Leukocyte count is associated with reduced endothelial reactivity.
Leukocyte count has been associated with cardiovascular and cerebrovascular disease in several studies. We hypothesized that white blood cell count is associated with endothelial reactivity. Leukocyte count was measured in a sample of stroke-free community participants undergoing brachial artery testing for endothelial reactivity. Flow-mediated dilation (FMD) during reactive hyperemia was assessed in each subject using high-resolution B-mode ultrasound. Multivariate linear regression was used to calculate the effect of leukocyte count on endothelial reactivity after adjusting for potential confounding factors. Mean age of the 868 participants was 66.7+/-8.8 years; 57% were women. Mean leukocyte count was (6.1+/-1.8)x10(9)/L. Each unit increase in leukocyte count was associated with a mean 0.18% decrease in FMD (p = 0.01). After adjusting for other atherosclerosis risk factors, including age, sex, hypertension, diabetes, hyperlipidemia, and smoking, the relationship persisted (mean decrease in FMD per unit leukocyte count = 0.17%, p = 0.02). There was a linear decrease in FMD by quartile of leukocyte count (p = 0.0014). The effect of leukocyte count on FMD was greater for women, those under age 70, and non-diabetics. Relative elevations in leukocyte count are associated with a reduction in brachial artery endothelial reactivity. These findings are consistent with current hypotheses regarding the inflammatory or infectious etiology of risk of atherosclerosis and stroke, but also suggest interactions with demographic and other risk factors.


Complete versus culprit-only revascularization in ST-elevation myocardial infarction and multivessel disease.
In 30-60 % of patients presenting with ST-segment elevation myocardial infarction (STEMI), significant stenoses are present in one or more non-infarct-related arteries (IRA). This correlates with an increased risk of major adverse cardiac events (MACE). Current guidelines, do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock or persistent ischemia after primary percutaneous coronary intervention (PCI). Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results regarding the optimal revascularization strategy in STEMI patients with multivessel disease. Recently, randomized studies (PRAMI, CvLPRIT, and DANAMI 3-PRIMULTI) provide encouraging data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. Differently, in the PRAGUE-13 trial there were no differences in MACE between complete revascularization and culprit-only PCI. Several meta-analyses were recently published including randomized and non-randomized clinical trials, showing different results depending on the included trials. In conclusion, the current available evidence from the randomized clinical trials, with a total sample size of only 2000 patients, is not robust enough to firmly recommend complete revascularization in STEMI patients. This uncertainty lends support to the continuation of the COMPLETE trial. This ongoing trial is anticipated to enroll 3900 patients with STEMI from across the world, and will be powered for the hard outcomes of death and myocardial infarction. Until the results of the COMPLETE trial are reported, physicians need to individualize care regarding the opportunity and the timing of the non-IRA PCI.


Histological alterations and biochemical changes in the liver of sheep following Echis coloratus envenomation.
Snake envenoming is a major problem in Al-Jouf Province of Saudi Arabia where most of these envenoming are caused by Echis coloratus which is the highest risk to human and animals in this Province. Little, if any, has been carried out on the histological alterations and biochemical changes in the liver of sheep following snake envenomation. Healthy adult male Ovis orientalis sheep were subjected to E. coloratus envenomation in an attempt to evaluate the histological alterations and biochemical changes in the liver. E. coloratus venom elevated glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglyceride and total bilirubin while cholesterol was reduced. The histological alterations were mainly pyknosis, karyorrhexis, cytoplasmic vacuolation, necrosis, fatty changes and hepatocytes atrophy. Sinusoidal dilatation, Kupffer cell activation, amyloidosis, portal vein thrombosis, partial glycogen depletion and hepatic architecture distortion were also detected. The findings revealed that E. coloratus venom produced biochemical changes and histological alterations in the liver of the envenomated sheep that might affect the functions of this organ severely.


High-performance liquid chromatographic determination of methylprednisolone and methylprednisolone 21-[8-[methyl-(2-sulfoethyl)amino]-8-oxoctanoate] sodium salt in human plasma.
A high-performance liquid chromatographic assay method with ultraviolet detection at 243 nm has been developed for the quantitative determination of methylprednisolone (MP) and methylprednisolone 21-[8- [methyl-(2-sulfoethyl)amino]-8-oxoctanoate] sodium salt (MPSO) in human plasma. The method is simple, rapid and sensitive to detect MP and MPSO in human plasma following administration of therapeutic doses of MPSO. The assay procedure involved stabilization of plasma samples by addition of disodium ethylenediaminetetraacetic acid and ion-pair extractions of MPSO with tetraethylammonium chloride. After extracting both drugs and internal standard into chloroform, the extract was evaporated to dryness under nitrogen. The resulting residue was reconstituted in 200-500 microliter of mobile phase and chromatographed on a C18 IBM reversed-phase column (5 micron). The mobile phase was a mixture of water-actetonitrile-isopropanol (71:19.9:10) containing 50 microliter of 0.1 M hydrochloric acid and 0.497 g tetraethylammonium chloride. Propyl p-hydroxybenzoate was used as an internal standard. The chromatographic responses were linear up to about 200 micrograms/ml for MP and 80 micrograms/ml for MPSO in human plasma. The assay detection limit was approximately 7 ng/ml for MP and 25 ng/ml for MPSO in human plasma. Statistical analysis indicated an average recovery of 102.0 +/- 4.71% for MP and 75.2 +/- 2.88% for MPSO. Human plasma levels are reported for MP and MPSO following single-dose intravenous administration of 100-mg equivalents of MPSO.


Monoclonal antibody binding affinity determined by microchip-based capillary electrophoresis.
The affinity constant of a monoclonal antibody to fluorescently labeled bovine serum albumin (BSA) was measured in diluted mouse ascites fluid using a microfluidic chip to perform affinity capillary electrophoresis. Borofloat glass-based devices could be used repeatedly with samples for many months. On-chip separations were performed in less than 60 s, and 30-60 s was required for manual sample exchange. The change in peak height for BSA with increasing BSA/anti-BSA concentration ratio was used to determine concentration changes in bound and free BSA. A Scatchard plot analysis gave an affinity constant (more exactly the intrinsic association constant) of 3.5+/-0.6 x 10(7) M(-1) for a 1:1 stoichiometric ratio. Two affinity complexes were separated. One complex was identified by the Scatchard method as having a 1:1 stoichiometric ratio. The other complex is proposed to have a stoichiometry with an excess of anti-BSA to BSA, most likely (anti-BSA)2-BSA, on the basis of a faster migration time than the 1:1 complex, a decrease in the amount of this complex with increasing [BSA], and predictions of theoretical models for multi-valent antigens. Potential applications of microchip-based devices in affinity measurements are discussed.


Pattern of expression of immune-relevant genes in the gonad of a teleost, the gilthead seabream (Sparus aurata L.).
Immune responses in the testis are regulated in a way that provides protection for the developing male germ cells, while permitting qualitatively normal inflammatory responses and protection against infection. In addition, germ cells are potent targets for the growth factors and cytokines which regulate the reproductive process. Our study analyzes for the first time the pattern of expression of several immune-relevant genes in the gonad of a seasonal breeding teleost fish. The immune molecules analyzed include (i) inflammatory molecules, such as interleukin-1b (il1b), il6, tumor necrosis factor-a (tnfa), cyclooxygenase-2 (cox2) and the NADPH oxidase subunit p40(phox) (ncf4 gene); (ii) the anti-inflammatory cytokine transforming growth factor-b1 (tgfb1) and its type 2 receptor tgfbr2; (iii) innate immune receptors, including toll-like receptor 9 (tlr9), tlr5, tlr22 and macrophage-colony stimulating factor receptor (mcsfr); (iv) lymphocyte receptors, such as the beta subunit of T-cell receptor (Tcrb) and the heavy chain of immunoglobulin M (ighm); (v) the anti-bacterial molecules lysozyme (lyz), hepcidin (hamp) and complement component 3 (c3); (vi) the anti-viral molecule myxovirus (influenza) resistance protein (mx); and (vii) molecules related to leukocyte infiltration, including the CC chemokine ccl4, the CXC chemokine il8 and the leukocyte adhesion molecule E-selectin (Sele). Notably, all of them show a pattern of expression that depends on the reproductive stage of the first two reproductive cycles when the fish develop and function as males. Furthermore, we demonstrate that some of these immune-relevant molecules, such as Il1b and Mcsfr, are produced by germ cells (Il1b) and ovarian and testicular somatic cells (Mcsfr). These data suggest that, as occurs in mammals, there is a critical balance between immune molecules and that these may play an essential role in the orchestration of gametogenesis and the maintenance of gonad tissue homeostasis in fish.


Error analysis and applications in transportation systems.
This paper presents an overview of the field of error analysis. Section 1 shows why discussions about human error are relevant for societal safety. With regard to safety research, it is important to predict abnormal events. At the machine side, reliability studies proved their value, but to predict failures in the human factor has been shown to be very difficult. Therefore, problems in how to define the notion of human error (Section 2) and how to classify different types of error (Section 3) are discussed. Some researchers started to use systematical classifications of human error types based on a recent, hierarchical model of human task performance. The outline of the model is presented. Examples of error analysis studies from the field of transportation research (Section 4) provide some basic suggestions on how to reduce error rates. Some conclusions on error control are given in Section 5. The responsibility of managers and system designers in this respect is strongly emphasized.


Excretion and detection of SARS coronavirus and its nucleic acid from digestive system.
To study whether severe acute respiratory syndrome coronavirus (SARS-CoV) could be excreted from digestive system. Cell culture and semi-nested RT-PCR were used to detect SARS-CoV and its RNA from 21 stool and urine samples, and a kind of electropositive filter media particles was used to concentrate the virus in 10 sewage samples from two hospitals receiving SARS patients in Beijing in China. It was demonstrated that there was no live SARS-CoV in all samples collected, but the RNA of SARS-CoV could be detected in seven stool samples from SARS patients with any one of the symptoms of fever, malaise, cough, or dyspnea, in 10 sewage samples before disinfection and 3 samples after disinfection from the two hospitals. The RNA could not be detected in urine and stool samples from patients recovered from SARS. Nucleic acid of SARS-CoV can be excreted through the stool of patients into sewage system, and the possibility of SARS-CoV transmitting through digestive system cannot be excluded.


