs in the mucin content from goblet cells after pyronin Y staining at 10(-3) mol. Some features of the metachromatic reactions by cationic dyes are briefly discussed.


Does the Coexistence of Multiple Segmental Rib Fractures in Polytrauma Patients Presenting With "Major" Vertebral Fracture Affect Care and Acute Outcomes?
To determine whether operating on "major" vertebral fractures leads to premature abortion of surgery and/or other acute cardiopulmonary complications. Retrospective review. Level 1 trauma center. We retrospectively queried our institutional Trauma Rregistry for all cases presenting with concomitant rib fractures and surgically managed vertebral fractures. The main outcomes included the surgical outcome (aborted vs. successfully performed), total and Intensive Care Unit length of stay (LOS), adverse discharge, mortality, and functional outcomes. We found 57 cases with concomitant segmental rib fractures and surgically managed vertebral fractures. Seven patients (12%) received a rib fixation, of which 1 received before vertebral fixation and 6 after. Importantly, 4 vertebral fixation cases (7.02%) had to be aborted intraoperatively because of the inability to tolerate prone positioning for surgery. For case-control analysis, we performed propensity score matching to obtain matched controls, that is, cases of vertebral fixation but no rib fractures. On matched case-control analysis, patients with concomitant segmental rib fractures and vertebral fractures were found to have higher Intensive Care Unit LOS [median = 3 days (Inter-Quartile Range = 0-9) versus. 8.4 days, P = 0.003], whereas total LOS, frequency of complete, incomplete or functional spinal cord injury, discharge to rehab, and discharge to nursing home were found to be similar between the 2 groups. Our findings demonstrate that segmental rib fractures with concomitant vertebral fractures undergoing surgical treatment represent a subset of patients that may be at increased risk of intraoperative cardio-pulmonary complications and rib fixation before prone spine surgery for cases in which the neurological status is stable is reasonable. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Amino-Nogo-A antagonizes reactive oxygen species generation and protects immature primary cortical neurons from oxidative toxicity.
Nogo-A is originally identified as an inhibitor of axon regeneration from the CNS myelin. Nogo-A is mainly expressed by oligodendrocytes, and also by some neuronal subpopulations, particularly in the developing nervous system. Although extensive studies have uncovered regulatory roles of Nogo-A in neurite outgrowth inhibition, precursor migration, neuronal homeostasis, plasticity and neurodegeneration, its cell-autonomous functions in neurons are largely uncharacterized. Here, we show that HIV-1 trans-activating-mediated amino-Nogo-A protein transduction into cultured primary cortical neurons achieves an almost complete neuroprotection against oxidative stress induced by exogenous hydrogen peroxide (H(2)O(2)). Endogenously expressed neuronal Nogo-A is significantly downregulated upon H(2)O(2) treatment. Furthermore, knockdown of Nogo-A results in more susceptibility to acute oxidative insults and markedly increases neuronal death. Interacting with peroxiredoxin 2 (Prdx2), amino-Nogo-A reduces reactive oxygen species (ROS) generation and extracellular signal-regulated kinase phosphorylation to exert neuroprotective effects. Structure-function mapping experiments reveal that, out of NiG-Δ20, a novel region comprising residues 290-562 of amino-Nogo-A is indispensable for preventing oxidative neuronal death. Moreover, mutagenesis analysis confirms that cysteine residues 424, 464 and 559 are involved in the inhibition of ROS generation and neuroprotective role of amino-Nogo-A. Our data suggest that neuronal Nogo-A might play a cell-autonomous role in improving neuronal survival against oxidative insult through interacting with Prdx2 and scavenging of ROS.


Multiple yet switchable hydrogen-bonded organic frameworks with white-light emission.
The development of new strategies to construct on-demand porous lattice frameworks from simple motifs is desirable. However, mitigating complexity while combing multiplicity and reversibility in the porous architectures is a challenging task. Herein, based on the synergy of dynamic intermolecular interactions and flexible molecular conformation of a simple cyano-modified tetraphenylethylene tecton, eleven kinetic-stable hydrogen-bonded organic frameworks (HOFs) with various shapes and two thermo-stable non-porous structures with rare perpendicular conformation are obtained. Multimode reversible structural transformations along with visible fluorescence output between porous and non-porous or between different porous forms is realized under different external stimuli. Furthermore, the collaborative of flexible framework and soft long-chain guests facilitate the relaxation from intrinsic blue emission to yellow emission in the excited state, which represents a strategy for generating white-light emission. The dynamic intermolecular interactions, facilitated by flexible molecular conformation and soft guests, diversifies the strategies of construction of versatile smart molecular frameworks.


History of nurse-midwifery in reproductive health care.
From the maternity cycle to the primary health care of women, this article traces the expansion of the role of midwives in reproductive health care over the past 3 decades. Included are the recollections of Shirley Okrent about the early development of this role expansion and a few of the author's personal memories.


Acute toxicity and bioaccumulation of arsenic in tilapia (Oreochromis mossambicus) from a blackfoot disease area in Taiwan.
The general objective of our work was to determine the acute toxicity and bioaccumulation of arsenic (As) in tilapia (Oreochromis mossambicus) from the blackfoot disease (BFD) area in Taiwan. The average concentration of As in pond water ranged from 17.8 to 49 microg L(-1). Acute toxicity tests showed that the As concentration that caused toxicity to tilapia ranged from 69 060 microg As L(-1), in the 24-h toxicity test, to 28 680 microg As L(-1), in the 96-h toxicity test. We measured As concentrations in various tissues of tilapia to identify the affinities of tissues for As. Significant correlations were found among the As concentrations in all tissues. The highest bioconcentration factor (BCF) was found in the intestine (maximum value: 2270). The order of BCFs was: intestine > stomach > liver approximately gill > muscle. Arsenic concentrations in all tissues were allometric, negatively correlating with fish body weight [r(2) = 0.63 +/- 0.045 (mean +/- SE), p < 0.05]. Our results also revealed that As concentrations in muscle tissue were positively correlated with As accumulation in the viscera (r(2) = 0.85, p < 0.05). Significantly higher concentrations of As were obtained in the viscera of tilapia [12.65 +/- 10.17 microg g(-1) dry wt (mean +/- SD)] than in the muscle tissue (3.55 +/- 0.42 microg g(-1) dry wt). Our results suggest that a simple way of reducing the health risk associated with consuming tilapia is to trim and cook the fish properly, that is, removing the viscera of tilapia can greatly reduce the amount of As ingested and consequently reduce the health risks.


An apple long-chain acyl-CoA synthetase, MdLACS4, induces early flowering and enhances abiotic stress resistance in Arabidopsis.
The aerial parts of apple are protected against environmental stress by cuticular wax. Although it has been suggested that several long-chain acyl-CoA synthetases are involved in wax biosynthesis, the molecular pathway of apple cuticular wax biosynthesis remains unclear. In this study, an MdLACS4 protein with long-chain acyl-CoA synthetase activity was isolated from apple. The MdLACS4 gene was highly expressed in pericarp, stem, and mature leaf tissues. Ectopic expression of MdLACS4 in Arabidopsis induced early flowering. Compared with wild-type plants, MdLACS4 transgenic Arabidopsis exhibited lower water loss rates, reduced epidermal permeability, increased cuticular wax in stems and leaves, and altered cuticular ultrastructure. Furthermore, the accumulation of cuticular wax enhanced the resistance of MdLACS4 transgenic plants to drought and salt stress. Finally, predicted protein functional interaction networks for LACS4 suggested that the molecular regulation pathway of MdLACS4 mediates wax biosynthesis in apple.


Diagnosis and therapy of anticoagulant rodenticide intoxications.
The mechanism of toxicity and agents of anticoagulant rodenticides are discussed. The diagnosis of anticoagulant poisoning is outlined and discussed by applying clinical, laboratory, and therapeutic response measures as a means to confirm poisoning. Additional therapeutic concerns and newly developed diagnostic tests are discussed. Application of the therapeutic and diagnostic measures provides a successful plan to manage anticoagulant poisonings.


Evaluation of Pseudomonas aeruginosa an innovative bioremediation tool in multi metals ions from simulated system using multi response methodology.
Under certain conditions bacteria can act as a good biosorbent towards heavy metals in simultaneous removal from effluents. The present study explores overlay plots of multi response surface methodology for simulated wastewater treatment potential. Pseudomonas aeruginosa was used for bioremediation of metallic ions, where removal of Cd (80-90%), Mn (85-90%), Fe (50-55%), Cr (70-75%) can be achieved by fixing the pH, oxidation reduction potential (mV) and one of the metallic constituent in the simulated effluent. The metal ions Cd and Cr (T), Fe and ORP (mV) are relatively closely located to each other in the loading plot indicating co-variance between these components. However Cr(VI) transformation and Mn removal are distantly placed in the bi-plot indicating the existed significant difference. Elevated reductase enzyme activity (31.75 μg/minmg) observed in the isolate showing the ability to effectively reduce metals ions.


