Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass.
Black/white disparities in stroke incidence are well documented, but few studies have assessed the contributions to the disparity. Here we assess the contribution of "traditional" risk factors. A total of 25 714 black and white men and women, aged≥45 years and stroke-free at baseline, were followed for an average of 4.4 years to detect stroke. Mediation analysis using proportional hazards analysis assessed the contribution of traditional risk factors to racial disparities. At age 45 years, incident stroke risk was 2.90 (95% CI: 1.72-4.89) times more likely in blacks than in whites and 1.66 (95% CI: 1.34-2.07) times at age 65 years. Adjustment for risk factors attenuated these excesses by 40% and 45%, respectively, resulting in relative risks of 2.14 (95% CI: 1.25-3.67) and 1.35 (95% CI: 1.08-1.71). Approximately one half of this mediation is attributable to systolic blood pressure. Further adjustment for socioeconomic factors resulted in total mediation of 47% and 53% to relative risks of 2.01 (95% CI: 1.16-3.47) and 1.30 (1.03-1.65), respectively. Between ages 45 to 65 years, approximately half of the racial disparity in stroke risk is attributable to traditional risk factors (primarily systolic blood pressure) and socioeconomic factors, suggesting a critical need to understand the disparity in the development of these traditional risk factors. Because half of the excess stroke risk in blacks is not attributable to traditional risk factors and socioeconomic factors, differential impact of risk factors, residual confounding, or nontraditional risk factors may also play a role.


Healthcare Costs of Laparoscopic versus Open Surgery for Rectal Cancer Patients in the First 12 Months: A Secondary Endpoint Analysis of the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT).
Laparoscopic-assisted surgery for rectal cancer is widely used, however the healthcare costs are thought to be higher than for open resection. This secondary endpoint analysis of a randomized controlled trial aimed to evaluate total healthcare costs of laparoscopic-assisted surgery compared with open resection for rectal cancer over a 12-month period. Patients in the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) were included in a prospective costing analysis. All healthcare use for the index surgery and hospital admission, readmissions, and follow-up care over 12 months were included. Unit costs were valued in Australian dollars (AUD$) using scheduled Medicare fees and hospital cost weights. The primary outcome was mean per patient cost. Non-parametric bootstrapping with 10,000 replications was undertaken for robustness checks. Data from 468 patients indicated that the laparoscopic-assisted surgical procedure incurred a mean cost of AUD$4542 (standard deviation [SD] AUD$1050)-AUD$521 higher than the open procedure mean cost of AUD$4021 (SD AUD$804) due to longer operative time and involvement of more costly equipment (95% confidence interval [CI] AUD$354-AUD$692). At 12 months, the average cost for the laparoscopic-assisted and open groups was AUD$43,288 (SD AUD$40,883) and AUD$45,384 (SD AUD$38,659), respectively, due to the shorter subsequent hospital stays. No overall significant cost difference between groups was found (95% CI -AUD$9358 to AUD$5003). One-way sensitivity analyses confirmed the robustness of the results. While initially higher, the costs of laparoscopic-assisted surgery for rectal cancer were similar to open resection at 12 months. Clinicians may choose a surgical approach based on clinical need. The Australasian Gastro-Intestinal Trials Group (AGITG) was the legal sponsor and trial coordination was performed by the NHMRC Clinical Trials Centre. The trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12609000663257).


Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients.
To compare the risk for microbial keratitis in contact lens wearers stratified by wear schedule with the risk after laser in situ keratomileusis (LASIK). Hamilton Eye Institute and Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Comparative metaanalysis and literature review. An extensive literature search was performed in the PubMed database between December 2014 and July 2015. This was followed by a metaanalysis using a mixed-effects modeling approach. After 1 year of daily soft contact lens wear, there were fewer microbial keratitis cases than after LASIK, or approximately 2 cases fewer cases per 10 000 (P = .0609). If LASIK were assumed to have essentially a 1-time risk for microbial keratitis, 5 years of extrapolation would yield 11 more cases per 10 000 with daily soft contact lens wear than with LASIK, or approximately 3 times as many cases (P < .0001). The extended use of soft contact lenses led to 12 more cases at 1 year than LASIK, or approximately 3 times as many cases (P < .0001), and 81 more cases at 5 years (P < .0001). When incorporating an estimated 10% retreatment rate for LASIK, these results changed very little. Microbial keratitis is a relatively rare complication associated with contact lens use and LASIK postoperatively. The risk for microbial keratitis was similar between patients using contact lenses for 1 year compared with LASIK. Over time, the risk for microbial keratitis was higher for contact lens use than for LASIK, specifically with extended-wear lenses.


Equal Efficacy and Safety Profile in Elderly Patients with Hepatocellular Carcinoma Receiving Palliative Treatment.
Palliative treatment of elderly patients with hepatocellular carcinoma (HCC) is often challenging due to comorbidities or frailty, and data about the outcome and overall survival (OS) in these patients are limited. This was a retrospective single centre study. Patients were grouped according to their age as young (<60 years; YP), intermediate (60-70 years; IP) or elderly (>70 years; EP). Administration of chemotherapy or transarterial chemoembolization (TACE) was defined as palliative treatment. Therapy-related adverse events (AE) were assessed via CTCAE 5.0. Out of 656 patients analyzed, n = 359 received palliative treatment: YP: n = 90; IP: n = 127 and EP: n = 142. The median OS (months) in patients receiving TACE (n = 254) was 17 vs. 18 vs. 20 months for YP, IP, and EP, respectively (p = 0.44) and 15 vs. 16 vs. 17 months (p = 0.56), respectively, in patients receiving chemotherapy (n = 105). AEs differed non-significantly between the subgroups. Multivariate analysis revealed impaired liver function and advanced tumor stage as significant factors for impaired OS. In this study, the mOS and rate of AEs were equal between elderly and younger HCC patients receiving palliative treatment. Therefore, we propose regular palliative treatment stratification in spite of the high age of patients.


[White dot syndromes : Principles, diagnostics, and treatment].
The white dot syndromes include a group of diseases which are characterized by multiple yellowish-white foci in the outer retina, retinal pigment epithelium, and choroid. For clinicians and researchers alike they present significant diagnostic and therapeutic challenges. White dot syndromes include primary inflammatory choriocapillaropathies, such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE)/acute multifocal ischemic choriocapillaropathy (AMIC), multiple evanescent white dot syndrome (MEWDS)/acute idiopathic blind spot enlargement (AIBSE), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), serpiginous choroiditis (SC), acute zonal occult outer retinopathy (AZOOR), and acute macular neuroretinopathy (AMN). Among the primary stromal choroiditis is birdshot retinochoroidopathy (BSRC); however, the pathogenesis of these disorders is largely unknown. Immunological reactions to previous viral infections with a genetic disposition seem to be a common denominator.


Dithiocarbamate fungicides decrease histochemical reactivity of cholinesterases in the gut wall of the rat.
The toxicity of dithiocarbamate fungicides is poorly known, especially in the autonomic nervous system. Male Wistar rats were given tetraethylthiuramdisulfide (DSF), maneb, and zineb as a suspension in saline i.p. 200 mg/kg daily for 4 d. Rats received a similar dose of ethylenethiourea (ETU) as a solution in saline i.p., and the control rats received a corresponding volume of saline i.p. After decapitation, pieces of ileum were taken, and the enzyme histochemical reactivity for the acetylcholinesterase (AChE) and for the nonspecific cholinesterase (nsChE) in the ilea of the treated and control animals was studied. The reaction intensities in the samples were estimated by eye using a scale from 0 (no reaction product) to 3+ (maximal reaction). DSF was used as an internal standard. Controls showed the maximal reaction for the AChE and for the nsChE. Maneb, ETU and zineb showed consistent decrease in the reactivity for the AChE (+ +) and for the nsChE (+ +). The decrease by DSF of the reactions for both the AChE (+) as well as for the nsChE(+) was even more pronounced indicating a possible nerve damage to the cholinergic innervation of rat intestine. Kinetic differences may explain the divergent effects between the agents studied.


Mononuclear Diploidy at the Heart of Cardiomyocyte Proliferation.
Reporting in Nature Genetics, Patterson et al. (2017) show that adult mammalian hearts possess an innate capacity to regenerate, which depends on a small population of mononuclear diploid cardiomyocytes. These cells undergo karyokinesis and cytokinesis, raising the possibility that endogenous cardiac muscle cells can be stimulated to proliferate for myocardial repair.


Electrooxidative grafting of amine-terminated dendrimers encapsulating nanoparticles for spatially controlled surface functionalization of indium tin oxide.
We report the electrochemical grafting of amine-terminated dendrimers encapsulating nanoparticles onto indium tin oxide (ITO) surfaces.


Biochemical effects of formocresol on bovine pulp tissue.
Calf pulp was treated with full-strength formocresol, diluted formocresol, or saline for 4 hours. After washing and homogenization, the water extractable supernates were analyzed for total amino acid, carbohydrate, and hydroxyproline content. Additional samples were tested against trypsin, pepsin, collagenase, and hyaluronidase. Other tissue samples treated with 1/5, 1/10, and 1/25 dilutions of formocresol were subjected to trypsin and collagenase. The control tissue gave 50 per cent more extractable material, which contained over 300 per cent more total amino acids and hydroxyproline but only slightly more carbohydrate than the treated tissue. Formocresol treatment produced an 80 to 90 per cent reduction in reactivity to trypsin, pepsin, and collagenase but little change from hyaluronidase action. The increase in reactivity of the tissue to enzyme hydrolysis paralleled the increase in dilution of formocresol. These results indicate a profound effect on the protein fraction of pulp exposed to full-strength formocresol.


The other rabies viruses: The emergence and importance of lyssaviruses from bats and other vertebrates.
The recognition that viruses related to rabies virus cause rabies in humans has stimulated research into the relationships, geographic distribution and natural histories of these viruses. This paper reviews what is known of these fascinating viruses and the complexity of prevention and treatment of the disease they cause.


