[Orbital metastasis from mucinous adenocarcinoma of the rectum].
Orbital metastasis from colorectal cancer are extremely rare. Only six cases are described in the literature. The discrepancy between the frequency of colorectal cancer and the rarity of metastasis to the eye and orbit remains paradoxical and enigmatic. We report the case of an 18-year-old young woman with orbital metastasis as the presenting sign of rectal cancer. Proptosis is the most frequent presenting clinical sign. Once the diagnosis is made, the prognosis is poor and treatment is palliative.


Comparing scrotoplasty complication rates in transgender and cisgender men: An ACS NSQIP study.
While masculinizing gender-affirming genital surgeries may include scrotoplasty, there has been limited research on the safety and outcomes of scrotoplasty among transgender men. We compared scrotoplasty complication rates between cisgender and transgender patients using data from the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) database. Data was queried between 2013 and 2019 for all patients with procedure codes for scrotoplasty. Transgender patients were identified through a gender dysphoria diagnosis code. T-tests and Fisher's exact test were used to identify any differences in demographics, operative characteristics, and outcomes. The primary outcomes of interest were demographic factors, operative details, and surgical outcomes. A total of 234 patients were identified between 2013 and 2019. Fifty were transgender and 184 were cisgender. Age and BMI were significantly different between the two cohorts, such that the cisgender cohort was older (M trans = 38 years (SD:14), M cis = 53 years (SD: 15)) and had higher BMI than the transgender cohort (M trans = 26.9 (SD: 5.5), M cis = 35.2 (SD: 11.2)). Cisgender patients also had poorer overall health (p = 0.001), and were more likely to have hypertension (p = 0.001) and diabetes (p = 0.001). Race and ethnicity did not vary significantly between the cohorts. Operative details differed significantly between cohorts, such that transgender patients had a longer operating time (M trans = 303 min (SD: 155), M cis = 147 min (SD: 107)) and fewer transgender patients had a simple scrotoplasty (p = 0.02). The majority of gender-affirming scrotoplasties were performed by plastic surgeons (62%) whereas the majority of cisgender scrotoplasties were performed by urologists (76%). Despite these demographic and pre-operative differences, the number of patients who underwent complex scrotoplasty experiencing any of the tested complications did not differ by gender. Our results support scrotoplasty as a safe procedure for transgender patients, with no significant differences in outcomes between transgender and cisgender patients.


Advancing the use of new approach methodologies for assessing teratogenicity: Building a tiered approach.
Many New Approach Methodologies (NAMs) have been developed for the safety assessment of new ingredients. Research into reproductive toxicity and teratogenicity is a particularly high priority, especially given their mechanistic complexity. Forty-six non-teratogenic and 39 teratogenic chemicals were screened for teratogenic potential using the in silico DART model from the OECD QSAR Toolbox; the devTox quickPredict™ (devTox assay) test and the Zebrafish Embryotoxicity Test (ZET). The sensitivity and specificity were 94.7% and 84.1%, respectively, for the DART tree (83 chemicals), 86.1% and 35.6% for the devTox (81 chemicals) and 77.8% and 76.7% for the ZET (57 chemicals). Fifty-three chemicals were tested in all three assays and when results were combined and based on a "2 out of 3 rule", the sensitivity and specificity were 96.0% and 71.4%, respectively. The specificity of the devTox assay for a sub-set of 43 chemicals was increased from 26.1% to 82.6% by incorporating human plasma concentrations into the assay interpretation. When all 85 chemicals were assessed in a decision tree approach, there was an excellent predictivity and assay robustness of 90%. In conclusion, all three models exhibited a good sensitivity and specificity, especially when outcomes from all three were combined or used in "2 out of 3" or a tiered decision tree approach. The latter is an interesting predictive approach for evaluating the teratogenic potential of new chemicals. Future investigations will extend the number of chemicals tested, as well as explore ways to refine the results and obtain a robust Integrated Testing Strategy to evaluate teratogenic potential.


Insomnia.
Insomnia complaints are common in the general population and are seen with even greater frequency among psychiatric patients. In any patient, the development of insomnia complaints may reflect the combined influences of various psychological, psychophysiologic, pharmacologic, and other medical factors. The capacity to describe and define specific sleep disorders is an important component in the development of a workable plan for the treatment of these disturbances. Knowledge of specific behavioral and pharmacologic modalities is also necessary for the choice of safe and effective treatment approaches.


Acute dermal capillary rupture associated with noninvasive blood pressure monitoring.
We report a case of Rumpel-Leede phenomenon, or acute dermis capillary rupture, secondary to noninvasive blood pressure monitoring in a patient with type 2 diabetes mellitus. The most likely cause was increased venous pressure during cycling of the blood pressure cuff during a hypertensive state. Anesthesiologists need to be aware that acute dermal capillary rupture, although rare, can occur in patients with thrombocytopenia and/or long-standing diabetes.


Laparoscopic hysteropexy in a patient with spina bifida and ventriculoperitoneal shunt.
Laparoscopic repair of pelvic organ prolapse in patients with ventriculoperitoneal shunts has not been previously described. The optimum management of patients with ventriculoperitoneal shunts undergoing laparoscopy is uncertain. We describe the case of a 21-year-old female patient with spina bifida and ventriculoperitoneal shunt who underwent laparoscopic hysteropexy for severe pelvic organ prolapse. The implications of performing laparoscopy on patients with ventriculoperitoneal shunts are reviewed along with strategies to reduce potential intraoperative complications.


Isoenzymes of canine plasma alkaline phosphatase: an investigation using isoelectric focusing and related to diagnosis.
The isoenzymes of canine alkaline phosphatase have been separated by isoelectric focusing on agarose gels. Alkaline phosphatase from normal tissue extracts gave heterogeneous focusing patterns with the following isoelectric points: liver pH 4.3, bone pH 4.0 to 4.9, kidney pH 4.4 to 4.7 and intestine pH 3.6 to 4.6. Plasma alkaline phosphatase isoenzymes were examined in 123 dogs with activities at least twice the normal maximum. The isoenzymes from these plasma samples had multiple bands at pH 4.3 to 4.6 but in 67 per cent of all cases, the predominant isoenzyme, named isoenzyme A, was a single band of isoelectric point pH 3.5. Isoenzyme A occurred in all dogs with diabetes mellitus or Cushing's syndrome and in 93 per cent of animals receiving steroid therapy. Increased activities of the pH 4.3 to 4.6 isoenzymes were more likely to occur in cases of hepatic degeneration.


A case report on probable short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing following vairechanika nasya in Ménière's disease.
A 62 year old woman diagnosed with Ménière's disease, who underwent vairechanika nasya (VN) with shadbindu taila presented with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) like phenomena immediately after the procedure. Rescue measures of abhyanga (local oil massage) and nadi sweda (local fomentation) were administered. Within half an hour the symptoms considerably declined and after 1 hour got completely relieved. The exact symptom disclosure by the patient who herself was a doctor helped in detecting the classic pattern of 'saw tooth phenomena' giving leads into a rare manifestation of probable SUNCT. Naranjo scale yielded zero score and thus the probable causality of VN with shadbindu taila could not be established so as to cause probable SUNCT as an adverse drug reaction (ADR). This case study is not put up for reporting an ADR of VN with shadbindu taila; rather this illustrates an uncommon, yet imperative adverse event of probable SUNCT while undergoing nasya procedure probably due to judgment error while fixing the VN dose in a patient with Ménière's disease. Transparent reporting of such unusual events during panchakarma procedures is necessary so that clinicians can understand, evaluate and take appropriate initiatives to manage them.


Photothermal-responsive fiber dressing with enhanced antibacterial activity and cell manipulation towards promoting wound-healing.
For chronic persistent skin injuries, functional wound dressings with improved antibacterial action and cell control are extremely appealing. In this study, we design and fabricate a composite fiber dressing with near-infrared (NIR) laser-induced hyperthermia and transformable topographies that can protect the wound from bacterial infection while also encouraging cell recruitment and tissue regeneration. Polycaprolactone/gelatin (PCL/Gel) with melting point close to photothermal temperature were electrospun as the supporting matrix. The zeolitic imidazolate framework-8 (ZIF-8)-derived nanocarbon was synthesized as NIR laser-triggered nanoagent and then electrospun within oriented PCL/Gel fibers to enable the inorganic/polymer composite fiber dressing with photo-to-thermal conversion effect and drug loading capability. The composite fiber dressing exhibits excellent photothermal performance and stage-specific transformable topographies (photothermal-triggered melting behavior of oriented PCL/Gel fibers) after multiple laser irradiations, which can generate local massive heat and abundant drug release for synergistic sterilization, as well as direct cell migration and adhesion/spreading to promote tissue regeneration. Furthermore, in vivo testing demonstrates that the photothermal-responsive fiber dressing accelerates wound closure process by synergistically improving antibacterial and cell manipulation. Overall, this composite fiber dressing offers a promising integrated wound healing strategy.


Dipyridamole modulates multidrug resistance and intracellular as well as nuclear levels of doxorubicin in B16 melanoma cells.
Simultaneous occurrence of resistance to many chemotherapeutic agents, termed multidrug resistance (MDR), is a complex phenotype. MDR occurs due to several reasons, including over-expression of a 170-kDa membrane-bound protein, called P-glycoprotein (P-gp), which apparently participates in active drug efflux. Multidrug-resistant cells also frequently exhibit an altered pattern of intracellular drug distribution, resulting in a reduction in the nuclear level of drugs such as doxorubicin (DOX). In this study, the effect of dipyridamole (DP) on drug resistance and on intracellular as well as nuclear levels of DOX in multidrug-resistant melanoma cells has been examined. For this purpose, drug-sensitive murine melanoma cells (B16V) and their multidrug-resistant variant cells, (B16VDXR; selected for resistance to DOX) which over-produce P-gp, were employed. B16VDXR cells were cross-resistant to several anti-cancer agents including etoposide (VP-16) and mitoxantrone (Mitox). DP (10 microM) significantly potentiated the cytotoxicity of DOX, VP-16 and Mitox towards multidrug-resistant B16VDXR cells but not in parental drug-sensitive B16V cells. The presence of DP resulted in a 3.7-fold increase in the total cellular level and a 4.2-fold increase in the nuclear content of DOX in the resistant cells. Isobologram analysis indicates that DP at several pharmacologically relevant concentrations synergistically potentiates the activity of DOX in B16VDXR cells.


