Memory phenotype and polyfunctional T cells in kidney transplant patients.
Allospecific memory T cells are a barrier against long-term graft survival. Production of multiple cytokines by a single T cell is considered a sign of an active ongoing immune response, the presence of these polyfunctional cells has not been addressed in transplanted patients accordingly to graft outcome. Memory phenotype, based on the expression of CD45RO and CD27, and polyfunctional T cells were evaluated in long-term graft survival patients (LTS), short-term survival patients (STS), chronic rejection patients (ChrRx), dialysis patients (DIAL) and healthy controls (Ctrls). Memory T cells were quantified ex vivo, after allogeneic and anti-CD3 plus anti-CD28 stimulation, in cells proliferating or not to these stimuli. The percentages of cells producing IFNγ, IL-2 and/or TNFα after allogeneic stimulation and the memory phenotype of single cytokine producing cells were evaluated. Ex vivo CD8+CD45RO-CD27- effector cells were decreased in transplanted patients compared to non-transplanted individuals. After allogeneic stimulation, CD4+CD45RO+CD27+, central memory cells in LTS and CD4+CD45RO-CD27- effector cells in Dial were augmented compared to Ctrls and ChrRx, and CD8+CD45RO-CD27- effector cells were increased in ChrRx. There were no differences in the percentage of single cytokine producing cells among the groups. IFNγ+TNFα+CD4 and CD8 cells were detected in Ctrls, STS and ChrRx and no cells positive for the three cytokines were found. The phenotype of cytokine producing cells was mainly effector memory. Interestingly, in LTS there was an increase in effector cells producing IFNγ and IL-2. Changes in subpopulation distribution in patients with different outcomes may be a reflection of the graft acceptance or rejection status.


Reduced urinary excretion of homocysteine could be the reason of elevated plasma homocysteine in patients with psychiatric illnesses.
Although increased plasma total homocysteine (tHcy) concentrations were reported in psychiatric diseases, currently the reasons of elevated tHcy levels were not clearly understood. In this study we aimed to investigate the contribution of renal clearance of homocysteine on plasma tHcy load in patients with depression and first episode psychosis. Thirty depression, 14 first episode psychosis patients and 34 healthy individuals (control group) were involved in the study. In patients and control groups, plasma and urine tHcy levels, urine methylmalonic acid (uMMA), serum vitamin B12 and folate concentrations were measured. Although there was not any difference between depression, psychosis and control groups with respect to mean (SD) values of vitamin B12 (289(131), 230 (72) and 249(79) pg/mL, respectively) and folate (6.4(4.0), 5.3(2.3) and 5.7(2.3) ng/mL, respectively), plasma tHcy levels of depression and psychosis group were higher than the control values (16.3(6.2), 15.5(4.3) and 9.9(2.1) micromol/L, respectively). Urine tHcy values of patient groups were significantly lower than those in the control group (14.5(7.6), 15.8(6.8) and 29.6(16.9) micromol/g creatinine, respectively). There were elevated uMMA levels in depression and psychosis groups compared with control group (4.9(2.4), 6.6(3.2) and 2.8(1.2) mmol/mol creatinine, respectively). There were a significant and negative correlation between urinary tHcy and plasma tHcy levels (r=-0.258 and p=0.011). In conclusion, reduced urinary tHcy levels in psychiatric patients could be one of the reasons of plasma tHcy elevations with normal folate and vitamin B12 levels. Altered renal handling mechanisms of homocysteine may lead to elevated plasma tHcy levels by reduced clearance of homocysteine via glomerular filtration.


Clinical commentary: Atypia in lung and mediastinal lymph node fine-needle aspiration.
In patients with known or suspected lung cancer, pathologic reports of cytologic "atypia" in the mediastinal nodal fine-needle aspirate samples pose a diagnostic and therapeutic dilemma. For the patents with non-operable disease, should the radiation oncologist empirically include lymph nodes with atypical findings in the radiation field, or should they exclude these mediastinal lymph nodes from the treatment field? Inclusion of an atypical finding in the management decision or radiation target would mean that the treating physicians are interpreting a pathologic report of "atypia" as probably "positive" rather than probably "negative" disease. Empirically treating lymph nodes without cancer involvement in thoracic radiotherapy for non-small cell lung cancer, also known as elective nodal irradiation, is generally avoided given increased treatment-related toxicities including esophagitis, pneumonitis, and cardiotoxicity without a demonstrated survival benefit. However, in the case of potentially curative chemoradiation, the discretion is left to the treating radiation oncologist to estimate the likelihood of oncologic involvement based on available and often clinically indeterminate radiologic findings and known routes of cancer spread. Alternatively, physicians may consider repeat or invasive diagnostic measures. The risks and benefits of additional procedures must be taken into careful consideration in our older patient population who present with co-morbid cardiopulmonary disease and pulmonary symptoms from their cancer. If atypia is reported, written and verbal communication to relay pathologist's concern for oncologic involvement is critical as it may affect oncologic treatment recommendations and cancer outcomes.


Comprehensive expectoration nursing in elderly patients with pulmonary infection and its influence on respiratory function.
To investigate the effect of comprehensive expectoration nursing in elderly patients with pulmonary infection and its influence on respiratory function. Clinical data of 88 elderly patients with pulmonary infection treated in our hospital from March 2018 to May 2020 were analyzed retrospectively. During treatment, 40 patients receiving conventional nursing mode were included in the control group (CG), and 48 with comprehensive expectoration nursing were included in the observation group (OG). The number of patients with spontaneous expectoration, assisted expectoration and sputum aspiration one week after nursing, the related indices of blood oxygen and lung function before and after nursing, and the sputum excretion volume, respiratory rate and neutrophils one week after nursing, were compared between the two groups. The hospitalization time, expenses, patients' quality of life after nursing and nursing satisfaction were also compared between the two groups. Compared with the CG, the hospitalization time and expenses of patients in OG were obviously lower, while the effective rate of sputum excretion was obviously higher after nursing. The blood oxygen, lung function, sputum excretion volume, respiratory rate and neutrophil recovery in OG were obviously better than those in CG. Meanwhile, compared with the CG, the quality of life and nursing satisfaction of patients in OG were obviously higher after nursing. Comprehensive expectoration nursing in elderly patients with pulmonary infection has better effect and is able to effectively improve their respiratory function, quality of life and nursing satisfaction.


Changes in illusory ankle movements induced by tendon vibrations during the delayed recovery phase of stretch-shortening cycle fatigue: an indirect study of muscle spindle sensitivity modifications.
This study examined the perceived movement velocity induced by tendon vibrations during the delayed recovery phase of a stretch-shortening cycle (SSC)-type exercise characterized by 2 to 4 days of neuromuscular and proprioceptive impairments. Seven subjects performed until exhaustion series of unilateral rebounds involving mostly the triceps surae muscle group. Fatigue effects were quantified for the exercised and non-exercised legs through muscle soreness and maximal voluntary plantarflexion test (MVC) performed immediately before (PRE) and after the SSC exercise, and repeated 2 days later (D2). At PRE and D2, mechanical vibrations at 40, 60, 80, 100, and 120 Hz were applied to distal tendons of the exercised ankle. For each vibration, the subjects had to reproduce the perceived movement velocity with the non-exercised ankle. According to previous studies, the sole exercised leg was characterized by a D2 peak of muscle soreness associated, in the MVC test, with significant decreases in maximal force and mean soleus muscle activity. As compared to the PRE test and in all subjects, the vibrations applied at D2 to the tendon of the fatigued ankle extensor muscles led to significant decreases in the perceived movement velocity at 80 and 100 Hz, but to an increased one at 40 Hz. In contrast, vibrations applied to the tendon of the non-fatigued ankle flexor muscle did not result in any significant change. These results suggest that the delayed recovery phase of SSC fatigue is characterized by changes in muscle proprioception, which may partly result from a decreased sensitivity of the primary endings.


Outcome of hypospadias reoperation based on preoperative antimicrobial prophylaxis.
From August 1981 to June 2004, we retrospectively reviewed 66 hypospadias, treated with 123 operations, to analyze the outcome of reoperation based on preoperative antimicrobial prophylaxis. All patients received primary treatment in our hospital, and all had postoperative antimicrobial prophylaxis in all surgical procedures. We define a hypopadias repair as "corrected without fistula" if no urethrocutaneous fistula formation, or complete wound disruption is found within at least a 2-week follow-up period. Of the 123 operations, there were 66 primary repairs and 57 reoperations. The mean age at primary repair was 4.33 years. The overall rate of correction without fistula was 53.0% (35/66), with a mean of 14 months, follow-up. A total of 88 failure repairs resulted from 67 (76.0%) fistulas and 21 (24.0%) disruptions. A higher rate of correction without fistula (81.0%) was related to subcoronal hypospadias (p = 0.020) in three types. The rate of correction without fistula of two-staged repair was lowest in primary operations (12.5%), but these cases had a significantly higher rate of correction without fistula in following reoperations (66.7%, p = 0.043). Of the 123 repairs, only 46 (37%) had preoperative antibiotic prophylaxis, and these had lower early complication rates, both in primary and reoperation groups (42.3% vs 52.5% and 40.0% vs 54.1%, respectively). The differences, however, were not statistically significant (p = 0.231 and p = 0.289, respectively). In terms of rate of correction without fistula, a higher rate of correction without fistula was observed in reoperations with preoperative antibiotic prophylaxis (57.1%), compared to those without prophylaxis (23.1%). This difference was statistically significant (p = 0.031). The data from this study suggest that a lower early complication rate and a significantly higher rate of correction without fistula are related to the hypospadias reoperations with preoperative antimicrobial prophylaxis. The use of broad-spectrum antibiotics before surgery is recommended for these cases. However, more precise and prospective studies are warranted.


