Post-cesarean ileus: An assessment of incidence, risk factors and outcomes.
To estimate the frequency of post cesarean paralytic ileus and to identify associated risk factors and outcomes. A retrospective cohort study of woman who underwent cesarean delivery between 2005 and 2019. All parturients who had cesarean delivery were stratified and compared according to whether or not they were diagnosed with a paralytic ileus. Women were excluded if they had an intestinal injury or repair during the cesarean or if they suffered from a post cesarean mechanical bowel obstruction diagnosed during re-laparotomy. Basic demographics, obstetric history, current delivery characteristics, re-suturing indications and outcomes were obtained and analyzed. Univariate analyses were followed by a multivariate analysis (adjusted Odds Ratio (aORs) ; [95% Confidence Interval]). A total of 23,486 women met the inclusion and exclusion criteria of which 135 (0.6%) were diagnosed with paralytic ileus whilst 23,347 (99.4%) did not and served as the control group. Multivariate analysis revealed that an estimated intra-operative blood loss ≥ 1000 ml was the most significant risk factor for post cesarean paralytic ileus (aOR 2.27 (1.18-4.36)), followed by multifetal gestation (aOR 2.08 (1.24-3.51)), corporeal uterine incision (aOR 1.97 (1.07-3.63)), use of topical hemostatic agents (aOR 1.78 (1.19-2.66)) and increasing maternal age (aOR 1.78 (1.19-2.66)). Regarding maternal outcomes, post cesarean paralytic ileus was associated with higher rates of postpartum hemorrhage (44.4% vs. 13.4%, p < 0.01), transfusion of blood products (23.7% vs. 3.9%, p < 0.01), post-cesarean exploratory laparotomy (4.4% vs. 0.1%, p < 0.01) and prolonged hospital stay (32.6% vs. 5.2%, p < 0.01). In our population, whilst post cesarean paralytic ileus is infrequent, when it occurs it is associated with increased short-term maternal morbidity.


A simple theoretical model for ⁶³Ni betavoltaic battery.
A numerical simulation of the energy deposition distribution in semiconductors is performed for ⁶³Ni beta particles. Results show that the energy deposition distribution exhibits an approximate exponential decay law. A simple theoretical model is developed for ⁶³Ni betavoltaic battery based on the distribution characteristics. The correctness of the model is validated by two literature experiments. Results show that the theoretical short-circuit current agrees well with the experimental results, and the open-circuit voltage deviates from the experimental results in terms of the influence of the PN junction defects and the simplification of the source. The theoretical model can be applied to ⁶³Ni and ¹⁴⁷Pm betavoltaic batteries.


Early fresh frozen plasma prophylaxis of abnormal coagulation parameters in the severely head-injured patient is not effective.
Serious head injury may be complicated by coagulation abnormalities. Fresh frozen plasma (FFP) has been advocated as resuscitation fluid, in patients with head injury, to prevent the development of abnormal coagulation. The efficacy of this practice has never been established. We retrospectively reviewed the records of 149 head-injured patients having a Glasgow Coma Scale of 9 or less. One hundred six received FFP and were without evidence of coagulopathies, while 42 received no FFP or had coagulopathies. Group 1 received FFP within a time from injury (T1) and group 2 received FFP after time (T2) or not at all. Groups were similar in demographics, injuries, presenting Glasgow Coma Scale, and presenting hematologic parameters in serial pretreatment or posttreatment hematologic parameters (P less than .05). There were no differences between patients receiving "early" FFP, as compared with those receiving FFP later or not at all. The time of FFP administration did not appear to be critical for effective prophylaxis against coagulopathy.


The need for reliable serum parathyroid hormone measurements.
Serum parathyroid hormone (PTH) is a recognized marker of bone remodeling in patients with renal osteodystrophy. However, identification of N-terminal truncated PTH fragments and a new form of PTH that interfere with second-generation PTH assays may be responsible for the great variability of PTH values and the difficulties of implementing the recommendations of the National Kidney Foundation/Kidney Disease Outcomes Quality Initiative.


Cholera toxin stimulates division of 3T3 cells.
Cholera toxin was used in an attempt to inhibit epidermal growth factor stimulated 3T3 cell division. Instead, cholera toxin alone at low concentrations (10(-10) M), was able to stimulate cell division and could augment EGF stimulated cell division. The mitogenic effect of cholera toxin can occur despite a dramatic increase in the intracellular levels of cAMP in 3T3 cells. Cholera toxin stimulated mitogenesis could not be mimicked by choleragenoid, the binding but inactive subunit of cholera toxin, or by other agents which elevate cAMP levels in 3T3 cells.


Quantitative precipitin studies on the specificity of an extract from Tridacna maxima (Röding).
Haemolymph from the clam Tridacna maxima precipitated with purified H-blood-group substances, Helix pomatia galactogen, and pneumococcus type XIV polysaccharide. Although gel diffusion, gel electrophoresis, and inhibition experiments indicated that only a single precipitating lectin was present in the haemolymph, quantitative precipitin and haemagglutination results suggested that a second agglutinin with anti-H-like specificity was also present. Evidence obtained from hapten inhibition experiments indicated that the precipitin that reacts with pneumococcus type XIV polysaccharide can be inhibited by a number of simple sugars. Of the compounds tested, 2-acetamido-2-deoxy-D-galactose was the best inhibitor of precipitation with pneumococcus type XIV polysaccharide and of haemagglutination with human erythrocytes, but the inhibition experiments showed that the extract was also markedly inhibited by D-galactosamine hydrochloride, D-galactose, lactose, and p-nitrophenyl beta-D-galactopyranoside. The latter compound was more active than its parent sugar, which was in turn a more potent inhibitor than p-nitrophenyl alpha-D-galactopyranoside. Melibiose, raffinose, and stachyose, compounds which each contain terminal alpha-linked D-galactopyranosyl residues, were relatively weak inhibitors. The combining sites of the lectin that reacts with pneumococcus type XIV polysaccharide appear, therefore, to be most complementary to 2-acetamido-2-deoxy-D-galactopyranosyl residues, probably in beta linkage.


Sesquiterpene lactones from Carpesium abrotanoides.
Phytochemical study on the ethanol extract of the aerial parts of Carpesium abrotanoides led to the isolation of two new sesquiterpene lactones, carabrolactone A (1) and carabrolactone B (2). Their structures were elucidated on the basis of extensive spectroscopic analysis.


Foraging in a patchy environment by a predatory net-spinning caddis larva: A test of optimal foraging theory.
The predatory larvae of the caddis Plectrocnemia conspersa (Curtis) cause significant prey depletion in a habitat in which prey are patchily distributed. Optimal foraging theory predicts that under these circumstances a predator should stay in any given patch until the prey capture rate there drops to a value equal to the average for the habitat as a whole. This was tested using a combination of field and laboratory data and the results were in broad agreement with the prediction. A second prediction is that the marginal capture rate should be higher in a habitat richer in prey and this was not supported. It is argued that by using a simple rule-of-thumb (constant giving-up-time) P. conspersa is able to approach the optimal solution for much of the time.


Effects of feeding aFusarium poae extract and a natural zeolite to broiler chickens.
A feeding trial was conducted in order to determine the effects of aFusarium poae extract on the health and performances of broiler chickens and the possible protective effect of a natural zeolite. TheF. poae extract contained nivalenol, T-2 toxin and diacetoxyscirpenol and demonstrated high toxicity when administeredi.p. to rats. One-day-old broiler chickens were fedad libitum over a period of 28 days with the following diets: group I - control; group II - 0.5% zeolite; group III -F. poae extract; group IV-0.5% zeolite andF. poae extract. Broilers were sacrificed at 28 days for the measurement of relative organs weights, leukocyte counts and serum biochemical values. No mortality was recorded over the experiment. Body weight gains, feed intake, feed utilisation and water consumption were depressed by theF. poae extract (p<0.05). A decrease of these parameters were also observed in group IV which received the diet with zeolite and theF. poae extract. No significant differences were seen in group II when compared to control. In groups III and IV the relative weights of liver, kidney, hearth and gizzard were significantly increased (p<0.05), while in group II only the relative liver weight was increased.F. poae extract, administered singly or in combination with zeolite, significantly decreased leukocytes count, serum total protein and serum albumin. Zeolite andF. poae extract, singly or combined, increased serum creatinine and uric acid concentrations (p<0.05).These findings indicate that sublethal doses of F. poae extract can affect adversely the performances and the health in broiler chickens. By adding zeolite these impairments could not diminished and for some parameters the zeolite additive increased the adverse effects of the F. poae extract.


Interventions to enhance maternal awareness of decreased fetal movement: a systematic review.
Decreased fetal movement is associated with adverse pregnancy and birth outcomes; timely reporting and appropriate management may prevent stillbirth. Determine effects of interventions to enhance maternal awareness of decreased fetal movement. Cinahl, The Cochrane Library, EMBASE, MEDLINE, PsycINFO and SCOPUS databases; without limitation on language or publication year. Randomised or non-randomised studies evaluating interventions to enhance maternal awareness of decreased fetal movement. Two authors independently extracted data and assessed quality. We included 23 publications from 16 studies of fair to poor quality. We were unable to pool results due to substantial heterogeneity between studies. Three randomised controlled trials (RCTs) and five non-randomised studies (NRSs), involving 72 888 and 115 435 pregnancies, respectively, assessed effects of interventions on stillbirth and perinatal death. One large cluster RCT (n = 68 654) reported no stillbirth reduction, one RCT (n = 3111) reported significant stillbirth reduction, and one RCT (n = 1123) was small with no deaths. All NRSs favoured intervention over standard care; three studies (n = 31 131) reported significant reduction, whereas two studies (n = 84 304) reported non-significant reductions in stillbirth or perinatal deaths. Promising results from NRSs warrant further research. We found no evidence of increased maternal concern following interventions. No cost-effectiveness data were available. We found no clear evidence of benefit or harm; indirect evidence suggests improved pregnancy and birth outcomes. The optimal approach to support women in monitoring their pregnancies needs to be established. Meanwhile, women need to be informed about the importance of fetal movement for fetal health. The benefits and risks of interventions to increase pregnant women's awareness of fetal movement are unclear.