The hepatic excretion of 131I-rose bengal and 99mTc-IDA derivatives in Rotor's syndrome.
Bilirubin kinetics and hepatobiliary excretion of some exogenous anions (BSP, 131I-rose bengal, diethyl and parabutly-IDA labeled with 99mTc) were studied in three patients presenting with Rotor's syndrome. Two were brothers; a nonjaundiced fraternal twin of one of them was also evaluated. The hepatic clearance of the radiopharmaceuticals was impaired in the affected patients but the degree of impairment was different among the tested anions, i.e., maximal for 99mTc-diethyl-IDA and minimal for 131I-rose bengal. Parabutyl-IDA was cleared better than the diethyl derivative. The metabolic derangement seems to be at the level of transfer from plasma to liver and of the hepatic storage, rather than at the level of hepatocyte excretory pathways, as in the case of Dubin-Johnson syndrome.


Effects of spatial attention on detection and identification of oriented lines.
In this paper, we study the effects of spatial attention on detection and identification of oriented lines presented at near-threshold luminance. In the first experiment, we found that the cuing effect was greater when observers had to discriminate between two close orientations than when they had to discriminate between two far-apart orientations. In the second experiment, we examined the effects of peripheral cues on summation of low-contrast oriented lines. We found that the range of orientations within which summation occurred was greater when the cues were invalid than when they were valid. Our results suggest that attention to a specific location in the visual field modulates the neural channels which code orientation in at least two different ways: (a) spatial attention increases the responsivity of these channels to stimuli presented at this location, and (b) it reduces the bandwidths or ranges of orientations to which these channels are sensitive. These results suggest that the properties of the orientation-tuned channels, including those that seem to exert their effects at early stages of orientation processing (e.g., tuning function), may not be fixed, but rather vary according to the attention being paid to the spatial region within which the target stimulus is presented.


[Review of 22 patients with 22q11.2 deletion syndrome: phenotype spectrum].
The 22q11.2 deletion syndrome is a contiguous gene deletion syndrome with an incidence rate of 1/4,000-6,000 live births. The most specific clinical features are: congenital conotruncal heart diseases, palate anomalies, hypocalcaemia, immunity and learning problems, and a characteristic facial phenotype. The objective of this work is to review the presenting phenotype and clinical features of children with 22q11.2 deletion syndrome as a guide for early diagnosis. Retrospective study of 22 patients with 22q11.2 deletion syndrome diagnosed at our hospital in the time period 2004-2007. Variables analyzed: incidence, sex, age at diagnosis, presenting phenotype, clinical features, positive family history, mortality and natural history. From a total of 22 patients, 63 % were males, and the median age at diagnosis was of 4.5 years. Presenting pheno-type: congenital heart disease, milestones delay, velopharyngeal incompetence, hypocalcaemia, and mental retardation/psychiatric disturbances. congenital heart disease (84 %), velopharyngeal incompetence (47 %), milestones delay and learning disabilities (79 %). All of the deletions were de novo, except in one case where the deletion was present as mosaicism in the father. Three patients died, due to congenital heart disease. Clinical expression is widely variable, although a characteristic phenotype exists. Patients with heart disease are diagnosed earlier than other patients with unusual presenting phenotype such as congenital dysphagia. It is important to recognize less common phenotypes at early ages in order to provide multidisciplinary monitoring and accurate genetic counselling.


Immunogenicity of pneumococcal vaccine in persons with spinal cord injury.
To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). Double-blind, randomized, placebo control study. SCI unit in a tertiary care medical center and community. Eighty-seven persons with recent SCI. Participants were randomized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. Antibody concentrations were measured prior to intervention and 1, 2, and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae. Effects of demographic and injury-related variables on immune response were also evaluated. Timing of vaccination did not influence mean antibody concentrations for any serotype (p > .05). Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35% of placebo groups (p < .01). After 12 months, 93% of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values. Most participants developed an immune response to at least one serotype that was maintained for at least 12 months. Immune response varied according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during initial hospitalization.


Structure of the thrombopoietin-MPL receptor complex is a blueprint for biasing hematopoiesis.
Thrombopoietin (THPO or TPO) is an essential cytokine for hematopoietic stem cell (HSC) maintenance and megakaryocyte differentiation. Here, we report the 3.4 Å resolution cryoelectron microscopy structure of the extracellular TPO-TPO receptor (TpoR or MPL) signaling complex, revealing the basis for homodimeric MPL activation and providing a structural rationalization for genetic loss-of-function thrombocytopenia mutations. The structure guided the engineering of TPO variants (TPOmod) with a spectrum of signaling activities, from neutral antagonists to partial- and super-agonists. Partial agonist TPOmod decoupled JAK/STAT from ERK/AKT/CREB activation, driving a bias for megakaryopoiesis and platelet production without causing significant HSC expansion in mice and showing superior maintenance of human HSCs in vitro. These data demonstrate the functional uncoupling of the two primary roles of TPO, highlighting the potential utility of TPOmod in hematology research and clinical HSC transplantation.


First records of the Pacific sleeper shark Somniosus cf. pacificus in the western tropical Pacific.
Technological advances have enabled the expansion of ocean exploration to include the deep ocean, providing new species observations. Here, the authors present two new observations, captured by deep-sea cameras, of the sleeper shark Somniosus cf. pacificus from the Solomon Islands and Palau. This presents the first observation of S. cf. pacificus in the western Pacific tropics and extends its range about 2000 nautical miles south. The observations presented here provide much-needed information on the range of this species which can help guide future management and conservation actions.


A selective annotated bibliography for clinical audiology (1989-2009): books.
This is the 2nd in a series of 3 planned companion articles that present a selected, annotated, and indexed bibliography of clinical audiology publications from 1989 through 2009. Research and preparation of the bibliography were based on published guidelines, professional audiology experience, and professional librarian experience. The first article in the series covered reference works. This article focuses on other books. The planned third companion article will present periodicals and online resources. Audiologists and librarians can use this bibliography to help them identify relevant clinical audiology literature.


Attenuation of KATP channel-opener induced shortening of repolarization time by alpha 1-adrenoceptor antagonist during ischemia in canine heart.
The purpose of the study was to determine whether a new KATP channel opener, Y 26763 (Y), can influence the electrophysiological properties in the ischemic myocardium as well as to determine whether the blunting effect of the alpha 1-adrenoceptor antagonist bunazosin (BN) on an ischemia-induced shortening of repolarization time can be related to the KATP channel activity. The anterior descending branch of the left coronary artery was ligated four times for 5 minutes, separated by 15 minutes of reperfusion (stages 1-4) to test the dose-dependent effect of drugs on repolarization. Dogs received either vehicle (n = 9), Y (0.4, 2.0, and 4.0 micrograms/kg at stages 2, 3, and 4, respectively, with 0.4 microgram/kg/min drip infusion at each of stages 2-4, n = 7), BN (0.1 mg at each of stages 2-4, n = 8), or a combination of these two drugs (BN + Y, the same dose of BN and Y in groups BN and Y, respectively, n = 9). Drugs were administered into the left atrium. The monophasic action potential (MAP) and regional electrograms were recorded. The MAP90 and the duration of the slow deflections (DSD) of the regional electrogram were used as markers of repolarization. The Vmax of the MAP and the rapid deflections (DRD) of the regional electrogram were used as markers of conduction. Y augmented an ischemia-induced shortening of MAP90 and DSD in proportion to an increase in the dose given and the plasma concentration (P < .05-.01), especially at the epicardial site. BN and BN + Y blunted the ischemia-related shortening of MAP90 and DSD, causing a reduction in repolarization time dispersion between the ischemic and normal zones. There were no significant changes in the Vmax or DRD in the ischemic zone between periods before and after an increase in each drug dose in the four groups. None of the seven dogs developed ventricular tachycardia (VT)/ventricular fibrillation (VF) in the Y group, whereas two of the eight dogs in the BN group, three of the nine dogs in the BN + Y group, and three of the nine dogs in the control group developed VT/VF. These results suggest that the alpha 1-adrenergic blocker bunazosin blunts the shortening effect of KATP channel activator on repolarization time, and that the KATP channel opener Y may be antiarrhythmic, although the repolarization time dispersion during myocardial ischemia is increased.


Virtual vascular endoscopy for acute aortic dissection.
Virtual endoscopy of the aorta is a new three-dimensional reconstruction method from multislice computed tomography or magnetic resonance that offers a virtual navigation through the aorta, and the possibility of having a new preoperative endoluminal vision. We present a case of subacute aortic dissection with a preoperative virtual endoscopy of the aorta.


Prevalence of Female Sexual Dysfunction Among Psoriatic Females: A Cross Sectional Case Controlled Study.
Sexual relationships are an integral part of females psychological and physiological wellbeing. The study aimed to identify prevalence and impact of Female Sexual Dysfunction (FSD) in women affected with psoriasis. This cross-sectional study was carried out on 150 married females who were interviewed to answer Female Sexual Function Index (FSFI) questionnaire and were divided into two groups: the first group included 100 female patients complaining of psoriasis (50 suffering from moderate psoriasis and 50 with severe psoriasis). The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) while the second group included 50 age matched women who served as controls. Female sexual dysfunction (FSD) in psoriasis female groups was higher than that in the control group (47%, 24%, P < 0.05). The mean total scores of FSFI ranged from 12.30 to 34.20 and were significantly lower in the severe PASI affected group (22.34 ± 5.35) when compared to moderate PASI group (26.24 ± 2.67) or control group (28.79 ± 2.22). In addition, total scores were significantly lower among moderate PASI affected females when compared to control group. Sexual dysfunction should be routinely investigated in female patients with psoriasis in the case of moderate-severe disease due to its negative impact on quality of life. Further research over the effect of certain interventional programs on FSD should be considered for patients suffering from psoriasis.


