Post-explant visualization of thrombi in outflow grafts and their junction to a continuous-flow total artificial heart using a high-definition miniaturized camera.
Post-explant evaluation of the continuous-flow total artificial heart in preclinical studies can be extremely challenging because of the device's unique architecture. Determining the exact location of tissue regeneration, neointima formation, and thrombus is particularly important. In this report, we describe our first successful experience with visualizing the Cleveland Clinic continuous-flow total artificial heart using a custom-made high-definition miniature camera.


Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement.
To determine whether the use of tranexamic acid in the setting of hypotension induced by hypotensive epidural anesthesia (HEA) has any additional beneficial effects in reducing perioperative blood loss and transfusion requirements in total hip replacement. Prospective, randomized, double-blinded trial. University-affiliated hospital. 68 adult, ASA physical status 1 and 2 patients undergoing primary unilateral cementless total hip replacement with general anesthesia and HEA. The HEATA group received a bolus dose of 15 mg/kg of tranexamic acid before surgical incision, followed by a continuous 15 mg/kg infusion until skin closure. The HEA group received normal saline instead of tranexamic acid in the same manner. Intraoperative blood loss was measured using the difference between the weights of used gauze and the original unused gauze, in addition to the blood volume accumulated in suction bottles. Postoperative blood loss was considered to be the amount of blood accumulated in drainage bags. There was no significant difference in intraoperative blood loss between the HEA and HEATA groups (251.8 ± 109.9 mL vs. 234.9 ± 93.9 mL), but postoperative blood loss was significantly less in the HEATA group than the HEA group (439.3 ± 171. 6 mL vs. 1074.4 ± 287.1 mL), as was total cumulative blood loss (674.2 ± 216.4 mL vs. 1326.2 ± 347.8 mL). There was no significant difference in intraoperative transfusion incidences, but postoperative transfusion was greater in the HEA group than the HEATA group. Administration of tranexamic acid combined with hypotensive epidural anesthesia reduced postoperative and total accumulative blood loss and transfusion requirements more than did hypotensive epidural anesthesia alone.


Vestibular Exercises as a Fall Prevention Strategy in Patients with Cognitive Impairment.
Vestibular impairment (VI) and cognitive impairment (CI) are risk factors for senior falls. We tested the feasibility of a self-directed 12-week vestibular rehabilitation (VR) program in Memory Clinic patients (65 years+) with a fall, CI and VI. We assessed recruitment, exercise adherence and ability to complete questionnaires/assessments. Twelve patients with CI and falls were screened and 8/12 (75% - prevalence) had VI. All patients completed the screening tests/questionnaires (100% - completeness); 7/8 patients were recruited (87.5% - recruitment); 1/7 (85.7% - attrition) patient attended follow-up. VI is prevalent in patients with CI experiencing falls but traditional VR is not feasible, so a novel delivery of VR must be explored.


Attentional distractor interference may be diminished by concurrent working memory load in normal participants and traumatic brain injury patients.
A reduction in congruency effects under working memory (WM) load has been previously described using different attentional paradigms (e.g., Kim, Kim, & Chun, 2005; Smilek, Enns, Eastwood, & Merikle, 2006). One hypothesis is that different types of WM load have different effects on attentional selection, depending on whether a specific memory load demands resources in common with target or distractor processing. In particular, if information in WM is related to the distractors in the selective attention task, there is a reduction in distraction (Kim et al., 2005). However, although previous results seem to point to a decrease in interference under high WM load conditions (Kim et al., 2005), the lack of a neutral baseline for the congruency effects makes it difficult to differentiate between a decrease in interference or in facilitation. In the present work we included neutral trials in the task introduced by Kim et al. (2005) and tested normal participants and traumatic brain injury patients. Results support a reduction in the processing of distractors under WM load, at least for incongruent trials in both groups. Theoretical as well as applied implications are discussed.


The second PGD(2) receptor CRTH2: structure, properties, and functions in leukocytes.
Prostaglandin (PG) D(2) plays a broad range of physiological and pathophysiological functions. Until just a few years ago, it was thought that most of the biological actions of PGD(2) are mediated via the classical PGD(2) receptor DP. Recently, we identified a second PGD(2) receptor, chemoattractant receptor-homologous molecule expressed on T helper (Th)2 cells (CRTH2), with different functions relative to DP. Here, we review the recent findings on the structure, tissue distribution, ligand selectivity, signalling pathways, and functions in leukocytes of this receptor. The data suggest that the PGD(2)/CRTH2 system play important roles in allergic inflammation through its stimulatory effects on Th2 cells, eosinophils, and basophils.


Deafness in an old English sheepdog. A case report.
The histopathological features of the inner ears in a case of deafness in an old English sheepdog reveal a cochleo-saccular (Scheibe) type of degeneration. However, also the hair cells in the vestibular part of the labyrinth were reduced in number though there appeared no clinical signs or symptoms of vestibular dysfunction. The present case is the so far only known old English sheepdog with a hearing loss reported in Sweden.


Plasma arginine esterase in cystic fibrosis: kinetics of activation, identification as plasma kallikrein, reaction with alpha 2-macroglobulin and comparison with levels in normal plasma.
Treatment of normal plasma with chloroform and ellagic acid yielded esterase activity against tosylarginine methyl ester, which reached a maximum within 2 h. After 2 h most or all of the activity as resistant to inhibition by soybean trypsin inhibitor (STI), but was still sensitive to the low molecular weight inhibitors di-isopropyl fluorophosphate, aprotinin and prolyl-phenylalanyl-arginyl chloromethane. The activity ran in gel chromatography with alpha 2 macroglobulin (ampha 2M), as if it were due to an alpha 2M proteinase complex. The generation of the arginine esterase activity by chloroform and ellagic acid was apparently dependent on the activation of factor XII, being blocked by Polybrene. In plasma pretreated with methylamine-HCl (an inactivator of alpha 2M), the arginine esterase was 95% sensitive to inhibition by STI. With regard to substrate specificity, inhibition characteristics, and gel chromatographic behaviour, it was indistinguishable from plasma kallikrein (EC 126.96.36.199, formerly 220.127.116.11). The chloroform and ellagic acid treatment of plasma resulted in a disappearance of prokallikrein simultaneous with the appearance of the arginine esterase. By these criteria, the arginine esterase activity was attributable entirely to plasma kallikrein either in its free form (methylamine-treated plasma) or bound to alpha 2M (buffer-treated plasma). Comparisons of STI-sensitive and STI-resistant arginine esterase activities of plasma samples from cystic fibrosis patients, obligate heterozyotes or other groups showed no significant differences in levels of activity, kinetics of activation or gel chromatographic behaviour. We conclude that cystic fibrosis is unrelated to any abnormality in plasma arginine esterase activity, contrary to some previous reports.


Quality evaluation of meshed split-thickness skin grafts stored at 4°C in isotonic solutions and nutrient media by cell cultures.
Excess split-skin autografts harvested and meshed during burn surgery are often stored at 4°C temporarily for later use. The quality of the stored skin is critical to clinical outcome and needs to be assured. Meshed split-thickness skin graft (mSSG) stored in saline, Hartmann's solution and two cell culture media, Dulbecco's Modified Eagle Medium (DMEM) and DMEM/Ham F12 (DMEM/F12, 3:1 mixture) were analyzed by trypan blue staining, cell culture and microbiological testing through a 28-day time course for cell viability and microbial contamination. mSSG samples in all groups showed a progressive decrease of cell viability and colony forming efficiency through the time course of storage at 4°C. Cell culture media were better than saline and Hartmann's solution in maintaining the viability and growth capability of skin cells. The viability observed by trypan blue staining did not truly reflect the cell growth capacity after storage. mSSG in saline and Hartman's solution retained minimal keratinocyte growth potency after 7 days. mSSG in cell culture media had significant loss of keratinocyte colony growth potency after 7 days and minimal keratinocyte growth after 14 days. Dermal fibroblasts of all groups were less tolerant than keratinocytes to the storage. Microbial contaminations were common in mSSG harvested from burn surgery. Culture media instead of saline or Hartman's solution should be used for temporary storage of mSSG at 4°C. The stored mSSS should be used within seven days to have sufficient viable number and cell growth efficiency. After then, the efficacy of stored mSSG as a source of living cells for wound closure could be full of uncertainty due to significant decrease of keratinocyte colony forming efficiency. Precaution should be taken during skin harvest and storage to minimize the risk of sample contamination. Inclusion of antimicrobial agents in storage solution and microbiological testing are advisable to ensure the quality and clinical outcome.


Endoplasmic reticulum stress and MAPK signaling pathway activation underlie leflunomide-induced toxicity in HepG2 Cells.
Leflunomide, used for the treatment of rheumatoid arthritis, has been reported to cause severe liver problems and liver failure; however, the underlying mechanisms are not clear. In this study, we used multiple approaches including genomic analysis to investigate and characterize the possible molecular mechanisms of the cytotoxicity of leflunomide in hepatic cells. We found that leflunomide caused endoplasmic reticulum (ER) stress and activated an unfolded protein response, as evidenced by increased expression of related genes including CHOP and GADD34; and elevated protein levels of typical ER stress markers including CHOP, ATF-4, p-eIF2α, and spliced XBP1. The secretion of Gaussia luciferase was suppressed in cells treated with leflunomide in an ER stress reporter assay. Inhibition of ER stress with an ER stress inhibitor 4-phenylbutyrate, and knockdown of ATF-4 and CHOP genes partially protected cells upon leflunomide exposure. In addition, both genomic and biochemical analyses revealed that JNK and ERK1/2 of MAPK signaling pathways were activated, and both contributed to the leflunomide-induced cytotoxicity. Inhibiting JNK activation using a JNK inhibitor attenuated the ER stress and cytotoxicity of leflunomide, whereas inhibiting ERK1/2 using an ERK1/2 inhibitor or ERK1/2 siRNA increased the adverse effect caused by leflunomide, suggesting opposite roles for the two pathways. In summary, our data indicate that both ER stress and the activation of JNK and ERK1/2 contribute to leflunomide-induced cytotoxicity.


