Persistence of Maternal Anti-Rotavirus Immunoglobulin G in the Post-Rotavirus Vaccine Era.
To assess whether titers of anti-rotavirus immunoglobulin G persist during the post-rotavirus vaccine era, the Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal (PREVAIL) Cohort analyzed serum samples collected from Cincinnati-area mothers and young infants in 2017-2018. Rotavirus-specific antibodies continue to be transferred from US mothers to their offspring in the post-rotavirus vaccine era, despite dramatic decreases in childhood rotavirus gastroenteritis.


Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting.
The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.


Comparative effects of some 3-amino 4,6-diarylpyridazines on the biosynthesis in vitro of TXA2 and PGI2- and on the TXA2- and PGI2-synthesizing activities of cardiac tissue.
Some 3-amino 4,6-diarylpyridazine derivatives were tested for their effects on TXA2 and PGI2 biosyntheses in vitro and on the TXA2- and PGI2-synthesizing activities of cardiac tissue. Horse platelet and aorta microsomes were used as sources of thromboxane and prostacyclin synthetases respectively. The TXA2- and PGI2-synthesizing activities of cardiac tissue were studied on isolated perfused rabbit hearts (the heart microsomes being used both as TXA2 synthetase and PGI2 synthetase sources). TXB2 and 6-keto PGF1 alpha were determined by RIA. Among the compounds under study, 3-morpholino 4,6-diphenylpyridazine (III) was shown to inhibit specifically the TXA2 synthetase. Substitution of the morpholino group by a dimethylamino one (I) reinforced the inhibiting effects on TXA2 synthetase but it also revealed a slight anti-prostacyclin synthetase action of the molecule. Replacement of 3-morpholino moieties by either a 3-hydrazino (IV), or a 2-dimethylaminoethylamino (V), or a 2-morpholinoethylamino group (VI) abolished completely the effects of the molecule on TXA2 and PGI2 synthetases. Likewise the addition of chlorine on the para-position on the phenyl ring of I neutralized all its inhibitory effects both on TXA2 and PGI2 synthetases in vitro. None of the 3-amino 4,6-diarylpyridazine derivatives was active on either the TXA2- or PGI2-synthesizing activities of cardiac tissue.


Lipopolysaccharide exposure makes allergic airway inflammation and hyper-responsiveness less responsive to dexamethasone and inhibition of iNOS.
Allergic airway disease can be refractory to anti-inflammatory treatment, whose cause is unclarified. Therefore, in the present experiment, we have tested the hypothesis that co-exposure to lipopolysacharide (Lps) and allergen results in glucocorticoid-resistant eosinophil airway inflammation and hyper-responsiveness (AHR). Ovalbumin (Ova)-sensitized BALB/c mice were primed with 10 microg intranasal Lps 24 h before the start of Ova challenges (20 min on 3 consecutive days). Dexamethasone (5 mg/kg/day) was given on the last 2 days of Ova challenges. AHR, cellular build-up, cytokine and nitrite concentrations of bronchoalveolar lavage fluid (BALF) and lung histology were examined. To assess the role of iNOS-derived NO in airway responsiveness, mice were treated with a selective inhibitor of this enzyme (1400W) 2 h before AHR measurements. More severe eosinophil inflammation and higher nitrite formation were found in Lps-primed than in non-primed allergized mice. After Lps priming, AHR and concentrations of T-helper type 2 cytokines in BALF were decreased, but still remained significantly higher than in controls. Eosinophil inflammation was partially, while nitrite production and AHR were observed to be largely dexamethasone resistant in Lps-primed allergized animals. 1400W effectively and rapidly diminished the AHR in Ova-sensitized and challenged mice, but failed to affect it after Lps priming plus allergization. In conclusion, Lps inhalation may exaggerate eosinophil inflammation and reduce responsiveness to anti-inflammatory treatment in allergic airway disease.


Interaction between NH(2)-tau fragment and Aβ in Alzheimer's disease mitochondria contributes to the synaptic deterioration.
Although amyloid beta (Aβ) peptide can promote tau pathology and its toxicity is concurrently tau-dependent, the underlying mechanisms of the in vivo interplay of these proteins remain unsolved. Structural and functional mitochondrial alterations play an early, precipitating role in synaptic failure of Alzheimer's disease (AD) pathogenesis and an aggravated mitochondrial impairment has been described in triple APP/PS/tau transgenic mice carrying both plaques and tangles, if compared with mice overexpressing tau or amyloid precursor protein (APP) alone. Here, we show that a neurotoxic aminoterminal (NH(2))-derived tau fragment mapping between 26 and 230 amino acids of the human tau40 isoform (441 amino acids)-but not the physiological full-length protein-preferentially interacts with Aβ peptide(s) in human AD synapses in association with mitochondrial adenine nucleotide translocator-1 (ANT-1) and cyclophilin D. The two peptides-Aβ 1-42 and the smaller and more potent NH(2)-26-44 peptide of the longest 20-22 kDa NH(2)-tau fragment-inhibit the ANT-1-dependent adenosine diphosphate-adenosine triphosphate (ADP/ATP) exchange in a noncompetitive and competitive manner, respectively, and together further aggravate the mitochondrial dysfunction by exacerbating the ANT-1 impairment. Taken together, these data establish a common, direct and synergistic toxicity of pathological APP and tau products on synaptic mitochondria and suggest potential, new pathway(s) and target(s) for a combined, more efficient therapeutic intervention of early synaptic dysfunction in AD.


[Changes of plasma renin activity during perfusion with dextran 40. Functional study; statistical evaluations and cl-nical considerations].
Changes in RAP, AP (max and min), Ht and R.R. induced by daily perfusion with 250 and 500 ml Dextran 40 in a 10% isotonic solution were examined in two groups of patients with peripheral obstructive arteriopathy. Systemic AP showed no appreciable changes, whereas RAP and Ht fell in direct proportion of the dose given. This effect tended to disappear after 96 hr. Administration of this plasma volume extender 4 days per week is recommended.


A compact view of isochores in the draft human genome sequence.
Prior to genome sequencing, information on base composition (GC level) and its variation in mammalian genomes could be obtained using density gradient ultracentrifugation. Analyses using this approach led to the conclusion that mammalian genomes are organized into mosaics of fairly homogeneous regions, called isochores. We present an initial compositional overview of the chromosomes of the recently available draft human genome sequence, in the form of color-coded moving window plots and corresponding GC level histograms. Results obtained from the draft human genome sequence agree well with those obtained or deduced earlier from CsCl experiments. The draft sequence now permits the visualization of the mosaic organization of the human genome at the DNA sequence level.


High-risk HPV infection-associated hypermethylated genes in oropharyngeal squamous cell carcinomas.
HPV-positive oropharyngeal squamous cell carcinomas (OPSCCs) are sensitive to chemo-radiation therapy and have favorable survival outcomes compared with HPV-negative cancers. These tumors are usually not related to tobacco and alcohol exposure. Therefore, diagnosing HPV-positive OPSCCs for the appropriate disease management is crucial, and no suitable markers are available for detecting early malignancies in HPV-infected tissues. In this study, we attempt to find HPV-specific epigenetic biomarkers for OPSCCs. A total of 127 surgical samples were analyzed for HPV positivity and promoter methylation of a panel of genes. HPV detection was performed by PCR detection of HPV E6 and E7 viral oncoproteins. In addition, promoter methylation of a total of 8 genes (DAPK, FHIT, RASSF1A, TIMP3, AGTR1, CSGALNACT2, GULP1 and VGF) was analyzed by quantitative-methylation specific PCR (QMSP), and their associations with HPV positivity or RB/p16 expressions were evaluated. AGTR1 and FHIT were frequently methylated in HPV-positive OPSCC samples with a good area under the curve (AUC over 0.70). In addition, these genes' promoter methylation was significantly associated with p16 positive and RB negative cases, which were the characteristics of OPSCC cases with favorable survival outcomes. Either AGTR1 or FHIT methylated cases were significantly associated with HPV-positive cancers with 92.0% sensitivity (P < 0.001). Also, they had significantly better overall survival (P = 0.047) than both unmethylated cases. A combination of AGTR1 and FHIT methylation demonstrated a suitable detection marker of OPSCCs derived from the HPV-infected field, familiar with p16-positive and RB-negative phenotypes.


Necrotizing staphylococcal pneumonia in a neonate.
Hospitalized neonates are commonly colonized soon after birth with Staphylococcus aureus. The majority of neonates do not develop infectious sequelae; however, premature neonates appear to be more susceptible to serious infections, such as pneumonia. We report a case of an extremely low birth weight infant who developed necrotizing pneumonia due to methicillin-resistant Staphylococcal aureus (MRSA). The MRSA isolate from this neonate is identical to the strains that have been causing primarily community-associated skin and soft tissue infections. The severe course of this patient may be attributed to the presence of the Panton-Valentine leukocidin gene, a well-known virulence factor leading to soft tissue and pulmonary infections.


Empirical relationships between predator and prey size among terrestrial vertebrate predators.
In an effort to make complex food web relations more tractable, published data on the food habits of terrestrial vertebrate predators were analyzed for patterns in the use of prey by size. Regressions of prey weight on predator weight were run and provided descriptions of both the relationship between mean prey weight and predator weight and the variation in prey weights taken by the predators. Separate models proved necessary for three trophic specializations: insectivores, piscivores and carnivores. Insectivores were found to take proportionately much smaller prey than carnivores. Mean prey weight tends to decrease slightly relative to predator weight among larger insectivores, while the ratio of prey weight to predator weight tends to increase with carnivore size. On average, insectivores also take a relatively wider range, of prey sizes than carnivores. In all respects, piscivores were intermediate to insectivores and carnivores. These models produce log-normal approximations to the frequency distributions (by weight) of prey sizes in the ration of predators from knowledge of the predators's body mass. Combined with allometric models of the bionergetics and productivity of animals, these relations are used to predict, that: (1) the daily kill rate declines with predator weight and (2) the upper limit to predator biomass is independent of predator weight.


