Characteristics of Elderly Hip Fracture Patients in Jordan: A Multicenter Epidemiological Study.
Elderly hip fractures represent a global health care burden. Several reports expected a massive increase in the incidence of hip fractures by the next few decades. Knowing the epidemiology of hip fractures is crucial for planning health care policies. The purpose of this study is to provide a nationwide epidemiological overview of hip fractures in Jordan and to report the perioperative outcomes that may help to improve the delivered healthcare. . We conducted  a retrospective study at 2 university hospitals and 2 major governmental hospitals in Jordan. We reviewed the records for all patients (age >55 years) who were diagnosed with hip fractures over a 3 years duration (2019-2021). We documented the patient's characteristics and the perioperative data (including preoperative, intraoperative, and postoperative details including the 1-year mortality).. The total number of included patients was 1268; more than half (53.7%) were females. The mean age is 75 years (SD 9.7).  The most common fracture type was trochanteric (66.2%). 7% of patients had a prior contralateral hip fracture. The average time from admission to surgery was 2.96 days (SD 2.63). The surgery was done within 48 hours for 56.7% of patients. Approximately, one-third of all patients (34.5%) received a blood transfusion. The average length of hospital stay is 7.44 days (SD 5). The overall rate of postoperative thromboembolic events, readmission within 1 month, and revision for the same surgery are 2.4%, 10.7%, and 3% respectively. The 1-month, 6-month, and 12-month mortality rates are 4.5%, 9.1%, and 12.8% respectively. The annual incidence of elderly hip fractures in Jordan is approximately 96 per 100,000 individuals. The 1-year mortality rate of hip fractures in Jordan is 12.8%. Both findings are in the lower range of nearby Arab countries.


Comparison of pirarubicin-based versus gemcitabine-docetaxel chemotherapy for relapsed and refractory osteosarcoma: a single institution experience.
The prognoses for patients with relapsed and refractory osteosarcoma are poor and the optimal treatment strategy is still to be defined. We conducted this retrospective study to compare the feasibility and efficacy of pirarubicin-based chemotherapy with gemcitabine-docetaxel combination regimens for the salvage of these patients. The clinical data of 75 patients who received pirarubicin-based (n = 52) or gemcitabine-docetaxel (n = 23) chemotherapy as a second-line treatment for relapsed and refractory osteosarcoma between January 2005 and September 2011were reviewed retrospectively. Tumor response was evaluated every two chemotherapy cycles by computed tomography/magnetic resonance imaging (CT/MRI) scans using the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival (OS) were evaluated by Kaplan-Meier analysis. Toxicity was examined according to the National Cancer Institute Toxicity Criteria grading system. Patient characteristics were well balanced in the two groups. The response rate was 25.0 % in patients who received pirarubicin-based chemotherapy, while it was 13.0 % in the gemcitabine-docetaxel group. Moreover, the median OS was longer in the pirarubicin-based chemotherapy group (14.0 vs. 9.0 months, P < 0.05), especially in the pirarubicin-ifosfamide (14.0 months) and pirarubicin-cisplatin (15.0 months) subgroups. The incidence of grade 3-4 neutropenia was higher in the gemcitabine-docetaxel group (5.8 vs. 43.5 %, P < 0.05); other grade 3-4 toxicities were comparable in the two groups. In our experience, pirarubicin-based chemotherapy was comparable with gemcitabine-docetaxel as a second-line treatment for relapsed and refractory osteosarcoma, and it even seemed to show greater efficacy, with milder toxicity. Further studies, especially prospective clinical trials, focusing on pirarubicin-based treatments for relapsed and refractory osteosarcoma patients should be strongly considered.


Primary concerns of advanced cancer patients identified through the structured life review process: a qualitative study using a text mining technique.
This study aims to clarify characteristics of the contents of life review in reminiscence therapies in cancer patients by age, gender, and stage of disease. Sixteen patients who were terminally ill and were receiving anticancer treatments participated in life review therapy. Patients reviewed there lives according to their developmental stage, and they mainly reviewed impressive achievements. A clinical psychologist interviewed each patient four times and the total number of sessions was 64. The contents of each life review were transcribed, and a correspondence analysis and a significance test were conducted on these data to choose characteristic words or phrases. The main concern of 40-year-olds was "about children." For 50-year-olds, it was "how to confront death" and for 60-year-olds, "death-related anxiety" and "new discoveries". For 70-year-olds, "resignation about death" and "evaluative reminiscence of their lives" were most important, and for 80-year-olds the main concern was "relationships with others." When analyzing the data according to disease stage and gender, "transcendence to children", "reflection on their past behavior", and "gratitude for my family" were characteristic words for males receiving treatment, "work," "worries about children," "side effects," "homecare," and "reflection on their past behavior" were characteristic words for females receiving treatment. "Physical condition", "desire for death" and "how to confront death" were common phrase for males in the terminal stages of the disease process, while "resignation to life" was characteristic reaction for females. There appear to be considerable differences in the focus of life review interviews by age, disease age, disease stage, and gender. Clinicians should consider these differences when using life-review therapy in order to tailor it to the individual.


Novel oral anticoagulants: clinical pharmacology, indications and practical considerations.
Novel oral anticoagulants are approved in several indications: rivaroxaban, apixaban, and dabigatran for the prevention of venous thromboembolism after elective hip or knee replacement surgery, and edoxaban for hip or knee replacement surgery and hip fracture surgery (in Japan only); rivaroxaban for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE; and rivaroxaban, apixaban, and dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. These agents overcome some limitations of traditional anticoagulants, are suggested to have no requirement for routine coagulation monitoring, and are administered orally. Rivaroxaban, apixaban, and dabigatran have different pharmacological characteristics, and guidance is needed on optimum doses and dosing intervals and the effects of renal or hepatic impairment, age, food, and other drugs. Dabigatran has stricter prescribing advice than rivaroxaban or apixaban for patients with moderate-to-severe renal impairment. All three drugs have restrictions on use in patients with hepatic impairment. Apixaban requires twice-daily dosing in all indications, whereas rivaroxaban and dabigatran are dosed once- or twice-daily depending on indication. Although head-to-head comparisons are lacking, the novel oral anticoagulants may show favorable cost-benefit relations compared with traditional vitamin K antagonists or no therapy. This review summarizes the pharmacology of rivaroxaban, apixaban, edoxaban, and dabigatran, and the indications for which they are approved. Issues regarding the optimization of the use of these anticoagulants for the management of thromboembolic disorders will also be discussed.


Impact of an exercise intervention on methamphetamine use outcomes post-residential treatment care.
We examined the efficacy of an 8-week exercise intervention on posttreatment methamphetamine (MA) use among MA-dependent individuals following residential treatment. 135 individuals newly enrolled in treatment were randomly assigned to a structured 8-week exercise intervention or health education control group. Approximately 1 week after completion of the intervention, participants were discharged to the community. Interview data and urine samples were collected at 1-, 3-, and 6-months post-residential care. Of the sample, 54.8% were classified as higher severity users (using MA more than 18 days in the month before admission) and 45.2% as lower severity users (using MA for up to 18 days in the month before admission). Group differences in MA use outcomes were examined over the 3 timepoints using mixed-multivariate modeling. While fewer exercise participants returned to MA use compared to education participants at 1-, 3- and 6-months post-discharge, differences were not statistically significant. A significant interaction for self-reported MA use and MA urine drug test results by condition and MA severity was found: lower severity users in the exercise group reported using MA significantly fewer days at the three post-discharge timepoints than lower severity users in the education group. Lower severity users in the exercise group also had a lower percentage of positive urine results at the three timepoints than lower severity users in the education group. These relationships were not present in the comparison of the higher severity conditions. Results support the value of exercise as a treatment component for individuals using MA 18 or fewer days/month.


Monte Carlo simulations of a kilovoltage external beam radiotherapy system on phantoms and breast patients.
To determine the most suitable lesion size and depth for radiotherapy treatments with a prototype kilovoltage x-ray arc therapy (KVAT) system through Monte Carlo simulations of the dose delivered to lesion, dose homogeneity, and lesion-to-skin ratio. Monte Carlo simulations were used to calculate dose distributions generated by a novel low-energy kilovoltage x-ray system to a variety of clinically relevant lesion sizes and depths in phantoms and for hypothetical partial breast irradiations of patients in supine and prone positions. The treatments by 200 kV KVAT system were modeled for four sizes of tumor (1-4 cm diameter) at three depths (superficial, middle, and deep) in two sizes of cylindrical water phantoms (16.2-cm and 32.2-cm diameter). In addition, treatments of 3-cm and 4-cm diameter lesions were modeled for two breast patients in prone and supine positions. Dose distributions were calculated using the EGSnrc/DOSXYZnrc code package. Phantom study metrics included lesion-to-skin ratio, dose delivered to isocenter (cGy/min), dose homogeneity, dose profiles, and cumulative dose volume histograms. Lesion-to-skin ratio, lesion-to-rib ratio, dose profiles, and cumulative dose volume histograms were used to evaluate simulated breast patient treatments. Supine breast irradiations were compared to 6-MV VMAT plans. The criterion applied to evaluate the dose distributions was derived from NSABP-B39/RTOG 0413 for accelerated partial breast irradiation. Skin dose was limited to a maximum of 250 cGy for a prescribed lesion dose of 385 cGy per fraction (with the whole treatment being delivered in 10 fractions). This produced the minimum lesion-to-skin dose ratio of 1.5 that served as the main guideline, along with other metrics, for evaluation of future clinical viability of treatments. Phantom dose distributions in the centrally located lesions treated with 360-degree KVAT were found to be superior to dose distributions in off-center lesions with the exception of isocenter dose, which was highest for lesions located closer to the phantom surface. Dose metrics were more favorable for smaller lesions, suggesting that KVAT might be most suitable for treatment of lesions of 1-2 cm in diameter down to depths of 8.1 cm along with 3 cm lesions at depths from 3 cm to 8.1 cm. In addition, treatments of 4-cm lesions were found to be acceptable down to the depths of 4.1 cm (in the 16.2-cm phantom) and 8.1 cm (in the 32.2-cm phantom). At depths from 8.1-cm to 16.1-cm, treatments of 1-cm to 4-cm lesions are possible at the cost of decreased dose rate. KVAT breast treatments in the supine patient position demonstrated that increasing the arc angle and decreasing lesion size improved lesion-to-skin ratio and lesion-to-rib ratio. Supine breast data indicate that 3-cm lesions are treatable at a minimum depth of 3 cm. The 6-MV VMAT plan resulted in lower doses to the ipsilateral lung and the body, but a higher heart dose compared to the KVAT plans. Dose distributions for the prone breast phantoms were superior to the supine cases due to the increased treatment angle of 360-degrees. Although nonoptimized KVAT dose distributions presented here were of inferior quality to VMAT plans, this work has demonstrated the feasibility of delivering low-energy kilovoltage x-rays to lesions up to 4 cm in diameter to depths of 8.1 cm while sparing surrounding tissue.


