Sports-related testicular injuries and the use of protective equipment among young male athletes.
To survey young male athletes to determine the self-reported prevalence of sports-related testicular injuries and use of protective equipment among adolescents and young adults. A self-administered questionnaire was distributed to male students at local high schools and colleges. Respondents were asked about personal and team member usage of athletic cups and history of testicular injuries. Returned surveys were analyzed for descriptive statistics and compared between high school and college respondents. Approximately 1700 surveys were distributed and 731 returned. The mean age of all respondents was 17.7 years. Across all sports, 18% of athletes experienced a testicular injury during sports and 36.4% observed injuries in team members, whereas only 12.9% of respondents reported wearing athletic cups. The prevalence of testicular injuries for lacrosse, wrestling, baseball, and football was 48.5%, 32.8%, 21%, and 17.8%, respectively. Of athletes reporting a prior injury, 20.1% reported that they wear a cup now. Rates of athletic cup usage were significantly less for college baseball, football, and all respondents compared with their high school counterparts. Previously reported rates of testicular injury with sports participation may underestimate the prevalence of these injuries among adolescent and young adult athletes among whom testicular protective equipment is infrequently used.


Effectiveness of Presurgical Nasoalveolar Molding Appliance in Infants With Complete Unilateral Cleft Lip and Palate.
To assess the effectiveness of the presurgical nasoalveolar molding appliance among infants with unilateral cleft lip and palate. In this prospective study, 95 pairs of casts of infants with unilateral cleft lip and palate treated by presurgical nasoalveolar molding were selected at the Children's Hospital 1 at Ho Chi Minh City, Vietnam. The average time of treatment was 3 months. All casts were scanned and measured using 3-dimensional technology before and after treatment. Paired t tests were applied for comparisons. There was a statistically significant increase in the nostril height in cleft side (P < .001), decrease in the nostril width and columella angle (P < .001), and decrease in cleft width and midline deviation (P < .001) after treatment with presurgical nasoalveolar molding appliance. Nasoalveolar molding appliance is effective in improving the morphology of nostril and maxillary alveolar. Understanding this helps orthodontists and surgeons in treatment outcome expectations.


Increasing usage of chlorhexidine in health care settings: blessing or curse? A narrative review of the risk of chlorhexidine resistance and the implications for infection prevention and control.
Chlorhexidine digluconate (CHG) is an antiseptic frequently used in hospitals to prevent healthcare-related infections. It is used in different formulations for skin antisepsis, oral care, patient bathing, and hand hygiene. Also, CHG impregnated vascular catheters and wound dressings contribute to increased exposure of hospital germs to this biocide. In the last decade, concerns are rising about decreasing susceptibility of microorganisms to CHG and its potential cross-resistance with antibiotics. This study reviewed the published data regarding the evidence of reduced CHG susceptibility, the cross-resistance with antibiotics, and the implications for infection control for S. aureus, coagulase-negative staphylococci, E. coli, K. pneumoniae, and P. aeruginosa. Despite incongruity in definitions of "resistance," increased CHG minimal inhibitory values of these pathogens have been described, and different mutations encoding for CHG efflux pumps have been identified. Clinical relevance of species with reduced susceptibility to CHG is debatable and cross-resistance with antibiotics remains controversial. However, some studies link the increased usage of CHG to multidrug resistance, and the potential cross-resistance with colistin for K. pneumoniae is of major concern. More research in this matter is necessary. For infection control, it is advisable to use CHG applications only for indications with a clear patient benefit. It is important to follow manufacturer's instructions, and exposure of microorganisms to sub-lethal CHG concentrations should be avoided.


Epigenetics in human gliomas.
Aberrant epigenetic landscapes and their involvement in genesis and progression of tumors, as well as in treatment responses and prognosis, indicate one of the most emerging fields in cancer research. In gliomas, the most common human primary brain tumors, and in particular in glioblastoma, the most malignant and devastating brain tumor entity in adults, the elucidation of distinct patterns of aberrant DNA methylation, histone modification, and miRNA expression and their interrelationship has fundamentally changed our point of view on these highly heterogeneous tumors. In the current review article, we address the basic principles of epigenetic control in gliomas, their current and putative future role in prognostic and predictive models and possible interactions within the epigenetic network. We discuss diagnostic and therapeutic opportunities appearing at horizon of epigenetic research. Moreover, we present current and propose future clinical workflow models for molecular characterization of malignant gliomas.


The intracellular tyrosine kinase Brk sensitizes non-transformed cells to inducers of apoptosis.
The intracellular tyrosine kinase Brk is expressed in regenerating epithelial tissues with highest levels in the gastrointestinal tract and skin. In these tissues, Brk is restricted to epithelial cells that are exiting the cell cycle and undergoing terminal differentiation. While not expressed in mammary gland, Brk expression is often induced in primary breast tumors and breast tumor cell lines. To identify potential oncogenic functions of Brk, we utilized the immortalized Rat1a rat fibroblast cell line that is highly sensitive to transformation. We generated Rat1a cell lines that stably overexpress wild-type and activated Brk, and we analyzed their growth properties and ability to undergo apoptosis in response to stress and DNA damage. Overexpression of Brk did not induce anchorage-independent growth, and no changes in cell morphology or cell cycle progression were observed. However, when constitutively expressed, Brk sensitized Rat1a cells to a variety of apoptotic stimuli including serum deprivation and a combination of UV irradiation and serum starvation. These findings indicate that Brk does not promote proliferation of non-transformed cells, but plays a positive role in the regulation of the apoptotic response to DNA-damage and stress.


Invasive cervical resorption Class III in a maxillary central incisor: diagnosis and follow-up by means of cone-beam computed tomography.
Invasive cervical resorption (ICR) is a type of external resorption that begins below the epithelial attachment. The etiology of ICR is mainly caused by trauma or orthodontic treatment. In many cases, cone-beam computed tomography (CBCT) is a very useful tool to achieve proper diagnosis. This case presented with invasive cervical resorption class III (Heithersay) caused by trauma on tooth #9. CBCT was performed allowing observation of the extent of the lesion in the three spatial planes. Treatment was combined: surgical treatment to expose the resorptive defect and nonsurgical root canal therapy to remove the necrotic pulp and disinfect the root canal system; finally, the resorptive defect was filled up with resin ionomer (Geristore; Den-Mat Corporation, Santa Maria, CA). Follow up x-ray films showed healing of the periradicular tissues, and then a control CBCT was performed to assess the reliability of the conventional x-ray film; a small periapical lesion was observed in two of the CBCT sections.


Of mice and men: experimental autoimmune encephalitis and multiple sclerosis.
Research using experimental autoimmune encephalitis (EAE) models accounts for almost 20% of the papers. published in multiple sclerosis (MS). We performed a literature review of papers indexed with ISI Web of Science on EAE and MS over the last 30 years and a detailed analysis of studies of molecular pathways in EAE published in 2008 and 2009. The impact of EAE studies declines more rapidly than other studies published on MS (EAE cited corrected half-life = 4·00 years vs. MS cited corrected half-life = 9·66 years, P < 0·0001). The pathology of EAE differs quite markedly from that observed in the human disease. EAE has implicated many different genes as important to pathogenesis but only a minority of these are supported by human studies. Future research should critically appraise precisely what is being modelled by EAE before drawing conclusions about human disease.


A self-driving laboratory advances the Pareto front for material properties.
Useful materials must satisfy multiple objectives, where the optimization of one objective is often at the expense of another. The Pareto front reports the optimal trade-offs between these conflicting objectives. Here we use a self-driving laboratory, Ada, to define the Pareto front of conductivities and processing temperatures for palladium films formed by combustion synthesis. Ada discovers new synthesis conditions that yield metallic films at lower processing temperatures (below 200 °C) relative to the prior art for this technique (250 °C). This temperature difference makes possible the coating of different commodity plastic materials (e.g., Nafion, polyethersulfone). These combustion synthesis conditions enable us to to spray coat uniform palladium films with moderate conductivity (1.1 × 105 S m-1) at 191 °C. Spray coating at 226 °C yields films with conductivities (2.0 × 106 S m-1) comparable to those of sputtered films (2.0 to 5.8 × 106 S m-1). This work shows how a self-driving laboratoy can discover materials that provide optimal trade-offs between conflicting objectives.


Results from 8 years of the proficiency testing program for diagnosis of hemoglobinopathies under the prevention and control program of thalassemia in Thailand.
Hemoglobin (Hb) analysis is a key testing for diagnosis of hemoglobinopathies. Accurate analysis, interpretation of results, and genetic risk assessment are important. We report on 8 years of the proficiency testing (PT) program for hemoglobinopathies in Thailand. Laboratory participants were required to test two simulated PT items in each cycle using capillary electrophoresis, one was a husband and another was his pregnant wife. Related hematological parameters were provided. The participants also provide interpretation and evaluate the risk of having three severe thalassemia diseases in an expected fetus. Three cycles were operated per year in accordance with the ISO17043 and ISO13528 guidelines. A total of 84 laboratories throughout Thailand were participated. A total of 24 PT cycles were performed during 2012-2019. Most participants had Excellent performance for the PT items with normal, β-thalassemia trait, hemoglobin E trait, hemoglobin E trait with α-thalassemia, and Hb H disease. However, when the PT items with homozygous Hb E and Hb E-β-thalassemia were tested, an increase in a Needs improvement performance was noted. From 24 PT cycles, the performance with Excellent, Good, Fair, and Needs improvement was ranging from 10.5%-95.8%, 0%-11.3%, 0%-77.2%, and 2.3%-37.0%, respectively. Most participants have proven their performance to be reliable and demonstrated their abilities to provide interpretation and genetic risk assessment on most of the PT items. For complex thalassemia however, a need to improve the interpretation and risk assessment skills is required which is essential for effective prevention and control of severe thalassemia diseases in Thailand.


Risk factors for 30-day readmissions after hepatectomy: analysis of 2444 patients from the ACS-NSQIP database.
The aim of this study was to identify risk factors associated with unplanned readmissions after hepatectomies. Patients who underwent hepatectomies between January and December of 2011 were identified using the ACS-NSQIP database. A multivariate logistic regression analysis was performed to determine predictors of unplanned readmissions related to the procedure within 30 days. Unplanned readmissions occurred in 10.5 % of all patients who received a hepatectomy. On multivariate analysis, transfusion within 72 h after surgery (odds ratio [OR] 1.74, p < 0.001), complexity of procedure (extended, OR 1.84, p = 0.004; right hepatectomy, OR 1.66, p = 0.003), and longer operative time (>median 320 min, OR 2.43, p < 0.001) were independent perioperative predictors of unplanned readmissions. Independent preoperative risk factors included elevated alkaline phosphatase (OR 1.45, p = 0.017), bleeding disorders (OR 1.72, p = 0.051), and lower albumin levels (OR 1.30, p = 0.036). Transfusion, complexity of procedure, and duration of operation were the strongest predictors of unplanned readmissions after liver resection.


