Examining the role of problematic drug use in the relationship between discrimination and sleep disturbance in transgender and nonbinary individuals.
Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. In this study, we investigated the role of problematic drug use (PDU) in the relationship between discrimination and sleep disturbance in TGNB individuals. The study sample included 194 TGNB participants from Wave 5 (2021) of Project AFFIRM, a multi-site longitudinal study of transgender health. Discrimination, PDU, and sleep disturbance were measured using the Everyday Discrimination Scale, Drug Use Disorders Identification Test (DUDIT), and PROMIS Sleep Disturbance measures, respectively. Individuals were classified as having PDU using established DUDIT criteria that were applied based on sex assigned at birth. Regression analyses were used to estimate the associations of study variables, and subsequently, mediation analysis was used to determine whether PDU partially mediated the association between discrimination and sleep disturbance. Nearly half of participants reported PDU, of which 83.2% reported cannabis use. Higher levels of discrimination were associated with worse self-reported sleep disturbance scores. Additionally, participants with greater discrimination were more likely to have PDU. Surprisingly, participants with PDU had lower sleep disturbance scores. Our cross-sectional findings suggest that PDU partially suppressed the association between discrimination and sleep disturbance in TGNB people. Efforts to address PDU in TGNB adults may consider assessing sleep disturbance as a motivating factor for drug use and the potential role of discrimination in perpetuating PDU.


Adverse effect of donor-specific anti-human leukocyte antigen (HLA) antibodies directed at HLA-DP/-DQ on engraftment in cord blood transplantation.
While donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) in the recipient before transplantation are associated with graft failure in cord-blood transplantation (CBT), effects of DSAs other than against HLA-A, -B or -DRB1 on transplantation outcomes remained poorly understood. We retrospectively analyzed 567 single-unit CBT recipients to evaluate impact of DSAs against HLA-DP and -DQ on CBT outcomes. Among 143 recipients (25.2%) who had anti-HLA antibodies, nine harbored DSAs against HLA-DP or -DQ. DSAs against HLA-DP or -DQ were associated with a significantly lower neutrophil engraftment rate (55.6% versus 91.8%, P = 0.032) and with a marginally lower platelet engraftment rate (46.7% versus 75.3%, P = 0.128) at day 100 after transplantation, compared with patients without anti-HLA antibodies. Time to neutrophil and platelet engraftment in patients with DSAs for HLA-DP or -DQ was significantly longer than that in patients without anti-HLA antibodies (median, 25 versus 21 days, P = 0.002 in neutrophil; median 61 versus 46 days, P = 0.014 in platelet). Cumulative incidence of bacterial infection at day 100 was significantly greater (88.9% versus 57.1%, P = 0.024), and re-transplant-free survival was marginally lower (55.6% versus 76.8%, P = 0.132) in patients with DSAs against HLA-DP or -DQ, compared with those without anti-HLA antibodies. These findings suggest that DSAs against HLA-DP or -DQ lead to unfavorable engraftment, which may increase risk of bacterial infection, and reduce survival soon after CBT. Our results suggest the importance of evaluating DSAs against HLA-DP and -DQ in recipients before selecting CB units.


Qualification of nursing potential in maternal mortality in Mexico.
To develop a method that measures nursing potential through the factor analysis of relevant nursing data and social context by taking maternal mortality as the study problem. A Cross-sectional and analytical study, a multivariate analysis was performed. The Nursing Coverage Index, the Human Development Index, population density and the proportion of nurses with a bachelor's degree or upper degree, are studied by federative entity, only data from government sources are used. The Index of Nursing Qualification in Mexico (INQM) was constructed through principal component analysis. The highest correlation was between the INQM and the Nursing Coverage Prioritization Index (NCPI), which was 0.849 (P < 0.01) and showed a strong positive linear relationship. The Population Density Prioritization Index (PDPI) shows a strong positive correlation with the INQM (0.716, P < 0.01). Three factors were extracted by principal component analysis and the INQM was generated with the three main components in a model. There is very low correlation between INQM and maternal mortality rate (MMR) and no statistical significance was found. This study shows that nursing qualification must include economic, geographic and social variables. The INQM is an indicator that summarises the potential of each federative entity. Given these results, a contribution is provided for the application of these indices, which can help determine nursing potential in a specific geographical region.


Co-exposure to metals modulates CYP1A mRNA inducibility in Atlantic tomcod Microgadus tomcod from two populations.
Populations from urbanized and industrialized sites are often exposed to mixtures of chemical contaminants including aromatic hydrocarbons (AHs) and heavy metals. The effects of mixtures of these contaminants on these populations are largely unknown. The Hudson River Estuary is highly contaminated with a variety of AHs including, PCBs and PAHs, and metals, and its population of Atlantic tomcod Microgadus tomcod bioaccumulates those which are persistent. The Hudson River's tomcod population exhibits resistance to persistent AHs as exemplified by significantly decreased inducibility of hepatic cytochrome P4501A (CYP1A) mRNA. We used hepatic CYP1A mRNA inducibility in tomcod from the Hudson River and a sensitive population to investigate the effects of acute co-exposure to metals on aryl hydrocarbon receptor (AHR)-mediated gene expression. Adult tomcod from the Hudson River and the cleaner Miramichi River were i.p. injected with one dose of benzo[a]pyrene (B[a]P) or coplanar PCB77 and graded doses of four metals, As, Cd, Cr, and Ni, and levels of hepatic CYP1A mRNA and protein were assayed. We observed no effects of metals treatment on basal levels of hepatic CYP1A mRNA expression, but all four metals significantly reduced CYP1A mRNA inducibility in tomcod from one or both populations. The magnitude of the inhibition of CYP1A mRNA inducibility differed among the metals and fish from the two populations. Also, the profile of the metals modulation of induced CYP1A mRNA showed differences that depended on the time after treatment of sacrifice. Our results demonstrate that co-exposure to several metals can impact inducible, but not basal levels of CYP1A expression and perhaps other toxicities mediated by the AHR.


Midline catheters in the operating room.
Among various vascular access devices, midline catheters (MCs) are commonly used in emergency departments, but rarely in operating rooms. To evaluate the feasibility and safety of MCs in the operating room. This was a retrospective study. The medical records of patients who underwent MC placement in the operating room from October 2020 to July 2022 were reviewed. The rates of successful catheter insertion as well as major and minor complications were assessed. Successful catheter insertions were achieved in 149 of 161 patients (92.5%). The median dwell time of midlines was eight days (IQR: 6-10 days). A major or minor complication occurred in 6.7% of the midlines. The rates of major complications of occlusion, upper extremity deep vein thrombosis (DVT), and catheter-related bloodstream infection were 1.3%, 0.7%, and 0%, respectively. Placement of MCs in the operating room was feasible and safe. Also, the procedure provides an acceptable alternative for replacing central line catheters and peripherally inserted central catheters.


Cytochrome b561 regulates iron metabolism by activating the Akt/mTOR pathway to promote Breast Cancer Cells proliferation.
Breast cancer (BC) is the leading cause of cancer-related mortality in women, necessitating the development of novel therapeutic targets. While cytochrome b561 (CYB561) expression is associated with poor prognosis in BC, the precise role of CYB561 in BC and its potential mechanisms remain unclear. In the present study, we found that CYB561 plays an essential role in BC growth. CYB561 expression was up-regulated in surgically resected cancerous tissues and in six BC cell lines. Lentivirus-mediated CYB561 knockdown in BC cells significantly reduced their proliferation, migration, and invasiveness. CYB561 participates in the regulation of iron metabolism in BC. CYB561 knockdown reduced total iron content, increased ferrous iron content, and down-regulated the expression of proteins associated with iron metabolism (transferrin receptor 1, divalent metal transporter 1, and ferritin heavy chain 1). Conversely, up-regulation of CYB561 through co-incubation with exogenous iron (ferric ammonium citrate) produced contrary outcomes. Additionally, CYB561 activated the protein kinase B/mammalian target of rapamycin (Akt/mTOR) signaling pathway in BC cells. Down-regulation of CYB561 expression inhibited the Akt/mTOR signaling pathway activity. The application of an mTOR agonist (MHY1485) rescued this negative effect, as well as the inhibitory effect of CYB561 knockdown on cell proliferation. Importantly, the dual mTOR inhibitor MLN0128 (50 nM, 48 h) down-regulated CYB561 expression and the iron metabolism-related proteins transferrin receptor, divalent metal transporter 1, and ferritin heavy chain 1, whereas the mTOR agonist MHY1485 rescued the down-regulation of CYB561 knockdown on iron metabolism-related proteins. We conclude that CYB561 promotes the proliferation of BC cells by regulating iron metabolism through the activation of the Akt/mTOR signaling pathway.


Chronic obstructive pulmonary diseases in children.
To verify and describe the main events related to the diagnosis and management of chronic obstructive pulmonary diseases in children (COPDC) and adolescents, considering the interrelated physiopathology, genetic, and environmental characteristics. Relevant literature from PubMed was selected and reviewed. COPDC have an environmental and/or genetic origin and its manifestation has manifold genotypes, phenotypes, and endotypes. Although COPDC has no cure, it can be clinically controlled. Chronic cough is the main symptom and bronchiectasis can be present in several COPDC patients. The management of COPDC is more effective if based on guidelines and when treatment regimen adherence is promoted. Oral and inhaled corticosteroids, bronchodilators, inhaled antibiotics, and treatment of pulmonary exacerbation (PE) are the bases of COPDC management, and should be individualized for each patient. Correct diagnosis and knowledge of risk factors and comorbidities are essential in COPDC management. Procedures and drugs used should be based on specific guidelines for each COPDC case. Treatment adherence is critical to obtain the benefits of management. COPDC clinical control must be evaluated by the decrease in PEs, improved quality of life, reduction of pulmonary function loss, and lung structural damage. For most cases of COPDC, monitoring by interdisciplinary teams in specialized reference centers with surveillance strategies and continuous care leads to better outcomes, which must be evaluated by decreasing pulmonary function damage and deterioration, better prognosis, better quality life, and increased life expectancy.


