Colchicine-induced resistance to antibiotic and amino-acid analogue in plant cell cultures.
Colchicine-resistant plant cell strains have been isolated from cell suspensions of carrot and sycamore. In the same way as colchicine-resistant animal cell strains, they show an increased resistance towards streptomycin and N-methylalanine. Cultivation under non selective conditions leads to a slow progressive loss of the resistance.


Elective Caesarean section on maternal request in Germany: factors affecting decision making concerning mode of delivery.
To investigate sociopsychological factors of women undergoing a caesarean section on maternal request (CSMR). Twenty-eight women who underwent CSMR and 29 women with vaginal delivery (VD) filled in standardized questionnaires concerning psychological burden (SCL-R 90), fear of childbirth (W-DEQ, STAI), personality structure (HEXACO-Pi-R) and social support (F-SozU) as well as one questionnaire assessing potential factors influencing their mode of delivery. Women with CSMR were older (36.5 ± 5.4 vs. 30.6 ± 5.2 years; p < 0.001) and suffered more from fear of childbirth (W-DEQ 4.3 ± 0.8 vs. 3.7 ± 1.2; p = 0.041), concerns for their child (W-DEQ 2.0 ± 1.5 vs. 1.3 ± 0.7; p = 0.026) and appraised the birth less negative (W-DEQ 2.0 ± 0.7 vs. 2.7 ± 1.1; p = 0.008). The majority of parturients had chosen their preferred mode of delivery before pregnancy (CS 61% vs. VD 82%, p = 0.328). In the decision-making process for the mode of delivery, the advice of the partner (85 and 90%) played an important role. 82% of the women who delivered via CSMR did not regret the decision for this mode of delivery. Women who underwent CS had higher fear of childbirth and appraised the birth less negative. The majority did not regret the decision for the CS and would even choose this mode of delivery for their next pregnancy. Although the partner and the physician seem to be important in the decision process for of the mode of delivery, reasons for the choice for CSMR appear to be multifactorial.


Are pharmacists reducing COPD'S impact through smoking cessation and assessing inhaled steroid use?
The National Institute for Health and Clinical Excellence (NICE) COPD 2004 guidelines recommend: ∗ COPD patients who smoke should be encouraged to stop at every opportunity; ∗ Inhaled corticosteroid should be used only among patients with moderate to severe COPD; ∗ Pharmacists should identify smokers and provide smoking cessation advice. The community pharmacy contract requires pharmacists to review patients' medications, creating an opportunity for reviewing the prescribing of inhaled corticosteroids in COPD. The survey explored the degree to which community pharmacists in North West England identify and provide advice to smokers and assess prescribed inhaled corticosteroids among COPD patients. A self-completion questionnaire was sent to 2080 community pharmacists from the 2005 pharmacist census database. Of the 1051 (50.5%) respondants, 37.1% mentioned COPD as a risk from smoking most or every time and 54.5% sometimes or rarely, and 19.6% routinely asked about smoking status when dispensing COPD medication. Pharmacists with more than 20 years experience were more likely to have read the Guideline compared to pharmacists with 10 years or less (OR: 1.54; 95% CI: 1.13 to 2.10). Pharmacists who had read the NICE Guideline (46.8%) were around twice as likely to mention COPD as a risk of smoking, ask about COPD if inhaled corticosteroids were dispensed and ask about smoking routinely if COPD medication was dispensed. (p<0.005). The NICE guidelines on COPD encourage community pharmacists to carry out smoking cessation and educational interventions, but further support is needed.


[Infliximab in aggressive and refractory rheumatoid arthritis. A pilot study].
Rheumatoid arthritis is a chronic inflammatory disease with a progressive course, that frequently provokes permanent incapacity if not adequately treated. Rheumatoid arthritis may be not responsive to the common second line drugs. This study was aimed to treat 15 patients affected by severe refractory rheumatoid arthritis with infliximab. Fifteen patients with refractory rheumatoid arthritis were treated with infliximab--monoclonal antibody direct to TNF alpha--in association with methotrexate or azathioprine. Infliximab was administered at the dosage of 3 mg/Kg at the weeks 0, 2 and 6 and then every 8 weeks. About half patients ameliorated in agreement with both ACR 20 criteria and DAS28 evaluation. The clinical improvement was accompanied by a reduction of the steroid daily dosage. No relevant side effects were observed. Infliximab is effective in a significant number of patients with severe rheumatoid arthritis, with a good tolerability.


In-situ utilization of membrane foulants (FeOx+MnOx) for the efficient membrane cleaning.
Preoxidation-ultrafiltration process is an effective method for Fe2+ and Mn2+removal, in which Fe2+ (Mn2+) are firstly oxidized to FeOx (MnOx), then collected by the ultrafiltration membrane. However, the simultaneous presence of Fe2+, Mn2+, and organics in feed can cause severe membrane fouling, which inhibits the overall performance of this method prominently. In this study, a novel FeOx+MnOx+H2O2 membrane cleaning method is proposed based on the idea of turning in-situ generated membrane foulants, i.e., FeOx+MnOx, into the catalysts for membrane cleaning. The results demonstrate that the FeOx+MnOx+H2O2 system can achieve more than 95% membrane flux recovery and remove almost all irreversible membrane foulants within only 5 min and with only 0.5%wt% H2O2 solution. The outstanding performance of the system is mainly attributed to the catalytic decomposition of H2O2 to generate both highly reactive radicals, such as hydroxyl radicals (·OH), and abundant oxygen. In addition, when the membrane is loaded by only MnOx, polyaluminium chloride (PAC) as the coagulator demonstrates prominent influence on the performance of membrane cleaning. However, PAC makes almost no contribution to membrane cleaning when the membrane is loaded by FeOx. This is because coagulation induced by PAC exerts more prominent impact on the particle size distribution of MnOx than that of FeOx. In conclusion, the catalytic decomposition of H2O2 by in-situ generated FeOx+MnOx is a promising advanced oxidation process to achieve outstanding membrane cleaning performance under the condition of low H2O2 concentration and no extra dosage of catalysts. The novel membrane cleaning system exhibits high potential for the practical membrane treatment processes to treat water with high contents of Fe and Mn.


Sickness behavior is not all about the immune response: Possible roles of expectations and prediction errors in the worry of being sick.
People react very differently when sick, and there are only poor correlations between the intensity of the immune response and sickness behavior. Yet, alternative predictors of the individual differences in sickness are under-investigated. Based on the predictive coding model of placebo responses, where health outcomes are function of bottom-up sensory information and top-down expectancies, we hypothesized that individual differences in behavioral changes during sickness could be explained by individual top-down expectancies and prediction errors. Twenty-two healthy participants were made sick by intravenously administering lipopolysaccharide (2 ng/kg body weight). Their expectations of becoming sick were assessed before the injection. Participants having lower expectations of becoming sick before the injection reacted with more emotional distress (i.e., more negative affect and lower emotional arousal) than those with high expectations of becoming sick, despite having similar overall sickness behavior (i.e., a combined factor including fatigue, pain, nausea and social withdrawal). In keeping with a predictive coding model, the "prediction error signal", i.e., the discrepancy between the immune signal and sickness expectancy, predicted emotional distress (reduction in emotional arousal in particular). The current findings suggest that the emotional component of sickness behavior is, at least partly, shaped by top-down expectations. Helping patients having a realistic expectation of symptoms during treatment of an illness may thus reduce aggravated emotional responses, and ultimately improve patients' quality of life and treatment compliance. REGISTRATION: "Endotoxin-induced Inflammatory and Behavioral Responses and Predictors of Individual Differences", https://clinicaltrials.gov/ct2/show/NCT02529592, registration number: NCT02529592.


Convalescence after inguinal herniorrhaphy.
Convalescence after inguinal herniorrhaphy is usually 3-4 weeks and is an important outcome parameter of hernia surgery. The aim of this study was to describe in detail the consequences of recommending a short convalescence, including the risk of recurrence. This was a multicentre prospective questionnaire study in patients given a recommendation for short convalescence (1 day); information was recorded on expected length of convalescence, employment status, physical workload and limiting factors. The reoperation rate in patients included in the study (group 1, n = 1059) was compared with that for comparable patients treated in participating departments but not part of the study group (group 2, n = 1306) and patients in the Danish Hernia Database (group 3, n = 8297). The median time off work was 7 days and the time interval before carrying out the most strenuous leisure activity was 14 days. After 30 days, 6.8 per cent of patients had not resumed employment and 17.0 per cent had not yet resumed strenuous leisure activity. Important reasons for not resuming work and leisure activity were pain (approximately 60 per cent of patients) and wound problems (approximately 20 per cent). The reoperation rate in group 1 at the median observation time was 0.7 per cent, which was no different to that in group 2 (1.6 per cent) (P = 0.186) or group 3 (1.4 per cent) (P = 0.092). Reduced convalescence after inguinal herniorrhaphy may be recommended without incurring a risk of higher reoperation rates. Pain and wound problems remain the most important factors for not resuming work or leisure activity as recommended.


Helicobacter pylori specific nested PCR assay for the detection of 23S rRNA mutation associated with clarithromycin resistance.
Clarithromycin is one of the most important antibiotics for Helicobacter pylori eradication. However, 5-10% of strains are reported to be resistant. It has been shown that one point mutation in the 23S rRNA gene is associated with resistance to clarithromycin. To establish a polymerase chain reaction (PCR) system which amplifies a segment of the 23S rRNA gene containing the mutation points with primers specific for H pylori, so that H pylori infection and the mutation associated with clarithromycin resistance can be examined simultaneously. To detect H pylori infection and the mutation simultaneously, primers specific for the H pylori 23S rRNA gene were designed based on sequence conservation among H pylori strains and sequence specificity as compared with other bacteria. DNA from 57 cultured strains and from 39 gastric juice samples was amplified in the seminested 23S rRNA PCR. Clinical applicability was evaluated in 85 patients. DNA samples from 57 cultured strains were all amplified. The novel assay and the urease A PCR agreed in 37/39 gastric juice samples with no false positives. The assay did not amplify the DNA of bacteria other than H pylori. Eight of 85 samples had the mutation before treatment. In clarithromycin based treatment, eradication was achieved in 2/5 (40%) with the mutation and 29/34 (85%) without the mutation. The assay using gastric juice is quick (within 12 hours) and non-invasive (endoscopy not required), enabling rapid initiation of appropriate antibiotic treatment.


Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study.
The objective of this study was to evaluate the sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients as compared with clinical examination and nerve conduction study (NCS). This study included 120 type 2 diabetes patients (58 men) with a mean age of 67.3 +/- 5.9 years and a mean diabetes duration of 13.1 +/- 3.2 years. Diabetic neuropathy was diagnosed through the Neuropathy Disability Score. An NCS was performed on radial, ulnar, sural, and common and deep peroneal nerves. Patients were also examined with the new indicator test. The "time to complete color change of the test" from blue to pink was recorded. The test was considered abnormal in patients who exhibited a time to complete color change of the test exceeding 600 s in at least one foot. Neuropathy was diagnosed by clinical examination in 83 (69.2%) patients. The sensitivity of the indicator test for clinical neuropathy was 95.2%, and its specificity was 67.6%. The sensitivity of NCS for clinical neuropathy was 94%, and its specificity was 62.1%. The sensitivity of the indicator test for abnormal NCS was 97.8%, and its specificity was 96.4%. The new indicator test has a very high sensitivity not only for the diagnosis of clinical neuropathy but also for the diagnosis of neurophysiological neuropathy. Specificity is moderately high for the diagnosis of clinical neuropathy, while it is particularly high for the diagnosis of neurophysiological neuropathy. The indicator test has a validity comparable to that of NCS for the diagnosis of diabetic neuropathy. Finally, the time to complete color change of the test is associated with the severity of nerve conduction impairment.


Timing of morphologic and apoptotic changes in the sheep fetal kidney in response to bladder outflow obstruction.
Posterior urethral valves are the main cause of bladder outflow obstruction in human fetuses. Thirty per cent of boys with valves develop end-stage renal disease, despite intervention in the postnatal period. The timing and mechanisms of renal damage in bladder outflow obstruction are unknown. We investigated the timing of changes in morphology and apoptosis in the fetal sheep kidney in response to obstruction. Thirty-three fetal lambs at day 70 of gestation underwent surgical creation of bladder outflow obstruction. Twenty-nine fetal lambs had sham surgery. Fetal kidneys were collected 2, 5, 10, 20 and 30 days after surgery. Renal histology was examined. Real-time PCR was used to quantify the renal cortical expression of the pro-apoptotic gene Bax and anti-apoptotic gene Bcl-X. The TUNEL technique was used to assess regional renal apoptosis in response to obstruction. Changes in renal morphology were evident as early as 2 days after surgery in fetuses with bladder outflow obstruction, and progressed over 20-30 days to cystic renal dysplasia. Bladder outflow obstruction increased the renal cortical expression of Bax relative to Bcl-X. Tubular apoptosis peaked after 2 days of obstruction. Blastemal apoptosis peaked after 5 days of obstruction. Changes in pro- and anti-apoptotic gene expression in the fetal renal cortex, and alterations in the number of apoptotic cells and renal morphology are evident soon after the onset of bladder outflow obstruction. These findings suggest that damage to the developing fetal kidney begins to occur at the onset of obstruction. Attempts to preserve renal function by antenatal interventions may best be achieved by early treatment.


Management of contralateral N0 neck in tonsillar squamous cell carcinoma.
It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory during initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. A retrospective analysis of 43 N0-3 tonsillar cancer patients with contralateral clinically negative necks from 1992 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral N0 necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, P = < .05). The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contralateral metastatic neck have a worse prognosis than those who are staged as N0. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.


The characteristics and outcomes in patients with acute heart failure who used tolvaptan: from KCHF registry.
The use of tolvaptan is increasing in clinical practice in Japan. However, the characteristics of patients who used tolvaptan and the timing of its use in patients with acute heart failure (AHF) are not fully elucidated. Among consecutive 4056 patients in the Kyoto Congestive Heart Failure registry, we analysed 3802 patients after excluding patients on dialysis, prior or unknown tolvaptan use at admission, and unknown timing of tolvaptan use, and we divided them into two groups: tolvaptan use (N = 773) and no tolvaptan use (N = 3029). The prevalence of tolvaptan use varied widely from 48.7% to 0% across the participating centres. Factors independently associated with tolvaptan use were diabetes, poor medical adherence, oedema, pleural effusion, hyponatraemia, estimated glomerular filtration rate < 30 mL/min/1.73 m2 , moderate/severe tricuspid regurgitation, dobutamine infusion within 24 h, and additional inotropes infusion beyond 24 h after admission. The mortality rate at 90 days after admission was significantly higher in the tolvaptan use group than in the no tolvaptan use group (14.3% vs. 8.6%, P = 0.049). However, after adjustment, the excess mortality risk of tolvaptan use relative to no tolvaptan use was no longer significant (hazard ratio = 1.53, 95% confidence interval = 0.77-3.02, P = 0.22). Patients with tolvaptan use had a longer hospital stay [median (interquartile range): 22 (15-34) days vs. 15 (11-21) days, P < 0.0001] and a higher prevalence of worsening renal failure (47.0% vs. 31.8%, P < 0.0001) and worsening heart failure (24.8% vs. 14.4%, P < 0.0001) than those without. AHF patients with tolvaptan use had more congestive status with poorer in-hospital outcomes and higher short-term mortality than those without tolvaptan use. https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).


Topical tretinoin (retinoic acid) treatment of hyperpigmented lesions associated with photoaging in Chinese and Japanese patients: a vehicle-controlled trial.
Hyperpigmented lesions are a predominant component of photoaging in Chinese and Japanese persons. Topical 0.1% tretinoin cream improves the hyperpigmentation associated with photoaging in Caucasian persons. Our purpose was to assess the efficacy of 0.1% tretinoin cream treatment of hyperpigmented lesions associated with photoaging in Chinese and Japanese patients. Forty-five photoaged patients (23 Chinese, 22 Japanese) completed a double-blind, randomized study in which 21 applied 0.1% tretinoin cream and 24 applied vehicle cream once daily to face and/or hands for 40 weeks. Patients' hyperpigmented lesions were evaluated clinically and by colorimetry throughout the study and by histologic analysis of skin biopsy specimens taken before therapy and at the end of treatment. At the end of treatment, hyperpigmented lesions of the face and hands were lighter or much lighter in 90% of patients receiving tretinoin compared with 33% receiving vehicle (p < 0.0001). Colorimetry demonstrated significant lightening of lesions after tretinoin compared with vehicle (p < 0.05). Histologic analysis of hyperpigmented lesions demonstrated a statistically significant 41% decrease in epidermal pigmentation with tretinoin therapy as compared with a 37% increase in the vehicle group (p = 0.0004). No patient withdrew for adverse effects. By clinical, colorimetric, and histologic evaluation, 0.1% tretinoin cream significantly lightens the hyperpigmentation of photoaging in Chinese and Japanese patients.


[Primary culture and identification of rat glomerular microvascular endothelial cells].
The aim of the present study was to establish a simple and efficient method for isolation and culture of primary rat glomerular microvascular endothelial cells in vitro. The bilateral kidneys were taken from 7-10-day old Sprague-Dawley rats, and the renal cortex was separated. Glomeruli were obtained by cutting and continuously passing 200-mesh and 300-mesh sieves. After type IV collagenase digestion for 15-20 min, renal microvascular globules were collected for inoculation and culture. The cultured cells were identified by cell morphology observation and immunocytochemical staining with factor VIII related antigen. The results showed that the renal microvascular globules were irregularly spherical, without cysts, and the capillary loop structure was clear; after 3 days of primary culture, short spindle-shaped cells crawled out around the renal microvascular globules and gradually formed cell colonies, showing an "island-like shape" distribution; 4-5 days later, the cell colonies fused with each other; 6 days later, the cells covered the bottom of the dish, showing a typical monolayer, paving stone-like, mosaic arrangement. The immunocytochemical staining of factor VIII related antigen showed that the cytoplasm was lightly stained brownish red, and factor VIII related antigen-positive rate of cells was nearly 100%. The above results suggested that this study successfully established a method combining continuous screening and collagenase digestion for culture of primary rat glomerular microvascular endothelial cells in vitro. It provides an important tool cell for studying the mechanism of the occurrence and development of diabetic nephropathy.


Morphological and immunohistochemical phenotype of TCs in the intestinal bulb of Grass carp and their potential role in intestinal immunity.
The current study investigated telocytes (TCs) in the intestinal bulb of Grass carp using light microscopy (LM), Transmission electron microscopy (TEM), scanning electron microscopy, and immunohistochemistry (IHC). By LM, TCs were distinguished by the typical morphological features that had a cell body and telopodes using HE, toluidine blue, methylene blue, Marsland silver stain, Grimelius's silver nitrate, Giemsa, PAS, combined AB pH2,5/PAS, Crossmon's and Mallory triple trichrome, Van Gieson stains, Verhoeff's stain, Sudan black, osmic acid, performic acid with methylene blue and bromophenol blue. TCs were identified under the epithelium as an individual cell or formed a TCs sheath. They detected in the lamina propria, between muscle fibers, around the myenteric plexus and fibrous tissue. TCs acquired immunological features of endocrine cells that exhibited high affinity for silver stain, performic acid with methylene blue, Marsland stain, and immunohistochemical staining using chromogranin A. Sub epithelial TCs were closely related to the endocrine cells. TCs and their secretory activities were recognized using acridine orange. TCs were identified by IHC using CD34, CD117, S100-protein, desmin. TCs formed a3D network that established contact with macrophage, mast cells, dendritic cells, lymphocytes, smooth muscle fibers, fibroblast, Schwann cells and nerve fibers. In conclusion, the localization of TCs in relation to different types of immune cells indicated their potential role in the maintenance of intestinal immunity.


