Body size overestimation and its association with body mass index, body dissatisfaction, and drive for thinness in anorexia nervosa.
Body size overestimation is a fundamental feature in anorexia nervosa (AN). There have been inconclusive findings about the extent to which this feature distinguishes psychopathology and some authors have argued that overestimation may be a function of lower body mass index (BMI). We examine body size estimation accuracy and body dissatisfaction in 74 females with AN and 11 age-matched female controls using two well-established psychophysical procedures. Participants with AN overestimated their body size more and had greater body dissatisfaction than controls. Size accuracy was found to be independent of BMI and correlated with body dissatisfaction and drive for thinness in participants with AN. We conclude that overestimation of body size in AN is related to the psychopathology associated with the disorder and is not due to any perceptual tendency for people with lower BMI to overestimate their body size. We discuss the implications of these findings for treatment of AN.


A prospective validation of the HEART score for chest pain patients at the emergency department.
The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score. A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks. Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores. Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75)and GRACE (0.70) respectively (p<0.0001). The HEART score provides the clinician with a quick and reliable predictor of outcome, without computer-required calculating. Low HEART scores (0-3), exclude short-term MACE with >98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies.


Fundus autofluorescence in multifocal choroiditis and panuveitis.
To investigate the autofluorescence findings associated with multifocal choroiditis and panuveits (MCP), a condition that has marked potential to affect the retinal pigment epithelium (RPE). Observational case series. This is a retrospective review of consecutive patients with MCP examined in a retinal referral practice. Each patient was given a comprehensive examination including fundus photographs, angiographic studies, and autofluorescence photography with an excitation filter with the bandpass wavelengths of 535 to 585 nm and a barrier filter with a bandpass of 615 to 715 nm. Integrative analysis was performed of the ocular imaging to ascertain abnormalities caused by the disease. Thirty-six eyes of 18 consecutive patients were evaluated. The mean duration of symptoms was 86.2 months and the mean visual acuity was 20/50. Of the 36 eyes, 23 had choroidal neovascularization (CNV). Chorioretinal hypoautofluorescent spots >or= 125 microns usually, but not always, had the clinically evident correlate of a punched-out scar visible by color fundus photography. Chorioretinal hypoautofluorescent spots less than 125 microns, which could number in the hundreds, typically were not visible by color fundus photography. All chorioretinal scars visible by color fundus photography were visible by autofluorescence photography. During follow-up many patients developed new clinically evident chorioretinal scars, which were presaged in earlier autofluorescence photographs. CNV had a hyperautofluorescent boundary, making it readily visible. Patients with MCP have much more widespread involvement of the RPE than would be suspected by other means of imaging. Autofluorescence photography supplies information about inflammatory damage and secondary CNV in a noninvasive manner.


Hepatitis B exposure in emergency medical personnel. Prevalence of serologic markers and need for immunization.
To assess the occupational risk of hepatitis B infection in emergency medical personnel, a seroepidemiologic survey of 87 emergency medical technicians and paramedics was conducted. Serologic markers indicating exposure to hepatitis B virus were detected in 18 percent. The prevalence of markers was associated with race (p = 0.006), with a relative risk of 3.5 (95 percent confidence interval 1.42 to 8.63) for nonwhites. Seropositivity was not associated with age, sex, previous clinical hepatitis, or blood transfusion. There was a suggestion that duration of employment as an emergency medical technician was related to the prevalence of hepatitis B markers (p = 0.11). Efforts to control the risk of hepatitis B infection in this profession are complicated by unique problems with post-exposure prophylaxis and uncontrolled exposure to blood. Immunization with hepatitis B vaccine would be the optimal strategy to reduce infection in this high-risk occupation.


The influence of humanised anatomical pedagogy on psychophysiological responses and academic achievement in nursing students.
Anatomy, a fundamental subject in nursing education, provides students with knowledge of human structure and function. The study was to explore the influence of humanised anatomy educational method on nursing students' psychophysiological responses and academic achievement to human anatomy using cadavers, and to examine the correlations between the students' characteristics (such as gender), psychophysiological responses, and academic achievement in anatomy. A correlational study design was adopted. A total of 80 participants with a 4-year BSN degree were recruited from a nursing school located in eastern Taiwan. Human anatomy teaching using cadavers was delivered. Standardised and researcher-modified questionnaires were used to collect data. Either parametric or nonparametric methods were used for data analysis depending on data distribution. A small proportion of students experienced physical symptoms and stress. Gender difference was observed in death anxiety caused by working with cadavers. All psychophysiological responses of students did not influence their achievement. Further, the students demonstrated that using cadavers had a certain level of engagement with the course, which was positively correlated with academic grades. This study suggests that human anatomy using cadavers is a feasible educational method to broaden students learning experience in class.


The measurement of pulmonic valve area by angiocardiographic and hemodynamic methods.
The validity of angiocardiographic measurements in assessing the severity of pulmonic valve stenosis was determined. The pulmonic valve orifice area was measured in the lateral projection on cineangiocardiographic films in 24 patients with valvar pulmonic stenosis. The valve orifice area was also obtained in the same patients by the Gorlin and Bache formulae. The right ventricular output value required for insertion in these formulae was obtained by angiocardiographic right ventricular volume measurement and by the Fick method. The correlation between the directly measured valve orifice area and the area calculated using the Fick principle and the Bache formula was 0.80. The substitution of angiocardiographically measured right ventricular stroke volume for the Fick value gave a correlation of 0.82. The results support validity of employing direct angiocardiographic measurements of pulmonic valve orifice area and angiocardiographic right ventricular volume measurements for quantitative assessment of the severity of pulmonic valve stenosis. The angiocardiographic methods thus represent an alternative to the Fick technique which can be used in conditions where the Fick method cannot be expected to give valid results.


[Analysis of death causes of gestational trophoblastic neoplasia patients].
To analyze retrospectively the causes of death in gestational trophoblastic neoplasia (GTN) patients. The prognostic risk factors were also discussed. One thousand one hundred and thirty GTN patients were hospitalized and treated at Peking Union Medical College Hospital from 1985 to 2004. Sixty-four of them died later and retrospective analyses were carried out on these patients. Fifty-eight out of the 64 patients died during initial treatment. The other six died from disease relapse and progression of the disease (PD). The major causes of death were multi-organ failure, intracranial haemorrhage, cerebral herniation, side-effects of chemotherapy, and PD after relapse. The result of multivariate analysis indicated the adverse prognostic factors included the interval between antecedent pregnancy and chemotherapy treatment (OR = 2.857, P < 0.01), the titer of beta subunit of human chorionic gonadotropin (beta-hCG, P < 0.05), the diagnosis of choriocarcinoma (OR = 3.635, P < 0.05), clinical stage (P < 0.05), multiple metastases (OR = 2.201, P < 0.01) and drug resistance (OR = 0.181, P < 0.01). A proper evaluation of a GTN patient before initial treatment is important. More attention should be paid to the death-related prognostic risk factors to improve the prognosis of high risk GTN patients.


Ancillary documents for NIH grant applications: The pages beyond the science.
Preparing a grant proposal is no small feat, especially for research (R-series) grants from the National Institutes of Health. The National Institutes of Health is the largest public funder of biomedical research in the world, and as such, procuring a research grant from the National Institutes of Health is one of the ultimate benchmarks of success for a surgeon-scientist. Most investigators are familiar with the page limits for most R-series grants (12 pages for an R01 and 6 pages for an R21), with the addition of a single page allotted for the specific aims. Interestingly, despite the usual focus on the aforementioned research section, the rest of the application can routinely consist of an additional 100 to 150 pages, which means that pages allotted for the specific aims and research strategy represent only 10% of the complete application package. For busy surgeons, it is this abundance of ancillary documentation that can make preparing a research grant particularly onerous. Fortunately, for some, support exists within the department to help prepare much of this documentation by drawing from previous sources, templates, and boilerplate language that has been developed. Although these resources can significantly reduce the burden on individual investigators, there is a danger of leaning on generalized templates that can dilute the message of the overall grant proposal and introduce extraneous or incorrect information that can ultimately impact the cohesiveness and ultimately the competitiveness of the grant. The focus of this article is to educate surgeon-scientists regarding the purpose and importance of the ancillary information required for National Institutes of Health research grants and how to make the most of institutional resources while tailoring these materials to create a cohesive, competitive grant application.


Deep-sea meiofauna assemblages with special reference to marine nematodes in the Caiwei Guyot and a Polymetallic Nodule Field in the Pacific Ocean.
Meiofauna particularly marine nematodes around the Caiwei Guyot in the northwest Pacific Ocean and a Polymetallic Nodule Field in the northeast Pacific Ocean were studied. Due to the geographic structure, the Caiwei Guyot and the Polymetallic Nodule Field had different environmental characteristics. Meiofaunal abundances around the Guyot area ranged from 9.18 to 25.59 ind./10 cm2, which were much lower than those in the Polymetallic Nodule Field. Marine nematode was the most dominant group. A total of 123 species, belonging to 74 genera and 29 families were found. Xyalidae (21.43%), Cyatholaimidae (9.82%), Linhomoeidae (8.03%) were the dominant families. The values of species number, Margalef's species richness and Shannon-Wiener diversity index ranged from 15 to 62, 4.75 to 12.84 and 2.58 to 3.93, respectively. The combination of water depth, silt-clay content and chlorophyll-a concentration can best explain the differences of nematode community. This study provides a baseline for deep-sea meiofauna distribution.


Mangafodipir trisodium-enhanced MRI of hepatocellular carcinoma: correlation with histological characteristics.
To define histopathological factors related to the degree of mangafodipir trisodium (MnDPDP) uptake in hepatocellular carcinomas (HCCs) on magnetic resonance imaging (MRI). In-phase and opposed-phase gradient-echo MRI images were obtained preoperatively in 37 patients with 38 HCCs before and 15-30 min after intravenous injection of MnDPDP. Subjective ratings of the enhancement degree, the signal-to-noise ratio (SNR) of the lesion and the liver, and the contrast enhancement ratios (CER) were compared with histopathological factors. The mean SNR of HCCs increased from 59.6 to 95.0 (CER=59.5%), whereas that of the liver increased from 75.1 to 108.7 (CER=45.2%). Eight HCCs showed mild enhancement, 11 moderate enhancement, and 15 strong enhancement. There was no visually perceptible enhancement in four HCCs (10.3%). The degree of MnDPDP enhancement was significantly related with the cell density ratio (p<.05) and monoclonal hepatocyte antibody positivity (p<0.005), but not with size, growth type, cell type, histological type, cytokeratin 7, or cytokeratin 19. Well-differentiated HCC showed higher MnDPDP enhancement compared with higher grade HCCs, but the differences were not statistically significant. The uptake of MnDPDP by HCC was correlated with hepatocyte antibody expression and the cellular density ratio. Well-differentiated HCC tended to show higher MnDPDP enhancement.


