Evaluation of the delivery of long-term at-home nursing care: An example of good practice.
To evaluate the influence of long-term at-home nursing care (LTHNC) on patient functional status. The specific aims were as follows: (1) to analyse the influence of LTHNC on patient functional status in terms of activities of daily living; (2) to evaluate the risk of pressure sores and pressure sore prevention in patients receiving LTHNC. LTHNC is a form of care for chronically ill persons staying at home who do not need hospitalisation, but due to their health problems they require regular nursing care that can be provided at home. A retrospective descriptive study. A document research method was used. We collected data from the medical records of 1,058 patients receiving LTHNC at the Non-Public Health Care Centre OMNI-MED in Bialystok (Poland) for the years 2005-2012. Detailed analysis of scores on the Barthel Activities of Daily Living Index revealed significant improvement in patient functional status as a result of LTHNC. In patients aged 65-80, the Barthel score increased by 8.83 points, and in patients aged 64 years and younger, the score increased by 6.58 points (p < 0.001). In the oldest patients (>80 years), functional status improved the least, gaining a mean of 4.97 points on the Barthel scale. Overall, the demonstrated improvement of patient functional status and reduced risk of pressure sore development provide evidence that LTHNC is an effective form of care for elderly and chronically ill persons staying at home. The findings of our study represent a positive example of the way good nursing care can benefit patients while promoting the autonomous nature of nursing. The results add to our understanding of the functioning of LTHNC by providing relevant scientific evidence which may contribute to the development of community nursing.


Clerodendron glandulosum.Coleb extract ameliorates high fat diet/fatty acid induced lipotoxicity in experimental models of non-alcoholic steatohepatitis.
This study evaluates the protective role of Clerodendron glandulosum.Coleb (CG) aqueous extract against high fat diet/fatty acid induced lipotoxicity in experimental models of non-alcoholic steatohepatitis (NASH). Supplementation of NASH mice with CG extract (1% and 3% in high fat diet for 16 weeks) prevented high fat diet induced elevation in liver enzymes, plasma and hepatic lipids, mitochondrial oxidative stress and compromised enzymatic and non-enzymatic antioxidant status and histopathological damage to hepatocytes. Furthermore, results from in vitro study indicates, addition of CG extract (20-200 μg/ml for 24h) to HepG2 cells minimizes oleic acid induced lipid accumulation, higher lipid peroxidation, cytotoxicity and reduced cell viability. These in vivo and in vitro studies suggest that CG extract has the potential of preventing high fat/fatty acid induced NASH.


Benign cystic mesothelioma of the peritoneum in a 12-year-old boy, diagnosed via telepathology.
Low resource countries often have inadequate healthcare systems that, among other problems, suffer from a severe shortage of local expertise. In fields such as pathology, however, where diagnoses are mainly based on macroscopic and histological images, telemedicine can provide an opportunity to supplement the local capabilities by involving a world-wide network of experts. For this, the local pathologist can upload images to an online platform and then consult with international colleagues via teleconferencing, which can be particularly useful in rare or difficult cases. We present the case of a 12-year-old Afghan boy with benign cystic mesothelioma, an extremely rare benign tumour. Using the online platform IPath, we were able to diagnose the eighth reported case of this rare condition in a child, in collaboration with our colleagues in Afghanistan.


Assessment of endobronchial ultrasound-guided bronchoscopy (EBUS) intranodal forceps biopsy added to EBUS 19-gauge transbronchial needle aspiration: A blinded pathology panel analysis.
Endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS-TBNA combined with EBUS-IFB, compared to EBUS-TBNA alone. Consecutive patients who had 19-G EBUS-TBNA and EBUS-IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS-TBNA samples (cell block), then, at least 1 month later, both samples from EBUS-TBNA and from EBUS-IFB together. Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS-TBNA alone and 94% (49/52) when combined with EBUS-IFB (p = 0.023). Malignancy was diagnosed with EBUS-TBNA combined with EBUS-IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS-TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS-IFB and 0.87 for EBUS-TBNA alone. Nonmalignant condition was diagnosed with EBUS-TBNA combined with EBUS-IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS-TBNA alone (p = 0.07). The use of EBUS-IFB combined with 19-G EBUS-TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology.


The acceptance and applicability of a patient-reported experience measurement tool in oncological care: a descriptive feasibility study in northern Germany.
Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools for assessing outcomes of and experiences with health care from the patient's perspective. In Germany, PROMs are widely used in research for evaluating patient outcomes and quality of care. However, the application of PREMs is rather scant, especially in oncology. The study aimed to assess the feasibility of patient-centred quality evaluation in oncological care in Germany using the German adaptation of the Danish National Cancer Patient Questionnaire. This questionnaire is a PREM/PROM-tool addressing patients of all cancer sites and covering the entire cancer patient pathway. The Danish National Cancer Patient Questionnaire was translated into German via forward-backward translation. Face-validity was tested among three cancer patients in a conventional pre-test. The German adaptation contains 99 questions. A pilot test was carried out among 245 newly diagnosed breast and colorectal cancer patients in the German federal state Schleswig-Holstein. Patients were recruited via clinics participating in the Oncological Care Registry (12 specialised units in seven hospitals) and contacted six to nine months after diagnosis. Response behaviour and response patterns were compared to the Danish study population (n = 1964). The willingness among clinicians to support patient recruitment as well as the response rate of patients to the questionnaire was high (65%). Moreover, response behaviour and response patterns of German and Danish patients were consistent. Despite the generally good response behaviour of patients to the single items, the authors observed that questions assessing the diagnostic process did not fully capture German pathways. Only 19.3% of the German patients stated that their diagnostic process was initiated by a visit to a general practitioner (GP) in contrast to 52% in Denmark. The assessment of patient experiences in the diagnostic phase heavily focuses on experiences in general practice, which does not seem appropriate in the German health care setting. The translation was successful, and the feasibility of a future large-scale study within existing structures is given. However, some modifications of questions heavily related to the Danish health care system, especially referring to the diagnostic phase, are necessary.


Superficial desmoid tumors: MRI and ultrasound imaging characteristics.
To describe the imaging characteristics of superficial desmoid tumors using magnetic resonance imaging (MRI) and high-resolution sonography (HRUS). We retrospectively examined 18 patients (12 females and 6 males) with histologically proven superficial desmoids. Fourteen patients received MRI examinations, while 12 patients were examined with HRUS. The lesions were assessed with regard to location, muscular fascia involvement, and spread into the subcutaneous fatty tissue septa, adjacent muscle, and bone. In addition, size, shape, signal intensity/echogenicity relative to muscle, amount of collagen components, Doppler vascularity on HRUS and the degree of contrast enhancement in MRI were evaluated. Altogether there were 20 subcutaneous lesions: six involved the chest wall and the breasts, five the hip, four each the shoulder and the flank, and one the abdominal wall. All but three lesions showed a stellar-type configuration with multiple irregular sun-burst-like extensions along the fascial planes and septa of the subcutaneous fat tissue. The extensions spread away from the main tumor focus, and in nine lesions, these extensions reached the cutis. The remaining three lesions had a spindle shape and also presented extensions along the fascial planes. Another imaging feature in all lesions was the presence of variable amounts of collagen components, with typical low signal on MRI and/or fibrillar hyperechoic appearance in HRUS. The distinctive imaging features of collagen components associated with sun-burst-like extensions in our sample of superficial desmoids are valuable diagnostic clues in the challenging non-invasive differential diagnosis of these tumors.


Risk factor analysis of thoracic endovascular repair using the Matsui-Kitamura stent graft for acute aortic emergencies in the descending thoracic aorta.
In recent years, thoracic endovascular aneurysm repair (TEVAR) has been attempted for acute aortic emergencies (AAEs). However, the risk factors for achieving good results have not been identified. Besides focusing on Acute Physiology and Chronic Health Evaluation (APACHE) II score as a general indicator of patient condition, we analyzed both preoperative factors and intraoperative/postoperative factors. The purpose of this study was to identify those factors affecting the results of TEVAR using our Matsui-Kitamura stent graft (MKSG) for AAEs involving descending thoracic aortic aneurysm. Between July 2000 and June 2008, a total of 32 patients (23 men, 9 women) with AAEs underwent endovascular repair. AAE was a result of aortic aneurysm rupture in 16 cases, rupture of penetrating atherosclerotic ulcer in 2 cases, traumatic aortic injury in 9 cases, complicated type B dissection in 4 cases, and aortic infiltration of sarcoma in 1 case. Low blood pressure in 6 patients, acute renal failure in 7 patients, anemia due to bleeding in 12 patients were found at the time of operation. Urgent TEVAR using the MKSG was performed. Perioperative and long-term results for these patients were investigated. The delivery and technical success rate for TEVAR using the MKSG, was 100%. Perioperative mortality was 12.5%, and 5-year survival rate was 71%. In both univariate and multivariate analysis, the APACHE II score clarified a risk factor. Among the various elements of an APACHE II score, age, hematocrit, and total score were identified as significant factors. The mean of an APACHE II score was 9.5. Patients with an APACHE II score ≥ 10 showed significantly lower 5-year survival rates than patients with an APACHE II score ≤ 9. Good results were obtained using TEVAR to treat AAEs with MKSGs, both perioperatively and during medium-term follow-up. Evaluation of risk factors for TEVAR of AAEs showed the utility of APACHE II score (particularly age, hematocrit, and total score) with a score ≥ 10 indicating high risk.


Pore hydration states of KcsA potassium channels in membranes.
Water-filled hydrophobic cavities in channel proteins serve as gateways for transfer of ions across membranes, but their properties are largely unknown. We determined water distributions along the conduction pores in two tetrameric channels embedded in lipid bilayers using neutron diffraction: potassium channel KcsA and the transmembrane domain of M2 protein of influenza A virus. For the KcsA channel in the closed state, the distribution of water is peaked in the middle of the membrane, showing water in the central cavity adjacent to the selectivity filter. This water is displaced by the channel blocker tetrabutyl-ammonium. The amount of water associated with the channel was quantified, using neutron diffraction and solid state NMR. In contrast, the M2 proton channel shows a V-shaped water profile across the membrane, with a narrow constriction at the center, like the hourglass shape of its internal surface. These two types of water distribution are therefore very different in their connectivity to the bulk water. The water and protein profiles determined here provide important evidence concerning conformation and hydration of channels in membranes and the potential role of pore hydration in channel gating.


