Infection in the compromised host.
In spite of the development of successive generations of more powerful antibiotics, sepsis remains a common cause of death in the surgical patient. This fact is not surprising, since it is of little importance which organism is causing the infection if the patient's intrinsic antibacterial defenses cannot respond. Realization of the limitations of antibiotic therapy has prompted many investigators to study the immune and inflammatory systems with the ultimate goal of improving host defenses and increasing survival. In this article the local and systemic antibacterial defense systems have been reviewed. It is clear that the immunocompromised state is associated with multiple defects of the humoral and cellular components of both the nonspecific host defense system and the specific immune defense system. However, although consensus has not been reached on either the mediators responsible for the immunocompromised state or the prognostic and clinical significance of many of the described defects, work in this field is progressing rapidly. Nonetheless, knowledge that the host's antibacterial defense systems can be aided by good surgical technique, nutrition, appropriate use of antibiotics, and the sterile care of invasive catheters, lines, and tubes is critical in the prevention of fatal infections in the immunocompromised patient. When more information becomes available concerning the complex interrelations between the various cellular and humoral components of the host defense systems and their mediators and the symbiotic relations between man and his bacterial flora, it should be possible to develop specific strategies for the clinician to use to reduce the risk of infection in the high-risk surgical patient. Thus, in the future it may not be unusual for the clinician to alter the immunologic system of the host by the use of immunomodulators or vaccines to increase the host's resistance to infection. On the other hand, by manipulating the complex interrelations between the host and the indigenous bacterial flora, it may be possible to prevent the development of opportunistic infections originating from the gastrointestinal tract.


Hypertension, antihypertensive treatment, and sudden coronary death. The Framingham Study.
During 30 years of follow-up, there were 183 sudden deaths in men and 77 in women ages 35 to 94 years who participated in the Framingham Study. Risk of sudden death was increased threefold in hypertensive persons but only if there was no previously diagnosed coronary heart disease. Men receiving antihypertensive treatment had more than twice the risk of sudden death compared with those who were untreated, whether or not they had prior manifestations of coronary heart disease. More than twice as many men who died suddenly were receiving antihypertensive therapy compared with those in the population at risk of the same age. In those with overt coronary heart disease, 34% of those dying suddenly were on antihypertensive treatment compared with 18% of those of the same age in the general population. Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure, all of which are predisposing factors for sudden death, indicated a persistent increased risk of sudden death in association with antihypertensive treatment. Tests of interaction indicate that the excess sudden death risk was not confined to those with electrocardiographic abnormalities. In women, it may be associated with diabetes. These data suggest that some feature of antihypertensive treatment as practiced in the general population may contribute to sudden death incidence in an ill-defined subgroup of hypertensive persons.


Measurement and Calculation of Three-Dimensional Grain Sizes and Size Distribution Functions.
: Three-dimensional (3D) grain sizes and size distribution functions (SDFs) are generally obtained by converting the 2D or 1D grain sizes to 3D with the methods based on a spherical grain shape model (S-model), which can produce large systematic errors. In this report, a new polyhedral grain model (P-model) is developed and experimentally checked with the directly measured 3D grain sizes. The results show that the systematic error originating from the S-model can be corrected by using the new polyhedral grain model.


[Effect of anticonvulsant gabapentin on visceral nociception and its relationship with amino acid neurotransmitters released from spinal cord].
To test whether gabapentin, an anticonvulsant, is able to inhibit responses to peritoneal irritation-induced visceral pain and to examine the effect of gabapentin on spinal cord amino acid release. Forty-eight SD rats randomly received intraperitoneal (i.p.) injection of saline or gabapentin (50, 100, or 200 mg.kg-1), and 40 minutes later, 0.6% acetic acid (4 ml.kg-1) was administrated intraperitoneally. The acetic acid-induced writhing assay was used to determine the degree of nociception. The beam balance task was employed to test a possible inhibitory or sedative effect of the central nervous system. Cerebrospinal fluid dialysate was collected by microdialysis from the spinal subarachnoid space in anesthetized rats. Concentrations of amino acids in the dialysate, including glutamate, aspartate, serine, glutamine and glycine, following i.p. injection of acetic acid were evaluated. The effects of pretreatment with saline or gabapentin (100 mg.kg-1 i.p.) on amino acid release were compared. Gabapentin reduced writhing responses in a dose-related fashion. Beam-balance time was significantly shortened after pretreatment with 200 mg.kg-1 of gabapentin. Dialysate concentrations of glutamate, aspartate and serine increased significantly-following i.p. injection of acetic acid, while glutamine and glycine concentrations were not. When compared to saline-treated rats, animals pre-treated with 100 mg.kg-1 of gabapentin showed suppression of the acetic acid-induced increases in glutamate, aspartate and serine concentrations. These data demonstrate that gabapentin effectively inhibited acetic acid-induced nociception, and the antinociceptive effect of gabapentin might correlate with the suppression of noxious-evoked release of excitatory amino acids in the spinal cord.


AMPK is down-regulated by the CRL4A-CRBN axis through the polyubiquitination of AMPKα isoforms.
As a master regulator for metabolic and energy homeostasis, AMPK controls the activity of metabolic enzymes and transcription factors in response to cellular ATP status. AMPK has been thus recognized as a main target for the regulation of cellular energy metabolism. Here, we report that AMPK can be down-regulated by the cullin-RING ubiquitin E3 ligase 4A (CRL4A) with cereblon (CRBN). CRL4A interacted with AMPK holoenzymes and mediated AMPKα-specific polyubiquitination for its proteasomal degradation through non-K48 polyubiquitin linkages. In the ubiquitination system, CRBN was required for efficient polyubiquitination of AMPKα subunits. Consistently, polyubiquitination of AMPKα subunits was reduced by inhibitors of CRL4A-CRBN. Physiologic function of AMPK down-regulation by CRL4-CRBN was also confirmed using mouse bone marrow-derived mast cells (BMMCs). The inactivation of CRL4A-CRBN in BMMC increased AMPK stability and suppressed secretion of allergic mediators via AMPK activation followed by MAPK inhibition. In addition, CRBN knockout of BMMC also decreased allergic responses in mice. Our results suggest that the CRL4A-CRBN axis could be a target for the regulation of AMPK-dependent responses.-Kwon, E., Li, X., Deng, Y., Chang, H. W., Kim, D. Y. AMPK is down-regulated by the CRL4A-CRBN axis through the polyubiquitination of AMPKα isoforms.


Complete genome sequence of a sucrose-nonfermenting epidemic strain of Vibrio cholerae O1 from Brazil.
We report the genome sequence of Vibrio cholerae strain IEC224, which fails to ferment sucrose. It was isolated from a cholera outbreak in the Amazon. The defective sucrose phenotype was determined to be due to a frameshift mutation, and a molecular marker of the Latin American main epidemic lineage was identified.


Automatic seizure detection and seizure pattern morphology.
We studied the influence of seizure pattern morphology on detection rate and detection delay of an automatic seizure detection system. We correlated seizure pattern morphology with seizure onset zone and assessed the influence of seizure onset zone on the performance of the seizure detection system. We analyzed 10.000 hours of EEG in 129 patients, 193 seizures in 67 patients were included in the final analysis. Seizure pattern morphologies were classified as rhythmic activity (alpha, theta and delta), paroxysmal fast activity, suppression of activity, repetitive epileptiform and arrhythmic activity. The seizure detection system EpiScan was compared with visual analysis. Detection rates were significantly higher for rhythmic and repetitive epileptiform activities than for paroxysmal fast activity. Seizure patterns significantly correlated with seizure onset zone. Detection rate was significantly higher in temporal lobe (TL) seizures than in frontal lobe (FL) seizures. Detection delay tended to be shorter in seizures with rhythmic alpha or theta activity. TL seizures were significantly more often detected within 10 seconds than FL seizures. Seizure morphology is critical for optimization of automatic seizure detection algorithms. This study is unique in exploring the influence of seizure pattern morphology on automatic seizure detection and can help future research on seizure detection in epilepsy.


Passive exercise and reinnervation of the rat denervated extensor digitorum longus muscle after nerve crush.
Denervated extensor digitorum longus muscles of Wistar rats were passively exercised for 4 days (2 h/day) after peroneal nerve crush 1 cm from the muscle. Isometric contractile properties and endplate ultrastructure were measured 11 days postcrush. No significant differences were observed in tension characteristics between the exercised and nonexercised muscles on day 11. However, the postsynaptic area of endplates for exercised muscles were closer in size to controls than those for the nonexercised ones. In addition, the endplates from the exercised muscles exhibited increased numbers of axonal sprouts and terminals than nonexercised muscles. These results demonstrate that denervated muscles exercised 4 days before reinnervation can preserve the structure of the endplate as well as enhance reinnervation and sprouting at these endplates after 11 days of denervation.


Participation of the adrenal gland in the anti-inflammatory effect of polyunsaturated diets.
The effect of an n-3 (fish) and n-6 (soybean) fatty acid-rich diet on carrageenin paw oedema in rats, and the participation of adrenal gland, corticosterone and alpha(2)-macroglobulin (alpha(2)-M) in this process were studied. A significant inhibition of carrageenin oedema was observed not only in rats fed a diet rich in fish oil but also in the soybean group. alpha(2)-M was not detectable before carrageenin injection, suggesting that this putative antiinflammatory factor does not participate in the observed anti-inflammatory effect. Corticosterone levels were higher in fat-fed than in control rats, before carrageenin stimulus and adrenalectomy abolished the anti-inflammatory response in fat-fed animals, showing the important role of the adrenocortical hormones in this process.


