Priming of human neutrophil functions by tumor necrosis factor: enhancement of superoxide anion generation, degranulation, and chemotaxis to chemoattractants C5a and F-Met-Leu-Phe.
Recombinant human tumor necrosis factor-alpha (rTNF) stimulated increased generation of superoxide anion (O2-) by human neutrophils in a concentration-dependent fashion. Preincubation of human neutrophils with rTNF (2.2-2200 units/ml) for 10 min enhanced the subsequent generation of O2- in response to C5a and f-Met-Leu-Phe (FMLP). Recombinant TNF did not enhance O2- generation by neutrophils stimulated with phorbol myristate acetate (PMA). Recombinant TNF alone failed to induce release of myeloperoxidase (MPO) and lysozyme by neutrophils. However, it did enhance the release of MPO and lysozyme by neutrophils stimulated with C5a and FMLP, but not with PMA. Although rTNF alone (0.001-50,000 units/ml) was not chemotactic for neutrophils, preincubation of neutrophils with rTNF (0.001-0.1 units/ml) enhanced the chemotactic activity of suboptimal concentrations of C5a (0.1 nM) and FMLP (5 nM). Neutrophils treated with high concentrations of rTNF (100-10,000 units/ml) showed inhibition of random movement and of chemotaxis induced by C5a or FMLP. We conclude from these studies that rTNF primes neutrophils for enhanced responses to subsequent stimuli and thus may augment the inflammatory response by increased oxidant production and lysosomal enzyme release and promote down-regulation of chemotactic movement.


Particulate matter 2.5 induced bronchial epithelial cell injury via activation of 5'-adenosine monophosphate-activated protein kinase-mediated autophagy.
The impact of particulate matter 2.5 (PM2.5) on the respiratory system is a worldwide concern. However, the mechanisms by which PM2.5 causes disease are still unclear. In this study, we investigated the effect of PM2.5 on autophagy and studied the effect of PM2.5-induced autophagy and 5'-adenosine monophosphate-activated protein kinase (AMPK) on cell proliferation, cell cycle, apoptosis, reactive oxygen species (ROS), and airway inflammation using human bronchial epithelial cells 16HBE140 cells. Results showed that exposure of cells to PM2.5 at a concentration of 100 μg/mL for 24 hours was most effective for inhibiting cell viability. PM2.5 induced cell arrest in the G0/G1 phase and increased mitochondrial membrane potential, ROS, and cell apoptosis with increasing concentration. PM2.5 downregulated cyclin D and matrix metallopeptidase-9 (MMP-9) expression but upregulated tissue inhibitor of metalloproteinases-1 (TIMP-1) expression, significantly promoted interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) production, and enhanced the level and activation of AMPK. The levels of autophagy-related protein 5 (ATG5), Beclin-1, and LC3II/I were significantly increased by PM2.5. The activation of Unc-51-like autophagy activating kinase 1 was significantly inhibited by PM2.5. Moreover, ATG5 knockdown inhibited PM2.5-induced autophagy, ROS, and cell apoptosis significantly. The expression of cyclin D, MMP-9, and TIMP-1 was reversed by ATG5 suppression. PM2.5-induction of IL-6 and TNF-α was significantly inhibited by knockdown of ATG5. Thus, inhibition of autophagy protected the cells from PM2.5-induced injury. PM2.5 induced injury in human bronchial epithelial cells via activation of AMPK-mediated autophagy, suggesting possible therapeutic targets for the treatment of respiratory diseases.


Uncovering the role of juvenile hormone in ovary development and egg laying in bumble bees.
Juvenile hormone (JH) regulates developmental and physiological processes in insects. In bumble bees, the hormone acts as a gonadotropin that mediates ovary development, but the exact physiological pathways involved in ovary activation and subsequent egg laying are poorly understood. In this study, we examine how queen hibernation state, caste, and species impact the gonadotropic effect of JH in bumble bee queens through methoprene (JH analogue) application. We extend previous research by assessing queen egg laying and colony initiation, alongside ovary development. Furthermore, we compared sensitivity of workers of both species to the juvenile hormone's gonadotropic effect. In both bumble bee species, the ovaries of hibernated queens were developed five to six days after breaking diapause, regardless of methoprene treatment. By contrast, methoprene did have a stimulatory effect on ovary development in non-hibernated queens. The dose needed to obtain this effect was higher in B. impatiens. Methoprene did not have gonadotropic effects in callow workers of both species. These results indicate that the physiological effect of exogenous methoprene application varies according to species, caste and hibernation status. Interestingly, despite gonadotropic effects in non-hibernated queens, oviposition was not accelerated by JH. This suggests that JH alone is insufficient to induce egg laying and that an additional stimulus, which is naturally present in hibernated queens, is required. Consequently, our findings indicate that other physiological processes, beyond a rise in JH alone, are required for oviposition and colony initiation.


Selective increase in endothelin-1 and endothelin A receptor subtype in the hypertrophied myocardium of the aorto-venacaval fistula rat.
At present little is known about the factors that regulate the expression of the endothelins and their receptors in cardiac tissue in vivo. The aim of this study was to investigate changes in expression of the endothelins (ET-1, ET-2, and ET-3) and their receptors (ETAR and ETBR) in the hypertrophied heart of the aortovenocaval (AV) fistula rat. Reverse transcription-polymerase chain reaction (RT-PCR) was used to quantify cardiac mRNA expression of the endothelins and their receptors during the development of cardiac hypertrophy, while radioligand binding was employed to quantify the amount of [125I]-ET-1 binding to cardiac membranes. Tissue and plasma concentrations of ET-1 were measured by radioimmunoassay. In control sham operated animals, ET-1 mRNA was approximately fivefold greater in atria than in ventricles (P < 0.05), but there were no atrioventricular differences in ET-2 or ET-3 mRNA. In the AV fistula rats there was a prompt three- to fourfold increase in ET-1 mRNA in atria and a progressive five- to sevenfold rise in ventricles during cardiac hypertrophy. There were no changes in ET-2 or ET-3 transcript prevalences, except for a late rise (35 d) in ET-2 mRNA levels in left ventricle. Consistent with ET-1 mRNA measurements, immunoreactive endothelin levels were increased by 7 d in atria, but not in ventricles. In control rat hearts, ETAR mRNA levels were similar in atria and ventricles, but the prevalence of ETBR was approximately sevenfold greater in the former. ETAR mRNA prevalence increased with hypertrophy in all chambers, while ETBR transcript levels were raised only in the right ventricle. There was no significant difference in [125I]-ET-1 binding between atrial samples from 35 d control and 35 d AV fistula rats, suggesting rapid turnover of endothelin receptors balanced by increased transcription from the ETAR gene. During cardiac hypertrophy in AV fistula rats there is increased activity of the endothelin system mediated principally by ET-1 and the ETAR subtype.


Structure of an endosomal signaling GPCR-G protein-β-arrestin megacomplex.
Classically, G-protein-coupled receptors (GPCRs) are thought to activate G protein from the plasma membrane and are subsequently desensitized by β-arrestin (β-arr). However, some GPCRs continue to signal through G protein from internalized compartments, mediated by a GPCR-G protein-β-arr 'megaplex'. Nevertheless, the molecular architecture of the megaplex remains unknown. Here, we present its cryo-electron microscopy structure, which shows simultaneous engagement of human G protein and bovine β-arr to the core and phosphorylated tail, respectively, of a single active human chimeric β2-adrenergic receptor with the C-terminal tail of the arginine vasopressin type 2 receptor (β2V2R). All three components adopt their canonical active conformations, suggesting that a single megaplex GPCR is capable of simultaneously activating G protein and β-arr. Our findings provide a structural basis for GPCR-mediated sustained internalized G protein signaling.


Sustained reduction of intraocular pressure by supraciliary delivery of brimonidine-loaded poly(lactic acid) microspheres for the treatment of glaucoma.
Although effective drugs that lower intraocular pressure (IOP) in the management of glaucoma exist, their efficacy is limited by poor patient adherence to the prescribed eye drop regimen. To replace the need for eye drops, in this study we tested the hypothesis that IOP can be reduced for one month after a single targeted injection using a microneedle for administration of a glaucoma medication (i.e., brimonidine) formulated for sustained release in the supraciliary space of the eye adjacent to the drug's site of action at the ciliary body. To test this hypothesis, brimonidine-loaded microspheres were formulated using poly(lactic acid) (PLA) to release brimonidine at a constant rate for 35 days and microneedles were designed to penetrate through the sclera, without penetrating into the choroid/retina, in order to target injection into the supraciliary space. A single administration of these microspheres using a hollow microneedle was performed in the eye of New Zealand White rabbits and was found to reduce IOP initially by 6 mmHg and then by progressively smaller amounts for more than one month. All administrations were well tolerated without significant adverse events, although histological examination showed a foreign-body reaction to the microspheres. This study demonstrates, for the first time, that the highly-targeted delivery of brimonidine-loaded microspheres into the supraciliary space using a microneedle is able to reduce IOP for one month as an alternative to daily eye drops.


Biochemical pharmacology of functional foods and prevention of chronic diseases of aging.
The major mechanisms and consequences of free radicals in foods and biological systems that result in the occurrence of chronic diseases of aging (atherosclerosis, cataract, cancers, diabetes, neurological diseases, immune-inflammatory disorders) are described. The main antioxidant defense mechanisms from foods and cells and tissues are also reported. Many nutraceutical substances, with their respective beneficial actions (antioxidant, detoxifying, apoptotic actions) and effects, and most common food sources are also described. There are many options of foods to prevent cancer and chronic diseases, to improve life's quality in maturity.


Metal contamination in the sediment, pondweed, and snails of a stream receiving effluent from a lead/zinc mine in southern China.
This study assessed the potential of Potamogeton crispus and Pomacea canaliculata as biomonitors of sedimentary metal contamination. The results indicate P. crispus possesses several attributes of a biomonitor and its tissue concentrations of Cd, Pb and Zn may reflect the levels of sedimentary contamination by these metals. Although P. canaliculata can accumulate metals to high levels and serve as an indicator of metal contamination, its tissue metal concentrations did not correlate with those of the sediments or macrophytes.


