Multi-sensor data fusion based on soft likelihood functions and OWA aggregation and its application in target recognition system.
Multi-sensor data fusion plays an irreplaceable role in actual production and application. Dempster-Shafer theory (DST) is widely used in numerous fields of information modeling and information fusion due to the flexibility and effectiveness of processing uncertain information and dealing with uncertain information without prior probabilities. However, when highly contradictory evidence is combined, it may produce results that are inconsistent with human intuition. In order to solve this problem, a hybrid method for combining belief functions based on soft likelihood functions (SLFs) and ordered weighted averaging (OWA) operators is proposed. More specifically, a soft likelihood function based on OWA operators is used to provide the possibility to fuse uncertain information compatible with each other. It can characterize the degree to which the probability information of compatible propositions in the collected evidence is affected by unknown uncertain factors. This makes the results of using the Dempster's combination rule to fuse uncertain information from multiple sources more comprehensive and credible. Experimental results manifest that this method is reliable. Example and application show that this method has obvious advantages in solving the problem of conflict evidence fusion in multi-sensor. In particular, in target recognition, when three pieces of evidence are fused, the target recognition rate is 96.92%, etc.


Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017.
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to hip pain and mobility deficits. J Orthop Sports Phys Ther. 2017;47(6):A1-A37. doi:10.2519/jospt.2017.0301.


Effects of nalmefene on feeding in humans. Dissociation of hunger and palatability.
Effects of nalmefene on eating were investigated in two groups of ten male volunteers, in a double-blind placebo-controlled study. The nalmefene treated group ate 22% less, both in terms of absolute weight and caloric intake, of a standardised buffet-meal than did the placebo group. No differences in subjective ratings of hunger or satiety were found between the groups, suggesting that the reduced feeding was not a consequence of any change in motivation to eat. When analysed by nutrient content, nalmefene was found to reduce fat and protein, but not carbohydrate, intakes. Analyses of intakes of individual foods showed a differential effect of nalmefene on foods rated as highly palatable. Thus the apparent nutrient specificity of nalmefene appeared to be an indirect consequence of its effect on palatability. Nalmefene also caused slight increases in self-rated alertness, and decreases in ratings of tiredness and elation, although it was thought unlikely that these accounted for observed changes in eating behaviour. No other side-effects were detected, and performance on a choice reaction time task was unaffected. These results add weight to suggestions that endogenous opioids are involved in reward-related aspects of feeding associated with food palatability.


Biosynthesis of cycloartenol by expression of plant and bacterial oxidosqualene cyclases in engineered Rhodobacter capsulatus.
Cyclic triterpenes are a large group of secondary metabolites produced by plants, fungi and bacteria. They have diverse biological functions, and offer potential health benefits for humans. Although various terpenes from the mono-, sesqui- and diterpene classes are easy to produce in engineered bacteria, heterologous synthesis of cyclic triterpenes is more challenging. We have recently shown that the triterpene cycloartenol can be produced in Rhodobacter capsulatus SB1003 but initial titers were low with 0.34mgL-1. To assess, if this phototrophic α-proteobacterium can be engineered for enhanced triterpene production, we followed two alternative strategies by comparing the performance of the R. capsulatus SB1003 wildtype strain with two recombinant strains carrying either a mevalonate pathway implemented from Paracoccus zeaxanthinifaciens or a deletion in the intrinsic carotenoid biosynthesis gene crtE. These strains are thus engineered for an enhanced isoprenoid biosynthesis or a suppressed precursor conversion by the competing carotenoid pathway. Moreover, three different cycloartenol synthase (CAS) genes from Arabidopsis thaliana or the myxobacterial strains Stigmatella aurantiaca Sga15 and DW4/3-1 were tested for heterologous cycloartenol synthesis. We found that the heterologous expression of mevalonate pathway enzymes had little impact on cycloartenol levels irrespective of the chosen CAS. In contrast, the use of the newly constructed carotenoid-deficient crtE deletion strain showed threefold increased cycloartenol product titers. We conclude that R. capsulatus is a promising alternative host for the functional expression of triterpene biosynthetic enzymes from plants and microbes. Apparently, product titers can also be improved by suppression of competing precursor consumption.


Structure of high-temperature oxidation zones of gold alloys for metal-porcelain bonding containing small amounts of In and Sn.
Changes in the morphology of the oxidation zone and the quantities of oxide for gold alloys containing two base metals (In and Sn) were investigated by exposing alloys at 1000 degrees C for one h in air. The contents of In and Sn were varied in the range of from 0-1.5 wt%. In the range of from 1.5-0.35 wt% In (from 0-1.15 wt% Sn), In 2O3 was formed predominantly at the alloy surface. The electron probe x-ray micro-analyzer detected no uniform external oxidation zone. A mixture composed of In2O3 and SnO2 precipitated internally in the alloy matrix. An external oxidation zone composed of SnO2 was formed on the alloys containing over 1.2 wt% Sn, and no internal oxidation zone was observed.


Maximally efficient prediction in the early fly visual system may support evasive flight maneuvers.
The visual system must make predictions to compensate for inherent delays in its processing. Yet little is known, mechanistically, about how prediction aids natural behaviors. Here, we show that despite a 20-30ms intrinsic processing delay, the vertical motion sensitive (VS) network of the blowfly achieves maximally efficient prediction. This prediction enables the fly to fine-tune its complex, yet brief, evasive flight maneuvers according to its initial ego-rotation at the time of detection of the visual threat. Combining a rich database of behavioral recordings with detailed compartmental modeling of the VS network, we further show that the VS network has axonal gap junctions that are critical for optimal prediction. During evasive maneuvers, a VS subpopulation that directly innervates the neck motor center can convey predictive information about the fly's future ego-rotation, potentially crucial for ongoing flight control. These results suggest a novel sensory-motor pathway that links sensory prediction to behavior.


Impacts of climate change and human activities on different degraded grassland based on NDVI.
Grassland degradation has emerged as a serious socio-economic and ecological problem, endangering both long-term usage and the regional biogeochemical cycle. Climate change and human activities are the two leading factors leading to grassland degradation. However, it is unclear what the degradation level caused by these two factors is. Using the normalized difference vegetation index (NDVI) and coefficient of variation of NDVI (CVNDVI), the spatial distribution features of grassland degradation or restoration were analyzed in Qilian County in the northeast of the Qinghai-Tibet Plateau. The dominant climate variables affecting NDVI variation were selected through the combination of random forest model and stepwise regression method to improve the residual trend analysis, and on this basis, twelve possible scenarios were established to evaluate the driving factors of different degraded grasslands. Finally, used the Hurst index to forecast the trend of grassland degradation or restoration. The results showed that approximately 55.0% of the grassland had been degraded between 2000 and 2019, and the area of slight degradation (NDVIslope > 0; CVNDVI (slope) > 0; NDVIvalue > 0.2) accounted for 48.6%. These regions were centered in the northwest of Qilian County. Climate and human activities had a joint impact on grassland restoration or degradation. Human activities played a leading role in grassland restoration, while climate change was primarily a driver of grassland degradation. The regions with slight degradation or re-growing (NDVIslope > 0; CVNDVI (slope) > 0), moderate degradation (NDVIslope < 0; CVNDVI (slope) > 0), and severe degradation or desertification (NDVIslope < 0; CVNDVI (slope) < 0) were dominated by the joint effects of climate and anthropogenic activity accounted for 34.3%, 3.3%, and 1.3%, respectively, of the total grassland area. Grasslands in most areas of Qilian County are forecasted to continue to degrade, including the previously degraded areas, with continuous degradation areas accounting for 54.78%. Accurately identifying the driving factors of different degraded grassland and predicting the dynamic change trend of grassland in the future is the key to understand the mechanism of grassland degradation and prevent grassland degradation. The findings offer a reference for accurately identifying the driving forces in grassland degradation, as well as providing a scientific basis for the policy-making of grassland ecological management.


Molecular dynamics simulations of nafion and sulfonated poly ether sulfone membranes II. Dynamic properties of water and hydronium.
We measured the self-diffusion coefficients of water in a Nafion membrane and two sulfonated polyethersulfone (SPES) membranes with varying ion-exchange capacities (IEC) in terms of relative humidity using the pulse field gradient NMR (PFG-NMR) technique. The self-diffusion coefficients were plotted against the number of water molecules per sulfonic acid group, λ, and compare these values with the results of molecular dynamics (MD) simulations. Classical MD simulations for all membranes were carried out using a consistent force field at λ = 3, 6, 9, 12, and 15. The dynamic properties of water (H(2)O) and hydronium (H(3)O(+)) on a molecular level were estimated as self-diffusion coefficients and residence times around a sulfonate group ([Formula: see text]). The diffusion coefficients of H(2)O and H(3)O(+) followed the order, Nafion > SPES with IEC = 1.4 > SPES with IEC = 1.0 > SPES with IEC = 0.75, which agreed with the experimental data. The residence time distribution of H(2)O around [Formula: see text] in Nafion was in the range of 1-6 ps, whereas H(2)O in the SPES exhibited a residence time of greater than 20 ps.


Effect of different combinations of antibiotics on fruit quality and antioxidant defense system in Huanglongbing infected Kinnow orchards.
Huanglongbing (HLB), also known as citrus greening disease, is the most devastating disease of citrus across the world, caused by the phloem limited fastidious bacterium 'Candidatus Liberibacter spp.'. This research was conducted on HLB infected 10-year-old Kinnow orchard located at Multan, Pakistan. Different classes of antibiotics in various combinations were applied on HLB-infected trees. The antibiotic treatments were applied before flowering in February, during fruit setting in April and at fruit growth stage in June. The different antibiotics combinations used were Ampicillin sodium + Rifampicin, Cefalexin + Rifampicin, Ampicillin sodium + Cefalexin, Ampicillin sodium + Cefalexin + Rifampicin and Control (distilled water). Different fruit qualitative and quantitative attributes were examined. The application of antibiotics significantly decreased 2-11% in flower, June and pre-harvest drops as compared to control. Further, antibiotics increased fruit weight and yield by five times while the juice content, total soluble solids, ripening index, total sugars, phenolic and vitamin C content were also increased in fruits. In addition, total soluble proteins, peroxidase and catalase activities were increased in fruits harvested from antibiotic treated plants compared to control, however the superoxidase dismutase activity was decreased in fruits of antibiotic treated plants. Finally, it is concluded that application of different antibiotics combinations helps in improving the fruit yield and different quality attributes of HLB infected Kinnow trees.


