Improving the transition of highly complex patients into the community: impact of a pharmacist in an allogeneic stem cell transplant (SCT) outpatient clinic.
Patients having undergone allogeneic stem cell transplantation (SCT) require complex medication regimens. To ensure the safe and effective management of this patient group, specialised care in a centre with a dedicated and experienced healthcare team is essential. The aim of this study was to evaluate the effectiveness of a specialty clinical pharmacist working in an ambulatory SCT clinic. A prospective cohort study was conducted on patients post SCT and discharged to the ambulatory setting. Patients were reviewed by a clinical pharmacist weekly for six visits. At these visits a medication review was undertaken. Interventions from these reviews were recorded. Interventions were then assigned a risk rating by a multidisciplinary panel. Adherence was also assessed by a Morisky questionnaire and review of dose administration aids. Comparison of data over the six-visit period was undertaken. In total 23 patients were enrolled in the study. All six visits were completed in 17 patients and 161 interventions were recorded at an average of 1.4 interventions per patient visit. The panel rated 40 % of interventions as high risk, 46 % as medium risk and 14 % as low risk. At all visit points high- and medium-risk interventions constituted >80 % of the total. Morisky scores improved by an average of 1.53 (p < 0.0001) between visits 1 and 6. All patients were scored as highly adherent by visit 6. A specialist clinical pharmacist in the SCT outpatient clinic resulted in regular and effective intervention contributing to improved medication management and adherence.


Use of hospital services by breast cancer patients by stage of the disease: implications on the costs of cancer control.
The use of resources for breast cancer during the first five years after diagnosis by different stages of disease was evaluated on the basis of all breast cancer patients (555) diagnosed in the Tampere University hospital district (Finland). All outpatient visits or inpatient-days of these patients in any hospital of the district were recorded and the average costs of hospital-day and of outpatient visit were applied to quantify the total use of resources. During the first five years of follow-up 535 breast cancer patients had 8206 follow-up visits and spent 18472 days in hospital. The stage II-IV patients had more than twice as many outpatient visits and inpatient-days as the stage I patients. The number of hospital-days/patient-year was 2.4-fold for stage II patients and 4.1-fold for stage III-IV patients as compared to stage I patients. The overall use of resources/patient for those with nonlocalized disease was twice as high as the use for stage I patients, while the use of resources/person-year was 2.3-fold for stage II patients and 3.6-fold for stage III-IV as compared to stage I patients. Our study in an unselected patient population during the first five years of follow-up shows that breast cancer patients diagnosed in the early stage (stage I) require far fewer health care resources than if diagnosed in advanced stages. The results can be directly transformed into costs of breast cancer control by stage of breast cancer.


Porcine dermal collagen (Permacol) for redo bladder exstrophy closure.
This report describes the use of a biosynthetic graft (Permacol) derived from porcine dermal collagen to reconstruct the abdominal wall of a 2-year-old boy with classic bladder exstrophy. The child had undergone 2 previous failed attempts at closure.


Economic Decisions through Circuit Inhibition.
Economic choices between goods are thought to rely on the orbitofrontal cortex (OFC), but the decision mechanisms remain poorly understood. To shed light on this fundamental issue, we recorded from the OFC of monkeys choosing between two juices offered sequentially. An analysis of firing rates across time windows revealed the presence of different groups of neurons similar to those previously identified under simultaneous offers. This observation suggested that economic decisions in the two modalities are formed in the same neural circuit. We then examined several hypotheses on the decision mechanisms. OFC neurons encoded good identities and values in a juice-based representation (labeled lines). Contrary to previous assessments, our data argued against the idea that decisions rely on mutual inhibition at the level of offer values. In fact, we showed that previous arguments for mutual inhibition were confounded by differences in value ranges. Instead, decisions seemed to involve mechanisms of circuit inhibition, whereby each offer value indirectly inhibited neurons encoding the opposite choice outcome. Our results reconcile a variety of previous findings and provide a general account for the neuronal underpinnings of economic choices.


3-Nitropropionic acid depresses spinal reflexes involving GABAergic and glycinergic transmission in neonatal rat spinal cord in vitro.
3-Nitropropionic acid (3-NPA) is a naturally occurring fungal toxin that leads to ATP-depletion by inhibiting mitochondrial succinate dehydrogenase and produces chemical anoxia. The present study was conducted to identify the involvement of inhibitory system in 3-NPA-induced depression of spinal reflexes. The monosynaptic (MSR) and polysynaptic reflex (PSR) potentials were recorded at ventral root by stimulating the corresponding dorsal root in hemisected (sagitally) spinal cord from 4-8 day old rats. Effect of 3-NPA in the absence and presence of antagonists was evaluated on the reflexes. Superfusion of 3-NPA (3.4 mM) depressed the reflexes in a time-dependent manner abolishing them by 35 min. The T-50 values were around 18 and 16 min for MSR and PSR, respectively. An NMDA receptor antagonist, DL-2-amino-5-phosphonovaleric acid (10 microM) failed to block the 3-NPA (3.4 mM)-induced depression of reflexes. Superfusion of bicuculline (GABAA receptor antagonist; 1 microM), or strychnine (glycineA receptor antagonist; 1 microM) antagonized the 3-NPA-induced depression of reflexes significantly. The T-50 values were 26 and 30 min in bicuculline and strychnine pretreated groups, respectively and were significantly greater than 3-NPA only group. The results indicate that 3-NPA-induced depression of spinal reflexes is partially mediated by GABAergic and glycinergic inhibitory transmission.


Rehabilitation Nutrition for Injury Recovery of Athletes: The Role of Macronutrient Intake.
An adequate and balanced diet is of utmost importance in recovery and rehabilitation. "Rehabilitation nutrition" for injury recovery of athletes is similar to sports nutrition, except for the differences that concern the prevention of the risk or presence of sarcopenia, malnutrition, or dysphagia. Rehabilitation nutrition also aims, combined with training, to an adequate long-term nutritional status of the athlete and also in physical condition improvement, in terms of endurance and resistance. The aim of this paper is to define the proper nutrition for athletes in order to hasten their return to the sports after surgery or injury. Energy intake should be higher than the energy target in order to fight sarcopenia-that is 25-30 kcal/kg of body weight. Macro- and micro-nutrients play an important role in metabolism, energy production, hemoglobin synthesis, lean mass and bone mass maintenance, immunity, health, and protection against oxidative damage. Nutritional strategies, such as supplementation of suboptimal protein intake with leucine are feasible and effective in offsetting anabolic resistance. Thus, maintaining muscle mass, without gaining fat, becomes challenging for the injured athlete. A dietary strategy should be tailored to the athlete's needs, considering amounts, frequency, type and, most of all, protein quality. During rehabilitation, simultaneous carbohydrates and protein intake can inhibit muscle breakdown and muscle atrophy. The long-term intake of omega-3 fatty acids enhances anabolic sensitivity to amino acids; thus, it may be beneficial to the injured athlete. Adequate intakes of macronutrients can play a major role supporting athletes' anabolism.


Two doses of NGR-hTNF in combination with capecitabine plus oxaliplatin in colorectal cancer patients failing standard therapies.
asparagine-glycine-arginine-human tumour necrosis factor (NGR-hTNF), an agent selectively damaging the tumour vasculature, showed a biphasic dose-response curve in preclinical models. Previous phase I trials of NGR-hTNF indicated 0.8 and 45 μg/m(2) as optimal biological and maximum-tolerated dose, respectively. Two sequential cohorts of 12 colorectal cancer (CRC) patients who had failed standard therapies received NGR-hTNF 0.8 or 45 μg/m(2) in combination with capecitabine-oxaliplatin (XELOX). Median number of prior treatment lines was 3 in the low-dose and 2 in the high-dose cohort. Overall, 21 patients had been pretreated with oxaliplatin-based regimens. No grade 3-4 NGR-hTNF-related toxicities were observed. Grade 1-2 chills were reported in 43% and 40% of cycles in the low-dose and high-dose cohorts, respectively. In the low-dose cohort, one patient achieved a partial response and five had stable disease for a median of 4.6 months. In the high-dose cohort, six patients had stable disease for a median of 3.6 months. Three-month progression-free survival (PFS) rates were 50% and 33% in the low-dose and high-dose cohort, respectively. Three patients in low-dose cohort experienced PFS longer than PFS on last prior therapy. Both NGR-hTNF doses were safely combined with XELOX in pretreated CRC patients. Hint of activity was apparent only with low-dose NGR-hTNF.


Anaphylaxis to intravenous furosemide.
A patient with long-standing hypertension developed urticaria, angioedema, and hypotension within 5 minutes after the intravenous administration of furosemide. Immediate hypersensitivity was documented by positive skin tests to furosemide as well as to related sulfonamide-based drugs. This is the first finding of an anaphylactic reaction to furosemide and underscores the need to consider such adverse reactions when patients who are sensitive to other sulfonamide-containing drugs are being treated.


Intralesional Bleomycin for the Treatment of Resistant Palmoplantar and Periungual Warts.
Periungual, palmar, and plantar warts are difficult to treat with poor treatment response. Intralesional (IL) bleomycin has shown promising results for their treatment in a few reports. However, we need further evidence before opting it for treating difficult sites and resistant warts. Hence, we conducted this study to assess the efficacy and safety of IL bleomycin for the treatment of resistant palmoplantar and periungual warts. In this retrospective study, we included all patients who were given IL bleomycin for warts over a year. Maximum three sittings of bleomycin (1 mg/ml) were given monthly, and they were followed up for 3 months after the procedure. The response was categorized as complete, near-complete, significant, moderate, mild, and no clearance for 100%, 75-99%, 50-74%, 25-49%, 1-25%, and 0% clearance, respectively. Out of 29 patients, follow-up details were available only in 19 patients (53 warts). The mean duration was 2.5 ± 1.47 years. The number of past interventions ranged from 2-4. Wart clearance after the first intervention was complete in 36.84%, near-complete in 26.31%, significant in 26.31%, and moderate in 10.53%. Wart clearance after the last intervention was complete in 89.47% and near-complete in 10.52% of patients. However, during 3 months of follow-up after the last injection, 15.78% had a recurrence. None of them had severe local and systemic side effects. IL bleomycin could be a better treatment option for the treatment of resistant and difficult warts. However, we observed a higher recurrence rate even in a shorter follow-up. Hence, we need further studies with larger samples.