The pyrethroid λ-cyhalothrin induces biochemical, genotoxic, and physiological alterations in the teleost Prochilodus lineatus.
The λ-cyhalothrin (CL) is a globally used pyrethroid insecticide that has been detected in different water bodies worldwide. However, studies on the effects of CL on freshwater fishes are still incipient. In this context, we evaluated the acute effects of a commercial formulation containing CL (Karate Zeon® CS 50) in juveniles of the teleost Prochilodus lineatus exposed for 96 h to four concentrations of the active ingredient (5, 50, 250 and 500 ng.L-1). Biochemical, physiological, and genotoxic biomarkers were evaluated in different organs of the fish. Exposure to CL induced significant changes in the enzymatic profiles of P. lineatus, with specific alterations in biotransformation enzymes and antioxidant defence in different tissues. Lipid peroxidation was observed in fish gills and kidney. Increases in esterases were observed in the liver of fish exposed to all CL concentrations evaluated, whereas acetylcholinesterase activity decreased in the muscles of fish at all concentrations. CL also promoted osmoregulatory disorders, with decreases in calcium and magnesium gill ATPases, with consequent hypocalcaemia, in addition an increase in sodium-potassium ATPase activity was observed in the gills of fish exposed to the highest CL concentration, probably in order to compensate a reduction in plasma sodium. Besides, increases in DNA damage were observed in the erythrocytes of fish exposed to all CL concentrations. Thus, despite the low CL concentrations and the short exposure time, this pyrethroid caused hematological adjustments, oxidative stress, osmoregulatory disorders, and DNA damage in P. lineatus, showing that the species is highly sensitive to the deleterious effects of CL.


Therapeutic efficacy of Kangen-karyu against H2O2-induced premature senescence.
The anti-aging potential of Kangen-karyu extract was investigated using the mechanisms of the cellular aging model of stress-induced premature senescence (SIPS) in TIG-1 human fibroblasts. SIPS was induced by a sublethal dose of H2O2 and chronic oxidative stress with repeat treatment of low-dose H2O2. Reactive oxygen species generation, lipid peroxidation, and senescence-associated beta-galactosidase activity were elevated in TIG-1 cells under SIPS induced by H2O2. However, Kangen-karyu extract led to significant declines in these parameters, suggesting its role in ameliorating oxidative stress-related aging. It was also observed that SIPS due to H2O2 treatment led to the loss of cell viability, whereas Kangen-karyu extract improved cell viability by attenuating H2O2-induced oxidative damage. TIG-1 cells under the condition of SIPS caused by sublethal and chronic low doses of H2O2 showed nuclear factor-kappaB (NF-kappaB) translocation to the nucleus from the cytosol, while Kangen-karyu extract inhibited NF-kappaB nuclear translocation, implying that Kangen-karyu extract could exert an anti-aging effect through NF-kappaB modulation. In addition, treatment with Kangen-karyu extract under H2O2-induced chronic oxidative stress normalized the cell cycle by reducing the number of cells in the G0/G1 phase and elevating the proportion of those in the S phase, indicating the role of Kangen-karyu extract in cell cycle regulation. On the other hand, Kangen-karyu extract did not exert such an effect on cell cycle regulation under acute oxidative stress induced by sublethal H2O2. Furthermore, treatment with Kangen-karyu extract prolonged the lifespan of TIG-1 cells under SIPS. The present study suggests that Kangen-karyu might play a therapeutic role against the aging process caused by oxidative stress.


Brain and behaviour phenotyping of a mouse model of neurofibromatosis type-1: an MRI/DTI study on social cognition.
Neurofibromatosis type-1 (NF1) is a common neurogenetic disorder and an important cause of intellectual disability. Brain-behaviour associations can be examined in vivo using morphometric magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to study brain structure. Here, we studied structural and behavioural phenotypes in heterozygous Nf1 mice (Nf1(+/-) ) using T2-weighted imaging MRI and DTI, with a focus on social recognition deficits. We found that Nf1(+/-) mice have larger volumes than wild-type (WT) mice in regions of interest involved in social cognition, the prefrontal cortex (PFC) and the caudate-putamen (CPu). Higher diffusivity was found across a distributed network of cortical and subcortical brain regions, within and beyond these regions. Significant differences were observed for the social recognition test. Most importantly, significant structure-function correlations were identified concerning social recognition performance and PFC volumes in Nf1(+/-) mice. Analyses of spatial learning corroborated the previously known deficits in the mutant mice, as corroborated by platform crossings, training quadrant time and average proximity measures. Moreover, linear discriminant analysis of spatial performance identified 2 separate sub-groups in Nf1(+/-) mice. A significant correlation between quadrant time and CPu volumes was found specifically for the sub-group of Nf1(+/-) mice with lower spatial learning performance, suggesting additional evidence for reorganization of this region. We found strong evidence that social and spatial cognition deficits can be associated with PFC/CPu structural changes and reorganization in NF1.


2-Ethynylbenzenealkanamines. A new class of calcium entry blockers.
A series of 2-(aryl- or alkylethynyl)benzenealkanamines were synthesized. They exhibit antihypertensive activity in spontaneously hypertensive rats and coronary vasodilator activity with minimal negative inotropic activity in the "Langendorff" guinea pig heart in vitro. They have been shown to exert their activity by inhibition of Ca2+ influx across cell membranes. Optimal activity is found among the N-(arylethyl)-5-methoxy-alpha-methyl-2-(phenylethynyl)ben zeneethanamines and -propanamines.


Pneumothorax and pneumomediastinum complicating acute miliary tuberculosis.
Five adult cases of acute miliary tuberculosis are described. Four were complicated by pneumothoraces and 1 by pneumomediastinum. In 2 cases pneumothorax occurred on the left side while in 2 it was bilateral. None of the 5 patients died.


Stimulus control in fixed interfood intervals.
The control exerted by various portions of fixed-time and fixed-interval schedules was assessed with a trace-conditioning procedure. The intervals were segmented into 10 bins. In all but 1 of those bins, the stimuli were presented in different random orders on each trial. In 1 bin, the stimulus was the same on each trial. The position of this trace stimulus was varied across phases. The results indicated that a trace stimulus can come to control behavior and that differential control can extend to even the second tenth of an interfood interval. The results were interpreted as indicating that traditional explanations of the rate loss in earlier portions of an interfood interval are inadequate and that models such as Palya's (1993) bipolar model or Miller and Schachtman's (1985) comparator model may provide a principled framework with which to understand within-trial effects.


Scalability of the muscular action in a parametric 3D model of the index finger.
A method for scaling the muscle action is proposed and used to achieve a 3D inverse dynamic model of the human finger with all its components scalable. This method is based on scaling the physiological cross-sectional area (PCSA) in a Hill muscle model. Different anthropometric parameters and maximal grip force data have been measured and their correlations have been analyzed and used for scaling the PCSA of each muscle. A linear relationship between the normalized PCSA and the product of the length and breadth of the hand has been finally used for scaling, with a slope of 0.01315 cm(-2), with the length and breadth of the hand expressed in centimeters. The parametric muscle model has been included in a parametric finger model previously developed by the authors, and it has been validated reproducing the results of an experiment in which subjects from different population groups exerted maximal voluntary forces with their index finger in a controlled posture.


Characterization of bioactive peptides obtained from marine invertebrates.
Bioactive peptides as products of hydrolysis of diverse marine invertebrate (shellfish, crustacean, rotifer, etc.) proteins are the focus of current research. After much research on these muscles and by-products, some biologically active peptides were identified and applied to useful compounds for human utilization. This chapter reviews bioactive peptides from marine invertebrates in regarding to their bioactivities. Additionally, specific characteristics of antihypertensive, anti-Alzheimer, antioxidant, antimicrobial peptide enzymatic production, methods to evaluate bioactivity capacity, bioavailability, and safety concerns of peptides are reviewed.


Influence of demographic and clinical characteristics of elderly patients with a hip fracture on mortality: A retrospective, total cohort study in North-East Spain.
The increased mortality after hip fracture (HF) is caused by multiple factors, and large samples are needed to assess the weight of each factor. To date, few studies have investigated these factors through a total cohort approach, and the complexity of underlying medical conditions has not been considered. To investigate the influence of demographic and clinical characteristics on increased mortality risk in elderly patients with hip fracture (HF). Retrospective, total cohort study collecting 4-year data. All hospitals and primary care units owned by, or associated with, Catalonia's local health department (CatSalut) (north-east Spain). All patients aged ≥65 years, admitted to Catalan hospitals from CatSalut because of a HF between 1st January 2012 and 31st December 2015. Hip fracture. The main outcome was survival. Measures regarding demographic and clinical characteristics at the moment of hospital admission included age, sex, osteoporosis treatment, previous fractures, type of intervention, nutritional status, and comorbidities. Patients were stratified using the Adjusted Morbidity Groups (GMA) risk assessment tool. Of the 30,552 patients included in the study sample, 10,439 (34%) died during follow-up, 6821 (22%) within the first year after hospital admission. Mean (SD) age was 84 (7) years; 75% were female. Baseline factors with greater influence on survival were age (HRs 1.44 [95% CI 1.22-1.70], 2.38 [2.03-2.79], and 4.38 [3.73-5.15] for age groups 70-79, 80-89, and >89, respectively), underweight (HR 1.65 [1.36-2.01]), lack of surgical intervention (HR 2.64 [2.47-2.83]), and very high risk stratum of GMA risk (HR 1.58 [1.45-1.73]). Vitamin D/calcium supplementation and osteoporosis treatment showed a significant but moderate influence on mortality (HRs 0.84 (0.79-0.88) and 0.92 [0.85-0.99], respectively). In elderly patients with HF, age and health status factors at hospital admission have the greatest impact on mortality risk after hospital admission. Our findings encourage a comprehensive intervention aimed at improving underlying medical conditions of HF patients.