Cost-Consequence Analysis of Single-Dose Dalbavancin Versus Standard of Care for the Treatment of Acute Bacterial Skin and Skin Structure Infections in a Multisite Healthcare System.
Acute bacterial skin and skin structure infections (ABSSSIs) are common infectious diseases that cause a significant economic burden on the healthcare system. This study aimed to compare the cost-effectiveness of dalbavancin vs standard of care (SoC) in the treatment of ABSSSI in a community-based healthcare system. This was a retrospective study of adult patients with ABSSSI treated with dalbavancin or SoC during a 27-month period. Patients were matched based on age and body mass index. The primary outcome was average net cost of care to the healthcare system per patient, calculated as the difference between reimbursement payments and the total cost to provide care to the patient. The secondary outcome was proportion of cases successfully treated, defined as no ABSSSI-related readmission within 30 days after the initiation of treatment. Of the 418 matched patients, 209 received SoC and 209 received dalbavancin. The average total cost of care per patient was greater with dalbavancin vs SoC ($4770 vs $2709, P < .0001). The average reimbursement per patient was $3084 with dalbavancin vs $2633 SoC (P = .527). The net cost, calculated as revenue minus total cost, was $1685 with dalbavancin vs $75 with SoC (P = .013). The overall treatment success rate was 74% with dalbavancin vs 85% with SoC (P = .004). Dalbavancin was more costly than SoC for the treatment of ABSSSI, with a higher 30-day readmission rate. Dalbavancin does not offer an economic or efficacy advantage.


Hematogenous brain metastasis in children.
Hematogenous brain metastases are uncommon in childhood. Three patients and a literature review that includes centers reporting up to 36 years of experience are presented in this study. The total of 2,040 patients includes our three examples of one neuroblastoma, one hepatoblastoma, and one adrenal carcinoma. Cerebral hematogenous metastases were reported in 4.4% of 429 patients with neuroblastoma, 1.9% of 574 rhabdomyosarcoma patients, 6.5% of 386 patients with osteosarcoma, 3.3% of 487 Ewing sarcoma patients, 3.6% of 44 melanoma patients, 13.5% of 37 patients with germ cell tumors, and 1.3% of the 78 patients with Wilms tumor. Five miscellaneous patients included three with a hepatoblastoma and one each with adrenal carcinoma and nephroma. All of the large series reports have been published in oncology journals.


The prospects of community-based natural resource management in Ghana: A case study of Zukpiri community resource management area.
The Community Resource Management Area (CREMA) model was adopted in Ghana in the 1990s to help conserve and increase the forest area of Ghana. Since its adoption, little is known about the prospects of the model in the scientific literature. To fill this gap, this study examined the management strategies, benefits and challenges of the Zukpiri CREMA in the Upper West Region. Mixed methods research involving a survey of 190 households, seven (7) focus group discussions and key informant interviews were employed to collect data in seven (7) CREMA communities. The study found that local communities employed several strategies including the formation of community resource management committees, enactment of bye-laws and fines regarding the management and extraction of the CREMA resources. The CREMA has positively impacted the livelihoods of the inhabitants through the harvesting of non-timber forest products (NTFPs) and support from Governmental and Non-Governmental Organisations. Nonetheless, the CREMA is not without challenges. These include land tenure and the CREMA resource use conflicts. This study, therefore, argued that besides creating an enabling ecologically balanced environment, inhabitants of the CREMA communities are reaping the benefits of the CREMA in many ways. Hence, the Forestry Commission of Ghana should focus on aligning relevant livelihood strategies in line with the CREMA approach to further deepen local communities' commitment to the conservation drive.


[Histological analysis of dental follicles after unerupted mandibular third molar extraction].
The extraction of third mandibular tooth germ (M3) is often prophylactic to avoid orthodontic treatment relapse and to prevent infectious or tumoral diseases developing from the dental sac. The purpose of this study was to screen for early histopathological modification of dental follicles (inflammatory, infiltration, or epithelial metaplasia) after extraction of third mandibular tooth germ (M3) on asymptomatic patients. The secondary objective was to study the proliferative activity of the epithelium by dosing the anti Ki-67 antibody. Twenty dental follicles extracted from 12 boys and eight girls between 14 and 18 years of age were examined under phototonic microscopy. The proliferative activity of the epithelium was assessed by immuno-histochemistry. Three dental follicles presented with focal epidermoid metaplasia of the epithelium, without odontogenic tumoral proliferation. In all other cases, the cylindrical epithelial cell structure was normal. A mild chronic inflammatory infiltrate was present in 30% of the cases. Immuno-histochemical analysis revealed labeling of very rare epithelial lining cells, slightly more in cases presenting with metaplasia. The prevalence of early morphological changes of dental sac is low. This histo-morphological study does not support the systematic extraction of asymptomatic mandibular tooth germs (M3).


A Novel Method of Quantifying the Choriocapillaris in Normal and Post-inflammatory Eyes.
To assess the reliability and validity of gray level co-occurrence matrices (GLCM) in the quantification of choriocapillaris and describe GLCM features in normal and eyes with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis (SC). In this, multicenter, reliability, validity and comparative study; OCTA was performed on eyes with resolved APMPPE and SC and normal individuals. CC texture classification, low flow area measurements and GLCM feature extraction were performed. A total of 13 normal, 8 APMPPE and 15 SC eyes were analyzed. All GLCM parameters demonstrated an excellent reliability. GLCM parameters were differently distributed across the three groups. Decision-tree based on the random forest predictive model provided an overall accuracy of 86% in classifying the three groups using GLCM features. These data demonstrated an excellent reliability and validity of GLCM features in quantifying the choriocapillaris in healthy and diseased eyes.


Effect of the natural winemaking process applied at industrial level on the microbiological and chemical characteristics of wine.
The composition of yeast and lactic acid bacteria (LAB) communities and the chemical evolution of the large-scale commercial vinification of Catarratto IGT Sicilia, carried out under the biological regime, was followed from grape harvest until bottling. Simultaneously to the maximum growth of yeasts, LAB counts reached high level of concentration (6-7 log CFU mL(-1)) during the first steps of the alcoholic fermentation. Yeast identification was determined applying different molecular methods. The highest species biodiversity was observed on grape and must samples taken soon after pressing. Saccharomyces cerevisiae was detected at dominant concentrations during the entire winemaking process. LAB cultures were grouped and identified by a combined phenotypic and genotypic approach. Leuconostoc mesenteroides, Lactobacillus hilgardii and Lactobacillus plantarum species were identified; the last was the main LAB recognized during vinification. The winemaking process was also chemically monitored. The alcoholic content was approximately 12.67% (v v(-1)) at bottling; pH, volatile acidity and total acidity showed a moderate increase during vinification. Tartaric, citric and malic acids decreased until bottling, while lactic acid showed a rapid increase at the end of maceration and bottling. Trans-caffeil tartaric acid was the most abundant phenolic compound and volatile organic compounds (VOC) were mainly represented by isoamylic alcohol, isobutanol, ethyl acetate and octanoic acid.


Linkage of 11 beta-hydroxylase mutations with altered steroid biosynthesis and blood pressure in the Dahl rat.
In Dahl salt-hypertension sensitive (S) and resistant (R) strains fed a high NaCl diet, 11 beta-hydroxylase polymorphisms cosegregate with the adrenal capacity to synthesize 18-hydroxy-11-deoxycorticosterone (18-OH-DOC) and blood pressure. The R rat carries an 11 beta-hydroxylase allele that: (i) differs from those of 12 other rat strains; (ii) is associated with a uniquely reduced capacity to synthesize 18-OH-DOC; and (iii) encodes 5 amino acid substitutions in the 11 beta-hydroxylase protein. The robust salt-resistance of the Dahl R rat may be due in part to reduced synthesis of the mineralocorticoid 18-OH-DOC stemming from mutations in the 11 beta-hydroxylase gene. 11 beta-hydroxylase, located on rat chromosome 7, is the first candidate gene identified in an animal model in which coding sequence mutations have been linked to the regulation of blood pressure.


CT-guided implantation of radioactive 125I seed in advanced non-small-cell lung cancer after failure of first-line chemotherapy.
We investigated implanting computed tomography (CT)-guided (125)I seed to treat locally advanced non-small-cell lung cancer (NSCLC) after chemotherapy failure. From January 2005 to July 2010, we recruited 69 patients with locally advanced NSCLC who had each had first-line chemotherapy four to six times but had progressive disease; 34 received (125)I seed implantation with second-line chemotherapy (Group A) and 35 received second-line chemotherapy only (Group B). Mean follow-up was 32 months (range 5-56 months). Overall 2-year local control rate for existing lung lesions was Group A: 39.9 %; Group B: 12.5 % (P < 0.05). The 1-, 3-year, and median overall survival was 68.7 and 20.8 % at 17.4 months in Group A; and 45.1 and 18.7 % at 11.3 months in Group B, respectively (P > 0.05). Local 3-, 24-month, and median progression-free survival was Group A: 100 and 79.1 % at 11 months; Group B: 76.5 and 18.7 % at 7.3 months, respectively. The groups did not significantly differ in treatment toxicity. Chest pain remission was Group A: 82.1 % (23/28); Group B: 30.8 % (8/26) (P < 0.05). Group A showed no radiation-related pneumonia, esophagitis, bronchial fistulae, or life-threatening morbidity. CT-guided radioactive seed (125)I implantation procedure is safe and well tolerated in treating locally advanced NSCLC, with few complications. It has good local control rate and can relieve symptoms without increasing side effects.


