Fibrotic racemose haemangioma of the retina.
The racemose - or arteriovenous - haemangioma of the retina is a rare developmental anomaly. It can be associated with similar vascular anomalies in other regions of the central nervous system (Wyburn-Mason syndrome). We report a 24-year-old woman with a chronic headache from our outpatient clinic. Other than a white tortuous strand in the retina of the right eye, which resembled a filarium at first glance, no pathologies were found. Its ends were located at the optic disc forming a sling-shaped lesion extending to the anterior nasal periphery. Partial filling was shown by fluorescence angiography. An MRI of the neurocranium detected no additional vascular abnormalities. So far our patient has not suffered from any visual complaints and she will be followed up yearly. We show an unusual presentation of a retinal racemose haemangioma. Diagnosis of this entity should prompt further examinations to exclude any additional haemangiomas with respect to the Wyburn-Mason syndrome.


A genetic approach to the biosynthesis of the rifamycin-chromophore in Nocardia mediterranei. I. Isolation and characterization of a pentose-excreting auxotrophic mutant of Nocardia mediterranei with drastically reduced rifamycin production.
The mutant under study, designated A8, is derived from a Nocardia mediterranei strain, N813, which is a high rifamycin B producer. A8 is auxotrophic for aromatic amino acids and produces much less rifamycin B than the parent. A mixture of pentoses with D (--) ribulose as the main product is accumulated in the fermentation broth of this mutant. It was shown to be affected in its transketolase activity as no formation of D-sedoheptulose -7P from pentose-phosphates could be detected in vitro using crude extracts. The only pathway so far known which is derived from D-sedoheptulose-7P is the shikimate pathway leading to aromatic amino acids and vitamins. Biochemical and genetic investigations with mutant A8, which is defective in both the biosynthesis of rifamycins and the biosynthesis of shikimate pathway products, show that the seven-carbon amino unit of the rifamycin-chromophore must be derived from an intermediate of the shikimate pathway.


Signaling mechanisms underlying inhibition of neuroinflammation by resveratrol in neurodegenerative diseases.
Neurodegenerative diseases (NDs), including Alzheimer's disease (AD), and Parkinson's disease (PD), are characterized by the progressive loss of the structure and function of neurons and most commonly occur in the elderly population. Microglia are resident macrophages of the central nervous system (CNS). The neuroinflammation caused by excessive microglial activation is closely related to the onset and progression of many NDs. Therefore, inhibiting excessive microglial activation is a potential drug target for controlling neuroinflammation. In recent years, natural products as modulators of microglial polarization have attracted considerable attention in the field of NDs therapy. Furthermore, resveratrol (RES) has been found to have a protective effect in NDs through the inhibition of microglial activation and the regulation of neuroinflammation. In this review, we mainly summarize the therapeutic potential of RES and its various molecular mechanisms in the treatment of NDs through the modulation of microglial activation.


Site-directed mutation of β-galactosidase from Streptococcus thermophilus for galactooligosaccharide-enriched yogurt making.
β-Galactosidase is one of the most important enzymes used in dairy processing. It converts lactose into glucose and galactose, and also catalyzes galactose to form galactooligosaccharides (GOS), so-called prebiotics. However, most of the β-galactosidases from the starter cultures have low transgalactosylation activities, the process that results in galactose accumulation in yogurt. Here, a site-directed mutation strategy was attempted, to genetically modify β-galactosidase from Streptococcus thermophilus. Out of 28 Strep. thermophilus strains, a β-galactosidase gene named bgaQ, encoded for high β-galactosidase hydrolysis activity (BgaQ), was cloned from the strain Strep. thermophilus SDMCC050237. It was 3,081 bp in size, with 1,027 deduced amino acid residuals, which belonged to the GH2 family. After replacing the Tyr801 and Pro802 around the active sites of BgaQ with His801 and Gly802, the GOS synthesis of the generated mutant protein BgaQ-8012 increased from 20.5% to 26.7% at 5% lactose, and no hydrolysis activity altered obviously. Subsequently, the purified BgaQ or BgaQ-8012 was added to sterilized milk inoculated with 2 starters from Strep. thermophilus SDMCC050237 and Lactobacillus delbrueckii ssp. bulgaricus ATCC11842. The GOS yields with added BgaQ or BgaQ-8012 increased to 5.8 and 8.3 g/L, respectively, compared with a yield of 3.7 g/L without enzymes added. Meanwhile, the addition of the BgaQ or BgaQ-8012 reduced the lactose content by 49.3% and 54.4% in the fermented yogurt and shortened the curd time. Therefore, this study provided a site-directed mutation strategy for improvement of the transgalactosylation activity of β-galactosidase from Strep. thermophilus for GOS-enriched yogurt making.


Analysis of patients' willingness to be mobile, taking into account individual characteristics and two exemplary indications.
With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept great-er efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard. Data collection was carried out in the context of a multicenter cross-sectional study among office-based and hospital-affiliated (University Medical Center Hamburg-Eppendorf) dermatologists. Patients (n = 309) with psoriasis and chronic wounds were surveyed about their mobility patterns and disease severity. Data analysis was performed using descriptive and multivariate methods. The willingness to accept additional efforts/expenses is primarily determined by a physician's expertise and service portfolio. Comparing both diagnoses showed that psoriasis patients usually traveled longer distances than wound patients. Among psoriasis patients, one significant predictor for accepting additional efforts/expenses was the level of education. With regard to wound patients, key factors included wound size (severity). The present study revealed complex mobility patterns among patients, which are affected by numerous personal as well as clinical factors. Depending on the diagnosis and individual preferences, additional efforts/expenses can - among other things - be explained by disease severity. Further studies are required to obtain more conclusive data.


Embodied language of emotions: Predicting human intuitions with linguistic distributions in blind and sighted individuals.
Recent constructionist theories have suggested that language and sensory experience play a crucial role not only in how individuals categorise emotions but also in how they experience and shape them, helping to acquire abstract concepts that are used to make sense of bodily perceptions associated with specific emotions. Here, we aimed to investigate the role of sensory experience in conceptualising bodily felt emotions by asking 126 Italian blind participants to freely recall in which part of the body they commonly feel specific emotions (N = 15). Participants varied concerning visual experience in terms of blindness onset (i.e., congenital vs late) and degree of visual experience (i.e., total vs partial sensory loss). Using an Italian semantic model to estimate to what extent discrete emotions are associated with body parts in language experience, we found that all participants' reports correlated with the model predictions. Interestingly, blind - and especially congenitally blind - participants' responses were more strongly correlated with the model, suggesting that language might be one of the possible compensative mechanisms for the lack of visual feedback in constructing bodily felt emotions. Our findings present theoretical implications for the study of emotions, as well as potential real-world applications for blind individuals, by revealing, on the one hand, that vision plays an essential role in the construction of felt emotions and the way we talk about our related bodily (emotional) experiences. On the other hand, evidence that blind individuals rely more strongly on linguistic cues suggests that vision is a strong cue to acquire emotional information from the surrounding world, influencing how we experience emotions. While our findings do not suggest that blind individuals experience emotions in an atypical and dysfunctional way, they nonetheless support the view that promoting the use of non-visual emotional signs and body language since early on might help the blind child to develop a good emotional awareness as well as good emotion regulation abilities.


A concept analysis: Emotional regulation of nurses.
To explore the concept of emotional regulation in nursing. People are exposed to a variety of potentially emotion-provoking stimuli almost on a daily basis. The fact that these types of stimuli do not trigger full-blown emotions every time suggests that people are able to manage their own emotions through an internal process. The process is referred to as emotional regulation (ER). Nursing is a stressful and emotionally charged profession, yet the concept of ER is not well explored in the nursing literature. Concept analysis. Electronic databases searched were CINAHL, PubMed, PsycInfo, and Google Scholar. Forty-one articles were used in the review of this concept, of which six articles were used to review ER in nursing. Most of the articles on ER were from the field of psychology. Walker and Avant's eight-step to concept analysis. Data extracted from the articles were used in identifying the definitions, related concepts, uses of the concept of ER, and antecedents, consequences, and empirical referents. Four defining attributes of ER were identified as self-awareness, control, emotional expression, and active thinking. Definitions, the uses of the concept of ER, antecedents, consequences, and empirical referents are discussed. Model, related and contrary cases were developed. The concept of ER has implications and significance to nursing as nurses are exposed to a variety of emotion-provoking situations when performing nursing tasks.


Anorectal functioning in fecal incontinence.
Manometric testing was performed on three groups of subjects: 14 patients complaining of fecal incontinence, 14 age- and sex-matched continent patients, and 14 sex-matched younger normal controls. The younger group displayed significantly stronger contractions of the external anal sphincter and puborectalis than the two patient groups, which did not differ. No differences were found in the relaxation of the internal and sphincter. The incontinent group required a significantly larger stimulus in order to detect rectal distension compared to either the continent patients or the younger normals. An additional group of unmatched normals and incontinent patients demonstrated significant differences in their ability to retain rectally infused saline. The patients leaked sooner and retained less; however, the performance of the normals was considerably reduced from that reported in previous studies. The aging process seems to result in weakening of the striated muscles of the anal canal, although fecal incontinence need not occur. The afferent limb of the anorectal sensorimotor mechanism does not necessarily deteriorate with aging. A lower threshold for sensation of rectal distension among continent individuals apparently helps them to avoid incontinent episodes, even though maximum contractile pressures in their anal canal are no different from a comparable group of incontinent individuals.


