BpTRUth: do automated blood pressure monitors outperform mercury?
Manual measurement of blood pressure (BP) in the office (MOBP) is inferior in accuracy when compared with ambulatory BP measurements (ABPM) since it misses white coat and masked effects on BP. BpTRU, an automated office BP device (AOBP), has been reported to reduce white coat effect. We performed a retrospective review of the diagnostic accuracy of MOBP (taken by a trained nurse in clinical hypertension) and AOBP using the Bland-Altman method in hypertensive patients referred to a Renal Hypertension Clinic. In 329 hypertensive patients, the 95% limits of agreement between systolic AOBP and ABPM were -31 mm Hg to 33 mm Hg and for MOBP and ABPM were -27.8 mm Hg to 37.4 mm Hg. The bias between systolic MOBP and systolic ABPM was 4.9 mm Hg (95% confidence interval, 3.0-6.6 mm Hg) whereas the bias between the systolic AOBP and the systolic ABPM was -3.2 (95% confidence interval, -1.3 to -5.0). AOBP did not improve treatment relevant classification errors compared with MOBP (28% vs. 23%; P = .052). Our data support findings by others showing that AOBP improves, but does not eliminate, white coat effect. The increased detection of white coat effect appears related to systematic downward bias by BpTRU. As a result, detection of masked effect is undermined by BpTRU.


Studies on the embryotoxicity and mutagenicity of mycotoxins.
Embryotoxicity: Aflatoxin B1(AFB1), G1 (AFG1), and Patulin (PA) were investigated in NMRI mice for embryotoxic and teratogenic activity. These three mycotoxins were injected intraperitoneally or given orally on day 12 and 13 of pregnancy. AFB1 (15, 45, and 90 mg/kg ip or 45 mg/kg po) produced a moderate retardation in the fetal development and a dose related increase of cleft palates, wavy ribs, and diaphragm changes. The effects after injection of AFG1 (45 and 90 mg/kg ip) were reduction of fetal weights, increase of diaphragm changes, and malformations of kidneys. PA (1.25, 2.5, and 3.75 mg/kg ip or 3.75 mg/kg po) elevated the rate of cleft palates after 3.75mg/kg. In the dominant lethal assay neither PA (2.5 and 5 mg/kg ip) nor AFB1) (15 and 45 mg/kg ip) increased the frequency of the dominant lethal mutations. Both mycotoxins showed no mutagenic activity in this test system. The capability of AFB1, AFG1, and PA to induce chromosome damages in vivo was tested in the Chinese Hamster by examination of bone marrow cells, each after two oral doses (AFB1: 12.5 and 25 mg/kg; 25 and 50 mg/kg; PA: 10 and 20 mg/kg). The three mycotoxins induced chromosome aberrations in the following order of activity: PA > AFB1 > AFG1.


A 50-year review of minimal extraocular surgery for retinal detachment: five hurdles had to be overcome for its acceptance.
The non-drainage segmental buckling procedure by Custodis for repair of a retinal detachment harboured serious postoperative complications. To amend this new technique to a minimal extraocular surgery with practically no intra- nor postoperative complications, four hurdles had to be overcome: diathermy was replaced by cryosurgery, polyviol plombe by the silicone sponge, eight rules were defined to find the break in a primary retinal detachment or in an eye up for reoperation and a subsequent 15-year follow-up of anatomical and functional results confirmed that minimal extraocular surgery for repair of retinal detachment suffices for optimal long-term results without harbouring secondary complications threatening regained visual acuity.


Beyond Magnification and Illumination: Ergonomics with a 3D Exoscope in Lumbar Spine Microsurgery to Reduce Musculoskeletal Injuries.
The risk of musculoskeletal injuries (MSIs) increases over years of practice which may lead to career-ending among surgeons. Exoscopes represent a new generation of imaging systems that help surgeons operate in a more comfortable posture. This article aimed to assess advantages and limitations, especially ergonomics with a 3D exoscope in lumbar spine microsurgery versus an operating microscope (OM) to reduce MSIs. From March 2018 to May 2020, 90 patients with lumbar disc herniation undergoing a single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure were included. Forty-seven patients were operated with the assistance of the exoscope and 43 patients were operated with the assistance of the OM. Clinical data, magnification, and illumination were evaluated. In particular, the ergonomics of surgeons was evaluated by a questionnaire (subjective) and a rapid entire body assessment (REBA; objective). The postoperative outcomes were reasonably well balanced between the two groups. The handling of the exoscope was comparable to that of the OM. The depth perception, image quality, and illumination of the exoscope were inferior to those of the OM in MIS-TLIF with long and deep approaches. The educational and training function of the exoscope was superior to that of the OM. Importantly, surgeons rated the ergonomics of the exoscope as very high on the questionnaire and the REBA to the OM (P = 0.017). This study showed that the exoscope was a safe and effective alternative to the OM for assisting the MIS-TLIF procedure with the unique advantage of ergonomics to reduce musculoskeletal injuries.


Cerebrospinal fluid levels of neurofilament light in chronic experimental autoimmune encephalomyelitis.
Experimental autoimmune encephalomyelitis (EAE) induced by myelin oligodendrocyte glycoprotein (MOG) is a chronic relapsing-remitting animal model of multiple sclerosis (MS). Neurofilament light (NF-L), a structural protein expressed in neuronal cells can be used to quantify the amount of neuronal damage in MS patients. An immunoassay was used to measure levels of neurofilament light in cerebrospinal fluid (CSF) in rats with myelin oligodendrocyte glycoprotein-induced EAE. Significantly increased levels of neurofilament were found in the immunized animals compared to the controls, strengthening the similarities in the diseases and the progression pattern between the animal model and MS. The turnover of NF-L during this disease is increased since significantly elevated levels also were identified in the spinal cord of the diseased animals and immunohistochemistry gave support for this observation. Monitoring neurofilament levels in EAE can be used to follow disease progression and effects of therapy.


Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach.
The purpose of this study is to evaluate the efficacy of the fronto-temporal epidural approach in managing intracavernous trigeminal schwannomas. Five unselected patients harboring an intracavernous trigeminal schwannoma were operated on. Each of them was cured by a single craniotomy. In all cases the skull base approach described by Dolenc [Acta Neurochir. (Wien) 130 (1994) 55] was performed. The complete resection of the tumor and its capsule was gained in all five cases. There was no surgical mortality. No patient developed postoperative major complications. The fronto-temporal epidural approach can be applied for parasellar type trigeminal schwannomas, thus avoiding the exposure of the temporal lobe, and resulting in good chance for total excision of the tumor together with minimal surgical complications.


Utility of the New Early Warning Score (NEWS) in combination with the neutrophil-lymphocyte ratio for the prediction of prognosis in older patients with pneumonia.
Predictors of prognosis are necessary for use in routine clinical practice for older patients with pneumonia, given the ageing of the population. Recently, the National Early Warning Score (NEWS), a comprehensive predictor of severity that consists solely of physiological indicators, has been proposed to predict the prognosis of pneumonia. The neutrophil/lymphocyte ratio (NLR) is a simple index of inflammation that may also be predictive of pneumonia. In the present study, we aimed to determine whether NEWS or a combination of NEWS and NLR predicts mortality in older patients with pneumonia. A retrospective cohort study. A general hospital in Japan. We collected data from patients aged ≥65 years with pneumonia who were admitted between 2018 and 2020 (n=282; age=85.3 (7.9)). Data regarding vital signs, demographics and the length of hospital stay, in addition to the NEWS and NLR, were extracted from the participants' electronic medical records. The utility of the combination of NEWS and NLR was assessed using NEWS×NLR and NEWS+NLR. Their predictive ability for 30-day mortality as the primary outcome was assessed using receiver operating characteristic (ROC) curve analysis. According to the NEWS classification, 80 (28.3%), 64 (22.7%) and 138 (48.9%) of the participants were at low, medium and high risk of mortality, respectively. The 30-day mortality for the entire cohort was 9.2% (n=26), and the mortality rate increased with the NEWS classification: low, 1.3%; medium, 7.8%; and high, 14.5%. The NLRs were 6.0 (4.2-9.8), 6.8 (4.8-10.4) and 14.6 (9.4-22.2), respectively (p<0.001). The areas under the ROC curves for 30-day mortality were 0.73 for the NEWS score, 0.84 for NEWS×NLR and 0.83 for NEWS+NLR, indicating that the combinations represent superior predictors of mortality to the NEWS alone. NEWS×NLR and NEWS+NLR tended to have better sensitivity, accuracy, positive predictive value and negative predictive value than NEWS alone (p=0.06). A combination of the NEWS and NLR (NEWS×NLR or NEWS+NLR) may be superior to the NEWS alone for the prediction of 30-day mortality in older patients with pneumonia. However, further validation of these combinations for use in the prediction of prognosis is required.


Intracerebroventricular treatment of mice with pertussis toxin induces hyperalgesia and enhances 3H-nitrendipine binding to synaptic membranes: similarity with morphine tolerance.
The effect of intracerebroventricular treatment of mice with pertussis toxin (PTX) on pain perception and 3H-nitrendipine binding was examined to study a possible change in the GTP-binding proteins in morphine tolerant rodents. It was observed that both PTX treatment and chronic administration of morphine cause hyperalgesia in the acetic acid-induced writhing test. Analgesic effects brought by the acute administration of morphine or nifedipine, a calcium antagonist, were not affected by PTX treatment. In synaptic membrane fractions prepared from mice treated with PTX or morphine chronically, specific binding of 3H-nitrendipine was enhanced approximately 41.8% and 35.7%, respectively, without alteration in its affinity. Chronic administration of morphine followed by PTX treatment did not display further increases in 3H-nitrendipine binding. These results suggest that the PTX-sensitive GTP-binding proteins may not be involved in the manifestation of the analgesic effect of morphine in mice.


