Impact of age on outcome in patients with advanced ovarian cancer treated within a prospectively randomized phase III study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR).
Ovarian cancer exhibits the highest mortality rate among gynecologic cancer and survival rates vary considerably by age. Therefore, we investigated impact of age on outcome in advanced ovarian cancer. We performed a subgroup-analysis concerning influence of age classified according to three categories: younger patients (YP; <50 years) vs. middle-aged patients (MP; 50-65 years) vs. elderly patients (EP; >65 years). 686 patients with FIGO IIB-IV were treated within a prospectively randomized phase III study (AGO-OVAR 3) comparing cisplatin-paclitaxel vs. carboplatin-paclitaxel. This subgroup-analysis consisted of patients with homogeneous histology and complete surgical data. YP had statistically more often achieved no residual tumor after primary surgery than MP and EP (P < 0.0001) resulting in improved median overall survival: 60.7, 41.3, and 33.2 months for YP, MP, and EP, respectively. The survival advantage of YP compared to EP remained significant even in completely debulked patients. Multivariable analysis revealed age being an independent prognostic factor. Reduced surgical radicality, that means both less optimal debulking and also less radical surgery, contributes to poorer outcome in elderly patients with advanced ovarian cancer. However, age-specific surgical approaches did only partially explain age-dependent outcome. Therefore, generalization of study results to all patient age groups might be limited and further studies should focus specifically on treatment in elderly patients.


Abortion care availability, readiness, and access: linking population and health facility data in Kinshasa and Kongo Central, DRC.
The Democratic Republic of Congo (DRC) legalized abortion in 2018 to preserve health and pledged to provide quality postabortion care (PAC), yet little is known about the availability of abortion care services and if facilities are prepared to provide them; even less is known about the accessibility of these services. Using facility and population-based data in Kinshasa and Kongo Central, this study examined the availability of abortion services, readiness of facilities to provide them, and inequities in access. Data on 153 facilities from the 2017-2018 DRC Demographic and Health Survey Service Provision Assessment (SPA) were used to examine signal functions and readiness of facilities to provide services across three abortion care domains (termination of pregnancy, basic treatment of abortion complications, and comprehensive treatment of abortion complications). To examine PAC and medication abortion provision before and after abortion decriminalization, we compared estimates from the 2017-2018 SPA facilities to estimates from the Performance Monitoring for Action (PMA) data collected in 2021 (n = 388). Lastly, we assessed proximity to PAC and medication abortion using PMA by geospatially linking facilities to representative samples of 2,326 and 1,856 women in Kinshasa and Kongo Central, respectively. Few facilities had all the signal functions under each abortion care domain, but most facilities had many of the signal functions: overall readiness scores were > 60% for each domain. In general, readiness was higher among referral facilities compared to primary facilities. The main barriers to facility readiness were stock shortages of misoprostol, injectable antibiotics, and contraception. Overall, provision of services was higher post-decriminalization. Access to facilities providing PAC and medication abortion was almost universal in urban Kinshasa, but patterns in rural Kongo Central showed a positive association with education attainment and wealth. Most facilities had many of the necessary signal functions to provide abortion services, but the majority experienced challenges with commodity availability. Inequities in accessibility of services also existed. Interventions that address supply chain challenges may improve facility readiness to provide abortion care services, and further efforts are needed to narrow the gap in accessibility, especially among poor women from rural settings.


Approaches for quantifying reactive and low-volatility biogenic organic compound emissions by vegetation enclosure techniques - part B: applications.
The focus of the studies presented in the preceding companion paper (Part A: Review) and here (Part B: Applications) is on defining representative emission rates from vegetation for determining the roles of biogenic volatile organic compound (BVOC) emissions in atmospheric chemistry and aerosol processes. The review of previously published procedures for identifying and quantifying BVOC emissions has revealed a wide variety of experimental methods used by various researchers. Experimental details become increasingly critical for quantitative emission measurements of low volatility monoterpenes (MT) and sesquiterpenes (SQT). These compounds are prone to be lost inadvertently by uptake to materials in contact with the sample air or by reactions with atmospheric oxidants. These losses become more prominent with higher molecular weight compounds, potentially leading to an underestimation of their emission rates. We present MT and SQT emission rate data from numerous experiments that include 23 deciduous tree species, 14 coniferous tree species, 8 crops, and 2 shrubs. These data indicate total, normalized (30 degrees C) basal emission rates from <10 to 5600ngCg(-1)h(-1) for MT, and from <10 to 1150ngCg(-1)h(-1) for SQT compounds. Both MT and SQT emissions have exponential dependencies on temperature (i.e. rates are proportional to e(betaT)). The inter-quartile range of beta-values for MT was between 0.12 and 0.17K(-1), which is higher than the value commonly used in models (0.09K(-1)). However many of the MT emissions also exhibited light dependencies, making it difficult to separate light and temperature influences. The primary light-dependent MT was ocimene, whose emissions were up to a factor of 10 higher than light-independent MT emissions. The inner-quartile range of beta-values for SQT was between 0.15 and 0.21K(-1).


A facile fluorescent chemosensor based on a water-soluble porphyrin for Mo(6+) in aqueous solution.
A novel water-soluble porphyrin (5,10,15,20-tetra(3-ethoxy-4-hydroxy-5-sulfonate) phenylporphyrin, H2TEHPPS) was synthesized. H2TEHPPS exhibited high sensitivity and selectivity towards Mo(6+). The enhanced fluorescence response of H2TEHPPS after titration with Mo(6+) in aqueous solution at pH3.5 was attributed to the formation of an inclusion complex between the porphyrin ring and Mo(6+), which R(2)=0.999 from 10 to 1000μgL(-1), providing a detection limit of 1.5μgL(-1). The fluorescence response of H2TEHPPS towards Mo(6+) showed excellent selectivity over other transition metal cations.


Constitutive SIRT1 overexpression impairs mitochondria and reduces cardiac function in mice.
Heart failure is associated with a change in cardiac energy metabolism. SIRT1 is a NAD(+)-dependent protein deacetylase, and important in the regulation of cellular energy metabolism. To examine the role of SIRT1 in cardiac energy metabolism, we created transgenic mice overexpressing SIRT1 in a cardiac-specific manner, and investigated cardiac functional reserve, energy reserve, substrate uptake, and markers of mitochondrial function. High overexpression of SIRT1 caused dilated cardiomyopathy. Moderate overexpression of SIRT1 impaired cardiac diastolic function, but did not cause heart failure. Fatty acid uptake was decreased and the number of degenerated mitochondria was increased dependent on SIRT1 gene dosage. Markers of reactive oxygen species were decreased. Changes in morphology and reactive oxygen species were associated with the reduced expression of genes related to mitochondrial function and autophagy. In addition, the respiration of isolated mitochondria was decreased. Cardiac function was normal in transgenic mice expressing a low level of SIRT1 at baseline, but the mice developed cardiac dysfunction upon pressure overload. In summary, the constitutive overexpression of SIRT1 reduced cardiac function associated with impaired mitochondria in mice.


Record of Psilotornus confertus Machalska, 1974 (Trematoda: Psilostomidae), a parasite of birds, in water-shrew Neomys fodiens Pennant, 1771 (Insectivora: Soricidae) in the Oriental Pyrenean Mountains.
Psilotornus confertus Machalska, 1974 was found in the water-shrew Neomys fodiens Pennant, 1771 in the Oriental Pyrenean Mountains. This fact may be considered as accidental for the time being. The findings of P. confertus, Brachylaemus fulvus (Dujardin, 1843) and Pseudoleuco-chloridium soricis (Soltys, 1952) in N. fodiens in these mountains are discussed from the bioecological aspect.


What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians.
To explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician. 150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups. Three dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients. What is considered clinical empathy is not the same across individuals and stakeholder groups. Physicians and patients differ in how much they include the physicians' emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person's feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients' perception of clinical empathy.


[Unexplained edema in females--diuretic-induced or idiopathic?].
Both women with diuretic induced edema and with idiopathic edema present a typical history leading to the diagnosis in most cases. These women are almost exclusively in the reproductive age and they tend to have some other characteristics in common additionally. There is controversy whether idiopathic edema exists as a syndrome with multifactorial pathogenesis or if fluid retention in these women is due to diuretic abuse. In either case the use of diuretics is not indicated as they can increase and perpetuate the edema and moreover may bring about impairment of renal function. Abstinence of diuretic intake is the only way out of the vicious circle of fluid retention induced by intermittent diuretic intake resulting in intermittent edema and prostrained use of diuretics. Therapy of idiopathic edema is difficult; it includes physical therapy, psychotherapy and pharmacotherapy with aldosterone antagonists or ACE-inhibitors in some severe cases.


Spatial scale of aggregation in three acarine predator species with different degrees of polyphagy.
Aggregative responses by the predatory mites, Phytoseiulus persimilis, Typhlodromus occidentalis, and Amblyseius andersoni (Acari: Phytoseiidae), to spatial variation in the density of mobile stages of Tetranychus urticae (Acari: Tetranychidae) were studied over different spatial scales on greenhouse roses. Significant spatial variations in prey numbers per leaflet, per leaf, per branch or per plant were present in all experimental plots. None of the predator species responded to prey numbers per plant, and all searched randomly among plants. Within a plant, the oligophagous P. persimilis searched randomly among branches, but aggregated strongly among leaves within a branch and among leaflets within a leaf. The narrowly polyphagous T. occidentalis searched randomly among leaflets within a leaf and amond leaves within a branch, but aggregated strongly among leaflets or leaves within a plant. The boradly polyphagous A. andersoni searched randomly among leaflets within a leaf, a branch or a plant, and among leaves within a branch or a plant, but distributed themselves more often on branches with lower prey densities. Thus, specialist predators aggregate strongly at lower spatial levels but show random search at higher spatial levels, whereas generalist predators show random search at lower spatial levels but aggregate at higher spatial levels. This is the first empirical evidence demonstrating the relation between the degree of polyphagy and the spatial scale of aggregation. It is also concluded that both the prey patch size (i.e. grain) and predator foraging range (i.e. extent) are important for analyzing spatial scales of predator aggregation. The importance of studying spatial scale of aggregation is also discussed in relation to predator-prey metapopulation dynamics.