Broadband modulation of terahertz waves through electrically driven hybrid bowtie antenna-VO2 devices.
Broadband modulation of terahertz (THz) light is experimentally realized through the electrically driven metal-insulator phase transition of vanadium dioxide (VO2) in hybrid metal antenna-VO2 devices. The devices consist of VO2 active layers and bowtie antenna arrays, such that the electrically driven phase transition can be realized by applying an external voltage between adjacent metal wires extended to a large area array. The modulation depth of the terahertz light can be initially enhanced by the metal wires on top of VO2 and then improved through the addition of specific bowties in between the wires. As a result, a terahertz wave with a large beam size (~10 mm) can be modulated within the measurable spectral range (0.3-2.5 THz) with a frequency independent modulation depth as high as 0.9, and the minimum amplitude transmission down to 0.06. Moreover, the electrical switch on/off phase transition depends very much on the size of the VO2 area, indicating that smaller VO2 regions lead to higher modulation speeds and lower phase transition voltages. With the capabilities in actively tuning the beam size, modulation depth, modulation bandwidth as well as the modulation speed of THz waves, our study paves the way in implementing multifunctional components for terahertz applications.


Lectin-like oxidized LDL receptor-1 (LOX-1) supports adhesion of mononuclear leukocytes and a monocyte-like cell line THP-1 cells under static and flow conditions.
Adhesion of mononuclear leukocytes to vascular endothelial cells appears one of the initial steps in the process of atherogenesis and inflammation. We examined if LOX-1, an endothelial scavenger receptor with C-type lectin-like structure, can support adhesion of mononuclear leukocytes. Under a static condition, CHO-K1 cells stably expressing LOX-1 showed more prominent adhesion of human peripheral blood mononuclear leukocytes and THP-1 cells than untransfected CHO-K1 cells, in a temperature-independent fashion. Mononuclear leukocytes also adhered to plastic plates precoated with recombinant soluble LOX-1 extracellular domain. A neutralizing anti-LOX-1 monoclonal antibody, as well as oxidized low-density lipoprotein, significantly blocked adhesion of THP-1 cells to CHO-K1 cells overexpressing LOX-1 and bovine aortic endothelial cells. Under a flow condition, increased numbers of THP-1 cells showed rolling with reduced velocities on LOX-1-expressing CHO-K1 cells, compared with those on untransfected CHO-K1 cells. Taken together, LOX-1 can work as a cell surface receptor for mononuclear leukocytes under both static and flow conditions.


Raman spectroscopy detection of molecular changes associated with two experimental models of osteoarthritis in rats.
The aim of the present study was to evaluate the feasibility of applying Raman spectroscopy in probing the molecular changes in terms of collagen deposition and tissue remodeling associated with two well-established experimental models of osteoarthritis (OA) in knee of rats. In order to evaluate alterations in the articular surface area, the menisci-covered tibial region was assessed into three groups as follows: control (joint preserved) and two models of experimental knee OA: collagenase-induced model (n = 8) and treadmill exercise-induced model (n = 8). Each group was examined for molecular changes using spectral parameters related to cartilage, subchondral bone, and bone tissues. A significant increase of Raman ratios related to mineralization and tissue remodeling was found (p < 0.05), suggesting that both models were successful for inducing OA in rats. The significantly lower phenylalanine content and higher crystallinity in the treadmill exercise-induced model of OA than collagenase-induced model of OA (p < 0.05) indicated that the OA pathogenesis was model-dependent. Thus, this work suggests that the Raman spectroscopy technique has potential for the diagnosis and detection of cartilage damage and monitoring of subchondral bone and bone in OA pathogenesis at the molecular level.


Molecular cloning of rat liver sulfite oxidase. Expression of a eukaryotic Mo-pterin-containing enzyme in Escherichia coli.
The cDNA encoding sulfite oxidase has been cloned from a rat liver cDNA library. The gene contains a single open reading frame of 1464 nucleotides encoding a protein of 488 amino acids. The deduced amino acid sequence contains a 22-residue amino-terminal presequence that may serve as a mitochondrial targeting signal. The amino acid sequence deduced from the cDNA shows significant similarity to those of sulfite oxidase from chicken liver and nitrate reductases from algal, fungal, and plant sources. Two cysteine residues are conserved in all of these proteins, and it is proposed that one or both of these cysteines serve as ligands to molybdenum. The gene has been expressed in Escherichia coli to a level equivalent to that observed in rat liver. The recombinant enzyme has been found to contain the molybdopterin form of the molybdenum cofactor and is active as determined by the sulfite dependent reduction of cytochrome c.


The relationship of parental overprotection, perceived vulnerability, and parenting stress to behavioral, emotional, and social adjustment in children with cancer.
To examine the relationship of self-reported parental overprotection, perceived child vulnerability, and parenting stress to parent-reported behavioral, emotional, and social adjustment of children currently on treatment for cancer. Parents of 62 children (34 boys, 28 girls) currently on treatment for cancer were recruited from an outpatient pediatric cancer clinic. Children ranged in age from 2 to 12 years; age at diagnosis ranged from 1.33 to 11.83 years. Higher levels of parenting stress, but not parental overprotection or perceived child vulnerability, were associated with poorer behavioral and social adjustment. Higher levels of perceived child vulnerability and parenting stress, but not parental overprotection, were independently associated with poorer emotional adjustment. Specific parenting variables appear to be related to specific adjustment outcomes in children with cancer. Longitudinal follow-up of these children is necessary to determine the developmental trajectory of parent variables and long-term child outcomes.


Phylogenetic analyses of phylum Actinobacteria based on whole genome sequences.
Actinobacteria constitute one of the largest and ancient taxonomic phylum within the domain bacteria and are well known for their secondary metabolites. Considerable variation in the metabolic properties, genome size and GC content of the members of this phylum has been observed. Therefore, the placement of new or existing species based on 16S rRNA gene sometimes becomes problematic due to the low congruence level. In the present study, phylogeny of ninety actinobacterial genomes was reconstructed using single gene and whole genome based data. Where alignment-free phylogenetic method was found to be more robust, the concatenation of 94 proteins improved the resolution which all single gene based phylogenies failed to resolve. The comprehensive analysis of 94 conserved proteins resulted in a total of 42,447 informative sites, which is so far the largest meta-alignment obtained for this phylum. But the ultimate resolved phylogeny was obtained by generating a consensus tree by combining the information from single gene and genome based phylogenies. The present investigation clearly revealed that the consensus approach is a useful tool for phylogenetic inference and the taxonomic affiliations must be based on this approach. The consensus approach suggested that there is a need for taxonomic amendments of the orders Frankiales and Micrococcales.


Endopyelopyelotomy: percutaneous surgery for ureteropelvic junction obstruction in a bifid pelvis: further experience.
A patient with a bifid pelvis and ureteropelvic junction obstruction of the lower system was managed successfully by endopyelopyelotomy. This percutaneous procedure consists of creation of an internal fistula between the 2 pelves by incision of the intervening tissue with an optical urethrotome. This procedure provided a satisfactory and reproducible result.


Interrater reliability of the International Continence Society and International Urogynecological Association (ICS/IUGA) classification system for mesh-related complications.
We sought to assess interrater reliability of the International Continence Society (ICS)/International Urogynecological Association (IUGA) classification system of vaginal mesh-related complications and compare this with several other available complication classification systems. This was a retrospective analysis of mesh-related complications in patients presenting after pelvic organ prolapse or incontinence surgery. The complications were classified by 2 independent reviewers using the ICS/IUGA classification system as well as 3 other available classification systems. Interrater reliability was assessed using percent agreement and the weighted κ statistic. The ICS/IUGA mesh complication classification system was found to have poor interrater reliability (κ = 0.15-0.78). The other systems yielded a κ that ranged from 0.18-0.60, but were too general or could only be applied to 68% of the complications. The complexity of the ICS/IUGA mesh complication system, the large number of categories, and lack of clarity likely contribute to its poor interrater reliability.


Establishing a novel C. elegans model to investigate the role of autophagy in amyotrophic lateral sclerosis.
To develop a C. elegans model of amyotrophic lateral sclerosis (ALS) and to evaluate the role of autophagy in the disease. Stable transgenic worms expressing the G93A mutant form of Cu,Zn-superoxide dismutase (SOD1) in GABAergic motor neurons were generated. Axon guidance and protein aggregation in the motor neurons were observed with fluorescence microscopy. A paralysis assay was performed to evaluate the motor function of the transgenic worms. The expression of autophagic genes in daf-2(e1370) mutants was analyzed using real-time PCR. The reporter GFP::LGG-1 was used to verify whether autophagy was induced in motor neurons. Expression of G93A SOD1 in motor neurons caused age-dependent motor defects accompanied by significant SOD1 aggregation and axon guidance failure. After 12 d, over 80% of the G93A worms became paralyzed, whereas less than 10% of the controls showed a paralytic phenotype. In the daf-2(e1370) mutants of C. elegans, the levels of autophagic genes bec-1, atg-7, lgg-1, and atg-18 were upregulated by approximately 1.5-fold, the level of unc-51 increased by approximately fourfold, and autophagosomes in motor neurons was markedly increased. Crossing the daf-2(e1370) mutation into the G93A SOD1 mutant worms significantly ameliorated the motor defects, SOD1 aggregation, and axon guidance failure. G93A SOD1 expression in motor neurons of C. elegans results in characteristic alterations of ALS. Increased autophagy protects C. elegans motor neurons against the toxicity of mutant SOD1.


