Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma.
There is no standard method for predicting remnant liver functional reserve after hepatectomy or for monitoring it in real time. Indocyanine green (ICG) clearance (K) was measured non-invasively and instantaneously using pulse spectrophotometry before surgery, during inflow occlusion and after hepatectomy in 75 patients who underwent anatomical liver resection for hepatocellular carcinoma (HCC). Eight patients (11 per cent) suffered liver failure and one (1 per cent) died in hospital. An estimated remnant K value of 0.090 per min was the cut-off value for liver failure. In a logistic regression model, the estimated remnant K (0.090 per min; P = 0.022) and age (65 years; P = 0.025) were significant predictors of postoperative liver failure. There was a correlation between the estimated and measured post-hepatectomy K, and between the inflow occlusion K and measured post-hepatectomy K (P < 0.001). The cut-off value of less than 0.090 per min for the estimated remnant K resulted in 88 per cent sensitivity and 82 per cent specificity for predicting liver failure. Perioperative real-time monitoring of ICG-K is useful for evaluating the remnant liver functional reserve before, during and after liver resection for HCC. The estimated remnant K is a significant predictor of liver failure.


Multiple pituitary hormone deficiencies in eight siblings of one Jewish Moroccan family.
In a Jewish Moroccan inbred family, 8 of 12 siblings were found to have multiple deficiencies of pituitary hormones, including GH, TSH and gonadotrophins. The parents showed no deficiency and are in good health, as are the other 4 siblings. The investigations carried out indicate that in this family the etiology is hereditary in nature, probably being autosomal recessive, with the defect located in the pituitary gland.


Suppression of chaos by periodic oscillations in a model for cyclic AMP signalling in Dictyostelium cells.
We investigate how the introduction of cells oscillating periodically affects the behaviour of a suspension of Dictyostelium discoideum amoebae undergoing chaotic oscillations of cyclic AMP. The analysis of a model indicates that a tiny proportion of periodic cells suffices to transform chaos into periodic oscillations in such suspensions. A similar result is obtained by forcing the aperiodic oscillations by a small-amplitude, periodic input of cyclic AMP. The results provide an explanation for the observation of regular oscillations in suspensions of a putatively chaotic mutant of Dictyostelium discoideum. More generally, the results show how chaos in biological systems may disappear through the coupling with periodic oscillations.


Glial cells as intrinsic components of non-cell-autonomous neurodegenerative disease.
A lesson from dominantly inherited forms of diverse neurodegenerative diseases, including amyotrophic lateral sclerosis, spinocerebellar ataxia and Huntington's disease, is that the selective dysfunction or death of the neuronal population most at risk in each disease is not mediated solely by damage from the mutant protein within the target neurons. The disease-causing toxic process, which in each case is caused by mutation in a gene that is widely or ubiquitously expressed, involves damage done by mutant proteins within the non-neuronal glial cells of the central nervous system, especially astrocytes and microglia. The disease mechanism is non-cell-autonomous, with toxicity derived from glia as a prominent contributor driving disease progression and in some instances even disease initiation.


The Macro Impact of Microtransitions in Post-acute and Long-Term Care.
The care transitions concept emerged in medical literature more than 40 years ago, with an exponential rise in publications dedicated to its exploration since that time. It is generally accepted that older patients are particularly vulnerable during care transitions because of complex medical comorbidity, frailty, cognitive dysfunction, and the fragmented nature of health care. A care transition is defined as the movement of patients from one health care setting to another as their care needs change during acute or chronic illness. Easily recognizable examples include the discharge of a patient from the hospital to a skilled nursing facility or an admission to the hospital after a patient is evaluated in the emergency department. These macrotransitions are marked by major changes in clinical condition and span days to weeks. This discussion examines a new term coined by the authors: microtransitions, which are care transitions characterized by movement of a patient between health care settings or within a given setting, usually over shorter periods (less than 24 hours) and accompanied by changes in clinical or custodial responsibility for a patient. Although often unrecognized as formal care transitions, these microtransitions, if not handled appropriately, can lead to poor outcomes, including clinical deterioration and the need for macrotransition. The authors propose formal recognition of microtransitions, standardization of processes related to them, and practical considerations for implementation.


[Pulmonary hypertension and femoral neck fracture: interest of continuous spinal anaesthesia].
Anaesthetic management of patients with pulmonary hypertension is challenging and alternatives to general anaesthesia are encouraged. We report anaesthetic management of two patients with pulmonary hypertension admitted for femoral neck fracture. In order to reduce the risk of right-sided heart failure and systemic hypotension, it was decided to operate the patients under continuous spinal anaesthesia. Anaesthesia was induced with excellent hemodynamic tolerance. Quality and extension of the block was correct and allowed surgery. No postoperative complication was observed. These cases suggest that continuous spinal anaesthesia may be considered for the management of patients with pulmonary hypertension undergoing femoral neck fracture surgery.


The ontogeny of sensory perception in preterm infants.
The extra- vs intrauterine development of both visual and auditory cortical evoked response patterns was compared at 33, 37 and 40 weeks conceptional age. The maturation of visual cortical evoked responses is retarded in infants at 37 and 40 weeks conceptional age when born with a gestational age of less than 32 weeks, which thus implies a long extrauterine life span. The maturation of the auditory cortical evoked responses is not influenced by premature exposure to the extrauterine environment. The results are explained on the basis of the particular central nervous system growth spurt periods and a thus defined vulnerable period of different brain structures.


Atypical endometriosis is related to a higher recurrence rate.
The aims of this study were to evaluate the clinical characteristics and recurrence rate of atypical endometriosis (AE)1 compared to typical endometriosis (TE) in addition to the malignant transformation rate among a large cohort. The medical records of 2681 patients who had undergone surgical treatment of ovarian endometrioma between January 2008 and September 2019 were retrospectively reviewed. The patients were divided into AE (n = 86) and TE (n = 2595) groups. Patients' characteristics and recurrence rates were evaluated and compared between the two groups. The mean size of ovarian cysts was significantly larger in the AE group (7.6 ± 3.5 cm vs 6.7 ± 3.3 cm, p = 0.01) and the proportion of nulliparous women was significantly lower in AE group (65.1 % vs 77.8 %, p = 0.008). Otherwise, there were no statistically significant differences in patient characteristics between the two groups. After Cox regression analyses with IPTW was adjusted, the risk factors for recurrent endometrioma were higher preoperative CA125 level >48 U/mL (hazard ratio [HR] = 2.741; 95 % confidence interval [CI] = 1.517-4.952; p < 0.001), multilocular cyst (HR = 1.909; 95 % CI = 1.128-3.230; p = 0.016), and atypical endometriosis (HR = 2.666; 95 % CI = 1.659-4.284; p < 0.001). The AE group displayed a significantly higher cumulative recurrence rate than the TE group (p = 0.0057, log-rank test). No patients were diagnosed with atypical endometriosis to malignant transformation during the follow-up periods. However, two typical endometriosis patients experienced borderline malignancy and serous carcinoma, respectively. Recurrence rates for AE were higher than for TE. Although the AE group included no patient with malignant transformation in this study, considering the higher recurrence as well as the possibility of malignant transformation, long-term close surveillance is warranted.


Gender differences in the relationships between parental phubbing and adolescents' depressive symptoms: The mediating role of parent-adolescent communication.
Phubbing, as a common phenomenon in modern society's communication, describes the act of using one's phone in face-to-face interactions. In recent years, parental phubbing has attracted the attention of researchers, and it is imperative to explore the relationship between father phubbing (Fphubbing), mother phubbing (Mphubbing) and adolescent development. Therefore, this study investigated 4213 adolescents (mean age = 16.41, SD = 0.77, 52.5% were boys) and explored the relationship between Fphubbing and Mphubbing and adolescents' depressive symptoms. Our single-group path analysis showed that both Fphubbing and Mphubbing were positively associated with adolescents' depressive symptoms. These positive associations were mediated by father-adolescent communication and mother-adolescent communication. Furthermore, multiple-group path analysis revealed that, compared to male adolescents, the relationship between Fphubbing and father-adolescent communication, and the relationship between Mphubbing and mother-adolescent communication were stronger in female adolescents. These findings offer a more ecological and comprehensive understanding of how parental phubbing associates with parent-adolescent communication and adolescents' depressive symptoms.


The effects of mechanical stability on the macromolecules of the connective tissue matrices produced during fracture healing. II. The glycosaminoglycans.
The glycosaminoglycans secreted into the matrices associated with fractures of the rabbit tibia healing under stable and unstable mechanical conditions have been characterized histochemically using the dye Alcian Blue at pH 5.7 in the presence of increasing concentrations of magnesium chloride, and after enzymatic extractions. These results are compared with those of immunohistochemical experiments using monoclonal antibodies which recognize epitopes specific to various glycosaminoglycans. The results indicate that the fibrous tissues, including those of the cavities of the cancellous bone and periosteum, possess hyaluronate and chondroitin sulphate, but the amounts present are small. The glycosaminoglycans detected in the cortical bone are located mainly around the osteocyte lacunae where chondroitin and keratan sulphates are found. The developing trabeculae of cancellous bone in the callus contain chondroitin and keratan sulphates, but as the trabeculae mature, these glycosaminoglycans are no longer present throughout the matrix; they are found particularly around the osteocyte lacunae. The cartilage in the callus of mechanically unstable fractures contains chondroitin, chondroitin-4- and 6-sulphates and keratan sulphate, through their distribution is variable. The small, transient areas of cartilage in the callus of mechanically stable fractures also contain those glycosaminoglycans, but they appear to be less highly sulphated. The mechanical stability of the fractures appears to affect the amount and degree of sulphation of the glycosaminoglycans, rather than the types of glycosaminoglycan produced. The glycosaminoglycans produced during fracture healing are compared with those produced during embryonic development and other healing processes.


Some aspects of the physiological and pharmacological control of the synthesis of triacylglycerols and phospholipids.
The effects of dietary modification, starvation, stress and diabetes on the activity of phosphatidate phosphohydrolase are discussed. Evidence is presented that this enzyme is involved in controlling the rate of triacylglycerol synthesis in the liver. Drugs such as fenfluramine and benfluorex are able to inhibit phosphatidate phosphohydrolase by interacting with the substrate. This decreases the rate of triacylglycerol synthesis and redirects the route of glycerolipid metabolism. Benfluroex also partly prevents the ethanol-induced increase in triacylglycerol synthesis and in phosphohydrolase activity. The implications of these findings are discussed with respect to the mode of action of fenfluramine and benfluorex and to the control of triacylglycerol synthesis.