Molecular identification of Neoechinorhynchus rutili parasite diagnosed in some fish species caught in Menzelet dam lake in Kahramanmaras province (Turkey).
This study details the molecular identification of the parasite Neoechinorhynchus rutili diagnosed in fish (Capoeta barroisi, Cyprinus carpio, Barbus rajanorum) caught in Menzelet Dam Lake in Kahramanmaras Province, Turkey. Parasite samples were obtained from the intestines of fish caught from January to June of 2013. The collected parasites were stored in sample vials containing 70% alcohol. Using staining methods and based on morphology, 120 N. rutili specimens were identified. DNA isolation of N. rutili was accomplished using special tissue sets for parasites. Specific primers were utilized in the molecular identification of N. rutili using polymerase chain reaction (PCR) and it was possible to verify that all of the parasites contained N. rutili molecules. In conclusion, using multiple methods we successfully identified and confirmed the presence of N. rutili parasites in the fish caught in Kahramanmaras Province. The process of identification of N. rutili using morphology and staining methods is time-consuming; however, PCR was successfully performed in a short time to accomplish the same results. The success of this study may lead to more original and extensive work aimed at the efficient molecular identification of parasitic agents found in fish.


Familial Currarino syndrome associated with Hirschsprung disease: two cases of a mother and daughter.
Currarino syndrome with Hirschsprung disease (CS-HD) is extremely rare. We present the first family with CS-HD. Case 1: A 28-year-old woman was admitted with severe abdominal distension and dyspnea. She was diagnosed with anal stenosis, hemisacrum, anterior sacral meningocele (ASM), tethered cord (TC), and short-segment aganglionosis. She underwent the modified Duhamel operation after meningocele repair and cord detethering. A bicornuate uterus, bilateral ovarian dermoid cysts, and small rectal duplication were also noted intraoperatively. Case 2: The daughter of case 1 was admitted for abdominal distension and anal stenosis at the age of 17 days. Studies revealed a hemisacrum, ASM, TC, presacral mass, atrial septal defect, polyp in the right nasal cavity, right vesicoureteral reflux, and short-segment aganglionosis. She underwent the modified Soave operation at the age of 1 year and 4 months after meningocele repair, cord detethering, and resection of the presacral mass (epidermoid cyst). In both cases, the aganglionic segments were confirmed by preoperative rectal suction biopsy and postoperative pathological examination on full-thickness rectal specimens. Some causal genes for Currarino syndrome (CS) and Hirschsprung disease (HD) are currently investigated. Thus far, 10 CS-HD cases have been reported, including 6 cases of familial CS. However, all the patients had sporadic HD. Recent reports suggest that anomalies of the enteric nerve system contribute to postoperative constipation in CS cases.


Improved recovery selectivity of rare earth elements from mining wastewater utilizing phytosynthesized iron nanoparticles.
While rare earth elements (REEs) play key roles in many modern technologies, the selectivity of recovering of REEs from mining wastewater remains a critical problem. In this study, iron nanoparticles (FeNPs) synthesized from euphorbia cochinchinensis extracts were successfully used for selective recovery of REEs from real mining wastewater with removal efficiencies of 89.4% for Y(III), 79.8% for Ce(III) and only 6.15% for Zn(Ⅱ). FTIR and XPS analysis suggested that the high selective removal efficiency of Y(III) and Ce(III) relative to Zn(Ⅱ) on FeNPs was due to a combination of selective REEs adsorption via complexing with O or N, ion exchange with H+ present in functional groups contained within the capping layer and electrostatic interactions. Adsorptions of Y(III) and Ce(III) on FeNPs conformed to pseudo second-order kinetics and the Langmuir isotherm model with maximum adsorption capacities of 5.10 and 0.695 mg∙g-1, respectively. The desorption efficiencies of Y(III) and Ce(III) were, respectively, 95.0 and 97.9% in 0.05 M acetic acid, where desorption involved competitive ion exchange between Y(III), Ce(III) and Zn(Ⅱ) with H+ contained in acetic acid and intraparticle diffusion. After four consecutive adsorption-desorption cycles, adsorption efficiencies for Y(III) and Ce(III) remained relatively high at 52.7% and 50.1%, respectively, while desorption efficiencies of Y(III) and Ce(III) were > 80.0% and 95.0%, respectively. Overall, excellent reusability suggests that FeNPs can practically serve as a potential high-quality selectivity material for recovering REEs from mining wastewaters.


High-performance liquid chromatography of amino acids, peptides and proteins. LXXV. Isolation of isohormones of bovine thyrotropin and lutropin.
Purification of bovine thyrotropin and lutropin by conventional soft-gel chromatographic methods is shown to yield microheterogeneous products. High-performance ion-exchange chromatography (HPIEC) can be used to purify these isohormones further for investigations into the structure/function role of glycoprotein microheterogeneity. Hormonal microheterogeneity is shown to be reflected in differences in surface-accessible charged groups, as demonstrated by HPIEC, and differences in net charge, as indicated by isoelectric focusing. Optimal separation of the glycoprotein hormones, based on protein charge, can therefore be achieved by a combination of these two methods.


A simple geometrical model of the electrostatic environment around the catalytic center of the ribosome and its significance for the elongation cycle kinetics.
The central function of the large subunit of the ribosome is to catalyze peptide bond formation. This biochemical reaction is conducted at the peptidyl transferase center (PTC). Experimental evidence shows that the catalytic activity is affected by the electrostatic environment around the peptidyl transferase center. Here, we set up a minimal geometrical model fitting the available x-ray solved structures of the ribonucleic cavity around the catalytic center of the large subunit of the ribosome. The purpose of this phenomenological model is to estimate quantitatively the electrostatic potential and electric field that are experienced during the peptidyl transfer reaction. At least two reasons motivate the need for developing this quantification. First, we inquire whether the electric field in this particular catalytic environment, made only of nucleic acids, is of the same order of magnitude as the one prevailing in catalytic centers of the proteic enzymes counterparts. Second, the protein synthesis rate is dependent on the nature of the amino acid sequentially incorporated in the nascent chain. The activation energy of the catalytic reaction and its detailed kinetics are shown to be dependent on the mechanical work exerted on the amino acids by the electric field, especially when one of the four charged amino acid residues (R, K, E, D) has previously been incorporated at the carboxy-terminal end of the peptidyl-tRNA. Physical values of the electric field provide quantitative knowledge of mechanical work, activation energy and rate of the peptide bond formation catalyzed by the ribosome. We show that our theoretical calculations are consistent with two independent sets of previously published experimental results. Experimental results for E.coli in the minimal case of the dipeptide bond formation when puromycin is used as the final amino acid acceptor strongly support our theoretically derived reaction time courses. Experimental Ribo-Seq results on E. coli and S. cerevisiae comparing the residence time distribution of ribosomes upon specific codons are also well accounted for by our theoretical calculations. The statistical queueing time theory was used to model the ribosome residence time per codon during nascent protein elongation and applied for the interpretation of the Ribo-Seq data. The hypo-exponential distribution fits the residence time observed distribution of the ribosome on a codon. An educated deconvolution of this distribution is used to estimate the rates of each elongation step in a codon specific manner. Our interpretation of all these results sheds light on the functional role of the electrostatic profile around the PTC and its impact on the ribosome elongation cycle.


Prediction of sub-pyramid texturing as the next step towards high efficiency silicon heterojunction solar cells.
The interfacial morphology of crystalline silicon/hydrogenated amorphous silicon (c-Si/a-Si:H) is a key success factor to approach the theoretical efficiency of Si-based solar cells, especially Si heterojunction technology. The unexpected crystalline silicon epitaxial growth and interfacial nanotwins formation remain a challenging issue for silicon heterojunction technology. Here, we design a hybrid interface by tuning pyramid apex-angle to improve c-Si/a-Si:H interfacial morphology in silicon solar cells. The pyramid apex-angle (slightly smaller than 70.53°) consists of hybrid (111)0.9/(011)0.1 c-Si planes, rather than pure (111) planes in conventional texture pyramid. Employing microsecond-long low-temperature (500 K) molecular dynamic simulations, the hybrid (111)/(011) plane prevents from both c-Si epitaxial growth and nanotwin formation. More importantly, given there is not any additional industrial preparation process, the hybrid c-Si plane could improve c-Si/a-Si:H interfacial morphology for a-Si passivated contacts technique, and wide-applied for all silicon-based solar cells as well.


Management of isolated tubal torsion in a premenarchal adolescent female with prior oophoropexy: a case report and review of the literature.
Isolated tubal torsion in a premenarchal adolescent girl is a rare phenomenon. Preoperative diagnosis remains a challenge. A 14-year-old premenarchal girl, with a history of bilateral ovarian torsion treated by laparoscopic detorsion and oophoropexy two years prior, presented to the emergency room with lower abdominal pain accompanied by nausea and vomiting. Pelvic ultrasound demonstrated an enlarged left adnexa. Diagnostic laparoscopy revealed an isolated left tubal torsion. Surgical evidence of previous bilateral plication of the utero-ovarian ligaments was confirmed. Untwisting of the left fallopian tube immediately restored the vascular supply. Subsequently, her symptoms resolved. Clinicians should consider torsion of the fallopian tube in the differential diagnosis of lower abdominal pain in all female patients. Prompt laparoscopic intervention is essential. Oophoropexy, while usually efficacious, may not prevent recurrence.


