Factors influencing self-management of adults living with HIV on antiretroviral therapy in Northwest Ethiopia: a cross-sectional study.
Effective self-management is an important consideration for adults living with HIV on therapy to enable people to maintain their health and well-being whilst living with chronic HIV. Although numerous attempts have been made to implement and improve HIV self-management practice, there is limited evidence on effective self-management strategies, particularly in sub-Saharan Africa. This study aimed to identify the level and factors influencing the self-management practice of adults living with HIV on antiretroviral therapy. A cross-sectional survey was conducted on a sample of 415 adults living with HIV on antiretroviral therapy at a major referral hospital in Northwest Ethiopia using convenience sampling. A theory of self-management - the Individual and Family Self-Management Theory - guided the study design, analysis and presentation of the data. A face-to-face survey tool was administered for data collection, and the data were entered and analyzed using SPSS version 25.0. Over half (58.1%) of the respondents were female. Many of the respondents did not know their HIV stage (76.9%) but reported adequate knowledge of their treatment (79.5%). The mean self-management score was 1.94+ 0.22 out of a total score of 3. Female gender was associated with decreased self-management. Contextual factors (gender, educational level, job status, income, living in a rural area, and awareness of HIV stage) explained 8.2% of the variance in self-management. The explanatory power increased by 9.2% when self-management process variables (self-efficacy, setting a goal, knowledge of antiretroviral therapy, HIV disclosure, and use of reminders) were added. Intervention-focused variables (encouraging disclosure and adherence support) increased the proportion of explained variance by 2.3%. The findings of the study indicate that the level of self-management practice amongst the population studied was low compared to international literature. Our study findings support the theoretical model and previously identified factors influencing HIV self-management. The most important predictors of lower self-management practice in Ethiopia were female gender, illiteracy, lack of awareness of HIV stage, low self-efficacy, absence of reminders, lack of encouragement to disclose and absence of adherence support. HIV care providers should seek ways to empower and support adults living with HIV to self-manage, particularly through enhancing self-efficacy and encouraging the use of reminders.


Trend in healthcare-associated infections due to vancomycin-resistant Enterococcus at a hospital in the era of COVID-19: More than hand hygiene is needed.
Variable control measures for vancomycin-resistant Enterococcus (VRE) infections were adopted among different hospitals and areas. We investigated the burden and patient characteristics of healthcare-associated VRE infections in 2018-2019 and 2020, when multiple preventive measures for COVID-19 were taken. During the COVID-19 pandemic, mask waring and hand hygiene were enforced in the study hospital. The incidence densities of healthcare-associated infections (HAIs), including overall HAIs, methicillin-resistant Staphylococcus aureus (MRSA) HAIs, VRE HAIs, and VRE healthcare-associated bloodstream infections (HABSIs), consumption of broad-spectrum antibiotics and hygiene products, demographic characteristics and medical conditions of affected patients, were compared before and after the pandemic. The incidence density of both VRE HAIs and VRE HABSIs did not change statistically significantly, however, the highest in 2020 than that in 2018 and 2019. This was in spite of universal mask waring and increased consumption of 75% alcohol in 2020 and consistent implementation of an antibiotic stewardship program in three observed years. The increased prescriptions of broad-spectrum cephalosporins might partially explain the increase of VRE infection. Increased mask wearing and hand hygiene may not result in the decline in the development of VRE HAIs in the hospital during the COVID-19 pandemic, and continued monitoring of the dynamics of HAIs remains indispensable.


Technical Considerations of the Transforaminal Approach for Lumbar Disk Herniation.
Transforaminal full endoscopic lumbar diskectomy (TELD) is a typical minimally invasive surgery, with the associated benefit of decreased possibility of anatomic structural injury, and is an effective alternative to open diskectomy. Among the various endoscopic spinal surgical techniques currently available, TELD is the most basic and traditional surgery that can be performed through the transforaminal route; it has been used for >30 years. Recently, with the advancements in surgical techniques, TELD has been successfully performed for patients with lumbar disk herniation of different types. However, beginner surgeons are unfamiliar with the anatomy of transforaminal endoscopic surgery and this surgery has a steep learning curve to date. If not well prepared, operators may experience complications that require reoperation in the early stages. These complications may include symptomatic incomplete decompression, exiting nerve root injury, dural tearing, and rarely, hematoma, infection, and visceral injury. Here, we propose several technical guidelines for TELD to increase the possibility of successful lumbar diskectomy and to reduce the incidence of complications. The first step is the accurate anatomic understanding of Kambin triangle and determining the appropriate endoscopic access angle, depending on the type of disk herniation. The second step is to determine a safe and easily accessible entry point and then landing and docking the working sleeve as close to the target as possible without causing exiting nerve root injury. The third step is complete decompression of the symptomatic nerve with free mobilization of the neural tissue. The final step involves performing foraminoplasty using an advanced technique to overcome the limitations associated with TELD in difficult cases.


Commentary: toward an improved understanding of administrative segregation.
The questions raised by O'Keefe et al. challenge us to think clearly about the intent of incarceration generally and the objective of administrative segregation in particular. Our comments address several points: the study's methodology, the context of administrative segregation, several attendant pragmatic concerns linked to its practice, and the challenges of understanding the needs and motivations of individual offenders.


Neutral storage lipids of Histoplasma capsulatum: effect of culture age.
Lipids contribute significantly to the pathogenesis of fungal infectious diseases and an understanding of lipid metabolism occurring in fungal pathogens can help the development of more efficient antifungal therapeutic strategies. In this study, the effect of culture age on the distribution of fatty acids among different neutral lipid (NL) classes in the dimorphic fungus Histoplasma capsulatum was investigated. Yeast cells of the G217B strain grown in two different media were collected after 4 and 7 days of growth, which roughly correspond to log and stationary culture growth phases, respectively. Neither culture age nor medium type had any influence on qualitative fatty acid (FA) profiles; however, the FA percentage composition varied with culture growth. A culture age-related decrease in the content of unsaturated FAs could be observed in all four of the NL classes examined, but the most intensive changes were detected in diacylglycerol and free FA fractions. Conversely, an increase in saturated FAs was observed. The transcriptional analysis of two major delta 9- and delta 12-FA desaturase genes, ode1 and sde1, showed no differences in their expression levels under experimental conditions. These results showing the dynamics of changes in FA composition in the NL fraction were concomitant with nutrient exhaustion in aging H. capsulatum cultures. Overall, the results presented in this work not only have implications for our knowledge of basic lipid biochemistry of H. capsulatum, but also will contribute to better understanding of biology and pathogenesis of this fungus and, consequently, can help in the discovery of more effective antifungal drugs.


Prognostic models based on patient snapshots and time windows: Predicting disease progression to assisted ventilation in Amyotrophic Lateral Sclerosis.
Amyotrophic Lateral Sclerosis (ALS) is a devastating disease and the most common neurodegenerative disorder of young adults. ALS patients present a rapidly progressive motor weakness. This usually leads to death in a few years by respiratory failure. The correct prediction of respiratory insufficiency is thus key for patient management. In this context, we propose an innovative approach for prognostic prediction based on patient snapshots and time windows. We first cluster temporally-related tests to obtain snapshots of the patient's condition at a given time (patient snapshots). Then we use the snapshots to predict the probability of an ALS patient to require assisted ventilation after k days from the time of clinical evaluation (time window). This probability is based on the patient's current condition, evaluated using clinical features, including functional impairment assessments and a complete set of respiratory tests. The prognostic models include three temporal windows allowing to perform short, medium and long term prognosis regarding progression to assisted ventilation. Experimental results show an area under the receiver operating characteristics curve (AUC) in the test set of approximately 79% for time windows of 90, 180 and 365 days. Creating patient snapshots using hierarchical clustering with constraints outperforms the state of the art, and the proposed prognostic model becomes the first non population-based approach for prognostic prediction in ALS. The results are promising and should enhance the current clinical practice, largely supported by non-standardized tests and clinicians' experience.


Selenium Biomarkers and Their Relationship to Cardiovascular Risk Parameters in Obese Women.
A cross-sectional study was carried out with 210 women divided into a case group (obese, n = 84) and a control group (eutrophic, n = 126). Body weight, height, waist circumference (WC), and hip and neck circumference were measured and the waist-hip ratio and conicity index were calculated. Selenium in plasma, erythrocytes and urine, erythrocyte GPx activity, lipid profile, Castelli I and II indices, and systolic and diastolic blood (DBP) pressure were evaluated. Mean dietary selenium intake (µg/kg/day) and plasma and erythrocyte concentrations were lower in the obese group compared to the healthy group (p < 0.001). while urinary selenium concentrations were higher (p < 0.001). There was a statistical difference between groups regarding cardiovascular risk parameters: waist circumference, neck circumference, waist-hip ratio, conicity index, triacylglycerols (TGC), and lipoproteins rich in triacylglycerols (VLDL-c) (p > 0.05). There was a negative correlation between plasma selenium concentrations and total cholesterol (TC), non-high-density lipoprotein (non-HDL), low-density lipoprotein (LDL-c), and systolic blood pressure (SBP). Urinary selenium correlated negatively with waist circumference and hip circumference and positively with neck circumference, TC, TGC, high-density lipoprotein (HDL-c), non-HDL, and VLDL-c. There was a negative correlation between dietary selenium and waist circumference, waist-hip ratio, neck circumference, conicity index, non-HDL cholesterol, LDL-c, and Castelli indices I and II, as well as a positive correlation with HDL-c and diastolic blood pressure. Women with obesity present changes in their nutritional status related to selenium, as well as increased cardiovascular risk parameters. Thus, the positive role of selenium in protecting the risk of cardiovascular disease is likely.


