Assessment of ecological environment impact in highway construction activities with improved group AHP-FCE approach in China.
Highway construction is time consuming and complicated. Various environmental issues can be encountered during this process. Therefore, it is necessary to assess the impact of ecologic environment in highway construction. However, the traditional assessment approaches paid more attention to the environmental factors rather than the ecological problems, and the weights of evaluation indexes were assigned with relatively average values, which cannot comprehensively and accurately to assess the impact of ecological environment in highway construction. In order to solve these problems, this paper established a new model to combine improved group AHP and FCE. A total of six main factors and 22 sub-factors from three aspects of social, ecological, and natural environment were identified. The model and index system were applied to the ecological environment impact assessment of the highway from the city of Hanzhong to Lueyang County section in Shaanxi Province, and compared with traditional fuzzy AHP approach to verify the feasibility of this model. The results showed that only the ranking of social and ecological factor changed when comparing with the traditional approach. The weight of social factor determined by the improved approach was 0.2835, while that of the traditional approach was only 0.2365, and the weight difference was 0.047. This improved approach highlighted the importance of social factor and overcame the equal weight distribution of traditional approach, which made the overall weight ratio distribution more reasonable and objective. The comprehensive assessment result was 0.3482, which was in line with the "general impact" level. This was consistent with the actual situation of highway construction. The improved group AHP-FCE model could be used successfully for assessing the impact of the ecological environment in highway construction, and it had good applicability and popularization value in ecological environment assessment.


Multifocal osteonecrosis related to corticosteroid: ten years later, risk of progression and observation of subsequent new osteonecroses.
No study has reported the risk of other site osteonecroses after the diagnosis of multifocal osteonecrosis related to corticosteroids in patients who continue this corticosteroid treatment. An analysis of the time-course to other sites of osteonecrosis, as well as the effects of underlying corticosteroid risk factor on the evolution of asymptomatic lesions at the time of diagnosis, is presented. Two hundred patients were followed prospectively every year during a minimum ten years with a radiograph if a joint became symptomatic. In absence of evidence of osteonecrosis on radiographs of a symptomatic or non-symptomatic joint (hips, shoulders, knees, ankles), patients had an MRI performed at the most recent follow up. The average duration of follow-up after inclusion of the patient in the study was 15 years (range 10-20). Of the 200 patients followed for an average of 15 years (minimum 10 years, maximum 20 years), 35 patients developed new osteonecrosis lesions during the period of study. Asymptomatic lesions became symptomatic and a high number of collapse was observed resulting in 258 arthroplasties (187 hips, 51 shoulders, 20 knees) at the most recent follow up. The continuation of peak doses (>200 mg) of corticosteroids predicted (p = 0.04) occurrence of new lesions and the continuation of corticosteroids without peak dose was a risk for quicker progression to collapse.


Nurse led care coordination: trial protocol and development of a best practice resource guide for a cluster controlled clinical trial in Australian aged care facilities.
In this paper we describe (i) the protocol for a cluster controlled clinical trial of nurse led care coordination in residential aged care facilities (RACF); and (ii) the development and content of a best practice resource guide to be implemented as part of this trial. We used published systematic reviews of quantitative studies, existing resources and multidisciplinary expert opinion to develop an intervention for testing in a cluster controlled trial (Australian and New Zealand Clinical Trials Registry Number 12611000933954). The trial will determine whether care coordination of multiple evidenced based strategies can improve quality of life and reduce hospitalization rates amongst people living in RACF. Central to the intervention arm of the trial are two components: (i) experienced nurse practitioners responsible for resident care and (ii) a best practice guide for the care processes being delivered and coordinated by those nurses. In this paper we outline how this practice guide, which is published herein, was refined through consultative processes and practitioner testing.


Interface engineering of transition metal-nitrogen-carbon by graphdiyne for boosting the oxygen reduction/evolution reactions: A computational study.
Exploring high-efficiency electrocatalysts to boost the oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) is pivotal to the large-scale applications for clean and renewable energy technologies, such as fuel cells, water splitting, and metal-air batteries. Herein, by means of density functional theory (DFT) computations, we proposed a strategy to modulate the catalytic activity of transition metal-nitrogen-carbon catalysts through their interface engineering with graphdiyne (TMNC/GDY). Our results revealed that these hybrid structures exhibit good stability and excellent electrical conductivity. Especially, CoNC/GDY was identified as a promising bifunctional catalyst for ORR/OER with rather low overpotentials in acidic conditions according to the constant-potential energy analysis. Moreover, the volcano plots were established to describe the activity trend of the ORR/OER on TMNC/GDY using the adsorption strength of the oxygenated intermediates. Remarkably, the d-band center and charge transfer of the TM active sites can be utilized to correlate the ORR/OER catalytic activity and their electronic properties. Our findings not only suggested an ideal bifunctional oxygen electrocatalyst, but also provided a useful strategy to obtain highly efficient catalysts by interface engineering of two-dimensional heterostructures.


Measles pneumonitis.
To investigate the finding of increased alveolar-arterial (A-a) gradient in adult patients with measles who have normal results on both pulmonary auscultation and chest radiography. Retrospective, descriptive case series. An urban county teaching hospital in southern California. Consecutive adult patients with the clinical diagnosis of measles seen in the emergency department. Patients were considered to have pneumonitis if they had any of the following: ED diagnosis of pneumonia; an A-a gradient of more than 30 mm Hg; one or more infiltrates on chest radiograph. Seventy-five patients, including 44 men and 31 women (median age, 25 years; 25% to 75% interquartile range [IQR], 20 to 28 years) were seen during the 36-month study period. Forty-three patients (57%; 95% confidence interval [CI], 45% to 69%) had pneumonitis, with a median A-a gradient of 42 mm Hg (IQR, 34 to 48 mm Hg). Twenty-seven of the 43 patients with pneumonitis (63%; CI, 48% to 77%) had both normal pulmonary auscultation findings and normal chest radiographs; this represented 36% of the study population (CI, 25% to 50%). Thirty-eight of the 43 patients with pneumonitis were admitted; one patient was later intubated after respiratory failure developed. Two of the 5 patients with pneumonitis who were sent home were admitted the following day for worsening symptoms. All 75 patients eventually did well. A significant percentage of adult patients with measles presenting to an ED with both normal pulmonary auscultation and normal chest radiographs have increased A-a gradients. These patients warrant close follow-up and perhaps hospital admission.


The neural correlates of verbal encoding and retrieval in monozygotic twins at low or high risk for depression and anxiety.
Emotional processing and brain activation were examined during an encoding and recognition paradigm using emotionally salient words in a sample of monozygotic twin pairs at low or high risk for anxiety and depression. Discordant twin pairs were used to chart the effects of environmental risk factors and concordant twin pairs were used to chart the effects of genetic risk factors on performance and brain activation. Performance data did not support the existence of a negative response bias in subjects at high risk. At the neural level, however, increased left inferior frontal gyrus (LIFG) activation by negative words was found in high-risk subjects, most prominently during recognition. Increased LIFG activity was found in subjects at high risk through either genetic or environmental risk factors. These results suggest that fMRI activation of the LIFG in a verbal emotional memory task may be a useful vulnerability marker for anxiety and depression.


The effects of COVID-19 pandemic on patients with acute appendicitis.
The effects of the COVID-19 infection on the world's health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies. In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied. In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05). We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.


Tumor-Stroma Ratio in Colorectal Cancer-Comparison between Human Estimation and Automated Assessment.
The tumor-stroma ratio (TSR) has been repeatedly shown to be a prognostic factor for survival prediction of different cancer types. However, an objective and reliable determination of the tumor-stroma ratio remains challenging. We present an easily adaptable deep learning model for accurately segmenting tumor regions in hematoxylin and eosin (H&E)-stained whole slide images (WSIs) of colon cancer patients into five distinct classes (tumor, stroma, necrosis, mucus, and background). The tumor-stroma ratio can be determined in the presence of necrotic or mucinous areas. We employ a few-shot model, eventually aiming for the easy adaptability of our approach to related segmentation tasks or other primaries, and compare the results to a well-established state-of-the art approach (U-Net). Both models achieve similar results with an overall accuracy of 86.5% and 86.7%, respectively, indicating that the adaptability does not lead to a significant decrease in accuracy. Moreover, we comprehensively compare with TSR estimates of human observers and examine in detail discrepancies and inter-rater reliability. Adding a second survey for segmentation quality on top of a first survey for TSR estimation, we found that TSR estimations of human observers are not as reliable a ground truth as previously thought.


Brief cognitive screening instruments for early detection of Alzheimer's disease: a systematic review.
The objective of this systematic review was (1) to give an overview of the available short screening instruments for the early detection of Alzheimer's disease (AD) and (2) to review the psychometric properties of these instruments. First, a systematic search of titles and abstracts of PubMed and Web of Science was conducted between February and July 2015 and updated in April 2016 and May 2018. Only papers written in English or Dutch were considered. All full-text papers about cognitive screening instruments for the early detection of AD were included, resulting in the identification of 38 pencil and paper tests and 12 computer tests. In a second step, the psychometric quality of these instruments was evaluated. Therefore, the same databases were searched again to identify papers that described the psychometric properties of the instruments meanwhile applying diagnostic criteria for the diagnostic groups included. Out of 1454 papers, 96 clearly discussed the psychometric properties of the instruments. Eighty-nine papers discussed pencil and paper tests of which 80 were validated in a memory clinic setting. Based on the number of studies (31 articles) and the sensitivity (84%) and specificity (74%) values, the Montreal Cognitive Assessment (MoCA) seems to be a promising (pencil and paper) screening test for memory clinic testing as well as for population screening. Regarding computer tests, validation studies were only available for 7 out of 12 tests. A large number of screening tests for AD are available. However, most tests are only validated in a memory clinic setting and description of the psychometric properties of the instruments is limited. Especially, computer tests require further research. The MoCA is a promising instrument, but the specificity to detect early AD is rather low.