Immunogenicity of protein therapeutics.
Protein therapeutics, such as monoclonal antibodies, enzymes and toxins, hold significant promise for improving human health. However, repeated administration of protein therapeutics, whether natural or recombinant, often leads to the induction of undesirable anti-drug antibodies (ADAs), which interfere with or neutralize the effect of the drug. Although an immune response to foreign proteins can be expected and is well understood, the basis for the development of responses to therapeutic autologous proteins is the subject of some debate. Inflammatory components of the drug delivery vehicle, T cell responses, T and B cell epitopes in the protein drug, and the associated B cell response are all targets for interventions aimed at reducing ADA responses. Here, we review some theories put forward to explain the immunogenicity of therapeutic proteins and describe some emerging protein-engineering approaches that might prevent the development of anti-drug antibodies.


Forest management impacts on stream integrity at varying intensities and spatial scales: Do abiotic effects accumulate spatially?
Though effects of forest harvesting on small streams are well documented, little is known about the cumulative effects in downstream systems. The hierarchical nature and longitudinal connectivity of river networks make them fundamentally cumulative, but lateral and vertical connectivity and instream processes can dissipate the downstream transport of water and materials. To elucidate such effects, we investigated how a suite of abiotic indicators changed from small streams to larger downstream sites (n = 6) within three basins ranging in forest management intensity (intensive, extensive, minimal) in New Brunswick (Canada) in the summer and fall of 2017 and 2018. Inorganic sediments, the inorganic/organic ratios and water temperatures significantly increased longitudinally, whereas nutrients and the fluorescence index of dissolved organic carbon (DOC; indication of terrestrial source) decreased. However, some longitudinal trends differed across basins and indicated downstream cumulative (inorganic sediments, the inorganic/organic ratios and to a lesser extent DOC concentration and humification) as well as dissipative (temperatures, nutrients, organic sediments) effects of forest management. Overall, we found that the effects previously reported for small streams with managed forests also occur at downstream sites and suggest investigating whether different management practices can be used within the extensive basin to reduce these cumulative effects.


A new method for the detection of hydroxyl radical production by phagocytic cells.
Benzoic acid, a specific scavenger of hydroxyl radical (OH.) is known to be oxidized as the result of a reaction with OH.. We have determined that the decarboxylation of benzoic acid can be used to detect OH. generated in cell-free systems and human granulocytes. Benzoic acid is oxidized by the xanthine-xanthine oxidase enzyme system. This system is known to generate O2-, H2O2 and OH.. This oxidation is inhibited by superoxide dismutase, catalase and mannitol. Therefore, the oxidation of benzoic acid occurs by a mechanism similar to that reported for the oxidation of methional to ethylene and involves OH.. Resting granulocytes do not oxidize benzoic acid. However, marked oxidation of this substrate occurs during the phagocytosis of opsonized zymosan particles, indicating the production of OH. by these cells. The reaction can be inhibited by superoxide dismutase, catalase, azide and mannitol. Therefore, the production of OH. in the cell may be similar to that observed in the cell-free system. The granulocytes of a patient with known chronic granulomatous disease did not oxidase benzoic acid, indicating a defect in the generation of OH. by these cells.


Tumor Location on the Vertical Section of the Anterior Wall Is Related to Favorable Prognosis and Low Incidence of Lymph Node Metastasis in Lower-third Gastric Cancer.
This retrospective study investigated the clinical significance of vertical location in gastric cancer (GC) and the optimal treatment strategy according to the vertical location. Between 1997 and 2018, 1,304 consecutive patients with GC who underwent curative surgical resection with lymphadenectomy were analyzed retrospectively. Patients with GC in the anterior wall (AW) had a significantly better prognosis compared to those in other sites of the lower third stomach (p=0.040). Multivariate analysis showed that tumor location in the AW was an independent prognostic factor and was associated with a lower incidence of lymph node metastasis (LNM) (p=0.023). The frequency of LNM in the area of D2 was lower in patients with AW GC than those with GC in other locations. Patients with AW GC had a favorable prognosis, with a lower incidence of LNM in lower-third GC.


Allosteric activation of brain mitochondrial Ca2+ uptake by spermine and by Ca2+: developmental changes.
Kinetic analysis of 45Ca2+ uptake by rat brain mitochondria in Ca2+ - 1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid buffers indicated that spermine both increased the apparent affinity for Ca2+ and decreased the cooperativity of uptake. Both effects are consistent with an allosteric activation of uptake by spermine. The stimulating effect of spermine on 45Ca2+ uptake was maximal with mitochondria from postnatal day 10 animals and then steadily decreased with increasing age to reach adult values by approximately 30 postnatal days; this was observed independently of the substrates used to fuel mitochondria. Mitochondrial Ca2+ buffering was also analyzed by use of a Ca2+-selective electrode. Addition of a large bolus of Ca2+ produced a decrease in the subsequent equilibrium extramitochondrial Ca2+ concentration (or a "rebound overshoot") under some conditions. It is proposed that this effect is the result of an allosteric activation of Ca2+ uptake by Ca2+. This effect was slowly reversible, or hysteretic, and was blocked by spermine. The overshoot was increased in the presence of higher concentrations of Mg2+ and was absent when mitochondria were incubated with 0.3 mM Mg2+. It was maximal in mitochondria prepared from early postnatal brain, and changes in the magnitude of the effect during development paralleled those obtained with spermine stimulation of 45Ca2+ uptake. The data suggest that spermine produces an allosteric activation of Ca2+ uptake by binding to the same regulatory sites that are involved in the Ca2+-induced activation. The results as a whole suggest that spermine could modulate mitochondrial buffering of the intracellular Ca2+ concentration in brain, particularly during the early postnatal period.


Successful allogeneic bone marrow transplantation in an adult with aplastic anemia following orthotopic liver transplantation for non-A, non-B, non-C hepatitis.
A 29-year-old male patient presented with acute liver failure from non-A, non-B and non-C hepatitis, necessitating orthotopic liver transplantation. After operation he developed progressive pancytopenia on the basis of aplastic anemia, which was probably hepatitis associated. After therapy with GM-CSF had failed, he underwent allogeneic BMT from his HLA genotypically identical brother following a conditioning regimen of CY 50 mg/kg x 4 and 500 cGy total lymphoid irradiation. He engrafted promptly but transfusion dependency did not resolve until CMV viremia was treated with ganciclovir. The patient is alive and well 2 years after BMT.


Differential expression and release of CD54 induced by cytokines.
Intercellular adhesion molecule-1 (ICAM-1, CD54) is upregulated in many cell types stimulated by cytokines. A human hepatoblastoma cell line (C3A, a subclone of HepG2/C3 that is currently being used as a surrogate liver) and human lung adenocarcinoma cells (A549) were stimulated with interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF alpha), interferon-gamma (IFN gamma), or IL-6 to determine any differences in cell type responsiveness to individual cytokines for ICAM-1 upregulation. Time courses were performed with each cytokine evaluating ICAM-1 mRNA, surface expression, and cICAM-1 in the cell culture media. Between 3 and 6 hours, IL-1 beta (30 U/mL) stimulated the greatest increase in hepatocyte ICAM-1 mRNA, followed by IFN gamma (100 U/ mL), and IL-6 (100 U/mL) in order of potency. Except for IL-6, cytokine-induced hepatocyte surface levels of ICAM-1 (immunofluorescence flow cytometry, mAb R6.5) were dose dependent, with inhibition at higher concentration. Highest levels followed stimulation with INF gamma (P < .05). Significantly less was found after both IL-1 beta and TNF alpha; none was detected after IL-6 (P < .05). In contrast, IL-1 beta stimulated significantly more cICAM-1 release from hepatocytes than the other cytokines (P < .001), and IL-6 stimulated modest cICAM-1. Between 3 and 6 hours in the A549 cells, IL-1 beta stimulated the greatest increase in ICAM-1 mRNA, followed by TNF alpha. Both responses were greater than that observed in the hepatocytes. IFN gamma- and IL-6-induced ICAM-1 mRNA synthesis was not different from unstimulated A549 cells. Cytokine-induced A549 surface levels of ICAM-1 (immunofluorescence flow cytometry, mAb R6.5) was highest for IL-1 beta (peak levels similar to hepatocyte response), modest with TNF alpha (peak levels less than hepatocytes), detectable with IFN gamma (much less than hepatocytes), and nondetectable after IL-6. No ICAM-1 release from A549 cells was induced under any condition. In hepatocytes the amount of ICAM-1 mRNA was best accounted for by considering both cell surface levels of ICAM-1 and cICAM-1 levels. In human lung adenocarcinoma cells, the cytokine induction of ICAM-1 mRNA could potentially be accounted for by observing cell surface levels of ICAM-1 because no cICAM-1 was produced. These results suggest that surface ICAM-1 and cICAM-1 may be differentially controlled by each cytokine and by each parenchymal cell type.


Synthesis of cationic cardiolipin analogues.
An approach was developed to synthesize a new class of cationic cardiolipin analogues containing two quaternary ammonium groups with tetra alkyl groups retaining "glycerol" moiety, the central core of the molecule. Cationic cardiolipin analogues were modified via introduction of either two or four oxyethylene groups to enhance the solubility in polar solvents. These newly synthesized cationic cardiolipin analogues can be applied to a broad range of drug delivery systems such as transfection reagents.


Torsion of wandering spleen after Fontan operation in a patient with situs inversus: a rare complication.
Torsion of wandering spleen after the Fontan operation with situs inversus is rare.Here, we report the case of a 6-year-old girl with a single ventricle and complete situs inversus who developed torsion of wandering spleen due to splenomegaly caused by post-operative haemodynamics of the Fontan operation. The platelet count was suggested to be useful in predicting splenic torsion.


