Pediatric esophageal diverticulum following button batter ingestion. A case report.
Foreign body ingestion is a frequent and potentially life-threatening concern in children, with button batteries being the second most frequently ingested object trailing coins. The mechanical and chemical impact of foreign objects on delicate esophageal lumen poses a grave concern. Herein, we unveil a compelling case of a two-year-old girl who suffered from difficulty in swallowing, weight loss, and frequent chest infections. A chest X-ray revealed a halo sign within the confines of her thoracic esophagus. However, the formidable challenge of extensive inflammation greatly hindered visibility during esophagoscopy, leading to an imperative decision of thoracotomy. The surgical exploration uncovered an esophageal diverticulum, skillfully managed with a conservative approach. Three months postoperatively, she resumed regular feeds without chest symptoms. Foreign body ingestion is predominantly among children below four years, with button batteries being among the frequent objects involved. Endoscopic retrieval is an effective and less morbid procedure for foreign body retrieval. Esophageal diverticula following button battery ingestion have rarely been reported. Timely diagnosis and effective management of esophageal foreign bodies are crucial, as chemical reactions from button batteries can commence within two hours of ingestion. Swift and decisive actions, coupled with less morbid procedures such as endoscopic retrieval should be prioritized in the management.


Process optimization in poultry feed mill.
The poultry feed industry is pretty much active in a lot of countries and it is achieved market acceptance. The final products are supposed to meet certain specifications to fulfill the nutritional need of animals at different life periods. The final product for poultry is shipped in the form of pelleted feed for the convenience of consumption. One of the major challenges of poultry feed production is the principal complement of equipment necessary for the local production. Imported poultry pellets are quite expensive and unaffordable for many poultry feed industries. Hence, the need to be able to produce poultry feed at lower cost yet achieve the objective of quantity and quality expected of pelleted feeds is critical to the viability of the enterprise. The study aims to investigate the effects of some operating parameters (pressure and temperature of the compounded feed) and die hole size on the pelleting efficiency, throughput capacity, and to optimize the conditions. The improvement approach is conducted by observing the main operating parameters of productivity; statistical analysis is conducted to observe the effect of those parameters on the production rate and the quality of the product. Comparison between parameter levels is done through analysis of variance to determine the significance of the tested parameters. The optimization of parameters was applied with Minitab and designed expert software to determine the best operating conditions. The obtained results showed that the downtime decreased by 77% monthly and productivity increased by 32.5% per hour and the pellet durability index increased by 1.23%. The total sales increased by 6,750,600 LE/Month.


Abundance of intrinsic structural disorder in the histone H1 subtypes.
The intrinsically disordered proteins consist of partially structured regions linked to the unstructured stretches, which consequently form the transient and dynamic conformational ensembles. They undergo disorder to order transition upon binding their partners. Intrinsic disorder is attributed to histones H1, perceived as assemblers of chromatin structure and the regulators of DNA and proteins activity. In this work, the comparison of intrinsic disorder abundance in the histone H1 subtypes was performed both by the analysis of their amino acid composition and by the prediction of disordered stretches, as well as by identifying molecular recognition features (MoRFs) and ANCHOR protein binding regions (APBR) that are responsible for recognition and binding. Both human and model organisms-animals, plants, fungi and protists-have H1 histone subtypes with the properties typical of disordered state. They possess a significantly higher content of hydrophilic and charged amino acid residues, arranged in the long regions, covering over half of the whole amino acid residues in chain. Almost complete disorder corresponds to histone H1 terminal domains, including MoRFs and ANCHOR. Those motifs were also identified in a more ordered histone H1 globular domain. Compared to the control (globular and fibrous) proteins, H1 histones demonstrate the increased folding rate and a higher proportion of low-complexity segments. The results of this work indicate that intrinsic disorder is an inherent structural property of histone H1 subtypes and it is essential for establishing a protein conformation which defines functional outcomes affecting on DNA- and/or partner protein-dependent cell processes.


Posterior capsule opacification after silicone lens implantation and its management.
The incidence and time of onset of posterior capsular opacification in a consecutive series of 147 silicone lens implants and in 585 polymethylmethacrylate (PMMA) lens implants were compared. Silicone lenses, sulcus and capsular bag fixated, had an opacification rate of 27.9%, while PMMA had a rate of 7.0%. In the silicone lens series, 65.9% of the opaque capsules required YAG laser posterior capsulotomies in the first four months. In the PMMA implants, only 28.6% required YAG laser capsulotomies in the first four months. The mean follow-up time was nine months. Management of capsular opacification in silicone lenses required early YAG laser capsulotomy, with focusing posterior to the capsule to avoid pitting the implant.


A new African species of parasitic Dero (Annelida, Clitellata, Naididae) in the urinary tract of reed frogs.
A new species of naidid oligochaete, Dero rwandae, detected in the bladder and the Wolffian ducts of reed frogs Hyperolius kivuensis from Rwanda, is described. Until now, D. bauchiensis was the only endoparasitic Dero known to infect African frogs infesting the eyes and Harderian glands. To the best of our knowledge, the finding of D. rwandae is the first record of an African Dero species infecting the urinary tract of anurans. In general morphology, the two African Dero parasites resemble each other, but differences in the features of ventral setae morphology exist. Parts of the mitochondrial 16S rRNA locus and the nuclear 18S and 28S rRNA loci were sequenced to assess the phylogenetic relationships to other Dero spp. Among those few species, that are barcoded so far, the closest relative of the new taxon is D. superterrenus, a free-living South American species. The species groups formerly termed subgenera Allodero, Aulophorus and Dero within the genus Dero do not represent distinct evolutionary lineages and the genus is paraphyletic including Branchiodrilus.


Tricuspid Valve Repair Can Restore the Prognosis of Patients with Hypoplastic Left Heart Syndrome and Tricuspid Valve Regurgitation: A Meta-analysis.
To date, evidence supporting the efficacy of tricuspid valve (TV) repair in interrupting the progression of systemic right ventricular (RV) adverse remodeling in hypoplastic left heart syndrome (HLHS) is conflicting. We conducted a systematic review and meta-analysis of scientific literature to assess the impact of TV repair in effectively modifying the prognosis of patients with HLHS. We conducted a systematic review of PubMed, Web of Science, and Scopus databases. A random-effect meta-analysis was performed and transplant-free survival, freedom from TV regurgitation, and TV reoperation data were reconstructed using the published Kaplan-Meier curves. Nine studies were included, comprising 203 HLHS patients undergoing TV repair and 323 HLHS controls. The estimated transplant-free survival at 1, 5, and 10 years of follow-up was 75.5% [95% confidence interval (CI) = 67.6-84.3%], 63.6% [95% CI = 54.6-73.9%], and 61.9% [95% CI = 52.7-72.6%], respectively. Transplant-free survival was comparable to HLHS peers without TV regurgitation (p = 0.59). Five-year freedom from recurrence of TV regurgitation and freedom from TV reoperation was 57% [95% CI = 46.7-69.7%] and 63.6% [95% CI = 54.5-74.3%], respectively. Younger age and TV repair at the time of Norwood operation increased the risk of TV regurgitation recurrence and the need for TV reoperation. Our meta-analysis supports the efficacy of TV repair in favorably modifying the prognosis of patients with HLHS and TV regurgitation, reestablishing a medium-term transplant-free survival which is comparable to HLHS peers. However, durability of surgery and long-term fate of TV and RV performance are still unclear.


Changes in resting metabolic rate and body composition due to intragastric balloon therapy.
Intragastric balloon (IGB) insertion leads to dietary restriction; however, its neurohormonal actions were also described. Resting metabolic rate (RMR) adjusted for body mass (RMR/mass) seems to increase after bariatric interventions, whereas it generally decreases after caloric restriction-based therapies. However, no studies have evaluated the changes in body composition and RMR over IGB treatment. To evaluate the relationships between changes in body composition, RMR, RMR/mass, and RMR adjusted for fat-free mass (FFM) (RMR/FFM) over IGB treatment lasting 6 months. Single-center observational study. Twenty-one morbidly obese patients treated with IGB (143 ± 20 kg, body mass index [BMI] = 49.5 ± 7.3, 98% ± 29% percent excess weight, 43.6 ± 12.6 yr) were enrolled. Changes in body composition, RMR, RMR/mass, and RMR/FFM were evaluated between 1 month before IGB insertion (time point 1 [TP1]) and 3 months thereafter (TP2). Fourteen patients were also assessed 1 month after IGB removal (TP3). There was a 9.5% reduction in weight, a 9.4% reduction in BMI, and 19.1% decrease in percent excess weight at TP2 (n = 21; P < .001); a further 6.5% reduction in weight and BMI and a 13.1% drop in percent excess weight (n = 14, P < .001) at TP3. They were accompanied by a 5.4% reduction in FFM between TP1 and TP2 (n = 21, P < .001). Compared with pretreatment values, at TP2 RMR was 12.5% lower (P < .001) but did not change thereafter. RMR/mass increased 12.4% between TP2 and TP3 (n = 14, P = .02) but on average did not change between TP1 and TP3. The results in the smaller cohort (n = 14) between TP1 and TP2 were consistent with results obtained for the entire cohort. Similar findings were obtained for RMR/FFM. The larger increases in RMR/mass between TP1 and TP3 were associated with more weight loss, larger drop in BMI, and more loss of excess weight (r < -.55, P < .03). This is the first study to evaluate the relationship between changes in body composition and RMR over IGB treatment. IGB therapy leads to both fat and fat-free mass reductions and RMR decreases. More weight reduction is associated with larger increases in RMR/mass.


An outbreak of invasive group A streptococcal infection among elderly patients receiving care from a district nursing team, October 2013 - May 2014.
Between October 2013 and April 2014 five elderly patients living within a 2 square mile radius, were admitted to local hospitals with severe group A streptococcal cellulitis and septicaemia. Molecular typing confirmed four patients for whom typing results were available to have the same emm gene sequence type, emm st89. An outbreak investigation was launched and identified that each patient had received care interventions from a district nursing team at their home or local health clinic in the 7 days prior to onset of symptoms.