Insect learning flights and walks.
Knowledge of where things are in one's habitual surroundings cannot be encoded genetically and must be acquired in those surroundings. Many ants, bees and wasps forage from a home base and before doing so learn where resources are to be found and how to return with them to their nest. A significant component of this navigational learning seems to be the acquisition of panoramic views that insects record close to their nests and resource sites and along the paths between these places. Behavioural evidence indicates that these views are retinotopic, meaning, for instance, that an insect knows that it faces along a familiar route, if the image on its retina matches a view that it had previously recorded, when facing in that direction during route learning.


Splenectomy for adult chronic idiopathic thrombocytopenic purpura: experience from a single center in China.
The aim of this study was to explore the results of Chinese chronic idiopathic thrombocytopenic purpura (ITP) patients who underwent splenectomy (SE). Data of 149 chronic ITP patients were retrospectively analyzed. Relapse-free survival was estimated by Kaplan-Meier analysis. Differences between responders and non-responders were evaluated using the chi-square. The immediate response rate was 82.6% and the sustained response rate was 63.1%. Twenty-nine patients (19.5%) relapsed during follow-up. The 5-year actuarial relapse-free survival was about 75%. The overall morbidity was 26.1% and mortality was 2.7%. Patients with higher postsplenectomy peak platelet count, shorter time from diagnosis to SE and previous response to IVIG therapy were more likely to have sustained response to SE. SE is potentially a useful therapy to provide long-term control of disease in adults with chronic ITP and is associated with low morbidity and mortality. Postsplenectomy peak platelet count, time from diagnosis to SE and previous response to intravenous immune globulin therapy appear predictive for response to SE.


[Inoculation of murine bone marrow mesenchymal stem cells induces tumor necrosis in mouse with orthotopic hepatocellular carcinoma].
To observe whether murine bone marrow mesenchymal stem cells (MSCs) implantation improves the survival of hepatocellular carcinoma (HCC)-bearing mice,and to investigate whether MSCs can differentiate to hepatocytes in HCC microenvironment in a mouse model of orthotopic HCC and its effects on tumor cells. Murine bone morrow MSCs were obtained through adherent culture method combined with magnetic cell sorting CD45(-), CD11b(-)cells, labeled with CFSE in vitro. Phenotypes of MSCs were analyzed by flow cytometry. A murine model of orthotopic HCC was induced by intrahepatic injection of 5 x 10(5) murine H22 hepatoma cells in a BALB/c mouse. In this experiment,twelve BALB/c mice were randomly divided into MSCs implantation and saline administration groups on the 7th day after establishment of orthotropic HCC. CFSE labeled MSCs were injected into tumor and/or normal liver tissue in MSCs implantation group. The life span of HCC-bearing mice was observed. After three weeks, albumin was determined by immunohistochemistry. The livers of HCC-bearing mice were observed by light microscopy. In MSCs group, the mean survival time was 25 days (95% Confidence interval: 22-28 d), while, in the control group, mean survival time was 21 days (95% CI: 20-23 d). However, the statistical difference was not obvious between the two groups (P = 0.0713). It showed that the CFSE labeled cells mainly localized in the border of tumor, also a few in the tumor bed, and expressed albumin. Interestingly, there was a larger area of necrosis in the tumor bed, compared with that in the controls. It can be concluded that MSCs not only could engraft in livers of carcinoma-bearing BALB/c mice, but also could differentiate to hepatocyte-like cell. At the same time, MSCs might induce tumor cells necrosis. Further mechanism need to be studied.


Is laparoscopic appendectomy an effective procedure?
To compare the results of open and laparoscopic appendectomy and to determine if the laparoscopic approach might be more effective for some subgroups of patients. We retrospectively analysed the computerised data of 326 consecutive adult patients operated on for suspected appendicitis between 2001 and 2005. The series consisted of 166 men and 160 women with a mean age of 32 +/- 16 years and a mean Body Mass Index (BMI) of 24 +/- 4. There were 265 ASA I, 46 ASA II and 5 ASA III patients. According to the surgeon's preference, 176 patients had an open appendectomy (OA) and 150 a laparoscopic appendectomy (LA). The mean operative time and hospital stay were equivalent in the two groups : respectively 49 +/- 19 min. and 4.1 +/- 2.5 days in OA and 50 +/- 16 min. and 3.5 +/- 1.8 days in LA. However, subgroup analysis revealed that overweight (BMI > 25) patients (n = 102) and patients with ectopic appendices (n = 86) had an obvious benefit from LA. In cases of OA, operative time and hospital stay were longer in overweight patients than in normal weight patients: respectively 63 +/- 20 min. and 5.3 +/- 2.9 days versus 44 +/- 16 min. (p < 0.01) and 3.7 +/- 2.2 days (p < 0.01). On the contrary, no difference was observed in the LA group. Operative time and hospital stay were also longer in patients with ectopic appendices submitted to OA than in patients with an appendix in the normal position: respectively 60 +/- 18 min. and 4.7 +/- 2.7 days versus 45 +/- 18 min. (p < 0.01) and 3.9 +/- 2.4 days (p < 0.01). Again, such a difference was not observed in cases of LA. We noted no mortality, but 24 patients (7%) developed an abdominal complication : 18 wound infections and 6 intra-abdominal abscesses. Wound infections were more common in the OA than in the LA group : 7.3% (13/176) versus 3.3% (5/150) (p = 0.1). In the LA group, 4 wound infections were observed in our early experience, at a time where no endoscopic bag was used for the removal of the appendix. The rate of intra-abdominal abscesses was similar: 1.7% (3/176) in the OA group and 2% (3/150) in the LA group. LA is an effective procedure with a reduced risk of developing wound infection. The laparoscopic approach is particularly effective for overweight patients and/or patients with ectopic appendices as far as shortening the operative time and hospital stay is concerned.


Detection of in vitro interferon-gamma and serum tumour necrosis factor-alpha in multidrug-resistant tuberculosis patients.
Multidrug-resistant tuberculosis (MDR-TB) is known as having a poor prognosis with a weak response to therapy and very high death rates. The aim of this work was to assess the immune response to the RD1-encoded antigen ESAT-6 of Mycobacterium tuberculosis in MDR-TB patients and compare to non-resistant (NR) TB patients and healthy controls (HC). Evaluation of interferon (IFN)-gamma production showed that, although 55% of the MDR patients were responsive to ESAT-6, they produced lower IFN-gamma levels (553 +/- 11 pg/ml) when compared to NR-TB (1179 +/- 163 pg/ml; P < 0.05) but not to controls (412 +/- 65.7 pg/ml). Differences in the response to ESAT-6 and to its overlapping peptides mixture were also significant between MDR versus treated pulmonary NR-TB. Furthermore, a very low rate of response to PPD (23.5%) and to Ag85B (33.3%) was noted in MDR-TB patients as compared to the other groups. To determine the inflammatory response in patients' groups, detection of tumour necrosis factor (TNF)-alpha was assessed in their sera before and during chemotherapy. Mean TNF-alpha levels in MDR-TB (43.8 +/- 9 pg/ml) paralleled those found in treated pulmonary, and it was significantly different (P < 0.05) from the values found in untreated NR and HC. Interestingly, secretion of IFN-gamma and TNF-alpha were predominant in MDR patients who presented with bilateral pulmonary lesions and lung cavitation. The present data indicate that the overall immune response to mycobacterial antigens is decreased in resistant TB and the major role inflammatory cytokines may play in perpetuating pulmonary tissue damage.


Seasonality and selective trends in viral acute respiratory tract infections.
Influenza A and B, and many unrelated viruses including rhinovirus, RSV, adenovirus, metapneumovirus and coronavirus share the same seasonality, since these viral acute respiratory tract infections (vARIs) are much more common in winter than summer. Unfortunately, early investigations that used recycled "pedigree" virus strains seem to have led microbiologists to dismiss the common folk belief that vARIs often follow chilling. Today, incontrovertible evidence shows that ambient temperature dips and host chilling increase the incidence and severity of vARIs. This review considers four possible mechanisms, M1 - 4, that can explain this link: (M1) increased crowding in winter may enhance viral transmission; (M2) lower temperatures may increase the stability of virions outside the body; (M3) chilling may increase host susceptibility; (M4) lower temperatures or host chilling may activate dormant virions. There is little evidence for M1 or M2, which are incompatible with tropical observations. Epidemiological anomalies such as the repeated simultaneous arrival of vARIs over wide geographical areas, the rapid cessation of influenza epidemics, and the low attack rate of influenza within families are compatible with M4, but not M3 (in its simple form). M4 seems to be the main driver of seasonality, but M3 may also play an important role.


Psychodynamic treatment of depression.
Findings reviewed in this article show that PT should be included in treatment guidelines for depression. BPT in particular has been found to be superior to control conditions, equally effective as other active psychological treatments, with treatment effects that are often maintained in the long run, conferring resistance to relapse. Moreover, BPT is as effective as pharmacotherapy in the acute treatment of mild to moderate depression, and, either as monotherapy or combined with medication, BPT is associated with better long-term outcome compared with pharmacotherapy alone. PT is accepted by many depressed patients as a viable and preferred treatment. Furthermore, LTPT and PA have shown promise in treating patients with complex psychological disorders characterized by mood problems, often with comorbid personality problems. Finally, although studies suggest that effects of PT may be achieved somewhat slower compared with other forms of psychotherapy as well as medication in the acute treatment of depression, LTPT appears to be more clinically effective and perhaps more cost effective in the long run, particularly for chronically depressed patients. As noted, these conclusions need to be interpreted within the context of important limitations. Compared with other treatments, the evidence base for PT in depression remains relatively small, despite a respectable research tradition supporting psychodynamic assumptions with regard to the causation of depression. Moreover, and perhaps most importantly, although more studies now include longer follow-up assessments, our knowledge about the long-term effects of so-called evidence-based treatments of depression remains sketchy at best. In this context, the growing evidence for the efficacy and effectiveness of LTPT is promising. Overall, it is clear that the future of the treatment of depression may lie in a combined disorder- and person-centered, tailored-made approach, which takes into account, particularly in chronic depression, the broader interpersonal context and life history of the individual. It is clear that psychodynamic therapies have an important role to play in this respect.