Partial replacement of nitrite with a novel probiotic Lactobacillus plantarum on nitrate, color, biogenic amines and gel properties of Chinese fermented sausages.
This article explored the positive effects of partial replacement of sodium nitrite by Lactobacillus plantarum on reducing nitrite and biogenic amine content, improving color and gel structure of Chinese fermented sausages. The results indicated that the strain had nitrate and nitrite reductase activities, which can reduce nitrate and nitrite. And the final reduction products of nitric oxide can react with myoglobin to generate pink nitrosylmyoglobin (Mb(Fe2+)-NO), which can improve sausage color. Dynamic rheological test showed that the strain improved viscoelasticity and gel properties of the samples. Low field nuclear magnetic resonance (LF-NMR) measurement illustrated that the strain enhanced immobilised water in myofibrillar network of the sausages. The protein gels were improved by changes of C-H stretching and bending vibrations, reduction of α-helix and increase of β-sheet and random coil in secondary structure, changes of microenvironment in tertiary structure. Analysis of biogenic amines showed that the strain reduced risk from biogenic amines by reducing tyramine content. Overall, our findings demonstrated that combination of L. plantarum and low levels of sodium nitrite could be a potential strategy to produce high-quality, healthier sausage by lowering nitrite and biogenic amine levels, improve color and gel properties of Chinese fermented sausages.


A Young Japanese Patient with Spinocerebellar Ataxia Type 3 Presenting Depressive State with Cenesthopathy and Delusion: a Case Report.
Depressive state is a common complication of spinocerebellar ataxia type 3 (SCA3). To the best of our knowledge, cases of SCA3 presenting with cenesthopathy have not been described. Here, we present a case of a severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3. A 43-year-old Japanese man with SCA3 developed a severe depressive state with associated cenesthopathy and delusion. He was treated with escitalopram (10 mg/day) and olanzapine (2.5 mg/day). Computed tomography showed atrophy of the cerebellum, bilateral superior cerebellar peduncle, and tegmentum of the pons. Single-photon emission computed tomography demonstrated reduced blood flow in the cerebellum, vermis, and brainstem. After 8 weeks, his depressive state and delusion improved; however, his cenesthopathy persisted. We encountered a case of a severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3. This case supports previous studies that the cerebellum could have a role beyond motor functions.


[Education in health and conceptual interfaces: representations of students of a nursing course].
Article produced from the a doctoral thesis: "The Education in Health in the scenarios of teach-learning: representations of professors and students from the Nursing School of the University Vale of the Acaraú", whose objective was to apprehend the direction of the representations elaborated for professors and students of the Graduation Nursing Course, about Education in Health. The results presented here come from the Free Test of Words Association. It was possible to infer that the novice students' representations are in the nucleus of what is established as common sense, considering the reductionism concept in health, proper form of the biomedical model. The veterans students evidence a positive concept of health, what points toward a conceptual change, influenced by the theoretician-practical experiences during the graduation.


Eliminating the isoleucine biosynthetic pathway to reduce competitive carbon outflow during isobutanol production by Saccharomyces cerevisiae.
Isobutanol is an important biorefinery target alcohol that can be used as a fuel, fuel additive, or commodity chemical. Baker's yeast, Saccharomyces cerevisiae, is a promising organism for the industrial manufacture of isobutanol because of its tolerance for low pH and resistance to autolysis. It has been reported that gene deletion of the pyruvate dehydrogenase complex, which is directly involved in pyruvate metabolism, improved isobutanol production by S. cerevisiae. However, the engineering strategies available for S. cerevisiae are immature compared to those available for bacterial hosts such as Escherichia coli, and several pathways in addition to pyruvate metabolism compete with isobutanol production. The isobutyrate, pantothenate or isoleucine biosynthetic pathways were deleted to reduce the outflow of carbon competing with isobutanol biosynthesis in S. cerevisiae. The judicious elimination of these competing pathways increased isobutanol production. ILV1 encodes threonine ammonia-lyase, the enzyme that converts threonine to 2-ketobutanoate, a precursor for isoleucine biosynthesis. S. cerevisiae mutants in which ILV1 had been deleted displayed 3.5-fold increased isobutanol productivity. The ΔILV1 strategy was further combined with two previously established engineering strategies (activation of two steps of the Ehrlich pathway and the transhydrogenase-like shunt), providing 11-fold higher isobutanol productivity as compared to the parent strain. The titer and yield of this engineered strain was 224 ± 5 mg/L and 12.04 ± 0.23 mg/g glucose, respectively. The deletion of competitive pathways to reduce the outflow of carbon, including ILV1 deletion, is an important strategy for increasing isobutanol production by S. cerevisiae.


The effects of cerebral sensory and motor cortical lesions on conditioned tactile placing in cats with pyramid section.
Cats after unilateral bulbar pyramid section showed permanent loss of tactile placing in the contralateral limbs. However, the cats could be trained to place the forelimb following light touch in a conditioning situation with food as a reward. Subsequent unilateral or bilateral cerebral cortical lesions involving sensory and/or motor areas did not abolish this conditioned response. Since these cortical areas are essential to reflex tactile placing, the results indicate that reflex and conditioned responses can be mediated differently at the cerebral cortical level.


Adjuvant chemotherapy in osteosarcoma - effects of cisplatinum, BCD, and fibroblast interferon in sequential combination with HD-MTX and adriamycin. Preliminary results of the COSS 80 study.
In a cooperative adjuvant chemotherapy study of osteosarcoma (COSS-80), 192 patients were registered from December 1979 to March 1982. Forty-one patients have been excluded from study because of their nonadjuvant situation, therapy-limiting clinical conditions, or inadequate diagnosis. One hundred and fifty-one patients have been randomized to receive either the drug combination bleomycin + cyclophosphamide + dactinomycin (BCD) or cisplatinum (CPL) within a course of sequential multidrug chemotherapy including adriamycin (ADR) and high dose methotrexate (HDMTX). After exclusion of 51 patients with some deviation in history and/or management 100 selected patients were randomized once more to receive in addition or not fibroblast interferon after preoperative chemotherapy and surgical removal of the primary tumor. Patients were stratified for age and sex and for site and extension of tumor as well in both randomizations. Median follow up is now 12 (1-16) months. The expected 2-year disease free survival (DFS) rate of the total doubly randomized group is 78% and of the single randomized group 76%. No difference could be discerned between recombined groups receiving BCD vs CPL or interferon vs no interferon. The effect of preoperative chemotherapy on the tumor was evaluated clinically and by histopathologic grading; 66/85 (78%) patients were judged clinically as responders with pathohistologic verification of this finding in 71% of these cases. No adverse effect arose from delaying definite surgery for preoperative chemotherapy, but initial application of chemotherapy as well as planning, preparing, and performing of the surgical procedure have been facilitated. The majority of patients received some kind of limb-salvage treatment without local recurrences so far. A statistically insignificant but intriguing tendency for a slightly higher incidence of pulmonary metastases after resection as opposed to amputation could be detected. Similar to observations in the previous study COSS-77.


Predictors of recurrence based on intravascular ultrasound findings after Eluvia placement in symptomatic peripheral arterial disease: A retrospective study.
Polymer-coated drug-eluting stents (Eluvia) have shown favorable clinical outcomes in real-world registries. There are no reports on recurrent predictors after Eluvia placement based on intravascular ultrasound (IVUS) findings. We analyzed clinical data from the ASIGARU PAD registry, a retrospective, multicenter, observational study that enrolled patients who underwent endovascular therapy for superficial femoral and proximal popliteal arteries lesions using Eluvia or drug-coated balloon. The primary outcome was the identification of recurrent predictors, including IVUS parameters at 12 months. The rate of target lesion recurrence was also assessed. IVUS images were obtained in 54 of 65 cases. Seven recurrent cases (13.0%) were observed within 12 months. The random survival forest method presented eight predictive variables of recurrence: Clinical Frailty Scale (CFS), distal stent edge area, distal plaque burden, age, sex, distal external elastic membrane (EEM) area, minimum stent area (MSA), and distal lumen area. Furthermore, the partial dependence plot showed that frailty (CFS ≥ 6), smaller distal stent edge area, higher and lower distal plaque burden, older and younger age, female sex, smaller distal EEM area, smaller MSA, and smaller and larger distal lumen area predicted recurrence after Eluvia placement within 12 months. CFS, distal stent edge area, distal plaque burden, age, sex, distal EEM area, MSA, and distal lumen area were significant recurrent predictors after Eluvia placement.


