Management of cirrhotic ascites: Seven-step treatment protocol based on the Japanese evidence-based clinical practice guidelines for liver cirrhosis 2020.
Liver cirrhosis is a severe illness, associated with multiple complications, which can lead to liver failure. One of the major complications of cirrhosis is ascites. This review describes a stepped treatment approach for the management of ascites in Japanese patients with cirrhosis. It is broadly based on the 2020 update of the Japanese clinical practice guidelines for liver cirrhosis, which is briefly compared with guidelines from Europe and the United States. Step 1 is sodium restriction at a level suitable for Japanese individuals (5-7 g/day), Step 2 is albumin treatment to counteract underlying hypoalbuminemia, Step 3 is initiation of diuretic treatment with spironolactone, followed by add-on loop diuretic treatment at Step 4. Patients refractory to sodium restriction and sodium diuretics can be treated with tolvaptan (Step 5) - a vasopressin V2 receptor antagonit that is available in Japan. Patients at Steps 6 and 7 have refractory ascites and are treated with large volume paracentesis (LVP) in combination with an albumin infusion. High-dose albumin infusion (6-8 g/L) at the time of LVP has recently become possible in Japan. Cell-free and concentrated ascites reinfusion therapy (CART) is also an option at Step 6. Two of the treatment options at Step 7 are limited in Japan (transjugular intrahepatic portosystemic shunts are not approved, and access to liver donors is very limited), but patients can undergo a peritoneovenous shunt if no other options are available. While challenges remain in the treatment of ascites, adopting this stepwise treatment approach may improve patient outcomes. This article is protected by copyright. All rights reserved.


Selenoprotein W enhances skeletal muscle differentiation by inhibiting TAZ binding to 14-3-3 protein.
Selenoprotein W (SelW) is expressed in various tissues, particularly in skeletal muscle. We have previously reported that SelW is up-regulated during C2C12 skeletal muscle differentiation and inhibits binding of 14-3-3 to its target proteins. 14-3-3 reduces myogenic differentiation by inhibiting nuclear translocation of transcriptional co-activator with PDZ-binding motif (TAZ). Phosphorylation of TAZ at Ser89 is required for binding to 14-3-3, leading to cytoplasmic retention of TAZ and a delay in myogenic differentiation. Here, we show that myogenic differentiation was delayed in SelW-knockdown C2C12 cells. Down-regulation of SelW also increased TAZ binding to 14-3-3, which eventually resulted in decreasing translocation of TAZ to the nucleus. However, phosphorylation of TAZ at Ser89 was not affected. Although phosphorylation of TAZ at Ser89 was sustained by the phosphatase inhibitor okadaic acid, nuclear translocation of TAZ was increased by ectopic expression of SelW. This result was due to decreased binding of TAZ to 14-3-3. We also found that the interaction between TAZ and MyoD was increased by ectopic expression of SelW. Taken together, these findings strongly demonstrate that SelW enhances C2C12 cell differentiation by inhibiting TAZ binding to 14-3-3.


COVID-19 Vaccine Hesitancy among Clinical Medical Students in Enugu, South East Nigeria.
Clinical medical students are exposed to COVID-19 infection, thus it is imperative to achieve a high COVID-19 vaccination rate among this group of people. To determine the level of acceptance of COVID-19 vaccine and possible reasons for COVID-19 vaccine hesitance among medical students in Enugu, Nigeria. A cross-sectional study of 420 medical students at the two university teaching hospitals in Enugu. A p-value of less than .05 was considered statistically significant. Only 36.1% of the respondents were willing to take the COVID-19 vaccine. Extra source of income was significantly associated with the acceptability of the COVID-19 vaccine among the students (p = .012). COVID-19 vaccine acceptance rate among medical students in Enugu appears to be very low. There is an urgent need for more advocacy and enlightenment to address the misconceptions and fears fueling the high vaccine hesitance rate seen in the study.


Effect of ketoleucine treatment on atrophy of skeletal muscle.
There is a net loss of skeletal muscle protein in muscle-wasting disorders including the muscular dystrophies and denervation atrophy. Regardless of the nature of the underlying defect, a treatment that could reduce the rate of muscle protein degradation may be of therapeutic value in these conditions. Ketoleucine (alpha-ketoisocaproic acid) has been reported to reduce the rate of protein degradation in skeletal muscle. To evaluate ketoleucine's therapeutic potential, we studied its effect on the muscle protein loss that follows denervation in rats. Maximum tolerated doses of ketoleucine were administered twice daily to rats after surgical denervation of one leg. Wet weights and noncollagen proteins of the soleus and extensor digitorum longus muscles were measured. The ketoleucine-treated animals failed to show significant decrease in muscle wasting, compared with nontreated denervated controls. Further, urinary 3-methylhistidine excretion, a putative measure of muscle breakdown, was not reduced in ketoleucine-treated animals. Our findings do not support the suggested therapeutic role for ketoleucine in muscle-wasting disease.


Research Misconduct in the Croatian Scientific Community: A Survey Assessing the Forms and Characteristics of Research Misconduct.
The prevalence and characteristics of research misconduct have mainly been studied in highly developed countries. In moderately or poorly developed countries such as Croatia, data on research misconduct are scarce. The primary aim of this study was to determine the rates at which scientists report committing or observing the most serious forms of research misconduct, such as falsification , fabrication, plagiarism, and violation of authorship rules in the Croatian scientific community. Additionally, we sought to determine the degree of development and the extent of implementation of the system for defining and regulating research misconduct in a typical scientific community in Croatia. An anonymous questionnaire was distributed among 1232 Croatian scientists at the University of Rijeka in 2012/2013 and 237 (19.2 %) returned the survey. Based on the respondents who admitted having committed research misconduct, 9 (3.8 %) admitted to plagiarism, 22 (9.3 %) to data falsification, 9 (3.8 %) to data fabrication, and 60 (25.3 %) respondents admitted to violation of authorship rules. Based on the respondents who admitted having observed research misconduct of fellow scientists, 72 (30.4 %) observed plagiarism, 69 (29.1 %) observed data falsification, 46 (19.4 %) observed data fabrication, and 132 (55.7 %) respondents admitted having observed violation of authorship rules. The results of our study indicate that the efficacy of the system for managing research misconduct in Croatia is poor. At the University of Rijeka there is no document dedicated exclusively to research integrity, describing the values that should be fostered by a scientist and clarifying the forms of research misconduct and what constitutes a questionable research practice. Scientists do not trust ethical bodies and the system for defining and regulating research misconduct; therefore the observed cases of research misconduct are rarely reported. Finally, Croatian scientists are not formally educated about responsible conduct of research at any level of their formal education. All mentioned indicate possible reasons for higher rates of research misconduct among Croatian scientists in comparison with scientists in highly developed countries.


Electrically quiet temperature controller.
A circuit for an electrically quiet temperature controller is described that is suitable for controlling the temperature of a neurophysiological preparation above ambient temperature. By not generating spurious electrical signals it facilitates the recording of low level biological potential changes when temperature control is required. The device, constructed of standard electronic components, uses a thermistor as a sensing element and an ordinary heat lamp or heating strip as a heating element.


Self-reported functional outcome after primary total hip replacement treated with two different periopera-tive regimes: a follow-up study involving 61 patients.
Fast-track surgery has been reported to improve rehabilitation outcome after major surgery, with length of hospitalization and muscle strength as outcome measures. We assessed the effect of optimization of perioperative care during admission on self-reported functional outcome, and compared patient status 6 months after THR with an age-matched healthy cohort. 79 THR patients were randomized to optimized perioperative care (OPC) or conventional perioperative care (CPC). 61 patients fulfilled the requirements of the study protocol. Endpoint outcome was measured by SF-36 and WOMAC. To compare functional outcome in the THR group with that in healthy controls, we used data from a representative sample of 4,098 non-institutionalized Danish adults collected by the Danish National Institute of Public Health. We found similar improvements in SF-36 and WOMAC scores for the OPC and CPC groups postoperatively, except for the total WOMAC score and the WOMAC subscore "function"-in which the CPC group did statistically significantly better. The OPC and CPS groups had similar score levels. 6 months after surgery, THR patients scored higher overall in the general health subscale and lower in three physical subscales of SF-36 compared to age-matched healthy controls. Interpretation We found no evidence for the effect of optimization strategies during admission on self-reported functional outcome after THR. Although THR patients improved considerably after treatment, their physical status remained below the level of the healthy controls. Our results may indicate that the potential for functional improvement in THR patients is not fully realized, but this must be studied further.


Spirulina Cultivation Under Different light-emitting Diodes for Boosting Biomass and Protein Production.
Microalgae biomass and pigments have a high economic value due to their many biological and commercial applications. In this sense, Spirulina platensis was grown under different (LEDs) light-emitting diodes. The current examination aims to increase the biomass production of S. platensis by formulating an optimal growth condition under different LED lights. Light-emitting diodes have a precise wavelength that has an encouraging effect on microalgae biomass production. For this purpose, the light intensity of 3000 lx was used to illuminate the culture medium, resulting in enhanced S. platensis biomass production. The highest optical density of 0.576 and dry cell weight of 0.343 g/L was recorded for the white light-emitting diode, and the red light-emitting diode, the optical density of 0.479 and dry cell weight of 0.321 g/L was recorded. The highest protein content of 66.10 ± 0.44% was registered with a blue light-emitting diode, followed by a white light-emitting diode with a protein content of 60.86 ± 0.39%. This research is an essential step in defining the light condition that might be useful to increase the biomass production of S. platensis. The study's findings demonstrated that exposure to various light-emitting diode colors could enhance both the quality and quantity of biomass produced in S. platensis cultures and encourage the use of light-emitting diodes as a light source for S. platensis farming without any undesirable effects on growth.