Temperature-dependent cage effects from triplet radical pairs generated upon irradiation of 1-(4-methylphenyl)-3-phenyl-2-propanone in polyethylene films.
The photochemistry of 1-(4-methylphenyl)-3-phenyl-2-propanone (MeDBK) in polyethylene (PE) films of varying crystallinity and at different temperatures has been investigated. Specifically, the selectivity of combination of the initially formed triplet pairs of benzylic radicals derived from irradiation of MeDBK has been used to determine the natures of the PE reaction cavities and how they influence the motions of the radicals. The results indicate that in-cage combinations are favored at lower temperatures and in PE of higher crystallinity. At temperatures significantly above the glass transition of PE, the fraction of radical pairs combining in-cage (F(c)) is independent of the extent of conversion of MeDBK. The data are interpreted according to a structural model that considers the shape, free volume, wall stiffness, and permeability of the reaction cavities and a dynamic model that includes the competition between the rates of in-cage combination and cage escape by the radical pairs. Near the glass transition temperature, F(c) decreases as the temperature is reduced and the data are interpreted using a stochastic model that considers the slow relaxation of the walls of the reaction cavities. The results demonstrate that the cavities afforded by PE can be subtly 'tuned' by temperature changes and microscopic variations in the polymer structure and morphology.


Heterogeneity and endotypes in type 1 diabetes mellitus.
Despite major advances over the past decade, prevention and treatment of type 1 diabetes mellitus (T1DM) remain suboptimal, with large and unexplained variations in individual responses to interventions. The current classification schema for diabetes mellitus does not capture the complexity of this disease or guide clinical management effectively. One of the approaches to achieve the goal of applying precision medicine in diabetes mellitus is to identify endotypes (that is, well-defined subtypes) of the disease each of which has a distinct aetiopathogenesis that might be amenable to specific interventions. Here, we describe epidemiological, clinical, genetic, immunological, histological and metabolic differences within T1DM that, together, suggest heterogeneity in its aetiology and pathogenesis. We then present the emerging endotypes and their impact on T1DM prediction, prevention and treatment.


Erratum: Multidisciplinary Taiwan Consensus Recommendations for the Use of DEBDOX-TACE in Hepatocellular Carcinoma Treatment.
[This corrects the article DOI: 10.1159/000487608.].


Comment on "Phonemic diversity supports a serial founder effect model of language expansion from Africa".
Atkinson (Reports, 15 April 2011, p. 346) argues that the phonological complexity of languages reflects the loss of phonemic distinctions due to successive founder events during human migration (the serial founder hypothesis). Statistical simulations show that the type I error rate of Atkinson's analysis is hugely inflated. The data at best support only a weak interpretation of the serial founder hypothesis.


A novel self-expanding transcatheter heart valve: Shaping the story beyond accuracy.
As transcatheter aortic valve implantation expands to low risk patients, the key to prolonged survival would be large effective orifice area with extremely low rates of paravalvular leak and permanent pacemaker implantation. New transcatheter valve technologies look promising to enable this, ACURATE neo is one such device. The results of ongoing trials with ACURATE neo and ACURATE neo2 are keenly awaited.


[Persistence of the right venous sinus valve simulating a right atrial myxoma in a case of total anomalous pulmonary venous return. Echocardiographic, anatomo-clinical and surgical aspects].
A case of persistence of the right venous sinus valve that on echocardiographic examination simulated right atrial myxoma is reported in a patient with total abnormal pulmonary venous return in the coronary sinus. Echocardiography showed a mobile, pedunculated mass present in systole in the right atrium that shifted to diastole in the right ventricle, highly suggestive of right atrial myxoma. The right ventricle also showed a volume overload and a space without echoes behind the left atrium. A membrane was encountered in the right atrium at surgery. This was removed and the venous return corrected.


Retrospective analysis of aeroallergen's sensitization patterns in Edmonton, Canada.
Sensitization to common environmental aeroallergens plays a significant role in the pathogenesis and severity of respiratory allergic disorders, specifically asthma and allergic rhinitis. Understanding sensitization patterns helps clinicians tailor care more effectively. This study examines patterns of sensitization to aeroallergens in subjects suspected of having an allergic disease in Edmonton and catchment area. Retrospective chart review of skin prick test (SPT) results to 11 environmental aeroallergens performed between January 1st and June 30th 2014 at a University-based clinic, where patients are referred for SPT by allergists, respirologists, otolaryngologists, internists and general practitioners. Potential differences in aeroallergen sensitization patterns were evaluated. A total of 623 patients (36.9% males; 63.1% females), aged 4-84 years (mean age 38.6 years) had SPT done, of which 438 (70.3%) had a positive test for at least one aeroallergen (atopy). There were no significant sex differences in the frequency of atopy (males: 71.3% versus females: 69.7%; p = 0.373). The frequency of sensitivity to particular allergens among atopic subjects was: cat (53.1%), house dust mites (50.3%), grass (39.2%), birch (23.7%), alternaria (23.7%), dog (17.3%), poplar (12.1%), cedar (9.6%), aspergillus (9.6%), hormodendrum (8%), and penicillium (6.2%). Of 438 atopic patients, 110 (25.1%) were mono sensitized, 199 (45.4%) oligosensitized (2-3 allergens), and 129 (29.5%) polysensitized (≥ 4 allergens). There were no significant differences between males and females in the odds of being oligo-sensitized (OR: 0.95; 95% CI 0.58, 1.57). Polysensitization was significantly more frequent in males 37.2% than in females 24.8%; (OR: 0.95; 95% CI 0.58, 1.57). Cat is the most frequent perennial allergen and timothy grass pollen the most frequent seasonal allergen in Edmonton and catchment area. There was no significant difference in the frequency of atopy between males and females. However, males were more likely to be polysensitized compared to females.


Greater α1-adrenergic-mediated vasoconstriction in contracting skeletal muscle of patients with type 2 diabetes.
Patients with type 2 diabetes mellitus (T2DM) exhibit diminished exercise capacity likely attributable to reduced skeletal muscle blood flow (i.e., exercise hyperemia). A potential underlying mechanism of the impaired hyperemic response to exercise could be inadequate blunting of sympathetic-mediated vasoconstriction (i.e., poor functional sympatholysis). Therefore, we studied the hyperemic and vasodilatory responses to handgrip exercise in patients with T2DM as well as vasoconstriction to selective α-agonist infusion. Forearm blood flow (FBF) and vascular conductance (FVC) were examined in patients with T2DM (n = 30) as well as nondiabetic controls (n = 15) with similar age (59 ± 9 vs. 60 ± 9 yr, P = 0.69) and body mass index (31.4 ± 5.2 vs. 29.5 ± 4.6 kg/m2, P = 0.48). Intra-arterial infusion of phenylephrine (α1-agonist) and dexmedetomidine (α2-agonist) were used to induce vasoconstriction: [(FVCwith drug - FVCpredrug)/FVCpredrug × 100%]. Subjects completed rest and dynamic handgrip exercise (20% of maximum) trials per α-agonist. Patients with T2DM had smaller increases (Δ from rest) in FBF (147 ± 71 vs. 199 ± 63 ml/min) and FVC (126 ± 58 vs. 176 ± 50 ml·min-1·100 mmHg-1, P < 0.01 for both) during exercise compared with controls, respectively. During exercise, patients with T2DM had greater α1- (-16.9 ± 5.9 vs. -11.3 ± 3.8%) and α2-mediated vasoconstriction (-23.5 ± 7.1 vs. -19.0 ± 6.5%, P < 0.05 for both) versus controls. The magnitude of sympatholysis (Δ in %vasoconstriction between exercise and rest) for PE was lower (worse) in patients with T2DM versus controls (14.9 ± 12.2 vs. 23.1 ± 8.1%, P < 0.05) whereas groups were similar during DEX trials (24.6 ± 12.3 vs. 27.6 ± 13.4%, P = 0.47). Our data suggest patients with T2DM have attenuated hyperemic and vasodilatory responses to exercise, which could be attributable to greater α1-mediated vasoconstriction in contracting skeletal muscle.NEW & NOTEWORTHY Findings presented in this article are the first to show patients with type 2 diabetes mellitus have blunted hyperemic and vasodilatory responses to dynamic handgrip exercise. Moreover, we illustrate greater α1-adrenergic-mediated vasoconstriction may contribute to our initial observations. Collectively, these data suggest patients with type 2 diabetes may have impaired functional sympatholysis, which can contribute to their reduced exercise capacity.


Provocative challenge with local anesthetics in patients with a prior history of reaction.
Possible allergic sensitivity to local anesthetic agents remains problematic for some patients who could benefit from their use. We retrospectively reviewed all our consultations for evaluation of local anesthetic allergy from 1965 to 1985 to assess the safety and efficacy of skin testing and provocative test dosing with a variety of local anesthetic agents. Fifty-nine patients reported 70 reactions from the administration of six different local anesthetics. Fifty-four patients could name one or more local anesthetic agents they believed were responsible, and five patients named only "caine" drugs. Multiple reactions of the same type to the same agent were considered as one reaction. On the basis of their history of reaction, the patients were categorized as follows: anaphylactoid reactions (urticaria, angioedema, wheezing, or hypotension within 1 to 2 hours of exposure), possible anaphylactoid reactions (tachycardia, dizziness, syncope, breathlessness, or pruritus occurring within 1 to 2 hours of exposure), contact dermatitis (a typical eczematous skin eruption after appropriate cutaneous sensitization), and other reactions (nonanaphylactoid reactions other than those already described or those occurring more than 2 hours after exposure). Fifty-nine patients were administered local anesthetics after skin testing and provocative test dosing, including two patients who required intravenous lidocaine (Xylocaine; Astra Pharmaceutical Products, Inc., Westboro, Mass.) acutely to control cardiac arrhythmias. These two patients had reported anaphylactoid reactions to oral antiarrhythmic drugs of the local anesthetic class. Despite the history of previous reactions, there were no positive skin tests or positive provocative drug challenges in any patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Causal and Candidate Gene Variants in a Large Cohort of Women With Primary Ovarian Insufficiency.
A genetic etiology likely accounts for the majority of unexplained primary ovarian insufficiency (POI). We hypothesized that heterozygous rare variants and variants in enhanced categories are associated with POI. The study was an observational study. Subjects were recruited at academic institutions. Subjects from Boston (n = 98), the National Institutes of Health and Washington University (n = 98), Pittsburgh (n = 20), Italy (n = 43), and France (n = 32) were diagnosed with POI (amenorrhea with an elevated follicle-stimulating hormone level). Controls were recruited for health in old age or were from the 1000 Genomes Project (total n = 233). We performed whole exome sequencing (WES), and data were analyzed using a rare variant scoring method and a Bayes factor-based framework for identifying genes harboring pathogenic variants. We performed functional studies on identified genes that were not previously implicated in POI in a D. melanogaster model. Genes with rare pathogenic variants and gene sets with increased burden of deleterious variants were identified. Candidate heterozygous variants were identified in known genes and genes with functional evidence. Gene sets with increased burden of deleterious alleles included the categories transcription and translation, DNA damage and repair, meiosis and cell division. Variants were found in novel genes from the enhanced categories. Functional evidence supported 7 new risk genes for POI (USP36, VCP, WDR33, PIWIL3, NPM2, LLGL1, and BOD1L1). Candidate causative variants were identified through WES in women with POI. Aggregating clinical data and genetic risk with a categorical approach may expand the genetic architecture of heterozygous rare gene variants causing risk for POI.