Fabrication of silver nanoparticles by a diethylene triamine-hyaluronic acid derivative and use as antibacterial coating.
In this work a synthetic protocol for the functionalization of hyaluronic acid with diethylenetriamine (DETA) was standardized. HA-DETA derivatives were characterized by NMR and proton carbon correlation analysis HSQC and HMBC to confirm chemical structure. A selected derivative was used to set up a green fabrication procedure for HA-DETA capped silver nanoparticles with the aim to achieve a polymeric based coating with potential application in the treatment of medical devices associated infections. Data from UV-visible spectroscopy, electron scanning and transmission microscope (STEM), photoelectric spectroscopy (XPS) and rheological characterization were combined to characterize the HA-DETA/Ag nanocomposites. HA-DETA stabilized Ag nanoparticles (10-30 nm) were obtained through an UV accelerated production. The viability of MC3T3-E1 was analyzed with the aim of designing a cytocompatible antimicrobial coating. Antibacterial and antibiofilm activity of HA-DETA/Ag nanocomposites have been tested in vitro against Staphylococcus aureus and Pseudomonas aeruginosa both in culture plates than on titanium specimens.


Clinical trials and outcome reporting in congenital diaphragmatic hernia overlook long-term health and functional outcomes-A plea for core outcomes.
To review the selection, measurement and reporting of outcomes in studies of interventions in Congenital Diaphragmatic Hernia (CDH). We searched the Cochrane Central Register of Controlled Trials from 2000-2020 for randomised trials and observational studies. Outcomes reported were classified into seven key domains modelled on the patient journey. Our search yielded 118 papers; 27 were eligible. The most frequent domains measured were 'short-term markers of disease activity' (17/27), whereas long-term outcomes (3/27) and outcomes relating to functional health status (8/27) were reported infrequently. There was heterogeneity in the methods and timing of outcome reporting. Primary outcomes were varied and not always clearly stated. Long-term health and functional outcomes involving interventional studies in CDH are infrequently reported, which hinders the process of shared decision-making and evidence-based healthcare. A CDH core outcome set is needed to standardise outcome reporting that is relevant to both families and healthcare teams.


The recognition potential: semantic processing or the detection of differences between stimuli?
The recognition potential is traditionally described as an electrical index elicited when subjects view a recognizable stimulus. Recent studies further show that it may be influenced by semantic processing. In this study, we investigated whether this observed influence is really produced by differences in semantic processing or whether it might be caused by the detection of differences between sequentially presented stimuli. In two different experiments, we systematically altered the type of background images presented while keeping the recognizable word constant. Analyses revealed that the same recognizable words elicited an RP with different amplitudes and latencies when viewed under different background conditions. Control stimuli, which were identical to background stimuli, did not elicit the RP. Hence, we postulate that when using the rapid stream stimulation paradigm, RP might also be influenced by the detection of differences between sequentially input stimuli. It is necessary to clarify whether RP changes are caused by the processing of the stimuli or by the detection of difference between successively input stimuli before any conclusion could be made.


MitoRibo-Tag Mice Provide a Tool for In Vivo Studies of Mitoribosome Composition.
Mitochondria harbor specialized ribosomes (mitoribosomes) necessary for the synthesis of key membrane proteins of the oxidative phosphorylation (OXPHOS) machinery located in the mitochondrial inner membrane. To date, no animal model exists to study mitoribosome composition and mitochondrial translation coordination in mammals in vivo. Here, we create MitoRibo-Tag mice as a tool enabling affinity purification and proteomics analyses of mitoribosomes and their interactome in different tissues. We also define the composition of an assembly intermediate formed in the absence of MTERF4, necessary for a late step in mitoribosomal biogenesis. We identify the orphan protein PUSL1, which interacts with a large subunit assembly intermediate, and demonstrate that it is an inner-membrane-associated mitochondrial matrix protein required for efficient mitochondrial translation. This work establishes MitoRibo-Tag mice as a powerful tool to study mitoribosomes in vivo, enabling future studies on the mitoribosome interactome under different physiological states, as well as in disease and aging.


Unfolding the future: Self-controlled catalytic nanomotor in healthcare system.
Nanomotors, multimetallic systems are biologically inspired self-propelled tiny engines able to perform difficult tasks of transporting cargos from one end to another in presence of hydrogen peroxide fuel. Nanomotors can revolutionize the drug delivery system at the desired target by converting chemical energy into mechanical energy. Nanomotors exhibit unique properties like moving at higher speed, self-propulsion and drilling into the complex cellular environment. The review focuses on fuel dependent and fuel-free nanomotors with their propulsion mechanism. Further, the review highlights the method of fabrication, biohybrid nanomotors, toxicities along with their application in the field of active drug delivery, diabetes, precise surgery, ischemic stroke therapy, diagnosis and treatment of coronavirus, microwave hyperthermia, zika virus detection, anti-bacterial activity, water treatment and sensing and challenges lying at the forefront in the development of these tiny nanomachines. Hydrogen peroxide is toxic to mankind; biohybrid motors give an extra edge of eliminating hydrogen peroxide as fuel for self-propulsion, this can be used for smart drug delivery by reducing toxicities as compared to artificial nanomotors. Cost-effective fabrication of nanomotors will extend their applications in commercial sector overcoming limitations like scale-up and regulatory approval. In near future, nanomotors will diversify in fields of restoring conductivity of electronic medical devices, 3D printing and theranostics.


"I wanted information": navigating breast Cancer and its treatment in Lima, Peru.
Breast cancer impacts millions of people worldwide, and in Peru, breast cancer is the most common cause of cancer related death among women. Breast cancer treatment is physically and emotionally burdensome and challenging for patients. In-depth interviews were conducted with 14 female breast cancer patients and survivors in Lima, Peru. The interviews explored four main themes: the women's emotional experiences, coping mechanisms, resources available or needed, and advice for newly diagnosed breast cancer patients. Respondents described a tremendous lack of informational support during and after diagnosis and treatment and requested more of this support from health professionals. Social support groups were helpful to participants; however, these forms of support were not available to all participants. Emotional and esteem support seemed amply received from family and friends, faith organizations, and fellow cancer patients. Participants experienced a range of emotions upon diagnosis and during treatment including fear, anxiety, difficulty accepting bodily changes, loneliness, and denial. Breast cancer and its treatment can be a long, emotional journey; more extensive forms of informational support could help patients cope with this process.


High-frame-rate echocardiography using diverging transmit beams and parallel receive beamforming.
Echocardiography is a widely used modality for diagnosis of the heart. It enables observation of the shape of the heart and estimation of global heart function based on B-mode and M-mode imaging. Subsequently, methods for estimating myocardial strain and strain rate have been developed to evaluate regional heart function. Furthermore, it has recently been shown that measurements of transmural transition of myocardial contraction/relaxation and propagation of vibration caused by closure of a heart valve would be useful for evaluation of myocardial function and viscoelasticity. However, such measurements require a frame rate much higher than that achieved by conventional ultrasonic diagnostic equipment. In the present study, a method based on parallel receive beamforming was developed to achieve high-frame-rate (over 300 Hz) echocardiography. To increase the frame rate, the number of transmits was reduced to 15 with angular intervals of 6°, and 16 receiving beams were created for each transmission to obtain the same number and density of scan lines as realized by conventional sector scanning. In addition, several transmits were compounded to obtain each scan line to reduce the differences in transmit-receive sensitivities among scan lines. The number of transmits for compounding was determined by considering the width of the transmit beam. For transmission, plane waves and diverging waves were investigated. Diverging waves showed better performance than plane waves because the widths of plane waves did not increase with the range distance from the ultrasonic probe, whereas lateral intervals of scan lines increased with range distance. The spatial resolution of the proposed method was validated using fine nylon wires. Although the widths at half-maxima of the point spread functions obtained by diverging waves were slightly larger than those obtained by conventional beamforming and parallel beamforming with plane waves, point spread functions very similar to those obtained by conventional beamforming could be realized by parallel beamforming with diverging beams and compounding. However, there was an increase in the lateral sidelobe level in the case of parallel beamforming with plane and diverging waves. Furthermore, the heart of a 23-year-old healthy male was measured. Although the contrast of the B-mode image obtained by the proposed method was degraded due to the increased sidelobe level, a frame rate of 316 Hz, much higher than that realized by conventional sector scanning of several tens of Hertz, was realized with a full lateral field of view of 90°.


Chronic Rhinosinusitis With Nasal Polyposis Treated With Dupilumab: Real-World Use and Outcomes.
Biologic medications are increasingly incorporated into chronic rhinosinusitis with nasal polyps (CRSwNP) management. However, little is known about prescribing patterns in real-world settings and how this relates to proposed international guidelines and outcomes. To characterize use patterns of dupilumab for CRSwNP better in relation to proposed guidelines and explore real-world outcomes. We used the TriNetX Web-based tool to identify patients who were prescribed dupilumab for CRSwNP. Patients prescribed dupilumab for a CRSwNP indication were included for analysis. Dupilumab initiation criteria were determined via the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020). In total, 121 patients were identified who were prescribed dupilumab for a CRSwNP indication. Of these, 86 (71%) met EPOS2020 indications for biologic initiation and 35 (29%) did not. Overall, patients had significant improvements in the 22-item SinoNasal Outcome Test scores (mean improvement of 24.3 points) and nasal polyp scores (mean improvement of 1.0 point). However, 20 patients (30%) did not show meaningful improvement in the 22-item SinoNasal Outcome Test scores. Twenty-one patients (17%) failed a previous biologic attempt. Therapy was discontinued by six patients (5%) due to side effects, and by six (5%) owing to a lack of efficacy. In our experience, patients prescribed dupilumab for CRSwNP frequently may not meet EPOS2020 Guidelines. Over 25% of those who do not meet criteria may not have CRSwNP. Overall, dupilumab use among well-selected patients appears to be safe and effective. Further real-world study of biologic use for CRSwNP will help improve its judicious use and identify populations who benefit most from biologic therapies.


