Optical Coherence Tomography: Current Applications for the Assessment of Coronary Artery Disease and Guidance of Percutaneous Coronary Interventions.
Coronary angiography (CAG) is the standard modality for assessment of coronary stenoses and intraprocedural guidance of percutaneous coronary interventions (PCI). However, the limitations of CAG are well recognized. Intracoronary imaging (ICI) can potentially overcome these limitations. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the main ICI techniques utilized in clinical practice. This narrative literature review addresses the current clinical applications of OCT in relation to IVUS and CAG in patients with coronary artery disease (CAD). Items reviewed are: technical implications of OCT and IVUS, lesion characterization and decision-making, stent optimization criteria, post-stenting results, safety in terms of procedural complications, clinical outcomes, and indications. OCT is able to reveal more detail than IVUS due to its higher resolution. However, this higher resolution comes at the cost of a lower penetration depth. Pre-stenting OCT results in procedural change in more than 50% of the cases in terms of stent length and diameter. Post-stenting OCT resulting in stent optimization is reported in at least 27% of the cases. Malapposition and under-expansion are treated with post-dilatations, while edge dissections are treated with additional stent placement. Stent expansion, stent apposition, distal stent edge dissections, and reference lumen areas seem to be the most important stent optimization criteria for both decision-making and for reducing the risk of adverse events during follow-up. Both OCT and IVUS are superior in terms of post-stenting results compared with CAG alone. However, there is no consensus about whether OCT guidance results in better stent expansion than IVUS guidance. OCT, IVUS, and CAG are safe procedures with few reported procedural complications. In general, OCT guidance seems to contribute to favorable clinical outcomes compared with CAG guidance only. However, OCT guidance results in similar clinical outcomes as with IVUS guidance. OCT could be considered for lumen assessment and stent-related morphology in more complex cases in which CAG interpretation remains uncertain. Since OCT and IVUS have distinct characteristics, these techniques are complementary and should be considered carefully for each patient case based on the benefits and limitations of both techniques.


Does telomere length predict decline in physical functioning in older twin sisters during an 11-year follow-up?
Leukocyte telomere length (LTL) is known to be associated with mortality, but its association with age-related decline in physical functioning and the development of disability is less clear. This study examined the associations between LTL and physical functioning, and investigated whether LTL predicts level of physical functioning over an 11-year follow-up. Older mono- (MZ) and dizygotic (DZ) twin sisters (n = 386) participated in the study. Relative LTL was measured by qPCR at baseline. Physical functioning was measured by 6-min walking distance and level of physical activity (PA). Walking distance was measured at baseline and at 3-year follow-up. PA was assessed by questionnaire at baseline and at 3- and 11-year follow-ups. The baseline analysis was performed with path models, adjusted with age and within-pair dependence of twin pairs. The longitudinal analysis was performed with a repeated measures linear model adjusted for age and longitudinal within-pair dependence. A nonrandom missing data analysis was utilized. At baseline, in all individuals, LTL was associated with PA (est. 0.14, SE 0.06, p = 0.011), but not with walking distance. Over the follow-up, a borderline significant association was observed between LTL and walking distance (est. 0.14, SE 0.07, p = 0.060) and a significant association between LTL and PA (est. 0.19, SE 0.06, p = 0.001). The results suggest that LTL is associated with PA and may, therefore, serve as a biomarker predicting the development of disability. Longitudinal associations between LTL and PA were observed only when nonrandom data missingness was taken into account in the analysis.


Anti-predator strategies in oviposition site selection of Pyrrhosoma nymphula (Zygoptera: Odonata).
Selection of sites for oviposition when the risk of predation by green frogs was variable studied in tandems of the damselfly Pyrrhosoma nymphula. In the absence of predators the number of tandems landing increased with the size of the oviposition site and with the number of pairs already present. Pairs approaching an oviposition site landed promptly and preferred locations near other ovipositing pairs. Pairs which had landed near others left the landing site and flew to another water plant after a shorter period than those landing alone. They stayed in groups for only 16.5% of the total duration of stay at the oviposition site. With predators present fewer tandems landed. There was no relationship between the landing site of solitary tandems and the locations of the perching frogs. Pairs landing in groups were disturbed by frogs after a shorter period than pairs landing alone. Damselfly aggregation did not affect the predation success of the frogs, but the predation risk to individual tandem pairs was reduced.


Psoriasis: current concepts and new approaches to therapy.
Psoriasis is a common disorder characterized by marked increases in keratinocyte proliferation, abnormal patterns of keratinocyte differentiation, prominent alterations in dermal capillary vasculature and the presence of dermal and epidermal T cells, monocytes/macrophages and neutrophils. It is now known that psoriasis can occur due to abnormalities in essential fatty acid metabolism, lymphokine secretion, free radical generation, lipid peroxidation and eicosanoid metabolism. It is possible to suppress almost completely psoriatic lesions by judicious use of methotrexate, cyclosporine A, and eicosapentaenoic acid. Our studies have shown that in patients with psoriasis there is an increase in the generation of free radicals with an alteration in essential fatty acid metabolism and that side-effects of anti-cancer drugs can be blocked by essential fatty acids in vivo. Thus, essential fatty acid metabolism seems to play a crucial role both in the pathogenesis and treatment of psoriasis.


De novo biosynthesis of rubusoside and rebaudiosides in engineered yeasts.
High-sugar diet causes health problems, many of which can be addressed with the use of sugar substitutes. Rubusoside and rebaudiosides are interesting molecules, considered the next generation of sugar substitutes due to their low-calorie, superior sweetness and organoleptic properties. However, their low abundance in nature makes the traditional plant extraction process neither economical nor environmental-friendly. Here we engineer baker's yeast Saccharomyces cerevisiae as a chassis for the de novo production of rubusoside and rebaudiosides. In this process, we identify multiple issues that limit the production, including rate-liming steps, product stress on cellular fitness and unbalanced metabolic networks. We carry out a systematic engineering strategy to solve these issues, which produces rubusoside and rebaudiosides at titers of 1368.6 mg/L and 132.7 mg/L, respectively. The rubusoside chassis strain here constructed paves the way towards a sustainable, large-scale fermentation-based manufacturing of diverse rebaudiosides.


Variations in growth and reproduction within populations of two rhizomatous plant species: Typha latifolia and Typha angustifolia.
Seasonal excavations of ramet systems in overlapping natural populations of Typha latifolia and T. angustifolia revealed intrapopulation variation in ramet size and reproduction. Reproductive "states" were recognized based on whether or not a ramet had flowered and the number of offspring ramets it possessed. As the growing season progressed, the populations became increasingly heterogeneous in their reproductive-state composition with the largest size classes of ramets containing the greatest number of reproductive states. Therefore, despite a strong correlation between size and reproduction, average ramet size was considered to be an inadequate predictor of population growth in ramet numbers. Results for vegetative reproduction and ramet mortality indicate that the T. latifolia population was growing while the T. angustifolia population was approximately stable. In contrast to most results reported for other species, the frequency distributions of ramet size classes showed T. angustifolia to have a normally distributed population. A slight degree of positive skewing occurred in T. latifolia with the greatest skewing at the end of the growing season. Despite the lack of strong skewing of ramet weights, evidence from other sources have demonstrated that competition was intense and we hypothesize that competition in clonal populations may not not always act to cause positive skew in weight distributions.


Geldanamycin provides posttreatment protection against glutamate-induced oxidative toxicity in a mouse hippocampal cell line.
The benzoquinoid ansamycin geldanamycin interferes with many cell signaling pathways and is currently being evaluated as an anticancer agent. The main intracellular target of geldanamycin is the 90-kDa heat shock protein, hsp90. In this report we demonstrate that geldanamycin is effective at preventing glutamate-induced oxidative toxicity in the HT22 mouse hippocampal cell line, even if given 4 h after glutamate treatment. Geldanamycin prevents glutamate-induced internucleosomal DNA cleavage in the HT22 cells but does not reverse the depletion of glutathione levels brought about by glutamate treatment. Both anabolic and catabolic effects are generated by geldanamycin treatment of HT22 cells, as evidenced by the induction of hsp70 expression and degradation of c-Raf-1 protein, respectively. Thus, geldanamycin may provide an effective strategy for manipulating signaling pathways in neuronal cells that use hsp90 as they proceed through a programmed cell death pathway in response to oxidative stress.


Cross-reconstitution of the extrinsic proteins and photosystem II complexes from Chlamydomonas reinhardtii and Spinacia oleracea.
Cross-reconstitution of the extrinsic proteins and Photosystem II (PS II) from a green alga, Chlamydomonas reinhardtii, and a higher plant,Spinacia oleracea, was performed to clarify the differences of binding properties of the extrinsic proteins between these two species of organisms. (1) Chlamydomonas PsbP and PsbQ directly bound to Chlamydomonas PS II independent of the other extrinsic proteins but not to spinach PS II. (2) Chlamydomonas PsbP and PsbQ directly bound to the functional sites of Chlamydomonas PS II independent of the origins of PsbO, while spinach PsbP and PsbQ only bound to non-functional sites on Chlamydomonas PS II. (3) Both Chlamydomonas PsbP and spinach PsbP functionally bound to spinach PS II in the presence of spinach PsbO. (4) While Chlamydomonas PsbP functionally bound to spinach PS II in the presence of Chlamydomonas PsbO, spinach PsbP bound loosely to spinach PS II in the presence of Chlamydomonas PsbO with no concomitant restoration of oxygen evolution. (5) Chlamydomonas PsbQ bound to spinach PS II in the presence of Chlamydomonas PsbP and PsbO or spinach PsbO but not to spinach PS II in the presence of spinach PsbP and Chlamydomonas PsbO or spinach PsbO. (6) Spinach PsbQ did not bind to spinach PS II in the presence of Chlamydomonas PsbO and PsbP. On the basis of these results, we showed a simplified scheme for binding patterns of the green algal and higher plant extrinsic proteins with respective PS II.


