Congenital syphilis in Maryland, 1989-1991: the effect of changing the case definition and opportunities for prevention.
The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. This was a retrospective cohort study. When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.


KIF2A silencing inhibits the proliferation and migration of breast cancer cells and correlates with unfavorable prognosis in breast cancer.
Kinesin family member 2a (KIF2A), a type of motor protein found in eukaryotic cells, is associated with development and progression of various human cancers. The role of KIF2A during breast cancer tumorigenesis and progression was studied. Immunohistochemical staining, real time RT-PCR and western blot were used to examine the expression of KIF2A in cancer tissues and adjacent normal tissues from breast cancer patients. Patients' survival in relation to KIF2A expression was estimated using the Kaplan-Meier survival and multivariate analysis. Breast cancer cell line, MDA-MB-231 was used to study the proliferation, migration and invasion of cells following KIF2A-siRNA transfection. The expression of KIF2A in cancer tissues was higher than that in normal adjacent tissues from the same patient (P < 0.05). KIF2A expression in cancer tissue with lymph node metastasis and HER2 positive cancer were higher than that in cancer tissue without (P < 0.05). A negative correlation was found between KIF2A expression levels in breast cancer and the survival time of breast cancer patients (P < 0.05). In addition, multivariate analysis indicated that KIF2A was an independent prognostic for outcome in breast cancer (OR: 16.55, 95% CI: 2.216-123.631, P = 0.006). The proliferation, migration and invasion of cancer cells in vitro were suppressed by KIF2A gene silencing (P < 0.05). KIF2A may play an important role in breast cancer progression and is potentially a novel predictive and prognostic marker for breast cancer.


Evaluation of hypoxia-specific cytotoxic bioreductive agent-sodium borocaptate-10B conjugates as 10B-carriers in boron neutron capture therapy.
To evaluate the usefulness of 5 new 10B-compounds (TX-2091, TX-2095, TX-2097, TX-2100, and TX-2110) as 10B-carriers in boron neutron capture therpy (BNCT). They were conjugates that had been synthesized from a hypoxia-specific cytotoxic bioreductive agent, quinoxaline oxide TX-402, and a clinically used 10B-carrier, sodium borocaptate-10B (BSH). The 5 new compounds were hybrid compounds that have both a hypoxic cytotoxin unit and a thermal neutron-sensitizing unit, BSH. These new compounds and BSH were administered intraperitoneally to SCC VII tumor-bearing mice. Then, the 10B concentrations in the tumors and normal tissues were measured by gamma-ray spectrometry. Subsequently, SCC VII tumor-bearing mice were continuously given 5-bromo-2'-deoxyuridine (BrdU) to label all proliferating (P) cells in the tumors, then treated with TX-2100, which was chosen based on the results of the above-mentioned biodistribution analyses, or BSH in the same manner as in the biodistribution studies. Right after irradiation, during which intratumor 10B concentrations were kept at levels similar to each other, the tumors were excised, minced, and trypsinized. The tumor cell suspensions thus obtained were incubated with cytochalasin-B (a cytokinesis blocker), and the micronucleus (MN) frequency in cells without BrdU labeling [= quiescent (Q) cells] was determined using immunofluorescence staining for BrdU. Meanwhile, the MN frequency in the total (P+Q) tumor cell population was determined from the tumors that were not pretreated with BrdU. Clonogenic cell survival was also determined in mice given no BrdU. 10B biodistribution analyses in tumors, brain, skin, muscles, blood, and liver indicated that TX-2100 has the most favorable characteristics for concentrating a sufficient amount of 10B in tumors and maintaining a high enough 10B concentration during irradiation. In addition, TX-2100 had a significantly stronger radio-sensitizing effect with reactor thermal neutron beams than BSH on both total and Q cells in solid tumors. Further, TX-2100 clearly exhibited a radio-sensitizing effect with gamma-rays not only on total cells but also on Q and hypoxic tumor cells, which was not achieved by BSH. A 10B-carrier that acts as a hypoxic cytotoxin on tumor cells as well as having the potential to keep 10B in tumors and sensitize tumor cells more markedly than conventional 10B-carriers, such as TX-2100, is a promising candidate for use in BNCT.


Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Focal Hand Dystonia: A Pilot Study.
The efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for the treatment of focal hand dystonia (FHD) is not well known. We aimed to prospectively investigate the efficacy of MRgFUS thalamotomy for the treatment of FHD. We performed MRgFUS thalamotomy of the ventro-oral (Vo) nucleus in 10 patients with FHD. We evaluated the scores of the Writer's Cramp Rating Scale (WCRS, 0-30; higher scores indicating greater severity), Tubiana Musician's Dystonia Scale (TMDS, 0-5; lower scores indicating greater severity), and Arm Dystonia Disability Scale (ADDS, 0%-100%; lower scores indicating greater disability) at baseline and 3 and 12 months post-treatment. WCRS, TMDS, and ADDS scores significantly improved from 6.3 ± 2.7, 1.4 ± 0.5, and 58.7% ± 14.3% at baseline to 1.6 ± 3.1 (P = 0.011), 5.0 ± 0 (P = 0.0001), and 81.6% ± 22.9% (P = 0.0229) at 12 months, respectively. There was one prolonged case of dysarthria at 12 months. We show that MRgFUS Vo-thalamotomy significantly improved FHD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.


The fate of acutely inflamed joints with a negative synovial fluid culture.
The purpose of this study was to evaluate the management and fate of acutely inflamed joints with a negative synovial fluid culture. Between January and December 2009, all the patients who presented to our institution with an acutely inflamed joint and were subjected to microbiological assessment of their synovial fluid, were included in the study. Patients with a positive synovial fluid culture, a prosthetic joint replacement in situ and where an aspirate was obtained for a rheumatological diagnosis were excluded. This cohort was then divided into two groups depending on whether a diagnosis could be established through the course of their treatment. Group I included patients in whom a diagnosis could be established and group II included patients in whom a diagnosis could not be established. A thorough review of the patients' medical records and the hospital database was performed. Following this, a database consisting of the patient demographics, clinical features, investigations, treatment and outcome was created. A total of 144 patients met the inclusion criteria (group I: 95, group II: 49). The most commonly affected joint in both the groups was the knee. The average time to presentation was shorter in group II. Clinical findings at presentation were comparable in both groups. However, inflammatory markers were more likely to be raised in group II in comparison with group I. Eighty-two percent of group II required antibiotic treatment compared with 15% of group I. The mean duration of antibiotic treatment in group I was ten days and in group II was 26 days. Mean hospital stay differed significantly between the two groups, with group II being more than twice as long as compared with group I (p=0.001). The rate of mortality was also higher in group II (8.2%, p=0.03). Our study shows that patients presenting with an acutely inflamed joint and a negative synovial fluid culture in whom a diagnosis cannot be established during their hospital stay have a longer hospital stay and an increased rate of mortality as compared with patients in whom a diagnosis can be established.


Potential drug-drug interactions in outpatient department of a tertiary care hospital in Pakistan: a cross-sectional study.
Potential drug-drug interactions (pDDIs) are one of the preventable drug related problems having the risk of serious adverse events or therapeutic failure. In developing countries like Pakistan, this issue remains poorly addressed. The objective of this study was to explore prevalence of pDDIs in the Outpatient Department (OPD) of a tertiary care hospital in Pakistan. The secondary aim was to describe the levels of reported pDDIs and develop a list of widespread clinically relevant interactions. Prescriptions of 2400 OPD patients were analyzed for pDDIs through Micromedex Drug-Reax®. Prevalence, severity- and documentation-levels and widespread clinically relevant interactions were reported. Of total 2400 prescriptions, pDDIs were present in 22.3%. Whereas, moderate- and major-pDDIs were found in 377 (15.7%) and 225 (9.4%), respectively. PDDIs were more prevalent in Medicine (9.2%) and Cardiology (2.6%) as compared with other OPD specialties. Total 942 pDDIs were identified, of which, the majority were either moderate- (61.9%) or major-pDDIs (32.1%). Some of the most common interactions were ibuprofen + levofloxacin (n = 50), ciprofloxacin + diclofenac (32), aspirin + atenolol (24), and diclofenac + levofloxacin (19). The potential adverse outcomes of widespread interactions were seizures, bleeding, QT-interval prolongation, arrhythmias, tendon rupture, hypoglycemia/hyperglycemia, serotonin syndrome, drug toxicity, and decreased therapeutic response. OPD patients were at risk to pDDIs, particularly to major- and moderate-pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety.


The defense potential of glutathione-ascorbate dependent detoxification pathway to sulfur dioxide exposure in Tagetes erecta.
Sulfur dioxide (SO2) exposure is associated with increased risk of various damages to plants. However, little is known about the defense response in ornamental plants. In this study, an artificial fumigation protocol was carried out to study the defense potential of the glutathione (GSH)-ascorbate (AsA) dependent detoxification pathway to SO2 exposure in Tagetes erecta. The results show that when the plants were exposed to different doses of SO2 (0, 15, 30, 50 or 80 mg m(-3)) for different times (6, 12, 18, 24 or 33 h), SO2 induced oxidative stress was confirmed by the increased hydrogen peroxide (H2O2), malondialdehyde (MDA) and relative conductivity of membrane (RC) in a dose-dependent manner for different exposure times. However, the increased levels for H2O2, MDA and RC were not significant vis-a-vis the control when SO2 doses and exposure times were lower than 15 mg m(-3)/33 h, 30 mg m(-3)/24 h or 50 mg m(-3)/12 h (p>0.05). The results could be explained by the increases in the content of reduced form of glutathione (GSH), total glutathione (TGSH), ascorbate (AsA), ratio of GSH/GSSG (oxidized form of glutathione), activities of ascorbate peroxidase (APX), glutathione peroxidase (GPX), glutathione reductase (GR) and glutathione S-transferases (GST). On the other hand, exposure to higher doses of SO2 and longer exposure times, the values of the GSH-AsA dependent antioxidative indices decreased significantly (p<0.01), manifested by increased levels of H2O2. Furthermore, the levels of H2O2, MDA and RC varied little when SO2 doses and exposure times reached a 'critical' value (50 mg m(-3)/24 h). The defense ability of T. erecta to SO2 reached nearly extremity. To summarize, the response of T. erecta to elevated SO2 was related to higher H2O2 levels. GSH-AsA dependent detoxification pathway played an important role in against SO2-induced toxicity, although the defense response could not sufficiently alleviate oxidative damage when SO2 doses and exposure times reached critical value.


