Clinical Guidelines for the Evaluation and Treatment of Lumbar Disc Herniations: How Accurate is the Internet?
To compare information online regarding lumbar disc herniation (LDH) on commonly searched websites and compare those findings with the evidence-based recommendations listed in the North American Spine Society (NASS) clinical practice guidelines. NASS Clinical Practice Guidelines, Internet searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected. The content regarding diagnosis and treatment of LDH was compared to the NASS clinical practice guidelines. On average, websites mentioned only 59% of recommendations supported by Level I evidence. Websites included an average of 3 recommendations not discussed in the NASS guidelines out of an average of 12 total recommendations. Muscle and sensory testing and physical therapy were the most frequent recommendations, appearing on over 80% of websites. Websites were equally likely to contain recommendations backed by high-quality evidence as recommendations not included in NASS guidelines. This study demonstrates that websites regarding LDH contain a mix of information, with only a fraction of recommendations aligning with NASS clinical guidelines. Patients who use these websites are presented with unsubstantiated information, conceivably impacting their understanding, expectations and decision-making in physician offices.


Modulation of hepatic fibrogenesis by antioxidants.
The oxidative damage of liver tissue appears to favour a fibrogenic process, through the stimulation of TGF beta 1 and procollagen gene expression. The latter effect has been also showed by a well defined end-product of lipid peroxidation, 4-hydroxy-2,3-nonenal in human Ito cell culture. "In vivo" and "in vitro" data give evidence of a strong down modulation of TGF beta 1 and collagen expression afforded by supplementation with different antioxidant molecules.


Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection.
The purpose of this study was to investigate the factors related to early postoperative psychological conditions in breast cancer patients with axillary lymph node dissection 3 months after the surgery. The subjects of this study were 200 consecutive patients who underwent axillary lymph node dissection for breast cancer at our hospital. Age, body mass index, surgical side, work, marriage, presence of children, presence of co-resident household members, resection of the pectoralis minor muscle, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and psychological conditions were evaluated. In this study, a Distress and Impact Thermometer was used to classify patients with adjustment disorders, depression, or major depression and suicidal ideation into a group with psychological problems and the remaining patients into a group with no psychological problems. Logistic regression analysis showed that only DASH was statistically significantly associated with psychological conditions (p < 0.05). Using receiver operating characteristic curve analysis, a DASH score of 18 or greater was found to be very specific for predicting psychological conditions. The observation that somatic symptoms and disability of upper limb function are related to psychological conditions may indicate the importance of postoperative rehabilitation in breast cancer patients with axillary lymph node dissection.


A simple method for identifying the palindromic sequences recognized by restriction endonucleases: the nucleotide sequence of the AvaII site.
Tables specifying the frequencies, distances between and positions of all possible tetra-, penta- and hexanucleotide palindromes in phiX174 and SV40 viral DNAs were prepared by a computer search of their base sequences. A simple method based on these tables is described for identifying the sequence recognized by any specific restriction endonuclease. The method requires experimental determination of the number and approximate sizes of the fragments obtained by digestion of phiX174 RF and SV40 DNAs. Using this method we identified the sequence for AvaII restriction endonuclease as 5'-GG(AT)CC.


Electroimmunoassay of a subunit protein in a macromolecular complex (apolipoprotein B in human plasma very low density lipoprotein); implications for other electroimmunoassay systems.
With an electroimmunoassay ("rocket") system for the apolipoprotein B component of the plasma very low density lipoprotein complex we obtained results which were similar to those obtained by a colorimetric tetramethylurea extraction method. Results were up to twice as high as those using radioimmunoassay. Low density lipoprotein containing apolipoprotein B as the only demonstrable protein component was used as the standard for these assays. This protein produced larger and higher rockets at pH 8.6 when the negative particle charge was increased by maleylation. The very low density lipoprotein complex has a higher negative charge at pH 8.6 than low density lipoprotein. These findings suggest that some apolipoprotein B in vary low density lipoprotein is not "recognised" by anti-apolipoprotein B antibodies, hence radioimmunoassay results are lower than those obtained with the tetramethylurea extraction method. The higher negative charge on very low density lipoprotein particles (compared with low density lipoprotein), as a factor tending to increase rocket area and height, is counterbalanced by reduced recognition by antiapolipoprotein B antibodies. The net result of these opposing tendencies is that the rocket electroimmunoassay of apolipoprotein B in very low density lipoprotein fortuitously gives valid results, under the specified assay conditions. We conclude that electroimmunoassays of complex proteins are not necessarily valid if protein subunits are used for standards. This has implications for the electroimmunoassay of other apolipoproteins.


[Psychiatry as a profession].
With reference to Max Weber's timeless analysis of science and politics as a profession, the present paper describes the philosophical background and historical development of the tasks and tools, institutionalization, and socialization of psychiatry as a profession. In the mid twentieth century, psychiatrists' emergence from ideological confinement in asylums, where they were separated from urban culture and medicine in general, finally allowed them to benefit from accumulating knowledge and technological progress in the field of medicine. After its transition from a custodial to a therapeutic discipline, psychiatry has acquired a variety of new fields of action and duties that require a high degree of expertise on psychological and biological levels. At the same time, people have increasingly come to expect relief not only from disease, but also from manifold problems of everyday life. As a consequence, there has been an inflationary growth of professional psychiatric and psychotherapeutic and nonprofessional services. The professional requirements that psychiatrists should meet have also increased quantitatively and qualitatively in the wake of the historical change from a caring, paternalistic attitude towards the mentally ill to a therapeutic partnership. To a greater degree than physicians working in other medical fields, psychiatrists get personally involved with their patients. As a consequence, the mental burden of their profession is at times immense. For this reason, the ethics of a medical profession has special implications for psychiatrists. The fascinating advances in therapeutic methods, neurobiological knowledge, and the increasingly differentiated diagnostic tools, e.g., noninvasive investigation of the morphology and functioning of the brain, have turned psychiatry into one of the most interesting contemporary professions. Psychiatry is now facing an enormous challenge of meeting the standards of expertise.


Easily Operable Quantification Method of 21 Plant-Derived Alkaloids in Human Serum by Automatic Sample Preparation and Liquid Chromatography-Tandem Mass Spectrometry.
In this study, we developed an easily operable quantification method for 21 plant-derived alkaloids in human serum by automatic sample preparation and liquid chromatography-tandem mass spectrometry. We designed to perform parallel sample preparation by a developed apparatus, which increased sample throughput. We conducted an automatic sample preparation through de-proteinization with 0.1% formic acid in methanol and achieved recovery rates of 89-107% (2.0-14% RSD) for all targeted analytes, demonstrating its high repeatability. The method validation results were satisfactory as follows: the linearity (r 2) of each calibration curve ranged from 0.978 to 1.000; the inter- and intra-day accuracies were 89.0-125% and 82.1-110%, respectively; the inter- and intra-day precisions were below 13% and 10%, respectively. Additionally, the lower limits of detection and quantification were 0.0044-0.047 and 0.013-0.14 ng/mL, respectively. Finally, the developed method was applied to pseudo-protoveratrine A poisoning serum and pseudo-colchicine poisoning serum, which were prepared by diluting acute-poisoning mice serum with human serum. Our method successfully quantitated protoveratrine A (0.15-0.25 ng/mL) and colchicine (4.8-6.0 ng/mL). Thus, our method is essential for prompt clinical treatment and critical care on patient in acute intoxication cases caused by plant-derived alkaloids. The online version contains supplementary material available at 10.1007/s10337-022-04212-5.


Facilitation and masking of briefly presented gratings: time-course and contrast dependence.
We measured two-alternative forced-choice contrast thresholds for briefly presented sinusoidal gratings in the presence of superimposed masking gratings of various contrasts, and at a range of onset asynchronies. Facilitation (lower thresholds) occurred when the mask was simultaneous, in-phase, and near-threshold, but was abolished at asynchronies of 50 msec or more and by presenting the test grating as a brief contrast reversal instead of a pulse. We argue that facilitation requires temporal summation of responses within the same neural channels, but our results do not distinguish between transducer and uncertainty models. Masking (threshold elevation) occurred over a broader range of asynchronies, and was not abolished by test contrast reversal. Masking and facilitation probably depend on different processes with different time-courses. The occurrence of masking at asynchronies outside the range of temporal summation suggests that a static, compressive transducer does not, in general, account for masking. Brief masking and prolonged contrast adaptation are very similar in magnitude, and as a function of contrast and relative spatial frequency. Masking and adaptation may have a common origin, but differ in speed of recovery.


A method for relocation of specified regions in tissue culture dishes.
An apparatus and method are described which facilitate the rapid and accurate visual relocation of specified areas within ordinary, circular, plastic petri-dishes.


Improved microarray gene expression profiling of virus-infected cells after removal of viral RNA.
Sensitivity and accuracy are key points when using microarrays to detect alterations in gene expression under different conditions. Critical to the acquisition of reliable results is the preparation of the RNA. In the field of virology, when analyzing the host cell's reaction to infection, the often high representation of viral RNA (vRNA) within total RNA preparations from infected cells is likely to interfere with microarray analysis. Yet, this effect has not been investigated despite the many reports that describe gene expression profiling of virus-infected cells using microarrays. In this study we used coronaviruses as a model to show that vRNA indeed interferes with microarray analysis, decreasing both sensitivity and accuracy. We also demonstrate that the removal of vRNA from total RNA samples, by means of virus-specific oligonucleotide capturing, significantly reduced the number of false-positive hits and increased the sensitivity of the method as tested on different array platforms. We therefore recommend the specific removal of vRNA, or of any other abundant 'contaminating' RNAs, from total RNA samples to improve the quality and reliability of microarray analyses.


Physiologic determinants of coronary blood flow during external cardiac massage.
Adequate coronary blood flow is a major determinant for successful resuscitation from cardiopulmonary arrest. To develop compression techniques that optimize coronary blood flow, we implanted in eight dogs electromagnetic flow probes that measured circumflex coronary blood flow and ascending aortic blood flow. Micromanometers measured left ventricular and aortic pressures. Each dog was anesthetized and intubated, and the heart was fibrillated electrically. High-impulse manual chest compressions were performed with the dog in the supine position, and compression rate was varied from 60/min to 150/min. Antegrade coronary blood flow occurred primarily during artificial diastole, and there was a brief period of retrograde coronary blood flow with compression during artificial systole. Cardiac output and diastolic aortic pressure increased with compression rate, significantly augmenting peak coronary blood flow velocity. However, diastolic perfusion time decreased linearly with compression rate and limited coronary perfusion at rates greater than 120/min. As a result, net coronary blood flow during high-impulse manual chest compression was determined primarily by diastolic aortic pressure and diastolic perfusion time. Coronary blood flow was optimized in this model at a compression rate of 120/min.