Perfluoroalkyl carboxylates and sulfonates and precursors in relation to dietary source tracers in the eggs of four species of gulls (Larids) from breeding sites spanning Atlantic to Pacific Canada.
In the present study, we identified and examined the spatial trends, sources and dietary relationships of bioaccumulative perfluorinated sulfonate (PFSA; C(6), C(8), and C(10) chain lengths) and carboxylate (PFCA; C(6) to C(15) chain lengths) contaminants, as well as precursor compounds including several perfluorinated sulfonamides, and fluorotelomer acids and alcohols, in individual eggs (collected in 2008) from four gull species [glaucous-winged (Larus glaucescens), California (Larus californicus), ring-billed (Larus delawarensis) and herring (Larus argentatus) gulls] from 15 marine and freshwater colony sites in provinces across Canada. The pattern of PFSAs was dominated by perfluorooctane sulfonate (PFOS; >89% of ΣPFSA concentration) regardless of egg collection location. The highest ΣPFSA concentrations were found in the eggs collected in the urbanized areas in the Great Lakes and the St. Lawrence River area [Big Chicken Island 308 ng/g ww, Toronto Harbour 486 ng/g ww, and Ile Deslauriers (HG) 299 ng/g ww]. Also, eggs from all freshwater colony sites had higher ΣPFSA concentrations, which were significant (p<0.05) in many cases, compared to the marine sites with the exception of the Sable Island colony in Atlantic Canada off the coast of Nova Scotia. C(6) to C(15) chain length PFCAs were detected in the eggs, although the pattern was variable among the 15 sites, where PFUnA and PFTrA dominated the pattern for most colonies. Like the ΣPFSA, the highest concentrations of ΣPFCA were found in the eggs from Big Chicken Island, Toronto Harbour, Ile Deslauriers (HG), and Sable Island, although not all freshwater sites had higher concentrations compared to marine sites. Dietary tracers [δ(15)N and δ(13)C stable isotopes (SIs)] revealed that PFSA and PFCA exposure is colony dependent. SI signatures suggested that gulls from most marine colony sites were exposed to PFCs via marine prey. The exception was the Mandarte Island colony in Pacific British Columbia, where PFSA and PFCA exposure appeared to be via terrestrial and/or freshwater prey consumption. The same was true for the freshwater sites where egg SIs suggested both aquatic and terrestrial prey consumption as the source for PFC exposure depending on the colony. Both aquatic (marine and freshwater) and terrestrial prey are likely sources of PFC exposure to gulls but exposure scenarios are colony-specific.


Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database.
There is an ongoing debate regarding the extent of resection for splenic flexure tumors (SFT). The purpose of this study was to compare segmental and extended resections in terms of overall survival (OS) and pathologic outcomes. Retrospective analysis of all patients surgically treated for SFT in the National Cancer Database (NCDB) for the period 2010-2019. Outcomes of segmental and extended resections were compared and a 1:1 propensity score matching was used to match for confounders. Primary outcome was OS. In total 3498/668,852 (0.5%) patients with clinical stage I-III splenic flexure adenocarcinoma in the NCDB were included. Of these, 1533 (43.8%) underwent segmental resection while 1965 (56.1%) underwent extended resection. After matching, mean OS was similar between the groups (92 vs 91 months; p = 0.94). When survival was stratified by clinical N stage, an 8-month survival benefit was shown in the extended resection group for clinical N-positive status (86 vs 78); however, this difference did not achieve statistical significance (p = 0.078). Median number of harvested lymph nodes was significantly lower in the segmental resection group (16 vs 17; p < 0.001) and the percentage of patients with fewer than 12 harvested nodes was significantly higher (18.4% vs 11.6%; p < 0.001). Length of stay was significantly shorter in the segmental resection group (5 vs 6 days; p = 0.027). There were no significant differences between the groups in terms of 30-day readmission or 30- or 90-day mortality. While segmental and extended resections were associated with similar OS for clinically node-negative SFT, there might be a survival benefit for extended resection in patients with clinical evidence of lymph node involvement.


Expression of mRNAs for pro-and anti-apoptotic factors in granulosa cells and follicular fluid of women undergoing in vitro fertilization. A pilot study.
This observational clinical study evaluated the expression levels and predictive values of some apoptosis-related genes in granulosa cells (GCs) and follicular fluid (FF) of women undergoing in vitro fertilization (IVF). GCs and FF were obtained at oocyte retrieval from 31 consecutive patients with heterogeneous infertility diagnosis (age: 34.3 ± 5.8 years, body mass index: 24.02 ± 3.12 kg/m2, duration of infertility: 4.2 ± 2.1 years). mRNA expression of pro-apoptotic (BAX, CASP3, CASP8) and anti-apoptotic (BCL2, AMH, AMHR, FSHR, LHR, CYP19A1) factors was determined by quantitative RT-PCR using ROCHE LightCycler 480. No significant difference in GC or FF mRNA expression of pro- and anti-apoptotic factors could be demonstrated between IVF patients with (9 patients) or without (22 patients) clinical pregnancy. Each transcript investigated was detected in FF, but their levels were markedly reduced and independent of those in GCs. The number of retrieved oocytes was positively associated with GC AMHR (r = 0.393, p = 0.029), but the day of embryo transfer was negatively associated with GC LHR (r = - 0.414, p = 0.020) and GC FSHR transcripts (r = - 0.535, p = 0.002). When pregnancy positive group was analysed separately the impact of apoptosis- related gene expressions on some selected measures of IVF success could be observed. Strong positive relationship was found between gene expression levels of pro- and anti-apoptotic factors in GCs. Our study provides only marginal evidences for the apoptosis dependence of IVF outcome and suggests that the apoptosis process induces adaptive increases of the anti-apoptotic gene expression to attenuate apoptosis and to protect cell survival.


The rapid identification of Chido and Rodgers antibodies using C4d-coated red blood cells.
A simple method for the recognition of anti-Ch and anti-Rg, using red blood cells coated in vitro with C4d, is described. Of 58 anti-Ch and 20 anti-Rg sera studied, all caused direct agglutination of C4d-coated red blood cells in tests incubated at room temperature. Moreover, selected sera were shown to react strongly (3+ to 4+) with C4d-coated red blood cells when tested by the indirect antiglobulin test without prior incubation at 37 C. Sera containing other high-titer, low avidity (HTLA) antibodies were either nonreactive with C4d-coated red blood cells, or reacted to the same degree with "non-C4d-coated" trypsin-treated red blood cells. Similar findings were obtained in tests with non-HTLA antibodies of assorted specificities, including a variety of alloantibodies to high-incidence red blood cell antigens. These findings indicate that the use of C4d-coated red blood cells in investigative immunohematology may aid in the rapid identification of Ch and Rg antibodies.


Long-term results of choledochoduodenostomy in the treatment of choledocholithiasis: assessment of 225 cases.
During a 10-year period 2610 patients were operated on for biliary lithiasis; in 225 (8.6 per cent) cases the operation concluded with a choledochoduodenostomy. The commonest preoperative diagnosis (62.2 per cent) in these 225 patients was choledocholithiasis; 30 patients had previously had a cholecystectomy. After choledochoduodenostomy, 4.0 per cent of patients had an intra-abdominal complication; six patients developed an intra-abdominal abscess and three developed an external biliary fistula. Four patients (1.8 per cent) died, three from pulmonary complications and one from a biliary fistula. After a mean follow-up period of 4.6 years, 71.5 per cent of patients were asymptomatic. The remainder suffered from dyspepsia (15.1 per cent), colicky pain (8.7 per cent) or episodes of cholangitis (4.7 per cent). Endoscopy in the symptomatic patients allowed the following conclusions: (a) no patient with dyspepsia had a problem at the anastomosis; (b) 27 per cent of those with colic had anastomotic stenosis or the sump syndrome; and (c) all patients with cholangitis had anastomotic stenosis and residual calculi.


Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft.
To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery. A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group. Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (p < 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions. In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling. Level III.


Data on HO-1 and CD200 protein secretion during T-cells and mesenchymal stromal cells co-cultures.
In this Data in Brief, we have provided data describing the secretion profile of two main immunoregulatory proteins, heme oxygenase-1 (HO-1) and CD200, from bone marrow (BM), Wharton׳s Jelly (WJ) or adipose tissue (AT) mesenchymal stromal cells (MSCs) being cultivated either in the absence or presence of activated T-cells. Whilst HO-1 is a stress-responsive enzyme displaying diverse cytoprotective effects, CD200 is a membrane glycoprotein delivering immunoregulatory signals following interaction with its receptor (CD200R). Using Enzyme-linked immunosorbent assay (ELISA) techniques, these data are presented to show distinct constitutive secretion of both HO-1 and CD200 depending on MSC types. The data presented also demonstrate that the protein levels of HO-1 and CD200 are differentially modulated during co-culture with activated T-cells. All assays were carried out in triplicates and the mean values are reported. The data presented in this article are complementary to our previously published report entitled "The Immunomodulatory Potential of Mesenchymal Stromal Cells: A Story of a Regulatory Network." [1].