Adenosine A1 receptors mediate the intracisternal injection of orexin-induced antinociceptive action against colonic distension in conscious rats.
We have recently demonstrated that orexin acts centrally through the brain orexin 1 receptors to induce an antinociceptive action against colonic distension in conscious rats. Adenosine signaling is capable of inducing an antinociceptive action against somatic pain; however, the association between changes in the adenosinergic system and visceral pain perception has not been investigated. In the present study, we hypothesized that the adenosinergic system may be involved in visceral nociception, and thus, adenosine signaling may mediate orexin-induced visceral antinociception. Visceral sensation was evaluated based on the colonic distension-induced abdominal withdrawal reflex (AWR) in conscious rats. Subcutaneous (0.04-0.2mg/rat) or intracisternal (0.8-4μg/rat) injection of N(6)-cyclopentyladenosine (CPA), an adenosine A1 receptor (A1R) agonist, increased the threshold volume of colonic distension-induced AWR in a dose-dependent manner, thereby suggesting that CPA acts centrally in the brain to induce an antinociceptive action against colonic distension. Pretreatment with theophylline, an adenosine antagonist, or 1,3-dipropyl-8-cyclopentylxanthine, an A1R antagonist, subcutaneously injected potently blocked the centrally injected CPA- or orexin-A-induced antinociceptive action against colonic distension. These results suggest that adenosinergic signaling via A1Rs in the brain induces visceral antinociception and that adenosinergic signaling is involved in the central orexin-induced antinociceptive action against colonic distension.


Magnetic resonance imaging radiomic analysis can preoperatively predict G1 and G2/3 grades in patients with NF-pNETs.
We aimed to explore the relationship between the magnetic resonance imaging (MRI) radiomic score (rad-score) and the grades of non-functioning pancreatic neuroendocrine tumors (NF-pNETs) and evaluate the potential of the calculated MRI rad-score to differentiate grade 1 from grade 2/3 NF-pNETs. This retrospective study assessed 157 patients with surgically resected, pathologically confirmed NF-pNETs who underwent magnetic resonance scans from November 2012 to December 2019. Radiomic features were extracted from arterial and portal venous MRI. The least absolute shrinkage and selection operator method were used to select the features. Multivariate logistic regression models were used to analyze the association between the MRI rad-score and NF-pNET grades. The MRI rad-score performance was assessed based on its discriminative ability and clinical usefulness. The MRI rad-score, which consisted of seven selected features, was significantly associated with the NF-pNET grades. Every 1-point increase in the rad-score was associated with a 35% increased risk of grade 2/3 disease. The score also showed high accuracy (area under the curve = 0.775). The best cut-off point for maximal sensitivity and specificity was at 0.41. In the decision curves, when the threshold probability was higher than 0.3, the rad-score used in this study to distinguish grades 1 and 2/3 NF-pNETs offered more benefits than the use of a treat-all-patients or a treat-none scheme. The MRI rad-score showed a significant association with the grades of NF-pNETs. Thus, it may be used as a valuable non-invasive tool for differential NF-pNET grading.


Characterization of mimivirus NAD+-dependent DNA ligase.
Mimivirus, a parasite of Acanthamoeba polyphaga, is the largest DNA virus known; it encodes a cornucopia of proteins with imputed functions in DNA replication, modification, and repair. Here we produced, purified, and characterized mimivirus DNA ligase (MimiLIG), an NAD+-dependent nick joining enzyme homologous to bacterial LigA and entomopoxvirus DNA ligase. MimiLIG is a 636-aa polypeptide composed of an N-terminal NAD+ specificity module (domain Ia), linked to nucleotidyltransferase, OB-fold, helix-hairpin-helix, and BRCT domains, but it lacks the tetracysteine Zn-binding module found in all bacterial LigA enzymes. MimiLIG requires conserved domain Ia residues Tyr36, Asp46, Tyr49, and Asp50 for its initial reaction with NAD+ to form the ligase-AMP intermediate, but not for the third step of phosphodiester formation at a preadenylylated nick. MimiLIG differs from bacterial LigA enzymes in that its activity is strongly dependent on the C-terminal BRCT domain, deletion of which reduced its specific activity in nick joining by 75-fold without affecting the ligase adenylylation step. The DeltaBRCT mutant of MimiLIG was impaired in sealing at a preadenylylated nick. We propose that eukaryal DNA viruses acquired the NAD+-dependent ligases by horizontal transfer from a bacterium and that MimiLIG predates entomopoxvirus ligase, which lacks both the tetracysteine and BRCT domains. We speculate that the dissemination of NAD+-dependent ligase from bacterium to eukaryotic virus might have occurred within an amoebal host.


Strategies utilized to prevent and control SARS-CoV-2 transmission in two congregate, psychiatric healthcare settings during the pandemic.
The COVID-19 pandemic has had a substantial effect on the delivery of psychiatric health care. Inpatient psychiatric health care facilities have experienced outbreaks of COVID-19, making these areas particularly vulnerable. Our facility used a multidisciplinary approach to implement enhanced infection prevention and control (IPC) interventions in our psychiatric health care areas. In a 16-month period during the COVID-19 pandemic, our 2 facilities provided >29,000 patient days of care to 1,807 patients and identified only 47 COVID-19 positive psychiatric health inpatients (47/1,807, or 2.6%). We identified the majority of these cases by testing all patients at admission, preventing subsequent outbreaks. Twenty-one psychiatric health care personnel were identified as COVID+ during the same period, with 90% linked to an exposure other than a known positive case at work. The IPC interventions we implemented provided multiple layers of safety for our patients and our staff. Ultimately, this resulted in low SARS-CoV-2 infection rates within our facilities. Psychiatric health care facilities are uniquely vulnerable to COVID-19 outbreaks because they are congregate units that promote therapeutic interactions in shared spaces. IPC interventions used in acute medical care settings can also work effectively in psychiatric health care, but often require modifications to ensure staff and patient safety.


Application of collapsing methods for continuous traits to the Genetic Analysis Workshop 17 exome sequence data.
Genetic Analysis Workshop 17 used real sequence data from the 1000 Genomes Project and simulated phenotypes influenced by a large number of rare variants. Our aim is to evaluate the performance of various collapsing methods that were developed for analysis of multiple rare variants. We apply collapsing methods to continuous phenotypes Q1 and Q2 for all 200 replicates of the unrelated individuals data. Within each gene, we collapse (1) all SNPs, (2) all SNPs with minor allele frequency (MAF) < 0.05, and (3) nonsynonymous SNPs with MAF < 0.05. We consider two tests when collapsing variants: using the proportion of variants and using the presence/absence of any variant. We also compare our results to a single-marker analysis using PLINK. For phenotype Q1, the proportion test for collapsing rare nonsynonymous SNPs often performed the best. Two genes (FLT1 and KDR) had statistically significant results. A single-marker analysis using PLINK also provided statistically significant results for some SNPs within these two genes. For phenotype Q2, collapsing rare nonsynonymous SNPs performed the best, with almost no difference between proportion and presence tests. However, neither collapsing methods nor a single-marker analysis provided statistically significant results at the true genes for Q2. We also found that a large number of noncausal genes had high correlations with causal genes for Q1 and Q2, which may account for inflated false positives.


Prenatal care: the patient's perspective. A qualitative study.
To investigate the subjective experiences and perceptions of the prenatal care system for women following a prenatal diagnosis and to assess the factors related to dissatisfaction with medical treatment. Data derived from a follow-up investigation in fifty women following a prenatal diagnosis is presented. Women were asked to give written comments concerning their feelings and experiences during their time at the prenatal care unit. A qualitative content analysis was performed in order to examine the patients' perceptions and expectations of the prenatal care management and to seek potential associations of certain attitudes with socio-demographic, clinical, or psychological characteristics. Womens' comments were coded within established categories including 'satisfaction', 'dissatisfaction' and 'communicated emotionality'. A high proportion of women were found to be dissatisfied with the physicians' attitudes (42%), the amount of information provided (46%), and medical staffs' attitudes (30%). One criticism, in particular, concerned a lack of communication skills in doctors and medical staff members. Forty-eight percent of our study population mentioned that they had benefited from psychological support. 'Nullipara' was the only variable associated with dissatisfaction with the received prenatal care. The results of the study suggest that the high degree of discontent found in prenatal care patients could at least in some part be alleviated by implementation of communication training and supervision services for prenatal care workers. Moreover, nullipara may constitute a particular vulnerable subgroup that may need special attention and support. However, given the qualitative nature of our study, our results warrant replication in further empirically based research.


Ser-256 phosphorylation dynamics of Aquaporin 2 during maturation from the ER to the vesicular compartment in renal cells.
Aquaporin 2 (AQP2) phosphorylation at Ser-256 by protein kinase A (PKA) is a key signal for vasopressin-stimulated AQP2 insertion into the plasma membrane in renal cells. This study underscores the possible role of phosphorylation at Ser-256 in regulating AQP2 maturation. AQP2-transfected renal CD8 cells were incubated with brefeldin A (BFA) to accumulate newly synthesized AQP2 in the endoplasmic reticulum (ER), and AQP2 flow from ER to the vesicular compartment was analyzed after BFA washout. We found that a) in the ER, AQP2 is weakly phosphorylated; b) the amount of phosphorylated AQP2 (p-AQP2) at Ser-256 increased significantly during transit in the Golgi, even in the presence of the PKA inhibitor H89; and c) AQP2 transport from the Golgi to the vasopressin-regulated vesicular compartment occurred with a concomitant decrease in p-AQP2 at Ser-256. These results support the hypothesis that AQP2 transition in the Golgi apparatus is associated with a PKA-independent increase in AQP2 phosphorylation at Ser-256. Conversely, impaired constitutive phosphorylation in a Golgi-associated compartment occurring in cells expressing mutated S256A-AQP2 or E258K-AQP2 causes phosphorylation-defective AQP2 routing to lysosomes. This result might explain the molecular basis of the dominant form of nephrogenic diabetes insipidus caused by the mutation E258K-AQP2, in which the phenotype is caused by an impaired routing of AQP2.


Synthesis and biological evaluation of oleanolic acid derivatives as antitumor agents.
Derivatives of oleanolic acid were synthesized and evaluated in vitro for their growth inhibition against human hepatocellular carcinoma cell line (HepG2) and colon cancer cell line (Col-02). Several derivatives exhibited moderate-to-good inhibitory activity, with 3 displaying the most promising inhibition [GI₅₀ = 1.75 μM (HepG2), 0.71 μM (Col-02)]. Structure-activity relationship analyses of these derivatives demonstrated that a 1-en-2-cyano-3-oxo in ring A and a nitro at C-17 were important in retention of the inhibition against HepG2 and Col-02 cells.