Dynamics of the S(1D2)+HD(j=0) reaction at collision energies approaching the cold regime: a stringent test for theory.
We report integral cross sections for the S(1D2)+HD(j=0)→DS+H and HS+D reaction channels obtained through crossed-beam experiments reaching collision energies as low as 0.46 meV and from adiabatic time-independent quantum-mechanical calculations. While good overall agreement with experiment at energies above 10 meV is observed, neither the product channel branching ratio nor the low-energy resonancelike features in the HS+D channel can be theoretically reproduced. A nonadiabatic treatment employing highly accurate singlet and triplet potential energy surfaces is clearly needed to resolve the complex nature of the reaction dynamics.


The clinical significance of computed tomography texture features of renal cell carcinoma in predicting pathological T1-3 staging.
Precise T staging is an important prerequisite for the treatment decisions of patients with renal cell carcinoma (RCC). We aimed to predict the pathological T1-3 staging of RCC with an automatic multiclass T staging prediction mode. We retrospectively enrolled 100 consecutive patients with pathologically proven RCC that was newly diagnosed and untreated from Sun Yat-sen University Cancer Center and randomly split these patients into a training set (70%) and an internal testing set (30%). We enrolled additional 29 patients with pathologically proven RCC from The Third Affiliated Hospital of Shenzhen University as the external testing set. We used the training set data to establish a prediction model for pathological T1-3 staging of RCC and validated the effect of the training model using the internal and external testing sets. Quantitative decomposition of the prediction model was conducted to explore the contribution of each extracted feature. The computed tomography (CT) images of 100 patients (37, 29, and 34 patients with T1, T2, and T3 staging, respectively, according to the eighth tumor-node-metastasis staging system) were used to establish the prediction model for T staging using delineation of the target area, image segmentation, and feature extraction. The micro area under the curve (AUC) and macro-AUC of the model were 0.90 [95% confidence interval (CI): 0.84-1.00] and 0.91 (95% CI: 0.86-1.00), respectively. In terms of validation with the external testing set, the micro-AUC and macro-AUC were 0.72 (95% CI: 0.66-0.84) and 0.78 (95% CI: 0.69-0.88), respectively. Our prediction model showed good performance in predicting the pathological T1-3 staging of RCC.


Rituximab exhibits a better safety profile when used as a first line of treatment for pemphigus vulgaris: A retrospective study.
Pemphigus is an autoimmune disease that is challenging to treat and has few available therapeutic options. Recently, several studies have demonstrated that rituximab may be an efficacious first-line treatment in newest guidelines. To compare the side effect profiles of rituximab administered after a course of immunosuppressant agents versus as a first-line therapy and evaluate the impact of patient characteristics and disease severity indices on occurrence of adverse effects. A retrospective cross-sectional study was conducted on 999 patients with pemphigus vulgaris who received rituximab either as a first-line treatment or after conventional adjuvant therapies. The occurrence of partial or complete remission as well as the incidence of drug-related adverse effects were evaluated and compared between the two groups. Smoking, pulmonary comorbidity, and mucocutaneous phenotype were associated with an increased risk of developing infectious complications by 12.49, 5.79, and 2.37 fold, respectively. These associations were more prominent among those who received rituximab after immunosuppressant agents. Early use of rituximab benefits pemphigus patients, especially those with a mucocutaneous phenotype, pulmonary comorbidity, or history of smoking, and reduces their risk of infectious adverse events.


Single-balloon enteroscopy for treating Roux-en-Y choledochojejunostomy stenosis after liver transplantation: a case report.
Endoscopic treatment of biliary tract complications after Roux-en-Y surgery is still a challenge. With balloon enteroscopy, we can reach previously inaccessible areas changing the management of biliopancreatic diseases in patients with surgically altered anatomy. We report a case of single-balloon enteroscopy plus endoscopic retrograde cholangiopancreatography for the treatment of a pinpoint stricture in a hepaticojejunal anastomosis after liver transplantation.


Precipitating factors of catastrophic antiphospholipid syndrome: the role of anticoagulant treatment in a series of 112 patients.
The prevention of catastrophic antiphospholipid syndrome (CAPS), a rare complication of antiphospholipid syndrome (APS), is a major goal. We analyzed its precipitating factors, focusing on anticoagulation immediately before CAPS episodes. We retrospectively analyzed patients in the French multicenter APS/systemic lupus erythematosus database with at least 1 CAPS episode. Then we compared each patient with known APS before CAPS with 2 patients with non-CAPS APS matched for age, sex, center, and APS phenotype. We included 112 patients with CAPS (70% women; mean age, 43 ± 15 years). At least 1 standard precipitating factor of CAPS was observed for 67 patients (64%), which were mainly infections (n = 28, 27%), pregnancy (n = 23, 22%), and surgery (n = 16, 15%). Before the CAPS episode, 67 (60%) patients already had a diagnosis of APS. Of the 61 treated with anticoagulants, 32 (48%) received vitamin K antagonists (VKAs), 23 (34%) heparin, and 2 (3%) a direct oral anticoagulant. They were less likely than their matched patients with APS without CAPS to receive VKA (48% vs 66%, p = .001). Among those treated with VKA, 72% had a subtherapeutic international normalized ratio (ie, <2) versus 28% in patients with APS without CAPS (p < .001). Finally, excluding pregnant patients (n = 14) for whom we could not differentiate the effect of treatment from that of pregnancy, we were left with 47 cases, 32 (68%) of whom had recently begun a direct oral anticoagulant, planned bridging therapy, or had VKA treatment with international normalized ratio <2. These results strongly suggest that suboptimal anticoagulation management can trigger CAPS in patients with thrombotic APS.


Removal of several pesticides in a falling water film DBD reactor with activated carbon textile: Energy efficiency.
Bio-recalcitrant micropollutants are often insufficiently removed by modern wastewater treatment plants to meet the future demands worldwide. Therefore, several advanced oxidation techniques, including cold plasma technology, are being investigated as effective complementary water treatment methods. In order to permit industrial implementation, energy demand of these techniques needs to be minimized. To this end, we have developed an electrical discharge reactor where water treatment by dielectric barrier discharge (DBD) is combined with adsorption on activated carbon textile and additional ozonation. The reactor consists of a DBD plasma chamber, including the adsorptive textile, and an ozonation chamber, where the DBD generated plasma gas is bubbled. In the present paper, this reactor is further characterized and optimized in terms of its energy efficiency for removal of the five pesticides α-HCH, pentachlorobenzene, alachlor, diuron and isoproturon, with initial concentrations ranging between 22 and 430 μg/L. Energy efficiency of the reactor is found to increase significantly when initial micropollutant concentration is decreased, when duty cycle is decreased and when oxygen is used as feed gas as compared to air and argon. Overall reactor performance is improved as well by making it work in single-pass operation, where water is flowing through the system only once. The results are explained with insights found in literature and practical implications are discussed. For the used operational conditions and settings, α-HCH is the most persistent pesticide in the reactor, with a minimal achieved electrical energy per order of 8 kWh/m3, while a most efficient removal of 3 kWh/m3 or lower was reached for the four other pesticides.


Differentiation and vascularization of the metanephric kidney grafted on the chorioallantoic membrane.
The origin and development of mouse kidney vasculature were examined in chorioallantoic grafts of early kidney rudiments and of experimentally induced explants of separated metanephric mesenchymes. Whole kidney rudiments developed into advanced stages, expressed the segment-specific antigenic markers of tubules and the polyanionic coat of the glomeruli. In contrast to development in vitro, these grafts regularly showed glomeruli with an endothelial component and a basement membrane expressing type IV collagen and laminin. The glomerular endothelial cells in these grafts were shown to carry the nuclear structure of the host. This confirms the outside origin of these cells and the true hybrid nature of the glomeruli. When in vitro induced mesenchymes were grafted on chorioallantoic membranes, abundant vascular invasion was regularly found but properly vascularized glomeruli were exceptional. Uninduced, similarly grafted mesenchymal explants remained avascular as did the undifferentiated portions of partially induced mesenchymal blastemas. It is concluded that the stimulation of the host endothelial cells to invade into the differentiating mesenchyme requires the morphogenetic tissue interaction between the ureter bud and the mesenchyme. The induced metanephric cells presumably start to produce chemoattractants for endothelial cells at an early stage of differentiation. Kidney development thus seems to require an orderly, synchronized development of the three cell lineages: the branching ureter, the induced, tubule-forming mesenchyme, and the invading endothelial cells of outside origin.


A conserved sequence motif at the 5' terminus of the Southampton virus genome is characteristic of the Caliciviridae.
We have determined the 5'terminal cDNA sequence for the genome of Southampton virus, a recently characterized, human, small round-structured virus (SRSV). Genomic RNA was extracted directly from a stool sample and amplified by RT-PCR by homopolymer tailing of the 3' terminus of the cDNA. The additional sequence increases the overall length of the Southampton virus genome by 12 nucleotides, resulting in a significant change to the genome organization by extending the first large open reading frame (ORF) by 51 amino acids. The 5'terminal bases pGpT and the presence of conserved genome and putative subgenomic RNA terminal motifs are now prominent features shared between the human SRSV Southampton virus and the animal caliciviruses rabbit hemorrhagic disease virus and feline calicivirus.


Modeling the binding mechanism of Alzheimer's Aβ1-42 to nicotinic acetylcholine receptors based on similarity with snake α-neurotoxins.
For over a decade, it has been known that amyloid β (Aβ) peptides of Alzheimer's disease bind to the nicotinic α7 acetylcholine receptor (AChR) with picomolar affinity, and that snake α-neurotoxins competitively inhibit this binding. Here we propose a model of the binding mechanism of Aβ peptides to α7-AChR at atomic level. The binding mechanism is based on sequence and structure similarities of Aβ residues with functional residues of snake α-neurotoxins (ATX) in complex with AChR. The binding mechanism involves residue (Aβ)K28 (similar to (ATX)R32) which forms cation/π interactions in the acetylcholine binding site, and residues (Aβ)G29-(Aβ)I32 [GAII] (similar to (ATX)G33-(ATX)I36 [GTII]) which form an intermolecular β-sheet with residues (α7)F189-(α7)E191 of AChR. Through these interactions, we propose that the AChR serves as a chaperone for Aβ conformational changes from α- to β-hairpin. The interactions which block channel opening provide fundamental insight into Aβ neurotoxicity and cognition impairment, that could contribute to pathogenic processes in Alzheimer's disease, thus paving the way for structure based therapies.