Cytokine-induced immunoglobulin production in primary IgA nephropathy.
Increased IgA synthesis probably plays a role in the pathogenesis of IgA nephropathy (IgAN). We investigated whether an increased sensitivity to the effect of various growth factor combinations leads to increased immunoglobulin synthesis by peripheral blood mononuclear cells (PBMC) from IgAN patients, in comparison to healthy controls. Although none of the growth factors studied (pokeweed mitogen [PWM], interleukin [IL]-2, IL-6, transforming growth factor-beta [TGF-beta], and combinations) led to greater IgA synthesis in IgAN patients than in controls, the IgA subclass ratio was shifted in favor of IgA1. In controls, but not in IgAN patients, IL-2 enhanced the production of IgA and IgA1 compared with media alone. This possibly reflects previous in vivo activation by IL-2 in IgAN patients. The suppressive effect of TGF-beta on immunoglobulin synthesis was modestly greater in IgAN patients than in controls. Increased production of IL-2 and perhaps other cytokines by T cells in vivo may be responsible for the elevated IgA immune response in these patients.


Working Dog Dentistry.
Working dogs serve different functions based on their trained purpose. Due to the nature of their work, they are prone to traumatic dentoalveolar injuries (TDIs). TDIs include tooth wear, fracture, discoloration, and displacement. Undiagnosed or untreated TDIs result in pain, which could lead to poor performance. Veterinarians should educate handlers on potential injuries and perform a thorough oral examination and appropriate diagnostics to identify any oral abnormalities and initiate treatment. The primary goal of treatment is to return dogs to normal function so that they can continue to perform their assigned duty at maximum performance.


Value of Micro Flow Imaging in the Prediction of Adenomatous Polyps.
The aim of this study was to assess the value of micro flow imaging (MFI) in distinguishing adenomatous polyps from cholesterol polyps. A total of 143 patients who underwent cholecystectomy for gallbladder polyps were retrospectively analyzed. B-mode ultrasound (BUS), color Doppler flow imaging (CDFI), MFI and contrast-enhanced ultrasound (CEUS) were performed before cholecystectomy. The weighted kappa consistency test was used to evaluate the agreement of vascular morphology among CDFI, MFI and CEUS. Ultrasound image characteristics, including BUS, CDFI and MFI images, were compared between adenomatous polyps and cholesterol polyps. The independent risk factors for adenomatous polyps were selected. The diagnostic performance of MFI combined with BUS in determining adenomatous polyps was compared with CDFI combined with BUS. Of the 143 patients, 113 cases were cholesterol polyps, and 30 cases were adenomatous polyps. The vascular morphology of gallbladder polyps was more clearly depicted by MFI than CDFI, and it had better agreement with CEUS. Differences in maximum size, height/width ratio, hyperechoic spot and vascular intensity on CDFI and MFI images were significant between adenomatous polyps and cholesterol polyps (p < 0.05). The maximum size, height/width ratio, and vascular intensity on MFI images were independent risk factors for adenomatous polyps. For MFI combined with BUS, sensitivity, specificity and accuracy were 90.00%, 94.69% and 93.70%, respectively. Area under the receiver operating characteristic curve (AUC) of MFI combined with BUS was significantly higher than that of CDFI combined with BUS (AUC = 0.923 vs. 0.784). Compared with CDFI combined with BUS, MFI combined with BUS had higher diagnostic performance in determining adenomatous polyps.


Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes.
Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, we analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. Qualitative descriptive study using prospective field-based assessment of workflows. Six NHs in Wisconsin (n = 3) and Pennsylvania (n = 3). A total of 44 interviews with 68 NH professionals, including leadership, nurses, and prescribers. During a 1-day field visit in each NH, we conducted semistructured interviews with NH professionals, collected artifacts (policies, procedures, and documentation and communication tools), and observed clinical meetings. Study participants were interviewed (30-60 minutes) about antibiotic prescribing workflows in their facility. Information collected during site visits was used to create a representative workflow map of NH antibiotic prescribing. The workflow map guided thematic analysis to identify barriers corresponding to workflow steps across multiple NHs. The representative antibiotic preprescribing workflow map included 17 steps, beginning with resident change in condition and ending with the decision to prescribe an antibiotic. Thematic analysis identified common step-specific barriers to antibiotic stewardship centering on three themes: (A) information barriers, comprising (A1) inconsistent nurse assessment report and (A2) misalignment between the work and tools of information sharing within the facility, (B) communication barriers, comprising (B1) mismatched perception of prescriber information needs and (B2) difficulty reaching prescribers for direct interaction, and (C) professional barriers, comprising (C1) low prescriber confidence in nurse assessment report and (C2) nurse reluctance to express their professional opinions. Strategies addressing workflow barriers are important targets for antibiotic stewardship. Such strategies include structured information tools, nurse and prescriber education, and organizational improvement. Future research can build on combinations of existing and new strategies to measure their effects in improving antibiotic prescribing. J Am Geriatr Soc 68:2222-2231, 2020.


Improving urinary tract infection treatment through a multifaceted antimicrobial stewardship intervention in the emergency department.
Urinary tract infection (UTI) is frequently encountered in the emergency department (ED). We assessed an antibiotic stewardship intervention tailored for the ED. The primary objective was improving overall adherence to agent choice and treatment duration. The secondary objective was a decrease in fluoroquinolone prescription. This pre-post study included patients discharged from the ED with a UTI diagnosis. The intensive intervention period lasted three months and involved dissemination of guidelines, short lectures, incorporation of order sets into electronic ED charts and weekly personal audit and feedback. The following 11-month phase was a booster period consisting of monthly text messages of the treatment protocol. Assessment of adherence to the protocol was compared between the three-month pre-intervention period and the last two months of the intensive intervention period, as well as with the last two months of the booster period. A total of 177 patients were included in the pre-intervention period, 156 in the intervention period, and 94 in the late follow-up assessing the booster period. Median age was 49 (18-94) years, 78.2% were female, 84.8% had cystitis. During the intervention period, protocol adherence with antibiotic selection and duration increased from 41% to 84% (p < 0.001). Adherence remained high in the late follow-up period (73.4% vs. 41%, p < 0.001). Fluoroquinolone use decreased from 19.1% pre-intervention, to 5% in the intervention and 7.4% in the late follow-up periods (p < 0.001). An antibiotic stewardship intervention in a busy ED resulted in adherence to treatment protocols, including a decrease in fluoroquinolone use. A monthly reminder preserved most of the effect for a year.


Comparison of structural differences between yeast β-glucan sourced from different strains of saccharomyces cerevisiae and processed using proprietary manufacturing processes.
In this study, we explored structural differences of five commercial samples of yeast β-glucan. Samples were assayed for their β-glucan content and the yeast storage carbohydrate, glycogen. The β-glucan content ranged from 74% to 86%, the glycogen content varied from 0 to 20%. The linkage pattern of each sample was measured by the partially methylated alditol acetate method. This method showed that the samples varied from 1.9% to 9.2% branching. The side chain length distribution for each sample was analyzed by an alkaline degradation assay followed by ion chromatography. The side length distributions of the samples were shown to be similar. The samples were also analyzed by FT-IR and 1HNMR spectroscopy but it was difficult to derive quantitative differences in the samples by these methods. Our findings confirm that each proprietary source of yeast β-glucan has a unique purity profile, branching, and linkage patterns that determine the chemical structure and composition.


T cell surface antigen expression on lymphocytes of patients with AIDS during in vitro mitogen stimulation.
Surface marker expression on peripheral blood mononuclear cells (PBMC) was evaluated daily in PHA- and PWM-stimulated cultures of eight AIDS patients and eight normals. Before culture, the patients' cells showed the characteristic decrease in OKT 4+ cells (normals 40.4%, patients 22.3%; P less than 0.001), increase in OKT 8+ cells (normals 27.6%, AIDS 38.4%; P = 0.002), increase in OKT 10+ cells (normals 15.5%, AIDS 42.8%; P = 0.002), and increase in HLA-DR+ cells (normals 11.4%, AIDS 28.7%; P = 0.01). The percentage of OKT 11+ cells remained unchanged, while the percentage of OKT 3+ cells dropped over the first 2 days in PHA but not in PWM cultures of both groups (PHA: normals 69.8% to 35.1%; P = 0.001, AIDS 56.5 to 38.5%; P = 0.001, PWM: normals 62.8%-65.9%, AIDS 66.8% to 63.9%), and recovered in both groups by day 5. In PWM cultures OKT 3+ cells increased significantly in normals but not in AIDS (normals 62.6%-77.7%; P = 0.04, AIDS 61.8 to 48.7%). OKT 4 expression decreased in normal PHA cultures after 1 day (38.9% to 29.6%; P = 0.05) and then recovered by day 5. Its expression increased in AIDS PHA cultures by day 5 (18.0%-41.1%; P less than 0.001). The final percentage of OKT 4+ cells in AIDS cultures was within the normal range (35.0%-49.0%). OKT 8 expression increased in both study groups after PHA stimulation (normals 29.5%-50.4%; P = 0.002, AIDS 37.4%-50.7%; P = 0.02) and in normals but not AIDS after PWM stimulation (normals 28.9%-35.5%; P = 0.004, AIDS 38.5%-35.6%). Because of the relative changes in expression of OKT 4 and OKT 8, the 4/8 ratio declined in the normal PHA cultures (1.89 to 1.03; P = 0.1) and increased in the AIDS cultures (0.68-1.18; P = 0.09). Also, the sum of OKT 4+ and OKT 8+ cells in PHA cultures increased from 68% to 94% whilst expression of OKT 11 remained unchanged, indicating co-expression of these antigens on individual cells. Both PHA-and PWM-stimulated normal cells showed an increase in OKT 10 (PHA 16.0%-53.4%; P = 0.01, PWM 16.1%-33.9%; P = 0.03) and HLA-DR (PHA 8.6%-27.3%; P = 0.03, PWM 12.5%-26.6%; P = 0.07). In AIDS PHA cultures this did not change, and in their PWM cultures OKT 10 expression declined (44.8 to 23.0%; P = 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)


