Electrochemical properties of CoFe3Sb12 as potential anode material for lithium-ion batteries.
A skutterudite-related antimonide, CoFe(3)Sb(12), was prepared with vacuum melting. XRD analysis showed the material contained Sb, FeSb(2), CoSb(2) and CoSb(3) phases. The electrochemical properties of the ball-milled CoFe(3)Sb(12)-10 wt% graphite composite were studied using pure lithium as the reference electrode. A maximal lithium inserting capacity of about 860 mAh/g was obtained in the first cycle. The reversible capacity of the material was about 560 mAh/g in the first cycle and decreased to ca. 320 mAh/g and 250 mAh/g after 10 and 20 cycles respectively. Ex-situ XRD analyses showed that the antimonides in the pristine material were decomposed after the first discharge and that antimony was the active element for lithium to insert into the host material.


Intraoperative complications of vertebral body stenting system.
Vertebral body stenting systems (VBSs) are superior to balloon kyphoplasty for performing vertebral augmentation and height restoration. However, VBS may likely result in more material-related complications that have been under-reported. Here, an 84-year-old female's vertebral stents "toppled over" before the filling cement was fully applied, thus necessitating an additional posterior fusion. An 84-year-old female presented with low back pain after a fall. Dynamic standing and decubitus X-rays revealed a vertebral compression fracture at T12 resulting in an intravertebral vacuum cleft (i.e., the lowermost level of diffuse idiopathic skeletal hyperostosis). When the VBS was performed, the stents "toppled over" just after removing the balloon catheters; we successfully restored with the cement volume in one stent but not the other, thus warranting an additional posterior fusion to maintain stability. The proper injection of cement into a VBS requires dual correct stent positioning, and careful control of requisite stent expansion. In an 84-year-old female with a T12 vertebral body fracture and a remarkable vacuum cleft, the VBS procedure resulted in an inadvertent injection into one stent thus warranting a secondary posterior fusion.


The stroke east Saxony pilot project for organized post-stroke care: a case-control study.
Low adherence to secondary prevention guidelines in stroke survivors may increase the risk for recurrent stroke and adversely impact quality of life. We aimed to determine the feasibility of a self-developed standardized post-stroke pathway and its impact on secondary stroke prevention and long-term outcome in patients with acute stroke. Consecutive patients with acute stroke were prospectively included in a standardized post-stroke pathway accomplished through a single certified CM (case manager), which comprised educational discussions and quarterly checkups for vascular risk factors and adherence to antithrombotic/anticoagulant medication in addition to usual care. At 12 months, we compared achieved target goals for secondary prevention, functional outcome, stroke recurrence, and vascular death with age- and gender-matched controls that received only usual care after stroke. We included 45 cases and 45 controls. The following target goals were more frequently achieved in CM-patients than in controls: blood pressure (100% vs. 46.2%, P < 0.001), cholesterol (100% vs. 74.4%, P < 0.001), and body mass index (67.4% vs. 46.2%, P = 0.052). The CM-intervention emerged as an independent predictor of favorable functional outcome (mRS ≤ 2) at 12 months after adjusting for stroke severity and systemic thrombolysis (OR: 4.27; 95%CI:1.2-15.21; P = 0.025). Quality of life was rated significantly higher in CM-patients than in controls (P = 0.049). As opposed to controls, none of the cases experienced a recurrent stroke (0% vs. 13.3%; P = 0.026) or suffered from vascular death (0% vs. 6.7%; P = 0.242). Our pilot data suggest that organized post-stroke care enhances achievement of secondary prevention goals. Its possible effect on stroke recurrence, long-term disability, and quality of life is currently investigated in a prospective cohort study.


Single nucleotide polymorphisms in the u-PA gene are related to susceptibility to oral tongue squamous cell carcinoma in the Northern Chinese Han population.
The purpose of this study was to determine whether susceptibility to oral tongue squamous cell carcinoma (OSCC) is related to polymorphisms in the u-PA gene. We examined the rs2227564 C/T and rs2227562 G/A single nucleotide polymorphisms (SNPs) in 196 OSCC patients and 201 age- and gender- matched controls via direct sequencing and PCR-RFLP methods. Significant differences were found in allelic and genotypic distributions of the rs2227564 and rs2227562 loci when comparing cases and controls. In addition, logistic analyses indicated that the rs2227564 C/T genotype was related to a 1.52-fold increased risk of developing OSCC (adjusted OR=1.521, 95%CI: 1.144~2.022, P=0.004). Linkage disequilibrium analysis was conducted and no association between the two loci was found (D'=0.031, r2=0.000). Our findings provide evidence that the rs2227564 C/T SNP in the u-PA gene is associated with the development of OSCC.


The expression of murine alloantigens on blood lymphocytes.
Single- and two-colour immunofluorescence was used to analyse and compare the expression of 12 antigens on the surface of Ig- mouse blood lymphocytes (BL) and Ig- lymph node (LN) cells. Studies in different strains of mice showed that: (i) there were fewer Thy-1+, Ly 1+, L3T4+ cells in BL compared to LN; (ii) Ly 2+ BL showed a unique fluorescence profile with a temporal variation in antigen density not evident in LN; (iii) Thy-1- Ly 1- cells were more common in BL than LN; (iv) L3T4 and Ly 2 were present on mutually exclusive subpopulations in BL; (v) Ly 6A, (Ly 6.2), Ly 6C (Ly 28.2) Ly 28.6C and Ly 12.1 antigenic determinants were expressed on the same proportion of BL and LN cells and to the same level; (vi) Ly 24 (Pgp-1) was the only alloantigen examined where the number of positive cells was increased in BL (65%) compared to LN (40%); (vii) Ly 5 and Ly 15 (LFA-1) showed significant differences in antigen density distribution between BL and LN; (viii) Ly 21.2 was similar to Ly 15.2 expression; (ix) 20% of Ig-LN cells were Ia+, but Ia was absent from Ig-BL. Thus, BL differ in antigen distribution and density from lymphocytes in LN and other tissues and should be considered as a unique population of lymphocytes.


PD-L1 Expression Is a Prognostic Factor in Patients with Thoracic Esophageal Cancer Treated Without Adjuvant Chemotherapy.
Programmed death-1 ligand 1 (PD-L1) induces apoptosis of tumor-reactive T-cells, that enables tumors to evade immune defense and thus furthers their growth. Our aim was to determine whether PD-L1 expression status correlates with prognosis in patients with advanced thoracic esophageal squamous cell carcinoma. The PD-L1 expression status of 177 patients treated with esophagectomy without preoperative therapy was evaluated immunohistochemically using tissue microarray. We then statistically analyzed the relationships between PD-L1 expression status and clinicopathological features and survival. In patients undergoing surgery alone, PD-L1 expression was significantly positivity associated with a better prognosis. By contrast, there were no significant correlations between PD-L1 expression and clinicopathological features or outcomes in patients treated with surgery plus postoperative adjuvant chemotherapy. PD-L1 positivity in advanced thoracic esophageal squamous cell carcinoma may be predictive of a positive prognosis in patients treated without adjuvant chemotherapy.


Hiding in plain sight: Inconvenient facts for patient safety in non-24/7 theatre on-site staffed obstetric units.
The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on-site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on-call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro-located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles.


Pam3CSK4 adjuvant given intranasally boosts anti-Leishmania immunogenicity but not protective immune responses conferred by LaAg vaccine against visceral leishmaniasis.
The use of adjuvants in vaccine formulations is a well-established practice to improve immunogenicity and protective immunity against diseases. Previously, we have demonstrated the feasibility of intranasal vaccination with the antigen of killed Leishmania amazonensis promastigotes (LaAg) against experimental leishmaniasis. In this work, we sought to optimize the immunogenic effect and protective immunity against murine visceral leishmaniasis conferred by intranasal delivery of LaAg in combination with a synthetic TLR1/TLR2 agonist (Pam3CSK4). Intranasal vaccination with LaAg/PAM did not show toxicity or adverse effects, induced the increase of delayed-type hypersensitivity response and the production of inflammatory cytokines after parasite antigen recall. However, mice vaccinated with LaAg/PAM and challenged with Leishmania infantum presented significant reduction of parasite burden in both liver and spleen, similar to those vaccinated with LaAg. Although LaAg/PAM intranasal vaccination had induced higher frequencies of specific CD4+ and CD8+ T cells and increased levels of IgG2a antibody isotype in serum, both LaAg and LaAg/PAM groups presented similar levels of IL-4 and IFN-y and decreased production of IL-10 when compared to controls. Our results provide the first evidence of the feasibility of intranasal immunization with antigens of killed Leishmania in association with a TLR agonist, which may be explored for developing an effective and alternative strategy for vaccination against visceral leishmaniasis.


Antioxidant capacity of human milk: effect of thermal conditions for the pasteurization.
Pasteurization is the thermal treatment usually applied in milk banks to eliminate the risk of transmission of infectious agents. The aim of this study was to investigate the effect of heat processing upon the antioxidant properties of human milk. Milk samples collected from 31 healthy women were subjected to two different pasteurization techniques: Holder pasteurization (63 degrees C for 30 min) and high pasteurization (75 degrees C for 15 sec) and oxidative stress markers (glutathione, glutathione peroxidase activity, malondialdehyde and total antioxidant capacity) were determined in comparison to fresh milk. Malondialdehyde concentration was the same in all samples, while there was a decrease in glutathione concentration and total antioxidant capacity in milk samples subjected to thermal processing versus fresh milk samples. However, the drop in these parameters was seen to be significantly greater when applying Holder pasteurization. Both thermal treatments induced considerable and similar loss of glutathione peroxidase activity. Thermal processing of human milk implies a decrease in its antioxidant properties but, when necessary, high pasteurization should be the election method in terms of milk oxidative status.


