Ribosomal RNA gene sequencing for early diagnosis of Blastomyces dermatitidis infection.
Prompt detection and identification of fungal pathogens at the genus and species level is critical in order to provide timely antifungal therapy. Here, we highlight the vital role of molecular diagnostics in achieving a fast and definitive diagnosis of disseminated blastomycosis in a diabetic patient presenting as a brain mass initially thought to be tumoral in nature. A broad-range PCR amplification and sequencing of the fungal ribosomal RNA genes on brain biopsy tissue obtained during elective craniotomy revealed a final microbial identification of Ajellomyces dermatitidis (telemorph of Blastomyces dermatitidis).


Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery.
Three-dimensional surface imaging (3D-SI) is being marketed as a tool in aesthetic breast surgery. It has recently also been studied in the objective evaluation of cosmetic outcome of oncological procedures. The aim of this review is to summarise the use of 3D-SI in oncoplastic, reconstructive and aesthetic breast surgery. An extensive literature review was undertaken to identify published studies. Two reviewers independently screened all abstracts and selected relevant articles using specific inclusion criteria. Seventy two articles relating to 3D-SI for breast surgery were identified. These covered endpoints such as image acquisition, calculations and data obtainable, comparison of 3D and 2D imaging and clinical research applications of 3D-SI. The literature provides a favourable view of 3D-SI. However, evidence of its superiority over current methods of clinical decision making, surgical planning, communication and evaluation of outcome is required before it can be accepted into mainstream practice.


Empirical evaluation of a virtual laboratory approach to teach lactate dehydrogenase enzyme kinetics.
Personalised instruction is increasingly recognised as crucial for efficacious learning today. Our seminal work delineates and elaborates on the principles, development and implementation of a specially-designed adaptive, virtual laboratory. We strived to teach laboratory skills associated with lactate dehydrogenase (LDH) enzyme kinetics to 2nd-year biochemistry students using our adaptive learning platform. Pertinent specific aims were to:(1)design/implement a web-based lesson to teach lactate dehydrogenase(LDH) enzyme kinetics to 2nd-year biochemistry students(2)determine its efficacious in improving students' comprehension of enzyme kinetics(3)assess their perception of its usefulness/manageability(vLab versus Conventional Tutorial). Our tools were designed using HTML5 technology. We hosted the program on an adaptive e-learning platform (AeLP). Provisions were made to interactively impart informed laboratory skills associated with measuring LDH enzyme kinetics. A series of e-learning methods were created. Tutorials were generated for interactive teaching and assessment. The learning outcomes herein were on par with that from a conventional classroom tutorial. Student feedback showed that the majority of students found the vLab learning experience "valuable"; and the vLab format/interface "well-designed". However, there were a few technical issues with the 1st roll-out of the platform. Our pioneering effort resulted in productive learning with the vLab, with parity with that from a conventional tutorial. Our contingent discussion emphasises not only the cornerstone advantages, but also the shortcomings of the AeLP method utilised. We conclude with an astute analysis of possible extensions and applications of our methodology.


Perception of motion trajectory of object from the moving cast shadow in infants.
A moving cast shadow of the object affects the perception of the object's trajectory in adults [Kersten, D., Mamassian, P., & Knill, D. C. (1997). Moving cast shadow induce apparent motion in depth. Perception, 26, 171-192]. In the present study, we investigated by using a habituation-dishabituation procedure whether infants at 4- to 7-months old discriminate the motion trajectory of a ball from the moving shadow it casts. In Experiment 1, 4- to 5-month-old and 6- to 7-month-old were tested for ability to discriminate between a "depth" display containing a ball and a cast shadow with a diagonal trajectory and an "up" display containing a ball with a diagonal trajectory and a cast shadow with a horizontal trajectory. Six- and 7-month-old, but not 4- and 5-month-old, infants looked significantly longer at the "up" display than at the "depth" display. In Experiment 2, we tested whether 4- to 5-month-old and 6- to 7-month-old infants would perceive "up" motion as categorically different from "depth" depending on the object's 3-D trajectory. We used displays containing a ball and a cast shadow with the same trajectories as those in Experiment 1 except that the cast shadows appeared above the ball. These displays did not produce 3-D impressions in adults. Neither age group of infants exhibited significant differences between "up" and "depth" displays. When the results from the two experiments are considered, 6- and 7-month-old infants discriminated the motion trajectory of the ball from the moving cast shadows. This developmental emergence of depth perception from a moving cast shadow at 6 months of age is consistent with that of other pictorial depth cues.


Structure-activity study of L-cysteine-based N-type calcium channel blockers: optimization of N- and C-terminal substituents.
Synthesis and structure-activity relationship (SAR) studies of L-cysteine-based N-type calcium channel blockers are described. In the course of exploring SAR of the N- and C-terminal substituents, the L-cysteine derivative was found to be a potent N-type calcium channel blocker with an IC(50) value of 0.14 microM on IMR-32 assay. Compound showed 12-fold selectivity for N-type over L-type calcium channels on AtT-20 assay.


CORBA security services for health information systems.
The structure of healthcare systems in developed countries is changing to 'shared care', enforced by economic constraints and caused by a change in the basic conditions of care. That development results in co-operative health information systems across the boundaries of organisational, technological, and policy domains. Increasingly, these distributed and, as far as their domains are concerned, heterogeneous systems are based on middleware approaches, such as CORBA. Regarding the sensitivity of personal and medical data, such open, distributed, and heterogeneous health information systems require a high level of data protection and data security, both with respect to patient information and with respect to users. This paper, relying on experience gained through our activities in CORBAmed, describes the possibilities the CORBA middleware provides to achieve application and communication security. On the background of the overall CORBA architecture, it outlines the different security services previewed in the adopted CORBA specifications which are discussed in the context of the security requirements of healthcare information systems. Security services required in the healthcare domain but not available at the moment are mentioned. A solution is proposed, which on the one hand allows to make use of the available CORBA security services and additional ones, on the other hand remains open to other middleware approaches, such as DHE or HL7.


Poly(N,N-dimethylacrylamide)-grafted polyacrylamide: a self-coating copolymer for sieving separation of native proteins by CE.
The potential of a series of newly synthesized poly(N,N-dimethylacrylamide) (PDMA) grafted polyacrylamide (PAM) copolymers (P(AM-PDMA)) as a replaceable separation medium for protein analysis was studied. A comparative study with and without copolymers was performed; the separation efficiency, analysis reproducibility and protein recovery proved that the P(AM-PDMA) copolymers were efficient in suppressing the adsorption of basic proteins onto the silica capillary wall. Furthermore, the size-dependent retardation of native proteins in a representative P(AM-PDMA) copolymer was demonstrated by Ferguson analysis. The results showed that the P(AM-PDMA) copolymers combine the good coating property of PDMA and the sieving property of PAM and could be applied as a sieving matrix for the analysis of native proteins.


Determination of perfluoroalkyl substances (PFASs) in fats and oils by QuEChERS/micro-HPLC-MS/MS.
Per- and polyfluoroalkyl substances (PFASs) are man-made chemicals that have been identified as global pollutants. Their widespread occurrence, including in food, is a potential concern for consumers. This work focuses on the application of a simple and reliable analytical method for the simultaneous determination of ten perfluoroalkyl acids in highly complex fatty matrices (fats and oils). The perfluoroalkyl substances were extracted by the QuEChERS method, based on the dispersive-Solid Phase Extraction using styrene-divinylbenzene bulk sorbent, and quantitatively analysed by micro-high performance liquid chromatography tandem mass spectrometry. Recoveries ranged from 72 to 104% with an acceptable relative standard deviation below 10%. Limits of quantification were within the range 0.002-0.075 ng/g depending on the perfluoroalkyl compound. The most predominant compound in fat and oil food samples was perfluorooctanoic acid (PFOA) with a detection frequency of 100%, and the highest levels were found for perfluorobutanoic acid (PFBA). The estimated exposure to PFOA, which was 46% and 19% of the existing TWI for the EU and Polish population, respectively, is relatively high and indicates a potential risk to human health.


Venous Thromboembolism Risk in Patients With Newly Diagnosed Multiple Myeloma Treated with Carfilzomib or Bortezomib in Combination With Lenalidomide and Dexamethasone.
Multiple myeloma (MM), as well as some treatments for MM, increase the risk of venous thromboembolism (VTE). Prior literature suggests carfilzomib, lenalidomide, and dexamethasone (KRd) may have a higher incidence of thromboembolic events compared with bortezomib, lenalidomide, and dexamethasone (VRd). We aimed to evaluate VTE risk with KRd induction compared to VRd at a large academic medical center in the United States. We retrospectively reviewed patients with newly diagnosed MM presenting at a single institution. Patients were followed for objectively diagnosed VTE events for 6 months following the start of induction therapy. A total of 209 patients were included, with 69 (33%) receiving KRd and 140 (67%) receiving VRd. Overall, 18 patients (9%) had a VTE event, with 5 (7%) in the KRd cohort and 13 (9%) in the VRd cohort (P = .80). Treatment with KRd was not associated with an increased risk of VTE compared to VRd (HR 0.74; 95% CI 0.26-2.08; P = .57). In this cohort, KRd was not associated with an increase in VTE risk compared to VRd, contrary to prior literature.


CD40-CD40L interactions induce chemokine expression by human microglia: implications for human immunodeficiency virus encephalitis and multiple sclerosis.
CD40 is a protein on microglia that is up-regulated with interferon (IFN)-gamma and is engaged by CD40L, found on CD4+ T cells, B cells, and monocytes. These interactions may be important in central nervous system inflammatory diseases. Microglia have been shown to be a source of chemokines, whose expression plays a key role in central nervous system pathologies. We examined the expression of CD40 on microglia in human immunodeficiency virus (HIV) encephalitic brain, and the effects of CD40-CD40L interactions on the expression of chemokines by cultured microglia. We found significantly increased numbers of CD40-positive microglia in HIV-infected brain tissue. Treatment of cultured microglia with IFN-gamma and CD40L increased expression of several chemokines. IFN-gamma- and CD40L-induced MCP-1 protein was mediated by activation of the ERK1/2 MAPK pathway, and Western blot analysis demonstrated phosphorylation of ERK1/2 upon stimulation of microglia. In contrast, IFN-gamma- and CD40L-induced IP-10 protein production was mediated by the p38 MAPK pathway. Our data suggest a mechanism whereby CD40L+ cells can induce microglia to secrete chemokines, amplifying inflammatory processes seen in HIV encephalitis and multiple sclerosis, and implicate CD40-CD40L interactions as a target for interventional strategies.