Comparison of Therapeutic Efficacies of Norethisterone, Tranexamic Acid and Levonorgestrel-Releasing Intrauterine System for the Treatment of Heavy Menstrual Bleeding: A Randomized Controlled Study.
Our aim was to compare the therapeutic efficacies of norethisterone acid (NETA), tranexamic acid and levonorgestrel-releasing intrauterine system (LNG-IUS) in treating idiopathic heavy menstrual bleeding (HMB). Women with heavy uterine bleeding were randomized to receive NETA, tranexamic acid or LNG-IUS for 6 months. The primary outcome was a decrease in menstrual bleeding as assessed by pictorial blood loss assessment charts and hematological parameters analyzed at the 1st, 3rd and 6th months. Health-related quality of life (QOL) variables were also recorded and analyzed. Twenty-eight patients were enrolled in each treatment group, but the results of only 62 were evaluated. NETA, tranexamic acid, and LNG-IUS reduced menstrual blood loss (MBL) by 53.1, 60.8, and 85.8%, respectively, at the 6th month. LNG-IUS was more effective than NETA and tranexamic acid in decreasing MBL. LNG-IUS was also more efficient than tranexamic acid in correcting anemia related to menorrhagia. Satisfaction rates were comparable among the NETA (70%), tranexamic acid (63%) and LNG-IUS (77%) groups. QOL in physical aspects increased significantly in the tranexamic acid and LNG-IUS groups. The positive effect of LNG-IUS on QOL parameters, as well as its high efficacy, makes it a first-line option for HMB.


Itaconate: A Potent Macrophage Immunomodulator.
With advances in immunometabolic studies, more and more evidence has shown that metabolic changes profoundly affect the immune function of macrophages. The tricarboxylic acid cycle is a central metabolic pathway of cells. Itaconate, a byproduct of the tricarboxylic acid cycle, is an emerging metabolic small molecule that regulates macrophage inflammation and has received much attention for its potent anti-inflammatory effects in recent years. Itaconate regulates macrophage function through multiple mechanisms and has demonstrated promising therapeutic potential in a variety of immune and inflammatory diseases. New progress in the mechanism of itaconate continues to be made, but it also implies complexity in its action and a need for a more comprehensive understanding of its role in macrophages. In this article, we review the primary mechanisms and current research progress of itaconate in regulating macrophage immune metabolism, hoping to provide new insights and directions for future research and disease treatment.


Induction of fatty acid-binding protein 3 in brown adipose tissue correlates with increased demand for adaptive thermogenesis in rodents.
We investigated the contribution of fatty acid-binding protein 3 (FABP3) to adaptive thermogenesis in brown adipose tissue (BAT) in rodents. The expression of FABP3 mRNA in BAT was regulated discriminatively in response to alteration of the ambient temperature, which regulation was similar and reciprocal to the regulation of uncoupling protein 1 (UCP1) and leptin, respectively. FABP3 expression in the BAT was significantly higher in the UCP1-knockout (KO) mice than in the wild-type ones, and these KO mice showed a higher clearance rate of free fatty acid from the plasma. In addition, FABP3 expression in the BAT was increased greatly with the development of diet-induced obesity in mice. These results indicate that the induction of FABP3 in BAT correlates with an increased demand for adaptive thermogenesis in rodents. FABP3 appears to be essential for accelerating fatty acid flux and its oxidation through UCP1 activity for non-shivering thermogenesis in BAT.


Hepatitis B surface antigen prevalence in pregnant women: A cross-sectional survey in Iran.
Vertical transmission of hepatitis B virus (HBV) from infected mothers to their neonates is one of the most important routes of infection. The exact prevalence rate of HBV in Iranian pregnant mothers is not well known but based on different studies it is estimated between 0.35% and 6.5%. The aim of this study was to determine the seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women of selected provinces in Iran. At this cross-sectional study, seven provinces supposed to be of high and low prevalence of hepatitis B in the general population selected. Multistage sampling was used to enroll 5261 parturient women who attended the target provinces birth facilities, during January to March of 2011, were recruited to study. To determine the statistically significant mean and proportion differences, t-test and χ (2) test were used, respectively. Overall 1.2% was positive HBsAg of which 11% of them were hepatitis B e-antigen positive as well. The eastern and north eastern provinces were considerably higher in HBsAg seropositivity than the west and northwest of the country. In view of the considerable prevalence of hepatitis B in pregnant women, screening all pregnant women prioritizing the eastern and north-eastern provinces is strongly recommended.


In vivo 31P-NMR studies of myocardial high energy phosphate metabolism during anoxia and recovery.
31P NMR spectra of heart in-situ in live guinea pigs were obtained continuously in 20.5 s time blocks during 3 min of anoxia, during subsequent reoxygenation and, in separate animals, during terminal anoxia. Reversible anoxia resulted in rapid degradation of phosphocreatine (t 1/2 = 54.5 +/- 2.5 s) which recovered fully during reoxygenation. Heart Pi increased during anoxia and returned to basal levels after oxygen was restored. During 3 min of anoxia, no significant changes in ATP levels or pH were detected. The results demonstrate that it is feasible to measure rapid fluxes of high energy phosphates by 31P NMR in intact animals during and after anoxic stress to the myocardium.


An engineered change in substrate specificity of ribulosebisphosphate carboxylase/oxygenase.
The potential for altering the specificity of ribulosebisphosphate carboxylase/oxygenase toward gaseous substrates is explored through a modest perturbation of the active site microenvironment. Specifically, replacement of active site Glu-48 with carboxy-methylcysteine is achieved in a two-step process in which the catalytically incompetent Cys-48 mutant protein is first generated and then treated with iodoacetic acid. This regimen of concerted site-directed mutagenesis and chemical modification, effectively lengthening the glutamyl side chain by insertion of a sulfur atom between the beta- and gamma-methylene groups, results in a protein possessing 4-6% of wild-type carboxylase activity. Concomitantly, the engineered enzyme exhibits a specificity factor 5-fold lower than that of wild-type enzyme. This represents the first example of a major change in substrate specificity, albeit in favor of oxygenation, effected by structural alteration of an active site side chain.


Children of the sug: a study of the daily lives of street children in Khartoum, Sudan, with intervention recommendations.
The study examines street children's daily lives in Khartoum, Sudan to recommend ways to improve their conditions and to successfully assist them off the streets. In 2000-2001, eight researchers conducted participant observation for 7 weeks; 20 groups of children engaged in role-plays and drawing activities; over 500 children participated in qualitative group and individual interviews; and 872 current and former street children were surveyed. Approximately half of children were 14 years old or younger. Daily life focused on eating, sucking glue-soaked rags, obtaining money, and sometimes movies or games; many children valued their freedom and relatively abundant food on the streets. Boys engaged in odd jobs, and sometimes theft, begging, or sex work. Girls had fewer work opportunities and primarily obtained money through begging and sex work. Almost half of children saw their families weekly. Children belonged to same-sex groups of common geographic origin, which shared food, shelter, and care when sick; boys' group leaders could be both protectors and aggressors. Most girls had a boyfriend who financially assisted and protected her. Girls frequently were raped by street boys, police, or other men. Children feared routine capture, beating and incarceration by authorities. Former street children were housed in large camps where abuse was common, or costly small residencies. Street-based services to improve children's health and safety are urgently needed. Re-integration programs may help large numbers of children voluntarily and permanently leave the streets. Advocacy campaigns and collaborative efforts with the police, judiciary and legislature should be intensified. The paper highlights important challenges facing street children in Khartoum, and provides specific recommendations for how they might be better assisted while on the streets and successfully helped off of the streets through community re-integration, rather than current (1) large-scale beating and incarceration by government authorities, or (2) small-scale and costly residential housing by NGOs. The findings have already been used in a sustained advocacy campaign that has resulted in a number of positive legislative changes for street children, such as parliamentary endorsement of a new bill that improves street children's legal status.


Late reconstruction of chronic distal biceps tendon ruptures with a semitendinosus autograft technique.
We compared 2 groups of patients with chronic distal biceps tendon ruptures, 7 patients treated nonoperatively and 7 undergoing semitendinosus autograft tendon reconstruction. The mean time to surgery after the initial injury was 17 weeks. The mean clinical follow-up in the operative group was 63 months. Functional strength and endurance testing was measured at a mean of 30 months after injury in the nonoperative group and 26 months in the operative group. A 2-incision technique was used. In the allograft reconstruction group, flexion and supination strength was restored to the normal range. The nonoperative group lacked 20% of normal strength. Endurance in both groups was within the normal range. Autograft semitendinosus reconstruction in chronic distal biceps tendon ruptures improves flexion and supination strength when compared with nonoperative treatment. No radial nerve injuries or heterotopic ossification occurred, and all reconstructions remain intact.


The effect of the predator-avoidance behavior of the sea urchin, Centrostephanus coronatus, on the breadth of its diet.
The sea urchin, Centrostephanus coronatus, exhibits a relatively broad diet. Evidence presented in this paper suggests that evolution of dietary breadth is favored by two mechanisms. First, individual urchins occur in habitat types that support somewhat different foods. Urchins consume principally the most preferred food where it is common but are forced to eat other food types where it is rare. Second, overgrazing by individual urchins reduces the local abundance of the most preferred food, thereby forcing them to add less preferred items to their diet. Previous work indicates that the escape behavior of Centrostephanus from its fish predator, Pimelometopon pulchrum, results in different individuals being exposed to different foods and in reduction of the size of urchin grazing ranges to the point that overgrazing occurs. Hence, by the two mechanisms discussed in this paper, the presence of the fish predator favors the broad diet of its sea urchin prey.


