Twelve-month outcomes of an ab interno gelatin stent combined with cataract surgery or as a standalone procedure in pseudophakic eyes with open-angle glaucoma.
To provide safety and effectiveness outcomes at 12 months postsurgery for an ab interno transscleral gelatin stent in patients with advanced refractory glaucoma or intolerant of medical therapy. Multisubspecialty ophthalmology practice and surgery center. Retrospective, single-arm, cohort study. All patients implanted with the gelatin stent either combined with cataract surgery or as a solo procedure between February 2017 and April 2018 and meeting eligibility criteria were included. Outcome measures included proportion of patients achieving a 20% reduction in intraocular pressure (IOP), proportions at or below 12 mm Hg, 15 mm Hg, and 18 mm Hg, IOP, medication usage, needling rate, and adverse events. The study included 92 eyes of 69 patients. Mean preoperative IOP and medications were 16.6 mm Hg on 2.1 medications. Average visual field mean deviation was -13.7 dB. Half (48%) of the patients achieved the primary endpoint of 20% reduction while medication use decreased by -1.7 medications. Most patients at 12 months had IOP of 18 mm Hg or less on zero medications (74%), whereas 34% were medication free and had IOP of 12 mm Hg or less. Bleb needling was required for only 14% of patients. There were few adverse events (13% of eyes), the most common being corrected distance visual acuity loss and hyphema. Eyes with advanced glaucoma despite maximum tolerated medical therapy achieved lower target IOP on fewer medications after implantation with the gelatin microstent.


A Noteworthy Case Report of Neuroborreliosis in an Unvaccinated Pediatric Patient.
Lyme disease typically presents with viral-like symptoms and a pathognomonic rash. With disease progression, symptoms of nervous system involvement usually include facial nerve palsy and meningitis, but other atypical neurologic manifestations have less commonly been documented. A six-year-old male presented with prolonged fevers, rash, headache, and non-specific neurologic symptoms. The diagnosis of neuroborreliosis with meningitis and polyradiculitis was confirmed with laboratory evaluation and lumbar puncture. Neuroborreliosis is a disseminated form of Lyme disease. While meningitis is a common sign, the presentation of polyradiculitis in children is rare and can lead to misdiagnosis and delay in treatment.


Severe liver disease in pregnancy.
To determine the clinical characteristics of patients with fulminant hepatitis of pregnancy (FHP) and acute fatty liver of pregnancy (AFLP) and analyze their correlation with pregnancy outcome. Of 55 pregnant women with severe liver disease, 41 had FHP and 14 had AFLP. Jaundice was the primary manifestation for both FHP and AFLP and hepatic encephalopathy was the most significant complication for both. Disseminated intravascular coagulation, albuminuria, and prothrombin activity were found to be independent risk factors of maternal mortality for both. However, the rates of preterm labor, fetal demise, and neonatal asphyxia were lower in the FHP group. Women with FHP or AFLP are at risk for severe complications and adverse pregnancy outcome. Since the 2 conditions are managed differently, early diagnosis is essential.


Bridging environmental and financial cost of dairy production: A case study of Irish agricultural policy.
The Irish agricultural policy 'Food Harvest 2020' is a roadmap for sectoral expansion and Irish dairy farming is expected to intensify, which could influence the environmental and economic performance of Irish milk production. Evaluating the total environmental impacts and the real cost of Irish milk production is a key step towards understanding the possibility of sustainable production. This paper addresses two main issues: aggregation of environmental impacts of Irish milk production by monetization, to understand the real cost of Irish milk production, including the environmental costs; and the effect of the agricultural policy 'Food Harvest 2020' on total cost (combining financial cost and environmental cost) of Irish milk production. This study used 2013 Irish dairy farming as a baseline, and defined 'bottom', 'target' and 'optimum' scenarios, according to the change of elementary inputs required to meet agricultural policy ambitions. The study demonstrated that the three monetization methods, Stepwise 2006, Eco-cost 2012 and EPS 2000, could be used for aggregating different environmental impacts into monetary unit, and to provide an insight for evaluating policy related to total environmental performance. The results showed that the total environmental cost of Irish milk production could be greater than the financial cost (up to €0.53/kg energy corrected milk). The dairy expansion policy with improved herbage utilization and fertilizer application could reduce financial cost and minimize the total environmental cost of per unit milk produced.


(15S)-15 methyl prostaglandin F2 alpha levels in amniotic fluid and blood in second trimester abortions.
A single intra-amniotic injection of (15S)-15 methyl prostaglandin F2 alpha (THAM) was used to induce second trimester abortion in five patients. Serial levels of (15S)-15 methyl prostaglandin F2 alpha were subsequently measured in amniotic fluid and plasma by radioimmunoassay. The slow removal of this drug from the amniotic fluid was documented. Plasma levels of (15S)-15 methyl prostaglandin F2 alpha increased fourfold to sevenfold after clinical rupture of the membranes in three patients, supporting the fact that prostaglandins are well absorbed from the vagina. Because this analogue of prostaglandin can cause marked peripheral bronchoconstriction when administered systemically, it is best to avoid its use in patients with a history of asthma.


Peripheral nerve allografts. I. Distinctive histological features of nerve degeneration and immunological rejection.
Sequential sections were prepared from isografted or allografted sciatic nerves in adult female DBA/2 mice and were compared with the wallerian degeneration in the same inbred strain. Transverse sections were studied by qualitative and quantitative histology. Rejection was manifested by an important infiltration of mononuclear cells, including large pyroninophilic cells, around the grafted nerve, followed by the appearance of irregular infiltrates around the neovessels within the nerve. In parallel, the number of endoneural nuclei increased less rapidly in allografts than in isografts up to day 15 and diminished thereafter, in association with a possible reduction of neural vascularisation.


Endovascular management of ruptured abdominal aortic aneurysms: an 8-year single-centre experience.
We aimed to review our experience with the endovascular treatment of ruptured abdominal aortic aneurysm (RAAA). During an 8-year period, 69 patients with a RAAA presented to our department; 67 underwent assessment by computed axial tomography, and 2 died on arrival before any evaluation was possible. A total of 42 patients (63%) were suitable for stent-grafting, and all but 1 (c-arm failure) proceeded to endovascular repair. Of these, 27 underwent surgery with local anaesthesia; 3 did so under general anaesthesia; and a further 11 procedures were commenced with the patient under local anaesthesia and then converted to general anaesthesia. A total of 28 bifurcated and 14 aorto-uni-iliac stent-grafts were implanted. Aortic occlusion balloons were used in 2 (5%) patients. The in-hospital and the 30-day mortality rates were 36% and 41%, respectively. After surgery, 21 complications were encountered in 17 patients. Two patients required reintervention during their hospital stay (1 type I endoleak and 1 limb occlusion). During the follow-up (median 730 days [range 90 to 580 days]), the 1-year and 5-year cumulative survival probabilities were 53% (SE 7.9%) and 50% (SE 8.0%), respectively. Three reinterventions were necessary during follow-up (2 type I endoleaks and 1 graft occlusion). We conclude that endovascular treatment is feasible in the emergency setting, and the early experience is promising. Whether such an approach is superior to open surgery remains to be determined.


Genomic Characterization of Twelve Lytic Bacteriophages Infecting Midgut Bacteria of Aedes aegypti.
Mosquito-borne diseases such as malaria and dengue are global severe public health threats. Due to the lack of efficient control methods, alternative approaches to decreasing arboviral transmitted diseases are prioritized to reduce morbidity and mortality in every endemic region. Mosquito midgut bacteria play an essential role in physiological development, fitness, and the arthropods´ vectorial capacity. Bacteriophages are viruses that infect bacteria and are considered a promising biocontrol method by eliminating midgut microbiota that plays an essential role in mosquitoes´ health. Here, we isolate and identify 22 bacteria from mosquito´s midgut belonging to the genera Mesobacillus, Enterobacter, Klebsiella, Microbacterium, Micrococcus, Pantoea, Serratia, and Staphylococcus, mainly. Twelve phages with lytic activity against Enterobacter, Klebsiella, and Pantoea were also isolated. All 12 phages showed a double-stranded DNA genome, ranging from 36,790 to 149,913 bp, and were taxonomically classified as members of the Drexlerviridae family, Molineuxvirinae, Studiervirinae, and Vequintavirinae subfamilies. Open reading frames associated with phage structure, packing, host lysis, DNA metabolism, and additional functions were predicted in all 12 phage genomes, while tRNAs were predicted in five phage genomes. In addition, the life cycle was predicted as virulent for the 12 phages, and no antibiotic resistance, virulence, allergenic, or lysogenic genes were found in either genome. These findings suggest that the 12 phages have biocontrol potentials; however, it is necessary to elucidate specific bacterial host's roles and then the phages' ability to serve as effective vector control.


Roles of the intestinal microbiota and microbial metabolites in acute GVHD.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the most curative strategies for the treatment of many hematologic malignancies and diseases. However, acute graft-versus-host disease (GVHD) limits the success of allo-HSCT. The prevention and treatment of acute GVHD is the key issue for improving the efficacy of allo-HSCT and has become a research hotspot. The intestine is the primary organ targeted by acute GVHD, and the intestinal microbiota is critical for maintaining the homeostasis of the intestinal microenvironment and the immune response. Many studies have demonstrated the close association between the intestinal microbiota and the pathogenesis of acute GVHD. Furthermore, dysbiosis of the microbiota, which manifests as alterations in the diversity and composition of the intestinal microbiota, and alterations of microbial metabolites are pronounced in acute GVHD and associated with poor patient prognosis. The microbiota interacts with the host directly via microbial surface antigens or microbiota-derived metabolites to regulate intestinal homeostasis and the immune response. Therefore, intervention strategies targeting the intestinal microbiota, including antibiotics, prebiotics, probiotics, postbiotics and fecal microbiota transplantation (FMT), are potential new treatment options for acute GVHD. In this review, we discuss the alterations and roles of the intestinal microbiota and its metabolites in acute GVHD, as well as interventions targeting microbiota for the prevention and treatment of acute GVHD.