Hierarchical nanostructured noble metal/metal oxide/graphene-coated carbon fiber: in situ electrochemical synthesis and use as microelectrode for real-time molecular detection of cancer cells.
We report the design and fabrication of a new type of nanohybrid microelectrode based on a hierarchical nanostructured Au/MnO2/graphene-modified carbon fiber (CF) via in situ electrochemical synthesis, which leads to better structural integration of different building blocks into the CF microelectrode. Our finding demonstrates that wrapping CF with graphene nanosheets has dramatically increased the surface area and electrical conductivity of the CF microelectrode. The subsequent template-free electrodeposition of MnO2 on graphene-wrapped CF gives rise to a porous nanonest architecture built up from twisted and intersectant MnO2 nanowires, which serves as an ideal substrate for the direct growth of Au nanoparticles. Owing to the structural merit and synergy effect between different components, the hierarchical nanostructured noble metal/metal oxide/graphene-coated CF demonstrates dramatically enhanced electrocatalytic activity. When used for nonenzymatic H2O2 sensing, the resultant modified microelectrode exhibits acceptable sensitivity, reproducibility, stability, and selectivity, which enable it to be used for real-time tracking H2O2 secretion in human cervical cancer cells. Graphical abstract A schematic illustration of preparation of hierarchical Au/MnO2/ERGO/CF nanohybrid electrode for real-time molecular detection of cancer cells.


Mesenchymal tumours of the mediastinum--part II.
This is the second part of a two-part review on soft tissue tumours which may be encountered in the mediastinum. This review is based on the 2013 WHO classification of soft tissue tumours and the 2015 WHO classification of tumours of the lung, pleura, thymus and heart and provides an updated overview of mesenchymal tumours that have been reported in the mediastinum.


Bronchodilator responsiveness and atopy in 5-10-yr-old coughers.
Cough-variant asthma is considered by some to be an asthma phenotype. Bronchodilator responsiveness (BDR) is an undisputed feature of asthma. Of school-aged wheezers, 90% are atopic. Are school-aged coughers who demonstrate BDR also atopic? If so, then it would be reasonable to reserve the diagnosis cough-variant asthma for this particular group. Airway resistance was measured by the interrupter technique (Rint) before and after salbutamol in controls (n=73), coughers (n=63) and previous wheezers (n=63) aged 5-10 yrs. Immunoglobulin (Ig)-E was measured in coughers and wheezers. BDR was expressed as the ratio baseline:post-salbutamol Rint. Groups were of similar age (mean 6.7, range 5-9.9 yrs). Geometric mean baseline Rint was similar in controls and coughers (0.66 and 0.68 kPa x L(-1) x s), but the baseline Rint for wheezers (0.73 kPa x L(-1) s) was greater than that for controls (p=0.05) but not significantly different from coughers (p=0.17). Geometric mean BDR in coughers was 1.22, controls 1.13 and wheezers 1.30 (p=0.01 for coughers and controls; p=0.08 for coughers and wheezers; p<0.001 for controls and wheezers). IgE was lower in coughers than wheezers (geometric means 36 and 364 International Units (IU) x L(-1), p<0.001) and was unrelated to BDR in both groups. In summary, atopy, and not bronchodilator responsiveness, distinguishes groups of coughers from groups of wheezers. A diagnosis of cough-variant asthma cannot be reserved for even those school-aged coughers, who demonstrate bronchodilator responsiveness.


Dual Diagnosis in an Aging Population: Prevalence of Psychiatric Disorders, Comorbid Substance Abuse, and Mental Health Service Utilization in the Department of Veterans Affairs.
In the context of an aging baby boom cohort with higher rates of substance use disorders than previous cohorts, the abuse of substances and dual diagnosis represent growing areas of concern among older adults. The aims of this study were to determine the current treated prevalence of major psychiatric illnesses, substance use disorders, and dual diagnosis across multiple age groups in a national sample of mental health patients and to examine associated service utilization. Using administrative data from specialty mental health clinics in the Department of Veterans Affairs (N = 911,725), treated prevalence of major psychiatric illnesses, substance use disorders, and dual diagnosis across multiple age groups were determined over a 1-year interval (FY 2009). Associated mental health service utilization was examined. Treated prevalence of almost all major psychiatric and substance use disorders decreased with age, while dementias increased with age. Across all major psychiatric illnesses, documented comorbid substance abuse decreased with age. Those with dual diagnoses had higher utilization of outpatient services compared to those without substance use disorders. With older age, patients had fewer outpatient visits and reduced likelihood of psychiatric hospitalization, but incurred more inpatient days per episode. Treated prevalence of substance use disorders and dual diagnosis decreases with age, falling to approximately 10% in those older than 65. Questions remain regarding the possibility of underdiagnosis of substance use disorders in the elderly.


Male African Elephant (Loxodonta africana) Behavioral Responses to Estrous Call Playbacks May Inform Conservation Management Tools.
Driven by reproductive motives, male African elephants (Loxodonta africana) in musth often expand their home ranges to locate estrous females. This extended range, coupled with heightened aggression often observed in musth males, can be particularly problematic in regions where human-modified landscapes and elephant territories increasingly overlap. Several mitigation tools have been tested to resolve a wide range of human-elephant conflicts with varying degrees of success due to geographical disparities and habituation. We present findings on the potential application of estrous call playbacks in manipulating the behavior and movement of male elephants non-invasively, particularly mature musth adults and younger post-dispersal males, in Etosha National Park. Estrous vocalizations were presented across 26 experimental trials to mature musth adults (n = 5), mature non-musth adults (n = 6), and non-musth males belonging to younger, post-dispersal age classes (n = 8), with behavioral responses scored on a gradient scale from 0-1. Both mature musth adults and younger non-musth elephants were significantly more likely to respond with the highest intensity by approaching the acoustic source compared to mature non-musth adults that avoided the call. However, younger males tested in the presence of an older, higher-ranking male tended to react with a lower intensity than those tested alone. This result likely demonstrates the influence of social hierarchy and associations on male elephant behavior. We also observed a significant increase in physiological response, measured by defecation rate, across all male groups in response to the estrous call playbacks. Our findings suggest that using estrous calls as acoustic deterrents may effectively and non-invasively aid in reducing tension at the human-elephant interface, depending on the age, social context, and reproductive status of the male elephant.


Combined diffuse alveolar hemorrhage and venous thrombosis in a patient with granulomatosis with polyangiitis: Case report and systematic review of literature.
Antineutrophil cytoplasmic antibody-associated vasculitis has associations with both thrombosis and diffuse alveolar hemorrhage (DAH). Management of patients having coexistence of both thrombotic and hemorrhagic manifestations is challenging. Thrombotic conditions require anticoagulation, which can theoretically increase the risk of bleeding and thereby worsen DAH. In this review, we highlight the management of a patient of granulomatosis with polyangiitis with DAH who developed deep vein thrombosis. A systematic review of the literature was also performed summarizing and discussing the issues pertaining to the management of such patients.


In Situ Generation of Ruthenium Carbonyl Phosphine Complexes as a Versatile Method for the Development of Enantioselective C-O Bond Arylation.
We report here a method for in situ generation of various ruthenium carbonyl phosphine catalysts for arylation via cleavage of inert aromatic carbon-oxygen bonds. The use of catalyst systems consisting of [RuCl2 (CO)(p-cymene)], CsF, styrene, and phosphines enabled facile screening of phosphine ligands. Asymmetric C-O arylation was also achieved for atropo-enantioselective biaryl synthesis using a chiral monodentate phosphine ligand.


Shaping of discrete auditory inputs to extramodular zones of the lateral cortex of the inferior colliculus.
The multimodal lateral cortex of the inferior colliculus (LCIC) exhibits a modular-extramodular micro-organization that is evident early in development. In addition to a set of neurochemical markers that reliably highlight its modular-extramodular organization (e.g. modules: GAD67-positive, extramodular zones: calretinin-positive, CR), mature projection patterns suggest that major LCIC afferents recognize and adhere to such a framework. In adult mice, distinct afferent projections appear segregated, with somatosensory inputs targeting LCIC modules and auditory inputs surrounding extramodular fields. Currently lacking is an understanding regarding the development and shaping of multimodal LCIC afferents with respect to its emerging modular-extramodular microarchitecture. Combining living slice tract-tracing and immunocytochemical approaches in GAD67-GFP knock-in mice, the present study characterizes the critical period of projection shaping for LCIC auditory afferents arising from its neighboring central nucleus (CNIC). Both crossed and uncrossed projection patterns exhibit LCIC extramodular mapping characteristics that emerge from initially diffuse distributions. Projection mismatch with GAD-defined modules and alignment with encompassing extramodular zones becomes increasingly clear over the early postnatal period (birth to postnatal day 12). CNIC inputs terminate almost exclusively in extramodular zones that express CR. These findings suggest multimodal LCIC inputs may initially be sparse and intermingle, prior to segregation into distinct processing streams. Future experiments are needed to determine the likely complex interactions and mechanisms (e.g. activity-dependent and independent) responsible for shaping early modality-specific LCIC circuits.