MRI appearance of perianal carcinoma in Crohn's disease.
Detection of carcinoma in perianal Crohn's disease can be difficult. The purpose of this study was to describe the MRI appearance of anorectal cancer in patients with perianal Crohn's disease. A total of six patients with anorectal carcinoma (four mucinous adenocarcinoma, two squamous) in Crohn's disease were retrospectively reviewed. Axial T2 and dynamic postcontrast fat-suppressed T1-weighted gradient echo sequences were performed, and findings were compared with 18 noncancer patients with perianal fistulae in Crohn's disease. MRI characteristics of carcinoma were irregular inner wall contours and delayed mild enhancement of internal tissue. The combined features of an irregular internal wall and delayed enhancing tissue were seen exclusively in cancer patients. The four cases of mucinous adenocarcinoma all displayed a pattern of lobulated fluid-filled cavities with delayed internal tissue enhancement. This pattern was not seen in any of the control cases. The presence of a double-layered enhancement pattern was seen in both cases of squamous carcinoma and in only one of four cases of mucinous adenocarcinoma and one of 18 noncancer cases. The pattern of contrast enhancement is valuable in the MRI diagnosis of carcinoma in perianal Crohn's disease.


Unexpected COVID-19 Opportunity: Applied Experience for the Nurse Educator Student.
Lack of experiential learning in nurse educator (NE) programs may result in students completing didactic coursework with limited or no opportunities to supervise nursing students in a clinical environment. During the coronavirus disease 2019 pandemic, one organization transformed an educational challenge into an opportunity for NE students. Programmatic evaluation, using a 10-item Likert scale evaluation tool, was used to obtain feedback from 15 NE students regarding their perceived value of an experiential learning activity. Aggregate mean evaluation scores ranged from 2.7 to 4.3. An aggregate mean of 4.3 was attributed by the NE students to the possibility of spending additional clinical hours providing oversight to nursing students participating in this process. Applied experiential learning may enhance the quality of NE students' educational experience, provide needed opportunity for developing critical expertise as a NE, and create a window of opportunity for future application of NE students' experiential learning. [J Nurs Educ. 2021;60(11):642-645.].


Vaccination with Toxoplasma lysate antigen and CpG oligodeoxynucleotides: comparison of immune responses in intranasal versus intramuscular administrations.
Toxoplasma gondii (T. gondii) is one of the most successful intracellular protozoan parasites on earth and highly prevalent in most warm-blooded vertebrates. There are no drugs that target the chronic cyst stage of this infection; therefore, development of an effective vaccine would be an important advance in disease control. Oligodeoxynucleotides (ODN) which contain immunostimulatory CG motifs (CpG ODN) can promote T-helper 1 (Th1) responses, an adjuvant activity that is desirable for vaccination against intracellular pathogen. In this study, we compare the immune responses of Toxoplasma susceptible C57BL/6 mice following intranasal and intramuscular vaccination with Toxoplasma lysate antigen (TLA) with or without CpG ODN as adjuvant. Immunized and control non-immunized mice were challenged with 85 cyst of the moderately virulent Beverley strain of T. gondii. Intranasal vaccination gave significantly a higher protection compared to other groups as indicated by prolonged survival and significantly reduced brain cyst burden (P < 0.01). Intranasal vaccination stimulated cellular immunity towards Th1 response characterized by significant INF-γ production (P < 0.01). Furthermore, fecal IgA antibody levels as an indicator of mucosal immune responses were significantly higher (P < 0.05) in intranasal vaccinated group before the challenge compared to all other groups. Intranasal vaccination was not able to upgrade the Th1 humoral arm. In contrast, intramuscular vaccination enhanced humoral immunity towards a type Th1 pattern characterized by a significant increase of specific IgG and Ig2a. Our results suggest that intranasal administration of CpG/TLA would provide a stable, pronounced, and effective vaccine against toxoplasmosis through stimulation of Th1 cellular immunity and mucosal IgA.


Distinct neurophysiological mechanisms for manic and cycloid psychoses: evidence from a P300 study on manic patients.
Pathologically asymmetrical P300 fields with right lateralized peaks were described in core schizophrenia as an expression of left-temporal functional deficits, while higher than normal amplitudes were found in cycloid psychosis. This latter finding appeared to be specific for cycloid psychosis and was explained by a generalized cerebral hyperarousal. Based on some psychopathological analogies with cycloid psychosis, and on the comparable pharmacological treatment of the acute episodes, a group of 19 manic patients was investigated immediately after remission and clinical stabilization of an episode. Patients with psychotic features were excluded to avoid overlaps with cycloid psychosis. Patients showed normal P300 amplitudes and no pathological asymmetries of the field, but more posterior positive areas compared to age- and sex-matched controls. This indicates that the neurophysiological changes underlying mania are different from both core schizophrenia and cycloid psychosis. Based on previous three-dimensional source location studies, this finding indicates that disinhibition due to reduced frontal lobe activity, and not hyperarousal, is the basic functional mechanism of manic disorders.


Combination of inulin and β-cyclodextrin properties for colon delivery of hydrophobic drugs.
Colon drug delivery is aimed at the administration of selected drugs to act locally or even systematically. Corticosteroid drugs are often used exerting even pronounced side effects due to systemic absorption. Here a new drug delivery system (DDS) based on the chemical conjugation of β-cyclodextrin to inulin to form the INUCD bioconjugate is described. It was designed with the aim to provide this DDS with colon degradable portions (inulin) which degradation products have direct beneficial effects on the well-being of the colon and with a carrier that can solubilize hydrophobic drugs (β-cyclodextrin). This system was specifically designed to promote a local/topical activity with a significant reduction of the drug systemic absorption. The INUCD bioconjugate was obtained by a simple chemistry binding β-cyclodextrin to an inulin succinate previously synthesized. The bioconjugate was then characterized in terms of physicochemical properties by ATR-FTIR, 1H NMR, DSC and TGA, DLS and SEM. Furthermore phase-solubility test by using curcumin as a model drug were performed as well as biologic evaluations for cytocompatibility and drug transport across in vitro simulated physiological barriers. Moreover enzymatic degradation studies by inulinase were performed. From the gained results a predictable local drug release of the payload could be attained so allowing a local delivery of e.g. corticosteroids thus avoiding a systemic absorption especially in prolonged therapies.


Impact of loss of skeletal muscle mass within 6-12 months after gastrectomy and S1 adjuvant chemotherapy on the survival prognosis of elderly patients with gastric cancer.
We investigated the impact of postoperative changes in the psoas muscle mass index (PMI) after gastrectomy and S1 adjuvant chemotherapy (AC) on the long-term outcomes of elderly patients with gastric cancer. We reviewed the medical records of 228 patients aged over 75 years, who underwent distal, proximal, or total gastrectomy between January, 2013 and March 2017. Among these patients, 78 with pStage IIA-IIIC who survived for at least 1 year without recurrence after gastrectomy were the subjects of this analysis. The log-rank test using the cut-off value from the rate of change in PMI from 6 to 12 months after gastrectomy (late rate of decrease) showed significantly poorer prognosis for the group above the cut-off value for both overall survival (OS) and recurrence-free survival (RFS) (RFS: PMI decrease ≥ 1.55%, p < 0.001; OS: PMI decrease ≥ 1.55%, p < 0.001). Patients with a relative dose intensity of S1 below 68.7% and a late rate of decrease in PMI above 1.55% were found to have a poor prognosis. It is necessary to prevent decline in the PMI of elderly patients from 6 months after gastrectomy and to administer adjuvant chemotherapy with about two-thirds or more RDI of S1 to improve their survival prognosis.


Carbendazim residue in plant-based foods in China: Consecutive surveys from 2011 to 2020.
Carbendazim, a widely used fungicide in China, has been found to have reproductive toxicity and mutagenic effects. However, information on the spatial-temporal variations of carbendazim residues in food in China is limited. Here, we investigated the presence of carbendazim in China's plant-based foods from 2011 to 2020, evaluated the spatial-temporal characteristics, and assessed the associated exposure risks in the Chinese diet. The results revealed a high detection frequency of carbendazim in fruits (26.4%) and high concentrations in vegetables (∼110 mg kg-1), indicating widespread misuse of the fungicide. The acute risks of consuming certain vegetables and cereals exceeded the recommended limits by up to 12 and 5 times, respectively. Although there has been a decline in carbendazim residue levels in food since the implementation of the Chinese government's action plan for zero growth of pesticide use in 2015, some provinces still exhibited high levels of carbendazim in multiple food categories, which were positively correlated with annual pesticide application. We highlight that carbendazim contamination reflects the broader issue of pesticide use in China. It emphasizes the need for committed and targeted national policies to reduce carbendazim residues in food and suggests that such measures could also regulate the use of other pesticides, given that pesticide abuse in China is not limited to specific types. We call for the re-evaluation of maximum residue limits of carbendazim, particularly in highly consumed foods such as cereals.