Studies on the mechanism of positive inotropic activity of Ro 13-6438, a structurally novel cardiotonic agent with vasodilating properties.
We investigated the possible mechanisms involved in the positive inotropic activity of Ro 13-6438 (R-6-chloro-1,5-dihydro-3- methylimidazo -[2,1-b] quinazolin -2[ 3H]-one), a structurally novel cardiotonic agent with vasodilating properties. The positive inotropic response to Ro 13-6438 of the isolated guinea pig papillary muscle was accompanied by inhibition of myocardial phosphodiesterase (PDE) activity and elevation of intracellular cyclic AMP (cAMP) levels Ro 13-6438 had no effect on Na+,K+-stimulated or Ca2+-stimulated ATPase activity and did not influence the rate of 45Ca uptake in cardiac membrane vesicles. Ro 13-6438 caused a concentration-dependent increase in the upstroke velocity, overshoot, and duration of slow action potentials evoked in partially depolarized papillary muscles. Pretreatment of guinea pigs with reserpine did not prevent the effects of Ro 13-6438 on slow action potentials, but slightly decreased its positive inotropic activity. The muscarinic agonist carbachol reversed the Ro 13-6438-induced enhancement of contractility and changes in the slow action potential in an atropine-sensitive manner. These results indicate that the positive inotropic effects of Ro 13-6438 are correlated with PDE inhibition, increased cAMP levels, and an increase of the slow action potential in ventricular myocardium. It is suggested that the elevated cAMP levels resulting from the Ro 13-6438-induced inhibition of PDE enhance the slow inward Ca2+ current.


Sex-dependent accumulation and maternal transfer of Dechlorane Plus flame retardant in fish from an electronic waste recycling site in South China.
Knowledge is limited on sex-related accumulation and maternal transfer of Dechlorane Plus (DP) flame retardant in wildlife. In the present study, DP isomers were examined in liver and eggs of two fish species, northern snakehead and crucian carp, from an electronic waste recycling site in China. Hepatic ∑DP (sum of syn- and anti-DP) concentrations ranged 260-1920 ng/g lipid in northern snakehead and 340-1670 ng/g in crucian carp, with significantly higher levels in males relative to females. ∑DP concentrations ranged 4.6-310 ng/g lipid in the eggs, demonstrating their maternal transfer in the female fish. The mean eggs to liver concentration ratios (E/L ratios) were 0.03 and 0.03 in northern snakehead, and 0.26 and 0.25 in crucian carp, for syn- and anti-DP, respectively. A significantly negative correlation between the E/L ratios and the hepatic DP concentrations was observed, indicating a dose-dependent maternal transfer of DP isomers in the fish.


Hip fractures and dementia: clinical decisions for the future.
Severe dementia is a life-limiting condition; hip fractures are more common in patients who have dementia. This study outlines the case of a 92-year-old female with severe dementia who sustained a hip fracture. Despite having a terminal diagnosis (severe dementia and hip fracture) and poor premorbid quality of life, she had a life-prolonging surgery. The report outlines issues around treatment options in such circumstances, informed consent and substitute decision-making. The authors propose a 'goals of care' approach to manage patients in whom the best treatment is unclear, during their attendance to the emergency department. It is suggested that utilization of such a model may help with substitute decision-making and true informed consent.


Radiotherapy for penile cancers.
Penile cancers are uncommon and should be treated in expert center. Radiotherapy indications are mainly limited to exclusive brachytherapy for early stage penile glans cancer. Brachytherapy yields to excellent outcome for disease control and organ and function preservation. Only scarce data are available for external beam radiation therapy. It could be considered as palliative setting for irradiation of the primary tumor. For lymph node irradiation, external beam radiation therapy (with or without chemotherapy) could be discussed either as neoadjuvant approach prior to surgery for massive inguinal lymph node invasion or as adjuvant approach in case of high-risk of relapse. However, these cases should be discussed on an individual basis, as the level of evidence is poor. We present the recommendations of the French Society of Oncological Radiotherapy on the indications and techniques for external beam radiotherapy and brachytherapy for penile glans cancer.


Genetic isolation in an endemic African habitat specialist.
The Chestnut-banded Plover Charadrius pallidus is a Near-Threatened shorebird species endemic to mainland Africa. We examined levels of genetic differentiation between its two morphologically and geographically distinct subspecies, C. p. pallidus in southern Africa (population size 11 000-16 000) and C. p. venustus in eastern Africa (population size 6500). In contrast to other plover species that maintain genetic connectivity over thousands of kilometres across continental Africa, we found profound genetic differences between remote sampling sites. Phylogenetic network analysis based on four nuclear and two mitochondrial gene regions, and population genetic structure analyses based on 11 microsatellite loci, indicated strong genetic divergence, with 2.36% mitochondrial sequence divergence between individuals sampled in Namibia (southern Africa) and those of Kenya and Tanzania (eastern Africa). This distinction between southern and eastern African populations was also supported by highly distinct genetic clusters based on microsatellite markers (global FST = 0.309, GST' = 0.510, D = 0.182). Behavioural factors that may promote genetic differentiation in this species include habitat specialization, monogamous mating behaviour and sedentariness. Reliance on an extremely small number of saline lakes for breeding and limited dispersal between populations are likely to promote reproductive and genetic isolation between eastern and southern Africa. We suggest that the two Chestnut-banded Plover subspecies may warrant elevation to full species status. To assess this distinction fully, additional sample collection will be needed, with analysis of genetic and phenotypic traits from across the species' entire breeding range.


Regulated and prolonged expression of mIFN(alpha) in immunocompetent mice mediated by a helper-dependent adenovirus vector.
A major goal in gene therapy is to develop efficient gene transfer protocols that allow tissue-specific, long-term and tightly regulated expression of the desired transgene. This objective is becoming more attainable through the co-evolution of gene transfer vectors and regulation systems. The ideal vector should efficiently transduce non-dividing cells with minimal toxicity, thus endowing the system with persistent transgene expression. The helper-dependent adenovirus vectors meet these requirements, as demonstrated in various studies in the literature. The most promising regulation system is the tet-on system, which has low basal transcriptional activity and high inducibility. To explore the regulated transgene expression in the context of a helper-dependent vector, we constructed the HD-TET-IFN vector, containing the mIFN(alpha) gene under the control of the tetracycline inducible transactivator rtTA2(s)-S2. Mice injected with HD-TET-IFN showed high levels of serum mIFN(alpha) only upon transcriptional activation. The transgene expression was reinducible to the same high level up to 3 months p.i., and the amount of expressed cytokine could be regulated by dosing doxycycline. Transcriptional activation of mIFN(alpha) induced by doxycycline resulted in prolonged survival and reduced liver damage in HD-TET-IFN-injected mice challenged with a lethal dose of coronavirus. Activation of antiviral genes mediated by doxycycline-dependent mIFN(alpha) expression was also observed at low HD-TET-IFN doses. The possibility of controlling gene expression by the combination of HD vectors and the latest tet-on transactivator also holds promise for studying gene function in other animal models.


Long-term observations on ceramic ossicular replacement prosthesis (CORP).
Long-term observations on the ceramic ossicular replacement prosthesis (CORP) were performed. Extrusion rates were 8.3% for CORP-P and 5.2% for CORP-T, with most extrusions occurring within 2 years. Hearing results were satisfactory. Air-bone gaps at 1 year were within 10 dB in 44.8% with CORP-P and 31.2% with CORP-T. At 3 to 5 years, air-bone gaps were within 10 dB in 42.2% and 33.3%, respectively. It was found that the short-term results were maintained even for the long period. Unsatisfactory hearing gains were caused mainly by the displacement or extrusion of CORP which could be prevented by fixation with the cartilage plate, deepening of the base of CORP-P, fixing of the base of CORP-T with the fascia, and additional fixing with the malleus handle and chorda tympani nerve.


Intraspecific phenotypic differences in climbing perch Anabas testudineus (Bloch, 1792) populations may be linked to habitat adaptations.
The climbing perch, Anabas testudineus, is a nutritionally and economically significant food fish. The present study reveals the first comprehensive description of the life-history traits of A. testudineus scooped up through different traditional fishing gears from July 2020 to December 2020. Among the 120 collected specimens, the smallest and largest specimens were 8.5 cm-14.6 cm TL in Nilphamari and Patuakhali, respectively. The estimated b values for LLRs indicated positive allometric growth in all sampling points (b > 1.0). The LWRs of A. testudineus indicated positive allometric growth in the Gazipur and Nilphamari districts (b > 3.00) and negative allometric growth in the Patuakhali and Khulna districts (b < 3.00). A Wilcoxon sign-ranked test for WR showed no significant dissimilarity from 100, signifying the balanced habitat for A. testudineus. The estimated a3.0 was minimum in Khulna (0.0110) and maximum in Nilphamari (0.0825). "The Lm was estimated at 7.4032 (7.4) cm TL in Nilphamari and 8.86 (8.9) cm TL in Patuakhali". Nineteen of twenty morphometric measurements and ten of twelve meristic characters showed substantial variations (p < 0.0001). The principal component analysis indicated shape variation and explained 85.361% of the total variance and showed differences in TL, SL, HL, LBD, LE1, D1D2, A1A2, and VV2. The cluster heatmap demonstrates that the other stocks segregated Gazipur stock. Our findings reveal a significant dataset about intraspecific phenotypic differentiation, which will aid the long-term exploration and management of A. testudineus species in Bangladesh and its neighboring countries.


Diagnosis of Benign and Malignant Breast Lesions on DCE-MRI by Using Radiomics and Deep Learning With Consideration of Peritumor Tissue.
Computer-aided methods have been widely applied to diagnose lesions detected on breast MRI, but fully-automatic diagnosis using deep learning is rarely reported. To evaluate the diagnostic accuracy of mass lesions using region of interest (ROI)-based, radiomics and deep-learning methods, by taking peritumor tissues into consideration. Retrospective. In all, 133 patients with histologically confirmed 91 malignant and 62 benign mass lesions for training (74 patients with 48 malignant and 26 benign lesions for testing). 3T, using the volume imaging for breast assessment (VIBRANT) dynamic contrast-enhanced (DCE) sequence. 3D tumor segmentation was done automatically by using fuzzy-C-means algorithm with connected-component labeling. A total of 99 texture and histogram parameters were calculated for each case, and 15 were selected using random forest to build a radiomics model. Deep learning was implemented using ResNet50, evaluated with 10-fold crossvalidation. The tumor alone, smallest bounding box, and 1.2, 1.5, 2.0 times enlarged boxes were used as inputs. The malignancy probability was calculated using each model, and the threshold of 0.5 was used to make a diagnosis. In the training dataset, the diagnostic accuracy was 76% using three ROI-based parameters, 84% using the radiomics model, and 86% using ROI + radiomics model. In deep learning using the per-slice basis, the area under the receiver operating characteristic (ROC) was comparable for tumor alone, smallest and 1.2 times box (AUC = 0.97-0.99), which were significantly higher than 1.5 and 2.0 times box (AUC = 0.86 and 0.71, respectively). For per-lesion diagnosis, the highest accuracy of 91% was achieved when using the smallest bounding box, and that decreased to 84% for tumor alone and 1.2 times box, and further to 73% for 1.5 times box and 69% for 2.0 times box. In the independent testing dataset, the per-lesion diagnostic accuracy was also the highest when using the smallest bounding box, 89%. Deep learning using ResNet50 achieved a high diagnostic accuracy. Using the smallest bounding box containing proximal peritumor tissue as input had higher accuracy compared to using tumor alone or larger boxes. 3 Technical Efficacy: Stage 2.


