Effect of topical glucocorticoid treatment in chinchilla model of lipopolysaccharide induced otitis media with effusion.
To compare the efficacy of topical treatment with three glucocorticoids in lipopolysaccharide induced otitis media with effusion (OME). Chinchillas were divided into seven treatment groups consisting of vehicle and three glucocorticoids: dexamethasone sodium phosphate (DSP), fluticasone propionate (FP), and hydrocortisone, each at concentrations of 0.1% and 1.0%. LPS (300 μg) was injected into the superior bullae of chinchillas to induce OME. Animals were treated with test substances at -2, 24, and 48 h relative to LPS inoculation. After 96 h, chinchillas were euthanized, samples of middle ear effusion (MEE) were collected, and temporal bones were removed for histopathological examination. Reduction of OME was evaluated by measuring MEE volume and thickness of mucosal lining for each bulla. One percent treatment of FP significantly reduced MEE. One percent treatment of DSP and HC significantly reduced the mucosal thickness (MT), DSP (15.0 μM) more than HC (30.8 μM). Treatment with 0.1% glucocorticoids did not lead to any significant reduction. Clearance of otitis media with effusion seems to be a class effect among glucocorticoids. DSP was the best in reducing MT. It is important to evaluate treatment with various glucocorticoids in order to discover alternative drugs for OME.


TNF receptor 1 signaling is critically involved in mediating angiotensin-II-induced cardiac fibrosis.
Angiotensin-II (Ang-II) is associated with many conditions involving heart failure and pathologic hypertrophy. Ang-II induces the synthesis of monocyte chemoattractant protein-1 that mediates the uptake of CD34(+)CD45(+) monocytic cells into the heart. These precursor cells differentiate into collagen-producing fibroblasts and are responsible for the Ang-II-induced development of non-adaptive cardiac fibrosis. In this study, we demonstrate that in vitro, using a human monocyte-to-fibroblast differentiation model, Ang-II required the presence of tumor necrosis factor-alpha (TNF) to induce fibroblast maturation from monocytes. In vivo, mice deficient in both TNF receptors did not develop cardiac fibrosis in response to 1week Ang-II infusion. We then subjected mice deficient in either TNF receptor 1 (TNFR1-KO) or TNF receptor 2 (TNFR2-KO) to continuous Ang-II infusion. Compared to wild-type, in TNFR1-KO, but not in TNFR2-KO hearts, collagen deposition was greatly attenuated, and markedly fewer CD34(+)CD45(+) cells were present. Quantitative RT-PCR demonstrated a striking reduction of key fibrosis-related, as well as inflammation-related mRNA expression in Ang-II-treated TNFR1-KO hearts. TNFR1-KO animals also developed less cardiac remodeling, cardiac hypertrophy, and hypertension compared to wild-type and TNFR2-KO in response to Ang-II. Our data suggest that TNF induced Ang-II-dependent cardiac fibrosis by signaling through TNFR1, which enhances the generation of monocytic fibroblast precursors in the heart.


Expectancy, fear and pain in the prediction of chronic pain and disability: a prospective analysis.
Studies with (sub) acute back pain patients show that negative expectancies predict pain and disability at a one-year follow up. Yet, it is not clear how expectations relate to other factors in the development of chronic disability such as pain and fear. This study investigates the relationship between expectations, pain-related fear and pain and studies how these variables are related to the development of chronic pain and disability. Subjects (N = 141) with back and/or neck pain (duration <1 year) were recruited via primary care. They completed measures on pain, expectancy, pain-related fear (pain-related negative affect and fear avoidance beliefs) and function. A one-year follow up was conducted with regard to pain and function. It was found that pain, expectancy, pain-related fear and function were strongly interrelated. In the cross-sectional analyses negative expectancies were best explained by frequent pain and a belief in an underlying and serious medical problem. Prospectively, negative expectancy, negative affect and a belief that activity may result in (re) injury or increased pain, explained unique variance in both pain and function at one-year follow up. In conclusion, expectancy, negative affect and fear avoidance beliefs are interrelated constructs that have predictive value for future pain and disability. Clinically, it can be helpful to inquire about beliefs, expectancy and distress as an indication of risk as well as to guide intervention. However, the strong interrelations between the variables call for precaution in treating them as if they were separate entities existing in reality.


Balloon pulmonary angioplasty combined with riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (PRACTICE study): study protocol for a randomized controlled trial.
Management of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) remains a clinical challenge. Currently, riociguat, a soluble guanylate-cyclase stimulator is recommended by international guidelines. More recently, balloon pulmonary angioplasty (BPA) develops as an alternative treatment for inoperable CTEPH. This study is a single-center randomized controlled trial. Subjects with inoperable CTEPH are randomized into either a BPA combined with riociguat or riociguat monotherapy group (2:1) and observed for 12 months after initiation of treatment. The primary endpoint is the change in pulmonary vascular resistance from baseline to 12 months after initiation of treatment. The secondary endpoints include 6-min walk distance (6MWD), WHO-FC, NT-proBNP, SF-36, and other hemodynamic parameters. Safety endpoints are analyzed too. This study aims to compare the efficacy and safety of BPA combined with riociguat and riociguat monotherapy for inoperable CTEPH. Chinese Clinical Trial Registry ChiCTR2000032403 . Registered on 27 April 2020.


Evaluation of fracture resistance of inlay-retained fixed partial dentures fabricated with different monolithic zirconia materials.
Data are lacking on the fracture resistance of monolithic zirconia inlay-retained fixed partial dentures as a conservative treatment for a single missing tooth. The purpose of this in vitro study was to evaluate the fracture resistance of inlay-retained fixed partial dentures produced from 3 different monolithic zirconia materials and based on 2 preparation types and applications with and without thermocycling. A model with missing right and left mandibular first molars was used for different cavity preparations. A tube-shaped cavity and a box-shaped cavity were prepared. Seventy-two epoxy resin casts were prepared from an additional silicone impression. Twenty-four inlay-retained fixed partial dentures from each monolithic zirconia material (Prettau, Zirkonzahn; Katana, Noritake; and Copran, Whitepeaks) were fabricated for each preparation type and cemented to their epoxy model with dual-polymerizing adhesive resin cement; 50% of all specimens were thermocycled for 10000 cycles. The specimens were subjected to a fracture resistance test using a universal testing machine with a crosshead speed of 0.5 mm/min. Fracture surfaces were examined with scanning electron microscopy (SEM), and a specimen from each group was examined for structural changes with differential thermal analysis (DTA). No statistically significant differences in terms of fracture resistance were found among brands with both cavity designs and with and without thermal cycles (P>.05). However, SEM and DTA results showed some changes in monolithic zirconia structure after 1 year of aging. The brands and cavity preparation types for single posterior tooth loss generated similar fracture resistance.


A microarray analysis of developmentally regulated genes during macronuclear differentiation in the stichotrichous ciliate Stylonychia lemnae.
After sexual reproduction in ciliated protozoa a new macronucleus differentiates from a micronuclear derivative. In the course of macronuclear development dramatic DNA- and chromatin reorganisation processes occur, which include splicing of DNA sequences such as IES (internal eliminated sequences) and transposon-like elements during formation of polytene chromosomes, degradation of the polytene chromosomes and specific elimination of micronuclear-specific DNA, de novo addition of telomeres and specific amplification of DNA sequences. In order to understand the molecular basis of this nuclear differentiation process, analysis of developmentally regulated genes seems to be a necessary prerequisite. We performed a microarray analysis to identify genes differentially expressed during macronuclear differentiation. 467 sequences from cDNA libraries were identified as possible candidates from which 384 sequences were further characterised by sequence analysis. These sequences were identified, if possible, by DNA and protein BLAST analysis. Expression of one of these sequences was silenced by RNAi and a preliminary functional analysis performed. Results presented in this study provide the basis for a functional characterisation of genes differentially expressed during this nuclear differentiation process.


Retrieval of a penny from the pediatric esophagus: a cost analysis.
As part of the oral phase of development, children commonly ingest foreign bodies. The most common lodged foreign body, requiring operative removal, in the United States is the penny. Valued at 1 cent, comprised of materials valued at less than 1 cent, costing 1.62 cents to manufacture, and being never removed from circulation, pennies are aplenty. But ingestion can lead to mucosal damage, the consequences of which can be esophageal perforation or stricture formation. We hypothesize that the monetary value of the penny is far less than the cost of its ingestion and removal. This quality assurance study examines the effect of the penny on the purse. This retrospective review identified 180 foreign bodies in children under the age of 18 over a five year period. Eighty-two were pennies. Operative notes revealed degree of injury. Hospital charge assessments revealed the "cost" of each visit. There were no esophageal perforations, and cases were divided evenly among injury grades 0-III. The average total charge for all penny-related injuries was $7164.78. The purpose was to examine the actual cost of a penny (more than its value in production) and the potential cost of its damage (thousands of dollars in measurable costs, untold immeasurable costs). The goal of this study is to draw healthcare professional and public attention to a potentially serious and yet highly preventable injury in young children.


Spin-orbit Rabi oscillations in optically synthesized magnetic fields.
Rabi oscillation has been proven to be one of the cornerstones of quantum mechanics, triggering substantial investigations in different disciplines and various important applications both in the classical and quantum regimes. So far, two independent classes of wave states in the Rabi oscillations have been revealed as spin waves and orbital waves, while a Rabi wave state simultaneously merging the spin and orbital angular momentum has remained elusive. Here we report on the experimental and theoretical observation and control of spin-orbit-coupled Rabi oscillations in the higher-order regime of light. We constitute a pseudo spin-1/2 formalism and optically synthesize a magnetization vector through light-crystal interaction. We observe simultaneous oscillations of these ingredients in weak and strong coupling regimes, which are effectively controlled by a beam-dependent synthetic magnetic field. We introduce an electrically tunable platform, allowing fine control of transition between different oscillatory modes, resulting in an emission of orbital-angular-momentum beams with tunable topological structures. Our results constitute a general framework to explore spin-orbit couplings in the higher-order regime, offering routes to manipulating the spin and orbital angular momentum in three and four dimensions. The close analogy with the Pauli equation in quantum mechanics, nonlinear optics, etc., implies that the demonstrated concept can be readily generalized to different disciplines.