Testing the specificity of interpretation biases in women with eating disorder symptoms: An online experimental assessment.
Cognitive biases, such as memory, attention, and interpretation bias, are thought to play a central role in the development and maintenance of eating disorders (EDs). The aim of the present study was to investigate whether the interpretation bias is ED-specific or can be generalized to comorbid disorder-related threats in women with high levels of ED symptoms. In an online study, we measured interpretation bias using the modified Sentence Word Association Paradigm (SWAP), comparing women with (n = 39) and without (sub)threshold eating disorders (n = 56). We assessed endorsement and rejection rates as well as reaction times in response to a positive/neutral or a negative ED-specific, social anxiety-specific (SAD), or generalized anxiety-specific (GAD) interpretive word following an ambiguous sentence. In ambiguous situations, women with high ED symptoms selected more negative (p < .001) and fewer positive/neutral ED-related interpretations (p < .001). Negative interpretations were endorsed significantly faster (p < .001), while positive interpretations were rejected faster in this group (p < .001). These women also manifested negative SAD-specific interpretation bias patterns in reaction time measures. Nevertheless, ED severity was best predicted by the endorsement of negative ED-specific stimuli, whereas ED and SAD reaction time measures seemed to have a negligible effect. The results indicate that the interpretation bias might be ED-specific. The SWAP can be a useful tool for the further investigation of the etiological relevance of the interpretation bias as well as for the development of modification training interventions.


Splanchnic acid-base status and urea metabolism in uremic rats.
Acidosis may alter hepato-splanchnic amino acid metabolism during uremia.26 uremic rats and 30 controls were studied for portal and arterial acid-base balance and urea synthesis during enteral nutrition. Uremic rats exhibited increased (p < 0.05) portal H(+) (47.20 +/- 0.018 vs 43.05 +/- 0.49 nmol/I) and decreased HCO(3)(-) (19.45 +/- 0.69 vs 23.01 +/- 0.57 mmol/l) without significant change in arterial H(+) (45.29 +/- 1.13 vs 43.15 +/- 0.49) and HCO(3)(-) (18.41 +/- 0.64 vs 19.59 +/- 0.49). Porto-arterial difference showed an intestinal HCO(3)(-) release in controls only (3.53 +/- 0.64 mmol/l). Urea synthesis rate was significantly enhanced by enteral nutrition in controls only: 54.33 +/- 17.3 vs -11.8 +/- 20 micromol/min 100g body mass. Thus, during uremia, portal acidosis was associated with a decrease in enteral nutrition-induced urea synthesis.


An analysis of 13 patients with perforated gastric carcinoma: A surgeon's nightmare?
Perforation is a rare complication of gastric carcinoma and generally not diagnosed preoperatively. To clarify the clinicopathologic characteristics of patients with this condition we reviewed 13 cases of gastric cancer perforation who required emergency surgery. A total of 13 patients with gastric cancer perforation were retrospectively reviewed. The clinicopathological features including tumor stage and survival and also the type of treatment were analyzed and compared to literature data. There were 13 patients (10 males and 3 females) with a mean age of 59.0 +/- 9.56 years. The incidence of perforated gastric cancer was 9.6% among gastric carcinoma and 4.2% of all gastric perforation cases. The perforation was more frequently in stage III-IV (2-10), but one case of stage II (T3N0M0) gastric cancer was also observed. None of the patients had curative resection or radical lymph-node dissection. Six (46%) patients were treated by palliative, local surgery. Emergency gastrectomy were performed in 7 (54%) patients. Overall 30-day mortality rate was % 46. The overall survival time was 128.2 +/- 184.8 days for all patients, it was 52.8 +/- 52.9 days for locally treated group, and 192.9 +/- 235.4 days for patients who underwent resectional surgery. The difference between the treatment groups was not significant Perforation usually occurs in advanced stages of gastric cancer. These patients had a poor prognosis because of the presence of advanced cancer.


Percutaneous and minimally invasive valve procedures: a scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group.
The incidence of valvular heart disease is expected to increase over the next several decades as a large proportion of the US demographic advances into the later decades of life. At the same time, the next several years can be anticipated to bring a broad transition of surgical therapy to minimally invasive (minithoracotomy and small port) access and the more gradual introduction of percutaneous approaches for the correction of valvular heart disease. Broad acceptance of these technologies will require careful and sometimes perplexing comparisons of the outcomes of these new technologies with existing standards of care. The validation of percutaneous techniques, in particular, will require the collaboration of cardiologists and cardiac surgeons in centers with excellent surgical and catheter experience and a commitment to trial participation. For the near term, percutaneous techniques will likely remain investigational and will be limited in use to patients considered to be high risk or to inoperable surgical candidates. Although current-generation devices and techniques require significant modification before widespread clinical use can be adopted, it must be expected that less invasive and even percutaneous valve therapies will likely have a major impact on the management of patients with valvular heart disease over the next several years.


Corrigendum: Evaluation of success criteria for temporomandibular joint arthrocentesis.
[This corrects the article on p. 15 in vol. 45, PMID: 30847292.].


Isolation and identification of inhibitory compounds on TNF-alpha production from Magnolia fargesii.
Three TNF alpha-inhibitory lignans were isolated from the flower buds of Magnolia fargesii through bioassay-guided isolation. They were identified as eudesmin, magnolin and lirioresinol-B dimethylether on the basis of their spectroscopic data. All three lignans showed inhibitory effects on TNF-alpha production in LPS-stimulated murine macrophage cell line, RAW264.7 and eudesmin showed the strongest activity (IC50 = 51 microM).


Gene synteny and evolution of genome architecture in trypanosomatids.
The trypanosomatid protozoa Trypanosoma brucei, Trypanosoma cruzi and Leishmania major are related human pathogens that cause markedly distinct diseases. Using information from genome sequencing projects currently underway, we have compared the sequences of large chromosomal fragments from each species. Despite high levels of divergence at the sequence level, these three species exhibit a striking conservation of gene order, suggesting that selection has maintained gene order among the trypanosomatids over hundreds of millions of years of evolution. The few sites of genome rearrangement between these species are marked by the presence of retrotransposon-like elements, suggesting that retrotransposons may have played an important role in shaping trypanosomatid genome organization. A degenerate retroelement was identified in L. major by examining the regions near breakage points of the synteny. This is the first such element found in L. major suggesting that retroelements were found in the common ancestor of all three species.


Surface glycoprotein components in isolated melanotic melanoma cells in the golden hamster.
A study of glycoprotein components in trypsin-digested material from the surface of isolated melanotic melanoma cells showed presence of amino sugars, protein-bound hexoses, fucose and sialic acids. The high content of fucose and low content of sialic acids in the surface material from the cells were striking.


Molecular mechanisms of action and potential biomarkers of growth inhibition of dasatinib (BMS-354825) on hepatocellular carcinoma cells.
Molecular targeted therapy has emerged as a promising treatment of Hepatocellular carcinoma (HCC). One potential target is the Src family Kinase (SFK). C-Src, a non-receptor tyrosine kinase is a critical link of multiple signal pathways that regulate proliferation, invasion, survival, metastasis, and angiogenesis. In this study, we evaluated the effects of a novel SFK inhibitor, dasatinib (BMS-354825), on SFK/FAK/p130CAS, PI3K/PTEN/Akt/mTOR, Ras/Raf/MAPK and Stats pathways in 9 HCC cell lines. Growth inhibition was assessed by MTS assay. EGFR, Src and downstream proteins FAK, Akt, MAPK42/44, Stat3 expressions were measured by western blot. Cell adhesion, migration and invasion were performed with and without dasatinib treatment. The IC50 of 9 cell lines ranged from 0.7 μM ~ 14.2 μM. In general the growth inhibition by dasatinib was related to total Src (t-Src) and the ratio of activated Src (p-Src) to t-Src. There was good correlation of the sensitivity to dasatinib and the inhibition level of p-Src, p-FAK576/577 and p-Akt. No inhibition was found on Stat3 and MAPK42/44 in all cell lines. The inhibition of cell adhesion, migration and invasion were correlated with p-FAK inhibition. Dasatinib inhibits the proliferation, adhesion, migration and invasion of HCC cells in vitro via inhibiting of Src tyrosine kinase and affecting SFK/FAK and PI3K/PTEN/Akt, but not Ras/Raf/MEK/ERK and JAK/Stat pathways. T-Src and p-Src/t-Src may be useful biomarkers to select HCC patients for dasatinib treatment.


The life cycle of Rhipicephalus lunulatus Neumann, 1907 (Acarina:Ixodidae) under laboratory conditions, with notes on its ecology in Zimbabwe.
The durations of the developmental periods of Rhipicephalus lunulatus at 25 degrees C and 87% RH were: preoviposition, 2-9 days; oviposition, 29-34 days; minimum incubation, 11-27 days; nymphal premoult period, 11-23 days; and adult premoult period, 19-30 days. The durations of the feeding periods on a rabbit were: 3-7 days for larvae and 4-11 days for nymphs. Adult feeding was completed on a rabbit and a sheep in 10-22 days in January and 14-64 days in September, and only fertilized females completed engorgement. The mean number of eggs laid by engorged females was 4732, with 95% being laid within the first 16 days. In the southeastern lowveld of Zimbabwe adult ticks were most abundant on cattle between November and December, and their preferred sites of attachment were the legs and tail. Other hosts of adult R. lunulatus were impala (Aepyceros melampus), warthog (Phacochoerus aethiopicus), kudu (Tragelaphus strepsiceros) and eland (Taurotragus oryx).


Depression and Medication Beliefs in African Americans with Diabetes.
Medication non-adherence impacts health significantly in African Americans with diabetes. We performed a retrospective data analysis on 56 patients who presented to the emergency departments of two hospitals in Philadelphia, PA, USA. Demographic data, medical history, and point-of-care hemoglobin A1c were collected at baseline. Using Spearman rank correlations, we examined whether depressive symptoms measured with the Patient Health Questionnaire-9 (PHQ-9) were associated with diabetes health beliefs, which were assessed with the Diabetes Health Belief Scale (DHBS). PHQ-9 scores were significantly correlated with DHBS's Perceived Side Effects scores [r(56) = 0.474, p < 0.01] and Perceived Barriers scores [r(56) = 0.337, p < 0.05]. These findings suggest that negative health beliefs may play a role in the relationship between depression and low medication adherence. Treatment of diabetes in middle-aged and older African American individuals should address both depression and negative health beliefs on side effects and perceived barriers.


