Distribution of ABO and Rhesus Types in the Northern Asir Region in Saudi Arabia.
The ABO blood group system is used to denote the presence of one, both, or neither of the A and B antigens on erythrocytes. In humans, this is the most important of the 43 different blood type (or group) classification systems currently recognized. Distribution of ABO and Rh among the Saudi population could affect many factors such as blood transfusion, prognosis, resistance and susceptibility to diseases. The impetus of this study was to develop an understanding of the distribution of the ABO and Rh types of healthy volunteer blood donors in the northern Asir region of Saudi Arabia, comparing the findings to similar studies. Understanding the frequency of different blood types in different populations is imperative. This study was performed during the period of January 1, 2020, to December 31, 2020, using samples from 4167 voluntary subjects obtained from the blood bank of the King Abdullah Hospital, Bisha. Commercially provided anti-A, anti-B and anti-D antibodies were used for the standard blood grouping procedure. The findings in this study showed that O was the most prominent ABO blood group, whereas AB was the least so. The frequency of the blood type A was the second highest, followed by the blood group B, whereas Rh positivity was more common than Rh negativity. O+ > A+ > B+ > O-> AB+> A-> B- > AB- was found to be the order of blood group frequency in the current study.


Prosopis juliflora hydrothermal synthesis of high fluorescent carbon dots and its antibacterial and bioimaging applications.
Carbon dots have stimulated the curiosity of biomedical researchers due to their unique properties, such as less toxicity and high biocompatibility. The synthesis of carbon dots for biomedical application is a core area in research. In the current research, an eco-friendly hydrothermal technique was employed to synthesize high fluorescent, plant-derived carbon dots from Prosopis juliflora leaves extract (PJ-CDs). The synthesized PJ-CDs were investigated by physicochemical evaluation instruments such as fluorescence spectroscopy, SEM, HR-TEM, EDX, XRD, FTIR, and UV-Vis. The UV-Vis absorption peaks obtained at 270 nm due to carbonyl functional groups shifts of n→π*. In addition, a quantum yield of 7.88 % is achieved. The synthesized PJ-CDs showing the presence of carious functional groups O-H, C-H, C=O, O-H, C-N and the obtained particles in spherical shape with an average size of 8 nm. The fluorescence PJ-CDs showed stability against various environmental factors such as a broad range of ionic strength and pH gradient. The antimicrobial activity of PJ-CDs was tested against a Staphylococcus aureus, and a Escherichia coli. The results suggest that the PJ-CDs could substantially inhibit the growth of Staphylococcus aureus. The findings also indicate that PJ-CDs are effective materials for bio-imaging in Caenorhabditis elegans and they can be also used for pharmaceutical applications.


Aspirin for CV prevention -- for which patients?
Put your patient on aspirin? Take him off? Here's what you need to know to get it right.


Daprodustat for anaemia in patients with heart failure and chronic kidney disease: A randomized controlled study.
Hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors have been developed for the treatment of renal anaemia; however, no study has evaluated the safety and efficacy of HIF-PH inhibitors in patients with heart failure (HF). This study was designed to evaluate the safety and efficacy of daprodustat, a HIF-PH inhibitor, in patients with HF and renal anaemia. We designed a pilot, multi-centre, open-label, randomized controlled study, in which 50 patients with HF complicated with chronic kidney disease and anaemia will be randomized 1:1 to either the daprodustat or control group at seven sites in Japan. Study entry requires New York Heart Association Class II HF symptoms or a history of hospitalization due to HF, an estimated glomerular filtration rate of <60 mL/min/1.73 m2 , and a haemoglobin level of 7.5 to <11.0 g/dl. Patients randomized to the daprodustat group will be treated with oral daprodustat, and the dose will be uptitrated according to the changes in the haemoglobin level from previous visits. In this study, we will evaluate the impact of HIF-PH inhibitors on cardiac function using advanced cardiovascular imaging modalities, including cardiac magnetic resonance imaging. The primary outcome is the haemoglobin level at 16 weeks of randomization, and all adverse events will be recorded and evaluated for any association with daprodustat treatment. Considering the hypothetical upside and downside of using HIF-PH inhibitors in anaemic patients with HF and chronic kidney disease, and because there are virtually no safe and effective treatments for patients with anaemia not caused by iron deficiency, our study results will contribute significantly to this field.


Effects of zinc salt addition on perfluorooctanoic acid (PFOA) removal by electrocoagulation with aluminum electrodes.
In this study, the electrocoagulation (EC) of perfluorooctanoic acid (PFOA) by an aluminum electrode with the addition of zinc salt was investigated. Adding ZnCl2 successfully prevented a rise in pH during EC and increased the efficiency from 73.7% to over 99%. In addition, the longer the carbon chain of a PFA was, the better the removal of that PFA by electrocoagulation. The main functions of ZnCl2 were to prevent the rise in pH and improve flotation because the flocs with added ZnCl2 were easy to gather together and had a faster floating speed. The XPS results demonstrated the occurrence of bonding between aluminum and fluoride. This finding indicates that complexation between aluminum and fluoride may be the main mechanism for removal when aluminum electrodes are used to remove perfluoroalkyl (PFA) compounds.


Development of insulin and epidermal growth factor receptors during the differentiation of rat preadipocytes in primary culture.
An homogeneous cell population isolated from the inguinal tissue of 3-day-old rats is able to proliferate in primary culture. In the presence of a physiological concentration of insulin (1.5 nM) it converts into cells exhibiting the morphology and the biochemical characteristics of adipocytes. Insulin and epidermal growth factor (EGF) receptors were studied during both the exponential growth and the adipose conversion phases of these cells. Binding experiments with 125I-labelled peptides were performed directly in the culture dishes. The number of high affinity insulin binding sites increased, during the entire culture period studied, reaching 18 days after plating the value of 10,600 x 2360. Control cells (cultured in the presence of anti-insulin antibody) exhibited an increase of the concentration of insulin binding sites from no more than 500 sites/cell to 6880 +/- 1710 sites/cell between dat 0 and 9 (corresponding to the exponential growth phase); this increase was followed by a rapid reduction in insulin receptors during the stationary phase. The density of EGF binding sites increased between day 0 and 4 (one cell cycle), whether the cells were maintained or not with insulin, and plateaued thereafter. Mature adipocytes freshly isolated from the inguinal tissue of 3-day-old rats had no detectable EGF binding sites, but their content in high affinity binding sites for insulin was similar to that of cells after complete adipocyte conversion in primary culture.


[Sensitivity and specificity of the occlusion pressure method in measuring airway resistance compared to whole body plethysmography, studies within the scope of inhalative provocation tests].
129 children and adolescents had 111 bronchial histamine and 85 allergen challenges. Airways resistance measured by the occlusion technique was found to be inferior to the body plethysmography in discriminating children with hyperreactive or allergic airways from healthy children.


Implications of macrophage polarization in corneal transplantation rejection.
Corneal transplantation rejection remains an urgent problem threatening the success rate of high-risk patients. Macrophages are involved in the rejection of corneal transplants. Macrophages have M1 and M2 phenotypes, classified according their response to external stimuli. Macrophage polarization, through which these distinct forms are activated, is not only involved in the occurrence and development of inflammation, tumors, and autoimmune and other diseases, but also participates in graft rejection. This study provides an overview of the types of macrophages and mechanisms of their polarization, and review current knowledge regarding their involvement in corneal transplantation and potential therapeutic applications. Consideration of the relationship between the direction of macrophage polarization and the determination of graft survival and how it can be modified, is important for the development of novel corneal anti-rejection therapies.


Microbiota-mediated shaping of mouse spleen structure and immune function characterized by scRNA-seq and Stereo-seq.
Gut microbes exhibit complex interactions with their hosts and shape an organism's immune system throughout its lifespan. As the largest secondary lymphoid organ, the spleen has a wide range of immunological functions. To explore the role of microbiota in regulating and shaping the spleen, we employ scRNA-seq and Stereo-seq technologies based on germ-free (GF) mice to detect differences in tissue size, anatomical structure, cell types, functions, and spatial molecular characteristics. We identify 18 cell types, 9 subtypes of T cells, and 7 subtypes of B cells. Gene differential expression analysis reveals that the absence of microorganisms results in alterations in erythropoiesis within the red pulp region and congenital immune deficiency in the white pulp region. Stereo-seq results demonstrate a clear hierarchy of immune cells in the spleen, including marginal zone (MZ) macrophages, MZ B cells, follicular B cells and T cells, distributed in a well-defined pattern from outside to inside. However, this hierarchical structure is disturbed in GF mice. Ccr7 and Cxcl13 chemokines are specifically expressed in the spatial locations of T cells and B cells, respectively. We speculate that the microbiota may mediate the structural composition or partitioning of spleen immune cells by modulating the expression levels of chemokines.


Genetic polymorphisms of serotonin transporter and receptor 1A could influence success during embryo implantation and maintenance of pregnancy.
To explore whether serotonin-related gene polymorphisms influence clinical outcomes of IVF treatment in recipients using donated oocytes. Nested case-control study. University-affiliated infertility clinic. Two hundred forty-five women undergoing IVF treatment with donated oocytes. None. Genotype and haplotype analysis of the serotonin transporter-linked polymorphic region (5-HTTLPR), rs1800532, rs6295, rs6313, and rs3813929, between recipients grouped according to the results of the oocyte donation for IVF treatment. No differences were found between genotype distribution of the tryptophan hydroxylase 1, serotonin receptor 2A, and serotonin receptor 2C polymorphisms. Recipients carrying the LL genotype for 5-HTTLPR had lower clinical pregnancy rates (PR) and higher biochemical pregnancy loss (BPL) events. Lower implantation rates were found in CC carriers for 5-HT1A.rs6295 who also presented higher BPL rates. A lower incidence of clinical pregnancy was observed for LC haplotypes, corresponding to an increase in BPL rates. A strong association was found between early pregnancy loss and recipients carrying the 5-HTTLPR and rs6295 genetic variants. Identifying biological processes involving serotonin and embryo implantation may help to understand the dynamics of the maternal-embryo dialogue.