Selection of the internal control gene for real-time quantitative rt-PCR assays in temperature treated Leptospira.
Analysis of gene expression requires sensitive, precise, and reproducible measurements for specific mRNA sequences. To avoid bias, real-time RT-PCR is referred to one or several internal control genes. Here, we sought to identify a gene to be used as normalizer by analyzing three functional distinct housekeeping genes (lipL41, flaB, and 16S rRNA) for their expression level and stability in temperature treated Leptospira cultures. Leptospira interrogans serovar Hardjo subtype Hardjoprajitno was cultured at 30 degrees C for 7 days until a density of 10(6) cells/ml was reached and then shifted to physiological temperatures (37 degrees C and 42 degrees C) and to environmental temperatures (25 degrees C and 30 degrees C) during a 24 h period. cDNA was amplified by quantitative PCR using SYBR Green I technology and gene-specific primers for lipL41, flaB, and 16S rRNA. Expression stability (M) was assessed by geNorm and Normfinder v.18. 16S rRNA registered an average expression stability of M = 1.1816, followed by flaB (M = 1.682) and lipL41 (M = 1.763). 16S rRNA was identified as the most stable gene and can be used as a normalizer, as it showed greater expression stability than lipL41 and flaB in the four temperature treatments. Hence, comparisons of gene expression will have a higher sensitivity and specificity.


The caloric vestibular test in weightlessness.
Although the theoretical background for the caloric vestibular test was assumed to be known, recent studies in weightlessness have thrown doubts on the original theory of its mechanism. It is most likely that several mechanisms are involved in the generation of caloric nystagmus in addition to the convection current theory. Experiments with the caloric test in humans conducted during parabolic flight are described. These results are compared with the results of similar experiments performed in orbital missions.


Contemporary Management of Prostate Cancer.
Prostate cancer represents a spectrum ranging from low-grade, localized tumors to devastating metastatic disease. We discuss the general options for treatment and recent developments in the field.


Trained sensory descriptors and volatile aroma compounds of USDA Select steaks using five grill temperatures.
Thirty-three USDA Select boneless top loins were selected from carcasses at a commercial major packing plant, vacuum-packaged, and aged for 14 d (4 °C). The loins were then divided into 10 portions (5 grill temperatures for each of trained sensory panel and Warner-Bratzler shear force). Flat-top electric grills were pre-heated to 1 of 5 different temperatures: 149 °C (149), 177 °C (177), 204 °C (204), 232 °C (232), or 260 °C (260). Steaks were placed on the grill, turned when the internal temperature reached 35 °C and removed when the internal temperature reached 71 °C. A trained sensory panel evaluated ten basic flavors and five texture attributes. Extra cubes from each sample were frozen in liquid nitrogen and stored at -80 °C for GC/MS volatile aroma compound analysis. Beef identity, brown, and roasted flavor descriptors increased linearly (P < 0.001) while bloody/serumy tended to decrease (P = 0.016) and sour flavor decreased (P = 0.006) linearly as grill temperature increased. Furthermore, burnt (deviation P = 0.008) and bitter (deviation P = 0.012) flavor descriptors were affected by effects other than linear or quadratic, while umami (P = 0.002) and overall sweet (P = 0.016) flavors increased quadratically from 149 to 232 then declined at 260 grill temperatures. Two alcohols, eight aldehydes, four alkanes, three furans, eight ketones, and twelve pyrazines were impacted by differences the grill temperature. Increasing grill temperature increases volatile compounds, primarily from the Maillard reaction, that improve positive beef flavor descriptors.


Neonatal Wilms tumor.
Neonatal renal tumors are very rare. We have identified 15 cases of Wilm's tumors diagnosed in the first 30 days of life. The most common presentation was an abdominal mass on routine newborn examination, and three tumors were noted on an antenatal ultrasound. All of the infants underwent primary excision of the tumor. Five infants were not given postoperative chemotherapy after surgical excision. One of these children had a relapse and later died of progressive disease. The remaining children are alive at a median follow-up of 31 months. Eight of the tumors had evidence of nephrogenic rests. More frequent follow-up physical and imaging examinations are indicated in children not given adjuvant chemotherapy or whose tumors show nephrogenic rests.


Composition of the colon microbiota in the individuals with inflammatory bowel disease and colon cancer.
The human intestine is a habitat for microorganisms and, recently, the composition of the intestinal microbiota has been correlated with the etiology of diseases such as inflammations, sores, and tumors. Although many studies have been conducted to understand the composition of that microbiota, expanding these studies to more samples and different backgrounds will improve our knowledge. In this work, we showed the colon microbiota composition and diversity of healthy subjects, patients with inflammatory bowel disease (IBD), and colon cancer by metagenomic sequencing. Our results indicated that the relative abundance of prokaryotic and eukaryotic microbes differs between the healthy vs. tumor biopsies, tumor vs. IBD biopsies, and fresh vs. paraffin-embedded tumor biopsies. Fusobacterium, Escherichia-Shigella, and Streptococcus genera were relatively abundant in fresh tumor biopsies, while Pseudomonas was significantly elevated in IBD biopsies. Additionally, another opportunist pathogen Malasseziales was revealed as the most abundant fungal clade in IBD biopsies, especially in ulcerative colitis. We also found that, while the Basidiomycota:Ascomycota ratio was slightly lower in tumor biopsies compared to biopsies from healthy subjects, there was a significant increase in IBD biopsies. Our work will contribute to the known diversity of prokaryotic and eukaryotic microbes in the colon biopsies in patients with IBD and colon cancer.


On the dependence of the elasticity and strength of cancellous bone on apparent density.
This paper presents a statistical analysis of the pooled data from a number of previous experiments concerning the dependence of the Young's moduli and strength of cancellous bone tissue upon apparent density. The results show that both the Young's moduli and the strength are proportional to the square of apparent density of the tissue and are therefore proportional to one another. It is shown that the coefficient of proportionality is different for human and bovine tissue. It is concluded that the suggestion of Wolff (Das Gesetz der Transformation der Knochen, Hirschwald, Berlin, 1892) that compact bone tissue is simply more dense cancellous bone tissue is not an accurate statement when only the mechanical properties of these two tissues are considered. It is noted that estimates for the elastic modulus of the individual trabecula of human cancellous bone vary from 1 to 20 GPa and it is suggested that this question needs further study.


Morphology of the spermatid and spermatozoon of Amblyomma hebraeum Koch (Acarina; Ixodidae).
Spermatids and spermatozoa of Amblyomma hebraeum were examined by scanning and transmission electron microscopy as well as by freeze-etch and freeze-fracture techniques. The external surface of the spermatid is smooth except for a rim of two parallel grooves near the anterior apex. This rim probably marks the level at which a cap detaches, permitting extrusion of the inner cord during spermatozoon maturation. Both ends of the spermatid are closed, the anterior part being slightly thicker than the posterior. The spermatozoon is clavate anteriorly and tail-like posteriorly. The tip of the anterior part is a hemispherical structures carrying numerous bulbous expansions. Apart from the hemispherical structure, the entire spermatozoon surface is covered with parallel longitudinal cellular processes. Waves of constrictions on the tail-like part of the spermatozoon and undulations of the cellular processes are considered to be involved in sperm motility.


Visual inertia in apparent motion.
Four dots in an imaginary diamond were flashed in succession to give ambiguous apparent motion (AM). The top and bottom dots were flashed at time t1 and replaced by the left and right dots at time t2. If two priming dots were flashed beforehand at time t0 in line with two parallel sides of the diamond, AM was seen along those sides. We call this "visual inertia". The amount of visual inertia (measured by a null method) fell off with increasing angle between the priming dot and the side of the diamond. Visual inertia was still seen when the priming dots were presented to one eye and the test dots to the other, so the effect must be partly central. The timing and length of the priming path made little difference to visual inertia. However, static priming dots were ineffective. We conclude that the visual system was examining at least three successive time frames in deciding which items in one frame correspond with which items in succeeding frames.


"Subclinical atherosclerosis in acromegaly: Possible association with cardiovascular risk factors rather than disease activity".
Cardiovascular (CV) disease is still a major cause of excessive morbidity and mortality in patients with active acromegaly, which may be attributed to a high prevalence of associated pro-atherosclerotic risk factors. However, a direct effect of GH/IGF-1 excess on the vasculature has been previously suggested, warranting further investigation. The present study was designed to investigate whether chronic GH/IGF-1 excess is associated with an increased prevalence of subclinical atherosclerosis in patients with acromegaly. We measured carotid intima-media thickness (cIMT) and assessed carotid plaques by ultrasonography along with classical CV risk factors in 54 acromegaly patients (34 females, 50 ± 12 years and compared those with 62 (42 females, 53 ± 13 years) age-, sex- and CV risk factors- matched controls. In order to compare cIMT measurements between patients and controls we analyzed common carotid artery far wall data as well as a combined measurement result, which consisted of the mean value of the six different measurements, three at each side. mean ± SD serum GH and IGF-1 levels were 2.76 ± 4.65 ng/mL and 1.7 ± 1.25 x ULN, respectively, in all acromegaly patients. Age, body mass index, blood pressure, lipid levels, fasting glucose and Framingham's global cardiovascular risk score classification were similar comparing patients and controls. Combined median [IQR] cIMT measurements were similar in acromegaly patients and matched controls (0.59 [0.52-0.66] mm vs. 0.59 [0.52-0.69] mm; P = 0.872) as well as in acromegaly patients with active and controlled disease (0.59 [0.51-0.68] mm vs. 0.60 [0.54-0.68] mm; P = 0.385). No significant correlations were observed between cIMT measurements and GH (Spearman r = 0.1, P = 0.49) or IGF-1 (Spearman r = 0.13, P = 0.37) levels in patients with acromegaly. Carotid atherosclerotic plaques prevalence was similar in patients and controls (26% vs. 32%; P = 0.54) as well as in patients with active and controlled acromegaly (22% vs. 30%; P = 0.537). Our data suggest that GH/IGF-1 excess itself is not one of the main drivers of subclinical morphological atherosclerosis changes in patients with acromegaly and that optimal control of acromegaly-associated CV risk factors may preserve vasculature structure even when strict biochemical control is not achieved.