A preclustering-based ensemble learning technique for acute appendicitis diagnoses.
Acute appendicitis is a common medical condition, whose effective, timely diagnosis can be difficult. A missed diagnosis not only puts the patient in danger but also requires additional resources for corrective treatments. An acute appendicitis diagnosis constitutes a classification problem, for which a further fundamental challenge pertains to the skewed outcome class distribution of instances in the training sample. A preclustering-based ensemble learning (PEL) technique aims to address the associated imbalanced sample learning problems and thereby support the timely, accurate diagnosis of acute appendicitis. The proposed PEL technique employs undersampling to reduce the number of majority-class instances in a training sample, uses preclustering to group similar majority-class instances into multiple groups, and selects from each group representative instances to create more balanced samples. The PEL technique thereby reduces potential information loss from random undersampling. It also takes advantage of ensemble learning to improve performance. We empirically evaluate this proposed technique with 574 clinical cases obtained from a comprehensive tertiary hospital in southern Taiwan, using several prevalent techniques and a salient scoring system as benchmarks. The comparative results show that PEL is more effective and less biased than any benchmarks. The proposed PEL technique seems more sensitive to identifying positive acute appendicitis than the commonly used Alvarado scoring system and exhibits higher specificity in identifying negative acute appendicitis. In addition, the sensitivity and specificity values of PEL appear higher than those of the investigated benchmarks that follow the resampling approach. Our analysis suggests PEL benefits from the more representative majority-class instances in the training sample. According to our overall evaluation results, PEL records the best overall performance, and its area under the curve measure reaches 0.619. The PEL technique is capable of addressing imbalanced sample learning associated with acute appendicitis diagnosis. Our evaluation results suggest PEL is less biased toward a positive or negative class than the investigated benchmark techniques. In addition, our results indicate the overall effectiveness of the proposed technique, compared with prevalent scoring systems or salient classification techniques that follow the resampling approach.


Initial empirical antibiotics of non-carbapenems for ESBL-producing E. coli and K. pneumoniae bacteremia in children: a retrospective medical record review.
The efficacy of non-carbapenems as an empirical antibiotic for extended-spectrum β-lactamases (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia in children remains controversial. We compared clinical and microbial outcomes according to the types of empirical antibiotics for treating pediatric patients with ESBL-producing E. coli and K. pneumoniae bacteremia. Data from pediatric patients aged ≤ 18 years who were hospitalized with monomicrobial ESBL-producing E. coli or K. pneumoniae bacteremia at Asan Medical Center Children's Hospital, Seoul, Korea between January 2014 and May 2019 were analyzed retrospectively. The impact of empirical therapy was assessed as 30-day all-cause mortality and 2-day microbiological outcomes evaluated by the sterility of blood cultures collected on day 2 after empirical antibiotic administration. Logistic regression analysis was used to control for the effects of confounding variables. A total of 53 patients with bacteremia caused by ESBL-producing E. coli (n = 29) and K. pneumoniae (n = 24) were included in this study; the median age was 3.6 years, and all had underlying comorbidities. As empirical antibiotics, 27 patients were treated with meropenem, and non-carbapenem agents were administered to 26 patients; 84.6% (22/26) were converted to carbapenem antibiotics as the definitive antibiotic by day 2 after empirical antibiotic administration. Overall, the 30-day all-cause mortality of ESBL-producing E. coli and K. pneumoniae bacteremia was 17.0% (9/53). After adjustment, there was no statistically significant association of use of a non-carbapenem agent as an empirical antibiotic with microbiological failure on day 2 and 30-day all-cause mortality [adjusted odds ratio (OR) 1.0; 95% confidence interval (CI) 0.22-4.88, and adjusted OR 0.1; 95% CI 0.01-1.56]. The empirical use of non-carbapenems might not be a risk factor for mortality and early microbiological outcomes in pediatric patients with ESBL-producing E. coli and K. pneumoniae BSI if early transition to appropriate antimicrobial therapy was possible.


Rhythmic habit patterns (stereotypies).
Rhythmic movements such as head-rolling, head-banging and body-rocking are seen in normal children in early life, but much more commonly in the mentally handicapped. Emotional disturbance and boredom tend to increase the movements. Various theories have been advanced to account for these stereotyped patterns. They appear to be intentional and may satisfy some inner need or allay frustations, but it is concluded that their true significance is unknown.


The Jagged-1/Notch-1/Hes-1 pathway is involved in intestinal adaptation in a massive small bowel resection rat model.
Notch signaling is required for the maintenance of intestinal epithelial proliferation. Dysfunction of this signaling pathway is associated with the loss of proliferated crypt epithelial cells. The aim of this study was to investigate the role of Notch signaling in small bowel resection (SBR)-associated crypt epithelial cell proliferation. Male Sprague-Dawley rats were subjected to sham operation (bowel transection and reanastomosis) or 70% mid-SBR. Intestinal tissue samples were collected at 0.5, 1, 6, 12, 24, 72, and 168 h after operation. The expression of Notch pathway mRNAs and proteins was analyzed using RT-PCR and Western blot. The expression of the Notch pathway proteins Jagged-1, NICD and Hes-1 was also determined through immunohistochemical staining using day 3 postoperative intestinal tissues. The degree of crypt epithelial cell proliferation was evaluated using the immunohistochemical staining of proliferating cell nuclear antigen (PCNA). Furthermore, IEC-6 cells were used to examine the function of the Jagged-1 signaling system. SBR led to increased crypt epithelial cell proliferation and increased expression of Jagged-1 and Hes-1 mRNA and protein along with cleaved Notch-1. Immunohistochemical staining showed that Jagged-1, cleaved Notch-1 and Hes-1 colocalized in the same proliferated crypt epithelial cell population. Recombinant Jagged-1 significantly stimulated the proliferation of IEC-6 cells. Transient upregulation of Jagged-2 expression was found 1 h after SBR, and it was accompanied by cleaved Notch-1 and Hes-1 upregulation. The Jagged-1/Notch-1/Hes-1 signaling pathway is involved in intestinal adaptation through increasing crypt epithelial cell proliferation.


Direct current cardioversion does not cause cardiac damage: evidence from cardiac troponin T estimation.
To determine whether elective direct current (dc) cardioversion of atrial fibrillation/flutter causes myocardial damage. Cardiac troponin T and creatine kinase were estimated 20-28 hours after dc cardioversion in 51 patients who received dc shocks for elective cardioversion of chronic atrial fibrillation/flutter. Although creatine kinase was raised in 44 patients, cardiac troponin T was undetectable in all patients. Cardiac damage does not occur as a result of cardioversion.


Research on serum metabolomics of ovariectomized rats and intervention effect of Cuscuta chinensis on metabolic pattern.
As a traditional Chinese medicine of invigorating the kidney, Cuscuta chinensis (CC) can be applied in improving the deficiency of kidney qi in menopausal women and regulating the level of estrogen. Previously, it was found that the ethanol extract of CC had an estrogen-like effect. In this study, the metabolic profile and metabolic pathways of rats in sham, ovariectomized model and CC groups were analyzed using UPLC-TOFMS-based metabolomics and the pattern recognition technology. The serum endogenouse metabolites could be well differentiated in different group, indicating significant differences of metabolic profiles. CC had an reverse adjustment effect on 14 differential metabolites of ovariectomized rats, including sinapyl alcohol, deoxycholic acid, prostaglandin B2, prostaglandin I2, dihydrosphingosine, choline, pentadecanoic acid, arachidonic acid, 1-stearoyl-Sn-Glycerol-3-Phosphocholine, palmitoleic acid, palmitic acid, vaccenic acid, oleic acid and stearic acid. Furthermore, these differential metabolites were categorized into several major pathways, such as biosynthesis of unsaturated fatty acids, lycerophospholipid metabolism and arachidonic acid metabolism. Therefore, it could be concluded that the estrogen-like effect of CC was related to the lipid metabolism to some extent. The research results provide useful help for the in-depth research and development of CC.


[Contact lens wearers as candidates for LASIK surgery: two pitfalls to avoid].
We present two cases of persons wearing hard contact lenses resulting in corneal modifications which could have falsified the indications for LASIK. In the first case the use of hard contact lenses led to thickening of the cornea which might have led to an erroneous indication for LASIK and an excessive thinning of the cornea. In the second case, the shape of the cornea was modified and the rigid lens masked a subclinical keratoconus. Since corneal ectasia is the major complication of LASIK surgery due to excessive thinning of the cornea or LASIK surgery on an undiagnosed keratoconus, these two cases illustrate the importance of a pre-LASIK eye examination for patients wearing hard lenses several weeks after these contact lenses have been discontinued.


IUD complications in perspective.
All methods of contraception are associated with the risk of pregnancy and complications. Although there is extensive literature on complications associated with the use of IUD, there are some aspects of IUD use that require further study including pelvic actinomycosis, pelvic inflammatory disease, and tubal infertility. Each of these are reviewed briefly. Ways in which the use of currently available IUDs may be made safer are discussed.


Siderophore iucA of hypermucoviscous Klebsiella pneumoniae promotes liver damage in mice by inducing oxidative stress.
The hypermucoviscosity/hypervirulent K. pneumoniae (hvKP) is a dominant cause of pyogenic liver abscess (PLA) and has contributed to the endemicity of disease in Asian country. The siderophore aerobactin (iucA) is highly expressed in hvKP and acting virulence role during hvKP infection. However, its role in the PLA is poorly understood. We constructed iucA deletion mutant (ΔiucA-hvKP852) and used animal study to characterize the role of siderophore iucA in K. pneumoniae liver abscess. The animal experiments showed that ΔiucA-hvKP852 strain had lower virulence in mice compared to hvKP852 wild type strain. At 24 h after infection, only two of ten mice developed liver abscess during infection with ΔiucA-hvKP852 strain, while nine of ten mice infected with wild type hvKP852 strain showed multiple lesions of liver abscess. The liver tissue infected with ΔiucA-hvKP852 exhibited low reactive oxygen stress levels compared to those infected by wild type hvKP852 strain (P < 0.05). The results suggest that siderophore iucA play an important role in the liver abscess by inducing oxidative stress.