Cardiac differentiation of mouse embryonic stem cells is influenced by a PPAR γ/PGC-1α-FNDC5 pathway during the stage of cardiac precursor cell formation.
Peroxisome proliferator-activated receptor (PPAR) γ co-activator 1α (PGC-1α) up-regulation induces FNDC5 expression in muscle and consequently causes browning of white adipose tissue (WAT). In addition to skeletal muscle, FNDC5 is mainly expressed in heart and brain tissues. Here, we demonstrate that FNDC5 expression increased during the process of cardiac differentiation of mouse embryonic stem cells (mESCs) similar to PGC-1α and PPARα. To testify the correlation between PGC-1α and FNDC5 in cardiac cell differentiation of mESCs, we utilized specific PPARγ agonist and antagonist in two stages of cardiac differentiation, during and post-cardiac precursor cells (CPCs) formation. Our results indicated that a reduction in PGC-1α expression, via treatment with GW9662 during CPCs formation stage, down-regulated FNDC5 transcript levels as well as mitochondrial markers which negatively influenced on the whole process of cardiac differentiation efficiency. On the other hand, increase PGC-1α expression during CPCs formation stage via rosiglitazone treatment increase FNDC5 and mitochondrial markers transcript levels which enhanced cardiac differentiation efficiency. Importantly, such alteration in PGC-1α expression at post-CPCs formation stage did not affect overall cardiac differentiation rate as expression of FNDC5 and mitochondrial markers were not significantly changed. We concluded that PPARγ agonist and antagonist induced up and down-regulation of PGC-1α and subsequently modulated the process of CPCs formation through an alteration in FNDC5 and mitochondrial markers expression.


Biomechanical model to simulate tissue differentiation and bone regeneration: application to fracture healing.
Bone regeneration is a common biological process occurring, for example, during fracture healing or osseo-integration of prostheses. Computer simulation of bone regeneration is difficult to carry out because it is a complex sequence of cell-mediated processes regulated by mechanobiological stimuli. An algorithm to predict the time-course of intramembranous and endochondral ossification has been developed. The algorithm assumes that there are precursor cells in the undifferentiated tissue and that these cells differentiate into either fibroblasts (to form fibrous connective tissue), chondrocytes (to form cartilaginous tissue) or osteoblasts (to form bone), based on a combination of biophysical stimuli derived from strain in the collagenous matrix and flow of the interstitial fluid. Both these stimuli are known to deform the precursor cells, and the authors hypothesise that this causes activation of cell differentiation pathways. The observation that precursor cells take time to spread throughout the fracture callus has been included in the algorithm. The algorithm was tested in an investigation of the fracture healing of a long bone using an axi-symmetric finite element model. The spatio-temporal sequence of tissue phenotypes that appear in the course of fracture healing was successfully simulated. Furthermore, the origin of the precursor cells (either surrounding muscle, bone marrow or periosteum) was predicted to have a fundamental effect on the healing pattern and on the rate of reduction of the interfragmentary strain (IFS). The initial IFS = 0.15 drops to 0.01 within seven iterations if cells originated from the surrounding soft tissue, but took more than 50% longer if cells originated in the inner cambium layer of the periosteum, and four times longer if precursor cells originated from the bone marrow only.


Nano- and micro-polystyrene plastics interfered the gut barrier function mediated by exosomal miRNAs in rats.
Microplastics (MPs) are widely distributed in the global environment, entering and accumulating in organisms in various ways and posing health threats. MPs can damage intestine; however, the mechanism by which MPs cause intestinal damage in rats is unclear. Here, rats were exposed to 50 nm PS-NPs or 5 μm PS-MPs for 4 weeks to evaluate the possible effects on intestinal barrier function and exosomal miRNAs expressions. The results showed that PS-NPs or PS-MPs disrupted the gut microbiota and affected gut barrier function at the biological level. In addition, PS-NPs and PS-MPs altered the composition of exosomal miRNAs in the intestinal and serum. Both PS-NPs and PS-MPs decreased the expression of miR-126a-3p in the intestinal and serum exosomes, which is an important signalling molecule involved in MPs induced gut barrier function disorder. More importantly, both in vitro and in vivo experiments indicated that miR-126a-3p was closely related to oxidative damage of intestinal cells through the PI3K-Akt pathway and eventually promote cell apoptosis by regulating the target gene of PIK3R2. Our study suggested that PS-NPs and PS-MPs could affect rat intestinal barrier function through an exosomal miRNA mediated pathway.


Regulation of human glutathione S-transferase pi gene transcription: influence of 5'-flanking sequences and trans-activating factors which recognize AP-1-binding sites.
To investigate the transcriptional regulation of human glutathione S-transferase pi (GST pi) gene expression, we fused the GST pi promoter, including 2203 bp of the 5'-flanking region, exon 1, and most of intron 1, to the chloramphenicol acetyltransferase (CAT)-encoding reporter gene (cat). When transfected into human cell lines, this GST-cat construct (-2203 GST-cat) supported high level cat gene expression. RNase-protection and primer-extension experiments showed that the normal GST pi transcriptional start point (tsp) is utilized, and furthermore, that intron 1 is faithfully removed by splicing from the majority of primary GST-cat transcripts. A series of constructs containing deletions in the GST pi sequences of the -2203 GST-cat vector were prepared to define potential regulatory regions. Transfection of these deletion plasmids revealed that a region between GST pi sequences -80 and -8 is absolutely required for cat expression. Furthermore, transfection of the -2203 GST-cat and deletion vectors into two human cell lines--one line which does not produce endogenous GST pi (HeLa cells) and one which produces high levels of endogenous GST pi (HS 578T cells)--failed to identify sequences that differentially influence the level of transcription in either cell line. A putative TRE (TPA responsive element or AP-1 recognition sequence) strategically situated upstream from the GST pi tsp (-69 to -63) was examined by TPA treatment of HeLa cells transfected with GST-cat DNA. Additionally, the potential interaction of fos and jun proteins with the GST pi promoter was examined by co-transfection of GST-cat constructs with jun and fos expression vectors in F9 cells. Both of these treatments, which are known to enhance transcription of several genes containing 5'-flanking TREs, failed to induce GST-cat expression. These data suggest that the putative TRE sequence in GST pi is unresponsive both to phorbol esters and to these particular transcriptional activating factors of the fos and jun family.


Diseases caused by arboviruses--dengue haemorrhagic fever and Japanese B encephalitis.
Dengue haemorrhagic fever is a recent and more serious variant of dengue infection, causing significant mortality in children under 14 years of age in South-East Asia and the Western Pacific regions. Successful treatment depends on early recognition of the disease and careful monitoring of the development of shock. Japanese B encephalitis has a case fatality rate of 10%-30% in these regions, but may be controlled by vaccination.


The emerging roles of HTRA1 in musculoskeletal disease.
High-temperature requirement serine protease A1 (HTRA1) is one of four known proteases belonging to the broadly conserved family of HTRA proteins. Although it was originally considered as representing an important modulator of tumorigenesis, an increasing number of reports have suggested that its influence on human disease may extend beyond cancer. HTRA1 has the capacity to degrade numerous extracellular matrix proteins, and as such, its potential involvement in diseases of the musculoskeletal system has been gaining increased attention. Musculoskeletal disease constitutes a wide variety of degenerative conditions that can manifest themselves in different ways such as joint and back pain, as well as deficiencies in skeletal bone quality, and ultimately result in significant suffering and reduced quality of life. Convincing data now exist to support a detrimental role for HTRA1 in the pathogenesis of joint and intervertebral disk degeneration. However, the function of HTRA1 in other closely related musculoskeletal diseases affecting bone and muscle remains unclear and largely unexplored. To help set the stage for future research, we discuss here some of the recent advances in our understanding of the role played by HTRA1 in musculoskeletal pathology.


Lipopolysaccharide suppresses cytokine release from coxsackie virus-infected human monocytes.
Infections by coxsackie virus B3 (CVB3) have been reported to be associated with an enhanced influx of mononuclear leukocytes into afflicted tissue. Current evidence indicates that monocytes/macrophages are specifically involved in CVB3-induced myocarditis by maintaining a chronic inflammatory response. To examine susceptibility and reactivity to CVB3, freshly isolated human monocytes were exposed to various virus doses (0.1-10 MOI) in the presence or absence of macrophage-activating lipopolysaccharide (LPS). CVB3 infection alone induced an activation of monocytes as evidenced by enhanced adherence, release of cytokines and secretion of prostaglandin E2 (PGE2). Simultaneous addition of LPS almost entirely suppressed LPS-specific production of tumour necrosis factor alpha (TNF alpha) and PGE2, partially inhibited release of interleukin 1 beta (IL 1 beta) and did not affect interleukin 6 (IL6) synthesis of CVB3-infected monocytes. These data show that CVB3 activates monocytes to cytokine production but renders them unreactive to further activating stimuli. Further studies should determine the extent to which continuous cytokine release from persistently CVB3-infected monocytes, and their apparent unresponsiveness to other stimuli, contribute to chronic myocarditis.


Expression of trkB and trkC mRNAs by adult midbrain dopamine neurons: a double-label in situ hybridization study.
The documented trophic actions of the neurotrophins brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4/5 (NT-4/5) upon ventral mesencephalic dopamine neurons in vitro and in vivo are presumed to be mediated through interactions with their high-affinity receptors TrkB (for BDNF and NT-4/5) and TrkC (for NT-3). Although both neurotrophin receptor mRNAs have been detected within the rat ventral midbrain, their specific association with mesencephalic dopaminergic cell bodies remains to be elucidated. The present study was performed to determine the precise organization of trkB and trkC mRNAs within rat ventral midbrain and to discern whether the neurotrophin receptor mRNAs are expressed specifically by dopaminergic neurons. In situ hybridization with isotopically labeled cRNA probes showed that trkB and trkC mRNAs were expressed in all mesencephalic dopamine cell groups, including all subdivisions of the substantia nigra and ventral tegmental area, and in the retrorubral field, rostral and caudal linear raphe nuclei, interfascicular nucleus, and supramammillary region. Combined isotopic/nonisotopic double-labeling in situ hybridization demonstrated that virtually all of the tyrosine hydroxylase (the catecholamine biosynthetic enzyme) mRNA-containing neurons in the ventral midbrain also expressed trkB or trkC mRNAs. Additional perikarya within these regions expressed the neurotrophin receptor mRNAs but were not dopaminergic. The present results demonstrate that essentially all mesencephalic dopaminergic neurons synthesize the neurotrophin receptors TrkB and TrkC and thus exhibit the capacity to respond directly to BDNF and NT-3 in the adult midbrain in vivo. Moreover, because BDNF and NT-3 are produced locally by subpopulations of the dopaminergic cells, the present data support the notion that the neurotrophins can influence the dopaminergic neurons through autocrine or paracrine mechanisms.