Prognostic significance of preoperative consolidation to maximum tumour diameter ratio and SUVmax in pathological stage I lung adenocarcinoma.
Consolidation/tumour (C/T) ratio means the maximum diameter of the consolidation is divided by the maximum diameter of the tumour and it is predictive for pathologic subtypes and prognosis after resection of the tumour. The purpose of this study is to clarify impact of C/T ratio along with maximum standardized uptake value (SUV) in pathological stage I lung adenocarcinoma. Only patients with pathological stage I lung adenocarcinoma diagnosed by resection were included. Prognostic impact of C/T ratio and SUVmax were analysed by using regression analyses. Totally 156 patients (121 males, 35 females) were evaluated retrospectively. Overall survival (OS) and progression free survival (PFS) were higher in patients with C/T ratio ≥0.5 (OS: 46.3 ± 23.7 vs 30.4 ± 14.6, P = 0.002 and PFS: 43.0 ± 25.4 vs 27.8 ± 15.8, P = 0.005). But PFS and OS curves did not reveal any significant differences with Kaplan-Meier method (P = 0.45 and P = 0.055 respectively). Resection type (limited vs anatomic) and C/T ratio were predictors for OS in multivariate analyses (resection type: HR: 2.21 (1.01-4.83), P = 0.045 and C/T ratio: HR: 0.44 (0.20-0.98), P = 0.045). For PFS, resection type and SUVmax had prognostic significance (resection type: HR: 3.56 (1.64-7.74), P = 0.001 and SUVmax: HR: 1.31 (0.82-2.99), P = .002). In pathological stage 1 lung adenocarcinomas, SUVmax and surgery type are important predictors for recurrence rates. For early stage, adenocarcinoma patients with high SUVmax value, tumour size ≥3 cm and high grade subtype, C/T ratio should not be considered significant alone on survival and recurrence.


Rapid functional genetics of the oligodendrocyte lineage using pluripotent stem cells.
Oligodendrocyte dysfunction underlies many neurological disorders, but rapid assessment of mutation-specific effects in these cells has been impractical. To enable functional genetics in oligodendrocytes, here we report a highly efficient method for generating oligodendrocytes and their progenitors from mouse embryonic and induced pluripotent stem cells, independent of mouse strain or mutational status. We demonstrate that this approach, when combined with genome engineering, provides a powerful platform for the expeditious study of genotype-phenotype relationships in oligodendrocytes.


Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study.
Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services. To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China. The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies. Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice. The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.


Chronic exposure to UVB induces nephritis and gut microbiota dysbiosis in mice based on the integration of renal transcriptome profiles and 16S rRNA sequencing data.
Ultraviolet (UV) is a common and abundant environmental factor that affects daily life. Although the effects of UV radiation on the skin have been extensively reported, studies on the influence of UV radiation on internal organs are still limited. This study aimed to evaluate the influence of UVB exposure on the kidney of mice and to investigate the possible mechanism. In the present study, histopathology changes, oxidative stress, and inflammatory response were used to evaluate the kidney and colon injury induced by UVB exposure. The results showed that the 14-week chronic skin exposure to UVB triggers a kidney injury response characterized by macrophage infiltration, elevated oxidative stress as well as inflammatory and injury markers. The RNA sequencing demonstrated that chronic UVB exposure could alter the kidney transcriptomic profile distinguished by the regulation of genes involved in the Notch signaling pathway, JAK-STAT signaling pathway, and ECM-receptor interaction. Besides, chronic UVB exposure also resulted in gut dysbiosis, manifested as colon macrophage infiltration, stimulated inflammatory responses, impaired barrier integrity, and microbiota structural and functional disorders. The Spearman analysis results further revealed a strong correlation between gut microbiota and kidney injury. In conclusion, skin chronic exposure to UVB causes nephritis and gut microbiota dysbiosis in mice, and these findings provide new insight into the underlying risks of chronic UVB exposure to human wellness.


A new method of measuring lens refractive index.
A new clinical method for determining the refractive index of a lens is described. By measuring lens power in air and then immersing the lens in a liquid of known refractive index (n), it is possible to calculate the refractive index of the lens material (micro) by using the formula: micro = (nK (v,1) - K(v,n))/(K (v,1) - K (v,n)) where K (v,1) is the lens power determined in air K (v,n) is the lens power determined in the immersion liquid. The only materials required are a digital lensmeter and a wet cell for holding the lens in a liquid. The theoretical basis of the method is explained and a description given of the limitations. The optimal method of measuring different types of lenses is discussed. Sources of error include the thin lens theory behind the method, the use of a wetcell and the digital lensmeter. The theoretical accuracy of the results is given as 0.02 but 0.01 is usually achieved. In all cases, measuring the front vertex powers (FVP) yields a more accurate estimate of refractive index of a lens than measuring back vertex power (BVP). The author found half the lenses measured attained values within 0.005 of the known material index. This method is usually sufficiently accurate to isolate which lens material has been used in manufacturing and permit manufacturing spectacles that mimic the appearance of an earlier pair. Some suggestions for further refinement are given.


New imidazolylpyrazoles of potential pharmaceutical interest.
New imidazolylpyrazoles were synthesized and tested for antimicrobial activities. The compounds did not show any significant activity.


Pharmacotherapy of an ulcer in Barrett's esophagus: carbenoxalone and cimetidine.
A 70-year old man is described who had specialized columnar epithelium in the esophagus up to the upper esophageal sphincter, 19 cm from the incisor teeth. The patient had a small sliding hiatus hernia but the lower esophageal sphincter was located at 39-41 cm. Above the sphincter the patient had large peptic ulcers which failed to heal after 1 year of a conventional antireflex regimen. Carbenoxalone sodium administration led to healing in 3 months. However, the ulcers recurred after discontinuation of the drug. On a second attempt carbenoxalone effected modest healing but was stopped because of hypertension and hypokalemia. Cimetidine therapy led to complete healing of the the ulcer within a month. The authors concluded that both carbenoxalone and cimetidine are useful in the treatment of an ulcer in Barrett's esophagus. However, cimetidine may be more rapidly effective and does not produce dangerous side effects.


The effects of tislelizumab plus chemotherapy as first-line treatment on health-related quality of life of patients with advanced squamous non-small cell lung cancer: Results from a phase 3 randomized clinical trial.
This study assessed the effects of adding tislelizumab to first-line standard-of- care chemotherapy on the health-related quality of life (HRQoL) of patients with advanced squamous non-small cell lung cancer (sq-NSCLC). Patients in this open-label, multicenter, phase 3 RATIONALE 307 trial were randomized to one of the three arms: tislelizumab plus carboplatin and paclitaxel (Arm A), tislelizumab plus carboplatin and nab-paclitaxel (Arm B), or paclitaxel plus carboplatin (Arm C). HRQoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and the EORTC Quality of Life Questionnaire Lung Cancer 13-item module (QLQ-LC13). Mean score change from baseline at Weeks 6 and 12 in the QLQ-C30's global health status/quality of life (GHS/QoL), fatigue, and physical functioning scores and QLQ-LC13 lung cancer specific subscales were examined. Time to deterioration was estimated for the GHS/QoL score. A total of 355 sq-NSCLC patients received at least one dose of study drug and completed at least one HRQoL assessment. The GHS/QoL scores improved in Arms A and B relative to Arm C at Weeks 6 and 12. Arms A and B also experienced a reduction in most lung cancer-specific symptoms relative to Arm C. Time to deterioration of GHS/QoL was not reached by any of the three arms. The addition of tislelizumab to platinum-based chemotherapy is associated with improvements in sq-NSCLC patients' HRQoL, especially in GHS/QoL and most importantly in lung cancer-specific symptoms including coughing, dyspnea, and hemoptysis.


The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.
To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (p<0.001) in patient's length of stay in the intervention group in relation to the comparison group. The intensity of care slightly declined with p<0.001. No significant changes were found concerning health care outcomes measured by emergency department visits, readmissions, and mortality after discharge. The DRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system.


Simultaneous vaccination by three living attenuated strains of Brucella, Salmonella and Chlamydia in mice.
Associations of vaccines for simultaneous administration were successfully developed long ago, in particular in human medicine, although there have been very few attempts to associate living bacterial vaccines. Unfortunately, living vaccines can interact with one another resulting in either a virulent infection or an exclusion of one by the other. Having developed two new low virulence vaccinal strains of Chlamydia psittaci var. ovis and Salmonella abortus ovis for use in veterinary medicine, we studied associations of both and with the Brucella melitensis Rev1 vaccine in mice. There was no interaction between the Chlamydia and the Salmonella vaccines and between the Salmonella and the Brucella vaccines from the point of view of immunogenicity. In contrast, anti-Chlamydia immunity was decreased by about 15-19% when the Chlamydia vaccine was associated with the Brucella vaccine in double or triple association. Surprisingly, the Chlamydia vaccinal strain infection was slightly extended when administered in association. The simultaneous vaccination we tested could be of great interest in veterinary medicine, but special attention must be devoted to anti-Chlamydia immunity and would have to be studied in a ewe model.


Prostatic and peripheral blood selenium levels after oral supplementation.
The dietary trace element selenium has been proposed to be a potential chemopreventive agent for prostate cancer. Epidemiological studies have suggested an inverse association between blood selenium and prostate cancer incidence. However, to our knowledge no study to date has examined selenium absorption by the prostate. Therefore, we determine whether oral selenium supplementation alters selenium levels within the prostate and/or peripheral blood. In this prospective trial 51 men undergoing transurethral resection of the prostate for benign prostatic hyperplasia were randomly assigned to serve as controls or receive 200 microg selenium daily orally for 1 month. Sample size was calculated to detect a difference of 30 ng/gm in prostate tissue with a power of 80%. Peripheral blood was obtained at enrollment and subsequently at surgery, when prostate tissue was also sampled. Selenium levels were determined using inductively coupled plasma mass spectrometry. Baseline erythrocyte selenium was within the standard reference range. Supplementation increased erythrocyte (initial median 173 and final median 209 ng/ml, p = 0.008) and prostate (supplement median 241 and control median 196 ng/gm, p = 0.016) levels. Erythrocyte levels at surgery correlated poorly with prostate levels in the control (r = 0.18) and supplement (r = 0.07) groups. Oral selenium supplementation increases prostatic and peripheral blood levels in men in a nonselenium deficient population. Blood and prostate levels correlated poorly, suggesting that peripheral blood measurements are a poor indicator of prostatic selenium content.