The Dicer from oyster Crassostrea gigas functions as an intracellular recognition molecule and effector in anti-viral immunity.
Dicer, as a member of ribonuclease III family, functions in RNA interference (RNAi) pathway to direct sequence-specific degradation of cognate mRNA. It plays important roles in antiviral immunity and production of microRNAs. In the present study, a Dicer gene was identified from oyster Crassostrea gigas, and its open reading frame (ORF) encoded a polypeptide (designed as CgDicer) of 1873 amino acids containing two conserved ribonuclease III domains (RIBOc) and a double-stranded RNA-binding motif (DSRM). The deduced amino acid sequence of CgDicer shared identities ranging from 18.5% to 46.6% with that of other identified Dicers. The mRNA transcripts of CgDicer were detectable in all the examined tissues of adult oysters, with the highest expression in hemocytes (11.21 ± 1.64 fold of that in mantle, p < 0.05). The mRNA expression level of CgDicer in hemocytes was significantly up-regulated (36.70 ± 11.10 fold, p < 0.01) after the oysters were treated with double-stranded RNA (dsRNA). In the primarily cultured oyster hemocytes, the mRNA transcripts of CgDicer were significantly induced at 12 h after the stimulation with poly(I:C), which were 2.04-fold (p < 0.05) higher than that in control group. Immunocytochemistry assay revealed that CgDicer proteins were mainly distributed in the cytoplasm of hemocytes. The two most important functional domains of CgDicer, DSRM and RIBOc, were recombinant expressed in Escherichia coli transetta (DE3), and the recombinant DSRM protein displayed significantly binding activity to dsRNA and poly(I:C) in vitro, while the recombinant RIBOc protein exhibited significantly dsRNase activity to cleave dsRNA in vitro. These results collectively suggested that CgDicer functioned as either an intracellular recognition molecule to bind dsRNA or an effector with ribonuclease activity, which might play a crucial role in anti-viral immunity of oyster.


"Out of the Depths Have I Called Thee": Jewish Israeli Undertakers' Management of Death Anxiety.
According to Terror Management Theory, there are three common buffers that minimize the anxiety of mortality salience: affirmation of one's cultural worldview, the self and one's personal values, and one's significance in the context of close personal relationships. The current study aimed to explore the manner by which Jewish Israeli undertakers manage their constant exposure to death and buffer against death anxiety. A deductive and inductive thematic analysis captured a dialectical movement between, and within, two conflicting worldviews participants were engaged in, in their attempt to manage the mortality salience effect they experience and buffer against death anxiety.


Trace elements and oxidative stress levels in the blood of painters in Lagos, Nigeria: occupational survey and health concern.
Adverse effects attributed to exposure to paints are currently a concern because of the continued widespread use of paint containing trace elements. Thus, occupational survey amongst painters in Lagos and determination of trace elements and oxidative stress parameters were carried out. Descriptive cross-sectional survey was done using a standardized questionnaire to obtain job safety-related information. Forty-eight percent of the painters were aware of hazards associated with painting and 52 % of these workers were aware of the necessary precautionary measures during painting. There were no significant differences (p ≥ 0.05) between the levels of trace elements in the blood of painters and the control subjects. However, there was a significance increase (p ≤ 0.0001) in the level of malondialdehyde and a decrease (p ≤ 0.001) in the levels of reduced glutathione, superoxide dismutase, and catalase of the painters compared to the control. An increase in oxidative stress parameters may not only be due to trace element concentrations, but also the painters' exposure to some petrochemical solvents during mixing of paints.


The application of potassium ferrate for sewage treatment.
The comparative performance of potassium ferrate(VI), ferric sulphate and aluminium sulphate for the removal of turbidity, chemical oxygen demand (COD), colour (as Vis400-abs) and bacteria in sewage treatment was evaluated. For coagulation and disinfection of sewage, potassium ferrate(VI) can remove more organic contaminants, COD and bacteria in comparison with the other two coagulants for the same doses used. Also, potassium ferrate(VI) produces less sludge volume and removes more contaminants, which should make subsequent sludge treatment easier.


Intelligent Model of Nursing Shift in Tehran University of Medical Sciences, Tehran, Iran.
Nurses play a key role in increasing the efficiency of healthcare systems. Given the 24-hour performance of hospitals and the small number of nurses in the field of treatment, it is quintessential to re-shift them in the hospital. This study set out to achieve coherence in nursing shift planning and justice in the order of shifts in hospital. This applied and a developmental study was performed from 2019 to 2020. We used genetic algorithm to provide operational solutions and define flexible shifts and plan nurses' working hours in Yas Hospital, Tehran University of Medical Sciences Hospital, Tehran, Iran. Based on the selection of each nurse and determining the approved shifts of each ward, the possibility of appropriate planning was provided to determine the required shifts per month and to estimate the needs of each department. Using genetic algorithm and nursing shift in office automation console provides useful tools for managers at all organizational levels, according to which a good balance between the hospital's need for nurse and nurses' demands in different time periods.


Toxicity studies with pure trans-capsaicin delivered to dogs via intravenous administration.
Previous toxicology and pharmacology studies have reported variable acute cardiac effects of capsaicin, primarily involving hypotension and bradycardia. However, these studies have suffered from two important limitations. First, the capsaicin tested has been derived from pepper plant extracts, which is likely to display varying degrees of purity and possibly diverse impurity profiles. Second, post-dosing follow-up was generally limited to three or fewer days. Therefore, the objective of the studies reported here was to test the cardiac and other target organ toxicity potential of pure, synthetic trans-capsaicin (the only naturally occurring stereoisomer of capsaicin) when delivered via intravenous administration to dogs either acutely or for 14 days. Taken together, results from these two studies indicate that pure trans--capsaicin--even when delivered directly into the systemic circulation at high dose levels--is rapidly eliminated, induces transient tachycardia and hypertension, does not alter the duration of cardiac action potentials, and causes only very minimal organ toxicities. The different toxicity profiles of pure trans-capsaicin reported here and chili pepper extracts previously reported suggest that the purity and source of capsaicin should be an important consideration for toxicological evaluations.


Increasing motor cortex plasticity with spaced paired associative stimulation at different intervals in older adults.
The ability of priming non-invasive brain stimulation (NIBS) to modulate neuroplasticity induction (i.e. metaplasticity) within primary motor cortex (M1) may be altered in older adults. Previous studies in young subjects suggest that consecutive NIBS protocols interact in a time-dependent manner and involve homoeostatic metaplasticity mechanisms. This was investigated in older adults by assessing the response to consecutive blocks of paired-associative stimulation (PAS) separated by different inter-PAS intervals (IPIs). Fifteen older (62-82 years) subjects participated in four sessions, with each session involving two PAS blocks separated by IPIs of 10 (IPI10 ) or 30 (IPI30 ) mins. For each IPI, the first (priming) PAS block was either PASLTP (N20 latency + 2 ms) or PASLTD (N20 latency - 10 ms), while the second (test) PAS block was always PASLTP . Changes in M1 excitability were assessed by recording motor evoked potentials from a muscle of the right hand. For both IPIs, the response produced by PASLTD -primed PASLTP was significantly greater than the response produced by PASLTP -primed PASLTP . Furthermore, the effects of PASLTD priming on PASLTP were significantly greater for IPI30 . These findings suggest that priming PAS can increase plasticity induction in older adults, and this occurs through mechanisms involving homoeostatic metaplasticity. They also demonstrate that the timing between priming and test NIBS is a crucial determinant of this effect, with a 30-min interval being most effective. Providing a 30-min delay between priming NIBS and motor training may improve the efficacy of NIBS in augmenting motor performance and learning in the elderly.


Drugs in the brain--cellular imaging with receptor microscopic autoradiography.
For cell and tissue localization of drugs, receptor microscopic autoradiography is reviewed, including its development history, multiple testing, extensive applications and significant discoveries. This sensitive high-resolution imaging method is based on the use of radiolabeled compounds (esp. tagged with (3)H or (125)I), preservation through freezing of in vivo localization of tissue constituents, cutting thin frozen sections, and close contact with the recording nuclear emulsion. After extensive testing of the utility of this method, the distribution of radiolabeled compounds has been identified and characterized for estradiol, progestagens, adrenal steroids, thyroid hormone, ecdysteroids, vitamin D, retinoic acid, metabolic indicators glucose and 2-deoxyglucose, as well as extracellular space indicators. Target cells and associated tissues have been characterized with special stains, fluorescing compounds, or combined autoradiography-immunocytochemistry with antibodies to dopamine-beta-hydroxylase, GABA, enkephalin, specific receptor proteins, or other cellular products. Blood-brain barrier and brain entries via capillary endothelium, ependyma, or circumventricular recess organs have been visualized for (3)H-dexamethasone, (210)Pb lead, and (3)H-1,25(OH)(2) vitamin D(3). With this histopharmacologic approach, cellular details and tissue integrative overviews can be assessed in the same preparation. As a result, information has been gained that would have been difficult or impossible otherwise. Maps of brain drug distribution have been developed and relevant target circuits have been recognized. Examples include the stria terminalis that links septal-amygdaloid-thalamic-hypothalamic structures and telencephalic limbic system components which extend as the periventricular autonomic-neuroendocrine ABC (Allocortex-Brainstem-Circuitry) system into the mid- and hindbrain. Discoveries with radiolabeled substances challenged existing paradigms, engendering new concepts and providing seminal incentives for further research toward understanding drug actions. Most notable are discoveries made during the 1980s with vitamin D in the brain together with over 50 target tissues that challenged the century-old doctrine of vitamin D's main role as 'the calcitropic hormone', when the new data made it apparent that the main biological function of this multifunctional sunshine hormone rather is maintenance of life and adapting vital functions to the solar environment. In the brain, vitamin D, in close relation to sex and adrenal steroids, participates in the regulation of the secretion of neuro-endocrines, such as, serotonin, dopamine, nerve growth factor, acetyl choline, with importance in prophylaxis and therapy of neuro-psychiatric disorders. Histochemical imaging with high cellular-subcellular resolution is necessary for obtaining detailed information, as this review indicates. New spectrometric methods, like MALDI-MSI, are unlikely to furnish the same information as receptor microautoradiography does, but can provide important correlative molecular information.


