Do patient outcomes and follow-up completion rates after shoulder arthroplasty differ based on insurance payor?
Disparities associated with socioeconomic status (SES) and insurance coverage have been shown to affect outcomes in different medical conditions and surgical procedures. We hypothesized that patients insured by Medicaid will be associated with lower follow-up rates and inferior outcomes relative to those with Medicare or private insurance. Patients undergoing shoulder arthroplasty, including anatomic total shoulder arthroplasty, reverse arthroplasty, and hemiarthroplasty, were enrolled preoperatively in an institutional database. Preoperative demographics, payor (Medicaid, Medicare, or private insurance), and baseline American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores were recorded. Postoperatively, patients completed ASES scores at multiple time points. Follow-up completion rate was calculated as the number of follow-up visits completed relative to possible visits. Continuous variables were compared between groups with 1-way analyses of variance, and chi-squared tests were used for categorical variables. Significance was defined as P < .05. There were 491 shoulder replacements performed for 438 patients from 2012-2017. The mean follow-up completed percentage was significantly lower (P < .001) for Medicaid patients (62.6% ± 33.7%) relative to Medicare patients (80.2% ± 26.7%; P < .001) and private insurance patients (77.8% ± 22.1%; P = .001). The ASES Composite score increased significantly for all patients from baseline to final follow-up. At each time point, including before surgery and each postoperative time point, patients with Medicaid insurance had significantly lower ASES Composite scores. The final ASES Composite score was significantly lower in the Medicaid patients (66.1 ± 28.7) relative to private insurance patients (78.3 ± 20.8; P = .023). Medicaid patients had significantly lower preoperative (P < .001) and postoperative (P = .018) ASES Pain subscores. In multivariate regression analysis, Medicaid insurance was associated with both inferior preoperative and postoperative ASES scores relative to patients with Medicare or private insurance. We observed that all patients, regardless of insurance payor, improved by similar magnitudes after shoulder arthroplasty, though patients with Medicaid insurance had significantly lower preoperative and postoperative ASES scores, primarily because of the ASES Pain subscore. Patients with Medicaid insurance also have lower follow-up rates than other payors.


Radiofrequency energy-induced heating during MR procedures: a review.
During an MR procedure, most of the transmitted RF power is transformed into heat within the patient's tissue as a result of resistive losses. Not surprisingly, the primary bioeffects associated with the RF radiation used for MR procedures are directly related to the thermogenic qualities of this electromagnetic field. This review article discusses the characteristics of RF energy-induced heating associated with MR procedures, with an emphasis on thermal and other physiologic responses observed in human subjects.


Variations of dry eye disease prevalence by age, sex and geographic characteristics in China: a systematic review and meta-analysis.
Dry eye disease (DED) is one of the most prevalent ocular diseases in the world. In China, new lifestyles driven by information technology and the rapid ageing process have brought DED a severe public health concern. The aim of our study was to obtain the pooled prevalence of DED in China and explore its potential correlates. A comprehensive systematic review was conducted to identify all relevant literature published since 1990. Meta-analysis and meta-regression approaches were adopted to estimate the prevalence of DED. The number of people with DED was obtained by multiplying the corresponding demographic data in 2010. Advanced age, female sex and larger latitude were significant risk factors for DED by symptoms and signs, whereas only advanced age was positively associated with an increased prevalence of DED by symptoms. In 2010, the prevalence of DED by symptoms and signs were 13.55% (95% CI = 10.00-18.05) and that of DED by symptoms was 31.40% (95% CI = 23.02-41.13) in Chinese people aged 5-89 years, corresponding to a total of 170.09 million (95% CI = 125.52-226.63) and 394.13 million (95% CI = 288.99-516.30) affected individuals respectively. The huge burden of DED in China calls for more public health attention and actions. Improved epidemiological studies on DED prevalence are still urgently needed.


The interferon-regulated gene signature is elevated in subacute cutaneous lupus erythematosus and discoid lupus erythematosus and correlates with the cutaneous lupus area and severity index score.
There is increased expression of type I interferon (IFN)-regulated proteins in the blood and target tissues of patients with cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). Patients with SLE have increased IFN-regulated gene expression pointing towards a possible underlying genetic defect. To determine expression levels of five type I IFN-regulated genes that are highly expressed in SLE in the peripheral blood of patients with CLE and to correlate the expression levels with cutaneous disease activity. Peripheral blood was obtained from 10 healthy controls and 30 patients with CLE, including eight with concomitant SLE. Total RNA was extracted and reverse transcribed into complementary DNA. Gene expression levels were measured by real-time polymerase chain reaction. Gene expression was normalized to GAPDH, standardized to healthy controls and then summed to calculate an IFN score for each patient. Disease activity was assessed with the Cutaneous Lupus Area and Severity Index (CLASI). Patients with subacute CLE (SCLE) and discoid lupus erythematosus (DLE) had elevated IFN scores compared with healthy controls regardless of concomitant SLE (P < 0·01 with SLE and P < 0·05 without SLE). There was no difference between patients with tumid lupus erythematosus (TLE) and healthy controls. The IFN score correlated with CLASI scores (Spearman's rho = 0·55, P = 0·0017). Patients with SCLE and DLE have an IFN signature, as seen in SLE. The level of gene expression correlates with cutaneous disease activity. These findings support a shared pathogenesis between SLE and some subtypes of CLE.


Employment Outcomes From a Randomized Controlled Trial of Two Employment Interventions With Homeless Youth.
Limited research exists on how employment interventions contribute to employment outcomes for homeless youth. This study examines the comparative efficacy of 2 interventions-Social Enterprise Intervention (SEI) and Individual Placement and Support (IPS)-provided to homeless youth with mental illness in a randomized controlled trial. Participants were recruited from 1 homeless youth agency in Los Angeles, CA, and randomized to the SEI (n = 36) or IPS (n = 36) conditions. Over 20 months, SEI participants received 4 SEI components, and IPS participants received IPS services based on 8 principles. Data were collected at baseline and follow-up for the primary employment outcome (paid employment) and 5 secondary employment outcomes. Over 20 months, 39% of SEI participants and 32% of IPS participants reported any paid employment. Across both groups, participants who reported working at baseline had nearly 8 times the odds of working at follow-up (OR = 7.91, p < 0.05). No statistically significant differences were detected across the full sample or between groups on the primary or secondary employment outcomes. Future effectiveness research is needed to compare the long-term employment outcomes of the SEI and IPS with a more heterogeneous sample of homeless youth using customized homelessness support services and more nuanced employment outcomes.


Control of filament length by the regulatory light chains in skeletal and cardiac myosins.
The possible role of the regulatory light chains (LC2) in in vitro assembly of rabbit skeletal and dog cardiac myosins was examined by formation of minifilaments and synthetic thick filaments. After LC2 was removed, the resulting myosin preparations exhibited little aggregation in 0.5 M KCl and 0.05 M potassium phosphate (pH 6.5). Minifilaments migrated as a single, hypersharp peak during sedimentation velocity, but electron microscopic analysis revealed a more destabilized structure for LC2-deficient minifilaments. Thick filaments were formed in buffers containing 0.15 M KCl and the following: 20 mM imidazole; 20 mM imidazole, 5 mM ATP; or 20 mM imidazole, 5 mM ATP, and 5 mM MgCl2, all at pH 7.0. Skeletal and cardiac myosin filaments formed in imidazole buffer alone were bipolar, tapered at both ends, and about 1.6 micron long. Removal of LC2 resulted in the formation of shorter thick filaments (1.2 micron long). This effect could be reversed by reassociation with LC2. Inclusion of ATP in the buffer disrupted the filament structure, resulting in irregular, short filaments (less than 0.6 micron); addition of both ATP and MgCl2 largely reversed the effects of ATP alone. In cardiac myosin filaments, the bare zone diameter increased from 16 nm as measured in control and LC2-recombined samples to 20 nm in LC2-deficient myosin assemblies. These results implicate LC2 in an active role in controlling synthetic thick filament length in both skeletal and cardiac muscles.


1-(3-Chloro-phen-yl)-5-(2,4-di-hydroxy-benzo-yl)pyridin-2(1H)-one.
The chloro-phenyl group of the title compound, C18H12ClNO4, is disordered over two orientations with occupancies of 0.331 (8) and 0.669 (8). An intra-molecular hydrogen bond is formed between a hy-droxy group and the acyclic carbonyl group. In the crystal, molecules are linked into chains along [110] by O-H⋯O and C-H⋯O hydrogen bonds, forming a ladder motif.


Analysis of neutrophil polarization and chemotaxis.
Neutrophil polarization and directed migration (chemotaxis) are critical for the inflammatory response. Neutrophil chemotaxis is achieved by the sensing of narrow gradients of chemoattractant and the subsequent polarization and directed migration toward the chemotactic source. Despite recent progress, the signaling mechanisms that regulate neutrophil polarization during chemotaxis have not been clearly defined. Here, we describe methods to analyze neutrophil polarization and asymmetric redistribution of signaling components induced by chemoattractant using immunofluorescence. Further, methods are described to dissect the role of specific signaling pathways during chemotaxis by the use of murine neutrophils from transgenic mouse models. Finally, methods for time-lapse microscopy and transwell assay for the analysis of neutrophil chemotaxis will also be discussed.


Hormone Receptor Status and HER2 Expression in Primary Breast Cancer Compared With Synchronous Axillary Metastases or Recurrent Metastatic Disease.
Estrogen receptor (ER), progesterone receptor (PR), and HER2/neu are the most important tissue markers in the management of breast cancer, in the adjuvant setting and in the setting of metastatic disease. Many studies have demonstrated a discordance of expression between primary breast cancer, synchronous axillary metastases, and metastatic sites. The aim of this article is to review studies on discordance of expression of these predictive parameters to better understand the importance of a reassessment of biomolecular status to modify treatment strategies. We performed a literature review to identify studies that assessed ER, PR, and HER2 discordance between primary breast cancer, synchronous axillary lymph node metastasis, and other metastatic sites. We reviewed these data related to (1) relevance of discordance rates in clinical practice and (2) therapeutic consequences of discordance rate. Results were analyzed qualitatively. Changes in ER and particularly in PR are observed in locoregional and in distant metastases reaching a rate of 10% to 30% for ER and 20% to 50% for PR. The loss of PR is more frequent than ER loss. High HER2 concordance between primary tumors and axillary lymph node or distant metastases has been demonstrated in many studies; in the discordant cases, it is more frequent to have HER2-positive metastases with negative primary tumors than the opposite. A reassessment of biomolecular status in residual tumors after neoadjuvant treatment or in metastatic sites is advisable, whenever it is possible, to correct/modify the treatment schedule and to estimate the actual prognosis.