Rectal compliance and rectal sensation in constipated adolescents, recovered adolescents and healthy volunteers.
A subgroup of children with functional constipation (FC) are unresponsive to conventional treatment. Abnormal rectal function due to increased distensibility (compliance) might be an underlying mechanism of therapy-resistant FC. It is hypothesised that rectal compliance is normal in patients who are successfully recovered from FC (RC). Using a barostat, a pressure-controlled intermittent distension protocol was performed in FC patients, RC subjects free of symptoms for at least 4 years and healthy volunteers (HVs). Rectal compliance was calculated using a non-linear mixed-effect model for volume-pressure curves. Forty-seven FC patients, median (range) age of 12 (11-17) years, and 20 RC subjects, 15 (11-18) years, were studied and compared with 22 HVs, 14 (8-16) years. The median (5th-95th percentile) rectal compliance in HVs was 16 (12-20) ml/mm Hg. FC patients had a median rectal compliance of 25 (13-47) ml/mm Hg and RC subjects 20 (12-35) ml/mm Hg, which was significantly higher compared with HVs (p<0.001 and p = 0.003). RC subjects had lower rectal compliance when compared with FC patients (p = 0.02). Forty-five percent of RC subjects had a rectal compliance above the upper limit of normal (>95th percentile of HVs), which was significantly less compared with 75% of FC patients (p = 0.02). While rectal compliance in RC subjects is lower when compared with adolescents with FC, almost half of the RC subjects showed an increased rectal compliance. The role of rectal compliance in therapy-resistant FC seems limited, because recovery is possible despite an increased rectal compliance.


Direct synthesis of hydrogen fluoride-free multilayered Ti3C2/TiO2 composite and its applications in photocatalysis.
Ti3C2/TiO2 hybrids are environment-friendly and exhibit excellent photocatalytic and hydrogen-generating power characteristics. Herein, a novel single-step method is proposed for fabricating multilayer structures in which TiO2, generated from (NH4)2TiF6, wraps the Ti3C2 MXene by etching Ti3AlC2 with (NH4)2TiF6. The optimal reaction conditions for the etching of Ti3AlC2 with (NH4)2TiF6 were systematically studied. The phase composition, morphology, and photophysical properties of the Ti3C2/TiO2 hybrids were investigated using X-ray diffraction, field-emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, Raman spectroscopy, and UV-vis spectrophotometry. The thermal stability of the hybrids was investigated using thermogravimetric and differential thermal analyses. Along with the formation of Ti3C2 MXene, Ti3AlC2 reacted with (NH4)2TiF6 at 60 °C for 24 h to form hybrids surrounded by NH4TiOF3 crystals. Subsequent reactions of these hybrids with H3BO3 resulted in the conversion of NH4TiOF3 crystals into TiO2 and eventually into Ti3C2/TiO2 hybrids. Furthermore, the photocatalytic activity of the Ti3C2/TiO2 hybrids was measured by monitoring the photodegradation of methylene blue under ultraviolet light, which showed that the photocatalytic activity of the Ti3C2/TiO2 hybrids was higher than that of the commercial anatase TiO2 nanoparticles.


Dual Key-Activated Nir-I/II Fluorescence Probe for Monitoring Photodynamic and Photothermal Synergistic Therapy Efficacy.
As cancer markers, hydrogen peroxide (H2 O2 ) and viscosity play an essential role in the development of tumors. Meanwhile, based on the performance of near-infrared (NIR) fluorescence imaging and the high efficiency of photodynamic therapy (PDT) and photothermal therapy (PTT) synergistic therapy, it is urgent to develop a dual-key (H2 O2 and viscosity) activated fluorescence probe for cancer phototherapy. Herein, a NIR-I/II fluorescence probe named BX-B is reported. In the presence of both H2 O2 and viscosity, the fluorescence signal of NIR-I (810 nm) and NIR-II (945 nm) can be released. In the presence of H2 O2 , the PDT and PTT effects are observed. BX-B is used to monitor its therapeutic effects in cancer cells and tumor-bearing mice due to the increased viscosity caused by PDT and PTT. In addition, the tumors of mice treated with BX-B are almost completely ablated after the laser irradiation based on its PDT and PTT synergistic therapy. This work provides a reliable platform for effective cancer treatment and immediate evaluation of therapeutic effects.


Certified nurse specialists in cancer nursing and prophylactic antiemetic prescription for chemotherapy patients.
The prevention of chemotherapy-induced nausea and vomiting (CINV), a common chemotherapy side effect, should be attempted by oncology nurses. Certified nurses could be certified nurse specialists in cancer nursing (CNSCNs), who have high-level graduate education, or certified nurses in cancer chemotherapy nursing (CNCCNs), who have short-term training. The relationship between these certifications and compliance with the CINV prevention guidelines has not been investigated. We aimed to evaluate the association between certified nurse staffing and prescription of prophylactic antiemetic drugs for chemotherapy patients with high emetic risk. We used health service utilisation data for cancer patients diagnosed in 2016 from 474 hospitals nationwide in Japan and a list of certified nurses published by the Japanese Nurse Association. Patients receiving highly emetic chemotherapy were included. A multilevel mixed-effect logistic regression analysis was conducted to estimate the prescription of prophylactic antiemetic drugs associated with CNSCN and/or CNCCN staffing. Data of 46,306 patients were analysed. Overall, 68.4% and 94.0% of the patients received chemotherapy at hospitals with CNSCNs and CNCCNs, respectively. Small cell lung cancer, non-small cell lung cancer, breast cancer, and oesophageal cancer were positively associated with the prescription of recommended antiemetic drugs. CNSCNs was significantly associated with the prescription of prophylactic antiemetic drugs, while CNCCNs was positively but non-significantly associated with antiemetic prescriptions. This study is the first to demonstrate that CNSCN placement was significantly associated with prescribing antiemetic drugs recommended by clinical guidelines. Patients are likely to receive appropriate supportive care with the proper placement of CNSCNs.


Some radiological, structural, and physical properties of a clinical X-ray unit oil.
Radiological, structural, and physical properties of an x-ray oil which absorbed a photon dose of approximately 2.0 ± 0.2 Gy during its operational life (∼10 years), were investigated. An attenuation coefficient of 0.198 ± 0.003 cm-1 (at 122 keV) was obtained. NMR, ESR, and FTIR spectroscopy suggest a preponderance of pentane, and hexane. Mass spectrometry detected tertrapentacontane, nonadecane, and docosane. No gamma-emitters were revealed with gamma spectroscopy. A boiling temperature of approximately 300 °C was measured. Microscopy revealed the presence of gas bubbles.


Elevated C-reactive protein is significantly associated with left ventricular dysfunction in patients with aortic regurgitation and concomitant collagen disease.
Collagen disease is an important cause of aortic regurgitation (AR). Although aortic valve surgery is recommended for patients with AR and depressed left ventricular (LV) function, there have been few reports about risk factors for LV dysfunction in patients with AR concomitant with collagen disease. We conducted this study at Kumamoto University Hospital in Japan. A total of 41 patients who had moderate to severe AR and concomitant collagen disease between January 2014 and December 2019 were enrolled. With regard to baseline characteristics, there were no significant differences in the type of collagen disease or El Khoury class between patients with preserved LV function and those with reduced LV function. B-type natriuretic peptide (375.2 [257.9-3852.6]pg/ml vs. 64.0 [33.3-133.6]pg/ml, p < 0.01), C-reactive protein (CRP) levels (2.00 [1.24-9.14]mg/dl vs. 0.19 [0.06-0.52]mg/dl, p < 0.01) and neutrophil-to-lymphocyte ratio (7.94 [3.30-9.98] vs. 3.94 [1.83-5.58], p < 0.05) were significantly higher, and hemoglobin level (10.7 ± 1.6 g/dl vs. 12.2 ± 1.8 g/dl, p < 0.05) was significantly lower in patients with reduced LV function than in those with preserved LV function. There were no significant differences in any variables associated with severity and features of AR. Multivariable logistic regression analysis showed that high CRP levels (≥1.0 mg/dl) were independently and significantly associated with LV dysfunction in patients with AR and collagen disease, even after adjusting for the severity of AR (odds ratio: 95.7; 95% confidence interval: 4.6-1990.4, p < 0.01). Uncontrolled inflammation, represented as high CRP levels, is an important marker for LV dysfunction in patients with AR and collagen disease.


Pharyngeal reconstruction with a modified free alt flap with parastomal fascial wings.
Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels. This was a single-center retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC. All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theater for exposed major vessels and the wound healed within 6 weeks requiring dressings only. Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure.


Genome-wide analysis of SARS-CoV-2 virus strains circulating worldwide implicates heterogeneity.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel evolutionary divergent RNA virus, is responsible for the present devastating COVID-19 pandemic. To explore the genomic signatures, we comprehensively analyzed 2,492 complete and/or near-complete genome sequences of SARS-CoV-2 strains reported from across the globe to the GISAID database up to 30 March 2020. Genome-wide annotations revealed 1,516 nucleotide-level variations at different positions throughout the entire genome of SARS-CoV-2. Moreover, nucleotide (nt) deletion analysis found twelve deletion sites throughout the genome other than previously reported deletions at coding sequence of the ORF8 (open reading frame), spike, and ORF7a proteins, specifically in polyprotein ORF1ab (n = 9), ORF10 (n = 1), and 3´-UTR (n = 2). Evidence from the systematic gene-level mutational and protein profile analyses revealed a large number of amino acid (aa) substitutions (n = 744), demonstrating the viral proteins heterogeneous. Notably, residues of receptor-binding domain (RBD) showing crucial interactions with angiotensin-converting enzyme 2 (ACE2) and cross-reacting neutralizing antibody were found to be conserved among the analyzed virus strains, except for replacement of lysine with arginine at 378th position of the cryptic epitope of a Shanghai isolate, hCoV-19/Shanghai/SH0007/2020 (EPI_ISL_416320). Furthermore, our results of the preliminary epidemiological data on SARS-CoV-2 infections revealed that frequency of aa mutations were relatively higher in the SARS-CoV-2 genome sequences of Europe (43.07%) followed by Asia (38.09%), and North America (29.64%) while case fatality rates remained higher in the European temperate countries, such as Italy, Spain, Netherlands, France, England and Belgium. Thus, the present method of genome annotation employed at this early pandemic stage could be a promising tool for monitoring and tracking the continuously evolving pandemic situation, the associated genetic variants, and their implications for the development of effective control and prophylaxis strategies.


The prognostic value of intra-operative observations during thalamotomy for parkinsonian tremor.
Data from 27 thalamotomies were analyzed with respect to possible correlations between certain intra-operative observations and the long-term effect on parkinsonian tremor. Tremor reduction caused by mechanical impact of the electrodes in the target area was not correlated with the long-term effect on the tremor. The same was true for the threshold intensities during the intra-operative electrical stimulation of the target area, stimulation that facilitates and/or inhibits the tremor. In a minority of the patients, all with good long-term results, a combination of a pronounced tremor inhibition from the electrode insertion and a low threshold intensity was observed. Variations in other lesion parameters were not correlated with the outcome. The results are discussed within the framework of a "tremor" vs. a "tonus" mechanism underlying the thalamotomy effect.