Prenatal toxicity of simultaneously administered ethanol and pentobarbital in the rat.
The use and abuse of drugs has reached epidemic proportions among individuals of child-bearing age. The frequency with which alcohol and pentobarbital are used in our society increases the probability that they will be taken simultaneously. Experiments were designed to investigate the prenatal toxicity of alcoho and pentobarbital interaction in the rat. Pregnant Sprague-Dawley rats were treated intraperitoneally with one of three doses of ethanol (0.56 to 1.4 g/kg) in combination with 5, 15, or 25 mg/kg pentobarbital on days 9 through 12 of gestation. Maternal and fetal toxicities were evaluated and compared with the results of previous studies using the same doses of ethanol and pentobarbital. In pregnant rats treated with combinations of the two drugs, there was no consistent pattern of response. With respect to the offspring, there was no evidence that combinations of ethanol and pentobarbital, at the dose levels used here, had any more deleterious effect on fetal development than either drug acting independently.


Acid tolerance of gastrointestinal pathogens.
The ability of pathogenic bacteria to survive in the face of host defense systems is intimately linked to virulence. This is exemplified by gastrointestinal pathogens that must survive exposure to extreme acid conditions within the stomach and organic acid conditions within the small intestine. These organisms have evolved complex systems to respond to acid stress, and recent work has revealed new genetic components involved in survival and virulence. Here, we review recent work on four gastrointestinal pathogens, focusing on studies that reveal both acid-inducible resistance systems and inherent (basal state) acid-resistance systems.


Myxomatous corneal degeneration: a clinicopathological study of six cases and a review of the literature.
Thirteen cases with myxomatous changes of the corneal stroma have been reported to date. We report six additional cases with clinical, histopathological, and immunohistochemical data. The clinical appearance is most often a gelatinous, whitish elevation with insidious onset. Histopathologically, there are inconspicuous spindle- and stellate-shaped cells in a loose, myxoid matrix. The typical location is in the anterior cornea beneath the epithelium, with varying degrees of extension into the stroma. Vimentin and smooth-muscle actin immunohistochemical stains are characteristically positive, and staining occasionally may be seen with muscle-specific actin, whereas CD34 staining usually is negative. In most cases, myxomatous changes are a degenerative process involving transformation of stromal keratocytes into cells with prominent secretory activity and myofibroblastic differentiation. Most occur in corneas with a history of ocular disease or trauma that disrupts Bowman's layer. We suggest labelling lesions with these features as "myxomatous corneal degeneration." So-called "primary corneal myxomas" also exist where there is no significant history. It remains unclear whether the myxomatous changes in such lesions are neoplastic or degenerative. Myxomatous corneal changes are likely under-recognized and under-diagnosed.


Lymph-node ratio is an independent prognostic factor in patients with stage III colorectal cancer: a retrospective study from the Middle East.
In this retrospective study, we evaluated the prognostic effect of positive lymph-node ratio (pLNR) on patients with stage III colorectal cancer (CRC). Our paper is the first analysis, to our knowledge, to deal with such data from the Middle East. We analyzed the clinicopathological data of 535 patients diagnosed with colorectal cancer at our institution between 1983 and 2003. The 164 patients diagnosed with stage III disease were divided into two categories based on lymph-node ratio (LNR) being the ratio of positive lymph nodes over total lymph nodes dissected: LNR ≤ 0.4 and LNR >0.4. We used Kaplan-Meier and Cox proportional hazard models to evaluate the prognostic effect of pLNR. The 10-year survival rate for the patients with stage IIIA, IIIB and IIIC cancers were 76%, 56% and 0% respectively (P = 0.014). Using pLNR of 0.4 as the cutoff point was found to yield clinically and significant results, with a significant difference in the outcomes of patients with pLNR ≤ 0.4 compared to those with pLNR >0.4 (hazard ratio = 5.25, 95% confidence interval = 1.2 to 22.1, P = 0.02). The ratio-based staging (pLNR) of CRC is a more accurate and clinically useful prognostic method than the number of positive LNs resected or the total number of LNs retrieved for predicting the course of patients with stage III CRC.


[Clinical studies on the complaints of survivors living more than 3 months after total gastrectomy].
From 1973 to 1983, 802 patients with gastric cancer were operated on. Out of them, 292 (36.4%) received total gastrectomy. Reconstruction was performed mainly by the Billroth II procedure associated with the closure of the afferent loop according to Plenk's method. 90 patients living more than 3 months complained of the following: heartburn, 18 (20%); reflux, 12 (13.3%); retrosternal pain, 3 (3.3%); stenotic sensation, 23 (25.6%); diarrhea, 10 (11.1%); abdominal pain, 14 (15.6%); and dumping syndrome, 6 (6.7%). It seems to indicate that the quality of life after total gastrectomy is satisfactory.


[Expression level of MDR1, and MRP in patients with malignant blood disease and its clinical significance].
RT-PCR method was used to detect the expression level of multi-drug resistance gene (MDR1) and multi-drug resistance associated protein (MRP) in patients with malignant blood disease, including 19 cases of acute leukemia and 6 cases of multiple myeloma. The results showed: expression level of MDR1 in patients with known clinical drug resistance elevated obviously and was significantly associated with clinical drug resistance (r = 0.612, P < 0.01), which indicated that expression of MDR1 was the main mechanism of clinical drug resistance. There is no obvious relationship between expression level of MDR1 and MRP (r = 0.035, P > 0.05).


Coordination-Driven Self-Assembly of Biomedicine to Enhance Photodynamic Therapy by Inhibiting Proteasome and Bcl-2.
Tumor cells resist oxidative damage and apoptosis by activating defense mechanisms. Herein, a self-delivery biomedicine (designated as BSC) is developed by the self-assembly of Bortezomib (BTZ), Sabutoclax (Sab) and Chlorin e6 (Ce6). Interestingly, BTZ can be coordinated with Sab to promote the assembly of uniform ternary biomedicine through non-covalent intermolecular interactions. Moreover, BTZ as a proteasome inhibitor can prevent tumor cells from scavenging damaged proteins to reduce their oxidative resistance. Sab can downregulate B-cell lymphoma 2 (Bcl-2) to decrease the antiapoptotic protein. Both the proteasome and Bcl-2 inhibitions contribute to increasing cell apoptosis and amplifying photodynamic therapy (PDT) efficacy of Ce6. Encouragingly, carrier-free BSC receives all biological activities of these assembly elements, including photodynamic performance as well as inhibitory capabilities of proteasome and Bcl-2. Besides, BSC has a preferable cellular uptake ability and tumor retention property, which increase the drug delivery efficiency and bioavailability. In vitro and in vivo research demonstrate the superior PDT efficiency of BSC by proteasome and Bcl-2 inhibitions. Of special note, the coordination-driven self-assembly of BSC is pH-responsive, which can be disassembled for controlled drug release upon tumor acidic microenvironment. This study will expand the applicability of self-delivery nanomedicine with sophisticated mechanisms for tumor treatment.


Multiple health behavior change research: an introduction and overview.
In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.


Palmitoylation of lung surfactant protein SP-C alters surface thermodynamics, but not protein secondary structure or orientation in 1,2-dipalmitoylphosphatidylcholine langmuir films.
Pulmonary surfactant-specific protein, SP-C, isolated from porcine lung lavage, has been deacylated to investigate the role of the two thioester linked palmitoyl chains located near the N-terminus. Surface thermodynamic properties, secondary structure, and orientation of native and deacylated SP-C in 1, 2-dipalmitoylphosphatidylcholine (DPPC) monolayers has been characterized by combined surface pressure-molecular area (pi-A) isotherms and infrared reflection-absorption spectroscopy (IRRAS) measurements. The isotherms indicate that deacylation of SP-C produces more fluid monolayers at pressures less than 30 mN m-1. The helical secondary structure and tilt angle (70-80 degrees relative to the surface normal) of SP-C remained essentially unchanged upon deacylation in DPPC monolayers at a surface pressure approximately 30 mN m-1. The results are consistent with a model that acylation of SP-C may influence the rapid protein-aided spreading of a surface-associated surfactant reservoir, but not the structure of DPPC or SP-C in the monolayer at higher surface pressures.


ARDS associated with pneumonia caused by avian influenza A H7N9 virus treated with extracorporeal membrane oxygenation.
This is a sporadic H7N9 avian influenza case that was the first severe imported case in Beijing and the first case of Hebei province in China. A 61-year-old female who had rapidly progressive pneumonia with respiratory distress and bilateral exduation and consolidation changes on chest X-ray and computerized tomography (CT) scan that did not respond to ordinary antibiotics was diagnosed with influenza A (H7N9) infection in our hospital on July 19, 2013. Intravenous peramivir, veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous veno-venous hemofiltration were given on the same day of lab diagnosis because of severe acute respiratory distress syndrome and acute renal failure. With antimicrobial therapy and other supportive treatment, clinical symptoms and oxygenation of the patient improved gradually. VV-ECMO was successfully removed on the 13th day. The testing for influenza A (H7N9) turned negative on day 16 since the antivirus therapy. Twenty-three days after hospitalization, blood stream infection with multidrug-resistant Acinetobacter Baumannii occurred, which lead to septic shock and death. Whether or not the influenza season in north China, the influenza screening should be carried out as a conventional test for the patients who are suspected of viral pneumonia. For the patients who need mechanical ventilation and ECMO support, the lung protective strategy under the guidance of transpulmonary pressure may be helpful for recovering the lung.