Biliary motor function in gallstone patients evaluated by fatty-meal MR cholangiography.
To investigate the possibility of evaluating biliary motor function with magnetic resonance cholangiography (MRC). Twenty patients with gallstones and 30 control subjects were studied using fatty-meal MRC. After baseline MRC, they were encouraged to drink 250 mL of milk and underwent postprandial MRC every 10 minutes for 60 minutes. Postprandial changes in gallbladder volume and the diameter of the common duct were assessed as indicators of gallbladder contractility and biliary obstruction, respectively. Postprandial dilatation at 60 minutes was considered indicative of persistent biliary obstruction. Gallbladder ejection fraction was calculated at 66.0% +/- 12.2% (range, 40.3%-88.6%) in the controls. Gallbladder volume expressed as a percentage of the baseline value was significantly larger at 20-60 minutes in the gallstone patients than in the controls. Gallbladder ejection fraction varied widely (mean, 46.4% +/- 24.4%; range, 2.8%-81.5%) and was significantly reduced in comparison with that of the controls (P < 0.01). In two gallstone patients with co-existing ductal stones, transient postprandial dilatation associated with ampullary impaction was observed. Persistent biliary obstruction was not indicated in any subjects. The results of this study suggest the feasibility of fatty-meal MRC, as well as its potential for evaluating biliary motor function.


Capacity of capsazepinoids to relax human small airways and inhibit TLR3-induced TSLP and IFNβ production in diseased bronchial epithelial cells.
Thymic stromal lymphopoietin (TSLP), an immunomodulating potentially disease-inducing cytokine, is overproduced in TLR3-stimulated bronchial epithelial cells from asthmatic donors whereas production of antiviral IFNβ is deficient. It is of therapeutic interest that capsazepine inhibits epithelial TSLP and relaxes human small airways with similar potencies. However, it is not known if other capsazepine-like compounds share such dual actions. This study explores epithelial anti-TSLP and anti-IFNβ effects of capsazepine and novel capsazepine-like bronchorelaxants. We used primary bronchial epithelial cells from asthmatic and chronic obstructive pulmonary disease (COPD) donors, and human small airways dissected from surgically removed lungs. Seven novel capsazepinoids were about 10 times, and one compound (RES187) >30 times, more potent than capsazepine as relaxants of LTD(4)-contracted small airways. TLR3-induced TSLP, TNFα, CXCL8, and IFNβ mRNA and protein levels were dose-dependently and non-selectively inhibited by capsazepine, equally in cells from asthmatic and COPD donors. The novel compounds, except RES187, reduced TSLP and IFNβ but none are more potent than capsazepine. Only capsazepine consistently inhibited TNFα and CXCL8 production and attenuated TLR3-induced epithelial NF-κB signalling. Hence, the present compounds did not separate between inhibition of TLR3-induced epithelial TSLP and IFNβ, but all compounds, except capsazepine, did separate between the bronchorelaxant and the epithelial immune effects. We conclude that similar mechanisms may be involved in capsazepine-like inhibition of TLR3-induced epithelial TSLP and IFNβ and that these are distinct from mechanisms involved in relaxation of small airways by these compounds.


Effect of adding dimethyl carbonate and gasoline to diesel fuel + corn oil blend on performance and combustion characteristics of a diesel engine.
Diesel fuel and corn oil are mixed in the 80:20 volumetric ratio. Dimethyl carbonate and gasoline are added to diesel fuel + corn oil blend in 4:96, 6:94, 8:92, and 10:90 volumetric ratios to obtain ternary blends. Effects of ternary blends on the performance and combustion characteristics of a diesel engine are investigated under different engine speeds (1000-2500 rpm). 3D Lagrange interpolation method is applied to measured data of dimethyl carbonate blends to predict the engine speed, blending ratio, and crank angle giving maximum peak pressure and peak heat release rate. On average, dimethyl carbonate blends and gasoline blends show 4.3642-12.1578% and 1.0323-8.6843% reduction in effective power, and 1.4938-3.4322% and 4.3357-8.7188% reduction in effective efficiency, respectively, relative to diesel fuel. On average, there is a reduction in cylinder peak pressure (4.6701-7.3418%; 4.0457-6.2025%) and peak heat release rate (0.8020-4.5627%; 0.4-1.2654%) for dimethyl carbonate blends and gasoline blends, respectively, compared to diesel fuel. Because of low relative errors (1.0551% and 1.4553%), 3D Lagrange provides well accuracy in the prediction of maximum peak pressure and peak heat release rate. On average, dimethyl carbonate blends produce less CO (7.4744-17.5424%), HC (15.5410-29.5501%) and smoke (14.1767-25.2834%) emissions, compared with diesel fuel.


Cold-water acclimation does not modify whole-body fluid regulation during subsequent cold-water immersion.
We investigated the impact of cold-water acclimation on whole-body fluid regulation using tracer-dilution methods to differentiate between the intracellular and extracellular fluid compartments. Seven euhydrated males [age 24.7 (8.7) years, mass 74.4 (6.4) kg, height 176.8 (7.8) cm, sum of eight skinfolds 107.4 (20.4) mm; mean (SD)] participated in a 14-day cold-water acclimation protocol, with 60-min resting cold-water stress tests [CWST; 18.1 (0.1) degrees C] on days 1, 8 and 15, and 90-min resting cold-water immersions [18.4 (0.4) degrees C] on intervening days. Subjects were immersed to the 4th intercostal space. Intracellular and extracellular fluid compartments, and plasma protein, electrolyte and hormone concentrations were investigated. During the first CWST, the intracellular fluid (5.5%) and plasma volumes were reduced (6.1%), while the interstitial fluid volume was simultaneously expanded (5.4%). This pattern was replicated on days 8 and 15, but did not differ significantly among test days. Acclimation did not produce significant changes in the pre-immersion distribution of total body water, or changes in plasma osmolality, total protein, electrolyte, atrial natriuretic peptide or aldosterone concentrations. Furthermore, a 14-day cold-water acclimation regimen did not elicit significant changes in body-fluid distribution, urine production, or the concentrations of plasma protein, electrolytes or the fluid-regulatory hormones. While acclimation trends were not evident, we have confirmed that fluid from extravascular cells is displaced into the interstitium during acute cold-water immersion, both before and after cold acclimation.


Granulomatous mastitis, erythema nodosum, and polyarthritis: a case report.
Granulomatous mastitis is a rare inflammatory disease of the breast, typically seen in woman of child-bearing age. No definitive etiology has been described. In rare instances, this condition has been reported to be associated with extramammary manifestations such as erythema nodosum and arthritis. We describe this rare condition in an adolescent female. A 16-year-old, Hispanic female presented with right-sided painful breast swelling, polyarthritis, and erythema nodosum on bilateral shins and lower thighs. Physical examination was negative for lymphadenopathy and pulmonary, gastrointestinal, and cardiovascular findings. Ophthalmologic examination for uveitis and serologic tests for autoimmune diseases were negative. Diagnosis of idiopathic granulomatous mastitis was made by exclusion of other etiologies and conditions. Confirmation was made by histopathologic examination demonstrating noncaseating granuloma within breast lobules with neutrophils and microabscess formation. After wide local excision and a short course of trimethoprim-sulfamethoxazole, our patient was placed on naproxen and prednisone, the latter being tapered off over 3 months, with steady and complete resolution of all symptoms. This is the first reported case of idiopathic granulomatous mastitis in a pediatric patient who also had extramammary manifestations, including erythema nodosum and polyarthritis. In this case-based review, we summarize the phenotype, risk factors, prognosis, and treatment options of this rare condition, chiefly to make the readers cognizant of such a diagnostic possibility in similar clinical presentation in the future.


Systems approach to reduce errors in surgery.
Reducing the number of medical errors significantly is the challenge for the coming decade. In medicine and in surgery, in particular, errors are traditionally treated as being committed by individuals. To reduce human errors, two approaches can be used: the person approach and the systems approach. In the systems approach, the operator is not blamed, but the system is analyzed in order to find the causes of errors. Furthermore, defenses are built into the system so that errors will not result in an adverse outcome anymore. This article aims to provide insight into the systems approach.


Unusual minor nonmethylene-interrupted di-, tri-, and tetraenoic fatty acids in limpet gonads.
Unusual minor nonmethylene-interrupted (NMI) FA have been identified in the lipids of gonads from the limpets Cellana grata and Collisella dorsuosa by using GC-MS of the combination of their 4,4-dimethyloxazoline derivatives and picolinyl esters. Among 23 NMI unsaturated FA from C18 to C22 and C24 identified in this study, 5,11-nonadecadienoic (5,11-19:2), 7,1 6-heneicosadienoic (7,16-21:2), 9,15-tetracosadienoic (9,15-24:2), 5,9,15-docosatrienoic (5,9,15-22:3), and 5,9,15-tetracosatrienoic (5,9,15-24:3) acids may not have been reported previously from living organisms. The presence of 5,11,14,17-eicosatetraenonoic (5,11,14,17-20:4) and 7,13,16,19-docosatetraenenoic (7,13,16,19-22:4) acids as FA components in marine mollusks may be reported here for the first time. In this study, the male and female gonads of both species showed distinct differences in both their composition and proportions of NMI FA. Most NMI FA identified were mainly present in the female gonads of both species, especially in TAG that contained 21 NMI FA.


Cardiac arrhythmias after laparoscopic banding.
Morbid obesity is associated with various disorders and may effectively be treated by restrictive surgery, such as laparoscopic adjustable gastric banding (LAGB). We observed a patient suffering from cardiac arrhythmias following LAGB. These cardiac events were likely evoked by hypokalemia due to persistent vomiting after placement of the band. We describe a case of continuing vomiting following a gastric banding procedure. Causes may include both mechanical, i.e. gastric prolapse, and psychological factors. The present case stresses the need for frequent follow-up for patients after a gastric restrictive operation.


Normal tension glaucoma management: a survey of contemporary practice.
The aim of this study was to investigate contemporary practice patterns with respect to normal tension glaucoma (NTG) management and to determine whether the 2 largest NTG trials have influenced ophthalmologists' clinical practice. A survey questionnaire was sent to ophthalmologists via the American Glaucoma Society, the Canadian Glaucoma Society, and the Canadian Ophthalmological Society. The questionnaire was designed to investigate ophthalmologists' usual practice with respect to NTG and the extent to which practice has been influenced by the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Low pressure Glaucoma Treatment Study (LoGTS). In total, 419 ophthalmologists completed the survey. Of these, 264 respondents were glaucoma subspecialists. The survey showed that 95% and 64% of ophthalmologists were familiar with the CNTGS and the LoGTS, respectively. Of the respondents, 70% indicated that they would initiate treatment in mild-to-moderate NTG without waiting for documented disease progression. Of the respondents, 61% of the total surveyed and 50% of the glaucoma subspecialists felt that the LoGTS results had no impact on their usual clinical practice. The first-choice topical drug for NTG was a prostaglandin analogue (88% of respondents) or brimonidine (10% of respondents). Most ophthalmologists treat NTG more aggressively than recommended by the CTNGS protocol. Most ophthalmologists felt that the LoGTS results had no impact on their normal clinical practice. The prostaglandin analogues are, by far, the most popular choice of drug for contemporary management of NTG.