DNA conformation is determined by economics in the hydration of phosphate groups.
Mixed sequence DNA can exist in two right-handed and one left-handed double helical conformations--A, B and Z. Under conditions of high water activity the B conformation prevails. If the water activity is reduced on addition of salt or organic solvents, transformation occurs to A-DNA or, in DNAs with alternating purine-pyrimidine sequences, to the left-handed Z-DNA. In crystal structure analyses of oligonucleotides, the free oxygen atoms of adjacent phosphate groups along the polynucleotide chain in B-DNA are found at least 6.6 A apart and individually hydrated whereas they are as close as 5.3 A in A-DNA and 4.4 A in Z-DNA, and bridged by water molecules. We suggest that this more economical hydration in A- and Z-DNA compared with B-DNA is the underlying cause of B----A and B----Z transitions.


Intersubunit fluorescence energy transfer in human factor VIII.
Human factor VIII circulates as a series of active heterodimers composed of a light chain (83 kDa) linked by divalent metal ion(s) to a variable sized heavy chain (93-210 kDa). Purified factor VIII subunits were modified with sulfhydryl-specific fluorophores. Probe selection was based upon the limited number of free cysteine residues in each subunit. Levels of probe incorporation suggested the presence of a single reactive cysteine residue per subunit. Amino-terminal sequence analysis of fluorescent tryptic peptides derived from the modified subunits indicated fluorophore attachment sites at Cys528 of the heavy chain (A2 domain) and Cys1858 of the light chain (A3 domain). Subunit reassociation was measured by fluorescence energy transfer using light chain modified with N-[1-pyrenyl] maleimide (fluorescence donor) and heavy chain modified with 7-diethylamino-3-[4'-maleimidophenyl]-4-methylcoumarin (fluorescence acceptor). Donor fluorescence quenching paralleled the formation of factor VIII clotting activity, and both effects were saturable with respect to added heavy chain. Based upon the degree of donor quenching, a distance of 20 A was calculated separating the two fluorophores. These results indicate a close spatial relationship between the A2 domain of heavy chain and the A3 domain of light chain in the factor VIII heterodimer.


Colon-specific 9-aminocamptothecin-HPMA copolymer conjugates containing a 1,6-elimination spacer.
N-(2-Hydroxypropyl)methacrylamide (HPMA) copolymer-9-aminocamptothecin (9-AC) conjugate for oral colon-specific drug delivery was designed, synthesized, and characterized. The drug, 9-AC, was attached to the polymer carrier via a spacer containing a combination of an aromatic azo bond and a 4-aminobenzylcarbamate group. The design of the spacer ensured a fast and highly efficient release of unmodified 9-AC from the polymer in the colon by azo bond cleavage followed by a 1,6-elimination mechanism. An in vitro degradation study indicated that this conjugate was stable in simulated upper GI tract conditions, including small intestine (SI) contents, SI mucosa suspension, and in PBS (pH 1.5 and 7.4). A fast release of the unmodified drug (85+/-10% of 9-AC in 12 h) was detected in rat cecal contents. This drug delivery system has potential in the treatment of colon cancer.


Optimism, mindfulness, and resilience as potential protective factors for the mental health consequences of fear of the coronavirus.
The COVID-19 pandemic has a substantial impact on mental health. Prior reports have shown that depression, anxiety, and stress have increased throughout the pandemic. Nonetheless, not everyone is affected by these negative consequences and some people may be relatively unaffected. In this online study in a predominantly Dutch and Belgian sample (N = 546), we investigated whether positive personality traits such as optimism, mindfulness, and resilience may protect against the negative mental health consequences (i.e., fear of the coronavirus, depression, stress, and anxiety) of the COVID-19 pandemic. We found that fear of COVID-19 was related to higher depression, stress, and anxiety. However, for participants scoring high on mindfulness, optimism, and resilience, this relationship was weakened. In addition to these findings, we present the results of network analyses to explore the network structure between these constructs. These results help to identify possible ways through which psychological well-being can be promoted during the COVID-19 pandemic.


Validation of the Spanish version of the physical activity questionnaire used in the Nurses' Health Study and the Health Professionals' Follow-up Study.
The objective of this analysis was to test the validity of the estimates of energy expenditure and sedentary lifestyle obtained through a self-administered questionnaire of physical activity for Spanish-speaking people adapted from US questionnaires (Nurses' Health Study and Health Professionals' Follow-up Study) using a triaxial accelerometer (RT3 Triaxial Research Tracker) as the reference. Validation study, calculating the non-parametric correlation coefficients between the level of physical activity and sedentary lifestyle collected by the self-administered questionnaire and the triaxial accelerometer measurements. Percentage of misclassification and kappa coefficients were also calculated. The study population consisted of a sample of 40 obese women who were participants of the SUN (Seguimiento Universidad de Navarra) project (a prospective cohort study among Spanish university alumni). They were selected because of their peculiar metabolic characteristics, in the search for a sub-optimal scenario for validity. Physical activity during leisure time (estimated as MET-h week(-1)) derived from the self-administered questionnaire moderately correlated with kcal day(-1) assessed through the accelerometer (Spearman's rho = 0.507, 95% confidence interval (CI) 0.232, 0.707). The Spearman correlation between the ratio of sedentary lifestyle to physical activity obtained through the questionnaire and the direct estimation (RT3) was -0.578 (95% CI -0.754, -0.325). The kappa index was 0.25 (P = 0.002) when assessing the cross-classification into quintiles and 0.41 for the dichotomous estimation of a sedentary lifestyle. Only 2.5% of participants were misclassified by the questionnaire more than two quintiles apart from the estimates of the RT3. The moderate values obtained for correlation in a sub-optimal scenario for validity and the low percentage of extreme misclassification suggest the validity of the questionnaire to assess physical activity in Spanish-speaking women aged 20-50 years.


Comparison of effects of Aroclors 1016 and 1260 on non-human primate catecholamine function.
Adult male non-human primates, Macaca nemestrina, were orally-exposed to corn oil or corn oil containing either Aroclor 1016 or 1260 at doses of 0.8, 1.6 or 3.2 mg/(kg.day) for 20 weeks. Brain concentrations of biogenic amines and individual PCB congeners were determined following exposure. Aroclor 1016 significantly decreased concentrations of dopamine and its metabolites in the caudate, putamen, substantia nigra and hypothalamus but did not alter neurotransmitter or metabolite concentrations in the globus pallidus and hippocampus. Total PCB concentrations ranged from 1 to 5 ppm with only three congeners detected (2,4,4'; 2,4,2',4' and 2,5,2',5') making up, on average, 72%, 18% and 7% respectively of the total residue in brain. There were no discernible differences in the congener make-up between brain regions. Aroclor 1260 reduced dopamine concentrations in the caudate, putamen and hypothalamus but produced no effects in the substantia nigra, globus pallidus or hippocampus. Aroclor 1260 concentrations ranged from 18 to 28 ppm with the highest levels found in the hippocampus. Of the congeners that made up more than 5% of the total residue in brain, all were hexa- and heptachlorinated di-ortho-substituted congeners. There were no discernible differences in congener make-up between brain regions. We conclude that: (1) ortho-substituted non-planar congeners are responsible for the observed changes in neurochemical function; (2) both Aroclor 1016 and Aroclor 1260 decrease dopamine concentrations by similar mechanisms; and (3) based on differences in brain concentrations of Aroclor 1260 congeners compared to Aroclor 1016 congeners, lightly-chlorinated congeners are more effective in reducing central dopamine concentrations than are the more highly chlorinated congeners.


Effects of mutual grafting on cadmium accumulation characteristics of first post-generations of Bidens pilosa L. and Galinsoga parviflora Cav.
We studied the effects of mutual grafting on cadmium (Cd) accumulation characteristics on the first post-generations of the Cd-hyperaccumulator plants Bidens pilosa L. and Galinsoga parviflora Cav. The seeds from scions and rootstocks of B. pilosa and G. parviflora were collected and planted in Cd-contaminated soil in pot and field experiments. In the pot experiment, rootstock treatment increased the shoot biomass of B. pilosa post-grafting generations, compared with ungrafted B. pilosa, but decreased the Cd content in shoots and Cd extraction by shoots of post-grafting generations; scion treatment decreased or had no significant effect. Mutual grafting resulted in no significant differences to the photosynthetic pigment contents in B. pilosa post-grafting generations. Compared with ungrafted G. parviflora, scion treatment increased the shoot biomass, photosynthetic pigment content, and Cd extraction by shoots of G. parviflora post-grafting generations, but rootstock treatment did not lead to significant differences. Mutual grafting resulted in no significant differences to the Cd contents in shoots of G. parviflora post-grafting generations. In the field experiment, only rootstock treatment increased the shoot biomass of B. pilosa post-grafting generations, and only scion treatment increased the shoot biomass and the Cd extraction by shoots of G. parviflora post-grafting generations. Therefore, mutual grafting of scions may enhance the phytoremediation ability of G. parviflora first post-grafting generations.


Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334].
Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk. However, the effect of domperidone on the macronutrient composition of breast milk has not been studied and current guidelines for fortification of human milk for premature infants do not distinguish between those women using or those not using domperidone. The purpose of this study is to evaluate the effect of domperidone (given to lactating mothers of very preterm infants) on the macronutrient composition of breast milk. Mothers of infants delivered at less than 31 weeks gestation, who are at least 3 weeks postpartum, and experiencing lactational failure despite non-pharmacological interventions, will be randomized to receive domperidone (10 mg three times daily) or placebo for a 14-day period. Breast milk samples will be obtained the day prior to beginning treatment and on days 4, 7 and 14. The macronutrient (protein, fat, carbohydrate and energy) and macromineral content (calcium, phosphorus and sodium) will be analyzed and compared between the two groups. Additional outcome measures will include milk volumes, serum prolactin levels (measured on days 0, 4, and 10), daily infant weights and breastfeeding rates at 2 weeks post study completion and at discharge. Forty-four participants will be recruited into the study. Analysis will be carried out using the intention to treat approach. If domperidone causes significant changes to the nutrient content of breast milk, an alteration in feeding practices for preterm infants may need to be made in order to optimize growth, nutrition and neurodevelopment outcomes.