Dataset on aerosol loading, size and statistics over Sanpedro.
Dataset on the aerosol loading and aerosol size radius was provided to guide researcher on the health implication of the air pollution over the research area. Fifteen years primary (aerosol optical depth) dataset was obtained from the Multi-angle Imaging Spectro-Radiometer (MISR). Aerosol loading were generated from the primary dataset. The dataset is important the major cause of respiratory diseases recorded in Sanpedro-Cote d'Ivoire.


The click-evoked oto-acoustic emission, c-EOAE, in preterm-born infants in the post conceptional age range between 30 and 68 weeks.
Click-evoked otoacoustic emissions (cEOAEs) were repeatedly recorded in an operational sample of 144 very low birth weight (VLBW) infants. A subgroup of 22 was composed of all those babies in which at least 4 recordings were successfully done. The mean birth weight of this group was 1040 g, and the mean duration of assisted ventilation was 17 days. The OAE-recordings were done in the post conceptional age (PCA) range between 30 and 68 weeks. In relation to ear function screening it was shown that the EOAE was present in 95% of the ears at least once at any age, while it was present in all recordings in only 34%. From a longitudinal analysis of the recordings per infant it appeared that: (1) the OAE recorded was already present in one infant at the PCA of 29.4 weeks; (2) in most infants the level of the OAE varies strongly between recordings; (3) in each infant the OAE-level shows an increase with age, on average this growth amounts to 10 dB between the PCAs of 31 and 42 weeks; (4) there is no clearcut difference in the growth of high- and low-frequency components of the EOAE.


Hypnosis to reduce fear of falling in hospitalized older adults: a feasibility randomized controlled trial.
Fear of falling is associated with numerous negative health outcomes in older adults and can limit the rehabilitation process. Hypnosis is now recognized as an effective treatment for a variety of conditions, especially anxiety and pain, which can be integrated safely with conventional medicine. The objective of this study was to assess the feasibility and acceptability of a hypnosis intervention in hospitalized older adults to reduce fear of falling. In this feasibility randomized controlled trial, 32 older patients, hospitalized in geriatric rehabilitation wards, were randomly allocated (1:1 ratio) to either an intervention group (hypnosis, 2 sessions, one per week, plus usual rehabilitation program) or a control group (usual rehabilitation program only). Clinical assessors and statistician were blinded to group allocation. Primary outcomes were recruitment rate, retention rate, and adherence to the intervention. Exploratory outcomes, analyzed according to the intention-to-treat principle, included impact of hypnosis on fear of falling (assessed by a new scale perform-FES), functional status, in-hospital falls, and length of hospital stay. Recruitment rate was 1.3 patients per week. The recruitment of the population sample was achieved in 5.5 months. The retention rate did not differ significantly between groups and a good adherence to the hypnosis intervention was achieved (77% of patients received the full intervention). No adverse event related to the hypnosis intervention was observed. Regarding exploratory clinical outcomes, no differences were found between groups on any outcome. Hypnosis is feasible and well accepted in a geriatric hospitalized population undergoing rehabilitation. Further pilot work should be conducted, with an increased number of hypnosis sessions, before conducting a full-scale trial to conclude whether, or not, hypnosis is effective to reduce fear of falling. NCT04726774.


Update in surgical therapy for chronic obstructive pulmonary disease.
Bullectomy for giant bullae, lung volume reduction surgery, and lung transplantation are three surgical therapies that may benefit highly selected patients with advanced chronic obstructive pulmonary disease. In this article, each procedure is reviewed, with an emphasis on guidelines for patient selection and clinical outcomes for the practicing pulmonologist. Recent results from the National Emphysema Treatment Trial, updated International Society for Heart and Lung Transplantation Registry data, and revised guidelines for patient selection for lung transplantation are discussed.


Contribution of historical herbarium small RNAs to the reconstruction of a cassava mosaic geminivirus evolutionary history.
Emerging viral diseases of plants are recognised as a growing threat to global food security. However, little is known about the evolutionary processes and ecological factors underlying the emergence and success of viruses that have caused past epidemics. With technological advances in the field of ancient genomics, it is now possible to sequence historical genomes to provide a better understanding of viral plant disease emergence and pathogen evolutionary history. In this context, herbarium specimens represent a valuable source of dated and preserved material. We report here the first historical genome of a crop pathogen DNA virus, a 90-year-old African cassava mosaic virus (ACMV), reconstructed from small RNA sequences bearing hallmarks of small interfering RNAs. Relative to tip-calibrated dating inferences using only modern data, those performed with the historical genome yielded both molecular evolution rate estimates that were significantly lower, and lineage divergence times that were significantly older. Crucially, divergence times estimated without the historical genome appeared in discordance with both historical disease reports and the existence of the historical genome itself. In conclusion, our study reports an updated time-frame for the history and evolution of ACMV and illustrates how the study of crop viral diseases could benefit from natural history collections.


Psychological impact of abnormally invasive placenta: an underestimated and hidden morbidity.
To evaluate anxiety and psychological impact of abnormally invasive placenta (AIP) diagnosis during pregnancy. A cross-sectional survey study was performed to assess the psychological response of pregnant women with an antenatally AIP diagnosis. The psychological impact was measured through a visual analogue scale (VAS) for anxiety, which ranged from 0 (not at all anxious) to 100 (extremely anxious) and was referred to three questions: (1) How anxious were you the first time they counselled you about AIP?; (2) How anxious were you the day of the planned cesarean delivery in terms of morbidity/mortality?; (3) How anxious were you in terms of future sexual activities? 48 singleton pregnancies that underwent planned cesarean hysterectomy for AIP, met the inclusion criteria and were surveyed for the study. Mean VAS was 41.6 ± 25.6, with 47.9% of women with VAS >50 for question 1 (p=0.015). Mean VAS was 52.9 ± 19.1, with 75.0% of women with VAS >50 for question 2 (p=0.02). Mean VAS was 49.6 ± 20.4, with 83.3% of women with VAS >50 for question 3 (p=0.006). More than half of pregnant women with an antenatally AIP diagnosis reported a high VAS score regarding anxiety, in particular when morbidity/mortality and long-term consequences on sexual activities were analyzed. Our findings could be used to formulate timely psychological interventions to improve mental health and psychological resilience in women with AIP.


Crowd cluster data in the USA for analysis of human response to COVID-19 events and policies.
We provide data on daily social contact intensity of clusters of people at different types of Points of Interest (POI) by zip code in Florida and California. This data is obtained by aggregating fine-scaled details of interactions of people at the spatial resolution of 10 m, which is then normalized as a social contact index. We also provide the distribution of cluster sizes and average time spent in a cluster by POI type. This data will help researchers perform fine-scaled, privacy-preserving analysis of human interaction patterns to understand the drivers of the COVID-19 epidemic spread and mitigation. Current mobility datasets either provide coarse-level metrics of social distancing, such as radius of gyration at the county or province level, or traffic at a finer scale, neither of which is a direct measure of contacts between people. We use anonymized, de-identified, and privacy-enhanced location-based services (LBS) data from opted-in cell phone apps, suitably reweighted to correct for geographic heterogeneities, and identify clusters of people at non-sensitive public areas to estimate fine-scaled contacts.


Program expedites reporting, resolving medical incidents.
Given the current seismic wave of malpractice and liability litigation, hospitals must implement programs to effectively manage loss caused by injury within their institutions. A risk management program at Halifax Hospital Medical Center effects prevention of medical incidents, identifies and investigates incidents, and administratively deals with incidents entailing risk of financial loss.


Lower urinary tract symptoms of men seeking medical care--comparison of symptoms found in the clinical setting and in a community study.
To investigate which lower urinary tract symptoms were most influential in causing men to seek medical care. We evaluated the International Prostate Symptom Score (IPSS) and quality-of-life (QOL) score of 235 outpatients having lower urinary tract symptoms and 242 participants in a community-based study of Japanese men aged 50 to 79 years old. Although the proportion of outpatients in the severe IPSS category (IPSS 20 to 35) was greater than that in the participants of the community-based study in each age decade, the proportion in the moderate IPSS category (IPSS 8 to 19) in both groups overlapped each other. On the other hand, the distribution of QOL scores was considerably different, with only a small portion of overlap in each age decade. Although scores for both voiding symptoms (incomplete emptying, intermittency, weak stream, and hesitancy) and storage symptoms (increased frequency, urgency, and nocturia) were significantly greater in outpatients than in study participants in each age decade, the difference was more obvious for voiding symptoms than for storage symptoms. The QOL score appeared to show more pronounced differences between men in a clinic setting and those in a community setting than the IPSS category. Voiding symptoms may affect medical care-seeking behavior through QOL impairment in Japanese men.


Fundus Tessellated Density Assessed by Deep Learning in Primary School Children.
To explore associations of fundus tessellated density (FTD) and compare characteristics of different fundus tessellation (FT) distribution patterns, based on artificial intelligence technology using deep learning. Comprehensive ocular examinations were conducted in 577 children aged 7 years old from a population-based cross-sectional study, including biometric measurement, refraction, optical coherence tomography angiography, and 45° nonmydriatic fundus photography. FTD was defined as the average exposed choroid area per unit area of the fundus, and obtained by artificial intelligence technology. The distribution of FT was classified into the macular pattern and the peripapillary pattern according to FTD. The mean FTD was 0.024 ± 0.026 in whole fundus. Multivariate regression analysis showed that greater FTD was significantly correlated with thinner subfoveal choroidal thickness, larger parapapillary atrophy, greater vessel density inside the optic disc, larger vertical diameter of optic disc, thinner retinal nerve fiber layer, and longer distance from optic disc center to macular fovea (all P < 0.05). The peripapillary distributed group had larger parapapillary atrophy (0.052 ± 0.119 vs 0.031 ± 0.072), greater FTD (0.029 ± 0.028 vs 0.015 ± 0.018), thinner subfoveal choroidal thickness (297.66 ± 60.61 vs 315.33 ± 66.46), and thinner retinal thickness (285.55 ± 10.89 vs 288.03 ± 10.31) than the macular distributed group (all P < 0.05). FTD can be applied as a quantitative biomarker to estimate subfoveal choroidal thickness in children. The role of blood flow inside optic disc in FT progression needs further investigation. The distribution of FT and the peripapillary pattern correlated more with myopia-related fundus changes than the macular pattern. Artificial intelligence can evaluate FT quantitatively in children, and has potential value for assisting in myopia prevention and control.