Folliculin Interacting Protein 1 Maintains Metabolic Homeostasis during B Cell Development by Modulating AMPK, mTORC1, and TFE3.
Folliculin interacting protein 1 (Fnip1) is a cytoplasmic protein originally discovered through its interaction with the master metabolic sensor 5' AMP-activated protein kinase (AMPK) and Folliculin, a protein mutated in individuals with Birt-Hogg-Dubé Syndrome. In response to low energy, AMPK stimulates catabolic pathways such as autophagy to enhance energy production while inhibiting anabolic pathways regulated by the mechanistic target of rapamycin complex 1 (mTORC1). We previously found that constitutive disruption of Fnip1 in mice resulted in a lack of peripheral B cells because of a block in B cell development at the pre-B cell stage. Both AMPK and mTORC1 were activated in Fnip1-deficient B cell progenitors. In this study, we found inappropriate mTOR localization at the lysosome under nutrient-depleted conditions. Ex vivo lysine or arginine depletion resulted in increased apoptosis. Genetic inhibition of AMPK, inhibition of mTORC1, or restoration of cell viability with a Bcl-xL transgene failed to rescue B cell development in Fnip1-deficient mice. Fnip1-deficient B cell progenitors exhibited increased nuclear localization of transcription factor binding to IgHM enhancer 3 (TFE3) in developing B cells, which correlated with an increased expression of TFE3-target genes, increased lysosome numbers and function, and increased autophagic flux. These results indicate that Fnip1 modulates autophagy and energy response pathways in part through the regulation of AMPK, mTORC1, and TFE3 in B cell progenitors.


What is the optimal timing for thoracic endovascular aortic repair in uncomplicated Type B aortic dissection?
Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterized by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimized cardiovascular control (blood pressure and heart rate) is the current gold standard treatment according to current international guidelines. However, emerging evidence indicates that thoracic endovascular aortic repair (TEVAR) is both safe and effective in the treatment of un-TBAD with improved long-term survival outcomes in combination with optimal medical therapy (OMT) relative to OMT alone. However, the optimal timeframe for intervention is not entirely clarified. This review critically addresses current state-of-the-art comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD based on timing of intervention. We carried out a comprehensive literature search on multiple electronic databases including PUBMED and Scopus to collate all research evidence on timing of TEVAR in uncomplicated Type B aortic dissection. TEVAR has proven to be a safe and effective treatment for un-TBAD in combination with OMT through comparable survival outcomes, improved aortic remodeling, and relatively low periprocedural added risks. Though the timing of intervention remains controversial, it is becoming clear that performing TEVAR during the subacute phase of un-TBAD yields better outcomes compared to earlier and delayed (>90 days) intervention. Further research is required into both short- and long-term outcomes of TEVAR in addition to its optimal therapeutic window for un-TBAD. With stronger evidence, TEVAR is likely to be adopted as the gold-standard intervention for un-TBAD with definitive timeframe guidelines.


Differentiating malignant pleural mesothelioma and metastatic pleural disease based on a machine learning model with primary CT signs: A multicentre study.
It is still a challenge to make confirming diagnosis of malignant pleural mesothelioma (MPM), especially differentiating from metastatic pleural disease (MPD). The aim of this study was to develop a model to distinguish MPM with MPD based on primary CT signs. We retrospectively recruited 150 MPM patients and 147 MPD patients from two centers and assigned them to training (115 MPM patients and 113 MPD patients) and testing (35 MPM patients and 34 MPD patients) cohorts. The images were analyzed for pleural thickening, hydrothorax, lymphadenopathy, thoracic volume and calcified pleural plaque (CPP). The selected clinical characteristics and primary CT signs comprised the model by multivariate logistic regression in the training cohort. Then the model was tested on the external testing cohort. ROC curve and F1 score were used to validate the capability of the model in both two cohorts. There were significant differences between two groups: (1) carcinoembryonic antigen (CEA); (2) nodular and mass pleural thickening; (3) the enhancement of pleura; (4) focal, diffuse and circumferential pleural thickening; (5) the thickest pleura; (6) thickening of diaphragmatic pleura; (7) multiple nodules and effusion of interlobar pleura; (8) hilar LN and ring enhancement of LN; (9) punctate and stipe CPP. The AUC and F1 score of the model were 0.970 and 0.857 in the training cohort, 0.955 and 0.818 in the testing cohort. The model holds promise for use as a diagnostic tool to distinguish MPM from MPD.


Chemical and electron microscopic studies of factors associated with the release of penicillinase from Staphylococcus aureus.
The effect of various factors such as sodium chloride, sodium citrate, pH, linase by Staphylococcus aureus ATCC 14458 was investigated. Penicillinase was measured at selected time intervals from supernates of cultures grown in Antibiotic Medium 3 broth containing various concentrations of salts or buffers or from supernates of cultures treated with lysostaphin and subsequently disrupted by French press treatment. Incubation of cells with media containing either sodium chloride (5, 10, and 15%), sodium citrate (5 and 10%), or organic buffers (Tris-HCl, 2.5, 5.0, and 7.5%; BES, 10 and 20%) resulted in a significant stimulation of the release of penicillinase when compared to control cells. It was also observed that pH 7.0-7.5 was optimal for penicillinase activity and release. From studies of enzymatic and mechanical disruption of cells, it was observed that an increase in ionic strength of the suspending medium to certain optimal levels appeared to stimulate the conversion of penicillinase to an extracellular form. Electron microscopic studies revealed that a large number of mesosomal vesicles seemed to be present in cells incubated for 4 hours in media containing various concentrations of sodium chloride. It is proposed that either appearance of vesicles or convolution of cell membrane, which may be caused by further synthesis of new membrane, is involved in stimulation of the synthesis and release of membrane-bound penicillinase.


Influence of acute pulmonary interstitial inflammation on kinetics of phagocytosis by alveolar macrophages.
The pulmonary alveolar macrophage (PAM) is central to lung cellular defenses and is a potential participant in lung injury, but little is known about the influence of the nature and anatomic pattern of acute lung injury on PAM function. To assess the relationship between ongoing pulmonary inflammation and PAM function, we evaluated PAM phagocytic kinetics in a model system of experimental interstitial adjuvant pneumonitis (EIAP) in calves. PAMs were obtained from lung one and seven days postinduction (dpi) of EIAP. Lesions were typical of EIAP, characterized by acute multifocal to coalescing exudative interstitial pneumonitis at 1 dpi, which progressed to granulomatous interstitial pneumonitis by 7 dpi. The total recoverable lung cells and percentage of neutrophils (PMNs) were elevated (P less than 0.01) from animals with EIAP at both 1 and 7 dpi, and there was a four-fold increase (P less than 0.01) in the PAM yield by 7 dpi. Linear regression equations revealed that a larger proportion of control PAMs were phagocytic than were PAMs from animals with EIAP. The mean initial phagocytic rates of PAM following acute lung injury were significantly elevated (P less than 0.05) over controls; this difference was concentration dependent and required a phagocytic bead stimulus concentration in excess of 12.5 x 10(6) beads/ml. PAMs from animals with EIAP had a greater maximum rate of phagocytosis (Vmax) and Km than control PAMs. PAMs from animals with EIAP had a slightly higher proportion of cells which phagocytosed multiple beads. Levels of beta-glucuronidase were elevated (P less than 0.02) in PAM from animals with EIAP at 7 dpi. The results document enhanced PAM phagocytic function in EIAP and differ from our previous experiments in which depressed PAM phagocytic indices were obtained in a model of virus-induced acute bronchiolitis and alveolitis. The functional activities of the PAMs thus appear to be modified by injury-specific events in the lung microenvironment which may, in part, reflect the nature and anatomic pattern of developing pulmonary inflammatory reactions.


Comparison of potency of substance P and related peptides on [3H]-acetylcholine release, and contractile actions, in the guinea-pig ileum.
A range of tachykinins including substance P were studied for their ability to contract the guinea-pig ileum longitudinal muscle preparation on brief exposure (20S) to the peptides, and their ability to evoke the release of [3H]-acetylcholine (ACh) from previously labelled stores within the myenteric plexus. With respect to their immediate spasmogenic activity, none of the peptides differed greatly in potency from substance P. Atropine did not modify the response to the tachykinins suggesting that the release of ACh does not contribute to the contraction resulting from brief exposure to the peptides. In the release studies, all tachykinins used produced a dose-related, calcium-dependent release of [3H]-ACh but the differences in potency were much greater. Eledoisin was the most potent and its evoked release of ACh was unaffected by hyoscine, hexamethonium, guanethidine and naloxone suggesting the release is not mediated via, or modulated by, opiate or autonomic neuronal influences. The two orders of tachykinin potency found suggest that the two processes, initial contraction and ACh release, may be principally mediated via two distinct subclasses of substance P receptor designated SP-P and SP-E respectively.


Effects of Liraglutide and Behavioral Weight Loss on Food Cravings, Eating Behaviors, and Eating Disorder Psychopathology.
This exploratory analysis examined the effects of intensive behavioral therapy (IBT) for obesity ("IBT-alone"), IBT plus liraglutide 3.0 mg/d ("IBT-liraglutide"), and IBT plus liraglutide 3.0 mg/d plus 12 weeks of a portion-controlled diet that provided 1,000 to 1,200 kcal/d ("Multicomponent") on changes in food cravings, eating behaviors, and eating disorder psychopathology at 24 and 52 weeks post randomization. Adults with obesity (mean age = 47.6 ± 11.8 years and BMI = 38.4 ± 4.9 kg/m2 ; 79.3% female; 54.0% non-Hispanic white; 44.7% black) were randomized to IBT-alone (n = 50), IBT-liraglutide (n = 50), or Multicomponent (n = 50). At weeks 24 and 52, liraglutide-treated groups reported significantly larger declines in weight concern relative to the IBT-alone group. At week 24, compared with IBT-alone, liraglutide-treated groups reported significantly greater reductions in dietary disinhibition, global eating disorder psychopathology, and shape concern. The Multicomponent group had significantly greater reductions in binge eating at week 24 relative to the IBT-alone group. However, differences among groups were no longer significant at week 52. Groups did not differ in total food cravings at week 24 or 52. The combination of liraglutide and IBT was associated with greater short-term improvements in dietary disinhibition, global eating disorder psychopathology, and shape concern than IBT alone.