Diallyl sulfide ameliorates carbon tetrachloride-induced hepatotoxicity in rats via suppressing stress-activated MAPK signaling pathways.
The underlined effects of diallyl sulfide (DAS) against CCL4 -induced oxidative, inflammatory, and apoptotic acute hepatic damage were assessed. Administration of DAS (50, 100, and 200 mg/kg) along with CCL 4 effectively mitigated serum aspartate aminotransferase, alanine aminotransferase activities, MDA, TNF-α, IL-1β, and MCP-1 levels, as well as significantly restored HO-1, GSH levels and SOD activity in liver tissues compared with those in rats treated with CCL 4 . Moreover, DAS inhibited CCL 4 -induced increase of liver NF-κB (p65), Bax, p38 MAPK, and JNK protein expression. In addition, DAS accelerated protein expression of Nrf2 and Bcl-2. The hepatoprotective properties of DAS were further confirmed by the reduced severity of hepatic damage as demonstrated by histopathological findings. In conclusion, DAS achieved its protective potential against CCL4-induced hepatotoxicity through antiapoptotic activity, as well as the synchronized modulation of NF-κB and Nrf2 for the favor of antioxidant/anti-inflammatory effects via suppression of the upstream stress-activated MAPKs pathways.


GISToscopy.
Gastrointestinal stromal tumors (GIST) tumors are a rare, though typical cause for upper GI bleeding. Excavated ulcerated lesions are common; however, a clear-cut visualization of the tumor surface ("GISToscopy") itself has not yet been reported. In line, careful biopsy taking streamlines the diagnostic work-up by providing pathologic diagnosis.


Unexplained week-to-week variation in BNP and NT-proBNP is low in chronic heart failure patients during steady state.
The usefulness of brain-natriuretic-peptide (BNP) and N-terminal-pro-brain-natriuretic-peptide (NT-proBNP) for monitoring of chronic heart failure (CHF) patients has been questioned because of high levels of unexplained variation. Week-to-week total variance (CV(T)), unexplained variation (CV(I)), reference change values (RCV), index of individualities (IOI) and number of samples (N) with week-to-week intervals needed to estimate the underlying homeostatic set point (+/-15%) for BNP and NT-proBNP were calculated in pre-specified stable CHF patients. We measured plasma concentrations of BNP and NT-proBNP, clinical and laboratory variables in 20 CHF patients with a 7-days interval. Only patients considered to be in steady state were included. The CV(I) was 15% (BNP) and 8% (NT-proBNP). CV(T) was 16% (BNP) and 8% (NT-proBNP) and RCV was 43% (BNP) and 23% (NT-proBNP). IOI was 0.14 for BNP and 0.03 for NT-proBNP and N was 1 for BNP and 1 for NT-proBNP. Our data demonstrate that unexplained variation of BNP and NT-proBNP is low in CHF patients during steady state, which is a prerequisite for the use of these peptides for monitoring of the disease.


A critical evaluation of physical and manufacturing properties of genuine and counterfeit rotary nickel-titanium endodontic instruments.
Rotary nickel-titanium (NiTi) instruments are made to exacting standards and are costly to manufacture, and quality control is paramount. Consequently, unauthorized factories make counterfeit instruments that are less expensive and may therefore be attractive to dentists. Little information exists about the metallurgy and manufacturing quality of such instruments. There is the potential for counterfeit instruments to be at higher risk of fracture during treatment, thereby compromising clinical outcomes. The aim of this study was to evaluate physical and manufacturing properties of genuine and counterfeit ProTaper Next™ and Mtwo® rotary NiTi instruments. This study investigated the metallurgical properties, manufacturing quality, microhardness and number of cycles to failure of two commonly used rotary NiTi systems and compared them with counterfeit products purporting to be genuine articles. Counterfeit instruments were found to be inferior in manufacturing standards and were less resistant to cyclic fatigue when compared to genuine instruments. Counterfeit rotary NiTi instruments may be less efficient at preparing root canals and may be at higher risk of fracture during endodontic treatment. Dentists must be aware that, although less expensive, counterfeit instruments may be of dubious manufacturing quality and at higher risk of fracture if used in patients. © 2023 Australian Dental Association.


Epidermocyte nuclear-nucleolar system in atopic dermatitis and lichen planus.
Study of the epidermocyte nuclear-nucleolar system in atopic dermatitis and lichen planus by computer morphometry of preparations stained with 50% AgNO3 showed an increase in their morphometric parameters, reflecting hyperregeneratory processes.


Ureteroscopy under local anesthesia.
Ureteroscopy has been performed with local anesthesia with and without sedation in 30 patients. Flexible endoscopes were used in 18, rigid endoscopes alone in 7, and rigid and flexible instruments in 5 patients. The flexible instruments ranged in size from 4F to 10F, while rigid instruments were 10F to 12F. Although most procedures were diagnostic, calculi were removed from the distal ureter in 4 patients and from the midureter in 1 patient. Ultrasonic lithotripsy was utilized in 1 patient. The success and tolerance of flexible or distal rigid ureteroscopy with local anesthesia permits its recommendation in carefully selected patients.


Genetic modulators associated with regulatory surveillance of mitochondrial quality control, play a key role in regulating stress pathways and longevity in C. elegans.
The multi-factorial Parkinson's disease (PD) is known to be associated with mitochondrial dysfunction, endoplasmic reticulum stress, alpha synuclein aggregation and dopaminergic neuronal death, with oxidative stress being a common denominator to these underlying processes. The perception of mitochondria being 'just ATP producing compartments' have been counterpoised as studies, particularly related to PD, have underlined their strong role in cause and progression of the disease. During PD pathogenesis, neurons encounter chronic stress conditions mainly due to failure of Mitochondrial Quality Control (MQC) machinery. To dissect the regulatory understanding of mitochondrial dysfunction during neurological disease progression, we endeavored to identify key regulatory endpoints that control multiple facets of MQC machinery. Our studies, employing transgenic C. elegans strain expressing human α-synuclein, led us to identification of mitochondrial genes nuo-5 (involved in oxidative phosphorylation), F25B4.7 (exhibits ATP transmembrane transporter activity) and C05D11.9 (having ribonuclease activity), which form predicted downstream targets of most elevated and down-regulated mi-RNA molecules. RNAi mediated silencing, gene ontology and functional genomics analysis studies demonstrated their role in modulating major MQC pathways. The attenuated MQC pathways mainly affected clearance of misfolded and aggregated proteins, redox homeostasis and longevity with compromised dopaminergic functions. Overexpression of the mitochondrial genes by 3 beta-hydroxyl steroid, Tomatidine, was found to curtail the redox imbalance thus leading to amelioration of effects associated with PD and an increase in the lifespan of treated nematodes. Therefore, this study unveils the regulatory role of mitochondrial genes as critical modulators of stress control involved in effects associated with PD pathogenesis.


Patterns of tumor incidence in two-year cancer bioassay feeding studies in Fischer 344 rats.
Patterns of tumor incidence in 25 of the National Toxicology Program's (NTP's) two-year cancer bioassay feeding studies in Fischer 344 rats were investigated. It was found that the overall frequencies of statistically significant (P less than 0.01) increases and decreases in organ-specific tumor incidence in treated groups relative to controls were approximately the same. The decreases were due primarily to mammary gland fibroadenomas in females (which were clearly associated with decreased weight gain in the treated groups) and leukemia/lymphoma in both sexes (which were frequently associated with increased liver tumor incidences in the treated groups). A clear explanation for this latter association was not apparent. The increased tumor incidences in the treated groups relative to controls were due primarily to liver neoplastic nodules. Treated animals of either sex had slightly (but significantly) improved overall survival relative to controls. The intra- and inter-laboratory variability in control tumor incidence frequently exceeded what one would expect to find by chance alone. This investigation helps explain the decreased tumor incidences observed in many NTP feeding studies. It also indicates that attention should be directed toward the determination of underlying mechanisms responsible for the negative correlation between the incidences of liver tumors and leukemia/lymphoma.


Alternative activation of ruminant macrophages by Fasciola hepatica.
The helminth parasite, Fasciola hepatica, has a worldwide distribution and infects a wide variety of mammalian hosts, including ruminants and man. In response to infection, these hosts mount a type 2 helper (Th2) response that is highly polarized and results in the downregulation of type 1 helper (Th1) mechanisms. In a murine macrophage model F. hepatica induces alternative activation of macrophages. These macrophages differ from classically activated cells in that they preferentially use arginase instead of inducible nitric oxide synthase (iNOS) for metabolism of nitrogen. In this study we sought to characterize macrophage phenotype following stimulation of the ovine cell line MOCL7 with recombinant F. hepatica enzymes and crude parasite extracts. An in vitro model using the MOCL7 cell line was established and arginase levels in cells were used to determine the activation status of cells. Stimulation of this cell-line in vitro with F. hepatica products induces alternative activation. We have also found a chitinase-like protein in supernatants which is capable of differentiating alternatively activated from classically activated macrophages.


Postmortem Metabolism and Pork Quality Development Are Affected by Electrical Stimulation across Three Genetic Lines.
Variations in postmortem metabolism in muscle impact pork quality development. Curiously, some genetic lines are more refractile to adverse pork quality development than others and may regulate energy metabolism differently. The aim of this study was to challenge pork carcasses from different genetic populations with electrical stimulation (ES) to determine how postmortem metabolism varies with genetic line and explore control points that reside in glycolysis in dying muscle. Three genetic populations (GP) were subjected to ES (100 V or 200 V, 13 pulses, 2 s on/2 s off) at 15- or 25-min post-exsanguination, or no stimulation (NS). Genetic population affected relative muscle relative abundance of different myosin heavy chains, glycogen, G6P, and lactate concentrations. Genetic lines responded similarly to ES, but a comparison of ES treatment groups revealed a trend for an interaction between voltage, time of ES, and time postmortem. Higher voltage accelerated pH decline at 20 min up to 60 min postmortem. Trends in color and firmness scores and L* values were consistent with pH and metabolite data. These data show that genetic populations respond differently to postmortem perturbation by altering glycolytic flux and suggest differences in postmortem glycolysis may be partially responsible for differences in meat quality between genetic populations, though not entirely.