Defining monetary values for quality of life improvements: an exploratory study.
QOL improvements, which can in many cases reflect the overall effect of a health intervention, are frequently measured. It would therefore be useful to define the monetary value of QOL improvements in order to subsequently estimate the value of a given intervention on the basis of its impact on QOL. To explore the feasibility of assessing the monetary value of an intervention by translating the improvement in QOL it produces into willingness to pay (WTP) amounts. Seven different hypothetical health state descriptions were developed. Five hundred and forty-five subjects randomly selected among the staff of the University of Montreal, Canada were sent a self-administered questionnaire asking them to evaluate the QOL corresponding to various hypothetical health states and indicate the amount they would be willing to pay for interventions that would enable them to move from these health states to perfect health. The response rate was 55% (n = 294). A significant correlation was found between the WTP amount and the anticipated QOL improvement, and between the WTP amount and the respondent's family income. A regression equation for WTP amounts was derived from a step-wise model including the anticipated QOL improvement and the respondent income. While the model could only account for about 20% of the WTP variance (R(2) = 0.2), the mean predicted WTP amounts were very close to the mean WTP amounts observed in the sample. This study indicates that a definite correlation exists between willingness to pay for an intervention and the improvement in QOL it produces.


Acylated flavonol glycosides from Epimedium elatum, a plant endemic to the Western Himalayas.
Herba Epimedii is a well-known Botanical preparation used over long time in traditional Chinese medicine. The extracts and chemical constituents from Epimedium species are aphrodisiac as well as to treat many ailments. Chemical investigation of lonely species growing in Kashmir Himalaya Epimedium elatum was undertaken to evaluate its chemical profile. Two unusual substituted acylated flavonol glycosides named Elatoside A (1) and Elatoside B (2) have been isolated from the ethanolic extract of E. elatum along with 23 previously known ones (3-25). All isolates were evaluated for antimicrobial and PPAR-γ ligand binding activity, and some of them appeared to be modestly active.


Neural activation during an explicit categorization task: category- or feature-specific effects?
Previous lesion-deficit and functional imaging studies have suggested that there are distinct category-specific regions within the human brain. Using functional magnetic resonance imaging, we tested this claim with a task in which participants decided if two items, represented by words, were members of the same category. Signal changes detected for all pairs of items that were from the same category and for tool pairs were found in rostromedial BA 6, rostral cingulate, and at the BA 6/44 and BA 45/46 junctions. Activation was seen in BA 6 and the left BA 6/44 junction for fruits and vegetables pairs and only in rostromedial BA 6 for animal pairs. The common signal changes in the frontal lobes (BA 6/44) for the categories of fruits and vegetables and tools suggest that this region may be organized in a feature-specific, as opposed to a category-specific, manner.


Playing conditions, player preparation and rugby injury: a case-control study.
This paper investigates the effect of player preparation, ground conditions and weather conditions upon the injury risk for Rugby Union players. A population-based case-control study was performed using a sample (n= 1043) of New Zealand Rugby Union players aged 16 y and above. Details concerning game preparation (warm-up and usual position), and ground and weather conditions (precipitation, wind and temperature) were obtained from the players. If players were injured during the season (n= 624) they were asked to provide details about the game in which they were last injured. Uninjured players (n= 419) provided details about the last game in which they played. Injuries were more likely to occur when games were played on hard grounds or in calm or warm conditions. Playing out of position and the duration of warming up did not significantly alter the risk of injury. When player preparation, ground and weather conditions, grade, age, playing position and rugby experience were simultaneously controlled for, hard ground and the absence of wind were associated with increased risk. The influence of these factors may be indirect, through adaptation to the conditions in which a game is played.


Differential properties of mitosis-associated events following CHK1 and WEE1 inhibitor treatments in human tongue carcinoma cells.
CHK1 and WEE1 play pivotal roles in G2/M checkpoint following exogenous DNA damage and regulation of DNA replication under normal cellular conditions. Here, we monitored and compared the cell cycle kinetics of mitosis-associated events after CHK1 and WEE1 inhibitor treatments in a human tongue cancer cell line (SAS). A fluorescent ubiquitination-based cell cycle indicator (Fucci) that reflects SCFSKP2 and APCCDH1 E3 ligase activities was used to monitor cell cycle progression. Numerous γH2AX-positive cells were observed within the S phase population of cells following CHK1 inhibitor treatment, and polyploid cells exhibiting DNA damage emerged via abortive mitosis (endomitosis) at 24 h post treatment. While WEE1 inhibitor-treated cells exhibited similar polyploidy via endomitosis at later time points, they possessed fewer γH2AX foci during S phase, and polyploid cells exhibiting DNA damage were scarce. Instead, mitosis duration greatly extended and was accompanied by an abnormal emission of Fucci red fluorescence. Kinetic analysis of Fucci fluorescence revealed that abnormal emission occurred at early M phase in a manner independent of green fluorescence degradation as a marker of APCCDH1 activation. When an inhibitor of the essential spindle checkpoint factor MPS1 was co-treated with a WEE1 inhibitor, the elongated mitosis duration and abnormal red fluorescence were abrogated, and WEE1-induced reduction of clonogenic survival was offset. We demonstrate novel differential effects on mitosis-associated events following CHK1 and WEE1 inhibitor treatments.


Pathological and perioperative outcomes of extracorporeal versus intracorporeal anastomosis in laparoscopic transverse colon cancer resection: retrospective multicentre study.
The aim of this study was to compare the pathological and perioperative outcomes of extracorporeal versus intracorporeal anastomosis after laparoscopic transverse colon cancer resection. In this retrospective study, patients from seven institutions in China who underwent laparoscopic resection of transverse colon cancer between 2019 and 2021 were selected and included. Either extended right hemicolectomy or transverse colectomy/extended left hemicolectomy was performed. The clinical characteristics and the pathological and perioperative outcomes were compared between patients undergoing extracorporeal or intracorporeal anastomosis. Resection margin lengths were measured on formalin-fixed specimens and an inadequate margin was defined as less than 4.2 cm between the division and the tumour. The outcome of interest was the prevalence of specimens with an inadequate margin. Length of incision, bowel function recovery, hospital stay, early postoperative pain (first day after surgery), 30-day complications, and nodal harvest were investigated as secondary outcomes. Of 411 patients treated during the study interval, 370 patients with transverse colon cancer were included (23.2 per cent treated with intracorporeal anastomosis and 76.8 per cent treated with extracorporeal anastomosis). The prevalence of specimens with inadequate margins was lower in the intracorporeal anastomosis group compared with the extracorporeal anastomosis group in patients undergoing extended right hemicolectomy (P = 0.045) and in patients undergoing transverse colectomy/extended left hemicolectomy (P = 0.030). In multivariate analysis, extracorporeal anastomosis (OR 2.94 (95 per cent c.i. 1.33 to 6.49), P = 0.008) and transverse colectomy/extended left hemicolectomy (OR 1.75 (95 per cent c.i. 1.03 to 2.96), P = 0.038) were independent risk factors for specimens with an inadequate margin. Intracorporeal anastomosis was associated with a shorter incision length (P < 0.001), an earlier recovery of bowel function (P = 0.035), a shorter postoperative hospital stay (P = 0.042), less early postoperative pain (P < 0.001), a longer specimen length (P = 0.042), a longer resection margin (P = 0.007), and a greater lymph node harvest (P = 0.036). There was no statistically significant difference in 30-day complications. Patients with transverse colon cancer have better perioperative outcomes, fewer margins of less than 4.2 cm, and larger lymph node harvests when the anastomosis is performed intracorporeally. Further studies are needed to confirm these findings. NCT05061199 (www.clinicaltrials.gov).


Possible recovery from an acute envenomation in male rats with LD50 of Echis coloratus crude venom: I-A seven days hematological follow-up study.
The effect of an acute LD50 dose of Echis coloratus crude venom in male albino rats was tested on blood parameters: white blood cells (WBCs), red blood cells (RBCs), platelets count, hemoglobin, hematocrit, mean cell volume (MCV), mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC), also serum glucose, total protein, triglycerides with alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and γ-glutamyl transferase (GGT) enzyme activities. The effect of the LD50 dose was monitored over a period of seven days, with time intervals of 1, 3, 6, 12, 24, 72 h. All of the tested parameters show fluctuations with time and with tendency to regain normal control level after 12 h. At 12-24 h it seems to be crucial for the process of physiological recovery, in spite of the irreversible damage and tissue distraction. The process of physiological adaptation and recovery from the lethal destructive venom effect seems to stabilize after one week, leaving the animal alive with several biochemical altered metabolisms and disturbed physiological profile.


Charged groups on pyropheophorbide-based photosensitizers dictate uptake by tumor cells and photodynamic therapy efficacy.
This study investigated the impact of anionic and cationic substituents of the pyropheophorbide-based photosensitizers (PS) on uptake and retention by tumor epithelial cells and photodynamic therapy (PDT). A series of PSs were generated that bear carboxylic acid functionalities, alkyl amines with variable length of carbon units or as a quaternary ammonium salt introduced at position 172 of 3-(1'-hexyloxy)ethyl-3-devinylpyropheophorbide-a (HPPH). The nature of the functionalities in the macrocycle made a significant difference in overall lipophilicity (log D values at pH 7.4), and in binding to and retention by human and murine tumor cells. Depending on the presence of functional groups, the PSs showed a change in cellular uptake from diffusion to endocytosis and in the preference for subcellular localization to mitochondria/ER or lysosomes. Two and more carboxylic groups drastically reduced uptake by all cell types. In contrast, PSs with amine and quaternary amine salt showed higher cellular binding, uptake and in vitro PDT efficacy than HPPH. The enhanced cellular uptake of the cationic PSs was accompanied by a loss of tumor cell specificity and contributed to severe systemic toxicity in tumor-bearing mice intravenously injected with the PS and subjected to investigate their therapeutic potential.


Word recall process and physiological activation in the tip-of-the-tongue state: Comparison of young and middle-aged groups.
To clarify the feeling of knowing a name but not being able to recall it, known as having a "tip-of-the-tongue" (TOT) experience, we proposed a TOT model consisting of three stages combining a face recognition model and autonomic sympathetic nerve activity. Since TOT increases with age, we compared two age groups: young (N = 27, M = 20.4 ± 1.5 years) and middle-aged (N = 29, M = 58.5 ± 8.0 years). Experiment 1 showed that successfully naming low-frequency common names increased the skin conductance response (SCR) value, and the time to reach the maximum SCR value was longer. Experiment 2 was a naming task for face photographs. The younger group showed higher SCR values during successfully naming, while the middle-aged group showed similar SCR values for successfully naming and experiencing TOT. Both groups had the longest time to reach maximum SCR in TOT. In this study, physiological arousal of TOT was not affected by aging.