Indications, complications and long-term follow-up of patients undergoing percutaneous endoscopic gastrostomy: A retrospective study.
Gastroenterology units have faced a major increase in referrals for PEG insertion over the last decade. For this reason we decided to review our PEG insertion procedures with regard to indications, complications and follow-up. The indications, success of procedure, complications, long-term results of PEG in patients of Gulhane Military Medical Academy, Haydarpasa Training Hospital between October 2002 and April 2009 were retrospectively evaluated. 81 patients had undergone PEG insertion and follow-up information has been available for 77 patients. 40 were men with the mean age of all patients 70.74 ± 20.82 (range 20 to 104 years). PEG was successfully placed in all patients except in one patient who had gastric bleeding during the procedure. There was only one mortality related with the placement procedure. The most common indication for PEG was neurologic disorders in 71 (92%) patients. Other indications were head and neck cancers in 6 (8%) patients. Median follow-up period was 12 months (range, 3 days to 78 months). PEG related complications were seen in only 14 patients (18.2%) in 16 events with a total complication rate as 21%. PEG placement is a safe procedure and well-tolerated with a low mortality and complication rate even in older patients who have multiple co-morbidities under adequate precautions.


Comparative in vitro and DFT antioxidant studies of phenolic group substituted pyridine-based azo derivatives.
Two azo compounds 2-(3-pyridylazo)-3,5-dihydroxybenzoic acid (PAB) and 4-(3-pyridylazo)resorcinol (PAR) thought to have the potential to be used as antioxidants were designed, synthesized and antioxidant activities were investigated both in vitro and in silico. The synthesized compounds were characterized by 1H-NMR, 13C-NMR, FT-IR, UV-Vis and mass spectra. The molecular geometry and vibrational frequency calculations of the synthesized compounds in ground state were performed by the density functional theory (DFT) employing B3LYP level with the 6-311 G(d,p) basis set. The gauge independent atomic orbital (GIAO) method was used to determine the chemical shift values of 1H-NMR and 13C-NMR. HOMO-LUMO calculations were carried out by time-dependent DFT (TD-DFT) approach. Computational spectroscopic data of the synthesized compounds are fully compatible with experimental ones. The antioxidant activities of the PAB and PAR were investigated by using DPPH assay. It was determined that the PAB molecule showed better antioxidant activity than PAR and, butylated hydroxytoluene (BHT) which is the standard antioxidant. In addition, the thermodynamic stability parameters obtained with the help of DFT calculations were found to be quite compatible with the antioxidant capacity sequence derived from the DPPH assay. HighlightsTwo pyridine derivative azo compounds were synthesized and evaluated for its antioxidant activityMolecular geometry and spectroscopic properties of the molecules were calculatedin vitro and in silico antioxidant activities were investigated by DPPH free radical scavenging assayThe PAB molecule showed better antioxidant activity than BHTCommunicated by Ramaswamy H. Sarma.


Use of vena cava to extend the right renal vein in cadaveric transplants.
A method to extend the length of the right renal vein of cadaveric kidneys is described. Use of this technique establishes vascular anastomosis and makes positioning of the right kidney technically easier.


A subset of gastrointestinal stromal tumors previously regarded as wild-type tumors carries somatic activating mutations in KIT exon 8 (p.D419del).
About 10-15% of gastrointestinal stromal tumors (GISTs) carry wild-type sequences in all hot spots of KIT and platelet-derived growth factor receptor alpha (PDGFRA) (wt-GISTs). These tumors are currently defined by having no mutations in exons 9, 11, 13, and 17 of the KIT gene and exons 12, 14, and 18 of the PDGFRA gene. Until now, the analysis of further exons is not recommended. However, we have previously published a report on a KIT exon 8 germline mutation, which was associated with familial GIST and mastocytosis. We therefore investigated whether KIT exon 8 mutations might also occur in sporadic GIST. We screened a cohort of 145 wt-GISTs from a total of 1351 cases from our registry for somatic mutations in KIT exon 8. Two primary GISTs with an identical exon 8 mutation (p.D419del) were detected, representing 1.4% of all the cases analyzed. Based on all GISTs from our registry, the overall frequency of KIT exon 8 mutations was 0.15%. The first tumor originating in the small bowel of a 53-year-old male patient had mostly a biphasic spindled-epithelioid pattern with a high proliferative activity (14 mitoses/50 HPF) combined with a second low proliferative spindle cell pattern (4/50 HPF). The patient developed multiple peritoneal metastases 29 months later. The second case represented a jejunal GIST in a 67-year old woman who is relapse-free under adjuvant imatinib treatment. We conclude that about 1-2% of GISTs being classified as 'wild type' so far might, in fact, carry KIT mutations in exon 8. Moreover, this mutational subtype was shown to be activating and imatinib sensitive in vitro. We therefore propose that screening for KIT exon 8 mutations should become a routine in the diagnostic work-up of GIST and that patients with an exon 8 mutation and a significant risk for tumor progression should be treated with imatinib.


Enhanced Single-tube Multiplex PCR Assay for Detection and Identification of Six Arcobacter Species.
A single-tube multiplex PCR (mPCR) assay was developed for rapid, sensitive and simultaneous detection and identification of six Arcobacter species including two new species, A. lanthieri and A. faecis, along with A. butzleri, A. cibarius, A. cryaerophilus and A. skirrowii on the basis of differences in the lengths of their PCR products. Previously designed monoplex, mPCR and RFLP assays do not detect or differentiate A. faecis and A. lanthieri from other closely related known Arcobacter spp. Primer pairs for each target species (except A. skirrowii) and mPCR protocol were newly designed and optimized using variable regions of housekeeping including cpn60, gyrA, gyrB and rpoB genes. The accuracy and specificity of the mPCR assay was assessed using DNA templates from six targets and 11 other Arcobacter spp. as well as 50 other bacterial reference species and strains. Tests on the DNA templates of target Arcobacter spp. were appropriately identified, whereas all 61 other DNA templates from other bacterial species and strains were not amplified. Sensitivity and specificity of the mPCR assay was 10 pg μl-1 of DNA concentration per target species. The optimized assay was further evaluated, validated and compared with other mPCR assays by testing Arcobacter cultures isolated from various faecal and water sources. Study results confirm that the newly developed mPCR assay is rapid, accurate, reliable, simple, and valuable for the simultaneous detection and routine diagnosis of six human- and animal-associated Arcobacter spp. The new mPCR assay is useful not only for pure but also mixed cultures. Moreover, it has the ability to rapidly detect six species which enhances the value of this technology for aetiological and epidemiological studies.


Inhibition of the action of anticonvulsants by lithium treatment.
The present study demonstrates that the effectiveness of anticonvulsants significantly decreases following lithium treatment (3 doses of 50 mg/kg of LiCl given every 12 hr). The anticonvulsant action of phenytoin, phenobarbital and of 3 carbonic anhydrase inhibitors: methazolamide, acetazolamide, ethoxzolamide, was assessed in rats subjected to maximal electroshock. In a chronic study on tolerance development to the anticonvulsant action of acetazolamide, lithium treatment (10 mg/kg per day) has been shown to inhibit gradually the action of acetazolamide. These results are consistent with the hypothesis that norepinephrine and dopamine are involved in the action of anticonvulsants.


Lipid-induced changes in the secondary structure of snake venom cardiotoxins.
The secondary structures of three snake venom cardiotoxins (from Hemachatus hemachatus, Naja naja atra, and Naja naja naja), in aqueous solution and in a lipid-bound form, were investigated by Fourier-transform infrared spectroscopy. The conformation-sensitive protein infrared bands in the amide I region were analyzed using deconvolution and band-fitting procedures. The spectra of the three cardiotoxins in aqueous buffer are very similar; they indicate a high content of both antiparallel beta-sheet structure and unordered conformation. Moreover, component bands characteristic of turns can also be identified. The binding of cardiotoxins to bilayers of dimyristoylphosphatidyl-glycerol results in an increased content of a beta-structure at the expense of the nonordered conformation. It is suggested that lipid-induced conformational transitions to a beta-structure, similar to that observed with cardiotoxins, may be operative also in membrane interaction of other proteins and peptides, particularly with those which have a small tendency to form alpha-helices.


Face Masks and Emotion Literacy in Preschool Children: Implications During the COVID-19 Pandemic.
With the arrival of the COVID-19 pandemic, safety regulations, such as face mask wearing, have become ubiquitous. Due to such regulations, many children's interpersonal interactions occurring outside of the home now involve face coverings. The present study examined young children's ability to identify emotions in an adult model wearing a face mask. Children (n = 77) between the ages of 3 and 5 were shown 16 different graphics of a model expressing four common emotions (happy, sad, angry, scared) across four conditions: still unmasked photo, still masked photo, masked video verbally implying the emotion, masked video verbally explicitly stating the emotion. We found that children were better able to identify emotions in an unmasked model and when the masked model explicitly stated or implied the emotion. No difference was found between an unmasked model, an explicitly stated emotion, or a verbally implied emotion. Children who were older, had more exposure to adults wearing masks, and attending group care were better able to identify the emotions. No relationship was found between the type of emotion, or participant's gender or race and the ability to identify the emotions. Implications of these results are discussed.


[Fibrogastroduodenoscopy in the evaluation of late results of suturing perforated gastroduodenal ulcers].
Results of a dynamic endoscopic examination of 213 patients after operations of suturing perforating gastric and duodenal ulcers are described. Stable healing of the ulcer was obtained in 20.2% of the patients. In 79.8% of the patients the ulcer failed to heal or recidivated. A comparison of roentgen findings and results of endoscopic examinations has shown that roentgen analysis gave the correct diagnosis but in 44.7% of the patients examined.


Quantification of 7 cannabinoids in cannabis oil using GC-MS: Method development, validation and application to therapeutic preparations in Friuli Venezia Giulia region, Italy.
The use of therapeutic cannabis preparations in Friuli Venezia Giulia is increasingly expanding. Even if cannabis oil finds its applications in several disorders affecting adults and children, it is not yet a standardized product and, to ensure the quality of the preparation, a quantitative analysis must be carried out before dispensing it to patients. Gas chromatography coupled to mass spectrometry (GC-MS) is a frequently used technique for quantification of cannabinoids, the active compounds of C. sativa. In this context, we developed a GC-MS method for the simultaneous quantification of 7 cannabinoids (CBD, CBDA, CBG, CBN, THCA, THCV and Δ9-THC) that is not time and sample consuming: 10 μL of cannabis oil were used for the sample preparation, that consists in derivatization of analytes through silylation. Calibration curves were built from 0.2 to 2 μg/mL. The percentage of accuracy and precision did not exceed the values recommended by validation guidelines. The limit of detection was 0.01 μg/mL; whereas the lower limit of quantification was 0.2 μg/mL. There was no carry over. The proposed GC-MS method showed good sensitivity, specificity, linearity, accuracy, precision and applicability to therapeutic preparations.