GeneTests-GeneClinics: genetic testing information for a growing audience.
The development and usage of two companion NIH-funded genetic testing information databases, GeneTests (www.genetests.org) and GeneClinics (www.geneclinics.org), now merged into one web site, reflect the steadily increasing use of genetic testing and the expanding audience for genetic testing information. Established in 1993 as Helix, a genetics laboratory directory of approximately 110 listings, GeneTests has grown into a database of over 900 tests for inherited diseases, a directory of over 500 international laboratories, a directory of over 1,000 U.S. and international genetics clinics, and a resource for educational/teaching materials and reports of summary genetic test data. GeneClinics, founded in 1997 as an expert-authored, peer-reviewed, disease-specific knowledge base relating genetic testing to patient care, has grown steadily, now containing over 130 expert-authored, peer-reviewed full-text entries relating genetic testing information to diagnosis, management, and genetic counseling of specific inherited diseases. In spring 2001 the two databases were merged and in October 2001 the two web sites were merged for the purpose of seamless navigation into the GeneTests-GeneClinics site (www.genetests.org or www.geneclinics.org); the GeneClinics knowledge base was renamed "GeneReviews" to avoid confusion with the U.S. and international clinic directories. As genetic testing has moved steadily out of research venues and into routine medical practice, the user audience for these databases has become international and expansive and includes healthcare providers, patients, educators, policy makers, and the media. The use of these combined resources has grown to approximately 3,200 visits/day.


Detection of Staphylococcus aureus enterotoxin B at femtomolar levels with a miniature integrated two-channel surface plasmon resonance (SPR) sensor.
Surface plasmon resonance (SPR) biosensors offer the capability for continuous real-time monitoring. The commercial instruments available have been large in size, expensive, and not amenable to field applications. We report here an SPR sensor system based on a prototype two-channel system similar to the single channel Spreeta devices. This system is an ideal candidate for field use. The two-channel design provides a reference channel to compensate for bulk refractive index (RI), non-specific binding and temperature variations. The SPR software includes a calibration function that normalizes the response from both channels, thus enabling accurate referencing. In addition, a temperature-controlled enclosure utilizing a thermo-electric module based on the Peltier effect provides the temperature stability necessary for accurate measurements of RI. The complete SPR sensor system can be powered by a 12V battery. Pre-functionalized, disposable, gold-coated thin glass slides provide easily renewable sensor elements for the system. Staphylococcus aureus enterotoxin B (SEB), a small protein toxin was directly detectable at sub-nanomolar levels and with amplification at femtomolar levels. A regeneration procedure for the sensor surface allowed for over 60 direct detection cycles in a 1-month period.


Immunocytochemistry of brain-reactive monoclonal antibodies in peripheral tissues.
Among a total of 135 tissue-reactive monoclonal antibodies previously prepared, 81 were brain-selective and were classified into neuronal and non-neuronal categories. The neuronal antibodies were again subdivided into antineurofibrillar, antiperikaryonal-neurofibrillar, and antisynapse-associated groups. On the basis of morphologic, developmental, biochemical, and pathologic criteria, the antibodies in at least two of these groups were found to detect heterogeneous antigens (called "neurotypes") rather than different antigenic determinants in single antigens. On examining the distribution in peripheral organs of staining patterns of 11 antineuronal brain-reactive antibodies, we now confirm that these antibodies are, indeed, largely brain-specific. In general, non-neuronal elements in liver, lung, heart, thymus, intestine, adrenal, and spleen remained unstained. However, most of the antibodies stained peripheral neural elements. Occasional antibodies did stain selected, non-neuronal structures. Four out of five antineurofibrillar antibodies stained nerve fibers in adrenal medulla, intestine and thymus. All of three antiperikaryonal-neurofibrillar antibodies also stained nerve fibers in the adrenal medulla, but not in other organs. Two out of three antisynapse-associated antibodies stained what appear to be nerve contacts on adrenal medullary cells, but not on any other peripheral cells examined. The non-neuronal peripheral staining patterns were restricted to selective nuclear staining exhibited by two out of five antineurofibrillar antibodies and the staining of macrophage and selected cardiac muscle nuclei by two of three antisynapse-associated antibodies. However, one antineurofibrillar antibody also stained the cytoplasm of selected liver cells. Among non-neuronally reacting antibodies, two antibodies stained nuclei of all cells except neurons in brain as well as peripheral organs. An antibody staining the ciliary epithelium of choroid plexus also stained basal bodies of ciliated bronchial epithelium. The overall data suggest that the specificity of brain-reactive antibodies is high and that their cross-reactivity with epitopes in non-nervous tissue is rare. In these cases, the antibodies seem to provide specific reagents for these additional structures as well as for their specific brain antigens.


Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait.
The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients. The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients' records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered. Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5-17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53-21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01-1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course. This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.


Buspirone attenuated methotrexate-induced hippocampal toxicity in rats by regulating Nrf2/HO-1, PPAR-γ, NF-κB/nNOS, and ROS/NLRP3/caspase-1 signaling pathways.
Methotrexate (MTX) is a chemotherapeutic agent widely used to treat a variety of tumors. Nonetheless, MTX-induced hippocampal neurotoxicity is a well-defined dose-limiting adverse effect that limits clinical utility. Proinflammatory cytokine production and oxidative stress are possible mechanisms for MTX-induced neurotoxicity. Buspirone (BSP), a partial agonist of the 5-HT1a receptor (5-HT1aR), has emerged as an anxiolytic drug. BSP has been shown to possess antioxidant and anti-inflammatory effects. The current study investigated BSP's potential anti-inflammatory and antioxidant effects in attenuating MTX-induced hippocampal toxicity. Rats received either BSP (1.5 mg/kg) orally for 10 days and MTX (20 mg/kg) i.p. on Day 5. BSP administration markedly protected hippocampal neurons from drastic degenerated neuronal changes induced by MTX. BSP significantly attenuated oxidative injury by downregulating Kelch-like ECH-associated protein 1 expression while potently elevating hippocampal Nrf2, heme oxygenase-1, and peroxisome proliferator-activated receptor expression. BSP dampened inflammation by reducing NO2 - , tumor necrosis factor-alpha, IL-6, and interleukin 1 beta levels mediated by downregulating NF-κB and neuronal nitric oxides synthase expression. Moreover, BSP potently counteracted hippocampal pyroptosis by downregulating NLRP3, ASC, and cleaved-caspase-1 proteins. Therefore, BSP may represent a promising approach to attenuate neurotoxicity in patients receiving MTX.


Haemodynamic effects of atropine during halothane or isoflurane anaesthesia in infants and small children.
In this study, two-dimensional and pulsed Doppler echocardiography were used to measure cardiovascular changes before and after IV atropine in 31 infants and small children during halothane (n = 15) or isoflurane (n = 16) anaesthesia. Prior to induction of anaesthesia heart rate (HR), mean blood pressure (MBP), and two-dimensional echocardiographic dimensions of the left ventricle and pulmonary artery blood flow velocity were measured by pulsed Doppler echocardiography. Cardiovascular measurements were repeated while anaesthesia was maintained at 1.5 MAC halothane (n = 15) or isoflurane (n = 16). Atropine 0.02 mg.kg-1 IV was then administered and two minutes later, a third set of cardiovascular data was obtained. Heart rate decreased during halothane anaesthesia but did not change significantly during isoflurane anaesthesia. Mean blood pressure, cardiac output (CO) and stroke volume (SV) decreased similarly during 1.5 MAC halothane or isoflurane anaesthesia. Ejection fraction (EF) decreased and left ventricular end-diastolic volume (LVEDV) increased significantly in both groups, but decreases in EF (32 +/- 5 per cent vs 18 +/- 5 per cent) and increases in LVEDV (18 +/- 7 per cent vs 7 +/- 5 per cent) were significantly greater during halothane than during isoflurane anaesthesia. Following atropine, HR increased more in the patients maintained with halothane (31 +/- 6 per cent), than during isoflurane anaesthesia (18 +/- 5 per cent). Atropine increased CO in both groups of patients, but SV and EF remained unchanged. When compared with awake values, HR increased similarly and significantly (18 +/- 4 per cent) following atropine in both groups, and CO returned to control levels.(ABSTRACT TRUNCATED AT 250 WORDS)


The impact of COVID-19 pandemic on key performance indicators in three Saudi hospitals.
The coronavirus disease (COVID-19) disrupted healthcare systems and medical care worldwide. This study attempts to assess the performance of three Saudi hospitals during COVID-19 by comparing waiting times for outpatient appointments and the volume of elective surgeries before and after COVID-19. We used ADA'A data collected from three Saudi hospitals for this retrospective cohort study. The outcome variables were "Waiting Time for Appointment" and "Elective OR Utilization". The hospitals included in this study were: a 300-bed maternity and children's hospital; a 643-bed general hospital; and a 1230-bed tertiary hospital. We included all patients who visited the OPD and OR in the time period from September 2019 to December 2021. A two-way ANOVA test was used to examine the differences in the outcome variables by hospital and by the phase of COVID-19. For the elective OR utilization rate, the results showed that both the hospital and the phase of COVID-19 were significantly different (p-value < 0.05). On average, the elective OR utilization rate dipped considerably in the early phase of COVID-19 (33.2% vs 44.9%) and jumped sharply in the later phase (50.3%). The results showed that the waiting time for OPD appointment was significantly different across hospitals and before and after COVID-19 in each hospital (p-value < 0.05). the waiting time dropped during the early phase of COVID-19 for both the general hospital (GEN) (24.6 days vs 34.8 days) and the tertiary hospital (MDC) (40.3 days vs 48.6 days), while the maternity and children's hospital (MCH)'s score deteriorated sharply (24.6 days vs 9.5 days). This study indicates that COVID-19 led to a significant impact on elective surgery rates and waiting time for OPD appointments in the early stage of the pandemic when the lockdown strategy was implemented in the country. Although the elective surgery rate had decreased at the designated COVID-hospital, the waiting time for OPD appointment had improved. This is a clear indication that the careful planning and management of resources for essential services during pandemic was effective.


Selective rostral transection of the fornix spares the hippocampal commissural pathway in the rat: a Phaseolus vulgaris leucoagglutinin tracing study.
This study describes an approach for disconnecting the septal region from the hippocampus by fimbria-fornix lesions while sparing the commissural projections. After a frontal cut through the rostral fornix, commissural fibres were labelled with the anterograde tracer Phaseolus vulgaris leucoagglutinin. The commissural fibre bundle located in the posterior-basal fornix (ventral hippocampal commissure) remained unaffected by the rostral fornix transection, whereas the absence of septal fibres in the hippocampus could be verified using AChE histochemistry. Thus, using this approach, selective studies of the septo-hippocampal projection can be performed while leaving the overwhelming portion of the commissural fibre system intact.