CRISPR Knockouts of pmela and pmelb Engineered a Golden Tilapia by Regulating Relative Pigment Cell Abundance.
Premelanosome protein (pmel) is a key gene for melanogenesis. Mutations in this gene are responsible for white plumage in chicken, but its role in pigmentation of fish remains to be demonstrated. In this study, we found that most fishes have 2 pmel genes arising from the teleost-specific whole-genome duplication. Both pmela and pmelb were expressed at high levels in the eyes and skin of Nile tilapia. We mutated both genes in tilapia using CRISPR/Cas9. Homozygous mutation of pmela resulted in yellowish body color with weak vertical bars and a hypopigmented retinal pigment epithelium (RPE) due to significantly reduced number and size of melanophores. In contrast, we observed an increased number and size of xanthophores in mutants compared to wild-type fish. Homozygous mutation of pmelb resulted in a similar, but milder phenotype than pmela-/- mutants. Double mutation of pmela and pmelb resulted in loss of additional melanophores compared to the pmela-/- mutants, and also an increase in the number and size of xanthophores, producing a golden body color. The RPE pigmentation of pmela-/-;pmelb-/- was similar to pmela-/- mutants, with much less pigmentation than pmelb-/- mutants and wild-type fish. Taken together, our results indicate that, although both pmel genes are important for the formation of body color in tilapia, pmela plays a more important role than pmelb. To our knowledge, this is the first report on mutation of pmelb or both pmela;pmelb in fish. Studies on these mutants suggest new strategies for breeding golden tilapia, and also provide a new model for studies of pmel function in vertebrates.


Effect of the menstrual cycle, oral contraception and pregnancy on forearm blood flow, venous distensibility and clotting factors.
Forearm blood flow, venous distensibility and various clotting factors were determined in 118 apparently healthy women (mean age 26 years), either during the menstrual cycle, or while taking a combined contraceptive (A) with high progestin:estrogen ratio (d-norgestrel 0.125 mg + ethinylestradiol 0.03 mg), or a sequential contraceptive (B) with low progestin: estrogen ratio (megestrol 0.1/1 mg + ethinylestradiol 0.1 mg), or in the 1st, 2nd and 3rd trimester of pregnancy. Venous distensibility in women taking contraceptive A was higher than in other women during the follicular phase of a normal menstrual cycle. Venous distensibility was not affected by contraceptive B. Blood flow and blood pressure remained unchanged by contraceptives A and B. Fibrinogen concentration was increased by both contraceptives, factor VII was either decreased (A) or unchanged (B), and factor X was either unchanged (A) or increased (B). The oral contraceptive with the high progestagen component appeared to increase venous capacitance and may induce venous stasis, whereas coagulability was particularly enhanced by the estrogen-type contraceptive. Pregnant women differed from women on oral contraceptives in regard to peripheral circulation; they showed a tremendous increase of blood flow with secondary vasodilation.


Evaluation of an Integrated Rescue Task Force Model for Active Threat Response.
An integrated response to active threat events is essential to saving lives. Coordination of law enforcement officer (LEO) and emergency medical services (EMS) roles requires joint training, as maximizing survival is a shared responsibility. We sought to evaluate the performance of an integrated LEO-EMS Rescue Task Force (RTF) response to a simulated active shooter incident utilizing objective performance measures. Following prior didactic training, we conducted a series of evaluation scenarios for EMS providers and patrol officers in our urban/suburban advanced life support EMS system (pop. 1,000,000). The scenario-tested command staff, LEOs tasked with neutralizing an active shooter threat, and two RTFs of LEOs and EMS providers each tasked with triage and treatment of 11 simulated casualties scattered over 2 office building floors totaling 13,000 square feet. Trained evaluators recorded performance on 30 objective data elements related to LEO-EMS operations/communication, time intervals, and trauma care. Data were analyzed using descriptive statistics and t-tests for between group comparisons. Over 18 days, 69 scenario events evaluated 388 EMS providers and 468 LEOs. Overall median (90th percentile) times in minutes from dispatch were: unified command established 4.1 (5.5), RTF assembled 9.4 (13.5), first victim contact 11.9 (16.5), first victim to internal casualty collection point (CCP) 16.6 (20.8), all victims ready for evacuation 21.6 (26.0). Life-saving interventions included tourniquet placed: 96% (95% CI 92-99) and LEO placed tourniquet: 88% (79-94). Clinical delays included inappropriate chest decompression: 4% (2-9) and unnecessary initial treatment: 17% (12-25). Correct operational actions included communication with LEO to ensure EMS was safe to treat: 70% (61-77) and appropriate CCP selection: 84% (74-91). Incorrect operational actions included failure to maintain protective LEO-EMS formation: 49% (45-62) and inappropriate single patient evacuation: 20% (14-28). Limitations included the lack of a pre-training control group for this novel program. We described the performance of an integrated LEO-EMS Rescue Task Force response to a simulated active shooter event in a large city. In general, clinical care was appropriate while operational targets can be improved. Objective measurement of response goals may be used for benchmarking and performance improvement for active threat events.


Expanding the criteria for defining success when evaluating weight loss intervention programs.
In order to evaluate outcomes among former participants in a residential weight loss program, attendees were surveyed from 1 to 5 years post-intervention. A total of 187 respondents were studied for weight changes and behavioral practices. Diet practices were assessed by number of servings per day using the Food Guide Pyramid recommendations as a guideline for indicating fruit and vegetable intake. Exercise behaviors were measured in frequency, duration, and intensity, and a weighted score was computed to obtain units for describing physical activity. Maintaining a 10% weight loss from the program entry weight, consuming five or more servings per day of fruits and/or vegetables (5-a-day) and maintaining an "active" level of physical activity were included in criteria for describing intervention success. Those meeting two of the three criteria were categorized as "successful," which included 35.8% of the study population. Because each of these behaviors (5-a-day, active lifestyle, and modest weight loss maintenance) result in independent risk reduction, it is recommended that future weight loss intervention evaluations expand the criteria for describing successful impacts and outcomes to include not only weight maintenance, but also physical activity and diet compliance behaviors.


Growth of two Pisidium (Bivalvia, Sphaeriidae) species in the laboratory.
Growth of Pisidium casertanum and P. subtruncatum from the profundal of the eutrophic Lake Esrom was followed at four temperatures in the laboratory. The growth rate of both species increased with increasing temperature, but the maximum in P. casertanum was attained at 12° C, instead of at 20° C as in P. subtruncatum. The variation of Q10 of growth in relation to animal weight was of similar form in both species at higher temperatures (6-12°C) but opposite at low temperatures (2-6°C). In the latter case Q10 of P. casertanum had a peak and that of P. subtruncatum a low value at a corresponding size preceding maturity. At constant temperatures growth curves of the form y=a+bx+cx2 were obtained, where y is weight in μg and x is time in days. The growth of both species under natural conditions was simulated by use of the experimental growth rate equation and natural birth periods, sizes at birth, and temperature cycles. These simulations gave a maximum life span of 2.5-3 years for P. casertanum and 3.5-4.5 years for P. subtruncatum. The latter species showed slower growth rates at the low or medium temperatures prevailing in the profundal of this lake. A comparison with growth in nature reveals that the simulation overestimated growth in case of P. casertanum.


The characteristics of erythrocyte Na+ transport systems in normal pregnancy and pregnancy-induced hypertension.
To assess the role Na plays in the pathogenesis of pregnancy-induced hypertension (PIH). We assessed Na and K content, the maximum number of ouabain binding sites, Na(+)-Li+ countertransport and Na(+)-K+ cotransport in erythrocytes from women with untreated PIH, normal pregnant women and healthy non-pregnant women. In normal pregnancy, the Na content of erythrocytes decreased, accompanied by the activation of Na excretion systems. In women with PIH, the Na content of erythrocytes and the Na(+)-K+ cotransport activity significantly increased, whilst erythrocyte K content and the maximum number of ouabain binding sites significantly decreased, compared with observations in normal pregnancy. In both normal pregnancy and PIH, there were no differences in Na(+)-Li+ countertransport. These results suggest that the increase of erythrocyte Na content in women with PIH may be contributed to by a reduction in the number of ouabain binding sites, whilst Na(+)-K+ cotransport and Na(+)-Li+ countertransport may compensate for this effect in women with PIH.


Numerical simulations of river discharges, nutrient flux and nutrient dispersal in Jakarta Bay, Indonesia.
The present application of numerical modelling techniques provides an overview of river discharges, nutrient flux and nutrient dispersal in Jakarta Bay. A hydrological model simulated river discharges with a total of 90 to 377m(3)s(-1) entering Jakarta Bay. Daily total nitrogen and total phosphorus loads ranged from 40 to 174tons and 14 to 60tons, respectively. Flow model results indicate that nutrient gradients are subject to turbulent mixing by tides and advective transport through circulation driven by wind, barotropic and baroclinic pressure gradients. The bulk of nutrient loads originate from the Citarum and Cisadane rivers flowing through predominantly rural areas. Despite lower nutrient loads, river discharges from the urban area of Jakarta exhibit the highest impact of nutrient concentrations in the near shore area of Jakarta Bay and show that nutrient concentrations were not only regulated by nutrient loads but were strongly regulated by initial river concentrations and local flow characteristics.


Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines.
BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.