Species temporal variability: epigaeic ant assemblages and management for abundance and scarcity.
Ant assemblages in five closely-spaced point habitats were studied over a three-year period in a subtropical area of South Africa. A total of 20,746 individuals in 56 species were sampled with pitfall traps. Rapid species turnover occurred during short periods after longer intervals of relatively constant species composition. There was annual cycling of total numbers of individuals. The temporal variance for total number of individuals within each habitat increased significantly with mean population size by a logarithmic regression. This indicates that population fluctuations are dependent upon the mean, with a distinctive relationship. The total number of species was cyclical, with annual and approximately half-yearly cycles. Each habitat nevertheless carried a characteristic mean number of species. The temporal variance of species richness showed a highly significant positive logarithmic relationship with the mean number of species. Pheidole megacephala (F.) accounted for 45% of all individuals. Its overall population showed annual cycles. Ph. megacephala population trend was the main determinant for seasonal variation of the whole assemblage in most habitats. Percentage dominance was positively linearly correlated with the variance and with mean population level. Although Ph. megacephala population variance increased with the mean, proportionate variability did not, indicating that high populations are no more variable than low populations. Five variability measures were compared with each other on ant assemblages containing only the common species (1st quartile) and then including the increasingly rare species (1st and 2nd, 1st, 2nd and 3rd, and all quartiles). Williamson's Variability Measure, using logarithmic or inverse sine transformations, gave variable results depending whether or not the rarer species were included in the analysis. The Coefficient of Fluctuation also gave variable results depending on assemblage size. The Coefficient of Variation and Proportionate Variability Measure gave similar and consistent results, indicating that common species are not more variable than rare ones. The rarer species are stenotopic and tend always to be rare, whereas the common species are eurytopic, highly competitive and demographically volatile. Control measures for common ants, and conservation of rare ants, should take cognizance of these trends.


Heroin self-administration: effects of antagonist treatment in lateral hypothalamus.
The involvement of the lateral hypothalamus and medial prefrontal cortex in mediating heroin self-administration was examined by means of intracranial microinjections of the quaternary opiate antagonist methyl naltrexone over a dose range of 0-3.0 micrograms. In animals trained to respond on a continuous reinforcement schedule for intravenous heroin (0.03 mg/kg/infusion), microinfusions of antagonist into the lateral hypothalamus prior to a self-administration session produced significant dose-related increases in responding on the drug manipulandum, similar to increases in responding observed after treatment with naltrexone systemically. Microinfusions of quaternary antagonist into the medial prefrontal cortex over the same dose range effective in the lateral hypothalamus did not produce response increases. These data suggest that opiate action in the lateral hypothalamus, but not in the medial prefrontal cortex, is salient in maintenance of intravenous self-administration.


Postsynaptic and presynaptic GABA(B) receptor-mediated inhibition in rat superficial superior colliculus neurons.
It has been reported that GABA(B) receptors are abundantly expressed in the superficial superior colliculus (sSC). To elucidate the action of GABA(B) receptors in the sSC, we tested the effect of a specific GABA(B) receptor agonist baclofen on sSC neurons in slices obtained from rats (16-22 days postnatal) using the whole-cell patch clamp technique. Bath application of baclofen (10-30 microM) elicited hyperpolarization associated with an increase in potassium conductance in morphologically different types of neurons including putative excitatory and inhibitory neurons. In addition, baclofen presynaptically suppressed electrically induced excitatory postsynaptic currents and inhibitory postsynaptic currents. These effects of baclofen were antagonized by a specific GABA(B) receptor antagonist CGP55845A (1 microM). The results suggest that the GABA(B) receptors have an inhibitory action at both post- and pre-synaptic sites in the sSC.


Radiation response of the central nervous system.
This report reviews the anatomical, pathophysiological, and clinical aspects of radiation injury to the central nervous system (CNS). Despite the lack of pathognomonic characteristics for CNS radiation lesions, demyelination and malacia are consistently the dominant morphological features of radiation myelopathy. In addition, cerebral atrophy is commonly observed in patients with neurological deficits related to chemotherapy and radiation, and neurocognitive deficits are associated with diffuse white matter changes. Clinical and experimental dose-response information have been evaluated and summarized into specific recommendations for the spinal cord and brain. The common spinal cord dose limit of 45 Gy in 22 to 25 fractions is conservative and can be relaxed if respecting this limit materially reduces the probability of tumor control. It is suggested that the 5% incidence of radiation myelopathy probably lies between 57 and 61 Gy to the spinal cord in the absence of dose modifying chemotherapy. A clinically detectable length effect for the spinal cord has not been observed. The effects of chemotherapy and altered fractionation are also discussed. Brain necrosis in adults is rarely noted below 60 Gy in conventional fractionation, with imaging and clinical changes being observed generally only above 50 Gy. However, neurocognitive effects are observed at lower doses, especially in children. A more pronounced volume effect is believed to exist in the brain than in the spinal cord. Tumor progression may be hard to distinguish from radiation and chemotherapy effects. Diffuse white matter injury can be attributed to radiation and associated with neurological deficits, but leukoencephalopathy is rarely observed in the absence of chemotherapy. Subjective, objective, management, and analytic (SOMA) parameters related to radiation spinal cord and brain injury have been developed and presented on ordinal scales.


Induction of umuC gene expression by nitrogen dioxide in Salmonella typhimurium.
Gaseous nitrogen dioxide (NO2) was found to induce umuC gene expression in Salmonella typhimurium carrying the umuC-lacZ fusion plasmid. The induction level of the umu operon responsible for inducible mutagenesis was measured by the level of beta-galactosidase in the cell, encoded by the fusion gene. NO2 gas was bubbled into bacterial suspensions at 10, 30 and 90 microliters/l for 30 min at a flow rate of 100 ml/min. Expression of the umuC gene varied with the concentration, flow rate and bubbling time of the NO2 gas. Although NO2 gas induces SOS functions, mutagenesis due to it was not detectable in Salmonella typhimurium TA100 and TA102. Nitric oxide gas (NO) did not induce any umuC gene expression.


Hydrogel-laden paper scaffold system for origami-based tissue engineering.
In this study, we present a method for assembling biofunctionalized paper into a multiform structured scaffold system for reliable tissue regeneration using an origami-based approach. The surface of a paper was conformally modified with a poly(styrene-co-maleic anhydride) layer via initiated chemical vapor deposition followed by the immobilization of poly-l-lysine (PLL) and deposition of Ca(2+). This procedure ensures the formation of alginate hydrogel on the paper due to Ca(2+) diffusion. Furthermore, strong adhesion of the alginate hydrogel on the paper onto the paper substrate was achieved due to an electrostatic interaction between the alginate and PLL. The developed scaffold system was versatile and allowed area-selective cell seeding. Also, the hydrogel-laden paper could be folded freely into 3D tissue-like structures using a simple origami-based method. The cylindrically constructed paper scaffold system with chondrocytes was applied into a three-ring defect trachea in rabbits. The transplanted engineered tissues replaced the native trachea without stenosis after 4 wks. As for the custom-built scaffold system, the hydrogel-laden paper system will provide a robust and facile method for the formation of tissues mimicking native tissue constructs.


Emergencies in space.
Manned spaceflight is inherently risky and results in unique problems from a trauma and medical perspective. Emergency care under these special physiologic and environmental conditions calls for novel techniques for diagnosis and therapy.


Laimydorus zehsaziani n. sp., a new member of the genus from northwest of Iran, with additional data on Labronema vulvapapillatum (Meyl, 1954) Loof & Grootaert, 1981 (Dorylaimida: Dorylaimidae).
A new species belonging to the genus Laimydorus, and a known species of the genus Labronema, collected from the rhizosphere of grassland plants in West Azarbaijan province, Iran, are presented. The new species is characterized by its body length (1.56-1.81 mm in females and 1.39-1.57 mm in males), lip region offset by weak constriction and wider than adjacent body (11-14 μm), odontostyle 17-20 μm long, neck length 312-434 μm, vulva longitudinal (V = 42.2-46.5), uterus well-developed and with Z-differentiations, tail long (219-237 μm, c = 6.9-8.3, c´ = 8.2-10) in females, short and convex-conoid with blunt terminus (19-22 μm, c = 68-72.5, c´= 0.77-0.84) in males, spicules 40-45 μm long, and 18-20 contiguous ventromedian supplements with hiatus. Molecular analyses, using Bayesian inference based on D2-D3 expansion segments of the 28S rRNA (LSU), placed the new species in a clade comprising representatives of the genera Nevadanema, Dorylaimus, Labronema, Calcaridorylaimus, Mesodorylaimus, and Prodorylaimus, which all belong to Dorylaimidae. In addition, new data (molecular, morphometrics, images, and geographic distribution) are presented for the Iranian population of Labronema vulvapapillatum.


Coping with the COVID-19 pandemic by Paralympic athletes preparing for elite sport events: A longitudinal study.
This study investigates the impact of the COVID-19 pandemic on mental health, coping styles and their relationship, and training opportunities in elite athletes with disabilities (AwD) preparing for national and international sport events during a ten-month observation period. The study covered four time points in 3-month intervals, one retrospective, and three times during the 10 months of the pandemic period with diversified numbers of average new infections per day: A-pre-pandemic, B-third wave of the pandemic (mean = 15 681), C-decrease of the pandemic (mean = 102), and D-fourth wave of the pandemic (mean = 22 591). Main outcome measures included the Coping Inventory for Stressful Situations and the Hospital Anxiety and Depression Scale. The models regarding changes in anxiety (F(3,72) = 22.43; p < 0.001; partial η2 = 0.48) and depression (F(3,72) = 23.82; p < 0.001; partial η2 = 0.50) over the four time points of examination were significant. The pattern of relationship between coping styles and mood changes during COVID-19 pandemic periods, that is, a sudden increase in anxiety during dynamic growth of infections (waves of a pandemic) and a steady increase in depression over the course of the pandemic was not found. The difference in planned and actual training decreased significantly over time (p < 0.001). During the transitionary times of the COVID-19 pandemic, both mental health and training opportunities of AwD were at increased risk. Individual coping styles used by AwD were insufficient resources to cope with the extreme stress caused by the COVID-19 pandemic. Their mental health should be monitored in pandemics and similar situations to ensure appropriate and timely organizational and psychological intervention.