Effect of dietary fat source and exercise on odorant-detecting ability of canine athletes.
Eighteen male English Pointers (2-4 years of age, 23.94+/-0.54 kg body weight) were allotted to three diet and two physical conditioning groups to evaluate the effect of level and source of dietary fat on the olfactory acuity of canine athletes subjected to treadmill exercise. Diet groups (6 dogs/diet) consisted of commercially prepared diets (minimum of 26% crude protein) containing 12% fat as beef tallow (A), 16% fat provided by equivalent amounts of beef tallow and corn oil (B), or 16% fat provided by equivalent amounts of beef tallow and coconut oil (C). This dietary formulation resulted in approximately 60% of the total fatty acid being saturated for diets A and C, while approximately 72% of the total fatty acids were unsaturated in diet B. One-half of the dogs within each dietary group were subjected to treadmill exercise 3 times per week for 30 min (8.05 km/h, 0% grade) for 12 weeks. All dogs were subjected to a submaximal exercise stress test (8.05 km/h, 10% slope for 60 min) every four weeks beginning at week 0. Olfactory acuity was measured utilizing behavioral olfactometry before and after each physical stress test. Non-conditioned (NON) dogs displayed a greater decrease (P<0.05) in olfactory acuity following exercise, while physically conditioned (EXE) dogs did not show a change from pre-test values. A diet by treatment interaction (P<0.10) was detected over the course of the study. NON dogs fed coconut oil had decreased odorant-detecting capabilities when week 4 values were compared with week 12 values. Feeding a diet that is predominately high in saturated fat may affect the odorant-detecting capabilities of working dogs. Additionally, these data indicate that utilization of a moderate physical conditioning program can assist canine athletes in maintaining olfactory acuity during periods of intense exercise.


[Expression of survivin protein in prostatic carcinoma tissues and its correlation with apoptosis of cancer cells].
To investigate the expression of survivin protein in the tissues of prostatic carcinoma and its correlation with apoptosis of cancer cells. Expression of survivin protein and apoptosis index(AI) were detected by immunohistochemical and terminal deoxynucleotidyl transterase-mediated dUTP biotin nich end labeling(TUNEL) technique in the tissues of 42 cases of prostatic carcinima (PCa) and 10 cases of normal prostate (NP). Survivin prosteins were expressed in 34 of the 42 (80.59%) cases of PCa. The positive rate of survivin was strongly associated with pathological grades, clinical stages and lymphmetastasis in PCa(P < 0.05). In contrast, NP did not express survivin. Survivin protein expression was negatively correlated with AI in PCa(r = -0.679, P < 0.001). Apoptosis inhibition by survivin may participate in the onset and progression of PCa, and the detection of survivin protein and AI in PCa may help to evaluate the degree of cell differentiation, decide therapeutic strategies and estimate prognosis.


Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes.
Little is known about therapeutic ultrasound (TUS) to diagnose bone stress injuries. Therapeutic ultrasound is an accurate, cost-efficient alternative to other imaging methods for primary assessment of bone stress injuries. Cohort study (diagnosis); Level of evidence, 2. One hundred thirteen elite track and field athletes (mean age, 20.1 years; range, 17-28 years) underwent TUS and magnetic resonance imaging (MRI) for clinical suspicion of a bone stress injury. A 5-stage MRI grading system was used to classify bone stress injuries. Sensitivity, specificity, accuracy, and positive and negative predictive values of TUS were calculated using MRI as the standard for diagnosis. At MRI, of 113 assessed patients, 3 (2.7%) had grade 0 injuries, 12 (10.6%) had grade 1, 15 (13.3%) had grade 2, 77 (68.2%) had grade 3, and 6 (5.3%) had grade 4. At TUS, no injury was detected in 22 of 113 patients: 2 with grade 0 injury, 8 with grade 1, 8 with grade 2, and 4 with grade 3. Using MRI as the gold standard, TUS showed 81.8% sensitivity, 66.6% specificity, 99.0% positive predictive value, 13.4% negative predictive value, and 81.4% accuracy. Therapeutic ultrasound is a reproducible procedure that is reliable to diagnose bone stress injuries.


Serum selenium level and glutathione peroxidase activity in steroid-sensitive nephrotic syndrome.
In our previous study the pattern of glutathione peroxidase (GPX) activity in the course of steroid-sensitive nephrotic syndrome (SSNS) in children suggested a defect in antioxidant defense. In the present report the serum selenium (Se) level, an essential component of GPX activity, was measured in a comparable group of children with SSNS at the same clinical stages at which GPX activity was determined in the previous study. Nephrotic children had normal serum Se levels during the edematous stage, at the end of prednisone treatment, and in remission. At the end of high-dose prednisone treatment, the serum Se level increased ( P<0.01) simultaneously with enhanced activity of GPX. These results suggest that children with SSNS have a persistent defect in the antioxidant defense at the important stage of hydrogen peroxide and fatty acid hydroperoxide decomposition. This defect is transiently alleviated by high-dose prednisone treatment.


Resonance Frequency Breathing Biofeedback to Reduce Symptoms of Subthreshold PTSD with an Air Force Special Tactics Operator: A Case Study.
The prevalence rates of post-traumatic stress disorder (PTSD) have been estimated to be several times higher in military populations compared to the national average. Special Tactics operators are a group that is more likely to avoid seeking psychological care due to the stigma and other consequences the diagnosis may have on their military careers. There is a need for more effective and less stigmatizing interventions to treat this population. Psychophysiological methods have been proven to be efficacious in treating PTSD, yet have received less attention as an adjunctive intervention. Resonance frequency (RF) biofeedback is a form of cardiorespiratory intervention that has shown promise as an effective treatment. The current case study examined the use of RF biofeedback in combination with other physiological and evidence-based methods as part of a comprehensive treatment approach. The client showed a significant drop from his initial scores on a screening assessment by the end of treatment, and demonstrated continued progress despite a 3-month break from the therapy. This author proposed that the synergistic effects of the multi-phased treatment approach contributed to the client's progress. Furthermore, a case was made for using multiple techniques when treating subthreshold PTSD and related symptoms within a treatment resistant population.


The prevalence of CD33 and MS4A6A variant in Chinese Han population with Alzheimer's disease.
CD33 and MS4A6A genes play potential key roles in the pathogenesis of Alzheimer's disease (AD). One recent genome-wide association study has revealed that the rs3865444 polymorphism in the CD33 gene and rs610932 polymorphism in the MS4A6A gene are associated with susceptibility to AD in Caucasians. To evaluate the relationship between the polymorphism of the CD33, MS4A6A gene and AD in the ethnic Chinese Han, we conducted a case-control study (n = 383, age > 54) to determine the prevalence of single-nucleotide polymorphism of two genes in patients with AD in Chinese population of Mainland, and clarified whether these polymorphisms are risk factors for AD. The prevalence of the allele (T) in the rs3865444 polymorphism of the CD33 gene and allele (C) in rs610932 polymorphism of the MS4A6A gene was significantly different in AD patients and control subjects (P < 0.001, respectively), and the results were not influenced by age, gender, or APOE status. Our data revealed the allele (T) of the rs3865444 polymorphism of the CD33 gene and the allele (C) of the rs610932 polymorphism of the MS4A6A gene may contribute to AD risk in the Chinese Han population.


Starch metabolism in Pseudomonas stutzeri. II. Purification and properties of a dextrin glycosyl-transferase (D-enzyme) and amylomaltase.
Amylomaltase and disproportionating enzyme (D-enzyme) were purified to homogeneity from cell-free extracts of Pseudomonas stutzeri using a six-step procedure. The presence of both glycosyltransferases in the same organism has not been reported before. Molecular weight determination by gel chromatography gave a value of 74,000 for the amylomaltase and 115 000 for the D-enzyme. Two subunits of different molecular weight were found in each enzyme as proved by sodium dodecyl sulfate-gel electrophoresis. The optimum pH of amylomaltase and D-enzyme activity is 7.6--7.7. Action of both glycosyltransferases on different maltodextrins showed that amylomaltase is most active with maltotetraose, and the Km value for this substrate is 7.1 mM. D-Enzyme catalyzed glucose release from maltose (Km = 8.3 mM) at a higher rate than from maltotriose and maltotetraose. With maltotriose as initial substrate, D-enzyme forms glucose, maltopentaose, maltoheptaose, maltononaose, maltoundecaose as major products. Amylomaltase acts on maltotriose, maltotetraose, and maltopentaose to form a series of homologous 1,4-alpha-glucans. No essential chain-lengthening reaction occurred with maltohexaose.


Purification and characterization of lymphocytic clonal growth factor (LCGF) derived from human-human hybridoma SH-76 cells.
Human-human hybridoma SH-76 cells were found to produce a factor that supported the growth of lymphocytic cells at low densities. The factor was purified from serum-free conditioned medium of the hybridoma cells by a successive application of ammonium sulfate precipitation, DEAE-Toyopearl, TSK G3000 SW and DEAE-5PW column chromatograph. The purified factor was a 72K single protein. The factor showed marked growth stimulating effect on lymphocytic cell lines, but had no effect on the growth of human adhesive cancer cell lines. Thus, the factor is a lymphocytic clonal growth factor (LCGF), as found previously in human plasma (Miyata, 1988). The LCGF of SH-76 cells could be produced in growth factor-free RPMI medium and purified easily from the conditioned medium. The factor is inactivated by heating at over 80°C, but is much more stable than the LCGF in human plasma.


Superfluid turbulence in neutron stars.
The neutron superfluid in most neutron stars should be in a highly turbulent state. If so, this turbulence drastically alters its rotational properties.


The use of levomepromazine in Hyperemesis Gravidarum resistant to drug therapy--a case series.
Hyperemesis Gravidarum (HG) is a potentially serious complication of early pregnancy, which may rarely be severe enough to warrant termination of pregnancy. HG requires prompt treatment with intravenous fluids, thiamine supplementation and appropriate anti-emetic therapy. Anti-histamines such as promethazine are favoured as first-line agents, with prochlorperazine being used as a second-line drug. However, there is no clear data as to the most appropriate drug if these are ineffective. A case series of six women who presented with HG resistant to drug treatment is described. In these cases, levomepromazine 6.25mg tds was used to control HG. Five pregnancies progressed leading to live born infants with no evidence of congenital anomaly. One pregnancy resulted in an intra-uterine death with no external or ultrasound evidence of congenital anomaly. The role of phenothiazines in the pharmacological management of HG is discussed.


Maintaining Psoroptes ovis (Acari: Psoroptidae) off-host in the laboratory.
Feeding and maintaining sheep scab mites off-host is an important step towards achieving a safer, environmentally-friendly means of controlling sheep scab disease. The test arena developed by Thind and Muggleton (Exp Appl Acarol 22:543-552, 1998) has been adapted for feeding and maintaining Psoroptes ovis off-host. The test arenas are simple to construct and use, and escape-proof to all stages of mites. The performance of the test arenas was assessed by determining the survival of the scab mites at 33 and 36 degrees C and >95% r.h. on different diets. With this test arena the best reported mean survival of 10.3 days was achieved with both females and nymphs at a temperature of 33 degrees C on a diet of sheep serum; the mean maximum survival of females at these conditions was 18.8 days, which is at least a threefold improvement on previous reports. With further development it may be possible to adapt the test arena for assessing both slow and fast acting agents for controlling sheep scab.