Long-term outcome after sclerotherapy with or without a beta-blocker for variceal bleeding in children.
Esophageal variceal bleeding is a life-threatening complication of portal hypertension. Optimal treatment for the prophylaxis of variceal rebleeding in children has not yet been determined. In the present study, we aimed to compare the long-term efficacy of endoscopic sclerotherapy with or without oral beta-blocker therapy in the secondary prophylaxis of variceal bleeding. Thirty-eight children who had undergone endoscopic sclerotherapy (EST) sessions for variceal bleeding in the Department of Pediatric Gastroenterology, Istanbul University Istanbul School of Medicine, were entered into this retrospective cohort study. Twenty patients (mean +/- SD age 7.0 +/- 2.7 years) had undergone only sclerotherapy sessions (SG), whereas 18 patients (mean age 6.8 +/- 3.4 years) had received oral propranolol (1-2 mg/kg per day) additionally for 2 years (SPG). The number of patients with successful obliteration, the time required for obliteration and variceal recurrence rate were analyzed as primary indicators of the effectiveness of therapy. Variceal obliteration was achieved in 16 of 20 patients (80%) in the SG group and in 16 of 18 patients (88%) in the SPG group. Time required for variceal obliteration was significantly shorter in the SPG group compared with the SG group (4.1 +/- 1.4 vs 3.2 +/- 0.9 months; P < 0.05). The variceal recurrence rate was 65 and 38.8% in the SG and SPG groups, respectively. Compared with the SG group, less variceal rebleeding was observed during EST in the SPG group (25 vs 16.6%, respectively).However, these differences were not statistically significant. Endoscopic sclerotherapy combined with oral propranolol treatment shortens the time required for variceal obliteration. However, the other indicators of treatment effectiveness are not influenced statistically by the addition of propranolol to the treatment regimen. Randomized prospective clinical studies in larger pediatric series are needed before offering a combination of EST with oral propranolol as the most rational approach in the secondary treatment of esophageal variceal bleeding in children.


Treatment of Metastatic Uveal Melanoma: Systematic Review.
More than 50% of patients with uveal melanoma end up developing metastases. Currently, there is no standard first-line treatment that facilitates proper management of the metastatic disease. A systematic review of the last 40 years in PubMed with an exhaustive and strict selection of studies was conducted, in which the unit of measurement was overall survival (OS) expressed in Kaplan-Meier curves or numerically. After the selection process, 110 articles were included. Regional therapies, such as intra-arterial liver chemotherapy (OS: 2, 9-22 months), isolated liver perfusion (OS: 9, 6-27, 4 months), or selective internal radiation therapy (OS: 18 months in monotherapy and 26 months in combination with other therapies) showed some superiority when compared to systemic therapies, such as chemotherapy (OS: 4, 6-17 months), immunotherapy (OS: 5-19, 1 month), immunosuppression (OS: 11 months), or targeted therapy (OS: 6-12 months), without being significant. The results of this review suggest that there are no important differences in OS when comparing the different current treatment modalities. Most of the differences found seem to be explained by the heterogenicity of the different studies and the presence of biases in their design, rather than actual extensions of patient survival.


Theoretical foundation for designing multilayer Halbach array magnets for benchtop NMR and MRI.
Multilayer Halbach array magnets support portable NMR and MRI, but optimizing their design to maximize performance and minimize the use of expensive magnet materials is challenging. This is partly because our theoretical understanding of such arrays is incomplete and computationally intensive. Here we provide a theoretical description of the magnetic field distribution and we demonstrate that inhomogeneity is greatest along the z axis in multilayer Halbach array magnets. This allows the configuration of the multilayer Halbach array magnets to be optimized in a way that takes into account homogeneity, magnet volume, and magnetic flux density. At the same time, our description simplifies the design of multilayer array magnets, while accommodating the possibility of different outer radii, lengths for each layer array, or the presence of separation between the rings. We validated the theoretical description in simulations of a three-layer Halbach array magnet, then with a prototype three-layer 1-T Halbach array magnet. After adjusting the position of magnet blocks in the neighboring rings, we achieved homogeneity of 220 ppm for a standard 5 mm NMR tube while the inner diameter of the magnet is 20 mm. Our work provides a theoretical foundation for designing multilayer Halbach array magnets to maximize homogeneity and minimize the use of magnet materials.


Pro- and anti-inflammatory cytokine gene polymorphism profiles in Bulgarian multiple sclerosis patients.
Dysregulation in the expression of pro- and anti-inflammatory cytokines is one of the milestones in multiple sclerosis (MS) development and progression. The aim of this study was to investigate the possible influence of TNF-alpha (-308), TGF-beta (codons 10 and 25), IL-10 (-1082, -819, -592), IL-6 (-174) and IFN-gamma (+874) polymorphisms on susceptibility to multiple sclerosis (MS). Genotyping was performed by PCR-SSP method in 55 MS patients with relapsing-remitting form of the disease and 86 healthy subjects from Bulgarian population. We observed a statistically significant increase in the CC genotype of IL-10 -819 and -592 SNPs coupled with a decreased frequency of the TGF-beta +915 CG genotype in our MS patients (Pc<0.05). No significant differences were observed between MS patients and controls with respect to the distribution of the other cytokine gene polymorphisms investigated. Although the size of the study group is small, these results indicate that polymorphic variations of two of the major anti-inflammatory cytokines, IL-10 and TGF-beta, may play a role in MS susceptibility.


Characterization of multidrug-resistant potential pathogens isolated from milk and some dairy products in Egypt.
This study aimed to explore the incidence and antimicrobial resistance (AMR) of Escherichia coli, Staphylococcus aureus, and Bacillus cereus in raw milk and some Egyptian dairy products, namely Kariesh cheese and rice with milk. 112 samples (70 raw milk, 30 Kariesh cheese, and 12 rice with milk) were randomly collected from different districts in Cairo and Giza, Egypt. The samples were examined for E. coli, S. aureus, and B. cereus presence. The susceptibility of the obtained isolates was tested against 11 antimicrobials using the disk diffusion method, and further, the presence of AMR genes was examined. The incidences of E. coli, S. aureus, and B. cereus were 69.64%, 12.5%, and 16.7% in the examined samples, respectively. The antibiogram indicated that E. coli isolates (n = 60) were resistant to gentamycin (73.33%), ampicillin (AM, 53.3%), and cefotaxime (CTX, 16.66%). Multidrug-resistant (MDR) E. coli strains (n = 5) were tested for β-lactams resistance genes. blaTEM was detected in all isolates, and two of them additionally carried blaCTX-M. Staphylococcus aureus isolates (n = 10) were resistant to AM (100%), followed by tetracycline (TE), CTX, and gentamycin (60% each). All MDR S. aureus strains (n = 4) carried blaZ and tetK, and three of them additionally carried aac(6')-aph (2''). Bacillus cereus isolates (n = 30) showed resistance to AM (100%), amoxicillin (20%), and TE (6.66%). bla and tetA genes were detected in all MDR B. cereus isolates (n = 6). Our findings denote the high incidence of potential health hazards in raw milk and some of its products and the existence of AMR bacteria, including MDR strains, which can cause human illnesses that are difficult to treat.


Arsenic release from the abiotic oxidation of arsenopyrite under the impact of waterborne H2O2: a SEM and XPS study.
Our previous study has proven that waterborne hydrogen peroxide can affect the arsenic releasing process from arsenopyrite powder, but little is known about the change of morphology and element constitutes on arsenopyrite surface. In this study, a simulated experiment was conducted to examine the effects of hydrogen peroxide (at a concentration range of 5-50 μM) on the abiotic oxidation of arsenopyrite cubes. Scanning electron microscopy (SEM), energy dispersive X-ray spectrometer (EDS), and X-ray photoelectron spectroscopy (XPS) were used to characterize the changes of microstructure morphology and elemental species on arsenopyrite surface. The results showed that micromolar level of H2O2 accelerated the release of arsenic and iron but passivated the sulfur release from arsenopyrite surfaces. As(III) oxidation in solution was enhanced at the early part of the experiment, but the release of As(III) was facilitated at the latter part. As(V) concentrations in solution increased along with the elevated H2O2 dosage level. The SEM images showed different surface microstructure on the surface of CK and all the treatments. EDS results showed that the ratios of S/Fe, Fe/As, and S/As in bulk arsenopyrite revealed evident increasing trend along with the increase of H2O2 dosage level. As the result of surface leaching, the XPS results did not show significant trend, while it suggests that H2O2 accelerated the formation of Fe-As oxidized layer on the arsenopyrite surface.


Textural and structural properties of a κ-carrageenan-konjac gum mixed gel: effects of κ-carrageenan concentration, mixing ratio, sucrose and Ca2+ concentrations and its application in milk pudding.
Mixtures of carrageenan and konjac gum are useful for specific applications in gel-based foods. Focusing on the changes of textural and structural properties, the effects of κ-carrageenan and konjac ratio and sucrose and Ca2+ concentrations on mixed gels were studied in this research. Furthermore, application of κ-carrageenan-konjac gum mixed gel to milk puddings was investigated. There was a better synergistic effect when the ratio of κ-carrageenan and konjac was 7:3. The mixed gel containing 10 g kg-1 κ-carrageenan-konjac gum was characterized by higher hardness, chewiness, adhesiveness and resilience and denser network structure. Besides, the addition of 5-10 wt% sucrose or 0.02 wt% Ca2+ could enhance the hardness, chewiness and adhesiveness of the mixed gel, as well as affording a denser network structure. For milk pudding, moderate hardness, chewiness and resilience could be obtained by adding 1.5 g kg-1 κ-carrageenan-konjac gum mixture. This research provides useful information for the formation of κ-carrageenan-konjac gum gel and its application in milk pudding. © 2020 Society of Chemical Industry.


Survival during the Breeding Season: Nest Stage, Parental Sex, and Season Advancement Affect Reed Warbler Survival.
Avian annual survival has received much attention, yet little is known about seasonal patterns in survival, especially of migratory passerines. In order to evaluate survival rates and timing of mortality within the breeding season of adult reed warblers (Acrocephalus scirpaceus), mark-recapture data were collected in southwest Poland, between 2006 and 2012. A total of 612 individuals (304 females and 308 males) were monitored throughout the entire breeding season, and their capture-recapture histories were used to model survival rates. Males showed higher survival during the breeding season (0.985, 95% CI: 0.941-0.996) than females (0.869, 95% CI: 0.727-0.937). Survival rates of females declined with the progression of the breeding season (from May to August), while males showed constant survival during this period. We also found a clear pattern within the female (but not male) nesting cycle: survival was significantly lower during the laying, incubation, and nestling periods (0.934, 95% CI: 0.898-0.958), when birds spent much time on the nest, compared to the nest building and fledgling periods (1.000, 95% CI: 1.00-1.000), when we did not record any female mortality. These data (coupled with some direct evidence, like bird corpses or blood remains found next to/on the nest) may suggest that the main cause of adult mortality was on-nest predation. The calculated survival rates for both sexes during the breeding season were high compared to annual rates reported for this species, suggesting that a majority of mortality occurs at other times of the year, during migration or wintering. These results have implications for understanding survival variation within the reproductive period as well as general trends of avian mortality.