Brief report: risk stratification following curative therapy for stage I NSCLC.
Surveillance with computed tomography (CT) imaging following curative treatment of stage I non-small cell lung cancer (NSCLC) is important to identify recurrence or second primary lung cancers (SPLC). The pattern and risks of recurrence following curative therapy and optimal duration of surveillance scans remain unknown. The objective of our study is to assess the pattern of recurrence and development of SPLC to risk stratify patients with stage I NSCLC following curative therapy. We identified 261 patients who received curative therapy for stage I NSCLC at Mayo Clinic Florida. Data was collected on clinical and demographic features including gender, smoking history, stage, treatment, histologic subtype, and tumor grade. Kaplan-Meier method was used to evaluate the disease free survival (DFS). Cox proportional hazard model was used to identify risk factors for recurrence. Negative tobacco history and stage IA tumors were associated with significantly prolonged DFS after adjusting for co-variates (p=0.001 and p=0.005). Univariate Cox proportional hazards model identified tobacco history and stage 1B as risk factors for recurrence with unadjusted hazard ratio (HR) of 2.8 and 2.0, respectively. After adjusting for covariates, only stage IB was statistically significant predictor of recurrence with a hazard ratio of 2.1 (Confidence Interval (CI) 95% 1.2-3.6; p=0.007). An individualized approach that considers risk factors of stage and smoking history may be useful in determining whether to continue annual CT surveillance after five years post curative therapy for stage I NSCLC.


Time-course transcriptome analysis identifies rewiring patterns of transcriptional regulatory networks in rice under Rhizoctonia solani infection.
Sheath Blight (SB) disease in rice is caused by the infection from the fungal pathogen Rhizoctonia solani (R. solani). SB is one of the most severe rice diseases that can cause up to 50% yield losses in rice. Naturally occurring rice varieties resistant to SB have not been reported yet. We have performed a Time-Series RNA-Seq analysis on a widely cultivated rice variety BPT-5204 for identifying transcriptome level response signatures during R. solani infection at 1st, 2nd and 5th day post infection (dpi). In total, 428, 3225 and 1225 genes were differentially expressed in the treated rice plants on 1, 2 and 5 dpi, respectively. GO and KEGG enrichment analysis identified significant processes and pathways differentially altered in the rice plants during the fungal infection. Machine learning and network based integrative approach was used to construct rice Transcriptional Regulatory Networks (TRNs) for the three time points. TRN analysis identified SUB1B, MYB30 and CCA1 as important regulatory hub transcription factors in rice during R. solani infection. Jasmonic acid, salicylic acid, ethylene biogenesis and signaling were induced on infection. SAR was up regulated, while photosynthesis and carbon fixation processes were significantly down regulated. Involvement of MAPK, CYPs, peroxidase, PAL, chitinase genes were also observed in response to the fungal infection. The integrative analysis identified seven putative SB resistance genes differentially regulated in rice during R. solani infection.


Occult infected fracture of the femur: report of two cases with long-term followup.
The unusual occurrence of secondary infection of a closed fracture in two patients is described. The various possible etiologies of this syndrome and alternatives for treatment are discussed. Recognition of this entity and initiation of early definitive care, usually including open packing of the fracture wound, are emphasized.


Management of Severe and Critical COVID-19 Infection with Immunotherapies.
Following the reduction in mortality demonstrated by dexamethasone treatment in severe COVID-19, many targeted immunotherapies have been investigated. Thus far, inhibition of IL-6 and JAK pathways have the most robust data and have been granted Emergency Use Authorization for treatment of severe disease. However, it must be noted that critically ill patients comprised a relatively small proportion of most of the trials of COVID-19 therapeutics, despite bearing a disproportionate burden of morbidity and mortality. Furthermore, the rapidity and fluidity with which clinical trials have been conducted in the pandemic setting have contributed to difficulty in extrapolating available trial data to critically ill patients. The exclusion of many patients requiring invasive mechanical ventilation, preponderance of ordinal scale based endpoints, and frequent lack of blinding are particular challenges. More data is needed to identify beneficial treatments in the complex milieu of critical illness from COVID-19 infection.


Glove utilization in the prevention of cross transmission: a systematic review.
Gloves are worn to protect hands from contamination from microorganisms and to reduce the risks of transmission of microorganisms from healthcare workers to patients and vice versa. However, gloves should be changed between patient contacts and hand washing is necessary before putting on gloves and immediately after removing gloves. The objective of this review was to evaluate and synthesize the best available research evidence that investigates clinical use of gloves in the prevention of cross transmission. Health care workers.Types of intervention(s): Glove use intervention. Types of outcomes: Contamination of healthcare workers' hands, transmission of infections, adherence to glove usage, inappropriate uses of gloves, and adherence to hand hygiene. Types of studies: Quasi-experimental studies and descriptive studies. The search sought to find published and unpublished studies. The time period of the search covered articles published from 2000 to 2012 in English and Thai. The databases searched included: MEDLINE, CINAHL, EMBASE, The Cochrane Library, PubMed, Science Direct, Current Content Connect, Blackwell synergy, Thai Nursing Research Database, Thai thesis database, Digital Library of Thailand Research Fund, Research of National Research Council of Thailand, and Database of Office of Higher Education. Studies selected for retrieval were assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software. Data extraction was performed using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument software. A meta-synthesis was not possible due to the methodological heterogeneity of the included papers. The evidence was thus presented as a narrative summary. Twenty-three studies were included in this review. The results indicated that contamination of a healthcare worker's gloves with bacteria during routine care activities is common. The use of gloves can protect the hands of healthcare workers from bacterial contamination, but the protection afforded by the gloves was incomplete. Adherence to glove utilization among healthcare workers was suboptimal. Gloves were overused and often misused. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. Inappropriate glove use can increase the risk of cross transmission. It is unclear if modifications in glove use alter compliance with hand hygiene among healthcare workers. Gloving can reduce acquisition of microorganisms on the hands. However, gloving does not completely prevent contamination of the hands. Compliance with glove use among healthcare workers is poor. Gloves were also overused and often misused. Inappropriate glove use can increase the risk of cross transmission via contaminated gloved hands. There is still not enough evidence to prove the influence of glove use on adherence to hand hygiene. This review strengthens the recent suggestion on the use of gloves to reduce bacterial contamination. However, gloving does not completely prevent contamination, thus emphasizing the need for hand antisepsis before and after patient contact. Intervention to improve the use of gloves and hand hygiene compliance after gloving in the healthcare settings should be implemented. Further studies should target poor compliers with glove use and promote strategies that can be evaluated.


[Access to care and prevention for people with disabilities in France: Analysis based on data from the 2008 French health and disabilities households surveys (Handicap-Santé-Ménages)].
Using data from the 2008 French health and disabilities households surveys, this study examines the use of three types of routine medical care (dental, ophthalmological and gynecological care) and four preventive services (cervical cancer screening, breast cancer screening, colon cancer screening and vaccination against hepatitis B) both for people with disabilities and for those without. Two definitions of disability were retained: (1) functional limitations (motor, cognitive, visual or hearing limitations) and (2) administrative recognition of disability. For each type of care, binary logistic regression was used to test whether access to care is influenced by any of the disability indicators as well as by other explanatory variables. Two set of explanatory variables were included successively: (1) sociodemographic variables such as age, gender as well as a proxy variable representing medical needs and (2) socioeconomic variables such as level of education, household income per consumption unit, supplementary health insurance coverage, co-payment exemption and geographic variables. Persons reporting functional limitations are less likely to access to all types of care, in a proportion that varies between 5 to 27 points, compared to persons without functional limitations, except for eye care for which no gap is observed. The same results are obtained for persons reporting an administrative recognition of disability, and more precisely for those who benefit from the Disability allowance for adults (Allocation adulte handicapé [AAH]). After adding the social variables to the model, problems of access to health care decrease significantly, showing that disabled persons' social situation tends to reduce their access to care. This study reveals, for a broad range of care, a negative differential access to care for persons reporting functional limitations compared to those without limitations which is confirmed when identifying disability through administrative recognition. Furthermore, it also discusses factors explaining these differentials. It highlights the role of the social situation of disabled people as an additional barrier to already limited access to healthcare.


Lack of effect of fever on antipyrine oxidation in the rat.
The pharmacokinetics of 14C-antipyrine were studied in rats with fever induced by intracerebroventricular injections of prostaglandin E1. The rats were used as their own controls with at least 5 days between the control and the fever period. The effect of temperature on rates of antipyrine metabolism (oxidation followed by conjugation) and paracetamol metabolism (conjugation) was also tested in suspensions of isolated liver cells. Fever increased the biological half-life of antipyrine to 147% of control values (P less than 0.01) and the apparent volume of distribution to 113% of control values (P less than 0.05). In individual rats the increase in biological half-life was most counterbalanced by the increase in apparent volume of distribution, resulting in non-significant changes in the metabolic clearance of the drug. The half-life of antipyrine elimination in suspensions of isolated liver cells was not changed by increasing the temperature from 29 to 39 degrees C. The half-life of paracetamol elimination in suspensions of isolated liver cells decreased, however, when the temperature was increased from 29 to 39 degrees C. The results suggest that antipyrine oxidation was not influenced by temperature changes in the range of moderate fever and that temperature changes affected different types of metabolic reactions differently.


The modified essay question: an evaluation of its use in a family medicine clerkship.
This paper describes the extensive experience of the Department of Family Medicine at Jefferson Medical College in utilizing the modified essay question (MEQ) as a final examination for its required third-year clerkship in family medicine. The results of a preliminary study are presented, comparing the MEQ as a method of evaluation with the multiple choice question (MCQ) format on similar content material. MCQ performance was found to be a better predictor of National Board Part I and II scores, but neither format was found to be a good predictor of postgraduate performance. The data were statistically significant (P less than 0.05) that MEQ performance was related to postgraduate performance in the area of professional attitude while the MCQ was not; however, the number of students in the analysis was small. Additional studies are planned to test this hypothesis further.


Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis.
Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.