A study of change and depression among Havik Brahmin women in a south Indian village.
The author has gathered data from Havik Brahmin women on depression. Cultural factors predisposing to depression are especially salient to this analysis. Beck's triad of negative self image, negative interpretation of life events, and negative view of the future is regarded as the cultural ideal for older women. With cultural changes including an increased marriage age, increased educational level, and increased decision-making for women Beck's triad is no longer culturally sanctioned. Although these cultural changes are recent and the sample is too small for a statistical analysis, the article concludes that there is a possible association between depression and cultural factors such as early marriage. Additional possible associations with depression reviewed in this paper are separation from important people, support systems, loss of parent at an early age, poor marital relationship, and the perception of helplessness.


Combining plasma gasification and solid oxide cell technologies in advanced power plants for waste to energy and electric energy storage applications.
The waste to energy (WtE) facilities and the renewable energy storage systems have a strategic role in the promotion of the "eco-innovation", an emerging priority in the European Union. This paper aims to propose advanced plant configurations in which waste to energy plants and electric energy storage systems from intermittent renewable sources are combined for obtaining more efficient and clean energy solutions in accordance with the "eco-innovation" approach. The advanced plant configurations consist of an electric energy storage (EES) section based on a solid oxide electrolyzer (SOEC), a waste gasification section based on the plasma technology and a power generation section based on a solid oxide fuel cell (SOFC). The plant configurations differ for the utilization of electrolytic hydrogen and oxygen in the plasma gasification section and in the power generation section. In the first plant configuration IAPGFC (Integrated Air Plasma Gasification Fuel Cell), the renewable oxygen enriches the air stream, that is used as plasma gas in the gasification section, and the renewable hydrogen is used to enrich the anodic stream of the SOFC in the power generation section. In the second plant configuration IHPGFC (Integrated Hydrogen Plasma Gasification Fuel Cell) the renewable hydrogen is used as plasma gas in the plasma gasification section, and the renewable oxygen is used to enrich the cathodic stream of the SOFC in the power generation section. The analysis has been carried out by using numerical models for predicting and comparing the systems performances in terms of electric efficiency and capability in realizing the waste to energy and the electric energy storage of renewable sources. Results have highlighted that the electric efficiency is very high for all configurations (35-45%) and, thanks to the combination with the waste to energy technology, the storage efficiencies are very attractive (in the range 72-92%).


Imaging findings in a case of epidermal inclusion cyst arising within the breast parenchyma.
Epidermal inclusion cysts rarely occur in the breast, but when they do, the consequences can be severe. Here, we report the case of a 23-year-old woman who presented with a palpable mass in the right breast. The mass had persisted for 4 years and had been causing pain for 1 month at the time of the patient's presentation. We examined the mass by means of mammography and sonography. Sonographic examination revealed a well-circumscribed solid, avascular mass suggestive of an epidermal inclusion cyst. Excision was performed at the patient's request. Histopathologic examination of the mass after excision confirmed the diagnosis of epidermal inclusion cyst and its localization within the breast parenchyma. To our knowledge, reports on epidermal inclusion cysts within the breast parenchyma are rare.


Platelet tropomyosin binding protein is identical with serum albumin.
We have shown that the platelet tropomyosin binding protein described in the accompanying paper (Gerhard, M. D., DiGirolamo, P. M., and Hitchcock-DeGregori, S. E. (1985) J. Biol. Chem. 260, 3221-3227) is identical with human serum albumin. The immunological determinants are completely shared; the tryptic peptide maps are the same; the proteins comigrate on two-dimensional gels; and the amino acid sequences of the first 33 amino acids are the same. Although human serum albumin in plasma or commercially prepared protein will not bind tropomyosin-Affi-Gel 15, it will bind following purification from plasma by chromatography on hydroxylapatite.


Factors associated with (non-)participation of cancer survivors with job loss in a supportive return to work program.
To evaluate and implement supportive programs, it is important to understand which cancer survivors (CSs) are participating in these programs and which motives exist for declining participation. Recently, a supportive return-to-work (RTW) program was offered to CSs with job loss. The purpose of this study was to identify factors and motives associated with (non-)participation of CSs with job loss in the RTW program. In this cross-sectional study (N = 286), information on socio-demographic, health-related, psychosocial, and work-related characteristics of CSs in the program was collected. Similar data were collected from those who declined participation. Multivariable logistic regression analyses were conducted (p < 0.05) to identify factors associated with (non-)participation. Motives for declining participation were identified using descriptive analysis. Being married (odds ratio (OR) 0.23; 95 % confidence interval (CI) 0.08-0.69) or living together (OR 0.25; 95 % CI 0.07-0.96) decreased the likelihood of participation in the RTW program. Having a temporary employment contract prior to unemployment (OR 2.60; 95 % CI 1.20-5.63), a clear intention to RTW (OR 2.65; 95 % CI 1.20-5.82), and higher scores on a readiness to RTW instrument, i.e., contemplation scale (OR 2.00; 95 % CI 1.65-2.40) and prepared for action-self-evaluative scale (OR 1.27; 95 % CI 1.04-1.54), increased the likelihood of participation. Physical (50 %) and mental problems (36 %) were leading motives for declining participation. The results from this study help to distinguish CSs that may not need RTW support, from those who are most in need of RTW support. Practitioners and researchers should tailor RTW support to CSs' socio-demographic, health-related, and work-related characteristics.


Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality.
Pyometra is an uncommon and potentially lethal disease that occurs mainly in postmenopausal women. Spontaneous perforation of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, and the patients are always admitted to the emergency department. An additional case is reported herein. In addition, a literature review was performed between 1949 and 2015. A correct preoperative diagnosis was made in 21.05% of all the cases. Of all cases, 25.71% were associated with malignant disease. The mortality rate of spontaneous perforation of pyometra is 31.88%. Thus, it should be considered in the differential diagnosis of acute abdomen in elderly women. Total hysterectomy along with bilateral salpingo-oophorectomy is the preferred treatment. Administration of broad-spectrum antibiotics and postoperative intensive care support are essential to reduce the high mortality.


One-session treatment is as effective as multi-session therapy for young people with phobias.
The studyWright B, Tindall L, Scott AJ, et al. One-session treatment compared with multisession CBT in children aged 7-16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technol Assess 2022;26:1-174.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/one-session-cbt-treatment-effective-for-young-people-with-phobias/.


Non-psychotropic analgesic drugs from the endocannabinoid system: "magic bullet" or "multiple-target" strategies?
The exploitation of preparations of Cannabis sativa to combat pain seems to date back to time immemorial, although their psychotropic effects, which are at the bases of their recreational use and limit their therapeutic use, are at least as ancient. Indeed, it has always been different to tease apart the unwanted central effects from the therapeutic benefits of Δ⁹-tetrahydrocannabinol (THC), the main psychotropic component of cannabis. The discovery of the cannabinoid receptors and of their endogenous ligands, the endocannabinoids, which, unlike THC, play a pro-homeostatic function in a tissue- and time-selective manner, offered the opportunity to develop new analgesics from synthetic inhibitors of endocannabinoid inactivation. The advantages of this approach over direct activation of cannabinoid receptors as a therapeutic strategy against neuropathic and inflammatory pain are discussed here along with its potential complications. These latter have been such that clinical success has been achieved so far more rapidly with naturally occurring THC or endocannabinoid structural analogues acting at a plethora of cannabinoid-related and -unrelated molecular targets, than with selective inhibitors of endocannabinoid enzymatic hydrolysis, thus leading to revisit the potential usefulness of "multi-target" versus "magic bullet" compounds as new analgesics.


Time window of nitroxide effect on myocardial ischemic-reperfusion injury potentiated by iron.
Transition metals such as iron and copper potentiate the postischemic reperfusion (I/R) injury induced by oxygen-derived radical and nonradical toxic species (ROS). Various natural and synthetic antioxidants have been previously tested to ameliorate such injury, yet the limitations of the common antioxidants are well known. An alternative strategy for combating oxidative damage is presented wherein cell-permeable, nitroxide stable radicals, which act as SOD-mimics and oxidize reduced metals thus prompting the Fenton-like chemistry, are investigated for utility in ameliorating I/R injury. Our study concentrates on the early effect of nitroxide on the myocardial I/R injury. Isolated rat hearts in the Langendorff configuration were equilibrated with Krebs-Henseleit buffer and then subjected to 18 min of normothermic global ischemia followed by 20 min reperfusion. Iron administered as Fe(III)-citrate (10 microM) did not affect the cardiac function under normoxia but did potentiate I/R injury and decreased the recovery during reperfusion. The iron-induced damage was manifested by further deterioration of the cardiac hemodynamic function and the energy status as reflected by decreased tissue level of phosphorylated nucleotides. Nitroxide at 200 microM protected against the iron-potentiated I/R injury by improving the recovery of the hemodynamic function and the cardiac energy status. Exogenously added iron requires bioreduction to form deleterious Fe(II) bound to critical cellular sites. The nitroxide, which enters the cell and oxidizes the reduced metal instantaneously, provided protection even when administered 2 or 3.5, but not 5 min, after the onset of reperfusion. Thus, its narrow therapeutic time window provides insight into the schedule of the I/R injurious process.