Aging of impregnated charcoal studied by powder x-ray diffraction.
The effects of aging, naturally and artificially, on the cyanogen chloride capacity of copper and chromium impregnated charcoals were demonstrated by means of an x-ray technique. The results reveal that crystallite growth of water soluble impregnants seems to be the primary cause of the capacity loss.


Apo-10'-lycopenoic acid impacts adipose tissue biology via the retinoic acid receptors.
Apo-10'-lycopenoic acid (apo-10-lycac), a metabolite of lycopene, has been shown to possess potent biological activities, notably via the retinoic acid receptors (RAR). In the current study, its impact on adipose tissue and adipocytes was studied. In microarray experiments, the set of genes regulated by apo-10-lycac treatments was compared to the set of genes regulated by all-trans retinoic acid (ATRA), the natural ligand of RAR, in adipocytes. Approximately 27.5% of the genes regulated by apo-10-lycac treatments were also regulated by ATRA, suggesting a common ability in terms of gene expression modulation, possibly via RAR transactivation. The physiological impact of apo-10-lycac on adipose tissue biology was evaluated. If it had no effect on adipogenesis in the 3T3-L1 cell model, this metabolite may have a preventative effect against inflammation, by preventing the increase in the inflammatory markers, interleukin 6 and interleukin 1β in various dedicated models. The ability of apo-10-lycac to transactivate the RAR and to modulate the transcription of RAR target gene was brought in vivo in adipose tissue. While apo-10-lycac was not detected in adipose tissue, a metabolite with a molecular weight with 2Da larger mass was detected, suggesting that a dihydro-apo-10'-lycopenoic acid, may be present in adipose tissue and that this compound could active or may lead to further active RAR-activating apo-10-lycac metabolites. Since apo-10-lycac treatments induce anti-inflammatory effects in adipose tissue but do not inhibit adipogenesis, we propose that apo-10-lycac treatments and its potential active metabolites in WAT may be considered for prevention strategies relevant for obesity-associated pathologies.


Dopamine receptor D1 signaling stimulates lipolysis and browning of white adipocytes.
Adipocytes express several kinds of catecholamine receptors, including adrenergic receptors, and dopamine receptors. Signaling pathways mediated by catecholamine receptors, such as β3-adrenergic receptor pathway, can induce body energy expenditure via activating thermogenesis of adipose tissue. However, the roles of adipose dopamine receptors on adipocytes are still unclear. Here, we investigate the role of dopamine receptor D1 (DRD1) on adipocytes. To this end, we use DRD1 agonist Fenoldopam and antagonist SCH23390 to stimulate and inhibit DRD1 signaling, respectively. We found that, compared with control group mice, Fenoldopam-treated and SCH23390-treated high-fat-diet (HFD)-fed mice showed smaller and bigger white adipose tissue/adipocyte sizes, respectively. Meanwhile, activating of DRD1 signaling enhanced intracellular levels of cAMP, phosphorylation levels of protein kinase A substrates, and hormone-sensitive lipase, a key enzyme for lipolysis in mature 3T3-L1 adipocytes and white adipose tissue of HFD-fed mice. As a result, the levels of free fatty acid or glycerol were increased, indicating stimulation of lipolysis by DRD1 activation. Moreover, activating DRD1 can induce the browning of adipocytes, as indicated by enhanced phosphorylation of P38 MAP kinase, increased expression of beige cell markers (PGC-1α, UCP-1, and CD81), mitochondrion content, and expression of β-oxidation related genes. All of these effects were reduced after treating with SCH23390 both in vitro and in HFD-fed mice. Collectively, our study indicated that DRD1 signaling stimulates lipolysis and browning of white adipocytes in vitro and in vivo. Understanding the functions of DRD1 on human adipocytes and adipose tissues will help us to design novel strategies to treat obesity.


The ultimate question? Evaluating the use of Net Promoter Score in healthcare: A systematic review.
Patient experience is a complex phenomenon that presents challenges for appropriate and effective measurement. With the lack of a standardized measurement approach, efforts have been made to simplify the evaluation and reporting of patient experience by using single-item measures, such as the Net Promoter Score (NPS). Although NPS is widely used in many countries, there has been little research to validate its effectiveness and value in the healthcare setting. The aim of this study was to systematically evaluate the evidence that is available about the application of NPS in healthcare settings. Studies were identified using words and synonyms that relate to NPS, which was applied to five electronic databases: Medline, CINAHL, Proquest, Business Journal Premium, and Scopus. Titles and abstracts between January 2005 and September 2020 were screened for relevance, with the inclusion of quantitative and qualitative studies in the healthcare setting that evaluated the use of NPS to measure patient experience. Twelve studies met the inclusion criteria. Four studies identified benefits associated with using NPS, such as ease of use, high completion rates and being well-understood by a range of patients. Three studies questioned the usefulness of the NPS recommendation question in healthcare settings, particularly when respondents are unable to select their service provider. The free-text comments section, which provides additional detail and contextual cues, was viewed positively by patients and staff in 4 of 12 studies. According to these studies, NPS can be influenced by a wide range of variables, such as age, condition/disease, intervention and cultural variation; therefore, caution should be taken when using NPS for comparisons. Four studies concluded that NPS adds minimal value to healthcare improvement. The literature suggests that many of the proposed benefits of using NPS are not supported by research. NPS may not be sufficient as a stand-alone metric and may be better used in conjunction with a larger survey. NPS may be more suited for use in certain healthcare settings, for example, where patients have a choice of provider. Staff attitudes towards the use of NPS for patient surveying are mixed. More research is needed to validate the use of NPS as a primary metric of patient experience. Consumer representatives were provided with the research findings and their feedback was sought about the study. Consumers commented that they found the results to be useful and felt that this study highlighted important considerations when NPS data is used to evaluate patient experience.


Evaluation of Nontarget Long-Term LC-HRMS Time Series Data Using Multivariate Statistical Approaches.
The use of liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS) has steadily increased in many application fields ranging from metabolomics to environmental science. HRMS data are frequently used for nontarget screening (NTS), i.e., the search for compounds that are not previously known and where no reference substances are available. However, the large quantity of data produced by NTS analytical workflows makes data interpretation and time-dependent monitoring of samples very sophisticated and necessitates exploiting chemometric data processing techniques. Consequently, in this study, a prioritization method to handle time series in nontarget data was established. As proof of concept, industrial wastewater was investigated. As routine industrial wastewater analyses monitor the occurrence of a limited number of targeted water contaminants, NTS provides the opportunity to detect also unknown trace organic compounds (TrOCs) that are not in the focus of routine target analysis. The developed prioritization method enables reducing raw data and including identification of prioritized unknown contaminants. To that end, a five-month time series for industrial wastewaters was utilized, analyzed by liquid chromatography-time-of-flight mass spectrometry (LC-qTOF-MS), and evaluated by NTS. Following peak detection, alignment, grouping, and blank subtraction, 3303 features were obtained of wastewater treatment plant (WWTP) influent samples. Subsequently, two complementary ways for exploratory time trend detection and feature prioritization are proposed. Therefore, following a prefiltering step, featurewise principal component analysis (PCA) and groupwise PCA (GPCA) of the matrix (temporal wise) were used to annotate trends of relevant wastewater contaminants. With sparse factorization of data matrices using GPCA, groups of correlated features/mass fragments or adducts were detected, recovered, and prioritized. Similarities and differences in the chemical composition of wastewater samples were observed over time to reveal hidden factors accounting for the structure of the data. The detected features were reduced to 130 relevant time trends related to TrOCs for identification. Exemplarily, as proof of concept, one nontarget pollutant was identified as N-methylpyrrolidone. The developed chemometric strategies of this study are not only suitable for industrial wastewater but also could be efficiently employed for time trend exploration in other scientific fields.


Using Z-scores to evaluate levator hiatal dimensions with four-dimensional translabial ultrasound.
This study represents the first attempt to use 'Z-scores' to assess levator hiatal dimensions and quantify hiatal expansion. We undertook a retrospective study on the data of 110 nulliparae and 73 pelvic organ prolapse (POP) patients who had a clinical POP exam and translabial 4-D ultrasound. We used Z-scores to normalize the dimensions of nulliparae levator hiatus and to build a Z-score model to evaluate the 'hiatal ballooning' against the POP staging. Valid data were gathered from 102 nulliparae and 64 POP patients. We built the Z-score models as follows: Z-Av = (measured value - 17.19) / 2.98, Z-Lv = (measured value - 55.65) / 5.48, where 'Av' and 'Lv' represented the 'hiatal area' and the 'anterior-posterior diameter' on Valsalva, respectively. The '90% reference range' of Z-Av was (-1.8-+1.8) and that of Z-Lv was (-2.0-+2.0). On receiver-operator curve analysis, the cut-off against POP stage 2 for Av was 20 cm2 (sensitivity of 79%, specificity of 66%), and that for Lv was 6.0 cm (sensitivity of 68%, specificity of 65%), which were approximately equal to a Z-Av of 1.0 and a Z-Lv of 1.0, correspondingly. For POP stage 3, the cut-off was an Av of 24 cm2 (sensitivity of 85%, specificity of 83%) or an anterior-posterior diameter of 6.3 cm (sensitivity of 77%, specificity of 80%), which was approximately equal to a Z-Av of 2.0 or a Z-Lv of 1.5, respectively. 'Normal hiatal dimension' was defined as Z-Av ≤ 1.0 or Z-Lv ≤ 1.0, and 'hiatal ballooning' was defined as Z-Av ≥ 2.0 or Z-Lv ≥ 1.5.


Novel euglycemic and hypolipidemic agents: Part-2. Antioxidant moiety as structural motif.
Several thiazolidinediones having antioxidant moities in their structural motif have been synthesised and evaluated for their euglycemic and hypolipidemic activities. A few of them have been found to be superior to troglitazone.