Equivalency challenge: Evaluation of Lipodox® as the generic equivalent for Doxil® in a human ovarian cancer orthotropic mouse model.
The objective of this study was to evaluate the in vivo growth inhibition activity and tumor distribution of Doxil® compared to Lipodox® as its generic (GLD) in human ovarian cancer orthotopic mouse model. In the efficacy study 50 mice were randomized to: vehicle, Doxil® 5mg/kg or 10mg/kg, or GLD 5mg/kg or 10mg/kg for a total of three cycles with monitoring for response and toxicity with 10 mice in each arm. In the microdialysis(MD) study, 60 mice were randomized to: Doxil® 5mg/kg or 10mg/kg, or GLD 5mg/kg or 10mg/kg single dose (n=15 mice/arm). MD sample time points included total of 29 samples from baseline through 100h and were evaluated with a validated PaperSpray LC/MS assay. There was 15.7% decrease (p<0.0001) in efficacy of GLD the 5mg/kg and 21.3% decrease (p<0.0001) in efficacy of the 10mg/kg dose of GLD when compared to equivalent doses of Doxil®. The intratumoral concentration for the GLD ranged from 1.0 to 25.5ng/mL (5mg/kg) and 2.9-35.6ng/mL (10mg/kg) compared to 2.7-42.2ng/mL (p<0.04, 5mg/kg) and 2.0-76ng/mL (p<0.02, 10mg/kg) for the Doxil®, respectively. Significant differences in preclinical efficacy were observed between Doxil® and GLD. These may be due to significant pharmacodynamic effects of drug distribution and decrease uptake of GLD in tumor tissue. A prospective clinical comparison of these two products is warranted to determine equivalency.


Multiple symmetric lipomatosis: clinical aspects and outcome in a long-term longitudinal study.
Multiple symmetric lipomatosis (MSL) is a rare disease characterized by the growth of uncapsulated masses of adipose tissue. MSL is associated with high ethanol intake and complicated by somatic and autonomic neuropathy and by the infiltration of the adipose tissue at the mediastinal level. To date, the disease is considered as slowly progressive, but long-term longitudinal data are still lacking. In this study, a long-term follow-up of a large series of MSL patients is presented. We studied 31 patients with MSL (30 males and one female) first evaluated at our institution from 1973 to 1992. All patients were followed until 1998-1999 or until death, with a mean follow-up of 14.5+/-5.0 y (range 4-26 y). Both at baseline and during follow-up, the location and the size of the subcutaneous lipomatous fat depots, the presence and the extension of deeply localized lipomatous tissue, and the presence and the severity of both somatic and autonomic neuropathy were evaluated. Eight MSL patients died during follow-up (25.8% of patients). A sudden death was proved to be the cause of death in three patients. All these three patients had severe autonomic neuropathy and none had coronary disease, acute myocardial infarction or other cardiac abnormalities. No signs or symptoms of coronary heart disease were present in the whole series. In addition to this high fatality rate, a substantial morbidity related to the occupation of the mediastinal space by the lipomatus tissue and to somatic neuropathy was also observed. MSL is associated with a significant morbidity and mortality. Therefore, the definition of 'benign symmetric lipomatosis', still adopted by several authors, cannot be justified.


Characteristics of bacterial pathogens associated with acute diarrhea in children under 5 years of age: a hospital-based cross-sectional study.
Acute diarrhea is a leading cause of morbidity and mortality in children, particularly in those under the age of 5 years. Rotavirus is recognized as the leading cause of acute diarrhea in children, however, the contribution of bacterial pathogens as causative agents varies throughout the world. Here we report a hospital-based prospective study to analyze the characteristics of bacterial pathogens associated with acute diarrhea in children under 5 years of age. Stool samples were collected from 508 patients with acute diarrhea under 5 years of age who presented at our hospital. Nine pathogens were isolated and identified by culturing, serology or PCR, these included Salmonella spp., Shigella spp., Vibrio cholerae, diarrheagenic Escherichia coli (DEC), Aeromonas spp., Plesiomonas spp., Vibrio parahaemolyticus, Campylobacter spp. and Yersinia enterocolitica. Antimicrobial sensitivity tests of these pathogens were conducted. The most commonly detected pathogen, Salmonella spp., was further investigated by PCR and sequencing of antibiotic resistance-related genes. Pathogens were identified in 20.1 % of the 508 samples. The most commonly detected pathogens were Salmonella spp. (8.5 %), followed by DEC (4.7 %), Campylobacter jejuni (3.0 %) and Aeromonas spp. (2.0 %). The resistance rates to ampicillin and tetracycline in Salmonella spp. were >60 %, but were <30 % to cephalosporins and quinolones. More than 50 % of DEC strains displayed resistance to ampicillin, cefotaxime and tetracycline, and 60 % of C. jejuni strains were resistant to ciprofloxacin but highly sensitive to the other antibiotics. Among 12 cephalosporin-resistant Salmonella isolates, TEM-1 and CTX-M-14 determinants were present in two (16.7 %) isolates. PCR screening for plasmid-mediated quinolone resistance genes revealed gyrA mutations in one of three highly quinolone resistant isolates. Salmonella spp., DEC, Campylobacter spp. and Aeromonas spp. were the most commonly detected bacterial pathogens in children under the age of 5 years with acute diarrhea. Our findings indicate that ampicillin and tetracycline are not suitable as first line therapeutic drugs against Salmonella spp. Resistance to third generation cephalosporins and quinolones was also detected. TEM-1 and CTX-M-14 genetic determinants, and gyrA mutations, were the major mechanisms associated with high levels of cephalosporin and quinolone resistance, respectively, in Salmonella isolates.


Utilizing connectivity and data management system for effective quality management and regulatory compliance in point of care testing.
Point of care testing (POCT) is one of the fastest growing disciplines in clinical laboratory medicine. POCT devices are widely used in both acute and chronic patient management in the hospital and primary physician office settings. As demands for POCT in various healthcare settings increase, managing the quality and regulatory compliance are continually challenging. Despite technological advances in applying automatic system checks and built-in quality control to prevent analytical and operator errors, poor planning for POCT connectivity and informatics can limit data accessibility and management efficiency which impedes the utilization of POCT to its full potential. This article will summarize how connectivity and data management system can improve timely access to POCT results, effective management of POCT programs, and ensure regulatory compliance.


Diagnostic performance of the EU TI-RADS and ACR TI-RADS scoring systems in predicting thyroid malignancy.
Several ultrasound scoring systems have been developed to stratify the risk of malignancy of thyroid nodules, including ACR (American College of Radiology) and EU (European) TI-RADS. This study aimed to assess the diagnostic performance of these two classifications using histology as a reference standard. It was a single-centre, retrospective study including 156 patients who underwent thyroidectomy. Ultrasound data of 198 nodules (99 malignant nodules and 99 benign nodules) were analysed. Both classifications were applied for all nodules. Ultrasound criteria associated with malignancy were solid composition (OR=7.81; p < 10-3 ), hypoechoic character (OR=16.42; p < 10-3 ), irregular contours (OR=7.47; p < 10-3 ), taller-than-wide shape (OR=3.58; p = 0.02), microcalcifications (OR=3.02; p = .006) and the presence of cervical adenopathy (OR=3.89; p = .006). The prevalence of malignancy was 15.5%, 69% and 76.9% for EU TI-RADS categories 3, 4 and 5, respectively. It was 33.3%, 57% and 91.1% for ACR TI-RADS categories 3, 4 and 5, respectively. For category 5, EU TI-RADS and ACR TI-RADS had sensitivities of 60% and 41%, specificities of 82% and 96%, respectively. For categories 4 and 5 combined, the diagnostic performance of these two classification systems became comparable with a sensitivity of 89% and 86% for EU-TIRADS and ACR-TIRADS, respectively. The area under the ROC curve was 0.81 for the EU TI-RADS classification and 0.82 for the ACR TI-RADS classification. EU TI-RADS and ACR TI-RADS scoring systems seem to be comparable in predicting malignancy in thyroid nodules.


The rise and demise of pain exterminator Thomas S. McNeil: Every rose has its thorns.
United Brethren minister Thomas S. McNeil formulated an analgesic nostrum in 1848, most likely from opium, alcohol, ether, and other proprietary ingredients. Massaged on externally as a pain liniment, his so-called pain exterminator could also be mixed in sweetened water and imbibed as an analgesic, antitussive, and antidiarrheal. A familiar antebellum remedy for both Union and Confederate forces in the Civil War, McNeil's Pain Exterminator would be manufactured by McNeil's pastor and then successors, for more than a half-century after McNeil's accidental drowning in 1874.


Effect of intravenous L-NMMA on nitric oxide production in collagenous colitis.
Nitric oxide (NO) is greatly increased in the colon of patients with inflammatory bowel disease of different aetiology, including collagenous colitis. In man, NO can be generated from NO synthases as well as from non-enzymatic sources. The source of the NO found in luminal intestinal gas has not been exactly pinpointed. We investigated the effect of the NO synthase inhibitor L-NMMA on intestinal concentrations of NO in patients with clinically active collagenous colitis. In addition, we measured NO levels from the respiratory tract. Ten patients with active collagenous colitis were studied. NO levels were measured from the respiratory tract and in the rectum before and after i.v. administration of L-NMMA (7.5 mg/kg) using a chemiluminescence method. Airway NO release decreased markedly, and mean arterial blood pressure increased in all patients following L-NMMA treatment. Basal rectal NO levels were high (median > 10000 ppb) and decreased markedly in 5 patients after L-NMMA. In contrast, NO levels remained completely unchanged or even increased in the other 5 patients. Rectal levels of NO are greatly increased in patients with symptomatic collagenous colitis. Intravenous administration of an NO synthase inhibitor reduced rectal NO only in half of the patients despite clear evidence of effective systemic NO synthase inhibition. This could indicate alternative NOS-independent sources of intestinal NO in this disease.