Severe osteoporosis in a young man with bilateral Cushing's syndrome: a case report.
The diagnosis of Cushing's syndrome is challenging; however, through the clinical picture and the search for secondary causes of osteoporosis, it was possible to reach the diagnosis of the case reported. There was an independent, symptomatic ACTH hypercortisolism manifested by typical phenotypic changes, severe secondary osteoporosis and arterial hypertension in a young patient. A 20-year-old Brazilian man with low back pain for 8 months. Radiographs showed fragility fractures in the thoracolumbar spine, and bone densitometry showed osteoporosis, especially when evaluating the Z Score (- 5.6 in the lumbar spine). On physical examination, there were wide violaceous streaks on the upper limbs and abdomen, plethora and fat increase in the temporal facial region, hump, ecchymosis on limbs, hypotrophy of arms and thighs, central obesity and kyphoscoliosis. His blood pressure was 150 × 90 mmHg. Cortisol after 1 mg of dexamethasone (24.1 µg/dL) and after Liddle 1 (28 µg/dL) were not suppressed, despite normal cortisoluria. Tomography showed bilateral adrenal nodules with more severe characteristics. Unfortunately, through the catheterization of adrenal veins, it was not possible to differentiate the nodules due to the achievement of cortisol levels that exceeded the upper limit of the dilution method. Among the hypotheses for the differential diagnosis of bilateral adrenal hyperplasia are primary bilateral macronodular adrenal hyperplasia, McCune-Albright syndrome and isolated bilateral primary pigmented nodular hyperplasia or associated with Carney's complex. In this case, primary pigmented nodular hyperplasia or carcinoma became important etiological hypotheses when comparing the epidemiology in a young man and the clinical-laboratory-imaging findings of the differential diagnoses. After 6 months of drug inhibition of steroidogenesis, blood pressure control and anti-osteoporotic therapy, the levels and deleterious metabolic effects of hypercortisolism, which could also impair adrenalectomy in the short and long term, were reduced. Left adrenalectomy was chosen, given the possibility of malignancy in a young patient and to avoid unnecessary definitive surgical adrenal insufficiency if the adrenalectomy was bilateral. Anatomopathology of the left gland revealed expansion of the zona fasciculate with multiple nonencapsulated nodules. The early identification of Cushing's syndrome, with measures based on the assessment of risks and benefits, remains the best way to prevent its progression and reduce the morbidity of the condition. Despite the unavailability of genetic analysis for a precise etiological definition, it is possible to take efficient measures to avoid future damage.


Attenuation of insulin resistance in rats by agmatine: role of SREBP-1c, mTOR and GLUT-2.
Insulin resistance is a serious health condition worldwide; however, its exact mechanisms are still unclear. This study investigates agmatine (AGM; an endogenous metabolite of L-arginine) effects on insulin resistance induced by high fructose diet (HFD) in rats and the possible involved mechanisms. Sprague Dawley rats were fed 60% HFD for 12 weeks, and AGM (10 mg/kg/day, orally) was given from week 9 to 12. AGM significantly reduced HFD-induced elevation in fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR) index and liver glycogen content from 3.44-, 3.62- and 2.07- to 2.59-, 2.78- and 1.3-fold, respectively, compared to the control group, while it increased HFD-induced reduction in glucose tolerance. Additionally, AGM significantly decreased HFD-induced elevation in serum triglycerides, low density lipoprotein cholesterol and very low density lipoprotein cholesterol levels from 3.18-, 2.97- and 4.75- to 1.25-, 1.25- and 1.07-fold, respectively, compared to control group. Conversely, AGM had no significant effect on HFD-induced changes in fasting glucose, glycosylated hemoglobin, insulin tolerance and high density lipoprotein cholesterol. Furthermore, AGM significantly reduced HFD-induced elevation in mRNA expression of glucose transporter type-2 (GLUT-2), mammalian target of rapamycin (mTOR) and sterol regulatory element-binding protein-1c (SREBP-1c) without affecting that of peroxisome proliferator-activated receptor-alpha (PPAR-α) in the liver. Additionally, AGM enhanced ACh-induced aortic relaxation and attenuated liver steatosis induced by HFD. In conclusion, AGM may have a therapeutic potential in insulin resistance through suppressing SREBP-1c, mTOR and GLUT-2 in liver.


The value of genetic information in selecting dairy replacements.
The objective of this study was to empirically determine the economic value of genetic information in the selection of dairy replacements, and assess whether this value was sufficient to prompt producers to select replacements on this basis. The data set consisted of 1982 Michigan Holstein replacements in 115 herds. Each herd had a minimum of 10 replacements that were born in the last 6 months of 1992 and calved within the last 6 months of 1994. The data for each replacement included the estimated breeding value (EBV) for milk at the beginning and end of the rearing period, and the estimated lifetime profit corrected for the opportunity cost of postponed replacement (ELPCOC). The replacement selection decision for a profit-maximizing dairy producer selecting 70 or 80% of the replacements was modeled. We modeled three methods of selection: genetic, random and ex poste. Genetic selection was evaluated using the EBV milk available at the beginning or end of the rearing period. For each herd, the profit associated with each of the three methods of selection was simulated. The value of the genetic information and perfect information were the differences in herd profits of genetic selection and ex poste selection relative to random selection, respectively. The difference in value of the genetic information between the end of the rearing period and the beginning of the rearing period was the increase in value of the genetic information due to updating. The value of information was calculated as the average herd profit per replacement. The value of the genetic information ranged from 22 dollars/replacement to 30 dollars/replacement and was statistically greater than zero at a 95% confidence level. It is unclear whether this value is sufficient to prompt producers to select replacements on the basis of EBV milk as has been recommended. The negative value of EBV milk (from the end of the rearing period when selecting 80% of the replacements) for 32 herds was consistent with the noisiness of the genetic estimates as messages of ELPCOC. The increased value of the genetic information due to updating was approximately 5 dollars/replacement. This increased value is likely insufficient to warrant delaying replacement selection decisions solely to obtain the updated information. The value of EBV milk was approximately 4 dollars/replacement higher when selecting 70% of the replacements versus 80%. The genetic information captured between 15% (selecting 70% at the beginning of the rearing period) and 20% (selecting 80% at the end of the rearing period) of the value of perfect information.


Microalgal Torrefaction for Solid Biofuel Production.
Microalgae are recognized as promising feedstocks for biofuel production and have been intensively studied. However, a systematic investigation of the relationship between cellular components and fuel properties in microalgae is currently absent. This review introduces recent advances in microalgal torrefaction and critically evaluates the properties of torrefied products from the viewpoint of molecular conversion. We also critically review how to regulate biosynthesis to better modulate microalgal metabolism and how cellular components impact fuel properties. Process optimization to improve solid fuel properties using different torrefaction technologies are furthermore comprehensively compared and summarized. This review provides new insights into developing innovative microalgal solid biofuels and increasing their commercial viability.


Paraneoplastic Erythropoiesis in Patients With Ovarian Sertoli Leydig Cell Tumors: Retrospective Study From Tertiary Care Institute.
To study the clinical, paraneoplastic hematological presentation of Sertoli Leydig cell tumor patients. This retrospective study involved women with Sertoli Leydig cell tumors treated at JIPMER from 2018 to 2021. We reviewed the hospital registry for the Sertoli Leydig cell tumor among all the ovarian tumors being treated in the department of obstetrics and gynecology. We retrieved the datasheets of patients with Sertoli Leydig cell tumor and studied their clinical and hematological presentation, their management, complications, and follow-up. We had 5 patients of Sertoli Leydig cell tumor of 390 ovarian tumors operated during the study period. The mean age at presentation was 31.6 years. All 5 patients had hirsutism and menstrual irregularity. One patient presented with symptoms of polycythemia along with these complaints. Elevated serum testosterone was seen in all (mean being 688 ng/ml). Mean preoperative hemoglobin was 15.84%, and mean hematocrit was 50.14%. Fertility-sparing surgery was performed in 3 of them and the rest had complete surgery. All patients were in Stage IA. Histologically, one had Pure Leydig cell, three had steroid cell tumor not otherwise specified and one was mixed Sertoli Leydig cell tumor. After the operation, the hematocrit and testosterone levels came down to the normal range. The virilizing manifestations regressed over 4-6 months. With a follow-up period ranging from 1 to 4 years, all 5 patients are alive, one patient had a disease recurrence in the ovary after 1 year of primary surgery. She is disease-free following the second surgery. The rest of the patients had no disease recurrence and are disease-free following surgery. Virilizing ovarian tumors can have paraneoplastic polycythemia which needs to be looked into while evaluating these patients. Similarly, while evaluating polycythemia in young females, an androgen-secreting tumor has to be ruled out as it is reversible and completely treatable.


A randomized trial of class 2 and class 3 elastic compression in the prevention of recurrence of venous ulceration.
Venous leg ulcers (VLUs) are a major health problem because of their high prevalence and associated high cost of care. Despite the widespread use of compression, treatment recurrence rates remain high. Numerous studies have suggested that regular use of compression stockings reduces VLU recurrences. However, there are limited data concerning how long compression hosiery should be worn after ulcer healing and which class of compression hosiery achieves better results in the prevention of VLU recurrences. An open, prospective, randomized, single-center study with a 5-year follow-up was performed to establish the efficacy of two different strengths of knee-high compression hosiery (class 2 and class 3) in the prevention of VLU recurrences. The study included patients with recently healed venous ulcers and no significant arterial disease, rheumatoid disease, diabetes mellitus, and restriction in range of ankle movement. Overall, 361 patients were randomized, and 308 patients (170 men, 138 women; mean age, 59 years) completed the study. Patients were randomized into two groups: group A, 186 patients who wore a heel-less open-toed elastic class 3 compression device knitted in tubular form (Tubulcus; Laboratoires Innothera, Arcueil, France); and group B, 175 patients who wore a class 2 elastic stocking (Rudo, Nis, Serbia). All patients were instructed to wear compression stockings continuously for the first 2 years of follow-up (both during the day and at night). In the third, fourth, and fifth years of follow-up, patients were instructed to wear elastic stockings during the day only. The main outcome measures were recurrence of leg ulceration and compliance with the treatment. Rates of ulcer recurrence after the 5 years of follow-up were 28.98% for the compression class 3 group and 60% for the compression class 2 group (P < .001, log-rank test). Patients in the compression class 3 group experienced significantly longer absolute (46 vs 40 months; P < .001, Mann-Whitney U test) and proportional (77% vs 67%; P < .001, Mann-Whitney U test) ulcer-free time after 5 years than those in the compression class 2 group. Rates of noncompliance after 5 years were 10.23% for the compression class 3 group and 6.25% for the compression class 2 group (P = .188, χ2 test). The results obtained in this study suggest that class 3 compression stockings provide a statistically significant lower recurrence rate compared with the class 2 compression stockings.