Influence factors analysis of COVID-19 Prevention behavior of chinese Citizens: a path analysis based on the hypothetical model.
Under the outbreak of Coronavirus disease 2019 (COVID-19), a structural equation model was established to determine the causality of important factors that affect Chinese citizens' COVID-19 prevention behavior. The survey in Qingdao covered several communities in 10 districts and used the method of cluster random sampling. The research instrument used in this study is a self-compiled Chinese version of the questionnaire. Of the 1215 questionnaires, 1188 were included in our analysis. We use the rank sum test, which is a non-parametric test, to test the influence of citizens'basic sociodemographic variables on prevention behavior, and the rank correlation test to analyze the influencing factors of prevention behavior. IBM AMOS 24.0 was used for path analysis, including estimating regression coefficients and evaluating the statistical fits of the structural model, to further explore the causal relationships between variables. The result showed that the score in the prevention behavior of all citizens is a median of 5 and a quartile spacing of 0.31. The final structural equation model showed that the external support for fighting the epidemic, the demand level of health information, the cognition of (COVID-19) and the negative emotions after the outbreak had direct effects on the COVID-19 prevention behavior, and that negative emotions and information needs served as mediating variables. The study provided a basis for relevant departments to further adopt epidemic prevention and control strategies.


Sponges, apples or almonds in the isthmus of the throat.
Removal of the tonsils is one of the most commonly performed surgical procedures in children. The purpose of this historical note is to analyse the first description of this surgery, understand the first terms used to name the tonsil, and describe the first instruments used to perform this surgery.


Clinicopathological analysis of nonfunctioning pituitary adenomas in patients younger than 25 years of age.
The authors evaluated the pathological and clinical characteristics of young patients with clinically nonfunctioning pituitary adenomas (NFPAs). Twenty-one patients (13 males and 8 females) with NFPAs who were 25 years of age or younger (mean 20 years, range 13-25 years) were retrospectively investigated. The following factors were examined: results of conventional light microscopy, immunohistochemistry, and electron microscopy; clinical symptoms; tumor size and invasion on MRI; and clinical course after therapeutic procedures such as surgery and adjuvant radiotherapy. Two major significant findings in young patients with NFPAs were noted. First, silent subtype 3 adenomas were common, whereas silent gonadotroph adenomas were rare. Second, silent subtype 3 adenomas in young patients tended to be clinically and radiologically aggressive. To correct the morphological diagnosis, NFPAs in young patients should be examined by immunohistochemical analysis and electron microscopy, as well as by light microscopy. The authors' results provide information that will be useful when making decisions regarding the treatment of young patients with NFPAs.


Kinetics of insulin secretion following glucose infusion in patients with atherosclerotic peripheral vascular disease.
Kinetics of insulin secretion following an i.v. glucose infusion, according to the protocol described by Cerasi and Luft, were studied in 19 patients with angiographically documented atherosclerotic peripheral vascular disease and in a group of appropriate controls without clinical signs of disease. No significant differences were noted between patients and controls in plasma cholesterol levels and in the K value following a standard i.v. glucose tolerance test. Blood glucose levels were significantly lower in the patients, whereas mean plasma insulin and triglyceride levels were significantly higher. Analysis of the glucose and insulin responses to the glucose infusion test indicated that 31.6% of the patients had a delayed and sluggish insulin response to the glucose load, fitting the criteria suggested for the diagnosis of prediabetes, versus 10% of the appropriate controls. In particular, simulation of the plasma insulin responses by a square-wave glucose stimulus, confirmed that in a significantly higher number of patients the early insulin peak was below normal limits. The results of this study suggest that increased insulin secretion is not present in patients with atherosclerotic vascular disease, in contrast to reports by other authors, and that inefficient insulin secretory mechanisms may be observed in these patients, thus possibly contributing to the development of the atherosclerotic disease.


Clinical significance of articulating facet displacement of lateral atlantoaxial joint on 3D CT in diagnosing atlantoaxial subluxation.
To improve the recognition of articulating facet displacement of lateral atlantoaxial joint (AFDLAJ), and to evaluate the significance of AFDLAJ in diagnosing atlantoaxial subluxation. The three-dimensional computed tomography (3D CT) imaging findings of 54 patients with atlantoaxial subluxation were retrospectively analyzed, and the imaging features of AFDLAJ were discussed. All the patients were examined in neutral position, and 25 in an additional rotary position. 3D images of the atlantoaxial joints were obtained by surface shade display and volume rendering. The diagnostic results of 3D CT, routine CT and X-ray were compared. All the 54 patients with atlantoaxial subluxation were correctly diagnosed by 3D CT with no suspicious or missed diagnoses, including 38 cases of rotatory subluxation, 11 of anterior subluxation and five of posterior subluxation. AFDLAJ was found in all the 54 patients in neutral position, with the extent of subluxation between 2.0 mm and 9.0 mm. Among the 25 cases in rotary position, rotational fixation was found in 10 cases and rotational asymmetry in 15. The diagnostic accuracy of 3D CT was higher than that of X-ray or routine CT. Once AFDLAJ appears in neutral position and rotational fixation or asymmetry in rotary position, atlantoaxial subluxation can be ascertained, as well as the type and extent of subluxation, and fake subluxation due to the heads rotation or normal lateralized odontoid can be excluded. AFDLAJ is a vital direct sign in diagnosing atlantoaxial subluxation.


Impact of transition from permanent pasture to new swards on the nitrogen use efficiency, nitrogen and carbon budgets of beef and sheep production.
There is currently much debate around the environmental implications of ruminant farming and a need for robust data on nitrogen (N) and carbon (C) fluxes from beef and sheep grazing systems. Here we use data collected from the North Wyke Farm Platform along with the SPACSYS model to examine the N and C budgets and the N use efficiency (NUE) of grassland swards at different stages of establishment. We assessed the transition from permanent pasture (PP) to a high-sugar grass (HSG), and a mixed sward of HSG with white clover (HSGC), identifying data specifically for the reseed (RS) years and the first year following RS (HSG-T and HSGC-T). Dominant fluxes for the N budget were N offtake as cut herbage and via livestock grazing, chemical-N fertiliser and N leaching at 88-280, 15-177, and 36-92 kg N ha-1 a-1, respectively. Net primary productivity, soil respiration and C offtake as cut herbage and via livestock grazing at 1.9-15.9, 1.74-12.5, and 0.34-11.7 t C ha-1 a-1, respectively, were the major C fluxes. No significant differences were found between the productivity of any of the swards apart from in the RS year of establishment. However, NUE of the livestock production system was significantly greater for the HSGC and HSGC-T swards at 32 and 42% compared to all other swards, associated with the low chemical-N fertiliser inputs to these clover-containing swards. Our findings demonstrate opportunities for improving NUE in grazing systems, but also the importance of setting realistic NUE targets for these systems to provide achievable goals for land-managers.


[So-called juxtaglomerular benign tumor of the kidney with renin secretion. Optical and ultrastructural study].
Benign renin secreting tumors of the kidney, of which the authors report a new case, are an uncommon cause of arterial hypertension. The lesion is unique, benign, richly vascularized and constituted by epithelioid cells similar to those seen in the normal juxta-glomerular apparatus. Noteworthy and of great diagnostic value is the massive infiltration of the tumoral tissue by mastocytes. The ultrastructural examination clearly shows the differentiation of the secretory cells from the smooth muscular fibresof the vessel walls. The other types of renin secreting tumours are briefly considered.


Performance of raw bovine meat preservation by hyperbaric storage (quasi energetically costless) compared to refrigeration.
Hyperbaric storage at room temperature (without temperature control) of raw bovine meat was studied and compared to refrigeration. Samples were first stored for 12h at 50, 100 and 150MPa, and in a second set of experiments, for a longer period of 10days at 50MPa. For the 12h storage, refrigeration and 50MPa had a similar microbial growth inhibition effect and, at 100 and 150MPa an additional microbial inactivation effect was found. For the longer experiment (10days at 50MPa) results pointed for a shelf-life increase of raw beef compared to samples stored under refrigeration. For both tests (12h and 10days) samples preserved under pressure showed no detrimental effect on physicochemical parameters comparatively to the initial and refrigerated samples. These results indicate that hyperbaric storage at room temperature not only allows high energy savings, but additionally has potential to extend the shelf-life of a perishable food product compared to refrigeration.


Clonidine transdermal patch poisoning.
A case of infant clonidine poisoning from a transdermal patch that had been worn for five days by an adult and then discarded is described. The infant became hypotensive with a systolic blood pressure of 38 mm Hg, and a dopamine infusion was required for six hours to maintain adequate blood pressure. The infant was discharged 24 hours after admission. Clonidine toxicity, transdermal delivery system pharmacokinetics, and poison prevention are discussed.


Airway management in microgravity: A systematic review.
In the near future, space programs will shift their focus toward long-duration interplanetary missions, in particular to the Moon and Mars. These exploration missions will be associated with an increased risk of acute medical problems, which will need to be handled by an autonomous crew operating in extreme isolation. An important skill in emergencies is represented by airway management. Many airway devices are available and it is unclear which one would be the most suitable in the context of a space mission. The aim of this systematic review was to analyze the existing literature on airway management in the special situation of weightlessness during space missions. We performed a standardized review of published literature on airway management in spaceflight and analogue environments using the database PubMed. We identified a total of 3111 publications of which 3039 were initially excluded after evaluation. The screening identified three randomized comparative manikin studies, two of them in parabolic flights, one in a submerged setup. Under free-floating conditions, the insertion success rate of supraglottic airway devices (SGA) was excellent (91%-97%). The administration of artificial ventilation could be successfully achieved in weightlessness with SGA. The success rate of conventional laryngoscopy under free-floating conditions fluctuated between 15% and 86%. It appears possible to safely manage the airway in weightlessness, provided that certain conditions are ensured, such as restraining the patient and operator for conventional orotracheal intubation. If airway protection is required with endotracheal intubation, both the operator and the patient should be restrained.