Methylprednisolone blocks interleukin 1 beta induced calcitonin gene related peptide release in trigeminal ganglia cells.
Methylprednisolone (MPD) is a rapid acting highly effective cluster headache preventive and also suppresses the recurrence of migraine attacks. Previously, we could demonstrate that elevated CGRP plasma levels in a cluster headache bout are normalized after a course of high dose corticosteroids. Here we assess whether MPD suppresses interleukin-1β (IL-1β)- and prostaglandin E2 (PGE2)-induced CGRP release in a cell culture model of trigeminal ganglia cells, which could account for the preventive effect in migraine and cluster headache. Metoprolol(MTP), a migraine preventive with a slow onset of action, was used for comparison. Primary cultures of rat trigeminal ganglia were stimulated for 24 h with 10 ng/ml IL-1β or for 4 h with 10 μM PGE2 following the exposure to 10 or 100 μM MPD or 100 nM or 10 µM MTP for 45 min or 24 h. CGRP was determined by using a commercial enzyme immunoassay. MPD but not MTP blocked IL-1β-induced CGRP release from cultured trigeminal cells. PGE2-stimulated CGRP release from trigeminal ganglia cell culture was not affected by pre-stimulation whether with MPD or MTP. MPD but not MTP suppresses cytokine (IL-1β)-induced CGRP release from trigeminal ganglia cells. We propose that blockade of cytokine mediated trigeminal activation may represent a potential mechanism of action that mediates the preventive effect of MTP on cluster headache and recurrent migraine attacks.


Spontaneous retroperitoneal haemorrhage following re-perfusion of an ischaemic kidney leading to emergency trauma nephrectomy.
Here we present a rare case of life-threatening spontaneous renal haemorrhage following elective vascular surgery. A 73-year-old gentleman presents to the ED with acute onset right sided flank pain, 24 hours post bilateral renal artery stent insertion for renal artery stenosis. Subsequent angiography demonstrated bilateral renal artery stent occlusion with near complete bilateral kidney infarction. The patient urgently underwent bilateral renal artery thrombectomy. Post-operatively the patient developed severe unilateral flank pain and became haemodynamically unstable. Subsequent imaging revealed a large right sided retroperitoneal haematoma with active arterial bleeding. The patient ultimately underwent a right sided trauma nephrectomy for haemorrhage control.


Intracisternal bombesin induced inhibition of gastric secretion is not mediated through prostaglandin or opioid pathways.
Neuromedin B, a mammalian decapeptide which shares homology with the carboxyl terminal fragment of ranatensin R and bombesin, injected intracisternally (880 pmol) did not modify gastric acid secretion stimulated either by pylorus ligation in conscious rats or by pentagastrin infusion in urethane-anesthetized rats. Intracisternal bombesin (300 pmol) further enhanced PGE2-induced inhibition of gastric acid secretion and suppressed prostaglandin-induced stimulation of gastric secretory volume. Gastric response to intracisternal bombesin was not modified by indomethacin (10 mg/kg) or naloxone pretreatment (5 mg/kg). These results suggest that prostaglandin and opiate pathways are not mediating the inhibitory effect of intracisternal bombesin on gastric secretion and that neuromedin B does not mimic the central action of bombesin to inhibit gastric acid secretion.


Visual and rapid detection of escolar (Lepidocybium flavobrunneum) using loop mediated isothermal amplification in conjunction with a specific molecular beacon probe.
Species adulteration has become a main reason for the unexpected exposure to escolar, which is often related with the gastrointestinal disease called keriorrhea. Sensitive and accurate identification of escolar is required to protect consumers from commercial and health frauds. The present study established a visual and rapid method for escolar detection using LAMP (loop-mediated isothermal amplification) in conjunction with a MB (molecular beacon) probe. The visual MB-LAMP assay demonstrated high specificity and superb sensitivity (1 pg DNA) for escolar and low to 0.1 % (w/w) simulated adulteration could be detected within 25 min. Additionally, method validation on commercial products highlighted the umbrella term of white tuna for escolar on Chinese market. All these results indicated that the MB-LAMP method is a useful tool for rapid, sensitive and convenient detection of escolar and can also be used as a point-of-care molecular diagnostic technique since it does not require the expensive equipment.


First record of the Nephropid genus Acanthacaris Bate, 1888 (Crustacea: Decapoda: Nephropidae) from Taiwan.
The giant deep-sea lobster genus Acanthacaris Bate, 1888 is reported for the first time from Taiwan. The single specimen with a total length of 36 cm was collected near a cold seep off southwestern Taiwan at about 1300 m deep and identified as A. tenuimana Bate, 1888.


Comprehensive quality evaluation of Lignum Caraganae and rapid discrimination of Caragana jubata and Caragana changduensis based on characteristic compound fingerprints by HPLC-UV and HPLC-MS/MS coupled with chemometrics analysis.
Caragana jubata Poir (CJ) and Caragana changduensis Liou f. (CC) are the two main original plants of Lignum Caraganae (LIC, a clinically effective Tibetan materia medica) and the red heartwoods of CJ and CC have been used for the treatment of polycythemia, hypertension and menstrual disorders. To establish a comprehensive method for rapid quality assessment of LIC based on revealing the characteristic components of LIC and to discriminate the plant sources and LIC from its adulterations. A multi-index and synthetically balanced orthogonal design L9 (34 ) experiment was performed to obtain an efficient ultrasonic extraction condition of LIC sample. High-performance liquid chromatography coupled with an ultraviolet detector (HPLC-UV) techniques were developed for fingerprinting and quantitative analysis of 14 major compounds in LIC, and the main components were identified by HPLC tandem mass spectrometry (HPLC-MS/MS). HPLC fingerprint and chemometrics analysis were employed to visualise the distinction and relationship of LIC obtained from CJ and CC and to determine their potential characteristic markers. Fourteen compounds including a new compound were identified and quantified in LIC. The potential characteristic markers in LIC were identified based on qualitative and fingerprint analysis. The hierarchical cluster analysis (HCA) and principle component analysis (PCA) showed obvious discrimination between LIC obtained from CJ and CC. Five batches of LIC samples were authenticated, and its adulterations were successfully found. A facile HPLC combined with fingerprint and chemometrics methods could rapidly evaluate the quality of LIC and discriminate LIC obtained from CJ and CC.


Defining the user role in infection control.
Health policy initiatives continue to recognize the valuable role of patients and the public in improving safety, advocating the availability of information as well as involvement at the point of care. In infection control, there is a limited understanding of how users interpret the plethora of publicly available information about hospital performance, and little evidence to support strategies that include reminding healthcare staff to adhere to hand hygiene practices. To understand how users define their own role in patient safety, specifically in infection control. Through group interviews, self-completed questionnaires and scenario evaluation, user views of 41 participants (15 carers and 26 patients with recent experience of inpatient hospital care in London, UK) were collected and analysed. In addition, the project's patient representative performed direct observation of the research event to offer inter-rater reliability of the qualitative analysis. Users considered evidence of systemic safety-related failings when presented with hospital choices, and did not discount hospitals with high ('red' flagged) rates of meticillin-resistant Staphylococcus aureus. Further, users considered staff satisfaction within the workplace over and above user satisfaction. Those most dissatisfied with the care they received were unlikely to ask staff, 'Have you washed your hands?' This in-depth qualitative analysis of views from a relatively informed user sample shows 'what matters', and provides new avenues for improvement initiatives. It is encouraging that users appear to take a holistic view of indicators. There is a need for strategies to improve dimensions of staff satisfaction, along with understanding the implications of patient satisfaction.


Changes in macular function throughout adulthood.
Recent reports suggest that the neural system is the principal cause of loss of visual function with age and that senile lenticular and pupillary changes are of minor importance. In order to investigate this neural deterioration further we measured Logmar visual acuity and photostress recovery time (PSRT) in 61 subjects over an age range of 19 to 78 years. The magnitude of the PSRT reflects the efficiency with which the visual system recovers from exposure to a glare source and is principally dependent upon the integrity of the photoreceptors and the retinal pigment epithelium. The results indicate that macular function declines significantly throughout adulthood.


A cost comparison between reusable flexible and disposable laryngoscopes.
To compare the costs of disposable laryngoscopes to reusable scopes in outpatient and inpatient settings. The total variable and fixed costs involved in flexible scope reprocessing were collected from two general otolaryngology clinics, a pediatric otolaryngology clinic, and a children's hospital. Variable costs of disposable materials and labor were collected from 65 scope reprocessing events to identify the cost of reprocessing. Fixed costs of scope maintenance, monitors, video towers, and storage equipment were collected from financial records. Fixed and variable costs were analyzed to identify the cost per scope event. The costs were then compared to a theoretical model where disposable scopes were used to meet the volume demands of each clinic and children's hospital setting. The model of disposable scopes was generated after obtaining volume costs specific to each setting from a disposable scope company. The average cost of a reusable scope model per scope event was $66.02 ± 4.49 at the three clinics and $130.66 at the children's hospital. The average cost of the disposable scope model per scope event was $152.55 ± 0.55 in the three clinics and $172.61 in the children's hospital. The cost differences were $86.53 ± 3.96 and $41.95 respectively. In an outpatient clinic, reusable scopes are less expensive than a disposable scope model. In children's hospital inpatient setting, the difference in costs between disposable and reusable scopes is lower. When considering other non-economic factors, disposable scopes may be a feasible option, especially in the children's hospital setting.


Complexes of 2,4,6-trihydroxybenzoic acid: effects of intramolecular hydrogen bonding on ligand geometry and metal binding modes.
This article describes a series of more than 20 new compounds formed by the combination of 2,4,6-trihydroxybenzoic acid (H4thba) with metal ions in the presence of a base, with structures that include discrete molecular units, chains, and two- and three-dimensional networks. As a result of the presence of two ortho-hydroxy groups, H4thba is a relatively strong acid (pKa1 = 1.68). The carboxylate group in H3thba- is therefore considerably less basic than most carboxylates with intramolecular hydrogen bonds, conferring a rigid planar geometry upon the anion. These characteristics of H3thba- significantly impact upon the way it interacts with metal ions. In s-block metal compounds, where the interaction of the metal centres with the carboxylate O atoms is essentially ionic, the anion bonds to up to three metal centres via a variety of binding modes. In cases where the metal ion is able to form directional coordinate bonds, however, the carboxylate group tends to bond in a monodentate mode, interacting with just one metal centre in the syn mode. A dominant influence on the structures of the complexes seems to be the face-to-face stacking of the aromatic rings, which creates networks containing layers of metal-oxygen polyhedra that participate in hydrogen bonding. This investigation was undertaken, in part, by a group of secondary school students as an educational exercise designed to introduce school students to the technique of single-crystal X-ray diffraction and enhance their understanding of primary and secondary bonding.