The tumor suppressor activity of DLC1 requires the interaction of its START domain with Phosphatidylserine, PLCD1, and Caveolin-1.
DLC1, a tumor suppressor gene that is downregulated in many cancer types by genetic and nongenetic mechanisms, encodes a protein whose RhoGAP and scaffolding activities contribute to its tumor suppressor functions. The role of the DLC1 START (StAR-related lipid transfer; DLC1-START) domain, other than its binding to Caveolin-1, is poorly understood. In other START domains, a key function is that they bind lipids, but the putative lipid ligand for DLC1-START is unknown. Lipid overlay assays and Phosphatidylserine (PS)-pull down assays confirmed the binding of DLC1-START to PS. Co-immunoprecipitation studies demonstrated the interaction between DLC1-START and Phospholipase C delta 1 (PLCD1) or Caveolin-1, and the contribution of PS to those interactions. Rho-GTP, cell proliferation, cell migration, and/or anchorage-independent growth assays were used to investigate the contribution of PS and PLCD1, or the implications of TCGA cancer-associated DLC1-START mutants, to DLC1 functions. Co-immunoprecipitations and PS-pull down assays were used to investigate the molecular mechanisms underlying the impaired functions of DLC1-START mutants. A structural model of DLC1-START was also built to better understand the structural implications of the cancer-associated mutations in DLC1-START. We identified PS as the lipid ligand for DLC1-START and determined that DLC1-START also binds PLCD1 protein in addition to Caveolin-1. PS binding contributes to the interaction of DLC1 with Caveolin-1 and with PLCD1. The importance of these activities for tumorigenesis is supported by our analysis of 7 cancer-associated DLC1-START mutants, each of which has reduced tumor suppressor function but retains wildtype RhoGAP activity. Our structural model of DLC1-START indicates the mutants perturb different elements within the structure, which is correlated with our experimental findings that the mutants are heterogenous with regard to the deficiency of their binding properties. Some have reduced PS binding, others reduced PLCD1 and Caveolin-1 binding, and others are deficient for all of these properties. These observations highlight the importance of DLC1-START for the tumor suppressor function of DLC1 that is RhoGAP-independent. They also expand the versatility of START domains, as DLC1-START is the first found to bind PS, which promotes the binding to other proteins.


Variations in host defence mechanisms and blastogenesis in chickens and mice after rifamycin treatments.
The immunobiological effect of rifamycins on different experimental models has been comparatively studied in chickens and mice using cyclophosphamide as a reference immunosuppressive agent. "In vivo" treatments with rifampicin and rifamycin SV diminished interferon levels in chickens and mice up to two hours after virus challenge. Mitogen induced blastogenesis was significantly depressed by either "in vivo" (5-50 mg/kg) or "in vitro" (5-20 micrograms/ml) drug treatments, although the activation of B lymphocytes was more easily inhibited than that of T lymphocytes. Primary anti-SRBC immune responses suffered a similar immune suppressive action by rifamycin treatments "in vivo". In every case, cyclophosphamide (10-20 micrograms/ml "in vitro" and 25 mg/kg "in vivo") proved to be the most active immunosuppressant. On the other hand, a remarkable parallelism in the effect of rifamycins in chickens and mice was observed in all the experimental systems used.


Editorial Commentary: The Forgotten Joint Score Is Valid, But Should Not Be Used to Compare Heterogeneous Procedures.
Patient-reported outcome measures are sometimes difficult to use. In contrast, the Forgotten Joint Score (FJS) is efficient and easy for patients to understand. FJS is used to assess patient awareness of joint symptoms or more specifically, as indicated by the word "forgotten," the lack thereof. Another advantage of the FJS is that it is quite discriminating compared with other patient-reported outcome measures, which may show low ceiling effects, meaning that a maximum score is easy to achieve. The FJS is valuable, but it should not be used to compare heterogeneous procedures.


Photodynamic therapy for leishmaniasis: Recent advances and future trends.
Leishmaniasis has infected more than 12 million people worldwide. This neglected tropical disease, causing 20,000-30,000 deaths per year, is a global health problem. The emergence of resistant parasites and serious side effects of conventional therapies has led to the search for less toxic and non-invasive alternative treatments. Photodynamic therapy is a promising therapeutic strategy to produce reactive oxygen species for the treatment of leishmaniasis. In this regard, natural and synthetic photosensitizers such as curcumin, hypericin, 5-aminolevulinic acid, phthalocyanines, phenothiazines, porphyrins, chlorins and nanoparticles have been applied. In this review, the recent advances on using photodynamic therapy for treating Leishmania species have been reviewed.


What's new in: "genetics in childhood epilepsy".
In recent years, different mutations in genes that control the excitability of neurons have been described in idiopathic childhood epilepsies. Most commonly, sodium/potassium channelopathies and GABA-receptor mutations are involved. Major progress has been made in the field of idiopathic generalised epilepsies associated with febrile seizures (GEFS+). It now is becoming clear that mutations should not only be looked for in familial cases, but also in sporadic cases, especially in infants and young children with unexplained severe epileptic encephalopathies. Many studies also define 'epilepsy susceptibility genes', which contribute to one's individual genetic vulnerability to develop epilepsy. It should be realized, however, that in the most common idiopathic benign childhood epilepsies (benign rolandic and occipital epilepsies), major breakthroughs are still awaited. In addition, a better clinical description of the epileptic phenotypes is needed to explain more precisely the genotypic and phenotypic heterogeneity. Genetic studies are nowadays becoming a necessary diagnostic step in the evaluation of idiopathic childhood epilepsies, not only in familial cases, but also in sporadic cases.


Dormancy release and flowering time in Ziziphus jujuba Mill., a "direct flowering" fruit tree, has a facultative requirement for chilling.
In deciduous fruit trees, the effect of chilling on flowering has mostly been investigated in the "indirect flowering" group, characterized by a period of rest between flower bud formation and blooming. In the present study, we explored the effects of chilling and chilling deprivation on the flowering of Ziziphus jujuba, a temperate deciduous fruit tree belonging to the "direct flowering" group, in which flower bud differentiation, blooming and fruit development occur after dormancy release, during a single growing season. Dormancy release, vegetative growth and flowering time in Z. jujuba cv. Ben-Li were assessed following several treatments of chilling. Chilling treatments quantitatively decreased the timing of vegetative bud dormancy release, thereby accelerating flowering, but had no effect on the time from dormancy release to flowering. Trees grown at a constant temperature of 25°C, without chilling, broke dormancy and flowered, indicating the facultative character of chilling in this species. We measured the expression of Z. jujuba LFY and AP1 homologues (ZjLFY and ZjAP1). Chilling decreased ZjLFY expression in dormant vegetative buds but had no effect on ZjAP1expression, which reached peak expression before dormancy release and at anthesis. In conclusion, chilling is not obligatory for dormancy release of Z. jujuba cv. Ben-Li vegetative buds. However, the exposure to chilling during dormancy does accelerate vegetative bud dormancy release and flowering.


A giant metastatic low-grade endometrial sarcoma requiring surgical management.
Low-grade endometrial stromal sarcomas are relatively rare tumors. We here report a case of a woman presenting with a giant metastatic low-grade endometrial stromal sarcoma with thromboembolic complications requiring urgent surgical management. A 58-year-old obese female was admitted, with a voluminous abdominopelvic mass, due to complications related to its size and extent. The tumor derived from the uterus and invaded the ureters, bladder and rectum. It compressed the right iliac vessels causing both deep vein thrombosis and pulmonary embolism. She developed a painful irreducible umbilical. We proceeded with a debulking surgery (hysterectomy with bilateral salpingo-oophorectomy). Histological findings were consistent with a low-grade endometrial stromal sarcoma. Low-grade endometrial stromal sarcomas are generally low-grade malignant neoplasms with an indolent clinical course. Surgery is the cornerstone of treatment. In low-income countries, malignancies are more often diagnosed at a late stage, which limits therapeutic options. Cytoreduction is recommended in advanced tumors with extrauterine manifestation, depending on symptoms and with palliative intent. Low-grade endometrial stromal sarcomas are indolent uterine malignancies with metastatic potential. Even in advanced cases, cytoreduction must be considered.


Interface designed MoS2/GaAs heterostructure solar cell with sandwich stacked hexagonal boron nitride.
MoS2 is a layered two-dimensional semiconductor with a direct band gap of 1.8 eV. The MoS2/bulk semiconductor system offers a new platform for solar cell device design. Different from the conventional bulk p-n junctions, in the MoS2/bulk semiconductor heterostructure, static charge transfer shifts the Fermi level of MoS2 toward that of bulk semiconductor, lowering the barrier height of the formed junction. Herein, we introduce hexagonal boron nitride (h-BN) into MoS2/GaAs heterostructure to suppress the static charge transfer, and the obtained MoS2/h-BN/GaAs solar cell exhibits an improved power conversion efficiency of 5.42%. More importantly, the sandwiched h-BN makes the Fermi level tuning of MoS2 more effective. By employing chemical doping and electrical gating into the solar cell device, PCE of 9.03% is achieved, which is the highest among all the reported monolayer transition metal dichalcogenide based solar cells.


Performance of two Picea abies (L.) Karst. stands at different stages of decline : III. Canopy transpiration of green trees.
The water relations of Picea abies in a healthy stand with green trees only and a declining stand with trees showing different stages of needle yellowing were investigated in northern Bavaria. The present study is based on observations of trees differing in their nutritional status but apparently green on both sites in order to identify changes in the response pattern which might be caused by atmospheric concentrations of air pollutants and could lead to the phenomenon of decline. Transpiration was measured as water flow through the hydroactive xylem using an equilibrium mass-flow measurement system. Total tree transpiration was monitored diurnally, from July 1985 until October 1985 at both sites. The relationship between transpiration and meteorological measurements indicated that transpiration was a linear function of the vapor pressure deficit. No differences in transpiration of green trees were observed between the two sites. Canopy transpiration was 57%-68% of total throughfall and 41%-54% of total rainfall. Due to this positive water balance, soil water potential at 10 and 20 cm depths remained close to-0.02 MPa (max.-0.09 MPa) for most of the summer. Soil water potential was correlated with the difference between the weekly precipitation and transpiration. No differences in the water relations of apparently healthy trees in the two P. abies stands were observed. It is concluded that differences between green trees at the two sites in terms of nutrient relations or growth rate cannot be explained by changes in whole-tree transpiration or soil water status.