Are we making progress with emergency contraception? Recent findings on American adults and health professionals.
To determine how awareness of and practices and attitudes toward emergency contraceptive pills (ECPs) have progressed among the American public and US health professionals. In 1997, we conducted two nationally representative telephone surveys of Americans and health professionals of their knowledge, attitudes, and practices on ECPs and compared the findings to previous surveys. 66% of women and 51% of men 18 to 44 years old had heard of ECPs, up from 61% of women and 45% of men the same age in 1994. Only 1% of women surveyed reported having ever used this method, reflecting no change from 1994. Only 11% of women knew enough about ECPs to be able to use them. Americans named media as the primary source of information about ECPs. The proportion of physicians who had prescribed ECPs at least once in the preceding year increased significantly in 1997: 85% of obstetrician/gynecologists and 50% of family physicians compared to 69% and 34% in 1995. Almost all health professionals considered ECPs to be safe (99%) and effective (100%), yet relatively few discussed this option with their patients, and even fewer commonly prescribed it. Ongoing efforts are needed to improve awareness among the general public and to encourage health professionals to discuss and offer ECPs more widely.


Family Communication About Climate Change in the United States.
Family discussions about climate change are a critical factor influencing children's climate change perceptions and behaviors. Yet, there is limited research on family communication about climate change in the US. Drawing from an online longitudinal sample, 214 parents reported on their 336 children. Descriptive statistics examined engagement in family climate change communication. Children's climate change concerns and parents' interest in engaging in conversations about climate change were assessed by the child's age. Logistic models examined how recent family climate change communication was associated with parents' perceived roles and barriers to engaging in conversations. Most parents (68%) were interested in talking to their children about climate change; of those expressing interest, only 46% reported recent communication. Parents reported that older children were more concerned about climate change than younger children (0-5 years: 21%; 6-11 years: 43%; 12-17 years: 56%), but no differences were identified in parents' interest in communicating with their children by the child's age. Recent family climate change communication was significantly associated with not knowing what to say and parents' perception that their role was to support their children in action. Study findings suggest a significant opportunity to involve families in climate change communication. Parents may benefit from training resources, especially those tailored to children's age, to help them communicate with their children about climate change. Strategies that engage parents and children in activism activities together are also needed.


The characterization of sulphated metabolites of norethindrone in human milk after oral administration of contraceptive steroids.
The excretion of ethynyl steroids in milk from a lactating woman taking a daily dose of an oral contraceptive (Conlumin) containing 1 mg of norethindrone and 50 micrograms of mestranol has been studied. Milk was diluted with aq. triethylamine sulphate and steroids were extracted on a Sep-Pak C18 cartridge at 60-64 degrees C. Groups of unconjugated steroids, glucuronides, mono- and disulphates were separated on triethylaminohydroxypropyl Sephadex LH-20. Following hydrolysis and further purification, steroids possessing an ethynyl-substituent were isolated by chromatography on sulphohydroxypropyl Sephadex LH-20 in silver form. Gas chromatographic-mass spectrometric analysis of the O-methyloxime-trimethylsilyl ether derivatives of these steroids, showed the presence of norethindrone and mestranol in the free fraction and of tetrahydro metabolites of norethindrone with 3 alpha,5 alpha, 3 alpha,5 beta and 3 beta,5 alpha configurations in the mono- and disulphate fractions. The disulphate of the 3 alpha,5 alpha isomer was the most abundant ethynyl steroid in milk after 13 days of administration. The site of conjugation of the monosulphates was established by acetylation prior to solvolysis and analysis by gas chromatography-mass spectrometry. This showed that the 3 alpha,5 alpha isomer was conjugated mainly in the 17 beta-position while the 3 alpha,5 beta isomer was conjugated at C-3.


Effect of vitamin A administered at Expanded Program on Immunization contacts on antibody response to oral polio vaccine.
Vitamin A supplementation to mothers in the postpartum period and to their infants at routine immunization contacts is being considered to reduce vitamin A deficiency in infancy. This study was conducted to determine the impact of maternal and infant vitamin A supplementation on antibody response to oral polio vaccine (OPV). Randomized, double blind, placebo-controlled trial. Mothers in the intervention group received 60 mg retinol equivalent (RE) vitamin A 3-4 weeks after delivery and their infants 7.5 mg RE with each OPV dose at 6, 10 and 14 weeks of age. The control group mothers and their infants received a placebo at each of these contacts. Geometric mean (GM) titer of neutralizing antibodies and proportion of children with protective titer to the three polioviruses at 26 weeks of age. Vitamin A supplementation increased the proportion of infants with protective antibody titer against poliovirus type 1 (relative risk (RR) 1.15, 95% confidence interval (CI) 1.03-1.28) and the GM antibody titer (ratio of GM 1.55, 95% CI 1.03-2.31) following immunization. The proportion of infants with protective antibody titer against poliovirus type 2 (RR 0.99, 95% CI 0.94-1.05) or type 3 (RR 1.05, 95% CI 0.96-1.15) was not significantly different in vitamin A and placebo groups. The GM antibody titer for poliovirus type 2 (ratio of GM 0.99, 95% CI 0.64-1.54) or poliovirus type 3 (ratio of GM 1.10, 95% CI 0.69-1.75) also did not differ across groups. Vitamin A given to the mothers in the postpartum period and their infants with OPV did not interfere with the antibody response to any of the three polioviruses and enhanced the response to poliovirus type 1.


[Complete resection of a vertebral body (author's transl)].
The resection of one or more vertebral bodies is technically difficult and quite demanding for the patient. In cases of solitary metastases to a vertebral body such a procedure may be considered when the general condition of the patient is satisfactory. To mobilise the patient quickly the stabilisation of the spine with bone cement and plates is mandatory. Three of four cases have been treated by two consecutive operations, one patient received a prefabricated ceramic implant. Mobilisation was maintained until four months after surgery. An analysis of previously published reports on complete vertebral body resection shows advantages and disadvantages of several methods.


Effects of bandwidth feedback on the automatization of an arm movement sequence.
We examined the effects of a bandwidth feedback manipulation on motor learning. Effects on movement accuracy, as well as on movement consistency, have been addressed in earlier studies. We have additionally investigated the effects on motor automatization. Because providing error feedback is believed to induce attentional control processes, we suppose that a bandwidth method should facilitate motor automatization. Participants (N=48) were assigned to four groups: one control group and three intervention groups. Participants of the intervention groups practiced an arm movement sequence with 760 trials. The BW0-Group practiced with 100% frequency of feedback. For the BW10-Group, feedback was provided when the errors were larger than 10°. The YokedBW10-Group participants were matched to the feedback schedule of research twins from the BW10-Group. All groups performed pre-tests and retention tests with a secondary task paradigm to test for automaticity. The BW10-Group indicated a higher degree of automatization compared with the BW0-Group, which did not exhibit a change in automaticity. The comparison of the YokedBW10-Group, which also exhibited automatization, and the BW10-Group leads to the proposal that reduction of quantitative feedback frequency and additional positive feedback are responsible for the bandwidth effect. Differences in movement accuracy and consistency were not evident.


[Results of panastragal arthrodesis performed on basis of different indications].
The indications of pantalar arthrodeses - performed in 21 years - and their results are discussed. In the authors' opinion, the compression arthrodessis carried out in one sitting is the method of choice.


Does Ileocecal Resection Affect Children's Medium-Long-Term Growth and Defecation Patterns? A Matched Case-Control Study.
Ileocecal resection leads to some early complications, but it is unknown whether it affects children's medium-long-term growth and defecation patterns. To determine if there was an association, we conducted this matched case-control study. This study was conducted in Beijing Children's Hospital and included three groups: the case group (n = 30) included patients with ileocecal duplication undergoing ileocecal resection between January 2010 and June 2021, the control group (n = 90) included outpatient patients without ileocecal resection in January 2022, and the appendectomy group (n = 90) included patients who underwent appendectomy between January 2010 and June 2021. The 1:1 matching criteria included gender and age (within 1 year). The evaluation indicators were growth (height-for-age, BMI) and defecation patterns (stool frequency, stool consistency) over 6 months after surgery. Defecation patterns were assessed in patients older than 4 years. Stool consistency was evaluated by the modified Bristol Stool Form Scale. There were no significant differences, except for stool consistency, between the case and control groups regarding their growth and defecation patterns before case-control matching. The patients in the case group had a significantly higher prevalence of dry stool (P < 0.008). After case-control matching, there were no significant differences in the growth and defecation patterns between the case and control groups. Before and after case-control matching, there were no significant differences in the defecation patterns between the control group and the appendectomy group. Children's medium-long-term growth and defecation patterns were not affected by ileocecal resection.


Combination of vancomycin and rifampicin for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.
Coagulase-negative staphylococci are the most common cause of late-onset sepsis in premature neonates. The optimal approach in persistent coagulase-negative staphylococcal bacteremia, despite adequate treatment with glycopeptides, is not well established. A retrospective study was conducted on preterm neonates with persistent coagulase-negative staphylococcal bacteremia treated with the combination of vancomycin-rifampicin. Ten cases were included, with a median gestational age of 26 weeks (range 24 weeks + 3 days-31 weeks + 4 days, interquartile range 25 weeks + 3 days-29 weeks + 3 days) and a median birth weight of 715 g (range 555-2,030). The median age at the onset of infection was 9 days (range 5-37). The most frequent clinical presentation was apnea or increased ventilatory support. Bacteremia persisted for a median of 9 (range 6-19) days until rifampicin initiation. Bacteremia was resolved in all cases on vancomycin-rifampicin with no serious side effects. Our study provides data supporting the safety and efficacy of vancomycin-rifampicin combination for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.