Effects of peer-mentoring on stress and anxiety levels of undergraduate nursing students: An integrative review.
Nursing students, whether undergraduate or graduate, are at a higher risk for stress and anxiety due to competitiveness and complexities of nursing school. There is evidence in the literature on the effects of peer mentoring among nursing students. Peer mentoring has been associated with increased retention, student engagement, and skills competence among nursing students. There is, however, paucity in the literature about peer mentoring's effect on stress and anxiety levels of undergraduate nursing students. To examine the literature on the effect of peer mentoring on stress and anxiety levels among undergraduate nursing students. Bandura's Self-Efficacy Theory was used to guide this review. An integrative review of the literature was conducted. Electronic databases searched included PubMed, CINAHL, PsychINFO, and ERIC using keywords: nurse*, student*, undergrad*, stress and nursing students, anxiety and nursing students, and mentor*. Review was limited to peer reviewed articles published in the English language from January 2000 to August 2018. Articles were independently reviewed by three authors, and the quality of data was evaluated using established criteria. Eight articles were included in the review. Review suggested that peer mentoring decreases stress, and situation or short-term anxiety levels of undergraduate nursing students. However, results should be interpreted with caution based on limited studies identified.


Anomeric specificity of the insulin and glucagon secretory responses to D-glucose in lean and obese Zucker rats.
The perfused pancreas of lean and obese Zucker rats was exposed, in the presence of L-leucine, to the anomers of D-glucose, which were administered on four successive occasions in the alpha/beta/alpha/beta or beta/alpha/beta/alpha sequence. In 5 lean and 6 obese rats, alpha-D-glucose was more efficient than beta-D-glucose in both stimulating insulin secretion and suppressing glucagon release. Although D-glucose evoked a greater release of insulin and, during prolonged exposure to the hexose, a less pronounced suppression of glucagon secretion in obese than lean rats, the anomeric specificity of these secretory responses was not different in the two groups of animals. In one lean rat, however, alpha-D-glucose, while efficiently stimulating insulin release, failed on two occasions to inhibit glucagon secretion. This isolated observation raises the possibility that the anomeric specificity of functional events evoked by D-glucose in the endocrine pancreas may occasionally be perturbed.


Mycotoxins in soybean feedstuffs used in Germany.
Fifty samples of soybean meal-25 of them samples of high-protein soybean meal-and one sample of soybean hulls obtained from the feed industry in Germany were analysed for the mycotoxins aflatoxins, deoxynivalenol (DON), zearalenone (ZON) and ochratoxin A (OTA). Additionally, 4 samples of high protein soybean meal which were suspected of containing high mycotoxin levels were analysed. Aflatoxin B1 (AFB1) was detected in 32 of the 51 non-suspicious samples but the maximal concentration was only 0.41 μg/kg. DON could not be detected in any of the non-suspicious samples. ZON was detected in 23 of the 51 samples with a maximal concentration of 18 μg/kg. It was present in 18 of 25 samples of soybean meal and in the sample of soybean hulls but only in 4 of 25 samples of highprotein soybean meal. This finding suggests that ZON is mainly located in the hulls of soybeans, because high-protein meal does not contain hulls. OTA was found in 4 samples, with the greatest concentration detected being 1 μg/kg.All of the four suspicious samples of high protein soybean meal contained high ZON concentrations of up to 363 μg/kg. The contamination with other mycotoxins was on the same order of magnitude as in the case of the non-suspicious samples.


First seizure in adults: to treat or not to treat.
A double-blind trial was done in 228 patients with one single seizure 2 weeks before coming to the author. One group was given sodium valproate, the other group placebo. The duration of therapy was 12 months. The results of this trial show that a person with a single seizure has epilepsy and should be treated with sodium valproate.


Psychosocial and behavioral outcomes of genomic testing in cancer: a systematic review.
Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.


Acute peritonitis in the rabbit (Oryctolagus cuniculus) resulting from a gastric trichobezoar.
A case of gastric ruputre secondary to a trihobezoar occurred in a rabbit. A review of the literature showed that, although trichobezoars are common in rabbits, antemortem gastric rupture has not been reported previously.


Controlled-rate versus uncontrolled-rate cryopreservation of peripheral blood progenitor cells: a prospective multicenter study. Group for Cryobiology and Biology of Bone Marrow Transplantation (CBTMO), Spain.
Cryopreservation of hemopoietic progenitors for transplantation has been traditionally performed by the use of a controlled-rate freezer. Several groups have reported successful cryopreservation of progenitor cells at -80 degrees C without a controlled-rate freezer. In an attempt to elucidate whether both methods are equally efficient, we compared controlled-rate versus uncontrolled cryopreservation of peripheral blood progenitor cells (PBPC) in a prospective, multicenter study. Apheresis products from patients undergoing PBPC mobilization were split into two aliquots, and cryopreserved simultaneously by both methods, in autologous plasma plus 10% dimethylsulfoxide. Controlled-rate samples were placed into a programmable freezer with a cooling rate of 1-2 degrees C/min. Uncontrolled-rate samples were directly introduced into a -80 degrees C mechanical freezer. After thawing, cell counts, assays for viability, clonogenic cultures and CD34+ cell enumeration were performed. A total of 105 cases were included. No significant differences were found in viability (mean 88.8 +/- 13% in the controlled-rate group vs. 89.7 +/- 12% in the uncontrolled-rate group), nucleated cell loss (23.5 +/- 23% vs. 23 +/- 22%), mononuclear cell loss (19 +/- 23% vs. 19.1 +/- 22%), and loss of CD34+ cells (34.3 +/- 33% vs. 28.6 +/- 34%). On the other hand, recovery of granulomonocytic colony-forming units (CFU-GM), was significantly better with the controlled-rate technique, than with the non-controlled-rate method (104.3 +/- 95 vs. 86.5 +/- 80, respectively; p = 0.048). Our results indicate that both techniques are suitable for cryopreservation of PBPC, although a better recovery of committed progenitors is achieved by the controlled-rate method. Therefore, the use of controlled-rate freezer should probably be recommended.


Identification and functional analysis of an immunoreactive DsbA-like thio-disulfide oxidoreductase of Ehrlichia spp.
Novel homologous DsbA-like disulfide bond formation (Dsb) proteins of Ehrlichia chaffeensis and Ehrlichia canis were identified which restored DsbA activity in complemented Escherichia coli dsbA mutants. Recombinant Ehrlichia Dsb (eDsb) proteins were recognized by sera from E. canis-infected dogs but not from E. chaffeensis-infected patients. The eDsb proteins were observed primarily in the periplasm of E. chaffeensis and E. canis.


Differences in antigenic properties of Fc-binding activity during infection with herpes simplex virus type 1.
The antigenic properties of the Fc receptor induced by herpes simplex virus type 1 (HSV-1) were studied with anti-HSV F(ab')2 and pFc' from infected rabbits. It appeared that the HSV-induced Fc-binding receptor had different antigenic characteristics at different times after infection. The Fc receptor present early in the infection (0.5 hours), during the adsorption period, most probably is the result of a fusion event between the virus envelope and the infected cell. We found that this Fc receptor reacted with anti-HSV F(ab')2 and thus showed HSV-antigenic properties in such a way that binding of anti-HSV F(ab')2 prevented the binding of pFc' fragments. Later on in the infection (5 hours), the Fc-binding activity present on the surface of the infected cell is the result of newly synthesized and in the plasma membrane integrated polypeptides. The Fc-binding activity present on the cell surface of 5 hours infected cells could not be inhibited by anti-HSV F(ab')2 and did not interfere with the binding of pFc' to the Fc receptor.


Anatomic relationships of the orbital muscle of Müller in human fetuses.
A study was carried out in twenty human fetuses on the relationships of the orbital muscle of Müller. This muscle forms a lamina of smooth muscle fibres that cover the inferior orbital fissure. The latter is very wide during the fetal period because ossification of the bones that delimit this region is still incomplete. Some fibres of the orbital muscle extend along the superior orbital fissure under the inferior ophthalmic vein and the lower wall or floor of the cavernous sinus. This association suggests a possible influence on autonomically mediated vascular dynamics.


Concomitant autoimmune hemolytic anemia and pulmonary embolism associated with mild COVID-19: A case report.
Despite its rarity, AIHA can be associated with COVID-19. It should be suspected in a patient with recent COVID-19 presenting with unexplained anemia.


Access to novel anti-diabetic agents in resource limited settings: A brief commentary.
The prevalence of diabetes mellitus is increasing in resource limited settings. Simultaneously, there has been an increase in the number of novel therapies for the management of diabetes mellitus. However, use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings. Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes, and thus most likely to benefit from the therapy, are less likely to have negative budget impact for funders. To improve access, and reduce morbidity and mortality, requires alignment amongst key stakeholders including patient advocacy groups, health care professional councils, national departments of health, the pharmaceutical industry, treasury and finance departments.


Endocytotic pathways across the human gall-bladder mucosa: permeability studies using horseradish peroxidase.
Human gall-bladder epithelium obtained straight from the operating theatre was incubated in an Ussing chamber with the fluid phase marker, horseradish peroxidase (HRP), for up to 60 min. When the marker was presented on the apical surface, within 30 min it had moved readily across the apical cytoplasm in transport vesicles to receptosomes and into the lateral intercellular space, extending across the basement membrane into the lamina propria. When HRP was presented at the basal aspect, within 30 min it had moved through the lamina propria, across the basement membrane and into the lateral intercellular space. By 60 min, only small amounts had been taken up by the epithelial cells and transported to receptosomes. These data indicate a rapid transmucosal endocytotic pathway for blood- or bile-borne macromolecules.


Classification of adnexal adhesions: a proposal and evaluation of its prognostic value.
A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.