Extraction of testosterone and epitestosterone in human urine using aqueous two-phase systems of ionic liquid and salt.
Based on aqueous two-phase systems (ATPS) consisting of 1-butyl-3-methylimidazolium chloride, a hydrophilic ionic liquid (IL), and K2HPO4, a new and simple extraction technique, coupled with a reversed-phase high performance liquid chromatography (RP-HPLC), was developed for the simultaneous concentration and analysis of testosterone (T) and epitestosterone (ET) in human urine. Under the optimal conditions, the extraction efficiencies for both analytes were 80-90% in a one-step extraction. The method required only 3.0 mL of urine and a single hydrolysis/deproteinization/extraction step followed by direct injection of the IL-rich upper phase into HPLC system for analysis. The method has been satisfactorily applied to the analysis of T and ET in human urine with detection limits of 1 ng/mL and linear ranges of 10-500 ng/mL for both compounds. Compared with conventional liquid-liquid extraction or solid phase extraction, this new method is much "greener" due to no use of volatile organic solvent and low consumption of IL. The proposed extraction technique opens up new possibilities in the separation of other drugs.


Relapse among alcoholics with phobic and panic symptoms.
A group of 35 alcoholics who indicated they had symptoms of phobia, panic, or both (the anxiety problem group) were compared to their matched controls who did not indicate having anxiety problems. Comparisons of relapse rates, reasons for relapse, and rates of emotional problems at six months posttreatment were made. Results showed that although relapse rates were similar between the two groups, significantly more anxious subjects reported relapsing to cope with depression and experiencing problems with nervousness, tension, and anger posttreatment. Implications for treatment and the need for further research are discussed.


Muscle mechanical work and elastic energy utilization during walking and running near the preferred gait transition speed.
Mechanical and metabolic energy conservation is considered to be a defining characteristic in many common motor tasks. During human gait, the storage and return of elastic energy in compliant structures is an important energy saving mechanism that may reduce the necessary muscle fiber work and be an important determinant of the preferred gait mode (i.e., walk or run) at a given speed. In the present study, the mechanical work done by individual muscle fibers and series-elastic elements (SEE) was quantified using a musculoskeletal model and forward dynamical simulations that emulated a group of young healthy adults walking and running above and below the preferred walk-run transition speed (PTS), and potential advantages associated with the muscle fiber-SEE interactions during these gait modes at each speed were assessed. The simulations revealed that: (1) running below the PTS required more muscle fiber work than walking, and inversely, walking above the PTS required more muscle fiber work than running, and (2) SEE utilization in running was greater above than below the PTS. These results support previous suggestions that muscle mechanical energy expenditure is an important determinant for the preferred gait mode at a given speed.


Monomethylarsonate (MMAv) exerts stronger effects than arsenate on the structure and thermotropic properties of phospholipids bilayers.
Methylation of inorganic arsenic has been regarded as a detoxification mechanism because its metabolites monomethylarsonic acid (MMA(v)) and dimethylarsinic acid (DMA(v)) are supposed to be less toxic than inorganic arsenite and arsenate. In recent years, however, this interpretation has been questioned. Additionally, there are insufficient reports concerning the effects of arsenic compounds on cell membrane structure and functions. With the aim to better understand the molecular mechanisms of the interaction of MMA(v) and arsenate with cell membranes, we have utilized molecular models consisting in bilayers of dimyristoylphosphatidylcholine (DMPC) and dimyristoylphosphatidylethanolamine (DMPE), representative of phospholipid classes located in the outer and inner monolayers of many cell membranes including that of the human erythrocyte. The capacity of MMA(v) and arsenate to perturb the bilayer structures of DMPC and DMPE was evaluated by X-ray diffraction; the modifications of their thermotropic behavior were followed by differential scanning calorimetry (DSC), while DMPC large unilamellar vesicles (LUV) were studied by fluorescence spectroscopy. It was found that MMA(v) and arsenate did not structurally perturb DMPC bilayers; however, DMPE bilayers did suffer structural perturbations by MMA(v). DSC measurements also revealed that DMPE's thermotropic properties were significantly affected by arsenicals, where MMA(v) was more effective than arsenate, whilst only slight modifications were observed in the case of DMPC-MMA(v) system.


Maternal childhood adversity and prenatal depression: the protective role of father support.
Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be particularly helpful in combatting depressive symptoms for mothers with adverse childhood experiences. The study aims to explore the role of biological father support as a protective factor against the risks associated with childhood adversity for maternal prenatal depression. Sample included 133 pregnant women recruited from two university-affiliated OB-GYN clinics serving diverse and low-income patients. Participants completed measures on childhood adversity, prenatal depressive symptoms, and father support. Results showed a significant moderating effect of father support on the relation between maternal ACEs and prenatal depressive symptoms, suggesting that higher levels of father support are protective against prenatal depressive symptoms, specifically in mothers with low-to-moderate ACEs. These results highlight the positive impact of paternal support for maternal well-being during pregnancy. Although mothers with low-to-moderate ACEs experience a buffering effect of father support, mothers with high levels of childhood adversity remain at elevated risk for prenatal depressive symptoms even with high father support. As such, screening mothers for ACEs in addition to father support may help identify those at higher risk of prenatal depression.


The Synthesis of LiMnxFe1-xPO₄/C Cathode Material through Solvothermal Jointed with Solid-State Reaction.
LiMnxFe1-xPO₄/C material has been synthesized through a facile solid-state reaction under the condition of carbon coating, using solvothermal-prepared LiMnPO₄ and LiFePO₄ as precursors and sucrose as a carbon resource. XRD and element distribution analysis reveal completed solid-state reaction of precursors. LiMnxFe1-xPO₄/C composites inherit the morphology of precursors after heat treatment without obvious agglomeration and size increase. LiMnxFe1-xPO₄ solid solution forms at low temperature around 350 °C, and Mn2+/Fe2+ diffuse completely within 1 h at 650 °C. The LiMnxFe1-xPO₄/C (x < 0.8) composite exhibits a high-discharge capacity of over 120 mAh·g-1 (500 Wh·kg-1) at low C-rates. This paves a way to synthesize the crystal-optimized LiMnxFe1-xPO₄/C materials for high performance Li-ion batteries.


Health-related quality of life in Japanese patients with multiple sclerosis.
Neurological disabilities, especially physical issues, can adversely affect the daily lives of people with multiple sclerosis (MS) and negatively impact their health-related quality of life (HRQOL). On the other hand, physical and psychiatric symptoms are variable in people with MS, and QOL can be influenced by cultural and educational background. This study aimed to evaluate the association of HRQOL with disabilities, fatigue, and depression in Japanese subjects with MS. Evaluation of HRQOL, fatigue, and depression was performed in 184 Japanese individuals with MS, using the Functional Assessment of MS (FAMS), Fatigue Severity Scale (FSS), and Beck Depression Inventory-Second Edition (BDI-II), respectively. Multiple linear regression analysis demonstrated negative correlations of the Expanded Disability Status Scale (EDSS) with scores on the FAMS subscales of mobility, symptoms, thinking and fatigue, total FAMS, and additional concerns. The FSS score had negative correlations with mobility, symptoms, emotional well-being, thinking and fatigue, total FAMS, and additional concerns. There were negative correlations between BDI-II scores and all items of FAMS. HRQOL had relatively close correlations with disabilities and fatigue, and depression had an especially close relationship with HRQOL.


Fetal exposure to phytoestrogens--the difference in phytoestrogen status between mother and fetus.
The goal of this study was to investigate fetal exposure to phytoestrogens, estrogenic compounds derived from plants, by measuring serum concentrations of phytoestrogens in maternal and cord blood. This study included 51 mothers scheduled for cesarean section (C-section), to obtain the serum of mother and fetus at almost the same time. Serum concentrations of phytoestrogens, including genistein (Gen), daidzein (Dai), coumestrol (Cou), equol (Equ; a metabolite of Dai), and sulfate-conjugated Gen, were measured in maternal and cord blood samples by LC-MS/MS and HPLC. It was found that phytoestrogens were transferred from mother to fetus. The detection rates of Gen, Dai, Equ, and Cou in cord serum were 100%, 80%, 35%, and 0%, respectively. Levels of Gen and Dai were higher in cord than in maternal serum (mean=19.4 ng/ml vs.7.2 ng/ml and 4.3 ng/ml vs.1.8 ng/ml for Gen and Dai, respectively). However, a reverse pattern was seen for Equ (cord mean=0.9 ng/ml, maternal mean=2.0 ng/ml). The correlations were significant between the concentration levels of Gen and Dai, Gen and Equ, and Gen and Dai plus Equ in cord serum. However, in maternal serum, the correlations were weak. Also, in 8 of 10 cord serum samples, sulfate-conjugated Gen was detected (mean=5.2 ng/ml, standard deviation=4.7), but it was detected from only one maternal serum (8.7 ng/ml). This study demonstrates placental transfer of phytoestrogens from mother to fetus. It is suggested that the metabolic and/or excretion rates of phytoestrogens are different between mother and fetus and once phytoestrogens are transferred to the fetus, they tend to stay in the fetal side longer than in the maternal side. While the implications for the health and development of the newborn are not known, these data suggest that the effects of fetal exposure to phytoestrogens should be studied further.


Effect of sodium loading and ACTH on blood pressure of sheep with reduced renal mass.
Sodium chloride loading produced a rise in blood pressure in intact sheep which was potentiated by reduction in renal mass. ACTH induced hypertension was also potentiated by reduced renal mass, suggesting a volume component for the hypertension when renal excretory capacity for salt and water is reduced.


An AFLP-based database of Shigella flexneri and Shigella sonnei isolates and its use for the identification of untypable Shigella strains.
Amplified fragment length polymorphism (AFLP) can be used to assess the genetic diversity of closely related microbial genomes. In this study, the first of its kind for identification of Shigella, the high discriminatory power of AFLP has been used to determine the genetic relatedness of 230 isolates of Shigella flexneri and Shigella sonnei strains. An AFLP database was generated to demonstrate its utility in the discrimination of closely related strains. Based on AFLP, S. flexneri strains could be grouped into separate clusters according to their serotypes. Within each serotype, strains demonstrated 80-100% similarity indicating that identical strains and closely related strains could be distinguished by this technique. S. flexneri 6 formed a distinct cluster with 55% similarity to the rest of the S. flexneri strains showing significant divergence from the rest of the S. flexneri strains. Significantly, S. sonnei isolates formed a distinct group and showed approximately the same level of genetic linkage to S. flexneri as Escherichia coli strains. Untypable isolates that showed conflicting agglutination reactions with conventional typing sera were identifiable by AFLP. Thus AFLP can be used for genetic fingerprinting of Shigella strains and aid in the identification of variant untypable isolates.