Germline mutation analysis of MLH1 and MSH2 in Malaysian Lynch syndrome patients.
To investigate the protein expression profile of mismatch repair (MMR) genes in suspected cases of Lynch syndrome and to characterize the associated germline mutations. Immunohistochemical analysis of tumor samples was performed to determine the protein expression profile of MMR protein. Germline mutation screening was carried out on peripheral blood samples. The entire exon regions of MLH1 and MSH2 genes were amplified by polymerase chain reaction, screened by denaturing high performance liquid chromatography (dHPLC) and analyzed by DNA sequencing to characterize the germline mutations. Three out of 34 tissue samples (8.8%) and four out of 34 tissue samples (11.8%) showed loss of nuclear staining by immunohistochemistry, indicating the absence of MLH1 and MSH2 protein expression in carcinoma cells, respectively. dHPLC analysis followed by DNA sequencing showed these samples to have germline mutations of MSH2 gene. However, no deleterious mutations were identified in any of the 19 exons or coding regions of MLH1 gene, but we were able to identify MLH1 promoter polymorphism, -93G > A (rs1800734), in 21 out of 34 patients (61.8%). We identified one novel mutation, transversion mutation c.2005G > C, which resulted in a missense mutation (Gly669Arg), a transversion mutation in exon 1, c.142G > T, which resulted in a nonsense mutation (Glu48Stop) and splice-site mutation, c.2006-6T > C, which was adjacent to exon 13 of MSH2 gene. Germline mutations were identified in four Malaysian Lynch syndrome patients. Immunohistochemical analysis of tumor tissue proved to be a good pre-screening test before proceeding to germline mutation analysis of DNA MMR genes.


Three-dimensional quantitative changes of condyle in patients with skeletal class III malocclusion after bimaxillary orthognathic surgery with 5-year follow-up.
The present study aimed to characterize three-dimensional (3D) long-term quantitative condyle change including positional, surface, and volumetric alterations in patients with skeletal class III malocclusion treated with bimaxillary orthognathic surgery. Twenty-three eligible patients (9 males, 14 females, mean age: 28.28 years old) treated from Jan. 2013 to Dec. 2016 with postoperative follow-up over 5 years were retrospectively enrolled. Cone-beam computed tomography scan for each patient was conducted at 4 stages: 1 week preoperatively (T0), immediately after surgery (T1), 12 months postoperatively (T2), and 5-year postoperatively (T3). Positional changes, surface, and volumetric remodeling of condyle were measured in segmented visual 3D models and statistically compared between stages. Our 3D quantitative calibrations revealed that the condylar center shifted in anterior (0.23 ± 1.50 mm), medial (0.34 ± 0.99), and superior (1.11 ± 1.10 mm) directions and rotated outward (1.58 ± 3.11°), superior (1.83 ± 5.08°), and backward (4.79 ± 13.75°) from T1 to T3. With regard to condylar surface remodeling, bone formation was frequently observed in the anteromedial areas, while bone resorption was commonly detected in the anterolateral area. Moreover, condylar volume remained largely stable with a minimal reduction during the follow-up. Collectively, although condyle undergoes positional changes and bone remodeling after bimaxillary surgery in patients with mandibular prognathism, these changes largely fall in the range of physical adaptations in the long run. These findings advance the current understanding of long-term condylar remodeling after bimaxillary orthognathic surgery in skeletal class III patients.


Small vessel disease burden and risk of recurrent cerebrovascular events in patients with lacunar stroke and intracerebral haemorrhage attributable to deep perforator arteriolopathy.
Deep perforator arteriolopathy (DPA) causes intracerebral haemorrhage (ICH) and lacunar strokes (LS). We compare patient characteristics, MRI findings and clinical outcomes among patients with deep ICH and LS. We included patients with MRI-confirmed LS or ICH in the basal ganglia, thalamus, internal capsule or brainstem from the Bernese Stroke Registry. We assessed MRI small vessel disease (SVD) markers, SVD burden score, modified Rankin Scale (mRS) and ischaemic stroke or ICH at 3 months. We included 716 patients, 117 patients (16.3%) with deep ICH (mean age (SD) 65.1 (±15.2) years, 37.1% female) and 599 patients (83.7%) with LS (mean age (SD) 69.7 (±13.6) years, 39.9% female). Compared to LS, deep ICH was associated with a higher SVD burden score (median (IQR) 2 (1-2) vs 1 (0-2)), aORshift 3.19, 95%CI 2.15-4.75). Deep ICH patients had more often cerebral microbleeds (deep ICH: 71.6% vs LS: 29.2%, p < 0.001, median count (IQR) 4(2-12) vs 2(1-6)) and a higher prevalence of lacunes (deep ICH: 60.5% vs LS: 27.4% p < 0.001). At 3 months, deep ICH was associated with higher mRS (aORshift 2.16, 95%CI 1.21-3.87). Occurrence of ischaemic stroke was numerically but not significantly higher in deep ICH (4.3% vs 2.9%; p = 0.51). One patient (1.1%) with ICH but none with LS suffered ICH recurrence. DPA manifesting as ICH is associated with more severe MRI SVD burden and worse outcome compared to LS. The short-term risks of subsequent ischaemic stroke and recurrent ICH are similar in ICH and LS patients. This implies potential consequences for future secondary prevention strategies.


Effect of Sex on Clinical Outcome and Imaging after Endovascular Treatment of Large-Vessel Ischemic Stroke.
It is unclear if sex differences explain some of the variability in the outcomes of stroke patients who undergo endovascular treatment (EVT). In this study we assess the effect of sex on radiological and functional outcomes in EVT-treated acute stroke patients and determine if differences in baseline perfusion status between men and women might account for differences in outcomes. We included patients from the CRISP (Computed tomographic perfusion to Predict Response to Recanalization in ischemic stroke) study, a prospective cohort study of acute stroke patients who underwent EVT up to 18 hours after last seen well. We designed ordinal regression and univariable and multivariable regression models to examine the association between sex and infarct growth, final infarct volume and 90-day mRS score. We included 198 patients. At baseline, women had smaller perfusion lesions, more often had a target mismatch perfusion profile, and had better collateral perfusion. Women experienced less ischemic core growth (median 15 mL vs. 29 mL, p < 0.01) and had smaller final infarct volumes (median 26 mL vs. 50 mL, p < 0.01). Female sex was associated with a favorable shift on the modified Rankin Scale (adjusted cOR 1.79 [1.04 - 3.08; p = 0.04]) and lower odds of severe disability or death (adjusted OR 0.29 [0.10 - 0.81]; p = 0.02). The results suggest that women have better collaterals and, therefore, more often exhibit a favorable imaging profile on baseline imaging, experience less lesion growth, and have better clinical outcomes following endovascular therapy.


Efficacy and Feasibility of Complete Mesocolic Excision with Central Vascular Ligation in Complicated Colorectal Cancer.
Complete mesocolic excision (CME) with central vascular ligation (CVL) involves sharp dissection through the embryological planes. However, it may be associated with high mortalities and morbidities especially in colorectal emergencies. This study aimed to investigate the outcomes of CME with CVL in complicated colorectal cancers (CRCs). This was a retrospective study of emergency CRC resection in a tertiary center between March 2016 and November 2018. A total of 46 patients, with a mean age of 51 years, underwent an emergency colectomy for cancer (males, 26 [56.5%]; females, 20 [43.5%]). CME with CVL was performed for all patients. The mean operative time and blood loss were 188 min and 397 mL, respectively. Only five (10.8%) patients presented with burst abdomen, whereas only three (6.5%) presented with anastomotic leakage. The mean length of vascular tie was 8.7 cm, and the mean number of harvested lymph nodes (LNs) was 21.2. Emergency CME with CVL is a safe and feasible technique when performed by a colorectal surgeon and will result in obtaining a superior specimen with a large number of LNs.


Cardio-metabolic risk in Rotterdam clinical phenotypes of PCOS.
Elevated anti-Müllerian hormone (AMH) in polycystic ovary syndrome (PCOS) characterizes the clinical severity of the 4 phenotypes; but whether it also reflects the corresponding differences in cardio-metabolic risk remains to be elucidated. This study aimed to compare metabolic profile between the 4 clinical phenotypes of PCOS and to determine the influence of AMH levels on metabolic severity. One hundred and forty-four women with PCOS, aged between 20 and 40years, were recruited in this cross-sectional study and categorized according to the 4 phenotypes of the Rotterdam criteria. Anthropometry and blood pressure were recorded. Fasting lipid profile, fasting glucose, fasting insulin, homeostasis model assessment insulin resistance, total testosterone and AMH were estimated. Clinical, anthropometric and metabolic profiles were compared between the 4 phenotypes. There were significant differences in menstrual abnormalities, weight, hip circumference, clinical hyperandrogenism, ovarian volume and AMH levels between the 4 phenotypes. Cardio-metabolic risk factors and rates of metabolic syndrome (MS) and insulin resistance (IR) were comparable. Cardio-metabolic risk is similar in all phenotypes of PCOS despite differences in anthropometry and AMH levels. All women diagnosed with PCOS should undergo screening and lifelong surveillance for MS, IR and cardiovascular diseases, irrespective of clinical phenotype or AMH level. This needs further validation in prospective multi-center studies across the country, with larger sample sizes and adequate power.