Biologically active peptides in milk proteins.
Bioactive peptides have been identified as digestion products of several food proteins. All the bioactive sequences are hidden in an inactive state inside the polypeptide chain of the larger protein. Milk proteins are a rich source of biologically active peptides such as exorphins (casomorphins), phosphopeptides and immunopeptides. Such peptides are released during intestinal digestion of caseins and whey proteins. They may be involved in regulation of nutrient entry and influence the postprandial metabolism via stimulation of the secretion of hormones. Furthermore, they may exert a stimulating effect on the immune system. These findings offer new aspects for evaluating the nutritive value of food proteins. Moreover, bioactive peptides have already found interesting applications as dietary supplements and as pharmaceutical preparations.


Phosphopeptide immuno-affinity enrichment to enhance detection of tyrosine phosphorylation in plants.
Tyrosine (Tyr) phosphorylation plays an essential role in signaling in animal systems, but the relative contribution of Tyr phosphorylation to plant signal transduction has, until recently, remained an open question. One of the major issues hampering the analysis is the low abundance of Tyr phosphorylation and therefore underrepresentation in most mass spec-based proteomic studies. Here, we describe a working approach to selectively enrich Tyr-phosphorylated peptides from complex plant tissue samples. We describe a detailed protocol that is based on immuno-affinity enrichment step using an anti-phospho-tyrosine (pTyr)-specific antibody. This single enrichment strategy effectively enriches pTyr-containing peptides from complex total plant cell extracts, which can be measured by LC-MS/MS without further fractionation or enrichment.


Glucocorticoid-induced leucine zipper is downregulated in human alveolar macrophages upon Toll-like receptor activation.
Induction of the glucocorticoid-induced leucine zipper (GILZ) by glucocorticoids plays a role in their antiinflammatory action, whereas GILZ expression is reduced under inflammatory conditions. The mechanisms regulating GILZ expression during inflammation, however, have not yet been characterized. Here, we investigated GILZ expression in human alveolar macrophages (AMs) following Toll-like receptor (TLR) activation. Macrophages were shown to predominantly express GILZ transcript variant 2. Lipopolysaccharide-treated AMs, THP-1 cells, and lungs of lipopolysaccharide-exposed mice displayed decreased GILZ protein and mRNA levels. The effect was strictly dependent on the adapter molecule MyD88, as shown by using specific ligands or a knockdown strategy. Investigations on the functional significance of GILZ downregulation performed by GILZ knockdown revealed a proinflammatory response, as indicated by increased cytokine expression and NF-κB activity. We found that TLR activation reduced GILZ mRNA stability, which was mediated via the GILZ 3'-untranslated region. Finally, involvement of the mRNA-binding protein tristetraprolin (TTP) is suggested, since TTP overexpression or knockdown modulated GILZ expression and TTP was induced in a MyD88-dependent fashion. Taken together, our data show a MyD88- and TTP-dependent GILZ downreg-ulation in human macrophages upon TLR activation. Suppression of GILZ is mediated by mRNA destabilization, which might represent a regulatory mechanism in macrophage activation.


Enhancing the bio-prospective of microalgae by different light systems and photoperiods.
Microalgae are a source of highly valuable bioactive metabolites and a high-potential feedstock for environmentally friendly and sustainable biofuel production. Recent research has shown that microalgae benefit the environment using less water than conventional crops while increasing oxygen production and lowering CO2 emissions. Microalgae are an excellent source of value-added compounds, such as proteins, pigments, lipids, and polysaccharides, as well as a high-potential feedstock for environmentally friendly and sustainable biofuel production. Various factors, such as nutrient concentration, temperature, light, pH, and cultivation method, effect the biomass cultivation and accumulation of high-value-added compounds in microalgae. Among the aforementioned factors, light is a key and essential factor for microalgae growth. Since photoautotrophic microalgae rely on light to absorb energy and transform it into chemical energy, light has a significant impact on algal growth. During micro-algal culture, spectral quality may be tailored to improve biomass composition for use in downstream bio-refineries and boost production. The light regime, which includes changes in intensity and photoperiod, has an impact on the growth and metabolic composition of microalgae. In this review, we investigate the effects of red, blue, and UV light wavelengths, different photoperiod, and different lighting systems on micro-algal growth and their valuable compounds. It also focuses on different micro-algal growth, photosynthesis systems, cultivation methods, and current market shares.


Identification of regulated proteins in naked barley grains (Hordeum vulgare nudum) after Fusarium graminearum infection at different grain ripening stages.
We analyzed the effect of Fusarium graminearum infection on field-grown naked barley (Hordeum vulgare nudum). The ears were inoculated with F. graminearum spores during anthesis. In the course of ripening, grains in five phenological growth stages of naked barley from milk ripe to plant death were sampled. The albumin and globulin proteins of inoculated grains and untreated (control) grains were separated by two-dimensional gel electrophoresis. Forty-five spots composing of proteins that were changed in abundance due to F. graminearum infection were subsequently identified by mass spectrometry. Various proteins showing altered expression pattern after Fusarium infection were linked to stress response such as plant signal transduction pathways, fungal defense and oxidative burst. More proteins changed during early grain ripening stages than during later ripening stages. Protease inhibitors occurred at increased abundancy during milk ripe stage. A thaumatin-like protein accumulated at plant death stage. Proteins linked to nitrogen metabolism and protein biosynthesis were mainly reduced, whereas those linked to carbon metabolism were predominantly increased in infected grains. Fusarium graminearum infection can lead to significant contamination of grains with mycotoxins. With this 2D-based proteomics study we give an insight into plant–pathogen interactions between the non-model plant naked barley and the fungus F. graminearum during five stages of grain development. Over the multiple developmental stages we observed specific patterns of changes induced by the fungus: the primary plant metabolism and inhibition of fungal protease were predominantly affected during early grain development stages. During the entire grain development we found an induced accumulation of thaumatin-like proteins due to the fungal infection indicating their fundamental role for naked barley defense.


Identification of the active site of legumain links it to caspases, clostripain and gingipains in a new clan of cysteine endopeptidases.
We show by site-directed mutagenesis that the catalytic residues of mammalian legumain, a recently discovered lysosomal asparaginycysteine endopeptidase, form a catalytic dyad in the motif His-Gly-spacer-Ala-Cys. We note that the same motif is present in the caspases, aspartate-specific endopeptidases central to the process of apoptosis in animal cells, and also in the families of clostripain and gingipain which are arginyl/lysyl endopeptidases of pathogenic bacteria. We propose that the four families have similar protein folds, are evolutionarily related in clan CD, and have common characteristics including substrate specificities dominated by the interactions of the S1 subsite.


Mixed-density extradural hematomas on computed tomography-prognostic significance.
It has been variably reported that patients who acutely present with low- or mixed-density blood on CT scan are associated with poor clinical outcome. The aim of the study was to correlate the presence or absence of mixed density within EDHs on CT scanning with the clinical outcome. This is a retrospective study of a total of 109 patients with EDHs who were operated on from August 2001 to August 2002. The CT scans were reviewed and classified into 2 categories-predominantly hyperdense and mixed density. This was correlated with clinical details and outcome. In all, 43.2% (16/37) of patients in the mixed-density category presented with GCS of no more than 8 as compared with 23.6% (17/72) of patients in the hyperdense group (P < .05). Mean hematoma volume in the mixed-density group was 72 cm(3) as compared with 42 cm(3) in the hyperdense group (P < .05). Mortality rate was significantly higher in the mixed-density category (21.6% vs 4.2%, P < .05). The study portends mixed density in EDH as a potent poor prognostic indicator. The mixed density of the clot probably indicates that the clot is rapidly increasing in size and requires even earlier and more aggressive treatment.


Role of AAA(+)-proteins in peroxisome biogenesis and function.
Mutations in the PEX1 gene, which encodes a protein required for peroxisome biogenesis, are the most common cause of the Zellweger spectrum diseases. The recognition that Pex1p shares a conserved ATP-binding domain with p97 and NSF led to the discovery of the extended family of AAA+-type ATPases. So far, four AAA+-type ATPases are related to peroxisome function. Pex6p functions together with Pex1p in peroxisome biogenesis, ATAD1/Msp1p plays a role in membrane protein targeting and a member of the Lon-family of proteases is associated with peroxisomal quality control. This review summarizes the current knowledge on the AAA+-proteins involved in peroxisome biogenesis and function.


Incidence and causes of early unplanned readmission after hospitalisation with peripheral arterial disease in Australia and New Zealand.
To evaluate the characteristics and predictors of unplanned readmission within 30 days of hospitalisation for the treatment of peripheral arterial disease (PAD) in Australia and New Zealand. Analysis of hospitalisations data in the Admitted Patient Collection for each Australian state and territory and the New Zealand National Minimum Dataset (Hospital Events). All public and 80% of private hospitals in Australia and New Zealand. Adults (18 years or older) hospitalised with a primary or conditional secondary diagnosis of PAD during 1 January 2010 - 31 December 2015. Rate of unplanned readmission (any cause) within 30 days of hospitalisation with PAD. Of 104 979 admissions included in our analysis (mean patient age, 73.7 years; SD, 12.4 years), 9765 were followed by at least one unplanned readmission within 30 days of discharge (9.3%): 3395 within one week (34.8%) and 7828 within three weeks (80.2%). The most frequent readmission primary diagnoses were atherosclerosis (1477, 15.3%), type 2 diabetes (1057, 10.8%), and "complications of procedures not elsewhere classified" (963, 9.9%). Readmission was more frequent after acute (4830 of 26 304, 18.4%) than elective PAD hospitalisations (4935 of 78 675, 6.3%), but the readmission characteristics were similar. Factors associated with greater likelihood of readmission included acute PAD hospitalisations (odds ratio [OR], 2.04; 95% CI, 1.96-2.17), surgical intervention during the PAD hospitalisation (OR, 1.74; 95% CI, 1.64-1.84), and chronic limb-threatening ischaemia (OR, 1.55; 95% CI, 1.47-1.63). Unplanned readmissions within 30 days of hospitalisation for PAD are often for potentially preventable reasons. Their number should be reduced to improve clinical outcomes for people with PAD.