Incidence, clinical characteristics, risk factors and outcomes of patients with mixed Candida/bacterial bloodstream infections: a retrospective study.
The mixed Candida/bacterial bloodstream infections (mixed C/B-BSIs) is worthy of particular attention recently, and we analyzed the incidence, co-pathogens, clinical characteristics, risk factors, and outcomes of mixed C/B-BSIs compared with monomicrobial candidemia (mono-candidemia) in adult patients in China. All hospitalized adults with candidemia were recruited for this retrospective observational study from January 1, 2013, to December 31, 2019. Of the 296 patients with candidemia, 78 cases (26.3%) were mixed C/B-BSIs. Candida albicans (C. albicans) was the most common Candida species among all candidemia, and Klebsiella pneumoniae (K. pneumoniae) was the most concomitant bacteria (30.6%), followed by Acinetobacter baumannii (A. baumannii) (12.9%) and Enterococcus faecium (E. faecium) (11.8%) in mixed C/B-BSIs. In the multivariable analysis, prior β-lactams exposure [adjusted odds ratio (aOR), 1.97; 95% confidence interval (CI), 1.01-3.87], burn injury (aOR, 6.35; 95% CI 1.82-22.21) and continuous renal replacement therapy (CRRT) (aOR, 3.00; 95% CI 1.46-6.17) were independent risk factors for mixed C/B-BSIs. Compared with mono-candidemia, patients with mixed C/B-BSIs developed with more proportion of septic shock (55.1% vs. 39.9%, P < 0.05), prolonged stay in ICU [22.0(12.0-57.0) vs. 9.5(0.0-37.0) days, P < 0.001] and longer mechanical ventilation time [19.0(4.5-40.8) vs. 6.0(0.0-24.8) days, P < 0.001]. The in-hospital mortality in patients with mixed C/B-BSIs was higher than those with mono-candidemia (59.0% vs. 34.9%, P < 0.001). Survival analysis revealed that 28-day and 60-day mortality were significantly higher in patients with mixed C/B-BSI than in those with mono-candidemia (57.7% vs. 31.7%, P < 0.001; 59.0% vs. 34.9%, P < 0.001; respectively). There is a high rate of mixed C/B-BSIs cases among candidemia, and K. pneumoniae is the predominant coexisting species. Prior β-lactams exposure, burn injury, and CRRT are independent risk factors for mixed C/B-BSIs. The mortality of patients with mixed C/B-BSIs is significantly higher than those with mono-candidemia, this deserves further attention for clinicians.


Image-free handheld robotic-assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes.
The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent simultaneous bilateral total knee arthroplasty (SB-TKA) using either robotic-assisted TKA (RA-TKA) or conventional TKA (C-TKA). Included were the patients who underwent SB-TKA between January 2018 and January 2020 and had a minimum follow-up of 2 years. Of 151 patients included, 117 patients were operated using an image-free handheld robotic sculpting system (RA-TKA group) and 34 patients operated using conventional instrumentation (C-TKA group). The key outcomes noted were multiple patient-reported outcomes (PROs), adverse events, and radiological outcomes. Two investigators independently measured the radiological outcomes on pre- and post-operative radiographs in coronal plane (medial proximal tibial angle [MPTA] and anatomic lateral distal femoral angle [aLDFA]) and sagittal plane (posterior tibial slope [PTS] and posterior condylar offset [PCO]). The chi-square test was used to examine categorical variables. Student's t test was used to analyze the continuous variables. Patients in both groups were similar in baseline characteristics (gender, body mass index, incidence of comorbidities, and length of hospital stay) except that RA-TKA group patients younger (66.7 ± 8.9 vs 70.4 ± 10.5, P = 0.037) than C-TKA group. The operative time was longer in RA-TKA group as compared to C-TKA (189.3 ± 37.1 vs 175.0 ± 28.2, P = 0.040). The final PROs at each were similar between the two groups (P > 0.05). The values of PROs at final follow-up in RA-TKA compared to C-TKA were VAS pain (0.4 ± 0.9 vs 0.4 ± 0.5), KOOS-JR (89.3 ± 5.8 vs 87.1 ± 5.3), and physical (55.9 ± 2.8 vs 55.4 ± 3.2), mental (61.1 ± 4.4 vs 60.2 ± 4.7) component of VR-12 scores, and KSS satisfaction (37.5 ± 1.1 vs 37.1 ± 2.2) (all P > 0.50 or non-significant [n.s.]). While one patient in RA-TKA required revision of femoral component for peri-prosthetic fracture, none of the patient in conventional group were revised (0.85% vs 0%, P = n.s.). The proportion of patients with outliers in RA-TKA group was lower for aLDFA (2.6% vs 22.1%, P < 0.01) and PTS (0% vs 35%, P < 0.01). This comparative study in patients undergoing SB-TKA found reduction of outliers in femoral and tibial implant positioning with RA-TKA as compared to C-TKA. There were no differences in both groups for pain, function, and satisfaction at a minimum of 2 years of follow-up. III Therapeutic Study.


In vitro microleakage of adhesive-sealed dentin with lactic acid and saliva exposure: a radio-isotope analysis.
The aim of this study was to evaluate the dentin-protective potential of two dentin-bonding systems (Syntac and Clearfil SE Bond) on artificial saliva and lactic acid exposure. Radiochemical analysis in combination with polarization-microscopy was used in the current study. Different applications in MOD preparations in irradiated human molars were compared. Untreated cavities and cavities covered with flowable resin served as controls. Forty-eight specimens were immersed in artificial saliva (pH 7.5), 48 in lactic acid (pH 4). Activity of (32)P was measured between days 1 and 21 and loss of mineralized tissue was estimated. In lactic acid, cavities sealed with single bond, double bond or bond plus cavity sealer application resulted in significantly lower mineralized tissue loss compared to negative controls (p < 0.05). Upon both saliva and lactic acid exposure, bonding plus sealer application proved to be the most protective treatment (p < 0.05). Based on these in vitro findings it may be advisable to use a filled cavity sealer or a flowable resin to protect dentin from demineralization. The radiochemical analysis appeared to be valuable in evaluating the protective potential of bonding agents against dentin demineralization.


Mannose and galactose as substrates for production of itaconic acid by Aspergillus terreus.
Itaconic acid (IA), an unsaturated 5-carbon dicarboxylic acid, is a building block platform chemical that is currently produced industrially from glucose by fermentation with Aspergillus terreus. Softwood has the potential to serve as low cost source of sugars for its production. Effective utilization of all softwood derived sugars such as glucose, mannose and galactose by the fungus for production of IA will lower the cost of its production. In this work, 20 A. terreus strains were evaluated for the first time for IA production from mannose and galactose in shake-flasks at initial pH of 3·1, 33°C and 200 rev min-1 for 7 days. Strain NRRL 1971 possesses the unique ability to produce high concentrations of IA from mannose. It produced 36·4 ± 0·2 g IA from 80 g mannose per litre with a yield of 0·46 g g-1 mannose (highest titre reported so far). This strain has the potential to be used for IA production from softwood. The maximum (1·1 ± 0·2 g) IA was produced by strain DSM 23081 from 80 g galactose per litre utilizing only 9·1 ± 0·3 g. Galactose was not suitable for IA production by these strains. This is the first detailed report on the production of IA from mannose and galactose. Itaconic acid (IA) is a building block platform chemical which is currently produced industrially from glucose by fermentation with Aspergillus terreus. In order to expand the use of IA, its production cost must be lowered. Softwood has the potential to serve as low cost source of sugars for its production. In this work, 20 A. terreus strains were evaluated for the first time for production of IA from mannose and galactose, sugars derived from softwood. A novel strain was found that gave the highest IA titre reported so far. Galactose was a poor substrate for IA production by A. terreus.


Highly polymorphic vitelline-coat protein HaVC80 from the ascidian, Halocynthia aurantium: structural analysis and involvement in self/nonself recognition during fertilization.
Ascidians release sperm and eggs simultaneously, but self-fertilization is effectively blocked by unknown mechanisms. We previously reported that a 70-kDa sperm receptor HrVC70 on the egg vitelline coat (VC) consisting of 12 EGF-like repeats is a candidate self/nonself recognition molecule during fertilization of the ascidian, Halocynthia roretzi. Here, we report that Halocynthia aurantium also utilizes a homolog (HaVC80) of HrVC70 as an allorecognizable sperm receptor. HaVC80 is attached to the VC during the acquisition of self-sterility and is detached from the VC by acid treatment, allowing self-fertilization. A cDNA clone of the HaVC80 precursor, HaVC130, consists of 3726 nucleotides and encodes an open reading frame of 1208 amino acids. The structure of HaVC130 is very similar to the HrVC70 precursor HrVC120, but the number of EGF-like repeats of HaVC130/VC80 is one repeat larger than that of HrVC120/VC70. There are several amino acid substitutions between different individuals, and two alleles of the HaVC80 sequence were detected in each individual. Genomic DNA sequence analysis reveals that each EGF-like domain corresponds to a specific exon, and HaVC130 may have been evolutionarily generated from HrVC120 by duplication of the 8th EGF-like repeat. The data support the hypothesis that HaVC80 is a highly polymorphic protein responsible for self-sterility in H. aurantium.


Prognostic relevance of serum inhibitory factors (SIF) in protracted and persistent hepatitis B.
In a follow-up study of 3 years' duration, serum inhibitory factors (SIF) were analysed in 23 patients with a protracted course of viral hepatitis B (PVH) and 12 patients with chronic persistent hepatitis (CPH). Four patients showed a progressive course, developing chronic active hepatitis, and one died of liver failure. All 4 patients had high and persisting SIF activity. The other patients were either SIF negative or lost SIF during the observation period. The inhibitory moiety was isolated from an albumin-rich serum fraction, indicating that the factor was of the same nature as previously described in patients with acute viral hepatitis B. SIF was also demonstrated in other viral infections but was absent or of low activity in autoimmune, toxic or nutritive disorders. These results suggest that SIF may act as an immunoregulatory molecule protecting the liver from exaggerated immune response.


Cellular basis for differences in humoral immune responses of sheep immunized with living or killed Staphylococcus aureus vaccines.
An immunohistological study was made of immunoglobulin-containing cells and antibody-containing cells in abscesses/granulomas which formed at the injection site, draining popliteal nodes and contralateral popliteal nodes of sheep given either a living Staphylococcus aureus vaccine (Group L), a killed S. aureus vaccine with Freund's complete adjuvant (FCA) (Group K) or FCA alone (Group C). The injections were made subcutaneously in the hind legs and second injections were given 4 weeks later in the same site. Very large numbers of IgM-containing cells were found in granulomas of Groups K and C at 1 week post-injection (PI) but by 2 weeks PI only small numbers were recorded. Following booster immunization, the numbers of IgM-containing cells were greater in abscesses from sheep in Group L than from granulomas from sheep in Group K. Levels for Group C remained low after 1 week PI. There was evidence that the very early IgM-containing cell response in Group K was largely unrelated to specific anti-staphylococcal antibody synthesis. The IgG2-containing cell response was significantly greater than the IgG1-containing cell response in abscesses and nodes in Group L. In contrast, for animals in Groups K and C the IgG1-containing cell response predominated over the IgG2-containing cell response in granulomas and draining nodes. There were generally greater numbers of cells containing anti-staphylococcal antibody in abscesses/granulomas and nodes in Group L than in Group K.