[Jejunal perforation secondary to pulmonary mucoepidermoid carcinoma metastasis. Case report and review].
The first reported case of intestinal perforation secondary to metastatic lung carcinoma was reported in 1957. Intestinal metastases are present in up to 1.8% of the cases, with small bowel obstruction as the most common clinical presentation. An 89 year-old male, who was diagnosed with a high-grade pulmonary mucoepidermoid tumour 2 months previously. The patient was admitted to the hospital for 3 days due to diffuse colic abdominal pain of moderate to severe intensity, accompanied by nausea and gastric vomiting, as well as 2 episodes of bloody bowel movements. On physical examination, the patient was noted to have tachycardia and tachypnoea, as well as clinical signs of acute abdomen. He had white cells of 24,900 per mm3, and 87% neutrophils. Exploratory laparotomy was performed, which showed a bowel perforation associated with a tumour mass 15cm beyond the angle of Treitz. Bowel resection and primary anastomosis were performed. The histopathological analysis reported the diagnosis of a high-grade mucoepidermoid tumour with small bowel and mesentery with disease-free surgical margins. Unfortunately the patient had a fatal outcome secondary to hospital-acquired pneumonia. The cases of metastases to small bowel are extremely rare, and to our knowledge this is first case reported in Mexico. The patient described went to the emergency room with gastrointestinal bleed and intestinal perforation that required urgent surgical intervention with small bowel resection and primary anastomosis. Unfortunately the patient died secondary to hospital acquired pneumonia.


Effect of eye laterality on correction of myopic astigmatism with small incision lenticule extraction (SMILE) using vector analysis.
To compare the vector analysis, visual, and refractive outcomes after myopic astigmatic correction using SMILE between the right and left eyes. This is a retrospective study including 41 right and 40 left eyes that underwent SMILE for correction of myopic astigmatism greater than 0.75 diopters (D) with a follow-up of at least 3 months. Vector analysis for astigmatic correction was done. Visual and refractive parameters were compared between both groups by measuring mean postoperative logMAR uncorrected distance visual acuity, mean postoperative spherical equivalent (SE), cylinder, and refractive predictability in terms of SE and cylindrical correction. Efficacy and safety of SMILE were also determined. No significant difference was found between vector outcomes except for angle of error (AE). The right eye group yielded a negative mean AE (- 2.71 ± 5.35), while the left eye group yielded a positive mean AE (0.23 ± 9.60). Correction index, magnitude of error and refractive predictability of cylindrical correction showed undercorrection of astigmatism in both groups. The right eye group showed lower predictability for higher cylindrical correction. Visual outcomes were similar for both eyes. Rotational errors account for vectorial outcome differences between right and left eyes. Despite achieving good visual and refractive outcomes with low cylinder correction, the tendency to undercorrect between eyes due to this error may be more evident when treating higher amounts of astigmatism. More careful preoperative control for cyclotorsion is warranted for right eyes compared to left eyes.


Effects of VIIth (facial) nerve degeneration on vasoactive intestinal polypeptide and substance P levels in ocular and orbital tissues of the rabbit.
Levels of vasoactive intestinal polypeptide (VIP)- and substance P (SP)-like immunoreactivity were measured in ocular and orbital tissues of albino rabbits. Substantial amounts of VIP were detected in the choroid (22.6 +/- 3.6 pmol g-1), and in the lacrimal (13.6 +/- 4.4 pmol g-1) and Harderian glands (20.2 +/- 4.9 pmol g-1). Somewhat less was found in the anterior uvea (3.6 +/- 1.1 pmol g-1), retina (5.4 +/- 1.3 pmol g-1) and optic nerve head (4.1 +/- 1.1 pmol g-1). Other tissues, including conjunctiva and extraocular muscle showed very little VIP-like immunoreactivity. Seven days after diathermic damage to the region of the pterygopalatine ganglion VIP was virtually eliminated from all these tissues. SP levels were also reduced, notably in the anterior uvea, probably due to concurrent destruction of sensory fibres. Electron microscopy revealed extensive degeneration of unmyelinated axons in the short ciliary nerves and in the choroid. No changes in ocular VIP levels were detected after sympathetic denervation, although a significant rise in SP was observed in the anterior uvea. The decrease in retinal VIP, believed to be confined to the amacrine cells, is considered to be a result of post-operative lid closure, rather than of VIIth nerve degeneration. Nevertheless, with this exception, VIP in ocular and orbital tissues of the rabbit appears to be contained exclusively within parasympathetic fibres of facial nerve origin.


Mechanism of cytostatic action of novel 5-(thien-2-yl)- and 5-(furan-2-yl)-substituted pyrimidine nucleoside analogues against tumor cells transfected by the thymidine kinase gene of herpes simplex virus.
Several novel 5-substituted 2'-deoxyuridine (dUrd) analogues were evaluated as substrates for highly purified herpes simplex virus type 1 (HSV-1)-encoded thymidine kinase (TK) derived from HSV-1 TK gene-transfected murine mammary carcinoma FM3A cells, and human platelet thymidine (dThd) phosphorylase. The Ki of 5-(furan-2-yl)-dUrd, 5-(thien-2-yl)-dUrd and 5-(thien-2-yl)-dCyd for HSV-1 TK was 0.94, 0.71, and 1.32 microM, respectively. Inhibition was competitive with respect to the natural substrate dThd. With dCyd as substrate, the Ki of 5-(thien-2-yl)-dCyd for HSV-1 TK was 4.5 microM (Ki/Km = 0.17). In striking contrast with (E)-5-(2-bromovinyl)-dUrd, the 5-(thien-2-yl)- and 5-(furan-2-yl)-dUrd derivatives were not substrates for human dThd phosphorylase. 5-(Thien-2-yl)-dUrd, 5-(furan-2-yl)-dUrd and 5-(thien-2-yl)-dCyd were at least 100-fold more cytostatic to the HSV TK gene-transfected FM3A tumor cells than wild-type FM3A/0 cells. The viral TK expressed in the HSV-1 TK gene-transfected tumor cells merely acts as an activating enzyme, whereas thymidylate synthase serves as the target enzyme for the cytostatic action of the compounds. The novel 5-substituted dUrd analogues should be further pursued as candidate drugs in the treatment of HSV TK gene-transfected tumors.


Dissecting the molecular mechanism of cepharanthine against COVID-19, based on a network pharmacology strategy combined with RNA-sequencing analysis, molecular docking, and molecular dynamics simulation.
Recently, it has been reported that cepharanthine (CEP) is highly likely to be an agent against Coronavirus disease 2019 (COVID-19). In the present study, a network pharmacology-based approach combined with RNA-sequencing (RNA-seq), molecular docking, and molecular dynamics (MD) simulation was performed to determine hub targets and potential pharmacological mechanism of CEP against COVID-19. Targets of CEP were retrieved from public databases. COVID-19-related targets were acquired from databases and RNA-seq datasets GSE157103 and GSE155249. The potential targets of CEP and COVID-19 were then validated by GSE158050. Hub targets and signaling pathways were acquired through bioinformatics analysis, including protein-protein interaction (PPI) network analysis and enrichment analysis. Subsequently, molecular docking was carried out to predict the combination of CEP with hub targets. Lastly, MD simulation was conducted to further verify the findings. A total of 700 proteins were identified as CEP-COVID-19-related targets. After the validation by GSE158050, 97 validated targets were retained. Enrichment results indicated that CEP acts on COVID-19 through multiple pathways, multiple targets, and overall cooperation. Specifically, PI3K-Akt signaling pathway is the most important pathway. Based on PPI network analysis, 9 central hub genes were obtained (ACE2, STAT1, SRC, PIK3R1, HIF1A, ESR1, ERBB2, CDC42, and BCL2L1). Molecular docking suggested that the combination between CEP and 9 central hub genes is extremely strong. Noteworthy, ACE2, considered the most important gene in CEP against COVID-19, binds to CEP most stably, which was further validated by MD simulation. Our study comprehensively illustrated the potential targets and underlying molecular mechanism of CEP against COVID-19, which further provided the theoretical basis for exploring the potential protective mechanism of CEP against COVID-19.


Fluorescence quenching of substituted polyperylene with functionalized polythiophenes.
The present investigation focuses the influence of polythiophene i) containing hetero aromatic structures and ii) containing mesogenic groups towards the photoluminescence properties of substituted polyperylene (PPE). The structural contribution towards the optical properties was individually discussed. The photoluminescence of PPE was quenched to the maximum level (30%) when it was blended with polythiophene with mesogenic groups containing longer alkyl spacer. Results of the same blend in solid-state shows 85% of PL quenching.


Time-sequential correlations between diabetic kidney disease and diabetic retinopathy in type 2 diabetes - an 8-year prospective cohort study.
To investigate the time-sequential correlations between progression/remission of diabetic kidney disease (DKD) and development of diabetic retinopathy (DR) or diabetic macular oedema (DME) in type 2 diabetes (T2D). This was an 8-year prospective cohort study in which 576 patients with T2D and microalbuminuria from one medical centre in Taiwan were recruited. Progression of microalbuminuria was defined as shift of urinary albumin/creatinine ratio (ACR) into 300 mg/g or more; remission of microalbuminuria was defined as having a urinary ACR less than 30 mg/g in at least two of three tests over a period of 6 months. Cox regression analysis was used to evaluate the hazard ratios (HRs) for progression or remission of microalbuminuria on development of any DR, proliferative DR (PDR) and DME. After adjusting for baseline characteristics , remission of microalbuminuria was a significant protecting factor for development of PDR (HR = 0.290, 95% CI: 0.102-0.826, p = 0.020) and DME (HR = 0.404, 95% CI: 0.188-0.864, p = 0.020). After further adjustment for the mean follow-up HbA1c and systolic blood pressure, remission of microalbuminuria was still a significant protecting factor for development of PDR (HR = 0.348, 95% CI: 0.122-0.992, p = 0.048). Remission of microalbuminuria was an independent protecting factor for development of PDR and DME. Aggressive treatment for DKD might help prevent the progression of DR.