Postradical orchiectomy hemorrhage: should an alteration in staging strategy for testicular cancer be considered?
We report 3 cases of postradical orchiectomy hemorrhage from separate institutions. The retroperitoneal and pelvic hematoma formed as a complication of orchiectomy can be misinterpreted to represent metastatic disease on postoperative staging computed tomography scans. As a result of inaccurate information obtained from these evaluations, significant alterations in patient management will result. Prevention and early recognition of this complication are crucial if unnecessary treatment is to be avoided.


Economic Evaluation of Prenatal and Postpartum Care in Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review.
This study aimed to summarize evidence on the economic outcomes of prenatal and postpartum interventions for the management of gestational diabetes mellitus and hypertensive disorders of pregnancy (HDP), assess the quality of each study, and identify research gaps that may inform future research. Electronic databases including PubMed/MEDLINE, Embase, the Cochrane Library, and Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to October 1, 2021. Selected studies were included in narrative synthesis and extracted data were presented in narrative and tabular forms. The quality of each study was assessed using the Consolidated Health Economic Evaluation Reporting Standards and Consensus on Health Economic Criteria list. Among the 22 studies identified through the systematic review, 19 reported favorable cost-effectiveness of the intervention. For prenatal management of HDP, home blood pressure monitoring was found to be cost-effective compared with in-person visits in improving maternal and neonatal outcomes. For postpartum care, regular screening for hypertension or metabolic syndrome followed by subsequent treatment was found to be cost-effective compared with no screening in women with a history of gestational diabetes mellitus or HDP. Existing economic evaluation studies showed that prenatal home blood pressure monitoring and postpartum screening for hypertension or metabolic syndrome were cost-effective. Nevertheless, limitations in the approach of the current economic evaluations may dampen the quality of the evidence and warrant further investigation.


Urate transporter inhibitor lesinurad is a selective peroxisome proliferator-activated receptor gamma modulator (sPPARγM) in vitro.
Gout is the most common arthritic disease in human but was long neglected and therapeutic options are not satisfying. However, with the recent approval of the urate transporter inhibitor lesinurad, gout treatment has experienced a major innovation. Here we show that lesinurad possesses considerable modulatory potency on peroxisome proliferator-activated receptor γ (PPARγ). Since gout has a strong association with metabolic diseases such as type 2 diabetes, this side-activity appears as very valuable contributing factor to the clinical efficacy profile of lesinurad. Importantly, despite robustly activating PPARγ in vitro, lesinurad lacked adipogenic activity, which seems due to differential coactivator recruitment and is characterized as selective PPARγ modulator (sPPARγM).


Evaluation of exposure factors of dual-energy contrast-enhanced mammography to optimize radiation dose with improved image quality.
Dual-energy contrast-enhanced mammography (DECEM) is an advanced breast imaging technique of digital mammography. To assess the total radiation dose received from complete DECEM using different combinations of exposure parameters for low- and high-energy images. A dedicated phantom with three different concentrations of iodine inserts was used. Each iodine insert was 10 mm in diameter and concentration of 1.0 mgI/cm3, 2.0 mgI/cm3, and 4.0 mgI/cm3. The phantom was exposed at varying kVp levels. Mean glandular dose (MGD) was estimated. Contrast to noise ratio (CNR) and figure of merit (FOM) of the iodine inserts were used to assess the image quality. The optimum CNR of the recombined images was obtained by using 28 kVp + 49 kVp tube voltage combination for 50 mm thickness, 50% fibroglandular phantom only with a 26% dose increase compared to the highest voltages (32 kVp + 49 kVp) that can be used for low energy (LE) and high energy (HE) imaging. The CNR value was increased with increasing iodine concentration (R 2 > 0.99). The use of as low as possible tube voltage for the LE imaging of standard 50% fibroglandular-50% adipose, 50 mm thickness breast while using the highest tube voltage for HE imaging has reduced the MGD while keeping optimum image quality.


Retention rate and illicit opioid use during methadone maintenance interventions: a meta-analysis.
The efficacy of methadone maintenance in opioid addiction was assessed in terms of programme retention rate and reduction of illicit opioid use by means of a meta-analysis of randomised, controlled and double blind clinical trials. The results were compared with interventions using buprenorphine and levo-acetylmethadol (LAAM). Trials were identified from the PubMed database from 1966 to December 1999 using the major medical subject headings 'methadone' and 'randomised controlled trial'. Data for a total of 1944 opioid-dependent patients from 13 studies were analysed. Sixty-four percent of patients received methadone, administered either as fixed or adjusted doses. Thus, 890 patients received > or = 50 mg/day (high dose group) and 392 were given < 50 mg/day (low dose group). Of 662 controls, 131 received placebo, 350 buprenorphine (265 at doses > or = 8 mg/day and 85 at doses < 8 mg/day) and 181 LAAM. High doses of methadone were more effective than low doses in the reduction of illicit opioid use (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.26--2.36). High doses of methadone were significantly more effective than low doses of buprenorphine (< 8 mg/day) for retention rates and illicit opioid use, but similar to high doses of buprenorphine (> or = 8 mg/day) for both parameters. Patients treated with LAAM had more risk of failure of retention than those receiving high doses of methadone (OR 1.92, 95% CI 1.32--2.78). It is proposed that in agonist-maintenance programmes, oral methadone at doses of 50 mg/day or higher is the drug of choice for opioid dependence.


In vitro and in silico studies of 8(17),12E,14-labdatrien-18-oic acid in airways smooth muscle relaxation: new molecular insights about its mechanism of action.
In the field of experimental pharmacology, researchers continuously investigate new relaxant agents of the airway smooth muscle cells (ASMCs), since the pathophysiology of respiratory illnesses, such as asthma, involves hyperresponsiveness and changes in ASMC homeostasis. In this scenario, labdane-type diterpenes, like forskolin (FSK), are a class of compounds known for their relaxing action on smooth muscle cells (SMCs), being this phenomenon related to the direct activation of AC-cAMP-PKA pathway. Considering the continuous effort of our group to study the mechanism of action and prospecting for compounds isolated from natural sources, in this paper, we presented how the diterpene 8(17),12E,14-labdatrien-18-oic acid (LBD) promotes relaxant effect on ASMC, performing in vitro experiments using isolated guinea pig trachea and in silico molecular docking/dynamics simulations. In vitro experiments showed that in the presence of aminophylline, FSK and LBD had their relaxant effect potentiated (EC50 from 1.4 ± 0.2 × 10-5 M to 1.5 ± 0.3 × 10-6 M for LBD and from 2.0 ± 0.2 × 10-7 M to 6.4 ± 0.4 × 10-8 M for FSK) while in the presence of Rp-cAMPS this effect was attenuated (EC50 from 1.4 ± 0.2 × 10-5 M to 3 × 10-4 M for LBD and from 2.0 ± 0.2 × 10-7 to 3.1 ± 1.0 × 10-6 M for FSK). Additionally, in silico simulations evidenced that the lipophilic character of LBD is probably responsible for its stability on AC binding site. LBD presented two preferential orientations, where the double bonds of the isoprene moiety as well as the unique polar group (carboxylic acid) in this compound form important anchoring points. In this sense, we consider that the LBD can interact stabilizing the catalytic dimmer of AC as the FSK, although less efficiently.


Work, family, and managerial attitudes and practices in the European workplace: comparing Dutch, British, and Slovenian financial sector managers.
Managers are key actors shaping employees' capabilities to utilize work–life policies. However, most research on managers' implementation of these policies has been conducted in liberal welfare states and ignores the impact of institutional context. In this study, we situate managers within specific workplace and national layers of context. We investigated how managers in financial organizations in the Netherlands, UK, and Slovenia talk about the utilization of work–life policies. Managers' discourses stressed disruption and dependency considerations in these case studies, as in the US research. However, a further management discourse of the moral case or right thing to do also emerged. The lack of resources for replacing staff on leave creates disruption and reduces managers capability to support the use of work–life policies, even when they are statutory or if managers are inclined be supportive (dependency or moral argument). This is likely to impact on parents' capabilities.


Germline and Somatic DNA Damage Repair Gene Mutations and Overall Survival in Metastatic Pancreatic Adenocarcinoma Patients Treated with FOLFIRINOX.
Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer with lack of predictive biomarkers. We conducted a study to assess DNA damage repair (DDR) gene mutations as a predictive biomarker in PDAC patients treated with FOLFIRINOX. Indiana University Simon Cancer Center pancreatic cancer database was used to identify patients with metastatic PDAC, treated with FOLFIRINOX and had tissue available for DNA sequencing. Baseline demographic, clinical, and pathologic information was gathered. DNA isolation and targeted sequencing was performed using the Ion AmpliSeq protocol. Overall survival (OS) analysis was conducted using Kaplan-Meier, logistic regression and Cox proportional hazard methods. Multivariate models were adjusted for age, gender, margin status, CA 19-9, adjuvant chemotherapy, tumor and nodal stage. Overall, 36 patients were sequenced. DDR gene mutations were found in 12 patients. Mutations were seen in BRCA1 (N = 7), BRCA2 (N = 5), PALB2 (N = 3), MSH2 (N = 1), and FANCF (N = 1) of all the DDR genes sequenced. Median age was 65.5 years, 58% were male, 97.2% were Caucasian and 51.4% had any family history of cancer. The median OS was near significantly superior in those with DDR gene mutations present vs. absent [14 vs. 5 months; HR, 0.58; 95% confidence interval (CI), 0.29-1.14; log-rank P = 0.08]. Multivariate logistic (OR, 1.47; 95% CI, 1.04-2.06; P = 0.04) and Cox regression (HR, 0.37; 95% CI, 0.15-0.94; P = 0.04) showed presence of DDR gene mutations was associated with improved OS. In a single institution, retrospective study, we found that the presence of DDR gene mutations are associated with improved OS in PDAC patients treated with FOLFIRINOX.