Super-Flexible Freestanding BiMnO3 Membranes with Stable Ferroelectricity and Ferromagnetism.
Multiferroic materials with flexibility are expected to make great contributions to flexible electronic applications, such as sensors, memories, and wearable devices. In this work, super-flexible freestanding BiMnO3 membranes with simultaneous ferroelectricity and ferromagnetism are synthesized using water-soluble Sr3 Al2 O6 as the sacrificial buffer layer. The super-flexibility of BiMnO3 membranes is demonstrated by undergoing an ≈180° folding during an in situ bending test, which is consistent with the results of first-principles calculations. The piezoelectric signal under a bending radius of ≈500 µm confirms the stable existence of electric polarization in freestanding BiMnO3 membranes. Moreover, the stable ferromagnetism of freestanding BiMnO3 membranes is demonstrated after 100 times bending cycles with a bending radius of ≈2 mm. 5.1% uniaxial tensile strain is achieved in freestanding BiMnO3 membranes, and the piezoresponse force microscopy (PFM) phase retention behaviors confirm that the ferroelectricity of membranes can survive stably up to the strain of 1.7%. These super-flexible membranes with stable ferroelectricity and ferromagnetism pave ways to the realizations of multifunctional flexible electronics.


Human health risk-based soil environmental criteria (SEC) for park soil in Beijing, China.
Urban parks are important places that allow urban residents to experience nature but are also associated with the risk of exposure to contaminated soil. Therefore, it is necessary to establish appropriate soil environment criteria (SEC) to manage park soil quality. Studies on the demographic characteristics and behavioral patterns of urban park visitors are helpful for the selection of sensitive receptors and the determination of parameters in the establishment of SEC. This study explored the park visitors' demographic characteristics and behavioral patterns, and applied the results to derive SEC. Eighty-six parks in Beijing were selected, and mobile phone data were obtained to analysis the demographic characteristics and residence time of the visitors. Kruskal-Wallis test, kernel density estimation and random forest model were used for data analysis. The CLEA model was used to derive SEC. The results showed that the demographic characteristics and behavioral patterns of visitors in different types of parks were quite different. Parks were mostly used by males and visitors aged 31-45. Most visitors stayed in the park for 1-2 h, and the distance from a given visitor's home to the park was the most important factor affecting stay time. Then, several parameters such as the parameters related to the receptors and occupation period were optimized, and the SEC of sensitive parks and non-sensitive parks were derived. Exposure frequency may be the main reason for the difference of SEC between the two types of parks. The SECs of sensitive parks were higher than the soil screening values (SSVs) for class 1 land in GB36600-2018, indicating that the current SSVs for some parks may be too conservative. This study provides a reference for the formulation and revision of soil environmental standards for park land, and suggests strengthening research on human behavioral patterns.


Integrative transcriptome and metabolome revealed the molecular mechanism of Bacillus megaterium BT22-mediated growth promotion in Arabidopsis thaliana.
Plant growth-promoting rhizobacteria (PGPR) can promote plant growth and protect plants from pathogens, which contributes to sustainable agricultural development. Several studies have reported their beneficial characteristics in facilitating plant growth and development and enhancing plant stress resistance through different mechanisms. However, there is still a challenge to study the molecular mechanism of plant response to PGPR. We integrated the transcriptome and metabolome of Arabidopsis thaliana (Arabidopsis) to understand its responses to the inoculation with an isolated PGPR strain (BT22) of Bacillus megaterium. Fresh shoot weight, dry shoot weight and leaf number of Arabidopsis were increased by BT22 treatment, showing a positive growth-promoting effect. According multi-omics analysis, 878 differentially expressed genes (296 up-regulated, 582 down-regulated) and 139 differentially expressed metabolites (66 up-regulated, 73 down-regulated) response to BT22 inoculation. GO enrichment results indicate that the up-regulated genes mainly enriched in the regulation of growth and auxin response pathways. In contrast, the down-regulated genes mainly enriched in wounding response, jasmonic acid and ethylene pathways. BT22 inoculation regulated plant hormone signal transduction of Arabidopsis, including auxin and cytokinin response genes AUX/IAA, SAUR, and A-ARR related to cell enlargement and cell division. The contents of nine flavonoids and seven phenylpropanoid metabolites were increased, which help to induce systemic resistance in plants. These results suggest that BT22 promoted Arabidopsis growth by regulating plant hormone homeostasis and inducing metabolome reprogramming.


Effects of propylene glycol on redox state of the perfused rat liver--a note of caution.
Propylene glycol is used as a solvent for bile salts in studies on their biologic effects on the liver. While using this solvent (32-64 mmol/l) in the isolated perfused rat liver, we found a significant change in the extramitochondrial redox system as indicated by a fivefold increase of the lactate pyruvate ratio in the perfusate. The increase was due to an increased uptake of pyruvate (0.8 mumol/g/min) and to a release of lactate (1.8 mumol/g/min). The intramitochondrial redox state was affected to a lesser degree as estimated by the beta-hydroxybutyrate acetoacetate ratio (twofold increase). These abnormalities resemble those induced by similar concentrations of ethanol. We suggest, therefore, that investigators studying bile acids should be aware of this artifact which causes significant alterations in cellular energy systems and enzyme activities.


Surgical salvage of heart rupture: report of two cases and review of the literature.
Two patients who sustained cardiac rupture complicating recent myocardial infarction were salvaged by expeditious diagnosis and surgical treatment. The cases of 9 other similar patients have been reported in the English-language literature. The cases of these 11 patients were reviewed in an attempt to find common clinical, pathological, and therapeutic features that might have been instrumental in the successful outcome of this usually fatal complication.


Well-differentiated papillary adenocarcinoma arising in a supratentorial enterogenous cyst: case report.
We report a case of a well-differentiated papillary adenocarcinoma arising in an supratentorial enterogenous cyst. The clinicopathological features of this case and a brief review of the literature are presented. A 45-year-old woman presented with abrupt onset of sensory seizures and abnormal sensation on the left side of her face, left leg, and left arm. Radiological studies showed a cystic extraaxial tumor with mass effect in the right parietal area. The initial clinical impression was a metastatic lesion, and a comprehensive metastatic workup revealed no evidence of tumor elsewhere. A gross total resection of the solid cystic tumor was achieved by a frontoparietal craniotomy. Sixteen months after the initial surgery, the patient presented with signs of increased intracranial pressure and a large parietal cyst. The cyst was fenestrated at the time of the second craniotomy. A pathological study of the initial surgical material revealed it to be a well-differentiated papillary adenocarcinoma in association with an enterogenous cyst. The second surgical specimen consisted only of the benign cyst wall. The patient recovered uneventfully from the second surgery and was free of symptoms 6 months postoperatively. The importance of recognizing the rare possibility of malignant progression of a benign enterogenous cyst in the central nervous system is discussed.


African-American Parents' Knowledge and Perceptions About BMI Measurements, School-Based BMI Screening Programs, and BMI Report Cards: Results from a Qualitative Investigation and Implications for School-to-Parent Communication.
School-based body mass index (BMI) screenings can help parents make informed decisions about their child's health, but schools have questioned parents' understanding and attitudes about BMI measures and report cards. Although researchers have investigated minority parents' perceptions of their child's weight, no research has explored minority parents' knowledge and perceptions related to BMI measurements, school-based BMI screening programs, and BMI report cards. To address this gap, focus groups were conducted (n = 20) with female Black or African-American parents/guardians from a large urban school district. Participants were asked to share their perceptions before and after receiving education about BMI measurements and screening programs. Pre-education: Many participants had heard of BMI, thought it was similar to body fat, believed screenings were intended to track students' weights and monitor eating habits, and were concerned that screenings could cause their child embarrassment. Post-education: Most participants did not object to screenings, but said they would have without education about why and how BMI measurements are taken. They also voiced concerns about lack of prior notice, confidentiality, and the need for schools to serve healthier food. Some of these findings support those of other qualitative studies of parents' concerns about BMI screenings, but no previous studies have compared parents' perceptions of screening programs pre-/post-education. The results reinforce that schools' efforts to explain what BMI measurements are as well as why and how they are taken can increase parents' confidence in the schools and level of comfort with BMI screening programs and report cards.


Pyogenic vertebral osteomyelitis in a breast cancer patient: report of a case.
We herein report a rare case of pyogenic vertebral osteomyelitis (PVO) coexisting with breast carcinoma. A 71-year-old female presented with neck pain without fever. Magnetic resonance imaging (MRI) showed suspected metastatic lesions in her neck (C7 and Th1). Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased FDG uptake in the neck spines and in the left breast. A core needle biopsy of the left breast revealed the presence of invasive ductal carcinoma. Our first tentative diagnosis of the patient was left breast carcinoma with bone metastases, and first-line endocrine therapy was started. However, surgical intervention for the spines had to be considered, because her neurological symptoms progressed. A repeated MRI scan showed a narrowing of the disc space and fluid accumulation around the vertebrae. This suggested the presence of PVO rather than metastases. Surgery confirmed the presence of PVO in C7 and Th1, and a culture of the abscess yielded Escherichia coli. The patient's neurological symptoms dramatically improved after surgery. Breast conserving surgery was performed 3 months after the surgery for PVO. The patient is well and has no clinical evidence of disease 18 months after the breast conserving surgery. PVO is rare, but should be included in the differential diagnosis in patients presenting with early breast carcinoma.


Intracranial neoplasms in infants.
Fifty-four primary intracranial neoplasms occurred in infants (18 months of age or younger) in Connecticut during a 40-year period, 1935 to 1974. Thirty percent were medulloblastomas and 16% were ependymal neoplasms. An equal number of males and females were affected. Forty percent were located in the cerebellum, 37% in the cerebral hemispheres, and 17% in the brain stem. The most common symptom was vomiting. Abnormally large head circumference was the most common physical finding. Average survival was 43 months. Survival relative to histopathologic type and location of the neoplasm is discussed. Eighteen patients survived longer than one year and the level of neurological function of these longer survivors is presented.