Compound Astragalus and Salvia miltiorrhiza extract inhibits cell proliferation, invasion and collagen synthesis in keloid fibroblasts by mediating transforming growth factor-β / Smad pathway.
The transforming growth factor (TGF)-β/Smad pathway plays a key role in keloid development. We have previously demonstrated that compound Astragalus and Salvia miltiorrhiza extract (CASE) inhibits liver fibrosis and reduces invasion capacity of HepG2 cells by mediating the TGF-β/Smad pathway. We therefore hypothesize that CASE may also exert antifibrotic effects in keloids by mediating the TGF-β/Smad pathway. To investigate the effects of CASE on cell proliferation, invasion and collagen synthesis in keloid fibroblasts, and to explore the effects of CASE on the TGF-β/Smad signal pathway in order to elucidate its mechanisms of action. The inhibitory effects of CASE on keloid fibroblasts were evaluated. Cell proliferation was studied by MTT assay; cell invasion was observed utilizing Transwell invasion chambers; and collagen synthesis in keloid fibroblasts was measured by (3) H-proline incorporation assay. Expression of proteins induced by TGF-β1 and their intracellular localization in keloid fibroblasts were investigated by Western blot and immunofluorescence, respectively. Plasminogen activator inhibitor-1 (PAI-1) transcriptional activity was measured by real-time reverse transcription-polymerase chain reaction. CASE significantly inhibited cell proliferation induced by newborn bovine serum as well as collagen synthesis and cell invasion induced by TGF-β1 in keloid fibroblasts, while it showed weak effects on normal fibroblasts. The phosphorylation of Smad2/3 was markedly reduced by CASE treatment, while CASE exhibited stronger inhibitory effects on linker region phosphorylation (pSmad2L and pSmad3L) compared with effects on C-terminal region phosphorylation (pSmad2C and pSmad3C). In addition, CASE blocked formation of Smad2/3/4 complexes and their nuclear translocation, but upregulated Smad7 expression in a dose-dependent manner. PAI-1 mRNA and protein levels were also suppressed by CASE treatment. These results suggest that CASE exhibits inhibitory effects on cell proliferation, invasion and collagen synthesis in keloid fibroblasts, and its mechanisms of action may involve the TGF-β/Smad pathway.


[Simulation of laparoscopic surgery--four years' experience at the Department of Surgery of the University Hospital Marburg].
It is well known that learning curves are longer for laparoscopic surgery compared to open surgery. Recently, virtual reality (VR) simulation was developed as alternative to conventional training. Such a new training system makes it possible to offer a wide range of repeatable surgical situations, and thus, enable assessments based on direct observation of performance. During the last four years we did several studies using a VR simulator (LapSim). After a constructive validity study - discrimination between novices and experienced laparoscopic surgeons, we were able to show that advanced residents benefit most from a three-day practical course for laparoscopic surgery, while - in a further investigation - we found contrary to training at the Pelvitrainer that novices in laparoscopic surgery have the most benefit from VR training. Minimally invasive surgery is significantly more sophisticated for the surgeon than open surgery. While Research on laparoscopic surgery has focused primarily on the development and assessment of technical skills, non technical skills such as visual-spatial perception and stress coping has received much less attention. We showed that spatial perception as well as stress coping positively correlates with virtual laparoscopic skills. A high degree of spatial perception led to faster adaption to a non-stereo environment and correlated with high level of laparoscopic skills. Furthermore, Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. VR simulation seems to be a promising tool to improve laparoscopic skills in a modern apprenticeship model. According to patient safety, the development of this instrument for surgery should be advanced professionally just as a flight simulators in aviation.


Vascular endothelial growth factor in neonates with perinatal asphyxia.
Vascular endothelial growth factor (VEGF) is a polypeptide growth factor that is activated by tissue hypoxia. The role of VEGF in perinatal asphyxia in human neonates is yet to be clarified. In infants who develop moderate to severe acute hypoxic ischemic encephalopathy (HIE) it is crucial to clearly understand physiologic and biochemical changes that accompany HIE before a novel treatment can be developed. To assess VEGF in cord blood of infants suffering from perinatal asphyxia, and to determine whether an association exists between increased concentrations of VEGF and the risk for development of encephalopathy. We prospectively studied 40 full term infants; of them 20 infants suffered from perinatal asphyxia, and 20 control infants of comparable age and sex. We obtained cord blood samples from all subjects immediately after delivery. Neurological examination and grading of HIE were performed during the first day of life. Birth weight, gestational age and gender did not differ between the control (n=20) and asphyxia (n=20) groups. Within the asphyxia group four infants developed HIE; one with severe encephalopathy who died shortly after birth, while the other three infants had moderate HIE. Concentrations of VEGF were increased in infants with asphyxia when compared to controls (P0.001). Within the asphyxia group, infants with HIE had significantly increased concentrations of VEGF when compared to non-HIE asphyxiated infants (P=0.008). In the logistic regression model, VEGF inversely correlated with pH and PO(2) in cord blood, and Apgar scores at 1min, while it did not associate with gestational age and birth weight. This study indicates that VEGF is increased in cord blood of neonates following birth asphyxia, and that VEGF is specifically most increased in infants who later developed encephalopathy. Further studies are required to determine the role of VEGF in brain insult. Such studies will help determine whether a therapeutic role for VEGF or VEGF inhibitors can exist for HIE infants.


Sonic hedgehog protects cortical neurons against oxidative stress.
Oxidative stress is one of the most important pathological mechanisms in neurodegenerative diseases and ischemia. Recent studies have indicated that the sonic hedgehog (SHH) signaling pathway is involved in these diseases, but the underlying mechanisms remains elusive. Here we report that the SHH pathway was activated in primary cultured cortical neurons after exposure to hydrogen peroxide (H₂O₂). H₂O₂ treatment decreased the cell viability of neurons, and inhibition of endogenous SHH signaling exacerbated its neurotoxicity. Activation of SHH signaling protected neurons from H₂O₂-induced apoptosis and increased the cell viability while those effects were partially reversed by blocking SHH signals. Exogenous SHH increased the activities of Superoxide dismutase (SOD) and Glutathione peroxidase (GSH-PX) in H₂O₂-treated neurons and decreased production of Malondialdehyde (MDA). It also promoted expression of the anti-apoptotic gene Bcl-2 and inhibited expression of pro-apoptotic gene Bax. Activation of SHH signals upregulated both Neurotrophic factors vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF). Pretreatment with SHH inhibited the activation of ERK (extracellular signal-regulated kinases) signals induced by H₂O₂. Our findings demonstrate that activation of SHH signaling protects cortical neurons against oxidative stress and suggest a potential role of SHH for the clinic treatments of brain ischemia and neurodegenerative disorders.


Elementary steps of proton translocation in the catalytic cycle of cytochrome oxidase.
Proton translocation in the catalytic cycle of cytochrome c oxidase (CcO) proceeds sequentially in a four-stroke manner. Every electron donated by cytochrome c drives the enzyme from one of four relatively stable intermediates to another, and each of these transitions is coupled to proton translocation across the membrane, and to uptake of another proton for production of water in the catalytic site. Using cytochrome c oxidase from Paracoccus denitrificans we have studied the kinetics of electron transfer and electric potential generation during several such transitions, two of which are reported here. The extent of electric potential generation during initial electron equilibration between CuA and heme a confirms that this reaction is not kinetically linked to vectorial proton transfer, whereas oxidation of heme a is kinetically coupled to the main proton translocation events during functioning of the proton pump. We find that the rates and amplitudes in multiphase heme a oxidation are different in the OH-->EH and PM-->F steps of the catalytic cycle, and that this is reflected in the kinetics of electric potential generation. We discuss this difference in terms of different driving forces and relate our results, and data from the literature, to proposed mechanisms of proton pumping in cytochrome c oxidase.


PTCA following myocardial infarction: use of bailout fibrinolysis to improve results.
The results of percutaneous transluminal coronary angioplasty (PTCA) in 307 lesions in 235 patients within 60 days of myocardial infarction (MI) were compared with the PTCA results in 591 lesions in 489 patients without recent MI, and the effect of fibrinolysis to treat recurring occlusive clot during angioplasty was studied. In 210 lesions in patients with MI who did not receive fibrinolysis during the MI (group A), 58 lesions were categorized as primary failures; bailout fibrinolysis brought the final failure incidence to 42 lesions (20%). In 97 lesions in patients with MI who received fibrinolysis during the acute MI (group B), 22 lesions were categorized as primary failures; bailout fibrinolysis resulted in final failures of 16 lesions (16.5%). In 591 lesions in patients without a recent MI (group C), there were 85 primary failures and 81 final failures after bailout fibrinolysis. Analysis of the PTCA results in each group with respect to whether the lesions were totally or partially occluded showed that more of the lesions attempted in the groups with MI (groups A and B) were totally occluded (TO) and that with use of bailout fibrinolysis the success rate of PTCA in TO lesions was the same in all groups. Similarly, with use of fibinolytic bailout during PTCA the success rate in partially occlusive lesions was not different between the groups. We conclude that bailout thrombolysis during PTCA is usually effective, especially in those who have recently had an MI, and that with availability of bailout fibrinolysis, PTCA in those with recent MI is not any less sucessful than in those without recent MI.(ABSTRACT TRUNCATED AT 250 WORDS)


Enhanced sulfamethazine detoxification by a novel BiOCl (110)/NrGO/BiVO4 heterojunction.
The emerging contaminants removal from the environment has recently been raised concerns due to their presence in higher concentrations. Over usage of emerging contaminant such as sulfamethazine poses serious threat to the aquatic and human health as well. This study deals with rationally structured a novel BiOCl (110)/NrGO/BiVO4 heterojunction which is used to detoxify sulfamethazine (SMZ) antibiotic efficiently. The synthesised composite was well characterized and the morphological analysis evidenced the formation of heterojunction consisted of nanoplates BiOCl with dominant exposed (110) facets and leaf like BiVO4 on NrGO layers. Further results revealed that the addition of BiVO4 and NrGO tremendously increased the photocatalytic degradation efficiency of BiOCl with the rate of 96.9% (k = 0.01783 min-1) towards SMZ within 60 min of visible light irradiation. Furthermore, heterojunction energy-band theory was employed to determine the degradation mechanism of SMX in this study. The larger surface area of BiOCl and NrGO layers are believed to be the reason for higher activity which facilitates the excellent charge transfer and improved light absorption. In addition, SMZ degradation products identification was carried out by LC-ESI/MS/MS to determine the pathway of degradation. The toxicity assessment was studied using E. coli as a model microorganism through colony forming unit assay (CFU), and the results indicated a significant reduction in biotoxicity was observed in 60 min of degradation process. Thus, our work gives new methods in developing various materials that effectively treat emerging contaminants from the aqueous environment.


Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis.
Acute appendicitis is one of the most common emergency requiring operation. As the first discovered coagulation factor, plasma fibrinogen frequently increases with inflammation due to the activation of coagulation. The aim of this retrospective study was to investigate the diagnostic value of hyperfibrinogenemia as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. We identified 455 patients (202 females, 253 males; mean age, 31.7 years) with histologically confirmed acute appendicitis who underwent laparoscopic or open appendectomy. Results of preoperative laboratory values and post-operative histologic results were analysed retrospectively. A multivariate logistic regression model was performed to determine patient's age and laboratory tests associated with perforated appendicitis. Mean plasma fibrinogen level of all patients was 3.99 g/L (1.41 SD; range, 1.73-10.6 g/L; median, 3.69 g/L). Patients with appendiceal perforation had a mean fibrinogen level of 5.72 g/L (1.52 SD; range, 3.38-10.04 g/L; median, 5.28 g/L), which was significantly higher than those with nonperforated groups (P = 0.001). Multivariate analysis showed fibrinogen and D-dimer were associated with perforation (P = 0.001, P = 0.014, respectively). Areas under the receiver operating characteristic curve of fibrinogen for discriminating acute perforated appendicitis from non-perforated groups were larger than white blood cell and D-dimer. Hyperfibrinogenemia was common in patients with acute appendicitis and fibrinogen may be useful as a predictive factor for appendiceal perforation.


A comparative analysis of aerosol exposure and prevention strategies in bystander, pre-hospital, and inpatient cardiopulmonary resuscitation using simulation manikins.
To evaluate aerosol exposure risk and prevention strategies during bystander, pre-hospital, and inpatient cardiopulmonary resuscitation (CPR). This study compared hands-only CPR, CPR with a surgical or N95 mask, and CPR with a non-rebreather mask at 15 L/min. 30:2 compression-ventilation ratio CPR was tested with face-mask ventilation (FMV), FMV with a high efficiency particulate air (HEPA) filter; supraglottic airway (SGA), SGA with a surgical mask, SGA with a HEPA filter, or SGA with both. Continuous CPR was tested with an endotracheal tube (ET), ET with a surgical mask, a HEPA filter, or both. Aerosol concentration at the head, trunk, and feet of the mannequin were measured to evaluate exposure to CPR personnel. Hands-only CPR with a surgical or N95 face mask coverings and ET tube ventilation CPR with filters showed the lowest aerosol exposure among all study groups, including CPR with NRM oxygenation, FMV, and SGA ventilation. NRM had a mask effect and reduced aerosol exposure at the head, trunk, and feet of the mannequin. FMV with filters during 30:2 CPR reduced aerosol exposure at the head and trunk, but increased at the feet of the mannequin. A tightly-sealed SGA when used with a HEPA filter, reduced aerosol exposure by 21.00-63.14% compared with a loose-fitting one. Hands-only CPR with a proper fit surgical or N95 face mask coverings is as safe as ET tube ventilation CPR with filters, compared with CPR with NRM, FMV, and SGA. FMV or tight-sealed SGA ventilation with filters prolonged the duration to achieve estimated infective dose of SARS-CoV-2 2.4-2.5 times longer than hands-on CPR only. However, a loose-fitting SGA is not protective at all to chest compressor or health workers standing at the foot side of the victim, so should be used with caution even when using with HEPA filters.


Tonic and dynamic gonadotropin secretion in depressive and normothymic phases of affective disorders.
Baseline follicle stimulating hormone (FSH) and luteinizing hormone (LH) plasma levels and their responses to luteinizing hormone releasing hormone (LHRH) stimulation were investigated in 72 patients who met Research Diagnostic Criteria for affective disorders and in 72 healthy volunteers. Fifty-six patients were examined during a depressive phase and 16 during a normothymic phase. LH-FSH basal levels were significantly lower in postmenopausal depressed and normothymic women than in controls. In fertile women and men, concentrations of the two gonadotropins were also lower in patients than in controls, but the phenomenon did not generally reach statistical significance. LHRH-induced LH rises were lower in postmenopausal and fertile depressed and normothymic women than in controls, while FSH rises were reduced only in postmenopausal depressive women in both depressed and normothymic phases. The impairment underlying the gonadotropin secretory deficiency remains to be elucidated.


Use of scrotal skin to cover cutaneous defects resulting from palliative lymph node dissections in groin and suprapubic area.
Scrotal skin was employed to cover skin defects resulting from palliative groin and suprapubic dissections designed to remove large masses of tumor which had eroded the skin. This technique provides a simple and effective alternative to more complex procedures using rotational skin and myocutaneous flaps to achieve primary skin closure in similar circumstances.


Intratumoral bacteria in uveal melanoma: A case report.
Intratumoral bacteria and their potential application to cancer immunotherapy have been a topic of interest in recent studies. To our knowledge, bacteria in uveal melanoma have not been previously reported. We describe a patient with a large choroidal melanoma, measuring 18 × 16 mm in basal dimension and 15 mm in ultrasonographic thickness, managed by plaque brachytherapy. At the time of plaque removal, a prophylactic scleral patch graft was placed to protect from anticipated scleral necrosis. Progressive ocular ischemia led to a blind and painful eye. The enucleated eye demonstrated an extensively necrotic and heavily pigmented mushroom-shaped regressed cilichoroidal mass deep to the scleral patch graft. Numerous Gram-positive cocci were noted within the regressed uveal melanoma and the adjacent sclera. This case highlights the fact that regressed uveal melanomas can contain intra-tumoral bacteria.


A hyaluronic acid-derived imaging probe for enhanced imaging and accurate staging of liver fibrosis.
Timely detection and accurate staging of liver fibrosis still remains a challenge. Herein, we report a hyaluronic acid (HA)-based magnetic resonance (MR)/fluorescence imaging agent, HA-Target-Cy5.5-DOTA-Gd (HTCDGd) with oxyamine groups to target allysine in the fibrous tissue, and a control agent, HA-Cy5.5-DOTA-Gd (HCDGd) without the targeting group was also prepared. Both agents have a nanoscale size with a high relaxivity, and show a rapid blood clearance rate and great biosafety. Compared to HCDGd, interaction of the targeting oxyamine groups in HTCDGd with allysine of collagen in the fibrosis tissue facilitates high accumulation of HTCDGd in the liver and allows sensitive and long-term detection of liver fibrosis at the early stage (Ishak = 3) and the late stage (Ishak = 5) in animal models via its enhanced MR signal. Those results are confirmed by fluorescence images. Overall, HTCDGd has been demonstrated as an effective agent for non-invasive and accurate diagnosis of liver fibrosis.


Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee.
Considerable interest has been developed over the past several years in expanding the treatment of symptomatic femoral condylar articular cartilage lesions in active patients. Multiple surgical techniques have been reported and evolving technologies, equipment and approaches continue to expand. The purpose of this paper is to review the presentation of focal articular cartilage lesions including treatment indications, current surgical options and postoperative protocols emphasizing advanced techniques used to preserve or restore hyaline cartilage tissue. The various surgical options are discussed and the advantages and disadvantages are reviewed and highlighted in a clinical practice guideline algorithm.


Monoclonal antibody-based analysis of cell wall remodeling during xylogenesis.
Xylogenesis, a process by which woody tissues are formed, entails qualitative and quantitative changes in the cell wall. However, the molecular events that underlie these changes are not completely understood. Previously, we have isolated two monoclonal antibodies, referred to as XD3 and XD27, by subtractive screening of a phage-display library of antibodies raised against a wall fraction of Zinnia elegans xylogenic culture cells. Here we report the biochemical and immunohistochemical characterization of those antibodies. The antibody XD3 recognized (1→4)-β-D-galactan in pectin fraction. During xylogenesis, the XD3 epitope was localized to the primary wall of tracheary-element precursor cells, which undergo substantial cell elongation, and was absent from mature tracheary elements. XD27 recognized an arabinogalactan protein that was bound strongly to a germin-like protein. The XD27 epitope was localized to pre-lignified secondary walls of tracheary elements. Thus these cell-wall-directed monoclonal antibodies revealed two molecular events during xylogenesis. The biological significance of these events is discussed in relation to current views of the plant cell wall.


Transcriptomic responses to silver nanoparticles in the freshwater unicellular eukaryote Tetrahymena thermophila.
Currently, silver nanoparticles (AgNPs) are being increasingly used as biocides in various consumer products and if released in the environment they can affect non-target organisms. Therefore, understanding the toxicity mechanism is crucial for both the design of more efficient nano-antimicrobials and for the design of nanomaterials that are biologically and environmentally benign throughout their life-cycle. Here, the ciliate Tetrahymena thermophila was used to elucidate the mechanisms of action of AgNPs by analysing the gene expression profile by RNA-seq and the transcriptomic effects of AgNPs were compared to those induced by soluble silver salt, AgNO3. Exposure to AgNPs at sublethal concentrations for 24 h induced phagocytosis, transport pathways, response to oxidative stress, glutathione peroxidase activity, response to stimulus, oxidation-reduction, proteolysis, and nitrogen metabolism process. Based on gene set enrichment analysis (GSEA), some biological processes appeared targets of both toxicants. In addition to many similarities in affected genes, some effects were triggered only by NPs, like phagocytosis, glutathione peroxidase activity, response to stimulus, protein phosphorylation and nitrogen metabolism process. This research provides evidence that AgNPs compared to AgNO3 at the same concentration of dissolved silver ions dysregulate a higher number of cellular pathways. These findings confirm that AgNPs can induce toxicity not only due to soluble silver ions released from the particles but also to particle intrinsic features.