Hyperactivity and pediatrician diagnoses, parental ratings, specific cognitive abilities, and laboratory measures.
Children diagnosed as hyperactive and treated for hyperactivity by private pediatricians were compared to a large unselected sample of children on parental ratings of behavioral problems (Conners Symptoms Rating Questionnaire), laboratory measures (a week-long assessment of locomotion as measured by pedometers, sustained attention, selective attention, fidgeting, and aggressiveness), and 10 tests of specific cognitive abilities (verbal reasoning, spatial reasoning, memory, and perceptual speed). Test-retest reliability was obtained for all measures. The results indicated that pediatrician diagnoses of hyperactivity are related to parental ratings but not to laboratory assessments. Diagnoses by private pediatricians may include more heterogeneous and nonspecific behavioral problems than diagnoses made in most research contexts. Pediatrician diagnoses were related to deficits in specific cognitive abilities, most notably perceptual speed and verbal ability. Hyperactivity as diagnosed by private pediatricians may reflect deficits in skills necessary to pace oneself appropriately in school-related tasks. In general, these results suggest that the criteria and methods used to diagnose hyperactivity deserve greater attention.


Anesthetic considerations for a patient with compound heterozygous medium-chain Acyl-CoA dehydrogenase deficiency.
We describe the anesthetic management of a parturient with compound heterozygous medium chain acyl-CoA dehydrogenase deficiency, the most common disorder of fatty acid metabolism.


Distal ureteral stone in an ileal conduit: A case treated by antegrade flexible ureteroscopic lithotripsy.
Antegrade flexible URSL is a minimal invasive option for treating distal ureteral stones in patient after urinary diversion.


Comparing the effects of anticipatory postural adjustments focused training and balance training on postural preparation, balance confidence and quality of life in elderly with history of a fall.
Impairment of postural adjustments in elderly is associated with decreased functional mobility, balance confidence and quality of life. We studied the effects of anticipatory postural adjustments focused training on postural preparation, balance confidence and quality of life of the elderly. It was a single-blind randomized controlled trial. The sample included 60 males with history of falling (at least once in the past 6 months). They were matched and randomly assigned into three groups: perturbation, balance, and no training. The electrical activity of the muscles was measured by electromyography. The Activities-specific Balance Confidence (ABC) scale and the SF-36 questionnaire were used to assess balance confidence and quality of life, respectively. Repeated-measures ANOVA was used for data analysis (significant level 0.05). The type of training had significant interaction effect on muscle latency (F(2, 46) ≥ 71.06, P ≤ 0.001, η2 ≥ 0.75). Compared to the other two groups, perturbation training group showed significantly more improvement in ABC scale (F(2, 46) = 14.94, P ≤ 0.000, η2 ≥ 0.39). It also significantly showed more improvement than no training group in all areas of SF-36 questionnaire, except for mental health (F(2, 46) ≥ 6.56, P ≤ 0.03, η2 ≥ 0.22). Our findings support the use of perturbation training, as it reduced the probability of falling (by decreasing muscle latency and increasing posture preparation), improved the balance confidence for daily activities, and improved the quality of life.


Effects of phenytoin on [3H]diazepam binding in dissociated primary cortical cell culture.
The effects of chronic exposure of primary dissociated cerebral cortical cells in culture to the anticonvulsant drug phenytoin have been investigated using benzodiazepine binding techniques. By separating benzodiazepine binding into pharmacologically distinct subtypes, the data indicate that clonazepam-displaceable benzodiazepine binding (associated primarily with neuronal membranes) is significantly decreased by exposure to therapeutic and toxic doses of phenytoin while R05-4864-displaceable benzodiazepine binding (associated principally with non-neuronal elements) is enhanced. The ratio of clonazepam-displaceable to R05-4864-displaceable benzodiazepine binding appears to be the most sensitive indicator for these changes.


Visceral adiposity, subcutaneous adiposity, and severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis.
Body mass index (BMI) has previously been shown to increase mortality and disease severity in patients with COVID-19, but the pooled effect estimate was heterogeneous. Although BMI is widely used as an indicator, it cannot distinguish visceral from subcutaneous fat. This systematic review and meta-analysis aimed to investigate the association between visceral adiposity, subcutaneous fat, and severe COVID-19. We performed a systematic literature search using the databases: PubMed, Embase, and EuropePMC. Data on visceral fat area (VTA), subcutaneous fat area (SFA), and total fat area (TFA) were collected. The outcome of interest was severe COVID-19. We used a REML random-effects model to pool the mean differences and odds ratio (OR). There were 5 studies comprising of 539 patients. Patients with severe COVID-19 have a higher VTA (mean difference 41.7 cm2 [27.0, 56.4], p < 0.001; I2: 0%) and TFA (mean difference 64.6 cm2 [26.2, 103.1], p = 0.001; I2: 0%). There was no significant difference in terms of SFA between patients with severe and non-severe COVID-19 (mean difference 9.3 cm2 [-4.9, 23.4], p = 0.199; I2: 1.2%). Pooled ORs showed that VTA was associated with severe COVID-19 (OR 1.9 [1.1, 2.2], p = 0.002; I2: 49.3%). Visceral adiposity was associated with increased COVID-19 severity, while subcutaneous adiposity was not. CRD42020215876.


Online surveys as discourse context: Response practices and recipient design.
While a growing body of work has focused on the interactional organization of telephone survey interviews, little if any research in conversation and discourse analysis has examined written online surveys as a form of talk-in-interaction. While survey researchers routinely examine such responses using content analysis or thematic analysis methods, this shifts the focus away from the precise language and turn constructional practices used by respondents. By contrast, in this study we examine open-ended text responses to online survey questions using a conversation analytic and discourse analytic approach. Focusing on the precise turn constructional practices used by survey respondents- specifically, how they formulate multi-unit responses and make use of turn-initial discourse markers- we demonstrate how online survey respondents treat open-ended survey questions much as they would any similar sequence of interaction in face-to-face or telephone survey talk, making online surveys a tenable source of data for further conversation analytic inquiry.


[The practice and acceptance of physician preventive medicine services in a Montreal university hospital and the obstacles that deter their implementation.].
Present a picture of physicians' preventive clinical practices (PCP) at a university medical centre, and identify the obstacles that hinder their implementation. Self-administered questionnaire survey addressed to 367 general practitioners and specialists working at the Centre hospitalier de l'Université de Montréal (CHUM) in 2006. Respondents claim to be recommending PCP (often or very often) in approximately 60-82% of cases. Women physicians report a larger integration for screening and vaccination (p < 0.05). General physicians claim to apply or recommend PCP more frequently than specialists (p < 0.05), except for anti-tobacco counseling. Lack of time (82%) and deficiencies in continuity of treatment (75%) are considered by the majority of respondents as major obstacles to the realization of PCP. Most participants (99%) consider delivering preventive services to be part of their role and 98% claim to be motivated to integrate PCP into their practice. However, almost half of physicians do not apply preventive recommendations to their own life and at least two thirds of them doubt the efficacy of counseling. Despite observed encouraging results, actions must be taken to improve the integration of PCP to general and specialized health care and to bring physicians around to adopting healthy lifestyle habits themselves.


Result of a low-cost follow-up study of discharged alcoholics.
This paper describes a simple procedure for determining which variables in treatment programs are related to treatment outcome.


Accuracy of colon capsule endoscopy for advanced neoplasia.
Second-generation colon capsule endoscopy (CCE-2) has shown promising accuracy for the diagnosis of overall neoplasia. Advanced neoplasia (AN) represents the main target of colorectal cancer screening programs. Our aim was to assess the diagnostic accuracy of CCE-2 for the detection of AN in patients with a positive result for the fecal immunochemical test (FIT) who are undergoing screening. Patients aged 50 to 69 years with a positive result for the FIT in 4 population screening programs in Italy and Spain were enrolled. Screenees were asked to undergo CCE-2, followed by traditional colonoscopy (TC). TC was performed the same day or the following morning. Bowel preparation included a split-dose polyethylene glycol-based regimen, with sodium phosphate (NaP) with gastrografin as boosters. The CCE-2 video was read by an endoscopist blinded to the results of TC. The main outcomes were CCE-2 accuracy in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for AN when using 2 different size thresholds for TC referral (ie, polyps ≥6 mm and ≥10 mm). Two hundred twenty-two patients were enrolled, and 178 patients completed both CCE-2 and TC (87.7%). Overall, 59 cases of AN were detected at TC. CCE-2 sensitivity was 90%, specificity was 66.1%, PPV was 57.4%, and NPV was 92.9% for AN when using a 6-mm cut-off (TC referral rate, 52.8%) and 76.7%, 90.7%, 80.7%, and 88.4% when using a 10-mm cut-off (TC referral rate, 32%), respectively. CCE-2 detected that 8 of 9 already developed colorectal cancers. Among the 41 false positives at the 6-mm cut-off, 34 (82.9%) presented with a nonadvanced adenoma at TC. Mean transit time was 4 hours and 4 minutes, and ≥70% of patients excreted the capsule within 5 hours. In an enriched disease setting, we showed the high sensitivity of CCE-2 for the diagnosis of AN at a 6-mm cut-off. The apparently low CCE-2 specificity is related to the choice of AN as the main outcome. (Clinical trial registration number: ISRCTN 62158762.).