Total Ankle Arthroplasty: An Overview of the Canadian Experience.
Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.


Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion.
To determine the levels of the tumor markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and carbohydrate antigen 15-3 (CA 15-3) in the blood and pleural fluid of patients with benign or malignant pleural effusion, evaluating the sensitivity of each marker in these fluids. We prospectively evaluated 85 patients with pleural effusion. The study of the pleural fluid observed the criteria established in the literature. Levels of the markers were determined using electrochemiluminescence. The sensitivity was determined on the condition that the specificity was > or = 90%. Of the 85 cases, 36 (42.4%) were malignant, 30 (35.3%) were benign, and the results were inconclusive in 19 (22.3%). In the malignant cases, the CEA and CYFRA21-1 levels were higher in the pleural fluid than in the blood, which was not observed for CA 15-3. In the benign cases, the CYFRA21-1 levels were higher in the pleural fluid than in the blood, whereas the opposite was found for CEA and CA 15-3. There were significant differences between malignant and benign cases for all markers, in pleural fluid and blood. In the pleural fluid, the sensitivity of CEA, CYFRA21-1 and CA 15-3 was 69.4, 69.4 and 66.7%, respectively, and the combined sensitivity was 80.6%. In the blood, the sensitivity was 57.1%, 71.4% and 48.6% for CEA, CYFRA21-1 and CA 15-3, respectively, and the combined sensitivity was 77%. The results suggest that these markers might be useful in the differentiation between malignant and benign pleural effusion.


Retinoic acid promotes the proliferation of primordial germ cell-like cells differentiated from mouse skin-derived stem cells in vitro.
Skin-derived stem cells (SDSCs) have the potential to differentiate into gametes and are a potential resource for research and clinical applications. Sufficient amount of primordial germ cells (PGCs) is an important requirement for successful differentiation of SDSCs into gametes in vitro. Retinoic acid (RA), a vitamin A-derived small lipophilic molecule, promotes the growth of PGCs in vivo; however, the role of RA on the proliferation of PGC-like cells (PGCLCs) derived from SDSCs remains unknown. In this study, SDSCs were induced to differentiate into the embryoid body and cocultured with mouse fibroblasts to form PGCLCs. The proliferation of PGCLCs with the presence of various concentrations of RA was investigated in vitro. Immunofluorescence labeling showed that the 5-Bromo-2-deoxyUridine-positive ratio of PGCLCs was increased after the cells were treated with 5-μM RA, and flow cytometry results showed that the number of cells in the S phase was increased significantly. The messenger RNA expression levels of cell cycle-related genes, CCND1 and CDK2, were also increased. Furthermore, RA effectively promoted the external proliferation of endogenous PGCs when 11.5-days postcoitum fetal mouse genital ridges were cultured in vitro. In conclusion, 5-μM RA promoted the proliferation of SDSCs-derived PGCLCs and endogenous PGCs. Our study will provide a valuable model system for studying the differentiation of stem cells into gametes in vitro.


Predictive factors of mortality in patients treated with tocilizumab for acute respiratory distress syndrome related to coronavirus disease 2019 (COVID-19).
COVID-19 patients (n = 34) suffering from ARDS were treated with tocilizumab (TCZ). Outcome was classified in two groups: "Death" and "Recovery". Predictive factors of mortality were studied. Mean age was 75.3, mean oxygen (O2) requirements 10.4 l/min. At baseline, all patients had multiple biological abnormalities (lymphopenia, increased CRP, ferritin, fibrinogen, D-dimer and liver enzymes). 24 patients (70.5%) recovered after TCZ therapy and 10 died (29.5%). Deceased subjects differed from patients in whom treatment was effective with regard to more pronounced lymphopenia (0.6 vs 1.0 G/l; p = 0.037), lower platelet number (156 vs 314 G/l; p = 0.0001), lower fibrinogen serum level (0.6 vs 1.0 G/l; p = 0.03), higher aspartate-amino-transferase (108 vs 57 UI/l; p = 0.05) and greater O2 requirements (11 vs 8 l/min; p = 0.003).


Passive immune therapy and other immunomodulatory agents for the treatment of severe influenza: Systematic review and meta-analysis.
A range of immunomodulatory therapies have been proposed as adjuncts to conventional antivirals to suppress harmful inflammation during severe influenza infection. We conducted a systematic review to assess available data of the effect of adjunctive non-corticosteroid immunomodulatory therapy and potential adverse effects. We searched MEDLINE, Embase, Web of Science and clinical trial databases for published and unpublished studies, and screened the references of included articles. We included RCTs, quasi-RCTs and observational studies of virologically confirmed influenza infections in hospitalised patients. We did not restrict studies by language of publication, influenza type/subtype or age of participants. Where possible, we pooled estimates of effect using random-effects meta-analysis models. We identified 11 eligible studies for inclusion: five studies (4 RCTs and 1 observational; 693 individuals) of passive immune therapy; four studies (3 RCTs and 1 observational; 1120 individuals) of macrolides and/or non-steroidal anti-inflammatory drugs (NSAIDs), one RCT of mTOR inhibitors (38 individuals), and one RCT of statin therapy (116 individuals). Meta-analysis of RCTs of passive immune therapy indicated no significant reduction in mortality (OR 0.84, 0.37-1.90), but better clinical outcomes at Day 7 (OR 1.42, 1.05-1.92). There was a significant reduction in mortality associated with macrolides and/or NSAIDs (OR 0.28; 0.10-0.77). Passive immune therapy is unlikely to offer substantial mortality benefit in treatment of severe seasonal influenza, but may improve clinical outcomes. The effect of other immunomodulatory agents is uncertain, but promising. There is a need for high-quality RCTs with sufficient statistical power to address this evidence gap.


Interpretation of the formation of unstable halogen-containing disinfection by-products based on the differential absorbance spectroscopy approach.
Concentrations of several toxic disinfection by-products (DBP), notably haloacetonitriles (e.g., trichloroacetonitrile, TCAN) and haloketones (e.g., di- and trichloropropanone, DCPN and TCPN, respectively) are affected by chlorination conditions and the inherent instability of these DBPs. In this study, effects of temperature, chlorine dose and reaction time on the formation of TCAN, DCPN and TCPN were interpreted using the approach of differential absorbance spectroscopy. Experimental data obtained for a wide range of water quality conditions demonstrate that in some cases the concentrations of some of the unstable DBPs increased rather than decreased at low temperatures and realistically long contact times. Despite the presence of pronounced changes of the kinetics of generation and degradation of these DBPs at varying temperatures and chlorine doses, their concentrations were strongly correlated with the concurrent changes of spectroscopic properties of DOM quantified via differential absorbance measurements at 272 nm (ΔA272). The maximum values of TCAN, DCPN and TCPN concentrations observed for the chlorination of eight different surface waters occur at the relative decreases of absorbance at 272 nm (defined as RΔA272) values of ca. 0.32 (±0.03), 0.24 (±0.05), and 0.42 (±0.03), respectively. The activation energies of degradation reactions of unstable DBPs were examined and the results indicate that TCAN and TCPN are caused by their hydrolysis with OH- while the degradation of DCPN is mainly caused by halogenation reaction with HOCl. These results in this study may be important for controlling the formation of unstable DBPs and further optimization of drinking water treatment.


Oestrogen and parathyroid hormone alleviate lumbar intervertebral disc degeneration in ovariectomized rats and enhance Wnt/β-catenin pathway activity.
To investigate the mitigation effect and mechanism of oestrogen and PTH on disc degeneration in rats after ovariectomy, as well as on Wnt/β-catenin pathway activity, thirty 3-month-old rats were ovariectomized and divided into three groups. Ten additional rats were used as controls. Eight weeks later, the rats were administered oestrogen or PTH for 12 weeks, and then discs were collected for tests. Results showed that nucleus pulposus cells in the Sham group were mostly notochord cells, while in the OVX group, cells gradually developed into chondrocyte-like cells. Oestrogen or PTH could partly recover the notochord cell number. After ovariectomy, the endplate roughened and endplate porosity decreased. After oestrogen or PTH treatment, the smoothness and porosity of endplate recovered. Compared with the Sham group, Aggrecan, Col2a and Wnt/β-catenin pathway expression in OVX group decreased, and either oestrogen or PTH treatment improved their expression. The biomechanical properties of intervertebral disc significantly changed after ovariectomy, and oestrogen or PTH treatment partly recovered them. Disc degeneration occurred with low oestrogen, and the underlying mechanisms involve nutrition supply disorders, cell type changes and decreased Wnt/β-catenin pathway activity. Oestrogen and PTH can retard disc degeneration in OVX rats and enhance Wnt/β-catenin pathway activity in nucleus pulposus.


Association of remnant cholesterol with frailty: findings from observational and Mendelian randomization analyses.
Recent insights suggest that remnant cholesterol (RC) plays a role in cellular senescence, yet its specific contribution to frailty remains indeterminate. Through the integration of observational and mendelian randomization (MR) studies, this research explores the impact of elevated serum RC levels on frailty susceptibility. A dual-method approach, combining an observational study with an MR study, was employed to investigate the connection between RC and frailty. The observational study included 11,838 participants from the National Health and Nutrition Examination Survey. Multivariable logistic regression and propensity score matching were employed to control for potential confounders. The non-linear relationship was assessed using restricted cubic splines. To circumvent observational study limitations, a two-sample MR analysis was conducted using the inverse-variance weighted method, leveraging genome-wide association studies (GWAS) data. After adjusting for potential confounding variables, the observational study identified a significant association between high serum RC levels and frailty in middle-aged and older adults (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.20 to 2.33, P = 0.003), exhibiting a non-linear dose-response correlation (non-linear P = 0.011). This association persisted after propensity score matching (OR = 1.53, 95% CI = 1.14 to 2.06, P = 0.005). The MR study echoed these results, demonstrating a causal association of RC with the frailty index (β = 0.059, 95% CI = 0.033 to 0.085, P = 1.05E-05), consistent with the observational findings (β = 0.017, 95% CI = 0.008 to 0.026, P = 4.51E-04). This study provides evidence that higher RC levels amplify frailty risk in middle-aged and older adults, implying that the reduction of RC levels may present a promising strategy for frailty prevention and management.