Factors Affecting the Performance of Trickle Dusters for Preventing Explosive Dust Accumulations in Return Airways.
Correctly applied rock dust can dilute, inert, and mitigate the explosive potential of float coal dust. Trickle dusters are one element of a comprehensive system to help prevent coal dust explosions in underground coal mines. Trickle dusters supply rock dust to inert fine float coal dust in areas where it is commonly deposited, such as the longwall tailgate returns, return airways, pillaring areas, and downwind of belt transfers. Dust deposition studies show that the effectiveness of trickle dusters depends on several key factors. Using multiple orifices, rock dust should be released near the mine roof in the direction of the airflow in order to spread the cloud cross the entry. The rock duster should have a mechanism to break up rock dust agglomerates as they leave the rock duster. The particle size distribution of the limestone rock dust and its airborne concentration should be proportional to the airborne size distribution and concentration of coal dust passing by the trickle duster. Specifically, rock dusts having a greater proportion of <74 µm material are more effective at minimizing downwind zones of explosible mixtures than mostly larger particles. In our testing, rock dusts having more than 95% of <74 µm sized particles were adequately dispersed by trickle dusters. Based on our results, the mass rate of rock dust discharge from the trickle duster should exceed the rate of float coal production by at least a factor of four in order to minimize accumulations of explosible dusts.


Optimising simulation learning experiences for mature, postgraduate nursing students.
Mature students do not always approach learning activities according to expected adult learner behaviour. In addition, they may have never experienced simulation as a learning opportunity before. This creates a unique opportunity for nurse educators to contextualise education principles that are most applicable to mature students' learning needs. Education action research was conducted with two groups of mature postgraduate students, using nominal and focus groups to optimise their simulation learning experiences. Results showed that mature students should be thoroughly oriented beforehand about simulation practice and what is expected of them during participation. Through scaffolding and a succession of at least six to 10 simulation sessions, learner independence and adult learner behaviour can be developed. Begin with less complex scenarios before moving to ones that are more complex - this will prevent cognitive overload. Keeping the simulation environment as authentic and reliable as possible will promote suspension of disbelief. A non-punitive debriefing model is essential for enhancing student engagement and motivating improved performance in follow-up simulation learning sessions. If nurse educators stay open and responsive to the learning needs of mature students, the advantages of learning through simulation can be realised fully.


Echocardiographic quantification of Dirofilaria immitis in experimentally infected cats.
The safety of heartworm preventives in heartworm-positive cats has traditionally been evaluated using adult Dirofilaria immitis removed from infected dogs and surgically implanted into the cats. An alternate study model uses infective larvae to establish adult infections in cats. Unfortunately, the number of adult worms resulting from the latter method varies widely from none to more than 30, both unacceptable for studies of natural heartworm infection and for studies evaluating product safety in heartworm-infected cats. We sought to determine infection severity in experimental infections via echocardiography to reduce the chances of enrolling uninfected and heavily infected cats into a study. Eighty adult cats were each inoculated with 60 infective D. immitis larvae and maintained for 8 months to allow for the development of adult worms. Antigen and antibody testing, as well as echocardiographic imaging, were performed to confirm and estimate adult worm burdens. Approximately 8 and 12 months post-infection, echocardiographic examination was performed to confirm and enumerate adult D. immitis populations in the cardiovascular system. Worm burdens were stratified as 0, 1-3, 4-11, and > 11 adults, with 0 being considered uninfected and more than 11 considered too heavily infected to be relevant for anthelmintic studies. Cats with clinically relevant infections (1-10 adults) subsequently received multiple treatments with the investigational drug, and worm burdens were confirmed by necropsy 30 days following the final treatment. Worm burden estimated with echocardiography correlated well, but not precisely, with post-mortem counts (p < 0.001, r2 = 0.67). Echocardiography under-, over-, and exactly estimated heartworm burden 53%, 27%, and 22% of the time, respectively. Although the correct category (0-4) was determined by echocardiography in only 54% of cats, positive cats were distinguished from negative cats 88% of the time and the heaviest infections (> 11) were correctly categorized 95% of the time. Both false negative and false positive results were observed. We conclude that echocardiography is useful for detecting mature experimental heartworm infections, identifying cats that have rejected mature infection, and detecting very heavy heartworm burdens, but it is only moderately accurate in classifying lesser burdens. While echocardiography cannot be relied upon to consistently determine the exact heartworm burden in experimentally infected cats, it is useful in stratifying worm burdens for anthelmintic safety studies.


Localization of the active center of microsomal cytochrome P-450.
To solve the problem of localization of the active center of cytochrome P-450 in microsomal membranes, new bifunctional compounds (I-IV), which contain pyridine radical, aliphatic chain of variable length and diphosphonic acid ("floating" molecules) have been applied. These compounds inhibit oxidation and binding of the substrates of cytochrome P-450 (aminopyrine and aniline), inhibition being of a competitive character. Measurements of distribution coefficients between water and membranes of microsomes and liposomes from egg phosphatidylcholine evidence that the microsomal proteins are necessary for providing effective interaction of I-IV with microsomal membrane. The 1H-NMR method has demonstrated compounds to be incorporated into lipid bilayer so that the non-polar part is in the inner membrane volume. The results obtained confirm our previous conclusion (Krainev A.G., Weiner L.M., Alferyev I.S., Slynko N.M. (1985) Biochim. Biophys. Acta, 818, 96-104) about localization of the active center of microsomal cytochrome P-450 at the depth of approximately 18 A from the hydrophilic surface of a membrane.


Vanadium Phosphorus Oxide/Siliceous Mesostructured Cellular Foams: efficient and selective for sustainable acrylic acid production via condensation route.
A new type of supported vanadium phosphorus oxide (VPO) with self-phase regulation was simply fabricated (organic solvent free) for the first time by depositing the specific VPO precursor NH4(VO2)HPO4 onto the Siliceous Mesostructured Cellular Foams (MCF) with controlled activation. The resulting materials were found to be highly efficient and selective for sustainable acrylic acid (AA) plus methyl acrylate (MA) production via a condensation route between acetic acid (HAc) and formaldehyde (HCHO). A (AA + MA) yield of 83.7% (HCHO input-based) or a (AA + MA) selectivity of 81.7% (converted HAc-based) are achievable at 360 °C. The systematic characterizations and evaluations demonstrate a unique surface regulation occurring between the MCF and the NH4(VO2)HPO4 precursor. NH3 release upon activation of NH4(VO2)HPO4 precursor together with adsorption of NH3 by MCF automatically induces partial reduction of V5+ whose content is fine-tunable by the VPO loading. Such a functionalization simultaneously modifies phase constitution and surface acidity/basicity of catalyst, hence readily controls catalytic performance.


Applicability of an ultrasonic nebulization system for the airways delivery of beclomethasone dipropionate in a murine model of asthma.
We have assessed the use of an ultrasonic nebulization system (UNS), composed of ultrasonic nebulizer and diffusion dryer filled with charcoal, for the effective delivery of beclomethasone to the airways in a murine asthma model. Solution of beclomethasone in ethanol was aerosolized using an ultrasonic nebulizer. Passage of the aerosol through a drying column containing charcoal and deionizer produced dry beclomethasone particles. Particles were delivered to BALB/c mice placed in a whole-body exposition chamber 1 h before intranasal challenge with ovalbumine. Efficacy of beclomethasone delivery was evaluated by examining bronchoalveolar lavage fluid (BALF) cytology. Effect of three UNS system parameters on aerosol particle size was investigated. The critical parameter affecting the size of dry particles was beclomethasone concentration in aerosolized solution and solution flow rate while power level of ultrasonic nebulizer generator had no effect. Administration of beclomethasone at calculated dose of 150 microg/kg to mice significantly decreased total cell number and relative eosinophil number in BALF. The UNS system produces a monodisperse aerosol that can be used for inhalative delivery of poorly water soluble substances to experimental animals. The UNS system minimizes formulation requirements and allows rapid and relatively simple efficacy and toxicity testing in animals.


The incidence of malignancy in carotid body tumours.
Twenty-three patients with 24 carotid body tumours are reviewed. A high incidence of malignancy (30%) was encountered. It is recommended that all carotid body tumours be removed unless there are contraindicating medical or technical reasons.


Effect of the crosslinker type on the enantioseparation performance of β-cyclodextrin functionalized monoliths prepared by the one-pot approach.
Low column efficiency for enantioseparations in capillary liquid chromatography (CLC) is a major problem commonly encountered with β-cyclodextrin (β-CD) functionalized polymer-based monoliths. In order to investigate the effect of the crosslinker type on enantioseparation performance, three commonly used crosslinkers, i.e. 1,4-bis(acryloyl)piperazine (PDA), ethylene dimethacrylate (EDMA) and N,N-methylenebisacrylamide (MBA), were copolymerized using the one-pot approach with glycidyl methacrylate-mono-6-amino-6-deoxy-β-CD (GMA-NH2-β-CD) as functional monomer. The three monolithic columns, including poly(GMA-NH2-β-CD-co-PDA) and poly(GMA-NH2-β-CD-co-MBA), as well as the previously reported column poly(GMA-NH2-β-CD-co-EDMA) were systematically compared with respect to morphology, permeability, β-CD density, retention mechanism and efficiency. The enantioseparation ability of each column was evaluated using 14 chiral compounds, including mandelic acid derivatives, profens, N-derivatized amino acids, and herbicides, as test substances. The β-CD-functionalized monolith with MBA as crosslinker was found to exhibit higher polarity, higher column efficiency and better enantioseparation performance than those with PDA or EDMA as crosslinker.


2"-O-phosphorylation of gentamicin components by a Staphylococcus aureus strain carrying a plasmid.
A wild-type strain of Staphylococcus aureus that inactivates the 4,6-glycosidically linked deoxystreptamine aminoglycoside antibiotics by a plasmid-mediated process was found to harbor two enzymes: an acetyltransferase of the AAC(6') type and a new phosphotranferase specific to the gentamicin components. The target of this last enzyme is the 2''-hydroxyl function of these antibiotics, since one inactivated compound is 2''-(O)-phosphorylsisomicin.


A new immune resonance scattering spectral assay for trace fibrinogen with gold nanoparticle label.
Gold nanoparticles in size of 9.0 nm was prepared by the trisodium citrate and used to label goat anti-human fibrinogen. In the pH 6.2 buffer solution and in the presence of polyethylene glycol (PEG), the immune reaction between gold-labeled goat anti-human fibrinogen and fibrinogen took place and the labeled gold nanoparticles were released from the goat anti-human fibrinogen, and the released gold particles aggregated which leaded the resonance scattering intensity at 560 nm (I560 nm) to enhance greatly. The I560 nm is proportional to the fibrinogen concentration in the range from 0.027 to 1.07 microg mL(-1). The detection limit is 1.14 ng mL(-1). This simple assay was applied to determination of fibrinogen in human plasma, with satisfactory results.