The complexity of human ribosome biogenesis revealed by systematic nucleolar screening of Pre-rRNA processing factors.
Mature ribosomal RNAs (rRNAs) are produced from polycistronic precursors following complex processing. Precursor (pre)-rRNA processing has been extensively characterized in yeast and was assumed to be conserved in humans. We functionally characterized 625 nucleolar proteins in HeLa cells and identified 286 required for processing, including 74 without a yeast homolog. For selected candidates, we demonstrated that pre-rRNA processing defects are conserved in different cell types (including primary cells), defects are not due to activation of a p53-dependent nucleolar tumor surveillance pathway, and they precede cell-cycle arrest and apoptosis. We also investigated the exosome's role in processing internal transcribed spacers (ITSs) and report that 3' end maturation of 18S rRNA involves EXOSC10/Rrp6, a yeast ITS2 processing factor. We conclude that human cells adopt unique strategies and recruit distinct trans-acting factors to carry out essential processing steps, posing fundamental implications for understanding ribosomopathies at the molecular level and developing effective therapeutic agents.


Mechanism of constitutive activation of FLT3 with internal tandem duplication in the juxtamembrane domain.
Internal tandem duplication (ITD) of the juxtamembrane (JM) domain of FLT3 is the most frequent mutation in human acute myeloid leukemia, and is significantly associated with leukocytosis and a poor prognosis. Previously we reported that FLT3 with ITD (FLT3/ITD) formed a homodimer and was autophosphorylated on tyrosine residues, while the mechanism remains unclear. In this study, we elucidated the role of the JM domain in FLT3 activation. Mutant FLT3 with not only ITD but also an elongating or shortening JM domain transformed murine IL3-dependent myeloid progenitor cell line 32D regardless of the tyrosine residues in the JM domain. These mutant FLT3s were constitutively tyrosine phosphorylated and activated signal-transduction molecules such as SHC, MAP kinase and STAT5a. Notably, co-transfection of the truncated FLT3/ITD lacking kinase and C-terminal domains with the wild type (Wt)-FLT3 into 32D cells resulted in the autonomous proliferation. In these cells, truncated FLT3/ITD generated a hetero-complex with Wt-FLT3 and Wt-FLT3 was constitutively tyrosine phosphorylated. These findings indicate that the FLT3 JM domain plays an important role in receptor activation, and that the length-mutated JM domain induces ligand-independent receptor activation but also activates Wt-FLT3 in a trans-manner.


Light sensitivity and chromium dermatitis.
In 25 consecutive cases of chromium contact allergy we have made four parallel serial dilution tests and irradiated three of the test rows, two with solar-spectrum-like radiation from a 150 W Xenon lamp (4/5 MED and 4 MED) and one row with long-wave ultraviolet radiation (blacklight) alone. Comparing an unirradiated row (control) and the row irradiated with 4/5 MED, the reactions were significantly more intense in 48% of the cases, i.e. the patients reacted at lower chromium concentrations. In a corresponding comparison with 4 MED a significantly more intense reaction was obtained in 36% of the cases, whereas blackslight showed no significant difference compared with the control row. The most intense reactions were obtained in the cases which were anamnestically photosensitive and had low MED values.


[Long term electrocardiography (Holter monitoring)].
During the past almost 50 years Holter monitoring has become an established non-invasive diagnostic tool in clinical electrophysiology. It allows ECG recording independent of stationary monitoring facilities during daily life and, therefore, contains much information. In the beginning the main interest was directed towards quantitative and qualitative assessment of arrhythmias, their circadian behaviour, and the circadian behaviour of the heart rate. With advances in technology the analysis spectrum of Holter monitoring expanded, and it was used also for detection of silent myocardial ischaemia. New digital recorders and computers with large capacities made it possible to measure every single heart beat very accurately, which was a prerequisite for heart rate variability and QT-interval analysis, which provided new knowledge about the autonomic modulation of the heart rate and the circadian dynamicity of the QT interval, respectively. Beyond arrhythmia analysis Holter monitoring was increasingly used to assess prognosis in different cardiac conditions. It can also be valuable in assessing transient symptoms possibly related to arrhythmias or device dysfunction, which will not necessarily be revealed by simple device control.


Effects of the depletion of CD8(+) T cells and monocytes on the proliferative responses of peripheral blood leucocytes from Trypanosoma evansi-infected sheep.
Sheep peripheral blood mononuclear cells and those depleted of CD8(+) T cells and/or monocytes were stimulated with polyclonal mitogens and specific antigens, and analysed by means of cell proliferation assay procedure to examine whether these cell populations are involved in Trypanosoma evansi-induced immunosuppression. The removal of CD8(+) T cells failed to normalize the proliferative responses of peripheral blood mononuclear cells from infected sheep to concanavalin A stimulation while the depletion of monocytes resulted in full and enhanced response, showing that macrophages are mainly responsible for the suppression. Although the depletion of CD8(+) T cells, monocytes or both restored the responses of the cells to lipopolysaccharide stimulation, the responsiveness of the undepleted cells to this mitogen was significantly higher from day 24 post infection (p<0.01). The results were discussed in relation to current known mechanisms of depressed lymphocyte proliferation in tsetse-transmitted African trypanosome infections.


Automatic detection of valve events by epicardial accelerometer allows estimation of the left ventricular pressure trace and pressure-displacement loop area.
Measurements of the left ventricular (LV) pressure trace are rarely performed despite high clinical interest. We estimated the LV pressure trace for an individual heart by scaling the isovolumic, ejection and filling phases of a normalized, averaged LV pressure trace to the time-points of opening and closing of the aortic and mitral valves detected in the individual heart. We developed a signal processing algorithm that automatically detected the time-points of these valve events from the motion signal of a miniaturized accelerometer attached to the heart surface. Furthermore, the pressure trace was used in combination with measured displacement from the accelerometer to calculate the pressure-displacement loop area. The method was tested on data from 34 animals during different interventions. The accuracy of the accelerometer-detected valve events was very good with a median difference of 2 ms compared to valve events defined from hemodynamic reference recordings acquired simultaneously with the accelerometer. The average correlation coefficient between the estimated and measured LV pressure traces was r = 0.98. Finally, the LV pressure-displacement loop areas calculated using the estimated and measured pressure traces showed very good correlation (r = 0.98). Hence, the pressure-displacement loop area can be assessed solely from accelerometer recordings with very good accuracy.


Expression of prostaglandin E2 receptor in hamster buccal pouch: effect of benzo (a) pyrene and nicotine.
Prostaglandin E2 (PGE2) plays an important role in the maintenance of oral mucosal integrity. In this study, we characterized PGE2 receptor binding in the buccal mucosa of Syrian hamster and assessed the effect of nicotine (NC) and benzo (a) pyrene (BP), the two major ingredients in cigarette smoke, on this receptor. Adult male animals were treated for 4 weeks by apical swabbing of the buccal pouch with corn oil (control, C), 1 mM NC, BP, or NC + BP in corn oil, twice a day, 5 days a week. The results obtained with the untreated group revealed the presence of a specific PGE2 receptor consisting of two binding sites (high affinity with Kd = 1.52 nM and Bmax = 37 fmol/mg protein and low affinity with Kd = 813 nM and Bmax = 1.29 pmol/mg protein). The treatment with NC, BP, and NC + BP caused a significant decrease in PGE2 receptor binding (specific binding: 10.20 +/- 0.42, 6.84 +/- 1.32**, 6.58 +/- 0.67** and 5.88 +/- 1.03** fmol/mg protein; C, NC, BP, and NC+BP, respectively; Mean +/- SD, n = 5, **p < 0.01). The data suggest that decreased receptor binding for PGE2 in the buccal mucosa may be the cause for the adverse effect of cigarette smoke on the health of oral mucosa.


Embryonic stem cell-derived astrocytes: a novel gene therapy vector for brain tumors.
For gene therapy strategies currently in clinical trials, viral vectors are used to deliver transgenes directly to normal and tumor cells within the central nervous system (CNS). The use of viral vectors is limited by several factors. The aim of this study was to assess whether embryonic stem cell (ESC)-derived astrocytes expressing a doxycyclineinducible transgene can be used as a vector for gene therapy. The authors generated a pure population of ESC-derived astrocytes carrying a transgene, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), inserted in the chromosome under the control of a highly regulated doxycycline-inducible expression system. Fully differentiated ESC-derived astrocytes were stereotactically transplanted in the mouse brain, and then cell migration and transgene expression were studied. The ESC-derived astrocytes started to migrate from the transplant site 48 hours after the procedure. They were found to have migrated throughout the brain tissue by 6 weeks. Transplanted ESC-derived astrocytes expressed the TRAIL transgene after doxycycline induction throughout the duration of the experiment. Teratoma formation was not observed in long-term experiments (12 weeks). These data show that ESC-derived astrocytes can be used as delivery vectors for CNS tumors. This technique might have a major impact on the treatment of patients with malignant gliomas and a wide spectrum of other neurological diseases.


Submergence promotes auxin-induced callus formation through ethylene-mediated post-transcriptional control of auxin receptors.
Plant cells in damaged tissue can be reprogrammed to acquire pluripotency and induce callus formation. However, in the aboveground organs of many species, somatic cells that are distal to the wound site become less sensitive to auxin-induced callus formation, suggesting the existence of repressive regulatory mechanisms that are largely unknown. Here we reveal that submergence-induced ethylene signals promote callus formation by releasing post-transcriptional silencing of auxin receptor transcripts in non-wounded regions. We determined that short-term submergence of intact seedlings induces auxin-mediated cell dedifferentiation across the entirety of Arabidopsis thaliana explants. The constitutive triple response 1-1 (ctr1-1) mutation induced callus formation in explants without submergence, suggesting that ethylene facilitates cell dedifferentiation. We show that ETHYLENE-INSENSITIVE 2 (EIN2) post-transcriptionally regulates the abundance of transcripts for auxin receptor genes by facilitating microRNA393 degradation. Submergence-induced calli in non-wounded regions were suitable for shoot regeneration, similar to those near the wound site. We also observed submergence-promoted callus formation in Chinese cabbage (Brassica rapa), indicating that this may be a conserved mechanism in other species. Our study identifies previously unknown regulatory mechanisms by which ethylene promotes cell dedifferentiation and provides a new approach for boosting callus induction efficiency in shoot explants.