COMT Val158Met polymorphism in schizophrenia with obsessive-compulsive disorder: a case-control study.
This is the first study of a possible molecular genetic basis for schizophrenia with obsessive-compulsive disorder (OCD). We performed a case-control association study of the catechol-O-methyltransferase (COMT) Val158Met polymorphism in schizophrenia-OCD patients, OCD and healthy controls. One hundred and thirteen schizophrenia-OCD patients, 79 OCD patients and 171 control subjects were genotyped for the Val(158)Met polymorphism in the COMT gene. There was no significant difference in allele and genotype distribution of the COMT gene between schizophrenia-OCD patients and healthy controls. The low-activity Met allele and Met/Met genotype were more frequent in OCD men than in schizophrenia-OCD and control individuals. This difference, however, was not statistically significant following correction for multiple comparisons. These results do not support the hypothesis that the COMT Val158Met gene polymorphism is associated with liability to schizophrenia-OCD.


Evidence that increased 12-lipoxygenase expression impairs pancreatic beta cell function and viability.
Leukocyte type 12-lipoxygenase (12-LO) is an enzyme specifically expressed in the beta cells of the pancreas. 12-LO oxidizes fatty acids such as arachidonic acid and linoleic acids to their respective hydroperoxides. Increased concentration of lipid hydroperoxides causes oxidative stress and this could lead to cellular dysfunction. Increased expression of 12-LO in beta cells has been observed with use of inflammatory cytokines and during the prediabetic phase of beta cell dysfunction in the Zucker diabetic fatty rat model. Also mice deficient in 12-LO expression show a decreased incidence of immune-mediated diabetes. To further understand the role of 12-LO in beta cell metabolism, we over-expressed mouse leukocyte type 12-LO in INS-1 cells (transformed rat beta cell line) using an adeno-associated virus (AAV) vector system. In 12-LO over-expressing cells, cell-associated 12-HETE levels increased approximately 5- and approximately 3-fold in the culture supernatant. In the cells over-expressing 12-LO, glucose-stimulated insulin secretion (GSIS) decreased by 25-30% one hour after exposure to high glucose (15mM). By 2h, GSIS decreased by 50-54% at high glucose levels. These data suggest that increased 12-LO products can reduce the synthesis, processing or secretion of insulin in beta cells. We next examined the effect of 12-LO over-expression on mitogen-activated protein kinases (MAPK) by Western blot analyses using antibodies specific for different phospho-MAP kinases. Over-expression of 12-LO led to an activation of c-Jun N-terminal kinase while it markedly reduced Erk1 and 2 phosphorylation (4-fold). Further, over-expression of 12-LO led to induction of apoptosis in beta cells as determined by DNA ladder assay. These results suggest that increased 12-LO plays a key role in altering beta cell metabolism. Thus, increased 12-LO expression can have a detrimental effect on pancreatic beta cell function and viability, suggesting that blockade of 12-LO activity or expression could provide a novel way to protect beta cells from inflammatory injury.


Isolation of mycobacteria from patients seropositive for the human immunodeficiency virus (HIV) in south east England: 1984-92.
Tuberculosis and other mycobacterial infections are well recognised complications of HIV infection and surveillance is thus required. All mycobacteria isolated from HIV positive subjects and referred to the Public Health Laboratory Service South East Regional Tuberculosis Centre (SERTC) from the first such case in 1984 until the end of 1992 were reviewed. A total of 803 mycobacteria isolated from 727 HIV positive subjects were referred to the SERTC during the study period. A single species was isolated from 660 patients: 150 members of the tuberculosis complex (146 M tuberculosis, two M bovis, and two M africanum), 356 M avium-intracellulare (MAI), and 154 other environmental mycobacteria. More than one mycobacterium was isolated from 67 patients. In 12 cases M tuberculosis and MAI were isolated from the same patient, almost always in that sequence, with an interval of 8-41 months between isolations. Most of the 407 isolates of MAI (74%) were considered to be clinically significant and often caused disseminated disease. In other cases single isolates of MAI were obtained from sputum or faeces and occasionally such isolates preceded disseminated disease by several months. Only 33 (14%) of the 229 isolates of environmental mycobacteria other than MAI were considered clinically significant. HIV related mycobacterial disease is increasing in incidence in south east England. Further studies are required to determine the significance of single isolates of MAI and other environmental mycobacteria as a guide to the need for preventive chemotherapy or immunotherapy.


What are the most important factors that determine the overall quality of dermatology residency training: A resident survey.
Currently no broadly accepted and standardized objective ranking system for dermatology residency programs exist. A new ranking system was recently developed in an attempt to address this issue. However, it remains unclear if the algorithm employed is based on factors that have a tangible impact on the quality of training provided by dermatology residency programs [1]. Our authors surveyed all current dermatology residents in order to investigate the factors that they feel are most important in determining the strength of training provided by a residency program.


Nursing teachers' job burnout and teaching ability: The mediating role of social support based on the Person-Context interaction theory.
Great attention has been attached to the quality of nursing along with the development of medical treatment, which gives rise to the higher demand for colleges to cultivate high-quality nursing students, as well as the higher standard for teaching performance of the nursing faculty. This study aimed to investigate the effect of teachers' job burnout on teaching ability among nursing teachers in Chinese colleges and to examine the mediating role of social support in this relationship based on the Person-context interaction theory. A cross-sectional descriptive design has been adopted. From February to June 2021, a total of 416 Chinese nursing teachers from 27 colleges filled out the questionnaires with a response rate of 97.42%. The questionnaire included general demographic questionnaire, teaching ability in nursing scale, teacher burnout scale and social support scale. The data were analyzed by SPSS26.0 statistical software in terms of Pearson's correlation the Structural Equation Model (SEM) was adopted to test the mediating effect of social support between job burnout and teaching ability in nursing of nursing teachers using Mplus 8.3. Job burnout of nursing teachers was negatively and significantly correlated with the teaching ability in nursing and social support (p < 0.01). And Structural Equation Model results showed that social support mediated the relationship between teacher burnout and teaching ability in nursing. Social support could help nursing teachers manage their job burnout, and eventually help them overcome the negative impact of teachers' job burnout on teaching ability in nursing. Social support could promote the teaching ability of nursing teachers by playing an intermediary role between them.[Box: see text].


The BUME method: a new rapid and simple chloroform-free method for total lipid extraction of animal tissue.
In this study we present a simple and rapid method for tissue lipid extraction. Snap-frozen tissue (15-150 mg) is collected in 2 ml homogenization tubes. 500 μl BUME mixture (butanol:methanol [3:1]) is added and automated homogenization of up to 24 frozen samples at a time in less than 60 seconds is performed, followed by a 5-minute single-phase extraction. After the addition of 500 μl heptane:ethyl acetate (3:1) and 500 μl 1% acetic acid a 5-minute two-phase extraction is performed. Lipids are recovered from the upper phase by automated liquid handling using a standard 96-tip robot. A second two-phase extraction is performed using 500 μl heptane:ethyl acetate (3:1). Validation of the method showed that the extraction recoveries for the investigated lipids, which included sterols, glycerolipids, glycerophospholipids and sphingolipids were similar or better than for the Folch method. We also applied the method for lipid extraction of liver and heart and compared the lipid species profiles with profiles generated after Folch and MTBE extraction. We conclude that the BUME method is superior to the Folch method in terms of simplicity, through-put, automation, solvent consumption, economy, health and environment yet delivering lipid recoveries fully comparable to or better than the Folch method.


Profiling of chemical constituents of Matricarla chamomilla L. by UHPLC-Q-Orbitrap-HRMS and in vivo evaluation its anti-asthmatic activity.
Matricarla chamomilla L. is native to European countries and widely cultivated in China, especially in Xinjiang. It has been used in Uygur medicine for the treatment of cough caused by asthma. In this study, UHPLC-Q-Orbitrap-MS was used to detect and identify the components from the active fraction of M. Chamomile, 64 compounds were identified by combining the standards, related literatures and mass spectrometry fragments, including 10 caffeoyl quinic acids, 38 flavonoids, 8 coumarins, 5 alkaloids and 3 other compounds. Furtherly, the anti-asthma activity of active fraction of M. Chamomile was investigated in OVA-induced allergic asthma rat model. The results showed that the number of EOS in Penh and bronchoalveolar lavage fluid (BALF) in the group of the active fraction of M. Chamomile was significantly lower than that in the model group. Besides, the active fraction of M. Chamomile can significantly reduce the IgE level and increased glutathione peroxidase (GSH-Px) in the serum of OVA-induced rats, and ameliorated OVA-induced lung injury. Hence, M. Chamomile could be used to treat asthma through their in vivo antioxidant and anti-inflammatory effects. This study explored the potential material basis of M. Chamomile for the treatment of asthma.


Bioenergetic Evaluation of Muscle Fatigue in Murine Tongue.
Muscle fatigue is the diminution of force required for a particular action over time. Fatigue may be particularly pronounced in aging muscles, including those used for swallowing actions. Because risk for swallowing impairment (dysphagia) increases with aging, the contribution of muscle fatigue to age-related dysphagia is an emerging area of interest. The use of animal models, such as mice and rats (murine models) allows experimental paradigms for studying the relationship between muscle fatigue and swallowing function with a high degree of biological precision that is not possible in human studies. The goal of this article is to review basic experimental approaches to the study of murine tongue muscle fatigue related to dysphagia. Traditionally, murine muscle fatigue has been studied in limb muscles through direct muscle stimulation and behavioral exercise paradigms. As such, physiological and bioenergetic markers of muscle fatigue that have been validated in limb muscles may be applicable in studies of cranial muscle fatigue with appropriate modifications to account for differences in muscle architecture, innervation ratio, and skeletal support. Murine exercise paradigms may be used to elicit acute fatigue in tongue muscles, thereby enabling study of putative muscular adaptations. Using these approaches, hypotheses can be developed and tested in mice and rats to allow for future focused studies in human subjects geared toward developing and optimizing treatments for age-related dysphagia.


Effectiveness of abdominal radiographs in visualizing chewable iron supplements following overdose.
The purpose of this study was to determine the clinical effectiveness of visualizing chewable and nonchewable iron supplements remaining in the gastrointestinal tract following an overdose. A 5-year retrospective review of 93 pediatric patients who had ingested potentially toxic amounts of an iron supplement found that 58% had abdominal radiographs taken. Fifty-five percent of these patients had ingested chewable multiple vitamins with iron and 40% had ingested nonchewable tablets. After radiographic review, radiopaque densities could be marginally visualized in only one case of ingestion of a chewable iron supplement. The mean serum iron level of patients who had ingested a chewable form of iron was 270 micrograms/dL. An in vitro study was performed to determine the radiopacity of various chewable multiple vitamins with iron. It was concluded that although chewable multiple vitamins with iron are radiopaque in vitro, clinical radiographic visualization is unlikely.


