Methods of Sterilization and Monitoring of Sterilization AcrossSelected Dental Practices in Karachi, Pakistan.
To assess methods of sterilization in dental practices in Karachi and secondly to investigate methods of monitoring sterilization in dental practices in Karachi, Pakistan. Cross-sectional, descriptive study. Dental colleges, hospitals and private clinics of Karachi, Pakistan, from January to March 2013. A total of 251 questionnaires were obtained. Descriptive statistics were computed and differences between groups were assessed through chi-square test using Statistical Package for the Social Sciences (SPSS) version 16.0. P-value < 0.05 was taken as statistically significant. Autoclave, used by 155 (61.8%) dentists was the most common method of sterilization followed by more than one method, 65 (25.9%); dry heat, 24 (9.6%); and cold sterilization, 7 (2.8%). Majority of dentists, 126 (50.1%), never monitored sterilization and those who did monitored mostly monthly. Statistically significant difference was found amongst the three groups of dentists monitoring sterilization (p=0.09) and methods of sterilization (p < 0.01). Statistically significant difference was found in infection control practices of specialists, postgraduate trainees and general dentists regarding method of monitoring sterilization with majority of dentists never monitoring sterilization.


Current concepts in asthma management.
This short paper investigates the effects of prophylaxis on re-admission rates at the Royal Alexandra Hospital for Children, Camperdown, New South Wales.


Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients.
Although hormonal contraceptives may help acne or worsen it, there is limited evidence on the effects of many commonly prescribed agents. The present study evaluates patient-reported effect on acne from 2147 patients who were utilizing a hormonal contraceptive at the time of their initial consultation for acne.
 At the time of initial consultation for acne, each of 2147 consecutive patients using hormonal contraception provided her assessment of how her contraceptive had affected her acne. The Kruskal-Wallis test and logistic regression analysis were used to compare patient-reported outcomes by contraceptive type.
 Depot injections, subdermal implants, and hormonal intrauterine devices worsened acne on average, and were inferior to the vaginal ring and combined oral contraceptives (COCs; P ≤ .001 for all pairwise comparisons), which improved acne on average. Within COC categories, a hierarchy emerged based on the progestin component, where drospirenone (most helpful) > norgestimate and desogestrel > levonorgestrel and norethindrone (P ≤ .035 for all pairwise comparisons). The presence of triphasic progestin dosage in COCs had a positive effect (P = .005), while variation in estrogen dose did not have a significant effect (P = .880).
 Different hormonal contraceptives have significantly varied effects on acne, including among types of COC.

 J Drugs Dermatol. 2016;15(6):670-674.


Individual and Household Level Risk Factors Associated with Malaria in Nchelenge District, a Region with Perennial Transmission: A Serial Cross-Sectional Study from 2012 to 2015.
The scale-up of malaria control interventions has resulted in substantial declines in transmission in some but not all regions of sub-Saharan Africa. Understanding factors associated with persistent malaria transmission despite control efforts may guide targeted interventions to high-risk areas and populations. Household malaria surveys were conducted in Nchelenge District, Luapula Province, in northern Zambia. Structures that appeared to be households were enumerated from a high-resolution satellite image and randomly sampled for enrollment. Households were enrolled into cross-sectional (single visit) or longitudinal (visits every other month) cohorts but analyses were restricted to cross-sectional visits and the first visit to longitudinal households. During study visits, a questionnaire was administered to adults and caretakers of children and a blood sample was collected for a malaria rapid diagnostic test (RDT) from all household residents. Characteristics associated with RDT positivity were analyzed using multi-level models. A total of 2,486 individuals residing within 742 households were enrolled between April 2012 and July 2015. Over this period, 51% of participants were RDT positive. Forty-three percent of all RDT positive individuals were between the ages of 5 and 17 years although this age group comprised only 30% of study participants. In a multivariable model, the odds being RDT positive were highest in 5-17 year olds and did not vary by season. Children 5-17 years of age had 8.83 higher odds of being RDT positive compared with those >18 years of age (95% CI: 6.13, 12.71); there was an interaction between age and report of symptoms, with an almost 50% increased odds of report of symptoms with decreasing age category (OR = 1.49; 95% CI 1.11, 2.00). Children and adolescents between the ages of 5 and 17 were at the highest risk of malaria infection throughout the year. School-based programs may be effective at targeting this high-risk group.


Comparison between patients with and without reliable ventricular escape rhythm in the presence of long standing complete atrioventricular block.
The underlying heart rhythm was evaluated in 74 patients with complete atrioventricular block and had a permanent pacemaker implantation. The pacing was inhibited for 10 seconds or until the patient developed symptoms of presyncope or syncope. Fifty-six patients (74%) had a reliable escape with a mean cycle length of 2010 +/- 596 msec and a mean escape interval of 2335 +/- 971 msec. In 93% of these patients the escape interval was < 4 seconds. The patients without reliable escape (24%), developed symptoms only after a mean of 7153 +/- 1875 msec. The duration of the conduction disorder was longer in the patients without escape and the intraventricular conduction was slower. More patients without escape were treated and antiarrhythmic agents. Forty-eight patients were followed for 1 year and underwent at least two different studies and 13% had different results at different tests. In conclusion, patients without reliable escape have a longer history of conduction disorder, a slower intraventricular conduction, and are frequently treated with antiarrhythmic agents. Even patients with reliable escape occasionally may show a greater pacemaker dependence; therefore, they should also be considered as pacemaker dependent.


Nitric oxide, oxidant status and antioxidant response in morbidly obese patients: the impact of 1-year surgical weight loss.
The aims of this study were to evaluate nitric oxide (NO) metabolites (nitrite/nitrate NO x ) as proinflammatory parameter and total oxidant status (TOS) as well as total antioxidant response (TAR) as oxidative stress (OS) markers in morbidly obese (MO) patients in comparison with normal-weight healthy (NWH) subjects and to determine the post-bariatric surgery changes of NO x and OS indicators in relation with weight loss. We examined serum NO x , TOS, and TAR in a bariatric group of MO patients and a NWH control group (n = 23 each group). In the NWH group, serum was examined once, while in the MO group, serum was examined before and at 3, 6, and 12 months after silastic ring vertical gastroplasty (SRVG). Serum NO x and TOS values were higher (p < 0.001), while TAR level was lower (p < 0.001) in MO patients as compared to the NWH group. No significant changes occurred at 12 months after surgery in the MO group as far as the NO x (p = 0.93), TOS (p = 0.11), and TAR (p = 0.15) levels were concerned as compared to baseline values. However, NO x increased at 6 months after surgery (p < 0.008) and then decreased by the 12th month after SRVG (p < 0.008), reaching almost baseline values. At baseline, there was a high production of proinflammatory and OS markers in MO patients. SRVG surgical weight loss was not accompanied by significant changes of these parameters at 1 year after surgery.


The effect of rider weight and additional weight in Icelandic horses in tölt: part II. Stride parameters responses.
This study investigated the effects of rider weight in the BW ratio (BWR) range common for Icelandic horses (20% to 35%), on stride parameters in tölt in Icelandic horses. The kinematics of eight experienced Icelandic school horses were measured during an incremental exercise test using a high-speed camera (300 frames/s). Each horse performed five phases (642 m each) in tölt at a BWR between rider (including saddle) and horse starting at 20% (BWR20) and increasing to 25% (BWR25), 30% (BWR30), 35% (BWR35) and finally 20% (BWR20b) was repeated. One professional rider rode all horses and weight (lead) was added to saddle and rider as needed. For each phase, eight strides at speed of 5.5 m/s were analyzed for stride duration, stride frequency, stride length, duty factor (DF), lateral advanced placement, lateral advanced liftoff, unipedal support (UPS), bipedal support (BPS) and height of front leg action. Stride length became shorter (Y=2.73-0.004x; P0.05). In conclusion, increased BWR decreased stride length and increased DF proportionally to the same extent in all limbs, whereas BPS increased at the expense of decreased UPS. These changes can be expected to decrease tölt quality when subjectively evaluated according to the breeding goals for the Icelandic horse. However, beat, symmetry and height of front leg lifting were not affected by BWR.


Multivariate chromosome analysis and complete karyotyping using dual labeling and fluorescence digital imaging microscopy.
The combination of multiple dye-DNA interactions, a fluorescence digital imaging system with a scientific CCD camera, and multivariate image analysis allows the rapid karyotyping of fluorescent human metaphase chromosome spreads. Chromosomes are stained with the bisbenzimidazole dye Hoechst 33342 and chromomycin A3, a dye pair used frequently in bivariate flow analysis and sorting of metaphase chromosomes in suspension. The use of ratio functions involving the total and peak intensities of the two dyes provides increased resolution of the karyotype in the microscope, and it can be anticipated that the same approach could lead to improved performance with flow systems as well. High pass filtering with a Laplace operator yields characteristic banded images of the individual chromosomes, even with total fields that are less than 200 pixels on a side.


Alteration of multiple cell membrane functions in L-6 myoblasts by T-2 toxin: an important mechanism of action.
Recent studies suggest that T-2 toxin interacts with cell membranes and alters membrane function. This study was done to assess the effect of T-2 toxin on a broad range of cell membrane functions in L-6 myoblasts. The following parameters were assessed after exposure to T-2 toxin for 10 min: (1) the uptake of calcium, rubidium, and glucose; (2) the uptake of leucine and tyrosine and incorporation into protein; (3) the uptake of thymidine and incorporation into DNA; and (4) residual cellular lactate dehydrogenase (LDH) as a measure of cell membrane integrity. The effects of T-2 toxin on these parameters were: (1) The minimal effective concentration (MEC) of T-2 toxin that caused a reduction in the uptake of calcium and glucose was 4 pg/ml. The uptake of rubidium was increased at 0.4 pg/ml and then reduced at 4 pg/ml and higher concentrations. (2) The MEC for reduction of the uptake of leucine and tyrosine and their incorporation into protein was 4 pg/ml. (3) Thymidine uptake and incorporation into DNA showed a biphasic response with an increase at 0.4 pg/ml and a reduction at 4 pg for uptake and 40 pg/ml for incorporation. (4) Intracellular LDH was reduced at 4 ng/ml. (5) Calcium efflux was reduced after 1-, 5-, and 15-min exposures to T-2 toxin in a concentration of 40 ng/ml. All of the changes noted, including protein synthesis inhibition, were present to a significant degree within 10 min of exposure to T-2 toxin. This time interval is too short to attribute all of these effects directly to protein synthesis inhibition since most short-lived proteins have half-lives measured in hours. In conclusion, T-2 toxin appears to have multiple effects on cell membrane function at very low concentrations (0.4 pg/ml to 4 ng/ml), which are independent of protein synthesis inhibition. These likely include effects either direct or indirect on amino acid, nucleotide, and glucose transporters, as well as calcium and potassium (rubidium) channel activities.