Method of assessing involved facial areas: rule of fours.
Disease extent or affected area is probably the most easily and most frequently measured index of patient disability in dermatological disorders such as psoriasis. However, no standard method is available for assessing involved facial areas. To devise a method for assessing involved facial areas and to examine its validity and reliability. In study 1, the facial areas of 26 healthy adults were analysed and a new method for assessing facial areas was devised. In study 2, the validity and reliability of the devised method were investigated by 10 dermatologists using 30 photographs of patients with facial psoriasis. In study 1, facial regions were defined to have percentage areas that were multiples of 4% of the total facial area (which we refer to as the rule of fours), i.e. forehead 24%, one cheek 20%, perioral area 8%, one aspect of an ear 4%, one periorbital area 4%, and nose 4%. In study 2, a comparison of values obtained using the rule of fours with those obtained using an image analysis system showed excellent intrarater and inter-rater reliability when using the rule of fours. The rule of fours is useful for assessing involved facial areas. The application of this rule was found to provide an accurate and reliable method as compared with image analysis.


Association of emotional support with quality of life, mental health, and survival in older adults with gastrointestinal malignancies-Results from the CARE registry.
Emotional support (ES) is the most frequently reported support need among older adults with cancer. Yet, the association of ES with cancer outcomes is largely unknown. This study examined the association of ES with health-related quality of life (HRQoL), mental health, and survival among older adults with gastrointestinal (GI) malignancies. We included newly diagnosed older adults (≥60 years) with GI cancer undergoing self-reported geriatric assessment at their first clinic visit. ES was measured using an adaptation of the Medical Outcomes Study (dichotomized adequate ES vs. inadequate ES). Outcomes included physical and mental HRQoL, anxiety, depression, and survival. Multivariable linear regression evaluated the association between ES and HRQoL scores. Multivariable logistic regression evaluated the association of ES with anxiety and depression. All models were adjusted for age at geriatric assessments, race, sex, and cancer type/stage. 795 participants were included. Median patient age was 68 years (IQR: 64-74), 58% were male, and most cancers were either colorectal (37.9%) or pancreatic (30.8%). Most (77.6%) had adequate ES. Patients with inadequate ES were more likely to be Black (31.5 vs. 20.8%, p = 0.005), disabled (24.1 vs. 10.4%, p < 0.001), widowed/divorced (54.2 vs. 24.8%, p < 0.001) and had lower physical and mental HRQoL t-scores (Physical β: -3.35, 95% CI: -5.25, -1.46; Mental β: -2.46, 95% CI: -4.11, -0.81) and higher odds of depression (aOR: 2.22, CI: 1.34-3.69). This study found no difference between those with adequate ES versus inadequate ES in the proportion of deaths within 1 year of diagnosis (24.3% vs. 24.2%, p = 0.966), or within 2 years of diagnosis (32.4% vs. 33.2%, p = 0.126). Older adults with inadequate ES have worse physical and mental HRQoL and higher odds of depression compared to those with adequate ES.


Pituitary-thyroid axis, thyroid volume and leptin in healthy adults.
Patients with thyroid diseases usually have disturbances relating to body weight and thermogenesis. On the other hand, leptin is involved in the regulation of body weight, food intake and thermogenesis. Some studies have investigated the relationship between leptin and dysthyroid states, but the complex interactions between leptin and pituitary-thyroid axis have led to controversial results. The aims of this cross-sectional study were to investigate the relationship among basal TSH, ultrasonographic thyroid volume and leptin in a group of 268 healthy adults randomly selected from our city, L'Hospitalet de Llobregat, Barcelona, an area free of iodine deficiency. In this euthyroid group, we determined basal TSH, thyroid autoantibodies, leptin concentrations, and thyroid volume by ultrasonography, body anthropometry, and body composition. All subjects were free of goitre and were negative for anti-thyroid antibodies. Basal TSH concentrations were 1.49 +/- 0.8 mU/l in males and 1.67 +/- 0.83 mU/l in females (p = 0.6). Anti-thyroid antibodies were negative in all cases; leptin concentrations were 6.1 +/- 4 ng/ml in males and 16.8 +/- 11.7 ng/ml in females (p = 0.0001). Thyroid volume was 9.8 +/- 4.6 ml in males and 6.5 +/- 2 ml in females (p = 0.001). There were significant correlations among leptin concentrations and anthropometric and body composition variables in both sexes, without correlation with TSH concentrations. There was no significant correlation between anthropometric and body composition variables and thyroid volume in males but there was a correlation in females. In females, there was a positive correlation between leptin and thyroid volume (r = 0.181, p = 0.038). In males, there was a negative correlation between TSH concentrations and thyroid volume (r = - 0.271, p = 0.002). We did not find any correlation between leptin levels and pituitary-thyroid axis in this control population. The correlation between leptin and thyroid volume in females is probably a consequence that leptin and thyroid volume are regulated in parallel by variables relating to anthropometry and body composition.


Anti-inflammatory activity of root bark and stem bark of Shyonaka.
Shyonaka (Oroxylum indicum Vent.; Bignoniaceae) root bark is one of the ingredients of dashamoola (a group of 10 roots), and is used for its anti-inflammatory and analgesic action in a number of compound formulations in Ayurveda. Ayurvedic Pharmacopoeia of India (API) recommends using the stem bark instead of root bark. An attempt has been made to study the anti-inflammatory activity of both root bark and stem bark kashaya (decoction) experimentally. Results showed significant anti-inflammatory activity of root bark and stem bark decoction.


Comparison of stent retriever thrombectomy using 3-dimensional patient-specific models of intracranial circulation with actual middle cerebral artery occlusion thrombectomy cases.
Stent retriever (SR) thrombectomy is commonly used for the treatment of emergent large vessel occlusion (ELVO) in acute ischemic stroke. Clot imaging parameters such as clot length, diameter, distance to the internal carotid artery terminus, and vessel angle where the SR is deployed may predict the likelihood of achieving first pass effect (FPE). Most of the proposed factors that seem to affect recanalization success have been studied individually, and conflicting data derived from clinical versus in vitro studies using 3-dimensional printed models of intracranial circulation currently exist. Using patient-specific 3-dimensional phantoms of the cervical and intracranial circulation, we simulated middle cerebral arteries (MCA) M1 and M2 occlusions treated with SR thrombectomy using Solitaire (Medtronic) or Trevo (Styker). Our primary outcome was FPE, defined as Thrombolysis in Cerebral Infarction score of 2c-3 achieved after a single thrombectomy attempt. We also performed retrospective analysis of same clot imaging characteristics of consecutive cases of MCA occlusion and its association with FPE matching the 3-dimensional in vitro experiments. Analysis was conducted using IBM SPSS Statistics Version 25 (IBM Corp., Armonk, NY). Chi-square tests and bivariate logistic regressions were the main statistical tests used in analysis. A p-value of less than .05 was considered to indicate statistical significance. Ninety-five confidence intervals (95% CI) were generated. We compared 41 thrombectomy experiments performed using patient-specific 3-dimensional in vitro models with a retrospective cohort of 41 patients treated with SR thrombectomy. We found that in the in vitro cohort, higher MCA angulation was associated with a lower likelihood of FPE (odds ratio [OR] = 0.967, 95% CI = 0.944-0.991, p = .008). Meanwhile in the in vivo cohort, higher MCA angulation was associated with a higher likelihood of FPE (OR = 1.039, 95% CI = 1.003-1.077, p = .033). Neither clot length nor location of clot (M1 vs. M2) was associated with a difference in FPE rates in either cohort. Comparison of SR thrombectomy performed during actual MCA occlusion cases versus patient-specific 3-dimensional replicas revealed MCA angulation as an independent predictor of procedure success or failure. However, the opposite direction of effect was observed between the two studied environments, indicating potential limitations of studying SR thrombectomy using 3-dimensional models of LVO.


Androgen-regulated expression of secretory protein synthesis in mouse ventral prostate.
Two proteins of molecular weights 25 and 12 kDa (p25 and p12 respectively), whose expression is regulated by testosterone, were identified in mouse ventral prostate. An antiserum raised to mouse ventral prostate secretion was used to demonstrate that p25 corresponds to the major secretory glycoprotein in mouse prostatic fluid. This antiserum does not cross-react with the major secretory proteins of the rat ventral prostate. Western blot analysis of mouse ventral prostate proteins using the prostatic secretion antiserum demonstrates that p12 and p25 are detectable at 3 weeks of age, but the maximum level of both proteins is not attained until 5 weeks of age. In addition, synthesis of p25 was also observed in prostate tissue derived from differentiated embryonic urogenital sinus tissue growing as implants under the renal capsule of syngeneic male hosts.


Magnitude and time course of changes induced by continuous-flow left ventricular assist device unloading in chronic heart failure: insights into cardiac recovery.
This study sought to prospectively investigate the longitudinal effects of continuous-flow left ventricular assist device (LVAD) unloading on myocardial structure and systolic and diastolic function. The magnitude, timeline, and sustainability of changes induced by continuous-flow LVAD on the structure and function of the failing human heart are unknown. Eighty consecutive patients with clinical characteristics consistent with chronic heart failure requiring implantation of a continuous-flow LVAD were prospectively enrolled. Serial echocardiograms (at 1, 2, 3, 4, 6, 9, and 12 months) and right heart catheterizations were performed after LVAD implant. Cardiac recovery was assessed on the basis of improvement in systolic and diastolic function indices on echocardiography that were sustained during LVAD turn-down studies. After 6 months of LVAD unloading, 34% of patients had a relative LV ejection fraction increase above 50% and 19% of patients, both ischemic and nonischemic, achieved an LV ejection fraction ≥ 40%. LV systolic function improved as early as 30 days, the greatest degree of improvement was achieved by 6 months of mechanical unloading and persisted over the 1-year follow up. LV diastolic function parameters also improved as early as 30 days after LVAD unloading, and this improvement persisted over time. LV end-diastolic and end-systolic volumes decreased as early as 30 days after LVAD unloading (113 vs. 77 ml/m(2), p < 0.01, and 92 vs. 60 ml/m(2), p < 0.01, respectively). LV mass decreased as early as 30 days after LVAD unloading (114 vs. 95 g/m(2), p < 0.05) and continued to do so over the 1-year follow-up but did not reach values below the normal reference range, suggesting no atrophic remodeling after prolonged LVAD unloading. Continuous-flow LVAD unloading induced in a subset of patients, both ischemic and nonischemic, early improvement in myocardial structure and systolic and diastolic function that was largely completed within 6 months, with no evidence of subsequent regression.


