Clinical facilitator learning and development needs: exploring the why, what and how.
This study explores the practice experiences of clinical facilitators providing a voice for nurses undertaking the role, a group who up until now has been silent. Seven clinical facilitators from acute care areas within Tasmania participated in the interpretive and participatory study. Three core aspects of clinical facilitation identified were the why, what and how of facilitation. The study identified why nurses became clinical facilitators, what their experiences involved - both positive and negative; and enabled exploration as to how the role could be better supported in the future, through addressing ongoing professional development learning needs. Results of this study have provided in depth insight into the world of the clinical facilitator. The importance of key strategies to implement ongoing professional development through mentorship, provision of feedback and the development of communities of practice are seen as imperative to ensure the role of clinical facilitator reaches its full potential to bridge the gap between theory and practice experienced by undergraduates during clinical placements. Such strategies will help ensure quality clinical placements for undergraduate nursing students.


Spatial representations in the primate hippocampus, and their functions in memory and navigation.
Hippocampal spatial view neurons in primates respond to the place where a monkey is looking, with some modulation by place. In contrast, hippocampal neurons in rodents respond mainly to the place where the animal is located. We relate this difference to the development of a fovea in primates, and the highly developed primate visual system which enables identification of what is at the fovea, and a system for moving the eyes to view different parts of the environment. We show that the spatial view representation in primates is allocentric, and provide new animations using recorded neuronal activity to illustrate this. We also show that this spatial representation becomes engaged in tasks in which the location 'out there' in a scene of objects and rewards must be remembered. We show that this representation of space being viewed provides a framework for the encoding of episodic memory and the recall of these memories in primates including humans, with hippocampal neurons responding for example in a one-trial object / place recall task. These functions of the primate hippocampus in scene-related memory, provide a way for the primate hippocampus to contribute to actions in space and navigation. We consider in a formal model the mechanisms by which these different spatial representations may be formed given the presence of the primate fovea, and how these mechanisms may contribute to the representations found during navigation in a virtual environment.


Postinfectious purpura fulminans caused by an autoantibody directed against protein S.
To determine the mechanism responsible for idiopathic purpura fulminans, we investigated the procoagulant and anticoagulant pathways in five consecutive patients, four after varicella, and the fifth after a nonspecific infection. Procoagulant and anticoagulant factors, including protein C, protein S, and antithrombin III, were measured by quantitative or functional assays. Anti-protein S autoantibodies were identified by dot blotting and Western blotting, and quantified serially by enzyme-linked immunosorbent assay. Clinical and laboratory data were collated retrospectively. In each case the disease began 7 to 10 days after the onset of the precipitating infection, with rapidly progressive purpura leading to extensive areas of skin necrosis. The illness was complicated by impaired perfusion of limbs or digits (two patients), peripheral gangrene resulting in an above-knee amputation (one patient), and major organ dysfunction caused by thromboembolic phenomena involving the lungs (two patients), the heart (one patient), or the kidneys (one patient). Protein S levels were virtually undetectable at the time of admission and failed to respond to infusions of fresh frozen plasma, despite correction of other procoagulant and anticoagulant factors. All five children had anti-protein S IgM and IgG autoantibodies, which persisted for less than 3 months after admission. Decline in the anti-protein S IgG antibody concentration was associated with normalization of the plasma protein S levels. Autoimmune protein S deficiency may be a common mechanism causing postinfectious idiopathic purpura fulminans. Recognition of the pathophysiologic mechanism may provide a rational basis for treatment. Immediate heparinization, infusions of fresh frozen plasma, and, in cases complicated by major vessel thrombosis, the use of tissue-type plasminogen activator may limit thromboembolic complications.


Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation.
A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) (clinicaltrials.gov/ct2/show/NCT00747838). This is a report showing the utility and feasibility of the registry. All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61%). The mean age was 64±9 years. CHADS2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78%), antiarrhythmic medications in 108 (92%), and 35 (30%) had previous catheter ablation. Paroxysmal AF was present in 80 (68%), persistent AF present in 35 (30%), and long-standing persistent present in 3 (2%). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58%) and totally thoracoscopic in 49 (42%). The left atrial appendage was excluded or excised in 112 (95%) patients. There were no deaths related to the procedure. Only 5 (4%) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2%) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80% of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.


Drosophila arginine methyltransferase 1 (DART1) is an ecdysone receptor co-repressor.
Histone arginine methylation is an epigenetic marker that regulates gene expression by defining the chromatin state. Arginine methyltransferases, therefore, serve as transcriptional co-regulators. However, unlike other transcriptional co-regulators, the physiological roles of arginine methyltransferases are poorly understood. Drosophila arginine methyltransferase 1 (DART1), the mammalian PRMT1 homologue, methylates the arginine residue of histone H4 (H4R3me2). Disruption of DART1 in Drosophila by imprecise P-element excision resulted in low viability during metamorphosis in the pupal stages. In the pupal stage, an ecdysone hormone signal is critical for developmental progression. DART1 interacted with the nuclear ecdysone receptor (EcR) in a ligand-dependent manner, and co-repressed EcR in intact flies. These findings suggest that DART1, a histone arginine methyltransferase, is a co-repressor of EcR that is indispensable for normal pupal development in the intact fly.


Web-based questionnaires - a tool used in a Campylobacter outbreak investigation in Stockholm, Sweden, October 2007.
Campylobacteriosis is the most common reported bacterial gastrointestinal disease in Sweden. Food-borne outbreaks of campylobacteriosis in Sweden are rather rare except for, usually rather small, family outbreaks. Water-borne outbreaks of campylobacteriosis, however, have affected several thousand persons in the past.


Localization in rat brain of binding sites for parkinsonian toxin MPTP: similarities with [3H]pargyline binding to monoamine oxidase.
A high-affinity binding site exists in rat brain for the parkinsonian toxin 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine (MPTP). The pharmacological specificity of this binding site suggests that it may correspond to monoamine oxidase (MAO). We have used quantitative autoradiography to map in detail the anatomical distribution of the [3H]MPTP binding site in rat brain and compared it with the anatomical distribution of MAO as determined by in vitro autoradiography with [3H]pargyline. Under the conditions of the assay, [3H]pargyline labeled the type B form of MAO. There were strong similarities in the anatomical distribution of [3H]MPTP and [3H]pargyline, with high levels of both binding sites occurring in the arcuate nucleus, the locus coeruleus, the dorsal raphe nucleus and all circumventricular organs. Low levels of both binding sites were found in the substantia nigra and the caudate-putamen. These results provide additional evidence that the high-affinity binding site for MPTP is MAO. The parkinsonian actions of MPTP might result from metabolites produced by MAO.


Predictors during childhood of future health-related quality of life in adults with Gilles de la Tourette syndrome.
Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental disorder characterised by multiple motor and phonic tics and behavioural problems. Patients with GTS of all ages often report a poor health-related quality of life (HR-QOL). The diagnosis of GTS is usually established in childhood but little is known about factors that predict the long-term well-being of patients, especially in the presence of co-morbid behavioural problems. To investigate the childhood predictors of HR-QOL in a cohort of adult patients with GTS. Forty-six patients with GTS aged 6-16 years underwent a baseline standardised clinical assessment of both tics and behavioural symptoms at a specialist GTS clinic. The same patients were re-assessed aged 16 years and above, with a mean follow-up period of 13 years (range 3-25 years), when they completed the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), a disease-specific measure of HR-QOL. Tic severity, premonitory urges and family history of GTS were identified as predictors during childhood of a poorer HR-QOL in adults with GTS by multiple linear regression analysis. Specifically, tic severity significantly predicted poor outcome across physical, psychological and cognitive domains of the GTS-QOL, reflecting widespread effects on HR-QOL. Young patients with severe tics associated with characteristic premonitory urges and a family history of tic disorders appear to be at higher risk for poorer HR-QOL as adults. Further prospective research into HR-QOL in GTS is required in order to inform long-term strategic resource allocation.


Association of Ig L chain-like protein lambda 5 with a 16-kilodalton protein in mouse pre-B cell lines is not dependent on the presence of Ig H chain protein.
Using a polyclonal rabbit antiserum against recombinant mouse lambda 5 protein, we determined that the pre-B cell specific mouse lambda 5 gene encodes a 22-kDa protein. The lambda 5 protein, which is related to conventional Ig lambda L chain proteins forms a complex with Ig mu H chain protein and an as yet unidentified 16-kDa protein (p16) in mu+ pre-B cell lines carrying a functionally rearranged VH-DH-JH allele. In pre-B cell lines which carry DH-JH rearrangements and do not express mu H chain protein, lambda 5 protein is associated with p16. Thus the expression of lambda 5 protein precedes the expression of intact mu H chain protein. This suggests the existence of developmentally regulated protein complexes involving the Ig L chain-like protein lambda 5 and p16 in mu- pre-B cells; lambda 5, p16, and Ig H chain protein in mu+ pre-B cells and Ig H chain and conventional Ig L chain proteins in B cells and plasma cells.


Orotic acid: its influence on nuclear RNA and microsomal protein synthesis in brain cells of undernourished rat pups.
Malnourished rat pups were supplemented with orotic acid. RNA-synthesizing activity of isolated brain cell nuclei and microsomal protein synthesis was measured in vitro. A marked increase was found in the activity of nuclear RNA synthesis but not in microsomal protein synthesis after orotic acid treatment for 7 days.


Influence of bromoergocryptine on estrogen-modulated prolactin receptors of mouse mammary gland.
Modulation of specific binding of prolactin to murine mammary gland as a response to treatment with various doses of estradiol benzoate (EB) was studied. Measurements of serum and pituitary levels of prolactin were also carried out simultaneously. Estradiol benzoate at a dose of 5 microgram significantly increased the binding of 125I-labelled rat prolactin (rPRL) to mammary gland concomitant with increased serum prolactin levels in ovariectomized mice. Administration of bromoergocryptine along with EB resulted in decreased serum prolactin levels as well as binding of prolactin to breast tissue. It thus appears that the influence of estradiol on binding of prolactin to mammary gland is mediated primarily via its property of enhancing serum prolactin concentration apart from its possible direct effect at the target tissue level.