Minimally invasive dynamic screw stabilization using cortical bone trajectory.
The conventional pedicle-screw-based dynamic stabilization process involves dissection of the Wiltse plane to cannulate the pedicles, which cannot be undertaken with minimal surgical invasion. Despite some reports having demonstrated satisfactory outcomes of dynamic stabilization in the management of low-grade spondylolisthesis, the extensive soft tissue dissection involved during pedicle screw insertion substantially compromises the designed rationale of motion (muscular) preservation. The authors report on a novel method for minimally invasive insertion of dynamic screws and a mini case series. The authors describe innovations for inserting dynamic screws via the cortical bone trajectory (CBT) under spinal navigation. All the detailed surgical procedures and clinical data are demonstrated. A total of four (2 females) patients (mean age 64.75 years) with spinal stenosis at L4-5 were included. By a combination of microscopic decompression and image-guided CBT screw insertion, laminectomy and dynamic screw stabilization were achieved via one small skin incision (less than 3 cm). These patients' back and leg pain improved significantly after the surgery. This innovative dynamic screw stabilization via the CBT involved no discectomy (or removal of sequestrated fragment only), no interbody fusion, and little muscle dissection (not even of the Wiltse plane). As a minimally invasive surgery, CBT appeared to be a viable alternative to the conventional pedicle-screw-based dynamic stabilization approach.


The three-dimensional conformation and activity of mitochondria in syncytial male germ line-cysts of medicinal leeches.
We studied the spatial conformation and activity of mitochondria in the developing syncytial male germline cysts during spermatogenesis of the medicinal leeches using light, fluorescent, transmission electron microscopy, and serial block-face scanning electron microscopy. In cysts with spermatogonia and spermatocytes, mitochondria form networks and are in a dynamic hyperfusion state, while in cysts with spermatids, a single huge mitochondrion is observed. As spermiogenesis progresses, this huge mitochondrion is finally located in the future midpiece. The highest activity, in terms of membrane potential, of the mitochondria in H. medicinalis germline cysts was observed in cysts with spermatocytes; the lowest was in cysts with late elongated spermatids.


Clinical features of deep neck infection: analysis of 77 patients.
This retrospective study aims to detect the prognostic factors which affect the duration of hospital stay and evaluate the complications which develop in patients with deep neck infection. The study included 77 patients (40 males, 37 females; mean age 42.4±20.1 years; range 11 to 88 years) treated with a diagnosis of deep neck infection in our clinic between November 2006 and November 2012. Patients' demographic and clinical features were analyzed to detect their associations with development of complications and hospitalization time. Odontogenic origin and submandibular localization were the most frequently observed clinical appearance. Of eight patients (10.4%) who developed serious complications, two (2.6%) died. Age, comorbidity, presence of anemia alone, Ludwig's angina and retropharyngeal involvement were associated with increased rate of complications (p<0.05); while sex, antibiotic usage prior to admittance and primary location of infection were not related (p>0.05). Submandibular localization and absence of leucopenia reduced the risk of complications (p<0.05). The mean duration of hospital stay was 12.9±8.7 days (range 2-59 days). Age, presence of comorbidity and development of complications extended the hospitalization period (p<0.05). In spite of the improvements in diagnosis and treatment, deep neck infection may be an important cause of mortality if complications develop. Comorbid anemia, Ludwig's angina and retropharyngeal involvement were identified as the strongest predictors in terms of development of complications. Duration of hospital stay extended in patients who developed complications.


Relationships of disability with age among adults aged 50 to 85: evidence from the United States, England and continental europe.
To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.


Hypothermia from a two-component mixture comprising Amoxicillin and Sulbactam.
Hypothermia might be an adverse effect of Amoxicillin and/or Sulbactam, and clinicians should be aware of this effect. Further clinical and laboratory investigations are also needed to confirm and clarify the underlying mechanism of this side effect.


Pharmacogenetics of alcohol use disorders and comorbid psychiatric disorders.
Alcohol use disorders (AUDs) represent a significant health burden worldwide. Currently, there are three medications approved by the U.S. Food and Drug Administration for the treatment of AUDs, and other drugs are being prescribed off-label for this purpose. However, response rates for pharmacologic treatment are low, and extant research suggests that treatment effects may partially depend on genetic factors. Personalized medicine, or using a patient's genetics and/or personal history to determine efficacy of treatment prior to prescription, is an emerging tool that will help clinicians treat their patients more effectively and safely. This review systematically discusses current findings from AUD pharmacotherapy trials examining disulfiram, acamprosate, naltrexone, the injectable naltrexone, and topiramate. Furthermore, it presents pharmacogenetics findings associated with these medications in an attempt to further the field of personalized medicine. Research from trials examining AUDs and comorbid major depressive disorder and anxiety disorders is also presented, and pharmacogenetic findings for these treatments are discussed. Lastly, the authors comment on the present and future states of the field of personalized medicine for AUD.


The lifetimes of Pharaonis phoborhodopsin signaling states depend on the rates of proton transfers--effects of hydrostatic pressure and stopped flow experiments.
Pharaonis phoborhodopsin (ppR), a negative phototaxis receptor of Natronomonas pharaonis, undergoes photocycle similar to the light-driven proton pump bacteriorhodopsin (BR), but the turnover rate is much slower due to much longer lifetimes of the M and O intermediates. The M decay was shown to become as fast as it is in BR in the L40T/F86D mutant. We examined the effects of hydrostatic pressure on the decay of these intermediates. For BR, pressure decelerated M decay but slightly affected O decay. In contrast, with ppR and with its L40T/F86D mutant, pressure slightly affected M decay but accelerated O decay. Clearly, the pressure-dependent factors for M and O decay are different in BR and ppR. In order to examine the deprotonation of Asp75 in unphotolyzed ppR we performed stopped flow experiments. The pH jump-induced deprotonation of Asp75 occurred with 60 ms, which is at least 20 times slower than deprotonation of the equivalent Asp85 in BR and about 10-fold faster than the O decay of ppR. These data suggest that proton transfer is slowed not only in the cytoplasmic channel but also in the extracellular channel of ppR and that the light-induced structural changes in the O intermediate of ppR additionally decrease this rate.


Dataset of sodium chloride sterile liquid in bottles for intravenous administration and fill level monitoring.
We propose a dataset to investigate the relationship between the fill level of bottles and tiny machine learning algorithms. Tiny machine learning is represented by any Artificial Intelligence algorithm (spanning from conventional decision tree classifiers to artificial neural networks) that can be deployed into a resource constrained micro controller unit (MCU). The data presented has been originally collected for a joint research project by STMicroelectronics and Sesovera.ai. This article describes the recorded image data of bottles with 4 levels of filling. The bottles contain sodium chloride sterile liquid for intravenous administration. One subject of investigation using this dataset could be the classification of the liquid fill level, for example, to ease continuous human visual monitoring which may represent an onerous time-consuming task. Automating the task can help to increase the human work productivity thus saving time. Under normal circumstances, human visual monitoring of the saline level in the bottle is required from time to time. When the saline liquid in the bottle is fully consumed, and the bottle is not replaced or the infusion process stopped immediately, the difference between the patient's blood pressure and the empty saline bottle could cause an outward rush of blood into the saline.


Highly sensitive and simultaneous detection of melamine and aflatoxin M1 in milk products by multiplexed planar waveguide fluorescence immunosensor (MPWFI).
Mycotoxins and industrial chemicals, such as aflatoxin M1 and melamine, now commonly exist in milk and cause potential health risks. This study presents an indirect competitive immunoassay through multiplex planar waveguide fluorescence immunosensor (MPWFI) for rapid, sensitive, and simultaneous detection and quantification of aflatoxin M1 and melamine by applying the principle of immunoreaction and total internal reflect fluorescent. Double-channel standard curves with appropriate logistic correlation (R(2)>0.99) were plotted, respectively. The working ranges (0.073-0.400 ng/mL and 26.38-270.00 ng/mL, respectively) were calculated, as well as the limit of detection (0.045 and 13.37 ng/mL, respectively), when two analytes were simultaneously detected. Both results satisfied the requirements for the maximum amount set by the WHO, which illustrated that the current method was better than some other standard methods. The recovery rates in the actual samples ranged from 85% to 103%, with relative standard deviations between 1.3% and 6.5%, which indicated high accuracy and repeatability.


Use of the bayley infant neurodevelopmental screener with premature infants.
To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) for the neurodevelopmental follow up of high-risk preterms. The study group consisted of 122 preterm infants of the gestational ages between 26 and 37 weeks. Medical factors such as; mean birth weight, gestational age, gender, birth place and type, number of multiple pregnancy, days of hospitalization and oxygen therapy, use of antenatal steroids, and occurrence of sepsis for each patient were evaluated. The neurodevelopmental examination and BINS administration was made at each visit to the patients whose ages were adjusted for prematurity. At the corrected age of 7-10 months patients at 26-29 GA had significantly lower total means of BINS scores when compared to those of the other two groups at 30-32 and 33-37 GA (P<0.01 and P<0.001). At the corrected age of 3-4 months, the total means of the BINS scores of the patients at 30-32 GA were lower than that of the patients at 33-37 GA (P<0.009). at 7-10 months the scores of the items defining the expressive and cognitive functions of the patients at 26-29 GA were lower than those of the patients at 30-32 GA (P<0.05) and 33-37 GA (P<0.05). At 16-20 months the mean scores of the items of expressive functions were significantly lower in patients of the 26-29 GA compared to those of the patients of 33-37 GA (P<0.03). As data accumulates, BINS will turn out to be a quick way of determining infants at risk of developmental delay in many aspects of neurologically high risk conditions.