Effects of different levels of compression during sub-maximal and high-intensity exercise on erythrocyte deformability.
The aim of the study was to test the hypothesis whether different levels of sock compression (0, 10, 20, and 40 mmHg) affect erythrocyte deformability and metabolic parameters during sub-maximal and maximal running. Nine well-trained, male endurance athletes (age 22.2 ± 1.3 years, peak oxygen uptake 57.7 ± 4.5 mL min(-1) kg(-1)) carried out four periods of sub-maximal running at 70% of peak oxygen uptake for 30 min followed by a ramp test until exhaustion with and without compression socks that applied different levels of pressure. Erythrocyte deformability, blood lactate, heart rate and arterial partial pressure of oxygen (pO(2)) were monitored before and during all of these tests. Erythrocyte deformability, heart rate, pO(2) and lactate concentration were unaffected by compression, whereas exercise itself significantly increased erythrocyte deformability. However, the increasing effects of exercise were attenuated when high compression was applied. This first evaluation of the potential effects of increasing levels of compression on erythrocyte deformability and metabolic parameters during (sub-) maximal exercise, revealed no effects whatsoever.


Differential roles of the adrenal gland in the suppression of morphine antinociceptive tolerance development by alpha- and beta-adrenergic blockers.
Concomitant treatment with phentolamine, an alpha-blocker, or with propranolol, a beta-blocker, suppressed the development of morphine tolerance in sham-operated (Sham) mice. In adrenalectomized (ADX) mice, daily morphine developed tolerance as well as in the Sham group, and concurrent phentolamine suppressed the development of tolerance, whereas such suppression by propranolol was abolished. Supplemental treatment of ADX mice with dexamethasone did not restore the suppressive effect of propranolol. These results suggest that different mechanisms underlie the prevention of tolerance development by alpha- and beta-blockers, and that adrenal cortex does not seem to participate in the suppression by beta-blockers.


A role for RKIP in cell motility.
The target of locostatin, a small-molecule inhibitor of cell movement, has been identified as RKIP, a Raf-1 kinase modulator [1]. In addition to advancing our understanding of cell locomotion, this work represents a major landmark in the development of chemical genetics.


In vitro photosensitization with a benzoporphyrin derivative.
Biophysical and photobiological properties of two benzoporphyrin derivatives were examined. These dyes exhibit substantial absorbance in the red, and are potent photosensitizers in vitro. After brief (0.5 h) incubations, phototoxicity was more closely correlated with membrane than with mitochondrial photodamage. Affinity of these dyes toward plasma lipoproteins are consistent with a mode of localization via the LDL-mediated mechanism utilized by the hematoporphyrin-derived product, HPD.


Diabetes, coeliac disease, multiple sclerosis and chronic arthritis in first-degree relatives of patients with juvenile idiopathic arthritis.
To evaluate the occurrence of autoimmune diseases in first-degree relatives of children with juvenile idiopathic arthritis (JIA) and to compare the figures with published population data. Families of the 362 children with recently diagnosed JIA admitted to Rheumatism Foundation Hospital, Finland, from 1996 to 2001 were contacted by questionnaires regarding autoimmune diseases in family members. Data were collected on type 1 diabetes, coeliac disease, multiple sclerosis and chronic arthritis, consisting mainly of JIA, rheumatoid arthritis, spondyloarthropathy or psoriatic arthritis. In all, 21.4% of the 355 families with a patient with JIA had members with type 1 diabetes, coeliac disease, multiple sclerosis or chronic arthritis. Thirty-three mothers and 23 fathers had type 1 diabetes, coeliac disease, multiple sclerosis or chronic arthritis in 15.2% (95% CI 11.6-19.4) of the families, and 23 mothers and 15 fathers had chronic arthritis in 10.7% (95% CI 7.7-14.5) of the families. When compared with available research data, the prevalences of rheumatoid arthritis, spondyloarthropathy, psoriatic arthritis, paediatric type 1 diabetes and JIA (in siblings) were increased in JIA families. Coeliac disease was as prevalent as in the population. Autoimmune diseases cluster in families with a child with JIA.


Thoroughly modern risk prediction?
Researchers use a data-driven technique called statistical learning to fashion risk prediction algorithms for clinical situations with low event rates.


Infection of SARS-CoV-2 in domestic dogs associated with owner viral load.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive pet owners are reported to be a risk factor for infection of their pets; however, the influence of the viral load and associated risks has not been fully established. This study aimed to assess potential association of viral load in owners with the presence of SARS-CoV-2 infection in their dogs. Of 20 SARS-CoV-2-positive pet owners from 13 families in Curitiba, Brazil, 5 of 22 (22.7%) dogs were positive for SARS-CoV-2. Viral presence was detected in oropharyngeal samples for 2 of 5 (40.0%) dogs at 8 and 9 days after the first positive sample. Detection of SARS-CoV-2 in these dogs was associated with higher viral loads in the owners and close owner contact. All 5 RT-qPCR-positive dogs had antibodies to at least one viral protein tested in the serological assay. Molecular detection of SARS-CoV-2 in dogs was statistically associated with clinical signs in owners such as cold, cough, or diarrhea (P = 0.039), number of positive persons in the household (P = 0.002), and higher viral load (P = 0.039). Such findings serve as a warning for risks of human to dog infection, mainly due to sharing beds and other close interactions without protection. In conclusion, people with coronavirus disease 2019 (COVID-19), particularly in households with multiple residents and high viral load, should take the same preventive measures when interacting with their dogs during self-isolation as they do with people.


Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: A retrospective analysis of the fourth-generation Medical Information Mart for Intensive Care database.
This study aimed to investigate the relationship between the blood urea nitrogen to serum albumin ratio (BAR) and in-hospital mortality in patients with sepsis. This is a retrospective cohort study. All septic patient data for the study were obtained from the intensive care unit of Beth Israel Deaconess Medical Center. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression analyses. Survival curves were plotted and subgroup analyses were stratified by relevant covariates. Among 23,901 patients, 13,464 with sepsis were included. The overall in-hospital mortality rate was 18.9% (2550/13464). After adjustment for confounding factors, patients in the highest BAR quartile had an increased risk of sepsis death than those in the lowest BAR quartile (HR: 1.42, 95% CI: 1.3-1.55), using BAR as a categorical variable. When BAR was presented as a continuous variable, the prevalence of in-hospital sepsis-related death increased by 8% (adjusted HR: 1.08, 95% CI: 1.07-1.1, P < 0.001) for each 5-unit increase in BAR, irrespective of confounders. Stratified analyses indicated age interactions (P < 0.001), and the correlation between BAR and the probability of dying due to sepsis was stable. BAR was significantly associated with in-hospital mortality in intensive care patients with sepsis. A higher BAR in patients with sepsis is associated with a worse prognosis in the ICU in the USA. However, further research is required to confirm this finding.


Liver fat is superior to visceral and pancreatic fat as a risk biomarker of impaired glucose regulation in overweight/obese subjects.
To investigate the distribution of abdominal fat, particularly ectopic fat accumulation, in relation to glucose metabolism in overweight/obese patients. This study included 257 overweight/obese subjects with body mass index ≥23 kg/m2 . All the subjects underwent an oral glucose tolerance test. Magnetic resonance imaging-proton density fat fraction was used to measure fat accumulation in the liver, pancreas and abdomen. Impaired glucose regulation (IGR) was defined as the presence of prediabetes or diabetes. Liver fat content (LFC) and visceral adipose tissue (VAT) were higher in overweight/obese subjects with diabetes than in those with normal glucose tolerance (NGT). No significant differences were observed in the pancreas fat content and subcutaneous fat area between subjects with NGT and IGR. LFC was an independent risk factor of IGR (odds ratio = 1.824 per standard deviation unit, 95% CI 1.242-2.679, p = .002). Compared with the lowest tertile of LFC, the multivariate-adjusted odds ratio for the prevalence of IGR in the highest tertile was 2.842 (95% CI 1.205-6.704). However, no association was observed between the VAT per standard deviation increment and tertiles after adjusting for multiple factors. For discordant visceral and liver fat phenotypes, the high LFC-low VAT and high LFC-high VAT groups had a higher prevalence of IGR than the low LFC-low VAT group. However, there was no difference in the prevalence of IGR between the low LFC-low VAT and low LFC-high VAT groups. Compared with visceral and pancreatic fat content, LFC is a superior risk biomarker for IGR in overweight/obese subjects.


[Morphological signs of impaired excitation conduction in the myocardium].
The article describes morphological changes in cardiac muscular fibers and cardiomyocytes secondary to disorders in conduction of excitation in the myocardium. These changes may indicate cardiac arrest as a result of reflex impacts including cases of damage which is not lethal.


Ultrasensitive and selective gold film-based detection of mercury (II) in tap water using a laser scanning confocal imaging-surface plasmon resonance system in real time.
An ultrasensitive and selective detection of mercury (II) was investigated using a laser scanning confocal imaging-surface plasmon resonance system (LSCI-SPR). The detection limit was as low as 0.01ng/ml for Hg(2+) ions in ultrapure and tap water based on a T-rich, single-stranded DNA (ssDNA)-modified gold film, which can be individually manipulated using specific T-Hg(2+)-T complex formation. The quenching intensity of the fluorescence images for rhodamine-labeled ssDNA fitted well with the changes in SPR. The changes varied with the Hg(2+) ion concentration, which is unaffected by the presence of other metal ions. The coefficients obtained for ultrapure and tap water were 0.99902 and 0.99512, respectively, for the linear part over a range of 0.01-100ng/ml. The results show that the double-effect sensor has potential for practical applications with ultra sensitivity and selectivity, especially in online or real-time monitoring of Hg(2+) ions pollution in tap water with the further improvement of portable LSCI-SPR instrument.


[The life and scientific work of outstanding Ukrainian obstetrician-gynecologist Grygoriĭ Fedorovych Pisemskyĭ (to 150th birthday anniversary)].
Thy article presents data about well-known Ukrainian physician, obstetrician-gynecologist, scientist, organizer, teacher prof. G. F. Pisemsky, his role in the development of Obstetrics and Gynecology.