A 12-month, prospective, observational study of ranibizumab in treatment-naïve Taiwanese patients with neovascular age-related macular degeneration: the RACER study.
The current National Health Insurance scheme in Taiwan reimburses 3 initial plus 4 additional injections of ranibizumab 0.5 mg for eligible patients with neovascular age-related macular degeneration (nAMD). The Ranibizumab AMD Clinical Efficacy in Real-world practice (RACER) study aimed to observe the effectiveness of ranibizumab injections under this reimbursement system. RACER was a 12-month, prospective, observational study conducted in treatment-naïve, adult Taiwanese patients with nAMD. Patients received intravitreal ranibizumab 0.5 mg injections in adherence with local prescribing information. Of 161 patients enrolled, 114 (70.8%) completed the 12-month study. Overall, patients received a mean (standard deviation [SD]) of 4.3 (1.7) ranibizumab injections. The mean (SD, [95% confidence interval], P value) gain in best-corrected visual acuity (BCVA) from baseline at Month 3 was 5.2 (12.2, [3.1, 7.3] letters, P < 0.0001) and at Month 12 was 3.4 (15.4, [0.2-6.6] letters, P = 0.0352). Mean central retinal thickness also decreased from baseline at Months 3 and 12 (both P < 0.001). In subgroup analyses, better treatment outcomes at Months 3 and 12 were observed among patients who received a loading dose and those who had a shorter duration of nAMD at baseline. Adverse events were reported in 58.4% of patients; most (94.4%) were mild-to-moderate in severity and 98.8% were deemed unrelated to study treatment. Treatment with ranibizumab 0.5 mg resulted in significant improvements in visual outcomes among treatment-naïve Taiwanese patients with nAMD. Early treatment and frequent dosing in the real-world setting may be the key to achieving better outcomes.


Developmental trends of liver parenchyma in the terminal period of gestation: a stereological approach.
The aim of the presented study was to establish the baseline data concerning the volumes density of basic architectonic components of human fetal liver parenchyma. The stereological measuring principles of the point-counting method were used. The livers of 38 appropriate for gestational age fetuses, and 12 small for gestational age fetuses were measured. All fetuses investigated were stillborns. A lower volume density of hepatocytic population was found in full-term mature fetuses, when compared with the adults. A lower volume density of hepatocytes has been also disclosed in intra-uterine growth retarded fetuses, when compared with their physiologically developed counterparts of the same gestational age.


Hypertensive disorders of pregnancy are associated with dysmenorrhea in early adulthood: A cohort study.
Hypertensive disorders of pregnancy (HDP) are serious conditions that occur in 5-10% of pregnancies. Maternal factors, such as maternal age, obesity, and renal disease, have been described as risk factors. In order to extract the background lifestyle and gynecological characteristics for HDP, we conducted a prospective cohort study. Pregnant participants were administered a questionnaire on characteristics, menstrual abnormalities and lifestyle factors. The women were followed individually until 1-month postpartum. We used medical records to examine the relationship between menstrual abnormalities and the onset of HDP. We collected data from 193 pregnant women, and excluding 3 who had miscarriage, examined the records of 190. A total of 26 patients developed HDP, of which 10 had early-onset HDP and 16 had late-onset HDP. Although there was no significant association between HDP and dysmenorrhea just prior to pregnancy, there was a significant increase in the incidence of HDP in patients who experienced dysmenorrhea around the age of 20 years (odds ratio 4.362 [95% CI 1.61-11.81]). We found that patients with a history of dysmenorrhea around the age of 20 years have a significantly higher risk of developing HDP. Although dysmenorrhea in young adulthood is ameliorated, it may become apparent as a perinatal disease when a physical load such as pregnancy is applied.


Partial splenic embolization for cancer patients with thrombocytopenia requiring systemic chemotherapy.
Partial splenic embolization (PSE) has been used to improve hematologic parameters related to hypersplenism. The purpose of this study was to review our institutional experience with PSE for cancer patients with thrombocytopenia because of splenic sequestration precluding the administration of systemic therapy (ST). A retrospective review of cancer patients undergoing PSE was undertaken. Twenty-eight patients underwent PSE to correct thrombocytopenia to facilitate the initiation or resumption of ST. Primary and secondary endpoints of the current study included a platelet count increase > 150 K/UL and the initiation of ST, respectively. Periprocedural laboratory values and adverse events were recorded. Thirty PSEs were performed in 28 patients. Two patients underwent repeat PSE because of recurrent thrombocytopenia after the successful initiation of ST. For procedures with adequate follow-up, primary and secondary endpoints were achieved in 96.3% (26 of 27 patients) and 95.7% (22 of 23 patients) of patients, respectively. The mean platelet count was 81 K/UL immediately before PSE and peaked at 293 K/UL after PSE. For 23 patients with frequent laboratory follow-up, the mean time to a platelet count > 150 K/UL was 10 days. The mean hospital stay was 4.5 days. Postprocedure abdominal pain occurred in all patients. Fever was documented in 16 patients and pulmonary consolidation/atelectasis or effusion was documented in 10 patients; 9 patients received empiric antibiotic coverage. The median overall survival was 9.40 months (95% confidence interval, 8.2-10.7 months) among the 28 patients after PSE. PSE is a safe and effective means of managing thrombocytopenia secondary to hypersplenism to facilitate the administration of ST in patients with cancer.


Relevance of genipin networking on rheological, physical, and mechanical properties of starch-based formulations.
The small amount of proteins in starch-rich food industry byproducts can be an advantage to crosslink with genipin and tailor the performance of biobased films. In this work, genipin was combined with non- purified starch recovered from industrial potato washing slurries and used for films production. Starch recovered from potato washing slurries contained 0.75% protein, 2 times higher than starch directly obtained from potato and 6 times higher than the commercial one. Starch protein-genipin networks were formed with 0.05% and 0.10% genipin, gelatinized at 75 °C and 95 °C in presence of 30% glycerol. Bluish colored films were obtained in all conditions, with the higher surface roughness (Ra, 1.22 μm), stretchability (elongation, 31%), and hydrophobicity (water contact angle, 127°) for 0.10% genipin and starch gelatinized at 75 °C. Therefore, starch-rich byproducts, when combined with genipin, are promising for surpassing the starch-based films hydrophilicity and mechanical fragilities while providing light barrier properties.


Ultrasound-guided radiofrequency ablation of symptomatic uterine fibroids: short-term evaluation of effect of treatment on quality of life and symptom severity.
To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid. Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded. Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred. USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.


The Spectrum of Anterior Cruciate Ligament Reconstruction Options for the Pediatric and Adolescent Patient: A Narrative Review.
As youth sports participation has increased in recent years, injuries to the anterior cruciate ligament (ACL) have become increasingly common in pediatric patients. Historically, ACL reconstruction was delayed in pediatric patients to avoid physeal damage with the potential for leg-length discrepancy or angular deformity. Current research shows that delaying reconstruction or choosing nonoperative management is associated with increased rates of meniscal and chondral injuries, persistent knee instability, and low rates of return to previous activity. Early ACL reconstruction using techniques to avoid physeal growth disturbance is now widely accepted among physicians. The purpose of this review was to describe the pediatric ACL in terms of the relevant anatomy and biomechanics, physical examination, and diagnostic imaging. In addition, the importance of skeletal age and possible physeal injury is discussed in the context of ACL reconstruction options by skeletal age and remaining growth potential.


A multicenter retrospective analysis of the clinical and pathological characteristics of 1188 cases of actinic keratosis in different ultraviolet radiation intensity areas of China.
Actinic keratosis (AK) is a precancerous disease, caused by ultraviolet radiation (UV). To analyze the clinical and pathological characteristics of AK in four areas with different ultraviolet radiation intensities. 1188 diagnosed AK patients, from January 2000 to July 2015, in dermatology department of four hospitals were collected. The UV intensity of hospital located cities from high to low is Kunming, Yinchuan, Shenyang and Nanjing. The information comes from medical records, and the pathological types and Keratinocyte Intraepithelial Neoplasia (KIN) grades were checked by two experienced pathologists. All information was conducted a retrospective multicenter research. The patients were mainly middle-aged and elderly female, which was in direct contrast to the majority of men in European. The age of onset in Kunming group was lower than that in Yinchuan Group (p = 0.013) and Nanjing Group (p < 0.01). The course of disease in Kunming group was significantly shorter than that in Nanjing Group (p < 0.001). The lesions were almost located in the exposed area. The proportion of unexposed areas in Shenyang group was significantly higher than that in other groups (p < 0.001). There were statistical differences in pathological morphological classification among the four groups. These differences were not affected by age and gender. The number of KIN III grade patients in Shenyang group was significantly higher than that in other three groups (p < 0.05). The Asian patients were mainly female. The clinical characteristics of AK are closely related to UV intensity, and environmental pollution, lifestyle, religious beliefs and other factors are also related.


Ten-year safety and clinical benefit from open-label etanercept treatment in children and young adults with juvenile idiopathic arthritis.
CLIPPER2 was an 8-year, open-label extension of the phase 3 b, 2-year CLIPPER study on the safety and efficacy of etanercept in patients with juvenile idiopathic arthritis (JIA), categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA), or psoriatic arthritis (PsA). Participants with eoJIA (2-17 years old), ERA, or PsA (each 12-17 years old) who received ≥1 etanercept dose (0.8 mg/kg weekly; maximum 50 mg) in CLIPPER could enter CLIPPER2. Primary end point was occurrence of malignancy. Efficacy assessments included proportions achieving JIA American College of Rheumatology (ACR) 30/50/70/90/100 criteriaand ACR inactive disease criteria, and clinical remission (ACR criteria) or Juvenile Arthritis Disease Activity Score (JADAS) ≤1. Overall, 109/127 (86%) CLIPPER participants entered CLIPPER2 (n = 55 eoJIA, n = 31 ERA, n = 23 PsA; 99 [78%] on active treatment); 84 (66%) completed 120 months' follow-up (32 [25%] on active treatment). One malignancy (Hodgkin's disease in 18-year-old patient with eoJIA treated with methotrexate for 8 years) was reported; there were no cases of active tuberculosis or deaths. Numbers and incidence rates [events per 100 patient-years] of TEAEs (excluding infections/ISRs) decreased from 193 [173.81] in Year 1-9 [27.15] in Year 10; TE infections and serious infections also decreased. Over 45% of participants (N = 127) achieved JIA ACR50 responses from Month 2 onwards; 42 (33%) and 17 34 (27%) participants achieved JADAS and ACR clinical remission, respectively. Etanercept treatment up to 10 years was well tolerated, consistent with the known safety profile, with durable response in the participants still on active treatment. The benefit-risk assessment of etanercept in these JIA categories remains favorable. CLIPPER (NCT00962741); CLIPPER2 (NCT01421069).


Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation.
We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation. Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery. We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications. The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy.


Multishot EPI-SSFP in the heart.
Refocused steady-state free precession (SSFP), or fast imaging with steady precession (FISP or TrueFISP), has recently proven valuable for cardiac imaging because of its high signal-to-noise ratio (SNR) and excellent blood-myocardium contrast. In this study, various implementations of multiecho SSFP or EPI-SSFP for imaging in the heart are presented. EPI-SSFP has higher scan-time efficiency than single-echo SSFP, as two or more phase-encode lines are acquired per repetition time (TR) at the cost of a modest increase in TR. To minimize TR, a noninterleaved phase-encode order in conjunction with a phased-array ghost elimination (PAGE) technique was employed, removing the need for echo time shifting (ETS). The multishot implementation of EPI-SSFP was used to decrease the breath-hold duration for cine acquisitions or to increase the temporal or spatial resolution for a fixed breath-hold duration. The greatest gain in efficiency was obtained with the use of a three-echo acquisition. Image quality for cardiac cine applications using multishot EPI-SSFP was comparable to that of single-echo SSFP in terms of blood-myocardium contrast and contrast-to-noise ratio (CNR). The PAGE method considerably reduced flow artifacts due to both the inherent ghost suppression and the concomitant reduction in phase-encode blip size. The increased TR of multishot EPI-SSFP led to a reduced specific absorption rate (SAR) for a fixed RF flip angle, and allowed the use of a larger flip angle without increasing the SAR above the FDA-approved limits.


Factors affecting temporal H2S emission at construction and demolition (C&D) debris landfills.
Odor problems associated with H2S emissions often result in odor complaints from nearby residents of C&D debris landfills, especially in the early morning. As part of a field study conducted on H2S removal ability using different cover materials, daily and seasonal H2S emissions through a soil cover layer were monitored at a C&D debris landfill to investigate factors affecting H2S emissions. H2S emission rates were not a constant, but varied seasonally, with an average emission rate of 4.67×10(-6)mgm(-2)s(-1). During a the 10-month field study, as the H2S concentration increased from 140ppm to about 3500ppm underneath the cover soil in the testing cell, H2S emissions ranged from zero to a maximum emission rate of 1.24×10(-5)mgm(-2)s(-1). Continuous emission monitoring indicated that H2S emissions even changed over time throughout the day, generally increasing from morning to afternoon, and were affected by soil moisture and temperature. Laboratory experiments were also conducted to investigate the effects of H2S concentration and cover soil moisture content on H2S emissions. The results showed that increased soil moisture reduced H2S emissions by retarding H2S migration through cover soil and dissolving H2S into soil water. The field study also indicated that due to atmospheric dispersion, high H2S emissions may not cause odor problems.


An improved graph Laplacian regularization method for identifying biomarkers of Alzheimer's disease.
Alzheimer's disease (AD) is one of the most common dementia, and its pathogenesis has not been clarified. The failure of amyloid targeted therapy has led us to rethink the pathogenesis of AD. There is growing evidence that complex diseases usually involve the impairment of multiple biological functions, rather than focus on several single genes. Protein-protein interaction network (PPIN) has been recognized as an important tool for identifying and predicting disease biomarkers. It is a great challenge to design network-based classification method for identifying effective, stable and interpretable biomarkers to distinguish the disease phenotype based on gene expression profile data. In this study, we used graph Laplacian regularization method to introduce topology information of PPIN, which can reveal the damaged networks involved in disease from heterogeneous gene expression profile data and identify disease-related biomarkers. The results in three AD datasets showed that the biomarkers identified by our method can not only distinguish the sample categories more accurately, but also help researchers understand the biological meaning behind complex diseases.


Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery.
One of the most frequent complications after laparoscopic antireflux surgery is estimated to be the intrathoracic herniation of the wrap into the chest. Therefore, in up to 5% of patients, revisional surgery is necessary. Patients who undergo laparoscopic refundoplication for postoperative intrathoracic wrap herniation using a circular polypropylene mesh for hiatal closure have a good to excellent functional outcome, during a complete follow-up of 1 year. Prospective nonrandomized trial of a consecutive sample. University-affiliated community hospital. Twenty-four patients undergoing laparoscopic refundoplication for persistent or recurrent symptoms of gastroesophageal reflux disease as a result of postoperative intrathoracic wrap migration. All patients underwent laparoscopic refundoplication with a circular polypropylene mesh for hiatal closure. Recurrences, complications, postoperative lower esophageal sphincter pressure, DeMeester score, esophagogastroduodenoscopy results, and barium swallow results. All refundoplications were completed laparoscopically. There were no intraoperative complications. Twenty-one patients underwent laparoscopic Nissen fundoplication; in 3 patients, a laparoscopic Toupet fundoplication was performed. Previous antireflux procedures included an open Nissen fundoplication (n = 5), a laparoscopic Nissen fundoplication (n = 15), and a laparoscopic Toupet fundoplication (n = 4). Postoperatively, one patient had severe dysphagia and had to undergo pneumatic dilatation once. During a follow-up of 1 year after surgery, no patient developed a recurrent hiatal hernia, with or without intrathoracic wrap herniation. The mean lower esophageal sphincter pressure increased significantly (P<.01) at 3 months (12.2 mm Hg) and 1 year (11.9 mm Hg) after refundoplication. The mean DeMeester score decreased significantly (P<.01) from 50.5 points preoperatively to 16.0 points at 3 months and 14.7 points at 1 year after refundoplication. Laparoscopic refundoplication with prosthetic hiatal closure is a safe and effective procedure for preventing recurrent intrathoracic wrap herniation, with good to excellent functional outcome for a complete follow-up of 1 year.


Molecular identification of Sch28080-sensitive K-ATPase activities in the mouse kidney.
Rat collecting ducts display either an ouabain-insensitive or an ouabain-sensitive K-ATPase activity inhibited by Sch28080 according as animals are fed a normal or a potassium-depleted diet (types I and III K-ATPase, respectively). Two isoforms of H,K-ATPase have been cloned from rat gastric mucosa and colon, respectively. Gastric and colonic H,K-ATPase are expressed in the kidney, suggesting that they might account for types I and III K-ATPases. However, this hypothesis is not fully supported by segmental expression of gastric and colonic H,K-ATPase along the rat collecting duct, as well as by comparison of the pharmacological properties of gastric and colonic H,K-ATPase expressed in Xenopus ovocyte and types I and III K-ATPases in rat collecting ducts. The aim of the present work is to address directly the molecular origin of types I and III K-ATPases in the mouse collecting duct by measuring K-ATPase activities in collecting ducts of wild-type mice and mice genetically deficient in either gastric or colonic H,K-ATPase fed either a regular or a potassium-depleted diet. Like the rat, mouse collecting ducts display type I or III K-ATPase activity when fed a regular or a potassium-depleted diet, respectively. Type I K-ATPase activity is detected in colonic H,K-ATPase-deficient mice but not in gastric H,K-ATPase-deficient animals. Conversely, type III K-ATPase activity disappears in colonic H,K-ATPase-deficient but not in gastric H,K-ATPase-deficient mice. In conclusion, types I and III K-ATPases measured in collecting ducts of normal and potassium-depleted mice reflect the functional expression of gastric and colonic H,K-ATPase, respectively.


CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass).
To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P < 0.05) of the surgical side were significantly lower than pre-operation. In patients (n = 20) with bypass patency, postoperative rCBF, rMTT and rTTP values (P < 0.05) of the surgical side were significantly improved. However, the differences of all parameters were not significant (P > 0.05) in the patients (n = 4) without bypass patency after revascularization. This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. Twenty-four MMS patients undergoing STA-MCA bypass received CTP pre- and post-surgery. Cerebral haemodynamics improved on the surgical side post-surgery on CTP maps. rCBF might have a better correlation with patency of the bypass artery. CTP can evaluate cerebral perfusion changes in MMS patients after cerebral revascularization.


Stimuli-responsive natural gums-based drug delivery systems for cancer treatment.
Chemotherapy as the main cancer treatment method has non-specific effects and various side-effects. Accordingly, significant attempts have been conducted to enhance its efficacy through design and development of "smart" drug delivery systems (DDSs). In this context, natural gums, as a nice gift by the nature, can be exploited as stimuli-responsive DDSs for cancer treatment in part due to their renewability, availability, low cost, bioactivity, biocompatibility, low immunogenicity, biodegradability, and acceptable stability in both in vitro and in vivo conditions. However, some shortcomings (e.g., poor mechanical properties and high hydration rate) restrict their biomedical application ranges that can be circumvented through modification process (e.g., grafting of stimuli-responsive polymers or small molecules) to obtain tailored biomaterials. This review article aimed to compile the stimuli-responsive DDSs based on natural gums. In addition, different types of stimuli, the fundamental features of natural gums, as well as their chemical modification approaches are also shortly highlighted.