Inhibition of collagen and DNA biosynthesis by a novel amidine analogue of chlorambucil is accompanied by deregulation of β(1)-integrin and IGF-I receptor signaling in MDA-MB 231 cells.
A novel amidine analogue of chlorambucil N-(2-(4-(4-bis(2-chloroethyl)aminophenyl)butyryl)aminoethyl)-5-(4-amidinophenyl)-2-furanecarboxamide hydrochloride (AB(1)), and the parent drug were compared for their effects on collagen and DNA synthesis in breast cancer MDA-MB 231 cells. IC(50) values for chlorambucil and its amidine analogue for collagen synthesis were found to be about 44 and 19μM, respectively. Increased ability of AB(1) to suppress the protein synthesis, compared to chlorambucil, was found to be related to an inhibition of prolidase activity and expression. The phenomena were probably a result of disruption of β(1)-integrin and the insulin-like growth factor-I (IGF-I) receptor mediated signaling caused by this compound. Expression of β(1)-integrin receptor, as well as focal adhesion kinase pp125(FAK) (FAK), growth-factor receptor-bound protein 2 (GRB2), son of sevenless protein 1 (Sos1) and phosphorylated mitogen activated protein kinases (MAPK), extracellular-signal-regulated kinase 1 (ERK(1)) and kinase 2 (ERK(2)) but not Src and Shc proteins was significantly decreased in cells incubated for 24h with 10μM AB(1), compared to controls. Chlorambucil in the same conditions did not evoke any changes in expression of all these signaling proteins, as shown by Western immunoblot analysis. In addition, AB(1) revealed a higher antiproliferative activity than chlorambucil, accompanied by a stronger down-regulation of IGF-I receptor expression. The results were confirmed by [(3)H]thymidine incorporation assay. Incubation of the cells with 10μM AB(1) for 12 and 24h contributed to a decrease in DNA synthesis by about 33 and 46% of the control values, respectively, while in case of chlorambucil by about 23 and 29%, respectively. These data suggest that the amidine analogue of chlorambucil (AB(1)) disturbs MDA-MB 231 cell metabolism more potently than does the parent drug, chlorambucil. The mechanism of this phenomenon may be due to its stronger suppression of β(1)-integrin and IGF-I receptor signaling.


Cloning, stable expression of human phosphodiesterase 7A and development of an assay for screening of PDE7 selective inhibitors.
Phosphodiesterases (PDEs) constitute a superfamily of enzymes that plays an important role in signal transduction by catalysing the hydrolysis of cAMP and cGMP. cDNA encoding PDE7A1 subtype was cloned and a stable recombinant HEK 293 cell line expressing high levels of PDE7A1 was generated. Transient transfection of pCRE-Luc plasmid, harboring luciferase reporter gene into the stable recombinant cell line and subsequent treatment with PDE7 inhibitor, resulted in a dose-dependent increase in luciferase activity. This method provides a simple and sensitive cell-based assay for screening of PDE7 selective inhibitors for the treatment of T cell mediated diseases.


Second x-ray reading not always necessary.
Primary care clinicians are able to identify radiographs for which a second reading by a radiologist is unlikely to result in a change in clinical care. The investigators report that no substantial changes in care or episodes of averted patient harm occurred.


Left pulmonary artery sling complex: computed tomography and hypothesis of embryogenesis.
We retrospectively reviewed cases of left pulmonary artery (LPA) sling complex with computed tomography to explore its possible meaning in embryogenesis. Eighteen children (6 girls and 12 boys aged 5 days to 17.5 years; mean, 1.5 years) were identified as having LPA sling during the period of October 1996 to March 2006. Another 2,364 cardiac computed tomography scans that had no LPA sling were included as control. The associated bronchopulmonary and vascular anomalies were identified. Chi-square tests were used to compare the probabilities of coexistence of these anomalies, with or without LPA sling. All patients with LPA sling presented with tracheal stenosis (100%), and there was a high incidence of combined right tracheal bronchus (22%), underdeveloped right lung (22%), persistent left superior vena cava (22%), and left patent ductus arteriosus (39%). These associated anomalies were more highly associated with subjects who had LPA sling than with those who did not (p < 0.01). Owing to the spatial coexistence of LPA sling with the associated anomalies in the embryonic foregut mesoderm, we propose that a "space available" hypothesis in the local environment appears to be important in the embryogenesis of an LPA sling complex.


Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis.
What is the relationship between specific quality of life domains and depression, anxiety and stress in the endometriosis population? Psychosocial domains of quality of life, such as a perception of social support and self-image, are more strongly associated with depression, anxiety and stress than pain and medical factors. Prior research indicates a high prevalence of anxiety and depression in individuals with endometriosis. Pain is thought to be critical in the development of psychological distress, however prior research has investigated this association without consideration of psychosocial quality of life domains such as social functioning, perceived social support and self-image. This study is a cross-sectional analysis of baseline data collected in a longitudinal study exploring psychological distress in endometriosis (n = 584). Individuals living with endometriosis participated in this study and were recruited via online platforms of community organizations and support groups. Demographic and medical information concerning endometriosis treatment and diagnosis was self-reported. Psychological distress and quality of life was measured using the Depression, Anxiety and Stress Scale (DASS-21), Endometriosis Health Profile-30 (EHP-30) and the Short Form Survey (SF-36v2). A series of linear regression analyses explored the relationship between specific quality of life domains and the primary outcomes of depression, anxiety and stress. Approximately half of the participants in this sample reported moderate to severe anxiety, depression and stress. Quality of life domains, particularly perceived social support, social functioning and self-image, were more strongly associated with psychological distress than medical or demographic factors. Pain was associated with anxiety, but not depression or stress. A greater number of endometriosis symptoms was only associated with depression. These data are cross-sectional and, therefore, causality cannot be inferred from this analysis. Information about endometriosis diagnosis and treatment was self-reported, and not verified against medical records. This study indicates that psychosocial factors may be more salient factors underlying depression, anxiety and stress in the endometriosis population than pain and medical factors. There is a need for interventions that target psychological distress in this population with a focus on the broader impact of endometriosis beyond pain and physical symptomatology. This research was supported by the Research Training Program (RTP) Scholarship awarded to C.S.M. by Macquarie University. The remaining authors have nothing to declare. ACTRN12619001508167.


Multi-arterial phase MRI depicts inconsistent arterial phase hyperenhancement (APHE) subtypes in liver observations of patients at risk for hepatocellular carcinoma.
According to LI-RADS, a major discriminating feature between hepatocellular carcinoma (HCC) and non-HCC malignancies is the subtype of arterial phase hyperenhancement (APHE). The aim of this study was to investigate whether APHE subtypes are consistent across multi-arterial phase (mHAP) MRI acquisitions while evaluating reader agreement. Secondarily, we investigated factors that may affect reader agreement for APHE subtype. In this retrospective study, consecutive patients with liver cirrhosis and focal observations who underwent mHAP were included. Five radiologists reviewed MR images in 2 reading sessions. In reading session 1, individual AP series were reviewed and scored for presence of APHE and subtype. In reading session 2, readers scored observations' major and ancillary features and LI-RADS category in the complete MRI examination. Reader agreement was calculated using Fleiss' kappa for binary outcomes and Kendall's coefficient of concordance for LI-RADS categories. Univariate mixed effects logistic regressions were performed to investigate factors affecting agreement. In total, 61 patients with 77 focal observations were analyzed. Of observations unanimously scored as having APHE, 27.7% showed both rim and nonrim subtypes on mHAP. Inter-reader agreement for APHE subtype ranged from 0.49 (95% CI: 0.33, 0.64) to 0.57 (95% CI: 0.40, 0.74) between reading sessions. Observation size had a trend level effect on rim APHE agreement (p = 0.052). Approximately 1/3 of observations demonstrated inconsistent APHE subtype during mHAP acquisition. Small lesions were particularly challenging. Further guidance on APHE subtype classification, especially when applied to mHAP, could be a focus of LI-RADS refinement. • In a cohort of patients at risk for HCC, 28% of the observations showed inconsistent arterial phase hyperenhancement (APHE) subtypes (rim and nonrim) on multi-arterial phase imaging according to the majority score of 5 independent readers. • Inconsistent APHE subtypes may challenge reliable imaging diagnosis, i.e., LI-RADS categorization, of focal liver observations in patients at risk for HCC.


Surgical anatomy of the temporal lobe.
The complex functional and anatomic relationships between the structures in and around the temporal lobe are central to the problem of intractable partial complex seizures. Resecting those areas that are responsible for seizures and protecting those that are essential for the normal functioning of the patient are the fundamental tasks of the epilepsy surgeon. A thorough understanding of the structural and functional anatomy of this region is essential to achieve these goals.


Malignant pheochromocytoma with liver invasion treated successfully by combined retroperitoneal laparoscopic control of arterial in-flow followed by open hepatectomy: A case report.
Pheochromocytoma surgery is generally challenging for surgeons and anesthesiologists for cardiovascular complications. A 54-year-old Japanese man was found to have a large right pheochromocytoma infiltrating the posterior part of his liver and vena cava and multiple lung metastases. After retroperitoneal laparoscopic dissection of the dorsal side of the tumor and ligation of the feeding vessels, total resection of the primary tumor, extended posterior sectional hepatectomy, and partial vena cava resection were performed by open surgery via a thoracoabdominal approach. Abundant congestive bleeding with instability of vital signs occurred during transection. It could be finally controlled by dissect the remnant feeding artery in the inmost space. Prior control of arterial in-flow enabled successful completion of the planned surgical procedure. The patient has now survived for 27 months since resection of the primary lesion. Ligation of the feeding arteries to this hypervascular catecholamine-releasing tumor via a retroperitoneal laparoscopic approach prior to performing combined organ resection facilitated successful excision of this large malignant pheochromocytoma.


Reduced ambient PM2.5, better lung function, and decreased risk of chronic obstructive pulmonary disease.
Several studies reported that long-term exposure to fine particulate matter (PM2.5) was associated with an increased risk of chronic obstructive pulmonary disease (COPD). It remains unclear whether reduced PM2.5 can decrease the risk of COPD development. To investigate the associations of dynamic changes (including deterioration and improvement) in long-term exposure to ambient PM2.5 with changes in lung function and the incidence of COPD. A total of 133,119 adults (aged 18 years or older) were recruited in Taiwan between 2001 and 2014. All participants underwent at least two standard medical examinations including spirometry test. We estimated PM2.5 concentrations using a high-resolution (1 km2) satellite-based spatio-temporal model. The change in PM2.5 (ΔPM2.5) was defined as the difference in concentration of PM2.5 between the respective visit and the previous visit. We used a multivariable mixed linear model and time-varying Cox model to investigate the associations of change in PM2.5 with annual change of lung function and the incidence of COPD, respectively. The PM2.5 concentration in Taiwan increased during 2002-2004 and began to decrease around 2005. Every 5-µg/m3/year decrease in the annual change of PM2.5 (i.e., ΔPM2.5/year of 5 µg/m3/year) was associated with an average increase of 19.93 mL/year (95 %CI: 17.42,22.43) in forced expiratory volume in 1 s (FEV1), 12.76 mL/year (95 %CI: 9.84,15.66) in forced vital capacity (FVC), 70.22 mL/s/year (95 %CI: 64.69,76.16) in midexpiratory flow between 25 and 75% of the forced vital capacity (MEF25-75), 0.27%/year (95 %CI: 0.21%, 0.32%) in FEV1/FVC/year. Every 5 µg/m3 decrease in PM2.5 (i.e., ΔPM2.5 of 5 µg/m3) was associated with a 12% (95 %CI: 7%, 17%) reduced risk of COPD development. The stratified and sensitivity analyses generally yielded similar results. An improvement in PM2.5 pollution exposure was associated with an attenuated decline in lung function parameters of FEV1, FVC, MEF25-75, and FEV1/FVC, and a decreased risk of COPD development. Our findings suggest that strategies aimed at reducing air pollution may effectively combat the risk of COPD development.