Human papillomavirus seropositivity and subsequent risk of HIV acquisition in rural South African women.
This study aimed to provide a population-based estimate of human papillomavirus (HPV) seropositivity for women in a rural African context and to evaluate the impact of HPV serostatus on subsequent acquisition of HIV outside a clinical setting. A random sample of women participating in a longitudinal, population-based HIV survey combined with a case-control study. Blood samples of women participating in a single round of population-based HIV surveillance (N = 1049) in a rural South African population were used to measure vaccine-preventable HPV seropositivity (types 6, 11, 16, and 18) in the general population in 2010. Using results from the repeat HIV surveys, a case-control analysis was then performed comparing HPV sero-status in samples taken from HIV sero-converting women (prior to infection with HIV) against samples from HIV-uninfected, sexually-active controls matched 1:1 according to 5-year age band (377:377). Unconditional multivariable logistic regression with multiple imputations was used to control for sociodemographic and behavioral variables associated with HIV acquisition. Human papillomavirus seropositivity in the population-based sample of women was 20.8% (95% confidence interval [CI], 18.3-23.4), and HIV prevalence was 27.6% (95% CI, 24.9-30.4). In the case-control analysis, allowing for variables known to be associated with HIV incidence, HPV seropositivity was associated with nearly 2.5 times the odds of subsequent acquisition of HIV (adjusted odds ratio, 2.33 [95% CI, 1.61-3.39]; P < 0.001). These results suggest that HPV vaccination before or soon after sexual debut could lower HIV infection risk. Randomized trials that quantify the impact of HPV vaccination in girls on the risk of acquiring HIV are urgently required.


Validation of Matrix Metalloproteinase-9 (MMP-9) as a Novel Target for Treatment of Diabetic Foot Ulcers in Humans and Discovery of a Potent and Selective Small-Molecule MMP-9 Inhibitor That Accelerates Healing.
Diabetic foot ulcers (DFUs) are a significant health problem. A single existing FDA-approved drug for this ailment, becaplermin, is not standard-of-care. We previously demonstrated that upregulation of active matrix metalloproteinase (MMP)-9 is the reason that the diabetic wound in mice is recalcitrant to healing and that MMP-8 participates in wound repair. In the present study, we validate the target MMP-9 by identifying and quantifying active MMP-8 and MMP-9 in human diabetic wounds using an affinity resin that binds exclusively to the active forms of MMPs coupled with proteomics. Furthermore, we synthesize and evaluate enantiomerically pure ( R)- and ( S)-ND-336, as inhibitors of the detrimental MMP-9, and show that the ( R)-enantiomer has superior efficacy in wound healing over becaplermin. Our results reveal that the mechanisms of pathology and repair are similar in diabetic mice and diabetic humans and that ( R)-ND-336 holds promise for the treatment of DFUs as a first-in-class therapeutic.


Why platelet mechanotransduction matters for hemostasis and thrombosis.
Mechanotransduction is the ability of cells to "feel" or sense their mechanical microenvironment and integrate and convert these physical stimuli into adaptive biochemical cellular responses. This phenomenon is vital for the physiology of numerous nucleated cell types to affect their various cellular processes. As the main drivers of hemostasis and clot retraction, platelets also possess this ability to sense the dynamic mechanical microenvironments of circulation and convert those signals into biological responses integral to clot formation. Like other cell types, platelets leverage their "hands" or receptors/integrins to mechanotransduce important signals in responding to vascular injury to achieve hemostasis. The clinical relevance of cellular mechanics and mechanotransduction is imperative as pathologic alterations or aberrant mechanotransduction in platelets has been shown to lead to bleeding and thrombosis. As such, the aim of this review is to provide an overview of the most recent research related to platelet mechanotransduction, from platelet generation to platelet activation, within the hemodynamic environment and clot contraction at the site of vascular injury, thereby covering the entire "life cycle" of platelets. Additionally, we describe the key mechanoreceptors in platelets and discuss the new biophysical techniques that have enabled the field to understand how platelets sense and respond to their mechanical microenvironment via those receptors. Finally, the clinical significance and importance of continued exploration of platelet mechanotransduction have been discussed as the key to better understanding of both thrombotic and bleeding disorders lies in a more complete mechanistic understanding of platelet function by way of mechanotransduction.


Promoting AMPK/SR-A1-mediated clearance of HMGB1 attenuates chemotherapy-induced peripheral neuropathy.
Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect of chemotherapy with poorly understood mechanisms and few treatments. High-mobility group box 1 (HMGB1)-induced neuroinflammation is the main cause of CIPN. Here, we aimed to illustrate the role of the macrophage scavenger receptor A1 (SR-A1) in HMGB1 clearance and CIPN resolution. Oxaliplatin (L-OHP) was used to establish a CIPN model. Recombinant HMGB1 (rHMGB1) (his tag) was used to evaluate the phagocytosis of HMGB1 by macrophages. In the clinic, HMGB1 expression and MMP-9 activity were increased in the plasma of patients with CIPN. Plasma HMGB1 expression was positively correlated with the cumulative dose of L-OHP and the visual analog scale. In vitro, engulfment and degradation of rHMGB1 increased and inflammatory factor expression decreased after AMP-activated protein kinase (AMPK) activation. Neutralizing antibodies, inhibitors, or knockout of SR-A1 abolished the effects of AMPK activation on rHMGB1 engulfment. In vivo, AMPK activation increased SR-A1 expression in the dorsal root ganglion, decreased plasma HMGB1 expression and MMP-9 activity, and attenuated CIPN, which was abolished by AMPK inhibition or SR-A1 knockout in the CIPN mice model. Activation of the AMPK/SR-A1 axis alleviated CIPN by increasing macrophage-mediated HMGB1 engulfment and degradation. Therefore, promoting HMGB1 clearance may be a potential treatment strategy for CIPN. Video abstract.


ConNEcT: An R package to build contingency measure-based networks on binary time series.
Dynamic networks are valuable tools to depict and investigate the concurrent and temporal interdependencies of various variables across time. Although several software packages for computing and drawing dynamic networks have been developed, software that allows investigating the pairwise associations between a set of binary intensive longitudinal variables is still missing. To fill this gap, this paper introduces an R package that yields contingency measure-based networks (ConNEcT). ConNEcT implements different contingency measures: proportion of agreement, corrected and classic Jaccard index, phi correlation coefficient, Cohen's kappa, odds ratio, and log odds ratio. Moreover, users can easily add alternative measures, if needed. Importantly, ConNEcT also allows conducting non-parametric significance tests on the obtained contingency values that correct for the inherent serial dependence in the time series, through a permutation approach or model-based simulation. In this paper, we provide an overview of all available ConNEcT features and showcase their usage. Addressing a major question that users are likely to have, we also discuss similarities and differences of the included contingency measures.


The relationship between the sexual care attitudes, beliefs and self-efficacy of nursing students and gender roles: A cross-sectional study.
The aim of the research is to determine the relationship between the gender role approaches and the sexual care attitudes, beliefs, and self-efficacy of nursing students. This cross-sectional study included 109 nursing students. A negative correlation was found between the Gender Roles Attitude Scale and the Sexual Attitudes and Beliefs Scale (p < 0.001). A positive correlation was found between the Gender Roles Attitude Scale and the self-efficacy in clinical performance scale total score and its assessment, diagnosis, planning, and implementation subscales (p < 0.05). This study is considered to be useful to specify the education and awareness strategies that will contribute to better preparation of the nursing students for sexual health services.


Intramuscular Immunization Induces Antigen-specific Antibodies in Urine.
Towards the development of vaccines against urinary tract infections (UTI), we determined the ability of intramuscular (i.m.) immunization to result in antigen-specific antibodies in urine. As a model antigen/vaccine, levels of total and vaccine-specific antibodies were determined in urine as a spin-out study of a phase 1 trial. Non-muscle-invasive bladder cancer (NMIBC) patients at different risks of progression, undergoing intravesical bacillus Calmette-Guérin (BCG) immunotherapy or not, received an adjuvanted recombinant protein vaccine that resulted in high titers of vaccine-specific serum immunoglobulin G (IgG) in all patients, regardless of the risk group. Vaccine-specific IgG and immunoglobulin A (IgA) were detected in urine of half of the patients at low risk of progression NMIBC and in all the intermediary/high- (int/high) risk patients. Vaccine-specific IgG titers were correlated to total urinary IgG levels, the latter being higher in the int/high-risk patients. In contrast, vaccine-specific IgA did not correlate to urinary IgA levels. Furthermore, vaccine-specific antibodies were transiently increased by intravesical BCG instillations. Altogether, our data show that a standard i.m. immunization can effectively induce antigen-specific antibodies in urine, which, upon selection of optimal vaccine targets, may provide protection against UTI. Vaccine-specific IgG titers were dependent on conditions affecting total urinary IgG levels, while production of vaccine-specific IgA in situ might independently contribute to protection against infections in the bladder. PATIENT SUMMARY: Towards the development of vaccines able to protect against urinary tract infections, we examined the potential of the intramuscular vaccination using a model antigen. We found two types of specific antibodies in the urine, which together may locally contribute to protection against infections, thus supporting the use of such a standard immunization route.


Intrarenal epidermal cyst.
An epidermal cyst is a very unusual cause of a renal mass, with only three cases reported in English literature. The authors report a case of this in a 51-year-old man with left flank pain and hematuria. A 5 x 4 cm-sized cystic mass, having an irregular margin with stippled calcification, was identified in the lower pole of the left kidney. A retroperitoneal laparoscopic simple nephrectomy was performed under the assumption that it was a renal tumor. Histologically, the tumor was identical in appearance to an epidermal cyst within the skin. Aberrant ectodermal implantation during embryogenesis has been postulated as a histogenesis of intrarenal epidermal cyst. However, the present case had a history of renal stone, which was treated with extracorporeal shock wave lithotripsy. Therefore, the authors suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin. The diagnosis of an epidermal cyst was not made preoperatively in the present case, or in the cases described in the literature. This diagnosis should be included in the differentiation of calcified intrarenal masses.