Managing local government opposition to community-based residential facilities for the mentally disabled.
"Prior Notification" policies have elicited fears of community opposition from agencies who have adopted a "low profile" approach in locating community-based residential facilities. Nevertheless, data from a survey of New Jersey community care providers indicate that local government officials express less opposition when informed of the proposed location and invited to meet with the provider. Arranging to meet with local officials is most important when neighbors have leadership, since officials express more intense opposition when neighbors invite them to a meeting. The literature has already established the fact that meeting with neighbors can facilitate mobilization and thereby engender more intense opposition, both from neighbors and from local officials. Hence, the available evidence suggests that providers should meet with local officials to discuss the community care program but should attempt to deal with neighbors individually. This strategy is compatible with the policy of "prior notification" adopted in New Jersey.


Experience of a single healthcare system with screening mammography before and after COVID-19 shutdown.
To evaluate COVID-19's longitudinal impact on screening mammography volume trends. HIPAA-compliant, IRB-approved, single institution, retrospective study of screening mammogram volumes before (10/21/2016-3/16/2020) and greater than two years after (6/17/2020-11/30/2022) a state-mandated COVID-19 shutdown (3/17/2020-6/16/2020) were reviewed. A segmented quasi-poisson linear regression model adjusting for seasonality and network and regional population growth compared volume trends before and after the shutdown of each variable: age, race, language, financial source, risk factor for severe COVID-19, and examination location. Adjusted model demonstrated an overall increase of 65 screening mammograms per month before versus a persistent decrease of 5 mammograms per month for >2 years after the shutdown (p < 0.0001). In subgroup analysis, downward volume trends were noted in all age groups <70 years (age < 50: +9/month before vs. -7/month after shutdown; age 50-60: +17 vs. -7; and age 60-70: +21 vs. -2; all p < 0.001), those identifying as White (+55 vs. -8, p < 0.0001) and Black (+4 vs. +1, p = 0.009), all financial sources (Medicare: +22 vs. -3, p < 0.0001; Medicaid: +5 vs. +2, p = 0.006; private insurance/self-pay: +38 vs. -4, p < 0.0001), women with at least one risk factor for severe COVID-19 (+30 vs. -48, p < 0.0001), and screening mammograms performed at a hospital-based location (+48 vs. -14, p = 0.0001). The screening mammogram volume trend more than two years after the COVID-19 shutdown has continued to decline for most patient populations. Findings highlight the need to identify additional areas for education and outreach.


MiR-146a inhibits proliferation and induces apoptosis in murine osteoblastic MC3T3-E1 by regulating Bcl2.
The dysregulation of proliferation and apoptosis plays a significant role in the pathogenesis of hormone-induced osteonecrosis of femoral head (ONFH). The research aimed to explore the regulatory role of miR-146a in dexamethasone (DEX)-induced proliferation and apoptosis change in MC3T3-E1 cells from murine osteoblastic. In this study, MC3T3-E1 was co-cultured with 10-7 DEX for 6 h, then RT-PCR was employed to test the expression level of miR-146a and Bcl2. CCK8 assay and flow cytometry were adopted to verify miR-146a could regulate proliferation and apoptosis. After transfected MC3T3-E1 with mimics and inhibitor, RT-PCR and Western blot was used to detect Bcl2 expression level. In DEX treated MC3T3-E1 cells showed higher MiR-146a expression level and lower Bcl2 expression level. MiR-146a could inhibit proliferation and promotes apoptosis in murine osteoblastic MC3T3-E1 cells. Additionally, Bcl2 gene is regulated by MiR-146a. The MiR-146a expression level increased, while Bcl2 has low expression level in dexamethasone treated MC3T3-E1 cells. MiR-146a regulates proliferation and apoptosis of mouse bone cells. The low expression level of Bcl2 in DEX treated MC3T3-E1 cells is caused by increased MiR-146a level.


Keratitis with loss of useful vision after photorefractive keratectomy.
A 30-year-old man was referred as an acute case for keratitis. Two days earlier he had had photorefractive keratectomy for myopia at another clinic; a bandage contact lens was placed over the eye, but prophylactic antibiotics were not prescribed. The keratitis was treated with gentamicin sulfate (Garamycin) and chloramphenicol eyedrops. Scrapings from the cornea showed nonhemolytic streptococci. Two and a half months later, visual acuity was finger counting because of gross distortion of the corneal contour. The combination of a bandage contact lens and the lack of prophylactic antibiotics may have been the source of bacterial keratitis.


The Effect of Spirituality on Illness Perceptions in Patients Undergoing Hemodialysis : Spirituality and Health.
The aim of this study was to assess the effect of spirituality on illness perceptions of Greek patients on hemodialysis. The cross-sectional study design was employed for this purpose. The sample comprised of 367 patients on hemodialysis. Data were collected via a three-part questionnaire consisting of a sheet containing demographic and clinical information, the Illness Perceptions Questionnaire, and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). Data were processed with SPSS V.21, descriptive as well as inferential statistics were applied. The significant level was set at 0.05; 62.1% of the patients in the sample were men and 37.9% women. Their ages ranged from 18 to 92 years old, with an average of 61.80 years old. The findings of the research showed that the spirituality score both total and the subscales leads to a decrease illness perceptions score, meaning that patients perceive the disease as less threatening. The overall score of the Illness Perceptions Questionnaire was above the median, which means that patients perceive their condition as quite threatening. Overall, individual spirituality has a positive impact on the way patients perceive their condition.


A new entry to enantiopure polysubstituted cyclopropanes: stereoselective denitrogenation of sulfinylpyrazolines under Yb(OTf)3 catalysis.
[Structure: see text] Chemoselective and completely stereoselective denitrogenation of optically pure pyrazolines, derived from 3-sulfinylfuran-2(5H)-ones, into cyclopropanes can be achieved under substoichiometric Yb(OTf)3 catalysis. Reactions evolve in almost quantitative yields with complete retention of the configuration at both carbons flanking the nitrogen atoms. The resulting enantiomerically pure polysubstituted cyclopropanes, containing up to five substituens, can be desulfinylated with Ra-Ni providing polysubstituted cyclopropanecarboxylic acid derivatives.


Crystal structure of the Pseudomonas aeruginosa cytoplasmic heme binding protein, Apo-PhuS.
Iron is an essential element to all living organisms and is an important determinant of bacterial virulence. Bacteria have evolved specialized systems to sequester and transport iron from the environment or host. Pseudomonas aeruginosa, an opportunistic pathogen, uses two outer membrane receptor mediated systems (Phu and Has) to utilize host heme as a source of iron. PhuS is a 39 kDa soluble cytoplasmic heme binding protein which interacts and transports heme from the inner membrane heme transporter to the cytoplasm where it is degraded by heme oxygenase thus releasing iron. PhuS is unique among other cytoplasmic heme transporter proteins owing to the presence of three histidines in the heme binding pocket which can potentially serve as heme ligands. Out of the three histidine residues on the heme binding helix, His 209 is conserved among heme trafficking proteins while His 210 and His 212 are unique to PhuS. Here we report the crystal structure of PhuS at 1.98Å resolution which shows a unique heme binding pocket and oligomeric structure compared to other known cytoplasmic heme transporter and accounts for some of the unusual biochemical properties of PhuS.


Novel variant in NSDHL gene associated with CHILD syndrome and syndactyly- a case report.
Congenital hemidysplasia with ichthyosiform erythroderma and limb defects also known as CHILD syndrome is an X-linked dominant, male lethal genodermatosis with a prevalence of 1 in 100,000 live births. Mutations in NSDHL gene located at Xq28 potentially impair the function of NAD(P) H steroid dehydrogenase-like protein and is responsible for its pathogenesis. The proband was a 9-month-old twin (T2) girl with a healthy twin sister (T1) of Sri Lankan origin born to non-consanguineous parents. She presented with right sided continuous icthyosiform erythroderma and ipsilateral limb defects and congenital hemidysplasia since birth. Notably the child had ipsilateral hand hypoplasia and syndactyly. There were other visceral abnormalities. We performed whole exome sequencing and found a novel heterozygous variant (NSDHL, c.713C > A, p.Thr238Asn). We report a novel missense variant in the NSDHL gene that resides in a highly-conserved region. This variant affects the NAD(P) H steroid dehydrogenase-like protein function via reduction in the number of active sites resulting in the CHILD syndrome phenotype and syndactyly.


Control of plasmid DNA replication by iterons: no longer paradoxical.
Replication origins of a family of bacterial plasmids have multiple sites, called iterons, for binding a plasmid-specific replication initiator protein. The iteron-initiator interactions are essential for plasmid replication as well as for inhibition of plasmid over-replication. The inhibition increases with plasmid copy number and eventually shuts plasmid replication off completely. The mechanism of inhibition appears to be handcuffing, the coupling of origins via iteron-bound initiators that block origin function. The probability of a trans-reaction such as handcuffing is expected to increase with plasmid copy number and diminish with increases in cell volume, explaining how the copy number can be maintained in a growing cell. Control is also exerted at the level of initiator synthesis and activation by chaperones. We propose that increases in active initiators promote initiation by overcoming handcuffing, but handcuffing dominates when the copy number reaches a threshold. Handcuffing should be ultrasensitive to copy number, as the negative control by iterons can be stringent (switch-like).


Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women.
Pregnancy in women on dialysis is associated with a higher risk of adverse events, and the best care for this population remains to be established. In this series, we aimed to identify factors associated with the risk of adverse fetal outcomes among 93 pregnancies in women on hemodialysis. Dialysis dose was initially assigned according to the presence of residual diuresis, body weight, and years on dialysis. Subsequent adjustments on dialysis dose were performed according to several parameters. The overall successful delivery rate was 89.2%, with a dialysis regimen of 2.6 ± 0.7 h/d, 15.4 ± 4.0 h/wk, and mean weekly standard urea Kt/V of 3.3 ± 0.6. In the logistic models, preeclampsia, lupus, primigravida, and average midweek blood urea nitrogen (BUN) level were positively related to the risk of a composite outcome of perinatal death or extreme prematurity, whereas polyhydramnios was inversely related to it. In multivariable linear regression, preeclampsia, polyhydramnios, primigravida, average midweek BUN, and residual diuresis remained significantly and independently related to fetal weight, which is a surrogate marker of fetal outcome. An average midweek BUN of 35 mg/dl was the best value for discriminating the composite outcome, and BUN ≥35 mg/dl was associated with a significant difference in a Kaplan-Meier curve (P = 0.01). Our results showed that a good fetal outcome could be reached and that preeclampsia, lupus, primigravida, residual diuresis, polyhydramnios, and hemodialysis dose were important variables associated with this outcome. In addition, we suggested that a midweek BUN <35 mg/dl might be used as a target for adjusting dialysis dose until hard data were generated.