Deep learning-based algorithm improved radiologists' performance in bone metastases detection on CT.
To develop and evaluate a deep learning-based algorithm (DLA) for automatic detection of bone metastases on CT. This retrospective study included CT scans acquired at a single institution between 2009 and 2019. Positive scans with bone metastases and negative scans without bone metastasis were collected to train the DLA. Another 50 positive and 50 negative scans were collected separately from the training dataset and were divided into validation and test datasets at a 2:3 ratio. The clinical efficacy of the DLA was evaluated in an observer study with board-certified radiologists. Jackknife alternative free-response receiver operating characteristic analysis was used to evaluate observer performance. A total of 269 positive scans including 1375 bone metastases and 463 negative scans were collected for the training dataset. The number of lesions identified in the validation and test datasets was 49 and 75, respectively. The DLA achieved a sensitivity of 89.8% (44 of 49) with 0.775 false positives per case for the validation dataset and 82.7% (62 of 75) with 0.617 false positives per case for the test dataset. With the DLA, the overall performance of nine radiologists with reference to the weighted alternative free-response receiver operating characteristic figure of merit improved from 0.746 to 0.899 (p < .001). Furthermore, the mean interpretation time per case decreased from 168 to 85 s (p = .004). With the aid of the algorithm, the overall performance of radiologists in bone metastases detection improved, and the interpretation time decreased at the same time. • A deep learning-based algorithm for automatic detection of bone metastases on CT was developed. • In the observer study, overall performance of radiologists in bone metastases detection improved significantly with the aid of the algorithm. • Radiologists' interpretation time decreased at the same time.


Effects of railway noise and vibrations on dissatisfaction of residents: case study of Iran.
In this study, the effects of noise and vibrations caused by railways on the lives of residents around the railways in districts 17 and 18 of Tehran, the capital of Iran which amounts to about 700,000 people, are investigated. In the first stage the actual level of noise was measured at various points which showed above standard levels. Afterward, the authors developed a questionnaire and the survey was conducted from 376 residents. The findings of this study show that the most important factor for the residents adjacent to the railway line is the need for action by the country's railway authorities to reduce and control the adverse effects of noise and vibration. Also, the analysis of inferential statistics performed by chi-square test shows that the variables of gender and proximity of residence or workplace or both to the railway do not affect any of the railway noise or vibration dissatisfaction. The age variable also has no effect on noise dissatisfaction but does impact on vibration. Finally, distance from the railway affects both disaffection from noise and vibration.


Sliding flap advancement for the treatment of high level fistulae.
The technique of sliding flap advancement for the treatment of high anal fistulae is described. The technique is not suitable for cases with an acute abscess and is reserved for patients with a well-established chronic fistula track. Thirty patients with anal fistulae were treated by sliding flap advancement from 1980 to 1984. Twenty-nine patients had satisfactory results. With a follow-up ranging from 18 months to 4 years no recurrence of fistulae or abscess were observed. The advantages of the advancement flap technique over the staging division technique with application of a seton and over the rerouting technique are discussed.


Assessment of subchronic toxicity and toxicokinetics of AG NPP709 in Sprague-Dawley rats.
Hedera helix L. (HH) leaves and Coptidis rhizoma (CR) have traditionally been used to treat respiratory conditions. AG NPP709, which is formulated using extracts of both these herbs, has been developed as an expectorant and antitussive. The objective was to evaluate the subchronic toxicity and toxicokinetic characteristics of AG NPP709 in laboratory rats. AG NPP709 was orally administered to rats at doses of up to 2.0 g/kg/day for a duration of 13 weeks. Various health parameters were measured throughout the treatment period. At the end of the treatment, a necropsy was conducted and additional parameters were analyzed. Toxicokinetic analyses were also performed on hederacoside C and berberine, the active components of HH leaves and CR, respectively, in the plasma of rats treated with AG NPP709. AG NPP709-treated rats exhibited several health issues, such as reduced feed intake, altered differential white blood cell (WBC) count, increased plasma Alb/Glo ratio in females, and reduced kidney weight in males. However, these changes appeared to be incidental and fell within the typical range for healthy animals of this species. Additionally, toxicokinetic analysis of hederacoside C and berberine showed no accumulation in the plasma of rats during the repeated treatments with AG NPP709. Our study demonstrates that AG NPP709 does not have any harmful effects on rats under experimental conditions. Based upon these findings, the no observed adverse effect level of AG NPP709 can be estimated to be 2.0 g/kg/day in rats.


Simplified peroperative placement of temporary right atrial pacing leads.
A simple technique for securing right atrial pacing leads is described. The method relies on pressure fixation by haemostatic clips. Clinical experience over a 2 year period has demonstrated that this system provides safe, reliable and rapid lead attachment. No problems with lead removal have been encountered.


[Corticofugal effects on the neuronal activity of the vestibular nuclei in the cat].
Neuronal responses to stimulation of vestibular (V1), motor and orbital brain cortex were recorded extracellularly in lateral and medial vestibular nuclei of bulbar complex in experiments carried on nonanesthetized immobilized cats. Both phasic and (more often) tonic responses mainly of inhibitory type were observed. In morphological experiments the horseradish peroxidase was injected into the above nuclei. Marked neurons were found in the anterior supra- and ectosylvian brain gyri, in the region of cruciform sulcus and orbital cerebral cortex. The obtained data are discussed in the aspect of corticovestibular interaction.


Magnetic resonance imaging in the evaluation of leukocoria.
Leukocoria is an important clinical sign in ophthalmology. Conditions producing this white pupillary reflex must be differentiated from retinoblastoma to insure appropriate and timely treatment. Auxiliary diagnostic testing has been helpful in securing a clinical diagnosis. A new diagnostic modality, magnetic resonance imaging, provides similar morphologic information with the additional potential for biochemical characterization. A series consisting of 14 patients presenting with leukocoria as a result of retinoblastoma and simulating conditions was examined. The magnetic resonance imaging findings are discussed.


Morphology of dendrite bundles in the cervical spinal cord of the rat: a light microscopic study.
Histological staining techniques and Golgi-Cox impregnation revealed three discrete dendrite bundles in the ventral horn of the rat cervical spinal cord. A midline dendrite bundle (MDB) traversed the ventromedial gray matter (C3-6), a central dendrite bundle (CDB) coursed the medial aspect of the ventral horn (C3-5), and a lateral dendrite bundle (LDB) traveled in the ventrolateral gray matter (C2-4). At the light microscopic level, the three dendrite bundles were composed of longitudinally oriented intertwined dendrites that coursed in close apposition among motoneuron perikarya, neuroglia, and capillaries. A gradient of packing density of dendrites in the bundles existed, the MDB displaying the greatest packing density and the LDB forming the most loosely interwoven dendritic plexus. Dendrites contributing to the bundles originated from several different motoneuron pools. Smaller transverse dendrite bundles radiated from the longitudinal dendrite bundles at right angles and appeared to interconnect the MDB, CDB, and LDB. Transverse dendrite bundles also exited the MDB and LDB to course into the anterior and lateral funiculi, respectively. The presence of dendrite bundles among fields of motoneurons suggests that dendrite bundles may provide an anatomical substrate for the synchronization of neuronal activity for coordination of muscle groups involved in particular movements. Dendrite bundles also would provide a means whereby functionally similar motoneurons can receive and integrate similar synaptic inputs, and thus allow these inputs to modulate and coordinate groups of neurons that act as a functional unit. The presence of transverse dendrite bundles interconnecting the longitudinal bundles may permit the fine tuning of motoneuron activity for better coordination of movements involving synergistic and antagonistic muscle groups.


Myocardial infarction and normal coronary arteriography: a 10 year clinical and risk analysis of 74 patients.
Myocardial infarction with normal coronary arteries was identified in 74 patients with a mean age of 43 years (range 19 to 66). A mean follow-up period of 10.5 years after documented myocardial infarction and 8.6 years after cardiac catheterization was obtained. The survival rate was 85% (n = 63). There were no statistical differences in age or clinical risk factor prevalence between survivors and nonsurvivors. Moderate (55%) to severe (27%) left ventricular impairment was more common in nonsurvivors. Nine of 11 deaths were cardiovascular, 6 were sudden and 8 occurred in patients with moderate to severe global left ventricular impairment. Seventy-six percent of survivors were asymptomatic and 86% were fully active at follow-up. Two survivors and three nonsurvivors experienced a second myocardial infarction. The clinical risk factors of the study group (Group I) were compared by age, sex and year of catheterization with risk factors in two matched groups. Group II consisted of 74 patients with coronary occlusive disease and myocardial infarction and Group III consisted of 148 patients with normal arteriograms. Group I differed from Group II in having fewer clinical risk factors (p = 0.01 to less than 0.0001). Cigarette smoking did not differ significantly between Group I (72%) and Group II (69%) but was less common in Group III (45%) (p less than 0.001). Hormone therapy or the peripartum state was more common in women in Group I (34%) than in women in Group III (14%) (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)


Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.
Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance.


[Van Buchem disease. Study of 2 cases and review of the literature].
We report two members of one family, a 51-year-old man a 16-year-old son, with enlargement of the jaw, palatine taurus, endosteal sclerosis of the neurocranium and symmetrical diaphyseal cortical thickening. On the basis of those typical findings, the diagnosis of recessive endosteal hyperostosis (Van Buchem's disease) was mode. This unusual hereditary sclerosing bone dysplasia is discussed with respect to the clinical and radiological features as well as its distinction from other sclerosing disorders.