[From reconstruction to function : Hands-on training in tympanoplasty using real-time feedback].
Surgery of the middle ear requires a very high level of fine motor skills. Due to the increased potential for complications in middle ear operations, it is appropriate to acquire these skills beforehand by operating on a model. How satisfactory is the training on suitable models? Are the skills acquired from working on a model transferable to intraoperative situations? Will the type of model and its use for training influence ear surgery in the future? Available publications and own experiences with the Dresden tympanoplasty model (DTM) are analyzed and discussed. Although middle ear surgery makes very high demands on the surgeon and there is a significant risk for severe complications to the ear as a sense organ, there are currently very few options to train surgeons in advance. The DTM is a validated training model, which is capable of closing this gap. Due to the possibility of using a real-time feedback variation of the model, the understanding for reconstruction quality and intraoperative acoustic stress can be improved. The translation of the real-time feedback idea into actual middle ear surgery can improve reconstruction quality in the future. Training on suitable models is indispensable, especially when training as a surgeon to carry out middle ear operations. Adding another sense perception to the internal and external quality assessment of tympanoplasty by inclusion of the real-time feedback option, can optimize learning and operating processes.


Biliary lipid secretion in the rat during infusion of increasing doses of unconjugated bile acids.
The aim of the present study was to examine the secretion of biliary components in rats during infusion of increasing doses of either deoxycholic acid, chenodeoxycholic acid or cholic acid and to test the hypothesis that biliary phospholipids may regulate the hepatic bile acid secretory capacity. Analysis of bile samples, collected every 10 min throughout the infusion period showed that there was an elevation of bile acid, phospholipid, cholesterol and alkaline-phosphodiesterase secretion, with all the bile acids, peaking and then gradually declining. Their secretory rates maximum differed and were inversely related to their detergent strength. However, the secretory rates maximum and total output of phospholipids and cholesterol were similar for all bile acids infused. The per cent contribution of phosphatidylcholine to total bile acid-dependent phospholipid secretion was reduced from 84% (in the pre-infusion period) to 59, 46 and 13% at the end of the cholic acid, chenodeoxycholic acid and deoxycholic acid infusions, respectively. This decrease in the per cent contribution of phosphatidylcholine was associated with an increase in the contribution of both sphingomyelin and phosphatidylethanolamine. The biliary phospholipid fatty acid pattern corroborated these changes in the phospholipid classes. Since sphingomyelin and phosphatidylethanolamine are major phospholipids in bile canalicular and other hepatocellular membranes, the marked increase in their secretion in bile during the infusion of high doses of bile acids may indicate solubilization of membrane phospholipids, resulting in membrane structural changes responsible for the reduced excretory function of the liver.


Interaction of pseudorabies virus with immortalized porcine B cells: influence on surface class I and II major histocompatibility complex and immunoglobulin M expression.
We examined whether the L14 cell line, an immortalized B cell line originating from inbred miniature pigs of the MHC haplotype d/d, could be useful to study T cell responses of pigs to pseudorabies virus (PRV). Compared with porcine kidney cells, the replication of PRV in L14 cells was slower and yielded lower quantities of infectious virus, which agrees with the reported poor replication of PRV in peripheral blood lymphocytes of swine. The virus yield and the number of L14 cells expressing the viral glycoprotein gE were both maximal at 48 h postinfection, when approximately 90% of all viable L14 cells expressed gE. Morphologically detectable effects of PRV replication in L14 cells were not obvious, but the number of viable cells at 72 h postinfection was lower in infected cultures than in uninfected cultures. Major histocompatibility complex (MHC) class I and II antigen expression was significantly higher at different time points postinfection on infected than on uninfected L14 cells. In contrast, expression of IgM appeared very slightly reduced on infected L14 cells, indicating a selective influence of PRV on cellular protein expression. PRV-infected L14 cells were lysed by lymphocytes from PRV-immune minipigs of MHC haplotype d/d, indicating their usefulness in in vitro cytolytic assays.


Acute central nervous system graft-versus-host-disease after liver transplantation.
Acute Central Nervous System (CNS) Graft Versus Host Disease (GvHD) is a rare form of GvHD, only described in case reports. Knowledge about this condition is extrapolated from chronic CNS GvHD cases occurring mostly after hematopoietic stem cell transplantation. GvHD following solid organ transplantation is an unexpected complication. GvHD after liver transplantation has a poor prognosis, and the optimal management is not yet known. Here we describe the case of a 63-year-old man who underwent deceased donor liver transplantation and subsequently developed skin rash, colitis and pancytopenia followed by refractory status epilepticus. Following the identification of lymphocytes of donor origin in the cerebrospinal fluid of the patient, he was diagnosed with acute CNS GvHD. He was treated with an intensive immunosuppressive regimen, but care was withdrawn due to lack of improvement and worsening neurologic prognosis. It is the second known case of acute CNS GvHD following liver transplantation. Clinicians should be aware of this possible, although rare, complication of liver transplantation, especially when there is refractory status epilepticus of unknown origin.


Elevation of antioxidant potency in the brain of mice by low-dose gamma-ray irradiation and its effect on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced brain damage.
The elevation of endogenous thiol-related antioxidants and free radical scavenging enzymes in the brain of C57BL/6 female mice after low-dose gamma-ray irradiation and its inhibitory effect on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced brain damage were investigated. The brain level of the reduced form of glutathione (GSH) increased soon after irradiation with 50 cGy of gamma-rays, reached a maximum at 3 h post-treatment, and remained elevated until 12 h. Thioredoxin (TRX) was also transiently increased after irradiation. The activities of free radical scavenging enzymes, including Cu/Zn-superoxide dismutase, catalase and glutathione peroxidase, were significantly induced after irradiation as well. Cerebral malondialdehyde was remarkably elevated by MPTP treatment, and this elevation was suppressed by pre-irradiation (50 cGy). The contents of GSH and TRX were significantly decreased by MPTP treatment in comparison with those of the control group. These reductions both seemed to be attenuated by pre-irradiation with gamma-rays. These results suggest that low-dose gamma-ray irradiation induces endogenous antioxidative potency in the brain of mice and might be effective for the prevention and/or therapy of various reactive oxygen species-related neurodegenerative disorders, such as Parkinson's disease and Alzheimer's disease.


Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease.
Low medication adherence is known to contribute to worse health outcomes in the general population. We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease. We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score <8 classified as low adherence. Medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI) tool. Factors associated with low adherence were identified by logistic regression. Of 181 patients, 33% were female, median age was 62, and model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7-13), and the MRCI was 19 (13-27). In total, 54 (30%) were high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low adherence were: forgetfulness (27%) and side effects (14%). Compared to high adherence, low adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence. A majority of patients awaiting liver transplantation demonstrated low medication adherence. Total number of medications and regimen complexity were strong correlates of low adherence. Our data underscores the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.


Isolated systolic hypertension in the elderly: pathophysiology and treatment.
Isolated systolic hypertension (ISH) is a common clinical finding in the elderly population and appears to be a risk factor for cardiovascular morbidity and mortality. It appears feasible and safe to treat patients with various antihypertensive drugs; however, the morbidity and mortality benefits still need to be determined.


Obesity, insulin resistance, and its link to non-insulin-dependent diabetes mellitus.
Studies have shown that obese patients have a lower tissue response to insulin than lean individuals, suggesting that obesity promotes the development of insulin resistance. The mechanisms linking obesity and insulin resistance are not known. Obese patients have decreased glucose oxidation and increased lipid oxidation compared with lean individuals, and are hyperinsulinemic, which may result in downregulation of insulin receptors. Studies in healthy subjects have shown that increased plasma levels of nonesterified free fatty acids resulted in a decrease in peripheral insulin-induced glucose uptake. Obese patients have increased plasma levels of nonesterified free fatty acids, which may be involved in the development of insulin resistance. Patients with central obesity have a greater degree of peripheral insulin resistance and higher plasma insulin levels than patients with lower body obesity. Patients with non-insulin-dependent diabetes mellitus (NIDDM) who become obese have a further reduction in insulin sensitivity. Studies in Pima Indians have shown that adiposity is the most important predictor for NIDDM in children with at least one parent who have diabetes. Insulin sensitivity improves with weight loss in obese patients.


Hypertension treatment in the new millennium: the importance of controlling systolic blood pressure and the pulse pressure.
The sixth Joint National Committee on Hypertension (JNC-VI) has recently been published. The new criteria emphasize the importance of controlling systolic blood pressure and paying attention to the level of pulse pressure. The authors believe in the importance of controlling both in compliance with the new criteria established by JNC-VI.


Role of the vascular diagnostic laboratory in the evaluation of male impotence.
Penile systolic pressures, penile volume waveforms, and postischemic reactive hyperemia were measured in 106 patients (38 potent and 68 impotent). With such testing the vascular laboratory can clearly identify those impotent patients in whom penile blood flow is normal and who would not benefit from direct arterial surgery. Unfortunately, abnormal results give no assurance that ischemia is responsible for a given patient's impotence and a multimodal approach is necessary to further evaluate such patients.


Signal reduction in choriocapillaris and segmentation errors in spectral domain OCT angiography caused by soft drusen.
To analyze signal reduction in choriocapillaris (CC) and segmentation errors in spectral domain optical coherence tomography angiography (OCT-A) caused by soft drusen due to age-related macular degeneration (AMD). Twenty-four eyes of 24 patients underwent multimodal retinal imaging including central 3 × 3mm2 OCT-A (AngioVue, Optovue). Three drusen per study eye were randomly chosen and evaluated regarding drusen height, diameter, and accuracy of OCT-A layer segmentation in lesion proximity. Structural en-face OCT CC images were graded qualitatively and quantitatively regarding signal loss underneath the individual drusen area. Those drusen that showed no distinct signal loss in structural en-face OCT CC images were further evaluated in OCT-A. CC decorrelation signal index was measured within a 30-μm OCT-A CC slab in the exact area of drusen affection. Data were compared to healthy age-matched control subjects. Accuracy of layer segmentation, OCT CC data, and OCT-A CC data were correlated to morphological drusen parameters. Mean drusen height and diameter were 91.57 ± 19.5μm and 315.17 ± 116.7μm. OCT-A layer segmentation of the inner plexiform layer (IPL) was disturbed by more than 50 μm in proximity to 26 drusen (36.1%). In these patients, drusen height was significantly higher compared to those with accurate IPL segmentation (p = 0.0126). Sixty-six out of 72 drusen (91.7%) caused a distinct signal loss in the structural en-face OCT CC image. Drusen height and drusen diameter were significantly higher in this group compared to the six drusen with a sufficient signal (p = 0.0276, p = 0.0025). CC decorrelation signal index measured in the area of these six drusen without OCT signal loss (8.3%) was reduced compared to age-matched healthy controls (73.6 vs. 100.1; p = 0.001). Signal attenuation in CC slabs and segmentation errors of the IPL depend on drusen morphology. Both are frequent artifacts in OCT-A imaging in patients with soft drusen and must be considered during image analysis.