ATP protects against FITC labeling of Solanum lycopersicon and Arabidopsis thaliana Ca2+-ATPase ATP binding domains.
Ca(2+)-ATPases are integral membrane proteins that actively transport Ca(2+) against substantial concentration gradients in eukaryotic cells. This active transport is energized by coupling ion translocation with ATP hydrolysis. In order to better understand this coupling mechanism, we studied the nucleotide specificities of isolated ATP binding domains (ABDs) of Solanum lycopersicon Ca(2+)-ATPase (LCA), a type IIA non-calmodulin regulated P-type pump found in tomato plants that is very similar to mammalian sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA), and Arabidopsis Ca(2+)-ATPase, isoform 2 (ACA2), a type IIB calmodulin regulated P-type ATPase found in the endoplasmic reticulum of Arabidopsis cells. We used nucleotide protection against FITC labeling as a measure of binding since both LCA and ACA contained the KGAP(S,V,F)E motif, which has been shown to be modified by fluorescein isothiocyanate (FITC) in P-type pumps from animal cells. We demonstrated that the heterologously expressed GST-tagged ABDs from both LCA and ACA2 were modified by FITC and that ATP protects against this modification. Moreover, GTP was able to reduce, but not eliminate, the level of FITC labeling in both ABD constructs, suggesting that these plant pumps may also bind GTP with low affinity, which is in contrast to mammalian SERCA and PMCA type pumps which do not bind GTP.


Ergonomics applied to anaesthesia record keeping.
For almost 100 years, the anaesthesia record has been the sole information tool trying to fulfill an ample catalogue of functions related to the anaesthesia information processes. Automated anaesthetic record systems have evolved around data being available online, as an imitation of the handwritten record. None has developed an information tool capable of an efficient utilization of the wide range of resources provided by modern technology to fulfill the information requirements of the anaesthetic environment. We used a system ergonomic analysis trying to find the best solutions. As a result of it we drafted an Anaesthesia Information Concept (AIC) in which the complexity of data & information (D&I) processes is broken down to modules called Clinical Information Process Units (CIPUs). A CIPU is mainly defined by the responsibility of a staff member and focuses on the basic system patient, staff and machine (all devices). The internal functions of a CIPU are treatment control and medicolegal documentation. The external functions are fulfilled by transferring required sets of D&I for subsequent treatment control (next CIPU), audit, quality control, cost calculation, etc. Using such an approach, an Anaesthesia Information Concept (AIC) can be realized by a wide range of modular and hybrid systems (combination of different tools such as paper records, computers, etc), as opposed to universal and single automated documentation systems, which up to now have failed to fulfill the information demands of the anaesthetic environment.


The progression of traumatic Stanford type A acute aortic dissection.
Cardiopulmonary bypass for trauma patients carries the risk of bleeding from injured organs, while traumatic aortic dissection can progress rapidly. It is sometimes difficult to determine the optimal time for aortic repair in trauma patients. An 85-year-old woman was diagnosed with traumatic ascending aortic dissection, right clavicle and left first rib fracture, and abdominal contusions after a vehicle accident. After admission, the aortic dissection progressed, and emergent surgery was performed. Although the risk of hemorrhagic complications needs to be evaluated, prompt aortic repair is required.


GABA(B) receptors as potential targets for drugs able to prevent excessive excitatory amino acid transmission in the spinal cord.
The effects of GABA(B) receptor activation on the Ca2+-dependent depolarization-induced overflow of endogenous glutamic acid and gamma-aminobutyric acid (GABA) was studied in rat spinal cord nerve terminals exposed in superfusion to 15 mM KCl. The GABA(B) receptor agonist (-)-baclofen inhibited the K+-evoked overflow of glutamate (EC50=0.098 microM) but was almost inactive against that of GABA. The overflow of both transmitters could be quite similarly inhibited by two other GABA(B) receptor agonists, 3-APPA (3-aminopropylphosphonous acid; EC50=0.087 and 0.050 microM in the case of GABA and glutamate, respectively) and CGP 44532 (3-amino-2(S)-hydroxypropyl)methylphosphinic acid; EC50=0.81 and 0.50 microM). The GABA(B) receptor antagonist CGP 35348 [3-amino-propyl(diethoxymethyl)phosphinic acid] blocked the effect of 3-APPA (1 microM) at the autoreceptors (IC50 approximately = 1 microM), but not at the heteroreceptors. In contrast, the effects of 3-APPA at both autoreceptors and heteroreceptors could be similarly prevented by another GABA(B) receptor antagonist, CGP 52432 [3-[[(3,4-dichlorophenyl)methyl]amino]propyl](diethoxymethyl) phosphinic acid (IC50 approximately = 10 microM). The data suggest that, in the spinal cord, GABA(B) autoreceptors on GABA-releasing terminals differ pharmacologically from GABA(B) heteroreceptors on glutamatergic terminals. Selective GABA(B) receptor ligands may be helpful for conditions characterized by excessive glutamatergic transmission in the spinal cord.


BILN: A Human-Readable Line Notation for Complex Peptides.
We present an easy, human-readable line notation to describe even complex peptides.


A metaanalysis of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography in the staging and restaging of patients with lymphoma.
In recent years, the use of positron emission tomography (PET) has become widespread for the staging and follow-up of several malignancies. In the current study, the authors conducted a metaanalysis of the published literature to evaluate the diagnostic performance of 18F-2-deoxy-2-fluoro-D-glucose PET (FDG-PET) in the staging of patients with lymphoma. The authors conducted a systematic MEDLINE search of articles published between January 1995 and June 2004. Studies that evaluated FDG-PET with a dedicated camera and that reported sufficient data to permit the calculation of sensitivity and specificity were included in the analysis. Two reviewers independently reviewed the eligibility of the studies and abstracted data (sample population; characteristics of FDG-PET; and the number of true-positive results, true-negative results, false-positive results, and false-negative results). The authors estimated the pooled sensitivity, false-positive rate, and maximum joint sensitivity and specificity. Twenty studies were eligible for the metaanalysis. Fourteen studies included patient-based data, comprising a sample size of 854 subjects, and 7 studies included lesion-based data, totaling 3658 lesions. Among those studies with patient-based data, the median sensitivity was 90.3% and the median specificity was 91.1%. The pooled sensitivity was 90.9% (95% confidence interval [95% CI], 88.0-93.4) and the pooled false-positive rate was 10.3% (95% CI, 7.4-13.8). The maximum joint sensitivity and specificity was 87.8% (95% CI, 85.0-90.7). The pooled sensitivity and false-positive rate appeared to be higher in patients with Hodgkin disease compared with those with non-Hodgkin lymphoma. The results of the current study indicate that FDG-PET is a valuable tool for the staging and restaging of patients with lymphoma; showing a high positivity and specifity. Clinicians may consider adding FDG-PET to the staging workup of patients with lymphoma.


Photocatalytic and biodegradation treatments of paracetamol: investigation of the in vivo toxicity.
Medicines and drugs consumption by all populations of the world can be expected to result in the contamination of the environment since 30-90% of residual drugs will be found into wastewaters. In this study, we investigate the degradation of acetaminophen, selected as a xenobiotic model molecule, via two separate procedures, the TiO2 impregnated on cellulosic paper photocatalysis, and specific bacterial biodegradation process. Results showed that for initial drug content of 400 mg/L and after 5 hours of processing, around 85% of paracetamol was photocatalytically degraded. The use of Pseudomonas putida E1.21 isolate allowed an abatement of around 92% after 32 h of processing. The acetaminophen toxicity conducted in vivo on laboratory mice showed a net decrease of the creatinine release and enzymes activities like ALP, ALT, AST, and LDH decreased significantly (p < 0.05) when mice were treated distinctly by acetaminophen treated with UV/TiO2 and the Pseudomonas putida E1.21 strain compared with the control experiments. CAT, MDA, and AchE serum level disruption measurement indicated a serious affection of the mice antioxidant system. These results were found to be in correlation with the ones of the histological analysis of the liver and kidney.


Sickness absence among young employees in private and public sectors with a history of depression and anxiety.
The aim was to investigate occurrence and duration of sickness absence (SA) among young employees with previous depression/anxiety in private and public sectors. This population-based prospective study included 11,519 Swedish twin individuals of age 19-29 years that were followed regarding SA during 2006-2016. Data on previous depression/anxiety came from two screening surveys in 2005. Data on SA and employment sector were received from national registries. Descriptive statistics and logistic regression were used, also controlling for familial factors. Proportion of employees with SA was significantly higher among those with, as compared to those without, previous depression/anxiety, regardless the employment sector. Individuals with previous depression/anxiety had increased risk for future SA, in both private (OR 2.25, 95% CI 1.90-2.66) and public sectors (OR 2.10, 95% CI 1.73-2.54). Familial factors played a role in the association among employees in the private sector. A higher proportion of long-term SA was observed among employees with previous depression/anxiety in the private as compared to the public sector. To conclude, previous depression/anxiety tends to increase risk for SA among young employees in both employment sectors, whereas long-term SA seemed to be more prevalent among those in the private as compared to the public sector.


Immunogenic Chemotherapy Enhances Recruitment of CAR-T Cells to Lung Tumors and Improves Antitumor Efficacy when Combined with Checkpoint Blockade.
Adoptive therapy using chimeric antigen receptor-modified T cells (CAR-T cells) is effective in hematologic but not epithelial malignancies, which cause the greatest mortality. In breast and lung cancer patients, CAR-T cells targeting the tumor-associated antigen receptor tyrosine kinase-like orphan receptor 1 (ROR1) infiltrate tumors poorly and become dysfunctional. To test strategies for enhancing efficacy, we adapted the KrasLSL-G12D/+;p53f/f autochthonous model of lung adenocarcinoma to express the CAR target ROR1. Murine ROR1 CAR-T cells transferred after lymphodepletion with cyclophosphamide (Cy) transiently control tumor growth but infiltrate tumors poorly and lose function, similar to what is seen in patients. Adding oxaliplatin (Ox) to the lymphodepletion regimen activates tumor macrophages to express T-cell-recruiting chemokines, resulting in improved CAR-T cell infiltration, remodeling of the tumor microenvironment, and increased tumor sensitivity to anti-PD-L1. Combination therapy with Ox/Cy and anti-PD-L1 synergistically improves CAR-T cell-mediated tumor control and survival, providing a strategy to improve CAR-T cell efficacy in the clinic.


Diagnosis of hereditary spherocytosis in newborn infants.
The normal range of red blood cell osmotic fragility and autohemolysis was determined in venous blood of 32 healthy newborn infants. With these normal ranges as a reference, the diagnosis of hereditary spherocytosis was definitely possible in five newborn infants by demonstration of increased osmotic fragility of fresh and incubated red blood cells, moderately increased autohemolysis, and partial reduction of autohemolysis by the addition of glucose. Most previously studied newborn infants with hereditary spherocytosis have had atypical hyperbilirubinemia. Inconstant signs are anemia, reticulocytosis, erythroblastosis, spherocytes in the blood smear, and increased mean corpuscular hemoglobin concentration. In newborn infants with atypical hyperbilirubinemia in whom blood group incompatibilities are excluded, studies for hereditary spherocytosis should be done.