Biochemical characterization and cellular localization of a formalin-resistant melanoma-associated antigen reacting with monoclonal antibody NKI/C-3.
A monoclonal antibody (MAb NKI/C-3) produced against a purified membrane preparation of human melanoma cells reacts preferentially with sections of formaldehyde-fixed and paraffin-embedded tissues of melanoma, nevocellular nevi, carcinoids and medullary carcinomas of the thyroid. NKI/C-3 did not react with basal-cell carcinoma, brain tissue or brain tumors, and in only 14/196 other tumors was a clear cross-reactivity observed, e.g. with prostate carcinomas and a minority of primary breast, ovarian, lung and clear-cell carcinomas. This antibody was used in an immuno-electron microscopic study for the cellular localization of the antigen. The antigen was dispersed in the cytoplasm of melanoma cells, and more concentrated inside vacuoles and sometimes also on the melanosomes. Occasionally, the antigen was seen on the cell surface. The nature of the antigen was determined in an enzyme immunoassay (EIA). It was found that the antigen is a glycoprotein with a disulfide-dependent configuration that is essential for recognition by the MAb. The antigen was distributed heterogeneously during gel filtration as well as during SDS-polyacrylamide gel electrophoresis in the region of 25-110 kd proteins. A purified antigen preparation that was obtained after affinity chromatography on a column of MAb NKI/C-3 linked to Sepharose 4B contained a carbohydrate:protein ratio of 1:3.5.


What is the Best Therapeutic Strategy for Metachronous Resectable Colorectal Liver Metastases After Adjuvant Oxaliplatin-Based Chemotherapy? A Multidisciplinary Inter-Group Survey.
To report the current clinical practice of French physicians for metachronous resectable liver metastasis (LM) occurring after a FOLFOX adjuvant chemotherapy for primary cancer. Twenty four clinical situations were proposed to a panel of experts via 4 learned societies. Clinical situations varied according time of recurrence (early between 6 and 12 month or > 12 month), extension of LM (limited ≤ 2 or extended > 2 lesions), presence of a neuropathy or not, and of a RAS or BRAF mutation. A total of 157 physicians participated in this study. A consensus was reached in 17 (71%) clinical situations. For an early limited recurrence, whatever presence of neuropathy, the preferred therapeutic approach (45%) was upfront surgery. For an early extended recurrence, whatever presence of neuropathy, there was a consensus (64%) for a preoperative chemotherapy by FOLFIRI + biologic agent. For a late recurrence without neuropathy, there was a consensus (50%) for a preoperative FOLFOX chemotherapy, whatever the extension of LM. For a late recurrence with neuropathy, upfront surgery was chosen (52%) for limited LM, and preoperative chemotherapy by FOLFIRI + biologic agent (73%) for extended LM. No response was influenced by the RAS mutation status. There was a strong consensus for intensified preoperative chemotherapy in all clinical situations for BRAF-mutated LM. This national survey provides an overview of the practice patterns in the treatment of LM occurring after adjuvant FOLFOX for primary. It could be a basis to establish expert's recommendations for the clinical practice.


[Effect of tiapride on the side effects of cerebrospinal fluid depletions in spinal puncture, pneumoencephalography and air myelography].
The authors report their experience of the treatment post-cerebrospinal fluid loss syndrom, following subtraction by lumbar puncture, pneumoencephalography and air myelography. The study of 70 patients, divided in two equal groups, one receiving classic therapy, one receiving tiapride, a new molecule of original conception, lead to emphasize the interest of this drug. Tolerance in general is good, despite the administration of high doses and effects on the syndrom are positive and remarkable in preventive and curative treatment.


Cognitive reserve.
Cognitive reserve is a latent construct theorized to account for the discrepancy between observed brain deterioration and ultimate clinical outcomes. This review outlines the theoretical development of the reserve concept and presents major trends within epidemiological and neuroimaging research literatures in support of such a construct. Particular focus is placed on the implications for cognitive aging and dementia.


Sympathetic vasoconstriction in the rat anterior choroid is mediated by alpha1-adrenoceptors.
These experiments were undertaken in an attempt to use laser-Doppler flowmetry to measure anterior choroidal blood flow in the anesthetized rat and to study the mechanism by which sympathetic nerve stimulation might produce vasoconstriction in this vascular bed. Electrical stimulation of the preganglionic cervical sympathetic nerve produced reproducible, frequency-related ocular vasoconstrictor responses with maximal vasoconstriction seen at about 32 Hz. Ocular vasoconstrictor responses were blocked by intravenous treatment with the nonselective alpha-adrenoceptor antagonists, phentolamine (5 mg kg(-1)) and phenoxybenzamine (2 mg kg(-1)), as well as with the selective alpha1-adrenoceptor antagonist, prazosin (0.3 mg kg(-1)). In contrast, the selective alpha2-adrenoceptor blocker, rauwolscine (0.5 mg kg(-1)), only potentiated the vasoconstriction. Neither intravenous atropine (1 mg kg(-1)) nor propranolol (1 mg kg(-1)) altered the magnitude of neurally evoked vasoconstriction. These results demonstrate the usefulness of laser-Doppler flowmetry in studies of the rat anterior choroidal circulation and suggest that adrenergic neurogenic vasoconstriction in the anterior segment of the rat eye is mediated almost exclusively by alpha1-adrenoceptor mechanisms.


Simulating dark-field X-ray microscopy images with wavefront propagation techniques.
Dark-field X-ray microscopy is a diffraction-based synchrotron imaging technique capable of imaging defects in the bulk of extended crystalline samples. Numerical simulations are presented of image formation in such a microscope using numerical integration of the dynamical Takagi-Taupin equations and wavefront propagation. The approach is validated by comparing simulated images with experimental data from a near-perfect single crystal of diamond containing a single stacking-fault defect in the illuminated volume.


Novel mutations in xanthine dehydrogenase/oxidase cause severe hypouricemia: biochemical and molecular genetic analysis in two Czech families with xanthinuria type I.
The article describes the clinical, biochemical, enzymological and molecular genetics findings in two patients from two families with xanthinuria type I. Biochemical analysis using high performance liquid chromatography, allopurinol loading test and analysis of xanthine oxidase activity in plasma and of uromodulin excretion in urine were performed. Sequencing analysis of the xanthine dehydrogenase gene and the haplotype and statistical analyses of consanguinity were performed. Probands showed extremely low concentrations of uric acid, on seven occasions under the limit of detection. The concentration of uric acid in 38-year-old female was 15 μmol/L in serum and 0.04 mmol/L in urine. Excretion of xanthine in urine was 170 mmol/mol creatinine. The concentration of uric acid in 25-year-old male was 0.03 mmol/L in urine. Excretion of xanthine in urine was 141 mmol/mol creatinine. The allopurinol loading test confirmed xanthinuria type I. The xanthine oxidase activities in patients were 0 and 0.4 pmol/h/mL of plasma. We found three nonsense changes: p.P214QfsX4 and unpublished p.R825X and p.R881X. We found two nonconsanguineous compound heterozygotes with xanthinuria type I caused by three nonsense changes. The methods used did not confirm consanguinity in the probands, thus there might be an unconfirmed biological relationship or mutational hotspot.


How do midwives in Slovenia view their professional status?
The aim of the study was to explore Slovenian midwives' views of their professional status. The influence of participants' educational background on their views was also examined, since higher education is related to professionalism. This was a quantitative descriptive survey, using postal data collection. The questionnaire comprised of six elements crucial for professionalism--three elements distinctive of 'old' professionalism (power, ethics, specific knowledge) and three characteristics of 'new' professionalism (reflective practice, inter-professional collaboration and partnership with users). A total of 300 midwives who were registered in a national register of nurses and midwives at the time of the study. The response rate was 50.7% (152 returned the questionnaire). Participants that were on a probationary period were excluded, leaving 128 questionnaires for analysis (43%). Some 40.9% participants had secondary midwifery education, 56.7% had higher midwifery education and only few (2.4%) finished postgraduate education. The majority of participants did not consider midwifery to be a specific profession. Midwives with secondary education were more likely to consider practical skills to be important than theoretical midwifery knowledge. In general midwives did not feel enabled to practice autonomously; and this caused them to face ethical dilemmas when aiming to fulfil women's wishes. All participants with midwifery secondary school education thought that obstetrics jeopardises midwifery scope of practice, but only half of the BSc participants thought this. One-fifth of all participants estimated that midwifery is also threatened by nursing. The respondents reported feeling a lack of control over their professional activity and policy making; however the majority of midwives claimed that they were willing to take on more responsibility for independent practice. Slovenian midwifery cannot be considered to be a profession yet. It faces several hindrances, due to its historical development. In order to develop a specific professional identity for midwives, the content and structure of education should be analysed and changed in order to improve socialisation and professionalism. In clinical settings, the scope of midwifery practice and responsibilities, as defined by EU directives, should be agreed by all professional groups.


Horizontal transfer of RNA and proteins between cells by extracellular microvesicles: 14 years later.
Extracellular microvesicles (ExMVs) are part of the cell secretome, and evidence has accumulated for their involvement in several biological processes. Fourteen years ago our team demonstrated for the first time that ExMVs carry functional RNA species and proteins from one cell to another, an observation that opened up the new research field of horizontal transfer of bioactive molecules in cell-to-cell communication. Moreover, the presence of mRNA, noncoding RNA, and miRNA in ExMVs in blood and other biological fluids opened up the possibility of employing ExMVs as new detection markers for pathological processes, and ExMVs became a target for "liquid biopsy" approaches. While ExMV-derived mRNAs may be translated in target cells into appropriate proteins, miRNAs regulate expression of corresponding mRNA species, and both RNA-depended ExMV-mediated mechanisms lead to functional changes in the target cells. Following from this observation, several excellent papers have been published that confirm the existence of the horizontal transfer of RNA. Moreover, in addition to RNA, proteins, bioactive lipids, infectious particles and intact organelles such as mitochondria may follow a similar mechanism. In this review we will summarize the impressive progress in this field-14 years after initial report.


