Budd-chiari syndrome after taking oral contraceptives. A case report and review of 14 reported cases.
A case of Budd-Chiari syndrome in a young woman taking oral contraceptives is described. Her main complaints were abdominal pain and ascites without hepatosplenomegaly and the subsequent development of shock. Diagnosis was established by selective hepatic arteriogram and vena cavagram. She was treated with supportive measures, anticoagulants and neomycin. At the time of this report, the patient is slowly convalescing, taking coumadin, diuretics and Aldactone, as well as supplementary vitamins. Reviewed are 14 cases of Budd-Chiari syndrome occurring while patients were taking oral contraceptives.


Preferential processing of self-relevant stimuli occurs mainly at the perceptual and conscious stages of information processing.
Self-related stimuli, such as one's own name or face, are processed faster and more accurately than other types of stimuli. However, what remains unknown is at which stage of the information processing hierarchy this preferential processing occurs. Our first aim was to determine whether preferential self-processing involves mainly perceptual stages or also post-perceptual stages. We found that self-related priming was stronger than other-related priming only because of perceptual prime-target congruency. Our second aim was to dissociate the role of conscious and unconscious factors in preferential self-processing. To this end, we compared the "self" and "other" conditions in trials where primes were masked or unmasked. In two separate experiments, we found that self-related priming was stronger than other-related priming but only in the unmasked trials. Together, our results suggest that preferential access to the self-concept occurs mainly at the perceptual and conscious stages of the stimulus processing hierarchy.


Eczema phenotypes are associated with multiple vitamin D pathway genes in Chinese children.
Vitamin D is increasingly recognized to play crucial roles in cutaneous immunity, and vitamin D treatment improved eczema control in small clinical trials. Several vitamin D-related genes were associated with asthma, but there are no data for eczema. Twenty-three single-nucleotide polymorphisms (SNPs) of five vitamin D-related genes (CYP27A1, CYP2R1, CYP27B1, GC and VDR) were genotyped in 1442 Chinese children with eczema and 1231 non-allergic controls. SNPs that followed Hardy-Weinberg equilibrium and yielded ≥ 95% genotyping call-rate were included. Haplotypic associations and SNP-SNP interactions for eczema diagnosis and subphenotypes were analysed. Atopic eczema was associated with rs4674343 of CYP27A1 (odds ratio 0.66, 95% confidence interval 0.53-0.83, P = 0.0004). Increased eosinophil percentage was associated with CYP2R1 rs2060793A (P = 0.001) and rs1933064A (P = 0.001). Two CYP2R1 haplotypes increased eczema risk whereas one VDR haplotype lowered eczema risk. GC rs7041 and CYP2R1 rs7935792 interacted to modulate total IgE (cross-validation consistency 10/10, P = 0.047). Specifically, high-risk eczema patients had higher log-transformed total IgE than low-risk patients (2.76 ± 0.76 vs 2.60 ± 0.80, P = 0.002). A vitamin D-related SNP rs4674343 on CYP27A1 was found to be protective against atopic eczema. CYP2R1 and VDR haplotypes altered eczema susceptibility and eosinophil percentage, and GC and CYP2R1 interacted to determine total IgE among eczema patients.


Nitinol stents loaded with a high dose of antitumor 5-fluorouracil or paclitaxel: esophageal tissue responses in a porcine model.
A poor prognosis associated with esophageal cancer leads to surgical resection not suitable for most patients. Nitinol stents loaded with 50% 5-fluorouracil (5-FU) or paclitaxel (PTX), functioning both as a stent and local chemotherapy, could provide a new therapy modality for these patients. To investigate esophageal tissue responses to nitinol stents loaded with 50% 5-FU or PTX implanted in the esophagus of healthy pigs. Twenty-three healthy Bama mini-pigs were randomly divided into 4 groups for stent implantation: group A (PTX stent, n = 13), group B (5-FU stent, n = 8), group C (blank film-covered stent, n = 1), and group D (bare stent, n = 1). Tissue responses were observed by endoscopy or pathologic analyses, and 5-FU or PTX concentrations were measured in the esophagus at the stent implantation site at different time points. Animal laboratory. Endoscopic placement of esophagus stent. Endoscopic examination, histology, and drug concentration analysis. In general, the esophageal tissue responses varied according to different parts of 5-FU or PTX stent (middle part [drug-containing part] and bare ends [drug-free part]). Severe tissue responses at the bare ends of the stent included inflammation, ulceration, and granulation. However, the tissue responses were greatly reduced in the middle part of the stent. The drug concentrations in the esophagus that had contact with the 5-FU stent or PTX stent were very high, especially for the first period after implantation, which did not cause obvious tissue damage. Some subjects had incomplete follow-up because of unexpected deaths and stent migration. The nitinol stents loaded with 50% 5-FU or PTX did not cause severe esophageal tissue responses, although there was a large concentration of the drug in these tissues.


Serum biomarkers of colorectal cancer with AU and NP20 chips including a diagnosis model.
Colorectal cancer, including colon cancer and rectal cancer, is often diagnosed at an intermediate or late stage with poor prognosis. Hence, there is an urgent need for new biomarkers for the early detection of colorectal cancer. Proteomics in combination with other techniques is rapidly being developed as a potential route in tumor diagnosis. A case-control study was performed on serum proteomics of colorectal cancer in the Chinese population using magnetic beads associated with surface enhanced laser desorption/ionization time-of-flight mass spectrometry with gold chips and normal phase 20 chips. By serum protein profiling, peak intensities between colorectal cancer and normal controls were compared, as well as the different clinical stages of colorectal, colon or rectal cancer. Experiments with NP20 and AU chips showed two protein peaks, m/z=13732-4 and m/z=13912-3, which could discriminate colorectal samples from normal controls. Early- and late-stage colorectal cancer could also be easily distinguished, though the distinction between colon cancer and rectal cancer was less clear. These results suggest that the use of magnetic beads combined with a surface enhanced laser desorption/ionization protein chip is a promising route for the diagnosis of early colorectal cancer.


Cardiovascular reactions to myelography with watersoluble contrast media.
Arterial blood pressure and heart rate were recorded for 5 to 7 h during myelography with iothalamate meglumine and metrizamide in 23 rabbits. After 0.6 ml iothalamate meglumine containing 280 mg I/ml a significant decrease in blood pressure and signs of circulatory failure were found. After identical doses of metrizamide and after reduction of the dose of iothalamate meglumine to 0.4 ml containing 140 mg I/ml no significant fall in blood pressure was recorded. A decrease of blood pressure was always accompanied by a decrease of heart rate. Arterial blood pressure and heart rate during experimental myelography are suggested as useful variables in the evaluation and comparison of new contrast media for myelography.


Ultrastructural localization of peanut lectin binding to extravascular white blood cells in the bone marrow of embryonic chicks.
Labelling by the galactose-specific lectin peanut agglutinin was studied in bone marrow of the embryonic chick at the electron-microscopic level by use of both a gold-conjugated lectin and an indirect, ferritin-conjugated, biotinylated lectin. Cell surface labelling is exclusively restricted to developing and mature heterophilic granulocytes, monocyte/macrophages, mast cells/basophils, all of which appear to develop and reside in the extravascular spaces of the bone marrow. Resident small lymphocytes, which comprise a minor portion of the cell population, are also labelled. Erythroid cells and thrombocytic cells, which develop inside venous sinusoidal vessels, display no labelling. The latter cells, like extravascular leukocytes, contain surface galactosyl residues located in subterminal positions on cell surfaces, since they are labelled by the galactose-specific Ricinus communis agglutinin-I. It is postulated that terminal galactosyl residues might be involved in interactions between the surfaces of extravascular leukocytes and extracellular matrix and/or stromal cell surfaces.


Specific Guanosines in the HIV-2 Leader RNA are Essential for Efficient Viral Genome Packaging.
HIV-2, a human pathogen that causes acquired immunodeficiency syndrome, is distinct from the more prevalent HIV-1 in several features including its evolutionary history and certain aspects of viral replication. Like other retroviruses, HIV-2 packages two copies of full-length viral RNA during virus assembly and efficient genome encapsidation is mediated by the viral protein Gag. We sought to define cis-acting elements in the HIV-2 genome that are important for the encapsidation of full-length RNA into viral particles. Based on previous studies of murine leukemia virus and HIV-1, we hypothesized that unpaired guanosines in the 5' untranslated region (UTR) play an important role in Gag:RNA interactions leading to genome packaging. To test our hypothesis, we targeted 18 guanosines located in 9 sites within the HIV-2 5' UTR and performed substitution analyses. We found that mutating as few as three guanosines significantly reduce RNA packaging efficiency. However, not all guanosines examined have the same effect; instead, a hierarchical order exists wherein a primary site, a secondary site, and three tertiary sites are identified. Additionally, there are functional overlaps in these sites and mutations of more than one site can act synergistically to cause genome packaging defects. These studies demonstrate the importance of specific guanosines in HIV-2 5'UTR in mediating genome packaging. Our results also demonstrate an interchangeable and hierarchical nature of guanosine-containing sites, which was not previously established, thereby revealing key insights into the replication mechanisms of HIV-2.


Transcriptomic analysis reveals process of autolysis of Kluyveromyces marxianus in vacuum negative pressure and the higher temperature.
Kluyveromyces marxianus is expected to be used in the production of yeast extracts due to its good fermentation ability and nutritional properties. Yeast autolysis is a key process to produce yeast extract and vacuum negative pressure stress can be used as an effective way to assist autolysis. However, the molecular mechanism of initiating Kluyveromyces marxianus autolysis induced by vacuum negative pressure and the higher temperature is still unclear. In this study, RNA-seq technology was performed mainly to analyze autolytic processes in Kluyveromyces marxianus strains. Considerable differentially expressed genes (DEGs) of downregulation were significantly enriched in 7 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways related to synthesis and transport of RNA and ribosome, which indicated that abnormal protein translations had already occurred in autolytic process. Interestingly, due to obvious change of related DEGs, endoplasmic reticulum-associated degradation (ERAD) and autophagy were activated and cell wall integrity pathway was hindered. Under the continuous influence of the external stress environment, the long-term changes of the above pathways triggered a vicious circle of gradual damage to yeast cells, which is the main cause of yeast autolysis. These results may provide important clues for the in-depth interpretation of the yeast autolytic mechanism.