Abrocitinib efficacy and safety in patients with moderate-to-severe atopic dermatitis: Results from phase 3 studies, including the long-term extension JADE EXTEND study.
Abrocitinib improved signs and symptoms of moderate-to-severe atopic dermatitis (AD) at 12 or 16 weeks in phase 3 studies with a manageable safety profile. Further understanding of the abrocitinib long-term efficacy and safety profile is important for its appropriate use in treating chronic AD. To evaluate the abrocitinib efficacy up to 48 weeks and long-term safety in patients with moderate-to-severe AD. JADE EXTEND (NCT03422822) is an ongoing, phase 3, long-term extension study that enrolled patients from previous abrocitinib AD trials. This analysis focusses on patients from the phase 3 JADE MONO-1 (NCT03349060), JADE MONO-2 (NCT03575871) and JADE COMPARE (NCT03720470) studies who completed the full treatment period of placebo or abrocitinib (200 mg or 100 mg once daily) and subsequently entered JADE EXTEND. Efficacy endpoints included the proportion of patients achieving skin clearance (Investigator's Global Assessment [IGA] 0/1 [clear/almost clear]; ≥75% improvement in Eczema Area and Severity Index [EASI-75]) and itch response (Peak Pruritus Numerical Rating Scale [PP-NRS] severity ≥4-point improvement). Safety endpoints included treatment-emergent adverse events (TEAEs), serious TEAEs and TEAEs leading to discontinuation. Data cut-off: April 22, 2020. As of the data cut-off, ~70% and ~45% of patients received abrocitinib for ≥36 and ≥48 weeks, respectively. Nasopharyngitis, atopic dermatitis, nausea and upper respiratory tract infections were the most frequent TEAEs. Serious TEAEs occurred in 7% and 5% and TEAEs leading to study discontinuation occurred in 9% and 7% of patients receiving abrocitinib 200 mg and 100 mg, respectively. Week 48 efficacy responses with abrocitinib 200 mg and 100 mg were as follows: IGA 0/1 52% and 39%; EASI-75 82% and 67%, and PP-NRS severity ≥4-point improvement 68% and 51%. In patients with moderate-to-severe AD, long-term abrocitinib treatment resulted in clinically meaningful skin and pruritus improvement. The long-term safety profile was manageable and consistent with previous reports.


Spontaneous neurotransmission: a SNARE for the rest.
In addition to activity-dependent neurotransmission, neurons can undergo spontaneous activity-independent neurotransmitter release with low probability. In this issue of Neuron, Ramirez et al. (2012) now identify the noncanonical endosomal SNARE Vps10p-tail-interactor1a (Vti1a) as a regulator of spontaneously fusing vesicles.


Progression of amygdala volumetric abnormalities in adolescents after their first manic episode.
Although previous neuroimaging studies suggest that adolescents with bipolar disorder exhibit smaller amygdala volumes compared with healthy adolescents, whether these abnormalities are present at illness onset or instead develop over time remains unclear. The aim of this study was to conduct a prospective longitudinal investigation comparing amygdala neurodevelopment among adolescents after their first manic episode, adolescents with attention-deficit/hyperactivity disorder (ADHD), and healthy adolescents. A total of 30 adolescents hospitalized for their first manic/mixed episode associated with bipolar disorder, 29 adolescents with ADHD, and 24 demographically matched healthy teens underwent magnetic resonance imaging scanning at index assessment and approximately 12 months later. Adolescents with bipolar disorder were prospectively evaluated using diagnostic interviews and with symptom rating scales. Mixed models examining the group × time effect for both left (p = .005) and right (p = .002) amygdala volumes were statistically significant. Change in left (p = .01) and right (p = .0008) amygdala volumes from baseline to 12 months were significantly different among groups. Specifically, left amygdala volumes increased over time in healthy adolescents (p = .008) and adolescents with ADHD (p = .0009), but not in adolescents with bipolar disorder (p = .3). Right amygdala volume increased over time in adolescents with ADHD (p < .001), but not in healthy adolescents nor in adolescents with bipolar disorder (p = .1 and p = .3, respectively). In adolescents with bipolar disorder, baseline total amygdala volume was significantly greater in those who subsequently achieved symptomatic recovery as compared with those who did not achieve recovery (p = .02). Adolescents with mania do not exhibit normal increases in amygdala volume that occur during healthy adolescent neurodevelopment.


Rat muscle during post-natal development: evidence in favour of no interconversion between fast- and slow-twitch fibres.
1. It was confirmed that in the fourth deep lumbrical muscle of the rat the number of muscle fibres at birth is about half that in the adult. 2. The average number of slow-myosin-containing (S) fibres (as determined by specific antibody binding) remains constant from birth to adulthood. Therefore it is likely that all the muscle fibres generated post-natally are type F (i.e. slow-myosin-free). 3. A comparison in the electron microscope between transverse mid-belly sections from new-born (day 0) and 4 day muscles showed many muscle fibres or myotubes to be intimately associated with other fibres and cells of other types in the new-born, but to be much less closely grouped at 4 days. 4. A full cell count was obtained from electron microscopy of a mid-belly section of a lumbrical muscle at birth. 5. Cross-sectional area measurements in the light microscope at 3-5 days and in the adult showed that at 3-5 days on average the S fibres have a greater cross-sectional area than the F fibres. This is reversed in the adult where the S fibres are the smaller. At 3-5 days the range of cross-sectional areas of F fibres is much wider than for S fibres. Some F fibres are among the largest fibres in the muscle. 6. It is argued from the data that the motor units of adult muscle, which are homogeneous with respect to muscle-fibre types, are produced by selective withdrawal of neonatal motor-unit contacts during developmental synapse elimination.


Initial Clinical Experience with a Simple, Home System for Early Detection and Monitoring of Diabetic Foot Ulcers: The Foot Selfie.
Diabetic foot ulcers (DFUs) are a leading cause of disability and morbidity. There is an unmet need for a simple, practical, home method to detect DFUs early and remotely monitor their healing. We developed a simple, inexpensive, smartphone-based, "Foot Selfie" system that enables patients to photograph the plantar surface of their feet without assistance and transmit images to a remote server. In a pilot study, patients from a limb-salvage clinic were asked to image their feet daily for six months and to evaluate the system by questionnaire at five time points. Transmitted results were reviewed weekly. Fifteen patients (10 male) used the system after approximately 5 minutes of instruction. Participants uploaded images on a median of 76% of eligible study days. The system captured and transmitted diagnostic quality images of the entire plantar surface of both feet, permitting clinical-management decisions on a remote basis. We monitored 12 active wounds and 39 pre-ulcerative lesions (five wounds and 13 pre-ulcerative lesions at study outset); we observed healing of seven wounds and reversal of 20 pre-ulcerative lesions. Participants rated the system as useful, empowering, and preferable to their previous methods of foot screening. With minimal training, patients transmitted diagnostic-quality images from home on most days, allowing clinicians to review serial images. This system permits inexpensive home foot screening and monitoring of DFUs. Further studies are needed to determine whether it can reduce morbidity of DFUs and/or the associated cost of care. Artificial intelligence integration could improve scalability.


Plain film, CT and MRI sensibility in the evaluation of intraorbital foreign bodies in an in vitro model of the orbit and in pig eyes.
Detection and characterization of intraorbital foreign bodies (IFB) is fundamental in acute trauma setting, preventing inflammatory sequelae or complications related to IFB movements when a MRI study is planned. Papers concerning plain film and CT sensibility in IFB detection show controversial results. For this reason we investigated plain film, CT and MRI sensibility in the evaluation of IFB. For an in vitro model, specimens of dry and fresh wood, glass, iron, plastic and graphite were immersed in animal lard and in a 0.9% sodium chloride plus 3.5 g/dl human serum albumin solution. Specimens of different size and nature where also implanted into enucleated pig eyes. Air bubbles were introduced also. Plain film, CT and MRI investigation were performed. Plain films underestimated intraocular IFB as plastic, fresh or dry wooden IFB were not demonstrated. The CT study was always able to depict and differentiate IFB according to the attenuation values. Severe artefacts prevented demonstration of iron, glass and graphite IFB on MRI, whereas plastic or wooden IFB were always detected. Despite radiographs have been suggested as a prerequisite for MR imaging, because our results showed plain film to underestimate radiolucent IFB, we suggest CT as the modality of choice when IFB has to be ruled out.


Inflicted and noninflicted injuries: differences in child and familial characteristics.
Clinicians involved in child protection work are frequently confronted with decisions as to whether a child's injury is inflicted or accidental. This study examines child, parental, familial, and environmental characteristics in a group of 25 abused children compared to a group of 90 children with accidents. Significant differences and commonalities are discussed.


Ensembles of synthetic polymers mimic biological fluids.
Recently a report by Ruan et al. in Nature described how relatively simple random heteropolymers can replicate the properties of biological fluids. These polymers capture the segmental-level interactions between proteins and could enhance folding of membrane proteins, improve stability, and enable DNA sequestration in a chemistry specific manner.


Microinjection of normal cell extracts into Fanconi anemia fibroblasts corrects defective scheduled DNA synthesis recovery after 8-methoxypsoralen plus UVa treatment.
Fanconi anemia (FA) cells show an increased sensitivity to 8-methoxypsoralen (8-MOP) plus UVa treatment; after an initial reduction of their semiconservative DNA synthesis rate, they do not recover like normal cells. We microinjected extracts from normal cells into FA fibroblasts from complementation group A and determined semiconservative DNA synthesis rates by autoradiography; the hampered recovery phase was completely restored.


Reduction of gastric hyperemia by glypressin and vasopressin administration in cirrhotic patients with portal hypertensive gastropathy.
Gastric mucosal perfusion is increased in portal-hypertensive gastropathy, and this may contribute to gastric bleeding from these lesions. Therefore drugs reducing gastric mucosal perfusion may be beneficial in the treatment of overt bleeding from portal-hypertensive gastropathy. In this study gastric mucosal perfusion was assessed in 28 cirrhotic patients with portal-hypertensive gastropathy under basal conditions and after double-blind intravenous administration of vasopressin (0.4 U/min), glypressin (2-mg injection) or placebo, with laser-Doppler flowmetry and reflectance spectrophotometry. Vasopressin and glypressin induced a significant increase in blood pressure and a decrease in heart rate. These effects were more pronounced in the vasopressin group. Both vasopressin and glypressin induced a sustained and similar reduction in gastric mucosal perfusion as assessed by laser-Doppler flowmetry (-36% +/- 8% and -34% +/- 6%, respectively; p < 0.05 with respect to basal values and with respect to the control group), whereas placebo had no effect. Both drugs significantly reduced the oxygen content of the gastric mucosa; however, the impairment in mucosal oxygenation was greater (p < 0.05) in the vasopressin group (-17% +/- 3%) than in the glypressin group (-6% +/- 0.1%). We conclude that the increased gastric perfusion in cirrhotic patients with portal-hypertensive gastropathy may be reduced by either vasopressin or glypressin. These findings support the use of these drugs in clinical trials treating bleeding portal-hypertensive gastropathy. The lower reduction in gastric mucosal oxygen content observed with glypressin could decrease the incidence of ischemic adverse events associated with the use of vasopressin.