Results of an international survey about methods used to isolate human endothelial colony-forming cells: guidance from the SSC on Vascular Biology of the ISTH.
Assessment of endothelial colony-forming cell (ECFC) number and vasculogenic properties is crucial for exploring vascular diseases and regeneration strategies. A previous survey of the Scientific and Standardization Committee on Vascular Biology of the International Society on Thrombosis and Haemostasis clarified key methodological points but highlighted a lack of standardization associated with ECFC culture. The aim of this study was to provide expert consensus guidance on ECFC isolation and culture. We surveyed 21 experts from 10 different countries using a questionnaire proposed during the 2019 International Society on Thrombosis and Haemostasis Congress in Melbourne (Australia) to attain a consensus on ECFC isolation and culture. We report here the consolidated results of the questionnaire. There was agreement on several general statements, mainly the technical aspects of ECFC isolation and cell culture. In contrast, on the points concerning the definition of a colony of ECFCs, the quantification of ECFCs, and the estimation of their age (in days or number of passages), the expert opinions were widely dispersed. Our survey clearly indicates an unmet need for rigorous standardization, multicenter comparison of results, and validation of ECFC isolation and culture procedures for clinical laboratory practice and robustness of results. To this end, we propose a standardized protocol for the isolation and expansion of ECFCs from umbilical cord and adult peripheral blood.


Regulation and modulation of antitumor immunity in pancreatic cancer.
Pancreatic ductal adenocarcinoma carries a dismal prognosis, and outcomes have improved little with modern therapeutics. Checkpoint-based immunotherapy has failed to elicit responses in the vast majority of patients with pancreatic cancer. Alongside tumor cell-intrinsic mechanisms associated with oncogenic KRAS-induced inflammation, the tolerogenic myeloid cell infiltrate has emerged as a critical impediment to adaptive antitumor immune responses. Furthermore, the discovery of an intratumoral microbiome and the elucidation of host-microbe interactions that curtail antitumor immunity also present opportunities for intervention. Here we review the mechanisms of immunotherapy resistance in pancreatic ductal adenocarcinoma and discuss strategies to directly augment T cell responses in parallel with myeloid cell- and microbiome-targeted approaches that may enable immune-mediated control of this malignancy.


Medical and cytotoxicity effects of green synthesized silver nanoparticles using Achillea millefolium extract on MOLT-4 lymphoblastic leukemia cell line.
Green chemistry, which aims at the development of efficient methods for the synthesis of nanoparticles, is a relatively new emerging field of nanotechnology, which has economic and environment-friendly benefits over chemical and physical processes. The present work was carried out to develop silver nanoparticles (Ag-NPs) using the plant (Achillea millefolium or yarrow) aqueous extract as both a reducing and capping agent under the green synthesis method. Characterization of synthesized Ag-NPs was done using IR spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD), and ultraviolet-visible (UV-vis). The UV-vis spectrum showed the maximum absorbance at around 440-470 nm, which suggested the formation of green synthesized Ag-NPs. The morphological study demonstrated that the Ag-NPs were spherical in shape with an average size of 22.4 ± 7.4 nm. The antimicrobial activities of Ag-NPs against Fusarium and Aspergillus niger species of fungal and Escherichia coli species of bacteria were investigated through the disc diffusion and well-diffusion method using their zone of inhibition. The cytotoxicity effect of Ag-NPs on cell lines MOLT-4 was evaluated by using MTT assay. These nanoparticles showed remarkable antimicrobial activity against bacterias and fungus in low concentration. The cytotoxicity studies showed that IC50 of green synthesized Ag-NPs was 0.011 µm in comparison to 1.8 for Cisplatin which more active than anticancer drug for MOLT-4 cell line. The results showed that the green synthesized Ag-NPs are expected to have notable applications and can be potentially useful in pharmaceutical and biomedical applications.


Role of Hematological Markers in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma.
Various haematological markers have been shown to be diagnostic and prognostic in oral cancer. This study compares the values of the inflammatory metrics neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), ESR and HB in precancerous and cancerous lesions to see if one of them can be utilised to make an early diagnosis of oral squamous cell carcinoma. To compare haematological markers as a diagnostic marker to differentiate healthy individuals, oral potentially malignant disorders from oral squamous cell carcinoma patients. One hundred fifty patients were divided into three groups which includes 50 apparently healthy individuals (group A), 50 individuals with premalignant disorders (group B) and 50 individuals with oral squamous cell carcinoma (OSCC) (group C). The levels of various haematological parameters obtained from 5 ml of intravenous blood was drawn from each subject were compared between these three groups. Using Kruskal Wallis and the Mann Whitney post hoc U test, comparisons between the NLR values were examined. A total of number of 150 individuals were included in the current study. The mean age is 43.3 years out of which 49 (81.6%) were male and 11(18.3%) were female. The mean NLR in group 1, 2 and 3 were 2.16, 3.12 and 3.67 respectively and mean PLR were 91.1, 110.3 and 160.6 respectively. The mean Hb content was 14.8, 13.77 and 12.76 respectively. The mean ESR was 9.65, 17.2 and 27.4 respectively. These parameters can be used as valuable adjuvant in identifying and understanding the nature of disease of both potentially malignant diseases and oral cancer.


Incorporating albumin-bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma.
The albumin-bilirubin (ALBI) grade is a recently emerging alternative of the Child-Pugh (CP) grade. The Cancer of the Liver Italian Program (CLIP) was demonstrated to be a useful prognostic model for hepatocellular carcinoma (HCC) in large prospective cohorts. We aimed to investigate the feasibility of substituting the CP grade by the ALBI grade in the CLIP system and compare the prognostic performance with other existing staging systems. A large cohort of 1973 Chinese patients with HCC was recruited to evaluate the prognostic performance of CP-based CLIP (CP-CLIP) and ALBI-based CLIP (ALBI-CLIP) systems and nine other staging systems by homogeneity likelihood chi-square, c-index, and corrected Akaike information criterion. The ALBI-CLIP system provided comparable prognostic performance than the CP-CLIP system, which was indicated by homogeneity likelihood chi-squares (ALBI-CLIP 1186.35 vs CP-CLIP 1145.54), c-indices (ALBI-CLIP 0.789 vs CP-CLIP 0.785) and AICs (ALBI-CLIP 15 493.47 vs CP-CLIP 15 534.28). Among 11 staging systems, ALBI-CLIP and CP-CLIP systems were associated with the highest homogeneity chi-squares and c-indices, and the lowest corrected Akaike information criterion. Patients in ALBI-CLIP score 0-4 had better median survival than those in corresponding CP-CLIP score. The ALBI grade performs as well as the CP grade when integrating into the CLIP system. ALBI-CLIP and CP-CLIP systems are the most accurate prognostic models among 11 existing staging systems.


Cost-Effectiveness of Continuous Positive Airway Pressure Therapy Versus Other Treatments of Obstructive Sleep Apnea.
Obstructive sleep apnea (OSA) is a common disorder that is increasing in prevalence, both in the United States and worldwide. Continuous positive airway pressure (CPAP), the gold-standard treatment for OSA, is cost-effective from both a payer and societal perspective. Alternative treatments of OSA, including oral appliance therapy, various surgeries, and hypoglossal nerve stimulation have also been evaluated from a cost-effectiveness perspective although results are less consistent. Some studies directly compare these alternative therapies with CPAP. This review will discuss the available literature for cost-effectiveness analysis in the treatment of OSA.


Relationship between sleep problems and psychological outcomes in adolescent and young adult cancer survivors and controls.
How cancer history and distress relate to sleep outcomes of adolescents and young adults (AYAs) is unclear. The current study compares AYA cancer survivors to controls on indicators of sleep and fatigue; examines the concurrent association between psychological status, sleep, and fatigue; and investigates the lagged relationship between sleep and fatigue problems with psychological functioning. AYA cancer survivors (n = 167) and controls (n = 170), ages 16 to 30, completed measures at a survivorship clinic/primary care visit (time 1) and 2 months later (time 2). Participants completed questions about sleep quality, quantity, sleep medication use, self-reports of sleep problems, and fatigue in addition to measures of depression, anxiety, and posttraumatic stress symptoms (PTSS). There were no differences in sleep quantity or quality between survivors and controls, but survivors reported significantly more fatigue. Within groups, AYAs with self-reported sleep and fatigue problems reported significantly higher depression, anxiety, and PTS symptoms. Controlling for baseline depression, sleep, and fatigue problems at time 1 significantly predicted depression at time 2 in survivors but not in controls. This study offers important insight into the psychological functioning of childhood cancer survivors and prospectively describes sleep and fatigue as risk factors for poor psychological functioning in survivors. These findings support screening for sleep problems in AYA survivors as these difficulties are closely related to mental health functioning.


The nexus between HRM, employee engagement and organizational performance of federal public service organizations in Ethiopia.
The study of HRM and Performance of public service is an extremely relevant theme. Although studies on the HRM-performance link have been well documented, the results were inconclusive. Besides, previous studies have paid little attention to the public service from developing country's context. Drawing on the AMO Model and SET, the present study examined the effect of HRM System on Employee Engagement and Organizational Performance. Likewise, this study tested the intervening effect of Employee Engagement in the HRM-performance link. Using a sample of federal employees (n = 340) in government organizations, we tested the hypothesized three-factor model using SEM. The finding of the study shows that there is a positive and significant relationship between HRM, Employee Engagement and Organization Performance. Besides, employee engagement partially mediated the link between HRM and Performance. Concerning the effect of the individual HR practices, the present study revealed a positive and differing effect of HR practices on both engagement and performance although the magnitude effect is smaller than, the combined effect of the HR practices together. Moreover, Autonomy was identified as an important driver of both engagement and performance. This result contributes to the HRM-performance debate. As a final point, the present study incorporates conclusions, implication and future research direction.