Design and fabrication of field-deployable microbial biosensing devices.
Biosensors could enable a wide range of applications in environmental monitoring, pathogen detection, and biomarker diagnostics. While conventional diagnostic platforms like chemical sensors and PCR-based assays are capable of highly sensitive detection in laboratory conditions, their configurations, production cost, and operational requirements are not suitable for applications beyond the laboratory. Recent advances in synthetic biology, bioelectronics, and materials sciences have paved the way for the creation of novel microbial biosensing devices, which integrate core synthetic biosensors with state-of-the-art deployment platforms to create unique biosensor products. Here, we review the latest developments in microbial biosensing devices and discuss challenges and perspectives towards realizing their broad applications in real-world settings.


Cobaltic lysine study of the morphology and distribution of the cranial nerve efferent neurons (motoneurons and preganglionic parasympathetic neurons) and rostral spinal motoneurons in the Japanese toad.
The morphology and distribution of the cranial nerve motoneurons (except III, IV, and VI) and rostral spinal motoneurons were systematically studied in the Japanese toad (Bufo japonicus) by retrograde labelling with cobaltic lysine complex. The cobaltic lysine clearly labelled whole neurons, i.e., cell bodies, proximal and distal dendrites, and axons. The branchial motoneurons (V, VII, IX, and X) had similar morphological characteristics and formed a more-or-less continuous cell column through the brainstem. The dendrites could be grouped mainly into the dorsomedial and the ventrolateral dendritic arrays. The dorsomedial dendrites formed a dendritic plexus in the subependymal gray matter, which extended as far peripherally as beneath the ependymal layer. The ventrolateral dendrites formed a broom-like dendritic plexus in the lateral to ventrolateral white matter. They usually extended as far peripherally as the pial surface. The rostrocaudal extent of the dendritic field was also wide and usually exceeded the motor nuclear boundaries. The hypoglossal motoneurons were grouped into the dorsomedial and ventrolateral cell groups, and the latter was considered to be part of the rostral spinal motoneuron column, from their morphology and distribution. The former had well-differentiated dendrites and occupied a more medial position than the branchial motoneurons. Besides the equivalent of the dorsomedial and ventrolateral dendritic arrays of the branchial motoneurons, they had dorsal and commissural dendrites. The accessory motoneurons had morphological characteristics and a distribution pattern similar to those of the rostral spinal motoneurons rather than the branchial motoneurons. The rostral spinal motoneurons had morphological characteristics somewhat different from the branchial motoneurons and the hypoglossal motoneurons (dorsomedial group). Functional implications of the motoneuron morphology are discussed, mainly based on the present results and earlier anatomical and physiological studies of the spinal motoneurons. The present study also revealed the anatomical features of the preganglionic parasympathetic neurons supplying some cranial nerves. These neurons had small somata with less elaborate dendrites and formed an almost continuous cell column that occupied a more dorsal position than the motoneurons of the corresponding nerve. They are thought to be homologous to the salivatory nucleus and the dorsal motor nucleus of the vagus. The basic anatomical organization of the general visceral efferent column seems to be similar throughout vertebrates.


Lymph Node Metastasis in Cutaneous Head and Neck Squamous Cell Carcinoma.
Cutaneous squamous cell carcinoma (CSCC), the second most common cancer in whites, may result in nodal metastasis in 4% of patients. In the last decade, sentinel lymph node biopsy (SLNB) became the common practice for treating patients with invasive skin cancers such as melanoma, although its use in patients with CSCC is still under debate. To find the rate of cervical lymph node metastasis in the series of patients with CSCC of the head and neck and to identify those who may need SLNB. A retrospective data collection on all patients diagnosed with CSCC of head and neck during the years 1998 to 2005. A total of 572 patients with 725 head and neck CSCC were included in the study group. During the follow-up period, 10 (1.3%) patients developed lymph node metastases and no patient developed distant metastases. The probability of lymph node metastasis within 6 years for T1 and T2 tumors was 1.09% and 5.46%, respectively (p = .0387). Because of the relatively low incidence of cervical lymph node metastases in patients with CSCC of the head and neck, SLNB for clinically N0 patients is not justified.


Robotic extended pelvic lymphadenectomy for intermediate- and high-risk prostate cancer.
Accurate staging of prostate cancer is enhanced by a thorough evaluation of the pelvic lymph nodes. Limited data are available regarding robotic extended pelvic lymphadenectomy (PLA) in this setting. Analyze our experience performing robotic extended PLA. A total of 143 consecutive men with intermediate- or high-risk clinically localized adenocarcinoma of the prostate underwent robotic extended PLA and radical prostatectomy between September 2010 and November 2011 by a single surgeon. Lymph node packets were sent separately from bilateral common, external, and internal iliacs, obturators, node of Cloquet, and anterior prostatic fat. Descriptive statistics were used to summarize lymph node yields and positive nodes. Clinical variables were examined in logistic regression models to predict lymph node positivity. Median lymph node yield was 20 (range: 9-65, interquartile range: 15-25). Eighteen patients (13%) were found to have metastatic prostate cancer in the lymph nodes. The mean number of positive nodes found was 2.9 (range: 1-11). In 14 of 18 node-positive patients (78%), the extent of nodal invasion was outside the boundaries of a limited PLA. For four patients with positive nodes (22%), prostate biopsy predicted unilateral disease but PLA revealed contralateral positive lymph nodes. A total of 82% of patients experienced no complications, and most Clavien grade 1-2 complications consisted of anastomotic leakage, urinary retention, ileus, and lymphocele. Only 4% of patients experienced a grade 3 complication. Under multivariate regression analysis, prostate-specific antigen (PSA), clinical stage, and maximum biopsy core tumor volume were identified as significant predictors of finding positive pelvic lymph nodes (area under the curve: 91%). The main limitations include short follow-up and lack of randomization. Robotic extended bilateral PLA for prostate cancer up to the common iliac bifurcation increases nodal yield and positive nodal rate and can be performed safely. PSA, clinical stage, and maximum biopsy core volume are predictors for lymph node invasion. Long-term follow-up is needed to evaluate for therapeutic benefit.


Use of bipolar diathermy to prevent posterior capsule opacification(1).
To determine the feasibility of using directed bipolar diathermy to eliminate or reduce the formation of new cortical lens material following phacoemulsification in a rabbit model. Department of Research & Development, Bausch & Lomb Surgical, and Department of Ophthalmology, St. Louis University, St. Louis, Missouri, USA. A rabbit model for posterior capsule opacification (PCO) was used. A continuous curvilinear capsulorhexis was performed followed by phacoemulsification to remove cortical lens material. In 2 experimental groups, modified bipolar instruments were used to apply diathermy to residual lens epithelial cells using an intracapsular or extracapsular method of application. Postoperative clinical examinations were at 1, 3, and 7 days and then weekly up to 60 days. Selected animals were followed for a longer period. Capsule integrity was evaluated by measuring the pressure required to rupture the capsule in similarly treated porcine eyes. Diathermy prevented PCO in 4 of 4 eyes in the intracapsular treatment group and 4 of 5 in the extracapsular group. Eyes remained free of new lens cortex for the life of the animal, which was as long as 18 months. New cortical material was detected after 35 days in 1 animal in the extracapsular group. Mean time for the formation of observable cortical material was 29 days +/- 5 (SD) in the control animals. Physical measurements did not detect a reduction in capsule integrity with diathermy treatment. The extracapsular treatment method resulted in fewer iris complications. Directed diathermy has the potential to eliminate secondary cataract formation with minimal damage to collateral tissues.


[Psychosocial rehabilitation in France].
For a long time in France, readaptation and reinsertion have been considered separately. While readaptation focuses on the way the patient "adapts again", reintegration looks at the place of the readaptation, the society or the group. Today, psychosocial rehabilitation encompasses both of these notions by taking into account the medical and social aspects.


Double spin crossovers: a new double salt strategy to improve magnetic and memory properties.
The structural, magnetic and Mössbauer spectral properties of a double salt, mixed-valent material, [FeII(3,5-Me2TPM)(TPM)][FeIII(azp)2]ClO4·2MeCN, 1, reveal spin transitions occur at both the metal sites, with hysteresis, indicative of 1 being a double spin crossover material.


Technique for locating the start of the ovarian cycle in women who have no uterus.
A technique was required to identify the start of the ovarian cycle in hysterectomized women. Daily observations of the excretion of pregnanediol relative to creatinine by menstruant women during the course of 15 ovulatory cycles have been used to establish (a) that the centre of the pregnanediol peak can be located from as few as two pregnanediol measurements per week and (b) that this centre precedes the start of menstruation by 7.14 +/- 0.07 days (mean +/- SEM). With this information the onset of menstrual bleeding in an ovulatory cycle can be predicted. Comparison of the prediction with the observation of menstrual onset in 50 cycles gave a mean deviation of 0.276 +/- 0.109 days with a maximum deviation of 1.9 days. In three women observed before and after hysterectomy there was no significant change in the length of the ovarian cycle. It is concluded that this procedure provides a way of identifying the start of a new ovarian cycle in women who have no uterus. The procedure is only applicable to ovulatory cycles.


Dual antiplatelet therapy in myocardial infarction with non-obstructive coronary artery disease - insights from a nationwide registry.
Dual antiplatelet therapy (DAPT) is a mainstay for myocardial infarction (MI) therapy. However, in patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA), clear recommendations are lacking in the literature. This study aims to identify the cases in which DAPT is currently prescribed at discharge for MINOCA. The authors analyzed a cohort of patients from a multicenter national registry enrolling patients who suffered their first MI between 2010 and 2017, and underwent coronary angiography revealing absence of stenosis ≥50%. Individual antithrombotic therapy was identified. A logistic regression analysis was applied to search for predictors of DAPT. From a total of 16 237 patients analyzed, 709 (4.4%) were categorized as MINOCA. Mean age was 64±13 years, 46.3% (n=409) were females. 390 (55.0%) of MINOCA patients were discharged on DAPT. Males (OR 1.67, CI 95 [1.05-2.38], p=0.027), active smokers (OR=1.82, CI 95 [1.05-3.16], p=0.033), previous percutaneous intervention (OR 3.18, CI 95 [1.48-6.81], p=0.003), ST elevation MI (OR 2.70, CI 95 [1.59-4.76], p<0.001) and sinus rhythm at admission (OR=3.94, CI 95 [2.07-7.48], p<0.001) were independent predictors of DAPT use. In this nationwide registry, DAPT was prescribed at discharge in 55% of MINOCA patients. Beyond sinus rhythm, the variables presented as independent predictors for DAPT use identify subgroups of patients who are classified as more prone to thrombotic events. The issue of how to handle antithrombotic agents in MINOCA patients is a topic open for discussion.