On-surface synthesis of ballbot-type N-heterocyclic carbene polymers.
N-Heterocyclic carbenes (NHCs) are established ligands for metal complexes and surfaces. Here we go beyond monomeric NHCs and report on the synthesis of NHC polymers on gold surfaces, consisting of ballbot-type repeating units bound to single Au adatoms. We designed, synthesized and deposited precursors containing different halogens on gold surfaces under ultrahigh vacuum. Conformational, electronic and charge transport properties were assessed by combining low-temperature scanning tunneling microscopy, non-contact atomic force microscopy, X-ray photoelectron spectroscopy, first-principles calculations and reactive force field simulations. The confirmed ballbot-type nature of the NHCs explains the high surface mobility of the incommensurate NHC polymers, which is prerequisite for their desired spatial alignment. The delicate balance between mobility and polymerization rate allows essential parameters for controlling polymer directionality to be derived. These polymers open up new opportunities in the fields of nanoelectronics, surface functionalization and catalysis.


Flaxseed oil during lactation changes milk and body composition in male and female suckling pups rats.
We have reported several changes in neonate or adult offspring after the maternal use of whole flaxseed or its components. However, it is unknown the use of higher oil intake in the neonatal period. Here we evaluated the effects of high maternal intake of flaxseed oil during lactation upon milk and body composition in male and female offspring. Lactating rats were divided into: (1) control (C, n=10), 7% soybean oil; (2) hyper 19% soybean oil (HS, n=10); and (3) hyper 17% flaxseed oil+2% soybean oil (HF, n=10). Dams and offspring were killed at weaning. HS and HF dams, male and female offspring presented lower body weight during lactation. HF mothers presented lower body and visceral fat masses. HF male offspring presented lower body and subcutaneous fat masses. HS and HF milk presented lower triglycerides (TG) and cholesterol. HF male and female offspring showed lower triglyceridemia and insulinemia, but no changes in glycemia and leptinemia. The higher intake of flaxseed oil during lactation reduced the body weight of mothers and offspring, decreases milk lipids and apparently increases insulin sensitivity in this critical period of life. Those changes may explain the previously reported programming effect of maternal flaxseed intake during lactation.


CCR5 mediates specific migration of Toxoplasma gondii-primed CD8 lymphocytes to inflammatory intestinal epithelial cells.
Toxoplasma gondii, an obligate intracellular parasite, can invade intestinal epithelial cells and elicit a robust Th1 immune response. In this model of intestinal inflammation, CD8(+) intraepithelial lymphocytes (IELs) secrete transforming growth factor (TGF)-beta, which appears necessary for the maintenance of homeostasis in the intestine. However, the mechanism responsible for the IEL migration to the inflamed intestine is still unclear. An in vitro coculture cell system was used to quantify the IEL attraction by an infected intestinal epithelial cell line (m-IC(cl2)). We used CCR5-deficient mice to determine which chemokine receptor-chemokine interaction could be responsible for the recruitment of antigen-specific CD8(+) IELs to the small intestine for the promotion of parasite clearance and host recovery. We observed increased expression of several chemokine receptors (CCR1, CCR2, CCR5, CXCR3) in the infected ileum. In particular, CCR5 expression was markedly increased in antigen-primed CD8(+) IELs. Experiments using recombinant chemokines as well as blocking antibodies showed that macrophage inflammatory protein (MIP)-1alpha and MIP-1beta were critical for their homing. CD8(+) IELs isolated from CCR5-deficient mice (CCR5-/-), despite their high production of TGF-beta and overexpression of activation markers, were impaired in their ability to migrate in vitro to the m-IC(cl2) monolayer or in vivo to the inflamed intestine after adoptive transfer. Our data emphasize the biologic role of CCR5 as an important component in the migration of intraepithelial CD8(+) T cells and the regulation of the inflammatory response following parasite infection.


Influence of central nicotinic receptors on arachidonylcyclopropylamide (ACPA)-induced antinociception in mice.
The nicotinic cholinergic receptors have been reported to be involved in several actions of cannabinoids (e.g., bradycardia, hypothermia). However, the influence of central cholinergic system on cannabinoids antinociceptive effect has not been reported. This study investigated the possible part played by nicotinic cholinergic modulator drugs on the antinociceptive effect of central administration of arachidonylcyclopropylamide (ACPA) in mice. The antinociceptive effects of intracerebroventricular (i.c.v.) administration of ACPA using the formalin test have been studied in mice. The effects of nicotine or mecamylamine (a nicotinic cholinergic antagonist) on ACPA analgesia are also studied. i.c.v. administration of ACPA (0.004-1 microg/mice) induced antinociceptive effect in mice. i.c.v. administration of nicotine (0.1 or 0.5 microg/mice) or mecamylamine (2 microg/mice) potentiated or antagonized ACPA antinociceptive effects, respectively. It is concluded that ACPA-induced analgesia is influenced by central nicotinic cholinergic activity.


Delay to Adjuvant Chemotherapy: Survival and Recurrence in Patients of Rectal Cancer Treated with Neo-adjuvant Chemoradiotherapy and Surgery.
This aim of the study is to evaluate the survival function and hazard risks of delayed adjuvant chemotherapy (ChT) to distant recurrence risk in patients with non-metastatic rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) and surgery. A single tertiary hospital retrospective cohort study of a duration of 5 years between January 2012 and December 2016 was performed. As no previous study shown a temporal relationship of delay to adjuvant/systemic ChT leading to increased risk of metastatic disease, we compared between our proposed cut-off with the median and mean value determined by our dataset. Time to event analysis and log rank tests were conducted. A total of 269 patients with rectal cancer were identified. Two hundred eighteen patients were ineligible, leaving 51 patients for final analysis. Patients in the non-delayed group at 23 (proposed) and 25 (median) weeks' cut-off reported better 5 years' disease free survival (DFS) compared with the delayed group by 4.1% and 0.8%. Inversely, at the cut-off 28 (mean) weeks, the delayed group had a better DFS by 4.4%. Females and patients less than 60 years old had better 5-year DFS by 22.8% and 24%. Delayed group has a higher hazard risk ratio (HR) of 1.28 of distant recurrence compared with non-delayed at 23 weeks' cut-off. This study has demonstrated delaying a patient to adjuvant ChT will lower their DFS and increase their HR compared with those whose treatment is not delayed. We have long been too focused on local control; hence, priority needs to be shifted to efforts in managing potential distant disease in a timely manner.


[Take-home messages from the COPD 2021 biennial of the French Society of Respiratory Diseases. Understanding to so as to better innovate].
The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021. The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches. The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration. The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.


Cardiac rehabilitation: Appraisal of current evidence and utility of technology aided home-based cardiac rehabilitation.
Cardiac rehabilitation (CR) is an evidence-based intervention that uses exercise training, health behaviour modification, medication adherence and psychological counselling to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, following coronary intervention, heart failure, or cardiac surgery. These are significantly underused, with only a minority of eligible patients participating in CR in India. Novel delivery strategies and CR endorsement by healthcare organizations are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). Differing from centre-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision. It is provided mostly or entirely outside of the traditional centre-based setting and could be facilitated by the aid of technology and web based applications. The purpose of this appraisal is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR. This appears to hold promise in expanding the use of CR to eligible patients. Additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and people in remote and rural areas. HBCR may be a reasonable option for a selected group of patients and could be a game changer in low- and middle-income countries who are eligible for CR.


Validity of a food frequency questionnaire and a food diary in a short-term recall situation.
The purpose of this study was to compare intakes of eight nutrients computed from a food frequency questionnaire (FFQ) and from 3-day food diaries with known values. Total food intake of 19 healthy adult volunteers (10 men and 9 women) was monitored for 2 weeks. Each week, subjects completed a 3-day diary and a 1-week FFQ. Subjects had previously completed one diary and one FFQ with respect to their usual diets. FFQs and diaries were analyzed for calories, protein, fat, cholesterol, calcium, iron, vitamin A, and vitamin C. All nutrients were underestimated by the FFQ (all p less than .05). Subjects omitted foods from the FFQ and incorrectly reported consumption frequencies. Vitamin A (p less than .001) and calories (p less than .05) were underestimated by the food diary. It is concluded that factors such as frequency of eating, pairing of foods, and explicitness of FFQ items affect recall accuracy. Those factors could influence the choice of FFQ design and administration.


Local immunity and Ostertagia circumcincta: changes in the gastric lymph of sheep after a primary infection.
Some aspects of the kinetics of the primary local immune response to O. circumcincta were studied by monitoring the flow and composition of gastric lymph from 4 sheep for 3 weeks after infection with 50 000 larvae. A significant increase in the frequency of lymphoblasts in the lymph showed that all the sheep were responding immunologically to the parasites from day 8 onwards. However, considerable individual variation in degree and timing was evident in other aspects of the immune response; 2 animals responded with large increases in lymphocyte output which reached a peak on day 5 or day 10, whereas the main response in the other 2 sheep appeared to be inflammatory in nature, with large increases in lymph flow and eosinophil output which occurred during the third week of infection. No significant changes in the content of IgA or IgA anti-worm antibody were detected in the lymph, but pepsinogen concentrations were significantly raised from day 12 onwards.


[Association between test results for HIV/AIDS screening and sex. Esmeraldas-Ecuador, 2016].
A descriptive, correlational, retrospective cross-sectional study was carried out to determine if there was any dependence between sex and the results of HIV/AIDS screening tests in the 08D01 district of the city of Esmeraldas, Ecuador, for the period covered January-December 2016. 100% of the people who were screened for HIV/AIDS were included in the study. Central tendency measures such as mean, rank and percentage were used, as well as Chi square tests to determine dependence between both variables. There is a higher prevalence in men than in women, reaching a ratio of one woman infected with HIV/AIDS for every 1.2 men, as well as a tendency to have a significant increase of reactive results in males and a decrease of reactive results in the female sex when performing the test.