Shanzhiside methylester, the principle effective iridoid glycoside from the analgesic herb Lamiophlomis rotata, reduces neuropathic pain by stimulating spinal microglial β-endorphin expression.
Lamiophlomis rotata (L. rotata, Duyiwei) is an orally available Tibetan analgesic herb widely prescribed in China. Shanzhiside methylester (SM) is a principle effective iridoid glycoside of L. rotata and serves as a small molecule glucagon-like peptide-1 (GLP-1) receptor agonist. This study aims to evaluate the signal mechanisms underlying SM anti-allodynia, determine the ability of SM to induce anti-allodynic tolerance, and illustrate the interactions between SM and morphine, or SM and β-endorphin, in anti-allodynia and anti-allodynic tolerance. Intrathecal SM exerted dose-dependent and long-lasting (>4 h) anti-allodynic effects in spinal nerve injury-induced neuropathic rats, with a maximal inhibition of 49% and a projected ED50 of 40.4 μg. SM and the peptidic GLP-1 receptor agonist exenatide treatments over 7 days did not induce self-tolerance to anti-allodynia or cross-tolerance to morphine or β-endorphin. In contrast, morphine and β-endorphin induced self-tolerance and cross-tolerance to SM and exenatide. In the spinal dorsal horn and primary microglia, SM significantly evoked β-endorphin expression, which was completely prevented by the microglial inhibitor minocycline and p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580. SM anti-allodynia was totally inhibited by the GLP-1 receptor antagonist exendin(9-39), minocycline, β-endorphin antiserum, μ-opioid receptor antagonist CTAP, and SB203580. SM and exenatide specifically activated spinal p38 MAPK phosphorylation. These results indicate that SM reduces neuropathic pain by activating spinal GLP-1 receptors and subsequently stimulating microglial β-endorphin expression via the p38 MAPK signaling. Stimulation of the endogenous β-endorphin expression may be a novel and effective strategy for the discovery and development of analgesics for the long-term treatment of chronic pain.


Phase III, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of teneligliptin monotherapy in Chinese patients with type 2 diabetes mellitus inadequately controlled with diet and exercise.
Although the efficacy of teneligliptin, a highly selective dipeptidyl peptidase-4 inhibitor, has been amply studied for the treatment of type 2 diabetes, no clinical trials of teneligliptin have been carried out in China. We evaluated the efficacy and safety of teneligliptin monotherapy compared with a placebo in Chinese patients with type 2 diabetes mellitus inadequately controlled with diet and exercise. This multicenter, randomized, double-blind, placebo-controlled, parallel-group study, carried out at 42 sites, enrolled type 2 diabetes patients with glycosylated hemoglobin 7.0 to <10.0% and fasting blood glucose <270 mg/dL. Patients were randomly assigned, in a 1:1 ratio, to treatment with 20 mg teneligliptin or a placebo (n = 127, each) administered orally once daily before breakfast for 24 weeks. Change in glycosylated hemoglobin from baseline to week 24 was the primary efficacy end-point. Safety was assessed by the incidence of adverse events and adverse drug reactions. The least square mean (LSM) change in glycosylated hemoglobin from baseline to week 24 was -0.95% with teneligliptin versus -0.14% with a placebo, yielding an LSM difference (teneligliptin vs placebo) of -0.80% (P < 0.0001). For the secondary end-point, from baseline to week 24, the LSM change in fasting blood glucose was -21.9 mg/dL with teneligliptin versus -1.4 mg/dL with a placebo, yielding an LSM difference (teneligliptin vs placebo) of -20.5 mg/dL (P < 0.0001). The adverse event and adverse drug reaction incidence rates, including hypoglycemia, were similar in both groups. At 24 weeks, teneligliptin was generally well tolerated and effective in Chinese patients with type 2 diabetes mellitus inadequately controlled with diet and exercise.


Minimally invasive and inexpensive percutaneous abscess drainage using an indwelling needle cannula.
Abscess is still a formidable disease and requires adequate drainage. Moreover, drainage in the head and neck area needs cosmetic care, especially in the pediatric population. In this report, we introduce our method of percutaneous abscess drainage using an indwelling needle cannula. Ten pediatric and five adult patients with cervical and/or facial abscess treated with this drainage method were retrospectively reviewed. Using an indwelling needle cannula (18-14 G Surflow®, Terumo, Tokyo, Japan), abscesses were penetrated under ultrasonic examination. Once purulent retention was identified, the inner metal needle was removed and the outer elastic needle was left and fixed. The outer needle was connected to the tube for continuous suction drainage for large abscess. The primary diseases of these abscesses were cervical abscess of dental origin (5), purulent lymphadenitis (3), pyriform sinus fistula (2) and subperiosteal abscess due to mastoiditis (2), circumorbital cellulitis (1), infection of Warthin's tumor (1), and unknown origin (1). The median (range) duration of drainage was 4 days (3-9 days). Abscesses were successfully treated, and no patients required additional incision for abscess drainage. No apparent scars after drainage were observed. This technique resembles the usual venous placement of an indwelling needle cannula and is thought to be familiar to physicians. Although simple and inexpensive, this drainage is safe, effective, and minimally invasive for the treatment of abscess.


Optimizing the efficiency and implementation of cash transfers to improve adherence to antiretroviral therapy: study protocol for a cluster randomized controlled trial.
Antiretroviral therapy (ART) for HIV, taken daily, is an effective strategy to clinically suppress the virus, providing the dual benefit of improved survival and vastly decreasing the risk of transmission. However, this highly effective intervention has not yet reached all who could benefit. Cash transfers are increasingly recognized as an effective strategy to motivate behavior change and improve HIV care and treatment outcomes, including engagement in HIV care and adherence to ART. Despite a growing evidence base and strong theoretical foundation for the cash transfer approach, key questions remain. To address these questions and begin to bridge the "know-do gap" with respect to cash transfers, our team is employing an implementation science approach to iterative development of an incentive-based intervention to promote ART uptake and adherence among people living with HIV (PLHIV) in the Lake Zone region, Tanzania. We will conduct a type I hybrid implementation-effectiveness trial to test the effectiveness of a cash transfer intervention on the outcome of HIV viral suppression, and concurrently examine the potential for real-world implementation with a mobile health technology (mHealth) system. Specifically, our team will expand the intervention to 32 clinics and enroll 1984 PLHIV to (a) evaluate its effectiveness by conducting a cluster randomized controlled trial with clinics as the unit of randomization and 12-month viral suppression as the primary outcome and (b) evaluate the implementation challenges and successes at multiple levels (patient, provider, clinic). This trial will provide evidence not only about the real-world effectiveness of cash transfers for retention in HIV care and viral suppression, but also on the implementation challenges and successes that will facilitate or hinder wider scale-up within Tanzania and beyond. ClinicalTrials.gov NCT04201353 . Registered on December 17, 2019.


Cell mechanical responses to subcellular perturbations generated by ultrasound and targeted microbubbles.
The inherently dynamic and anisotropic microenvironment of cells imposes not only global and slow physical stimulations on cells but also acute and local perturbations. However, cell mechanical responses to transient subcellular physical signals remain unclear. In this study, acoustically activated targeted microbubbles were used to exert mechanical perturbations to single cells. The cellular contractile force was sensed by elastic micropillar arrays, while the pillar deformations were imaged using brightfield high-speed video microscopy at a frame rate of 1k frames per second for the first 10s and then confocal fluorescence microscopy. Cell mechanical responses are accompanied by cell membrane integrity changes. Both processes are determined by the perturbation strength generated by microbubble volumetric oscillations. The instantaneous cellular traction force relaxation exhibits two distinct patterns, correlated with two cell fates (survival or permanent damage). The mathematical modeling unveils that force-induced actomyosin disassembly leads to gradual traction force relaxation in the first few seconds. The perturbation may also influence the far end subcellular regions from the microbubbles and may propagate into connected cells with attenuations and delays. This study carefully characterizes the cell mechanical responses to local perturbations induced by ultrasound and microbubbles, advancing our understanding of the fundamentals of cell mechano-sensing, -responsiveness, and -transduction. STATEMENT OF SIGNIFICANCE: Subcellular physical perturbations commonly exist but haven't been fully explored yet. The subcellular perturbation generated by ultrasound and targeted microbubbles covers a wide range of strength, from mild, intermediate to intense, providing a broad biomedical relevance. With µm2 spatial sensing ability and up to 1ms temporal resolution, we present spatiotemporal details of the instantaneous cellular contractile force changes followed by attenuated and delayed global responses. The correlation between the cell mechanical responses and cell fates highlights the important role of the instantaneous mechanical responses in the entire cellular reactive processes. Supported by mathematical modeling, our work provides new insights into the dynamics and mechanisms of cell mechanics.


Five new cytotoxic triterpenoid saponins from the roots of Symplocos chinensis.
Five new triterpenoid saponins, named symplocososides G-K, were isolated from the roots of Symplocos chinensis. Their structures were elucidated by spectral and chemical methods as symplocososide G, 3beta-O-{[beta- D-glucopyranosyl(1-->2)][alpha-L-arabinofuranosyl(1-->4)]-beta-D-(3-O-acetyl)-glucuronopyranosyl}-21beta- O-[(2 Z)-3,7-dimethyl-2,6-octadienoyl]-22 alpha-O-(2-methylbutanoyl)-R1-barrigenol, symplocososide H, 3beta-O-{[beta-D-glucopyranosyl(1-->2)][alpha-L-arabinofuranosyl(1-->4)]- beta-D-(3-O-acetyl)-glucuronopyranosyl}-21beta-O-[(2E)3,7-dimethyl-2,6-octadienoyl]-22alpha-O-(2-methylbutanoyl)-R1-barrigenol, symplocososide I, 3beta-O-{[beta-D-glucopyranosyl(1-->2)][ alpha-L-arabinofuranosyl(1-->4)]-beta-D-(3- O-acetyl-6-O-methyl)-glucuronopyranosyl}-21beta-O-[(2 Z)3,7-dimethyl-2,6-octadienoyl]-22alpha-O-(2-methylbutanoyl)-R1-barrigenol, symplocososide J, 3 beta-O-{[ beta-D-glucopyranosyl(1-->2)][alpha-L-arabinofuranosyl(1-->4)]-beta-D-(3- O-acetyl)-glucuronopyranosyl}-21beta-O-[(2 Z)3,7-dimethyl-2,6-octadienoyl]-22alpha-O-benzoyl-R1-barrigenol, and symplocososide K, 3beta-O-{[beta-D-glucopyranosyl (1-->2)][alpha-L-arabinofuranosyl(1-->4)]- beta-D-(3-O-acetyl-6-O-methyl)-glucuronopyranosyl}-21beta-O-[(2Z)3,7-dimethyl-2,6-octadienoyl]-22alpha-O-benzoyl-R1-barrigenol. Symplocososides G-K showed significant cytotoxicity against cancer cell lines KB, HCT-8, Bel-7402, BGC-823 and A549 with IC50 values ranging from 0.82 microM to 5.09 microM, except for symplocososide I against cancer cell lines KB, BGC-823, A549 and symplocososide K against cancer cell line BGC-823 with IC50 values >10.00 microM.