Melatonin effect on rat body weight regulation in response to high-fat diet at middle age.
We previously demonstrated that daily melatonin administration to middle-aged rats to restore youthful plasma melatonin levels also decreased body weight, visceral fat, plasma leptin, and plasma insulin to more youthful levels, without detectable changes in consumption of chow diet. We now evaluate: (a) whether melatonin alters consumption of a more precisely quantifiable liquid diet similar in high-fat content to the typical American diet; (b) differences between melatonin-induced endocrine responses in the fasted vs fed state; and (c) time course of these responses. Ten-month-old male Sprague- Dawley rats received liquid diet containing either 0.2 micro g/mL melatonin (MELATONIN) or vehicle (CONTROL) (n = 14/treatment); the diet was available throughout each night, but was removed for the final 10 h of each daytime. MELATONIN rats gained 4% body weight during the first 2 wk and then stabilized, whereas CONTROL rats continued to gain for an additional week, achieving 8% gain (p < 0.05 vs MELATONIN). During the first 3 wk, afternoon tail-blood leptin, but not insulin, levels decreased in melatonin-treated rats (p < 0.05 vs CONTROL). After 8 wk, half of the rats were killed at the midpoint of the dark period (NIGHT; fed) and half at the end of the light period (DAYTIME; fasted). NIGHT but not DAYTIME plasma leptin levels were decreased in MELATONIN rats, whereas DAYTIME but not NIGHT plasma insulin levels were decreased (p < 0.05 vs CONTROL). Melatonin treatment did not alter cumulative food consumption. Thus, melatonin decreased weight gain in response to high-fat diet, decreased plasma leptin levels within 3 wk-before decreasing plasma insulin-and exerted these metabolic effects independent of total food consumption.


Regulation of expression of sulfoglucuronyl carbohydrate (HNK-1), Amphoterin and RAGE in retinoic acid-differentiated P19 embryonal carcinoma cells.
HNK-1 antibody reactive sulfoglucuronyl carbohydrate (SGC) and SSEA-1 antibody reactive Lewis X (Lex) epitope are expressed on several glycolipids, glycoproteins, and proteoglycans of the nervous system and have been implicated in cell-cell recognition, neurite outgrowth, and/or neuronal migration during development. Interaction of SGC with its binding protein Amphoterin and interaction of Amphoterin with a cell-signaling molecule, receptor for advance glycation end product (RAGE) have been suggested to regulate neurite outgrowth and neuronal migration. The regulation of expression of SGC, Lex, Amphoterin, and RAGE was studied in embryonal carcinoma P19 cells after treatment with retinoic acid (RA). The untreated proliferating P19 cells strongly expressed the Lex epitope, which was mostly due to Lex-glycoproteins. P19 cells, when differentiated into neuron-like cells by RA, did not express the Lex epitope, but expressed increasing levels of SGC, with time in culture. Quantitative biochemical analyses showed that in the P19 cells after RA treatment, the amount of SGC-glycoproteins increased at a significantly higher level than sulfoglucuronyl glycolipid-1 (SGGL-1). The increase in the levels of SGGL-1 was due to 16-fold upregulation in the activity of lactosylceramide: N-acetylglucosaminyl-transferase (Lc3 synthase), which synthesizes the key intermediate lactotriosylceramide (Lc3Cer), for lacto- and neolacto-glycolipids. The large increase in the activity of Lc3 synthase appeared to regulate the levels of other neolacto glycolipids, such as Lc3Cer, nLc4Cer, nLc6Cer, disialosyl-nLc4Cer (LD1), and Lex-glycolipids. Strong upregulation of glucuronyl-transferase and modest twofold enhancement in the activity of the glucuronyl-sulfotransferase, which catalyze the final steps in the SGC synthesis, also would account for the large increase in the synthesis SGC-glycoproteins. RA also upregulated the synthesis of Amphoterin and RAGE in P19 cells. SGC, RAGE, and Amphoterin were co-localized in the RA-differentiated neurons. The initiation of neurite outgrowth along with co-ordinated upregulation of Amphoterin, RAGE, SGC-glycoproteins, and SGGLs in RA-treated P19 cells support the hypothesis that these molecules are involved in the neuronal process formation.


Reduced DNA repair synthesis in healthy women having first degree relatives with breast cancer.
The DNA repair synthesis induced by UV-C irradiation was studied in unstimulated lymphocytes of 64 healthy women whose mothers, or sisters, or mothers and sisters had had breast cancer. For comparison we took 48 control women. As the parameter for the determination of DNA repair synthesis the incorporation of [3H]thymidine in the presence of 2 mM hydroxyurea was taken. The levels of [3H]thymidine incorporation were reduced by 19 of the 29 women whose mothers, in 17 of the 25 women whose sisters and in nine of the 10 women whose mothers and sisters had had breast cancer. By comparison a decreased level was found in only seven of the 48 control women. This difference between the controls and women having first degree relatives with breast cancer was significant in each group. In an earlier study a reduced DNA repair synthesis in breast cancer patients was established. The present findings suggest that DNA repair synthesis may be one of the factors involved in the genesis of breast cancer.


Does dual task placement and duration affect split-belt treadmill adaptation?
Dual tasking during prolonged split-belt adaptation (10-15 min) has shown to slow the adaptation process and prolong aftereffects. Therefore, dual tasks during split-belt adaptation are being explored for their potential in gait symmetry rehabilitation. However, the ideal paradigm configuration it is still not clear. To determine whether split-belt adaptation and ensuing aftereffects are altered by dual task placement, specifically looking at onset of split-belt adaptation or later part way through Adaptation (Experiment 1) and dual task duration (Experiment 2). Healthy young adults (n = 40) performed 5 min of tied-belt walking, followed by 14 min of split-belts (Adaptation, 1:3 ratio) and 5 min of de-adaptation (both belts at same speed) to assess after effects (Post-Adaptation). Experiment 1: To assess the effects of dual task placement, an auditory version of an n-back task was presented during the first 8 min or last 8 min of Adaptation. Experiment 2: To assess the effects of dual task duration, the cognitive task was presented during the entire split-belt Adaptation phase (14 min) or during four 2-minute bouts (8 min). Cognitive task accuracy, dual support symmetry, and rates of adaptation and de-adaptation were compared. When both the onset of the auditory cognitive task and the onset of Adaptation (split-belts) occurred simultaneously, participants prioritized split-belt adaptation and in doing so, cognitive task accuracy was reduced (Experiment 1). By prioritizing gait symmetry over cognitive performance, there were no differences in dual support symmetry adaptation (magnitude, variability or rate of Adaptation/De-adaptation) regardless of cognitive task placement or duration (Experiment 2). We believe the early portion of split-belt treadmill adaptation to be a cognitive interference period. These results support future work exploring the use of dual task in a rehabilitation setting with more complicated motor-cognitive dual task paradigms during this key period.


Low-carbohydrate diet in the treatment of type 2 diabetes mellitus (LoCaT): study protocol for a multicenter, randomized controlled trial.
Low-carbohydrate diet (LCD) is an emerging therapy for type 2 diabetes mellitus (T2DM). Although its effect on glucose control has been confirmed in previous clinical trials, most of those studies have focused on comparing calorie-restricted LCD to iso-caloric low-fat diets. In this study, we aim to compare the effects of LCD and canagliflozin, a sodium-glucose cotransporter 2 inhibitor, in patients with T2DM. This is a multicenter, randomized controlled trial. We will recruit 120 patients with poor-controlled T2DM. Participants will be randomly divided into canagliflozin and LCD groups in a 1:1 ratio. The primary outcome is the change in hemoglobin A1C levels after the 3-month intervention. The secondary outcomes are the time in range and cost of antihyperglycemic agents. Exploratory outcomes include physical examination, body composition, glucose variability, appetite, glycolipid metabolism, liver lipid content, and urine glucose threshold. No previous study has compared an LCD with antihyperglycemic agents. In LoCaT, participants' metabolism will be assessed from multiple perspectives. It is believed that the finding obtained from this trial will optimize the treatments for patients with T2DM. Chinese Clinical Trial Registry ChiCTR1900027592. Registered on November 20, 2019.


Health promotion programs in prison: attendance and role in promoting physical activity and subjective health status.
Maintaining an inmate's health can serve as a challenge due to unhealthy background, risky behavior, and long imprisonment. This study aimed to analyze the prevalence of participation in health promotion activities among Israeli inmates and its association with their physical activity levels and subjective health status. A cross-sectional study was designed to examine 522 inmates (429 males, 93 females). The data were collected by trained face-to-face interviewers and self-report questionnaires. Most of the participants (82.37%) did not meet the recommended physical activity level. Half of the participants reported that their physical activity levels decreased since they were in prison compared with 29.50% who reported that their physical activity levels increased. Physical activity and subjective health status were significantly higher among younger male inmates. Furthermore, participation in health-promoting activities was associated with higher levels of physical activity and subjective health status. Health promotion activities may play an important role in addressing the challenges of maintaining inmate health. Implications of the findings are further discussed.


Intra-parenchymal mesenchymal chondrosarcoma of the cerebellum: case report and review of the literature.
A 44-year-old male presented with a 3-week history of clumsiness and numbness of the left hemibody. CT scan and MRI revealed a 2 cm mass in the right hemisphere of the cerebellum. The patient underwent a sub-occipital craniotomy with gross total resection of the intra-parenchymal lesion. On pathology, the lesion was found to be compatible with a mesenchymal chondrosarcoma. The patient received adjuvant radiation treatment and remains free of disease 60 months after completion of treatment. Mesenchymal chondrosarcomas are neoplasms that rarely arise intra-cranially. Thirty cases have been found in the literature. Our case resembles more closely six of these cases because the tumour had no dural attachment. We describe our case in more detail and review similar cases found in the English literature.