A new approach to multi-professional end of life care training using a sequential simulation (SqS Simulation™) design: A mixed methods study.
A need for improved education and training for hospital staff caring for patients in the last year of life was identified at an urban UK hospital. Sequential Simulation (SqS Simulation™) is a type of simulation that recreates a patient's journey, considering the longitudinal element of care and how this might impact on the patient's experiences, wishes and needs. The aim of this study was to investigate a new end of life care training intervention for multi-professional hospital staff, and its effect on their confidence in managing patients at the end of their life. Based on the results of a formal Training Needs Analysis, four SqS Simulation™ specialty-based courses were designed for general medical and surgical multidisciplinary teams in an acute UK hospital. Over three months, seven SqS Simulation™ sessions were attended by fifty-seven multidisciplinary healthcare professionals. A quasi-experimental mixed-methods study was conducted using open and closed-ended questionnaires, pre and post-intervention. Changes in course attendees' confidence levels were analysed and qualitative data from free-text answers informed potential reasons for any differences identified. Confidence improved for all professional cohorts (p < 0.001). The differences were found to be highly significant for 'doctors' (p < 0.001), significant for 'therapists' (p = 0.02) and not significant for the 'nurses' cohort (p = 0.238). This was explored further using a qualitative explanatory framework. Categories included: Communicating with Families; Teamwork; Goal Planning; Do Not Attempt Cardiopulmonary Resuscitation; Course Usefulness; Prior Training; and Clinical Experience. This study has shown an overall improvement in confidence across disciplines after attending a SqS Simulation™ course. The differences in quantitative results between disciplines were explored through the qualitative data and revealed a difference in what the professionals gained from it. Further studies are required to assess its effectiveness in maintaining confidence of end of life care in practice, as well as its benefit to patient outcomes.


Homogeneous Oligomeric Ligands Prepared via Radical Polymerization that Recognize and Neutralize a Target Peptide.
Abiotic ligands that bind to specific biomolecules have attracted attention as substitutes for biomolecular ligands, such as antibodies and aptamers. Radical polymerization enables the production of robust polymeric ligands from inexpensive functional monomers. However, little has been reported about the production of monodispersed polymeric ligands. Herein, we present homogeneous ligands prepared via radical polymerization that recognize epitope sequences on a target peptide and neutralize the toxicity of the peptide. Taking advantage of controlled radical polymerization and separation, a library of multifunctional oligomers with discrete numbers of functional groups was prepared. Affinity screening revealed that the sequence specificity of the oligomer ligands strongly depended on the number of functional groups. The process reported here will become a general step for the development of abiotic ligands that recognize specific peptide sequences.


"What Hath Night to Do with Sleep?": The Caregiving Context and Dementia Caregivers' Nighttime Awakenings.
Care provision for persons with dementia can be rewarding yet may disrupt caregiver's sleep health. Using the National Health & Aging Trends Study and the National Study of Caregiving, we examine care receiver and caregiver contextual factors, caregiver health and psychological wellbeing as predictors of caregivers' nighttime awakenings. The sample for this cross-sectional study included 451 caregivers for individuals with dementia surveyed by telephone. Nighttime awakenings (1 item measure of waking and not being able to return to sleep) almost every night were reported by 16% of caregivers and 10% reported that helping the care receiver caused their sleep to be interrupted most nights. In a multinomial logistic regression, caregivers' greater nighttime awakenings were associated with caring for care recipients with higher fall risk, as well as caregiver characteristics of more chronic medical conditions and emotional difficulty of the care role. Emotional caregiving difficulties were associated with nighttime awakenings even accounting for caregivers' health and care receivers' disability. Thus, interventions improving caregiver distress may improve sleep health. Clinicians should screen caregivers for nighttime awakenings so that evidence-based interventions and treatments can be implemented to prevent persistent sleep disturbances.


Somatosensory evoked potentials following median and tibial nerve stimulation in patients with Friedreich's ataxia.
The changes in evoked potentials following median and tibial nerve stimulation in nine patients with clinically defined Friedreich's ataxia are reported and discussed. The response originating in the brachial plexus (Erb's point potential) was absent or reduced in amplitude with no prolongation of peak latency, and the response generated in the cauda equina (N18) was absent in all cases. Conduction time from the brachial plexus to cervical spine and medulla oblongata was normal, whereas the central conduction time (N13a/N20, N13b/N20) was delayed. There was moderate to marked attenuation of the primary cortical response to median nerve stimulation. In one patient N20 disappeared during the course of the disease as opposed to the persisting subsequent negative wave, the latter thus simulating a very marked delay in the primary cortical response. Accordingly the cortical response to tibial nerve stimulation, which was only present in two patients and was markedly delayed, might represent a later potential with the primary response absent. The findings are consistent with neuropathological descriptions of a dying back neuropathy with primary axonal degeneration concerning the 1st order sensory neuron. In addition there is evidence either of delayed conduction in 2nd and 3rd order sensory neurones or of abnormal synaptic transmission.


Effect of renal insufficiency on the concentration of free retinol-binding protein in urine and serum.
The concentration of retinol-binding protein (RBP) in urine was determined in 20 healthy individuals and 119 patients with various renal diseases involving tubular or glomerular dysfunction. The sera from 4 healthy individuals and 33 patients were chromatographed on Sephadex G-75 to measure the concentration of free (i.e. not prealbumin-bound) RBP. In healthy individuals, the mean concentration of free RBP in serum was 5.8 mg/l and represented 14% of total RBP; the renal clearance and the fractional tubular uptake of free RBP averaged 0.032 ml/min and 99.97%, respectively. In patients, the concentration of free RBP and the percentage of free RBP in serum were on logarithmic scales inversely correlated with the endogenous creatinine clearance (r = -0.80 and -0.76) and increased in parallel with the serum creatinine (r = 0.67 and 0.66) and beta 2-microglobulin concentrations (beta 2-m, r = 0.76 and 0.89). The semi-logarithmic plot of urine versus serum concentration of free RBP suggests a renal threshold for the tubular reabsorption of this protein at a concentration of about 25 mg/l in serum. The existence of this threshold is confirmed by the relationship between urinary RBP and serum beta 2-m showing that urinary excretion of RBP is invariably high when the serum level of beta 2-m exceeds 5 mg/l. The latter value corresponds precisely to the renal threshold for the tubular reabsorption of beta 2-m. The corresponding value for free RBP derived from the relationship between both proteins is 24 mg/l.(ABSTRACT TRUNCATED AT 250 WORDS)


Growth hormone influences the content and composition of collagen in the aorta from old rats.
Collagen and elastin are major components of the aortic extracellular matrix and crucial in determining the stiffness of the aorta. We recently showed that growth hormone (GH) changes the mechanical properties, content and composition of aortic collagen from young rats. In the present study, the effect of GH on aorta from old rats was investigated. Old female rats (18(1/2)-20(1/2) months) were injected with either GH (5 mg/kg per day; n=15) or vehicle (n=14) for 80 days. Mechanical and biochemical properties of the thoracic aorta were investigated. Long-term GH injections increased the body weight of female rats by 47% accompanied by a threefold increase in serum IGF-I. The diameter of the aorta was increased by 5%, resulting in a 10% increase in the cross-section of the aortic lumen. Growth hormone increased the content of collagen per sample by 6% and increased the amount of type I collagen relative to type III collagen. No changes in the mechanical properties or elastin content per sample were found. In conclusion, GH induced a substantial growth of old rats. However, although the diameter and the collagen content were increased, the mechanical properties of the aorta were preserved in the GH-injected rats.


Global Regulatory Differences for Gene- and Cell-Based Therapies: Consequences and Implications for Patient Access and Therapeutic Innovation.
Gene- and cell-based therapies (GCTs) offer potential new treatment options for unmet medical needs. However, the use of conventional regulatory requirements for medicinal products to approve GCTs may impede patient access and therapeutic innovation. Furthermore, requirements differ between jurisdictions, complicating the global regulatory landscape. We provide a comparative overview of regulatory requirements for GCT approval in five jurisdictions and hypothesize on the consequences of the observed global differences on patient access and therapeutic innovation.


Technics and signs: anthropogenesis in Vygotsky, Leroi-Gourhan, and Stiegler.
This paper reconstructs L.S. Vygotsky's account of anthropogenesis with respect to the work of anthropologist André Leroi-Gourhan and late philosopher Bernard Stiegler, situating Vygotsky as a forerunner to recent theories that posit cultural scaffolding and niche construction as the main drivers of human cognitive evolution. One might think there is an immediate affinity between Vygotsky and the techno-centric accounts of Leroi-Gourhan and Stiegler. Following Leroi-Gourhan, Stiegler argues that "technics" is the main driver in the anthropogenic development of "reflective consciousness." Vygotsky likewise claims that "psychological tools" are responsible for the development of uniquely human forms of consciousness. However, closer inspection reveals deep disparities between Vygotsky and the French thinkers. In Stiegler's philosophical redeployment of Leroi-Gourhan's anthropology, "reflective" cognition is the product of a prehistorical rupture in which some threshold of technical-cortical complexification is breached. For Vygotsky, on the other hand, the inverse scenario obtains. Technical development initially proceeds in tandem with the complexification of biologically based signaling behavior until the introduction of signs, which then radically restructure the cognitive apparatus. Due to inconsistencies regarding the equivalency of the technical and semiotic in Stiegler and Leroi-Gourhan, I advance a Vygotskian account where anthropogenesis is the result of semiotic rather than technical intervention. This aims to establish Vygotsky's "Cultural Historical" approach, and the Marxian-dialectical tradition from which he draws, as not only presaging recent naturalistic accounts of development, but offering a relevant theoretical program that may continue to inspire contemporary enculturated accounts of anthropogenesis.