Light and ultrastructural studies in sural biopsies of the pseudopolyneuropathic form of ALS.
The aim of this work was to study the neuropathological picture of the sural nerve in the pseudopolineuropathic form of A.L.S. Five patients were considered: in all cases the clinical and electromyographic follow-up excluded other diseases. EMG-studies were repeatedly performed: they showed the progressive evolution of the spinal anterior horn cell pathology from lower spinal to cervical levels. The sural nerve was processed according to the procedure used in our laboratory for light and ultrastructural examination. Quantitative analysis of myelinated fiber density was carried out on photographic enlargement and reported on histograms. The light and ultrastructural examination showed a severe loss of myelinated fibers; the decrease affected all types of fibers, but predominated in the largest ones. In the axons there was an increase of mitochondria, dilation of the small vesicles and increase in the number of neurofilaments. It is our opinion that all histopathologic data obtained in the sural nerve biopsy in this form of A.L.S. reveal a clear involvement of the sensory neurons of the spinal ganglia and the results can be useful for the study of precocius lesions in the A.L.S.


Expression of a novel sodium-hydrogen exchanger in the gastrointestinal tract and kidney.
We have recently cloned a novel Na+/H+ exchanger (NHE-2) from rat small intestinal cDNA library. The present report characterizes the expression of (NHE-2) mRNA in the rat small intestine, stomach, and kidney using Northern blot analysis and in situ hybridization techniques. NHE-2 mRNA was detected in the surface epithelium of the stomach, villus but not crypt epithelial cells of the small intestine and in the distal convoluted, but not in the proximal tubules of the kidney. This distribution suggests a functional role in the transport of sodium across the apical membrane of the gastrointestinal tract and the kidney.


Tumor contour irregularity on preoperative imaging: a practical and useful prognostic parameter for papillary renal cell carcinoma.
To illustrate tumor contour irregularity on preoperative imaging with a practical method and further determine its value in predicting disease-free survival (DFS) in patients with pRCC (papillary renal cell carcinoma). We performed a retrospective single-institution review of 267 Chinese pRCC patients between March 2009 and May 2019. Contour irregularity on cross-section was classified into smooth but distorted margin, unsmooth and sharply nodular margin, and blurred margin. Then, the ratio of the cross-section numbers of irregularity and the total tumor was defined as the contour irregular degree (CID). Cox regression and Kaplan-Meier analysis were performed to analyze the impact of CID on DFS. Then, the prognostic performance of CID was compared with pRCC risk stratification published by Leibovich et al. RESULTS: The median follow-up was 45 months (IQR: 23-69), in which 27 (10%) patients had metastasis or recurrence. Observed DFS rates were 95%, 90%, and 88% at 1, 3, and 5 years. The CID was an independent prognostic factor of DFS (HR = 1.048, 95% CI = 1.029-1.068, p < 0.001). The Kaplan-Meier plot showed that high-risk patients (CID ≥ 50%) tended to have a significantly shorter DFS (p < 0.001). The CID and Leibovich's pRCC model for DFS prediction had a C-index of 0.934 (95% CI = 0.907-0.961) and 0.833 (95% CI = 0.739-0.927) respectively. With our standard and practical method, the CID can be a reliable imaging marker for DFS prediction in patients with pRCC. • The updated contour irregularity was an independent parameter for predicting disease-free survival in patients with pRCC. • High-risk pRCC patients (contour irregular degree ≥ 50%) tended to have a shorter disease-free survival. • Tumor contour irregularity in pRCC risk stratification outperformed Leibovich's model from our cohort.


Endogenous ouabain and acute salt loading in low-renin hypertension.
Endogenous ouabain (EO), which is structurally identical to the cardiac glycoside ouabain, has been isolated in human plasma. The substance EO has been implicated in states of volume expansion and in some types of arterial hypertension, especially as a factor of salt sensitivity of blood pressure. On the other hand, salt sensitivity has been described in low-renin hypertension. The aim of this study was to determine the response of plasma EO to acute sodium expansion in low-renin hypertension. We performed an acute intravenous sodium load (2 L of saline in 4 h) in 13 hypertensive subjects with low renin values (<0.65 ng/mL/h). We measured EO in plasma extracts by a radioimmunoassay and compared it with other endocrine parameters including atrial natriuretic peptide (ANP), aldosterone (ALDO), cortisol (CORT), adrenocorticotropic hormone (ACTH), and plasma renin activity (PRA). We found that EO showed only a mild nonsignificant decrease after saline infusion (from 938.8+/-218.8 pmol/L to 781.4+/-181.4 pmol/L ouabain equivalents), whereas ALDO and PRA significantly decreased (P<.0001; P<.05 respectively). The ANP significantly increased, as a marker of effective volume expansion (P<.01). At the end of the infusion, we found that EO was positively related to ACTH levels and to ALDO changes from baseline. Our results do not support the hypothesis that EO is stimulated in low-renin hypertension by acute salt-volume expansion. ACTH could be a factor modulating EO secretion in this condition.


Effect of the Chinese traditional prescription Suo Quan Wan on TRPV1 expression in the bladder of rats with bladder outlet obstruction.
Suo Quan Wan (SQW) is a Chinese traditional prescription that has been used in clinical treatment of lower urinary tract symptoms for centuries. However, scientific basis of SQW efficacy and mechanism is still needed. This study investigated the effect of SQW on bladder function and transient receptor potential vanilloid 1 (TRPV1) expression in the bladder of rats with bladder outlet obstruction (BOO). The induced changes in bladder function in overactive bladder (OAB) rat model were observed following different periods of outlet obstruction to obtain an appropriate rat model. This study was carried out in two parts. In the first part, female Sprague-Dawley rats received sham operations or partial BOO operations. Two, four, and six weeks later, the OAB model groups and control were subjected to urodynamic tests to measure differences in bladder functions. Once the appropriate rat model was obtained, the second part of the experiment was performed. The rat model was recreated and treated with SQW. Urodynamic assessment was conducted, and the bladders of the rats were then removed. Immunofluorescence staining, real-time PCR, and Western blot were performed to localize and quantify the expression of TRPV1 in the bladder. Results of the first part indicated that at 2 and 4 weeks, the OAB model group exhibited significant differences in urodynamic parameters, including bladder pressure, maximum voiding pressure, and maximum bladder capacity, compared with the sham group. At 4 and 6 weeks, the OAB model group exhibited significant differences in residual volume (RV) and non-voiding contraction frequency. Six-week OAB model group showed much more RV but less voiding efficiency when compared with 6-week sham group or 2-and 4-week OAB model group. Rats that underwent BOO exhibited similarities with the compensated state before four weeks and may have entered decompensated state at six weeks. Studies conducted with 4-week OAB model were appropriate. In part two of the experiment, unstable bladder in the OAB model group recovered bladder stability after SQW treatment, accompanied by improved bladder hypertrophy, as well as corrected urodynamic parameters. Expression of TRPV1 mRNA and proteins in the bladder was significantly greater in the OAB model group than that in the control group, which subsequently decreased significantly with SQW treatment in BOO-induced rats. SQW can modulate the expression of TRPV1 in accordance with the recovery of bladder function.


Future target molecules for influenza treatment.
Induction of apoptosis and pro-inflammatory cytokine gene expression in influenza virus-infected cells activates production of toxic superoxide by macrophages. Pyrrolidine dithiocarbamate and nordihydroguaiaretic acid inhibit influenza virus proliferation and scavenge superoxide. These results suggest that they can be potential candidates for a drug of choice for influenza chemotherapy.


Predicting powder feedability: A workflow for assessing the risk of flow stagnation and defining the operating space for different powder-feeder combinations.
Powder feeding is of critical importance for continuous manufacturing (CM) since next to in-process segregation it is the phenomenon primarily responsible for fluctuations in content uniformity and for content deviations in the final drug product. So far, feeding studies have focused on the characterization of specific feeders and the prediction of their performance for various materials. This work presents a more holistic approach, an early general assessment of the "feedability" of raw materials. With that regard, we established a workflow to: i) predict potential feeding issues, such as the flow stagnation in the hopper based on both the material attributes and the feeder's geometry; and ii) predict the feed rate space using various feeder/screw combinations for powders with an acceptable risk of hopper flow stagnation. Statistical models were developed for this twofold approach using a dataset comprising nine powders and four different feeders. In order to include different feeding equipment into the statistical models, novel equipment descriptors (capturing the effect of different geometries) and performance indicators (the end fill level as indicator for the risk of powder flow stagnation) were introduced. The application of the workflow was demonstrated for a simple formulation, and model validation was successfully performed for an additional powder that was not contained in the original dataset. Finally, the most relevant material attributes were identified, and reduced material characterization data sets were investigated in terms of effects on the model's prediction performance. The workflow presents a promising tool for initial process assessment in early-phase development.


Endocrine control of electrolyte balance during development.
The endocrine control of electrolyte balance during development is reviewed. It is suggested that the high urinary sodium excretion observed in premature infants may be secondary to the immaturity of the adrenal gland to adequately increase the secretion of aldosterone (Sulyok et al, 1979b), and to the inability of the distal tubule to respond appropriately to a rise in circulating aldosterone levels (Sulyok et al, 1979a). On the other hand, the elevated plasma aldosterone levels observed in term newborn infants may play an important role in the blunted response of the newborn kidney to saline loading (Sulyok et al, 1979a; Spitzer, 1982). The ability of ANP to induce a natriuresis and to contribute to fluid and electrolyte homeostasis during development has been investigated. It has been found that the immature kidney is less responsive to ANP than later in life (Chevalier et al, 1988; Robillard et al, 1988). On the other hand, it has been suggested that a rise in plasma ANP during the first five days of life may contribute to the physiological weight loss associated with the extracellular volume contraction occurring shortly after birth (Tulassay et al, 1987). The role of glucocorticoids, prostaglandins and the kallikrein-kinin system in regulating electrolyte balance during development is also reviewed.


Severe skin ulcer caused by taking lenvatinib after proton beam therapy.
A 69-year-old man was treated with lenvatinib after three sessions of proton beam therapy (PBT) for hepatocellular carcinoma. Five months after administration of lenvatinib, a dermatitis with huge skin ulcer formed in the site of PBT irradiation. Lenvatinib was immediately withdrawn, but the skin ulcer continued growing until about 2 weeks later. With topical and antibiotic treatment, the skin ulcer resolved after about 4 months. After administration of lenvatinib, potential skin damage due to PBT at the irradiated site may have become apparent. This is the first report describing skin ulcer by the combination of lenvatinib administration and PBT.