Interactions between heavy metals and sleep duration among pre-and postmenopausal women: A current approach to molecular mechanisms involved.
The effects of heavy metals (cadmium, lead, and mercury) and their mixtures on sleep duration in pre-and postmenopausal women, particularly the molecular mechanisms, remain unknown. Here, we assessed the interaction between heavy metals and sleep duration among pre-and postmenopausal women (n = 1134). Furthermore, molecular mechanisms related to sleep disorders induced by studied heavy metals were further analyzed to support the previous findings. We found that serum lead levels were positively related to weekend and weekday sleep duration in premenopausal women. There were interactions between serum lead and mercury and menopausal status for sleep duration. Serum lead and mercury levels were shown to be inversely related to sleep duration in postmenopausal women. Despite the lack of statistically significant associations between mixed heavy metals and sleep duration, there were increasing trends in premenopausal women's sleeping patterns and decreasing trends in postmenopausal women's sleeping patterns. In silico analysis, IL1B, hsa-21-5p, hsa-887-3p, hsa-877-3p, and NR4A1 were identified as the most relevant genes, miRNAs, and transcription factors linked with sleep disorders induced by combined heavy metals (cadmium, lead, and mercury). Furthermore, "type 1 melanocortin receptor binding," "endocrine hormone secretion," "interleukin-1 receptor antagonist activity," "altered melanocortin system," and "sleep wake disorders" were identified as the predominant molecular mechanisms involved in the pathophysiology of sleep disorders induced by the studied heavy metals. Cut off point values and miRNA sponge templates for heavy metal exposure levels relevant to sleep disorders in pre- and postmenopausal women were reported. Future research is needed to verify our findings and provide insight into the molecular processes of long-term mixed heavy metal exposure in various populations, such as children and the elderly.


Factors associated with dietary acculturation among international students at the University of Georgia.
Western diet is associated with chronic disease risk, and degree of dietary acculturation can impact susceptibility. This study sought to understand the factors associated with changes in food consumption habits among international students at a large public university in the southern US. A convenience sample of 173 international students representing 41 countries at The University of Georgia participated in the survey. This cross-sectional online survey assessed dietary habits, perception of healthy eating, and level of acculturation using previously validated measures. Highest number of participants were from China (19.2%), 89.0% were graduate students with an average age of 27.5 ± 4.83 years. The majority (62.0%) of participants were dietary acculturated with affordability and accessibility determining types of food consumption, as fewer whole foods and more processed foods were consumed in the U.S. Findings suggest dietary acculturation may be driven by economic factors, making the transition to Westernized food items a convenient and cost-effective choice among international students.


"Tooth worms", poverty tattoos and dental care conflicts in Northeast Brazil.
While medical anthropologists have studied doctor-patient clinical conflicts during the last 25-30 years, dentist-patient communication clashes have received scant attention to date. Besides structural barriers and power inequities, such conceptual differences further dehumanize dental care and lower service quality. Potential for dentist-patient discordance is greater in developing regions--such as Northeast Brazil--where there exists a wider socio-economic gap between professionals and laypersons. A critical anthropological evaluation of oral health services quality is undertaken in two rural communities in Ceará, Brazil where the PAHO-inspired Local Oral Health Inversion of Attention Program was implemented in 1994. This 6-month qualitative field study utilized ethnographic interviews with key informants, participant-observation and projective techniques to probe professionals' and patients' explanatory models (EMs) of oral health. Despite the recent expansion of services into rural regions, the authors conclude that the quality of dental care remains problematic. Patients' culturally constructed EMs of teeth rotted (estraga) by "tooth worms" (lagartas) differ substantively from dentists' model of dental decay by Streptococcus mutans. "Exploding chins" (queixo estourado), "spoiled, rotting teeth" (dente pĵdi) and "false plates" or teeth (chapas) tattoo and stigmatize the poor, reinforcing gross class inequities. Dentists' dominant discourse largely ignores lay logic, ridicules popular practices and de-legitimates, even castigates, popular healers despite their pivotal role in primary oral health care. Poor parents are not only barred from clinics but are blamed for children's rotten teeth. In sum, universal access to dental care is more a myth (even nightmare) than a reality. Dentists all too often "avert"--not "invert"--attention from poor Brazilian patients. In order to improve oral health in this setting, both "societal decay" and bacteria-laden plaque deposits must be removed.


The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study.
There are well-documented barriers to nurse participation in cancer multidisciplinary team (MDT) meetings. This paper aims to identify the approaches used by Clinical Nurse Specialists (CNSs) in this setting to contribute during discussion, and to consider the impact of these approaches on the decision making process. In doing so it aims to highlight ways that CNSs can increase their influence, and enhance multidisciplinary engagement. This study is based on analysis of observation data from 122 MDT meetings in gynaecology, haematology and skin cancer MDTs. Field notes were reviewed, identifying 58 cases where CNSs contributed to MDT discussion. Audio recordings of the relevant sections were then transcribed and analysed thematically. Five approaches were used by CNSs to contribute in MDT meetings: sharing information, asking questions, providing practical suggestions, framing and using humour. These approaches influenced three key intermediary processes identified during the analysis ('successful contributions'): prompting discussion, influencing a treatment plan and facilitating teamwork. CNSs contributed successfully in cases where medical factors (such as relapsed disease or complex comorbidities) or non-medical factors (such as strong patient preference), had the potential to impact on the ability of teams to deliver treatment. CNSs have an important role in cancer MDT meetings. By focusing on a subset of cases where CNSs contributed during MDT discussion, this study has provided an insight into approaches that can be adopted by CNSs to increase their influence on the decision making process, enabling teams to capitalise on their knowledge and expertise in MDT meetings.


Effect of photodynamic therapy on microleakage of class V composite restorations in primary teeth.
Photodynamic therapy (PDT) is a treatment by which, light sensitive chemicals are activated at a specific wavelength, generating reactive oxygen species which can be antimicrobial and assist in disinfection. However, the oxygen radicals may interfere with the bonding process. The purpose of this study was to assess the effect of PDT with different photosensitizers on microleakage of composite restorations. Seventhy-two primary teeth with sound labial/buccal and lingual surfaces were collected for this study. The teeth were randomly divided into four groups of control, PDT with indocyanine green, PDT with methylene blue, and PDT with toluidine blue. Next, the cavities were restored with composite resin. The specimens were stained with 0.5 % Fuchsine and sectioned. The specimens were observed under a microscope to determine the microleakage score. The microleakage was compared between the groups and between the occlusal and cervical walls in each group. Data were analyzed using SPSS version 25. According to the kruskal-wallis test, no significant difference was observed in microleakage between the groups in the occlusal wall (p = 0.859). However, there was a significant difference in the cervical wall between the control and toluidine blue (p = 0.019), and the control and methylene blue (p = 0.008) groups. The Wilcoxon test showed a significant difference in microleakage (p < 0.05) between the occlusal and cervical walls within each group. PDT may be used in cavities with enamel margins to decrease the microbial load and prevent secondary caries. PDT is not recommended for cavities with cementum margins. Alternatively, it can be performed with indocyanine green as photosensitizer in such cases.


Genome-wide analysis of heavy metal ATPases (HMAs) in Poaceae species and their potential role against copper stress in Triticum aestivum.
Plants require copper for normal growth and development and have evolved an efficient system for copper management based on transport proteins such as P1B-ATPases, also known as heavy metal ATPases (HMAs). Here, we report HMAs in eleven different Poaceae species, including wheat. Furthermore, the possible role of wheat HMAs in copper stress was investigated. BlastP searches identified 27 HMAs in wheat, and phylogenetic analysis based on the Maximum Likelihood method demonstrated a separation into four distinct clades. Conserved motif analysis, domain identification, gene structure, and transmembrane helices number were also identified for wheat HMAs using computational tools. Wheat seedlings grown hydroponically were subjected to elevated copper and demonstrated toxicity symptoms with effects on fresh weight and changes in expression of selected HMAs TaHMA7, TaHMA8, and TaHMA9 were upregulated in response to elevated copper, suggesting a role in wheat copper homeostasis. Further investigations on these heavy metal pumps can provide insight into strategies for enhancing crop heavy metal tolerance in the face of heavy metal pollution.


Noninvasive method for determination of immobilized protein A.
The pH transition method, developed for the determination of the ion-exchange group density on chromatographic stationary phase, was used for the quantification of immobilized protein A. Monolithic epoxy polyHIPE and particulate CNBr-Sepharose supports were used for immobilization. A lactate buffer was selected, having a buffer capacity peak approximately 0.5 pH units below the maximum buffer capacity of protein A. The pH transition measurements were performed at pH 4.3, where protein A exhibits maximum buffer capacity, with a lactate buffer concentration of 1 mM for protein A immobilized on polyHIPE monoliths and of 5 mM for protein A immobilized on CNBr-Sepharose. The pH transition height and full width at half maximum for the particulate support and the height for the polyHIPE matrix, showed a linear correlation with the amount of immobilized protein A determined from the absorbance difference before and after immobilization for both supports. The developed method allows a simple, non-invasive on-line determination of immobilized protein A using biological buffers, even for chromatographic columns with an amount of immobilized protein A as low as 0.25 mg. In addition, its sensitivity and duration can be easily adjusted by varying the buffer concentration and pH.


Changing preferences for information and participation in the last phase of life: a longitudinal study among newly diagnosed advanced lung cancer patients.
The objective is to explore changes over time in the information and participation preferences of newly diagnosed stage IIIb/IV non-small-cell lung cancer patients. Patients were recruited by physicians in 13 hospitals and interviewed every 2 months until the fourth and every 4 months until the sixth interview. Sixty-seven patients were interviewed three times. Over a period of 4 months from diagnosis, half of patients changed their information preferences for palliative care and end-of-life decisions with a possible or certain life-shortening effect (ELDs, e.g., non-treatment decisions) in both directions, from not wanting to wanting the information, but also--and as much--from wanting to no longer wanting it. The latter were more likely to be in a better physical condition. Preferences for participation in medical decision making also changed: 50% to 78%, depending on the type of decision (general, treatment, transfer or ELD), changed their preference towards wanting more or less participation. Pain seemed to be a trigger for patients wanting more involvement, which contrasts with studies suggesting that patients who are more ill tend to give up more control. Doctors should regularly ask their advanced lung cancer patients how much information and participation they want because preferences do change in unexpected ways.