Eco-fabrication of antibacterial nanofibrous membrane with high moisture permeability from wasted wool fabrics.
Wasted wool fabrics are a kind of textile waste source and the upcycle of them can not only benefit the environmental protection, but also turn waste into treasure by developing other potential applications. In this work, ionic liquid (IL) 1-butyl-3-methylimidazolium chloride ([Bmim]Cl) was used as a green solvent to upcycle wasted wool fabrics into a wool keratin (WK)/IL/polyacrylonitrile (PAN) composite nanofibrous membrane with good antibacterial and high moisture permeability through electrospinning. The morphology and structure of the regenerated nanofibrous membrane were characterized by Scanning Electronic Microscopy (SEM), Energy Dispersive Spectrometer (EDS), Fourier Transfer Infrared Spectroscopy (FTIR). The antibacterial test demonstrates that it has 89.21% inhibition rate against E. coli, and 60.70% against S. aureus. Furthermore, the keratin containing in the membrane can effectively improve the hydrophilic property of it, as Moisture Management Test (MMT) indicates that it performs an excellent wetting performance and water transport property. In addition, IL is supposed to be recycled from the composite membrane through immersing in distilled water, which makes the fabrication process green and sustainable.


Linear growth velocity in children with cerebral palsy.
Retrospective analysis of an anthropometric database collected prospectively in children with cerebral palsy (CP) was carried out to evaluate linear growth velocity and identify risk factors for poor linear growth. Growth velocity measures were compared with published norms for prepubertal growth velocity and z scores were calculated. Mean growth velocity z score (Gvz) was -0.97+/-1.9. Boys grew more slowly than girls (mean Gvz = -1.5+/-1.9 versus -0.3+/-1.7 P = 0.003). Gvz did not correlate with type of CP or presence/absence of microcephaly. Young age was a risk factor for poor linear growth (mean Gvz = -2.40+/-2.6 for children under 2 years of age versus -0.76+/-1.9 ages 2 to 6 and -0.77+/-1.6 ages 6 to 10, P = 0.04). Children at nutritional risk (triceps skinfold thickness < or =55%) grew poorly (mean Gvz = -1.46+/-1.5 versus -0.30+/-1.8, P = 0.01). For children over 2 years, those with cognitive impairments grew more slowly than those with normal cognition (mean Gvz = -1.25+/-1.9 versus -0.12+/-1.8, P = 0.02) and non-ambulatory children grew more slowly than ambulatory children (mean Gvz = -1.20+/-1.5 versus -0.35+/-1.9, P = 0.03). Prepubertal children with CP grow more slowly than expected compared with age- and sex-based standards. Sex, age, cognitive impairment, ambulatory status, and nutritional state are factors which may contribute to slow growth. These results add to the growing data that children with CP have unique growth patterns. Further study is needed to clarify the factors which contribute to poor linear growth in this population.


The N-CAM D2-protein as marker for synaptic remodelling in the red nucleus.
We have followed the time-course of changes in the concentration of 3 neuronal and one glial antigen in the red nucleus in rats after unilateral lesion of the cerebellorubral connections. The neuronal markers were the neuronal cell adhesion molecule (N-CAM) D2-protein which is prevalent in newly formed neuronal membranes, and the D1- and D3-proteins, which are found mainly in mature neuronal membranes. The glial marker was S-100, a cytoplasmic protein. Six days after the lesion no changes in the concentration of the markers were found in the partially deafferentiated red nucleus. However, 10 days after the lesion the D2-protein concentration was significantly increased, in contrast to the D1-protein concentration which was decreased. After a further 3 days the D2-protein concentration began to decrease, approaching the still significantly decreased D1-protein concentration. Twenty-one days after the lesion the marker protein concentrations were not significantly changed from normal. However, whereas the concentrations of neuronal membrane markers were lower, the glial S-100 concentration showed a tendency to increase. Furthermore, although the changes in D3-protein concentration were unable to reach statistical significance alone they always followed the direction of D1-protein and were significantly in variance with the changes in D2-protein and S-100 concentrations. Our results support the notion of the N-CAM D2-protein as a useful marker for synaptic turnover in adult brain.


The mechanisms of PM2.5 and its main components penetrate into HUVEC cells and effects on cell organelles.
Atmospheric particulate matter (PM2.5) is associated with the morbidity and mortality of cardiovascular diseases. However, whether PM2.5 penetrates into the cells and the potential mechanisms are unknown. Hence, the study firstly indicated that PM2.5 could penetrate into the HUVEC cells, and phagocytosis, micropinocytosis, caveolin as well as clathrin mediated the internalization of PM2.5 into HUVEC cells. Particularly, the components of PM2.5-Metal, PAHs and WSC could enter into HUVEC cells mainly via the micropinocytosis, clathrin and caveolin mediated endocytosis, respectively. The current data of environmental assessments indicated that PM2.5-Metal were extremely harmful to the ecological environment and human health. Moreover, accompanying with mitochondrial fusion gene Mfn1 was increased and fission genes Opa1 and Drp1 were decreased, and the lysosome related genes LAMP2 and LAMP3 were decreased, the phenomenon that the morphology of mitochondrial and lysosome injured was observed in HUVEC cells treated with PM2.5 and/or PM2.5-Metal. These data suggest that PM2.5 and its main components depend on different endocytosis penetrate into HUVEC cells and cause the mitochondrial and lysosomal damages. Thereby, our study provides the potential mechanism of haze particles penetration into HUVEC cells and damage to organelles.


Urinary chloride concentration as a prognostic marker in critically ill patients.
Associations have been reported among serum chloride concentration, mortality and incidence of acute kidney injury (AKI) in intensive care units (ICU). This study aimed to examine associations among urinary chloride, mortality, and AKI incidence in ICU patients. A retrospective observational study was conducted among medical-surgical ICU in a tertiary hospital wherein 170 consecutive ICU patients were evaluated from October 2015 to March 2016 and 116 patients were enrolled. Serial data of serum and urine electrolytes from day 1 to day 4 of ICU admission were examined. The primary and secondary outcomes were ICU mortality and incidence of AKI in the ICU, respectively. Among the 116 enrolled patients, 15 (13%) died during their ICU stay. Although serum and urinary sodium and potassium on day 1 did not significantly differ between ICU survivors and non-survivors, urinary chloride concentration on day 1 was significantly lower in non-survivors. Receiver operating characteristic analysis showed that the cutoff value of day 1 urinary chloride concentration for prediction of ICU mortality was 53 mEq/L. The lower urinary chloride concentration group on day 1 showed a significantly lower survival rate, even in long-term follow-up, compared with the higher urinary chloride group. Addition of day 1 urinary chloride concentration improved prediction of AKI incidence in the ICU by Sequential Organ Failure Assessment score alone. Lower urinary chloride concentration was associated with increased mortality and incidence of AKI in the ICU. Further investigation is necessary to clarify the mechanism of urinary chloride regulation.


A classic mimicker of systemic vasculitis.
Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described. A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences. Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months. Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications.


3D Bioprinting for Regenerating COVID-19-Mediated Irreversibly Damaged Lung Tissue.
While the tension of COVID-19 is still increasing, patients who recovered from the infection are facing life-threatening consequences such as multiple organ failure due to the presence of angiotensin-converting enzyme 2 receptor in different organs. Among all the complications, death caused by respiratory failure is the most common because severe acute respiratory syndrome coronavirus 2 infects lung's type II epithelial, mucociliary, and goblet cells that eventually cause pneumonia and acute respiratory distress syndrome, which are responsible for the irreversible lung damage. Risk factors, such as age, comorbidities, diet, and lifestyle, are associated with disease severity. This paper reviews the potential of three-dimensional bioprinting in printing an efficient organ for replacement by evaluating the patient's condition.


ISEApeaks: an Excel platform for GeneScan and Immunoscope data retrieval, management and analysis.
ISEApeaks retrieves and handles DNA sequencer raw data (peak area and nucleotidic length). This Macintosh package efficiently interfaces GeneScan and Immunoscope softwares to Excel by extracting data from scattered files, organizing data and gathering it into a unique peak database for all samples.


Inhaled nitric oxide in the term newborn.
Inhaled nitric oxide is a selective pulmonary vasodilator that serves integral diagnostic and therapeutic roles in the clinical management of near-term and term newborns with hypoxemic respiratory failure and pulmonary hypertension. Its proper use and potential limitations in current clinical practice are reviewed.


Subcellular localization, modification and protein complex formation of the cdk-inhibitor p16 in Rb-functional and Rb-inactivated tumor cells.
The cdk-inhibitor p16 is a tumor suppressor gene that is inactivated in many forms of cancer. Despite numerous studies, the exact mechanism of regulation of p16 has not been clarified, although the status of retinoblastoma (Rb) seems to be one important factor that influences the p16 expression. The specificity and validity of cytoplasmic localization of p16 observed in some tumors has further been questioned. Here, by subcellular fractionation of Rb-functional and Rb-inactivated cell lines, we show that p16 indeed is expressed in the cytoplasm as well as in the nucleus. Post translational modifications of p16 in different subcellular compartments as well as its capacity to form protein complexes were further delineated. Two dimensional gel electrophoresis showed that two forms of p16 appeared in the cytoplasm, while only one form was detected in the nucleus. Samples of basal cell carcinoma and squamous cell carcinoma of the skin with either functional or non-functional Rb also exhibited at least two forms of p16. In addition, cytoplasmic p16 bound cyclin dependent kinase (cdk)4/6, potentially indicating that p16 could have a function in the cytoplasm.


Evidence for the involvement of branchial Vacuolar-type H+-ATPase in the acidification of the external medium by the West African lungfish, Protopterus annectens, exposed to ammonia-loading conditions.
African lungfishes are obligatory air-breathers with exceptionally high environmental ammonia tolerance. They can lower the pH of the external medium during exposure to ammonia-loading conditions. This study aimed to demonstrate the possible involvement of branchial vacuolar-type H+-ATPase (Vha) in the ammonia-induced acidification of the external medium by the West African lungfish, Protopterus annectens, and to examine whether its capacity to acidify the medium could be augmented after exposure to 100 mmol l-1 NH4Cl for six days. Two full coding cDNA sequences of Vha subunit B (atp6v1b), atp6v1b1 and atp6v1b2, were obtained from the internal gills of P. annectens. The sequence of atp6v1b1 comprised 1548 bp, encoding 515 amino acids (57.4 kDa), while that of atp6v1b2 comprised 1536 bp, encoding 511 amino acids (56.6 kDa). Using a custom-made antibody reactive to both isoforms, immunofluorescence microscopy revealed the collective localization of Atp6v1b (atp6v1b1 and atp6v1b2) at the apical or the basolateral membrane of two different types of branchial Na+/K+-ATPase-immunoreactive ionocyte. The ionocytes labelled apically with Atp6v1b presumably expressed Atp6v1b1 containing a PDZ-binding domain, indicating that the apical Vha was positioned to transport H+ to the external medium. The expression of Atp6v1b was regulated post-transcriptionally, as the protein abundance of Atp6v1b and Vha activity increased significantly in the gills of fish exposed to 100 mmol l-1 NH4Cl for six days. Correspondingly, the fish exposed to ammonia had a greater capacity to acidify the external medium, presumably to decrease the ratio of [NH3] to [NH4+] in order to reduce the influx of exogenous NH3.