Various glucocorticoids differ in their ability to induce gene expression, apoptosis and to repress NF-kappaB-dependent transcription.
Glucocorticoids (GCs) influence a great variety of cellular functions by at least three important modes of action: the activation (or repression) of genes controlled by binding sites for the glucocorticoid receptor (GR), the induction of apoptosis in lymphocytes and the recently discovered cross-talk to other transcription factors such as NF-kappaB. In this study we systematically compared various natural and synthetic steroid hormones frequently used as therapeutic agents on their ability to mediate these three modes of action. Betamethasone, triamcinolone, dexamethasone and clobetasol turned out to be the best inducers of gene expression and apoptosis. All GCs including the antagonistic compound RU486 efficiently reduced NF-kappaB-mediated transactivation to comparable extents, suggesting that ligand-induced nuclear localization of the GR is sufficient for transrepression. Glucocorticoid treatment of cells did not result in elevated IkappaB-alpha expression, but impaired the tumor necrosis factor (TNF)-alpha-induced degradation of IkappaB-alpha without affecting DNA binding of NF-kappaB. The structural requirements for the various functions of glucocorticoids are discussed.


Muscle fiber-type distribution pattern in the human cricopharyngeus muscle.
Our previous studies described that the human cricopharyngeus (CP) is composed of two neuromuscular compartments (NMCs), horizontal and oblique. The present study was designed to explore the differences in muscle fiber-type distribution between the NMCs within the human CP and to examine the oxidative capacity of the muscle fibers. Seven adult human CP muscles obtained from autopsies were stained for myofibrillar ATPase, reduced nicotinamide adenine dinucleotide tetrazolium reductase (NADH-TR), and succinic dehydrogenase (SDH) to analyze enzyme-histochemical fiber-type characteristics. Notable findings obtained from this study are as follows: (1) Different NMCs within the human CP contained different percentages of muscle fiber types. The horizontal CP (CPh) contained more slow-twitch fibers than the oblique CP (CPo). (2) Each of the NMCs was dividable histochemically into two layers or subcompartments: a slow fiber-type inner layer and a relatively fast fiber outer layer. (3) As a whole, type I fibers had higher levels of NADH-TR and SDH than type II fibers. However, in both type I and II muscle fiber types, different patterns of oxidative enzyme activity were seen. Histochemically defined fiber layers of the CP are not seen in other mammals, suggesting that CP function is more specialized in humans.


Effect of granulocyte colony-stimulating factor on myocardium recovery in postinfarction period.
The effect of Neutrostim (preparation of granulocytic colony-stimulating factor) on recovery of myocardial tissue after acute myocardial infarction was studied in rats. A course of Neutrostim after ligation of the left coronary artery led to normalization of electrocardiographic and morphological parameters of the myocardium after one month.


Preliminary evidence for the metabolism of benzo(a) pyrene by Plantago lanceolata.
Polycyclic aromatic hydrocarbons (PAHs) have long been recognised as potential carcinogens in animals in which biotransformation into reactive metabolites can lead to DNA damage. In animals PAHs metabolism mainly occurs in hepatic microsomes and is associated with the cytochrome p-450 mediated mixed functional oxidase (MFO) system. PAH metabolism in plants has been shown to occur via a similar enzyme system, but has received relatively little attention. This study is looking at how the plant species Plantago lanceolata metabolizes benzo(a)pyrene (B(a)P), which is one of the PAHs whose metabolism has been studied extensively in animals. The aim of the work is to establish firstly that the B(a)P is taken up and secondly that it is biotransformed by the plant to products possibly similar to those found in animals. This work is achieved by using C-14-B(a)P along with whole body autoradiography, scintillation analysis and chromatography techniques to locate the B(a)P and its metabolites.


Central presbycusis: an emerging view.
Age-related dysfunction of the central auditory system (central presbycusis) is common but rarely looked for by those who provide aural rehabilitation. Patients who complain of difficulty hearing in noise--the key symptom of central presbycusis--are generally disadvantaged with conventional rehabilitation. This symptom should be documented with commercially available speech-in-noise tests, which use materials that are uncomplicated to administer. Those patients who perform poorly on such tests should have a customized rehabilitation program aimed at optimizing their remaining communication abilities. Otolaryngologists who provide auditory rehabilitation may wish to consider expanding their practices to meet the communication needs of older patients with central presbycusis. Central presbycusis is an emerging area for basic and clinical research in auditory neurotology, particularly in the relation of cognitive dysfunction to impaired auditory processing.


Lung ultrasound in children: What does it give us?
Lung ultrasound (LUS), a non-invasive non-ionizing radiation tool, has become essential at the bedside in both adults and children, particularly in the critically ill. This manuscript reviews normal LUS patterns and the most important pathologies that LUS allows to diagnose. Normal LUS is represented by the pleural line, the lung-sliding and the A-lines and B-lines. These two last findings are artifacts derived from the pleural line. Pleural effusion appears as an anechoic collection. Pneumothorax is suspected when only A-lines are present, without lung-sliding and B-lines. Alveolo-interstitial syndrome is characterized by different degrees of confluent B-lines and can be present in different pathologies such as pulmonary edema and acute respiratory distress syndrome. The distribution of B-lines helps to differentiate between them. LUS is useful to evaluate the response to lung recruitment in pathologies such as acute respiratory distress syndrome or acute chest syndrome. The distribution of B-lines also appears to be useful to monitor the response to antibiotics in pneumonia. However, further studies are needed to further ascertain this evidence. LUS is also useful to guide thoracocentesis.


Real-time 3-dimensional Doppler echocardiography for the assessment of stroke volume: an in vivo human study compared with standard 2-dimensional echocardiography.
Invasive monitors and noninvasive 2-dimensional echocardiography are the standard clinical methods for stroke volume (SV) and cardiac output computation. We studied the use of real-time color Doppler 3-dimensional (3D) echocardiography (3DE) for the assessment of SV in human beings. In all, 55 pediatric and adult patients with good transthoracic windows and a normal aortic valve were studied. Real-time 3DE color Doppler volumes incorporating the left ventricular outflow tract and aortic valve were taken. SV was calculated from the color Doppler data in the 3DE DICOM dataset. This was compared with 2-dimensional echocardiography SV calculation from the pulsed wave velocity through the aortic valve along with the left ventricular outflow tract diameter. Five patients were excluded because of mismatching of the 3D color Doppler segments in the 3D volume. The 3D Doppler volumes from the remaining 50 patients were analyzed. There was good correlation between the patients' averaged 3DE SV calculations and the 2-dimensional echocardiography pulsed wave SV estimation (y = 0.84x + 7.8, r2 = 0.90). Real-time 3D Doppler echocardiography can be used to accurately calculate SV and cardiac output, compared with conventional pulsed Doppler measurement, in pediatric and adult patients from transthoracic imaging.


Effect of nebivolol and atenolol on brachial artery flow-mediated vasodilation in patients with coronary artery disease.
Endothelial dysfunction is considered to be the first step in atherogenesis as well as a predictor of adverse cardiovascular events in patients with coronary artery disease (CAD), while endothelial function improvement is associated with improved clinical outcome. Nebivolol is a beta1-adrenoreceptor antagonist with an independent beneficial action on endothelial function, increasing nitric oxide bioavailability. The aim of the present study was to examine the effects of nebivolol on endothelial function in the brachial artery in patients with CAD compared with another selective beta1 adrenergic receptor antagonist, atenolol. Thirty-five patients with stable CAD were randomized to receive either 5 mg nebivolol (n = 17) or 50 mg atenolol (n = 18) daily for 4 weeks. Each patient underwent measurement of endothelial function by means of flow-mediated dilatation (FMD) of the brachial artery before and after 4 weeks of treatment. All vasoactive drugs and cardiovascular risk factors were comparable in the two groups. No significant differences were observed between the two groups at baseline in FMD. In the atenolol group FMD remained unchanged at the end of the 4-week treatment, but in patients treated with nebivolol FMD showed a significant increase by the end of the treatment period (3.9 +/- 2.7% vs. 5.6 +/- 2.9%, p = 0.047) leading to a significantly higher value compared to patients treated with atenolol (5.6 +/- 2.9% vs. 3.4 +/- 3.2%, p = 0.041).Beta(1) blockade by nebivolol but not atenolol improves endothelial dysfunction in patients with CAD, an effect that might further reduce the risk for cardiovascular events in patients with CAD.


Neurophysiological mechanisms involved in tonic immobility (TI).
This chapter summarizes the main neurophysiological characteristics of tonic immobility (TI), in many susceptible species of mammals and birds. During TI, cortical EEG shows high voltage slow waves whose amount is affected by events preceding TI induction and is positively correlated with TI duration. The pattern of hippocampal activity helps to predict TI onset and TI termination. Both polysynaptic flexor and monosynaptic heteronymous reflexes are depressed independently from the EEG activity. Brain metabolism, signaled by glycogen mobilization and glucose utilization, indicates a reduced neuronal activity during TI. Learned avoidance responses to shock can be extinguished during TI and recover after TI. Moreover, during TI animals may learn how to avoid the shock by a motor response that may be followed by TI interruption. Decortication, decerebellation and telencephalic sections do not affect TI characteristics, whereas ponto-mesencephalic sections abolish both righting reflexes and TI.


Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students.
Despite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group. Using national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention. Overall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p < .001). Similar findings were observed in the transgender cultural competence scores (pre- (M = 4.02); post- (M = 5.08); one-month (M = 4.92, p < .001)). Educational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.


Internal mammary artery for arterial pressure monitoring after pediatric cardiac operations.
Establishing and maintaining arterial access in pediatric cardiac operations is a frequent and sometimes frustrating problem. We have modified a procedure commonly used in our research laboratory for arterial pressure monitoring and applied it successfully to the pediatric cardiac surgical patient. The internal mammary artery can provide reliable arterial access in the postoperative period.