Genomic characterization of BKC-1-producing Klebsiella pneumoniae strain belonging to high-risk clone sequence type 11 isolated from a river in Brazil.
Carbapenem-resistant Klebsiella pneumoniae is a common cause of healthcare-related infections, and it is widespread in hospitals and diverse environments with potentially serious public health implications. Herein, we have reported the isolation and characterization of an environmental Brazilian Klebsiella carbapenemase (BKC-1)-producing K. pneumoniae strain (IEC1205) isolated in 2018 from a river in the Amazon region, Brazil. Antimicrobial susceptibility of this strain was evaluated by broth microdilution and demonstrated resistance to several antibiotics including β-lactams, aminoglycosides, fluoroquinolones, and polymyxins. It has an extensively drug-resistant phenotype. Genomic analysis revealed that IEC1205 belonged to sequence type 11, clonal complex 258 and the presence of blaBKC-1 and two other β-lactamase-encoding genes (blaCTX-M-15 and blaSHV-11). The predicted virulence was associated with biofilm formation-related genes, a type VI secretion system, siderophore production, and type I and II fimbriae formation. We have identified an IncQ1 plasmid, named pIEC1205, harboring blaBKC-1 with high similarity to previously described plasmids carrying blaBKC-1 and blaBKC-2 genes. To our knowledge, this is the first report of an environmental BKC-1-producing K. pneumoniae strain.


Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis.
Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States. We searched the literature in November 2020 to update a 2014 Agency for Healthcare Research and Quality review by integrating newly available data. Studies of vaccines that used a comparator and reported the presence or absence of key adverse events were eligible. Adhering to Evidence-based Practice Center methodology, we assessed the strength of evidence (SoE) for all evidence statements. The systematic review is registered in PROSPERO (CRD42020180089). Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE). Across a large body of research we found few associations of vaccines and serious key adverse events; however, rare events are challenging to study. Any adverse events should be weighed against the protective benefits that vaccines provide.


Novel diagnostic tests for the putative agent of bacterial gill disease in Pacific razor clams (Siliqua patula).
Nuclear inclusion X (NIX) is a gamma proteobacteria that infects the nuclei of gill epithelial cells in Pacific razor clams. NIX has been associated with clam die-offs in coastal Washington. A quantitative PCR (qPCR) assay was developed to detect NIX in Pacific razor clams, and assay specificity was confirmed by chromogenic in situ hybridization (CISH). Both tests were applied to evaluate NIX infections in wild Pacific razor clams collected during spring 2019. Consistent with results from earlier histopathological assessments, qPCR and CISH indicated 100% prevalence in razor clams from two Washington beaches and 0% prevalence from two Alaskan beaches.


Multicentennial record of Labrador Sea primary productivity and sea-ice variability archived in coralline algal barium.
Accelerated warming and melting of Arctic sea-ice has been associated with significant increases in phytoplankton productivity in recent years. Here, utilizing a multiproxy approach, we reconstruct an annually resolved record of Labrador Sea productivity related to sea-ice variability in Labrador, Canada that extends well into the Little Ice Age (LIA; 1646 AD). Barium-to-calcium ratios (Ba/Ca) and carbon isotopes (δ13C) measured in long-lived coralline algae demonstrate significant correlations to both observational and proxy records of sea-ice variability, and show persistent patterns of co-variability broadly consistent with the timing and phasing of the Atlantic Multidecadal Oscillation (AMO). Results indicate reduced productivity in the Subarctic Northwest Atlantic associated with AMO cool phases during the LIA, followed by a step-wise increase from 1910 to present levels-unprecedented in the last 363 years. Increasing phytoplankton productivity is expected to fundamentally alter marine ecosystems as warming and freshening is projected to intensify over the coming century.


Low-energy cranberry juice decreases lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome.
Cranberries, high in polyphenols, have been associated with several cardiovascular health benefits, although limited clinical trials have been reported to validate these findings. We tested the hypothesis that commercially available low-energy cranberry juice (Ocean Spray Cranberries, Inc, Lakeville-Middleboro, Mass) will decrease surrogate risk factors of cardiovascular disease, such as lipid oxidation, inflammation, and dyslipidemia, in subjects with metabolic syndrome. In a randomized, double-blind, placebo-controlled trial, participants identified with metabolic syndrome (n = 15-16/group) were assigned to 1 of 2 groups: cranberry juice (480 mL/day) or placebo (480 mL/day) for 8 weeks. Anthropometrics, blood pressure measurements, dietary analyses, and fasting blood draws were conducted at screen and 8 weeks of the study. Cranberry juice significantly increased plasma antioxidant capacity (1.5 ± 0.6 to 2.2 ± 0.4 μmol/L [means ± SD], P < .05) and decreased oxidized low-density lipoprotein and malondialdehyde (120.4 ± 31.0 to 80.4 ± 34.6 U/L and 3.4 ± 1.1 to 1.7 ± 0.7 μmol/L, respectively [means ± SD], P < .05) at 8 weeks vs placebo. However, cranberry juice consumption caused no significant improvements in blood pressure, glucose and lipid profiles, C-reactive protein, and interleukin-6. No changes in these parameters were noted in the placebo group. In conclusion, low-energy cranberry juice (2 cups/day) significantly reduces lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome.


Exposure assessment on aflatoxin M1 from milk and dairy products-relation to public health.
Aflatoxin M1 (AFM1) contaminates milk and dairy products that are widely consumed foods. Therefore, there is increased concern for human exposure to the toxic action and the negative health effects that AFM1 presents. The aim of this study was to assess the contamination levels with AFM1, of dairy products available in the Greek market (Thessaly), and also to estimate the relevant nutritional exposure. A total of 52 infant milk, 25 Feta cheese and 32 pasteurized milk samples were randomly selected from the market. The determination of AFM1 was based on indirect immunoenzymatic ELISA method with two analytical packages; namely Tecna (Italy) and Prognosis Biotech (Greece), for comparison purposes, strictly following the manufacturer's instructions. The estimated daily intake (EDI) of AFM1 through dairy consumption and the relevant hazard index (HI) were calculated. The levels of AFM1, in all samples tested, were below the tolerable maximum level of 50 ng/L for milk and 25 ng/L for infant formulas (EC Regulation 1881/2006), while concentrations were very low (0.23-9.38 ng/L for infant formula, 0.54-4.09 ng/L for cheese and 0.20-17.84 ng/L for pasteurized milk). The exposure assessment revealed that infants, toddlers and children were the most exposed groups in AFM1 via milk and formula consumption (0.65, 0.35 and 0.35 respectively). The HI was also noticed higher in those ages, with the maximum value to reach 1.90. Though, for feta cheese the exposure was calculated as very low (EDI: 0.01 and HI: 0.05). Comparing the two analytical packages used, no statistically significant difference was found (p-value >0.05). Milk and dairy products tested were found safe for consumption, regarding the AFM1 levels. From a public health perspective, the results are satisfactory, given that the population exposure to AFM1, based on the nutrient profile, was rather limited.


Size of the Streptococcus mutans GS-5 chromosome as determined by pulsed-field gel electrophoresis.
Rare cutting restriction endonucleases were used to cut the Streptococcus mutans chromosome into large fragments. Restriction enzymes utilizing recognition sites containing 6-, 7-, or 8-base-pair sequences with only G and C nucleotides produced few fragments, most of which were greater than 100 kilobase pairs in size. Addition of the fragments from digests of SmaI, NotI, ApaI, RsrII, and EagI yielded a molecular size for the S. mutans GS-5 genome of 2,819 +/- 60 kilobase pairs.


A translatome-transcriptome multi-omics gene regulatory network reveals the complicated functional landscape of maize.
Maize (Zea mays L.) is one of the most important crops worldwide. Although sophisticated maize gene regulatory networks (GRNs) have been constructed for functional genomics and phenotypic dissection, a multi-omics GRN connecting the translatome and transcriptome is lacking, hampering our understanding and exploration of the maize regulatome. We collect spatio-temporal translatome and transcriptome data and systematically explore the landscape of gene transcription and translation across 33 tissues or developmental stages of maize. Using this comprehensive transcriptome and translatome atlas, we construct a multi-omics GRN integrating mRNAs and translated mRNAs, demonstrating that translatome-related GRNs outperform GRNs solely using transcriptomic data and inter-omics GRNs outperform intra-omics GRNs in most cases. With the aid of the multi-omics GRN, we reconcile some known regulatory networks. We identify a novel transcription factor, ZmGRF6, which is associated with growth. Furthermore, we characterize a function related to drought response for the classic transcription factor ZmMYB31. Our findings provide insights into spatio-temporal changes across maize development at both the transcriptome and translatome levels. Multi-omics GRNs represent a useful resource for dissection of the regulatory mechanisms underlying phenotypic variation.


Tactile motion adaptation reduces perceived speed but shows no evidence of direction sensitivity.
While the directionality of tactile motion processing has been studied extensively, tactile speed processing and its relationship to direction is little-researched and poorly understood. We investigated this relationship in humans using the 'tactile speed aftereffect' (tSAE), in which the speed of motion appears slower following prolonged exposure to a moving surface. We used psychophysical methods to test whether the tSAE is direction sensitive. After adapting to a ridged moving surface with one hand, participants compared the speed of test stimuli on the adapted and unadapted hands. We varied the direction of the adapting stimulus relative to the test stimulus. Perceived speed of the surface moving at 81 mms(-1) was reduced by about 30% regardless of the direction of the adapting stimulus (when adapted in the same direction, Mean reduction = 23 mms(-1), SD = 11; with opposite direction, Mean reduction = 26 mms(-1), SD = 9). In addition to a large reduction in perceived speed due to adaptation, we also report that this effect is not direction sensitive. Tactile motion is susceptible to speed adaptation. This result complements previous reports of reliable direction aftereffects when using a dynamic test stimulus as together they describe how perception of a moving stimulus in touch depends on the immediate history of stimulation. Given that the tSAE is not direction sensitive, we argue that peripheral adaptation does not explain it, because primary afferents are direction sensitive with friction-creating stimuli like ours (thus motion in their preferred direction should result in greater adaptation, and if perceived speed were critically dependent on these afferents' response intensity, the tSAE should be direction sensitive). The adaptation that reduces perceived speed therefore seems to be of central origin.