A novel method for quantifying peripheral tissue amyloid load by using the radiolabeled amyloidophilic peptide, p5.
Quantitation of peripheral amyloid deposits by non-invasive molecular imaging can be useful for diagnosis, prognostication and monitoring response to therapy. In order to obtain reliable quantitative data, it is necessary to show a linear positive correlation between the uptake of the molecular probe and the tissue amyloid load. The transgenic H-2/IL-6 mouse model of AA amyloidosis was used to generate animals with varied stages of visceral amyloid disease. The mice were injected with 125I-labeled peptide p5 and tissues analyzed 2 h post-injection using Congo red (CR) staining, radioisotope biodistribution and micro-autoradiography (ARG). Micro-ARG confirmed that 125I-p5 was deposited at all amyloid deposits and sites of Congophilia but not at amyloid-free sites within the tissues evaluated. Furthermore, biodistribution studies revealed that the amount of 125I deposited in liver and spleen correlated with the amount of CR birefringence (expressed as 0-4+ or as tissue area [µm2]) in these tissues with correlation coefficients of r > 0.7 (p < 10(-6)). Deposition of 125I-p5 is a quantitative measure of the amount of AA amyloid in liver and spleen in this mouse model. The p5 peptide has potential as a quantitative amyloid imaging agent in human disease.


Knockdown of IRF6 Attenuates Hydrogen Dioxide-Induced Oxidative Stress via Inhibiting Mitochondrial Dysfunction in HT22 Cells.
Oxidative stress-induced cell damage is involved in many neurological diseases. Interferon regulatory factor 6 (IRF6), a member of the IRF family of transcription factors, is required for the differentiation of skin, breast epithelium, and oral epithelium. However, the regulation and function of IRF6 in central nervous system remain unknown. This study aimed to investigate the role of IRF6 in hydrogen peroxide (H2O2)-induced oxidative neuronal injury in HT22 mouse hippocampal cells. Treatment with H2O2 significantly increased the expression of IRF6 at both mRNA and protein levels, and knockdown of IRF6 using specific small interfering RNA reduced H2O2-induced cytotoxicity, as evidenced by increased cell viability and decreased apoptosis. Knockdown of IRF6 attenuated intracellular reactive oxygen species (ROS) generation and lipid peroxidation, and also preserved endogenous antioxidant enzyme activities. The inhibitory effect of IRF6 knockdown on mitochondrial dysfunction was demonstrated by reduced mitochondrial oxidative level, preserved mitochondrial membrane potential (MMP) and ATP generation, as well as attenuated mitochondrial swelling. In addition, down-regulation of IRF6 inhibited the activation of mitochondrial apoptotic factors, whereas IRF6 knockdown together with caspase inhibitors had no extra effect on cell viability and LDH release. These results suggest that knockdown of IRF6 has protective effects against H2O2-induced oxidative stress by reducing ROS accumulation and apoptosis, and these protective effects are dependent on preservation of mitochondrial function.


Mechanism of Antidepressant Action of (2R,6R)-6-Hydroxynorketamine (HNK) and Its Compounds: Insights from Proteomic Analysis.
The effects of HNK, I5, and I6 on the expression of protein in hippocampus of depressed mice were studied by isobaric tags for relative and absolute quantitation (iTRAQ) to explore the mechanism of their antidepressant action. HNK, I5, and I6 were administered intragastric administration once a day in the morning for 7 days. The drug was subsequently discontinued for 7 days (without any treatment). On the 15th day, mice in each group were given the drug (1.0, 10.0, 30.0 mg/kg) intragastric stimulation and mouse hippocampal tissues were taken to perform iTRAQ to identify differentially expressed proteins, and bioinformatics was used to analyze the functional enrichment of the differentially expressed proteins. Compared with Ctr group, the number of differentially expressed proteins in HNK, I5, and I6 treatment groups was 158, 88, and 105, respectively. The three groups shared 29 differentially expressed proteins. In addition, compared with HNK group, the number of differentially expressed proteins in I5 and I6 groups was 201 and 203, respectively. A total of 47 and 56 differentially expressed proteins were co-expressed in I5 and I6 groups. Bioinformatics analysis showed that these differentially expressed proteins mainly had the functions of binding, biocatalysis, and transport, and mainly participated in cellular process, biological regulation process, biological metabolism process, and stress reaction process. GO and KEGG pathway analysis found that these differentially expressed proteins were involved long-term potentiation, G13 pathway, platelet activation pathway, and MAPK signaling pathway. HNK, I5, and I6 antidepressants are closely related to sudden stress sensitivity, stress resistance, neurotransmitter, and metabolic pathways. This study provides a scientific basis to further elucidate the mechanism and clinical application of HNK, I5, and I6 antidepressants.


[Differentiated methods of treating atherosclerotic patients at the Kislovodsk health resort at early periods after transient cerebral circulatory disorders].
A dynamic examination of 135 patients with transient disorders of cerebral circulation (TDCC) was conducted in conditions of a sanatorium-resort treatment in Kislovodsk in early stages following the last attack (from 2-3 months). The method of a phasic examination and treatment was accomplished according to the following principle: polyclinic -- hospital -- resort -- polyclinic. Apart from the clinical dynamic examinations such methods as EEG, REG studies of blood coagulation and basic metabolism, and if necessary angio- and dopplerosonography were used. During their stay at the resort diadynamic currents werer used according to the method of a weak effect on the projection of spinal arteries, sinusoidal modulated currents on the cervical sympathetic nodes and plexus, carbon dioxide Narzan baths, and terrain cure. A significant improvement was seen in 10, improvement in 115, insignificant improvement in 9 patients. One patient showed no changes.


Unconditioned and conditioned anxiogenic effects of the cannabinoid receptor agonist CP 55,940 in the social interaction test.
In spite of the addictive properties of cannabinoids, under certain circumstances, they can evoke strong anxiogenic and aversive responses in humans and in animal tests of anxiety. Effects of different doses of CP 55,940 (10, 20, and 40 microg/kg) were tested in the low-light, familiar (LF) apparatus test condition of the social interaction test. The 40-microg/kg dose of CP 55,940 significantly decreased the time spent in social interaction, indicating an anxiogenic effect. This dose also had an independent effect of reducing locomotor activity. In rats tested undrugged 24 h after testing with 40 microg/kg, there was a significant anxiogenic effect, indicating conditioned anxiety. The group of rats injected with 40 microg/kg immediately after the social interaction test showed an unexpected significant anxiolytic effect when tested undrugged 24 h later. In an additional experiment, rats were tested in the high-light, familiar (HF) apparatus test condition after 10 or 40 microg/kg, and only those that were tested after 40 microg/kg showed an anxiogenic effect on the test day and a conditioned anxiogenic effect when tested undrugged 24 h later. Once again, those injected with 40 microg/kg after the social interaction test displayed an anxiolytic effect when tested undrugged 24 h later. We provide the first evidence for unconditioned and conditioned anxiogenic-like responses to a cannabinoid agonist in the social interaction test.


Health risk assessment and growth characteristics of wheat and maize crops irrigated with contaminated wastewater.
The present study evaluated the effect of untreated wastewater irrigation and its health risks in Triticum aestivum (wheat) and Zea mays (maize) cultivated at south Cairo, Egypt. Morphological measurements (stem and root lengths, number of leaves per plant, and dry weights of main organs) as well as soil, irrigation water, and plant analyses for nutrients and heavy metals were conducted in polluted and unpolluted sites. Wastewater irrigations leads to reduction in the morphological traits of the plants and reduced its vegetative biomass and yield production, with more negative impacts on maize than wheat. The concentrations of Pb, Cd, Cr, and Fe in roots and leaves of wheat were above the phytotoxic limits. Conversely, Pb, Cd, and Fe were significantly high and at phytotoxic concentrations in the leaves of maize at polluted site. The present study indicated that wheat plants tend to phytostabilize heavy metals in their roots, while maize accumulates it more in their leaves. Maize and wheat had toxic concentrations of Pb and Cd in their grains under wastewater irrigation. The health risk index showed values > 1 for Pb and Cd in polluted site for both crops, in addition to maize in unpolluted site. Consequently, this will have greatest potential to pose health risk to the consumers.


Microfluidic aqueous two phase system for leukocyte concentration from whole blood.
Leukocytes from a whole blood sample were concentrated using a microfluidic aqueous two phase system (microATPS). Whole blood was simultaneously exposed to polyethylene glycol (PEG) and dextran (Dex) phase streams and cells were partitioned based on their differential affinity for the streams. The laminar flow characteristic of microfluidic devices was used to create zero, one, and two stable interfaces between the polymer streams. Three different patterns of three polymer streams each were evaluated for their effectiveness in concentrating leukocytes: immiscible PEG-PEG-Dex, immiscible Dex-PEG-Dex, and miscible PEG-PBS-Dex. The most effective configuration was the Dex-PEG-Dex stream pattern which on average increased the ratio of leukocytes to erythrocytes by a factor of 9.13 over unconcentrated blood.


Blistering dactylitis caused by group B streptococci.
A 6-month-old girl had blisters on her volar index finger and palm. Bacterial culture grew group B streptococci. Group B streptococci (in addition to group A streptococci) can be a cause of blistering dactylitis.


The synthesis of estriol 16- and 17-monoglucuronide from estriol.
An efficient and convenient procedure for the synthesis of estriol 16- and 17-monoglucuronides from estriol is described. This is achieved by the selective protection and deprotection of the hydroxy groups in estriol, Koenigs-Knorr reactions with methyl 1-bromo-1-deoxy-2,3,4-tri-O-acetyl-alpha-D-glucopyranuronate and subsequent hydrolysis. The products have been characterized by proton nuclear magnetic resonance (1H NMR), two-dimensional 1H homonuclear shift-correlated spectra (2D-COSY) and mass spectra. The selective Koenigs-Knorr reaction of the alcoholic hydroxyl group in the presence of a phenolic hydroxyl group is also reported.