Occult invasive aspergillosis infection following multivisceral transplantation.
Patients undergoing multivisceral transplantation are particularly susceptible to post-operative infections due to immunosuppression and the inclusion of bowel in the transplanted graft. These patients typically receive broad-spectrum antimicrobial and antifungal agents as prophylaxis and treatment. However, evidence for this is limited due to the small number of patients undergoing the procedure. We present a case of occult disseminated invasive aspergillosis infection in a patient who underwent multivisceral transplantation.


Identification of trichostatin A as a novel transcriptional up-regulator of scavenger receptor BI both in HepG2 and RAW 264.7 cells.
Scavenger receptor class B type I (SR-BI) and its human homologue CLA-1 plays an important role in reverse cholesterol transport (RCT). Using a previously established cell-based CLA-1 up-regulator screening assay, one of the positive strains, 04-9179, presented potent activity in elevating CLA-1 transcriptional level. We report here the identification of an active compound 9179A as a known compound trichostatin A (TSA), and its effects on CLA-1/SR-BI expression both in HepG2 human hepatoma cells and RAW 264.7 murine macrophage cells in vitro. The results showed that the mRNA and protein level of CLA-1/SR-BI were significantly up-regulated by 9179A both in HepG2 and RAW 264.7 cells. Corresponding to this, the uptake of DiI-HDL by both cells and the efflux of [(3)H]cholesterol by RAW 264.7 cells were increased by 9179A in dose-dependent manner. ABCA1 was also increased but SR-A decreased by 9179A in RAW 264.7 cells. Using a combination of reporter assays with various deletion in CLA-1 promoter and electrophoretic mobility shift assay, we demonstrated that -419/-232 bp fragment of the CLA-1 promoter mediated the effects of 9179A (i.e., TSA). Together, these studies identified TSA as a novel up-regulator of CLA-1/SR-BI both in HepG2 and RAW 264.7 cells.


Development of a magnetic MoS2 system camouflaged by lipid for chemo/phototherapy of cancer.
Untargeted release of traditional chemotherapeutic drugs can damage normal tissues in the body and cause serious side effects for patients. Therefore, the research of targeted drug delivery system based on nanomaterials has become a hot topic in the field of cancer therapy. Magnetic molybdenum disulfide (mMoS2) was modified by liposomes with a cell membrane-like structure to prepare nanocarrier complex (mMoS2-Lipid) with high biocompatibility and stability. Then, combined photo-chemotherapeutic therapy was realized both in vitro and in vivo by its ultra-high photothermal conversion efficiency and excellent drug loading profile of mMoS2-Lipid. The characterization showed that the lamellar magnetic molybdenum disulfide modified by liposomes was not easy to aggregate in physiological solution, and had a lower non-specific protein adsorption rate, which was beneficial for biomedical application. In vitro cell experiments exhibited a successful cellular uptake profile of MCF-7 cells with no significant cytotoxicity, while a concentration dependent cytotoxicity for both chemotherapy alone and photo-chemotherapy combined therapy. Compared with the unmodified mMoS2, mMoS2-Lipid injected into mice through tail vein can accumulate more in the tumor site, and in vivo anti-tumor studies have shown that the synergistic treatment of the mMoS2-Lipid has an obvious inhibitory effect on the tumor with less toxic and side effects on mice. In conclusion, mMoS2-Lipid treatment system provides a safe, rapid and effective choice for the treatment of breast cancer in the future.


3D printing and its applications in orthopaedic trauma: A technological marvel.
With rapid emergence of 3D printing technology, surgeons have recently started to apply this for nearly all areas of orthopaedic trauma surgery. Computed tomography or magnetic resonance images of trauma patients can be utilized for making graspable objects from 3D reconstructed images. Patient specific anatomical models can thereby be created. They enhance surgeon's knowledge of their patients' precise patho-anatomy, regarding both traumatized bones and soft tissue as well as normal areas, and therefore help in accurate preoperative planning. 3D printed patient specific instrumentation can help to achieve precise implant placement, and better surgical results. Most importantly, customized implants, casts, orthoses and prosthetics can be manufactured to match an individual's anatomy. Three dimensional (3D) printing, also called as 'additive manufacturing' and 'rapid prototyping' is considered as the "second industrial revolution", and this appears to be especially true for orthopaedic trauma surgery. A literature search was performed for extracting all papers related to 3D Printing applications in orthopaedics and allied sciences on the Pubmed, and SCOPUS; using suitable key terms and Boolean operators ("3D Printing" OR "3 dimensional printing" OR "3D printed" OR "additive manufacturing" OR "rapid prototyping") AND (''Orthopaedics" OR "Orthopaedics'') AND ("Trauma" OR "Injury")in June 2018. Search was also performed in Web of Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. No limits were set on the time period or evidence level, as 3D printing in orthopaedics is relatively recent and mainly low level evidence is available. Titles and abstracts were screened and all duplicate and unrelated papers were excluded. Papers related to orthopaedic trauma were manually selected for this review. The search on Pubmed retrieved 144 Papers and similar search on SCOPUS retrieved 94 papers. Additional searches did not reveal more relevant papers. After excluding duplicates and unrelated papers, and on screening of titles and abstracts, 59 papers were considered for review. Papers related to spine fractures only were not included, as they have been covered in another paper in this journal issue. All over the world, orthopaedic Surgeon's and allied professionals and scientists are enthusiastically using 3D printing technology for designing patient specific models, instrumentation, implants, orthosis and prosthesis, besides 3D bioprinting of bone and cartilage scaffolding, and the same has been applied for nearly all areas of orthopaedic trauma surgery, from head to foot.


Exploring medical students' perceptions of the challenges and benefits of volunteering in the intensive care unit during the COVID-19 pandemic: a qualitative study.
In March 2020, the WHO declared SARS-CoV-2 a pandemic. Hospitals across the world faced staff, bed and supply shortages, with some European hospitals calling on medical students to fill the staffing gaps. This study aimed to document the impact of volunteering during the COVID-19 pandemic on students' professional development, resilience and future perceived career choices. This is a retrospective, qualitative study of student reflections, using purposive sampling.The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences recruited 26 medical student volunteers to assist in pronation and supination of ventilated patients affected by SARS-CoV-2. These students were invited to complete an anonymous survey based on their experiences as volunteers. Thematic analysis was performed on these written reflections. The results showed that volunteering during the COVID-19 pandemic developed key skills from RCSI's medical curriculum, significantly fostered medical students' resilience and guided their career choices. Major areas of development included communication, teamwork, compassion and altruism, which are not easily developed through the formal curriculum. A further area that was highlighted was the importance of evidence-based health in a pandemic. Finally, our respondents were early stage medical students with limited clinical exposure. Some found the experience difficult to cope with and therefore supports should be established for students volunteering in such a crisis. These results suggest that clinical exposure is an important driver in developing students' resilience and that volunteering during a pandemic has multiple benefits to students' professional development and professional identity formation.


Do we need friendship in the workplace? The effect on innovative behavior and mediating role of psychological safety.
Employees spend a huge time of their lives at work. As a result, friendships are often formed between individuals in the workplace. Workplace friendship is a fundamental value of human nature. Forming friendships in the workplace is vital to increase satisfaction and engagement at work. The present study proposes and tests a theoretical framework to explore the workplace friendship mechanisms and their impact on the innovative behavior of employees in the Omani service sector, and to clarify the mediating role of psychological safety. The data was gathered from the employees of private service sector in Oman. An online questionnaire form was distributed to the participants and 405 valid questionnaires were analyzed by SmartPLS software using structural equation modeling. The results indicated that workplace friendship aspects namely, friendship opportunity and friendship prevalence positively affected innovative behavior. Furthermore, friendship prevalence was positively correlated in relation to psychological safety. However, psychological safety did not have a mediating role between workplace friendship and innovative behavior. The findings are meaningful for the academic research and also give some practical suggestions for managers from a new viewpoint for the evaluation of workplace friendship in the context of the service sector, in order to achieve psychological safety, and to promote the innovative behavior of employees in this sector.


Antigen-specific helper activity in serum of mice primed with sheep red cells II. Partial purification of the factors involved.
The nature of antigen-specific, T-cell dependent helper activity (SSHA), present in serum of mice 9 h after intraperitoneal immunization with 2 x 10(8) sheep erythrocytes, was studied in more detail. SSHA could be enriched from serum by adsorption to formalinized sheep erythrocytes, elution of the cells with a chaotropic substance, and subsequent dialysis. This resulted in an enrichment of about 900 x with a yield of 64%. Further fractionation of the material by ultrafiltration resulted in two subfractions with helper activity indicating SSHA to be composed of two factors with mol. wt's of greater than 300,000 and about 60,000. The eventual purification for the two factors was about 1650 and 2000 x respectively, and the total yield 46%. The possible relationship between the factors and factors described by others after induction in vitro is discussed. The purification procedure appears useful for the enrichment of SRBC-specific helper factors from serum.


A new species of pentastomida infecting Tropidurus hispidus (Squamata: Tropiduridae) from Caatinga in Northeastern Brazil.
This article describes a new species of Brazilian Raillietiella Sambon, 1910 from lungs of Tropidurus hispidus (Spix, 1825). Between July and October 2005 eighteen specimens of T. hispidus were actively captured with elastic rubber slings in granite outcrops (lajeiros) (06 degrees 59' S and 39 degrees 31' W) from caatinga formations in the municipality of Farias Brito, State of Ceará, Northeastern Brazil. One female and one male of T. hispidus had lungs infected by Raillietiella mottae sp. nov. (prevalence 11.1% and mean intensity of infection 6.0 +/- 1.4, range 5-7). The parasite's main diagnostic characteristics include the dimensions of sharp hooks and strongly curved or "C-shaped" male copulatory spicules with knob-like posterior projection from the base towards the inner curvature of the spicule.