No evidence of differential impact of sunflower and rapeseed oil on biomarkers of coronary artery disease or chronic kidney disease in healthy adults with overweight and obesity: result from a randomised control trial.
The perceived benefits and risks associated with seed oil intake remain controversial, with a limited number of studies investigating the impact of intake on a range of compounds used as cardiometabolic markers. This study aimed to explore the proteomic and cardiometabolic effects of commonly consumed seed oils in the UK, with different fatty acid profiles. In a parallel randomised control design, healthy adults (n = 84), aged 25-72 with overweight or obesity were randomised to one of three groups: control (habitual diet, CON); 20 mL rapeseed oil per day (RO), or 20 mL sunflower oil per day (SO). Blood, spot urine and anthropometric measures were obtained at 0, 6 and 12 weeks. Proteomic biomarkers analysis was conducted for coronary arterial disease (CAD) and chronic kidney disease (CKD) using capillary electrophoresis coupled to mass spectrometry (CE-MS). Blood lipids, fasting blood glucose, glycative/oxidative stress and inflammatory markers were also analysed. No differences in change between time points were observed between groups for CAD or CKD peptide fingerprint scores. No change was detected within groups for CAD or CKD scores. No detectable differences were observed between groups at week 6 or 12 for the secondary outcomes, except median 8-isoprostane, ~ 50% higher in the SO group after 12-weeks compared to RO and CON groups (p = 0.03). The replacement of habitual fat with either RO or SO for 12 weeks does not lead to an improvement or worsening in cardiovascular health markers in people with overweight or obesity. Trial registration clinicaltrials.gov NCT04867629, retrospectively registered 30/04/2021.


tDCS and motor training in individuals with central nervous system disease: A systematic review.
Transcranial direct current stimulation (tDCS) is a promising tool for patients with neurological disorders, as it increases cortical excitability, motor learning and functionality. The studies up to date have focused on the tDCS parameters while the effects of the motor training have not yet been fully addressed. The purpose of this study is to present a systematic review of all studies related to tDCS in conjunction with motor training (MT) to improve gait performance, functionality, mobility and balance in individuals with non-progressive central nervous system diseases. Seven databases were searched for articles from inception to October 2018. The search strategy followed Collaboration guidelines. The Physiotherapy Evidence Database (PEDro) Scale and Cochrane Collaboration's tool for assessing the risk of bias were applied to evaluate methodological quality. Four hundred and sixteen recorded were screened. Ten studies met the inclusion criteria. All studies were randomized controlled trials, two of them had a crossover design and other two were pilot studies. Three paper analyzed children and adolescents with cerebral palsy, seven papers analyzed adults and elderly post stroke. tDCS with MT lead to significant results. This review found limited evidence for the use of tDCS with MT for in children with CP and adults post stroke, due to the small number of studies as well as their methodological heterogeneity. In the absence of more robust evidence, further studies with a consistent methodological design are needed to endorse the clinical application of tDCS with motor training.


Revascularization of an arm for incipient gangrene after Blalock-Taussig anastomosis.
A case is reported of incipient gangrene of the right arm developing after a Blalock-Taussig (subclavian-pulmonary) shunt operation in an infant. The ischaemia was reversed by immediate common carotid-axillary artery-vein bypass, using a microvascular technique.


The effect of FeCl3 on the accumulation of gallium-67 into inflammatory and normal tissues.
The effect of FeCl3 on the uptake of 67Ga by inflammatory and normal tissues was studied to clarify the role of transferrin in 67Ga uptake by inflammatory tissue. The administration of FeCl3 5 min before the injection of 67Ga decreased the uptake of 67Ga by liver and spleen, but had little effect on the uptake of 67Ga by the inflammatory tissue. These results suggest that 67Ga is taken up by normal tissues in a transferrin-bound form but in an unbound form by inflammatory tissue. On the other hand, when FeCl3 was simultaneously injected with 67Ga, the uptake of 67Ga by liver and spleen was markedly increased but the uptake by inflammatory tissue was decreased.


Histamine release on rat pleural and peritoneal mast cells elicited by human GRF(1-29)NH2.
We have studied the release of histamine elicited by human GRF(1-29)NH2 on rat peritoneal and pleural mast cells. The secretion is temperature dependent, the release being optimal at 37 degrees C, and it can be inhibited with antimycin A. The activation of pleural and peritoneal mast cells is similar, but there is a slight inhibition for both populations after purification with Percoll.


Does tiotropium lower exacerbation and hospitalization frequency in COPD patients: results of a meta-analysis.
International guidelines recommend long-acting bronchodilators in patients who remain symptomatic despite adequate treatment with short-acting bronchodilators. The purpose of this study is to estimate the effect of tiotropium, a long-acting anticholinergic inhalant, on exacerbation and hospitalisation frequency. Electronic databases (Medline, Embase, INAHTA, CRD databases, and the Cochrane Library) were searched for randomised controlled trials, comparing tiotropium to placebo, or other bronchodilators. Outcomes were the exacerbation frequency and hospitalisation frequency. Data were pooled using the generic inverse variance method for continuous outcomes. Nine studies reported comparisons with placebo (n = 8), ipratropium (short-acting anticholinergic inhalant, n = 1), and salmeterol (long-acting β₂-agonist inhalant, n = 1). Only two studies reported adequate concealment of allocation. Tiotropium reduces the number of exacerbations per patient year by 0.31 (95% CI 0.46- 0.17) compared to placebo, and by 0.23 (95% CI 0.31- 0.15) compared to ipratropium. A significant difference in exacerbation frequency between tiotropium and salmeterol was found (-0.16; 95% CI -0.29 - -0.03) based on approximations of the results of one study.The number of hospitalisations is reduced by 0.04 (95% CI 0.08- 0.01) per patient year compared to placebo and by 0.06 (95% CI -0.09 - -0.03) per patient year compared to ipratropium. Statistically significant but clinically small effects were found for tiotropium compared to placebo and ipratropium. The comparison with salmeterol is significant for exacerbation frequency but not for hospitalisation frequency. Publication bias may be present.


Long term visual outcomes in laser treated threshold retinopathy of prematurity in Central Saudi Arabia.
To assess the long term visual outcomes and refractive status of patients who underwent diode laser for threshold retinopathy of prematurity (ROP) and to investigate the risk factors leading to poor visual outcomes. Fifty-seven patients (114 eyes) with threshold ROP who underwent laser therapy were contacted for reassessment. A chart review was performed for all patients to collect data on visual acuity, retinal status and strabismus. A favorable visual outcome was defined as ⩾20/160 (Snellen acuity) for young adults (cooperative patients), and ⩾CSM for children (uncooperative patients) while unfavorable visual outcome was defined as <20/160 or <CSM. Vision in uncooperative children was graded as central, steady, maintain. Descriptive and inferential analyses were conducted. Chi(2) and odds ratios were calculated whenever appropriate. A P value <0.05 was considered as statistically significant. The mean age at reassessment was 5.2 ± 2.5 years (range, 1-10 years) where 36 (63.2%) patients were males and 21 (36.8%) were females. Out Of the 114 laser treated eyes, 73 (64%) were myopic, with mean spherical equivalent (SE) of -6.69 (5.9), range (-0.25 to -21) diaopters, 8 (7%) were emmetrope, while other 33 (29%) were hyperopic with mean SE of +2.43 (3.04), range (+0.25 to +17) diaopters. Strabismus was present in 31 patients (54.4%) of whom 81% (25/31) were esotropic. Retina was found to be normal in 77.1% of the examined eyes, while the remaining eyes had either macular dragging or retinal detachment. Almost 70% of the eyes with a normal retinal examination had favorable visual outcome. Thirteen (11.4%) eyes had zone 1 retinopathy, 83 (72.8%) eyes had zone 2 retinopathy and 2 (1.8%) eyes had zone 3 retinopathy. Vitreous hemorrhage was present in 7 (6.1%) eyes prior to laser treatment. The relationship between final retinal status and visual outcome was statistically significant (P < 0.0001). There was no statistically significant correlation between visual outcome and the zone of the retinopathy (P = 0.448). The majority of patients who underwent diode laser therapy for threshold ROP had favorable anatomical and visual outcomes. However, high refractive error and strabismus may be clinically the pertinent causes of visual impairment.


Therapeutic strategies based on immunological hypotheses of Alzheimer's disease.
There are several findings demonstrating the importance of inflammatory or immunological processes in the etiopathogenesis of Alzheimer's disease (AD). Several studies on nonsteroidal anti-inflammatory drugs (NSAID) give evidence for a therapeutic effect of these drugs in AD, among other the prospective double-blind placebo-controlled study on indomethacin, strongly support the therapeutic effect of these agents. Possibly also the therapeutic effects of propentofylline might be interpreted in the light of this theory.


Insulin exhibits short-term anti-inflammatory but long-term proinflammatory effects in vitro.
Although insulin is indispensable for maintaining glucose homeostasis, it is still controversial whether or not a high concentration of insulin is deleterious. We examined the effect of insulin on the transcriptional activity of NF-kappaB, which mediates the expression of a variety of inflammation/coagulation-related genes using hepatocyte cell lines in vitro. We found that insulin (1 nM) alone caused minimal increase in NF-kappaB-mediated transcription. On the other hand, when cells were simultaneously treated with proinflammatory cytokines such as TNFalpha, the following dual effect of insulin was observed: short-term (6h) suppressive, and long-term (36 h or later) stimulatory effects. The former effect was transient and appears to be mediated by the phosphatidylinositol 3 kinase (PI(3)K) signaling pathway. The latter effect, in contrast, was more pronounced, enhancing the TNFalpha-stimulated NF-kappaB-dependent transcription by more than sevenfold. This positive effect was NF-kappaB-specific, and was eliminated by mitogen-activated protein kinase (MAPK) inhibitors. Altogether, our data suggest that insulin has short-term anti-inflammatory but long-term proinflammatory effects. From a clinical standpoint, this implies that low basal and periodically high plasma insulin is beneficial, whereas a sustained rise in plasma insulin, as often seen in patients with obesity, may induce atherothrombotic disorders, because of the NF-kappaB-mediated overexpression of proinflammatory/procoagulant/antifibrinolytic proteins in the liver.


Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest.
Despite recent efforts, most people are not trained in cardiopulmonary resuscitation (CPR), which has a major impact on survival following cardiac arrest (CA). We have set up a dispatcher-assisted CPR protocol at our call centre, based on international guidelines issued in 2010. The aim of our study was to evaluate the impact of this protocol on CA diagnosis and quantity of recommendations given by telephone dispatchers to untrained witnesses. We performed a 'before and after' monocentric observational study. Data were compared before and a short time after (2 months) implementation of the protocol. We included patients presenting as an out-of-hospital CA in the presence of a witness untrained in CPR. Fisher's test was used to compare periods. P < 0.05 was considered significant. During the 8 month period before the protocol, 115 victims were potentially eligible for CPR. Diagnosis was achieved in 63.5% of cases and CPR recommendations given in 6.1%. After implementation of the protocol, 130 victims were potentially eligible for CPR. Frequency of CA diagnosis was significantly higher after the protocol with 76% of cases (P = 0.0359). Frequency of CPR recommendations given to witnesses was also significantly higher after the protocol, with a fivefold increase up to 29.2% (P < 0.0001). Implementation of a dispatcher-assisted CPR protocol was efficient in improving both CA diagnosis and CPR recommendations given to untrained witnesses for out-of-hospital CA with a very short time of dispatcher training. It is a simple and efficacious measure, at no additional cost and with the promises of improving prognosis following cardiac arrest in a centre not equipped with computerised dispatcher support programmes.


Production of malonaldehyde from squalene, a major skin surface lipid, during UV-irradiation.
Malonaldehyde (MA), a product of lipid peroxidation, is known to have a number of toxicological effects. Among skin surface components, squalene has been suggested as a significant source of MA following UV exposure. Irradiation of squalene coated on the inside surface of glass tubes served as a simple model to examine skin surface photochemistry. Malonaldehyde produced during UV-irradiation was reacted with methyl hydrazine to form N-methylpyrazole, which was then measured by gas chromatographic analysis. Ultraviolet A-irradiation produced low levels of MA from squalene, with a maximum of 1.0 nmol MA/mumol squalene near 6 h. Malonaldehyde production varied with the energy of irradiation, with levels of 176 nmol/mg squalene and 9 nmol/mg squalene produced after 3 h of irradiation with UVB and UVA, respectively. The thiobarbituric acid (TBA) assay for lipid peroxidation showed large overestimations of MA levels under all irradiation conditions tested. The TBA assay predicted the highest levels of MA with UVC but we did not detect any MA with our assay.


A questionnaire study of support for adult survivors of childhood cancer.
Childhood cancer survivors (CCSs) entering adulthood experience different problems, including late therapy-related complications. Long-term follow up (LTFU) is important for early intervention and psychosocial support for CCSs with late complications but it is frequently discontinued. This study aimed (i) to identify clearly the factors responsible for LTFU discontinuation, and (ii) to define the support needs of CCSs. From July, 2017 to March, 2019 we conducted a questionnaire survey of 121 CCSs aged ≥ 18 years at the time of the survey to investigate people who have experienced childhood cancer and identify their support needs. This was conducted in cooperation with patient associations throughout Japan. The LTFU levels were determined by CCSs themselves based on their treatment history. Long-term follow-up rates and LTFU discontinuation factors were assessed using the Kaplan-Meier method and the Cox proportional-hazards model. Late complications were the most common problem encountered by CCSs (80%). The most common support need was "explanation of late complications by a physician," reported by 86.9% of respondents. The rate of LTFU continuation decreased over time. The LTFU was discontinued both for physicians' reasons (35.6%) and patients' reasons (64.4%). Not knowing the extent or level of one's LTFU was reported to be an independent factor (P < 0.05) preventing LTFU continuation. As necessary support to continue LTFU, 67.9% of respondents stated the need for "explanation of LTFU by a doctor" and 60.7% stated "convenience of outpatient visit". Childhood cancer survivors require support, especially for late complications. It is necessary to continue LTFU, raising LTFU awareness among physicians and CCSs.


Tubulin, but not microtubules, is the substrate for tubulin:tyrosine ligase in mature avian erythrocytes.
Chicken erythrocytes, which contain a marginal band of microtubules, were used to study the influence of the aggregation state of tubulin on the post-translational incorporation of tyrosine into the alpha-tubulin subunit. We found that the incorporation of [14C]tyrosine occurs almost exclusively into the nonassembled tubulin pool. The marginal band was practically not labeled. The low incorporation into microtubules was not due to the lack of tubulin with acceptor capacity since after cold-induced disassembly, an additional amount of [14C]tyrosine could be incorporated. 14C-Tyrosinated tubulin of the nonassembled pool could not be incorporated into microtubules of the marginal band after prolonged incubation at 37 degrees C or when the marginal band was regenerated after cold-induced depolymerization. In erythrocytes, tubulin:tyrosine ligase behaved as a soluble entity when the cells were lysed under microtubule-preserving conditions.


Prevalence and trends of insulin resistance, impaired fasting glucose, and diabetes.
Our aim was to measure the prevalence and time trends of diabetes, impaired fasting glucose, and insulin resistance in the United States during the periods 1988-1994 and 1999-2002. Data were derived from two nationally representative samples of the adult U.S. population collected as part of the National Health and Nutrition Examination Surveys of 1988-1994 (n=18,800) and 1999-2002 (n=10,283). We compared these two samples with respect to the following outcomes: previously diagnosed diabetes defined by self-report; undiagnosed diabetes defined as fasting plasma glucose > or =126 mg/dl; impaired fasting glucose defined as fasting plasma glucose 100-125 mg/dl; and insulin resistance calculated using the homeostasis model assessment as {[fasting serum insulin (microU/ml)] x [fasting plasma glucose (mmol/L)]/22.5}. The age- and sex-adjusted prevalence of diagnosed diabetes increased from 5.5% in 1988-1994 to 6.8% in 1999-2002 (change 1.3%, 95% confidence interval 0.5-2.1). Little change occurred in the adjusted prevalence of undiagnosed diabetes (from 3.0 to 3.0%) and impaired fasting glucose (from 26.2 to 26.9%). Mean insulin resistance and the proportion with high insulin resistance increased significantly both among normoglycemic persons (mean: from 2.0 to 2.2; proportion >2.35: from 26.2 to 32.2%) and among persons with undiagnosed diabetes or impaired fasting glucose (mean: from 4.0 to 4.5; proportion >4.4: from 24.8 to 31.1%). In 1999 to 2002, diagnosed and undiagnosed diabetes were most common in non-Hispanic blacks, whereas impaired fasting glucose was most common in Mexican Americans. Diabetes, impaired fasting glucose, and insulin resistance are common in the United States and their prevalence continues to increase.


Is it worth the risk? Frailty transition and complications following robotic total knee arthroplasty: A retrospective observational study.
Frailty is an underutilized prognostic parameter in the geriatric population. Our study aimed to analyse the frailty incidence, its transition over 1 year and its influence on complication rate in patients undergoing elective robotic-assisted total knee arthroplasty (TKA). This was a retrospective study wherein an accumulation of deficits model was used to evaluate frailty of 435 consecutive patients undergoing primary unilateral Mako-assisted cemented TKA between January 2020 and July 2021. Based upon the preoperative values, participants were divided into three groups; non-frail (FI < 0.11), vulnerable (0.11-0.20) and frail (FI > 0.20) states and were followed up for 1 year for change in frailty class, complications, re-admissions and mortality. A total of 435 patients were divided into three groups, non-frail (178), vulnerable (208) and frail (49). Improvement in mean frailty scores was seen in all three groups (P < 0.0001); 21.63% of the vulnerable and 48.97% of the frail participants improved by one frailty class. Multivariate analysis showed the co-relation of change in frailty index (ΔFI) with preoperative FI (r = 0.083) and Knee Society Score (KSS) (r = 0.742). The frail group had a significantly higher re-admission rate over 1 year. When compared with the vulnerable group, the frail group had a higher hazard ratio for readmission (3.12 vs. 0.96) and complications (1.62 vs. 1.26). Although frail individuals are at a higher risk for readmissions and perioperative complications, TKA significantly improves the mobility and frailty status of elderly individuals. With explained higher risk of complications, surgeons should not refrain from offering TKA to elderly frail individuals disabled with knee pain.


Candida-host cell receptor-ligand interactions.
The interaction of Candida species with their cognate host receptors is a key factor in the pathogenesis of different types of candidiasis. The recognition of different forms of Candida albicans by Toll-like receptors 2 and 4 on mononuclear leukocytes has recently been discovered to determine the function and activity of regulatory T-cells, determine the balance of Type 1 and Type 2 cytokines and, thereby, influence the antifungal activity of both the innate and adaptive immune response. Different forms of C. albicans are also recognized by different lectins that are expressed on the surface macrophages. C. albicans and Candida glabrata express the ALS (agglutinin-like sequence) and EPA (epithelial adhesin) families of adhesins, respectively. A key difference between C. glabrata and C. albicans is that EPA expression in C. glabrata is governed by sub-telomeric silencing, whereas ALS expression in C. albicans is regulated by other mechanisms.


Elevations of urinary MHPG in depressed patients with panic attacks.
Anxiety may be associated with increased norepinephrine activity. Urinary levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) were examined in depressed patients with and without panic attacks. Depressed patients with panic attacks had significant elevations of MHPG.