Prediction of Cross-Clamp-Induced Cerebral Ischemia During Carotid Endarterectomy Using Arterial Blood Flow Assessment.
Cross-clamping during carotid endarterectomy (CEA) is associated with the risk of cerebral ischemia. Various studies have evaluated different criteria for detecting cerebral ischemia, but difficulties arise when ischemic changes appear after the carotid artery is cross-clamped and incised. Here, we explored a parameter that can predict cerebral ischemia prior to cross-clamping during CEA using a blood-flow meter. The carotid arterial blood flow was measured directly (direct ABF) in the common carotid artery prior to cross-clamping. The anatomical information in preoperative magnetic resonance imaging, cerebral blood flow in xenon-enhanced computed tomography, and carotid peak systolic flow velocity by carotid echo from the skin surface were also evaluated. A decrease in the short-latency somatosensory evoked potentials (SSEP) during cross-clamping to insert a shunt was assessed, and a decrease in amplitude of ≥ 50% was considered an indicator for cerebral ischemia. Surgery was performed under general anesthesia, and a shunt was inserted in all cases. Of 156 CEA patients between April 2013 and March 2020, 30 had decreased SSEP during cross-clamping. The baseline characteristics and intra- and postoperative findings were not significantly different between patients with and without a decrease in SSEP. Among the evaluated parameters, only the direct-ABF ratio (ABF-internal carotid artery/ABF-common carotid artery) differed significantly between the 2 groups (P = 0.011). The direct-ABF ratio ≤ 0.58 was predictive of cerebral ischemia during CEA. Direct-ABF measurement with an ultrasonic blood-flow meter can be useful for predicting cerebral ischemia prior to carotid artery cross-clamping during CEA.


Author Correction: Efficient proximity labeling in living cells and organisms with TurboID.
An amendment to this paper has been published and can be accessed via a link at the top of the paper.


A comparison in rabbit isolated hearts of the dysrhythmogenic potential of amitriptyline, maprotiline and mianserin in relation to their ability to block noradrenaline uptake.
1. In isolated hearts of rabbits, perfusion with (-)-noradrenaline (0.0059 to 5.9 micronM) resulted in chronotropic and inotropic responses and a shortening of the interval between peak atrial and peak ventricular tensions (the A-V contraction interval). No dysrhythmias developed but at higher concentrations (590 micronM) 2 out of 7 hearts developed dysrhythmias (extrasystoles). 2. Perfusion with the antidepressants amitriptyline or maprotiline (4.8 micronM) or mianserin (28.8 micronM) reduced ventricular force, did not change heart rate and only amitriptyline reduced atrial force and lengthened the A-V contraction interval. At 4.8 micronM mianserin produced only a marginal shortening of the A-V contraction interval. 3. At these concentrations no dysrhythmias developed but at higher concentrations (amitriptyline 8 micronM, maprotiline 8 micronM, mianserin 60 micronM) all the agents produced dysrhythmias involving an interference with atrio-ventricular synchronization. 4. In the presence of mianserin (4.8 micronM) perfusion with noradrenaline (0.0059 to 5.9 micronM) shortened the A-V contraction interval and did not produce dysrhythmias. In the presence of amitriptyline or maprotiline (4.8 micronM) or mianserin (28.8 micronM) the A-V contraction interval generally lengthened and most hearts developed dysrhythmias (usually involving interference with atrio-ventricular synchronization). 5. [3H]-(-)-Noradrenaline uptake in perfused rabbit hearts and in mouse isolated atria or vasa deferentia was inhibited by the antidepressants to a similar extent, amitriptyline being marginally most potent (molar potency taken as 1.0), maprotiline being less potent (1.5) and mianserin least potent (2.0)). 6. It is concluded that of these three antidepressants, mianserin is least cardiotoxic in this preparation and that the ability of these antidepressants to predispose to noradrenaline-induced dysrhythmias is not related to blockade of noradrenaline uptake.


Different adaptive traits to cold exposure in young senescence-accelerated mice.
A reduced adaptation to cold is a prominent feature in aged mammals, including humans. The accelerated senescence-prone strain of mice (SAMP) has been studied as an animal model for several age-associated disorders and in the acceleration of senescence. Recent studies revealed that SAMP strains have dysfunctional hyperactive mitochondria and are under a higher oxidative stress status from a young age. To investigate whether young SAMP mice show impaired cold adaptation abilities, we performed cold-exposure experiments. There were no strain differences in baseline body temperature and lowest reached temperature during cold exposure. SAMP1 mice took longer times to reach their lowest temperature in comparison to SAMR1 mice. SAMR1 mice showed an elevation in temperature following cold exposure, whereas SAMP1 mice did not. Behavioral observations demonstrated that SAMP1 mice moved more actively than SAMR1 during cold exposure. However, mRNA levels of uncoupling protein 1 (UCP1), a heat generating protein, as well as plasma norepinephrine levels, were higher in SAMP1 than in SAMR1 mice. This newly found physiological phenotype in SAMP1 mice provides us with a tool to clarify the genetic mechanism which accelerates the senescence process and helps us develop medical means which will bring mankind to a healthy old age.


Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia.
This study aimed to determine whether (1) cognitive behavioural therapy with behavioural analysis for insomnia (CBTi-BA) is more effective for insomnia and co-morbid depressive symptoms than treatment as usual (TAU) and (2) whether CBTi-BA promotes earlier reduction of the daily dose of hypnotic medication in chronic insomnia resistant to pharmacological treatment. A total of 63 patients with chronic insomnia aged 20-77 years who already received hypnotic medication regularly were assigned to two interventions: combined therapy or TAU alone. The subjects provided demographic information and completed self-rating scales for insomnia and depressive symptoms. After treatment, the combined therapy group showed significant decreases in the symptoms of both insomnia and depression and significant reductions in the daily dose of hypnotic medication compared with the group receiving TAU alone. In the combined therapy group, 71% of the participants reported a reduction in insomnia to normal levels and 79% succeeded in decreasing the daily dose of hypnotics to 50% or less of the baseline dose. These results revealed that CBTi-BA can reduce insomnia and depressive symptoms as well as the daily dose of hypnotic medication in patients with chronic insomnia resistant to pharmacological treatment.


Disposable versus reusable gastroscopes: a prospective randomized noninferiority trial.
Disposable gastroscopes have recently been developed to eliminate the risk of infection transmission from contaminated reusable gastroscopes. We compared the performance of disposable and reusable gastroscopes in patients undergoing gastroscopy. Patients requiring gastroscopy were randomized to either the disposable or reusable digital gastroscope group. The primary endpoint was the success rate of photographing customary anatomic sites, with a noninferiority margin of -8%. Secondary endpoints were technical performance factors such as gastroscope imaging quality, maneuverability, gastroscopy completion rate, device failure/defect rate, operating time, and safety. Data were analyzed using the Newcombe-Wilson score method and Fisher exact 2-tailed t test. Of 110 patients, 55 were treated using disposable gastroscopes and 55 using reusable gastroscopes. The success rate for capturing images of customary anatomic sites was 100% in both groups. The average imaging quality score was significantly lower (37.02 ± 3.09 vs 39.47 ± 1.92, P < .001) and the operating time significantly longer (P < .001) in the disposable gastroscope group. No significant differences in maneuverability, gastroscopy completion rate, device failure/defect rate, operating time, or safety were found between the 2 groups. Given the overall safety profile and similar technical performance, disposable gastroscopes represent an alternative to reusable gastroscopes for routine examination, bedside first aid, and some certain circumstances.


Sport Injuries of the Ear and Temporal Bone.
In cases of head trauma, the ear should be evaluated in all of its components. A good understanding of otologic and skull base anatomy enables a thorough trauma assessment of this complex anatomic region. Auricular laceration, abrasion, avulsion, hematoma, frostbite, otitis externa, exostosis, tympanic membrane perforation, ossicular discontinuity, perilymphatic fistula, labyrinthine concussion, temporal bone fracture, facial nerve paresis, and sensorineural hearing loss are a few of the more common otologic injuries seen in active patients. Prevention of otologic trauma by wearing protective equipment during activity is the best way of maintaining the long-term health of the ear and audiovestibular function.


Does differential drop-out explain the influence of study design on antidepressant response? A meta-analysis.
Response to antidepressants is higher in active comparator relative to placebo-controlled clinical trials. Increased patient expectancy in comparator trials has been hypothesized to explain this finding, but previous analyses have not accounted for the increased drop-out observed in placebo-controlled trials. A systematic literature review was conducted to identify published antidepressant clinical trials reporting data on intent-to-treat (ITT) as well as completer patient populations. The influence of participant drop-out on observed antidepressant response was investigated by comparing the ITT and completer data sets in separate multilevel meta-analyses of antidepressant response in placebo-controlled and comparator trials. 18 placebo-controlled and 18 active comparator studies were available for analysis. Using the intent-to-treat data, the odds of responding to medication in comparator trials were 1.9 times the odds in placebo-controlled trials (95% CI=1.3-2.7, p=0.001). The same pattern was obtained among study completers, in whom the odds of responding to antidepressant medication were 1.9 times higher in comparator as opposed to placebo-controlled study designs (95% CI=1.2-3.0, p=0.009). Publication bias, the use of trial-level summary data, and unreported clinical or demographic differences between the ITT and completer patient populations may have influenced the study results. Increased drop-out in placebo-controlled vs. active comparator studies of antidepressant medications does not appear to explain the difference in response rates between these study types. Rather, increased patient expectancy resulting from the certainty of receiving active medication in comparator trials may lead to improved response rates.


The Core Pattern Analysis on Chinese Herbal Medicine for Sjögren's syndrome: A Nationwide Population-Based Study.
This large-scale survey aimed to evaluate frequencies and patterns of Chinese herbal medicine (CHM) used for Sjögren's syndrome (SS) in Taiwan by analyzing the National Health Insurance Research Database (NHIRD) for cases in which CHM was used as an alternative therapy to Western medicine for improving patients' discomforts. We analyzed cases of SS principal diagnosis (ICD-9:710.2) with a catastrophic illness certificate (CIC) in traditional Chinese medicine (TCM) outpatient clinics from three cohorts of the Longitudinal Health Insurance Database (LHID) in the NHIRD between 2002 and 2011. CHM prescription patterns for SS were evaluated from claimed visitation files and corresponding prescription files. There were 15,914 SS patients with CIC (SS/CIC), and we found only 130 SS/CIC cases visiting TCM clinics in LHID2000, 133 in LHID2005, and 126 in LHID2010. After removing duplicate data, 366 SS/CIC and 4,867 visits were analyzed. The 50-59 year age group showed the highest ratio (29.51%) in both women and men. "Qi-Ju-Di-Huang-Wan" and "Xuan-Shen" (Scrophularia ningpoensis Hemsl.) was the most commonly used formula and single herb, respectively. "Qi-Ju-Di-Huang-Wan, Gan-Lu-Yin, Xuan-Shen, Mai-Men-Dong (Ophiopogon japonicus (L. f.) Ker-Gawl.), and Sheng-Di-Huang (raw Rehmannia glutinosa Libosch)" were the core pattern prescriptions in treating SS/CIC.