Comparative studies of the ethynyl estrogens used in oral contraceptives. VII. Effects with and without progestational agents on ultracentrifugally fractionated plasma lipoproteins in humans, baboons, and beagles.
Ethynyestradiol and mestranol, in doses ranging from 50 to 100 microgram/day, were given to women in 21-day cycles; baboons and beagle dogs received 1 and 4 microgram/kg/day in a similar regimen. After a number of such cycles, megestrol acetate, norethindrone acetate, or dl-norgestrel was given concomitantly. Protein, cholesterol, triglyceride, and phospholipid levels were determined in total plasma and in ultracentrifugally separated lipoprotein fractions. Over the dosage range studied, the effects of the two kinds of estrogen were indistinguishable. Except for human total plasma triglyceride, no dose-related differences were observed. The lowering of serum protein and the increase in cholesterol induced by estrogen were more pronounced in baboons and beagles than in human subjects. The cholesterol-depressing effect of progestational compounds observed in humans was very pronounced in baboons but absent in beagles. In all three species, estrogen increased the lipoprotein fraction cholesterol, except for human low-density lipoprotein cholesterol, which was decreased. Human plasma triglyceride and phospholipid increased on estrogen administration and were decreased by the progestins; in the two animal species, triglyceride is normally very low and the estrogen-induced changes were negligible; the phospholipid rose with estrogen but was unaffected by progestins. In sum, the two animal species show many similarities to, as well as important differences from, the human response of plasma lipids to various contraceptive steroids.


An integrated medical record and data system for primary care. Part 3: the diagnostic index manual and computer methods and applications.
Manual and computer versions of the diagnostic of the index-E-Book are described. Methods for establisment and maintenance of both indexes are given and the relative merits of each are delineated. Uses of diagnostic indexes are presented which are appropriate to solo and group practices. The role of the diagnostic index in curriculum development within a family practice training setting is also illustrated.


The role of Chaetogaster limnaei in the dynamics of trematode transmission in natural populations of freshwater snails.
Chaetogaster limnaei, an oligochaete was always found infesting Bulinus (Phy.) globosus, B.(B.) forskalii and Lymnaea natalensis in Bo, Sierra Leone, living below the shell or embedded in the mucus of the foot. The worms had no preference for snails with trematode infection. The population was highest in the dry season when fewer snails were infected by trematodes. This is suggested to be a result of the protection the worms give to snails against invading miracidia.


Information sources and clinical decisions.
This study was undertaken to assess the dissemination of information about the management of chronic airway obstruction (CAO) in small community hospitals. The charts of all patients with CAO discharged from six hospitals were audited at two points in time, 1978 and 1983. In addition, physicians were surveyed to determine what information sources were critical in changing their behavior. Significant changes were seen in the use of diagnostic tests and therapeutic agents. Continuing medical education (CME) played a key role in test ordering, while pharmaceutical manufacturers' representatives were important sources of information concerning new therapeutic agents. The dissemination of information is a complex process. Physicians frequently use multiple sources of information in the decision making process. Physicians and planners of CME must be aware of what types of educational activities are best suited for their needs.


Associations between laboratory variables and clinical features in patients hospitalized with COVID-19 after non-mRNA vaccination in China: A cross-sectional study.
Based on the data during the outbreak of COVID-19 in Wuxi city in China, we explored the relationship between laboratory variables and clinical features in patients hospitalized with COVID-19 after non-mRNA vaccination, and attempted to identify the significant impact of vaccination and COVID-19 infection on humans. A retrospective observational cohort study was carried out. Patients who received non-mRNA COVID-19 vaccines and were hospitalized with COVID-19 between June 28, 2022, and July 24, 2022 were included. The correlation between different vaccine statuses, the time to negative PCR test, and biochemical parameters were investigated. All patients had a mild COVID-19 disease. The number of vaccine doses exerted no effects on the time to negative PCR test (P = 0.559). No differences were evident among inactivated, adenoviral-vectored, and recombinant subunit vaccines in the time to negative PCR test.Patients who just received one dose had significantly lower blood glucose levels than those who received three doses (P = 0.024), whereas two doses had no effect on blood glucose levels (one dose vs. two doses, P = 0.223; two doses vs. three doses, P = 0.457).Body temperature (β = 0.168, P = 0.011) and the percentage of lymphocytes (β = -0.219, P = 0.001) were substantially correlated with the time to COVID-19 negative PCR test. The prolonged stay was linked to a rise in GOT that fell within the usual range (P = 0.025).The percentage of lymphocytes (P = 0.007) and serum potassium (P = 0.004) were concordant with the marked change in body temperature. The dose and type of vaccination had no effect on the time to COVID-19 negative PCR test in patients with mild COVID-19. Comparing the first dose with the booster dose, the blood glucose levels increased within the normal range. The period at which the COVID-19 nucleic acid turned negative correlated with body temperature, the proportion of lymphocytes, GOT, and serum potassium.


Pilot study of tandem high-dose chemotherapy and autologous stem cell transplantation with a novel combination of regimens in patients with poor risk lymphoma.
In an effort to improve the outcome of poor-risk lymphoma patients, we evaluated a novel regimen of tandem high-dose chemotherapy (THDC) with autologous stem cell transplantation. A total of 41 patients (median age 40 years, range 15-68 years) with poor-risk non-Hodgkin's lymphoma and Hodgkin's disease were enrolled. THDC consisted of melphalan (180 mg/m2) and escalating dose mitoxantrone (30-50 mg/m2) (MMt) for the first conditioning regimen, and thiotepa (500 mg/m2), carboplatin (800 mg/m2), and escalating dose etoposide phosphate (400-850 mg/m2), (ETCb) as the second regimen. In all, 31 patients (76%) completed both transplants, with a median time between transplants of 55 days (range 26-120). The maximum tolerated dose was determined as 40 mg/m2 for mitoxantrone and 550 mg/m2 for etoposide phosphate. The overall toxic death rate was 12%. Following high-dose chemotherapy, 10 of 24 evaluable patients (42%) were in CR. The two-year overall survival and event-free survival is 67% (95% CI, 52-81%) and 45%, (95% CI, 29-61%) for the 41 patients enrolled; and 69% (95% CI, 525-586%) and 48% (95% CI, 30-67%) for the 31 patients completing both transplants. This THDC regimen is feasible but with notable toxicity in heavily pretreated patients; its role in the current treatment of high-risk lymphoma remains to be determined.


Fully supported open stent grafting applied with a Matsui-Kitamura (MK) stent in treatment of distal arch aneurysm.
Our purpose was to examine the use of fully supported open stent grafting (OSG) with a Matsui-Kitamura (MK) stent for treatment of distal arch aneurysm (DAA). Surgery was performed using a newly developed device in seven DAA patients (six men and one woman) from 58 to 86 years of age (mean, 73 years old) from August 2005 to June 2007. The aorta was transected at the arch between bracheocephalic artery and left subclavian artery under circulatory arrest with total cardiopulmonary bypass and selective cerebral perfusion; then the stent grafting (SG) system was inserted and positioned with a 14 Fr. pusher. The SG and a transected edge were then sutured and anastomosed with the arch graft. The surgery was completed by constructing three cerebral branches. The mean SG diameter and length were 34.6 mm (range, 32-38 mm) and 150 mm (120-200 mm), respectively. The mean time of circulatory arrest time and surgery were 41 min (35-55 min) and 358 min (269-450 min), respectively. Simultaneous mitral valve replacement was performed in one patient. All surgeries were completed successfully, and complete thrombosis of the aneurysm was obtained. Paraparesis and respiratory failure occurred in one patient each, and one patient died of brainstem infarction 1 month after surgery. These initial results suggest that the OSG method is a useful surgical procedure for the treatment of DAA.


Nesfatin-1 - as a diagnosis regulatory peptide in type 2 diabetes mellitus.
One of the most common metabolic diseases, Type 2 Diabetes Mellitus (T2DM), is caused by a combination of two basic factors: insufficient insulin secretion by pancreatic -cells or a failure of insulin-sensitive tissues to respond adequately to insulin. The aim of this paper was to assess the diagnostic accuracy of serum nesfatin-1 in type 2 diabetes mellitus (T2DM). Sixty patients with T2DM were recruited from (Baquba Teaching Hospital) in Iraq during the period (from November 2021 - March 2022). T2DM group was classified into 30 newly diagnosis patients (without treatment) and 30 ongoing diabetic patients (with treatment) for comparison, as well 30 healthy individuals were included as a control. The ELISA Kit was used to measure serum nesfatin-1 and serum insulin, fasting serum glucose, and lipid profile test were measured through spectrophotometric, instead of HbA1c was determined using HPLC method. The concentration of serum nesfatin-1 in the T2DM group was significantly lower than that of the healthy subjects (p < 0.05). There was a significant difference in the serum nestafin-1 concentrations between newly diagnosis and ongoing T2DM patients. There were substantial negative connections between serum Nesfatin-1 concentration and HOMA-IR, as well as strong negative correlations between serum nesfatin-1 and serum insulin level. The concentration of serum Nesfatin-1, on the other hand, had no significant association with the anthropometries measurements and biochemical parameters. The area under the curve was excellent (AUC = 0.827, p = 0.0001), with high diagnostic accuracy (86.2) in differentiating newly diagnosis T2DM from the healthy subject group. Nesfatin-1 levels in the sera of diabetic patients was shown to be lower and nesfatin-1 levels were shown to be significantly linked to newly diagnosed patients.


Effect of noxious tail pinch on the discharge rate of mesocortical and mesolimbic dopamine neurons: selective activation of the mesocortical system.
The effects of noxious tail pinch on the activity of mesocortical and mesolimbic dopamine (DA) neurons located in the ventromedial mesencephalic tegmentum were analyzed in ketamine-anesthetized rats. The great majority of mesocortical DA neurons responded to tail pinch, either by an excitation (65%), or by an inhibition (25%). In contrast, most DA neurons projecting either to the nucleus accumbens or the septum remained unaffected. These results demonstrate that noxious tail pinch selectively influences the firing rate of mesocortical DA neurons.


