Ethics and human-companion animal interaction. A plea for a veterinary ethics of the human-companion animal bond.
For both moral and practical reasons, the veterinary profession must begin to nurture a serious veterinary ethics of human-companion animal interaction. Among the central concerns of such a discipline will be the moral value of the veterinary patient: the moral significance of human-animal companionship; the proper response of the practitioner to conflicts of interests between the patient, its owner, and himself; and the proper role of the practitioner in the client's decisions. Approaches that urge moral equality of man and animal or encourage the veterinarian to control the client's decision undervalue the moral status of the animal owner in the human-companion animal bond.


Adjuvant chemotherapy for soft tissue sarcomas.
Soft tissue sarcomas are rare mesenchymal neoplasms with considerable heterogeneity in biologic behavior and response to systemic therapy. Most patients present with localized disease and are potentially curable with multidisciplinary treatment. In patients with a high risk of developing metastatic disease, optimal use of neoadjuvant/adjuvant therapy has a definite role in improving patient outcomes by decreasing local and distant recurrences. Histology-specific clinical trials enrolling a homogenous high-risk population have been more successful in demonstrating benefit than larger trials with unselected heterogeneous patient populations. In specific histologic subtypes responsive to chemotherapy, neoadjuvant chemotherapy with close monitoring of response is recommended.


Tracker-assisted versus manual ablation zone centration in laser in situ keratomileusis for myopia and astigmatism.
Eye tracker systems have been developed concomitantly with small scanning beams to theoretically reduce ablation zone decentration and for accurate registration of all the laser pulses on the cornea. The purpose of the study was to compare the tracker-assisted with the manual centration method. Twenty-five patients (48 eyes) with myopia and/or astigmatism had laser in situ keratomileusis (LASIK) between August 1998 and February 1999 with the Technolas 117C laser. Twenty patients (38 eyes, 80%) were available for follow-up at 3 months after surgery. Eyes were assigned randomly to one of two ablation zone centration methods: Group 1: Tracker-assisted (20 eyes), Group 2: Manual (18 eyes). Mean distance between the ablation zone center and the pupillary center in the tracker-assisted centration group was 0.55 +/- 0.30 mm (range, 0.10 to 1.4 mm), and in the manual centration group, 0.43 +/- 0.23 mm (range, 0.10 to 1.0 mm) (P = .177). There was no statistically significant difference in postoperative contrast sensitivity, glare, and Topographical Corneal Surface Regularity Index (SRI) between the two groups. We obtained good results with both centration methods. We did not find superiority of the tracker-assisted over manual regarding ablation zone centration, vision quality, or regularity of the ablation.


GRK5 Inhibition Attenuates Cartilage Degradation via Decreased NF-κB Signaling.
NF-κB-dependent signaling is an important modulator in osteoarthritis (OA), and G protein-coupled receptor kinase 5 (GRK5) regulates the NF-κB pathway. This study was undertaken to investigate the functional involvement of GRK5 in OA pathogenesis. GRK5 expression in normal and OA human knee joints was analyzed immunohistochemically. Gain- or loss-of-function experiments were performed using human and mouse chondrocytes. OA was induced in GRK5-knockout mice by destabilization of the medial meniscus, and histologic examination was performed. OA was also induced in wild-type mice, which were then treated with an intraarticular injection of amlexanox, a selective GRK5 inhibitor, every 5 days for 8 weeks. GRK5 protein expression was increased in human OA cartilage. In vitro, expression levels of OA-related factors and NF-κB transcriptional activation were down-regulated by suppression of the GRK5 gene in human OA chondrocytes (3.49-fold decrease in IL6 [P < 0.01], 2.43-fold decrease in MMP13 [P < 0.01], and 2.66-fold decrease in ADAMTS4 [P < 0.01]). Conversely, GRK5 overexpression significantly increased the expression of OA-related catabolic mediators and NF-κB transcriptional activation. On Western blot analysis, GRK5 deletion reduced IκBα phosphorylation (up to 4.4-fold decrease [P < 0.05]) and decreased p65 nuclear translocation (up to 6.4-fold decrease [P < 0.01]) in mouse chondrocytes. In vivo, both GRK5 deletion and intraarticular amlexanox protected mouse cartilage against OA. Our results suggest that GRK5 regulates cartilage degradation through a catabolic response mediated by NF-κB signaling, and is a potential target for OA treatment. Furthermore, amlexanox may be a major compound in relevant drugs.


Factors associated with increased risk of lurasidone-induced somnolence: Two case-control studies based on one bioequivalence trial in healthy volunteers.
Somnolence is a common adverse effect of antipsychotic drugs used to treat psychotic disorders. It causes problems in many areas of life, such as gainful employment, driving, childcare, and social interactions. Somnolence is a major problem for a relatively new antipsychotic drug, lurasidone, whose dose-effect relationship remains unclear. Based on data from a bioequivalence study of two 40 mg lurasidone hydrochloride tablets, we designed two case-control studies to explore the correlation between somnolence and exposure to lurasidone and determine the factors associated with lurasidone-induced somnolence. In the first case-control study, lurasidone was administered to healthy volunteers; 30 experienced somnolence (as pre-defined) but 29 did not. Moreover, plasma concentration at 1 h was significantly associated with somnolence (OR = 1.124; p = 0.001). In the second case-control study, 48 volunteers administered lurasidone were classified into somnolence and no-somnolence groups based on different time-related criteria. We observed a positive association between plasma concentration at 0.75 h and somnolence (OR = 1.024; p = 0.002). Receiver operating characteristic analysis revealed that a plasma lurasidone concentration >21.65 ng/mL 1 h after administration strongly predicted somnolence. Our findings in healthy volunteers need to be further validated in patients in clinical settings to determine the optimal dose and duration of lurasidone administration.


Use of CroFab antivenin in the management of a very young pediatric copperhead envenomation.
The use of crotalid Fab antivenin (CroFab) in the treatment of snake envenomations in the pediatric population is still an underexplored area. There are very limited data to confirm the efficacy and safety of dosing children the same as adults and even less information available to evaluate this antivenin use in copperhead snake bites in children. We report the first use of crotalid Fab antivenin in an adult dose for a copperhead snake envenomation in a 2-year-old child. She had rapid resolution of symptoms with no adverse effects. The report serves to increase the literature supporting the current dosing recommendations of crotalid Fab antivenin in very young pediatric patients evidenced by its effectiveness in this patient.


Shen-Fu Decoction could ameliorate intestinal permeability by regulating the intestinal expression of tight junction proteins and p-VASP in septic rats.
Shen-Fu Decoction (SFD), a classic Traditional Chinese paired herb formulation, has been widely used for the treatment of sepsis in China. This study was carried out to assess the effects of SFD in sepsis-induced intestinal permeability and intestinal epithelial tight junction damage in rats with sepsis. A rat model of sepsis was created by cecal ligation and puncture (CLP). Rats in Sham and CLP + vehicle groups received equal distilled water, while rats in SFD group were treated by gavage of SFD (3 mg/kg, twice a day) for 72h. Mortality, sepsis-induced peritoneal inflammation, intestinal and liver histopathology damage, intestinal permeability (serum FITC-dextran and D-lactate), serum LPS, serum inflammation (PCT, TNF-α, and IL-6), and liver function (AST and ALT) were evaluated. The levels of zonula occluden (ZO-1), Occludin, Claudin-1 were analyzed by Real-time quantitative PCR and Western blotting (WB) respectively. Vasodilator-stimulated phosphoprotein (VASP) and p-VASP in intestinal epithelium were analyzed by WB. Our study showed that SFD markedly reduced the mortality rate of CLP rats, prevented intestine and liver damage, relieved sepsis-induced intestinal permeability and inflammation elevation, ameliorated sepsis-induced impaired intestinal permeability by regulating the expression of ZO-1, Occludin, Claudin-1 and p-VASP. The herbal formula SFD may be useful for reducing sepsis-induced organic damage and mortality by ameliorating the condition of sepsis-induced intestinal permeability by regulating tight junction proteins and p-VASP.


Effects of various processed methods on chemical constituents and anti-hepatitis activity of Bupleurum scorzonerifolium Willd. by metabonomics and molecular docking.
In this study, a plant metabonomics technique, utilizing ultra-high performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry (UPLC-ESI--QTOF), was used to clarify the differences of various processed Bupleurum scorzonerifolium Willd. Principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to determine the differences in raw and different processed B. scorzonerifolium samples, including vinegar stir-fry, wine stir-fry, honey stir-fry, honey bran stir-fry and charcoal stir-fry. Thus, 39 significant compounds, e.g., saponins, free fatty acids, fatty acid pentitol glycosides, organic acid and linalool glycosides, were clearly or tentatively identified by UPLC-ESI--QTOF-MS/MS fragmentation pathways and by comparison with available reference standards. Most importantly, fatty acid pentitol glycosides were discovered and identified in B. scorzonerifolium for the first time. Furthermore, a HepG2 hepatitis model induced by TNF-α was used to measure the anti-hepatitis effect of raw and processed B. scorzonerifolium in vitro. Molecular docking was used to understand the interaction of key Q-markers with the active sites of the target protein. The results show that the UPLC-QTOF-MS metabolomics coupled with molecular docking is a powerful tool to quickly identify quality control characteristics of B. scorzonerifolium and its products.


Placental considerations in multiple pregnancy.
This article contains a brief description of the placenta in multiple pregnancy, including a classification based on embryogenesis. The biologic and clinical importance of recognition of the different types of twin placentas is emphasized. Finally, a classification of the pathological lesions seen in these placentas, either because of the twinning process or simply associated with it, is proposed.


RUNX3 promoter region is specifically methylated in poorly-differentiated colorectal cancer.
It has recently become clear that RUNX3 expression is frequently silenced by aberrant methylation in gastric cancers. In this study, we investigated the methylation status of the RUNX3 gene in 92 resected primary colorectal cancers using methylation-specific PCR (MSP) and correlated the results with the clinicopathological features of affected patients. Aberrant promoter methylation of the RUNX3 gene was detected in 31 out of 92 (34%) colorectal cancers. A significant difference in histology (p = 0.028) was also found on comparing the RUNX3 methylation of poorly-differentiated colorectal cancers to that of other differentiated ones. RUNX3 aberrant methylation might play an important role in colorectal cancers, especially in poorly-differentiated colorectal cancers.