Morbidity and mortality after hepatic and pancreatic resections: results from one surgeon at a low-volume urban hospital over thirty years.
Recent reviews of state and national databases suggest that hospital volume is inversely proportional to morbidity after hepatic and pancreatic resection. Volume may be a surrogate marker for factors such as coordination of care and surgeon training. The authors hypothesized that low-volume centers can obtain acceptable outcomes if these requirements are satisfied. A retrospective review was performed of all hepatic and pancreatic resections performed from 1978 to 2008 by 1 surgeon at 1 low-volume institution. The etiology of disease, type of resection, and 30-day morbidity and mortality were assessed. One hundred sixty-eight hepatic resections were performed for malignant (76%) or benign (24%) etiologies. Major resections included extended lobectomy (n = 19), lobectomy (n = 58), and segmentectomy (n = 62); minor resections consisted of wedge resections (n = 29). Overall 30-day mortality was 1.8%, and major morbidity was 17.9%; for major hepatic resections, mortality and morbidity were 1.4% and 20.1%, respectively. One hundred fourteen pancreatic resections were performed for malignant (76.3%) or benign (23.7%) etiologies. Major resections included pancreaticoduodenectomy (n = 91), central pancreatectomy (n = 1), and total pancreatectomy (n = 4); minor resections consisted of distal pancreatectomy (n = 18). Overall 30-day mortality was 2.6%, and major morbidity was 27.2%; for major pancreatic resections, mortality and morbidity were 3.1% and 31.3%, respectively. Hepatic and pancreatic resections can be performed safely at a low-volume hospital with adequate surgeon training and perioperative systems of care.


Decreased cAMP content of the hypothalamus of genetically hypertensive rats.
In genetically hypertensive rats an altered catecholamine content of hypothalamic structures has been reported. In the present study cAMP was estimated in the hypothalamus and cortex of genetically hypertensive rats and compared with normotensive controls of the same strain. It is shown, that the cAMP content of the hypothalamus of the hypertensive animals was decreased to about 60% of control values, whereas there was no difference of the cAMP content in the cortical regions of the same animals. These results indicate an alteration of the adenyl cyclase-cAMP-phosphodiesterase system in hypothalamic structures of genetically hypertensive rats.


Psychiatric morbidity in children involved in bullying treated at the Free State Psychiatric Complex.
Bullying is a multifaceted problem with many consequences. This study aimed to determine the psychiatric morbidity of children involved in bullying, either as bullies or victims, treated at the Child and Adolescent Mental Health Care Centre of the Free State Psychiatric Complex (FSPC). Free State Psychiatric Complex, Bloemfontein, South Africa. This retrospective cross-sectional study included children under 18 years treated at the FSPC Care Centre between January and September 2017. Information was extracted from patient files. Of 288 patients, 98 (34.0%) were involved in bullying: 66 were bullies, 28 victims, 3 bully-victims, and 1 unspecified. For gender and family structure, there were no statistically significant differences between children involved and those not involved in bullying and between bullies and victims. Almost all bullies (95.4%) had aggression as presenting complaint compared with 39.3% of the victims (p < 0.01). Statistically significantly more victims, than bullies, reported sadness (21.4%, 4.6%, p = 0.02). Attention deficit/hyperactivity disorder (ADHD) was diagnosed in most children, both involved (73.5%) and not involved (63.2%). Statistically significant differences for the presence of conduct disorder were found between children involved and those not involved in bullying (31.6%, 10.0%, p < 0.01) and between bullies and victims (39.4%, 14.3%, p = 0.02). The prevalence of conduct disorder diagnosis was more common in bullies than in victims and those involved in bullying as opposed to those not involved. Psychiatric information of bullying victims and perpetrators in the Free State, which had a high prevalence of bullying in a national survey.


Management of mountainous meadows associated with biodiversity attributes, perceived health benefits and cultural ecosystem services.
Associations between biodiversity, human health and well-being have never been discussed with reference to agriculturally managed, species-rich mountainous meadows. We evaluated these associations between extensively managed (one mowing a year, no fertilization) and abandoned (no mowing since more than 80 years, no fertilization) semi-dry meadows located in the Austrian and Swiss Alps. We quantified the richness and abundance of plants, grasshoppers, true bugs, bumblebees, syrphids and landscape characteristics in the surroundings of the meadows. Associations between these biodiversity attributes and short-term psychological and physiological human health effects were assessed with 22 participants (10 males, 12 females; mean age 27 years). Participants´ pulse rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not affected during visits to managed or abandoned meadows. However, perceived health benefits (e.g., stress reduction, attention restoration) were higher during their stays in managed than in abandoned meadows. Also, the attractiveness of the surrounding landscape and the recreation suitability were rated higher when visiting managed meadows. Perceived naturalness was positively correlated with plant richness and flower cover. A positive correlation was found between SBP and forest cover, but SBP was negatively correlated with the open landscape. A negative association was found between grasshoppers and recreational and landscape perceptions. We suggest to discuss biodiversity attributes not only in connection with agricultural management but also with cultural ecosystem services and health benefits to raise more awareness for multifaceted interrelationships between ecosystems and humans.


[The influence of the capsular defect as a risk factor for recurrence in pleomorphic adenoma].
Aim of this study was to enlighten various aspects of the capsular defect of a pleomorphic adenoma and to analyze its influence on recurrence rate with the help of our data and the relevant literature. The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2005 and 2020 were evaluated retrospectively. The histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. The records of the cases with a capsular defect were examined for information on age, gender, type of surgery and surgical outcome. A total of 845 patients were included in the primary group. 7 (0.8 %) recurrences were detected, all of these were resected without a capsular rupture. Positive margins were found in 37 cases (4.4 %). In 13/37 cases the capsular defect was detected intraoperatively, whereas the defect was only identified histopathologically in 24 of the 37 cases. In the group of the intraoperative capsular opening, with a median follow-up of 62 months, the sonographic examination suspected a unilocular recurrence of the pleomorphic adenoma in two cases. The intraoperative capsule opening does not inevitably seem to lead to a pre-programmed recurrence.


A prototype rehabilitation device with variable resistance and joint motion control.
Resistance exercise has been widely reported to have positive rehabilitation effects for patients with neuromuscular and orthopaedic conditions. This paper presents the design of a versatile rehabilitation device in the form of a rotating joint arm mounted on the adjustable seat that provides passive resistance during strength training for muscles. The resistance is supplied by a magnetorheological damper. Intelligent controls are developed to produce resistance force based on the prescription of the therapist. The device provides both isometric and isokinetic strength training and is reconfigurable for several human joints. Special consideration has been given to the human-machine interaction in the adaptive control algorithms that can modify the behavior of the device to account for strength gains or muscle fatigue.


Association of body composition with bone mineral density in northern Chinese men by different criteria for obesity.
With impressive economic development, obesity has emerged as a critical public health issue in China. Recently it was reported that obesity has taken an adverse effect on osteoporosis. Because there is different body mass index (BMI) for obesity globally, studies based on BMI levels on association of obesity with osteoporosis were quite few. Therefore, we discussed the relationship of body composition with skeletal BMD according to WHO BMI and BMI on Working Group on Obesity in China (WGOC). A total of 502 adult men aged 20-89 were enrolled as healthy subjects for osteoporosis study at Qianfoshan Hospital, Shandong University between September 2008 and August 2010. According to WHO BMI, all subjects were divided into three groups: normal weight (18.5 ≤ BMI < 25 kg/m(2), n = 202), overweight (25 ≤ BMI < 30 kg/m(2), n = 242), and obesity (BMI ≥ 30 kg/m(2), n = 58). According to WGOC BMI, normal weight (18.5 ≤ BMI < 24 kg/m(2), n = 137), overweight (24 ≤ BMI < 28 kg/m(2), n = 225), and obesity (BMI ≥ 28 kg/m(2), n = 140). Total body and regional BMD, lean mass (LM), lean body mass index (LBMI), fat mass (FM), percent body fat (%BF) and fat mass index (FMI) were measured by dual-energy X-ray absorptiometry. Age-partial Pearson correlation analyses between body composition-related parameters and BMD. Multiple regression analyses were performed to explore the associations of BMD with LM, LBMI, FM, %BF and FMI. Fat mass (FM), %BF, FMI, LM and LBMI were positively correlated with BMD at almost sites (P < 0.001) in all subjects. However, the relationship was not different among groups. LM, LBMI, FM and FMI were positively correlated with BMD (P < 0.01) in normal weight. LM and LBMI appeared significantly positive with BMD in overweight and obesity according to WHO and WGOC criteria. %BF and FMI were negative significance with BMD at total body and some regional BMD according to WHO criteria in overweight (P < 0.05). In two obese groups, %BF appeared negatively significant with BMD (P < 0.05) according to WGOC criteria, and %BF and FMI appeared negatively significant with BMD (P < 0.05) according to WHO criteria. In regression of independent variables as FM and LM, LM showed statistically positively significant relations with BMD at almost sites (P < 0.05) in all groups. FM appeared positively significant with BMD in normal groups and overweight group according to WGOC criteria. In regression of independent variables as %BF and FMI, %BF and FMI appeared statistically negatively significant relations with BMD in overweight and obesity, but %BF and FMI were inconsistent in same site. Lean mass (LM) and LBMI could help to determinant of BMD, and %BF and FMI were adverse to BMD in overweight and obesity. Comparing with two criteria, we found the differences in fat-related parameters and BMD according to WHO criteria were more obvious than that according to WGOC criteria. We also found that %BF and FMI were useful to research the relationship between osteoporosis and obesity at the same time.


Real-world surgical treatment patterns and clinical outcomes in patients with stages IA-IIIA non-small cell lung cancer: a retrospective multicentric observational study involving 11,958 patients.
Surgical resection is cornerstone treatment for early-stage non-small cell lung cancer (NSCLC) and offers a chance for cure. This study was conducted to determine current surgical treatment patterns and outcomes of Chinese patients with NSCLC. Data of patients with histologically confirmed NSCLC of stages IA-IIIA and who underwent surgery between July 2014 and July 2020 were retrospectively collected from 9 tertiary hospitals in China. Cox model was used for multivariate analyses. This study included 11,958 patients, among whom 59.1%, 19.2%, and 21.7% were in stages I, II, and IIIA, respectively. Lobectomy was the most common operation method (78.4%), followed by wedge resection (8.2%), segmentectomy (5.4%), pneumonectomy (5.2%), and bronchial sleeve lobectomy (2.8%). Among patients who underwent wedge resection and segmentectomy, majority had stage I NSCLC (87.2% and 93.3%, respectively), and sublobectomy accounted for 20.7% of stage I operations. With a median follow-up time of 30.2 months, disease-free survival (DFS) and overall survival (OS) rates of entire population were 88.9% and 96.1% at 1 year, 75.2% and 85.1% at 3 years, and 65.3% and 77.0% at 5 years, respectively. The 5-year OS rates for stages IA, IB, IIA, IIB, and IIIA disease were 93.2%, 82.7%, 70.3%, 67.0%, and 52.1%, respectively. This is the largest real-world cohort study of patients with NSCLC who underwent surgery in China, where we described characteristics of surgical treatment and survival outcomes. The results of our study provide insights into real-world surgical treatment status for surgeons and clinicians.


