Evaluating a pilot, structured, face-to-face, antimicrobial stewardship, prospective audit-and-feedback program in emergency general surgery service in a community hospital.
Prospective audit and feedback (PAF) is an established practice in critical care settings but not in surgical populations. We pilot-tested a structured face-to-face PAF program for our acute-care surgery (ACS) service. This was a mixed-methods study. For the quantitative analysis, the structured PAF period was from August 1, 2017, to April 30, 2019. The ad hoc PAF period was from May 1, 2019, to January 31, 2021. Interrupted time-series segmented negative binomial regression analysis was used to evaluate change in antimicrobial usage measured in days of therapy per 1,000 patient days for all systemic and targeted antimicrobials. Secondary outcomes included C. difficile infections, length of stay and readmission within 30 days. Each secondary outcome was analyzed using a logistic regression or negative binomial regression model. For the qualitative analyses, all ACS surgeons and trainees from November 23, 2015, to April 30, 2019, were invited to participate in an email-based anonymous survey developed using implementation science principles. Responses were measured using counts. In total, 776 ACS patients were included in the structured PAF period and 783 patients were included in the in ad hoc PAF period. No significant changes in level or trend for antimicrobial usage were detected for all and targeted antimicrobials. Similarly, no significant differences were detected for secondary outcomes. The survey response rate was 25% (n = 10). Moreover, 50% agreed that PAF provided them with skills to use antimicrobials more judiciously, and 80% agreed that PAF improved the quality of antimicrobial treatment for their patients. Structured PAF showed clinical outcomes similar to ad hoc PAF. Structured PAF was well received and was perceived as beneficial by surgical staff.


Fusion versus Bryan Cervical Disc in two-level cervical disc disease: a prospective, randomised study.
In this prospective study, our aim was to compare the functional results and radiographic outcomes of fusion and Bryan Cervical Disc replacement in the treatment of two-level cervical disc disease. A total of 65 patients with two-level cervical disc disease were randomly assigned to two groups, those operated on with Bryan Cervical Disc replacement (31) and those operated on with anterior cervical fusion with an iliac crest autograft and plate (34). Clinical evaluation was carried out using the visual analogue scale (VAS), the Short Form 36 (SF-36) and the neck disability index (NDI) during a two year follow-up. Radiological evaluation sought evidence of range of motion, stability and subsidence of the prosthesis. Substantial reduction in NDI scores occurred in both groups, with greater percent improvement in the Bryan group (P = 0.023). The arm pain VAS score improvement was substantial in both groups. Bryan artificial cervical disc replacement seems reliable and safe in the treatment of patients with two-level cervical disc disease.


Validation of testicular germ cell tumor staging in nationwide cancer registries.
Nationwide cancer registries such as the National Cancer Database and Surveillance, Epidemiology, and End Results rely on accurate data from tumor registries to formulate hypotheses and report outcomes and treatment patterns. We evaluated the accuracy of our institutional registry for testicular germ cell tumors by comparing data abstracted by urologists with data abstracted by registry. We performed a retrospective review of patients receiving initial diagnosis and treatment for germ cell tumors at our hospital system from 2005 to 2016. We compared coding for American Joint Committee on Cancer TNMS staging, overall composite stage, and first-line treatment between urologists and tumor registry at the time of diagnosis. Paired staging from registry and urologist was available for 80 patients. T, N, M, and S-staging were accurate for 90%, 81%, 94%, and 54% of records, respectively. Composite staging and first-line treatment were concordant for 39% and 90% of patients, respectively. A separate review of 33 Stage IS patients per registry for composite staging revealed 15% concordance. Our institutional tumor registry had substantial inconsistencies in accurately staging N stage, S stage, and thus, composite stage for testicular cancer. An educational intervention to improve abstraction by registry led to increased concordance. Assuming similar discrepancies may exist at other institutions and for other cancer types, caution should be used when interpreting staging data in nationwide cancer registries. This sheds light on the need for improved clarification of staging guidelines, dynamic institutional internal auditing, and training reform within cancer registries.