Patients' experiences of atrial fibrillation and non-vitamin K antagonist oral anticoagulants (NOACs), and their educational needs: A qualitative study.
Qualitative research on atrial fibrillation (AF) patient's experiences and perceptions of taking the non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention is limited. This study explores patients' experiences of dabigatran and their recommendations for development of educational materials. Semi-structured individual interviews with 8 warfarin-naive and 8 warfarin-experienced AF patients, using qualitative deductive thematic analysis. The four main overarching themes included: understanding the diagnosis; reaching a treatment decision; challenges of living with OAC; and patient perceptions of treatment. Patients discussed their shock of diagnosis, and seeking information and support at that time. Narratives suggest patients preferred to be led by the doctor when making treatment decisions, and would often compare dabigatran to warfarin. Patients reported side-effects and challenges with both treatment options, and discussed their beliefs surrounding medications, including misconceptions. In addition to the original framework, two further themes were added: challenges of living with AF, and patient recommendations. Generally patients found AF symptoms distressing, which impacted their quality of life. Patient recommendations included the content and delivery of educational materials and development of tools to help with their understanding of AF and anticoagulation, as well as treatment adherence and anxiety surrounding symptoms and side effects. Patient recommendations emphasised the need for interventions to relieve anxiety surrounding the diagnosis and possible treatment side effects. Tailored 'disease-specific' support is essential to ensure efficacious treatment. This qualitative study highlights the need for patient involvement in the development of educational materials and resources for patients commencing treatment with NOACs.


Short-term step-to-step correlation in plantar pressure distributions during treadmill walking, and implications for footprint trail analysis.
The gait cycle is continuous, but for practical reasons one is often forced to analyze one or only a few adjacent cycles, for example in non-treadmill laboratory investigations and in fossilized footprint analysis. The nature of variability in long-term gait cycle dynamics has been well-investigated, but short-term variability, and specifically correlation, which are highly relevant to short gait bouts, have not. We presently tested for step-to-step autocorrelation in a total of 5243 plantar pressure (PP) distributions from ten subjects who walked at 1.1m/s on an instrumented treadmill. Following spatial foot alignment, data were analyzed both from three points of interest (POI): heel, central metatarsals, and hallux, and for the foot surface as a whole, in a mass-univariate manner. POI results revealed low average step-to-step autocorrelation coefficients (r=0.327±0.094; mean±st. dev.). Formal statistical testing of the whole-foot r distributions reached significance over an average of only 0.42±0.52% of the foot's surface, even for a highly conservative uncorrected threshold of p<0.05. The common assumption, that short gait bouts consist of independent cycles, is therefore not refuted by the present PP results.


Predictive factors for docking site procedure in bone transport for large lower extremity segmental defects.
Segmental bone transport is a common technique for treating large segmental bone defects. However, a docking site procedure is often necessary in segmental bone transport. To date, no prognostic factors for the need of docking site procedure have been reported. Thus, the decision is often made at random, based on the surgeon's subjective judgment and experience. The aim of this study was to identify prognostic factors for the need of docking site operation. Patients with segmental bone transport in lower extremity bone defects were included regardless of age, aetiology, and defect size. We excluded patients undergoing treatments that were not yet completed, and those who discontinued therapy by any reason. The need for docking site operation was modelled with logistical and linear regression as well as univariate analysis of variances (ANOVA). Receiver operating characteristics (ROC) curve analysis was also performed. Twenty-seven patients from age 12 to 74 years (mean age: 39.07 ± 18.20 years) were included. The mean defect size was 76.39 ± 41.10 mm. The duration of transport (days) showed a significant influence (p = 0.049, 95%CI: 1.00-1.02) on the need for docking site operation. No other significant influences were detected. A link between the duration of transport and the need for docking site operation was detected. Our data showed that if a threshold of about 188 days is exceeded, docking surgery should be considered.


Impacts of several pollutants on the distribution of recent benthic foraminifera: the southern coast of Gulf of Gabes, Tunisia.
In addition to physicochemical methods, benthic foraminifera have become an essential tool for the assessment of polluted environments. The main objectives of the present work were to study the distribution of benthic foraminifera along the coastline of Skhira and Gabes (southern coast of Gulf of Gabes) and to predict the impact of pollution on these organisms. Thirty-one samples were studied and a polluted area was delimited by chemical analysis, where heavy metal, fluoride, phosphorus, nitrogen, and COT contents are very high. Thirty-four species of benthic foraminifera were identified and their response to pollution is very remarkable, in which their distribution shows barren area, corresponding to the highly polluted area. Away from the contaminated area, the density and the diversity of these organisms increase. Statistical analyses (principal component analysis (PCA)/FA and matrix correlation) show a possible control of these pollutants on biotic indices (with negative correlation), in addition to the presence of tolerant and sensitive species to pollution. A variety of test malformations were noticed especially in Ammonia beccarii, Peneroplis planatus, Sorites variabilis, and Adelosina pulchella. Unpolluted stations were dominated by species characteristic of shallow water environments with sandy sediment such Ammonia parkinsoniana, Triloculina trigonula, Quinqueloculina agglutinans, and P. planatus.


Essential thrombocythemia and aortic dissection,causal or incidental association?
Only few cases of vascular dissection and essential thrombocythemia association have been reported. To the best of our knowledge, we reported the second case of aortic dissection and essential thrombocythemia association in a 60-year-old man with positive JAK2V617F mutation who had no history of hypertension or connective tissue disorders. Through this case, we discussed the eventual existence of a causal relationship between the two conditions. We also suggested the use of hydroxyurea as a prevention treatment of thrombosis in myeloproliferative neoplasms.


Clinical trial of risedronate in Japanese volunteers: a study on the effects of timing of dosing on absorption.
Because of its chemical structure, risedronate was thought to form a complex with divalent cations, e.g., Ca(2+), and to be likely to show changes in the efficiency of absorbance from the gastrointestinal tract according to the presence of food. Therefore, we conducted a crossover study using healthy Japanese adults to examine the effects of food intake on absorption after the oral administration of risedronate and to choose the best timing of regimen for risedronate. Using single doses of 5 mg risedronate, the following four dose times were investigated: (a) in the morning under a fasting condition without breakfast; (b) 30 min before breakfast; (c) 30 min after breakfast; and (d) 3 h after breakfast. The results showed that the C(max) and AUC(0-24) of the plasma risedronate concentrations and its cumulative urinary excretions decreased in the following order: fasting without breakfast >>30 min before breakfast >>3 h after breakfast >>30 min after breakfast. In other words, it was demonstrated that the absorption of risedronate decreases due to the effects of food. Several adverse events, whose causality with risedronate was unknown or possibly related, were observed, including headaches, diarrhea, increased CK-BB, and an increased urinary Beta(2)-microglobulin excretion rate, but none of these events was clinically significant, and none differed in frequency or severity from the events after a single oral administration. In consideration of the optimal practical timings required to administer risedronate for Japanese patients, therefore, it was found that ingesting the drug immediately after waking up in the morning, when the stomach is empty, was optimal, and that it was necessary to refrain from eating and drinking for at least 30 min after drug ingestion. Therefore, we determined that the optimal time for risedronate to be administered in Japanese patients is 30 min before breakfast.


A t(11;14)(p13;q11) specific for T-cell malignancies in acute megakaryoblastic leukemia.
A 2-year-old girl with a very rare form of acute megakaryoblastic leukemia (AMKL), having the 11p13;14q11 translocation specific for T-cell malignancies, is reported. She was diagnosed as having AMKL on the basis of her bone marrow, which contained 30% megakaryoblasts identified by characteristic morphology on May-Giemsa stain, positive for platelet peroxidase activity and for the surface marker of platelet glycoprotein IIb/IIIa, CD41. Cytogenetic studies of marrow cells revealed 47,XX,i(7q), +der(11)t(11;14)(p13;q11), -14, +21. She achieved hematologic remission after two courses of chemotherapy including behenoyl cytarabine, acracinorubicin, 6 mercaptopurine, and prednisolone, but soon relapsed and died 11 months after admission. This case suggests that adequate diagnostic assessments of morphology, surface markers, and cytogenetics are necessary for proper diagnosis in leukemia and lymphoma, and that an important, though as-yet unidentified, gene in megakaryopoiesis may reside in the 14q11 chromosomal region.


Possible effects of the kallikrein-kinin system on male reproductive functions.
All four components of the kallikrein-kinin system--kininogens, tissue kallikreins, kinins, and kininases--have been found in human male genital secretions. Kinins are continuously released from seminal plasma kininogens through limited proteolysis by kininogenases like tissue kallikrein from prostate and sperm acrosin. Kinins are the terminal effectors of the kallikrein-kinin system and increase sperm motility and sperm metabolism at nanomolar concentrations. Recent investigations indicate that these effects are possibly mediated by a specific sperm membrane integrated bradykinin receptor, subtype B2. The two major kininase that are present in seminal plasma are kininase II and neutral metallo-endopeptidase. Kininase II, which is identical with angiotensin-converting enzyme, is also involved in the renin-angiotensin system as it converts angiotensin I into angiotensin II and thus is the connecting enzyme of both systems. Apart from the observed effects of kinins on sperm motility, the kallikrein-kinin system is thought to be involved in the regulation of spermatogenic functions of the testis: in the rat, kallikrein activates Sertoli cell function, increases the relative number of spermatocytes and the [3H] thymidine incorporation of testicular tissue, enhances glucose-intake, and increases testicular blood flow. Clinical trials showed that systemic administration of kallikrein may be particularly useful for treatment of infertile men suffering from asthenozoospermia and/or oligozoospermia. During kallikrein therapy, the number of spermatozoa and both quantitative and qualitative sperm motility increased, and a significant improvement of the conception rate was achieved. An increased sperm number was also observed after application of the specific kininase II inhibitor captopril.(ABSTRACT TRUNCATED AT 250 WORDS)