On the nature of the RecBC and RecF pathways of conjugal recombination in Escherichia coli.
The molecular mechanisms of the RecBC and RecF pathways for genetic recombination in E. coli were investigated by studying the kinetics of RecA protein function during conjugation. RecF recombination in recBC sbcB mutants is shown to be a much slower process than RecBC recombination in recBC+ sbcB+ strains, and is blocked by a mutation in lexA that prevents induction of RecA protein. Progress of the RecF pathway is greatly accelerated by a recAoc mutation which increases synthesis of RecA protein, but this does not restore recombination proficiency to a recBC sbcB lexA mutant. These results are interpreted to suggest that the RecF pathway directs integration of single-stranded Hfr DNA into the recipient chromosome whereas the RecBC pathway catalyses the exchange of largely double stranded DNA. This is consistent with the known stoichiometry of RecA protein catalysed heteroduplex DNA formation in vitro and with the delayed replication of RecF pathway recombinants which approximates to the time required for one round of DNA replication to generate homoduplex DNA. The regulation of the RecF pathway by lexA repressor is discussed in relation to the factors that govern the relative utilization of the two recombination pathways in wild-type cells.


Effects of intrahepatic canine islet autotransplantation on the portal vein pressure and liver function.
Currently, the most common method used for human islet transplantation is intrahepatic implantation via the portal vein, which may affect portal vein pressure and liver function. The aim of this study was to investigate the effects of intrahepatic canine islet autotransplantation on portal vein pressure and liver function. After total pancreatectomy was performed in 30 mongrel dogs, islets were isolated and transplanted back into the portal vein of the same dog. In our series, 12 dogs achieved normoglycemia (fasting glucose <200 mg/dL) without exogenous insulin after transplantation. The portal vein pressure increased from 4.6 +/- 1.5 to 7.7 +/- 2.9 cm H(2)O after islet infusion (P < .05). Alanine transferase amino transferase (ALT) levels gradually increased after pancreatectomy with the peak at 4 weeks after islet infusion. But the changes of portal vein pressure and ALT were not significantly different between successful and failed islet transplantation. In summary, elevation of portal vein pressure and liver enzymes were noted after intrahepatic canine islet autotransplantation. However, they did not influence the transplant outcome.


Organoantimony (III) Derivative Induces Necroptosis in Human Breast Cancer MDA-MB-231 Cells.
This study aimed to investigate the anticancer effect and the underlying mechanisms of organoantimony (III) fluoride on MDA-MB-231 human breast cancer cells. Five cancer and one normal cell line were treated with an organoantimony (III) compound 6-cyclohexyl-12- fluoro-5,6,7,12-tetrahydrodibenzo[c,f][1,5]azastibocine (denoted as C4). The cell viability was detected by MTT assay. Induction of cell death was determined by Hoechst 33342/PI staining and Annexin-V/PI staining. The effect of C4 on the necroptotic relative protein was determined by Western blot analysis. Among the five cancer cell lines, C4 decreased the viability of MDA-MB-231, MCF-7 and A2780/cisR, and showed less toxicity on normal human embryonic kidney cells. In breast cancer cell line MDA-MB-231, the C4 treatment induced necrotic cell death as well as LDH release in a time- and dose-dependent manner. Moreover, C4 could increase the expression of phosphorylated RIPK3 and MLKL proteins. Overall, the C4 treatment resulted in the reduction of mitochondrial transmembrane potential and accumulation of ROS in MDA-MB-231 cells. C4-induced necroptosis could be ascribed to glutathione depletion and ROS elevation in MDA-MB-231 cells. Our findings illustrate C4 to be a potential necroptosis inducer for breast cancer treatment.


Estimating human exposure through multiple pathways from air, water, and soil.
This paper describes a set of multipathway, multimedia models for estimating potential human exposure to environmental contaminants. The models link concentrations of an environmental contaminant in air, water, and soil to human exposure through inhalation, ingestion, and dermal-contact routes. The relationship between concentration of a contaminant in an environmental medium and human exposure is determined with pathway exposure factors (PEFs). A PEF is an algebraic expression that incorporates information on human physiology and lifestyle together with models of environmental partitioning and translates a concentration (i.e., mg/m3 in air, mg/liter in water, or mg/kg in soil) into a lifetime-equivalent chronic daily intake (CDI) in mg/kg-day. Human, animal, and environmental data used in calculating PEFs are presented and discussed. Generalized PEFs are derived for air----inhalation, air----ingestion, water----inhalation, water----ingestion, water----dermal uptake, soil----inhalation, soil----ingestion, and soil----dermal uptake pathways. To illustrate the application of the PEF expressions, we apply them to soil-based contamination of multiple environmental media by arsenic, tetrachloroethylene (PCE), and trinitrotoluene (TNT).


A group of segmental premotor interneurons regulates the speed of axial locomotion in Drosophila larvae.
Animals control the speed of motion to meet behavioral demands. Yet, the underlying neuronal mechanisms remain poorly understood. Here we show that a class of segmentally arrayed local interneurons (period-positive median segmental interneurons, or PMSIs) regulates the speed of peristaltic locomotion in Drosophila larvae. PMSIs formed glutamatergic synapses on motor neurons and, when optogenetically activated, inhibited motor activity, indicating that they are inhibitory premotor interneurons. Calcium imaging showed that PMSIs are rhythmically active during peristalsis with a short time delay in relation to motor neurons. Optogenetic silencing of these neurons elongated the duration of motor bursting and greatly reduced the speed of larval locomotion. Our results suggest that PMSIs control the speed of axial locomotion by limiting, via inhibition, the duration of motor outputs in each segment. Similar mechanisms are found in the regulation of mammalian limb locomotion, suggesting that common strategies may be used to control the speed of animal movements in a diversity of species.


Alkaline phosphatase and calcification, correlated or not?
The effects of alkaline phosphatase inhibitors (levamisole, L-bromotetramisole) on the activity of the enzyme and on calcification in vitro were studied, to find out whether there is a relationship between alkaline phosphatase and calcification. Metatarsal bones of 15 1/4-day-old embryonic mice were dissected and cultured for 40 hours in the presence and absence of inhibitor. Levamisole and L-bromotetramisole fully inhibited calcification in vitro when present in concentrations which almost totally inhibited alkaline phosphatase activity, as measured biochemically or histochemically. However, incorporation of 3H-thymidine and 35S-sulphate was also inhibited. Furthermore, D-bromotetramisole, the dextroform of bromotetramisole which has no effect on alkaline phosphatase, inhibited calcification and 3H-thymidine and 35S-sulphate incorporation as well. The results of this study show that these inhibitors cannot be used to study the relationship between alkaline phosphatase and calcification. In addition, they suggest that although alkaline phosphatase may be important for the process of calcification, it is probably not a critical factor.


The interference with transapical transcatheter aortic valve implantation by the anterior chordae tendineae preserved at previous mitral valve replacement.
Preserved anterior chordae tendineae is a possible risk factor for disturbing delivery of a transcatheter heart valve. Inserting a sheath just below the aortic valve for delivery of the transcatheter heart valve might be proposed as an alternative to avoid the chordae tendineae.


A sequence homology between the pX genes of HTLV-I/II and the murine IL-3 gene.
Searching the protein sequence database for amino acid sequences homologous to the x-lor sequence in the pX region of human T-cell leukemia virus types I and II (HTLV-I/II), we found that there is a region of 38 amino acids where the murine interleukin 3 (IL-3) sequence has a 40% homology with the x-lor sequence. A statistical analysis shows that this homology is highly significant with a probability of 1.57 X 10(-10). The biological implication of this homology is discussed.


High efficiency plant production of North American ginseng via somatic embryogenesis from cotyledon explants.
An efficient in vitro protocol for plant production of North American ginseng has been established. The pretreatment of cotyledon explants with 1.0 M sucrose at 4 degrees C resulted in an improvement of embryo quality and, combined with a higher sucrose content (7%) in induction medium, improved the embryogenesis frequency from 40% to 75% and the number of embryos per explant from 10 to 21. The frequency of secondary embryogenesis from somatic embryo-derived tissues cultured on MS medium with 1.0 mg l(-1) 2, 4-D and 1.0 mg l(-1) NAA is up to 90%. Somatic embryos can further develop to maturity on SH medium supplemented with 1% activated charcoal and half of them can germinate. About 85% of the germinated embryos will convert into plants with well-developed taproot systems on 1/2 SH medium with 0.5% activated charcoal. The growth chamber and field establishment rates were 95.6 and 93.7%, respectively. The plants transplanted to growth chambers and field plots appear normal.


seqgra: principled selection of neural network architectures for genomics prediction tasks.
Sequence models based on deep neural networks have achieved state-of-the-art performance on regulatory genomics prediction tasks, such as chromatin accessibility and transcription factor binding. But despite their high accuracy, their contributions to a mechanistic understanding of the biology of regulatory elements is often hindered by the complexity of the predictive model and thus poor interpretability of its decision boundaries. To address this, we introduce seqgra, a deep learning pipeline that incorporates the rule-based simulation of biological sequence data and the training and evaluation of models, whose decision boundaries mirror the rules from the simulation process. We show that seqgra can be used to (i) generate data under the assumption of a hypothesized model of genome regulation, (ii) identify neural network architectures capable of recovering the rules of said model and (iii) analyze a model's predictive performance as a function of training set size and the complexity of the rules behind the simulated data. The source code of the seqgra package is hosted on GitHub (https://github.com/gifford-lab/seqgra). seqgra is a pip-installable Python package. Extensive documentation can be found at https://kkrismer.github.io/seqgra. Supplementary data are available at Bioinformatics online.


Sarcoma IL-12 overexpression facilitates NK cell immunomodulation.
Interleukin-12 (IL-12) is an inflammatory cytokine that has demonstrated efficacy for cancer immunotherapy, but systemic administration has detrimental toxicities. Lentiviral transduction eliciting IL-12-producing human sarcoma for autologous reintroduction provides localized delivery for both innate and adaptive immune response augmentation. Sarcoma cell lines and primary human sarcoma samples were transduced with recombinant lentivirus engineering expression of human IL-12 (hu-IL-12). IL-12 expressing sarcomas were assessed in vitro and in vivo following implantation into humanized NSG and transgenic human IL-15 expressing (NSG.Tg(Hu-IL-15)) murine models. Lentiviral transduction (LV/hu-IL-12) of human osteosarcoma, Ewing sarcoma and rhabdomyosarcoma cell lines, as well as low-passage primary human sarcomas, engendered high-level expression of hu-IL-12. Hu-IL-12 demonstrated functional viability, eliciting specific NK cell-mediated interferon-γ (IFN-γ) release and cytotoxic growth restriction of spheroids in vitro. In orthotopic xenograft murine models, the LV/hu-IL-12 transduced human sarcoma produced detectable IL-12 and elicited an IFN-γ inflammatory immune response specific to mature human NK reconstitution in the NSG.Tg(Hu-IL-15) model while restricting tumor growth. We conclude that LV/hu-IL-12 transduction of sarcoma elicits a specific immune reaction and the humanized NSG.Tg(Hu-IL-15) xenograft, with mature human NK cells, can define in vivo anti-tumor effects and systemic toxicities. IL-12 immunomodulation through autologous tumor transduction and reintroduction merits exploration for sarcoma treatment.