Microbiota-gut-brain axis: relationships among the vagus nerve, gut microbiota, obesity, and diabetes.
The purpose of this review is to explore the interconnected pathways of the microbiota-gut-brain axis (MGBA), focusing on the roles of the vagus nerve and glucagon like peptide-1 in appetite control, and in the development of obesity and diabetes. Type 2 diabetes mellitus (T2DM) and obesity are metabolic disorders whose prevalence has significantly increased in recent decades and is expected to increase every year, to pandemic proportions. These two pathologies often coexist and have substantial public health implications. The term "diabesity" defines the pathophysiological connection between overweight and T2DM. The gut microbiota affects many aspects of the host. Beyond the regulation of intestinal functions and the activation of immune responses, the gut microbiota plays a role in central nervous system functions (i.e., mood, and psychiatric conditions associated with stress and memory) and is a central regulator of metabolism and appetite. The MGBA involves pathways such as the autonomic and enteric nervous systems, the hypothalamic- pituitary-adrenal axis, the immune system, enteroendocrine cells, and microbial metabolites. Notably, the vagus nerve plays an essential role in eating behavior by modulating appetite and learning nutritional preferences. Because of its enteroendocrine cell-mediated interaction with the gut microbiota, the vagus nerve may provide a potential pathway through which gut microorganisms influence host feeding behavior and metabolic control of physiological and pathological conditions.


Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry.
Neuroendocrine neoplasia (NEN) are rare and heterogenous tumours. Few data exist on the impact of surgical therapy. This is a retrospective analysis of prospectively collected data of gastroenteropancreatic NEN in the German NET-Registry (1999-2012). It focuses on patients without distant metastases (limited disease, LD, stage I-IIIB). Data of 2239 patients with NEN were recorded. Median age was 59 years, the gender ratio was 1:1.3 (f:m). A total of 986 patients (44%) had LD, and the 5-year survival rate (5 years) was 77% for all and 90% for patients with LD. A total of 1635 patients (73%) received a surgical therapy (1st to 6th line); the 5 and 10 ysr were 83/65% after and 59/35% without surgery for all patients (p < .001). The resection margins in the LD patients were 76%, 16%, and 3% for R0, R1 and R2, respectively. The 10 ysr was 84%, 59% and 42% for R0, R1 and R2 resections, respectively (p = .021 R0/R1, p < .001 R0/R2). The R0 resection rate was 75% for G1/G2 NET and 67% for G3 NEC. The rate of complete tumour resection (R0) in LD is independent of tumour grading, and R0 resection is the key determinant of long-term survival, as demonstrated by the 10 ysr. of 84%. All NEN patients with limited disease should be considered for operation, if possible, as the best 10-year survival is shown after an R0 resection.


The Zentensivist Manifesto. Defining the Art of Critical Care.
Evidence-based medicine asks us to integrate the best available evidence with clinical experience and patient values. In the modern intensive care unit, the primary focus is on complex technology and electronic health records, often away from the bedside. Excess interventionism is the norm. The term "intensivist" itself implies an intensive management strategy, which can lead us away from a patient-centered practice and toward iatrogenic harm. Under the hashtag #zentensivist, an international, multiprofessional group of clinicians has begun to discuss via Twitter how to apply key principles of history taking, physical examination, physiology, pharmacology, and clinical research in a competent, compassionate, and minimalist fashion. The term "zentensivist" intentionally combines concepts seemingly at odds-Zen philosophy and intensive care-to describe a holistic approach to the art of caring for the critically ill. We describe the key tenets of zentensivist practice and how we may inspire these actions in those we lead and educate.


Substituted dipyridophenazine complexes of Cr(III): synthesis, enantiomeric resolution and binding interactions with calf thymus DNA.
[Cr(phen)(2)(X(2)dppz)](3+) {X = H, Me, or F} have been synthesised, characterised, and chromatographically resolved into their constituent Delta and Lambda enantiomers. The DNA-binding interactions of each of the racemic complexes were investigated, with the results of linear dichroism, thermal denaturation, and emission quenching studies indicative of intercalative binding to CT-DNA with a significant electrostatic contribution. UV/Vis absorption titrations suggest strong DNA binding by each of the racemic complexes, with the methylated analogue [Cr(phen)(2)(Me(2)dppz)](3+) exhibiting the largest equilibrium binding constant. Emission quenching and UV-Vis titrations of the enantiomers of [Cr(phen)(2)(dppz)](3+) imply similar binding affinities for the Delta and Lambda isomers, although significant differences between the circular dichroism spectra of the enantiomers in the presence of DNA connote differences in binding orientation and/or conformation between the two.


Sequelae of sural nerve biopsies.
Sequelae of sural nerve biopsy were examined in 24 patients. Fourteen subjects reported persisting pain or dysaesthesias for more than one year. In nine patients the symptoms were mild, in five severe. Hypaesthesia of the lateral aspect of the foot was found in 17 out of 18 patients with otherwise normal or only slightly impaired sensory function. In one patient sural nerve biopsy did not cause permanent sensory loss. Pain and dysaesthesia were not significantly related to post-biopsy or generalized hypaesthesia.


A call to action: securing an uninterrupted supply of Africa's medical products and technologies post COVID-19.
The COVID-19 pandemic unveiled the vulnerability of many African healthcare systems, amplifying inadequacies and constraints in the supply chain for medical products and technologies on the continent. Disruptions in the global supply chain due to the pandemic resulted in the continent's population of over one billion people grappling with shortages in the supply of essential medicines. The shortages and their consequences set back achievement of Sustainable Development Goals and progress towards universal health coverage. A virtual meeting of global experts in medical products and supply chain identified as urgent the need for Africa to build capacity for a self-reliant public health system. Discussants challenged the governments of African countries to turn the continent from its current import driven economy to a continent of indigenous research and development, local production, and an exporter of its medical products and innovations.


Environmental Change in Southern Appalachia: Local Ecological Knowledge across Residential Groups.
This paper examines how residents of Southern Appalachia observe changes in their natural environment, the values that they assign to plants and animals in that environment, and their understandings and explanations of environmental change. We use semi-structured interviews and participant observation to determine that multigenerational residents and newcomers to the region are observing and noting change in different components of the environment and that they have different determinations of both the causes and likely consequences of that change. While multigenerational residents focus their observation and commentary on staple crops and culturally-important species, newcomers to the area concentrate on species related to recreational pursuits, giving each group insights into different aspects of environmental change. These findings are translated into recommendations for more inclusive and effective environmental and conservation planning.


A Case Series Assessing the Effects of Lomitapide on Carotid Intima-Media Thickness in Adult Patients with Homozygous Familial Hypercholesterolaemia in a Real-World Setting.
Homozygous familial hypercholesterolaemia (HoFH) is characterised by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and results from multiple mutations in genes affecting the LDL receptor pathway. Patients are at risk of premature atherosclerotic cardiovascular disease (ASCVD) and premature death. Lomitapide is a microsomal triglyceride transfer protein inhibitor developed to treat HoFH, but cardiovascular outcome data are lacking. We evaluated detailed data from five HoFH patients and one patient with heterozygous FH (HeFH) and a very severe phenotype. We also analysed confirmatory data from a further 8 HoFH cases. In total, we analysed data from patients in seven global centres in six countries who were all treated with lomitapide with long-term follow-up. Carotid intima-media thickness (CIMT) imaging was recorded on an ad hoc basis to monitor ASCVD in HoFH. Lomitapide resulted in marked decreases in LDL-C of 56.8-93.9% [77.7-93.9% in the 6 initial cases (mean nadir 64.8 ± 30.1 mg/dL); 56.8-86.0% in the 8 confirmatory cases (mean nadir 131.4 ± 38.2 mg/dL)]. CIMT regressed in 50% of cases (mean follow-up 5.0 ± 3.1 years in initial six cases, and 4.4 ± 1.4 years in confirmatory cases). In the remaining patients, CIMT showed little further change. In patients where assessments of plaque area were available, regression or stabilisation in CIMT was accompanied by clinically significant regression of plaque area. Lomitapide reduces LDL-C levels in patients with HoFH and severe LDL-C phenotypes, and results in stabilisation and/or regression of CIMT, which is an established marker of ASCVD risk. Additional data are needed to determine if this confers a survival benefit in these very high-risk patients.


Defining low-risk lesions in early-stage esophageal adenocarcinoma.
As endoscopic approaches become more widely used to treat early-stage esophageal cancer, reliably identifying patients with less-aggressive tumors is paramount. We sought to identify risk factors for recurrence in patients with completely resected T1 esophageal adenocarcinoma. We retrospectively analyzed a single-institutional database for all patients with completely resected pathologic T1 esophageal adenocarcinoma (1996-2016). Risk factors for recurrence were identified using competing-risk regression methods. Risk stratification was performed on the basis of known preoperative clinicopathologic factors; this model's discriminative power for overall survival was evaluated using a Cox proportional hazards model. Of 243 patients, 32 experienced recurrence. At a median follow-up among survivors of 4 years (range, 0.05-19 years), the 5-year cumulative incidence of recurrence was 15%, and median time to recurrence was 2 years (range, 0.26-6.13 years). On univariable analysis, submucosal invasion, N1 disease, poor differentiation, tumor length, lymphovascular invasion, and multicentricity were significantly associated with recurrence. On multivariable analysis, N1 disease (hazard ratio, 2.93; 95% confidence interval, 1.17-7.34; P = .022) and tumor length (hazard ratio, 1.44; 95% confidence interval, 1.12-1.86; P = .004) were independently associated with recurrence. Risk stratification showed that patients without lymphovascular invasion and a with median tumor length of 0.8 cm (range, 0.10-1.70 cm) had a <10% risk of recurrence and improved survival. Pathologic T1 tumors have a 5-year cumulative incidence of recurrence of 15%. Nodal involvement and tumor length were independent risk factors for recurrence, whereas tumors <2 cm in length without lymphovascular invasion were associated with a low risk of recurrence.