Hypoglycemia in the Newborn.
This article covers several aspects of the clinical management of neonatal hypoglycemia that have recently evolved, reviewing the evidence informing these recommended changes in practice. Topics covered include use of buccal dextrose gel, rationale for avoiding the traditional "mini dextrose bolus," and benefits of direct breastfeeding for the treatment of asymptomatic hypoglycemia in at-risk newborns. The reasons for increasing use of more accurate point-of-care devices for measuring neonatal glucose concentrations are discussed, as well as the implications of different published opinions regarding the determination of readiness for discharge and the most important considerations when making this determination.


Prognostic Impact of Poor Differentiation of Squamous Cell Carcinoma in Treatment Naïve Node-Negative Early Oral Cancers.
We have conducted this study to understand the impact of poor differentiation (PD), as a sole poor prognostic factor, in early oral cancers. This was a retrospective analysis of a prospectively maintained database of clinically node-negative early T stage OSCC patients operated between 2012 and 2014. Impact of PD on the survival and role of adjuvant therapy in these patients was noted. Out of 1172 patients screened, 280 patients were found to be eligible for the study. 11.4% patients had PDSCC. It was found to be associated with tongue cancers and peri-neural invasion. It had a significant impact on OS and DFS (48.7 months vs 81.4 months, p < 0.00 and 44.6 months vs 73.5 months, p < 0.00 respectively. Hazard ratio for DFS: 4.08. Although patients with PDSCC had better survival with radiotherapy, but this was not statistically significant. Poor differentiation as a stand-alone factor impacts survival in patients with early oral cancer. It may be seen more often in patients with tongue cancer and may have associated PNI. The role of adjuvant therapy in such patients is not clear.


Standards of neurosurgical procedures.
Written specifications with regard to procedures performed, equipment used, and training of the involved personnel are widely used in the industry and aviation to guarantee constant quality. Similar systems are progressively being introduced to medicine. We have made an effort to standardize surgical procedures by introducing step-by-step guidelines and checklists. The current experience shows that a system of written standards is applicable to neurosurgery and that the use of checklists contributes to the prevention of forgetting essential details. Written standards and checklists are also a useful training tool within a university hospital and facilitate communication of essentials to the residents. Comparison with aviation suggests that standardization leads to a remarkable but nonetheless limited reduction of adverse incidents.


Naphazoline and oxymetazoline are superior to epinephrine in enhancing the cutaneous analgesia of lidocaine in rats.
This study observed the cutaneous analgesic effect of adrenergic agonists when combined with lidocaine. We aimed at the usefulness of four adrenergic agonists and epinephrine as analgesics or as tools to prolong the effect of local anesthetics using a model of cutaneous trunci muscle reflex (pinprick pain) in rats. We showed that subcutaneous four adrenergic agonists and epinephrine, as well as the local anesthetic bupivacaine and lidocaine, developed a concentration-dependent cutaneous analgesia. The rank order of the efficacy of different compounds (ED50 ; median effective dose) was epinephrine [0.013 (0.012-0.014) μmol] > oxymetazoline [0.25 (0.22-0.28) μmol] > naphazoline [0.42 (0.34-0.53) μmol] = bupivacaine [0.43 (0.37-0.50) μmol] > xylometazoline [1.34 (1.25-1.45) μmol] > lidocaine [5.86 (5.11-6.72) μmol] > tetrahydrozoline [6.76 (6.21-7.36) μmol]. The duration of full recovery caused by tetrahydrozoline, oxymetazoline, or xylometazoline was greater (P < 0.01) than that induced via epinephrine, bupivacaine, lidocaine, or naphazoline at equianesthetic doses (ED25 , ED50 , and ED75 ). Co-administration of lidocaine (ED50 ) with four adrenergic agonists or epinephrine enhanced the cutaneous analgesic effect. We observed that four adrenergic agonists and epinephrine induce analgesia by themselves, and such an effect has a longer duration than local anesthetics. Co-administration of lidocaine with the adrenergic agonist enhances the analgesic effect, and the cutaneous analgesic effect of lidocaine plus naphazoline (or oxymetazoline) is greater than that of lidocaine plus epinephrine.


Epigenetic inactivation of the RASSF1A tumour suppressor gene in ependymoma.
To investigate the role of aberrant epigenetic events in ependymoma and identify critical genes in its pathogenesis, the methylation status of nine tumour suppressor genes (TSGs: p14(ARF), p15(INK4B), p16(INK4A), CASP8, MGMT, TIMP3, TP73, RB1 and RASSF1A) was assessed. Extensive hypermethylation across the RASSF1A CpG island was detected frequently in ependymomas of all clinical and pathological disease subtypes (86% of cases, n=35), but not in non-neoplastic brain tissues (n=6). Less frequent methylation was observed for CASP8, MGMT and TP73 (5-20%). The remaining TSGs showed no evidence of methylation. RASSF1A hypermethylation represents the most common gene-specific defect identified in ependymoma highlighting the importance of its further investigation in this disease.


Is There Enough Evidence to Regularly Apply Bone Screws for Intermaxillary Fixation in Mandibular Fractures?
Intermaxillary fixation (IMF) is traditionally achieved with arch bars; however, this method has several well-known disadvantages and other techniques, such as bone screws, are available. This study evaluated current evidence regarding these IMF screws (IMFSs) for mandibular trauma and to assess whether this allows a change of treatment protocol for IMF. A systematic electronic literature search was conducted in the PubMed, Embase, and Cochrane databases. Titles and abstracts retrieved from the search were screened and evaluated for inclusion and exclusion criteria. The full text of all relevant articles was read and citation lists were checked for any missing references. All randomized controlled trials (RCTs) were subjected to a quality assessment. Included articles were checked for outcome measurements concerning occlusion, operative time, oral hygiene, root trauma, wire-stick injuries, and mucosa overgrowth. Twenty-two articles (17 case series, 4 RCTs, and 1 cohort study) were included. None of the RCTs scored high methodologic results in the quality assessment. The results suggest IMFSs have similar malocclusion rates as arch bars, fewer wire-stick injuries, improved oral hygiene, and shorter operative time. Root damage is less likely to occur with self-drilling screws and seldom requires treatment. Although the methodologic quality of the included studies is poor, self-drilling IMFSs are recommended for temporary per-operative IMF of noncomminuted mandibular fractures. More high-quality studies are required to allow an evidence-based change of protocol.


A practical genome-enabled legitimacy assay for oil palm breeding and seed production.
Legitimacy in breeding and commercial crop production depends on optimised protocols to ensure purity of crosses and correct field planting of material. In oil palm, the presence of three fruit forms permits these assumptions to be tested, although only after field planting. The presence of incorrect fruit forms in a cross is a clear sign of illegitimacy. Given that tenera forms produce 30% more oil for the same weight of fruit as dura, the presence of low levels of dura contamination can have major effect during the economic lifespan of an oil palm, which is around 25 years. We evaluated two methods for legitimacy test 1) The use of SHELL markers to the gene that determines the shell-thickness trait 2) The use of SNP markers, to determine the legitimacy of the cross. Our results indicate that the SHELL markers can theoretically reduce the major losses due to dura contamination of tenera planting material. However, these markers cannot distinguish illegitimate tenera, which reduces the value of having bred elite tenera for commercial planting and in the breeding programme, where fruit form is of limited utility, and incorrect identity could lead to significant problems. We propose an optimised approach using SNPs for routine quality control. Both dura and tenera contamination can be identified and removed at or before the nursery stage. An optimised legitimacy assay using SNP markers coupled with a suitable sampling scheme is now ready to be deployed as a standard control for seed production and breeding in oil palm. The same approach will also be an effective solution for other perennial crops, such as coconut and date palm.


Inhibition of fungal ABC transporters by unnarmicin A and unnarmicin C, novel cyclic peptides from marine bacterium.
Novel inhibitors of fungal ATP-binding cassette transporters were obtained by screening compounds and crude extracts from marine-derived fungi and bacteria using disk diffusion assays of Saccharomyces cerevisiae strains overexpressing a variety of fungal multi-drug efflux pumps. The cyclodepsipeptides unnarmicin A and unnarmicin C were able to sensitize cells overexpressing azole drug pumps ScPdr5p, CaCdr1p, CgCdr1p, and CgPdh1p to sub-MIC concentrations of fluconazole without affecting the growth of CaCdr2p and CaMdr1p overexpressing cells. Unnarmicin A and unnarmicin C were potent inhibitors of rhodamine 6G efflux of CaCdr1p expressing cells with IC50 values of 3.61 and 5.65 microM, respectively. They inhibited the in vitro CaCdr1p ATPase activity at IC50 values of 0.495 and 0.688 microM, respectively. And most importantly, they were able to sensitize azole-resistant Candida albicans clinical isolates to fluconazole. Unnarmicin A and unnarmicin C are candidate efflux pump inhibitors with the potential to be used as adjuvants for antifungal chemotherapy.


Determining a threshold measurement of endometrial thickness for asymptomatic postmenopausal women: A tertiary centre case series.
An incidental finding of a thickened endometrium on ultrasound in the postmenopausal patient without bleeding is a common presentation to gynaecological services; however there is limited evidence to guide clinical practice as to when hysteroscopic evaluation and endometrial sampling is required. To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic postmenopausal women referred with thickened endometrium on ultrasound. A single-centre retrospective case series of postmenopausal women without bleeding undergoing hysteroscopy was conducted. Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness. The optimal endometrial thickness threshold was identified to maximise model sensitivity. A total of 404 postmenopausal women were included in this study, having undergone a hysteroscopy at the study site between 1 July 2008 and 30 June 2018. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean body mass index was 29.86 kg/m2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and seven (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153: 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut-off of ≥9 mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre-malignant or malignant pathology (classification accuracy of 64.8%; area under the receiver operating characteristic: 0.7358, 95% CI: 0.6439, 0.8278) in this cohort. Using an endometrial thickness of ≥9 mm can be used as a cut-off for endometrial sampling in postmenopausal women without bleeding.