The design and synthesis of second generation leukotriene B4 (LTB4) receptor antagonists related to SC-41930.
SC-41930, 7-[3-(4-acetyl-3-methoxy-2-propylphenoxy)propoxy]-3,4- dihydro-8-propyl-2H-1-benzopyran-2-carboxylic acid, is a selective, orally active, LTB4 receptor antagonist currently in clinical trials for psoriasis and ulcerative colitis. Exhaustive SAR studies found a potential backup compound, SC-50605, which was 7-16 times more potent than SC-41930 in LTB4 receptor binding, chemotaxis and degranulation assays. SC-50605 also inhibited LTB4-induced intradermal chemotaxis in cavine skin at an oral dose of 0.10 mg/kg and displayed good activity in animal models of colitis and epidermal inflammation both orally and topically.


Activation of glycine site and GluN2B subunit of NMDA receptors is necessary for ERK/CREB signaling cascade in rostral anterior cingulate cortex in rats: implications for affective pain.
The rostral anterior cingulate cortex (rACC) is implicated in processing the emotional component of pain. N-methyl-D-aspartate receptors (NMDARs) are highly expressed in the rACC and mediate pain-related affect by activating a signaling pathway that involves cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) and/or extracellular regulated kinase (ERK)/cAMP-response element-binding protein (CREB). The present study investigated the contributions of the NMDAR glycine site and GluN2B subunit to the activation of ERK and CREB both in vitro and in vivo in rat rACC. Immunohistochemistry and Western blot analysis were used to separately assess the expression of phospho-ERK (pERK) and phospho-CREB (pCREB) in vitro and in vivo. Double immunostaining was also used to determine the colocalization of pERK and pCREB. Both bath application of NMDA in brain slices in vitro and intraplantar injection of formalin into the rat hindpaw in vivo induced significant up-regulation of pERK and pCREB in the rACC, which was inhibited by the NMDAR antagonist DL-2-amino-5-phospho-novaleric acid. Selective blockade of the NMDAR GluN2B subunit and the glycine-binding site, or degradation of endogenous D-serine, a co-agonist for the glycine site, significantly decreased the up-regulation of pERK and pCREB expression in the rACC. Further, the activated ERK predominantly colocalized with CREB. Either the glycine site or the GluN2B subunit of NMDARs participates in the phosphorylation of ERK and CREB induced by bath application of NMDA in brain slices or hindpaw injection of 5% formalin in rats, and these might be fundamental molecular mechanisms underlying pain affect.


The amino acid composition of rat bile.
The pattern of amino acids in the bile of rats differs from the pattern in the serum of these animals, since bile contains significantly greater amounts of acidic and sulphur-containing amino acids and glycine than serum, while the serum contained more basic amino acids than bile, indicating that secretion of amino acids into bile may involve specific transport processes.


Socioeconomic Differences of Intimate Partner Violence among Married Women in Indonesia: Does Poverty Matter?
Society placed women living in the men's world as inferior. Poverty as a stressor for men has the opportunity to make women victims of violence from their partners. The study aimed to analyze the effects of poverty on the risk of intimate partner violence among married women in Indonesia. The samples used were married women aged 15-49 years old. The weighted sample size was 34,086 women. Besides intimate partner violence as the dependent variable, other variables analyzed as independent variables were wealth status, residence, age, education, employment, living with in-laws, and recent sexual activity. The study employs binary logistic regression to determine intimate partner violence risk in the final stage. The results show the poorest married women were 1.382 times more likely than the richest married women to experience intimate partner violence. Married women with wealthy status in the lower category were 1.320 times more likely than the richest married women to experience intimate partner violence. Married women with a wealthy group in the middle class were 1.262 times more likely than the richest married women to experience intimate partner violence. Married women with wealthy status in the more decadent category were 1.132 times more likely than the richest married women to experience intimate partner violence. The study concluded that poverty was a risk factor for intimate partner violence among married women in Indonesia. The lower the socioeconomic status, the greater the risk of intimate partner violence.


Pesticide residues in river sediments from the Pantanal Wetland, Brazil.
Sediment samples from 25 sites in 17 rivers of the Pantanal (Brazil) were analyzed with the objective of evaluating pesticide contamination in sediments. Samples were extracted with an acetone, ethylacetate, and water mixture 2:2:1 (v/v/v). The extract was purified by flash chromatography with aluminum oxide and florisil. A multiresidue gas chromatography-mass spectrometry method was applied to monitor 23 pesticides of different chemical classes (organochlorine, organophosphorus, triazines, anilides and pyrethroids) with some of their degradation products. Compounds identified in sediment samples included lambda -cyhalothrin (1.0 to 5.0 micro g kg(- 1)), p,p'-DDT (3.6 micro g kg(- 1)), deltamethrin (20.0 micro g kg(- 1)) and permethrin (1.0 to 7.0 micro g kg(- 1)).


Application of the Rasch rating scale model to the assessment of quality of life of persons with intellectual disability.
Most instruments that assess quality of life have been validated by means of the classical test theory (CTT). However, CTT limitations have resulted in the development of alternative models, such as the Rasch rating scale model (RSM). The main goal of this paper is testing and improving the psychometric properties of the INTEGRAL Quality of Life Scale (i.e., fit statistics, person and item reliability coefficients) with RSM. The sample comprised 271 Spanish adults with intellectual disability. The results showed that the data fitted the model, point-biserial correlations were adequate, items showed precision, reliability of items (.98) and persons (.89) were adequate, and the response categories were suitable (thresholds were ordered). However, one item ("I feel excluded from society") did not fit the model and a few items were too easy for participants to achieve. Although it seems necessary to include more difficult items and to delete one, the INTEGRAL Scale is a useful instrument with evidence of validity.


Synthesis and recommendations of the economic evaluation of OHS interventions at the company level conference.
In today's economic environment, enterprises may not be able to fund every new project aimed at promoting health and safety in the workplace. Company level economic evaluation of interventions can provide guidance in sound business decision-making. The Economic Evaluation of Occupational Health and Safety Interventions at the Company Level Meeting brought together members of the global occupational safety and health community interested in encouraging the use of economic knowledge and tools to evaluate economic gains from occupational health and safety interventions. Discussions of the six models presented explored similarities, reliability, and potential use by corporate enterprises, small and medium enterprises, developing and transitioning nations, and economic theorists. Each group provided specific projects that could be pursued to advance knowledge in the area of economic evaluation at the company level. This conference established pathway to incorporate economic evaluation of health and safety interventions or programs at the workplace.


WCRF-AICR continuous update project: Systematic literature review of prospective studies on circulating 25-hydroxyvitamin D and kidney cancer risk.
As part of the World Cancer Research Fund/American Institute for Cancer Research (WCRF-AICR) Continuous Update project we performed a systematic review of prospective studies with data for both measured or predicted 25(OH)D concentration and kidney cancer risk. PubMed was searched from inception until 1st December 2014 using WCRF/AICR search criteria. The search identified 4 papers suitable for inclusion, reporting data from three prospective cohort studies, one nested case-control study and the Vitamin D Pooling Project of Rarer Cancers (8 nested case-control studies). Summary effect sizes could not be computed due to incompatibility between studies. All studies except the Pooling Project suggested a reduced risk of kidney cancer by 19-40% with higher or adequate vitamin D status,. However, these estimates only reached statistical significance in one cohort (Copenhagen City Heart Study; CCHS, HR=0.75 (0.58 to 0.96)). In the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a significant reduction in risk by 18% was seen when using combined matched and non-matched controls OR=0.82 (0.68, 0.99), but not when using only matched controls (OR=0.81 (0.65, 1.00). Pooled (but not single cohort) data for predicted 25(OH)D from the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS) showed a statistically significant reduction in risk by 37% (HR=0.63 (0.44, 0.91)). There is no clear explanation for the inconsistency of results between studies, but reasons may include prevalence of smoking or other study population characteristics. Methods for assessing circulating 25(OH)D levels and control for confounders including seasonality or hypertension do not seem explanatory.


Evaluation of children and adults with post-COVID-19 persistent smell, taste and trigeminal chemosensory disorders: A hospital based study.
Smell disorders are the most frequent persistent coronavirus disease 2019 (COVID-19) complications. To describe the patterns and characteristics of persistent smell and taste disorders in Egyptian patients. Assessment was done to 185 patients (adults = 150, age: 31.41 ± 8.63 years; children = 35; age: 15.66 ± 1.63 years). Otolaryngology and neuropsychiatric evaluations were done. Measurements included: A clinical questionnaire (for smell and taste); sniffin' odor, taste and flavor identification tests and the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). Duration of disorders was 11.53 ± 3.97 ms (6-24 ms). Parosmia (n = 119; 64.32%) was developed months after anosmia (3.05 ± 1.87 ms). Objective testing showed anosmia in all, ageusia and flavor loss in 20% (n = 37) and loss of nasal and oral trigeminal sensations in 18% (n = 33) and 20% (n = 37), respectively. Patients had low scoring of sQOD-NS (11.41 ± 3.66). There were no specific differences in other demographics and clinical variables which could distinguish post-COVID-19 smell and taste disorders in children from adults. The course of small and taste disorders are supportive of the nasal and oral neuronal compromises. Post-COVID-19 taste and trigeminal disorders were less frequent compared to smell disorders. Post-COVID-19 flavor disorders were solely dependent on taste and not smell disorders. There were no demographics, clinical variables at onset or specific profile of these disorders in children compared to adults.