Isolation of novel lipolytic genes from uncultured bacteria of pond water.
Metagenomic libraries give access to gene pool of bacteria present in environmental samples avoiding the culture bias. A metagenomic library of pond water microbial assemblage in plasmid vector containing about 532 Mb of community DNA was prepared. Screening of a part of the unamplified library resulted in isolation of 11 unique lipolytic clones with an ability to hydrolyze tributyrin. DNA sequence of the lipolytic genes varied in G+C composition from 57% to 75%. Twelve lipolytic genes encoding proteins with 25-70% amino acid identity with proteins in the databases were identified. Ten of the encoded proteins belonged to seven known lipolytic protein families. One of the proteins was similar to recently identified esterase BioH. A lipolytic protein with high similarity to yet uncharacterized alpha/beta hydrolase protein family abh_upf0017 was identified from one of the clones. Conserved motif for lipolytic enzymes GXSXG, conserved aspartic and histidine residues were identified in this encoded protein.


Statistical analysis of COVID-19 infection severity in lung lobes from chest CT.
Detection of the COVID 19 virus is possible through the reverse transcription-polymerase chain reaction (RT-PCR) kits and computed tomography (CT) images of the lungs. Diagnosis via CT images provides a faster diagnosis than the RT-PCR method does. In addition to low false-negative rate, CT is also used for prognosis in determining the severity of the disease and the proposed treatment method. In this study, we estimated a probability density function (PDF) to examine the infections caused by the virus. We collected 232 chest CT of suspected patients and had them labeled by two radiologists in 6 classes, including a healthy class and 5 classes of different infection severity. To segment the lung lobes, we used a pre-trained U-Net model with an average Dice similarity coefficient (DSC) greater than 0.96. First, we extracted the PDF to grade the infection of each lobe and selected five specific thresholds as feature vectors. We then assigned this feature vector to a support vector machine (SVM) model and made the final prediction of the infection severity. Using the T-Test statistics, we calculated the p-value at different pixel thresholds and reported the significant differences in the pixel values. In most cases, the p-value was less than 0.05. Our developed model was developed on roughly labeled data without any manual segmentation, which estimated lung infection involvements with the area under the curve (AUC) in the range of [0.64, 0.87]. The introduced model can be used to generate a systematic automated report for individual patients infected by COVID-19.


When is a herbivore not a herbivore?
Young herbivores are not herbivores. With the apparent exception of some chewing insects they cannot survive and growth without eating animal or microbial protein. Further reinforcing how short available nitrogen is in plant food, adult herbivores must feed selectively and depend on intestinal microorganisms to obtain sufficient nitrogen for maintenance and breeding.


The Gore Global Registry for Endovascular Aortic Treatment: Objectives and Design.
The Global Registry for Endovascular Aortic Treatment (GREAT) is a prospective observational multicenter cohort registry that was initiated in November 2011. The aim of the GREAT is to collect contemporary real-world data on the performance of all Gore aortic endografts in the treatment of multiple aortic pathologies. The primary and secondary objectives, design, and future directions of the GREAT are described. The GREAT aims to enroll 5000 consecutive patients with Gore thoracic and abdominal aortic endografts from multiple centers throughout the world. The GREAT has broad inclusion criteria with minimal exclusion criteria to reflect real-world practice such as including off-label use, nonstandard indications and devices deployed outside instruction for use. Follow-up will extend to 10 years providing major insights into the long-term durability and behavior of Gore aortic endografts. Primary end points include the incidence and timing of (1) endoleak of any type, (2) endograft migration and/or stent fracture, (3) endograft explantation, and (4) aortic rupture. Secondary end points include the following: (1) incidence of serious device events by pathology, (2) incidence of serious device events by aortic segment (ascending aorta, arch of aorta, descending thoracic aorta, abdominal aorta), (3) long-term survival by pathology, and (4) aorta-related mortality by pathology. As of June 2015, 2960 patients have been enrolled into the GREAT from 78 centers in Europe, the United States, Australia, New Zealand, and Brazil. The majority of patients and centers are from Europe and the United States. Completion of enrollment is anticipated to be in 2017 with interim results planned to be published during enrollment and on follow-up. Upon completion, the GREAT will be among the largest clinical registry to date of abdominal and thoracic aortic devices manufactured by a single sponsor. It will provide valuable real-world data on the use and durability of Gore aortic endografts in the treatment of a variety of aortic pathologies and devices deployed within and outside instruction for use.


Focused Ultrasound Lipolysis in the Treatment of Abdominal Cellulite: An Open-Label Study.
Despite a growing popularity of noninvasive ultrasonic lipolysis procedure, there is a lack of evidence about the efficacy of this method. This study was performed to evaluate the efficacy of focused ultrasonic lipolysis on abdominal cellulite treatment. Twenty-eight consecutive subjects (age: 37.8 ± 8 years) underwent weekly transdermal focused ultrasonic lipolysis (Med Contour, General Project Ltd., Florence, Italy) and vacuum drainage for a maximum of eight sessions. Largest abdominal girth and 2 lines at 4 cm to 7 cm distance above and under it were located as fixed points of measurements. The mean value of the three fixed lines was considered as the abdominal circumference. Subjects were evaluated using measurements of circumference, immediately after and 3 weeks after the final treatment and compared using paired t test. One hundred ninety-four ultrasonic lipolysis procedures were performed on 28 subjects. A statistically significant (P < .001) average of 1.89 cm (95% CI: 1.63-2.02 cm) decrease of circumference value was observed in each session of ultrasonic lipolysis. The mean pretreatment to posttreatment circumference reduction was 8.21 cm (95% CI: 6.38-10.04, P < .001) that declined to 7 cm (95% CI: 3.2-10.8, P < .001) at the 3-month follow-up visit. Focused ultrasonic lipolysis appears to be an effective method for reduction of abdominal cellulite, although some amount of circumference reduction reversal may be observed in long term follow-up visit.


Endothelin B receptor agonist, IRL-1620, reduces neurological damage following permanent middle cerebral artery occlusion in rats.
Endothelin and its receptors have long been considered therapeutic targets in the treatment of ischemic stroke. Recent studies indicate that ET(B) receptors may provide both vasodilatation and neuroprotection. The purpose of this study was to determine the effect of selectively activating the ET(B) receptors following permanent middle cerebral artery occlusion in rats. IRL-1620 [Suc-[Glu9,Ala11,15]-Endothelin-1(8-12)], a highly selective ET(B) agonist, was used alone and in conjunction with BQ788, an ET(B) antagonist, to determine the role of ET(B) receptors in cerebral ischemia. Rats were assessed for neurological deficit and motor function, and their brains were evaluated to determine infarct area, oxidative stress parameters, and ET receptor protein levels. Animals treated with IRL-1620 showed significant improvement in all neurological and motor function tests when compared with both vehicle-treated and BQ788-treated middle cerebral artery occluded groups. In addition, there was a significant decrease in infarct volume 24h after occlusion in animals treated with IRL-1620 (24.47±4.37mm(3)) versus the vehicle-treated group (153.23±32.18mm(3)). Blockade of ET(B) receptors by BQ788 followed by either vehicle or IRL-1620 treatment resulted in infarct volumes similar to those of rats treated with vehicle alone (163.51±25.41 and 139.21±15.20mm(3), respectively). Lipid peroxidation, as measured by malondialdehyde, increased and antioxidants (superoxide dismutase and reduced glutathione) decreased following infarct. Treatment with IRL-1620 reversed these effects, indicating that ET(B) receptor activation reduces oxidative stress injury following ischemic stroke. Animals pretreated with BQ788 showed similar oxidative stress damage as those in the vehicle-treated group. No significant difference was observed in ET(B) receptor levels in any of the groups. The present study demonstrates that ET(B) receptor activation may be a novel neuroprotective therapy in the treatment of focal ischemic stroke.


Assessment of health benefit of PM2.5 reduction during COVID-19 lockdown in China and separating contributions from anthropogenic emissions and meteorology.
The national lockdown policies have drastically disrupted socioeconomic activities during the COVID-19 pandemic in China, which provides a unique opportunity to investigate the air quality response to such anthropogenic disruptions. And it is meaningful to evaluate the potential health impacts of air quality changes during the lockdown, especially for PM2.5 with adverse health effects. In this study, by using PM2.5 observations from 1388 monitoring stations nationwide in China, we examine the PM2.5 variations between the COVID-19 lockdown (February and March in 2020) and the same period in 2015-2019, and find that the national average of PM2.5 decreases by 18 μg/m3, and mean PM2.5 for most sites (about 75%) decrease by 30%-60%. The anthropogenic and meteorological contributions to these PM2.5 variations are also determined by using a stepwise multiple linear regression (MLR) model combined with the Kolmogorov-Zurbenko filter. Our results show that the change of anthropogenic emissions is a leading contributor to those widespread PM2.5 reductions, and meteorological conditions have the negative influence on PM2.5 reductions for some regions, such as Beijing-Tianjin-Hebei (BTH). Additionally, the avoided premature death due to PM2.5 reduction is estimated as a predicted number based on a log-linear concentration-response function. The total avoided premature death is 9952 in China, with dominant contribution (94%) from anthropogenic emission changes. For BTH, Yangtze River Delta, Pearl River Delta and Hubei regions, the reductions of PM2.5 are 24.1, 24.3, 13.5 and 29.5 μg/m3, with the avoided premature deaths of 1066, 1963, 454 and 583, respectively.


RNA-Seq Analyses Reveal Roles of the HVCN1 Proton Channel in Cardiac pH Homeostasis.
The voltage-gated proton channel HVCN1 is a member of the voltage-gated ion channel family. HVCN1 channel controls acid extrusion and regulates pH homeostasis in various cell types. Recent evidence indicated that the HVCN1 channel was associated with cardiac function. To investigate the role of HVCN1 in cardiac myocytes, we performed an RNA sequencing analysis of murine hearts and showed that HVCN1 null hearts exhibited a differential transcriptome profile compared with wild-type hearts. The RNA-seq data indicating impaired pH homeostasis in HVCN1 null hearts were the downregulated NADPH oxidoreductases (NOXs) and decreased expression of Cl-/HCO3 - exchanger, indicating HVCN1 is a regulator of gene transcriptional networks controlling NOX signaling and CO2 homeostasis in the heart. Additionally, HVCN1 null hearts exhibited differential expression of cardiac ion channels, suggesting a potential role of HVCN1 in cardiac electrophysiological remodeling. The study highlights the importance of HVCN1 in cardiac function and may present a novel target associated with heart diseases.