Hypercapnic acidosis attenuates severe acute bacterial pneumonia-induced lung injury by a neutrophil-independent mechanism.
Deliberate induction of hypercapnic acidosis protects against lung injury after nonseptic lung injury. In contrast, concerns exist regarding the effects of hypercapnic acidosis in the setting of severe pulmonary sepsis. The potential for the effects of hypercapnic acidosis to be neutrophil-mediated remains to be determined. We investigated whether hypercapnic acidosis--induced by adding CO2 to inspired gas--would protect against severe acute lung injury induced by pulmonary Escherichia coli instillation and the role of neutrophils in mediating this effect. Prospective randomized animal study. University Research Laboratory. Adult male Sprague-Dawley rats. In series 1, after induction of anesthesia and tracheostomy placement, animals were randomized to normocapnia (FICO2 0.00, n = 12) or hypercapnic acidosis (FICO2 0.05, n = 12). E. coli (0.5-3.0 x 10(15) colony-forming units) was instilled intratracheally and the animals were ventilated for 6 hrs to allow a severe acute lung injury to evolve. In series 2, animals were randomized to neutrophil depletion or nondepletion before bacterial instillation, in a three-group design: normocapnia alone (Normo + polymorphonuclear neutrophils [PMN], n = 9), normocapnia with neutrophil depletion (Normo - PMN, n = 9), or hypercapnic acidosis with neutrophil depletion (hypercapnic acidosis - PMN, n = 9). After intratracheal E. coli administration these animals were also ventilated for 6 hrs. Hypercapnic acidosis protected against evolving pneumonia-induced acute lung injury, attenuating the increase in airway pressure, and the decrement in lung compliance and arterial PO2. However, hypercapnic acidosis did not reduce histologic injury. Hypercapnic acidosis also protected against evolving pneumonia-induced acute lung injury in the presence of neutrophil depletion, reducing both physiologic and histologic indices of lung injury. Hypercapnic acidosis reduces indices of intratracheal E. coli induced lung injury by a mechanism that seems to be neutrophil-independent.


A novel method to quantify the activity of alcohol acetyltransferase Using a SnO2-based sensor of electronic nose.
Alcohol acetyltransferase (AATFase) extensively catalyzes the reactions of alcohols to acetic esters in microorganisms and plants. In this work, a novel method has been proposed to quantify the activity of AATFase using a SnO2-based sensor of electronic nose, which was determined on the basis of its higher sensitivity to the reducing alcohol than the oxidizing ester. The maximum value of the first-derivative of the signals from the SnO2-based sensor was therein found to be an eigenvalue of isoamyl alcohol concentration. Quadratic polynomial regression perfectly fitted the correlation between the eigenvalue and the isoamyl alcohol concentration. The method was used to determine the AATFase activity in this type of reaction by calculating the conversion rate of isoamyl alcohol. The proposed method has been successfully applied to determine the AATFase activity of a cider yeast strain. Compared with GC-MS, the method shows promises with ideal recovery and low cost.


Diagnostic performance of FDG PET/CT for surveillance in asymptomatic gastric cancer patients after curative surgical resection.
The present study evaluated the diagnostic performance of 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) for surveillance in asymptomatic gastric cancer patients after curative surgical resection. We retrospectively recruited 190 gastric cancer patients (115 early gastric cancer patients and 75 advanced gastric cancer patients) who underwent 1-year (91 patients) or 2-year (99 patients) postoperative FDG PET/CT surveillance, along with a routine follow-up program, after curative surgical resection. All enrolled patients were asymptomatic and showed no recurrence on follow-up examinations performed before PET/CT surveillance. All PET/CT images were visually assessed and all abnormal findings on follow-up examinations including FDG PET/CT were confirmed with histopathological diagnosis or clinical follow-up. During follow-up, 19 patients (10.0 %) developed recurrence. FDG PET/CT showed abnormal findings in 37 patients (19.5 %). Among them, 16 patients (8.4 %) were diagnosed as cancer recurrence. Of 153 patients without abnormal findings on PET/CT, three patients were false-negative and diagnosed as recurrence on other follow-up examinations. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET/CT were 84.2 %, 87.7 %, 43.2 %, and 98.0 %, respectively. Among 115 early gastric cancer patients, PET/CT detected recurrence in four patients (3.5 %) and one patient with local recurrence. Among 75 advanced gastric cancer patients, PET/CT detected recurrence in 12 patients (16.0 %), excluding two patients experiencing peritoneal recurrence. In addition, FDG PET/CT detected secondary primary cancer in six (3.2 %) out of all the patients. Post-operative FDG PET/CT surveillance showed good diagnostic ability for detecting recurrence in gastric cancer patients. FDG PET/CT could be a useful follow-up modality for gastric cancer patients, especially those with advanced gastric cancer. However, further careful evaluation is needed because of false-positive findings on PET/CT.


Experimental phasing with vanadium and application to nucleotide-binding membrane proteins.
The structure determination of soluble and membrane proteins can be hindered by the crystallographic phase problem, especially in the absence of a suitable homologous structure. Experimental phasing is the method of choice for novel structures; however, it often requires heavy-atom derivatization, which can be difficult and time-consuming. Here, a novel and rapid method to obtain experimental phases for protein structure determination by vanadium phasing is reported. Vanadate is a transition-state mimic of phosphoryl-transfer reactions and it has the advantage of binding specifically to the active site of numerous enzymes catalyzing this reaction. The applicability of vanadium phasing has been validated by determining the structures of three different protein-vanadium complexes, two of which are integral membrane proteins: the rabbit sarcoplasmic reticulum Ca2+-ATPase, the antibacterial peptide ATP-binding cassette transporter McjD from Escherichia coli and the soluble enzyme RNAse A from Bos taurus. Vanadium phasing was successful even at low resolution and despite severe anisotropy in the data. This method is principally applicable to a large number of proteins, representing six of the seven Enzyme Commission classes. It relies exclusively on the specific chemistry of the protein and it does not require any modifications, making it a very powerful addition to the phasing toolkit. In addition to the phasing power of this technique, the protein-vanadium complexes also provide detailed insights into the reaction mechanisms of the studied proteins.


Myelopathy associated with systemic lupus erythematosus (erythema nodosum).
Two patients with sudden onset of myelopathy associated with Systemic Lupus Erythematosus (Erythema Nodosum) are described. Pertinent literature is extensively reviewed and these two new patients are added to previously reported 26 patients.


The National EMS Research strategic plan.
One of the eight major recommendations put forth by the National EMS Research Agenda Implementation Project in 2002 was the development of an emergency medical services (EMS) research strategic plan. Using a modified Delphi technique along with a consensus conference approach, a strategic plan for EMS research was created. The plan includes recommendations for concentrating efforts by EMS researchers, policy makers, and funding resources with the ultimate goal of improving clinical outcomes. Clinical issues targeted for additional research efforts include evaluation and treatment of patients with asthma, acute cardiac ischemia, circulatory shock, major injury, pain, acute stroke, and traumatic brain injury. The plan calls for developing, evaluating, and validating improved measurement tools and techniques. Additional research to improve the education of EMS personnel as well as system design and operation is also suggested. Implementation of the EMS research strategic plan will improve both the delivery of services and the care of individuals who access the emergency medical system.


Bilayer sample for fast or slow magic angle oriented sample spinning solid-state NMR spectroscopy.
An alternative setup for Magic Angle Oriented Spinning Spectroscopy is proposed. Samples were prepared by orienting lipid bilayers onto polymer films, which were wrapped into a spiral so as to fit into 4 or 7 mm MAS rotors. This geometry resulted in narrow line widths and a higher upper spinning limit when compared to the conventional MAOSS setup with stacked glass plates. Whereas orientational information was extracted from low spinning spectra, fast spinning will be applicable to high-resolution multidimensional NMR pulse sequences.


Sexual behavior in healthy married elderly men.
Sexual behavior was evaluated in 81 men aged 60-71 years (34 men aged 60-65 years and 47 men aged 66-71 years). All subjects were married, physically healthy, and with no psychopathology or marital problems. Sexual function was evaluated by a self-report three-point rating scale. Thirty-six percent of the whole study population reported impotence, with no significant difference between the two age groups. About half of the total population reported regular masturbatory activity. A decline in frequency of sexual intercourse and an increase in frequency of masturbation in subjects aged 66-71 years as compared to subjects aged 60-65 indicates that the interest in sexuality continues in elderly men although the form of sexual expression changes from active sexual intercourse to a self-pleasuring/autoerotic form. Evaluation of sexual activity in advanced age is recommended and appropriate therapy in case of sexual dysfunction should be offered to elderly men.


Advanced glycation endproducts trigger autophagy in cadiomyocyte via RAGE/PI3K/AKT/mTOR pathway.
Previous studies showed that the accumulation of advanced glycation end products (AGEs) induce cardiomyocyte apoptoisis, leading to heart dysfunction. However, the effect of AGEs on another cell death pathway, autophagy, in cardiomyocytes remains unknown. Rat neonate cardiomyocytes were cultured and treated with AGEs at different concentration. Two classic autophagy markers, microtubule-associated protein 1 light chain 3 (LC3) and Beclin-1, were detected by western blot assay. The inhibition of RAGE and phosphatidylinositol 3-phosphate kinase (PI3K)/Akt/mTOR pathway were applied to cells, respectively. AGEs administration enhanced the expression of Beclin-1 and LC3 II in cardiomyocytes, increased the number of autophagic vacuoles and impaired the cell viability in dose-dependant manners. Also, AGEs inhibited the PI3K/Akt/mTOR pathway via RAGE. Inhibition of RAGE with RAGE antibody reduced expression of Beclin-1 and LC3 II/I and inhibited the cellular autophagy, accompanied by the reactivation of PI3K/Akt/mTOR pathway in cultured cells. Notably, the presence of inhibition of PI3K/Akt/mTOR pathway abolished the protective effect of RAGE inhibition on cardiomyocytes. This study provides evidence that AGEs induces cardiomyocyte autophagy by, at least in part, inhibiting the PI3K/Akt/mTOR pathway via RAGE.


5-HT3A -driven green fluorescent protein delineates gustatory fibers innervating sour-responsive taste cells: A labeled line for sour taste?
Taste buds contain multiple cell types with each type expressing receptors and transduction components for a subset of taste qualities. The sour sensing cells, Type III cells, release serotonin (5-HT) in response to the presence of sour (acidic) tastants and this released 5-HT activates 5-HT3 receptors on the gustatory nerves. We show here, using 5-HT3A GFP mice, that 5-HT3 -expressing nerve fibers preferentially contact and receive synaptic contact from Type III taste cells. Further, these 5-HT3 -expressing nerve fibers terminate in a restricted central-lateral portion of the nucleus of the solitary tract (nTS)-the same area that shows increased c-Fos expression upon presentation of a sour tastant (30 mM citric acid). This acid stimulation also evokes c-Fos in the laterally adjacent mediodorsal spinal trigeminal nucleus (DMSp5), but this trigeminal activation is not associated with the presence of 5-HT3 -expressing nerve fibers as it is in the nTS. Rather, the neuronal activation in the trigeminal complex likely is attributable to direct depolarization of acid-sensitive trigeminal nerve fibers, for example, polymodal nociceptors, rather than through taste buds. Taken together, these findings suggest that transmission of sour taste information involves communication between Type III taste cells and 5-HT3 -expressing afferent nerve fibers that project to a restricted portion of the nTS consistent with a crude mapping of taste quality information in the primary gustatory nucleus.