Treatment of aneurysm of transverse aortic arch.
Although aneurysms involving the aortic arch are usually well localized and amenable to reconstructive operation, the reported results of this form of therapy at this level are not as good as in other portions of the aorta. The difference is due to cerebral and bleeding disturbances associated with cerebral protection techniques. This report describes 30 patients and emphasizes the variability of extent of these lesions and the results of methods employed for cerebral protection, which varied according to extent of disease. The aneurysm involved all but the proximal ascending aorta in one patient and was replaced with a permanent ascending aorta-innominate and left common carotid artery bypass graft. Eight aneurysms were limited to the transverse arch; one was removed with the aid of temporary bypass and seven with cardiopulmonary bypass and separate brachiocephalic normothermic perfusion. Temporary and permanent bypass grafts were used in four patients with lesser involvement. None of these techniques was used in 17 patients who had distal arch involvement. Of the 30 patients, 26 survived and 18 are still alive despite the treatment being spread over a 22 year period. Cerebral complications occurred in 3 patients, two of whom died. These problems were avoided in five patients treated more recently by using lows flows under low pressures. Coagulopathies did not occur. Although the technique of cardiopulmonary bypass, profound hypothermia, and circulatory arrest provides a more convenient and technically simpler method of operation, the disadvantages of coagulopathies with excessive bleeding, pulmonary problems, and lack of consistent cerebral protection argue against its routine use at this time.


Discovery of GS-9256: a novel phosphinic acid derived inhibitor of the hepatitis C virus NS3/4A protease with potent clinical activity.
A potent and novel class of phosphinic acid derived product-like inhibitors of the HCV NS3/4A protease was discovered previously. Modification of the phosphinic acid and quinoline heterocycle led to GS-9256 with potent cell-based activity and favorable pharmacokinetic parameters. Based on these attributes, GS-9256 was advanced to human clinical trial as a treatment for chronic infection with genotype 1 HCV.


Bone Mineral Density During and After Lactation: A Comparison of African American and Caucasian Women.
During lactation, changes in maternal calcium metabolism are necessary to provide adequate calcium for newborn skeletal development. The calcium in milk is derived from the maternal skeleton through a process thought to be mediated by the actions of parathyroid hormone-related protein (PTHrP) in combination with decreased circulating estrogen concentrations. After weaning, bone lost during lactation is rapidly regained. Most studies of bone metabolism in lactating women have been performed in Caucasian subjects. There are well-documented differences between African American (AA) and Caucasian (C) bone metabolism, including higher bone mineral density (BMD), lower risk of fracture, lower 25-hydroxyvitamin D (25(OH) D), and higher PTH in AA compared to C. In this prospective paired cohort study, BMD and markers of bone turnover were compared in self-identified AA and C mothers during lactation and after weaning. BMD decreased in both AA and C women during lactation, with similar decreases at the lumbar spine (LS) and greater bone loss in the C group at the femoral neck (FN) and total hip (TH), demonstrating that AA are not resistant to PTHrP during lactation. BMD recovery compared to the 2 week postpartum baseline was observed 6 months after weaning, though the C group did not have complete recovery at the FN. Increases in markers of bone formation and resorption during lactation were similar in AA and C. C-terminal telopeptide (CTX) decreased to 30% below post-pregnancy baseline in both groups 6 months after weaning, while procollagen type 1 N-terminal (P1NP) returned to baseline in the AA group and fell to below baseline in the C group. Further investigation is required to determine impacts on long term bone health for women who do not fully recover BMD before a subsequent pregnancy.


Not by bread alone project: a 2-year follow-up report.
We have previously reported the developmental gains achieved, after introducing a simple programme of structured play to stimulate children in an orphanage. It was envisaged that the caregivers could continue the programme. However, the enthusiasm of the caregivers waned over the year the programme was entrusted to them. After 1 year, a full time play therapist was recruited to rejuvenate the play programme. Children's development was assessed using the Indian adaptation of the Bayley Scales of Infant Development. The first assessment was done when the play therapist joined. Subsequently, three-monthly assessments were done and the scores achieved were recorded. The initial mean motor and mental scores, when the play therapist joined, were 66.14 and 56.95, respectively (similar to the pre-intervention scores of the pilot study reported in an earlier paper). The scores improved to 81.84 and 78.25 within 3 months of restarting the play programme. The schedule of the 'Not by Bread Alone' project can accelerate the motor and mental development of children in orphanages. However, it requires a highly motivated and dedicated person to sustain this programme over long periods.


Comparing methods of determining Legionella spp. in complex water matrices.
Legionella testing conducted at environmental laboratories plays an essential role in assessing the risk of disease transmission associated with water systems. However, drawbacks of culture-based methodology used for Legionella enumeration can have great impact on the results and interpretation which together can lead to underestimation of the actual risk. Up to 20% of the samples analysed by these laboratories produced inconclusive results, making effective risk management impossible. Overgrowth of competing microbiota was reported as an important factor for culture failure. For quantitative polymerase chain reaction (qPCR), the interpretation of the results from the environmental samples still remains a challenge. Inhibitors may cause up to 10% of inconclusive results. This study compared a quantitative method based on immunomagnetic separation (IMS method) with culture and qPCR, as a new approach to routine monitoring of Legionella. First, pilot studies evaluated the recovery and detectability of Legionella spp using an IMS method, in the presence of microbiota and biocides. The IMS method results were not affected by microbiota while culture counts were significantly reduced (1.4 log) or negative in the same samples. Damage by biocides of viable Legionella was detected by the IMS method. Secondly, a total of 65 water samples were assayed by all three techniques (culture, qPCR and the IMS method). Of these, 27 (41.5%) were recorded as positive by at least one test. Legionella spp was detected by culture in 7 (25.9%) of the 27 samples. Eighteen (66.7%) of the 27 samples were positive by the IMS method, thirteen of them reporting counts below 10(3) colony forming units per liter (CFU l(-1)), six presented interfering microbiota and three presented PCR inhibition. Of the 65 water samples, 24 presented interfering microbiota by culture and 8 presented partial or complete inhibition of the PCR reaction. So the rate of inconclusive results of culture and PCR was 36.9 and 12.3%, respectively, without any inconclusive results reported for the IMS method. The IMS method generally improved the recovery and detectability of Legionella in environmental matrices, suggesting the possibility to use IMS method as valuable indicator of risk. Thus, this method may significantly improve our knowledge about the exposure risk to these bacteria, allowing us to implement evidence-based monitoring and disinfection strategies.


Intra-procedural determination of viability by myocardial deformation imaging: a randomized prospective study in the cardiac catheter laboratory.
The benefit of revascularization for functional recovery depends on the presence of viable myocardial tissue. Myocardial deformation imaging allows determination of myocardial viability. In a first approach, we assessed the optimal cutoff value to determine preserved viability by layer-specific echocardiographic myocardial deformation imaging at rest and low-dose dobutamine (DSE) echocardiography: regional endocardial circumferential strain (eCS) <-19% at rest was as accurate as eCS at DSE. In a main study, 123 patients (66% men, age 59 ± 6 years) with relevant coronary stenoses and corresponding severe regional myocardial dysfunction were included and randomized in 2 groups after coronary angiography: group A: intra-procedural myocardial deformation imaging in the cardiac catheter laboratory (CLab), determination of myocardial viability by regional eCS <-19%, in case of positive viability immediate coronary intervention in the same session. Group B: two-step determination of myocardial viability by cardiovascular magnetic resonance (CMR), in case of positive viability coronary intervention. After 18 months follow-up an analysis of the endpoints regarding cardiovascular events, left ventricular (LV) function, and comparison of cost was performed. Group A (N = 61) and group B (N = 62) showed no differences concerning localization of the coronary stenosis, comorbidities, or medical therapy. Cardiovascular events at 18-month follow-up were as follows: group A 13% (N = 10) vs. group B 14% (N = 9, p = 0.288); improvement of LV function: group A: +7 ± 2% vs. group B: +7 ± 3%, p = 0.963; costs: group A: 3096 Dollar vs. group B: 6043 Dollar, p < 0.001. Intra-procedural determination of myocardial viability by myocardial deformation imaging in the CLab is feasible, safe, and cost effective and may become an emerging alternative to the current practice of two-stage viability diagnostics.


HLA-DR7-specific monoclonal antibodies and a chimpanzee anti-DR7 serum detect different epitopes on the same molecule.
We describe here two monoclonal antibodies with HLA-DR7 serologic specificity. The antibodies, SFR16-DR7M, a cytotoxic rat IgM antibody of high affinity, and SFR16-DR7G, a noncytotoxic antibody of the rat IgG 2a class, react with only DR7-positive cells in radioimmunoassay. The cytotoxic activity of SFR16-DR7M correlates completely with the presence of the DR7 specificity, and segregates with the DR7-bearing haplotype in a family. SFR16-DR7M precipitates a class II molecule with the electrophoretic characteristics of DR molecules from LG-10, an HLA-DR7 homozygous cell line. SFR16-DR7G completely inhibits the cytotoxicity of SFR16-DR7M, but only partially inhibits the cytotoxicity of a chimpanzee antiserum with DR7 specificity, Gay/Swei. In binding-inhibition studies, binding of SFR16-DR7M to LG-10 cells is only partially inhibited by the chimpanzee antiserum and vice versa. Both SFR16-DR7M and Gay/Swei reciprocally deplete the same class II molecules from a 35S-methionine-labeled detergent-solubilized membrane preparation of the LG-10 cell line. The chimpanzee serum Gay contains antibodies reactive with epitopes on separated DR7 beta chains, while both SFR16-DR7M and SFR16-DR7G bind only to DR7 alpha-beta complexes. These data suggest that at least two allogenic epitopes exist which result in the same serologic specificity, and that these epitopes differ in their requirement for alpha-beta complex formation.