In vitro and in vivo pharmacology of a structurally novel Na+-H+ exchange inhibitor, T-162559.
1. We investigated the inhibitory effects of a non-acylguanidine Na(+)-H(+) exchange (NHE) inhibitor, T-162559 ((5E,7S)-[7-(5-fluoro-2-methylphenyl)-4-methyl-7,8-dihydro-5(6H)-quinolinylideneamino] guanidine dimethanesulphonate), on NHE-1, and its cardioprotective effect against ischaemia and reperfusion injury in rats and rabbits. 2. T-162559 inhibited human platelet NHE-1 in a concentration-dependent manner, with an IC(50) value of 13+/-3 nmol l(-1), making it 16 and three times more potent than cariporide IC(50): 209+/-75 nmol l(-1), P<0.01) and eniporide (IC(50): 40+/-11 nmol l(-1), P=0.066), respectively. T-162559 also inhibited rat NHE-1 with an IC(50) value of 14+/-2 nmol l(-1), which was five and three times lower than that of cariporide (IC(50): 75+/-7 nmol l(-1), P<0.01) and eniporide (IC(50): 44+/-2 nmol l(-1), P<0.01), respectively. 3. T-162559 inhibited, in a concentration-dependent manner, the reduction in cardiac contractility, progression of cardiac contracture, and increase in lactate dehydrogenase release after global ischaemia and reperfusion in perfused rat hearts. The inhibitory effects of T-162559 were observed at a lower concentration range (10 - 100 nmol l(-1)) than with cariporide and eniporide. T-162559 did not alter basal cardiac contractility or coronary flow after reperfusion, suggesting that it exerts direct cardioprotective effects on the heart. 4. Intravenous administration of T-162559 (0.03 and 0.1 mg kg(-1)) significantly inhibited the progression of myocardial infarction induced by left coronary artery occlusion and reperfusion in rabbits; the infarct size normalized by area at risk was 74+/-6% in the vehicle group, and 47+/-5% and 51+/-7% in the T-162559-0.03 mg kg(-1) and T-162559-0.1 mg kg(-1) groups (both P<0.05), respectively. 5. These results indicate that the new structural NHE-1 inhibitor T-162559 is more potent than cariporide and eniporide and possesses a cardioprotective effect against ischaemia and reperfusion injury in rat and rabbit models.


Abnormal vasculature in intestinal neuronal dysplasia.
Intestinal neuronal dysplasia (IND) is an intestinal motility disorder, which clinically resembles Hirschsprung's disease (HD). Adventitial fibromuscular dysplasia (AFMD) consists of proliferation of smooth muscle cells and collagen fibers in the adventitia of blood vessels. The purpose of this study was to investigate vascular abnormalities in large bowel biopsies from patients with isolated HD, IND associated with HD and isolated IND. Large bowel biopsies from patients presenting with isolated HD ( n=23), IND associated with HD ( n=11), isolated IND ( n=16) and normal bowel as controls ( n=6) were investigated using acetylcholinesterase (AChE) histochemistry, van Gieson staining and alpha-smooth muscle actin (alpha-SMA) immunohistochemistry. Increased AChE activity around submucosal vessels was found in 9/16 (56%) cases with isolated IND, 3/11 (27%) cases of IND associated with HD, 5/23 (21%) isolated HD cases and 0/6 controls. AFMD was found in 10/16 (62%) of the isolated IND cases, 4/11 (362) of the cases with IND associated with HD and 4/23 (17%) cases of HD without IND using van Gieson staining. None of the control specimens revealed AFMD. Increased alpha-SMA immunoreactivity filaments were demonstrated in the submucosal vessel wall in 9/16 (56%) of isolated IND and 2/11(18%) of IND associated with HD cases. Normal alpha-SMA immunoreactivity around submucosal vessels was seen in isolated HD and controls. Abnormal submucosal vasculature is a common histological finding in isolated IND and IND associated with HD and may be a useful additional diagnostic feature in these patients.


Characteristics of local electrograms with diastolic potentials: identification of different components of return pathways in ventricular tachycardia.
Diastolic potentials are often sought as a possible site for catheter ablation in post-infarct ventricular tachycardia. However, delivery of energy at such sites is often unsuccessful. The purpose of this study was to determine the characteristics of local electrograms with diastolic potentials and to identify activation pattern which might indicate the critical portion of the return path of the ventricular tachycardia reentry circuit. In 17 patients with post-myocardial infarction ventricular tachycardia, 30 ventricular tachycardias were mapped with an 112 bipolar endocardial balloon at the time of surgery. Diastolic mapping of the return tract in ventricular tachycardia was performed. Four activation patterns were observed (15 figure 8 patterns, 2 circular patterns, 2 biregional patterns and 11 monoregional patterns). Of 3,360 local electrograms, 207 (6.2%) demonstrated a diastolic potential in ventricular tachycardia. They were classified into following four categories, based on the appearance and timing of the systolic component. Type A-1 electrogram: systolic activation was of low amplitude (< 2 mV) and was prolonged (> or = 100 msec), but preceded the onset of the surface QRS in ventricular tachycardia. Type A-2 electrogram: systolic activation was of low amplitude, was prolonged, but followed the onset of the surface QRS. Type B electrogram: systolic electrogram was fractionated, but relatively normal amplitude (2.0-3.6 mV). Type C electrogram: systolic electrogram was almost normal. Of all electrograms with diastolic potentials, three type A-1 electrograms (1.4%) were located at the exit of the return pathway, 11 type A-1 electrograms (5.3%) were located at the pre-exit site. No type A-1 was found at an entrance/bystander area. 21 type A-2 electrograms (10.1%) were at the pre-exit and 83 type A-2 electrograms (40.2%) were located at the entrance/bystander area, but such electrograms were never found at the exit site. 71 type B electrograms (34.3%) and 18 type C electrograms (8.7%) were located at the entrance/bystander area. To distinguish the type A-2 electrograms at the pre-exit site from those at the entrance/bystander area, the diastolic potential to QRS interval was measured. This interval at the pre-exit was significantly shorter than that at the entrance/bystander area (-47.2 +/- 10.7 vs -96.3 +/- 31.3 msec, p = 0.0001). Type A-1 electrograms indicated the exit or pre-exit site of return pathway. Type A-2 electrograms with diastolic potential to QRS interval < -50 msec indicated the pre-exit site. However, the other types of local electrograms with diastolic potential did not indicate the critical portion of the ventricular tachycardia circuit. These observations may be helpful during catheter mapping and ablation of patients with post-infarct ventricular tachycardia. Diastolic potentials are often sought to direct catheter ablation in post-infarct ventricular tachycardia. We investigated the characteristics of local electrograms showing diastolic activity in an attempt to determine whether critical portions of the ventricular tachycardia circuit could be identified by a typical "signature." In 17 patients with a remote myocardial infarction, 30 ventricular tachycardias were mapped with 112 bipolar endocardial balloon at the time of surgery. Diastolic potentials in association with low amplitude (< 2 mV) and prolonged (> or = 100 msec) systolic electrograms preceding the onset of QRS were found at the exit site and pre-exit site of return pathway. A similar systolic electrogram occurring after QRS onset with a diastolic potential to QRS interval of < -50 msec was found at the pre-exit site. However, other local electrograms with diastolic activity were at sites remote from the exit or pre-exit of the return pathway. These observations may be helpful during catheter mapping and ablation in patients with ventricular tachycardia.


Higher tacrolimus trough levels and time in the therapeutic range are associated with the risk of acute rejection in the first month after renal transplantation.
Tacrolimus trough levels (C0) are used in most transplant centres for therapeutic drug monitoring (TDM) of tacrolimus (Tac). The target range of Tac C0 has been remarkably changed, with a target as low as 3-7 ng/ml in the 2009 European consensus conference and a target of 4-12 ng/ml (preferably to 7-12 ng/ml) following the second consensus report in 2019. Our aim was to investigate whether reaching early Tac therapeutic targets and maintaining time in the therapeutic range (TTR) according to the new recommendations may be necessary for preventing acute rejection (AR) during the first month after transplantation. A retrospective study including 160 adult renal transplant patients (113 men and 47 women) with a median age of 36.3 (20-44) years was conducted between January 2018 and December 2019 at 103 Military Hospital (Vietnam). Tac trough levels were recorded in the first month, and episodes of AR were confirmed by kidney biopsy. Tac TTR was calculated as the percentage of time within the target range of 7-12 ng/ml, according to the 2019 second consensus report. Multivariate Cox analysis was performed to identify the correlation between the Tac target range and TTR with AR. In the first month after RT, 14 (8.8%) patients experienced AR. There was a significant difference in the incidence of AR between the Tac level groups of < 4, 4-7 and > 7 ng/ml (p = 0.0096). In the multivariate Cox analysis, after adjusting for related factors, a mean Tac level > 7 ng/ml was associated with an 86% decreased risk of AR compared with that of 4-7 ng/ml in the first month (HR, 0.14; 95% CI, 0.03-0.66; p = 0.0131). Every 10% increase in TTR was associated with a 28% lower risk of AR (HR, 0.72; 95% CI, 0.55-0.94; p = 0.014). Gaining and maintaining Tac C0 according to the 2019 second consensus report might reduce the risk of AR in the first month following transplantation.


Intrathecal kappa free light chains as markers for multiple sclerosis.
Cerebrospinal fluid (CSF) kappa free light chain (KFLC) index has been described as a reliable marker of intrathecal IgG synthesis to diagnose multiple sclerosis (MS). Our aims were: (1) to compare the efficiency of KFLC through different interpretation approaches in diagnosing MS. (2) to evaluate the prognostic value of KFLC in radiologically and clinically isolated syndromes (RIS-CIS). We enrolled 133 MS patients and 240 with other neurological diseases (93 inflammatory including 18 RIS-CIS, 147 non-inflammatory). Albumin, lambda free light chain (LFLC) and KFLC were measured in the CSF and serum by nephelometry. We included two groups of markers: (a) corrected for blood-CSF barrier permeability: immunoglobulin G (IgG), KFLC and LFLC indexes. (b) CSF ratios (not including albumin and serum-correction): CSF KFLC/LFLC, CSF KFLC/IgG, CSF LFLC/IgG. KFLC were significantly higher in MS patients compared to those with other diseases (both inflammatory or not). KFLC index and CSF KFLC/IgG ratio showed high sensitivity (93% and 86.5%) and moderate specificity (85% and 88%) in diagnosing MS. RIS-CIS patients who converted to MS showed greater KFLC index and CSF KFLC/IgG. Despite OB are confirmed to be the gold-standard to detect intrathecal IgG synthesis, the KFLC confirmed their accuracy in MS diagnosis. A "kappa-oriented" response characterizes MS and has a prognostic impact in the RIS-CIS population.