Parallel simulations for QUAntifying RElaxation magnetic resonance constants (SQUAREMR): an example towards accurate MOLLI T1 measurements.
T1 mapping is widely used today in CMR, however, it underestimates true T1 values and its measurement error is influenced by several acquisition parameters. The purpose of this study was the extraction of accurate T1 data through the utilization of comprehensive, parallel Simulations for QUAntifying RElaxation Magnetic Resonance constants (SQUAREMR) of the MOLLI pulse sequence on a large population of spins with physiologically relevant tissue relaxation constants. A CMR protocol consisting of different MOLLI schemes was performed on phantoms and healthy human volunteers. For every MOLLI experiment, the identical pulse sequence was simulated for a large range of physiological combinations of relaxation constants, resulting in a database of all possible outcomes. The unknown relaxation constants were then determined by finding the simulated signals in the database that produced the least squared difference to the measured signal intensities. SQUAREMR demonstrated improvement of accuracy in phantom studies and consistent mean T1 values and consistent variance across the different MOLLI schemes in humans. This was true even for tissues with long T1s and MOLLI schemes with no pause between modified-Look-Locker experiments. SQUAREMR enables quantification of T1 data obtained by existing clinical pulse sequences. SQUAREMR allows for correction of quantitative CMR data that have already been acquired whereas it is expected that SQUAREMR may improve data consistency and advance quantitative MR across imaging centers, vendors and experimental configurations. While this study is focused on a MOLLI-based T1-mapping technique, it could however be extended in other types of quantitative MRI throughout the body.


In vivo autoradiographic analysis of prolactin binding in brain and choroid plexus of the domestic ring dove.
The binding of intravenously administered prolactin to choroid plexus and brain tissue was determined radioautographically in the ring dove, a species that exhibits prolactin-induced alterations in brain function. An intense autoradiographic reaction was detected over the epithelial cells of the choroid plexus 5 min after the intravenous injection of 125I-ovine prolactin. A significant reaction was also observed over the infundibulum but no significant uptake of prolactin occurred in other brain areas. The binding of radiolabelled prolactin to infundibulum appeared to be non-specific, since excess unlabelled hormone did not reduce silver grain density. In contrast, 125I-ovine prolactin binding in choroid plexus was significantly reduced by excess unlabelled ovine prolactin or human growth hormone, but not by ovine luteinizing hormone. Specific binding to choroid plexus was also detected in vitro. The lack of significant brain uptake of prolactin in vivo is discussed in relation to recent in vitro evidence for specific binding sites for prolactin in several dove brain regions. Similarities between the binding results obtained in this avian species and those reported previously in mammals suggest that the two vertebrate groups exhibit similar patterns of prolactin interaction with neural target tissues.


Hearing-aid use and benefit: a long-term follow-up in patients undergoing surgery for otosclerosis.
The aims of the study were to assess hearing-aid uptake in patients with otosclerosis 28-30 years after stapedectomy and to evaluate hearing-aid benefit to users. A retrospective study was performed; it included a review of medical records and follow-up 28-30 years after surgery, including audiometry, clinical examination, structured interview, and a validated questionnaire, IOI-HA. Sixty-five patients, who had undergone stapedectomy at a tertiary referral center in 1977-79. In 95% of the subjects there was a theoretical need for hearing-aid amplification at follow-up; 46% of the subjects had no hearing aids, while 26% had unilateral and 28% bilateral hearing aids. Hearing sensitivity in the best ear predicted hearing-aid uptake. Of the subjects with a hearing aid, 94% were everyday users and 54% were full-time users (> 8 hours/day). The subjects reported a high level of satisfaction (mean 4.5) and benefit (mean 4.2), but also residual activity limitations (mean 3.1). The study shows that there is an unmet need for long-term hearing rehabilitation among patients previously undergoing surgery for otosclerosis. The patients who were using hearing aids were generally very satisfied with their hearing aids, but they still reported residual activity limitations.


Postoperative environmental anesthetic vapour concentrations following removal of the airway device in the operating room versus the postanesthesia care unit.
This study was designed to compare waste anesthetic gas (WAG) concentrations within patients' breathing zones after removal of the patient's airway device in the postanesthesia care unit (PACU) vs in the operating room (OR). Following Research Ethics Board approval and patient consent, we recruited patients undergoing surgery who received volatile anesthesia via an endotracheal tube or supraglottic airway. Patients had their airway device removed in the OR or in the PACU depending on the attending anesthesiologist's preference. Upon the patient's arrival in the PACU, concentrations of exhaled sevoflurane and desflurane were measured at their breathing zone (i.e., 15 cm from the patient's mouth and nose) using a single-beam infrared spectrophotometer. Seventy patients were recruited during the five-month study period. The median [interquartile range] WAG levels in the patients' breathing zones were higher when their airway devices were removed in the PACU vs in the OR. The WAG levels for sevoflurane were 0.7 [0.4-1.1] parts per million (ppm) vs 0.5 [0.4-0.7] ppm, respectively; median difference, 0.3; 95% confidence interval (CI), 0.1 to 0.6; P = 0.04. The WAG levels for desflurane were 2.4 [1.2-3.4] ppm vs 4.1 [2.5-5.2] ppm, respectively; median difference, 1.5; 95% CI, 0.3 to 2.7; P = 0.04. After a volatile-based anesthetic, our results suggest that removal of the airway device in the PACU vs in the OR increases the amount of waste anesthetic gas in a patient's breathing zone and thus potentially in the PACU nurse's working zone.


Isolation and characterization of a lindane degrading bacteria Paracoccus sp. NITDBR1 and evaluation of its plant growth promoting traits.
Lindane contamination in different environmental compartments is still posing a serious threat to our environment and effective measures need to be taken for the detoxification of lindane. Soil bacteria isolated from agricultural fields are known to possess certain plant growth promoting traits like the production of phytohormones, production of ammonia, nitrogen fixation and solubilization of phosphorus, etc. In the present study, an indigenous bacterial strain Paracoccus sp. NITDBR1 have been isolated from an agricultural field in Manipur, India which could grow on 100 mg L-1 lindane as the sole source of carbon and could degrade up to 90% of lindane in mineral salt media under liquid culture conditions in 8 days. The strain NITDBR1 was able to form biofilm in lindane media and the addition of substrate like glucose and sucrose enhanced the biofilm formation by 1.3 and 1.17-fold respectively in 3 days. The strain NITDBR1 could produce glycolipid and glycoprotein based biosurfactants. It was also found to possess plant growth promoting traits like nitrogen fixation and indole-3-acetic acid production to assist crop production. The phytotoxicity studies carried out on mustard seeds revealed that the degradation products formed after treatment with NITDBR1 could lower the toxicity of lindane for root elongation by 1.3-fold. Therefore, strain NITDBR1 could be useful for the bioremediation of soil contaminated with lindane with lesser damage to the environment, biofilm forming ability may help the bacteria survive under stressed environmental conditions, and biosurfactant production will help in increasing the bioavailability of contaminants. The plant growth promoting traits can be beneficial for agriculture. With such soil friendly activities coupled with pesticide degradation, this strain can be used for environmental as well as agricultural applications.


No effect of the Trp64Arg variant of the beta3-adrenergic receptor gene on weight loss by diet and exercise intervention among Japanese adults.
Controversy remains as to whether the presence of the tryptophan-to-arginine (Trp64Arg) variant of the beta(3)-adrenergic receptor gene impedes the magnitude of body weight loss by diet and exercise intervention. The objectives of the present study were to compare the changes in body weight between carriers and noncarriers of the Trp64Arg variant before and after 6 months of diet and exercise interventions for weight loss. A total of 37 middle-aged Japanese individuals (12 carriers and 25 noncarriers of the Trp64Arg variant) participated in the study. There were no significant differences in body weight between the 2 groups at the baseline. There were significant reductions in body weight both in carriers and noncarriers, but no significant differences between the 2 groups with respect to changes in these variables. The weight changes were -2.52 kg (95% confidence interval [CI], -3.56 to -1.48) among carriers and -1.89 kg (95% CI, -2.65 to -1.13) among noncarriers, and the change in the variant carrier group minus the change in the variant noncarrier group was -0.47 (95% CI, -1.97 to 1.02). These results suggest that the presence of the Trp64Arg variant of the beta(3)-adrenergic receptor gene may not play a major role as a hindrance to weight reduction.


Information processing in a binary classification task.
Three choice-reaction time studies were conducted to investigate whether information processing is exhaustive or self-terminating, serial or parallel, and N-dependent or N-independent. A total of 54 subjects were required to make key-pressing responses to one, two, or three digits presented in a circular display; one key was pressed if the display contained one or more target digits and another key was pressed if the display contained only nontarget digits. The first two studies utilized within-subjects designs in which the displays were constructed from only one target and one nontarget item (Study 1) or from three target and seven nontarget items (Study 2). The third study used a between-subjects design in which different groups of subjects responded to one-, two-, or three-element displays. In general, the results indicate that CRTs increased as the total number of display elements increased and decreased as the number of target elements (or the ratio of target to nontarget items) increased for a given display size. When only target elements were presented, CRT was independent of the number of elements displayed, and when only one target was presented, CRT increased as total number of elements increased. Theses combined results are interpreted as support for the inference that information processing in visual search tasks tends to be self-terminating, serial, and N-dependent (of limited capacity).


Endoscopic-Assisted Transaxillary Breast Augmentation.
Breast augmentation with implants is becoming a more widely accepted and popular procedure in Asia. The axillary approach remains the preferred incision for Asian women. Endoscope technique is the best option for transaxillary breast augmentation. It greatly increases control over the process, avoids various drawbacks, reduces the incidence of complications, and improves the stability of clinical effects of transaxillary implant breast augmentation. Freestyle endoscopic technique may greatly improve the flexibility and efficiency of the endoscope operation through the axillary approach. This article introduces the freestyle endoscopic-assisted transaxillary breast augmentation with high position dual-plane technique.