Diffuse lamellar keratitis after LASIK with low-energy femtosecond laser.
To evaluate the incidence, evolution, and prognosis of diffuse lamellar keratitis (DLK) in a large series of laser in situ keratomileusis (LASIK) with low-energy femtosecond laser. Private practice, Siena, Italy. Retrospective, consecutive, noncomparative case series study. Single-use instruments, powder-free gloves, and no corneal marking were used. Flap was created by a low-energy femtosecond laser (Ziemer Z2 and Z4). A total of 37 315 eyes of 19 602 patients were reviewed. DLK was observed in 236 eyes (0.63%) of 149 patients (0.76%). Grade 1 DLK was observed in 231 eyes of 142 patients, grade 2 in 1 eye: when treated with topical steroids, they had no visual consequences. Three patients had bilateral grade 3 to 4 DLK: one of them, with bilateral grade 3, despite flap lifting and irrigation worsened to stage 4 (central stroma thinning and flattening), partially recovered in 2 years, and underwent repeat femtosecond laser-assisted LASIK for hyperopic shift in 1 eye. In all the 5 eyes that developed grade 4 DLK, corneal thickness decreased until the first month and then partially recovered; mean final tissue loss at 1 to 2 years was 35 µm. Compensatory epithelial thickening was observed. DLK after low-energy femtosecond laser-assisted LASIK is rare; severe DLK (stages 3 and 4) was found in only 6 eyes (0.016%). Flap lifting and irrigation might not prevent progression. Spontaneous reformation of stromal tissue and epithelial thickening improve visual acuity in the long term; residual hyperopic shift can be corrected by repeat femtosecond laser-assisted LASIK.


Socioeconomic Disparities in Unmet Need for Student Mental Health Services in Higher Education.
Mental health problems are highly prevalent among college students in many countries. However, evidence suggests that many at-risk students do not receive professional help. We aimed to understand which students are most likely to have unmet need for mental health services. Given increasing and widening participation in higher education, we focused attention on disparities by socioeconomic background. We analysed data from a recent survey of over 6000 students enrolled in higher education in Ireland. Using three separate measures of mental health problems, namely stress, anxiety, and depression, we developed and modelled an indicator of unmet need. We found that students from the lowest social class and students with the greatest difficulty in making ends meet have higher rates of unmet need overall, but that these disparities disappear once we control for mental ill-health. For those with mental health problems, unmet need is shown to be independently higher for students who are younger, male, heterosexual, and studying for a Ph.D. We also found a strong independent association between unmet need and self-stigma, as well as considerable differences in unmet need across institutions. Socioeconomic disparities in unmet need are driven by higher rates of mental ill-health among those from lower socioeconomic backgrounds. Our findings have implications for the targeting of services, as well as the provision of information about mental health and associated services.


Signs of inflammation in both symptomatic and asymptomatic muscles from patients with polymyositis and dermatomyositis.
To determine whether muscle weakness is correlated with inflammation, expression of interleukin 1alpha (IL1alpha) and major histocompatibility complex (MHC) class I and II antigens on muscle fibres. Biopsy specimens from clinically symptomatic (proximal muscles) and asymptomatic (all distal but two proximal) muscles in eight patients with polymyositis, three patients with dermatomyositis and six healthy controls were analysed by immunohistochemistry for the presence of T cells and macrophages, and expression of IL1alpha and of MHC class I and II antigens. were evaluated by conventional light microscopy and by computerised image analysis. Results: Inflammatory infiltrates with T cells and macrophages were observed to an equal degree in both symptomatic and asymptomatic muscle. The numbers of capillaries with IL1alpha expression were significantly higher (p<0.05) in the symptomatic and asymptomatic muscles of patients than in controls. The total IL1alpha expression per tissue section assessed by computerised image analysis was significantly higher in symptomatic muscles but not in asymptomatic muscles compared with that in controls. Neither the number of IL1alpha-positive capillaries nor the total IL1alpha expression differed significantly between symptomatic and asymptomatic muscles. Expression of MHC class I and II antigens on muscle fibres was detected in both symptomatic and asymptomatic muscles but rarely in healthy controls. Presence of inflammatory infiltrates, T cells and macrophages, and expression of MHC class I and II antigens and of IL1alpha on muscle fibres were independent of clinical symptoms, and were present to an equal degree in both proximal and distal muscles. Thus, other factors seem to determine the development of clinical symptoms. One such factor could be variations in physical demands.


An anatomical variation during para-aortic lymphadenectomy.
Failure to identify anatomical variations may contribute to surgical errors or perioperative complications during abdominal and oncological surgery. We report the case of an anatomical variation of the inferior vena cava revealed during para-aortic lymphadenectomy for advanced ovarian cancer. Due to renal insufficiency, preoperative CT-scan was performed without contrast injection and the variation was not clearly detected. Our clinical case underlines the importance of the preoperative diagnosis of anatomical variations and highlights the need to provide young surgeons with adequate technical training in para-aortic lymphadenectomy.


Benzo[a]pyrene-induced early alterations of the respiratory epithelium in the Syrian golden hamster.
Pathological alterations occurring in the epithelia of the trachea and the lobar and segmental bronchi of Syrian golden hamsters during a 20-week period of weekly BaP administrations were examined by means of light and electron microscopy. In the trachea these early changes included hyperplasia and squamous metaplasia. In the bronchi the development of small adenomas was observed, but no squamous metaplasia occurred.


Sustained elevation in hippocampal NGF-like biological activity following medial septal lesions in the rat.
Several laboratories have documented an increase in hippocampal nerve growth factor (NGF) levels, measured with biological or immunological assays, within 1-2 weeks following septal lesions or fimbria/fornix transections. In the present study we have determined the increase in NGF-like biological activity in medium conditioned by hippocampal slices at more prolonged times following medial septal lesion. In contrast to reports based on immunological assays, which demonstrate a transient increase in hippocampal NGF, elevated NGF-like biological activity was present in hippocampal slice-conditioned medium up to one year after a medial septal lesion.


Portable ATP bioluminescence sensor with high specificity for live Escherichia coli O157:H7 strain synergistically enhanced by orientated phage-modified stir bar extraction and bio-proliferation.
Live foodborne pathogens proliferate rapidly and do great harm to human health, which requires appropriate methods to supervise. In this work, a portable adenosine triphosphate (ATP) bioluminescence sensor with high specificity for live E. coli O157:H7 strain synergistically enhanced by orientated phage-modified stir bar extraction and bio-proliferation was developed. In brief, the selected phages were directionally immobilized on the poly(diallyldimethylammonium chloride)-modified gold stir bar as the bioreceptor. Following the simple stir bar absorptive extraction and bio-proliferation in the Luria-Bertani medium, the number of captured E. coli O157:H7 exploded. Finally, it was quantified by a portable ATP bioluminescence sensor. Benefitting from the high specificity of phage and simple signal dual-amplification strategy, the proposed biosensor achieved the recognition of live bacteria at strain level with superior sensitivity. Also, the portable signal readout made it suitable for on-site detection. Under optimal conditions, this bioassay provided a detectable range of 102-107 CFU mL-1 with a low detection limit of 30 CFU mL-1 within 30 min. The detection results for real samples demonstrated that there were no differences between the assay and the plate counting method, while the detection time was largely shortened. Furthermore, the assay gives a novel path for the point-of-care test (POCT) of live E. coli strain, which is promising to be extended to other virulent strains measurement with corresponding phages.


The impact on biochemical profiles and allograft function for patients converted from cyclosporine to tacrolimus after clinical heart transplantation.
Tacrolimus, a potent calcineurin inhibitor, is a widely used immunosuppressant. This study sought to determine whether conversion from cyclosporine to tacrolimus afforded benefits on biochemical profiles and graft function among Chinese heart transplantation recipients. Forty-nine patients (44 men and 5 women) among 252 heart transplantations performed from 1995 to 2005 were converted from cyclosporine to tacrolimus due to rejection (69%) or to cyclosporine intolerance (31%). The median age of these recipients at transplantation was 46.4 years (range, 5 months to 68 years). Their median body weight was 60 kg (range, 4-84 kg). The allograft median ischemic time was 145 minutes (range, 52-300 minutes). We compared the biochemical markers, rejection episodes and allograft function. The mean duration from heart transplantation to conversion was 419 days. After conversion, the serum bilirubin and alanine transaminase levels were significantly improved at 1 year. The lipid profiles, including triglycerides, total cholesterol, and low-density lipoprotein were nonsignificantly changed. The rejection episodes significantly decreased from 1.53 to 0.15 per patient per year (P < .001). The left ventricular ejection fraction significantly improved from 54.3 +/- 17.9% to 63.2 +/- 10.9% (P < .01). The right atrial pressure significantly decreased from 9.1 +/- 5.8 mmHg to 6.3 +/- 4.3 mm Hg (P < .01). The pulmonary capillary wedge pressure significantly decreased from 15.3 +/- 9.5 mm Hg to 10.8 +/- 5.3 mm Hg (P = .04). In heart transplantation, conversion to tacrolimus owing to rejection or cyclosporine intolerance showed better liver profiles with fewer rejection episodes and improved graft function.


Rapid actions of aldosterone on cells from renal epithelium: the possible role of EGF-receptor signaling.
It has been suggested that steroids interact with peptide hormones in part by rapid, potentially non-genomic, mechanisms. The peptide hormone epidermal growth factor (EGF) regulates cell proliferation and ion transport using ERK1/2 as downstream signal. Furthermore, the EGF-receptor (EGF-R) is involved in signaling by G-protein-coupled receptors, growth hormone and cytokines via transactivation. We show that aldosterone modulates Na(+)/H(+)-exchange in renal collecting duct-derived Madin-Darby canine kidney (MDCK) cells via ERK1/2 in a similar way as compared to growth factors. Furthermore, we tested the hypothesis that aldosterone uses the EGF-R as heterologous signal transducer in MDCK cells. Aldosterone induces a rapid increase of ERK1/2 phosphorylation and cytosolic Ca(2+)-concentration of similar extend as compared to EGF. Furthermore, aldosterone stimulates EGF-R Tyr-phosphorylation. Inhibition of EGF-R kinase abolished aldosterone-induced signaling. Aldosterone-induced Ca(2+)-influx seems to be mediated by the activation of ERK1/2, whereas ERK1/2 activation does not depend on Ca(2+)-influx. Our data show that aldosterone uses the EGF-R-ERK1/2 signaling cascade to elicit its rapid effects in MDCK cells.