The potential for clinical application of automatic quantification of olfactory bulb volume in MRI scans using convolutional neural networks.
The olfactory bulbs (OBs) play a key role in olfactory processing; their volume is important for diagnosis, prognosis and treatment of patients with olfactory loss. Until now, measurements of OB volumes have been limited to quantification of manually segmented OBs, which is a cumbersome task and makes evaluation of OB volumes in large scale clinical studies infeasible. Hence, the aim of this study was to evaluate the potential of our previously developed automatic OB segmentation method for application in clinical practice and to relate the results to clinical outcome measures. To evaluate utilization potential of the automatic segmentation method, three data sets containing MR scans of patients with olfactory loss were included. Dataset 1 (N = 66) and 3 (N = 181) were collected at the Smell and Taste Center in Ede (NL) on a 3 T scanner; dataset 2 (N = 42) was collected at the Smell and Taste Clinic in Dresden (DE) on a 1.5 T scanner. To define the reference standard, manual annotation of the OBs was performed in Dataset 1 and 2. OBs were segmented with a method that employs two consecutive convolutional neural networks (CNNs) that the first localize the OBs in an MRI scan and subsequently segment them. In Dataset 1 and 2, the method accurately segmented the OBs, resulting in a Dice coefficient above 0.7 and average symmetrical surface distance below 0.3 mm. Volumes determined from manual and automatic segmentations showed a strong correlation (Dataset 1: r = 0.79, p < 0.001; Dataset 2: r = 0.72, p = 0.004). In addition, the method was able to recognize the absence of an OB. In Dataset 3, OB volumes computed from automatic segmentations obtained with our method were related to clinical outcome measures, i.e. duration and etiology of olfactory loss, and olfactory ability. We found that OB volume was significantly related to age of the patient, duration and etiology of olfactory loss, and olfactory ability (F(5, 172) = 11.348, p < 0.001, R2 = 0.248). In conclusion, the results demonstrate that automatic segmentation of the OBs and subsequent computation of their volumes in MRI scans can be performed accurately and can be applied in clinical and research population studies. Automatic evaluation may lead to more insight in the role of OB volume in diagnosis, prognosis and treatment of olfactory loss.


Formate analogs as antagonists of the sex pheromone of the honeydew moth, Cryptoblabes gnidiella: electrophysiological, behavioral and field evidence.
Cryptoblabes gnidiella Milliére (Lepidoptera: Pyralidae) is an economically important exotic pest of vineyards in Southern Brazil and Uruguay. The sex pheromone of C. gnidiella was identified as a mixture of (Z)-11-hexadecenal and (Z)-13-octadecenal, and has been used to monitor populations of this pest in Israel. The development of mating disruption for this species may be hampered by the chemical instability of the natural pheromone components. Therefore, studies on more stable pheromone analogs may provide tools for a control strategy based on behavior-modifying chemicals. We report here the electrophysiological and behavioral responses of C. gnidiella males to (Z)-9-tetradecenyl formate and (Z)-11-hexadecenyl formate, structural analogs of the pheromone components. In gas chromatography-electroantennogram detection (GC-EAD) studies, both analogs elicited responses from C. gnidiella male antennae. Pre-exposure to the formates did not affect the subsequent EAD responses to the natural pheromone components. The formates acted as pheromone antagonists in wind tunnel tests, inhibiting the responses of males toward both synthetic pheromone and calling females. In the field, captures of males in pheromone-baited traps decreased, in a dose-response pattern, when different amount of formates were added to the pheromone. These pheromone antagonists, thus, are potentially useful as mating disruptants for C. gnidiella in commercial vineyards.


The management of retroperitoneal sarcoma: The experience of a single institution and a review of the literature.
Retroperitoneal sarcomas (RPSs) are rare mesenchymal tumors. The objective of this study was to discuss the different clinical, therapeutic and prognostic aspects of RPS in our institution. This was a retrospective study conducted at the Department of Medical Oncology in the Habib Bourguiba University Hospital in Sfax, including 19 patients who were treated for RPSs between 1999 and 2016. The median age was 49 years (range: 18-83 years); 68.4% of the patients were female. The commonest symptom was abdominal pain (88%) and the median tumor size was 15 cm (range: 4-30 cm). Complete resection was achieved in only five cases (26.3%). The most common histological subtypes were liposarcoma (47.4%) and leiomyosarcoma (26.3%). Eight patients had a high-grade tumor (G2 = 2 or G3 = 6). Adjuvant radiotherapy was administered in 5 patients (26%). Seventeen patients were treated with chemotherapy; six received chemotherapy in an adjuvant treatment, three as a neoadjuvant treatment, and eight were treated during the palliative phase. Relapse was observed in 58% of cases. For all patients, the overall survival (OS) was 89.5% at 1 year and 40.3% at 5 years. Prognostic factors influencing OS were sex (p = 0.037), resection margins (p = 0.02), recurrence (p = 0.042), and radiotherapy (p = 0.023). In multivariate analysis, radiotherapy (p = 0.031) and histological subtype (p = 0.028) were independent factors influencing OS and disease-free survival (DFS) respectively. We showed that the treatment of RPSs relies on surgery with complete resection. Other factors, such as radiotherapy and the occurrence of relapse, also have an impact on OS. To facilitate surgery and to obtain negative resection margins, preoperative radiotherapy is indicated in selected patients with a high risk of relapse. Further prospective trials are warranted to select optimal therapies with less toxicity and better efficacy in reducing recurrences, mainly at a local level.


A core outcome set for all types of cardiac surgery effectiveness trials: a study protocol for an international eDelphi survey to achieve consensus on what to measure and the subsequent selection of measurement instruments.
Cardiovascular disease (CVD) is a major contributor to the burden of disease and the number one cause of death worldwide. From 1990 until today, more people died from coronary heart disease than from any other cause. CVD is regularly treated with minimally or non-minimally invasive off- or on-pump cardiothoracic surgery and several interventions related to the outcome of the surgical procedures have been evaluated in clinical trials, but heterogeneity in outcome reporting hinders comparison of interventions across trials and limits the ability of research synthesis. This problem is encountered with the introduction of core outcome sets (COSs), which should be measured and reported, as a minimum, in all clinical trials for a specific clinical field. This study protocol describes the methods used to develop a COS for all types of cardiac surgery effectiveness trials. We aim to reach consensus on what to measure in an international three-round eDelphi exercise involving adult patients in need or after cardiothoracic surgery, cardiothoracic surgeons, cardiologists, anaesthesiologists, nursing staff and researchers with expertise in this particular field of medical research. Subsequently, outcome measurement instruments (how to measure) will be determined. Recommendations on COS development given by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative and the Outcome Measures in Rheumatology (OMERACT) Initiative were followed. The proposed COS aims to provide methodological guidance for future cardiothoracic surgical trials to ensure the comparability of effects of interventions across studies and enable research synthesis. This does not imply that primary outcomes should always and exclusively be those of the COS. However, to ensure the comparability of results across trials, the outcomes included in this COS should be considered for inclusion besides measuring trial-specific clinical endpoints.


Evans osteotomy and risk to subtalar joint articular facets and sustentaculum tali: a cadaver study.
The Evans lateral column lengthening procedure allows correction of abduction, improved talar head coverage, decreased forefoot and rearfoot valgus, and improvement of medial column arch height. However, identifying the structures at risk when performing this osteotomy has proved difficult in vivo. Using 10 cadaveric lower limbs, we performed the Evans calcaneal osteotomy and determined whether violation of the calcaneal facets and the sustentaculum tali occurred. Based on our findings, we recommend directing the osteotomy from posterolateral to anteromedial.


Screening for occupational asthma by using a self-administered questionnaire in a clinical setting.
Because of its high prevalence, early screening for occupational asthma (OA) is crucial. We aimed to evaluate the screening performance of the Occupational Asthma Screening Questionnaire-11 items (OASQ-11) in a clinical setting. Between January 2009 and December 2011, 169 workers referred for potential OA to our hospital completed the OASQ-11 and underwent workups to determine the final diagnosis. The discriminative abilities of the OASQ-11 as a whole and in relation to demographic and exposure parameters were determined by the area under the receiving operator characteristic curve (AUC). Model 1, consisting of the OASQ's items, showed fair discrimination (AUC, 0.69; 95% confidence interval, 0.58 to 0.80). Addition of age and exposure duration to model 1 improved discrimination (AUC, 0.80; confidence interval, 0.72 to 0.88). A simple model consisting of the OASQ-11's items, age, and exposure duration could well discriminate subjects with OA in a clinical setting.


Properties of a Method for Performing Adaptive, Multilevel QM Simulations of Complex Chemical Reactions in the Gas-Phase.
The properties of a new method of performing molecular dynamic simulations of complex chemical processes are presented. The method is formulated to give a time-dependent, multilevel representation of the total potential that is derived from spatially resolved quantum mechanical regions. An illustrative simulation is performed on a 110 atom system to demonstrate the continuity and energy conserving properties of the method. The effect of a discontinuous total potential upon the kinetic energy of the system is examined. The discontinuities in the magnitude of atomic force vectors due to changing the electronic structure during the simulation are examined as well as the effect that these discontinuities have upon the atomic kinetic energies. The method, while not conserving total energy, does yield canonical (NVT) simulations. The time reversibility property of the simulation with an extremely discontinuous total potential is discussed. The computational scaling associated with the formation of the spatially resolved, time-dependent groups is also investigated.


Permanent cutaneous ureterostomy: 18 years of experience.
We have reviewed 84 patients managed with cutaneous ureterostomy during the last 18 years. If at least 1 hypertrophied and dilated ureter is available cutaneous ureterostomy is a safe and effective diversion, with satisfactory late functional results. Stomal stenosis remains a continuing problem but usually is managed easily if present. Cutaneous ureterostomy should be used in selected patients until the ideal form of vesical substitution is achieved.


Ex vivo expansion of natural killer cells for hematological cancer immunotherapy: a systematic review and meta-analysis.
The present systematic review aimed to investigate natural killer (NK) cell ex vivo expansion protocols within the scope of clinical trials targeting hematological cancer and to conduct a meta-analysis to assess the effect of NK cell infusion on survival. Research articles of clinical studies in which cell products produced by ex vivo expansion, consisting of a certain amount of NK cells and infused to patients with hematological cancer, were included in the systematic review. We conducted a proportion analysis with random effects for product purity and viability values. Studies having control groups were included in the survival meta-analysis. Among 11.028 identified records, 21 were included in the systematic review. We observed statistically significant heterogeneity for viability (I2 = 97.83%, p < 0.001) and purity values (I2 = 99.95%, p < 0.001), which was attributed to the diversity among isolation and expansion protocols. In addition, the survival meta-analysis findings suggested that NK cell therapy favors disease-free survival (DFS) of patients with myeloid malignancies but limited to only two clinical studies (odds ratio = 3.40 (confidence interval:1.27-9.10), p = 0.01). While included protocols yielded cell products with acceptable viability, the utility of immunomagnetic methods; feeder cells such as K562 expressing membrane-bound IL15 and 4-1BBL or expressing membrane-bound IL21 and 4-1BBL might be preferable to achieve better purity. In conclusion, NK cell therapy has a potential to improve DFS of patients with myeloid malignancies.