Pharmacotherapy for the treatment of aggression in pediatric and adolescent patients with autism spectrum disorder comorbid with attention-deficit hyperactivity disorder: A questionnaire survey of 571 psychiatrists.
Both attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are frequently accompanied by serious aggression that requires psychiatric treatment. However, little is known about the experiences psychiatrists have had using pharmacotherapy to treat aggression in patients who have both ASD and ADHD (ASD/ADHD). The purpose of this study was to examine the experiences of Japanese child and adolescent psychiatrists in prescribing medication for aggression in patients with ASD/ADHD. A prospective questionnaire was mailed to 2001 psychiatrists affiliated with the Japanese Society for Child and Adolescent Psychiatry. Multivariate logistic regression analysis was used to identify factors predicting the outcome of pharmacotherapeutic treatment of aggression in pediatric and adolescent patients with ASD/ADHD. Of 2001 psychiatrists, 571 (28.5%) completed the full questionnaire (final sample). Of these, 488 (85.4%) prescribed psychotropic medication in treating pediatric and adolescent patients with ASD/ADHD, 299 (61.3%) of them doing so to treat aggression. Prescribers' duration of practice (odds ratio, 1.055; P = 0.038) and patient symptoms of residual impulsivity (odds ratio, 2.479; P = 0.039) increased the odds of prescribing psychotropic medications to treat aggression in these patients. The respondents reported a similar effect for patients with ADHD/ASD compared with those with ADHD only in treating aggression. Japanese psychiatrists tended to prescribe psychotropic medication for aggression in pediatric and adolescent patients with ASD/ADHD. Future studies examining aggression in pediatric and adolescent patients with ASD/ADHD should aim to accumulate evidence for the use of psychotropic medications, which could help clinicians make better decisions.


Fulfilling EU Laws to Ensure Marine Mammal Protection During Marine Renewable Construction Operations in Scotland.
Large-scale offshore renewable energy infrastructure construction in Scottish waters is anticipated in coming decades. An approach being pursued, with a view to preventing short-range marine mammal injury, is the introduction of additional noise sources to intentionally disturb and displace animals from renewable sites over the construction period. To date, no full and transparent consideration has been given to the long-term cost benefits of noise reduction compared with noise-inducing mitigation techniques. It has yet to be determined if the introduction of additional noise is consistent with the objectives of the EU Habitats Directive and the Marine Strategy Framework Directive.


The effects of aging time on the fraction distribution and bioavailability of PAH.
Understanding the effects of aging time on the fraction distribution and bioavailability of PAH, such as phenanthrene (PHE) and pyrene (PYR), has considerable benefits for risk assessment, food security and remediation strategies for contaminated soil. The results of the present study show that the proportion of the desorbed PHE decreased from ca. 82% at day 0 to ca. 65% at day 150. In addition, non-desorbed PHE increased from ca. 18% at day 0 to ca. 31% at day 150, whereas the changes of desorbed and non-desorbed PYR showed no significant trend during this aging period. The proportion of desorbed PYR was lower than that of PHE, whereas the opposite occurred with the non-desorbed fraction. After 150 d of aging, the proportion of bound residues (PHE and PYR) increased significantly with the cultivating time from ca. 0.2% to ca. 4.7% and ca. 0.1% to ca. 1.2% for PHE and PYR, respectively. In addition, the bioavailability of PAH (PHE and PYR) to earthworms was also assessed over 0-150 d. The results showed that the uptake rate and bioconcentration factor (BCF) of pollutants by earthworms displayed the following biphasic character: a rapid decrease over the first 15 d followed by a slow decrease over the next 135 d. Moreover, the earthworm uptake rate of PHE was greater than that of PYR throughout the incubation period, indicating that PHE has a higher bioavailability than PYR. In addition, the positive correlation between the uptake rate of earthworms and PAH extractability suggested that a three-step extraction is a reliable approach to predict PHE bioavailability in soil. However, a limit was observed for PYR.


The fate of adenosine monophosphate in the rat after a single oral administration. Influence of a simultaneous treatment by papaverine.
The fate in the organism of Adenosine Monophosphate after a single oral administration of 10 mg/kg, was studied in the Rat, using 14C-labelled AMP. This paper deals more specially with the study of the plasmatic kinetics of AMP, since we proved at first that the AMP molecule goes intact through the intestinal barrier into the blood. The effects on these kinetics of a joint administration of Papaverine are considered.


Pelvic ring disruptions: treatment modalities and analysis of outcomes.
A systematic review of the English literature over the last 30 years was conducted in order to investigate the correlation of the clinical outcome of different types of pelvic ring injuries to the method of treatment. Three basic therapeutic approaches were analysed: non-operative treatment (group A), stabilisation of anterior pelvis (group B) and internal fixation of posterior pelvis (group C). Of 818 retrieved reports, 27 case series, with 28 groups of patients and 1,641 patients, met our inclusion criteria. The quality of the literature was evaluated using a structured questionnaire. Outcomes of the eligible studies were summarised by the medians of the reported results. Most of the component studies were of fair or poor quality. Certain radiological results (quality of reduction, malunion rates) were significantly better in group C. From the functional point of view only walking capacity was proved to be significantly better in the groups of operative treatment compared to the non-operative group.


Enhancing Freeze-Thaw Resistance of Alkali-Activated Slag by Metakaolin.
Incorporating metakaolin (MK) into slag to prepare alkali-activated materials can reduce shrinkage and improve the durability of alkali-activated slag (AAS). But its durability under freeze-thaw conditions is unknown. In this paper, the effects of MK content on the freeze-thaw properties of AAS were investigated from the perspective of gel composition and pore solution. The experimental results showed that the addition of MK generates a gel mixture of C-A-S-H and N-A-S-H with a cross-linked structure and decreases the content of bound water and pore water absorption. With the increase of alkali dosage, water absorption decreased to 0.28% and then increased to 0.97%, and the leaching rate of ions was Ca2+ > Al3+ > Na+ > OH-. When the alkali dosage was 8 wt % and the MK content was 30 wt %, the compressive strength loss rate of AAS was 0.58% and the mass loss rate was 0.25% after 50 freeze-thaw cycles.


Primary modular total knee replacement in severe and unstable osteoarthritis. Predictive factors for failure.
Severe cases of osteoarthritis with ligamentous instability require the use of a modular knee arthoplasty. To assess the survival, the complications, the clinical, radiological and functional outcomes, and the quality of life of those patients in whom a Optetrak Condylar Constrained Knee (CCK) had been implanted as a primary implant. To study how the pre-operative conditions (deformity, age, sex …) and the characteristics of the arthroplasty (stems, supplements, constrained component …) could change the survival or the clinical outcomes of the implants. We performed an observational retrospective study of 105 CCKs implanted between 1999 and 2005. The mean follow-up was nine years (7, 13). Mean age was 70.5 years. The mortality was 6.9 %. There were 9.3 % of the patients lost during the follow-up. We studied all the medical files of the patients in order to assess the pre-operative, surgical and postoperative conditions. We used the Knee Society Score (KSS), both clinical and functional, to study the functional and clinical situation. We analysed the X-ray using the Knee Society roentgenographic evaluation. The quality of life was studied using the Oxford Knee Score (OKS). Then in order to find predictor conditions, we made statistical multivariable predictive studies attending to the preoperative factors and to the arthroplasty conditions to compare both outcomes and survival (Kaplan-Meier groups curves and Cox Multivariable Models [hazard ratio]). Processing and data analysis was performed using SPSS 15.0. The outcomes did not show differences between all the groups. While the mean result of the clinical KSS was 75.8, the mean functional KSS was 73.1. We did not find a condition associated with worst results of the knees (p > 0.05). The KSS obtained was excellent or good in 74.9 %. The global survival at 24 months was 93.8 % and at 96 months was 90.1 %. There were some conditions associated with poorest survival of the arthroplasties: patients younger than 70 years old, tibial tuberosity osteotomy, use of long stems and new surgery two months after arthoplasty (p < 0.05). The 11.1 % of the arthroplasties required more surgeries (3.3 % were soft tissue surgeries and 7.8 % were revisions). The mean OKS obtained was 34.78. Satisfaction was obtained by 86.2 % of the patients. All severe and unstable knees obtained similar and overall excellent-good outcomes and survival using the Optetrak CCK. Although we found that there are some factors that could change the survival of the total knee replacement, these did not change the outcomes.


Assessment of regional coronary flow reserve by digital angiography in patients with coronary artery disease.
Digital angiography provides a convenient means to quantify the progression of a contrast medium bolus injected into a coronary artery throughout the myocardium, which in turn yields information on myocardial perfusion. Sixteen patients presenting a single critical proximal stenosis (estimated diameter reduction greater than 80%) on either the left anterior descending coronary artery (LAD) or the left circumflex coronary artery (LCX) were studied. First, 12 consecutive end-diastolic images of an ECG-triggered intracoronary injection of 4 ml of iopamidol were acquired on 60 degree left anterior oblique projection under basal conditions. This was repeated 30 s after intracoronary injection of 12 mg of papaverine. For each image sequence, a densogram was computed in each pixel by fitting a curve through its 12 consecutive intensity values. The 'time of maximal pixel opacification' (TMAX) and the 'mean ascending time' (TMAT), expressed in cardiac cycles, were determined from each curve. Two myocardial regions of interest (ROI) were defined for each patient, one in the perfusion bed of the LAD, the other in the bed of the LCX. The mean values of TMAX and TMAT in each ROI were computed, at rest and during hyperemia. At rest, the mean values of TMAX and TMAT obtained from the ROI associated to the stenosis artery were not significantly different from the values obtained in the ROI associated with the intact artery. During hyperemia, a significant decrease of the mean TMAX and TMAT was observed in the normally perfused regions (p less than 0.001). The rest to hyperemia ratios of both TMAX and TMAT mean values were considered to be indices of coronary flow reserve.(ABSTRACT TRUNCATED AT 250 WORDS)


Sex differences in amygdala subregions: evidence from subregional shape analysis.
Each subregion of the amygdala is characterized by a distinct cytoarchitecture and function. However, most previous studies on sexual dimorphism and aging have assessed differences in the structure of the amygdala at the level of the amygdala in its entirety rather than at the subregional level. Using an amygdala subregional shape analysis, we investigated the effects of sex, age, and the sex × age interaction on the subregion after controlling for intracranial volume. We found the main effect of age in the subregions and the effect of sex in the superficial nucleus, which showed that men had a larger mean radius than women. We also found a sex × age interaction in the centromedial nucleus, in that the radius of the centromedial nucleus showed a steeper decline with age in women compared with men. Regarding the amygdala volume as a whole, we found only an age effect and did not find any other significant difference between genders. The sex difference in the amygdala subregion and its relevance to the circulating gonadal hormone were discussed.