Separated kin: location of multiple children and mental health trajectories of older parents in rural China.
This study examines the longitudinal association between the location of multiple children and depressive symptoms of older parents in rural China, where massive rural-to-urban migration has profoundly altered the family life of the aging population. Using seven waves of panel data from the Longitudinal Study of Older Adults in Anhui Province (2001-2018, N = 8,253) and multilevel growth curve models, this study compares mental health trajectories of old parents across different compositions of local and migrant children over an 18-year time period. The results show that older parents with a greater share of adult children who had migrated away not only scored worse mental health on average, but also experienced a more rapid increase in depressive symptoms across ages, after accounting for other covariates. Further, older adults who had their most children migrated away for a longer period of time suffered from the steeper rate of increase in depressive symptoms as they got older. We suggest that it is not the geographic locality of a single child but the location of multiple children that matters for parental mental health in later life.


Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire.
The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire. A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients. Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed. The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.


Trajectories of life satisfaction after traumatic brain injury: Influence of life roles, age, cognitive disability, and depressive symptoms.
(a) Identify life satisfaction trajectories after moderate to severe traumatic brain injury (TBI); (b) establish a predictive model for these trajectories across the first 5 years postinjury; and (c) describe differences in these life satisfaction trajectory groups, focusing on age, depressive symptoms, disability, and participation in specific life roles. Analysis of the longitudinal TBI Model Systems National Database was performed on data collected prospectively at 1-, 2-, and 5-years post-TBI. Participants (n = 3,012) had a moderate to severe TBI and were 16 years old and older. Four life satisfaction trajectories were identified across the first 5 years postinjury, including: stable satisfaction, initial satisfaction declining, initial dissatisfaction improving, and stable dissatisfaction. Age, depressive symptoms, cognitive disability, and life role participation as a worker, leisure participant, and/ or religious participant at 1-year postinjury significantly predicted trajectory group membership. Life role participation and depressive symptoms were strong predictors of life satisfaction trajectories across the first 5 years post-TBI. The previously documented loss of life roles and prevalence of depression after a moderate to severe TBI make this a vulnerable population for whom low or declining life satisfaction is a particularly high risk. Examining individual life role participation may help to identify relevant foci for community-based rehabilitation interventions or supports.


Combined chemo-endocrine therapy as a potential new option for HR+/HER2- advanced breast cancer: a prospective study of fulvestrant plus oral vinorelbine.
Endocrine therapy with fulvestrant has shown synergistic antitumor effects with some chemotherapy drugs in vitro. This study evaluated the efficacy and safety of fulvestrant with vinorelbine in patients with hormone receptor positive (HR+)/human epidermal growth factor receptor-2-negative (HER2-) recurrent or metastatic breast cancer. Patients were intramuscularly administered fulvestrant 500 mg (day 1 per cycle for 28 days) and oral vinorelbine (60 mg/m2 on days 1, 8, and 15 of each cycle). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival, objective response rate, disease control rate, duration of response, and safety. A total of 38 patients with HR+/HER2- advanced breast cancer included in the study were followed up for a median time of 25.1 months. The overall median PFS was 9.86 months [95% confidence interval (CI) 7.2-23.13], and the median PFS of the first-line and the second-line treatment population was 20.73 months (95% CI 9.82 to NR) and 4.27 months (95% CI 3.68 to NR), respectively. Most adverse events reported were of grade 1/2, and none were of grade 4/5. This is the first exploratory study of a fulvestrant and oral vinorelbine regimen in the treatment of HR+/HER2- recurrent and metastatic breast cancer. The combination chemo-endocrine therapy was efficacious, safe, and promising for patients with HR+/HER2- advanced breast cancer.


The occurrence of preformed N-nitroso compounds in food samples from a high risk area of esophageal cancer in Kashmir, India.
Several commonly used raw foodstuffs from a high risk esophageal cancer region in Kashmir (India) were analysed for the presence of N-nitroso compounds. The food items were selected on the basis of their frequent consumption with particular emphasis on the preserved foods (dried, pickled and smoked) and those which are unique to the region. Nine out of 11 food items were found to contain low concentrations of N-nitrosodimethylamine (NDMA), N-nitrosopyrrolidine (NPYR), N-nitrososarcosine (NSAR), N-nitrosoproline (NPRO) and N-nitrosothaizolidine-4-carboxylic acid (NTCA). The preliminary survey shows a widespread contamination of N-nitroso compounds in raw foodstuffs from Kashmir.


Relevance of Immune-Sympathetic Nervous System Interplay for the Development of Hypertension.
Historically, the sympathetic nervous system (SNS) has been mostly associated with the 'fight or flight' response and the regulation of cardiovascular function. However, evidence over the past 30 years suggests that SNS may also influence the function of immune cells. In this review we describe the basic research being done in the area of SNS regulation of immune function. Further, we show that the SNS-immune interplay during circadian rhythm may modulate the robustness of the inflammatory response, critical for survival during periods of increased activity. Finally, new concepts of a close relationship between these systems in the pathogenesis of hypertension are discussed.


Insulin and Glucagon: Partners for Life.
In August 2016, several leaders in glucagon biology gathered for the European Association for the Study of Diabetes Hagedorn Workshop in Oxford, England. A key point of discussion focused on the need for basal insulin to allow for the therapeutic benefit of glucagon blockade in the treatment of diabetes. Among the most enlightening experimental results presented were findings from studies in which glucagon receptor-deficient mice were administered streptozotocin to destroy pancreatic β cells or had undergone diphtheria toxin-induced β cell ablation. This article summarizes key features of the discussion as a consensus was reached. Agents that antagonize glucagon may be of great benefit for the treatment of diabetes; however, sufficient levels of basal insulin are required for their therapeutic efficacy.


Synthesis and antihormonal properties of novel 11β-benzoxazole-substituted steroids.
Early studies led to the identification of 11β-aryl-4',5'-dihydrospiro[estra-4,9-diene-17β,4'-oxazole] analogs with potent and more selective antiprogestational activity compared to antiglucocorticoid activity than mifepristone. In the present study, we replaced the 4'-dimethylaminophenyl group of mifepristone with the benzoxazol group to give 5a-d. We also prepared the 17β-formamido analogs 6a,b using a new synthetic strategy via the intermediate epoxide 21. These compounds were evaluated for their antagonist hormonal properties using the T47D cell-based alkaline phosphatase assay and the A549 cell-based functional assay. Compound 5c showed potent antagonist activity at GR with better selectivity for GR versus PR than mifepristone and is a promising lead for further development.


A technique to measure tidal volume during noninvasive respiratory support by continuous-flow helmet CPAP.
The coronavirus disease 2019 (COVID-19) pandemic has promoted the use of helmet continuous positive airway pressure (CPAP) for noninvasive respiratory support in hypoxic respiratory failure patients, despite the lack of tidal volume monitoring. We evaluated a novel technique designed to measure tidal volume during noninvasive continuous-flow helmet CPAP. A bench model of spontaneously breathing patients undergoing helmet CPAP therapy (three positive end-expiratory pressure [PEEP] levels) at different levels of respiratory distress was used to compare measured and reference tidal volumes. Tidal volume measurement by the novel technique was based on helmet outflow-trace analysis. Helmet inflow was increased from 60 to 75 and 90 L/min to match the patient's peak inspiratory flow; an additional subset of tests was conducted under the condition of purposely insufficient inflow (i.e., high respiratory distress and 60 L/min inflow). The tidal volumes examined herein ranged from 250 to 910 mL. The Bland‒Altman analysis showed a bias of -3.2 ± 29.3 mL for measured tidal volumes compared to the reference, corresponding to an average relative error of -1 ± 4.4%. Tidal volume underestimation correlated with respiratory rate (rho = .411, p = .004) but not with peak inspiratory flow, distress, or PEEP. When the helmet inflow was maintained purposely low, tidal volume underestimation occurred (bias - 93.3 ± 83.9 mL), corresponding to an error of -14.8 ± 6.3%. Tidal volume measurement is feasible and accurate during bench continuous-flow helmet CPAP therapy by the analysis of the outflow signal, provided that helmet inflow is adequate to match the patient's inspiratory efforts. Insufficient inflow resulted in tidal volume underestimation. In vivo data are needed to confirm these findings.


Divergent neurodevelopmental profiles of very-low-birth-weight infants.
Advanced perinatal medicine has decreased the mortality rate of preterm infants. Long-term neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs) remain to be investigated. Participants were 124 VLBWIs who had in-hospital birth from 2007 to 2015. Perinatal information, developmental or intelligence quotient (DQ/IQ), and neurological comorbidities at ages 3 and 6 years were analyzed. Fifty-eight (47%) VLBWIs received neurodevelopmental assessments at ages 3 and 6 years. Among them, 15 (26%) showed DQ/IQ <75 at age 6 years. From age 3 to 6 years, 21 (36%) patients showed a decrease (≤-10), while 5 (9%) showed an increase (≥+10) in DQ/IQ scores. Eight (17%) with autism spectrum disorder or attention-deficit hyperactivity disorder (ASD/ADHD) showed split courses of DQ/IQ, including two with ≤-10 and one with +31 to their scores. On the other hand, all 7 VLBWIs with cerebral palsy showed DQ ≤35 at these ages. Magnetic resonance imaging detected severe brain lesions in 7 (47%) of those with DQ <75 and 1 (18%) with ASD/ADHD. VLBWIs show a broad spectrum of neurodevelopmental outcomes after 6 years. These divergent profiles also indicate that different risks contribute to the development of ASD/ADHD from those of cerebral palsy and epilepsy in VLBWIs. Very-low-birth-weight infants (VLBWIs) show divergent neurodevelopmental outcomes from age 3 to 6 years. A deep longitudinal study depicts the dynamic change in neurodevelopmental profiles of VLBWIs from age 3 to 6 years. Perinatal brain injury is associated with developmental delay, cerebral palsy and epilepsy, but not with ASD or ADHD at age 6 years.