Isofraxidin inhibits interleukin-1β induced inflammatory response in human osteoarthritis chondrocytes.
Osteoarthritis (OA) is the most prevalent disease of knee especially in the aged people. Isofraxidin (IF) is a coumarin compound refined from traditional Chinese medicines with potential anti-inflammatory ability. This study aimed to evaluate protective anti-inflammatory effects of IF in human OA chondrocytes. The chondrocytes were isolated from OA patients and pretreated with IF before treatment with IL-1β. The results showed that IF blocked IL-1β-stimulated production of NO and PGE2. In addition, IF inhibited the expression of COX-2, iNOs, MMP-1, MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5, and increased the levels of aggrecan and collagen-II. Mechanistically, IF suppressed IL-1β-induced IκB-α degradation and NF-κB activation. In conclusion, our results demonstrate that IF inhibits inflammation in OA via the regulation of NF-κB signaling, and suggest that IF may be a potential therapeutic agent for OA.


Quality of life in Indian patients with rheumatoid arthritis.
Rheumatoid arthritis (RA) is a multisystem disease with various extra-articular manifestations (EAMs). Health-related quality of life (HRQOL) issues are assuming increasing importance in chronic rheumatic diseases like RA. No data on QOL in RA is available from the Indian subcontinent. There is also a paucity of literature on the impact of EAMs on HRQOL in RA. The objective of this study was to address these lacunae. The study group comprised 81 patients with RA from a rheumatology clinic in India. Quality of life was estimated by the generic HRQOL measure: World Health Organization quality of life instrument (WHOQOL-Bref). Disease activity in RA was measured by calculating Disease Activity Score-28 (DAS28). The mean HRQOL scores of the patients were 12.0+/-2.8, 13.2+/-2.7, 14.4+/-2.9 and 13.3+/-2.6 in the physical, psychological, social, and environmental domains of the WHOQOL-Bref respectively. Age, gender, disease duration, educational status, constitutional symptoms, rheumatoid factor positivity, erosions and deformities did not influence HRQOL. Disease activity had a negative influence on the physical and psychological domains. Patients with EAMs had significantly higher DAS28 scores compared to patients without EAMs. Even after adjustment for disease activity, patients with EAMs had lower HRQOL scores than patients without these features (statistically significant for physical domain). The physical domain of HRQOL is most affected in Indian patients with RA. Increasing disease activity and presence of EAMs worsens the quality of life.


Characteristics variations of size-fractionated anammox granules and identification of the potential effects on these evolutions.
Anaerobic ammonium oxidation (anammox) granulation which contributed to system stabilization and performance improvement has great potential in the field of wastewater nitrogen removal. The researchers fractionated anammox granules into small-size (0.5-0.9 mm), medium-size (1.8-2.2 mm), and large-size (2.8-3.5 mm) categories to examine their properties and mechanisms. Various analyses, including high-throughput sequencing, determination of inorganic elements and extracellular polymeric substances (EPS), and microbial function prediction, were conducted to characterize these granules and understand their impact. The results revealed distinct characteristics among the different-sized granules. Medium-size granules exhibited the highest sphericity, EPS content, and anammox abundance. In contrast, large-size granules had the highest specific surface area, heme c content, specific anammox activity, biodiversity, and abundance of filamentous bacteria. Furthermore, the precipitates within the granules were identified as CaCO3 and MgCO3, with the highest inorganic element content found in the large-size granules. Microbial community and function annotation also varied with granule size. Based on systematic analysis, the researchers concluded that cell growth, chemical precipitation, EPS secretion, and interspecies interaction all played a role in granulation. Small-size granules were primarily formed through cell growth and biofilm formation. As granule size increased, EPS secretion and chemical precipitation became more influential in the granulation process. In the large-size granules, chemical precipitation and interspecies interaction, including synergistic effects with nitrifying, denitrifying, and filamentous bacteria, as well as metabolic cross-feeding, played significant roles in aggregation. This interplay ultimately contributed to higher anammox activity in the large-size granules. By fully understanding the mechanisms involved in granulation, this study provides valuable insights for the acclimation of anammox granules with optimal sizes under different operational conditions.


Sickle Cell Disease Pathophysiology and Related Molecular and Biophysical Biomarkers.
One of the challenges in sickle cell disease is its clinical variability. Our ability to identify the complications that a patient is at risk for is limited by a lack of validated diagnostic and prognostic biomarkers. Clinical care is limited by a lack of diagnostics to capture the biological variability needed to precisely direct patient care. Many biomarkers have been proposed, but few validated. We must make a concerted effort as a field to rigorously test proposed biomarkers to improve outcomes for our patients.


Effects of budesonide/formoterol combination therapy versus budesonide alone on airway dimensions in asthma.
Combination therapy with inhaled corticosteroids and long-acting β(2)-agonists results in improved asthma symptom control compared with the use of inhaled corticosteroids alone. However, the effects of combination therapy on structural changes and inflammation of the airways are still unknown. The aim of this study was to compare the effects of budesonide/formoterol with those of budesonide alone on airway dimensions and inflammation in individuals with asthma. Fifty asthmatic patients were randomized to treatment with budesonide/formoterol (200/6 µg, two inhalations bd) or budesonide (200 µg, two inhalations bd) for 24 weeks. Airway dimensions were assessed using a validated computed tomography technique, and airway wall area (WA) corrected for body surface area (BSA), percentage WA (WA%), wall thickness/Ösquare root BSA, and luminal area (Ai)/BSA at the right apical segmental bronchus, were measured. The percentage of eosinophils in induced sputum, pulmonary function, and Asthma Quality of Life Questionnaires (AQLQ) were also evaluated. There were significantly greater decreases in WA/BSA (P < 0.05), WA% (P < 0.001) and wall thickness/square root BSA (P < 0.05), and increases in Ai/BSA (P < 0.05), in subjects treated with budesonide/formoterol compared with those treated with budesonide. The reduction in sputum eosinophils and increase in per cent of predicted forced expiratory volume in 1 s (FEV(1) %) were greater for subjects treated with budesonide/formoterol compared with those treated with budesonide alone. In the budesonide/formoterol group, the changes in WA% were significantly correlated with changes in sputum eosinophils and FEV(1%) (r = 0.84 and r = 0.64, respectively). There were improvements in the AQLQ scores after treatment with budesonide/formoterol. Budesonide/formoterol combination therapy is more effective than budesonide alone for reducing airway wall thickness and inflammation in individuals with asthma.


Adaptive energy metabolism in four chromosomal species of subterranean mole rats.
Gross energy intake and apparent dry matter digestibility of animals fed carrots ad lib in the laboratory, were measured in the four chromosomal species of the Spalax ehrenbergi superspecies in Israel. Gross energy intake of 132.8 and 155.9 kJ/day was measured for the 2n=52 and 2n=58 chromosomal "mesic" species, while in the 2n=54 and 2n=60 chromosomal "xeric" species it measured only 80.3 and 75.0 kJ/day, respectively. Dry matter digestibility ranged between 92.3 and 95.6% in thefour chromosomal species. The differences in gross energy intake between the "mesic" and "xeric" species, appeared to reflect adaptive energy metabolism variation associated with geographic variation in climate, habitat productivity, and food availability.


Precipitation of organic arsenic compounds and their degradation products during struvite formation.
Roxarsone (ROX) and arsanilic acid (ASA) have been extensively used as organoarsenic animal feed additives. Organic arsenic compounds and their degradation products, arsenate (As(V)) and arsenite (As(III)), exist in the effluent from anaerobic reactors treating animal manure contaminated by ROX or ASA with ammonium (NH4(+)-N) and phosphate (PO4(3-)-P) together. Therefore, arsenic species in the effluent might be involved in the struvite formation process. In this study, the involvement of organic arsenic compounds and their degradation products As(V) and As(III) in the struvite crystallization was investigated. The results demonstrated that arsenic compounds did not substantially affect the PO4(3-)-P recovery, but confirmed the precipitation of arsenic during struvite formation. The precipitation of arsenic compounds in struvite was considerably affected by a solution pH from 9.0 to 11.0. With an increase in pH, the content of ASA and ROX in the precipitation decreased, but the contents of As(III) and As(V) increased. In addition, the arsenic content of As(V) in the struvite was higher than that of As(III), ASA and ROX. The results indicated that the struvite could be contaminated when the solution contains arsenic species, but that could be minimized by controlling the solution pH and maintaining anaerobic conditions during struvite formation.


Comparison of phencyclidine-induced spatial learning and memory deficits and reversal by sertindole and risperidone between Lister Hooded and Wistar rats.
Visual learning and memory are one of the key cognitive domains disturbed in schizophrenia. Glutamate NMDA receptors play a crucial role in spatial learning and memory and NMDA receptor antagonists, such as phencyclidine (PCP), impair spatial learning and memory. Pigmented rat strains have superior vision than albino rat strains and are therefore commonly used in visually-demanding cognitive tests. However, all previous water maze experiments using acutely administered PCP to induce schizophrenia-like cognitive deficits have been conducted with albino Wistar rats. This study was designed to assess whether pigmented Lister Hooded (LH) rats would be more suitable in modeling acute PCP-induced deficits in Morris water maze (MWM) task than Wistar rats. We also evaluated whether the efficacy of atypical antipsychotics in reversing PCP-induced spatial navigation deficits was dependent on the rat strain. First, we compared the PCP dose-response in the range of 1.3-2.0mg/kg (s.c.) at causing deficits in MWM performance. Then, the efficacies of sertindole 1.6mg/kg (s.c.) and risperidone 0.04mg/kg (s.c.) in reversing PCP-induced spatial navigation deficits were investigated. Drug-naïve LH rats showed a better spatial memory than Wistar rats. Furthermore, PCP induced deficits in spatial navigation at lower doses in LH than in Wistar rats. In addition, PCP-induced deficits were partly reversed by sertindole in LH but not in Wistar rats. Our results suggest that the deficits in spatial learning and memory that resemble memory deficits found in schizophrenia patients are better modeled by PCP in LH rats than Wistar rats.