SWI phase asymmetries in deep gray matter of healthy adults: is there an association with handedness?
To explore the handedness effects on phase asymmetries in deep gray matter of healthy adults by using magnetic susceptibility-weighted imaging (SWI) phase. Thirty left-handed (16 men, 14 women; age range, 20 to 57 years) and 30 age- and sex-matched right-handed (16 men, 14 women; age range, 20 to 58 years) healthy adults were examined at 3.0 T MRI. For each subject, phase values were detected in bilateral frontal white matters (FWM), caudate nucleus (CA), putamen (PU), globus pallidus (GP), thalamus (TH), red nucleus (RN) and substantia nigra (SN) on phase images. Statistical analysis was performed with paired-samples t-test and independent-samples t-test. In both handedness groups, the corrected phase values in the left hemisphere were significantly lower than those in the right one in FWM, CA, PU, GP (P < 0.05) and there was no significant hemispheric asymmetry in TH, RN and SN (P > 0.05). Differences in corrected phase values in corresponding brain regions of the same hemisphere between left-handed and right-handed groups were not statistically significant (P > 0.05). Hemispheric asymmetry of SWI phase in deep gray matter may not associate with handedness in adult brain.


Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures.
The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients. To examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic. We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy. Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitizing their hands upon entering the clinic. The TDF domains 'memory, attention, and decision processes' and 'emotions' significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators. Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.


Immune-complex alveolitis in the rat: evidence for platelet activating factor and leukotrienes as mediators of the vascular lesions.
In the present study we investigated the involvement of lipid mediators in an experimental model of immune-complex alveolitis induced in rat lungs by intrabronchial instillation of rabbit antibodies to ovalbumin followed by i.v. injection of the antigen. It was found that the reaction did not induce detectable oedema, as measured by the dry:wet weight ratio. A marked influx of neutrophils was observed in the bronchoalveolar lavage fluid, progressing from 6 to 24 h in parallel with the development of haemorrhagic lesions in lung parenchyma. The intensity of these lesions, evaluated by the concentration of extravascular haemoglobin, was not significantly affected by pretreatment of the animals with a cyclo-oxygenase inhibitor (indomethacin), a thromboxane inhibitor (econazole) or a thromboxane antagonist (L-655,240). However, the antagonists of platelet activating factor (PAF), WEB-2086 and BN-52021, and the lipoxygenase inhibitors, nor-dihydroguaiaretic acid and L-663,536, all significantly inhibited the haemorrhagic lesions. A peptide leukotriene antagonist (L-660,711) had no effect. Furthermore, the PAF antagonists inhibited the levels of LTB4, but not of PGE2 and thromboxane, released into the bronchoalveolar space 1 h after induction of the reaction. These results suggest that the haemorrhagic lesions in this model of immune-complex alveolitis are mediated by PAF and leukotrienes, possibly LTB4.


A new species of the genus Anthaxia (Anthaxia) (Coleoptera: Buprestidae) from Republic of South Africa.
Anthaxia (Anthaxia) kamieserrima sp. nov., a new endemic species from Republic of South Africa is described. New synonymy of Anthaxia (Anthaxia) aterrima Kerremams, 1903 (= Anthaxia (Anthaxia) braunsi Obenberger, 1922 syn. nov.) is proposed. Lectotypes and paralectotypes of A. aterrima and A. braunsi are designated.


Human servo responses to load disturbances in fatigued muscle.
Short and long latency EMG responses to muscle stretch and shortening were investigated in the triceps brachii muscle of 16 human subjects during a fatiguing isometric contraction. Increased amplitude reflex responses to stretch, and accentuated reductions in EMG in response to shortening, were evident as fatigue progressed in the majority of subjects. These changes indicate internal compensatory adjustments in the nervous system offsetting the deleterious mechanical effects of muscular fatigue.


[The analysis of a mobile mental health outreach team activity: from psychiatric emergencies on the street to practice of hospitalization at home for homeless people].
Since their creation in 2005 in France, mobile mental health outreach teams (EMPP) have been working to improve the health of the homeless who, for 30 to 50% of them, present severe mental disorders. Their missions are defined by ministerial circular's specifications. Few studies have been undertaken in France to analyze the practices of these teams' professionals, nor the characteristics of the populations with whom they are involved. The EMPP described in this paper had in 2010 a greater staff than other French EMPPs. It has 15 full-time staff, including four doctors (two psychiatrists, one GP, one house physician), two nurses, two educators, one social worker, three peer-workers, one secretary and two coordinators. The article analyzes the way of support developed within the range of EMPP's missions defined by the ministerial circular. Descriptive statistical analysis was carried out using standardized data from four different sources (round sheet, record of activity, record of hospitalization, housing information, interviews conducted by medical and social professionals with patients). Another source of data consists of records describing the operation of the team (reference framework) and annual activities (annual report). The method of care was developed based on a street working, involving a full medical and its relationship with the hospital and a place to live in a semi-community context. The Mobile Mental Health Outreach team documented 318 rounds in 2010, describing 666 contacts among whom 87.9% were followed regularly thereafter. It focuses to a target population. The team actively followed 198 people including 161 for whom a psychiatric diagnosis was done: 48.5% of the patients followed presented schizophrenic-type disorders, 21.8% bipolar disorders and other mood-linked problems, 13% behavioral disorders and 6.2% substance-use disorders. A percentage of 44.9 presented with a physical disease. Among the 89 hospitalizations, 86.5% were motivated by psychiatric disorders and 43% were forced. In about one third of the cases, hospitalizations were motivated by a double indication - psychiatric and physical - and in 13.5% for only a physical indication. Thirty people of the actively followed people had stayed in a halfway house as an alternative to hospitalization, restoring a continuity of care and allowing to resolve social problems that had until then been hopeless. The strategies developed by this Mobile Health Outreach Team ensure local community medical, psychiatric and social care for "hard to reach" people. The results confirm the interest of the link between the street work, the hospital and the halfway home, both as a living facility and an alternative to hospitalization. They suggest the importance of a critical minimum size for these EMPP that allows them a street work with doctors providing guidance. The presence of a GP is another welcome development because of the severity and the entanglement of somatic and psychiatric problems of these populations.


Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa.
Paucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa. This cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140 mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension. Of the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p<0.0001), excessive alcohol intake (p = 0.005) and consumption of western-type diet (p<0.0001) were positively associated with uncontrolled hypertension. In multivariate logistic regression (LR method) analysis, unemployed status (p<0.0001), excessive alcohol intake (p = 0.007) and consumption of western-type diet (p<0.0001) were independently and significantly associated with uncontrolled hypertension. There is significant association between increasing number and classes of anti-hypertensive drugs and uncontrolled hypertension (p = 0.05 and 0.02, respectively). Prevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and T2DM in the study population. Male sex, aging, clinic inertia, unemployed status and nutritional transitions are the most important determinants of uncontrolled hypertension in T2DM in Mthatha, South Africa. Treatment to blood pressure targets, though feasible in our setting, would require concerted efforts by addressing these determinants and clinic inertia.


Molecular mechanism of titanium dioxide nanoparticles-induced oxidative injury in the brain of mice.
Numerous studies have demonstrated that the brain is one of the target organs in acute or chronic titanium dioxide (TiO2) nanoparticles (NPs) toxicity, and oxidative stress plays an important role in this process. However, whether brain oxidative injury responds to TiO2 NPs by activating the P38-nuclear factor-E2-related factor-2 (Nrf-2) pathway is not fully understood. The present study aimed to examine activation of the P38-Nrf-2 signaling pathway associated with oxidative stress in the mouse brain induced by intranasal administration of TiO2 NPs for 90 consecutive days. Our findings indicate that TiO2 NPs caused overproliferation of spongiocytes and hemorrhage in the mouse brain. Furthermore, TiO2 NPs significantly activated p38, c-Jun N-terminal kinase, nuclear factor kappa B, Nrf-2 and heme oxygenase-1 expression in the brain, which in turn, led to increased production of reactive oxygen species, as well as lipid, protein and DNA peroxidation. These findings suggest that TiO2 NPs-induced oxidative damage in the mouse brain may occur via the p38-Nrf-2 signaling pathway. Therefore, application of TiO2 NPs in the environment should be performed with caution.


Improving the quality of radiation oncology: 10years' experience of QUATRO audits in the IAEA Europe Region.
The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. The 31 QUATRO reports collected over 10years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations). Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation protection were frequently commended by QUATRO. This analysis points to barriers to quality care such as insufficient staffing, education/training, equipment and lack of quality management. It highlights the correlation between the human resources availability and quality of care. It has also identified common action items for enhancing quality of radiotherapy programmes in the Region.


Longitudinal treatment of a severely atrophic mandible: a clinical report.
This clinical report presents the treatment of a patient with a severely atrophic mandible. The report details the clinical successes and failures over nearly a 20-year period. Clinical and surgical procedures are presented in a longitudinal fashion, as well as the rationale at the time to support each procedure.


Spontaneous third ventriculostomy.
Spontaneous ventriculostomy (SV) is a rare condition where there is a spontaneous communication between the ventricle and the subarachnoid space as a result of hydrocephalus. Only four cases of SV through the floor of the third ventricle have been previously reported. Two further cases are presented and the literature reviewed.