Performance of a segmented HPGe detector at KRISS.
A 24 segmented HPGe coaxial detector was set up with a digitized data acquisition system (DAQ). The DAQ was composed of a digitizer (5 × 107sampling/s), a Field-Programmable Gate Array (FPGA), and a real time operating system. The Full Width Half Maximum (FWHM), rise time, signal characteristics, and spectra of a 137Cs source were evaluated. The data were processed using an in-house developed gamma-ray tracking system.


Role of N-linked oligosaccharides attached to human renin expressed in COS cells.
One or both of two putative N-glycosylation sites (at asparagine-5 and -75) of human renin was eliminated by amino acid replacement of the asparagine residue with an alanine residue using site-directed mutagenesis. The three glycosylation-deficient renins (Asn-5, Asn-75, Asn-5 and -75 mutants) were expressed in COS cells and secreted into the conditioned media. The secreted amounts of the three mutants were different from one another, although the mutant and wild-type renins had practically the same specific activity. An Asn-5 and -75 mutant which did not contain any glycosylation sites was unstable in the medium, suggesting that the N-linked oligosaccharides play an important role in stabilization of human renin.


Regulation of intracranial pressure in rat, dog, and man.
Intracranial resistance and compliance were assessed in the cerebrospinal fluid system of rat, dog, and man by means of low-volume, short-duration infusions of artificial CSF into the subarachnoid space. A family of pressure/time response curves was obtained for each species: at low flow rates, steady-state pressure elevations were associated with normal neurological function; at high flow rates, rapid linear pressure elevations were associated with marked neurological dysfunction. From these curves a mathematical model was developed which describes transport and pressure-dependent valvelike characteristics of the CSF outflow resistance. This resistance shows a progressive phylogenetic change in rat, dog, and man which increasingly enhances the species' abilities to vent fluid from the intracranial cavity into the venous circulation. Arachnoid villi appear to be the major structures modulating sustained, nonlethal elevations of intracranial pressure.


Prefrontal involvement in "temporal bridging" and timing movement.
Brain activity exclusively related to a temporal delay has rarely been investigated using modern brain imaging. In this study we exploited the temporal resolution of functional magnetic resonance imaging (fMRI) to characterise, by sinusoidal regression analysis, differential neuroactivation patterns induced in healthy subjects by two sensorimotor synchronization tasks different in their premovement delay of either 0.6 s or 5 s. The short event rate condition required rhythmic tapping, while the long event rate condition required timing of intermittent movements. Left rostral prefrontal cortex, medial frontal cortex, SMA and supramarginal gyrus demonstrated increased MR signal intensity during low frequency synchronization, suggesting that these brain regions form a distributed neural network for cognitive time management processes, such as time estimation and motor output timing. Medial frontal cortex showed a biphasic pattern of response during both synchronization conditions, presumably reflecting frequency-independent motor output related attention. As predicted, sensorimotor and visual association areas demonstrated increased MR signal intensity during high frequency synchronization.


Pattern of compartmentation in human seminiferous tubules showing dislocation of spermatogonia.
The pattern of compartmentation of the seminiferous epithelium was investigated, using a lanthanum tracer technique, in human testicular biopsies of adult infertile men (age 27 to 44 years), where dislocation of spermatogonia from the basal lamina occurred. Spermatogonia type A and B were found in a two- or three-layered arrangement, in aberrant locations throughout the seminiferous epithelium, and in intratubular positions associated with fragments of Sertoli cell cytoplasm. Tracer impregnation was found around spermatogonia in a multilayered arrangement, indicating the extension of the basal compartment in a luminal direction. Single spermatogonia within the second or third layer of the seminiferous epithelium were regularly found to be surrounded by tracer. The junctional complex between the lateral membranes of adjacent Sertoli cells was devoid of tight junctions. Tracer penetration around spermatogonia in a more luminal position was prevented by intact Sertoli cell junctional complexes; tracer was also absent from intraluminal located spermatogonia associated with cytoplasmic fragments of Sertoli cells. The luminal extension of the basal compartment associated with the dislocation of spermatogonia clearly differs from the pattern of compartmentation during the movement of primary spermatocytes within undisturbed epithelium. There is a strong incidence of elevated serum levels of follicle-stimulating hormone (greater than 7 U/l), indicating a suppression of Sertoli cell function; this may be the cause for the dislocation of spermatogonia and the changes of compartmentation.


[Catheter recanalization of a post-traumatic occlusion of the popliteal artery (author's transl)].
An acute occlusion of the popliteal artery occurred in an 19-year-old football player as a result of a kick into the back of the knee. Twenty months later recanalization was successfully accomplished by percutaneous transluminal catheter dilatation. It is concluded that not only atheromatous but also post-traumatic arterial occlusions can be successfully treated by this method.


The effects of prior growth as a biofilm on the virulence of Salmonella typhimurium for mice.
Relatively little is known about how growth as a biofilm affects the virulence of pathogenic bacteria. In this study, the virulence of Salmonella typhimurium grown as a biofilm, or as planktonic cells, was compared in mice. Increased numbers of colony forming units were recovered from the spleens of mice 5 days after i.p. injection with S. typhimurium grown as a biofilm, as compared with planktonic cells (P < 0.05). No significant difference in the CFU of S. typhimurium recovered from the liver was noted at the same time point, and no difference was noted in the CFU recovered from the spleen or liver at 5 days after i.v. or i.g. inoculation with 10(5) S. typhimurium. Nor were any differences noted at 7 days after i.p., i.v. or i.g. inoculation. Thus, any effect of growth as a biofilm has on the virulence of S. typhimurium seems to be limited to the first 5 days after i.p. inoculation.


Doripenem: A new carbapenem antibiotic a review of comparative antimicrobial and bactericidal activities.
Doripenem is a new parental 1-beta-methyl carbapenem which, unlike imipenem, does not require the addition of cilastatin on administration because of the protection afforded to doripenem by the 1-beta-methyl component. It combines the in vitro activities of imipenem and ertapenem against gram-positive bacteria with the in vitro activity of meropenem against gram-negative bacteria. It has excellent bactericidal activity against Streptococcus neumoniae. Carbapenem resistant mutants were selected with less frequency and lower minimum inhibitory concentrations (MICs) after exposure to doripenem than to imipenem or meropenem. High concentration levels of doripenem may be achieved in plasma. The half life of doripenem is higher than imipenem or meropenem. This new antibiotic has excellent in vitro activity and pharmacological properties. but how it may best be utilized still needs to be determined.


Becoming a better paramedic through the special needs school placement program.
Paramedics provide care in medical emergencies to patients with varying ages and from a range of settings, cultures, backgrounds and experiences. As such, the paramedic needs a very diverse skill set which is difficult to obtain at university. For this reason, undergraduate paramedic students often engage in clinical placements to apply their knowledge to real world experiences. Most of these placements, however, are in hospitals or ambulance settings, but part of the diverse community that paramedics treat are children with special needs, including children with disabilities. This study measured the attitudes of paramedic students to people with disabilities and explored the effectiveness of paramedic student clinical placements in special needs schools. 109 paramedic students enrolled in their first year of the Bachelor of Paramedicine at Monash University undertook placements in special needs schools across Victoria, Australia. These students completed the Interactions with Disabled Persons Scale. Of these students, 5 participated in two focus groups to gain a deeper understanding of their placement experience. The results showed that paramedic students enjoyed their placements and gained a more positive attitude towards special needs students, but also felt challenged and overwhelmed. Also found were four main characteristics that students believed paramedics needed to be effective; empathy, being genuine, the ability to listen to someone even though they are not speaking to you verbally, and the ability to gain the trust of someone quickly where gaining trust is difficult. This study was the first time an entire cohort of paramedic students have undertaken placements at special needs schools. The findings provide a baseline and incentive for further exploration of the benefits of the placement of paramedic students (and student from a variety of healthcare professions) in special needs schools, as well as other marginalised communities.


Skin biophysical properties including impaired skin barrier function determine ultraviolet sensitivity.
The levels of burning susceptibility to ultraviolet (UV) radiations are affected by various factors, including Fitzpatrick skin types, skin color, sex, and ethnicity. However, studies on the relationship between skin biophysical properties and erythemal responses to UV radiations are rare. This study aimed to investigate biophysical properties of the skin that determined individual skin sensitivity to UV radiation. As an indicator of skin sensitivity to UV radiation, Korean women were subjected to minimal erythema dose (MED) testing. The skin biophysical properties, such as skin hydration, transepidermal water loss (TEWL), were measured. MED were also evaluated in further variations in the skin, including barrier disruption. A significant negative correlation was observed between TEWL and MED. With an increase in TEWL, that represents reduced skin barrier function, skin UV sensitivity also increased. Artificial alteration of skin conditions also changed erythemal response to UV radiation. When the skin barrier was disrupted, MED significantly decreased, indicating increased skin UV sensitivity. It is hypothesized that the altered penetration of UV radiation into the stratum corneum under the respective skin conditions caused different erythema reactions. For the first time in a clinical study, the skin biophysical properties, including skin barrier function, were found to have significant effects on skin sensitivity to UV radiation. This finding could help predict individual susceptibility to UV damage. Therefore, skincare products that improve skin conditions associated with UV sensitivity, as well as sunscreen are important for protection against the hazards of UV radiation.


Release of DEFB126 from macaque sperm and completion of capacitation are triggered by conditions that simulate periovulatory oviductal fluid.
Capacitation of macaque sperm in vitro has been achieved efficiently only with the addition of both cyclic nucleotides and methylxanthines. The use of these exogenous sperm activators clouds an understanding of the normal mechanisms underlying capacitation and may slow early embryo development following in vitro fertilization (IVF). We demonstrate that culture medium which simulates periovulatory oviductal fluid with respect to bicarbonate (HCO(3)(-)) and glucose concentration induces capacitation in a high percentage of macaque sperm as determined by the ability of sperm to undergo both the release of coating protein DEFB126 and the zona pellucida-induced acrosome reaction (AR). Few sperm were able to undergo the AR following 6 hr incubation in medium containing either 35 mM HCO(3)(-) (approximately 7.2 pH) or 90 mM HCO(3)(-) (approximately pH 7.8) with 5 mM glucose. When glucose concentration was lowered to 0.5 mM to match levels reported for women at midcycle, the AR rate increased significantly in sperm incubated in both levels of HCO(3)(-), indicating that glucose interferes with sperm responsiveness to increasing HCO(3)(-) concentration observed in the primate oviduct during ovulation. Even greater synchronization of capacitation could be achieved with nonphysiologic extremes of alkalinity or energy substrate deprivation. In the latter case, sperm achieved high rates of IVF. A shift in pH from 7.2 to 7.8 in a HEPES-buffered medium was sufficient to remove DEFB126 from the surface of most sperm after only 3 hr. The loss of DEFB126 from sperm under periovulaory fluid conditions has implications for the timing of release of sperm from the oviductal reservoir.