[Arizona bacteria (salmonella subgenus III), a rarely identified cause of food infections (author's transl)].
A report is given of the infection, described under the clinical picture of enteritis, of a one-year old Turkish child with Salmonella arizonae 61:k:1,5,7 (Arizona 26:29-30) which is largely adapted to sheep. It appears that, outside of the USA reports have not been published on infections with this species of Salmonella. Considering that reports on human infections with Salmonellae of the subgenus III (Arizona bacteria) have rarely been published, it was decided to deal with these Salmonellae in general, especially with their reservoirs, the clinical pathological pictures and the problems associated with the bacteriological diagnosis which is made on the basis of the ready splitting of lactose of numerous species of the Arizona group.


Development of a prognostic model of overall survival in oropharyngeal cancer from real-world data: PRO.M.E.THE.O.
The PRO.M.E.THE.O. study (PredictiOn Models in Ent cancer for anti-EGFR based THErapy Optimization) aimed to develop a predictive model (PM) of overall survival (OS) for patients with locally advanced oropharyngeal cancer (LAOC) treated with radiotherapy (RT) and cetuximab (Cet) from an Italian dataset. We enrolled patients with LAOC from 6 centres treated with RT-Cet. Clinical and treatment variables were collected. Patients were randomly divided into training (TS) (80%) and validation (VS) (20%) sets. A binary logistic regression model was used on the TS with stepwise feature selection and then on VS. Timepoints of 2, 3 and 5 years were considered. The area under the curve (AUC) of receiver operating characteristic of 2, 3 and 5 year and confusion matrix statistics at 5-threshold were used as performance criteria. Overall, 218 patients were enrolled and 174 (79.8%) were analysed. Age at diagnosis, gender, ECOG performance, clinical stage, dose to high-risk volume, overall treatment time and day of RT interruption were considered in the final PMs. The PMs were developed and represented by nomograms with AUC of 0.75, 0.73 and 0.73 for TS and 0.713, 0.713, 0.775 for VS at 2, 3 and 5 years, respectively. PRO.M.E.THE.O. allows the creation of a PM for OS in patients with LAOC treated with RT-Cet.


Ecological response to antibiotics re-entering the aquaculture environment with possible long-term antibiotics selection based on enzyme activity in sediment.
Antibiotics are frequently applied in aquaculture to control infectious diseases and promote aquaculture production. The long-term application of antibiotics can lead to antibiotic resistance within an ecosystem. Herein, we assessed the ecological responses to two antibiotics (oxytetracycline (OTC) and sulfadiazine (SD)) at three concentrations (0 mg/kg (control), 10 mg/kg, and 1000 mg/kg) re-entering the aquaculture sediments of shrimp ponds with an approximately long-term drug application history (5, 15, and more than 30 years) for 2 and 4 months. For the newly reclaimed aquaculture ponds (approximately 5 years), the re-entered OTC significantly promoted urease activity (UA) and peroxidase activity (POA), while inhibited dehydrogenase activity (DHA) and fluorescein diacetate esterase activity (FDA). Meanwhile, the re-entered SD showed promotional effects on POA and DHA, and inhibitory effects on UA and FDA. For ponds with 15 years of aquaculture history, re-entered OTC promoted POA, inhibited FDA, and changed the influencing effects of UA and DHA with exposure time. The re-entered SD showed promotional effects on UA, POA and DHA, and inhibitory effects on FDA. For long-term aquaculture ponds (more than 30 years of aquaculture history), re-entered OTC promoted POA, DHA, and FDA, while it inhibited UA. Meanwhile, SD promoted all four enzyme activities. Pearson correlation analysis indicated that the variances of enzyme responses to the re-entry of antibiotics in the three sediment environments were related with the type, concentration, and exposure time of antibiotics, as well as the sediment properties and aquaculture history. The enzyme activities in the sediment environment from newly reclaimed aquaculture ponds were more sensitive to the re-entered antibiotics, while the enzyme activities displayed a clear tolerance in the sediment environment with more than 30 years of aquaculture history. However, in the sediment environment with 15 years of aquaculture history, the response of the enzyme activities to re-entered antibiotics demonstrated time processes of antibiotic adaptation during antibiotic resistance selection. This study has illustrated the effects of re-entered antibiotics on enzyme activities in the aquaculture environment with long-term antibiotic resistance/tolerance profiles, and further establishes the possible effects on ecosystem functioning in continuous antibiotic selection pressure.


[HPLC Fingerprint of QingGuangAn and Determination of the Main Components].
To establish an HPLC fingerprint of ethanol extract of QingGuangAn, and to determine the contents of paeoniflorin and calycosin-7-glucosid. HPLC analysis was performed on an Agilent 1260 Infinity LC system and carried out at 35 degrees C on a column of GRACE Alltima C18 (250 mm x 4.6 mm, 5 μm). A binary gradient elution system was composed of acetonitrile (phase A) and water solution (phase B). Detection was performed at the wavelength of 254 nm, the mobile flow rate was 0.8 mL/min. A matrix including 20 variations (characteristic peaks area) and 10 samples was constructed for similarity evaluation. The results showed that the collected samples had a good similarity. A specificity fingerprint was produced and 20 characteristic peaks were designated. The content of paeoniflorin and calycosin-7-glucosid was 0.368 and 0.049 mg/g, respectively. It is a reliable, available and quick method for quality control of QingGuangAn,which provides some reference for the comparison of different extracting methods of QingGuangAn and the differences of pharmacodynamic.


Shortening the duration between ovarian removal and cryopreservation helps preserve fertility and maintain ovarian reserve after transplantation in mice.
To evaluate the effect of storage of ovaries before cryopreservation on long-term fertility and ovarian reserve after transplantation in mice. Experimental study. University hospital. C57BL/6J and C57BL/6J-Tg (CAG-GFP) female mice. Storage and cryopreservation of mouse ovaries. Long-term fertility analysis of mice transplanted with thawed ovaries. Estrous cycles, number of live births, ovarian weight, and follicular counts of ovarian grafts. At the first mating 3 months after ovarian transplantation, the mean number of live births was 2.6 ± 0.6 in the control group (no storage); in the storage groups, the mean number of live births was 2.9 ± 0.7 after 4 hours, 1.3 ± 0.5 after 8 hours, 0.2 ± 0.2 after 12 hours, and 0.8 ± 0.5 after 24 hours of storage; the difference from the control group was significant in the 12-hour storage group. At the second mating 6 months after ovarian transplantation, the mean number of live births was 1.8 ± 0.6 in the control group and 2.4 ± 0.6 and 0.3 ± 0.2 in the 4- and 8-hour storage groups, respectively; no live births occurred in the 12- and 24-hour storage groups. Seven months after ovarian transplantation, the numbers of primordial, primary, early secondary, and late secondary follicles were significantly lower in the 8-, 12-, and 24-hour storage groups than in the control group. In mice, shortening the storage time of ovaries before cryopreservation preserved fertility and ovarian reserve after transplantation, indicating that human ovaries might be cryopreserved immediately after harvesting or transported as quickly as possible to a cryopreservation facility to allow young patients with cancer to preserve long-term fertility and ovarian reserve.


A High-Precision and Miniature Fiber Bragg Grating-Based Force Sensor for Tissue Palpation During Minimally Invasive Surgery.
This paper presents a novel Fiber Bragg Grating (FBG)-based palpation force sensor to explore tissue abnormalities during minimally invasive surgery. The proposed sensor design mainly consists of a miniature force-sensitive flexure, one tightly suspended optical fiber embedded with one FBG element and associated connectors and fixations. The flexure design has been prototyped through the configuration synthesis of Sarrus mechanism by using a rigid-body replacement method to achieve an excellent axial linear force-deformation relationship and a large measurement range. The mounted fiber has been configured at the flexure's central line with its two ends glued, and its tight suspension configuration can achieve improved resolution and sensitivity and avoid the FBG chirping failure compared to the commonly used direct FBG-pasting methods. Finite element method (FEM)-based simulation has been performed to investigate both static and dynamic performance to aid in structural design. Simulation-enabled structural optimization design has also been implemented to further improve the proposed design and the sensor's sensitivity has been increased. The optimized sensor design has been prototyped and calibrated to demonstrate an excellent linearity with a small linearity error of 0.97% and achieve a high resolution of 2.55 mN within a relatively large measurement range of 0-5 N. Dynamic force stimulation experiments, in vitro palpation implementation on a silicone phantom embedded with simulated tumors and ex vivo indentation experiments on a porcine liver have validated the effectiveness of the presented sensor design.


Talc pleurodesis in malignant pleural effusion: a systematic review and meta-analysis.
Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz < 0.0001], and bleomycin [RR (95% CI) 1.22 (1.05, 1.42); Pz = 0.008]. The comparison between talc pleurodesis and controls at the > 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); Pz = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.


Cytotoxicity and effects of T2-toxin on plasma proteins involved in coagulation, fibrinolysis and kallikrein-kinin system.
The activity of both the coagulation and fibrinolytic systems was markedly depressed 24 h after a sublethal dose of T-2 toxin. T-2 toxin was active as an anticoagulant at low doses, which did not affect the basal state of the animals. The kallikrein-kinin system was also affected by depletion of the prekallikrein, which indicates increased bradykinin levels in plasma. At the same time there was an increased activity of some clinically relevant enzymes in serum, indicating tissue injuries caused by T-2 toxin. All effects observed in this study reached their maximum within 24 h after administration, which corresponds to the time animals usually die when receiving a lethal dose. T-2 toxin does not, however, seem to affect the protease enzymes by reduced protein synthesis, because of early onset of the effects, nor does it act as a trigger itself. The effect of T-2 toxin on plasma protease enzymes is probably secondary to cytotoxic effects in the vascular endothelium.