Reactions of isolated persulfides provide insights into the interplay between H2S and persulfide reactivity.
Hydrogen sulfide is ubiquitous in biological systems and exerts function over a wide range of important physiological processes. Complementing free H2S, the reductant-labile sulfur pool plays significant roles in the translocation and action of sulfide, however the chemistry of reductant-labile sulfide sources has not been studied systematically. Using a combination of NMR and UV-Vis spectroscopy, we investigated the spectroscopic properties and reactivity of three isolated organic persulfides and report a simple model for persulfide reactivity, including their roles as nucleophiles, electrophiles, and sulfide donors.


Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP.
Surgical resection of colorectal liver metastasis (CRLM) provides the best opportunity for prolonged survival. Eligibility for metastasectomy has expanded with technical advancements including parenchymal-sparing hepatectomy (PSH). Meanwhile, enthusiasm for minimally invasive surgery (MIS) has increased, though this approach may be preferentially utilized for technically straightforward cases. The purpose of this study is to characterize modern trends in open versus MIS approaches to partial hepatectomy and anatomic hepatectomy for CRLM within a nationwide cohort. The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was used to investigate trends in MIS versus open hepatectomy for CRLM from 2015 to 2019. We examined baseline clinicopathologic and disease-related characteristics and compared trends in treatments over the study period. A total of 7457 patients undergoing hepatectomy for CRLM were identified (1367 MIS, 6090 open). Patients had similar clinicopathologic features between the two groups. Patients undergoing MIS resection less frequently received neoadjuvant therapy (51.1% vs 64.0%, p < 0.001) or concurrent intraoperative ablation (15.0% vs 21.3%, p < 0.001). Patients with tumors < 2 cm (34.9% vs 26.8%, p < 0.001) or only one to two tumors (82.8% vs 65.0%, p < 0.001) more commonly underwent MIS. MIS and open partial hepatectomies both significantly increased over the study period, but open partial hepatectomy increased at a greater rate than MIS (p < 0.001). Rates of anatomic resections have remained the same, with a greater proportion performed using an open approach (34.9% vs 16.4%, p < 0.001). Rates of operations consisting of > 1 concurrent partial hepatectomy are stable, but significantly more likely to be performed open (p < 0.001). Hepatectomy for CRLM has increased from a rise in partial hepatectomy, potentially translating to increased use of PSH. Current trends suggest MIS approaches appear to be increasing, but selectively implemented for patients with less technically demanding disease characteristics. Educational efforts should be directed towards increased dissemination of parenchymal-sparing MIS techniques for more complex resections.


Degradation of the mixed organic solvents of tributyl phosphate and n-dodecane by heterogeneous Fenton-like oxidation using nanoscale zero-valent iron as the catalyst.
The treatment and disposal of spent radioactive organic solvents, i.e., tributyl phosphate (TBP) and diluent (such as kerosene, n-dodecane, etc.), produced in the reprocessing of spent fuel in the closed cycle are crucial for the sustainable development of the nuclear industry. In this study, the synthesized nanoscale zero-valent iron (nZVI) was used as the heterogeneous Fenton-like catalyst to promote the generation of hydroxyl radicals (•OH) by reacting with H2O2 to degrade the mixed organic solvents of TBP and n-dodecane. nZVI was characterized by scanning electron microscopy (SEM), nitrogen adsorption/desorption isotherms, and X-ray photoelectron spectroscopy (XPS) to investigate the micro-morphology, nano-particle size, and surface valence state. The change of Fe2+/Fe3+ concentration ratio during the reaction was measured to clarify the performance of nZVI. The effects of temperature, catalyst dosage, H2O2 dosage, and acidifier concentration on the degradation of TBP and n-dodecane were studied, and the results were complemented by the COD of the aqueous solution and the volume reduction rate of the organic phase. The mixed organic solvents of TBP and n-dodecane containing Co2+ were used to simulate the spent radioactive organic solvents and to study the distribution of nuclides after the reaction. The results showed that most of the radioactivity was in the residual solution, and the condensate contained almost no radioactivity. The degradation of TBP and n-dodecane was carried out separately, which showed that n-dodecane was more difficult to degrade. Density functional theory (DFT) calculations were applied to determine the adsorption energy of organic solvents and nZVI. According to the Fourier transform infrared spectra (FTIR) and their corresponding DFT calculations, liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) of the sample after the reaction, the possible intermediates were analyzed, and the degradation mechanism was speculated.


Influence of glycation on cis/trans isomerization and tautomerization in novel morphiceptin-related Amadori compounds.
The influence of N-glycation of the N-terminus on amide bond stereochemistry and tautomeric distribution has been explored via the synthesis and NMR analysis of novel N-(1-deoxy-D-fructos-1-yl) derivatives (Amadori compounds) of the exogenous, milk derived, opioid tetrapeptide morphiceptin (H-Tyr-Pro-Phe-Pro-NH2). NMR analysis of the protected Amadori compounds revealed the presence of four configurational isomers in DMSO solution arising from cis/trans isomerization about Tyr1-Pro2 and Phe3-Pro4 peptide bonds. Comparison of the data obtained for protected Amadori compounds with those obtained for morphiceptin showed that equilibrium fraction of all-trans isomers in N-glycated peptide derivatives was smaller than in the parent peptide compound. Spectroscopic investigation of unprotected morphiceptin-related Amadori compound revealed the presence of multiple conformers in solution due to cis/trans isomerization of the peptide backbone and tautomerization of the sugar moiety. The equilibrium composition in DMSO is markedly shifted towards furanose forms, amounting to two-thirds of the mixture. The estimated equilibrium of the tautomeric forms in water solution revealed the beta-pyranose form as the major tautomer (66%).


[Postoperative eventration in newborn infants].
A method of prophylactics and treatment of postoperative eventrations in newborns (25 observations), is described. The incidence of this complication was decreased from 2,19% (1960-1971) to 0,95% (1972-1983).


Fadenoperation for the management of complicated incomitant vertical strabismus.
We reviewed retrospectively the records of 17 patients with incomitant vertical diplopia secondary to an underacting inferior rectus muscle who had been treated by surgically weakening the contralateral inferior rectus muscle with a posterior fixation suture (fadenoperation). This was the sole procedure in four patients with blowout fractures and in two patients with restriction secondary to scleral buckling procedures. It was combined with horizontal or vertical muscle surgery in 11 patients. The procedure was particularly useful in preventing diplopia on downgaze after excessive weakening of a tight inferior rectus muscle in seven patients with thyroid ophthalmopathy. In three patients it was used in anticipation of an iatrogenic incomitancy in downgaze secondary to a large recession of a tight inferior rectus muscle. All patients were markedly improved after surgery and no complications were encountered.


Population and Resource Utilization Among Patients With Adult Congenital Heart Disease: A Snapshot View of a Moderate-Size Canadian Regional Centre.
Health care resource utilization for patients with adult congenital heart disease (ACHD) has not been well characterized outside of large Canadian specialized regional centres. We sought to describe the ACHD population and resource utilization patterns seen in a medium regional Canadian centre providing specialized ACHD care. A cross-sectional retrospective study was done from a sample of patients seen in 2018 at the ACHD clinic in Manitoba, Canada. Demographic data were collected along with cardiac anatomy and repair type. Health care resource utilization, clinic visits, hospital admissions, unexpected hospital presentations, and cardiac interventions were measured over a 5-year period. A random sample of 262 patients was selected from our specialized ACHD clinic. Mean age was 33.5 (±13.7) years; 48% of the population was female, and >50% resided within the major city limits. A total of 21% of the population had simple anatomy, 44% had moderate anatomy, and 35% had complex anatomy. The most commonly used imaging modality was echocardiography, followed by cardiac magnetic resonance imaging, with more frequent imaging done in patients with complex anatomy. Unexpected hospital encounters occurred at a rate of 16 per 100 person-years. Total inpatient hospital days occurred at a rate of 33 per 100 person-years, and visits to the congenital clinic occurred at a rate of 90 per 100 person-years. Health care resource utilization appears to be highest in older adults and those with more complex ACHD anatomy. As the overall cohort of adults with ACHD continues to age, resource needs are likely to increase.


Imaging appearances and endovascular management of uncommon pseudoaneurysms.
Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.


Prognostic significance of Tks5 expression in gliomas.
A pathological hallmark of gliomas is their extensive invasion into the brain parenchyma regardless of tumour grade. Clinically this is a major factor in tumour recurrence as surgery and adjuvant therapies are unable to eradicate all the infiltrating malignant cells. Tyrosine kinase substrate with five SH3 domains (Tks5, also known as SH3PXD2A) and cortactin are required for the formation of invadopodia, actin-based protrusions of tumour cells with associated proteolytic activity implicated in tumour invasion. We investigated the prognostic significance of Tks5 and cortactin expression in 57 patients with various grades of glioma. Expression of Tks5 or cortactin occurred in all grades of tumours and expression of Tks5, but not cortactin, was associated with significantly reduced patient survival among glioma patients. This association was clearest in patients with low-grade astrocytomas and oligoastrocytomas. These results suggest a prognostic relevance for the Tks5 invadopodial protein in glial-derived brain tumours.