Bladder function in 17β-estradiol-induced nonbacterial prostatitis model in Wistar rat.
To investigate bladder function in a model of nonbacterial prostatitis (NBP) induced in castrated rats by 17β-estradiol injection. Ten-month-old male Wistar rats were divided into two groups, sham and NBP (both N = 8). NBP was induced by castration followed by daily subcutaneous injection of 17β-estradiol for 30 days. On the 31st day after surgery, we investigated (1) voiding behavior, (2) bladder blood flow (BBF), (3) prostate and bladder weight, and proinflammatory cytokines (TNF-α and CXCL1) levels and (4) bladder contractile responses to electrical field stimulation (EFS), carbachol and KCl. (1) Voiding behavior (average micturition volume, total urine volume and number of micturitions) and (2) BBF were not significantly different between the sham and NBP groups. (3) NBP led to a significant decrease in prostatic weight and increase in proinflammatory cytokine levels in the prostate, but NBP did not cause a significant change in bladder weight or proinflammatory cytokine levels in the bladder. (4) Bladder contractile forces in response to EFS, carbachol and KCl were not significantly affected by NBP. In this rat model, NBP did not cause a significant change in the level of proinflammatory cytokines in the bladder and affect bladder function.


Endorectal formalin instillation or argon plasma coagulation for hemorrhagic radiation proctopathy therapy: a prospective and randomized clinical trial.
Radiotherapy may cause hemorrhagic radiation proctopathy (HRP). For conservative treatment of refractory HRP, argon plasma coagulation (APC) is the first-choice therapy. Endorectal formalin instillation (EFI), in turn, is an attractive treatment option because of its satisfactory results, great availability, and low cost. Nevertheless, comparative studies between these procedures are rather scarce. This study aims to make a prospective and randomized comparison of the outcomes in 2 HRP patient groups treated with either APC or EFI. Twenty-seven patients (11 women), with a mean age of 67 years (range, 36-83), were randomized to receive either APC (n = 14) or EFI (n = 13). On completion of the treatment, comparisons were made in relation to the baseline for each patient and between groups for endoscopic findings according to the Vienna score and the telangiectasia distribution pattern score (TDP); the impact of radiation proctitis on patients' lives was made according to the modified radiation toxicity score (MRTS) and hemoglobin levels. Number of sessions, duration of therapy, and adverse events were also compared between groups. The endoscopic therapeutic success (ETS) was defined by the absence or only few residual telangiectasias (TDP ≤1) on conclusion. An ETS of 92.8% was achieved in patients treated with APC and 92.3% for those treated with EFI (P > .05); there was an MRTS improvement of 85.7% in APC patients and 69.2% in EFI patients (P > .05). Mild adverse events occurred, respectively, in 23% and 28.5% in the EFI and APC groups (P > .05). The study showed that APC and EFI have similar efficacy and a high safety profile for HRP treatment. (Clinical trial registration number: 3.120.353.).


Depletion of chlortetracycline during composting of aged and spiked manures.
Chlortetracycline (CTC) is one of the most important pharmaceuticals occurring in the environment. An increase of its application as feed supplement for livestock and poultry in the world leads to a substantial CTC contamination of manures, because most of the CTC is excreted to manure. The simulation experiment of aerobic composting was adopted to investigate CTC depletion in aged and spiked manure composting, and to address the extent of CTC depletion during composting. The results showed that the extractable CTC initial concentration was markedly different between the different manures, with 94.71mgkg(-1) in broiler manure and 879.6mgkg(-1) in hog manure. The concentration of extractable CTC decreased rapidly at the initial stage of composting, and subsequently declined slowly during aged and spiked manure composting. At the end of composting, more than 90% of CTC in the manure composting process (42 days) was depleted, except for hog manure composting with a removal of only 27%. The CTC half-lives were 11.0 days in broiler manure, 86.6 days in hog manure, 12.2 days in layer-hen manure (150.3mgkg(-1) CTC), 12.0 days in layer-hen manure (100.0mgkg(-1) CTC) and 4.39 days in layer-hen manure (53.10mgkg(-1) CTC), all according to the first order kinetics. The significance of experimental parameters in CTC depletion was assessed by the Pearson correlation approach. Microbial degradation of CTC was not effective from manure composting. CTC depletion was in good correlation with total organic carbon, total nitrogen, total phosphorus, C/N, N/P and total heavy metals.


Expression of the amphioxus Pit-1 gene (AmphiPOU1F1/Pit-1) exclusively in the developing preoral organ, a putative homolog of the vertebrate adenohypophysis.
For the Florida amphioxus (Branchiostoma floridae), the full-length sequence and developmental expression of AmphiPOU1F1/Pit-1 are described. This gene, which is present in a single copy in the genome, is homologous to Pit-1 genes of vertebrates that play key roles in the development of the adenohypophysis. During amphioxus development, AmphiPOU1F1/Pit-1 transcripts are limited to Hatschek's left diverticulum and the larval tissue developing from it--namely the concave portion of the preoral organ. No other expression domains for this gene were detected during embryonic and larval development. From data currently available for hemichordates, amphioxus and ascidians, the best supported homologs for the vertebrate adenohypophysis are the preoral ciliary organ of hemichordates, preoral organ/Hatschek's pit of amphioxus and the neural gland/duct complex of ascidians. Better insights into pituitary evolution will require additional information: for invertebrate deuterostomes, more of the key pituitary genes in hemichordates and tunicates need to be studied; for the more basal groups vertebrates, it will be important to determine whether the source of the adenohypophysis is endodermal or ectodermal and to demonstrate what, if any, contribution mesodermal head coeloms might make to the developing pituitary.


Isotype switching and titer variation of anti-Ro/SSA antibodies over time in 100 patients with undifferentiated connective tissue disease (UCTD).
To correlate the clinical course of the disease with the titer, the isotype profile and the switch of the anti-Ro/SSA antibodies in a cohort of patients affected by UCTD. One hundred selected patients with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis (CIE), and affected by UCTD with a mean follow-up of 7.6 years (SD 4.8 yrs.), were studied. The titer of IgA, IgG and IgM anti-Ro/SSA antibodies was determined in two different sera, obtained at the time of diagnosis and at the last visit, by ELISA with Ro/SSA recombinant proteins as substrate. Thirty-five patients evolved from UCTD to a different connective tissue disease, while 65 showed a stable disease. Anti-Ro/SSA antibodies were detected in 91% and 97% of the patients, at baseline and during follow-up, respectively. IgG dominates the anti-Ro response. The titer of IgA, IgM and IgG anti-Ro/SSA did not differ significantly between the two groups of patients with UCTD. An increasing trend of IgG and IgA anti-Ro/SSA titer could be detected in patients evolving in primary Sjögren's Syndrome (pSS), but only the increase of IgG anti-Ro/SSA was significant (p=0.0235). IgG dominates the anti-Ro/SSA response in patients with UCTD. No substantial change of the antibody isotype against Ro/SSA peptides could be observed during follow-up. The titer of IgG anti-Ro/SSA significantly raised in the group of patients evolving in pSS.


Gastric carcinoma in dogs produced by the combined use of N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) and gastrin--with special reference to development of scirrhous carcinoma.
Eight beagle dogs of four-month-old received both oral administration of N-Ethyl-N'-Nitro-N-Nitrosoguanidine (ENNG) and subcutaneous injection of gastrin, and one of them was found to have an annularly infiltrating advanced carcinoma with marked fibrous thickening of the antral wall resulting in stenosis of the antrum (carcinoma scirrhosum) which resembled "Linitis plastica" (Borrmann's type IV carcinoma) in human stomach.


Geochemical Characteristics and Preliminary Assessment of Geochemical Threshold Values of Technology-Critical Elements in Soils Developed on Different Geological Substrata Along the Sava River Headwaters (Slovenia, Croatia).
The increased demand for technology-critical elements (TCEs) in emerging technologies brings about the need to determine their spatial distribution in the environment and establish regulatory guidelines. In this paper, concentrations of Li, Sc, Nb, W, Ga, Ge, and REY (rare earth elements, including yttrium) in soils collected from different parent materials in the upper catchment of the Sava River (Slovenia, Croatia) were analysed. Results of multivariate (principal component analysis) and univariate (threshold methods) statistical techniques were used to determine geochemical characteristics of studied soils to identify the background variations and to establish geochemical threshold values. The investigated area is characterized by great lithological diversity and substantial variation of TCE concentrations. Among methods for assessment of geochemical threshold, the TIF (Tukey inner fence) and 97.5th percentile delivered the most reasonable results. Some exceedances above the 97.5th percentile were natural in origin, caused by local geology. These findings can provide baseline data because little is known about TCE variation on different geological substrata.


Quality-Control Analytical Methods: Particulate Matter In Injections: What is It and What are the Concerns?
The presence of particulate matter in intravenous injections, especially in large numbers, represents a potentially life-threatening health hazard. The United States Pharmacopeia has established procedures and standards to ensure the quallity of intravenous injections, including particulate counts. Compounding pharmacists can reduce the incidence of adverse events in patients by assuring the quality of their preparations through filtration of intravenous preparations and analytical testing procedures.


Prolonged cerebral transit time in CADASIL: a transcranial ultrasound study.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary angiopathy caused by mutations in Notch3. Cerebral microvessels show an accumulation of granular osmophilic material in the vicinity of degenerating vascular smooth muscle cells. In this study, we measured the arteriovenous cerebral transit time (CTT) to identify changes related to the microangiopathy in CADASIL. CTT is the time that a contrast agent needs to pass from a cerebral artery to its corresponding vein. CTT was measured in 17 CADASIL individuals (mean age, 50.2+/-12.3 years) and an equal number of age- and sex-matched control subjects (mean age, 48.9+/-13.0 years) with transcranial color-coded duplex sonography. The intensity curves were recorded in the P2 segment of the posterior cerebral artery and the vein of Galen after injection of the ultrasound contrast agent Levovist. CTT was significantly prolonged in individuals with CADASIL (4.4+/-1.9 seconds) compared with control subjects (1.3+/-0.5 seconds, P<0.0001). This difference was also significant when only nondisabled CADASIL individuals (Rankin score=0, n=9) were analyzed (P<0.0001). There was a nonsignificant trend for a correlation between Rankin score and CTT (r=0.39, P=0.11). The prolonged CTT likely reflects microvascular changes in CADASIL. Measurements of the CTT may be used clinically to disclose small-vessel disease. Studies comparing CADASIL subjects with other patient populations seem warranted to determine possible differences in CTT between different types of small-vessel disease.