Possible Therapeutic Effect of Stem Cell in Atherosclerosis in Albino Rats. A Histological and Immunohistochemical Study.
Atherosclerosis is the leading cause of death worldwide. there are no effective approaches to regressing atherosclerosis due to not fully understood mechanisms. Recently, stem cell-based therapies have held promises to various diseases, including vascular diseases. The present study aimed at investigating the possible effect of cord blood mesenchymal stem cell (MSC) therapy on atherosclerosis. Eighty adult male albino rats were divided into control group (I), atherogenic group (II): subjected to high cholesterol fed diet (200~300 mg/kg body weight) for 12 weeks and 1.8 million units of vitamin D / kg of diet for 6 weeks. Stem cell therapy group (III): injected with stem cells in the tail vein following confirmation of atherosclerosis. Histological, Immunohistochemical and morphometric studies were performed were conducted. Atherogenic group (II) showed increased aortic thickness, intimal proliferation, smooth muscle proliferation and migration. Increased area % of collagen fibers, iNOS and vimentin immunoreactions were recorded and proved morphometrically. All findings regressed on stem cell therapy. A definite therapeutic effect of mesenchymal stem cells was found on atherosclerosis.


Studies on brain lesions after administration of monosodium L-glutamate to mice. II. Absence of brain damage following administration of monosodium L-glutamate in the diet.
The effects of monosodium L-glutamate (MSG) on the brain of mice were examined by light-microscopy under the intended conditions of use of this material. Basal diet containing 5, 10 or 15% w/w MSG was fed to pregnant, lactating and weanling mice ad libitum, resulting in the ingestion of 14.0, 42.8 or 42.0 g/kg body wt. of MSG a day respectively. Mice at the same developmental stages were given the basal diet and 5% w/w MST in aqueous solution ad libitum, the maximum ingestion of MSG being 16.9, 31.4 and 26.8 g/kg body wt. a day respectively. Light-microscopy examination revealed no pathological changes in the hypothalamic arcuate nuclei (AN) of all treated mice, i.e., pregnant females and their fetuses, lactating females and their sucklings, and weanlin mice. Pregnant females and their fetuses, and weanling mice, injected subcutaneously with either 5.0 or 4.0 g/kg body wt. of MSG, showed "Glu-type lesions" in the hypothalamus.


A theory for the acquisition and loss of neuron specificity in visual cortex.
We assume that between lateral geniculate and visual cortical cells there exist labile synapses that modify themselves in a new fashion called threshold passive modification and in addition, non-labile synapses that contain permanent information. In the theory which results there is an increase in the specificity of response of a cortical cell when it is exposed to stimuli due to normal patterned visual experience. Non-patterned input, such as might be expected when an animal is dark-reared or raised with eyelids sutured, results in a loss of specificity, with details depending on whether noise to labile and non-labile junctions is correlated. Specificity can sometimes be regained, however, with a return of input due to patterned vision. We propose that this provides a possible explanation of experimental results obtained by Imbert and Buisseret (1975); Blakemore and Van Sluyters (1975); Buisseret and Imbert (1976); and Frégnac and Imbert (1977, 1978).


TGIF transcription factors repress acetyl CoA metabolic gene expression and promote intestinal tumor growth.
Tgif1 (thymine-guanine-interacting factor 1) and Tgif2 repress gene expression by binding directly to DNA or interacting with transforming growth factor (TGF) β-responsive SMADs. Tgifs are essential for embryogenesis and may function in tumor progression. By analyzing both gain and loss of Tgif function in a well-established mouse model of intestinal cancer, we show that Tgifs promote adenoma growth in the context of mutant Apc (adenomatous polyposis coli). Despite the tumor-suppressive role of TGFβ signaling, transcriptome profiling of colon tumors suggests minimal effect of Tgifs on the TGFβ pathway. Instead, it appears that Tgifs, which are up-regulated in Apc mutant colon tumors, contribute to reprogramming metabolic gene expression. Integrating gene expression data from colon tumors with other gene expression and chromatin-binding data identifies a set of direct Tgif target genes encoding proteins involved in acetyl CoA and pyruvate metabolism. Analysis of both tumor and nontumor tissues indicates that these genes are targets of Tgif repression in multiple settings, suggesting that this is a core Tgif function. We propose that Tgifs play an important role in regulating basic energy metabolism in normal cells, and that this function of Tgifs is amplified in some cancers.


Characteristics of the static muscle stiffness of ankle plantar flexors in individuals with chronic ankle instability.
Individuals with chronic ankle instability (CAI) have deficits in closed kinetic chain dorsiflexion that may perpetuate injury. Determining the characteristics of muscle stiffness in the plantar flexors of individuals with CAI may help in developing appropriate treatments. We aimed to highlight the characteristics of static muscle stiffness in ankle plantar flexor muscles during the passive dorsiflexion of the ankle joint in individuals with CAI. A total of 30 patients were included in the study based on the International Ankle Consortium criteria. The patients were categorized evenly into healthy, coper, and CAI groups (i.e., 10 patients in each group). After measuring the dorsiflexion range of motion (non-weight-bearing/weight-bearing) of the ankle joint, the static muscle stiffness measurements of the medial gastrocnemius, lateral gastrocnemius, soleus, and peroneus longus were obtained. The measurements were performed during the knee joint's extension and 50° flexion and passive dorsiflexion between the range of 40° plantar flexion and 20° dorsiflexion. The dorsiflexion range of motion of the CAI group was significantly smaller than that of the healthy and coper groups in the weight-bearing position. No interaction was observed for muscle stiffness in both the knee flexion and extension positions, and no significant differences were identified among the three groups. The shear modulus of the soleus at 20° ankle dorsiflexion with knee flexion had a significant negative correlation with the weight-bearing range of motion of the ankle. The limitation in the weight-bearing dorsiflexion range of motion in CAI was largely due to factors other than the increased elasticity of the ankle plantar flexor muscles.


The in vivo metabolic stability of dipeptide analogues of the quinazoline antifolate, ICI 198583, in mice.
In the search for quinazoline thymidylate synthase inhibitors that are not subject to intracellular polyglutamation, a class of dipeptide analogues of the diglutamate of 2-desamino-2-methyl-N10-propargyl-5,8-dideazafolic acid (ICI 198583-gamma-L-glu) has been evaluated for their stability to in vivo hydrolysis. Replacement of the second glutamate with another amino acid, e.g. alanine, prevented polyglutamation in vitro but such compounds were subject to hydrolysis when injected into mice. The extent of hydrolysis was measured in plasma, liver and kidney by HPLC analysis of tissue removed from mice 1 hr after i.p. injection. The enzyme responsible for this hydrolysis is thought to be a gamma-glutamyl hydrolase which hydrolyses the amide bond, releasing ICI 198583 which may then be polyglutamated. Development of stable dipeptide compounds was achieved by structural modification in two principal ways: either by replacement of the second amino acid (e.g. glutamate or alanine) with its D-enantiomer or removal of the carboxyl on the alpha-carbon of the second amino acid (alpha'-COOH). In this second approach two series of compounds were investigated. Monocarboxylate-derived dipeptides, e.g. ICI 198583-gamma-L-phenylalanine or ICI 198583-gamma-phenylglycine, resulted in stable compounds after removal of the alpha'-COOH (to give -ethylamide and -benzylamide derivatives, respectively). However, for the dicarboxylic amino acids a less clear picture emerged. Although removal of the alpha'-COOH from ICI198583-gamma-L-glutamate to give ICI 198583-gamma-gamma-aminobutyric acid resulted in a stable compound, the corresponding aspartate analogue (-beta-alanine) was subject to hydrolysis.


Evolutionary dynamics within and among competing groups.
Biological and social systems are structured at multiple scales, and the incentives of individuals who interact in a group may diverge from the collective incentive of the group as a whole. Mechanisms to resolve this tension are responsible for profound transitions in evolutionary history, including the origin of cellular life, multicellular life, and even societies. Here, we synthesize a growing literature that extends evolutionary game theory to describe multilevel evolutionary dynamics, using nested birth-death processes and partial differential equations to model natural selection acting on competition within and among groups of individuals. We analyze how mechanisms known to promote cooperation within a single group-including assortment, reciprocity, and population structure-alter evolutionary outcomes in the presence of competition among groups. We find that population structures most conducive to cooperation in multiscale systems can differ from those most conducive within a single group. Likewise, for competitive interactions with a continuous range of strategies we find that among-group selection may fail to produce socially optimal outcomes, but it can nonetheless produce second-best solutions that balance individual incentives to defect with the collective incentives for cooperation. We conclude by describing the broad applicability of multiscale evolutionary models to problems ranging from the production of diffusible metabolites in microbes to the management of common-pool resources in human societies.


Did the European suspension of the AstraZeneca vaccine decrease vaccine acceptance during the COVID-19 pandemic?
On March 11, 2021, the AstraZeneca vaccine against COVID-19 was suspended in three Nordic countries and, on subsequent days, in other European countries. Using data on vaccine acceptance in eight Western countries obtained on a daily basis, we show that these decisions - and associated news - decreased public vaccine acceptance in several countries and part of this decrease happened in response to suspensions in other countries. The findings demonstrate the importance of international coordination between health authorities during a pandemic such that local authorities are able to put the decisions of foreign authorities into perspective.


Pharmacist-led collaborative medication management programs for oral antineoplastic therapies: A systematic literature review.
The aim of this systematic review is to summarize the structure, process, and outcomes of pharmacist-led collaborative medication management programs for oral antineoplastic therapies (OATs). Included studies were peer-reviewed journal articles published in English, between January 2000 to May 2020, and reporting on pharmacist-led collaborative medication management programs for patients on OATs. To be included, studies had to report on the pharmacy practice model, pharmacist interventions, and outcomes of the medication management program. The Donabedian model informed the data extraction and summary. Two independent researchers assessed the risk of bias (confounding) for all included studies (n = 12) using the NIH tool and Cochrane ROBINS-I for observational research. There were 12 studies that met inclusion criteria. The structure of the programs included hiring oncology pharmacists to deliver interventions, standardized templates for electronic medical record documentation, and administrative workflow changes (e.g., automatic referrals). The most common pharmacist interventions (processes) were patient education and counseling, adverse event monitoring, and dose modifications. All studies reported one or more positive outcomes, including improved patient adherence, safety, cost savings, cost avoidance, and patient satisfaction. All included studies used an observational study designs, and the majority of studies had moderate to high risk of bias. The evidence suggests that pharmacist-led collaborative medication management programs may have beneficial clinical and economic outcomes. The implementation of these programs could be strengthened by using a conceptual framework to guide program development, implementation, and evaluation and effectiveness-hybrid study designs to assess clinical and implementation outcomes. The risk of bias should be addressed by using more robust study designs and rigorous data collection and analysis methods.