In the area of investigation 50 species of Pteromalidae (2 Spalangiinae, 19 Miscogasterinae 4 Tridyminae and 25 Pteromalinae) were caught. The species which are most numerous and ecologically most important are Cyrtogaster vulgaris Asaphes vulgaris and Meraporus graminicola. Endemic species are missing. Urolepis maritima is the only species which lives at salt pools.Only a few species live in the pastured salt marshes: in the lower area of Puccinellia maritima there is only I indigenous species, in the area of Festuca rubra littoralis there are 6. Polders and terpen on the marsh islands are populated by the same species of Pteromalidae. The marsh islands resemble the salt marshes on the mainland in their combination of species. The development from salt marsh to polder causes some changes in the density of species and specimens. A rapid course of successions results from the building of dikes and reserves. The number of Pteromalid species rises from 6 in pastured salt marshes to 30 in polders or salt marsh reserves. At the same time the number of specimens increases.Most species have several generations. Most of them parasitise Diptera undermining plant tissue. The existence of monophagous Pteromalids could not be proven with certainty. The females fly up but then are drifted away by winds. After having drifted for 30 to 40 km over the sea they are still able to distinguish yellow and blue traps on light ships. When settling in a new area they have a high coincidence with their hosts.The adult Pteromalids are active only in the day-time and above a certain threshold of temperature which varies according to the particular season. This threshold can easily be raised or lowered experimentally. By adjusting the threshold the daily activity is limited to the warmest hours of the day. Even in periods of continuously warm weather the animals are active for about 6 hours a day only. Activity patterns with 2 peaks (bigeminus) were not found in the field.Pteromalid adults flooded for a short time were damaged to such an extent that they could hardly move after the water had run off. Higher temperatures of water accelerate the development of irreversible damage. Flooded specimens are lighter than water and dry to reach the surface. After a few hours they die. In the open they are drifted away by high tides. The areas depopulated after such a high tide are quickly populated again by new specimens.Adaptation of adult Pteromalids to specific factors of the tidal region could not be found. Pteromalids living in this area are able to survive because 1. they do not hibernate as adults; 2. they parasitise hosts living safely in plants; 3. they hatch from their hosts in a metachronous fashion. 4. they fill up population gaps quickly. This shows that despite their high abundance in the tidal regions Pteromalids have not adapted themselves to tidal factors.


Fibroblast growth factor 23 levels in cord and peripheral blood during early neonatal period as possible predictors of affected offspring of X-linked hypophosphatemic rickets: report of three female cases from two pedigrees.
The role of serum fibroblast growth factor 23 (FGF23) level in early neonatal period on the diagnosis of X-linked hypophosphatemic rickets (XLH) remains unclear. Two female patients from the first pedigree had an affected mother, and the other female from the second pedigree had an affected father. In all three cases, FGF23 levels were high in cord blood and peripheral blood at day 4-5. Additionally, the FGF23 levels considerably increased from birth to day 4-5. We identified a PHEX pathogenic variant and initiated treatment during infancy in each case. In neonates with a parent diagnosed as PHEX-associated XLH, FGF23 in cord blood and peripheral blood at day 4-5 may be useful markers for predicting the presence of XLH.


Serine and glycine metabolism in schizophrenic patients.
1. The brain glycine is almost exclusively derived from serine via serine-hydroxymethyltransferase. 17 males schizophrenic inpatients and 10 males healthy volunteers were submitted to the serine tolerance test. 2. Plasma serine and glycine concentration were evaluated before and after 1, 2, 3, 4 hours of an oral load with L-serine to test the interconversion between the two amino acids. 3. The authors did not find any significant difference between schizophrenic patients and control group and concluded that the enzyme serine-hydroxymethyltransferase is not deficient in the conversion of serine to glycine in schizophrenic patients as suggested by other authors.


Reproducibility of Systolic Strain in Mice Using Cardiac Magnetic Resonance Feature Tracking of Black-Blood Cine Images.
Mouse models are widely utilized to enhance our understanding of cardiac disease. The goal of this study is to investigate the reproducibility of strain parameters that were measured in mice using cardiac magnetic resonance (CMR) feature-tracking (CMR42, Canada). We retrospectively analyzed black-blood CMR datasets from thirteen C57BL/6 B6.SJL-CD45.1 mice (N = 10 female, N = 3 male) that were imaged previously. The circumferential, longitudinal, and radial (Ecc, Ell, and Err, respectively) parameters of strain were measured in the mid-ventricular region of the left ventricle. Intraobserver and interobserver reproducibility were assessed for both the end-systolic (ES) and peak strain. The ES strain had larger intraclass correlation coefficient (ICC) values when compared to peak strain, for both the intraobserver and interobserver reproducibility studies. Specifically, the intraobserver study showed excellent reproducibility for all three ES strain parameters, namely, Ecc (ICC 0.95, 95% CI 0.83-0.98), Ell (ICC 0.90, 95% CI 0.59-0.97), and Err (ICC 0.92, 95% CI 0.73-0.97). This was also the case for the interobserver study, namely, Ecc (ICC 0.92, 95% CI 0.60-0.98), Ell (ICC 0.76, 95% CI 0.33-0.93), and Err (ICC 0.93, 95% CI 0.68-0.98). Additionally, the coefficient of variation values were all < 10%. The results of this preliminary study showed excellent reproducibility for all ES strain parameters, with good to excellent reproducibility for the peak strain parameters. Moreover, all ES strain parameters had larger ICC values than the peak strain. In general, these results imply that feature-tracking with CMR42 software and black-blood cine images can be reliably used to assess strain patterns in mice.


Microsurgical cordotomy in 20 patients with epi-/intradural fibrosis following operation for lumbar disc herniation.
Using an improved microsurgical technique, cordotomy was carried out by the cervicothoracic route in 20 patients with persistent radicular pain due to epi-/intradural fibrosis following operation for lumbar disc herniation. 65% of them had good long-term results with respect to radicular pain (follow-up period 6-132 months; mean 66 months). Permanent severe motor impairment was not observed. In patients with severe pain of benign organic origin microsurgical cordotomy can be considered as a "last resort".


A key to cercariae of British strigeoids (Digenea) for which the life-cycles are known, and notes on the characters used.
From original observations and from data in the literature, a key to cercariae of British strigeoids for which life-cycles are known has been compiled. The value of various characters of systematic importance is discussed.


Randomized clinical trial of the effect of a saline-linked radiofrequency coagulator on blood loss during hepatic resection.
Use of a saline-linked radiofrequency coagulator (dissecting sealer) has been suggested to reduce blood loss during hepatic resection. A randomized clinical trial was conducted to assess the effects of using the device on the amount of blood loss. Patients scheduled to undergo hepatic resection were randomly assigned to either use of the dissecting sealer or the clamp crushing method. The primary outcome measure was blood loss during liver parenchymal division. Multivariate analysis was also performed. Ninety-four consecutive patients underwent hepatic resection and 40 patients were assigned to each group. There were no significant differences between the dissecting sealer and clamp crushing groups in blood loss during liver parenchymal division (median 373 versus 535 ml; P = 0.252) or total intraoperative blood loss (665 versus 733 ml; P = 0.450). Multivariate analysis revealed that use of the dissecting sealer offered no protection against blood loss compared with the clamp crushing method (odds ratio 1.17 (95 per cent confidence interval 0.39 to 3.53); P = 0.777), whereas number of resections, thoracotomy and type of resection had a significant effect. Use of a dissecting sealer offered no substantial benefit over the clamp crushing method in reducing blood loss during hepatic resection.


Supratentorial dural-based collision of cavernoma and meningioma: a case report.
Collision tumor is a very rare case of cerebral lesion. Approximately 50 reports of intracranial collision tumors were described in the literature. We present a case of supratentorial dural-based convexity collision tumor radiologically mimicking cavernous malformation and composed of cavernous malformation and meningioma. The case presents a 63-year-old female having MR findings such as hemorraged supratentorial dural-based mass with "popcorn" signs and hemosiderin deposits. The patient underwent craniotomy and evacuation of the subdural hematoma with resection of the tumor mass. Histologically the lesion had signs of a cavernoma and meningioma. MRI in a year after surgery did not reveale residual tumor mass or recurrence. Collision tumor is a very rare case. Preoperative diagnosis of a dural lesion is difficult and challenging. A neuroradiological differential diagnosis of similar cases needs focused attention.


International epidemiology of intracerebral hemorrhage.
Intracerebral hemorrhage is the second most common subtype of stroke. In recent decades our understanding of intracerebral hemorrhage has improved. New risk factors have been identified; more knowledge has been obtained on previously known risk factors; and new imaging techniques allow for in vivo assessment of preclinical markers of intracerebral hemorrhage. In this review the latest developments in research on intracerebral hemorrhage are highlighted from an epidemiologic point of view. Special focus is on frequency, etiologic factors and pre-clinical markers of intracerebral hemorrhage.