[Acute kidney injury--prevention, risk stratification and biomarkers].
Acute kidney injury influences negatively morbidity and mortality of the critically ill patient and causes increased costs by prolonged length of stay in the intensive care unit. At present the diagnosis and classification of acute kidney injury is derived from the RIFLE and AKIN criteria based on serum creatinine and urine output. The possible pre-, intra- and postrenal causes of acute kidney injury are the starting points of preventive therapy and risk stratification.Because of the unreliability of serum creatinine in critically ill patients the development of new biomarkers raises hope. But none of the promising candidates is used in clinical routine up to now. For evaluation of clinical benefit the results of large prospective multicenter studies have to be awaited.


The impact of left ventricular diastolic dysfunction for the prognosis in patients with lower extremity arterial disease.
Lower extremity arterial disease (LEAD) and left ventricular diastolic dysfunction (LVDD) share many risk factors, but the characteristics of LVDD and its association with prognosis in patients with LEAD have not been fully examined. We investigated the impact of LVDD on the clinical outcomes in LEAD patients. LVDD was classified according to the newest suggested classification by the American Society of Echocardiography. Survival analysis for mortality (primary endpoint) and major adverse cardiac events (MACE; secondary endpoint) was calculated with all clinical variables and adjusted by multivariate Cox regression. We consecutively enrolled 221 controls and 464 LEAD patients from outpatient clinics and hospitals. The prevalence of LVDD was proportional to the severity of LEAD defined by the Rutherford class. The difference of LVDD severity is significant when compared with the control and LEAD patients or LEAD patients who underwent endovascular therapy (EVT), and it is also proportional to the LEAD severity. The grade of LVDD was a significant factor in predicting MACE and mortality in LEAD patients after multivariate Cox regression analysis [hazard ratio (HR) = 2.11, 95% CI = 1.47-2.83, P = 0.026; HR = 1.47, 95% CI = 1.02-2.02, P = 0.041]. This impact remained significant in LEAD patients who underwent EVT. The degree of LVDD may predict MACE and mortality in LEAD patients. Whether early identification of LVDD in LEAD patients is helpful warrants further large-scale prospective randomized studies.


Hydrocephalus in Crouzon's syndrome.
We reviewed 42 cases of Crouzon's syndrome. There were 16 cases with ventricular dilation. We believe that shunt should be inserted after fronto-orbital advancement if there are persistent signs of raised intracranial pressure. However, in cases presenting with severe ventricular dilation and papilloedema, a shunt is inserted prior to fronto-orbital advancement. Medium- or high-pressure systems should be used.


Elevation of cytokines during open heart surgery with cardiopulmonary bypass: participation of interleukin 8 and 6 in reperfusion injury.
Myocardial ischaemia is one of the major causes of low output syndrome during open heart surgery. Injury associated with ischaemia and reperfusion has been considered to result, in part, from the action of neutrophils, the interaction of neutrophils with vascular endothelial cells, and the effects of cytokines which are mediators that induce and modify reactions between these substances. We investigated cell injury in relation to the concentrations of interleukins 6 and 8 (IL-6 and IL-8), which have recently received attention as neutrophil activators. Neutrophil counts, granulocyte elastase (GEL), IL-6, IL-8, tumour necrosis factor-alpha (TNF-alpha), CK, and CK-MB concentrations were determined serially in 11 patients undergoing open heart surgery with cardiopulmonary bypass (CPB). Neutrophil counts (mean +/- SD 2717 +/- 2421 microliters-1 preoperatively) peaked 60 min after declamping the aorta at 7432 +/- 4357 microliters-1 (P < 0.01) and remained elevated 7136 +/- 5194 microliters-1 at 180 min (P < 0.01). Plasma GEL level (168 +/- 71 micrograms.L-1 preoperatively) peaked at 1134 +/- 453 micrograms.L-1 120 min after declamping of the aorta (P < 0.01) and remained elevated, 1062 +/- 467 micrograms.L-1, after 180 min (P < 0.01). Serum IL-6 level (118 +/- 59 pg.ml-1 preoperatively) peaked at 436 +/- 143 pg.ml-1 60 min after declamping of the aorta (P < 0.01) and remained elevated, 332 +/- 109 pg.ml-1, after 180 min. Serum IL-8 level (37 +/- 44 pg.ml-1 preoperatively) peaked at 169 +/- 86 pg.ml-1 at 60 min after declamping of the aorta (P < 0.001) and remained elevated at 113 +/- 78 pg.ml-1 180 min after declamping of the aorta.(ABSTRACT TRUNCATED AT 250 WORDS)


Modeling the Effect of Shared Care to Optimize Acne Referrals From Primary Care Clinicians to Dermatologists.
Access to dermatologists remains a nationwide challenge. Optimizing referrals to a dermatologist may reduce patient wait times. To model the effect of algorithm-based acne treatment by primary care clinicians on referral patterns and costs. Overall, 253 referrals from primary care clinicians to dermatologists for acne from January 2014 through March 2015 were reviewed at Brigham and Women's Hospital. No-show rate, diagnostic concordance between primary care clinicians and dermatologists, treatment at the time of referral, and treatment by a dermatologist were ascertained, and we modeled 2 treatment algorithms-initiation of topical treatments by primary care clinicians (algorithm A) and initiation of topical treatments and oral antibiotics by primary care clinicians (algorithm B)-to identify the most effective referral patterns and costs. The primary outcome was the elimination of unnecessary appointments with a dermatologist. Secondary outcomes included reduction in delay to treatment, health care cost savings, and decrease in no-show rate. Overall, 150 of 253 referred patients were seen and treated by a dermatologist; 127 patients (50.2%) were not on prescription acne treatment at the time of dermatology referral. Model A reduced initial referrals in 72 of 150 cases (48.0%), eliminated referrals in 60 of 150 cases (40%), and reduced average delay-to-treatment by 28.6 days. This resulted in cost savings of $20.28 per patient, reduction of wait time by 5 days per patient, and decreased the no-show rate by 13%. Model B reduced initial referrals in 130 of 150 cases (86.7%), eliminated referrals in 108 of 150 cases (72%), and reduced average delay-to-treatment by 27.9 days. This resulted in cost savings of $35.68 per patient, shortened wait-time by 9 days per patient, and decreased the no-show rate by 24%. Algorithm-based treatment of acne by primary care clinicians may eliminate unnecessary appointments, reduce wait time for treatment, lower costs, and reduce patient no-shows.


Inhibitory effects on fast sympathetic rhythms.
In decerebrate cats, the effects of barbiturate anesthesia and of pulmonary afferent activity (produced by lung inflation) on fast (ca. 10/s) rhythms in sympathetic efferent discharges (cervical sympathetic and splanchnic) were analyzed. These inhibitory influences, in addition to reducing overall activity, eliminated or drastically reduced the highest frequency oscillations. Barbiturate anesthesia also markedly reduced high frequency oscillations (ca. 100/s) in phrenic discharge. Apparently, then, the occurrence of fast neural rhythms is dependent on the level of tonic excitatory activity.


Transcription phase, protein characteristics of DEV UL45 and prokaryotic expression, antibody preparation of the UL45 des-transmembrane domain.
Some UL45 gene function of Herpesvirus was reported. While there was no any report of the duck enteritis virus (DEV) UL45 protein as yet. The UL45 gene and des-transmembrane domain of UL45 (named UL45Δ gene, 295-675bp of UL45) of DEV were amplified by PCR and subcloned into the prokaryotic expression vector pET-32a(+). The constructed recombinant plasmids were transformed into the host strain BL21(DE3) PLysS and induced by IPTG. SDS-PAGE analysis showed the UL45 gene couldn't express while UL45Δ gene was highly expressed. His Purify Kit or salting-out could purify the protein effectively. Using the purified protein to immunize New-Zealand rabbits and produce polyclonal antibody. The agar diffusion reaction showed the titer of antibody was 1:32. Western blot analysis indicated the purified rabbit anti-UL45Δ IgG had a high level of specificity and the UL45 gene was a part of DEV genome. The transcription phase study of UL45 gene showed that expression of UL45 mRNA was at a low level from 0 to 18 h post-infection (pi), then accumulated quickly at 24 h pi and peaked at 42 h pi. It can be detected till 72 h pi. Besides, western blot analysis of purified virion and different viral ingredients showed that the UL45 protein resided in the purified virion and the viral envelope. The rabbit anti-UL45Δ IgG was produced successfully and it can serve as a good tool for penetrating studies of the function of DEV UL45 protein. The transcription phase and protein characteristics analysis indicated that DEV UL45 gene was a late gene and UL45 protein may be a viral envelope protein.


Nutrition communication styles of family doctors: results of quantitative research.
To assess the nutrition communication styles of Dutch family doctors and in particular to assess its psychosocial and sociodemographic correlates. A cross-sectional study in which a representative sample of 600 Dutch family doctors completed a questionnaire. The survey was conducted in October and November 2004 in the Netherlands. A total of 267 family doctors completed the questionnaire (response rate 45%). Principal component factor analyses with varimax rotation were performed to construct factors. Cronbach's alpha was used as an index of reliability. Our hypothetical model for nutrition communication style was tested using multiple regression analysis, combining the forward and backward procedures under the condition of the same results. Many family doctors felt at ease with a motivational nutrition communication style. The main predictor for motivational nutrition communication style was task perception of prevention (26%). Some individual and environmental correlates had an additional influence (explained variance 49%). Other styles showed explained variances up to 57%. The motivational style was the best predictor for actual nutrition communication behaviour (35%), while the confrontational style was the best predictor for actual nutrition communication behaviour towards overweight (34%). In contemporary busy practice, family doctors seem to rely on their predominant nutrition communication style to deal with standard situations efficiently: for the majority, this proved to be the motivational nutrition communication style. Moreover, family doctors used a combination of styles. This study suggests that family doctors behave like chameleons, by adapting their style to the specific circumstances, like context, time and patient. If family doctors communicate about nutrition in general, they select any of the five nutrition communication styles. If they communicate about overweight, they pick either the confrontational or motivational style.


Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer.
To evaluate computed tomography (CT) findings able to predict outcome in patients with ovarian cancer (OC) and concomitant bowel occlusion. This institutional review board-approved retrospective study included 31 patients with OC and clinical evidence of bowel occlusion who underwent CT at presentation between February 2013 and June 2015. Two radiologists recorded various qualitative CT features. Correlations between CT and survival data were made with Mann-Whitney test, Wilcoxon test, and χ2 test, as appropriate. Receiver operating characteristic curves were generated for statistically significant CT findings using logistic regression model. Two of 31 patients (6.5%) were alive at the end of this study; 29 patients (93.5%) died of disease. Median overall survival was 90 days. CT features associated with short life expectancy were bowel mural thinning (p=0.03), mesenteric tumor deposits (p=0.009), mesenteric infiltration (p=0.02), and ascites (p=0.04). Area under the curve was 0.728 (p=0.03) for mesenteric tumor deposits in predicting malignant bowel obstruction. Accurate interpretation of CT features may guide decisions in care of women with OC and bowel obstruction.


Solid pseudopapillary tumour of the pancreas: Incidence, prognosis and outcome of surgery (single center experience).
Solid pseudopapillary tumour (SPT) of the pancreas is a rare neoplasm of low malignant potential. The pathogenesis and guidelines for its treatment remain unclear. This study was designed to evaluate the diagnosis, surgical treatment and prognosis of SPT. A retrospective study during the period between January 1995 to October 2012. Cases with SPTs treated at our institution were reviewed. Demographic data, clinical manifestations, radiological, surgical, and pathological records were reviewed for patients with SPT. Twenty four patients with SPT were identified (22 women and 2 men with a mean age 24.83 ± 8.66 (12-52 years). The tumour was located in the head in (50%) and in the body (8.3%) and in the tail (41.7%). The mean size was 9.2 ± 5.3 (3-25 cm). The main clinical presentation was abdominal pain in (83.3%). All 24 patients had curative resection including pancreaticoduodenectomy (50%), central pancreatectomy (8.3%) and distal pancreatectomy (41.7%). Sex, age, symptoms, tumour size, CT image and tumour markers were not significant clinical factors to predict SPT with malignant behavior. The recurrence rate was (8.3%) after 5 years postoperatively. No hospital mortality, all patients except 2 patients (8.3%) were alive at follow up period. The estimated 1, 3, and 5 year survival rate was 95%, 95%, and 88%. SPT are rare neoplasms with malignant potential. Aggressive surgical resection is needed even in presence of local invasion, and also for recurrence as patients had a good long term survival.


Clinical neurophysiology for neurological prognostication of comatose patients after cardiac arrest.
Early prognostication of outcome in comatose patients after cardiac arrest represents a daunting task for clinicians, also considering the nowadays commonly used targeted temperature management with sedation in the first 24-48 h. A multimodal approach is currently recommended, in order to minimize the risks of false-positive prediction of poor outcome, including clinical examination off sedation, EEG (background characterization and reactivity, occurrence of repetitive epileptiform features), and early-latency SSEP responses represent the core assessments in this setting; they may be complemented by biochemical markers and neuroimaging. This paper, which relies on a recent comprehensive review, focuses on an updated review of EEG and SSEP, and also offers some outlook into long-latency evoked potentials, which seem promising in clinical use.


Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study.
Stroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone. This retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients' demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009. We studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29-88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32-3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43-5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17-12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1-9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96-9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44-6.36), p = 0.001]. Women had poorer outcome than men. This study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care.


Phosphorus amendment reduces hepatic and renal oxidative stress in mallards ingesting lead-contaminated sediments.
Lead poisoning of waterfowl has been reported for decades in the Coeur d'Alene River Basin (CDARB) in Idaho as a result of the ingestion of lead-contaminated sediments. This study was conducted to determine whether the addition of phosphoric acid to CDARB sediments would reduce the bioavailability and toxicity of lead to the liver and kidney of mallards (Anas platyrhynchos). Mallards received diets containing 12% clean sediment (controls) or 12% sediment from three different CDARB sites containing 4520, 5390, or 6990 microg/g lead (dry weight) with or without phosphoric acid amendment. Liver and kidney lead concentrations were significantly higher in all CDARB treatment groups and ranged from geometric mean values of 18.2 (liver) and 28.7 (kidney) for the first 2 sites to 22.5 (liver) and 45.6 (kidney) microg/g (wet weight) for the third site. With amendments all liver lead concentrations were reduced 36 to 55%, and all kidney lead concentrations were lowered 54 to 73%. Unamended CDARB sediment from the third site resulted in the following hepatic effects: over 1.6-fold elevation of liver glutathione (reduced form; GSH) concentration, higher GSH S-transferase and oxidized glutathione (GSSG) reductase activities, and lower protein-bound thiols (PBSH) concentration. Renal effects included higher kidney GSH concentrations for all CDARB sites, with over 2.1-fold higher for the third site. Resulting kidney GSSG to GSH ratios were lower at two sites. At the third site, gamma-glutamyl transferase (GGT) activity was elevated, and lipid peroxidation as thiobarbituric acid-reactive substances (TBARS) was 1.7-fold greater. Amendment restored all hepatic variables as well as the renal variables TBARS and GGT so they did not differ from controls. Although amendments of phosphorus substantially reduced the bioavailability of lead and some of the adverse effects, lead concentrations in the tissues of mallards fed the amended sediments were still above those considered to be harmful to waterfowl under the present conditions.


Plasma and lung concentrations of ceftazidime administered in continuous infusion to critically ill patients with severe nosocomial pneumonia.
To determine the steady-state plasma and epithelial lining fluid (ELF) concentrations of ceftazidime administered in continuous infusion to critically ill patients with severe nosocomial pneumonia. Prospective, open-label study. An intensive care unit and research ward in a university hospital. A total of 15 adult patients with severe nosocomial bacterial pneumonia on mechanical ventilation were enrolled. All subjects received a 30 min intravenous infusion of 2 g ceftazidime followed by a continuous infusion of 4 g over 24 h. The concentrations of ceftazidime in plasma and ELF were determined at steady-state after 2 days of therapy by high performance liquid chromatography. The mean +/-SD steady-state plasma and ELF concentrations of 4 g ceftazidime in continuous infusion were 39.6+/-15.2 microg/mL and 8.2+/-4.8 microg/mL, respectively, showing a mean +/-SD percentage penetration of ceftazidime into ELF of 20.6+/-8.9%. The administration of 4 g ceftazidime in continuous infusion in critically ill patients with severe nosocomial pneumonia provides concentrations in excess of the minimal inhibitory concentration of many susceptible organisms over the course of therapy both in serum and ELF. However, for some pathogens such as P. aeruginosa, higher doses of ceftazidime should be administered, or another agent should be used in combination.


The importance of utilizing 24-h Holter monitoring as a non-invasive method of predicting the mechanism of supraventricular tachycardia.
Despite the emergence of advanced invasive technology in identifying the various types of arrhythmia mechanisms, 24-h ambulatory electrocardiogram monitoring as a non-invasive method remains an invaluable informative tool in delineating such mechanisms. Furthermore, one observational study has supported the utilization of 24-h Holter monitoring in exploring AV Node (AVN) characteristics sufficiently in correlation with invasive studies when limited to patients without Wolf Parkinson White syndrome showing a positive predictive value of 98% in their supraventricular tachycardia (SVT) assessment (Fukuda et al., 2005). We describe in this report suspected tachycardia initiation mechanism in three SVT cases based on 24-h Holter recordings. Premature atrial contraction with subsequent AVN fast pathway conduction block initiated the common type AVN re-entrant tachycardia (AVNRT). Dual AVN physiology was documented during the electrophysiological studies in all three cases and a definitive therapy was achieved by the AVN slow pathway modification.


Channel Interaction and Current Level Affect Across-Electrode Integration of Interaural Time Differences in Bilateral Cochlear-Implant Listeners.
Sensitivity to interaural time differences (ITDs) is important for sound localization. Normal-hearing listeners benefit from across-frequency processing, as seen with improved ITD thresholds when consistent ITD cues are presented over a range of frequency channels compared with when ITD information is only presented in a single frequency channel. This study aimed to clarify whether cochlear-implant (CI) listeners can make use of similar processing when being stimulated with multiple interaural electrode pairs transmitting consistent ITD information. ITD thresholds for unmodulated, 100-pulse-per-second pulse trains were measured in seven bilateral CI listeners using research interfaces. Consistent ITDs were presented at either one or two electrode pairs at different current levels, allowing for comparisons at either constant level per component electrode or equal overall loudness. Different tonotopic distances between the pairs were tested in order to clarify the potential influence of channel interaction. Comparison of ITD thresholds between double pairs and the respective single pairs revealed systematic effects of tonotopic separation and current level. At constant levels, performance with double-pair stimulation improved compared with single-pair stimulation but only for large tonotopic separation. Comparisons at equal overall loudness revealed no benefit from presenting ITD information at two electrode pairs for any tonotopic spacing. Irrespective of electrode-pair configuration, ITD sensitivity improved with increasing current level. Hence, the improved ITD sensitivity for double pairs found for a large tonotopic separation and constant current levels seems to be due to increased loudness. The overall data suggest that CI listeners can benefit from combining consistent ITD information across multiple electrodes, provided sufficient stimulus levels and that stimulating electrode pairs are widely spaced.


Chloride: the queen of electrolytes?
Channelopathies, defined as diseases that are caused by mutations in genes encoding ion channels, are associated with a wide variety of symptoms and have been documented extensively over the past decade. In contrast, despite the important role of chloride in serum, textbooks in general do not allocate chapters exclusively on hypochloremia or hyperchloremia and information on chloride other than channelopathies is scattered in the literature. To systematically review the function of chloride in man, data for this review include searches of MEDLINE, PubMed, and references from relevant articles including the search terms "chloride," "HCl," "chloride channel" "acid-base," "acidosis," "alkalosis," "anion gap" "strong anion gap" "Stewart," "base excess" and "lactate." In addition, internal medicine, critical care, nephrology and gastroenterology textbooks were evaluated on topics pertaining the assessment and management of acid-base disorders, including reference lists from journals or textbooks. Chloride is, after sodium, the most abundant electrolyte in serum, with a key role in the regulation of body fluids, electrolyte balance, the preservation of electrical neutrality, acid-base status and it is an essential component for the assessment of many pathological conditions. When assessing serum electrolytes, abnormal chloride levels alone usually signify a more serious underlying metabolic disorder, such as metabolic acidosis or alkalosis. Chloride is an important component of diagnostic tests in a wide array of clinical situations. In these cases, chloride can be tested in sweat, serum, urine and feces. Abnormalities in chloride channel expression and function in many organs can cause a range of disorders.