Food systems microbiome-related educational needs.
Within the European-funded Coordination and Support Action MicrobiomeSupport (https://www.microbiomesupport.eu/), the Workshop 'Education in Food Systems Microbiome Related Sciences: Needs for Universities, Industry and Public Health Systems' brought together over 70 researchers, public health and industry partners from all over the world to work on elaborating microbiome-related educational needs in food systems. This publication provides a summary of discussions held during and after the workshop and the resulting recommendations.


Synaptic strength and horseradish peroxidase uptake in crayfish nerve terminals.
Uptake of horseradish peroxidase was studied by examining percentages of labelled synaptic vesicles in nerve endings of the excitatory axon innervating the opener muscle of the walking leg in the crayfish (Procambarus clarkii). Terminals on fibres with large excitatory postsynaptic potentials (EPSP) had higher percentage of labelled vesicles than terminals of fibres with small EJPs. The extent of labelling in the synaptic vesicle pool was greater for terminals with higher transmitter output. Evidence for three possible routes of synaptic vesicle formation was found. Movement of vesicles within the terminal as a whole appeared to be constrained, but rapid movement of vesicles within local populations probably occurs.


Strategy and tactic of modern Parkinson therapy.
The aim of modern Parkinson therapy is to overcome the dopamine deficit in the brain of parkinsonian patients which is the cause of their motor disability. This can be achieved in two ways: (a) substitution of the lacking dopamine by l-dopa, or (b) stimulation of the endogenous biosynthesis by activating the enzyme tyrosine hydroxylase. The latter approach is possible by the iron compound oxyferriscorbone or by the coenzyme nicotinamide adenine dinucleotide (NADH). In addition to these two major medications the essential therapeutic additives such as the decarboxylase inhibitor benserazide, the monoamineoxidase B inhibitor deprenyl and the dopamine receptor agonist lisuride should be used for the fine adjustment of the individual patient.


Effects of exposure to six chemical ultraviolet filters commonly used in personal care products on motility of MCF-7 and MDA-MB-231 human breast cancer cells in vitro.
Benzophenone (BP)-1, BP-2, BP-3, octylmethoxycinnamate (OMC), 4-methylbenzilidenecamphor and homosalate are added to personal care products to absorb ultraviolet light. Their presence in human milk and their oestrogenic activity suggests a potential to influence breast cancer development. As metastatic tumour spread is the main cause of breast cancer mortality, we have investigated the effects of these compounds on migration and invasion of human breast cancer cell lines. Increased motility of oestrogen-responsive MCF-7 human breast cancer cells was observed after long-term exposure (>20 weeks) to each of the six compounds at ≥10-7 m concentrations using three independent assay systems (scratch assay, live cell imaging, xCELLigence technology) and increased invasive activity was observed through matrigel using the xCELLigence system. Increased motility of oestrogen-unresponsive MDA-MB-231 human breast cancer cells was observed after 15 weeks of exposure to each of the six compounds by live cell imaging and xCELLigence technology, implying the increased migratory activity was not confined to oestrogen-responsive cells. Molecular mechanisms varied between compounds and cell lines. Using MCF-7 cells, reduction in E-cadherin was observed following 24 weeks' exposure to 10-5 m BP-1 and 10-5 m homosalate, and reduction in β-catenin was noted following 24 weeks' exposure to 10-5 m OMC. Using MDA-MB-231 cells, increased levels of matrix metalloproteinase 2 were observed after 15 weeks exposure to 10-7 m OMC and 10-7 m 4-methylbenzilidenecamphor. Although molecular mechanisms differ, these results demonstrate that exposure to any of these six compounds can increase migration and invasion of human breast cancer cells.


Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success.
During the past decade, bariatric surgery has become an increasingly popular treatment option for the growing number of individuals with extreme obesity. For most individuals, the size and durability of the weight loss and improvements in co-morbidity and mortality have far surpassed those typically seen with behavioral modification and pharmacotherapy. A significant minority of patients, however, will experience suboptimal outcomes, including less than expected weight loss, premature weight regain, and frequent vomiting and/or gastric dumping. The reasons for these outcomes are not well understood, but likely involve both behavioral and physiologic processes. The present review highlights current knowledge on the changes in dietary intake and eating behavior that occur after bariatric surgery in terms of the potential threats these changes might pose to long-term postoperative success. The paper also identifies several strategies from the nonsurgical weight loss literature that might help optimize long-term weight maintenance after surgery.


The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience.
Healthcare organizations are expanding community-based serious illness care programs to deliver care for homebound patients. Programs typically focus on home-based primary care or home-based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program. Our objective was to determine the impact of the REACH program on healthcare utilization and the patient care experience. Case study using medical record review and telephone interviews. Home-based serious illness care program in central North Carolina. Patients enrolled in the REACH program from August 2014 to March 2016 (n = 159). Home-based primary and palliative care delivered by an interdisciplinary team for seriously ill older adults. Structured medical record review including demographics, health and functional status, and acute hospitalization and emergency department (ED) visits in the 12 months preceding and following initiation of the REACH program. A convenience sample of participants completed telephone interviews that measured the quality-of-care experience and quality of communication. REACH patients had a 43% reduction in hospital visits and a 25% reduction in ED visits. Participants in telephone interviews reported a high-quality care experience and very good quality of communication with REACH providers. A care model that integrates home-based primary care and palliative care has the potential to reduce health service utilization and enhance the care experience for older patients with serious illness. J Am Geriatr Soc 67:825-830, 2019.


PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes.
A reference library of types of Clostridium difficile has been constructed by PCR ribotyping isolates (n = 2,030) from environmental (n = 89), hospital (n = 1,386), community practitioner (n = 395), veterinary (n = 27), and reference (n = 133) sources. The library consists of 116 distinct types identified on the basis of differences in profiles generated with PCR primers designed to amplify the 16S-23S rRNA gene intergenic spacer region. Isolates from 55% of infections in hospitals in the United Kingdom belonged to one ribotype (type 1), but this type was responsible for only 7. 5% of community infections.


The Number Needed to Vaccinate (NNV) against herpes zoster: a systematic review with meta-analysis.
The number needed to vaccinate (NNV) quantifies the effectiveness of vaccination programs. We summarised the published data on NNV against herpes zoster to inform vaccination policies. We systematically identified studies based on a priori established and registered methods. The main outcomes were the NNV against herpes zoster infection, hospitalisation and mortality. Where appropriate, we conducted meta-analyses using inverse variance, random-effects models, pooling estimated NNV with associated 95% confidence interval (CI). Statistical heterogeneity between pooled estimates was calculated using the I2 statistic. Out of 229 unique citations, we included eight nonrandomized studies. Among 50+ year-olds, the NNV against herpes zoster infection using the recombinant subunit vaccine was 11 (95%CI 8-14; I2 = 0%; 3 studies) and variable (I2 = 94.4%; 7 studies) using live attenuated vaccine, ranging from 10 (95%CI 1-19) to 58 (95%CI 49-67). Among 65+ year-olds, the NNV against herpes zoster infection using the recombinant subunit vaccine was 12 (95%CI: 9-15; I2 = 0%; 2 studies) and variable (I2 = 98.5%; 4 studies) using live attenuated vaccine, ranging from 14 (95%CI 5-23) to 75 (95%CI 66-84). The NNV against herpes zoster hospitalisation among 65+ year-olds using the live attenuated vaccine was 280 (95%CI 209-352; I2 = 0%; 2 studies). There was a paucity of data to inform other meta-analyses. Evidence on the NNV against herpes zoster is scarce. Vaccination with the recombinant subunit herpes zoster vaccine may be more effective than with the live attenuated vaccine in preventing infection among 50+ year-olds. More studies are needed for a stronger evidence base for decision-making.


Separation of bovine pigmented ciliary epithelial cells by density gradient and further characterization in culture.
Dissociated pigmented epithelial (PE) cells from ciliary processes (CP) of bovine eyes were separated by isopycnic centrifugation in metrizamide gradients and further cultivated. The level of cellular contamination during separation of PE by non-pigmented epithelial (NPE) cells was estimated to be 5-10% and by non-epithelial cells (i.e. endothelial, fibroblasts and blood cells) less than 1%. Bovine PE cells were found to have different serum requirements than NPE to grow in vitro. PE cells were actively stimulated to proliferate in the presence of fetal calf serum for a few generations. Short-term culture of NPE was only obtained in media containing a low concentration of L-tyrosine and no serum. Two morphological markers, namely desmosomes and intermediate-sized filaments (IF) of the vimentin type, were found by immunolabeling to be coexpressed in cultured PE and were used as criteria to define the epithelial identity of these cells. The present study was unable to detect any tyrosinase activity in cultured PE cells.


Bone marrow derived mesenchymal stem cells from chronic myeloid leukemia t(9;22) patients are devoid of Philadelphia chromosome and support cord blood stem cell expansion.
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of hematopoietic stem cells. It is characterized at cytogenetic level by the Philadelphia (Ph) chromosome and at the molecular level by the BCR/ABL gene rearrangement. Bone marrow derived mesenchymal stem cells (MSCs) are also pluripotent stem cells that can differentiate into several mesenchymal tissues. To date, no study has been performed to characterize whether MSCs from CML harbor the abnormal Ph chromosome similar to CML bone marrow cells. We isolated and characterized MSCs from diagnostic marrow samples (n=11) and showed that MSCs can be readily isolated from CML marrow and exhibit major expansion potential as well as intact osteogenic differentiation ability. Moreover, they do not harbor the Ph chromosome confirmed by fluorescence in situ hybridization (FISH) and reverse transcriptase polymerase chain reaction (RT-PCR). Thus, we demonstrated that CML marrow is an abundant source of MSCs appearing through both FISH and RT-PCR not to be involved by the malignant process of CML. Furthermore, these MSCs from a CML patient could support in vitro cord blood expansion as those MSCs from a normal donor. Since MSCs are able to support engraftment of hematopoietic stem cells in stem cell transplantation (SCT) as well as suppress alloreactive T cells causing graft-versus-host disease, this current report thus provides evidence that in a SCT setting of CML patients, autologous MSCs could be a source of stem cell support in future cell therapy applications.