Reproductive, productivity, and mortality outcomes in late-gestation gilts and their litters following simulation of inadvertent exposure to a modified-live vaccine strain of porcine reproductive and respiratory syndrome (PRRS) virus.
The study evaluated the safety of a modified live-virus (MLV) porcine reproductive and respiratory syndrome (PRRS) vaccine in susceptible, pregnant gilts. To simulate inadvertent exposure secondary to postvaccination shedding of PRRS-MLV, seronegative gilts (n=51) were exposed by IM vaccination at 90 days of gestation. Vaccinated and nonvaccinated, seronegative control gilts (n=25) were maintained in separate facilities. The PRRS-MLV vaccine was given in a 2mL dose on day 0. On day 7 all vaccinated gilts were PRRSV-PCR-positive for PRRSV and had responded serologically as determined by an ELISA. All control gilts remained PRRSV-PCR- and ELISA-negative throughout the study. Abortions did not occur in gilts from either group. The difference between vaccinated and control gilts in average number of piglets per litter (12.43 and 12.16, respectively), number of live births per litter (11.21 and 11.54), and mean piglet birth weight (3.22 and 3.26 lbs) were not significantly different. Piglets in the control group had significantly greater average daily gain versus piglets from vaccinated gilts (0.52 vs. 0.46 lbs, P<0.0001). Preweaning mortality was significantly greater (P=0.0023) in piglets from the vaccinated gilts (19.7% vs. 10.9%). A single gilt accounted for 18.2% of stillbirths in the vaccinated group. Air samples were borderline PRRSV-PCR-positive for PRRSV on days 29 and 32, after more than 98% of gilts had farrowed. Results demonstrated that vaccination of pregnant gilts at the time of peak fetal susceptibility was non-abortigenic and that the PRRS-MLV agent did not significantly affect reproductive outcomes. Lower ADG in piglets from vaccinated gilts may be due to PRRS-MLV viremia following transplacental or post-farrowing exposure. Air sampling results indicated that environmental contamination with PRRS-MLV shed from vaccinated gilts was minimal.


Effects of interventions based on the theory of planned behavior on sugar-sweetened beverage consumption intentions and behavior.
There is increasing concern about the health risks of added dietary sugar, perhaps particularly when consumed in beverages that contain no essential nutrients (e.g., sodas). The purpose of this experiment was to examine the relative and combined efficacy of three interventions based on the theory of planned behavior (TPB) for motivating reductions in sugar sweetened beverage (SSB) consumption. Four-hundred-thirty undergraduates were randomised in a 2*2*2 factorial design. Participants received either information designed to increase awareness of the risks of SSB consumption or control information, and received either information about SSB consumption norms or no norms information, and either made plans to reduce their SSB consumption or engaged in a control planning task. Results demonstrated that the interventions, separately and in conjunction, resulted in greater intentions to reduce SSB consumption in the future, and there was evidence that these effects were mediated by the effects the interventions had on the TPB constructs. Further, the risks information resulted in more behaviors indicative of preparations to alter SSB consumption and those who engaged in the SSB planning task reported significantly lower SSB consumption at follow-up compared to controls. The three interventions utilized showed promise for altering SSB consumption intentions and behavior and, given their brevity and low cost, have potential to be developed into large scale community-based interventions that may lead to meaningful public health benefits.


Utilization and Impact of Complementary and Alternative Medicines in Symptomatic Autoimmune Hepatitis Patients.
Complementary and alternative medicine (CAM) use has become increasingly common. It is also prevalent in patients with chronic liver disease, but the scope, depth, and safety of use is not well known. This study aimed to evaluate the prevalence and patterns of CAM use in autoimmune hepatitis (AIH) patients. Electronic invitation to complete a 22 item CAM-specific questionnaire was posted weekly to well-established AIH Facebook communities (combined membership of 4700 individuals) during a 6-week study period. Age ≥ 18 years and AIH diagnosis made by a treating physician were the eligibility criteria. The prevalence of ever CAM use among participants was 56.4%, and nearly 42% used CAM after AIH diagnosis. Among those reporting CAM use after diagnosis, 53.7% (51/95) indicated CAM was used to mitigate AIH-related phenomenon, most often targeting liver inflammation/fibrosis (67.7%), fatigue (51%), joint pain (47.1%), and sleep issues (45.1%). Most frequent physical CAM strategies were exercise (49.5%) and yoga (34%), whereas most frequent consumable CAM included healthier eating (45.3%), cannabidiol preparations (45.3%), and probiotics (44.3%). Seventy-five percent reported that CAM improved AIH symptoms and no severe adverse events were reported. CAM use in AIH patients is prevalent, yet providers have historically failed to document their patient's CAM strategies. Beyond inherent drug-induced liver injury risk, drug-drug interactions remain a concern and could alter baseline immunosuppression levels in AIH. Despite a majority found CAM approaches that improved targeted symptoms, all were unable to alter the course of chronically prescribed medications by physicians.


Cystic dysplasia of testis.
A rare developmental disorder, cystic dysplasia of the testis, encountered in a newborn infant, is described. The relationship to renal dysplasia and the recent literature are reviewed.


Evidence-based labor management: before labor (Part 1).
In preparation for labor and delivery, there is high-quality evidence for providers to recommend perineal massage with oil for 5-10 minutes daily starting at 34 weeks until labor; ≥1 daily sets of repeated voluntary contractions of the pelvic floor muscles, performed at least several days of the week starting at approximately 30-32 weeks gestation; no x-ray pelvimetry; sweeping of membranes weekly starting at 37-38 weeks gestation; for women with a risk factor for abnormal outcome plans should be made to deliver in a hospital setting; for low-risk women, alongside birth center birth is associated with maternal benefits and higher satisfaction, compared with hospital birth; midwife-led care for low-risk women; continuous support by a professional such as doula, midwife, or nurse during labor; and training of birth attendants in low- and middle-income countries.


Is the hindlimb representation of the rat's cortex a 'sensorimotor amalgam'?
In the rat, the hindlimb representation of the sensorimotor cortex is characterized by the presence of large pyramids in the fifth layer and a dense granular layer ('sensorimotor amalgam'). The objective was to investigate in the rat, whether or not the efferent zones to the gastrocnemius muscle and the proprioceptive feedback projection from that muscle to the cortex are co-extensive. To this end, the proprioceptive zone was mapped by means of field potentials and single unit discharges evoked by controlled longitudinal displacements of the gastrocnemius tendon. The efferent zones to the gastrocnemius muscle were mapped by means of intracortical microstimulation (ICMS; less than 30 microA). The proprioceptive zone occupied a territory extending from 1.0 to 2.5 mm caudal to the bregma and from 2.0 to 3.0 mm lateral from the midline. The response properties were similar to those observed previously in area 3a of monkeys. For sinusoidal displacements threshold amplitude decreased with increasing stretch frequency. The modal value of response latency was 7 ms, the shortest latency 4 ms. The ICMS zone lay 0.5 to 1.5 mm caudal to bregma having an overlap of 0.5 mm with the proprioceptive region. The proprioceptive as well as the motor areas lay within the granular cortex, but overlapped only to a small extent.


Vascular amyloid deposition in Alzheimer's disease. Neither necessary nor sufficient for the local formation of plaques or tangles.
To determine the relationship between vascular beta-amyloid (beta A4) and senile plaques (SPs) and neurofibrillary tangles (NFTs). We counted vascular amyloid deposition with SP and NFT density in the medial temporal lobe (CA1 plus the subiculum) and the cerebellum. The brains of seven patients with Alzheimer's disease and of three age-matched nondemented control subjects were studied. In Alzheimer's disease, the density of beta A4-laden blood vessels was significantly higher in the cerebellum than in CA1 plus the subiculum. Conversely, the densities of SPs and NFTs were much greater in the CA1 plus the subiculum than in the cerebellum. This study indicates that local vascular beta A4 deposition is not directly correlated with SP and NFT densities. Deposition of beta A4 in blood vessel walls may not be instrumental in the formation of SPs and/or NFTs in the brain.


Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study.
Proximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia. We included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6-8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6-8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence. There were no differences in the duration of ICU stay - gr.1 72 [70-75], gr.2 74 [72-76], gr.3 72 [70-75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170-184], gr.2170 [148-188], gr.3178 [144-200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0-5] mg versus 15 [10-20] and 20 [15-25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0-1] vs. 3 [2-4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7-9] vs. 6 [5-7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery - sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01-77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2-91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium. Perioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed. Clinicaltrials.gov: NCT04648332 , first registration date 1/12/2020.


Social dominance orientation, prejudice, and discrimination: a new computer-based method for studying discriminatory behaviors.
A number of studies have shown that the scale of social dominance orientation (SDO), used to measure the degree of preference for inequality among social groups, is a predictive measure of social and political attitudes toward stigmatized outgroups. However, the relationship between SDO and discrimination has received little attention. The main goal of this study was to assess the validity of a new computer-based method used to measure discriminatory behaviors in a laboratory setting. An additional goal was to test the mediating role of prejudice in the relation between SDO and discrimination. The results provide a first validation of this new method and demonstrate that the effect of SDO on discrimination is mediated by prejudice.


Parental characteristics have a larger effect on children's health behaviour than their body weight.
Parents take an important role in a child's development, but there is currently limited information on parental correlates with children's health behaviour. The purpose of this study, therefore, was to examine whether parental characteristics, such as body weight, TV consumption and sport participation, affect children's body weight and health behaviour. To examine the effects of parental characteristics on children's body weight and health behaviour, baseline data of 1,118 elementary school children (7.6 ± 0.4 years) participating in a school-based intervention in southwest Germany was used. Children's height and weight were measured and parent as well as child behaviour was assessed via questionnaire. BMI percentiles of children were positively associated with parental BMI (r = 0.2, p <0.01). Further, high parental TV time increased the odds for high TV time in children (OR mother= 2.2, OR father = 2.3) and parental club sport participation increased the odds for club sport participation in children (OR mother = 1.9, OR father = 1.7). The relationship between parental and child behaviour was stronger than the relationship between parental BMI and BMI percentiles of the child. These results suggest that parental behaviour and role modeling provide an important contribution to childrens' health behaviour, especially at younger ages.