Expression of CD117 (c-kit) receptor in dysgerminoma of the ovary: diagnostic and therapeutic implications.
The proto-oncogene c-kit encodes a tyrosine kinase receptor, c-kit (CD117), which has been implicated in the development of a number of human malignancies. While the preferential expression of this protein has been well documented in testicular seminomas, there is little data concerning its expression in dysgerminomas of the ovary. We examined the expression of c-kit in 30 cases of ovarian dysgerminomas using immunohistohemical staining with a polyclonal anti-CD117 antibody. Staining was graded in a semiquantitative manner as follows: negative (no staining), 1+(1-10% staining), 2+(10-29% staining), 3+(30-50% staining), or 4+ (>50% staining). Of the 30 cases examined, 26 (87%) demonstrated immunoreactivity for CD117. In total, 10 (33%) demonstrated 4+ staining; 9 (30%) demonstrated 3+staining; 3 (10%) demonstrated 2+staining; 4 (13%) demonstrated 1+staining; and 4 (13%) demonstrated no staining. In conclusion, CD117 immunoreactivity was detected in 87% of ovarian dysgerminomas, a finding that correlates with previously reported frequencies of CD117 expression in seminomas (78-100%). Thus, antibodies to c-kit may be a useful diagnostic marker for ovarian dysgerminoma. Although the prognosis of patients with dysgerminoma is generally good, this receptor could potentially serve as a target for site-specific immunotherapy as an alternative and/or complement to conventional treatment options.


Search for intermediates of photosynthetic water oxidation.
Photosystem II of cyanobacteria and plants incorporates the catalytic centre of water oxidation. Powered and clocked by quanta of light the centre accumulates four oxidising equivalents before oxygen is released. The first three oxidising equivalents are stored on the Mn(4)Ca-cluster, raising its formal oxidation state from S0 to S3 and the third on YZ, producing S3 YZ ox. From there on water oxidation proceeds in what appears as a single reaction step (S3 YZ ox(H2O)2 <==>O2 + 4H+ + S0. Intermediate oxidation products of bound water had not been detected, until our recent report on the stabilisation of such an intermediate by high oxygen pressure (NATURE 430, 2004, 480-483). Based on the oxygen titration (half-point 2.3 bar) the standard free-energy profile of a reaction sequence with a single intermediate was calculated. It revealed a rather small difference (-3 kJ mol-1) between the starting state [S3YZ OX(H2O2) and the product state S0YZ + O2 + 4H+ . Here we describe the tests for side effects of exposing core particles to high oxygen pressure. We found the reduction of P680 +* in ns and the reduction/dismutation of quinones at the acceptor side of PSII both unaffected, and the inhibition of the oxygen evolving reaction by exposure to high O2-pressure was fully reversible by decompression to atmospheric conditions.


An exploratory analysis of factors associated with traffic crashes severity in Cartagena, Colombia.
Traffic fatalities are the second cause of violent deaths in Colombia. However, due to the signing of the peace agreement and the growing number of fatalities in road crashes, it is possible that soon traffic fatalities will be the primary cause of violent deaths in the country, particularly in urban areas. This study is an exploratory analysis focused on identifying the main factors associated with the severity of traffic crashes in urban areas, using Cartagena as a case study. We analyzed three levels of crash severity, namely fatal, injury, and property-damage-only, considering factors in several different dimensions: victim, vehicle, road infrastructure, traffic and control, day and time, and environmental factors. A modeling approach based on multinomial ordered discrete models was used to properly identify the main factors associated with the severity levels. We found that the probability of fatal accidents is higher on streets with speed limits over 40 km/h, and that males and people aged 60 years or older are the victims with the most significant risk of fatal crashes. Motorcycles were also identified as vehicles with the highest probability of fatal crashes in the city. We showed that the probability of fatal crashes occurring is higher on streets where pedestrian bridges, traffic lights, and crosswalks are present. These findings are worthy because, in Colombia and other developing countries, the authorities normally expect to reduce the probability of fatal accidents through investments in pedestrian bridges, signaling devices, and crosswalk markings. However, according to our results, it possibly will not occur unless further countermeasures are taken. Based on these findings, reducing speed limits, operational improvements at signalized intersections, zero tolerance for traffic violations related to pedestrians, an awareness campaign on pedestrian safety focused on males and people aged 60 or older, and improving motorcycle safety are the countermeasures we proposed. Furthermore, as the authorities make significant efforts to investing in pedestrian bridges, we propose a further investigation into the traffic crashes in streets where there is this infrastructure since more severe events occur near them.


Kin location and racial disparities in exiting and entering poor neighborhoods.
Blacks and Latinos/as are less likely than Whites to move from a poor neighborhood to a non-poor neighborhood and are more likely to move in the reverse direction. Using individual-level data from the Panel Study of Income Dynamics (1980-2013) and neighborhood-level census data, this study explores the role that the spatial location of familial kin networks plays in explaining these racially and ethnically disparate mobility patterns. Blacks and Latinos/as live closer than Whites to nuclear kin, and they are also more likely than Whites to have kin members living in poor neighborhoods. Close geographic proximity to kin and higher levels of kin neighborhood poverty inhibit moving from a poor to a non-poor neighborhood, and increase the risk of moving from a non-poor to a poor tract. Racial/ethnic differences in kin proximity and kin neighborhood poverty explain a substantial portion of racial gaps in exiting and entering poor neighborhoods.


Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry.
To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes. Retrospective cohort study. American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years. Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery. Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery. The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01). Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.


Mandibular overdentures supported by two or four endosteal implants. A prospective, comparative study.
The aim of this prospective study was to evaluate the effect of the number of implants supporting a mandibular overdenture on the condition of the peri-implant tissues. Sixty edentulous patients (Cawood class V VI) participated in this study. After randomization, thirty patients were treated with an overdenture supported by two IMZ implants (group A) and thirty patients with an overdenture on four IMZ implants (group B). The implants were inserted in the anterior region of the mandible. After three months overdentures were constructed, supported by round bar and clip attachments. A standardized clinical and radiographic evaluation was performed 0, 6 and 12 months after insertion of the denture. One implant was lost (group A) during the healing period. There were no significant differences with regard to any of the studied clinical or radiographic parameters of the peri-implant tissues, neither were significant differences found between the lateral and central implants in group B. None of the patients reported a sensory change in lip or chin region. From this study it is concluded that there seems to be no need to insert more than two endosteal implants to support an overdenture, however, long-term prospective studies are needed to support this notion.


Services received and treatment outcomes in day-hospital and residential programs.
This longitudinal health services study (N = 733) (1) examines the impact of services received on 6-month outcomes, and (2) compares day-hospital to residential programs on services received. Services were measured at 2, 4, and 8 weeks postbaseline using a version of the Treatment Services Review. Higher odds of total sobriety at 6 months were associated with greater participation in (a) extracurricular (but not curricular) 12-step meetings, (b) sober recreational events, and (c) educational sessions. Program effects also emerged. Unexpectedly, extracurricular 12-step meeting attendance and the odds of having a sponsor were lower among residential (vs. day hospital) participants through 4 weeks, despite higher participation in curricular 12-step meetings among residential participants at 2 weeks. Still, residential participants reported higher involvement in sober recreation and informal peer socialization across most analyses. Findings suggest that residential and day-hospital programs might maximize outcomes by facilitating optional 12-step involvement and sober recreation, respectively.


New mandatory course in alcohol and drug dependence for medical students at the Karolinska Institute.
Traditionally, instruction concerning alcohol and drug dependence has been insignificant in medical schools. The Karolinska Institute in Stockholm, Sweden, decided to introduce a special course starting in the academic year of 1983-84. It is given 4 times a year and is of a comprehensive nature. It comprises 2 weeks, 1 week of lectures and 1 week of clinical training and is followed by a separate examination. The first 7 courses from the fall of 1983 to the spring of 1985 are described and evaluated here. Evidently, the new course is much appreciated by the students and there is also a marked shift in opinion towards a more positive attitude in coping with these problems.


Structure of a modular polyketide synthase reducing region.
The chemical scaffolds of numerous therapeutics are polyketide natural products, many formed by bacterial modular polyketide synthases (PKS). The large and flexible dimeric PKS modules have distinct extension and reducing regions. Structures are known for all individual enzyme domains and several extension regions. Here, we report the structure of the full reducing region from a modular PKS, the ketoreductase (KR), dehydratase (DH), and enoylreductase (ER) domains of module 5 of the juvenimicin PKS. The modular PKS-reducing region has a different architecture than the homologous fatty acid synthase (FAS) and iterative PKS systems in its arrangement of domains and dimer interface. The structure reveals a critical role for linker peptides in the domain interfaces, leading to discovery of key differences in KR domains dependent on module composition. Finally, our studies provide insight into the mechanism underlying modular PKS intermediate shuttling by carrier protein (ACP) domains.


[Comparative evaluation of the efficacy of surgical treatment methods in duodenal ulcers].
On the basis of an analysis of organic and functional disorders revealed in 195 patients operated on for duodenal ulcer with a 1 to 20 years follow-up the authors propose a classification of evaluation of long-term results with consideration of rehabilitative and prophylactic measures. It was established that long-term results revealed a tendency to the increase of good and excellent outcomes both after gastric resection and after the two types of vagotomy.


Quality of life in women following various surgeries of body manipulation: organ transplantation, mastectomy, and breast reconstruction.
This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.