Global analysis of gene expression in gastric ischemia-reperfusion: a future therapeutic direction for mucosal protective drugs.
Gastric ischemia-reperfusion is a relatively common condition leading to mucosal injury and may affect mucosal repair via modulating the gene expression of growth factors. Therefore, precise understanding of the molecular mechanism of ischemia or ischemia-reperfusion may lead to the discovery of new mucosal protective drugs. DNA microarray analysis followed by powerful data analysis has the potential to uncover previously undescribed genes involved in gastric injury and lead to an increased understanding of gastric mucosal cytoprotection. We introduced the laser-assisted microdissection to obtain cell-specific RNA from gastric mucosa in vivo and obtained sufficient amounts of cRNA for GeneChip analysis. This comprehensive approach enabled the simultaneous analysis of many genes, including transcriptional factors, as well as the generation of novel hypothesis on the mechanism of action of gastro-protective agents.


Barriers to the management of obstructed defaecation according to colorectal surgeons.
Obstructed defaecation (OD) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of OD as perceived by specialist colorectal surgeons treating this disorder. A postal questionnaire was administered to a bi-national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in OD management, including clinical access, decision-making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables. The response rate was 68.5% (n = 113). Most surgeons managed OD (94%), and preferred to treat OD patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in OD investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision-making by surgeon age and practice location (P < 0.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria. Barriers to OD management include surgeon-specific factors, patient-specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of OD investigations and improved access to specialist investigations and allied-health management services could improve outcomes for OD.


A genome-wide housekeeping role for TFIID and a highly regulated stress-related role for SAGA in Saccharomyces cerevisiae.
TFIID and SAGA share a common set of TAFs, regulate chromatin, and deliver TBP to promoters. Here we examine their relationship within the context of the Saccharomyces cerevisiae genome-wide regulatory network. We find that while TFIID and SAGA make overlapping contributions to the expression of all genes, TFIID function predominates at approximately 90% and SAGA at approximately 10% of the measurable genome. Strikingly, SAGA-dominated genes are largely stress induced and TAF independent, and are downregulated by the coordinate action of a variety of chromatin, TBP, and RNA polymerase II regulators. In contrast, the TFIID-dominated class is less regulated, but is highly dependent upon TAFs, including those shared between TFIID and SAGA. These two distinct modes of transcription regulation might reflect the need to balance inducible stress responses with the steady output of housekeeping genes.


Posterior addition acromioplasty in the treatment of recurrent posterior instability of the shoulder.
The purpose of the present study is to describe a previously unreported extraarticular surgical procedure for the treatment of recurrent posterior instability of the shoulder. Stabilization is achieved by grafting an inverted segment of the scapular spine to the posterior border of the acromion. The osseous segment is removed from the middle third of the spine and is positioned so that it exerts a slight pressure over the infraspinatus muscle. Eight consecutive patients with nontraumatic, recurrent posterior dislocation of the shoulder and 2 who had a history of minor trauma were operated on and reviewed at a mean follow-up of 9.5 years. Seven patients underwent addition acromioplasty alone, but the first 3 patients of the series also underwent posterior capsular plication. There were no operative complications. All of the patients were fully satisfied with the results. None complained of pain or recurrent dislocation. A slight and not incapacitating limitation of internal rotation of the shoulder was noted in 2 of the 3 patients of the group in which capsular plication was associated. This limitation was overcome in all successive patients by intraoperative fixation of the graft to the acromion with the arm positioned in extension and internal rotation. The procedure is a new and safe treatment option for achieving stabilization of this rare juvenile condition.


Self-Construction of Efficient Interfaces Ensures High-Performance Direct Ammonia Protonic Ceramic Fuel Cells.
Direct ammonia protonic ceramic fuel cells (PCFCs) are highly efficient energy conversion devices since ammonia as a carbon-neutral hydrogen-rich carrier shows great potential for storage and long-distance transportation when compared with hydrogen fuel. However, traditional Ni-based anodes readily suffer from severe structural destruction and dramatic deactivation after long-time exposure to ammonia. Here a Sr2 Fe1.35 Mo0.45 Cu0.2 O6-δ (SFMC) anode catalytic layer (ACL) painted onto a Ni-BaZr0.1 Ce0.7 Y0.1 Yb0.1 O3- δ (BZCYYb) anode with enhanced catalytic activity and durability toward the direct utilization of ammonia is reported. A tubular Ni-BZCYYb anode-supported cells with the SFMC ACL show excellent peak power densities of 1.77 W cm-2 in wet H2 (3% H2 O) and 1.02 W cm-2 in NH3 at 650 °C. A relatively stable operation of the cells is obtained at 650 °C for 200 h in ammonia fuel. Such achieved improvements in the activity and durability are attributed to the self-constructed interfaces with the phases of NiCu or/and NiFe for efficient NH3 decomposition, resulting in a strong NH3 adsorption strength of the SFMC, as confirmed by NH3 thermal conversion and NH3 -temperature programmed desorption. This research offers a valuable strategy of applying an internal catalytic layer for highly active and durable ammonia PCFCs.


Association between episodes of upper respiratory infection and exacerbations in adult patients with asthma.
Asthma has several phenotypical features, including recurrent exacerbations and recurrent episodes of upper respiratory infection (URI). A retrospective study was performed to identify the characteristics of adult patients with recurrent exacerbations of asthma, especially in association with recurrent episodes of URI. Information was collected using a self-administered questionnaire given to 7070 patients in autumn-winter 2006, 4859 patients in spring-summer 2007, and 4452 patients in autumn-winter 2007. The patients reported the degree of symptoms and the frequency of febrile episodes of URI and exacerbations. Severe exacerbations were defined as a self-report of asthma-related hospitalization, an emergency department visit, or a requirement for systemic corticosteroids. Recurrent febrile URI and exacerbations were defined as two or more episodes within the previous 6 months. A Poisson regression model was used to identify the factors that were predictors of a risk for exacerbations. Of the 6266 patients who completed the questionnaire, the frequencies of febrile URI and episodes of severe exacerbations were 1.54 and 0.54 per subject per year, respectively. Logistic regression analysis showed that an older age [odds ratio (OR): 1.57; 95% confidence interval (CI): 1.15-2.13], female sex (OR: 1.58; 95% CI: 1.20-2.08), recurrent febrile episodes of URI (OR: 2.68; 95% CI: 1.47-4.91), a history of previous exacerbation within 1 year (OR: 1.74; 95% CI: 1.28-2.34), disuse of inhaled corticosteroids (ICSs) (OR: 2.63; 95% CI: 1.68-4.12), and disuse of add-on leukotriene receptor antagonists (LTRAs) (OR: 1.42; 95% CI: 1.06-1.74) were independently associated with moderate to severe symptom-severity. Poisson regression analysis showed that the independent factors that contributed to the frequency of recurrent severe exacerbations were female sex (regression coefficient β = 0.62, p < .01), an episode of sputum with coughing (β = 1.23, p < .01), nocturnal awakening (β = 1.22, p < .01), and severe exacerbation (β = 0.78, p < .01) within the previous 6 months. Symptom-severity of asthma and the frequency of severe exacerbations were associated with previous exacerbations and susceptibility to URI.


Medical treatment patterns of ASCRS members for primary open-angle glaucoma--1998 survey.
A survey of medical treatment patterns for primary open-angle glaucoma (POAG) was mailed to all United States members of the American Society of Cataract and Refractive Surgery (ASCRS) in March 1998; 21.2% responded. Demographic information pertinent to glaucoma care was also obtained. The use of diagnostic ancillary tests, as well as the sequential order of preferred therapy, in 3 hypothetical patient populations was analyzed: patients with mild, moderate, and advanced POAG. Preferred medical therapy was cross-tabulated with number of years in practice, fellowship training in glaucoma, and geographic location.


IgG-Fc and C3 receptors in the chicken: distribution, tissue localization and functional significance.
This paper summarizes data obtained in our laboratory on the demonstration of receptors for IgG-Fc (FcR) and complement (CR) on mononuclear cells of the fowl. A clearcut distinction of these two structures on spleen cells was achieved in rosette assays using SRBC coated with rabbit IgG as indicator cells which bind avian complement, but are not bound by the FcR. The tissue distribution and localization of FcR and CR positive cells was studied in mixed hemadsorption assays on sections of both central (bursa, thymus) and peripheral (spleen) lymphoid organs from normal chickens, as well as lymphocytic infiltrated thyroid glands from animals of the Obese strain (OS) afflicted with spontaneous autoimmune thyroiditis. The possible significance of both receptors in the pathogenesis of this autoimmune process is discussed.


Dysbiosis of the Gut Microbiota on the Inflammatory Background due to Lack of Suppressor of Cytokine Signalling-1 in Mice.
Both environmental and genetic factors have been implicated in the induction of autoimmune disease. Therefore, it is important to understand the pathophysiological significance of the gut microbiota and host genetic background that contribute to an autoimmune disease such as inflammatory bowel disease (IBD). We have previously reported that mice deficient for suppressor of cytokine signaling-1 (SOCS1), in which SOCS1 expression was restored in T and B cells on an SOCS1-/- background (SOCS1-/-Tg mice), developed systemic autoimmune diseases accompanied by spontaneous colitis. To investigate whether the proinflammatory genetic background affects the gut microbiota, we used SOCS1-/-Tg mice as a model of spontaneous chronic colitis. Fecal samples were collected from SOCS1-/-Tg mice and SOCS1+/+Tg (control) mice at 1 and 6 months of age, and the fecal bacterial 16S ribosomal RNA genes were sequenced using the Illumina MiSeq platform. Gut microbial diversity was significantly reduced and the intestinal bacterial community composition changed in SOCS1-/-Tg mice in comparison with the control mice. Interestingly, the population of Prevotella species, which is known to be elevated in ulcerative colitis and colorectal cancer patients, was significantly increased in SOCS1-/-Tg mice regardless of age. Taken together, these results suggest that the proinflammatory genetic background owing to SOCS1 deficiency causes dysbiosis of the gut microbiota, which in turn generates a procolitogenic environment.