Survival outcomes of patients treated with local therapy for nonmetastatic prostate cancer with high prostate-specific antigen concentrations.
Patients with nonmetastatic prostate cancer (nmPCa) and high prostate-specific antigen (PSA) levels due to the high likelihood of metastasis pose a clinical dilemma regarding their optimal treatment and long-term outcomes after initial local therapy. We aimed to evaluate the oncologic outcomes of patients treated with radical prostatectomy (RP) or radiotherapy (RT) for nmPCa with high PSA levels. We queried the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with nmPCa who received RP or RT from 2004 through 2015. We included nmPCa patients with high PSA levels categorized as ≥50 and ≥98 ng/mL, the highest level recorded in SEER. We used the Kaplan-Meier method and Cox proportional hazards to analyze cancer-specific (CSS) and overall survival (OS). We included 6177 patients with nmPCa and PSA ≥ 50 ng/mL at diagnosis; 1698 (27%) had PSA ≥ 98 ng/mL. Of these, 1658 (26.8%) underwent RP and 4519 (73.16%) patients received primary RT. Within a median of 113 months (interquartile range 74-150 months), the 5- and 10-year CSS estimates were 92.3% and 81.5% respectively; 10-year OS was 61%. In the PSA ≥ 98 ng/mL subgroup 5- and 10-year CSS estimates were 89.2% and 76%, respectively. In multivariable analyses for CSS, ISUP grade group (p < 0.001), N stage (p < 0.001), treatment with RP (hazard ratio [HR] = 0.60, 95% confidence interval [CI] 0.43-0.83, p < 0.001), and patient's age (p < 0.05) were associated with improved CSS. In the whole cohort of patients with PSA ≥ 50 ng/mL and RP subgroup, PSA failed to retain its independent prognostic value for CSS. Patients treated with local therapy for nmPCa with very high PSA at diagnosis have relatively good long-term oncological outcomes. Therefore, among well-selected patients with nmPCa, high PSA levels alone should not preclude the use of radical local therapy. Potential selection bias limits inferences about the relative effectiveness of specific local therapies in this setting.


A commentary on interpreting the United States preventive services task force autism screening recommendation statement.
In 2016, the US Preventive Services Task Force concluded that there was "insufficient" ("I" statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the "I" statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.


Identification of unknown disinfection byproducts in drinking water produced from Taihu Lake source water.
Although disinfection byproducts (DBPs) in drinking water have been suggested as a cancer causing factor, the causative compounds have not yet been clarified. In this study, we used liquid chromatography quadrupole-time-of-flight spectrometry (LC-QTOF MS) to identify the unknown disinfection byproducts (DBPs) in drinking water produced from Taihu Lake source water, which is known as a convergence point for the anthropogenic pollutants discharged from intensive industrial activities in the surrounding regions. In total, 91 formulas of DBPs were discovered through LC-QTOF MS nontarget screen, 81 of which have not yet been reported. Among the 91 molecules, 56 only contain bromine, 15 only contain chlorine and 20 DBPs have both bromine and chlorine atoms. Finally, five DBPs including 2,4,6-tribromophenol, 2,6-dibromo-4-chlorophenol, 2,6-dichloro-4-bromophenol, 4-bromo-2,6-di-tert-butylphenol and 3,6-dibromocarbazole were confirmed using standards. The former three compounds mainly formed in the predisinfection step (maximum concentration, 0.2-2.6 µg/L), while the latter two formed in the disinfection step (maximum concentration, 18.2-33.6 ng/L). In addition, 19 possible precursors of the discovered DBPs were detected, with the aromatic compounds being a major group. 2,6-di-tert-butylphenol as the precursor of 4-bromo-2,6-di-tert-butylphenol was confirmed with standard, with a concentration of 20.3 µg/L in raw water. The results of this study show that brominated DBPs which are possibly formed from industrial pollutants are relevant DBP species in drinking water produced form Taihu source water, suggesting protection of Taihu Lake source water is important to control the DBP risks.


Nerve gliding exercises for thoracic outlet syndrome.
Nerve gliding exercises (NGE) are an important part of the treatment of thoracic outlet syndrome (TOS), whether conservative or surgical. They also can be useful for other peripheral nerve problems.


[Correlation of the relative population count of ixodid ticks with various recording methods].
Data are given on the relative abundance ratio of 3 species of ixodid ticks obtained by different counting methods.


Occult carbon monoxide poisoning: a cause of winter headache.
Headache is an early symptom of carbon monoxide (CO) poisoning, occurring at carboxyhemoglobin (COHb) levels of greater than 10%. We investigated 37 patients presenting to an emergency department during the winter-heating season with a complaint of headache for evidence of CO exposure. Seven of the 37 patients (18.9%) had COHb levels in excess of 10%, with a mean of 14.0%. Three of these seven patients (42.9%) used gas space heaters or kitchen stoves to heat their homes, and three (42.9%) had cohabitants at home with headache. Of the 30 patients with COHb levels of less than 10% (mean level, 3.2%), only four (13.3%) used gas space heaters and kitchen stoves for heat (P = NS), and none (0%) had cohabitants with headache (P = .0045). In six of the seven patients with elevated COHb levels (85.7%), gas company investigation or historical information obtained retrospectively revealed a definite or probably toxic CO exposure. In none of these patients had the diagnosis of CO poisoning been suspected by the emergency department physician or the patient prior to obtaining the result of the COHb level. Occult CO poisoning may be an important cause of winter headache.


Does an increase in irradiance influence periphyton in a heavily-grazed woodland stream?
Irradiance level and grazer density were manipulated in a factorial design to examine the relative effects of biotic and abiotic factors on periphyton biomass, productivity, and taxonomic structure in a heavily grazed, woodland stream. Irradiance levels were increased from 0.26 to 12.42 mol quanta/m2/d by placing metal halide lamps over the stream. The major grazer in this system was the prosobranch snail Elimia clavaeformis. Its densities were reduced from ca. 750 individuals/m2 to near zero by raising platforms off the stream bottom. Experimental treatments were maintained for 48 days. Biomass-specific carbon fixation rates increased significantly in response to higher light levels, indicating that periphyton communities were light-limited at this time of year. However, positive effects of irradiance on areal-specific carbon fixation and biomass were detected only when grazer density was reduced. Basal cells of the chlorophyte Stigeoclonium dominated communities exposed either to low light or high grazing pressure. When light was increased and grazer density reduced, large or upright diatoms became more abundant. Results from this study indicated that limitation of periphyton photosynthesis could be mitigated by increasing the levels of an abiotic resource (light) to this system, but that periphyton biomass was controlled by biotic interactions.


A bibliometric and visual analysis of obesity and polycystic ovary syndrome from 2012 to 2022.
Obesity is associated with polycystic ovary syndrome (PCOS). We aimed to elucidate the research status and explore research trends and future directions of research on obesity and PCOS. A bibliometric analysis of the published papers in the field of obesity and PCOS between 2012 and 2022 was conducted on the basis of the Web of Science Core Collection database. The collaboration networks, research trends, literature sources, citation analysis, co-citation analysis, and keywords analysis were statistically analyzed and visualized using the VOSviewer software. We retrieved 2843 records from 681 journals by 12307 authors from 2942 institutes in 99 countries. The number of published papers and citations had a roughly increasing trend annually. The United States and China contributed the majority of the records. Monash University, Shanghai Jiaotong University, Aristotle University of Thessaloniki, Karolinska Institute, University of São Paulo, and Tehran University of Medical Sciences were the biggest nodes in their cluster of the collaboration network map, and Moran LJ, Teede HJ, Joham AE, Escobar-Morreale HF, and Macut D were prolific authors. Research trends and hotspots were identified and visualized in the field of obesity and PCOS. Research hotspots in this field focused on insulin resistance (IR), metabolic syndrome, metformin, and inflammation. Bariatric surgery, mitochondrial dysfunction, binding globulins, and comorbidities may be the frontiers of future research. We concluded the research status and trends in the field of obesity and PCOS. A better understanding of collaboration patterns, research hotspots, and frontiers may be useful for researchers.


Postexercise VO2 "Hump" phenomenon as an indicator for inducible myocardial ischemia in patients with acute anterior myocardial infarction.
At exercise testing with respiratory gas analysis in patients with inducible myocardial ischemia, we have occasionally observed abnormal transient oxygen uptake (VO2) components with a characteristic "Hump"-shaped morphology early after exercise, which may serve as an index for inducible ischemia. We examined this hypothesis in patients with anterior q-wave myocardial infarction in whom the accuracy to identify ischemia by exercise ECG is limited. From patients with acute anterior q-wave infarction but without clinically overt heart failure who underwent pre-discharge exercise testing, we examined patients with (Group-I, n = 30) and without (Group-N, n = 29) inducible ischemia. To identify "Hump", postexercise VO2 (up to 4 min) standardized for peak VO2 was exponentially fitted with use of peak VO2 and VO2 of 90-240 s, yielding "expected VO2". "D-curve" was obtained by subtracting "expected VO2" from measured VO2. Although exercise-induced ST depressions more frequently appeared in Group-I (27%) than in Group-N (3%, p < 0.05), the prevalence was low. D-curve peaked later (p < 0.01) and its value was greater (p < 0.05) in Group-I than in Group-N. When "Hump" was defined to be present if D-curve peaked > or =40 s and its peak value > or =15%, it was far more frequently found in Group-I (n = 17/30) than in Group-N (n = 1/29, p < 0.01). Thus, "Hump" could diagnose inducible ischemia with a sensitivity of 57% and a specificity of 97%. Although not highly sensitive, postexercise VO2 "Hump" with its peak occurring around 60 s after exercise is a specific marker for inducible ischemia. The identification may be useful, particularly in patients with limited accuracy of exercise ECG such as those with q-wave anterior infarction.


Rotavirus infection induces G1 to S phase transition in MA104 cells via Ca⁺²/Calmodulin pathway.
Viruses, obligate cellular parasites rely on host cellular functions and target the host cell cycle for their own benefit. In this study, effect of rotavirus infection on cell cycle machinery was explored. We found that rotavirus (RV) infection in MA104 cells induces the expression of cyclins and cyclin dependent kinases and down-regulates expression of CDK inhibitors, resulting in G1 to S phase transition. The rotavirus induced S phase accumulation was found to be concurrent with induction in expression of calmodulin and activation of CaMKI which is reported as inducer of G1-S phase transition. This cell cycle manipulation was found to be Ca(+2)/Calmodulin pathway dependent. The physiological relevance of G1 to S phase transition was established when viral gene expressions as well as viral titers were found to be increased in S phase synchronized cells and decreased in G0/G1 phase synchronized cells compared to unsynchronized cells during rotavirus infection.