Changes in matrix metalloproteinase (MMP)-2 and MMP-9 in the fetal amnion and chorion during gestation and at term and preterm labor.
Increased matrix metalloproteinase (MMP)-9 proteolytic activity is associated with term birth, preterm birth and premature rupture of membranes. However, most studies show no changes with MMP-2, which binds tightly to cell and matrix proteins. We hypothesized better protein extraction would reveal new MMP patterns. Human amnion and chorion were collected from 25 patients at preterm or term, extracted with 2% SDS (a high concentration), and the MMP protein levels and pro-enzyme activities were determined by Western immunoblotting and zymography. MMP-2 protein and MMP-2 and -9 pro-enzyme activities in the amnion increased significantly (p<0.05) with labor at term, and were higher than at preterm labor (p<0.05), when extracted with high SDS concentration. There were no changes in chorion MMPs under any condition. These associations suggest MMP-2 may be another regulator of membrane rupture and other labor-associated mechanisms at term parturition, and its role(s) should be examined further.


Enhancement of anaerobic digestion of phoenix tree leaf by mild alkali pretreatment: Optimization by Taguchi orthogonal design and semi-continuous operation.
This study aimed at evaluating the valorization of a typical yard waste, phoenix tree leaf (PTL), through mild alkali pretreatment followed by anaerobic digestion (AD). To this end, L9 Taguchi orthogonal biochemical methane potential (BMP) tests and semi-continuous AD experiments were conducted to examine the optimum pretreatment condition and the long term effect of alkali pretreatment on AD. The community structure evolutions were analyzed by high throughput 16S rRNA gene pyrosequencing. The results indicated that alkali pretreatment was effective on decrystallization and releasing more surface of PTL for enzyme attacking. The methane yield was positively correlated with lignin removal (R2=0.8242). In semi-continuous mode, 151.5±7.9 mL/g VS of the methane yield was obtained for alkali pretreated PTL, which was 80% higher than that of untreated one. Microbial community analysis indicated that alkali pretreatment led to a higher abundance of dominated bacteria (Bacteroidetes and Clostridia) and archaea of Methanosaeta.


[1,3-Bis(2,6-diiso-propyl-phen-yl)-1,3-di-hydro-2H-imidazol-2-yl-idene]tri-iodo-borane benzene hemisolvate.
In the title hemisolvate, C27H36BI3N2 .0.5C6H6, the dihedral angles between the central heterocyclic ring and pendant benzene rings are 82.9 (8) and 88.7 (9)° and the complete benzene solvent mol-ecule of crystallization is generated by a crystallographic centre of inversion. In the crystal, one very weak C-H⋯I inter-action links the mol-ecules into [001] chains.


Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China.
To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients' medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients' health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient's annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient's annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient's annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn't change. Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.


Estrogen synthetase in the horse. Comparison of equine placental and rat liver NADPH-cytrochrome c (P-450) reductase activities.
NADPH-cytochrome c (P-450) reductases from horse placenta and rat liver were purified and their biological activities compared using cytochrome c as substrate. Rat liver reductase was purified to electrophoretic homogeneity in one chromatographic step on 2',5'-ADP agarose, and had a relative mass of 85,000 Da as estimated by SDS-PAGE. Equine placental reductase was separated from cytochrome P-450 on aminohexyl-Sepharose 4B and further purified on 2',5-ADP agarose; this preparation exhibited two bands, one of 85,000 and one of 80,000 Da, on SDS-PAGE. The lower molecular weight form was assumed to be a proteolytic product of the higher molecular weight form. A high retention of activity was obtained in both preparations. Equine placenta and rat liver enzymes were found to exhibit very similar Vmax and Km, suggesting that they are not species specific.


Survival analysis of gastric cancer patients with tumor thrombus in the portal vein.
A tumor thrombus in the portal vein originating from gastric cancer is a rare condition. Little is known about the development of portal vein tumor thrombus (PVTT) and its effect on the survival of gastric cancer patients. PVTT originating from gastric cancer was identified retrospectively with computed tomography in 51 patients, from January 2002 to June 2007. PVTT was classified by metastatic routes as follows: lymph node (LN), hepatic mass, and hematogenous type. The median survival from PVTT, and the factors affecting the survival of gastric cancer patients with PVTT were analyzed. The median survival of gastric cancer patients with PVTT (N = 51) was 5.4 months. The median survival was compared according to clinical characteristics, and multivariate analysis proved that female and hepatic mass type were independent risk factors for poor prognosis. The characteristics of the hepatic mass type were old age, higher proportion of tumors located in the upper-third of the stomach, and liver metastasis, compared to the LN or the hematogeneous type. PVTT originating from gastric cancer was a poor prognostic factor and the median survival from PVTT was different according to several clinical factors.


Association between Sarcopenia and Immediate Complications and Mortality in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgery.
Sarcopenia negatively affects oncologic outcomes. However, studies have yet to reveal whether it is associated with postoperative complications and survival among patients with oral cavity squamous cell carcinoma (OSCC). This study retrospectively enrolled 592 patients undergoing primary OSCC surgery with available computed tomography (CT) images of their third cervical vertebrae (C3) within 30 days before surgery between January 2011 and December 2020. Preoperative sarcopenia, nutritional and frailty status, tumor characteristics, comorbidities, and inflammatory markers were assessed. The outcome variables included 30-day complications based on the Buzby and Dindo classification, reoperation, 5- and 8-year overall survival, and disease-free survival. A total of 318 (53.7%) had sarcopenia; of these patients, 217 (68.2%) presented with postoperative complications, and 48 (15.1%) underwent reoperations. Sarcopenia and higher systemic immune-inflammatory index were independently associated with local to systemic 30-day complications. Sarcopenia, advanced-stage disease, and extracapsular spread were correlated with 5- and 8-year survival. The presence of sarcopenia is associated with the 30-day complications and short- and long-term survival of patients who had OSCC and underwent surgery.


A comprehensive nutrition case management system.
An innovative, state-of-the-art, comprehensive nutrition assessment and case management system has been developed by nutritionists (R.D.s) and public health nurses with the San Bernardino County Public Health Department in California. The system consists of three major components: flowsheets for the infant, the child, the perinatal client, family planning, and the adolescent/adult/aging client; a manual that defines and describes nutrition assessment guidelines and interventions; and an appendix that includes resource/reference information. Distinct advantages and unique features of this system include the following: (a) decrease in charting time; (b) precise documentation; (c) a workable diagnostic tool for implementing nutrition interventions; (d) a standard for consistent, quality nutrition care; (e) computer adaptability; and (f) easy accessibility for quality assurance audits.


Molecular probes for fluorescent sensing of metal ions in non-mammalian organisms.
While metal ions play an important role in the proper functioning of all life, many questions remain unanswered about exactly how different metals contribute to health and disease. The development of fluorescent probes, which respond to metals, has allowed greater understanding of the cellular location, concentration and speciation of metals in living systems, giving a new appreciation of their function. While the focus of studies using these fluorescent tools has largely been on mammalian organisms, there has been relatively little application of these powerful tools to other organisms. In this review, we highlight recent examples of molecular fluorophores, which have been applied to sensing metals in non-mammalian organisms.


Development of an ease-of-use remote healthcare system architecture using RFID and networking technologies.
The study aims to provide an ease-of-use approach for senior patients to utilize remote healthcare systems. An ease-of-use remote healthcare system (RHS) architecture using RFID (Radio Frequency Identification) and networking technologies is developed. Specifically, the codes in RFID tags are used for authenticating the patients' ID to secure and ease the login process. The patient needs only to take one action, i.e. placing a RFID tag onto the reader, to automatically login and start the RHS and then acquire automatic medical services. An ease-of-use emergency monitoring and reporting mechanism is developed as well to monitor and protect the safety of the senior patients who have to be left alone at home. By just pressing a single button, the RHS can automatically report the patient's emergency information to the clinic side so that the responsible medical personnel can take proper urgent actions for the patient. Besides, Web services technology is used to build the Internet communication scheme of the RHS so that the interoperability and data transmission security between the home server and the clinical server can be enhanced. A prototype RHS is constructed to validate the effectiveness of our designs. Testing results show that the proposed RHS architecture possesses the characteristics of ease to use, simplicity to operate, promptness in login, and no need to preserve identity information. The proposed RHS architecture can effectively increase the willingness of senior patients who act slowly or are unfamiliar with computer operations to use the RHS. The research results can be used as an add-on for developing future remote healthcare systems.


Cholangiocarcinoma and liver cirrhosis in relation to changes due to thioacetamide.
Different doses of thioacetamide (0.05%, 0.1% and 0.15%) were used to induce liver cirrhosis in Wistar rats. Thioacetamide at 0.5% caused cirrhosis by the twelfth week of treatment. A severe bile duct proliferation and cholangiocarcinoma was seen at longer intervals. Animals treated with higher doses (0.1% and 0.15%) of thioacetamide developed more severe intense degenerative changes in the liver and died in the twelfth and eighth week respectively. The serum and tissue contents of Zn and Cu changed in a characteristic fashion that was consistent with the severity of the liver damage. Serum Zn and Cu concentrations were at their lowest in the animals that developed severe degenerative liver and died at higher dose (0.15%) of thioacetamide. This study indicates that treatment of rats with 0.05% thiocetamide is more effective and appropriate for the induction of liver cirrhosis. Continued administration of the drug at this dosage led to the development of further changes in the liver. This model may be suitable for studying these long term changes that occur in the liver and lead to cirrhosis. Events that precede the development of severe bile duct proliferation and cholangiocarcinoma may also be studied.


Association between circulating fibrocytes and angiographic coronary collaterals in patients with obstructive coronary artery disease.
Circulating fibrocytes are a population of bone marrow-derived progenitor cells that have been implicated in neovascularization. The recruitment of coronary artery collaterals, a form of neovascularization, is associated with improved outcomes in coronary artery disease. In this study, we tested the hypothesis that, in subjects with stable chronic coronary artery disease, the blood concentration of fibrocytes is associated with the presence of angiographic coronary collaterals. A total of 58 subjects with at least one epicardial coronary artery with ≥ 90% luminal stenosis were enrolled, among whom 26 (45%) had angiographic evidence of coronary collaterals. Subjects with collaterals had significantly elevated circulating concentrations of all examined subsets of activated fibrocytes, suggesting that there is a relationship between fibrocytes and coronary collateral recruitment.