Desirable PEGylation for improving tumor selectivity of hyaluronic acid-based nanoparticles via low hepatic captured, long circulation times and CD44 receptor-mediated tumor targeting.
PEG coating was regarded as one effective method to improve the tumor-targeting efficiency of hyaluronic acid-based nanoparticles (HBN). However, the research of interaction between PEG coating and different receptors such as stabilin-2 and CD44 was limited. Herein, we synthesized a series of PEGylated hyaluronic acid with Curcumin (PHCs) to evaluate the role of PEG coating density in the interaction between HA and its receptors, which influenced tissues targeting activity, pharmacokinetic profiles and therapeutic efficacy of HBN. Compared with other counterparts, PHC HBN with about 5% PEG coating density preferably accumulated in the tumor mass, rather than in the liver, and hold desirable anti-cancer effect. These results indicated that to obtain optimized anticancer effect of HBN, the cellular uptake efficiency between different types of the cells should be carefully balanced by different PEG densities.


A simple general method of exactly comparing different binding activities and antigenic properties of antibodies by obtaining duplicate copies from a single isoelectric focusing gel.
We report a simple general method of exactly comparing different binding activities and/or antigenic properties of antibodies in ascites fluid after fractionation on a single isoelectric focusing gel. Two copies of the gel are made on nitrocellulose: 1 copy is overlaid with the radioiodinated form of one overlay protein and the other copy is overlaid with the radioiodinated form of another. By superimposing X-ray films obtained after radioautography, any 2 binding activities or antigenic properties of antibodies can be compared exactly and in detail. The procedure is simple, highly sensitive, and independent of the molecular weight of the overlay protein. This is accomplished without requiring isolation of the antibodies, denaturing agents, precipitation, chemical fixation or other modification reactions.


Screening for celiac disease in the general population and in high-risk groups.
Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.


Emotional exhaustion and medication administration work-arounds: the moderating role of nurse satisfaction with medication administration.
Burnout is very common and has significant negative outcomes for both nurses and patients. However, this literature has only recently begun to address the processes that explain why health care provider burnout leads to negative patient outcomes. This article extends that literature by examining how satisfaction with work processes impacts the link between nurse burnout and work-arounds. The purpose of this study was to examine the relationships between emotional exhaustion and potentially unsafe work practices (work-arounds) in the context of nursing administration of medication. The data were collected using online survey software and pencil-and-paper surveys returned directly to the researchers. The study was conducted among nurses in 2 acute care hospitals in the Midwestern United States. For one of the samples, data on work-arounds were provided by the nurses' supervisors. For the other sample, data were collected at a 6-month interval. The survey included measures of emotional exhaustion (the Maslach Burnout Inventory), work-arounds, and nurse satisfaction with medication administration processes. We found that exhaustion was associated with greater use of work-arounds of medication administration processes. We also found that when nurses were more satisfied with the medication administration process, exhausted nurses were less likely to engage in work-arounds. The findings suggest that although exhaustion in nurses can lead to potentially unsafe practices, satisfaction with the work process can either exacerbate or reduce the problem.


Effects of mobile phone exposure (GSM 900 and WCDMA/UMTS) on polysomnography based sleep quality: An intra- and inter-individual perspective.
Studies on effects of radio frequency-electromagnetic fields (RF-EMF) on the macrostructure of sleep so far yielded inconsistent results. This study investigated whether possible effects of RF-EMF exposure differ between individuals. In a double-blind, randomized, sham-controlled cross-over study possible effects of electromagnetic fields emitted by pulsed Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA)/Universal Mobile Telecommunications System (WCDMA/UMTS) devices on sleep were analysed. Thirty healthy young men (range 18-30 years) were exposed three times per exposure condition while their sleep was recorded. Sleep was evaluated according to the American Academy of Sleep Medicine standard and eight basic sleep variables were considered. Data analyses at the individual level indicate that RF-EMF effects are observed in 90% of the individuals and that all sleep variables are affected in at least four subjects. While sleep of participants was affected in various numbers, combinations of sleep variables and in different directions, showing improvements but also deteriorations, the only consistent finding was an increase of stage R sleep under GSM 900MHz exposure (9 of 30 subjects) as well as under WCDMA/UMTS exposure (10 of 30 subjects). The results underline that sleep of individuals can be affected differently. The observations found here may indicate an underlying thermal mechanism of RF-EMF on human REM sleep. Nevertheless, the effect of an increase in stage R sleep in one third of the individuals does not necessarily indicate a disturbance of sleep.


A virtual experimenter does not increase placebo hypoalgesia when delivering an interactive expectancy manipulation.
Lack of standardization and unblinding threaten the research of mechanisms involved in expectancy effects on pain. We evaluated a computer-controlled virtual experimenter (VEx) to avoid these issues. Fifty-four subjects underwent a baseline-retest heat pain protocol. Between sessions, they received an expectancy manipulation (placebo or no-treatment) delivered by VEx or text-only control condition. The VEx provided standardized "social" interaction with the subjects. Pain ratings and psychological state/trait measures were recorded. We found an interaction of expectancy and delivery on pain improvement following the intervention. In the text conditions, placebo was followed by lower pain, whereas in the VEx conditions, placebo and no-treatment were followed by a comparable pain decrease. Secondary analyses indicated that this interaction was mirrored by decreases of negative mood and anxiety. Furthermore, changes in continuous pain were moderated by expectation of pain relief. However, retrospective pain ratings show an effect of expectancy but not of delivery. We conclude that we successfully applied an automated protocol for inducing expectancy effects on pain. The effect of the VEx regardless of treatment may be due to interactions of attention allocation and locus of control. This points to the diversity of expectancy mechanisms, and has implications for research and computer-based treatment applications.


An anti-apoptotic role for galectin-3 in diffuse large B-cell lymphomas.
Increased resistance to apoptosis promotes lymphomagenesis with aberrant expression of cell survival proteins such as BCL-2 and c-MYC occurring in distinct lymphoma subtypes. Galectin-3 is an anti-apoptotic protein that protects T cells, macrophages, and breast carcinoma cells from death triggered by a variety of agents. We have found high levels of galectin-3 protein expression in a subset of B-cell neoplasms including diffuse large B-cell lymphoma (DLBCL), primary effusion lymphoma (PEL), and multiple myeloma (MM), in both cell lines and patient samples. However, we failed to detect galectin-3 in Burkitt lymphoma (BL), follicular lymphoma (FL), marginal zone lymphoma (MZL), MALT lymphoma or B-small lymphocytic lymphoma (B-SLL) cell lines or patient samples. To determine whether galectin-3 expression protects B cells from apoptosis, galectin-3-negative BL cells were transfected with a galectin-3 expressing plasmid, which resulted in markedly increased resistance to anti-Fas-induced cell death. In contrast, galectin-3-positive PEL cells transfected with an amino-terminal truncated galectin-3 vector showed increased sensitivity to anti-Fas induced apoptosis. During normal B-cell development, galectin-3 expression was lowest in germinal center and plasma B cells, from which DLBCL, PEL, and MM derive, and highest in long-lived naïve and memory B cells. This pattern of expression suggests that aberrantly increased galectin-3 levels in specific B-cell populations may yield a protective advantage during transformation and/or progression of certain B-cell neoplasms.


Wearable Egocentric Camera as a Monitoring Tool of Free-Living Cigarette Smoking: A Feasibility Study.
Wearable sensors may be used for the assessment of behavioral manifestations of cigarette smoking under natural conditions. This paper introduces a new camera-based sensor system to monitor smoking behavior. The goals of this study were (1) identification of the best position of sensor placement on the body and (2) feasibility evaluation of the sensor as a free-living smoking-monitoring tool. A sensor system was developed with a 5MP camera that captured images every second for continuously up to 26 hours. Five on-body locations were tested for the selection of sensor placement. A feasibility study was then performed on 10 smokers to monitor full-day smoking under free-living conditions. Captured images were manually annotated to obtain behavioral metrics of smoking including smoking frequency, smoking environment, and puffs per cigarette. The smoking environment and puff counts captured by the camera were compared with self-reported smoking. A camera located on the eyeglass temple produced the maximum number of images of smoking and the minimal number of blurry or overexposed images (53.9%, 4.19%, and 0.93% of total captured, respectively). During free-living conditions, 286,245 images were captured with a mean (±standard deviation) duration of sensor wear of 647(±74) minutes/participant. Image annotation identified consumption of 5(±2.3) cigarettes/participant, 3.1(±1.1) cigarettes/participant indoors, 1.9(±0.9) cigarettes/participant outdoors, and 9.02(±2.5) puffs/cigarette. Statistical tests found significant differences between manual annotations and self-reported smoking environment or puff counts. A wearable camera-based sensor may facilitate objective monitoring of cigarette smoking, categorization of smoking environments, and identification of behavioral metrics of smoking in free-living conditions. The proposed camera-based sensor system can be employed to examine cigarette smoking under free-living conditions. Smokers may accept this unobtrusive sensor for extended wear, as the sensor would not restrict the natural pattern of smoking or daily activities, nor would it require any active participation from a person except wearing it. Critical metrics of smoking behavior, such as the smoking environment and puff counts obtained from this sensor, may generate important information for smoking interventions.


Ultrastructural immunochemistry of J chains in chickens.
Using ultrastructural immunochemistry, we have determined subcellular localization of J chain molecules in chicken splenic cells. The majority of J chain positive cells (JPC) were lymphoblast-like cells. The data show that J chains predominantly are localized in cytoplasm with a considerable amount distributed on the cell surface. In the cytoplasm, J chains were diffusely expressed. Furthermore, these J chain molecules were clearly seen as cluster type. In addition to the J chain localization of subcellular organelles as described above, J chains were partly found on perinuclear spaces. As J chains are key protein in B cell differentiation into immunoglobulin (Ig) producing cells, these findings might help for studying regulation of B cell differentiation in addition to revealing the molecular assembly of polymeric Ig.