Radiology of an atypical fibro-osseous lesion confined to the nasal cavity.
Fibro-osseous lesions of the sinonasal region are relatively frequent, but those strictly confined to the nasal cavity are rare. We report an atypical fibro-osseous lesion in the nasal cavity and describe its radiological features. The differential diagnosis is discussed.


Ovarian cyst torsion in Prader-Willi Syndrome.
Prader-Willi syndrome (PWS) is a genetic disorder involving multiple systems, with an incidence of about 1/10000-25000. Ovarian torsion (OT) is not commonly found in children. Ovarian cyst acts as one of the primary factors resulting in OT. While ovarian cyst torsion with Prader-Willi Syndrome has not been reported before. A 12-years old female was admitted to Emergency Department of our hospital with the chief complaint of abdominal pain. The outcomes of physical examination revealed the height of 150 cm, weight of 103 kg, BMI of 45.77 kg/m2. The patient manifested the special facial features, an obese body, with the abdomen distended into a spherical shape. The fat accumulation in the abdomen significantly embarrassed the palpation. The abdominal CT scan indicated a huge cystic mass in the abdominal cavity, sized about 138 mm × 118 mm. According to medical history, the patient was born with low crying and hypotonia, who has developed the uncontrollable eating behavior since 3-years old. These abnormalities led to a speculation of PWS syndrome, so a genetic test was performed and finally confirmed it, concluding a torsion of ovarian cyst with PWS. With the multidisciplinary consultation, a careful treatment strategy containing the control of blood pressure and blood sugar, coenzyme Q10 was administrated to nourish the myocardium and the application of Growth Hormone was developed. All the above preoperative treatments have brought great benefits to patients. Thus promising the successful completion of operation. The postoperative follow-up till now indicated that the abdominal incision was well healed, without operative complications. This may be the first case report. In the treatment of ovarian cyst torsion, PWS syndrome requires fully consideration, as the latter can lead to multisystem abnormalities, especially the relation to perioperative management, and even fatalities. Genetic testing should be conducted early when PWS was suspected, accompanied with adequate preparation for the perioperative period, the follow-ups of patients should be maintained for a long time after surgery.


NS-3(CG3703), a TRH analog, ameliorates scopolamine-induced memory disruption in rats.
The effects of a metabolically stable TRH analog, N-[[(3R, 6R)-6-methyl-5-oxo-3-thiomorpholinyl]carbonyl]-L-histidyl-L- prolinamide tetrahydrate (NS-3, CG3703) on the scopolamine-induced memory disruption in maze performance tests were investigated in rats. a) In the delayed nonmatching-to-sample (DNMS) task using a T-maze, NS-3 (0.3 mg/kg) produced a significant reversal of the marginal disruption of choice accuracy induced by scopolamine (0.3 mg/kg) at the short (5 s) and long (120, 480 s) interval delays. Physostigmine (0.5 mg/kg) produced a significant reversal only at a 5-s interval delay. b) In the eight-arm radial maze task, NS-3 (0.3 mg/kg) significantly reversed the deficit of choice accuracy induced by scopolamine (0.3 mg/kg), whereas neither TRH (3-30 mg/kg) nor physostigmine (0.1-1 mg/kg) had any effect. The consistent reversal of these maze-learning performances by NS-3, but not by TRH or physostigmine, may be due to its potent enhancement of cholinergic and noradrenergic neuronal activities.


Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.
Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.


Renal changes in heterozygous Fabry's disease--a family study.
Two sisters, one with a long history of proteinuria and the other of hematuria, came for examination. Physical examination and routine laboratory workups did not show any significant abnormalities. The renal ultrastructural changes in case 1 showed marked enlargement and foamy vacuolation of all the glomerular capillary visceral epithelial cells, which was not found in other glomerular cells. The renal changes in case 2 showed similar lesions but with fewer cells involved and also with less severity, but the involved cells showed marked lamellation within the vacuoles. The serum alpha-galactosidase activity was 4.9 and 3.0 nmol/h/mL serum, respectively (normal values, 12.1 +/- 1.6 nmol/h/mL serum, mean +/- SD, n = 11), thus confirming the heterozygous variety of Fabry's disease. Our findings in these two cases reveal that patients with heterozygous Fabry's disease may present with renal symptoms only, which may be either proteinuria or hematuria.


Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model.
Focusing on a representative abdominal aortic aneurysm (AAA) with a bifurcating stent-graft (SG), a fluid-structure interaction (FSI) solver with user-supplied programs has been employed to solve for blood flow, AAA/SG deformation, sac pressure and wall stresses, as well as the downward forces acting on the SG. Simulation results indicate that implanting a SG can significantly reduce sac pressure, mechanical stress, pulsatile wall motion, and maximum diameter change in AAAs; hence, it may restore normal blood flow and prevent AAA rupture effectively. The transient SG drag force is similar in trend as the cardiac pressure. Its magnitude depends on multi-factors including blood flow conditions, as well as SG and aneurysm geometries. Specifically, AAA neck angle, iliac bifurcation angle, neck aorta-to-iliac diameter ratio, SG size, and blood waveform play important roles in generating a fluid flow force potentially leading to SG migration. It was found that the drag force can exceed 5N for an AAA with a large neck or iliac angle, wide aortic neck and narrow iliac arteries, large SG size, and/or abnormal blood waveform. Thus, the fixation of self-expandable or balloon-expandable SG contact may be inadequate to withstand the forces of blood flowing through the implant and hence means of extra fixation should be considered. A comprehensive FSI analysis of the coupled SG-AAA dynamics provides physical insight for evaluating the luminal hemodynamics, and maximum AAA-stresses as well as biomechanical factors leading potentially to SG migration.


The modified Fontan operation for double inlet left ventricle. Surgical results, early haemodynamic and functional assessment.
Twenty-one patients with a double inlet left ventricle underwent a modified Fontan between May 1979 and August 1987. All but the first patient in this series were operated upon after August 1984. Their age at operation ranged from 4 to 23 years with a median age of 8 years. Initial palliation was required in 12 patients and the mean interval to repair was 77.1 months, ranging from 38 to 112. Only one of the criteria of Choussat was exceeded in 12 patients. The pulmonary vascular resistance was always less than 4 Um2. A direct atriopulmonary anastomosis was performed in 19 patients and an aortic homograft interposition was used in 2. There was one hospital death due to acute cardiac failure and no late deaths. The average of the mean right and left atrial pressures measured early postoperatively was 12.9 and 8 mmHg respectively. A prolonged hospitalization with a mean of 23 days, ranging from 9 to 69, was required because of recurrent pleural and pericardial effusions which usually resolved after the first 6 postoperative months. The need for early anticoagulation is recommended to prevent the risk of pulmonary thromboembolism observed in 2 of our patients. Cardiac catheterization performed in 19 patients within 1 year after surgery showed that the average of the mean right atrial pressure had decreased to 11.3 mmHg without a gradient across the anastomosis in any case. Two patients required reoperation: one for enlargement of a restrictive ventricular septal defect and the other for closure of a recurrent dehiscence of the patch used for closure of the right a-v valve. Three patients developed a significant subaortic obstruction and have been scheduled for reoperation. Ventricular function was assessed at a mean interval of 11.9 months (17 patients) and 25.5 months (13 patients) from surgery. Gated equilibrium radionuclide ventriculography showed that the ejection fraction was normal (greater than or equal to 50%) and it had increased with time in 10. Yet, the response to exercise was normal in only 5 of the 13 patients re-evaluated. Treadmill exercise testing showed an increase in exercise tolerance from a mean of 7.4 min to a mean of 8.7 min.(ABSTRACT TRUNCATED AT 400 WORDS)


Infant sleep behaviors relate to their later cognitive and language abilities and morning cortisol stress hormone levels.
This longitudinal study examined parents' perceptions of infant sleep behaviors in relation to cognitive and language development, and infants' stress hormone (cortisol) levels. Infants were recruited and assessed at 8 months and then again 6 months later at 14 months. At both times, parents reported on infants' home sleep environment and sleep behaviors; the infants' childcare classroom teachers completed standardized questionnaires on the children's cognitive and language development skills; and researchers collected numerous saliva samples from infants at both times to assay cortisol stress hormone levels. Pearson correlation analyses indicated that 8-month-old infants' optimal sleep in their home environment positively and modestly related to their cognitive skills and language development when they were 14-month-old toddlers. These results suggest that cognitive development and language learning in the first year of life are linked to sleep behaviors. Additionally, optimal home sleep in toddlerhood was positively and moderately correlated with higher morning stress hormone levels. The development of the HPA axis in infancy and toddlerhood is discussed as is the development and regulation of the hypothalamic-pituitary-adrenal axis and diurnal cycles.


Mechanism of anti-nociceptive effects of Asarum sieboldii Miq. radix: potential role of bradykinin, histamine and opioid receptor-mediated pathways.
The radix of Asarum sieboldii Miq. (AR) has been used to treat pain and inflammation in Korea. The present study was conducted to gain insights into the mechanism of actions regarding anti-nociceptive and anti-inflammatory activities of AR. Administration of methanol extract of AR caused dramatic anti-nociceptive effects based on acetic acid writhing and tail-flick assay. When naloxone (Nx) was pre-treated, AR extract failed to exert such anti-nociceptive effect in the tail-flick assays. These results suggest that AR extract have opioid-like activity. It also exerted significant anti-inflammatory effects in the rat paw edema assay. AR extract caused inhibition in the bradykinin (BK)/histamine-mediated ileum contractions of guinea pig. Taken together, these results provide evidence that the methanol extract of AR exerts anti-nociceptive and anti-inflammatory effects by activating opioid receptor as well as by inhibiting bradykinin and histamine-mediated actions.