Complementary therapy use in metropolitan and regional Australian radiotherapy centres; do patients report effective outcomes?
Complementary and alternative medicine (CAM) is increasingly used with radiotherapy treatment for cancer. This study aimed to explore patient expectations of concurrent CAM, positive/negative outcomes and any variation of use across regional and metropolitan demographics. An ethics-approved survey was provided to radiotherapy outpatients in regional and metropolitan Victoria, Australia. The survey enquired about demographical details, CAM uptake, perceived benefits/effects, source of CAM information and disclosure of use. Two hundred sixty-five patients were recruited across both sites. Patients reporting concurrent CAM use were 45 % (regional site, April-August 2012) and 47 % (metropolitan site, January-May 2013). More patients at the regional centre reported living away from home during treatment (35 vs 8 %) though this did not impact upon CAM uptake. For both sites, 60 % of CAM users felt they had been provided with sufficient CAM information with family/friends the most common source. The highest reported rationale for CAM use was the patient's choice (61 and 52 %). Only 19 % of patients at either site claimed the recommendation of a doctor was the reason for CAM use. 'Improving immune system' was the most common expectation of CAM at both sites (39 and 50 %). More than half of CAM users felt that it was effective (51 and 54 %). CAM use across regional and metropolitan Australia is equivalent, constitutes a substantial proportion of radiotherapy outpatients and is largely considered effective by CAM users. Healthcare professionals need to improve knowledge, communication, reporting and awareness of concurrent CAM in radiotherapy practice.


Statistical properties of flip-flop processes associated to the chaotic behavior of systems with strange attractors.
The chaotic behavior of systems with strange attractors can be discussed by examining the flip-flop process associated to the system dynamics. This was already shown by Lorenz (1963) in his first seminal paper. A somewhat surprising result was obtained by Aizawa (1982), who, studying the same Lorenz attractor at the parameter value r = 28, reached the conclusion that the associated flip-flop was a typical Markov process. Since the process is generated in a deterministic way, one may wonder if the Aizawa result is accidental, depending on the particular parameter value, or if a similar conclusion can be extended to other systems, with different attractors. Our conclusions are that the Aizawa result is mostly accidental, because for other parameter values and for other attractors there are sharp deviations from the Markovian process.


Fixation of a double-coated titanium-hydroxyapatite focal knee resurfacing implant: a 12-month study in sheep.
Focal cartilage lesions according to International Cartilage Repair Society (ICRS) grade 3-4 in the medial femoral condyle may progress to osteoarthritis. When treating such focal lesions with metallic implants a sound fixation to the underlying bone is mandatory. We developed a monobloc unipolar cobalt-chrome (Co-Cr) implant with a double coating; first a layer of commercially pure titanium (c.p.Ti) on top of which a layer of hydroxyapatite (HA) was applied. We hypothesised that such a double coating would provide long-lasting and adequate osseointegration. Unilateral medial femoral condyles of 10 sheep were operated. The implants were inserted in the weight-bearing surface and immediate weight-bearing was allowed. Euthanasia was performed at 6 (three animals) or 12 months (six animals). Osseointegration was analysed with micro-computer tomography (CT), light microscopy and histomorphometric analyses using backscatter scanning electron microscopy (B-SEM) technique. At 6 months one specimen out of three showed small osteolytic areas at the hat and at 12 months two specimens out of six showed small osteolytic areas at the hat, no osteolytical areas were seen around the peg at any time point. At both time points, a high total bone-to-implant contact was measured with a mean (95% confidence interval - CI) of 90.6 (79-102) at 6 months and 92.3 (89-95) at 12 months, respectively. A double coating (Ti + HA) of a focal knee resurfacing Co-Cr implant was presented in a sheep animal model. A firm and consistent bond to bone under weight-bearing conditions was shown up to 1 year.


Proteins of the sea urchin egg vitelline layer.
The vitelline layers (VL) of unfertilized sea urchin eggs were isolated, and the diversity of their polypeptide constitutents estimated by two-dimensional polyacrylamide gel electrophoresis. At least 25 components are reproducibly observed. While VL polypeptides are almost certainly synthesized in the growing oocyte, they are not among the more prevalent newly synthesized proteins detected in oocytes that were isolated and labeled in vitro for 4 hr. A set of monoclonal antibodies was raised against VL components and partially characterized. The 31 monoclonals analyzed fell into 11 classes with respect to their avidity for VL proteins solubilized under mild and under strongly denaturing conditions, and to their reactions with surface components of the VLs of living eggs. Fluorescence microscopy showed diverse patterns of surface reactivity when different monoclonal antibodies were compared. Two of the monoclonal antibodies reacted with specific sets of three proteins each on VL protein blots. It is concluded that the VL is a complex structure containing a large number of different polypeptide components, the genes for several of which should now be experimentally accessible.


The relationship between obesity and seasonal variation in body weight among elementary school children in Tokyo.
Typical patterns of seasonal variation in body weight among Japanese children involve increases during the fall and/or winter and decreases during the summer. However, atypical variations, namely, increases in weight during the summer, have been reported for obese children. The present study examines whether weight gain during the summer (i.e., July through September) is a possible cause of obesity. We examined seasonal changes in weight for 446 elementary school children in Tokyo in six waves between 1972 and 2004. Weight was measured monthly for 6 years in each child and was evaluated by means of time-series analysis. Overall, significant seasonal variations in weight were found in 86% of the children, most of which were typical (i.e., decreases during the summer and increases during the fall, winter, and/or early spring). On the other hand, weight gain in the summer was observed exclusively among obese children. Children whose weight increased during the summer holiday spent most of their time comfortably indoors because of air conditioners, which became popular in 1970s. A possible explanation of the observed weight gain during the summer seems to be changes in life style associated with the use of air conditioning, concomitant with insufficient physical exercise and excessive consumption of food and drink, which could disturb the rhythms of seasonal weight changes and lead to obesity.


[Recurrent hernia of the Jean Louis Petit triangle: a case study].
Hernia of the Jean Louis Petit triangle and hernia of Grynfeltt's quadrilateral space can be classified as lumbar hernias. Its clinical diagnosis is confirmed by computed tomography and, possibly, by ultrasound or x-ray. There is a formal indication for surgery including swelling or functional discomfort but, above all, the risk of strangulation. We here report a rare case of recurrence of primary hernia of the Jean Louis Petit triangle in a 65-year old man.


Cinobufacini protects against paclitaxel-induced peripheral neuropathic pain and suppresses TRPV1 up-regulation and spinal astrocyte activation in rats.
Chemotherapy-induced peripheral neuropathic pain is a major limiting factor affecting cancer patients. No effective treatment is currently available. Cinobufacini, an aqueous extract from toad skin, is a widely used anti-cancer drug in China. Clinical evidence has demonstrated the safety and effectiveness of cinobufacini in combination with chemotherapy to promote the therapeutic efficacy while alleviating side effects, especially cancer-related pain symptoms. In this study, the effects of cinobufacini were investigated in a rat model of paclitaxel-induced peripheral neuropathic pain (PIPNP) to better understand and expand its clinical application. A single injection of cinobufacini (2.5 g/kg, i.p.) alleviated pre-established PIPNP, as indicated by decreased mechanical and thermal hypersensitivity compared with paclitaxel-treated rats. Repeated cinobufacini (1.25 and 2.5 g/kg, i.p.), given during the induction of PIPNP, prevented the establishment of paclitaxel-induced mechanical and thermal hypersensitivity. This preventative effect was associated with suppressed paclitaxel-induced TRPV1 up-regulation and spinal astrocyte activation, as well as decreased production of spinal TNF-α and IL-1β. These findings reveal cinobufacini as a therapeutic potential to treat and prevent paclitaxel-induced peripheral neuropathic pain.


A proposal for standardization of psychiatric consultation-liaison data.
There is still a striking lack of homogeneity in the terminology and classifications used in the registration of psychiatric consultation-liaison (C-L) data. Nowadays, the need for standardization of C-L data is greater than ever. Each registration consists of two components: the items and their categories. The present authors distinguish three levels of C-L data: fundamental, epidemiologic, and clinical-educational. A comprehensive proposal for standardization of such items and categories is presented, both on the fundamental and on the epidemiologic level. Data on 2657 consultations carried out by the Netherlands Consortium for C-L Psychiatry (NCCP) and from a literature review of 48 C-L reports serve to illustrate and as a supply for a large database. Various characteristics of the general hospital and of the C-L service are considered to be fundamental, that is, should be presented in each C-L publication. The epidemiologic data are divided into eight groups: sociodemographics, referral characteristics, history, diagnoses, diagnostic recommendations, ward management, discharge and aftercare management, and termination data. Finally, definitions and decision rules are given.


Content and concentration of taurine, hypotaurine, and zinc in the retina, the hippocampus, and the dentate gyrus of the rat at various postnatal days.
Taurine and zinc possess neurotrophic and neuroprotective properties, and they have been demonstrated to interact in the central nervous system (CNS). The aim of this work was to determine taurine, hypotaurine, and zinc levels during postnatal development and any possible significant correlation between them in selective areas of the CNS with differential taurine level regulation and intrinsic capacity to proliferate. Taurine and hypotaurine content (nM/region) and concentration (nM/mg protein) and total zinc levels were determined in the retina, hippocampus, and dentate gyrus of the rat at postnatal days 5, 10, 15, 20, 30, and 50. Taurine and hypotaurine increased during development in the retina without significant correlation between them. In the hippocampus there was a progressive decrease, and in the dentate gyrus there was an initial increase and a posterior decrease of taurine and hypotaurine levels. Correlation between the two amino acids was observed at P10, P15, and P50 for the hippocampus and at P15, P30, and P50 for the dentate gyrus. The variations in total zinc levels followed a biphasic behavior, with an early decrease and later increase. Significant and positive correlation of zinc and taurine was only observed in the hippocampus at P30 and P50 and negative in the dentate gyrus at P30. No significant correlation was obtained for the retina. The maintenance of taurine levels in specific CNS areas does not seem to be related to the availability of the precursor, hypotaurine, which might have a role by itself. There are critical postnatal periods during which there is a preservation of taurine, hypotaurine, or zinc levels. It seems that these requirements could be related to zinc-taurine interactions.