Effects of inoculation of corn silage with Lactobacillus spp. or Saccharomyces cerevisiae alone or in combination on silage fermentation characteristics, nutrient digestibility, and growth performance of growing beef cattle.
This study evaluated the effects of a novel silage inoculant containing Saccharomyces cerevisiae strain 3 as a direct fed microbial (DFM) on the ensiling, aerobic stability, and nutrient digestibility of whole-crop corn silage and growth performance of beef cattle. Treatments included uninoculated corn silage (CON) or corn silage inoculated with a mixture of 1.1 × 105 cfu g-1 fresh forage Lactobacillus plantarum and Lactobacillus buchneri (INOC1) or 1.0 × 104 cfu g-1 fresh forage S. cerevisiae strain 3 (INOC2) or a mixture of INOC1 and INOC2 (INOC3). Silage in INOC1 had lower (P = 0.03) proportion of lactate, with acetate (Ac) proportion ranking as INOC1 > INOC3 > INOC2 (P < 0.01). In terminal silage, numbers of lactic acid bacteria were greater (P = 0.05) for INOC1 than CON and INOC2, while yeast counts tended (P = 0.08) to be greater for INOC2 than INOC3 on day 3 of aerobic exposure. Aerobic stability of corn silage was not impacted by inoculation with S. cerevisiae strain 3. Heifers fed INOC2 and INOC3 had lower (P < 0.01) ruminal Ac concentration than those fed CON. Apparent total tract digestibilities of DM, OM, ADF, and NDF were greater (P ≤ 0.03) for heifers fed INOC2 than those fed CON. Growth performance was similar across treatments, excepting DMI as percent of BW tended to be lower (P = 0.08) for INOC2 steers compared to CON steers. These results suggest that S. cerevisiae strain 3 has potential as a component in a fourth generation DFM silage inoculant.


Nasal myiasis by fruit fly larvae: a case report.
We report a case of human nasal myiasis caused by fruit fly larvae in a 33-year-old man who visited the south coast of Turkey. The fruit fly (Drosophila melanogaster) is endemic in the southern part of Turkey. Infestation with fruit fly larvae must be considered in patients who are visiting areas of the world where Drosophila is endemic. This is the first reported case of fruit fly larvae causing human nasal myiasis. The clinical presentation and treatment strategies are discussed.


Benign Synthesis of Metal-organic Framework (MIL-101-Cr) and Evaluation of Carbon- dioxide Adsorption Behaviour Employing Adsorption Isotherm Models.
In today's world, rising temperature due to global warming is caused by higher concentration of carbon dioxide (CO2) emissions in the atmosphere. Metal-Organic Framework (MOF) materials have the potential to be used in carbon dioxide capture and utilization technology. The purpose of this work is to prepare metal-organic framework materials by a benign synthesis method using water as the solvent, followed by the characterization and property evaluation for CO2 adsorption study. MIL-101-Cr metal-organic framework and its derivatives with alkali ion dopants were prepared by benign hydrothermal synthesis route, which were characterized by powder X-ray diffraction method. The adsorption isotherms of CO2 for MIL-101-Cr and its derivatives were studied to comprehend the influence of alkali dopants on CO2 sorption behaviour. The equilibrium uptakes of CO2 were further evaluated by fitting the isotherms with Langmuir, Toth and Dubinin - Astakohv adsorption models to determine the adsorption parameters. The crystalline structural integrity of MIL-101-Cr is not affected by doping with alkali ions. The isosteric heat of CO2 adsorption is diminished with an increase in alkali dopant size, while the induced surface structural heterogeneity increases with increasing alkali dopant size. The equilibrium and thermodynamic parameters calculated from this study are useful for applications in carbon dioxide capture and utilization technology.


Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - a randomised, controlled simulation study of two micro-interventions.
Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork. To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio. 46 physicians graduated within 5 years. A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer. Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action". Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment.


Dosage effect of micron zero-valent iron during thermophilic anaerobic digestion of waste activated sludge: Performance and functional community.
This work examined the performance and microbial traits in a thermophilic anaerobic digestion (TAD) of waste activated sludge that was impacted by micron zero valent iron (mZVI). Results showed that methane production was promoted by 0.8, 11.9, and 12.0 times, respectively, when mZVI was at dosages of 25, 100, and 250 mg/g total solid (TS). Also, the consumption of volatile fatty acids was increased by mZVI at higher dosages (100 and 250 mg/g TS). Furthermore, 16S rRNA sequencing demonstrated that microbial community stabilized after day 18 regardless of the dosage of mZVI, and that different dosages of mZVI induced different shifts in the functional community of the archaea rather than the bacteria involved in TAD. As a result, mZVI at 100 mg/g TS could increase the relative abundance of archaeal genera Methanothermobacter the most, increasing by 22.8% at the end of TAD compared to CK. Besides, redundancy analysis revealed that the physicochemical properties explained 79.65% and 89.10% of the variations of bacterial and archaeal abundance, respectively. Also, the findings of the correlation analysis revealed that total dissolved iron, ferrous iron, pH, and ammonium nitrogen, may be the key divers of altering functional communities, particularly archaea. Moreover, mZVI at 100 and 250 mg/g TS boosted the metabolic pathways of environmental information processing (ABC transporters) in bacteria and carbon metabolism and methane metabolism for archaea, as well as relative abundances of enzymes and their activities involved in various methanogenic pathways. This study provides new perspectives on the application of mZVI in solid wastes treatments.


An original antireflux ureteroileal implantation technique: long-term followup.
An original ureteroileal reimplantation technique in which the ureter is placed in a sulcus created in the ileal mucosa was performed on 51 patients (97 ureters). Followup ranged from 3 to 8 years. As determined by excretory urography, retrograde ileography and urine bacteriology studies the method was effective in 85 per cent of the patients, with a low rate of stenosis (1.5 per cent). The use of this technique, initially limited to patients with the U-shaped continent ileal bladder, has been broadened to include those who undergo various reconstructive or urinary diversion procedures that require ureteroileal reimplantation.


Phytochemical profiling of Salsola tetragona Delile by LC-HR/MS and investigation of the antioxidant, anti-inflammatory, cytotoxic, antibacterial and anti-SARS-CoV-2 activities.
This study aimed to investigate the phytochemical composition and biological activity of Salsola tetragona Delile. (Amaranthaceae), a medicinal plant. The study evaluated the antioxidant potential of the crude extract and five fractions of S. tetragona using DPPH•, ABTS•+, CUPRAC, and metal chelating assays. The anti-inflammatory activity was determined using a protein denaturation assay, and the antibacterial activity was determined by the Minimum inhibitory concentrations (MICs) for the growth of Escherichia coli and Staphylococcus aureus strains. The MTT test and an in vitro scratch assay evaluated the effects on cell viability and cell migration. The potential anti-SARS-CoV-2 activity was assessed by analyzing the effects on the interaction between ACE2 and Spike protein. The bioactive compounds present in the plant were identified using LC-HR/MS analysis. The crude hydromethanolic extract (STM) and five fractions of S. tetragona, n-hexane (STH), dichloromethane (STD), ethyl acetate (STE), n-butanol (STB), and aqueous (STW) showed significant antioxidant activity in four different tests. In the anti-inflammatory assay, the ethyl acetate fraction exhibited significantly higher activity than Aspirin® (IC50 = 13 ± 5 µg/mL). The crude extract and its fractions showed positive antibacterial activity with similar MICs. In the cytotoxicity assay against the breast cancer cell line MCF7, the dichloromethane fractions (STD) were very effective and demonstrated superiority over the other fractions (IC50 = 98 µg/mL). Moreover, the potential of the extract and fractions as anti-SARS-CoV-2, the ethyl acetate, and dichloromethane fractions demonstrated important activity in this test. LC-HR/MS analysis identified 16 different phenolic compounds, Eleven of which had not been previously reported in the genus Salsola. The results suggest that the extracts of S. tetragona have the potential to become new sources for developing plant-based therapies for managing a range of diseases.


Molecular diagnosis of infectious diseases using cytological specimens.
Pathologists have an important role in the diagnosis of infectious disease (ID). In many cases, a definitive diagnosis can be made using cytopathology alone. However, several ancillary techniques can be used on cytological material to reach a specific diagnosis by identifying the causative agent and consequently defining the management of the patient. This review aims to present the effectiveness of the application of molecular studies on cytological material to diagnose IDs and discuss the advantages and disadvantages of the various molecular techniques according to the type of cytological specimen and the infectious agents.


Cancer-associated fasciitis panniculitis.
Eosinophilic fasciitis and the related fasciitis panniculitis syndrome (FPS) are the clinical and morphologic expression of a variety of disorders, of which chronic inflammation and fibrous thickening of the subcutaneous septa, fascia, and perimysium are common. FPS in patients with cancer has been reported sporadically. In the course of our studies of FPS we have encountered three patients who had an associated neoplasia. Nine reports of patients have been taken from the literature. The clinical and histologic data of FPS in the 12 patients were analyzed in the search of distinctive features from FPS in patients with no evidence of malignancy. Among patients with cancer-associated FPS there was a female predominance (8 patients), predilection for hematolymphatic malignancies (9 patients), precedence of the FPS to cancer diagnosis (10 patients) by a median lag time of 1 year, and unresponsiveness to prednisone therapy in most patients (7 of 8 patients). Cancer-associated FPS has several characteristics of a paraneoplastic syndrome: it occurs at a distance from the tumor, certain types of tumors are overrepresented among patients with FPS, it evolves in concert with the neoplasia, and it sometimes remits after successful cancer surgery. In contrast to idiopathic FPS, cancer-associated FPS shows a female predominance, and it usually fails to respond to corticotherapy.


Combination chemotherapy for the treatment of Hodgkin's disease in relapse. Results with lomustine (CCNU), melphalan (Alkeran), and vindesine (DVA) alone (CAD) and in alternation with MOPP and doxorubicin (Adriamycin), bleomycin, and vinblastine (ABV).
Vindesine (desacetyl vinblastine amide sulfate, DVA) was used in combination with CCNU (lomustine) and melphalan (Alkeran) (CAD) to treat 15 heavily pretreated patients with Hodgkin's disease in relapse. The patients were treated with up to six cycles, depending upon their response. Two patients (13%) achieved a complete remission (CR) and five (33%) patients a partial remission (PR). The major toxicity was prolonged thrombocytopenia, which was decreased by a reduction in the initial drug doses for patients who had received extensive prior chemotherapy and radiotherapy (RT). The CAD regimen was then alternated with nitrogen mustard or cyclophosphamide, vincristine, procarbazine, and prednisone (MOPP, C-MOPP) and doxorubicin (Adriamycin), bleomycin, and vinblastine (ABV) for a total of nine cycles in 25 patients with Hodgkin's disease in relapse with somewhat more favorable prognostic features. Two patients also received low-dose RT to areas of bulky nodal disease. Eleven patients (44%) achieved a CR and seven (28%) a PR. Of the 11 CR patients, six remain in remission. The serious toxicity was comparable to that seen with other combination chemotherapy regimens. These results indicated that the CAD/MOPP/ABVD regimen is as active as other so-called 'salvage' regimens for Hodgkin's disease in relapse, and suggest that it might be useful for newly diagnosed Hodgkin's disease.