Author Correction: Root growth in light of changing magnesium distribution and transport between source and sink tissues in potato (Solanum tuberosum L.).
An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Utility of Single-Photon Emission Computed Tomography/Computed Tomography in Suspected Unilateral Condylar Hyperplasia: A Histopathologic Validation Study.
The purpose of this study is to evaluate the utility of hybrid single-photon emission computed tomography (SPECT) and computed tomography (CT) with technetium-99m methylene diphosphonate in patients with suspected active unilateral condylar hyperplasia (UCH) using histopathology as the reference standard. Twenty-four patients with suspected active UCH prospectively underwent technetium-99m methylene diphosphonate planar bone scintigraphy with SPECT/CT of the mandible. Qualitative and quantitative readings for growth activity were performed by 3 nuclear medicine physicians and the final diagnosis was derived from postoperative histopathological examination. Readings were reported as positive, equivocal, or negative. Total, maximum, and mean counts were recorded for each condyle on SPECT/CT images. The uptake of the index (suspected) condyle was expressed as a count ratio (Rtotal, Rmean, Rmax), a percentage uptake (Ptotal, Pmean, Pmax), background-corrected counts (Btotal, Bmean, Bmax), as well as CT-based condylar diameters (RCT,PCT) relative to the contralateral condyle. Interobserver agreement was 0.79 and 0.83 for planar bone scintigraphy and SPECT/CT, respectively, with a total of 5 and 1 equivocal readings from the respective modalities. Surgery was performed in 22 patients; all of them had pathologically proven UCH. SPECT/CT was slightly more sensitive than planar bone scintigraphy (91 vs 78%) with identical specificity (96%). Rtotal, Rmean, Ptotal, and Pmean demonstrated area under the curve between 84% and 86%. Metrics based on CT diameters and background-corrected counts were not associated with UCH diagnosis. Quantitative approaches based on total or mean count ratio or relative count percentage were equally predictive for UCH diagnosis; however, they were slightly less sensitive compared with qualitative technetium-99m methylene diphosphonate SPECT/CT evaluation. SPECT/CT evaluation has the potential to decrease the equivocal readings.


Assessing the transport rate of hyperpolarized pyruvate and lactate from the intra- to the extracellular space.
The use of [1-(13) C]pyruvate hyperpolarized by means of dynamic nuclear polarization provides a direct way to track the metabolic transformations of this metabolite in vivo and in cell cultures. The identification of the intra- and extracellular contributions to the (13) C NMR resonances is not straightforward. In order to obtain information about the rate of pyruvate and lactate transport through the cellular membrane, we set up a method that relies on the sudden 'quenching' of the extracellular metabolites' signal. The paramagnetic Gd-tetraazacyclododecane triacetic acid (Gd-DO3A) complex was used to dramatically decrease the longitudinal relaxation time constants of the (13) C-carboxylate resonances of both pyruvate and lactate. When Gd-DO3A was added to an MCF-7 cellular culture, which had previously received a dose of hyperpolarized [1-(13) C]pyruvate, the contributions of the extracellular pyruvate and lactate signals were deleted. From the analysis of the decay curves of the (13) C-carboxylate resonances of pyruvate and lactate it was possible to extract information about the exchange rate of the two metabolites across the cellular membrane. In particular, it was found that, in the reported experimental conditions, the lactate transport from the intra- to the extracellular space is not much lower than the rate of lactate formation. The method reported herein is non-destructive and it could be translated to in vivo studies. It opens a route for the use of hyperpolarized pyruvate to assess altered activity of carboxylate transporter proteins that may occur in pathological conditions. Copyright © 2016 John Wiley & Sons, Ltd.


Rationale and Design of the Multicenter Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot Study.
Patients with repaired tetralogy of Fallot are at elevated risk for ventricular arrhythmia and sudden cardiac death. Over the past decade, the pathogenesis and natural history of ventricular tachycardia has become increasingly understood, and catheter ablation has emerged as an effective treatment modality. Concurrently, there has been great progress in the development of a versatile array of transcatheter valves that can be placed in the native right ventricular outflow tract for the treatment of long-standing pulmonary regurgitation. Although such valve platforms may eliminate the need for repeat cardiac operations, they may also impede catheter access to the myocardial substrates responsible for sustained macro-reentrant ventricular tachycardia. This manuscript provides the rationale and design of a recently devised multicenter study that will examine the clinical outcomes of a uniform, preemptive strategy to eliminate ventricular tachycardia substrates before transcatheter pulmonary valve implantation in patients with tetralogy of Fallot.


Mannan-binding lectin genotypes and genotype-phenotype relationships in a large cohort of Polish neonates.
Circulating mannan (or mannose)-binding lectin (MBL) is genetically determined. Low MBL concentrations are associated with certain point mutations in the human MBL2 gene. Here we report the full MBL2 genotypes of 1800 Polish neonates and relate individual genotypes to serum MBL and MBL-dependent activity of the lectin pathway of complement activation. The seven acknowledged common haplotypes were found, plus the uncommon LYPD haplotype, combining to form 33 genotypes in this population. As expected, a strong correlation existed between genotypes and serum MBL or lectin pathway activity, and the latter two entities correlated strongly with each other. However, serum MBL values varied up to greater than 90-fold within genotypes. Unexpectedly, higher lectin pathway activity was found in association with the P allele relative to the Q allele. These data from a large cohort of neonates, representing an ethnically homogenous population, suggest that the current knowledge of the genetics of MBL2 is inadequate to predict serum MBL concentration and MBL-dependent lectin pathway activity in individual subjects.


Heparin increases mRNA levels of thrombospondin but not fibronectin in human vascular smooth muscle cells.
The effects of heparin (180 micrograms/ml) on steady state mRNA levels for fibronectin, thrombospondin, actin and collagen types I and III were investigated in human umbilical artery smooth muscle cells. Heparin caused a 120% increase in thrombospondin mRNA levels and a 60% and 180% increase in the mRNA levels of procollagen chains alpha 2(I) and alpha 1(III), respectively. No change in fibronectin or actin mRNA levels resulted from heparin treatment. We reported earlier (Biochem. Biophys. Res. Comm. 148:1264, 1987) that heparin increases smooth muscle cell synthesis of both fibronectin and thrombospondin. These data show that heparin coordinately regulates thrombospondin mRNA and protein levels. The heparin induced increase in fibronectin biosynthesis apparently reflects control at the translational or post-translational level.


[A training program for dementia trainers: does this program have practical relevance?].
Specific curricula for professionals working in various settings with persons with dementia have been developed and implemented into practice. In this study, the practical relevance of a teaching program for the M.A.S (Morbus Alzheimer syndrome) dementia trainer was evaluated. The curriculum was developed in 2002 within a scientific project. The goal was that care professionals and noncare professionals learn how to support and train persons with dementia and their caregivers. The task of the trainer is to support the functional and emotional resources of the person with dementia employing stage-specific training according to principles of the theory of retrogenesis. Trainers are also able to support family caregivers in their difficult day-to-day care for the person with dementia. With this training and support program, persons with dementia can train their residual capacities and develop a life perspective which enables them to cope with the long duration of Alzheimer's disease. The curriculum for the training methodology is based in the theory of retrogenesis. The 1-year training course is held in the form of modules and includes the following topics: (1) stages of dementia and medical aspects, (2) communication with persons with dementia, (3) stage-specific retrogenic training, (4) physical training for the elderly and persons with dementia, (5) coaching family caregivers through the long disease duration, and (6) care issues for persons without education in care. M.A.S trainers were questioned after they had concluded the teaching program successfully and had the chance to apply the content of the teaching program in their practical work. A short questionnaire was sent via e-mail or a telephone interview was performed. A total of 279 trainers graduated and were certified. Of these, 140 persons (53.6% of the population) could be questioned after an average of 2.69 years after completion of the course: 93.6% of trainees were still using the principles of the teaching course successfully; of these, 56% were working in the function of a trainer full time and 44% used the principles within their work environment (mainly in the nursing home environment). The study found that the majority of questioned trainers are still using the principles taught in the course successfully with persons with dementia living at home and the content was found to be relevant for practice. The content of the teaching course, applying principles of retrogenesis, which was originally designed for persons with dementia living at home, can also be successfully applied in the nursing home environment. Increasing interest has been shown by institutions employing professionals whose task it is to keep persons with dementia active and interested as well as physically functioning at their best possible level. As a consequence, persons with dementia perceive higher quality of life and exhibit fewer behavior problems which complicate care. More research is needed to accumulate evidence and to support these findings.


Anti-inflammatory and antinociceptive activities of the leaf methanol extract of Miconia minutiflora (Bonpl.) DC. and characterization of compounds by UPLC-DAD-QTOF-MS/MS.
Some species of the genus Miconia are used in Brazilian folk medicine as analgesic and anti-inflammatory; however, several species of this genus are still poorly studied. Therefore, the aims of this study were to investigate the phytochemistry characterization by UPLC-DAD-QTOF-MS/MS, acute toxicity, anti-inflammatory and antinociceptive properties of Miconia minutiflora (Bonpl.) DC. The methanol extract of M. minutiflora (Mm-MeOH) was subjected to ultra-high-performance liquid chromatography (UPLC-DAD-QTOF-MS/MS) for the identification of the main phytocompounds. The anti-inflammatory properties of the extracts were studied using several inflammation models induced by carrageenan and acetic acid-induced vascular permeability. Antinociceptive effects of Mm-MeOH were assessed in nociception induced by intraperitoneal acetic acid or subplantar formalin injection. The role of α-adrenergic, cholinergic, and opioid receptors in modulating the extract's antinociceptive activity was determined. Analyses by UPLC-DAD-QTOF-MS/MS revealed the presence of ellagic acid, gallotannin, and terpenes in the methanol extract. Mm-MeOH (100 mg/kg) reduced carrageenan-induced paw edema and vascular permeability and inhibited leukocyte migration toward the air pouch and pleural cavity. Furthermore, Mm-MeOH decreased tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels. Administration of Mm-MeOH reduced the number of writhes by 58.9% and increased the pain threshold in the formalin test. The anti-inflammatory action mechanism of Mm-MeOH is associated with inhibition of proinflammatory cytokines TNF-α and IL-1β, whereas the antinociceptive actions involve peripheral and central mechanisms with participation of α2-adrenergic receptors. These effects may be attributed to the presence of polyphenolics in the extract.