Ammoniated MOF-74(Zn) derivatives as luminescent sensor for highly selective detection of tetrabromobisphenol A.
In this study, a porous framework MOF-74(Zn) (Zn2 (DHBDC)(DMF)(H2O)2, H4dondc = 1, 5-dioxido-2, 6-naphthalenedicarboxylic acid) with open metal sites was successful synthesized. MOF-74(Zn) as a template was grafted on the open metal sites with ethylenediamine (en) named MOF-74(Zn)-en to develop a highly selective and sensitive fluorescence detector for rapid determination of tetrabromobisphenol A (TBBPA). The obtained MOF-74(Zn)-en was well characterized by Fourier Transform Infrared (FT-IR), Scanning Electron Microscopy (SEM) and showed ideal properties of photoluminescence. The fluorescence enhancement showed a good linear relationship with the concentrations of TBBPA in the range of 50-400 μg/L, and its limit of detection could reach to 0.75 μg/L. Furthermore, the possible sensing mechanism of the fluorescence enhancement could be attributed to Förster resonance energy transfer (FRET). The results will provide a convenient and quick method for detection of TBBPA. To the best of my knowledge, this is the first case to detect TBBPA by fluorescence enhancement with MOF derivatives.


An ethnic model of Japanese overseas tourism companies.
This study aims to analyze the administrative behavior of Japanese travel companies overseas. Through case studies and questionnaire surveys, the characteristics of Japanese travel multinationals are compared to those of manufacturing companies. An "Ethnic Model" is developed which explains the unique behavior of these companies. It concludes that they are ethnically characterized in target markets, management styles in foreign subsidiaries, emphases on service, and competitors. Though this study focuses on the Japanese tourism industry, the result is potentially generalizable and applicable to other countries and other non-manufacturing industries.


Is Living in an Ethnic Enclave Associated With Cognitive Function? Results From the Population Study of Chinese Elderly (PINE) in Chicago.
Ethnic enclaves provide pivotal coping resources for immigrants, having important implications for cognitive health. This study examined the association between living in an ethnic enclave (i.e., Chinatown) and cognition, and potential moderating effect of education on such an association among Chinese older immigrants in the United States. We further examined subgroup differences based on preferred language (Mandarin, Cantonese, and Taishanese). Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,105, mean age = 73). Global cognition, assessed by a battery including Mini-Mental State Examination, working memory, episodic memory, and executive function, was compared between those who lived in Chinatown (n = 1,870) and those who did not (n = 1,235). Linear regressions with interaction terms were performed in the entire sample and subsamples with different language preferences. Chinatown residents had significantly poorer cognition than non-Chinatown residents. Regression results identified both protective and risk factors for cognition associated with living in Chinatown. Among them, education (β = 0.072, p < .001) played a salient role in explaining the cognitive disadvantage of Chinatown residents. Education also moderated the influence of Chinatown residence on cognition, but only among Mandarin speakers (β = -0.027, p = .04). Living in an ethnic enclave may be a risk factor for poor cognition for Chinese immigrants. Neighborhood-specific health assessment may facilitate early identification and prevention of cognitive impairment in this population. Studies need to examine divergent aging experiences of immigrants within single ethnic groups.


Crossed corticothalamic and thalamocortical connections of macaque prefrontal cortex.
We have conducted a systematic comparison of the ipsilateral (uncrossed) and contralateral (crossed) thalamic connections of prefrontal cortex in macaque monkeys, using cortical implants of horseradish peroxidase pellets and tetramethyl benzidine histochemistry to demonstrate anterograde and retrograde thalamic labeling. Contrary to the prevailing belief that thalamocortical projections are entirely uncrossed, our findings indicate that a modest crossed projection to prefrontal cortex arises from the mesial thalamus, principally the anteromedial and midline nuclei. Also, while confirming that corticothalamic projections are bilateral, we found that the pattern of crossed projections differs from that of uncrossed projections. Projections to mesial thalamic nuclei, specifically to the anteromedial nucleus, the midline nuclei, and the magnocellular part of the mediodorsal nucleus are bilateral, the contralateral projection being nearly as dense as the ipsilateral projection. Projections to the parvicellular part of the mediodorsal and ventral anterior nuclei are also bilateral, but the contralateral projection is much weaker than the ipsilateral projection. Prefrontal projections to the reticular nucleus, medial pulvinar, suprageniculate nucleus, and limitans nucleus appear to be exclusively ipsilateral. These results indicate that prefrontal cortex has prominent bilateral and reciprocal connections with the nuclei of the mesial thalamic region. As this region of the diencephalon has been implicated by anatomical and behavioral studies in memory functions, our findings suggest that prefrontal cortex, through its connections with this region, may be involved in the bilateral integration of mnemonic systems.


Neuropathological aspects of infantile spasms.
A review of the neuropathological findings in 50 personal autopsy cases and in the available literature (214 confirmed cases) of infantile spasms demonstrates that this type of early infantile epilepsy occurs in a wide range of cerebral lesions caused by various noxae during different stages of brain development. With regard to morphology and the presumed time of occurrence of the CNS lesions, four groups can be distinguished: (1) embryofetal lesions, including a) cerebral malformations or developmental disorders-agyria-pachygyria (lissencephaly), micrencephaly, micropolygyrias, (hemi)megalencephaly, agenesis of corpus callosum, tuberous sclerosis, heterotopias, cortical microdysplasias, b) metabolic disorders (leukodystrophies, neurolipidoses, spongy dystrophies, Leigh and Alpers diseases, aminoacidopathies); (2) perinatal and postnatal encephalopathies, e.g. polycystic brain, diffuse and lobar sclerosis, ulegyrias, white matter and basal ganglia scars, status marmoratus, hippocampal sclerosis, and cerebellar atrophy; (3) combined embryofetal (developmental) and perinatal or postnatal brain lesions, particularly association of microdysplasias with secondary anoxic or vascular changes; (4) acute vascular and inflammatory brain injuries; (5) cases without definite brain pathology. Evaluation of the available data indicates that embryo-fetal lesions alone or accompanied and/or superimposed by perinatal or postnatal lesions account for about 61% of the cases confirmed by autopsy, in which infantile spasms can be regarded as fetal epilepsies, while a smaller group is featured by perinatal or postnatal lesions occurring in early age, i.e. affecting the immature brain. Similar lesions are observed in cases showing transition of West syndrome to Lennox syndrome. Negative pathology findings in a small number of cases do not necessarily implicate negative pathobiology.(ABSTRACT TRUNCATED AT 250 WORDS)


SURE Test Accuracy for Decisional Conflict Screening among Parents Making Decisions for Their Child.
Background. We aimed to validate the SURE test for use with parents in primary care. Methods. A secondary analysis of cluster randomized trial data was used to compare the SURE test (index, higher score = less conflict) to the Decisional Conflict Scale (DCS; reference, higher score = greater conflict). Our a priori hypothesis was that the scales would correlate negatively. We evaluated the association between scores and estimated the proportion of variance in the DCS explained by the SURE test. Then, we dichotomized each measure using established cutoffs to calculate diagnostic accuracy and internal consistency with confidence intervals adjusted for clustering. We evaluated the presence of effect modification by sex, followed by sex-specific calculation of validation statistics. Results. In total, 185 of 201 parents completed a DCS and SURE test. Total DCS (mean = 4.2/100, SD = 14.3) and SURE test (median 4/4; interquartile range, 4-4) scores were significantly correlated (ρ = -0.36, P < 0.0001). The SURE test explained 34% of the DCS score variance. Internal consistency (Kuder-Richardson 20) was 0.38 (P < 0.0001). SURE test sensitivity and specificity for identifying decisional conflict were 32% (95% confidence interval [CI], 20%-44%) and 96% (95% CI, 93%-100%), respectively. The SURE test's positive likelihood ratio was 8.4 (95% CI, 0.1-17) and its negative likelihood ratio was 0.7 (95% CI, 0.53-0.87). There were no significant differences between females and males in DCS (P = 0.5) or SURE test (P = 0.97) total scores; however, correlations between test total scores (-0.37 for females v. for -0.21 for males; P = 0.001 for the interaction) and sensitivity and specificity were higher for females than males. Conclusions. SURE test demonstrated acceptable psychometric properties for screening decisional conflict among parents making a health decision about their child in primary care. However, clinicians cannot be confident that a negative SURE test rules out the presence of decisional conflict.


iTRAQ-based differential proteomic analysis in Mongolian gerbil brains chronically infected with Toxoplasma gondii.
The aim of our study was to detect differentially regulated proteins and specific signaling pathways in Mongolian gerbil brains during chronic Toxoplasma gondii (T.gondii) PRU strain infection. We use a iTRAQ-based strategy to detecte 4935 proteins, out of which 110 proteins were differentially expressed (>/=2.0-fold, p value <0.05) when the brain of gerbils infected with T.gondii was compared to control brain tissues. We confirmed the authenticity and the accuracy of iTRAQ results through quantitative real-time PCR and western blot (WB), which was consistent with mass spectrometry analysis. Pathway analysis and GO (Gene Ontology) annotations indicated the deregulation of several pathways related to immune response, metabolism and neurological processes, like neuronal growth and neurotransmitter transport. Through the iTRAQ-based strategy, we obtained a comparative proteome profile of brain tissues from Mongolian gerbils with chronic infection of T.gondii. Several differentially expressed proteins involved in neurological pathways, like Parvalbumin, Drebrin or Synaptotagmin, can be further investigated to enhance our understanding of central nervous system (CNS) injury caused by T.gondii. T.gondii can infect almost all nucleated cells with a preference for the CNS, which can induce Toxoplasma encephalitis (TE). However, the pathogenesis and mechanisms between the parasite and host associated with TE are largely unexplored. Around 30% of the world population is considered to have latent infection with T.gondii and >90% patients died of TE, while the proportion of secondary paralysis is also high. Patients of TE may have highly varied neurological symptoms with both focal and diffuse neurological lesions, while mental symptoms and behavior disorders are frequently accompanied, like the Alzheimer's disease (AD). We present a comparative proteomics analysis to explore the differences of protein expression caused by chronic T.gondii infection. The results of this analysis can be helpful for identifying key proteins involved in the pathogenesis of TE. In addition, the study can contribute to a better understanding of molecular mechanisms underlying the host-parasite relationship in chronic infection of T.gondii and facilitate further development of new therapies for TE.