A randomised prospective comparison of cefotaxime versus netilmicin/penicillin for treatment of suspected neonatal sepsis.
In an open prospective study performed in 2 neonatal units, infants with suspected neonatal sepsis (SNS) of unknown microbial cause were randomly allocated to receive treatment with either cefotaxime (CTX) or netilmicin plus penicillin (N + P). 236 patients were entered into the trial, of whom 222 were evaluable. The number of 'definitely' and 'probably' infected babies was similar in both groups. There was no difference in clinical outcome between patients in the 2 treatment groups and no side effects were recorded for either of the antibiotic regimens. Antibiotic sensitivity testing of bacterial isolates from peripheral sites showed almost universal sensitivity of potential pathogens to both antibiotic regimens at the start of treatment in all infants. Thereafter, organisms resistant to CTX were isolated from patients in both treatment groups, possibly reflecting the antibiotic sensitivity profile of the colonising bacteria in both neonatal units. The results of this study indicate that either CTX or N + P are suitable, in our units, for the 'blind' treatment of early SNS. In units where listerial infections are prevalent, specific cover should be added to CTX. For SNS developing after admission, the choice of antibiotics will depend upon the background antibiotic sensitivity profile of the colonising bacteria.


In vitro activity of micafungin against biofilms of Candida albicans, Candida glabrata, and Candida parapsilosis at different stages of maturation.
Candida spp. is able to form a biofilm, which is considered resistant to the majority of antifungals used in medicine. The aim of this study was to evaluate the in vitro activity of micafungin against Candida spp. biofilms at different stages of their maturation (2, 6, and 24 h). We assessed the inhibitory effect of micafungin against 78 clinical isolates of Candida spp., growing as planktonic or sessile cells, by widely recommended broth microdilution method. The in vitro effect on sessile cells viability was evaluated by colorimetric reduction assay. All examined strains were susceptible or intermediate to micafungin when growing as planktonic cells. At the early stages of biofilm maturation, from 11 (39.3%) to 20 (100%), tested strains, depending on the species, exhibited sessile minimal inhibitory concentrations (SMICs) of micafungin at ≤ 2 mg/L. For 24-h-old Candida spp. biofilms, from 3 (10.7%) to 20 (100%) of the tested strains displayed SMICs of micafungin at ≤ 2 mg/L. Our findings confirm that micafungin exhibits high potential anti-Candida-biofilm activity. However, this effect does not comprise all Candida species and strains. All strains were susceptible or intermediate to micafungin when growing as planktonic cells, but for biofilms, micafungin displays species- and strain-specific activity. Paradoxical growth of C. albicans and C. parapsilosis was observed. Antifungal susceptibility testing of Candida spp. biofilms would be the best solution, but to date, no reference method is available. The strongest antibiofilm activity of micafungin is observed at early stages of biofilm formation. Possibly, micafungin could be considered as an effective agent for prevention of biofilm-associated candidiasis, especially catheter-related candidaemia.


A systematic review of the use of local analgesia in medically compromised children and adolescents.
To determine if the use of routine techniques and agents for topical and injectable dental local analgesia (LA) are safe for use in medically compromised children and adolescents. Medline, Embase and Cochrane Oral Health Group's trials register, were searched electronically, supplemented by hand searching of relevant journals. RCTs, cohort studies, case-control studies, observational studies, case series, case reports, evidence based guidelines reporting on children and adolescents aged 18 years or younger with one/more pre-designated medical condition, being administered topical and/or injectable local analgesic for dental procedures using standard techniques of delivery. Outcomes were presence of adverse events which were attributable directly or indirectly to the underlying medical condition. N = 71 studies were retrieved but only three observational studies, one case series, two case reports and four evidence based guidelines met the criteria for inclusion. A disparate set of medical conditions were reported upon and sparse guidance given in these areas. Thirty-nine review articles and consensus documents provided little or no clinical data to support their recommendations. There are insufficient high quality data reporting on the use of topical and local analgesia to medically compromised children and adolescents. Apart from a known allergy to local analgesia or one of the agents, there appears to be very few absolute or relative contra-indications to the use of local analgesia in children and adolescents based on medical history. There is an urgent need for high quality studies wherever possible and appropriate, in order to improve and inform the evidence-base in this cohort.


Cardioautonomic control in healthy singleton and twin pregnancies.
In conjunction with significant cardiovascular adaptation, changes in cardioautonomic balance, specifically greater sympathetic activation and vagal withdrawal, are considered normal adaptations to healthy singleton pregnancy. Cardiovascular adaptation to twin pregnancy is more profound than that of singleton pregnancies; however, the changes in cardioautonomic control during multifetal gestation are unknown. To address this gap, beat-by-beat blood pressure (photoplethysmography) and heart rate (lead II electrocardiogram) were measured continuously in 25 twin pregnancies and 25 singleton pregnancies (matched for age, prepregnancy body mass index, and gestational age) during 10 min of rest. Data extracted from a 3- to 5-min period were used to analyze heart rate variability (HRV), blood pressure variability (BPV), cardiovagal baroreflex gain, and cardiac intervals as indicators of cardioautonomic control. Independent t tests were used to determine statistical differences between groups (α = 0.05), and the false rate discovery was determined to adjust for multiple comparisons. Resting heart rate was greater in twin compared with singleton pregnancies (91 ± 10 vs. 81 ± 10 beats/min; P = 0.001), but blood pressure was not different. Individuals with twin pregnancies had lower HRV, evidenced by lower standard deviation of R-R intervals (32 ± 11 vs. 47 ± 18 ms; P = 0.001), total power (1,035 ± 810 vs. 1,945 ± 1,570 ms2; P = 0.004), and high frequency power (224 ± 262 vs. 810 ± 806 ms2; P < 0.001) compared with singleton pregnancies. There were no differences in cardiac intervals, BPV, and cardiovagal baroreflex gain between groups. Our findings suggest that individuals with twin pregnancies have greater sympathetic and lower parasympathetic contributions to heart rate and that cardiac, but not vascular, autonomic control is impacted during twin compared with singleton pregnancy.NEW & NOTEWORTHY Individuals with healthy twin pregnancies had lower overall heart rate variability compared with those with singleton pregnancies at similar gestational ages. These results suggest a greater sympathetic and reduced parasympathetic contribution to cardiac control in twin pregnancies. Baseline heart rate was elevated, while arterial pressure and spontaneous cardiovagal baroreflex gain were not different between groups. This was result of the upward resetting of the cardiovagal baroreflex during healthy twin pregnancy, thus maintaining arterial pressure.


Tau as a mediator of neurotoxicity associated to cerebral amyloid angiopathy.
Cerebral amyloid angiopathy (CAA) is typified by the cerebrovascular deposition of amyloid. Currently, there is no clear understanding of the mechanisms underlying the contribution of CAA to neurodegeneration. Despite the fact that CAA is highly associated with accumulation of Aβ, other types of amyloids have been shown to associate with the vasculature. Interestingly, in many cases, vascular amyloidosis is accompanied by significant tau pathology. However, the contribution of tau to neurodegeneration associated to CAA remains to be determined. We used a mouse model of Familial Danish Dementia (FDD), a neurodegenerative disease characterized by the accumulation of Danish amyloid (ADan) in the vasculature, to characterize the contribution of tau to neurodegeneration associated to CAA. We performed histological and biochemical assays to establish tau modifications associated with CAA in conjunction with cell-based and electrophysiological assays to determine the role of tau in the synaptic dysfunction associated with ADan. We demonstrated that ADan aggregates induced hyperphosphorylation and misfolding of tau. Moreover, in a mouse model for CAA, we observed tau oligomers closely associated to astrocytes in the vicinity of vascular amyloid deposits. We finally determined that the absence of tau prevents synaptic dysfunction induced by ADan oligomers. In addition to demonstrating the effect of ADan amyloid on tau misfolding, our results provide compelling evidence of the role of tau in neurodegeneration associated with ADan-CAA and suggest that decreasing tau levels could be a feasible approach for the treatment of CAA.


Quality assessment for processed and sterilized bone using Raman spectroscopy.
To eliminate the potential for infection, many tissue banks routinely process and terminally sterilize allografts prior to transplantation. A number of techniques, including the use of scanning electron microscopy, bone graft models, and mechanical property tests, are used to evaluate the properties of allograft bone. However, as these methods are time consuming and often destroy the bone sample, the quality assessment of allograft bones are not routinely performed after processing and sterilization procedures. Raman spectroscopy is a non-destructive, rapid analysis technique that requires only small sample volumes and has recently been used to evaluate the mineral content, mineral crystallinity, acid phosphate and carbonate contents, and collagen maturity in human and animal bones. Here, to establish a quality assessment method of allograft bones using Raman spectroscopy, the effect of several common sterilization and preservation procedures on rat femoral bones were investigated. We found that freeze-thawing had no detectable effects on the composition of bone minerals or matrix, although heat treatment and gamma irradiation resulted in altered Raman spectra. Our findings suggest Raman spectroscopy may facilitate the quality control of allograft bone after processing and sterilization procedures.


The Individual Victim. Hypogeneralization within a New Social Type.
Over the past several decades we have seen increased attention paid to victimhood. However, many of these dialogues are only tangentially related to actual experiences of victimization. They are better understood as reflections of a new Simmelian social type, that is, a new pattern emerging within psycho-social interaction-namely, the Victim. The current reflections focus on the meaning making processes within these broader discussions of victimhood. We first briefly review Georg Simmel's understanding of social types and explore the Victim as a new social type. We then examine how the process of hypogeneralization appears within social types, including the Victim, whereby the patterned social interactions that constitute a social type are seen as a single individual or collective. Finally, we examine a recent example from popular discourse of the hypogeneralized Victim.