Acute Calcineurin Inhibitor Nephrotoxicity Diagnosed Using Kidney Doppler Ultrasonography After Heart Transplant: A Case Report.
Acute calcineurin inhibitor (CNI) nephrotoxicity is a common complication associated with CNI exposure. However, it can be difficult to diagnose. Herein, we report a case of acute CNI nephrotoxicity after heart transplant that was visualized using kidney Doppler ultrasonography. A 38-year-old female patient underwent heart transplant 5 years after the use of left ventricular assist device support because of advanced heart failure due to ischemic cardiomyopathy. Corticosteroids, tacrolimus, and mycophenolate mofetil were administered as immunosuppressive regimens postoperatively. The patient gradually developed kidney dysfunction despite a favorable perioperative clinical course and hemodynamics. Serum creatinine increased to 1.89 mg/dL on postoperative day (POD) 9, and the kidney Doppler ultrasonography examination showed severely reduced blood flow in the renal and renal segmental arteries, indicating acute CNI nephrotoxicity due to vasoconstriction of the renal arterioles. After the cessation of tacrolimus, kidney function returned to baseline levels within 2 days, and the kidney Doppler ultrasonography examination on POD 19 revealed a significant increase in blood flow in the renal and renal segmental arteries. Basiliximab followed by everolimus were administered as alternative immunosuppressants. No organic stenosis of the renal artery was detected on the kidney magnetic resonance angiography, and the patient was discharged on POD 51, without any other adverse events, including rejection. Although CNIs are widely used after heart transplant, acute nephrotoxicity should always be considered. After heart transplant, a kidney Doppler ultrasonography should be performed routinely and promptly if there are any clinical manifestations related to kidney function.


Clinical, genetic profile and therapy evaluation of 55 children and 5 adults with sitosterolemia.
Sitosterolemia is a rare autosomal recessive disease characterized by phytosterol accumulation in the blood and tissues. However, the detailed clinical and genetic spectra are lacking. To describe and compare the clinical, biochemical, genetic, therapeutic, and follow-up characteristics of 55 pediatric and five adult sitosterolemia patients. Clinical, genetic and therapeutic data from 60 patients at Xinhua Hospital from January 2016 to June 2021 were retrospectively collected. Pediatric patients' manifestations included xanthomas(93%), hematological disorders(30%), arthralgia(24%), splenomegaly(11%), atherosclerosis(10%). Adult patients had symptoms such as atherosclerosis(5/5), xanthomas(4/5), hematological disorders(3/5), arthralgia(3/5), splenomegaly(3/5). Elevated total cholesterol(TC) and low-density lipoprotein cholesterol(LDL-C) were observed in 96% patients (pediatric 98%, adult 3/4), and phytosterol levels in 100% patients. The age of onset was also negatively correlated with blood TC (P < 0.0001, r = -0.5548) and LDL-C (P = 0.0001, r = -0.4859) levels. Targeted treatments resulted in symptomatic remission(pediatric 96%, adult 4/5), and significantly decreased lipid and phytosterol levels(all P<0.05). In the dietary-therapy cohort(n=34), blood lipid levels decreased(all P<0.05). In the 13 pediatric patients from the dietary-therapy cohort who switched from dietary to combination therapy with ezetimibe, dietary therapy decreased TC and LDL-C levels by 54% and 52%, and ezetimibe further decreased them by 18% and 20%, respectively. Further, we identified 15 novel ABCG5/ABCG8 variants. This study expands the clinical and genetic spectra of sitosterolemia. The low-phytosterol diet is the cornerstone of sitosterolemia treatment. Ezetimibe can further decrease blood lipid levels and increase daily dietary phytosterol tolerance.


Magnetic molecularly imprinted polydopamine nanolayer on multiwalled carbon nanotubes surface for protein capture.
A novel, facile and low cost process for imprinting protein on the surface of magnetic multiwalled carbon nanotubes (MMWNTs) was developed using human serum albumin (HSA) as the template and dopamine as the functional monomer. The magnetic imprinted polymers were characterized with transmission electron microscope (TEM), scanning electron microscope (SEM), Fourier-transform infrared spectrometry (FT-IR), vibrating sample magnetometer (VSM) and thermogravimetric analysis (TGA) in detail. The maximum adsorption capacity of the magnetic imprinted polymers toward HSA was 66.23 mg g(-1) and it took 20 min to achieve the adsorption equilibrium. The magnetic imprinted polymers exhibited the specific selective adsorption toward HSA. Coupled with high performance liquid chromatography (HPLC) analysis, the magnetic imprinted polymers were used to solid-phase extract and detect HSA in urine samples successfully with the recoveries of 91.95-97.8%.


Taurine as a modulator of excitatory and inhibitory neurotransmission.
We present data that summarize our findings on the role of taurine in the central nervous system and in particular taurine's interaction with the inhibitory and excitatory systems. In taurine-fed mice, the expression level of glutamic acid decarboxylase (GAD), the enzyme responsible for GABA synthesis, is elevated. Increased expression of GAD was accompanied by increased levels of GABA. We also found in vitro, that taurine regulates neuronal calcium homeostasis and calcium-dependent processes, such as protein kinase C (PKC) activity. This calcium-dependent kinase was regulated by taurine, whereas the activity of protein kinase A (PKA), a cAMP-dependent, calcium-independent kinase, was not affected. Furthermore, as a consequence of calcium regulation, taurine counteracted glutamate-induced mitochondrial damage and cell death.


Posttraumatic innominate artery aneurysm with occlusion of the common carotid artery at its origin by an intimal flap.
Blunt trauma involving the innominate and carotid arteries is a rare occurrence that can be lethal or have serious neurologic sequelae. To our knowledge this is the first reported case in the international literature describing the association of posttraumatic innominate artery aneurysm with total occlusion and thrombosis of the common carotid artery at its origin by an intimal flap. The diagnostic problems created by this unusual injury are discussed. In this case the patency of the distal portion of the common and internal carotid arteries was demonstrated by magnetic resonance angiography (MRA), whereas color duplex and digital arteriographic studies were unsuccessful. This demonstration was crucial to patient management. Since no studies are available comparing color duplex imaging, conventional arteriography, and MRA in the evaluation of blunt carotid trauma, this case study is presented to demonstrate the utility of MRA in emergency situations. In addition, we analyze the possible pathogenesis and discuss the surgical treatment.


Skipping meals 'typical' in NHS work day.
Most nurses and doctors skip meals and snack instead, with about one third of nurses eating only one meal a day at work, a study has found.


Treating the Individual Ear in Children: Results of Cochlear Implantation in Children With Asymmetric Sensory Hearing Loss.
Determine speech outcomes of children undergoing cochlear implantation with severe-to-profound hearing loss in the implanted ear and moderate or better hearing loss in nonimplanted ear. Retrospective chart review. Tertiary referral center. Forty-nine children with severe-to-profound hearing loss in the ear to be implanted (pure-tone average), and no worse than moderate hearing loss in the nonimplant ear. Subjects underwent cochlear implantation from 2007 and 2017 in the ear with severe-to-profound hearing loss. Consonant Nucleus Consonant or Phonetically Balanced Kindergarten word scores pre- and postoperatively were compared in both the implanted ear and binaural setting. Comparisons were made between Phonetically Balanced Kindergarten scores pre- and postoperatively or Consonant Nucleus Consonant scores pre- and postoperatively. The average pure-tone average for the implant ear was 92 ± 13 dB HL and 55 ± 12 dB HL in the nonimplant ear. Word scores for the implant ear increased an average of 58 (±27) % following cochlear implantation at 12 months and 62 (±20) % at 24 months. Binaural best-aided word scores increased an average of 36 (±29) % at 12 months and 49 (±24) % at 24 months. Children with asymmetric sensory hearing loss should have each ear treated individually as significant benefits can be gained not only in the implanted ear, but also in binaural hearing.