A gain-of-function study of amelioration of pentylenetetrazole-induced seizures by endogenous prostaglandin D2.
We previously showed that knockout mice of hematopoietic prostaglandin (PG) D synthase (H-PGDS) produce less PGD2 to exacerbate pentylenetetrazole (PTZ)-induced seizures. Here, we adopted a gain-of-function strategy and used transgenic mice that over-express human H-PGDS enzyme, to elucidate the role of overproduction of endogenous PGD2 in PTZ-induced seizures. H-PGDS-transgenic mice showed the elevated level of a urinary metabolite of PGD2, tetranor-PGDM, 3.3- and 2.8-fold higher than the wild-type littermates under the basal condition and after the PTZ administration, respectively, without significantly changing the urinary concentration of a PGE2-metabolite, tetranor-PGE2. The intensity of PTZ-induced seizures was decreased in H-PGDS-transgenic mice as evident by the increased seizure onset latency, and a decrease in total duration of generalized tonic-clonic seizures and a total number of EEG seizure spikes during the postictal period (84 s, 17 s, and 5.3/min, respectively), as compared to wild-type mice (53 s, 24 s, and 12.6/min, respectively). These results indicate that overproduction of endogenous PGD2 decreased PTZ-induces seizures.


Cold hardiness in various organs and tissues of Rhododendron species and the supercooling ability of flower buds as the most susceptible organ.
The freezing resistance of various organs and tissues was determined in 24 Rhododendron species (mainly Subgenus Tsutsutsi) having different ecological distributions. The order of hardiness for organ or tissue is as follows: leaf bud greater than wood greater than or equal to bark greater than flower bud, and the flower bud is characterized as the most cold-susceptible organ. The relationship of killing temperature (KT) to northern distribution was the most significant in leaf buds compared to other organs and tissues. KTs of leaf buds for the most hardy species were -45 degrees C (or below) and those for the most tender species were about -23 degrees C, while KTs of flower buds were about -28 degrees C for the former and -16 degrees C for the latter. Although KTs of flower buds native to southwestern Japan were well correlated with the exothermic temperature distribution (ETD) of florets, those in the more northern species were generally lower than ETDs. The supercooling ability of flower buds appears to be sufficient to avoid the freezing stress since the extreme minimum temperature (EMT) at the northern limit of natural distribution for each tree species examined was not lower than the KT and ETD of the flower buds.


Parasitic conjoined twins: a case report.
Parasitic twins are a rare phenomenon and a challenge for caregivers. Occurring as a result of abnormal processes in the first several weeks of embryologic development, this condition is oftentimes diagnosed by prenatal ultrasound. This unusual condition may go undiagnosed until the time of delivery, however, despite the availability and use of advanced ultrasound techniques. The challenges presented by this condition are multiple and complex. The following case report demonstrates some of these challenges.


A possible role of estrone produced in adipose tissues in modulating postmenopausal bone density.
Estrogen deficiency in postmenopausal women is a major contributing factor to bone loss occurring after menopause. Although serum estradiol levels decrease conspicuously, a considerable amount of estrone still exists in women after natural menopause. Since most of the estrone is converted from androgens in adipose tissues, we attempted to seek interrelationship among serum estrone levels, fat mass and bone mineral density (BMD) in postmenopausal women. Thirty women who underwent natural menopause at the age between 45 and 53 were examined for BMD of head, arms, trunk and legs, as well as total body fat and total lean body mass using a Lunar DPX, a dual energy X-ray absorptiometer. Serum estrone concentration in each subject was measured by RIA. BMD of all sites of bones examined showed a positive correlation with relative fat mass (total body fat/body weight). Serum estrone levels were positively correlated with BMD of arms, trunk and legs, as well as relative fat mass. Multiple regression analysis further demonstrated that relative fat mass and serum estrone levels were significantly related to BMD of both arms and trunk, and BMD of trunk, respectively. These results suggest that estrone produced in adipose tissues may have, if only in part, a role in modulating the loss of bone mass occurring after menopause.


Spinal projections from the lower brain stem in the cat as demonstrated by the horseradish peroxidase technique. I. Origins of the reticulospinal tracts and their funicular trajectories.
Using a retrograde tracer technique with horseradish peroxidase (HRP) attempts were made to determine the origins of reticulospinal tracts and their funicular trajectories. Reticulospinal tracts originating from the mesencephalic reticular formation (RF) were composed of: (1) descending projections arising from the cluster of cells located just lateral to the periaqueductal gray that course in the anterior funiculus (AF) and ventral part of the lateral funiculus (LF) with ipsilateral predominance; and (2) projections from the cluster of cells located dorsal to the brachium conjunctivum that course in the ipsilateral LF. Origins of the pontine reticulospinal tracts arising from the n. reticularis pontis oralis (Poo) have been divided qnto three parts: (1) medial one-third; (2) middle; and (3) ventrolateral. The axons from the medial part descend ipsilaterally via the medial part of the AF, while the axons from the ventrolateral part of the Poo give rise to diffuse descending projections in the AF and LF. The middle part of the Poo has been further subdivided into: (1) dorsal part that gives rise to spinal projections ipsilaterally in the ventrolateral funiculus (VLF); and (2) ventral, particularly its upper part, whose axons descend bilaterally via the DLF. Origins of reticulospinal tracts from the n. reticularis pontis caudalis (Poc) could be divided into three parts: (1) medial; (2) dorsolateral; and (3) ventrolateral. The medial part of the Poc is a source of axons via the medial part of the ipsilateral AF, while the ventrolateral part of the nucleus is a source of axons via the contralateral LF. The spinal projections from the dorsolateral part of the Poc appears to course diffusely in the AF and LF, but with DLF predominance. The n. reticularis gigantocellularis (Gc) was found to be a main medullary source of the spinal projections in the ipsilateral AF, while n. reticularis magnocellularis (Mc) is the major source of the fibers coursing ipsilaterally in the VLF. The most medial part of the Mc descends ipsilaterally via the medial part of the AF, while the ventrolateral part of the nucleus together with the n. reticularis lateralis of Meesen and Olszewski descends ipsilaterally via the DLF. It has also been found that the axons from the n. reticularis paramedianus pass via both the AF and LF with ipsilateral predominance, while the n. reticularis dorsalis and ventralis course via the LF with ipsilateral predominance.


[Surgical approach and materials in reparation of cerebrospinal rhinorrhea (54 cases reports)].
To find out the best surgical approach and repair material in repairing cerebrospinal rhinorrhea by comparing their characteristics. The clinical data of 54 cases from March 1983 to June 2001 with continuous cerebrospinal rhinorrhea treated by different approaches and repair materials were retrospective analyzed. The highest recurrent rate was by anterior cranial fossa approach, while the lowest was by nasal endoscope. The bleeding volume in nasal endoscope approach was less than other surgical approaches with the significant differences (P <0.01). Galea frontalis myofascial flap and fascia lata were often used to repair fistula in operation. Nasal endoscope is the best approach. Cranionasal combination approach can be used in cases with larger defect in basis crania by galea frontalis myofascial flap reparation. The proper approach and repair materials should be selected according to the practical situation.


Priming donor lungs with thioredoxin-1 attenuates acute allograft injury in a rat model of lung transplantation.
Lung graft dysfunction and rejection are significant causes of morbidity and mortality in transplant recipients. Thioredoxin-1, a redox-regulatory protein, functions as an antioxidant in multiple organs, including lungs. We examined whether priming of the donor lungs with thioredoxin-1 before transplantation attenuates acute lung injury. Orthotopic left lung transplantation was performed from Lewis (donor) to Sprague-Dawley (recipient) rats. Donor lungs were perfused and stored in Perfadex solution (Vitrolife, Uppsala, Sweden), with or without purified thioredoxin-1. Changes in bronchoalveolar lavage (BAL) analysis, allograft oxygen exchange function, nuclear factor kappaB (NF-kappaB)/DNA binding, myeloperoxidase activities, and immunohistologic evaluation of neutrophils, macrophages, and cytotoxic T-cells (CD8(+)) infiltration were examined in post-transplant allograft (left) and native (right) lungs at Days 1 and 5. BAL cell differential analysis showed significant increases in macrophages and neutrophils in allografts at Day 1 post-transplant. At Days 1 and 5, lymphocyte infiltration was significantly increased and myeloperoxidase and NF-kappaB/DNA binding activities were increased vs basal activities. Immunohistology staining revealed increased infiltration of macrophages, neutrophils, and CD8(+) T cell sub-sets. Pre-transplant priming of donor lungs with thioredoxin-1 improved oxygen exchange and attenuated NF-kappaB/DNA binding activity, and infiltration of macrophages, neutrophils, and CD8(+) T cell sub-sets in allografts at Days 1 and 5 post-transplant. Priming of donor lungs with thioredoxin-1 before transplant attenuates acute allograft injury in a rat model of lung transplantation, and appears to be associated with the antioxidant function of thioredoxin-1 that limits early ischemia-reperfusion injury, NF-kappaB activation, and progressive infiltration of inflammatory and immune cells in allografts.


Protein kinase C impairs the coupling of the GTP-binding protein to LTB4 receptor in neutrophil.
In the present study, the mechanism of LTB4 receptor down regulation by protein kinase C (PKC) has been investigated using porcine neutrophil membranes. Pretreatment of intact porcine neutrophils with 12-O-tetradecanoylphorbol-13-acetate (TPA) for 2 min prior to the preparation of plasma membrane, demonstrated a reduced binding sites (Bmax) for LTB4 without altering the receptor affinity (Kd). This effect of TPA on LTB4 receptor binding was found to be due to the activation of PKC as membrane treated with purified PKC (type III) produced the same effect. When membranes from neutrophils pretreated with TPA were exposed to non-hydrolyzable GTP analog, GTP-gamma S, or GMP-PNP, no further decrease in receptor Kd was observed, while the Bmax was reduced to the level observed in TPA treated samples. Treatment of isolated neutrophil membranes with purified PKC reduced the Bmax and blocked the effect of GTP analogs on the receptor affinity. These results suggest that, PKC interrupts the receptor binding to G-protein.


Electrorheological properties of PMMA-b-PSt copolymer suspensions.
In this study, a block copolymer of methyl methacrylate (MMA) and styrene (St) synthesized by combined ultrasonic irradiation and reverse atom transfer radical polymerization (RATRP) processes was used. PMMA-b-PSt was partially hydrolyzed and converted to a lithium salt, PMMA-b-PSt-Li, before the electrorheological (ER) measurements carried out. Average particle diameter of PMMA-b-PSt-Li polymeric salt was determined by dynamic light scattering (DLS) as 22 mum. Suspensions of PMMA-b-PSt-Li polymeric salts were prepared in silicone oil. ER properties of PMMA-b-PSt-Li/silicone oil suspensions were studied as a function of electric field strength, dispersed phase concentration, shear rate, shear stress, temperature, frequency, and polar promoter. Further dielectric properties of PMMA-b-PSt-Li ionomer were also investigated.