[Effect of polycyclic aromatic hydrocarbons on laccase production by white rot fungus Pleurotus ostreatus D1].
The effect of polycyclic aromatic hydrocarbons (PAHs) on the dynamics of laccase production by the fungus Pleurotus ostreatus D1 under conditions of submerged cultivation on Kirk's medium has been studied. It has been shown that phenanthrene, fluoranthene, pyrene, and chrysene actively induce this enzyme, whereas fluorene and anthrecene had a smaller effect. Addition of Mn2+ ions to cultivation medium elevates the laccase activity twofold and more in the presence of all the studied PAHs. Electrophoresis under nondenaturing conditions demonstrates induction of additional laccase species by xenobiotics. Ligninolytic peroxidase activities are undetectable under the conditions used.


Douglas-fir (Pseudotsuga menziesii)-spruce budworm (Choristoneura occidentalis) interactions: the effect of nutrition, chemical defenses, tissue phenology, and tree physical parameters on budworm success.
Measurements of foliage quality, physiological, and phenological condition of sample trees were used as independent variables in multiple correlation analyses to determine their effect on female and male spruce budworm larval dry weights. Female budworm from trees high in foliar concentrations of beta-pinene, myrcene and total nitrogen weighed less than those from trees lacking these characteristics. Male budworm from trees high in foliar concentrations of alpha-pinene, myrcene, terpinolene, citronellyl acetate, and bornyl acetate weighted less than those from trees lacking these characteristics. Additionally, relatively vigorous and productive trees tended to be less susceptible (as evidenced by reduced larval weight) to budworm of either sex.


Longitudinal Examination of Bone Loss in Male Rats After Moderate-Severe Contusion Spinal Cord Injury.
To elucidate mechanisms of bone loss after spinal cord injury (SCI), we evaluated the time-course of cancellous and cortical bone microarchitectural deterioration via microcomputed tomography, measured histomorphometric and circulating bone turnover indices, and characterized the development of whole bone mechanical deficits in a clinically relevant experimental SCI model. 16-weeks-old male Sprague-Dawley rats received T9 laminectomy (SHAM, n = 50) or moderate-severe contusion SCI (n = 52). Outcomes were assessed at 2-weeks, 1-month, 2-months, and 3-months post-surgery. SCI produced immediate sublesional paralysis and persistent hindlimb locomotor impairment. Higher circulating tartrate-resistant acid phosphatase 5b (bone resorption marker) and lower osteoblast bone surface and histomorphometric cancellous bone formation indices were present in SCI animals at 2-weeks post-surgery, suggesting uncoupled cancellous bone turnover. Distal femoral and proximal tibial cancellous bone volume, trabecular thickness, and trabecular number were markedly lower after SCI, with the residual cancellous network exhibiting less trabecular connectivity. Periosteal bone formation indices were lower at 2-weeks and 1-month post-SCI, preceding femoral cortical bone loss and the development of bone mechanical deficits at the distal femur and femoral diaphysis. SCI animals also exhibited lower serum testosterone than SHAM, until 2-months post-surgery, and lower serum leptin throughout. Our moderate-severe contusion SCI model displayed rapid cancellous bone deterioration and more gradual cortical bone loss and development of whole bone mechanical deficits, which likely resulted from a temporal uncoupling of bone turnover, similar to the sequalae observed in the motor-complete SCI population. Low testosterone and/or leptin may contribute to the molecular mechanisms underlying bone deterioration after SCI.


Augmentation of keratinocyte differentiation by the epidermal mitogen, 8-bromo-cAMP.
The effect of the epidermal mitogen, 8-bromo-cAMP, on keratinocyte differentiation was studied. A 3 X 10(-4) M dose of 8-bromo-cAMP was added to primary neonatal mouse epidermal keratinocyte cultures that slowly proliferate, stratify and differentiate over 2-3 weeks time. [3H]Thymidine autoradiography coupled with an NH4Cl plus reducing agent technic which separates basal and differentiating keratinocytes was used to determine the target cell for the 8-bromo-cAMP mitogenic effect. A histologic stain and a four buffer protein extraction protocol, in conjunction with PAGE and fluorographic technics, were used to assess the differentiation of the cultures. The data indicated that 8-bromo-cAMP primarily stimulated the proliferation of the basal cell monolayer. Simultaneous with the mitogenic effect was an increase in the production of keratohyalin granule, keratin and cell envelope proteins, which are specific markers of epidermal differentiation. The results indicate that keratinocytes stimulated by the epidermal mitogen 8-bromo-cAMP simultaneously express differentiation-related processes.


Evaluation of Forkhead BOX M1 (FOXM1) gene expression in colorectal cancer.
Forkhead Box M1 (FOXM1)-a key cell cycle regulator is a member of the Forkhead transcription factor family. It plays a key role in embryogenesis and cell proliferation and has been strongly linked to various solid tumors. We sought to understand the regulation of FOXM1 in colorectal cancer (CRC), as well as if and to what extent other clinicopathological characteristics are associated with FOXM1. The investigation comprised 98 CRC samples and normal tissues (controls). All colon cancer patients had a colonoscopy and targeted biopsy. All rectal cancer patients had a CT and MRI. Real-time PCR, Immunohistochemistry, and Western blotting were used to evaluate FOXM1 expression, and the findings were analyzed using SPSS (v.26). FOXM1 mRNA and protein expression were substantially upregulated in tumor tissues, with the majority of these proteins localized in nucleo-cytoplasm. Elevated protein levels of FOXM1 were strongly correlated with lower education level, larger tumor size, lymph node status, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node metastasis (LNM), tumor invasion depth (subserosal and serosal invasion), late stage (III and IV), localization (nucleo-cytoplasmic), intensity (strong) and recurrence. Based on survival analysis, FOXM1 overexpression and nucleo-cytoplasmic localization were associated with shorter disease-free survival while stage and PNI were linked to poorer overall and disease-free survival. According to the results of the Cox regression analysis, stage and PNI were significant predictors of prognosis in CRC patients. FOXM1 expression was elevated in CRC and was linked to reduced disease-free survival. These findings support prior reports and hence FOXM1 can be an important prognostic marker for CRC and a promising therapeutic target. Additionally, we found a link between poor disease-free survival and FOXM1's nucleo-cytoplasmic localization. However, since the sample size of this study was small, further research is needed to validate our findings.


Bioequivalence of levamlodipine besylate tablets in healthy Chinese subjects: a single-dose and two-period crossover randomized study.
Levamlodipine, a calcium channel blocker, has been show act as a cardiovascular drug. To compare the pharmacokinetic parameters between levamlodipine (test formulation) at a single dose of 5 mg and amlodipine (reference formulation) at a single dose of 10 mg, the bioequivalence study was carried out. A single-dose randomized, open-label, two-period crossover study was designed in healthy Chinese subjects. 48 subjects were divided into fasted and fed groups equally. The subjects randomly received the test or reference formulations at the rate of 1:1. Following a 21-day washout period, the alternative formulations were received. The blood samples were collected at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 24, 36, 48, 72, 96, 120, 144, 168 h later. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was applied to determine the plasma concentrations of levamlodipine. Adverse events were recorded. The 90% confidence intervals (CIs) of the ratio of geometric means (GMRs) of Cmax, AUC0-t, and AUC0-∞ under both fasted and fed conditions were within the prespecified bioequivalence limits between 80 ~ 125%. Under fasted conditions, 24 subjects were enrolled and completed the study. The mean Cmax was (2.70 ± 0.49) ng/mL, AUC0-t was (141.32 ± 36.24) ng × h/mL and AUC0-∞ was (157.14 ± 45.65) ng × h/mL after a single dose of 5 mg levamlodipine. The mean Cmax was (2.83 ± 0.52) ng/mL, AUC0-t was (153.62 ± 33.96) ng × h/mL and AUC0-∞ was (173.05 ± 41.78) ng × h/mL after a single dose of 10 mg amlodipine. Under fed conditions, 24 subjects were enrolled and completed the study. The mean Cmax was (2.73 ± 0.55) ng/mL, AUC0-t was (166.93 ± 49.96) ng × h/mL and AUC0-∞ was (190.99 ± 70.89) ng × h/mL after a single dose of 5 mg levamlodipine. The mean Cmax was (2.87 ± 0.81) ng/mL AUC0-t was (165.46 ± 43.58) ng × h/mL and AUC0-∞ was (189.51 ± 64.70) ng × h/mL after a single dose of 10 mg amlodipine. Serious adverse event was not observed. The trial confirmed that levamlodipine at a single dose of 5 mg and amlodipine at a single dose of 10 mg were bioequivalent under both fasted condition and fed condition. Cinicaltrials, NCT04411875 . Registered 3 June 2020 - Retrospectively registered.


Fish tissue quality in near-coastal areas of the Gulf of Mexico receiving point source discharges.
The objective of this study was to determine inorganic and organic contaminant concentrations in edible tissue of fish collected from eight coastal areas receiving wastewater discharges and from two reference locations. Trace metal residues were statistically similar regardless of the collection site. Zinc (100% detection in all samples), total mercury (100%), total arsenic (92%), copper (92%), and selenium (88%) were the more commonly detected trace metals. Mercury concentrations exceeded the Florida health-based standard of 0.5 microg/g for limited fish consumption in 30% of the total samples and averaged 0.40 (+/- 1 S.D. = 0.22, range < or = 0.08 to 0.85) microg/g wet weight. The average total PAH concentrations were 1.79 (+/- 1.60) ng/g (reference areas) and 2.17 (+/- 3.29) ng/g (wastewater-impacted areas). Pyrene was detected most frequently (63% of the total samples) and averaged 0.74 (+/- 0.35) ng/g wet wt. The average total PCB concentrations were 4.8 (+/- 7.1) ng/g (reference areas) and 31.6 (+/- 31.3) ng/g (wastewater-impacted areas) Concentrations of dieldrin and cis-chlordane were approximately eight times greater, respectively, in fish collected from wastewater receiving waters, whereas total DDT and total pesticide concentrations were not elevated in the same areas. Concentrations of total PCBs and all chlorinated pesticides were below US health-based standards. The lack of a published reference data base for fish tissue quality in near-coastal areas of the Gulf of Mexico restricts an assessment of the environmental significance of results from this and similar studies investigating the fate of point source contaminants.