Assessment of lipid profile in Saudi type 2 diabetic and non-diabetic periodontal patients.
To study the extent of periodontal disease in diabetic and non-diabetic periodontitis patients, and to investigate the relationship of dyslipidemia and periodontal disease, in diabetic and non-diabetic periodontitis patients. This is a cross-sectional study at the Department of Preventive Dental Sciences (College of Dentistry) and Department of Physiology (College of Medicine), King Saud University, Riyadh, Kingdom of Saudi Arabia, from February 2003 to June 2004. A total of 90 patients was recruited, and divided into 3 equal groups of 30 subjects, with age and gender matched, and divided as follows: group 1 healthy group: periodontally and systemically healthy subjects, group 2 periodontitis group: chronic periodontitis patients with no systemic disease, group 3 diabetic group: chronic periodontitis patients with type 2 diabetes mellitus. Plaque index, bleeding on probing, probing pocket depth (PPD), and clinical attachment level (CAL) were measured at the time of initial examination. The glycated hemoglobin, total cholesterol, low density lipoprotein (LDL), triglyceride, high density lipoprotein were also measured. Periodontal parameters (PPD and CAL) were of significantly higher value in the diabetic patients, when compared to the periodontitis patients (p<0.05). The total cholesterol, LDL, and triglyceride were also found to be significantly higher among the periodontitis patients than the healthy subjects (p<0.05). This study indicated that type 2 diabetic patients had a higher risk to develop advanced periodontal disease than the non-diabetic subjects. It also highlighted the association of dyslipidemia in periodontitis patients.


Organizing pneumonia in mice and men.
Organizing pneumonia is a reaction pattern and an inflammatory response to acute lung injuries, and is characterized by intraluminal plugs of granulation tissue in distal airspaces. In contrast to other fibrotic pulmonary diseases, organizing pneumonia is generally responsive to corticosteroids. However, some patients do not respond to treatment, leading to respiratory failure and potentially death (up to 15 % of patients). In order to devise new therapeutic strategies, a better understanding of the disease's pathomechanisms is warranted. We previously generated a mouse model overexpressing CCL2, which generates organizing pneumonia-like changes, morphologically comparable to human patients. In this study, we investigated whether the histopathological similarities of human and murine pulmonary organizing pneumonia lesions also involve similar molecular pathways. We analyzed the similarities and differences of fibrosis-associated gene expression in individual compartments from patients with organizing pneumonia and transgenic (CCL2) mice using laser-assisted microdissection, real-time PCR and immunohistochemistry. Gene expression profiling of human and murine organizing pneumonia lesions showed in part comparable expression levels of pivotal genes, notably of TGFB1/Tgfb1, TIMP1/Timp1, TIMP2/Timp2, COL3A1/Col3a1, CXCL12/Cxcl12, MMP2/Mmp2 and IL6/Il6. Hence, the transgenic CCL2 mouse model shows not only pathogenomic and morphological features of human organizing pneumonia but also a similar inflammatory profile. We suggest that the CCL2-overexpressing transgenic mouse model (CCL2 Tg mice) is suitable for further investigation of fibrotic pulmonary remodeling, particularly of organizing pneumonia pathogenesis and for the search for novel therapeutic strategies.


Tissue factor and tissue factor pathway inhibitor in hemodialysis patients.
Tissue factor and tissue factor pathway inhibitor are important in extrinsic coagulation. We investigated their clinical significance in hemodialysis patients. We took blood samples, prior to initiation of routine hemodialysis, from 73 patients on hemodialysis (35 men and 38 women aged 56.1+/-11.7 years on dialysis for 82.1+/-61.0 months), and determined tissue factor and tissue factor pathway inhibitor levels by ELISA. In the patients the tissue factor level was 704.5+/-141.6 pg/ml and the tissue factor pathway inhibitor level was 44.5+/-23.3 ng/ml; both values were significantly higher than in normal controls (192.7+/-36.6 pg/ml and 18.6+/-5.7 ng/ml, respectively). In patients with shunt obstruction, tissue factor pathway inhibitor levels were significantly higher than in those without it. Therefore, the tissue factor pathway inhibitor level may be a marker of shunt obstruction.


Fibromyalgia: Could hyperbaric oxygen therapy make the difference? Our experience.
Fibromyalgia is a rare disease, difficult to diagnose and to treat. We think that hyperbaric oxygen therapy could improve its signs and symptoms although more evidences have to be accumulated.


Does nutritional supplementation influence the voluntary dietary intake in an acute geriatric hospitalized population?
Undernutrition is a significant problem in hospitalized elderly patients, and is associated with a higher morbidity and mortality. The aim of this study is to assess the effect of an oral nutritional supplementation on the total daily caloric intake in an acute geriatric hospitalized population. A dietary assessment and a total food intake were collected on admission and every other day (day 0, 2, 4, 6 ...) during hospitalization (mean duration, 12.8 days+/-6) in 50 randomly chosen elderly patients (mean age 82.5+/-5.5 years, 18 men and 32 women). The mean daily caloric intake was calculated from 108 dietary assessments after receiving oral supplementation (Nutridrink-Nutricia, 300 kcal/200 mL), and 154 when a voluntary diet without supplementation was consumed. The mean voluntary energy intake (including parenteral fluid) was similar on days a nutritional supplementation was given or not (1546 kcal/d vs 1475 kcal/d, respectively, p=0.27), but the total caloric intake was significantly higher on days a nutritional supplementation was consumed (1825 kcal/d vs 1475 kcal/d, p=0.0006). This beneficial effect of a nutritional supplementation on the total caloric intake existed when patients were divided into well nourished (N=15) and those at risk or malnourished (N=35), according to the Mini-Nutritional Assessment. In conclusion, short-term nutritional supplementation has a beneficial effect on the total daily caloric intake in elderly hospitalized patients with and without malnutrition, but the wastage remains high.


Layer-by-layer self assembly of a water-soluble phthalocyanine on gold. Application to the electrochemical determination of hydrogen peroxide.
A self-assembled molecular film of a water-soluble cobalt tetrasulfophthalocyanine was deposited on a gold substrate premodified with poly(diallyldimethylammonium chloride). The process of layer-by-layer assembly on the gold substrate was characterized using UV-Vis, Raman spectroscopy, ellipsometry, contact angle measurements, atomic force microscopy and electrochemical methods. Results demonstrate the formation of a completely covered phthalocyanine film on the gold surface. UV-Vis spectra indicated the formation of monolayer film of the phthalocyanine on the surface. The functionalized surface is uniformly covered and becomes hydrophilic after modification. The modified gold surface exhibits a reversible redox behavior and acts as an electronic conductor for the electrochemical reduction of hydrogen peroxide in pH 7.0 phosphate buffer. A linear increase in the catalytic current is observed for the reduction of hydrogen peroxide in the concentration range from 1 to 20 μM, with a detection limit of 0.4 μM. Hydrogen peroxide spiked pond water sample showed a recovery of 94% indicating the method is selective and can be applied for various applications. The present method is a simple, cost effective and sensitive electrochemical method for the detection and quantification of hydrogen peroxide.


Implementation of Obstetric Telehealth During COVID-19 and Beyond.
The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth. The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations-including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing. The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care. Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.


The economic burden of incisional ventral hernia repair: a multicentric cost analysis.
A systematic review of literature led us to take note that little was known about the costs of incisional ventral hernia repair (IVHR). Therefore we wanted to assess the actual costs of IVHR. The total costs are the sum of direct (hospital costs) and indirect (sick leave) costs. The direct costs were retrieved from a multi-centric cost analysis done among a large panel of 51 French public hospitals, involving 3239 IVHR. One hundred and thirty-two unitary expenditure items were thoroughly evaluated by the accountants of a specialized public agency (ATIH) dedicated to investigate the costs of the French Health Care system. The indirect costs (costs of the post-operative inability to work and loss of profit due to the disruption in the ongoing work) were estimated from the data the Hernia Club registry, involving 790 patients, and over a large panel of different Collective Agreements. The mean total cost for an IVHR in France in 2011 was estimated to be 6451€, ranging from 4731€ for unemployed patients to 10,107€ for employed patients whose indirect costs (5376€) were slightly higher than the direct costs. Reducing the incidence of incisional hernia after abdominal surgery with 5 % for instance by implementation of the European Hernia Society Guidelines on closure of abdominal wall incisions, or maybe even by use of prophylactic mesh augmentation in high risk patients could result in a national cost savings of 4 million Euros.


Muscle expression of glucose-6-phosphate dehydrogenase deficiency in different variants.
Muscle expression of G6PD deficiency has been investigated in Mediterranean, Seattle-like and A-variants. G6PD activity was detected in samples obtained from biopsies on the quadriceps muscle of seven males and one female. The type of genetic variant was determined by molecular analysis of DNA, extracted from blood samples. All variants showed the enzyme defect in muscle. A statistically significant relationship was found in the activity of G6PD between erythrocytes and muscle of the male subjects (r = 0.968; p = 0.00008). The equation for the best fit line was: Y = 0.390X + 0.198. The results suggest that, for a given variant, the extent of the enzyme defect in muscle may be determined, using this equation, from the G6PD activity of erythrocytes.


[Hypertensive retinopathy in child with pheochromocytoma].
Pheochromocytoma is a tumor secreting catecholamines, it occurs in different age, rarely in children. The disorder coexists with malignant arterial hypertension. We present a case of patient with ophthalmic alterations in the course of pheochromocytoma. In 12-year old boy operated on pheochromocytoma full ophthalmic examination, fluorescent angiography and ERG were performed. We found decreased visual acuity, hypertensive retinopathy and the scotopic and fotopic ERG alterations. Hypertensive retinopathy in the course of pheochromocytoma could be the first symptom of the disease, especially in children. The earlier this disorder is diagnosed and operated on, the better is the prognosis for health and regression of retinal findings.


[Multidimensional and computational theory of mood].
What is mood? Despite its crucial place in psychiatric nosography and cognitive science, it is still difficult to delimit its conceptual ground. The distinction between emotion and mood is ambiguous: mood is often presented as an affective state that is more prolonged and less intense than emotion, or as an affective polarity distinguishing high and low mood swinging around a baseline. However, these definitions do not match the clinical reality of mood disorders such as unipolar depression and bipolar disorder, and do not allow us to understand the effect of mood on behaviour, perception and cognition. In this paper, we propose a multidimensional and computational theory of mood inspired by contemporary hypotheses in theoretical neuroscience and philosophy of emotion. After suggesting an operational distinction between emotion and mood, we show how a succession of emotions can cumulatively generate congruent mood over time, making mood an emerging state from emotion. We then present how mood determines mental and behavioral states when interacting with the environment, constituting a dispositional state of emotion, perception, belief, and action. Using this theoretical framework, we propose a computational representation of the emerging and dispositional dimensions of mood by formalizing mood as a layer of third-order Bayesian beliefs encoding the precision of emotion, and regulated by prediction errors associated with interoceptive predictions. Finally, we show how this theoretical framework sheds light on the processes involved in mood disorders, the emergence of mood congruent beliefs, or the mechanisms of antidepressant treatments in clinical psychiatry.