Higher Grades and Repeated Recurrence of Hepatic Encephalopathy May Be Related to High Serum Manganese Levels.
Hepatic encephalopathy is a serious complication of liver failure. Until now, the precise pathophysiologic mechanisms are not fully determined. It has been demonstrated that manganese plays an important role in the pathogenesis of hepatic encephalopathy. Therefore, we studied manganese levels in serum of cirrhotic patients with hepatic encephalopathy in relation to grading and recurrence of hepatic encephalopathy. One hundred persons were enrolled in the study, 80 cirrhotic patients with or without encephalopathy and 20 healthy controls. Hepatic encephalopathy was diagnosed clinically and by laboratory findings. Serum manganese levels were measured in all participants. The grading of hepatic encephalopathy was significantly correlated to the severity of liver dysfunction. The mean serum manganese level was significantly higher in cirrhotic patients than in controls and in cirrhotic patients with encephalopathy than in those without encephalopathy. It was also significantly higher in patients with advanced grading of hepatic encephalopathy. Serum manganese level was positively correlated to number of recurrences of encephalopathy during a 6-month follow-up period. Serum manganese levels were able to predict recurrence of hepatic encephalopathy within 6 months following the episode. Serum manganese levels are positively correlated to the modified Child-Pugh score of cirrhosis as well as grading and number of recurrences of hepatic encephalopathy. Higher manganese levels seem to be related to worsening of the condition, and its measurement may be used as a predictor of repeated recurrences.


Immunohistochemical examination of Peyer's patches in autoimmune mice.
The distribution of T-cells and B-cells in Peyer's patches was examined in three autoimmune model mice, MRL/Mp-lpr/lpr, BXSB, NZBWF1/J mice and normal BALB/c mice, between one and ten months old. A multiple layering technique was used for immunohistochemical detection of lymphocyte surface antigens of T-cells (Thy1.2, Lyt1, Lyt2) and B-cells (surface IgM) and peanut agglutinin receptor for germinal center cells. The T-cell population of female MRL/Mp-lpr/lpr mice increased markedly with age, and the B-cell population of the male BXSB mouse tended to increase. However, little change was observed with age in the NZBWF1/J mice. The immunohistochemical properties of the Peyer's patches in the three autoimmune model mice were different.


[Periconceptional toxoplasmic seroconversion: about 79 cases].
Toxoplasmosis is a cosmopolitan zoonose led by an intracellular protozoon, Toxoplasma gondii. Severe fetal consequences can be encountered in case of infection during pregnancy. Since 1978, a specific screening program has been implemented in France during pregnancy. The purpose of our study is to evaluate the fetal consequences of a maternal contamination during the periconceptional period. We retrospectively analyzed, over a 10-year period, the outcome of all the pregnancies with a suspicion of periconceptional seroconversion. Periconceptional seroconversion was defined as infection occurring during the two months prior to or following the assumed date of the conception. The obstetric care, the fetal ultrasound scan and the neonatal features were all closely looked at. Seventy-nine patients (81 fetus) showed evidence of the diagnosis criteria of periconceptional infection. Three cases (3.8%) of congenital infection were observed: two late miscarriages (at 15 weeks and 24 weeks) and one case of an alive child with infraclinic toxoplasmosis. In our study, the rate of congenital toxoplasmosis (3.8%) in the event of a periconceptional infection is slightly above the rate previously described in the literature (0.6 to 3.3%). The rate of miscarriage is also high: 66% in case of congenital infection. A regular ultrasound follow-up until the end of the pregnancy is necessary to ensure the best care available. The decision whether to carry out an amniocentesis is discussed in that case.


The effects of time, luminance, and high contrast targets: revisiting grating acuity in the domestic cat.
Based on optical clarity and retinal cone density, the cat has a potential acuity of 20-30 cycles per degree (cpd), yet most behavioral studies estimate feline acuity between 3 and 9 cpd. Those studies, however, were limited by restrictive experimental conditions that may have inadvertently lowered the estimated grating acuity. Two domestic cats previously trained on a two-choice visual discrimination task were retrained on a grating detection/discrimination task with unlimited time, high luminance, high contrast targets, and adequate space to prevent poor accommodation from affecting the results. Initially, vertical gratings of increasing cpd were tested until failure. Then, horizontal gratings of increasing cpd were tested until failure. Finally, the finest horizontal grating resolved was confirmed with a third test requiring 24 correct out of 36 consecutive trials, yielding a binomial probability less than 0.02 of non-random occurrence. M1, a 7-year-old male gray tabby with +2.00 OU refraction, tested for a grating detection acuity of 15 cpd for both vertical and horizontal gratings (binomial probability = 0.009). F1, a 2-year-old female gray tabby with +0.25 OU refraction, tested for a grating orientation discrimination acuity of 20 cpd for both vertical and horizontal gratings (binomial probability = 0.004). These results demonstrate that a young cat with good focus is capable of discriminating 20 cpd, in close agreement with the physiologic maximum. Uncorrected focusing errors appear to degrade visual performance. Optimum experimental conditions resulted in better grating acuity measurements than previously reported, emphasizing the importance of environmental factors in feline behavioral testing.


Comparative effects of insulin and proinsulin in vitro on pathways of glucose utilization and lipid synthesis in the lactating rat mammary gland.
The effects of insulin and proinsulin have been measured on the rates of glucose oxidation via the pentose phosphate pathway and incorporation into lipid in slices of lactating rat mammary gland. Half-maximal stimulation of glucose oxidation was observed with 1-3 x 10(-8)M insulin while 1 x 10(-7)M proinsulin was required to achieve half-maximal stimulation. A similar, approximately 10-fold, difference in potency was observed in relation to lipid synthesis. The present results appear to indicate that the maximum stimulation of either glucose oxidation via the pentose phosphate pathway or lipid synthesis by proinsulin did not reach the same level as that found for insulin.


A redescription of Pintneriella Yamaguti, 1934 (Cestoda: Trypanorhyncha and an examination of its systematic position.
Specimens of Pintneriella musculicola Yamaguti, 1934 are redescribed based on paratype material and specimens subsequently allocated to the species by its describer. The cestode species is characterised by two bothridia, a typical heteroacanthous armature with a distinctive basal swelling and basal armature, a space between hook files 1 and 1', nine hooks per principal row, no intercalary hooks and bands of hooklets or chainettes but a distinctive space on the external surface of the tentacle between hook files 9 and 9'. The strobilia is unknown. The features described indicate that Pintneriella is a valid genus within the Heteracanthoidea. Its currently known morphological features do not allow its allocation to an existing family.


Assessment of lead availability in contaminated soil using isotope dilution techniques.
Isotope dilution methods using a stable isotope tracer ((207)Pb) were developed for the determination of Pb availability in contaminated soils. The methods included determination of E values (isotopically exchangeable pool), L values (plant labile pool) and isotopic exchange kinetics (IEK). Isotopically exchangeable Pb was monitored at different exchange times based on measurement of the (207)Pb/(208)Pb ratio in soil solution following addition of the tracer. The rate of decrease in the (207)Pb/(208)Pb ratio in solution could be described by using the same IEK equation as used previously with radioisotope tracers. The amounts of isotopically exchangeable Pb in Pb-contaminated soils estimated from long-term IEK parameters were in good agreement with directly determined E values up to 15 days. However, values of some of the fitted IEK parameters cast doubts on the validity of using the IEK approach with (207)Pb, most probably as a result of irreversible fixation of some of the spike by reactive surfaces in the soils. Estimation of isotopically exchangeable Pb using short-term kinetics data was unsuccessful, substantially underestimating E values. Results for the control (uncontaminated) soil were highly variable, most probably as a result of fixation of tracer by the soil and poor analytical precision due to low solution Pb concentrations. A compartmental analysis of the variation in E values with time indicates a good potential for estimating bioavailable Pb in contaminated soils. The amounts of available Pb obtained from summation of the E(1)(min) and E(1 min-24 h) pools (E((available))), accounting for an average of 57.62% of total soil Pb, were significantly correlated with both the L values and with Pb extracted from soil with EDTA.


Plant disease prescription recommendation based on electronic medical records and sentence embedding retrieval.
In the era of Agri 4.0 and the popularity of Plantwise systems, the availability of Plant Electronic Medical Records has provided opportunities to extract valuable disease information and treatment knowledge. However, developing an effective prescription recommendation method based on these records presents unique challenges, such as inadequate labeling data, lack of structural and linguistic specifications, incorporation of new prescriptions, and consideration of multiple factors in practical situations. This study proposes a plant disease prescription recommendation method called PRSER, which is based on sentence embedding retrieval. The semantic matching model is created using a pre-trained language model and a sentence embedding method with contrast learning ideas, and the constructed prescription reference database is retrieved for optimal prescription recommendations. A multi-vegetable disease dataset and a multi-fruit disease dataset are constructed to compare three pre-trained language models, four pooling types, and two loss functions. The PRSER model achieves the best semantic matching performance by combining MacBERT, CoSENT, and CLS pooling, resulting in a Pearson coefficient of 86.34% and a Spearman coefficient of 77.67%. The prescription recommendation capability of the model is also verified. PRSER performs well in closed-set testing with Top-1/Top-3/Top-5 accuracy of 88.20%/96.07%/97.70%; and slightly worse in open-set testing with Top-1/Top-3/Top-5 accuracy of 82.04%/91.50%/94.90%. Finally, a plant disease prescription recommendation system for mobile terminals is constructed and its generalization ability with incomplete inputs is verified. When only symptom information is available without environment and plant information, our model shows slightly lower accuracy with Top-1/Top-3/Top-5 accuracy of 75.24%/88.35%/91.99% in closed-set testing and Top-1/Top-3/Top-5 accuracy of 75.08%/87.54%/89.84% in open-set testing. The experiments validate the effectiveness and generalization ability of the proposed approach for recommending plant disease prescriptions. This research has significant potential to facilitate the implementation of artificial intelligence in plant disease treatment, addressing the needs of farmers and advancing scientific plant disease management.