Revision anterior cruciate ligament surgery: causes of graft failure and technical considerations of revision surgery.
The frequency of revision ACL surgery is sure to become more common as the number of primary intraarticular reconstructions increase. Identifying the potential causes of failure through a detailed history, physical examination, and radiographic evaluation is of paramount importance prior to planning a revision surgery if the repetition of errors is to be avoided.


Small bowel augmentation in children with neurogenic bladder: an initial report of urodynamic findings.
Augmentation cystoplasty is a useful adjunct in the treatment of the neurogenic bladder. After preoperative urodynamic and clinical assessment, 10 children with neurogenic bladders underwent small bowel augmentation. Presenting clinical problems included incontinence and hydronephrosis. Urodynamic studies after small bowel augmentation demonstrated that bladder capacity increased an average of 184 per cent. Maximum intravesical pressures diminished considerably compared to preoperative values and no patient suffered significant uninhibited contractions. Nine children are totally dry and 1 has stress incontinence. Our initial findings demonstrate the efficacy of small bowel augmentation in the treatment of lower urinary tract neurogenic dysfunction owing primarily to alterations in detrusor function.


Diagnostic test restraint and the specialty consultation.
To assess the effect consultants had on the diagnostic process in the management of patients admitted to the medical service of a university hospital. Cohort study utilizing prospective evaluation by residents, retrospective chart review, and direct communication with the patient, a family member, or the patient's physician one year after admission to the hospital. The medical inpatient service of an urban university hospital. The 580 patients admitted to the medical service during one month in 1984 for whom complete data were available. Sixty-three percent of the patients had consultations. Seventy percent (198/284) of the patients admitted by generalists had consultations, while 57% (170/296) of the patients admitted by subspecialists had consultations. Of the 1,422 major diagnostic tests performed on these patients, 504 (35%) were first recommended by consultants, and the consultants recommended cancellation of only ten major diagnostic tests. Patients who were seen by consultants had a length of stay that was more than double that of patients not seen by consultants. Consultation was associated with prolonged stay when patients were stratified by important clinical variables and remained an important independent factor in a multivariate model. The prolongation of hospitalization was principally due to delays in scheduling and interpreting sophisticated tests recommended by the consultants. When stratified into prognostically similar clinical groupings, there was no significant difference in in-hospital mortality between patients seen and those not seen by a consultant. Efforts to foster diagnostic restraint in the management of hospitalized patients should be broadened to include attention to the specialty consultation process.


Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.


Fluorogenic substrates for sensitive and differential estimation of urokinase and tissue plasminogen activator.
Two fluorogenic peptide amides have been synthesized, i.e. BOC-L-valyl-glycyl-L-arginine 2-naphthylamide (I) and L-valyl-glycyl-L-arginine 2-naphthylamide (II). The kinetic parameters of plasmin, urokinase and human uterine tissue plasminogen activator on substrates I and II have been determined. Quite unexpectedly, the tissue activator appeared to require for its activity a blocked amino terminus on the substrate. This was further corroborated with other synthetic substrates. Plasmin and urokinase did not show this requirement.


Low back pain among professional bus drivers: a cross-sectional study from Bangladesh.
Low back pain (LBP) is a common condition contributing to impaired quality of life among professional vehicle drivers. Our study aimed to assess LBP prevalence and associated factors among professional bus drivers in Bangladesh. A cross-sectional study was conducted among 368 professional bus drivers using a semi-structured questionnaire. A Nordic Musculoskeletal Questionnaire (NMQ) subscale was used to measure LBP. Multivariable logistic regression analysis was used to identify the factors associated with LBP. In the last month, 127 (34.51%) participants reported experiencing pain or discomfort in the lower backside. Multivariable logistic regression analysis showed that age of more than 40 years (adjusted odds ratio (aOR): 2.07, 95% confidence interval (CI): 1.14 to 3.75), the income of more than 15,000 BDT per month (aOR: 1.91, 95% CI: 1.11 to 3.26), work duration more than ten years (aOR: 2.53, 95% CI: 1.12 to 5.70), working more than 15 days per month (aOR: 1.93, 95% CI: 1.02 to 3.65), working more than 10 h per day (aOR: 2.46, 95% CI: 1.05 to 5.75), poor condition of the driving seat (aOR: 1.80, 95% CI: 1.08 to 3.02), current smoking habit (aOR: 9.71, 95% CI: 1.25 to 75.15), illicit substances use (aOR: 1.97, 95% CI: 1.11 to 3.48), and four hours or less sleeping time per day (aOR: 1.83, 95% CI: 1.09 to 3.06) were positively associated with LBP. The high burden of LBP among the participants calls for a focus on this vulnerable group's occupational health and safety, with particular emphasis on implementing standard measures.


Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa.
The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.


Articulation skills in bilingual children with a migration background: a comparison between bilingual Turkish-Dutch, Arabic-Dutch and monolingual Dutch children.
There is a lack of studies investigating articulation skills in bilingual children with a migration background. Therefore, the present study compared articulation skills in bilingual Turkish-Dutch/Moroccan Arabic-Dutch children with migration background and monolingual Dutch children without migration background. Moreover, possible factors influencing articulation skills were determined. 15 bilingual Turkish-Dutch, 15 bilingual Moroccan Arabic-Dutch and an age and gender matched group consisting of 15 monolingual Dutch children, all aged between 6 and 7 years and living in Flanders, were included in the present study. Articulation was evaluated using a picture naming test. Speech samples were transcribed phonetically and articulatory analysis, including a phonetic inventory and phonetic and phonological analyses, was performed. The phonetic analysis made a distinction between distortions, substitutions, additions, and omissions. For the phonological analysis, a distinction between syllable structure processes, substitution processes and assimilation processes was made. Moreover, parents were administered a self-report questionnaire to determine possible factors influencing articulation skills. A statistically significant difference in additions was found when comparing the three groups. Interestingly, both the Turkish-Dutch and Moroccan Arabic-Dutch groups used additions that were not present in the Dutch group (i.e. respectively addition of the [ə] and [ər]). Concerning phonological analysis, it was found that deletions of final consonants were more present in the bilingual groups compared to the monolingual group. Moreover, statistically significant effects of origin, home language, and language preference of the child were found on presence of both phonetic errors and phonological disorders. Findings of the present study showed that some phonetic errors and phonological processes were more present in the group of bilingual children with migration background compared to the group of monolingual children without migration background. Interestingly, phonetic errors and phonological processes were more present when (1) the child had a Turkish origin, or (2) when the dominant language at the home environment was Turkish, or (3) when the preferred language of the child was Turkish. Given the increased attention to migration, findings of the present study are highly important for speech-language pathologists, teachers, and more generally, all professionals working with bilingual populations with a Moroccan Arabic or Turkish migration background.


Disease surveillance in England and Wales, November 2016.
▪Current and emerging issues: recrudescence of Schmallenberg virus▪Highlights from the scanning surveillance network▪Update on international disease threats▪Focus on avian influenza in EuropeThese are among matters discussed in the Animal and Plant Health Agency's (APHA's) November disease surveillance report.


A short-term, hydroponic-culture of ginseng results in a significant increase in the anti-oxidative activity and bioactive components.
Panax ginseng CA Meyer has a variety of biological effects, including antioxidant and antidiabetic activities. Ginseng requires long-term cultivation, but this can be shortened using hydroponic systems to facilitate the commercial development of ginseng as a functional food. However, the characteristics of short-term-cultured (< 30 days) hydroponic ginseng (sHCG) are unclear. We investigated the characteristics of 21-day-cultured sHCG compared 5-year-old normally cultured ginseng. The free radical-scavenging activity and total ginsenoside and phenolic contents were significantly higher in sHCG than in normally cultured ginseng. Fifteen ginsenosides were detected in sHCG, and the concentrations of most were higher in shoots than roots. These findings suggest that 21-day-cultured sHCG, due to its enhanced antioxidant activity and higher concentrations of total phenolics and ginsenosides (including Rd and Re), has potential as a functional food.


Monoclonal antibodies reactive with normal and neoplastic T cells in paraffin sections.
Without fresh or frozen tissue, it previously has been impossible to confirm the T-cell nature of reactive or neoplastic lymphoid cells. The availability of antibodies reactive with T cells in paraffin sections now allows retrospective analysis of a large number of cases. Two commercially available monoclonal antibodies, MT1 and MT2, were tested for their reactivities with T cells in a wide range of formalin-fixed, paraffin-embedded tissues, including 130 cases of immunologically characterized lymphoma. In reactive lymph nodes, MT1 stained the T-cell areas, whereas MT2 stained both the T-cell areas and mantle-zone B lymphocytes. MT1 stained 38 of 55 T-cell lymphomas (69.1%; 94.7% of cases from one hospital that used a shorter fixation time, and 55.6% of cases from another hospital that used a longer fixation time). MT2 stained only 6 (10.9%) of the T-cell lymphomas. Among the 74 cases of B-cell lymphoma, 3 (4.0%) were stained by MT1 and 30 (40.5%) by MT2.MT1 was also reactive with 3 of 4 cases of granulocytic sarcoma, as expected from its reactivity with normal granulocytes. Neither MT1 nor MT2 stained Reed-Sternberg cells or their variants in HodgKin's disease. We conclude that MT1 is a valuable marker for T cells, particularly when used with a panel of antibodies reactive with B cells in paraffin sections. MT2 is of limited value because of its cross-reactivity with many B-cell lymphomas.