Stable Zinc Anodes Enabled by Zincophilic Cu Nanowire Networks.
Zn-based electrochemical energy storage (EES) systems have received tremendous attention in recent years, but their zinc anodes are seriously plagued by the issues of zinc dendrite and side reactions (e.g., corrosion and hydrogen evolution). Herein, we report a novel strategy of employing zincophilic Cu nanowire networks to stabilize zinc anodes from multiple aspects. According to experimental results, COMSOL simulation and density functional theory calculations, the Cu nanowire networks covering on zinc anode surface not only homogenize the surface electric field and Zn2+ concentration field, but also inhibit side reactions through their hydrophobic feature. Meanwhile, facets and edge sites of the Cu nanowires, especially the latter ones, are revealed to be highly zincophilic to induce uniform zinc nucleation/deposition. Consequently, the Cu nanowire networks-protected zinc anodes exhibit an ultralong cycle life of over 2800 h and also can continuously operate for hundreds of hours even at very large charge/discharge currents and areal capacities (e.g., 10 mA cm-2 and 5 mAh cm-2), remarkably superior to bare zinc anodes and most of currently reported zinc anodes, thereby enabling Zn-based EES devices to possess high capacity, 16,000-cycle lifespan and rapid charge/discharge ability. This work provides new thoughts to realize long-life and high-rate zinc anodes.


Studies on glomerular immune solubilization by complement in patients with IgA nephropathy.
A study of the solubilization of glomerular immune deposits by serum or complement in patients with IgA nephropathy is described. Renal biopsy specimens were obtained from 15 patients with IgA nephropathy. These specimens were incubated with fresh and heated sera from healthy adults or with lyophilized complement components, i.e., C3 and C4, at 37 degrees C for one hour in plastic tubes. The sections were then stained with fluorescein isothiocyanate (FITC)-labelled anti-human IgA antisera and examined by fluorescence microscopy. Normal sera showed a marked capacity to solubilize the glomerular immune deposits characteristic of IgA nephropathy. The solubilization capacity was reduced after inactivation and absorption of sera with anti-human C3 antiserum. Lyophilized C3 or C4 did not show any ability to solubilize such deposits. It was concluded that the solubilization of glomerular immune deposits may require whole active (fresh) components of complement related to the alternative pathway.


Mechano-devo.
In "On growth and form", D'Arcy Wentworth Thompson (1917) stresses the inevitable interactions between physics and developmental biology. With the recent progress in molecular genetics, live imaging, micromechanics and modeling, the study of morphogenesis has been rejuvenated in the present century: the activity of developmental genes can be interpreted in terms of mechanical properties to dissect the chain of events behind shape changes; in turn, patterns of shape- and growth-derived mechanical stress are calculated and shown to act as signals controlling cell effectors, in synergy with biochemical cues, thereby channeling morphogenesis. In short, the relation between the mechanics and the biochemistry of shape changes is now addressed more comprehensively. Beyond the legacy left by this unique, elegant, and thought provoking analysis of development, D'Arcy rooted a new field, that one could call "mechano-devo", and used didactic analogies to bridge biology and physics. Here are some subjective take home messages from this seminal book, for the developmental biologist interested in conducting such interdisciplinary research.


Presence and role of viruses in anaerobic digestion of food waste under environmental variability.
The interaction among microorganisms in the anaerobic digestion of food waste (ADFW) reactors lead to the degradation of organics and the recycling of energy. Viruses are an important component of the microorganisms involved in ADFW, but are rarely investigated. Furthermore, little is known about how viruses affect methanogenesis. Thousands of viral sequences were recovered from five full-scale ADFW reactors. Gene-sharing networks indicated that the ADFW samples contained substantial numbers of unexplored anaerobic-specific viruses. Moreover, the viral communities in five full-scale reactors exhibited both commonalities and heterogeneities. The lab-scale dynamic analysis of typical ADFW scenarios suggested that the viruses had similar kinetic characteristics to their prokaryotic hosts. By associating with putative hosts, a majority of the bacteria and archaea phyla were found to be infected by viruses. Viruses may influence prokaryotic ecological niches, and thus methanogenesis, by infecting key functional microorganisms, such as sulfate-reducing bacteria (SRB), syntrophic acetate-oxidizing bacteria (SAOB), and methanogens. Metabolic predictions for the viruses suggested that they may collaborate with hosts at key steps of sulfur and long-chain fatty acid (LCFA) metabolism and could be involved in typical methanogenesis pathways to participate in methane production. Our results expanded the diversity of viruses in ADFW systems and suggested two ways that viral manipulated ADFW biochemical processes. Video Abstract.


Direct Link between Structure and Hydration in Ammonium and Aminium Bisulfate Clusters Implicated in Atmospheric New Particle Formation.
The acid-base chemistry of amines and sulfuric acid promotes growth in the early stages of atmospheric new particle formation, with more basic amines enhancing growth rates. Hydration of these particles has been proposed to depend on acidity or basicity but is difficult to quantify; therefore, the role of water in this process is not well understood. Using tandem mass spectrometry coupled to a temperature-controlled ion trap, we show that water uptake by aminium bisulfate clusters depends on the total number of free hydrogen bond donors in the cluster and is unaffected by the interchange of amines featuring the same number of substituents but differing gas-phase basicity. Analyzing this trend reveals site-specific propensities for hydration. These results indicate that hydration is determined by structural factors and that reported dependences on acidity or basicity arise from the weaker correlation between the number of hydrogen bond donors of amines and their gas-phase basicity.


The Toll of Too Much Technology on Teens' Mental Health.
Technology is here to stay, and forbidding adolescents to access electronic media may not be a sustainable solution. Pediatric health care providers should include technology use and the parents' knowledge of the child's technology use, in their screening practices with patients. With the guidance of pediatric nurses, parents and children together can collaborate on ways to maximize the benefits of technology and decrease its risks.


Impact of hypertension, overall obesity and abdominal obesity on diabetes incidence in Shanghai residents with different glucose levels.
The impact of hypertension, overall obesity and abdominal obesity, individually or collectively, on diabetes incidence over a period of 5 years in residents with different glucose levels is diverse, with abdominal obesity having an impact in both non-diabetic hyperglycaemia and normal groups.


Evaluation of theranostic nanocarriers for near-infrared imaging and photodynamic therapy on human prostate cancer cells.
This paper evaluates how effectively chloroaluminum phthalocyanine (ClAlPc) entrapped in colloidal nanocarriers, such as nanocapsule (NC) and nanoemulsion (NE), induces photodamage in human prostate cancer cells (LNCaP) during photodynamic therapy (PDT). The MTT cell viability assay showed that both ClAlPc-NC and ClAlPc-NE induced phototoxicity and efficiently killed LNCaP cells at low ClAlPc-NC and ClAlPc-NE concentrations (0.3μgmL-1) as well as under low light doses of 4Jcm-2 and 7Jcm-2, respectively, upon PDT with a 670-nm diode laser line. Confocal imaging studies indicated that ClAlPc-NC and ClAlPc-NE were preferentially localized in the perinuclear region of LNCaP cells both in the dark and upon irradiation with laser light. After PDT treatment, ClAlPc-NC-treated LNCaP cells exhibited a higher green fluorescence signal, possibly due to the larger shrinkage of the actin cytoskeleton, compared to ClAlPc-NE-treated LNCaP cells. Additionally, ClAlPc-NC or ClAlPc-NE and mitochondria showed a relatively high co-localization level. The cellular morphology did not change in the dark, but confocal micrographs recorded after PDT revealed that LNCaP cells treated with ClAlPc-NC or ClAlPc-NE underwent morphological alterations. Our preliminary in vitro studies reinforced the hypothesis that biocompatible theranostic ClAlPc-loaded nanocarriers could act as an attractive photosensitizer system in PDT and could serve as an interesting molecular probe for the early diagnosis of prostate cancer and other carcinomas.


Head and neck cancer associated with Bloom's syndrome.
Bloom's syndrome (BS) is an autosomal recessive growth disorder associated with chromosomal breaks and rearrangements. Affected individuals exhibit a significantly elevated rate of cancer at an early age. Twenty-seven percent of patients with BS have malignant neoplasms at a mean age of 20.7 years. Since the first description of BS in 1954, five cases of primary head and neck cancer have been identified in the first 103 patients, including two tongue carcinomas and three laryngeal carcinomas. The patients ranged in age from 26 to 34 and included smokers and nonsmokers. The presenting symptoms and histology were identical with those of non-Bloom's syndrome patients. Head and neck cancer represents approximately 6% of all human tumors. This is in contrast with an 18% incidence rate of head and neck cancer among all cancers observed in BS patients. The head and neck surgeon should consider BS in the differential diagnosis of young cancer patients.


Small-scale experimental study of vaporization flux of liquid nitrogen released on water.
A small-scale experimental study was conducted using liquid nitrogen to investigate the convective heat transfer behavior of cryogenic liquids released on water. The experiment was performed by spilling five different amounts of liquid nitrogen at different release rates and initial water temperatures. The vaporization mass fluxes of liquid nitrogen were determined directly from the mass loss measured during the experiment. A variation of initial vaporization fluxes and a subsequent shift in heat transfer mechanism were observed with changes in initial water temperature. The initial vaporization fluxes were directly dependent on the liquid nitrogen spill rate. The heat flux from water to liquid nitrogen determined from experimental data was validated with two theoretical correlations for convective boiling. It was also observed from validation with correlations that liquid nitrogen was found to be predominantly in the film boiling regime. The substantial results provide a suitable procedure for predicting the heat flux from water to cryogenic liquids that is required for source term modeling.