[Prevention of platelet transfusion refractoriness and HLA alloimmunization by leukocyte filtered platelet transfusion: a meta analysis].
To compare and assess the effectiveness of leukocyte-filtered platelet and standard platelet concentrates transfusion in preventing platelet transfusion refractoriness (PTR) and human leukocyte antigen (HLA)-alloimmunization. Randomized controlled trials (RCTs) or quasi-RCTs comparing leukocyte-filtered platelet with standard platelet concentrates transfusion (up to December 31, 2009) were searched and identified from Medline, EMBASE, The Cochrane Library, and CBM. A meta-analysis was conducted with Cochrane Collaboration's RevMan 5. 0. The search identified 558 citations in total, in which 7 articles in English were finally included in the meta-analysis. The analysis showed that compared with standard platelet concentrates transfusion, leukocyte-filtered platelet transfusion significantly decreased PTR [ RR = 0. 59, 95% CI (0. 42, 0. 82) , P = 0. 002 ] and HLA-alloimmunization [ RR = 0. 49,95% CI (0. 33, 0. 74) , P =0. 0006]. Subgroup analysis showed that HLA-alloimmunization was significantly reduced by leukocyte-filtered platelet transfusion among the patients with acute myelocytic leukemia [ RR =0.42, 95% CI (0.32, 0.56), P <0. 00001], while no significant difference was detected in patients with acute lymphoblastic leukemia because of the limited sample size [ RR = 0. 50, 95% CI (0. 10, 2.41) , P =0. 39]. The current evidence shows that leukocyte-filtered platelet transfusion can prevent PTR and HLA-alloimmunization more effectively than standard platelet transfusion. Well-designed large-scale RCTs are still needed to further confirm this finding.


Low-Level Laser Therapy for Reducing the Hip, Waist, and Upper Abdomen Circumference of Individuals with Obesity.
To assess the effectiveness of low-level laser therapy (LLLT) for reducing hip, thigh, and abdomen circumference of individuals with body-mass index (BMI) between 30 and 40 kg/m2. Previous studies demonstrated the effectiveness of LLLT for reducing body circumference in the hips, thighs, and abdomen of nonobese individuals with a BMI <30 kg/m2. In this randomized, double-blind sham-controlled study, obese, but otherwise healthy, individuals were randomized to undergo 30-min LLLT (n = 28) or sham treatments (n = 25) three times weekly for 4 weeks. Body measurements were obtained after 2 and 4 weeks of treatment and 2 weeks post-treatment ( ClinicalTrials.gov Identifier: NCT01821352). After 4 weeks, 20 LLLT-treated subjects (71.43%) achieved ≥7.2 cm decrease in combined measurements versus three sham-treated subjects (12%; p < 0.00005). The mean (standard deviation) decrease in combined measurement for LLLT-treated subjects was 10.52 (7.59) cm (p < 0.0001 vs. baseline) versus 1.80 (3.20) cm for sham-treated subjects. Among subjects with a combined ≥7.2 cm decrease, the mean total decrease 2 weeks post-treatment was 15.21 cm. There were no adverse events. Based on these results, the device was cleared by the U.S. Food and Drug Administration as a noninvasive esthetic treatment for reduction of circumference of hips, waist, and upper abdomen when applied to individuals with a BMI between 30 and 40 kg/m2.


Quinidine-induced photodermatitis confirmed by photopatch testing.
A patient with quinidine-induced photosensitivity confirmed by photopatch testing is presented. The action spectrum for the reaction appeared to be in the UVA range, and the patient's minimal erythema dose was lower than expected while the patient was on quinidine.


Polyethylene wear simulation models applied to a prosthetic hip joint based on unidirectional articulations.
Ultra-high molecular weight polyethylene (UHMWPE) is commonly used as soft-bearing material in total joint replacements. However, the release of polymeric wear debris is still related to complications leading to aseptic loosening. Recently, a novel hip prosthesis showing reduced wear was developed by the authors of this study, consisting of unidirectional cylindrical articulations instead of the conventional multidirectional ball-and-socket design. This study evaluates four different theoretical wear models applied to this new design. The calculated volumetric wear was compared to experimental results. Although all models provided a good indication of the wear rates for the ball-and-socket prosthesis, they exhibited high discrepancies when predicting the amount of wear of the new unidirectional design. It was observed that the closest agreement with experimental results was obtained by the models that consider the friction-induced molecular orientation phenomenon exhibited by UHMWPE.


Perinatal airway management of neonatal cervical teratomas.
Cervical teratomas are rare but life-threatening neonatal tumors and management of the fetus with a cervical teratoma that threatens the airway remains a clinical challenge. This has been revolutionized by advances in fetal imaging and management of the airway at delivery including the use of Ex-utero Intrapartum Treatments (EXIT procedures). We present a retrospective case series of three neonates managed over a 12-month period. Following pre-natal fetal MRI and a multi-disciplinary management approach, two newborns were managed by prompt post-natal endotracheal intubation while an EXIT procedure was required in one. All three underwent surgical resection in the first few days of life. A decision regarding the best means by which to manage the airway in fetal cervical teratoma requires fetal MRI and a multi-disciplinary team approach to determine whether EXIT, or a safer approach from a maternal perspective can be employed. We also recommend routine endotracheal intubation at birth, due to the risk of spontaneous intra-tumoral hemorrhage. The need for surgery should be planned early, as rapid growth of the tumor can threaten the viability of the overlying skin and surrounding structures.


Hypoparathyroidism with Fahr's syndrome: A case report and review of the literature.
Hypoparathyroidism with basal ganglia calcification is clinically rare. Here, we report a case of Fahr's syndrome due to hypoparathyroidism and review the literature in terms of etiology, clinical manifestation, diagnosis, and treatment. A 62-year-old man experienced repeated twitching of both hands in recent 10 years. On July 28, 2017, the patient was admitted to our hospital due to slow response and speech difficulties. On medical examinations, he had a positive Chvostek sign, while no Albright's hereditary osteodystrophy signs or history of neck surgery or radiation, and his family members had no similar medical history. Laboratory examinations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone (PTH) levels. Computed tomography revealed basal ganglia calcification. Based on these investigations, a diagnosis of Fahr's syndrome due to hypoparathyroidism was suggested. After receiving intravenous calcium gluconate to relieve symptoms, the patient continued to take oral calcium carbonate and calcitriol for treatment. The possibility of hypoparathyroidism should be considered in patients with chronic hypocalcemia, recurrent tetany, and even neuropsychiatric symptoms. Hypoparathyroidism is a common cause of basal ganglia calcification. Therefore, it is recommended that blood calcium, phosphorus, and PTH levels should be measured in all individuals with basal ganglia calcification to exclude hypoparathyroidism.


Bile acid profiles in bile, urine, and feces of a patient with cerebrotendinous xanthomatosis.
Bile acid profiles of bile, urine, and feces obtained from a patient with cerebrotendinous xanthomatosis on the same day have been analyzed by gas-liquid chromatography-mass spectrometry after fractionation into groups by mode of conjugation by an ion-exchange chromatography. The predominant biliary bile acid was cholic acid conjugated with glycine and taurine. Lesser amounts of the amino acid conjugates of chenodeoxycholic acid, ursodeoxycholic acid, 7-ketodeoxycholic acid, allocholic acid, and deoxycholic acid, and of unconjugated norcholic acid and allonorcholic acid were also present in the bile. The major fecal bile acid was 7-epicholic acid. Relatively large amounts of bile acids were excreted in the urine. Unconjugated 7-epicholic acid, norcholic acid, allonorcholic acid, and cholic acid predominated. The bile acid profiles of the patient were different from those of normal subjects and should be useful for the diagnosis.


Comparative adherence to weekly oral and quarterly intravenous bisphosphonates among patients with limited heath literacy who sustained distal radius fractures.
Individuals with limited health literacy (HL) are less likely to obtain preventive care. We designed a study to compare adherence to weekly oral and quarterly intravenous bisphosphonates among patients with low HL. The study enrolled a total of 432 female patients who presented with a distal radius fracture caused by low-energy trauma. Participant HL was measured using the Newest Vital Sign tool, and patients were randomized to weekly oral or quarterly intravenous bisphosphonate groups. Subjects in the intravenous bisphosphonate group received intravenous injections of 3 mg ibandronate every 3 months, and those in the oral bisphosphonate group self-administered 70 mg alendronate orally once each week for 12 months. The adherence to weekly oral or quarterly intravenous bisphosphonates was analyzed by HL level. The rate of adherence to quarterly intravenous bisphosphonates was significantly higher than that for weekly oral bisphosphonates in patients with inadequate HL (73 vs. 46%, p = 0.001), whereas no significant differences were observed between HL groups in adherence to intravenous bisphosphonate. Conversely, the rate of adherence to orally administered bisphosphonates was significantly lower in patients with inadequate HL than in those with appropriate HL (46 vs. 65%, p = 0.005). After controlling for confounding variables, inadequate HL, the presence of comorbidities, and weekly oral bisphosphonates were associated with a higher likelihood of nonadherence to osteoporosis treatment. Thus patients with limited health literacy can achieve rates of adherence to quarterly intravenous bisphosphonates, as opposed to weekly oral bisphosphonates, similar to rates among patients with appropriate literacy.


[Comparative study on therapeutic effect of Ashi-points and anti-ashi-points on external humeral epicondylitis].
To compare the clinical efficacy between Ashi-points and anti-Ashi-points for external humeral epicondylitis. Sixty-eight cases were randomly devided into an anti-Ashi-points group (group A) and an Ashi-points group (group B), 34 cases in each group. In the group A, anti-Ashi-points (points of pain relief or disappearance after local press) were selected for acupuncture; in the group B, Ashi-points (pain spots) were selected for acupuncture and surrounded needling therapy was added . Once other day, 10 treatments made one session, altogether 2 courses. The clinical effects were observed at the ending day, the 7th day, the 30th day, the 6th months and one year after treatment. The effective rates at the ending day, the 7th day, the 30th day after treatment in the group A were 100.0% (34/34), 94.1% (32/34) and 91.2% (31/34), which were superior to those of 73.5% (25/34), 70.6% (24/34), 67.6% (23/34) respectively in group B (all P < 0.01). In the group A, the effective rates at the 6 th months and one year after treatment were 73.5% (25/34) and 52.9% (18/34); in group B, they were 64.7% (22/34) and 61.8% (21/34) respectively, there were no significant differences between the two groups (both P > 0.05). The acupoint selection of anti-Ashi-points has a better transient effect on external humeral epicondylitis, but it's long-term curative effects is similar to Ashi-points.


Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial.
A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training. This study compares the effects of structured speed-dependent treadmill training (STT) (with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology) with limited progressive treadmill training (LTT) and conventional gait training (CGT) on clinical outcome measures for patients with hemiparesis. Sixty ambulatory poststroke patients were each randomly selected to receive 1 of the 3 different gait therapies: 20 subjects were treated with STT, 20 subjects were trained to walk on a treadmill with a 20% increase of belt speed over the treatment period (LTT), and 20 subjects were treated with CGT. Treatment outcomes were assessed on the basis of overground walking speed, cadence, stride length, and Functional Ambulation Category scores. After a 4-week training period, the STT group scored significantly higher than the LTT and CGT groups for overground walking speed (STT versus LTT, P<0.001; STT versus CGT, P<0.001), cadence (STT versus LTT, P=0.007; STT versus CGT, P<0.001), stride length (STT versus LTT, P<0.001; STT versus CGT, P<0.001), and Functional Ambulation Category scores (STT versus LTT, P=0.007; STT versus CGT, P<0.001). Structured STT in poststroke patients resulted in better walking abilities than LTT or CGT. This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke.


Sea-originated cytotoxic substances.
Cancer accounted for huge number of deaths, which represents about 13% of all deaths worldwide, and the number of the deaths due to cancer is increasing. Natural products and their synthetic analogs are widely used as antitumor drugs. As represented by these drugs, many anticancer drugs originated from cytotoxic compounds. Marine natural products are a gold mine of strong bioactive compounds with unique structures created in evolution of organisms over hundred million years. However, in the field of drug discovery, most studies have focused on plant essences and bacterial metabolites, and candidate compounds from marine origin are still remaining relatively unexplored.


Isotopomeric Elucidation of the Mechanism of Temperature Sensitivity in 59Co NMR Molecular Thermometers.
Understanding the mechanisms governing temperature-dependent magnetic resonance properties is essential for enabling thermometry via magnetic resonance imaging. Herein we harness a new molecular design strategy for thermometry─that of effective mass engineering via deuteration in the first coordination shell─to reveal the mechanistic origin of 59Co chemical shift thermometry. Exposure of [Co(en)3]3+ (1; en = ethylenediamine) and [Co(diNOsar)]3+ (2; diNOsar = dinitrosarcophagine) to mixtures of H2O and D2O produces distributions of [Co(en)3]3+-dn (n = 0-12) and [Co(diNOsar)]3+-dn (n = 0-6) isotopomers all resolvable by 59Co NMR. Variable-temperature 59Co NMR analyses reveal a temperature dependence of the 59Co chemical shift, Δδ/ΔT, on deuteration of the N-donor atoms. For 1, deuteration amplifies Δδ/ΔT by 0.07 ppm/°C. Increasing degrees of deuteration yield an opposing influence on 2, diminishing Δδ/ΔT by -0.07 ppm/°C. Solution-phase Raman spectroscopy in the low-frequency 200-600 cm-1 regime reveals a red shift of Raman-active Co-N6 vibrational modes by deuteration. Analysis of the normal vibrational modes shows that Raman modes produce the largest variation in 59Co δ. Finally, partition function analysis of the Raman-active modes shows that increased populations of Raman modes predict greater Δδ/ΔT, representing new experimental insight into the thermometry mechanism.


Identification and characterization of lysophosphatidylcholine 14:0 as a biomarker for drug-induced lung disease.
Drug-induced interstitial lung disease (DILD) occurs when drug exposure causes inflammation of the lung interstitium. DILD can be caused by different types of drugs, and some DILD patterns results in a high mortality rate; hence, DILD poses a serious problem in clinical practice as well as drug development, and strategies to diagnose and distinguish DILD from other lung diseases are necessary. We aimed to identify novel biomarkers for DILD by performing lipidomics analysis on plasma samples from patients with acute and recovery phase DILD. Having identified lysophosphatidylcholines (LPCs) as candidate biomarkers for DILD, we determined their concentrations using validated liquid chromatography/mass spectrometry biomarker assays. In addition, we evaluated the ability of LPCs to discriminate patients with acute phase DILD from those with recovery phase DILD, DILD-tolerant, or other lung diseases, and characterized their association with clinical characteristics. Lipidomics analysis revealed a clear decrease in LPC concentrations in the plasma of patients with acute phase DILD. In particular, LPC(14:0) had the highest discriminative index against recovery phase and DILD-tolerant patients. LPC(14:0) displayed no clear association with causal drugs, or subjects' backgrounds, but was associated with disease severity. Furthermore, LPC(14:0) was able to discriminate between patients with DILD and other lung diseases, including idiopathic interstitial pneumonia and lung disease associated with connective tissue disease. LPC(14:0) is a promising biomarker for DILD that could improve the diagnosis of DILD and help to differentiate DILD from other lung diseases, such as idiopathic interstitial pneumonia and connective tissue disease.


Contamination, ecological-health risks, and sources of potentially toxic elements in road-dust sediments and soils of the largest urban riverfront scenic park in China.
Identifying the contamination and sources of potentially toxic elements (PTEs) in road-dust sediment (RDS) and the surrounding greenspace soil of urban environments and understanding their ecological-health risks are important for pollution management and public health. The contamination characteristics, ecological and probabilistic health risks, and source apportionment of eight PTEs (Cd, Pb, Cr, Cu, Ni, As, Zn, and Hg) in the Yellow River Custom Tourist Line of Lanzhou, which is the largest open urban riverfront scenic park in China, were investigated. The results showed that all the RDS PTE mean concentrations exceeded their soil background values, whereas for the surrounding greenspace soils, the concentrations of the PTEs, except for Cr and Ni, were also higher than their local background levels. Moreover, the RDS-soil system was mainly contaminated by Cd, Zn, Pb, Cu, and Hg to varying degrees, and the integrated ecological risks of PTEs in the RDS and soil were high and considerable at most sites, respectively. The probabilistic health risk assessment results demonstrated that the non-carcinogenic hazard risk for humans was negligible, but the total carcinogenic risks should be considered. Source apportionment using a positive matrix factorization model combined with multivariate statistical analyses revealed that Cr, Ni, and As in the RDS-soil system were from natural and industrial sources, Cd, Pb, Zn, Cu came from vehicle emissions and pesticide and fertilizer applications, and Hg was from natural and industrial sources and utilization of pesticides with fertilizers. This work provides scientific evidence for urban planning and human health protection in urban environments.


Impact of exosome-mediated feto-maternal interactions on pregnancy maintenance and development of obstetric complications.
Pregnancy is an immunological paradox, a phenomenon in which the foetus and the placenta, containing foreign antigens to the mother, develop without inducing rejection by the maternal immune system. Cell-to-cell communication between the foetus and the mother is mediated by secreted factors such as cytokines, hormones and extracellular vesicles (EVs) for a successful pregnancy and to avoid rejection. Exosomes, the smallest of EVs, are released extracellularly, where they are taken up by proximal or distant recipient cells. Here, we discuss the role of EVs, especially exosomes in feto-maternal communication during pregnancy. This review will provide an overview of the functional roles exosomes may play during embryo implantation, modulating immune responses during pregnancy and the onset of labour. Moreover, we will discuss exosomal function in obstetric pathology, and the development of pregnancy-associated complications such as preeclampsia and preterm birth as well as the biomarker potential of exosomes for detecting such conditions.


Prostaglandins and the dog stomach: effects of misoprostol on the proportion of mucosa to muscle and on the proportion of different epithelial cell types.
Dogs were given an oral dose of 300 micrograms/kg/day of the prostaglandin E1 analogue, misoprostol for 11 weeks. The relative areas of the main components of the fundus and antrum per unit area of serosa were quantified. While the volume occupied by the muscle layers did not change, there was an increase in mucosal volume in both sites. The relative volume fraction of the main mucosal cell types was then determined by a point counting technique. Misoprostol very highly significantly increased the fraction of mucosal volume occupied by surface mucus cells, and also significantly decreased the volume fraction of the parietal cells.


Inflammatory and immune effects on tumor progression.
Tumor progression is known occur in a complex microenvironment that leads to genetic, cellular, and metabolic adaptations. Two articles from Martin et al. and Del Poggetto et al. enlighten us on the role of inflammation and the immune system in guiding the progression of preneoplastic cells to oncogenic transformation and on subsequent tumor evolution.


Investigating the dynamics of Salmonella contamination in integrated poultry companies using a whole genome sequencing approach.
The study of non-typhoid Salmonella in broiler integrations has been limited by the resolution of typing techniques. Although serotyping of Salmonella isolates is used as a traditional approach, it is not of enough resolution to clearly understand the dynamics of this pathogen within poultry companies. The aim of this research was to investigate the epidemiology and population dynamics of Salmonella serotypes in 2 poultry integrations using a whole genome sequencing approach. Two hundred and forty-three Salmonella isolates recovered from the broiler production chain of 2 integrated poultry companies were whole genome sequenced and analyzed with dedicated databases and bioinformatic software. The analyses of sequences revealed that S. Infantis was the most frequent serotype (82.3%). Most isolates showed a potential for resistance against medically important antibiotics and disinfectants. Furthermore, 97.5% of isolates harbored the pESI-like mega plasmid, that plays an important role in the global dissemination of AMR. SNP tree analysis showed that there were clones that are niche-specific while other ones were distributed throughout the broiler production chains. In this study, we demonstrated the potential of whole genome sequencing analysis for a comprehensive understanding of Salmonella distribution in integrated poultry companies. Data obtained with these techniques allow determination of the presence of genetic factors that play an important role in the environmental fitness and pathogenicity of Salmonella.