Repeated mass treatment of schistosomiasis mansoni: experience in hyperendemic areas of Brazil. 3. Techniques for assessment and surveillance.
Severe morbidity due to schistosomiasis mansoni is now quite rare in Brazil; thus it is proposed that surveillance plus selective and multidisciplinary intervention limited to areas at high risk be the next step. Such a policy has to be carried out periodically and on a state-wide scale, and therefore will have to rely upon cheap and time-saving sampling procedures. Clinical features cannot at present be used as indicators, with the exception of grossly enlarged livers, which are more frequent in areas at high risk. Overall prevalence rates for a county or even city may also be misleading, even if broken down into units of smaller size. Thus, egg counts in the young age groups remain the best indicators for the detection of areas at high risk (i.e., the main foci of transmission). Egg counts performed on pooled specimens adequately reflect the risk rating of a particular neighbourhood, and have a favourable cost-benefit ratio. In addition, it is suggested that field personnel be trained in the empirical recognition of potential foci; such 'screening by suspicion' has been tested and found to be reliable.


Risk Assessments at Birth Predict Kindergarten Achievement and Involvement with Child Protective Services.
Screening for family risk factors at birth is one way that early childhood programs and practitioners can identify families who might benefit from prevention efforts. Some prevention programs currently use cumulative risk (i.e., total number of risk factors present) to determine eligibility for services. More recently, however, person-centered approaches that take into account combinations of risk (versus cumulative risk) have emerged as an approach that could complement current risk assessment methods and illuminate the extent to which classes of family risk are associated with different outcomes in early childhood. Grounded in ecological theory, we tested cumulative family risk and latent classes of family risk at birth as predictors of kindergarten outcomes and mother-reported involvement with Child Protective Services (CPS). Families in the Fragile Families and Child Well-being Study were included in this study if they had medical records data available at the child's birth as well as children's age 5 kindergarten outcomes (N = 757). Cumulative risk was positively associated with children's attention problems, letter-word recognition skills, CPS involvement, and both covariates (i.e., child's diagnosed disability status and mother's ethnicity/race), but not aggression or social skill problems. In terms of latent classes, children from higher risk classes tended to fare significantly worse on kindergarten outcomes and were more likely to have reported involvement with CPS when compared to the lower risk classes. Implications are discussed related to primary prevention, the merits of screening for risk, and comparisons between cumulative risk and classes of risk approaches.


Changes in circulatory FSH of Barbari goats following treatment with high molecular weight inhibin isolated from buffalo follicular fluid.
The objective of the present study was to isolate and purify high MW inhibin (≈ 129 kDa) from buffalo ovarian follicular fluid (buFF) and to investigate its biological activity. Throughout the process of purification, the inhibin fractions were evaluated for bioactivity by a specific, sensitive and uniformly reproducible bioassay in mice. The final biological activity of this preparation was tested in normal cycling adult female Barbari goats. Eight animals, randomly divided into two groups, were synchronized for estrus by administering PGF2α twice at an interval of ten days. Following synchronization, the treatment group (n=4) received (i.m.) 0.4 ml (240 μg protein total dose) of purified inhibin (MW ≈ 129 kDa) of buFF in the morning at 08.00 h for the four consecutive days of follicular phase, while the control group (n=4) received only saline (0.4 ml). Blood samples were collected from jugular vein immediately before the first injection and subsequent collections were made daily in the afternoon until day 8 of the experiment including four days (0, 1, 2, & 3 days) of the next cycle. FSH was assayed in all the samples by ELISA. The peripheral FSH concentration sharply declined from 1.854±0.137 to 0.979 ± 0.02 u/l, 8h after the administration of inhibin on the first day. The value in controls was 2.004 ± 0.132 u/l. For the duration of treatment of four consecutive days, the FSH level in experimental group remained significantly low (p<0.05) compared to control group. After cessation of treatment, the FSH level remained low on day 0 and 1 of the next cycle in the experimental and control animals. However, a significant rebound increase in plasma FSH levels occurred on day 2 & 3 (2.73 ± 0.179 & 1.849 ± 0.128 u/l) only in the experimental group compared to control animals (P<0.05). This increment might be caused by the rebound surge of FSH from anterior pituitary which further corroborates the effect of inhibin in treated animals. In conclusion, the present study demonstrates that the high MW form of inhibin (≈ 129 kDa) isolated from buFF has comparable biological activity as revealed by 31-32 kDa inhibin from other species.


Systemic lupus erythematosus and risk of sexual dysfunction: A systematic review and Meta-Analysis.
To systematically review and summarize the available literature regarding the association between systemic lupus erythematosus (SLE) and sexual dysfunction (SD) in both sexes. We retrieved relevant studies from the following databases: PubMed, Embase,Cochrane Library, and Web of Science. Two reviewers independently reviewed the studies in our sample, assessed their validity, and extracted relevant data. Sensitivity and subgroup analyses were performed to distinguish sources of heterogeneity. Our search resulted in a sample of eight eligible studies, which involved 758 patients in the SLE group and 1724 individuals in the control group. The pooled RR for the increased risk for SD compared to those in the control group was 1.80 (95%CI 1.12-2.87). Subgroup analysis by sex revealed that males (pooled RR = 2.98, 95%CI 2.41-3.68) had a higher risk of SD compared to females (pooled RR = 1.56, 95%CI 0.99-2.48). Females with SLE had significantly lower values in FSFI compared to the healthy individuals (WMD=-0.224, 95%CI -0.441 to -0.078). Age of participants and the quality of studies might influence the results. Our meta-analysis suggests that SLE is significantly associated with an increased risk of sexual dysfunction. It is of great urgency to implement for active interventions that aimed to treat or prevent SD among SLE patients.


Lipid/myelin basic protein multilayers. A model for the cytoplasmic space in central nervous system myelin.
A multilayered complex forms when a solution of myelin basic protein is added to single-bilayer vesicles formed by sonicating myelin lipids. Vesicles and multilayers have been studied by electron microscopy, biochemical analysis, and X-ray diffraction. Freeze-fracture electron microscopy shows well-separated vesicles before myelin basic protein is added, but afterward there are aggregated, possibly multilayered, vesicles and extensive planar multilayers. The vesicles aggregate and fuse within seconds after the protein is added, and the multilayers form within minutes. No intra-bilayer particles are seen, with or without the protein. Some myelin basic protein, but no lipid, remains in the supernatant after the protein is added and the complex sedimented for X-ray diffraction. A rather variable proportion of the protein is bound. X-ray diffraction patterns show that the vesicles are stable in the absence of myelin basic protein, even under high g-forces. After the protein is added, however, lipid/myelin basic protein multilayers predominate over single-bilayer vesicles. The protein is in every space between lipid bilayers. Thus the vesicles are torn open by strong interaction with myelin basic protein. The inter-bilayer spaces in the multilayers are comparable to the cytoplasmic spaces in central nervous system myelins . The diffraction indicates the same lipid bilayer thickness in vesicles and multilayers, to within 1 A. By comparing electron-density profiles of vesicles and multilayers, most of the myelin basic protein is located in the inter-bilayer space while up to one-third may be inserted between lipid headgroups. When cytochrome c is added in place of myelin basic protein, multilayers also form. In this case the protein is located entirely outside the unchanged bilayer. Comparison of the various profiles emphasizes the close and extensive apposition of myelin basic protein to the lipid bilayer. Numerous bonds may form between myelin basic protein and lipids. Cholesterol may enhance binding by opening gaps between diacyl-lipid headgroups.


Oral focal mucinosis of the tongue.
Oral focal mucinosis (OFM) is an uncommon clinicopathological entity which is considered to be the oral counterpart of cutaneous focal mucinosis and cutaneous myxoid cyst. It is comprised of a clinically elevated mass with a histological feature of localised areas of myxomatous connective tissue. The present study adds a rare case of OFM of the tongue to the literature, and we present a review of the most characteristic oral myxomatous lesions.


[Erythema nodosum due to tinea].
Erythema nodosum (EN) is the most common clinical and pathological variant of panniculitis. A Celsus kerion is an inflammatory and suppurative tinea of the scalp. We report on a rare case of EN secondary to a kerion of the scalp. A 9-year-old child without a notable medical history, had a squamous plaque of the vertex for 15 days, which became painful and purulent. Five days after the plaque appeared, he presented with painful, hot, erythematous lesions symmetrically on the extensor surfaces of the legs and forearms. A medical examination found a fever of 38.5°C, a squamous purulent and crusty plate of the vertex (6/5cm) with pustules and a few hairs cut short, and symmetrical painful erythematous hot nodules on the anterior surfaces of the two legs and forearms. A mycological sample of the crusts of the scalp lesion confirmed the presence of Trichophyton mentagrophytes. A bacteriological sample was not taken, and a skin biopsy confirmed the diagnosis of EN. The results of other paraclinical investigations were normal. The diagnosis of EN secondary to an inflammatory scalp tinea was established, and our patient was prescribed an orally and locally administered antimycotic, rest, and elevation of the limbs. EN is an acute nodular hypodermitis considered a nonspecific hypersensitive reaction to various allergens. Rarely, it can occur secondary to a fungal infection of the scalp such as a kerion or even secondary to the antifungal treatment of this tinea. EN secondary to a kerion of the scalp before the beginning of antifungal treatment has been reported in the literature, with a spontaneous improvement of the EN after treatment of the tinea.