[Melorheostosis: study of a case (author's transl)].
The Authors describe a case of melorheostosis. The diagnosis, which is only radiological, is characteized by the tipical aspect of flowing hyperostosis.


The role of carotid bodies in the establishment of oral breathing during nasal obstruction in lambs and ewes.
This study was aimed at determining the role of carotid bodies in the initiation and maintenance of oral breathing during nasal obstruction. We have previously shown in sheep that oral breathing during nasal obstruction was less effective in the neonate than in older lambs or adults. We considered it possible that the reduced response of the neonate was due to immaturity of carotid body chemoreceptors. Respiratory and blood gas responses to nasal obstruction were determined in 5 neonatal lambs, 6 older lambs and 6 adult ewes before and after surgically denervating the carotid bodies. Denervations were performed at 4.2 +/- 0.9 days after birth in the neonatal lambs and at 41.5 +/- 2.5 days in the older lambs. Carotid body denervation led to hypoxia, hypercapnia and acidaemia in lambs and ewes during unobstructed nasal breathing, and, in response to nasal obstruction, delayed the onset of oral breathing so that it occurred at a greater degree of hypoxia. Following carotid body denervation the degree of hypercapnia and acidaemia during nasal obstruction was greater in lambs than in ewes. We conclude that the carotid bodies in lambs and ewes play an important role in the regulation of normal blood gases and pH, and in the establishment and effectiveness of oral breathing during nasal obstruction.


Identification by combined gas chromatography-mass spectrometry of constituent long-chain fatty acids and alcohols from the meibomian glands of the rat and a comparison with human meibomian lipids.
Constituent long-chain fatty acids and alcohols from the meibomian secretions of the rat were examined as trimethylsilyl (TMS) and methyl ester-TMS derivatives by capillary gas chromatography and by combined gas chromatography-mass spectrometry. The positions of double bonds and methyl branch points were determined by the mass spectra of picolinyl esters and nicotinates for long-chain fatty acids and alcohols, respectively. Fatty acids had chain lengths from C12 to C34 and were of the straight-chain iso, anteiso and monounsaturated types. The unsaturated acids had double bonds in the omega-7 and omega-9 positions. The alcohols had corresponding structures. In common with the constituent acids and alcohols of other meibomian secretions, the chain lengths of the constituents showed a biphasic distribution with maxima around C16-C18 and C25-C27. The profile was qualitatively similar to that obtained from human meibomian secretion but with some differences in the relative proportions of certain acids and alcohols.


Taraxerol inhibits LPS-induced inflammatory responses through suppression of TAK1 and Akt activation.
Taraxerol, a triterpenoid compound, has potent anti-inflammatory effects. However, the molecular mechanisms are not clear. In the study, taraxerol concentration dependently inhibited nitric-oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) at the protein and mRNA levels and these inhibitions decreased the production of nitric oxide (NO), prostaglandin 2 (PGE2), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β induced by LPS. Furthermore, we found that taraxerol suppressed translocation of nuclear factor-κB (NF-κB), phosphorylation of IκBα, blocked the IκBα degradation as well as IKK and mitogen-activated protein kinase (MAPK) activation by inactivation of TGF-β-activated kinase-1 (TAK1) and Akt. In addition, taraxerol significantly inhibited the formation of TAK1/TAK-binding protein1 (TAB1), which was accompanied by inducing degradation of TAK1, decreasing LPS-induced polyubiquitination of TAK1 as well as TAK1 phosphorylation. Taken together, our data suggest that taraxerol downregulates the expression of proinflammatory mediators in macrophages by interfering with the activation of TAK1 and Akt, thus preventing NF-κB activation.


Strain improvement and optimization studies for enhanced production of erythromycin in bagasse based medium using Saccharopolyspora erythraea MTCC 1103.
In the present study, Saccharopolyspora erythraea MTCC 1103 was used for the enhanced production of erythromycin. To enhance the yield of erythromycin, effects of various parameters such as bagasse concentration, organic nitrogen source, inorganic nitrogen source, pH and temperature were analysed. It was found that bagasse can be used as an alternate carbon source in erythromycin production medium. Erythromycin production in the new formulation of bagasse based medium was found to be 512 mg/L which was 28 % higher than glucose based medium. Strain improvement was done by random UV-mutagenesis. When compared to wild type strain, mutant strain showed 40 % higher yield in production medium. Erythromycin potency assay and HPLC analysis were performed to confirm the presence of erythromycin in the partially purified samples. These optimized conditions could be used for the commercial production of this unique antibiotic which gave significant industrial perspectives.


Telmisartan increases fatty acid oxidation in skeletal muscle through a peroxisome proliferator-activated receptor-gamma dependent pathway.
Telmisartan is an angiotensin II receptor blocker and selective modulator of peroxisome proliferator-activated receptor-gamma reported to increase energy expenditure and improve glucose and lipid metabolism compared with other angiotensin II receptor blockers. As muscle fatty acid oxidation is a major determinant of energy expenditure, we investigated the effects of telmisartan on skeletal muscle fatty acid oxidation in a rat model of the metabolic syndrome. We measured fatty acid oxidation in soleus muscles obtained from polydactylous (PD)/Cub rats fed a high sucrose, high fat diet and treated with either telmisartan or losartan. In addition, we measured fatty acid oxidation in soleus muscle tissue isolated from Sprague-Dawley rats, incubated for 3 h with either telmisartan or valsartan. Compared with treatment with losartan, treatment with telmisartan was associated with significantly greater palmitate oxidation in skeletal muscle (44.4 +/- 2.9 versus 28.9 +/- 3.2 nmol palmitate/g/2 h, P = 0.004) as well as significantly greater glucose tolerance and significantly lower body weight and visceral adiposity. In addition, in-vitro incubation of skeletal muscle with telmisartan induced significantly greater increase in palmitate oxidation than in-vitro incubation with valsartan (9.4 +/- 1.6 versus 0.2 +/- 4.3 nmol palmitate/g/h, P < 0.05). The increased fatty acid oxidation induced by telmisartan in vitro was blocked by addition of the peroxisome proliferator-activated receptor-gamma antagonist GW9662 (-0.4 +/- 1.8 nmol palmitate/g/h, P < 0.05). The current results are consistent with the possibility that telmisartan may increase energy expenditure and protect against dietary induced obesity and features of the metabolic syndrome at least in part by increasing muscle fatty acid oxidation through activation of peroxisome proliferator-activated receptor-gamma.


Effects of two in-office bleaching agents with different pH values on enamel surface structure and color: an in situ vs. in vitro study.
To investigate in situ and in vitro effects of acidic and neutral in-office bleaching agents on human enamel in terms of chemical structure and tooth color. Ninety enamel slabs were obtained from premolars. Then specimens were randomly distributed into six groups (n=15) and the human saliva (HS) in volunteers' oral cavities was used to simulate in situ condition: group Beyond+distilled water (DW); group Opalescence Boost (O-Boost)+DW; group control+DW; group Beyond+HS; group O-Boost+HS and group control+HS. Twice in-office bleaching treatments were performed with a one-week interval and the total bleaching time was 90 min. ATR-IR spectroscopy, Raman spectroscopy and color measurement were performed before the bleaching treatment and after one week post-treatment, respectively. Then ATR-IR and Raman spectroscopies were analysed and the carbonate: mineral (C:M) ratio, Raman absolute intensity (RAI), Raman relative intensity (RRI) and laser-induced fluorescence intensity (FI) were calculated for evaluation. C:M ratio and percentage RRI showed significantly decrease in group Beyond+DW (p<0.001, p<0.001) while little variation was observed in the other groups (p>0.05, p>0.05). Percentage FI and ΔE revealed statistical difference in all bleached groups (p<0.001, p<0.001) while no statistical difference in control groups (p>0.05, p>0.05). Acidic and neutral in-office bleaching agents had the same whitening efficiency in situ and in vitro. Acidic agents could induce demineralisation of human enamel in vitro and the presence of natural human saliva could minimise this adverse effect.


Optimization of HIV testing services in Germany using HIV indicator diseases: study protocol of the HeLP study.
Despite the potentially accompanying negative clinical, epidemiologic, and health economic effects, a large proportion of persons living with the human immunodeficiency virus (HIV) are diagnosed late. Internationally, numerous diseases are known to be HIV indicator diseases. Adequate HIV testing in the presence of HIV indicator diseases could help to diagnose unknown HIV infections earlier. The objective of the HeLP study is to validate published HIV indicator diseases for the German setting and to identify guidelines in terms of these indicator diseases in order to reduce knowledge gaps and increase HIV testing when HIV indicator diseases are diagnosed. A mixed methods approach is used. In a first step, published HIV indicator diseases will be identified in a systematic literature review and subsequently discussed with clinical experts regarding their relevance for the German setting. For the validation of selected indicator diseases different data sets (two cohort studies, namely HIV-1 seroconverter study & ClinSurv-HIV, and statutory health insurance routine data) will be analyzed. Sensitivity analyses using different time periods will be performed. Guidelines of HIV indicator diseases validated in the HeLP study will be reviewed for mentioning HIV and for HIV testing recommendations. In addition, semi-standardized interviews (followed by a free discussion) with guideline creators will identify reasons why HIV testing recommendations were (not) included. Subsequently, a random sample of physicians in medical practices will be surveyed to identify how familiar physicians are with HIV testing recommendations in guidelines and, if so, which barriers are seen to perform the recommended tests in everyday care. The HeLP-study adopts the challenge to validate published HIV indicator diseases for the German setting and has the potential to close a knowledge gap regarding this objective. This has the potential to improve targeted HIV testing for patients with HIV indicator diseases and consequently lead to earlier HIV diagnosis. DRKS00028743.