Coagulation factors in renal adenocarcinoma.
Coagulation factors, including plasma fibrinogen, serum fibrinogen-fibrin degradation products, platelet counts and prothrombin times, were studied in patients with renal adenocarcinoma. Plasma fibrinogen levels were elevated and correlated with tumor stage, disease activity and therapy. Fibrinogen-fibrin degradation product levels also were elevated, although such elevations did not correlate with other parameters. Platelet count and prothrombin times were normal. Fibrinogen may be a valuable marker of disease activity in patients with renal carcinoma. In addition, since significant intratumoral fibrin deposits have been demonstrated anticoagulants or fibrinolytic agents may enhance cytotoxic therapy and should be considered in adjunctive chemotherapeutic protocols.


WITHDRAWN: Levels of Vitamin D Are Low Before or After Crohn's disease Is Established?
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.


Identification of phospholipase D (PLD) activity in mouse peritoneal macrophages.
It is now believed that PLD may contribute to the sustained generation of diacylglycerol (DAG) within activated cells. DAG can be formed from phosphatidylcholine by the sequential actions of PLD and phosphatidic acid phosphohydrolase. Phorbal myristate acetate (PMA, 1 microM), A23187 (10 microM) or platelet-activating factor (PAF, 100 nM) caused significant enhancement of intracellular 14C-phosphatidic acid levels 2-5 min after the addition of stimulus, in cultures of peritoneal macrophages pre-labelled with 14C-palmitate. Bacterial lipopolysaccharide (LPS) (5 micrograms/ml) or zymosan (375 micrograms/ml) also stimulated the production of 14C-phosphatidic acid, but over a longer time course (15-60 min). In the presence of 1% ethanol each stimulus caused significant production of 4C-phosphatidylethanol at the expense of 14C-phosphatidic acid, thus confirming a contribution of PLD in these reactions. This is the first report of PLD activity in this cell type.


Cannabis use is associated with monocyte activation (sCD163) in patients admitted for alcohol use disorder treatment.
The effect of concomitant cocaine and cannabis use on monocyte activation and inflammation in patients with alcohol use disorder (AUD) is unknown. To analyze the impact of cocaine and cannabis use on levels of markers of monocyte activation (sCD163 and sCD14) and systemic inflammation (interleukin-6 [IL-6]) in AUD patients admitted for hospital treatment between 2013 and 2018. Clinical and laboratory parameters were obtained upon admission. IL-6, sCD163, and sCD14 were measured in frozen plasma samples. We performed logistic regression to detect associations between cocaine and cannabis use and markers of monocyte activation and inflammation in the highest quartile. A total of 289 patients (77.5 % male) were included (median age = 50 years). The median alcohol intake upon admission was 142 g/day. The median duration of AUD was 20 years. Of the 289 patients with AUD, 76 % were active smokers, 23.1 % and 22.1 % concomitantly used cocaine and cannabis, respectively The median levels of IL-6, sCD163, and sCD14 were 4.37 pg/mL, 759 ng/mL, and 1.68 × 106 pg/mL, respectively. We did not detect associations between cocaine use and inflammation or monocyte activation. Cannabis use was associated with a higher odds of having sCD163 levels in the highest quartile (adjusted odds ratio = 2.34, 95 % confidence interval = 1.07-5.15, p = 0.03). Cannabis use was not associated with inflammation. In this series of AUD patients the concomitant use of cannabis use was associated with sCD163 levels that were in the highest quartile, consistent with monocyte activation.


Medical students' perception and academic performance after team-based and seminar-based learning in human anatomy.
Student-centered educational strategies like problem-based learning (PBL), case-based learning (CBL), team-based learning (TBL), and seminars enhance group and self-learning. This study was carried out to evaluate students' achievements in anatomy topics delivered through TBL sessions and seminars and to survey student preferences regarding these two modalities in anatomy learning. TBL was conducted through individual readiness assurance tests (IRATs), group readiness assurance tests (GRATs), mini-lectures, and application exercises. Seminars included pretests, peer lecturing, and posttests. The performance of 117 students in three TBL sessions and three seminars was compared after standardizing the questions. The students were second-year (42), third-year (40), and fourth-year (35) students at the College of Medicine, University of Bisha, KSA, during the 2019/2020 academic year. A gradual increase in the means of TBL grades was noticed among second-, third-, and four-year students (means ± SD: 68.6 ± 9.56, 82.8 ± 12.25, and 92.7 ± 4.70, respectively), but their seminar grades were nearly stationary (means ± SD: 80.0 ± 9.66, 85.11 ± 10.16, and 85.9 ± 8.80, respectively). Cohen's d-test to check the strength of the relationship between the two activities showed 1.03, 0.16, and 0.74 in the same order. We statistically analyzed perception and preference questionnaire results received from 39, 35, and 28 second-, third-, and four-year students, respectively. The majority of the students selected TBL as their preferred learning modality. However, their acceptance of the seminars was very poor. It can be concluded that TBL is more beneficial to the students, even in practical sciences like anatomy, most likely because group peer teaching enhances the sense of collegial competition, as opposed to the self-learning nature of seminars, which might suppress the sense of competition.


Reducing Length of Labor and Cesarean Surgery Rate Using a Peanut Ball for Women Laboring With an Epidural.
One strategy for reducing the primary cesarean surgery rate and length of labor is using a peanut-shaped exercise ball for women laboring under epidural analgesia. A randomized, controlled study was conducted to determine whether use of a "peanut ball" decreased length of labor and increased the rate of vaginal birth. Women who used the peanut ball (n = 107) versus those who did not (n = 91) demonstrated shorter first stage labor by 29 min (p = .053) and second stage labor by 11 min (p < .001). The intervention was associated with a significantly lower incidence of cesarean surgery (OR = 0.41, p = .04). The peanut ball is potentially a successful nursing intervention to help progress labor and support vaginal birth for women laboring under epidural analgesia.


Symmetric bilateral implantation of a distance-dominant diffractive bifocal intraocular lens.
To assess visual results after symmetrical bilateral implantation of a distance-dominant bifocal diffractive intraocular lens (IOL). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Fifty patients had bilateral implantation of a distance-dominant diffractive bifocal 447D IOL (Acri.Tec GmbH) in a prospective study. Monocular and binocular best corrected distance visual acuities and best distance-corrected near visual acuity, binocular best distance-corrected intermediate visual acuity, and distance contrast sensitivity under photopic (85 cd/m(2)) and mesopic (5 cd/m(2)) conditions were determined. At the 6-month postoperative visit, the mean binocular best corrected distance acuity and best corrected distance near acuity were 0.02 +/- 0.04 logMAR and 0.04 +/- 0.03 logMAR, respectively. Binocular best corrected distance intermediate visual acuity worsened significantly as a function of the distance of the test: from 0.04 +/- 0.03 logMAR at 33 cm to 0.21 +/- 0.08 logMAR at 70 cm (P<.01). Contrast sensitivity was within normal limits under photopic and mesopic conditions. Binocular contrast sensitivity was statistically significantly better than monocular contrast sensitivity at all spatial frequencies under both illumination levels (P<.01). Bilateral implantation of the distance-dominant bifocal 447D IOL provided good simultaneous distance, near, and intermediate vision with improved contrast sensitivity under photopic and mesopic conditions.


Carbonization and H3PO4 activation of fern Dicranopteris linearis and electrochemical properties for electric double layer capacitor electrode.
Today, the world's climate change is a growing problem, plant carbon sequestration is one of the effective ways to mitigate climate change by reducing greenhouse gases, mostly carbon gases. Dicranopteris linearis (D. linearis), a common fern species in the tropic or subtropic ecoregions, has been recently recognized as a potential feedstock to produce highly porous biochar. This study aims to enhance the specific surface area (SSA) and pore volumes of biochars derived from the D. linearis by H3PO4 activation and examine electrical properties of the activated biochars and their possible usage for the electric double-layer capacitor (EDLC) electrode. The treated raw fern was activated with H3PO4 85% by the three different mixing ratios 1:0, 1:1, and 1:3 (w/w) and then pyrolysis under N2 flow maintained at 500 °C for 1 h. The performance as the electrode for an EDLC was evaluated in 1 mol L-1 H2SO4 solution for the H3PO4-activated samples. The SSA and pore volumes were drastically increased after activation. The maximum SSA and pore volume were 1212 m2 g-1 and 1.43 cm3 g-1, respectively for the biochar activated at 400 °C with a weight mixing ratio 1:3 (w/w) between the fern and H3PO4 acid while these values of the biochar at 400 °C were 12 m2 g-1 and 0.02 cm3 g-1, respectively. The biochar activated at 600 °C with the mixing ratio 1:1 (w/w) showed the maximum capacitance value, ca. 108 F g-1 at 1 mV s-1. The activation using H3PO4 showed a positive tendency to enhance electrochemical properties and it could be a premise toward a higher performance of EDLC from the D. linearis derived activated biochar.


Correction to: Invited Discussion on: ''Transaxillary Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction Using a Simplified Endoscopic Approach: Indications, Cosmetic Outcomes and Technical Refinements''.
This erratum is to add reference citation to the original article discussed in this invited commentary. Original reference 1 in the article becomes reference 2. Updated reference list appears below.


Larynx preservation trials: a critical appraisal.
Controlled trials testing the concept of laryngeal preservation for patients with locally advanced stage III and IV cancers of the larynx or hypopharynx were initiated in the mid-1980s. Three randomized trials, evaluating the same cisplatin plus 5-fluorouracil induction chemotherapy regimen and conventional radiotherapy compared with surgery and radiotherapy, have been completed, and the results of two are published. In addition, a meta-analysis of these three trials was completed. The studies are critically reviewed. Conclusions from these trials are that the induction approach is feasible; local and regional control are not improved, whereas distant metastases are delayed; there is no evidence of a difference in overall survival; and of the patients alive at 3 and 5 years, a functional larynx can be preserved in 67% and 58%; there are not enough data to know if there are differences in outcome by subsite. Several unanswered questions are being addressed in phase III trials. These include defining the precise contribution of chemotherapy by comparing induction chemotherapy and radiotherapy to treatment with radiotherapy alone; determining if elective neck dissection for patients with N2N3 neck disease would improve survival; and determining whether local control can be improved by using concomitant or alternating chemotherapy and radiotherapy.