Clinical assessments of increased sensory sensitivity in dogs with cranial cruciate ligament rupture.
Dogs with chronic pain have a compromised quality of life. Repeatable and accurate sensory assessments form a means by which the hypersensitivity likely to reflect chronic pain may be quantified. These assessments can be applied to individuals to identify those that may benefit from improved analgesic relief. In this study four sensory assessments were evaluated in dogs presenting with a naturally occurring chronic painful condition (cranial cruciate ligament rupture, CCLR) and were compared with healthy control animals of similar age and weight. Inter-digital von Frey filament and thermal sensitivity tests revealed that the affected hind limb of dogs with CCLR was significantly more sensitive than the opposing limb. Static weight bearing and gait parameter scores were also reduced in the affected hind limb compared to the opposing hind limb of dogs with CCLR; no such differences were found between the hind limbs of healthy (control) dogs. The quantitative sensory tests permitted the differentiation of limbs affected by CCLR from healthy limbs. Dogs presenting with CCLR demonstrate objectively quantitative sensory sensitivities, which may require additional consideration in case management.


Surgical management of inferior vena cava strut penetration causing hydronephrosis: case report.
We present a case of penetration of inferior vena cava (IVC) by primary struts of Cook Celect filter and impingement on right ureter, causing symptomatic hydronephrosis and hydroureter, which was managed surgically by ureterolysis, mobilization of the ureter by retroperitoneal approach, excision of the filter strut, and omental wrap around the ureter.


Reduced expression of miR-30c-5p promotes hepatocellular carcinoma progression by targeting RAB32.
Hepatocellular carcinoma (HCC) remains among the most lethal of human cancers, despite recent advances in modern medicine. miR-30c-5p is frequently dysregulated in different diseases. However, the effects and the underlying mechanism of miR-30c-5p in HCC are still elusive. Here, we show that miR-30c-5p is downregulated in HCC and significantly associated with survival and tumor size in patients with HCC. We demonstrate that aberrant miR-30c-5p markedly affects HCC cell proliferation and migration. Further experiments show that RAB32 is an essential target of miR-30c-5p in HCC. These studies highlight an important role of miR-30c-5p in growth and invasion of HCC and indicate that the miR-30c-5p-RAB32 axis is an important underlying mechanism.


Sinus culture differences in patients with radiographic evidence of odontogenic disease.
Odontogenic sinusitis is a well-known entity with a different pathogenesis than chronic rhinosinusitis. Nonspecific symptoms can make diagnosis difficult. This study aims to compare culture results between patients with and without computed tomography findings indicative of possible odontogenic disease. This was a retrospective cohort study in which patients undergoing endoscopic sinus surgery for chronic sinusitis over a three-year period at a single institution were reviewed. CT imaging was reviewed for evidence of dental disease, specifically periapical lucency, dehiscence of the floor of the maxillary sinus, oroantral fistula, or foreign body. Culture results were then assessed and compared between groups with CT evidence of a possible odontogenic source to those without. Overall, 231 patients were evaluated. 92 patients (39.8 %) were found to have evidence of a likely odontogenic source on CT. Cultures were available for 118 of 231 patients (51.1 %). Patients with CT signs of odontogenic disease were significantly more likely to grow Proteus mirabilis (p = 0.018) and Klebsiella pneumoniae (p = 0.037) on culture. Patients without CT signs of odontogenic sources were significantly more likely to grow Pseudomonas aeruginosa (p = 0.009). Of note, patients with CT findings concerning for an odontogenic source were also more likely to grow fungi other than Aspergillus and Mucor species on culture (p = 0.004). Patients with CT findings concerning for an odontogenic source of sinus disease showed differences in culture results that could be important in differentiating pathogenesis of sinus disease.


Fine distribution of gamma-aminobutyric acid, glutamic acid decarboxylase, and glutamic acid in the rabbit cerebellum.
The fine distribution of GABA, glutamic acid decarboxylase, and glutamic acid within each layer of the rabbit cerebellar cortex was determined with microanalytical methods. The greatest glutamic acid decarboxylase activity and the highest GABA concentration were found in the Purkinje cell layer. In the distribution of GABA and glutamic acid decarboxylase the peak of glutamic acid decarboxylase activity was more pronounced than that of GABA; the concentration of glutamic acid did not show much variation between each layer.


Coevolution between Cancer Activities and Food Structure of Human Being from Southwest China.
Yunnan and Tibet are the lowest cancer mortality and the largest producer for anticancer crops (brown rice, barley, buckwheat, tea, walnut, mushrooms, and so forth). Shanghai and Jiangsu province in China have the highest mortality of cancers, which are associated with the sharp decline of barley.


Pre-clinical evaluation of cognition enhancing drugs.
1. The need of the treatment of cognitive impairment due to aging or dementia has led to the search for potential cognition enhancing drugs. The various compounds presently under development represent an alternative to the cholinomimetic therapy and include new chemical entities as well as piracetam and its newer analogs. 2. Recent results from pre-clinical evaluation of the effects on learning on memory are summarized. Emphasis is put on learning and memory experiments under normal and pathological conditions. Most of the nootropics attenuate experimental amnesias induced by scopolamine, cycloheximide, ECS, hemicholinium-3 or forebrain ischemia. These findings suggest that the nootropics may be influencing a common mechanism underlying the amnesias. 3. Biochemical data suggest a potential cholinergic neuronal activity of some of the piracetam analogs. They increase high-affinity choline uptake, and antagonize scopolamine- and ECS-induced decreases in acetylcholine concentrations in the hippocampus. The mode of action of these and all other nootropic compounds, however, is still not known. 4. Despite the interesting results from learning and memory studies and from biochemical investigations, the clinical relevance of these results for amelioration of the cognitive impairment in humans remains to be proven for most of the compounds.


Comparison of machine learning algorithms for the prediction of five-year survival in oral squamous cell carcinoma.
Machine learning analyses of cancer outcomes for oral cancer remain sparse compared to other types of cancer like breast or lung. The purpose of the present study was to compare the performance of machine learning algorithms in the prediction of global, recurrence-free five-year survival in oral cancer patients based on clinical and histopathological data. Data were gathered retrospectively from 416 patients with oral squamous cell carcinoma. The data set was divided into training and test data set (75:25 split). Training performance of five machine learning algorithms (Logistic regression, K-nearest neighbours, Naïve Bayes, Decision tree and Random forest classifiers) for prediction was assessed by k-fold cross-validation. Variables used in the machine learning models were age, sex, pain symptoms, grade of lesion, lymphovascular invasion, extracapsular extension, perineural invasion, bone invasion and type of treatment. Variable importance was assessed and model performance on the testing data was assessed using receiver operating characteristic curves, accuracy, sensitivity, specificity and F1 score. The best performing model was the Decision tree classifier, followed by the Logistic Regression model (accuracy 76% and 60%, respectively). The Naïve Bayes model did not display any predictive value with 0% specificity. Machine learning presents a promising and accessible toolset for improving prediction of oral cancer outcomes. Our findings add to a growing body of evidence that Decision tree models are useful in models in predicting OSCC outcomes. We would advise that future similar studies explore a variety of machine learning models including Logistic regression to help evaluate model performance.


New discovery of cryptorchidism: Decreased retinoic acid in testicle.
This study focuses on investigation of cryptorchidism induced by flutamide (Flu) and its histopathological damage, and detects retinoic acid concentration in testicle tissue, in order to find a new method for clinical treatment to infertility caused by cryptorchidism. Twenty SD (Sprague Dawley) pregnant rats were randomly divided into Flu cryptorchidism group (n = 10) and normal control group (n = 10). HE stained for observing morphological difference. Transmission electron microscope (TEM) was used for observing the tight junction structure between Sertoli cells. Epididymal caudal sperms were counted and observed in morphology. The expression of stimulated by retinoic acid gene 8 (Stra8) was detected using immunohistochemistry, western blot, and Q-PCR. High performance liquid chromatography (HPLC) analysis was made on retinoic acid content. Sperm count and morphology observation confirmed cryptorchidism group was lower than normal group in sperm quantity and quality. The observation by TEM showed a loose structure of tight junctions between Sertoli cells. Immunohistochemistry, western blot, and Q-PCR showed that cryptorchidism group was significantly lower than normal group in the expression of Stra8. HPLC showed that retinoic acid content was significantly lower in cryptorchid testis than in normal testis. In the cryptorchidism model, retinoic acid content in testicular tissue has a significant reduction; testicles have significant pathological changes; damage exists in the structure of tight junctions between Sertoli cells; Stra8 expression has a significant reduction, perhaps mainly contributing to spermatogenesis disorder.


Idiopathic pulmonary artery aneurysm.
A case of idiopathic pulmonary artery aneurysm is presented along with a review of our experience of this rare condition. These entities may have an association with cystic medial degeneration of the arterial wall and are subject to the same complications as aortic aneurysms.


A successful model of setting up a bariatric practice.
Vital for any surgeon choosing to perform bariatric surgery is to be financially savvy. Establishing a practice is not a simple matter. This article will describe how physicians can establish their practice in weight loss medicine. To better insure success, wisdom dictates that one perform a geographical study with respect to (1) obesity in the population, (2) number of bariatric surgeons in the area, (3) the nature of the insurance companies, (4) the type of insurance (health maintenance organization, HMO versus private pay versus Medicare, Medicaid, etc.), and (5) the leverage that the practice might be able to acquire (what is not being done by your competitors). To improve the financial strength of your practice, (1) learn what must be improved within your practice; (2) increase the ratio of time in the operating room to time in the office; (3) increase the number of patients referred to you. Most important is flexibility; the only people who really survive are chameleons because only chameleons adapt to different situations. Setting up a bariatric practice can be quite difficult, especially in the academic setting, but it is not impossible. A team approach is essential, whether one is speaking of a team of characteristics that make an office suitable, a team of experts within the office to appropriately evaluate patients, a team of professionals in the office to ensure efficient insurance approval, or a team of persons in the operating room to ensure that the surgery is optimized. The local environment must always be kept in mind.