Oncogenic microRNA signature for early diagnosis of cervical intraepithelial neoplasia and cancer.
Cervical cancer is one of the leading causes of cancer death in women globally, despite the widespread use of cytology/human papillomavirus (HPV) screening. In the present study, we aimed to identify the potential role of microRNA (miRNA) as a diagnostic biomarker in the detection of cervical pre-malignant lesions and cancer. In total, we recruited 582 patients with cervical diseases and 145 control individuals. The expression levels of six miRNAs (miR-20a, miR-92a, miR-141, miR-183*, miR-210 and miR-944) were found to be significantly up-regulated in cervical cancer and pre-malignant lesions compared to normal cervical samples, indicating that they are oncogenic miRNAs. Receiver operating characteristic curve analysis showed that these six miRNAs can be used to distinguish patients with cervical pre-malignant lesions or cancer from normal individuals and they also had a good predictive performance, particularly in cervical lesions. Combined use of these six miRNAs further enhanced the diagnostic accuracy over any single miRNA marker, with an area under the curve of 0.998, 0.996 and 0.959, a diagnostic sensitivity of 97.9%, 97.2% and 91.4%, and a specificity of 98.6%, 96.6% and 87.6% for low-grade lesions, high-grade lesions and cancer, respectively. This six oncogenic miRNA signature may be suitable for use as diagnostic marker for cervical pre-malignant lesions and cancer in the near future.


Transcriptional elongation factor ENL phosphorylated by ATM recruits polycomb and switches off transcription for DSB repair.
Transcription is repressed if a DNA double-strand break (DSB) is introduced in close proximity to a transcriptional activation site at least in part by H2A-ubiquitination. While ATM signaling is involved, how it controls H2A-ubiquitination remains unclear. Here, we identify that, in response to DSBs, a transcriptional elongation factor, ENL (MLLT1), is phosphorylated by ATM at conserved SQ sites. This phosphorylation increases the interaction between ENL and the E3-ubiquitin-ligase complex of Polycomb Repressive Complex 1 (PRC1) via BMI1. This interaction promotes enrichment of PRC1 at transcription elongation sites near DSBs to ubiquitinate H2A leading to transcriptional repression. ENL SQ sites and BMI1 are necessary for KU70 accumulation at DSBs near active transcription sites and cellular resistance to DSBs. Our data suggest that ATM-dependent phosphorylation of ENL functions as switch from elongation to Polycomb-mediated repression to preserve genome integrity.


DIABETIC FOOT ULCERS -12 MONTHS PROSPECTIVE REVIEW OF PATTERN OF PRESENTATION AT ENUGU STATE UNIVERSITY OF TECHNOLOGY TEACHING HOSPITAL, PARKLANE, ENUGU: A BASIS FOR DIABETIC FOOT CLINIC?
Diabetic foot ulcer is a common complication of diabetes. This morbidity results in long hospitalization and high cost of management. It is a significant cause of non-traumatic amputation. Reduction in incidence and progression to amputation will be highly desired. To highlight the pattern of presentation and to emphasize the need for multidisciplinary approach in prevention by integration of focused footcare plan. A prospective interviewer administered questionnaire based study. A total of 36 patients were recruited with a male female ratio of 1.8:1. Mean age of presentation was 55.5 years and commoner in those that have had diabetes for 10 - 15 years. Low level of education had a direct relationship with occurrence of DFU. Neuropathy was a common predisposing factor to DFU. More than 60% had no knowledge of foot care even though they have been educated on dietary control here was average hospital stay of 48 days, amputation rate of 19.4% and mortality rate of 8.3%. A comprehensive foot care program should be incorporated in the management of diabetes as soon as diagnosis is made in other to reduce the huge burden of DFU.


MMP-11 as a biomarker for metastatic breast cancer by immunohistochemical-assisted imaging mass spectrometry.
MMP-11 is a member of the matrix metalloproteinase family (MMPs) which are overexpressed in cancer cells, stromal cells and the adjacent microenvironment. The MMP protein family encompasses zinc-dependent endopeptidases that degrade the extracellular matrix (ECM), facilitating the breakdown of the basal membrane and matrix connective tissues. This function is believed to be important in cancer development and metastasis. This paper investigated a gold nanoparticle-based immunohistochemical assay to visualise the distribution of MMP-11 in human breast cancer tissues from eight patients with and without metastases by employing laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). The expression of MMP-11 was increased and more heterogeneous in metastatic specimens compared to non-metastatic tumour samples. These findings demonstrate that imaging breast tumours by LA-ICP-MS may be a useful tool to aid the prognosis and treatment of breast cancer. As an example, samples of two patients are presented who were diagnosed with matching characteristics and grades of breast cancer. Although both patients had a similar prognosis and treatment, only one developed metastases.


Dental erosion caused by Granny Smith apples: An evidence-based case report and 1-year follow-up.
Apples, if indiscriminately consumed without appropriate preventive measures to check erosion, can cause accelerated wear of the teeth.Dentists must be fully aware of the intrinsic and extrinsic factors that cause erosive tooth wear. Management strategy for tooth erosion depends on the severity of erosion, esthetics, function, and patient's preference.


Lactiplantibacillus plantarum, lactiplantibacillus pentosus and inulin meal inclusion boost the metagenomic function of broiler chickens.
The inclusion of alternative ingredients in poultry feed is foreseen to impact poultry gut microbiota. New feeding strategies (probiotics/prebiotics) must be adopted to allow sustainable productions. Therefore, the current study aimed to use metagenomics approaches to determine how dietary inclusion of prebiotic (inulin) plus a multi-strain probiotic mixture of Lactiplantibacillus plantarum and Lactiplantibacillus pentosus affected microbiota composition and functions of the gastro-intestinal tract of the broilers during production. Fecal samples were collected at the beginning of the trial and after 5, 11 and 32 days for metataxonomic analysis. At the end of the trial, broilers were submitted to anatomo-pathological investigations and caecal content was subjected to volatilome analysis and DNAseq. Probiotic plus prebiotic inclusion did not significantly influence bird performance and did not produce histopathological alterations or changes in blood measurements, which indicates that the probiotic did not impair the overall health status of the birds. The multi-strain probiotic plus inulin inclusion in broilers increased the abundance of Blautia, Faecalibacterium and Lachnospiraceae and as a consequence an increased level of butyric acid was observed. In addition, the administration of probiotics plus inulin modified the gut microbiota composition also at strain level since probiotics alone or in combination with inulin select specific Faecalibacterium prausnitzi strain populations. The metagenomic analysis showed in probiotic plus prebiotic fed broilers a higher number of genes required for branched-chain amino acid biosynthesis belonging to selected F. prausnitzi strains, which are crucial in increasing immune function resistance to pathogens. In the presence of the probiotic/prebiotic a reduction in the occurrence of antibiotic resistance genes belonging to aminoglycoside, beta-lactamase and lincosamide family was observed. The positive microbiome modulation observed is particularly relevant, since the use of these alternative ingredients could promote a healthier status of the broiler's gut.


Hypomagnesemia in Post Thyroidectomy Patient: An Underestimated Entity.
In post thyroidectomy patients hypocalcemia is one of the known complication many factors play important role in calcium hemostasis and magnesium is one among them. So this study was conducted to assess the prevalence of hypomagnesemia in post thyroidectomy patients and its relationship with calcium homeostasis. A prospective observational study was conducted among 31 patients who underwent total thyroidectomy or completion thyroidectomy over a period of 1 year. Patient's pre-operative and post-operative day 1 and day 2 serum calcium, magnesium and iPTH was recorded and their correlation was analyzed using SPSS 21.0. and p value of < 0.05 was taken as statistically significant. Calcium supplementation was only given to patients who developed symptomatic hypocalcemia in postoperative period. In our study hypomagnesemia in post thyroidectomy patients on post -operative day 1 and day 2 was 71% and 74.2% respectively. Hypocalcemia was seen in 64.5% of patients on post-operative day 1 and 96.8% on post-operative day 2. Symptomatic hypocalcemia was seen in 22.6% of study population on post-operative day 1 and 22.6% of patients on post-operative day 2 while 25.8% patients newly developed symptoms of hypocalcemia. Statistically significant correlation was found between calcium and magnesium levels in post op day 1(< 0.001) and post op day 2(< 0.004) and also statistically significant correlation was found between post-operative day 1 magnesium levels and post-operative day 2 calcium levels (0.001). Symptomatic hypocalcemia was more commonly seen among patients who had hypomagnesemia along with hypocalcemia though it failed to show any statistical significance. Post thyroidectomy hypomagnesemia is frequent event and magnesium acts as an independent risk factor in development of post thyroidectomy hypocalcemia. Hypomagnesemia tends to alleviate symptomatic hypocalcemia in post thyroidectomy patients. So the role of magnesium correction to alleviate severe hypocalcemia needs to be further studied.


Long-term mortality after transvenous lead extraction.
The number of cardiovascular implantable electronic devices has increased progressively and has led to an increased need for transvenous lead extraction (TLE). Multiple reports of TLE procedural outcomes exist; however, data regarding postprocedural and long-term mortality are limited. We performed a retrospective study of consecutive patients undergoing TLE at a single, high-volume center. Patient characteristics, indications, and outcomes were analyzed. A multivariable Cox regression model was developed to identify factors associated with mortality. Between January 2000 and December 2010, 985 patients underwent 1043 TLE procedures. The cohort was 68% male, with a mean age of 63 years (range, 15-95 years) and a left ventricular ejection fraction of 40±17%. Indications included systemic infection (18%), pocket infection (32%), lead malfunction (30%), and other (device upgrade, venous occlusion, and advisory leads; 20%). There were no procedure-related deaths. The mean follow-up was 3.7 years (range, 0.1-11.3 years). Kaplan-Meier analysis demonstrated a cumulative mortality of 2.1% at 30 days, 4.2% at 3 months, 8.4% at 1 year, and 46.8% at 10 years. In multivariable analysis, systemic infection (hazard ratio [HR], 3.52; 95% CI, 1.95-6.38; P<0.0001), local infection (HR, 2.70; 95% CI, 1.55-4.67; P=0.0004), device system upgrade (HR, 2.14; 95% CI, 1.07-4.25; P=0.03; indication compared with a reference group of extraction for lead malfunction), diabetes mellitus (HR, 1.71; 95% CI, 1.25-2.35; P=0.0009), increasing age (HR, 1.05; 95% CI, 1.04-1.07; P<0.0001), and serum creatinine (HR, 1.16; 95% CI, 1.01-1.35; P=0.04) were significant correlates of increased mortality risk. Although TLE procedural mortality is exceedingly low at high-volume centers, postprocedural and long-term mortality remain high in certain patient populations, such as elderly patients and those undergoing TLE for infectious indications and device system upgrade. Information regarding TLE long-term outcomes may help guide cardiovascular implantable electronic device and lead management.