The selective S-alkylation of a methionine residue in an elapid venom cardiotoxin.
1. The reaction of cardiotoxin with iodoacetamide or iodomethane at pH 3.0 afforded the corresponding methionine sulphonium derivatives. The major products were S-alkylated at Met-26 whilst the minor products were S-alkylated at both Met-24 and -26. 2. Reaction with iodoacetamide under denaturing conditions led to a reversal of the relative abundances of the two derivatives in the respective reaction mixtures. 3. The derivative S-methylated at Met-26 was about 5-fold less toxic than the parent cardiotoxin. That derivatised at both Met-24 and -26 was non-toxic, indicating the importance of Met-24. 4. The results are discussed in the light of a structural model, previous chemical modifications and 1H-NMR data. It appeared that Met-24 is important for the integrity of an important structural feature of cardiotoxin.


Role of the glutaredoxin domain and FAD in the stabilization of thioredoxin glutathione reductase.
Thioredoxin glutathione reductase (TGRsec) is a multi-domain flavoprotein that plays a principal role in redox homeostasis maintenance. We have previously demonstrated the role of selenocysteine in maintaining TGRsec structure-function, but the role of the glutaredoxin (Grx) domain and FAD is still unclear. In the present study, the urea-induced unfolding of recombinant Fasciola gigantica TGRsec (FgTGRsec) and its N-terminal truncated variant (ΔNTD-FgTGRsec) were examined to understand the role of the Grx domain and FAD in the stabilization of FgTGRsec and ΔNTD-FgTGRsec. Our results showed that both proteins underwent unfolding in a three state manner. First, the protein undergoes a conformational transition rendering a near-native state with no FAD bound, and then full unfolding of the apo-dimer occurs without dissociation. The Grx domain stabilized the global FgTGRsec structure and positively regulated FgTGRsec activity, and alteration in the FAD microenvironment was directly proportional to the loss of thioredoxin reductase (TrxR) and glutathione reductase activities. Based on these results, we concluded that the Grx domain stabilizes the full-length FgTGRsec protein for efficient catalysis. Thus, we suggest that in platyhelminth parasites, during evolution, the Grx domain merged with the TrxR domain to confer higher catalytic activity and provide additional structural stability to the full-length TGR.


The use of allograft. Techniques and results.
There are several advantages to allograft use for ACL reconstruction. Bone-patella, tendon-bone, and achilles tendon allografts are routinely used. The one-incision endoscopic technique is described. Very few comparative studies exist in the current literature, but clinical results with allograft tissues appear to be similar to those of autograft use.


Comparative analysis and distribution of pP9014, a novel drug resistance IncP-1 plasmid from Photobacterium damselae subsp. piscicida.
Photobacterium damselae subsp. piscicida, a causative agent of pseudotuberculosis, often harbours resistance plasmids (R plasmids) that facilitate horizontal gene transfer of drug resistance genes. R plasmid pP9014 was isolated from P. damselae subsp. piscicida and its complete nucleotide sequence was determined using Next Generation Sequencing technology. A protein network analysis was conducted to determine the relatedness of protein coding sequences, and ClustalW was used for the full nucleotide sequences. The occurrence of pP9014-like plasmids compared with pP99-018-like plasmids in a specific region was determined using probes for their transfer regions. pP9014 is 55851bp long with an overall GC content of 44.4% encoding 61 open reading frames (ORFs) including antimicrobial resistance genes and two conjugative transfer regions (Tra and Trb). The backbone showed highest similarity to Marinobacter adhaerens pHP-42 and Methylophaga sp. JAM7. pP9014 is similar to several IncP plasmids but forms a different subgroup. pP9014 is a unique plasmid in P. damselae subsp. piscicida and was not commonly found in drug-resistant P. damselae subsp. piscicida isolated from different areas and years in Japan. Plasmids similar to the previously reported pP99-018 are more widely distributed. This rarity suggests that plasmids similar to pP99-018 are more compatible with γ-proteobacteria. pP9014 is the first reported IncP-1 plasmid from fish pathogens. Its similarity to other IncP plasmids isolated from soil and human pathogens suggests that plasmids of the IncP-1 incompatibility group are vectors for the transfer of drug resistance genes among diverse environments.


Association of hepatitis B virus mutations in basal core promoter and precore regions with severity of liver disease: an investigation of 793 Chinese patients with mild and severe chronic hepatitis B and acute-on-chronic liver failure.
To investigate the features of hepatitis B virus (HBV) basal core promoter/precore (BCP/PC) mutations and genotypes in a large number of mild/severe chronic hepatitis B (CHB-M/CHB-S), and acute-on-chronic liver failure (ACLF) patients and analyze the clinical implications of the virologic features. Sera of 793 (325 CHB-M, 170 CHB-S, and 298 ACLF) patients admitted to or who had visited Beijing 302 Hospital from January 2005 to December 2008 were collected and successfully amplified for the HBV BCP/PC and a 1225-bp-long S/Pol (nt 54-1278) gene regions. Biochemical and serological parameters and HBV DNA level were routinely performed. Viral DNA was extracted and subjected to a nested PCR. Genotypes/subgenotypes were determined based on complete genomic sequence or on analysis of the 1225-bp-long S/Pol-gene sequence. HBV genotyping was performed by direct PCR sequencing followed by molecular evolutionary analysis of the viral sequences. A P value of <0.05 (two-sided) was considered to be statistically significant. Our findings suggest that CHB patients infected with BCP/PC mutant viruses are more susceptible to severe hepatitis and ACLF than those with the BCP/PC wild-type virus and that ACLF patients with PC mutant viruses have an increased risk of death. As such, the HBV PC mutation is a potential predictive indicator of ACLF outcome.


A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial.
Randomised controlled trial. To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. Bangladesh. A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.


Metabolism of methaqualone in geriatric patients.
The urinary excretion of five C-monohydroxy metabolites and the N-oxide of methaqualone has been measured in a group of eleven geriatric patients aged 71--90 years. The total excretion of the six metabolites in 24 h after the oral administration of a single dose was approximately one-half of that in a group of young healthy adults. The relative importance of the six metabolites was 4'-hydroxy greater than N-oxide greater than 2'-hydroxymethyl = 3'-hydroxy greater than 6-hydroxy = 2-hydroxymethyl which was the same order as that in young adults. The ratio of C-to N-oxidation was also the same in the two groups. There was no impairment of conjugation of the C-hydroxy metabolites with glucuronic acid in the geriatric group but there was greater interindividual variation in metabolite excretion. There was also evidence for delayed metabolism in the geriatric patients.


Multi-modal volume registration by maximization of mutual information.
A new information-theoretic approach is presented for finding the registration of volumetric medical images of differing modalities. Registration is achieved by adjustment of the relative position and orientation until the mutual information between the images is maximized. In our derivation of the registration procedure, few assumptions are made about the nature of the imaging process. As a result the algorithms are quite general and can foreseeably be used with a wide variety of imaging devices. This approach works directly with image data; no pre-processing or segmentation is required. This technique is, however, more flexible and robust than other intensity-based techniques like correlation. Additionally, it has an efficient implementation that is based on stochastic approximation. Experiments are presented that demonstrate the approach registering magnetic resonance (MR) images with computed tomography (CT) images, and with positron-emission tomography (PET) images. Surgical applications of the registration method are described.


Evidence that angiotensin-(1-7) is an intermediate of gonadotrophin-induced oocyte maturation in the rat preovulatory follicle.
Several studies have shown the presence of components of the renin-angiotensin system in mammalian ovaries and their involvement in ovarian physiology. We have previously shown the presence of angiotensin-(1-7) [Ang-(1-7)], an important biologically active component of the renin-angiotensin system, and its receptor, Mas, in rat, rabbit and human ovaries. We have also shown the involvement of Ang-(1-7) in the rabbit ovulatory process in vitro. In the present study, we observed that Ang-(1-7) stimulated the resumption of meiosis in oocytes of rat preovulatory follicles, reaching more than 30% of oocytes with germinal vesicle breakdown. The specific antagonist of the Mas receptor, A-779, inhibited the germinal vesicle breakdown induced by Ang-(1-7) and reduced the oocyte maturation stimulated by luteinizing hormone (LH). Immunohistochemistry showed that LH increased both Ang-(1-7) and angiotensin-converting enzyme 2 (ACE2) staining in preovulatory follicles. The effect of gonadotrophins on mRNA expression of Mas and ACE2 in ovaries of immature equine chorionic gonadotrophin-primed rats was analysed by real-time PCR after 6 h of human chorionic gonadotrophin (hCG) injection, which exhibits LH-like effects. After hCG treatment, ACE2 mRNA expression was higher in the ovaries of treated rats than in the ovaries of control rats, whereas Mas mRNA levels were unchanged. A-779 changed the steroidogenesis stimulated by LH. An increased testosterone concentration and decreased progesterone levels were measured in the follicle medium. In conclusion, our results suggest that LH upregulates the ACE2-Ang-(1-7)-Mas axis and that Ang-(1-7) promotes meiotic resumption, possibly as a gonadotrophin intermediate.


Drip fertigation sustains crop productivity while mitigating reactive nitrogen losses in Chinese agricultural systems: Evidence from a meta-analysis.
Drip fertigation can synchronize the supply of nutrients and water for crop demand, offering the potential for minimizing negative environmental impacts and sustaining crop productivity. However, there are no comprehensive evaluations on performances of drip fertigation on environmental nitrogen (N) losses and crop productivity, nationwide. Here, a meta-analysis was performed to quantify overall effects of drip fertigation on N losses and crop productivity in Chinese agricultural systems based on 443 observations from 42 field studies. The results showed that drip fertigation significantly increased crop yields by 9.8 % and slightly increased soil NO emission by 13.9 % compared to the traditional irrigation and fertilization practices (e.g. flooding/furrow irrigation and N broadcasting), while significantly decreasing NH3 volatilization by 14.2 %, soil N2O emission by 28.1 % and NO3--N leaching loss by 71.2 %. There were significant mitigation potentials of environmental N losses by drip fertigation for cereal cropping systems, not for horticultural crops in terms of soil NO emission and not for cotton in terms of NH3 volatilization. Non significant promotion effect on NO emission and significant reduction effects on the other all kinds of environmental N losses by drip fertigation were observed for alkaline soils (pH > 7.3) and coarse-textured soils. In addition, the use of different fertilizer sources and/or soil amendments have shown in popularity as strategies to offset the negative feedback associated with agricultural N losses, no direct synthetic result was shown in drip-fertigated soils. We synthesized 19 studies so as to assess the potential mitigation options for further minimizing N losses in drip fertigation systems, which suggested that deleterious environmental pollution could be further reduced while still achieving high crop yields with a combination of enhanced-efficiency fertilizers (e.g. nitrification or urease inhibitors) or soil amendments (e.g. biochar or straw) to drip fertigation systems.