Duration, time constant, and decay of the linear motion aftereffect as a function of inspection duration.
Subjects rated the strength of the motion aftereffect (MAE) produced by the upward motion of a horizontal grating in two experiments. Inspection periods ranged from 30 to 900 sec in Experiment 1 and from 20 to 120 sec in Experiment 2. A minimum of 22 h elapsed between trials. The decay time constant increased as the square root of the inspection duration for values between 1 min and 15 min of inspection. The ratings suggested that the MAEs consisted of three phases: an initial maximum-strength phase, a decay phase, and a tail. The duration of all three phases increased and the decay rate decreased with increasing inspection duration over the entire range. The results indicate that duration, time constant, and decay rate are not fixed properties of the motion-processing channels in the visual system.


Utilization of an ultra-low-field, portable magnetic resonance imaging for brain tumor assessment in lower middle-income countries.
Access to neuroimaging is limited in low-middle-income countries (LMICs) due to financial and resource constraints. A new, ultra-low-field, low-cost, and portable magnetic resonance imaging (pMRI) device could potentially increase access to imaging in LMICs. We have presented the first brain tumor case scanned using an Ultra-low-field pMRI at Aga Khan University Hospital in Karachi, Pakistan. The imaging results suggest that the pMRI device can aid in neuroradiological diagnosis in resource-constrained settings. Further, research is needed to assess its compatibility for imaging other neurological disorders and compare its results with conventional MRI results.


Intrahepatic cholestasis of pregnancy with marked elevation of transaminases in a black American.
A case of intrahepatic cholestasis of pregnancy (ICP) in a black American is presented. This is the first case reported in a black. Marked elevation of transaminases with mild biochemical evidence of cholestasis was initially suggestive of viral hepatitis. A clinical course characterized by pruritus with minimal constitutional symptoms, rapid resolution of biochemical abnormalities after delivery, and negative hepatitis A and B serologies was consistent with the diagnosis of ICP. Review of the classic features of ICP with emphasis on some unusual aspects of the disorder is included.


Predicting cervical lymph node metastasis in OSCC based on computed tomography imaging genomics.
To investigate the correlation between computed tomography (CT) radiomic characteristics and key genes for cervical lymph node metastasis (LNM) in oral squamous cell carcinoma (OSCC). The region of interest was annotated at the edge of the primary tumor on enhanced CT images from 140 patients with OSCC and obtained radiomic features. Ribonucleic acid (RNA) sequencing was performed on pathological sections from 20 patients. the DESeq software package was used to compare differential gene expression between groups. Weighted gene co-expression network analysis was used to construct co-expressed gene modules, and the KEGG and GO databases were used for pathway enrichment analysis of key gene modules. Finally, Pearson correlation coefficients were calculated between key genes of enriched pathways and radiomic features. Four hundred and eighty radiomic features were extracted from enhanced CT images of 140 patients; seven of these correlated significantly with cervical LNM in OSCC (p < 0.01). A total of 3527 differentially expressed RNAs were screened from RNA sequencing data of 20 cases. original_glrlm_RunVariance showed significant positive correlation with most long noncoding RNAs. OSCC cervical LNM is related to the salivary hair bump signaling pathway and biological process. Original_glrlm_RunVariance correlated with LNM and most differentially expressed long noncoding RNAs.


Volumetric Markers of Body Composition May Improve Personalized Prediction of Major Arterial Bleeding After Pelvic Fracture: A Secondary Analysis of the Baltimore CT Prediction Model Cohort.
This work is a retrospective secondary analysis of a single institution cohort used in the development of the Baltimore CT prediction model. The cohort includes 115 consecutive patients that underwent admission contrast-enhanced CT of the abdomen and pelvis for blunt trauma with pelvic ring disruption followed by conventional angiography. Major arterial injury requiring angioembolization served as the outcome variable. Angioembolization was required in 73/115 patients (63% of the cohort). Average age was 46.9 years (±SD 20.4). Body composition measurements were determined as 2-dimensional (2D) or 3-dimensional (3D) parameters and included mid-L3 trabecular bone attenuation, abdominal visceral fat area or volume, and percent muscle fat fraction (as a marker of sarcopenia) measured using segmentation and histogram analysis. Models incorporating 2D (Model B) or 3D markers (model C) of body composition showed improvement over the original Baltimore model (model A) in all parameters of performance, quality, and fit (area under the receiver-operating curve [AUC], Akaike information criterion, Brier score, Hosmer-Lemeshow test, and adjusted-R2). Area under the receiver-operating curve increased from 0.83 (A), to 0.86 (B), and 0.88 (C). The greatest improvement was seen with 3D parameters. Once automated, quantitative visualization tools providing "free" 3D body composition information can be expected to improve personalized precision diagnostics, outcome prediction, and decision support in patients with bleeding pelvic fractures.


Comparison of the air pollution biomonitoring ability of three Tillandsia species and the lichen Ramalina celastri in Argentina.
Bioaccumulation ability and response to air pollution sources were evaluated for Tillandsia capillaris Ruíz and Pav. f. capillaris, T. recurvata L., T. tricholepis Baker and the lichen Ramalina celastri (Spreng.) Krog. and Swinsc. Epiphyte samples collected from a non contaminated area in the province of Córdoba were transplanted to a control site and three areas categorised according to agricultural, urban and industrial (metallurgical and metal-mechanical) emission sources. Bioindicators were exposed for 3-, 6- and 9-month periods. A foliar damage index was established for Tillandsia and a pollution index for the lichen, and S, Fe, Mn and Zn concentrations were determined. An order of efficiency for the species and conditions studied is proposed taking into account heavy metal accumulation: T. recurvata >T. tricholepis >R. celastri >T. capillaris. All species studied showed Mn to be related to agricultural activity and Fe to industries and soil particles, and Zn was related to urban and industrial sources. As far as physiological response is concerned, T. tricholepis and T. capillaris were more sensitive to agricultural activities, whereas T. recurvata was sensitive to urban and industrial sources, and only partially to agricultural sources. No relationship was found for R. celastri.


COVID-19 infection among pregnant and non-pregnant women: Comparison of biochemical markers and outcomes during COVID-19 pandemic, A retrospective cohort study.
& Objectives: We conducted this single-centered retrospective study including female patients infected with COVID-19 with aim to compare laboratory findings and the outcomes between pregnant and non-pregnant women infected with COVID-19. Previous data rendered pregnant women as vulnerable population for COVID-19. We included 131 patients in our analysis out of which 60 were pregnant females and rest 71 were non-pregnant females. Factors like fatigue, total leukocyte count (TLC) and neutrophils were higher in pregnant patients, while mean age, fever, hemoglobin, ferritin, D-dimer and use of mechanical ventilation was lower in pregnant patients as compared to non-pregnant females. Our study concluded that COVID-19 do not show significant high risk of disease severity when compared with non-pregnant females of similar age group.


Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial.
To evaluate the effect of an arm training programme combining repetition of unilateral and symmetrical bilateral tasks for people in the subacute phase after stroke. Randomized controlled trial. Inpatient functional rehabilitation unit. Forty-one people who had had a stroke, in the subacute phase, receiving conventional arm occupational and physical therapy, were randomized to an experimental group (n=20) and a control group (n=21). In addition to the usual arm therapy in the rehabilitation unit, the experimental group received an arm therapy programme (15-20 45-min sessions) based on repetition of unilateral and symmetrical bilateral tasks. The control group received additional usual arm therapy of a similar duration and frequency to the experimental treatment. The effect of the programme was judged on the basis of: (1) arm impairments (motor function, grip strength, gross and fine manual dexterity and motor co-ordination), (2) arm disabilities in tasks related to daily activities, and (3) functional independence in activities of daily living (ADL) and instrumental ADL (IADL). Although both experimental and control groups of participants improved similarly during the study period, the statistical analyses did not show any difference between the groups at the end of the treatment for the different dependent variables evaluated: (1) arm impairments: p = 0.43-0.79; (2) arm disabilities: p = 0.16-0.90; and (3) functional independence: p = 0.63 and 0.90. An arm training programme based on repetition of unilateral and symmetrical bilateral practice did not reduce impairment and disabilities nor improve functional outcomes in the subacute phase after stroke more than the usual therapy.


Glycemic control mentored implementation: creating a national network of shared information.
The Society of Hospital Medicine's (SHM's) Glycemic Control Mentored Implementation (GCMI) program, which, like all MI programs, is conducted as an improvement collaborative, is intended to help hospitals improve inpatient glycemic control in diabetic and nondiabetic patients by educating and mentoring quality teams. Hospital quality improvement (QI) teams applied for participation in GCMI from 2009 through 2012. Accepted sites were assigned either a hospitalist or endocrinologist mentor to work through the life cycle of a QI project. SHM's Implementation Guide, online resources, measurement strategies, Web-based Glycemic Control Data Center for Performance Tracking, webinars, interactive list-serve, and other tools help mentors guide these teams through the program. Mentors in GCMI bring expertise in both inpatient glycemic control and QI. One hundred fourteen hospital QI teams were enrolled into the GCMI program in the course of 2.5 years. Of these 114 sites, 90 completed the program, with 63 of them uploading data to the Data Center. Feedback from the sites was consistently positive, with the listserve, Data Center, and mentorship reported as the top three most effective components of the program. Ninety-five percent of respondents stated that they would recommend participation in an SHM-mentored implementation program to a colleague. Participants reported improved leadership skills and increased institutional support for glycemic control. Hospital quality teams participating in the GCMI program gained support to overcome barriers, focus on improving glycemic control, network with peers and expert mentor physicians, collect and analyze data, and build quality leaders. The features and structure of this program can be used in other multisite QI goals and projects.