Plasma fibronectin concentrations in blood products.
Plasma fibronectin is an important opsonic protein of the mononuclear phagocyte system (MPS). In this study, plasma fibronectin concentrations were measured in stored and fresh whole blood, fresh frozen plasma and AGH cryoprecipitate. Stored whole blood had the lowest concentrations (151 +/- 50 mg/l). The concentrations in fresh whole blood plasma (227 +/- 66 mg/l) and fresh frozen plasma (224 +/- 78 mg/l) were similar but significantly higher than in stored whole blood (p less than 0.05). In contrast, AHG cryoprecipitate had the highest fibronectin concentrations (3249 +/- 502 mg/l) (p less than 0.001). In correcting fibronectin deficiency the best results can thus be expected from an infusion of cryoprecipitate, but fresh whole blood and fresh frozen plasma may also increase depressed fibronectin levels.


Relaxing intraoperative natural sound blunts haemodynamic change at the emergence from propofol general anaesthesia and increases the acceptability of anaesthesia to the patient.
It is known that auditory input, such as comforting music or sound, blunts the human response to surgical stress in conscious patients under regional anaesthesia. As auditory perception has been demonstrated to remain active under general anaesthesia, playing comforting sounds to patients under general anaesthesia might also modulate the response of these patients to surgical stress. Fifty-nine patients scheduled for laparoscopic cholecystectomy were anaesthetized with propofol general anaesthesia in combination with epidural anaesthesia. Natural sounds, chosen preoperatively by each patient as being comforting, were played to 29 patients using headphones during surgery (S group) and the remainder of the patients (n = 30) were fitted with dummy open-type headphones (N group). We compared the haemodynamic change during anaesthesia and the acceptability of anaesthetic practice between the two groups in a randomized double-blind design. There were no differences in haemodynamics between the S and N groups during surgery. During the emergence from anaesthesia, the mean blood pressure and heart rate gradually increased; both parameters were significantly higher in the N group than in the S group. Postoperatively, patients in the S group perceived the experience of anaesthesia as significantly more acceptable than did those in the N group. These findings indicate that allowing patients comforting background sounds during general anaesthesia may blunt haemodynamic changes upon emergence from general anaesthesia and increase the acceptability of the experience of anaesthesia.


Ontario adopts policy on discrimination based on gender identity.
On 30 March 2000, as a follow-up to a discussion/consultation paper on gender identity, the Ontario Human Rights Commission approved a "Policy on Discrimination and Harassment because of Gender Identity."


Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis.
With the advent of laparoscopic cholecystectomy, optimal management of common duct stones remains controversial. Seven hundred six patients underwent laparoscopic cholecystectomy in our institution from January 1990 through January 1992. From this group of patients, 50 were identified as having clinical or radiographic evidence of common duct stones. Thirty-one patients demonstrated preoperative risk factors for common duct stones and underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP). The risk factors included jaundice (19%), pancreatitis (23%), elevated liver function tests (52%), and ultrasound evidence of choledocholithiasis (6%). Preoperative ERCP was performed in 94% of patients. There were two failures due to periampullary diverticula. Common duct stones were identified in 18 patients (62%) and successfully removed by endoscopic sphincterotomy in all of these patients. Nineteen patients were found to have unsuspected common duct stones on intraoperative cholangiography. Eighteen patients (95%) underwent successful ERCP and endoscopic sphincterotomy with stone extraction. Overall, major morbidity was 2% and included one patient who experienced endoscopic sphincteroplasty. The three endoscopic failures were managed by open common duct exploration, laparoscopic duct exploration, and combined laparoscopic and open common duct exploration. We conclude that combined laparoscopic and endoscopic therapy is a viable option for the management of cholelithiasis with choledocholithiasis.


Analysis of phenolic acids as chloroformate derivatives using solid phase microextraction-gas chromatography.
In the presented study, a simple and original procedure of phenolic acids derivatization treated by ethyl and methyl chloroformate performed in an aqueous media consisting of acetonitrile, water, methanol/ethanol and pyridine has been modified and optimized. Seven phenolic acid standards-caffeic, ferulic, gallic, p-coumaric, protocatechuic, syringic and vanillic were derivatized into corresponding methyl/ethyl esters and subsequently determined by the means of gas chromatography connected to the flame-ionisation detector (FID). Some selected validation parameters as linearity, detection and quantitation limits and peak area repeatability were valued. The total time of gas chromatography (GC) analysis was 24 min for methyl chloroformate and 30 min for ethyl chloroformate derivatization. The more suitable methyl chloroformate derivatization was used for further experiments on the possibility of multiple pre-concentration by the direct solid phase microextraction technique (SPME). For this purpose, polyacrylate (PA), polydimethylsiloxane (PDMS), carboxen/polydimethylsiloxane (CAR/PDMS) and polydimethylsiloxane/divinylbenzene (PDMS/DVB) fibres were tested and the extraction conditions concerning time of extraction, temperature and time of desorption were optimized. The most polar PA fibre gave the best results under optimal extraction conditions (50 min extraction time, 25 degrees C extraction temperature and 10 min desorption time). As a result, the total time of SPME-GC analysis was 74 min and an increase in method sensitivity was reached. The limits of quantitation (LOQ) of p-coumaric, ferulic, syringic and vanillic acid esters after SPME pre-concentration were 0.02, 0.17, 0.2 and 0.2 microg mL(-1), respectively, showing approximately 10 times higher sensitivity in comparison with the original GC method.


Truncation artifacts in magnetic resonance imaging.
A method has been developed to reduce a magnetic resonance image artifact arising from the Fourier transformation of data truncated in the phase-encoding direction. The discontinuity is eliminated between the phase of the complex data sample associated with the maximum negative phase-encoding gradient and the phase of the maximum positive gradient sample. Images retain sharper edges than if low-pass filtering is employed. The method is demonstrated on clinical images, then an explanation of the method is presented.


Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop.
This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.


Amine-modified poly(vinyl alcohol)s as non-viral vectors for siRNA delivery: effects of the degree of amine substitution on physicochemical properties and knockdown efficiency.
The objective of this study was to investigate how the degree of amine substitution of amine-modified poly(vinyl alcohol) (PVA) affects complexation of siRNA, protection of siRNA against degrading enzymes, intracellular uptake and gene silencing. A series of DEAPA-PVA polymers with increasing amine density was synthesized by modifying the hydroxyl groups in the PVA backbone with diethylamino propylamine groups using CDI chemistry. These polymers were characterized with regard to their ability to complex and protect siRNA against RNase. Finally, their potential to mediate intracellular uptake and gene silencing in SKOV-luc cells was investigated. A good correlation between amine density and siRNA complexation as well as protection of siRNA against RNase was found. Consisting solely of tertiary amines, this class of polymer was able to mediate efficient gene silencing when approximately 30% of the hydroxyl groups in the PVA backbone were modified with diethylamino propylamine groups. Polymers with a lower amine density (up to 23%) were inefficient in gene silencing, while increasing the amine density to 48% led to non-specific knockdown effects. DEAPA-PVA polymers were shown to mediate efficient gene silencing and offer a promising platform for further structural modifications.


[Modern modifications of uvulopalatopharyngoplasty].
Uvulopalatopharyngoplasty (UPPP) was first described in 1964 with regard to surgical treatment of snoring and in 1981 with regard to treatment of obstructive sleep apnea (OSA). The initial surgical techniques for OSA were very invasive, frequently leading to significant morbidity and complications. Wolfgang Pirsig et al. were the first in Germany to recognize that a radical surgical technique increased only the complications, not the efficacy of UPPP. The less invasive surgical technique developed based on these findings is still established in Germany. A meta-analysis from 1996 described a success rate of UPPP of about 50%. High-quality randomized trials demonstrate significant superiority of UPPP plus tonsillectomy compared to untreated controls. However, the objective outcome measures of classic UPPP could not be improved even with additional patient selection criteria, and the effects of UPPP often deteriorate over time. To overcome these limitations, various modifications of UPPP have been developed. Due to limited data, evaluation of these new techniques and their comparison with conventional UPPP is difficult at present. In studies comparing a modification of UPPP with the standard approach, the tested modification was demonstrated to be superior. A relevant limitation of the available data results from the small number of institutions (usually not more than two) that investigated the respective modification and the follow-up periods of usually only 6 months. Data are also too sparse to reliably assess complication rates. For conventional UPPP there are considerably more data, wider experience with long-term outcome, and more robust studies examining treatment effects beyond basic respiratory parameters. At present, modifications of UPPP should be principally employed in clinical trials.


Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes.
This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01-10.0, 10.01-20.0, 20.01-30.0, 30.01-40.0, 40.01-50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1-40.7) and in pregnancies with APOs 40.3 (49.4-41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365-1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581-2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56-0.61, p < 0.001). Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.


Mammography-based radiomic analysis for predicting benign BI-RADS category 4 calcifications.
We developed and validated a radiomic model based on mammography and assessed its value for predicting the pathological diagnosis of Breast Imaging Reporting and Data System (BI-RADS) category 4 calcifications. Patients with a total of 212 eligible calcifications were recruited (159 cases in the primary cohort and 53 cases in the validation cohort). In total, 8286 radiomic features were extracted from the craniocaudal (CC) and mediolateral oblique (MLO) images. Machine learning was used to select features and build a radiomic signature. The clinical risk factors were selected from the independent clinical factors through logistic regression analyses. The radiomic nomogram incorporated the radiomic signature and an independent clinical risk factor. The diagnostic performance of the radiomic model and the radiologists' empirical prediction model was evaluated by the area under the receiver operating characteristic curve (AUC). The differences between the various AUCs were compared with DeLong's test. Six radiomic features and the menopausal state were included in the radiomic nomogram, which discriminated benign calcifications from malignant calcifications with an AUC of 0.80 in the validation cohort. The difference between the classification results of the radiomic nomogram and that of radiologists was significant (p < 0.05). Particularly for patients with calcifications that are negative on ultrasounds but can be detected by mammography (MG+/US- calcifications), the identification ability of the radiomic nomogram was very strong. The mammography-based radiomic nomogram is a potential tool to distinguish benign calcifications from malignant calcifications.