Deficiency of the mitochondrial ribosomal subunit, MRPL50, causes autosomal recessive syndromic premature ovarian insufficiency.
Premature ovarian insufficiency (POI) is a common cause of infertility in women, characterised by amenorrhea and elevated FSH under the age of 40 years. In some cases, POI is syndromic in association with other features such as sensorineural hearing loss in Perrault syndrome. POI is a heterogeneous disease with over 80 causative genes known so far; however, these explain only a minority of cases. Using whole-exome sequencing (WES), we identified a MRPL50 homozygous missense variant (c.335T > A; p.Val112Asp) shared by twin sisters presenting with POI, bilateral high-frequency sensorineural hearing loss, kidney and heart dysfunction. MRPL50 encodes a component of the large subunit of the mitochondrial ribosome. Using quantitative proteomics and western blot analysis on patient fibroblasts, we demonstrated a loss of MRPL50 protein and an associated destabilisation of the large subunit of the mitochondrial ribosome whilst the small subunit was preserved. The mitochondrial ribosome is responsible for the translation of subunits of the mitochondrial oxidative phosphorylation machinery, and we found patient fibroblasts have a mild but significant decrease in the abundance of mitochondrial complex I. These data support a biochemical phenotype associated with MRPL50 variants. We validated the association of MRPL50 with the clinical phenotype by knockdown/knockout of mRpL50 in Drosophila, which resulted abnormal ovarian development. In conclusion, we have shown that a MRPL50 missense variant destabilises the mitochondrial ribosome, leading to oxidative phosphorylation deficiency and syndromic POI, highlighting the importance of mitochondrial support in ovarian development and function.


A simple microtitration technique for quantitating total haemolytic complement levels.
A simple microtitration technique for the determination of total haemolytic complement levels in human serum is described. The method is fast and reproducible, and provides a routine screen of total complement activity for use in clinical medicine.


Acute exacerbation of chronic obstructive pulmonary disease in United States emergency departments, 2010-2018.
Little is known about the recent status of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the U.S. emergency department (ED). This study aimed to describe the disease burden (visit and hospitalization rate) of AECOPD in the ED and to investigate factors associated with the disease burden of AECOPD. Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010-2018. Adult ED visits (aged 40 years or above) with AECOPD were identified using International Classification of Diseases codes. Analysis used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design. There were 1,366 adult AECOPD ED visits in the unweighted sample. Over the 9-year study period, there were an estimated 7,508,000 ED visits for AECOPD, and the proportion of AECOPD visits in the entire ED population remained stable at approximately 14 per 1,000 visits. The mean age of these AECOPD visits was 66 years, and 42% were men. Medicare or Medicaid insurance, presentation in non-summer seasons, the Midwest and South regions (vs. Northeast), and arrival by ambulance were independently associated with a higher visit rate of AECOPD, whereas non-Hispanic black or Hispanic race/ethnicity (vs. non-Hispanic white) was associated with a lower visit rate of AECOPD. The proportion of AECOPD visits that were hospitalized decreased from 51% to 2010 to 31% in 2018 (p = 0.002). Arrival by ambulance was independently associated with a higher hospitalization rate, whereas the South and West regions (vs. Northeast) were independently associated with a lower hospitalization rate. The use of antibiotics appeared to be stable over time, but the use of systemic corticosteroids appeared to increase with near statistical significance (p = 0.07). The number of ED visits for AECOPD remained high; however, hospitalizations for AECOPD appeared to decrease over time. Some patients were disproportionately affected by AECOPD, and certain patient and ED factors were associated with hospitalizations. The reasons for decreased ED admissions for AECOPD deserve further investigation.


Structural polypeptides of the enteropathogenic bovine coronavirus strain LY-138.
The bovine coronavirus strain LY-138 was purified by differential as well as velocity and isopycnic centrifugation in sucrose or CsCl gradients. The substrate for purification was contents of the small intestine of experimentally inoculated calves. This strain is highly enteropathogenic, but it could not yet be propagated in cultured cells. Intact virions had a density of 1.245 g/cm3 in CsCl and 1.185 g/cm3 in sucrose. A spherical core-like structure with an average diameter of 82 nm remaining after treatment with chloroform had a density of 1.299 g/cm3 in CsCl and 1.201 g/cm3 in sucrose. Seven distinct bands of polypeptides and 4 shoulders were detected after electrophoresis of SDS-solubilized virions in polyacrylamide gels. The approximate molecular weights ranged from 110,000 to 36,000. Four of the bands gave a PAS positive reaction. These 4 glycoproteins and an additional protein with an approximate molecular weight of 70,000 were removed by chloroform treatment. The remaining core-like structure contained the 2 polypeptides VP3 and VP7.


Predictors of health related job loss: a two-year follow-up study in a general working population.
Job loss may be attributed to a number of causes. The medical profession is often involved in counselling or case work when citizens are excluded from work for health reasons. The aim of this study was to identify predictors of health related job loss (HRJL) in a cohort of Danish employees. A total of 39 workplaces with 5,604 employees aged from 18 to 67 years participated. Questionnaires were obtained at baseline and follow up. Participants reported reason for job loss whilst employers' information provided the date. Hazard Ratios (HR) for HRJL with 95% confidence intervals (CI) were analysed. 4006 responses were obtained at baseline (71.5%), and 3,276 (81.8%) at follow up. About 567 (17.3%) had lost their job, and 135 (23.8%) reported HRJL. 51.5% of HRJL was related to pain, disease, or discomfort in the neck, the back, arms, or legs, and another 23% to stress or stress related symptoms. HRJL involved low reemployment rate compared to non-HRJL. After multiple mutual adjustments, HRJL among females was associated with reports of a work compensation claim within the year previous to baseline (HR 3.0; 95% CI 1.6-5.1), high level of health anxiety (3.7; 2.1-6.6), one or more contacts to the general practitioner in the year previous to baseline (2.2;1.4-3.6), and reported poor leadership quality at work (1.8;1.2-2.9). Among males, HRJL was associated with high levels of health anxiety (2.5; 1.0-6.2) and repetitive work (2.7; 1.4-5.4). About 4% of employees experienced HRJL, which was associated with care seeking and high levels of health anxiety. Further studies of gender differences in HRJL are warranted.


Ultrasound guided fine-needle aspiration biopsy of abdominal masses.
Twenty-six cases of ultrasonically guided percutaneous fine-needle aspiration biopsies of abdominal masses are reported. Included are masses in the pancreas, retroperitoneum, liver, kidney, and pelvis. Aspiration biopsies accurately diagnosed or excluded malignancy in 21 patients (81%). The procedure, performed under local anesthesia, is rapid, simple and almost painless. No complications occurred; specifically, there was no hemorrhage, peritonitis, or spread of tumor along the needle tract.


Cervical cancer among Vietnamese women: efforts to define the problem among Houston's population.
Asian American/Pacific Islanders (AAPIs) in the United States (US) continue to bear a disproportionate burden of cancer. This report focuses on the interviews with local health-care delivery providers, directors, administrators, and community outreach liaisons in the Vietnamese community in Houston, Texas. The Center for Minority Health (CMRH) at the University of Texas M.D. Cancer Center interviewed 17 leaders, as defined above, to identify factors that have a negative impact on screening practices among Vietnamese women. The results show that some of the barriers to cervical cancer screening include: lack of knowledge, lack of female physicians, language barriers, lack of insurance, and embarrassment. Interviews established that "prevention" is a Western concept that the Vietnamese community has not yet adopted. Vietnamese women used their churches, community physicians (licensed or not), circle of friends, and families for their health information. Many patients used herbs as alternative or complementary therapies. Cultural factors play a vital role in limiting Vietnamese women in the use of cervical screening. Further research needs to focus on identifying specific barriers and how they can be overcome.


Chemonucleolysis with Chondroitin Sulfate ABC Endolyase for Treating Lumbar Disc Herniation: Exploration of Prognostic Factors for Good or Poor Clinical Outcomes.
Background and Objectives: Chondroitin sulfate ABC endolyase (condoliase) was launched as a new drug for chemonucleolysis in 2018. Few studies assessed its clinical outcomes, and many important factors remain unclear. This study aimed to clarify the preoperative conditions in which condoliase could be highly effective. Materials and Methods: Of 47 patients who received condoliase, 34 were enrolled in this study. The mean age of the patients was 33 years. The average duration since the onset of disease was 8.6 months. We evaluated patients' low back and leg pain using a numerical rating scale (NRS) score at two time points (before therapy and 3 months after therapy). We divided the patients into two groups (good group (G): NRS score improvement ≥ 50%, poor group (P): NRS score improvement < 50%). The parameters evaluated were age, disease duration, body mass index (BMI), and positive or negative straight leg raising test results. In addition, the loss of disc height and preoperative radiological findings were evaluated. Results: In terms of low back and leg pain, the G group included 9/34 (26.5%) and 21/34 (61.8%) patients, respectively. Patients' age (low back pain G/P, 21/36.5 years) was significantly lower in the G group for low back pain (p = 0.001). High-intensity change in the protruded nucleus pulposus (NP) and spinal canal occupancy by the NP ≥ 40% were significantly high in those with leg pain in the G groups (14/21, p = 0.04; and 13/21, p = 0.03, respectively). Conclusions: The efficacy of improvement in leg pain was significantly correlated with high-intensity change and size of the protruded NP. Condoliase was not significantly effective for low back pain but could have an effect on younger patients.


Effects of aquatic humus on accumulation and acute toxicity of some organic micropollutants.
Accumulation experiments in a natural humic water revealed significantly lower bioconcentration of dehydroabietic acid and benzo(a)pyrene into Daphnia magna when compared with a standardized soft freshwater. For pentachlorophenol no such effect could be observed. Depending on the chemical involved, the natural humic water might affect the acute lethal toxicity of aquatic contaminants to this organism.