Use of the percutaneous thrombolytic device for the treatment of thrombosed pseudoaneurysms during mechanical thrombectomy of hemodialysis grafts.
This article describes a method to remove thrombus from pseudoaneurysms associated with hemodialysis grafts during a percutaneous mechanical thrombectomy procedure. This effective and easily performed technique involves manual compression of the pseudoaneurysm during activation of the Arrow Percutaneous Thrombolytic Device. The authors describe their clinical experience with use of this technique to treat 18 patients during percutaneous mechanical thrombectomy procedures. In addition, the development, morphology, and management of hemodialysis graft-related pseudoaneurysms are discussed.


Pathogenic Variants in the Myosin Chaperone UNC-45B Cause Progressive Myopathy with Eccentric Cores.
The myosin-directed chaperone UNC-45B is essential for sarcomeric organization and muscle function from Caenorhabditis elegans to humans. The pathological impact of UNC-45B in muscle disease remained elusive. We report ten individuals with bi-allelic variants in UNC45B who exhibit childhood-onset progressive muscle weakness. We identified a common UNC45B variant that acts as a complex hypomorph splice variant. Purified UNC-45B mutants showed changes in folding and solubility. In situ localization studies further demonstrated reduced expression of mutant UNC-45B in muscle combined with abnormal localization away from the A-band towards the Z-disk of the sarcomere. The physiological relevance of these observations was investigated in C. elegans by transgenic expression of conserved UNC-45 missense variants, which showed impaired myosin binding for one and defective muscle function for three. Together, our results demonstrate that UNC-45B impairment manifests as a chaperonopathy with progressive muscle pathology, which discovers the previously unknown conserved role of UNC-45B in myofibrillar organization.


The anterior cruciate ligament in the multiple ligament-injured knee.
The ACL may be associated with concomitant injury to the posterior cruciate ligament, collateral structures, bone or cartilage. An approach to the multiligament injured knee is discussed including evaluation, treatment, graft selection, operative techniques, graft placement, tensioning, fixation, impingement, postoperative care, and complications.


The right paratracheal stripe in children.
The width of the right paratracheal stripe (RPS) has been established in normal adults but not in normal children. The thymus and great vessels are relatively larger in children than in adults and could obscure or widen the RPS. We found that obscuration does occur and, therefore, the RPS is less often measurable in children than in adults. Widening by the thymus and great vessels, however, does not occur. The width of the RPS in normal children, 0.5 to 3.0 mm, is slightly less than in adults. From this study of normal children and our subsequent experience with pediatric patients, we conclude that in a child an RPS 4 mm or wider is reliable evidence of disease affecting the trachea, mediastinum, or pleura.


Influence of habitat and season on foraging flock composition in the European Starling (Sturnus vulgaris).
This study examines the relative importance of habitat and season in determining size and composition of foraging flocks of European Starlings (Sturnus vulgaris). We hypothesized that if season was the principal determinant of flock size, variation across seasons (within habitat) would be greater than variation across habitats (within season). The calendar year was divided into 6 seasons corresponding to major stages in the annual cycle of starlings. After measuring the availibility of 15 foraging habitats occurring within the study area, we drove a 184 km route weekly (over a 17 month period) to census starling flock size, species composition, habitat use, and activity.Although flock size was influenced by both season and habitat, it varied relatively less within seasons (across habitats). Only five of nine seasons showed significant habitat effects, and two (of the five) were significant mainly because of large aggregations in habitats with unusually abundant food (e.g. feedlots, cornfields). In contrast, eight of nine habitats showed significant seasonal effects. The only exception (hay) was little used (<1% of all birds observed). For starlings the activities associated with seasonal events of the annual cycle were a major influence on patterns of social foraging. Habitat factors were less important because of constraints imposed by seasonal factors, but under some conditions (e.g. drought, clumped food supply) they became dominant.


The flexible/intact-bridge tympanomastoidectomy technique.
A combination of otologic techniques has been presented in the step-wise surgical rationale that we call the flexible approach. The sequence of steps involved in the flexible approach allows the surgeon to adjust his or her surgery to the individual patient's needs. Very often, in patients with chronic otitis media, a middle ear reconstructive procedure (ossiculoplasty including lateralization of the malleus, removal of pathological tissue, insertion of an implant of silicone rubber sheets, and use of ventilation tubes with or without tympanic grafts) will obviate mastoidectomy. When a mastoidectomy is indicated, the IBM is a suitable procedure that encompasses the advantages of both closed and open mastoidectomy techniques.


Sialylation of anti-histone immunoglobulin G autoantibodies determines their capabilities to participate in the clearance of late apoptotic cells.
The Fc portion of immunoglobulin (Ig)G harbours a single glycosylation site. Glycan sialylation is critical for structure and for certain effector functions of IgG. Anti-histone IgG of patients with systemic lupus erythematosus is reportedly responsible for the recruitment of polymorphonuclear cells (PMN) to the clearance of apoptotic cells. Autoantibodies decorating secondary necrotic cells (SNEC) induce proinflammatory responses after activation of blood-borne phagocytes. Analysing the sialylation status of affinity-purified anti-histone IgG in patients with systemic lupus erythematosus (SLE), we demonstrated that the anti-histone IgG was contained preferentially in the non-sialylated fraction. In functional ex-vivo phagocytosis studies, non-sialylated anti-SNEC IgG directed SNEC preferentially into PMN but did not change their cytokine secretion profiles. In contrast, sialylated IgG reduced the phagocytosis by monocytes of SNEC. Moreover, the sialylated anti-SNEC IgG was not simply anti-inflammatory, but switched the cytokine secretion profiles from interleukin (IL)-6/IL-8 to tumour necrosis factor (TNF)-α/IL-1β. Here we describe how different sialylation statuses of IgG autoantibodies contribute to the complex inflammatory network that regulates chronic inflammation.


Stability of films with nanoparticles.
Numerous products (such as paints, inks, foods, and beverages) and processes (such as coating, coagulation, sedimentation, lubrication, and paper-making) depend on the stability of the liquid films separating the dispersed phase from the continuous phase in the presence of nanoparticles or surfactant micelles. Nanoparticles exhibit a tendency to form ordered layers (i.e., stratification) and particle in-layer structures in these thin films at a sufficiently high concentration, resulting in a structural force that stabilizes the dispersion. The dispersion stability depends on the film size and the nanoparticle concentration.


Mendelian Randomization Analysis Identified Potential Genes Pleiotropically Associated with Polycystic Ovary Syndrome.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with unclear etiology. Some genes may be pleiotropically or potentially causally associated with PCOS. In the present study, the summary data-based Mendelian randomization (SMR) method integrating genome-wide association study (GWAS) for PCOS and expression quantitative trait loci (eQTL) data was applied to identify genes that were pleiotropically associated with PCOS. Separate SMR analysis was performed using eQTL data in the ovary and whole blood. Although no genes showed significant pleiotropic association with PCOS after correction for multiple testing, some of the genes exhibited suggestive significance. RPS26 showed the strongest suggestive pleiotropic association with PCOS in both SMR analyses (β[SE]=0.10[0.03], PSMR=1.72×10-4 for ovary; β[SE]=0.11[0.03], PSMR=1.40×10-4 for whole blood). PM20D1 showed the second strongest suggestive pleiotropic association with PCOS in the SMR analysis using eQTL data for the whole blood and was also among the top ten hit genes in the SMR analysis using eQTL data for the ovary. Two other genes, including CTC-457L16.2 and NEIL2, were among the top ten hit genes in both SMR analyses. In conclusion, this study revealed multiple genes that were potentially involved in the pathogenesis of PCOS.


The identification of suppressor cells in the murine fetal liver.
Fetal suppressor cells are potentially important for maintenance of pregnancy and for the immune regulation of the identification of self. We have identified and partially characterized a population of murine fetal liver cells which are active suppressors of a variety of immune responses, including mixed lymphocyte responses (MLR), responses to mitogens, and plaque-forming cell responses to heterologous erythrocytes. The suppression is non-H-2-restricted and can act via a factor. The cell is preactivated in fetal liver and may represent a T-cell precursor. The suppression of MLR is maximal (approximately 100%) if cells are added within the first 48 h of culture initiation. The characteristics of this suppressor cell are compared to other known MLR and perinatal suppressor systems.


The AIDS crisis: a United States health care perspective.
The unanticipated onset of Acquired Immunodeficiency Syndrome in the United States, followed by its gradual progression into a full-blown, uncontrollable epidemic, has had severe economic and organizational consequences for the American health care system. AIDS has taken its toll on the health workforce as well in terms of stress, anxiety and workload demands. In the absence of adequate community-based treatment and care resources for persons with AIDS, hospitals had to assume the major burden for providing basic medical care and developing the needed range of services required. This expansion of responsibilities strained hospitals and other health care agencies beyond their capabilities. Some hospitals have faced economic and allocation dilemmas because of high occupancy rates by AIDS patients since there are no specialized reimbursement rates for the intensive resource utilization required for their care. These substantial burdens underscored the need for coordinated long-term planning for a continuum of in-patient, out-patient and community support services. A major response to the epidemic has been a restructuring of the health and social service delivery systems. Hospitals have had to maintain patients beyond their need for an acute level of care, develop infrastructures to manage the increasing numbers of patients, alter physical facilities, provide educational programs and support groups to increase staff's knowledge and decrease fears of AIDS, consider alternatives to in-patient medical management, and lobby with local, state and federal governments to obtain increased public monies for AIDS treatment and care. In the past year, there has been a discernible shift to widening the network of ambulatory medical services and community-based social and health care supports. A major focus of this paper is the social and organizational impact of this epidemic on the hospital and health care system and the systems' responses. Alternatives to an acute care treatment locus for persons with AIDS are explored. Recommendations for future directions for a comprehensive, coordinated health and social services delivery network are presented.