Bone marrow biopsy instead of 'marrow juice' for cell kinetic analysis. Comparison of bone marrow biopsy and aspiration material.
Since cell kinetic bone marrow studies have so far exclusively been carried out on aspiration material and have yielded inconsistent or even contradictory results, we investigated the adequacy and reliability of aspirates for cell kinetic analyses in comparison to biopsies. Paired samples of bone marrow (133) were taken simultaneously by aspiration and Jamshidi biopsy from 48 patients with acute leukemias and 67 patients with non-leukemic disorders. Cell kinetic analysis by (1) flow cytometry (FCM) of cellular DNA and RNA content, (2) autoradiography for [3H]TdR pulse labelling indices and (3) liquid scintillation counting of [3H]TdR uptake revealed significantly higher values in biopsies (p less than 0.001) exceeding the corresponding results from aspirates on average by factors of 1.65 for FCM S-phase index, 1.90 for G0/1 cells with high RNA content, 1.82 for [3H]TdR LI and 1.90 for [3H]TdR uptake. In more than 70% of all samples results from biopsies were 1.1-11.4 times higher, indicating that aspirates were equivalent to biopsies in fewer tan 30% of cases. Cell kinetic analysis in vitro blood/biopsy mixtures and measurements of DNA synthesis rate in corresponding aspirates and biopsies revealed that these discrepancies are due to the contamination of aspirates with non-proliferating nucleated blood cells. Biopsy, however, was found to provide representative and reproducible sampling of marrow for cell kinetic studies and should replace the presently used aspirate already characterized as "unreliable marrow juice" by Dameshek et al. in 1937 [18].


Must we discontinue selective cervical nerve root blocks? Report of two cases and review of the literature.
We report two detrimental neurologic complications after technically correct selected cervical nerve root blocks. Based on these cases and a thorough review of the literature, the indication for cervical nerve root blocks was reconsidered and limited. Similarly, we modified our technique to further reduce the likelihood for the occurrence of such severe complications.


Minimally Invasive Coronary Artery Bypass Grating Using Bilateral In Situ Internal Thoracic Arteries.
When performing minimally invasive coronary artery bypass grafting (MICS CABG), it is difficult to access the right internal thoracic artery (ITA) under direct vision. We successfully performed off-pump MICS CABG using the bilateral in situ ITAs through a 8-cm left thoracotomy under direct vision for a 76-year-old man. His postoperative course was uneventful and all the grafts were patent. This novel, minimally invasive approach safely preserves the sternum and delivers the benefits of bilateral in situ ITA grafting, providing an alternative to conventional CABG and off-pump CABG.


High Thermoelectric Power Factor of Poly(3-hexylthiophene) through In-Plane Alignment and Doping with a Molybdenum Dithiolene Complex.
We report a record thermoelectric power factor of up to 160 μW m-1 K-2 for the conjugated polymer poly(3-hexylthiophene) (P3HT). This result is achieved through the combination of high-temperature rubbing of thin films together with the use of a large molybdenum dithiolene p-dopant with a high electron affinity. Comparison of the UV-vis-NIR spectra of the chemically doped samples to electrochemically oxidized material reveals an oxidation level of 10%, i.e., one polaron for every 10 repeat units. The high power factor arises due to an increase in the charge-carrier mobility and hence electrical conductivity along the rubbing direction. We conclude that P3HT, with its facile synthesis and outstanding processability, should not be ruled out as a potential thermoelectric material.


Artificial photosynthesis for production of hydrogen peroxide and its fuel cells.
The reducing power released from photosystem I (PSI) via ferredoxin enables the reduction of NADP(+) to NADPH, which is essential in the Calvin-Benson cycle to make sugars in photosynthesis. Alternatively, PSI can reduce O2 to produce hydrogen peroxide as a fuel. This article describes the artificial version of the photocatalytic production of hydrogen peroxide from water and O2 using solar energy. Hydrogen peroxide is used as a fuel in hydrogen peroxide fuel cells to make electricity. The combination of the photocatalytic H2O2 production from water and O2 using solar energy with one-compartment H2O2 fuel cells provides on-site production and usage of H2O2 as a more useful and promising solar fuel than hydrogen. This article is part of a Special Issue entitled Biodesign for Bioenergetics--The design and engineering of electronc transfer cofactors, proteins and protein networks, edited by Ronald L. Koder and J.L. Ross Anderson.


Anti-HBc, HBeAg and DNApolymerase activity in healthy HBsAg carriers and patients with inflammatory liver diseases.
In this paper we report on anti-HBc-titers, HBcAg, DNApolymerase activity in the serum and intracellular HBsAg in healthy HBsAg-carriers and patients with HBsAg-positive inflammatory liver diseases. 32/44 patients with acure virus-B-hepatitis were negative for anti-HBc in the first week of the disease. Anti-HBc-titers in healthy HBsAg-carriers varied between 1:10 and 1:32,000 (medium titer 1:4,000). In HBsAg-positive CAH we found a medium titer between 1:32,000 and 1:64,000, in cases with CPH of about 1:16,000. All autoimmune type CAH showed anti-HBc-titers less than 1:10. By immunofluorescence we could demonstrate in a group of 71 asymptomatic HBsAg-carriers in none of the healthy HBsAg-carriers HBcAg in the liver cell nuclei. In contrast HBcAg could only be found in 4/5 HBsAg positive CAH- and 6/9 CPH patients. No elevated DNApolymerase activity could be demonstrated in healthy HBsAg-carriers. Out of 44 patients with virus-B-hepatitis only 3 showed elevated DNApolymerase activity. On the other hand DNApolymerase elevation was demonstrable in 17/37 cases with CAH and 9/15 with CPH. The investigations showed a strong correlation between the demonstration of HBcAg in the serum and the DNApolymerase activity. The characteristic findings enabled us to differentiate between "healthy" HBsAg-carriers and HBsAg-carriers with inflammatory liver diseases.


An Evolution of Suffering: Anesthesiology's Contribution to Pain Management.
The modern human, and all progenitor species before it, evolved in a milieu of pain and suffering. Recent innovations in medicine have permitted the development of tools to mitigate these powerful experiences. Anesthesiologists have been on the vanguard of developing treatments and systems to face this challenge. Pain is a heterogeneous entity that requires precise categorization, and targeted, multimodal treatment to optimally manage. Anesthesiologists have developed a system whereby analgesia permits a myriad of life-saving surgeries, and have expanded their role beyond the perioperative setting. This includes unique contributions to how the concept of pain is experienced by infants, and appropriate interventions in this population. Contemporary anesthesiologists have extended their responsibilities to include harnessing robust technologies to manage pain in outpatient clinics, and serving as pain experts within hospital systems. This article serves as a primer to the history of anesthesiologists' contributions to pain management.


The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash.
Compared to younger age groups, older people are more likely to be seriously injured or to die as a result of a traffic crash. The aim of the study is to examine the impact of environmental, vehicle, crash, and driver characteristics on injury severity in older drivers involved in traffic crashes by using recently linked police crash records and hospitalization data from New South Wales, Australia. The severity of injury resulting from traffic crashes was measured using the International Classification of Diseases, 10th revision (ICD-10) Injury Severity Score (ICISS). Multivariate analysis identified rurality, presence of complex intersections, road speed limit, driver error, speeding, and seat belt use as independent predictors of injury severity in older people. The type of intersection configuration explained over half of the observed variations in injury severity. Environmental modification such as intersection treatments might contribute to a decrease in the severity of injury in older people involved in road crashes.


Kidney function and cognitive impairment among older hospitalized patients: a comparison of four glomerular filtration rate equations.
The relationship between the estimated glomerular filtration rate (eGFR) and cognitive impairment may change as a function of the equation used. We aimed at investigating the association between four different eGFR equations and cognitive impairment among older hospitalized patients. Our series consisted of 795 older patients consecutively admitted to 7 geriatric and internal medicine acute care wards. The eGFR was calculated by Chronic Kidney Disease Epidemiologic Collaboration (CKD-EPI), Cockcroft-Gault (CG), Berlin Initiative Study (BIS) and Full Age Spectrum (FAS) equations. Study outcomes were total Mini Mental State Examination (MMSE) < 24 and sub-scores related to orientation to time, orientation to space, registration, calculation, three words recall, language and constructional praxis. Statistical analysis was carried out by logistic or Poisson regressions when appropriate. The accuracy of eGFR equations in identifying cognitive outcomes was investigated by calculating the area (AUC) under the receiver operating characteristic (ROC) curve for each equation. After adjusting for potential confounders, eGFR < 30 was significantly associated with MMSE < 24 only with CKD-EPI equation (OR 2.03, 95% CI 1.04-3.96). eGFR < 30 was significantly associated with constructional apraxia with all study equations (CKD-EPI: OR 3.62, 95% CI 1.73-7.56; BIS: OR 2.86, 95% CI 1.31-6.26; FAS: OR 2.83, 95% CI 1.44-5.56; CG: OR 2.08, 95% CI 1.09-3.99). The accuracy of eGFR < 30 in identifying patients with defective constructional praxis was poor with all (BIS: AUC 0.54, 95% CI 0.52-0.55; CKD-EPI: AUC 0.55, 95% CI 0.53-0.57; CG: AUC 0.58, 95% CI 0.55-0.61; FAS: AUC 0.56, 95% CI 0.54-0.58). Constructional apraxia may characterize the cognitive profile of older patients with severe CKD. The accuracy in identifying patients with constructional apraxia is only fair, and studies including other biomarkers of kidney function are needed.