Breast cancer trends: opportunistic screening in Austria versus controlled screening in Finland and Sweden.
The objective of the study was to compare the trends of incidence and of mortality of breast cancer in Austria, Finland and Sweden, where different mammography screening strategies (opportunistic versus controlled) are applied. Furthermore, to find out whether a change in screening strategies would be feasible for Austria. Age-standardized incidence rates (1983-2000) and mortality rates (1980-2001/2) were analysed. Furthermore, the annual per cent change and the annual rate change (annual rate change=+/-n/100,000 per year) and the 95% confidence interval were calculated. In all three countries, incidence rates increased significantly (Austria +26.4%, Finland +86.7%, Sweden +38.8%) during the period analysed (P<0.01). The annual per cent change and the annual rate change in Austria (1.57 and 1.56, respectively) are below the annual per cent change and the annual rate change in Finland (3.38 and 3.49, respectively) and in Sweden (1.80 and 2.19, respectively) for the period analysed. Total breast cancer mortality decreased significantly in Sweden since 1980 (-20.5%, P<0.01), in Finland since 1988 (-18.3%, P<0.05) and in Austria since 1990 (-19.8%, P<0.01). The annual per cent change and the annual rate change in Austria (-1.81 and -0.59, respectively) are below the annual per cent change and the annual rate change in Finland (-0.57 and -0.16, respectively) and in Sweden (-1.02 and -0.28, respectively) for the period analysed. In conclusion, despite its unsophisticated opportunistic screening, Austria does well in comparison with countries operating organized breast cancer screenings.


Normal volume and cellular contents of pleural fluid.
Because of the technical difficulties in obtaining a-traumatical access to the normal pleural space, the exact volume and cellular content of normal pleural fluid in humans were still unknown until very recently, and animal-derived extrapolation data had to be used. After having developed a minimally invasive thoracoscopic technique for performing sympathectomy in patients suffering from essential hyperhidrosis, but with otherwise absence of thoracic disease, we have been able to achieve minimally traumatic access to normal pleural spaces. Using pleural lavage, a technique consisting of injection and immediate aspiration of 150 mL of prewarmed saline into the pleural space, we were able to determine the total and differential cell content of the few milliliters of original pleural fluid. The exact volume of this original pleural fluid could be measured using urea as an endogenous marker of dilution. Expressed per kilogram of body mass, total pleural fluid volume in healthy, non-smoking humans was 0.26+/-0.1 mL kg(-1). Total white blood cell count (after correction for dilution) was 1.716 x 10(3) cells mL(-1). Differential cell counts yielded median 75% (IR 16%) macrophages, 23% (IR 18%) lymphocytes, and marginally present mesothelial cells (1%, IR 2%), neutrophils (0%, IR 1%) and eosinophils (0%, IR 0%). There was no significant correlation between age and pleural lavage results in a study population aged 17 to 54 years old, which suggests that these results may be extrapolated to the situation in children and adolescents.


Mechanisms of compensatory for cervical lordosis changes after laminectomy with fusion.
The compensatory mechanisms for cervical lordosis change after laminectomy with fusion was not clear. The objective of this study was to evaluate the compensatory behaviors for cervical lordosis change after laminectomy with fusion. This was a retrospective radiological analysis of 43 patients with cervical spondylotic myelopathy who underwent laminectomy with fusion (LCF). The following cervical parameters were measured: C2-7 Cobb angle (C2-7), occiput-C2 angle (O-C2), the cervical sagittal vertical axis (cSVA), and T1 slope (T1S). The difference was calculated for all angle parameters between the two time points using the following formula: the amount of change (Δ) = (value at the follow-up)-(preoperative value). Non-parametric tests and the t-test were used to compare the difference. The Pearson correlation test was performed, and stepwise multiple regression analysis was performed to determine the best correlation between ∆cSVA and ∆T1S. The mean age of 43 patients was 65.51 ± 9.80 years. All patients were classified into two subgroups based on ΔcSVA: Group M (maintained) and, Group I (increased). The preoperative O-C2, C2-7, T1S, and cSVA were similar between Group M and group I (p = 0.950, p = 0.731, p = 0.372, and p = 0.152, respectively). Postoperative O-C2 and postoperative cSVA were significantly different (p = 0.036 and p = 0.004, respectively). ∆O-C2, ∆T1S and ∆cSVA were significantly different between the two groups (p = 0.006, p = 0.000, and p = 0.000, respectively). ΔcSVA had significant correlations with ΔO-C2 neutral angle (r = 0.377) and ΔT1S (r = 0.582). A linear regression equation was established: ΔcSVA = 0.602 + 0.103 * ΔT1S (R = 0.582, R2 = 0.339). The decrease of TIS should be the first and foremost compensation for the loss of lordosis in C2-7 segments after LCF. When the change of T1S alone can not prevent the deterioration of cervical sagittal balance, further increases in the O-C2 segment occur.


Silver nanoparticle toxicity to the larvae of oyster Crassostrea angulata: Contribution of in vivo dissolution.
Understanding the toxic mechanism of silver nanoparticles (AgNPs) is crucial for it risk assessment in marine environment, but the role of Ag+ release in the AgNP toxicity to marine biota is not yet well addressed. This study investigated the toxicity of AgNPs to the veliger larvae of oyster Crassostrea angulata, with a specific focus on the possibility of the involvement of in vivo dissolution of AgNPs in the toxicity via an aggregation-induced emission luminogen (AIEgen)-based imaging technique. AgNO3 exhibited significantly greater toxicity than AgNPs based on the total Ag, as indicated by lower 50 % growth inhibition concentration (EC50). The average concentration of soluble Ag in seawater at the EC50 of AgNPs was far lower than the EC50 of AgNO3, indicating that the AgNP toxicity could not be fully explained by the dissolved Ag in the medium. Despite the comparable soluble Ag concentration in seawater for both treatments, more Ag was accumulated in the larvae exposed to AgNPs, suggesting their ability to directly ingest particulate Ag, which was further confirmed by the presence of AgNPs aggregates in the esophagus and stomach. With the application of AIEgen-based imaging technique, in vivo dissolution of AgNPs in oyster larvae was thoroughly verified by an increase in Ag(I) content in the larvae exposed to AgNPs after depuration. The results collectively implied that apart from the Ag released in the medium, the Ag dissolved from the ingested AgNPs may also greatly contribute to the toxicity of AgNPs toward the oyster larvae. The findings of this work shed new light on the bioavailability and toxicity of AgNPs in marine environment.


Coronary Artery Bypass Grafting: A Comparative Exercise between Patients from the BYPASS Registry and Patients from a University Hospital.
The coronary artery bypass grafting (CABG) data provided by the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS) Registry is a Brazilian reality. To carry out a comparative exercise between the BYPASS Registry published data and data from patients operated on in a randomly chosen period (2013-2015) at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). This is a retrospective study reviewing 173 electronic medical records of CABG patients from the HCFMRP-USP. These data were compared with the BYPASS Registry published data. Chi-square test was used to verify the changes within the prevalence of adequate/inadequate biochemical tests before and after surgery. The sample was divided into groups consistent with cardiopulmonary bypass (CPB) time (CPB ≤ 120 minutes and CPB > 120 minutes). For the complications, prevalence by the chi-square test was adopted. Significant P-values are < 0.05. The comparative operative data of the BYPASS Registry and the HCFMRP-USP patients were quite similar, except for the isolate use of only arterial grafts, which was more frequent on HCFMRP-USP patients (30.8% vs. 15.9%), and the use of radial artery, also more frequent on HCFMRP-USP patients (48.8% vs. 1.1%). The comparative study suggested that the BYPASS Registry should be a reference for CABG quality control.


Estimating spatial and temporal variations of the reproduction number for highly pathogenic avian influenza H5N1 epidemic in Thailand.
Since 2003, highly pathogenic avian influenza (HPAI) H5N1 virus has spread, causing a pandemic with serious economic consequences and public health implications. Quantitative estimates of the spread of HPAI H5N1 are needed to adapt control measures. This study aimed to estimate the variations of the reproduction number R in space and time for the HPAI H5N1 epidemic in Thailand. Transmission between sub-districts was analyzed using three different and complementary methods. Transmission of HPAI H5N1 was intense (R(t)>1) before October 2004, at which point the epidemic started to progressively fade out (R(t)<1). The spread was mainly local, with 75% of the putative distances of transmission less than 32km. The map of the mean standardized ratio of transmitting the infection (sr) showed sub-districts with a high risk of transmitting infection. Findings from this study can contribute to discussions regarding the efficacy of control measures and help target surveillance programs.


Sperm binding to the pig zona pellucida and inhibition of binding by solubilized components of the zona pellucida.
An assay to determine the binding of pig spermatozoa to the zona pellucida (ZP) of pig oocytes was developed using conditions compatible with in-vitro fertilization of pig eggs and with pig sperm penetration of zona-free hamster ova. These conditions were used to define which of the pig oocyte ZP components were involved in sperm binding by a competitive inhibition approach. Assay variables that were optimized included: the method of sperm preparation; sperm preincubation time; sperm-oocyte coincubation time; sperm concentration and temperature; and methods for the separation of free from oocyte-bound spermatozoa. Inclusion of solubilized ZP in the sperm preincubation medium inhibited sperm binding approximately 50%. Both the 55K and 90K components inhibited sperm binding although the 55K component was more effective. The two polypeptides derived from chemical deglycosylation of the 55K families did not inhibit sperm binding. Of several monoclonal antibodies to the ZP components tested, only one directed against the 55K alpha glycoprotein family inhibited sperm binding. Sperm binding to pig oocyte ZP is therefore dependent on the carbohydrate moiety of the glycoproteins and appears to involve more than a single ZP glycoprotein.


Data assessing the usefulness of screening obstetrical ultrasonography for detecting fetal and placental abnormalities in uncomplicated pregnancy: effects of screening a low-risk population.
To investigate the usefulness of screening in low-risk populations, the authors evaluated the yield of ultrasonography for detecting abnormalities in 678 clinically uncomplicated pregnancies. The yield of ultrasonography in high-risk women who were referred for amniocentesis was remarkably similar to the yield in other women. All four diagnoses of twins were correct, but overall only six of 12 initial ultrasound diagnoses of fetal demise or fetal anomalies were confirmed at delivery. Of the eight major fetal anomalies present at delivery, including two cases of Down's syndrome, three had been detected by ultrasonography; none of the nine minor anomalies had been detected, usually because they were too small or might be detectable only at a later gestational age. Although ultrasonography may have a nearly perfect predictive value for certain anomalies, on average, in this study, positive ultrasonography increased the probability of an adverse outcome of pregnancy from 5.3% to 36%, while a normal ultrasound examination decreased the probability to 4.4%. These data, which emphasize the implications of screening a low-risk population, suggest that recommendations regarding routine screening obstetrical ultrasonography should await sufficiently large controlled trials demonstrating consistent clinical benefit, in terms of reassurance or of providing a baseline for future comparison or in terms of improved outcome at a reasonable cost.