Autofluorescence of clofazimine in discoid lupus erythematosus.
A 70-year-old woman developed dark reddish blue pigmentation in scarred areas of discoid lupus erythematosus after taking clofazimine intermittently over a period of 10 years. Although light microscopy of routinely processed tissue failed to define the cause of the pigment, fluorescent microscopy showed vivid red deposits concentrated around larger vessels within the dermis. These deposits were shown to correspond to birefringent red clofazimine crystals on fresh frozen sections. Although the hyperpigmentation may clinically resemble melanin, biopsy specimens from our patient revealed a loss of melanin pigment in lesional skin, suggesting a primary role for clofazimine in producing the color changes observed.


Evaluation of telithromycin against Streptococcus pneumoniae with ribosomal mutations utilizing in vitro time-kill methodology.
In a recent study, our in vivo data suggested that clinically achievable levels of telithromycin are more effective than azithromycin against selected Streptococcus pneumoniae isolates with ribosomal mutations in 23S rRNA gene alleles and L22 region mutations. In the current study, we attempt to investigate further the antibacterial activity of telithromycin against these isolates to better delineate the disparity between isolates based on allelic differences. Four isolates of S. pneumoniae with ribosomal mutations were tested using in vitro time-kill methodology. Isolates were exposed to telithromycin at concentrations of 0.5-8 x the minimum inhibitory concentration (MIC). At these exposures, telithromycin demonstrated concentration-dependent killing for three of the four isolates. Against the fourth isolate, telithromycin affected only a 1 log decrease in colony-forming units/mL despite exposures of 8 x MIC. These data demonstrate the in vitro killing profile of telithromycin against S. pneumoniae isolates with ribosomal and L22 mutations. Whilst telithromycin did not demonstrate bactericidal activity against all isolates in these time-kill studies, the in vivo human-simulated exposures did result in a high degree of bacterial kill. Full evaluation of the potential utility of new antimicrobial agents against these emerging genotypic profiles requires both in vitro and in vivo assessments.


Mechanisms of depression of splenic natural killer cell function in C57BL/6 mice infected with Leishmania donovani.
C57BL/6 mice chronically infected with the protozoan parasite Leishmania donovani exhibit profoundly depressed splenic natural killer (NK) cell activity as measured by in vitro cytolysis of lymphoma target cells. Injection of infected mice with an interferon (IFN) inducer or in vitro treatment of infected splenocytes with IFN, a phorbol ester, or indomethacin failed to restore their NK activity to the degree shown by age-matched, uninfected mice. Fractionation of infected splenocytes by nylon wool, Sephadex G-10, or carbonyl iron and magnetism treatments was also unable to effect an increase in NK activity. Addition of infected splenocytes to uninfected ones in in vitro NK assays suppressed the NK activity of the latter, and the suppression could be partially or wholly abrogated by prior fractionation of infected splenocytes by the methods noted above. In vitro treatment of infected splenocytes with concanavalin A revealed the presence of NK activity in these cell populations. The results indicate that splenocytes in L. donovani-infected mice become insensitive to IFN stimulation; and the impairment of another, possibly IFN-independent pathway of NK-cell activation may also contribute to the observed L. donovani-induced depression in splenic NK activity in C57BL/6 mice.


Efficient alachlor degradation by the filamentous fungus Paecilomyces marquandii with simultaneous oxidative stress reduction.
The acceleration of alachlor degradation by Paecilomyces marquandii under controlled and optimized conditions of fungal cultivation in liquid batches was observed (by ca. 20% in comparison to the flask cultures). Acidic environment and oxygen limitation resulted in deterioration of herbicide elimination. Efficient xenobiotic degradation did not correlate with free radicals formation, but some conditions of bioreactor cultivation such as neutral pH and oxygen enriched atmosphere (pO2⩾30%) caused a decrease in the reactive oxygen species (ROS) accumulation in mycelia. The changes in the glutathione (GSH) and ascorbic acid (AA) levels, also in the dismutase (SOD) and catalase (CAT) activities showed active response of the tested fungus against alachlor induced oxidative stress. These results will contribute to the improvement of chloroacetanilides elimination by fungi and extend the knowledge concerning oxidative stress induction and fungal cellular defense.


Dorsal internal carotid artery aneurysm: classification, pathogenesis, and surgical considerations.
Despite the rarity of dorsal internal carotid artery (ICA) aneurysms they still offer surgical challenge to achieve a safe successful clipping due to their peculiar projection. In the past 13 years, 24 cases of dorsal ICA aneurysm were operated upon in our hospitals. Three separate groups of such aneurysms could be identified: group 1; where the aneurysms were located most proximally at the carotid-ophthalmic region, group 3; in which the aneurysms were present most distally just proximal to the ICA bifurcation, and group 2; where the aneurysms were located in between. All cases in this surgical series will be reviewed stressing upon the classification, pathogenesis, and surgical tactics of such a rare type of aneurysm.


Limbic status epilepticus: behaviour and sleep alterations after intra-amygdaloid kainic acid microinjections in Papio Papio baboons.
Limbic status epilepticus was produced with single microinjections of kainic acid in the amygdala of baboons (Papio papio). Long-term studies of the behavioural, electrographic and sleep alterations were performed. During status epilepticus the animals did not display aggressive behaviour. Feeding behaviour was diminished. Sleep was also deeply disturbed. Wakefulness was greatly increased, light slow wave sleep was diminished and deep slow wave sleep and paradoxical sleep was abolished. Sleep alterations persisted throughout the duration of status epilepticus (48-72 h). A modulation of paroxysmal discharges was observed depending on the degree of epileptogenicity of the limbic focus. Increased wakefulness cannot be attributed to convulsions since limbic status epilepticus in baboons is not accompanied by positive motor signs. It is proposed that increased wakefulness, of, a particular type as revealed by the alterations of different accompanying behaviours, during this type of status epilepticus, depends on an internal arousing mechanism.


Temporal relationship between lumbar spine surgeries, return to work, and workers' compensation costs in a cohort of injured workers.
Determine the relationship between time to surgery, lost time, and insurance costs. A cohort of 582 claimants undergoing lumbar spine surgery (1999 to 2002) in the state of Louisiana was observed for 7 years. The shorter the time interval between injury and first lumbar surgery, the lower the cost and time lost from work. Average days lost from work and claim costs for 42% of those undergoing early lumbar surgery did not differ from injured workers who lost time from work for claims not involving lumbar surgery. Claim cost for the remaining 58% who had delayed surgery was 5.7 times greater than that for the early surgery cohort. The decision to perform lumbar surgery is not necessarily associated with high claim costs or longer time out from work, provided that the determination to operate is early.


Oxygen concentrations at the rear and front of the bag in bag valve mask devices during oxygenation of neonates.
To study the concentration of oxygen flowing passively from the front and the rear parts of different brands of self-inflating bag valve mask ventilation devices at different oxygen flows and that flowing actively from the front part at different ventilation rates. Two devices were tested, the Ambu device in which the added oxygen enters at a right angle to the axis of the bag and the VBM in which the oxygen enters parallel to the axis of the bag and faces either a hole or a ridge in the intake valve. An oxygen analyzer was used to measure the oxygen concentration at different oxygen flow rates (2, 4, 6, 8 and 10 L/min) supplied by a 100% oxygen source. This was measured in both devices from the front and rear parts as step one. With active ventilation compressing the bag, oxygen concentration was measured from the front part. This was done at ventilation rates of 30 and 60 min(-1). Passive flow oxygenation. With the Ambu device, the oxygen concentration measured at the front part of the bag was 21% and that measured from the rear part was 100%, at all oxygen flow rates. With the VBM brand, in the first position with the oxygen source facing a hole (VBM-hole), the oxygen concentration was high at low flow rates and decreased with increased flow. Similar findings happened when measuring oxygen concentration from its rear part. With the oxygen source facing a ridge (VBM-ridge), the oxygen concentration measured from the front was directly proportional to the oxygen flow rate i.e. it increased with increasing flow. From the rear part, the oxygen concentration was near 100% at all flow rates. Active ventilation. Using the Ambu device, the oxygen concentration increased with increasing flow rate and reached 100% at 10 L/min flow. With VBM-hole, the oxygen concentration increased gradually with increasing flow but never reached 100%. With VBM-ridge, the performance was comparable to the Ambu. In all the situations, the oxygen concentration was higher when the ventilation was done at 30 min(-1) than at 60 min(-1). The Ambu device can provide 100% oxygen from its rear part even at low flow rates and 100% oxygen during active ventilation provided at least 10 L/min oxygen is used. The VBM is at a disadvantage when the oxygen source faces a hole; as the jet flowing in the bag causes a Venturi effect; which sucks air in from outside and dilutes the oxygen concentration provided. The ridge type does not have this problem. Ventilation at a rate of 30 min(-1) produced a higher oxygen concentration. The operator should be aware of the limitations of the device used.


Professional Practice Environment Scale-Chinese Version: Development and Psychometric Testing.
The Professional Practice Environment (PPE) scale is widely used to assess the quality of the healthcare environment around the world. No validated Chinese-language scale that is designed to address this issue currently exists. The present study evaluates the construct validity of the Chinese-version PPE on a sample of 290 healthcare workers in Taiwan. Forward and backward translations of the PPE scale of Halcomb et al. were used to ensure semantic equivalence. Further, multiple psychometric properties were examined. The developed scale showed sufficient equivalence. The results of a survey of 290 healthcare providers demonstrated that the developed Chinese-version PPE scale had high reliability (Cronbach's alpha = .88) and validity. The findings of the present study support the effectiveness and efficiency of the Chinese-version 30-item Halcomb's PPE in assessing the professional practice environment in Taiwan.


Urocortins: emerging metabolic and energy homeostasis perspectives.
The effects of stress on energy balance and the involvement of the neuropeptide corticotropin releasing factor in modulating the anorexia of stress and sympathetic nervous system tone are well recognized. Currently, studies centered on the roles of the more recently described members of this family of ligands, the urocortins, and their preferred receptor, the corticotropin releasing factor type 2 receptor, suggest that they are important modulators of centrally controlled metabolic functions. In addition, urocortins also regulate fuel utilization in the periphery by acting locally within key metabolic tissues through autocrine and/or paracrine mechanisms. Recent findings have demonstrated that urocortin 2 and urocortin 3, by acting through their specific receptor in peripheral tissues, are novel modulators of glucose homeostasis and metabolic functions.