Combined Type III and Type II Endoleaks after Endovascular Aneurysm Repair: Presentation of 2 Cases and a Literature Review.
Although endovascular aneurysm repair is a feasible option for high-risk patients resulting in lower perioperative mortality when compared with open repair, the need for reintervention and long-term follow-up affects its use. The aim of the current report is to present 2 cases of patients with type IIIa endoleak from limb disconnection (one patient with double-bilateral endoleak) combined with a late type II endoleak and symptomatic sac growth treated in our department. We also performed a literature review about type III endoleaks and their treatment options.


The effect of relaxants working through different transduction mechanisms on the tonic contraction produced in rat aorta by 4 beta-phorbol dibutyrate.
1. We have examined the effects of a range of smooth muscle relaxants on the maintained contractions produced in rat aortic rings by the protein kinase C activator, 4 beta-phorbol dibutyrate; these effects were compared with those on the contraction induced by the selective alpha 1-adrenoceptor agonist, methoxamine. The phorbol ester, at 0.3 microM, gave a sustained contraction which was, on average, of approximately the same magnitude as the maximum contraction produced by methoxamine, 10 microM. 2. The beta-adrenoceptor agonist, isoprenaline (0.01-1 microM) caused a dose-related relaxation of the methoxamine-induced contraction but had no effect on the contraction induced by the phorbol ester. 3. An activator of adenylate cyclase, forskolin (0.01-1 microM) produced a dose-related relaxation of the methoxamine-induced contraction and at 0.01-10 microM caused relaxation of the contraction induced by the phorbol ester. Similar results were obtained with the potassium channel activator, cromakalim (0.001-10 microM). 4. An activator of guanylate cyclase, sodium nitroprusside (0.001-100 microM) caused a dose-related relaxation of both the methoxamine-induced and the phorbol ester-induced contraction, being more effective on the former than on the latter. Similar results were obtained with enprofylline (1-1000 microM). 5. Methoxamine (10 nM-100 microM), given cumulatively, caused a dose-related contractile response. Pretreatment with isoprenaline (1 microM), enprofylline (10 microM) and nicorandil (1 microM) resulted in partial decrease of the subsequent response to methoxamine, while nicorandil (10 microM), forskolin (1 microM), sodium nitroprusside (10 microM) and cromakalim (1 microM) totally abolished it. 6. The phorbol ester, given cumulatively, caused increasing contraction in the concentration range 30 nM-10 microM. Pretreatment with forskolin (1 microM), sodium nitroprusside (10 microM), isoprenaline (1 microM), enprofylline (10 microM), nicorandil (1 microM or 10 microM), or cromakalin (1 microM or 10 microM), resulted in partial decrease of the subsequent response to 4 beta-phorbol dibutyrate. 7. These results are discussed in the light of the suggestion that protein kinase C may have a role in the 'latch-bridge' phase of smooth muscle contraction, and that inappropriate activation of protein kinase C may contribute to the pathogenesis of hypertension and other conditions involving vasospasm.


Feeding strategies for the enhanced production of α-arbutin in the fed-batch fermentation of Xanthomonas maltophilia BT-112.
To develop a cost-effective method for the enhanced production of α-arbutin using Xanthomonas maltophilia BT-112 as a biocatalyst, different fed-batch strategies such as constant feed rate fed-batch, constant hydroquinone (HQ) concentration fed-batch, exponential fed-batch and DO-control pulse fed-batch (DPFB) on α-arbutin production were investigated. The research results indicated that DPFB was an effective method for α-arbutin production. When fermentation with DO-control pulse feeding strategy to feed HQ and yeast extract was applied, the maximum concentrations of α-arbutin and cell dry weight were 61.7 and 4.21 g/L, respectively. The α-arbutin production was 394% higher than that of the control (batch culture) and the molar conversion yield of α-arbutin reached 94.5% based on the amount of HQ supplied (240 mM). Therefore, the results in this work provide an efficient and easily controlled method for industrial-scale production of α-arbutin.


Sex steroids in diploid and triploid gibel carp (Carassius gibelio) of both sexes in different phases of the reproductive cycle.
The changes in concentrations of 17ß-estradiol (E2), testosterone (T), 11-ketotestosterone (11-KT) in the gonads and plasma of diploid and triploid gibel carp (Carassius gibelio) from the Siemianowka Reservoir, the Vistula River drainage were quantified and compared using an enzyme immunoassay. The phase of gonad maturity was based on histological analysis and the gonadosomatic index. All fish had properly developed gonads in the pre-spawning, spawning and late spawning phases of the reproductive cycle in the fish collected in April, June and October, respectively. Diploid and triploid females and males did not differ in mean GSI in all reproductive phases. In October, ovaries of most females contained vitellogenic oocytes, testes had large numbers of spermatozoa. The hormone concentrations in both tissues depended mainly on the reproductive phase, but not on ploidy. The patterns of changes in E2 concentrations was similar in females and males. In the pre-spawning phase, diploid and triploid females showed differences in the concentrations of 11-KT in gonads and plasma, and T in plasma. Diploid males differed in pattern of T concentrations in gonads and plasma, while all males showed a similar pattern of 11-KT plasma concentrations. Spermatozoa observed in triploid males suggest that they participate in reproduction. Gibel carps, regardless of ploidy, had an extended period of reproduction, which makes this invasive species a potentially greater threat to native ichthyofauna. The sex androgen concentrations that differed between 2 n and 3 n females could be physiological factors potentially contributing to the coexistence of gynogenetic C. gibelio females and sexual diploids.


Conformational stability and self-association equilibrium in biologics.
Biologics exist in equilibrium between native, partially denatured, and denatured conformational states. The population of any of these states is dictated by their Gibbs energy and can be altered by changes in physical and solution conditions. Some conformations have a tendency to self-associate and aggregate, an undesirable phenomenon in protein therapeutics. Conformational equilibrium and self-association are linked thermodynamic functions. Given that any associative reaction is concentration dependent, conformational stability studies performed at different protein concentrations can provide early clues to future aggregation problems. This analysis can be applied to the selection of protein variants or the identification of better formulation solutions. In this review, we discuss three different aggregation situations and their manifestation in the observed conformational equilibrium of a protein.


[Histological investigations on adrenal cortex of sand rats (Psammomys obesus) during development of the diabetes mellitus (author's transl)].
The investigations were carried out on 20 sand rats (6 prediabetic, 6 diabetic and 8 normoglycemic animals). The cortices of adrenal glands were studied with histological methods. The thickness of the zona glomerulosa is in this 3 groups different. In the prediabetic group is the zona glomerulosa higher, in the diabetic group lower than the normoglycemic group. The relationship is 1.5 (normoglycemic group) : 2.9 (prediabetic group) : 0.8 (diabetic group). It is concluded that the zona glomerulosa in the prediabetic group is stimulated.


Effects of alcohol consumption during pregnancy on subsequent maternal behaviour in rats.
Nine Holtzman rats were maintained from days 5-18 of pregnancy on a liquid diet of which ethanol constituted 35% of the calories while nine rats were pair-fed an isocaloric diet that had maltose-dextrin substituted for the ethanol. Beginning on day 19 of gestation and continuing for five days the dams in both groups were given a choice among lab chow, water, and their respective liquid diets. During the five days of choice, alcohol consumption dropped to approximately 20% of pre-choice levels. The dams and pups showed no behavioural withdrawal symptoms. While the alcohol-treated litters showed greater variability in litter size and more pup deaths during nursing, the maternal behaviour of the alcohol dams was essentially normal, with only their pup protectiveness being rated lower than that of the control dams.


Cuticular hydrocarbons suggest three lineages in Reticulitermes (Isoptera: Rhinotermitidae) from North America.
Cuticular hydrocarbon mixtures can be used to discriminate insect taxa. They have utility for determining phylogenetic relationships where they are independent characters with discrete states and represent a hierarchical distribution of shared, derived characters. We report inferred degrees of relatedness among the chemical phenotypes of Reticulitermes from PAUP (phylogenetic analysis using parsimony) analyses of cuticular hydrocarbon characters. One hundred and forty-one Reticulitermes colonies collected from California, Georgia, New Mexico, Arizona and Nevada were used. Initial maximum parsimony analyses sorted the 141 colonies into 26 chemical phenotypes. Subsequent analyses, using the ancestral species Coptotermes formosanus and Heterotermes sp. as outgroups, sorted Reticulitermes taxa into three major lineages, each characterized by a different set of dominant methyl-branched or unsaturated hydrocarbon components. Reticulitermes in lineage I have cuticular hydrocarbon mixtures with a preponderance of internally branched monomethylalkanes and 11,15-dimethylalkanes. Those in lineage II are defined by a preponderance of 5-methylalkanes and 5,17-dimethylalkanes. Taxa in lineage III are characterized by the predominance of olefins and a relative paucity of n-alkanes and methyl-branched alkanes. Bootstrap analyses and decay indices provided statistical support and robustness for these chemical-based relationships.


Exacerbation of autoimmune pulmonary alveolar proteinosis that improved with lone treatment of complicating nontuberculous mycobacterial infection: A case report.
Herein, we present the case of a 63-year-old man with autoimmune pulmonary alveolar proteinosis (APAP) complicated by Mycobacterium avium complex (MAC) infection. APAP was diagnosed based on serum anti-granulocyte-macrophage colony-stimulating factor antibody, bronchoalveolar lavage fluid (BALF) findings, and transbronchial lung biopsy. Nodular shadows with cavities were visible on chest CT images, and Mycobacterium intracellulare was identified by BALF culture. Rifampicin, ethambutol, and clarithromycin were administered, and 4 months later, the nodular shadows of MAC had disappeared, and APAP was remarkably improved. Thus, in cases of APAP exacerbation complicated with infections, such as MAC, control of the infections may improve APAP.