First study on trichothecene and zearalenone exposure of the Romanian population through wheat-based products consumption.
In this study, a dietary exposure assessment of mycotoxins was conducted for the Romanian population using the contamination data of a various categories of wheat-based products for direct human consumption. Wheat-based foods (n = 181) commercialized in Romania, including flour, bread, biscuits, breakfast cereals and pasta, were evaluated by GC-QqQ-MS/MS for the occurrence of deoxynivalenol (DON), 3-acetyldeoxynivalenol (3AcDON), 15-acetyldeoxynivalenol (15AcDON), fusarenon-X, nivalenol, HT-2 and T-2 toxins, diacetoxyscirpenol, neosolaniol and zearalenone (ZEA). DON and 15AcDON were detected in 63 and 5% of all the analyzed samples, whereas 13-AcDON, HT-2, T-2, NIV and ZEA were not detected. Exposure of Romanian adult population was assessed, the EDIs for the sum of DON+3AcDON+15AcDON were 669 ng kg-1 bw day-1 at low-bound estimation, and 690 ng kg-1 bw day-1 at upper-bound estimation, being lower than the TDI set (1000 ng kg-1 bw day-1).


Radiation dose to staff from scatter radiation in the post-anaesthetic recovery ward.
Though recovery is a significant aspect of the post-surgical orthopaedic patient pathway, radiation dose from medical imaging to staff within the post-anaesthetic recovery unit, is not extensively researched. This study aimed to quantify the distribution of scatter radiation for common post-surgical orthopaedic examinations. A Raysafe Xi survey meter was used to record scattered dose at various locations around an anthropomorphic phantom, with positions simulating the potential positions of nearby staff and patients. X-ray projections of the AP Pelvis, Lateral Hip, AP and lateral knee were simulated using a portable x-ray machine. Readings were tabulated and diagrams drawn representing the distribution of scatter measurements from each of the four procedures. Magnitude of dose was dependent on imaging parameters (ie. kVp and mAs), the area of body exposed (ie. hip or knee), and the type of projection (ie. AP or lateral). Knee exposures proved much lower than hip exposures at any distance from the radiation source. Maintaining a two-metre distance from the x-ray source was justified most profoundly by the hip exposures. Staff should have confidence that occupational limits will not be reached with adherence to the practices suggested. This study provides comprehensive diagrams and dose measurements with the aim of educating staff working around radiation.


Sindbis virus core protein crystals.
The core protein of Sindbis virus has been crystallized. Three different crystal forms have been observed. They diffract variously from 2.5 A to 3.5 A resolution.


Resilience and efficiency for the nanotechnology supply chains underpinning COVID-19 vaccine development.
Nanotechnology facilitated the development and scalable commercialization of many SARS-CoV-2 vaccines. However, the supply chains underpinning vaccine manufacturing have demonstrated brittleness at various stages of development and distribution. Whereas such brittleness leaves the broader pharmacological supply chain vulnerable to significant and unacceptable disruption, strategies for supply chain resilience are being considered across government, academia, and industry. How such resilience is understood and parameterized, however, is contentious. Our review of the nanotechnology supply chain resilience literature, synthesized with the larger supply chain resilience literature, analyzes current trends in implementing and modeling resilience and recommendations for bridging the gap in the lack of quantitative models, consistent definitions, and trade-off analyses for nano supply chains.


Heterosynaptic plasticity induced by intracellular tetanization in layer 2/3 pyramidal neurons in rat auditory cortex.
Associative Hebbian-type synaptic plasticity underlies the mechanisms of learning and memory; however, Hebbian learning rules lead to runaway dynamics of synaptic weights and lack mechanisms for synaptic competition.Heterosynaptic plasticity may solve these problems by complementing plasticity at synapses that were active during the induction, with opposite-sign changes at non-activated synapses. In visual cortex, a potential candidate mechanism for normalization is plasticity induced by a purely postsynaptic protocol, intracellular tetanization. Here we asked if intracellular tetanization can induce long-term plasticity in auditory cortex. We recorded excitatory postsynaptic potentials (EPSPs) of regular (n =76) and all-or-none (n =24) type in layer 2/3 pyramidal cells in slices from rat auditory cortex. After intracellular tetanization, 32 of 76 regular inputs (42%) showed long-term depression, 21 inputs (28%) showed potentiation and 23 inputs (30%) did not change. The direction of plasticity correlated with the initial release probability: inputs with initially low release probability tended to be potentiated, while inputs with high release probability tended to be depressed. Thus, intracellular tetanization had a normalizing effect on synaptic efficacy. Induction of plasticity by intracellular tetanization required a rise of intracellular [Ca(2+)], because it was impaired by chelating intracellular calcium with EGTA. The long-term changes induced by intracellular tetanization involved both pre and postsynaptic mechanisms. EPSP amplitude changes were correlated with changes of release indices: paired-pulse ratio and the inverse of the coefficient of variation (CV(-2)). Furthermore at some all-or-none synapses, changes of averaged response amplitude were correlated with a change of the failure rate, without a change of the synaptic potency, measured as averaged amplitude of successful responses. Presynaptic components of plastic changes were abolished in experiments with blockade of NO-synthesis and spread, indicating involvement of NO signalling. These results demonstrate that the ability of purely postsynaptic challenges to induce plasticity is a general property of pyramidal neurons of both auditory and visual cortices.


Fatal lactic acidosis and mimicking Guillain-Barré syndrome in an adolescent with human immunodeficiency virus infection.
We report a case of antiretroviral therapy-related fatal lactic acidosis occurring in a vertically infected HIV-positive 17-year-old patient. While receiving antiretroviral therapy with stavudine, didanosine, tenofovir and amprenavir, the patient developed severe acidosis and rapid neuromuscular and respiratory failure mimicking Guillain-Barré syndrome.


Cardiac pacing using transmural multi-LED probes in channelrhodopsin-expressing mouse hearts.
Optogenetics enables cell-type specific monitoring and actuation via light-activated proteins. In cardiac research, expressing light-activated depolarising ion channels in cardiomyocytes allows optical pacing and defibrillation. Previous studies largely relied on epicardial illumination. Light penetration through the myocardium is however problematic when moving to larger animals and humans. To overcome this limitation, we assessed the utility of an implantable multi light-emitting diode (LED) optical probe (IMLOP) for intramural pacing of mouse hearts expressing cardiac-specific channelrhodopsin-2 (ChR2). Here we demonstrated that IMLOP insertion needs approximately 20 mN of force, limiting possible damage from excessive loads applied during implantation. Histological sections confirmed the confined nature of tissue damage during acute use. The temperature change of the surrounding tissue was below 1 K during LED operation, rendering the probe safe for use in situ. This was confirmed in control experiments where no effect on cardiac action potential conduction was observed even when using stimulation parameters twenty-fold greater than required for pacing. In situ experiments on ChR2-expressing mouse hearts demonstrated that optical stimulation is possible with light intensities as low as 700 μW/mm2; although stable pacing requires higher intensities. When pacing with a single LED, rheobase and chronaxie values were 13.3 mW/mm2 ± 0.9 mW/mm2 and 3 ms ± 0.6 ms, respectively. When doubling the stimulated volume the rheobase decreased significantly (6.5 mW/mm2 ± 0.9 mW/mm2). We have demonstrated IMLOP-based intramural optical pacing of the heart. Probes cause locally constrained tissue damage in the acute setting and require low light intensities for pacing. Further development is necessary to assess effects of chronic implantation.


Pleural ultrasound for clinicians.
Pleural ultrasonography is useful for identifying and characterising pleural effusions, solid pleural lesions (nodules, masses, swellings) and pneumothorax. Pleural ultrasonography is also considered the standard care for guiding interventionist procedures on the pleura at the patient's bedside (thoracentesis, drainage tubes, pleural biopsies and pleuroscopy). Hospitals should promote the acquisition of portable ultrasound equipment to increase the patient's safety.


A locally advanced pancreatic body cancer presenting common bile duct invasion resected via distal pancreatectomy after gemcitabine plus nab-paclitaxel chemotherapy: A case report.
The locally advanced pancreatic cancer has been steadily recognized as a potentially curable disease by a combination of chemotherapy and surgery. The remarkable effect of advanced chemotherapy would help surgeons do a function-preserving operation for advanced pancreatic cancer. A 73-year-old woman presenting with obstructive jaundice was diagnosed to have a 3-cm pancreatic body cancer invading the celiac axis (CA), superior mesenteric artery (SMA), portal/splenic vein confluence, and the common bile duct (CBD). A plastic internal stent tube was placed endoscopically. After 11 cycles (231 days) of a weekly doublet chemotherapy with 1000 mg/m2 of gemcitabine and 125 mg/m2 of albumin-bound paclitaxel, the tumor shrunk based on imaging done every four months during chemotherapy, with residual periarterial high-density area around CA and proximal SMA and the patient was referred for surgery. During the operation, the absence of cancer cells was confirmed at (1) the origin of the proper hepatic artery, gastroduodenal artery and the left gastric artery, and (2) pancreatic cut stump along the right border of the portal vein; thus, distal pancreatectomy with coeliac axis resection was done. The patient had postoperative adjuvant chemotherapy with 100 mg/day of tegafur/gimeracil/oteracil for half a year and is currently alive and well, without signs of recurrence and diabetes mellitus a year after surgery. Although surgical techniques aimed at local radicality are important, especially for conversion surgery for locally advanced pancreatic cancer, surgeons should consider the balance between radicality, safety, and functional preservation of surgery.


Dental Pathology in a Wild Serval (Leptailurus serval) Population.
Members of the family Felidae suffer from a wide range of dental, oral and maxillofacial conditions that can cause significant morbidity and mortality. Although many dental, oral and maxillofacial anomalies of the domestic cat (Felis catus) also occur in wild felines, we could find no investigations of these conditions in servals (Leptailurus serval). The objective of this study was to describe the dental, oral and maxillofacial pathology of a wild serval population in South Africa. Detailed extraoral and intraoral examinations and full-mouth dental radiographs on 30 wild servals revealed 14 different dental conditions but no other oral or maxillofacial pathology.