Participant Perspectives on the Effects of an African American Faith-Based Health Promotion Educational Intervention: a Qualitative Study.
In the USA, African Americans (AAs) experience a greater burden of mortality and morbidity from chronic health conditions including obesity, diabetes, and heart disease. Faith-based programs are a culturally sensitive approach that potentially can address the burden of chronic health conditions in the AA community. The primary objective was to assess (i) the perceptions of participants of Live Well by Faith (LWBF)-a government supported faith-based program to promote healthy living across several AA churches-on the effectiveness of the program in promoting overall wellness among AAs. A secondary objective was to explore the role of the church as an intervention unit for health promotion among AAs. Guided by the socio-ecological model, data were collected through 21 in-depth interviews (71% women) with six AA church leaders, 10 LWBF lifestyle coaches, and five LWBF program participants. Interviews were audio-recorded, transcribed verbatim, and analyzed by three of the researchers. Several themes emerged suggesting there was an effect of the program at multiple levels: the intrapersonal, interpersonal, organizational, and community levels. Most participants reported increased awareness about chronic health conditions, better social supports to facilitate behavior change, and creation of health networks within the community. Our study suggests that one approach to address multilevel factors in a culturally sensitive manner could include developing government-community partnership to co-create interventions.


Metastatic renal cell carcinoma in the bladder following complex partial nephrectomy: A case report.
Metastasis of renal cell carcinoma (RCC) to the bladder is rare. We present a case of a 74-year-old patient with a metachronous, solitary metastasis of RCC to the bladder twenty months after partial nephrectomy and JJ-stent placement for a complex renal tumor. The mechanism of RCC metastasis to the bladder remains controversial, and we believe this case adds support to the drop metastasis theory.


Intra- and interscanner reliability and reproducibility of 3D whole-brain pseudo-continuous arterial spin-labeling MR perfusion at 3T.
To assess the reliability and reproducibility of pseudo-continuous arterial spin labeling (pCASL). Intra- and interscanner reliability and reproducibility are essential before pooling perfusion imaging data. Eight volunteers were scanned three times on two 3.0T magnetic resonance imaging (MRI) scanners using the pCASL technique. The first and third tests were conducted on scanner one, while the second test was on scanner two. The pCASL was acquired with postlabeling delay time (PLD) of 1.5 and 2.5 seconds. The cerebral blood flow (CBF) of gray matter, white matter, frontal lobe, parietal lobe, occipital lobe, temporal lobe, putamen, posterior cingulate, and thalamus were extracted for comparison. Reliability and reproducibility were measured using the intraclass correlation coefficient (ICC) and within-subject coefficients of variation (wsCV), respectively. The pCASL consistently had high intra- and interscanner measurement reliability and reproducibility. Reproducibility of the CBF values was higher, with PLD 2.5 seconds than with PLD 1.5 seconds. Different PLDs had considerable influence on the reproducibility of the different regions of the brain. Although excellent intra- and interscanner reliability and reproducibility could support the feasibility of cross-site pooling of ASL data, pCASL with multiple PLDs may better assess the CBF of the human brain.


Scaffold-based tissue engineering approaches in treating infertility.
Tissue engineering and the use of scaffolds have shown high therapeutic potentialities about male and female infertility. Nowadays, many couples are suffering from infertility problems. There are different causes for infertility including chemotherapy (for male and female), uterine injuries, and intrauterine adhesions. Extra-cellular matrix in tissue engineering provides a supportive medium for blood or lymphatic vessels making it a suitable substrate for cell implantation and growth. Dominant successes in this branch have been in use of patient-derived primary cells, these cells loaded in scaffolds and used to generate tissue for re-implantation. However, this method has limitations, because of the invasive nature of cell collection, also the cells patient-derived may be not healthy and become the source of disease. Therefore, use of stem cells, including embryonic stem (ES) cells, bone marrow mesenchymal stem cells (BM-MSCs) and umbilical cord-derived mesenchymal stem cells (UC-MSCs) have been considered. Cell/scaffold systems have a substantial role in fertility organs or agents repair or regeneration. This review summarizes the novel scaffold-based tissue engineering approaches to treat infertility.


Fear of the unknown: ionizing radiation exposure during pregnancy.
Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.


Calmodulin-binding profiles for nebulin and dystrophin in human skeletal muscle.
Nebulin and dystrophin are two high-molecular-mass skeletal muscle proteins that have both been associated with the defective gene in Duchenne muscular dystrophy, although the function of neither protein is known. Other high-molecular-mass, calmodulin-binding proteins have recently been implicated in regulating calcium release from skeletal muscle. Western blots of human skeletal muscle biopsy samples were probed with biotinylated calmodulin; nebulin was identified as a prominent high-molecular-mass calmodulin-binding protein but dystrophin did not bind detectable amounts of biotinylated calmodulin. Dystrophin was absent in a Duchenne muscle biopsy.


The effects of pregnancy on the pharmacokinetics of infliximab and adalimumab in inflammatory bowel disease.
Transplacental transfer of infliximab and adalimumab results in detectable drug levels in the cord blood and infant. To determine if pregnancy influenced the pharmacokinetics of anti-TNF agents in women with inflammatory bowel disease. Twenty-five women from the University of Calgary inflammatory bowel disease(IBD) pregnancy clinic on maintenance infliximab or adalimumab were recruited prospectively with serum bio-banking performed each trimester. Infliximab trough and adalimumab steady-state levels were the outcomes of interest and were analysed using the ANSER infliximab and adalimumab assays. Multivariate linear mixed-effects models were constructed to assess infliximab and adalimumab drug levels during pregnancy adjusting for the clinical covariates of albumin, BMI and CRP. Fifteen women (eight Crohn's disease, seven ulcerative colitis) received infliximab and 10 women with 11 pregnancies were treated with adalimumab. Median age was 29.6 years (IQR: 27.6-31.2 years). Median disease duration was 9.2 years (IQR: 3.16-15.0 years). Median trough infliximab concentrations were 8.50 μg/mL (IQR: 7.23-10.07 μg/mL), 10.31 μg/mL (IQR: 7.66-15.63 μg/mL) and 21.02 μg/mL (IQR: 16.01-26.70 μg/mL) at trimesters 1, 2 and 3 respectively. Significant changes in albumin and BMI (P < 0.05) but not CRP (P > 0.05) were documented throughout pregnancy. After adjusting for albumin, BMI and CRP, infliximab trough levels increased during pregnancy, by 4.2 μg/mL per trimester (P = 0.02), while adalimumab drug levels remained stable (P > 0.05). Infliximab levels rise during pregnancy, whereas adalimumab levels remain stable after accounting for changes in albumin, BMI and CRP. Therapeutic drug monitoring in the second trimester may be useful in guiding dosing in the third trimester.


The Relationship Between Sjogren's Syndrome and Sleep Disturbance: A Case Report.
Sjogren's syndrome is an autoimmune disorder characterized by the infiltration and disruption of exocrine glands by the host's immune cells. It is the third most common autoimmune syndrome after systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). This syndrome most commonly affects females. This disorder most typically presents as sicca symptoms, though plenty of other symptoms can exist. One of these other symptoms is the disturbance of sleep. The insomnia component of Sjogren's syndrome is the focus of this case report.


Safety and efficacy of 4% articaine in mandibular third-molar extraction: A systematic review and meta-analysis of randomized clinical trials.
The authors aimed to assess whether 4% articaine is a safe and effective local anesthetic (LA) for mandibular third-molar extractions. The authors searched MEDLINE (PubMed), Cochrane Library, Scopus, and Web of Science databases to identify randomized clinical trials that fulfilled the eligibility criteria. Risk of bias was evaluated using the Cochrane risk-of-bias assessment tool. The authors performed a meta-analysis of safety and efficacy variables comparing 4% articaine with different LAs. The authors assessed 482 articles but only 14 randomized clinical trials met the inclusion criteria for review. No statistically significant differences were found among the selected LAs regarding safety. Four percent articaine required fewer reinjections than 2% lidocaine and had a shorter onset time than 2% lidocaine, 0.5% bupivacaine, and 4% lidocaine. Four percent articaine had a longer anesthesia effect than 2% lidocaine and 2% mepivacaine, but a shorter anesthesia effect than 0.5% bupivacaine. Use of 4% articaine for mandibular third-molar extraction is a safe choice that requires fewer reinjections and has a shorter onset time than other aminoamide-type LAs.


Release of fluorine and chlorine during increase of phosphate rock grade by calcination and digestion.
A series of experiments for calcination and subsequent digestion to increase the grade of phosphate rock were performed. Fluorine and chlorine released by calcination and digestion were investigated. The forms of both elements were studied by sequential chemical extraction. The grades of raw and calcined phosphate rocks, and their phosphorus concentrates were confirmed according to the value of P2O5%. The results showed that fluorine and chlorine in phosphate rock mainly existed in carbonate-bound and residual forms. The grade of phosphate rock can be well increased by calcination and subsequent digestion. By digestion at the optimal condition of 2.5:1 for liquid-solid ratio, 60 °C for digestion temperature and 50 min for digestion time, the phosphorus concentrates digested from the calcined phosphate rock of 1000 °C reached the highest grade (P2O5% = 33.24%). By calcination, the released fluorine was mainly HF at a low temperature and SiF4 at a high temperature, with fluorine release amount of 1.61 × 104-3.82 × 104 g/t at 900-1100 °C. Cl2, HCl and Cl- were mainly released at 200-500 °C, less than 800 °C and more than 800 °C, which release amount were 9.40 × 10-2.54 × 102 g/t, 2.10 × 102-1.53 × 104 g/t and 2.24 × 102-5.61 × 102 g/t, respectively. By digestion with water for the calcined phosphate rock of 900-1100 °C, the concentrations of fluorine and chlorine in effluent were respectively 77.2-160 mg/L and 7.99-19.6 mg/L. It can be concluded that fluorine and chlorine released by calcination for phosphate rock contribute greatly to atmospheric acid rain and equipment corrosion; by digestion, the discharge of fluorine seriously exceeds the standard and may cause greater pollution to the water body.