Comparative Histological Study on the Therapeutic Effect of Green Tea and Stem Cells in Alzheimer's Disease Complicating Experimentally Induced Diabetes.
Alzheimer's disease (AD) is a devastating neurodegenerative disorder. Increasing evidence implicates diabetes mellitus (DM) as a risk factor for AD. Green tea (GT) has several beneficial effects attributed to its anti-oxidant phenolic compounds. Adipose tissue is a rich source of adipose-derived mesenchymal stem cells (ADSCs). This study was designed to evaluate and compare the possible therapeutic effect of green tea extract (GTE) and ADSCs on AD complicating induced DM in male rat. 31 adult male albino rats were divided into 5 groups. Group I (Control), Group II received GTE, 50 mg/kg daily orally for 4 weeks, Group III received a single intraperitoneal injection of Streptozotocin (STZ), 50 mg/kg, Group IV: received STZ followed by GTE and Group V: received STZ followed by human ADSCs (hADSCs) intravenously. Multiple acidophilic masses, deformed neurons, Congo red +ve masses and Caspase 3 +ve neurons were seen in group III, became few in group IV and occasional in group V. Multiple Prussian blue +ve cells were detected in group V. Some CD44 +ve cells were noticed in group III, became multiple in groups IV and V. The mean area of neurons exhibiting acidophilic cytoplasm, mean area of amyloid plaques and mean area % of Caspase 3 +ve cells indicated a significant increase in group III. The mean area % of CD44 +ve cells recorded a significant increase in group IV. hADSCs exerted a more marked therapeutic effect on the neurodegenerative changes complicating DM and corresponding to AD.


Lymphoepithelial cyst of the pancreas--evaluation with multidetector CT.
Lymphoepithelial cyst of the pancreas is a rare cystic pancreatic tumor. In this case report we provide the imaging perspective of the lesion including the role of multidetector CT (MDCT) and CT angiography and 3D imaging.


Emerging role of Fli1 in autoimmune diseases.
The Ets transcription factor family exerts crucial role in cell proliferation, apoptosis, differentiation and migration. Friend leukemia integration 1 (Fli1), a member of the Ets family, is expressed in fibroblasts, endothelial cells and immune cells. Fli1 gene is participated in the development, proliferation, activation, migration and other processes of immune cells. Fli1 can also affect the function of immune cells by regulating cytokines and chemokines. Emerging evidence has shown that Fli1 is implicated in the etiology of several autoimmune diseases, including systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). In this review, we mainly discuss the current evidence for the role of Fli1 in these diseases.


Ibrutinib Delays ALS Installation and Increases Survival of SOD1G93A Mice by Modulating PI3K/mTOR/Akt Signaling.
Amyotrophic lateral sclerosis (ALS) is a fatal multisystem degenerative disorder with minimal available therapeutic. However, some recent studies showed promising results of immunological-based treatment. Here, we aimed to evaluate the efficacy of ibrutinib against ALS-associated abnormalities by targeting inflammation and muscular atrophy. Ibrutinib was administrated orally to SOD1 G93A mice from 6 to 19 weeks for prophylactic administration and 13 to 19 weeks for therapeutic administration. Our results demonstrated that ibrutinib treatment significantly delayed ALS-like symptom onset in the SOD1 G93A mice, as shown by improved survival time and reduced behavioral impairments. Ibrutinib treatment significantly reduced muscular atrophy by increasing muscle/body weight and decreasing muscular necrosis. The ibrutinib treatment also considerably reduced pro-inflammatory cytokine production, IBA-1, and GFAP expression, possibly mediated by mTOR/Akt/Pi3k signaling in the medulla, motor cortex and spinal cord of the ALS mice. In conclusion, our study demonstrated that ibrutinib could delay ALS onset, increase survival time, and reduce ALS progression by targeting inflammation and muscular atrophy via mTOR/Akt/PI3K modulation.


Supplementation of Moringa oleifera leaf concentrate pellets on nutrient utilization, antioxidant status, and reproductive performance of prolific ewes during extreme summer months in semi-arid tropical conditions.
A feeding trial was conducted for a period of 60 days during extreme summer months to observe the effect of supplementation of Moringa oleifera leaves containing concentrate pellets on nutrient utilization, antioxidant status, and reproductive performance in Avishaan ewes reared under semi-arid condition. Forty adult non-pregnant cyclic ewes (2-3 years, 31.8 ± 0.81 kg body weight) were selected and randomly allocated into 2 groups of 20 animals each, viz., G-I (control) and G-II (treatment). The ewes were grazed on natural pasture for 8 h, offered ad libitum Cenchrus ciliaris hay after grazing and concentrate pellets @ 300 g/animal/day. The ewes in G-I were offered conventional concentrate pellets, whereas G-II ewes were offered concentrate pellets containing 15% Moringa leaves. The mean temperature humidity index during the period of study was 27.5 ± 0.3 and 34.6 ± 0.4 at 0700 h and 1400 h, respectively, indicating severe heat stress. Nutrient intake and utilization were comparable between the two groups. The antioxidant status was higher in G-II ewes as the values of catalase, superoxide dismutase, and total antioxidant capacity were higher (P < 0.05) in G-II ewes compared to G-I. The conception rate was higher (100%) in G-II ewes than G-I ewes (70%). Multiple birth percentage was 77.8% in G-II ewes, and it was comparable with the herd average of Avishaan (74.7%). However, ewes in G-I group exhibited a marked decline in multiple birth percentage (28.6%) than the normal herd average. Hence, it can be concluded that inclusion of Moringa oleifera leaves in feeding of prolific Avishaan ewes improved their antioxidant status resulting in optimum reproductive performance during stressful summer months.


Striatal lesions in the mouse disrupt acquisition and retention, but not implicit learning, in the SILT procedural motor learning task.
People with Huntington's disease (HD) have been found to have an implicit learning deficit whereby they are typically unable to detect repeated sequences embedded within randomly presented stimuli. The operant serial implicit learning task (SILT) was designed to probe animal models of HD for implicit learning deficits using the 9-hole box apparatus. The present study used mice to determine whether "early" striatal lesions would prevent SILT acquisition and to confirm previous findings that post-training "late lesions" would impair the retention of task performance. The SILT is a two-phase task whereby an initial stimulus light (S1) presentation was presented in one of five possible locations. A correct nose-poke response to the S1 resulted in this light being extinguished and a second, apparently random light presentation (S2). A correct nose-poke to S2 resulted in a reward. Within the apparently random stimulus light presentations, a predictable S1/S2 combination was embedded. Both lesion groups ("early" pre-acquisition and "late" post-acquisition lesions) demonstrated increased reaction times to S1, with the late-lesion group also recording reduced task accuracy when compared with the sham control group. The early-lesion group also demonstrated increased response latencies for the S2 stimuli during task acquisition, this was also true for task retention in the late-lesion group. No difference between the control group and early-lesion group was found for the S2 response accuracy during the acquisition period. After the lesioning of the late-lesion group, both lesion groups demonstrated reduced accuracy to the S2 stimuli as the control group improved their performance throughout the test period, while the accuracy of both lesion groups remained stable at a lower performance level. All three experimental groups were able to utilize the embedded predictable information. The present data suggest that the striatum is important for the acquisition and retention of motor learning tasks, but does not play a role in the learning of implicit information.


Current status of percutaneous coronary intervention in patients with atrial fibrillation: The Fushimi AF Registry.
Antithrombotic therapies that are optimal for atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) have been studied but remain uncertain. We often encounter difficulties in choosing an appropriate antithrombotic therapy with antiplatelet agents after PCI in AF patients treated with oral anticoagulant due to a high CHADS2 score. Since there are no data on the incidences of PCI procedures in AF patients, we evaluated those incidences as well as the association between PCI and the CHADS2 score using data from the Fushimi AF Registry. The Fushimi AF Registry is a community-based prospective cohort study of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available for 4325 patients, and the median follow-up was 3.6 (interquartile range: 1.9-5.9) years. There were 143 PCI procedures performed in 122 patients during follow-up, and 28 (20%) were emergent ones. The crude incidence of PCI procedures was 9.36 per 1000 person-years. At 1 and 3 years, the cumulative incidences of PCI were 46 (1.1%) and 85 (2.4%), respectively. As for 4 age groups: <65 (n = 765), 65-75 (n = 1359), 75-85 (n = 1586), and 85≤ years (n = 615), the rates of PCI were 0.4%, 1.4%, 1.4%, and 0.6% at 1 year, and were 1.4%, 2.7%, 2.8%, and 1.6% at 3 years, respectively. The incidence of PCI procedures in patients with a CHADS2 score ≥2 (n = 2651, 61.3%) was higher than that in patients with a CHADS2 score ≤1 (n = 1674, 38.7%). Among the factors making up the CHADS2 score, only diabetes mellitus was associated with PCI procedures in patients with AF (hazard ratio, 1.95; 95% confidence interval, 1.34-2.83; p = 0.0005). About 1 in 100 AF patients underwent PCI annually, and patients with a CHADS2 score ≥2 were associated with higher incidences of PCI procedures.


Supersensitivity of Patients With Bipolar I Disorder to Light-Induced Phase Delay by Narrow Bandwidth Blue Light.
Bipolar disorder is a severe chronic mental disorder. There is a bidirectional relationship between disease course and circadian phase. Significant circadian phase shifts occur during transitions between episodes, but episodes can also be elicited during euthymia by forced rapid changes in circadian phase. Although an instability of circadian phase has been described in multiple observational reports, no studies quantifying the propensity to phase shift following an experimental standardized stimulus have been published. This study therefore aimed to assess whether patients with bipolar I disorder (BDI) are more prone to phase delay following blue light exposure in the evening than healthy control subjects. Euthymic participants with BDI confirmed by Structured Clinical Interview for DSM-IV Axis I (n = 32) and healthy control subjects (n = 55) underwent a 3-day phase shift protocol involving exposure to a standardized dose of homogeneous, constant, narrow bandwidth blue light (478 nm, half bandwidth = 18 nm, photon flux = 1.29 × 1015 photons/cm2/s) for 2 hours at 9:00 pm via a ganzfeld dome on day 2. On days 1 and 3, serial serum melatonin assessments during total darkness were performed to determine the dim light melatonin onset. Significant differences in the light-induced phase shift between BDI and healthy control subjects were detected (F 1,82 = 4.110; p = .046), with patients with bipolar disorder exhibiting an enhanced phase delay (η2 = 0.49). There were no significant associations between the magnitude of the phase shift and clinical parameters. Supersensitivity of patients with BDI to light-induced phase delay may contribute to the observed phase instability and vulnerability to forced phase shifts associated with the disorder.


Abscisic acid binds to recombinant Arabidopsis thaliana G-protein coupled receptor-type G-protein 1 in Sacaromycese cerevisiae and in vitro.
The G-protein coupled receptor-type G-proteins (GTG) 1 and 2 from Arabidopsis thaliana have been proposed to function in the modulation of abscisic acid (ABA) mediated responses to stress and development. In particular it has been suggested that they function as ABA receptors based on in planta and in vitro analyses. However a recent independent report was inconsistent with this, suggesting that there is no link between the GTGs and ABA in planta. Here we provide an independent assessment of the ability of ABA to bind to recombinant GTG1 in vitro and in vivo in Sacaromycese cerevisiae. Radio-labelled binding assays on enriched lipid-reconstituted recombinant GTG1, demonstrated specific concentration dependent binding of [(3)H]-ABA with a dissociation constant (KD) of 80 nM, corroborating previous reports. Assessment of the binding of [(3)H]-ABA to intact GTG1 expressing yeast, showed GTG1-dependent binding in vivo, yielding a physiologically relevant KD of 0.6 μM. Together these results provide independent evidence of a binding-interaction between ABA and GTG1 in vitro and in vivo, in support of the previously proposed possibility of a biologically relevant interaction between GTG1 and ABA.