Tuning of macrophage responses by Stat3-inducing cytokines: molecular mechanisms and consequences in infection.
A successful response to pathogen challenge requires that a balance is achieved between the induction of efficient anti-microbial effector mechanisms and the avoidance of detrimental tissue damage. While the Toll-like receptor (TLR) system is innate immunity's sensor of infectious danger, macrophages receive activating as well as inhibitory signals via the Jak-Stat pathway. IFNgamma is key to the control of infection particularly with intracellular pathogens and depends on functional Stat1 signal transduction. Stat3 signalling is activated by a range of cytokines, including IL-10, IL-6 and IL-27. Here, recent progress in understanding the regulation of macrophage function in inflammation and infection by Stat3-activating cytokines is reviewed. The use of targeted mouse mutants of these cytokines, their receptors or signalling components, revealed the importance of the Stat3 axis in the control of infection and immunopathology. Genome-wide transcriptome analyses of macrophages under the influence of these cytokines have contributed to advances in defining the molecular mechanisms of macrophage activation and deactivation. Functional characterization of Stat3-target genes should now identify the molecular mediators of impaired pathogen control and tissue protection.


The Impact of Donor and Recipient Renal Dysfunction on Cardiac Allograft Survival: Insights Into Reno-Cardiac Interactions.
Renal dysfunction (RD) is a potent risk factor for death in patients with cardiovascular disease. This relationship may be causal; experimentally induced RD produces findings such as myocardial necrosis and apoptosis in animals. Cardiac transplantation provides an opportunity to investigate this hypothesis in humans. Cardiac transplantations from the United Network for Organ Sharing registry were studied (n = 23,056). RD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m(2). RD was present in 17.9% of donors and 39.4% of recipients. Unlike multiple donor characteristics, such as older age, hypertension, or diabetes, donor RD was not associated with recipient death or retransplantation (age-adjusted hazard ratio [HR] = 1.00, 95% confidence interval [CI] 0.94-1.07, P = .92). Moreover, in recipients with RD the highest risk for death or retransplantation occurred immediately posttransplant (0-30 day HR = 1.8, 95% CI 1.54-2.02, P < .001) with subsequent attenuation of the risk over time (30-365 day HR = 0.92, 95% CI 0.77-1.09, P = .33). The risk for adverse recipient outcomes associated with RD does not appear to be transferrable from donor to recipient via the cardiac allograft, and the risk associated with recipient RD is greatest immediately following transplant. These observations suggest that the risk for adverse outcomes associated with RD is likely primarily driven by nonmyocardial factors.


Variation in hysterectomy prevalence and trends among U.S. States and Territories-Behavioral Risk Factor Surveillance System, 2012-2020.
We estimated up-to-date state- and territory-level hysterectomy prevalence and trends, which can help correct the population at risk denominator and calculate more accurate uterine and cervical cancer rates. We analyzed self-reported data for a population-based sample of 1,267,013 U.S. women aged ≥ 18 years who participated in the Behavioral Risk Factor Surveillance System surveys from 2012 to 2020. Estimates were age-standardized and stratified by sociodemographic characteristics and geography. Trends were assessed by testing for any differences in hysterectomy prevalence across years. Hysterectomy prevalence was highest among women aged 70-79 years (46.7%) and ≥ 80 years (48.8%). Prevalence was also higher among women who were non-Hispanic (NH) Black (21.3%), NH American Indian and Alaska Native (21.1%), and from the South (21.1%). Hysterectomy prevalence declined by 1.9 percentage points from 18.9% in 2012 to 17.0% in 2020. Approximately one in five U.S. women overall and half of U.S. women aged ≥ 70 years reported undergoing a hysterectomy. Our findings reveal large variations in hysterectomy prevalence within and between each of the four census regions and by race and other sociodemographic characteristics, underscoring the importance of adjusting epidemiologic measures of uterine and cervical cancers for hysterectomy status.


Edge effects on growth and biomass partitioning of an Amazonian understory herb (Heliconia acuminata; Heliconiaceae).
After deforestation, environmental changes in the remaining forest fragments are often most intense near the forest edge, but few studies have evaluated plant growth or plasticity of plant growth in response to edge effects. In a 2-year common garden experiment, we compared biomass allocation and growth of Heliconia acuminata with identical genotypes grown in 50 × 35 m common gardens on a 25-year-old edge and in a forest interior site. Genetically identical plants transplanted to the forest edge and understory exhibited different patterns of growth and biomass allocation. However, individuals with identical genotypes in the same garden often had very different responses. Plants on forest edges also had higher growth rates and increased biomass at the end of the experiment, almost certainly due to the increased light on the forest edge. With over 70000 km of forest edge created annually in the Brazilian Amazon, phenotypic plasticity may play an important role in mediating plant responses to these novel environmental conditions.


S616-p-DRP1 associates with locally invasive behavior of follicular cell-derived thyroid carcinoma.
Dynamin-related protein 1 (DRP1), a mitochondrial fission protein, and its active form phosphorylated at Serine 616 (S616-p-DRP1) have been increasingly associated with tumorigenesis and invasion in various tumor models, including oncocytic thyroid cancer (TC). In this study, the expression of DRP1 and S616-p-DRP1 and its relationship with patients' clinicopathological characteristics, tumor genetic profiles, and clinical outcomes were assessed in a large series of follicular cell-derived TC (FCDTC). Retrospective biomarker study characterizing the clinicopathological and immunochemistry DRP1 and S616-p-DRP1 expression of a series of 259 patients with FCDTC followed in two University Hospitals. DRP1 expression was positive in 65.3% (169/259) of the cases, while the expression of the S616-p-DRP1 was positive in only 17.3% (17/98). DRP1-positive expression was significantly associated with differentiated tumors (67.7 vs. 48.0%; P = 0.049), non-encapsulated tumors (73.8 vs. 57.4%; P = 0.011) and thyroid capsule invasion (73.4 vs. 57.5%; P = 0.013). S616-p-DRP1-positive expression was significantly associated with tumor infiltrative margins (88.9 vs. 11.1%; P = 0.033), thyroid capsule invasion (29.8 vs. 3.1%; P = 0.043), lymph node metastases (23.3 vs. 8.1%; P = 0.012), and higher mean cumulative radioiodine dosage (317.4 ± 265.0 mCi vs. 202.5 ± 217.7 mCi; P = 0.038). S616-p-DRP1 expression was negatively associated with oncocytic phenotype (0.0 vs. 26.2%; P = 0.028). S616-p-DRP1 is a better candidate than DRP1 to identify tumors with locally invasive behavior. Prospective studies should be pursued to assess S616-p-DRP1 role as a molecular marker of malignancy in TC and in patients' risk assessment.


Experiences of eating difficulties in siblings of people with anorexia nervosa: a reflexive thematic analysis.
Siblings of people with anorexia nervosa (AN) have been found to experience strong emotions, changing family roles and poorer wellbeing as a consequence of experiencing the effects of the illness on their sibling and family system. These factors, combined with genetic influences, may put siblings at an increased risk of developing eating disorder psychopathology in addition to other mental health issues. This research aims to explore the experiences of siblings of people with AN who have had eating difficulties themselves and investigate issues that may be important to the development and prevention of eating difficulties in this population. This qualitative study used a reflexive thematic analysis approach. Ten adults who had witnessed a sibling with AN and experienced eating difficulties themselves participated in semi-structured interviews. Participants' own eating difficulties were affected by the specific experience of witnessing a sibling with AN through mealtimes becoming emotionally charged, an increased focus on body size and diet, and comparisons with their sibling. Difficult experiences, such as marital discord amongst parents were common, as was a difficulty in managing emotions. The onset of AN within the family caused participants to take on caring responsibilities for their sibling and to hide their own difficulties for fear of adding additional burden to their parents. This reduced their perceived ability to access support and for some increased a desire to restrict as a coping mechanism for the stress they were experiencing. Systemic beliefs regarding the value of thinness were prevalent and influential. Protective factors, such as not wanting to become as unwell as a sibling with AN and an understanding of the negative consequences of AN, aided recovery. Eating difficulties in siblings of people with AN may be influenced by competition for slimness, increased focus on diet and body size, and a need to manage difficult emotions. The disruption to social connections and a difficulty finding emotional support that may be experienced by people when a sibling develops AN may further influence susceptibility to eating difficulties. Further research is needed into the best ways to support siblings of people with AN.


Specific electrical capacitance and voltage breakdown as a function of temperature for different planar lipid bilayers.
The breakdown voltage and specific electrical capacitance of planar lipid bilayers formed from lipids isolated from the membrane of archaeon Aeropyrum pernix K1 as a function of temperature were studied and compared with data obtained previously in MD simulation studies. Temperature dependence of breakdown voltage and specific electrical capacitance was measured also for dipalmitoylphosphatidylcholine (DPPC) bilayers and bilayers formed from mixture of diphytanoylphosphocholine (DPhPC) and DPPC in ratio 80:20. The breakdown voltage of archaeal lipids planar lipid bilayers is more or less constant until 50°C, while at higher temperatures a considerable drop is observed, which is in line with the results from MD simulations. The breakdown voltage of DPPC planar lipid bilayer at melting temperature is considerably higher than in the gel phase. Specific electrical capacitance of planar lipid bilayers formed from archaeal lipids is approximately constant for temperatures up to 40°C and then gradually decreases. The difference with MD simulation predictions is discussed. Specific electrical capacitance of DPPC planar lipid bilayers in fluid phase is 1.75 times larger than that of the gel phase and it follows intermediated phases before phase transition. Increase in specific electrical capacitance while approaching melting point of DPPC is visible also for DPhPC:DPPC mixture.