Poly[[triaqua-(μ(3)-4-oxidopyridine-2,6-dicarboxyl-ato)terbium(III)] monohydrate].
In the title coordination polymer, {[Tb(C(7)H(2)NO(5))(H(2)O)(3)]·H(2)O}(n), the Tb(III) atom is eight-coordinated by a tridentate 4-oxidopyridine-2,6-dicarboxyl-ate trianion, two adjacent monodentate anions and three water mol-ecules, forming a distorted bicapped trigonal-prismatic TbNO(7) coordination environment. The anions bridge adjacent Tb(III) ions into double chains. Adjacent chains are further connected into sheets parallel to (10). O-H⋯O hydrogen bonds involving both coordinated and uncoordinated water mol-ecules generate a three-dimensional network.


Labeling of monoclonal antibodies with a 67Ga-phenolic aminocarboxylic acid chelate. Part II. Comparison of immunoreactivity and biodistribution of monoclonal antibodies labeled with the 67Ga-chelate or with 131I.
Coupling of the 67Ga-P-EDDHA chelate via carbodiimide to the anti-melanoma monoclonal antibody (Mab) M.2.9.4 resulted in a low degree of oligomerization, but a considerable degree of intra-molecular (inter-chain) cross-linking. However, this did not impair immunoreactivity, nor did the half-life in vivo differ substantially from that of 131I-M.2.9.4. Biodistribution analysis in normal mice showed Ga:I ratios near 1 in the blood and other tissues not involved in degradation and label excretion. In tissues of the reticulo-endothelial system (RES) and the kidneys, Ga:I ratios up to 2.51 were reached within 4 days of administration. In antigen-positive MeWo tumor tissue, retention of 67Ga also excreted that of 131I, so that tumor; organ ratios (except tumor:liver) were superior for the 67Ga-labeled MAb. It is concluded that the method of coupling pre-established 67Ga-P-EDDHA chelate to antibody results in a functionally intact tracer molecule, whose persistence in vivo is not significantly impaired. The major difference to I-labeled MAbs may be a prolonged retention of Ga in tissues (cells) physiologically involved in antibody catabolism.


Evidence for motility-related fimbriae in the gliding microorganism Myxococcus xanthus.
An electron-microscopic examination of negatively stained preparations from cell lysates of Myxococcus xanthus and in situ samples of Myxococcus xanthus, Myxococcus virescens, and Myxococcus fulvus has demonstrated the presence of polar fimbriae, about 8.5 nm in diameter, on motile but not nonmotile cells.


Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article.
The authors analyzed the long-term results and radiological aspects of sphenoorbital meningioma (with emphasis on exophthalmos) in a series of 30 patients who underwent resection. Data obtained in all 30 patients who underwent surgery for typical sphenoorbital meningioma at the authors' institution between June 1994 and September 2005 were analyzed retrospectively. The exophthalmos index (EI) was measured on preoperative MR images and/or CT scans and compared between the early and last follow-up examinations. All patients were women 35-74 years of age (median 51 years). Exophthalmos was the presenting symptom in 28 patients (93%), and was observed on preoperative MR images in all patients. The median duration of symptoms before surgery was 10 months (2-120 months). Total resection (Simpson Grade I) was not achieved in these patients because of the impossibility of resecting the dura mater in the superior orbital fissure without causing significant complications. Subtotal resection (Simpson Grade II) was obtained in 90% of patients, and in 3 patients (10%) a portion of the tumor was deliberately left in place because of extensive macroscopic infiltration of the cavernous sinus and/or extraocular muscles (Simpson Grade III). No patient died. Radiological evaluation at a median follow-up of 61 months (range 17-136 months) showed no contrast enhancement in 14 patients (47%), residual contrast enhancement without evolution in 13 (43%), and recurrence (new contrast enhancement) in 3 (10%). The EI was improved at the first radiological follow-up (median 12 months) in 27 patients (90%), and at the last radiological follow-up (median 61 months) in 28 patients (93%). In the interval between the first and final imaging follow-up, the EI improved in only 8 patients (20%), worsened in 15 patients (50%), and showed no variation in 7 patients (30%). Sphenoorbital meningiomas are insidious tumors with slow progression. Even when exophthalmos is not clinically evident, it is always present on preoperative MR imaging. Total resection is not possible due to superior orbital fissure invasion, but subtotal resection (Simpson Grade II) can assure long-term stability due to the nonevolutive nature of most residual tumors. Exophthalmos improves at early radiological follow-up, but may worsen again as time passes.


Paeoniflorin suppresses the expression of intercellular adhesion molecule-1 (ICAM-1) in endotoxin-treated human monocytic cells.
Paeoniflorin (PF) has ameliorative effects on learning and memory impairment and cerebral ischaemia in rats and has protective effects against the degeneration of dopaminergic neurons in substantia nigra. The neuroprotective effects of PF are most probably derived from its anti-inflammatory property. Abnormally high levels of intercellular adhesion molecule-1 (ICAM-1) have been found to be associated with a wide range of inflammatory and immune responses. Here we studied whether PF regulates the levels of ICAM-1 elevated in LPS-activated differentiated human monocytic U937 cells and TNF-α-stimulated human umbilical vein endothelial cells (HUVECs). mRNA levels were evaluated by RT-PCR. Protein levels were evaluated by Western blot analysis. An immunofluorescence technique was used to estimate NF-κB translocation, and NF-κB binding to nuclear DNA was determined by EMSA. PF inhibited ICAM-1 expression elevated in LPS-induced U937 cells and TNF-α-stimulated HUVECs. Although previous reports showed that PF's action is mediated by activating adenosine A₁ receptors, application of a selective adenosine A₁ receptor antagonist did not change the inhibitory effect of PF in our experiments. To elucidate the underlying mechanisms of the effect of PF, we studied its effect on signalling pathways upstream of ICAM-1 expression. PF suppressed the activation of the NF-κB pathway, which regulates the expression of ICAM-1. The TLR4 and MAPK pathways were shown not to be involved in the effects of PF in these cells. PF inhibits ICAM-1 expression in LPS-treated U937 cells and TNF-α-stimulated HUVECs by suppressing the activation of the NF-κB pathway.


Educational Outcomes in Children and Adolescents With Type 1 Diabetes and Psychiatric Disorders.
Research shows that children and adolescents with type 1 diabetes (T1D), compared with their peers without diabetes, have a greater risk of psychiatric disorders. However, no study has comprehensively examined whether having psychiatric disorders is associated with educational outcomes in children and adolescents with T1D. To investigate educational outcomes in children and adolescents with T1D with and without psychiatric disorders. This cohort study used data from multiple Swedish registers. The main study cohort included individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed up from birth through December 31, 2013. Data analyses were conducted from March 1 to June 30, 2022. Type 1 diabetes and psychiatric disorders (including neurodevelopmental disorders, depression, anxiety disorders, eating disorders, bipolar disorder, psychotic disorder, and substance misuse) diagnosed before 16 years of age. Achieving educational milestones (completing compulsory school [primary and lower secondary education], being eligible to and finishing upper secondary school, and starting and finishing university) and compulsory school performances. Of 2 454 862 individuals (51.3% male), 13 294 (0.5%; 53.9% male) were diagnosed with T1D (median [IQR] age at diagnosis, 9.5 [6.0-12.5] years), among whom 1012 (7.6%) also had at least 1 psychiatric disorder. Compared with healthy individuals (without T1D and psychiatric disorders), individuals with T1D alone had slightly lower odds of achieving the examined educational milestones. However, those with both T1D and any psychiatric disorder had much lower odds of achieving milestones, including completing compulsory school (odds ratio [OR], 0.17; 95% CI, 0.13-0.21), being eligible for (OR, 0.25; 95% CI, 0.21-0.30) and finishing (OR, 0.19; 95% CI, 0.14-0.26) upper secondary school, and starting (OR, 0.36; 95% CI, 0.29-0.46) and finishing (OR, 0.30; 95% CI, 0.20-0.47) university. They also showed lower grade point averages for compulsory school subjects. These findings remained similar in sibling comparison analyses, suggesting independence from familial confounding. In this cohort study of Swedish-born children and adolescents, those with T1D alone had minor difficulties with their educational outcomes, whereas those with both T1D and psychiatric disorders had universal long-term educational underachievement. These findings highlight the importance of identifying psychiatric disorders in pediatric patients with T1D and the need for targeted educational intervention and support to minimize the education gap between the affected children and their peers.


Aversive conditioning of periodic spontaneous erection adversely affects sexual behavior and semen in stallions.
Periodic spontaneous erection and penile movements known as masturbation (SEAM) occur normally at approximately 90 min intervals in awake equids. SEAM in horses has traditionally been misunderstood by many horsemen as aberrant behavior that should be eliminated. Accordingly, it is not uncommon for trainers of performance stallions or managers of breeding stallions to punish SEAM in an attempt to eliminate the behavior. Previous clinical observations and preliminary unsystematic trials had suggested that attempts to stop stallion SEAM may lead to an increase rather than a decrease in SEAM, and at the same time may suppress sexual behavior (SB) in a breeding stallion. The present work evaluated the effects of aversive conditioning of SEAM on SEAM, SB, and semen. In Experiment 1, four mature pony stallions were subjected to aversive conditioning of SEAM in a within- and between-subjects half cross-over design. The SEAM erection interval tended to be less after aversive conditioning, suggesting an increase in SEAM frequency. Eleven other SEAM measures were each similar before and after aversive conditioning of SEAM. In standard sexual behavior trials with a stimulus mare and dummy mount, erection latency, ejaculation latency, mount readiness latency, and number of mounts to ejaculation increased after aversive conditioning of SEAM; erection rigidity score, number of ejaculatory pulses, and vocalization rate decreased. Number of thrusts to ejaculation was similar before and after aversive conditioning of SEAM. All affected SB measures indicated suppressed sexual arousal and breeding efficiency after SEAM. In Experiment 1, ejaculated semen was not evaluated. Because in Experiment 1, the number of ejaculatory urethral pulses was less after aversive conditioning, Experiment 2 was similarly designed, but included evaluation of semen, both immediately and again 1 week after aversive conditioning was completed. Experiment 2 included 12 aversively conditioned stallions, and 4 yoked controls. In Experiment 2, masturbation episode duration tended to be less after aversive conditioning, while the remaining 11 SEAM measures were unaffected by aversive conditioning of SEAM. Of SB measures, erection latency, mount readiness latency, thrusts to ejaculation, and ejaculation latency were significantly greater after aversive conditioning. Erection rigidity score and number of ejaculatory pulses were less after aversive conditioning. These differences are consistent with suppressed sexual arousal and reduced breeding efficiency. Semen volume and total number of sperm per ejaculate were significantly less after aversive conditioning. These findings are consistent with clinical anecdotes and preliminary trials indicating that aversive conditioning of SEAM in stallions suppresses sexual arousal and breeding behavior. Of considerable interest both clinically and theoretically, is the finding that aversive conditioning target behavior of SEAM was not suppressed by aversive conditioning, while SB and semen during semen collection trials were both adversely affected.