Fluorine in the rocks and sediments of volcanic areas in central Italy: total content, enrichment and leaching processes and a hypothesis on the vulnerability of the related aquifers.
Rock, sediment and water samples from areas characterised by hydrothermal alterations in the Sabatini and Vico Volcanic Districts, near Rome and the large city of Viterbo, respectively, were collected and analysed to determine the total fluorine (F) content and to understand the F geochemical background level in the volcanic districts of central Italy. Leaching and alteration processes controlling the high concentration of F in water were also investigated. Fluorine concentrations were directly determined (potentiometrically) by an F selective electrode in water samples, while the procedure for rock samples included preliminary F dissolution through alkaline fusion. F concentrations higher than 800 mg kg(-1) were commonly found in the analysed rocks and sediments; the concentration depended on the lithology and on the distance from the alteration areas. A specific successive sampling campaign was conducted in three areas where the F content in sediments was particularly high; in the same areas, measurements of CO(2) flux were also performed to investigate the possible deep origin of F. To verify the relationships among the high F contents in rocks and sediments, the leaching processes involved and the presence of F in the aquifer, we also collected water samples in the western sector of the Sabatini Volcanic District, where hydrothermal manifestations and mineral springs are common. The data were processed using a GIS system in which the F distribution was combined with morphological and geological observations. The main results of our study are that (1) F concentrations are higher in volcanic and recently formed travertine (especially in hydrothermally altered sediments) than in sedimentary rocks and decrease with distance from hydrothermal alteration areas, (2) F is more easily leached from hydrothermally altered rocks and from travertine and (3) sediments enriched with F may indicate the presence of deep regional fractures that represent direct pathways of hydrothermal fluids from the crust to the surface.


Nursing with dignity. Part 6: Sikhism.
This article describes the main teachings and customs of Sikhism. It offers some guidelines to enable nurses to provide sensitive and appropriate nursing care to Sikh patients.


Pigment produced from Arcopilus aureus isolated from grapevines: Promising natural yellow colorants for the food industry.
Interest in the use of natural non-toxic pigments by the food industry has grown. Some filamentous fungi are producers of natural pigments that are more stable at temperature and pH than other pigments also classified as natural, such as those produced by plants. Production potential of natural pigments by endophytic fungi from grapevines was evaluated. Arcopilus aureus was selected as a potential source for a yellow pigment, which was characterized and tested for stability to variations in temperature and pH. Components, cochlioquinol II and riboflavin, were detected, which has not previously been reported in A. aureus. The pigment was stable and showed increased absorption at lower / acidic pH. These results provide information on the potential of this fungus and a yellow pigment for the first time, which can be used for further development and industrial application.


Association of genetic polymorphisms in IL-23R and IL-17A with the susceptibility to IgA nephropathy in a Chinese Han population.
IgA Nephropathy (IgAN) is one of the most common causes of chronic kidney damage worldwide. Identifying new genetic factors associated with IgAN risk is of invaluable importance. To explore the association between polymorphisms of IL-23R and IL-17A and the susceptibility of IgAN, 164 IgAN patients and 192 healthy controls were genotyped for five SNPs in a Chinese Han population. A comparative analysis between genotype distributions, clinical indexes and pathological grades in the IgAN patients was also performed. The GG genotype and a G allele of rs7517847 were associated with a decreased IgAN risk (OR: 0.545; 95% CI: 0.299-0.993; p = 0.046; OR: 0.730; 95% CI: 0.541-0.984; p = 0.039) compared to the TT genotype and T allele respectively. Furthermore, the AA genotype of rs2275913 appeared to reduce the IgAN risk (OR: 0.405; 95% CI: 0.209-0.786; p = 0.007) compared to the GG genotype. Consistently, individuals harboring an AA genotype had a lower IgAN risk (OR: 0.380; 95% CI: 0.211-0.686; p = 0.001) under the recessive model. Our study demonstrated for the first time the significant associations of rs7517847 in IL-23R and rs2275913 in IL-17A with the risk of IgAN in Chinese Han.