Application of thin-layer chromatography with flame ionization detection to the characterization of organic extracts from diesel exhaust particulates.
Thin-layer chromatography with flame ionization detection has been applied to the analysis of organic extracts of diesel exhaust particulates. Non-volatile organics whose boiling points are higher than ca. 300 degrees C can be analyzed, with a detection limit of ca. 0.03 micrograms and a relative standard deviation of ca. 10%. The organic extracts are separated into aliphatics , aromatics and polars by the development procedure with n-hexane, and the polars can be separated further by using toluene as the solvent. Some examples of application are presented.


Study of copper, zinc, magnesium and cadmium in ICC patients, parents and siblings.
Twenty-seven histopathologically proved cases of Indian childhood cirrhosis (ICC), 13 parents (father and mother) and nine siblings of ICC patients were studied from serum and urinary Cu, Zn, Mg and Cd levels by Atomic Absorption Spectrophotometer (AAS). Milk and drinking water from various sources were analysed for Cu, Zn, Mg and Cd contents, as was milk boiled and stored for up to six hours in various utensils. Serum and urinary Cu excretion were high (P less than 0.001) in ICC patients and within normal limits in siblings and parents. In ICC patients most hepatocytes contained multiple, coarse and dark brown orcein staining granules representing Cu associated protein. Serum Zn was low and urinary Zn excretion high in ICC patients (P less than 0.001 and P less than 0.01 respectively) and within normal limits in siblings and parents. Mg and Cd in serum and urine of ICC patients, siblings and parents were within normal limits. Cu content of milk boiled and stored in peetal (brass) utensils was high and directly related to the duration of storage; there was no change in Cu level in milk boiled and stored in steel and aluminium utensils. Zn, Mg and Cd levels in milk boiled and stored in peetal (brass) utensils remained unchanged. The levels of these elements in drinking water from various sources were also within limits as recommended by WHO (1971). Milk boiled and stored in peetal (brass) utensils seemed to account for increased Cu intake. Excessive Cu intake in ICC should be eliminated by avoiding brass utensils for boiling and storing milk. Some treatment to chelate excess Cu is also warranted.


Combination of clofarabine, etoposide, and cyclophosphamide in adult relapsed/refractory acute lymphoblastic leukemia: a phase 1/2 dose-escalation study by the Japan Adult Leukemia Study Group.
This phase 1/2 study aimed to identify the maximum tolerated dose, the recommended phase 2 dose (RP2D), and efficacy of the clofarabine, etoposide, and cyclophosphamide combination regimen in adult patients with relapsed/refractory acute lymphoblastic leukemia (ALL). Patients aged ≥ 15 years with relapsed/refractory ALL were enrolled. Escalating doses of clofarabine (20-30 mg/m2/day × 5 days), etoposide (50-100 mg/m2/day × 5 days), and cyclophosphamide (200-440 mg/m2/day × 5 days) were administered. Dose-limiting toxicity was defined as Grade 3 or more non-hematological toxicities and others. A total of 18 patients (B-ALL; n = 13, T-ALL; n = 5) were recruited in phase 1; however, the protocol was amended to close study without proceeding to phase 2. Three patients were enrolled in cohort 1, three in cohort 2, six in cohort 3, and six in cohort 4. The RP2D of clofarabine, etoposide, and cyclophosphamide was 30, 100, and 440 mg/m2 daily, respectively. Complete remission (CR) was achieved in four patients (22%) and CR without platelet recovery in four patients (22%), with an overall response rate of 44%. The RP2D of the combination therapy was successfully determined in this study.


Relevance of the NOS3 T-786C and G894T variants for cholinergic and adrenergic coronary vasomotor responses in man.
We investigated the impact of the -786C allele at the promoter and the 894T allele in exon 7 of the gene encoding the endothelial nitric oxide synthase (NOS3) on coronary vasomotor responses to exogenous and endogenous stimuli. In 47 individuals undergoing coronary angiography for chest pain, but without significant stenosis in the left anterior descending artery (LAD), nitroglycerine and acetylcholine were infused intracoronarily, and a cold pressor test (CPT) was performed. Coronary blood flow (CBF) in the LAD was calculated from quantitative coronary angiography and intracoronary Doppler measurements. Aortic and coronary sinus lactate levels were determined in 18 individuals. To analyze the impact of NOS3 genotypes, a logistic regression model was used. In response to acetylcholine (p = 0.002) and CPT (p = 0.015) CBF reduction was associated with homocygosity for the -786C allele. Myocardial lactate uptake was reversed into net lactate production in CC homocygotes. No independent effects of the G894T polymorphism were observed in the present study. Haplotype analysis revealed a significant linkage disequilibrium between both polymorphisms (p < 0.001). Our findings suggest a pathophysiologically relevant role for the T-786C polymorphism in human coronary vasomotion. The observed linkage disequilibrium between both NOS3 genotypes deserves further research in future studies.


Failure of linezolid treatment for enterococcal endocarditis.
We describe a patient with Enterococcus faecalis endocarditis who failed to respond to treatment with linezolid.


Anatomical and functional results after stapled transanal rectal resection (STARR) for obstructed defaecation syndrome.
The STARR procedure is a surgical option for the treatment of rectocoele associated with obstructed defaecation syndrome (ODS). The aim of the study was to assess the efficacy of this technique in restoring anatomy and the long-term sustainability of symptom control and quality of life. Of 48 patients operated on from 2003 to 2007, 30 were enrolled for this prospective assessment of anatomical correction and functional improvement of ODS. Results from a standardised questionnaire concerning functional results (ODS score), faecal incontinence (Cleveland Clinic score) and Patient Assessment of Constipation Quality of Life (PAC-QoL) were prospectively collected. Systematic dynamic defaecography, together with anorectal physiology testing, were performed before surgery and 6 months after. 25 patients were available for long-term assessment of functional outcome (more than 4 years). The mean age of the population was 57 +/- 7 years. STARR produced significant improvements in the PAC QoL (p < 0.05) and ODS score (p < .0001), but not in the incontinence score. At defaecography, correction was significant with respect to the depth (p = 0.007), perimeter (p < 0.0001) and neck (p = 0.001) of rectocoele. Anorectal physiology revealed a lower maximal tolerated rectal volume (p<.0001). After 58 months, the 25 patients showed sustained functional results and QoL. Four patients (16%) underwent further surgical procedure for pelvic floor disorders and 8 patients (32%) still required laxatives. Our study confirms the efficacy of the STARR procedure, with sustained improvement in function and QoL. However, a substantial number of patients remain symptomatic.


Standardization of surgical care in a high-volume center improves survival in resected pancreatic head cancer.
Durable clinical gains in surgical care are frequently reliant on well-developed standardization of practices. We hypothesized that the standardization of surgical management would result in improved long-term survival in pancreatic cancer. Seventy-seven consecutive, eligible patients representing all patients who underwent pancreaticoduodenectomy and received comprehensive, long-term postoperative care at the University of Florida were analyzed. Patients were divided into prestandardization and poststandardization groups based on the implementation of a pancreatic surgery partnership, or standardization program. Standardization resulted in a reduction in median length of stay (10 vs 12 days; P = .032), as well as significant gains in disease-free survival (17 vs 11 months; P = .017) and overall survival (OS; 26 vs 16 months; P = .004). The improvement in overall survival remained significant on multivariate analysis (hazard ratio = .46, P = .005). Standardization of surgical management of pancreatic cancer was associated with significant gains in long-term survival. These results suggest strongly that management of pancreatic head adenocarcinoma be standardized likely by regionalization of care at high performing oncologic surgery programs.


Release of adrenaline by anaphylaxis in the guinea-pig: its effect on lung lipid content.
The study was undertaken to discover whether the catecholamines released as a result of the stress and hypoxia of anaphylaxis were responsible for the concomitant loss of lipid from the lung. A method is described whereby the respiratory rate and volume and heart-rate of conscious sensitized guinea-pig were measured and the electrocardiogram recorded during anaphylaxis induced by aerosolized antigen. After 7 days or more, some animals were anaesthetized with pentobarbitone and respiration was artificially maintained at the level recorded in the conscious state, whilst the quantity of catecholamines liberated during anaphylaxis was assayed using an extra-corporeal blood circulation to superfuse smooth muscle preparations. In other animals of the same group, it was shown that intravenous infusion of adrenaline in a similar quantity to that detected in the circulation following anaphylaxis (0.3 mug min-(-1) for 40 min) caused losses of triglyceride and partial glycerides from the lungs. Thus, the loss of choline-containing phospholipid was attributed to the direct effects of the anaphylactic reaction on the lung tissue.


Further studies on the use of the fluorescent tracers fast blue and diamidino yellow: effective uptake area and cellular storage sites.
Some basic methodological issues concerning the use of the fluorescent tracers Fast blue (FB) and Diamidino yellow (DY) were studied using the projections of the red nucleus to the nucleus interpositus anterior (NIA) of the cerebellum of the cat. On standard Nissl-stained sections, it was possible to delineate 4 distinct zones at the FB and DY injection sites. Correlative studies of injection sites in the NIA and retrograde labeling of cell bodies in the contralateral red nucleus showed that effective uptake occurred only from the zone mechanically damaged by the injection needle (termed zone 0). The tracer remains in this zone during the post-injection survival. The limited uptake area for both tracers is a valuable feature for studies of restricted neuronal projections. However, the tracers are not suitable for use in quantitative studies, especially those concerning axonal collateralization. Perfusion with water-soluble fixatives did not alter the cellular storage site. In double-labeling experiments using horseradish peroxidase and DY, the HRP histochemistry induced an important "washing out" of DY and consequently, an underestimation of the number of labeled neurons.