Immune Reconstitution Inflammatory Syndrome Secondary to Mycobacterium kansasii Infection in a Kidney Transplant Recipient.
Nontuberculous mycobacteria (NTM) infection is a challenging diagnosis for clinicians in solid organ transplantation. Immune reconstitution inflammatory syndrome (IRIS) is so far unreported in this context. We report here the case of a renal transplant recipient who developed Mycobacterium kansasii-associated lymphadenitis complicated by IRIS while undergoing reduction of his immunosuppressive therapy. For IRIS, the patient required low-dose steroids and an increase in global immunosuppression, in association with NTM antibiotherapy.


Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.
African Americans continue to suffer disproportionately from health disparities when compared to other ethnicities (ACS 2010; CDC 2007). Research indicates that the church and the pastor in the African American community could be enlisted to increase effectiveness of health programs (Campbell et al. in Health Edu Behav 34(6):864-880, 2007; DeHaven et al. in Am J Public Health 94(6):1030-1036, 2004). The objective of this study was to investigate African American pastors' perceptions about health promotion in the church and how these perceptions could serve as a guide for improving health communication targeting African Americans. Semi-structured interviews with African American clergy revealed that pastors feel strongly about the intersection of health, religion and spirituality; they also believe that discussing health screening and other health issues more frequently from the pulpit and their own personal experiences will ultimately impact health behavior among congregants. This study suggests that African American clergy see themselves as health promoters in the church and believe this communication (i.e., pastor-endorsed health information materials) will impact health behavior among underserved and minority populations.


Molecular Identification of Extended-Spectrum β-lactamase and Integron Genes in Klebsiella Pneumonia.
Infections caused by Gram negative bacteria, producing extended-spectrum β-lactamase, including Klebsiella pneumoniae are increasing all over the world with high morbidity and mortality. The aim of the present study was determined antimicrobial profile susceptibility and the prevalence of antibiotic resistance genes by multiplex PCR. In the present study, we obtained one-hundred isolates of K. pneumoniae from different clinical samples. The antibiotic susceptibility testing was done in thirteen antibiotic and, therefore, M-PCRs were conducted using the DNA amplification for detection of ESBLs (blaTEM, blaCTX-M, blaSHV) and int (I, II, III) genes. The results of resistance to amoxicillin/clavulanate, ciprofloxacin, amikacin, trimethoprim-sulfamethoxazole, cefotaxime, ampicillin, aztreonam, imipenem, gentamicin, ceftazidime, Cefepime, ceftriaxone and levofloxacin were obtained 37%, 37%, 93%, 84%, 52%, 87%, 59%, 8%, 24%, 67%, 52%, 43% and 26%, respectively. The frequency of the extended-spectrum β-lactamase K. pneumoniae was obtained 37%. The prevalence of resistance genes of ESBLs in the M-PCR method showed that the blaTEM, blaCTX and blaSHV were 38%, 24% and 19%, respectively, however, only 8 (8%) out of 100 isolates were found to have positive outcomes for the existence of class 1 integrons and there were no detected class 2 or class 3 integrons. Our results recommend the likely co-carriage of some ESBLs genes and antibiotic resistance integrons on the same plasmids harboring the MDR genes.


Correlation of netilmicin disk diffusion susceptibility and agar dilution susceptibility.
The minimal inhibitory concentration of netilmicin determined by the agar dilution method was correlated with the disk diffusion zone of inhibition against 322 clinical isolates. Regression line analysis revealed good correlation, r = -0.90, and suggested that isolates with zone sizes </=14 mm should be considered resistant.


AQP4-siRNA alleviates traumatic brain edema by altering post-traumatic AQP4 polarity reversal in TBI rats.
The spatial and temporal distribution of aquaporin-4 (AQP4) expression in rat brain following brain trauma and AQP4-siRNA treatment, as well as corresponding pathological changes, were studied to explore the mechanism underlying the effect of AQP4-siRNA treatment on traumatic brain injury (TBI). The rats in the sham operation group had normal structure, with AQP4 located in the perivascular end-foot membranes and astrocytic membranes in a polarized pattern. The accelerated polarity reversal was observed in the TBI group in 1-12 h after TBI. During this period, AQP4 abundance on the astrocytic membrane is gradually increased, while AQP4 abundance on the perivascular end-foot membrane declined rapidly. Twelve hours after TBI, AQP4 expression was depolarized, showing a shift from the perivascular end-foot membrane to the astrocytic membrane. Pathological observation showed that vasogenic edema occurred immediately after TBI, at which time the extracellular space was expanded, leading to severe intracellular edema. AQP4-siRNA reduced the polarity reversal index at the early stage of TBI recovery and reduced edema, demonstrating the potential benefit of reduced AQP4 expression during recovery from TBI.


Cationic surface-modified regenerated nanocellulose hydrogel for efficient Cr(VI) remediation.
Because nanocellulose has a large specific surface area and abundant hydroxyl functional groups due to its unique nanomorphology, interest increases as an eco-friendly water treatment material. However, the distinctive properties of nanocellulose, which exists in a dispersion state, strongly hamper its usage in practical water treatment processes. Additionally, nanocellulose shows low performance in removing anionic pollutants because of its anionic characteristics. In an effort to address this challenge, regenerated cellulose (RC) hydrogel was fabricated through cellulose's dissolution and regeneration process using an eco-friendly aqueous solvent system. Subsequently, a crosslinking process was carried out to introduce the cationic functional groups to the RC surface PEI coating (P/RC). As a result, the PEI surface cationization process improved the mechanical rigidity of RC and showed an excellent Cr(VI) removal capacity of 578 mg/g. In addition, the prepared P/RC maintained more than 90% removal efficiency even after seven reuses.


The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage.
Acute hydrocephalus is a common complication of subarachnoid hemorrhage (SAH). We investigated the effect of gender on acute hydrocephalus development in a rat SAH model. SAH was induced in adult male and female Sprague-Dawley rats using endovascular perforation. Sham rats underwent the same procedure without perforation. Magnetic resonance imaging (MRI) was performed 24 h after SAH to determine ventricular volume. Hydrocephalus was defined as a ventricular volume that was more than 3 standard deviations from the mean value in sham-operated animals. After MRI, animals were euthanized and the extent of SAH was assessed using a modified grading system. No sham animals died. Mortality rates after SAH induction in male and female animals were 27 and 22 %, respectively. SAH induced significant ventricular enlargement compared with sham-operated rats (p < 0.01). The T2* hypointensity volume in the ventricle (used to assess intraventricular blood) was correlated with ventricular volume after SAH (r = 0.33, p < 0.05). The incidence of acute hydrocephalus 24 h after SAH was greater in female (75 %) than in male animals (47 %, p < 0.05) and the relative changes in ventricular volume were significantly larger in female than in male rats (292 ± 150 % vs 216 ± 127 % of sham-operated animals, respectively, p < 0.05). The increased hydrocephalus occurred even though SAH severity grade and ventricular T2* hypointensity volumes were not significantly different between male and female animals. Our data demonstrate that gender influences acute hydrocephalus development in a rat SAH model. Future studies should determine the role of estrogen in SAH-induced hydrocephalus.


Vascular injuries in electrical burns--the pathologic basis for mechanism of injury.
These studies present a more complete picture of the pathological changes in injured arteries obtained from patients with electrical injuries affecting the upper extremity. The specific characteristics of vascular injury by electric current proceed from relatively mild to severe in the order of the intima, adventitia and whole-thickness. Vascular injury by electricity is a thermal process extending from the interior to the exterior.


Work stress, family stress, and suicide ideation: A cross-sectional survey among working women in Shenzhen, China.
This study aimed to explore the associations of work characteristics, work stress, and family stress with suicide ideation among working women, further to detect potential joint effects between different types of stress. From March to June in 2015, a cross-sectional survey on working women were conducted in Shenzhen, China. Demographic and work characteristics, work stress, family stress, and suicide ideation were collected. Multivariate logistic regression models were applied to assess possible associations by calculating the odds ratios (OR) and 95% confident intervals (CI). Totally 968 working women were included with a mean age of 31.62 (standard deviation: 7.43) years. The prevalence of suicide ideation was 19.4%. We found that night shift work, sickness absence, work stress, and family stress were positively associated with suicide ideation, after adjusting for age, education level, marital status, and occupation type. None joint effect on multiplicative or additive scale of work stress and family stress on suicide ideation was found (P for multiplicative and additive interaction: 0.736 and 0.595, respectively), however, women with both high work stress and high family stress appeared more than five-time odds of suicide ideation (OR: 5.253, 95%CI: 2.982∼9.252). We did not collect information on other psychosocial profiles and failed to explore potential mediated effects within current associations. This study lends support to suicide prevention that immediate relief allocated to working women with both high level of work stress and family stress is warranted of necessity.


Regional inequalities in self-rated health in Russia: What is the role of social and economic capital?
Using the data from the European Social Survey (round 6, 2012), this article studies regional inequalities in self-rated health in Russia and examines the role that socio-demographic factors and economic and social capital play in these differences. Also, the regional variation in the determinants of self-rated health is analysed. The article argues that there are considerable and statistically significant unadjusted differences in self-rated health across Russian Federal Districts. We elaborated these differences by regression adjustments, with the result that some of the differences were explained by our predictors and some were amplified. The odds for good self-rated health were lower in the Volga than in Central Russia due to age and socio-economic composition. In contrast, the regression adjustments amplified the differences of the Northwest and the South in comparison to the Central District. The odds for good self-rated health were considerably lower in the Far Eastern part of the country than in the Central District, independently of the adjustments. While social and economic capital predicted good self-rated health at the individual level, they did not explain regional differences. Interaction analyses revealed regional variation in some of the determinants of self-rated health. Most notably, the effects of age, trade union membership and volunteering depended on the regional context. This article argues that the healthcare reforms that transfer funding responsibilities to regional administration may be dangerous for the already less affluent and less healthy rural regions. Thus, regional governance has a growing importance in preventing increases in health inequalities.