Resistance to treatment in gastrointestinal stromal tumours: what radiologists should know.
Gastrointestinal stromal tumour resistance to treatment with imatinib occurs due to pre-existing or acquired mutations. Computed tomography and positron-emission tomography play an essential role in prompt recognition of resistance to treatment. Primary resistance to treatment, which is encountered in the first 6 months of treatment, is associated with specific mutations. Imaging of these tumours shows no anatomical or metabolic response to treatment. Secondary resistance to treatment, which develops after an initial response, is associated with a variety of mutations acquired after the start of treatment. Imaging findings of secondary resistance are of disease progression.


A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore.
To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore. This is an initial program evaluation of a national DACPR intervention. A before-after analysis was conducted using OHCA cases retrieved from a local registry and DACPR information derived from audio recordings and ambulance notes. The primary outcomes were survival to admission, survival at 30 days post-arrest and good functional recovery. Data was collected before the intervention (April 2010 to December 2011), during the run-in period (January 2012 to June 2012) and after the intervention (July 2012 to February 2013). A total of 2968 cases were included in the study with a mean age of 65.6. Overall survival rate was 3.9% (116) with good functional recovery in 2.2% (66) of the patients. BCPR rate increased from 22.4% to 42.1% (p<0.001) with odds ratio (OR) of 2.52 (95% confidence interval [CI]: 2.09-3.04) and ROSC increased significantly from 26.5% to 31.2% (p=0.02) with OR of 1.26 (95%CI: 1.04-1.53) after the intervention. Significantly higher survival at 30 days was observed for patients who received BCPR from a trained person as compared to no BCPR (p=0.001, OR=2.07 [95%CI: 1.41-3.02]) and DACPR (p=0.04, OR=0.30 [95%CI: 0.04-2.18]). A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.


ERCC1, XPD and RAI mRNA levels in lymphocytes are not associated with lung cancer risk in a prospective study of Danes.
Low DNA-repair capacity has been associated with increased risk of several types of cancer. mRNA levels of the nucleotide excision repair genes ERCC1 and XPD have been shown to correlate with the DNA-repair capacity. Likewise, mRNA levels of several DNA-repair genes including ERCC1 have been shown to be lower in lymphocytes from patients with lung cancer and head and neck cancer compared with healthy persons. In these studies, the low DNA-repair gene expression levels could be either a risk factor for disease or a consequence of the same. In this nested case-cohort study, which to our knowledge, is the first prospective study of DNA-repair gene mRNA levels as predictors of lung cancer, we have investigated the occurrence of lung cancer in relation to the mRNA level of the two DNA-repair genes ERCC1 and XPD and the NF kappaB inhibitor RAI in blood samples prior to disease. Among 54,220 members of a Danish prospective cohort study, 265 lung cancer cases were identified and a sub-cohort comprising 272 individuals was used for comparison. The expression levels of the three adjacent genes were found to be highly inter-correlated, to be higher in women compared to men and to be lower in older individuals. The incidence rate ratios for lung cancer in association with one log-unit increase (natural logarithm) in mRNA levels were 1.12 (CI=0.89-1.41) for ERCC1, 1.00 (CI=0.83-1.21) for XPD and 1.25 (0.89-1.74) for RAI. In conclusion, this study indicated no association between mRNA expression of the DNA-repair genes ERCC1 and XPD and risk of subsequent development of lung cancer.


Bilateral Recurrent Uveitis in a Young Patient with Family History of Spondyloarthritis: Spondyloarthritis or Not?
We present the case of a young man with a strong family history of SpA, who was referred to the Rheumatology Clinic due to bilateral uveitis refractory to treatment with corticosteroids. The patient's renal function gradually deteriorated and a subsequent biopsy was positive for interstitial nephritis. After excluding all other systemic diseases, the diagnosis of TINU syndrome was confirmed. Although rare, TINU syndrome should be considered in the differential diagnosis of non-infective uveitis especially in the presence of urinalysis abnormalities.


Tumoral calcinosis in the neck region involving an unusual site in a hemodialysis patient.
Tumoral calcinosis is a rare disorder characterized by calcium salt deposition in the periarticular soft tissue region. It often occurs in the hip, elbow, shoulder, foot, and wrist. Soft tissue calcification associated with tumoral calcinosis is rare in the head and neck. The present case describes a 65- year-old male who had been on hemodialysis for 3 years. A bulky mass, containing chalky amorphous calcified material, occurred at the lower neck and superior mediastinum. Chronic renal failure is a common condition associated with secondary tumoral calcinosis. The pathogenesis has been progressively unraveled, which indicates that secondary hyperparathyroidism and tissue injury play a part in multifactorial calcification. Laryngoscope, 126:E196-E198, 2016.


Efficient removal of sixteen priority polycyclic aromatic hydrocarbons from textile dyeing sludge using electrochemical Fe2+-activated peroxymonosulfate oxidation-A green pretreatment strategy for textile dyeing sludge toxicity reduction.
It is urgent to remove polycyclic aromatic hydrocarbons (PAHs) from textile dyeing sludge (TDS) before its final deposal due to their recalcitrant nature and generation of toxic byproducts during TDS treatment. In this study, an electrochemical Fe2+-activated peroxymonosulfate (PMS) oxidation process for removing 16 priority PAHs from real TDS was firstly investigated. The results showed that the removal efficiency of the ∑16PAHs in TDS was positively correlated to the concentration of Fe2+ released from sacrificial iron anode and the concentration of electroregenerated Fe2+ in the cathode by the reduction of Fe3+ within the applied voltage range of 3-7 V, but a higher voltage of 10 V did not lead to further improvement in ∑16PAHs removal due to the radical scavenging reaction resulted from the excessive accumulation of Fe2+. 64.7% and 16.1% of the ∑16PAHs were removed in the anodic and cathodic chamber under the optimum reaction conditions of 400 mg/g PMS/VSS, pH 3 and applied voltage 7 V, respectively. low-ring PAHs were preferentially degraded compared to high-ring PAHs. The O⋅Hplayed a major role while SO4⋅-had a minor role in PAHs degradation in TDS. The intracellular PAHs released from cracked sludge cells were found to undergo further degradation under free radical attack.


Proinflammatory cytokines.
To review the concept of proinflammatory cytokines. Review of published literature. Academic (university hospital). Cytokines are regulators of host responses to infection, immune responses, inflammation, and trauma. Some cytokines act to make disease worse (proinflammatory), whereas others serve to reduce inflammation and promote healing (anti-inflammatory). Attention also has focused on blocking cytokines, which are harmful to the host, particularly during overwhelming infection. Interleukin (IL)-1 and tumor necrosis factor (TNF) are proinflammatory cytokines, and when they are administered to humans, they produce fever, inflammation, tissue destruction, and, in some cases, shock and death. Reducing the biological activities of IL-1 and TNF is accomplished by several different, but highly specific, strategies, which involve neutralizing antibodies, soluble receptors, receptor antagonist, and inhibitors of proteases that convert inactive precursors to active, mature molecules. Blocking IL-1 or TNF has been highly successful in patients with rheumatoid arthritis, inflammatory bowel disease, or graft-vs-host disease but distinctly has not been successful in humans with sepsis. Agents such as TNF-neutralizing antibodies, soluble TNF receptors, and IL-1 receptor antagonist have been infused into > 10,000 patients in double-blind, placebo-controlled trials. Although there has been a highly consistent small increase (2 to 3%) in 28-day survival rates with anticytokine therapy, the effect has not been statistically significant. Anticytokine therapy should be able to "rescue" the patient whose condition continues to deteriorate in the face of considerable support efforts. Unfortunately, it remains difficult to identify those patients who would benefit from anticytokine therapy for septic shock.


Effects of chitosan oligosaccharides on drug-metabolizing enzymes in rat liver and kidneys.
To investigate the effect of chitosan oligosaccharides (COS) on drug-metabolizing enzymes in rat liver and kidneys, male Spraque-Dawley rats were fed a diet containing 1% or 3% COS for 5 weeks. The activities of cytochrome P450 (CYP) enzymes, UDP-glucurosyltransferase (UGT) and glutathione S-transferase (GST) in the liver and kidneys were determined. Significant decreases in microsomal CYP3A-catalyzed testosterone 6β-hydroxylation, CYP2C-catalyzed diclofenac 4-hydroxylation, and CYP4A-catalyzed lauric acid 12-hydroxylation in the liver of rats fed the COS diets were observed compared with those rats fed the control diet. Immunoblot analyses of CYP proteins showed the same trend as with enzyme activities. Increased glutathione content in liver was found in rats fed the 1% COS diet. Increased hepatic NADPH: quinone oxidoreductase 1 (NQO1) activity was found in rats fed the COS diets. In kidneys, COS had little or no effect on CYP enzyme activities. However, increased GST activity was observed in rats fed the COS diets. Moreover, a higher UGT activity was found in rats fed the 1% COS diet. Our results indicate that COS may suppress hepatic CYP enzymes and induce phase II detoxifying reactions in the liver and kidneys of rats.


Horses discriminate between human facial and vocal expressions of sadness and joy.
Communication of emotions plays a key role in intraspecific social interactions and likely in interspecific interactions. Several studies have shown that animals perceive human joy and anger, but few studies have examined other human emotions, such as sadness. In this study, we conducted a cross-modal experiment, in which we showed 28 horses two soundless videos simultaneously, one showing a sad, and one a joyful human face. These were accompanied by either a sad or joyful voice. The number of horses whose first look to the video that was incongruent with the voice was longer than their first look to the congruent video was higher than chance, suggesting that horses could form cross-modal representations of human joy and sadness. Moreover, horses were more attentive to the videos of joy and looked at them for longer, more frequently, and more rapidly than the videos of sadness. Their heart rates tended to increase when they heard joy and to decrease when they heard sadness. These results show that horses are able to discriminate facial and vocal expressions of joy and sadness and may form cross-modal representations of these emotions; they also are more attracted to joyful faces than to sad faces and seem to be more aroused by a joyful voice than a sad voice. Further studies are needed to better understand how horses perceive the range of human emotions, and we propose that future experiments include neutral stimuli as well as emotions with different arousal levels but a same valence.