Laparoscopic versus traditional peritoneal dialysis catheter insertion: a meta analysis.
The objective of this study is to compare the catheter-related complications as well as catheter survival between laparoscopic and traditional surgery in peritoneal dialysis catheter insertion. Five randomized controlled trials and 11 cohort studies were identified. Meta-analysis showed laparoscopic catheter is superior to traditional surgery in terms of controlling catheter migration (OR 0.17, 95% CI 0.08-0.33; p < 0.00001) and catheter survival rate (1-year survival rate: OR 3.05, 95% CI 1.72-5.41, p = 0.0001; 2-year survival rate: OR 2. 07, 95% CI 1.29-3.33, p = 0.0001), but slightly increases the risk of bleeding (OR 2.13, 95% CI 1.07-4.23, p = 0.03). The two groups were not significantly different in other catheter-related complications. As regards the quality of the analysis, only the migration analysis ranked A-level, while the rest fell into Class B or C. The overall research quality was moderate. Laparoscopic surgery is superior to traditional surgery on reducing catheter migration and prolonging catheter survival rate according to our analysis.


Monoclonal antibodies to crosslinked fibrin degradation products (XL-FDP). I. Characterization and preliminary evaluation in plasma.
Monoclonal antibodies (mabs) were raised against X-oligomers, the earliest soluble fragments released from crosslinked fibrin (XL-FN), by the action of plasmin. Two of the mabs (NIBn 52 and NIBn 123) were monospecific for X-oligomers in that they showed no binding to fibrinogen, the plasmic fragments of fibrinogen (D and E) and non-crosslinked fibrin (X, Y, D and E), or the terminal digestion product of XL-FN, fragment DD-E. One other mab (NIBn 178) was panspecific for X-oligomers in that it exhibited a weak affinity for fibrinogen. The mabs were used to develop a two-site immunoradiometric assay (IRMA) and an enzyme-linked immunospecific assay (ELISA) which permitted the specific measurement of X-oligomers directly in plasma, rather than in serum. This immunoassay is a true assay of fibrinolysis as distinct from fibrinogenolysis and may be a potential aid in the diagnosis and evaluation of thrombosis. In preliminary studies, the assay detected low levels of X-oligomers in normal plasma and elevated levels in patients with disseminated intravascular coagulation.


Crystal structure of Drosophila melanogaster tryptophan 2,3-dioxygenase reveals insights into substrate recognition and catalytic mechanism.
Tryptophan 2,3-dioxygenase (TDO) catalyzes the oxidative cleavage of the indole ring of l-tryptophan to N-formylkynurenine in the kynurenine pathway, and is considered as a drug target for cancer immunotherapy. Here, we report the first crystal structure of a eukaryotic TDO from Drosophila melanogaster (DmTDO) in complex with heme at 2.7Å resolution. DmTDO consists of an N-terminal segment, a large domain and a small domain, and assumes a tetrameric architecture. Compared with prokaryotic TDOs, DmTDO contains two major insertion sequences: one forms part of the heme-binding site and the other forms a large portion of the small domain. The small domain which is unique to eukaryotic TDOs, interacts with the active site of an adjacent monomer and plays a role in the catalysis. Molecular modeling and dynamics simulation of DmTDO-heme-Trp suggest that like prokaryotic TDOs, DmTDO adopts an induced-fit mechanism to bind l-Trp; in particular, two conserved but flexible loops undergo conformational changes, converting the active site from an open conformation to a closed conformation. The functional roles of the key residues involved in recognition and binding of the heme and the substrate are verified by mutagenesis and kinetic studies. In addition, a modeling study of DmTDO in complex with the competitive inhibitor LM10 provides useful information for further inhibitor design. These findings reveal insights into the substrate recognition and the catalysis of DmTDO and possibly other eukaryotic TDOs and shed lights on the development of effective anti-TDO inhibitors.


On the Pt(+) and Rh(+) Catalytic Activity in the Nitrous Oxide Reduction by Carbon Monoxide.
Nitrous oxide activation by CO in the presence of platinum and rhodium monocations was elucidated by density functional methods for ground and first excited states. Platinum and rhodium cations fulfill the thermodynamic request for the oxygen-atom transport that allows the catalytic cycle to be completed, but actually, just the first one meaningfully improves the kinetics of the process. For both catalysts, the reaction pathways show the only activation barrier in correspondence of nitrogen release and monoxide cation formation. The kinetic analysis of the potential energy profile, in agreement with ICP/SIFT MS experimental data, indicates that platinum performs more in the reduction, while the whole process is not sufficiently fast in the case of rhodium ionic catalyst.


Alterations in magnesium and zinc metabolism in thyroid disease.
Magnesium (Mg) and zinc (Zn) status was assessed in subjects to evaluate the effects of thyroid diseases on Mg and Zn metabolism. Plasma and red blood cell (RBC) concentration and peripheral blood mononuclear cell (MNC) content of Mg and Zn, and 24-hour urinary excretion of Mg, Zn, creatinine (Cr), calcium (Ca), sodium (Na), and potassium (K) were measured in 11 thyrotoxic, 29 hypothyroid, and 25 euthyroid control subjects. Serum albumin, alpha 2-macroglobulin, and the binding of Zn to albumin were also determined. Plasma and RBC Mg concentrations were low in half of the hyperthyroid subjects, but mean values were not significantly different from controls. Urinary excretion and clearance of Mg were lower in hypothyroid subjects, but differences were removed when expressed relative to Cr excretion and clearance. Similar patterns were noted for urinary Ca, Na, and K, suggesting that their reduced excretion reflects alterations in renal hemodynamics. Plasma Zn was lower in hypothyroid subjects and correlated with serum albumin; MNC Zn and urinary Zn were also low. Plasma Zn concentration was normal and serum albumin significantly lower in the hyperthyroid group than in the control group. Further, RBC Zn content was significantly lower in hyperthyroid subjects, and inversely related to plasma thyroxine concentration. The hyperthyroid group also excreted significantly greater amounts of Zn than controls, indicative of a catabolic process. This increased urinary loss may reflect a shift in the distribution of plasma Zn between ultrafilterable and Zn-albumin complexes. In summary, this study provides evidence for marked alterations in Zn homeostasis in persons with thyroid disease. Whether the observations indicate deficiency states and have clinical implications will require further investigation.


Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome.
To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs. Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI. Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (p<0.001). SWMR demonstrated a sensitivity of 97.7 % (CI=0.92-1) and a specificity of 91.3 % (CI=0.788-1) for the identification of spurs. Standard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R2=0.75;p<0.0001), while overestimating lesion size (5.7±1.2 mm; 4.3±1.3 mm;p<0.0001). Interobserver-agreement for spurs was high on SWMR (R2=0.74;p<0.0001), but low on standard MRI (R2=0.24;p<0.0001). SWMR allows a reliable detection of sub-coracoacromial spur formation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard. • SWMR has the potential to reliably identify sub-coracoacromial spurs without radiation exposure. • SWMR provides comparable detection rates to conventional radiography for sub-coracoacromial spur formation. • SWMR yields higher detection rates compared to standard-MR regarding sub-coracoacromial spur formation. • SWMR can be implemented in routine shoulder MRI protocols.


The plantar nerves-lumbrical muscles: a useful nerve-muscle preparation for assaying the effects of botulinum neurotoxin.
The plantar nerves-lumbrical muscles (PL) of the hindpaw of the mouse is a preparation that is particularly useful for assaying the effects of botulinum neurotoxin (NT) on the mammalian neuromuscular junction. Each mouse provides a minimum of 4 and a maximum of 8 such preparations. The muscles are thin enough so that neuromuscular junctions can be easily located with Nomarski interference contrast optics for impaling with microelectrodes. The preparations are small enough so they can be sectioned transversely or longitudinally, in their entirety, for light and electron microscopy, or just the regions containing end-plates can be used. An examination of the responses of this preparation to types A and E NT reveal its exceptional suitability for experiments with NT. The small number of fibers and their arrangement permit assays of low concentrations of NT to proceed to complete and total paralysis in a convenient period of time.


Aerobic, thermophilic, semi-continuous treatment of cattle slurry with whey and jam.
Aerobic thermophilic treatment (ATT) of cattle slurry and industrial food waste (whey and jam) was conducted semi-continuously, with the aim of developing the ATT process. We could improve the final products in terms of hygiene, environmental effects and heat production. In addition we tried to solve the foaming problem mechanically. The trial was done by using a farm-scale bioreactor with a total volume of 12 m3 and a theoretical retention time of some 15 days. Temperature increased to 55 degrees C at the end of the trial. The process could be an efficient method for the control of foam. Using the waste food (whey and jam) improved the process.


Long noncoding RNA TTN-AS1 facilitates tumorigenesis and metastasis by maintaining TTN expression in skin cutaneous melanoma.
The antisense transcript, emanating from the opposite strand to a protein-coding or sense strand, has been reported to have critical roles in gene regulation. The perturbation of an antisense RNA can alter the expression of sense messenger RNAs. In this study, a long noncoding RNA TTN-AS1 (lncRNA-TTN-AS1), which is transcribed in the opposite direction of the human titin (TTN) gene, has been identified and explored in skin cutaneous melanoma (SKCM). We found that the expression of TTN and lncRNA-TTN-AS1 had a significantly positive correlation in SKCM cells. Functionally, ectopic expression of TTN and lncRNA-TTN-AS1 promoted SKCM tumorigenesis and metastasis both in vitro and in vivo. Moreover, knockdown of TTN partially abrogated lncRNA-TTN-AS1 induced SKCM tumorigenesis. Mechanistically, hypomethylation of transcription initiation site was responsible for lncRNA-TTN-AS1 high expression levels. LncRNA-TTN-AS1 facilitated SKCM progression by promoting TTN expression at both transcriptional and posttranscriptional levels. As detailed, lncRNA-TTN-AS1 had a significant effect on the increase of TTN promoter activity. Besides, lncRNA-TTN-AS1 also induced the accumulation of TTN in cytoplasm by increasing the stability of TTN mRNA. Clinically, we found that high TTN and lncRNA-TTN-AS1 expression were positively correlated with poor overall survival of SKCM patients, and may be considered as novel biomarkers and drug targets for SKCM patients.