Sex and Maturation Differences in Performance of Functional Jumping and Landing Deficits in Youth Athletes.
Understanding how neuromuscular and biomechanical deficits that are associated with knee injuries change as youth mature may improve injury prevention strategies in this population. To investigate sex and maturation differences in jump-landing technique performance in youths using a practical clinical tool. Cross-sectional study. High Performance Center Laboratory. A total of 165 youth athletes were included in this study. The main outcome measures were each of the 10 items of the modified tuck jump assessment and the total score. These measures include (1) knee valgus at landing, (2) thighs do not reach parallel, (3) thighs not equal side to side, (4) foot placement not shoulder width apart, (5) foot placement not parallel, (6) foot contact timing not equal, (7) excessive landing contact noise, (8) pause between jumps, (9) technique declines prior to 10 seconds, and (10) does not land in same footprint. Only knee valgus at landing had a significant sex × maturation interaction. The main effect of maturation was significant for items 2, 3, 6, 7, 9, and total score. Plyometric technique performance improved with increasing maturation. The main effect of sex was significant for items 1 and 9, with males performing better than females. Female athletes demonstrate increased knee valgus at landing and fatigue relative to males during jump-landing performance. Overall, there was a trend of improved jump-landing performance with maturation.


Probiotic properties of vaginal lactic acid bacteria to prevent metritis in cattle.
The isolation of bovine vaginal lactic acid bacteria (LAB) and the screening of their beneficial properties to select those that could be used as probiotics in the prevention of bovine metritis were performed. Out of 76 Lactobacillus sp. and seven Streptococcus sp. strains, a small number showed high- and medium hydrophobicity when the microbial adhesion to hydrocarbons method (MATH) was applied. In the agar plate diffusion test, a large number of strains inhibited vaginal bovine Escherichia coli 99/14 and human E. coli. This inhibition was due to acid. Only a few strains inhibited Actinomyces pyogenes 96/393, a pathogen isolated from bovine metritis. This inhibition remained after neutralization. The taxonomic identification of the selected strains was carried out by an amplified ribosomal DNA restriction analysis (ARDRA). Most of the strains were identified as Lactobacillus fermentum, a few as Lactobacillus gasseri and one as Lactobacillus rhamnosus. Bovine vaginal lactobacilli strains have differential surface properties. The strains selected are capable of inhibiting specific metritis pathogens. Our results can be applied for future studies to design a probiotic product to prevent metritis in dairy postpartum cows.


Explicit and procedural memory in Parkinson's disease.
One of the aims of cognitive psychology is to breakdown complex tasks into their most basic components. The components of explicit (declarative) and implicit (procedural) memory were thus analyzed in undemented, non-depressed Parkinsonian patients under anti-Parkinsonian treatment, and compared with young and elderly healthy subjects. Three series of experiments were conducted in 61 patients in total. Statistically significant results revealed an impairment of explicit memory (verbal recall of words and drawings) with preserved recall of faces, in Parkinsonians. Implicit memory was also deficient, only in association tests (sound-form; arithmetical alphabet) and maze tests. Braille reading tests and Toronto tower tests did not discriminate between Parkinsonians and elderly subjects. Lastly, analyzing learning and automation revealed a dysfunctioning in Parkinsonian patients. All these data indicate a dysregulation of the cortical-sub-cortical systems, not essentially pre-frontal, and not necessarily dopaminergic. Cognitively, it appears that procedural and implicit memories should be dissociated conceptually.


Quality assessment of lemon (Citrus aurantifolia, swingle) coated with self-healed multilayer films based on chitosan/carboxymethyl cellulose under cold storage conditions.
The polyelectrolyte multilayer self-healing coating film of chitosan and carboxymethyl cellulose (PEM-SH) tended to maintain high sensory quality and control physiological and pathological decay of lemon fruits under cold storage. The PEM-SH film was characterized by ATR-IR, XRD, X-ray photoelectron spectroscopy, SEM analysis, swelling ratio, self-healing, and mechanical characteristics. The 3-layered film (3L) exhibited the optimum barrier properties; WVP: 3.32 ± 0.06 g. mm. k Pa-1.h-1.m-2 and GTR: 0.256 ± 0.032 cc.M-2.day-1. The moisture sorption isotherm data were fitted with BET, GAB, and Peleg models and three models showed applicability. The coated fruits exhibit superior features of fruit quality such as reduced weight loss %, respiration rate, and decay symptoms appearance. The 3L-coated fruit showed the lower pectinase enzyme activity (0.689 Ug-1 FW) up to 60 days. As well as, increased total soluble solids, keeping vitamin C of loss and decreasing percentage acidity of juice up to 60 days.


Erratum: Hopp, A.K., et al. Regulation of Glucose Metabolism by NAD+ and ADP-Ribosylation. Cells 2019, 8, 890.
Change in References list order. [...].


Changes in body temperature and metabolic rate following microinjection of Met-enkephalinamide in the preoptic/anterior hypothalamus of rats.
The effects of Met-enkephalinamide (MET-ENKamide) on brain temperature (Tb) and metabolic rate (MR) were assessed following direct administration into the preoptic/anterior hypothalamus (PO/AH) of freely moving rats. Bilateral microinjections of saline or MET-ENKamide (1-25 micrograms/microliter) were delivered through cannula guide tubes previously implanted in nine animals. Thiorphan, an enkephalinase inhibitor, was microinjected into the PO/AH of two of the animals. All injections were made remotely at an ambient temperature of 22 +/- 1 degree C in a volume of 1 microliter. Measurements of Tb (via a brain-dwelling thermistor) and MR were recorded continuously. The ability of naloxone to antagonize the effects of MET-ENKamide was investigated by fashioning a double-barreled injection cannula to fit within each guide tube; 1 microliter of saline or naloxone (1-10 micrograms) was delivered bilaterally into the PO/AH followed by 1 microliter of MET-ENKamide (25 micrograms) 5-10 min later. PO/AH administration of MET-ENKamide (1-25 micrograms) produced dose-dependent increases in Tb preceded by dose-dependent increases in MR, with a characteristic time course of approximately 30 min. Naloxone antagonized the rise in Tb and MR, either partially or completely, depending on dose. When administered alone, naloxone had no effect on Tb or MR. Microinjection of thiorphan (10 micrograms) into the PO/AH evoked increases in Tb and MR that were similar to those responses induced by MET-ENKamide. These results support a role for endogenous Met-enkephalin in the regulation of Tb in the rat.


Needs, concerns and self-management experiences of people with type 2 diabetes during the COVID-19 pandemic: A qualitative study.
Type 2 diabetes is associated with increased COVID-19 severity. Little is understood about the needs, concerns and self-management experiences of people with type 2 diabetes during the COVID-19 pandemic. To examine the lived experiences of people with type 2 diabetes during the COVID-19 pandemic. This qualitative study recruited people with type 2 diabetes from the SOUth-London Diabetes (SOUL-D) cohort. Semi-structured interviews via telephone were conducted between September 2020 and January 2021. Deductive thematic analysis derived themes from the data to explore needs, concerns and self-management experiences of people with type 2 diabetes. Twenty-nine people with type 2 diabetes were interviewed. Three themes with subthemes were outlined: (1) information needs of people with type 2 diabetes during the Covid-19 pandemic, (2) concerns about Covid-19 from people with type 2 diabetes and (3) diabetes self management and well-being during the Covid-19 pandemic. During a pandemic, there is a need for consistent, diabetes-specific, messaging from healthcare professionals for people with type 2 diabetes. People with type 2 diabetes need support to access digital resources to aid remote communication. Future research could help develop recourses to prevent social isolation and loneliness for people with type 2 diabetes during a pandemic.


Direct synthesis, crystal structures, high-field EPR, and magnetic studies of heterometallic polymers containing manganese(II) carboxylates interconnected by [Cu(en)2]2+.
Two heterometallic polymers containing cations [Cu(en)2]2+ and either the [Mn(mal)2(H2O)2]2- (1) or [Mn2(succ)2Cl2]n2n- (2) anions (mal=malonate and succ=succinate) were investigated by X-ray crystallography, high-field electron paramagnetic resonance (EPR) spectroscopy, and magnetic susceptibility measurements. Magnetic susceptibility and EPR spectra characteristic of antiferromagnetically coupled Mn2+-Mn2+ pairs were observed in 2, and the exchange integral J=31 cm(-1) (H=JS1S2) as well as the zero-field-splitting parameter D=-3.046 cm(-1) in the triplet state of the dimanganese entity was determined.


[The initiation and propagation of canine pelviureteral contraction studied through visual observation and simultaneous electromyographic recording (author's transl)].
The initiation and the propagation of the ureteral peristalsis were studied through the visual observation and the simultaneous recording of action potentials at both renal pelvis and ureter. The results were summarized as follows: 1) The contraction waves were seen to arise at the proximal end of the renal pelvis. Each wave moved from its origin across the adjacent part of the renal pelvis toward the pelviureteric junction forming a crescentric wave front centering the pelviureteric junction. But some waves failed to propagate not only at the pelviureteric junction but also within the renal pelvis. 2) By electromyographic study, pacemaker potentials were recorded clearly at the proximal end of the pelvis and the interval of the discharge was constant throughout the recording period. Some of the electrical waves failed to conduct within the renal pelvis as well as at the pelviureteric junction.


Efficacy of neomycin dosing regimens for treating enterotoxigenic Escherichia coli-related post-weaning diarrhoea in a Danish nursery pig herd not using medicinal zinc oxide.
Neomycin is a concentration-dependant aminoglycoside antimicrobial used to treat enterotoxigenic Escherichia coli (ETEC)-related post-weaning diarrhoea (PWD) in pigs. The objective was to compare the efficacy of neomycin administered in a single high dose (50,000 IU/kg) and a standard dose and frequency (25,000 IU/kg daily for 3 consecutive days) in reducing the number of pigs with clinical PWD. We also aimed to evaluate the development of antimicrobial resistance in E. coli following neomycin treatment. The study was performed in a Danish herd not using medicinal zinc oxide and experiencing outbreaks of PWD caused by ETEC in the first week after weaning. Pigs from six batches with perianal faecal staining on days 4-6 after weaning and a faecal score of 3-4 were ear tagged and treated with neomycin. Pens were randomly assigned to a treatment group before inclusion. A total of 772 pigs (471 in the control group and 301 in the experimental group) were included and treated orally. The apparent prevalence of diarrhoea on the first day of inclusion across six batches (n = 1,875) was 27%. The efficacy of the neomycin treatment strategy was 86% for the control group and 91% for the single high-dose group (p = 0.043), and the mean percentage (standard deviation (sd)) of haemolytic E. coli-like colonies was 12% (26) and 26% (37) (p < 0.001), respectively. Neomycin resistance did not differ between groups. Before treatment, all analysed isolates were identified as ETEC (n = 142), while after treatment, 91% were identified as ETEC (n = 69) and 9% (n = 7) as non-ETEC E. coli (without fimbria or toxins). A higher cure rate in the single high-dose group suggests that ETEC-related PWD can be treated with a single high dose of 50,000 IU/kg of neomycin, thereby reducing antimicrobial use by 33% compared to the standard treatment of 25,000 IU/kg for 3 consecutive days. The study indicated a higher number of haemolytic E. coli in the single high-dose group after treatment, but no evidence of increased neomycin resistance in coliforms was observed compared to the standard treatment.