What is the cause of death, when alcohol dependent persons die prematurely?
Although individuals with alcohol use disorder (AUD) have a significantly shorter lifespan than the general population, there is sparse evidence on cause of death when alcohol dependent people die prematurely. Especially the somatic causes of death are shed less light on. To determine the cause of premature death in individuals with AUD based on recent studies. This systematic review summarizes evidence from the last 10 years with cohort studies consisting of AUD patients with the subsequent outcome of cause of death and with at least two years of follow-up. Nine studies were included of which only two were assessed to be of good quality. Furthermore, two studies were of moderately good and acceptable quality, respectively. This review found increased mortality in AUD individuals with the main causes of death being malignancy, and problems of the cardiovascular- and the digestive system. Malignancy was the most common cause of death in the included AUD cohorts, but the overall quality of the included studies in this review is low. There is a need for high-quality studies to better understand cause-specific mortality among AUD individuals.


The bacterial HPr kinase/phosphorylase: a new type of Ser/Thr kinase as antimicrobial target.
Protein phosphorylation plays a major role in bacterial cellular regulation as in eukaryotes. The HPr Kinase/Phosphorylase (HprK/P) was the first bacterial serine protein kinase to have had its structure determined, establishing that it is unrelated to the eukaryotic kinases. HprK/P belongs to another large structural family, the P-loop containing proteins. Among them, P-loop containing kinases have been assumed to only phosphorylate small molecules, but the example of HprK/P suggests that some may have proteins as substrates, defining novel cellular signal transduction pathways. Another major result of the studies presented here is that HprK/P also catalyses the phosphorolysis of the phosphoserine, yielding serine and pyrophosphate. The two different catalytic activities are carried out at the same active site. The determination of the structure of the complex with the protein substrates HPr and PserHPr allowed us to propose a catalytic mechanism. Since regulation of HPr phosphorylation has been shown to be involved in the virulence process of pathogenic bacteria, a search for specific inhibitors of HprK/P is of clinical interest and the first hit has already been found.


MicroRNA profile in the squamous cell carcinoma: prognostic and diagnostic roles.
Head and neck squamous cell carcinomas (HNSCCs) are human malignancies associated with both genetic and environmental factors. MicroRNAs (miRNAs) as a group of small non-coding RNAs have prominent roles in the development of this kind of cancer. Expressions of several miRNAs have been demonstrated to be increased in HNSCC samples vs. non-malignant tissues. In silico prediction tools and functional analyses have confirmed the function of some miRNAs in the modulation of cancer-associated targets, thus indicating these miRNAs as onco-miRs. Moreover, numerous miRNAs have been down-regulated in HNSCC samples. Their targets mostly enhance cell proliferation or inhibit apoptosis. miRNAs signature has practical implications in the diagnosis, staging, and management of HNSC. Most notably, numerous miRNAs have been shown to alter response of tumor cells to anti-cancer drugs such as cisplatin and doxorubicin. Circulating levels of these small transcripts have been suggested as promising biomarkers for diagnosis of HNSCC. In the present manuscript, we sum up the available literature regarding the miRNAs signature in HNSCC and their role as diagnostic/prognostic biomarkers.


Which patients with chronic obstructive pulmonary disease benefit from the addition of an inhaled corticosteroid to their bronchodilator? A cluster analysis.
To identify subsets of chronic obstructive pulmonary disease (COPD) patients who are more protected from exacerbations with the use of an inhaled corticosteroid/long-acting β2 agonist (ICS/LABA) combination, compared with the use of LABA monotherapy. Post hoc cluster analysis of patients from two randomised clinical trials of salmeterol/fluticasone propionate (SFC) and salmeterol (SAL) that had primary endpoints of moderate/severe exacerbation rates. Centres in North America. 1543 COPD patients were studied. SFC 50/250 µg or SAL 50 µg, twice daily. The analysis identified clusters of COPD patients more responsive to SFC versus SAL with respect to the annual rate of moderate/severe exacerbations and compared their baseline clinical characteristics. Overall, SFC significantly reduced the annual rate of moderate/severe exacerbations as compared with SAL alone (rate ratio (RR)=0.701, p<0.001). Three-patient clusters were identified: COPD patients receiving diuretics (RR=0.56, p<0.001); patients not receiving diuretics but with forced expiratory volume in 1 s (FEV1) reversibility ≥12% (RR=0.67, p<0.001) exhibited a substantial reduction in the annual rate of moderate/severe exacerbations relative to SAL. A third cluster, consisting of patients not receiving diuretics and without FEV1 reversibility, demonstrated no difference for SFC versus SAL. Patients receiving diuretics had a significantly higher prevalence of comorbid cardiovascular disease. COPD patients receiving diuretics and those not receiving diuretics but with FEV1 reversibility >12% at baseline were significantly more likely to experience a reduction in COPD-associated exacerbations with SFC versus SAL alone. NCT00115492, NCT00144911.


Epicardial cyst originating from right ventricle.
Pericardial cysts are reported by some authors, but epicardial cysts are extremely rare. We report one case of epicardial cyst that was detected incidentally and was removed successfully. Furthermore, unusually, pathological examinations confirmed that the cyst wall was looked like a vessel wall.


Update on contraceptive options: a case-based discussion.
As health care providers, we must engage our female patients in a dialogue about their contraceptive and fertility decisions. Empowering and educating our patients about their bodies' hormones, the menstrual cycle, and the risk of unintended pregnancy are central to effective contraceptive counseling. Selecting an appropriate method for a patient and her medical profile is rewarding and challenging in view of new medications, novel delivery systems, and evolving research.


Pregnancy and childbirth in women with bleeding disorders: A retrospective cohort study.
Reproductive-age women with bleeding disorders (BDs) are underdiagnosed and understudied, despite their increased risk for adverse health outcomes and pregnancy complications. This study examines pregnancy outcomes and obstetric complications of Utah women with BDs. This retrospective cohort study utilized linked birth records and clinical billing data from two large Utah healthcare systems. Utah residents who had their first birth at > 20 weeks gestation (2008-2015) and who received non-emergent care within either system before delivery were included (n = 61 226). Multivariable logistic regression models were used to examine relationships between BDs and neonatal and obstetric outcomes. A total of 295 women (.48%) were included in the BD study population. Women with BDs had significantly increased odds of preterm birth (aOR 1.85, 95% CI 1.32-2.60), Caesarean delivery (aOR 1.38, 95% CI 1.06-1.79), postpartum blood transfusion (aOR 2.55, 95% CI 1.05-6.22), unplanned postpartum hysterectomy (aOR 33.96, 95% CI 7.30-157.89) and transfer to an intensive care unit (aOR 18.18, 95% CI 7.17-46.08). All of the women with BDs who experienced these serious complications were not diagnosed with a BD until the year of their first birth. Additionally, those with BDs were more likely to experience maternal and infant mortality. Women with BDs had an increased risk for preterm birth, Caesarean delivery, blood transfusion, unplanned hysterectomy, intensive care unit admission, maternal and infant mortality. Those who were not diagnosed with a BD before the year of their first birth were at an increased risk for serious pregnancy complications.


Radiation absorbed from dental implant radiography: a comparison of linear tomography, CT scan, and panoramic and intra-oral techniques.
Absorbed radiation dose in bone marrow, thyroid, salivary gland, eye, and skin entrance was determined by placement of lithium fluoride thermoluminescent dosimeters (TLD's) at selected anatomical sites within and on a human-like x-ray phantom. The phantom was exposed to radiation from linear tomographic and computer-assisted tomographic (CT) simulated dental implant radiographic examinations. The mean dose was determined for each anatomical site. Resulting dose measurements from linear tomography and computer-assisted tomography are compared with reported panoramic and intra-oral doses. CT examination delivered the greatest dose, while linear tomography was generally lowest. Panoramic and intra-oral doses were similar to those of linear tomography.


Biological properties and clinical application of propolis. IX. Experimental observation on the influence of ethanol extract of propolis (EEP) on dental pulp regeneration.
The use of ethanol extract of propolis (EEP) on injured dental pulp results in the stimulation of regenerative processes. A reduction of disorders of the circulatory system is observed, inflammatory and degenerative processes are also reduced.


Tracheoesophageal fistula presenting with ventilator air leaks and recurrent pneumonia.
We describe a patient who received tracheostomy but complicated with tracheoesophageal fistula, where the nasogastric tube was visible from the fistula under bronchoscopy. Tracheostomy tube was then replaced with an endotracheal tube to bypass the fistula.


Severe acidosis and subsequent neurologic status.
To examine the relationship between severe acidosis at birth and evidence of subsequent neurologic dysfunction, a 4-year review was performed encompassing 15,528 neonates. One hundred forty-two (0.91%) of these neonates had an umbilical cord arterial pH less than or equal to 7.05 with a base deficit greater than or equal to mEq/L. Neurologic assessments found 101 of 110 term neonates (91.8%) and 17 of 32 preterm neonates (53.1%) with severe acidosis to be free of neurologic deficits at the time of hospital discharge. Follow-up developmental evaluation data were available for 7 of 9 term neonates and 8 of 15 preterm neonates with abnormal examinations. Although 5 term and 6 preterm infants demonstrated mild developmental delays or mild tone abnormalities in the first year of life, none exhibited a major motor or cognitive abnormality at 12 to 24 months of age. Consequently, acidosis in umbilical cord blood, even when severe, is a poor predictor of subsequent neurologic dysfunction.


Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta-analysis.
There are two major methods for local anesthesia by lidocaine before upper gastrointestinal endoscopy: simple spray and viscous solution. We aimed to assess the efficacy and safety by meta-analysis between these two methods. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases through October 2019 to perform meta-analyses using random-effects models. The primary outcomes were participants' pain/discomfort, satisfaction, and anaphylactic shock. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in PROSPERO (CRD42020155611). We included seven randomized controlled trials (2667 participants). The participants' pain/discomfort may be similar between the lidocaine spray and viscous solution [standardized mean difference 0.03, 95% confidence intervals (CI) -0.37 to 0.42; I2 = 93%; low certainty of evidence]. The lidocaine spray probably increased participants' satisfaction compared with the viscous solution (relative risk 1.22; 95% CI, 1.02 to 1.47; I2 = 47%; moderate certainty of evidence). No anaphylactic shock occurred in four studies (low certainty of evidence). Four studies had high risks of selection bias. The use of lidocaine spray for local anesthesia provided better satisfaction scores than the viscous solution, and both methods have the same effect with regards to the control of discomfort and pain. Further studies in large multicenter randomized controlled trials with a pre-registration protocol are needed.