Decreased cerebral blood flow after administration of sodium bicarbonate in the distressed newborn infant.
In the course of our studies on cerebral blood flow in newborn infants, we have observed a striking depressing effect of sodium bicarbonate infusion on cerebral blood flow which in some cases may severely aggravate cerebral ischemia. We measured cerebral blood flow before and after the treatment with 1 to 8 meqs of sodium bicarbonate in seven distressed newborn infants. The 133 Xe clearance technique was used. The results showed in six of the seven cases a decrease in cerebral blood flow, which in most cases was reduced to 14 to 22 ml/100 g/min, which is about half the value prior to the bicarbonate infusion. In one case an extreme reduction occurred: cerebral blood flow was reduced to 3 ml/100 g/min, well below the level compatible with tissue survival. The results are discussed with regard to the optimal treatment of the acidotic newborn.


Comparison of the toxicity of methylcyclopentadienyl manganese tricarbonyl with that of its two major metabolites.
Pneumotoxicity and lethality resulting from administration of methylcyclopentadienyl manganese tricarbonyl (MMT) and its 2 major metabolites in rats were compared. Following i.p. injection, MMT was found to have an LD50 value of 12.1 mg/kg. Neither of the metabolites appeared to have significant acute toxicity even when doses as high as 250 mg/kg were given. This impressive difference in toxicity may be due in part to changes in solubility of the metabolites, allowing for (1) decreased distribution into the central nervous system, coupled with (2) a more rapid excretion rate. This suggests that the oxidative metabolism of MMT that results in the formation of these metabolites is an important detoxifying pathway.


Sulfated carboxymethylcellulose mediated enhancement of Timp3 efficacy synergistically attenuates osteoarthritis through inhibition of NFκB and JNK.
Osteoarthritis (OA) is a prevalent degenerative joint condition with no effective disease modifying treatments. In this study, we aimed to address multiple OA hallmarks using a combination of pro-chondrogenic sulfated carboxymethylcellulose (sCMC) and anti-catabolic tissue inhibitor of metalloproteases 3 (Timp3) in relevant disease systems. Firstly, we chemically sulfated carboxymethylcellulose to impart a negative charge and improve the stability of cationic Timp3. The modified sCMC exhibited a molecular weight of 10 kDa and a degree of sulfation of ∼10 %. We further demonstrated that sulfation of CMC confers pro-chondrogenic characteristics. Subsequently, we demonstrated that the combination of sCMC and Timp3 effectively reduced key OA hallmarks, such as matrix degradation, inflammation, and protease expression, in a goat ex vivo OA model compared to individual treatments. We further demonstrated that the anti-OA effect of sCMC and Timp3 is mediated through the suppression of NFκB and JNK activation. To validate the clinical potential and mechanism of action, we conducted experiments on human OA explants. The combination treatment synergistically reduced the expression of MMP13 and NFκB in human OA explants. Overall, sCMC-mediated enhancement of Timp3 efficacy synergistically reduced OA-like traits and demonstrates the potential for OA amelioration.


Evaluating the role of embolization and carotid artery sacrifice and reconstruction in the management of carotid body tumors.
To review the surgical management of carotid body tumors (CBT), outcomes of carotid artery reconstruction, as well as utility of preoperative embolization. Retrospective chart review. A single-surgeon case series with chart review was performed of all cases between 1997 and 2014 at a single institution. Tumor classification, major neurovascular resection, requirement for in-line carotid artery reconstruction, intraoperative blood loss, and operative time, and postoperative neurovascular complications were determined. In all, 96 patients with 101 CBTs underwent definitive resection disease. Vascular sacrifice was 2.9% (three) for the internal jugular vein, 8.9% (nine) for the external carotid artery, and 13.8% (14) for the internal carotid artery (ICA). ICA sacrifices were performed with immediate in-line arterial bypass grafting with vascular surgery. Permanent cranial neuropathies occurred in 4.9% (five) of patients, without cerebrovascular events. We recommend surgical resection as the primary approach to the management of these CBTs. In lesions involving the ICA, we recommend vein bypass grafting. We found no differences or advantages to preoperative embolization. 4 Laryngoscope, 126:2282-2287, 2016.


Knowledge and self-reported practice of the local inhabitants on traditional insect repellent plants in Western Hararghe zone, Ethiopia.
This paper reveals the trend of knowledge and self-reported practice of traditional insect repellent plants (TIRPs) and could serve as a baseline data to identify/formulate novel plant-based insect repellents in the near future. Insect repellent plants usage is a long-standing and age old tradition. Thus, the major objective of this survey was to assess the knowledge and self-reported practice of the local inhabitants on TIRPs in Western Hararghe zone, Ethiopia. The ethnobotanical survey was conducted between January and March 2011 via administering pre-tested questionnaire by involving the selected 150 household members in the study area. The survey results clearly reveal that nearly 92.1% [90.1% (99/110) of female and 97.5% (39/40) of male] of the respondents have had adequate awareness on TIRPs. Leaves were the most widely applied plant parts and burning/smoldering the plant materials in order to generate smoke was the most common practice. Chi-square statistical analysis shows that there was no significant difference observed in the knowledge of the repellent plants between the gender (P-value=0.134), average monthly income (P-value=0.529) and educational status (P-value=0.107) but there was a significant association with the age (P-value=0.012) of respondents. However, repellent plants usage custom is significantly associated with gender (P-value=0.021) and educational status (P-value=0.003) of the respondents but, there was such no significant relationship between the age (P-value=0.312) average monthly income (P-value=0.111) and repellent plants usage custom. Conducting more ethnobotanical survey on TIRPs is extremely important in order to generate and maintain the data-base. Besides, identifying the bio-active molecules, which are responsible for the repellent activity and eventually conducting laboratory and field based studies to evaluate their efficacy and safety are extremely imperative to formulate new classes of plant-based insect repellents/insecticides in the near future.


Impact of Increased Gastric pH on the Pharmacokinetics of Evacetrapib in Healthy Subjects.
To examine the effect of increased gastric pH on exposure to evacetrapib, a cholesteryl ester transfer protein inhibitor evaluated for the treatment of atherosclerotic heart disease. Open-label, two-treatment, two-period, fixed-sequence crossover study. Clinical research unit. Thirty-four healthy subjects. In period 1, subjects received a single oral dose of evacetrapib 130 mg on day 1, followed by 7 days of analysis for evacetrapib plasma concentrations. In period 2, subjects received a once/day oral dose of omeprazole 40 mg on days 8-20, with a single oral dose of evacetrapib 130 mg administered 2 hours after the omeprazole dose on day 14, followed by 7 days of pharmacokinetic sampling. Subjects were discharged on day 21 and returned for a follow-up visit at least 14 days after the last dose of evacetrapib in period 2. Gastric pH was measured before subjects received each evacetrapib dose. Noncompartmental pharmacokinetic parameters were estimated from plasma concentration-time data and compared between periods 1 and 2. Geometric mean ratios with 90% confidence intervals (CIs) were reported. Safety and tolerability were also assessed. The mean age of the 34 subjects was 40.9 years; mean body mass index was 27.2 kg/m(2) . Omeprazole treatment increased mean gastric pH across all subjects by 2.80 and increased evacetrapib area under the concentration versus time curve from time zero extrapolated to infinity (AUC0-∞ ) and maximum observed drug concentration (Cmax ) by 15% (90% CI -2 to 35) and 30% (90% CI 3-63), respectively. For both parameters, the upper bound of the 90% CI of the ratio of geometric least-squares means exceeded 1.25 but was less than 2, indicating a weak interaction. To assess the effect of gastric pH on subjects who responded best to omeprazole treatment, the analyses were repeated to include only the 22 subjects whose predose gastric pH was 3.0 or lower in period 1 and 4.0 or higher in period 2. In this subpopulation, mean gastric pH increased by 4.15 during omeprazole treatment, and evacetrapib AUC0-∞ and Cmax increased by 22% (90% CI 4-42) and 35% (90% CI 1-80), respectively. Despite the small mathematical differences between the analyses, the overall effect in both was a minimal increase in evacetrapib exposure. Of 35 adverse events reported during the study, 4 (11.4%) were considered to be treatment-related, and most were mild in severity. The impact of increased gastric pH on evacetrapib pharmacokinetics would not be expected to be clinically relevant. The magnitude of change in pH did not affect the degree of the interaction.


A 25-year experience with renal tumors of childhood.
A retrospective analysis of the medical records of 234 children with renal tumors managed over a 25-year period at the Children's Memorial Medical Center was undertaken to evaluate long-term morbidity and mortality. There was a significant increase in survival over the years of the study. The 5-year survival for patients treated during the period 1985 to 1989 was 94% versus 68% for the period 1965 to 1969. Thirty-three children have died, 15 with known disease progression. Long-term morbidity included scoliosis (39), cardiorespiratory insufficiency (13), hypertension (7), renal insufficiency (7), small bowel obstruction (10), chest wall deformity (3), amenorrhea (1), leg length discrepancy (1), and 1 patient with an esophageal stricture. One patient with cardiomyopathy secondary to adriamycin has recently undergone cardiac transplantation. Five patients with renal insufficiency have required dialysis. Of these five, one patient has had two renal transplants. The presence of distant metastases and positive hilar or regional lymph nodes were the only findings at operation that were associated with an increased mortality (P = .005). There was a significantly increased mortality in those children operated on by general surgeons or urologists at other hospitals (11/43) versus those operated upon at our hospital (22/191) (P = .033). There was no statistical difference in the staging or histology among these children. We feel that the careful and systematic approach of a radical nephrectomy assures accurate staging of the tumor removing gross and microscopic disease in the abdomen.


Clinical trials with one type of lithium pacemaker generator.
Cardiac Pacemakers, Inc. (CPI) solid-state, lithium-powered pulse generators were implanted in 100 patients by one surgeon in a twenty-eight-month period. Eleven CPI pacer generators were replaced, none due to pacer failure. Ninety-nine percent of the patients were followed for a total of 1,397.55 patient-months; 12 patients died, but no deaths appeared to be pacemaker related. The average age of the patients at the time of implantation was 72.8 years. If the warranty period of six years is achieved, the number of pacemaker generator changes required by many of the patients in this group could foreseeably be zero.