Pulmonary thromboembolism in children.
Pulmonary embolism in childhood is a rare but under-diagnosed condition. We report four children aged 5 to 13 years presenting with pulmonary emboli, their primary diagnoses being craniopharyngioma, asthma, Crohn's Disease and Reye's syndrome. The diagnosis was supported by technetium micro aggregate lung perfusion scans in three of the children and in the fourth, the only child to die, by autopsy. Three of the children had markedly elevated plasma osmolalities, one as a result of his diabetes insipidus and two following hyperosmolar treatment for cerebral oedema. The child who died was found to have a femoral vein thrombosis but the sites of origin of emboli in the other children were not defined.


Extensor indicis proprius syndrome secondary to an anomalous extensor indicis proprius muscle belly.
The complaint of dorsal hand pain is common among patients seen in a primary care practice. The differential diagnosis includes tenosynovial disease, ganglion, trauma, and soft-tissue tumors. Rarely is an anomalous muscle an etiologic factor. Reported here is an anomalous indicis proprius muscle that was manifested as a painful dorsal hand mass. Also discussed are the anatomic variations of the extensor indicis proprius syndrome.


Association of serum fibroblast growth factor 21 with diabetic complications and insulin dose in patients with type 1 diabetes mellitus.
Fibroblast growth factor (FGF) 21 is an important regulator of glycemic control, but the association between circulating FGF21 and diabetic complications is poorly understood. Moreover, basal FGF21 secretion, especially in response to insulin dose, in patients with type 1 diabetes mellitus (T1DM), has not been well examined. Therefore, this study aimed to determine the association of circulating FGF21 levels with diabetic complications and insulin dosage in middle-aged and elderly patients with T1DM. A total of 127 middle-aged and elderly patients with T1DM, including 68 patients with diabetic complications, and 106 non-diabetic individuals were analyzed in this cross-sectional study. Information on demographic characteristics and T1DM was extracted from their electronic medical records. Serum FGF21 levels were determined using ELISA. Serum FGF21 levels were significantly lower in T1DM patients (75.2 [37.4-135.1] pg/mL) than in non-diabetic participants (151.6 [92.0-224.6] pg/mL; P < 0.001). No diabetic complications were associated with serum FGF21 concentrations. Both basal and bolus insulin doses were significantly and positively correlated with serum FGF21 levels (P < 0.05). Stepwise multiple regression analysis showed that FGF21 level was associated with age and body mass index (P < 0.05), while the basal insulin dose was an independent positive predictor of serum FGF21 levels (β = 0.197, P = 0.032). Circulating FGF21 levels are reduced in patients with T1DM; however, they are not associated with diabetic complications. In addition, aging, obesity, and insulin dosage are positive determinants of circulating FGF21.


Relationship between pulse rate and pulse width for a constant-intensity level of electrocutaneous stimulation.
The relationship between pulse rate (PR) and pulse width (PW) for a constant level of electrocutaneous stimulation was ascertained using the method of comparative judgments. Twelve volunteer subjects were asked to adjust the PW of Comparison Stimulus (S2) until its intensity matched that of a Standard Stimulus (S1) for which the PW was 200 microseconds and PR was 10 or 20 pulses per sec (pps). As expected, the experimental results indicate that the PW of a constant-current amplitude pulse train should decrease as its PR increases if a constant level of tactile stimulation intensity is desired. However, PW and PR were not linear-inversely related (p less than 0.005). Rather, their relationship was best described by a logarithmic equation: log PW = a + b log PR, where PW is in microseconds, a is 2.82, b is -0.412, and PR is between 1 and 100 pps. Utilization of this relationship during electrical stimulation of the skin sense will decouple the intensity component of the tactile sensation from its frequency component, thereby enhancing the potential comfort and clarity of this sensory communication interface.


Could masking gestational age estimation during scanning improve detection of small-for-gestational-age fetuses? A controlled pre-post evaluation.
Antenatal detection of small-for-gestational-age fetuses improves outcomes and reduces perinatal mortality rates. However, ultrasonographic estimation of fetal weight is subject to several potential sources of error. One potential source of error is subconscious operator bias towards "normal" measurement values for gestational age (observer-expectancy bias). We aimed to determine whether the sensitivity of small-for-gestational-age detection is improved by removing real-time display of estimated gestational age during measurement of the abdominal circumference in the third trimester. This retrospective evaluation (November 2014-May 2018 inclusive) included all singleton infants liveborn at ≥28 weeks gestation in a single United Kingdom obstetrics center. In the preintervention phase, real-time estimated gestational age was displayed to sonographers as they measured fetal abdominal circumference (the key determinant of estimated fetal weight with the use of the INTERGROWTH 21st fetal weight equation) in the third trimester. In the postintervention phase, real-time gestational age information was removed on selected ultrasound machines. Accuracy of birthweight percentile estimation was assessed before and after intervention, both in the full cohort comprising all eligible scans and in a subcohort that was scanned within 4 weeks of delivery. We assessed the accuracy of small-for-gestational-age detection using the sensitivity, positive likelihood ratio, and area under the receiver-operator curve. Of the 18,342 eligible pregnancies, 9342 (51%) had a third-trimester growth scan. The sensitivity of ultrasonographic estimation of fetal weight for antenatal detection of small-for-gestational-age babies did not change significantly between the before and after intervention phases (31.5% confidence interval, 27.1-36.2 vs 31.7% confidence interval, 20.2-45.0). Although the sensitivity for small-for-gestational-age detection was higher in the subcohort that was scanned within 4 weeks of delivery than in the full cohort (P<.001), there was no significant difference between the before and after intervention phases (58% confidence interval, 50-66 vs 65% confidence interval, 43-84). With the use of an estimation of the abdominal circumference percentile rather than estimated fetal weight percentile significantly decreased the sensitivity for small-for-gestational-age detection in all groups (P<.01), but there was no difference between the before and after intervention phases. Blinding operators to the estimated gestation of the fetus during abdominal circumference measurement does not significantly alter the antenatal detection rate of small-for-gestational-age babies. The observer-expectancy effect is therefore unlikely to be a significant contributor to the error that is associated with ultrasonographic estimation of fetal weight.


An investigation on the new operational parameter effective in Cr(VI) removal efficiency: a study on electrocoagulation by alternating pulse current.
The performance of an electrocoagulation (EC) process with aluminum/iron electrodes for removal of chromium on laboratory scale was studied. The effect of operational parameters such as initial pH, current density (CD), reaction time, initial concentrations (50, 100, 500, 1000 mg/L), solution conductivity, electrical energy consumption (EEC) and type of circuit were studied in an attempt to reach higher Cr(VI) removal efficiency. Alternating pulse current (APC) was used to prevent the passivity or polarization of electrodes. Important operating parameters were optimized to access higher (99%) Cr(VI) removal efficiency as follows: EEC range: 4-58 kW h/m(3) wastewater, CD: 56-222 A/m(2), operating time: 20-110 min, pH 3-9 (pH(optimum) 5), voltage: 15-25 V. NaCl, KCl, PAC (poly aluminum chloride), NaNO(3) were used as supporting electrolytes. NaCl as well as KCl handled the EC with the best performance in every aspect; however, PAC and NaNO(3) did not have the same results (Applied conductivity is better than literature). The results of this work are comparable with those of recent studies. Equal removal efficiency was obtained in "direct current" (DC) and (APC); however, when "APC" was used, water recovery (0.92 m(3)/m(3) wastewater) was significant and the turbidity was 1 NTU. "APC" amazed our experimental team.


Coping behaviour following traumatic brain injury: what makes a planner plan and an avoider avoid?
Avoidant coping has consistently been related to negative outcomes following traumatic brain injury (TBI), although the mechanisms of this relationship are not clear. A recent study demonstrated that people with moderate-to-severe TBI engaged in more avoidant than planful coping behaviour during a psychosocial stress test, while their matched healthy counterparts engaged in the opposite pattern. The purpose of the current study was to evaluate the neuropsychological, physiological and psychological differences between planners and avoiders with TBI. Eighteen people with moderate-to-severe TBI completed the Baycrest Psychosocial Stress Test (BPST) where coping behaviour was evaluated and physiological measures recorded. Participants also completed a series of questionnaires and a neuropsychological test battery. Compared to avoiders, planners had better executive function, were more psychologically and physiologically reactive and performed better on the BPST. Dysfunction on tests assessing executive abilities was the best predictor of avoidant coping, while physiological and psychological reactivity were the best predictors of planful coping. This study is the first to document differences between planners and avoiders with TBI. Understanding the determinants of coping following TBI will allow for more sophisticated and targeted rehabilitative intervention.


Activation and toxicity of bromobenzene in nasal tissue in mice.
Autoradiography of mice injected i.v. with bromobenzene-14C (BB; 25 mumol/kg body wt) revealed a high concentration of non-volatile metabolites in the olfactory mucosa and in the glands around the maxillary sinuses. As determined with solvent-extracted tissue sections, there was a high level of irreversibly bound metabolites in the Bowman's glands in the olfactory mucosa, while the level of bound metabolites was low in the glands around the maxillary sinuses. Histopathological examination of the nose region of mice given a single i.p. dose of unlabelled BB (greater than or equal to 4.8 mmol/kg body wt) revealed degeneration and necrosis of the glands of Bowman. Degenerative changes in the olfactory epithelium were also observed. Moreover, focal degeneration and necrosis were found in the lateral nasal glands (greater than or equal to 4.8 mmol/kg body wt). Cyst-like dilatation of acini was observed in the lateral nasal glands and in the maxillary glands located around the maxillary sinus. Incubation of BB (26 microM) with a homogenate prepared from the olfactory mucosa revealed an irreversible binding, which clearly exceeded that of the liver. It is suggested that BB is activated in situ to a cytotoxic metabolite that reacts with the glands of Bowman. The specific toxicity observed in the lateral nasal glands correlated with a high concentration of non-volatile but extractable metabolites in these glands.