Qualitative assessment of postnatal maturation of the organ of Corti in two rat strains.
The radial width of three rows of cuticular plates of outer hair cells (width of the OHC triad), the distribution of inner hair cells along the organ of Corti, and postnatal maturation of the middle ear were examined in rats of the Srague-Dawley and Lewis strains aged 0-24 days and two months. The width of the OHC triad is a good indication of the course of maturation of the reticular lamina and the organ of Corti in different regions of the cochlea. The width of the OHC triad in adult rats decreases continuously from the apex toward the base, while in newborn pups the trend is just the reverse. Thus, there is a region of the cochlea in which the width of the OHC triad is the same, or changes insignificantly, from birth to adulthood. This particular region (where the process of postnatal maturation of the organ of Corti begins?) corresponds to the region of maximum density of inner hair cells and tonotopically to the region of 'best hearing'. The width of the OHC triad will reach its adult values earlier in the basal than in the apical regions. The time-course of middle ear maturation correlates well with the time-course of maturation of the reticular lamina. The parameters under study are in many respects strain-specific.


Administration of drugs known to inhibit P-glycoprotein increases brain bilirubin and alters the regional distribution of bilirubin in rat brain.
P-glycoprotein (P-gp) is an ATP-dependent integral plasma membrane efflux pump, expressed in abundance in brain capillary endothelial cells and astrocytes. P-gp contributes to the blood-brain barrier in limiting the influx and retention of a variety of lipophilic compounds, including unconjugated bilirubin. Several drugs block P-gp function and thereby enhance intracellular accumulation of P-gp substrates. In this study we proposed that pretreatment with drugs known to inhibit P-gp function in clinically relevant doses would alter the uptake of bilirubin in the brain of 32- to 36-d-old rats. In the first arm of the study, the animals received pretreatment with an i.v. infusion of either propanolol, erythromycin, verapamil, ceftriaxone, rifampin, or saline, 10 min before an i.v. bolus of 50 mg/kg bilirubin was given. Except for the erythromycin-treated rats, all treatment groups had significantly higher brain-to-serum bilirubin ratios than control animals (p < 0.05, Welch's t test). In the second arm of the study, treatment with either ceftriaxone or rifampin or saline i.v. preceded a 50 mg/kg i.v. bolus of radioactive bilirubin. Analysis of seven different brain regions by scintillation counting showed that the distribution patterns differed significantly between the study groups (p < 0.001, ANOVA), however, not in accordance with a kernicteric staining pattern. Because of limited knowledge of expression and function of P-gp and other membrane transport proteins in the newborn, the implications of this study remain to be seen. We speculate that drugs known to inhibit P-gp function may increase the risk of bilirubin encephalopathy in the hyperbilirubinemic infant.


Biofilm-specific surface properties and protein expression in oral Streptococcus sanguis.
Oral streptococci are primary colonisers of the tooth surface and are abundant in dental plaque biofilms. Bacteria growing in these relatively dense, surface-associated communities are phenotypically quite distinct from their planktonic counterparts. The purpose of the present study was to develop a method to investigate biofilm-specific surface protein expression by Streptococcus sanguis to help provide a better understanding of the critical events in plaque development. Biofilm cells were grown on the surface of glass beads in a biofilm device fed with mucin-containing artificial saliva. Planktonic cells were grown in continuous culture at approximately the same growth rate. Surface hydrophobicity of biofilm and planktonic cells was determined by hexadecane partitioning, and expression of streptococcal fibronectin adhesin CshA was determined in ELISA using specific antiserum. Antisera raised to glutaraldehyde-fixed whole biofilm or planktonic grown cells were used to screen an expression library of S. sanguis genomic DNA, and isolated clones were sequenced. Phenotypic analysis of biofilm and planktonic cells confirmed that mode of growth affected surface properties of S. sanguis. Thus, hydrophobicity and CshA expression was significantly elevated in biofilm cells. Library screening with biofilm antiserum yielded 32 recombinant clones representing 21 different S. sanguis proteins involved in adhesion and colonisation, carbohydrate utilisation or bacterial metabolism. In differential analysis of four selected Escherichia coli clones, biofilm antiserum reacted five times stronger than planktonic antiserum with cell-free extracts of clones encoding homologues of CshA and Cna collagen adhesin of Staphylococcus aureus, suggesting that these surface proteins are up-regulated in biofilm cells. In contrast, both antisera reacted equally strongly with cell-free extracts of the remaining two clones (encoding dihydrofolate synthase and an unknown protein). The method described represents a useful means for determining bacterial protein expression in biofilms based on a combination of molecular and immunological techniques. Surface expression of putative fibronectin and collagen adhesins was up-regulated in biofilm cells.


Anisotropy and reproducibility of ultrasound shear wave elastography in patella tendons with and without tendinopathy.
Ultrasound shear wave elastography (SWE) is a tool that can be utilized to assess biomechanical properties of tendons. Anisotropy, an ultrasound imaging artifact has been commonly cited as a potential source of error in the accuracy and reproducibility of SWE. The aim of the study was to assess reproducibility in performing SWE of patella tendons and differences in SWE and anisotropy between normal patella tendons and patellar tendinopathy. After obtaining the Institutional Review Board approval and written informed consent, we prospectively measured the shear wave velocity (SWV) of patella tendons with and without tendinopathy in 25 volunteers. SWVs were measured in three anatomic planes: longitudinal, perpendicular transverse, and tilted transverse with the probe tilted 15-30° from the perpendicular transverse plane by three operators with varied levels of experience. Anisotropy coefficient (A) was calculated by formula of A = (SWVLongitudinal - SWVTransverse) / SWVTransverse. Differences in SWV and anisotropy coefficient between normal tendons and tendons with tendinopathy were significant (p < 0.05). The intra- and inter-observer reproducibility in performing SWE were moderate to good (intraclass correlation coefficient: 0.81-0.95). The mean difference of 95% Bland-Altman limits of agreement for measuring tendon SWV ranged -0.08 to 0.41 (upper 0.08 to 1.14, lower -1.22 to -0.22) between senior and junior operators. The results of this study suggest that SWE and anisotropy coefficient are feasible tools to differentiate patellar tendinopathy from normal patella tendons. The reproducibility of performing SWE of patella tendons is moderate to good.


Lymphocyte capping in muscular dystrophies.
Since reports of lymphocyte capping in muscular dystrophies of various authors revealed controversial results, we investigated 47 patients and carriers with Duchenne or Becker-Kiener muscular dystrophy according to different methods. There was no significant reduction of cap formation compared to 64 healthy controls, both groups showing a mean of about 75% caps. Reduced numbers of caps, however, could be demonstrated in three otherwise healthy probands aged 70 years or more, two patients under interferon treatment, four patients under high dose methotrexate therapy as well as one patient with untreated chronic myeloic leukemia. Thus lymphocyte capping in our experience is far from being a valid method for carrier detection or prenatal diagnosis of muscular dystrophies.


Effects of psychological distress on quality of life of adult daughters and their mothers with cancer.
As the population continues to age, adult daughters are more likely to be involved in caregiving. Given the fact that sharing emotional experiences is common in female relationships, (dis)similarity between mothers with cancer and their adult caregiving daughters is expected. However, the extent to which the (dis)similarity in psychological distress influences the quality of life of each person remains unknown. This study aims at addressing this concern, using a total of 98 mother-daughter dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers. Using the Actor Partner Interdependence Model, the results showed that although each person's psychological distress is the strongest predictor of their own quality of life, a mother's distress also plays a significant role in the daughter's quality of life. Specifically, when mothers experienced greater levels of psychological distress, the daughters reported better mental health but poorer physical health. Our findings on the disproportionately strong association between psychological distress of mothers with cancer and their adult caregiving daughters' quality of life suggest that caregiving daughters may benefit from programs designed to assist them to cope better with their mothers' psychological distress when both are living with cancer.


Cellular pharmacology of protein kinase Mζ (PKMζ) contrasts with its in vitro profile: implications for PKMζ as a mediator of memory.
A number of recent studies have used pharmacological inhibitors to establish a role for protein kinase Mζ (PKMζ) in synaptic plasticity and memory. These studies use zeta inhibitory peptide (ZIP) and chelerythrine as inhibitors of PKMζ to block long term potentiation and memory; staurosporine is used as a negative control to show that a nonspecific kinase inhibitor does not block long term potentiation and memory. Here, we show that neither ZIP nor chelerythrine inhibits PKMζ in cultured cells or brain slices. In contrast, staurosporine does block PKMζ activity in cells and brain slices by inhibiting its upstream phosphoinositide-dependent kinase-1. These studies demonstrate that the effectiveness of drugs against purified PKMζ may not be indicative of their specificity in the more complex environment of the cell and suggest that PKMζ is unlikely to be the mediator of synaptic plasticity or memory.


Cardiac tamponade complicating anaesthetic induction for repair of ascending aorta dissection.
A case is described of a 69-year-old woman with dissection of the ascending aorta who developed cardiac tamponade during induction of anaesthesia. The tamponade was diagnosed by a haemodynamic profile showing approximation of the central venous, pulmonary wedge and pulmonary arterial diastolic pressures, and was treated with rapid surgical intervention and drainage of the haemopericardium. Cardiac tamponade and dissecting aneurysms of the ascending aorta are conditions with contrasting anaesthetic considerations and the problems encountered are discussed.


[ECG based diagnosis of right ventricular hypertrophy in patients with chronic obstructive bronchitis].
Two mathematical models developed on the basis of a discriminant analysis of the evidence obtained in examination of 84 patients with chronic obstructive bronchitis (COB) are proposed in early diagnosis of right ventricular hypertrophy (RVH) by ECG readings in COB patients. Application of hierarchic classification model is recommended for diagnosis of RVH in screening. The probability model is intended for follow-up of COB patients.