Differences in the hydrophobic properties of discrete alpha-helical domains of rat and human apolipoprotein A-IV.
The primary structure of human apolipoprotein A-IV has been analyzed to identify amphipathic alpha-helical regions and compare their hydrophobic properties with analogous segments of rat apolipoprotein A-IV. Significant differences were found in the mean hydrophobicity and/or mean helical hydrophobic moment of several discrete alpha-helical domains of rat and human apolipoprotein A-IV, which may determine the differences in their biophysical and biological behavior.


Outcome differences between gastroschisis repair methods.
Gastroschisis is a congenital abdominal wall defect that is repaired with either a primary closure or staged closure. The outcome of these infants may differ because of different closure techniques. In addition to the usual markers of parenteral nutrition (PN) use and length of stay (LOS) as outcome measures, we examined the duration of postoperative acidosis and positive fluid balance as markers for postoperative stress associated with these two techniques. A retrospective review of newborns with gastroschisis was conducted at a free-standing children's hospital from 2002 to 2008. The demographic data, gestational age, birth weight, operative reports, days on PN, LOS, duration of postoperative acidosis and fluid balances were reviewed. Data were analyzed using the Fisher's exact test or unpaired t test. Thirty-two infants with gastroschisis were identified. One was excluded from analysis due to incomplete follow-up. The patients were classified as either primary closure (n = 8) or staged repair (n = 23). There was one death in our series. Patients who underwent primary closure had significantly older gestational age and higher birth weight. Primary closure is associated with significantly less duration of postoperative metabolic acidosis and fewer days with positive fluid balance. Patients who had primary repair also had less parenteral nutrition use and shorter length of hospitalization, though not statistically significant. Gastroschisis with associated intestinal atresia was more likely to be repaired with staged closures. There are physiologic advantages to primary repair of gastroschisis that can lead to better outcome, but the indications for the choices of closure technique remain unclear. Primary closure should be used when possible.


Silicon-photonic PTAT temperature sensor for micro-ring resonator thermal stabilization.
We present a scheme for thermal stabilization of micro-ring resonator modulators through direct measurement of ring temperature using a monolithic PTAT temperature sensor. The measured temperature is used in a feedback loop to adjust the thermal tuner of the ring. The closed-loop feedback system is demonstrated to operate in presence of thermal perturbations at 20Gb/s.


Fluctuations of observed breeding Rough-legged Hawks and Gyrfalcons: regularity reconsidered.
We recently assessed regularity in fluctuation of annual numbers of breeding pairs observed for several raptor species, and found no indication of reputed regular or cyclic fluctuations in our Colville River, Alaska sample for Gyrfalcons (Falco rusticolus) or Rough-legged Hawks (Buteo lagopus) (Mindell et al. 1987). Discussions with colleagues have prompted us to expand our analysis and clarify key points. We present time series analyses, using the Colville River sample size and interval (13 surveys during a 27 year period) for a data set on lynx (Lynx canadensis) (Elton and Nicholson 1942) and for a hypothetical Gyrfalcon population. Indication of regular 10-year fluctuations (P<0.05) in these analyses supports the adequacy of our Colville River sample size and interval in assessing a possible 10-year cycle for Gyrfalcons. We provide dates and methods used for the annual Colville River surveys in discussing applications and limitations of the survey findings. We use the annual Colville River surveys as an index of fluctuation in actual numbers of Gyrfalcons and Rough-legged Hawks present in the study area at the time, based on similarity in timing of surveys between years, use of boat surveys in 12 of 13 years, evidence indicating similarity in sampling error between years, and demonstration of the adequacy of the sample interval. Whether or not numbers of breeding Gyrfalcons and Rough-legged Hawks fluctuate regularly remains an open question. We have provided a first assessment of regularity in fluctuation of observed numbers of breeding pairs, and find regularity for this parameter unsupported considering the Colville River study area as a whole. If other researchersare stirred to test "conventional wisdom" presuming regularity, our study will have served its purpose.


Mirtazapine in pregnancy and lactation - A systematic review.
Depression is common in pregnancy and associated with increased risk of adverse effects for the neonate. Treatment and prevention options include antidepressant therapy. The aim of this paper was to review the literature on safety of mirtazapine during pregnancy and lactation. In 31 papers a total of 390 cases of neonates exposed to mirtazapine during pregnancy or lactation have been described. There might be an association between mirtazapine and spontaneous abortion, however, this might be attributable to underlying psychiatric disease. An increased risk of major neonatal malformations associated with mirtazapine in pregnancy has not been reported. Although one study showed a nearly significant increase in occurrence of respiratory problems and hypoglycaemia, no indication of causality could be given. No other significant adverse effects on neonates were reported. Limited available data, four papers on 11 exposed neonates, suggest that use of mirtazapine during breastfeeding is safe due to a low relative infant dose. High plasma levels might be associated with increased body weight and sleep. However, the reported data are too scarce to come to a clear assessment of the risk of mirtazapine in lactation. No information is available on the use of mirtazapine in pregnancy and Poor Neonatal Adaptation Syndrome (PNAS) or neurobehavioral development at an age over one year. In conclusion, mirtazapine seems to be safe in pregnancy, especially regarding incidence of congenital malformations. There are not enough data available to come to a conclusion on the safety of mirtazapine during lactation.


Safety Profile of High-Dose Botulinum Toxin Type A in Post-Stroke Spasticity Treatment.
Botulinum toxin type A (BoNT-A) is considered the gold standard for the treatment of focal post-stroke spasticity (PSS). However, a recently published study estimated that a significant percentage of patients affected by PSS could benefit from higher doses of BoNT-A than those permitted by current directives in the countries studied. Several studies have reported the use of high doses of BoNT-A in the management of patients affected by severe PSS; however, the most important adverse effect of this drug might be systemic diffusion of the toxin, which could potentially be related to its dose. Even if systemic toxicity is a rare event, fear of systemic toxicity is still the most relevant concern regarding use of high doses. The aim of our narrative review was to show the state of the art on the use of high doses of BoNT-A in patients affected by PSS in order to define the safety profile, focusing on both clinical and instrumental assessment of systemic effects. Current evidence from the literature suggests that higher doses of BoNT-A are effective in reducing spasticity of upper and lower limbs after stroke, with rare occurrence of mild adverse effects. The use of high doses seems to be an effective and safe therapeutic option to reduce multifocal or generalized PSS in selected patients. In particular, the potential role of higher doses in order to improve the functional outcome of these patients should be noted.


Serum progesterone concentrations on the day of HCG administration cannot predict pregnancy in assisted reproduction cycles.
The effect of subtle rises of progesterone in the late follicular phase of cycles of ovarian stimulation with gonadotrophin-releasing hormone (GnRH) agonists on pregnancy outcome is controversial. This study used receiver-operating characteristic (ROC) analysis to gain further insight into the predictive value of serum progesterone concentrations on the day of human chorionic gonadotrophin (HCG) injection in normally responding patients receiving the long protocol of GnRH agonist (group L; n = 218) and in low responders receiving the short ('flare-up') protocol (group S; n = 159). ROC analysis showed that serum progesterone concentration on the HCG day was not indicative of conception and non-conception cycles in the whole population studied, in group L or in group S. To further assess the potential impact of 'high' concentrations of circulating progesterone on the day of HCG administration on pregnancy rates and outcome, the threshold value (<0.9 ng/ml) to discriminate between women with 'high' (group H; n = 197) and 'normal' (group N; n = 180) progesterone was applied. No significant differences were found with respect to pregnancy and miscarriage rates between these two groups. Serum progesterone concentrations on the day of HCG administration therefore cannot predict pregnancy in assisted reproduction cycles using GnRH agonists and gonadotrophins.


Analysis of HIV by entropy evolution rate.
We analyze the variation of HIV after infection by means of an information measure, called the entropy evolution rate. In our analysis, we use a part of the external glycoprotein gp120 including the V3 region observed from six patients. Then we could make the following two aspects clear; (1) the relation between the change of the entropy evolution rate and the appearance of symptoms of disease, and (2) the relation between the change of the entropy evolution rate and that of the CD4 count of the patients.


Exploring Challenges of Access to Non-Communicable Disease (NCD) Prevention, Treatment and Care: A Qualitative Study on People Living with NCDs (PLWNCDs) in West Bengal, India.
People living with noncommunicable diseases (PLWNCDs) are often disproportionately affected due to adverse interaction with socioecological and biological factors. Hence, it is imperative to learn from their lived experience to gain a greater understanding of interactions as well as explore their priorities and needs in accessing care and identify areas of priority action through multistakeholder engagement. The qualitative study with grounded theory approach was conducted between October and December 2020. An online key-informant interview with the health policymaker, virtual group discussion with eight PLWNCDs, and in-depth telephonic interviews with five PLWNCDs were conducted, after obtaining informed consent using interview guide, developed, and validated by the experts. Data collection continued till data saturation was achieved. Transcripts generated from the interview recordings were coded using hand-code technique and analyzed thematically. Challenges faced by PLWNCDs in accessing care were lack of empathy and support from health-care professionals, stigma, financial hardship, and hospital overcrowding. Caregivers emphasized on the felt need to involve civil society organizations (CSOs) in raising awareness toward noncommunicable diseases (NCDs) at family, community, and policymaking levels. The need for home-based NCD care and rehabilitation centers was voiced by the PLWNCDs. Impediments toward effective implementation of NCD policies were adoption of a "top-down" approach, poor awareness about government health insurance schemes, skewed distribution of empanelled hospitals in and around cities, nonavailability of qualified health-care professionals in underserved areas, aggravated allocation-utilization disparity during COVID-19 pandemic, and lack of robust information technology infrastructure to support access to telemedicine services. The collective role of governments, CSOs, and health-care providers, along with meaningful involvement of PLWNCDs, would help to create an enabling environment for overcoming the challenges of access to care and thus achieve universal health coverage.


Blastomycosis in wild wolves.
Blastomycosis was fatal to a wild wolf in Minnesota, and serologic evidence of blastomycosis was found in a Wisconsin wolf. No unusual movements were detected in the Minnesota animal from October 1983 through October 1985. However, by early December 1985, this wolf was weak and debilitated, and it perished on 14 December after approaching a human residence.