Persistence of Salmonella enterica subsp. enterica ser. Javiana, Listeria monocytogenes, and Listeria innocua in Hydroponic Nutrient Solution.
This study aimed to determine the persistence of Salmonella Javiana, Listeria monocytogenes, and Listeria innocua in nonsterile, hydroponic nutrient solution (NS) at 15, 25, 30, and 37°C over a 21-day period to mimic time from seedling to mature lettuce. Bacteria were inoculated in modified Hoagland's NS at 106 CFU/mL and maintained at 15, 25, 30, and 37°C. Samples were collected at various time points, and bacteria were quantified. A mixed model was used to determine the effect of bacteria type, time (day), and temperature on bacteria concentration (log CFU/mL). The least-squares means were calculated to compare the mean log CFU/mL, and the mean values were compared with Tukey-Kramer honest significant difference test with a significance level of P = 0.05. Statistical analysis indicated that a 3-way interaction effect between temperature, time, and bacteria type had a significant impact on bacterial persistence in NS (P < 0.0001). At all temperatures, S. Javiana persisted in NS throughout the 21-day study period, compared to L. innocua and L. monocytogenes where persistence was limited to between 1 and 14 days. Similarly, decimal reduction values (D-values) of S. Javiana indicated longer persistence in NS than L. innocua and L. monocytogenes at most temperatures. For instance, at 15°C and 25°C, D-values for S. Javiana were estimated at 82 and 26 d, respectively, compared to D-values of 3.6 and ∼3 d for L. monocytogenes. Data indicate that the temperature of NS has a differential effect on the persistence of S. Javiana and Listeria spp. This study furthers the understanding of potential food safety risks associated with hydroponic systems and will contribute to the refinement of further studies to aid in the development of operation-specific risk profiles.


Environment: peculiar pigment cell neoplasm in fish.
Chromatophoroma in the croaker (Nibea mitsukurii) showed a unique geographic distribution. The contribution of environmental chemicals to the cause of chromatophoroma in the feral croaker is considered likely on the basis of the following results in our studies. 1) Chromatophoroma was induced in tank-reared N. mitsukurii by administration of certain kinds of known carcinogens such as 7,12-dimethyl-benz(a)anthracene, N-methyl-N'-nitro-N-nitrosoguanidine, and nifurpirinol. 2) Local accumulation of pigment-cell hyperplasia in the catfish (Protosus anguillaris) showed similar tendencies to those of chromatophoroma in N. mitsukurii. 3) Removal of contaminated sediment from the harbor and the river appeared to reduce the incidence from 47% in 1973-1983 to about 20% in 1985-1987. 4) Waste water from a factory located at the station where the incidence of the neoplasm was the highest contained mutagenic substances such as chloroacetones and glyoxals [5]. Exposure of catfish to the waste water induced pigment-cell hyperplasia on the skin.


Genetically modified malaria parasites as vaccine candidates.
Induction of sterile immunity against sporozoite and liver stages of malaria is a long-standing aim in vaccine development. Genetically engineered, attenuated sporozoites were systematically evaluated in animal models. Murphy et al. present the first, promising clinical trial of early arresting parasites, PfGAP3KO, confirming safety and demonstrating efficacy against homologous challenge.


Electro-optic sensor from high Q resonance between optical D-fiber and slab waveguide.
An electro-optic sensor capable of detecting electric fields with a high degree of sensitivity and linearity is fabricated using optical D-fiber. The slab coupled optical sensor utilizes weak coupling and long evanescent interaction with a lithium niobate waveguide. Transmission dips from mode resonances have a linewidth of 0.12 nm and a Q factor of approximately 13,000. These sharp resonances improve device sensitivity and are achieved due to the unique fabrication process possible with D-shaped fibers. The sensor deviates <0.1% from linearity while monitoring fields between 200 V/m and 20 kV/m and promises high sensitivity to fields well beyond that range.


3D ultrastructure of the nuclear pore complex.
Nuclear pore complexes (NPCs) perforate the double-layered nuclear envelope and form the main gateway for molecular exchange between nucleus and cytoplasm of the eukaryotic cell. Because NPCs are extraordinarily complex and large, thus challenging to investigate on a molecular level, they are still rather poorly understood, despite their pivotal role in cellular homeostasis. To decipher the NPC structure at high resolution, the prerequisite to fully understand its function, a tailored approach is necessary that feeds from complimentary data, obtained at largely different spatial resolutions. The problem is further complicated by the dynamic nature of the NPC, manifested in flexible regions and dynamic components. Here we summarize the current state of these structural efforts, describe the breakthroughs of recent years, point out the existing disputes in the field, and give an outlook of what we should expect to happen in the near future.


Photoregulation of DNA polymerase I (Klenow) with caged fluorescent oligodeoxynucleotides.
The DNA polymerase reaction by Klenow fragment (KF) was efficiently regulated with UV light using a 25-mer caged fluorescent oligodeoxynucleotide (CFO) as the template. The CFO was functionalized with a fluorescein reporter (Fl) and photocleavable DABSYL quencher moiety (Dab). With Fl and Dab at adjacent cytidines in the middle at the template, KF was blocked from extending a complementary 12-mer primer. Upon UV photolysis of the DABSYL blocking group under aerobic conditions, fluorescein emission was restored and 50% of the primers were fully extended by KF.


A perichondrial flap for functional purposes in rhinoplasty.
Recent trends in rhinoplasty techniques have focused on anatomic repair as well as respect and preservation of soft tissue integrity. In this article, the authors describe the use of a perichondrial flap, then discuss technical considerations and clinical perspectives of their advantages. A perichondrial flap helps to restore the stability of the upper lateral cartilage, to achieve extra padding, and to secure osteocartilagenous grafts. The method described has been used for 60 consecutive patients. The majority of these patients were satisfied with the results. To obtain detailed information about the perichondrial flap, the authors performed an anatomic study of 13 cadavers. The average thickness of the perichondrium was 186+/-146.1 microm (range, 90--596 microm). On the basis of the results, it was concluded that elevation of the perichondrial flap with loupe magnification could improve the outcome of rhinoplasty.


Chronic Use of Theophylline and Mortality in Chronic Obstructive Pulmonary Disease: A Meta-analysis.
Theophylline has been shown to improve respiratory function and oxygenation in patients with chronic obstruction pulmonary disease (COPD). However, the impact of theophylline on mortality in COPD patients has not been not sufficiently evaluated. Two investigators independently searched for eligible articles in 4 databases. The eligibility criterion for this meta-analysis was an original research article that provided a hazard ratio for theophylline for all-cause mortality of COPD patients. Both randomized controlled trials and observational studies were accepted. After we confirmed no substantial heterogeneity (I(2)<50%), the fixed-model method with generic inverse variance was used for meta-analysis to estimate the pooled hazard ratio. We screened 364 potentially eligible articles. Of the 364 articles, 259 were excluded on the basis of title and abstract, and 99 were excluded after examination of the full text. Our final analysis included 6 observational studies and no randomized controlled trials. One study reported 2 cohorts. The number of patients in each cohort ranged from 47 to 46,403. Heterogeneity (I(2)=42%, P=.11) and publication bias (Begg's test r=0.21, P=.662) were not substantial. Fixed-model meta-analysis yielded a pooled hazard ratio for theophylline for all-cause death of 1.07 (95% confidence interval: 1.02-1.13, P=.003). This meta-analysis of 7 observational cohorts suggests that theophylline slightly increases all-cause death in COPD patients.


Histologic and clinical significance of atypical glandular cells on pap smears.
To determine the association between atypical glandular cells (AGC) on Pap smear and clinically significant histology, in a large health region. A cytologic database of over one million Pap smears was reviewed for a result of AGUS/AGC. Cytologic and histologic follow up was obtained to establish the presence of significant histology. 456 patients available for follow up had AGUS/AGC cytology results (0.043% of all Pap smear results). 197(45.2%) patients had a clinically significant diagnosis including 40 with adenocarcinoma in situ (AIS) of the cervix and 48 with endometrial cancer. AGC on a Pap smear is frequently associated with a clinically significant diagnosis.


The posterior two-portal approach for reconstruction of scapula fractures: results of 39 patients.
The purpose of this study was to describe the so-called posterior two-portal approach to the scapula in detail and to investigate the clinical outcome of patients with displaced glenoid and scapular neck fractures who were surgically treated using this approach. From February 1992 to August 2008, 39 patients (30 men and nine women; mean age: 53 years) with scapular fractures underwent surgical fixation at our institution. Thirty-three patients had glenoid fractures and six had unstable scapular neck fractures. All patients were treated via the two-portal approach. The reduction was evaluated radiographically, and the clinical results were analysed using the Constant score. The mean follow-up period was 78 months (range: 6-168). In 24 of the 33 glenoid fractures, the reduction was anatomical. The mean Constant score was 82.3 (range: 35-100) points. In one case, an early postoperative wound infection was cured by local revision, and one patient developed posttraumatic osteoarthritis of the acromioclavicular joint after 2 years. Only one patient developed specific glenohumeral degeneration after non-anatomical reduction. The posterior two-portal approach allows for a good visualisation of the posterior scapular neck and the glenoid area, facilitating the reduction and safe internal fixation of dislocated scapular neck and glenoid fractures.


A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI).
Individuals living with acquired brain injury, typically caused by stroke or trauma, are far less likely to achieve recommended levels of physical activity for optimal health and well-being. With a growing number of people living with chronic disease and disability globally, self-management programs are seen as integral to the management of these conditions and the prevention of secondary health conditions. However, to date, there has been no systematic review of the literature examining the efficacy of self-management programs specifically on physical activity in individuals with acquired brain injury, whether delivered face-to-face or remotely. Therefore, the purpose of this review is to evaluate the efficacy of self-management programs in increasing physical activity levels in adults living in the community following acquired brain injury. The efficacy of remote versus face-to-face delivery was also examined. A systematic review of the literature was conducted. Electronic databases were searched. Two independent reviewers screened all studies for eligibility, assessed risk of bias, and extracted relevant data. Five studies met the inclusion criteria for this review. Studies were widely heterogeneous with respect to program content and delivery characteristics and outcomes, although all programs utilized behavioral change principles. Four of the five studies examined interventions in which physical activity was a component of a multifaceted intervention, where the depth to which physical activity specific content was covered, and the extent to which skills were taught and practiced, could not be clearly established. Three studies showed favorable physical activity outcomes following self-management interventions for stroke; however, risk of bias was high, and overall efficacy remains unclear. Although not used in isolation from face-to-face delivery, remote delivery via telephone was the predominant form of delivery in two studies with support for its inclusion in self-management programs for individuals following stroke. The efficacy of self-management programs in increasing physical activity levels in community-dwelling adults following acquired brain injury (ABI) is still unknown. Research into the efficacy of self-management programs specifically aimed at improving physical activity in adults living in the community following acquired brain injury is needed. The efficacy of remote delivery methods also warrants further investigation. PROSPERO CRD42013006748.