Kyphotic deformity in spinal tuberculosis and its management.
Spinal tuberculosis is the most common cause of severe kyphosis in many parts of the world. Three percent of patients treated conservatively end up with a deformity greater than 60 degrees which can cause serious cosmetic, psychological, cardio-respiratory and neurological problems. Severe kyphotic deformities are usually the result of childhood spinal deformities and 'Spine at risk' radiological signs are helpful to identify children at risk of deformity. In children, a severe type of collapse, termed as 'Buckling Collapse' is also noted where the kyphosis is more than 120 degrees. Risk factors for buckling collapse include an age of less than seven years at the time of infection, thoracolumbar involvement, loss of more than two vertebral bodies and the presence of radiographic 'Spine-at-risk' signs. In correction of established deformity, posterior only surgery with a variety of osteotomies is now preferred. In patients with deformity of more than 90 degrees, an opening-closing wedge osteotomy must be done to prevent neurological deficit.


Hazard report. ECRI Institute recommends providing power-cord-specific data when reporting device incidents.
When power cord defects or damage contributes to device-related incidents, crucial information about the cord and/or plug (e.g., manufacturer, details of damage) is often not included in incident reports. To facilitate the investigation of these events--which frequently pose a risk of shock or fire--ECRI Institute is asking hospitals to include cord and plug details when reporting the incidents to us, to device manufacturers, and to regulatory agencies.


Comparison of 68Ga-labeled RGD mono- and multimers based on a clickable siderophore-based scaffold.
Cyclic pentapeptides containing the amino acid sequence arginine-glycine-aspartic (RGD) have been widely applied to target αvβ3 integrin, which is upregulated in various tumors during tumor-induced angiogenesis. Multimeric cyclic RGD peptides have been reported to be advantageous over monomeric counterparts for angiogenesis imaging. Here, we prepared mono-, di-, and trimeric cyclic arginine-glycine-aspartic-D-phenylalanine-lysine (c (RGDfK)) derivatives by conjugation with the natural chelator fusarinine C (FSC) using click chemistry based on copper (I)-catalyzed azide-alkyne cycloaddition (CuAAC). The αvβ3 binding properties of 68Ga-labeled mono-, di-, and trimeric c(RGDfK) peptides were evaluated in vitro as well as in vivo and compared with the references monomeric [68Ga]GaNODAGA-c(RGDfK) and trimeric [68Ga]GaFSC(suc-c(RGDfK))3. All 68Ga-labeled c(RGDfK) peptides displayed hydrophilicity (logD = -2.96 to -3.80), low protein binding and were stable in phosphate buffered-saline (PBS) and serum up to 2 h. In vitro internalization assays with human melanoma M21 (αvβ3-positive) and M21-L (αvβ3-negative) cell lines showed specific uptake of all derivatives and increased in the series: mono- < di- < trimeric peptide. The highest tumor uptake, tumor-to-background ratios, and image contrast were found for the dimeric [68Ga]GaMAFC(c(RGDfK)aza)2. In conclusion, we developed a novel strategy for direct, straight forward preparation of mono-, di-, and trimeric c(RGDfK) conjugates based on the FSC scaffold. Interestingly, the best αvβ3 imaging properties were found for the dimeric [68Ga]GaMAFC(c(RGDfK)aza)2.


Acute porphyrias: a German monocentric study of the biochemical, molecular genetic, and clinical data of 62 families.
In Germany, analyses of clinical and laboratory features of patients with acute porphyrias are only available for hereditary coproporphyria (HCP) but not with other acute porphyrias, acute intermittent porphyria (AIP) and variegate porphyria (VP). The aim of the study was to analyze a large cohort of patients with particular focus upon quality of life aspects. Sixty-two individuals from separate families with acute porphyrias (57 AIP, 5 VP) were included into an observational study collecting biochemical, genetic, and clinical data. A questionnaire was designed to complete anamnestic information and to assess the influence on quality of life. Most frequent signs and symptoms or laboratory abnormalities were abdominal colicky pain, red coloration of urine, and hyponatremia. Depression or anxiety was reported by 61% or 52% individuals, respectively. Fatigue was mentioned as the most quality of life-limiting symptom. In 59/61 patients, mutations could be identified. 44% (20/45) had to be admitted to an intensive care unit. Heme arginate was used in 64% (29/45) of patients for treatment of acute attacks at least once and in 33% for long-term treatment with high frequency of administration. Serum creatinine values increased in 47% (7/17) of the patients with recurrent attacks. Our analysis confirms a substantial influence of the diseases on the quality of life on patients. Percentages of urine discoloration and intensive care unit admissions were much higher than in other reports. Long-term treatment with heme arginate requires careful monitoring of iron status and renal values.


Crystallization of the arginine-dependent repressor/activator AhrC from Bacillus subtilis.
The arginine-dependent repressor/activator AhrC from Bacillus subtilis has been crystallized in space group C222(1), with unit cell dimensions a = 229.8 A, b = 72.8 A, c = 137.7 A and one aporepressor hexamer per asymmetric unit. Preliminary X-ray photographs show measurable intensities beyond 3.0 A.


Cytoplasmic Production of Nanobodies and Nanobody-Based Reagents by Co-Expression of Sulfhydryl Oxidase and DsbC Isomerase.
Nanobodies are stable molecules that can often fold correctly even in the absence of the disulfide bond(s) that stabilize their three-dimensional conformation. Nevertheless, some nanobodies require the formation of disulfide bonds, and therefore they are commonly expressed from vectors that promote their secretion into the oxidizing environment of the Escherichia coli periplasm. As an alternative, the bacterial cytoplasm can be an effective compartment for producing correctly folded nanobodies when sulfhydryl oxidase and disulfide-bond isomerase activities are co-expressed from a recombinant vector. The larger volume and wider chaperone/foldase availability of the cytoplasm enable the achievement of high yields of both nanobodies and nanobody-tag fusions, independently of their redox requirements. Among other examples, the protocol described here was used to successfully produce nanobody fusions with fluorescent proteins that do not fold correctly in the periplasm, nanobodies with Fc domains, and nanobodies containing free cysteine tags.


Classifying Polypharmacy According to Pharmacotherapeutic and Clinical Risks in Older Adults: A Latent Class Analysis in Quebec, Canada.
The simplistic definition of polypharmacy, often designated as the concomitant use of five medications or more, does not distinguish appropriate from inappropriate polypharmacy. Classifying polypharmacy according to varying levels of health risk would help optimise medication use. We aimed to characterise different types of polypharmacy among older adults and evaluate their association with mortality and institutionalisation. Using healthcare databases from the Quebec Integrated Chronic Disease Surveillance System, we selected a community-based random sample of the population ≥ 66 years old covered by the public drug plan. Categorical indicators used to describe polypharmacy included number of medications, potentially inappropriate medications (PIMs), drug-drug interactions, enhanced surveillance medications, complex route of administration medications, anticholinergic cognitive burden (ACB) score and use of blister cards. We used a latent class analysis to subdivide participants into distinct groups of polypharmacy. Their association with 3-year mortality and institutionalisation was assessed with adjusted Cox models. In total, 93,516 individuals were included. A four-class model was selected with groups described as (1) no polypharmacy (46% of our sample), (2) high-medium number of medications, low risk (33%), (3) medium number of medications, PIM use with or without high ACB score (8%) and (4) hyperpolypharmacy, complex use, high risk (13%). Using the class without polypharmacy as the reference, all polypharmacy classes were associated with 3-year mortality and institutionalisation, with the most complex/inappropriate classes denoting the highest risk (hazard ratio [HR] [95% confidence interval]: class 3, 70-year-old point estimate for mortality 1.52 [1.30-1.78] and institutionalisation 1.86 [1.52-2.29]; class 4, 70-year-old point estimate for mortality 2.74 [2.44-3.08] and institutionalisation 3.11 [2.60-3.70]). We distinguished three types of polypharmacy with varying pharmacotherapeutic and clinical appropriateness. Our results highlight the value of looking beyond the number of medications to assess polypharmacy.


Localized delivery of curcumin by thermosensitive hydrogels for promoting wound healing.
Curcumin can promote wound healing, but its drug delivery medium needs to be improved further. A curcumin-loaded thermosensitive hydrogel was prepared, its characterization was evaluated, and its promoting effect on wound healing was observed. Curcumin-loaded thermosensitive hydrogels were prepared with different percentages of poloxamer 188 and poloxamer 407. A small tube inversion assay was used to observe the sol-gel transition temperature, and a rotational rheometer was used to detect the sol viscosity, sol-gel phase transition temperature, and phase transition time. The microstructure of the gel was observed by scanning electron microscopy, and Fourier infrared spectroscopy was used to evaluate whether curcumin was successfully loaded. Finally, its promoting effect on wound healing was observed in vivo and in vitro. Poloxamer 407 24% and poloxamer 188 1% were selected to prepare curcumin-loaded thermosensitive hydrogels. After 60 ± 15 s at 32°C, the sol-gel transition process was completed, with certain elastic behavior and solid-like rheological properties. Scanning electron microscopy showed that the pores of the curcumin-P407/P188 thermosensitive hydrogel were interconnected, with an average pore size ranging from 5 to 10 μm. Hydrogels showed a higher swelling ratio. Fourier transform infrared spectroscopy showed that curcumin had been incorporated into the hydrogel. Live/dead cell assays suggested that the hydrogel was not toxic to fibroblasts. Curcumin-loaded thermosensitive hydrogels can promote an increase in S-phase fibroblasts and improve wound healing. Curcumin-loaded P407/P188 thermosensitive hydrogel improves wound healing. More in-depth research is needed in the future.