VGF, Which Is Induced Transcriptionally in Stroke Brain, Enhances Neurite Extension and Confers Protection Against Ischemia In Vitro.
Ischemic stroke is a devastating neural event as currently no therapies other than physical rehabilitation are available to enhance recovery after stroke. To identify endogenous mediators to repair stroke brain, we performed the expression profiling analysis of transcripts in the mouse photothrombotic stroke brain. Based on real-time PCR analysis, we found VGF, identified as a nerve growth factor (NGF)-regulated transcript, was induced transcriptionally in stroke brain at 1-7 days after insult. The immunoreactivites of VGF were observed in the neurons around the ischemic core of stroke brain. Experiments with various inhibitors and plasmid transfections indicated that cAMP response element binding protein-mediated complex signaling pathways are possibly implicated in the NGF-mediated VGF expressions in vitro. Furthermore, the over-expression of VGF promoted neurite extensions and conferred protections from ischemic stress in vitro. These findings raise the possibility the application of VGF could be one of the promising therapeutic strategies to enhance recovery after stroke.


Bloodstream infection related to catheter connections: a prospective trial of two connection systems.
Bloodstream infections (BSIs) related to central venous catheters (CVCs) and arterial catheters (ACs) are an increasing problem in the management of critically ill patients. Our objective was to assess the efficacy of a needle-free valve connection system (SmartSite), Alaris Medical Systems, San Diego, CA, USA) in the prevention of catheter-related bloodstream infection (CR-BSI). Patients admitted to an intensive care unit were prospectively assigned to have a CVC and AC connected with either a needle-free valve connection system (NFVCS) or a three-way stopcock connection (3WSC). The characteristics of the patients were similar in the two groups. Before manipulation, the NFVCS was disinfected with chlorhexidine digluconate 0.5% alcoholic solution. The 3WSC was not disinfected between use but it was covered with a protection cap. A total of 799 patients requiring the insertion of a multilumen CVC or AC for >48h from 1 April 2002 to 31 December 2003 were included. CR-BSI rates were 4.61 per 1000 days of catheter use in the disinfected NFVCS group and 4.11 per 1000 days of catheter use in the 3WSC group (P=0.59). When CVC-BSIs and AC-BSIs were analysed separately, the rate of CVC-BSI was 4.26 per 1000 days of catheter use in the NFVCS group, compared with 5.27 in the 3WSC group (P=0.4). The incidence rate of AC-BSI was 5.00 per 1000 days of catheter use in the NFVCS group, compared with 2.83 in the 3WSC group (P=0.08). The use of NFVCS does not reduce the incidence of catheter-related bacteraemia. The arterial catheter (AC) is a significant source of infection in critically ill patients.


[Astigmatism correction by femtosecond laser].
Through the creation of astigmatic keratotomies, femtosecond laser can correct congenital or post-surgical astigmatism. We have been using an optimized treatment nomogram, which offers superior and more predictable results than manual incisional techniques. Femtosecond arcuate incisions allow a reduction of over 50% of the preoperative astigmatism. Nonetheless, the efficacy can likely be improved further by refining these nomograms specific to the femtosecond laser.


Flavin-dependent alcohol oxidase from the yeast Pichia pinus. Spatial localization of the coenzyme FAD in the protein structure: hot-tritium bombardment and ESR experiments.
The spatial localization of the coenzyme FAD in the quaternary structure of the alcohol oxidase from the yeast Pichia pinus was studied by tritium planigraphy and ESR methods. In the present paper we measured the specific radioactivity of FAD labelled as a part of the alcohol oxidase complex. The specific-radioactivity ratio for two FAD portions (FMN and AMP) was calculated. ESR experiments show 4 A (0.4 nm) to be the depth of immersion of paramagnetic isoalloxazines into alcohol oxidase octamer molecules. It is suggested that FAD molecules are bound to the surface of the octamer, rather than to the subunit interfaces. The orientation of the prosthetic group FAD in the alcohol oxidase protein is discussed.


Exclusion of exogenous 5-methyl-2'-deoxycytidine from DNA in human leukemic cells. A study with [2(-14)C]- and [methyl-14C]5-methyl-2'-deoxycytidine.
Modification of DNA-cytosine by a 5-methyl group is thought to be an important mechanism which regulates the expression of eukaryotic genes. This modification takes place after semiconservative replication. There is very little evidence, if any, that 5MeCyt could be naturally incorporated into mammalian DNA in semiconservative replication. We have clarified the possibility of incorporating 5MedCyd pharmacologically into human leukemic cells in vitro. To this end, we developed a novel small-scale synthesis method for 14C-labeled 5MedCyd starting from commercially available [14C]dThd derivatives. Particular attention was focused upon possible incorporation of radioactive 5MedCyd derivatives into the acid-soluble cellular fraction as well as into nucleic acids and protein in human cells. The results showed that [2(-14)C]- and [methyl-14C]5MedCyd were incorporated into human leukemic cells to a similar extent. The radioactivity originating from these compounds was incorporated mainly into the acid-soluble pool and nucleic acids. The exact nature of the intracellular radioactive molecules in RNA is not known, but the radioactive label in DNA hydrolyzate co-chromatographed exclusively with thymine. Hence, 5MedCyd is deaminated to thymidine before incorporating into DNA. This deamination had taken place already (partially) in the culture medium. Human leukemic cells do effectively protect their DNA from incorporation of exogenous 5MedCyd.


Response surface optimization of the removal of nickel from aqueous solution by cone biomass of Pinus sylvestris.
Response surface methodology was applied to optimize the removal efficiency of Ni(II). Pinus sylvestris ovulate cones were used in this study. A 2(3) full-factorial central composite design was employed for experimental design and analysis of the results. The initial Ni(II) concentration (10-30 mg/l), pH (2.5-6.5) and biomass concentration (5-25 g/l) were the critical components of the removal optimized. The optimum pH, m (biomass concentration) and C0 (initial Ni(II) concentration) were found to be 6.17, 18.8 g/l and 11.175 mg/l, respectively. Under these conditions, removal efficiency of Ni(II) was 99.91%.


Cost analysis of neonatal and pediatric parenteral nutrition in Europe: a multi-country study.
Parenteral nutrition (PN) is critical in neonatal and pediatric care for patients unable to tolerate enteral feeding. This study assessed the total costs of compounding PN therapy for neonates, infants and children. Face-to-face and telephone interviews were conducted in 12 hospitals across four European countries (Belgium, France, Germany and UK) to collect information on resources utilized to compound PN, including nutrients, staff time, equipment cost and supplies. A bottom-up cost model was constructed to assess total costs of PN therapy by assigning monetary values to the resource utilization using published list prices and interview data. A total of 49,922 PN bags per year were used to treat 4295 neonatal and pediatric patients among these hospitals. The daily total costs of one compounded PN bag for neonates in the 12 hospitals across the four countries equalled euro 55.16 (Belgium euro 53.26, France euro 46.23, Germany euro 64.05, UK Ł 37.43/\[euro]42.86). Overall, nutrients accounted for 25% of total costs, supplies 18%, wages 54% and equipment 3%. Average costs per bag for infants <2 year were euro 84.52 (euro 74.65 in Belgium, euro 83.84 in France, euro 92.70 in Germany and Ł 52.63/euro 60.26 in the UK), and for children 2-18 years euro 118.02 (euro 93.85 in Belgium, euro 121.35 in France, euro 124.54 in Germany and Ł 69.49/euro 79.56 in the UK), of which 63% is attributable to nutrients and 28% to wages. The data indicated that PN costs differ among countries and a major proportion was due to staff time (Ł 1=euro 1.144959).


Anuran accents: Continental-scale citizen science data reveal spatial and temporal patterns of call variability.
Many animals rely on vocal communication for mating advertisement, territorial displays, and warning calls. Advertisement calls are species-specific, serve as a premating isolation mechanism, and reinforce species boundaries. Nevertheless, there is a great deal of interspecific variability of advertisement calls. Quantifying the variability of calls among individuals within a species and across species is critical to understand call evolution and species boundaries, and may build a foundation for further research in animal communication. However, collecting a large volume of advertisement call recordings across a large geographic area has traditionally posed a logistical barrier. We used data from the continental-scale citizen science project FrogID to investigate the spatial and temporal patterns of call characteristics in six Australian frog species. We found intraspecific call variability in both call duration and peak frequency across species. Using resampling methods, we show that variability in call duration and peak frequency was related to the number of individuals recorded, the geographic area encompassed by those individuals, and the intra-annual time difference between those recordings. We conclude that in order to accurately understand frog advertisement call variation, or "anuran accents," the number of individuals in a sample must be numerous (N ≥ 20), encompass a large geographic area relative to a species' range, and be collected throughout a species' calling season.


Autonomic control of von Ebner's lingual salivary glands and implications for taste sensation.
To learn the nature of the autonomic control of the serous lingual salivary glands of von Ebner, parasympathetic and sympathetic agonists were injected into rats, and the extent of depletion of the secretory granules in gland acini was measured. Injection of the beta-adrenergic agonist isoproterenol caused a concentration-dependent reduction of the secretory granule content of the acinar cells. Injection of the beta-adrenergic antagonist propranolol, combined with isoproterenol, blocked the reduction in secretory granule content seen with isoproterenol alone. Injection of the parasympathetic agonist carbachol also produced a concentration-dependent reduction in granule content of the acini. This reduction was partially blocked by injection of atropine, and completely blocked by injection of atropine and propranolol. beta-Adrenergic and parasympathetic agonists alone did not cause total degranulation of the acini. However, this was achieved by injection of both agonists. It is concluded that protein secretion in von Ebner's glands is under both sympathetic and parasympathetic nervous control. It is hypothesized that the glands contain two sets of granules with different compositions, each under the control of either the parasympathetic or sympathetic nervous system. Because von Ebner's glands are closely associated with taste buds and because the glands supply the microenvironment of these taste buds the secretion of these glands may be very important in the mechanism of taste transduction.