Chest radiology case exchange program: a paradigm for resident teaching and independent resident learning.
The purpose of this study was to test the effectiveness of resident-prepared, independent learning cases in teaching residents chest radiology. Three 2nd-year residents (one each from the University of Wisconsin, the Oregon Health Sciences University, and the University of Michigan) prepared four chest radiology teaching cases each (total, 12 cases). Radiology residents from each institution were randomly divided into control (n = 30) and experimental (n = 35) groups. Residents from both groups took a pretest of 36 multiple-choice questions covering the material from the 12 teaching cases. Residents in the experimental group reviewed these cases independently, and both groups took the same test (posttest) immediately after the teaching cases had been reviewed and again 3 months later (final test). Test scores were similar across institutions (P > .05) but differed across time and treatment groups (experimental vs control) (P < .0001). Mean differences in test scores between the experimental and control groups at pretest, posttest, and final test were -0.4, +9.0, +4.0, respectively, demonstrating increased performance at posttesting that was still present (though somewhat attenuated) 3 months later at final testing. Independent study of resident-prepared chest radiology teaching cases increases the resident's knowledge for as long as 3 months after instruction.


[Prediction of the severity of fetal erythroblastosis using the erythrocyte phagocytosis test and evaluating anti-Rh antibody titers and their levels by autoanalysis].
Erythrophagocytosis++ test was performed in 45 pregnant Rh-negative women together with routine anti-Rh antibodies assay with indirect antiglobulin test and their concentration determined in an autoanalyser. It was found that the degree of ++phagocytosis of the standard erythrocytes immunized with maternal anti-Rh antibodies by the monocytes from healthy subjects is an important predictive factor enabling to foresee a severity of hemolytic disease in newborn babies. ++Phagocytosis over 50% predicts a severe course of the disease whereas under 20%--a mild form of the serologic conflict.


Analysis of the Butyrate-Producing Pathway in Porphyromonas gingivalis.
Butyrate is one of the most harmful metabolic end products found in the oral cavity. Thus, it would be important to characterize the enzymes responsible for production of this metabolite to elucidate the pathogenicity of periodontogenic bacteria. Here, a spectrophotometric assay for butyryl-CoA:acetate CoA transferase activity and gas chromatography-mass spectrometry measurement of butyrate and other short chain fatty acids such as acetate, propionate, isobutyrate, and isovalerate are described.


Brief report: The relationship of parental support and conflict to physical activity in preadolescents with type 1 diabetes.
To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes. Parent-child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Control's Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day. Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity. In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.


Hair testosterone and visuospatial memory in middle-aged men and women with and without depressive symptoms.
Testosterone binds to androgen receptors, which can be found abundantly in the hippocampus. Associations between testosterone levels and visuospatial memory have been reported, albeit with inconsistent results. Previous studies have used point sampling of testosterone levels (blood, saliva) rather than long-term secretion measures. Hair analysis for steroids allows for retrospective ascertainment of cumulative steroid measures over several months. We examined hair testosterone and its association with verbal and visuospatial memory in middle-aged men and women with and without major depression. We examined a total of 73 middle-aged individuals (35 depressed patients, and 38 age-, sex- and education-matched healthy subjects). We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured testosterone in the hair by liquid chromatography tandem mass spectrometry. Hair testosterone levels did not differ between patients and controls (mean 1.35pg/mg vs. 1.40pg/mg, SD 0.61 and 0.80, respectively). In men (n=24) but not women (n=49), hair testosterone was associated with visuospatial memory in a multiple regression analysis after controlling for age, education, body mass index, and depression (adjusted R(2)=0.56). With the new method of testosterone measurement in hair allowing for long-term cumulative ascertainment of testosterone secretion, we extend recent results of a male-specific role for testosterone in visuospatial memory.


Cu-catalyzed transannulation reaction of pyridotriazoles: general access to fused polycyclic indolizines.
An efficient intramolecular transannulation reaction of pyridotriazoles using internal alkynes en route to various fused polycyclic indolizines has been developed. For the first time it is shown that in addition to the well-established Rh- or Cu-catalyzed carbene mechanism, the transannulation reaction could also follow a Lewis acid-mediated electrophilic pathway.


Verification of dynamic and segmental IMRT delivery by dynamic log file analysis.
A program has been developed to evaluate the delivered fluence of step-and-shoot segmental and sliding window dynamic multileaf collimator (MLC) fields. To automate these checks, a number of tools have been developed using data available from the dynamic log files that can be created each time a dynamic delivery occurs. Experiments were performed with a Varian 2100EX with a 120 leaf MLC equipped with dynamic capabilities. A dynamic leaf sequence is delivered and measured with film or an amorphous silicon imager. After delivery, the dynamic log file is written by the accelerator control system. The file reports the expected and actual position for each leaf and the dose fraction every 0.055 seconds. Leaf trajectories are calculated from this data and expected and actual fluence images are created from the difference of opposing leaf trajectories. These images can be compared with the expected delivery, measurements, and calculations of fluence. Tools have been developed to investigate other aspects of the delivery, such as specific leaf errors, beam hold-off flags sent by the control system to the MLC, and gap widths. This program is part of a semi-automated quality assurance (QA) system for pretreatment fluence verification and daily treatment verification of dynamic multileaf collimation (DMLC) delivery.


Recognition of leukotriene B4 by a unique subset of human T-lymphocytes.
Leukotriene (LT) B4, but not 12(S)-LTB4 or LTC4, inhibits the generation of lymphokine-designated leukocyte inhibitory factor by purified human T-lymphocytes. LTB4 coupled to fluorescein-labeled human serum albumin interacts specifically with approximately 11% of the T-lymphocytes as assessed by fluorescence-activated flow cytometry. The LTB4-reactive T-lymphocytes are distributed between the suppressor-cytotoxic (14%) and helper-inducer (8%) subsets, which were identified concurrently by phycoerythrin-labeled monoclonal antibodies to subset-specific antigens. LTB4, but not 12(S)-LTB4 or LTC4, significantly enhances the proliferation of mitogen-stimulated purified suppressor-cytotoxic T-lymphocytes at concentrations of 10(-12)M to 10(-6)M and significantly inhibits the proliferation of mitogen-stimulated purified helper-inducer T-lymphocytes at concentrations of 10(-8)M to 10(-6)M, as assessed by the uptake of [3H]thymidine. The net effect of LTB4 on blood T-lymphocytes is immunosuppression that may be expressed in some human hypersensitivity and inflammatory diseases.


Signal-on electrochemical detection of DNA methylation based on the target-induced conformational change of a DNA probe and exonuclease III-assisted target recycling.
A promising electrochemical system was explored for DNA methylation detection according to the construction of a signal-on biosensor. Based on the ingenious design of probe DNA and auxiliary DNA, methylated target DNA triggered the exonuclease III (Exo III) digestion of auxiliary DNA from 3'-terminus, resulting in the conformational change of probe DNA with an electroactive methylene blue (MB) tag at 5'-terminus. Consequently, the MB tag in the probe DNA was close to the electrode surface for electron transfer, generating an increased current signal. Because of the target recycling of methylated DNA, significant signal amplification was obtained. Moreover, bisulfite conversion conferred an efficient approach for the universal analysis of any CpG sites without the restriction of specific DNA sequence. As a result, the target DNA with different methylation statuses were clearly recognized, and the fully methylated DNA was quantified in a wide range from 10 fM to 100 pM, with a detection limit of 4 fM. The present work realized the assay of methylated target DNA in serum samples with satisfactory results, illustrating the application performance of the system in complex sample matrix.


Determination of short chain chlorinated paraffins in water by stir bar sorptive extraction-thermal desorption-gas chromatography-triple quadrupole tandem mass spectrometry.
A simple, robust, sensitive and environment friendly method for the determination of short chain chlorinated paraffins (SCCPs) in water using stir bar sorptive extraction (SBSE) coupled to thermal desorption-gas chromatography-triple quadrupole tandem mass spectrometry (TD-GC-QqQ-MS/MS) was developed. SBSE was performed using 100mL of water sample, 20mL of methanol as a modifier, and a commercial sorptive stir bar (with 10mm×0.5mm PDMS layer) during extraction period of 16h. After extraction, the sorptive stir bar was thermally desorbed and online analysed by GC-MS/MS. Method performance was evaluated for MilliQ and surface water spiked samples. For both types of matrices, a linear dynamic range of 0.5-3.0μgL-1 with correlation coefficients >0.999 and relative standard deviations (RSDs) of the relative response factors (RRFs) <12% was established. The limits of quantification (LOQs) of 0.06 and 0.08μgL-1, and the precision (repeatability) of 6.4 and 7.7% (RSDs) were achieved for MilliQ and surface water, respectively. The method also showed good robustness, recovery and accuracy. The obtained performance characteristics indicate that the method is suitable for screening and monitoring and compliance checking with environmental quality standards (EQS, set by the EU) for SCCPs in surface waters.


Post-processing of EPR spectra by convolution filtering: calculation of a harmonics' series and automatic separation of fast-motion components from spin-label EPR spectra.
This communication reports on post-processing of continuous wave EPR spectra by a digital convolution with filter functions that are subjected to differentiation or the Kramers-Krönig transform analytically. In case of differentiation, such a procedure improves spectral resolution in the higher harmonics enhancing the relative amplitude of sharp spectral features over the broad lines. At the same time high-frequency noise is suppressed through filtering. These features are illustrated on an example of a Lorentzian filter function that has a principal advantage of adding a known magnitude of homogeneous broadening to the spectral shapes. Such spectral distortion could be easily and accurately accounted for in the consequent least-squares data modeling. Application examples include calculation of higher harmonics from pure absorption echo-detected EPR spectra and resolving small hyperfine coupling that are unnoticeable in conventional first derivative EPR spectra. Another example involves speedy and automatic separation of fast and broad slow-motion components from spin-label EPR spectra without explicit simulation of the slow motion spectrum. The method is illustrated on examples of X-band EPR spectra of partially aggregated membrane peptides.