Carotid body tumour.
A case of carotid body tumour (paraganglioma) which is both unusual and highly vascular, arising from the carotid body is reported. The patient was a 68-year-old female with a right submandibular swelling. The initial pathological diagnosis was obtained from the incisional biopsy. Carotid angiography revealed the feeding vessels arising only from the external carotid artery. The tumour was completely removed and no evidence of recurrence could be found 2-years postoperatively.


[Peritoneal dialysis adequacy in pediatrics. From the peritoneal equilibration test to the aquaporins].
An evaluation of the characteristics of peritoneal solute and water transport is essential to assess the suitability of prescribing dialysis in patients suffering from chronic renal disease. There are currently a series of models to perform this evaluation. The peritoneal equilibration test (PET) evaluates the peritoneal transport capacity, classifying the patients into four transport categories: high, high-average, low-average, and low. The short PET enables the same evaluation to be made in only 2hours, and has been validated in paediatric patients. On the other hand, the MiniPET provides additional information by evaluating the free water transport capacity by the ultra-small pores, and the Accelerated Peritoneal Examination Time (APEX) evaluates the time when the glucose and urea equilibration curves cross, and has been proposed as the optimum dwell time to achieve adequate ultrafiltration. An analysis is presented on the current information on these diagnostic methods as regards free water transport via aquaporins, which could be an important tool in optimising solute and water transport in patients on chronic peritoneal dialysis, particularly as regards the cardiovascular prognosis.


Cost-effectiveness of methods in personalized medicine. Results of a decision-analytic model in patients with acute myeloid leukemia with normal karyotype.
During the last years, molecular genetic data are increasingly used as prognostic and predictive factors in acute myeloid leukemia (AML). The molecular genetic profile permits a rapid risk categorization and beyond that a prediction of differential treatment efficacy of post-remission chemotherapy versus an allogeneic hematopoietic cell transplantation (HCT) in specific subgroups. The aim of this study was to evaluate cost-effectiveness of two different strategies of risk categorization (conventional cytogenetic diagnostics (CCD) versus molecular genetic diagnostics (MGD)) in patients with AML, using a decision-analytic state-transition model. The model is run as (Monte Carlo) microsimulation in which individuals pass through in cycles with a cycle length of one month and a time horizon of ten years. Results show that on average, individuals within the MGD group generated about US$ 32,000 higher costs but survived about seven months longer than individuals within the CCD group. This leads to an Incremental Cost-Effectiveness Ratio (ICER) of about US$ 4928 per survived month. With a GDP (Gross Domestic Product) of US$ 26,467 (€ 33,630) per capita in Germany in 2012, the base-case ICER of US$ 4928 per survived month projected to US$ 59,136 per survived year is in between the simple GDP and the three times GDP per capita.


Parahydrogen-induced polarization enables the single-scan NMR detection of a 236 kDa biopolymer at nanomolar concentrations.
Nuclear magnetic resonance (NMR) experiments utilizing parahydrogen-induced polarization (PHIP) were performed to elucidate the PHIP activity of the synthetic 236 kDa biopolymer poly-γ-(4-propargyloxy)-benzyl-L-glutamate) (PPOBLG). The homopolypeptide was successfully hyperpolarized and the enhanced signals were detected in 11.7 T solution NMR as a function of the PPOBLG concentration. The hydrogenation with parahydrogen caused signal enhancements of 800 and more for the vinyl protons of the side chain at low substrate concentration. As a result of this high enhancement factor, even at 13 nM of PPOBLG, a single scan 1H-NMR detection of the hyperpolarized protons was possible, owing to the combination of hyperpolarization and density of PHIP active sites.


"God is my only health insurance": a mixed-methods study on the experiences of persons with disability in accessing sexual and reproductive health services in Ghana.
Access to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana's Ashanti region. A sequential explanatory mixed-methods study design was employed, involving quantitative (n = 402) and qualitative (n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis. The study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the individual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers. PwDs had relatively low utilisation of SRH services in Ghana's Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs' SRH outcomes and strategies to improve these outcomes in Ghana.


Fractionation, molecular composition, and biological effects of organic matter in bio-stabilization sludge with implication to land utilization.
Bioactive organic compounds (BOCs) contained in bio-stabilized products of waste activated sludge (WAS) have attracted considerable attention, as they can enhance the fertilizing effect of WAS in land applications. This study investigated the molecular composition and plant-growth-promoting mechanisms of various BOCs in the bio-stabilized products of WAS. After stepwise fractionation, aerobic composting sludge (ACS) and anaerobic digestion sludge (ADS) were chemically fractioned into five subcomponents, namely dissolved organic matter (DOM) (C1), weakly interacted organic matter (OM) (C2), metal-bonded OM (C3), NaOH-extracted OM (C4), and strongly interacted OM (C5), in sequence. The results showed that fatty acids and carboxylic acid (CAs) present in ACS C2 promoted plant growth and enhanced the ability of plants against stresses by upregulating pathways related to "carbohydrate metabolism," "lipid metabolism," "amino acid metabolism," and "phenylpropanoid biosynthesis." However, in ACS C4, plenty of amino acids could promote plant growth via upregulating "carbohydrate metabolism" and "amino acid metabolism" pathways. As an important precursor, aromatic amino acids inside ACS C4 also stimulated the production of indoleacetic acids. In ADS C1, amino sugar and phytohormone were the major BOCs causing the up-regulation of "carbohydrate metabolism" and AAA catabolism in "amino acid metabolism" pathways. CAs enriched in ADS C2 stimulated plant growth through "amino acid metabolism" pathway. In summary, alkali extraction can recycle a large proportion of BOCs with low environmental risk from the bio-stabilization products of WAS. The results from this study provide scientific guidance for safe and value-added resource utilization of bio-stabilization products of WAS in land applications.


Dosage variability of veterinary drug products, containing furosemide, linked to tablet splitting.
Furosemide is a potent diuretic drug widely used to treat congestive heart failure in dogs and cats, but it shows remarkable variability in bioavailability and efficacy when administered orally. In particular, a different diuretic effect can be detected after repeated administrations of the same medicinal product in the same animal. For this reason, we investigate the possible reasons for this peculiar behavior. Drug products for veterinary andhuman use are compared in terms of variability for tablet splitting, in vitro dissolution profiles (in different fluids that could simulate the gastrointestinal environment of pets), and drug distribution uniformity. To study the in vitro performances of drug products in terms of variability. Five veterinary products and five products for human use, containing different furosemide doses, are characterized. Tablets splitting uniformity, in vitro dissolution profiles in different fluids that could simulate the gastrointestinal environment of the different species, and drug content distribution, were tested. The in vitro dissolution profiles of the different medicines are comparable but confirm a different dissolution rate as a function of the medium pH and volume. Many of the products considered show wide variability in the division performances of the scored tablets, and this problem could lead to the detected fluctuations in the diuretic effect. The four-leaf clover shape of a veterinary product appears to give rise to more uniform fractions. A uniform distribution of the drug in the tablets and their fractions is confirmed for all the products considered. The possibility of tablets splitting allows considerable dosage flexibility, but a non-uniform break of the tablets to obtain the dosage suitable for the pet's weight, can cause dangerous over-or sub-dosing condition, especially in critical pathologies and in small breed pets.


Controversies surrounding the causes of brachial plexus injury.
In the past decades, obstetric personnel have attempted to reduce the frequency of brachial plexus injury (BPI) by attempting to use less traction during the delivery of the fetal anterior shoulder. Clearly, these attempts have been unsuccessful in preventing or reducing the frequency of BPI. We conducted a nonsystematic literature review of the reported controversies regarding the mechanisms of BPI causation and why this complication is not decreasing in frequency. The review indicates that maternal labor forces are the most likely cause of BPI.


The spindle pole body of Aspergillus nidulans is asymmetrical and contains changing numbers of γ-tubulin complexes.
Centrosomes are important microtubule-organizing centers (MTOCs) in animal cells. In addition, non-centrosomal MTOCs (ncMTOCs) are found in many cell types. Their composition and structure are only poorly understood. Here, we analyzed nuclear MTOCs (spindle-pole bodies, SPBs) and septal MTOCs in Aspergillus nidulans They both contain γ-tubulin along with members of the family of γ-tubulin complex proteins (GCPs). Our data suggest that SPBs consist of γ-tubulin small complexes (γ-TuSCs) at the outer plaque, and larger γ-tubulin ring complexes (γ-TuRC) at the inner plaque. We show that the MztA protein, an ortholog of the human MOZART protein (also known as MZT1), interacted with the inner plaque receptor PcpA (the homolog of fission yeast Pcp1) at SPBs, while no interaction nor colocalization was detected between MztA and the outer plaque receptor ApsB (fission yeast Mto1). Septal MTOCs consist of γ-TuRCs including MztA but are anchored through AspB and Spa18 (fission yeast Mto2). MztA is not essential for viability, although abnormal spindles were observed frequently in cells lacking MztA. Quantitative PALM imaging revealed unexpected dynamics of the protein composition of SPBs, with changing numbers of γ-tubulin complexes over time during interphase and constant numbers during mitosis.This article has an associated First Person interview with the first author of the paper.


One year follow-up of children and adolescents with chronic immune thrombocytopenic purpura (ITP) treated with rituximab.
We previously showed in a prospective study that rituximab appears to be effective in some children and adolescents with severe chronic immune thrombocytopenia. Eleven of 36 patients achieved and maintained platelet counts over 50,000/mm(3) within the first 12 weeks. These patients were followed for the next year. Platelet counts were monitored monthly and all subsequent bleeding manifestations and need for further treatment was noted. Eight of the 11 initial responders maintained a platelet count over 150,000/mm(3) without further treatment intervention. Three patients had a late relapse. One initial non-responder achieved a remission after 16 weeks, and two additional patients maintained platelet counts around 50,000/mm(3) without the need for further intervention. Rituximab resulted in sustained efficacy with platelet counts of 50,000/mm(3) or higher in 11 of 36 patients (31%).