Charge transfer induced excitons and nonlinear optical properties of ZnO/PEDOT:PSS nanocomposite films.
In this current work, we have prepared zinc oxide (ZnO) nanorods by sol-gel method, and its composite films with a conducting polymer poly (3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) also have been prepared by drop-casting method on the glass substrate. UV-Vis absorption and steady-state fluorescence studies revealed exciton dissociation and recombination at the interface of polymer chain and wide-bandgap semiconductor ZnO. Also, nonlinear optical properties of as-prepared nanocomposite films have been reported by employing an open aperture z-scan technique. A predominantly two-photon induced saturable absorption behavior, when excited with 532 nm, 10 ns laser pulses, appeared in nonlinear optical measurements. These results indicate that our as-synthesized composites can be useful in fabricating optical switch and saturable absorbers.


Effect of Commiphora molmol on leukocytes proliferation in relation to histological alterations before and during healing from injury.
Myrrh, Commiphora molmol has been used as anti-inflammatory and wound healing commercial product. Leukocyte count had been reliable indicator for clinicians to monitor progress of healing for their patients. We hypothesized that myrrh supplement participate in the activation of leukocyte proliferation pathway prior and post skin injury and gastric ulcer. The purpose of the present study was to examine long-term effect of myrrh on leukocytes proliferation before injury and during different stages of healing. Results showed that all types of leukocytes were significantly (p < 0.05) higher in the myrrh-treated groups before and during healing. The pretreatment with myrrh offered a time-dependent rise in leukocytes proliferation. Microscopic examination of blood smear from myrrh-treated rats with skin injury, showed an elevated count of middle-sized lymphocytes and neutrophils that were characterized with well-defined nuclear lobules and rich-granules cytoplasm. Furthermore, the microscopic examinations of the spleen and lymph nodes of myrrh-treated rats with skin injury, showed an increased thickness of lymphatic sheath around the arterioles in the white pulp that was associated with high density of the medium-sized lymphocytes in the secondary lymphoid follicles in the lymph nodes with engorged sinusoids. As myrrh enhanced leukocytes proliferation before injury, it can be concluded that myrrh posse's antigenic-driven responses and that indicated some foreignness or toxicity of some constituents of myrrh. Because myrrh helped to maintain the relative rise of leukocytes counts throughout healing period and that implied it activated late steps of both proliferation and differentiation pathways for all types of leukocytes during effective phase of the specific immune responses.


Rhabdomyoma of the head and neck: clinicopathologic features of two cases.
Extracardiac rhabdomyomas are rare benign tumors of the head and neck. They are frequently misdiagnosed and possibly overtreated when confused with other aggressive tumors. This article reports on the clinicopathologic features of two such tumors affecting adult patients and initially seen as slowly-growing, indolent neoplasms. The tumors were of fibrous consistency, mobile, with well-demarcated borders and evident lines of cleavage. Both patients were treated by conservative surgery and remained disease-free after prolonged clinical observation. Histologically, both tumors were composed of large eosinophilic cells intermingled with polyhedral clear cells. Both cell types contained abundant glycogen accumulations. The differential diagnosis is with granular cell tumor and with sarcomas, the former being easily distinguishable morphologically, and the latter be seen with more rapid growth and adherence to the adjacent tissues. On the basis of the preceding features, rhabdomyomas can be suspected at a preoperative stage and adequately managed with enucleation or simple excision.


Maternal perception of masking in children as a preventive strategy for COVID-19 in Nigeria: A multicentre study.
The use of face masks by children for the prevention of COVID 19 is still controversial, especially with regards to who should wear the face mask and at what age. The study aimed to ascertain the perception of mothers on masking in children as a preventive strategy for COVID-19. This was a cross-sectional study carried out in two health institutions among 387 mothers who presented with their children for the first time in the hospital during the COVID 19 pandemic. A pretested, semi-structured, interviewer-administered questionnaire which was designed by the researchers was used for data collection. Minority (44.7%) of the mothers perceived masking in children as an appropriate measure for the prevention of COVID-19. The frequent reasons given by majority (55.3%) of the mothers for the inappropriateness of face mask in children included perceived difficulty in breathing (38.5%) and the child's readiness to pull it off (29.3%). A significantly higher proportion of the children whose mothers were 35 years and above, 64.2% would wear face masks when compared with 31.7% of those whose mothers were < 30 years of age (χ2 = 28.632, p<0.001). Similarly, a significantly higher proportion (51.0%) of the children who were more than one year of age would wear a face mask when compared with 20.5% of those aged eight days to one year (χ2 = 19.441, p<0.001). The children whose mothers were <30 years were about four times less likely to wear a face mask when compared with those whose mothers were aged 35 years and above. (AOR = 0.273; 95%CI: 0.155-0.478). The children whose fathers have attained tertiary education were about twice less likely to wear face masks when compared with those whose fathers have attained secondary education and less. (AOR = 0.554; 95%CI: 0.334-0.919). Mothers' perception of COVID-19 had no significant influence on children's use of face mask (χ2 = 2.337, p = 0.127). Maternal perception of masking in children as an appropriate strategy for preventing COVID-19 is adjudged low in this study. Right perception is significantly enhanced by maternal educational status, employment and marital status.


Descriptive anatomy of the human auditory tube.
The aim of this study was to correlate current morphologic data relating to the lumen of the auditory tube. Four methods were used: dissection under the operating microscope; microendoscopy of the tubal lumen; optical and electron microscope histology; and MR or CT imaging. The auditory tube consists of two unequal cones, a small posterior third, fixed and osseous (protympanum), and a mobile fibrocartilaginous anterior two-thirds, both joined by the tubal isthmus, a short constriction which is pseudosphincteric at endoscopy. The tensor veli palatini muscle (TVPM) and the levator veli palatini muscle (LVPM) are the chief muscles that vary the tubal lumen of the fibrocartilaginous portion, which is collapsed at rest. CT and especially MR imaging allows their observation in static conditions. Serial histologic sections reveal the continuity between the TVPM and the tensor tympani muscle. The main cartilage framing the lumen varies in shape according to the level surveyed. The tubal mucosa is lined with an epithelium combining ciliated and mucus cells, involved in mucociliary drainage and gas exchanges in the auditory tube. These morphologic elements represent a basis for study of tubal physiology and for planning treatment in dysfunctions of the auditory tube.


Patients with a quadriceps tendon shorter than 60 mm require a patellar bone plug autograft in anterior cruciate ligament reconstruction.
To assess the length and thickness of the quadriceps tendon (QT) and anterior cruciate ligament (ACL) to predict the required QT length for individual ACL reconstruction. Thirty patients (9 females, 21 males; mean age 24.5 years; mean height 169.3 cm) who underwent ACL reconstruction using the QT with a bone plug autograft were enrolled. The length and thickness of the QT on preoperative magnetic resonance imaging (MRI) were compared with those measured under direct visualization. The ACL length was measured on preoperative MRI and three-dimensional computed tomography after ACL reconstruction. The QT length on MRI was compared with the required graft length, and the factors related to an adequate QT length were assessed. The mean QT length on MRI was 60.8 ± 1.3 mm and was significantly positively correlated with the QT length under direct visualization (P < 0.01). On MRI, the mean ACL length was 30.8 ± 1.2 mm and the mean QT thickness was 6.3 ± 0.2 mm. Although the mean QT was 0.1 mm longer than the mean required graft length, the QT on MRI was shorter than the required graft length in 37% of patients (11/30). Adequate QT length was related to a QT length of more than 60 mm, but not to age, sex, height, or ACL length. Although preoperative MRI predicted the required QT length for ACL reconstruction, 37% of patients lacked an adequate QT length, and a QT shorter than 60 mm required the addition of patellar bone. III.


Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke.
One-third of patients with acute ischemic stroke develop early neurologic worsening, which is associated with increased mortality and long-term functional disability. We investigated the predictive factors for neurologic deterioration in patients with acute ischemic stroke within 1 week of onset. We retrospectively investigated 643 patients who were admitted within 2 days of acute ischemic stroke between April 2007 and March 2010. Neurologic deterioration was defined as an increase of 4 points or more in the National Institutes of Health Stroke Scale (NIHSS) score within 1 week of admission. We retrieved data on demographic and clinical characteristics, medications, and stroke subtypes. Out of 537 patients, deterioration was noted in 64 patients (11.9%; deterioration group). Multivariate analysis identified history of myocardial infarction (P < .001), NIHSS score ≥8 at onset (P < .001), high leukocyte count (P = .035), low-density lipoprotein cholesterol ≥140 mg/dL (P = .002), and hemoglobin A1c ≥7% (P = .006) as significant factors associated with deterioration. Branch atheromatous disease was more frequent in the deterioration group, and >90% of patients with deterioration either were discharged to nursing home care or died. Multivariate analysis of magnetic resonance imaging findings identified internal carotid/middle cerebral artery occlusion (each P < .001), striate capsular infarction (P = .030), pontine infarction (P = .047), and lesion size of 15-30 mm (P = .011) as independent factors associated with deterioration. Stroke patients with a high low-density lipoprotein level, high hemoglobin A1c level on admission, a history of myocardial infarction, and high NIHSS score are at high risk for neurologic deterioration. Patients with multiple risk factors for deterioration can benefit most from intensive monitoring.


Endothelial mitochondria--less respiration, more integration.
Lining the inner surface of the circulatory system, the vascular endothelium accomplishes a vast variety of specialized functions. Even slight alterations of these functions are implicated in the development of certain cardiovascular diseases that represent major causes of morbidity and mortality in developed countries. Endothelial mitochondria are essential to the functional integrity of the endothelial cell as they integrate a wide range of cellular processes including Ca²⁺ handling, redox signaling and apoptosis, all of which are closely interrelated. Growing evidence supports the notion that impairment of mitochondrial signaling in the endothelium is an early event and a causative factor in the development of diseases such as atherosclerosis or diabetic complications. In this review, we want to outline the significance of mitochondria in both physiology and pathology of the vascular endothelium.