Kinetic and mechanistic investigations of mesotrione degradation in aqueous medium by Fenton process.
In this work, chemical oxidation of mesotrione herbicide by Fenton process in acidic medium (pH 3.5) was investigated. Total disappearance of mesotrione and up to 95% removal of total organic carbon (TOC) were achieved by Fenton's reagent under optimized initial concentrations of hydrogen peroxide (H(2)O(2)) and ferrous iron (Fe(2+)) at pH 3.5. The time-dependent degradation profiles of mesotrione were satisfactorily fitted by first-order kinetics. Competition kinetic model was used to evaluate a rate constant of 8.8(± 0.2) × 10(9)M(-1) s(-1) for the reaction of mesotrione with hydroxyl radicals. Aromatic and aliphatic intermediates of mesotrione oxidation were identified and quantified by high performance liquid chromatography (HPLC). It seems that the degradation of mesotrione by Fenton process begins with the rupture of mesotrione molecule into two moieties: cyclohexane-1,3-dione derivative and 2-nitro-4-methylsulfonylbenzoic acid. Hydroxylation and release of sulfonyl and/or nitro groups from 2-nitro-4-methylsulfonylbenzoic acid lead to the formation of polyhydroxylated benzoic acid derivatives which undergo an oxidative opening of benzene ring into carboxylic acids that end to be transformed into carbon dioxide.


[Effect of indications and pre-existing conditions on the result of McDonald's cervix-closure surgery].
Authors have performed the McDonald cerclage operation on 172 gravidae because of cervical incompetence. From these pregnancies 80.2 per cent of the infants have survived over the sixth day. While with operations performed on the basis of extended indications for surgery an effect of 56.5 per cent was achieved, it was in cases of classical ones 92.8 per cent. Two complicated cases are reported caused by blastospores or bacteria respectively, isolated also in the vaginal secretion which have ascended into the uterine cavity. Both cases resulted in fetal death and in a septic condition of the mother. It is emphasized that the normal vaginal bioflora is essential condition for the cervical suture.


Prevalence and factors associated with adult bronchial asthma in Aseer region, Southwestern Saudi Arabia.
Bronchial asthma (BA) is one of the most common chronic respiratory diseases in Saudi Arabia (SA). Most of the studies investigating the prevalence of BA in SA have focused on children and its exact prevalence in adults is unknown. The objective of this study is tto investigate the prevalence and factors associated with adult BA in Aseer region, southwestern SA. A cross-sectional study was conducted on a representative sample of adults who attended primary health care centers. A validated Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire was used. The presence of wheeze in the past 12 months was used as a proxy for BA. The study included 960 adults. The prevalence rate of BA was 19.2% (95% confidence interval [CI]: 16.72-21.80). In a multivariable analysis, the following factors were significantly associated with BA in adults; living in low-altitude areas (adjusted odds ratio [aOR] = 1.51, 95% CI: 1.04-2.21), being in rural areas (aOR = 1.58, 95% CI: 1.12-2.23), using analgesics (aOR = 1.52, 95% CI: 1.06-2.20), residing near heavy trucks traffics (aOR = 1.67, 95% CI: 1.13-2.46), having cats in the house (aOR = 2.27, 95% CI: 1.30-5.94), and being aged 55-64-year-old (aOR = 1.94, 95% CI: 1.02-3.69). The prevalence of BA was high, affecting one-fifth of adults in Aseer region. The study revealed some modifiable factors significantly associated with BA in adults. There is a need to improve asthma control programs at the primary health-care level, particularly at rural and at low-altitude areas, and more focus should address the elders. In addition, enhancing community-based health promotion programs tackling the identified modifiable factors of BA are required.


Contemporary orthokeratology.
Orthokeratology is the temporary reduction or elimination of myopia and astigmatism with rigid contact lenses having a tetra-curve reverse geometry back surface design are currently utilised for this purpose. The essential features of this construction are described. Those clinical characteristics which are favourable, and those which are unfavourable, for the technique of orthokeratology are listed. Reverse geometry lenses can either be fitted empirically or by the use of diagnostic lenses. Videokeratoscopy is of value in identifying corneal distortion induced by problems such as poor centration.


Semantic processing of unattended text during selective reading: how the eyes see it.
Subjects were instructed to read and comprehend a target (attended) passage while eye movements were recorded. A second (unattended) passage was also present, with attended and unattended passages occupying alternating lines of text. Subsequent multiple-choice questions showed acquisition of semantic information from attended and unattended text. However, a detailed examination of eye-fixation records showed that readers occasionally fixated unattended text, indicating the presence of shifts of visual attention to unattended text. When fixations of unattended text were excluded, there was no longer any indication that readers obtained useful semantic information from unattended text.


Ultrasound assessment of rectus femoris muscle in rehabilitation patients with chronic obstructive pulmonary disease screened for sarcopenia: correlation of muscle size with quadriceps strength and fat-free mass.
To determine the relationship of the size of the rectus femoris muscle, assessed by ultrasonography, with parameters of muscle strength and body composition that are commonly used in the case-finding of sarcopenia in rehabilitation patients with chronic obstructive pulmonary disease (COPD). Cross-sectional pilot study of 18 men with severe COPD and 17 healthy controls. cross-sectional area, thickness, and width of the non-dominant rectus femoris muscle obtained by ultrasound, muscle strength determined by voluntary maximum isometric contraction of the quadriceps muscle, and fat-free mass assessed by bioimpedance analysis. Ultrasounds detected differences in the size of the rectus femoris muscle: cross-sectional area was 4.3 (SD 1.05) cm2 in patients, compared to 5.6 (SD 1.25) cm2 in controls; patients also presented lower quadriceps strength, and fat-free mass index. Cross-sectional area of the rectus femoris muscle showed a moderate correlation with quadriceps strength (R = 0.497, p = 0.036) and fat-free mass (R = 0.584, p = 0.011). In a multivariate linear model adjusted for age, body mass index, fat-free mass and muscle size, muscle strength was 7.44 kg lower (p value = 0.014) in patients, compared to controls. A causal relationship was observed between the cross-sectional area of the rectus femoris muscle, assessed with ultrasonography, and maximum isometric strength of knee extension in COPD rehabilitation patients. Reduced cross-sectional area was also associated with loss of fat-free mass. Muscle ultrasound and bioimpedance analysis provide complementary and relevant information that could be useful in the case-finding of sarcopenia in COPD patients.


Surgical treatment of patients with congenital vascular malformation-associated aneurysms.
Aneurysms associated with congenital vascular malformation (CVM) comprise critical complication. We review our experience with extracranial CVM-associated aneurysms and attempt to clarify their clinical features. The prevalence, site, size and morphology of the accompanying aneurysms of 48 consecutive CVM patients, who were managed at our hospital from 1999 to 2008, were evaluated. After diagnosis or treatment, the patients were followed up, and the recurrence of aneurysms and patient survival were assessed. CVM-associated aneurysms were found in 14 patients (29%). CVMs were classified according to the Hamburg classification. The patients were classified into groups as follows: four (31%), in the 'predominantly arteriovenous (AV) shunting defect type'; eight (47%), 'combined vascular defects + predominantly AV shunting defects type'; and two (11%), 'combined vascular defects type'. All aneurysms except one situated at the CVM were saccular, whereas nine were fusiform aneurysms; all the ruptured aneurysms and seven out of the nine enlarging aneurysms were saccular. Surgical treatment was performed 8 times in six patients. During the postoperative follow-up period, recurrence and an aneurysm rupture were encountered in one patient each. Aneurysm is not a rare complication of CVM. It is important to treat CVM before the emergency presents. In addition to the treatment for malformation, regular screening for and proper management of the aneurysms in CVM patients are indispensable.


Slow rewarming has no effects on the decrease in jugular venous oxygen hemoglobin saturation and long-term cognitive outcome in diabetic patients.
The purpose of this study was to examine the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation (SjvO(2)) during the rewarming period, and long-term cognitive outcome in diabetic patients. We studied 30 diabetic patients scheduled for elective coronary artery bypass graft surgery. As a control, 30 age-matched nondiabetic patients were identified. The diabetic patients were randomly divided into two groups: the Slow Rewarming group (n = 15) (mean rewarming speed: 0.22 degrees +/- 0.07 degrees C/min, mean +/- SD) or the Standard Rewarming group (Standard group) (n = 15) (mean rewarming speed: 0.46 degrees +/- 0.09 degrees C/min, mean +/- SD). After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO(2) continuously. Hemodynamic variables and arterial and jugular venous blood gases were measured at nine time points. All patients underwent a battery of neurologic and neuropsychologic tests on the day before the operation and at 4 mo after surgery. The SjvO(2) values in the Standard group were decreased during the rewarming period compared with at the induction of anesthesia (P < 0.05). There was a significant difference in the SjvO(2) value in the Control group between standard rewarming and slow rewarming during rewarming periods (Standard Control group: 51% +/- 8%, Slow Control groups: 58% +/- 5%) (P < 0.05). However, there was no difference in the SjvO(2) value in diabetic patients between standard rewarming and slow rewarming during the rewarming period. The rewarming rates (odds ratio: 0.8; 95% confidence interval: 0.5-1.3; P = 0.6) had no correlation with cognitive impairment at 4 mo after the surgery. Diabetes (odds ratio: 1.6; 95% confidence interval: 0.9-2.6; P = 0.04) was a factor in relation to cognitive impairment at 4 mo after the surgery. We concluded that a slow rewarming rate had no effects on the reduction in SjvO(2) value and long-term cognitive outcome in diabetic patients. We examined the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation in diabetic and nondiabetic patients during the rewarming period and long-term cognitive outcome. Slow rewarming could not prevent the frequency of the reduction in internal jugular venous oxygen hemoglobin saturation and adverse cognitive outcome in diabetic patients.