Chemiluminescence determination of folic acid by a flow injection analysis assembly.
A flow injection (FI) method is reported for the determination of folic acid by chemiluminescence method. This method is based on the reaction of folic acid with Ru(bipy)(3)(2+) and Ce(IV) to produce chemiluminescence. The calibration curve was linear over the range of 2.5×10(-5)-3.1×10(-7) mol/L with a detection limit of 2.3×10(-8) mol/L (S/N=3). The relative standard deviation of 1.0×10(-6) mol/L folic acid was found 3.5% (n=11). The influences of potential interfering substances were studied. The recovery was higher than 95.3%. The method was accurate, sensitive, and effective for assay of folic acid. This CL method was successfully applied to the determination of folic acid in pharmaceutical preparations. The mechanism of CL reaction was also studied.


Social support reduces the impact of partner violence on health: application of structural equation models.
Intimate partner violence (IPV) is associated with poorer health, yet pathways through which IPV affects either mental or physical health are not well characterized. Structural equation modeling was used to test a model in which physical-IPV and battering were considered as separate independent variables. The sample included 191 women currently experiencing either physical IPV or battering. Emotional support provided to women experiencing IPV was hypothesized to mediate the impact of IPV on current mental and physical health (dependent variables). Higher scores on emotional support were associated with better physical (beta = -0.23, P < 0.01) and mental health (beta = -0.27, P < 0.001). Physical IPV was directly associated with poorer mental health (beta = 0.023, P < 0.01) and indirectly associated with poorer physical health (beta = 0.18, P < 0.001) and mental health (beta = -0.04, P < 0.05), primarily through battering. Higher battering scores were directly associated with less emotional support (beta = -0.33, P < 0.001) and indirectly associated with poorer physical (beta = 0.12, P < 0.01) and mental health (beta = 0.09, P < 0.01), primarily through emotional support. Model diagnostics indicated a good fit (chi(2) = 20.44, P = 0.37, GFI = 0.98, CFI = 0.99, RMSEA = 0.02). Higher levels of emotional support may modify the effect of IPV on health. Interventions to increase social and emotional support to abused women may reduce mental and physical health consequences.


[Prognostic value of Valsalva maneuver-induced change in Doppler-detected ventricular filling in patients with systolic dysfunction].
In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers. The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]=0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43). Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure.


Heat shock gene expression and function during zebrafish embryogenesis.
Recent work in the zebrafish, Danio rerio, indicates that heat shock genes are expressed in unique spatial patterns under non-stress conditions. In particular, hsp90alpha is expressed during the normal differentiation of striated muscle fibres, and hsp70-4 is expressed during normal lens development in the eye. Furthermore, disruption of the activity of either of these genes or their protein products gives rise to unique embryonic phenotypes that result from failures in proper somitic muscle development and lens development, respectively. Embryonic hsp70-4 expression is also activated in a cell-specific manner following heavy metal exposure. This has allowed for the development of a hsp70-4/eGFP reporter gene system in stable transgenic zebrafish that serves as a reliable yet extremely quick indicator of cell-specific toxicity in the context of the multicellular, living embryo.


A Bayesian Reanalysis of a Trial of Psilocybin versus Escitalopram for Depression.
To perform a Bayesian reanalysis of a recent trial of psilocybin (COMP360) versus escitalopram for Major Depressive Disorder (MDD) in order to provide a more informative interpretation of the indeterminate outcome of a previous frequentist analysis. Reanalysis of a two-arm double-blind placebo controlled trial. Fifty-nine patients with MDD. Two doses of psilocybin 25mg and daily oral placebo versus daily escitalopram and 2 doses of psilocybin 1mg, with psychological support for both groups. Quick Inventory of Depressive Symptomatology-Self-Report (QIDS SR-16), and three other depression scales as secondary outcomes: HAMD-17, MADRS, and BDI-1A. Using Bayes factors and 'skeptical priors' which bias estimates towards zero, for the hypothesis that psilocybin is superior by any margin, we found indeterminate evidence for QIDS SR-16, strong evidence for BDI-1A and MADRS, and extremely strong evidence for HAMD-17. For the stronger hypothesis that psilocybin is superior by a 'clinically meaningful amount' (using literature defined values of the minimally clinically important difference), we found moderate evidence against it for QIDS SR-16, indeterminate evidence for BDI-1A and MADRS, and moderate evidence supporting it for HAMD-17. Furthermore, across the board we found extremely strong evidence for psilocybin's non-inferiority versus escitalopram. These findings were robust to prior sensitivity analysis. This Bayesian reanalysis supports the following inferences: 1) that psilocybin did indeed outperform escitalopram in this trial, but not to an extent that was clinically meaningful--and 2) that psilocybin is almost certainly non-inferior to escitalopram. The present results provide a more precise and nuanced interpretation to previously reported results from this trial, and support the need for further research into the relative efficacy of psilocybin therapy for depression with respect to current leading treatments. NCT03429075.


Quantum chemical modeling of the thermodynamics of the formation of Au(III), Pd(II), and Pt(II) chloride complexes.
Quantitative prediction of physical properties of liquids and equilibrium constants is important for many applications. Computational methods based on either explicit or implicit solvent models can be used to approximate thermodynamics of complexation. A practical method for calculating the stability constant of d8 chlorocomplexes (PdCl42-, PtCl42-, AuCl4-) in aqueous solution has been developed by using DFT and DLPNO-CCSD with the SMD solvation model and 100 unique explicit water molecules. Stability constants have been calculated by using methods, such as DFT/PBE0-D3, DLPNO-CCSD, DLPNO-CCSD-DK, and DLPNO-CCSD(T), and basis sets, such as def2-TZVPD, def2-TZVPP, ma-def2-TZVP, ma-DKH-def2-TZVP, SARC-TZVP, and SARC-TZVPP. Calculations using DFT/PBE0-D3/def2-TZVPD and DLPNO-CCSD-DK/ma-DKH-Def2-TZVP/SARC-DKH-TZVP with SMD solvation with explicit waters are found to have errors of 2-3 log units relative to experimental data. The best results are obtained by using 8 explicit waters for d8 aqua complexes, 14 explicit waters for d8 chlorocomplexes, and 4 explicit waters for chloride ion.


Discrimination of Dioscorea species (Chinese yam) using FT-IR integrated with chemometric approach.
Dioscorea oppositifolia is an important crop and functional food. D. oppositifolia tuber is often adulterated with D. persimilis, D. alata, and D. fordii tuber in the commercial market. This study proposed an integrated Fourier transform infrared spectroscopy (FT-IR) with chemometric approach to differentiate these four Dioscorea species. A total of 107 Dioscorea spp. tuber samples were collected from different locations in China. Principal Component Analysis (PCA), PCA-Class, and Orthogonal Partial Least Square Discriminant Analysis (OPLS-DA) were utilised to classify the FT-IR spectra. In this PCA is unable to differentiate the Dioscorea spp. tuber effectively. However, PCA-Class and OPLS-DA can distinguish spp. these 4 species Dioscorea tuber with high accuracy, sensitivity, and specificity. Additionally, the RMSEE, RMSEP and RMSECV values for OPLS-DA model were low, showing that it is a good model. The combination of FT-IR with the PCA-Class and OPLS-DA is practical in discriminating Dioscorea spp. tubers.


Eosinophilic granuloma: Presenting as a draining fistula.
A case report of an orbital eosinophilic granuloma presenting as a fistula in a 15-year-old boy is presented. The patient had a history of a painful right upper eyelid swelling which required drainage and was considered as an abscess. An increase in swelling occurred and a small fistula appeared in the area subsequently. Computed tomography scan revealed a large soft tissue lesion in right superolateral orbit having intracranial extradural extension with destruction of bony orbital margin. Fine needle aspiration biopsy of the lesion revealed eosinophilic granuloma. A complete excision of the lesion was performed by a brow incision and histopathological examination of the excised specimen confirmed diagnosis. Although upper eyelid area eosinophilic granuloma is known to occur, its presentation as a fistula is not known.


Construction of degradable multilayer films for enhanced antibacterial properties.
Infections associated with medical devices have become a major concern. The adhesion of bacteria to the devices' surfaces during the initial 24 h is believed to be a "decisive period" for implant-associated infections, which pose key challenges to optimal antiadhesion of microbes in this period. Herein, we have designed and constructed a (heparin/chitosan)10-(polyvinylpyrrolidone/poly(acrylic acid))10 [(HEP/CHI)10-(PVP/PAA)10] multilayer film by layer-by-layer self-assembly. Assembly of the underlying (HEP/CHI)10 multilayer film is based on electrostatic interactions, showing the properties of contact killing of bacteria. Deposition of the top (PVP/PAA)10 multilayer film is based on hydrogen bond interactions. The PAA molecules are then cross-linked to form anhydride groups by thermal treatment at 110 °C for 16 h. Therefore, it shows a top-down degradable capability in the determined period, leading to almost no adhesion of bacteria in 24 h. Our system combining the adhesion resistance and the contact killing properties shows an enhanced antibacterial capability through targeting the "decisive period" of implantation may have great potential for applications in medical implants, tissue engineering, etc.


A novel scheme of dystrophin disruption for the progression of advanced heart failure.
The precise mechanism of the progression of advanced heart failure is unknown. We assessed a new scheme in two heart failure models: (I) congenital dilated cardiomyopathy (DCM) in TO-2 strain hamsters lacking delta-sarcoglycan (SG) gene and (II) administration of a high-dose of isoproterenol, as an acute heart failure in normal rats. In TO-2 hamsters, we followed the time course of the histological, physiological and metabolic the progressions of heart failure to the end stage. Dystrophin localization detected by immunostaining age-dependently to the myoplasm and the in situ sarcolemma fragility evaluated by Evans blue entry was increased in the same cardiomyocytes. Western blotting revealed a limited cleavage of the dystrophin protein at the rod domain, strongly suggesting a contribution of endogenous protease(s). We found a remarkable up-regulation of the amount of calpain-1 and -2, and no change of their counterpart, calpastatin. After supplementing TO-2 hearts with the normal delta-SG gene in vivo, these pathological alterations and the animals' survival improved. Furthermore, dystrophin but not delta-SG was disrupted by a high dose of isoproterenol, translocated from the sarcolemma to the myoplasm and fragmented. These results of heart failure, irrespective of the hereditary or acquired origin, indicate a vicious cycle formed by the increased sarcolemma permeability, preferential activation of calpain over calpastatin, and translocation and cleavage of dystrophin would commonly lead to advanced heart failure.