Rapid on-site cytologic evaluation during endoscopic ultrasound-guided biopsies of pancreatic solid lesions.
Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is safe and effective for the diagnosis of pancreatic adenocarcinoma. Although rapid on-site evaluation (ROSE) can improve tissue collection and increase diagnostic yield, its utility has been recently questioned. Determine the diagnostic efficacy of EUS-FNB with ROSE of pancreatic masses in a new echoendoscopy unit. Cross-sectional and comparative study of patients who underwent EUS-FNB of pancreatic masses between January and July 2017. Patient demographics, ultrasonographic details and pathology reports were examined. A total of 23 procedures were analyzed. Median age was 59 years (range: 46-77). The group with ROSE had 13 patients (56.5%) and the group without ROSE 10 (43.5%). The final pathology report showed enough and adequate sample in 100% of the group with ROSE (13/13 vs. 5/10; p = 0.007). Diagnosis of malignancy was established in 84.6% of the biopsies (11/13 vs. 2/10; p = 0.003) in the group with ROSE. ROSE is useful to improve the diagnostic efficacy of EUS-FNB of pancreatic masses, especially in new EUS centers or in centers with a low diagnostic yield.


Protein expression of urate transporters in renal tissue of patients with uric acid nephrolithiasis.
URAT1 and GLUT9 are two primary urate transporters involved in the renal urate handling. Renal urate underexcretion was reported in uric acid stone formers (UASF) in previous clinical studies. The aim of this study was to investigate the clinical features and possible impact of protein expression of URAT1 and GLUT9 in renal tissues of patients with uric acid (UA) nephrolithiasis. 23 UASF, 27 patients with calcium oxalate (CaOx) stones, and 22 normal controls were enrolled in this study. Clinical data revealed that older age of onset, high plasma UA concentration, low urinary PH, and relative renal urate underexcretion were associated with UASF. By immunohistochemical or western blotting analysis, a significant increase in the relative expression quantity of URAT1 in renal tissue of UASF was found compared to patients with CaOx nephrolithiasis and normal controls. In conclusion, our results suggested that upregulated URAT1 protein expression might contribute to the relative urate underexcretion from the kidney of UASF.


Molecular characterization of a calcium-binding protein from the filarial parasite Dirofilaria immitis.
A full length D. immitis cDNA (nDiCal) encoding a protein with significant similarity to the calreticulin protein family was isolated from a 6-day fourth-stage larval cDNA expression library by immunoscreening, using serum from a rabbit immunized by repeated injection of small numbers of third-stage larvae. nDiCal is 1538 bp long and contains the 21 bp nematode splice leader sequence SL1 at the 5' end. nDiCal encodes for a protein (pDiCal) with a predicted molecular mass of 46 kDa. pDiCal sequence analysis revealed similarities with calreticulin, a protein that typically resides in the endoplasmic reticulum. pDiCal possesses three consensus sequences of the calreticulin family of proteins: a neutral N-terminal region with a putative signal sequence; a proline- and tryptophan-rich P region; and a highly acidic C-terminal region. A 45Ca2+-overlay assay showed that recombinant pDiCal (rDiCal) is a Ca2+-binding protein. Antibodies to rDiCal identified a 56 kDa native antigen in all developmental stages including the excretory-secretory products derived from larvae and adult worms. Localization studies demonstrated the ubiquitous presence of pDiCal with intense expression in the hypodermis and syncitial muscle cells in both male and female adult worms. Labeling was also seen in the developing embryos within the uterus of the female worms. Sera from immune as well as chronically-infected microfilaremic dogs contained antibodies that bind rDiCal. In addition, immunoblot analysis showed that serum from a rabbit immunized with L3 cuticles reacted with rDiCal.


Food intake, body weight, and sweetness preferences over the menstrual cycle in humans.
The body weight and reported food intake of 34 women were measured at the midpoint of the follicular and luteal phases of the menstrual cycle. Both body weight and reported food intake were significantly higher during the luteal phase than during the follicular phase. In addition, sweetness (sucrose) preferences were measured on both occasions before and after a glucose load. Examination of the pre- to post-load changes revealed a significant decline during the luteal phase and the absence of such a decline in the follicular phase. The results were discussed in terms of the influence of ovarian hormones on food regulation and carbohydrate metabolism.


Perceptual learning in children with visual impairment improves near visual acuity.
This study investigated whether visual perceptual learning can improve near visual acuity and reduce foveal crowding effects in four- to nine-year-old children with visual impairment. Participants were 45 children with visual impairment and 29 children with normal vision. Children with visual impairment were divided into three groups: a magnifier group (n = 12), a crowded perceptual learning group (n = 18), and an uncrowded perceptual learning group (n = 15). Children with normal vision also were divided in three groups, but were measured only at baseline. Dependent variables were single near visual acuity (NVA), crowded NVA, LH line 50% crowding NVA, number of trials, accuracy, performance time, amount of small errors, and amount of large errors. Children with visual impairment trained during six weeks, two times per week, for 30 minutes (12 training sessions). After training, children showed significant improvement of NVA in addition to specific improvements on the training task. The crowded perceptual learning group showed the largest acuity improvements (1.7 logMAR lines on the crowded chart, P < 0.001). Only the children in the crowded perceptual learning group showed improvements on all NVA charts. Children with visual impairment benefit from perceptual training. While task-specific improvements were observed in all training groups, transfer to crowded NVA was largest in the crowded perceptual learning group. To our knowledge, this is the first study to provide evidence for the improvement of NVA by perceptual learning in children with visual impairment. (http://www.trialregister.nl number, NTR2537.).


Competitive binding of Cd, Ni and Cu on goethite organo-mineral composites made with soil bacteria.
Soil is a heterogeneous porous media that is comprised of a variety of organo-mineral aggregates. Sorption of heavy metals onto these composite solids is a key process that controls heavy metal mobility and fate in the natural environment. Pollution from a combination of heavy metals is common in soil, therefore, understanding the competitive binding behavior of metal ions to organo-mineral composites is important in order to predict metal mobility and fate. In this study, batch experiments were paired with spectroscopic studies to probe the sorption characteristics of ternary CdNiCu sorbates to a binary organo-goethite composite made with Bacillus cereus cells. Scanning electron microscopy shows that goethite nano-sized crystals are closely associated with the bacterial surfaces. Sorption experiments show a larger adsorptivity and affinity for Cu than Cd/Ni on goethite and B. cereus, and the goethite-B. cereus composite. X-ray photoelectron spectroscopy reveals that carboxylate and phosphate functional moieties present on the bacterial cell walls are primarily responsible for metal sorption to the goethite-B. cereus composite. Synchrotron-based X-ray fluorescence shows that Cu and Ni are predominately associated with the bacterial fraction of the goethite-B. cereus composite, whereas Cd is mainly associated with the goethite fraction. The findings of this research have important implications for predicting the mobility and fate of heavy metals in soil multi-component systems.


Divergent roles of Smad3 and PI3-kinase in murine adriamycin nephropathy indicate distinct mechanisms of proteinuria and fibrogenesis.
Multiple transforming growth factor (TGF)-β-induced fibrogenic signals have been described in vitro. To evaluate mechanisms in vivo, we used an adriamycin nephropathy model in 129x1/Svj mice that display massive proteinuria by days 5 to 7 and pathological findings similar to human focal segmental glomerulosclerosis by day 14. TGF-β mRNA expression increased after day 7 along with nuclear translocation of the TGF-β receptor-specific transcription factor Smad3. Inhibiting TGF-β prevented both pathological changes and type-I collagen and fibronectin mRNA expression, but proteinuria persisted. Renal Akt was phosphorylated in adriamycin-treated mice, suggesting PI3-kinase activation. Expression of mRNA for the p110γ isozyme of PI3-kinase was specifically increased and p110γ colocalized with nephrin by immunohistochemistry early in disease. Nephrin levels subsequently decreased. Inhibition of p110γ by AS605240 preserved nephrin expression and prevented proteinuria. In cultured podocytes, adriamycin stimulated p110γ expression. AS605240, but not a TGF-β receptor kinase inhibitor, prevented adriamycin-induced cytoskeletal disorganization and apoptosis, supporting a role for p110γ in podocyte injury. AS605240, at a dose that decreased proteinuria, prevented renal collagen mRNA expression in vivo but did not affect TGF-β-stimulated collagen induction in vitro. Thus, PI3-kinase p110γ mediates initial podocyte injury and proteinuria, both of which precede TGF-β-mediated glomerular scarring.


Glottic neurofibroma in an elderly patient: a case report.
Neurogenic tumors of the larynx are extremely rare, accounting for less than 1% of all benign laryngeal tumors. The lesions that have been described in current literature are located either in the supraglottis or subglottis, mainly affecting the pediatric population and associated with von Recklinghausen disease. Descriptive study of an unusual case of an isolated neurofibroma of the glottis in an elderly patient with no history of neurofibromatosis. We discuss preoperative clues to the diagnosis, our surgical experience, and propose a theory of its pathogenesis originating from encapsulated nerve structures within the vocal fold.


Blast-induced moderate neurotrauma (BINT) elicits early complement activation and tumor necrosis factor α (TNFα) release in a rat brain.
Blast-induced neurotrauma (BINT) is a major medical concern yet its etiology is largely undefined. Complement activation may play a role in the development of secondary injury following traumatic brain injury; however, its role in BINT is still undefined. The present study was designed to characterize the complement system and adaptive immune-inflammatory responses in a rat model of moderate BINT. Anesthetized rats were exposed to a moderate blast (120 kPa) using an air-driven shock tube. Brain tissue injury, systemic and local complement, cerebral edema, inflammatory cell infiltration, and pro-inflammatory cytokine production were measured at 0.5, 3, 48, 72, 120, and 168 h. Injury to brain tissue was evaluated by histological evaluation. Systemic complement was measured via ELSIA. The remaining measurements were determined by immunohistoflourescent staining. Moderate blast triggers moderate brain injuries, elevated levels of local brain C3/C5b-9 and systemic C5b-9, increased leukocyte infiltration, unregulated tumor necrosis factor alpha (TNFα), and aquaporin-4 in rat brain cortex at 3- and 48-hour post blast. Early immune-inflammatory response to BINT involves complement and TNFα, which correlates with hippocampus and cerebral cortex damage. Complement and TNFα activation may be a novel therapeutic target for reducing the damaging effects of BINT inflammation.