Human endometrium and menstrual fluid contain placental protein 10 (PP10).
Placental protein 10 (PP10), a newly isolated protein from the human placenta, was detected by radioimmunoassay in 10 out of 23 extracts of proliferative and secretory endometrium and in all of the 20 menstrual fluids examined. The concentrations were higher in the secretory phase, when the tissue PP10 content ranged from less than 0.2 to 1.3 microgram/g of endometrial cytosol protein. In menstrual fluid, PP10 was found at concentrations of 16 to 270 micrograms/l. In RIA, the dose-response curves of endometrial, menstrual fluid and purified PP10 were parallel. In gel filtration, the major part of PP10 from the endometrium and menstrual fluid eluted in the same fraction as purified placental PP10. Our results add another placental protein to the list of placental proteins which also appear in the endometrium.


Can tinnitus mask hearing? A comparison between subjective audiometric and objective electrophysiological thresholds in patients with tinnitus.
Very little has been written in the literature about the masking effect of tinnitus on hearing. This possibility arose from the clinical observations of hearing fluctuating with the intensity of tinnitus. To explore this hypothesis, a group of 19 patients suffering from hearing loss and tinnitus underwent a complete audiological evaluation and their audiometric and ABR thresholds were compared. Two other groups who were examined in the same manner, served as control groups. The first group consisted of 19 age- and sex-matched subjects with relatively normal hearing and no tinnitus. The second control group was composed of 8 patients suffering from sensorineural hearing loss without tinnitus. The differences between the subjective and ABR thresholds within each group and between the groups were statistically analyzed. The objective thresholds in the tinnitus group were found to be lower than the subjective thresholds.


Effect of serious infectious threat response initiative (SITRI) during the coronavirus disease 2019 (COVID-19) pandemic at the Veterans Affairs North Texas Health Care System.
Health care-associated infections (HAIs) increased worldwide as health care facilities struggled through the pandemic. We describe our methods in the implementation of a programmatic initiative called serious infectious threat response initiative (SITRI) that was conceptualized to support our staff, to facilitate day-to-day clinical operations related to COVID-19 and to shield our infection prevention and control program (IPC) from excessive COVID-19 work burden to the extent possible to retain routine prevention focused efforts. Post implementation, we sought to understand and quantify the workload and utility of SITRI, IPC burnout and HAI incidence during the implementation period. We correlated the number of weekly phone calls with inpatient COVID-19 census, assessed types of calls, staff feedback, IPC burnout, pre- and postpandemic HAI incidence, and the cost. There was significant correlation between SITRI calls and the weekly average COVID-19 census (P = .00026). IPC burnout evaluation indicated improvement in scores for exhaustion and reduced achievement and worsening in score for depersonalization. HAI incidence did not increase. SITRI's cost was $360,000. Staff solicited SITRI's support in tandem with the COVID-19 burden. Our HAI during the pandemic did not increase while SITRI was operational in contrast to what is published in literature.


Biotransformation and detoxification of inorganic arsenic in a marine juvenile fish Terapon jarbua after waterborne and dietborne exposure.
Arsenic (As) is a major hazardous metalloid in many aquatic environments. This study quantified the biotransformation of two inorganic As species [As(III) and As(V)] in a marine juvenile grunt Terapon jarbua following waterborne and dietborne exposures for 10d. The fish were fed As contaminated artificial diets at nominal concentrations of 50, 150, and 500μg As(III) and As(V)/g (dry weight), and their transformation and growth responses were compared to those exposed to 100μg/L waterborne As(III) and As(V). Within the 10d exposure period, waterborne and dietborne inorganic As exposure had no significant effect on the fish growth performance. The bioaccumulation of As was very low and not proportional to the inorganic As exposure concentration. We demonstrated that both inorganic As(III) and As(V) in the dietborne and waterborne phases were rapidly biotransformed to the less toxic arsenobetaine (AsB, 89-97%). After exposure to inorganic As, T. jarbua developed correspondingly detoxified strategies, such as the reduction of As(V) to As(III) followed by methylation to less toxic organic forms, as well as the synthesis of metal-binding proteins such as metallothionein-like proteins. This study elucidated that As(III) and As(V) had little potential toxicity on marine fish.


Profiles and Predictors of Neurodevelopmental Functioning among Young Children Experiencing Family Homelessness.
In the context of family homelessness, children experience acute adversities related to loss of housing and residential mobility compounded with more chronic, poverty-related adversities and stressors. Among children in families experiencing homelessness, variability in experiences and outcomes warrant person-centered approaches to better delineate patterns of risk and resilience. Using latent profile analysis as a person-centered approach, we identified five distinct profiles of neurodevelopmental functioning within a sample of 231 children (ages 3-5 years old) staying in emergency homeless shelters with their families. Latent profiles were informed by indicators from parent-reported items for ten different domains of neurodevelopmental functioning. We examined whether demographic and ecological factors including age, ethnicity, adverse childhood experiences, parent mental health, and overreactive parenting would predict profile membership. Overall, half of the children in the sample demonstrated a profile of resilient functioning across developmental domains. Profiles of maladaptive functioning differed in areas of strength and challenge, with a small percentage of children showing poor functioning across all domains. Children whose parents had more mental health problems or overreactive parenting were significantly more likely to show profiles of poor functioning than to show resilient functioning. Implications for future research, practice, and policy are discussed.


Gastrointestinal complications of bariatric surgery.
The current epidemic of obesity and its myriad comorbidities represents one of the true major public health crises in the United States today. Data reflecting durable weight loss achieved through surgical treatment of obesity demonstrate impressive results heretofore unattainable with less aggressive modalities. However, these outcomes are accompanied by expected side effects and complications, which require specific knowledge to diagnose accurately and a specialized skill-set to manage precisely. With the ever-increasing demand for bariatric surgery, the number of ensuing complications will also rise, requiring the expertise of a gastroenterologist for both diagnosis and treatment. Thus, the gastroenterologist must develop a keen understanding of bariatric surgical anatomy and physiology, as well as the expected postoperative side effects and potential complications experienced by the post-bariatric patient.


Plant/microbe cooperation for electricity generation in a rice paddy field.
Soils are rich in organics, particularly those that support growth of plants. These organics are possible sources of sustainable energy, and a microbial fuel cell (MFC) system can potentially be used for this purpose. Here, we report the application of an MFC system to electricity generation in a rice paddy field. In our system, graphite felt electrodes were used; an anode was set in the rice rhizosphere, and a cathode was in the flooded water above the rhizosphere. It was observed that electricity generation (as high as 6 mW/m(2), normalized to the anode projection area) was sunlight dependent and exhibited circadian oscillation. Artificial shading of rice plants in the daytime inhibited the electricity generation. In the rhizosphere, rice roots penetrated the anode graphite felt where specific bacterial populations occurred. Supplementation to the anode region with acetate (one of the major root-exhausted organic compounds) enhanced the electricity generation in the dark. These results suggest that the paddy-field electricity-generation system was an ecological solar cell in which the plant photosynthesis was coupled to the microbial conversion of organics to electricity.


The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis.
The development of acute respiratory distress syndrome (ARDS) is associated with dys-regulated inflammation. Since corticosteroids are potent anti-inflammatory drugs, they are thought to be beneficial for ARDS patients. The study aimed to investigate the effectiveness of corticosteroids on mortality outcome in ARDS patients. The study was a secondary analysis of a prospective randomized controlled trial (NCT00979121). ARDS patients with invasive mechanical ventilation were enrolled. Corticosteroids use was defined as IV or PO administration of corticosteroids totaling more than 20 mg methylprednisolone equivalents during one calendar day. Missing data were handled using multiple imputation technique. Multivariable model was built to adjust for confounding covariates. A total of 745 patients were enrolled, including 540 survivors and 205 non-survivors. Patients in the non-survivor group were more likely to use corticosteroids (38% vs. 29.8%; p = 0.032). After adjustment for other potential confounders, corticosteroids showed no statistically significant effect on mortality outcome (OR: 1.18; 95% CI: 0.81-1.71). Furthermore, we investigated the interaction between corticosteroid use and variables of vasopressor and PaO2. The result showed that there was no significant interaction. In conclusion, the study failed to identify any beneficial effects of corticosteroids on mortality outcome in patients with ARDS.


Analysis and prospects for curricular reform of medical schools in Southeast Europe.
To analyse the curricula of 16 medical schools in 6 countries in Southeast Europe in order to establish a prevailing standard curriculum against which a prospective curriculum reform could formulate its objectives. Curricular information was gathered from a questionnaire sent via e-mail to the respective medical schools. The data collected ranged from the numbers of enrolled students to a breakdown of courses with distribution of instruction hours for certain teaching formats. For easier comparison the courses were clustered into 5 groups: pre-clinical, clinical, public health, liberal arts and electives. Belgrade has the highest number of undergraduate students, while Mostar has the lowest. Novi Sad, Foca/Srbinje, Zagreb, Split, Sofia, Ljubljana and Mostar have more than 5000 instruction hours, but Sarajevo lags behind with 4005 hours. Anatomy dominates the course load in Year 1, ranging from a share of 18.4% in Sofia to 11.3% in Novi Sad. Physiology dominates Year 2, ranging from 16.8% in Rijeka to 8.9% in Split, whereas in Year 3 the dominating course is pathology, reaching a peak of 13.7% in Sarajevo. Sofia has the highest number of class hours of clinical courses. The predominant public health courses are social medicine, family medicine and medical ecology. Medical English is taught at all medical schools (as electives in Ljubljana and Rijeka). There is considerable potential for curriculum improvement in the region. Teacher training, student participation, the definition of core competencies and the introduction of new methodologies should all be implemented in the process.