Transient evoked otoacoustic emissions in hearing screening programs: protocol for developing countries.
To formulate a protocol for infant hearing screening in developing countries enabling it to be later incorporated into their national deafness screening programs. The screening tool should be sensitive in detecting hearing loss in infants with high specificity. 2659 infants in the age range of 0-3 months who reported to the Department of Otolaryngology were included in the study. As 537 children were lost to follow up after the first screening, the remaining 2122 infants only were considered for the statistical analysis. These were divided into 3 groups with age range between 0-1, 1-2 and 2-3 months of age. All were subjected to transient evoked otoacoustic emission (TEOAE) for hearing screening. Those who failed first screening were followed up after 1-month. Pass rate for TEOAE was calculated for each. Infants who had failed the second screening underwent Brainstem Evoked Response Audiometry (BERA). The data collected was statistically analyzed. 77.5% of infants in 0-1-month age group passed the screening test whereas 83.4% and 92.8% of infants passed the screening test in 1-2 months and 2-3 month age groups, respectively. On the first follow up, the pass percentage of the infants who had failed screening earlier rose significantly high up to age of 3 months. Those who had failed the follow up were scheduled for Brainstem Evoked Auditory testing. The concept of this delayed hearing screening at 3 months of age would considerably decrease the number of false positive cases undergoing unnecessary investigations and wastage of resources making the universal neonatal hearing screening within 48 h of life impractical for developing countries. Combining this delayed hearing screening with the 3rd dose of universal immunization program would constitute a viable, feasible and universal hearing screening program, which can be drafted into national deafness programs of the developing countries.


An investigation into the disturbance effects of coal mining on groundwater and surface ecosystems.
Coal mining disturbs surface ecosystems in coal mining subsidence areas. Based on the groundwater-surface composite ecosystem analysis, we constructed an ecological disturbance evaluation index system (18 indices) in a coal mining subsidence area using the analytic hierarchy process (AHP). Taking the Nalinhe mining area in Wushen Banner, China, in 2018-2020 as an example, the weight, ecological disturbance grade and correlation of different indicators were determined by implementing fuzzy mathematics, weighting method, and correlation analysis method. The major conclusions of this review were: (i) After two years of mining, ecological disturbance was the highest in the study area (Grade III) and the lowest in the non-mining area (Grade I). (ii) Coal mining not only directly interfered with the environment, but also strengthened the connection of different ecological indicators, forming multiple ecological disturbance chains such as "mining intensity-mining thickness-buried depth/Mining thickness", "coal mining-surface subsidence-soil chemical factors", and "natural environment-soil physical factors". The disturbance chain that controls the ecological response factors in the region remains to be determined. However, the ecological response factors are the most important factor that hinders the restoration of the ecology in a coal mining subsidence area. (iii) The ecological disturbance in the coal mining subsidence area continued increasing over two years due to coal mining. The ecological disturbance by coal mining cannot be completely mitigated by relying on the self-repair capability of the environment. This study is of great significance for ecological restoration and governance of coal mining subsidence areas.


Patterns of recurrence in head and neck squamous cell carcinoma to inform personalized surveillance protocols.
Development of evidence-based post-treatment surveillance guidelines in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is limited by comprehensive documentation of patterns of recurrence and metastatic spread. A retrospective analysis of patients diagnosed with R/M HNSCC at a National Cancer Institute-designated cancer center between 1998- 2019 was performed (n = 447). Univariate and multivariate analysis identified patterns of recurrence and predictors of survival. Median overall survival (mOS) improved over time (6.7 months in 1998-2007 to 11.8 months in 2008-2019, p = .006). Predictors of worse mOS included human papillomavirus (HPV) negativity (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.2-2.6), high neutrophil/lymphocyte ratio (HR, 2.1 [1.4-3.0], disease-free interval (DFI) ≤6 months (HR, 1.4 [1.02-2.0]), and poor performance status (Eastern Cooperative Oncology Group, ≥2; HR, 1.91.1-3.4). In this cohort, 50.6% of recurrences occurred within 6 months of treatment completion, 72.5% occurred within 1 year, and 88.6% occurred within 2 years. Metachronous distant metastases were more likely to occur in patients with HPV-positive disease (odds ratio [OR], 2.3 [1.4-4.0]), DFI >6 months (OR, 2.4 [1.5-4.0]), and body mass index ≥30 (OR, 2.3 [1.1-4.8]). Oligometastatic disease treated with local ablative therapy was associated with improved survival over polymetastatic disease (HR, 0.36; 95% CI, 0.24-0.55). These data regarding patterns of distant metastasis in HNSCC support the clinical utility of early detection of recurrence. Patterns of recurrence in this population can be used to inform individualized surveillance programs as well as to risk-stratify eligible patients for clinical trials. After treatment for head and neck cancer (HNC), patients are at risk of recurrence at prior sites of disease or at distant sites in the body. This study includes a large group of patients with recurrent or metastatic HNC and examines factors associated with survival outcomes and recurrence patterns. Patients with human papillomavirus (HPV)-positive HNC have good survival outcomes, but if they recur, this may be in distant regions of the body and may occur later than HPV-negative patients. These data argue for personalized follow-up schedules for patients with HNC, perhaps incorporating imaging studies or novel blood tests.


HER2/neu and Ki-67 expression predict non-invasive recurrence following breast-conserving therapy for ductal carcinoma in situ.
Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer that may progress to invasive cancer. Identification of factors that predict recurrence and distinguish DCIS from invasive recurrence would facilitate treatment recommendations. We examined the prognostic value of nine molecular markers on the risks of local recurrence (DCIS and invasive) among women treated with breast-conserving therapy. A total of 213 women who were treated with breast-conserving therapy between 1982 and 2000 were included; 141 received breast-conserving surgery alone and 72 cases received radiotherapy. We performed immunohistochemical staining on the DCIS specimen for nine markers: oestrogen receptor, progesterone receptor, Ki-67, p53, p21, cyclinD1, HER2/neu, calgranulin and psoriasin. We performed univariable and multivariable survival analyses to identify markers associated with the recurrence. The rate of recurrence at 10 years was 36% for patients treated with breast-conserving surgery alone and 18% for women who received breast-conserving surgery and radiotherapy. HER2/neu+/Ki-67+ expression was associated with an increased risk of DCIS recurrence, independent of grade and age (HR=3.22; 95% CI: 1.47-7.03; P=0.003). None of the nine markers were predictive of invasive recurrence. Women with a HER2/neu/neu+/Ki67+ DCIS have a higher risk of developing DCIS local recurrence after breast-conserving surgery.


Effect of decabromodiphenyl ether (BDE-209) on a soil-biota system: Role of earthworms and ryegrass.
In the present study, the toxic effect of decabromodiphenyl ether (BDE-209), an important brominated fire retardant, on soil was evaluated by amending with different concentrations (0 mg/kg, 1 mg/kg, 10 mg/kg, and 500 mg/kg dry wt) for 40 d. The activities of 3 soil enzymes (urease, catalase, and alkaline phosphatase) were measured as the principal assessment endpoints. Meanwhile, the effects of natural environmental factors, such as light conditions and soil biota, on BDE-209 intoxication were studied. For the latter, 30 earthworms (Metaphire guillelmi) with fully matured clitella or ryegrass (Lolium perenne) with fully matured leaves were exposed in soil amended with BDE-209. The activities of the soil enzymes were adversely affected by BDE-209, especially for the high-concentration treatments, with greater adverse effects in the dark than in the light. The presence of earthworms reduced toxicity to BDE-209, whereas ryegrass did not. The calculated integrated biomarker response index, which provides a general indicator of the health status of test species by combining different biomarker signals, further validated these findings. Moreover, the antioxidant status (oxidant-antioxidant balance) of these 2 biota was assessed. Results indicated that BDE-209 significantly affected the activities of antioxidant enzymes (superoxide dismutase and catalase) and enhanced the levels of malondialdehyde in both species. The present study may facilitate a better understanding of the toxicity of BDE-209 toward the soil environment. Environ Toxicol Chem 2016;35:1349-1357. © 2015 SETAC.


Teachers and Teaching: Speech Production Accommodations Due to Changes in the Acoustic Environment.
School teachers have an elevated risk of voice problems due to the vocal demands in the workplace. This manuscript presents the results of three studies investigating teachers' voice use at work. In the first study, 57 teachers were observed for 2 weeks (waking hours) to compare how they used their voice in the school environment and in non-school environments. In a second study, 45 participants performed a short vocal task in two different rooms: a variable acoustic room and an anechoic chamber. Subjects were taken back and forth between the two rooms. Each time they entered the variable acoustics room, the reverberation time and/or the background noise condition had been modified. In this latter study, subjects responded to questions about their vocal comfort and their perception of changes in the acoustic environment. In a third study, 20 untrained vocalists performed a simple vocal task in the following conditions: with and without background babble and with and without transparent plexiglass shields to increase the first reflection. Relationships were examined between [1] the results for the room acoustic parameters; [2] the subjects' perception of the room; and [3] the recorded speech acoustic. Several differences between male and female subjects were found; some of those differences held for each room condition (at school vs. not at school, reverberation level, noise level, and early reflection).