Pexidartinib (PLX3397) through restoring hippocampal synaptic plasticity ameliorates social isolation-induced mood disorders.
Social behavior is essential for the well-being and survival of individuals. However, social isolation is a serious public health issue, especially during the COVID-19 pandemic, affecting a significant number of people worldwide, and can lead to serious psychological crises. Microglia, innate immune cells in the brain, are strongly implicated in the development of psychiatry. Although many microglial inhibitors have been used to treat depression, there is no literature report on pexidartinib (PLX3397) and social isolation. Herein, we adopted PLX3397 to investigate the role of microglia in the modulation of social isolation. Our results found that social isolation during adolescence caused depressive-like, but not anxiety-like behavior in mice in adulthood, with enhanced expression of the microglial marker Iba1 in the hippocampus. In addition, treatment with PLX3397 reduced the expression of the microglial marker Iba1, decreased the mRNA expression of IL-1β, increased the mRNA expression of Arg1, elevated the protein levels of DCX and GluR1 and restored the dendritic spine branches and density, ultimately mitigating depressive-like behavior in mice. These findings suggest that inhibition of microglia in the hippocampus could ameliorate mood disorders in mice, providing a new perspective for the treatment of psychiatric disorders such as depression.


Peripheral primitive neuroectodermal tumour of the maxilla.
The peripheral primitive neuroectodermal tumour (pPNET) is a rare and highly malignant soft tissue neoplasm in children and young adults. We present a case of pPNET of the maxilla in a 49-year-old woman.


Aid and violence, with special reference to Sierra Leone.
This paper looks at how departures from humanitarian principles can be accommodated, legitimised and obscured within the international humanitarian system. It looks particularly at the case of Sierra Leone between 1991 and 1995. It analyses how misinformation about the causes and dynamics of violence and regarding the aid system contribute to the erosion of humanitarian principles.


Genotype and antiretroviral drug resistance of human immunodeficiency virus-1 in Saudi Arabia.
To analyze antiretroviral drug resistance and determine the genotype of human immunodeficiency virus (HIV)-1 in Saudi patients by sequencing an amplified region of the viral pol gene. This retrospective study analyzed data from plasma samples submitted for genotypic drug sensitivity monitoring. Samples were analyzed at the Special Infectious Agent Unit, King Fahd Medical Research Center of King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from August 2004 to June 2009. The Viroseq2.5 kit (Celera/Abbott) was used with ABI Prism 3100 sequencer. All patients were Saudi nationals and were on antiretroviral therapy, some experiencing treatment failure. Based on protease region (PR), genotypes of 63 samples were as follows: C:22, G:21, B:9, CRF02_AG:5, D:3, A:1, F:1, and J:1. Based on reverse transcriptase region (RT), genotypes were as follows: C:23, G:24, B:9, CRF02_AG: 2, D:2, A:1, and F:1. Antiretroviral susceptibility testing results were as follows: 52% of the isolates were susceptible to all 3 major classes of antiretroviral drugs used, 41% had mutations known to confer high level resistance to one or more of the nucleoside analogue reverse transcriptase inhibitors, 16% had mutations known to confer high level resistance to non-nucleoside analogues reverse transcriptase inhibitors, 13% had mutations known to confer high level resistance to one or more of the protease inhibitors (PI). Most isolates were susceptible to 2 or at least one class of antiretroviral, and only 3% of the isolates had resistance to several members of all 3 classes. Antiretroviral resistance is not uncommon in Saudi patients on antiretroviral therapy.


Positron emission tomography in ischemic heart disease.
Non-invasive assessment of ischemic heart disease remains a challenging task, even with a large armory of diagnostic modalities. Positron emission tomography (PET) is an advanced radionuclide technique that has been available for decades. Originally used as a research tool that contributed to advances in the understanding of cardiovascular pathophysiology, it is now becoming established in clinical practice and is increasingly used in the diagnosis and risk stratification of patients with ischemic heart disease. PET myocardial perfusion imaging has a mean sensitivity and specificity of around 90% for the detection of angiographically significant coronary artery disease, and is also highly accurate for assessing the prognosis of patients with ischemic heart disease. Depending on the radiotracer used, it can provide information not only on myocardial perfusion but also on myocardial metabolism, which is essential for viability assessment. The potential of this imaging technique has been further increased with the introduction of hybrid scanners, which combine PET with computed tomography or cardiac magnetic resonance imaging, offering integrated morphological and functional information and hence comprehensive assessment of the effects of atherosclerosis on the myocardium. The scope of this review is to summarize the role of PET in ischemic heart disease.


N6-methyladenosine RNA modification promotes viral genomic RNA stability and infection.
Molecular manipulation of susceptibility (S) genes that are antipodes to resistance (R) genes has been adopted as an alternative strategy for controlling crop diseases. Here, we show the S gene encoding Triticum aestivum m6A methyltransferase B (TaMTB) is identified by a genome-wide association study and subsequently shown to be a positive regulator for wheat yellow mosaic virus (WYMV) infection. TaMTB is localized in the nucleus, is translocated into the cytoplasmic aggregates by binding to WYMV NIb to upregulate the m6A level of WYMV RNA1 and stabilize the viral RNA, thus promoting viral infection. A natural mutant allele TaMTB-SNP176C is found to confer an enhanced susceptibility to WYMV infection through genetic variation analysis on 243 wheat varieties. Our discovery highlights this allele can be a useful target for the molecular wheat breeding in the future.


Effects of recorded maternal voice on anthropometric parameters and heart rate in premature infants: A pilot randomised controlled trial.
To explore the benefits of a recorded maternal voice intervention on weight, recumbent length, head circumference, and heart rate of preterm infants in the neonatal intensive care unit. A pilot randomised controlled trial was conducted in this study. Preterm infants in the neonatal intensive care unit (N = 109) were recruited and randomly assigned to an intervention or control group. Both groups received routine nursing care, while preterm infants in the intervention group received a recorded maternal voice program of 20 min, twice daily for 21 days. Preterm infants' daily weight, recumbent length, head circumference, and heart rate were collected during the 21-day intervention. Participants' heart rate in the intervention group was also recorded once a day pre-during-after the recorded maternal voice program. Preterm infants in the intervention group showed a significant increase in weight (-75.94, 95% CI -108.04, -43.85, P < 0.001), recumbent length (-0.54, 95% CI -0.76, -0.32, P < 0.001), and head circumference (-0.37, 95%CI -0.56, -0.18, P < 0.001) compared with the control group. Preterm infants in the intervention group also showed significant changes in heart rate pre-during-after the recorded maternal voice program. However, no significant differences were found in the heart rate scores between the two groups. The changes in heart rate pre-during-after the intervention may help explain participants' more significant increase in weight, recumbent length, and head circumference. The recorded maternal voice intervention could be incorporated into clinical practice to promote growth and development in preterm infants in the neonatal intensive care unit. Australian New Zealand Clinical Trials Register, https://www.anzctr.org.au/; (registration number: ACTRN12622000019707).


A decellularized lung extracellular matrix/chondroitin sulfate/gelatin/chitosan-based 3D culture system shapes breast cancer lung metastasis.
Distal metastasis of breast cancer is a primary cause of death, and the lung is a common metastatic target of breast cancer. However, the role of the lung niche in promoting breast cancer progression is not well understood. Engineered three-dimensional (3D) in vitro models capable of bridging this knowledge gap can be specifically designed to mimic crucial characteristics of the lung niche in a more physiologically relevant context than conventional two-dimensional systems. In this study, two 3D culture systems were developed to mimic the late stage of breast cancer progression at a lung metastatic site. These 3D models were created based on a novel decellularized lung extracellular matrix/chondroitin sulfate/gelatin/chitosan composite material and on a porcine decellularized lung matrix (PDLM), with the former tailored with comparable properties (stiffness, pore size, biochemical composition, and microstructure) to that of the in vivo lung matrix. The different microstructure and stiffness of the two types of scaffolds yielded diverse presentations of MCF-7 cells in terms of cell distribution, cell morphology, and migration. Cells showed better extensions with apparent pseudopods and more homogeneous and reduced migration activity on the composite scaffold compared to those on the PDLM scaffold. Furthermore, alveolar-like structures with superior porous connectivity in the composite scaffold remarkably promoted aggressive cell proliferation and viability. In conclusion, a novel lung matrix-mimetic 3D in vitro breast cancer lung metastasis model was developed to clarify the underlying correlativity between lung ECM and breast cancer cells after lung colonization. A better understanding of the effects of biochemical and biophysical environments of the lung matrix on cell behaviors can help elucidate the potential mechanisms of breast cancer progression and further improve target discovery of therapeutic strategies.


Multimode Mamyshev oscillator.
We present a spatiotemporally mode-locked Mamyshev oscillator. A wide variety of multimode mode-locked states, with varying degrees of spatiotemporal coupling, are observed. We find that some control of the modal content of the output beam is possible through the cavity design. Comparison of simulations with experiments indicates that spatiotemporal mode locking (STML) is enabled by nonlinear intermodal interactions and spatial filtering, along with the Mamyshev mechanism. This work represents a first, to the best of our knowledge, exploration of STML in an oscillator with a Mamyshev saturable absorber.


Terrathelphusa secula, a new species of semiterrestrial freshwater crab (Crustacea: Brachyura: Gecarcinucidae) from Sabah, East Malaysia, Borneo.
A new species of semiterrestrial gecarcinucid freshwater crab, Terrathelphusa secula, is described from Danum Valley in Sabah, East Malaysia, eastern Borneo. In the form of its carapace, third maxilliped, and male second gonopod, it most closely resembles T. ovis Ng, 1997, and T. telur Ng, 1997, from eastern Sarawak and Brunei, respectively. It differs markedly from these and other congeners in its proportionately much wider carapace, and a male first gonopod that is strongly curved and sickle-shaped.