Twelve years experience of juvenile dermatomyositis in North India.
The aim of this study was to evaluate outcome in children with juvenile dermatomyositis (JDMS) at a tertiary care center in North India and have a long term follow-up. Medical records of children with JDMS managed at a tertiary care hospital were reviewed during a 13-year period to determine (1) interval between onset of symptoms and diagnosis, (2) treatment modalities used and (3) long term functional outcome. Thirty three patients diagnosed with JDMS met the inclusion criteria. Mean age at diagnosis was 8.7 +/- 3.3 years. Mean duration of disease prior to treatment was 1.18 years (range 1 month-5 years). The total follow-up period was 136.7 patient-years. Immunosuppressive therapy was given in 31/33 and a distinct monocyclic course was seen in 72.7% cases. Lipodystrophy was seen in 10/33 (30.3%), calcinosis in 7/33 (27.3%), cutaneous ulcers in 6/33 (18.2%), dysphagia in 5/33 (15.2%), and contractures in 4/33 (12.1%) cases. A steady and sustained response was seen in patients who had received "adequate" doses of steroids at the time of initiation of treatment. Methotrexate, hydroxychloroquine, azathioprine and intravenous immunoglobulin were used in patients with poor response to corticotherapy. There were two deaths in our series. Stepwise, aggressive treatment directed at achieving rapid and complete control of muscle inflammation is highly successful in minimizing the long-range sequelae of JDMS. Our patients seem to have a different clinical profile on follow-up as compared to series published from the West.


BRCA2 represses the transcriptional activity of pS2 by E2-ERα.
Germline mutations to the breast cancer 2 (BRCA2) gene have been associated with hereditary breast cancer. In addition to estrogen uptake, BRCA2 expression increases in the S phase of the cell cycle and largely contributes to DNA damage repair associated with DNA replication. However, the role of BRCA2 in estrogen induction remains unclear. An expression plasmid was created to induce BRCA2 activation upon the addition of estradiol by introducing mutations to the binding sequences for the transcription factors USF1, E2F1, and NF-κB within the promoter region of BRCA2. Then, the estrogen receptor (ER) sites of the proteins that interact with BRCA2 upon the addition of estradiol were identified. Both proteins were bound by the helical domain of BRCA2 and activation function-2 of the ER, suggesting that this binding may regulate the transcriptional activity of pS2, a target gene of the estradiol-ER, by suppressing the binding of SRC-1, a coactivator required for activation of the transcription factor.


Meta-analysis: underutilisation and disparities of treatment among patients with hepatocellular carcinoma in the United States.
Despite wide availability of treatment options for hepatocellular carcinoma (HCC), several studies have suggested underutilisation in clinical practice. To quantify utilisation rates for HCC treatment among patients with HCC in the United States, and to summarise patterns of association between utilisation rates and patient socio-demographic characteristics. We performed a systematic literature review using the Medline database from January 1989 to March 2013. Two investigators independently extracted data on patient populations, study methods and results using standardised forms. Pooled treatment rates for any treatment and curative treatment, with 95% confidence intervals, were calculated. Prespecified subgroup analysis was performed to identify patient-level correlates of treatment utilisation. We identified 24 studies that met inclusion criteria. The pooled rates of any treatment and curative treatment were 52.8% (95% CI 52.2-53.4%) and 21.8% (95% CI 21.4-22.1%) respectively. Among patients diagnosed at an early stage, the pooled curative treatment rate was 59.0% (95% CI 58.1-59.9%). Elderly, non-Caucasians and patients of low socioeconomic status had lower treatment rates than their counterparts. Rates of HCC treatment in the United States, including curative treatment rates among patients detected at an early stage, are disappointingly low. Future efforts should focus on identifying appropriate intervention targets to increase treatment rates and reduce socio-demographic disparities.


Hybridization and the spread of the apple maggot fly, Rhagoletis pomonella (Diptera: Tephritidae), in the northwestern United States.
Hybridization may be an important process interjecting variation into insect populations enabling host plant shifts and the origin of new economic pests. Here, we examine whether hybridization between the native snowberry-infesting fruit fly Rhagoletis zephyria (Snow) and the introduced quarantine pest R. pomonella (Walsh) is occurring and may aid the spread of the latter into more arid commercial apple-growing regions of central Washington state, USA. Results for 19 microsatellites implied hybridization occurring at a rate of 1.44% per generation between the species. However, there was no evidence for increased hybridization in central Washington. Allele frequencies for seven microsatellites in R. pomonella were more 'R. zephyria-like' in central Washington, suggesting that genes conferring resistance to desiccation may be adaptively introgressing from R. zephyria. However, in only one case was the putatively introgressing allele from R. zephyria not found in R. pomonella in the eastern USA. Thus, many of the alleles changing in frequency may have been prestanding in the introduced R. pomonella population. The dynamics of hybridization are therefore complex and nuanced for R. pomonella, with various causes and factors, including introgression for a portion, but not all of the genome, potentially contributing to the pest insect's spread.


Effects of operating conditions on trihalomethanes formation and speciation during chloramination in reclaimed water.
In this study, a hybrid powdered activated carbon-membrane bioreactor (PAC-MBR) system was used to treat municipal wastewater in northern China intended for recycle. In order to control microbiological hazards in PAC-MBR effluent, chloramine was chosen as the disinfectant which could reduce the disinfection by-product yields. Effects of reaction time, chloramines dose, pH value, and bromide ion concentration on trihalomethanes (THMs) formation and speciation during chloramination of the reclaimed effluent were investigated. Study results indicated that the yield of total THMs (TTHM) increased at higher reaction time and chloramines dose. The trend of growth showed that slow reacting precursors were the main components of dissolved organic matter (DOM) in PAC-MBR effluent. THMs formation potential of PAC-MBR effluent achieved the maximum at chloramines dosage of 20 mg/L. Meanwhile, THMs formation was enhanced evidently under alkaline conditions. The yields of THMs species were in following order: CHCl3 > CHBrCl2 > CHBr2Cl > CHBr3, although in different reaction time, chloramines dose, and pH value. Furthermore, the formation of Br-THMs was promoted by the increasing concentration of bromide ion.


Subtalar joint arthrodesis.
Isolated subtalar joint arthrodesis has gained popularity more recently. Research has shown that it preserves rearfoot motion, does not increase the risk of arthritis in adjacent joints, and is not an especially complex operative procedure. It decreases the chance of midtarsal joint nonunion and malunion postoperatively. This article takes an in-depth approach to isolated talocalcaneal fusions. Anatomy and biomechanics of the subtalar joint are reviewed. Clinical presentation and radiologic evaluation are discussed. Conservative treatment, operative technique, and postoperative management are included.


Developmental evolution: Hox proteins ring the changes.
The evolution of body form is believed to involve changes in expression of developmental genes, largely through changes in cis-regulatory elements. Recent studies suggest that changes in the sequences of key developmental regulators, such as the Hox proteins, may also play an important role.


Cardiac surgery in patients with a history of malignancy: increased complication rate but similar mortality.
Little is known about the outcome of cardiac surgery in patients with a prior history of malignancy. Our aim was to investigate in our unit the population of patients with a known malignancy and compare their outcomes to a matched population without malignancy. We identified all patients who underwent cardiac surgery at the Alfred Hospital between February 2002 and December 2009 with malignancy. Cases were matched to 216 controls based on age, gender, major medical comorbidities and type of surgery. A univariate analysis was performed with Fishers exact test and χ(2) test. 83/4474 patients were identified with malignancy. Sixty-four (77%) were male. Mean age of the patients with malignancy was 66.7 years, and 67.4 in the control group. 68.7% had a solid organ tumour, and 31.3% had a haematological malignancy. There were no significant between-group differences in hospital or 30-day mortality. However, there were significantly higher rates of transfusion (79.5% vs 49%, p<0.0001), reintubation (8.4% vs 0.9%, p=0.0009), pneumonia (14.5% vs 6%, p=0.035), septicaemia (8.4% vs 1.9%, p=0.018), arrhythmias (42.2% vs. 33.8%, p=0.047) and anticoagulant complications (7.2% vs 0%, p=0.008) in patients with malignancies. Patients who present for cardiac surgery having had prior treatment for cancer are at particular risk for complications. However, these patients can be operated upon with acceptable risk. There is no difference in the short term mortality. Therefore, for selected patients who are undergoing curative treatment for their malignancy, or are in remission, cardiac surgery is not contraindicated.


Prevalence and factors associated with substance use among street children in Jimma town, Oromiya national regional state, Ethiopia: a community based cross-sectional study.
Street children constitute a marginalized population in most urban centers of the world. According to UN sources, there are up to 150 million street children in the world today. The estimated number of children who live on the streets in Ethiopia was 150,000, of which about 60,000 of them in Addis Ababa. However, aid agencies estimate that the problem may be far more serious, with nearly 600,000 street children country-wide and over 100,000 in Addis Ababa. World Health Organization estimates that globally, 25-90% of street children indulge in substance use. Even if substance use has become a common problem in Ethiopia, most of the studies done mainly focused among schools, college and university students. Research on street children and their substance use habits in Ethiopia was limited and specifically non in Jimma town. To assess the prevalence and factors associated with substance use among street children in Jimma town of Ethiopia in 2019. Cross sectional study was undertaken from March 1-31, 2019. Complete enumeration of study subjects was done and all 312 children of the streets were included. Interviewer administered structured questionnaires was used to collect the data. Bivariable logistic regression was carried out to select candidate for multiple logistic regression analysis with p-value < 0.25 at 95% confidence. Multiple logistic regression was carried out with those candidate variables using backward method and the associations predictors to the response variable was declared with p value of < 0.05 at 95% confidence level. Three hundred twelve street children were included in the study. The prevalence of substance use was 30.8% with 95% CI [25-36.2]. Age > 14 [AOR: 1.97 95%CI:1.00-3.889], attending grade 1-4th [AOR: 0.33 95%CI:0.151-0.737], attending 5th grade and above [AOR: 0.27 CI:0.093-0.756], child whose mother used substances [AOR: 7.78 95%CI:3.00-20.11], child did not know his maternal substance use status [AOR:5.1 95%CI: 2.19-11.81], child whose sibling use substance [AOR: 2.23 95%CI:1.254-5.63], best friend substance use [AOR: 11.01 95%CI:5.47-25.04] and staying 12-60 months on the street [AOR:3.00 95%CI:1.511-5.96] and staying > 5 years on the street [AOR:4.6 95%CI:1.06-19.7] were significantly associated with substance use. The prevalence of substance use among street children in Jimma town was high. Mothers and siblings have crucial roles in determining substance use behavior of the children. Stakeholders who are working on the improvement in the life of children of the street should try to satisfy the need of the children by intervening at individual level, at family or community level and at levels beyond community to lessen the problem to some extent. Researchers should do similar researches in more detail on these vulnerable but neglected groups of children to fully understand about the problem so the findings will be used as inputs for concerned bodies.