Assessment of TNFalpha contribution to the functional up-regulation of kinin B(1) receptors in the mouse paw after treatment with LPS.
It has been widely demonstrated that LPS is able to induce kinin B(1) receptor up-regulation throughout several models of inflammation. Using an in-vivo system in which LPS was administered systemically, we assessed the participation of the pro-inflammatory cytokine TNFalpha in the functional up-regulation of B(1) receptors in the mouse paw. Systemic treatment with LPS (10 microg/animal, i.v. 24 h before) resulted in a marked increase (about 5-fold) in the mouse paw edema induced by the selective B(1) receptor agonist des-Arg(9)-BK (50 nmol/paw) in both Swiss and C57/BL6 mice. The up-regulation of des-Arg(9)-BK-caused edema following LPS treatment was found to be greatly diminished in TNFalpha p55(-/-) receptor knockout mice. In addition, the paw edema evoked by des-Arg(9)-BK was significantly reduced when mice received the anti-TNFalpha antibody (100 [corrected] microg/kg, i.v.) 5 min before the LPS treatment. A similar inhibition of B(1) receptor-mediated paw edema was observed when mice were treated with thalidomide (30 mg/kg, s.c.) [corrected] a drug known for reducing TNFalpha synthesis, 5 min prior to LPS administration. ELISA experiment [corrected] revealed that TNFalpha serum levels were maximal at 1 h following LPS systemic treatment. Taken together, the present results suggest that the early production of the pro-inflammatory cytokine TNFalpha is probably responsible for driving the sequence of events involved in the functional up-regulation of B(1) receptors in the mouse paw.


Tissue printing and its applications in self-incompatibility studies.
In this study, the tissue printing technique has been used to rapidly localize in female tissues the presence of specific mRNA representing the products (or some of the products) of the self-incompatibility S-locus gene(s). The methodology, initially developed for Brassica oleracea (sporophytic self-incompatibility) has been successfully employed on Solanum chacoense (gametophytic self-incompatibility). In the Brassica system tissue printing has allowed rapid discrimination between S alleles belonging to class 1 (dominant types) vs. class 2 (recessive types), and thus parallels findings obtained by restriction analyses. In the Solanum system the level of the S-RNase messages was analysed by scanning laser densitometry, and it was found that the message levels of the allele S14 declined faster than those coming from S13 in mature flowers.


Characterization of beta-thalassaemia mutations using direct genomic sequencing of amplified single copy DNA.
Direct sequencing of specific regions of genomic DNA became feasible with the invention of the polymerase chain reaction (PCR) which permits amplification of specific regions of DNA. Recently, human mitochondrial DNA was amplified and directly sequenced. Using a thermostable DNA polymerase of T. aquaticus (Saiki, R.K. et al., manuscript in preparation) in the PCR, we have applied a combination of PCR and direct sequence analysis of the amplified product to a human single-copy gene. We studied the genomic DNA of five patients with beta-thalassaemia whose mutant alleles were uncharacterized, and found two previously undescribed mutations, along with three known alleles. One new allele is a frameshift at codons 106-107 and the other is an A-C transversion at the cap site (+1) of the beta-globin gene. This latter is the first natural mutation observed at the cap site and it occurs in a gene which is poorly expressed.


Quantification of 1,3-β-d-glucan by Wako β-glucan assay for rapid exclusion of invasive fungal infections in critical patients: A diagnostic test accuracy study.
Rapid and reliable exclusion of invasive fungal infections (IFI) by markers able to avoid unnecessary empirical antifungal treatment is still a critical unmet clinical need. We investigated the diagnostic performance of a newly available β-d-Glucan (BDG) quantification assay, focusing on the optimisation of the BDG cut-off values for IFI exclusion. BDG results by Wako β-glucan assay (lower limit of detection [LLOD] = 2.16 pg/mL, positivity ≥ 11 pg/mL) on two consecutive serum samples were retrospectively analysed in 170 patients, admitted to haematological wards (N = 42), intensive care units (ICUs; N = 80), or other wards (N = 48), exhibiting clinical signs and/or symptoms suspected for IFI. Only patients with proven IFI (EORTC/MSG criteria) were considered as true positives in the assessment of BDG sensitivity, specificity and predictive values. Patients were diagnosed with no IFI (69.4%), proven IFI (25.3%) or probable IFI (5.3%). Two consecutive BDG values < LLOD performed within a median of 1 (interquartile range: 1-3) day were able to exclude a proven IFI with 100% sensitivity and negative predictive value (primary study goal). Test's specificity improved by using two distinct positivity and negativity cut-offs (7.7 pg/mL and LLOD, respectively), but remained suboptimal in ICU patients (50%), as compared to haematological or other patients (93% and 90%, respectively). The classification of Wako's results as negative when < LLOD, and positive when > 7.7 pg/mL, could be a promising diagnostic approach to confidently rule out an IFI in both ICU and non-ICU patients. The poor specificity in the ICU setting remains a concern, due to the difficulty to interpret positive results in this fragile population.


Substitution of the transmembrane domain of Vpu in simian-human immunodeficiency virus (SHIVKU1bMC33) with that of M2 of influenza A results in a virus that is sensitive to inhibitors of the M2 ion channel and is pathogenic for pig-tailed macaques.
The Vpu protein of human immunodeficiency virus type 1 has been shown to shunt the CD4 receptor molecule to the proteasome for degradation and to enhance virus release from infected cells. The exact mechanism by which the Vpu protein enhances virus release is currently unknown but some investigators have shown that this function is associated with the transmembrane domain and potential ion channel properties. In this study, we determined if the transmembrane domain of Vpu could be functionally substituted with that of the prototypical viroporin, the M2 protein of influenza A virus. We constructed chimeric vpu gene in which the transmembrane domain of Vpu was replaced with that of the M2 protein of influenza. This chimeric vpu gene was substituted for the vpu gene in the genome of a pathogenic simian human immunodeficiency virus, SHIVKU-1bMC33. The resulting virus, SHIVM2, synthesized a Vpu protein that had a slightly different Mr compared to the parental SHIVKU-1bMC33, reflecting the different sizes of the two Vpu proteins. The SHIVM2 was shown to replicate with slightly reduced kinetics when compared to the parental SHIVKU-1bMC33 but electron microscopy revealed that the site of maturation was similar to the parental virus SHIVKU1bMC33. We show that the replication and spread of SHIVM2 could be blocked with the antiviral drug rimantadine, which is known to target the M2 ion channel. Our results indicate a dose dependent inhibition of SHIVM2 with 100 microM rimantadine resulting in a >95% decrease in p27 released into the culture medium. Rimantadine did not affect the replication of the parental SHIVKU-1bMC33. Examination of SHIVM2-infected cells treated with 50 microM rimantadine revealed numerous viral particles associated with the cell plasma membrane and within intracytoplasmic vesicles, which is similar to HIV-1 mutants lacking a functional vpu. To determine if SHIVM2 was as pathogenic as the parental SHIVKU-1bMC33 virus, two pig-tailed macaques were inoculated and followed for up to 8 months. Both pig-tailed macaques developed severe CD4+ T cell loss within 1 month of inoculation, high viral loads, and histological lesions consistent with lymphoid depletion similar to the parental SHIVKU-1bMC33. Taken together, these results indicate for the first time that the TM domain of the Vpu protein can be functionally substituted with the TM of M2 of influenza A virus, and shows that compounds that target the TM domain of Vpu protein of HIV-1 could serve as novel anti-HIV-1 drugs.


Protein carboxyl methyltransferase facilitates conversion of atypical L-isoaspartyl peptides to normal L-aspartyl peptides.
Prolonged incubation of L-isoaspartate-containing forms of lactate dehydrogenase (231-242), sperm activating peptide, and adrenocorticotropin (22-27) at 37 degrees C, pH 7.4, with S-adenosyl-L-methionine and protein carboxyl methyltransferase from bovine brain leads to extensive conversion of the atypical isopeptide bond to a normal peptide bond. For the lactate dehydrogenase-related peptide, conversion was 80% complete after 24 h. For the other two peptides, conversion reached a level of approximately 65% after 48 h. The mechanism of conversion involves (i) rapid enzymatic methylation of the alpha-carboxyl of the L-iso-Asp residue; (ii) nonenzymatic demethylation resulting in formation of an L-aspartyl cyclic imide; and (iii) a slow, nonenzymatic hydrolysis of the cyclic imide to form a mixture of 15-25% normal L-Asp peptide and 75-85% L-iso-Asp peptide. The regenerated L-iso-Asp peptide is remethylated and the cycle is repeated. The extent of conversion is limited by a competing side reaction wherein the L-imide slowly racemizes, leading to the formation of mainly D-iso-Asp peptide, which is not a substrate for the methyltransferase. The ability of protein carboxyl methyltransferase to initiate conversion of L-iso-Asp residues to normal L-Asp suggests a possible role for this enzyme in facilitating the repair or degradation of deamidated proteins in vivo.


Identifying Variations in Baseline Behavior of Killer Whales (Orcinus orca) to Contextualize Their Responses to Anthropogenic Noise.
Determining the baseline behavior of a whale requires understanding natural variations occurring due to environmental context, such as changes in prey behavior. Killer whales feeding on herring consistently encircle herring schools; however, depth of feeding differs from near the surface in winter to deeper than 10 m in spring and summer. These variations in feeding depth are probably due to the depth of the prey and the balance between the costs and benefits of bringing schools of herring to the surface. Such variation in baseline behavior may incur different energetic costs and consequently change the motivation of whales to avoid a feeding area. Here, we discuss these variations in feeding behavior in the context of exposure to noise and interpret observed responses to simulated navy sonar signals.


Disseminated cutaneous leishmaniasis after visceral disease in a patient with AIDS.
Leishmaniasis is emerging as a common and serious opportunistic disease for patients with HIV infection. Almost all cases of HIV-Leishmania coinfection have been described in Mediterranean countries and they occur with various clinical presentations, ranging from typical visceral forms to asymptomatic or atypical cases, including cutaneous and mucocutaneous leishmaniasis. Pentavalent antimony compounds have been the mainstays of antileishmanial therapy for half a century and new lipid formulations of amphotericin B seem reliable, but the most effective treatment remains unknown. We describe a patient who was HIV infected and an intravenous drug user, with an unusual disseminated cutaneous leishmaniasis, after an initial visceral disease and after a 13-month maintenance treatment with liposomal amphotericin. The severe concurrent immunosuppression probably played an essential role in leading to this atypical cutaneous form, characterized by diffuse, nonulcerated, nonscabby maculopapular lesions.