Identification and functional characterization of the mannose receptor in astrocytes.
The immune competence of astrocytes is still ill defined, especially their endocytic capacity, a prerequisite for efficient antigen presentation. We show that mannose receptor, a very important conduit for internalization of infectious agents and self antigens, is functionally expressed in the murine CNS. By in vitro assays, astrocytes and microglia were shown to be the prime cells expressing this receptor. Studies on astrocytes demonstrate that its expression and function are inversely regulated by anti-and pro-inflammatory compounds. Downregulation of the mannose receptor by IFN-gamma is concomitant with the induction of the invariant chain, which is also induced by GM-CSF + IL-4. Mannose receptor-expressing astrocytes may thus act as scavenger not only in CNS development but also in defense, against soluble and particulate mannosylated pathogens, presenting fragments thereof at strategic locations in the CNS. These findings unravel a new and putatively very important role of astrocytes in innate immunity and possibly development.


Protic ionic liquids based on phosphonium cations: comparison with ammonium analogues.
Novel protic ionic liquids (PILs) based on a tributyl phosphonium cation have been synthesised and characterised, revealing that the phosphonium based ILs show high thermal stability, high ionic conductivity and facile proton reduction compared to the corresponding ammonium based ILs.


PIWIL2 restrains the progression of thyroid cancer via interaction with miR-146a-3p.
The classical role of PIWIL2 is to regulate reproduction by binding to piRNA, but its tumor-related function has received increasing attention in recent years. This study aims to explore its role in the progression of thyroid cancer (TC). First, we measured and analyzed the levels of PIWIL2 and miR-146a-3p in TC tissue and adjacent tissues as well as several TC cell lines. We demonstrated the clinical significance of PIWIL2 and miR-146a-3p through the survival rate. Based on these results, we selected TPC-1 and KTC-3 cell lines for our cell experiments. We treated these cell lines with PIWIL2 lentivirus, PIWIL2 siRNA, miR-146a-3p mimic, or miR-146a-3p inhibitor and measured cell proliferation, cell cycle, apoptosis, migration, and invasion. We used PCR and Western blot to quantify the mRNA and protein levels of PIWIL2, while we used luciferase reporter assay and RNA binding protein immunoprecipitation to explore the relationship between miR-146a-3p and PIWIL2. Finally, we developed a xenograft tumor model to confirm the effects of the miR-146a-3p/PIWIL2 axis on TC progression in vivo. We identified that PIWIL2 and miR-146a-3p exhibit opposite expression alterations in TC tissues and that PIWIL2 serves as a 'sponge' by adsorbing miR-146a-3p. Up-regulating PIWIL2 decelerated the proliferation, metastasis, and cell cycle progression of TPC-1 and KTC-3 cells, but accelerated the apoptosis of TC cells, while miR-146a-3p exhibited opposite effects. Finally, overexpressing PIWIL2 restrained the progression of TC in nude mice, which can be reversed by increasing miR-146a-3p expression. Inhibiting PIWIL2, on the other hand, promoted the progression of TC in vivo, which can be reversed by inhibiting miR-146a-3p. PIWIL2 may inhibit the progression of TC by sponging miR-146a-3p, providing new insights into the early treatment, recrudescence treatment, and metastasis treatment of TC.


Simple, sensitive and rapid LC-MS method for the quantitation of indapamide in human plasma--application to pharmacokinetic studies.
A sensitive and specific method using liquid chromatography with electrospray ionization mass spectrometry (LC-ESI-MS) has been developed and validated for the identification and quantification of indapamide in human plasma. A simple liquid-liquid extraction procedure was followed by injection of the extracts on to a C18 column with gradient elution and detection using a single quadrupole mass spectrometer in selected ion monitoring (SIM) mode. The method was tested using six different plasma batches. Linearity was established for the concentration range 0.5-100.0 ng/ml, with a coefficient of determination (r) of 0.9998 and good back-calculated accuracy and precision. The intra- and inter-day precision (RSD%) was lower than 10%, and accuracy ranged from 85 to 115%. The lower limit of quantification was reproducible at 0.2 ng/ml with 0.2 ml plasma. The proposed method enables the unambiguous identification and quantification of indapamide for pre-clinical and clinical studies.


Purification and characterization of Aspergillus niger exo-1,4-glucosidase.
A specific exo-1,4-glucosidase (1,4-alpha-D-glucan glucohydrooase, EC 18.104.22.168) from Aspergillus niger has been partially purified and subsequently characterized by biochemical, physico-chemical and optical methods. Molecular sieve chromatography yields an enzyme with maximal activity at pH 4.2-4.5 close to its isoelectric point. Reduction and carboxymethylation leads to complete loss of activity and O-acetylation of 3 of the 13 tyrosine residues results in loss of 20 % of the activity. Sodium dodecylsulfate-polyacrylamide gel electrophoresis indicates that the native enzyme consists of two major components of molecular weights 63 000 and 57 500, respectively. Small amounts of dissociated material of molecular weight 28 000 and 16 000 as well as aggregates of the order of 100 000 are also present to the extent of 2-5% of the total potein. Following reduction and carboxymethylation under forcing conditions, the bands around 60 000 diminish and the 28 000-30 000, 16 000 and aggregate bands are dominant...


Immunohistochemical demonstration of the reticuloendothelial clearance of circulating fibrin aggregates.
In rabbits given an intravenous infusion of thrombin or an injection of endotoxin, immunohistochemical examination of the tissues, using conjugated antiserum against rabbit fibrin, showed bright intracytoplasmic staining in many of the phagocytic cells of the liver and spleen. In normal rabbits as well as in animals injected with large doses of heparin prior to thrombin or endotoxin administration, no such intracellular staining was observed. The findings of this study substantiate the hypothesis that fibrin aggregates formed in the circulating blood during low grade intravascular coagulation are largely removed by the reticuloendothelial system.


Relative contribution of flap thickness and ablation depth to the percentage of tissue altered in ectasia after laser in situ keratomileusis.
To evaluate the contribution of flap thickness and ablation depth to the percentage of tissue altered (PTA) (flap thickness plus ablation depth divided by central corneal thickness) in determining the risk for ectasia after laser in situ keratomileusis (LASIK). University of São Paulo, São Paulo, Brazil; Cleveland Clinic, Cleveland, Ohio, and Emory Vision at Emory University, Atlanta, Georgia, USA. Retrospective comparative study. The study included 1 group of eyes with bilateral normal preoperative topography that developed ectasia after LASIK (ectasia group) and 2 control groups of eyes that did not develop ectasia after LASIK, 1 with 40% or more of tissue altered (high-PTA group) and 1 with flaps 120 μm or thicker (thick-flap group). The 29 eyes (16 patients) in the ectasia group had thicker flaps (146 μm) than the 24 eyes (20 patients) in the high-PTA group (118 μm) and derived a higher portion of PTA from flap thickness. The ectasia group had a higher PTA (45%) than the 100 eyes (50 patients) in the thick-flap group (34%) and greater ablation depths (94 μm versus 43 μm) and derived a higher portion of the PTA from ablation depth. Flap thickness had more impact than ablation depth; however, thicker flaps were insufficient to create ectasia unless coupled with greater ablation depths and thus a high PTA. This percentage was a more significant factor than the variables it comprised. Drs. Santhiago and Smadja are consultants to Ziemer Ophthalmic Systems AG. No other author has a financial or proprietary interest in any material or method mentioned.


Regional anaesthesia for surgical repair in selected open globe injuries in adults.
To determine whether the combination of topical, intracameral and facial nerve blocks would produce adequate analgesia for repair of open globe injuries without increasing intraocular tension. A comparison of combined O'Brien's block (facial nerve block), topical ropivacaine and intracameral lignocaine versus peribulbar block in 100 randomly selected cases of traumatic corneal rupture. Patients were randomly divided in two groups of 50 each based on those receiving the combined approach (Group T) and those undergoing peribulbar block (Group P). Patients were excluded if there was rupture with significant scleral extension, the interval between trauma and presentation greater than 2 h, presence of hypopyon, rupture with significant corneal oedema, expulsion of intraocular contents with a collapsed globe and monocular cases. The effect of the anaesthetic was compared by patient comfort and surgeon comfort, the incidence of vitreous prolapse and the requirement of incremental sedation. The Student's "t" test, the "Z" test, and Chi Square tests were used where appropriate. P < 0.05 was considered statistically significant. The average patient comfort in Group P was 5.67% greater than Group T (P > 0.05). The average surgeon comfort and patient comfort between groups were similar (P > 0.05, both comparisons). Incremental sedation was required in 16% of patients in Group T compared to 8% in Group P (P = 0.218363). The total sedation dosage required for each group was similar. The incidence of vitreous prolapse was statistically significantly higher by 14% in Group P compared to Group T (P = 0.03731). Our combined technique proved as efficacious as peribulbar block in providing adequate local anaesthesia and reducing the incidence of vitreous prolapse. We recommend greater use of this technique for repair of open globe injuries especially in locations where full time anaesthesia services are not available.


Effects of monensin on insulin processing in adipocytes. Evidence that the internalized insulin-receptor complex has some physiological activities.
In the presence of 10-100 microM monensin (a monovalent cation ionophore), a considerable amount of 125I activity of iodoinsulin accumulated in isolated rat epididymal adipocytes during a 30-min incubation. The accumulation was secondary to the action of monensin to inhibit dissociation of a certain fraction of the cellbound 125I activity. This monensin effect was reversible. The accumulation of 125I activity was ATP dependent and so was the discharge of the accumulated radioactivity. Approximately 91% of the accumulated radio-activity was precipitable with trichloroacetic acid, and at least 84% was reactive to anti-insulin antibody. Monensin at 100 microM appeared to have only mild effects on the cellular activities of glucose transport and cAMP phosphodiesterase. Nevertheless, when cells were first exposed to 10 nM insulin in the presence of 100 microM monensin and then transferred into a hormone-free buffer that contained monensin, the phosphodiesterase activity in cells remained partially activated as if cells were kept exposed to approximately 0.5 nM insulin. Under similar conditions, glucose transport activity remained partially activated as if cells were incubated with approximately 70 pM insulin. Monensin did not inhibit the reversal of the insulin effect per se. Like monensin, 20-100 microM chloroquine (a lysosomotropic inhibitor) induced a considerable accumulation of [125I] iodoinsulin. However, cells that had been exposed to insulin in the presence of chloroquine retained little hormonal effect after washing. Based on these observations and on the reported biological effects of monensin, it is suggested (a) that monensin may induce intracellular accumulation of the insulin-receptor complex by blocking the acidification of endocytic vesicles and (b) that the accumulated insulin-receptor complex may retain a weak, but significant, capacity to stimulate both glucose transport and phosphodiesterase activities.