A lower fistula rate in hypospadias surgery.
To determine whether specific steps taken after a critical quality control of our results in hypospadias surgery lead to a decrease in fistula rate. Retrospective review of prospectively collected data. Between 1994 and 2001, our series of 85 tubularized plate urethroplasties (modified Duplay or Duplay-Snodgrass procedure) had a fistula rate of 25.9%. In 2001, we modified our approach by systematically padding the urethral suture with a layer of vascularized subcutaneous preputial tissue, as described by Snodgrass. Scrotal hypospadias were excluded. Surgical outcome was assessed at 1 and 12 months. In both groups, all repairs were performed by or under direct supervision of the senior author (BJM). After 2001, 57 hypospadias repairs were performed in 57 patients aged 8 months to 14 years (median 1.4 years). Fistula occurred in two cases, one of which closed spontaneously within 6 months. Our fistula rate had dropped to 3.5%, with a minimum follow up of 12 months. Covering the urethral suture with a padding flap of vascularized preputial tissue helps avoid fistula formation. Technique modification after critical appraisal of our own series led to a much better outcome in this demanding surgery.


Occurrence of yersiniosis and listeriosis in wild boars in Japan.
From December 1994 to February 1995, 131 wild boars (Sus scrofa leucomysta) living in a mountainous area in Japan were examined for yersiniosis and listeriosis. Of 131 wild boars, 76 (58%) were males and 55 (42%) were females. Four Yersinia spp. including Y. pseudotuberculosis, Y. enterocolitica, Y. frederiksenii, and Y. aldovei, were isolated from 49 (37%) of 131 wild boars. Yersinia pseudotuberculosis was isolated from five (4%) of 131 wild boars. All Y. pseudotuberculosis isolates were serotype 4b and harbored virulence plasmids. Yersinia pseudotuberculosis was isolated only from boars under 2-yr-old. No human pathogenic Y. enterocolitica was isolated. Listeria monocytogenes was isolated from two (1%) of the wild boars and both isolates were serotype 4b. These findings indicated that wild boar could be a reservoir of Y. pseudotuberculosis and L. monocytogenes in Japan.


The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke.
Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.


Perioperative outcomes of robotic-assisted partial nephrectomy in elderly patients: a matched-cohort study.
To compare elderly patients undergoing robotic assisted partial nephrectomy (RAPN) with a match cohort of younger patients. Investigating the benefits of minimally invasive RAPN including faster convalescence and decreased postoperative narcotic use make this an attractive option in patients with advanced age and numerous comorbidities. A retrospective review of 250 consecutive patients who underwent robotic-assisted partial nephrectomy (RAPN) for a solitary renal tumor from June 2006 to May 2010 at our institution was performed. Thirty-seven patients ≥ 70 years (G70) who underwent 38 robotic partial nephrectomy (RPN) procedures were identified. This group was matched with 38 patients <70 years (L70) who underwent 38 RPN procedures at our institution. Functional, perioperative, and oncological outcomes of RAPN in patients ≥ 70 years old were analyzed. Overall, the median tumor size was 2.65 cm. Tumor characteristics, renal function, nephrometry score, and incidence of renal cancer in lesions were similar between the L70 and G70 groups. The two groups showed no differences in American Society of Anesthesiologists scores of 1-4 or Charlson comorbidity index score. Perioperative and postoperative outcomes showed no variation between L70 and G70 patients. Postoperative complications rate of 21% and 31.6% in the L70 and G70 groups, respectively, showed no difference (P < .48). There were 5 deaths, 3 of which occurred in the G70 group (8.1%) at a median of 22 months after surgery. RAPN for small renal masses offers a safe alternative for patients >70 years of age, with no increase in perioperative and postoperative morbidity and mortality. Age may not be predictive of perioperative complications.


Pseudotumor cerebri manifesting as stiff neck and torticollis.
Stiff neck and torticollis are significant signs of neurologic disease. Nuchal rigidity is often associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumor. Torticollis may be encountered in inflammatory disorders, such as cervical lymphadenitis, or it can be a sign of spinal cord syrinx or of central nervous system neoplasm. We report on three prepubertal children in whom stiff neck and torticollis were the presenting signs of pseudotumor cerebri. In all, the removal of 6-7 mL of cerebrospinal fluid led to prompt relief of symptoms and signs. We suggest that in the presence of unexplained stiff neck or torticollis in children, the optic discs should be examined to exclude pseudotumor cerebri.


Enhanced Bone Regeneration Using a ZIF-8-Loaded Fibrin Composite Scaffold.
In the present study, fibrin-based biomaterials made of zeolite imidazole framework-8 (ZIF-8) and fibrin gel (Z-FG) are fabricated with the aim of enhancing skull regeneration. X-ray diffraction (XRD), scanning electron microscopy (SEM), ultraviolet (UV)-vis spectrophotometry, Fourier transform infrared spectroscopy, and rheometry are used to characterize ZIF-8 and Z-FG. The influences of ZIF-8 on the physical properties of fibrin gel (e.g., porosity, modulus, and in vitro biodegradation) are investigated, and the effect of ZIF-8 concentration on fibrin gel properties in vitro is determined by seeding ectomesenchymal stem cells (EMSCs) over Z-FG. EMSC osteogenic differentiation reveals higher expression of bone-related proteins and higher calcium deposition and alkaline phosphatase activity, indicating that Z-FG may be a good osteoinductive biomaterial. Furthermore, these results show that the piezochannel and yes-associated protein (YAP) signaling pathway are involved in the differentiation process. In addition, the in vivo results demonstrate that Z-FG increases bone formation in critical-sized calvarial defects in rats. Thus, the developed composite scaffold may be a suitable biomaterial for skull tissue-engineering applications.


An Investigation of Cognitive and Affective Changes During Group Imagery Rescripting for Social Anxiety Disorder.
Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioral therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.


Early induction of nerve growth factor-induced genes after liver resection-reperfusion injury.
Nur-related factor 1 (Nurr1) has been implicated in liver generation after hepatectomy. We hypothesized that the genes in the nerve growth factor-induced gene B (NGFI-B) family was induced in liver ischemia-reperfusion injury. Expression of the NGFI-B family genes was examined by the reverse transcription-polymerase chain reaction in rat and human livers. In situ hybridization was performed to check the localization of the NGFI-B gene in rat liver. Expression of phospho-Ser-133-specific cyclic adenosine-3' :5'-monophosphate response element binding (pCREB) protein was examined by Western blot analysis and gel shift assay, since the promoter region of the NGFI-B family genes contains CRE. The expression of the NGFI-B family genes were recognized within 30 min after ischemia-reperfusion in rat liver, which was augmented by cycloheximide injection. In human specimens, the NGFI-B family genes expression was stronger than that before ischemic insult. pCREB protein was detected in the rat liver sampled 15 min after reperfusion. Gel shift assay suggested that CREB bound to neuron-derived orphan receptor gene in rat liver cells. We recognized the early induction of the NGFI-B family genes after ischemia-reperfusion injury in rat and human livers. A pathway via CREB may be responsible for the induction.


Long-term follow-up of bilateral hip and knee arthroplasty secondary to ochronotic arthropathy.
Alkaptonuria is a rare metabolic disorder caused by the deficiency of homogentisic acid oxidase enzyme, which is responsible for eliminating homogentisic acid from the body through the renal system. Excessive accumulation of homogentisic acid leads to ochronosis and ochronotic arthritis. Owing to the rarity of the disease, long-term functional outcomes of joint replacements of the hips and knees in ochronosis arthropathy are unconfirmed, and only a limited number of case reports are available on this. We present a case of a 45-year-old man with ochronosis and advanced osteoarthritis of both the hips and knees. He underwent bilateral hip and knee replacements as staged procedures. At a follow-up of more than 12 years, the man had full mobility with no loosening of implants.


Case Report: COVID-19 Associated Renal Infarction and Ascending Aortic Thrombosis.
Following its discovery in Wuhan, China, in December 2019, COVID-19 has attained pandemic status in mere months. It is caused by SARS-CoV-2, an enveloped beta coronavirus. This infection causes a prothrombogenic state by interplay of inflammatory mediators, and endothelial, microvascular, and possible hepatic damage and tissue tropism of the virus. This leads to frequent pulmonary and cerebral thromboembolism as well as occasional involvement of other organs. We present a 71-year-old man who initially presented with 2 weeks of fever, cough, and shortness of breath and was diagnosed with COVID-19 pneumonia. He required readmission due to worsened hypoxia and was later found to have left renal artery thrombosis with left kidney infarction, associated with an ascending aortic thrombus. He was anticoagulated and recovered uneventfully. We suggest that physicians have a high degree of suspicion to diagnose and manage the novel manifestations of this disease.


Does the timing of esophagectomy after chemoradiation affect outcome?
After neoadjuvant chemoradiation (CXRT) for esophageal cancer, surgery has traditionally been recommended to be performed within 8 weeks. However, surgery is often delayed for various reasons. Data from other cancers suggest that delaying surgery may increase the pathologic complete response rate. However, there are theoretical concerns that waiting longer after radiation may lead to a more difficult operation and more complications. The optimal timing of esophagectomy after CXRT is unknown. From a prospective database, we analyzed 266 patients with resected esophageal cancer who were treated with neoadjuvant CXRT from 2002 to 2008. Salvage resections were excluded from this analysis. We compared patients who had surgery within 8 weeks of CXRT and those who had surgery after 8 weeks. We used multivariable analysis to determine whether increased interval between chemoradiation and surgery was independently associated with perioperative complication, pathologic response, or overall survival. One hundred fifty patients were resected within 8 weeks and 116 were resected greater than 8 weeks after completing CXRT. Mean length of operation, intraoperative blood loss, anastomotic leak rate, and perioperative complication rate were similar for the two groups. Pathologic complete response rate and overall survival were also similar for the two groups (p=not significant). In multivariable analysis, timing of surgery was not an independent predictor of perioperative complication, pathologic complete response, or overall survival. The timing of esophagectomy after neoadjuvant CXRT is not associated with perioperative complication, pathologic response, or overall survival. It may be reasonable to delay esophagectomy beyond 8 weeks for patients who have not yet recovered from chemoradiation.