Variability in the pediatric intensivists' threshold for withdrawal/limitation of life support as perceived by bedside nurses: a multicenter survey study.
We hypothesized that bedside nurses perceive significant variability in the pediatric intensivist thresholds for approaching a family about withdrawal/limitation of life-sustaining therapy. All nurses working in four university-affiliated medical-surgical pediatric intensive care units staffed by 11, 7, 6, and 5 intensivists with 36, 18, 10, and 8 beds were sent three mailings of a survey asking questions about intensivist decisions for withdrawal/limitation of life-sustaining therapy. Responses were tabulated; chi-square compared results among centers; a p < 0.05 after Bonferroni correction was significant. The response rate was 205 of 415 (49%); 152 of 205 (74%) disagreed with the statement that each of the intensivists had the same threshold for approaching a family to suggest withdrawal/limitation of life-sustaining therapy, with no significant difference between centers. Also, 110 of 205 (54%) and 119 of 205 (58%) disagreed with the statement that each intensivist has the same threshold of the patient's chance for survival or projected quality of life when making a decision to withdraw/limit life-sustaining therapy with no significant difference between centers. The threshold to suggest withdraw/limit life-sustaining therapy based on chance of survival or projected quality of life differs between intensivists by at least 10% according to 113 of 184 (61%) and 121 of 184 (66%) nurses; the two larger centers had significantly higher difference among intensivists for projected quality of life. Fifty-five of 200 (27%) disagreed with the statement that they would have equal confidence in each intensivist accepting a recommendation for withdrawal/limitation of life-sustaining therapy for their own child, with no difference between centers. Bedside pediatric intensive care unit nurses in this multicenter Canadian study perceive wide variability in intensivist thresholds for approaching a family to suggest withdrawal/limitation of life-sustaining therapy.


Epigenetic switch controls social actions.
Mutations in epigenetic factors are associated with autism spectrum disorder (ASD). In this issue of Neuron, Yan et al. (2022) show that the antagonism of ASH1L and PRC2 switches the equilibrium of histone methylation at the ephrin receptor A7 locus, causing decreased EphA7 expression, deficits in synaptic pruning, and ASD-like behaviors.


Androgen biosynthetic pathways in the human prostate.
It is well recognized that there are two androgens, namely testosterone (T) and dihydrotestosterone (DHT); T plays an important role in the testis and muscle, and DHT is crucial for the development, function and pathology of the prostate. It is generally thought that DHT is produced from the 5alpha-reduction of circulating T before being inactivated by 3alpha-hydroxysteroid dehydrogenase (3alpha-HSD) that converts DHT into 5alpha-androstane-3alpha,17beta-diol (3alpha-diol). However, the presence of various steroidogenic enzymes in the prostate as well as the availability at high levels of various steroid precursors such as dehydroepiandrosterone sulphate (DHEAS), dehydroepiandrosterone (DHEA) and 4-androstenedione (4-dione) strongly suggest the existence of additional pathways involved in the biosynthesis and metabolism of DHT. Because steroidogenesis could be different in different species, data from the literature obtained from various human, dog, rat and mouse prostate tissues, as well as primary cells and prostatic cancer cell lines, provide a somewhat confusing picture. In the present chapter, we review the data in order to provide a clearer picture of the pathways involved in DHT biosynthesis and metabolism in the human prostate.


Cardiac electrophysiologic effects of lidocaine and bupivacaine.
The cardiac electrophysiologic effects of bupivacaine (B) and lidocaine (L) were evaluated in an isolated rabbit Purkinje fiber-ventricular muscle model to determine the effects of a) progressively increasing and b) decreasing concentrations of B and L on transmembrane action potentials. Bupivacaine (3 and 5 micrograms/ml) significantly decreased diastolic resting potential, maximum rate of depolarization, and action potential amplitude. Lidocaine (10-20 micrograms/ml) also decreased maximum rate of depolarization and action potential amplitude, but the decreases were significantly different from those produced by B. High concentrations of B (30 micrograms/ml) and L (100 micrograms/ml) resulted in delayed conduction between Purkinje fibers and ventricular muscle cells and, ultimately, conduction blockade. The duration of conduction blockade was significantly longer with B than with L. The results of this study indicate that B produces electrophysiologic changes in cardiac tissue that may produce ventricular arrhythmias of a reentrant type.


25-hydroxyvitamin D levels in children of different ages and with varying degrees of Helicobacter pylori infection and immunological features.
Helicobacter pylori (HP) is a major cause of upper digestive tract diseases. However, the relationship between HP infection and 25-hydroxyvitamin D [25(OH)D] levels in children has not been fully elucidated. This study investigated the levels of 25(OH)D in children of different ages and with varying degrees of HP infection and immunological features as well as the correlations between 25(OH)D levels in children infected with HP and their ages and degrees of infection. Ninety-four children who underwent upper digestive endoscopy were divided into an HP-positive group without peptic ulcers (Group A), an HP-positive group with peptic ulcers (Group B) and an HP-negative control group (Group C). The serum levels of 25(OH)D and immunoglobulin and the percentages of lymphocyte subsets were determined. HP colonization, the degree of inflammation, and the degree of activity were further evaluated by HE staining and immunohistochemical staining in gastric mucosal biopsy. The 25(OH)D level of the HP-positive groups (50.93 ± 16.51 nmol/L) was significantly lower than that of the HP-negative group (62.89 ± 19.18 nmol/L). The 25(OH)D level of Group B (47.79 ± 14.79 nmol/L) was lower than that of Group A (51.53 ± 17.05 nmol/L) and was significantly lower than that of Group C (62.89 ± 19.18 nmol/L). The 25(OH)D level decreased with increasing age, and there was a significant difference between Group C subjects who were ≤5 years old and those who were aged 6-9 years and ≥10 years. The 25(OH)D level was negatively correlated with HP colonization (r = -0.411, P < 0.01) and the degree of inflammation (r = -0.456, P < 0.01). The percentages of lymphocyte subsets and immunoglobulin levels among Groups A, B and C were not significantly different. The 25(OH)D level was negatively correlated with HP colonization and the degree of inflammation. As the age of the children increased, the level of 25(OH)D decreased, and the susceptibility to HP infection increased.


Synthesis of celecoxib analogs that possess a N-hydroxypyrid-2(1H)one 5-lipoxygenase pharmacophore: biological evaluation as dual inhibitors of cyclooxygenases and 5-lipoxygenase with anti-inflammatory activity.
A hitherto unknown class of celecoxib analogs was designed for evaluation as dual inhibitors of the 5-lipoxygenase/cyclooxygenase-2 (5-LOX/COX-2) enzymes. These compounds possess a SO(2)Me (11a), or SO(2)NH(2) (11b) COX-2 pharmacophore at the para-position of the N(1)-phenyl ring in conjunction with a 5-LOX N-hydroxypyrid-2(1H)one iron-chelating moiety in place of the celecoxib C-5 tolyl group. The title compounds 11a-b are weak inhibitors of the COX-1 and COX-2 isozymes (IC(50)=7.5-13.2 microM range). In contrast, the SO(2)Me (11a, IC(50)=0.35 microM), and SO(2)NH(2) (11b, IC(50)=4.9 microM), compounds are potent inhibitors of the 5-LOX enzyme comparing favorably with the reference drug caffeic acid (5-LOX IC(50)=3.47 microM). The SO(2)Me (11a, ED(50)=66.9 mg/kg po), and SO(2)NH(2) (11b, ED(50)=99.8 mg/kg po) compounds exhibited excellent oral anti-inflammatory (AI) activities being more potent than the non-selective COX-1/COX-2 inhibitor drug aspirin (ED(50)=128.9 mg/kg po) and less potent than the selective COX-2 inhibitor celecoxib (ED(50)=10.8 mg/kg po). The N-hydroxypyridin-2(1H)one moiety constitutes a novel pharmacophore for the design of cyclic hydroxamic mimetics capable of chelating 5-LOX iron for exploitation in the design of 5-LOX inhibitory AI drugs.


Effects of Portulaca oleracea L. extract on lipid oxidation and color of pork meat during refrigerated storage.
The study explored the preservation effect of Portulaca oleracea L. extract (POE) on pork meat under refrigerated conditions for 9 days. POE was tested for antioxidant activity and antibacterial activity in vitro and the results showed that POE has strong antioxidant activity and has antibacterial activity against Pseudomonas aeruginosa, Bacillus subtilis and Bacillus cereus to some extent. Effect of POE in different levels (0.25%, 0.50% and 1.0%) on quality and shelflife of pork meat storage were evaluated. Results showed that the treatments of POE significantly inhibited microbial growth,delayed lipids oxidation, reduced values of thiobarbituric acid reactive substances (TBARS) and total volatile base‑nitrogen (TVB-N), increased superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and in a dose-dependent manner (P < .05). Concomitantly, 1.0%POE and 0.50%POE treatments had better appearance compared with control after 9 days storage. All results confirmed that POE could effectively maintain the quality of chilled pork compared to control.


Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi-center study.
This study assesses the concordance in migraine diagnosis between an online, self-administered, Computer-based, Diagnostic Engine (CDE) and semi-structured interview (SSI) by a headache specialist, both using International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Delay in accurate diagnosis is a major barrier to headache care. Accurate computer-based algorithms may help reduce the need for SSI-based encounters to arrive at correct ICHD-3 diagnosis. Between March 2018 and August 2019, adult participants were recruited from three academic headache centers and the community via advertising to our cross-sectional study. Participants completed two evaluations: phone interview conducted by headache specialists using the SSI and a web-based expert questionnaire and analytics, CDE. Participants were randomly assigned to either the SSI followed by the web-based questionnaire or the web-based questionnaire followed by the SSI. Participants completed protocols a few minutes apart. The concordance in migraine/probable migraine (M/PM) diagnosis between SSI and CDE was measured using Cohen's kappa statistics. The diagnostic accuracy of CDE was assessed using the SSI as reference standard. Of the 276 participants consented, 212 completed both SSI and CDE (study completion rate = 77%; median age = 32 years [interquartile range: 28-40], female:male ratio = 3:1). Concordance in M/PM diagnosis between SSI and CDE was: κ = 0.83 (95% confidence interval [CI]: 0.75-0.91). CDE diagnostic accuracy: sensitivity = 90.1% (118/131), 95% CI: 83.6%-94.6%; specificity = 95.8% (68/71), 95% CI: 88.1%-99.1%. Positive and negative predictive values = 97.0% (95% CI: 91.3%-99.0%) and 86.6% (95% CI: 79.3%-91.5%), respectively, using identified migraine prevalence of 60%. Assuming a general migraine population prevalence of 10%, positive and negative predictive values were 70.3% (95% CI: 43.9%-87.8%) and 98.9% (95% CI: 98.1%-99.3%), respectively. The SSI and CDE have excellent concordance in diagnosing M/PM. Positive CDE helps rule in M/PM, through high specificity and positive likelihood ratio. A negative CDE helps rule out M/PM through high sensitivity and low negative likelihood ratio. CDE that mimics SSI logic is a valid tool for migraine diagnosis.