Assessment of risk perception and subjective norms related to Mpox (monkeypox) among adult males in Bangladesh: A cross-sectional study.
Monkeypox (Mpox) has become a concern worldwide after spreading into nonendemic countries. The World Health Organization (WHO) has declared this a public health emergency of international concern and recommended to get vaccinated first who are at the highest risk. Risk perception and subjective norms can influence the decision of vaccine uptake. Therefore, we intended to perform a cross-sectional study on the male population in our country to assess their risk perception and subjective norms on Mpox. We measured participants' risk perception and subjective norms using Google form. Demographic profile of participants was obtained using a structured questionnaire. We performed a χ 2 test to compare the levels of risk perception and subjective norm perception and multiple logistic regression analysis to determine the association between the study parameters and the sociodemographic profile of the participants. Among the participants, 93 (23.72%), 288 (73.47%), and 11 (2.81%) had high, medium, and low-risk perceptions, respectively. For subjective norms, we observed 288 (58.16%) participants had a medium, 117 (29.85%) had high, and 47 (11.99%) had low levels of subjective norms, respectively. Most participants possessed medium risk perception (73.47%) and subjective norms (58.16%). Moreover, we observed that moderate risk perception was prevalent in people with body mass index (BMI) level between 18.5 and 25 (73.3%), married (63.5%), low economic background (94.1%), living with a family (77.1%), smokers (68.4%), heterosexuals (99%), people with no/little impact of coronavirus disease 2019 (Covid-19) on life (91%). Proportions of people with moderate subjective norms BMI level of 18.5-25 (73.2%), married (60.5%), low economic status (93.9%), rural (58.8%), living with family (77.2%), nonsmokers (71.1%), and people with no/little impact of Covid-19 in their lives (91.2%). The majority of participants perceived medium risk perception and subjective norms related to Mpox. Furthermore, we observed a significant association between the study parameters and the sociodemographic characteristics of our study participants. We recommend that further longitudinal studies to yield more accurate results.


Severe pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are common and contribute to decreased overall survival.
Extensive abdominal surgery is associated with the risk of postoperative pulmonary complications. This study aims to explore the incidence and risk factors for developing postoperative pulmonary complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and to analyze how these complications affect overall survival. Data were collected on 417 patients undergoing surgery between 2007 and2017 at Uppsala University Hospital, Sweden. Postoperative pulmonary complications were graded according to the Clavien-Dindo classification system where Grade ≥ 3 was considered a severe complication. A logistic regression analysis was used to analyze risk factors for postoperative pulmonary complications and a Cox proportional hazards model to assess impact on survival. Seventy-two patients (17%) developed severe postoperative pulmonary complications. Risk factors were full thickness diaphragmatic injury and/or diaphragmatic resection [OR 5.393, 95% CI 2.924-9.948, p = < 0.001]. Severe postoperative pulmonary complications, in combination with non-pulmonary complications, contributed to decreased overall survival [HR 2.285, 95% CI 1.232-4.241, p = 0.009]. Severe postoperative pulmonary complications were common and contributed to decreased overall survival. Full thickness diaphragmatic injury and/or diaphragmatic resection were the main risk factors. This finding emphasizes the need for further research on the mechanisms behind pulmonary complications and their association with mortality.


Rodent StAR mRNA is substantially regulated by control of mRNA stability through sites in the 3'-untranslated region and through coupling to ongoing transcription.
The steroidogenic acute regulator (StAR) gene is transcribed to 1.6 kb and 3.5 kb mRNAs that differ only through the length of the 3'-untranslated region (3'-UTR). These forms result from alternative polyadenylation sites in exon 7. These sites are utilized similarly in unstimulated adrenal cells whereas Br-cAMP selectively stimulates 3.5 kb mRNA. After removal of Br-cAMP, 3.5 kb mRNA declines rapidly (t(1/2) = 2 h) while 1.6 kb mRNA responds more slowly. This selective degradation is more evident in testis MA10 cells and is seen even in the presence of Br-cAMP. Transfection of Y-1 cells with CMV promoted StAR vectors confirmed that the 3.5 kb form is less stable and that Br-cAMP slowly increases this instability. Basal instability resides solely in the extended 3'-UTR which contains AU-rich elements. Br-cAMP enhances this degradation of 3.5 kb mRNA but additionally requires translated and 5'-UTR sequences. Degradation of both forms is arrested by inhibitors of transcription or translation, indicating that mRNA stability is coupled to these processes independent of the extended 3'-UTR. Br-cAMP stimulates substantial selective synthesis of 3.5 kb StAR mRNA despite this instability. The preferential generation of the unstable form may facilitate rapid increases and decreases of StAR activity in response to external changes.


Transcriptional regulation of miR-15b by c-Rel and CREB in Japanese encephalitis virus infection.
MicroRNAs (miRNAs) have been well known to play diverse roles in viral infection at the level of posttranscriptional repression. However, much less is understood about the mechanism by which miRNAs are regulated during viral infection. It is likely that both host and virus contain factors to modulate miRNA expression. Here we report the up-regulation of microRNA-15b (miR-15b) in vitro upon infection with Japanese encephalitis virus (JEV). Analysis of miR-15b precursor, pri-miR-15b and pre-miR-15b, suggest that the regulation occurs transcriptionally. Further, we identified the transcriptional regulatory region of miR-15b that contains consensus binding motif for NF-κB subunit c-Rel and cAMP-response element binding protein (CREB), which are known as transcription factor to regulate gene expression. By promoter fusion and mutational analyses, we demonstrated that c-Rel and CREB bind directly to the promoter elements of miR-15b, which are responsible for miR-15b transcription in response to JEV infection. Finally, we showed that pharmacological inhibition of ERK and NF-κB signaling pathway blocked induction of miR-15b in JEV infection, suggesting important roles of ERK and NF-κB pathway in the regulation of miR-15b gene. Therefore, our observations indicate that induced expression of miR-15b is modulated by c-Rel and CREB in response to JEV infection.


A solution SAXS study of Borrelia burgdorferi OspA, a protein containing a single-layer beta-sheet.
The crystal structure of a soluble form of Borrelia burgdorferi outer surface protein A (OspA) complexed with the Fab fragment of a monoclonal antibody has revealed an unusual structure that has a repetitive antiparallel beta topology with a nonglobular, single layer beta-sheet connecting the globular N- and C-terminal domains. Earlier NMR studies have shown that the local structure of OspA including the single layer beta-sheet is similar to the crystal structure. Here we report a small angle X-ray scattering (SAXS) study of the global conformation of OspA in solution. The radius of gyration (Rg) and the length distribution function (P(r)) of OspA measured by SAXS in solution are nearly identical to the calculated ones from the crystal structure, respectively. The NMR and SAXS experiments complement each other to show that OspA including the central single-layer beta-sheet is a stable structure in solution, and that the OspA crystal structure represents the predominant solution conformation of the protein.


The performance and mechanism of simultaneous removal of fluoride, calcium, and nitrate by calcium precipitating strain Acinetobacter sp. H12.
A calcium precipitating and denitrifying bacterium H12 was used to investigate the F- removal performance and mechanism. The results showed that the strain H12 reduced 85.24% (0.036 mg·L-1·h-1) of F-, 62.43% (0.94 mg·L-1·h-1) of Ca2+, and approximately 100% of NO3- over 120 h in continuous determination experiments. The response surface methodology analysis demonstrated that the maximum removal efficiency of F- was 88.98% (0.062 mg·L-1·h-1) within 72 h under the following conditions: the initial Ca2+ concentration of 250.00 mg·L-1, pH of 7.50, and the initial C4H4Na2O4·6H2O concentration of 800.00 mg·L-1. The scanning electron microscopy images, the X-ray photoelectron spectroscopy, and X-ray diffraction results suggested the following removal mechanism of F-: (1) the bacteria, as the nucleation site, were encapsulated by bioprecipitation to form biological crystal seeds; (2) Biological crystal seeds adsorbed F- to form Ca5(PO4)3F and CaF2; (3) Under the induction of bacteria, calcium, fluoride and phosphate coprecipitated to form Ca5(PO4)3F and CaF2. In addition, the gas chromatography data indicated that F- had little or no effect on the gas composition during denitrification, and the fluorescence spectroscopy analysis also proved that the extracellular polymeric substance (protein) is the site of bioprecipitation nucleation.


Metformin triggers apoptosis in PEL cells and alters bortezomib-induced Unfolded Protein Response increasing its cytotoxicity and inhibiting KSHV lytic cycle activation.
Metformin, the most used drug for the treatment of diabetes type 2 patients, has been shown to have anti-cancer properties. In this study, we found that metformin induced apoptosis in Primary Effusion Lymphoma (PEL) cells, an aggressive B cell lymphoma associated with KSHV against which the conventional therapies usually fail. The cytotoxic effect of metformin correlated with intracellular reactive oxygen species reduction, activation of AMPK, the inhibition of pro-survival pathways such as mTOR and STAT3 and the down-regulation of v-FLIP, a latent viral antigen that also plays a pivotal role in PEL cell survival. Interestingly, we found that metformin could be used to potentiate the bortezomib-mediated cytotoxicity against PEL cells and to inhibit the activation of KSHV lytic cycle, a side effect of this treatment that resulted in a block of autophagy in these cells. Mechanistically, metformin altered UPR activated by bortezomib, leading to a reduced expression of BiP, up-regulation of CHOP and down-regulation of Bcl-2. In summary, this study suggests that metformin could represent a promising strategy for the treatment of PEL alone or in combination with bortezomib. In the latter case, besides exerting a stronger cytotoxic effect, it might be used to restrain bortezomib-induced viral replication that is involved in the maintenance and progression of KSHV-associated malignancies.


Elimination of immediate-use steam sterilization of radioactive seed implants.
Immediate-use steam sterilization (IUSS) was routinely used to prepare radioactive seeds for use in elective urology cases at an urban academic medical center. In an attempt to eliminate this practice, the senior clinical nurse queried educators from nearby facilities about their practices for processing these implants and met with all stakeholders to identify concerns and explore acceptable alternatives. After rejecting the alternative of having central sterile processing personnel sterilize the seeds, a project team conducted a trial by using manufacturer presterilized seeds. After the trial and subsequent evaluation, the team decided to convert to using presterilized seeds for all procedures. The incidence of immediate-use steam sterilization for nonemergent brachytherapy procedures was reduced from an average of three per month to zero.


Correction to: prediction of thrombosis risk in patients with paroxysmal nocturnal hemoglobinuria.
The authors determined an error in the affiliation section; it was captured as Department of Hematology, Peking Union Hospital, CAMS & PUMC, Beijing 100,730, China. The correct affiliation should be Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.