Outcomes of ileocolic resection and right hemicolectomies for Crohn's patients in comparison with non-Crohn's patients and the impact of perioperative immunosuppressive therapy with biologics and steroids on inpatient complications.
The purpose of this study was to compare medication use and complication rates between Crohn's disease (CD) and non-CD patients undergoing ileocolic resections and right hemicolectomies. A review of patients who underwent ileocolic resections and right hemicolectomies from January 1, 2003, through December 31, 2010, was performed. Data collected included demographics and clinical information, biologics use (eg, infliximab, adalimumab), other medication use (eg, steroids), complications, and mortality. There were 791 records reviewed, with 93 CD patients. There was no significant difference in major or minor complications, anastomotic leaks, operating room time, or postoperative ileus occurrence between the CD and non-CD groups (P > .05). Use of biologics and steroids were significantly higher among the CD patients. Mortality, age, and American Society of Anesthesiologists score were significantly higher in the non-CD group. Ileocolic resections and right hemicolectomies in CD patients are not associated with an increase in complication rates even when the patients use steroids and biologics in the preoperative period.


Surgical enucleation for the treatment of renal tumors.
We analyzed our institutional experience with surgical enucleation for the primary treatment of small renal tumors. Patient demographics, histological features, effect of different types of vascular control and outcome from surgery were analyzed in 45 patients. A majority of the tumors (67%) were diagnosed incidentally. All were stage T(1), 77% were low grade (I-II) and 23% were high grade (III-IV). Complication occurred in 12% of patients. At a mean follow-up of 34 months (range 7-97), 28 of 33 patients (84%) with malignant tumors were alive without evidence of disease. One patient with a solitary kidney developed recurrent tumor after enucleation that required nephrectomy. Mean operative time was significantly lower with the compression technique versus direct vascular control (164 +/- 12 min vs. 233 +/- 15 min, p = 0.002). There were no differences in outcome between the two techniques. Surgical enucleation is a safe and viable procedure for the treatment of small renal tumors. Manual compression of the kidney appears to be at least as effective as clamping of the renal vessels in obtaining vascular control during the procedure and is more expeditious.


Enhanced photodegradation of pentachlorophenol by single and mixed cationic and nonionic surfactants.
The photocatalytic degradation of pentachlorophenol (PCP) using a TiO(2) catalyst in a surfactant-containing system was investigated. PCP abatement by photocatalysis was significantly enhanced by the addition of cationic and nonionic surfactants, both single and mixed, at appropriate concentrations. The enhanced photodegradation can be mainly attributed to the formation of admicelles on the TiO(2) surface. This phenomenon can lead to the incorporation of more PCP, thereby providing TiO(2) with remarkably higher capture rates for target pollutants. Hence, PCP was rendered easily available to photo-yielded oxidative radicals on the catalyst surface. Notably, mixed cationic-nonionic surfactants yielded much higher photodegradation efficiencies than the corresponding single surfactants, indicating the existence of a synergistic effect in the complex system. The adsorption behavior of PCP on TiO(2) in the surfactant solutions was investigated to elucidate this synergism. Fourier-transform infrared (FTIR) spectroscopy was adopted to gain insight into the structural changes induced by the surfactants and a better understanding of the surfactant-assisted photocatalytic degradation mechanism was obtained.


Altered agonist-activated 86Rb+ efflux from arteries in canine renal hypertension.
Basal rate constants for 86Rb+ efflux from renal arteries of renal hypertensive dogs were lower than those of control animals whereas no differences were found for coronary arteries. Norepinephrine produced parallel increases in efflux rate constants for hypertensive and control renal arteries, but serotonin produced smaller responses in hypertensive compared to control coronary arteries.


X-ray diffraction analysis of transversal osteonic lamellae.
When isolated osteon samples are submitted to wide-angle X-ray diffraction, it is not possible to detect any preferential orientation of the hydroxyapatite crystallites of the lamellae with transversally arranged fiber bundles. So a complete and exhaustive X-ray diffraction analysis of an osteon needs adequately prepared osteonic subunits. For the present investigation, 2 types of samples were prepared from longitudinal and alternate osteons: osteonic radial sections and isolated straightened transversal lamellae. An X-ray diffraction microcamera has been used with a rotating anode X-ray generator. In accordance with the data provided by the polarizing microscope, the orientation of crystallites runs parallel to the osteon axis in longitudinally structured osteons, whereas in alternate osteons the orientation changes by about 90 degrees in successive lamellae. Neither crystallites associated with the collagen fibrils that run alongside the osteocyte canaliculi nor those associated with the fibrils that run transversally in longitudinally structured osteons are revealed by X-ray diffraction, because there are so few of them.


Motor innervation of the striated oesophagus muscle. Part 1. Intramural distribution of the right and left vagus nerve in the rat oesophagus as revealed by the glycogen depletion technique.
The muscularis propria of the rat oesophagus is entirely made up of striated muscle fibres. All fibres are of the same histochemical type, which is characterized by high activity of actomyosin ATPase, medium activity of oxidative enzymes and relatively strong reaction for phosphorylase. Prolonged stimulation (10 Hz, 30 min) of the vagus nerves causes depletion of the glycogen content of the oesophageal muscle fibres. This stimulation effect can be visualized by means of the PAS technique as well as by the histochemical reaction for phosphorylase. In 8 animals the right and in 8 animals the left vagus nerve were stimulated repetitively and the stimulated muscle fibres were identified in transverse sections of the oesophagi, stained for phosphorylase. The muscle fibres supplied by one vagus nerve are distributed all over the circumference of the oesophagus. In the upper third of the oesophagus stimulation of either vagus nerve depletes slightly less than 50% of the muscle fibres, whereas in the lower two-thirds the right vagus nerve seems to predominate to a certain degree. In 3 animals both vagus nerves were stimulated simultaneously. Bilateral stimulation produced a very extensive depletion. Only a few muscle fibres remained unaffected. Functional implications of the results, the question of polyneuronal innervation and the role of the myenteric plexus are discussed.


Emerging viruses in blood transfusion.
The development of new technologies leads to the discovery of new viruses. For each of these new infectious agents relevance to transfusion needs to be assessed. The questions to be answered are transmissibility by transfusion, pathogenicity, prevalence in blood donors, persistence and the availability of screening assays. Since 1995, four new viruses have been identified and for three of them extensive studies have been carried out. GBV-C/HGV and TTV were both initially thought to be related to post-transfusion hepatitis but neither were proven to be in any way related to hepatitis and are still in search of a disease. HHV-8 is a major factor in the pathogenesis of Kaposi's sarcoma and other tumours related to immunodeficiency. HHV-8 transmission by organ transplantation but not by transfusion has been demonstrated. SEN-V has been claimed as a potential cause of non-A-E hepatitis but no data has been published. To date, none of the emerging viruses have been proven relevant to transfusion.


Maternal mortality in India: a 20-year study from a large referral medical college hospital, West Bengal.
The present study was carried out to analyze the maternal death rate and its changing trends over a 20-year period in a large referral/teaching institution in Eastern India. A retrospective analysis of maternal deaths was carried out from January 1986 to December 2005 at the Department of Obstetrics and Gynaecology, R. G. Kar Medical College and Hospital, Kolkata, India. Records were divided into four 5-yearly periods: 1986-1990; 1991-1995; 1996-2000; and 2001-2005, for comparison of the trends. The initial interval from 1986 to 1990 was chosen as the reference period. The cumulative maternal mortality ratio (MMR) was 599.3 per 100 000 live births. Comparison between the first 5-year period (1986-1991) and the last (2001-2005) showed a statistical significant downward trend in MMR (683.6 vs 474.3; P < 0.001). Deaths due to direct causes are still the leading cause, accounting for 82.09% of total deaths. Hypertensive disorders (36.14%), hemorrhage (21.91%) and sepsis (19.54%) were still the major causes of direct obstetric deaths throughout the study period. Hypertensive disorders alone showed a substantial decline after the introduction of magnesium sulphate. The fall in maternal mortality has been very slow.


Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris.
To compare the clinical efficacy and safety of combining flumetasone ointment with 308-nm excimer laser therapy vs. 308-nm excimer laser monotherapy for the treatment of psoriasis vulgaris. Forty patients with psoriasis vulgaris were recruited; 20 were treated with flumetasone ointment plus 308-nm excimer laser therapy, and the other 20 received only excimer laser monotherapy. The flumetasone ointment was applied topically twice a day, and laser treatments were scheduled twice weekly for a total of 10 treatments. Clinical efficacy was evaluated in a blinded manner by two independent physicians using photographs taken before and after treatment. Of the 40 patients who received and completed the entire course of therapy, the psoriasis area and severity index score was improved by 82.51 ± 11.24% and 72.01 ± 20.94% in the combination group and laser group, respectively (P > 0.05), and the average cumulative dose was 5.06 ± 2.20 j/cm(2) in the combination group and 7.75 ± 2.25 j/cm(2) in the laser-only group, respectively (P < 0.05). The clinical data suggest that combination treatment using flumetasone ointment and a 308-nm excimer laser is superior to laser monotherapy for treatment of psoriasis vulgaris. The combination therapy can increase effectiveness and decrease the total laser dose, thus potentially reducing side effects.