Superior Vena Cava Flow in Preterm Infants and Neonatal Outcomes: A Systematic Review.
Superior vena cava (SVC) flow has been considered a surrogate marker of systemic blood flow in neonates. We conducted a systematic review to evaluate the association between low SVC flow recorded during the early neonatal period and neonatal outcomes. We searched the following databases (until December 9, 2020; updated October 21, 2022): PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), Proquest Dissertations and Theses Global, and SCOPUS using controlled vocabulary and key words representing the concepts "superior vena cava" and "flow" and "neonate." Results were exported to COVIDENCE review management software. The search retrieved 593 records after the removal of duplicates, of which 11 studies (nine cohorts) met the inclusion criteria. The majority of the studies included infants born at <30 weeks of gestation. The included studies were assessed as high risk of bias in terms of the incomparability of the study groups, with infants in the low SVC flow group noted to be more immature than those in the normal SVC flow group or subjected to different cointerventions. We did not conduct meta-analyses in view of the significant clinical heterogeneity noted in the included studies. We found little evidence to suggest that SVC flow in the early neonatal period is an independent predictor for adverse clinical outcomes in preterm infants. Included studies were assessed at high risk of bias. We conclude that SVC flow interpretation for prognostication or for making treatment decisions should be restricted to the research setting for now. We highlight the need for strengthened methods in future research studies. KEY POINTS: · We studied whether low SVC flow in the early neonatal period is a marker for adverse outcomes in preterm infants.. · There is insufficient evidence to conclude that low SVC flow is a valid predictor of adverse outcomes.. · There is insufficient evidence to conclude that SVC flow-directed hemodynamic management improves clinical outcomes..


Photochemical reactions of chlorophyll in dehydrated photosystem II: two chlorophyll forms (680 and 700 nm).
Lichens and phototolerant poikilohydric mosses differ from spinach leaves, fern fronds or photosensitive mosses in that they show strongly decreased Fo chlorophyll fluorescence after drying. This desiccation-induced fluorescence loss is rapidly reversible under rehydration. Fluorescence emission from Photosystem II at 685 nm was decreased more strongly by dehydration than 720 nm emission. Reaction centers of Photosystem II lose activity on dehydration and regain it on hydration. Heating of desiccated lichens increased Fo chlorophyll fluorescence. The activation energy for the reversible part of the temperature-dependent fluorescence increase was 0.045 eV, which corresponds to the energy difference between the 680 and 697 nm absorption bands. In desiccated chlorolichens such as Parmelia sulcata, heating induces the appearance of positive variable fluorescence related to the reversible reduction of QA due to overcoming the energy barrier. This is interpreted to provide information on the mechanism of photoprotection: energy is dissipated by changing Chl680 or P680 into a chlorophyll form, which absorbs at 700 nm and emits light at 720 nm (Chl-720 or P680(700)) with a low quantum yield. Dissipation of light energy in this trap is activated by desiccation.


Cerebral metabolism in hypoxic hypoxia. I. Pattern of activation of glycolysis: a re-evaluation.
In order to evaluate the pattern of activation of glycolysis in cerebral cortex during hypoxic hypoxia, lightly anesthetized rats were subjected to a lowering of arterial Po2 to about 25 mm Hg and brains were frozen in situ for metabolite analyses either 1, 2, 5, 15 or 30 min following the induction of hypoxia. The lactate and pyruvate concentrations increased progressively during the 30 min period of hypoxia. At 1 and 2 min there were decreases in G-6-P and F-6-P, and increases in FDP, DHAP and 3-PG, indicating activation of phosphofructokinase. At 5 min this pattern of changes was less pronounced and at 15 min it was absent in spite of the fact that the lactate and pyruvate concentrations were further increased. At 30 min F-6-P and F-6-P had further increased but the levels of DHAP, FDP and 3-PG were normal. Evidently, phosphofructokinase activation can only be detected in the early stages of hypoxia, i.e. when the maximal increase in glycolytic flux occurs and before there has been a corresponding activation of other rate-limiting enzymatic steps. Signs of activation of phosphofructokinase were observed in the absence of changes in tissue concentrations of ATP or AMP, with minimal elevation of NH4plus, and in spite of increased (or unchanged) levels of citrate. However, since there were small but significant increases in ADP at 1 and 2 min, and pH-independent decreases in phosphocreatine, the results indicate that hypoxia is accompanied by an initial imbalance between production and utilization of ATP. The metabolic consequences of this imbalance (decrease in phosphocreatine, increases in ADP and P1) may be at least partly responsible for activation of phosphofructokinase.


Predicting haplogroups using a versatile machine learning program (PredYMaLe) on a new mutationally balanced 32 Y-STR multiplex (CombYplex): Unlocking the full potential of the human STR mutation rate spectrum to estimate forensic parameters.
We developed a new mutationally well-balanced 32 Y-STR multiplex (CombYplex) together with a machine learning (ML) program PredYMaLe to assess the impact of STR mutability on haplogourp prediction, while respecting forensic community criteria (high DC/HD). We designed CombYplex around two sub-panels M1 and M2 characterized by average and high-mutation STR panels. Using these two sub-panels, we tested how our program PredYmale reacts to mutability when considering basal branches and, moving down, terminal branches. We tested first the discrimination capacity of CombYplex on 996 human samples using various forensic and statistical parameters and showed that its resolution is sufficient to separate haplogroup classes. In parallel, PredYMaLe was designed and used to test whether a ML approach can predict haplogroup classes from Y-STR profiles. Applied to our kit, SVM and Random Forest classifiers perform very well (average 97 %), better than Neural Network (average 91 %) and Bayesian methods (< 90 %). We observe heterogeneity in haplogroup assignation accuracy among classes, with most haplogroups having high prediction scores (99-100 %) and two (E1b1b and G) having lower scores (67 %). The small sample sizes of these classes explain the high tendency to misclassify the Y-profiles of these haplogroups; results were measurably improved as soon as more training data were added. We provide evidence that our ML approach is a robust method to accurately predict haplogroups when it is combined with a sufficient number of markers, well-balanced mutation rate Y-STR panels, and large ML training sets. Further research on confounding factors (such as CNV-STR or gene conversion) and ideal STR panels in regard to the branches analysed can be developed to help classifiers further optimize prediction scores.


Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament.
Retrospective cohort study. Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (-) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.


Cellular inactivation by ultrasound.
The lethal effect of ultrasound (US) on mammalian cells has received relatively little attention. Understandably, potential genetic aspects of US have been of prime concern to physicians who use US as a diagnostic tool; at the average power densities involved (<<1 W cm(-2)) little, if any cell killing is to be expected. There have been sporadic attempts to use higher intensities ( approximately 1 W cm(-2)) as a treatment modality in cancer therapy, but those experiments seem to have been based on inadequate cellular studies. The effects of US usually were evaluated in terms of morphological criteria rather than on quantitative determination of the loss of viability as measured by colony formation. There are few reports of the effects of US on survival of mammalian cells, and none specifically examine hyperthermic interaction. With the increased interest in hyperthermia for tumour therapy, attention has been directed towards the use of ultrasound to achieve tumour heating. In preliminary experiments in which US was used to heat the EMT6 sarcoma and KHJJ carcinoma in mice, we found a high percentage of tumour cures with short (approximately 30 min) treatments at temperatures (43-44 degrees C) where in vitro results of hyperthermia-induced cell killing would not have led to a prediction of any cures. We therefore initiated an investigation of the effects of US on survival of Chinese hamster cells to see if direct cell killing by US could explain our in vivo results, or, as in the case of radiofrequency (RF) electromagnetic heating, we would be forced to invoke host response(8). In particular, we examined the thermal and non-thermal components of cellular inactivation by US. We report here that there is a definite non-thermal cytotoxic effect of US. Its relative contribution to cell killing is a highly nonlinear function of the temperature of the cellular milieu. The survival curves show clearly that, beyond an initial threshold, small changes in temperature and/or US intensity can give rise to impressive changes in survival values. The threshold nature of the data strongly suggests that by means of overlapping beams, ultrasound energy could be delivered to tumour tissue to achieve massive cell killings while sparing normal tissue outside the tumour volume to a degree far exceeding that of conventional techniques.


Prognostic significance of SOCS1 and SOCS3 tumor suppressors and oncogenic signaling pathway genes in hepatocellular carcinoma.
SOCS1 and SOCS3 genes are considered tumor suppressors in hepatocellular carcinoma (HCC) due to frequent epigenetic repression. Consistent with this notion, mice lacking SOCS1 or SOCS3 show increased susceptibility to diethylnitrosamine (DEN)-induced HCC. As SOCS1 and SOCS3 are important regulators of cytokine and growth factor signaling, their loss could activate oncogenic signaling pathways. Therefore, we examined the correlation between SOCS1/SOCS3 and key oncogenic signaling pathway genes as well as their prognostic significance in HCC. The Cancer Genome Atlas dataset on HCC comprising clinical and transcriptomic data was retrieved from the cBioportal platform. The correlation between the expression of SOCS1 or SOCS3 and oncogenic pathway genes was evaluated using the GraphPad PRISM software. The inversely correlated genes were assessed for their impact on patient survival using the UALCAN platform and their expression quantified in the regenerating livers and DEN-induced HCC tissues of mice lacking Socs1 or Socs3. Finally, the Cox proportional hazards model was used to evaluate the predictive potential of SOCS1 and SOCS3 when combined with the genes of select oncogenic signaling pathways. SOCS1 expression was comparable between HCC and adjacent normal tissues, yet higher SOCS1 expression predicted favorable prognosis. In contrast, SOCS3 expression was significantly low in HCC, yet it lacked predictive potential. The correlation between SOCS1 or SOCS3 expression and key genes of the cell cycle, receptor tyrosine kinase, growth factor and MAPK signaling pathways were mostly positive than negative. Among the negatively correlated genes, only a few showed elevated expression in HCC and predicted survival. Many PI3K pathway genes showed mutual exclusivity with SOCS1 and/or SOCS3 and displayed independent predictive ability. Among genes that negatively correlated with SOCS1 and/or SOCS3, only CDK2 and AURKA showed corresponding modulations in the regenerating livers and DEN-induced tumors of hepatocyte-specific Socs1 or Socs3 deficient mice and predicted patient survival. The Cox proportional hazards model identified the combinations of SOCS1 or SOCS3 with CXCL8 and DAB2 as highly predictive. SOCS1 expression in HCC has an independent prognostic value whereas SOCS3 expression does not. The predictive potential of SOCS1 expression is increased when combined with other oncogenic signaling pathway genes.