Insect alarm pheromones in response to predators: Ecological trade-offs and molecular mechanisms.
Insect alarm pheromones are chemical substances that are synthesized and released in response to predators to reduce predation risk. Alarm pheromones can also be perceived by predators, who take advantage of alarm cues to locate prey. While selection favors evolution of alarm pheromone signals that are not easily detectable by predators, predator evolution selects for better prey detection ability. Here, we review the diversity of alarm signals, and consider the behavioral and ecological conditions under which they have evolved. We show that components of alarm pheromones are similar across many insects, although aphids exhibit different behavioral responses to alarm cues compared to social insects. The effects of alarm pheromones on prey behavior depend on factors such as the concentration of pheromones and the density of conspecifics. We also discuss the molecular mechanisms of alarm pheromone perception underlying the evolutionary arms race between predators and prey, and the function of olfactory proteins and receptors in particular. Our review provides a novel synthesis of the diversity and function of insect alarm pheromones, while suggesting avenues that might better allow researchers to exploit population-level responses to alarm signaling for the sustainable management of pests and vector-borne pathogens.


[New indications for deep brain stimulation: ethical criteria for research and therapy].
The applications of deep brain stimulation (DBS) are rapidly increasing and now include a large variety of neurological and psychiatric diseases, such as depression, obsessive compulsive disorders, addiction, Alzheimer's disease, anorexia nervosa and rare movement disorders. These new applications confer a huge therapeutic potential in diseases for which often no treatment exists or which are refractory to existing therapies. This spread of applications, however, implies ethical problems in several domains: clinical use, research and presentation in the media and public. Thus, a systematic ethical analysis is needed to inform and guide this process. In this article we identify ethical problems involved in research and clinical use of novel DBS applications, suggest criteria and distinctions for structuring the ethical analysis, and articulate ethical demands for DBS research of novel applications.


Conformations and internal mobility of a glycopeptide derived from bromelain using molecular dynamics simulations and NOESY analysis.
The conformation and internal flexibility of a glycopeptide Manalpha1-6 (Xylbeta1-2)Manbeta1-4GlcNAcbeta1-4(Fucalpha1-3) GlcNAcbeta1-N(Asn-Glu-Ser-Ser), prepared from pineapple stem bromelain, have been analyzed using a combination of molecular dynamics (MD) simulations in water with NOESY 1H NMR spectroscopy. Theoretical NOESY cross-peak intensities were calculated by the CROSREL program on the basis of models, obtained from MD simulations, using a full relaxation matrix approach. Special attention was paid to the description of internal flexibility of the hexasaccharide moiety by the use of generalized order parameters, in combination with the application of an individual rotation correlation tme for each monosaccharide residue. The tetrapeptide moiety appeared to be very mobile during the MD simulations, which was confirmed by the absence of NOE cross peaks. For the oligosaccharide part a model was developed to estimate characteristic times for large reorientational motions around the glycosidic linkages, associated with conformational transitions. For the Manalpha1-6Man and the Fucalpha1-3GlcNAc linkages such a flexibility was found with a characteristic time of 2 ns. In contrast, the Xylbeta1-2Manbeta1-4GlcNAcbeta1-4GlcNAc part of the glycan appears to be relatively rigid.


Comparative studies on the effects of steroidal and nonsteroidal oestrogen antagonists on the proliferation of human breast cancer cells.
Pure and partial agonist antioestrogens, exemplified by ICI 164,384 and tamoxifen or 4-hydroxytamoxifen (4'-OHT) respectively, differ in their capacity to inhibit the growth of MCF-7 human breast cancer cells. Under basal conditions which maintain but do not permit proliferation of MCF-7 cells, growth rate was enhanced by oestradiol, Phenol Red, insulin and 4'-OHT but not by ICI 164,384. Oestradiol and insulin together enhanced cell growth rate synergistically. 4'-OHT, but not ICI 164,384, similarly increased insulin-stimulated cell growth in the absence of oestradiol. ICI 164,384 blocked the stimulatory action of 4'-OHT. The stimulatory effect of the peptide growth factors TGF-alpha and IGFI on MCF-7 cells were attenuated by ICI 164,384 and 4'-OHT; ICI 164,384 was more effective than 4'-OHT. The antiproliferative action of ICI 164,384 on oestradiol or growth factor stimulated MCF-7 cells was only weakly inhibited by TGF-beta antibodies.


High-pressure liquid chromatographic method for the simultaneous quantitative analysis of propranolol and 4-hydroxypropranolol in plasma.
A simple and rapid high-pressure liquid chromatographic procedure is reported for the simultaneous quantitative determination of propranolol and 4-hydroxypropranolol in plasma. Following an extraction the samples are chromatographed on a reversed-phase column and the components in the column effluent are detected by fluorescence monitoring. Using 1-ml plasma samples propranolol and 4-hydroxypropranolol concentrations at least as low as 1 ng/ml and 5 ng/ml, respectively, can be quantitated. The reproducibility of the method is satisfactory and no interference from endogenous plasma components or other drugs has been observed. A single plasma sample can be analyzed in approximately 20 min.


Impact of measurement error on quantifying the importance of proximity to point sources of air pollution.
This project was motivated by the investigation of the impact of primary oil and gas infrastructure on levels of air pollutants in western Canada. In the published models, we assumed that the distances between sources and air monitors were the key determinants of exposure and were measured precisely. These models related the logarithm of air pollutant concentration to a function of separation distance ("distance weight"). We undertook a simulation study to determine the impact on the observed source-pollutant association of uncertainty in the separation distance and the number of relevant sources per monitoring station. We observed that both the number of sources in the vicinity of the monitoring station and the extent of error in the estimate of separation distance influence the estimate of the slope of the source-pollution association. Measurement error tended to attenuate the association and degrade power, whereas the greater number of sources per monitoring station also led to a shallower observed slope. Attempts to correct the estimates of the slope were hampered by the non-standard nature of the frequency distribution of the difference between distance weights based on true and mismeasured distances. Our results revealed unanticipated challenges in the interpretation and estimation of the original analyses.


Percutaneous mitoxantrone injection for primary and secondary liver tumors: preliminary results.
To determine the effects of percutaneous intratumoral chemotherapy with mitoxantrone (PIM) in the palliative treatment of malignant liver lesions. We treated 15 progressive lesions in nine patients in whom either previous therapy failed or serious complications developed as a result. Seven lesions were metastatic and eight were due to foci of hepatocellular carcinoma. Under computed tomography (CT) guidance, we percutaneously injected 10-20 mg of mitoxantrone mixed with 0.5 ml of contrast medium into the tumor, performing one to three treatments at intervals of 1 month. There were no complications. The morphologic responses of the tumors after treatment were: minor response in one case, no change in 11 cases, progressive disease in three cases. Mitoxantrone induced tumor necrosis with no viable cancer tissue in eight of 11 biopsies. Recurrence was observed in nine of the treated lesions 2-9 months after treatment. New lesions were observed in five of nine patients 1-9 months after treatment. In patients with malignant liver lesions with no other therapeutic possibilities, minimally invasive intratumoral mitoxantrone injection was carried out safely with good tumor delivery of chemotherapy, and tumor necrosis was demonstrated at biopsy. We feel this approach warrants further investigation.


Direct evidence of host genome acquisition by the alphaherpesvirus Marek's disease virus.
Many herpesviruses including Marek's disease virus (MDV), a poultry alphaherpesvirus, carry homologous host genes presumably acquired during viral evolution. We have characterized one recent acquisition by MDV in considerable detail. The virulent MDV strain Md11 previously was isolated from a commercial chicken and initially propagated on duck cells. In the process of cloning the entire Md11 genome in a bacterial artificial chromosome (BAC), we obtained an infectious clone in which the entire terminal repeat short segment was replaced with a portion of the duck genome that corresponds to chicken chromosome 19. This sequence is not predicted to express any protein even though it contains one exon of the VAMP1 gene. The replacement did not affect MDV replication in vitro, despite the virus having only one copy of ICP4. Furthermore, we have shown that the variant MDV genome containing the duck genome substitution is present in the parental Md11 population and has been maintained through several subsequent propagations of the virus on chicken cells. This finding provides direct evidence that host genome acquisition by MDV actually occurs during virus replication, and that one or more such MDV genomes with host sequences may exist within MDV viral stocks which tend to be polyclonal, due to the cell-associated nature of its infection process.


Molecular recognition of ligands by native viruses and virus-like particles as studied by NMR experiments.
Viral entry into host cells is a process that in the majority of cases is not understoodin its molecular details. The first step of viral entry is the recognition of cellular receptorson host cells by viruses, and although X-ray crystallography had yielded some spectacular resultsin individual cases, in general there is little data available to unravel the principles of virus-ligandrecognition at atomic resolution. Therefore, new techniques that uncover the molecular details ofthese recognition processes are needed. The investigation of virus-ligand interactions usingligand-based NMR techniques is an emerging field with the potential to substantially contribute toa deeper understanding of the molecular aspects of viral entry into host cells. Here, we givean overview that covers some of the systems studied so far. This comprises native viruses as wellas virus-like particles (VLPs). We will not address studies that have been performed with individualproteins that are not in a native environment. It turns out that STD NMR in particular has a greatpotential to shine light on the viral entry process as this technique requires only very moderateamounts of viruses or VLPs and corresponding ligands. As a further advantage, this approachis also applicable to ligands that bind to viruses with medium to low affinity. Therefore, STD NMRis extremely well suited for development of antiviral entry inhibitors utilizing fragment-based approacheswith low molecular weight compounds.


Lung transplantation and Affordable Care Act Medicaid expansion in the era of lung allocation score - a retrospective study.
This study evaluated the impact of Medicaid eligibility expansion (ME) on lung transplant (LT) listings and Medicaid coverage. Data on LT candidates aged 18-64 were obtained from the Scientific Registry of Transplant Recipients (N = 9153). The impact of ME was evaluated by comparing LT listings in 2011-2013 with listings in 2014-2016, as well as comparing states that had and had not adopted ME in 2014. LT listings increased by 7.7% nationally post-ME. In ME states, LT listings increased by 15.2%, whereas nonexpansion states decreased by 1.5%. LT candidates with Medicaid increased after ME nationally (8.3% vs. 9.9%, P = 0.006) and in ME states (9.7% vs. 11.5%, P = 0.036), but not in nonexpansion states (6.6% vs. 7.7%, P = 0.170). Following multivariable adjustment, LT listings in ME states had 58% greater odds for Medicaid compared to nonexpansion states (P < 0.001). Expansion of Medicaid provided greater healthcare access and increased LT listings, but only within states that adopted eligibility expansion.