The Efficacy of In-Reach Rehabilitation in Morbidly Obese Post Septic Patients: Two Retrospective Case Reports.
To report the functional outcomes of two patients with morbid obesity (> 250 kg) who received in-reach rehabilitation after hospitalization for sepsis in Sydney, Australia. A retrospective review of hospital charts was performed with the informed consent of both patients. Body mass index, demographics, length of stay, functional status at admission and discharge, medical comorbidities, social history, hospital course, equipment needs, therapy methods used, and discharge disposition were compared. Both patients had a positive outcome. Function improved in case 1, from requiring hoist transfers, to mobilizing 80 m with 2 assistants. The patient was transferred to a subacute rehabilitation facility, but did not make any gain in Functional Independence Measure. Function improved in case 2, from requiring 2 assistants to walk with a frame, to walking independently with a 4-wheeled walker. The patient was discharged home from the acute hospital, with a minimal Functional Independence Measure gain of 8. Both patients lost approximately 45 kg during acute hospitalization. These case reports demonstrate that in-reach rehabilitation can play an important role in the functional recovery of morbidly obese patients hospitalized with severe sepsis. This report also highlights the need for preventive interventions to reduce avoidable acute hospital presentations and to prevent functional decline.


Multimodality treatment of complex renal calculi.
More than 2,500 patients were treated for urolithiasis from 1984 to 1987. In an effort to define the relative role of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy with respect to size, location and composition of the calculus 912 of these patients (224 of whom underwent percutaneous nephrolithotomy and 688 of whom underwent extracorporeal shock wave lithotripsy) were reviewed. Size proved to be the only significant factor in the success and complication rates of extracorporeal shock wave lithotripsy but it did not affect the outcome of percutaneous nephrolithotomy. The roles of these 2 modalities were then examined with respect to the treatment of complex renal calculi. We reviewed 376 patients with complex renal calculi, including 40 percutaneous nephrolithotomy patients from the initial 912 patients studied. The initial therapy in 100 of these patients, treated consecutively, was extracorporeal shock wave lithotripsy. The remaining 276 patients were treated by percutaneous nephrolithotomy. The success rate of extracorporeal shock wave lithotripsy monotherapy in the treatment of complex renal calculi was 36%. The success rate of primary percutaneous nephrolithotomy was 83%. We conclude that percutaneous nephrolithotomy should be the primary therapy for patients with complex renal calculi. Extracorporeal shock wave lithotripsy is the preferred treatment for patients with smaller calculi and as an adjunct to percutaneous nephrolithotomy.


Thiazolidinediones and type 2 diabetes: new drugs for an old disease.
Thiazolidinediones are a new class of drugs for the treatment of type 2 diabetes, and act by improving insulin sensitivity in adipose tissue, liver and skeletal muscle. Rosiglitazone and pioglitazone are registered for use in monotherapy, and in combination with sulfonylureas and metformin. Pioglitazone is also licensed for use in combination with insulin. There is level II evidence that in patients with inadequate glycaemic control both drugs reduce the level of HbA1c and fasting plasma glucose (FPG) when used as monotherapy and in combination with sulfonylurea or metformin or insulin; and both drugs increase levels of HDL and LDL and lower free fatty acid levels, but only pioglitazone significantly lowers triglyceride levels. Both drugs lower fasting insulin and C-peptide levels. In monotherapy, they may be slightly less potent at reducing the level of HbA1c than sulfonylureas or metformin. The maximal effect of these agents may not be seen for 6-14 weeks after commencement. Both drugs are well tolerated but liver function must be checked at baseline every second month for the first year, and periodically thereafter. The drugs are currently contraindicated in patients with moderate to severe liver dysfunction and alanine aminotransferase levels more than 2.5 times normal, New York Heart Association III-IV cardiac status, pregnancy, lactation and in children. The main side effects include weight gain, oedema, and mild dilutional anaemia.


Overweight children report qualitatively distinct asthma symptoms: analysis of validated symptom measures.
Past studies of asthma in overweight/obese children have been inconsistent. The reason overweight/obese children commonly report worse asthma control remains unclear. To determine qualitative differences in symptoms between lean and overweight/obese children with early-onset, atopic asthma. We conducted a cross-sectional analytic study of lean (20% to 65% body mass index) and overweight/obese (≥85% body mass index) 10- to 17-year-old children with persistent, early-onset asthma. Participants completed 2 to 3 visits to provide a complete history, qualitative and quantitative asthma symptom characterization, and lung function testing. We determined associations between weight status and symptoms using multivariable linear and logistic regression methods. Overweight/obese and lean asthmatic children displayed similar lung function. Despite lower fraction of exhaled nitric oxide (30.0 vs 62.6 ppb; P = .037) and reduced methacholine responsiveness (PC20FEV1 1.87 vs 0.45 mg/mL; P < .012), overweight/obese children reported more than thrice frequent rescue treatments (3.7 vs 1.1 treatments/wk; P = .0002) than did lean children. Weight status affected the child's primary symptom reported with loss of asthma control (Fisher exact test; P = .003); overweight/obese children more often reported shortness of breath (odds ratio = 11.8; 95% CI, 1.41-98.7) and less often reported cough (odds ratio = 0.26; 95% CI, 0.08-0.82). Gastroesophageal reflux scores were higher in overweight/obese children (9.6 vs 23.2; P = .003) and appear to mediate overweight/obesity-related asthma symptoms. Overweight/obese children with early-onset asthma display poorer asthma control and a distinct pattern of symptoms. Greater shortness of breath and β-agonist use appears to be partially mediated via esophageal reflux symptoms. Overweight children with asthma may falsely attribute exertional dyspnea and esophageal reflux to asthma, leading to excess rescue medication use.


Translational regulation of chloroplast genes. Proteins binding to the 5'-untranslated regions of chloroplast mRNAs in Chlamydomonas reinhardtii.
We have examined the effects of illumination, carbon source, and levels of chloroplast protein synthesis on trans-acting proteins that bind to the leaders of five representative chloroplast mRNAs. The accumulation of these five chloroplast mRNAs and the proteins they encode were measured in cells grown under identical conditions. Extracts from all cell types examined contain a minimum set of six chloroplast 5'-untranslated region (UTR)-binding proteins (81, 62, 56, 47, 38, and 15 kDa). Fractionation results suggest that multiple forms of the 81-, 62-, and 47-kDa proteins may exist. A 36-kDa protein was found in all cells except those deficient in chloroplast protein synthesis. Binding of the 81-, 47-, and 38-kDa proteins to the rps12 leader is effectively competed by the atpB or rbcL 5'-UTRs, indicating that the same proteins bind to all three leaders. In contrast, these three proteins do not bind to the nuclear-encoded alpha-1 tubulin leader, which bound novel proteins of 110, 70, and 43 kDa. Cis-acting sequences within the 5'-UTRs of two chloroplast mRNAs (rps7 and atpB) have been identified which are protected from digestion by RNase T1 by extracts enriched for the 81-, 47-, and 38-kDa proteins.


Perihilar cholangiocarcinoma: A much needed but imperfect new staging system.
A new staging system for perihilar cholangiocarcinoma has recently been proposed to standardize the reporting of this intractable disease. However, the system has several flaws; thus, many revisions are needed before a registry can be established that uses this system.


Comparison of effects of six main gastrectomy procedures on patients' quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45.
The effects of various gastrectomy procedures on the patient's quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted. To compare the effects of six main gastrectomy procedures on the postoperative QOL. Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means. TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures. Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.


Foot-and-mouth disease: the question of implementing vaccinal control during an epidemic.
The question of whether or not to use vaccines during an epidemic of foot-and-mouth disease (FMD) has interested veterinary administrators for many decades. This review assesses the historical uses, successes and failures of vaccinal control, and addresses the questions of where, how, and when to use vaccination against FMD. Approaching the problem in this manner can aid in identifying which tools are likely to be most effective during an epidemic, and how successful a given contingency plan might be. The infection status (endemic, semi-endemic, disease-free) of a region has historically mapped where global vaccination has been implemented according to the generality: endemic>semi-endemic>disease-free. More specifically, biomodels and cost-benefit analyses can indicate when vaccination should be implemented for optimal disease control. Finally, numerous local epidemiological factors will provide useful insights into how vaccinal controls can be used effectively.


Selfishness, fraternity, and other-regarding preference in spatial evolutionary games.
Spatial evolutionary games are studied with myopic players whose payoff interest, as a personal character, is tuned from selfishness to other-regarding preference via fraternity. The players are located on a square lattice and collect income from symmetric two-person two-strategy (called cooperation and defection) games with their nearest neighbors. During the elementary steps of evolution a randomly chosen player modifies her strategy in order to maximize stochastically her utility function composed from her own and the co-players' income with weight factors 1-Q and Q. These models are studied within a wide range of payoff parameters using Monte Carlo simulations for noisy strategy updates and by spatial stability analysis in the low noise limit. For fraternal players (Q=1/2) the system evolves into ordered arrangements of strategies in the low noise limit in a way providing optimum payoff for the whole society. Dominance of defectors, representing the "tragedy of the commons", is found within the regions of prisoner's dilemma and stag hunt game for selfish players (Q=0). Due to the symmetry in the effective utility function the system exhibits similar behavior even for Q=1 that can be interpreted as the "lovers' dilemma".