Development of a solid-phase microextraction-gas chromatography-tandem mass spectrometry method for the analysis of chlorinated toluenes in environmental waters.
In the present work, a simple and fast methodology has been developed for the analysis of chlorotoluenes in water samples using solid-phase microextraction (SPME) coupled to gas chromatography-tandem mass spectrometry (GC/MS/MS). A multifactorial experimental design strategy was used for studying the influence on extraction yield of factors such as fiber coating, extraction mode, temperature, and addition of sodium chloride. Quantitative recoveries (>/=84%) and satisfactory precision (relative standard deviations (RSD)</=12%) have been obtained. Limits of detection (LODs) in the sub-picogram per litre level from 0.030 to 0.330 were achieved for all analyzed compounds. Linearity was studied in a wide range of concentrations and an analysis of variance with a lack-of-fit test was run to validate the calibration data. Extraction time profiles were also studied, showing that most of chlorotoluenes reached the equilibrium or were close to it. Finally, the applicability of the proposed method has been demonstrated for real samples including river and sewage water samples. Since no matrix effects were observed, quantification could readily be carried out by external calibration with ultrapure water standards.


Genome-wide prediction using Bayesian additive regression trees.
The goal of genome-wide prediction (GWP) is to predict phenotypes based on marker genotypes, often obtained through single nucleotide polymorphism (SNP) chips. The major problem with GWP is high-dimensional data from many thousands of SNPs scored on several thousands of individuals. A large number of methods have been developed for GWP, which are mostly parametric methods that assume statistical linearity and only additive genetic effects. The Bayesian additive regression trees (BART) method was recently proposed and is based on the sum of nonparametric regression trees with the priors being used to regularize the parameters. Each regression tree is based on a recursive binary partitioning of the predictor space that approximates an unknown function, which will automatically model nonlinearities within SNPs (dominance) and interactions between SNPs (epistasis). In this study, we introduced BART and compared its predictive performance with that of the LASSO, Bayesian LASSO (BLASSO), genomic best linear unbiased prediction (GBLUP), reproducing kernel Hilbert space (RKHS) regression and random forest (RF) methods. Tests on the QTLMAS2010 simulated data, which are mainly based on additive genetic effects, show that cross-validated optimization of BART provides a smaller prediction error than the RF, BLASSO, GBLUP and RKHS methods, and is almost as accurate as the LASSO method. If dominance and epistasis effects are added to the QTLMAS2010 data, the accuracy of BART relative to the other methods was increased. We also showed that BART can produce importance measures on the SNPs through variable inclusion proportions. In evaluations using real data on pigs, the prediction error was smaller with BART than with the other methods. BART was shown to be an accurate method for GWP, in which the regression trees guarantee a very sparse representation of additive and complex non-additive genetic effects. Moreover, the Markov chain Monte Carlo algorithm with Bayesian back-fitting provides a computationally efficient procedure that is suitable for high-dimensional genomic data.


A new NOTCH3 damaging variant in a thrombocytopenia family of Miao ethnic group.
Pediatric inherited thrombocytopenia, also known as a deficiency of platelets in children, is caused by genetic factors and it is hard to obtain an effective treatment. Thus, it is necessary to identify the possible genetic variants that are responsible for thrombocytopenia. Whole exome sequencing was used to detect genetic variants in two members of a thrombocytopenia family of Miao ethnic group. Multiple in silico analyses were performed to evaluate the effects of the novel missense variants. Finally, a novel variant (chr19: g.15170364G>A) in the NOTCH3 gene was found, as confirmed with Sanger sequencing, which could result in a R1694Q substitution in the protein. This variant was consistently suggested to be damaging by sift (Sorting Tolerant From Intolerant; http://sift.jcvi.org), polyphen (Polymorphism Phenotyping, version 2.0; http://genetics.bwh.harvard.edu/pph2) and mutationtaster (http://www.mutationtaster.org) software. By building the 3D model of the key region of NOTCH3 protein and performing the structure simulation, we found that (i) this variant affected the 3D structure model with a root-mean-square deviation = 0.46 between wild-type and mutant type; (ii) this variant caused the protein to reduce the solvent accessible surface area by 421 Å2 ; and (iii) compared to the wild-type protein, the mutant protein had two less amino acids to maintain protein stability. A novel damaging variant in the NOTCH3 gene was identified in a thrombocytopenia family with respect to decreasing the stability of NOTCH3, which may help with the prognosis and therapy of inherited thrombocytopenia.


Suppression function against environmental dust exposure after Dermatophagoides pteronyssinus immunotherapy is associated with production of specific and cross-reactive immunoglobulin G4.
Whether Dermatophagoides pteronyssinus (Der-p) allergen immunotherapy (AIT) can induce Dermatophagoides farina (Der-f)-specific immunoglobulin (sIg) G4 production, and tolerance to environmental allergens has not been fully investigated. We aimed to determine serum Der-p-sIgG4 and Der-f-sIgG4 levels in asthma and/or rhinitis patients undergoing Der-p AIT and their ability to reduce immune responses triggered by indoor dust extracts. We performed a real-world prospective trial and enrolled patients with allergic rhinitis and/or asthma in Guangzhou, China. These patients received either Der-p AIT (SCIT group) or routine medications (non-SCIT group) for 156 weeks. Clinical outcomes were assessed by the combined symptom medication score (SMS) and FEV1 % changes. House dust samples were collected to analyse allergen levels. Serum levels of Der-p-sIgG4 and Der-f-sIgG4, serum inhibitory capacity against Der-p, Der-f and indoor dust extract by sIgE-facilitated allergen binding to B cells (IgE-FAB), and serum blocking indoor dust extract-induced basophil activation inhibition assays (BATI) in peripheral blood monocytes were carried out at weeks 0, 4, 12, 16, 52, 104 and 156 after the initiations of the treatments. Our study enrolled a total of 60 participants, with 30 patients in each group. Patients in the SCIT group had significantly improved SMS when compared with the baseline and the patients in the non-SCIT group. Median levels of Der-p 1 and Der-f 1 in indoor dust extract were 1.86 μg/g and 4.74 μg/g, respectively. Serum Der-p-sIgG4 and Der-f-IgG4 levels in SCIT patients showed a significant increase from weeks 12 to 156. Serum in these SCIT patients could significantly block Der-p, Der-f and indoor dust extract formation of allergen-sIgE complex and reduced the threshold of IgE-FAB from 16 weeks after the initiation of the treatment. The capacity to inhibit Der-p, Der-f and indoor dust extract BATI was observed in SCIT serum after 12 weeks. Der-p-sIgG4 and Der-f-sIgG4 had a significant correlation with IgE-FAB and BATI in SCIT patients at all time points. Single Der-p immunotherapy induced both Der-p-sIgG4 and Der-f-sIgG4 production, which might cross-reactively induce tolerance against environmental allergen exposure in patients with asthma and/or rhinitis.


Patterning chemical stimulation of reconstructed neuronal networks.
A spatially resolved delivery of substances integrated with cell culture substrates shows promise for application in pharmacological assays, bioanalytical studies on cell signaling pathways and cell-based biosensors, where control over the extracellular biochemical environment with a cellular resolution is desirable. In this work, we studied a biohybrid system where rat embryonic cortical neuronal networks are reconstructed on microstructured silicon chips and interfaced to microfluidics. The design of cell-cell and cell-medium interactions in confined geometries is presented. We developed an aligned microcontact printing technique (AmicroCP) for poly(lysine)-extracellular matrix proteins on microstructured chips, which allows a high degree of geometrical control over the network architecture and alignment of the neuronal network with the microfluidic features of a substrate. Spatially resolved on-chip delivery of compounds with a cellular resolution is demonstrated by chemical stimulation of patterned rat cortical neurons within a network with a number of solutions of excitatory neurotransmitter glutamate delivered via microfluidics. The combination of the system described with a patch-clamp technique allowed both modulation of the biochemical environment on a cellular level and the monitoring of electrophysiological properties in the reconstructed rat embryonic cortical networks changed by this microenvironment.


Self-supervised learning with application for infant cerebellum segmentation and analysis.
Accurate tissue segmentation is critical to characterize early cerebellar development in the first two postnatal years. However, challenges in tissue segmentation arising from tightly-folded cortex, low and dynamic tissue contrast, and large inter-site data heterogeneity have limited our understanding of early cerebellar development. In this paper, we propose an accurate self-supervised learning framework for infant cerebellum segmentation. We validate its accuracy using 358 subjects from three datasets. Our results suggest the first six months exhibit the most rapid and dynamic changes, with gray matter (GM) playing a dominant role in cerebellar growth over white matter (WM). We also find both GM and WM volumes are larger in males than females, and GM and WM volumes are larger in autistic males than neurotypical males. Application of our method to a larger population will fuel more cerebellar studies, ultimately advancing our comprehension of its structure and function in neurotypical and disordered development.


Effects of combined endothelin and angiotensin II antagonism on growth factor-induced proliferation of vascular smooth muscle cells isolated from uremic rats.
The activation of both the renin-angiotensin-aldosterone and endothelin (ET) system in uremia contributes to the development of cardiovascular disease. The combination of ET receptor antagonists and inhibitors of the angiotensin-converting enzyme (ACE) or angiotensin II type 1 (AT,) receptor could therefore inhibit atherogenesis. We studied the effects of different medications on growth-factor-induced proliferation of vascular smooth muscle cells (VSMC) isolated from uremic rats. Subtotally nephrectomized rats (SNX) were treated with an ETA receptor antagonist, losartan, trandolapril, or the combinations of an ETA receptor antagonist and losartan or trandolapril for 12 weeks. Proliferation induced by different growth factors in isolated aortal SMC was measured using a BrdU-ELISA. Maximum proliferation in response to PDGF-BB, bFGF, and TNF-alpha which was higher in untreated SNX than in controls (PDGF-BB: 486.60 +/- 8.27% versus 346.74 +/- 4.60%, n=8), was reduced after monotherapy with losartan or the ETA receptor antagonist. VSMC from trandolapril-treated rats showed an increased response to all growth factors (PDGF-BB: 663.48 +/- 7.00%, n=8). After combined therapy with the ETA receptor antagonist and trandolapril, maximum proliferation was lower than in untreated SNX (PDGF-BB: 162.6 +/- 1.40%; n=8; p < or = 0.01). Combined treatment with losartan and the ETA receptor antagonist attenuated the maximum levels of VSMC proliferation induced by PDGF-BB, bFGF, and TNF. In contrast to an increased response after trandolapril monotherapy, combined treatment of SNX with an ETA receptor antagonist and trandolapril reduced growth-factor-induced VSMC proliferation in vitro. Further investigations in uremic patients have to clarify whether the combination of endothelin receptor antagonists and ACE inhibitors inhibits atherogenesis.