Restless Legs Syndrome and fatigue in multiple sclerosis: A cross-sectional clinical study.
Restless Legs Syndrome is a sleep-related sensorimotor disorder with a higher prevalence in Multiple Sclerosis (MS) patients than in the general population. Our aim was to determine the prevalence of RLS in a group of relapsing-remittent multiple sclerosis (RRMS) patients, and to investigate whether RLS is associated with MS-related disability, sleep quality, mood disorders and fatigue. In this retrospective, mono-centric, observational study, 92 RRMS patients were recruited (median age 46.5 years, 68.5% female patients). Data on MS clinical and radiological variables were collected. Patients underwent a subjective evaluation with standardized questionnaires on sleep fatigue and mood, which were evaluated by an expert neurologists specialized in sleep disorders about the occurrence of RLS. Prevalence of RLS in our sample was of 47.8%. Patients with RLS had a significantly higher rate of worse sleep quality and fatigue, compared to non RLS subjects (respectively 56.8% vs. 35.4%, p=0.04 and 54.4% vs 22.7%, p=0.002). Univariate analysis showed that RLS was significantly more frequent in fatigued patients (66.7% vs 38.5% RLS- patients, p=0.009). Multivariate analysis showed that fatigue correlated with MS-related disability (OR 1.556, p=0.011), poor sleep quality (OR 1.192, p 0.036), and mood disorders (OR 1.096, p 0.046). RLS appears to independently increase the risk of fatigue of 50%, without reaching clear statistical significance (OR 1.572, p 0,0079). Our study confirms the high prevalence of RLS in patients with multiple sclerosis and highlights the potential impact of RLS on fatigue and its strict interaction with sleep quality.


Severe Edema and Venous Congestion Following Sphenoorbital Meningioma Resection in a Meningiomatosis Case: Importance of Predicting Venous Disturbances.
To achieve local disease control, radical removal is the best option for sphenoorbital meningiomas. Preservation of the venous system is crucial during the resection of skull base meningiomas. This vascular injury represents a major risk both for life and neurologic function. We present a case of a severe postoperative frontotemporal venous disturbance and cerebral edema following the radical removal of a giant sphenoorbital meningioma in a patient with meningiomatosis and occlusion of the superior sagittal sinus. The anatomical, radiologic, and surgical aspects are reviewed and discussed, with the aim of preventing such a serious complication.


Malignant triton tumor in a patient with neurofibromatosis type 1.
We report a case of neurofibromatosis type 1 (NF1) complicated by a malignant triton tumor (MTT), with an emphasis on B-mode sonographic (US) and contrast-enhanced US (CEUS) findings. To the best of our knowledge, this is the first report describing CEUS findings of MTT. The mass was poorly demarcated and composed of an internal echogenic area and an outer hypoechoic zone. CEUS findings showed the outer zone to be strongly enhanced, and the internal area was very poor in blood flow because of necrotic tissues.


Stability and aerodynamic behaviour of glucocorticoid particles prepared by a supercritical fluids process.
Particle processing techniques using supercritical fluids (SF) are potential alternative technologies to design particles for inhalation. Powders of budesonide and flunisolide were prepared using solution enhanced dispersion by supercritical fluids (SEDS) process. The aim was to determine thermodynamic stability of different polymorphs of flunisolide including new forms from SEDS technology and to characterise micronised and SEDS produced powders of budesonide and flunisolide for their suitability as inhalation powders. Acetone and methanol solutions of budesonide and flunisolide, with a concentration of 2.5 mg/ml, were used for the particle preparation. The pressure was 100 bar and temperatures were 60 degrees C or 80 degrees C. The flow rates of CO(2) and drug solution were 9 ml/min and 0.3 ml/min, respectively. Chemical purity of different polymorphs of flunisolide was estimated using high performance liquid chromatography (HPLC) and thermal behaviour was determined using differential scanning calorimetry (DSC). Particle morphology and surface examination were performed using scanning electron microscopy (SEM) and atomic force microscopy (AFM), respectively. The particle size distribution and density of the powders were determined with the help of Coulter Counter and helium pycnometer respectively. The in vitro deposition of the powders was studied using multistage liquid impinger (MLI). From the stability study, it was found that the two forms of flunisolide, polymorphs II and hemihydrate, were the most stable. Flunisolide form III was transformed to hemihydrate during the stability study. The chemical purity of the material was increased after SEDS processing. SEDS produced powders of budesonide and flunisolide form III from acetone showed narrow volumetric particle size distributions with 90% of the particles below 4 microm and geometric mean size around 3 microm. However, in the MLI study, budesonide powder obtained from SEDS with acetone showed favorable deposition in the lower stages with a mass median aerodynamic diameter (MMAD) of around 3 microm whilst the flunisolide form III was preferentially deposited in the higher stages of the MLI with MMAD of over 5 microm, due to aggregation of the particles. Particles of budesonide and flunisolide, in the size range, suitable for inhalation, were reproducibly produced using SEDS.


Postoperative acute kidney injury after thoracic endovascular aortic repair for acute type B aortic dissection.
Thoracic endovascular aortic repair (TEVAR) has evolved as the standard for treating complicated acute type B aortic dissection (ATBAD). Acute kidney injury (AKI) is a common complication in critically ill patients and is commonly observed in patients with ATBAD. The purpose of the study was to characterize AKI after TEVAR. All patients who underwent TEVAR for ATBAD from 2011 through 2021 were identified using the International Registry of Acute Aortic Dissection. The primary end point was AKI. A generalized linear model analysis was performed to identify a factor associated with postoperative AKI. A total of 630 patients presented with ATBAD and underwent TEVAR. The indication for TEVAR was complicated ATBAD in 64.3%, high-risk uncomplicated ATBAD in 27.6%, and uncomplicated ATBAD in 8.1%. Of 630 patients, 102 (16.2%) developed postoperative AKI (AKI group) and 528 patients (83.8%) did not (non-AKI group). The most common indication for TEVAR was malperfusion (37.5%). In-hospital mortality was significantly higher in the AKI group (18.6% vs 4%; P < .001). Postoperatively, cerebrovascular accident, spinal cord ischemia, limb ischemia, and prolonged ventilation were more commonly observed in the AKI group. The expected mortality was similar at 2 years between the two groups (P = .51). Overall, the preoperative AKI was observed in 95 (15.7%) in the entire cohort consisting of 60 (64.5%) in the AKI group and 35 (6.8%) in the non-AKI group. A history of CKD (odds ratio, 4.6; 95% confidence interval, 1.5-14.1; P = .01) and preoperative AKI (odds ratio, 24.1; 95% confidence interval, 10.6-55.0; P < .001) were independently associated with postoperative AKI. The incidence of postoperative AKI was 16.2% in patients undergoing TEVAR for ATBAD. Patients with postoperative AKI had a higher rate of in-hospital morbidities and mortality than those without. A history of CKD and preoperative AKI were independently associated with postoperative AKI.


Long-Term Outcome of Cardiac Denervation Procedures: The Anatomically Guided Septal Approach.
Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker. The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation. This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted. Ablation endpoints were: 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 ± 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed. The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up.


Neuronal localization of pseudocholinesterase in the rat cerebellum: sagittal bands of Purkinje cells in the nodulus and uvula.
The histochemical distribution of pseudocholinesterase was studied in the rat cerebellum using Koelle's copper-thiocholine method. Throughout the cerebellum, pseudocholinesterase is uniformly localized in the endothelial cells of blood vessels and in the cell bodies and processes of the Bergmann glia. In addition, we demonstrate that exclusively in the ventral uvula and in the nodulus (lobules IXc and X of Larsell) pseudocholinesterase is localized in a small subpopulation of Purkinje cells. The cell bodies and dendrites of these labeled Purkinje cells form at least 4 distinct parallel bands extending along the sagittal plane of each of the lobules. Two broad bands on either side of the midline, approximately 800-900 microns wide and composed of 15-20 Purkinje cells have been designated as A bands. Two narrower bands, approximately 160-300 microns wide and composed of 5-7 Purkinje cells, on the lateral aspects of the lobules have been designated as B bands. The unique distribution of pseudocholinesterase in a small and anatomically restricted population of neurons suggests that in the cerebellum this enzyme may play a role in the metabolism of neuroactive substances.


Impact of wind turbine sound on general health, sleep disturbance and annoyance of workers: a pilot- study in Manjil wind farm, Iran.
The wind turbine's sound seems to have a proportional effect on health of people living near to wind farms. This study aimed to investigate the effect of noise emitted from wind turbines on general health, sleep and annoyance among workers of manjil wind farm, Iran. A total number of 53 workers took part in this study. Based on the type of job, they were categorized into three groups of maintenance, security and office staff. The persons' exposure at each job-related group was measured by eight-hour equivalent sound level (LAeq, 8 h). A Noise annoyance scale, Epworth sleepiness scale and 28-item general health questionnaire was used for gathering data from workers. The data were analyzed through Multivariate Analysis of variance (MANOVA) test, Pillai's Trace test, Paired comparisons analysis and Multivariate regression test were used in the R software. The results showed that, response variables (annoyance, sleep disturbance and health) were significantly different between job groups. The results also indicated that sleep disturbance as well as noise exposure had a significant effect on general health. Noise annoyance and distance from wind turbines could significantly explain about 44.5 and 34.2 % of the variance in sleep disturbance and worker's general health, respectively. General health was significantly different in different age groups while age had no significant impact on sleep disturbance. The results were reverse for distance because it had no significant impact on health, but sleep disturbance was significantly affected. We came to this conclusion that wind turbines noise can directly impact on annoyance, sleep and health. This type of energy generation can have potential health risks for wind farm workers. However, further research is needed to confirm the results of this study.


Considering theory in assessing quality of web-based courses.
There are significant implications to jumping on the Internet-course bandwagon, and several questions should be answered before offering or enrolling in such a course. This article provides information on how quality has been assessed with online education, reviews the theoretical framework used in conducting such research, and provides a recommendation on which theory is most promising in evaluating the quality of Internet courses.


[Nursing consultations in pain assessment and treatment facilities].
The concept of nursing consultation takes on its full meaning with people suffering from chronic pain. The Société française d'étude et de traitement de la douleur (French Society for the Study and Treatment of Pain), and more specifically its professional nursing commission, has drawn up a reference framework of consultation activities on which pain resource nurses (PRNs) can draw. This describes the various stages in the management of chronic pain patients. In view of the needs and expectations expressed by the population in terms of care, the PRN function is likely to evolve towards that of advanced practice nurse.