The pathophysiology of the blood-brain barrier dysfunction induced by severe hypercapnia and by epileptic brain activity.
The cerebrovascular permeability to protein was studied in hypercapnic rats and in rats with epileptic seizures induced by bicuculline and homocysteine. Despite the differences of the basic pathophysiological mechanisms involved in these models, the blood-brain barrier (BBB) dysfunction was clearly related to the combined effects of high blood pressure and cerebral vasodilatation, thus indicating mechanical factors to be predominantly involved. The BBB changes were most frequent in central and basal regions in contrast to those induced by acute hypertension, which are most common in cortical areas.


Prosthodontic treatment of patients receiving implants by predoctoral students: five-year follow-up with the IMZ system.
Twenty-four patients were treated with 71 IMZ implants between 1987 and 1991 at Tufts University School of Dental Medicine by senior dental students. Soft tissue, marginal bone height, and prostheses were evaluated. Inflammation was noted around 70% of the implants, and marginal bone loss around 13% of the implants exceeded 2 mm. Prosthodontic complications included broken screws, broken dentures, broken intramobile elements (IMEs), porcelain fracture, and IMZ clip replacement. All 71 implants were immobile.


Keratinolytic fungi in Egyptian soils.
The frequency of occurrence of keratinolytic fungi in seventy soil samples collected from different sites in Upper Egypt and in the coastal area of the Mediterranean and baited with human and animal hair and pigeon feathers was determined. Twenty-one species in addition to an unidentified species, which belong to sixteen genera were collected. Chrysosporium indicum, B. tropicum, C. keratinophilum and Microsporum gypseum were the most frequent fungal species recovered from baited soils. The eight soil samples collected from the salt marshes of the coastal Mediterranean area were completely free from any keratinolytic fungi, whereas the sixty-two soil samples collected from cultivated soils contributed a species ranging from one to four species.


Effects of Ca Content on Formation and Photoluminescence Properties of CaAlSiN₃:Eu2+ Phosphor by Combustion Synthesis.
Effects of Ca content (in the reactant mixture) on the formation and the photoluminescence properties of CaAlSiN₃:Eu2+ phosphor (CASIN) were investigated by a combustion synthesis method. Ca, Al, Si, Eu₂O₃, NaN₃, NH₄Cl and Si₃N₄ powders were used as the starting materials and they were mixed and pressed into a compact which was then wrapped up with an igniting agent (i.e., Mg + Fe₃O₄). The compact was ignited by electrical heating under a N₂ pressure of ≤1.0 MPa. By keeping the molar ratios of Al and Si (including the Si powder and the Si in Si₃N₄ powder) both at 1.00 and that of Eu₂O₃ at 0.02, XRD (X-ray diffraction) coupled with TEM-EDS (transmission electron microscope equipped with an energy-dispersive X-ray spectroscope) and SAED (selected area electron diffraction) measurements show that AlN:Eu2+ and Ca-α-SiAlON:Eu2+ are formed as the major phosphor products when the Ca molar ratio (denoted by Y) is equal to 0.25 and AlN:Eu2+ and Ca-α-SiAlON:Eu2+ could not be detected at Y ≥ 0.75 and ≥1.00, respectively. CASIN (i.e., CaAlSiN₃:Eu2+) becomes the only phosphor product as Y is increased to 1.00 and higher. The extent of formation of CASIN increases with increasing Y up to 1.50 and begins to decrease as Y is further increased to 1.68. While the excitation wavelength regions are similar at various Y, the emission wavelength regions vary significantly as Y is increased from 0.25 to 1.00 due to different combinations of phosphor phases formed at different Y. The emission intensity of CASIN was found to vary with Y in a similar trend to its extent of formation. The Ca and Eu contents (expressed as molar ratios) in the synthesized products were found to increase roughly with increasing Y but were both lower than the respective Ca and Eu contents in the reactant mixtures.


[¹⁸F]FDOPA uptake in the raphe nuclei complex reflects serotonin transporter availability. A combined [¹⁸F]FDOPA and [¹¹C]DASB PET study in Parkinson's disease.
Brain uptake of [(18)F]FDOPA, measured with PET, reflects the activity of aromatic amino acid decarboxylase, an enzyme largely expressed in monoaminergic nerve terminals. This enzyme catalyzes a number of decarboxylation reactions including conversion of l-dopa into dopamine and 5-hydroxytryptophan into serotonin. For more than 20years [(18)F]FDOPA PET has been used to assess dopaminergic nigrostriatal dysfunction in patients with Parkinson's disease (PD). More recently, however, [(18)F]FDOPA PET has also been employed as a marker of serotoninergic and noradrenergic function in PD patients. In this study, we provide further evidence in support of the view that [(18)F]FDOPA PET can be used to evaluate the distribution and the function of serotoninergic systems in the brain. Eighteen patients with PD were investigated with both [(18)F]FDOPA and [(11)C]DASB PET, the latter being a marker of serotonin transport (SERT) availability. We then assessed the relationship between measurements of the two tracers within brain serotoninergic structures. [(18)F]FDOPA uptake in the median raphe nuclei complex of PD patients was significantly correlated with SERT availability in the same structure. Trends towards significant correlations between [(18)F]FDOPA Ki values and [(11)C]DASB binding values were also observed in the hypothalamus and the anterior cingulate cortex, suggesting a serotoninergic contribution to [(18)F]FDOPA uptake in these regions. Conversely, no correlations were found in brain structures with mixed dopaminergic, serotoninergic and noradrenergic innervations, or with predominant dopaminergic innervation. These findings provide evidence that [(18)F]FDOPA PET represents a valid marker of raphe serotoninergic function in PD and supports previous studies where [(18)F]FDOPA PET has been used to assess serotoninergic function in PD.


The effects of 28-day early-life exposure to triphenyl phosphate (TPhP) on odor preference and sexual behavior in female rats.
Many chemical substances are detectable in house dust, and they are consequently taken into our bodies via the mouth and nose. Triphenyl phosphate (TPhP), a flame retardant that has an estrogen-like effect in vitro, is present in house dust at high concentrations. Estrogen exposure during development has significant influences on reproductive behavior in rodents, and its effects persist until maturity. In the present study, we investigated the effect of early life exposure to TPhP on the reproductive behavior of female rats. Oral treatment with TPhP (25 or 250 mg/kg), ethinyl estradiol (EE; 15 μg/kg) as a positive control, or sesame oil as a negative control, were given to female rats (from birth to 28 days of age). The 8-week-old rats were bilaterally ovariectomized. At 12-15 weeks of age, the rats were subjected to odor preference and sexual behavior tests. In the odor preference test, the oil group showed significantly higher preference for male odor than female odor, but the low-dose TPhP treatment group lost the preference for male odor, indicating a possible outcome of early life TPhP exposure on sexual recognition. In the sexual behavior test, both the EE and TPhP treatment groups displayed significantly less proceptive behavior. These results suggest that early life exposure to TPhP disturbs the normal sexual behavior of female rats.


Physicochemical implications of cyanobacteria oxidation with Fe(VI).
Increases in harmful algal blooms has negatively impacted many surface-sourced drinking water utilities. To control these blooms, many water utilities implement pre-oxidation with ozone, chlorine, or permanganate; however, pre-oxidation of algae has both positive and negative water quality outcomes. This study investigated ferrate (Fe(VI)) as an alternative oxidant by measuring its effect on cell lysing, surface characteristics, and coagulation in waters containing the cyanobacteria Microcystis aeruginosa. Bench scale studies were conducted to examine the complex combination of processes in a Fe(VI)-algae system. These processes were characterized by fluorescence index, surface charge, collision frequency modeling, particle counts and sphericity, total nitrogen, and ferrate decomposition measurements. Results showed that Fe(VI) lysed algal cells, but further oxidation of released organic matter is possible. The presence of algae did not significantly impact the rate of Fe(VI) decomposition. Fe(VI) pre-oxidation may also be capable of decreasing the formation of nitrogenated disinfection byproducts through subsequent oxidation of released nitrogen rich organic matter. Streaming current and zeta potential results indicate destabilization of the resulting algae and iron suspension was incomplete under most conditions. Particle collision frequency modeling indicates fluid shear to be an important aggregation mechanism of the resulting suspension. Overall, Fe(VI) is a viable alternative to other strong oxidants for water utilities struggling with harmful algal blooms, but the final fate of the resulting organic matter must be further studied.


The role of sentinel lymph node status performed in melanoma patients with local recurrence or in transit metastasis.
Sentinel Node Biopsy (SNB) is routinely performed for primary melanoma, but its role in the treatment of Local Recurrence (LR) and In-Transit metastasis (IT) is controversial. This study aims to assess the role of SNB in melanoma patients who developed first loco-regional recurrence. A series of consecutive melanoma patients who received SNB for a first IT or LR at the National Cancer Institute of Milan, Italy, from 2000 to 2015 were selected from a prospective database. Clinicopathological characteristics were analyzed. Seventy-two patients met selection criteria. Forty-three patients (59.7%) received SNB for LR and 29 (40.3%) for IT. The average interval between treatment of primitive melanoma and first recurrence diagnosis was 19 months (interquartile range: 6.9-49.0). SN identification rate was 97.2%. SN positivity was detected in 26 (37.1%) patients. The SN-positive ratein melanoma patients who had LR or IT was significantly higher than reported for primary tumours. Of patients with nodal involvement 17 had LR and 9 IT lesions. Disease Free Survival (DFS) was slightly higher in SN negative patients, in the absence of statistically significant differences. Overall Survival (OS) analysis showed similar values in the two groups. Since DFS and OS do not show significant differences between SN negative and positive patients, our data do not give clear indications about performing SNB in case of first LR or IT. However, we suggest submitting patients with LR to this procedure to obtain a more accurate staging and eventually candidate these patients to adjuvant treatment.