Relationship of Oncotype Dx score with tumor grade, size, nodal status, proliferative marker Ki67 and Nottingham Prognostic Index in early breast cancer tumors in Saudi Population.
Oncotype Dx is a 21-gene recurrence score, which is used as a diagnostic tool for the recurrence of breast cancer. It is also used to determine the benefit of chemotherapy for breast cancer in early stages. This study investigates the relationship of Oncotype Dx with pathological prognostic markers of protein Ki 67, Nottingham Prognostic Index (NPI) and tumor grade. Data for early breast cancer patients treated at our tertiary care center was collected for statistical analysis. Data for patients from 2014 to 2018 was recorded for patient's age, ER/PR status, Ki 67, nodal status, tumor grade, NPI along with Oncotype Dx score. Metric measurements were described as mean ± SD and the non-metric data was represented by frequency (%). Chi-square or Fisher's exact tests as well as logistic regression was applied to assess the associations at 95% CI. Among 156 breast cancer patients, the mean age was 55.7 ± 9.4 years. The tumors were classified into Grade-I (12.8%), Grade-II (67.3%) and Grade-III (19.9%). Ki67 score was 12.8 ± 12.0 and NPI score was 3.7 ± 0.8. The mean Oncotype Dx score was 17.0 ± 9.1; it was 14.1 ± 6.8 for Grade-I tumors; 15.7 ± 7.5 for grade -II tumors; and 23.2 ± 12.3 for grade-III tumors [Mean Oncotype Dx score across Tumor grades was compared by ANOVA (η = 0.121), p < 0.001]. While logistic regression analyses for the dichotomized Oncotype Dx higher score (≥25) was significantly associated with grade-III tumors odds ratio (OR) = 13.72 (95% CI: 1.62-115.89), higher Ki67 (>20) OR = 14.40, (95% CI: 1.44-143.71), average NPI score (2.41-3.40), OR = 13.60, (95% CI: 1.57-117.94) to poor NPI (>5.4). The association of Oncotype Dx with age, tumor size and nodal status was statistically not significant. This study revealed that age, Ki67, tumor size and nodal status did not have a statistically significant impact on Oncotypye Dx recurrence score in the targeted patient population. There was a significant correlation of low grade node negative patients with Oncotype Dx while high grade node negative patients had poor correlations with Oncotype Dx. The use of Oncotype Dx has shown to be less cost-effective and has no noticeable association with improved life expectancy in the targeted patient population (i.e., hormone positive, node negative cases) in comparison with current clinical practices in Saudi Arabia and it is less likely to be cost-effective in this group of patients.


Complement fixation antibodies to glycosphingolipids in sera of rare blood group p and Pk phenotypes.
Blood group P antigen and Pk antigen were recently identified as glycosphingolipid globoside, GalNAc(beta, 1 leads to 3)Gal(alpha, 1 leads to 4)Gas(beta, 1 leads to 4)Glc(beta, 1 leads to 1)ceramide, and trihexosylceramide, Gal(alpha, 1 leads to 4)Gal(beta, 1 leads to 4)Gld(beta, 1 leads to 1)ceramide, respectively (Naiki & Marcus, 1974). The presence of antibodies to both antigens in the sera from rare p donors and antibodies to P antigen in the serum from a rare Pk donor were first demonstrated by the complement fixation test with the optimal antigen preparations containing each purified glycoplipid, lecithin and cholesterol. In the serum from a p donor, most of antibody population of anti-P was IgM and was cross-reacted to Forssman glycolipid, GalNAc(alpha, 1 leads to 3)GalNAc(beta, 1 leads to 3)Gal(alpha, 1 leads to 4)Gal(beta, 1 leads to 4)Glc(beta 1 leads to 1) ceramide, but the rest of the anti-P antibodies and most of anti-Pk antibodies were IgG and had marked specificities for globoside and trihexosylceramide, respectively.


[Total acid phosphatase. Trials of commercial kits and control sera (author's transl)].
The authors estimated the total serum acid phosphatase activity of human serum and that of ten commercial sera using seven commercial kits. The reproducibility and the average of the results, the value of the control sera are given for these seven commercial kits.


Malignant phosphaturic mesenchymal tumor, mixed connective tissue variant of the tongue.
The majority of the oncogenic osteomalacia-associated mesenchymal tumors are considered to belong to the category of phosphaturic mesenchymal tumors, mixed connective tissue (PMTMCT) variant, of which malignant cases are very rare. Here we report a case of a recurrent malignant PMTMCT variant which arose in the tongue. The patient was treated with surgery at an initial treatment and the first recurrence. In accordance with the tumor recurrence and resection, the hypophosphatemia progressed and improved. However, hypophosphatemia did not progress after receiving radiation therapy at the second recurrence even though the recurrent tumor gradually increased its size. These results suggest clinical feature of malignant PMTMCT could be changed by radiation therapy. Thus, this report could add an insight to the nature of PMTMCT.


Paternal perinatal depression: A concept analysis.
Our aim is to clarify the concept of paternal perinatal depression including its definition, attributes, antecedents and consequences. A concept analysis. To obtain relevant evidence, several databases were searched systematically including PubMed, EMBASE, Web of Science, CINAHL, PsycINFO and the Cochrane Library. Qualitative or quantitative articles published in English that focused on paternal perinatal depression were included. After the literature quality assessment, Walker and Avant's concept analysis strategy was used. Five defining attributes (i.e. symptoms occur during the partner's pregnancy or 1-year postpartum and last at least 2 weeks, emotional symptoms, somatic symptoms, negative parenting behaviours and 'masked' symptoms), four antecedents (i.e. personal issues, pregnancy-related issues, infant-related issues, social issues) and three consequences (i.e. offspring outcomes, marital relationship, maternal negative emotions) were identified.


Teaching developmental pediatrics to pediatric residents: effectiveness of a structured curriculum.
A national Task Force on Developmental Pediatrics was convened in 1979 to produce a curriculum for pediatric residents pertaining to the detection, assessment, and management of children with atypical development. During a 2-year period, the task force developed a structured curriculum composed of specific goals, educational objectives, and matched learning activities that identified and described the basic knowledge, skills, and attitudes of developmental pediatrics to be acquired during a pediatric residency. Subsequently, the curriculum was implemented and evaluated in 11 pediatric programs with a developmental pediatrics rotation. On a seven-point subjective scale, the mean resident (n = 64) rating of the curriculum's usefulness was 6.0 and of their perceived competence in the skills of developmental pediatrics was 5.2; the mean percent of this competence attributed to the curriculum-based rotation was 56.6. On an objective case management test, residents who used the curriculum scored significantly (P less than .005) higher than those who did not. These results suggest the efficacy of structured curricula in pediatric resident education.


Construction of optical solitons of magneto-optic waveguides with anti-cubic law nonlinearity.
Two efficient integration schemes, new extended hyperbolic function and generalized tanh are employed to discover optical soliton solutions to magneto-optic waveguides that retains anti-cubic form of nonlinear refractive index. Bright, dark, periodic singular, singular, and combo soliton solutions have created. These solutions expose the comprehensive variety of soliton solutions.


Overcoming the formulation obstacles towards targeted chemotherapy: in vitro and in vivo evaluation of cytotoxic drug loaded immunonanoparticles.
The aim of this study was to design a new one step conjugation of monoclonal antibodies (MAbs) to surface activated pegylated polyester nanoparticles (NPs) and evaluate the pharmacokinetic profile and therapeutic effect of paclitaxel palmitate (pcpl) loaded anti-HER2 immunoNPs in mice as compared to pcpl solution and NPs following IV injection. The density of the antibody conjugated to the NPs was found to be around 35 MAbs/NP (70% coupling efficiency). In vitro cell culture studies showed good binding and uptake results when immunoNPs were incubated with PC-3 and CAPAN-1 cell lines. Both pcpl NPs and immunoNPs showed significant increased t1/2, C(max) and AUC values as compared to the values of pcpl solution in mice. There was no significant difference in the C(max) and AUC values between pcpl NPs and pcpl immunoNPs. However, the immunoNPs concentrated much less in the liver and spleen than NPs. The pharmacokinetic behavior of the immunoNPs was markedly different from the pharmacokinetic profile of the naked MAb showing that the MAb lost its intrinsic molecular pharmacokinetic properties following conjugation to the NPs. The immunoNPs elicited a significant anti-tumor activity as compared to the pcpl solution and NPs, although the tumor growth was not fully inhibited.


A one-pot catalyst-free synthesis of functionalized pyrrolo[1,2-a]quinoxaline derivatives from benzene-1,2-diamine, acetylenedicarboxylates and ethyl bromopyruvate.
The catalyst-free multicomponent reaction of 1,2-diaminobenzene, dialkyl acetylenedicarboxylates, and ethyl bromopyruvate forms pyrrolo[1,2-a]quinoxaline derivatives in good yields. Ethylenediamine also reacts under similar conditions to produce new pyrrolo[1,2-a]pyrazine derivatives.


Identification of hepatitis B virus subgenotype A3 in rural Gabon.
An hepatitis B virus (HBV) molecular survey was conducted in five remote villages in the equatorial forest in Gabon, Central Africa. Two hundred seventy out of 311 inhabitants (86.8%) were HBV-infected or had evidence of past HBV infection. Chronic hepatitis corresponding to hepatitis B surface antigen (HBsAg) positivity was suspected in 27 (8.6%) of the HBV-infected subjects. High HBV viral loads were detected mainly in children aged 4-7 years. The pre-S/S domains were sequenced in 13 cases and 12 strains belonged to HBV-A genotype. In one case we found evidence for recombination between genotypes A and E. Phylogenetic analysis revealed that Gabonese HBV strains were distinct from HBV-A subgenotypes (A1 and A2). These new HBV strains from Gabon clustered with previously reported HBV-A3 subgenotype strains from Cameroon and Democratic Republic of Congo. The analysis of the pre-S2 domain allowed us to determine two amino acid substitutions (N/152/S and N/174/T) specific to the Central African HBV-A3 subgenotype strains and one amino acid substitution (P/155/Q) unique to these new Gabonese HBV-A3 subgenotype isolates. Two full genome sequences of two new Gabonese HBV isolates are also presented and confirm the distinctive HBV-Gab-A3 cluster.


Gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020-2021: systematic review of longitudinal studies.
To identify gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020-2021. The risk of gestational complications was confirmed during SARS-CoV and MERS-CoV infection. However, this is not robust for COVID-19 because there is still no scientific evidence from longitudinal studies. A systematic review was performed using four databases, and 14 prospective or retrospective cohorts were finally included in the analysis. The most frequently associated sociodemographic characteristic or comorbidity was the presence of any previous comorbidity (9 studies, 64.3%), followed by ethnicity and age (6 studies each one, 42.9%). The most frequently associated gestational complications in mothers were the admission to Intensive Care Unit (4 studies, 28.6%) and gestational age at delivery <37 weeks (3 studies, 21.4%). The most frequently associated gestational complications in newborns were preterm birth (4 studies, 28.6%) and the admission to Neonatal Intensive Care Unit (2 studies, 14.3%). Pregnant women infected with SARS-CoV-2 appear to have a higher risk of admission to Intensive Care Unit. Newborns of mothers infected with SARS-CoV-2 appear to have a higher risk of preterm birth and admission to Neonatal Intensive Care Unit.