A simple and inexpensive culture device for cell growth, quantitative microscopy and autoradiography.
An inexpensive culture chamber suitable for subsequent preparations for cytochemical or radiographic work is demonstrated. The chamber consists of two glass microscope slides suitably prepared for cell growth and a gasket of silicone rubber. The slides and gasket are sealed and held together with two ordinary spring letter clips or clothes-pins. Cells may be inoculated by piercing the gasket with a hypodermic needle, or by removing the top slide and adding cells directly. Long-term cultivation with medium replacement is easy and efficient and addition of isotopes or other materials may be done aseptically.


Facilitation of secondary site kindling in the dorsal hippocampus following forebrain bisection.
Bisection of the corpus callosum and hippocampal commissure, after the kindling of one dorsal hippocampus (primary site), had no effect on the rate of generalized kindled seizure development in the contralateral dorsal hippocampus (secondary site). The rate of kindling in the secondary site was very rapid in both intact and commissure-bisected rats, resulting in a positive transfer between the two sites of approximately 90%. In addition, the afterdischarge threshold response of the secondary site, after commissurotomy but before secondary site kindling, revealed mature local epileptogenesis. These observations support the suggestion that the positive transfer observed between the dorsal hippocampi is based on bilateral epileptogenesis during primary site kindling. Bisection of the anterior corpus callosum lateralized the forelimb convulsion while the hippocampal commissure independently mediated the laterality of the hippocampal afterdischarge. Commissurotomy had no significant influence on the latency to onset or offset of these motor and electrographic responses. These results are compared with those from the amygdala, and their implication for the laterality of epileptogenesis is discussed.


Analyzing traditional and accelerated nursing student exam answer changing behaviors: A retrospective study.
This study examined differences in exam answer changing behavior among baccalaureate students based on program pace, semester in the program, exam scores, and grade point average. The study is a retrospective review of quantitative data. The data was collected using standardized testing results taken by students at a private, liberal arts university in the midwestern United States. 774 normed standardized nursing exams were reviewed retrospectively for number and type of answer changes and analyzed between traditional and accelerated baccalaureate students early, middle, and late in the curriculum. Most answer changes (50%) were beneficial to grades. Answer changing decreased late in the program. Students scoring higher changed fewer answers. Program pace and grade point average did not influence answer changing. Answer changing should not be generally discouraged. Promoting adequate preparation and test taking skills may benefit nursing students, especially early in programs.


[Physiotherapy and physical therapy in pain management].
Patients attend physiotherapy and physical therapy (PT) due to pain problems and/or functional impairments. Although the main focus for therapists has traditionally been physical examination and treatment of tissue structures and biomechanics, over the last few decades a growing body of research has highlighted the importance of central nervous system processing and psychosocial contributors to pain perception. Treatment with PT aims to reduce disability and suffering by reducing pain and increasing tolerance to movement. In Germany, pain management conducted by physiotherapists is currently undergoing major changes. Firstly, PT education is transitioning from a vocational to a degree level and additionally new concepts for improved multidisciplinary treatment approaches are being developed. However, there still remain substantial differences between therapists working in multidisciplinary pain clinics and those following medical referral in private practices. This article provides information on how national and international impulses have contributed to the development of different concepts of passive therapies and active/functional pain rehabilitation in Germany. In the future PT will need to provide more evidence about efficiency and modes of actions for different treatment options to selectively reason the application to patients with acute, subacute and chronic pain.


Properties and uses of chlorpyrifos in the United States.
Physical properties and use data provide the basis for estimating environmental exposures to chlorpyrifos (CPY) and for assessing its risks. The vapor pressure ofCPY is low, solubility in water is <1 mg L-1, and its log Kow is 5. Chlorpyrifos has short to moderate persistence in the environment as a result of several dissipation pathways that may proceed concurrently. Primary mechanisms of dissipation include volatilization, photolysis, abiotic hydrolysis, and microbial degradation.Volatilization dominates dissipation from foliage in the initial 12 h after application,but decreases as CPY adsorbs to foliage or soil. In the days after application, CPY adsorbs more strongly to soil, and penetrates more deeply into the soil matrix,becoming less available for volatilization. After the first 12 h, other processes of degradation, such as chemical hydrolysis and catabolism by microbiota become important. The half-life of CPY in soils tested in the laboratory ranged from 2 toI ,575 d (N = 126) and is dependent on properties of the soil and rate of application.At application rates used historically for control of termites, the degradation rate is much slower than for agricultural uses. In agricultural soils under field conditions,half-lives are shorter (2 to 120 d, N=58). The mean water-soil adsorption coefficient(Koc) of CPY is 8,216 mL g-1; negligible amounts enter plants via the roots,and it is not translocated in plants. Half-lives for hydrolysis in water are inversely dependent on pH, and range from 16 to 73 d. CPY is an inhibitor of acetylcholinesterase and is potentially toxic to most animals. Differences in susceptibility result from differences in rates of adsorption,distribution, metabolism, and excretion among species. CPY is an important tool in management of a large number of pests (mainly insects and mites) and is used on a wide range of crops in the U.S. Estimates of annual use in the U.S. from 2008 to 2012 range from 3.2 to 4.1 M kg y-1, which is about 50% less than the amount used prior to 2000. Applications to corn and soybeans accounts for 46-50%of CYP's annual use in the U.S.


Effect of tyramine, a dietary amine, on glycerol and lactate release by isolated adipocytes from old rats.
Amine degradation by adipocyte amine oxidases leads to the production of metabolites that interact with lipid and glucose metabolisms and their hormonal regulations. To further investigate these interactions, we determined the effect of a dietary amine, tyramine (TYR), on glycerol and lactate releases, respectively taken as indices of lipolytic and glycolytic activities of isolated adipocytes. Old male Wistar rats were used to prepare adipocytes by collagenase dissociation of retroperitoneal fat pads. The two tested doses of tyramine (10 microM and 1 mM) had no effect on basal glycerol release. On the other hand, TYR, at the highest dose tested (1 mM), weakly but significantly increased basal lactate release, which was elevated in adipocytes from old rats. Norepinephrine (NE), highly stimulated adipocyte lipolysis with a submaximal effect at 1 microM which was slightly but significantly inhibited by TYR 1 mM. Insulin 1 nM (INS) also poorly inhibited the NE-stimulated lipolysis in adipocytes isolated from old rats. TYR was able to potentiate the poor antilipolytic efficiency of INS. Under similar conditions, a high dose of NE greatly reduced lactate production and TYR (1 mM) reversed this inhibition of lactate release. INS was also able to totally reverse the inhibitory effect of NE on lactate release, but there was no potentiation between insulin and tyramine effects. It can be concluded that high doses of TYR interact with norepinephrine and insulin, at least on the control of glycerol and lactate release, by counteracting catecholamine effects and by mimicking insulin actions.


The Anatomische Gesellschaft and National Socialism - A preliminary analysis based on the society proceedings.
The Anatomische Gesellschaft (AG) is an international society for the anatomical sciences and at the same time the main organising body for German anatomists. This study analyses how the AG went through the years of National Socialism. As the society does not possess archival material from that time, the analysis is mainly based on the society proceedings (Verhandlungen der Anatomischen Gesellschaft) published annually after each meeting from 1934 to 1939 and again in 1950. During the period of National Socialism, the AG kept its international status against demands to make it a purely German society. It did not introduce anti-Jewish regulations or the Führer principle into its bylaws. The membership directories reveal that it was at least possible for members whose career was disrupted by Nazi policies to remain on the membership lists throughout the Nazi period. However, in contrast to later assumptions that no persecuted member of the AG was ever struck from its register, 17 of 57 persecuted members left the society between 1933 and 1939. The membership of six of these members was cancelled, officially for unpaid fees. However, other members with much longer arrears were not cancelled. To date, no additional historical information is available to assess the circumstances of these cancellations. In general, it remains remarkable that, in contrast to many other societies, the AG did not follow the path of preemptive obedience towards the new rulers. More archival sources need to be uncovered to elucidate the external influences and internal negotiations behind the published documents.


Availability and performance of face based non-contact methods for heart rate and oxygen saturation estimations: A systematic review.
Consumer-level cameras have provided an advantage of designing cost-effective, non-contact physiological parameters estimation approaches which is not possible with gold standard estimation techniques. This encourages the development of non-contact estimation methods using camera technology. Therefore, this work aims to present a systematic review summarizing the currently existing face-based non-contact methods along with their performance. This review includes all heart rate (HR) and oxygen saturation (SpO2) studies published in journals and a few reputed conferences, which have compared the proposed estimation methods with one or more standard reference devices. The articles were collected from the following research databases: Institute of Electrical and Electronics Engineers (IEEE), PubMed, Web of Science (WoS), Science Direct, and Association of Computer Machinery (ACM) digital library. All database searches were completed on May 20, 2021. Each study was assessed using a finite set of identified factors for reporting bias. Out of 332 identified studies, 32 studies were selected for the final review. Additionally, 18 studies were included by thoroughly checking these studies. 3 out of 50 (6%) studies were performed in clinical conditions, while the remaining studies were carried out on a healthy population. 42 out of 50 (84%) studies have estimated HR, while 5/50 (10%) studies have measured SpO2 only. The remaining three studies have estimated both parameters. The majority of the studies have used 1-3 min videos for estimation. Among the estimation methods, Deep Learning and Independent component analysis (ICA) were used by 11/42 (26.19%) and 9/42 (21.42%) studies, respectively. According to the Bland-Altman analysis, only 8/45 (17.77%) HR studies achieved the clinically accepted error limits whereas, for SpO2, 4/5 (80%) studies have matched the industry standards (±3%). Deep Learning and ICA have been predominantly used for HR estimations. Among deep learning estimation methods, convolutional neural networks have been employed till date due to their good generalization ability. Most non-contact HR estimation methods need significant improvements to implement these methods in a clinical environment. Furthermore, these methods need to be tested on the subjects suffering from any related disease. SpO2 estimation studies are challenging and need to be tested by conducting hypoxemic events. The authors would encourage reporting the detailed information about the study population, the use of longer videos, and appropriate performance metrics and testing under abnormal HR and SpO2 ranges for future estimation studies.