Acid tolerant multicomponent bacterial enzymes production enhancement under the influence of corn cob waste substrate.
Cellulase enzymes have wide range of industrial application, but high production cost and relatively low efficiency are the main issues, which are needed to resolve. Substrate is known as the main contributor which can bring down the production cost of these enzymes at large scale. Therefore, in the present study, corn cob (Cc) waste has been employed as a potential substrate to produce efficient and good amount of cellulase using the bacterial strain Bacillus subtilis. Under the influence of optimal parameters while using the optimum concentration of Cc (7.0 g), maximum 12 IU/gds FP, 97 IU/gds BGL and 129 IU/gds EG have been recorded. Additionally, crude enzyme showed maximum FP activity of 14 IU/gds using 1.0 g/L peptone employed as the optimum organic nitrogen source. The bacterial cellulase exhibits temperature tolerance ability at 55 °C, and retains its half-life activity for 5 h and pH tolerance at pH 7.0 up to 55% of the relative activity. The results recorded in the present study may have potential for the large-scale and low-cost bacterial cellulase production using cellulose rich substrate e.g. Cc waste that can be vital for numerous industrial applications.


Enhanced oxygen evolution performance of iron-nickel oxide catalyst through dual-defect engineering.
Transition metal oxides have been extensively investigated for oxygen evolution reaction (OER). While the introduction of oxygen vacancies (Vo) was found to be an effective way to enhance the electrical conductivity and the OER electrocatalytic activity of transition metal oxides, the oxygen vacancies are easily damaged during the long-term catalytic process, resulting in rapid decay of the electrocatalytic activity. Herein, we proposed the strategy of dual-defect engineering to enhance the catalytic activity and stability of NiFe2O4 by filling the oxygen vacancies of NiFe2O4 with phosphorus atoms. The filled P atoms could form coordination with iron and nickel ions to compensate the coordination number and optimize the local electronic structure, which not only enhances the electrical conductivity but also improves the intrinsic activity of the electrocatalyst. Meanwhile, the filling of P atoms could stabilize the Vo and thus improving the cycling stability of the material. The theoretical calculation further demonstrates that the improvement in conductivity and intermediate binding by P refilling remarkably contributes to enhancing the OER activity of NiFe2O4-Vo-P. Benefiting from the synergistic effect of filled P atoms and Vo, the derived NiFe2O4-Vo-P exhibits fascinating activity with ultra-low OER overpotentials of 234 and 306 mV at 10 and 200 mA cm-2, together with the good durability for 120 h at relatively high current density of 100 mA cm-2. This work sheds light on the design of high-performance transition metal oxide catalysts through defect regulation in the future.


The reliability of excretory urography as a screening examination for blunt renal trauma.
A prospective study was designed to evaluate the reliability of excretory urography (EU) in excluding renal damage in patients with blunt abdominal trauma, using contrast-enhanced computed tomography (CECT) as the "gold standard" of diagnostic studies. Sixty patients with indications for genitourinary evaluation and with normal EU underwent CECT. Five renal injuries were demonstrated by CECT in patients with negative EU: one contusion, one subcapsular hematoma, two perirenal hematomas, and one renal laceration. All of these lesions resolved with conservative patient management. Thus, the CECT findings did not alter treatment in these five patients.


Sequence analysis of the protein-coding regions of foot-and-mouth disease virus O/HK/2001.
The nucleotide sequence of the protein-coding region of foot-mouth-disease virus (FMDV) strain O/HK/2001 was determined and compared with the sequences of other FMDVs that were registered in GenBank. The protein-coding region was 6966 nucleotides in length and encoded a protein of 2322 amino acid residues. Comparison of the nucleotide sequence and its deduced amino acid sequence with those of other isolates indicated that O/HK/2001 belonged to the Cathay topotype. A genomic coding region nucleotide sequence phylogenetic tree of several FMDV-O isolates showed that O/HK/2001 was most closely related to FMDV isolates found in Taiwan during 1997, and especially shared significant similarity to HKN/2002, suggesting that the virus causing outbreaks in Hong Kong was genetically most-closely related to that causing an outbreak of type O in Taiwan. Mutations in O/HK/2001 were revealed, including frequent substitutions in the VP1 and L proteins, and deletions involving 10 amino acid residues in the 3A protein. This study was undertaken to assess the regional variation of prevalent FMDV type O viruses and to establish a sequence database for FMDV molecular epidemiological investigation.


Acute generalized polyneuropathy accompanying lithium poisoning.
A woman with typical symptoms of lithium toxicity had, in addition, severe generalized sensorimotor peripheral neuropathy, which cleared completely as the recovered. Electrodiagnostic studies suggested axonal lesions; autopsy ten months later revealed no residual abnormalities. Previous studies have shown that lithium can affect peripheral nerve function, but this is the first reported case of peripheral neuropathy in association with lithium toxicity.


Management of Pediatric Postendoscopy Fever: Reducing Unnecessary Health Care Utilization With a Clinical Care Guideline.
The aim of the study was to validate rates of fever after pediatric gastrointestinal endoscopy, to describe clinical outcomes of postendoscopy fever (PEF) cases, and to assess the effect of a PEF clinical care guideline (CCG) on hospital use. Episodes of PEF were reviewed from a large prospective database of all adverse events following pediatric gastrointestinal endoscopy at an academic children's hospital. A CCG was implemented to standardize care of children with reported fever after endoscopy and reduce unnecessary resource use. Chi-squared analysis was performed to compare rates of hospital use for evaluation of PEF before and after implementation of the CCG. PEF occurred in 0.55% of the 27,100 endoscopies performed during the present study period. In the 150 cases of reported fever, the rate of identified endoscopy-related infection was low (4.0%). The rate of PEF was significantly higher in patients who underwent interventional procedures (0.81%) than those who underwent diagnostic endoscopy (0.51%, P = 0.02). In patients who experienced PEF, the CCG significantly reduced hospital use, decreasing emergency department visits and hospital admissions by 52.1% (P < 0.0001) without leading to negative patient outcomes. PEF in children rarely represents clinically significant infection and may be due in part to inflammation from tissue damage and/or physiologic stress. The present study shows that implementation of a PEF CCG may reduce unnecessary care while maintaining patient safety. Furthermore, multicenter studies are required to confirm the overall safety of similar clinical algorithms.


Accuracy and safety of fluoroscopic guided percutaneous pedicle screws in thoracic and lumbosacral spine: a review of 2000 screws.
Retrospective study. To investigate the accuracy and safety of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracic and lumbosacral spine. Several studies had examined the accuracy and safety of percutaneous pedicle screws but provided large variations in their results with small number of patients or few number of pedicle screws evaluated. Computerized tomography of patients who had surgery with fluoroscopic guided percutaneous pedicle screws were chosen from 2 centers: (1) European patients from University Medical Center Hamburg-Eppendorf, Germany and (2) Asian patients from University Malaya Medical Centre, Malaysia. Screw perforations were classified into Grade 0, Grade 1 (<2 mm), Grade 2 (2-4 mm), and Grade 3 (>4 mm). In total, 2000 percutaneous pedicle screws from 273 patients were analyzed: 1290 screws from 183 European patients and 710 screws from 90 Asian patients. The mean age was 59.1 ± 15.6. There were 140 male patients and 133 female patients. The total perforation rate was 9.4% with 151 (7.5%) Grade 1, 31 (1.6%) Grade 2, and 5 (0.3%) Grade 3 perforations. The total perforation rates among Europeans were 9.4% and among Asians were 9.3%. There was no difference between the 2 groups (P > 0.05). There were 3 distinct peaks in perforation rates (trimodal distribution) at T1, midthoracic region (T4-T7), and lumbosacral junction (L5 and S1). The highest perforation rates were at T1 (33.3%), S1 (19.4%), and T4 (18.6%). Implantation of percutaneous pedicle screws insertion using fluoroscopic guidance is safe and has the accuracy comparable to open techniques of pedicle screws insertion. 4.


CheckList for EvaluAtion of Radiomics research (CLEAR): a step-by-step reporting guideline for authors and reviewers endorsed by ESR and EuSoMII.
Even though radiomics can hold great potential for supporting clinical decision-making, its current use is mostly limited to academic research, without applications in routine clinical practice. The workflow of radiomics is complex due to several methodological steps and nuances, which often leads to inadequate reporting and evaluation, and poor reproducibility. Available reporting guidelines and checklists for artificial intelligence and predictive modeling include relevant good practices, but they are not tailored to radiomic research. There is a clear need for a complete radiomics checklist for study planning, manuscript writing, and evaluation during the review process to facilitate the repeatability and reproducibility of studies. We here present a documentation standard for radiomic research that can guide authors and reviewers. Our motivation is to improve the quality and reliability and, in turn, the reproducibility of radiomic research. We name the checklist CLEAR (CheckList for EvaluAtion of Radiomics research), to convey the idea of being more transparent. With its 58 items, the CLEAR checklist should be considered a standardization tool providing the minimum requirements for presenting clinical radiomics research. In addition to a dynamic online version of the checklist, a public repository has also been set up to allow the radiomics community to comment on the checklist items and adapt the checklist for future versions. Prepared and revised by an international group of experts using a modified Delphi method, we hope the CLEAR checklist will serve well as a single and complete scientific documentation tool for authors and reviewers to improve the radiomics literature.