Use of a combined effect model approach for discriminating between ABCB1- and ABCC1-type efflux activities in native bivalve gill tissue.
Aquatic organisms, such as bivalves, employ ATP binding cassette (ABC) transporters for efflux of potentially toxic chemicals. Anthropogenic water contaminants can, as chemosensitizers, disrupt efflux transporter function enabling other, putatively toxic compounds to enter the organism. Applying rapid amplification of cDNA ends (RACE) PCR we identified complete cDNAs encoding ABCB1- and ABCC1-type transporter homologs from zebra mussel providing the molecular basis for expression of both transporter types in zebra mussel gills. Further, efflux activities of both transporter types in gills were indicated with dye accumulation assays where efflux of the dye calcein-am was sensitive to both ABCB1- (reversin 205, verapamil) and ABCC1- (MK571) type specific inhibitors. The assumption that different inhibitors targeted different efflux pump types was confirmed when comparing measured effects of binary inhibitor compound mixtures in dye accumulation assays with predictions from mixture effect models. Effects by the MK571/reversin 205 mixture corresponded better with independent action, whereas reversin 205/verapamil joint effects were better predicted by the concentration addition model indicating different and equal targets, respectively. The binary mixture approach was further applied to identify the efflux pump type targeted by environmentally relevant chemosensitizing compounds. Pentachlorophenol and musk ketone, which were selected after a pre-screen of twelve compounds that previously had been identified as chemosensitizers, showed mixture effects that corresponded better with concentration addition when combined with reversine 205 but with independent action predictions when combined with MK571 indicating targeting of an ABCB1-type efflux pump by these compounds.


Adenosine induces a calcium-dependent glomerular contraction.
Glomeruli isolated from rat kidney cortex were incubated with adenosine in the presence or absence of verapamil and calcium and their change in cross-sectional area was recorded. Adenosine induced a 10% decrease in glomerular cross-sectional area. This decrease was blocked by verapamil or a calcium-free medium. The results suggest that the effect of adenosine in the kidney could be due to glomerular constriction, and that this constriction depends on the entry of calcium into glomerular cells.


Approach for treatment of subcoronal meatus with excessively deep glanular groove.
We report on 9 children with subcoronal meatus and an excessively deep glanular groove who underwent a simple surgical repair. All the procedures were done on an outpatient basis, and there was no urinary diversion. The surgical results have been satisfactory, with no fistula formation, or urethral or meatal stenosis. The technique described is useful in selected cases.


Basic fibroblast growth factor is synthesized in cultured retinal pigment epithelial cells.
Cultured cells derived from bovine retinal pigment epithelium (RPE) express the basic fibroblast growth factor (bFGF) gene and they contain 3.7 and 7.0 kb bFGF gene transcripts which are translated into immunoreactive bFGF of Mr 17,500 and 18,000, respectively. The RPE cell-derived bFGF is bioactive, i.e., it can stimulate the proliferation of capillary endothelial cells and the stimulation of cell proliferation is blocked by anti-bFGF antibodies. We suggest that RPE cell-derived bFGF may be involved in the repair mechanisms following retinal injury and in the intravitreal pseudoneoplastic proliferation of the injured RPE.


Formation and evolution of C-C, C-O, C[double bond, length as m-dash]O and C-N bonds in chemical reactions of prebiotic interest.
A series of prebiotic chemical reactions yielding the precursor building blocks of amino acids, proteins and carbohydrates, starting solely from HCN and water is studied here. We closely follow the formation and evolution of the pivotal C-C, C-O, C[double bond, length as m-dash]O, and C-N bonds, which dictate the chemistry of the molecules of life. In many cases, formation of these bonds is set in motion by proton transfers in which individual water molecules act as catalysts so that water atoms end up in the products. Our results indicate that the prebiotic formation of carbon dioxide, formaldehyde, formic acid, formaldimine, glycolaldehyde, glycine, glycolonitrile, and oxazole derivatives, among others, are best described as highly nonsynchronous concerted single step processes. Nonetheless, for all reactions involving double proton transfer, the formation and breaking of O-H bonds around a particular O atom occur in a synchronous fashion, apparently independently from other primitive processes. For the most part, the first process to initiate seems to be the double proton transfer in the reactions where they are present, then bond breaking/formation around the reactive carbon in the carbonyl group and finally rupture of the C-N bonds in the appropriate cases, which are the most reluctant to break. Remarkably, within the limitations of our non-dynamical computational model, the wide ranges of temperature and pressure in which these reactions occur, downplay the problematic determination of the exact constraints on the early Earth.


Integrated Care and the Evolution of the Multidisciplinary Team.
The primary care medical home continues to adapt by applying new research to population health approaches to care. With the discovery that life experiences trigger a chain of biologic events linked to chronic illnesses, the role of patient-centered multidisciplinary care teams becomes of paramount importance. Subsequently, mental health professionals are being incorporated into the primary care setting, using their skills in nontraditional models to customize care for each patient. This "integration" of primary care and unique mental health services engenders opportunity for enhanced clinical care, professional workforce development and support, more effective population health initiatives, and informed health care policy.


Restoring the imaging quality of circular transducer array-based PACT using synthetic aperture focusing technique integrated with 2nd-derivative-based back projection scheme.
Circular-array-based photoacoustic computed tomography (CA-PACT) is a promising imaging tool owing to its broad acoustic detection coverage and fidelity. However, CA-PACT suffers from poor image quality outside the focal zone along both elevational and lateral dimensions. To address this challenge, we proposed a novel reconstruction strategy by integrating the synthetic aperture focusing technique (SAFT) with the 2nd derivative-based back projection (2nd D-BP) algorithm to restore the image quality outside the focal zone along both the elevational and lateral axes. The proposed solution is a two-phase reconstruction scheme. In the first phase, with the assistance of an acoustic lens, we designed a circular array-based SAFT algorithm to restore the resolution and SNR along the elevational axis. The acoustic lens pushes the boundary of the upper limit of the SAFT scheme to achieve enhanced elevational resolution. In the second phase, we proposed a 2nd D-BP scheme to improve the lateral resolution and suppress noises in 3D imaging results. The 2nd D-BP strategy enhances the image quality along the lateral dimension by up-converting the high spatial frequencies of the object's absorption pattern. We validated the effectiveness of the proposed strategy using both phantoms and in vivo human experiments. The experimental results demonstrated superior image quality (7-fold enhancement in elevational resolution, 3-fold enhancement in lateral resolution, and an 11-dB increase in SNR). This strategy provides a new paradigm in the PACT system as it significantly enhances the spatial resolution and imaging contrast in both the elevational and lateral dimensions while maintaining a large focal zone.


Juvenile hormone mediates lipid storage in the oocytes of Dipetalogaster maxima.
Triatomines are vectors of Chagas disease and important model organisms in insect physiology. "Kissing bugs" are obligatory hematophagous insects. A blood meal is required to successfully complete oogenesis, a process primarily controlled by juvenile hormone (JH). We used Dipetalogaster maxima as an experimental model to further understand the roles of JH in the regulation of vitellogenesis and oogenesis. A particular focus was set on the role of JH controlling lipid and protein recruitment by the oocytes. The hemolymph titer of JH III skipped bisepoxide increased after a blood meal. Following a blood meal there were increased levels of mRNAs in the fat body for the yolk protein precursors, vitellogenin (Vg) and lipophorin (Lp), as well as of their protein products in the hemolymph; mRNAs of the Vg and Lp receptors (VgR and LpR) were concomitantly up-regulated in the ovaries. Topical administration of JH induced the expression of Lp/LpR and Vg/VgR genes, and prompted the uptake of Lp and Vg in pre-vitellogenic females. Knockdown of the expression of LpR by RNA interference in fed females did not impair the Lp-mediated lipid transfer to oocytes, suggesting that the bulk of lipid acquisition by oocytes occurred by other pathways rather than by the endocytic Lp/LpR pathway. In conclusion, our results strongly suggest that JH signaling is critical for lipid storage in oocytes, by regulating Vg and Lp gene expression in the fat body as well as by modulating the expression of LpR and VgR genes in ovaries.


Time-dependent gene expression and immunohistochemical analysis of the injured anterior cruciate ligament.
This study aimed to investigate time-dependent gene expression of injured human anterior cruciate ligament (ACL), and to evaluate the histological changes of the ACL remnant in terms of cellular characterisation. Injured human ACL tissues were harvested from 105 patients undergoing primary ACL reconstruction and divided into four phases based on the period from injury to surgery. Phase I was < three weeks, phase II was three to eight weeks, phase III was eight to 20 weeks, and phase IV was ≥ 21 weeks. Gene expressions of these tissues were analysed in each phase by quantitative real-time polymerase chain reaction using selected markers (collagen types 1 and 3, biglycan, decorin, α-smooth muscle actin, IL-6, TGF-β1, MMP-1, MMP-2 and TIMP-1). Immunohistochemical staining was also performed using primary antibodies against CD68, CD55, Stat3 and phosphorylated-Stat3 (P-Stat3). Expression of IL-6 was mainly seen in phases I, II and III, collagen type 1 in phase II, MMP-1, 2 in phase III, and decorin, TGF-β1 and α-smooth muscle actin in phase IV. Histologically, degradation and scar formation were seen in the ACL remnant after phase III. The numbers of CD55 and P-Stat3 positive cells were elevated from phase II to phase III. Elevated cell numbers including P-Stat3 positive cells were not related to collagens but to MMPs' expressions.