The survival time of rabbit's erythrocytes. I. Elimination of auto- and allogenic erythrocytes radioactively labeled with chromium 51Cr from circulation.
The speed of eliminating allogenic erythrocytes labeled with 51Cr from circulation was examined. Donor's erythrocytes with AFHR phenotype were injected to the recipient with FR phenotype. A fast elimination of allogenic erythrocytes was observed, T 1/2 = 7.6 days. The survival time of autogenic erythrocytes was T 1/2 = 18.2 days. In sera of those rabbits to whom allogenic erythrocytes had been injected, no anti-erythrocyte antibodies against the donor's hemocytes appeared.


Highly sensitive and stable fluorescent aptasensor based on an exonuclease III-assisted amplification strategy for ATP detection.
Fluctuations in intracellular adenosine triphosphate (ATP) concentration are closely associated with some cancer diseases. Thus, it is a worthwhile undertaking to predict sickness by monitoring changes in ATP levels. However, the detection limits of current fluorescent aptamer sensors for ATP detection are in the range of nmol L-1 to μmol L-1. It has become crucial to employ amplification strategies to increase the sensitivity of fluorescent aptamer sensors. In the current paper, a duplex hybrid aptamer probe was developed based on exonuclease III (Exo III)-catalyzed target recycling amplification for ATP detection. The target ATP forced the duplex probe configuration to change into a molecular beacon that can be hydrolyzed with Exo III to achieve the target ATP cycling to amplify the fluorescence signal. Significantly, many researchers ignore that FAM is a pH-sensitive fluorophore, leading to the fluorescence instability of FAM-modified probes in different pH buffers. The negatively charged ions on the surface of AuNPs were replaced by new ligands bis(p-sulfonatophenyl)phenylphosphine dihydrate dipotassium salt (BSPP) to improve the drawback of FAM instability in alkaline solutions in this work. The aptamer probe was designed to eliminate the interference of other similar small molecules, showing specific selectivity and providing ultra-sensitive detection of ATP with detection limits (3σ) as low as 3.35 nM. Such detection limit exhibited about 4-500-fold better than that of the other amplification strategies for ATP detection. Thus, a relatively general high sensitivity detection system can be established according to the wide target adaptability of aptamers, which can form specific binding with different types of targets.


Experimental studies of apocrine secretion in the dorsal prostate epithelium of the rat.
Rat dorsal prostate epithelium was studied in intact adult animals, in animals castrated for three days and in rats after inhibition of prolactin secretion. Thin sections, electron-microscopic autoradiographs and freeze-fracture replicas were used to analyze the process of apocrine secretion in this gland. The rough endoplasmic reticulum and the Golgi apparatus of the secretory cells are well developed, but secretory granules are absent. The only sign indicating release of secretory material is the appearance of blebs originating from the apical plasma membrane. Freeze-fracture replicas of the apical plasma membrane reveal that the blebs develop randomly from the bases of microvilli-like protrusions. In vitro pulse labeling of the proteins using 3H-leucine resulted in a labeling of the apical blebs. A post-castration period of three days was sufficient to reduce drastically the number and size of the apical blebs conhree weeks by application of lisuride, a synthetic ergot alkaloid, also induced regressive changes in the secretory cells. The apical blebs were still present, but they were shrunken and their content appeared condensed. These experimental conditions proved that the apical blebs are closely related to the functional activity of the cells and are interpreted as true apocrine secretion in the rat dorsal epithelium.


Patterns of mixed Plasmodium species infections among children six years and under in selected malaria hyper-endemic communities of Zambia: population-based survey observations.
Although malaria is preventable and treatable, it still claims 660,000 lives every year globally with children under five years of age having the highest burden. In Zambia, malaria rapid diagnostic tests (RDTs) that only detect Plasmodium falciparum are the main confirmatory means for malaria diagnosis in most health facilities without microscopy services. As a consequence of this P. falciparum species diagnostic approach, non-falciparum malaria is not only under-diagnosed but entirely missed, thereby making the exact disease burden unknown. We thus investigated the prevalence of various Plasmodium spp. and associated burden of infection in selected communities in Zambia. Data from two malaria hyper-endemic provinces (Eastern and Luapula) of the 2012 National Malaria Indicator Survey (MIS), conducted between April and May 2012, were used. The MIS is a nationally representative, two-stage cluster survey conducted to coincide with the end of the malaria transmission season. Social, behavioural and background information were collected from households as part of the survey. Thick blood smears, RDTs and dried blood spots (DBS) were collected from children below six years of age. Slides were stained using Giemsa and examined by microscopy while polymerase chain reaction (PCR) was used to analyse the DBS for malaria Plasmodium spp. Multivariate logistic regression was employed to examine the association between background factors and malaria. Overall, 873 children younger than six years of age were surveyed. The overall prevalence of Plasmodium spp. by PCR was 54.3% (95% CI 51-57.6%). Of the total Plasmodium isolates, 88% were P. falciparum, 10.6% were mixed infections and 1.4% were non-falciparum mono infections. Among the mixed infections, the majority were a combination of P. falciparum and P. malariae (6.5% of all mixed infections). Children two years and older (2-5 years) had three-fold higher risk of mixed malaria infections (aOR 2.8 CI 1.31-5.69) than children younger than two years of age. The high prevalence of mixed Plasmodium spp. infections in this population stresses review of the current malaria RDT diagnostic approaches. The observed less incidence of mixed infections in children under two years of age compared to their older two-to-five-year-old counterparts is probably due to the protective maternal passive immunity, among other factors, in that age group.


Synthesis and evaluation of human phosphodiesterases (PDE) 5 inhibitor analogs as trypanosomal PDE inhibitors. Part 2. Tadalafil analogs.
In this Letter we describe our ongoing target repurposing efforts focused on discovery of inhibitors of the essential trypanosomal phosphodiesterase TbrPDEB1. This enzyme has been implicated in virulence of Trypanosoma brucei, the causative agent of human African trypanosomiasis (HAT). We outline the synthesis and biological evaluation of analogs of tadalafil, a human PDE5 inhibitor currently utilized for treatment of erectile dysfunction, and report that these analogs are weak inhibitors of TbrPDEB1.


The optic fissure in the normal and microphthalmic mouse.
The gene for microphthalmia in the homozygous cinnamon mouse produces colobomatous microphthalmia due to failure of closure of the optic fissure. Optic fissure formation and closure were examined in control cinnamon and homozygous microphthalmic foetuses from the 10th to the 13th gestational day using light and electron microscopy. This study showed that basal lamina degeneration and cell death occurred in the area of fusion in the control eyes. Examination of the optic fissure in homozygous microphthalmic foetuses showed cell death in the fissure margins, but there was failure of optic fissure closure associated with persistence of the basal lamina. It is therefore suggested that absence or abnormality of programmed disintegration of the basal lamina prevents fusion in the mutant leading to the development of colobomatous microphthalmia.


Co-expression of vimentin and cytokeratins in parietal endoderm cells of early mouse embryo.
Of the five classes of intermediate filaments found in vertebrate tissues, the cytokeratins are considered unique to epithelial tissues, while vimentin is expressed by endothelial and mesenchymal cells. In neither case is the precise function of the filament system known. Epithelial cells in culture often express vimentin as well as cytokeratins, but co-expression in vivo, as reported for pleomorphic adenomas of the parotid gland and metastatic carcinoma cells in ascites or pleural fluid, is still controversial. Here we report the co-expression of cytokeratins and vimentin in situ, in the parietal endoderm of the mouse embryo 8.5-13.5 days old. This population of individual, motile cells seems to be derived from a conventional epithelium by migration and differentiation. Our results support the idea that vimentin expression is specifically related to reduced cell-to-cell contact, and to the independent existence of a cell following detachment from an epithelial sheet.


An efficient synthesis of a 6″-BODIPY-α-Galactosylceramide probe for monitoring α-Galactosylceramide uptake by cells.
Herein, an efficient synthesis of BODIPY-α-Galactosylceramide 3, which can be used to study the cellular uptake of the potent immunostimulatory parent compound α-Galactosylceramide, is reported. Key in our synthetic strategy is the six-step synthesis of the core BODIPY scaffold (64% yield overall) and its quantitative conversion to an N-hydroxysuccinimidyl ester to facilitate conjugation and purification of the target glycolipid. For the preparation of the core of the glycolipid, the solubility of the lipid acceptor proved to be critical. The ability of BODIPY-αGalCer 3 to activate invariant natural killer cells was then demonstrated in vitro.


Low-fluence rate, long duration photodynamic therapy in glioma mouse model using organic light emitting diode (OLED).
The treatment of gliomas poses significant clinical challenges due to resistance to chemo and radiation therapy, and treatment side effects. Metronomic photodynamic therapy (mPDT), which involves long treatment time with low fluence rate and multiple or continuous photosensitizer administrations, has potential in treating gliomas without threatening the quality of life and has been demonstrated in rats and rabbits. mPDT in small animals such as mouse is not yet shown due to lack of lightweight illumination device for long periods of time. We presented low fluence rate (3mW/cm(2)) and long duration (3.7h) PDT treatment in a nude mouse model of human glioblastoma by using organic light emitting diode (OLED) with single dose of 5-aminolevulinic acid (ALA) administration as photosensitizer. Tumor volume was measured using bioluminescent imaging and the animal survival time was recorded. Additionally, we have performed limited PDT dosimetric measurements of PpIX fluorescence, tumor oxygenation and hemoglobin concentration in 3 PDT mice. For animals with similar pre- and immediate post-light tumor volume, the averaged total survival time of PDT mice is 40.5±9.2 days that are significantly longer than the control mice (26.0±2.0 days). The post-light survival time of PDT mice is 14.3±5.9 days that are marginally longer than the control group (8.0±0.0 days). In the dosimetric measurement, good maintenance of PpIX fluorescence in one PDT mouse has relatively improved survival time, compared with the other two PDT mice (i.e., 24 days versus 16 and 17 days). This pilot study demonstrated the feasibility of low-fluence rate and long treatment time of ALA-PDT using OLED without anesthetization of animals. The response of PDT treated animals with similar pre- and post-light tumor volume is encouraging to show a longer survival time than the controls. The dosimetric indices such as photosensitizer fluorescence and tissue oxygenation would help understand the possible treatment barriers for further improvement of treatment plans.