Acute Hepatitis E Viral Infection in Pregnancy and Maternal Morbidity.
To determine the maternal morbidity in pregnant women with acute hepatitis E viral infection. Observational, cross-sectional study. Departments of Obstetrics and Gynaecology and Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Red Crescent General Hospital and Saint Elizabeth Hospital, Hyderabad, from January 2011 to December 2013. The study population was pregnant women with acute hepatitis E infection confirmed by ELIZA technique. Pregnant women with other hepatic viral infections were excluded. All medical and obstetric conditions, and mortality were noted on the predesigned proforma. Out of the total 45 admitted pregnant women with hepatitis E viral infection, 22 women (48.9%) had severe morbidity. The most common were hepatic coma in 8 (36.36%) cases and disseminated intravascular coagulation in 14 (63.63%) cases. Highest mortality rate was seen in women with hepatic coma (100%), while in those with disseminated intravascular coagulation, one out of the 14 cases (7.14%) died. The acute viral hepatitis E infection in pregnant women is associated with maternal morbidities and high mortality rate.


An overview of non-invasive imaging modalities for diagnosis of solid and cystic renal lesions.
Renal imaging is an essential investigative tool and preliminary task for determining a suitable sanative option for the treatment of kidney cancer. In recent decades, with the increasing usage of abdominal imaging, there is an upsurge in the number of adrenal incidentalomas. Among these accidentally revealed lesions, most of them are complex that warrant immediate aggressive treatment planning due to their malignant potential. The guidelines given by the American Urological Association (AUA), American College of Radiology (ACR), and European Association of Urology (EAU) vary concerning the use of ideal preliminary imaging modality to investigate the patients with suspected flank pain, hematuria, or palpable mass in the abdomen. Initially, an effort has been made to discriminate cystic and solid renal lesions which are helpful in separating benign and malignant nature as different imaging patterns are observed on distinct imaging modalities for solid and cystic renal lesions. Various attempts have been made to improve the accuracy of cancer diagnosis by employing different imaging modalities. The primary aim of this article is to study the capabilities of different imaging techniques for detecting and differentiating solid and cystic lesions to facilitate treatment planning based on computed tomography (CT), ultrasonography (US), magnetic resonance imaging (MRI), positron emission tomography (PET), and optical coherence tomography (OCT). Further, the advantages, disadvantages, new advancements, and future scope of each of the imaging modality have also been highlighted so that one can make a correct choice of imaging technique for diagnosis of a specific type of lesion. Additionally, some recommendations have also been mentioned by listing the requirements for the perfect imaging modality. Graphical abstract.


Illustrated glossary for spinal anatomy. With explanations and a French and German translation.
The authors define, explain, and illustrate a number of concepts pertaining to normal spinal anatomy that are of practical use but omitted in standard anatomical sources or are the subject of conflicting views: bony and cartilaginous end-plate, marginal ring, cortex of the vertebral body, isthmus, neurocentral junction, uncus, uncovertebral joint, zygapophyseal joint, annulus fibrosus, shorter and longer perivertebral ligaments, interspinous bursa, mamillo-accessory ligament. A French and German translation of recommended terms is provided as well.


An anti-p24 monoclonal antibody shows cross-reactivity with multiple HIV-1 proteins.
We produced three murine monoclonal antibodies (mAbs) against the HIV-1 proteins. These three mAbs, namely CA-1, CA-2, CA-4, were IgG1 and all reacted with p24 on the HIV-1 Western blot. One of the mAbs, CA-4, also recognized p13, p21, p28, p29, p32, p39, p47, p55 on the Biotech/Du Pont HIV-1 Western blot strips and p21, p24, p28, p29, p39, p47, p55, p68, p80, p96; p110 on the Bio-Rad strips. CA-4 did not react with H-9 cell lysate nor with other retroviral antigens such as HTLV-1 or HIV-2 proteins. The binding of CA-4 to HIV-1 proteins was not blocked by deglycosylation. All three mAbs reacted with recombinant DNA derived capsid protein (p24) of HIV-1. These results suggest that many proteins in the HIV-1 Western blot contain antigenic epitope(s) similar to that of p24.


Antibacterial kaneoheoic acids A-F from a Hawaiian fungus Fusarium sp. FM701.
Alarming rate of resistance to the existing antibiotics exhibits the importance of developing new antibiotic molecules from relatively under explored sources as well as implementing alternative approaches like antibiotic adjuvants. Six previously undescribed fungal polyketides, kaneoheoic acids A-F (1-6) were isolated from a fungal strain Fusarium sp. FM701 which was collected from a muddy sample of Hawaiian beach. The structures of these six compounds were elucidated by spectroscopic interpretation, including HRESIMS and NMR, and electronic circular dichroism (ECD) analysis. All six compounds that were inactive when tested alone showed significant antibacterial activity against Staphylococcus aureus and Bacillus subtilis, in the range of 10-80 μg/mL when assayed in combination with either chloramphenicol (half of the MIC, 1 μg/mL), an FDA approved antibiotic or disulfiram (6 μg/mL), an established antibiotic adjuvant that augmented the activity of antibiotics.


Aseptic meningitis associated with intravenous administration of dexchlorpheniramine.
Drug-induced aseptic meningitis has been reported mainly with the use of nonsteroidal anti-inflammatory drugs, antibiotics, intravenous immunoglobulins and OKT3 antibodies. We describe today a very unusual reaction on intravenous dexchlorpheniramine with this case of aseptic meningitis.


The Two-Step Allogeneic Stem Cell Transplantation Approach Results in Rapid Engraftment and Excellent Outcomes in Patients with Lymphoid Malignancies.
The 2-step graft engineering approach has been the main platform for allogeneic hematopoietic cell transplantation (allo-HCT) at Thomas Jefferson University since 2005. We have previously described separating donor lymphocyte infusion followed by cyclophosphamide for bidirectional tolerization from CD34-selected hematopoietic grafts in haploidentical and matched related donors. Here we analyzed 60 patients with high-risk lymphoid malignancies who underwent a 2-step allo-HCT between 2008 and 2020. The majority of patients received haploidentical stem cell grafts (82%), and 20% of patients received matched related donor stem cell grafts. The patients underwent allo-HCT for diffuse large C cell lymphoma (n = 17; 28%), chronic lymphoblastic leukemia (n = 10; 17%), follicular lymphoma (n = 8; 13%), and Hodgkin lymphoma (n = 7; 12%). Eight patients (13%) had received prior high-dose chemotherapy. Thirty patients (50%) had a Hematopoietic Cell Transplantation Comorbidity Index ≥3, and 20 patients (33%) had a Center for International Blood & Marrow Transplant Research Revised Disease Risk Index of high risk or very high risk. The median patient age was 56 years (range, 24 to 75 years). Neutrophils engrafted at a median of 11 days (range, 9 to 16 days), and platelets engrafted at a median of 16 days (range, 13 to 37 days). With a median follow-up of 6 years, the 3-year probability of overall survival was 62.9% (95% confidence interval [CI], 49.3% to 73.8%), and that of disease-free survival was 60.2% (95% CI, 46.4% to 71.6%). The cumulative incidence of relapse at 3 years was 11.9% (95% CI, 5.2% to 21.6%). The cumulative incidence of nonrelapse mortality at 3 years was 30.1% (95% CI, 1.91% to 42.0%). The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) at 1 year was 45% (95% CI, 32.2% to 57.0%), and that of grade III-IV acute GVHD at 1 year was 5% (95% CI, 1.3% to 12.6%). The cumulative incidence of cGVHD at 3 years was 15.2% (95% CI, 7.5% to 25.4%). The 2-step approach achieved excellent outcomes in high-risk lymphoid malignancies, with rapid neutrophil and platelet recovery.


Binding of FITC-coupled peanut-agglutinin (FITC-PNA) to embryonic chicken retinas reveals developmental spatio-temporal patterns.
FITC-labeled peanut agglutinin (PNA), a lectin from peanut (Arachis hypogaea) which binds specifically to D-galactose, was used as a probe to trace the distribution of PNA-lectin receptors during early development of chick retina. We found that specific fluorescence within the inner plexiform layer (IPL) and the outer plexiform layer (OPL) appears at different developmental stages. The specific fluorescence of the IPL first appears near the central area of the ventro-posterior quadrant of the 7-day retina, then extends progressively towards the periphery, reaching the ora serrata earlier on the posterior than on the anterior side. The development of the specific fluorescence of the OPL follows the same scheme, but it appears later (starting at day 9) than that of the IPL and it is less pronounced. The spatio-temporal patterns of the expression of the lectin receptors show relationships to those of withdrawal of proliferating cells from mitosis, and of other events related to differentiation.


A systems approach to planning large-scale, integrated health care facilities.
This paper presents an overview of a systems approach being implemented within the Kaiser-Permanente Medical Care Program (KPMCP) for the planning of large-scale, integrated health care facilities. This approach was motivated by the increasing change and complexity of factors, both external and internal to KPMCP, that now require more systematic treatment and that before were handled by more intuitive approaches. Among others, these factors include dealing with increasing regulation from government agencies and accommodating the active participation of knowledgeable personnel to ensure the continuation of a progressive and innovative system. Described within, along with more general issues, are various computer models, based upon Kaiser concepts and data that have been developed to facilitate the effective allocation of resources.