The exploration of surgical outcomes in patients with giant cell tumor of the tendon sheath in spine: An epidemiological, radiological, and follow-up investigation.
This study aimed to characterize giant cell tumor of the tendon sheath (GCTTS) in spine more fully and further validate the therapeutical effect of surgcial resection for treating this neoplasm. Patients diagnosed with spinal GCTTS and received surgical resection in our hospital between January 2009 and September 2021 were identified retrospectively. The clinical data and radiological images were summarized and the clinical outcomes of patients with a follow-up period of more than 12 months were analyzed. Thirty patients with benign GCTTS and one with malignant GCTTS were included. Preoperative radiological images were available in 28 of 30 benign cases. Benign lesions were revealed as soft tissue masses centering on the facet joint with osteolytic bone destruction in 26 patients on CT, and as prevertebral or intramuscular masses without bone erosion in 2. MRI showed the signal of isointensity or hypointensity on T1 weighted images (T1WI) in 25 patients and slightly hyperintense in three. On T2 weighted images (T2WI), 17 lesions displayed homogeneous hypointense signal, and eight lesions possessed heterogeneous signals. The remaining three lesions featured slightly hyperintense signal on T2WI. Follow-up data were available in 23 of 30 benign cases treated with gross-total resection, and two patients experienced recurrence. Spinal GCTTS should be suspected in cases with features such as the mass mainly involving the posterior bone elements, the lack of intralesional calcification, T2-weighted dark signals, and free of any cancer. Gross-total resection is an effective means for treating spinal GCTTS.


Catheter obstruction during prolonged parenteral alimentation. Are lipids responsible?
Catheter obstruction is a serious incident during prolonged parenteral nutrition (PN). This retrospective study was carried out in order to compare the frequencies of catheter obstruction with nutritive mixtures in bags according to whether or not lipids were mixed with the entire 24 h nutritional supply (Group I, n=33) or infused separately (Group II, n=30). Our results show that obstructions are significantly more frequent in Group I (11 13 ) than in group 2 (3 10 ), appearing within a mean interval of 29 days after inserting the catheter. The global percentages of patients undergoing cyclic PN were the same in both patient groups. In group I, however, the percentage of patients on cyclic PN was significantly higher for the obstructed catheters (100%) than for the unobstructed catheters (59%). In conclusion, the mixture of lipids with the remainder of the nutrients in the conditions of this study is the prime cause of catheter obstruction, although the exact mechanism is not elucidated. The role of cyclic PN appears to be accessory.


Livedoid vasculopathy.
Livedoid vasculopathy is a chronic and painful skin disease that progresses to ulceration. Due to its uncertain pathogenesis, there is no single effective treatment for this condition, and current therapeutic options are based on isolated case reports, or on case series. We report a case of a female patient with livedoid vasculopathy, which achieved excellent healing of lower limb ulcers after using an anti-TNF agent.


Amniotic fluid optical density: relationship to L:S ratio, phospholipid content, and desquamation of fetal cells.
The relationship between amniotic fluid optical density at 650 nm (OD650) and the lecithin:sphingomyelin (L:S) ratio was compared in 174 samples of amniotic fluid from 143 patients. An OD650 greater than 0.15 accurately predicted and L:S ratio greater than 2.0 with an overall reliability of 67.9%. There were 19.5% false-negative and 12.6% false-positive predictions. The OD650 was found to have close correlation with the number of fetal squames in suspension in amniotic fluid. Pure surfactant phospholipid standards were found to exhibit negligible absorbance at 650 mm. OD650 may be more closely related to fetal cutaneous maturity than to pulmonary surfactant content and bears only an indirect relationship with pulmonary preparedness for independent existence. The OD650 test does not appear to be sufficiently reliable and specific to replace phospholipid determination as a data phase upon which to make clinical decisions regarding fetal pulmonary surfactant maturity.


Influence of blood haemoglobin concentration on renal haemodynamics and oxygenation during experimental cardiopulmonary bypass in sheep.
Blood transfusion may improve renal oxygenation during cardiopulmonary bypass (CPB). In an ovine model of experimental CPB, we tested whether increasing blood haemoglobin concentration [Hb] from ~7 g dL-1 to ~9 g dL-1 improves renal tissue oxygenation. Ten sheep were studied while conscious, under stable isoflurane anaesthesia, and during 3 hours of CPB. In a randomized cross-over design, 5 sheep commenced bypass at a high target [Hb], achieved by adding 600 mL donor blood to the priming solution. After 90 minutes of CPB, PlasmaLyte® was added to the blood reservoir to achieve low target [Hb]. For the other 5 sheep, no blood was added to the prime, but after 90 minutes of CPB, 800-900 mL of donor blood was given to achieve a high target [Hb]. Overall, CPB was associated with marked reductions in renal oxygen delivery (-50 ± 12%, mean ± 95% confidence interval) and medullary tissue oxygen tension (PO2 , -54 ± 29%). Renal fractional oxygen extraction was 17 ± 10% less during CPB at high [Hb] than low [Hb] (P = .04). Nevertheless, no increase in tissue PO2 in either the renal medulla (0 ± 6 mmHg change, P > .99) or cortex (-19 ± 13 mmHg change, P = .08) was detected with high [Hb]. In experimental CPB blood transfusion to increase Hb concentration from ~7 g dL-1 to ~9 g dL-1 did not improve renal cortical or medullary tissue PO2 even though it decreased whole kidney oxygen extraction.


Expanding the phenotype of males with OFD1 pathogenic variants-a case report and literature review.
Pathogenic variants in the OFD1 gene have been classically associated with the Orofaciodigital syndrome type 1 in females, a condition previously considered to be X-linked dominant with male embryonic lethality. However, an increasing number of males with pathogenic OFD1 variants who survived beyond the neonatal period have now been reported in the literature. Although each new report has added to the ever-broadening spectrum of clinical findings seen in males, many questions about genotype-phenotype correlations and disease mechanism remain. Herein, we describe a 9-year-old male child with a novel hemizygous pathogenic OFD1 variant identified by exome sequencing and a unique combination of findings, not previously reported, including presence of both a hypothalamic hamartoma and the molar tooth sign. His clinical features overlap multiple ciliopathy phenotypes, blurring the boundaries of distinct ciliopathy gene-disease relationships. This case provides further evidence for the consideration of a broad OFD1-relateddisorder spectrum in affected males rather than multiple distinct phenotypes. Additionally, a review of previously published cases of the disorder in males support the inclusion of the OFD1 gene in the differential diagnosis and work up for all individuals who present with primary ciliopathy-type features, regardless of their gender. We also highlight current information about OFD1 variant types and pathogenesis and explore how these could mechanistically drive some of the observed phenotypic differences.


Cytotoxicity evaluation of methacrylate-based resins for clinical endodontics in vitro.
This study examines the cytotoxicity of Super-Bond C&B (SB-C&B), Super-Bond RC Sealer (SB-RC), MetaSEAL (Meta), and AH Plus Sealer (AH+). Freshly mixed and set materials (100 mg) were prepared in vitro and placed in cell culture medium (1 mL) for the working time and for 6 h, respectively. L929 cells seeded into 96-well plates at 5,000 cells/well were incubated with the eluted medium (200 µL) for 24 h. Cells cultured with medium alone served as the control. Cytotoxicity was evaluated by MTS assay and analyzed with ANOVA. In the freshly mixed group, the average ± SD (%) for cell viability were 66.0 ± 13.6, 55.5 ± 15.6, 10.6 ± 0.7, and 8.9 ± 2.2 for SB-C&B, SB-RC, Meta, and AH+, respectively. In the set group, the average ± SD (%) for cell viability were 100 ± 21.9, 81.8 ± 38.5, 24.9 ± 7.9, and 23.6 ± 10.0 for SB-C&B, SB-RC, Meta, and AH+, respectively. SB-C&B and SB-RC are less cytotoxic than are Meta and AH+.


Beneficial effects of early attention process training after acquired brain injury: A randomized controlled trial.
Evaluation of outcome after intensive cognitive rehabilitation early after brain injury is complicated due to the ongoing biological recovery process. To evaluate the efficacy of Attention Process Training early after acquired brain injury through time-series measurement with statistical process control. Randomized controlled trial. Patients with acquired brain injury (n = 59) within 4 months' post-injury in interdisciplinary rehabilitation received an additional 20 h of attention training with Attention Process Training or with activity-based attention training. The primary outcome variable was Paced Auditory Serial Attention Test (PASAT) evaluated using statistical process control. Both groups improved (p < 0.001), although a higher number of patients improved with attention process training (χ2 (1, n = 59) = 5.93, p = 0.015) and the variability was significantly decreased. The Attention Process Training group maintained or improved performance at 6 months follow-up (χ2 (1, n = 51) = 6,847, p = 0.033). Attention Process Training required fewer intervention hours for improvement. Based on individual performance, 3 improvement trajectories were identified: stationary, steady, and rapid improvers. The results indicate that attention training is promising early after acquired brain injury and that Attention Process Training boosts functional improvement. Notably, in the present group of relatively homogeneous patients, 3 different trajectories were identified for recovery after acquired brain injury regardless of intervention.


Usefulness of peak-to-peak pulsatility index in infrainguinal bypass graft surveillance.
We conducted this study to find out whether the peak-to-peak pulsatility index (PPI) predicted graft failure and which factors affected the PPI. Color-duplex sonography was used to take 520 scans of 74 infrainguinal bypasses, 62 of which were femoropopliteal bypasses and 12 of which were femorocrural bypasses. Vessel diameter and velocity waveform were measured in the graft as well as in the proximal and distal arteries. There were 13 cases of graft failure. The PPI in the mid-graft was significantly different in the normal group (12.30 +/- 8.77) and the graft failure group (4.17 +/- 1.79). A PPI of less than 7.0 in the mid-graft was defined as graft failure, with a sensitivity of 96.0% and a specificity of 77.6%. There was no correlation between the graft diameter and the PPI. The average mode frequency was inversely correlated with the PPI (PPI = 44.8 x Mode F(-1) + 3.50, correlation co-efficient: 0.78). One point measurement of the PPI in the mid-graft could be a simple and useful parameter for diagnosing graft failure, based on our finding that the waveform was very similar in the proximal artery, the entire graft, and the distal artery. PPI was inversely correlated with average mode frequency because reverse flow decreased or diminished when a significant stenosis existed.


Handgrip strength by dynamometry does not identify malnutrition in individual preoperative outpatients.
Low handgrip strength by dynamometry is associated with increased postoperative morbidity, higher mortality and reduced quality of life. The aim of this study was to evaluate the accuracy of four algorithms in diagnosing malnutrition by measuring handgrip strength. We included 504 consecutive preoperative outpatients. Reference standard for malnutrition was defined based on percentage involuntary weight loss and BMI. Diagnostic characteristics of the handgrip strength algorithms (Álvares-da-Silva, Klidjian, Matos, Webb) were expressed by sensitivity, specificity, positive and negative predictive value, false positive and negative rate. The prevalence of malnutrition was 5.8%. Although Klidjian showed the highest sensitivity (79%, 95% CI 62%-90%), 6 out of 29 malnourished patients were falsely identified as well-nourished (false positive rate 21%, 95% CI 9%-38%). In contrast, this algorithm showed the lowest positive predictive value (8%, 95% CI 5%-13%). Matos presented the highest positive predictive value; the post-test probability increased to 13% (95% CI 8%-20%). The 1-minus negative predictive value ranged between 3% and 5% for all algorithms. None of the algorithms derived from handgrip strength measurements was found to have a diagnostic accuracy good enough to introduce handgrip strength as a systematic institutional screening tool to detect malnutrition in individual adult preoperative elective outpatients.