Juvenile Antarctic rockcod (Trematomus bernacchii) are physiologically robust to CO2-acidified seawater.
To date, numerous studies have shown negative impacts of CO2-acidified seawater (i.e. ocean acidification, OA) on marine organisms, including calcifying invertebrates and fishes; however, limited research has been conducted on the physiological effects of OA on polar fishes and even less on the impact of OA on early developmental stages of polar fishes. We evaluated aspects of aerobic metabolism and cardiorespiratory physiology of juvenile emerald rockcod, ITALIC! Trematomus bernacchii, an abundant fish in the Ross Sea, Antarctica, to elevated partial pressure of carbon dioxide ( ITALIC! PCO2 ) [420 (ambient), 650 (moderate) and 1050 (high) μatm ITALIC! PCO2 ] over a 1 month period. We examined cardiorespiratory physiology, including heart rate, stroke volume, cardiac output and ventilation rate, whole organism metabolism via oxygen consumption rate and sub-organismal aerobic capacity by citrate synthase enzyme activity. Juvenile fish showed an increase in ventilation rate under high ITALIC! PCO2 compared with ambient ITALIC! PCO2 , whereas cardiac performance, oxygen consumption and citrate synthase activity were not significantly affected by elevated ITALIC! PCO2 Acclimation time had a significant effect on ventilation rate, stroke volume, cardiac output and citrate synthase activity, such that all metrics increased over the 4 week exposure period. These results suggest that juvenile emerald rockcod are robust to near-future increases in OA and may have the capacity to adjust for future increases in ITALIC! PCO2 by increasing acid-base compensation through increased ventilation.


Estimation of population productivity of Parapleurus alliaceus Germar (Orthoptera: Acridiidae) on a Miscanthus sinensis Anders. grassland : I. Estimation of population parameters.
To assess the population productivity of the grasshopper Parapleurus alliaceus Germar in a Miscanthus sinensis Anders. grassland, estimates of population density, survival, and dilution rates were attempted using the mark-release-recapture method. No significant departure from the random-catch hypothesis, which is the basic pre-requisite for the estimation of population parameters, was discovered. A comparison between the results of two experiments, attempted simultaneously in the same area of the grassland, indicated that the accuracy of the mark-release-recapture method was acceptable for our purpose. The population trends in 1968 and 1969 showed that mortality during the early nymphal instars was remarkably low (75% and 62%, respectively, for the period from the second instar nymph to adult), and that adult longevity was greater than 10 days. The number of nymphs hatched in 1969 was smaller than 1968, and the cause of this reduction was thought to be the predation of eggs during autumn and winter.


Trends in Lumbar Fusion Surgery Among Octogenarians: A Nationwide Inpatient Sample Study From 2004 to 2013.
Retrospective analysis. Given the aging US population and natural degenerative process of the spine, more elderly patients with lumbar spinal disease are surgical candidates. Prior studies have assessed safety and efficacy of lumbar fusion (LF) surgeries in the elderly, but none have reviewed fusion procedures from an epidemiological standpoint. Here, we report 2004-2013 national trends in demographics, discharge time, and economic impact of LF procedures for octogenarians. The Nationwide Inpatient Sample database was queried from 2004 to 2013 for LF procedures in patients aged 80 to 89 years. Patients were grouped by fusion level, demographics, comorbidity score, insurance, and hospital characteristics. Postoperative variables include length of stay and total in-hospital charges. Data was evaluated using chi-squared tests and t tests. The national sample included 17 471 LF procedures (mean age = 82.65 years). From 2004 to 2013, the annual number of LF procedures increased from 1144 to 2061 patients. Percentage of multilevel LF was relatively maintained (mean = 18%). The majority of patients were female (mean = 62%). The proportion of males increased during the study period (31.8% to 42.5%; P < .0001). The proportion of patients with a comorbidity score of 2 or 3 increased during the study period (P < .0001). Over time, average length of stay decreased (from 6 to 4.5 days; P < .0001), and total in-hospital charges increased (from $58 471 to $111 235; P < .0001). These results suggest that more lumbar fusion procedures are being performed on octogenarians in recent years. While these patients are discharged from hospitals more quickly after surgery, there is also greater financial burden placed on patients, hospitals, and society.


Epithelial-myoepithelial carcinoma of the parotid gland with adenoid cystic carcinoma-like features: a case report with immunohistochemical study.
A 69-year-old japanese female with epithelial myoepithelial carcinoma (EMC) in the parotid gland is reported. The tumor, 3.5 x 4.0 x 1.5 cm in size, was located in the left parotid gland. Histopathological examination of the surgically removed tumor revealed that it was composed of double-layered, tubule-like structures formed by inner eosinophilic ductal cells and outer clear cells, as well as solid clear cell nests. The unique histological finding of this tumor was that it had a cribriform-like arrangement of myoepithelial cells resembling an adenoid cystic carcinoma. On the other hand, the typical ductal and myoepithelial components of EMC showed the usual biphasic pattern and the expected immunophenotypes, with expression of low molecular weight cytokeratins, CAM 5.2 and EMA in the ductal part, and smooth muscle actin, S-100 protein, and vimentin in the myoepithelial component.


[Selective IgA deficiency, DPH-treated epilepsy and polyarthritis (author's transl)].
A selected IgA deficiency was found in a 66 years old, DPH-treated epileptic female, suffering from polyarthritis. Familial survey brings information for genetic transmission of IgA decreased concentrations in her offspring, unrelated with HLA A, B, C system.


Oxytocin and arginine vasopressin stimulate steroid secretion by the isolated perfused rat adrenal gland.
Using the intact isolated perfused rat adrenal preparation we have shown for the first time a direct effect of oxytocin on adrenocortical steroid secretion. Oxytocin specifically stimulated aldosterone secretion in a dose-dependent manner with a threshold dose of 1 pmol. Arginine vasopressin was also shown to be a potent stimulus to aldosterone secretion and was additionally found to stimulate inner zone function. Using superfused adrenal cells, the effects of arginine vasopressin were only seen at 10,000 times higher doses than were effective in the intact perfused gland, and oxytocin had no effect at any dose. These results reinforce the hypothesis that tissue integrity is essential for full expression of steroidogenic control mechanisms. We conclude that oxytocin and vasopressin may play a role in the control of steroidogenesis.


Physical activity levels and body weight in a nationally representative sample in the European Union.
The main objectives of this pan-European study were: (1) to identify different types of physical activity and the time devoted to them, (2) to assess physical activity/inactivity at work and in leisure time, and (3) to determine self-reported body weight and height. In each member state of the EU, approximately 1000 adults, aged 15 years or more, were selected to participate in an interview-assisted face-to-face questionnaire on physical activity and body weight. In each country, sample selection was quota-controlled to ensure national representativeness. Overall, 15,239 subjects in the EU completed the study. On average in the EU, nearly three-quarters of the population participate in some kind of activity. In general, the highest proportions of participants were found in the Nordic countries and the lowest in the southern ones. At the European level, the five most common activities include walking, gardening, cycling, keep fit and swimming. Higher participation rates were found among men, younger subjects and those with a higher level of education. The majority of Europeans fall within the normal body mass index (BMI) range but more than one-third are overweight (31%) or obese (10%) and 11% have a BMI below 20. Several risk groups related to physical activity emerge from this survey: women, those with a lower level of education, older subjects, the overweight/obese and the underweight. Programmes to promote physical activity need to be tailored to the different groups identified in each country/region in order to increase adherence of non-participants and for the maintenance of those already engaged in activities.


High-order harmonics enhancement in laser-induced plasma.
The methods of enhancement of the strong high-order harmonics of femtosecond pulses in laser-induced plasma are demonstrated. It comprises the application of the four techniques allowing the enhancement of harmonics in different spectral ranges. Among them are the selection of targets for ablation to create the conditions for resonance enhancement of single harmonic, formation of the quasi-phase-matching of a spectrally tunable group of harmonics, application of the two-color pump of plasma, and the formation of nanoparticles-contained plasmas. The number of generated coherent XUV photons increased in the region of single resonantly enhanced harmonic (62 nm) and the shorter-wavelength region (30-50 nm). The above techniques of harmonics enhancement allowed a significant (up to 50 times) growth in a whole harmonic yield in the case of indium plasma. We discuss the reasons preventing the joint implementation of the four methods of harmonics enhancement in the same spectral region.


When are anti-fat attitudes understood as prejudice versus truth? An experimental study of social influence effects.
If people who hold anti-fat attitudes believe these attitudes to be true, then anti-prejudice appeals are likely to be unsuccessful, if only because the targets will not see their attitudes as in need of change. The current study examined processes that may lead people to see their anti-fat attitudes as 'truth' or as 'prejudice'. Participants (N = 482) read anti-fat statements and were then presented with an interpretation of these statements as 'truth' or 'prejudice'. The source of this interpretation was either an (i) in-group or out-group member and (ii) expert or non-expert. Participants' judgements of the statements were expected to vary such that in-group others and experts would exert more influence than would out-group others and non-experts. Participants aligned their own interpretations of an anti-fat statement with those of an expert, but not with those of a non-expert, F(1,466) = 8.97, p < 0.05, ηp 2 = 0.02. The group membership variable had no effect on judgements of 'truth' or 'prejudice' of the anti-fat statement. The expressions that people believe constitute anti-fat prejudice versus truth about people described as overweight are influenced by exposure to expert opinion (in this case, by medical doctors). Implications for the success of weight-based anti-prejudice appeals and for healthcare provision are discussed.