Magnetic resonance imaging cerebral abnormalities and neuropsychologic test performance in elderly hypertensive subjects. A case-control study.
To search for a morphologic basis of cognitive impairment possibly associated with arterial hypertension using magnetic resonance imaging and a demanding neuropsychologic test battery. Case-control comparison with age, length of education, presence of diabetes, and presence of cardiac disease as matching criteria. Austrian Stroke Prevention Study. A total of 89 hypertensive subjects and 89 control subjects from a subset of 272 volunteers with no neurologic symptoms undergoing extensive diagnostic workup in a large-scale stroke prevention study among randomly selected elderly community members. Focal brain abnormalities and size of ventricles and cortical sulci as assessed by magnetic resonance imaging and neuropsychological test scores. Hypertensive subjects more commonly showed areas of white matter hyperintensity and moderately severe ventricular enlargement compared with controls. While no differences were noted between the investigational groups in test results of memory capacity and conceptualization, hypertensive subjects tended to perform worse when assessed for attentional and visuopractical skills. These differences became significant when comparing the brain-damaged subsets of patients and controls with their counterparts without cerebral changes. The pattern and extent of neuropsychologic deficits was similar in hypertensive and normotensive subjects with abnormal magnetic resonance imaging scans. Our data strongly suggest the high rate of brain abnormalities among hypertensive subjects as the cause of their subtle neuropsychological dysfunction.


The use of polyethylene mesh (Marlex) as an adjunct in reconstructive surgery of the extremities.
When Marlex mesh is inserted into the body it serves as a scaffold into which migrates fibroblastic tissue. Throughout the process of maturation of fibrous connective tissue, the mesh remains inert. Experience covering 15 years demonstrates that Marlex mesh is useful for repair of ligament, muscle, and bone defects.


Soil pollution at outdoor shooting ranges: Health effects, bioavailability and best management practices.
The total lead (Pb) concentrations of the surface soil, sub surface soil, vegetation and surface waters of outdoor shooting ranges are extremely high and above regulatory limits. Lead is dangerous at high concentrations and can cause a variety of serious health problems. Shooters and range workers are exposed to lead dust and can even take Pb dust home to their families while some animals around the shooting range can ingest the Pb bullets. The toxicity of Pb depends on its bioavailability which has been determined to be influenced greatly by the geochemical properties of each site. The bioavailability of Pb in shooting ranges has been found to be higher than other metal contaminated soils probably because of its very low residual Pb (<1%). Despite being an immobile element in the soil, migration of Pb within shooting ranges and offsite has been reported in literature. Best management practices to reduce mobility of Pb in shooting ranges involve an integrated Pb management program which has been described in the paper. The adoption of the non-toxic "green bullet" which has been developed to replace Pb bullets may reduce or prevent environmental pollution at shooting ranges. However, the contaminated soil resulting from decades of operation of several shooting ranges still needs to be restored to its natural state.


Sclerosing hemangioma of the lung: an ultrastructural study.
A well-circumscribed nodular mass was excised from the lingula of the left lung of a 40-year-old-female. The lesion was discovered on routine chest x-ray examination and corresponded to a typical "sclerosing hemangioma" described by Liebow and Hubbell. Electron microscopic study revealed unequivocal epithelial cells in both the irregular spaces and the solid areas of the tumor; some of these cells were identical to granular pneumonocytes. The true vascular component was sparsely distributed. We concluded that "sclerosing hemangioma" was a misnomer because we were dealing with an essentially epithelial lesion.


Calcium pyrophosphate dihydrate of the ligamentum flavum in the cervical spine - A review of the literature.
Calcium pyrophosphate dihydrate (CPPD) deposition, also known as pseudogout, in the cervical ligamentum flavum (CLF), is a rare disease which can cause spinal cord signaling changes leading to rapid deterioration in function. The natural history of cervical myelopathy as a result of CPPD deposition within the CLF is not well understood. Our objective is to describe the presentation, imaging findings, and treatment options of CPPD deposition or pseudogout of the cervical spine. Using PubMed, we analyzed studies published from 1978 to 2022. Key words used were "pseudogout," "CPPD deposit disease," "cervical yellow ligament," "CLF," and "cervical spine." We excluded "crowned dense syndrome" and "ossification of ligament flavum." Using a department database, we queried for patients treated for CPPD of the cervical spine. Twenty clinical studies on CPPD of the cervical spine with 69 patients aged between 15 and 92 years (mean = 72) were identified. Neck pain and numbness of the hands were the most common symptoms. Diabetes mellitus and hypertension were the most common comorbidities. Males and females were affected at equal rates. C4-C5 and C5-C6 were the most affected segments. Earlier surgical treatment produced better outcomes. A laminectomy and fusion or laminoplasty were the most common procedures performed with most patients experiencing some return of neurologic function. Although rare, CPPD deposit disease in the CLF should be readily considered as a differential diagnosis due to the continuously aging population. CPPD's progressively worsening nature makes an early diagnosis and treatment important in improving the patient's overall quality of life.


Hookworm infestation is not an uncommon cause of obscure occult and overt gastrointestinal bleeding in an endemic area: A study using capsule endoscopy.
Obscure gastrointestinal bleeding (OGIB), particularly occult, has been reported to be caused by hookworm infestation rarely from tropical countries, particularly India. Hence, we undertook a retrospective study evaluating frequency, clinical spectrum, and outcome of patients with OGIB associated with worm infestation. Data of consecutive patients with OGIB undergoing capsule endoscopy in a multilevel university hospital in northern India were retrospectively analyzed. Twenty-one out of 163 (13 %) patients with OGIB had hookworm infestation detected on capsule endoscopy. Of 21 patients (median age 65 years [range 19-82], 17 [81 %] male), 16 had overt and 5 had occult OGIB. Another lesion that could explain OGIB was present in 8/21 patients, 3/5 with OGIB occult, and 5/16 overt (p = ns). All the patients received treatment with albendazole and appropriate measures for the associated lesion, if any. Patients with hookworm infestation with another lesion experienced recurrent bleeding more often than those with worm infestation only. Hookworm infestation is an important cause of occult as well as overt OGIB and may be present even in association with another lesion. Those with additional lesion had recurrent bleeding more often than those with worm infestation alone.


Nucleosome gaping supports a functional structure for the 30nm chromatin fiber.
The biological functions played by the nucleus of eukaryotic cells and especially those involved in cellular differentiation not only depend on the genomic sequence but also on all the proteins which form the nucleo-protein complex named chromatin. The tridimensional organization of this huge polymer involves many structural levels, the most basic one being the nucleosome. Nucleosomes further organize into the so-called 30nm fiber, which, according to recent works, is likely to be the main functional level of chromatin. We wish here to propose a plausible structure for the 30nm chromatin fiber that could explain its functional role. In our model, silenced chromatin is locked by nucleosome stacking interactions. This is achieved by a conformational transition within the nucleosome core particle (NCP) which allows nucleosomes to stack along two helices without bending the DNA linkers. We used molecular modeling to check that this conformational transition was plausible. Then we proposed to modify the well-known two-angle model according to these atomic level results. The emerging picture is an allosteric behavior of the nucleosomes induced by their collective organization within the 30nm chromatin fiber.


Taxonomic and functional responses of macrofaunal assemblage provide insight into ecological impacts of bottom-based Manila clam aquaculture.
Understanding ecological impacts of bottom-based clam aquaculture can improve its management. In this study, taxonomic and functional macrofaunal assemblage were evaluated for two clam farms located in Laizhou Bay, China. Beta diversity and factors potentially regulating the dissimilarity of macrofauna were estimated. Both taxonomic and functional composition of macrofauna showed large differences between the clam farm and the control area. Functional dissimilarity within the clam farms was found to be nestedness and negatively correlated to local clam abundance. Additionally, the cultured clam enhanced the functional richness but made the macrofaunal assemblage more fragile against species or function loss. This effect would increase with clam abundance, which highlights the importance of identifying optimal clam culture intensity in developing a bottom-based clam aquaculture program.


Hip Function after Surgically Treated Isolated Traumatic Acetabular Fracture: A Prospective Series of Consecutive Cases.
Isolated acetabular fractures can occur as a result of a high energy impact on the hip joint. Surgery is required for most patients with an isolated acetabular fracture in order to alleviate pain, restore joint stability, and regain hip function. This study was conducted in order to examine the course of hip function in patients after surgical treatment of an isolated traumatic acetabular fracture. This prospective series of consecutive cases included patients who underwent surgery for treatment of an isolated acetabular fracture in a European level one trauma center between 2016 and 2020. Patients with relevant concomitant injuries were excluded. Scoring of hip function was performed by a trauma surgeon using the Modified Merle d'Aubigné and Postel score at six-week, 12-week, six-month, and one-year follow-up. Scores between 3-11 indicate poor, 12-14 fair, 15-17 good, and 18 excellent hip function. Data on 46 patients were included. The mean score for hip function was 10 (95% confidence interval [CI] 7.09-12.91) at six-week follow-up (23 patients), 13.75 (95% CI 10.74-16.76) at 12-week follow-up (28 patients), 16 (95% CI 13.40-18.60) at six-month follow-up (25 patients), and 15.50 (95% CI 10.55-20.45) at one-year follow-up (17 patients). After one-year follow-up, the scores reflected an excellent outcome in 11 patients, good in five patients, and poor in one patient. This study reports on the course of hip function in patients who have undergone surgical treatment for isolated acetabular fractures. Restoration of excellent hip function takes six months.