The differential effects of norepinephrine and dopamine on cerebrospinal fluid pressure and spinal cord perfusion pressure after acute human spinal cord injury.
Prospective vasopressor cross-over interventional studyObjectives:To examine how two vasopressors used in acute traumatic spinal cord injury (SCI) affect intrathecal cerebrospinal fluid pressure and the corresponding spinal cord perfusion pressure (SCPP). Vancouver, British Columbia, Canada. Acute SCI patients over the age of 17 with cervical or thoracic ASIA Impairment Scale (AIS). A, B or C injuries were enrolled in this study. Two vasopressors, norepinephrine and dopamine, were evaluated in a 'crossover procedure' to directly compare their effect on the intrathecal pressure (ITP). The vasopressor cross-over procedures were performed in the intensive care unit where ITP, mean arterial pressure (MAP) and heart rate were being continuously measured. The SCPP was calculated as the difference between MAP and ITP. A total of 11 patients were enrolled and included in our analysis. There were 6 patients with AIS A, 3 with AIS B and 2 with AIS C injuries at baseline. We performed 24 cross-over interventions in these 11 patients. There was no difference in MAP with the use of norepinephrine versus dopamine (84±1 mm Hg for both; P=0.33). Conversely, ITP was significantly lower with the use of norepinephrine than with dopamine (17±1 mm Hg vs 20±1 mm Hg, respectively, P<0.001). This decrease in ITP with norepinephrine resulted in an increased SCPP during the norepinephrine infusion when compared with dopamine (67±1 mm Hg vs 65±1 mm Hg respectively, P=0.0049). Norepinephrine was able to maintain MAP with a lower ITP and a correspondingly higher SCPP as compared with dopamine in this study. These results suggest that norepinephrine may be preferable to dopamine if vasopressor support is required post SCI to maintain elevated MAPs in accordance with published guidelines.


Associations between cyclosporine therapy and interstitial fibrosis in renal allograft biopsies.
A retrospective masked study of 120 consecutive renal transplant biopsies was performed to evaluate the potential associations of cyclosporine (CsA) therapy and other factors on the degree and progression of interstitial fibrosis (IF). Allograft biopsies were obtained from patients receiving CsA (CsA+; n = 59) and not receiving CsA (CsA-; n = 46); pretransplant donor biopsies were used as controls (n = 15). IF was evaluated by histologic grading (0-3+) as well as by quantitative morphometric measurements of Masson's trichrome stain positive material. Other biopsy measurements included the pattern of IF (focal, diffuse; graded 0-3+), and tubular epithelial cell reactivity, necrosis, and vacuolization (each graded 0-3+). Potential confounding variables were also considered, including time interval between transplant and biopsy; creatinine levels at the time of biopsy, 2 weeks and 10 weeks postbiopsy, and the last stable (baseline) creatinine prior to biopsy; recipient age, clinical evidence of rejection, and duration of rejection reactions; transplant number; and postbiopsy graft outcome. No significant difference in any measure of IF was found between all CsA+ vs. CsA- patients, although both groups showed a highly significant increase in IF compared with control pretransplant donor biopsies. Similarly, no differences in tubular changes or the patterns of fibrosis were identified between CsA groups. However, since the mean interval between transplant and biopsy was significantly (P less than 0.04) greater for the CsA- group, measures of creatinine and IF were normalized by the time interval between transplant and biopsy, and were stratified into biopsies obtained before or after 6 months posttransplant. By this stratification and normalization, both the baseline creatinine (P less than 0.01) and the degree of IF as measured by morphometry (P less than 0.04) were significantly higher in the CsA+ group, but only for biopsies obtained greater than 6 months posttransplant. Evaluation of biopsies less than 6 months posttransplant normalized by interval showed no suggested differences between the CsA+ and CsA- groups in terms of creatinine levels or any measure of IF. Tubular epithelial changes were not different in the CsA+ and CsA- groups within either period. These results suggest that CsA therapy is not associated with increased interstitial fibrosis in renal allografts prior to 6 months posttransplant, after which there is a significant increase in fibrosis relative to patients not receiving CsA.


Retrotransposons shuttling genetic and epigenetic information from the nuclear to the mitochondrial compartment: Do they play a pathogenetic role in scleroderma?
Endogenous retroelements are a class of ancient defective viral insertions contained in the genome of host cells, where they account for up to 40% of all DNA. Centuries of co-existence in host genome have led to the development of immunotolerance to endogenous retroelements, most of which are defective and unable to replicate or transcribe functional proteins. However, given their capacity to move across the nuclear and mitochondrial genome and recombine, they could mix phenotypes and give rise to infections that may trigger innate and adaptive immune responses by sensing receptors capable of recognising foreign nucleic acids and proteins. It has recently been suggested that they play a role in the pathogenesis of autoimmune diseases on the grounds of their partial reactivation or the epigenetic control of host gene transcription. A number of studies have confirmed their contribution to the development of rheumatoid arthritis, multiple sclerosis and systemic lupus erythematosus, but there is still a lack of data concerning systemic sclerosis (SSc). Their role in the pathogenesis of SSc can be hypothesised on the basis of mitochondrial and nuclear chromatinic damage, and hyper-activation of the immune pathway involved in antiviral defense. SSc is characterised by genetic and immunological evidence of a viral infection but, as no viral agent has yet been isolated from SSc patients, the hypothesis that partial reactivation of endogenous retroviruses may trigger the disease cannot be excluded and deserves further investigation.


Pneumonitis in Combined Anti-programmed Death-1 Immunotherapy and Radiation Therapy for Renal Cell Carcinoma.
Anti-programed cell death-1 (Anti-PD-1) is a promising immunotherapy for advanced cancers. Autoimmune pneumonitis is a rare but potentially serious toxicity induced by anti-PD-1 immunotherapy. We report a case of therapy-induced pneumonitis in the setting of combined nivolumab, anti-PD-1 immunotherapy, and radiation therapy for metastatic renal cell carcinoma (RCC).


Tea waste derived activated carbon for the adsorption of sodium diclofenac from wastewater: adsorbent characteristics, adsorption isotherms, kinetics, and thermodynamics.
The present experimental study reports the performance of tea waste (TW) derived adsorbent for the adsorption of sodium diclofenac (SD) from aqueous solution (SD concentration = 10-50 mg/L). The waste-derived activated carbon was prepared by chemical activation process of raw waste using H2SO4, KOH, ZnCl2, and K2CO3 as activating agents (TW: activating agent = 1:1 by weight). Subsequently, the oven-dried material was carbonized at 600-°C temperature for 2 h. The synthesized adsorbents were porous and their Brunauer-Emmett-Teller (BET) surface area was ranged 115-865 m2/g. Among all synthesized adsorbents, the adsorbent activated by ZnCl2 exhibited the highest adsorption capacity (= 62 mg/g), though it was much lower compared to 91 mg/g obtained with commercial activated carbon (CAC) (SD concentration = 30 mg/L, adsorbent dose = 300 mg/L and initial wastewater pH = 6.47). SD equilibrium data could be described by Langmuir isotherm adequately, while pseudo-second-order rate model showed better fit to the time based adsorption data. Low activation energy of the adsorption process suggests the reaction to be temperature independent. Thermodynamic parameters showed the spontaneous and endothermic nature of adsorption process conducted in the presence of waste derived adsorbent.


Association of gynecologic oncology versus medical oncology specialty with survival, utilization, and spending for treatment of gynecologic cancers.
We examined the association of gynecologic oncology (GYO) versus medical oncology (MEDONC) based care with survival, health care utilization and spending outcomes in women undergoing chemotherapy for advanced gynecologic cancers. Women with newly diagnosed stage III-IV uterine, ovarian, and cervical cancers from 2000 to 2015 were identified in SEER-Medicare. We assessed the association of provider specialty with overall survival, emergency department utilization, admissions, and spending. Outcomes were assessed using unadjusted and Inverse Treatment Probability Weighted propensity-score applied, multi-variable cox modeling, Poisson regression, and generalized models of log-transformed data. We identified 7930 gynecologic cancer patients (4360 ovarian, 2934 uterine, 643 cervix). 37% were treated by GYO and 63% by MEDONC. For ovarian patients, GYO care was associated with improved OS (median OS 3.3 v. 2.9 years; HR 0.85, 95%CI 0.80, 0.91, p < .0001) and similar mean spending per month ($4015 v. $4316, mean ratio 0.97 (95% CI 0.93, 1.02), p = .19), compared to MEDONC in adjusted analyses. For uterine patients, GYO care was associated with similar OS, but decreased spending ($3573 v. $4081, mean ratio 0.87 (95% CI.81, 0.93), p < .0001), and decreased ED utilization (RR 0.76, 95% CI 0.69, 0.85, p < .0001). For cervical patients, GYO care was associated with similar OS, and similar spending. Admissions were more likely in ovarian (RR 1.23, 95%CI 1.11, 1.37, p = .0001) and cervical patients (RR 1.26, 95% CI 1.05, 1.51, p = .015) treated by GYO, in adjusted analyses. GYO based care was associated with improved OS and equal spending for patients with advanced stage ovarian cancer. Uterine and cervix patients had similar OS, and less or equal spending respectively, when treated by GYO compared to MEDONC.


Regulation of a thermostable alpha-amylase of Streptomyces thermoviolaceus CUB74: maltotriose is the smallest inducer.
We have examined induction and repression by various sugars and carbon sources of the synthesis of a thermostable alpha-amylase in its natural host, S thermoviolaceus CUB74. The smallest molecule capable of inducing synthesis of the enzyme was maltotriose whereas maltose had no effect which might suggest a different control system from that found in other streptomycete amylases. Addition of mannitol to the growth medium impeded the alpha-amylase induction whereas glucose had no effect. After cloning of its gene into a new streptomycete host, S lividans TK24, the S thermoviolaceus alpha-amylase could not be induced by any of the sugars tested.


Bullous systemic lupus erythematosus. Report of a case with lupus erythematosus cells in the dermis.
A 20-year-old black patient with bullous systemic lupus erythematosus developed papular and vesicular lesions on the extensor surfaces of the extremities. Histologically, subepidermal blisters and papillary neutrophilic abscesses with a striking number of lupus erythematosus cells were observed. No circulating anti-basal-membrane-zone antibodies were found. By Western immunoblotting, the patient's serum showed no reactivity against epidermal or dermal extracts.


Exploring Social Desirability Bias in Perceptions of Dog Adoption: All's Well that Ends Well? Or Does the Method of Adoption Matter?
Dogs are a popular companion animal in the United States; however, dog acquisition is often a contentious subject. Adoption is often cited as an ethical and popular method of acquisition but interpretation of the term 'adoption' may vary. In a nationally representative survey of the U.S., 767 respondents were asked questions regarding their opinions of dog acquisition and adoption. Within the sample, 45% had a dog; of those, 40% had adopted a dog, and 47% visited a veterinarian once a year. A best-worst choice experiment, where respondents were asked to choose the most ethical and least ethical method of acquiring a dog from a statistically determined set of choices, was used to elicit respondents' preferences for the most ethical method of dog adoption. A random parameters logit and a latent class model were used to estimate relative rankings of dog adoption methods. In the random parameters logit model, the largest preference share was for adoption from a municipal animal shelter (56%) and the smallest preference share was for adoption from a pet store (3%). Dog acquisition was further evaluated by creating an index of social desirability bias using how important respondents believed certain dog characteristics were compared to how important respondents believed others would rate/rank the same dog characteristics. The highest incidences of social desirability bias occurred for the dog characteristics of appearance and breed.