Geographical disparities of infant mortality in rural China.
The purpose of the study was to investigate the trends and causes of regional disparities of infant mortality rate (IMR) in rural China from 1996 to 2008. A population-based, longitudinal study. The national child mortality surveillance network. Population of the 79 surveillance counties. IMR, leading causes of infant death and the RR of IMR. The IMR in coastal, inland and remote regions declined by 72.4%, 62.9% and 58.2%, respectively, from 1996 to 2008. Compared with the coastal region, the RR of IMR were 1.7 (95% CI 1.6 to 1.9), 1.9 (95% CI 1.7 to 2.0) and 1.8 (95% CI 1.6 to 2.0) for inland region and 2.6 (95% CI 2.4 to 2.7), 3.2 (95% CI 3.0 to 3.5) and 3.1 (95% CI 2.7 to 3.4) for the remote region during 1996-2000, 2001-2005 and 2006-2008, respectively. The regional disparities existed for both male and female IMRs. The postneonatal mortality showed the highest regional disparities. Pneumonia, birth asphyxia, prematurity/low birth weight, injuries and diarrhoea were the main contributors to the regional disparities. There were significantly more infants who did not seek healthcare services before death in the remote region relative to the inland and coastal regions. The results indicated persistent existence of regional disparities in IMR in rural China. It is worth noting that regional disparities in IMR increased in the remote and coastal regions during 2001-2005 in rural China. These disparities remained unchanged during 2006-2008. The results indicate that strategies to reduce mortality caused by pneumonia, birth asphyxia and diarrhoea are keys to reducing IMR.


Generating novel molecule for target protein (SARS-CoV-2) using drug-target interaction based on graph neural network.
The transmittable spread of viral coronavirus (SARS-CoV-2) has resulted in a significant rise in global mortality. Due to lack of effective treatment, our aim is to generate a highly potent active molecule that can bind with the protein structure of SARS-CoV-2. Different machine learning and deep learning approaches have been proposed for molecule generation; however, most of these approaches represent the drug molecule and protein structure in 1D sequence, ignoring the fact that molecules are by nature in 3D structure, and because of this many critical properties are lost. In this work, a framework is proposed that takes account of both tertiary and sequential representations of molecules and proteins using Gated Graph Neural Network (GGNN), Knowledge graph, and Early Fusion approach. The generated molecules from GGNN are screened using Knowledge Graph to reduce the search space by discarding the non-binding molecules before being fed into the Early Fusion model. Further, the binding affinity score of the generated molecule is predicted using the early fusion approach. Experimental result shows that our framework generates valid and unique molecules with high accuracy while preserving the chemical properties. The use of a knowledge graph claims that the entire generated dataset of molecules was reduced by roughly 96% while retaining more than 85% of good binding desirable molecules and the rejection of more than 99% of fruitless molecules. Additionally, the framework was tested with two of the SARS-CoV-2 viral proteins: RNA-dependent-RNA polymerase (RdRp) and 3C-like protease (3CLpro).


Enhancement of fetal lung surfactant production by aminophylline.
Antepartum administration of aminophylline to pregnant rabbits resulted in accelerated formation of phospholipids regarded to be important components of pulmonary surfactant. Increases in the tissue content and synthesis of saturated phosphatidylcholine and phosphatidylinositol were found in lung slice preparations obtained from fetuses previously treated with aminophylline. Synthesis of phospholipids was measured using labeled palmitate, oleate, and glucose as precursors. The results showed increased de novo production of these lipids, and that glucose and glycogen may serve as important precursors. There was a significant reduction in triglyceride content while free fatty acids increased suggesting increased lipolysis in the aminophylline-treated groups, but this did not measurably affect the rate of labeled palmitate incorporation into total phospholipids.


Atmospheric emission inventory of the Maurienne valley for an atmospheric numerical model.
Within the framework of an air quality study of the French alpine valleys (POVA program), an atmospheric emission inventory concerning major pollutants: CO, NOx, SO(2), CH(4), particles (PT) and non-methane volatile organic compounds (NMVOC) was carried out. This inventory has a spatial resolution of 1 km(2) and was established for the reference year 2003. The coexistence of economic activities and the Vanoise national park makes the Maurienne valley a sensitive site, particularly representative of the problems of sustainable development in alpine areas, where air pollution is one of the most important aspects. The area, which covers 4588 km(2), is an alpine valley that is sensitive to air pollution due to the emission sources (traffic, industries, private heating, etc.), its morphology (a narrow valley surrounded by high ranges), and local meteorology (temperature inversions and slope winds). As expected, the result which includes both biogenic and anthropogenic sources shows serious emissions of pollutants that are mainly due to the presence of highways and industries around. Two emission inventories were drawn up: one with emission factors determined by CORINAIR (from the European Environment Agency) and the other with emission factors determined by BUWAL-OFEFP (from Swiss Agency for the Environment, Forests and Landscape). The inventories were then compared thanks to concentrations calculated from a numerical model. Computations were run for an intensive field observation period from 25 June to 2 July 2003.


Giving the Genes a Shuffle: Using Natural Variation to Understand Host Genetic Contributions to Viral Infections.
The laboratory mouse has proved an invaluable model to identify host factors that regulate the progression and outcome of virus-induced disease. The paradigm is to use single-gene knockouts in inbred mouse strains or genetic mapping studies using biparental mouse populations. However, genetic variation among these mouse strains is limited compared with the diversity seen in human populations. To address this disconnect, a multiparental mouse population has been developed to specifically dissect the multigenetic regulation of complex disease traits. The Collaborative Cross (CC) population of recombinant inbred mouse strains is a well-suited systems-genetics tool to identify susceptibility alleles that control viral and microbial infection outcomes and immune responses and to test the promise of personalized medicine.


Phosphogypsum and poultry manure enhance diversity of soil fauna, soil fertility, and barley (Hordeum aestivum L.) grown in calcareous soils.
Enrichment of calcareous soils with phosphogypsum and poultry manure amendments could increase nutrient availability, improve calcareous chemical characteristics, and enhance barley plant growth. In the current study, phosphogypsum (PG) and poultry manure (PM) were used to determine the effects of PG and PM application on soil fauna diversity, soil fertility, and barley yield. The pot experiment treatments were: C: control; PG1: 4.20 g kg-1 soil; PG2: 6.30 g kg-1 soil; PM1: 4.20 g kg-1 soil; PM: 6.30 g kg-1 soil, and their combinations. The results indicated that the application of PM alone or combined with PG had significant effects on the microbial biomass carbon (MBC), organic matter (OM), soil NPK availability, and yield of barley. Collembola and Prostigmata accounted for 50.0 and 43.3%, respectively, of the total number of soil fauna. Shannon and evenness indices increased significantly in the soil amended with PM alone or combined with PG. Amended soil with PG and/or PM significantly increased the yield and yield components of plants compared to the control. The PM1PG2 treatment increased the yield by 76.2% above the control.


Development of methodologies to assess the relative hazards from thermal decomposition products of polymeric materials.
The physiological stress imposed upon mice due to the irritating properties of thermal decomposition products of polymeric materials was evaluated. Acute lethality and histopathological evaluation were included in the study. The rankings of the polymeric materials studied from most to least hazardous was concluded to be polytetrafluoroethylene greater than polyvinyl chloride greater than Douglas Fir and flexible polyurethane foam greater than fiber glass reinforced polyester greater than copper coated wire with mineral insulation.


(+)-Medioresinol leads to intracellular ROS accumulation and mitochondria-mediated apoptotic cell death in Candida albicans.
The phytochemical (+)-Medioresinol, a furofuran type lignan identification and isolation on the stem bark of Sambucus williamsii, which is a folk medicinal plant used in traditional medicine. (+)-Medioresinol is known to possess a lesishmanicidal activity and cardiovascular disease risk reduction but its antifungal effects have not yet been identified. In this study, to confirm (+)-Medioresinol's antifungal properties and mode of action, we observed morphological and physiological change in Candida albicans. In cells exposed to (+)-Medioresinol, arrested the cell cycle and intracellular reactive oxygen species (ROS) which is a major cause of apoptosis were increased. The increase of ROS induced oxidative stress and the mitochondria dysfunction which causes release of pro-apoptotic factors. We investigated a series of characteristic cellular changes of apoptosis by using various apoptosis detection methods. We report here for the first time that (+)-Medioresinol has effects on mitochondria and induced the accumulation of ROS in C. albicans cells. We demonstrated that one of the important features of apoptosis, mitochondrial membrane depolarization is caused by ROS. Substantially, we investigated the release of cytochrome c, which is one of the factors of metacaspase activity. We also show that the effects of (+)-Medioresinol are mediated at an early stage in apoptosis acting on the plasma membrane phosphatidylserine externalization. In addition, (+)-Medioresinol induced apoptotic morphological changes, showing the reduced cell size (low FSC) and enhanced intracellular density (high SSC). In late stage of confirmation of diagnostic markers in yeast apoptosis include the effects of nucleus morphological change, DNA fragmentation and condensation by influence of oxidative stress. These apoptotic phenomena represent that oxidative stress and mitochondria dysfunctions by inducing the phytochemical (+)-Medioresinol must be an important factors of the apoptotic process in C. albicans. These results support the elucidation of the underlying antifungal mechanisms of (+)-Medioresinol.


UV-B dose/dose-rate responses of seasonally abundant copepods of Puget Sound.
Refinements in modeling stratospheric processes and recent observational data have generated estimates of moderate future reductions in total global ozone. Nevertheless, considerable uncertainty and concern remain about whether or not the resulting increases in incident solar UV-B could increase the risk of harmful biological effects. The UV-B dose/dose-rate thresholds for five species of copepods collected at the surface in Puget Sound were determined and compared to previously studied zooplankton groups. Generally, species appearing later in the spring and summer were less UV-B sensitive. The UV-B daily-dose and dose-rate thresholds for the five species of copepods, while apparently less than present median incident levels, range from above to below estimated present and future subsurface (1 m) UV-B levels. A separate experiment with a relatively large copepod, Calanus pacificus, in which above and below threshold UV-B dose-rates were administered with various levels of photoreactivating light(UV-A and visible light), indicated the presence of photorepair and its full activation at relatively low intensity. To improve estimates of the extent to which present and predicted UV-B levels affect local populations of copepods and zooplankton, it is essential to more fully understant the natural conditions or processes which influence the composition and intensity of the UV irradiation these animals receive.