Reticulocyte-dependent labeling alterations of red cell membrane in pyruvate kinase deficiency anemia.
The radioactive labeling of spectrin using the pentavalent complex of molybdenum-99 was applied to the study of membrane protein in pyruvate kinase deficient red cells. Compared to the control, the labeling profile of the enzymopathic red cell membrane proteins remained generally unchanged but the molybdenum uptake was found to depend largely on the reticulocyte count. This finding may reflect changes during the cell maturation.


Could sexual selection have made us psychological altruists?
Psychological altruism (being motivated by the needs of others) has a tendency to produce behaviour that is costly in evolutionary terms. How, then, could the capacity for psychological altruism evolve? One suggestion is that it is the result of sexual selection. There are, however, two problems that face such an account: first, it is not clear that the resulting behaviour would be altruistic in the relevant sense, and second, it does not seem to fit with key features of our actual helping behaviour. I will argue that both of these problems can be avoided if we adopt a modular account of desire formation.


The framing effect of relative and absolute risk.
To test whether a patient's perception of benefit is influenced by whether the benefit is presented in relative or absolute terms. Questionnaire-based study. A general medicine outpatient clinic at a rural tertiary care center associated with a medical school. 470 of 511 consecutive patients who agreed to answer a questionnaire while waiting for their clinic visit. Mean age was 49.1 years, 62.1% were female, and 51.9% had at least one year of education beyond high school. Patient response to the choice of two equally efficacious medications for the management of a hypothetical serious disease. The benefit of one medication was stated in relative terms, the other in absolute terms. Patients could choose either medication alone, indicate indifference to the choice of medication, or choose not to answer. 56.8% of the patients chose the medication whose benefit was in relative terms. 14.7% chose the medication whose benefit was in absolute terms. Only 15.5% were indifferent to the choice of medication. The patients preferred the medication whose benefit was in relative terms across a wide range of ages and educational levels. Further questioning suggested that the patients thought benefit was greater when expressed in relative terms because they ignored the underlying risk of disease and assumed it was one. The "framing" of benefit (or risk) in relative versus absolute terms may have a major influence on patient preference.


In-situ formation of thermo-responsive petal-like cellulose nanocrystals hybridized particles towards optimizing mechanical, rheological and dielectric properties of polylactic acid blends.
Enhancing the toughness of biodegradable polylactic acid (PLA) blends with minimal filler content meanwhile preserving their thermomechanical properties remains a highly desirable objective. Here, through a simple in situ mixing of PLA with cellulose nanocrystals (CNC) and cellulose nanocrystal nanofluids (CNCfs), the electrostatic interaction between CNCfs (+22.6 mv) and CNC (-9.07 mv) formed petal-like hybridized particles with CNCfs as the core and CNC particles as the outer layer. The rheological tests indicated a significant reduction in the zero-shear viscosity and storage modulus of PLA/CNCfs blends, while the viscosity of PLA/CNCfs@CNC slightly decreased but retained its storage modulus compared to pure PLA. The optimized PLA/CNCfs@CNC blends not only exhibited excellent melt processing performance, but also increased the elongation at break (increased by 184 % and 375 % at 8 °C and 45 °C, respectively) and enhanced toughness remarkably (increased by 3.5 and 3.3-fold at 8 °C and 45 °C, respectively) meantime retaining the modulus with 1 GPa. The addition of CNCfs@CNC hardly affects the glass transition temperature and thermo-mechanical properties of PLA. The dielectric properties of PLA/CNCfs1.0/CNC2.0 blends were maximized at 1000 Hz, reaching a value of 21, which can be attributed to the synergistic effect of multilayer interfacial polarization.


Hydrodynamic cavitation efficiently inactivates potato virus Y in water.
Waterborne plant viruses can destroy entire crops, leading not only to high financial losses but also to food shortages. Potato virus Y (PVY) is the most important potato viral pathogen that can also affect other valuable crops. Recently, it has been confirmed that this virus is capable of infecting host plants via water, emphasizing the relevance of using proper strategies to treat recycled water in order to prevent the spread of the infectious agents. Emerging environmentally friendly methods such as hydrodynamic cavitation (HC) provide a great alternative for treating recycled water used for irrigation. In the experiments conducted in this study, laboratory HC based on Venturi constriction with a sample volume of 1 L was used to treat water samples spiked with purified PVY virions. The ability of the virus to infect plants was abolished after 500 HC passes, corresponding to 50 min of treatment under pressure difference of 7 bar. In some cases, shorter treatments of 125 or 250 passes were also sufficient for virus inactivation. The HC treatment disrupted the integrity of viral particles, which also led to a minor damage of viral RNA. Reactive species, including singlet oxygen, hydroxyl radicals, and hydrogen peroxide, were not primarily responsible for PVY inactivation during HC treatment, suggesting that mechanical effects are likely the driving force of virus inactivation. This pioneering study, the first to investigate eukaryotic virus inactivation by HC, will inspire additional research in this field enabling further improvement of HC as a water decontamination technology.


Effect of Dietary Supplementation of Organic Trace Minerals at Reduced Concentrations on Performance, Bone Mineralization, and Antioxidant Variables in Broiler Chicken Reared in Two Different Seasons in a Tropical Region.
Two experiments were conducted to study the performance, antioxidant activity, and bone mineral variables in broilers fed organic trace minerals (OTM) at lowered concentrations in the diet. In experiment 1, a total of 1500 day-old broiler male chicks were randomly distributed into six groups with 10 replicates of 25 chicks each and housed in floor pens (1.90 × 1.22 m). One group was fed the maize-soybean meal-based control diet, supplemented with inorganic trace mineral (ITM) premix containing Mn, Zn, Fe, Cu, Se, and Cr at 50, 45, 40, 7.5, 0.30, and 0.25 mg/kg, respectively. The remaining groups of chicks were fed the diets, where the ITM premix was replaced with OTM mix so as to provide the respective minerals at graded levels in the diet (100, 75, 50, 40, and 30% of the control diet). Similarly, in experiment II, a total of 1350 day-old male broiler chicks were divided at random into six groups with 9 replicates of 25 chicks each and fed the maize-soybean meal-based control diet having ITM at levels similar to those of experiment I or the test diets, where the ITM was replaced with OTM so as to provide the minerals at 100, 80, 60, 40, and 20% of the ITM-based control diet. Each diet was fed ad libitum from 0 to 42 days of age. The body weight gain, feed intake, and feed efficiency were not affected by supplementing OTM at 30 and 20% in experiments I and II, respectively. Slaughter variables, activities of glutathione peroxidase and super oxide dismutase, and lipid peroxidation and ferric reducing activity in serum were not affected by supplementing OTM at the lowest level of 20% in the diet. Similarly, bone-breaking strength, ash, and Mn contents were not affected by supplementing OTM at 20% of the mineral concentration in control diet containing ITM. Deposition of Ca, P, Cu, and Fe in tibia ash increased with increased concentration of OTM in the diet. However, Zn content in tibia ash reduced with reduction in OTM level in the diet. Based on the results, it is concluded that trace mineral supplementation in organic form even at 20% of the concentration recommended for ITM may be sufficient in maize-soybean meal-based diet to support the optimum growth, bone ash, bone strength, and serum antioxidant status in commercial broilers.


Activin A increases the number of follicle-stimulating hormone cells in anterior pituitary cultures.
The mode of action of activin A on the anterior pituitary gland (AP) was investigated using primary cultured cells. The AP cells were cultured with activin A (1 ng/ml) at various cell densities for 24-96 h, and further incubated for 3 h with activin A-free medium. When the cells were pretreated with activin A for 48 h, follicle-stimulating hormone (FSH) secretion during the following 3-h incubation was increased only at a density of 1 x 10(5) cells/200 mm2, but not at 2 x 10(5) or 4 x 10(5) cells/200 mm2. A longer pretreatment (96 h) was required in order to induce this response at a density of 2 x 10(5) cells/200 mm2. Luteinizing hormone (LH) secretion was not affected by activin A. Thus, the FSH secretory activity of the primary culture of AP was stimulated by activin A in a cell density-dependent manner. Furthermore, it was found that treatment with activin A (10 ng/ml) for 72 h increased the number of immunoreactive FSH cells by 25-41%, and that these newly induced FSH cells were low responders to gonadotropin-releasing hormone stimulation. The proportions of immunoreactive LH, thyroid-stimulating hormone, prolactin or growth hormone cells were not affected. From these results, we conclude that activin A increases FSH secretion by changing the cell population of pituitary gonadotropes.


Dietary origin of retained H+ in infants with acquired monosaccharide intolerance.
Net external acid balance was studied in 12 malnourished infants with chronic diarrhea (some of whom had acquired monosaccharide intolerance). When the infants achieved an adequate energy intake from a formula that contained either glucose or glucose polymers, seven developed metabolic acidosis and five remained free of acidosis. During the study, the acidotic infants produced a significant excess of acid (3.7 +/- 2 vs. 0.5 +/- 2 mEq/kg/day, p less than 0.005). The amount they excreted in urine (2.9 +/- 2 mEq/kg/day), however, was similar to that excreted by nonacidotic infants (2.7 +/- 2 mEq/kg/day) and indicated renal inability to reduce the excess acid load. The net effect was hydrogen ion (H+) retention (+0.8 +/- 0.8 vs. -2.2 +/- 0.8 mEq/kg/day, p less than 0.001). Good correlation existed between the net acid balance and the acid-base measurement in the blood. We speculate that (a) the increased acid load was a consequence of colonic bacterial production of volatile fatty acids from carbohydrate malabsorbed from the small bowel and (b) the renal incapacity to excrete H+ probably was secondary to potassium and phosphate depletion.


Danazol.
A comprehensive profile of danazol describing the nomenclatures, formulae, elemental composition, appearance, uses and applications is presented. The profile contains the method which was utilized for the preparation of the drug substance and its respective scheme is outlined. The physical characteristics of the drug including the solubility, X-ray powder diffraction pattern, differential scanning calorimetry, thermal behavior and spectroscopic studies are described. The methods which were used for the analysis of the drug substance in bulk drug and/or in pharmaceutical formulations including the compendial, spectrophotometric, electrochemical and the chromatographic methods are reported. The stability, toxicity, pharmacokinetics, bioavailability, drug evaluation and monitoring, comparisons, pharmacology, in addition to several compiled reviews on the drug substance which were involved. Finally, two hundred and seventy-nine references are listed at the end of this profile.