Experiences of paediatric emergence delirium - from parents' and a child's perspective.
Emergence delirium is a complex behaviour of perceptual disturbances that may occur after general anaesthesia in children. These children often exhibit delusions, confusion, restlessness and involuntary physical activity. They cry and are almost impossible to console. Research has mainly focused on comparing different medication agents in the occurrence of and dealing with emergence delirium. However, less is known about parents' experiences of emergence delirium during the recovery process, and there is hardly any research concerning the children's experiences. The primary aim of this study was to describe parents' experiences and reflections during their child's emergence delirium behaviour when recovering from anaesthesia. A secondary aim was to describe children's experiences of having been in this condition. A qualitative research approach with thematic analysis was applied. The study was conducted at two county hospitals in southern Sweden. A total of 16 parents and one child were interviewed. Watching their child demonstrate emergence delirium made parents feel as if they were encountering an incomprehensible scenario. They experienced fear and insecurity and had feelings of powerlessness and guilt. Information and previous experience turned out to offer relief, and being seen by the healthcare staff when they, in their vulnerability, failed to reach or console their child, gave hope and energy. The child confirmed the unexpected and uncontrolled behaviour described by parents. She clearly remembered being 'wild' and out of control. Emergence delirium must be extensively considered in children undergoing general anaesthesia. It is of great importance for healthcare staff to be aware of the parental difficulties it may cause and what is experienced as relieving, such as receiving information and staff members being available, responsive and supportive during the wake-up period.


[Measurement of accommodation using optical biometry].
Making accommodation possible for all age groups is a topic of great interest. We applied optical biometry in order to study the physiological mechanisms in detail. Longitudinal relations in the optical axis were measured during accommodation in volunteers of different ages and lens states. A total of 60 subjects (children, adolescents, adults, and pseudophakes) were examined using the IOL Master. We measured anterior chamber depth (ACD), axial length (AL), and changes in these two measurements during accommodation. Near accommodation (NA) in adolescents caused the largest ACD decrease (0.14+/-0.03 mm). ACD decreased in adults during NA but not in pseudophakic patients of comparable age. AL increased during NA in all groups by 0.01+/-0.01 mm. ACD decreased with age. Using a physiological stimulus, no change in ACD was measured during NA in pseudophakic patients. The documented increase in AL needs to be evaluated further.


Genital automatisms in childhood partial seizures.
To describe frequency and electroclinical characteristics as well as localizing and lateralizing value of childhood periictal genital automatisms (GAs). Five-hundred-forty-one videotaped seizures of 109 consecutive patients <12 years with refractory partial epilepsy and postoperatively seizure-free outcome were analyzed. Genital automatisms (scratching, fondling or grabbing of the genitals) were monitored by two independent investigators. Eight (four temporal, four extratemporal) patients (7%) showed GA at least once during 20 (3.7%) seizures. Age of patients with GA was between 4.5 and 11.9 (mean 9.5+/-2.4) years and was significantly higher than the age of children without GA (p=0.006). Boys showed GAs more frequently than girls (p=0.026). Genital automatisms appeared both ictally and postictally with a mean duration of 51s. They were unilateral (completed by one hand) in 18/20 seizures and were done by the hand ipsilateral to the seizure onset zone in 16/18 cases (p=0.001). Although consciousness was preserved during GA in 3/8 patients, neither periictal urinary urge nor penile erection was associated with it. Periictal GAs appear in school-age patients with a similar frequency to that in adults but almost lack in preschool children. Although the presence of childhood GA has neither localizing nor lateralizing value per se, the hand used for GA is more frequently ipsilateral to the seizure onset zone. The mechanisms for childhood GAs are not clear but probably different from those of adults.


Disposal methods, health effects and emission regulations for sulfur hexafluoride and its by-products.
Sulfur hexafluoride (SF6) is the most potent greenhouse gas contributed by the power and semiconductor industries. The global emissions of gas in the past 10 years have increased tremendously due to lack of disposal routes. This was brought to 190 nations' attention in the Kyoto Protocol for the need of emission control measures to reduce its impacts of climate change and global warming. Various novel techniques have surfaced to tackle this issue, such as non-thermal plasma (NTP) which includes radio frequency plasma, microwave plasma, dielectric barrier discharge, and electron beam. The main by-products resulting from the decomposition of SF6 by these techniques are sulfur oxyfluorides, sulfur dioxide, hydrofluoric acid, and fluorine gas. This environmental and health effects as well as global emission of SF6 gas are considered a threat to humans and the climate, where modern disposal methods of contaminated SF6 gas and its by-products should replace the conventional approaches. Relevant government policies on the safety and disposal concern of SF6 gas are reviewed and challenges and further research directions for the disposal of SF6 gas are highlighted in this review article.


Nucleus pulposus replacement: an emerging technology.
Debilitating low back pain as a result of symptomatic lumbar disc degeneration places a significant burden on an industrial society. Traditionally surgical treatment involving fusion of the anterior and posterior spinal elements has resulted in unpredictable and frequently irreproducible results, especially with regard to return to work rates. A new surgical method of managing symptomatic disc degeneration recalcitrant to nonoperative measures involves the partial or complete removal of the intervertebral disc with replacement with a motion-sparing device. A review of the English-speaking literature will be discussed evaluating the historical development, design considerations, animal models, basic science studies, cadaveric research, and clinical outcomes of the partial removal of the intervertebral disc (nucleus pulposus) and replacement with a motion-sparing implant. An overview of traditional methods of surgical management of lumbar degenerative disc disease will then be followed by an introduction to the concept of motion-sparing implants (nucleus pulposus replacement) intended to remove the pain generator without the associated morbidity of a surgical fusion.


Poly[[dodeca-aqua-hexa-kis-(μ(2)-pyridine-2,5-dicarboxyl-ato)tricopper(II)diytterbium(III)] dihydrate].
The asymmetric unit of the title heterometallic coordination polymer, {[Cu(3)Yb(2)(C(7)H(3)NO(4))(6)(H(2)O)(12)]·2H(2)O}(n), contains one Yb(III) and two Cu(II) atoms. The Cu(II) atom that is located on an inversion center is N,O-chelated by two pyridine-2,5-dicarboxyl-ate (pdc) anions in a square-planar geometry; the Cu atom located on a general position is N,O-chelated by two pdc anions in the basal plane and is further coordinated by a water O atom at the apical position in a distorted square-pyramidal geometry. The Yb(III) atom is eight coordinated in a distorted square-anti-prismatic geometry formed by three carboxyl-ate O atoms from three pdc anions and five water mol-ecules. The pdc anions bridge adjacent Yb(III) and Cu(III) atoms, forming a three-dimensional polymeric structure. The crystal structure contains extensive O-H⋯O hydrogen bonds. π-π stacking is present in the crystal structure, the shortest centroid-centroid distance between parallel pyridine rings of adjacent mol-ecules being 3.646 (3) Å.


Consumer preferences for beef with improved nutrient profile1.
Although beef is a nutrient-rich foodstuff excelling in protein, vitamins, and minerals, there is controversy regarding the fat content of beef and its healthfulness in the diet. Although much of the fatty acid (FA) content in beef is considered "healthy fats," many consumers are confused about the different classifications of FA. The objectives of this study were to determine consumers' knowledge about the nutritional value of beef and its importance in purchasing decisions, and to gain a better understanding about preferences for changes in FA composition. Objectives of the study were completed through 2 consumer studies: 1) an online survey and 2) a taste-panel auction. In the online survey, respondents were asked to choose between 2 steaks that varied in polyunsaturated and saturated FA levels, iron content, and price. Respondents were also asked to categorize "Monounsaturated Fat," "Polyunsaturated Fat," "Saturated Fat," and "Trans Fat," as either "healthy" or "unhealthy" both before and after an educational excerpt was provided. The results from the online survey indicated many consumers are unclear about the differences in beef nutritional value, specifically FA content. Initially, only 66.4%, 69.1%, 79.1%, and 79.2% of respondents correctly categorized the monounsaturated, polyunsaturated, saturated, and trans fat, respectively. However, more than 90% of respondents correctly categorized the various FAs after an educational excerpt was provided. After survey respondents better understood the healthfulness of FA in beef, they were also willing to pay a premium for a steak with improved FA composition. However, these premiums diminished when participants had to actually put forth a monetary value for a steak in the taste-panel auction. Research shows that there is variation among cattle for FA composition. This provides opportunity to identify cattle with a favorable composition and market this product to the increasing population of health-conscious consumers. Our results provide insight for beef promotion and marketing opportunities and indicate that relaying information about FA content is extremely important to collect a premium for healthier beef.


Postoperative adjuvant immunotherapy of gastric cancer with BCG-cell wall skeleton. 3- to 6-year follow up of a randomized clinical trial.
The clinical effectiveness of immunotherapy with the cell wall skeleton of Bacillus Calmette-Guérin was assessed in a study involving 140 consecutive patients with gastric cancer, who were gastrectomized at a single institution from January 1976 through December 1978. These patients were randomized by an envelope method after operation and divided into three treatment groups: 'control', 'chemotherapy', and 'chemotherapy plus immunotherapy with BCG-CWS.' Only two patients who died during surgery were excluded, and a survey of survival periods was made on the remaining 138 patients in January 1982. As a result, statistically significant differences in the survival rate curve were observed between the control and chemotherapy plus immunotherapy groups (P less than 0.01), and between the chemotherapy and chemotherapy plus immunotherapy groups (P less than 0.05). These results emphasize effectiveness of BCG-CWS as an adjuvant immunotherapeutic agent in gastrectomized cancer patients.


Oxidative Stress, Mitochondrial Dysfunction, and Premature Ageing in Severe Acute Malnutrition in Under-Five Children.
To assess oxidative stress, mitochondrial dysfunction, and premature ageing in children with severe acute malnutrition (SAM). This cross-sectional study was conducted in children (1 mo-5 y) with SAM (defined as per WHO criteria) presenting to Pediatrics inpatient department. Oxidative stress, mitochondrial dysfunction, and premature ageing were assessed by measuring and comparing total antioxidant status (TAOS), mitochondrial DNA (mtDNA) content, and telomere length (TL), respectively in 40 under-five children with SAM and 40 age- and sex-matched non-malnourished controls. Oxidative stress was significantly increased in children with SAM, reflected by lower median (IQR) TAOS in cases as compared to controls [10.78 (9.08, 12.3) vs. 16.63 (15.20, 18.03) mM Trolox, p < 0.001]. Median (IQR) mtDNA content was significantly increased in children with SAM [188.7 (105.2, 398.9) vs. 116.2 (67.2, 154.6), p < 0.001]. There was no significant difference in telomere length between cases and controls [1184.5 (894, 1408) vs.1082.6 (823.3, 1479), p = 0.747]. Children with SAM had significantly increased oxidative stress that possibly caused mitochondrial dysfunction but no premature ageing.