Quantitative infrared spectroscopy of common bile duct gallstones.
The aim of this study was to determine the composition of gallstones from the common bile duct of patients from the United States and the relationship of stone type to the time interval after cholecystectomy. We analyzed 56 sets of common bile duct gallstones collected over a 10-yr period using infrared and atomic absorption spectroscopy and chemical methods. Twenty-four sets (43%) of stones were cholesterol stones containing 85.3% cholesterol, 3.2% pigment, 0.6% phosphate, and 1.3% total calcium. Ten sets (18%) were black pigment stones containing 36.5% pigment, 11.4% cholesterol, 7.6% carbonate, 3.0% phosphate, and 6.2% total calcium. Twenty-two sets (39%) were brown pigment stones containing 52.7% pigment, 16.5% calcium palmitate, 10.1% cholesterol, 0.4% phosphate, and 3.4% total calcium. Most of the 26 stones found at the same time as or within several months after cholecystectomy were either cholesterol (69%) or black pigment (19%). In contrast, the majority (59%) of the 22 common duct stones that were diagnosed greater than or equal to 21 mo after cholecystectomy were brown pigment stones. In conclusion, brown pigment stones are a distinct type of pigment stone characterized by their content of substantial amounts of calcium palmitate. They comprise a significant proportion of common duct stones in this series of United States patients, particularly of those found greater than or equal to 21 mo after cholecystectomy.


Pelvic laparotomy without an indwelling catheter. A retrospective review of 949 cases.
A retrospective review of 949 cases of pelvic laparotomy without an indwelling catheter was conducted. Contrary to traditional beliefs, this study found that the use of an indwelling catheter was not necessary to assure either adequate exposure during operation or satisfactory voiding in the postoperative period. Various prophylactic steps included staff attention to the preoperative and postoperative voiding needs of patients and occasional bladder needling during operation. These efforts resulted in a low (22.1%) postoperative distress catheterization rate with no complications if needling was done. Urinary infection rates ranged from less than 1% for patients who did not require distress catheterization to 3.9% for a comparative population of patients who had an indwelling catheter during and after operation. Abstaining from the use of an indwelling catheter was also associated with lower cost and greater patient satisfaction.


The Calgary Code: a numerical and alphabetical nosography of retrolental fibroplasia.
With the Calgary Code, clinical observation in retrolental fibroplasia can be translated into numerical and alphabetical symbols. This paper outlines the prerequisites for use of the code, the method of use and the potential applications.


Dynamics of a membrane-bound tryptophan analog in environments of varying hydration: a fluorescence approach.
Tryptophan octyl ester (TOE) represents an important model for membrane-bound tryptophan residues. In this article, we have employed a combination of wavelength-selective fluorescence and time-resolved fluorescence spectroscopies to monitor the effect of varying degrees of hydration on the dynamics of TOE in reverse micellar environments formed by sodium bis(2-ethylhexyl) sulfosuccinate (AOT) in isooctane. Our results show that TOE exhibits red edge excitation shift (REES) and other wavelength-selective fluorescence effects when bound to reverse micelles of AOT. Fluorescence parameters such as intensity, emission maximum, anisotropy, and lifetime of TOE in reverse micelles of AOT depend on [water]/[surfactant] molar ratio (w (o)). These results are relevant and potentially useful for analyzing dynamics of proteins or peptides bound to membranes or membrane-mimetic media under conditions of changing hydration.


KLF5-Modulated lncRNA NEAT1 Contributes to Tumorigenesis by Acting as a Scaffold for BRG1 to Silence GADD45A in Gastric Cancer.
Long noncoding RNAs (lncRNAs), genomic "dark matter," are deeply involved in diverse biological processes. The lncRNA nuclear paraspeckle assembly transcript 1 (NEAT1) is a highly participatory lncRNA; however, its roles in gastric cancer (GC) remain largely unexplored. Here, we demonstrated that the expression of NEAT1 was significantly increased and negatively correlated with prognosis in GC. Subsequent experiments confirmed that KLF5 can induce NEAT1 expression by binding to the NEAT1 promoter region. Further experiments revealed that NEAT1 silencing significantly suppressed cell proliferation both in vitro and in vivo and induced apoptosis. We used mRNA sequencing (mRNA-seq) to identify the preferentially affected genes linked to cell proliferation in cells with NEAT1 knockdown. Mechanistically, NEAT1 bound BRG1 (SMARCA4) directly, modulating H3K27me3 and H3K4me3 in the GADD45A promoter to regulate GADD45A-dependent G2/M cell cycle progression. In addition, BRG1 was significantly upregulated and correlated with outcomes in GC; moreover, it promoted cell proliferation both in vitro and in vivo. Taken together, our data support the importance of NEAT1 in promoting GC tumorigenesis and indicate that NEAT1 might be a diagnostic and therapeutic target in GC.


The impact of environmental and genetic factors on neonatal late-onset sepsis.
To assess the genetic contribution to late-onset sepsis in twins in the newborn intensive care unit. A retrospective cohort analysis of twins born from 1994 to 2009 was performed on data collected from the newborn intensive care units at Yale University and the University of Connecticut. Sepsis concordance rates were compared between monozygotic and dizygotic twins. Mixed-effects logistic regression analysis was performed to determine the impact of selected nongenetic factors on late-onset sepsis. The influence of additive genetic and common and residual environmental effects were analyzed and quantified. One hundred seventy monozygotic and 665 dizygotic twin pairs were analyzed, and sepsis identified in 8.9%. Mean gestational age and birth weight of the cohort was 31.1 weeks and 1637 grams, respectively. Mixed-effects logistic regression determined birth weight (regression coefficient, -0.001; 95% CI, -0.003 to 0.000; P = .028), respiratory distress syndrome (regression coefficient, 1.769; 95% CI, 0.943 to 2.596; P < .001), and duration of total parenteral nutrition (regression coefficient, 0.041; 95% CI, 0.017 to 0.064; P < .001) as significant nongenetic factors. Further analysis determined 49.0% (P = .002) of the variance in liability to late-onset sepsis was due to genetic factors alone, and 51.0% (P = .001) the result of residual environmental factors. Our data support significant genetic susceptibility to late-onset sepsis in the newborn intensive care unit population.


Injuries to the cervical spine sustained while carrying loads on the head.
The level and type of injury in 12 patients with cervical spinal cord injury as a result of accidents while carrying heavy loads on the head is analysed. Lateral radiographs of the cervical spine in subjects loaded with 200 lb bags on the head, to assess the effects on the normal configuration of the spine, were obtained. Radiological assessment of a further group of labourers with long periods of this type of employment was done in an attempt to demonstrate any increased predisposition to osteo-arthrotic change in the cervical spine.


The embodiment of inequity: health disparities in aboriginal Canada.
Health disparities are, first and foremost, those indicators of a relative disproportionate burden of disease on a particular population. Health inequities point to the underlying causes of the disparities, many if not most of which sit largely outside of the typically constituted domain of "health". The literature reviewed for this synthesis document indicates that time and again health disparities are directly and indirectly associated with social, economic, cultural and political inequities; the end result of which is a disproportionate burden of ill health and social suffering upon the Aboriginal populations of Canada. In analyses of health disparities, it is as important to navigate the interstices between the person and the wider social and historical contexts as it is to pay attention to the individual effects of inequity. Research and policy must address the contemporary realities of Aboriginal health and well-being, including the individual and community-based effects of health disparities and the direct and indirect sources of those disparities.


Treatment of severe accidental hypothermia using the Clinitron bed.
Two cases of severe accidental hypothermia (core temperature less than 28 degrees C) rewarmed employing the Clinitron system are described. The physiological changes during hypothermia and rewarming are discussed and the current concepts of rewarming (active external versus internal) outlined. It is suggested that severely hypothermic patients can be successfully treated by rapid external rewarming using the Clinitron heated fluidised-bead bed. This method combines the advantages of rapid rewarming, minimal physiological disturbance and is non invasive.


Challenges experienced in the dental care of persons with special needs: a qualitative study among health professionals and caregivers.
This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country. This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed. Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies. Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.


A histological comparison of deep and superficial lobe pleomorphic adenomas of the parotid gland.
Excision of parotid superficial lobe pleomorphic adenomas requires removal of a surrounding cuff of normal parotid tissue. Less aggressive dissection in removing pleomorphic adenomas that occur in the deep lobe of the parotid gland does not seem to compromise prognosis in these patients. We attempted to define histologic characteristics, differentiating superficial and deep lobe tumors, in an attempt to explain this clinical phenomenon. Thirty-one pleomorphic adenomas, 12 deep-lobe tumors, and 19 superficial lobe tumors were analyzed and compared, looking at tumor size, capsule thickness, penetration of tumor through capsule, and predominant cell types present. The superficial lobe tumors had significantly thinner capsules (p =.02). There was increased extracapsular extension of tumor in the superficial lobe group compared with the deep lobe group (79% and 58%, respectively). The tumors were larger in patients with deep lobe lesions (2.6 cm vs 3.6 cm). There was no difference in predominant cell types. The anatomic location of deep lobe tumors is a likely explanation for the histologic differences observed in this study. These important differences allow less aggressive dissection in deep lobe tumors without compromising prognosis.


Comparison of effectiveness of different ashing auxiliaries for determination of phosphorus in natural waters, aquatic organisms and sediments by ignition method.
An improved method for the determination of phosphorus in natural waters, aquatic organisms and sediments by ignition method is proposed. The recoveries of phosphorus (P) from selected inorganic and organic P-containing compound standards after ignition with different auxiliaries, such as MgSO(4), Mg(NO(3))(2), MgCl(2), Mg(Ac)(2) and CaCl(2), were compared. We found that the phosphorus from most compound standards could not be completely recovered when these compounds were ignited (450-500 degrees C) with the MgSO(4) as auxiliary and the baked residue was extracted with 0.2 mol x l(-1) HCl for 30 min at 80 degrees C or at room temperature. P recoveries, for example, were poor, less than 85%, if pyrophosphate and metaphosphate were ignited with the addition of MgSO(4) prior to the extraction of the baked residue with 0.2 mol x l(-1) HCl at 80 degrees C for 30 min. In contrast, MgCl(2), Mg(Ac)(2) and CaCl(2), as well as Mg(NO(3))(2), could all yield complete P recoveries at routine ashing temperatures (450-500 degrees C). The results demonstrate that MgCl(2) is a more effective auxiliary agent for the determination of phosphorus in natural waters, aquatic organisms and sediments by ignition method than MgSO(4) which is commonly used.