The hemodynamic effects of newborn caudal anesthesia assessed by transthoracic echocardiography: a randomized, double-blind, controlled study.
Caudal anesthesia has been increasingly used in abdominal, urinary tract, and lower extremity surgery of infants. However, little was known about the hemodynamic effects of caudal anesthesia in them, especially in neonates. The purpose of this prospective study was designed to investigate the hemodynamic alterations by transthoracic echocardiography in newborn baby after caudal anesthesia with plain Bupivacaine or with epinephrine added Bupivacaine. Thirty full-term newborn infants scheduled for lower abdominal or urinary tract surgery were randomly allocated into three groups (n = 10 each) as follows: (i) GA group: general anesthesia with sevoflurane; (ii) GA+CP group: GA with sevoflurane, combined with caudal anesthesia of plain Bupivacaine (1.25 ml x kg(-1) of 0.2%); (iii) GA+CA group: sevoflurane GA combined with caudal anesthesia of epinephrine-added Bupivacaine (1.25 ml x kg(-1) of 0.2% Bupivacaine plus 1/200,000 epinephrine). Cardiac output (CO), arterial blood pressure, and heart rate were measured before (T-5) and 5(T5), 10(T10), 15(T15) min after performance of caudal anesthesia. In GA group, no significant hemodynamic alteration was observed in comparison with T-5, except HR, which decreased by 7% at T15; In GA+CP group, compared with T-5, HR decreased significantly at T5, T10 and T15, respectively, by 6%, 7% and 10%. And also CO decreased significantly at T15 by 8% compared with T-5; In GA+CA group, no significant hemodynamic alteration was observed expect diastolic arterial blood, which decreased significantly at T15 by 10% compared with T-5; At T15, the larger decrease of systolic arterial blood in GA+CP group and GA+CA group vs (GA) group (P < 0.05). The study shows the stability of hemodynamic variables during caudal anesthesia with Bupivacaine and with epinephrine-added Bupivacaine in newborn infants.


Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis.
Heller myotomy (HM) remains the gold standard procedure for achalasia. The addition of different types of fundoplication to HM has been debated in several studies. Given the contradictory reports, this meta-analysis was undertaken to compare different outcomes after HM and HM with fundoplication (HMF). An electronic search was performed among five major databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) from inception to October 2019, identifying all randomised and non-randomised studies comparing HM with HMF. Two authors searched electronic databases using the keywords 'achalasia' AND 'dysphagia' AND 'gastroesophageal reflux' and all data were pooled for random-effects meta-analysis. The primary and secondary outcomes were gastroesophageal reflux and dysphagia, respectively. A total of six studies were included and involved 576 patients comparing HM and HMF. There was no statistically significant difference between gastroesophageal reflux in the HM vs HMF group (21.3% vs 22.9%, RR 1.32, 95% CI 0.60-2.88, p = 0.49). There was a slightly higher incidence of dysphagia observed in HM vs HMF (14.8% vs 10.8%, RR 1.54, 95% CI 0.98-2.41, p = 0.06). There was no statistically significant difference in long-term outcomes between a group of patients undergoing HM and a group who underwent HM with fundoplication.


Cost-effectiveness of statins for primary cardiovascular prevention in chronic kidney disease.
The authors sought to evaluate the cost-effectiveness of statins for primary prevention of myocardial infarction (MI) and stroke in patients with chronic kidney disease (CKD). Patients with CKD have an elevated risk of MI and stroke. Although HMG Co-A reductase inhibitors ("statins") may prevent cardiovascular events in patients with non–dialysis-requiring CKD, adverse drug effects and competing risks could materially influence net effects and clinical decision-making. We developed a decision-analytic model of CKD and cardiovascular disease (CVD) to determine the cost-effectiveness of low-cost generic statins for primary CVD prevention in men and women with hypertension and mild-to-moderate CKD. Outcomes included MI and stroke rates, discounted quality-adjusted life years (QALYs) and lifetime costs (2010 USD), and incremental cost-effectiveness ratios. For 65-year-old men with moderate hypertension and mild-to-moderate CKD, statins reduced the combined rate of MI and stroke, yielded 0.10 QALYs, and increased costs by $1,800 ($18,000 per QALY gained). For patients with lower baseline cardiovascular risks, health and economic benefits were smaller; for 65-year-old women, statins yielded 0.06 QALYs and increased costs by $1,900 ($33,400 per QALY gained). Results were sensitive to rates of rhabdomyolysis and drug costs. Statins are less cost-effective when obtained at average retail prices, particularly in patients at lower CVD risk. Although statins reduce absolute CVD risk in patients with CKD, the increased risk of rhabdomyolysis, and competing risks associated with progressive CKD, partly offset these gains. Low-cost generic statins appear cost-effective for primary prevention of CVD in patients with mild-to-moderate CKD and hypertension.


Cardiovascular and behavioral effects of intracisternal 6-hydroxydopamine in the rabbit.
Acute effects of 6-hydroxydopamine (6-OHDA, 400--900 microgram kg-1 intracisternally, i.c.i.) consisted of bradycardia and hypertension, maximal 2--3 h after injection and preceded after some doses by a phase of hypotension. This pattern was obtained in completely conscious rabbits and after propanidid and sodium pentobarbitone anesthesia. After 600 microgram kg-1 i.c.i. 6-OHDA the peak rise in blood pressure (25 +/- 3.8 mm Hg) was due to a rise in peripheral resistance involving particularly renal and intestinal beds. Suprapontine mechanisms contributed to both hypertension and bradycardia. Giving pontine rabbits 6-OHDA elicited a short-latency fall in blood pressure, resembling the hypotensive phase in intact animals. Chronic effects 7 days after 600 microgram kg-1 included a rapid loss of 10% of body weight associated with reduction in food and water intake. To avoid secondary circulatory effects the rabbits were artificially fed, halving the weight loss. At 7 days blood pressure had fallen by 7.4 +/- 2.3 mm Hg probably owing to this residual weight loss. From experiments involving administration of phenotolamine and clonidine in intact rabbits and the responses of pontine animals it is likely that both descending and ascending catecholaminergic pathways have inhibitory effects on blood pressure, though some of the pathways may also be excitatory. Absence of specific chronic circulatory changes may be due to compensation through parallel pathways involving other transmitters.


Origin of the avian predentary and evidence of a unique form of cranial kinesis in Cretaceous ornithuromorphs.
The avian predentary is a small skeletal structure located rostral to the paired dentaries found only in Mesozoic ornithuromorphs. The evolution and function of this enigmatic element is unknown. Skeletal tissues forming the predentary and the lower jaws in the basal ornithuromorph Yanornis martini are identified using computed-tomography, scanning electron microscopy, and histology. On the basis of these data, we propose hypotheses for the development, structure, and function of this element. The predentary is composed of trabecular bone. The convex caudal surface articulates with rostromedial concavities on the dentaries. These articular surfaces are covered by cartilage, which on the dentaries is divided into 3 discrete patches: 1 rostral articular cartilage and 2 symphyseal cartilages. The mechanobiology of avian cartilage suggests both compression and kinesis were present at the predentary-dentary joint, therefore suggesting a yet unknown form of avian cranial kinesis. Ontogenetic processes of skeletal formation occurring within extant taxa do not suggest the predentary originates within the dentaries, nor Meckel's cartilage. We hypothesize that the predentary is a biomechanically induced sesamoid that arose within the soft connective tissues located rostral to the dentaries. The mandibular canal hosting the alveolar nerve suggests that the dentary teeth and predentary of Yanornis were proprioceptive. This whole system may have increased foraging efficiency. The Mesozoic avian predentary apparently coevolved with an edentulous portion of the premaxilla, representing a unique kinetic morphotype that combined teeth with a small functional beak and persisted successfully for ∼60 million years.


Mesh monitor casting of Ni-Cr alloys: element effects.
A mesh monitor has previously been used for quantitative evaluation of the casting of dental alloys. A castability value, Cv was defined. For curve-fitting, a transformed castability value, Cv,t, was used. A series of alloys was selected so that effects of major elements on Cv, t and, hence, on Cv could be determined. Compositions were chosen so that correlated effects would be avoided. Assuming a linear dependence on the concentrations of individual elements, one may use the following equation to describe Cv,t: (Formula: see text) where each term employs an elemental concentration in weight percent, (Ei), and a coefficient, Ki, for the ith term. Because Ei's are constant for each alloy, Ki = fi (TA, TM) = gi (TC, TM). The temperature-dependent coefficients, Ki, were determined for seven elements and for the (Ni/(Cr) ratio. It was also found that Si and Be produce a synergistic effect. The results help our understanding of the casting behavior of Ni-Cr dental alloys; this approach may be useful in the design of dental alloys.


Simulation of the purine nucleotide cycle as an anaplerotic process in skeletal muscle.
A computer model of purine nucleotide and citric acid cycles joined through fumarate is given. Steady-state equations corresponding to metabolic enzymes are written based on the information from the literature about their kinetic behavior. Numerical integration of this set of equations is performed and in order to maintain an overall stabilization between the two cycles, enzymatic activities, in the form of V, have been calculated. Sensitivity coefficients for enzymes indicate that the control is exerted, depending upon the intermediate concentrations, and furthermore, it is demonstrated that AMP concentration in muscle should be very low. From stabilization, simulation of exercise conditions has been performed by diminishing [ATP] and increasing accordingly [ADP] and [AMP]. In such conditions the operation of purine nucleotide cycle leads to a considerable increase in the level of citric acid cycle intermediates. Disruption of purine nucleotide cycle by altering some of the three enzymatic steps leads to a lesser increase of these intermediates. The set of results presented seems to confirm the hypothesis that purine nucleotide cycle acts as an anaplerotic process in muscle, as the experimental results of Aragon and Lowenstein (Aragon, J.J., and Lowenstein, J.M. (1980) Eur. J. Biochem. 110, 371-377) suggest.


A Rare Case of Heerfordt's Syndrome with Bilateral Facial Palsy.
Sarcoidosis is a multi systemic granulomatous disorder involving all the organs of the body. Heerfordt's syndrome is an acute and rare presentation of sarcoidosis. It presents with fever, uveitis and bilateral parotid swelling with unilateral or bilateral facial palsy. It is seen in 0.3 % of cases of sarcoidosis. Typical presentation of Heerfordt's syndrome is rare. Facial palsy is seen in 25-50 % of Heerfordt's syndrome. Bilateral facial palsy is very rare contributing to only 0.3-2 % of all cases of facial nerve palsies. The diagnosis is very difficult as the facial features are less obvious compared to unilateral palsy. In this case report, we have presented a rare case of Heerfordt's syndrome with bilateral facial palsy which was misdiagnosed as mumps. This case highlights the importance of including Heerfordt's syndrome in evaluating the causes of facial palsy. Bilateral facial palsy unlike unilateral is less obvious. Hence a detailed history, thorough clinical examination and relevant investigations will aid in arriving at diagnosis and better management of the patient.