Susceptibility weighted imaging for ruptured basilar artery perforator aneurysms in the setting of angiographically negative subarachnoid hemorrhage.
Ruptured basilar artery perforator aneurysms (BAPAs), defined as microaneurysms which develop in basilar perforator arteries without direct involvement of the basilar trunk, represent a rare cause of subarachnoid hemorrhage (SAH). The diagnosis of BAPAs is difficult because of their small size, with high rates of negative angiography. The development of high-resolution MRI could increase the diagnostic performance. In this study we describe the usefulness of susceptibility weighted imaging (SWI) for the diagnosis of ruptured BAPAs. In a case series, we retrospectively collected data of patients admitted to our institution from 2018 to 2021 for SAH with negative CT angiography who underwent MRI (including SWI) and DSA during hospitalization. Eight patients with a definitive diagnosis of ruptured BAPA and five patients with a definitive diagnosis of angiogram-negative SAH were included. In all of the patients with BAPAs MRI showed a focal, thick, semi-circumferential SWI hypointensity covering the vessel wall at the level of the BAPA subsequently revealed on DSA; this phenomen is known as 'SWI capping'. No SWI capping was observed in the five patients with a definitive diagnosis of angiogram-negative SAH. SWI capping appears to be a reliable indirect sign for the diagnosis and localization of ruptured BAPAs, a rare form of microaneurysm easily misdiagnosed on DSA in initial angiogram-negative SAH.


Application of the "Yang-Monti principle" in children with iatrogenic ureteral injuries.
Iatrogenic ureteral injuries in children are rare, due to its retroperitoneal position. The Yang -Monti ileal substitution serves as a good surgical option in such injuries associated with long segment defects of the ureter. To review our experience using the Yang Monti principle of ileal ureter substitution in children with long segment ureteric defects and analyse its intermediate term outcomes. This was a prospective study, conducted from 2014 to 2019. All children with iatrogenic ureteral injuries with delayed presentations, undergoing the Yang Monti principle of ileal ureter substitution, were included (as illustrated in summary image). These injuries were divided into upper, mid, and distal ureteral injuries and were diagnosed based on a standardized protocol. At follow up, findings of the CT urogram, functional isotope renogram, and renal functions were the key points monitored. The demographic, clinical profile, operative, post-operative complications and follow up data were collated and analyzed. 22 children were diagnosed with iatrogenic ureteral injuries. Of these, 14 children with delayed presentations underwent the Yang Monti principle of ileal ureter substitution. The primary pathology was gangrenous appendicitis (9 cases), calculus cholecystitis (3 cases) and torsion ovary (2 cases). Laparoscopic procedures were the commonest approach for the injury (10). The average age was 11.5 years, with a male predominance. The right ureter was affected in 12 cases. The average time to detection was 7 days. All children underwent an ultrasound guided nephrostomy tube insertion at presentation and the mid ureter (9) was most affected. The mean length of ureteric injury was 3.75 cm. Intra operatively, one ileal segment (2), two ileal segments (11) and three ileal segments (1) were used according to the length of the ureteric defect. Complications were urinary tract infections (2), adhesions (3) and leak (2) which were conservatively managed with no redo surgeries. The median follow up period was 4 years. At follow up CT urogram and isotope diuretic renogram were normal, with preserved renal functions and no metabolic complications in all. In children associated with iatrogenic ureteral injuries of long lengths, the "Yang Monti ileal substitution" serves as a good and simple option with lesser complications permitting the preservation of the renal function at follow up.


Use of GnRH Agonists in Hysteroscopic Surgery
Medical reduction of the endometrium before hysteroscopic procedures has been demonstrated by many authors. In endometrial ablation, the GnRH agonists are useful for endometrial reduction and correction of anemia preoperatively. However, in cases of emergency, (severe hemorrhage), mechanical reduction (D&C) or other drugs like danazol work quicker. The GnRH agonists are more efficient in the treatment of submucous myoma, because they reduce the fibroid's size between 10 and 60% and allow reduction of endometrium and vascularization which permit easier and safer surgical procedures. After more than 300 hysteroscopic procedures for myomectomy, we now use GnRH agonists (Zoladex, Decapeptyl) 8 weeks before the procedure in fibroids type one and two. In cases of large intramural fibroids, the agonists have been administered for 12 weeks with the first surgical step at week 4 and the second step at week 12. In three cases, a third surgical step was required. In these series, no major complication occurred. We concluded that GnRH agonists are useful in hysteroscopic surgery, particularly myomectomy.


In Vivo Modeling of Skeletal Muscle Diseases Using the CRISPR/Cas9 System in Rats.
The CRISPR/Cas9 system is a powerful gene editing tool that can be used to modify a target gene in almost all species. It unlocks the possibility of generating knockout or knock-in genes in laboratory animals other than mice. The Dystrophin gene is implicated in human Duchenne muscular dystrophy; however, Dystrophin gene mutant mice do not show severe muscle degenerating phenotypes when compared to humans. On the other hand, Dystrophin gene mutant rats made with the CRISPR/Cas9 system show more severe phenotypes than those seen in mice. The phenotypes seen in dystrophin mutant rats are more representative of the features of human DMD. This implies that rats are better models of human skeletal muscle diseases than mice. In this chapter, we present a detailed protocol for the generation of gene-modified rats by microinjection into embryos using the CRISPR/Cas9 system.


Uterine carcinosarcomas: From pathology to practice.
Uterine carcinosarcoma (UCS) is a rare but aggressive cancer. In early-stage disease data guiding treatment is sparse. The purpose of this review is to summarize the findings from the 2019 NRG oncology group summer symposium meeting as well as a review of the current literature, with a particular focus on molecular targets, ongoing clinical trials, and treatment of early and advanced/recurrent disease. A combination of expert presentations and an extensive literature search was undertaken to summarize the literature in this review. MEDLINE was queried for peer-reviewed publications on UCS. This search was not limited by year or study design, but was limited to English language publications. ClinicalTrials.gov was queried for ongoing trials in UCS. UCS is a rare cancer that is biphasic, with the carcinomatous component driving its aggressive nature. Level 3 evidence regarding early stage disease is lacking, but retrospective data suggests adjuvant therapy is warranted. The recent results of GOG 261 have contributed valuable information towards treatment strategy, including use of paclitaxel and carboplatin for UCS. Clinical trials are ongoing to investigate new targeted agents in UCS. Ongoing endometrial cancer clinical trials now include UCS patients. In combination with advances in molecular profiling, this will provide patients with UCS improved therapeutic options. Until that time, surgical resection and traditional cytotoxic chemotherapy remains standard of care.


The two stage tracheostomy as a safe technique in instances of severe coagulopathy.
A simple two stage tracheostomy procedure is described for use in respirator-dependent patients in intensive care units. It is useful in patients in whom tracheostomy is indicated, but refractory coagulopathy is a deterrent.


Biomechanical evaluation of acromioclavicular joint reconstructions using a 3-dimensional model based on the finite element method.
This study aims to evaluate the influence of stabilization of acromioclavicular (AC) joint dislocation through the modified Weaver-Dunn technique and coracoclavicular (CC) ligaments using the finite element method. The goal is to determine which surgical technique allows behavior that is most similar to the joint, guaranteeing the necessary stability without restricting joint movements for the considered conditions. The analysis is based on the three-dimensional finite element models. The control group of this study is represented by a three-dimensional model of the whole structure based on finite element methods. The finite element models showed the stress and displacement values found in the intact acromioclavicular joint and surgical procedures. It was concluded that transferring the coracoacromial ligament to stabilize the acromioclavicular joint did not have a positive impact on the outcome. The finite element analysis on the treatment of acromioclavicular dislocation presented here provides medical teams with new parameters for choosing a suitable surgical procedure in the occurrence of acromioclavicular dislocation. The development and validation of the finite element models allow the variation of the conditions and enables different surgical configurations to be simulated.


Clinical predictors of GH deficiency in surgically cured acromegalic patients.
Even in patients with cured acromegaly, GH deficiency (GHD) after transsphenoidal adenomectomy (TSA) adversely affects body composition and inflammatory biomarkers of cardiovascular risk. In this study, clinical parameters for predicting GHD after TSA in 123 cured acromegalic patients were investigated. GH levels were measured at 6, 12, 18, 24, 48, and 72 h after TSA and serial insulin tolerance tests were conducted at 6 months, 2 years, and then every 2 years after TSA. GHD was found in 12 patients (9.8%) at 4.1 (range: 0.5-4.1) years after TSA. IGF1 levels were significantly lower at 6 months after TSA in GHD group than intact GH group (175.9 vs 316.8 μg/l, range: 32.0-425.0 and 96.9-547.3 respectively, P=0.008). Adenomas involving both sides of the pituitary gland were significantly more frequent in GHD patients (29.7 vs 83.3%; P=0.002). Furthermore, immediate postoperative 72-h GH levels after TSA were significantly lower (0.17 vs 0.45, range: 0.02-0.93 and 0.02-5.95 respectively, P=0.019) in GHD patients. In multiple logistic regression analysis, bilaterality of tumor involvement (odds ratio (OR)=10.678, P=0.003; 95% CI=2.248-50.728) and immediate postoperative 72-h GH level (OR=0.079, P=0.047; 95% CI=0.006-0.967) showed significant power for predicting GHD. These data suggest that bilateral involvement of a pituitary adenoma and severely decreased immediate postoperative serum GH levels at 72 h after TSA may be independent risks factor for accelerated GHD in acromegalic patients.


Association of simple bone cyst and cemento-osseous dysplasia: A long-term follow-up.
Cemento-osseous dysplasia (COD) is a non-neoplastic, usually asymptomatic condition characterized by the presence of amorphous cement-like calcifications located exclusively in the tooth-bearing regions of the jawbone. Simple bone cysts (SBCs) of the jaws are benign intraosseous cavities, empty or filled with serous, serohematic, or blood fluid. They are characterized by the absence of an epithelial lining. COD and SBCs are two distinct lesions of the jaws that have long been described separately in the literature; however, their co-occurrence remains rare and only a few cases have been reported illustrating this relationship. This association can be considered as a distinct entity since it presents specific epidemiological, clinical, and radiological data. The aim of this article was to report a new case of association between COD and SBC by illustrating a florid COD formation in mandibular SBC detected in a 31-year-old patient followed over a period of 11 years.