Principal components ancestry adjustment for Genetic Analysis Workshop 17 data.
Statistical tests on rare variant data may well have type I error rates that differ from their nominal levels. Here, we use the Genetic Analysis Workshop 17 data to estimate type I error rates and powers of three models for identifying rare variants associated with a phenotype: (1) by using the number of minor alleles, age, and smoking status as predictor variables; (2) by using the number of minor alleles, age, smoking status, and the identity of the population of the subject as predictor variables; and (3) by using the number of minor alleles, age, smoking status, and ancestry adjustment using 10 principal component scores. We studied both quantitative phenotype and a dichotomized phenotype. The model with principal component adjustment has type I error rates that are closer to the nominal level of significance of 0.05 for single-nucleotide polymorphisms (SNPs) in noncausal genes for the selected phenotype than the model directly adjusting for population. The principal component adjustment model type I error rates are also closer to the nominal level of 0.05 for noncausal SNPs located in causal genes for the phenotype. The power for causal SNPs with the principal component adjustment model is comparable to the power of the other methods. The power using the underlying quantitative phenotype is greater than the power using the dichotomized phenotype.


Discontinuous insurance coverage predicts prolonged hospital stay after pediatric adenotonsillectomy.
Changes in health insurance coverage have been implicated in limiting access to care and increasing morbidity risk. The consequences of insurance discontinuity for surgical outcomes are unclear. In this study, we explored whether recent insurance discontinuity was associated with prolonged inpatient hospitalization after adenotonsillectomy in children. We retrospectively evaluated single-center data on children aged 2-18 y undergoing adenotonsillectomy with overnight stay in 2009-2014. Insurance coverage at surgery and over the preceding year was categorized as (1) continuous private, (2) continuous Medicaid, or (3) discontinuous (changes or gaps in coverage). The association between insurance discontinuity and prolonged hospitalization (≥2 d) was evaluated using multivariable logistic regression. The study included 1013 girls and 983 boys (aged 4.5 ± 2.9 y), of whom 205 (10%) required prolonged hospitalization. Insurance was continuous private for 749 patients (38%), continuous Medicaid for 1121 patients (56%), and discontinuous for 126 patients (6%). Prolonged stay was most common with discontinuous insurance (23/126, 18%), followed by continuous Medicaid (117/1,121, 10%), and continuous private insurance (65/749, 9%; P = 0.004). In multivariable analysis, discontinuous insurance remained associated with prolonged hospital stay, compared with continuous private insurance (odds ratio = 1.88; 95% confidence interval: 1.06-3.33; P = 0.031), and compared with continuous Medicaid (odds ratio = 1.86; 95% confidence interval: 1.09-3.19; P = 0.023). This study demonstrates greater odds of prolonged hospitalization after adenotonsillectomy among children with recent gaps or changes in insurance coverage and illustrates the feasibility of studying influences of health insurance change on surgical outcomes using existing data in hospital electronic records.


War surgery in Afghanistan: a model for mass causalities in terror attacks?
The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016-May 2016) were included. Patients´ characteristics were analyzed. The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.


Cholelithiasis in childhood: a follow-up study.
Fifteen children with cholelithiasis who were treated at the Royal Hospital for Sick Children, Glasgow between 1973 and 1985 are reviewed. Ten patients had idiopathic gallstones and five had gallstones in association with hereditary spherocytosis. All patients have been followed up for between 4 months and 12 years (mean 4.1 years): ultrasonography has been carried out on 13. Fourteen patients underwent surgery of whom only seven had symptoms from their gallstones. Nine patients had cholecystostomy and removal of gallstones, four patients had cholecystectomy (one had negative exploration of the common bile duct in addition) and one patient with choledocholithiasis underwent choledochotomy with transduodenal sphincterotomy. One patient did not have surgery; she has remained asymptomatic and ultrasound examination confirms that she still has a solitary gallstone in her gallbladder. Clinical review with ultrasonography shows that cholecystostomy with removal of gallstones appears to be an acceptable alternative to cholecystectomy.


Successful treatment of pulmonary hypertension in a neonate with bronchopulmonary dysplasia: A case report and literature review.
Pulmonary hypertension (PH) is a severe complication of bronchopulmonary dysplasia (BPD) in premature neonates and is closely related to prognosis. However, there is no effective and safe treatment for PH due to BPD in infants. Successful treatment for cases of BPD-associated PH with Tadalafil combined with bosentan is rare. This case may make a significant contribution to the literature because PH is difficult to manage as a serious complication of BPD in preterm infants. Mortality is high, especially when it is complicated by heart failure. An extremely premature neonate with a gestational age of 26+5 wk and birth weight of 0.83 kg was diagnosed with BPD associated with PH; oral sildenafil did not improve the PH. The infant experienced sudden cardiac arrest and serious heart failure with severe PH. After a series of treatments, including cardiopulmonary resuscitation, mechanical ventilation, and inhaled nitric oxide (iNO), the respiratory and circulatory status improved but the pulmonary artery pressure remained high. Then oral sildenafil was replaced with oral tadalafil and bosentan; pulmonary artery pressure improved, and the infant recovered at our hospital. After 2 years of follow-up, she is in good condition, without any cardiovascular complications. INO can effectively improve the respiratory and circulatory status of infants with PH associated with premature BPD. B-type natriuretic peptide should be routinely measured during hospitalization to evaluate the risk and prognosis of BPD-associated PH in preterm infants. Tadalafil combined with bosentan for the treatment of PH associated with premature BPD was better than sildenafil in this case. Further studies are needed to explore the efficacy and safety of different vasodilators in the treatment of PH associated with premature BPD.


Intracranial Rosai Dorfman Disease Presented With Multiple Huge Intraventricular Masses: A Case Report.
Rosai-Dorfman disease (RDD) usually presents with painless cervical lymphadenopathy during the two first decades of life, with or without extranodal involvement. Exclusive extranodal manifestation, and especially central nervous system (CNS) involvement, is uncommon. The etiology remains unknown and definitive diagnosis is based on characteristic histopathological and immunohistochemical features showing S100(+) CD1a(-) RDD type histiocytes with emperipolesis. Most CNS cases are dural-based masses. Herein, we present a case of RDD in an 8-year-old boy, who presented with multiple huge intraventricular masses. Regarding rare CNS involvement and lack of established evidence-based therapeutic approaches, reports of any individual case can supply further beneficial data concerning treatment approaches and long-term effectiveness of therapeutic strategies.


Nested stromal epithelial tumor of the liver: A multidisciplinary approach to the treatment of an extremely rare malignancy.
Nested stromal epithelial tumor (NSET) of the liver is an extremely rare and unusual liver neoplasm with limited evidence of best practice for management. We report a 28-year-old male with NSET managed with primary partial hepatectomy with subsequent disease recurrence with follow-up metastectomy and successful radiofrequency ablation (RFA). Management of NSET of the liver requires a multidisciplinary approach. RFA proves beneficial in a patient with disease recurrence following tumor resection. In order to validate the regular use of RFA, more long term studies would be required.


Polymerase chain reaction and focal contact formation indicate integrin expression in mesangial cells.
Cultured kidney glomerular mesangial cells (MCs) allow the role of extracellular matrix (ECM) and growth factors in glomerular inflammatory disease to be studied. To investigate the potential of MCs to interact with matrix components, the expression of integrin mRNA in cultured MCs was examined by polymerase chain reaction (PCR), by Northern blotting and by immunofluorescence. In addition, the effect of matrix substrates on mRNA expression was assessed by PCR. Northern blots with cDNA probes to integrin alpha-chains revealed that MCs expressed alpha 1, alpha 3 and alpha 5 integrin mRNA. alpha 1 and alpha 3 were the major messages. No alpha 2, alpha 4 or alpha 6 were detectable. RT-PCR revealed that alpha 2 and alpha 6 were also expressed at low levels. The control cells, HT1080, expressed alpha 2, alpha 3, alpha 4, alpha 5 and alpha 6 mRNA, and Rugli expressed alpha 1, alpha 3 and alpha 5, supporting previous studies. Immunocytochemistry confirmed that alpha 1 beta 1, alpha 2 beta 1, and alpha 5 beta 1 integrins were expressed and that they were concentrated into focal adhesions (alpha 1 beta 1 on type I collagen and laminin; alpha 2 beta 1 on type I collagen; alpha 3 beta 1 on type I collagen, laminin and fibronectin; alpha 5 beta 1 on fibronectin). alpha 6 beta 1 was not detected in focal contacts. Attachment, spreading, and formation of talin and integrin containing focal contacts still occurred when endogenous protein synthesis was blocked with 30 micrograms.ml-1 cycloheximide.(ABSTRACT TRUNCATED AT 250 WORDS)


Leveraging an electronic health record note template to standardize screening and testing for COVID-19.
The coronavirus disease 2019 (COVID-19) pandemic challenged health care organizations to develop ways to provide patient care with rapidly changing guidelines and scarce resources. Clinical leaders and informatics specialists partnered to rapidly develop an electronic health record (EHR) template for primary care staff to screen Veterans at Veterans Affairs (VA) Puget Sound. The template prompts categorization of patients by stability and suspicion for COVID-19, and provides just-in-time triaging advice for clinic staff. Each category is a discrete data element and this information was used by leadership to track screening and testing volumes. We found that a brief, practical EHR note template can be quickly adopted to inform guideline-based screening, direct patient care, and conserve resources.