Evaluation of different internal standardization approaches for the quantification of melatonin in cell culture samples by multiple heart-cutting two dimensional liquid chromatography tandem mass spectrometry.
We evaluate here different analytical strategies for the chromatographic separation and determination of N-acetyl-5-methoxytryptamine (MEL) and its oxidative metabolites N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK), N1-acetyl-5-methoxykynuramine (AMK) and cyclic 3-hydroxymelatonin (c3OHM) in cell culture samples. Two dimensional liquid chromatography (2D-LC) in the multiple heart-cutting mode was compared with regular 1D chromatographic separations of MEL and its oxidative metabolites. Our results showed that the use of trifluoroacetic acid (TFA) as mobile phase modifier was required to obtain a satisfactory resolution and peak shapes particularly for c3OHM. As TFA is not compatible with ESI ionization the application of the MHC mode was mandatory for a proper chromatographic separation. We evaluate also different internal standardization approaches based on the combined use of a surrogate standard (5-methoxytryptophol) and an internal standard (6-methoxytryptamine) for MEL quantification in cell culture samples obtaining unsatisfactory results both by 1D- and 2D-LC-ESI-MS/MS (from 9 ± 2 to 186 ± 38%). We demonstrate that only the application of isotope dilution Mass Spectrometry through the use of an in house synthesized 13C isotopically labelled analogue provided quantitative MEL recoveries both by using 1D- and 2D-LC-ESI-MS/MS (99±1 and 98±1. Respectively) in androgen-insensitive human prostate carcinoma PC3 cells.


Kernohan-Woltman notch phenomenon: an exceptional neurological picture?
Ipsilateral hemiparesis (IH) can be defined as a paradoxical dysfunction of the first motor neuron involving the extremities on the opposite side to that expected, given the location of the triggering intracranial pathology. Compression of the corticospinal tract (CSt) along its course through the contralateral cerebral peduncle against the free edge of the tentorium, known as the Kernohan-Woltman notch phenomenon (KWNP), represents the main cause of IH. This retrospective study analyses a series of 12 patients diagnosed with IH secondary to KWNP treated at our institution, including a descriptive study of epidemiological, clinical, radiological, neurophysiological, and prognostic variables. In 75% of the cases, symptoms had an acute or subacute onset. Initial imaging studies showed signs of significant mass effect in half of the patients, whereas magnetic resonance imaging (MRI) identified a structural lesion in the contralateral cerebral peduncle in two thirds of them. Impairment of the motor evoked potentials (MEP) was verified in 4 patients. During follow-up 7 patients experienced improvement in motor activity, and near half of the cases were classified in the first three categories of the modified Rankin scale. In contrast to prior historical series, most of our patients developed a KWNP secondary to a traumatic mechanism. MRI represents the optimal method to identify both the classic cerebral peduncle notch and the underlying structural lesion of the CSt. The use of MEP can help to establish the diagnosis, especially in those cases lacking definite radiological findings.


Thermal tolerance in the amphipod Sunamphitoe parmerong from a global warming hotspot, acclimatory carryover effects within generation.
The thermal response of the amphipod Sunamphitoe parmerong was contrasted between unacclimated 'wild' and acclimated populations. Brooding females were allocated to 17 °C or 23 °C treatments and their progeny developed to adulthood at the same temperature. Tolerance to acute thermal challenge (26-36 °C) was determined. The 17 °C and 23 °C acclimated S. parmerong had a 0.45 and 0.64 risk of death compared to the unacclimated individuals. The upper lethal temperature (LT50) was 27.4 °C for the unacclimated group and 29.6 °C and 30.4 °C for the 17 °C and 23 °C acclimated groups, respectively. Acclimation shifted their LT50 by 2.2 °C and 3 °C, respectively. The wild population exhibited high variability in thermal tolerance, potentially due to their environmental history and greater diversity of genotypes. After acclimation S. parmerong had decreased variability in thermal tolerance and that of the 23 °C group shifted by 1 °C compared with the 17 °C group. These results indicate developmental phenotypic plasticity or differential survival of resilient progeny as potential mechanisms to facilitate persistence in a warming ocean.


Heart rate variability in restless legs syndrome and periodic limb movements of Sleep.
The relationship between the autonomic nervous system and restless legs syndrome (RLS) and periodic limb movements of sleep (PLMS) consists of varied and somewhat conflicting reports. In order to further elucidate these complexities, a retrospective analysis of polysomnography (PSG) records and clinical data was performed. Records from 233 adult subjects were randomly selected and organized into one of four groups ("non-RLS/PLMS" [n=61], "RLS" [n=60], "PLMS" [n=58], and "RLS/PLMS" [n=54]). Heart rate variability (HRV) analysis was based on 5-minute samples of 2-lead electrocardiogram data isolated from PSG recordings during wakefulness and NREM sleep, and included mean RR interval (labeled "NN") and standard deviation of the RR intervals (labeled "SDNN"), and HRV power, very low frequency (VLF), low frequency (LF), and high frequency (HF) spectral bands. A significant reduction in the VLF band in the PLMS group as compared to the non-RLS/PLMS group (542±674 vs. 969±1025 ms2, p=0.038) was found in wakefulness. Statistically significant differences were seen in the PLMS group as compared to the non-RLS/PLMS group with a reduction in SDNN (p=0.001) and the HF (p=0.001) band, and an increase in HRV power (p=0.001), and the VLF (p=0.005) and LF (p=0.001) bands in NREM sleep. The PLMS group exhibited reduced basal sympathetic activity in wakefulness, but basal sympathetic predominance during NREM sleep, distinguishing this group from the RLS and RLS/PLMS groups.


Urethrovasocutaneous fistula.
We report a case of urethrovasocutaneous fistula in an elderly man. There were several possible etiologic factors in this case including: prior vasectomy and transurethral prostatectomy, urinary tract infection, and neurogenic bladder.


Computed Tomography Volumetry in Preoperative Living Kidney Donor Assessment for Prediction of Split Renal Function.
Transplant centers commonly evaluate split renal function (SRF) with Tc-99m-mercapto-acetyltriglycin (MAG3) scintigraphy in living kidney donation. Alternatively, the kidney volume can be measured based on predonation CT scans. The aim of this study was to identify the most accurate CT volumetry technique for SRF and the prediction of postdonation kidney function (PDKF). Three CT volumetry techniques (modified ellipsoid volume [MELV], smart region of interest [ROI] volume, renal cortex volume [RCV]) were performed in 101 living kidney donors. Preoperation CT volumetric SRF was determined and compared with MAG3-SRF, postoperation donor kidney function, and graft function. The correlation between donors predonation total kidney volume and predonation kidney function was the highest for RCV (0.58 with creatine clearance, 0.54 with estimated glomerular filtration rate-Cockcroft-Gault). The predonation volume of the preserved kidney was (ROI, MELV, RCV) 148.0 ± 29.1 cm, 151.2 ± 35.4 and 93.9 ± 25.2 (P < 0.005 MELV vs RCV and ROI vs RCV). Bland-Altman analysis showed agreement between CT volumetry SRF and MAG3-SRF (bias, 95% limits of agreement: ROI vs MAG3 0.4%, -7.7% to 8.6%; MELV vs MAG3 0.4%, -8.9% to 9.7%; RCV vs MAG3 0.8%, -9.1% to 10.7%). The correlation between predonation CT volumetric SRF of the preserved kidney and PDKF at day 3 was r = 0.85 to 0.88, between MAG3-SRF and PDKF (r = 0.84). The difference of predonation SRF between preserved and donated kidney was the lowest for ROI and RCV (median, 3% and 4%; 95th percentile, 9% and 13%). Overall renal cortex volumetry seems to be the most accurate technique for the evaluation of predonation SRF and allows a reliable prediction of donor's PDKF.


Superoxide dismutase--mentor of abiotic stress tolerance in crop plants.
Abiotic stresses impact growth, development, and productivity, and significantly limit the global agricultural productivity mainly by impairing cellular physiology/biochemistry via elevating reactive oxygen species (ROS) generation. If not metabolized, ROS (such as O2 (•-), OH(•), H2O2, or (1)O2) exceeds the status of antioxidants and cause damage to DNA, proteins, lipids, and other macromolecules, and finally cellular metabolism arrest. Plants are endowed with a family of enzymes called superoxide dismutases (SODs) that protects cells against potential consequences caused by cytotoxic O2 (•-) by catalyzing its conversion to O2 and H2O2. Hence, SODs constitute the first line of defense against abiotic stress-accrued enhanced ROS and its reaction products. In the light of recent reports, the present effort: (a) overviews abiotic stresses, ROS, and their metabolism; (b) introduces and discusses SODs and their types, significance, and appraises abiotic stress-mediated modulation in plants; (c) analyzes major reports available on genetic engineering of SODs in plants; and finally, (d) highlights major aspects so far least studied in the current context. Literature appraised herein reflects clear information paucity in context with the molecular/genetic insights into the major functions (and underlying mechanisms) performed by SODs, and also with the regulation of SODs by post-translational modifications. If the previous aspects are considered in the future works, the outcome can be significant in sustainably improving plant abiotic stress tolerance and efficiently managing agricultural challenges under changing climatic conditions.


Modifications of the extracellular matrix of aneurysmal abdominal aortas as a function of their size.
Collagen and elastin are the main extracellular matrix proteins providing the aortic wall with adequate mechanical properties and resistance for proper function. Our study aimed at investigating the relationship between the elastin concentration of the wall of normal and aneurysmal abdominal aortas (AAA), the collagen concentration, and its extractability, as a function of their size. Infrarenal aortas were collected from 30 patients undergoing operative repair of abdominal aortic aneurysm. Age-matched control samples were obtained from eight autopsies of individuals without vascular disease. Samples were divided into five groups according to the aortic diameter: control group (group N, n = 8); < 50 mm (group I, n = 6; between 50-75 mm (group II, n = 10); > 75 mm (group III, n = 7); and ruptured (group IV, n = 7). The collagen concentration in samples from group I was similar to the controls. An increased collagen concentration was observed in group II and remained at the same level in the largest and ruptured aneurysms. Extractability of collagen was found to be increased in group III and was even higher in group IV. A highly significant reduction in elastin concentration was observed in group I and there was progressive reduction with increasing diameter and rupture. A significant correlation could be established between aortic diameter, increased collagen extractability and decreased elastin content.