Collapsed Structure of Hydrophobically Modified Polyacrylamide Adsorbed at the Air-Water Interface: The Polymer Surface Excess and the Gibbs Equation.
Neutron reflectometry has been used to measure the surface excesses and structures of hydrophobically modified polyacrylamide polymers (HMPAMs) at the air-water (A-W) interface. The HMPAMs were based on a range of commercially available PAM, which were modified by the N-alkylation of the amide group to give an N-CnD2n+1 hydrophobic group with n = 8, 12, and 16 at levels of 0.5, 1, 2, 4, and 6 mol %. A further HMPAM was synthesized in two isotopic forms with either N-CnD2n+1 or N-CnH2n+1 as hydrophobes. For moderate- and high MW species the near surface structure at the A-W interface consists of two layers. All the hydrophobic units are in these two layers as well as a large fraction of backbone units, often amounting to a total volume comparable to that of the hydrophobes. The outer layer next to air contains no water, but the residual volume in the inner layer is filled with water. A further large fraction of the backbone units also form a diffuse third layer extending a substantial distance into the solution. In a low MW HMPAMs there was preferential adsorption of species with higher mol % of hydrophobe and a tendency to form apparently nonequilibrium structures, which in some cases resulted in more complex structures than the simple one characteristic of the large MW polymers. With the exception of this polymer, the variation of the patterns of surface excess and structure with solution concentration suggested that systems containing hydrophobic units at a level of 0.5, 1, and 2 mol % formed equilibrium or near-equilibrium surface layers at bulk concentrations of 0.01-0.35 wt % for C8 to C16 units. However, higher levels of 4 and 6 mol % of the C12 hydrophobe led to much less regular patterns of adsorption, indicating that equilibration is more difficult once the molar fraction of hydrophobe exceeds 2 mol %. The behavior of the surface tension (ST) over the same concentration range as the NR experiments could be accounted for by the Gibbs equation using the directly measured surface excesses and the incorporation of a low charge on the polymers (about 1 charge per 100 backbone units). The presence of such a charge in PAM can arise from hydrolysis of some amide to carboxylate and was known to be present for one of the polymers. The extra structural information obtained by NR on these HMPAMs combined with more recent measurements of the state of ionization in polyacrylates (PAA) allowed us to reinterpret earlier ST and X-ray reflection results on hydrophobically modified HMPAANa containing a similar level of 1 and 2 mol % C12H25 hydrophobes. The Gibbs equation again accounted quantitatively for the ST behavior by using the correct state of ionization of the polymer. Although the adsorption of hydrophobic groups in HMPAANa is about one-tenth of that for the corresponding HMPAM, the ST drops more quickly to lower values for HMPAANa because of its higher level of dissociation, which increases the magnitude of the slope in the Gibbs plot.


Evidence for hubs in human functional brain networks.
Hubs integrate and distribute information in powerful ways due to the number and positioning of their contacts in a network. Several resting-state functional connectivity MRI reports have implicated regions of the default mode system as brain hubs; we demonstrate that previous degree-based approaches to hub identification may have identified portions of large brain systems rather than critical nodes of brain networks. We utilize two methods to identify hub-like brain regions: (1) finding network nodes that participate in multiple subnetworks of the brain, and (2) finding spatial locations in which several systems are represented within a small volume. These methods converge on a distributed set of regions that differ from previous reports on hubs. This work identifies regions that support multiple systems, leading to spatially constrained predictions about brain function that may be tested in terms of lesions, evoked responses, and dynamic patterns of activity.


Bridging the gap for nonmetropolitan STEMI patients through implementation of a pharmacoinvasive reperfusion strategy.
Timely primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). However, universal access is limited outside metropolitan centres and portends worse outcomes for rural patients. This study evaluates the outcomes of STEMI patients treated in a metropolitan and nonmetroplitan setting within Vital Heart Response, an integrated reperfusion program developed to reduce reperfusion delay in Central and Northern Alberta. From October 2006 to March 2011, data on consecutive STEMI patients was prospectively recorded. Clinical characteristics, in-hospital management, and outcomes grouped by site of presentation are described. There were 1990 metropolitan and 1602 nonmetropolitan STEMI patients. Metropolitan were older (62.7 vs 60.4 years; P < 0.001) and had more: angina (21.2% vs 16.5%; P < 0.001), dyslipidemia (45.3% vs 39.6%; P = 0.001), and hypertension (49.9% vs 46.6%; P = 0.047). The reperfusion strategy for metropolitan and nonmetropolitan: primary PCI (57.4% vs 22.9%; P < 0.001), fibrinolysis (26.3% vs 61.2%; P < 0.001), and no reperfusion (16.3% vs 15.9%; P = 0.855). First medical contact to reperfusion was delayed in nonmetropolitan with fibrinolysis and PCI, 8 and 125 minutes. A rescue PCI or coronary angiography within 24 hours was completed in 41.4% and 46.2%, respectively. Nonmetropolitan patients had fewer deaths (4.1% vs 6.8%; P = 0.001) with no difference in the composite outcome (death, reinfraction, congestive heart failure, cardiogenic shock) (16.8% vs 15.1%; P = 0.161) or major bleeding (7.9% vs 8.0%; P = 0.951). Systematic application of a pharmacoinvasive strategy appears to be safe and effective for patients in whom a delay in mechanical reperfusion is anticipated.


Use of monoclonal antibody panel to identify malignant cells in cerebrospinal fluid.
A panel of monoclonal antibodies was systematically applied to cerebrospinal fluid from 17 patients with suspected neoplastic meningitis and the results were compared with those obtained from routine cytological preparations. The antibody panel consisted of markers for neuroectodermal tissue ( UJ13A ), epithelial cytokeratin ( LE61 ), leucocytes ( 2D1 ), and neoplastic neuroblasts ( UJ181 .4). Additional antibodies were used to refine diagnosis when indicated. Cerebrospinal fluid samples from 12 patients with non-neoplastic conditions were used as controls. The use of monoclonal antibodies gave a positive diagnosis in 16/17 cases and the cells were accurately categorised as carcinoma (5/6 cases), neuroectodermal tumour (8/8 cases), and lymphoma (3/3 cases). In the 14 cases examined by routine cytology, malignant cells were reported in 10 cases and accurately categorised in only 3/14 cases. Immunocytological testing of cerebrospinal fluid with an antibody panel has greatly increased the accuracy with which malignant cells can be identified and categorised.


Rate and clinical impact of intra-procedural complications during coil embolisation of ruptured small (3 mm or less) cerebral aneurysms.
Coiling of small (≤3 mm) cerebral aneurysms can be technically challenging and is associated with increased procedural-related morbidity and mortality. The authors report the clinical and radiological results following coiling of ruptured small cerebral aneurysms in a single-institution, and define the rates of intra-procedural rupture and thromboembolism. A retrospective analysis was conducted on consecutive patients from 01/01/2008 to 31/12/2010 with subarachnoid haemorrhage (SAH) from ruptured cerebral aneurysms (≤3 mm) managed in a tertiary neurosurgical institution in the United Kingdom. Of the 108 patients identified, 72 patients (66.7%) underwent coil embolisation. A favourable outcome, defined as a Glasgow outcome score of 4-5, was achieved in 63 (87.5%) of these patients. Intra-procedural complications were observed in 11.1% (±7.3% 95% CI) of cases, wherein the rate of intra-procedural rupture was determined to be 8.3% (±6.4% 95% CI) and intra-procedural thromboembolism to be 2.8% (±3.8% 95% CI). Although coil embolisation of small ruptured cerebral aneurysms is technically feasible and an efficacious means of treatment, it is associated with an increased rate of intra-procedural complications. This should be taken into account when embarking upon treatment of patients with ruptured small cerebral aneurysms.


Implementing solenoid microcoils for wide-line solid-state NMR.
Solid-state nuclear magnetic resonance (NMR) probeheads using solenoid microcoils with an inner diameter of 300-400 microm are developed for the study of mass-limited solid samples. Some attention is paid to the mechanical ruggedness of the probes allowing sample changing. The performance, in terms of sensitivity and RF-characteristics, of these probeheads is studied for (1)H, (31)P, and (27)Al in different model compounds in view of the feasibility of specific applications. The results show that the sensitivity is high enough to detect approximately 10(14) spins/sqrt Hz with a signal-to-noise ratio of 1 in a single scan. A specific advantage of microcoils for solid-state NMR applications is that they can generate extremely high RF-fields if implemented in appropriate circuits. Using RF-powers in the hundreds of Watts range, RF-fields well in excess of 1MHz can be made. This allows the excitation of spectra of nuclei whose resonance lines are dispersed of several megahertz. This is particularly useful for quadrupolar nuclei experiencing large quadrupolar interactions as is demonstrated for (27)Al in single crystal and powdered minerals.


A meta-analysis evaluating the role of high-intensity focused ultrasound (HIFU) as a fourth treatment modality for patients with locally advanced pancreatic cancer.
This study aimed to evaluate the outcomes of high-intensity focused ultrasound (HIFU) on patients with advanced pancreatic cancer. A literature search was performed in PubMed, Scopus and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated by means of the Random-Effects model. Nineteen articles met the inclusion criteria, incorporating 939 patients. This study reveals that patients in the HIFU group presented increased median overall survival (OS), along with higher OS at 6 and 12 months after treatment compared with the control group (p < 0.05). Furthermore, patients treated with HIFU in conjunction with chemotherapy presented reduced levels of pain (p < 0.05) compared to the traditional treatment group. In addition, HIFU contributed to significant tumor responsiveness, in terms of CA19-9 reduction (p < 0.05). Finally, HIFU was a considerably safe treatment modality with a low incidence of complications. These outcomes suggest that HIFU is a feasible and safe treatment modality for patients with advanced pancreatic cancer and provides enhanced outcomes regarding survival and quality of life. Given the lack of a significant number of randomized clinical trials, this meta-analysis represents the best currently available evidence. New randomized trials assessing HIFU are necessary to further evaluate their outcomes.


[Anomalous origin of the coronary artery in the pulmonary artery. Report of a case in adulthood].
We report a 50 year old patient who was admitted because of congestive heart failure. Under hemodynamic and angiographic study she was diagnosed of anomalous origin of the left coronary artery from the pulmonary trunk. We examine the main aspects of the disease, physiopathology and treatment.