Validation of a classification system for causes of death in critical care: an assessment of inter-rater reliability.
Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case). Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% CI, 0.49-0.60), and for proximate cause of death List B, kappa was 0.58 (95% CI, 0.53-0.63). For the underlying cause of death, kappa was 0.48 (95% CI, 0.44-0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%-93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%-92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%-81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators. The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.


Sensitization to p-amino aromatic compounds: Study of the covalent binding of 2,5-dimethyl-p-benzoquinonediimine to a model peptide by electrospray ionization tandem mass spectrometry.
To understand the hapten-protein complex formation in the context of skin contact allergy to p-amino aromatic derivatives, 2,5-dimethyl-p-benzoquinonediimine was used as a model compound to study the reactivity of p-benzoquinonediimines, first oxidation intermediates of allergenic p-amino aromatic compounds, toward a model peptide containing naturally occurring and potential reactive amino acids. LC-MS analysis, together with electrospray ionization MS/MS, was used for the determination of amino acid selectivity by studying the chemical modifications induced on the peptide due to covalent binding of the p-benzoquinonediimine. Results reported in this paper indicated that 2,5-dimethyl-p-benzoquinonediimine reacted with the epsilon-NH(2) group of lysine to first form a covalent adduct of the Schiff's base kind. Besides, an oxido-reduction process started that induced an oxidative deamination of lysine to form a peptidyl alpha-aminoadipic-delta-semialdehyde, by a mechanism similar to the one known for several enzymatic quinonoid co-factors, followed by an intramolecular cyclization of the peptide. From these results it could be concluded that lysine must be considered as an important amino acid for the hapten-protein complex formation in the case of p-benzoquinonediimines and that, in addition to direct covalent binding, further degradation of the peptide can be produced.


Current concepts in the treatment of disorders of micturition.
Disorders of micturition may be divided into disturbances of the storage function of the bladder, and disturbances of the emptying function. The main symptoms of disturbances of storage function are frequency, urgency and incontinence. Hyperactivity of the bladder may lead to urge incontinence, and incompetence of the urethral closure mechanism to stress incontinence. There are many drugs available for treating bladder hyperactivity, but their efficacy as judged from controlled clinical trials (when available) is often limited. Bladder contraction in man is mediated by stimulation of muscarinic receptors, and when given parenterally anticholinergic drugs have been shown to depress bladder hyperactivity irrespective of the underlying cause. Clinically, however, treatment of urge incontinence with anticholinergic drugs is often unsatisfactory. Lack of effect of oral treatment and systemic side effects limit the use of available agents. Drugs with "mixed" actions (anticholinergic and 'direct' muscle effects), for example oxybutynin and terodiline, have well-documented efficacy in bladder hyperactivity. Side effects are common with oxybutynin; terodiline seems to be well tolerated. The aim of drug treatment of stress incontinence is to increase outflow resistance. Although there is only limited possibility of improving the condition with drugs, beneficial effects can be obtained in some patients by use of orally active alpha-adrenoceptor agonists (e.g. phenylpropanolamine) and/or oestrogens. The main symptom of disturbed bladder emptying is urinary retention. Drug therapy is aimed at improving the contractile activity of the detrusor or reducing urethral outflow resistance. Drugs used for improving bladder contractility include parasympathomimetic agents, e.g. bethanechol or carbachol, and intravesical instillation of prostaglandins. Although the efficacy of both types of treatment is open to question, bethanechol seems to be widely used. Increased outflow resistance may be seen in patients with parasympathetic decentralization of the lower urinary tract or in patients with benign prostatic hypertrophy. These patients may respond favourably to alpha-adrenoceptor blockers such as phenoxybenzamine or prazosin.


Techniques to minimize the pain of injected local anesthetic.
The process of injecting local anesthetic still often remains the most uncomfortable part of dermatologic surgery for patients. This review discusses strategies that may be used to reduce this discomfort.


Bik reduces hyperplastic cells by increasing Bak and activating DAPk1 to juxtapose ER and mitochondria.
Bik reduces hyperplastic epithelial cells by releasing calcium from endoplasmic reticulum stores and causing apoptosis, but the detailed mechanisms are not known. Here we report that Bik dissociates the Bak/Bcl-2 complex to enrich for ER-associated Bak and interacts with the kinase domain of DAPk1 to form Bik-DAPk1-ERK1/2-Bak complex. Bik also disrupts the Bcl2-IP3R interaction to cause ER Ca2+ release. The ER-associated Bak interacts with the kinase and calmodulin domains of DAPk1 to increase the contact sites of ER and mitochondria, and facilitate ER Ca2+ uptake by mitochondria. Although the Bik BH3 helix was sufficient to enrich for ER-Bak and elicit ER Ca2+ release, Bik-induced mitochondrial Ca2+ uptake is blocked with reduced Bak levels. Further, the Bik-derived peptide reduces allergen- and cigarette smoke-induced mucous cell hyperplasia in mice and in differentiated primary human airway epithelial cultures. Therefore, Bik peptides may have therapeutic potential in airway diseases associated with chronic mucous hypersecretion.Bcl-2 interacting killer (Bik) decreases airway epithelial hyperplasia via apoptosis mediated by calcium release from the endoplasmic reticulum (ER), but the mechanism is unclear. Here the authors show that Bik promotes Bak enrichment at the ER to tether mitochondria for efficient calcium transfer.


Prevalence of familial autoimmune diseases in juvenile idiopathic arthritis: results from the international Pharmachild registry.
Little is known about the disposition to autoimmune diseases (ADs) among children diagnosed with JIA. In this study, we provide a comprehensive overview of the prevalence of and factors associated with ADs in parents of children with juvenile idiopathic arthritis (JIA). Prevalence rates of ADs and 95% Poisson confidence intervals were calculated for parents of JIA patients from the international Pharmachild registry and compared with general population prevalence rates as reported in the literature. Demographic, clinical and laboratory features were compared between JIA patients with and without a family history of AD using χ2 and Mann-Whitney U tests. Eight thousand six hundred seventy three patients were included and the most common familial ADs were psoriasis, autoimmune thyroid disease, rheumatoid arthritis and ankylosing spondylitis. The prevalence of several ADs was higher in parents of the included JIA patients than in the general population. Clinical Juvenile Arthritis Disease Activity Scores at study entry and last follow-up were not significantly different between patients with (n = 1231) and without a family history of AD (n = 7442). Factors associated with familial AD were older age at JIA onset (P < 0.01), Scandinavian residence (P < 0.01), enthesitis-related arthritis, psoriatic arthritis and undifferentiated arthritis (P < 0.01), ANA positivity (P = 0.03) and HLA-B27 positivity (P < 0.01). Familial AD proves to be a risk factor for JIA development and certain diseases should therefore not be overlooked during family health history at the diagnosis stage. A family history of AD is associated with the JIA category but does not influence the severity or disease course.


Immune complex-like material in the serum and plasma exchange in patients with metastatic cancer.
Clinical significance of immune complex-like material in the serum was investigated in tumour patients undergoing plasma exchange with albumin-saline solution and subsequent chemotherapy. Immune complexes were detected by the Clq binding assay or the Raji cell radioimmunoassay in nine out of forty-five patients before this therapy. Levels of immune complexes were decreased to 10-30% of the initial value by plasma exchange depending on exchanged plasma volume. In contrast to other serum proteins like alpha 1-antitrypsin and alpha 2-macroglobulin, which showed protein specific increase during follow up after plasma exchange in all patients, recovery rates of immune complexes and IgG were highly individual but parallel in each patient. Clinical response to this protocol did not correlate with immune complex status, suggesting that removal of the measured immune complex like material had little clinical significance or was not longlasting enough to provide therapeutic benefit.


Challenges relating to the inter-facility transport of high acuity paediatric cases.
The motivation for this study came from anecdotal reports and observations that there was a potential need for improvement to the systems that support inter-facility transfers of high acuity paediatric cases between referring and receiving facilities in Johannesburg, South Africa. In this exploratory study, we formally document and describe challenges being experienced by members of the healthcare team in facilitating the inter-facility transport of high acuity paediatric cases. A qualitative, explorative design was applied, making use of interviews with purposefully-identified role players involved in paediatric transportation and care. Verbatim transcripts from audio recorded interviews underwent content analysis to allow for the identification of common categories. Participants described a number of challenges, which included time delays, lack of qualified ambulance personnel, poor communication between role players, and lack of appropriate equipment. There are significant challenges experienced by members of the healthcare team with regard to inter-facility transport of high acuity paediatric and neonatal cases in Johannesburg, South Africa. Whilst we acknowledge the African context and resource constrained setting, health systems managers need to explore the feasibility of establishing dedicated and suitably resourced retrieval teams who specialise in the transfer of high acuity paediatric and neonatal patients in order to improve quality of care and overall patient outcomes in this population.


Bench-to-bedside review: sepsis, severe sepsis and septic shock - does the nature of the infecting organism matter?
International guidelines concerning the management of patients with sepsis, septic shock and multiple organ failure make no reference to the nature of the infecting organism. Indeed, most clinical signs of sepsis are nonspecific. In contrast, in vitro data suggest that there are mechanistic differences between bacterial, viral and fungal sepsis, and imply that pathogenetic differences may exist between subclasses such as Gram-negative and Gram-positive bacteria. These differences are reflected in different cytokine profiles and mortality rates associated with Gram-positive and Gram-negative sepsis in humans. They also suggest that putative anti-mediator therapies may act differently according to the nature of an infecting organism. Data from some clinical trials conducted in severe sepsis support this hypothesis. It is likely that potential new therapies targeting, for example, Toll-like receptor pathways will require knowledge of the infecting organism. The advent of new technologies that accelerate the identification of infectious agents and their antimicrobial sensitivities may allow better tailored anti-mediator therapies and administration of antibiotics with narrow spectra and known efficacy.