In vitro osteogenic capacity of bone marrow MSCs from postmenopausal women reflect the osseointegration of their cementless hip stems.
Age-related dysfunction of mesenchymal stromal cells (MSCs) is suggested as a main cause of altered bone repair with aging. We recently showed that in postmenopausal women undergoing cementless total hip arthroplasty (THA) aging, low bone mineral density (BMD) and age-related geometric changes of the proximal femur are risk factors for increased early migration and delayed osseointegration of the femoral stems. Extending these analyses, we have here explored how the in vitro osteogenic capacity of bone marrow MSCs from these patients reflects implant osseointegration, representing the patient's in vivo bone healing capacity. A total of 19 postmenopausal women with primary hip osteoarthritis (mean age 65 years, range 50-78) and well-defined bone quality underwent successful preoperative in vitro analysis of osteogenic capacity of iliac crest bone marrow MSCs as well as two-year radiostereometric (RSA) follow-up of femoral stem migration after cementless THA. In patients with MSCs of low osteogenic capacity, the magnitude of cumulative stem subsidence after the settling period of three months was greater (p = 0.028) and the time point for translational osseointegration was significantly delayed (p = 0.030) compared to patients with MSCs of high osteogenic capacity. This study suggests that patients with MSCs of low in vitro osteogenic capacity may display increased stem subsidence after the settling period of 3 months and thereby delayed osseointegration. Our study presents a novel approach for studying the biological progress of hip implant osseointegration and to verify the impact of decreased MSCs function, especially in patients with age-related dysfunction of MSCs and bone healing capacity.


DMSS--a computer-based diabetes monitoring system.
This paper describes a microcomputer-based decision support system (DSS) for diabetes monitoring. The system's basic functions include a patient management subsystem, an electronic logbook, a nutrition and exercise module, a dictionary for diabetes-related terminology, a diabetic-physician data transfer module and an on-line help capability. DMSS (Diabetes Monitoring Support System) provides a data capturing capability, trend analysis, and nutrition/exercise decision support to improve the monitoring and maintenance of diabetes. It was designed to be used by both a physician and a patient and can also serve as a useful teaching aid for a new diabetic. Its basic advantages lie in its comprehensiveness and flexibility. It is also user-friendly, easy to operate, and does not require any previous computer experience.


Ferritin-Mediated Iron Sequestration Stabilizes Hypoxia-Inducible Factor-1α upon LPS Activation in the Presence of Ample Oxygen.
Both hypoxic and inflammatory conditions activate transcription factors such as hypoxia-inducible factor (HIF)-1α and nuclear factor (NF)-κB, which play a crucial role in adaptive responses to these challenges. In dendritic cells (DC), lipopolysaccharide (LPS)-induced HIF1α accumulation requires NF-κB signaling and promotes inflammatory DC function. The mechanisms that drive LPS-induced HIF1α accumulation under normoxia are unclear. Here, we demonstrate that LPS inhibits prolyl hydroxylase domain enzyme (PHD) activity and thereby blocks HIF1α degradation. Of note, LPS-induced PHD inhibition was neither due to cosubstrate depletion (oxygen or α-ketoglutarate) nor due to increased levels of reactive oxygen species, fumarate, and succinate. Instead, LPS inhibited PHD activity through NF-κB-mediated induction of the iron storage protein ferritin and subsequent decrease of intracellular available iron, a critical cofactor of PHD. Thus, hypoxia and LPS both induce HIF1α accumulation via PHD inhibition but deploy distinct molecular mechanisms (lack of cosubstrate oxygen versus deprivation of co-factor iron).


Integrate carbon dynamic models in analyzing carbon sequestration impact of forest biomass harvest.
Biomass is an attractive natural energy resource for mitigating climate change. However, the loss of carbon sequestration as an ecosystem service due to biomass harvest has not been considered in previous studies. To assess the impact of biomass harvest on carbon sequestration, carbon dynamics in the forests and the atmosphere were integrated. The impact of forest biomass harvests on carbon sequestration was assessed based on the difference between carbon sequestration after harvest and carbon sequestration without harvest. A Chapman-Richards function and the forest vegetation simulator (FVS) were used to simulate the growth of a forest stand. The carbon dynamics in the atmosphere were simulated by the Bern2.5CC carbon cycle model. Characterization factors of the impact were calculated in three time horizons: 20-, 100- and 500-year. According to the simulations, postponement of harvest and low harvest intensity could prolong the compensation period. The annual impact on carbon sequestration was mostly negative over a short time and became positive in the end of compensation period. The highest characteristic factors of the impact on carbon sequestration were found in rotation length of 100years with the time horizon of 500-year in the Chapman-Richards simulation and in the lowest harvest intensity with the time horizon of 500-year in the FVS simulation. Based on the results, increasing growth rate, postponing harvest, reducing harvest intensity and increasing length of time horizon could reduce the impact of forest harvest on carbon sequestration. The method proposed in this study is more proper to assess the impact on carbon sequestration, and it has much wider applications in forest management practice.


Evaluation and calibration of a binocular infrared pupillometer for measuring relative afferent pupillary defect.
Binocular infrared pupillometry allows an estimate of the relative afferent pupillary defect (RAPD), designated the pupillometric RAPD (pRAPD). We calibrated the pRAPD of a commercially available pupillometer against neutral density filters (NDFs) of known attenuation. The performance of the pupillometer using its own proprietary algorithm is assessed and compared to that of alternative algorithms. The pRAPDs of 50 healthy volunteers were measured with each of 4 filters of known attenuation: 0.0, 0.3, 0.6, and 0.9 log units, positioned unilaterally in the light stimulus pathway. The filter values were plotted against the pupillometer output, and the slope and intercept were used to determine a calibration factor. Corrected pRAPD results were used to assess physiological ranges of pRAPD. The sensitivity and specificity to 0.3 log unit differences between increasing filter densities using receiver operator characteristic (ROC) curves. The calibrated physiological pRAPD ranged from 0 to 0.22 log units. The area under the ROC curve for detecting unilateral simulated pRAPD of 0.3 log units, the simulated disease progression from 0.3 to 0.6 log units, and a further progression from 0.6 to 0.9 log units by NDFs was 0.99 (95% confidence interval [CI], 0.95-1.00), 0.86 (95% CI, 0.78-0.92), and 0.79 (95% CI, 0.70-0.87), respectively. The optimum discrimination was for detecting a unilateral simulated pRAPD of 0.3 log units; sensitivity and specificity was 98% (95% CI, 88%-99%). The commercially available pupillometer detects the RAPD induced by the NDFs with high sensitivity and specificity. The results suggest that it is best for detecting unilateral early disease but potentially useful for assessing progression of disease.


Strategies to expand the therapeutic potential of superoxide dismutase by exploiting delivery approaches.
The overproduction of free radicals can cause oxidative-stress damage to a range of biomolecules, and thus potentially contribute to several pathologies, from neurodegenerative disorders to cardiovascular diseases and metabolic disorders. Endogenous antioxidant enzymes, such as superoxide dismutase (SOD), play an important role in diminishing oxidative stress. SOD supplementation could therefore be an effective preventive strategy to reduce the risk of free-radical overproduction. However, the efficacy of SOD administration is hampered by its rapid clearance. Several different approaches to improve the bioavailability of SOD have been explored in recent decades. This review intends to describe the rationale that underlie the various approaches and chemical strategies that have led to the most recent advances in SOD delivery. This critical description includes SOD conjugates, SOD loaded into particulate carriers (micelles, liposomes, nanoparticles, microparticles) and the most promising and suitable formulations for oral delivery, with a particular emphasis on reports of preclinical/clinical results. Likely future directions are also considered and reported.


Lower activity of serum peptidases in abstinent alcohol-dependent patients.
This study examines i) the activity of serum prolyl endopeptidase (PEP) and dipeptidlyl peptidase IV (DPP IV) in detoxified alcohol-dependent patients without liver disease versus normal controls, and ii) the relationships between serum DPP IV and PEP activity and the production of cytokines or cytokine receptors, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interferon-y (IFN-y), IL-1 receptor antagonist (IL-1RA), and IL-10, and granulocyte-macrophage colony stimulatory factor (GM-CSF). Alcohol-dependent patients had significantly lower serum PEP and DPP IV activity than normal controls. We found that 58.3% and 50.0% of the alcohol-dependent patients, respectively, had PEP and DPP IV activities, which were lower than the mean control values minus 2 SD. There were significant inverse correlations between lowered serum DPP IV and PEP activity and the increased production of IL-6, INF-gamma, IL-IRA, IL-10, and GM-CSF. These results show that lower serum DPP IV and PEP activity may be related to the pathophysiology of alcohol dependence.


Outcomes of deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconic eyes with and without previous hydrops.
The study aims to compare outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in keratoconic eyes with or without previous hydrops. Retrospective analysis of 211 eyes who received PK (group 1, n = 74 [history of hydrops: n = 33]) or DALK (group 2, n = 137 [history of hydrops: n = 9]) from 2012 to 2019 at the Department of Ophthalmology, University of Cologne, Germany. Analysis included best spectacle-corrected visual acuity (BSCVA), complications, immune reactions, graft survival and keratometry, and subgroup analyses for subjects with or without previous hydrops. Follow-up was 34.0 ± 23.6 months in group 1 and 30.7 ± 22.5 months in group 2. No significant difference was found in the course of BSCVA between groups 1 and 2 (p = 0.182) and in postoperative BSCVA between eyes with and without previous hydrops, regardless of the surgical method (p = 0.768). Endothelial immune reactions occurred exclusively in group 1 and did not occur more frequently in eyes with previous hydrops (p = 0.377). A higher risk of complications for eyes with previous hydrops was observed (p = 0.022). There was no difference in astigmatism and maximum keratometry (Kmax) preoperatively and postoperatively between eyes with and without history of hydrops. The prognosis for visual outcome after keratoplasty including visual acuity, astigmatism, and Kmax for keratoconic eyes with previous hydrops is as good as for keratoconic eyes without previous hydrops, irrespective of the surgical method. However, eyes after hydrops seem to have an increased risk of complications.