Fluoxetine normalizes the effects of prenatal maternal stress on depression- and anxiety-like behaviors in mouse dams and male offspring.
Maternal depression during pregnancy and the postpartum period (lactation) is a common debilitating condition affecting mother-fetus/-infant interactions, which can be a risk factor for cognitive and affective disorders in mothers and their children. Selective-serotonin-reuptake-inhibitor-(SSRI) pharmacotherapy is known as the first-line treatment of maternal depression. However, its use during pregnancy and lactation is a topic of concern. The present study aimed to investigate the effects of prenatal stress alone or in combination with fluoxetine (FLX) on hypothalamic-pituitary-adrenal axis (HPA) activity, anxiety-/depression-like behaviors in dams and in offspring. To do this, gestationally-stressed and non-stressed mouse dams were orally treated with FLX-(8/mg/kg/day) from gestational day 10 to lactation day 20. The behavioral outcomes of prenatal stress and FLX treatment in dams and male offspring were assessed using the sucrose preference, forced swim, zero maze, and light-dark box tests. Stress-induced corticosterone levels were also evaluated as indicative of abnormal HPA-axis function. Our findings indicated that maternal stress resulted in increased depression-like behavior and HPA axis hyperactivity in dams during pregnancy and lactation which were reversed by FLX. Furthermore, prenatal stress increased anxiety/depression-like behaviors and HPA-axis reactivity in male offspring. These effects were reversed by maternal FLX treatment. Developmental FLX exposure, without prenatal stress, did not have any adverse effects on the above measured parameters. Our results suggest that prenatal stress induces maternal depression-like behavior which affects the development of affective symptoms in male offspring, and that remediation of maternal depression-like behavior coincidences with the normalization of anxiety-and depression-like symptoms in male offspring.


[Substances having antiviral activity. IX. Synthesis and antiviral activity of 1-acyl-2-halo-3-formylindole thiosemicarbazones].
Some thiosemicarbazones of 1-acyl-2-chloro-3-formylindoles were synthesized and investigated for antiviral activity against vaccinia virus, HID stock and parainfluenza virus type 3 HA-I/CR-8 stock. Evidence of antiviral activity was found only against vaccinia virus, and was particular significant with the m-substituted 1-benzoyl-2-chloro-3-formylindoles. The first results of 2-substitution of chlorine by bromine in the indole skeleton, are reported.


A single dose of purple grape juice improves physical performance and antioxidant activity in runners: a randomized, crossover, double-blind, placebo study.
To investigate the effects of a single dose of juice on physical performance, oxidative stress, inflammation and muscle damage in runners. Fourteen recreational male runners (39 ± 9 years, VO2peak = 55.9 ± 6.5 ml/kg/min) performed two running tests to exhaustion at 80% of VO2max after ingesting grape juice or a placebo drink (10 ml/kg/day) randomly. Blood samples were taken before and 2 h after supplementation and immediately after running to analyze total antioxidant capacity (TAC), malondialdehyde (MDA), alpha-1 acid glycoprotein (A1GPA), high-sensitivity C-reactive protein (hs-CRP), creatine kinase (CK) and lactate dehydrogenase (LDH). The participants ran for an average of 59.2 ± 27.8 min until exhaustion in the placebo group and for 68.4 ± 29.7 min until exhaustion in the grape juice intake group, which was a significantly longer time (p = 0.008). This improvement in physical performance was accompanied by a 43.6% increase in TAC (p = 0.000) at the post-exercise timepoint compared to the level at baseline. MDA, A1GPA, hs-CRP, CK, and LDH did not exhibit changes. In contrast, no significant change in any variable was observed after consuming the placebo drink. The single-dose intake of purple grape juice demonstrated an ergogenic effect in recreational runners by increasing run time to exhaustion and increasing antioxidant activity.


[Study of local anaesthetics: Part 206* Micellization of selected of quaternary ammonium salt derived from heptacaine].
Micellization of selected quaternary ammonium compounds derived from heptacaine have been studied by absorption spectroscopy in the UV/VIS spectral region with the use of a pyrene probe. The compounds studied in the aqueous solution have been marked as H22, H26, H27, H29, H34, H + Al and H + B and the derivative marked as H34 was studied in a 3 mol/l ethanol solution at the temperature of 25 °C. In the homologous series of the studied bromides H22, H26, H27 and H29, cmc was observed to be dependent on the number of carbon atoms nc in the hydrophobic chain: ln (cmc) = -3.131-0.421nC. The Free Gibbs energy necessary for the transfer of a methyl group of the alkyl chain from the water phase to the inner part of the micelle at the temperature of 25 °C is (-0.421 ± 0.034)RT.


Search for anti-laminin antibodies in the serum of workers exposed to cadmium, mercury vapour or lead.
Anti-laminin antibodies were sought for in the serum of workers exposed to mercury vapour (Hg, n = 58), lead (Pb, n = 38) or cadmium (Cd, n = 47). Thirty-one workers removed from Cd exposure for an average of eight years were also examined. Compared with control workers matched for age and socio-economic status, the prevalence of circulating anti-laminin antibodies was not increased in workers exposed to Hg (mean duration of exposure: 7.9 years and mean urinary excretion of Hg: 72 micrograms/g creatinine) nor in those exposed to Pb (mean duration of exposure: 10.6 years and mean Pb levels in blood: 535 micrograms/l). In contrast, anti-laminin antibodies were significantly more prevalent in Cd-exposed workers whose urinary Cd exceeded 20 micrograms/g creatinine. This observation was made in both currently exposed workers and in workers removed from Cd exposure (mean duration of exposure: 9.4 and 24.6 years and mean urinary Cd: 7.8 and 13.4 micrograms/g creatinine respectively). These autoantibodies were found in Cd workers with normal renal function as well as in those with increased proteinuria.


Predictors of discordance between fractional flow reserve and resting full-cycle ratio in patients with coronary artery disease: Evidence from clinical practice.
Fractional flow reserve (FFR) is an established method for assessing functional myocardial ischemia. Recently, the resting full-cycle ratio (RFR) has been introduced as a non-hyperemic index of functional coronary stenosis. However, the effects of clinical characteristics on discordance between RFR and FFR have not been fully evaluated. We aimed to identify clinical characteristics that influence FFR-RFR concordance. We included 410 patients with 573 intermediate coronary lesions who underwent clinically indicated invasive coronary angiography, as well as assessments of FFR and RFR. Receiver-operating characteristic (ROC) curves were created to assess the optimal cut-off values of RFR for predicting FFR ≤0.80. RFR exhibited a strong correlation with FFR (r = 0.66, p < 0.0001). ROC analysis identified an optimal RFR cut-off value of 0.92 for categorization based on an FFR cut-off value of 0.8. The discordance of FFR >0.8 and RFR ≤0.92 (high FFR/low RFR) was observed in 112 lesions (20.9%), whereas the discordance of FFR ≤0.8 and RFR >0.92 (low FFR/high RFR) was observed in 35 lesions (6.5%). Higher rate of hemodialysis and lower hemoglobin levels were observed in the high FFR/low RFR group. Multivariate analyses identified female sex, left anterior descending artery (LAD) lesions, and hemodialysis as significant predictors of high FFR/low RFR. Conversely, body surface area and non-LAD lesions were significantly associated with low FFR/high RFR. Hemodialysis [odds ratio (OR): 2.41, 95% confidence interval (CI) 1.31-4.41; p = 0.005] and LAD lesions (OR: 1.86, 95% CI: 1.25-2.79; p = 0.002) were identified as independent predictors of overall FFR-RFR discordance. RFR exhibited good diagnostic performance in the identification of functionally significant stenosis. However, RFR may overestimate functional severity in patients undergoing hemodialysis or in those with LAD lesions. Further prospective trials are required to demonstrate the non-inferiority of RFR to FFR.


Laser Capture Microdissection: From Genomes to Chromosomes, from Complex Tissue to Single-Cell Analysis.
Laser microdissection (LM) is a powerful tool for various molecular analyses providing pure samples for genomic, transcriptomic, and proteomic studies. Cell subgroups, individual cells, or even chromosomes can be separated via laser beam from complex tissues, visualized under the microscope, and used for subsequent molecular analyses. This technique provides information on nucleic acids and proteins, keeping their spatiotemporal information intact. In short, the slide with tissue is placed under the microscope, imaged by a camera onto a computer screen, where the operator selects cells/chromosomes based on morphology or staining and commands the laser beam to cut the specimen following the selected path. Samples are then collected in a tube and subjected to downstream molecular analysis, such as RT-PCR, next-generation sequencing, or immunoassay.


Epidermal dysplasia and neoplasia in kidney transplant recipients.
Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC)/SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation (p = 0.005) and occupational sun exposure (p = 0.048) had statistical significance as risk factors. In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patient's age at the time of transplantation seem to be the most important risk factors.


On the efficiency of nonparametric variance estimation in sequential dose-finding.
Dose-finding in clinical studies is typically formulated as a quantile estimation problem, for which a correct specification of the variance function of the outcomes is important. This is especially true for sequential study where the variance assumption directly involves in the generation of the design points and hence sensitivity analysis may not be performed after the data are collected. In this light, there is a strong reason for avoiding parametric assumptions on the variance function, although this may incur efficiency loss. In this article, we investigate how much information one may retrieve by making additional parametric assumptions on the variance in the context of a sequential least squares recursion. By asymptotic comparison, we demonstrate that assuming homoscedasticity achieves only a modest efficiency gain when compared to nonparametric variance estimation: when homoscedasticity in truth holds, the latter is at worst 88% as efficient as the former in the limiting case, and often achieves well over 90% efficiency for most practical situations. Extensive simulation studies concur with this observation under a wide range of scenarios.


Aluminum induces the in vitro aggregation of bovine brain cytoskeletal proteins.
The addition of aluminum to purified cytoskeletal proteins in vitro selectively induces the aggregation of highly phosphorylated proteins, such as the two larger neurofilament subunits (200 and 160 kDa) and the microtubule-associated proteins of the MAP-1 group (MAP-1A and MAP-1B). Other cytoskeletal proteins with a substantially lower phosphate content, such as the smaller neurofilament subunit (68 kDa) and tubulin, remain soluble, even in the presence of high aluminum concentrations. This suggests that aluminum interacts with phosphate groups in cytoskeletal proteins, causing their precipitation. The protein aggregates formed in the presence of aluminum are resistant to reagents such as urea and sodium dodecyl sulphate (SDS) which dissolve normal cytoskeletal polymers (neurofilaments and microtubules). These results favor the view that the neurotoxic effect of aluminum may be due primarily to the disorganization of the neuronal cytoskeleton which may occur subsequent to the precipitation of certain highly phosphorylated cytoskeletal proteins.