Fast and sensitive determination of urinary 1-hydroxypyrene by packed capillary column switching liquid chromatography coupled to micro-electrospray time-of-flight mass spectrometry.
The present work reports capillary liquid chromatographic column switching methodology tailored for fast, sensitive and selective determination of 1-hydroxypyrene (1-OHP) in human urine using micro-electrospray ionization time-of-flight mass spectrometric detection. Samples (100 microl) of deconjugated, water diluted and filtered urine samples were loaded onto a 150 microm I.D.x 30 mm 10 microm Kromasil C(18) pre-column, providing on-line sample clean-up and analyte enrichment, prior to back flushed elution onto a 150 microm I.D.x 100 mm 3.5 microm Kromasil C(18) analytical column. Loading flow rates up to 100 microl/min in addition to the use of isocratic elution by a mobile phase composition of acetonitrile/water (70/30, v/v) containing 5 mM ammonium acetate provided elution of 1-OHP within 5.5 min and a total analysis time of less than 15 min with manual operation. Ionization was performed in the negative mode and 1-OHP was observed as [M-H](-) at m/z 217.08. The method was validated over the concentration range 0.2-40 ng/ml 1-OHP in pre-treated urine, yielding a coefficient of correlation of 0.997. The within-assay (n=6) and between-assay (n=6) precisions were in the range 6.4-7.3 and 7.0-8.1%, respectively, and the recoveries were in the range 96.2-97.5 within the investigated concentration range. The method mass limit of detection was 2 pg, corresponding to a 1-OHP concentration limit of detection of 20 pg/ml (0.09 nmol/l) diluted urine or 0.3 ng/ml (1.35 nmol/l) urine.


Regulation of natural killer cell cytotoxicity by prostaglandin E in the peripheral blood and cerebrospinal fluid of patients with multiple sclerosis and other neurological diseases. Part 2. Effect of exogenous PGE1 on spontaneous and interferon-induced natural killer.
Compared to normal and other neurological disease (OND) controls, multiple sclerosis (MS) pre nylon wool (pre NW) and nylon wool passed (NWP)-peripheral blood cells' natural killer (NK) activity was more sensitive to prostaglandin E (PGE1); it was suppressed to a greater degree and at lower concentrations of PGE1. At the single cell level this was reflected by lower numbers of target-binding cells (TBCs) and fewer killers among the TBCs. ONDs and normal controls were equally sensitive to PGE1. Though PGE-producing cells were depleted in the NWP population of normal and control ONDs, MS patients still had indomethacin-sensitive NK suppressors in the NWP population; these apparently did not suppress at the single cell effector level but at the level of recycling. MS and OND cerebrospinal fluid (CSF) cells' NK activity could not be 'enhanced' by indomethacin. Depression of interferon (IFN)-induced NK by PGE1 was greater in MS than in OND or normal controls perhaps through its effect on IFN-induced recycling. All subjects' cells maintained sensitivity to PGE1 after overnight incubation in the presence of PGE-producing cells (pre NW) or exogenous PGE1. In sharp contrast to normal and OND controls, MS NWP cells were still inhibited by PGE1 even after overnight incubation in the absence of PGE1.


Coding region polyadenylation generates a truncated tRNA synthetase that counters translation repression.
Posttranscriptional regulatory mechanisms superimpose "fine-tuning" control upon "on-off" switches characteristic of gene transcription. We have exploited computational modeling with experimental validation to resolve an anomalous relationship between mRNA expression and protein synthesis. The GAIT (gamma-interferon-activated inhibitor of translation) complex repressed VEGF-A synthesis to a low, constant rate independent of VEGF-A mRNA expression levels. Dynamic model simulations predicted an inhibitory GAIT-element-interacting factor to account for this relationship and led to the identification of a truncated form of glutamyl-prolyl tRNA synthetase (EPRS), a GAIT constituent that mediates binding to target transcripts. The truncated protein, EPRS(N1), shields GAIT-element-bearing transcripts from the inhibitory GAIT complex, thereby dictating a "translational trickle" of GAIT target proteins. EPRS(N1) mRNA is generated by polyadenylation-directed conversion of a Tyr codon in the EPRS-coding sequence to a stop codon (PAY(∗)). Genome-wide analysis revealed multiple candidate PAY(∗) targets, including the authenticated target RRM1, suggesting a general mechanism for production of C terminus-truncated regulatory proteins.


Identification, assessment and management of "endocrine disruptors" in wildlife in the EU substance legislation--discussion paper from the German Federal Environment Agency (UBA).
A discussion paper was developed by a panel of experts of the German Federal Environment Agency (UBA) contributing to the on-going debate on the identification, assessment and management of endocrine disruptors with a view to protect wildlife according to the EU substance legislation (plant protection products, biocides, industrial chemicals). Based on a critical synthesis of the state-of-the-art regarding regulatory requirements, testing methods, assessment schemes, decision-making criteria and risk management options, we advise an appropriate and consistent implementation of this important subject into existing chemicals legislation in Europe. Our proposal for a balanced risk management of endocrine disruptors essentially advocates transparent regulatory decision making based on a scientifically robust weight of evidence approach and an adequate risk management consistent across different legislations. With respect to the latter, a more explicit consideration of the principle of proportionality of regulatory decision making and socio-economic benefits in the on-going debate is further encouraged.


Long-term persistence of acquired resistance to 5-fluorouracil in the colon cancer cell line SW620.
Treatment resistance to antineoplastic drugs represents a major clinical problem. Here, we investigated the long-term stability of acquired resistance to 5-fluorouracil (FU) in an in vitro colon cancer model, using four sub-clones characterised by increasing FU-resistance derived from the cell line SW620. The resistance phenotype was preserved after FU withdrawal for 15weeks (~100 cell divisions) independent of the established level of drug resistance and of epigenetic silencing. Remarkably, resistant clones tolerated serum deprivation, adopted a CD133(+) CD44(-) phenotype, and further exhibited loss of membrane-bound E-cadherin together with predominant nuclear β-catenin localisation. Thus, we provide evidence for a long-term memory of acquired drug resistance, driven by multiple cellular strategies (epithelial-mesenchymal transition and selective propagation of CD133(+) cells). These resistance phenomena, in turn, accentuate the malignant phenotype.


Influence of Molecular Separation on Through-Space Intervalence Transient Charge Transfer in Metal-Organic Frameworks with Cofacially arranged Redox Pairs.
We demonstrate direct evidence of photoinduced through-space intervalence charge transfer (IVCT) between two cofacially arranged redox-active pairs in metal-organic frameworks and their dynamic variation with their molecular separation. Two homologous MOFs [Co2 (NDC)2 (DPTTZ)2 ]. DPTTZ. DMF, 1 and [Co2 (BDC)2 (DPTTZ)2 ]. DMF, 2 (where NDC=naphthalene dicarboxylate, BDC=benzene dicarboxylate, DPTTZ=N, N'-di(4-pyridyl)thiazolo-[5,4-d]thiazole, DMF=N, N'-dimethyl formamide) are considered for this, whose intra-dimer distance of redox-active DPTTZ ligands differs ca. 1 Å from one system to another. Spectroelectrochemical study detects the formation of IVCT band at the NIR region between cofacially oriented DPTTZ molecules in both MOFs. Transient spectroscopy shows faster charge separation as well as charge recombination when intra-dimer distance is lesser (in MOF 2) due to stronger electronic coupling. We quantify the extent of IVCT by charge transfer integral calculation; and also by optical pump terahertz probe spectroscopy, where MOF 2 shows three times higher carrier mobility due to lesser inter-DPTTZ distance than MOF 1. These findings reveal a more localized aspect of through-space IVCT between cofacially organized redox-active pair in a three-dimensional framework.


Treatment With Human Wharton's Jelly-Derived Mesenchymal Stem Cells Attenuates Sepsis-Induced Kidney Injury, Liver Injury, and Endothelial Dysfunction.
: The pathophysiology of sepsis involves complex cytokine and inflammatory mediator networks. Downregulation of endothelial nitric oxide synthase contributes to sepsis-induced endothelial dysfunction. Human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) are known to reduce expression of proinflammatory cytokines and markers of apoptosis. We hypothesized that treatment with WJ-MSCs would protect renal, hepatic, and endothelial function in a cecal ligation and puncture (CLP) model of sepsis in rats. Rats were randomly divided into three groups: sham-operated rats; rats submitted to CLP and left untreated; and rats submitted to CLP and intraperitoneally injected, 6 hours later, with 1 × 10(6) WJ-MSCs. The glomerular filtration rate (GFR) was measured at 6 and 24 hours after CLP or sham surgery. All other studies were conducted at 24 hours after CLP or sham surgery. By 6 hours, GFR had decreased in the CLP rats. At 24 hours, Klotho renal expression significantly decreased. Treatment with WJ-MSCs improved the GFR; improved tubular function; decreased the CD68-positive cell count; decreased the fractional interstitial area; decreased expression of nuclear factor κB and of cytokines; increased expression of eNOS, vascular endothelial growth factor, and Klotho; attenuated renal apoptosis; ameliorated hepatic function; increased glycogen deposition in the liver; and improved survival. Sepsis-induced acute kidney injury is a state of Klotho deficiency, which WJ-MSCs can attenuate. Klotho protein expression was higher in WJ-MSCs than in human adipose-derived MSCs. Because WJ-MSCs preserve renal and hepatic function, they might play a protective role in sepsis. Sepsis is the leading cause of death in intensive care units. Although many different treatments for sepsis have been tested, sepsis-related mortality rates remain high. It was hypothesized in this study that treatment with human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) would protect renal, hepatic, and endothelial function in a model of sepsis in rats. Treatment with WJ-MSCs improved the glomerular filtration rate, improved tubular function, decreased expression of nuclear factor κB and of cytokines, increased expression of eNOS and of Klotho, attenuated renal apoptosis, and improved survival. Sepsis-induced acute kidney injury is a state of Klotho deficiency, which WJ-MSCs can attenuate.