The pre-morbid psychometric profile is stable over time in subjects at high familial risk for affective disorders.
The pre-morbid personality profile 'autonomic lability' (e.g. elevated neuroticism, frequent somatic complaints and increased interpersonal sensitivity) is suggested to be an antecedent of major depression. Recently, we reported that the psychometric profile of healthy first-degree relatives of patients with an affective disorder (so-called high-risk probands; HRPs) was characterized by the personality trait 'rigidity' in association with 'autonomic lability' and speculated that such a profile might be a potential candidate for a true vulnerability marker for affective disorders. Because one major prerequisite for any valid vulnerability marker is its stability over time, we re-examined our HRPs about four years after index assessment. Sixteen HRPs from the initial sample (n=54) participated in the follow-up investigation which, on average, took place 47 months after index assessment. All these HRPs had remained mentally healthy during the follow-up period. The psychometric profile was remarkably stable over the four-year period when considering the total group of the 16 HRPs. On an individual level, similar findings were obtained. Allowing a fluctuation within a narrowly defined 'band width', a constancy of the self-ratings was found in 75% of the HRPs, within a broader 'band width' this was the case in 88% of the HRPs. The power of the present observations appears to be somewhat limited due to the still small sample size of HRPs re-investigated and the fact that the control probands were not yet re-examined. The present follow-up findings in 16 probands at high risk for an affective disorder indicate a sufficient stability of the psychometric profile over time, so that this requirement for a true vulnerability marker is fulfilled.


Diesel exhaust exposure system for animal studies.
Planned exposures of rodents to diesel exhaust required development of an exhaust generation and delivery system flexible enough to accommodate varied experimental designs. The features of the exposure system built to meet these needs are summarized. Essential aspects including both the exhaust dilution and delivery system and the computer monitoring and control functions are described. During the first 29 weeks of a study with target particle concentrations of 350, 3500, and 7000 micrograms/m3, the achieved values were 310, 3360, and 6830 micrograms/m3 with coefficients of variation of 23, 10, and 9%, respectively. The system has now operated reliably for more than 24 months.


Combination of best promoter and micellar catalyst for more than kilo-fold rate acceleration in favor of chromic acid oxidation of D-galactose to D-galactonic acid in aqueous media at room temperature.
Picolinic acid, 2,2'-bipyridine and 1,10-phenanthroline promoted Cr(VI) oxidation of D-galactose to D-galactonic acid in three representative aqueous micellar media has been studied. The anionic surfactant (SDS) accelerated the rate of reaction while the cationic surfactant (CPC) and neutral surfactant (TX-100) retarded the reaction rate. Combination of bipy and SDS is the best choice for chromic acid oxidation of D-galactose to D-galactonic acid in aqueous media although 1,10-phenanthroline is best promoter in absence of micellar catalyst.


Effect of the oral administration of branched chain amino acids on hepatic encephalopathy in the rat.
The aim of this study was to investigate the effect of oral administration of branched-chain amino acid (BCAA)-enriched diets after portacaval shunt (PCS) in rats. Fifty-one Sprague-Dawley male rats (200 gm) underwent PCS and 55 a sham operation. Half of the animals received BCAA 142 mg per day through a gastric tube; the other half underwent a sham procedure. Sleep disturbances were evaluated at 7, 14, and 28 days postoperatively by measurement of the excitability of the reticular brain-stem formation during the slow-wave sleep and paradoxical sleep. Animals were killed at the same intervals and liver/body weight ratio, plasma, and brain amino acids, brain norepinephrine, brain serotonin, 5-hydroxyindolacetic acid and histamine were measured. Each group of animals was matched with a similar group of sham-operated rats, i.e., receiving or not receiving BCAA. After PCS (as compared to sham-operated animals) a significant hyperexcitability of the reticular brain-stem formation was found during the slow-wave sleep. The liver/body weight ratio was significantly lower. Tryptophan (free tryptophan in the plasma), phenylalanine, tyrosine, and histidine increased in the plasma and the brain. Leucine and isoleucine were decreased in the plasma. After PCS, an initial decrease at 7 days postoperatively of brain norepinephrine and blockade of the intracerebral metabolism of tryptophan were observed. These changes were transient and progressively disappeared at 14 and 28 days postoperatively. Brain histamine remained at a very high level through the experiment. A good correlation was demonstrated between modification of the sleep disturbance and tryptophan (or 5- hydroxyindolacetic acid) and histamine brain levels.(ABSTRACT TRUNCATED AT 250 WORDS)


Role of social benefits for future long-term sickness absence, disability pension and unemployment among individuals on sickness absence due to mental diagnoses: a competing risk approach.
To investigate associations between social benefits and disability pension (DP), long-term sickness absence (LTSA, ≥ 90 days), or unemployment among Swedish twins with sickness absence (SA) due to mental diagnoses. This population-based prospective twin study included register data on first incident SA spell (< 90 days) due to mental diagnoses (ICD 10 codes F00-F99) during the follow-up 2005-2016. SA < 90 days due to other diagnoses than mental diagnoses or any other social insurance benefit was identified for the preceding year of the first incident SA spell due to mental diagnoses (coded yes/no). Comparing those with any previous social benefits vs without, cumulative incidence curve to compare time to an event, and Cox proportional hazards models for cause-specific hazard ratios (HR, 95% confidence intervals, CI) treating first incident DP, LTSA and unemployment as competing risks were modeled. During follow-up, 21 DP, 1619 LTSA, and 808 unemployment events took place. Compared to those without, those with at least one benefit had a higher risk for DP (HR 5.03; 95%CI 1.80, 14.01), LTSA (1.67; 1.50, 1.84) and unemployment (1.24; 1.03, 1.50). The cumulative incidence for DP was very low, < 1%, for LTSA 80% with any previous social benefits vs. 60% without, and for unemployment ≤ 5%. Social benefits received during the preceding year of SA due to mental diagnoses (< 90 days) predict DP, LTSA, and unemployment. Hence, previous social benefits may provide means for early identification of persons at risk for exit from labor market.


Natural occurrence of anaerobiosis in molluscs from intertidal habitats.
The scope for anaerobiosis of Patella vulgata and Scrobicularia plana was investigated during experimental hypoxia. Furthermore these two species as well as Mytilus edulis and Crdium edule were taken from their habitat during low tide in order to assess whether the animals were anaerobic.When kept in nitrogen saturated water Patella vulgata and Scrobicularia plana showed an increase in the concentration of succinate,acetate and propionate. In addition the energy charge fell and the content of phosphorylarginine decreased.On exposure to low tide, within their habitat, only Mytilus edulis and Scrobicularia plana became anaerobic as judged from a 10 to 30 fold increase of succinate concentrations. Succinate was never elevated in Cardium edule and Patella vulgata.Succinate concentrations of Mytilus edulis and Scrobicularia plana were measured at intervals throughout the year and found to increase whenever the animals were emersed.


Risk stratification for mortality in cardiovascular disease survivors: A survival conditional inference tree analysis.
Efficient analysis strategies for complex network with cardiovascular disease (CVD) risk stratification remain lacking. We sought to identify an optimized model to study CVD prognosis using survival conditional inference tree (SCTREE), a machine-learning method. We identified 5379 new onset CVD from 2006 (baseline) to May, 2017 in the Kailuan I study including 101,510 participants (the training dataset). The second cohort composing 1,287 CVD survivors was used to validate the algorithm (the Kailuan II study, n = 57,511). All variables (e.g., age, sex, family history of CVD, metabolic risk factors, renal function indexes, heart rate, atrial fibrillation, and high sensitivity C-reactive protein) were measured at baseline and biennially during the follow-up period. Up to December 2017, we documented 1,104 deaths after CVD in the Kailuan I study and 170 deaths in the Kailuan II study. Older age, hyperglycemia and proteinuria were identified by the SCTREE as main predictors of post-CVD mortality. CVD survivors in the high risk group (presence of 2-3 of these top risk factors), had higher mortality risk in the training dataset (hazard ratio (HR): 5.41; 95% confidence Interval (CI): 4.49-6.52) and in the validation dataset (HR: 6.04; 95%CI: 3.59-10.2), than those in the lowest risk group (presence of 0-1 of these factors). Older age, hyperglycemia and proteinuria were the main predictors of post-CVD mortality. ChiCTR-TNRC-11001489.


The pattern and control of eruptive tooth movements.
Assumptions about eruptive tooth movements based on experience with adolescents may not be applicable to all ages. The eruptive process can be subdivided into six phases--three profunctional stages of individual tooth eruption (follicular growth, pre-emergent eruptive spurt, and postemergent eruptive spurt) and three postfunctional stages of the eruption of the entire dentition (juvenile occlusal equilibrium, circumpubertal occlusal eruptive spurt, and adult occlusal equilibrium). Differences in tooth-eruption rates in each of these phases result from variations in systemic and local factors. A series of working hypotheses which incorporate recent research into a theoretical explanation of the control of eruption during each stage is presented. Prior to emergence, the force of eruption may influence the rate of bone resorption and later of gingival remodeling, but the resorptive processes occur independently and are the rate-limiting factors in pre-emergent eruption. After emergence, intermittent occlusal loading disrupts the generative or adaptive mechanisms of the periodontal ligament so that eruption slows. The light continuous forces from resting tongue pressure also are significant influences on tooth eruption during periods of rapid facial growth. Cellular adaptation of the alveolar bone and gingiva plays an important role in the control of tooth eruption in the adult.


Threshold equivalence between perimeters.
To determine equivalence between perimeters, 49 eyes of 35 subjects underwent static threshold testing of the central 30 degrees twice on each of three automated perimeters and twice by manual kinetic threshold testing with the Goldmann perimeter. The Octopus-Humphrey difference was 3.3 dB (2.3 dB in the upper two rows for programs 32 and 30-2). The Dicon-Octopus difference was 3.5 dB and the Dicon-Humphrey, 6.5 dB. The I4e stimulus of the Goldmann perimeter was equivalent to 17.1 dB, 13.6 dB, and 10.8 dB on the Humphrey, Octopus, and Dicon perimeters, respectively. The III4e stimulus of the Goldmann perimeter, used for visual impairment determination, was roughly equivalent to 7 to 10 dB, 4 to 7 dB, and 0 to 6 dB on the Humphrey, Octopus, and Dicon perimeters, respectively. The prediction when converting from one instrument to another was only 10% less reliable than the ability of a perimeter to predict the values on a second examination with the same perimeter. Validity of the conversion formulas was confirmed by the age-corrected normal values available for the Octopus, Humphrey, and Goldmann perimeters.


A saponin from the roots of Gypsophila bermejoi.
A new saponin was isolated from the methanol extract of the roots of Gypsophila bermejoi and identified by a combination of chemical degradation and spectral methods, which included negative FABMS and extensive 1D and 2D-NMR analysis (DQCOSY, TOCSY, ROESY, HMQC and HMBC), as gypsogenin 28-O-beta-D-glucopyranosyl(1-->2)-[beta-D-glucopyranosyl (1-->6)]-beta-D-glucopyranoside.