Color stability of ground beef packaged in a low carbon monoxide atmosphere or vacuum.
Ground beef was either packaged in an atmosphere of 0.4% CO, 30% CO₂, and 69.6% N₂ (CO-MAP) or vacuum. After storage (48 h, 2-3°C), packages of CO-MAP and vacuum were opened and overwrapped with polyvinyl chloride. Other CO-MAP and vacuum packages were left intact. Packages were initially displayed for 7 days (2-3°C). Intact packages were further displayed up to 35 days before being opened and displayed (1 or 3 days). Intact CO-MAP packaged ground beef was always more red than intact vacuum-packaged ground beef. Color was relatively stable for both types of intact packages over 35 days of display. Upon opening CO-MAP packaged ground beef, the red color decreased slower than in ground beef from vacuum packages.


Sensitivity of rat soleus muscle to a mechanical stimulus is decreased following hindlimb unweighting.
Mechanical loading is thought to be an important stimulus regulating muscle mass. However, the responsiveness of a muscle atrophied by a period of mechanical unloading to a subsequently imposed mechanical challenge is not well understood. This study examined the phosphorylation of the mechanically sensitive p54 c-jun NH(2)-terminal kinase (JNK) signaling protein in atrophied rat soleus muscle in response to a mechanical challenge in situ (isometric contractions; 100 Hz, 150 ms, once every 1 s for 5 min). Rats underwent either 7 or 14 days of hindlimb suspension (HLS) following which phosphorylation of JNK was measured biochemically. Immunofluorescence analysis revealed that phosphorylated JNK was localized in myonuclei. Baseline JNK phosphorylation measured in non-stimulated soleus muscles of 7- and 14-day HLS groups was 3.0- and 2.8-fold, respectively, the baseline phosphorylation measured in muscle of weight-bearing control animals (CTL). Following a mechanical challenge, JNK phosphorylation in stimulated CTL and 7-day HLS groups was significantly increased by 3.2- and 1.8-fold at the non-stimulated baseline levels, respectively. In stimulated muscle of 14-day HLS, JNK phosphorylation levels did not significantly differ from the baseline levels suggesting that the ability to elicit a mechanically induced phosphorylation of the JNK signaling protein gradually decreases with unweighting and is attenuated after 14-day HLS. Changes in the responsiveness of mechanically sensitive intracellular signaling pathways in atrophic muscle may contribute to the functional impairment experienced by muscle in the absence of weight bearing for prolonged periods.


Hospital outcome of acute myocardial infarction in patients with and without diabetes mellitus.
To assess hospital mortality and morbidity in diabetic and non-diabetic patients with acute myocardial infarction and to compare the results between the two groups. All patients admitted in 1999 to the intensive care unit of the Schwabing City Hospital with diagnosis of acute myocardial infarction were assessed for hospital mortality and co-morbidity. Three hundred and thirty patients with acute myocardial infarction were admitted. Of those, 126 (38%) were diabetic and 204 (62%) were non-diabetic patients. Mortality within 24 h after admission was 13.5% in diabetic patients and 5.4% in non-diabetic patients (P<0.01). Mortality during entire hospitalization was higher in diabetic than in non-diabetic patients (29.4% vs. 16.2%; P=0.004). Diabetic patients were resuscitated more frequently than non-diabetic patients (24% vs. 11%, P<0.01). In diabetic patients, heart rate at admission was increased (91 +/- 27 vs. 82 +/- 23/min; P<0.01) and presence of angina pectoris was reported less frequently (59% (n=72) vs. 82% (n=167); P<0.001). Preceding myocardial infarction, microalbuminuria, peripheral artery disease and arterial hypertension were more frequent in diabetic than in non-diabetic patients. Diabetic patients demonstrated higher C-reactive protein (CRP) levels than non-diabetic patients (91.4 +/- 78.2 mg/l vs. 45.2 +/- 62.4 mg/l; P<0.001). In diabetic patients with acute myocardial infarction, early hospital mortality is increased and signs of cardiac autonomic dysfunction and microangiopathy are detected more frequently than in non-diabetic patients. The need for advanced treatment strategies early in the course of diabetic patients with myocardial infarction is emphasized.


Ulcerative colitis.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown aetiology affecting the colon and rectum. Multiple factors, such as genetic background, environmental and luminal factors, and mucosal immune dysregulation, have been suggested to contribute to UC pathogenesis. UC has evolved into a global burden given its high incidence in developed countries and the substantial increase in incidence in developing countries. An improved understanding of the mechanisms underlying UC has led to the emergence of new treatments. Since the early 2000s, anti-tumour necrosis factor (TNF) treatment has significantly improved treatment outcomes. Advances in medical treatments have enabled a paradigm shift in treatment goals from symptomatic relief to endoscopic and histological healing to achieve better long-term outcomes and, consequently, diagnostic modalities have also been improved to monitor disease activity more tightly. Despite these improvements in patient care, a substantial proportion of patients, for example, those who are refractory to medical treatment or those who develop colitis-associated colorectal dysplasia or cancer, still require restorative proctocolectomy. The development of novel drugs and improvement of the treatment strategy by implementing personalized medicine are warranted to achieve optimal disease control. However, delineating the aetiology of UC is necessary to ultimately achieve disease cure.


Issues of causality in the history of occupational epidemiology.
Occupational epidemiology has its roots in classical medicine. However, it became a quantitative discipline only in the 20th century, through the pioneering work of individuals such as Case, Lloyd, and Selikoff and organizations such as the Division of Occupational Health of the U.S. Public Health Service. Studies of chemical dye workers, bituminous coal miners, smelting workers, and uranium miners have been especially important sources of innovations in methodology and in development of logical reasoning leading to acceptance of causal relationships of occupational exposures that lead to respiratory diseases and cancer. The cooperation of labor unions, such as those of steel and asbestos workers, has often been a crucial factor in providing essential data.


Reliability and validity of checklists and global ratings by standardized students, trained raters, and faculty raters in an objective structured teaching environment.
Objective structured teaching exercises (OSTEs) are relatively new in medical education, with few studies that have reported reliability and validity. To systematically examine the impact of OSTE design decisions, including number of cases, choice of raters, and type of scoring systems used. We examined the impact of number of cases and raters using generalizability theory. We also compared scores from standardized students (SS), faculty raters (FR) and trained graduate student raters (TR), and examined the relation between behavior checklist ratings and global perception scores. Generalizability (g) coefficients for checklist scores were higher for SSs than TRs. The g estimates based on SSs' global scores were higher than g estimates for FRs. SSs' checklist scores were higher than TRs' checklist scores, and SSs' global evaluations were higher than FRs' and TRs' global scores. TRs' relative to SSs' global perceptions correlated more highly with checklist scores. SSs provide more generalizable checklist scores than TRs. Generalizability estimates for global scores from SSs and FRs were comparable. SSs are lenient raters compared to TRs and FRs.


Allogeneic stem cell transplantation in patients with a prior history of prostate cancer.
A retrospective analysis of 25 patients with a history of prostate cancer (PC) who subsequently underwent allogeneic hematopoietic cell transplantation (HCT) for treatment of a hematologic malignancy was performed. Median patient age was 66.7 years. Median duration from the diagnosis of PC to HCT was 4.2 years. Twenty-three patients had Gleason group 1 or 2 disease. Therapy included prostatectomy (n = 13) and external beam or brachytherapy (n = 9). Hematologic diagnoses included both myeloid (n = 15) and lymphoid neoplasms (n = 10). Twenty-four patients received either a nonmyeloablative or reduced intensity conditioning regimen. GVHD prophylaxis included a calcineurin inhibitor and mycophenolate mofetil ± sirolimus. Twenty patients had HLA-matched sibling or HLA-matched unrelated donors; five patients had HLA-mismatched donors. Eleven patients are alive, and 14 have died. Median survival was 2.5 years (range, .02-12.6 years). The major cause of death was hematologic relapse. Only one patient had evidence of recurrent PC, occurring 1.5 years posttransplant. In carefully selected patients with a prior history of PC, there was no evidence of rapid recurrence of the solid tumor (ST) after HCT. PC patients who are in remission from their ST or have control of their disease on therapy should be considered eligible for HCT.


Epidemiological approach to the explanation of social differentiation in mortality: the Whitehall studies.
A consistent feature of mortality statistics in England and Wales are the social class differences which have even widened in the decade from 1971 to 1981. Two large studies of British Civil Servants, the Whitehall and Whitehall II studies, add to the understanding of social class differences in mortality and morbidity. Some of their results are presented to illustrate current concepts of social class differences in health. There is no evidence for an effect of health selection. The magnitude of social class differences vary for different causes of death, presumably as a sign of the effect of specific factors for specific disease. The observation that social class differences apply to most causes of death, however, suggest that factors like early life experience, difference in behaviour, material and psychosocial conditions act in an unspecific way.


Chromosomal location of genes coding for endosperm proteins of Hordeum chilense, determined by two-dimensional electrophoresis of wheat-H. chilense chromosome addition lines.
The proteins of Hordeum chilense grain were resolved into 25 major components by two-dimensional electrophoresis. Their solubilities in aqueous alcohol solutions were determined to distinguish prolamin storage proteins from metabolic and structural proteins. The prolamins were divided into two groups, based on the presence or absence of intermolecular disulfide bonds determined by gel-filtration chromatography. Using an incomplete set of Chinese Spring wheat-H. chilense disomic addition lines, the structural genes of 21 of the 26 most dominant seed proteins were assigned to chromosomes. The great majority of the prolamin genes, including those coding for a high molecular weight (HMW) prolamin subunit, was present on chromosome 1 Hch. However, a small number of prolamin genes also occurred on chromosomes 5 Hch and 7 Hch. A minor protein, probably belonging to the nonstorage group of proteins, is coded by genes on 5 Hch. Various ditelosomic addition lines and ditelosomic and disomic substitution lines for chromosome 7 Hch were also analyzed by electrophoresis. This technique revealed that the genes for three major prolamins occur on the beta arm of chromosome 7 Hch and that a gene for a minor protein, also thought to be a prolamin, occurs on the alpha arm. These results are discussed in relation to the evolution of prolamin genes in the Triticeae.


Correction masks for thickness uniformity in large-area thin films.
Experimental results from the emission of vapor sources are considered in designing correcting diaphragms to achieve a uniform thickness distribution during evaporation of thin films mounted on large-area substrate holders, in different geometric configurations.