Outcome of right hepatectomy for living liver donors: a single Egyptian center experience.
This study aims to evaluate living liver donor outcome after right hepatectomy in a single Egyptian center. Between April 2004 and July 2010, 100 living donors underwent right hepatectomy. Their medical records and postoperative follow-up visits were retrospectively revised. Perioperative complications were reported. Postoperative complications were classified according to the five tier version of Clavien system. There were 71 males and 29 females. The mean age was 27.6 ± 7.4 years. The mean graft weight was 999 ± 167 g and the mean volume percent of the remaining liver was 36.8 ± 8%. The mean ICU and hospital stay were 2.6 ± 2.7 and 12.4 ± 9.1, respectively. A total of 57 complications developed in 38 donors (38%). The commonest complication type was biliary complications. There were 22 grade I, 6 grade II, 15 grade IIIa, 12 grade IIIb, 1 grade IVa, and 1 grade V complications. One donor died due to posttransfusion ARDS on the 30th postoperative day. On follow-up, no donor developed long lasting disability. A donor died in a road traffic accident 1 year after donation. Donor right hepatectomy is not an entirely safe procedure. Biliary complications are the commonest early postoperative complications.


In situ hybridization.
In situ hybridization is a technique with wide application in laboratory medicine. In this article, the basic and technical aspects of in situ hybridization are reviewed, and applications are discussed that emphasize methods for the detection of gene expression.


Regulation of protein degradation by insulin-degrading enzyme: analysis by small interfering RNA-mediated gene silencing.
Proteins are vital to the overall structure of cells and to the function of cells in the form of enzymes. Thus the control of protein metabolism is among the most important aspects of cellular metabolism. Insulin's major effect on protein metabolism in the adult animal is inhibition of protein degradation. This is via inhibition of proteasome activity via an interaction with insulin-degrading enzyme (IDE). IDE is responsible for the majority of cellular insulin degradation. We hypothesized that a reduction in IDE would reduce insulin degradation and insulin's ability to inhibit protein degradation. HepG2 cells were transfected with siRNA against human IDE and insulin degradation and protein degradation measured. Both IDE mRNA and protein were reduced by >50% in the IDE siRNA transfected cells. Insulin degradation was reduced by approximately 50%. Cells were labeled with [3H]-leucine to investigate protein degradation. Short-lived protein degradation was unchanged in the cells with reduced IDE expression. Long-lived and very-long-lived protein degradation was reduced in the cells with reduced IDE expression (14.0+/-0.16 vs. 12.5+/-0.07%/4h (long-lived), 9.6+/-2.2% vs. 7.3+/-0.2%/3h (very-long-lived), control vs. IDE transfected, respectively, P<0.005). The inhibition of protein degradation by insulin was reduced 37-76% by a decreased expression of IDE in HepG2 cells. This shows that IDE is involved in cellular insulin metabolism and provides further evidence that insulin inhibits protein degradation via an interaction with IDE.


Calcium-dependent inhibition of T-type calcium channels by TRPV1 activation in rat sensory neurons.
We studied the inhibitory effects of transient receptor potential vanilloid-1 (TRPV1) activation by capsaicin on low-voltage-activated (LVA, T-type) Ca(2+) channel and high-voltage-activated (HVA; L, N, P/Q, R) currents in rat DRG sensory neurons, as a potential mechanism underlying capsaicin-induced analgesia. T-type and HVA currents were elicited in whole-cell clamped DRG neurons using ramp commands applied before and after 30-s exposures to 1 μM capsaicin. T-type currents were estimated at the first peak of the I-V characteristics and HVA at the second peak, occurring at more positive potentials. Small and medium-sized DRG neurons responded to capsaicin producing transient inward currents of variable amplitudes, mainly carried by Ca(2+). In those cells responding to capsaicin with a large Ca(2+) influx (59% of the total), a marked inhibition of both T-type and HVA Ca(2+) currents was observed. The percentage of T-type and HVA channel inhibition was prevented by replacing Ca(2+) with Ba(2+) during capsaicin application or applying high doses of intracellular BAPTA (20 mM), suggesting that TRPV1-mediated inhibition of T-type and HVA channels is Ca(2+)-dependent and likely confined to membrane nano-microdomains. Our data are consistent with the idea that TRPV1-induced analgesia may derive from indirect inhibition of both T-type and HVA channels which, in turn, would reduce the threshold of nociceptive signals generation (T-type channel inhibition) and nociceptive synaptic transmission (HVA-channels inhibition).


[Erythrocyte immunologic function effects of Patrinia scabra extracts by macroporous adsorptive resins on mice burdened transplanted tumor].
To research the erythrocyte immunoregulation effects of Patrinia scabra extracts by macroporous adsorptive resins on mice burdened transplanted tumor. Extracts of Patrinia scabra Bunge were separated by macroporous adsorptive resins, ingredients were analysised. Mice burdened transplanted tumor were given extracted drugs. Life prolongation rate was observed, erythrocyte immunologic function and the CD35, CD44s contents of red blood cell were evaluated. Polysaccharide and saponin accounted for 8.4% and 48.4%. Extracts could porolong life expectancy of mice, improve erythrocyte immunolgic function and increase the CD35 and CD44s contents of red blood cell. Extracts of Patrinia scabra Bunge by macroporous adsorptive resins have erythrocyte immunoregulation effects on mice burdened transplanted tumor.


Catastrophic Antiphospholipid Syndrome: Scintigraphic Demonstration With Correlated Cross-Sectional Imaging.
We present the case of catastrophic antiphospholipid syndrome occurring in a 44-year-old woman with a recent history of coronary artery bypass surgery. Postoperatively, she was urgently readmitted for a left middle cerebral artery stroke, and during workup she was found with a left ventricular thrombus on echocardiogram. Subsequently, the patient was diagnosed with antiphospholipid syndrome. Multimodality imaging, including bone and myocardial perfusion scintigraphy, CT, and MR, during her hospitalization, depicted all the characteristic features constituting the catastrophic form of antiphospholipid syndrome, also known as Asherson syndrome.


Experimental paracoccidioidomycosis: alternative therapy with ajoene, compound from Allium sativum, associated with sulfamethoxazole/trimethoprim.
Ajoene has been described as an antithrombotic, anti-tumour, antifungal, antiparasitic and antibacterial agent. This study deals with the efficacy of ajoene to treat mice intratracheally infected with Paracoccidioides brasiliensis. The results indicate that ajoene therapy is effective in association with antifungal drugs (sulfametoxazol/trimethoprim), showing a positive additive effect. Ajoene-treated mice developed Th1-type cytokine responses producing higher levels of IFN-gamma and IL-12 when compared to the infected but untreated members of the control group. Antifungal activity of ajoene involves a direct effect on fungi and a protective pro-inflammatory immune response. Reduction of fungal load is additive to chemotherapy and therefore the combined treatment is mostly effective against experimental paracoccidioidomycosis.


Limitations of diazomethane for the quantification of 15-oxo-prostaglandin F2alpha.
The relatively rapid formation of pyrazoline adducts is a serious side reaction in the esterification of 15-oxo-PGF2alpha with ethereal diazomethane under conditions used routinely in the chemical derivatization of prostaglandins.


Skeletal muscle alterations indicate poor prognosis in cirrhotic patients: a multicenter cohort study in China.
We aimed to determine the diagnostic criteria of myosteatosis in a Chinese population and investigate the effect of skeletal muscle abnormalities on the outcomes of cirrhotic patients. Totally 911 volunteers were recruited to determine the diagnostic criteria and impact factors of myosteatosis, and 480 cirrhotic patients were enrolled to verify the value of muscle alterations for prognosis prediction and establish new noninvasive prognostic strategies. Multivariate analysis showed age, sex, weight, waist circumference, and biceps circumference had a remarkable influence on the L3 skeletal muscle density (L3-SMD). Based on the cut-off of a mean - 1.28 × SD among adults aged < 60 years, the diagnostic criteria for myosteatosis was L3-SMD < 38.93 Hu in males and L3-SMD < 32.82 Hu in females. Myosteatosis rather than sarcopenia has a close correlation with portal hypertension. The concurrence of sarcopenia and myosteatosis not only is associated with poor liver function but also evidently reduced the overall and liver transplantation-free survival of cirrhotic patients (p < 0.001). According to the stepwise Cox regression hazard model analysis, we established nomograms including TBil, albumin, history of HE, ascites grade, sarcopenia, and myosteatosis for easily determining survival probabilities in cirrhotic patients. The AUC is 0.874 (95% CI 0.800-0.949) for 6-month survival, 0.831 (95% CI 0.764-0.898) for 1-year survival, and 0.813 (95% CI 0.756-0.871) for 2-year survival prediction, respectively. This study provides evidence of the significant correlation between skeletal muscle alterations and poor outcomes of cirrhosis, and establishes valid and convenient nomograms incorporating musculoskeletal disorders for the prognostic prediction of liver cirrhosis. Further large-scale prospective studies are necessary to verify the value of the nomograms.


COVID-19 and Rumors: A Dynamic Nested Optimal Control Model.
Unfortunately, the COVID-19 outbreak has been accompanied by the spread of rumors and depressing news. Herein, we develop a dynamic nested optimal control model of COVID-19 and its rumor outbreaks. The model aims to curb the epidemics by reducing the number of individuals infected with COVID-19 and reducing the number of rumor-spreaders while minimizing the cost associated with the control interventions. We use the modified approximation Karush-Kuhn-Tucker conditions with the Hamiltonian function to simplify the model before solving it using a genetic algorithm. The present model highlights three prevention measures that affect COVID-19 and its rumor outbreaks. One represents the interventions to curb the COVID-19 pandemic. The other two represent interventions to increase awareness, disseminate the correct information, and impose penalties on the spreaders of false rumors. The results emphasize the importance of interventions in curbing the spread of the COVID-19 pandemic and its associated rumor problems alike.


Structural neuroimaging of the basal ganglia in schizophrenic patients: a review.
The basal ganglia structures have quickened interests in schizophrenia research for several reasons: On the one hand, schizophrenic patients are successfully treated with neuroleptics acting on dopamine receptors, which are highly concentrated in the basal ganglia structures. On the other hand, basal ganglia play an important role in higher cognitive functions such as attention, working memory and goal-directed behavior, which are impaired in schizophrenia. Magnetic resonance imaging allows non-invasive in vivo volumetric measurement of these brain structures. In this review, we studied all available papers on MRI research of the basal ganglia in schizophrenic patients. We found a possibly decreased caudate volume in first-episode schizophrenic patients, whereas studies on chronic patients mostly reveal volume increases in caudate, putamen and pallidum. Data from longitudinal studies suggest on the one hand that typical and atypical neuroleptics may produce different effects on brain morphology and on the other hand, that these changes are dynamic and might be reversible. Further studies are warranted for a better understanding of the mechanisms, which may lead to structural basal ganglia abnormalities, with medication effects demanding particular attention.