Indications for Distal Salpingoscopy
Internal and external tubal pathology are the decisive factors for evaluating tubal function. Salpingoscopy is the most reliable method to determine the mucosal status as the correlation of external and internal pathology is low. We performed distal salpingoscopies according to the method and classification described by Brosens et al on 253 tubes in 159 women and compared external pathology with intratubal findings. In 126 tubes without external pathology, only 2 cases showed moderate mucosal damage (class III), whereas 124 tubes had an intact mucosa (119 class I) or minor pathology (5 class II). Of 127 tubes with external pathology, the mucosa was determined to be class I in 51 cases, class II in 17, class III in 30, class IV (severe damage) in 22, and class V (severe damage) in 7. The correlation of external and internal damage is low. For example, we found that from 10 thin-walled hydrosalpinges, that was formerly a strong indication for microsurgical intervention, 4 showed severely damaged mucosa and were sent for in vitro fertilization (IVF), 3 showed moderate damage (mucosa class III), and only 3 had minor damage (mucosa class II). For complications, we observed four cases with slight bleeding from the fimbriae, two with slight damage of the mucosa, and one incomplete perforation of the tubal wall. We conclude that salpingoscopy should be performed whenever external pathology is detected in an infertility workup. It leads to better evaluation for either microsurgery or IVF. Microsurgical intervention can be avoided in cases with a poor prognosis. If no external pathology of the tube is detected salpingoscopy is not necessary.


Responses of crop productivity and reactive nitrogen losses to the application of animal manure to China's main crops: A meta-analysis.
The effective utilization of manure in cropland systems is essential to sustain yields and reduce reactive nitrogen (Nr) losses. However, there are still uncertainties regarding the substitution of mineral nitrogen (N) fertilizer with manure in terms of its effects on crop yield and Nr losses. We conducted a comprehensive meta-analysis of wheat, maize, and rice applications in China and discovered that substituting mineral N fertilizer with manure increased wheat and maize yields by 4.9 and 5.5 %, respectively, but decreased rice yield by 1.7 %. The increase of yield is larger at low N application and low mineral N substitution rates ((SR) ≤30 %) for silt soils, warm regions, and acidic soils. High SR (>70 %) decreased rice yield as well as the N use efficiency of wheat and maize. Substitution of mineral N fertilizer with manure resulted in lower NH3 volatilization for wheat (48.7 %), lower N2O and NH3 emissions, and N runoff for maize (12.8, 49.6, and 66.7 %, respectively), and lower total Nr losses for rice (11.3-26.5 %). The loss of Nr was significantly and negatively correlated with soil organic carbon content. The rate of N application, soil properties, and climate were critical factors influencing N2O and NH3 emissions and N leaching, whereas climate or soil properties were the dominant factors influencing response in N runoff. We concluded that in silt soils, warm regions, and neutral soils, a ≤ 50 % substitution of mineral N fertilizer with manure can sustain crop yields while mitigating Nr losses.


Boosting the Performance of Environmentally Friendly Quantum Dot-Sensitized Solar Cells over 13% Efficiency by Dual Sensitizers with Cascade Energy Structure.
Generally, high light-harvesting efficiency, electron-injection efficiency, and charge-collection efficiency are the prerequisites for high-efficiency quantum-dot-sensitized solar cells (QDSCs). However, it is fairly difficult for a single QD sensitizer to meet these three requirements simultaneously. It is demonstrated that these parameters can be felicitously balanced by a cosensitization strategy through the adoption of environmental-friendly Zn-Cu-In-Se and Zn-Cu-In-S dual QD sensitizers with cascade energy structure. Experimental results indicate that: i) the combination of the dual QDs can improve the light-harvesting capability of the cells, especially in the visible light window; ii) the cosensitization approach can facilitate electron injection, benefitting from the cascade energy structure of the two QD sensitizers employed; iii) the charge-collection efficiency can be remarkably enhanced by the suppressed charge-recombination process due to the improved QD coverage on TiO2 . Consequently, this cosensitization strategy delivers a new certified efficiency record of 12.98% for liquid-junction QDSCs under AM 1.5G 1 sun irradiation. Moreover, the constructed cells exhibit good stability in a high-humidity environment.


Performance of Geno2Pheno[coreceptor] to infer coreceptor use in human immunodeficiency virus type 1 (HIV-1) subtype A.
Assessment of human immunodeficiency virus type 1 (HIV-1) coreceptor usage is required prior to treatment with the CCR5 antagonist maraviroc to exclude the presence of CXCR4-using (X4) strains. Genotype-based interpretation systems are mostly designed on subtype B and have been reported to be less accurate for subtype A/CRF02_AG. To evaluate the performance of the widely used Geno2Pheno[coreceptor] (G2P[c]) algorithm for prediction of coreceptor usage with subtype A/CRF02_AG vs. subtype B. Co-receptor tropism of 24 subtype A/CRF02_AG and 24 subtype B viruses was measured phenotypically by a homebrew single-cycle assay and genotypically by using G2P[c]. Samples with discrepant genotype-phenotype results were analyzed by next generation sequencing (NGS) and interpreted by the NGS Geno2Pheno algorithm (G2P[454]). At 10% false positive rate (FPR), the G2P[c]/phenotype discordance rate was 12.5% (n = 3) for subtype A/CRF02_AG and 8.3% (n = 2) for subtype B. Minority X4 species escaping detection by bulk sequencing but documented by NGS explained the two subtype B and possibly one subtype A/CRF02_AG discordant case. The other two subtype A/CRF02_AG miscalled by G2P[c] could be explained by X4 overcalling at borderline FPR and/or by algorithm failure. Our study did not demonstrate relevantly higher G2P[c] inaccuracy with subtype A/CRF02_AG with respect to subtype B. Genotype/phenotype discordances can be due to different reasons, including but not limited to, algorithm inaccuracy. Very large genotype/phenotype correlation panels are required to detect and explain the reason for any consistent difference in genotypic tropism prediction for subtype A/CRF02_AG vs. subtype B.


A novel case of inclusion body myositis and myasthenia gravis.
The co-existence of myasthenia gravis and other inflammatory myopathies has been reported in the literature before, but no clinical cases involving inclusion body myositis have been reported. We report a case of a 67-year-old patient who presented with dysphagia, exhibiting the typical electrophysiological features of postsynaptic neuromuscular junction defect with positive muscle acetylcholine receptor antibodies, consistent with the diagnosis of myasthenia gravis. Nevertheless, response to acetylcholinesterase inhibitors and immunomodulatory treatment was unexpectedly poor. As the disease progressed, the patient developed asymmetric muscle weakness, initially affecting mainly the quadriceps and the finger flexors. Muscle MRI imaging supported the presence of an inflammatory myopathy and muscle biopsy confirmed the diagnosis of inclusion body myositis. Thus, our patient represents the first reported overlap case of myasthenia gravis and inclusion body myositis.


Suppression of hypothalamic deiodinase type II activity blunts TRH mRNA decline during fasting.
Fasting is characterized by disrupted thyroid feedback, with suppressed levels of thyroid hormones and paraventricular thyrotropin releasing hormone (TRH). We found that third ventricle administration of the deiodinase inhibitor, iopanoic acid, dose-dependently reduced deiodinase type II (DII) activity selectively in the hypothalamus. This suppression of DII by iopanoic acid during fasting prevented elevated DII activity and blunted the decline in hypothalamic TRH mRNA levels. Because fasting-induced elevation in hypothalamic DII activity is paralleled by increased hypothalamic T3 concentration, our study suggests that T3 formation by DII in the hypothalamus is the cause of disrupted thyroid feedback during fasting.


Gasless laparoscopic esophagomyotomy.
A case of gasless laparoscopic esophagogastric myotomy for achalasia is presented. The technical aspects of the technique as well as the benefits of this approach are reviewed.


The effect of solifenacin on urethral sphincter morphology.
The aim of the study was to determine whether a 6-week course of 5 mg of solifenacin succinate used to treat mixed incontinence, produces measurable changes in the appearance of the urethral sphincter. Twenty-six women undergoing treatment for mixed incontinence were recruited from a urogynaecology unit after failing to improve with conservative treatments and bladder drill. All underwent dual channel subtracted cystometry, which showed mixed urodynamic stress incontinence and detrusor overactivity. All patients underwent a 3D transperineal ultrasound before solifenacin therapy was started and after 6 weeks of treatment. The urethral length, width and volume of the smooth muscle and total sphincter volume were compared before and after the treatment. Clinically, 13 reported no improvement in either stress or urge incontinence. Eight women reported improvement in their urgency symptoms but no benefit in their stress leakage. Four women reported resolution of both stress and urge incontinence. One woman reported worsening of her bladder symptoms. There was no significant change in the urethral length (p = 0.27), width (p = 0.50), volume of smooth muscle (p = 0.87) or total sphincter volume (p = 0.60) before and after treatment with solifenacin. A 6-week course of solifenacin resulted in no measurable changes in the appearance of the urethral sphincter.


Acute thrombosis after elective direct intracoronary stenting in primary antiphospholipid syndrome: a case report.
Antiphospholipid syndrome (APS) is an uncommon prothrombotic disorder that has been increasingly recognized in recent years. The diagnosis of APS must be associated with venous or arterial thrombosis or both. Patients with APS usually present with recurrent deep vein thrombosis, pulmonary thromboembolism, thromboembolic stroke, or myocardial infarction. Here, we report a case of a 61-year-old female who presented with a 3-month history of increasingly frequent retrosternal chest tightness. After treadmill test and thallium-201 myocardial perfusion scan, she was admitted and underwent elective coronary angiography but developed acute thrombosis after direct intracoronary stenting. She was successfully rescued with repeat percutaneous transluminal coronary angioplasty and prolonged heparin and glycoprotein IIb/IIIa antagonist use. Laboratory data showed prolongation of partial thromboplastin time and positive anti-cardiolipin antibody. These findings satisfied the criteria for APS; the patient was diagnosed with primary APS because she had neither typical symptoms nor signs of systemic lupus erythematosus or other immunologic disorders. Thereafter, long-term oral anticoagulant appeared to be effective. To our knowledge, this is the first report of acute stent thrombosis in a patient with primary APS.