Pupillary Reconstruction and Outcome after Artificial Iris Implantation.
Patients with iris defects suffer from severe visual impairment, especially increased glare sensitivity and cosmetic disturbances. This constitutes a great psychological strain for those patients. Until recently, possible treatment options were iris print contact lenses, sunglasses, and simple iris prostheses. The aim of this study was to investigate structural and functional outcome parameters and patient satisfaction after implantation of this new artificial iris prosthesis. Prospective case series investigating functional results and patient satisfaction after surgical iris reconstruction. Thirty-seven consecutive patients with traumatic iris defects presenting from 2011 through 2014 underwent pupillary reconstruction with a new artificial iris implant at the Department of Ophthalmology, Technical University Munich. The custom-made, flexible silicone iris prosthesis ArtificialIris (HumanOptics, Erlangen, Germany) used in this study is a novel and innovative device in the surgical treatment of iris defects. Patients were examined before and after iris reconstruction with the iris implant placed in the ciliary sulcus. Change of best-corrected visual acuity (BCVA), intraocular pressure (IOP), pupillary aperture, glare, contrast sensitivity, endothelial cell density, anterior chamber depth, anterior chamber angle, and patient satisfaction were assessed. Thirty-two eyes of 32 patients (mean age, 52.9±16.0 years) were included. After implantation and during follow-up, BCVA and IOP did not change significantly (BCVA, 0.77±0.62 logarithm of the minimum angle of resolution [logMAR] preoperatively vs. 0.68±0.64 logMAR 1 month postoperatively [P = 0.792]; IOP, 14.94±3.55 mmHg preoperatively vs. 17.72±5.88 mmHg 1 month postoperatively [P = 0.197]). The pupillary aperture was reduced significantly (42.11±20.1 mm(2) to 8.7±0.3 mm(2); P < 0.001). Contrast sensitivity increased significantly (0.80±0.51 to 0.93±0.49; P = 0.014). Endothelial cell count revealed a significant decrease postoperatively (1949±716 per 1 mm(2) to 1841±689 per 1 mm(2); P = 0.003). Anterior chamber depth (4.03±1.06 mm preoperatively vs. 4.29±0.70 mm postoperatively; P = 0.186) and angle (43.2±13.5° preoperatively vs. 40.5±10.8° postoperatively; P = 0.772) showed no significant differences. Subjective impairment through glare (9.12±1.62 preoperatively vs. 3.07±2.29 postoperatively; P < 0.001) and cosmetic disturbance (6.33±3.21 preoperatively vs. 1.58±0.86 postoperatively; P < 0.001) improved significantly. Patient satisfaction with the overall result was 8.91±1.51 of 10 points on an analog scale. The implantation of the artificial iris is a new and effective therapeutic option for the treatment of distinctive traumatic iris defects and results in an individual, aesthetically appealing, and good functional outcome in addition to high patient satisfaction.


In support of hassles as a measure of stress in predicting health outcomes.
We investigated the impact of frequently occurring minor stressors (hassles) upon health status in a sample of low-income, elderly persons with osteoarthritis. These individuals are characterized by conditions which are precursors to experiencing stress. Using a modified Hassles scale, we replicated some important findings in a sample demographically distinct from earlier studies on hassles. Specifically, hassles were better predictors of health status than major life change events, and the influence of life change events was indirect, i.e., it increased hassles, which in turn, negatively affected health status. Furthermore, hassles correlated strongly with validated indicators of health status. By replicating earlier studies in a demographically dissimilar sample, and by finding significant correlations between hassles and valid physical health measures, we have strengthened the conceptual development of hassles.


Mild or no COVID-19 symptoms in cladribine-treated multiple sclerosis: Two cases and implications for clinical practice.
The use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) could affect COVID-19 outcomes by modulating the immune response, which, in turn, might favor viral replication and/or confer protection from COVID-19 induced inflammatory response CASE REPORT: We report on two MS patients treated with cladribine, with heterogeneous demographics and clinical features, who developed mild or no symptoms from COVID-19 and produced anti-SARS-CoV-2 antibodies, notwithstanding low lymphocyte levels. Benign COVID-19 clinical course and anti-SARS-CoV-2 antibody production can occur in MS patients with lymphopenia, suggesting the possibility to respond to COVID-19 vaccination, once available, in this vulnerable population.


Topographical distribution of substance P in the cat substantia nigra.
The substance P (SP) content in cat substantia nigra (SN) was estimated by radioimmunoassay in microdiscs punched on successive frontal sections. Only slight differences were seen in the regional distribution of SP within the SN. The highest content was found in the pars reticulata (20.7 pmol/mg protein) which was two times higher than in the pars compacta and pars lateralis. Identical results were found in the right and left part of the SN. Out of this area, as pedunculus cerebri and zona incerta, very low concentrations were detected.


High-risk pregnancy and neonatal care.
The delivery of high-risk maternal and neonatal homecare has been shown to be a cost-effective model of care delivery. The homecare management of preterm labor, placenta previa. PIH, and hyperemesis gravidarum has proven to be a safe interventional strategy with successful clinical outcomes. Studies of home uterine activity monitoring and phototherapy have demonstrated that the use of advanced technologic devices is spearheading the drive to reduce hospital lengths of stay, enabling the safe return of the patient to the home setting, under the watchful supervision of the high-tech homecare nurse. High-risk mothers and their newborns can be assisted to achieve optimal clinical outcomes through a coordination of services provided by an interdisciplinary team of health professionals led by the homecare nurse.


When the dragon's awake: a needs assessment of people injecting drugs in a small urban centre.
St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services. A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities. This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services. Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.


Comparison of the effects of 10 GLP-1 RA and SGLT2 inhibitor interventions on cardiovascular, mortality, and kidney outcomes in type 2 diabetes: A network meta-analysis of large randomized trials.
The relative efficacy of different sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in reducing cardiorenal events in type 2 diabetic adults is unclear. We searched PubMed and Embase. Three primary endpoints were major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and kidney function progression (KFP). Bayesian network meta-analysis was conducted to synthesize hazard ratio (HR) and 95% confidence interval (CI). We calculated surface under the cumulative ranking curve (SUCRA) to rank drug treatments. Subcutaneous semaglutide (HR 0.73, 95% CI 0.55-0.96) and albiglutide (HR 0.76, 95% CI 0.63-0.93) significantly reduced MACE versus lixisenatide. Canagliflozin (HRs: 0.69, 0.68, 0.67 and 0.58) and empagliflozin (HRs: 0.70, 0.69, 0.68 and 0.59) significantly reduced HHF versus dulaglutide, exenatide, lixisenatide and subcutaneous semaglutide. Dapagliflozin (HRs: 0.62, 0.60, 0.68 and 0.63) and empagliflozin (HRs: 0.64, 0.61, 0.69 and 0.64) significantly reduced KFP versus dulaglutide, exenatide, liraglutide and lixisenatide. Different drug treatments had the maximum SUCRA values as for preventing different cardiorenal endpoints. Different GLP-1 RAs and SGLT2 inhibitors have different efficacy in preventing cardiorenal endpoints in type 2 diabetes, and the most efficacious drugs are different as for preventing different cardiorenal endpoints.


Relationship between cholecystectomy and colonic cancer in low-risk Japanese population. A preliminary study.
The relationship between colonic cancer and previous cholecystectomy was investigated in 90 Japanese patients treated surgically for colonic cancer during the period of 1971 to 1980. The patients were in an area where the inhabitants are considered to be at low risk for colonic cancer. The patients were matched for sex and age with other patients having gastric cancer or other digestive organ diseases. The results showed that previous cholecystectomy was prevalent, but the difference was not statistically significant, in the group of colonic cancer patients, compared with the groups of rectal cancer patients and matched controls. A positive association between the proximal colonic cancer and previous cholecystectomy, and between distal colonic cancer and asymptomatic gallstones found concomitantly with the cancer, was noted in the present study. To clarify the relationship between colonic cancer, and cholecystectomy and gallstones, further study of a large number of colonic cancer patients and a prospective study of the incidence of colonic cancer after cholecystectomy are proposed.


Polymorphisms in transforming growth factor-beta-related genes ALK1 and ENG are associated with sporadic brain arteriovenous malformations.
Mutations in endoglin (ENG) and activin-like kinase (ALK1) cause hereditary hemorrhagic telangiectasias, disorders characterized by pulmonary and brain arteriovenous malformations (BAVMs). We investigated whether polymorphisms in these genes are also associated with sporadic BAVM. A total of 177 sporadic BAVM patients and 129 controls (all subjects white) were genotyped for 2 variants in ALK1 and 7 variants in ENG. The ALK1 IVS3-35A>G polymorphism was associated with BAVM: (AnyA [AA+AG] genotype: odds ratio, 2.47; 95% CI, 1.38 to 4.44; P=0.002). Two ENG polymorphisms, ENG -1742A>G and ENG 207G>A, showed a trend toward association with BAVM that did not reach statistical significance. A common polymorphism in ALK1 is associated with sporadic BAVM, suggesting that genetic variation in genes mutated in familial BAVM syndromes may play a role in sporadic BAVMs.


Otoplasty: anterior abrasion of ear cartilage with dermabrader.
The international literature describes many different techniques for correcting prominent ears. Some of these techniques use weakening of the anterior surface in an "open or close" way. Others use suturing of the unfold antihelix. Still others suture the concha with mastoid, and some combine several of these procedures. There is thus no most widely accepted single method. Since 1993, the senior author has used the described technique on a group of 40 patients (35 bilateral and 5 monolateral cases). Before 1993, the senior author always used an "open" technique, but the anterior cartilage was weakened by the partial parallel incision procedure. In the current study, the surgical approach for cases with a normal or moderately deep concha consisted of open anterior otoplasty with cartilage abrasion by an electric burr alone. If the concha was severely hypertrophied, concha-mastoid suturing was combined with otoabrasion, as previously described. The follow-up period was a minimum of 16 months and a maximum of 8 years. Complications were rare and rapidly resolved. The outcome was successful whether the burr alone or a combined method was used. The authors believe that anterior abrasion of ear cartilage is a useful, simple technique that is not too time consuming by which an immediate postoperative aesthetic improvement is reached. It also is more precise and safe than the partial parallel incision procedure.