Research utilizaton: an evaluation and critique of research related to oral temperature measurement.
The problem addressed was whether a research-based protocol on oral temperature measurement could be developed and used in the practice setting. The first phase of the study proposed to (a) identify research articles related to the subject; (b) evaluate the quality of the research; (c) assess the adequacy of the research base; and (d) select areas for future study. The results indicated that further clinically-based studies are needed before a protocol can be designed and tested in clinical practice.


A short story of imaging and spectroscopy of two-dimensional materials by scanning transmission electron microscopy.
Here we present a short historical account of when single adatom impurities where first identified in two-dimensional materials by scanning transmission electron microscopy (STEM). We also present a study of the graphene low-loss (below 50eV) response as a function of number of layers using electron energy-loss spectroscopy (EELS). The study shows that as few as three layers of graphene behave as bulk graphite for losses above 10eV We also show examples of how point and extended defects can easily be resolved and structural dynamics can be readily capture by using aberration-corrected STEM imaging. Finally, we show that the new generation of monochromators has opened up possibilities to explore new physics with an electron microscope. All these capabilities were enabled by the development of spherical aberration correctors and monochromators, where Ondrej Krivanek has played a key role.


Polyphyly of the fern family Tectariaceae sensu Ching: insights from cpDNA sequence data.
Tectariaceae are a pantropical fern family of about 20 genera, among which 8 are distributed in China. The morphological distinctiveness of the family is widely recognized, yet relatively little systematic research has been conducted on members of Tectariaceae. Phylogenetic analyses of chloroplast DNA sequence data (rbcL and atpB) from 15 species representing all 8 genera in China were carried out under parsimony criteria and Bayesian inference. The phylogenetic reconstructions indicated that the fern family Tectariaceae as traditionally circumscribed are polyphyletic. Ctenitis, Dryopsis, Lastreopsis clustered with and should be included within the newly-defined Dryopteridaceae, and Pleocnemia is also tentatively assigned to it. A narrowly monophyletic Tectariaceae is identified, which includes Ctenitopsis, Hemigramma, Pteridrys, Quercifilix, and Tectaria. In the single rbcL analysis, Arthropteris clustered with the above-mentioned monophyletic Tectariaceae. Although further investigations are still needed to identify infrafamilial relationships within the monophyletic Tectariaceae and to redefine several problematic genera, we propose a working concept here that better reflects the inferred evolutionary history of this group.


Outcomes and Predictors of Mortality in Patients With Drug-Induced Liver Injury at a Tertiary Hospital in South India: A Single-Centre Experience.
Drug-induced liver injury (DILI) is an important cause of acute liver failure with significant morbidity and mortality. The outcome of DILI varies widely according to the drug implicated and the type of liver injury. Owing to the heterogeneous nature of liver injury, knowledge on clinical course and prognosis of DILI is limited. We had undertaken this study to determine the clinical characteristics, outcomes, and predictors of mortality in patients with DILI. This prospective study was conducted from January 2015 through December 2018. We analyzed the drugs implicated, clinical course, and the outcome. Causality assessment was performed by using Roussel Uclaf Causality Assessment Method scoring. Patients were followed for 6 months until recovery/death or liver transplantation. There were 133 cases with DILI. The mean age was 47.6 years, and 51.9% of them were men. Drugs causing DILI were antitubercular drugs (37.5%) followed by neuropsychiatric drugs (16.5%), antibiotics/antifungals (12%), complementary and alternative medicine (10.5%), immunomodulatory/chemotherapeutic drugs (10.5%), and nonsteroidal antiinflammatory drugs (7.5%). Eighty-two (61.6%) patients were classified as hepatocellular, 30 (22.5%) as mixed and 21 (15.7%) as cholestatic type of injury. There was no significant difference in the mortality and morbidity between the three types of liver injury. There were 18 deaths (13.5%), of which antitubercular drugs constituted the majority (55.5%) followed by neuropsychiatric drugs (27.7%) and complementary and alternative medicine (16.6%). Based on receiver operating characteristic curve analysis, model for end-stage liver disease (MELD) score >28, mean international normalized ratio (INR) >1.97, mean bilirubin level >15.6 mg/dl, and creatinine level >1.35 mg/dl were associated with mortality. Although DILI is uncommon, it has significant morbidity and mortality. Antitubercular drugs were the most common cause for DILI and DILI-related mortality in our study. Variables such as MELD, INR, bilirubin, albumin, and creatinine help in predicting severity of liver injury and may help in triaging the patient for referral for liver transplantation.


Cultured fucosidosis fibroblasts: a simple technique demonstrating storage of tritiated-fucose labeled material.
Incorporation of tritiated fucose into the acid-soluble and acid-insoluble fractions of cultured fucosidosis and control fibroblast monolayers was determined over a 10-day period. Fucosidosis cells incorporated significantly more label into the acid-soluble, but not the acid-insoluble fraction, than control cells. The ratio of acid-insoluble radioactivity increased lineraly from 1 to 10 days for the fucosidosis cells, indicating the storage of low molecular weight partial degradation products.


Adnexal masses caused by pelvic inflammatory disease: MR appearance.
To describe the morphologic and signal intensity characteristics of inflammatory adnexal masses in magnetic resonance (MR) images. MR images of 15 patients with a total of 20 confirmed inflammatory adnexal masses were analyzed retrospectively. The findings obtained from MR imaging were as follows: lesions have ill-defined borders; ill-defined areas of high intensity signals surround the masses on T(2)-weighted images; a "rim" at the innermost layer of the cyst wall exhibits high signal intensity on T(1)-weighted images and low intensity on T(2)-weighted images; secondary changes in the surrounding fat plane and bowel loops are extensive; and adhesions are dense. These findings reflect the basic characteristics of the inflammatory process, which are edema caused by increased permeability and highly vascularized granulation tissue caused by the strong tendency to repair. MR imaging findings well reflect the basic pathological process of inflammation, and inflammatory adnexal masses are associated with relatively specific appearances in MR images. MR imaging can be a problem-solving alternative in the diagnosis of inflammatory adnexal masses.


Synthesis and hybridization properties of oligonucleotides modified with 5-(1-aryl-1,2,3-triazol-4-yl)-2'-deoxyuridines.
Oligonucleotides modified with consecutive incorporations of 5-(1-aryl-1,2,3-triazol-4-yl)-2'-deoxyuridine monomers display strong thermal affinity and binding specificity toward RNA targets, due to formation of chromophore arrays in the major groove.


New score for predicting major bleeding in patients with atrial fibrillation using direct oral anticoagulants.
Our aim was to identify factors associated with major bleeding in patients with atrial fibrillation (AF) on direct oral anticoagulants (DOACs) and to construct and externally validate a predictive model that would provide a validated tool for clinical assessment of major bleeding. In the development cohort, prediction model was built by logistic regression, the area under the curve (AUC), and Nomogram. External validation, analytical identification and calibration of the model using AUC, calibration curves and Hosmer-Lemeshow test. The development cohort consisted of 4209 patients from 7 centers and the external validation cohort consisted of 1800 patients from 12 centers. Multifactorial analysis showed that age > 65 years, history of bleeding, anemia, vascular disease, antiplatelet therapy/non-steroidal anti-inflammatory drugs and rivaroxaban were independent risk factors for major bleeding, and gastrointestinal protective agents was a protective factor. The Alfalfa-MB model was constructed using these seven factors (AUC = 0.807), and in the external validation cohort, the model showed good discriminatory power (AUC = 0.743) and good calibration (Hosmer-Lemeshow test P value of 0.205). The predictive power of the six bleeding scores was ORBIT (AUC = 0.706), HAS-BLED (AUC = 0.648), ATRIA (AUC = 0.645), HEMORR2 HAGES (AUC = 0.632), ABC (AUC = 0.619) and Shireman (AUC = 0.599) in descending order. Based on 7 factors, we derived and externally validated a predictive model for major bleeding with DOACs in patients with AF (Alfalfa-MB). The model has good predictive value and may be an effective tool to help reduce the occurrence of major bleeding in patients with DOACs.


Immunoreactivity of bcl-2, p53 and EGFr is associated with tumor stage, grade and cell proliferation in superficial bladder cancer. Finnbladder III Group.
Immunoreactivity of bcl-2, p53, the epidermal growth factor (EGFr) and Ki-67 (MIB-1) proteins was assessed by immunohistochemistry in 185 patients with superficial bladder cancer (SBC) in order to evaluate their usefulness as indicators of tumor progression. Forty-one percent of the tumors were bcl-2 positive, 36% of them were positive for p53 (over 20% of nuclei), while 41% were positive for EGFr, and 30% of the tumors were MIB-1 positive (proliferation index > 15%). Immunoreactivity of all analyzed proteins was highly significantly related to tumor grade and stage. Tumors which were bcl-2, p53 or EGFr positive were also rapidly proliferative (MIB-1 score >15%). The obtained results suggest that all analyzed proteins may have prognostic significance in SBC. The prognostic value of the abnormal immunolabeling of the analyzed proteins will be established after an adequate follow-up period of this same cohort of patients.