The C-terminal RpoN domain of sigma54 forms an unpredicted helix-turn-helix motif similar to domains of sigma70.
The "sigma" subunit of prokaryotic RNA polymerase allows gene-specific transcription initiation. Two sigma families have been identified, sigma70 and sigma54, which use distinct mechanisms to initiate transcription and share no detectable sequence homology. Although the sigma70-type factors have been well characterized structurally by x-ray crystallography, no high resolution structural information is available for the sigma54-type factors. Here we present the NMR-derived structure of the C-terminal domain of sigma54 from Aquifex aeolicus. This domain (Thr-323 to Gly-389), which contains the highly conserved RpoN box sequence, consists of a poorly structured N-terminal tail followed by a three-helix bundle, which is surprisingly similar to domains of the sigma70-type proteins. Residues of the RpoN box, which have previously been shown to be critical for DNA binding, form the second helix of an unpredicted helix-turn-helix motif. The homology of this structure with other DNA-binding proteins, combined with previous biochemical data, suggests how the C-terminal domain of sigma54 binds to DNA.


DNA repair gene associated with clinical outcome of epithelial ovarian cancer treated with platinum-based chemotherapy.
The nucleotide excision repair (NER) and base excision repair (BER) pathways, two DNA repair pathways, are related to platinum resistance in cancer treatment. In this paper, we studied the association between single nucleotide polymorphisms (SNPs) of involved genes and response to platinum-based chemotherapy in epithelial ovarian cancer. Eight SNPs in XRCC1 (BER), XPC and XPD (NER) were assessed in 213 patients with epithelial ovarian cancer using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR) techniques. The median progression-free survival (PFS) of patients carrying the Lys/Lys and Lys/Gln+Gln/Gln genotype of the XPC Lys/Gln polymorphism were 25 and 12 months, respectively (P=0.039); and the mean overall survival (OS) of patients was 31.1 and 27.8 months, respectively (P=0.048). Cox's multivariate analysis suggested that patients with epithelial ovarian cancer with the Gln allele had an increased risk of death (HR=1.75; 95% CI=1.06-2.91) compared to those with the Lys/Lys genotype. There are no associations between the XPC PAT+/-, XRCC1 Arg194Trp, Arg280His, Arg399Gln, and XPD Asp312Asn, Lys751Gln polymorphisms and the survival of patients with epithelial ovarian cancer when treated with platinum-based chemotherapy. Our results indicated that the XPC Lys939Gln polymorphism may correlate with clinical outcome of patients with epithelial ovarian cancer when treated with platinum-based chemotherapy in Northern China.


[Inhibition of the growth of the Ca-755 tumor in mice with reconstitution of hematopoiesis].
Data on the growth inhibition of Ca-755 tumor transplanted to mice two months after hemopoiesis recovery with syngeneic bone marrow cells or allogeneic fetal liver are presented.


Knockdown of Porf-2 restores visual function after optic nerve crush injury.
Retinal ganglion cells (RGCs), the sole output neurons in the eyes, are vulnerable to diverse insults in many pathological conditions, which can lead to permanent vision dysfunction. However, the molecular and cellular mechanisms that contribute to protecting RGCs and their axons from injuries are not completely known. Here, we identify that Porf-2, a member of the Rho GTPase activating protein gene group, is upregulated in RGCs after optic nerve crush. Knockdown of Porf-2 protects RGCs from apoptosis and promotes long-distance optic nerve regeneration after crush injury in both young and aged mice in vivo. In vitro, we find that inhibition of Porf-2 induces axon growth and growth cone formation in retinal explants. Inhibition of Porf-2 provides long-term and post-injury protection to RGCs and eventually promotes the recovery of visual function after crush injury in mice. These findings reveal a neuroprotective impact of the inhibition of Porf-2 on RGC survival and axon regeneration after optic nerve injury, providing a potential therapeutic strategy for vision restoration in patients with traumatic optic neuropathy.


Cellular interactions in pulmonary oxygen toxicity in vitro: I. Hyperoxic induction of fibroblast factors which alter growth and lipid metabolism of pulmonary epithelial cells.
Pulmonary fibroblasts exposed to hyperoxic conditions in vitro release factors into their culture medium which influence the growth and lipid synthesis of tumor and nontumor pulmonary epithelial cells, but not pulmonary fibroblasts. These factors may be either inhibitory or stimulatory, depending on the degree and duration of hyperoxic exposure. Two stimulatory heat-labile factors have been tentatively identified by gel filtration. A growth-stimulating factor induced by hyperoxia has an apparent molecular weight approximately 20,000-26,000 daltons; a factor tht stimulates lipid synthesis has an apparent molecular weight approximately 8000 daltons. These factors appear distinct from other pneumocyte-specific peptides which occur in response to steroid therapy or pneumonectomy.


Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study.
Convulsive status epilepticus is the most common childhood medical neurological emergency, and is associated with significant morbidity and mortality. Most data for this disorder are from mainly adult populations and might not be relevant to childhood. Thus we undertook the North London Status Epilepticus in Childhood Surveillance Study (NLSTEPSS): a prospective, population-based study of convulsive status epilepticus in childhood, to obtain a uniquely paediatric perspective. Clinical and demographic data for episodes of childhood convulsive status epilepticus that took place in north London were obtained through a clinical network that covered the target population. We obtained these data from anonymised copies of a standardised admission proforma; accident and emergency, nursing, ambulance, and intensive-care unit notes; and interviews with parents, medical, nursing, and paramedic staff. We investigated ascertainment using capture-recapture modelling. Of 226 children enrolled, 176 had a first ever episode of convulsive status epilepticus. We estimated that ascertainment was between 62% and 84%. The ascertainment-adjusted incidence was between 17 and 23 episodes per 100,000 per year. 98 (56%, 95% CI 48-63) children were neurologically healthy before their first ever episode and 56 (57%, 47-66) of those children had a prolonged febrile seizure. 11 (12%, 6-18) of children with first ever febrile convulsive status epilepticus had acute bacterial meningitis. Conservative estimation of 1-year recurrence of convulsive status epilepticus was 16% (10-24%). Case fatality was 3% (2-7%). Convulsive status epilepticus in childhood is more common, has a different range of causes, and a lower risk of death than that in adults. These paediatric data will help inform management of convulsive status epilepticus and appropriate allocation of resources to reduce the effects of this disorder in childhood.


Phase behavior of flowerlike micelles in a SCF cell model.
We study the interactions between flowerlike micelles, self-assembled from telechelic associative polymers, using a molecular self-consistent field (SCF) theory and discuss the corresponding phase behavior. In these calculations we do not impose properties such as aggregation number, micellar structure and number of bridging chains. Adopting a SCF cell model, we calculate the free energy of interaction between a central micelle surrounded by others. Based on these results, we predict the binodal for coexistence of dilute and dense liquid phases, as a function of the length of the hydrophobic and hydrophilic blocks. In the same cell model we compute the number of bridges between micelles, allowing us to predict the network transition. Several quantitative trends obtained from the numerical results can be rationalized in terms of transparent scaling arguments.


Sulforaphane as an adjunctive to everolimus counteracts everolimus resistance in renal cancer cell lines.
The mechanistic target of rapamycin (mTOR) inhibitors, everolimus and temsirolimus, have widened therapeutic options to treat renal cell carcinoma (RCC). However, chronic treatment with these inhibitors often induces resistance, leading to therapeutic failure. The natural compound, sulforaphane (SFN), was added to an everolimus based regime in vitro in the hopes of preventing resistance development. A panel of RCC cell lines (A498, Caki-1, KTCTL-26) was treated with everolimus or SFN or with an everolimus-SFN-combination, either short- (24h) or long-term (8 weeks), and cell growth, proliferation, apoptosis, and cell cycle phases were measured. The cell cycle regulating proteins cdk1, cdk2, cyclin A, cyclin B, akt and raptor (both total and activated) were also evaluated. Short-term incubation with everolimus (1nM) or SFN (5µM) significantly reduced RCC cell growth. Additive effects on tumor growth and proliferation were evoked by the SFN-everolimus combination. Long-term everolimus-incubation led to resistance development in Caki-1 cells, evidenced by elevated growth and proliferation, associated with an increased percentage of G2/M (non-synchronized cell model) or S-phase (synchronized cell model) cells. Molecular analysis revealed up-regulation of the cdk1-cyclin B and cdk2-cyclin A axis, along with elevated phosphorylation of the mTOR sub-member, raptor. In contrast, resistance development was not observed with the long-term combination of SFN-everolimus. The combination suppressed Caki-1 growth and proliferation, and was associated with an increase in G0/G1-phase cells, diminished cdk1 and akt (both total and activated), cyclin B and raptor expression. Adding SFN to an everolimus based RCC treatment regimen in vitro delayed resistance development observed with chronic everolimus monotherapy. Ongoing in vivo studies are necessary to verify the in vitro data.


Practice-based research: necessary intersection between academics and practice.
Practice-based research networks are an exciting way for pediatric practitioners to contribute to the knowledge necessary to provide the best care to their patients. Academic pediatricians should view research networks a necessary and essential aspect of clinical research.


A neosphincter for continent urinary catheterizable channels made from rectus abdominal muscle (Yachia principle): preliminary clinical experience in children.
We investigated continence outcomes for patients undergoing primary or redo reconstruction of a urinary catheterizable reservoir involving the Yachia technique of intersecting two rectus abdominis strips over the outlet channel. A retrospective evaluation of 22 consecutive patients operated from March 2009 to August 2010 was performed, consisting of 16 primary reconstructions (Macedo catheterizable ileal reservoirs) and 6 rescue cases for leaking stomas. Our data comprised 18 spina bifida patients, 1 sacral agenesis, 1 posterior urethral valves and 1 genitourinary tuberculosis. Mean age at surgery was 8.5 years (3-21 years). We evaluated continence at 3, 6, 12 months, and at the last follow-up based on data from urinary charts. Mean follow-up was 21.1 months (12-29 months). Overall continence was 100% for the primary cases and 66% for the redos (2/6 failed). Three patients had initial difficulty in performing clean intermittent catheterization but this resolved with time and experience. Using Yachia's technique has improved the continence rate of our catheterizable reservoirs and was partially successful for suprafascial revision of incontinent conduits.