Complications in arthroscopic shoulder surgery.
Arthroscopic surgery of the shoulder is considered a safe technique, yet a variety of complications have been described. There are few published reports on the incidence of these complications. The aim of this study is to evaluate the complication rate of arthroscopic shoulder surgery. We retrospectively evaluated a series of 179 consecutive arthroscopic (n=141) and combined (arthroscopic plus open; n=38) procedures performed by the same surgeon. The overall complication rate was 9.49%. Combined procedures had a 5.26% complication rate and arthroscopic procedures a 10.63% complication rate.


Sudden Cardiac Death in People With Schizophrenia: Higher Risk, Poorer Resuscitation Profiles, and Differing Pathologies.
People with schizophrenia account for approximately 1.0% of the population and seem to experience increased rates of sudden cardiac death (SCD). This study sought to determine characteristics of increased SCD in people with schizophrenia. The End Unexplained Cardiac Death (EndUCD) prospective state-wide registry compared people aged 15 to 50 years with and without schizophrenia who experienced SCD within a 2-year time period and were referred for forensic evaluation. We identified 579 individuals, of whom 65 (11.2%) had schizophrenia. Patients with schizophrenia were more commonly smokers (46.2% vs 23.0%; P < 0.0001), consumed excess alcohol (32.3% vs 21.4%; P = 0.05), and used QTc-prolonging medications (69.2% vs 17.9%; P < 0.0001). They were less likely to arrest while exercising (0.0% vs 6.4%; P = 0.04). Unfavorable arrest-related factors included lower rates of witnessed arrest (6.2% vs 23.5%; P < 0.0001), more likely to be found in asystole (92.3% vs 73.3%; P < 0.0001), and being more likely to be found as part of a welfare check after a prolonged period of time (median 42 hours vs 12 hours; P = 0.003). There was more frequent evidence of decomposition, and they more commonly underwent autopsy (41.2% vs 26.4%; P = 0.04 and 93.8% vs 82.5%; P = 0.05), with a diagnosis of nonischemic cardiomyopathy being more common (29.2% vs 18.1%; P = 0.04). People with schizophrenia account for 11% of young SCD patients referred for forensic investigations, exceeding population rates by 11-fold. They have a higher preexisting cardiac risk factor burden, unfavorable resuscitation profiles, and higher rates of nonischemic cardiomyopathy. Strategies targeting biopsychosocial support may deliver not only psychological benefits, but also help to decrease unwitnessed cardiac arrest.


Integration of biomaterials implanted into abdominal wall: process of scar formation and macrophage response.
The behaviour of two biomaterials polytetrafluoroethylene (PTFE) and polypropylene (PL) has been studied, focussing especially on the macrophage response to the implant, as well as on certain aspects of the process of scar formation. A total of 24 animals (white New Zealand rabbits) received prostheses implanted into the anterior abdominal wall in such a way as to involve every layer over an area of 7 cm x 5 cm. The interfaces formed with the visceral peritoneum, subcutaneous tissue layer and the recipient muscle-aponeurotic tissue were assessed. The techniques employed were light microscopy, scanning electron microscopy and immunohistochemical methods, the latter using a monoclonal antibody specific for rabbit macrophages (RAM-11). From the results obtained, it can be seen that: (a) the structure of PL allows its total integration with the reparative tissue, while PTFE becomes encapsulated, on both the subcutaneous and the peritoneal aspects, by orderly connective tissue; (b) the macrophage response, determined on the basis of the presence of labelled macrophages, shows a similar pattern in both biomaterials; and (c) angiogenesis is very intense in the PL mesh, whereas the PTFE prosthesis undergoes almost no vascular colonization.


Effect of the dipeptidyl peptidase-4 inhibitor linagliptin on atherosclerotic lesions in Watanabe heritable hyperlipidemic rabbits: iMap-IVUS and pathological analysis.
Dipeptidyl peptidase-4 (DPP-4) inhibitors have potential as a treatment for atherosclerosis. However, it is unclear whether DPP-4 inhibitors stabilize atherosclerotic plaque or alter the composition of complex plaque. Sixteen Watanabe heritable hyperlipidemic rabbits aged 10-12 weeks with atherosclerotic plaque in the brachiocephalic artery detected by iMap™ intravascular ultrasound (IVUS) were divided into a DPP-4 inhibitor group and a control group. Linagliptin was administered to the DPP-4 inhibitor group via nasogastric tube at a dose of 10 mg/kg/day for 16 weeks, and control rabbits received the same volume of 0.5% hydroxyethylcellulose. After evaluation by IVUS at 16 weeks, the brachiocephalic arteries were harvested for pathological examination. IVUS revealed that linagliptin significantly reduced the plaque volume and vessel volume (control group vs. DPP-4 inhibitor group: ∆plaque volume, 1.02 ± 0.96 mm3 vs. - 3.59 ± 0.92 mm3, P = 0.004; ∆vessel volume, - 1.22 ± 2.36 mm3 vs. - 8.66 ± 2.33 mm3, P = 0.04; %change in plaque volume, 6.90 ± 5.62% vs. - 15.06 ± 3.29%, P = 0.005). With regard to plaque composition, linagliptin significantly reduced the volume of fibrotic, lipidic, and necrotic plaque (control group vs. DPP-4 inhibitor group: ∆fibrotic volume, 0.56 ± 1.27 mm3 vs. - 5.57 ± 1.46 mm3, P = 0.04; ∆lipidic volume, 0.24 ± 0.24 mm3 vs. - 0.42 ± 0.16 mm3 P = 0.04; ∆necrotic volume, 0.76 ± 0.54 mm3 vs. - 0.84 ± 0.25 mm3, P = 0.02). Pathological examination did not show any significant differences in the %smooth muscle cell area or %fibrotic area, but infiltration of macrophages into plaque was reduced by linagliptin treatment (%macrophage area: 12.03% ± 1.51% vs. 7.21 ± 1.65%, P < 0.05). These findings indicate that linagliptin inhibited plaque growth and stabilized plaque in Watanabe heritable hyperlipidemic rabbits.


A replacement-type electrochemiluminescent aptasensor for lysozyme based on full-electric modification electrode coupled to silica-coated Ru(bpy)32+/silver nanospheres.
This research proposed a replacement-type electrochemiluminescent (ECL) aptasensor for lysozyme (LYZ) detection at trace levels based on a full-electric modification electrode (FEMG) coupled to silica-coated Ru(bpy)32+/silver nanospheres (Ru/SNs@SiO2). The multi-walled carbon nanotubes-doped-thionine (MWCNTs/PTn) electropolymerized modified electrode was decorated with electrodeposited gold nanoparticles (GNs) to form the FEMG. Then, the FEMG was utilized as sensing substrates for the immobilization of the anti-lysozyme aptamer (LA); the stability and number of LA attaching onto the FEMG were dramatically increased. The ECL measurement was used to evaluate the hybridization reaction of LA and the Ru/SNs@SiO2 marked DNA probe, and it was noted as Ia. After the combination of the LA with the LYZ, the target-triggered replacement of the DNA probe was actualized and the ECL measurement descended to Ib. The ECL difference (ΔIECL = Ia - Ib) before and after the replacement event was utilized for quantitation of LYZ. As a result, the fabricated aptasensor with great sensitivity and specificity achieved a wide linear range (10 fM-10 pM) and a low limit of detection (5 fM). It obtained satisfactory recovery for the detection of LYZ in human serum, and the results were identified with the LYZ ELISA kit. Therefore, the proposed ECL sensor is expected to become a promising approach in the field of biomolecule detection.


Appropriate use of antibiotics for acute respiratory infections at primary healthcare facilities in China: a nationwide cross-sectional study from 2017 to 2019.
The appropriateness of antibiotic use for acute respiratory infections (ARIs) in Chinese primary healthcare facilities (PHFs) remained uncertain. We aimed to evaluate to what degree antibiotic prescribing for ARIs were aligned with guideline recommendations in primary settings across China. We collected outpatient prescriptions from 262 Chinese PHFs in 27 cities of six provinces between 2017 and 2019. The appropriate antibiotic prescribing was defined as prescribing antibiotic classes that were recommended by Chinese clinical guidelines, if patients were prescribed antibiotics. We evaluated the magnitude of antibiotics prescribed for acute upper respiratory infections (AURIs), acute bronchitis, and community-acquired pneumonia (CAP) and their appropriateness. Overall, 55.1% (87,684/159,150), 66.8% (30,836/46,153), and 68.5% (4615/6733) of outpatients with AURIs, acute bronchitis, and CAP treated at PHFs in China were prescribed with antibiotics. Of all antibiotic prescriptions, only 20.0% (17,542/87,684), 18.6% (5724/30,836) and 69.6% (3211/4615) used antibiotic classes that were recommended by the guidelines for AURIs, acute bronchitis, and CAP, respectively. Patients residing in the Chinese central region (17.0%, 15.4%, 69.3% for AURIs, acute bronchitis, and CAP, respectively) were less likely to be prescribed with antibiotics that were appropriately selected. Unnecessary antibiotics were widely prescribed for patients with AURIs or acute bronchitis and most patients with ARIs did not receive guideline-recommended antibiotic classes in Chinese PHFs. Interventions to promote evidence-based treatment and the appropriate use of antibiotics are urgently needed at the primary level across China. This work was supported by the National Natural Science Foundation of China [grant number 72074007, 81973294].


Accuracy of Algorithm to Non-Invasively Predict Core Body Temperature Using the Kenzen Wearable Device.
With climate change increasing global temperatures, more workers are exposed to hotter ambient temperatures that exacerbate risk for heat injury and illness. Continuously monitoring core body temperature (TC) can help workers avoid reaching unsafe TC. However, continuous TC measurements are currently cost-prohibitive or invasive for daily use. Here, we show that Kenzen's wearable device can accurately predict TC compared to gold standard TC measurements (rectal probe or gastrointestinal pill). Data from four different studies (n = 52 trials; 27 unique subjects; >4000 min data) were used to develop and validate Kenzen's machine learning TC algorithm, which uses subject's real-time physiological data combined with baseline anthropometric data. We show Kenzen's TC algorithm meets pre-established accuracy criteria compared to gold standard TC: mean absolute error = 0.25 °C, root mean squared error = 0.30 °C, Pearson r correlation = 0.94, standard error of the measurement = 0.18 °C, and mean bias = 0.07 °C. Overall, the Kenzen TC algorithm is accurate for a wide range of TC, environmental temperatures (13-43 °C), light to vigorous heart rate zones, and both biological sexes. To our knowledge, this is the first study demonstrating a wearable device can accurately predict TC in real-time, thus offering workers protection from heat injuries and illnesses.