Spatial attention and two modes of visual consciousness.
The relationship between spatial attention and visual consciousness was critically examined in an attempt to show the operation of two simultaneously available modes of visual consciousness (i.e., object consciousness, which concerns the conscious identification of objects, and background consciousness, which deals with conscious monitoring of the background scene). The traditional view seems to pay attention only to object consciousness, which is a product of spatial attention. To substantiate the hypothesis, five topics from varied fields of human experimental psychology were chosen: iconic storage, stabilized retinal image disappearance, stable perception of external space, texture segregation and attention, and spatial frequency sensitivity in a figure-ground reversal figure. The findings of these studies suggest that there may be visual consciousness outside of focal attention and that background consciousness operates as a default mode for global scene analysis and early warning of anomalies. Finally, neural substrata for these two modes of consciousness are suggested.


Intensity-modulated radiation therapy for the treatment of nonanaplastic thyroid cancer.
Intensity-modulated radiation therapy (IMRT) enables highly conformal treatment for thyroid cancer (TC). In this study, we review outcomes/toxicity in a series of TC patients treated with IMRT. Between July 2001 and January 2004, 20 nonanaplastic TC patients underwent IMRT. Mean age was 55. There were 3 T2 and 17 T4 patients. Sixteen patients had N1 disease. Seven patients had metastases before RT. Fifteen underwent surgery before RT. Radioactive iodine (RAI) and chemotherapy were used in 70% and 40%, respectively. Median total RT dose was 63 Gy. With two local failures, 2-year local progression-free rate was 85%. There were six deaths, with a 2-year overall survival rate of 60%. For patients with M0 disease, the 2-year distant metastases-free rate was 46%. The worst acute mucositis and pharyngitis was Grade 3 (n = 7 and 3, respectively). Two patients had Grade 3 acute skin toxicity and 2 had Grade 3 acute laryngeal toxicity. No significant radiation-related late effects were reported. IMRT for TC is feasible and effective in appropriately selected cases. Acute toxicity is manageable with proactive clinical care. Ideal planning target volume doses have yet to be determined. Additional patients and long-term follow-up are needed to confirm these preliminary findings and to clarify late toxicities.


Open rhinoplasty.
Open rhinoplasty provides visualization, which for many is essential for the best sculpturing. The indications for its use include every primary and secondary rhinoplasty candidate unless tip grafts are going to be under tension or if the deformity is minor. The technique of opening the nose has been described. Emphasis is placed on (1) suturing the medial crura together, (2) suturing the medial crura to the septum, (3) resecting a portion of the lateral crus, and (4) leaving as much cartilage in the supratip and cephalic parts of the lateral crus as possible. The result is (1) greater tip projection with fewer tip grafts, (2) improved correction of tip convexity, (3) fewer supratip deformities, and (4) fewer Weir excisions. The columella scar is usually inconspicuous and has not been a significant problem in any case.


Effects of 6- and 8-substituted analogs of adenosine 3':5'-monophosphate on phosphoenolpyruvate carboxykinase and tyrosine aminotransferase in hepatoma cell cultures.
A variety of 6- and 8-substituted analogs of cAMP (cyclic adenosine 3:5-monophosphate) have been tested for their ability to increase activity of tyrosine aminotransferase (EC 188.8.131.52) in cultured Reuber H35 hepatoma cells. Some analogs, particularly the 8-thio-substituted ones, produced effects approximately equivalent to those generated by N-6, O2'-dibutyryl cAMP. In contrast, cAMP and its O-2-monobutyryl derivative were relatively ineffective even at very high concentrations, whereas three other analogs actually depressed the activity of the aminotransferase. Changes in enzyme activity generated by the various analogs were paralleled closely by changes in the relative rate of aminotransferase synthesis. An excellent correlation was found to exist between the ability of any given analog to influence the activity of tyrosine aminotransferase and that of phosphoenolpyruvate carboxykinase (EC 188.8.131.52). A similar correlation was found to exist between the ability of various analogs to evelate the activity of these enzymes and to inhibit reversibly the growth of H35 cells. Only one of five inhibitors of cAMP phosphodiesterase activity tested produce any increase in aminotransferase activity when added alone. All of the 6- and 8-substituted analogs tested, including noniducers, stimulated f1 histone phosphorylation in crude rat liver extracts with approximately equal potencies. On the other hand, dibutyryl cAMP was only a weak activator of protein kinase in vitro, even though it is a potent enzyme inducer. A possible resolution of this apparent discrepancy has been provided by preliminary analyses of site-specific f1 histone phosphorylation in whole cells. Only compounds active as aminotransferase inducers are capable of stimulating phosphorylation of the serine-37 residue of endogenous f1 histone (3- to 10-fold).


'Diagnostic overkill?' An analysis of 88 negative renal angiograms.
11.3% of 776 renal angiograms evaluated retrospectively displayed normal findings. The main reasons which had led to the misuse of angiography in our cases were: technically poor urograms, incorrect interpretation of anatomical variations and the lack of other examinations associated with the urogram. A diagnostic plan including all less invasive and dangerous procedures is proposed placing sonography in central position.


NucleoSpin(®) XS Columns for DNA Concentration and Clean-Up.
The phenol-chloroform (organic) extraction method continues to be a preferred method for extraction of DNA from forensic evidence samples that may contain low quantities of DNA and polymerase chain reaction (PCR) inhibitors. The aqueous extracts from the organic extraction of DNA require subsequent concentration and cleanup, which has traditionally been performed with microdialysis filter units, including the Centricon(®) and Microcon(®) centrifugal filter devices. Here, we describe the use of the NucleoSpin(®) XS silica columns as an alternative for the concentration and purification of the aqueous extracts from the organic extraction and for the removal of PCR inhibitors from existing DNA extracts.


Implementation of Telemedicine Infectious Diseases Consultation in a Rural Hospital Using the Active Implementation Framework.
In this pilot study, guided by the Active Implementation Framework, telemedicine infectious diseases consultation was provided to hospitalized inpatients at a rural Missouri hospital. Measured outcomes included the implementation outcomes of feasibility, acceptability, appropriateness, and fidelity, as well as clinical outcomes of readmissions and death.


Primary splenic lymphoma discovered on massive splenomegaly: A case report.
Malignant lymphoma occurs in all the systemic organs. Rarely, large B-cell lymphoma is located in the spleen, making the diagnosis difficult. Herein, we report a patient presenting with massive splenomegaly due to LBCL. Splenectomy was essential to assess the diagnosis and to guide postoperative therapeutics. A 47-year-old woman, with no comorbidities, complained of weight loss and abdominal pain. She had a palpable spleen that extended below the navel. CT scan revealed massive splenomegaly and lymph nodes in the spleen hilum. Splenectomy was performed. Histopathological examination confirmed the diagnosis of large B-cell lymphoma. The postoperative course was uneventful. Three courses of chemotherapy were given. The patient was in remission after a follow-up of 8 months. Massive splenomegaly can be one of the circumstances of the discovery of large B-cell lymphoma. Splenectomy was then essential to confirm the diagnosis and to guide postoperative therapeutics. It also permits reducing hypersplenism and preventing spleen rupture. In patients with high operative risk, splenic needle biopsy should be taken into consideration. Splenic artery embolization before surgery can also be performed in patients having massive splenomegaly to reduce the spleen volume. We highlight the importance of splenectomy to confirm the diagnosis and to relieve the symptoms. Postoperative chemotherapy is essential to prevent relapses. Splenectomy is essential in spleen localized large B-cell lymphoma. It permits to confirm the diagnosis, relieve symptoms, and treatment of underlying hematologic malignancies. Postoperative chemotherapy is essential to prevent relapses.


Singular value decomposition--a general linear model for analysis of multivariate structure in the electroencephalogram.
The application of Singular Value Decomposition (SVD) to analysis of EEG and evoked potential data has led to a hypothesis concerning the underlying structure of the EEG recorded from multiple channels. Based on the SVD algorithm the EEG is considered to be the linear combination of a sufficient number of features, each of which is defined in terms of its spatial distribution, temporal distribution, and amplitude. Use of this model leads to clear concepts concerning sampling, data reduction, normalization, and calculation of statistical significance, some of which are less evident when analysis is restricted to a single domain of interest.


Groundwater contamination source identification using improved differential evolution Markov chain algorithm.
The groundwater contamination source identification (GCSI) can provide important bases for the design of pollution remediation plans. The Bayesian theory is commonly used in the GCSI problem. Usually, we use the Markov chain Monte Carlo (MCMC) method to realize the Bayesian framework. However, due to the ill-posed nature of the GCSI and the system model's complexity, the conventional MCMC algorithm is time-consuming and has low accuracy. In this study, we proposed an adaptive mutation differential evolution Markov chain (AM-DEMC) algorithm. In this algorithm, the Kent mapping chaotic sequence method, combined with differential evolution (DE) algorithm, was used to generate the initial population. In the iteration process, we introduced a hybrid mutation strategy to generate the candidate vectors. Moreover, we adaptively adjust the essential parameter F of the AM-DEMC algorithm according to the individual fitness value. For further improving the efficiency of solving the GCSI problem, the Kriging method was used to establish a surrogate model to avoid the enormous computational load associated with the numerical simulation model. Finally, a hypothetical groundwater contamination case was given to verify the effectiveness of the AM-DEMC algorithm. The results indicated that the proposed AM-DEMC algorithm successfully identified the contamination sources' characteristics and simulation model's parameters. It also exhibited stronger search-ability and higher accuracy than the MCMC and DE-MC algorithms.


Haemolytic activity and immunological adjuvant effect of a new steroidal saponin from Allium ampeloprasum var. porrum.
A new steroidal saponin was isolated from the bulbs of Allium ampeloprasum L. var. porrum. On the basis of chemical evidence, comprehensive spectroscopic analyses, and comparison with known compounds, its structure was established as (3β,5α,6β,25R)-3-{(O-β-D-glucopyranosyl-(1→3)-β-D-glucopyranosyl-(1→2)-O-[O-β-D-glucopyranosyl-(1→3)]-O-β-D-glucopyranosyl-(1→4)-β-D-galactopyranosyl)oxy}-6-hydroxyspirostan-2-one (1). Results of the present study indicated that 1 exhibited haemolytic activity in the in vitro assays, and immunological adjuvant activity on the cellular immune response against ovalbumin antigen.