A rapid method for the identification of nitrocellulose in high explosives and smokeless powders using GC-EI-MS.
Nitrocellulose (NC) is one of the most common ingredients in explosive mixtures, however because of its non-volatility, its detection using Gas Chromatography-Electron Ionization-Mass Spectrometry (GC-EI-MS) has not been achieved until today. A rapid method for the identification of NC in bulk explosives using GC-EI-MS was developed. The sample preparation is simple and takes place in a test tube, employing standard equipment of a forensics laboratory. The protocol was optimized and applied to seven, both high and low, commercial explosives, which contained the substance of interest. Moreover, three explosives in the absence of NC were tested to cross check for false positives. Fourteen different standard explosive substances that are usually found in explosive mixtures were then employed in order to monitor the effect of the method on these compounds and check for interferences. Results showed that NC was detected, by its trimethylsilyl (TMS) derivatives, in all the explosive mixtures analyzed and no false positives were observed. The proposed method showed selectivity for NC, as it had no interference coming from other ingredients of explosive mixtures. The protocol introduced offers considerable improvement in identifying the individual components of an explosive mixture and contributes in successful classification of explosives.


The relationship between patient's participation in shade selection and their satisfaction with their dental prostheses.
Multiple studies have measured the degree of patients' satisfaction with their dental prostheses. Some found that the preliminary cause for dissatisfaction was attributed to the shade used in the fabrication their prostheses. Therefore, the aim of this study is to evaluate the relationship between patients' participation in the shade selection procedure and their satisfaction with their prostheses. In this cross-sectional study, an online based questionnaire was distributed. Out of 475 participants, 374 who met inclusion criteria were enrolled in this study. A questionnaire consisting of 19 questions and two parts was utilized. Data were analyzed using IBM SPSS 25 with a level of significance (p value) ≤ 0.05. The majority of participants were involved in the shade selection procedure (81%) and satisfied with the shade of their dental prostheses (83.7%). Satisfaction rate was higher in patients who participated in shade selection (87.8%). One in every three patients wanted a lighter shade than that they currently have. All results were statistically significant. Patients' participation in their prostheses' shade selection increased their satisfaction with them. It is crucial that patients receive professional advice during shade selection for them to make an informed decision regarding the shade of their prostheses.


Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus.
The roles of hyperglycemia in diabetic gastroparesis and gastric delivery in postprandial hyperglycemia of diabetic patients are unclear. The aims of this study were to assess gastric emptying and its relation to postprandial glucose metabolism in patients with asymptomatic non-insulin-dependent diabetes mellitus (NIDDM) and no autonomic neuropathy and to identify motor mechanisms responsible for any accelerated gastric emptying. Autonomic function, gastric emptying, postprandial glucose metabolism, and hormone levels (glucagon, insulin, cholecystokinin, glucose-dependent insulinotropic polypeptide, neurotensin, and peptide YY) were assessed in healthy volunteers and patients with NIDDM. In a second study, gastric tone and motility were measured in patients with accelerated gastric emptying and in controls. Gastric emptying of solids did not differ in the two groups, but liquids emptied faster in patients with NIDDM (P < 0.02). The rate of entry of ingested glucose into the systemic circulation was similar, but higher postprandial glucagon and lower insulin concentrations led to greater (P < 0.01) postprandial hepatic glucose release. Levels of other enteropeptides, gastric accommodation, and antral motility were similar, but patients with NIDDM had greater proximal gastric phasic contractions than controls (P < 0.05). Excessive hepatic glucose release, not rapid entry of ingested glucose, is the primary cause of postprandial hyperglycemia in patients with NIDDM. Accelerated gastric emptying in patients with nonneuropathic NIDDM is associated with increased proximal stomach phasic contractions.


Salinomycin Modulates the Expression of mRNAs and miRNAs Related to Stemness in Endometrial Cancer.
Salinomycin, an ionophore antibiotic, has a strong anti-cancer effect, inducing the apoptosis of cancer cells and cancer stem cells. The aim of the study was to assess the influence of salinomycin on the expression profile of genes related to stemness and miRNA regulating their expression in endometrial cancer cells. Endometrial cancer cells of cell line Ishikawa were exposed to salinomycin at concentrations in the range of 0.1-100 μM, with the aim of determining its pro-apoptotic potential and the concentration which would cause the death of 50% of the cells (Sulforhodamine B test). In the following stages, the cells were incubated with the drug at a concentration of 1μM for 12,24 and 48 hour periods and compared to the control. Determining the changes in the expression of the genes related to stemness and regulating their miRNA was done using the microarray technique and RTqPCR. ELISA assay was performed in order to determine the level of TGFβ2, COL14A1, CDH2, WNT5A in cell culture under salinomycin treatment in comparison to the control. Salinomycin caused the apoptosis of cells. For the concentration of 0.1 μM, a decrease in the population of living cells by 11.9% was determined. For 1 μM, it was 49.8%, for 10 μM -69.4%, and for a concentration of 100 μM - 87.9%. The most noticeable changes in the expression caused by the addition of salinomycin into the culture were noted for mRNA: TGFβ2; WNT5A (up-regulated); COL14A1; CDH2 (down-regulated), as well as miRNA: hsa-miR-411 (up-regulated); hsa-miR-200a; hsa-miR-33a; hsa-miR-199a; hsa-miR-371-5p; hsa-miR-374; hsa-miR-374b (down-regulated). It was confirmed that salinomycin has an influence on the stemness process. The most noticeable changes in the expression were noted for mRNA: TGFβ2; COL14A1; CDH2; WNT5A, as well as for miRNA: hsa-miR-200a; hsa-miR-33a; hsa-miR-199a; hsa-miR-371-5p; hsa-miR-411; hsa-miR- 374a; hsa-miR-374b.


Patchouli alcohol suppresses castration-resistant prostate cancer progression by inhibiting NF-κB signal pathways.
There is evidence that patchouli alcohol (PA) has cytotoxic effects on human cancer cell lines, including inhibiting cell growth, migration, and invasion. However, the exact molecular mechanism of PA in human castration-resistant prostate cancer (CRPC) cells remains unclear. DU145 and PC-3 cells were treated with different concentrations of PA for 48 h. Cell counting kit-8 (CCK-8), colony formation, and 5-ethynyl-2'-deoxyuridine (EdU) staining were used to detect cell proliferation. Scratch tests and transwell assays were used to detect cell migration and invasion. TdT-mediated dUTP nick-end labeling (TUNEL) staining and flow cytometry were performed to examine apoptosis and mitochondrial membrane potential. The expression of the apoptosis- and migration-related proteins and the phosphorylation of the nuclear factor kappa -B (NF-κB) cells were detected by Western blot. A chromatin immunoprecipitation (ChIP) analysis was conducted to examine NF-κB p65 binding to the myeloid cell leukemia-1 (Mcl-1) promoter. A xenograft model of nude mice was established to verify the anticancer effects of PA in vivo. PA inhibited the proliferation, migration, and invasion, and induced the apoptosis of the DU145 and PC-3 cells in a concentration-dependent manner, and was accompanied by mitochondrial membrane potential depolarization, the upregulation of cleaved caspase-3, cleaved poly ADP-ribose polymerase (PARP) and Bcl-2-associated X protein (Bax), and the downregulation of B-cell lymphoma-2 (Bcl-2), Ki67, and Mcl-1. In relation to the mechanism, PA significantly downregulated the phosphorylation of inhibitor of NF-κB α (IκBα) and p65 and the expression of matrix metalloprotein (MMP)-2, MMP-7, MMP-9, and vascular endothelial growth factor (VEGF). PA prevented p65 binding to the Mcl-1 promoter by inactivating NF-κB p65, downregulated the transcription of Mcl-1, and the silencing of p65 increased the sensitivity of the CRPC cells to PA-induced apoptosis. The overexpression of Mcl-1 significantly reversed the PA-induced apoptosis of the CRPC cells. Additionally, consistent with our in-vitro study, PA inhibited tumor growth in the mouse xenograft model. We found that PA inhibits the growth, migration, and invasion of CRPC cells in vitro and in vivo by inducing an apoptosis mechanism and inhibiting NF-κB activity. Our findings may provide therapeutic targets for this malignant tumor.


Factors influencing quality of life in children with low-flow vascular malformations: a qualitative study using focus groups.
Very few studies have evaluated the quality of life (QoL) of children suffering from low-flow vascular malformations. This is the first study investigating the influencing factors. To identify the factors influencing QoL in children with low-flow vascular malformations. We conducted a qualitative study employing focus group interviews (Clinical Trials Number: NCT03440827). The study was a prospective, interventional, non-comparative, multicentre study performed in four expert centres for vascular anomalies. Qualitative data about personal experiences, feelings, difficulties, needs and various factors influencing behaviours were collected. Theme-based content analysis (manual and specialist textural software guided) were used to analyse the verbatim transcripts of all focus group sessions. Manual qualitative discourse analysis was performed to identify the different themes and categories. Informatics' analyses were subsequently performed for each individual category. Ten focus groups (26 individuals including 10 children aged 11 to 15 years) were conducted until saturation. Influencing factors were related to 4 categories: medical care, self-image, social impact on daily activities and challenging social relationships. These factors were responsible for intrafamily upheavals and may lead to future identity-building problems. This study provides an essential framework from which physicians can develop strategies to improve patient care and quality of life. These data may also be useful to develop specific age-sensitive QoL questionnaires.


Study of patient-reported morbidity following V-beam pulsed-dye laser treatment of port wine stains.
The V-beam pulsed-dye laser (PDL) (595 nm) has gained popularity in the treatment of port wine stains (PWS). It uses longer pulse durations than the standard flashlamp-pumped pulsed-dye laser (FPDL) (585 nm) and has an in-built cooling system to protect the epidermis. This should, theoretically, reduce the treatment-associated side effects, including discomfort. The aim of this questionnaire-based study was to confirm the clinical impression that V-beam PDL is well tolerated. The results were compared with a historical group of 62 PWS patients treated with FPDL. Fifty-one patients took part in the current study. Only 35.7% (vs. 81% in the historical comparison group) required topical anaesthetic prior to laser treatment. A shortening in the duration of bruising (8 vs. 10 days) and of symptoms such as burning and tightness (3 vs. 10 days) was recorded. Lifestyle change after treatment was recorded by fewer patients (39 vs. 57%). We conclude that V-beam PDL is better tolerated than FPDL when used at therapeutic levels in patients with PWS.