The impact of donor age on the outcome of adult living donor liver transplantation.
The negative effects of increased donor age on liver transplantation became evident in deceased donor liver transplantation. In living donor liver transplantation (LDLT), the details remain unclear. Initially, 137 adult LDLT recipients from August 1996 to May 2005 were divided into two groups (donors <50 years of age: n=99, donors >or= 50 years of age: n=38) for the retrospective study. Then, 24 recipients who received LDLT from June 2005 to July 2006 were divided into two groups: group 1 (donors <50 years of age, n=14) and group 2 (donors >or= 50 years of age, n=10) and enrolled in the prospective study to analyze their clinical course and prognostic factors in the aged graft. In the retrospective study, the younger donor group had significantly better survival than that of the aged donor group (P=0.015, Log rank test). In the prospective study, the postoperative graft functions showed that the serum total bilirubin levels were significantly lower in group 1 (P<0.02, by ANOVA analysis). The phosphorylated-Signal Transducer and Activator of Transcription3 expression at 4 hr after reperfusion (RT2) in group 2 was significantly lower than that in group 1. At RT2, the expressions were up-regulated in group 1, but were down-regulated in group 2. The serum 8-hydroxydeoxyguanosine value became significantly higher in group 1 two weeks after LDLT. In the near term, Signal Transducer and Activator of Transcription3 gene induction during cold preservation may be of great use in improving the outcome of aged grafts in LDLT.


Lung cell exposure to secondary photochemical aerosols generated from OH oxidation of cyclic siloxanes.
To study the fate of cyclic volatile methyl siloxanes (cVMS) undergoing photooxidation in the environment and to assess the acute toxicity of inhaled secondary aerosols from cVMS, we used an oxidative flow reactor (OFR) to produce aerosols from oxidation of decamethylcyclopentasiloxane (D5). The aerosols produced from this process were characterized for size, shape, and chemical composition. We found that the OFR produced aerosols composed of silicon and oxygen, arranged in chain agglomerates, with primary particles of approximately 31 nm in diameter. Lung cells were exposed to the secondary organosilicon aerosols at estimated doses of 54-116 ng/cm2 using a Vitrocell air-liquid interface system, and organic gases and ozone exposure was minimized through a series of denuders. Siloxane aerosols were not found to be highly toxic.


Frequency distribution of serum cholesterol levels in patients with panic disorder: comparison with normal controls.
We compared the frequency distribution of total cholesterol (TC) levels in 103 patients with panic disorder (PD) with that in 173 gender- and age-matched normal controls (NC). There was no significant difference in the mean TC level between the PD and the NC groups. The distribution of TC levels in the PD group was similar to that in the NC group. As a whole distribution pattern, there is no association between high serum cholesterol levels and panic disorder. However, four male PD patients had very high TC levels of more than 260 mg/dL, and two of them had obviously deviated values from the frequency distribution of TC levels in the NC group. Our findings are supportive of the view that male PD patients with high TC levels have excess mortality due to cardiovascular diseases.


Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2* correction and estimation.
To determine whether hepatic fat quantification is affected by administration of gadolinium using a multiecho reconstruction technique with T2* correction and estimation. Forty-eight patients underwent the investigational sequence for hepatic fat quantification at 3.0T MRI once before and twice after administration of gadopentetate dimeglumine (0.1 mmol/kg). A one-way repeated-measures analysis of variance with pairwise comparisons was conducted to evaluate the systematic bias of fat fraction (FF) and R2* measurements between three acquisitions. Bland-Altman plots were used to assess the agreements between pre- and post-contrast FF measurements in the liver. A P value <0.05 indicated statistically significant difference. FF measurements of liver, spleen and spine revealed no significant systematic bias between the three measurements (P > 0.05 for all). Good agreements (95 % confidence interval) of FF measurements were demonstrated between pre-contrast and post-contrast1 (-0.49 %, 0.52 %) and post-contrast2 (-0.83 %, 0.77 %). R2* increased in liver and spleen (P = 0.039, P = 0.01) after administration of gadolinium. Although under the impact of an increased R2* in liver and spleen post-contrast, the investigational sequence can still obtain stable fat quantification. Therefore, it could be applied post-contrast to substantially increase the efficiency of MR examination and also provide a backup for the occasional failure of FF measurements pre-contrast. • Fat quantification with IDEAL-based investigational sequence remains stable after gadolinium administration. • It can be integrated into tri-phase liver MRI without adding scan time. • This helps optimize MR protocols and provides more useful information for clinicians.


Hard palate resection, microvascular reconstruction, and prosthetic restoration: a 14-year retrospective analysis.
This retrospective analysis was conducted to evaluate self-reported patient and clinician assessed functional outcomes of patients who have undergone ablative hard palate oncologic resection and microvascular free-flap reconstruction with and without maxillofacial prosthetic intervention. All Head and Neck Surgery Service, Plastic and Reconstruction Surgery Service, and Dental Service charts and progress notes entered into the Institutional Health Care Information System of 57 patients who underwent hard palate resection and microvascular reconstruction at Memorial Sloan-Kettering Cancer Center (MSKCC) between January 1, 1988, and December 31, 2001 were reviewed retrospectively by three maxillofacial prosthodontists (BJB, JMH, IMZ). Prosthetic and nonprosthetic rehabilitation outcomes for each patient were reported as having normal; limited; or poor esthetics and function according to each prosthodontist's clinical evaluations; patients' self-perceptions; and feedback from friends, family members, and/or spouse. Speech intelligibility was determined in the same manner but reported as normal, hypernasal, and hyponasal. Most of the 26 prosthetically rehabilitated patients were reported as having normal esthetics (81%), normal function (77%), normal speech (96%), and were able to return to per oral full diets (81%) without any restrictions. Acceptable oral rehabilitation outcomes were reported for most prosthetically rehabilitated free-flap patients. Normal speech can be anticipated with a high degree of certainty, and a high percentage of prosthetically restored free-flap patients achieved per oral diets.


Genetic diversity of community-associated methicillin-resistant Staphylococcus aureus isolated from Tenerife Island, Spain.
With the recent detection of MRSA (methicillin-resistant Staphylococcus aureus) infections in patients lacking health care-related risk factors, the term community-acquired MRSA (CA-MRSA) has been become widely recognised. Many cases of CA-MRSA spreading to the community have been described worldwide. The aim of this study was to determine the features of CA-MRSA isolates from Tenerife Island. Toward this end, one hundred MRSA isolates were collected from eight different health regions, and their molecular features were investigated. This study revealed a wide variety of MRSA clones, including an emergent ST: ST1434 (CC8) and two new spa types, t7575 (ST125) and t7678 (ST22). The PVL genes were found in only five isolates belonging to unrelated lineages, ST8, ST30 and ST22, which could indicate at least three independent introductions of PVL(+) strains to Tenerife. Moreover, we detected that hospital MRSA clones, like EMRSA-15 and EMRSA-16, had spread to the community and are now circulating in both environments. Therefore, in our study, the CDC's rules were not specific enough to distinguish CA-MRSA from HA-MRSA. Thus, we think that the current epidemiological information is not enough to discriminate between both MRSAs, and it is necessary for prevention guidelines to include the routine determination of at least the genetic background, the antimicrobial susceptibility profile, and the PVL genes of each MRSA isolate.


FoxP3(+)CD4(+)CD25(+) T cells with regulatory properties can be cultured from colonic mucosa of patients with Crohn's disease.
Summary CD4(+)CD25(+) regulatory T cells (T(regs)) are involved in the maintenance of peripheral tolerance and ensure a balanced immune response competent of fighting pathogens and at the same time recognizing commensals as harmless. This feature is lost in Crohn's disease (CD). The forkhead/winged helix transcription factor FoxP3 is a master gene for T(reg) function and defects in the FoxP3 gene lead to a clinical picture similar to inflammatory bowel disease (IBD). Murine colitis can be cured by adoptive transfer of T(regs) and ex vivo-generated gut-specific T(regs) represent an attractive option for therapy in CD. Thus, defective T(regs) could contribute to the development of CD. We cultured biopsies of colonic mucosa in the presence of high concentrations of interleukin (IL)-2 and IL-4 to overcome the anergic nature of naturally occurring CD4(+)CD25(+) T(regs) in the mucosa. We investigated the expression of FoxP3 and regulatory potential of gut-derived CD4(+)CD25(+) T cells cultured from patients with CD and healthy individuals. The FoxP3 expression was analysed by reverse transcriptase polymerase chain reaction (RT-PCR), and the suppressive effect of FoxP3(+)CD4(+)CD25(+) T cells on proliferation and cytokine production of autologous CD4(+) T cells was assessed by flow cytometry. Cultured gut-derived T cells with CD4(+)CD25(+) phenotype expressed FoxP3 and were able as the freshly isolated T(regs) from peripheral blood to suppress proliferation and cytokine production of autologous CD4(+) T cells. Thus, we demonstrate that FoxP3(+)CD4(+)CD25(+) T cells with regulatory properties can be propagated in vitro from inflamed mucosa of CD patients, which may be of interest in adoptive immunotherapy.


Analysis of secondary mtDNA mutations in families with Leber's hereditary optic neuropathy: Four novel variants and their association with clinical presentation.
Leber's hereditary optic neuropathy (LHON) is a mitochondrial disease characterized by subacute optic atrophy which results in severe visual impairment. The penetrance, clinical expression and disease onset are variable, and frequently associated with other extraocular symptoms. The disease phenotype remains to be an intriguing question which is dependent upon primary as well as secondary mtDNA mutations. In this study we analyzed the whole mtDNA sequence in six LHON families from Serbian population. The mtDNA sequencing was performed by Sanger's method and various bioinformatic tools were used for analysis of detected mutations. LHON patients carry all three (m.3460G > A, m.11778G > A and m.14484 T > C) primary mutations, together with numerous secondary mtDNA mutations. Four novel mutations (m.4516G > A, m.8779C > T, m.13138G > A and m.15986insG) in four different families were discovered. The m.8779C > T and m.13138G > A mutations could have a potential influence on LHON symptoms, but the issue of effect of secondary mtDNA mutations in LHON patients needs to be better clarified in future studies.