Effect of urea-treatment on agonist binding affinity of the muscarinic acetylcholine receptor.
Urea-treatment of the microsome fraction of the heart of guinea-pigs caused selective reduction in the apparent affinity of an agonist (carbachol), but not an antagonist (atropine), to muscarinic acetylcholine receptors (mAChR), measured as inhibition of binding of 3H-quinuclidinyl benzilate (3H-QNB). This effect was similar to that of Gpp (NH)p. The effects of urea-treatment and Gpp (NH)p were not additive. On the other hand, treatment of the microsome fraction with 5,5'-dithiobis (2-nitrobenzoic acid) (DTNB) increased the apparent affinity of agonist, but not antagonist. The effect of DTNB predominated over those of urea-treatment and Gpp (NH)p, when these treatments were combined with DTNB.


A new Neotropical genus of Blastini (Psocodea: 'Psocoptera': Psocidae: Amphigerontiinae).
A monotypic genus of Psocidae (Amphigerontiinae: Blastini) from Santiago de Cali, Colombia, is here described and illustrated. It differs from Chaetopsocidus Badonnel, from the Páramo de Monserrate, near Bogotá, in having setae on the forewing veins.


U.S. medical students personal health behaviors, attitudes and perceived skills towards weight management counseling.
Physicians' abilities to address obesity in routine care may be affected by their own health behaviors, skills in and attitudes toward weight management counseling (WMC). Gender differences have been noted amongst these factors as well. We examined gender differences in personal health behaviors and predictors of perceived WMC skills and attitudes of medical students enrolled in a WMC trial. Enrollment took place in 2020 and consisted of students from eight U.S. medical schools. Baseline measures included demographics, exercise, and weight management behaviors, WMC attitudes and perceived skills. Descriptive statistics were calculated, and linear mixed models used to assess the effect of personal health behaviors on outcomes of WMC attitudes and perceived skills. Complete data were available for 1145 medical students. More males reported exercising 4 or more days/week (58.6% v. 41.4%), being more likely to monitor their weight (75.6% v. 70.3%) and less likely to intentionally attempt weight loss in the past (50.3% v. 65.3%) compared to females (all p's < 0.05). Exercising 4 or more days per week was positively associated with perceived WMC skills in the adjusted model (β = 0.10, CI 0.06 to 0.14, p < 0.01). Exercise frequency was positively associated with perceived WMC skills, regardless of gender. WMC curriculum may consider focusing on personal health behaviors such as exercise to increase perceived WMC skills.


Pharmacy practice research - A call to action.
Pharmacists have a societal duty of care. How to best provide that type of care requires scientific study. Pharmacy practice is a scientific discipline that studies the different aspects of the practice of pharmacy, and its impact on health care systems, medicine use, and patient care. Its scope has expanded globally to encompass clinical, behavioural, economic, and humanistic implications of the practice of pharmacy, as well as practice change and implementation in routine practice of innovations such as health interventions and patient-care services. The development, impact evaluation, implementation, and sustainability of health interventions and patient-care services represents a key research area for pharmacy practice. An approach for conducting these is provided. There is evidence that collaborative national and international research in this area is growing, showing an increased contribution to global health research. The role of universities and pharmacy professional associations in supporting the advancement of pharmacy through pharmacy practice research is also discussed. Finally, a call to action for pharmacy practice research, education, and practice is made.


Right hemisphere EEG sensitivity to speech.
Recent speech perception work with normals and aphasics suggests that the right hemisphere may be more adept than the left at making the voicing discrimination, and the reverse for place of articulation. We examined this right hemisphere voicing effect with natural speech stimuli: stop consonants in pre-, mid-, and postvocalic contexts. Using a neuroelectric event-related potential paradigm, we found numerous effects indicating bilateral components reflecting the voicing and place contrast and unique right hemisphere discrimination of both voicing and place of articulation.


Polycyclodextrins: Synthesis, functionalization, and applications.
Cyclodextrins (CDs) are cyclic oligosaccharides with unique conical structure enabling host-guest inclusion complexes. However, virgin CDs sufferfrom low solubility, lack of functional groups and its inability to strong complexation with the guests. One of the most efficient ways to improve the properties of cyclodextrins is the synthesis of polycyclodextrins. Generally, there are two types of polycyclodextrins: 1) polymers containing CD units as parts of the main backbone; and 2) polymers with CD units as side chains. These polycyclodextrins are produced (i) from direct copolymerization of virgin cyclodextrins or cyclodextrins derivatives with various monomers including isocyanates, epoxides, carboxylic acids, anhydrides, acrylates, acrylamides and fluorinated aromatic compounds, or (ii) by post-functionalization of other polymers with CDs or CD derivatives.. By selecting the proper derivatives of CDs and controlling the polymerization, polycyclodextrins with linear, hyperbranched, and crosslinked structures have been synthesized. Polycyclodextrins have found significant applications in numerous areas, as adsorbents for removal of organic pollutants, carriers in gene/drug delivery, and for preparation of supramolecular based hydrogels. The focus of this review paper is placed on the synthesis, characterization, and applications of CDs so as to highlight challenges as well as the promising features of the future ahead of material developments based on CDs.


Evaluation of house staff candidates for program fit: a cohort-based controlled study.
Medical school academic achievements do not necessarily predict house staff job performance. This study explores a selection mechanism that improves house staff-program fit that enhances the Accreditation Council for Graduate Medical Education Milestones performance ratings. Traditionally, house staff were selected primarily on medical school academic performance. To improve residency performance outcomes, the Program designed a theory-driven selection tool to assess house staff candidates on their personal values and goals fit with Program values and goals. It was hypothesized cohort performance ratings will improve because of the intervention. Prospective quasi-experimental cohort design with data from two house staff cohorts at a university-based categorical Internal Medicine Residency Program. The intervention cohort, comprising 45 house staff from 2016 to 2017, was selected using a Behaviorally Anchored Rating Scales (BARS) tool for program fit. The control cohort, comprising 44 house staff from the prior year, was selected using medical school academic achievement scores. House staff performance was evaluated using ACGME Milestones indicators. The mean scores for each category were compared between the intervention and control cohorts using Student's t-tests with Bonferroni correction and Cohen's d for effect size. The cohorts were no different in academic performance scores at time of Program entry. The intervention cohort outperformed the control cohort on all 6 dimensions of Milestones by end-PGY1 and 3 of 6 dimensions by mid-PGY3. Selecting house staff based on compatibility with Residency Program values and objectives may yield higher job performance because trainees benefit more from a better fit with the training program.


Ozone and carbon trioxide synthesis by low energy ion implantation onto solid carbon dioxide and implications to astrochemistry.
Ion implantation experiments were carried out on amorphous (30 K) and crystalline (80 K) solid CO2 using both reactive (D(+), H(+)) and non-reactive (He(+)) ions, simulating different irradiation environments on satellite and dust grain surfaces. Such ion irradiation synthesized several new species in the ice including ozone (O3), carbon trioxide (CO3), and carbon monoxide (CO) the main dissociation product of carbon dioxide. The yield of these products was found to be strongly dependent upon the ion used for irradiation and the sample temperature. Ion implantation changes the chemical composition of the ice with recorded infrared spectra clearly showing the coexistence of D3h and C2v isomers of CO3, for the first time, in ion irradiated CO2 ice.


[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior].
While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior. A cross-sectional study of 490 students from grade eight and nine from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, and soft drinks as well as weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS. Across all items, 15.3 to 37.5% of adolescents reported difficulties in acquiring and dealing with digital health information. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showed a limited digital HL. Adolescents with moderate and low digital HL reported higher levels of low physical activity and non-daily fruit and daily soft drink consumption. The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions. The school as a place of teaching and learning is a suitable setting because, among other things, of its fit with the mandatory strategy of media literacy education in schools.


Development and pilot study of "Smart Cancer Care": a platform for managing side effects of chemotherapy.
As outpatient chemotherapy treatment increases, cancer patients receiving chemotherapy spend more time at home. In addition, since the types of chemotherapy are gradually expanding, it will be essential to prepare patient self-management strategies for various chemotherapy-related side effects. This study aimed to develop a platform (called Smart Cancer Care) to implement a chemotherapy side effect management program and to evaluate its feasibility. Smart Cancer Care comprises an application for patients and a dashboard for medical staff. Thirty-two symptoms to be managed using Smart Cancer Care were summarized through a literature review and Delphi. Management guidelines were developed based on the severity of each symptom (3 stages), and installed in Smart Cancer Care according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 guidelines. To evaluate the feasibility of the developed application and medical dashboard, cancer patients and cancer treatment medical staff used Smart Cancer Care for 2 to 3 weeks and subsequently reported the experience of using them. The patient application provided a list of symptoms according to the cancer type and anticancer drug enabling presence and severity of each symptom to be evaluated. Patients received management guidelines for symptoms based on the symptom evaluation results. On the medical staff dashboard, administrators and authorized medical personnel could access and assess information regarding side effects and symptom severity submitted by the patient. The feasibility and usefulness of Smart Cancer Care were confirmed through a pilot test targeting 30 patients and 24 chemotherapy-related medical staff. For patients, the evaluation score for the "The program will be helpful when seeing medical staff" item was the highest. For medical staff, the score for the "By checking the patient's symptoms using the program, it helps to take appropriate measures for the patient" item was the highest. Although minor corrections were raised, most patients and medical staff expected that Smart Cancer Care would help their treatment. The configuration of the application and dashboard of Smart Cancer Care detailed in this study could be used for the development of a widely accepted platform to implement a chemotherapy side effect management program.


A simplified method to determine galactose elimination capacity in patients with liver disease.
Galactose elimination capacity (GEC) is one of the most widely used liver function tests. It is relatively simple but still involves a number of capillary blood samples and is therefore fairly expensive. In the current study we present a simplified formula, based on GEC investigations in 103 cirrhotic patients, with which it is possible to estimate the GEC with one or two blood samples. Using this formula: GEC = [7.422--corrected B-galactose60 min]/4.575, we could accurately predict GEC in 24 additional patients.


Putting Glioblastoma in Its Place: IRF3 Inhibits Invasion.
With an unsurpassed capacity for invasion into normal brain tissue, glioblastoma multiforme is the most lethal primary brain tumor. New research suggests that altering a subset of extracellular matrix factors, including interferon regulatory factor (IRF)3 and casein kinase (CK)2, may decrease the migratory potential of these aggressive tumors.