Multilayer bacterial cellulose/resole nanocomposites: Relationship between structural and electro-thermo-mechanical properties.
The aim of this research was to fabricate multilayer insulator nanocomposites using phenolic resin impregnated bacterial cellulose (BC) handsheets and investigate the relationships between their structural and electro-thermo-mechanical properties. G. xylinus was incubated in a static Hestrin-Schramm culture at 28 °C for 14 days. Then, BC aqueous suspension was added to kraft pulp aqueous suspension. The content of BC that was added to the pulp suspension was as follows: 5, 10 and 15%. The disintegrated BC was turned into handsheets by a vacuum method. Dried handsheets were immersed in phenolic resin. To obtain composites, 5 immersed handsheets from each treatment were laid-up and hot pressed at 150 °C under 100 MPa pressure for 10 min. The specimens were characterized by means of thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), thermal mechanical analysis (TMA), field-emission scanning electron microscopy (FE-SEM) techniques and insulating tests as dielectric loss factor and breakdown voltage. The results of thermal analysis showed an improvement in the thermal stability and an increase in the evaporation enthalpy of prepared samples with higher BC content. The mechanical examinations indicated that by increasing BC content in nanocomposites, the loss modulus and tan delta increased and the storage modulus of specimens decreased. The coefficient of thermal expansion (CTE) of samples diminished with increase of BC content. FE-SEM characterization showed different qualities of resin impregnation of the papers. The results of insulating tests confirmed that dielectric loss tangent and dielectric breakdown voltage increased in the specimens with higher BC content.


The design, synthesis, and anti-tumor mechanism study of N-phosphoryl amino acid modified resveratrol analogues.
A novel series of trans-N-phosphoryl amino acid modified resveratrol analogues were synthesized and evaluated in vitro for their cytotoxic effects against CNE-1 and CNE-2 cell lines. These analogues showed good anti-proliferative activity, among which 8d, 8e, 8j, and 9d displayed much stronger inhibition effect than resveratrol and 8d showed the most potent activity with IC(50) value at 3.45+/-0.82microM. The anti-tumor effects of 8d, 8e, 8j, and 9d were due to the induction of apoptosis, confirmed by the DNA fragmentation and flow cytometry analysis using PI (propidium iodide) staining and Annexin-V-FITC/PI staining assay. The PI staining assay also showed that 8d, 8e, 8j, and 9d caused cell cycles arrest at G(0)-G(1) phase which finally led to cell apoptosis. Further mechanism study on compound 8d against CNE-2 cells has shown the PARP cleavage, which is a hallmark of caspase-3 activation, as well as the activation of caspase-9, and the intracellular ROS generation. These results all suggest that 8d induced a mitochondrial-dependent apoptosis pathway.


Is tigecyclin a good choice in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia?
The aim of this study was to evaluate the efficacy of tigecycline in multidrug-resistant (MDR) Acinetobacter baumannii pneumonia. We retrospectively evaluated the outcome of adult patients with culture proven MDR A. baumannii pneumonia treated with tigecycline between January 2009 and March 2011. The study comprised a total of 72 MDR A. baumannii pneumonia cases (44 men, mean age 65.9±15.0). Tigecycline was used for a mean duration of 10.7±4.8 days. Microbiological eradication was observed in 47 cases (65.3%). Overall mortality was 55.5% and was lower in cases with microbiological eradication vs others (15/47 32% vs 25/25 100%, p<0.0001). Mortality and microbiological eradication rates were not different with monotherapy vs combination therapy (p>0.05). Patients who died had lower albumin levels, higher APACHE-II scores and CRP levels. The microbiological eradication rate of tigecycline in MDR A. baumannii was considerable. However, eradication of A. baumannii did not result in favorable clinical outcomes in those patients with low albumin, higher APACHE-II scores and CRP levels.


Aqueous-phase behavior and vesicle formation of natural glycolipid biosurfactant, mannosylerythritol lipid-B.
Mannosylerythritol lipids (MELs) are one of the most promising glycolipid biosurfactants produced by yeast strains of the genus Pseudozyma. In this study, the aqueous-phase behavior of a new monoacetyl MEL derivative, 1-O-beta-(2',3'-di-O-alka(e)noyl-6'-O-acetyl-d-mannopyranosyl)-d-erythritol (MEL-B), was investigated using polarized optical microscopy, small-angle X-ray scattering (SAXS), confocal laser scanning microscopy (CLSM), and differential scanning calorimetry (DSC). The present MEL-B was found to self-assemble into a lamellar (L(alpha)) phase over remarkably wide concentration and temperature ranges. According to SAXS measurement, the interlayer spacing (d) was estimated to be almost constant (about 4.7 nm) at the low MEL-B concentration (<or=60 wt.%) region where the L(alpha) phase is in equilibrium with the excess water phase (L(alpha)+W). On the other hand, at high MEL-B concentration (>60 wt.%) region, the d-spacing gradually decreased to 3.1 nm with an increase in the MEL-B concentration. The thermal stability of the liquid crystalline phase was investigated by DSC measurement. The obtained L(alpha) phase was found to be stable up to 95 degrees C below a MEL-B concentration of 85 wt.%; then, the melting temperature of the liquid crystalline phase dramatically decreased with an increase in MEL-B concentration (above 85 wt.%). Furthermore, we found relatively large vesicles (1-5 microm) at the low MEL-B concentration using CLSM observation. The trapped volume of the obtained MEL-B vesicle was estimated to be about 0.42 microL/mumol by glucose dialysis method. These results suggest that the natural glycolipid biosurfactant, the newly found MEL-B, would be useful in various fields of applications as an L(alpha) phase- and/or vesicle-forming lipid.


A test of the hypothesis of compensatory upstream dispersal using a stream-dwelling waterstrider, Gerris remigis Say.
This paper reports the results of 2 experiments designed to determine if adult Gerris remigis (Hemiptera, heteroptera), a stream-dwelling waterstrider, tend to disperse preferentially upstream, as predicted by the colonization cycle hypothesis summarized by Muller (1982). Markrecapture observations and experimental removals were used to assess the distance and direction of movement of adult G. remigis along a small mountain stream, over a full year. These experiments indicated that adult G. remigis show a significant upstream bias in movement distance, but not in numbers of animals moving. This upstream bias is characteristic of pre-reproductive, sexually immature adults of both sexes, and occurs primarily in association with movements to and from diapause sites. Although the existence of a significant upstream bias in movement distances tends to support the colonization cycle hypothesis, the data from the removal experiments clearly show that upstream dispersal is not sufficient to compensate entirely for downstream drift.


The hypothalamic melanocortin system stimulates the hypothalamo-pituitary-adrenal axis in vitro and in vivo in male rats.
alpha-Melanocyte-stimulating hormone (alpha-MSH) is an agonist, and agouti-related protein (Agrp) an endogenous antagonist at the melanocortin 3 and 4 receptors which are found in the central nervous system (CNS). We have examined the effect of alpha-MSH and Agrp on the hypothalamo-pituitary-adrenal (HPA) axis in vitro and in vivo in male rats. Intraparaventricular nuclear (iPVN) injection of [Nle(4),D-Phe(7)]-alpha-MSH (NDP-MSH) (a long-acting alpha-MSH analogue) increased plasma adrenocorticotropic hormone (ACTH) (10 min post-injection: 25.0 +/- 3.9 vs. saline 10.9 +/- 2.0, p < 0.05) and plasma corticosterone (10 min post-injection: 174.1 +/- 14.2 vs. saline 124.7 +/- 16.3 ng/ml, p < 0.05). iPVN injection of Agrp(83-132) increased plasma ACTH (24.2 +/- 4.0 vs. saline 10.1 +/- 1.0 pg/ml, p < 0.01). The combination of NDP-MSH and Agrp(83-132) administered iPVN significantly increased plasma ACTH (10 min post-injection: 21.3 +/- 3.8 vs. 10.9 +/- 2.0, p < 0.05) and plasma corticosterone (10 min post-injection: 169.0 +/- 15.1 vs. saline 124.7 +/- 16.3 ng/ml, p < 0.05), but there was no additive effect. Hypothalamic explants treated with alpha-MSH (100 nM) resulted in a 159 +/- 23% increase in corticotropin-releasing hormone (CRH) release (p < 0.01) and 175 +/- 12% increase in arginine vasopressin (AVP) release (p < 0.001) compared to basal. Agrp(83-132) (100 nM) administered to hypothalamic explants resulted in a 161 +/- 20% increase in CRH (p < 0.01) and 174 +/- 13% increase in AVP release (p < 0.001) compared to basal. Hypothalamic explants treated with the combination of alpha-MSH and Agrp(83-132) (100 nM) resulted in a 179 +/- 31% increase in CRH release (p < 0.01) and 130 +/- 9% increase in AVP release (p < 0.01) compared to basal, but there was no additive effect. This is the first report that both alpha-MSH and Agrp(83-132) stimulate the HPA axis. The combination of alpha-MSH and Agrp(83-132) has no additive effect in vitro and in vivo in male rats. These results suggest that there may be another receptor independent of the known melanocortin receptors at which Agrp is acting.


Long-term results of Chiari pelvic osteotomy on the preservation of hip function with mean follow-up of more than 30 years and its prognostic factors.
Clinical outcomes of Chiari pelvic osteotomy for acetabular dysplasia, including conversion to total hip arthroplasty (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its prognostic factors as the second outcome. This study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan-Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters. The study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan-Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0-98.4%) at 20 years and 73.5% (95% CI 61.1-86.0%) at 30 years. In contrast, the Kaplan-Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8-95.7%) at 20 years and 65.6% (95% CI 52.3-79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01). Chiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function.