Acyl glycosides with rare β-D-apiofuranosyl-β-D-glucopyranosyl-β-D-apiofuranosyl from Erycibe hainanesis.
Three new acyl glycosides with rare β-D-apiofuranosyl-(1→2)-[β-D-apiofuranosyl-(1→6)]-β-D-glucopyranosyl moieties, 2-O-[2,6-O-bis(5-O-syringoyl-β-D-apiofuranosyl)-β-D-glucopyranosyl]-isopropyl alcohol (1), 1-O-[2,6-O-bis(5-O-syringoyl-β-D-apiofuranosyl)-β-D-glucopyranosyl]-isoamyl alcohol (2), and 1-O-[2,6-O-bis(5-O-vanilloyl-β-D-apiofuranosyl)-β-D-glucopyranosyl]-3,4,5-trimethoxyphenol (3) were obtained from Erycibe hainanesis. Their structures were determined by UV, IR, HRESIMS, (1)D and (2)D NMR data, and by chemical methods. Compounds 1-3 were evaluated against D-galactosamine induced toxicity in WB-F344 rat hepatic epithelial stem-like cells, and compounds 1 and 3 showed moderate hepatoprotective activities.


Deep sedation for cardiac magnetic resonance imaging: a comparison with cardiac anesthesia.
To test the hypothesis that safety, efficacy, and image quality in pediatric patients who undergo deep sedation for cardiac magnetic resonance imaging (CMR) for congenital heart disease (CHD) is similar to general anesthesia (GA). Retrospective review of all CMR records from 1997-2006. Six hundred sixty patients underwent deep sedation (DS) and 161 underwent GA. Statistics included analysis of variance, chi(2) analysis, and the coefficient of variation. Diagnoses included a broad spectrum of CHD. No serious adverse events (AE) including mortalities and hospitalizations occurred because of DS. There were 18 (2.8%) self-limited events in the DS group with a success rate of 97.9%. The AE rate for patients undergoing GA was 3.9% (n = 6), including 2 overnight hospital stays with a success rate of 100%. AE and success rates did not differ between the 2 groups. Observers blinded to the patient's group found no difference in image quality. Even in young infants, excellent image quality was obtained. Sedation of appropriately screened pediatric patients with CHD undergoing CMR is safe and well tolerated and yields high-quality images similar to GA. GA should be considered for patients with CHD with hemodynamic or airway compromise, in whom sedation has failed, or who have special circumstances.


Phase II study of adriamycin with sequential methotrexate and 5-fluorouracil (AMF) in gastric carcinoma.
The purpose of this study was to evaluate the response rate, methotrexate plasma levels, and toxicity of a three-drug regimen in patients with gastric carcinoma. A total of 37 patients with advanced measurable adenocarcinoma of the stomach were treated with Adriamycin, methotrexate, and 5-fluorouracil (AMF). Adriamycin and methotrexate were given as i.v. infusions on day 1; 24 h following methotrexate administration, patients received an i.v. infusion of 5-fluorouracil concomitantly with oral leukovorin factor (given over 48 h). Methotrexate levels were monitored regularly in all patients, and courses were repeated every 3 weeks. The median dose levels per course were 50 mg/m2 (range, 40-60 mg/m2) for Adriamycin, 1,000 mg/m2 (range, 650-1,250 mg/m2) for 5-fluorouracil, and 500 mg/m2 (range, 160-625 mg/m2) for methotrexate. Of 36 evaluable patients, 8 (22%) achieved an objective response, including 1 complete remission. Stable disease was noted in 11 patients and a minor tumor regression occurred in 1. The median survival duration of all patients was 6 months (range, 2-31+ months). AMF was well tolerated; toxicities were mild to moderate, most frequently involving nausea and vomiting, mucositis, and neutropenia with or without fever. There was no death directly attributable to chemotherapy. Although the AMF regimen used a well-documented preclinical concept of synergism between methotrexate and 5-fluorouracil, response and survival results suggest a modest activity of this combination in patients with gastric cancer. Better preclinical models are necessary for the development of effective combination chemotherapy.


Data on the coefficient of friction and its prediction by a machine learning model as a function of time for open-cell AlSi10Mg-Al2O3 composites with different porosity tested by pin-on-disk method.
This data article presents the experimental data of the wear behavior of four types of open-cell AlSi10Mg materials and open-cell AlSi10Mg-Al2O3 composites with different pore sizes under dry sliding conditions tested by pin-on-disk method. The data include the coefficient of friction (COF) as a function of time for each material, as well as the predictions of COF using a machine learning model - Extreme Gradient Boosting. The data were generated to investigate the effect of pore size and reinforcement on the friction and wear properties of open-cell AlSi10Mg-Al2O3 composites, which are promising materials for lightweight and wear-resistant applications. The data can also be used to validate theoretical models or numerical simulations of wear mechanisms in porous materials, as well as to optimize the material design and processing parameters to enhance the wear resistance of open-cell AlSi10Mg materials. The data are available in DWF and XLSX format and can be opened by any text editor or spreadsheet software. The data article is related to an original research article entitled "Production and Tribological Characterization of Advanced Open-Cell AlSi10Mg-Al2O3 Composites", where the details of the experimental methods, the microstructural characterization, and the analysis of the wear mechanisms are provided [1].


In vitro degradation of very low density lipoprotein from diabetic patients by lipoprotein lipase.
Fatty acid release by incubation with lipoprotein lipase (LPL) in vitro from very low density lipoproteins (VLDL) obtained from diabetic patients was low compared with that from healthy subjects, though the compositions were similar in both VLDL. Percentages of the large size VLDL decreased and those of the small size VLDL increased after the incubation with LPL. At the same time, on polyacrylamide gel disk electrophoresis, the smaller catabolic products from these VLDL appeared at a similar position to that of low density lipoproteins (LDL) and at the running front where high density lipoproteins (HDL) had migrated. The amount of the small size VLDL and the LDL-like lipoproteins produced from diabetic VLDL were less than those from normal VLDL and inversely correlated with the percent decrease of the large original size VLDL. This fact suggests that VLDL from diabetic patients are poor substrates for LPL compared with normal VLDL.


Administration of prosaposin-derived neurotrophic factor to neural tube defects facilitates regeneration and restores neurological functions.
Neural tube defects (NTDs) cause fetal and pediatric deaths or lifelong neurological disabilities. No effective treatment is currently available for NTDs. We attempted to elucidate the pathogenesis of NTDs and propose a therapeutic strategy. Intra-amniotic treatment with prosaposin-derived 18-mer peptide (PS18) protected the spinal cord from secondary damage and rescued neurological function in an established chicken model of spina bifida aperta (SBA), the severe type of NTDs. PS18 promoted the formation of a neuroectodermal covering over the defective neural tube within 24-h after treatment, enhanced the regeneration/restoration process, and decreased apoptotic activity in the developing spinal cord. PS18 reduced the SBA wound and almost completely formed the spinal cord. SBA chicks that received PS18 exhibited relatively normal walking and sensorimotor responses, and reduced pain-associated behavior in postnatal life. In conclusion, PS18 is a promising therapeutic agent for NTDs and may be useful for treating other types of spinal cord injuries.


[Nosocomial infections in Germany. What are the numbers, based on the estimates for 2006?].
The aim of this study was to assess data about the annual incidence in Germany of nosocomial infections, the mortality attributable to these infections and the number of nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA). The data of the German Annual Statistical Report 2006, the national prevalence study NIDEP1, the German national nosocomial infections surveillance system (KISS) and a study to investigate the attributable mortality of nosocomial infections, based on the NIDEP2-study, were used to estimate the incidence for 2006. The annual number of nosocomial infections estimated for 2006 is between 400,000 and 600,000, the mortality attributable to them between 10,000 and 15,000 patients and the number of nosocomial MRSA infections about 14,000. These estimates have several limitations. But It would be possible to provide a more precise estimate of the current situation from a new national cross sectional study.


The acute effects of caffeine on evoked response, vigilance, and activity level in hyperkinetic children.
Seventeen hyperkinetic children who had previously responded to sympathomimetic amines were given three different dosages of caffeine in counterbalanced order (placebo, and low and high doses equivalent to one and three cups of coffee). One hour following ingestions they were tested, double-blind on measures of visual evoked response, alpha time, vigilance, and activity level. There was a significant effect on evoked response. The behavioral measures tended to be affected in a dose-related manner but not to a statistically significant degree. It is concluded that although centrally active, caffeine does not show the congruence between behavioral and central effects that other stimulants useful in behavioral management have shown.


Crevice corrosion of implants recovered after tibial plateau leveling osteotomy in dogs.
To describe corrosion discovered on implants recovered from dogs after tibial plateau leveling osteotomy (TPLO). Descriptive. Dogs (n=4) that had TPLO (n=7) approximately 3 years earlier. Implants were recovered surgically and lightly cleaned before visual inspection, scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). Multiple corrosion sites were found on the recesses of each plate; invariably, there was a corroded area present on that part of the bone screw which had been in contact with a corrosion site on a plate. Most corroded regions featured attached, nonmetallic material believed to be a precipitate arising from interaction with the local environment during electrochemical corrosion. SEM examination of TPLO plates revealed surface porosity, particularly visible in the screw hole recesses. Surface irregularities and porosity of TPLO plates--a consequence of the casting process--are initiation sites for corrosion which, in concert with the crevice geometry between the plate and screw, result in the observed corrosion defects. Implants used for TPLO, a commonly performed veterinary orthopedic procedures may corrode generating a number of chemical species that have the potential to cause disease.


A metastatic ureteral tumor successfully treated with multidisciplinary therapy including radiotherapy.
Metastatic ureteral tumors are difficult to diagnose pathologically. Treatment is only available for the primary disease, and prognosis is generally poor. A 63-year-old patient with a history of gastric cancer presented with asymptomatic right-sided hydronephrosis. Ureteroscopic examination revealed tissue in the ureter consistent with gastric cancer. The lesion was localized, and the patient was treated with chemotherapy and radiotherapy as part of a multidisciplinary treatment. The prognosis was better than in other reports. To the best of our knowledge, this is the first case of a patient with metastatic gastric cancer who received multidisciplinary treatment including radiotherapy and had a good prognosis. In cases where a localized metastatic ureteral tumor cannot be ruled out, ureteroscopy is an effective therapeutic strategy.