Myoglobin: an evaluation of its role as a marker of rhabdomyosarcomas.
Tumour markers now have an established role in tumour diagnosis and patient management. However, antibodies used to detect these tumour markers have in some instances proved unreliable, with a low rate of sensitivity and specificity. In this study we wished to evaluate the role of a commercial antibody to myoglobin as a marker of rhabdomyosarcomas. The purpose of this investigation was to assess the sensitivity and specificity of myoglobin antiserum as a marker of rhabdomyosarcomas. This was performed by reacting a large number of tumours (sarcomas, carcinomas and melanomas) with a polyclonal anti human myoglobin antiserum. Staining was demonstrated in 60% of rhabdomyosarcomas. Only two tumours from a total of 226 non-skeletal muscle tumours showed a positive reaction (0.88%). One was a leiomyosarcoma and the other had been classified as an undifferentiated sarcoma but a rhabdomyosarcoma was included in its differential diagnosis. It is of interest that both had been earlier irradiated. This antiserum was therefore a specific but not a very sensitive tumor marker. Its rate of staining of rhabdomyosarcomas is compared with the results in the literature. A great disparity is found and the reasons for this are discussed.


Remodeling of the rough endoplasmic reticulum during stimulation of procollagen secretion by ascorbic acid in cultured chondrocytes. A biochemical and morphological study.
The cellular and molecular mechanisms regulating the reversible accumulation of nonhelical, underhydroxylated procollagen in the rough endoplasmic reticulum (RER) remain obscure. To clarify these mechanisms, we isolated chondrocytes from chick vertebral cartilage and kept them in scorbutic monolayer cultures. By Day 9 of culture, the chondrocytes had accumulated a large amount of underhydroxylated Type II procollagen in their RER. Within 1 h of ascorbate treatment, the accumulated procollagen was hydroxylated; this was accompanied by a slight stimulation of procollagen secretion and was followed by a marked stimulation starting between 2 and 3 h of treatment. Secretion of the accumulated procollagen was completed by about 24 h of treatment. Strikingly, the marked stimulation of procollagen secretion at 2-3 h of treatment was associated with marked remodeling of the RER. This organelle came to consist of a few, unusually large cisternae ("sacs") and many flat cisternae while the RER in untreated cells consisted of uniform, oval cisternae. The RER remodeling was accompanied by a comparable redistribution of the accumulated Type II procollagen stored in it. The RER sacs and flat cisternae invariably communicated directly and were still detectable by 8 h but not by 24 h of treatment. RER remodeling and procollagen redistribution also occurred in untreated chondrocytes that had been shifted to 23 degrees C for 2-3 h. Together, the data indicate that folding of the accumulated procollagen molecules into their normal helical configuration is followed by procollagen redistribution within, and remodeling of, the RER. These processes may have a role in stimulating procollagen export from the RER and secretion.


Towards better delineation of hydrothermal alterations via multi-sensor remote sensing and airborne geophysical data.
Integrating various tools in targeting mineral deposits increases the chance of adequate detection and characterization of mineralization zones. Selecting a convenient dataset is a key for a precise geological and hydrothermal alteration mapping. Remote sensing and airborne geophysical data have proven their efficiency as tools for reliable mineral exploration. Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER), Advanced land imager (ALI), Landsat 8 (L8), and Sentinel 2 data are widely-used data among various types of remote sensing images in resolving lithological and hydrothermal alteration mapping over the last two decades. ASTER is a well-established satellite in geological remote sensing with detailed Short-wave infrared (SWIR) range compared to visible and near-infrared region (VNIR) that controls iron-associated alteration detection. On contrary, ALI has excellent coverage of the VNIR area (6 bands), but does not possess the potentiality of ASTER for the SWIR and thermal regions. Landsat 8 is widely used and highly recommended for lithological and hydrothermal alteration mapping. The higher spatial (up to 10 m) resolution of Sentinel 2 MSI has preserved its role in producing accurate geological mapping. Notwithstanding the foregoing, implementing the four datasets in a single study is time-consuming. Thus, an important question when commencing an exploration project for hydrothermal alterations-related mineralization (orogenic mineral deposits in the current research) is: which dataset should be adopted to fulfill proper and adequate outputs? Here the four widely recommended datasets (ASTER, ALI, L8, and sentinel 2) have been tested by applying the widely-accepted techniques (false color combinations, band ratios, directed principal component analysis, and constrained energy minimization) for geological and hydrothermal alteration mapping of Gabal El Rukham-Gabal Mueilha district, Egypt. The study area is covered mainly by Neoproterozoic heterogeneous collection of ophiolitic components, island arc assemblage, intruded by enormous granitic rocks. Additionally, airborne magnetic and radiometric data were applied and compared with the remote sensing investigations for deciphering the structural and hydrothermal alteration patterns within the study area. The results demonstrated a different extent from one sensor to another, highlighting their varied efficacy in detecting hydrothermal alterations (mainly hydroxyl-bearing alterations and iron oxides). Moreover, the analysis of airborne magnetic and radiometric data showed hydrothermal alteration zones that are consistent with the detected alteration pattern. The coincidence between high magnetic anomalies, high values of the K/eTh ratio, and the resultant alterations confirm the real alteration anomalies. Over and above that, the remote sensing results and airborne geophysical indications were verified with fieldwork and petrographic investigations, and strongly recommend combining ASTER and Sentinel 2 results in further investigations. Based on the outputs of the current research, we expect better hydrothermal alteration delineation by adopting the current findings as they sharply narrow the zones to be further investigated via costly geophysical and geochemical methods in mineral exploration projects.


Validation of the early open infarct vessel hypothesis.
The insights from the Global Utilization of Streptokinase and t-PA for Occluded Arteries (GUSTO) trial have paved the way for further refinement in myocardial reperfusion strategies. For the moment, there is a better pharmacologic approach for achieving rapid and complete coronary thrombolysis. However, for the future, the legacy from this project is much more meaningful, providing clear-cut validation of the "early open vessel hypothesis" while at the same time exemplifying how deficient our strategies for reperfusion are today. There are explicit signals for persistent, meaningful improvement in the years ahead.


Cytokeratin expression in pilonidal sinus.
Pilonidal sinus (PS) is considered to belong in the category of follicular occlusion diseases (acne triad). The aim of our study was to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression. CK expression in nine cases of PS was studied immunohistochemically using six antikeratin antibodies. Infundibular-like epithelium contained CK1, 10 and 14 similar to normal infundibulum, but it did not contain CK17. In non-infundibular-like epithelium, CK14, 16 and 17 were detected similar to that in normal outer root sheath. CK expression in PS was similar to that in hidradenitis suppurativa, suggesting that sinus epithelium may be fragile, hyperproliferative and undifferentiated. PS can be classified in the same entity as follicular occlusion diseases based on CK expression.


A Multicenter, Randomized, Controlled Study of the Breast Biopsy and Circumferential Excision System for Breast Lesions.
This study aimed to verify the effectiveness, safety, and reliability of the breast biopsy and circumferential excision system. It was designed as a multicenter, randomized, open-label, positive control, noninferiority trial. A total of 168 subjects who met the breast lesion screening requirements of the clinical trial protocol were randomly divided into a breast biopsy and circumferential excision dual cutting system test group or Mammotome control group. The main outcome was the successful removal rate of suspected lumps during surgery. Secondary outcomes included the operative times for individual lumps, weight of removed cord tissue, and several indicators of device performance. Safety indicators, including routine blood, blood biochemical and electrocardiogram examinations, were measured at baseline and 24 hours and 48 hours after the operation. Postoperative complications and combined medication use were observed and recorded until 7 days after the operation. The results showed no significant differences in efficacy and safety between the 2 groups (main efficacy, P = .7463; all secondary efficacy indicators, P > .05, except weight of removed cord tissue [P = .0070] and touch sensitivity of the device interface [P = .0275]; all safety indicators, P > .05). The results suggested that the test device is effective and is acceptable safe for use in breast lesion biopsy. For patients with a high incidence of breast lesions, the results of this study provide a safe, effective, sensitive and accessible option for the removal of breast mass biopsies at a price much lower than that of imported devices.


Colony morphology of Staphylococcus aureus in serum-soft agar following in vivo and in vitro growth.
Staphylococcus aureus isolated from cases of mastitis in ruminants were grown in vitro and in vivo and subsequently examined for expression of diffuse colony morphology in serum-soft agar. Growth in the bovine mammary gland, but not in the ovine mammary gland or ovine peritoneal cavity, resulted in subsequent expression of diffuse colony morphology.


Candida vertebral osteomyelitis: report of three cases and a review of the literature.
We have recently treated three patients with Candida vertebral osteomyelitis. In each patient there was at least one characteristic prodromal condition, including trauma, multiple antibiotics following bowel surgery, and acute nonlymphocytic leukemia. All patients were treated successfully with amphotericin B. Based on our findings and a review of the literature, we would recommend a 1.0-1.2 gm total dosage of amphotericin B. Alternative therapeutic choices such as 5FC and/or ketoconazole, under specific clinical conditions, have been successfully employed. However, cure can best be confirmed by post-treatment biopsy.


Self-reported cancer screening rates versus medical record documentation: incongruence, specificity, and sensitivity for African American women.
To evaluate levels of incongruence, specificity, and sensitivity between self-reported screening and medical record documentation for breast, cervical, and colorectal cancer screening. Descriptive, quantitative. Federally qualified health centers in the southeastern United States. 116 African American women. The mean age was 35 years, and the mean educational level was 12.6 years. Women were eligible to participate in the study if they were older than age 18 and able to understand English or Spanish. They were recruited from the waiting areas of health centers over a consecutive five-day period. Self-reported rates of screening and screening rates documented in the medical record. The level of incongruence between self-report and medical record documentation was more than 50% for some procedures. Rates of specificity were high, particularly over time. Rates of sensitivity were 33% or less. The women tended to overreport screenings in the past year when compared to medical records. The women and medical records indicated that the screenings had not been performed in the past two to five years or more than five years ago. Nurses are in a unique position to educate women about cancer screening in a culturally and educationally appropriate way while ensuring that those conversations and procedures are documented in the medical record by all providers.