Gender Bias in Nurse Evaluations of Residents in Obstetrics and Gynecology.
We examined the evaluations given by nurses to obstetrics and gynecology residents to estimate whether gender bias was evident. Women receive more negative feedback and evaluations than men-from both sexes. Some suggest that, to be successful in traditionally male roles such as surgeon, women must manifest a warmth-related (communal) rather than competence-related (agentic) demeanor. Compared with male residents, female residents experience more interpersonal difficulties and less help from female nurses. We examined feedback provided to residents by female nurses. We examined Professional Associate Questionnaires (2006-2014) using a mixed-methods design. We compared scores per training year by gender using Mann-Whitney and linear regression adjusting for resident and nurse cohorts. Using grounded theory analysis, we developed a coding system for blinded comments based on principles of effective feedback, medical learners' evaluation, and impression management. χ examined the proportions of negative and positive and communal and agentic comments between genders. We examined 2,202 evaluations: 397 (18%) for 10 men and 1,805 (82%) for 34 women. Twenty-three compliments (eg, "Great resident!") were excluded. Evaluations per training year varied: men n=77-134; women n=384-482. Postgraduate year (PGY)-1, PGY-2, and PGY-4 women had lower mean ratings (P<.035); when adjusted, the difference remained significant in PGY-2 (MWomen=1.5±0.6 compared with MMen=1.7±0.5; P=.001). Postgraduate year-1 women received disproportionately fewer positive and more negative agentic comments than PGY-1 men (positive=17.3% compared with 40%, negative=17.3% compared with 3.3%, respectively; P=.041). Evidence of gender bias in evaluations emerged; albeit subtle, women received harsher feedback as lower-level residents than men. Training in effective evaluation and gender bias management is warranted.


Extraintestinal rotavirus infections in children with immunodeficiency.
Some rotavirus strains, including vaccine candidates, have been demonstrated to cause hepatitis in immunodeficient and malnourished mice and to grow in human liver cells. To determine whether rotavirus spreads outside the intestine in naturally infected children, we examined tissues from four immunodeficient children affected with severe combined immunodeficiency disease, acquired immunodeficiency disease syndrome, or DiGeorge syndrome. Chronic rotavirus-related diarrhea, which persisted until death, had also developed in each child. Using indirect immunoperoxidase techniques, we identified rotavirus antigen in the liver and kidney with a hyperimmune guinea pig antiserum prepared to double-shelled rotavirus particles. Similar immunostaining with an antiserum to a rotavirus nonstructural protein (NS26) provided evidence of active virus replication. The observed reactivity was eliminated specifically when serial sections were immunostained with the same antiserum that had been absorbed with either double-shelled rotavirus particles or NS26. Immunostaining was not observed in the liver of children with other diseases (alpha 1-antitrypsin deficiency, inspissated bile syndrome, and acute rejection of a transplanted liver). These findings demonstrate that rotavirus infections in children can extend beyond the intestinal tract. Further studies are warranted to determine whether extraintestinal rotavirus replication occurs in children without severe immunodeficiency, such as malnourished children.


Is obesity associated with short-term revision after total knee arthroplasty? An analysis of 121,819 primary procedures from the Dutch Arthroplasty Register.
The prevalence of obesity is increasing. The association with knee osteoarthritis is well documented, resulting in the population requesting total knee arthroplasty (TKA) for invalidating symptoms to be heavier in nature. The purpose of the current analysis was to assess the association between preoperative body mass index (BMI) and short-term revision rate after TKA. The secondary aim was to investigate the influence of implant fixation method on the association between BMI and survivorship. This is a retrospective analysis of prospectively collected registry data (Dutch Arthroplasty Register; LROI). All primary TKA procedures in patients >18 years of age with registered BMI were selected (n = 121,819). Non-obese patients (BMI 18-25) were compared with overweight (BMI 25-30) and class I-III obese (BMI >30, >35, >40) patients. Crude all-cause revision rates were calculated using competing risk analysis. Adjusted hazard ratios (HRs) were determined with Cox multivariable regression analyses for all-cause, septic and aseptic revision and secondary patellar resurfacing. Revision rates were 3.3% for non-obese patients, 3.5% for overweight patients, 3.7% for class I obese patients, 3.6% for class II obese patients and 3.7% for class III obese patients. Class III obese patients had a significant higher risk for septic revision compared with non-obese patients (HR 1.53, 95% confidence interval (CI) 1.06-2.22). Class I obese patients had a higher risk for secondary patellar resurfacing (HR 1.52, 95% CI 1.12-2.08). All-cause and aseptic revision rates were similar between BMI groups. Obesity appeared to be associated with some short-term revision risks after TKA, but was not associated with an overall increase in revision rate.


Morphometric analysis of prognathic and non-prognathic mandibles in relation to BSSO sites using CBCT.
Bilateral sagittal split osteotomy (BSSO) is the most versatile procedure and adopted by many surgeons to relocate the mandible in patients having mandibular prognathism (MP). Injury to the inferior alveolar nerve (IAN) and unfavorable splits are two surgical complications of BSSO which are associated with mandibular morphology. Uses of cone beam computed tomography (CBCT) in providing 3-D images has gained a wider acceptance in surgical field nowadays. Its advantages are including reduced cost, lesser radiation dose and smaller physical footprint comparing to the conventional computed tomography. This study aims to identify the differences in morphology of prognathic and non-prognathic mandible at BSSO sites using cone beam computed tomography images. This retrospective study involved 51 CBCT images of patients having mandibular prognathism and without mandibular prognathism. The latter group made up from patients with Class I skeletal pattern. Samples were taken using purposive sampling method from two clinical centers. Prognathic mandible has higher lingula level, superiorly and buccally placed inferior alveolar nerve canal at distal second molar, thinner mediolateral width of ramus at anterior and posterior part and thinner anteroposterior width of the ramus. Morphology of mandible in patients with mandibular prognathism (MP) was significantly different from patients without mandibular prognathism (WMP) for most of the parameters. The high risk parameters may be highlighted to the patients using cone beam computed tomography images.


Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states.
Invasive cervical cancer (ICC) rates remain elevated in the Appalachian region of the United States. We investigated patterns of invasive cervical cancer incidence rates in three Appalachian states (Kentucky, West Virginia, Pennsylvania) to uncover specific high-risk subgroups within this large and heterogeneous region. The analysis was conducted for the three states combined and individually. Invasive cervical cancer rates were characterized by individual and county-level sociodemographic variables, including age, race, poverty, education, Appalachian status, and rural/urban status. Bivariate analyses and multivariable Poisson regression models were conducted to address the relative contributions of each variable to the risk of invasive cervical cancer. The three states differed in the contribution of each factor to the risk of invasive cervical cancer. The overall invasive cervical cancer incidence rates for Kentucky, West Virginia, and Pennsylvania were 13.4, 13.9, and 10.2 per 100,000/yr, respectively. After controlling for other demographic variables, the effect of Appalachian status on invasive cervical cancer was weaker, while rural status, education, and race were stronger, significant predictors. This study illustrates the heterogeneity of population demographics and invasive cervical cancer risk, and the need to identify subregions and subgroups within Appalachia at highest risk for this disease.


Stability of the Framingham Nutritional Risk Score and its component nutrients over 8 years: the Framingham Nutrition Studies.
Diet quality indices are increasingly used in nutrition epidemiology as dietary exposures in relation to health outcomes. However, literature on the long-term stability of these indices is limited. We aimed to assess the stability of the validated Framingham Nutritional Risk Score (FNRS) and its component nutrients over 8 years, as well as the validity of the follow-up FNRS. Framingham Offspring/Spouse Study women and men (n=1734) aged 22-76 years were evaluated over 8 years. Individuals' nutrient intake and nutritional risk scores were assessed using 3-day dietary records administered at baseline (1984-1988) and at follow-up (1992-1996). Agreement between baseline and follow-up FNRS and nutrient intakes was evaluated by Bland-Altman method; stability was assessed using intra-class correlation (ICC) and weighted Kappa statistics. The effect of diet quality (as assessed by the FNRS) on cardiometabolic risk factors was evaluated using analysis of covariance. Modest changes from baseline (15%) were observed in nutrient intake. The stability coefficients for the FNRS (ICC: women, 0.49; men, 0.46; P<0.0001) and many nutrients (ICC 0.3) were moderate. Over half of the women and men (58%) remained in the same or contiguous baseline and follow-up quartile of the FNRS and few (3-4%) shifted >1 quartile. The FNRS was directly associated with body mass index in women (P<0.01) and high-density lipoprotein cholesterol among both women (P<0.001) and men (P<0.01). The FNRS and its constituent nutrients remained relatively stable over 8 years of follow-up. The stability of diet quality has implications for prospective epidemiological investigations.


Endoscopic transaqueductal or interventricular stent placement for the treatment of isolated fourth ventricle and pre-isolated fourth ventricle.
The aim of our study is to evaluate the effectiveness of endoscopic transaqueductal or interventricular stent placement into the fourth ventricle for isolated fourth ventricle (IFV) and pre-isolated fourth ventricle (PIFV), in which occlusion of the fourth ventricle outlets and dilation of the fourth ventricle are seen while the aqueduct is still patent. We retrospectively analyzed pediatric patients who underwent endoscopic stent placement for IFV or PIFV. Five patients with IFV and four patients with PIFV underwent endoscopic stent placement. The mean age was 11.5 months. Three patients with IFV underwent aqueductoplasty with stent connected to an extracranial shunt system. Two patients with IFV and supratentorially protruded fourth ventricle underwent interventriculostomy with stent. In these patients, the stent was not connected to the shunt system as functional shunt had been already placed using the contralateral ventricle. In four patients with PIFV, transaqueductal stent was placed and connected to the extracranial shunt system. In all patients, preoperative symptoms improved and magnetic resonance imaging demonstrated reduction of the size of the fourth ventricle. The mean follow-up period was 49.6 months (range 5 to 99 months). Three patients (33 %) underwent reoperation due to obstruction of the abdominal catheter, partial occlusion of the ventricular catheter, and retraction of the fourth ventricular catheter. The endoscopic transaqueductal or interventricular stent placement into the fourth ventricle for the treatment of IFV is considered to be effective and safe. The transaqueductal stent placement for PIFV is also considered to be effective for resolution of symptoms and prevent progression into IFV.