Intravascular large B-cell lymphoma as a cause of hypopituitarism: gradual and late reversal of hypopituitarism after long-term remission of lymphoma with immunochemotherapy.
Intravascular large B-cell lymphoma (IVL) is a rare generally fatal disease characterized by massive proliferation of lymphoid cells within the small and medium blood vessels. Hypopituitarism has been reported only in a few fatal cases. We describe the clinical course of hypopituitarism as a complication of IVL, successfully treated with immunochemotherapy (cyclophosphamide/doxorubicin/vincristine/prednisone-CHOP) plus Rituximab anti-CD20 humanized antibody). Before immunochemotherapy, basal hormonal analysis and dynamic test for pituitary function were performed in a 67-year-old female with IVL. Endocrinological evaluation of the pituitary function was repeated after complete hematological remission and during the 2 years of follow-up. Multiple pituitary hormone deficiencies were diagnosed before therapy for IVL. Magnetic resonance imaging (MRI) of the pituitary gland showed partially empty sella. The patient was replaced with thyroxine 50 microg/day and prednisone 5 mg/day between the cycles of chemotherapy. After complete hematological remission (6 months after initial diagnosis) reversal of cortisol and gonadotropin deficiency occurred. After 18 months of hematological remission there was further improvement in growth hormone (GH) response to provocative testings (partial GH deficiency), with normalization of somatotropic and thyreotropic axis after 2 years of follow-up. This is the first case of IVL complicated with hypopituitarism, treated with immunochemotherapy which resulted in complete hematological remission and gradual and late reversal of hypopituitarism.


Developmental relationships between vitelline and intra-embryonic haemopoiesis studied in avian 'yolk sac chimaeras'.
Using the quail-chick marker technique, cells have been traced in the haemopoietic organs of 149 developing chimaeras composed of a quail embryo with a chick yolk sac. The existence of intraembryonic stem cell relaying yolk sac stem cells, previously demonstrated with this system, is confirmed. Thymus, bursa of Fabricius and bone marrow are preferentially populated by intraembryonic stem cells. The spleen shows a transitory phase of colonization by chick yolk sac stem cells at 11--12 days of incubation. From 7 days onwards the yolk sac receives quail stem cell emigrating from the embryo.


Dependence of histochemical staining of leukocyte aminopeptidase upon its biochemical enzyme activity.
The relationship between histochemical staining and biochemical activity of the enzyme was investigated using leukocytes with different aminopeptidase activities. In guinea-pig neutrophils and macrophages which have a relatively high enzyme activity, the histochemical staining correlated with the biochemical enzyme activity. On the other hand, guinea-pig lymphocytes and mouse neutrophils whose enzyme activities were 8.25 +/- 0.27 mU/10(7) cells and 6.18 +/- 0.87 mU/10(7) cells, respectively, were not stained by histochemical techniques. When guinea-pig neutrophils were modified chemically by diazotized sulfanilic acid at different concentrations, the histochemical staining of neutrophils decreased in proportion to the degree of inhibition of their biochemical enzyme activity and hardly became detectable below 10 mU/10(7) cells. However, guinea-pig neutrophils contained the soluble enzyme, corresponding to 5 mU/10(7) cells, which leaked out rapidly from cells during staining procedure, suggesting that the limit of visualization of the membrane-bound aminopeptidase activity by the histochemical techniques is about 5 mU/10(7) cells. The membrane-bound enzyme activities in guinea-pig lymphocytes and mouse neutrophils were 5 mU and 3 mU per 10(7) cells, respectively, and so it is possible that these leukocytes hardly stained histochemically.


Effect of chemotherapy on natural-killer activity and antibody-dependent cell-mediated cytotoxicity in carcinoma of the lung.
The effect of chemotherapy on natural killer (NK) activity and antibody-dependent cell-mediated cytotoxicity (ADCC) in 15 advanced carcinomas of the lung was examined with regard to the drug, dose, route and timing of administration. The relationship between the effect of chemotherapy on the prognosis for the patients, and the changes in NK activity and ADCC, was also analysed. The NK activity and ADCC in patients with poor prognosis were significantly subnormal, even before treatment. The NK activity and ADCC began to decrease 2 weeks after the initiation of treatment and reached the lowest level during the 3rd or 4th week in all patients. Thereafter, they returned to the pretreatment level in 8 patients with stabilized disease. In contrast, they were not restored in 7 patients with progressive disease and poor prognosis. In 4 patients it was found that the effect of chemotherapy with pepleomycin and carbazilquinone on NK activity and ADCC differed according to the drug used. From this pilot study it is suggested that NK activity and ADCC are valuable prognostic factors in patients with advanced carcinoma of the lung, and that detailed analysis of the effect of each anticancer agent on NK activity and ADCC is desirable for the establishment of better treatment regimens for advanced carcinoma of the lung.


MD PhD programmes with relevance to imaging. Results from a European survey.
Scientific research is an important part of radiology. PhDs for MDs are becoming increasingly important for an academic career. Developments in training for young radiologists show that the interest in completing a PhD programme with a focus on imaging is significantly increasing. It can be assumed that PhDs of relevance to imaging provide excellent training for later scientific work during radiology residency. To evaluate the situation for the availability of PhD programmes with relevance to imaging, a European survey was performed. In total, 100 universities and institutions from 24 European countries responded. In 50.5 % of the responses the universities/institutions offer imaging-related PhD programmes. In 25.6 % of responses radiology departments run their own PhD programme. With regard to handling PhD and radiology training, the most common response was that a PhD is allowed in parallel to radiology training (38.9 %), should be completed partly (15.3 %) and must be completed first (8.3 %). The most common responses for the duration of PhD programmes were 3 years and 4 years (27.8 % each). In conclusion, the survey has shown that imaging-related PhD programmes are available for radiologists and that radiology departments should be encouraged and supported to develop their own PhD programmes. Finally, this survey may be the first step to develop an online database comprising all these PhD programmes throughout Europe, allowing easy access to this information. • PhD programmes with relevance to imaging are becoming increasingly important for young radiologists. • In Europe about half of the universities/institutions offer imaging-related PhD programmes; about a quarter of radiology departments run their own PhD programme. • Where radiology departments have the appropriate facilities and staff they should be encouraged and supported to develop their own PhD programme. • An online database comprising PhD programmes worldwide would be a useful tool for radiologists, allowing for easy access to this information. • PhD programmes are a valuable asset not only for clinicians, but also for universities, institutions and individual radiology programmes alike.


Understanding approaches to measurement and impact of depth of invasion of oral cavity cancers: A survey of American Head and Neck Society Membership.
To investigate methods used by head and neck surgeons to pre-operatively measure depth of invasion (DOI) in light of the new staging for oral cavity squamous cell carcinoma (OCSCC). A survey was designed and sent to all American Head and Neck Society (AHNS) members via an email link. The last response was recorded on January 16, 2019. We received 185 (13.3%) responses from 184 surgeons and 1 radiation oncologist. The majority of surgeons correctly identified DOI (78.9%) and indicated measuring DOI pre-operatively (86%). The most common methods for measuring DOI were manual palpation (32.5%) and full thickness biopsy (25.2%). In addition, most surgeons (84.7%) reported using a DOI threshold (in mm) as their primary criterion in their decision to pursue a neck dissection in the N0 neck. The most common reported threshold was 4 mm (37.4% of those that reported using DOI), however, the range varied from 2 to >10 mm. Two-thirds of surgeons considered DOI an important indicator for adjuvant therapy. DOI is believed to be an important prognostic indicator guiding neck dissection and the need for adjuvant therapy. While most surgeons currently measure DOI pre-operatively, most use subjective methods. Future studies are needed to establish objective pre-operative DOI measurement techniques and to better inform the decision to perform prophylactic neck dissection, given the current majority practice of prophylactic neck dissection for DOI of 4 mm or greater.


Family physicians' role in palliative care throughout the care continuum: stakeholder perspectives.
While palliative care is still often viewed as care for the final stage of life provided usually by specialist health care professionals, ideally, a palliative care approach would start at an earlier stage, with an important role being assigned to the family physician (FP). However, the description of what the FP's tasks would be in the integration of a palliative care approach into the care continuum remains vague. To explore the views of FPs, nurses and patients about the tasks of the FP in palliative care for people with a life-limiting illness from diagnosis onwards. We performed 18 interviews with people with cancer, organ failure or dementia and 6 focus groups, 4 with FPs and 2 with community nurses. Analysis was guided by a thematic content analysis procedure to categorize perceived tasks into overarching themes. The tasks attributed to the FP could be categorized into four roles: FP as (i) available medical expert, (ii) communicator, (iii) collaborator and (iv) life-long learner committed to improving their palliative care competencies by training. Some perceived tasks varied depending on the different phases of illness (such as around diagnosis), while others were applicable throughout the whole illness course. Participants mostly had the same perception of the FPs' tasks, but there was disagreement on, for example, the timing of care planning. Our results help to elucidate the tasks and roles required of FPs to make integration of a palliative care approach into the care continuum possible.


The Sensory Experience of Waiting for Parents of Children Awaiting Transplant: A Narrative Ethnography.
Despite the senses being a valuable source of knowledge, little research has explored the sensory process of medical experiences. This narrative ethnographic study investigated how the senses shaped parents' experiences of waiting for their child to receive a solid organ, stem cell, or bone marrow transplant. Six parents from four different families primarily participated in sensory interviews as well as observations that explored the question: How do parents experience waiting using the five senses? Our narrative analysis suggested that parents' bodies stored sense memories, and they re-experienced stories of waiting through the senses and 'felt realities'. In addition, the senses transported families back to the emotional experience of waiting, which highlighted the longevity of waiting after receiving a transplant. We discuss how the senses provide important information about the body, waiting experiences, and the environmental contexts that mediate waiting. Findings contribute to theoretical and methodological work exploring how bodies are implicated in producing narratives.


Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial.
Severe traumatic brain injury (TBI) has been increasing with greater incidence of injuries from traffic or sporting accidents. Although there are a number of animal models of TBI using progesterone for head injury, the effects of progesterone on neurologic outcome of acute TBI patients remain unclear. The aim of the present clinical study was to assess the longer-term efficacy of progesterone on the improvement in neurologic outcome of patients with acute severe TBI. A total of 159 patients who arrived within 8 hours of injury with a Glasgow Coma Score </= 8 were enrolled in the study. A prospective, randomized, placebo-controlled trial of progesterone was conducted in the Neurotrauma Center of our teaching hospital. The patients were randomized to receive either progesterone or placebo. The primary endpoint was the Glasgow Outcome Scale score 3 months after brain injury. Secondary efficacy endpoints included the modified Functional Independence Measure score and mortality. In a follow-up protocol at 6 months, the Glasgow Outcome Scale and the modified Functional Independence Measure scores were again determined. Of the 159 patients randomized, 82 received progesterone and 77 received placebo. The demographic characteristics, the mechanism of injury, and the time of treatment were compared for the two groups. After 3 months and 6 months of treatment, the dichotomized Glasgow Outcome Scale score analysis exhibited more favorable outcomes among the patients who were given progesterone compared with the control individuals (P = 0.034 and P = 0.048, respectively). The modified Functional Independence Measure scores in the progesterone group were higher than those in the placebo group at both 3-month and 6-month follow-up (P < 0.05 and P < 0.01). The mortality rate of the progesterone group was significantly lower than that of the placebo group at 6-month follow-up (P < 0.05). The mean intracranial pressure values 72 hours and 7 days after injury were lower in the progesterone group than in the placebo group, but there was no statistical significance between the two groups (P > 0.05). Instances of complications and adverse events associated with the administration of progesterone were not found. Our data suggest that acute severe TBI patients with administration of progesterone hold improved neurologic outcomes for up to 6 months. These results provide information important for further large and multicenter clinical trials on progesterone as a promising neuroprotective drug. ACTRN12607000545460.


CHANGES IN SYSTEMIC LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR AFTER INTRAVITREAL INJECTION OF AFLIBERCEPT OR BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
To analyze and compare the effects of intravitreal brolucizumab versus aflibercept on systemic vascular endothelial growth factor (VEGF)-A levels in patients with neovascular age-related macular degeneration. In this prospective interventional case series study, brolucizumab (6.0 mg/50 µL) or aflibercept (2.0 mg/50 µL) was injected intravitreally in 30 patients each. Blood samples were drawn at baseline and 7 days and 28 days after the first injection. Systemic VEGF-A levels were measured using enzyme-linked immunosorbent assay. Thirty healthy individuals served as controls. The median baseline systemic VEGF-A levels in the brolucizumab, aflibercept, and control groups were 10.8 (8.0-13.2), 12.0 (8.0-18.5), and 10.0 (8.0-15.1) pg/mL, respectively (P = 0.315). In the brolucizumab group, VEGF-A levels significantly decreased to 8.0 (8.0-11.5) pg/mL on Day 7 (P = 0.0254) and to 8.0 (8.0-8.0) pg/mL on Day 28 (P < 0.001). In the aflibercept group, VEGF-A levels significantly decreased to 8.0 (8.0-8.0) pg/mL on Day 7 (P < 0.001) but returned to the baseline level, 12.5 (8.5-14.6) pg/mL, on Day 28 (P = 0.120). Vascular endothelial growth factor-A levels were significantly different between the treatment groups after 28 days (P < 0.001). Intravitreal brolucizumab resulted in a sustained reduction of systemic VEGF-A levels until 28 days posttreatment, which raises concerns regarding its safety and long-term effects.


Cutaneous-delayed hypersensitivity in nursing home and geriatric clinic patients. Implications for the tuberculin test.
Cutaneous-delayed hypersensitivity was studied by one and two-step Mantoux-type skin tests to four standard antigens in 33 elderly nursing home residents, 34 geriatric clinic patients, and 20 healthy young adult controls. Demographic and anthropometric data were collected to determine the effects of nutrition and other variables on cutaneous-delayed hypersensitivity. Anergy (a lack of response greater than 5 mm of induration when read at 48 hours) to any of the four antigens occurred in 34% of nursing home residents, 17% of geriatric clinic patients, and none of the healthy young adults. Mean and maximal responses were less in the nursing home residents than the clinic patients or controls, even if anergic individuals were excluded from analysis, suggesting both a qualitative and quantitative decline in cell-mediated immune function in this elderly population. Repeat testing with each antigen for which there was a negative initial response revealed a "booster" affect of 7 to 19% and occurred as commonly in the healthy young adults as in the nursing home residents or geriatric clinic patients. The mumps antigen elicited strong responses in the healthy young adults, but weak reactions in the nursing home residents. An unexpectedly high prevalence of positive tuberculin (PPD) responses occurred in the nursing home residents, suggesting recent exposure. Analysis of anthropometric and demographic characteristics show that neither nutritional status nor age alone can account for differences in cutaneous-delayed hypersensitivity observed between populations. Cutaneous-delayed hypersensitivity may vary widely between elderly populations and have important practical implications for the tuberculin test.


Heterosexual romantic relationships, interpersonal needs, and quality of life in prison.
The purpose of this study was to investigate the moderating effect of having vs. not having a and quality of life. In-person interviews were conducted with 55 male and 64 female inmates from the Topas Penitentiary (Spain). Higher levels of social loneliness and lower levels of sexual satisfaction were associated with lower levels of quality of life. In addition, the interaction between sexual satisfaction and romantic partner status was significant. Higher levels of sexual satisfaction were associated with higher levels of quality of life only for the group without a partner. These findings support a "bad is stronger than good" principle and indicate the detrimental aspects that can be associated with not having a satisfactory sexual life while incarcerated.


Intraoperative sonography: application in renal cell carcinoma.
Our ability to detect and potentially to treat renal tumors earlier has increased exponentially during recent years, in part owing to the introduction of more sophisticated imaging modalities. We report 2 cases in which intraoperative sonography was used to localize tumors not palpable at operation. In both cases surgery was performed on solitary kidneys for renal cell carcinoma in otherwise healthy patients.


Formation of isoaspartate at two distinct sites during in vitro aging of human growth hormone.
In vitro aging at pH 7.4, 37 degrees C causes natural sequence recombinant human growth hormone (rhGH), methionyl rhGH, and human pituitary growth hormone to become substrates for bovine brain protein carboxyl methyltransferase, an enzyme that modifies the "side chain" alpha-carboxyl group present at atypical isoaspartyl linkages. The substrate capacity of rhGH increased at a rate of 1.8 methyl-accepting sites/day/100 molecules of hormone. Reversed-phase high performance liquid chromatography (HPLC) of trypsin digests of aged rhGH revealed two altered peptides not present in digests of control rhGH. These two fragments, which had the amino acid compositions of residues 128-134 (Leu-Glu-Asp-Gly-Ser-Pro-Arg) and 146-158 (Phe-Asp-Thr-Asn-Ser-His-Asn-Asp-Asp-Ala-Leu-Leu-Lys), contained the majority of the induced methylation sites, 22 and 58%, respectively. Isoaspartate can result from deamidation of asparagine or isomerization of aspartate. Isomerization of Asp-130, the only candidate site in 128-134, was corroborated by coelution of the altered fragment with the synthetic isoaspartyl peptide upon reversed-phase HPLC. Evidence is presented that the altered 146-158 fragment is a mixture of two peptides resulting from deamidation of Asn-149 to form 70-80% isoaspartate and 20-30% aspartate at this position. The position of isoaspartate in the altered 146-158 fragment was deduced from mass spectrometry, which indicated a single deamidated asparagine; from methylation stoichiometry, which indicated only one methylation site; and from automated Edman degradation, which showed an absence of asparagine and a low yield of aspartate at position 149. These results show that isoaspartate formation from both aspartate and asparagine is a significant, and possibly the major, source of spontaneous covalent alteration of rhGH and that enzymatic carboxyl methylation provides a powerful tool for assessing this type of modification.


Leukocyte chemotactic factor 2: A novel renal amyloid protein.
Renal amyloid deposits can often be seen in primary amyloidosis (immunoglobulin light chain disease) or in secondary forms such as reactive amyloidosis as well as in several hereditary forms where a variety of mutant proteins 'precipitate' as amyloid plaques. However, in rare cases, amyloidosis may be identified by renal biopsy, but no definitive diagnosis could be made. We have isolated amyloid fibrils from such a case in which the patient presented with nephrotic syndrome and subsequent azotemia requiring hemodialysis. Evaluation for amyloid deposition in other organ systems was negative and immunohistochemical analysis of the kidney deposits for known contributing proteins was unrevealing. Biochemical analysis of the fibrils identified a new amyloid subunit protein, leukocyte chemotactic factor 2, originally identified as a possible chemotactic and growth factor. A monoclonal antibody to this protein reacted specifically with the amyloid deposits in the glomeruli and interstitium by immunohistochemistry. This study emphasizes the importance of biochemical characterization of amyloid present in renal biopsies.


The norepinephrine-sensitive Ca2+-storage site differs from the caffeine-sensitive site in vascular smooth muscle of the rat aorta.
Using microfluorometry of quin 2, a Ca2+-sensitive dye, we characterized the release and uptake of Ca2+ by the norepinephrine-sensitive Ca2+-storage site and the caffeine-sensitive one. The norepinephrine-sensitive Ca2+-storage site was readily depleted in Ca2+-free medium and almost completely replenished by loading with 1.0 mM Ca2+ solution for 3 min, whereas the caffeine-sensitive site was scarcely affected. Furthermore, norepinephrine has little effect on the caffeine-sensitive Ca2+-storage site in Ca2+-free medium, and vice versa. We conclude that the location and mechanisms of release and uptake of Ca2+ of these two Ca2+-storage sites differ in the case of rat aortic vascular smooth muscle cells in primary culture.


Inhibition of deoxyhypusine hydroxylase by polyamines and by a deoxyhypusine peptide.
The inhibition of deoxyhypusine hydroxylase was studied in vitro. Of the polyamines tested, spermine and its homologue thermine exhibited the strongest inhibition against the enzyme from rat testis. Kinetic analysis revealed that the inhibition by spermine was competitive (Ki, 0.25 +/- 0.02 mM) with respect to the deoxyhypusine protein substrate. Spermidine and its homologue caldine were also inhibitors, but less potent ones than spermine. The spermidine analogues with one or both primary amino groups replaced by the cyano group did not inhibit. A number of diamines, including putrescine, were found to display little or no inhibition. The observed effects of naturally occurring polyamines on deoxyhypusine hydroxylase activity is consistent with a suggestion of regulation of this enzymic activity by cellular levels of polyamines. A synthetic peptide Lys-Thr-Gly-deoxyhypusine-His-Gly-His-Ala-Lys, the amino acid sequence of which corresponds to that surrounding hypusine in eukaryotic initiation factor 4D, was found to display competitive-type inhibition (Ki, 0.44 +/- 0.02 mM) against deoxyhypusine hydroxylase from Chinese hamster ovary cells. Free hypusine and deoxyhypusine, on the other hand, possessed no inhibitory properties. A peptide analogous to the deoxyhypusine nonapeptide with lysine in place of deoxyhypusine had little effect on enzyme activity. The preparation of a derivative of deoxyhypusine, suitably protected for use in the solid-phase synthesis of deoxyhypusine peptides, is described.