Bacterial colonization and infection in an intensive care unit.
One hundred and one patients, nursed in an intensive care unit for at least 24 h, were monitored for bacterial colonization and infection. The infection rates were similar to those in other reports. Patients were not generally colonized with common environmental strains in the unit. Bacterial dissemination between patients was uncommon. No gentamicin resistant gram negative or Staphylococcus aureus strains were observed, nor methicillin resistant Staphylococcus aureus strains. The hypothesis that these favourable conditions are partly related to the excellent isolation and barrier nursing facilities in the unit cannot be fully substantiated.


Dietary consumption and its effect on nutrition outcome among under-five children in rural Malawi.
Despite remarkable progress in reducing under five mortalities in Malawi, a relative proportion of under nutrition among children still exist. The study examines dietary consumption factors and their effect on under nutrition outcomes among children under five years' children in rural Malawi. Using the 2015-16 Malawi Demographic and Health Survey, in which 4,150 children were reported of under nutrition statuses, the study used nested logistic regression models to estimate factors influencing the prevalence of under nutrition among children. Based on the results, exclusive breast feeding among children under five years, after controlling for parental socioeconomic factors, was found to reduce the levels of wasting (ODDS RATIO [OR] = 0.763; p < 0.05), underweight (OR = 0.548; p < 0.001) and stunting (OR = 0.709; p < 0.005). Furthermore, it was found that despite the perceived adequacy among women in accessing fruits and vegetables, carbohydrates and micro-nutrient supplements, their children under five years, still experiences public health challenges and suffers from wasting, underweight and stunting. There is need to implement extensive pro-rural under five nutritional and health educational advocacy using community-based approaches, targeting parents, emphasizing the significance of exclusive breast feeding and consistencies in giving dietary foods, if and only if the persistent public health challenges due to under nutrition among children under five years, is to be sustainably dealt with, in Malawi.


Linguistic markers and basic self-disturbances among adolescents at risk of psychosis. A qualitative study.
Language impairments are key features of schizophrenia spectrum disorders, and have also been suggested to signal enhanced psychosis risk. Incoherence, derailment, and monotonous speaking are however closely related to psychosis onset, and thus not very early markers. Recent phenomenologic-psychiatric studies claim that basic self-disturbance (BSD) may represent more useful early markers. We searched for distinctive irregular linguistics of 30 CHR outpatient adolescents, aged 12-18 years. Standard instruments established psychosis risk and BSD. Participants chose three personal and well manifested BSD phenomena. Ninety verbatim statements were analyzed and grouped into higher order clusters of linguistic irregularities. We identified five clusters of irregular language features: distinctive words, describing an atmosphere of unreality; irregular use of prepositions, indicating experiential detachment; shifts of personal pronouns, indicating identity confusion; near-literal use of metaphors and conjunctions indicating existential insecurity, and idiosyncratic use of adjectives indicating perceptual transcendence. The adolescents provided naturalistic descriptions of experiences that were markedly twisted and almost ineffable. This unique irregular "BSD -language" was highly meaningful in its proper context, expressing informative characteristics of first-personal experiential alterations, essential for early detection. The features may additionally represent precursors of psychosis transition, useful for clinical decision-making. Foundation Dam, Oslo, Norway (Grant Number 2017/FO143368).


Heart rate variability is reduced during the menstrual phase in women with catamenial C1-type temporal lobe epilepsy.
Temporal lobe epilepsy (TLE) is the most frequent focal epilepsy in adulthood. Catamenial C1-type TLE, is characterized by a cyclic seizure exacerbation during the menstrual phase. The heart rate variability (HRV) analysis assesses cardiac autonomic control and may represent a biomarker for Sudden Unexpected Death in Epilepsy (SUDEP). It is plausible that female sex hormones can influence HRV. These changes might be more pronounced in patients suffering from catamenial C1-type TLE where hormonal changes also increase seizure susceptibility. To that aim, we evaluated HRV changes during the menstrual phase of women suffering from catamenial C1-type TLE. We enrolled 12 adults with a diagnosis of catamenial C1-type TLE (Catamenial Group) and 12 age-, and seizure-frequency-matched controls with TLE (Non-Catamenial Group). Each patient underwent a 20-minute EEG + EKG recording in resting state during the menstrual phase. HRV parameters were calculated with a short-lasting analysis of EKG records. Time domain-related, frequency domain-related, as well as non-linear analysis parameters, were compared between the two groups. Compared to the Non-Catamenial Group, the Catamenial Group showed significant reductions in SDNN (p-value = 0.01), RMSSD (p-value = 0.04), pNN50 (p-value = 0.001), LnLF ms2 (p-value = 0.05), LnHF ms2 (p-value = 0.007), SD1 (p-value = 0.02), and SD2 (p-value = 0.01). These results were independent from age, disease duration, numbers of ASM, and seizure etiology. Our data provide experimental evidence that vagal output is reduced during the menstrual phase in patients with catamenial C1-type TLE. These results indicate that, during the menstrual phase, patients with catamenial C1-type TLE may be at a higher risk of developing cardiac dysfunctions and SUDEP.


Direct Repair of Flexor Tendons Close to Bony Insertion and Ruptured Collateral Ligaments.
Lacerated flexor tendons close to bony junction are commonly repaired using a pullout suture. However, these injuries very close to the tendon-bone junction can be repaired with robust direct suture repair of the proximal tendon stump with the short residual tendon stump and any local tissues such as periosteum and joint volar plate. Subacute or chronic traumatic rupture at the midpart of the collateral ligaments can also be repaired by "refreshing" the divided ligament ends and repairing the ligament stumps to local tissues with multiple sutures often combined with tightening the elongated joint capsule.


Limited value of programmed electrical stimulation from multiple right ventricular pacing sites in clinically sustained ventricular fibrillation or ventricular tachycardia associated with coronary artery disease.
One-hundred and fifty patients with coronary artery disease and a documented history of sustained ventricular tachyarrhythmias were studied to determine if programmed electrical stimulation (PES) from a second right ventricular (RV) pacing site optimizes the induction of such sustained arrhythmias. The first PES test was performed from 2 RV pacing sites (apex and outflow tract or septum) using the apex first in each patient. All patients underwent a second PES within 6 to 24 hours of the first; both studies used up to 4 ventricular extrastimuli, in the absence of antiarrhythmic treatment. The second PES was performed from a single RV apical site using a pacing catheter retained from the first study. During the first day's study, 74 patients (49%) had sustained ventricular tachycardia induced from the RV apex. Only 11 of the remaining 76 patients (7% of the total group) were inducible exclusively from a second RV pacing location during the first day's testing. Seven of these 11 patients, as well as 15 additional patients who did not have ventricular tachycardia induced from either site on the first day's study, were inducible from the RV apex during the second drug-free study. Among patients with sustained ventricular tachyarrhythmias, limiting PES to a single RV site, with the option of performing a second study in those who are initially noninducible is more effective in inducing sustained ventricular tachyarrhythmias than is PES performed from 2 RV pacing sites.


MS patients report excellent compliance with oral prednisone for acute relapses.
Multiple Sclerosis is characterized by relapses separated by periods of relative quiescence. High dose intravenous corticosteroid pulses for three to five days is the current standard for the treatment of acute relapses, but recent evidence supports the use of equivalent doses of oral therapy as an alternative. The highest single dose preparation of oral prednisone is a 50mg tablet, requiring patients to take 25 tablets a day. Questions regarding compliance with this oral regimen have been raised. To determine whether MS patients are complaint with 1,250 mg of oral prednisone daily for acute relapses. Between November 2008 and December 2009, all patients diagnosed with an acute relapse in the London (Ontario) MS clinic were prospectively identified. If treatment with oral prednisone was initiated, subjects were given a survey to be mailed anonymously to the clinic. Sixty eight MS relapses were diagnosed and treated with corticosteroids in 66 patients of which 60 (58 subjects) were treated with 1,250 mg prednisone. Fifty-three (91.4%) surveys were returned. The reported compliance rate was high at 94.3% (50/53) with only one patient reporting being unable to take all the required pills due to intolerance. Most subjects (43, 86.0%) encountered at least one side effect, most commonly insomnia, mood changes and increased appetite. Two thirds of subjects (69.8%) indicated a preference for oral medication for future relapses. High dose (1,250 mg) oral prednisone is an acceptable therapy to MS patients for the treatment of acute relapses with a high rate of compliance.


Evaluation of simulated dredging to control internal phosphorus release from sediments: Focused on phosphorus transfer and resupply across the sediment-water interface.
Sediment dredging is an effective restoration method to control the internal phosphorus (P) loading of eutrophic lakes. However, the core question is that the real mechanism of dredging responsible for sediment internal P release still remains unclear. In this study, we investigated the P exchange across the sediment-water interface (SWI) and the internal P resupply ability from the sediments after dredging. The study is based on a one-year field simulation study in Lake Taihu, China, using a Rhizon soil moisture sampler, high-resolution dialysis (HR-Peeper), ZrO-Chelex diffusive gradients in thin film (ZrO-Chelex DGT), and P fractionation and adsorption isotherm techniques. The results showed low concentration of labile P in the pore water with a low diffusion potential and a low resupply ability from the sediments after dredging. The calculated flux of P from the post-dredged sediments decreased by 58% compared with that of non-dredged sediments. Furthermore, the resupply in the upper 20mm of the post-dredged sediments was reduced significantly after dredging (P<0.001). Phosphorus fractionation analysis showed a reduction of 25% in the mobile P fractions in the post-dredged sediments. Further analysis demonstrated that the zero equilibrium P concentration (EPC0), partitioning coefficient (Kp), and adsorption capacity (Qmax) on the surface sediments increased after dredging. Therefore, dredging could effectively reduce the internal P resupply ability of the sediments. The reasons for this reduction are probably the lower contributions of mobile P fractions, higher retention ability, and the adsorption capacity of P for post-dredged sediments. Overall, this investigation indicated that dredging was capable of effectively controlling sediment internal P release, which could be ascribed to the removal of the surface sediments enriched with total phosphorus (TP) and/or organic matter (OM), coupled with the inactivation of P to iron (Fe) (hydr)oxides in the upper 20mm active layer.