On-line signal quality estimation of multichannel surface electromyograms.
When multichannel surface-electromyography (MCSEMG) systems are used, there is a risk of recording low-quality signals. Such signals can be confusing for analysis and interpretation and can be caused by power-line interference, motion artifacts or poor electrode-skin contact. Usually, the electrode-skin impedance is measured to estimate the quality of the contact between the electrodes and the skin. However, this is not always practical, and the contact can change over short time-scales. A fast method is described to estimate the quality of individual signals of monopolar MCSEMG recordings based on volume conduction of myo-electric signals. The characteristics of the signals were described using two descriptor variables. Outliers (extreme data points) were detected in the two-dimensional distributions of the descriptor variables using a non-parametric technique, and the quality of the signals was estimated by their outlier probabilities. The method's performance was evaluated using 1 s long signals visually classified as very poor (G 1), poor (G2) or good quality (G3). Recordings from different subjects, contraction levels and muscles were used. An optimum threshold at 0.05 outlier probability was proposed and resulted in classification accuracies of 100% and > 70% for G I and G2 signals, respectively, whereas <5% of the G3 signals were classified as poor. In conclusion, the proposed method estimated MCSEMG signal quality with high accuracy, compared with visual assessment, and is suitable for on-line implementation. The method could be applied to other multichannel sensor systems, with an arbitrary number of descriptor variables, when their distributions can be assumed to lie within a certain range.


Quantitative indices of clinical uremia.
The disabling, dialysis-responsive symptoms of clinical uremia primarily represent impaired functions of the nervous system. Accordingly, these studies used several quantitative electrophysiologic and cognition-dependent probes of nervous system function: peripheral nerve-conduction velocity, response latency and amplitude; electroencephalographic (EEG) power-spectrum analysis; visual evoked response latency; EEG responses to photic driving; and measures of integrated behavioral performance that stressed sustained and selective attention, reaction time, speed of decision-making, short-term memory, and mental manipulation of symbols. Probes of quanitified central nervous system function consistently revealed impairments that varied directly with the degree of renal failure, that improved following onset of maintenance dialysis, and that improved still further after successful renal transplantation. In contrast, measures of peripheral nerve function were generally unchanged. Neurobehavioral measures that are relevant to uremic symptomatology provide quantitative estimates of the clinically significant, whole-organism biologic effects of renal failure and its several treatments. Applications of such measures in studies of symptomatic states other than uremia are indicated also.


Enhanced hydrophobic ZSM-5 with high capacity for toluene capture under high-humidity conditions.
Industrial volatile organic compounds (VOCs) have the characteristics of large displacement and high humidity. The problem of water resistance of the adsorbent in treating VOCs by adsorption method under high humidity conditions needs to be solved urgently. Herein, methyl triethoxysilane (CH3Si(C2H5O)3) and methyl trimethoxysilane (CH3Si(CH3O)3) are used for hydrophobic modification of ZSM-5, and its adsorption properties for toluene are studied under high-humidity conditions. Fourier infrared spectroscopy and X-ray photoelectron spectroscopy indicate that the hydrophobic groups -CH3 and -CH2- are successfully grafted onto the surface of the ZSM-5. The adsorption-desorption results of toluene show that the hydrophobicity of the modified ZSM-5 is remarkably improved, and the adsorption capacity for toluene is almost 6.5 times higher than that of original ZSM-5 at 80 % relative humidity. The mechanism of surface hydrophobicity modification of ZSM-5 was further investigated and found that the silicone hydroxyl group on the surface of the material reacted with the modifier to graft the hydrophobic group onto the surface of the material, which improved the hydrophobic property of the material. Moreover, the universality of the hydrophobic modification method has been proved feasible in commercial ZSM-5. Therefore, this work provides an important theory and reference for improving the hydrophobic properties of ZSM-5 molecular sieve.


The particles of the embryonic cerebrospinal fluid: how could they influence brain development?
During brain development, the embryonic cerebrospinal fluid (E-CSF) allows brain expansion and promotes neuroepithelial cell survival, proliferation or differentiation. Previous analyses of E-CSF content have revealed a high protein concentration and the presence of membranous particles. The role of these particles in the E-CSF remains poorly investigated. In this study we showed that the E-CSF contains at least two pools of particles: lipoproteins and exosome-like particles. We showed that these two populations of particles strongly interact with neuropithelial cells via an endocytic process, which display regional specificity along the developing neural tube. Finally, we explore and discuss the possibility that these interactions may influence brain development through the regulation of morphogen and growth factor signaling transduction.


Pediatric cancer patient emergency department visits and disposition by sociodemographic and economic characteristics.
Limited research has been conducted on cancer-related emergency department (ED) patterns among pediatric cancer patients, including whether there are differences in the characteristics of individuals who seek ED care for cancer complications. The objectives of this study were to determine whether rates and disposition of cancer-related ED visits and hospital admissions in childhood cancer patients differ by sociodemographic factors. A cross-sectional analysis of ED encounters with a cancer diagnosis code among patients aged 0-19 years from the 2019 National Emergency Department Sample (NEDS) was conducted. Weighted logistic regression models were utilized to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for a primary cancer-related encounter, and hospital admission overall and by subgroup characteristics. Of the unweighted 6,801,711 ED encounters in children aged 0-19 years, 10,793 were classified as visits by cancer patients. ED encounters of Hispanic versus non-Hispanic White pediatric cancer patients had higher odds of having a cancer-related primary diagnosis (OR = 1.15, 95% CI: 1.04-1.27). ED encounters of non-Hispanic Black pediatric patients and those in the lowest zip code income quartile had higher odds of hospital admission (OR = 1.28, 95% CI: 1.08-1.53; OR = 1.30, 95% CI: 1.15-1.46), while rurality was associated with lower odds of hospital admission (OR = 0.69, 95% CI: 0.57-0.83). These results suggest that pediatric cancer patients from certain under-resourced communities are more likely to use the ED for cancer treatment complications, and their encounters are more likely to result in admission to the hospital.


Next-Generation Sequencing Reveals Potential Predictive Biomarkers and Targets of Therapy for Urothelial Carcinoma in Situ of the Urinary Bladder.
Bacillus Calmette-Guérin instillation after removal of the tumor is the first line of treatment for urothelial carcinoma in situ (CIS), the precursor lesion of most muscle-invasive bladder cancers. Bacillus Calmette-Guérin therapy fails in >50% of cases, and second-line radical cystectomy is associated with overtreatment and drastic lifestyle consequences. Given the need for alternative bladder-preserving therapies, we identified genomic alterations (GAs) in urothelial CIS having the potential to predict response to targeted therapies. Laser-capture microdissection was applied to isolate 30 samples (25 CIS and 5 muscle controls) from 26 fresh-frozen cystectomy specimens. Targeted next-generation sequencing of 31 genes was performed. The panel comprised genes frequently affected in muscle-invasive bladder cancer of nonpapillary origin, focusing on potentially actionable GAs described to predict response to approved targeted therapies or drugs that are in registered clinical trials. Of CIS patients, 92% harbored at least one potentially actionable GA, which was identified in TP53/cell cycle pathway-related genes (eg, TP53 and MDM2) in 72%, genes encoding chromatin-modifying proteins (eg, ARID1A and KDM6A) in 68%, DNA damage repair genes (eg, BRCA2 and ATM) in 60%, and phosphatidylinositol 3-kinase/mitogen-activated protein kinase pathway genes (eg, ERBB2 and FGFR1) in 36% of the cases. These data might help guide the selection of targeted therapies to be investigated in future clinical CIS trials, and they may provide a basis for future mechanistic studies of urothelial CIS pathogenesis.


Evaluation of laboratory assays for screening antibody to hepatitis C virus.
An evaluation study, involving 11 screening methods for the detection of antibody to hepatitis C virus (anti-HCV) and a panel of 500 serum samples, was performed. Samples were tested by all 11 methods, and those showing reactivity in at least one method were studied by a combination of supplemental assays (recombinant immunoblot assays, first and second generation; neutralization test for anti-c100; synthetic peptide immunoblot assay; recombinant multi-dot immunoassay) and classified as positive (110 samples), indeterminate (4 samples), or negative (386 samples) on the basis of the results obtained. Second-generation recombinant methods performed better on positive samples than first-generation assays or synthetic peptide-based methods (99.1-100% correlation vs. 64.5-85.5% and 93.6-99.1%, respectively), whereas the latter showed higher correlations on negative samples than recombinant assays (97.4-99.7% vs. 82.4-93%). Further investigations, using broad panels of indeterminate samples from blood donors, should be done, however, before synthetic peptide-based methods are recommended for blood bank screening. Reactivity of samples must be confirmed by one supplemental test in all cases before the donor is informed. In some cases, it may require the use of two or more different tests to obtain definite conclusions.


Functional changes in platelets during extracorporeal circulation.
An in vitro trauma test was conducted to determine the effects of extracorporeal circulation on platelet count and function. Fresh human blood was circulated in two identical in vitro circuits for six hours at a rate of 500 ml per minute (500 recirculations). One circuit included a G.E.--Peirce membrane lung and the other was a control. Platelet aggregation induced by adenosine diphosphate (ADP), epinephrine, or collagen was studied before and after six hours of perfusion. No important drop in platelet count occurred in the control circuit (Control-C) following bypass, but there was a 20% drop for the lung circuit (Lung-C). Platelet aggregation was reduced by about 30% for the control circuit and 65% for the lung circuit. The large decrease in platelet function accompanied by only a moderate decrease in platelet count is discussed in terms of loss of the youngest and most active platelets, platelet inhibition due to ADP released by red blood cell lysis, and platelet trauma.