Hybrid closed Loop improved glucose control compared to sensor-augmented pumps in outpatients with type 1 diabetes in real-life conditions with telehealth monitoring.
The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings. This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM (n = 26) or pump users who only changed their device (n = 51), with predictive low glucose management (n = 8) or with Hybrid Closed Loop using Medtronic 780G (n = 36) systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. All subjects received diabetes and carbohydrate-counting education if needed at time of initiation and were proposed a telehealth monitoring by a diabetic nurse educator. There was no episodes of severe hypoglycemia or diabetic ketoacidosis nor serious pump-related adverse events despite outpatient model of care. While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. Time in target range 3.9-10 mmol/L (70-180 mg/dl) also improved and was optimal with closed loop with 30/36 (83%) subjects with time in range above 70%. Initiation of insulin pump therapy for outpatients is safe with a dedicated facility. Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.


Multiply-resistant Staphylococcus aureus (bacteriophage type 90) in a special care baby unit.
An outbreak of infection in a special care baby unit due to a multiply-resistant Staphylococcus aureus is described. Although the organism was isolated from 35 babies over 1 year, only two were clinically infected, one of whom died of infection. New measures to prevent cross-infection were introduced but colonized babies continued to be detected. The unit was closed for several weeks but babies became colonized again after reopening. The route of cross-infection remained uncertain.


Intravacuolar Membranes Regulate CD8 T Cell Recognition of Membrane-Bound Toxoplasma gondii Protective Antigen.
Apicomplexa parasites such as Toxoplasma gondii target effectors to and across the boundary of their parasitophorous vacuole (PV), resulting in host cell subversion and potential presentation by MHC class I molecules for CD8 T cell recognition. The host-parasite interface comprises the PV limiting membrane and a highly curved, membranous intravacuolar network (IVN) of uncertain function. Here, using a cell-free minimal system, we dissect how membrane tubules are shaped by the parasite effectors GRA2 and GRA6. We show that membrane association regulates access of the GRA6 protective antigen to the MHC I pathway in infected cells. Although insertion of GRA6 in the PV membrane is key for immunogenicity, association of GRA6 with the IVN limits presentation and curtails GRA6-specific CD8 responses in mice. Thus, membrane deformations of the PV regulate access of antigens to the MHC class I pathway, and the IVN may play a role in immune modulation.


Identification of copy number variants associated with BPES-like phenotypes.
Blepharophimosis-Ptosis-Epicanthus inversus syndrome (BPES) is a well-characterized rare syndrome that includes an eyelid malformation associated with (type I) or without premature ovarian failure (type II). Patients with typical BPES have four major characteristics: blepharophimosis, ptosis, epicanthus inversus and telecanthus. Mutations in the FOXL2 gene, encoding a forkhead transcription factor, are responsible for the majority of both types of BPES. However, many patients with BPES-like features, i.e., having at least two major characteristics of BPES, have an unidentified cause. Here, we report on a group of 27 patients with BPES-like features, but without an identified genetic defect in the FOXL2 gene or flanking region. These patients were analyzed with whole-genome high-density arrays in order to identify copy number variants (CNVs) that might explain the BPES-like phenotype. In nine out of 27 patients (33%) CNVs not previously described as polymorphisms were detected. Four of these patients displayed psychomotor retardation as an additional clinical characteristic. In conclusion, we demonstrate that BPES-like phenotypes are frequently caused by CNVs, and we emphasize the importance of whole-genome copy number screening to identify the underlying genetic causes of these phenotypes.


Path analysis under generalized marital resemblance: evaluation of the assumptions underlying the mixed homogamy model by the Monte Carlo method.
Path analysis of nuclear family data has been widely applied to resolve genetic and environmental sources of familial resemblance. Here we report the results of a systematic evaluation of the effects of departures from five modeling assumptions often made when analyzing nuclear family data; i) the observed environmental index is unaffected by the genotype, ii) the basis of marital resemblance is correctly specified in the model, iii) there are no intergenerational differences in either the genetic or cultural heritability, iv) there is no genetic dominance, and v) there is no genotype by family environment interaction. "Deterministic simulations" identified various situations where model misspecification could lead to substantial bias in the estimation of the heritabilities. For these situations, "stochastic simulations" were performed to determine whether the "goodness-of-fit" test used in path analysis would correctly reject the misspecified model. In samples of 500 nuclear families, each comprising two parents and two children, the goodness-of-fit test was found to be sensitive to misspecifications of the source of marital resemblance and the existence of intergenerational differences in heritabilities, although reduced power would make the test less sensitive in smaller samples. The test was largely insensitive to misspecifications of possible genetic effects on the environmental index, and to the existence of multiplicative interaction between the genotype and familial environment. When genetic effects on the index are ignored, the genetic heritability (h2) is underestimated, the cultural heritability (c2) is overestimated, but h2+c2 remains unchanged. Neglecting the interaction was found to result in an overestimate of h2.


Evaluation of Arterial Erectile Dysfunction Using Shear Wave Elastography: A Feasibility Study.
To explore the feasibility of shear wave elastography (SWE) in the evaluation of arterial erectile dysfunction (ED). From November 2018 to November 2019, 26 patients with arterial ED and 30 patients with non-vascular ED were prospectively included. SWE values of corpus cavernosum penis (CCP) and the flow velocity of cavernous artery for all patients in both before intracavernous injection (ICI) (flaccid state) and after ICI (erectile state) were measured. Performance of SWE value in assessing arterial ED was studied. Correlation between SWE value of CCP and the age of patients was also investigated. ICI significantly reduced SWE values in both arterial and non-vascular group (from 19.57 ± 6.33 KPa to 12.17 ± 3.64 KPa in the first, and from 19.91 ± 6.69 KPa to 8.04 ± 3.13 KPa in the former, both P < .001). SWE values of CCP after ICI in arterial ED were significantly larger than that in non-vascular ED (P < .001). SWE values of CCP before ICI negatively correlated with age of patients in arterial ED (r = - 0.601, P < .001). With a cutoff value of 7.75 KPa, the area under curve, specificity, sensitivity, PPV, and NPV of SWE values of CCP after ICI in distinguishing arterial ED from non-vascular ED were 0.810, 63.3%, 96.2%, 96.2%, and 70%, respectively. SWE was expected to be a potential technique for the noninvasive, simply operated, repeatable and quantitative evaluation of arterial ED.


Hydride generation-flame atomic-absorption spectrometry as an arsenic detector for high-performance liquid chromatography.
Hydride generation-flame atomic-absorption spectrometry (HG-FAAS) was used as a continuous detection system for arsenic in the eluate from high-performance liquid chromatography (HPLC). Four arsenic species (arsenite, arsenate, monomethylarsonate and dimethylarsinate) were detected separately with the HPLC-HG-FAAS system equipped with an anion-exchange column. When hijiki (Hizikia fusiforme) extract was examined, arsenate was found predominantly and arsenite and dimethylarsinate were also detected. Liver supernatant fraction obtained from mice administered orally with arsenite was also studied with the HPLC-HG-FAAS system equipped with a gel permeation column. In addition to free or low-molecular-weight ligand-bound arsenic, high-molecular-weight protein-bound arsenic fractions were also detected.


Effects of Alzheimer's disease transgenes on neurochemical expression in the mouse brain determined by ¹H MRS in vitro.
Transgenic models of human disease can be used to understand pathology and to discover biomarkers of disease presence, progression and response to therapy. Here we report a study of longitudinal metabolic differences between TASTPM transgenic Alzheimer's disease (AD) mice and their wild type counterparts using (1)H magnetic resonance spectroscopy (MRS) to look for potential biomarkers for use in AD research and drug discovery. Chloroform methanol extractions were performed on the brains of mice aged between 3 and 18 months. (1)H MR spectra were recorded from the aqueous fractions. Absolute metabolite concentrations, determined from resonance integrals relative to an internal standard, were analysed by 2-way ANOVA (genotype x age). Significant effects of age alone were identified for creatine, glutamine and total choline-containing compounds. There was a marked increase in creatine in the oldest (15-18 mo) TASTPM mice. The increase in creatine was unexpected and may be caused by osmotic stress in older animals as plaque load increases. Care should be taken when using creatine as a reference metabolite during scans of these animals in vivo. A significant effect of genotype alone was identified for myo-inositol (MI), which was higher in TASTPM mice at all ages. Succinate, glycerophosphocholine and choline all showed significant effects of age and genotype. No significant effects were detected in N-acetylaspartate (NAA) levels. Increased MI could be a marker of gliosis or microglial activation in TASTPM mice, but the absence of an age dependence for MI levels means it may be a biomarker of disease, but not of disease progression. Decreased succinate is indicative of disrupted neuronal energy metabolism, an effect that has been seen in human AD.


The mechanism of coupling chemical and physical reactions by the calcium ATPase of sarcoplasmic reticulum and other coupled vectorial systems.
The coupling of the chemical reaction of ATP hydrolysis to the transport of calcium from the cytoplasm into the lumen of sarcoplasmic reticulum vesicles can be defined by a set of rules that define alternating changes in the specificities of the enzyme for catalysis of chemical and physical reactions.


Shape-designed frustration by local polymorphism in a near-equilibrium colloidal glass.
We show that hard, convex, lithographic, prismatic kite platelets, each having three 72° vertices and one 144° vertex, preferentially form a disordered and arrested 2D glass when concentrated quasi-statically in a monolayer while experiencing thermal Brownian fluctuations. By contrast with 2D systems of other hard convex shapes, such as squares, rhombs, and pentagons, which readily form crystals at high densities, 72° kites retain a liquid-like disordered structure that becomes frozen-in as their long-time translational and rotational diffusion become highly bounded, yielding a 2D colloidal glass. This robust glass-forming propensity arises from competition between highly diverse few-particle local polymorphic configurations (LPCs) that have incommensurate features and symmetries. Thus, entropy maximization is consistent with the preservation of highly diverse LPCs en route to the arrested glass.