Mathematical modeling for antibody therapy in the setting of antigenic modulation.
The in vivo efficacy of passive monoclonal antibody therapy is limited in certain systems by the process of antigenic modulation. We describe a compartmental model which addresses the kinetics of in vivo cell binding of murine monoclonal antibody T101, modulation of the T65 target antigen, serum levels of T101, and elimination of target cells. Observed data compare favorably to that predicted by the model. The model suggests that there is no rationale for administering T101 as a prolonged, continuous infusion for passive antibody therapy.


Adenosquamous lung carcinoma: clinical characteristics, treatment, and prognosis.
Adenosquamous carcinoma of the lung is a rare and poorly described entity. At the University of Chicago between 1974 and 1985, 2.3% (20/873) of patients with lung cancer had well-differentiated adenosquamous carcinoma. As in non-small cell lung cancer, patients with Stage I disease were amenable to operation with 60% (3/5) free from disease between one and six years postoperatively. However, Stage II adenosquamous carcinoma (14 patients) exhibited highly aggressive behavior with rapid progression of disease (mean interval, 2.1 months). Despite combinations of surgery (6 patients), chemotherapy (6 patients, one response), and radiotherapy (10 patients, no response), median survival for patients with Stage III adenosquamous carcinoma was 5.0 months, worse than that for Stage III small cell cancer (9.6 months), adenocarcinoma (9.0 months), and squamous cancer (7.8 months).


Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients hospitalized with COVID-19.
Cardiovascular events in the context of COVID-19 infection increase the risk of negative patient outcomes, but large cohort studies describing this association are limited. The purpose of the current study was to investigate the potential associations between cardiovascular events and mortality in patients hospitalized due to COVID-19. A retrospective chart review was performed in 2450 patients hospitalized for confirmed COVID-19 infection within a single hospital network between March 15 and June 15, 2020. Logistic regression analysis was used to identify predictors of mortality. In the study population, 57% of patients had elevated high sensitivity troponin (hs-TnT) levels. Acute heart failure occurred in 23% of patients and arrhythmias were observed in 8% of patients. Of the 1401 patients with elevated hs-TnT levels, a primary cardiac etiology (e.g., myocardial infarction) was identified in 653 (47%) patients. In the remaining 748 (53%) patients, there was evidence of a primary non-cardiac etiology for hs-TnT elevation such as renal failure (n = 304) and critical illness (n = 286). Elevated hs-TnT was associated with increased risk of mortality. A significantly higher mortality rate was observed for hs-TnT elevation associated with a primary cardiac etiology (OR 4.6, 95% CI: 2.7-7.6; P < 0.001) than a primary non-cardiac etiology (OR 2.7, 95% CI: 1.6-4.5; P < 0.001). Elevated hs-TnT in the context of COVID-19 infection is associated with a significantly increased mortality risk. Hs-TnT elevation in the context of a primary cardiac etiology confers a nearly 2-fold higher mortality risk than hs-TnT elevation due to a primary non-cardiac etiology.


[Continuous access to healthcare, a bond of trust with the patient].
Working with vulnerable patients who are in precarious situations or sometimes do not speak French raises questions about the caregiver's role. A "Permanence d'Accès aux Soins de Santé" (Pass--Continuous Access to Healthcare) requires patient involvement in their healthcare, communicating honestly and taking into account the various difficulties they are faced with every day, using a holistic approach. A physician and two nurses share their points of view and their way of doing things to ensure that their patients find their unique place as the subject of their healthcare.


Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients' Returning to Work (START): A Multi-center, Randomized Controlled Trial.
We developed a comprehensive return to work (RTW) intervention covering physical, psycho-social and practical issues for patients newly diagnosed and evaluated its efficacy in terms of RTW. A multi-center randomized controlled trial was done to evaluate the efficacy of the intervention conducted at two university-based cancer centers in Korea. The intervention program comprised educational material at diagnosis, a face-to-face educational session at completion of active treatment, and three individualized telephone counseling sessions. The control group received other education at enrollment. At 1-month post-intervention (T2), the intervention group was more likely to be working compared to the control group after controlling working status at diagnosis (65.4% vs. 55.9%, p=0.037). Among patients who did not work at baseline, the intervention group was 1.99-times more likely to be working at T2. The mean of knowledge score was higher in the intervention group compared to the control group (7.4 vs. 6.8, p=0.029). At the 1-year follow-up, the intervention group was 65% (95% confidence interval, 0.78 to 3.48) more likely to have higher odds for having work. The intervention improved work-related knowledge and was effective in facilitating cancer patients' RTW.


Aminopeptidase N is involved in cell motility and angiogenesis: its clinical significance in human colon cancer.
The molecular basis of cell motility is highly complex and is controlled by a number of molecular systems, whereas angiogenesis is an important biological component of tumor progression. The aims of this study were to investigate the possible involvement of proteins at the cell surface in controlling cell motility and angiogenesis, and to identify the cell surface molecules involved in gastrointestinal tumors. We addressed these issues using functional monoclonal antibodies, which inhibit cell motility, endothelial cell migration, and tube formation. Furthermore, we investigated the relationship between this antigen and colon cancer, and showed the prognostic significance in human colon cancer. We established a murine monoclonal antibody MH8-11, which inhibits cell motility and in vitro angiogenesis. This epitope was a 165-kilodalton protein, and the sequencing analysis revealed that it was almost identical to aminopeptidase N (APN)/cluster of differentiation (CD) 13. APN/CD13 expression was associated with tumor status (P = 0.025). The disease-free and overall survival rate for patients with positive APN/CD13 expression tumors was significantly lower than that for patients with negative APN/CD13 expression tumors (P = 0.014, 0.033, respectively). Among 47 node-positive patients, the survival rate of patients with negative APN/CD13 expression was better than that of those with positive APN/CD13 expression. Our data suggest that APN/CD13 is involved in cell motility and angiogenesis, and APN/CD13 expression may be a useful indicator of a poor prognosis for node-positive patients with colon cancer.


Buffalo hump in HIV patients: surgical management with liposuction.
Although lipohypertrophy has been reported in as many as 41% of patients with HIV, buffalo hump or cervical lipomatosis has been reported in only 1-2% of patients. There is no definitive medical treatment for this disabling condition. Few case series describing the role of liposuction in buffalo lump treatment have been published, with variable short-term and long-term results. We describe our experience in two patients, with a brief review of the literature.


U.S. perspective: Meat demand outdoes meat avoidance.
Despite ample discussion of health, environment, and animal welfare effects of meat production and consumption, this article documents past, current, and projected consumption patterns reflecting robust meat demand in the United States. There is some evidence of meat avoidance behavior among a segment of the population, including younger, higher educated, higher income consumers in the Western United States. At the same time, the majority of U.S. residents self-declare as regularly consuming products from animals, and there is evidence of strong demand growth for meat products in recent years. Key factors influencing protein purchasing decisions are presented revealing critical roles of taste, freshness, and safety. Combined this article summarizes both the aggregate and more refined, household-level situation underlying robust meat demand in the U.S.


Multi-scale Chimerism: An experimental window on the algorithms of anatomical control.
Despite the immense progress in genetics and cell biology, major knowledge gaps remain with respect to prediction and control of the global morphologies that will result from the cooperation of cells with known genomes. The understanding of cooperativity, competition, and synergy across diverse biological scales has been obscured by a focus on standard model systems that exhibit invariant species-specific anatomies. Morphogenesis of chimeric biological material is an especially instructive window on the control of biological growth and form because it emphasizes the need for prediction without reliance on familiar, standard outcomes. Here, we review an important and fascinating body of data from experiments utilizing DNA transfer, cell transplantation, organ grafting, and parabiosis. We suggest that these are all instances (at different levels of organization) of one general phenomenon: chimerism. Multi-scale chimeras are a powerful conceptual and experimental tool with which to probe the mapping between properties of components and large-scale anatomy: the laws of morphogenesis. The existing data and future advances in this field will impact not only the understanding of cooperation and the evolution of body forms, but also the design of strategies for system-level outcomes in regenerative medicine and swarm robotics.


PET studies of 18F-memantine in healthy volunteers.
Previous studies in mice and PET investigations in a Rhesus monkey showed that the regional uptake of 18F-memantine could be blocked by pharmacological doses of memantine and (+)-MK-801. In the present study, the binding characteristics of 18F-memantine was examined in five healthy volunteers. In humans, 18F-memantine was homogeneously distributed in gray matter i.e. cortex and basal ganglia regions, as well as the cerebellum. No radioactive metabolites were detected in plasma during the time-frame of the PET studies. The uptake of 18F-memantine in receptor-rich regions such as striatum and frontal cortex could be well described by a 1-tissue compartment model. The DV" values of all gray matter regions were similar and ranged from 15 to 20 ml/ml. The white matter showed lower DV" values of 15 +/- 1.4 ml/ml. These results suggest that 18F-memantine distribution in human brain does not reflect the regional NMDA receptor concentration, and therefore, this radioligand is not suitable for the PET imaging of the NMDA receptors.


Extensor tendon injuries. Presentation of a series of ninety-nine cases.
A series of 99 cases of injuries of the extensor system, followed in the 3 Traumatology and Orthopedics Ward (Dijon, France) is presented. Results were analyzed according to Verdan's classification. In most cases, a Jenning "barb-wire" type repair, introduced in France by Y. Allieu, was made. Early mobilization and skin tension problems are emphasized; two cases of degloving on the dorsum of the hand are presented with details. As well, a special place concerning the results of repair in the proximal interphalangeal joint must be reserved, because of the very frequent association of articular destruction and the very difficult problem s of surgical management which arise in these cases.