Identification and molecular characterization of three new K+-channel specific toxins from the Chinese scorpion Mesobuthus martensii Karsch revealing intronic number polymorphism and alternative splicing in duplicated genes.
K(+)-channel specific toxins from scorpions are powerful probes used in the structural and functional characterization of different subfamilies of K(+)-channels which are thought to be the most diverse ion channels. However, only a limited number of K(+)-channel toxins have been identified from scorpions so far; moreover, little is known about the mechanisms for the generation of a combinatorial peptide library in a venom gland of a scorpion. Here, we identified and characterized three new K(+)-channel toxin-like peptides from the scorpion Mesobuthus martensii Karsch, which were referred to as BmKcug1, BmKcug2 and BmKcugx, respectively. BmKcug1 and BmKcug2 are two new members of α-KTx1 subfamily, and have been classified as α-KTx1.14 and α-KTx1.15, respectively. BmKcugx represents a new subfamily of K(+)-channel specific toxins which was classified into α-KTx22. BmKcugx was thus classified as α-KTx22.1. Genomic analysis demonstrated that BmKcugx gene has two exons interrupted by an intron inserted in the signal peptide encoding region, whereas BmKcug1a (a close homologue of BmKcug1)/BmKcug2 gene was interrupted by two introns, located within the 5'UTR of the gene and in the signal peptide encoding region, respectively. Transcriptomic analysis for the venom glands of M. martensii Karsch indicated that the abundances of the transcripts of BmKcug1a and BmKcug2 are much higher than that of BmKcugx; it suggests that the intron in 5'UTR could markedly increase the expression level of the K(+)-channel toxins. Alignment of the genomic sequences of BmKcug1a and BmKcug2 revealed that an alternative splicing event occurred at the intron 1-exon 2 junction in the 5'UTR of BmKcug2 transcript.


[Rare or unusual forms of psoriasis].
Apart from plaque-type psoriasis, there are multiple particular or rare clinical presentations, according to signs and symptoms, localization or distribution of lesions. Psoriasis can affect mucous membranes, especially the genital areas of male and female patients, causing pain or burning sensation and decreased quality of life. Geographic tongue is not specific of psoriasis, but is more frequent in this context. Other localizations like the lips and the eylids are rare, but should not be overlooked. Certain lesions have an unusual distribution, like psoriasis gyrata and blaschko linear forms. Pustules are frequently observed on the palms and soles. Acrodermatitis continua is a rare chronic pustular condition affecting the acral areas, mainly the fingers, which is associated with severe nail involvement. Nails can also be involved in the unusual pachydermo-periostitis, a clinical form of psoriasis without epidermal lesions, which has characteristic radiologic presentation.


A five-year study of the microbiologic results of exit site infections and peritonitis in continuous ambulatory peritoneal dialysis.
We studied the culture results from 321 continuous ambulatory peritoneal dialysis (CAPD) related infections (exit site, tunnel infections, and peritonitis) in 137 patients over a 5-year period to determine the contribution of exit site and tunnel infections to peritonitis and catheter loss. Seventeen percent of peritonitis episodes were associated temporally and by microbiologic results with exit site or tunnel infections. Twenty-one percent of exit site and tunnel infections and 20% of peritonitis episodes resulted in catheter loss. Peritonitis due to Staphylococcus aureus was more likely to be associated with an exit site or tunnel infection and was more likely to result in loss of the catheter than peritonitis due to Staphylococcus epidermidis. Peritonitis and exit site infections due to Pseudomonas sp also frequently resulted in catheter removal. We found that exit site infections cause significant morbidity in CAPD patients. Further studies in this area are needed.


The protracted Holocene extinction of California's flightless sea duck (Chendytes lawi) and its implications for the Pleistocene overkill hypothesis.
Bones of the flightless sea duck (Chendytes lawi) from 14 archaeological sites along the California coast indicate that humans hunted the species for at least 8,000 years before it was driven to extinction. Direct (14)C dates on Chendytes bones show that the duck was exploited on the southern California islands as early as approximately 11,150-10,280 calendar years B.P., and on the mainland by at least 8,500 calendar years B.P. The youngest direct date of 2,720-2,350 calendar years B.P., combined with the absence of Chendytes bones from hundreds of late Holocene sites, suggests that the species was extinct by approximately 2,400 years ago. Although the extinction of Chendytes clearly resulted from human overhunting, its demise raises questions about the Pleistocene overkill model, which suggests that megafauna were driven to extinction in a blitzkrieg fashion by Native Americans approximately 13,000 years ago. That the extermination of Chendytes was so protracted and archaeologically visible suggests that, if the terminal Pleistocene megafauna extinctions were primarily the result of human exploitation, there should also be a long and readily detectable archaeological record of their demise. The brief window now attributed to the Clovis culture ( approximately 13,300-12,900 B.P.) seems inconsistent with an overhunting event.


Constrained analogues of tocainide as potent skeletal muscle sodium channel blockers towards the development of antimyotonic agents.
1-Benzyl-N-(2,6-dimethylphenyl)piperidine-3-carboxamide and 4-benzyl-N-(2,6-dimethylphenyl)piperazine-2-carboxamide, two conformationally restricted analogues of tocainide, were designed and synthesized as voltage-gated skeletal muscle sodium channel blockers. They showed, with respect to tocainide, a marked increase in both potency and use-dependent block.


A model of electrical excitation of the mammalian auditory-nerve neuron.
A model of the mammalian auditory-nerve neuron has been developed based on the classical work of Frankenhauser and Huxley [(1964) J. Physiol. 171, 302-315], modified by McNeal [(1976) IEEE Trans. Biomed. Eng. BME-23, 329-336], and Reilly et al. [(1985) IEEE Trans. Biomed. Eng. BME-32, 1001-1011], and fine tuned to represent physiological data obtained from single auditory-nerve fiber experiments in squirrel monkeys. The model is capable of reproducing neural action potential waveforms due to electrical stimulation, and can reliably predict action potential thresholds and strength-duration curves. This paper explains the derivation of the mathematical model and the effects of varying certain independent parameters including fiber diameter, length of the nodes of Ranvier, internodal length, and myelin thickness. The model parameters were selected according to the anatomical findings of Liberman and Oliver [(1984) J. Comp. Neurol. 223, 163-176], and Liberman (Pers. Commun.). The length of the unmyelinated termination of the auditory-nerve that survives after aminoglycoside damage to the inner ear has not been experimentally determined. Therefore, it was investigated as an independent variable in the model. An unmyelinated terminal length of 10.0 micron was found to most accurately describe the experimental neural strength-duration curves obtained from aminoglycoside-deafened squirrel monkeys. The parameter that had the next most significant effect on the model was fiber diameter which affects all conduction pathways, across the membrane and through the fiber. Finally the results of the model are compared with behavioral data obtained from patients and monkeys implanted with cochlear prostheses. In the companion paper [(1987) Hear. Res. 31, 267-286] predictions of the model are quantitatively compared with single-neuron data from squirrel monkeys.


[Efficacy of Stereotactic Body Radiotherapy versus Surgery for the Treatment of Early Non-small Cell Lung Cancer: A Meta-analysis].
To compare the clinical efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer through evidence based medicine analysis. A systematic search was performed in the PubMed, EMBASE, CNKI and Wan Fang databases to find studies published before June 2020. Two authors independently extracted the data and assessed the eligibility. All of the statistical analyses were performed using Stata 13.0. Subgroup analysis were performed according to the score matching study and operation type (lobectomy, segmentectomy and thoracoscopic assisted surgery). Finally, 14 articles were included, including 15,841 cases in SBRT group and 17,708 cases in operation group. 10 articles used propensity score matching methods for survival analysis. Thirteen were retrospective cohort studies and one was randomized controlled trial. The results of meta-analysis showed that the overall survival rate of the surgery group and the SBRT group was statistically significant. The overall survival rate of the SBRT group (HR=1.51, 95%CI: 1.31-1.74) was inferior to that of the surgery group. In the subgroup analysis of the surgical type, there was no statistical difference between the SBRT group and each surgical type. The difference of overall survival rate between SBRT group and surgery group was statistically significant (HR=1.66, 95%CI: 1.45-1.90) in studies of propensity score matching. There was no statistically significant difference in cancer-specific survival between the surgery and SBRT groups (HR=1.12, 95%CI: 0.83-1.52). The overall survival rate of surgical treatment is better than that of SBRT, but it has no obvious advantages in cancer specific survival rate.


Outcomes of Hodgkin variant Richter transformation in chronic lymphocytic leukaemia and small lymphocytic lymphoma in British Columbia.
Hodgkin variant Richter transformation (HvRT) is a rare and challenging complication of chronic lymphocytic leukaemia (CLL) for which information on prognostic factors and treatment approaches remain limited. We analysed characteristics and survival outcomes of a population-based cohort of 32 patients with HvRT identified in British Columbia over a 40-year period. Median interval from CLL diagnosis to HvRT was 5.6 years (range, 0-33.6), with five cases diagnosed concurrently. Most patients (80%) had treatment for CLL prior to HvRT. Median age at HvRT was 71 years (range, 51-86) and the majority of patients had high-risk disease, including stage 3-4 in 87% and International Prognostic Score (IPS) ≥ 4 in 65%. Two-year progression-free (PFS) and overall survival (OS) from HvRT were 47% (95% CI: 29%-64%) and 57% (95% CI: 38%-72%), respectively. OS from HvRT was significantly worse in those with anaemia (p = 0.02), elevated lactate dehydrogenase (p = 0.04), high IPS (p = 0.04), and worse performance status (p = 0.001). For those treated with curative-intent ABVD/ABVD-like therapy, 2-year PFS and OS were 70% (95% CI: 45%-85%) and 74% (95% CI: 49%-89%), respectively. In this real-world population-based cohort, HvRT was associated with poor clinical outcomes overall; however, those able to tolerate curative-intent therapy had similar survival to older patients with de novo HL.


Intracellular transport of class I histocompatibility molecules. Influence of protein folding on transport to the cell surface.
To examine the structural requirements for the intracellular transport and surface expression of Class I histocompatibility molecules, we studied somatic cell variants that produce altered forms of the H-2Kb molecule. One variant, R8.10, produced a mutant Kb molecule that was expressed on the cell surface at about 15% of the wild-type level. Nucleic acid sequence analysis identified the mutation as a single nucleotide change resulting in an amino acid substitution (Trp----Arg) at residue 167 in the alpha 2 extracellular domain. A comparative kinetic analysis of the intracellular transport of the wild-type and mutant molecules revealed that transport of the mutant product was remarkably impaired. Whereas wild-type molecules arrived at the cell surface with a half-time of about 30 min, 80% of newly synthesized mutant molecules did not progress beyond the rough endoplasmic reticulum, where they were slowly degraded. Surprisingly, the remaining 20% of the mutant population was capable of reaching the plasma membrane at a rate about one-half that of wild-type Kb. The accumulation of most of the mutant molecules in the rough endoplasmic reticulum was not due to aggregation or insolubility, nor could it be attributed to a lack of association with beta 2-microglobulin. Several techniques were employed in an effort to detect structural features unique to the transport-deficient mutant population. Monoclonal antibody binding experiments revealed structural differences between wild-type and mutant molecules in the region of the mutation but failed to distinguish the transport-competent and -deficient mutant populations. Detergent partitioning studies were also ineffective in this regard. However, differences between transported and untransported molecules were readily demonstrated by their disparate susceptibilities to proteolytic digestion. The results indicated that the transport-deficient form of the mutant assumed a conformation that was altered relative to both the transport-competent form and the wild-type molecule. The fact that the ability of wild-type and mutant molecules to be transported correlated with conformational features rather than with their specific primary sequences suggests that proper folding is an important requirement for their passage through the exocytotic pathway.