Drunkorexia behaviors and motives, eating attitudes and mental health in Lebanese alcohol drinkers: a path analysis model.
Drunkorexia refers to limited intake of high-calorie food to avert gaining weight and the need to increase in alcohol excessive consumption. The present study aimed to check for an association between depression, anxiety, and stress with drunkorexia behaviors/motives among Lebanese adults, while evaluating the mediating role of inappropriate eating attitude in those associations. Two hundred and fifty-eight participants enrolled in this cross-sectional study, who filled an online survey (September-December 2020). Drunkorexia behaviors were considered as the dependent variable; the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia behaviors and from anxiety to drunkorexia behaviors were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia behaviors. When taking the drunkorexia motives as the dependent variable, the path coefficients from stress to anxiety, from anxiety to eating attitudes, from eating attitudes to drunkorexia motives, and from anxiety to drunkorexia motives were all significant. The indirect relationships showed that eating attitudes mediated the association between anxiety and drunkorexia motives. This study highlighted that individuals with more psychological problems (depression, anxiety, and stress) and inappropriate eating habits exhibit more drunkorexic motivations and behaviors. Level V, Cross-sectional study.


Mechanical analysis of the improved superelastic Ni-Ti alloy wire using the orthodontic simulator with high-precision sensors.
The authors have been using improved superelastic Nickel-Titanium alloy wire (ISW) to close and align extraction spaces simultaneously, instead of separately using rigid wires for closing extraction spaces and Ni-Ti alloy wires for leveling and aligning. ISW has a low stiffness, which makes it challenging to generate sufficient moments. This study aimed to demonstrate the forces and moments exerted on adjacent brackets using an orthodontic simulator (OSIM) attached to a high-precision 6-axis sensor. In experiment 1, a 0.016 × 0.022-inch ISW, stainless steel (SS) wire, and β-titanium wires were ligatured into the two brackets. The 0.018 × 0.025-inch slot self-ligating brackets were bonded to two simulated teeth at the same height, and the experiment was conducted using the high-precision OSIM. The distance between the brackets was 10 mm, the V-bend angles of the installed wires were 10°, 20°, 30°, and 40°, and the apex position was set at the center of the bracket. In experiment 2, 6.0- and 9.0-mm long elastomeric chains were placed on the same brackets as in Experiment 1 to measure forces and moments. The distance between the brackets was increased by 1.0 mm from 6.0 to 15.0 mm. Both experiments were conducted in a 37 °C thermostatic chamber similar to the oral environment. In experiment 1, we measured moments on both sides for all the wires. As the V-bend angle increased, the absolute values of the moments also increased. With a V-bend angle of 10°, there was a significant (p < 0.05) difference in the moment generated in the left and right brackets among the three wire types. In the ISW, -1.67 ± 0.38 N・mm was generated in the left bracket, while 0.38 ± 0.26 N・mm was generated in the right bracket at 10°. At 20°, -1.77 ± 0.69 N・mm was generated in the left bracket, while 2.37 ± 0.94 N・mm was generated in the right bracket. At 30°, -2.98 ± 0.49 N・mm was generated in the left bracket, while 3.25 ± 0.32 N・mm was generated in the right bracket. Moreover, at 40°, -3.96 ± 0.58 N・mm was generated in the left bracket, while 3.55 ± 0.53 N・mm was generated in the right bracket. Furthermore, in experiment 2, the moments increased in proportion to the increase in distance between the centers of the two brackets. Absolute values of the moments were approximately equal for the left and right brackets. The 6.0-mm elastomeric chain generated a minimum force of -0.09 ± 0.05 N in the left direction when the distance between brackets was 6.0 mm, while a maximum of 1.24 ± 0.3 N when the distance between brackets was 12 mm in the right bracket. In the left bracket, minimum and maximum forces of -0.09 ± 0.07 and 1.3 ± 0.4 N were generated in the right direction, respectively. The 9.0-mm elastomeric chain generated a minimum force of 0.03 ± 0.07 N in the left direction when the distance between brackets was 9.0 mm, while a maximum of 1.3 ± 0.1 N when the distance between brackets was 15 mm in the right bracket. In the left bracket, minimum and maximum forces of 0.05 ± 0.06 and 0.98 ± 0.2 N were generated in the right direction, respectively. Mechanical data of the ISW have been collected in the study, which was previously difficult to perform owing to the low stiffness of the wire. It is suggested that the ISW can provide sufficient moments with the addition of V-bends to close the space by bodily movement.


Reduced Serotonin Transporter Levels and Inflammation in the Midbrain Raphe of 12 Month Old APPswe/PSEN1dE9 Mice.
Although mood and sleep disturbances are nearly universal among patients with Alzheimer's disease (AD), brain structures involved in non-cognitive processing remain under characterized in terms of AD pathology. This study was designed to evaluate hallmarks of AD pathology in the brainstem of the APPswe/PS1dE9 mouse model of familial AD. Fresh-frozen sections from female, 12 month old, transgenic and control B6C3 mice (n=6/genotype) were examined for amyloid burden and neurofibrillary alterations, by using 6E10 immunohistochemistry and the Gallyas silver stain, respectively. Serotonin transporter (SERT) densities in the dorsal and the median raphe were quantified by [3H]DASB autoradiography. SERT mRNA expression was measured by RT-PCR and visualized by in situ hybridization. Neuroinflammation was evaluated by immunohistochemical staining for microglia and astrocytes, and by measuring mRNA levels of the proinflammatory cytokines TNF-α, IL-1β and IL-6. No amyloid- and tau-associated lesions were observed in the midbrain raphe of 12 month old APPswe/PS1dE9 mice. SERT binding levels were reduced in transgenic animals compared to age-matched controls, and SERT mRNA levels were decreased by at least 50% from control values. Intense microglial, but not astrocytic immunoreactivity was observed in APPswe/PS1dE9 vs. wild-type mice. Levels of TNF-α mRNA were two-fold higher than control and correlated positively with SERT mRNA expression levels in transgenic animals. There was no amyloid accumulation and tau-associated pathology in the midbrain raphe of 12 month old APPswe/PS1dE9 mice. However, there was a local neuroinflammatory response with loss of serotonergic markers, which may partially account for some of the behavioral symptoms of AD.


Subcellular localization of prion proteins and the 37 kDa/67 kDa laminin receptor fused to fluorescent proteins.
The 37 kDa/67 kDa laminin receptor LRP/LR acts as a receptor for both PrPc and PrPSc at the cell surface. Here, we further analyzed the subcellular localization of fluorescent labeled prion protein (PrP) and laminin receptor (LRP/LR) molecules. We show that EGFP-PrP is localized at the cell surface and in a perinuclear compartment, respectively. In contrast, a DsRed-DeltaSP-PrP mutant lacking the signal peptide is almost exclusively found in the nucleus but does not colocalize with heterochromatin. Interestingly, LRP-DsRed efficiently colocalizes with EGFP-PrP in the perinuclear compartment and LRP-ECFP partly colocalizes with DsRed-DeltaSP-PrP in the nucleus, respectively. We conclude that the interactions of PrP and LRP/LR are not restricted to the cell surface but occur also in intracellular compartments suggesting a putative role of LRP/LR in the trafficking of PrP molecules.


Acute impact of moderate-intensity and vigorous-intensity exercise bouts on daily physical activity energy expenditure in postmenopausal women.
This study determined whether performing a single moderate- or vigorous-intensity exercise bout impacts daily physical activity energy expenditure (PAEE, by accelerometer). Overweight/obese postmenopausal women underwent a 5-month caloric restriction and moderate- (n = 18) or vigorous-intensity (n = 18) center-based aerobic exercise intervention. During the last month of intervention, in women performing moderate-intensity exercise, PAEE on days with exercise (577.7 ± 219.7 kcal·d(-1)) was higher (P = .011) than on days without exercise (450.7 ± 140.5 kcal·d(-1)); however, the difference (127.0 ± 188.1 kcal·d(-1)) was much lower than the energy expended during exercise. In women performing vigorous-intensity exercise, PAEE on days with exercise (450.6 ± 153.6 kcal·d(-1)) was lower (P = .047) than on days without exercise (519.2 ± 127.4 kcal·d(-1)). Thus, women expended more energy on physical activities outside of prescribed exercise on days they did NOT perform center-based exercise, especially if the prescribed exercise was of a higher intensity.


Parental experience of hypoglossal nerve stimulator implantation in adolescents with Down Syndrome and obstructive sleep apnea.
The purpose of this study is to explore the experience of parents in deciding whether to participate in a clinical trial of the insertion of the Hypoglossal Nerve Stimulator (HNS) to treat their adolescent with Down Syndrome (DS) and Obstructive Sleep Apnea (OSA). A qualitative descriptive design with interviews was used to gather parental experiences from those who consented to HNS for their adolescent with DS and OSA. Interviews were conducted, audiotaped, and transcribed. Basic content analysis was followed to interpret the data. Using a process of data debriefing/engagement, codes were generated, and field/reflective notes were used to assure trustworthiness of the data. Parents, 13 mothers/2 fathers, participated. Three themes were identified: Parents experience desperation about acceptance of standard of care for their adolescent with DS and OSA. This desperation led parents to seek information/insights from social media and they came to rely on those sites to explore options, ultimately leading them to HNS clinical trial. Finally, parents had a desire to share experience with HNS implantation. Parents described being desperate at acceptance of standards of care for OSA. They shifted reliance on experts and parents by searching social media pages to explore options for treatment of OSA. Parents wished to share experiences with the HNS implantation. Nurses play a role in preparing for the HNS by instructing/educating parents. Nurses can identify supportive social media sites for parents during the HNS decision and suggest ways to measure outcomes of HNS.