The fate of host and graft cells in early healing of bone tunnel after tendon graft.
The behavior of host and graft cells during the healing process after autologous tendon graft has not been elucidated. Host cells will integrate into the bone-tendon interface and contribute to cellular repopulation of the graft. Controlled laboratory study. Twelve-week-old, genetically identical, female green fluorescent protein transgenic rats (n = 20) and wild-type rats (n = 20) were used. The rats were divided into 2 experimental groups. In group A, the Achilles tendons of wild-type rats were harvested and transplanted into the transcondylar femoral bone tunnels of green fluorescent protein rats. In group B, the Achilles tendons of green fluorescent protein rats were transplanted into a transcondylar femoral bone tunnel of wild-type rats. Immediately after transplantation (time zero) and at 1, 2, and 4 weeks after the transplantation, distal femoral epiphyses were harvested and cut into 14-mum serial sagittal frozen sections. The sections were examined with a confocal laser-scanning microscope to quantify green fluorescent protein-positive cell survival. At time zero, only host cells in group A and only graft cells in group B demonstrated green fluorescent protein signals. At 1 week in group A, many green fluorescent protein-positive cells were found in the graft. In group B, a few green fluorescent protein-positive cells were found in the graft. At 2 and 4 weeks in group A, many green fluorescent protein-positive cells were detected in the graft, but green fluorescent protein-positive cells had disappeared completely in group B. Host cells, rather than graft cells, contribute to repair of the bone-tendon interface and the remodeling of grafts after simulated autologous tendon graft.


Gray matter associations with extinction-induced neural activation in patients with anxiety disorders.
The relationship between structural characteristics and extinction-induced brain activations in anxiety disorders (ANX) remains a space for greater exploration. In this study, we assessed gray matter volume (GMV) and its associated functional activations during fear extinction memory recall in an ANX cohort. We performed voxel-based morphometry analysis to examine GMVs from ANX (n = 92) and controls (n = 73). We further examined the correlation between GMVs and extinction-induced neural activations during recall across groups. In the patients' group, we observed decreased GMV in the anterior hippocampus and increased GMV in the dorsolateral prefrontal cortex (dlPFC). Hippocampal volume was positively correlated with ventromedial prefrontal cortex activation in healthy controls, while it was negatively correlated with dorsal anterior cingulate cortex (dACC) activation in ANX. The dlPFC volume was positively correlated with activations of dACC, pre- and post-central gyrus, and supramarginal gyrus only in healthy controls. Therefore, the link between structural and functional imbalance within the hippocampus and dlPFC might contribute to the pathophysiology of ANX. In the controls, the relationship between structural variance in the hippocampus and dlPFC and extinction-induced neural activations is consistent with a greater ability to regulate fear responding; associations that were absent in the ANX cohort. Furthermore, our findings of structure-function abnormalities within key nodes of emotional homeostasis in ANX point to dlPFC as a potential neural node to target using neuromodulation tools.


Prognostic value of preoperative circulating tumor cells for hepatocellular carcinoma with portal vein tumor thrombosis: A propensity score analysis.
The role of circulating tumor cells (CTCs) in hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is not fully understood. In this retrospective analysis, we included 316 HCC patients who underwent hepatectomy and preoperative CTC detection. We selected 41 pairs of matched HCC patients with and without PVTT using propensity score matching (PSM) analysis. We compared the preoperative CTC counts in patients from both the full cohort and the PSM model. We also analyzed their associations with disease-free survival (DFS) and overall survival (OS). Before and after PSM analysis, the preoperative CTC counts in the HCC with PVTT group were substantially higher than in the HCC without PVTT group. In both the full cohort of patients and the PSM model, patients with CTC ≥ 2 had significantly shorter OS and DFS than patients with CTC < 2. The outcomes of HCC patients with PVTT could be well differentiated by preoperative CTC levels. HCC patients with CTC ≥ 2 had noticeably shorter OS (9.9 months vs. 24.6 months, P = 0.0003) and DFS (6.0 months vs. 12.3 months, P = 0.0041) than those with CTC < 2. Moreover, preoperative CTC ≥ 2 remained an independent predictor in all groups' multivariate analysis. We discovered a link between preoperative CTC counts and the occurrence of PVTT and confirmed the prognostic significance of preoperative CTC in HCC patients with PVTT. These findings suggest that preoperative CTC counts have the potential to assist in identifying patients with HCC and PVTT who may benefit from surgery.


Nonpenetrating traumatic rupture of the tricuspid valve. Formation of ventricular septal aneurysm and subsequent septal necrosis: recognition by two-dimensional Doppler echocardiography.
A 26-year old man was admitted with blunt trauma to the chest following a high-speed deceleration injury. A two-dimensional Doppler echocardiogram demonstrated traumatic rupture of the tricuspid valve and a hematoma in the basilar portion of the interventricular septum. Serial two-dimensional Doppler echocardiographic analyses demonstrated evolutionary formation of a septal aneurysm and subsequent rupture with formation of a ventricular septal defect. The usefulness of the two-dimensional Doppler echocardiogram as a screening tool for cardiac contusion is discussed.


Coaxial scavenger for paediatric anaesthesia.
A new scavenging device suitable for the Jackson-Rees modification to the Ayre's T-piece is described. This device maintains the essential components of the modification while effectively scavenging the circuit.


Acquired jejuno-ileal diverticular disease: a diagnostic and management challenge.
Acquired jejuno-ileal diverticular disease (JID), a result of abnormalities in the smooth muscle or myenteric plexus of the small bowel, is less rare than was once believed. Approximately 1.3% of the population has JID, of whom approximately 10% present with life-threatening complications such as inflammation, perforation, bleeding, obstruction and malabsorption. Jejuno-ileal diverticular disease can be diagnostically and therapeutically challenging, and complications are often diagnosed only at laparotomy, while the best management is not agreed on in the literature. To increase the awareness of this condition and its complications, the Auckland Hospital's experience of JID was reviewed. Retrospective review was carried out of the audit data and the discharge coding records of Auckland Public Hospital for the 5 year period leading to November 2001. Nine cases with a variety of presentations were found. Those cases are described and a literature review of JID is provided. Jejuno-ileal diverticular disease should be included in the differential diagnosis when dealing with surgical emergencies in the elderly presenting with features of bowel perforation, obstruction or bleeding.


Characteristics of a new enantioselective thermostable dipeptidase from Brevibacillus borstelensis BCS-1 and its application to synthesis of a D-amino-acid-containing dipeptide.
A new thermostable dipeptidase gene was cloned from the thermophile Brevibacillus borstelensis BCS-1 by genetic complementation of the D-Glu auxotroph Escherichia coli WM335 on a plate containing D-Ala-D-Glu. Nucleotide sequence analysis revealed that the gene included an open reading frame coding for a 307-amino-acid sequence with an M(r) of 35,000. The deduced amino acid sequence of the dipeptidase exhibited 52% similarity with the dipeptidase from Listeria monocytogenes. The enzyme was purified to homogeneity from recombinant E. coli WM335 harboring the dipeptidase gene from B. borstelensis BCS-1. Investigation of the enantioselectivity (E) to the P(1) and P(1)' site of Ala-Ala revealed that the ratio of the specificity constant (k(cat)/K(m)) for L-enantioselectivity to the P(1) site of Ala-Ala was 23.4 +/- 2.2 [E = (k(cat)/K(m))(L,D)/(k(cat)/K(m))(D,D)], while the D-enantioselectivity to the P(1)' site of Ala-Ala was 16.4 +/- 0.5 [E = (k(cat)/K(m))(L,D)/(k(cat)/K(m))(L,L)] at 55 degrees C. The enzyme was stable up to 55 degrees C, and the optimal pH and temperature were 8.5 and 65 degrees C, respectively. The enzyme was able to hydrolyze L-Asp-D-Ala, L-Asp-D-AlaOMe, Z-D-Ala-D-AlaOBzl, and Z-L-Asp-D-AlaOBzl, yet it could not hydrolyze D-Ala-L-Asp, D-Ala-L-Ala, D-AlaNH(2), and L-AlaNH(2.) The enzyme also exhibited beta-lactamase activity similar to that of a human renal dipeptidase. The dipeptidase successfully synthesized the precursor of the dipeptide sweetener Z-L-Asp-D-AlaOBzl.


Effect of flushing of the liver graft upon plasma calcium and magnesium concentrations.
Previous studies of total and ionized calcium in the plasma of liver transplant recipients have been conducted in patients with preexisting liver disease or who received blood transfusion. The intraoperative decline in plasma total and ionized calcium has been attributed to the effects of liver disease and/or the citrate in transfused blood. The present study was conducted in normal porcine recipients of liver stored either with EuroCollins or University of Wisconsin (UW) solution for 6 hr, compared with livers flushed with Ringer's lactate without storage. No blood transfusion was given. Mean total plasma calcium levels declined significantly after storage with UW solution to a nadir approximately 65-70% of preoperative levels. This decline persisted for two to five days. Mean levels of plasma ionized calcium declined lowest after flushing with UW solution but only to 82% of preoperative (NS). There was an increase in plasma total magnesium in the recipients of livers flushed with EuroCollins or UW solutions, which resolved within 30 min and which was probably related to magnesium content of the flushing solution. It is concluded that while the changes in plasma total and ionized calcium are moderate and of little clinical significance, they could be aggravated under clinical conditions by massive blood transfusion. Changes in plasma magnesium seemed to be directly attributable to the magnesium content of flushing solutions but the same relationship did not exist for changes in plasma calcium.