Dynamics of p53 and Wnt cross talk.
We present the mechanism of interaction of Wnt network module, which is responsible for periodic somitogenesis, with p53 regulatory network, which is one of the main regulators of various cellular functions, and switching of various oscillating states by investigating p53-Wnt model. The variation in Nutlin concentration in p53 regulating network drives the Wnt network module to different states, stabilized, damped and sustain oscillation states, and even to cycle arrest. Similarly, the change in Axin2 concentration in Wnt could able to modulate the p53 dynamics at these states. We then solve the set of coupled ordinary differential equations of the model using quasi steady state approximation. We, further, demonstrate the change of p53 and GSK3 interaction rate, due to hypothetical catalytic reaction or external stimuli, can able to regulate the dynamics of the two network modules, and even can control their dynamics to protect the system from cycle arrest (apoptosis).


Isolation and taxonomic characterization of a novel type I methanotrophic bacterium.
A methane-oxidizing bacterium was isolated from the effluent of manure and its molecular and biochemical properties were characterized. The isolate was aerobic, Gram-negative, and non-motile. The organism had a type I intracytoplasmic membrane structure and granular inclusion bodies. The outer cell wall surface (S-layers) was tightly packed with cup-shaped structures. Colonies were light yellow on nitrate mineral salt agar medium. In addition, the organism was catalase and oxidase positive. The isolate used the ribulose monophosphate (RuMP) pathway for carbon assimilation, and was able to utilize methane and methanol as a sole carbon and energy source, however, it could not utilize any other organic compounds that were tested. The cells grew well in a mixture of methane and air (methane:air=1:1, v/v) in a compulsory circulation diffusion system, and when grown under those conditions, the optimum pH was approximately 7.0 and the optimal temperature was 30 degrees. In addition, the specific growth rate and generation time were 0.13 per h and 5.43 h, respectively, when grown under the optimum conditions. The major ubiquinone was Q-8, and the G+C mol% of the DNA was 55.3. Phylogenetic analyses based on the 16S rRNA gene sequence comparisons showed that this bacterium belongs to a group of type I methanotrophs, and that it is most closely related to Methylomicrobium, with a sequence similarity of 99%. Therefore, the isolate was named Methylomicrobium sp. HG-1.


Nutritional course of patients submitted to bariatric surgery.
Surgical treatment has proved to be effective for weight loss, improving the quality of life of obese individuals. However, metabolic and nutritional deficiencies may occur during the late postoperative period. The objective of the present study was to assess the metabolic and nutritional profile of grade III obese individuals for 12 months after Roux-en-Y gastric bypass (RYGBP). Forty-eight patients with mean body mass index (BMI) of 51.9 +/- 7.8 kg/m(2) were submitted to RYGBP. Anthropometric, food intake, and biochemical data were obtained before and for 12 months after surgery. There was an average weight and body fat reduction of 35% and 46%, respectively. Calorie intake was reduced, ranging from 773 +/- 206 to 1035 +/- 345 kcal during the study. Protein intake remained below recommended values throughout follow-up, corresponding to 0.5 +/- 0.3 g/kg/current body weight/day during the 12th month. Iron and fiber intake was significantly reduced, remaining below recommended levels throughout the study. Serum cholesterol, low-density lipoprotein cholesterol, and glycemia were reduced. Albumin deficiency was present in 15.6% of subjects at the beginning of the study vs 8.9% at the end, calcium deficiency was present in 3.4% vs 16.7%, and iron deficiency was present in 12.2% vs 14.6%. RYGBP was effective for weight loss and for the reduction of obesity rates and risk factors for comorbidities. The diet of these patients, who frequently present inadequate intake of macronutrients and micronutrients, should receive special attention. Patient follow-up and assessment at short intervals are necessary for an early correction of nutritional deficiencies.


Laboratory methods to simulate the mechanical degradation of resin composite restorations.
This study reviewed the literature to identify in vitro approaches that have been used to simulate the mechanical degradation and fatigue of resin composite restorations. A search for articles was carried out in 4 databases and included studies in which composite restorations were bonded to teeth and subject to cyclic loading. Articles were assessed for eligibility, and the following items were the extracted from the included studies: authors, country, year, materials tested, simulation device and details including load magnitude and frequency, number of cycles, type of antagonist, test medium, and temperature. Data were analyzed descriptively. The 49 studies included showed a high level of heterogeneity in methods, devices, and test parameters. Nineteen different simulation devices were used, applying loads varying between 30 and 2900 N, and frequencies varying between 0.4 and 12 Hz. The load and frequency used most often were ~ 50 N (63.3%) and 1.5-1.7 Hz (32.7%). The number of cycles varied between 10 K and 2.4 M, 1.2 M was the most prevalent (40.8%). The majority of studies combined cyclic loading with at least one additional aging method: static liquid storage, thermo-mechanical cycling applied simultaneously, and thermal cycling as a discrete aging step were the three most frequent methods. The overall evidence indicated reporting problems, and suggested a lack of clinical validation of the research methods used. Validation studies, underlying clinical supporting data, and better reporting practices are needed for further improving research on the topic. Specific suggestions for future studies are provided.


Intracerebral recording of potentials accompanying simple limb movements: a SEEG study in epileptic patients.
Slow potentials appearing during simple repetitive acral limb movement were investigated. Twenty-six patients suffering from drug resistant partial epilepsies and explored with implanted intracerebral electrodes were examined using two protocols. In 18 patients, readiness potential (RP), in 13 patients contingent negative variation (CNV), and in 7 patients both protocols, were tested. The recordings from leads with evident pathological EEG activity were excluded from evaluation. The results concerning the slow potentials preceding the movements in RP and CNV protocols have already been published. The movement-accompanying slow potentials (MASP) were polyphasic or monophasic, started before or during the movement. In the primary motor cortex they followed the pre-movement potentials depending on the protocol: in the RP paradigm they were present only contralateral to the movement, but were bilateral in the CNV protocol. In other areas they either followed the potentials preceding the movement, in some cases with opposite polarity, or they occurred alone. MASP was recorded in motor and supplementary motor, premotor and prefrontal, midtemporal, somatosensory, superior parietal and cingular cortices. The cingular cortex was heavily involved in the self-paced movements but rarely in the cued movements. The major involvement of the cingular gyrus contrasted with the absence of slow potentials in temporal limbic structures. MASP is evidently a heterogenic phenomenon. Its genesis could be involved in a spread of information through the relevant structures.


[Comparative studies with scanning electron microscope on the quality of corneal disk incision using various corneal trephine (author's transl)].
The cut surface of corneal stroma from rabbits was studied with a scanning-electron microscope and compared after using a manual trephine, a motor-driven rotor trephine and a rotor trephine with mechanical guidance. It became evident that the cut surface obtained with the motor-driven trephine is clearly smoother than that obtained with manual trephine. A further improvement in the quality of the cut is evident with a mechanically guided trephine.


Responsive fluorescence enhancement for in vivo Cu(II) monitoring in zebrafish larvae.
Several neurodegenerative diseases are ascribed to disorders caused by the secretion of Cu ions. However, a majority of the current techniques for copper ion detection are restricted to in vivo monitoring and nonspecific interactions. Their methods are limited to the systematic analysis of Cu ions in living organisms. Thus, a synthetic molecular fluorophore, 5-amino 2,3-dihydroquinolinimine (NDQI), has been developed and successfully utilized in in vivo monitoring of the distribution of Cu(II) in zebrafish larvae. The reversible formation of the NDQI-Cu complex allows its use with high metal concentrations and in oxidative stress conditions. The NDQI-directed strategy developed here can quantitatively differentiate cells with different Cu(II) concentrations. Remarkably, dynamic distribution of Cu(II) in the intestine and liver can be observed.


Referral patterns, treatment management and visual outcome in keratoconus.
To determine the patterns of referral, the hospital-based management and the subjective degree of visual success achieved by keratoconics attending the Corneal Service at Sunderland Eye Infirmary, England, a specifically designed anonymous questionnaire was mailed to 160 keratoconus subjects. The following responses were obtained from 97 (61%) respondents: mean age of first referral (22.88 +/- 8.36 years); gender (male:female ratio 3:1); source of initial referral (optometrists 90%); visual symptoms experienced before referral (46% complained of blurred/distorted vision); and the type of visual correction before referral (70% wore a refractive correction: 72% spectacles, 28% contact lenses). Initial post-referral treatment included bilateral contact lens fitting (65%), monocular contact lens correction (26%), penetrating keratoplasty (8%) and no intervention (1%). Two-thirds of subjects were presently wearing contact lenses (67%), with the mean period of successful lens wear being 8.26 +/- 7.92 years, and 31% had undergone penetrating keratoplasty (PK) since initial referral. A subjective evaluation of visual acuity with contact lenses was made by respondents using a visual analogue scale. The mean value was 86.86 +/- 15.25 (range 50-100 mm), with 50 mm representing moderate visual acuity. Of those who underwent PK the mean subjective evaluation of the change in post-operative vision compared with pre-operatively was 82.41 +/- 26.57 (range 1-100 mm), with 50 mm representing no visual change. The majority of subjects therefore noted a moderate to marked visual improvement following PK. In this fairly young group of patients, predominantly male, the majority wore a refractive correction for approximately 10 years before referral to the Hospital Eye Service (HES). Most referrals were initiated by optometrists. On initial HES assessment the treatment for two-thirds was bilateral contact lens fitting; only a quarter were fitted monocularly. However, by the time of this study only a tenth retained monocular contact lens correction, with the mean length of time from diagnosis to bilateral contact lens wearing being approximately 5 1/2 years. The progressive nature of this disease is further evidenced by the large number of contact lens sets required by patients (approximately 5) and by the number of patients (n = 22) requiring PK, the mean length of time from diagnosis to corneal graft being approximately 8 1/2 years.