A Randomized, Blinded Study to Validate the Merz Hand Grading Scale for Use in Live Assessments.
The Merz Hand Grading Scale (MHGS) is a 5-point scale used to grade appearance of the dorsum of the hand. The MHGS has been previously validated for assessment of photographed hands but not for live assessment. The purpose of this randomized, blinded study was to validate the MHGS for live assessment of the hands in the clinical setting. Three physician raters completed a scale qualification program that included MHGS training, ratings of standardized hand photographs, and statistical analysis for reliability. Eighty-four subjects (28 males, 30% Fitzpatrick skin Types IV-VI, mean age of 42 years), randomized to 2 live assessment sessions for independent and blinded observation of dorsa of their right hands, completed the study. Overall MHGS intrarater weighted Kappa value was 0.74 (0.68-0.79 [CI 95%]). First- and second-time hand-rating agreement scores ranged from 64% to 75%. Interrater weighed Kappa values ranged from 0.59 to 0.71, representing between-rater paired results of each combination of raters. High-weighted Kappa values and agreements demonstrate that consistency at different time points can be achieved individually and by different raters for live assessments. The MHGS is a suitable instrument for live assessment in the clinical setting.


Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis.
Splenic artery aneurysm (SAA) rarely occurs in the general population. Its increased incidence has been reported in cirrhosis. The aim of this retrospective study was to identify prevalence and predictive factor development of SAA in patients with cirrhosis. All patients with cirrhosis who were treated in our clinics between 2010 and 2014 were included in the study. Demographic features and clinical and laboratory findings were reviewed. Four-phase computerized tomography (CT) was used for identifying SAA. Imaging was reviewed for the presence of SAA as well as hepatic artery, portal vein, splenic artery, splenic vein, liver parenchyma, and intraabdominal cavity were evaluated. A total of 171 patients (age 55±13.9, 109 men) were included in the study. There was SAA in 27 (15.7 %) patients. Mean diameter of aneurysm was 11.66 (range, 6.06-27.1) mm. Aneurysm was located in the distal part of splenic artery in 20 (74 %) patients and solitary in 24 (88.8 %), and asymptomatic in all patients. Patients with SAA had larger portal vein and splenic vein compared to patients without SAA (15.3±3.9 vs. 13.1±2.9 mm, p=0.001; and 12.5±4.4 vs. 9.6±2.7 mm, p<0.001, respectively). We identified positive correlation between development of SAA and splenic vein diameter [hazard ratio (HR) =1.23; 95 % confidence interval (CI) 0.97-1.57; p = 0.009] and negative correlation between hepatic artery diameter and development of SAA HR = 0.46; 95 % CI 0.25-0.85; p = 0.002). SAA occurred in a significant proportion of patients with cirrhosis, and enlargement of the splenic vein seemed to be a predictive factor for the development of SAA.


Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: Growth mixture modeling across an 8-year cohort study.
Hypertension is one of the most prevalent chronic conditions and has been proven to be related to cognitive function. However, there is no evidence regarding the heterogeneity in cognitive trajectories among persons with hypertension. The aims of the current study were to characterize the heterogeneity in longitudinal trajectories of cognitive performance among Chinese middle-aged and older individuals with hypertension and to explore the potential determinants of trajectory memberships. Data from the 2011 to 2018 Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. Two cognitive measures of executive function and episodic memory were assessed, and conditional growth mixture modeling (GMM) was performed to identify the trajectories of cognitive performance and explore the related factors of cognitive change. The findings revealed three trajectory classes of executive function (stable, sharp decline, smooth decline) and two trajectory classes of episodic memory (stable, decline). Individuals with hypertension who had a higher educational level, moderate nighttime sleep duration, and lower depressive symptoms as well as those who reported consuming alcohol at least once a month were more likely to belong to the optimal stable executive function group. Subjects with a higher educational level, adequate daytime napping duration, and higher BMI were more likely to exhibit stable episodic memory over time. Other factors, including age, sex, community type, marital status, and hypertension treatment, exhibited class-specific effects on growth parameters of cognitive trajectory. Targeting intervention designation is proposed to ameliorate the burdens of cognitive impairment among individuals with hypertension.


Learning curve in pipeline embolization device: results from the pipeline embolization device in China post-market multicentre registry study.
Intracranial aneurysms pose a significant health issue, affecting 3-5% of the adult population. The pipeline embolization device (PED) has emerged as a promising treatment for these lesions. This study aimed to investigate the impact of operator experience on complication and poor outcome rates, as well as the learning curve for PED. A total of 217 patients were consecutively enroled from four eligible centres and divided into three groups based on the number of procedures performed: group 1 (first 10 procedures), group 2 (11-20 procedures), and group 3(>20 procedures). Major complications include operation-related ischaemic or haemorrhagic events and mass effect deterioration. Poor outcome was defined as a modified Rankin Scale score greater than 2 at discharge. Cumulative summation (CUSUM) analysis was generated to assess the learning curve according to major complications and poor outcome. The study found that major complications and poor outcomes occurred in 5.1% and 2.3% of cases, respectively. The rate of major complications decreased from 10.0% in group 1 to 2.9% in group 3 ( P =0.053), while the rate of poor outcomes decreased from 7.5% in group 1 to 0.7% in group 3 ( P =0.015). Multivariable regression analysis adjusted for covariates showed that operator experience was associated with a lower rate of poor outcomes ( P =0.034). CUSUM analysis demonstrated that the learning curve for avoiding major complications and poor outcomes required 27 (mean=13) and 40 (mean=20) cases, respectively. These findings suggest that PED treatment requires a learning curve of 40 cases to achieve reproducibility regarding complications and functional results. Additionally, major complications and poor outcomes significantly decreases after the first 20 procedures. CUSUM analysis can serve as a useful tool for monitoring and assessing surgical performance.


The effect of TENS for pain relief in women with primary dysmenorrhea: A systematic review and meta-analysis.
Primary dysmenorrhea (PD) is a chronic health condition that affects primarily young women and interferes with daily activities, causes loss of work productivity, and reduces quality of life. Transcutaneous electrical nerve stimulation (TENS) is a complementary and alternative therapy used to reduce pain related to PD. The purpose of this meta-analysis study was to evaluate the effectiveness of TENS in the treatment of pain in women with PD. A search of the English literature in the Cochrane Library, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, OVID, Science Direct, Scopus, Academic Search Complete databases was conducted using combinations of the following search terms: 'primary dysmenorrhea', 'pain', 'transcutaneous electrical nerve stimulation', 'TENS', and 'electrical stimulation'. All content from database inception through April 2020 was included in the search. The initial search strategy based on date range and language yielded 571 relevant records and 4 of them were about both TENS and PD. A total of 260 patients were enrolled in the included studies. In all of the included studies, the comparison intervention consisted of sham TENS. The primary outcome of interest was pain intensity. Our analysis indicated that TENS was statistically more effective than sham TENS in reducing PD-related pain (SMD=1.384; 95% CI=0.505, 2.262; p = 0.002). TENS is a safe and well-tolerated electrophysical therapy that may be effective for relieving pain in PD.


Factors associated with prognosis of upper limb function in branch atheromatous disease.
Branch atheromatous disease (BAD) is often associated with corticospinal tract injury, and some patients develop early neurological deterioration (END) in the acute phase. This study investigated the progress of upper limb prognosis after BAD in the acute phases and examined the factors related to the prognosis of upper limb function. 108 subjects diagnosed with BAD were included. Then subjects were classified into two groups: those with good recovery of upper limb function and those with poor recovery of upper limb function. Univariate and multivariate analyses were performed with the objective variable being good or poor upper limb function. The following factors were used as explanatory variables: age, the volume of infarction, initial Fugl-Meyer assessment (FMA) upper limb score, and presence of END. The univariate analysis showed significant differences in age and volume of infarction (p < 0.05). Multivariate analysis showed the following finding: age;(OR 0.977,95%CI 0.917-0.997,p = 0.0061; volume of infarction;(OR 0.645,95%CI 0.461-0.902,p = 0.0104). A significant difference was found in the age and volume of the infarct. This study finding suggests that age and volume of infarction are associated with the prognosis of upper extremity paralysis in BAD.


Dying with Style: Death Decision in Plant Embryogenesis.
Embryogenesis is a fascinating event during the plant life cycle encompassing several steps whereby the zygote develops into a fully developed embryo which, in angiosperms, is composed of an axis separating the apical meristems, and two cotyledons. Recapitulation of embryogenesis can also occur in vitro through somatic embryogenesis, where somatic cells are induced to form embryos, and androgenesis, in which embryos originate from immature male gametophytes. Besides cell division and differentiation, embryo patterning in vivo and in vitro requires the dismantling and selective elimination of cells and tissues via programmed cell death (PCD). While the manifestation of the death program has long been acknowledged in vivo, especially in relation to the elimination of the suspensor during the late phases of embryo development, PCD during in vitro embryogenesis has only been described in more recent years. Independent studies using the gymnosperm Norway spruce and the angiosperm maize have shown that the death program is crucial for the proper formation and further development of immature somatic embryos. This chapter summarizes the recent advances in the field of PCD during embryogenesis and proposes novel regulatory mechanisms activating the death program in plants.


Fate of deoxynivalenol and degradation products degraded by aqueous ozone in contaminated wheat.
Deoxynivalenol (DON) is a secondary metabolite produced by Fusarium species in cereals that can be harmful to the health of humans and animals. In this work, a treatment system of aqueous ozone hybrid hydroxyl free radical (·OH) was establishedto degrade DON. An ultra-performance liquid chromatography-quadrupole-time of flight mass spectrometry (UPLC-Q-TOF) method was applied to detect and follow the fate of DON throughout the degradation process. The electrospray ionization mass spectrometry (ESI/MS) analysis confirmed the presence of DON and two degradation products (at 313.0215 and 325.0101 m/z) with the secondary mass spectrogram in the ESI positive mode. Based on the ESI/MS data, a multiple reaction monitoring (MRM) method was established to screen and monitor DON and the two degradation products in contaminated wheat. The MRM method was applied to analyze the degree of DON degradation in the samples. Overall, this work investigated the characteristics of DON and products in the ozone degradation process, and provided new insights into the application of an aqueous ozone system for the detoxification of mycotoxin-contaminated cereals.