A controlled evaluation of staging dietary patterns to reduce the risk of diabetes in African-American women.
This study evaluated the 3-month follow-up data of the Eat Well, Live Well Nutrition Program, a culturally specific, peer-led dietary change program designed to reduce the risk of type 2 diabetes in low-income African-American women. This peer-led program was delivered in the community and was tailored to the participants' stage of change for individual dietary patterns. We report the results of the 3-month intervention and the extent to which dietary changes and other key outcomes were maintained at a 3-month follow-up assessment. Using an experimental control group design, 294 overweight African-American women (ages 25-55 years), recruited in collaboration with a neighborhood organization, completed pre- and posttest and 3-month follow-up interviews of dietary behaviors, knowledge, attitudes, fat intake, and weight. Significant reductions were found in fat intake among women in the treatment condition when compared with women in the control group; these reductions were maintained at 3-month follow-up assessment. Likewise, significant changes in dietary patterns were reported after the study and were maintained, except for one dietary pattern (replacement). This model of health promotion, which individually tailors dietary patterns through staging and use of peer educators, has the potential for decreasing fat intake and increasing and maintaining specific low-fat dietary patterns among overweight African-American women at risk for diabetes.


[Changes in homecare for preterm and low-birth-weight infants from 2002 to 2014].
Homecare (HC) is a service offering home medical and nursing care to the patient at home in equal quantity and quality as in the hospital. The aim of the article is to describe the changes in the HC of preterm and full-term low-birth-weight infants in our department from 2002-2014. The HC database is revised. The characteristics of the newborns and the social characteristics of the family in three consecutive time periods are analysed. A satisfaction survey of parents is also presented. The main changes in HC include a decrease in the weight at discharge (from 1880g in the 2002-2006 period to 1850g in the 2011-2014 period; P=.006) and at the end of HC (from 2187g to 2163g; P=.001), an increase in the duration of HC (from 10 to 11 days; P=.007) and a lower incidence of new hospitalization (from 3.4% to 1.3%; P=.019) The social characteristics of the family show a higher maternal age with more previous alive children, a family context better suited with a more appropriate housing, and an increase in exclusive breastfeeding at hospital discharge (from 25.5% to 49.0%; P<.001). The overall assessment of the program is ≥7/10 in 98.8% of responses. The results of the HC of preterm and low-birth-weight infants have improved over time, saving approximately 10-11 days of hospitalisation, and without compromising the quality of care or reducing family satisfaction.


Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy.
The primary aim of this study was to determine the prevalence of lumbosacral transitional vertebrae (LSTVs) in patients with symptomatic femoroacetabular impingement (FAI) requiring hip arthroscopy. The secondary aim was to determine whether there is an association between LSTV anatomy and patient-reported outcomes. This retrospective study included patients aged 18 to 45 years with symptomatic FAI who underwent arthroscopy between March 2010 and March 2016 and had anteroposterior pelvic radiographs. The exclusion criteria included lack of an FAI diagnosis, hip osteoarthritis (Tönnis grade ≥ 2), prior spinal fusion surgery, prior total hip arthroplasty, indications for total hip arthroplasty, and revision surgery on the affected hip. All radiographs were assessed by an interventional spine and sports fellow. The primary outcome was the prevalence of LSTVs, classified using the criteria of Castellvi et al. Secondary outcomes included the modified Harris Hip Score, Hip Outcome Score, and International Hip Outcome Tool 33 score. A total of 1,880 patients were included. Review of the patients' radiographs yielded 262 LSTVs, for an overall prevalence of 13.9% (type IA in 104 [5.5%], type IB in 53 [2.8%], type IIA in 60 [3.2%], type IIB in 25 [1.3%], type IIIA in 8 [0.4%], type IIIB in 0 [0%], and type IV in 12 [0.64%]). The prevalence of type II, III, and IV LSTVs was 5.6% (n = 105). Unilateral LSTV sidedness did not correlate with symptom laterality (κ = 0.07). There were no differences in patient-reported outcomes between patients with LSTV anatomy and those without it. In this large cohort of 1,880 patients with symptomatic FAI, the prevalence of LSTVs was 13.9%. There was no correlation between sidedness of unilateral LSTVs and the symptomatic hip. Furthermore, there was no association between LSTV anatomy and patient-reported outcomes. The prevalence of LSTVs in this cohort was similar to the prevalence rates previously reported in patients with low-back pain. Level IV, case series.


Carotid artery stenting: to be or not to be?
Carotid endarterectomy (CEA) has been the standard of care for suitable patients with symptomatic or asymptomatic high grade carotid stenosis since the landmark NASCET (North American Symptomatic Carotid Endarterectomy Trial), ECST (European Carotid Surgery Trial) and ACAS (Asymptomatic Carotid Artery Surgery) studies performed in the 1990s and more recently the ACST (Asymptomatic Carotid Surgery Trial). Carotid artery stenting (CAS) in the treatment of both symptomatic and asymptomatic patients with high grade carotid stenosis has recently been investigated as an alternative to CEA. We present a review of the most recent CAS trials and examine some of the controversies that surround them.


Critical care providers' opinion on unsafe abortion in Argentina.
To survey the opinion of critical care providers in Argentina about abortion. An anonymous questionnaire was distributed to critical care providers attending the 20th National Critical Care Conference in Argentina. 149 of 1800 attendees completed the questionnaire, 69 (46.3%) of whom were members of the Argentine Society of Critical Care (ASCC). 122 (81.9%) supported abortion decriminalization in situations excluded from the current law; 142 (95.3%) in cases of congenital defects; 133 (89.3%) in cases of rape; 115 (77.2%) when women's mental health is at risk; 71 (47.7%) when pregnancy is unintended; and 61 (40.9%) for economic reasons. 126 (84.6%) supported abortion in public and private institutions, and 121 (81.2%) before 12 weeks of pregnancy. Variables independently associated with abortion support among female versus male attendees were abortion to preserve women's mental health (OR 4.47; 95% CI, 1.61-12.42; P=0.004) and abortion before 12 weeks of pregnancy (OR 3.93; 95% CI, 1.29-11.94; P=0.015). Abortion at request was independently associated with ASCC membership (OR 2.63; 95% CI, 1.07-6.45; P=0.034). Critical care providers would support abortion in situations excluded from the current abortion law and before 12 weeks of pregnancy, in both public and private hospitals.


[Alpha/beta ratio revisited in the era of hypofractionation].
Large doses per fraction are not recommended in daily radiotherapy due to a higher risk of late normal tissue injury. The technical refinements of modern radiotherapy and suggestions that some tumors could be sensitive to dose per fraction have renewed the interest in hypofractionated schedules. The estimation of α/β ratio value requires large samples of carefully evaluated patients in whom total and fractional doses have varied independently. Tumor repopulation has to be considered when the treatment duration is altered. Without setting aside conflicting publication, the α/β ratio values for prostate and breast (after lumpectomy) cancers could be as low as 2.5 Gy and 4 Gy, respectively. While it is too early to change our routine protocols, the time has come to conduct clinical trials comparing different fractionation schedules.


[Hip joint status in adult patients with cerebral palsy].
In cerebral palsy, femoral head migration is defined as the loss of coverage of the femoral head by the acetabulum and is measured using the Reimer index. Surgical treatment can be preventive, reconstructive, or salvage, and failure rates of surgery are high and related to the severity of cerebral palsy. The aim of our work is to assess the incidence of hip migration in our series of adult patients with cerebral palsy, to determine the outcome of those who have undergone surgery, and to establish recurrence rates after the various surgical techniques. We designed a retrospective observational study to determine the hip status of adult patients with cerebral palsy visiting the Unit between 2008 and 2021. The overall incidence of hip displacement was 75%, patients with more extensive disability (GMFCS IV and V) were more predisposed to dislocation, also more severe. Soft tissue surgery made up 49.5% of the operations performed with a failure rate of up to 82%. Reconstructive surgery was performed in 45.5% of cases with a failure rate of more than 86%. The current hip surveillance programmes have been implemented to improve follow-up and interventions in hip displacement, with the objective of maintaining optimal acetabular coverage and reducing the failure rate of potential surgeries.


Computed Tomography and MR Imaging in Spondyloarthritis.
This article provides an overview of the computed tomography (CT) and MR imaging appearances suggestive of spondyloarthritis, with a specific emphasis on the MR imaging findings of vertebral and sacroiliac involvement, and presents relevant clinical features that assist early diagnosis. CT is a sensitive imaging modality for the assessment of structural bone changes, but its clinical utility is limited. MR imaging is the modality of choice for early diagnosis, because of its ability to depict inflammation long before structural bone damage occurs, for monitoring of disease activity, and for evaluating therapeutic response.


Toxicity studies for the use of prodrug of voriconazole in rats.
It has been reported that voriconazole is used to treat infections caused by invasive aspergillosis, fluconazole-resistant Candida, Actinoplanes and Fusarium. This study was performed to investigate the safety of prodrug of voriconazole (POV) and explore the distribution and metabolism of POV in vivo. The POV for injection was formulated into POV injection. In this study, POV injection was given intravenously at the doses of 0, 30, 60, and 120 mg/kg/d to SD rats for 4 weeks consecutively. Toxicokinetic study was also performed to explore its distribution and metabolism. POV injection was found to be safe and well tolerated. Some statistically significant differences in relative liver weight were observed and several cases of hepatocyte hypertrophy occurred after the 4-week POV injection treatment. Liver-related toxic response could be reversed after recovery period. The results of toxicokinetics showed that POV can rapidly converts to voriconazole in SD rats after administration. The exposure of voriconazole in each group was significantly different between male and female rats. The results showed that the target organ for the toxic effect of POV is liver and the no-toxic-reaction-dose for long-term administration of POV injection was 60 mg/kg/d.


Modeling the dissemination of mammography in the United States.
This paper presents a methodology for piecing together disparate data sources to obtain a comprehensive model for the use of mammography screening in the US population for the years 1975-2000. Two aspects of mammography usage, the age that a woman receives her first mammography and the interval between subsequent mammograms, are modeled separately. The initial dissemination of mammography is based on cross-sectional self report data from national surveys and the interval length between screening exams is fit using longitudinal mammography registry data. The two aspects of mammography usage are combined to simulate screening histories for individual women that are representative of the US population. Simulated mammography patterns for the years 1994-2000 were found to be similar to observed screening patterns from the state level mammography registry for Vermont. The model presented gives insight into screening practices over time and provides an alternative public health measure for screening usage in the US population. The comprehensive description of mammography use from its introduction represents an important first step to understanding the impact of mammography on breast cancer incidence and mortality.