Hepatic carcinosarcoma: evidence of polyclonal origin based on microsatellite analysis.
Hepatic carcinosarcoma (HCS) is an aggressive tumor for which a consensus regarding the clonal origin has not yet been reached. The aim of the study was to identify the origin of the hepatocellular carcinoma (HCC) and sarcoma components in HCS. We chose microsatellite technique containing loss of heterozygosity (LOH) and microsatellite instability (MSI) on three HCS patients who underwent curative resection confirmed by pathological examination. Tumors were firstly analyzed for Hep Par 1, CK18, CD10, CD117, SMA and vimentin expression by immunohistochemistry. LOH and MSI were then investigated. The incidence rate of LOH/MSI in all nine MS was calculated as the fractional allelic loss (FAL) index, which was internationally recognized standard. A FAL<30% was representative of a monoclonal origin and a FAL≥30% indicated a polyclonal origin. All patients were positive for HBsAg. Microscopic examination showed HCS containing two different cell types: a fibrosarcoma component with spindle cells and an HCC population of cells with a trabecular pattern. In the HCC tumor portions, Hep Par 1, CK18, CD10 were expressed while vimentin was not. In contrast, the spindle cell populations were positive for vimentin and negative for Hep Par 1, CK18, CD10. The highest frequencies of LOH and MSI were at the D16S505 (2/3; 66.7%), D17S831 (2/3; 66.7%) and D17S938 MS (2/3; 66.7%). The FALs for the three cases of HCS were 50% (4/8), 55.6% (5/9) and 33.3% (3/9), suggesting a polyclonal origin. Immunohistochemistry and analysis of LOH and MSI strongly demonstrated that the three HCS samples were consistent with a polyclonal origin for all three cases.


Genomic Alterations in Langerhans Cell Histiocytosis.
The discovery of recurrent somatic genomic alterations in Langerhans cell histiocytosis (LCH) has led to a new understanding of LCH as a clonal neoplastic disorder. Most of the abnormalities described to date affect the RAS/RAF/MEK/extracellular-signal-regulated kinase (ERK) pathway: more than 50% of LCH cases carry activating mutations in BRAF, whereas another 10% to 28% carry activating mutations of MAP2K1, which encodes MEK1. The pathogenetic importance of these mutations has been confirmed by reports of significant clinical responses to RAF inhibitors.


Anaesthesia for the patient with cardiac disease.
I have tried to summarize experimental work in human and animal models. This work is complex and difficult to interpret. Clinicians should not take isolated experimental studies and jump to conclusions about clinical use of anaesthetics. Experimenters should not arrive at sweeping conclusions based on a particular experimental study performed under some or other carefully or not so carefully controlled conditions. Editorialists, such as Becker in a recent issue of Anesthesiology, should not conclude that an anaesthetic is "dangerous," based on these kinds of studies. It is especially invalid to use the term "dangerous" unless the author is willing to present us with a viable, experimentally proven, safer alternative. To tell us that isoflurane is "dangerous" implies that we should switch to some unspecified other agent. What conclusions can be arrived at based on these studies? (1) It is possible to produce coronary steal, in dogs, at constant coronary flow, with isoflurane at 41 mmHg perfusion pressure. The comparison between halothane and isoflurane is suspect because is was performed at two markedly different coronary perfusion pressures. (2) Myocardial ischaemia can be induced in humans with coronary artery disease when hypotension and tachycardia is permitted during isoflurane anaesthesia. During these conditions, relative preservation of coronary blood flow greater than that which would be expected because of measured or calculated demand has been interpreted as meaning that the mechanism was that of coronary steal. I am not convinced that this mechanism needs to be invoked here, but we can conclude from these studies that if hypotension and tachycardia are allowed to occur in patients with coronary artery disease, ischaemia is possible.(ABSTRACT TRUNCATED AT 250 WORDS)


Delayed diagnosis of HIV infection in ophthalmic practice.
The introduction of potent antiretroviral drug combinations has transformed human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS) from an intractable and rapidly fatal disease to a chronic manageable illness with prolonged life survival for many patients. This paper discusses the ophthalmic and medical histories of two young female patients who presented with 'atypical' optic neuropathy and toxoplasma gondii retinochoroiditis and were later found to be HIV infected. We discuss the need for increased vigilance in the ophthalmic community for suspecting HIV infection to allow optimal management of the ophthalmic and systemic manifestations of the disease spectrum associated with HIV/AIDS.


Web-based teaching module improves success rates of postpyloric positioning of nasoenteric feeding tubes.
Bedside protocols improve success rates of postpyloric nasoenteric tube (NET) placement by nutrition teams and experienced individuals. However, many hospitals require novice practitioners to perform these procedures and often choose fluoroscopy, endoscopy, or newer alternative devices to achieve success. Little is known about the ability to train inexperienced practitioners or the effectiveness of the methods used to implement these protocols. Web-based learning is a potential tool to improve knowledge and procedural skills. The authors created a self-directed Web-based teaching module (WBTM) to educate and standardize placement of postpyloric NETs. Forty-three first-, second-, or third-year residents or medical or physician assistant students took pretests for knowledge and confidence surveys, viewed the WBTM, placed NET at the bedside, then took a posttest and confidence survey while awaiting confirmation of tube position by abdominal radiograph. Success was acknowledged if the tip of the NET was beyond the pylorus. A retrospective chart review was used to determine a historical success rate, which was used as a control. Knowledge and confidence significantly improved. Overall success rate of postpyloric NET placement for all participants on first attempt was 74.4% vs 46.7% in the control (P = .005). Improvement occurred in all subgroups, including those with no prior experience, who were successful 70.4% of the time (P = .009). This WBTM is simple to implement, inexpensive, and resource efficient. The improvement in postpyloric NET placement, especially among novice practitioners, demonstrates the benefit and applicability of this method of standardized education.


Generalized giant axonal neuropathy: a filament-forming disease of neuronal, endothelial, glial, and schwann cells in a patient without kinky hair.
The process of Giant Axonal Neuropathy (GAN) is not restricted to the peripheral nerves, but also involves the central nervous system. In a 25 year old man with normal hair, abundant axon swellings and spheroids were observed in the spinal cord, brain system, and cerebral cortex. The findings in the sural nerve have already been published by Boltshauser et al. (1977). Accumulations of filaments in the axons and in the perineural cells were accompanied by Rosenthal fibres. The ultrastructural pattern of GAN differs clearly from that of Neuroaxonal Dystrophies.


Relapse of Pediatric Coccidioidomycosis Tenosynovitis.
Disseminated coccidioidomycosis is a rare cause of flexor tendon tenosynovitis, particularly in the pediatric population. We present the case of a 2-month-old male infant with disseminated coccidioidomycosis of the right index finger, which was initially treated with debridement and long-term antifungal therapy. Six months after discontinuing antifungal medications and at the age of 2 years, the patient presented with relapse of coccidioidomycosis of his right index finger. Serial debridement and long-term antifungal therapy resulted in disease quiescence. The relapse of pediatric coccidioidomycosis tenosynovitis using surgical management with accompanying magnetic resonance imaging, histopathology, and intraoperative findings is described herein. Coccidioidomycosis should be considered for the differential diagnosis of pediatric patients who have traveled to or live in endemic areas and present with indolent hand infections.


Associations among childhood sexual abuse, language use, and adult sexual functioning and satisfaction.
To better understand the link between childhood sexual abuse (CSA) and adult sexual functioning and satisfaction, we examined cognitive differences between women with (N=128) and without (NSA, N=99) CSA histories. We used the Linguistic Inquiry Word Count, a computerized text analysis program, to investigate language differences between women with and without CSA histories when writing about their daily life (neutral essay) and their beliefs about sexuality and their sexual experiences (sexual essay). Compared to NSA women, women with CSA histories used fewer first person pronouns in the neutral essay but more in the sexual essay, suggesting women with CSA histories have greater self-focus when thinking about sexuality. Women who reported CSA used more intimacy words and more language consistent with psychological distancing in the sexual essay than did NSA women. Use of positive emotion words in the sexual essay predicted sexual functioning and satisfaction in both groups. These findings support the view that language use differs in significant ways between women with and without sexual abuse histories, and that these differences relate to sexual functioning and satisfaction.


Simple deep hypothermia for open heart surgery in infancy.
Results of open cardiac surgery under deep simple hypothermia in 121 infants with body weight of less than 10 kg are reported. Deep ether anaesthesia combined with large quantities of ganglion blocking agents (triflupromazine 3 mg/kg) constitutes the anaesthetic management of choice for deep surface-induced hypothermia. The mean lowest oesophageal temperature was 20.8 degrees C, and 18.9 degrees C rectally. The mean circulatory arrest time was 40 minutes. Seventeen infants (14.0 per cent) died post-operatively. There were no operative deaths attributable to failure of cardiac resuscitation. This technique widens the scope of open heart surgery in small infants. Most of the surgically correctable malformations should be operable by this method. More than the potential hazards of hypothermia, which we believe are solved by our technique, the major problem posed by surgery in these small infants is the trans and post-operative respiratory management.


Analysis of 35 priority semivolatile compounds in water by stir bar sorptive extraction-thermal desorption-gas chromatography-mass spectrometry. I. Method optimisation.
A multiresidue method for the determination of 35 organic micropollutants (pesticides and polycyclic aromatic hydrocarbons) in water has been optimised using stir bar sorptive extraction (SBSE) and thermal desorption coupled to capillary gas chromatography-mass spectrometry (GC-MS). In the present work, the different parameters affecting the extraction of the analytes from the water samples to the PDMS-coated stir bars and optimisation of conditions affecting thermal desorption are investigated. The optimised conditions consist of a 100-ml water sample with 20% NaCl addition extracted with 20 mm length x 0.5 mm film thickness stir bars at 900 rpm during 14 h at ambient temperature. Desorption is carried out at 280 degrees C during 6 min under a helium flow of 75 ml/min in the splitless mode while maintaining a cryofocusing temperature of 20 degrees C in the programmed-temperature vaporisation (PTV) injector of the GC-MS system. Finally, the PTV injector is ramped to a temperature of 280 degrees C and the analytes are separated in the GC and detected by MS using full scan mode (m/z 60-400). Under the described conditions, the good repeatability, high analyte recoveries and robustness, make SBSE a powerful tool for routine quality control analysis of the selected semivolatile compounds in water samples.