The effect of population density on the development of experimental atherosclerosis in female mice.
The effect of cage population density on plasma lipids and the development of atherosclerosis was examined in female C57BL/6 mice. Mice were housed at a density of one, two or five animals per cage and fed an atherogenic diet for 28 weeks. Subsequently, the animals were bled, sacrificed, the hearts removed and the extent of fatty lesion development in the aorta examined and quantified. As the population density increased, there was a statistically significant increase in total cholesterol levels, VLDL+LDL cholesterol levels, the VLDL+LDL/HDL ratio and lesion severity. These differences are due to the psychosocial stress associated with living within a confined space with high population density over an extended period of time.


Urinary α- and π-glutathione s-transferases for early detection of acute kidney injury following cardiopulmonary bypass.
Urinary α-GST and π-GST are renal tubular leakage markers. To evaluate the performance characteristics of these markers for the early detection of acute kidney injury (AKI). Multicenter prospective cohort study of 252 adults undergoing cardiopulmonary bypass (CPB). AKI developed in 72 patients. The 2 h post-CPB π-GST level modestly predicted the development of AKI, including higher stages of severity, whereas α-GST did not. Small number of events and absence of subsequent post-operative biomarker measurements. Among adults undergoing CPB, urinary π-GST outperformed α-GST for predicting AKI, but neither marker displayed good discrimination.


Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.
The objective of this study was to systematically determine the diagnostic accuracy of bedside tests for predicting difficult intubation in patients with no airway pathology. Thirty-five studies (50,760 patients) were selected from electronic databases. The overall incidence of difficult intubation was 5.8% (95% confidence interval, 4.5-7.5%). Screening tests included the Mallampati oropharyngeal classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score. Each test yielded poor to moderate sensitivity (20-62%) and moderate to fair specificity (82-97%). The most useful bedside test for prediction was found to be a combination of the Mallampati classification and thyromental distance (positive likelihood ratio, 9.9; 95% confidence interval, 3.1-31.9). Currently available screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of tests add some incremental diagnostic value in comparison to the value of each test alone. The clinical value of bedside screening tests for predicting difficult intubation remains limited.


Transcutaneous spinal cord stimulation of the cervical cord modulates lumbar networks.
It has been established that coordinated arm and leg (A&L) cycling facilitates corticospinal drive and modulation of cervico-lumbar connectivity and ultimately improves overground walking in people with incomplete spinal cord injury or stroke. This study examined the effect of noninvasive transcutaneous spinal cord stimulation (tSCS) on the modulation of cervico-lumbar connectivity. Thirteen neurologically intact adults participated in the study. The excitability of the Hoffmann (H) reflex elicited in the soleus muscle was examined under multiple conditions involving either the arms held in a static position or rhythmic arm cycling while tSCS was applied to either the cervical or lumbar cord. As expected, soleus H-reflex amplitude was significantly suppressed by 19.2% during arm cycling (without tSCS) relative to arms static (without tSCS). Interestingly, tSCS of the cervical cord with arms static significantly suppressed the soleus H-reflex (-22.9%), whereas tSCS over the lumbar cord did not suppress the soleus H-reflex (-3.8%). The combination of arm cycling with cervical or lumbar tSCS did not yield additional suppression of the soleus H-reflex beyond that obtained with arm cycling alone or cervical tSCS alone. The results demonstrate that activation of the cervical spinal cord through both rhythmic arm cycling and tonic tSCS significantly modulates the activity of lumbar networks. This highlights the potential for engaging cervical spinal cord networks through tSCS during rehabilitation interventions to enhance cervico-lumbar connectivity. This connectivity is influential in facilitating improvements in walking function after neurological impairment.NEW & NOTEWORTHY This is the first study to investigate the modulatory effects of transcutaneous spinal cord stimulation (tSCS) on cervico-lumbar connectivity. We report that both rhythmic activation of the cervical spinal cord through arm cycling and tonic activation of the cervical cord through tSCS significantly modulate the activity of lumbar networks. This suggests that engaging cervical spinal cord networks through tSCS during locomotor retraining interventions may not only enhance cervico-lumbar connectivity but also further improve walking capacity.


Improved method for purification of human platelet factor 4 by affinity and ion-exchange chromatography.
A simple method for the reproducible purification of human platelet factor 4 (PF4) is described. PF4 is obtained in a highly purified form from platelet concentrate by utilizing a combination of affinity and FPLC ion-exchange chromatography. In every instance, after elution from heparin affinity and cation exchange chromatography, SDS gel electrophoresis reveals a single band attributable to PF4. Moreover, the amino acid composition of PF4 isolated by this method is compatible with that described for a PF4 cDNA clone and with other reported PF4 analysis. The purified protein is used to study in vitro the affinity of PF4 for several glycosaminoglycans (GAGs), by measuring the fluorescence of each PF4-GAG complex bound to fluorescamine. PF4 affinity for GAGs is as follows: heparin greater than heparan sulphate much greater than dermatan sulphate.


Degradation of 2,4,6-trinitrotoluene by selected helophytes.
Four emergent plants (helophytes, synonyms emersion macrophytes, marsh plants, etc.) Phragmites australis, Juncus glaucus, Carex gracillis and Typha latifolia were successfully used for degradation of TNT (2,4,6-trinitrotoluene) under in vitro conditions. The plants took up and transformed more than 90% of TNT from the medium within ten days of cultivation. The most efficient species was Ph. australis which took up 98% of TNT within ten days. The first stable degradation products 4-amino-2,6-dinitrotoluene (4-ADNT) and 2-amino-4,6-dinitrotoluene (2-ADNT) were identified and analysed during the cultivation period. [14C] TNT was used for the detection of TNT degradation products and their compartmentalization in plant tissues after two weeks of cultivation. Forty one percent of 14C was detected as insoluble or bound in cell structures: 34% in roots and 8% in the aerial parts. These results open the perspective of using the above-mentioned plants for the remediation of TNT contaminated waters.


Random fields and the partially paramagnetic state of CsCo0.83Mg0.17Br3: critical scattering study.
We have performed measurements of the critical neutron scattering on CsCo0.83Mg0.17Br3, a dilute stacked triangular lattice (STL) Ising antiferromagnet (AF). A two component line shape associated with the critical fluctuations appears at a temperature coincident with T(N1) observed in pure CsCoBr3. Such scattering is indicative of fluctuations in prototypical random field Ising model (RFIM) systems. The random field domain state arises in this case due to geometrical frustration within the STL Ising AF, which gives rise to a three sublattice Néel state, in which one sublattice is disordered. Magnetic vacancies nucleate AF domains in which the vacancies reside on the disordered sublattice thereby generating a RFIM state in the absence of an applied magnetic field.


Oral vaccination for sustainable disease prevention in aquaculture-an encapsulation approach.
The prevalence of infectious diseases in the aquaculture industry and a limited number of safe and effective oral vaccines has imposed a challenge not only for fish immunity but also a threat to human health. The availability of fish oral vaccines has expanded recently, but little is known about how well they work and how they affect the immune system. The unsatisfactory efficacy of existing oral vaccinations is partly attributable to the antigen degradation in the adverse gastrointestinal environment of fishes, the highly tolerogenic gut environment, and inferior vaccine formulation. To overcome such challenges in designing: an easier, cost-efficient, and effective vaccination method, several encapsulation methods are being adopted to safeguard antigens from the intestinal atmosphere for their immunogenic functions. Oral vaccination is easily degraded by gastric acids and enzymes before reaching the immunological site; however, this issue can be solved by encapsulating antigens in poly-biodegradable nanoparticles, transgenic designed bacteria, plant systems, and live feeds. To enhance the immunological impact, each antigen delivery method operates at a different level. Utilizing nanotechnology, it has been possible to regulate vaccination parameters, target particular cells, and lower the antigen dosage with potent nanomaterials such as chitosan, poly D,L-lactic-co-glycolic acid (PLGA) as vaccine carriers. Live feeds such as Artemia salina can be utilized as bio-carrier, owing to their appropriate size and non-filter feed system, through a process called bio-encapsulation. It ensures the protection of antigens over the fish intestine and ensures complete uptake by immune cells in the hindgut for increased immune response. This review comprises recent advances in oral vaccination in aquaculture in terms of an encapsulation approach that can aid in future research.


Effect of Colquhoumia root on the expression of transforming growth factor-beta in mesangial proliferation glomerulonephritis model.
To study the efficacy and the mechanism of Colquhoumia root (Tripterygium hypoglaucum (Le,vL) Hutch) in the treatment of mesangial proliferation glomerulonephritis (MsPGN), SD rats were injected with anti-thymocyte serum (ATS) to make MsPGN model (anti-Thyl model). The rats were then divided into 3 groups: normal control group, anti-Thyl model group and treatment group. Histopathological (HE, PAS), immunohistochemical, RT-PCR technique and computer imaging analysis system were used to evaluate mesangial matrix production, the expression of TGF-beta1 protein and mRNA in the tissues of kidney. Our result showed that proteinuria and the ratio of extracellular matrix/glomerular capillaries area (ECM/CA) were increased significantly in model group. The expression of both TGF-beta1 protein and mRNA in glomeruli was much higher in model group than in control group (P < 0.01). After the treatment with Colquhoumia root, proteinuria, ECM/CA and the expression of both TGF-beta1 protein and mRNA in glomeruli were significantly decreased in treatment group as compared with those in model group. It is concluded that Colquhoumia root is effective in reducing proteinuria and mesangial matrix proliferation in MsPGN and it may achieve these effects by inhibiting the expressions of TGF-beta1 protein and mRNA of mesangial cells.


Characterization of a recombinant sucrose isomerase and its application to enzymatic production of isomaltulose.
To characterize a recombinant isomerase that can catalyze the isomerization of sucrose into isomaltulose and investigate its application for the enzymatic production of isomaltulose. A sucrose isomerase gene from Erwinia sp. Ejp617 was synthesized and expressed in Escherichia coli BL21(DE3). The enzymatic characterization revealed that the optimal pH and temperature of the purified sucrose isomerase were 6.0 and 40 °C, respectively. The enzyme activity was slightly activated by Mn2+and Mg2+, but partially inhibited by Ca2+, Ba2+, Cu2+, Zn2+ and EDTA. The kinetic parameters of Km and Vmax for sucrose were 69.28 mM and 118.87 U/mg, respectively. The time course showed that 240.9 g/L of isomaltulose was produced from 300 g/L of sucrose, and the yield reached 80.3% after bioreaction for 180 min. This recombinant enzyme showed excellent capability for biotransforming sucrose to isomaltulose at the substrate concentration of 300 g/L. Further investigations should be carried out focusing on selection of suitable heterologous expression system with the aim to improve its expression level.