Radical irradiation of T2 grade III and T3 bladder cancer--tumor response and prognosis.
A retrospective review was undertaken of the records of 69 patients treated by radical irradiation between 1972 and 1977 for T2 Grade III and T3 bladder cancer. Twenty-six of the patients were treated to a tumor dose of 54 Gy in 2 Gy fractions using five daily fractions per week and 24 of the patients were treated to a tumor dose of 48.6 Gy in 3.47 Gy fractions given tri-weekly. The tumor response and its relationship to patient five year survival with bladder conservation was determined. Tumor response was assessed on the basis of the documented gross cystoscopic findings between 6 and 12 months after radiotherapy. This could be done in 63 of the 69 patients. The complete response rate was 43%. The five year survival rate with bladder conservation for all the patients in the study was 24%; for those with a complete response at cystoscopy, 54%; and for those failing to achieve a complete response, 5.8%. A statistically significant improvement in survival with bladder conservation for patients with complete response was found in both subgroups of uniformly treated patients. A 17% incidence of severe late gastrointestinal tract complications was noted in the subgroup of patients treated with large radiation fractions. These results confirm the prognostic value of the tumor response at cystoscopy after radical radiotherapy, expand the total dose or TDF range over which it has been observed and document its occurrence with an unconventional radiation fractionation schedule.


Energy harvesting from the cardiovascular system, or how to get a little help from yourself.
Human energy harvesting is envisioned as a remedy to the weight, the size, and the poor energy density of primary batteries in medical implants. The first implant to have necessarily raised the idea of a biological power supply was the pacemaker in the early 1960s. So far, review articles on human energy harvesting have been rather unspecific and no tribute has been given to the early role of the pacemaker and the cardiovascular system in triggering research in the field. The purpose of the present article is to provide an up-to-date review of research efforts targeting the cardiovascular system as an alternative energy source for active medical implants. To this end, a chronological survey of the last 14 most influential publications is proposed. They include experimental and/or theoretical studies based on electromagnetic, piezoelectric, or electrostatic transducers harnessing various forms of energy, such as heart motion, pressure gradients, and blood flow. Technical feasibility does not imply clinical applicability: although most of the reported devices were shown to harvest an interesting amount of energy from a physiological environment, none of them were tested in vivo for a longer period of time.


Ambulatory monitoring of heart rate and blood pressure during the first week after smoking cessation.
To investigate the timecourse of cardiovascular changes immediately after smoking cessation, 16 subjects wore ambulatory monitors on alternate days during a 1-week residential smoking cessation program. Heart rate was significantly elevated at the time of cessation, then declined steadily until 6 h after cessation, when it reached the level of subsequent nonsmoking days. Systolic and diastolic blood pressures were elevated to a lesser degree for the same period after cessation. The timing of the decline in heart rate and blood pressure was coincident with the timing of an increase in withdrawal symptoms and has implications for laboratory and epidemiologic studies.


Hippocampal cell nuclear binding of corticosterone following 5,7-dihydroxytryptamine.
Adult male rats were injected into the lateral brain ventricle with 5,7-dihydroxytryptamine (5,7-DHT). They were adrenalectomized 5-7 days later and, following an additional 24 h, the specific in vitro [3H]corticosterone binding capacity of dorsal hippocampal slices was determined by estimation of uptake of radioactivity by the nuclear fraction. Specific corticosterone (CS) binding was reduced by 50-70% in the neurotoxin-treated as compared to vehicle-injected animals. Brain serotonin and 5-hydroxyindoleacetic acid concentrations were depleted by 50-70% in the 5,7-DHT-injected rats. These results suggest that the maintenance of normal dorsal hippocampal CS binding capacity is dependent upon the integrity of endogenous brain serotoninergic neuronal systems.


Novel Targets for the Treatment of Melanoma.
In this article, we will briefly review the current treatment landscape for metastatic melanoma and provide a comprehensive update on emerging novel treatment strategies. Over the past decade, remarkable advances in immunotherapy and targeted therapy have greatly improved outcomes for patients with advanced melanoma. Although a subset of patients is able to achieve durable responses, the majority experience eventual disease progression on existing therapies. Trials evaluating novel combinatorial strategies, checkpoint inhibitors, immune agonists, T cell-based therapies, intratumoral agents, and others are ongoing. While strides have been made in the treatment of advanced melanoma, further research is needed to identify alternative immune and molecular targets in order to overcome resistance and achieve better clinical outcomes.


Neonatal haemochromatosis associated with Down syndrome.
The clinical course of a child with neonatal haemochromatosis associated with Down syndrome is described, using case notes and post-mortem examination. The patient died of liver failure on day 36. Post-mortem examination showed siderosis of liver, pancreas, heart, kidney and thyroid. Neonatal haemochromatosis is a rare paediatric disease, the aetiology of which is unknown. Evidence suggests a disorder of fetoplacental iron handling with implications for recurrence in future pregnancies.


Antimicrobial therapy of bacterial sepsis in the newborn infant.
Septicemia continues to be an important cause of neonatal morbidity and mortality. The bacteria most commonly responsible are group B beta-hemolytic streptococci and Escherichia coli, but regional differences exist. Recently sepsis caused by Staphylococcus epidermidis has occurred with increasing frequency in several neonatal intensive care units. Other organisms are less commonly responsible. The choice of antibiotics for suspected sepsis is based on the possible organisms involved and their antibiotic susceptibility patterns, which vary from hospital to hospital and at different times in the same hospital. Currently recommended initial therapy consists of a penicillin and an aminoglycoside, usually ampicillin and gentamicin. The addition of vancomycin is indicated when staphylococcal septicemia is suspected. During outbreaks of neonatal sepsis caused by aminoglycoside-resistant gram-negative bacteria, the use of third-generation cephalosporins or acylaminopenicillins may be appropriate, depending on the results of susceptibility tests. Continuing efforts to develop antibiotics for the treatment of neonatal sepsis are warranted.


Congenital heart defects: the patients who die.
To register mortality and causes of death in patients with congenital heart defects (CHDs). Prospective population-based observational study. 553 infants with CHD (1.1% of live born) were observed for 1-22 y (median 10 7/12 y). Sixty-four died (11.6%), of whom 32 (50%) died during the first 4 wk, and 51 (79.7%) during the first year of life. Of the total neonatal deaths in the population (3 per 1000), CHDs occurred in 21.5%. Mortality for children with CHDs was not significantly different between the cohorts born in 1982-1991 and 1992-2002, for either neonatal deaths or deaths later on (p>0.05). Out of 170 patients in whom therapeutic procedures (surgery, catheter interventions) were undertaken, 34 (20%) died. Nine cases (1.6%) died with unrecognized CHDs; seven of these on the first day of life with severe extracardiac malformations. In 50 (78.1%) cases, death was judged to be caused directly or indirectly from the CHD, and in 14 (21.9%) from extracardiac malformations or other conditions. CHDs occur in a substantial number of neonatal deaths. Most deaths are caused by cardiac insufficiency. The mortality rate remained unchanged.


Nickel-induced histopathological alterations in the gill architecture of a tropical freshwater perch, Colisa fasciatus (Bloch & Schn.).
The effect of a sub-lethal concentration of 64 ppm (2.279 x 10(-4) mol l-1) of nickel sulphate (NiSO4.7H2O) on the gill of a freshwater tropical perch, Colisa fasciatus, was investigated after 96 h exposure. Prominent changes noticed were: hypertrophy of respiratory and mucous cells; separation of the epithelial layer from the pillar cell system; cauterization and sloughing; extensive necrosis of the epithelium; and hyperplasia leading to clubbing at the tip of the lamellae.


Differences in Postoperative Pain, Nausea, and Vomiting After Elective Laparoscopic Cholecystectomy in Premenopausal and Postmenopausal Mexican Women.
Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6 h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.


Demographic dynamics of waterborne disease and perceived associated WASH factors in Bushenyi and Sheema districts of South-Western Uganda.
Water remains a significant player in spreading pathogens, including those associated with neglected tropical diseases. The implications of socio-demographic delineations of water quality, sanitation, and hygiene ("WASH") interventions are on the downswing. This study assessed waterborne diseases and perceived associated WASH factors in the Bushenyi and Sheema districts of South-Western Uganda. This study examines the linear relationship between WASH and identifies the association of specific demographic factors as well as their contributions/correlations to waterborne disease in the study area. A structured qualitative and quantitative data collection approach was adopted in face-to-face questionnaire-guided interviews of 200 respondents on eight surface water usage. Most participants, 65.5%, were females and had a higher score of knowledge of WASH (71%), 68% score on the improper practice of WASH, and 64% score on unsafe water quality. Low score for basic economic status was (57%), report of common diarrhoea was (47%), and a low incidence of waterborne disease outbreaks (27%). The principal component analysis (PCA) depicts the knowledge and practice of WASH to have a strong positive correlation (r = 0.84, p < 0.001; r = 0.82, p < 0.001); also economic status positively correlated with grade of water source, knowledge, and practice of WASH (correlation coefficient = 0.72; 0.99; 0.76 and p-values = 0.001; < 0.001; < 0.001 respectively). Occupation (p = 0.0001, OR = 6.798) was significantly associated with knowledge and practice of WASH, while age (r = -0.21, p < 0.001) was negatively associated with knowledge and practice of WASH. The basic economic status explains why "low economic population groups" in the remote villages may not effectively implement WASH, and diarrhoea was common among the population. Diarrhoea associated with unsafe water quality and improper practice of WASH is common among the study population, and there is a low incidence of waterborne disease outbreaks. Therefore, government, stakeholders, and non-governmental organisations should work together to promote proper practice of WASH conditions to limit the occurrence of diarrhoea and prevent potential waterborne disease outbreaks.