Exogenous N-hexanoyl-L-homoserine lactone assists in upflow anaerobic sludge blanket recovery from acetate accumulation via aceticlastic methanogens enrichment.
Volatile fatty acids (VFAs) accumulation caused by shock loading severely hampers the performance and stability of anaerobic digestion. An upflow anaerobic sludge blanket (UASB) was operated to examine its performance, sludge properties, and microbial community behavior during shock loading and recovery with exogenous N-hexanoyl-L-homoserine lactone (C6-HSL). After shock loading, chemical oxygen demand (COD) removal was significantly reduced from 79.09% to 65.63%. The abundance of Methanosarcinales also significantly decreased, which resulted in acetate accumulation (1,163.55 mg/L). Sludge granules disintegrated along with the decrease in extracellular polymeric substances (EPS). After supplying 1 μg/L C6-HSL, COD removal resumed to 75.10%. Furthermore, C6-HSL enhanced the abundance and metabolic activity of aceticlastic methanogens, decreased acetate concentration to 146.87 mg/L, improved EPS secretion, and caused the re-assembly of disintegrated sludges to form large granules. These results advanced our understanding of microbial community behavior and provided an attractive strategy for restoration of UASB recovered from shock loading.


Development of a Scale to Measure an Unemployment Syndrome: Items Generation and Content Validity.
To develop a scale for a group of symptoms based on the unemployment syndrome. The development consisted of four phases: (I) review of literature, (II) concept elicitation, (III) concept selection and item construction, and (IV) content validation. Twenty final items that were established as adequate for being included in the instrument. The unemployment syndrome scale could be used to identify the needs and sintomatology of unemployed people and support the identification of the syndrome. The instrument makes it possible to assess the symptomatology specific to the syndrome and to record properly the assessment of the biopsychosocial conditions on the part of the nursing profession for providing quality comprehensive care.


A comparative study between direct testicular and pedal lymphography in dogs. (A preliminary report).
In 20 dogs, 12 bilateral and 8 unilateral pedal and direct testicular lymphographies were performed. Comparison between the two methods showed that pedal lymphography failed to visualize some of the regional lymph nodes of the testicle. Histological examinations of the excised testicles two months after the injection of the contrast material failed to show any significant abnormalities. The potential applications of direct testicular lymphography are discussed.


[Quality indicators of patient treatment of schizophrenic patients. Results of a pilot study for external quality assurance using tracer diagnosis].
In Germany, measures for assuring the quality of inpatient treatment are regulated by legislation. Treatment quality must be presented in comparison with other hospitals. Tracer diagnosis is an established method for external quality assurance in the sphere of somatic medicine. To evaluate this method of external quality assurance in psychiatry, the German Society for Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) defined and operationalised quality indicators for the treatment of schizophrenic inpatients. of a multicentre project supported by the German Federal Ministry of Health (BMG) using this inventory in 96 schizophrenic inpatients (ICD-10) from 4 hospitals are presented. The qualification of these indicators of structure, process and outcome while comparing the treatment quality of different hospitals as well as their applicability for internal quality management are discussed.


Cardioprotective Effect of Thiazide-Like Diuretics: A Meta-Analysis.
Thiazide diuretics (TD), including thiazide-type (chlorothiazide and hydrochlorothiazide) and thiazide-like diuretics (indapamide and chlorthalidone), have been used for the treatment of hypertension for more than 5 decades. This meta-analysis aimed to evaluate whether TD, including thiazide-type and thiazide-like diuretics have additional cardioprotective effects. We performed a pooled study of 19 randomized clinical trials (RCTs). PubMed and EMBASE databases were searched for RCTs assessing TD treatment in patients with hypertension. Nineteen RCTs involving 112,113 patients (56,802 in TD; 55,311 in control) were included. The incidence ratio of cardiac events (CVs) was 34.3 vs. 37.8 per 1,000 patient-years in patients randomized to TD and controls, respectively. TD treatment was associated with reductions in the risks of CVs (odds ratio (OR): 0.86, P = 0.007) and heart failure (OR: 0.62, P < 0.001), but not different in stroke (OR: 0.92, P = 0.438) or CHD (OR: 0.95, P = 0.378) between diuretics and controls. Further analysis showed that the observed benefits were mainly confined to thiazide-like diuretic therapy rather than thiazide-type diuretics with a significant reduction in the risk of CVs (OR: 0.78, P < 0.001), heart failure (OR: 0.57, P < 0.001) and stroke (OR: 0.82, P = 0.016). This study suggests that use of TD in hypertensive patients results in a reduction in the risk of CVs. Moreover, thiazide-like diuretics have greater protective effect against CVs than thiazide-type diuretics, especially on heart failure, suggesting that preferential use of thiazide-like diuretics over thiazide-type diuretics may result in greater cardiovascular benefits in hypertensive patients.


Creation and validation of a simulator for corneal rust ring removal.
To create and validate a simulation model for corneal rust ring removal. Rust rings were created on cadaveric eyes with the use of small particles of metal. The eyes were mounted on suction plates at slit lamps and the trainees practiced rust ring removal. An inexperienced cohort of medical students and first year ophthalmology residents (n=11), and an experienced cohort of senior residents and faculty (n=11) removed the rust rings from the eyes with the use of a burr. Rust ring removal was evaluated based on removal time, percentage of rust removed and incidence of corneal perforation. A survey was administered to participants to determine face validity. Time for rust ring removal was longer in the inexperienced group at 187±93 seconds (range of 66-408 seconds), compared to the experienced group at 117±54 seconds (range of 55-240 seconds) (p=0.046). Removal speed was similar between groups, at 4847±4355 pixels/minute and 7206±5181 pixels/minute in the inexperienced and experienced groups, respectively (p=0.26). Removal percentage values were similar between groups, at 61±15% and 69±18% (p=0.38). There were no corneal perforations. 100% (22/22) of survey respondents believed the simulator would be a valuable practice tool, and 89% (17/19) felt the simulation was a valid representation of the clinical correlate. The corneal rust ring simulator presented here is a valid training tool that could be used by early trainees to gain greater comfort level before attempting rust ring removal on a live patient.


An arousal interval scale: a psychophysical scale for GSR analysis.
An interval scale method of measuring GSR is presented, which measures only deflections without correction for base level. The scale is derived from psychophysics. A distinction is made between the psychological meaning a GSR is given and its physical measurement. This paper asserts, on the basis of empirical studies, that GSR measures the hypothetical construct arousal. Therefore, scales of physical units are unjustified. A review of the literature finds that GSR does not conform to Wilder's (1962) Law of Initial Values. Therefore, an interval scale assuming base level as a "zero" of convenience is justified. Extensions of the use of such an interval scale are discussed.


[Periodontal-orthodontic treatment possibilities for migrated front teeth--case selection and theoretical concept].
Migration of maxillary incisors caused by advanced periodontal disease induces functional, periodontal and esthetical problems to the patient. Under certain conditions a combined periodontal-orthodontal treatment should be considered. A successful treatment result depends on the selection of the patients. The presented concept offers good long-term results for a combined periodontal-orthodontal therapy.


A new external fixation device for treatment of complicated fractures of the leg.
An external fixation device has been designed for rigid fixation of fragments of bone. It can be used in operations to lengthen the tibia and can be adapted to the compression fixation of fractures. This paper describes the apparatus and its use in the treatment of 10 complicated fractures.


Effectiveness and tolerability of second-line therapy with vildagliptin vs. other oral agents in type 2 diabetes: a real-life worldwide observational study (EDGE).
Real-life studies are needed to confirm the clinical relevance of findings from randomised controlled trials (RCTs). This study aimed to assess the effectiveness and tolerability of vildagliptin add-on vs. other oral antihyperglycaemic drugs (OADs) added to OAD monotherapy in a real-life setting, and to explore the advantages and limitations of large-scale 'pragmatic' trials. EDGE was a prospective, 1-year, worldwide, real-life observational study in which 2957 physicians reported on the effects of second-line OADs in 45,868 patients with T2DM not reaching glycaemic targets with monotherapy. Physicians could add any OAD, and patients entered either vildagliptin or (pooled) comparator cohort. The primary effectiveness and tolerability end-point (PEP) evaluated proportions of patients decreasing HbA(1c) > 0.3%, without hypoglycaemia, weight gain, peripheral oedema or gastrointestinal side effects. The most clinically relevant secondary end-point (SEP 3) was attainment of end-point HbA(1c) < 7% without hypoglycaemia or ≥ 3% increase in body weight. In this large group of T2DM patients, a second OAD was added at mean HbA(1c) of 8.2 ± 1.3%, with no baseline HbA(1c) difference between cohorts. Second-line OAD therapy attained the PEP in the majority of patients, with higher attainment in those prescribed a vildagliptin-based regimen. The adjusted odds ratio was 1.49 (95% CI: 1.42, 1.55; p < 0.001). In patients with baseline HbA(1c) ≥ 7%, SEP 3 was achieved by 35% of patients on a vildagliptin-based combination and by 23% of those receiving comparator combinations. The adjusted odds ratio was 1.96 (95% CI: 1.85, 2.07; p < 0.001). Safety events were reported infrequently and safety profiles of vildagliptin and other OADs were consistent with previous data. EDGE demonstrates that in a 'real-life' setting, vildagliptin as second OAD can lower HbA(1c) to target without well-recognised OAD side effects, more frequently than comparator OADs. In addition, EDGE illustrates that conducting large-scale, prospective, real-life studies poses challenges but yields valuable clinical information complementary to RCTs.