Isolated limb infusion for melanoma.
Isolated limb infusion involves administrating cytotoxic drugs in a patient with malignant melanoma confined to one limb, and which is not surgically resectable. It provides palliation in cases where cutaneous disease is extensive.


Impact of Carbohydrate Content and Glycemic Load on Postprandial Glucose After Roux-en-Y Gastric Bypass.
Abnormal glucose profiles have been described after Roux-en-Y gastric bypass (RYGB) with intense postprandial hyperglycemic peaks in some but not all the patients. The underlying mechanisms of these anomalies are not totally understood. The aim of this study is to determine whether or not the composition of the meal impacts the existence and maximum interstitial glucose (IG) concentration, measured under real-life conditions. Retrospective cohort. Referral bariatric surgery left. Continuous glucose monitoring (CGM) and meal composition were recorded for at least 3 days on an outpatient basis in 56 patients after RYGB. The presence of postprandial peaks defined by IG above 140 mg/dl, the maximum postprandial IG, the carbohydrate content, and the glycemic load of the meals were analyzed. Thirty-two patients had a hyperglycemic peak (PEAK), and 24 did not (NO PEAK). The average max IG was 159.6 ± 33.0 mg/dl in PEAK individuals and 111.8 ± 13.0 mg/dl in NO PEAK. Age was significantly higher in PEAK, but no other parameter was different between the two groups, including meal composition. In the PEAK patients, in multivariate analyses, carbohydrate content in model one and glucose load in model two explained respectively 50 and 26 % of maximum IG variance. For each gram of ingested carbohydrates, interstitial glucose increased by 1.68 mg/dl. Following a gastric bypass, under real-life conditions, irrespective of the carbohydrate content of the meal, some patients develop postprandial hyperglycemic peaks, whereas others do not. In patients with postprandial hyperglycemic peaks, the maximum IG depends on the carbohydrate content of the meal.


Reduced surface accumulation of swimming bacteria in viscoelastic polymer fluids.
Surface-associated bacterial communities flourish in nature and in the body of animal hosts with abundant macromolecular polymers. It is unclear how the endowed viscoelasticity of polymeric fluids influences bacterial motile behavior in such environments. Here, we combined experiment and theory to study near-surface swimming of flagellated bacteria in viscoelastic polymer fluids. In contrast to the swimming behavior in Newtonian fluids, we discovered that cells swim in less curved trajectories and display reduced near-surface accumulation. Using a theoretical analysis of the non-Newtonian hydrodynamic forces, we demonstrated the existence of a generic lift force acting on a rotating filament near a rigid surface, which arises from the elastic tension generated along curved flow streamlines. This viscoelastic lift force weakens the hydrodynamic interaction between flagellated swimmers and solid surfaces and contributes to a decrease in surface accumulation. Our findings reveal previously unrecognized facets of bacterial transport and surface exploration in polymer-rich environments that are pertinent to diverse microbial processes and may inform the design of artificial microswimmers capable of navigating through complex geometries.


Acute inclusion-body leukemia. Case report and review of literature.
An unusual case of acute leukemia with basophilic cytoplasmic inclusion bodies in a child is described. Certain aspects of the case suggested a lymphoblastic phenotype and others a myeloid origin. The inclusions stained positively for acid phosphatase and toluidine blue. Too few patients have been reported to determine the prognostic significance of acute leukemia with inclusion bodies.


Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year.
Compare the outcomes of randomized clinical trials of cervical disc arthroplasty (CDA) versus anterior cervical discectomy with fusion (ACDF), with a minimum follow-up of 7 years. Nine randomized clinical trials were selected. The clinical, radiological, and surgical outcomes were analyzed, including functional and pain scores, range of motion, adjacent segment degeneration, adverse events, and need for reoperation. 2664 patients were included in the study. Pooled results indicated that the CDA group had a significantly higher overall success rate (p < 0.001), a higher improvement in the neck disability index (NDI) (p = 0.002), less VAS arm pain (p = 0.01), and better health questionnaire SF-36 physical component (p = 0.01) than ACDF group. Likewise, the pooled results indicated a significantly higher motion rate (p < 0.001), less adjacent syndrome (p < 0.05), and a lower percentage of reoperation (p < 0.001) in the CDA group. There were no significant differences between the CDA and ACDF groups in the neck pain scale (p = 0.11), the health questionnaire SF-36 mental component (p = 0.10), and in adverse events (p = 0.42). In long-term follow-up, CDA showed a better overall success rate, better improvement in NDI, less VAS arm pain, better health questionnaire SF-36 physical component, a higher motion rate, less adjacent syndrome, and less reoperation rate than ACDF. No significant differences were found in the neck pain scale, SF-36 mental component, and in adverse events.


Quantitative three-dimensional analysis of the intracellular trafficking of plasmid DNA transfected by a nonviral gene delivery system using confocal laser scanning microscopy.
Since endosomal escape and the nuclear delivery of plasmid DNA (pDNA) constitute major barriers for transgene expression, a quantitative evaluation of intracellular trafficking of pDNA would be highly desirable in terms of optimizing a nonviral gene delivery system. In the present study, a novel strategy is proposed for the quantification of rhodamine-labeled pDNA in endosomes/lysosomes, cytosol, and nucleus. Endosomes/lysosomes and nucleus were stained with LysoSensor DND-189 and Hoechst 33258, respectively, to distinguish them from the cytosol. The pixel areas of the clusters derived from the rhodamine were used as an index for the amount of pDNA. This approach was applied to the analysis of the intracellular trafficking of pDNA transfected by LipofectAMINE PLUS, stearylated octaarginine (STR-R8), and octaarginine (R8). In the case of R8, most of the pDNA was trapped by endosomes/lysosomes. STR-R8 exhibited endosomal escape followed by nuclear translocation in a time-dependent manner. LipofectAMINE PLUS was the most effective in rapidly delivering pDNA to the nucleus as well as the cytosol. These differences in the intracellular trafficking of pDNA correlated well with the transgene expression. Therefore, this method enables the quantitative analysis of the intracellular pharmacokinetics of pDNA and promises to provide useful information for optimizing nonviral gene delivery systems.


MicroRNA-Specificity Protein (Sp) Transcription Factor Interactions and Significance in Carcinogenesis.
Specificity protein (Sp) transcription factors (TFs) such as Sp1, Sp3 and Sp4 are overexpressed in tumors and Sp1 is a negative prognostic factor for multiple tumor types. Sp TFs regulate expression of pro-oncogenic factors important for cell proliferation, survival, angiogenesis, migration/invasion and inflammation and the high expression of Sp TFs in tumors is primarily due to miRNAs. For example, expression of tumor-suppressor-like miRNAs such as miR-200b/c, miR-335, miR-22, miR-149 and others that inactivate Sp1 expression is low in many tumor types. Research in our laboratory has also demonstrated that high expression of Sp TFs is also due to miRNA-dependent inhibition of the transcriptional repressors ZBTB10 and ZBTB4 by miR-27a and miR-20a/miR-17p, respectively. Thus, miRNAs play a critical role in maintaining high levels of Sp1, Sp3, Sp4 and pro-oncogenic Sp-regulated genes in tumors and cancer cells, and there is ample evidence that anticancer agents targeting the miRNASp TF axis can be highly effective for cancer chemotherapy.


Astroglial glutamate transporter 1 and glutamine synthetase of the nucleus accumbens are involved in the antidepressant-like effects of allopregnanolone in learned helplessness rats.
Clinical studies have demonstrated that allopregnanolone (3α5α-tetrahydroprogesterone, ALLO) has antidepressant-like effects on patients with depression. Previous studies have shown alteration of the astroglial glutamate transporter-1 (GLT-1) and glutamine synthetase (GS) in depression, and ALLO is known to modulate glutamate release. The present study aimed to investigate whether astroglial GLT-1 and GS are indeed involved in the antidepressant-like effects of ALLO in learned helplessness (LH) rats, a validated animal model of depression. The results of this study showed that bilateral microinjection of ALLO into the lateral ventricles could normalize the levels of GLT-1 and GS in the nucleus accumbens (NAc) and of GS in the hippocampal CA1 region of LH rats. These results suggest a certain connection between the antidepressant-like effects of ALLO and the astroglial GLT-1/GS system of the NAc in LH rats.


Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta-analysis.
This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random-effects meta-analysis using the death rate over the mean follow-up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all-cause mortality, including cardiovascular, non-cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta-analysis revealed an annual all-cause mortality rate of 7.9% [95% confidence interval (CI): 6.3-10.1; I2 = 97.74%; T2 = 0.70] among patients with chronic Chagas cardiomyopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9-8.0; I2 = 96.32%; T2 = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta-regression showed that low left ventricular ejection fraction (coefficient = -0.04; 95% CI: -0.07, -0.02; P = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% (P < 0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.


Label-free detection of multiple bacterial pathogens using light-scattering sensor.
Technologies for rapid detection and classification of bacterial pathogens are crucial for securing the food supply. This report describes a light-scattering sensor capable of real-time detection and identification of colonies of multiple pathogens without the need for a labeling reagent or biochemical processing. Bacterial colonies consisting of the progeny of a single parent cell scatter light at 635 nm to produce unique forward-scatter signatures. Zernike moment invariants and Haralick descriptors aid in feature extraction and construction of the scatter-signature image library. The method is able to distinguish bacterial cultures at the genus and species level for Listeria, Staphylococcus, Salmonella, Vibrio, and Escherichia with an accuracy of 90-99% for samples derived from food or experimentally infected animal. Varied amounts of exopolysaccharide produced by the bacteria causes changes in phase modulation distributions, resulting in strikingly different scatter signatures. With the aid of a robust database the method can potentially detect and identify any bacteria colony essentially instantaneously. Unlike other methods, it does not destroy the sample, but leaves it intact for other confirmatory testing, if needed, for forensic or outbreak investigations.