Pheochromocytoma - An ECG diagnosis?
Pheochromocytoma is a rare catecholamine-secreting tumor in the adrenal medulla. In some cases, the first symptoms are cardiovascular. We report on two patients with pheochromocytoma, who both presented with bidirectional ventricular tachycardia (BDVT). We elaborate on the mechanisms of BDVT in the setting of pheochromocytoma.


High frequency-low morbidity mechanical complications of tube feeding: a prospective study.
Because of preferential use of the enteral route for nutritional support, a prospective study of mechanical complications was done in 109 consecutive patients. One hundred seventy-two nasogastric tubes were placed in 60 patients, 42 esophagostomies in 28 patients, 32 gastrostomies in 22 patients and 9 jejunostomies in 8 patients. Data show that the use of enteral feeding tubes is not without complications. The complications fell into two major categories. There were 15 low frequency mechanical complications, of which four (2 carotid artery blowouts, 1 gastrointestinal perforation, and 1 aspiration) were of high morbidity and 11 of low morbidity. There were 132 high frequency-low morbidity complications with the use of 255 tubes. These consisted mainly of unplanned and untimely removal of feeding tubes with interruption of feedings and necessitating tube replacement. Data indicate that the main problems related to the use of enteral nutrition are not the dramatic complications which create notoriety but those related to the ordinary mechanical complications occurring daily and which command little attention because of their low mortality. These can assume importance because of their high frequency and as such are characterized as high frequency-low morbidity complications.


Hematological effects in dogs after sequential irradiation of the upper and lower part of the body with single myeloablative doses.
The compensating mechanisms determining the tolerance of the hemopoietic system to sequential hemibody irradiation (HBI) with large single doses, the regeneration of the irradiated bone marrow and the long-term effects of such treatment were studied in dogs. The main emphasis was laid on the determination of the granulocyte/macrophage progenitor cells (GM-CFC) in the bone marrow and blood. The general pattern of events in the GM-CFC compartment after each exposure was similar. Irradiation with a dose of 11.7 Gy of the upper body (UBI), that involved the abrogation of approximately 70% of the total active marrow, was followed by an immediate increase in the proliferation and differentiation of GM-CFC in the protected bone marrow. Repopulation of the GM-CFC in the irradiated sites most probably due to seeding of hemopoietic cells from the protected marrow already became evident at day 7 after UBI. At day 56 after UBI, when the irradiation of the lower body (LBI) was performed, the GM-CFC had recovered to between 30 and 40% of their pre-treatment values. Despite this incomplete regeneration, the GM-CFC compartment responded to LBI in a similar way as the GM-CFC had in the protected (normal) marrow after UBI, i.e. by an increased proliferation for at least 21 days. Already at day 7, the bone marrow of the iliac crest that had been exposed to LBI showed a considerable number of GM-CFC. Within no more than 370 days all the bone marrow sites irradiated during either the first or the second treatment had regained their normal GM-CFC values.


Vitamin D3 production by cultured human keratinocytes and fibroblasts.
We have demonstrated that monolayers of human cultured newborn foreskin keratinocytes and fibroblasts elaborate vitamin D3 following exposure to UV-B. This in vitro system provides a new means to study those factors (hormones, ions, vitamin D3 metabolites, etc.) that regulate the production of vitamin D3 by human skin cells. Vitamin D3 production was enhanced greatly by using cells that were pre-treated with AY-9944, a non-toxic drug that inhibits cholesterologenesis while elevating cellular levels of 7-dehydrocholesterol, the sterol precursor of vitamin D3. The pre-D3 formed within viable, irradiated cells is transformed to D3 within a matter of hours at 37 degrees C, and keratinocytes proved to be more proficient sources of the vitamin and its metabolites than corresponding skin fibroblasts.


Formation of a metabolite of dibromosulfophthalein (DBSP) in man.
In bile specimens from postoperative patients with biliary drainage following cholecystectomy, in addition to unchanged dibromosulfophthalein (DBSP), a single polar metabolite of DBSP was found after i.v. injection of 5 mg/kg of the diagnostic dye. This metabolite, which has not previously been detected, was resistant to beta-glucuronidase and arylsulfatase and was remarkably stable in strongly acid and alkaline solutions. It exhibited the same spectrum and colour change interval as unchanged DBSP. Further studies of its identity revealed that it gave a ninhydrin-positive reaction and that its Rf-value on TLC could be restored by Raney-nickel reduction. Amino-acid analysis after reduction and acid hydrolysis showed an increase in glutamic acid and alanine that can be considered as splitting products of conjugated glutathione following these procedures. Estimation of the quantity of this possible glutathione conjugate indicates that it is formed less rapidly than the glutathione derivative of the tetrabromoanalogue BSP, and that it represents up to 25% of the total dye excreted in bile. The observed metabolism of DBSP in man may complicate its use in the study of hepatic transport function, and negates the previous assumption that, as in certain other animal species, the dye is excreted unchanged.


Prediction of Falls in Acute Care Using The Morse Fall Risk Scale.
The high number of patient falls occurring within acute care hospitals throughout the United States has led to increased patient impairment and contributed to rising healthcare costs. The Morse Fall Risk Scale is a commonly used assessment tool for prediction of a patient's potential for experiencing a fall while in a healthcare facility. This retrospective study reviewed the use of the Morse Fall Risk Scale in a 300+ bed acute care hospital setting to determine adequacy for patient fall predictions over a four-month period. Use of multivariate regressions and Chi-Square test statistics revealed the Morse Fall Risk Scale was a predictor of patients' fall risk in this setting with other significant predictors of fall risk potential including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions). Patients experiencing a fall had a statistically significant longer hospital stay. Occupational therapy practitioners play an important role on the interdisciplinary team by providing a comprehensive fall assessment, developing fall prevention programs, and providing discharge recommendations.


To perceive is to doubt: the relativity of perception.
The uncertainty or entropy theory of perception is founded on the premise that for perception to occur, there must first of all be uncertainty. That is, perception or awareness is relative to the expectation of the perceiver. This view of perception leads to a seeming-paradox. How can there be uncertainty unless the alternatives have previously been perceived? But, by the premise of the theory, how can the alternatives have been perceived unless there was prior uncertainty? It is shown that this paradox may result physiologically in the concurrence of sensory and motor (or "active") events during the process of perceiving. It is shown, further, that a close analogy exists between systems of formal logic and systems which perceive through uncertainty. This, in turn, suggests a basis for a calculus of perception.


Differential phosphatidic acid metabolism in barley leaves and roots induced by chilling temperature.
Phosphatidic acid (PA) is an important bioactive lipid that mediates chilling responses in barley. Modifications in the lipid composition of cellular membranes during chilling are essential to maintain their integrity and fluidity. First, we investigated the molecular species of PA present in leaves and roots by ESI-MS/MS, to evaluate the modifications that occur in response to chilling. We demonstrated that PA pools in leaves differ from PA fatty acid composition in roots. Compared with plants grown at 25 °C, the short-term and long-term chilling for 3 h and 36 h at 4 °C not produced significant changes in PA molecular species. The endogenous DAG and PA phosphorylation by in vitro DAG and PA kinase activities showed higher activity in leaves compared with that in root, and they showed contrasting responses to chilling. Similarly, PA removal by phosphatidate phosphohydrolase was tested, showing that this activity was specifically increased in response to chilling in roots. The findings presented here may be helpful to understand how the PA signal is modulated between tissues, and may serve to highlight the importance of knowing the basal PA pools in different plant organs.


Accessing mental health walk-in clinics and other services for children and families.
Mental health walk-in clinics (MHWCs) are a model of service delivery that has gained increasing interest and traction. The aim of the study was to better understand how MHWC use is related to use of other services provided by agencies. (1) Explore if and how MHWCs are used alongside other services, including the different time points (e.g. MHWCs used exclusively, MHWCs used before other agency services); (2) identify correlates of MHWC use alongside other agency services. Administrative data from two child and youth mental health agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared with MHWC use exclusively. More than half of families used MHWCs and other agency services before or concurrently with other agency services. Child age, guardianship, and disposition at discharge emerged as correlates of MHWC use before other agency services. MHWCs are sufficient for some families, easing the pressure on other agency services. For the remaining families, MHWCs can help support them at the beginning of their service use journey.


LEDGF binding to stress response element increases alphaB-crystallin expression in astrocytes with oxidative stress.
AlphaB-crystallin, known as a vertebrate lens protein, is a member of the small heat shock proteins (sHSP). AlphaB-crystallin is abundantly expressed in the vertebrate lens and striated muscles and it is also expressed constitutively in other tissues including the central nervous system (CNS). In our previous report, we showed alphaB-crystallin induction in activated astrocytes, which are enriched in the penumbra after transient focal cerebral ischemia. We also reported that alphaB-crystallin is significantly induced in astrocytes in the CA3 region of the hippocampus following KA-induced seizure. Here, we report that the expression of alphaB-crystallin is upregulated in H2O2-treated primary astrocyte cultures, which was prepared from newborn male Sprague-Dawley rats and that the proximal 408 bp of the alphaB-crystallin promoter harboring stress response element (STRE) is responsible for this induction. This effect of H2O2 was found to be virtually abolished by introducing mutations into STRE, and these mutations also impaired increased lens epithelial derived growth factor (LEDGF) binding to STRE after H2O2 treatment. Moreover, LEDGF was induced in primary astrocyte cultures after H2O2 treatment and alphaB-crystallin induction was significantly suppressed by transfecting small interfering RNA (siRNA) targeting LEDGF. Together these results indicate that the H2O2-induced upregulations of alphaB-crystallin in astrocytes are mediated by the LEDGF-STRE interaction on alphaB-crystallin promoter.