The prevalence and influencing factors of coexisting prediabetes and prehypertension among Bangladeshi adults.
Early detection of diabetes and hypertension is helpful to prevent and/or delay the onset of these diseases through proper interventions. Therefore, it is a prerequisite to know the prevalence of prediabetes and prehypertension and the factors associated with these conditions but people from developing countries including Bangladesh often remain undiagnosed and unaware of these conditions. In this study we investigate the prevalence of prediabetes and prehypertension and their associated factors in Bangladesh using nationally representative data. We used nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 survey data, which included a total sample of 14,704 adults aged 18 years and more from whom blood pressure and fasting plasma glucose were collected. Chi-square test was used to examine the differences between sociodemographic and outcome variables. The univariate and multivariate logistic regression was performed to identify the factors associated with prediabetes and prehypertension. Overall, the prevalence of prediabetes and prehypertension was 8.6% with 14% of the sampled population having from prediabetes and prehypertension separately. Among the prediabetic and prehypertensive participants, one-fourth of the participant were from the richest families and around one-third were overweight/obese, while more than fifty percent had normal Body Mass Index (BMI) and completed secondary and higher education. In the univariate analysis, the richest wealth status (UOR 3.3, 95% CI: 2.46 -4.35) and overweight/obesity (UOR 3.2, 95% CI: 2.62-3.85) are the highest predictors for prediabetes and prehypertension. After adjusting the other variables, overweight/obesity remains the largest predictor for prediabetes and prehypertension (AOR:2.5, 95% CI:2.05-3.05). Further, people aged 31 and above and from the richest family had around 2 times and 1.8 times higher risk of being prediabetic and prehypertensive compared to the younger age people (18-30 years) and the poorest family (respectively). The coexistence of prediabetes and prehypertension is an early sign of a greater burden of noncommunicable diseases (NCDs) in the near future for Bangladesh. To reduce the higher burden of NCDs, our findings call for a multisectoral approach to identify the precondition of NCDs with particular attention to maintaining body weight.


Exploring nursing and allied health perspectives of quality oral care after stroke: A qualitative study.
Maintaining good oral health remains a challenge among those hospitalised after stroke. Stroke nurses and allied health clinicians have a potential role in providing oral care, but no studies in Australia to date have explored their perceptions and needs. To explore the perspectives of nursing and allied health stroke clinicians regarding oral care for stroke patients across acute care and stroke rehabilitation settings. This study followed an exploratory qualitative design, using a constructivist approach. Participants from two metropolitan public hospitals were purposively recruited to participate in focus groups. Data was thematically analysed. Twenty-one clinicians participated. Clinicians' knowledge and practices relating to oral healthcare for stroke patients were inadequate. Most staff felt they did not have adequate knowledge, resources and training to administer oral care in this setting and proposed enhancing education of stroke clinicians, patients and informal caregivers, as well as improving quality point of care resources. There was overall support for the integrated dental care after stroke model of care. This study revealed many gaps in current care and highlighted areas for improvement. Patients and their caregivers needed to be actively engaged as partners to improve oral healthcare within acute and rehabilitation stroke settings. This study provided insight into nurses' and allied health stroke clinicians' current knowledge and practices of oral care in various stroke settings. The findings from this study will inform development of a model of care to train stroke nurses in providing oral care.


Use of high-performance size-exclusion, ion-exchange, and hydrophobic interaction chromatography for the measurement of protein conformational change and stability.
Size-exclusion, ion-exchange, and hydrophobic interaction chromatographic techniques able to detect conformational changes induced by urea were developed for three globular proteins: bovine serum albumin, lysozyme, and trypsin. Alterations in tertiary structure were manifest chromatographically by highly reproducible changes in peak height, retention, and appearance of multiple peaks. Denaturation equilibria and kinetics obtained by classical physical methods, such as fluorescence intensity measurements for bovine serum albumin and enzyme activity for trypsin, could be correlated to particular changes in chromatographic behavior. The chromatographic methods utilized were selective toward specific structural changes and monitored independent denaturation steps via multiphasic kinetics. The correlation of chromatographic behavior to both independent measures of conformational changes and to assays which measure loss in biological activity, in the case of select proteins indicates that non-denaturing high-performance liquid chromatography can be a useful tool to detect and quantitate perturbations of protein three dimensional structure which result in a loss in biological activity.


Herb and supplement use among the retail population of an independent, urban herb store.
The prevalence of herbal medicine use among American adults is well documented. Because of the possible herb-drug interactions, health care providers need to be aware of herb and supplement use by their patients. This descriptive pilot study (N = 35) was designed to explore the demographics, beliefs, concurrent pharmaceutical use with herbs and supplements and their primary sources of information, and reporting of use to health care providers by customers at a retail specialty "herb" store. Results revealed that 62.5% of study participants who used herbs regularly also used pharmaceuticals. Among those who used herbs and supplements with pharmaceuticals, only 33% reported that they "always" tell their care provider about them. Forty-one percent reported that they receive most of their information about herbs and supplements from retail staff, but only 3% of participants reported that their primary source of information was a doctor, nurse, or pharmacist. Findings provide direction for future study.


Slack length of gastrocnemius medialis and Achilles tendon occurs at different ankle angles.
Although muscle-tendon slack length is a crucial parameter used in muscle models, this is one of the most difficult measures to estimate in vivo. The aim of this study was to determine the onset of the rise in tension (i.e., slack length) during passive stretching in both Achilles tendon and gastrocnemius medialis. Muscle and tendon shear elastic modulus was measured by elastography (supersonic shear imaging) during passive plantarflexion (0° and 90° of knee angle, 0° representing knee fully extended, in a random order) in 9 participants. The within-session repeatability of the determined slack length was good at 90° of knee flexion (SEM=3.3° and 2.2° for Achilles tendon and gastrocnemius medialis, respectively) and very good at 0° of knee flexion (SEM=1.9° and 1.9° for Achilles tendon and gastrocnemius medialis, respectively). The slack length of gastrocnemius medialis was obtained at a significantly lower plantarflexed angle than for Achilles tendon at both 0° (P<0.0001; mean difference=19.4±3.8°) and 90° of knee flexion (P<0.0001; mean difference=25.5±7.6°). In conclusion, this study showed that the joint angle at which the tendon falls slack can be experimentally determined using supersonic shear imaging. The slack length of gastrocnemius medialis and Achilles tendon occurred at different joint angles. Although reporting this result is crucial to a better understanding of muscle-tendon interactions, further experimental investigations are required to explain this result.


Association of the triglyceride-glucose index with subclinical left ventricular dysfunction in type 2 diabetes mellitus patients: A retrospective cross-sectional study.
The triglyceride-glucose (TyG) index is a simple and reliable indicator of insulin resistance, and is associated with the development and poor outcomes of cardiovascular disease. Subclinical left ventricular dysfunction (SLVD) is frequently detected in approximately one-third of diabetes patients, but it has not been established whether the TyG index correlates with SLVD. We carried out this research to evaluate the relationship between the TyG index and SLVD in type 2 diabetes mellitus patients. This was a cross-sectional and observational study of 183 type 2 diabetes mellitus inpatients at Nanjing Drum Tower Hospital, Nanjing, China. The TyG index and homeostasis model assessment 2 estimates for insulin resistance (HOMA2-IR) were calculated from biochemical measurements, and speckle-tracking echocardiography was carried out. According to global longitudinal strain (GLS) by echocardiography, participants were categorized into the SLVD (GLS <18%) group or the non-SLVD (GLS ≥18%) group. In comparison with non-SLVD participants, SLVD participants had higher insulin resistance, as reflected by elevated TyG and HOMA2-IR indices, as well as a higher body mass index, waist circumference and triglyceride level (P < 0.05 for each). When grouped by TyG index tertiles, an elevated TyG index was correlated with other cardiometabolic risk factors, as well as a decrease in GLS. In the multivariate logistic regression analyses, the TyG index was an independent risk factor for SLVD in type 2 diabetes mellitus patients (odds ratio 2.047, 95% confidence interval 1.07-3.914, P = 0.03), whereas HOMA2-IR was not. The TyG index is independently associated with SLVD in type 2 diabetes mellitus patients and is a more reliable indicator of SLVD than HOMA2-IR.


Lysozyme stimulates immunoglobulin production by human-human hybridoma and human peripheral blood lymphocytes.
Lysozyme [EC 220.127.116.11] derived from hen egg white stimulated immunoglobulin production by human-human hybridoma, HB4C5 cells producing human lung cancer specific monoclonal IgM. IgM production by HB4C5 cells was enhanced more than 13-fold by the addition of lysozyme at 380 μg/ml in a serum-free medium. The immunoglobulin production stimulating effect of lysozyme was observed immediately after inoculation and maintained for 5 days. Lysozyme enhanced immunoglobulin production by the hybridoma line without growth promotion. This enzyme also accelerated IgM and IgG production of human peripheral blood lymphocytes 5.3-fold and 2.3-fold, respectively. These results suggest that lysozyme stimulates immunoglobuling production of not only specific hybridoma line, but also non-specific immunoglobulin producers. However, although the enzymatic activity of lysozyme was almost lost by heat-treatment at 100 °C for 30 min, the IPSF activity was retained. This fact suggests that IPSF activity of lysozyme does not come from its enzymatic activity or reaction products. All these findings clearly indicate that lysozyme has a novel function as an immunoglobulin production stimulating factor. GAPDH - glyceraldehyde-3-phosphate dehydrogenase; Ig - immunoglobulin; IPSF - immunoglobulin production stimulating factor; PBL - peripheral blood lymphocytes; HPLC - high-performance liquid chromatography.