Regulation of myotrophin gene by pressure overload and stretch.
Hemodynamic load is a major determinant of cardiac mass and its phenotype, but very little is known about how mechanical load is converted into intracellular signals of gene expression and regulation. We have shown earlier that factors other than blood pressure control play a role in the mechanism involved in the development or regression of myocardial hypertrophy. We have identified a soluble factor, myotrophin, from the hearts of spontaneously hypertensive rats and dilated cardiomyopathic humans, which stimulates protein synthesis both in neonatal and adult rat cardiac myocytes. Myotrophin gene has been mapped and shown to be a novel gene localized in human chromosome 7q-33. The present study was conducted to evaluate the mechanism by which myotrophin is released and in turn initiates myocardial hypertrophy. We used an in vitro model, where neonatal cardiac myocytes were grown on stretchable plates and examined the effect of stretch on myotrophin gene expression (to mimic pressure overload), an in vivo model using beating non-working hearts exposed to high pressure and three different models of hypertensive rats. Our data showed that both cyclic stretch and exposure to high pressure caused significant increase in the transcript levels of myotrophin followed by expression of beta-myosin heavy chain and atrial natriuretic factor associated with an increase in myocardial protein synthesis. All three models of hypertensive rats also showed a significant increase in myotrophin transcripts. Altogether, our data strongly suggest that stretching of the cells by pressure or volume turns on the myotrophin, which in turn is responsible for the initiation process of myocardial hypertrophy in response to pressure or volume overload.


Degradation of poly(butylene adipate-co-terephthalate) by Stenotrophomonas sp. YCJ1 isolated from farmland soil.
In recent years, poly (butylene adipate-co-terephthalate) (PBAT) has been widely used. However, PBAT-degrading bacteria have rarely been reported. PBAT-degrading bacteria were isolated from farmland soil and identified. The effects of growth factors on the degradation of PBAT and the lipase activity of PBAT-degrading bacteria were assessed. The degradation mechanism was analyzed using scanning electron microscopy, attenuated total reflection Fourier transform infrared spectroscopy, proton nuclear magnetic resonance, X-ray diffraction, and liquid chromatography-mass spectrometry. The results showed that Stenotrophomonas sp. YCJ1 had a significant degrading effect on PBAT. Under certain conditions, the strain could secrete 10.53 U/mL of lipase activity and degrade 10.14 wt.% of PBAT films. The strain secreted lipase to catalyze the degradation of the ester bonds in PBAT, resulting in the production of degradation products such as terephthalic acid, 1,4-butanediol, and adipic acid. Furthermore, the degradation products could participate in the metabolism of YCJ1 as carbon sources to facilitate complete degradation of PBAT, indicating that the strain has potential value for the bioremediation of PBAT in the environment.


Prevalence of pus in radiologically diseased sinuses in patients undergoing surgery for chronic rhinosinusitis.
To establish the prevalence of pus in radiologically diseased sinuses in patients undergoing sinus surgery and to correlate this with the bacterial load in the sinuses. A prospective study performed on adult patients with the diagnosis of chronic sinusitis undergoing endoscopic sinus surgery at an Adelaide group of academic hospitals. In 45 consecutive and unselected patients, a radiologically diseased sinus was surgically opened, and a specially designed suction aspirator was placed into the sinus under endoscopic control. These aspirates were Gram stained and cultured to quantify the polymorphonuclear neutrophil count, bacterial flora, and bacterial colony count. The CT scans of all patients were graded by using the Lund-Mackay scoring system. A variety of bacteria, most commonly staphylococci, were cultured from a radiologically diseased sinus in 88% of patients. There was no correlation between the bacterial colony count and presence of pus, and only 11% of patients had microscopic evidence of inflammation in sinus aspirates. There was no correlation between the Lund-Mackay CT score and the presence of pus in the sinus. The majority of patients undergoing surgery for chronic sinusitis did not have a purulent exudate, and there was no correlation with the bacterial load. The usefulness of antibiotics in the treatment of chronic rhinosinusitis, in the absence of macroscopic pus, is questionable.


Characterization of Kemer L4 meteorite using Raman spectroscopy, X-ray diffraction, magnetization measurements and Mössbauer spectroscopy.
The bulk interior of Kemer L4 ordinary chondrite was characterized for the first time by means of optical microscopy, scanning electron microscopy with energy dispersive spectroscopy, Raman spectroscopy, X-ray diffraction, magnetization measurements and Mössbauer spectroscopy with a high velocity resolution. The main and minor iron-bearing phases were found as well as ferrihydrite as a result of weathering. The Fe2+ partitioning among the M1 and M2 sites in olivine, orthopyroxene and clinopyroxene was determined from the X-ray diffraction. The ratios of Fe2+ occupancies for these crystals were estimated from both X-ray diffraction and Mössbauer spectroscopy data and appeared to be in a good agreement. The distribution coefficients KD and the temperatures of equilibrium cation distribution Teq were also evaluated for olivine and orthopyroxene from two independent techniques and were in a good consistence: KD = 1.77, Teq = 441 K (X-ray diffraction) and KD = 1.77, Teq = 439 K (Mössbauer spectroscopy) for olivine and KD = 0.10, Teq = 806 K (X-ray diffraction) and KD = 0.09, Teq = 787 K (Mössbauer spectroscopy) for orthopyroxene. The fusion crust of Kemer L4 was studied using X-ray diffraction, magnetization measurements and Mössbauer spectroscopy. Magnesioferrite and probably maghemite were found in the fusion crust in addition to other phases observed in the bulk interior.


Variable diffusivity homogeneous surface diffusion model and analysis of merits and fallacies of simplified adsorption kinetics equations.
Adsorption and ion exchange phenomena are encountered in several separation processes, which in turn, are of vital importance across various industries. Although the literature on adsorption kinetics modeling is rich, the majority of the models employed are empirical, based on chemical reaction kinetics or oversimplified versions of diffusion models. In this paper, the fifteen most popular simplified adsorption kinetics equations are presented and discussed. A new versatile variable-diffusivity two-phase homogeneous diffusion model is presented and used to evaluate the analytical adsorption models. Aspects of ion exchange kinetics are also addressed.


Modular slowing of resting-state dynamic functional connectivity as a marker of cognitive dysfunction induced by sleep deprivation.
Dynamic Functional Connectivity (dFC) in the resting state (rs) is considered as a correlate of cognitive processing. Describing dFC as a flow across morphing connectivity configurations, our notion of dFC speed quantifies the rate at which FC networks evolve in time. Here we probe the hypothesis that variations of rs dFC speed and cognitive performance are selectively interrelated within specific functional subnetworks. In particular, we focus on Sleep Deprivation (SD) as a reversible model of cognitive dysfunction. We found that whole-brain level (global) dFC speed significantly slows down after 24h of SD. However, the reduction in global dFC speed does not correlate with variations of cognitive performance in individual tasks, which are subtle and highly heterogeneous. On the contrary, we found strong correlations between performance variations in individual tasks -including Rapid Visual Processing (RVP, assessing sustained visual attention)- and dFC speed quantified at the level of functional sub-networks of interest. Providing a compromise between classic static FC (no time) and global dFC (no space), modular dFC speed analyses allow quantifying a different speed of dFC reconfiguration independently for sub-networks overseeing different tasks. Importantly, we found that RVP performance robustly correlates with the modular dFC speed of a characteristic frontoparietal module.


Interleukin-7-enhanced cytotoxic T lymphocyte activity after viral infection in marrow transplanted mice.
Lethally irradiated BALB/c mice were reconstituted by syngeneic bone marrow transplantation (BMT), and injected with recombinant interleukin 7 (rIL-7), recombinant interleukin 2 (rIL-2), or saline 10 days post-transplantation. Intranasal infection with A/PR8/34 influenza virus 2 weeks after BMT was associated with the highest survival rate in the rIL-7 treated group. The protective mechanism elicited by rIL-7, as manifested by very low virus titers in the lung, involves T and B cell functions. High hemagglutinin inhibition antibody levels were observed on days 7 and 12 post-challenge in the rIL-7 mice. Moreover, the anti-influenza cytotoxic T lymphocyte activity was induced primarily by rIL-7, leaving the effect of rIL-2 on the same level as that of the control. Thus, rIL-7 promotes both T cell-mediated function and B cell production during the immunodeficient state after BMT. This cytokine may prove a potential immunotherapeutic modality in BMT recipients.


End of the line? Tramtrack and cell fate determination in Drosophila.
Cell differentiation reflects the balance of two opposing influences, pathways which confer specialized properties on specific cells or groups of cells, and antagonising mechanisms which modulate responsiveness to such differentiative cues. It appears that the zinc finger protein Tramtrack (Ttk) fulfils the latter function in the CNS and PNS of Drosophila. Ttk seems to be able to inhibit neural development by down-regulating competence to respond to neuralising signals. We speculate, however, that restriction of neural competence is merely one example of a more general ability of Ttk to influence differentiation and that, given its widespread expression profile, Ttk might be implicated in a number of differentiative events.


Factors influencing the detection limit of the lateral-flow sandwich immunoassay: a case study with potato virus X.
Key factors influencing the analyte detection limit of the sandwich immunochromatographic assay (ICA), namely, the size of gold nanoparticles, the antibody concentration, the conjugation pH, and characteristics of membranes, are discussed. The impacts of these factors were quantitatively characterized and compared for the first time using the same antigen (potato virus X). The antibody-colloidal gold conjugates synthesized at pH 9.0-9.5 (the pH was examined in the range from 7.5 to 10.0) and at an antibody concentration of 15 μg/mL (the concentration was tested from 10 to 100 μg/mL) demonstrated maximum binding with the analyte. The relationship between the size of gold nanoparticles and the ICA detection limit was determined. The detection limit decreases from 80 to 3 ng/mL (for antibodies with K (D) = 1.0 × 10(-9) M, data were obtained using a BIAcore X instrument) for a series of particles with a diameter from 6.4 to 33.4 nm (electron microscopy and dynamic light scattering data). In the case of larger particles (52 nm in diameter), the detection limit increases and reaches 9 ng/mL. A 10 mM phosphate buffer, pH 8, and a 50 mM phosphate buffer, pH 7, were the conditions of choice for the deposition of reactants. Taking into account these facts, we developed a lateral-flow test system for the rapid (10 min) detection of potato virus X in plant leaves. The ICA provided a visual detection limit of 3 ng/mL. In the case of the instrumental processing, potato virus X can be determined in the concentration range from 3 to 300 ng/mL with a detection limit 2 ng/mL.