Computer aided diagnosis method for steatosis rating in ultrasound images using random forests.
In this paper we discuss the problem of computer aided evaluation of the severity of steatosis disease using ultrasound images. The AIM of the study being to compare the automatic evaluation of liver steatosis using random forests (RF) and support vector machine (SVM) classifiers. One hundred and twenty consecutive patients with steatosis or normal liver, assessed by ultrasound by the same expert, were enrolled. We graded steatosis in four stages and trained two classifiers to rate the severity of disease, based on a large set of labeled images and a large set of features, including several features obtained by robust estimation techniques. We compared RF and SVM classifiers. The classifiers were trained using cross-validation. There was 80% of data randomly selected for training and 20% for testing the classifier. This procedure was performed 20 times. The main measure of performance was the accuracy. From all cases, 10 were rated as normal liver, 70 as having mild, 33 moderate, and 7 severe steatosis. Our best experts' ratings were used as ground truth data. RF outperformed the SVM classifier and confirmed the ability of this classifier to perform well without feature selection. In contrast, the performance of the SVM classifier was poor without feature selection and improved significantly after feature selection. The ability and accuracy of RF to classify well the steatosis severity, without feature selection, were superior as compared to SVM.


Immunological, biochemical and pathological effects of vitamin C and Arabic gum co-administration on H9N2 avian influenza virus vaccinated and challenged laying Japanese quails.
This study evaluated the effect of co-administration of vitamin C and Arabic gum (AG) supplements on the response of vaccinated (VAC) and challenged laying Japanese quails with avian influenza virus (AIV) H9N2. One hundred and fifty 49-day-old laying Japanese quails were divided into 5 groups (G1-G5): the G1 group was a negative control, G2 group was unvaccinated + H9N2 challenged (Ch), G3 group was unvaccinated + supplements + Ch, G4 group was VAC + Ch, and the G5 group was VAC + supplements + Ch. The supplements (vitamin C, 1 g/liter of drinking water and AG, 1% ration) were given for 5 weeks post-vaccination (PV). The birds were injected subcutaneously with an inactivated H9N2 vaccine at 49 days of age. The quails were then challenged intranasally with AIV H9N2 at the 3rd week PV. Blood, tracheal swab and tissue samples were collected at the 1st, 2nd, and 3rd weeks PV, and at different time points post-challenge (PC). Growth performance, egg production (%), egg and eggshell weights, HI antibody titers, clinical signs, lesions, mortality, virus shedding rates, leukogram, biochemical and immunological parameters and histopathological lesions PC showed significant differences (P < 0.05) between the vaccinated-unsupplemented (G4) group and the vaccinated-supplemented (G5) group. G5 showed the highest (P < 0.05) growth performance, egg production, HI antibody titers, and heterophil phagocytic activity and the lowest heterophil/lymphocyte (H/L) ratio, mortality, virus shedding rates, creatinine level and histopathological lesion scores in the lungs. The co-administration of vitamin C and AG for 5 weeks can improve growth performance, egg production and the immune response in vaccinated laying quails challenged with AIV H9N2.


Vaccination with an ovalbumin/interleukin-4 fusion DNA efficiently induces Th2 cell-mediated immune responses in an ovalbumin-specific manner.
To more effectively drive immune responses toward antigen-specific T helper type 2 (Th2) cell-mediated responses, we constructed a mammalian expression vector (pOVA/IL4) carrying a fused gene in which the ovalbumin (OVA) cDNA was covalently linked to murine interleukin-4 (IL-4) cDNA. A biologically active OVA/IL4 protein was expressed by the transfected COS cells with the pOVA/IL4 DNA, as demonstrated by Western blotting and cytokine bioassay. Intramuscular injection of BALB/c mice with the pOVA/IL4 DNA increased both the production of OVA-specific IL-4 by CD4+ T cells and the ratio of anti-OVA IgG1 to anti-OVA IgG2a isotypes, while the injection with the pOVA DNA alone, or with the mixture of the pOVA and pIL4 DNA did no or little increase. Furthermore, the OVA-specific, Th2 cell-mediated immune responses were significantly enhanced by multiple injections with the pOVA/IL4 DNA. These studies indicate that the direct linkage of an OVA gene to an IL-4 gene in the expression plasmid confines the effects of IL-4 to the OVA-specific cells, efficiently driving the immune response toward OVA-specific, Th2 cell-mediated responses.


A new measure of 'lay' care-giver activities.
The Lay Care-Giving for Adults Receiving Dialysis (LC-GAD) was developed using qualitative and quantitative approaches to systematically measure the breadth and quantity of caregiver activities. The reliability and validity of these evaluations was tested on a sample of 447 Canadian family members and friends who cared for adults on dialysis. Factor analysis was performed independently assessing two components. The first measured the abstract, cognitive work of care-giving (Think-LC-GAD) which included the subscales of appraisal, advocating, coaching, juggling and routinizing. These five factors explained two-thirds of the total variance of the Think-LC-GAD. The second component measured the concrete tasks of care-giving (Task-LC-GAD) which included providing transportation, performing dialysis, personal hygiene, diet, symptom relief, comfort measures and teaching self-care. These seven factors explained seven-eights of the total variance in the Task-LCGAD. Test-retest reliability of these two components had significant correlation coefficients. The validity of the Think- and Task-LC-GADs showed positive correlations between themselves and the perceived burden of care-giving, the trait of conscientiousness and self-reported self-care abilities.


[Tumor-like courses in lung sarcoidosis (4 observations)].
Case reports on 4 women operated on for suspected tumour. The diagnosis of sarcoidosis was confirmed histologically. The difficulties associated with the differential diagnosis are discussed and, the need for morphological clarification is emphasized.


Enterostatin increases extracellular serotonin and dopamine in the lateral hypothalamic area in rats measured by in vivo microdialysis.
The effect of enterostatin injection into the rat lateral hypothalamic area (LHA) on serotonin and dopamine releases in extracellular space was investigated by in vivo microdialysis technique. The primary focus being to understand whether a small amount of enterostatin crossing the blood-brain barrier correlates with activity changes in serotonergic and dopaminergic nervous systems or not. We found a significant elevation in serotonin release in the LHA. The enterostatin perfusion also induced a smaller but significant increase in dopamine level than serotonin one. This result suggests that enterostatin plays some sort of role in the control of feeding of fat through the control serotonergic and dopaminergic satiety mechanism.


Patterns of use of palliative radiotherapy fractionation for bone metastases and 30-day mortality.
Adoption of single-fraction radiation therapy (SFRT) has not been universal in the palliative treatment of bone metastases, despite evidence supporting its safety and efficacy. The aim of this study was to assess SFRT use for bone metastases in New South Wales (NSW), Australia, and the rate of 30-day mortality (30DM). This is a population-based cohort of patients who received palliative radiation therapy (RT) for bone metastases (2009-2014), as captured in the NSW Central Cancer Registry. A logistic regression model was used to identify factors associated with fractionation type. The proportion of patients dying within 30-days from treatment start date was calculated. Of the 14,602 courses of palliative RT delivered for bone metastases, 30% were SFRT. SFRT was more likely to be delivered to older patients: ≥80 years (34%) versus < 60 years (28%). Patients with lower socioeconomic status (SES) (35%) were more likely to receive SFRT compared with higher SES (25%). SFRT delivered to patients from outer regional area of residence (34%) were higher compared to those from the major city (29%). The proportion of SFRT delivered to patients with comorbidities ≥2 (34%) was higher than patients with no comorbidity (29%). SFRT was associated with higher 30DM of 21% compared with 11% for multi-fraction RT (MFRT). SFRT is underused for the treatment of bone metastases in NSW. This is an impetus to develop tools making SFRT obligatory in this setting unless there is good justification not to.


Datawarehouse-enabled quality control of atrial fibrillation detection in the stroke unit setting.
(1) To assess the accuracy of a standard operating procedure (SOP) regarding the utilization of atrial fibrillation (AF) alarms in everyday clinical practice, and (2) to evaluate the performance of automated continuous surveillance for atrial fibrillation (AF) in hospitalized acute stroke patients. Retrospective cohort study. Two stroke units from two tertiary care hospitals in Berlin, Germany. We identified 635 patients with ischemic stroke diagnosis for the time period between 01. January and 30. September 2021 of which 176 patients had recorded AF alarms during monitoring. Of those, 115 patients were randomly selected for evaluation. After excluding 6 patients with hemorrhagic stroke in their records, 109 patients (mean age: 79.1 years, median NIHSS at admission: 6, 57% female) remained for analysis. Using a clinical data warehouse for comprehensive data storage we retrospectively downloaded and visualized ECG data segments of 65 s duration around the automated AF alarms. We restricted the maximum number of ECG segments to ten per patient. Each ECG segment plot was uploaded into a REDCap database and categorized as either AF, non-AF or artifact by manual review. Atrial flutter was subsumed as AF. These classifications were then matched with 1) medical history and known diseases before stroke, 2) discharge diagnosis, and 3) recommended treatment plan in the medical history using electronic health records. The primary outcome was the proportion of previously unknown AF diagnoses correctly identified by the monitoring system but missed by the clinical team during hospitalization. Secondary outcomes included the proportion of patients in whom a diagnosis of AF would likely have led to anticoagulant therapy. We also evaluated the accuracy of the automated detection system in terms of its positive predictive value (PPV). We evaluated a total of 717 ECG alarm segments from 109 patients. In 4 patients (3.7, 95% confidence interval [CI] 1.18-9.68%) physicians had missed AF despite at least one true positive alarm. All four patients did not receive long-term secondary prevention in form of anticoagulant therapy. 427 out of 717 alarms were rated true positives, resulting in a positive predictive value of 0.6 (CI 0.56-0.63) in this cohort. By connecting a data warehouse, electronic health records and a REDCap survey tool, we introduce a path to assess the monitoring quality of AF in acute stroke patients. We find that implemented standards of procedure to detect AF during stroke unit care are effective but leave room for improvement. Such data warehouse-based concepts may help to adjust internal processes or identify targets of further investigations.