The role of valence and frequency in the emotional Stroop task.
People are generally slower to name the color of emotion-laden words than they are to name that of emotionally neutral words. However, an analysis of this emotional Stroop effect (Larsen, Mercer, & Balota, 2006) indicates that the emotion-laden words used are sometimes longer, have lower frequencies, and have smaller orthographic neighborhoods than the emotionally neutral words. This difference in word characteristics raises the possibility that the emotional Stroop effect is partly caused by lexical rather than by emotional aspects of the stimuli-a conclusion supported by the finding that reaction times to name the color of low-frequency words are longer than those for high-frequency words (Burt, 2002). To examine the relative contributions of valence and frequency in color naming, we had 64 participants complete an experiment in which each of these variables was manipulated in a 3 x 2 factorial design; length, orthographic neighborhood density, and arousal were balanced. The data indicate that valence and word frequency interact in contributing to the emotional Stroop effect.


Changes in hair cortisol concentration in intrauterine device initiators: A prospective cohort study.
Prior studies found increased hair cortisol concentration (a surrogate marker for hypothalamic-pituitary-adrenal axis activation) in users of the levonorgestrel intrauterine device (LNG 52 mg IUD). We evaluated change in hair cortisol and psychometric tests in women initiating a copper (CuT380 IUD) or LNG 52 mg IUD. We prospectively enrolled healthy women initiating an LNG 52 mg IUD or CuT380 IUD. Participants provided hair and blood samples and completed psychometric inventories (Patient Health Questionnaire-9, Positive and Negative Affect Schedule, and Psychological General Well-Being Index) after IUD insertion and at 6 and 12 months. We used liquid chromatography with tandem mass spectrometry to measure hair cortisol concentrations. We compared hair cortisol concentrations and psychometric test changes from baseline to 6 and 12 months using independent two-sample t tests. We enrolled 39 of our targeted 86 participants (LNG 52 mg IUD 26, CuT380 IUD 13). Thirty-eight subjects (LNG 52 mg IUD 25, CuT380 IUD 13) completed 6 months of follow-up. We found no difference between cohorts in the mean change in hair cortisol concentrations at 6 months (LNG 52 mg IUD n = 21 [-0.01 pg/mg (95% CI -1.26, 1.23); CuT380 IUD n = 13 [-1.31 pg/mg (-3.36, 0.73)]). While psychometric inventory results remained within normal ranges, LNG 52 mg IUD users reported a trend toward more favorable changes over time. We did not find clinically important differences in hair cortisol concentrations following initiation of a CuT380 IUD or LNG 52 mg IUD; psychometric inventories demonstrated no adverse effect of hormonal IUDs on mood. Our findings of similar hair cortisol concentrations following the initiation of either the LNG 52 mg IUD or CuT380 IUD suggest that hormonal IUDs do not increase cortisol concentrations or alter stress reactivity, and favorable effects on psychometric inventories provide further reassurance that the LNG 52 mg IUD has no adverse impact on mood. ClinicalTrials.gov NCT03499379.


An application of the image processing system for detecting and controlling pigeon's peck location.
A microcomputer system equipped with an image processing peripheral board was applied for detecting and controlling the pigeon's peck location. The peripheral board digitized a TV image of an experimental chamber at the instant of the occurrence of a response, and a simple machine language routine analyzed the digitized image to determine the location of pigeon's beak in real-time. Using this system, pigeons were trained to peck a target area of a long response key and their peck locations were analyzed.


Human gene expression first occurs between the four- and eight-cell stages of preimplantation development.
The earliest stages of development in most animals, including the few mammalian species that have been investigated, are regulated by maternally inherited information. Dependence on expression of the embryonic genome cannot be detected until the mid two-cell stage in the mouse, the four-cell stage in the pig (J. Osborn & C. Polge, personal communication), and the eight-cell stage in the sheep. Information about the timing of activation of the embryonic genome in the human is of relevance not only to the therapeutic practice of in vitro fertilization and embryo transfer (IVF), but more importantly for the successful development of techniques for the preimplantation diagnosis of certain inherited genetic diseases. We describe here changes in the pattern of polypeptides synthesized during the pre-implantation stages of human development, and demonstrate that some of the major qualitative changes which occur between the four- and eight-cell stages are dependent on transcription. In addition, it appears that cleavage is not sensitive to transcriptional inhibition until after the four-cell stage.


The response-cued completion hypothesis and the nature of residual cost in regular switch.
Three experiments are presented that compare the residual cost found when shifting from one task to another under different extra-response conditions, to test whether the response is the main factor to complete mental set reconfiguration. We investigated whether residual costs can be eliminated if participants carry out a response prior to completing switch trials. In all experiments, participants were required to press an extra key during the inter-trial interval (ITI) to proceed. In experiment 1, this extra response consisted of pressing the space bar. In experiment 2, the response consisted of pressing one of the two possible keys that belonged to the alternating tasks response set. In experiment 3, the interpolated response involved pressing one of the two possible keys, not belonging to the response set of the alternating tasks. We found no residual cost in the second or the third experiments. To explain the nature of residual cost we discuss the data in the context of a response cued completion hypothesis.


[Primary pulmonary lymphoma in the light of functional classification of malignant lymphomas].
A primary pulmonary lymphoma associated with paraproteinemia was observed in a man aged 73. Histologically, the tumour was classed as lymphoplasmocytic lymphoma. No metastases were disclosed at autopsy.


Clinical analysis of prophylactic central neck dissection for papillary thyroid carcinoma.
The need of prophylactic central neck dissection (PCND) in patients with papillary thyroid carcinoma (PTC) is still controversial. The major restriction of PCND is the potential complications. We undertook a retrospective study to discuss its necessity in PTC patients. A total of 188 patients with PTC who underwent total thyroidectomy and PCND were involved. In all of these, central lymph nodes were pathologic examined. Univariate and multivariate analyses were performed based on tumor location and size, etc. Overall, node metastases were found in 44.1 % (83/188) of patients. Tumor size was the independent positive predictor for lymph node metastasis, while gender, age, tumor multifocality, tumor location, and capsular infiltration were not independent predictors of central lymph node metastases. Postoperative complications happened in 5.3 % (10/188) of patients, which 4.8 % (9/188) had temporary hypocalcemia and 0 % (0/188) had permanent hypocalcemia. Rates of temporary and permanent recurrent laryngeal nerve injury were 0.5 % (1/188) and 0 % (0/188), respectively. PCND is recommended in all patients with PTC.


Cancer in Australia: Actual incidence data from 1991 to 2009 and mortality data from 1991 to 2010 with projections to 2012.
The Australian Institute of Health and Welfare (AIHW) is a major national agency established by the Australian government to provide information and statistics on Australia's health and welfare. The AIHW and the Australasian Association of Cancer Registries collaborate every year to provide updated information on cancer occurrences and trends in Australia. Actual number of cases and deaths is presented together with age-standardized rates for all cancers combined and selected cancer sites from 1991 to 2009 for incidence and from 1991 to 2010 for mortality, with projections to 2012. Differences in incidence and mortality rates according to age, Indigenous status and remoteness areas are also provided. In addition, information on hospitalizations due to cancer, palliative care and participation in Australia's national screening programs for breast, cervical and bowel cancer is presented. In 2012, it was estimated that 120 710 new cases of cancer (excluding basal and squamous cell carcinoma of the skin) were diagnosed. Prostate cancer was estimated to be the most commonly diagnosed cancer in males, while breast cancer was estimated to be the most commonly diagnosed cancer in females. In 2010, more than 42 800 deaths from cancer occurred in Australia. Lung cancer was by far the most common cause of cancer death in both males and females. In the last decade, cancer incidence rates increased in males and stabilized in females, while mortality rates decreased steadily. The overall incidence and mortality rates of cancer for Indigenous Australians were higher than for non-Indigenous Australians.


Structure and regulation of full-length human leucine-rich repeat kinase 1.
The human leucine-rich repeat kinases (LRRKs), LRRK1 and LRRK2 are large and unusually complex multi-domain kinases, which regulate fundamental cellular processes and have been implicated in human disease. Structures of LRRK2 have recently been determined, but the structure and molecular mechanisms regulating the activity of the LRRK1 as well as differences in the regulation of LRRK1 and LRRK2 remain unclear. Here, we report a cryo-EM structure of the LRRK1 monomer and a lower-resolution cryo-EM map of the LRRK1 dimer. The monomer structure, in which the kinase is in an inactive conformation, reveals key interdomain interfaces that control kinase activity as we validate experimentally. Both the LRRK1 monomer and dimer are structurally distinct compared to LRRK2. Overall, our results provide structural insights into the activation of the human LRRKs, which advance our understanding of their physiological and pathological roles.


Role of developmental stage of occlusion for articulatory disorders in speech among first-graders.
The purpose of this study was to examine the role of the eruption stage and that of occlusal anomalies among etiological factors for articulatory speech disorders in a series of first-graders. The results suggest that even though speech and sound production have been reported to be mature by the age of five, some spontaneous correction of speech sound articulation occurs with maturing of the articulators with age and with eruption of some permanent teeth during the first phase of the mixed dentition.


Submacular hemorrhage secondary to congenital toxoplasmosis.
We report the case of a patient with congenital toxoplasmosis and submacular hemorrhage caused by a neovascular membrane who underwent an intravitreal injection of C3F8 and bevacizumab, and had a good visual recovery.


Strain modulation in small molecule physisorption in two dimensions: LEED structure analysis and DFT modeling of the system.
The structure of the system was investigated experimentally by means of quantitative LEED I(V) analysis and computationally using dispersion corrected density functional theory (DFT-D). Three different structure models with four, five, and six molecules were considered. The lowest reliability factors and thus best agreement of measured and calculated I(V) curves was found for the structure model containing five molecules per surface unit cell. Essential features of the experimental best-fit adlayer structure are supported by DFT. A slight inclination and lateral shift of twofold coordinated molecules away from the on-top position over Na+ adsorption sites is interpreted as compensation of strain between substrate and adlayer.