The economic effect of child abuse in the burn unit.
The financial burden imposed on society by abusing children through burn injury is unknown. This study retrospectively evaluates the economic impact and demographics of such abuse on patients and their families treated at Children's Hospital Medical Center of Akron (CHMCA) from four counties over a 5 year period. The inclusive group consisted of all children evaluated during the stated period referred to Social Services for possible child abuse. There were 104 children (55 females and 49 males, 46% black and 56% white) with a mean age of 3.76 years. 71% of the patients came from single parent homes (all single mothers). There were a total of 58 admissions with a mean length of stay of 10.53 days. Total cost for all patients was approximately 1.2 million dollars for health care, of which 65% was government funded. In addition to hospital costs, the perpetrators incurred court costs and jail costs, all of which were the financial responsibility of Summit County. Child abuse through burns imposes a potentially preventable financial burden. This study does not take into account the socioeconomic and psychological impact on the abused victims through life, which is incalculable. By increasing awareness about the demographics and financial burden of child abuse, this paper may serve as a focus for further study and prevention of such abuse.


Vascular ultrasonography.
Vascular ultrasonography is now widely employed in the noninvasive screening of patients with atherosclerotic vascular disease. To date, radiologists have concentrated their efforts on the extracranial carotid arteries, but skills and technology developed in this area clearly have applicability elsewhere. Understanding of the physiologic parameters governing blood flow to the lower extremity is clearly useful in this day of interventional balloon angioplasty. There appears to be no single best test for noninvasive assessment of vascular disease, although each has its proponents and detractors. No single noninvasive technique described in this article appears to be a totally adequate screening test. Each has its strengths and limitations, but if one understands the different tests their complementary nature becomes clear. Utilization of a battery of noninvasive tests has been advocated, and various studies have suggested that when the results of two or more noninvasive tests agree, the diagnostic accuracy of that study increases significantly. In most noninvasive laboratories, at least two tests are performed, and in some noninvasive laboratories, as many as seven or eight tests are done. There is, of course, the danger that too much information may overwhelm the examiner, particularly when there may appear to be conflict among some of the test results. Furthermore, cost considerations and concern as to whether more is indeed better place realistic limitations on the number of studies that can and should be performed on any one individual. The choice of the most appropriate noninvasive tests for any single institution should be facilitated by a knowledge of the basic principles and strategies of vascular sonography outlined in this article.


Congenital spinal and cord lesions in children and computed tomographic metrizamide myelography.
Computed tomographic metrizamide myelography (CTMM) has developed into a highly sophisticated and accurate neuroradiologic technique in the diagnosis of childhood spinal dysrhaptic states. Of the 84 patients studied by this technique, 31 with the dysrhaphic spine also had lesions such as a tethered and low conus, diastematomyelia, or neuroenteric cysts. We believe that the exquisite pathologic anatomy obtained by CTMM obviates all neuroradiologic techniques other than a preliminary anteroposterior and lateral spinal roentgenograph.


Potential for volatile fatty acid production via anaerobically-fermenting rice straw pretreated with silage effluent and phenyllactic acid.
To resolve environmental problems associated with rice straw and silage effluent disposal, silage effluent pretreating rice straw for the anaerobic production of volatile fatty acids (VFAs) was investigated. To prevent the lactic acid bacteria in silage effluent from inhibiting anaerobic fermentation, four phenyllactic acid (PLA) levels were set (0, 0.1, 0.3, 0.5 mg/kg). The total VFA yields of treatments pretreated only with silage effluent (CK) were higher than the groups combined with PLA during 15 days fermentation. Compared to PLA treatments, the total VFA of CK increased by 11.4 % ∼ 25.1 % on day 15. The CK showed higher lactic and propionic acid contents and lower pH values (<4.9). The PLA treatments decreased Lactobacillus abundance while increasing bacterial richness and evenness, and acetic and butyric acid contents. These demonstrated silage effluent has the potential to be used as a biological pretreatment for VFA production in anaerobic fermentation.


Neurophysiological and CSF immunological study of 19 patients affected by acute idiopatic optic neuritis.
We studied 19 patients affected by acute idiopatic optic neuritis (ON), with neurophysiological tests: visual (VEP), somatosensory (SSEP), acoustic (ABR) evoked potentials and study of the blink reflex (BR), and with cerebrospinal fluid (CSF) examination, in order to detect "silent" lesions in the central nervous system (CNS) and/or immunological alterations, suggestive of multiple sclerosis (MS). The percentage of cases with at least one altered CSF IgG parameter (IgG index, IgG synthesis/day and IgG oligoclonal bands) has been higher than that of cases with one or more altered neurophysiological tests, regardless of the apparently intact eye VEP. If we also included this last test, the 2 percentages become identical. The validity of these tests in predicting the evolution of ON in MS is discussed.


Buttressing of the EEA stapler during gastrojejunal anastomosis decreases rate of bleeding-related complications for laparoscopic gastric bypass.
Bariatric surgery is a well-tolerated and effective treatment for severe obesity. Newer surgical techniques and equipment have improved safety standards surrounding bariatric surgery. In particular, buttressing of the staple line in sleeve gastrectomy has decreased rates of clinically significant postoperative bleeding. The present study investigates the effectiveness of buttressing the circular stapled anastomosis during laparoscopic Roux-en-Y gastric bypass (LRYGB). Academic, accredited hospital. A total of 253 patients undergoing LRYGB at a single academic institution were included in this retrospective study between 2014 and 2015. Buttressing material was used in 125 of these cases. Demographic information was collected from both groups preoperatively. Surgical characteristics were also obtained analyzed using unpaired t or χ2 tests. Patients in both buttressing and nonbuttressing groups were on average 46 years old and predominantly female (79.2% versus 74.2% female, respectively), with a body mass index of approximately 48 kg/m2. Postoperative weight loss did not significantly differ between groups at any time point (buttressing versus nonbuttressing percentage of excess weight loss: 39.5% versus 41.5% at 3 mo, P = .3860; 56.4% versus 56.7% at 6 mo, P = .9341). There were no significant differences for operating time, length of stay, readmissions, or reoperations. Complications due to strictures were found to be lower for the buttressing group (0% buttressing versus 2.3% nonbuttressing, P = .0851). Specific rates of bleeding-related complications were significantly lower for the group in which buttressing was used (0% buttressing versus 3.1% nonbuttressing, P = .0463). Buttressing of the gastrojejunal anastomosis during LRYGB significantly reduces bleeding-related complications and increases tolerability of the procedure.


Malignant peritoneal mesothelioma after remote abdominal radiation.
Peritoneal mesothelioma in a 61-year-old man, occurred 26 years after abdominal radiotherapy for a testicular seminoma. The patient had no history of asbestos exposure. After asbestos, radiation is the second most frequent defined cause of mesothelioma in North America, but the number of well-documented cases is small; this case represents only the fifth example of peritoneal mesothelioma after therapeutic irradiation of the abdomen.


Cationic perylenediimide as a specific fluorescent binder to mismatch containing DNA.
Small ligand molecules, which can recognize thermodynamically unstable site within DNA, such as mismatch base pair, abasic site, and single-bulge, have attracted much attention because of their potential diagnostics and biological applications. In this paper, we describe the binding of cationic perylenediimide (cPDI) molecules to thymine-containing mismatch base pair in DNA and the formation of cPDI dimer at the mismatch site. The cPDI dimer exhibits a characteristic excimer emission at 650nm. For T/T mismatch containing DNA, the switching behavior from the PDI dimer (650nm) to the monomer (550nm) emission in specific response to Hg(2+) ion was observed.


Ontogeny of neuropeptides in the nucleus ventromedialis hypothalami of the rat: an immunohistochemical analysis.
The ontogeny of leucine-enkephalin (ENK)-, cholecystokinin-8 (CCK)-, substance P (SP)- and neurotensin (NT)-like immunoreactive structures were examined in the nucleus ventromedialis hypothalami (vm) of the rat by means of an indirect immunofluorescence method. ENK- (ENKI), SP- (SPI) and CCK-like immunoreactive (CCKI) structures in the vm exhibited very similar ontogenetic developments, though no CCKI cells were detected. ENKI fibers as well as SPI fibers and neurons first appeared at gestational day 21, ENKI neurons at postnatal day 2, and CCKI fibers at postnatal day 1. These structures subsequently increased in number. The maximum content was reached at postnatal day 21 and was observed even in the adult rats (postnatal day 30). On the other hand, NTI fibers first appeared at postnatal day 1; they decreased in number and no or only a few NTI fibers were seen in the adult rats. No NTI cells were seen in the vm.


Improving performance of motorized slides for micromanipulation.
Motorized linear slides used as micromanipulators for biological use suffer from 3 problems: vibration at low speed, poor ergonomic design of the controller and slow coarse positioning. These problems are not hard to solve by minor modifications to the controller and the slides.


Cu-based MOF-derived architecture with Cu/Cu2O nanospheres anchored on porous carbon nanosheets for efficient capacitive deionization.
The design of high-performance electrode materials with excellent desalination ability has always been a research goal for efficient capacitive deionization (CDI). Herein, a hybrid architecture with Cu/Cu2O nanospheres anchored on porous carbon nanosheets (Cu/Cu2O/C) was first synthesized by pyrolyzing a two-dimensional (2D) Cu-based metal-organic framework and then evaluated as a cathode for hybrid CDI. The as-prepared Cu/Cu2O/C exhibits a hierarchically porous structure with a high specific surface area of 305 m2 g-1 and large pore volume of 0.55 cm3 g-1, which is favorable to accelerating ion migration and diffusion. The porous carbon nanosheet matrix with enhanced conductivity will facilitate the Faradaic reactions of Cu/Cu2O nanospheres during the desalination process. The Cu/Cu2O/C hybrid architecture displays a high specific capacitance of 142.5 F g-1 at a scan rate of 2 mV s-1 in 1 M NaCl solution. The hybrid CDI constructed using the Cu/Cu2O/C cathode and a commercial activated carbon anode exhibits a high desalination capacity of 16.4 mg g-1 at an operation voltage of 1.2 V in 500 mg L-1 NaCl solution. Additionally, the hybrid CDI exhibits a good cycling stability with 18.3% decay in the desalination capacity after 20 electrosorption-desorption cycles. Thus, the Cu/Cu2O/C composite is expected to be a promising cathode material for hybrid CDI.