Current management of retinoblastoma.
The recommended management of retinoblastoma based on personal experience with the assessment and treatment of more than 450 children with this intraocular malignant lesion is presented. Although retinoblastoma is usually managed by enucleation, the treatment of each case must be individualized; in an increasing number of children, the techniques of irradiation, photocoagulation, or cryotherapy are being used. In some patients, a combination of these techniques is necessary. Chemotherapy is often used to prevent distant metastatic involvement, although its effectiveness as a prophylactic treatment has not been clearly established. Because metastatic retinoblastoma is often fatal, intense chemotherapy is recommended in this setting. The prognosis for vision and life in patients with retinoblastoma has improved considerably during the past century, primarily because of earlier recognition of the tumor and use of modern therapeutic methods. All children of parents with a family history of retinoblastoma should be examined by a qualified ophthalmologist immediately after birth in order to detect and treat this condition as early as possible.


Impact of New Bed Assignment Information System on Emergency Department Length of Stay: An Effect Evaluation for Lean Intervention by Using Interrupted Time Series and Propensity Score Matching Analysis.
A long waiting period for available beds in emergency departments (EDs) is the major obstacle to a smooth process flow in ED services. We developed a new bed assignment information system that incorporates current strategies and resources to ease the bottleneck in the service flow. The study's purpose was to evaluate the effect of the lean intervention plan. We included 54,541 ED patient visits in the preintervention phase and 52,874 ED patient visits in the postintervention phase. Segmented regression analysis (SRA) was used to estimate the level and trend in the preintervention and postintervention phases and changes in the level and trend after the intervention. After the intervention, the weekly length of stay (LOS) for patient visits, admitted patient visits, and nonadmitted patient visits decreased significantly by 0.75, 2.82, and 0.17 h, respectively. The trendline direction for overall patient visits and nonadmitted patient visits significantly changed after the intervention. However, no significant change was noted for admitted patient visits, although the postintervention trend visually differed from the preintervention trend. The concept of lean intervention can be applied to solve various problems encountered in the medical field, and the most common approach, SRA, can be used to evaluate the effect of intervention plans.


Impact of renal involvement on survival in ANCA-associated vasculitis.
Renal involvement is a serious complication of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We describe the pattern of renal involvement and its correlation with outcomes. Medical records of 92 patients seen in rheumatology clinic and diagnosed as AAV between January 2007 and June 2014 were analysed. Patients were classified as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA) and undifferentiated AAV. Overall and renal outcomes were analysed. Patients were classified as advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), deranged RFT not qualifying the above parameters, and normal renal function. Sixty-seven (72.8 %) patients had GPA, 14 (15.2 %) had MPA, 8 (8.7 %) had EGPA, and 3 (3.3 %) had undifferentiated AAV. Renal involvement was seen in 51 (55.4 %) patients (46.3 % of GPA patients, 78.6 % of MPA, 37.5 % of EGPA and 33.3 % of unclassifiable AAV patients). Renal involvement was more common in males (p = 0.008). Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p < 0.01). Thirteen patients (25.5 %) presented with advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), 21 (41.2 %) had deranged renal functions but did not require dialysis, and the rest had proteinuria and active sediments with normal serum creatinine. Twenty-four patients (47.1 %) had good renal outcome with normal creatinine, 12 (23.5 %) had persistent renal insufficiency, 12 (23.5 %) died, and one (2 %) remained dialysis dependent. Mean survival and mortality did not differ in patients with and without renal involvement (p = 0.454, p = 0.388). Renal involvement was more common in males. BVAS was higher in patients with renal involvement. The mean survival and mortality were similar in patients with or without renal involvement.


Endothelin-3 is produced by metastatic melanoma cells and promotes melanoma cell survival.
Endothelin-3 (ET-3) is an essential paracrine factor for the proliferation, migration, and survival of embryonic melanocytes during fetal development. Its expression is tightly regulated, being completely turned off in adult skin. In this study, results are presented that demonstrate abnormal expression of ET-3 by metastatic melanoma cells in both tissue biopsies and cell culture. Further, in vitro experiments showed that metastatic melanoma cells have the capacity to respond to ET-3 stimulation by increasing survival. Therefore, an abnormal autocrine stimulation pathway involving ET-3 is present in metastatic melanoma cells. Blocking this signal transduction pathway may prove useful for the treatment of metastatic melanoma.


Nicolau Syndrome after Endodontic Treatment: A Case Report.
Calcium hydroxide has been used successfully in root canal therapy for many years. However, it can cause serious damage if it is inadvertently displaced into surrounding vital structures, resulting in thrombosis if displaced into blood vessels, damaging connective tissue, and causing skin necrosis. These adverse reactions are known as Nicolau syndrome (NS) or embolia cutis medicamentosa. Very few case reports have been published about these adverse effects of injecting calcium hydroxide beyond the apex during root canal therapy. A 16-year-old female patient was referred to the endodontic department of Hamad Dental Center for assessment after treatment by the maxillofacial surgery department for swelling and tissue necrosis that occurred after endodontic treatment in another clinic. When the patient initially attended the maxillofacial surgery department, she presented with swelling on the left side in the region of the maxillary left first permanent molar. On examination, there was a change in the color of the skin of the left cheek in that area along with some reported paralysis of the left side of her lips. Analgesics and antibiotics had already been prescribed at the referring clinic. Two weeks later, the patient developed a necrotic patch of skin on the same area. Subsequent evaluation at the endodontic department of Hamad Dental Center led to a diagnosis of NS. NS is a very rare iatrogenic condition. Displacing calcium hydroxide beyond the apex might increase the chance of NS. Clinicians should avoid overinstrumentation and forced injection of calcium hydroxide to prevent NS.


Effect of biomass addition on the surface and adsorption characterization of carbon-based adsorbents from sewage sludge.
Sewage sludge with the additive corn cob was used as prescusor to prepare sludge-based carbon adsorbents by pyrolysis method. And then, the carbonizated products were activated with potassium hydroxide. The mixing ratio of the corn cob to sewage sludge was investigated. The surface area and pore size distribution, elemental composition, surface chemistry structure and the surface physical morphology were determined and compared. The results demonstrated that the addition of corn cob into the sewage sludge sample could effectively improve the surface area (from 287 to 591 m2/g) and the microporosity (from 5% to 48%) of the carbon based adsorbent, thus enhancing the adsorption behavior. The sulfur dioxide adsorption capacity was measured according to breakthrough test. It was found that the sulfur dioxide adsorption capacity of the adsorbents was obviously enhanced after the addition of the corn cob. It is presumed that not only highly porous adsorbents, but also a high metallic content of these materials are required to achieve good performances.


Unfolding the genotype-to-phenotype black box of cardiovascular diseases through cross-scale modeling.
Complex traits such as cardiovascular diseases (CVD) are the results of complicated processes jointly affected by genetic and environmental factors. Genome-wide association studies (GWAS) identified genetic variants associated with diseases but usually did not reveal the underlying mechanisms. There could be many intermediate steps at epigenetic, transcriptomic, and cellular scales inside the black box of genotype-phenotype associations. In this article, we present a machine-learning-based cross-scale framework GRPath to decipher putative causal paths (pcPaths) from genetic variants to disease phenotypes by integrating multiple omics data. Applying GRPath on CVD, we identified 646 and 549 pcPaths linking putative causal regions, variants, and gene expressions in specific cell types for two types of heart failure, respectively. The findings suggest new understandings of coronary heart disease. Our work promoted the modeling of tissue- and cell type-specific cross-scale regulation to uncover mechanisms behind disease-associated variants, and provided new findings on the molecular mechanisms of CVD.


On the role of mechanical signals on sprouting angiogenesis through computer modeling approaches.
Sprouting angiogenesis, the formation of new vessels from preexisting vasculature, is an essential process in the regeneration of new tissues as well as in the development of some diseases like cancer. Although early studies identified chemical signaling as the main driver of this process, many recent studies have shown a strong role of mechanical signals in the formation of new capillaries. Different types of mechanical signals (e.g., external forces, cell traction forces, and blood flow-induced shear forces) have been shown to play distinct roles in the process; however, their interplay remains still largely unknown. During the last decades, mathematical and computational modeling approaches have been developed to investigate and better understand the mechanisms behind mechanically driven angiogenesis. In this manuscript, we review computational models of angiogenesis with a focus on models investigating the role of mechanics on the process. Our aim is not to provide a detailed review on model methodology but to describe what we have learnt from these models. We classify models according to the mechanical signals being investigated and describe how models have looked into their role on the angiogenic process. We show that a better understanding of the mechanobiology of the angiogenic process will require the development of computer models that incorporate the interactions between the multiple mechanical signals and their effect on cellular responses, since they all seem to play a key in sprout patterning. In the end, we describe some of the remaining challenges of computational modeling of angiogenesis and discuss potential avenues for future research.


Surgical management of de novo metastatic meningioma of the spine: An underestimated issue for WHO grade II/III meningiomas.
Meningioma is a slow-growing neoplasm derived from meningothelial cells. Extradural metastasis of WHO grade II/III meningiomas is relatively rare, and spinal metastatic meningiomas (SMM) have only been described in individual case reports. The aim of the present study is to discuss the clinical features and treatments of SMM patients. Fourteen SMM patients who received surgery in our center between 2010 and 2020 were reviewed retrospectively. Possible prognostic factors affecting local progression-free survival (LPFS) and overall survival (OS) were analyzed by log-rank analysis. Our series comprised nine men and five women, with a median age of 49 years. The interval from the primary treatment to SMM varied from 1 to 11 years. Lesions were mainly located in the lumbar-sacral region (7/14, 50.0%), followed by the thoracic spine (5/14, 35.7%) and cervical (2/14, 14.3%) spine. The median follow-up period was 42.7 months, during which six patients (42.9%) passed away. Local tumor progression was detected in four patients (28.6%). Log-rank analysis indicated that circumferential surgery was associated with good LPFS, whereas WHO grade III and visceral metastasis were factors adversely affecting OS. SMM is a challenging clinical entity, usually occurring in the fourth to fifth decades of life. Circumferential surgery is associated with good LPFS. WHO grade III and visceral metastasis are factors adversely affecting OS of patients with SMM. Long-term follow-up is recommended for patients who have received surgical treatment for primary meningiomas (Simpson Grade III/IV), especially for WHO III lesions.