Applicator for optimum cobalt-60 primary breast treatments.
A breast applicator has been designed to optimize 3 field breast treatments for 60Co. The device has a six half value layer beam splitting block constructed in two sections. The larger permanently mounted section is sufficient for treating 90% of the patients. Slots are available for mounting cerroband blocks, and any of five brass half field wedges. A magnetically attached front and back-pointer assembly readily breaks away in the event of a collision between pointer and patient. With this design the breast applicator with wedges and blocks has in-field surface doses reduced to that of an open field without accessory devices. The 50-90% dose decrement of the radiation penumbra for the half field block is comparable to that for the field edge of a typical 6 MV X ray unit, although the 50-10% decrement is larger. The average out-of-field dose at the surface is 8% and is 5% at the depth of dose maximum. The combination for this applicator of sharp penumbra and low out-of-field dose leads to reduced lung and opposite breast doses. The latter was confirmed with TLD measurements on 10 patients, and yielded an average opposite breast dose of 230 cGy for a 4600 cGy prescription. Thus, half-field blocking devices do not preclude, as has been stated in the literature, acceptable opposite breast doses. In addition, proper design of these devices can significantly improve the radiation characteristics for primary breast treatments.


[Comparison of tolerance to ischemia in human and animal myocardium during various forms of induced cardiac arrest (author's transl)].
In a total of 16 patients the tissue pH was determined on myocardium both during surgery and on isolated samples. Cardiac arrest was induced by hypothermal infusion cardioplegia and external cooling. In the isolated human myocardium section pH values were continuously determined at 15 degrees C. Parallel to these measurements samples were taken for electron microscopic examinations. In this way the pH limit under which the human myocardium cannot be revived could be visualized by additional morphologic examination. These results and those from the intrasurgical measurements with a fixed heart muscle surface probe were compared with each other and with results from animal experiments.


Improving water ecosystem sustainability of urban water system by management strategies optimization.
Water management strategies play an important role in water shortage alleviation. This study evaluates the cost and water ecosystem benefit of 14 water management strategies in Beijing in the future scenarios for 2020 and 2035. In addition, optimal implements of abatement strategies are obtained within the context of legislated targets, with the consideration of interaction among strategies. The result shows that Beijing can meet its commitments for total water use and pollution control by the water management strategies implementation in both 2020 and 2035. For 14 water management strategies analyzed in this study, 5 options with negative abatement cost value achieve 12.2-24.1% of the total water ecosystem benefit in 2020 and 2035. Wastewater reclamation is the most efficient strategy in water ecosystem impact (WEI) reduction, which contributes 38.4% of the total WEI reduction with an abatement cost of 1.6 Yuan/m3 H2O -eq. However, the sequence of optimal strategy implementation rate is not in accordance with the abatement cost of the strategies. The most cost-effective option is the water-efficient shower head, while the highest implementation rate is found for promotion of production technologies. A comparison between water management optimization with and without the consideration of interactions among strategies shows that taking the interaction among strategies into account imposes almost no influence on the total WEI reduction. But it has impacts on optimal implementation rate of each water management option and the cost estimation (+10.8%) of water management implementation. Such a systematic analysis of water management strategies provides general recommendations on sustainable water resource management in water scarce regions.


Right ventricular function in adult patients with Eisenmenger physiology: insights from quantitative echocardiography.
The favorable outcomes of Eisenmenger syndrome (ES) relative to other forms of pulmonary arterial hypertension (PAH) have been partially attributed to a unique adaptation of the right ventricle (RV). However, conventional measures of RV function may not adequately express this adaptation. We studied 23 patients with ES (age 43 ± 17 years, 16 women, pulmonary artery systolic pressure [PASP] 93 ± 26 mmHg), 25 patients with PAH (age 44 ± 13 years, 17 women, PASP 92 ± 19 mmHg), and 25 subjects without known structural disease (age 45 ± 16 years, 17 women). We evaluated long- and short-axis function of the RV with two-dimensional strain and anatomical M-mode echocardiography, respectively. Long-axis function of the RV was comparable between patients with ES and PAH although depressed relative to controls (global strain, -15.6 ± 4.7, -14.9 ± 4.3, and -22.4 ± 2.8%, respectively, P < 0.001; global RV systolic strain rate, -0.77 ± 0.26, -0.84 ± 0.24, and -1.11 ± 0.21 1/sec, respectively, P < 0.001). However, short-axis RV function was significantly better in patients with ES versus those with PAH and preserved relative to controls (RV fractional shortening by anatomical M-mode, median [interquartile range], 21%[14-33%], 14%[10-16%], and 26%[22-36%], respectively, P = 0.002 for ES vs. PAH, P = 0.09 for ES vs. controls). This differential was not reflected in conventional measures of RV function (fractional area change, 32 ± 10 vs. 29 ± 8% in ES and PAH, respectively, P = 0.26). In patients with ES, the RV is characterized by preserved short-axis function, despite a depressed long-axis function. Thus, conventional assessment of RV function might not be suitable for patients with ES.


Giant angiokeratoma of Fordyce over the vulva in a middle-aged woman: case report and review of literature.
Angiokeratoma of Fordyce occurring over vulva is rare. Angiokeratoma of Fordyce commonly occurs in males over scrotum or penile shaft and presents as multiple verrucous reddish papules. They are usually asymptomatic and noticed accidentally. In the present article, we present and review the literature of giant angiokeratoma of Fordyce in middle-aged women due to its rarity.


Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices.
The ABO blood group system is linked to hemostasis via its relationship with von Willebrand factor (VWF) and factor VIII (FVIII). In the current study, we investigated the association of the ABO system with clinical outcomes as well as VWF and platelet function in patients with left ventricular assist devices (LVADs). Bleeding and thromboembolic complications were assessed in 111 patients during 1 year after LVAD implantation. In 67 LVAD patients, VWF antigen, VWF activity, VWF ristocetin cofactor, VWF collagen-binding, and FVIII activity were assessed. Platelet surface P-selectin and activated glycoprotein IIb/IIIa were determined by flow cytometry, and soluble P-selectin was measured with an enzyme-linked immunoassay. Platelet aggregation was assessed by light transmission and impedance aggregometry. Thirty-six patients (32.4%) experienced a bleeding and 22 patients (19.8%) a thromboembolic event. In univariate analyses, patients with blood group O had numerically more bleeding complications and less thromboembolic events as compared to patients with blood group non-O (both p ≥ 0.05). After multivariable adjustment, blood group O was significantly associated with a higher risk of bleeding (hazard ratio 2.42 [95% confidence interval 1.03-5.70], p = 0.044) but not linked to thromboembolic complications. Patients with blood group O had significantly lower levels of VWF and FVIII (all p < 0.05), whereas P-selectin expression in response to thrombin-receptor activating peptide and soluble P-selectin were higher as compared to patients with blood group non-O (both p < 0.05). LVAD patients with blood group O are at an increased bleeding risk, potentially due to lower VWF and FVIII levels.


Effect of seven-day atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following percutaneous coronary intervention in patients receiving long-term statin therapy. A randomized study.
The aim of this randomized study was to investigate the effect of seven-day high-dose atorvastatin therapy on the incidence of peri-procedural myocardial infarction (PMI) in patients receiving long-term statin therapy. The patients with stable angina receiving statin therapy and referred for percutaneous coronary intervention (PCI) were randomized (ratio 1:1) to a 7-day pre-treatment with atorvastatin of 80 mg daily and subsequent PCI (Atorvastatin group), or immediate PCI (Control group). The incidence of PMI was based on serum concentration of creatine kinase myocardial band (CK-MB) mass and troponin I (TnI), which were measured prior to and between 16 and 24h post PCI. The values were considered as positive if they were elevated ≥ 3 times the upper limit normal. We randomized 202 patients (male 67%, 65.5 ± 9.2 years; 100 vs. 102 pts.). There were no significant differences in the baseline characteristics among the randomized groups. The incidence of PMI, based on post-interventional release of TnI and/or CK-MB mass was 15% in the Atorvastatin group vs. 14% in the Control group (p=0.80). One patient (3%) in Atorvastatin group suffered from MI between randomization and PCI. These results suggest that 7-day pre-PCI therapy with high-dose atorvastatin did not reduce the occurrence of PMI in patients receiving chronic statin therapy.


Effect of green synthesized cerium oxide nanoparticles on fungal disease of wheat plants: A field study.
Recently, there has been considerable attention towards the production of environmentally friendly nanoparticles (NPs). In this investigation, the successful synthesis of cerium oxide nanoparticles (CeO2 NPs) was achieved by employing an eco-friendly technique that utilized an extract from the leaves of local plant quinoa (Chenopodium quinoa L.). The synthesized CeO2 NPs were subjected to characterization using state-of-the-art methods. The prepared CeO2 NPs contained a round shape with clusters and have a size of 7-10 nm. To assess how effective CeO2 NPs derived from C. quinoa were against Ustilago tritici, a fungal disease that negatively affects wheat crop globally, a study was performed on two varieties of wheat crop comprised of Arooj (V1) and Akber (V2), cultivated under field conditions. CeO2 NPs were applied foliarly twice to the wheat crop at four different concentrations: T0 (0 mg/L), T1 (50 mg/L), T2 (75 mg/L), and T3 (100 mg/L). The results revealed that the control group (T0) exhibited the highest disease severity index (DSI) with a value of 75% compared to the other concentrations of CeO2 NPs on both varieties. At a concentration of 100 mg/L of CeO2 NPs, the DSI dropped to a minimum of 35% and 37% on both V1 and V2 respectively. These findings indicated that an increase in the concentration of CeO2 NPs has a beneficial impact on disease severity. Similar patterns have also been observed with disease incidence (DI), with the greatest efficacy observed at a concentration of 100 mg/L of CeO2 NPs. Our investigation has shown that CeO2 NPs exhibitd significant antifungal potential against U. tritici which may be a promising strategy to mitigate fungal disease and crop losses globally.


What older people do about their day-to-day mental and physical health symptoms.
In four detailed "yesterday" interviews, old people (n = 132) were studied to identify their day-to-day mental and physical symptoms. Previous reports have described the nature, frequency, and severity of the symptoms reported. This paper describes the actions taken by old people to alleviate discomfort from their symptoms. Some action was taken to treat four fifths of the complaints but virtually none of the symptoms were reported to health care professionals. Among the authors' findings are that about 20 per cent of the drug doses taken by the interviewees could not be identified and the remaining 80 per cent were divided equally between prescription drugs and over-the-counter medications. It is evident that there is a world of day-to-day health experiences and practices of which health care professionals are unaware. Sensitive questioning is needed to elicit information about that world from elderly patients, who in turn are often in considerable need of health education from professional sources.