Treatment of pyogenic granuloma in children with a 595 nm pulsed dye laser: A retrospective study of 212 patients.
Pyogenic granuloma (PG) is a common vascular neoplasm in children. Data on 595 nm pulsed dye lasers for the treatment of PG in children remain scarce. To summarize the clinical characteristics and to evaluate the effectiveness and safety of the 595 nm pulsed dye laser for the treatment of PG in children. Retrospective case series. A retrospective study was performed on 212 patients treated for PG with a 595 nm pulsed dye laser. SPSS version 19.0 was used for statistical analysis. Among all 212 patients treated, 208 showed complete resolution of the lesion, and 4 dropped out after one treatment due to bleeding. A single treatment was sufficient in 139 (66.8%) patients, while two or three treatments were sufficient in 69 (33.2%) patients. Male patients responded better than female patients (χ2 = 7.603, p =0.006). Lesions in the nonorbital region responded better than those in the orbital region (χ2 = 7.445, p =0.006). The size of the lesion affected the effectiveness, and lesions with smaller diameters (t = -5.776, p <0.01) and heights (t = -10.368, p <0.01) showed better results. Twelve patients (5.8%) were reported to have local complications and side effects, including edematous erythema, slight bleeding, hyperpigmentation, and hypopigmentation. The edematous erythema and slight bleeding disappeared gradually after several days. The localized pigment changes usually resolved spontaneously and disappeared completely after 6 months. Our experience confirmed the efficacy and safety of the 595 nm pulsed dye laser for the treatment of PG in children.


Effects of spermine on activity and stability of calcium-dependent guanosine 3',5'-monophosphate phosphodiesterase.
Spermine in micromolar concentrations decreased the basal activity of a guanosine 3',5'-monophosphate (cGMP) phosphodiesterase from bovine brain but had no effect in the presence of Ca2+ plus the calcium-dependent regulatory protein (CDR) which increased the activity of the enzyme 4- to 6-fold. Similar effects of spermine were observed on the enzyme at several stages of purification. Spermidine and putrescine were also inhibitory but higher concentrations were required. In the absence of Ca2+ and CDR, the enzyme exhibited two apparent Km values for cGMP (2.5 and 20 microM) which were unaltered by spermine. In the presence of Ca2+ and CDR (when spermine had no effect on activity), a single Km (3.5 microM) was observed. Enzyme purified by chromatography on CDR-Sepharose was rapidly inactivated during incubation at 30 degrees C in 5 mM potassium phosphate buffer (pH 7.0) with EDTA and ethylene glycol bis(beta-aminoethyl ether) N,N,N',N'-tetraacetic acid (EGTA). Spermine (20 microM) partially stabilized enzyme activity under these conditions, although it was somewhat less effective than 2 mM MgCl2. The inhibitory effects of spermine (or other polyamines) on basal phosphodiesterase activity, which can be overcome by Ca2+ and CDR, could be important in the regulation of cellular cyclic nucleotide content.


Surgical Management of Genitourinary Cancer Liver Metastases.
Genitourinary cancers are common. Liver metastases from genitourinary cancers are uncommon; isolated liver metastasis is rare. Liver resection in select patients with metastatic renal cell carcinoma can lead to prolonged survival. Patients with metachronous and low-burden disease are most likely to benefit. Chemotherapy is first-line treatment of metastatic germ cell tumors. Liver resection is dependent on germ cell lineage and initial response to chemotherapy. Prognosis with liver metastases from prostate cancer is poor; liver-only lesions are rare. Liver resection generally is not indicated. Cumulative experience with liver resection for metastatic bladder cancer is limited. Liver metastases are poor prognostic indicators for metastasectomy.


Exploring the relationship between co-worker and supervisor support, self- confidence, coping skills and burnout in residential aged care staff.
Staff working in residential aged care facilities face unique challenges and stressors in their workplaces which increase their risk for occupational burnout. Burnout in this workforce results in low job satisfaction, increased levels of absenteeism and poor retention rates. Given Australia's ageing population and the demand for residential aged care staff, it is imperative to explore predictors of burnout in this cohort in order to help staff prevent and manage burnout. This study examined the extent to which co-worker and supervisor support, self-confidence and adaptive coping skills predicted burnout among residential aged care staff, after controlling for staff demographics, organisational climate and work patterns. One hundred and thirty three residential aged care staff across Australia were surveyed using online questionnaires measuring levels of co-worker and supervisor support, self- confidence, adaptive coping skills and burnout. Regression analyses indicated that, overall, co-worker and supervisor support, self-confidence, and adaptive coping predicted each dimension of burnout (emotional exhaustion, depersonalization and personal accomplishment). After controlling for covariates and other predictors: confidence significantly predicted all three dimensions; support significantly predicted emotional exhaustion and depersonalization, and adaptive coping significantly predicted emotional exhaustion. These findings suggest that co-worker and supervisor support, self- confidence and adaptive coping skills need to be addressed to prevent and manage occupational burnout for residential aged care staff in Australia.


The Woes of a Stuffy Nose: A Case Report of Allergic Fungal Sinusitis.
Allergic fungal sinusitis (AFS) is a relatively uncommon cause of sinus pain and congestion. Extreme cases may require specialty evaluation and surgical treatment. In this case, an otherwise healthy young man presented to the emergency department with sinus pain and congestion for two weeks and was admitted to surgery for resection of his AFS. This case demonstrates how a thorough history and physical exam can help catch potentially serious diseases, such as allergic fungal sinusitis, from the frequently benign chief complaint of sinus pain.


Freezability and fertility results with uncentrifuged stallion semen.
The first (1 to 3) sperm-rich fractions of the ejaculate were collected from 4 stallions using an open-ended vagina. The volume of the collected fractions was 12 +/- 8 ml with a density of 475 +/- 200 million spermatozoa/ml. Before freezing, the semen was diluted with a skim-milk based extender 1:1 to 1:8 (volume of semen: volume of extender), depending on the initial sperm concentration to achieve a final concentration of 100 million/ml. The total number of spermatozoa in an insemination dose ranged from 0.7 to 1 billion spermatozoa. Within 12 h after ovulation, 48 mares were inseminated in 70 cycles. The total single-cycle pregnancy rate at day 21 was 24%, but varied from 10% to 33% per cycle among the stallions.


Novel cyclodextrin-based adsorbents for removing pollutants from wastewater: A critical review.
Over the past few decades, cyclodextrin-based adsorbents have drawn worldwide attention as new-generation adsorbents for wastewater treatment due to its extraordinary physicochemical properties. This review outlined the recent development in the synthesis of cyclodextrin-based adsorbents as well as highlighted their applications in the removal of heavy metals, dyes, endocrine disrupting chemicals (EDCs), and mixed pollutants from water. The cross-linked and immobilized cyclodextrin-based adsorbents exhibited excellent adsorption performances. The removal of dyes and heavy metals were effectively controlled by ion exchanging, mainly depending upon the pH; while the adsorptions of EDCs always occurred in cyclodextrin cavities and pH-independent. An easier separation process between aqueous and adsorbents could be achieved compared to native cyclodextrin, which promoted the application of cyclodextrin-based adsorbents in practical industry. This review could provide an inspiration for the advanced study in the development of cyclodextrin-based adsorbents for high efficiency wastewater treatment.


Targeted regulation of Rell2 by microRNA-18a is implicated in the anti-metastatic effect of polyphyllin VI in breast cancer cells.
Polyphyllin VI (PP-VI) is one of the major saponins present in Paris polyphylla Sm., a medicinal plant primarily used for cancer treatment in China and India. However, its anti-metastatic activity remains largely unknown. The current study thus investigated the anti-metastatic activity of PP-VI in mouse mammary carcinoma 4T1 and human breast cancer MDA-MB-231 cells. The anti-metastatic effect of PP-VI was investigated at a sub-cytotoxic dose in migration and invasion assays in vitro. Experimental metastasis mouse model was used to examine the anti-metastatic effect of PP-VI in vivo. Additionally, target prediction, real-time PCR, Western blotting and luciferase assay were performed to identify the target gene of a pro-metastatic microRNA, miR-18a in 4T1 cells. The effect of PP-VI on the identified target of miR-18a was further investigated. The results showed that PP-VI impaired the viability of 4T1 and MDA-MB-231 cells. Moreover, when applied at a sub-cytotoxic dose, PP-VI suppressed the metastatic potential of 4T1 and MDA-MB-231 cells. Receptor expressed in lymphoid tissue (RELT)-like 2 (Rell2) was identified as a direct target of miR-18a with anti-metastatic functions in 4T1 and MDA-MB-231 cells. PP-VI treatment resulted in increased expression of Rell2 and decreased level of miR-18a in 4T1 and MDA-MB-231 cells. PP-VI treatment also attenuated miR-18a mimic or Rell2 siRNA-augmented migration of MDA-MB-231 cells. The current work thus demonstrates for the first time that targeted regulation of Rell2 by miR-18a is in part implicated in the anti-metastatic effect of PP-VI in breast cancer cells, providing novel pharmacological insights into the anti-cancer effect of PP-VI.


Effect of intravenous inoculation of avian influenza virus on reproduction and growth in mallard ducks.
An avian influenza virus isolate, A/Mallard/Ohio/184/86 (H5N1), was evaluated for its effects on reproduction in isolation-reared adult mallard ducks (Anas platyrhynchos) and growth rate in juvenile mallards after intravenous inoculation. There was a significant decrease in egg production in the experimental group during the first week after inoculation, but it returned to the normal production level during the second week. No effect was seen on egg weight, shape, or fertility. Ducklings receiving this influenza virus isolate did not differ from controls in their rate of growth.


Facile DNA adsorption enabling ammonium-based hydrophilic affinity monolithic column for high-performance online selective microextraction of ochratoxin A.
Herein, a facile protocol of simple DNA adsorption on UV-initiated polymerization supports was proposed for effectively fabricating aptamer-based affinity monolithic column. Hydrophilic cationic monolith with an excellent mechanical stability was achieved within 7 min and then massive aptamers were directly bound by DNA charge-dependent adsorption. Strong cationic quaternary ammonium-based monomer was employed to provide effective and stable positive charge surface for aptamer immobilization in a wide range of pH. An ultra-high aptamer coverage density of 6813 pmol/μL was achieved to gain a highly specific online recognition performance. Limitations such as low aptamer capacity, tedious modification and time-consuming reactions in the traditional biological or covalent modification strategies were avoided. By using ochratoxin A (OTA) as the given analyte, the selective recognition and high recoveries were successfully achieved, and little cross-reactivity towards OTB analogue was only 0.5% even if the content of OTB got up to 125 folds of OTA. Applied to sample analysis, the satisfactory discriminations of trace OTA were obtained at 93.9 ± 1.9% - 96.5 ± 1.7%(n = 3)in beer, wheat and chicken liver samples. It might light a cost-effective access to efficiently preparing high-performance affinity monoliths towards the selective in-tube microextraction of OTA.