Secondary analysis of preoperative predictors for acute postoperative exacerbation in interstitial lung disease.
This study assessed whether perioperative management is associated with postoperative acute exacerbations (AEs) in interstitial lung disease (ILD) patients. Using secondary data from the study "Postoperative acute exacerbation of interstitial lung disease: a case-control study," we compared the perioperative clinical management of the AE and non-AE groups (1:4 case-control matching) selected by sex, year of surgery (2009-2011, 2012-2014, and 2015-2017), and multiple surgeries within 30 days. We compared 27 and 108 patients with and without AEs, respectively. Rates of one lung ventilation (OLV) cases (70 vs. 29%; OR, 5.9; 95%CI, 2.34-14.88; p < 0.001) and intraoperative steroid administration (48 vs. 26%; OR, 2.65; 95%CI, 1.11-6.33; p = 0.028), and average mean inspiratory pressure (9.2 [1.8] vs. 8.3 [1.7] cmH2O; OR, 1.36; 95%CI, 1.04-1.79; p = 0.026), were significantly higher in the AE group. There was a significant difference in OLV between the groups (OR, 4.99; 95%CI, 1.90-13.06; p = 0.001). However, the fraction of inspired oxygen > 0.8 lasting > 1 min (63 vs. 73%, p = 0.296) was not significantly different between the groups. OLV was significantly associated with postoperative AEs in patients with ILD undergoing both pulmonary and non-pulmonary surgeries. Thus, preoperative risk considerations are more important in patients who require OLV.


Malignant transformation initiated by Mll-AF9: gene dosage and critical target cells.
The pathways by which oncogenes, such as MLL-AF9, initiate transformation and leukemia in humans and mice are incompletely defined. In a study of target cells and oncogene dosage, we found that Mll-AF9, when under endogenous regulatory control, efficiently transformed LSK (Lin(-)Sca1(+)c-kit(+)) stem cells, while committed granulocyte-monocyte progenitors (GMPs) were transformation resistant and did not cause leukemia. Mll-AF9 was expressed at higher levels in hematopoietic stem (HSC) than GMP cells. Mll-AF9 gene dosage effects were directly shown in experiments where GMPs were efficiently transformed by the high dosage of Mll-AF9 resulting from retroviral transduction. Mll-AF9 upregulated expression of 192 genes in both LSK and progenitor cells, but to higher levels in LSKs than in committed myeloid progenitors.


Treatment strategy and long-term outcome in patients with deep lumbosacral arteriovenous fistulas. A single center analysis in nineteen patients.
Deep lumbosacral dural arteriovenous fistulas (lsDAVF) are rare and present serious diagnostic and treatment difficulties. In our current analysis we present our treatment strategy and the long-term clinical outcome of nineteen patients with lsDAVF. We retrospectively analyzed our radiological and medical records for patients presenting with SDAVF between 1990 and 2018 at the University Hospital Aachen. We identified twenty patients with a lsDAVF. All patients were treated surgically. One patient died of pulmonary embolism three months after treatment and was excluded from our outcome analysis. Clinical data at time of admission, discharge, one year after discharge and at the last follow-up were evaluated according to modified Aminoff-Logue disability score (AL-score) for this analysis. Mean age was 65 ± 7 years (median, 67; range, 53-78), sixteen patients (84 %) were male. After surgery, four patients developed a recurrent fistula in the same shunt zone and were re-treated microsurgically. Follow-up data one year after treatment was available in 15 patients. No relevant changes in AL-score were observed within this period. For the long-term follow-up analysis, data of 13 patients were available; 38.5 % of patients developed late functional deterioration. In our cohort, patients with deep lumbosacral dural arteriovenous fistula had a higher risk of early recurrence compared to patients with thoracolumbar SDAVF, with a considerable percentage of late functional deterioration. Thus strict clinical and radiologic long-term follow-up examinations are recommended in those patients.


Photosynthetic acclimation: structural reorganisation of light harvesting antenna--role of redox-dependent phosphorylation of major and minor chlorophyll a/b binding proteins.
In order to carry out photosynthesis, plants and algae rely on the co-operative interaction of two photosystems: photosystem I and photosystem II. For maximum efficiency, each photosystem should absorb the same amount of light. To achieve this, plants and green algae have a mobile pool of chlorophyll a/b-binding proteins that can switch between being light-harvesting antenna for photosystem I or photosystem II, in order to maintain an optimal excitation balance. This switch, termed state transitions, involves the reversible phosphorylation of the mobile chlorophyll a/b-binding proteins, which is regulated by the redox state of the plastoquinone-mediating electron transfer between photosystem I and photosystem II. In this review, we will present the data supporting the function of redox-dependent phosphorylation of the major and minor chlorophyll a/b-binding proteins by the specific thylakoid-bound kinases (Stt7, STN7, TAKs) providing a molecular switch for the structural remodelling of the light-harvesting complexes during state transitions. We will also overview the latest X-ray crystallographic and electron microscopy-derived models for structural re-arrangement of the light-harvesting antenna during State 1-to-State 2 transition, in which the minor chlorophyll a/b-binding protein, CP29, and the mobile light-harvesting complex II trimer detach from the light-harvesting complex II-photosystem II supercomplex and associate with the photosystem I core in the vicinity of the PsaH/L/O/P domain.


Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study.
This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. 984 patients (median age 84 years, IQR = 79-89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19-2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02-3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85-7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21-4.66, p < 0.001). POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.


Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores.
Bioelectrical impedance measurements were collected in the Third National Health and Nutrition Examination Survey (NHANES III), but their results have not been published. In the NHANES III population, resistance (R) and reactance (Xc) values at 50-kHz frequency were obtained with a Valhalla Scientific meter (model 1990B; San Diego, CA, USA). The RXc graph method was used to identify bivariate pattern distributions of mean vectors (95% confidence ellipses by sex, race, age, and body mass index [BMI]), and individual impedance vectors (50%, 75%, and 95% tolerance ellipses). Data from 10 222 adults (5261 men and 4961 women) formed 90 four-way classification groups, with two sexes, three races or ethnicities (non-Hispanic white, non-Hispanic black, Mexican American), five age classes (20-29, 30-39, 40-49, 50-59, and 60-69 y), and three BMI classes (19-24.9, 25-29.9, and 30-34.9 kg/m(2)). Sex, race or ethnicity, BMI and age, in decreasing order, influenced the vector distribution pattern. Mean vectors in women were significantly longer than those in men. Within each sex, the mean vector of non-Hispanic white subjects was shorter and with a smaller phase angle than that of corresponding BMIs from the two other race/ethnic populations. Tolerance ellipses were calculated from sex- and race-specific reference populations 20 to 69 y old and 19 < or = BMI < 30 kg/m(2) (8022 subjects, 4226 men and 3796 women). After transformation of impedance vector components into bivariate Z scores (standardized deviates, as differences from the mean divided by the standard deviation of the reference population), we constructed one standard, reference, RXc-score graph (50%, 75%, and 95% tolerance ellipses) that can be used with any analyzer in any population. The pattern of impedance vector distribution and reference bivariate intervals for the individual impedance vector are presented for comparative studies (free software at E-mail: firstname.lastname@example.com).


Hand rejuvenation with fat grafting: A 12-year single-surgeon experience.
Fat grafting has been successfully used for reconstructive and esthetic surgery of the breast, face, and other body parts. In this article, we present our protocol for hand fat grafting and over a decade of clinical experience. Fat tissue is obtained from the flanks, peri-umbilical region, or internal side of the thigh or knee. No centrifuge machine is used to prevent fat damage. After decantation, fat is injected into the dorsum of the hand using a cannula from the wrist and not from the fingers. Fat is distributed gently above the dorsal deep fascia to avoid perforation of the vessels. The proposed technique was applied to 65 patients. The amount of fat injected ranged from 10 to 30 cm3. No allergic reactions were noticed. Each patient's progress was followed-up for a minimum of 12 months. Over this period, contour changes and the effects of the procedure(s) on the skin were analyzed. Fifty-six patients (84%) were satisfied with the results during the observation period, 7 patients (12%) were somewhat satisfied and needed one more fat grafting procedure to achieve complete satisfaction, and 2 patients (4%) were dissatisfied with the results. Three cases of temporary swelling of the hands resolved naturally. No long-term complications were seen. This study covers over a decade of practical experience in applying fat grafts to hands. The procedure is effective in reshaping and rejuvenating the hand as it shows long-lasting results after 1-year follow-up.


The effects of testing environment, experimental design, and ankle loading on calibration to perturbed optic flow during locomotion.
Calibration is the process by which the execution of actions becomes scaled to the (changing) relationship between environmental features and the actor's action capabilities. Though much research has investigated how individuals calibrate to perturbed optic flow, it remains unclear how different experimental factors contribute to the magnitude of calibration transfer. In the present study, we assessed how testing environment (Experiment 1), an adapted pretest-calibration-posttest design (Experiment 2), and bilateral ankle loading (Experiment 3) affected the magnitude of calibration to perturbed optic flow. We found that calibration transferred analogously to real-world and virtual environments. Although the magnitude of calibration transfer found here was greater than that reported by previous researchers, it was evident that calibration occurred rapidly and quickly plateaued, further supporting the claim that calibration is often incomplete despite continued calibration trials. We also saw an asymmetry in calibration magnitude, which may be due to a lack of appropriate perceptual-motor scaling prior to calibration. The implications of these findings for the assessment of distance perception and calibration in real-world and virtual environments are discussed.