Nervous tissue thiamine metabolism in vivo. III. Influence of ethanol intake on the dynamics of thiamine and its phosphoesters in different brain regions and sciatic nerve of the rat.
The effects of chronic ethanol administration on different steps of the metabolism of thiamine (T), thiamine mono- (TMP) and thiamine pyrophosphate (TPP) in the cerebellum, brainstem, cerebral cortex and sciatic nerve were evaluated in vivo. The radioactivity of T and its phosphoesters was determined in plasma and in the selected nervous structures under steady-state conditions and at fixed time intervals (0.5-192 h) after an i.p. injection of [14C]T (30 micrograms: 1.25 microCi) to rats chronically (35 days) ethanol-treated (daily dose of 4.7 g X kg-1 b.wt. by gastric gavage) and pair-fed controls similarly treated with a sucrose solution isoenergetic with ethanol. All rats were given a nutritionally adequate diet supplying an excess of thiamine, which produced a virtually steady content of thiamine compounds in the tissues. By using a compartmental mathematical model, fractional rate constants, turnover rates and turnover times were calculated. Ethanol caused a reduction of the rate of thiamine compound enzymatic transformations (T phosphorylation to TPP, TPP dephosphorylation to TMP and TMP to T), and a facilitation of the regional uptake of T and TMP, associated to a less relevant influence on their release. Isoenergetic sucrose prevailingly caused an increased rate of thiamine metabolic steps (except phosphorylation in the brainstem and cerebral cortex), with negligible modifications of T and TMP uptake and release. Thus the changes induced by ethanol were virtually opposite to those caused by sucrose.


Application of Lineage Tracing in Central Nervous System Development and Regeneration.
The central nervous system (CNS) is a complicated neural network. The origin and evolution of functional neurons and glia cells remain unclear, as do the cellular alterations that occur during the course of cerebral disease rehabilitation. Lineage tracing is a valuable method for tracing specific cells and achieving a better understanding of the CNS. Recently, various technological breakthroughs have been made in lineage tracing, such as the application of various combinations of fluorescent reporters and advances in barcode technology. The development of lineage tracing has given us a deeper understanding of the normal physiology of the CNS, especially the pathological processes. In this review, we summarize these advances of lineage tracing and their applications in CNS. We focus on the use of lineage tracing techniques to elucidate the process CNS development and especially the mechanism of injury repair. Deep understanding of the central nervous system will help us to use existing technologies to diagnose and treat diseases.


Characterization of soluble circulating immune complexes by antigen-specific dissociation: detection in the Raji cell radioimmune assay.
The Raji cell radioimmune assay (RC-RIA) was used to demonstrate antigen-mediated dissociation of soluble circulating immune complexes (CICs). The dissociation resulted in a reduction in size and number of CICs which was reflected in diminished RC-RIA activity. Two sets of experiments were performed to examine the effect of preincubating excess antigen with immune complexes. First, bovine serum albumin (BSA) was preincubated with preformed BSA-anti-BSA immune complexes and RC-RIA activity was examined before and after incubating. Second, CIC-positive sera from two patients with human thyroglobulin (HuTg)-mediated immune complex glomerulonephritis were preincubated with HuTg and RC-RIA activity was examined. Significant reductions in RC-RIA activity were seen in both situations. The validity of these observations was confirmed by immunofluorescence and electrophoretic techniques. Sucrose density gradient ultracentrifugation studies confirmed the antigen-mediated diminution in size and number of soluble immune complexes as the mechanism responsible for diminished RC-RIA activity.


Amplitude and target diameter in motor programming of discrete, rapid aimed movements: Fitts and Peterson (1964) and Klapp (1975) revisited.
The reports by Fitts and Peterson [J. Exp. Psychol. 67(2) (1964) 103-113] and Klapp [J. Exp. Psychol. Hum. Percept. Perform. 104(2) (1975) 147-153] concerning the effects of movement amplitude and target diameter on reaction time present conflicting results. Fitts and Peterson reported that reaction time increased when movement amplitude was lengthened. Klapp reported an interaction in which target diameter effect on reaction time was moderated by movement length: for small targets, reaction time decreased with increasing movement length but reaction time remained unchanged (or increased modestly) when target diameter was large. Two experiments were conducted to replicate and examine the inconsistency in the reaction time results. For both experiments movement time results were in agreement with the predictions of Fitts' law. However, the results for reaction time were mixed: support was obtained for Klapp (1975) but not for Fitts and Peterson (1964). Further analysis identified several potential variables that could have influenced reaction time and explained the different effects on reaction time reported by Fitts and Peterson (1964) and Klapp (1975). The potential variables could include: limb posture at the start of a response; number of limb segments required to perform the task; and the effect of pooling reaction time data from targets located right and left of the start point, and from near and far targets.


Cardioprotective effects of Schisantherin A against isoproterenol-induced acute myocardial infarction through amelioration of oxidative stress and inflammation via modulation of PI3K-AKT/Nrf2/ARE and TLR4/MAPK/NF-κB pathways in rats.
The scientific community is concerned about cardiovascular disease mortality and morbidity, especially myocardial infarction (MI). Schisantherin A (SCA), a dibenzocyclooctadiene lignan monomer found in S. chinensis fruits has cardiovascular advantages such as increasing NO production in isolated rat thoracic aorta and reducing heart damage caused by ischemia-reperfusion (I/R) through decreasing apoptosis. The present study was undertaken to explore the potential effects of SCA on ISO-induced myocardial infarction in rats. Rats were randomly allocated to four groups: control; ISO-treated, and two additional groups of ISO + SCA (5 or 10 mg/kg body weight). All SCA-treated groups were administered with SCA for 20 days and all ISO groups were challenged with ISO on days 19 and 20. SCA significantly attenuated ISO-induced rise in heart/body weight ratio, myocardial infarct size, and cardiac functional biomarkers (CK-MB, cTnI and BNP). SCA pre- and co-treatment resulted in a significant reduction in oxidative stress (via MDA, NO and GSH and increased activities of SOD, CAT and GPx) and inflammation (via decreased levels of TNF-α, IL-6 and IL-1β) markers when compared to the same levels in cardiac tissue of ISO-treated rats. This study also showed that SCA protects ISO-induced oxidative stress and inflammation by activating the PI3K-AKT/Nrf2/ARE pathway and suppressing TLR4/MAPK/NF-κB pathways. Furthermore, SCA treatment protected histopathological alterations observed in only ISO-treated cardiac transverse sections of rats. In conclusion, the findings of this study suggest that SCA protects against cardiac injury in the ISO-induced MI model of rats.


Bile duct disruption after laparoscopic cholecystectomy.
The reported prevalence of biliary tract disruption following laparoscopic cholecystectomy has ranged from 0% to 7% in early reports. We have reviewed the first 823 laparoscopic cholecystectomies performed at our institution and found 13 symptomatic biliary complications necessitating further therapy (prevalence 1.6%). This finding represents a decrease from the 2.7% prevalence found in our earlier series. The incidence of biliary complications will likely continue to vary depending on patient selection, operator experience, and new developments in laparoscopic technique. Bile duct injury and bile leaks are often difficult to diagnose but must be strongly considered in postoperative patients with abdominal pain, fever, jaundice, or continued bilious drainage from a surgical drain. Whereas computed tomography (CT) and sonography are sensitive in detecting perihepatic or free peritoneal fluid collections, they are nonspecific and definitive diagnosis of biliary tract injury requires hepatobiliary scintigraphy, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), or percutaneous aspiration. Disruption of the biliary tree has commonly been treated with reoperation or percutaneous drainage. More recently, endoscopic management has shown encouraging results for bile leaks and strictures in small series.


The neurotransmitter N-acetylaspartylglutamate in models of pain, ALS, diabetic neuropathy, CNS injury and schizophrenia.
N-Acetylaspartylglutamate (NAAG) is the most abundant and widely distributed peptide transmitter in the mammalian nervous system. NAAG activates the metabotropic glutamate mGlu(3) receptor at presynaptic sites, inhibiting the release of neurotransmitters, including glutamate, and activates mGlu(3) receptors on glial cells, stimulating the release of neuroprotective growth factors from these cells. Elevated levels of glutamate released from neurons are associated with the pathology of stroke, traumatic nervous system injury, amyotrophic lateral sclerosis, inflammatory and neuropathic pain, diabetic neuropathy and the schizophrenia-like symptoms elicited by phencyclidine. NAAG is inactivated by specific peptidases following its synaptic release. Novel compounds that inhibit these enzymes prolong the activity of synaptically released NAAG and have significant therapeutic efficacy in animal models of these diverse clinical conditions. In this review, we summarize recent studies in these animal models and discuss the mechanisms by which NAAG peptidase inhibitors achieve these effects.


Enhancer decommissioning by MLL4 ablation elicits dsRNA-interferon signaling and GSDMD-mediated pyroptosis to potentiate anti-tumor immunity.
Enhancer deregulation is a well-established pro-tumorigenic mechanism but whether it plays a regulatory role in tumor immunity is largely unknown. Here, we demonstrate that tumor cell ablation of mixed-lineage leukemia 3 and 4 (MLL3 and MLL4, also known as KMT2C and KMT2D, respectively), two enhancer-associated histone H3 lysine 4 (H3K4) mono-methyltransferases, increases tumor immunogenicity and promotes anti-tumor T cell response. Mechanistically, MLL4 ablation attenuates the expression of RNA-induced silencing complex (RISC) and DNA methyltransferases through decommissioning enhancers/super-enhancers, which consequently lead to transcriptional reactivation of the double-stranded RNA (dsRNA)-interferon response and gasdermin D (GSDMD)-mediated pyroptosis, respectively. More importantly, we reveal that both the dsRNA-interferon signaling and GSDMD-mediated pyroptosis are of critical importance to the increased anti-tumor immunity and improved immunotherapeutic efficacy in MLL4-ablated tumors. Thus, our findings establish tumor cell enhancers as an additional layer of immune evasion mechanisms and suggest the potential of targeting enhancers or their upstream and/or downstream molecular pathways to overcome immunotherapeutic resistance in cancer patients.