Oral tumors: the surgeon and the medical oncologist.
Aggressive surgery has been the primary treatment for oral tumors through the 1980s. A review of the results of such treatment is presented. A new approach using neoadjuvant chemotherapy is proposed in order to improve long-term prognosis in malignant oral tumors.


Ambulance transport to the emergency department: A patient-selected signal of acuity and its effect on resource provision.
To determine whether ambulance arrival to the emergency department has remained an unidentified signal of perceived medical acuity. Informed by economic signaling theory, does arrival via ambulance affect resource utilization given varying levels of patient acuity? The analysis examined a nationally representative sample of de-identified emergency department patient encounters from 2011 to 2015, gathered from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Multivariate logistic regression analysis was employed using regional and time-fixed effects. The provision of twenty diagnostic and imaging services was analyzed. Patient encounters were also categorized into five acuity-levels. Drawing from the NHAMCS dataset, 98,888 emergency department records were analyzed, weighted to represent 504.5 million estimated emergency department patient encounters. Findings suggest that patients transported to the hospital via ambulance are more likely than those who arrive by other means to receive 19 of the 20 analyzed diagnostic testing and imaging services. Furthermore, when analyzed by acuity-level, the disparity of service provision is the greatest among low-acuity patients, where medical complaints are argued to be the most subjective. The results are consistent with the notion that emergency department medical providers readily accept ambulance transport as a valid signal of patient acuity, regardless of true acuity level. Consequently, patients transported to the hospital via ambulance may be receiving a disproportionate amount of medical resources in an increasingly cost-conscious environment.


Minimal incision laparoscopy assisted open pediatric pyeloplasty.
Minimal incision laparoscopy-assisted open pyeloplasty (MILAP) incorporates elements of open pyeloplasty (OP) and single incision laparoscopy to improve technical ease and cosmetic outcomes. Six MILAP procedures were performed using a single transumbilical incision through which the ureteropelvic junction (UPJ) is mobilized with standard laparoscopic instrumentation. The UPJ is brought extracorporeally through a 1-cm flank incision, and a traditional Anderson-Hynes open pyeloplasty is performed. Compared with OP, perioperative outcomes were similar. Follow-up renal scans all showed improvement of obstruction. A 1-cm flank incision is the only obvious scar.


Diagnostic accuracy of first generation dual-source computed tomography in the assessment of coronary artery disease: a meta-analysis from 24 studies.
The objective of this study is to evaluate the diagnostic accuracy of the first generation dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). We selected articles from four databases (Pubmed, Embase, the Cochrane central register of controlled trials (CENTRAL) and Chinese biomedical literature database. The strict study selection was made, and two reviewers independently extracted data back-to-back from included studies. Meta-Disc version 1.4 was used to obtain the pooled results. 24 studies were included in meta-analysis. A cut off point of ≥50% stenosis was used in all the studies to define significant coronary artery stenosis. In patient-based analysis (n = 801), pooled sensitivity was 0.980 [95% confidence interval (CI):0.970-0.990], specificity 0.870 (95% CI: 0.830-0.900), median positive predictive value (PPV) across studies 0.876 (range from 0.741 to 0.943) and negative predictive value (NPV) 0.964 (range from 0.900 to 1.000). In vessel-based analysis (n = 3,620) DSCT pooled sensitivity was 0.957 (95% CI: 0.943-0.969), specificity 0.930 (95% CI: 0.910-0.940), median PPV across studies 0.838 (range from 0.534 to 0.964) and NPV 0.973 (range from 0.885 to 0.996). In segment-based analysis (n = 6,177) DSCT pooled sensitivity was 0.915 (95% CI: 0.901-0.928), specificity 0.959 (95% CI: 0.956-0.963), median PPV 0.782 (range from 0.320 to 0.927) and NPV 0.985 (range from 0.929 to 0.999). In subgroups analysis, pooled sensitivity and specificity in segment based analysis were 93.1 and 92.3% when heart rate (HR) is beyond 70 bpm; when HR was below 70 bpm, the sensitivity was similar (93%), but specificity increased a little from 92.3 to 94%. When analysed based on segment with a cut-off calcium score of 400, the sensitivity was slightly higher in the subgroup with a score over 400 than in the subgroup with a score below 400 (94 vs. 91%), while the specificity was much lower in the subgroup with the high calcium score than the subgroup with the low calcium score (85 vs. 96%). For subgroups with heart rate beyond and below 65 bpm in patient-based analysis, sensitivities were 0.95 (95% CI: 0.86-0.99) and 0.98 (95% CI 0.91-1.00), respectively, while the specificities were 0.88 (95% CI 0.81-0.94) and 0.85 (95% CI 0.77-0.91), respectively. The area under the receiver operating characteristic curve (AUC) in the two subgroups were 0.9608 and 0.9786, respectively. DSCT is highly sensitive for patient-based analysis of CAD and has high specificity and NPV for segment-based analysis of CAD. First generation DSCT may have a role in the evaluation of patients with chest pain as a simple non-invasive examination because of its ability to diagnose or exclude significant CAD.


Decreased production of IL-6 by peripheral blood mononuclear cells of patients with chronic lymphocytic leukemia and related disorders.
The present study has shown a decreased production of IL-6 by LPS-stimulated mononuclear cells of B-CLL blood. This decrease with attributed to an abnormality of either monocytes or T lymphocytes. A similar decrease was seen in HCL and NHL. Experiments with mixtures of normal and CLL cells suggest that the decreased IL-6 production in CLL is due neither to an inhibition of normal blood mononuclear cells IL-6 production by B-CLL lymphocytes nor to the absence in CLL blood of cell(s) or cytokine(s) needed for IL-6 production.


High levels of endogenous 1,3-butanediol in the blood of a man after ethanol ingestion.
A young man was found to have 1,3-butanediol in his blood, much more after ethanol ingestion. This substance reacted in the enzyme procedure for measuring blood alcohol, giving falsely high values. The 1,3-butanediol was detected by gas chromatography.


The role of the N-terminus in the active conformation of the substance P analogues.
The role of the N-terminus in the activity of substance P analogues was studied with the isolated rat spinal cord and the guinea-pig ileum. When the C-terminal Leu10 or Met11 was replaced by the D-isomer, the analogues without the N-terminal tetrapeptide were 40-100 times less potent than those with the N-terminus in both motoneuron-depolarizing and ileum-contracting actions. These results that the N-terminus may stabilize the active conformation of the substance P analogues.


Comparison of cryoprotective effects of iodixanol, trehalose and cysteamine on ram semen.
This study was conducted to improve cryosurvival of electroejaculated (EE) ram semen in the presence of iodixanol (OptiPrep™), trehalose or cysteamine. A tris-based extender was used to prepare 12 extenders containing OptiPrep™ (Op), trehalose (Tr) or cysteamine (Cy) alone, or different combinations of these compounds. Extenders were designated as follows: Tris (control), Op1.25 (1.25% Op, v/v), Op2.5 (2.5% Op, v/v), Op5 (5% Op, v/v), Tr50 (50mM Tr), Tr100 (100mM Tr), Cy (5mM Cy), OpTr (2.5% Op and 100mM Tr), OpCy (2.5% Op and 5mM Cy), TrCy (100mM Tr and 5mM Cy), OpTrCy1 (2.5% Op, 100mM Tr and 5mM Cy) and OpTrCy2 (1.25% Op, 50mM Tr and 2.5mM Cy). A two-step dilution was used and glycerol was added at 5°C in the second step. Diluted samples were equilibrated for 1h, loaded in 0.25mL straws and frozen in a programmable freezing machine. Supplementation of 5% OptiPrep™ significantly protected post-thaw progressive motility, membrane integrity, acrosomal integrity and morphological damages. Trehalose supplementation protected membrane integrity of ram sperm; however, it did not help post-thaw motility and morphology. Supplementation of 5mM cysteamine had detrimental effect on cryosurvival of EE ram semen. These results demonstrate that the supplementation of iodixanol increases the cryosurvival of EE ram semen in a dose-dependent manner.


Graphene sheet-starch platform based on the groove recognition for the sensitive and highly selective determination of iodide in seafood samples.
The functionalization of graphene nanosheets was realized using a simple starch mixture to achieve a highly selective recognition of iodide, thereby surmounting the complicated reactions possibly leading to low yield during functionalization. The groove recognition for starch to iodide, a novel recognition model, was established. The starch-to-graphene nanosheet mass ratio of 3:2 produced an optimal current signal. The recognition and measurement procedures were conducted in different cells, respectively. These procedures improved the selectivity and sensitivity, and overcame the possibility of interference from coexisting ions. Under optimal conditions, the graphene sheet-starch electrode was immersed in a recognition cell at pH 2.0 for 10min, afterward, in a measurement cell at pH 1.0 for quantitative analysis, resulting in the highest current signals obtained. The quantitative electrochemical measurements yielded a mean value of 214.6mg/kg in actual samples of commercially available seafood sample, whereas the spectrophotometric measurements produced a mean value of 226.7mg/kg. If the spectrophotometric value for the seafood sample is accurate, the percentage error for the electrochemical method is only 5.3%. Therefore, the electrochemical method is reliable for qualitative iodide measurements. The groove recognition was highlighted to elucidate the specific selectivity.


Alternative polyadenylation mediates microRNA regulation of muscle stem cell function.
Pax3, a key myogenic regulator, is transiently expressed during activation of adult muscle stem cells, or satellite cells (SCs), and is also expressed in a subset of quiescent SCs (QSCs), but only in specific muscles. The mechanisms regulating these variations in expression are not well understood. Here we show that Pax3 levels are regulated by miR-206, a miRNA with a previously demonstrated role in myogenic differentiation. In most QSCs and activated SCs, miR-206 expression suppresses Pax3 expression. Paradoxically, QSCs that express high levels of Pax3 also express high levels of miR-206. In these QSCs, Pax3 transcripts are subject to alternative polyadenylation, resulting in transcripts with shorter 3' untranslated regions (3'UTRs) that render them resistant to regulation by miR-206. Similar alternate polyadenylation of the Pax3 transcript also occurs in myogenic progenitors during development. Our findings may reflect a general role of alternative polyadenylation in circumventing miRNA-mediated regulation of stem cell function.