Rapid intravenous low-dose diazepam as sedation for upper gastrointestinal endoscopy.
One hundred patients for endoscopy, aged, between 18 and 74 years were randomly allocated to two equal groups. Group A received 10 mg diazepam intravenously rapidly over 2-4 s; Group B received diazepam intravenously over 1-2 min, titrated to provide a satisfactory level of sedation (mean dose 15.9 mg). Patient co-operation during endoscopy was similar in both groups, but one patient in Group A developed respiratory depression. Tests of psychomotor function after endoscopy showed greater impairment 30 min following injection for Group B, compared with Group A (P less than 0.02). Total or partial amnesia for endoscopy was present in 62% of Group A, and 90% in Group B (P less than 0.005). However, postal follow-up showed that endoscopy was acceptable to 96% of Group A and 98% of Group B. Delayed sedation later in the day was reported by 26% of Group A compared with 48% of Group B.


Presumptive ciliated receptors associated with the fibrillar glands of the spines of the echinoderm Amphipholis squamata.
The ultrastructure of the cuticle, fibrillar glands and stäbchen (see Reichensperger 1908) of the arm spines of the brittle star Amphipholis squamata are described. Stäbchen are shown to be cuticular projections into which pass one or more uniciliate cytoplasmic processes. The proximal tips of the cilia protrude into the external environment to a variable extent. Evidence is presented for considering these ciliated endings to be the terminations of sensory neurites. Stäbchen are, in consequence, presumed to have a receptor function. Groups of stäbchen are spatially associated with fibrillar gland openings on the sides of spines while the bases of fibrillar gland cells are in contact with axons from the spine nerve which are laden with 45-270 nm diameter, electron-dense, membrane-bounded granules. The possible functional significance of these relationships is discussed in the context of a hypothesis in which fibrillar gland secretions are considered to act as food-catching mucus.


Degradation of somatomedins by the thioredoxin system.
The insulin disulfide reducing thioredoxin system from E. coli was used to investigate a possible mechanism of degradation for the two somatomedins, insulin-like growth factor I and II (IGF-I and -II). The amounts of IGF-I and -II remaining after degradation were measured by use of human placenta radioreceptor assay. The results show that both IGF-I and -II were as sensitive to disulfide reduction as insulin.


Unique N-terminal arm of Mycobacterium tuberculosis PhoP protein plays an unusual role in its regulatory function.
Mycobacterium tuberculosis PhoP, a master regulator involved in complex lipid biosynthesis and expression of unknown virulence determinants, is composed of an N-terminal receiver domain and a C-terminal effector domain. The two experimentally characterized PhoP orthologs, from Escherichia coli and Salmonella enterica, display vastly different regulatory capabilities. Here, we demonstrate that the 20-residue-long N-terminal arm unique to M. tuberculosis PhoP plays an essential role in the expanded regulatory capabilities of this important regulator. Although the arm is not required for overall structural stability and/or phosphorylation of the PhoP N-domain, strikingly it is essential for phosphorylation-coupled transcription regulation of target genes. Consistent with this view, arm truncation of PhoP is accompanied by a conformational change of the effector domain, presenting a block in activation subsequent to phosphorylation. These results suggest that presence of the arm, unique to this regulator that shares an otherwise highly conserved domain structure with members of the protein family, contributes to the mechanism of inter-domain interactions. Thus, we propose that the N-terminal arm is an adaptable structural feature of M. tuberculosis PhoP, which evolved to fine-tune regulatory capabilities of the transcription factor in response to the changing physiology of the bacilli within its host.


[Analysis of the N-acetyltransferase 2 gene polymorphism in the patients with chronic obstructive pulmonary disease and in populations of the Volga-Ural region].
Restriction fragment-length polymorphism of the gene coding for N-acetyltransferase 2 (NAT2) was typed in populations of the Volga-Ural region (Bashkirs, Tatars, Chuvashes, Udmurts, and Russians) as well as in patients with chronic obstructive pulmonary disease (COPD) and in healthy individuals. Rapid and slow acetylator phenotypes were determined based on the presence or absence of the KpnI, TaqI, and BamHI restriction endonuclease recognition sites. The proportion of slow acetylators in the populations examined varied from 40.00% in Bashkirs to 64.15% in Chuvashes with statistically significant difference between these two ethnic groups (chi 2 = 5.7; p = 0.02). Overall, in the Volga-Ural populations slow acetylators represented 56.25% of the subjects examined. This value was similar to those presented in other studies of Caucasoid populations. In the COPD patients a statistically significant decrease of the slow acetylator frequency to 48.28% compared to healthy individuals (62.18%) was observed (chi 2 = 4.60; p = 0.036). The data obtained suggest a possible association between the drug resistance in the COPD patients with the rapid acetylator phenotype, which can lead to the development of the chronic form of the disease.


Interventions to reduce medication prescribing errors in a paediatric cardiac intensive care unit.
To identify and reduce medication-prescribing errors by introducing systematic physician education and post-cardiac surgery admission prescription forms. Errors were defined as: incomplete prescriptions; potential adverse drug events (ADEs), i.e. either intercepted or non-intercepted incorrect prescriptions not resulting in an ADE; and incorrect prescriptions that resulted in ADEs. Two baseline blinded pre-intervention data collection periods of 4 weeks and 1 week were followed by implementation of a post-cardiac surgery templated physician order and prescription form and systematic physicians' education. Twelve post-intervention data collections of 1-week duration were completed over a 3-year period and were either blinded or informed with reinforcement of physicians' education. Tertiary paediatric cardiac intensive care unit. A total of 3648 prescriptions were evaluated at baseline (mean +/- SD of 687+/- 8 per week) and 811 +/- 129 prescriptions during each post-intervention period. Total baseline errors of 16.8% decreased to 8.4% after the first blinded data collection and to 4.8% at the final data collection (p<0.001). The occurrence of incomplete prescriptions fell from 15.3% at baseline to 3.6% at final data collection (p<0.001); intercepted potential ADEs fell from 1.3% to 1.1%; non-intercepted potential ADEs fell from 0.17% to zero; and post-operative prescribing errors fell from 44% to 4.6% (p<0.001), with the major reduction seen in incomplete prescriptions. The incidence of incomplete prescriptions significantly improved with education of physicians and use of post-cardiac surgery templated physician order and prescription forms. There was no impact on potential ADEs.


Hepatic dysfunction secondary to Kawasaki disease: characteristics, etiology and predictive role in coronary artery abnormalities.
Coronary artery abnormalities (CAAs) are prominent during the acute Kawasaki disease (KD) episode and represent the major contributors to the long-term prognosis. Several meta-analysis and published scoring systems have identified hepatic dysfunction as an independent predictor of CAA risks. The medical records of 210 KD children were reviewed. Blood samples were collected from all subjects at 24 h pre-therapy and 48 h post-therapy, respectively. Liver function test (LFT) and inflammatory mediators were detected. Multivariate logistic regression analysis was conducted to identify the reliable biomarkers predicting whether CAAs existed or not in KD patients. 90.95% of KD patients had at least 1 abnormal LFT. Hypoalbuminemia was the most prevalent type of hepatic dysfunction, followed by elevated aspartate aminotransferase, low TP, low A/G and hyperbilirubinemia, respectively. The elevated inflammatory mediators (procalcitonin and C-reactive protein) and moderate dose of aspirin played a synthetic role in hepatic dysfunction secondary to KD. However, LFT presented no significant differences between infectious and noninfectious conditions. By a multivariate analysis, a lower albumin/globulin ratio (A/G, OR 13.50, 95% CI 3.944-46.23) served as an independent predictor of CAAs and had a sensitivity of 56.25%, and a specificity of 61.11% at a cutoff value of < 1.48. In conclusion, hepatic dysfunction is a common complication during the acute KD episode, characterized by elevated serum liver enzymes, hypoalbuminemia and hyperbilirubinemia. Systemic inflammation and aspirin, rather than infectious agents, are both the major contributors of hepatic dysfunction secondary to KD. A lower A/G serves as an independent predictor of CAAs.


Optimal collection of blood samples for the measurement of tumor necrosis factor alpha.
We have examined how delayed separation of plasma from cells affects the recovery of recombinant human tumor necrosis factor alpha (rhTNF alpha) from whole blood. Storage of heparinized whole blood samples at room temperature for 1 hr results in a significant (p = 0.036) fall in recovery of plasma TNF alpha from 788 +/- 119 pg/mL to 472 +/- 77 pg/mL, measured by specific enzyme-linked immunosorbent assay (ELISA). Storage of whole blood samples at 4 degrees C for 1 hr reduces but does not prevent the fall in recovery of plasma TNF alpha: 725 +/- 82 pg/mL at time 0, 472 +/- 81 pg/mL after 1 hr, p = 0.038. Recovery of bioactive TNF alpha (cytotoxocity for L929 cells) after 1 hr at room temperature is also significantly reduced from 576 +/- 139 pg/mL to 450 +/- 154 pg/mL, p = 0.036. Studies with 125I-rhTNF alpha confirmed the fall in plasma activity and revealed a rapid commensurate increase in 125I-rhTNF alpha activity in the cell fractions. We recommend that clinical samples for the measurement of cytokines should be kept at 4 degrees C and separated rapidly (within half an hour) before storing the plasma at -70 degrees C.