Changes in antimicrobial resistance and molecular attributes of Salmonellae causing enteric fever in Kolkata, India, 2014-2018.
Globally, enteric fever caused by Salmonella Typhi (S. Typhi, ST) and S. Paratyphi A (SPA) remain one of the major diseases of public health importance. In this study, a total of 457 (380 ST, 77 SPA) blood isolates were collected from three tertiary care hospitals in Kolkata during 2014-18. Additionally, 66 (3.4%) ST and 5 (0.25%) SPA were recovered from blood culture of 1962 patients attending OPD of one pediatric hospital during 2016-18. The study isolates were tested for antimicrobial resistance (AMR) profiles; AMR genes; molecular sub-types by PFGE, MLVA and CRISPR. Among the total 446 ST and 82 SPA isolates, fluoroquinolone (FQ) resistance was very common in both serovars. Ciprofloxacin resistance of 24.9% and 9.8% & ofloxacin resistance of 20.9% and 87.8% were found in ST and SPA respectively. Majority (>70%) of the isolates showed decreased susceptibility to ciprofloxacin (DCS). A single point mutation in gyrA gene (S83F) was responsible for causing DCS in 37.5% (n = 42/112) ST and 63% (n = 46/73) SPA isolates. Multidrug resistance (MDR) was found only in 3.4% ST isolates and encoded the genes blaTEM-1, catA, sul, strA-strB, class 1 integron with dfrA7. All MDR ST (n = 15) possessed non-conjugative non-IncHI1 (180 kb) plasmid except one having conjugative IncHI1 (230 kb) plasmid and one without plasmid. The MDR genes were integrated near chromosomal cyaA gene site in ST with/without the presence of plasmid (nonIncH1). Almost 65.7% resistant ST belonged to H58 haplotype. PFGE showed clonally related isolates with 81% similarity in ST and 87% in SPA. Similarly, CRISPR typing showed less diversity among the isolates. However, the isolates (ST and SPA) were found to be more diverse by MLVA typing (D value 0.987 and 0.938). The study reports decrease in MDR and increase in FQ resistance among typhoidal Salmonella isolates over the years giving interesting information for enteric fever treatment.


Survivors' Dilemma: Young Adult Cancer Survivors' Perspectives of Work-Related Goals.
Young adult cancer survivors have significant work-related challenges, including interruptions to education and employment milestones, which may affect work-related goals (WRGs). The study purpose was to explore posttreatment perspectives of WRGs in a sample of young adult hematologic cancer survivors. This qualitative descriptive study used social media to recruit eligible cancer survivors (young adults working or in school at the time of cancer diagnosis). Data were collected through telephone semi-structured interviews and analyzed using directed content analysis, followed by thematic content analysis to identify themes. The sample (N = 40) were mostly female (63.5%), White (75%), and diagnosed with Hodgkin lymphoma (57.5%); most worked in professional (40%) or health care (23%) roles. The overarching theme, "Survivors' Dilemma," highlights a changed perspective on work-related fulfillment and financial obligations, capturing survivors' decision-making process regarding work. Three subthemes illustrated questions that participants contemplated as they examined how their WRGs had changed: (a) Self-identity: Do I want to do this work? (b) Perceived health and work ability: Can I do this work? and (c) Financial toxicity: Can I afford to/not to do this work? Participants experienced a state of dilemma around their WRGs, weighing areas around self-identity, perceived health and work ability, and financial toxicity. Findings suggest occupational health nurses should be aware of challenges surrounding WRGs, including how goals may change following a cancer diagnosis and treatment, and the potential stressors involved in the Survivors' Dilemma. Occupational health nurses should assess for these issues and refer young survivors to employee and financial assistance programs, as necessary.


Prospective, randomized, multicenter clinical study comparing a self-expanding covered stent to percutaneous transluminal angioplasty for treatment of upper extremity hemodialysis arteriovenous fistula stenosis.
Use of a covered stent after percutaneous transluminal angioplasty (PTA) was compared to PTA alone for treatment of upper extremity hemodialysis patients with arteriovenous fistula (AVF) stenoses. Patients with AVF stenosis of 50% or more and evidence of AVF dysfunction underwent treatment with PTA followed by randomization of 142 patients to include a covered stent or 138 patients with PTA alone. Primary outcomes were 30-day safety, powered for noninferiority, and six-month target lesion primary patency (TLPP), powered to test whether TLPP after covered-stent placement was superior to PTA alone. Twelve-month TLPP and six-month access circuit primary patency (ACPP) were also hypothesis tested while additional clinical outcomes were observed through two years. Safety was significantly non-inferior while six- and 12-month TLPP were each superior for the covered stent group compared to PTA alone (six months: 78.7% versus 55.8%; 12 months: 47.9% versus 21.2%, respectively). ACPP was not statistically different between groups at six-months. Observed differences at 24 months favored the covered-stent group: 28.4% better TLPP, fewer target-lesion reinterventions (1.6 ± 1.6 versus 2.8 ± 2.0), and a longer mean time between target-lesion reinterventions (380.4 ± 249.5 versus 217.6 ± 158.4 days). Thus, our multicenter, prospective, randomized study of a covered stent used to treat AVF stenosis demonstrated noninferior safety with better TLPP and fewer target-lesion reinterventions than PTA alone through 24 months.


Biochemical resolution of European and African isolates of Trichinella nelsoni Britov and Boev, 1972.
Isoenzyme analysis was used to characterize 47 isolates of Trichinella nelsoni from Europe (EUR) and two from Kenya and Tanzania (AFR). In all, 27 isoenzymes showed polymorphism within the species. The EUR parasites, isolated from domestic, synanthropic, sylvatic animals and man, showed isoenzymatic profiles different from those exhibited by AFR parasites isolated from sylvatic animals. The EUR parasites showed polymorphism due to three isoenzymes, i.e. ME, MPI and PGM. Euclidean distance and a dendrogram were used to evaluate the relationships among isolates. The Euclidean values showed that EUR and AFR genotypes are distant from each other and from the reference strains T. spiralis s.str. and T. pseudospiralis. The genetic data indicate the absence of gene flow between AFR and EUR isolates. The biochemical results suggest the presence of genetic heterogeneity in T. nelsoni and support the existence of a zoogeographical segregation of the two gene pools. The authors propose that as operational labels, code T3 be assigned to EUR isolates and code T7, to AFR isolates.


The distribution of ringworm infections amongst Nigerian nomadic Fulani herdsmen.
There are very few medical reports on the nomadic peoples of the world. In Nigeria such reports are non-existent. The present work has looked at the distribution of ringworm infections among the Nigerian nomadic Fulani herdsmen. An examination of their infected herds of cattle revealed similarities in the species of dermatophytes isolated from the herdsmen and those isolated from their cattle. Some of the leaves of the plants that lined the cattle tracks normally used by both the herdsmen and their cattle yielded some of the species of dermatophytes isolated from the herdsmen and their cattle. The possible origins of the dermatophytes that caused the ringworm infections amongst the nomads are discussed.


Efficacy of left colic artery preservation with D3 lymph node dissection in laparoscopic surgery for advanced sigmoid and rectal cancer.
For advanced left colon cancer, lymph node dissection at the root of the inferior mesenteric artery is recommended. Whether the left colic artery (LCA) should be preserved or resected remains contentious. The 367 patients who underwent laparoscopic sigmoidectomy or anterior resection and who were pathologically node-positive were reviewed. Patients were divided into LCA-preserving group (LCA-P, n = 60) and LCA-non-preserving group (LCA-NP, n = 307). Propensity score matching was applied to minimize selection bias and 59 patients were matched. Before matching, the rates of poor performance status and cardiovascular disease were higher in the LCA-P group (p < 0.001). After matching, operation time was longer (276 vs. 240 min, p = 0.001), the frequency of splenic flexure mobilization (62.7% vs. 33.9%, p = 0.003) and lymphovascular invasion (84.7% vs. 55.9%, p = 0.001) was higher in the LCA-P group. Severe postoperative complications (CD ≥ 3) occurred only in the LCA-NP group (0% vs. 8.4%, p = 0.028). The median follow-up period was 38.5 months (range 2.0-70.0 months). The 5-year RFS rates (67.8% vs. 66.0%, p = 0.871) and OS rates (80.4% vs. 74.9%, p = 0.308) were comparable between the groups. Laparoscopic LCA-sparing surgery for left-sided colorectal cancer reduces the risk of severe complications and offers a favorable long-term prognosis.


Prevalence of early repolarization pattern and its association with sudden cardiac death and arrhythmia over one-year follow-up in an Egyptian cohort.
Early repolarization pattern (ERP) is not uncommon electrocardiography (ECG) finding and could be associated with arrhythmia and sudden cardiac death (SCD). We aimed to prospectively determine the prevalence of ERP and its association with arrhythmia and SCD during one-year follow-up in an outpatient Egyptian cohort. Clinical assessment and ECG were performed to 1850 consecutive individuals presented at the outpatient clinic of Suez Canal University Hospital (SCUH). Then, the ERP group and 100 age and gender-matched ERP -ve controls had undergone echocardiography, 24-h Holter ECG and exercise stress ECG. ERP was found in 124 individuals (6.7%); we excluded 24 patients with structural heart disease. ERP group (No. = 100) were relatively young (80% <50 years-old) and showed male preponderance (60%). ERP frequencies were: inferolateral (50%), antero-lateral (38%), inferior (10%), and global (2%). ERP subjects were leaner than controls (BMI was 25.3 vs. 30 kg/m2, P value < 0.001) and achieved more metabolic equivalents (METS) on stress ECG (10.7 vs. 8.5 METS, P value < 0.01). Only 4% in the ERP group had horizontal/descending ST slope, while 8% had ST elevation ≥ 2 ms. No arrhythmia or SCD were reported during 1-year follow-up in both groups. Regression analysis showed that male gender, Sokolow-Lyon criteria and short QTc were significant independent predictors of ERP, P value < 0.05. In outpatient-based Egyptian cohort, the prevalence of ERP was 6.7%, mostly the inferolateral pattern. Our ERP subjects had low-risk clinical and ECG criteria for malignant ERP. Further epidemiological studies are needed to explore the natural history of ERP.