CT patterns of organizing pneumonia in patients treated with VEGF/mTOR inhibitors for metastatic renal cell cancer: an observational study.
Targeted therapies are the standard treatment in patients with metastatic renal cell carcinoma (mRCC) and are known to cause adverse pulmonary events. Organizing pneumonia (OP) with its various manifestations in computed tomography (CT) has therefore lately received more attention. To describe the spectrum of CT patterns of OP in patients with mRCC receiving targeted therapies. Seventeen patients with known therapy-related OP were analyzed retrospectively by two blinded radiologists in consensus. Images were scored according to OP patterns that have previously been described. Additionally, the distribution and the predominant imaging pattern in each patient were determined. In our cohort, ground glass opacity was the most common imaging pattern (17/17, 100%) in patients with OP followed by a reticular pattern (12/17, 71%), consolidations (10/17, 59%), nodules (7/17, 41%), crazy paving (5/17, 29%), bronchi(ol)ectasis (4/17, 24%), focal mass (3/17, 18%), and reversed halo (1/17, 6%). The most common imaging pattern was changing multifocal consolidations (8/17, 47%). A bronchocentric and a nodular pattern were found in four patients (24%) each, a progressive fibrotic pattern in none patient, and reversed halo/atoll pattern in one (6%) case. OP is the major differential diagnosis to be considered in patients with targeted therapies and pulmonary changes. Knowledge of the variety of imaging findings can facilitate diagnosis.


Modelling aerobic biodegradation in vertical flow sand filters: impact of operational considerations on oxygen transfer and bacterial activity.
Oxygen renewal, as a prominent phenomenon for aerobic bacterial activity, deeply impacts Vertical Flow Constructed Wetland (VFCW) treatment efficiency. We introduce a multiphase model able to simulate multi-component transfer in VFCWs. It is based on a two-phase flow module, and a transport module. The flow module can quantify both water and air velocities throughout the filter during operation. The reactive transport module follows dissolved and gaseous oxygen concentrations, and the transport of solutes such as ammonium and readily biodegradable COD (Chemical Oxygen Demand). The consumption of components is governed by Monod-type kinetics. Heterotrophic and autotrophic bacteria, which are responsible for COD and ammonium degradation respectively, are part of the model components. The kinetics are based on the Constructed Wetlands Model 1. The results from the simulation tool were compared with existing experimental data, and two kinds of operation with VFCWs were investigated. The authors show strong interplay between oxygen renewal and bacterial consumption in case of sequential batch feeding with transient flooding of surface. Oxygen renewal is essentially convection mediated in such operation, while convection is not significant in non-flooding operation. Simulated bacterial patterns are impacted by the operation, both quantitatively and spatially. From a modelling point of view, the authors highlight some limitations of the biological model: the description of bacterial lysis processes needs to be enhanced, as well as ammonium adsorption to organic matter.


Saturated triglycerides and fatty acids activate neutrophils depending on carbon chain-length.
Unsaturated fatty acids are known as neutrophil activators. In the present study we investigated whether saturated triglycerides and fatty acids may also contribute to the previously observed activation of neutrophils by nutritional lipid emulsions. Furthermore we tested the hypothesis that carbon-chain length is of importance in this respect. Neutrophils (1 x 10(6) mL(-1)) were isolated from the blood of nine volunteers. Chemiluminescence was used to evaluate neutrophil activation, characterized by the production of oxygen radicals by neutrophils during incubation with 1 mmol L(-1) saturated fatty acid (6-20 carbon) or triglycerides (6-12 carbon fatty acid), dissolved in aqueous medium by preparing micelles with dipalmitoyl phosphatidylcholine (DPPC). Results were expressed as means +/- SEMs of the overall luminescence signal relative to the signal of cells incubated in medium. Similar to a positive control, the polyunsaturated fatty acid arachidonic acid (C20 : 4), the triglycerides tricaproin (TC6 : 0), tricaprylin (TC8 : 0) and trilaurin (TC12 : 0) as well as the fatty acids lauric acid (C12 : 0), palmitic acid (C16 : 0), stearic acid (C18 : 0) and arachidic acid (C20 : 0) all induced oxygen radical production in neutrophils, while the medium-chain triglyceride tricaprin (TC10 : 0) and fatty acids caproic acid (C6 : 0), caprylic acid (C8 : 0) and capric acid (C10 : 0) exerted no clear effects, similar to negative controls (DPPC and glycerol). Besides their (poly)-unsaturated counterparts, saturated triglycerides and fatty acids also activate neutrophils. Carbon chain-length is pivotal in the interaction of fatty acids and triglycerides and cells of the immune system.


Clinicians' Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency.
Access to language services is a required and foundational component of care for patients with limited English proficiency (LEP). National standards for medical interpreting set by the US Department of Health and Human Services and by the National Council on Interpreting in Health Care establish the role of qualified medical interpreters in the provision of care in the United States. In the vignette, the attending physician infringes upon the patient's right to appropriate language services and renders unethical care. Clinicians are obliged to create systems and a culture that ensure quality care for patients with LEP.


A mathematical model to predict CO2 removal in hollow fiber membrane oxygenators.
A mathematical model has been developed to predict CO(2) removal in hollow fiber membrane oxygenators. The model is analogous to one developed previously for predicting O(2) transfer. A mass transfer correlation was determined in water for O(2) and CO(2) exchange and collapsed onto one universal curve. The correlation was used to predict CO(2) removal in blood by incorporating a 'facilitated diffusivity' to account for the transport of CO(2) present as bicarbonate. The diffusion of bicarbonate greatly increased the ability of the oxygenator to remove CO(2) in blood compared to water. A fiber bundle module was fabricated to test the model predictions. The fiber bundle had a length of 13 cm and a bundle thickness of 0.2 cm. The module was tested in bovine blood at flowrates of 0.75, 1.5, and 2.2 L/min and CO(2) removal rate predictions were within 9% of experimental measurements at all flowrates. The O(2) transfer rate predictions were within 10% of experimental measurements. A second module was manufactured with a bundle of length 4 cm and thickness of 1 cm. The CO(2) removal predictions were within the standard deviation of the experimental measurements.


Engineered antigen containing epitopes from Loxosceles spp. spider toxins induces a monoclonal antibody (Lox-mAb3) against astacin-like metalloproteases.
Loxoscelism pose a health issue in the South America. The treatment for these accidents is based on the administration of antivenom produced in animals immunized with Loxosceles venom. In this work, a previously produced non-toxic multiepitopic chimeric protein (rMEPlox), composed of epitopes derived from the main toxins families (sphyngomielinase-D, metalloproteases, and hyaluronidases) of Loxosceles spider venoms, was used as antigen to produce monoclonal antibodies (mAbs). A selected anti-rMEPlox mAb (Lox-mAb3) reacted with metalloprotease from L. intermedia venom and showed cross-reactivity with metalloproteses from Brazilian and Peruvian Loxosceles laeta and Loxosceles gaucho venoms in immunoassays. The sequence recognized by Lox-mAb3 (184ENNTRTIGPFDYDSIMLYGAY205) corresponds to the C-terminal region of Astacin-like metalloprotease 1 and the amino acid sequence IGPFDYDSI, conserved among the homologs metalloproteases sequences, is important for antibody recognition. Lox-mAb3 neutralizes the fibrinogenolytic activity caused by metalloprotease from L. intermedia spider venom in vitro, which may lead to a decrease in hemorrhagic disturbances caused by Loxosceles envenomation. Our results show, for the first time, the use of a non-toxic multiepitopic protein for the production of a neutralizing monoclonal antibody against a metalloprotease of medically important Loxosceles venoms. These results contribute for the production improvement of therapeutic antivenom against loxoscelism.


Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: a prospective qualitative study.
To explore the experience of post-stroke fatigue in community-dwelling stroke survivors with and without post-stroke mood disturbance within one year of stroke. This was a prospective qualitative cohort study including semistructured interviews undertaken at baseline (stroke onset), 3, 6, 9 and 12 months in 23 stroke survivors; eight single interviews were held with "supplementary" participants. Qualitative data analysis involved an inductive thematic approach using a process of constant comparison. Thirty-one participants (17 men, 14 women; age range 37-94 years) took part in 122 interviews. The majority of participants was independent and experienced few major depressive symptoms. Three trajectories emerged regarding the participants' experiences of fatigue including experience of fatigue, coping strategies and knowledge. The results of this study suggest that in spite of reasonable objective physical recovery post-stroke, fatigue in community-dwelling stroke survivors may be disabling. The use of qualitative methodology was sensitive in identifying the factors that play a role in the experience of fatigue. The essential role of health professionals in this context is to provide support and education regarding fatigue and to promote participation after stroke in therapy programs. Routine practice for stroke services should include fatigue advice prior to discharge.


Residential inequalities in health-related quality of life among women of reproductive age in four regions of Ethiopia: a decomposition analysis.
Ethiopian rural-urban disparities in key domains of health-related quality of life among women in reproductive age have been huge. However, sources of such inequalities were not studied well. Therefore, this study aimed to assess inequalities in health-related quality of life among women residing in urban and rural areas in four regions of Ethiopia. This study used data extracted from the 2016 Ethiopian Demographic and Health Survey; collected at national level from January 18, 2016, to June 27, 2016. Stratified two stage cluster sampling method were used. The data collected from 2385 women in the age group 15-49 years who were living in four regions (Afar, Benishangul-Gumuz, Gambela, and Somali regions) of Ethiopia were used for this study. The outcome variable, Health-Related Quality of Life (HRQoL), was generated by Principal Component Analysis. Further, Multivariable Ordinary Least Square and Oaxaca decomposition threefold (interaction) were used in the analysis with a p-value less than 0.05 and 95% confidence interval to declare statistical significances. Women education, region, religion, wealth index, and husband/partner education were identified as predictors of Health-Related Quality of Life. Women residing in rural areas had far lower health-related quality of life than those living in urban areas. The wealth index and educational level of women were the largest contributor of the inequality in health-related quality of life. A substantial inequality in quality of life exist between women who reside in rural and urban areas in those four regions of Ethiopia. The socioeconomic factors more importantly wealth index and educational attainment explained the significant portion of the reported rural-urban disparities. Therefore, Policymakers and local administrators should pay more attention on interventions that promote education and narrowing gap in wealth in rural and urban settings.