An evaluation of the acidogenic potential of asthma inhalers.
The aims of the present study were firstly to investigate the inherent pH and titratable acidity of commercially available paediatric asthma inhalers in the United Kingdom and secondly to assess their in vivo acidogenic potential (saliva pH and plaque pH (PpH) tests) in a group of healthy adult volunteers. Manually actuated metered dose inhaler (MDI) and dry powder inhaler (DPI) formulations of all available preventor (glucocorticoids, disodium chromoglycate), reliever (beta(2) agonists) and combination asthma medication were investigated. The inherent pH and titratable acidity of 18 inhalers were determined and analysed using t-tests, ANOVA and post hoc Tukey's tests. Following this the oral pH responses after inhaler use were assessed in 14 healthy adult volunteers (complying with the FNDH criteria, 1985) who participated in a random blind study to determine both the salivary pH (SpH) and plaque pH following inhaler use. Non-parametric tests of significance (Mann-Whitney and Wilcoxon Signed-Ranked Tests) were used to analyse pH responses according to vehicle of delivery (MDI/DPI), lactose content and generic drug. The inherent pH of the DPIs (n=8, mean pH=5.06) was significantly lower (P<0.005) than that of the MDIs (n=10, mean pH=6.45) and the titratable acidity of the lactose-based DPIs was twice that of the non-lactose-based DPIs (P<0.000). Lactose-based DPIs produced significantly lower salivary pH and plaque pH readings, greater maximum pH drops from baseline pH and larger areas below baseline pH in comparison with that of all other inhalers tested (P<0.05). All inhalers, however, failed to depress plaque pH below pH 6. Although none of the inhalers were able to demonstrate an acidogenic response below the "critical" pH, the substantial pH drops observed with the lactose-based DPIs may be an important consideration for enamel demineralisation.


Determination of the 161Tb half-life.
There is significant interest in the use of terbium radioisotopes for applications in cancer therapy and diagnosis. Of these, 161Tb, as a medium energy beta-emitter, is being investigated as a potential alternative to 177Lu. The relatively high proportion of conversion electron and Auger electron emissions per decay make 161Tb an attractive targeted therapeutic. As a product of nuclear fission, 161Tb is also of importance to nuclear forensics. The standard uncertainty of the current evaluated half-life of 6.89(2) d contributes significantly to the standard uncertainty of any decay corrected activity determination made. Furthermore, the accuracy of this evaluated half-life has been called into question by measurements reported in 2020 at the Institute of Radiation Physics (IRA), Switzerland, who reported a half-life of 6.953(2) d. In the current work, the half-life of the 161Tb ground state decay has been measured at three independent laboratories located in the United Kingdom and the United States of America for a total of six determinations using three independent measurement techniques; gamma-ray spectrometry, ionisation chamber measurement and liquid scintillation counting. The half-life determined for 161Tb of 6.9637(29) d confirms the observed 1% relative increase observed by IRA, though the reported half-lives in this work and at IRA are significantly different (ζ-score = 3.1).


Reflections on teaching health care ethics on the web.
As web instruction becomes more and more prevalent at universities across the country, instructors of ethics are being encouraged to develop online courses to meet the needs of a diverse array of students. Web instruction is often viewed as a cost-saving technique, where large numbers of students can be reached by distance education in an effort to conserve classroom and instructor resources. In practice. however, the reverse is often true: online courses require more of faculty time and effort than do many traditional classes. Based on personal experience teaching an online course in health care ethics for students in the Allied Health Professions, it is evident that there are both benefits and challenges in teaching online courses, particularly in ethics. Examples of benefits are (1) the asynchronous nature of web instruction allows students to progress through the course at their own pace and at times that are convenient given their clinical responsibilities; (2) web courses allow for a standardization of content and quality of instruction over a diversity of programs; and (3) examples can be tailored to the differing experiences of students in the course. Some challenges to teaching online ethics courses include (1) the fact that online instruction benefits visual learners and disadvantages those lacking good reading comprehension or strong writing skills; (2) developing meaningful student-student and student-instructor interaction; and (3) teaching ethics involves teaching a process rather than a product. Allowing students to apply their knowledge to real-world cases in their disciplines and encouraging them to share experiences from clinical practice is an effective way to meet several of these challenges. Building an online community is another good way to increase the interaction of students and their engagement with the material.


Immunotherapy in allergic respiratory diseases.
Much more work is needed to specify the correct indications for immunotherapy in respiratory allergic diseases. Immunotherapy with pollen and mite extracts has shown some clinical efficacy versus placebo in controlled studies in allergic rhinitis and/or asthma. However, controlled studies comparing the cost, the risk factors and the efficacy of immunotherapy versus treatment with antihistaminic drugs, bronchodilators and topical steroids are needed. Additional studies are needed to established the place of immunotherapy in animal danders and mould allergy. In any case, before initiating immunotherapy in respiratory allergy the following questions must be answered: is there sufficient evidence of a close relationship between symptoms and allergen exposure? is it possible to achieve efficient allergen avoidance? is simple drug treatment no sufficient? is there evidence in the literature of effectiveness of IT for this allergen? is the patient able to comply with a long and constraining treatment?


Thoracic transplantation during the COVID-19 pandemic.
The worldwide pandemic caused by COVID-19, resulting from the infection by betacoronarvirus SARS-CoV-2, has dramatically altered healthcare worldwide. Due to the highly contagious nature of SARS-CoV2, coupled with hospitals and intensive care units being overwhelmed, numerous transplant programs either slowed or shut down completely. While there have been isolated reports of COVID-19 in transplant recipients, no study to date has examined how COVID-19 affected actual transplant patterns and outcomes in the United States. Of particular importance is the impact of COVID-19 on mortality in waitlisted patients and transplant recipients. Using the Scientific Registry of Transplant Recipients (SRTR) dataset, we compared waitlist and transplant characteristics from 3/2019-8/2019 to 3/2020-8/2020, as well as COVID-19 associated mortality in patients with prior heart or lung transplant or those active on the waitlist. Overall, there was an initial decrease in transplant volume in April 2020; however, volumes have normalized since then, with comparable outcomes to similar calendar months in 2019. Additionally, there were no significant changes in post-transplant outcomes or waiting list mortality. Given the ongoing COVID-19 pandemic, it would be beneficial to maintain current practices for thoracic transplantation, to continue to provide this life-saving therapy to those in need.


Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention.
To determine those factors that are associated with nursing homes' success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program. Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program. The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort. After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team's openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed. The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.


[Lessons to be drawn from one year of surveillance of Escherichia coli in a urology department].
Escherichia coli (E. coli) is the micro-organism most frequently identified in urinary tract infections in adults. The authors analysed the nalidixic acid resistance rate of E. coli isolated over 12 consecutive months in a urology department. All E. coli-positive bacteriological examinations from a urology department during 2004 were retrospectively reviewed. Seventy five bacteriological examinations from 68 patients were positive for E. coli, corresponding to 67 urine cultures, 6 blood cultures and 2 drained collections. Twenty patients had taken fluoroquinolones during the previous 6 months and 10 patients were diabetic. A nalidixic acid-resistant (NR) E. coli was isolated in 11 patients (16%) aged 22 to 81 years (median: 58 years). Patients with nalidixic acid-resistant (NR) E. coli were compared to patients with nalidixic acid-susceptible (NS) E. coli. Predictive factors for nalidixic acid resistance of E. coli were fever higher than 38.4 degrees C (p = 0.022), leukocytosis (p = 0.002) and use of fluoroquinolones during the previous 6 months (p = 0.046). Prescription of a non-fluoroquinolone antibiotic may be preferable in the case of recent use of fluoroquinolones and signs of severe infection (leukocytosis and fever higher than 38.4 degrees C).


Older adults' experiences using Alexa.
The number of adults in the United States age 65 and older is expected to increase to 81 million in 2040 and 95 million in 2060. Voice-activated personal assistants (VAPAs), such as Amazon's Alexa, have the potential to ensure that older adults can successfully age in place using smart home technology to support health, wellness, social engagement, and daily functioning at home. To further explore this potential, twelve home-dwelling older adults aged 65 and older who had used the Amazon Alexa VAPA device for over six months were interviewed to learn about their perceptions and experiences with the use of the device and to gain insights into how this technology has shaped their aging experience. Findings suggest that the older adults did not fully understand the full spectrum of functionality and features of the Alexa device, as they received relatively little initial and ongoing training and support in using it. Participants enjoyed using the Alexa device for selective non-essential features and functions that were more convenient to use on the Alexa device than through alternative methods, but they did not see the use of the Alexa device as essential to their successfully aging in place. CCS CONCEPTS • Accessibility • Ubiquitous and mobile computing • Human-computer interaction.


Effects of hydrogen peroxide treatment on pulp breakdown, softening, and cell wall polysaccharide metabolism in fresh longan fruit.
Longan (Dimocarpus longan Lour.) is prone to pulp softening and pulp breakdown, leading to a loss of its nutrients including polysaccharides. ROS is one main factor affecting fruit quality. This work intended to explicate the influences of hydrogen peroxide, acting as a ROS, on pulp softening, pulp breakdown, and cell wall polysaccharides metabolism in longan fruit during storage. Contrasted to the control group, hydrogen peroxide-treated samples exhibited lower firmness, lower amounts of CWM, ISP, CSP, hemicellulose and cellulose, but higher breakdown index, WSP amount, expression levels of DlPG, DlPE, Dlβ-Gal, DlCx and DlXET and activities of their corresponding enzymes (PG, PE, β-Gal, Cx, XET). These results suggested that hydrogen peroxide reduced longan pulp firmness due to the increased gene expression levels and enzymes activities related to cell wall polysaccharide degradation to boost their decomposition, thereby led to the accelerated pulp softening and the expedited pulp breakdown of harvested longans.


Update on the diagnosis and treatment of autoimmune pancreatitis.
Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic fibroinflammatory disease (IgG4-related systemic disease) in which affected organs demonstrate dense lymphoplasmacytic infiltration with abundant IgG4-positive cells. The diagnosis of AIP and its differentiation from pancreatic cancer, its main differential diagnosis, remains a clinical challenge. The five cardinal features of AIP are characteristic histology, imaging, and serology; other organ involvement; and response to steroid therapy. Recent advances in our understanding of these features have resulted in enhanced recognition and diagnosis of this benign disease. This in turn has resulted in the avoidance of unnecessary surgical procedures for suspected malignancy. This article reviews recent updates in the diagnosis and treatment of autoimmune pancreatitis.