Novel Insights into the Role of Copper in Critical Life Stages of Oysters Revealed by High-Resolution NanoSIMS Imaging.
Copper (Cu) is a key trace element for many biological processes, but there is little available information regarding its requirements and functions in critical life stages of marine bivalves, during which dramatic morphological and physiological changes occur. In this study, the ontogeny pattern of Cu accumulation across the life history of oysters was explored for the first time and the distributions of Cu in oysters at critical life stages (pediveliger and early settled spat) were in situ mapped by nanoscale secondary ion mass spectrometry (NanoSIMS) with high lateral resolution. We first demonstrated that the late pelagic stage to early settled stage was the critical stage requiring Cu during oyster development. NanoSIMS imaging revealed a significant elevation of intercellular Cu levels along with mitochondrial calcium overload and obvious structural degradation of mitochondria in velar cells at the pediveliger stage, implying the possible role of Cu in cell apoptosis of the velum during larval metamorphosis. Furthermore, an obvious enrichment of Cu together with calcium was observed in the nucleus and mitochondria of ciliated cells of gill tissue at the early settled stage. Their accumulation in the gill cells was significantly higher than that in the juveniles, indicating the potential role of Cu in sustaining the fast growth of the gill filament and the concomitant acceleration of energy metabolism during early benthic development. Our findings offer new insights into the understanding of the interactions between trace metals and marine bivalves.


[A New Simple Technique for Producing Labeled Monoclonal Antibodies for Antibody Pair Screening in Sandwich-ELISA].
A simple and fast method for obtaining biotin-labeled monoclonal antibodies was developed usingcontent of hybridoma culture supernatant sufficient to select antibody pairs in sandwich ELISA. The method consists in chemical biotinylation of antigen-bound antibodies in a well of ELISA plate. Using as an example target Vaccinia virus A27L protein it was shown that the yield of biotinylated reactant is enough to set comprehensive sandwich ELISA for a moderate size panel of up to 25 monoclonal antibodies with an aim to determine candidate pairs. The technique is a cheap and effective solution since it avoids obtaining preparative amounts of antibodies.


Our approach to non-ablative treatment of photoaging.
Many laser, light and energy emitting devices are utilized for skin rejuvenation. The clinical approach to multiple problems of photoaging are discussed and an algorithm for approach by problem is presented. Clinical use of various modalities such as LED photomodulation, intense pulsed light, pulsed dye laser, KTP laser, radiofrequency and fractional resurfacing are presented with successful parameters, developed over several years, utilized on a daily basis in a busy cosmetic dermatology clinic. Significant improvement in the appearance of signs and symptoms of photoaging, including telangiectasias, mottled pigmentation, irregular surface texture, wrinkling and skin sagging can achieved by relatively non-invasive means.


Congenital dilatation of intrahepatic bile ducts associated with hepatic fibrosis and medullary sponge kidney--reconstruction and microdissection study.
An autopsy case of a four-year-old female with congenital dilatation of intrahepatic bile ducts with bilateral medullary sponge kidney is presented. The liver and kidney were investigated by reconstruction with serial sections and the kidney was also studied by microdissection. In this case the dilatations of collecting tubules and intra- and extrahepatic bile ducts were observed. We regard these lesions as developmental anomalies since these sites of both organs are excretory ducts derived from the endoderm. The liver cirrhosis observed at autopsy had developed in the course of the disease because the liver architecture was well preserved in the biopsy material. The patient had fatal cholangitis without cholelithiasis.


In situ hybridization to rat brain and pituitary gland of growth hormone cDNA.
Using in situ hybridization, we have investigated the presence of mRNA coding for growth hormone (GH) in the rat brain. Using 32P-labeled GH cDNA as a probe, the pituitary gland showed hybridization in unfixed sections. Using 3H-labeled GH cDNA hybridized to fixed sections, only cells in the anterior pituitary were labeled in good agreement with the localization of somatotropes. In the brain, wide zones were labeled with 32P-GH cDNA: the caudate putamen, the striatum, the ventral thalamus, the formatio reticularis and the basal cortex. With the 3H GH-cDNA probe, more discrete regions of the brain showed hybridization: the basal cortex, the outside part of the hippocampus and the caudate putamen.


Petit mal status in early childhood and dementia.
The course of 117 children with so-called centrencephalic myoclonic-astatic petit mal (Doose et al. 1970) was evaluated with the question, whether petit mal status can be the cause of dementia frequently seen in these patients. A dementia is found definitely more frequently in patients with petit mal status. With regard to the animal experimental studies of Wasterlain (1978, Lit.) and Meldrum (1978, Lit.) it seems possible that the prlonged generalized hypersynchronous discharges of the petit mal status lead to a serious disturbance of the neuronal energy metabolism and thus to cerebral organic damages or disturbances of the brain development.


Low prevalence of Post-thrombotic syndrome in patients treated with rivaroxaban.
Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT). Residual vein thrombus (RVT) on Doppler Ultrasound can be associated with PTS. Limited data are available on the effect of direct oral anticoagulants (DOACs) on the long-term outcome of PTS. This study aimed to compare the prevalence of PTS and RVT, in patients with previous DVT treated with rivaroxaban or enoxaparin/warfarin. A total of 129 patients with previous proximal lower limb DVT and treated with rivaroxaban (n = 71) or enoxaparin/warfarin (n = 58) for at least 3 months were included. The Villalta scale for PTS was performed after treatment. The median duration of the DVT symptoms before anticoagulation was 7 days for both groups. The rate of PTS was 50.7% in the patients treated with rivaroxaban and 69% in the enoxaparin/warfarin group. Enoxaparin/warfarin showed an increased prevalence of PTS (P = .018). An analysis in 3 different models showed that the relative risk of PTS decreased by 76% with rivaroxaban use when compared with enoxaparin/warfarin treatment. In addition, 93 of the 129 patients were evaluated regarding the presence of RVT, of which, 11 (24.4%) and 31 (64.6%) presented with RVT for rivaroxaban and enoxaparin/warfarin, respectively (P < .0001). The RVT analysis excluded the possibility of RVT as a mediator of the association between type of treatment and PTS when comparing rivaroxaban with enoxaparin/warfarin (odds ratio (OR) = 0.14; 95% confidence interval (CI): 0.1-1.0, P = .051) with rivaroxaban compared with enoxaparin/warfarin. Rivaroxaban treatment was associated with a lower risk of PTS when compared to enoxaparin/warfarin; RVT however, was not a mediator in the association between PTS and type of treatment.


An investigation of some factors affecting levels of erythrocyte inorganic pyrophosphatase activity.
A reproducible method has been devised for assaying erythrocyte inorganic pyrophosphatase. The activity level in healthy individuals appears to be a constant characteristic. Population surveys have been carried out in 100 Europeans and 34 Indians. In each population an otherwise normal individual was found with activity approximately three standard deviations from the mean. Investigation of the family of one such individual indicated that this was an inherited characteristic. A few individuals with clinical abnormalities were examined and some were found to have activity levels above the normal range. High activity levels appeared to be associated with those diseases in which raised circulating reticulocyte levels are found. The rate of in vivo decay of erythrocyte inorganice pyrophosphatase has been measured in healthy individuals. The decay pattern appears to be of the constant logarithmic type. An estimate has been made of the activity in circulating reticulocytes, and the half life of the enzymes has been calculated.


Pilot study for the development of a screening questionnaire to detect sarcopenic obesity.
Caloric restriction-the most prevalent obesity treatment-has a 97% failure rate when spread over 5-7 years. Sarcopenic obesity is thought to be the consequence of chronic dieting and the cause of weight management problems. This pilot study's goal was to develop a screening questionnaire that detects sarcopenic obesity in young and middle-aged female adults. A total of 23 women (ages 19-59) completed a sarcopenic obesity questionnaire and were assessed for total body weight (TBWt), percent fat mass, and percent fat-free mass (%FFM) using the Bod Pod (air plethsmography), and bioelectrical impedance analysis (BIA). Appendicular skeletal mass (ASM) was calculated using BIA. Resting energy expenditure was determined using indirect calorimetry, and the basal metabolic rate (BMR) was calculated using BIA. The screening questionnaire score was negatively correlated with BMR (r2 = 0.885), %FFM (r2 = 0.86), ASM (r2 = 0.79) relative to TBWt and to ASM/BMI (r2 = 0.58). The screening questionnaire had an acceptable sensitivity (83%) and specificity (87%) in detecting sarcopenia measured using ASM/BMI. This pilot intimates that subjects who frequently dieted suffered from a disproportionally lower FFM and BMR relative to the TBWt. The questionnaire can help clinicians recognize the presence of sarcopenic obesity in patients.


Primary central nervous system lymphoma with no enhancement initially and no significant progression over a long term: a case report and review of the literature.
Primary central nervous system lymphoma, a rare primary intracranial tumor, is highly malignant and usually associated with poor prognosis. Recent years, owing to the remarkable progress in intervention techniques, survival time reported has been significantly prolonged. Strategies targeting alleviation and remission are primarily depended on the early diagnosis. However, due to the heterogeneity of the clinical symptoms and imaging features, the disease is frequently misdiagnosed especially in the early phase, rendering a delay of optimal treatment. Herein, we reported the case of a 61-year-old man who was initially misdiagnosed as demyelinating encephalopathy. MRI images showed multifocal lesions across the cerebral cortex and deep white matter, which are not strengthened on contrast enhancements. In respect of clinical symptoms, no significant progress was observed over about 11 months. Finally, the diagnosis was revealed by brain biopsy. After reviewing all the images of the patient, we found that the corpus callosum was involved early in the course of the disease. Therefore, for multifocal intracranial lesions involving the corpus callosum, we should always be vigilant about the possibility of primary central nervous system lymphoma. Histopathological examination of brain biopsy is helpful for early definitive diagnosis.


Social stability on admission and success of in-patient treatment for alcoholism.
The pre-treatment social stability score (combined economic-familial-residential scales), indicating whether the patients were comparatively integrated or disintegrated socially, was found to be of greater prognostic value regarding post-treatment drinking than was information about whether they received full, part or "no" treatment. There was a differential treatment effect for the first 3 months of the 12-month period only. Of the overall sample, one-third of the patients could be considered to have improved following treatment, but two-thirds drank as much, if not more, than they did prior to treatment. These two groups were significantly different in terms of social stability and different types of treatment appear necessary to accommodate these differences. Social integration/disintegration is most readily seen in terms of the number of previous treatments (or institutionalisations) the subject has received for alcohol-related problems.