Equity and Disparities in Diagnosis, Management, and Research of Post-Traumatic Headache.
There are notable health disparities and inequities in individuals with traumatic brain injury (TBI) and concussion by race, ethnicity, gender, socioeconomic status, and geography. This review will evaluate these disparities and inequities and assess the social determinants of health that drive outcomes for post-traumatic headache. Interventions for achieving this are also discussed. Significant disparities and inequities exist in TBI and concussion among people of different races, socioeconomic status, and geographic locations. Migraine is a common symptom post-concussion, for which disparities and social determinants of health are also discussed. Overall, multi-level interventions to reduce these disparities and inequities are reviewed for post-traumatic headache but require further investigation. Interventions are needed to reduce disparities and inequities including public health initiatives, improvements in clinical care, diversity/inclusion training, and research efforts. As literature expands, we can form guidance to identify solutions for eliminating disparities in care of diverse populations.


Apolipoprotein E genotype influences vertical transmission of herpes simplex virus type 1 in a gender specific manner.
There is growing evidence that herpes simplex virus type 1 (HSV-1), together with the apolipoprotein E 4 (APOE4) allele, contribute to the pathogenesis of Alzheimer's disease (AD), although the mechanism of their interaction remains uncertain. Here we show that the combination of inherited APOE genotype and vertical transmission of HSV-1 confers a differential risk of brain infection. These risk factors are known to be associated with AD.


Virus inactivation by high frequency ultrasound in combination with visible light.
In this study, the effects of high frequency ultrasound (US) and visible light (VL) on virus inactivation were investigated. The bacteriophages ΦX174 and MS2 were used as model viruses. The experiments were performed at room temperature at three different, relatively high US frequencies (i.e., 582, 862, and 1142 kHz) with and without the use of VL, and different initial virus concentrations. The two bacteriophages were diluted in phosphate-buffered saline solution to a titer of 10(3)-10(4)pfu/mL. The experimental virus inactivation data were satisfactorily represented by a simple first-order kinetic expression. Virus inactivation was faster at the lower frequencies (582 and 862 kHz). Furthermore, it was observed that MS2 was inactivated faster than ΦX174. The simultaneous use of US and VL was found to be more effective than US alone for MS2 inactivation, indicating the existence of a synergistic effect. However, the use of VL in conjunction with high frequency US hindered the inactivation of ΦX174.


Involvement of external calcium in the release of arachidonic acid by mouse peritoneal macrophages.
The present investigation was undertaken to study the potential role of extracellular calcium on the release of arachidonic acid from mouse peritoneal macrophages. Both in phorbol ester-treated and in Ca2(+)-depleted cells, a rapid release of arachidonic acid was seen in direct response to added Ca2+. The response was directly dependent on the extracellular Ca2+ concentration, with a Ca2+ threshold of 100 nM. These results support the notion that arachidonic acid release in macrophages is functionally coupled to influx of external calcium.


Colloidal synthesis and electrical behaviour of n-ZnGdO/p-Si heterojunction diodes.
Studies on manoeuvring the optoelectronic characteristics of a semiconducting nanostructure are of recent specific interest for a wide range of photonic applications. In this regard, the optical and electrical characteristics of ZnO nanostructures have been tuned and studied systematically using Gd ions. The structural and morphological characteristics of the solution processed ZnGdO nanostructures were studied in detail using the results of X-ray diffraction and microscopic measurements. The absorption band edge in ZnO was noted to shift towards the lower wavelength values on Gd substitution, suggesting an increase in its energy band gap. The blue emissivity from ZnO complexes was also noted to improve as a function of Gd composition in ZnO. The potential of ZnGdO nanostructures for optoelectronic functions was evaluated by fabricating heterojunction diodes based on n-ZnGdO/p-Si. The diode characteristics revealed an improved electrical conductivity and rectifying behaviour from the fabricated architectures upon Gd substitution and photon illumination. The findings are correlated with the increased charge carrier concentration and defect states existing within ZnGdO species, through appropriate mechanisms.


A 2-year, randomized, comparative, placebo-controlled study on the effects of raloxifene on lipoprotein(a) and homocysteine.
Lipoprotein(a) (Lp(a)) and homocysteine (Hcy) are independent cardiovascular risk factors, which have been shown to be lowered by hormone replacement therapy (HRT). In this 2-year study, the long-term effects of raloxifene (Rlx) in two doses, on Lp(a) and Hcy, were studied and compared with the effects of continuously combined hormone replacement therapy (ccHRT). In a prospective, randomized, double-blind, placebo-controlled 2-year study, 95 healthy, non-hysterectomized, early postmenopausal women, received daily either oral Rlx 60 mg (N=24) or 150 mg (N=23), ccHRT (conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg; N=24) or placebo (N=24). Fasting serum Lp(a) and plasma Hcy concentrations were measured at baseline and at 6, 12 and 24 months. The mean individual changes compared to baseline after 24 months were for Lp(a): Rlx 60: - 5%, Rlx 150: -7%, ccHRT: -34%, placebo: +1% and for Hcy: Rlx 60: -3%, Rlx 150: -4%, ccHRT: -4%, placebo: +6%. ANCOVA was significant for Lp(a) under ccHRT versus placebo (P=0.001) and for Lp(a) under ccHRT versus each of the two Rlx groups (P<0.05). Long-term treatment with Rlx was not as effective as ccHRT in lowering Lp(a). Although not significant and without an obvious dose-related response, the Hcy values showed the same trend for each treatment arm, which is in line with data reported earlier.


Prevalence of diabetes and pre-diabetes in Greece. Results of the First National Survey of Morbidity and Risk Factors (EMENO) study.
To report the results of the first national Health Examination Survey (HES) on the prevalence of diabetes, its pharmacologic treatment and level of control, as well as pre-diabetes in Greece. Data were derived from the National Survey of Morbidity and Risk Factors (EMENO), in a randomly selected, representative sample of the adult Greek population. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age/sex distribution to the population. Non-response was adjusted by inverse probability weighting. Weighted prevalence estimates are provided. A total of 4393 persons with HbA1c and/or fasting plasma glucose measurements were included. Total diabetes prevalence was 11.9% (95% CI: 10.9-12.9), known diabetes 10.4% (9.5-11.4), and unknown 1.5% (1.1-1.9), with considerable increase in older age groups and no difference between genders. Pre-diabetes prevalence was 12.4% (11.4-13.6). The majority of persons with known diabetes were receiving metformin. Of those with known diabetes (and measured HbA1c), 70.9% were well controlled (HbA1c <7.0%). This first representative national HES showed high prevalence of diabetes in Greece, with low prevalence of unknown diabetes. Pre-diabetes prevalence is also substantial. These results will hopefully enable national authorities develop tailored and efficient strategies for disease prevention and management.


Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out.
People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.


Pathological Outcome following Radical Prostatectomy in Men with Prostate Specific Antigen Greater than 10 ng/ml and Histologically Favorable Risk Prostate Cancer.
Active surveillance is now the treatment of choice in men with low risk prostate cancer. Although there is no consensus on which patients are eligible for active surveillance, prostate specific antigen above 10 ng/ml is generally excluded. In an attempt to determine the validity of using a prostate specific antigen cutoff of 10 ng/ml to counsel men considering active surveillance we analyzed a multi-institution database to determine the pathological outcome in men with prostate specific antigen greater than 10 ng/ml but histologically favorable risk prostate cancer. We queried a prospectively maintained database of men with histologically favorable risk prostate cancer who underwent radical prostatectomy between 2003 and 2015. The cohort was categorized into 3 groups based on prostate specific antigen level, including low-less than 10 ng/ml, intermediate-10 or greater to less than 20 and high-20 or greater. Associations of prostate specific antigen group with adverse pathological and oncologic outcomes were analyzed. Of 2,125 patients 1,327 were categorized with histologically favorable risk disease. However on multivariate analyses the rates of up staging and upgrading were similar between the intermediate and low prostate specific antigen groups. In contrast compared to the intermediate prostate specific antigen group the high group had higher incidences of up staging (p = 0.02) and upgrading to 4 + 3 or greater disease (p = 0.046). Biochemical recurrence-free survival rates revealed no pairwise intergroup differences except between the low and high groups. Patients with preoperatively elevated prostate specific antigen between 10 and less than 20 ng/ml who otherwise had histologically favorable risk prostate cancer were not at higher risk for adverse pathological outcomes than men with prostate specific antigen less than 10 ng/ml.


Deaf and hard of hearing awareness training: A mentor-led workshop.
People who are deaf and hard of hearing (DHH) comprise a significant and increasing proportion of the population. They face many barriers to accessing good health care and major communication challenges with health professionals. There is evidence that DHH awareness training for health professionals needs improvement but little information about how such training is incorporated into curricula. The research question we address is how to develop and deliver an effective workshop for students led by people who, by definition, have barriers to communication due to hearing loss and deafness. Workshop development was initiated and led by a medical student as a course project, in collaboration with DHH people, other students, and university faculty in an iterative participatory educational design process, supported by a community-based organization that provides programs and services for DHH people. Development resulted in a pilot workshop suitable for all health professional students. Three workshops were attended by a total of 49 students from 10 different health disciplines. Workshops were highly rated. Thematic analysis of post-workshop reflections written by occupational therapy students showed learning in the domains of knowledge, skills (practical tips and techniques), and attitudes (assumptions, motivation, reflection). Partnership with a community organization makes it feasible for DHH people to design and facilitate workshops. The organization can provide the necessary environment, technology, and support, and identify people with lived experience to be workshop mentors. Workshops help make students more aware of the needs of DHH people and motivate them to provide better care.