Evaluation of Antegrade Intramedullary Compression Screw Fixation of Metacarpal Shaft Fractures in a Cadaver Model.
Surgical options for displaced metacarpal shaft fractures include the use of Kirschner wires, plates and screws, and most recently, intramedullary headless compression screws (IMHCS), which have been reported using only retrograde insertion through the metacarpal head. We evaluated IMHCS fixation of metacarpal shaft fractures through an antegrade approach in a cadaver model. We performed antegrade placement of IMHCS in 10 cadaver hands including all 5 digits (total of 50). Displaced transverse proximal metacarpal shaft fractures were created and reduced with a retrograde guidewire from the metacarpal head across the shaft fracture and exiting the metacarpal base. This was retrieved through a 6-mm dorsal wrist incision and overdrilled before the placement of a 4.1-mm-diameter IMHCS in the ring finger and a 4.7-mm screw in all other metacarpals. After IMHCS placement, carpometacarpal (CMC) joint violation was measured along with the optimal starting point for the guidewire on the metacarpal head relative to the dorsal cortex. In all 50 metacarpals, we achieved successful fracture reduction and fixation without violating the extensor mechanism at the wrist. Our retrograde guidewire entry point through the metacarpal head ranged from 4.2 to 4.7 mm volar to the dorsal cortex. The actual area of CMC joint violated by IMHCS placement was largest in the index CMC joint (4.9%), followed by the middle (3.7%), little (2.9%), ring (0.5%), and thumb joints (0.2%). Placement of IMHCS through an antegrade approach from the CMC joint can be performed effectively for all transverse metacarpal fractures, including the thumb, using a limited incision. There is minimal violation of the articular surfaces of the trapezium, capitate, and hamate for the thumb, middle, ring, and little metacarpals. Antegrade IMHCS fixation successfully avoids the potential morbidity of creating a metacarpal head articular surface or extensor mechanism defect at the metacarpophalangeal joint seen with the retrograde approaches.


Insights on genetic characterization and pathogenesis of a GI-19 (QX-like) infectious bronchitis virus isolated in China.
Infectious bronchitis virus (IBV) causes respiratory diseases in chickens, incurring great losses to the poultry industry worldwide. In this study, we isolated an IBV strain, designated as AH-2020, from the chickens vaccinated with H120 and 4/91 in Anhui, China. The sequence homology analysis based on the S1 gene revealed that AH-2020 shares low similarities with the 3 vaccine strains, namely, H120, LDT3-A, and 4/91 (78.19, 80.84, and 81.6%, respectively). Phylogenetic analysis based on the S1 gene revealed that AH-2020 clustered with the GI-19 type. Furthermore, protein modeling revealed that the mutations in the amino acids in AH-2020 were mainly located in the N-terminal domain of S1 (S1-NTD), and the pattern of deletion and insertion mutations in the S1 protein may have influenced the structural changes on the surface of S1. Further, approximately 7-day-old SPF chickens were inoculated with AH-2020 at 106.0 EID50. These chickens exhibited clinical signs of the infection such as listlessness, huddling, and head-shaking, accompanied by depression and 40% mortality. Serum antibody test demonstrated that in response to the AH-2020 infection, the antibody level increased the fastest at 7 dpi, with virus shedding rate of cloaca being 100% at 14 dpi. The viral titer in various tissues was detected using hematoxylin and eosin staining and immunohistochemistry, which revealed that AH-2020 infection can damage the kidney, trachea, lung, cecal tonsil, and bursa of Fabricius. Our study provided evidence that the GI-19-type IBV is undergoing more complex mutations, and effective measures are urgently needed to prevent the spread of these variant strains.


Immobilization of photocatalytic materials for (waste)water treatment using 3D printing technology - advances and challenges.
Photocatalysis has been considered a promising technology for the elimination of a wide range of pollutants in water. Various types of photocatalysts (i.e., homojunction, heterojunction, dual Z-scheme photocatalyst) have been developed in recent years to address the drawbacks of conventional photocatalysts, such as the large energy band gap and rapid recombination rate of photogenerated electrons and holes. However, there are still challenges in the design of photocatalytic reactors that limit their wider application for real (waste)water treatment, such as difficulties in their recovery and reuse from treated (waste)waters. 3D printing technologies have been introduced very recently for the immobilization of materials in novel photocatalytic reactor designs. The present review aims to summarize and discuss the advances and challenges in the application of various 3D printing technologies (i.e., stereolithography, inkjet printing, and direct ink writing) for the fabrication of stable photocatalytic materials for (waste)water treatment purposes. Furthermore, the limitations in the implementation of these technologies to design future generations of photocatalytic reactors have been critically discussed, and recommendations for future studies have been presented.


Detection of Cell-Derived Exosomes Via Surface-Enhanced Raman Scattering Using Aggregated Silver Nanoparticles.
Exosomes are small extracellular vesicles that contain RNA, lipids, and proteins and can act as cellular messengers, carrying information to cells and tissues in the body. Thus, sensitive, label-free, and multiplexed analysis of exosomes may help in early diagnosis of important diseases. Here, we describe the process of pretreatment of cell-derived exosomes, preparation of surface-enhanced Raman scattering (SERS) substrates, and label-free SERS detection of exosomes using sodium borohydride aggregators. This method can enable the observation of SERS signals of exosomes that are clear and stable and have a good signal-to-noise ratio.


International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review.
To identify and summarize the common clinical settings, interventions, and outcomes of nurse practitioner care specific to older people. Scoping review of the international published and grey literature. A structured literature search was conducted of CINAHL, EMBASE, MEDLINE, Google Scholar, and Cochrane Collaboration and Joanna Briggs Institute databases. Following the Arksey and O'Malley framework, randomized controlled and quasi-experimental studies of Masters-prepared nurse practitioners providing care for patients over 65 years were included. Studies were reviewed independently by two investigators. Data were extracted, collated by setting, summarized in tables and synthesized for analysis. In total, 56 primary research studies from four countries and 23 systematic reviews were identified. Primary studies were conducted in primary care (n=13), home care (n=14), long-term care (n=10), acute/hospital care (n=9), and transitional care (n=10). Nurse practitioner interventions included substitutive as well as a supplementation NP role elements to meet specific unmet patient care needs. Studies examined six main outcome measures: service utilization (n=41), cost (n=24), length of stay (n=14), health indices (n=44), satisfaction (n=14) and quality of life (n=7). Cumulatively, nurse practitioners demonstrated enhanced results in 83/144 (58%) of outcomes compared to physician-only or usual care. The most commonly measured financial-related outcome was service utilization (n=41) and benefits were frequently reported in home care (8/9, 89%) and long-term care (7/10, 70%) settings. Among patient and care-related outcomes health indices were most frequently measured (n=44). Primary care most frequently reported improved health indices (11/13, 85%). Transitional care reported improved outcomes across all measures, except for service utilization. This review demonstrates improved or non-inferiority results of nurse practitioner care in older people across settings. More well-designed, rigorous studies are needed particularly in relation to costs. The results of this review could be used for future systemic review of effectiveness of NP care specific to older people. Despite the demonstrated NP role value, barriers to implementing the nurse practitioner role persist internationally and more work is needed to develop and promote these roles.


Maximum likelihood method of estimating the conflict-crash relationship.
The fundamental matters of how traffic conflicts are connected to crashes and how to estimate this connection with traffic conflict data is an active subject of research and refinements. There are still open questions about traffic events that can be analytically extrapolated to related crashes, and how to efficiently estimate the probability of crash associated with such events to enable conversion of observed events to the corresponding expected number of crashes. There are two important uses of a working estimation method: (1) rapid assessment of safety at specific roads locations and evaluation of countermeasures by safety engineers, (2) modeling of safety effects by analysts based on relatively short observations at multiple locations or at limited number of locations but during extended periods. This paper focuses on the application of traffic conflicts by safety engineers where the method practicality is important. The paper first recalls the OLS method of estimating the shape parameter of the underlying Lomax distribution proposed in (Tarko, 2018). Then, the ML method is introduced and the Lomax-based crash estimates obtained with the two methods are compared. Both the methods assume the scale parameter to estimate the shape parameter. The effect of assuming the scale parameter on estimates of the expected number of crashes is evaluated. To bring the scale parameter's effect into a meaningful perspective, it is compared to two other effects: (1) type of driver, and (2) limited number of observations. Finally, re-parametrized Lomax distribution is pointed out as a potential way to address the difficulties with estimating the two distribution parameters simultaneously. The summary of the results closes the paper.


The gas stove-childhood asthma kerfuffle: A teaching opportunity.
Several recent news stories have alarmed many politicians and members of the public by reporting that indoor air pollution from gas stoves causes about 13% of childhood asthma in the United States. Research on the reproducibility and trustworthiness of epidemiological risk assessments has identified a number of common questionable research practices (QRPs) that should be avoided to draw sound causal conclusions from epidemiological data. Examples of such QRPs include claiming causation without using study designs or data analyses that allow valid causal inferences; generalizing or transporting risk estimates based on data for specific populations, time periods, and locations to different ones without accounting for differences in the study and target populations; claiming causation without discussing or quantitatively correcting for confounding, external validity bias, or other biases; and not mentioning or resolving contradictory evidence. We examine the recently estimated gas stove-childhood asthma associations from the perspective of these QRPs and conclude that it exemplifies all of them. The quantitative claim that about 13% of childhood asthma in the United States could be prevented by reducing exposure to gas stove pollution is not supported by the data collected or by the measures of association (Population Attributable Fractions) used to analyze the data. The qualitative finding that reducing exposure to gas stove pollution would reduce the burden of childhood asthma in the United States has no demonstrated validity. Systematically checking how and whether QRPs have been addressed before reporting or responding to claims that everyday exposures cause substantial harm to health might reduce social amplification of perceived risks based on QRPs and help to improve the credibility and trustworthiness of published epidemiological risk assessments.