Mononucleated and binucleated cardiomyocytes in left atrium and pulmonary vein have different electrical activity and calcium dynamics.
Cardiomyocytes consist of single- and bi-nucleus myocytes. However, the electrophysiological characteristics of mononucleated and binucleated myocytes have never been elucidated. Left atrium (LA) and pulmonary veins (PVs) are important substrate and initiators of atrial fibrillation. The purposes of this study were to evaluate the electrical properties and calcium homeostasis in mononucleated and binucleated cardiomyocytes in the LA and PVs. A whole-cell clamp, fluo-4 fluorescence, and immunocytostaining were used to investigated mononucleated and binucleated cardiomyocytes in the LA and PVs. Both mononucleated PV and LA cardiomyocytes had more positive resting membrane potential than respective PV and LA binucleated cardiomyocytes. Additionally, mononucleated PV cardiomyocytes (n = 36) had faster beating rates (2.1 ± 0.2 Hz versus 1.0 ± 0.2 Hz, P < 0.05) than binucleated (n = 10) PV cardiomyocytes. The PV (n = 18) and LA (n = 15) mononucleated cardiomyocytes had larger [Ca²⁺](i) transients (F/F₀ 1.64 ± 0.09 versus 1.20 ± 0.03 IU, P < 0.05; 1.52 ± 0.06 versus 1.19 ± 0.05 IU, P < 0.05) than the binucleated PV (n = 10) and LA (n = 10) cardiomyocytes. The immunostaining showed that mononucleated cardiomyocytes had lower Kir 2.3 and higher ryanodine receptor densities than did binucleated cardiomyocytes both in the PV and LA. In conclusions, mononucleated PV and LA cardiomyocytes contain distinctive electrophysiological characteristics with a higher arrhythmogenic activity, which indicates that cell nucleus number may potentially determine the electrical activity and calcium handling in cardiomyocytes.


Localisation of upper oesophageal foreign bodies in a recumbent tetraplegic patient.
Report of oesophageal obstruction in a tetraplegic patient following swallowing of a chicken bone. Removal following x-ray localisation.


Refractory hypoxemia associated with neonatal pulmonary disease: the use and limitations of tolazoline.
Thirty-nine critically ill infants with pulmonary disease received tolazoline because of severe hypoxemia refractory to administration of 100% O2 and mechanical ventilation. Twenty-seven (69%) of the infants responded with an increase in PaO2 greater than or equal to 20 torr in the first umbilical arterial gas after completion of the initial ten-minute infusion (1 to 2 mg/kg) of the drug. A response was not correlated with survival. The overall survival was 46%, essentially unchanged from our previous report (44%). Infants with hyaline membrane disease had the poorest survival rate (33%). Complications associated with the use of tolazoline occurred in 82% of the infants. A hypotensive reaction, defined as a 25% decrease in mean arterial pressure from the pre-tolazoline level, occurred in 67% of the infants, and more commonly in the infants with RDS (87%). In 11 infants who did not respond to the initial dose of tolazoline, the dose was increased up to 10 mg/kg/hour; only one infant responded, and eight (73%) had a hypotensive reaction.


Fractional analysis of unsteady squeezing flow of Casson fluid via homotopy perturbation method.
The objective of this article is to model and analyze unsteady squeezing flow of fractional MHD Casson fluid through a porous channel. Casson fluid model is significant in understanding the properties of non-Newtonian fluids such as blood flows, printing inks, sauces and toothpaste etc. This study provides important results as unsteady flow of Casson fluid in fractional sense with aforementioned effects has not been captured in existing literature. After applying similarity transformations along with fractional calculus a highly non-linear fractional-order differential equation is obtained. Modeled equation is then solved along with no-slip boundary conditions through a hybrid of Laplace transform with homotopy perturbation algorithm. For validity purposes, solution and errors at various values in fractional domain are compared with existing results. LHPM results are better in terms of accuracy than other available results in literature. Effects of fractional parameter on the velocity profile, skin friction and behaviors of involved fluid parameters is the focal point of this study. Comprehensive, quantitative and graphical analysis is performed for investigating the effects of pertinent fluid parameters on the velocity profile and skin friction. Analysis revealed that fractional parameter depicts similar effect in case of positive and negative squeeze number. Also, skin friction decreases with an increasing fractional parameter. Moreover, in fractional environment Casson parameter has shown similar effect on the velocity profile in case of positive and negative squeeze number.


The Spanish experience of future classrooms as a possibility of smart learning environments.
Developing advanced technologies and their integration into educational spaces generates new training opportunities. Examples of these are Future Classrooms (FC) and Smart Learning Environments (SLE), two concepts linked to educational innovation through technology but also have their differences. This paper aims to identify the similarities and differences between FC developed in the Spanish formal educational context concerning the theory of SLE. This study follows an exploratory research methodology using an ad hoc questionnaire applied transversally to a representative sample of teachers involved in the SLE (N = 66). SPSS V. 28 software was used. In relation to the results, some statistics (mean, standard deviation, kurtosis and skewness) were used to analyse the developed FC practices and professional satisfaction. In conclusion, the FC are at an initial stage of development in Spain, and although they could represent an approximation to what would be the practical basis of SLE, there are still several aspects to be developed, especially in relation to the technologies used and the dimension of attention to diversity. In relation to SLE technologies, they are related to the automation of certain processes and include artificial intelligence, learning analytics and sensors, among others. On the other hand, these technologies are not widely used in the FC, and the use of other more conventional technological resources, such as interactive whiteboards, online collaborative environments, LMS platforms, etc. In terms of attention to diversity, despite the existence of initiatives to personalise the learning experience in FC, assistive technologies are not considered, nor is automatic personalisation through certain SLE technologies.


Superoxide production by human eosinophils can be inhibited in an agonist-selective manner.
This paper focuses on eosinophil activation and its selective inhibition. Superoxide anion (O2-) production by human eosinophils, an indicator of their activation, was induced by a variety of activators. Several compounds which are known to inhibit protein kinase C (staurosporine, K252a, sphingosine) inhibited O2- production induced by phorbol ester (PMA) but failed to inhibit O2- production induced by IgG coupled to Sepharose beads. Inhibition of O2- production by other agents (plasma-activated zymosan, fMLP, and leukotriene B4 (LTB4), was intermediate. By contrast, wortmannin, a compound which has been previously reported to inhibit O2- production in neutrophils via a protein kinase-independent pathway, potently inhibited O2- production in eosinophils which had been activated by IgG and by Platelet-Activating Factor but was virtually inactive against PMA-induced O2- production. Taken together, the results indicate that, as a minimum, there must be two pathways of induction of O2- production in eosinophils. Moreover, the intermediate levels of inhibition in cells which had been activated with serum-activated zymosan, FMLP, and LTB4 suggest that these agents may either be acting via both of these pathways or that yet other pathways may exist.


Retinochoroidal microvascular changes in newly developed obese children: an optical coherence tomography angiography study.
Childhood obesity was associated with retinochoroidal microvascular changes using optical coherence tomography angiography (OCTA), but obesity duration was neglected. Obesity is chronic and progressive and obesity duration is related to microvascular function. Thus, it is important to identify microvascular changes in obese children timely to allow possible interventions with the increase in the number of obese children. This pilot study aimed to characterize retinochoroidal microvascular changes in newly developed obese children compared to age- and sex-matched controls. Forty newly developed obese children and 40 age- and sex-matched controls were recruited. All subjects completed comprehensive eye examinations, including axial length, cycloplegic refraction, optical coherence tomography angiography scans (AngioVue; Optovue Inc), etc. RESULTS: There were no statistically significant differences between groups in terms of month age (P = 0.927), spherical equivalent refraction (P = 0.753) and axial length (P = 0.196). Newly developed obese children had lower vessel density (VD) in the inferior parafovea (P = 0.026), nasal parafovea (P = 0.038) and temporal perifovea (P = 0.026) of deep vascular complex (DVC), higher VD in the fovea of superficial vascular complex (P = 0.021) and the fovea of DVC (P = 0.016), and smaller foveal avascular zone (P = 0.003) when compared to controls. Also, no apparent differences in any quadrant of total retinal thickness, subfoveal choroidal thickness (SFCT), and choriocapillaries fow voids were detected (all P > 0.05). Retinochoroidal microvascular changes had already occurred in newly developed obese children, so early screening and close follow-up eye examinations were recommended; Retinal microvascular insult may precede its structural change and that retina may be a better candidate to predict the onset of retinochoroidal microvascular changes than choroid in obese children.


Trajectories of cardiac troponin in the decades before cardiovascular death: a longitudinal cohort study.
High-sensitivity cardiac troponin testing is a promising tool for cardiovascular risk prediction, but whether serial testing can dynamically predict risk is uncertain. We evaluated the trajectory of cardiac troponin I in the years prior to a cardiovascular event in the general population, and determine whether serial measurements could track risk within individuals. In the Whitehall II cohort, high-sensitivity cardiac troponin I concentrations were measured on three occasions over a 15-year period. Time trajectories of troponin were constructed in those who died from cardiovascular disease compared to those who survived or died from other causes during follow up and these were externally validated in the HUNT Study. A joint model that adjusts for cardiovascular risk factors was used to estimate risk of cardiovascular death using serial troponin measurements. In 7,293 individuals (mean 58 ± 7 years, 29.4% women) cardiovascular and non-cardiovascular death occurred in 281 (3.9%) and 914 (12.5%) individuals (median follow-up 21.4 years), respectively. Troponin concentrations increased in those dying from cardiovascular disease with a steeper trajectory compared to those surviving or dying from other causes in Whitehall and HUNT (Pinteraction < 0.05 for both). The joint model demonstrated an independent association between temporal evolution of troponin and risk of cardiovascular death (HR per doubling, 1.45, 95% CI,1.33-1.75). Cardiac troponin I concentrations increased in those dying from cardiovascular disease compared to those surviving or dying from other causes over the preceding decades. Serial cardiac troponin testing in the general population has potential to track future cardiovascular risk.


Metschnikowia lunata sp. nov.
Ascosporulation in the yeast strain designated as Selenotila intestinalis Krassilnikov was achieved. On the basis of mode of ascus formation and ascospore morphology it is included in the genus Metschnikowia Kamienski as a new species, M. lunata.