"The dust hasn't settled yet": the National Q fever Management Program, missed opportunities for vaccination and community exposures.
To determine the proportion of notifiable cases of Q fever attributable to occupational and community exposures and to identify missed opportunities for Q fever vaccination in notifications of occupational exposures. A review of Q fever notifications to the BSPHU from January 2000 to September 2006 was undertaken. Notifications were categorised according to probable exposure source. Occupational exposures were further categorised according to reported past exposure to Q fever and Q fever vaccination status. One hundred and ninety-one Q fever notifications were identified, with occupational exposure reported in 106 cases and community exposure reported in 69 cases. In the occupational exposures, 76 cases (71%) were not vaccinated, 15 (14%) reported past exposure to Q fever and eight reported vaccination prior to illness onset, but vaccination status could not be independently verified. Community acquired Q fever was most commonly attributed to living or working near a high-risk industry (26, 38%), incidental exposures such as farm visits, or attending sale yards (27, 39%). Occupationally acquired cases of Q fever continue to be reported in significant numbers and opportunities for vaccination are being missed. There is an ongoing need to ensure that all employees in high-risk industries are screened and vaccinated. The proportion of community acquired notifications of Q fever has increased since the National Q fever Management Program started, commensurate with the decline in occupationally acquired cases. These proportions may be expected to change with the cessation of the program in Queensland in December 2006.


Antimicrobial Effect of Copper Oxide Nanoparticles on Some Oral Bacteria and Candida Species.
Acid producing bacteria including Streptococcus mutans and lactobacilli cause tooth demineralization and lead to tooth decay. Also, oral colonization of the species of Candida has been reported in many studies that are resistant to antifungal agents. In this study, antibacterial and antifungal effects of nano-CuO were studied against some oral bacteria and yeast fungi. The minimum inhibitory concentrations (MICs) of copper oxide nanoparticles (CuO NPs) for oral bacterial and fungal test strains were determined in 96-well microtiter plate technique. The agar diffusion test (ADT) was employed to assess the antifungal properties of nystatin. The MIC50 value of CuO NPs was determined at the range of 1-10 µg/ml for S. mutans, < 1 µg/ml for L. acidophilus, and 10 µg/ml for L. casei. Higher concentrations of CuO NPs (100-1000 µg/ml) were effective on the bacterial cell growth, resulting in 100% reduction in the optical density in TSB medium. The cells of Candida albicans, C. krusei and C. glabrata were treated with CuO NPs and the results showed a decrease in fungal growth at a concentration of 1-1000 µg/ml in TSB medium. The MIC50 value of CuO NPs was determined 1000 µg/ml for three species of Candida. The diameter of growth inhibition zones of 1100 µg/ml nystatin was obtained 15-21 mm for clinical isolates of three species of Candida. With respect to the potential bactericidal activity of CuO NPs on various cariogenic bacteria examined in this study, these NPs could be introduce as a candidate control agent for preventing dental caries or dental infections. In our study, on the other hand, Nano copper oxide had a weak effect on the candida species.


Evaluation of a Novel "Quad" Wavelength Light Curing Unit.
This study investigated the properties (depth of cure, surface hardness, and volumetric shrinkage) of two composite restorative materials when polymerized with a novel "quad" spectrum (PinkWave) light-curing unit (LCU) compared to a tri-spectrum LCU (Valo Grand). One Valo Grand LCU was modified to be similar in irradiance to the PinkWave, and a second Valo Grand was utilized at the manufacturer's standard irradiant settings. Depth of cure was evaluated using the scraping technique (ISO 4049). Top and bottom surface hardness and bottom/maximum hardness ratios were determined using a hardness tester. Volumetric shrinkage was determined using a video-imaging device. Additionally, the surface temperature of the light tips of the LCUs was measured using a K-type thermocouple. No significant difference in depth of cure was found with either composite between the PinkWave LCU and the modified Valo Grand LCU at similar irradiance. The unadjusted Valo Grand LCU had slightly less depth of cure. There was no difference in top or bottom surface hardness, bottom/maximum hardness ratios, or volumetric shrinkage between any of the LCU curing modes per composite type. The PinkWave LCU had a significantly greater increase in heat at the tip compared to the modified Valo Grand LCU at similar irradiance and the unadjusted Valo Grand LCU. The new quad-spectrum LCU, PinkWave, had a significant increase in surface temperature without any improvement in the composite properties tested compared to the tri-spectrum LCU, Valo Grand, at similar irradiance. Key words:Light-curing unit, emission spectrum, composite resin, mechanical and physical properties.


The effect of silicone ocular surgical devices on serum IgG binding to silicones.
To determine whether silicone materials used in retinal detachment repair and cataract surgery increase serum IgG binding to silicone and identify correlations with complications of ocular surgery. Serum from 49 patients who had ocular surgery using silicone materials was examined. Patient groups included scleral buckling (n = 25), silicone oil tamponade (n = 3), scleral buckling and silicone oil tamponade (n = 9), and silicone lens implants after cataract extraction (n = 12). Convalescent samples for all patients and preoperative samples from 19 patients (18 scleral buckling and one silicone oil tamponade) were examined. Postoperative complications were monitored for up to 108 months (mean, 10.7 months; mode, 1.5 months; range, 1 to 108 months). Samples were evaluated for the extent of IgG binding to silicones using a micromodification of a previously described enzyme-linked immunosorbent assay method. In 19 patients, IgG binding levels in preoperative samples were 21 arbitrary units (AU) or less. Of the 25 buckling patients, one developed complications; however, in all patients the postoperative levels of IgG binding to silicone were low (2.2 to 20.0 AU). Although four silicone lens patients developed mild complications, none displayed postoperative IgG binding levels of greater than 20 AU. Three patients who underwent both scleral buckling and silicone oil tamponade developed complications; one of these patients, who was also noted to have systemic connective tissue disease, had a significant elevation in postoperative serum IgG binding to silicone. Statistically significant elevations of serum IgG binding to silicone were noted postoperatively in only one patient who had a systemic connective tissue disease. The complication rate and frequency of enhanced serum IgG binding to silicone was low, making correlations to surgical complications difficult. Examination of matched samples suggested that if ocular exposure to silicone implants enhances the level of serum IgG binding to silicones, it must be a rare event that should not alter the clinical use of these important devices.


Characteristics of cervical disease among symptomatic women with histopathological sample at Hawassa University referral hospital, Southern Ethiopia.
Cervical cancer is one of the most common cancers of women in developing countries. It is also eminent cause of mortality and morbidity in women worldwide. Symptoms usually develop when the cancer has become invasive and invade nearby tissue. This has significant effect on treatment of cases in area where there is limited awareness. The aim of this study is to describe cervical disease among symptomatic women with a histhological sample at Hawassa University referral hospital, southern Ethiopia. Five years retrospective histopathological characteristics of symptomatic cervical cases were studied from January, 2010 to January, 2015 at Hawassa University referral hospital pathology laboratory. Clinical diagnosis of patients, patient's age, biopsy sample size and type, and microscopic finding of the cases were collected for this study. The data were entered by Epi-Info statistical software version 7 and later exported to SPSS version 20 for analysis. Descriptive analyses such as frequency, mean, and standard deviation were computed. A total of 513 patients with cervical lesion were examined histopathologically in the study period. The age ranges of the patients were from 17 to 85 years with mean and standard deviation of 42 ± 11 years. Of these symptomatic examined cases, 253 (49.3%) of them were cancerous lesion while non cancerous and precancerous cases account 166 (32.4%) and 51 (9.9%) respectively. Cervical squamous cell carcinoma was the predominant type cancer which accounts 211(83.4%) of all cancerous cervical cases. The proportion of cervical cancer was higher in age group older than 60. The magnitude of cervical cancer and precancerous cases were steadily increasing throughout study periods whereas non cancerous cases were fluctuating. Cervical cases were associated with wide range of disorders. Cervical cancer was the predominant cervical disease in symptomatic southern Ethiopian women. The high proportion of cervical cancer was observed in post-menopausal age when compared with other cervical cases. Effective uses of low-tech and inexpensive screening tools that already exist and giving awareness about the disease in combination with vaccine could reduce this high magnitude of cervical cancer in study area.


Critical pathway for an aggressive diagnostic strategy for patients who present with chest pain but a nondiagnostic electrocardiogram to the emergency department.
The prolonged length of stay for patients who seek treatment in the emergency department with chest pain and normal or nondiagnostic electrocardiogram has led to a backlog of patients in the emergency department and the telemetry unit. Correct early management requires risk stratification processes that can effectively separate the majority of these patients into low-risk, low/intermediate-risk, intermediate-risk, and high-risk subsets. Patients who seek treatment in the emergency department with chest pain are risk-stratified into low-risk, low/intermediate-risk, and high-risk categories using a Risk Score to determine who would benefit from immediate exercise stress testing. Nurse-directed exercise stress testing using the Duke Treadmill Score is used to risk-stratify intermediate-risk patients further "on-the-fly". Intermediate-risk Duke Treadmill Score patients are injected during exercise with a Tc-myocardial perfusion agent and undergo a gated single-photon emission computed tomography study. Normal exercise and single-photon emission computed tomography perfusion patients are discharged home. The overall length of stay and 30-day outcomes of these facilitated patients were compared with those of patients treated with a conservative approach using sequential electrocardiograms and cardiac enzymes. Patients who were evaluated using the facilitated approach had a shorter mean length of stay than those using a conservative method, with similar outcomes at 30 days. A facilitated approach incorporating on-demand nurse-directed early exercise stress testing with the injection of a Tc-myocardial perfusion agent on the fly in intermediate-risk patients is safe and has decreased the backlog of patients in the emergency department and telemetry unit and expedited appropriate treatment of patients with acute chest pain and nondiagnostic electrocardiograms.