Face painting as an anatomical learning tool based on individual ultrasonographic examination.
Considering the shift to online education during the COVID-19 pandemic, new and easily accessible educational videos and content on clinical anatomy are necessary. This study utilized numerous references and data on the anatomy of Asian facial muscles and blood vessels to accurately depict human anatomy through face painting. It aimed to provide clinicians accurate educational video content on anatomy to help prevent possible complications during noninvasive facial and surgical procedures. A 26-year-old Korean-Chinese male volunteer was used as a face painting model. The location of the blood vessels of the face was confirmed through ultrasonography images using a real-time two-dimensional B-mode. The model's face was painted by an artist majoring in anatomy. To reveal most anatomical structures on both sides of the face, the left side showed the structures observed when the skin and superficial fat layer are removed, and the right side revealed the deeper layer structures that can be seen when some muscles are cut. Fifteen superficial and deep muscles important in esthetic procedures were meticulously painted on the face. The face painting took a total of 6 h, and the video was edited to 5 min. This study merged the advantages of 2D and 3D by painting directly on the skin surface of a living model. Thus, it can provide more dynamic surface anatomy data. These contents inform clinicians about 3D anatomic location, which can help avoid complications when performing clinical procedures on the face.


Comparison of Patient and Proxy Assessment of Patient-Centeredness in the Care of Coronary Heart Disease: A Cross Sectional Survey Using the PACIC-S11.1.
When making medical care more patient-centered, surveys on patients' and their relatives' experiences can be helpful in identifying opportunities for improvement. In cases where the targeted patients are unable to express their own perspective, for example, due to them being too young or suffering from severe impairments, proxies can serve as substitutes. Proxies are frequently used in care planning and consent. Nevertheless, it is unclear whether patients' assessments of how patient-centered their medical care is are similar to those of their proxies. This study aims to assess the level of consistency between patients' and their proxies' assessments using an adapted version of the Patient Assessment of Chronic Illness Care (PACIC) short form questionnaire. In a cross-sectional study, patients with coronary heart disease were recruited at cardiologists' offices, rehabilitation clinics and hospitals. Participants were surveyed with regard to the perceived level of patient-centeredness during their care using an adapted version of the German PACIC short form (PACIC-S11.1). Correlations in the assessments made by each patient and their respective proxy were analyzed. On the level of the patients group and the relatives group differences between mean ratings for each item were compared using paired t-tests. In total, 74 pairs of patients and proxies submitted the completed questionnaire. On the level of the individual patient/proxy pairs, no correlation, or significant but low correlation, was found between the ratings. On the group level, patients' and their proxies' item ratings were similar in the interpretation of averages, but still demonstrated statistically significant differences. Overall, patients rated their care as more patient-centered than their proxies did. The study shows that, on the individual level, proxies' ratings do not necessarily reflect the patients' assessment of PCC. On the group level, the assessments of relatives regarding PCC are similar to those of the patients. German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: DRKS00012434 (URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012434).


Squamous cell carcinoma of the esophagus: a study of 153 cases.
The incidence of esophageal carcinoma in the United States is relatively low; total estimated cases annually are about 7,000 (Ca, 1975). The overall cure rate, however, is about the worst among all malignant diseases and is reported to be 3% (Ca, 1975). We reviewed cases of squamous cell carcinoma of the esophagus treated at Roswell Park Memorial Institute to understand the clinicopathologic features in order to improve our therapeutic results.


Influence of urbanisation on phytodiversity and some soil properties in riverine wetlands of Bamenda municipality, Cameroon.
In urban areas, human activities result in the discharge of a variety of chemical substances into the environment. This affects soil quality, plant species diversity and human security. To suggest appropriate management strategies that ensure soil quality and human security amid urbanization, this study assessed the relationship between macrophyte diversity and some soil characteristics of wetlands that are adjacent to urban, peri-urban and rural areas in Bamenda Municipality, Cameroon. Plant communities were sampled for species composition and relative abundance, using the Braun-banquet method. Species richness was evaluated using Simpson's diversity index. Twenty-one soil samples (0-25 cm depth) were randomly collected within the wetlands and analyzed for their physicochemical characteristics using standard methods. The hierarchical cluster analysis (HCA) was used to group the wetlands under managing units. The dominant species ranked in order of abundance in the rural wetland were Raphia farinifera > Ludwigia hexandra > Coix spp. > Leersia hexandra > Ehchinochloa paramidelis. The Peri-urban wetland dominant species stood at Commelina bengalensis > Leersia hexandra > Cyperus distance > Ehchinochloa pyramidalis. In the Urban segment, Pennisetum purpureum > Echinochloa pyramidalis > Tithonia diversifolia > Leersia hexandra were the abundant species. The Simpson index of diversity was 0.94 for the urban and 0.96 for the peri-urban and rural sites respectively. The soils were slightly acidic with pH KCl ranging from 4.87 to 5.41. From the coefficient of variability classes, Sand, pH-H2O, pH-KCl, and Na consistently varied slightly across the three sites. Two significant clusters (management units) representing a combination of urban, and peri-urban/rural were formed from the hierarchical dendrograms. The Mann-Whitney U test revealed a significant (P < 0.05) lower exchange acidity in the rural than the urban sites indicating contamination of the urban site, reducing its macrophyte diversity. Intensification and extension of urbanisation are gradually reducing the macrophyte diversity and also contaminating the soils of the wetlands of the Bamenda municipality in Cameroon, warranting monitoring. The chemical composition of soils in the urban cluster needs early remediation by encouraging the planting and monitoring of certain plants that can already take up the elements.


Life experiences, response styles and mental health among mothers and children in Beirut, Lebanon.
A sample of 152 women living in Beirut, Lebanon was studied to determine the relationship between life experiences, mothers' depression, and children's health and behavior. Measures of the perceived negative impact of both war and nonwar related events, measures of available social support, sociodemographic variables, coping or response strategies and displacement were used to predict mothers' depressive symptomatology and their children's health. The level of perceived negative impact of war-related events was found to be strongly associated with higher levels of depressive symptomatology among mothers. More surprising was the relative importance of experiences unrelated to the war in predicting higher levels of depressive symptoms. Among the most noteworthy of the findings was the association between the use of an emotional response style and the measure of psychological dysfunction. Finally, the level of a mother's depressive symptomatology was found to be the best predictor of her child's reported morbidity, with higher levels of symptoms associated with higher levels of morbidity.


Hemocyte adhesion in the California mussel (Mytilus californianus): regulation by adenosine.
On removal from the animal, molluscan hemocytes change from an aggregation-incompetent state to one in which they aggregate and stick avidly to foreign surfaces. Aggregation and substratum adhesion behaviors of Mytilus californianus (California mussel) hemocytes are inhibited reversibly and non-lethally by caffeine. We investigated the mechanistic basis of this inhibition by means of assays that determined the abilities of several compounds to compete or synergize with caffeine in achieving its effect. Adenosine and the adenosine receptor agonists 2-chloro-adenosine or 5'-N-ethylcarboxamido-adenosine reversed caffeine inhibition. In contrast, isobutyl-methyl-xanthine (both an adenosine receptor antagonist and an inhibitor of phosphodiesterase) and the adenosine receptor antagonists cyclo-hexyladenosine and R-N6-phenyl-isopropyladenosine synergized with caffeine to inhibit hemocyte adhesion. Caffeine treatment reduced intracellular cAMP. Alterations in cAMP concentrations in response to caffeine with or without adenosine and adenosine analogues reflected alterations in adhesion behavior in the same drugs. R-N6-phenyl-isopropyladenosine plus caffeine yielded intracellular cAMP levels lower than those in cells treated with caffeine alone. However, both cAMP level and hemocyte adhesion increased when adenosine or 5'-N-ethylcarboxamido-adenosine replaced R-N6-phenyl-isopropyladenosine. This mollusc's hemocytes appear to express adenosine receptors that modulate phagocyte behavioral responses by altering second messenger transduction.


PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions.
To present an overview of a series of studies in which the clinical validity of the National Institutes of Health's Patient Reported Outcome Measurement Information System (NIH; PROMIS) measures was evaluated, by domain, across six clinical populations. Approximately 1,500 individuals at baseline and 1,300 at follow-up completed PROMIS measures. The analyses reported in this issue were conducted post hoc, pooling data across six previous studies, and accommodating the different designs of the six, within-condition, parent studies. Changes in T-scores, standardized response means, and effect sizes were calculated in each study. When a parent study design allowed, known groups validity was calculated using a linear mixed model. The results provide substantial support for the clinical validity of nine PROMIS measures in a range of chronic conditions. The cross-condition focus of the analyses provided a unique and multifaceted perspective on how PROMIS measures function in "real-world" clinical settings and provides external anchors that can support comparative effectiveness research. The current body of clinical validity evidence for the nine PROMIS measures indicates the success of NIH PROMIS in developing measures that are effective across a range of chronic conditions.


Comparative study on anti-oxidative and anti-inflammatory properties of hydroponic ginseng and soil-cultured ginseng.
Hydroponic ginseng (HPG) and soil-cultured ginseng (SCG) were extracted in 70% methanol to quantify relative content of 8 ginsenosides and polyphenolic compounds, and flavonoids to compare their antioxidative effects. Level of nitric oxide and inflammatory targets produced in LPS-stimulated RAW 264.7 cells were measured. 2-year-old HPG shoots contained highest levels of ginsenoside Rb2, Rb3, Rd, Re, and F1. Total polyphenol content was highest in shoots of HPG, followed by roots of HPG and SCG. HPG shoots had high radical scavenging activity and an elevated ability to inhibit linoleic acid oxidation. 2-year-old HPG shoots reduced nitric oxide production in RAW 264.7 cells by 47%, whereas 6-year-old SCG roots reduced it by only 21%. HPG also significantly lowered mRNA expression of iNOS, TNF-α, IL-1β, and IL-6, as determined by RT-PCR, compared to SCGs. Therefore, HPG may have potential for utilization as an alternative to SCG, because of superior antioxidant and anti-inflammatory properties.


Functionalization of Natural Graphite for Use as Reinforcement in Polymer Nanocomposites.
Graphite is a naturally abundant material that has been used as reinforcing filler to produce polymeric nanocomposites for various applications including automotive, aerospace and electric-electronic. The objective of this study was to develop methodologies of graphite nanosheets preparation and for incorporation into polymer matrices. By means of different chemical and physical treatments, natural graphite was modified and subsequently characterized by X-ray diffraction (XRD), infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermogravimetry (TGA) and the particle size determination. The results obtained clearly show that after the treatments employed, polar chemical groups were inserted on the natural graphite surface. Nanosized graphite particles of high aspect ratio were obtained.