Induction of eosinophilic enteritis and eosinophilia in rats by vitamin E and selenium deficiency.
Eosinophilic enteritis and eosinophilia, in addition to muscular dystrophy and occasionally liver necrosis, were experimentally induced in male Sprague-Dawley rats with a vitamin E- and selenium-deficient diet (basal diet) for 9 weeks. Cecum and ileum were affected more frequently and severely than other segments of the gastrointestinal tract. Eosinophils were multifocally or diffusely distributed in the intestinal wall but were most severe in the muscular layer and in the submucosa. Eosinophils were also present in stomach, liver with massive hepatocellular necrosis, and skeletal muscle with marked myonecrosis. Eosinophilic enteritis and eosinophilia were not observed in rats fed the basal diet supplemented with either vitamin E (100 or 200 ppm) or selenium (0.1 or 1.0 ppm). Eosinophilic enteritis, eosinophilia, and muscular dystrophy regressed when vitamin E- and selenium-deficient rats were subsequently fed either the vitamin E- or selenium-supplemented diet for 4-5 weeks. These findings suggest that vitamin E and selenium deficiency may play a role in the development of a diffuse type of eosinophilic enteritis and eosinophilia.


Primary posterior chamber IOL implantation in penetrating ocular trauma.
This paper describes the experience of primary cataract extraction and posterior chamber IOL implantation in 11 eyes with penetrating ocular trauma. The primary surgical procedure consisted of repair of corneoscleral laceration, cataract extraction, posterior chamber IOL implantation and in certain cases, removal of intraocular foreign body and vitrectomy. 10 out of 11 cases had a post operative visual acuity of 6/18 or better, with 9 out of 11 having a post operative visual acuity of 6/12 or better. One case initially had a visual acuity of 6/24 but later developed retinal detachment with a visual acuity of 'hand movements'. Another patient developed a small localised retinal detachment during the tenth postoperative month but with successful surgery, attained a visual acuity of 6/6. The encouraging results suggest that this procedure may be recommended in carefully selected cases, under the management of an experienced surgeon.


Administration of branched-chain amino acids alters the balance between pro-inflammatory and anti-inflammatory cytokines.
Acute leucine intoxication and neurologic deterioration can develop rapidly at any age as a result of net protein degradation precipitated by infection or psychological stress in patients with maple syrup urine disease (MSUD). Here, we investigated the effects of acute and chronic Hyper-BCAA (H-BCAA) administration on pro- and anti-inflammatory cytokines in the brains of rats. For acute administration, Wistar rats (10 and 30 days) received three injections of BCAA pool (15.8 μL/g at 1-h intervals) or saline, subcutaneously. For chronic administration, Wistar rats (7 days) received of BCAA pool or saline twice a day for 21 days, subcutaneously. Our results showed that acute administration of H-BCAA increased IL-1β (∼ 78%; p ≤ 0.009) and TNF-α (∼ 155%; p ≤ 0.026) levels in the cerebral cortex but not in the hippocampus of infant rats. Moreover, IL-6 levels were increased in the hippocampus (∼ 135%; p ≤ 0.009) and cerebral cortex (∼ 417%; p ≤ 0.008), whereas IL-10 levels were decreased only in the hippocampus (∼ 42%; p ≤ 0.009). However, repeated administration of H-BCAA decreased IL-1β (∼ 59%; p ≤ 0.047), IL-6 (∼ 70%; p ≤ 0.009) and IFN-γ (∼ 70%; p ≤ 0.008) levels in the cerebral cortex, whereas the IL-6 (∼ 67%; p ≤ 0.009), IL-10 (∼ 58%; p ≤ 0.01) and IFN-γ (∼ 67%; p ≤ 0.009) levels were decreased in the hippocampus. These findings suggest that a better understanding of the inflammatory response in MSUD patients may be useful to develop therapeutic strategies to modulate the hyperinflammatory/hypoinflammatory axis.


A multimodal interdisciplinary rehabilitation programme (HAPPY) for patients undergoing allogeneic non-myeloablative haematopoietic stem cell transplantation: A feasibility study.
To evaluate the feasibility of the multimodal interdisciplinary rehabilitation programme HAPPY, targeting patients with haematological malignancy and undergoing allogeneic non-myeloablative haematopoietic stem cell transplantation (NMA-HSCT). A single arm longitudinal design was applied to test the feasibility of the 6-month HAPPY programme, which consisted of motivational interviewing dialogues, individual supervised physical exercise training, relaxation exercises, nutritional counselling, and home assignments. The feasibility measures included acceptability, fidelity, exposure, practicability, and safety. Descriptive statistics were conducted. From November 2018 to January 2020, thirty patients (mean age (SD) 64.1 (6.5)) were enrolled in HAPPY, of whom 18 patients completed the programme. Acceptance was 88%; attrition 40%; fidelity was 80%-100% for all HAPPY elements except phone calls; exposure of HAPPY elements at the hospital reflected individual differences but was acceptable, whereas exposure of HAPPY elements at home was low. Planning of HAPPY for the individual patient was time consuming, and patients were dependent of reminders and incites from the health care professionals. Most elements of the rehabilitation programme HAPPY were feasible. Yet, HAPPY will benefit from further development and simplifications before an effectiveness study can be conducted, especially regarding improvement of the intervention elements supporting patients at home.


Selecting the embryo with the highest implantation potential using a data mining based prediction model.
Embryo selection has been based on developmental and morphological characteristics. However, the presence of an important intra-and inter-observer variability of standard scoring system (SSS) has been reported. A computer-assisted scoring system (CASS) has the potential to overcome most of these disadvantages associated with the SSS. The aims of this study were to construct a prediction model, with data mining approaches, and compare the predictive performance of models in SSS and CASS and to evaluate whether using the prediction model would impact the selection of the embryo for transfer. A total of 871 single transferred embryos between 2008 and 2013 were included and evaluated with two scoring systems: SSS and CASS. Prediction models were developed using multivariable logistic regression (LR) and multivariate adaptive regression splines (MARS). The prediction models were externally validated with a test set of 109 single transfers between January and June 2014. Area under the curve (AUC) in training data and validation data was compared to determine the utility of the models. In SSS models, the AUC declined significantly from training data to validation data (p < 0.05). No significant difference was detected in CASS derived models. Two final prediction models derived from CASS were obtained using LR and MARS, which showed moderate discriminative capacity (c-statistic 0.64 and 0.69 respectively) on validation data. The study showed that the introduction of CASS improved the generalizability of the prediction models, and the combination of computer-assisted scoring system with data mining based predictive modeling is a promising approach to improve the selection of embryo with the highest implantation potential.


Sex steroid replacement during and after the induction of puberty.
The main aim of sex steroid replacement during induction of puberty is to obtain a balance between healthy psychological and somatic development and optimal final height and peak bone mass (PBM). At present, the age at which it is considered appropriate to begin inducing puberty is younger than it was in the past. This trend aims for optimisation of prepubertal and pubertal growth through earlier onset of growth hormone (GH) therapy and administration of higher doses during puberty as necessary. Adequate initiation of puberty should ensure not only optimal final height and psychological balance, but also normal body proportions, appropriate bone formation and preservation of fertility for children with GH and gonadotropin deficiencies.


Life and death of Pseudokirchneriella subcapitata: physiological changes during chronological aging.
The green alga Pseudokirchneriella subcapitata is widely used in ecotoxicity assays and has great biotechnological potential as feedstock. This work aims to characterize the physiology of this alga associated with the aging resulting from the incubation of cells for 21 days, in the OECD medium, with continuous agitation and light exposure, in a batch mode. After inoculation, cells grow exponentially during 3 days, and the culture presents a typical green color. In this phase, "young" algal cells present, predominantly, a lunate morphology with the chloroplast occupying a large part of the cell, maximum photosynthetic activity and pigments concentration, and produce starch as a reserve material. Between the 5th and the 12th days of incubation, cells are in the stationary phase. The culture becomes less green, and the cells stop dividing (≥ 99% have one nucleus) and start to age. "Old" algal cells present chloroplast shrinkage, an abrupt decline of chlorophylls content, and photosynthetic capacity (Fv/Fm and ɸPSII), accompanied by a degradation of starch and an increase of neutral lipids content. The onset of the death phase occurs after the 12th day and is characterized by the loss of cell membrane integrity of some algae (cell death). The culture stays, progressively, yellow, and the majority of the population (~93%) is composed of live cells, chronologically "old," with a significant drop in photosynthetic activity (decay > 75% of Fv/Fm and ɸPSII) and starch content. The information here achieved can be helpful when exploring the potential of this alga in toxicity studies or in biotechnological applications. KEY POINTS: • Physiological changes of P. subcapitata with chronological aging are shown • "Young" algae exhibit a semilunar shape, high photosynthetic activity, and accumulated starch • "Old"-live algae show reduced photosynthetic capacity and accumulated lipids.


Correlation between canine NK cell mediated cytotoxicity and radical production.
We investigated the relationship between natural killer (NK) mediated cytotoxicity and radical production in canine peripheral blood lymphocytes (PBLs). Canine NK cell mediated cytotoxicity, measured by 51Cr release assay, was found to be the highest in the T-cell (Thymus cell) subpopulation which partitioned into the 35-40% percoll fraction by centrifugation through a discontinuous gradient. Radical production showed a similar tendency in luminol-dependent chemiluminescence (CL) assay. Furthermore, enrichment of large granular lymphocytes (LGL) was observed in the cell fraction from the same percoll density. These results suggest that NK cell mediated cytotoxicity is related to radical production in canines.