Oxytocin receptor antagonists. Update.
For over three decades, scientists in a number of different laboratories have worked to design peptide analogues of oxytocin (OT) selective for the oxytocin receptor. Although there has been some interest in their use for treatment of dysmenorrhea, the principal clinical venue for such agents has been thought to lie in treatment of preterm labor. A major difficulty in identifying the clinical role for an OT antagonist had been our incomplete understanding of the role of OT in both term and preterm labor. This article begins with a review of the current understanding of the role of OT in the initiation and maintenance of labor in the human.


Insights into Coronavirus Papain-like Protease Structure, Function and Inhibitors.
The coronavirus family consists of pathogens that seriously affect human and animal health. They mostly cause respiratory or enteric diseases, which can be severe and life-threatening, such as coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS), and Middle East Respiratory Syndrome (MERS) in humans. The conserved coronaviral papain-like protease is an attractive antiviral drug target because it is essential for coronaviral replication, and it also inhibits host innate immune responses. This review focuses on the latest research progress relating to the mechanism of coronavirus infection, the structural and functional characteristics of coronavirus papain-like protease, and the potent inhibitors of the protease.


Inhibition of lung metastasis by synthetic and recombinant fragments of human fibronectin with functional domains.
We have investigated the antimetastatic effect of synthetic or recombinant peptides containing the functional domains of fibronectin on experimental and spontaneous lung metastases of murine tumor cells. CS1 peptide which is present within type III homology connecting segment (IIICS) as well as C-274 (cell-binding domain) were able to inhibit experimental lung metastasis when co-injected intravenously (iv) with B16-BL6 melanoma cells, while H-271 (heparin-binding domain) could not. In the spontaneous metastasis model, multiple iv administrations of CS1 or C-274 after surgical excision of primary tumors caused a significant reduction of metastatic colonies in the lung. Both CS1 and C-274 significantly inhibited cell adhesion and migration to fibronectin-coated substrates when added freely in solution. CS1 peptide also inhibited the cell adhesion and migration to laminin-coated substrates, but C-274 did not. H-271 did not have any inhibitory effect on cell adhesion or migration to either of the substrates. Similarly, CS1 inhibited tumor invasion to both Matrigel/fibronectin- and Matrigel/laminin-coated filters, whereas C-274 inhibited the invasion to only Matrigel/fibronectin-coated filter. These results indicate that CS1 peptide of fibronectin, lacking the Arg-Gly-Asp-containing domain, actively inhibits tumor metastases in spontaneous and experimental metastasis models. The use of such a peptide might offer a promising therapeutic approach for combatting or preventing cancer metastasis.


The origin and development of the vagal and spinal innervation of the external muscle of the mouse esophagus.
Retrograde and anterograde tracing and immunohistochemical techniques were used to examine the origin of the extrinsic innervation, and the development of the vagal innervation to the mouse esophagus. Cholinergic nerve terminals were localised using an antiserum to the vesicular acetylcholine transporter and cholinergic cell bodies were localised using an antiserum to choline acetyltransferase. Cholinergic nerve terminals, which also contained calcitonin gene-related peptide, were present at the motor end plates in the external (striated) muscle of the esophagus. Following injection of Fast Blue into subdiaphragmatic or cervical levels of the esophagus, the only retrogradely-labelled cholinergic nerve cell bodies that also contained calcitonin gene-related peptide were found in the nucleus ambiguus. Neurons in the dorsal motor nucleus of the vagus, the nodose ganglia and dorsal root ganglia gave rise to a number of different types of nerve terminals within the myenteric plexus. Retrogradely-labelled neurons in the dorsal motor nucleus of vagus contained cholinergic markers only, nitric oxide synthase only or cholinergic markers plus nitric oxide synthase, retrogradely-labelled neurons in the dorsal root ganglia contained calcitonin gene-related peptide only, and a small number of retrogradely-labelled neurons in the nodose ganglia contained tyrosine hydroxylase. The development of the vagal innervation to the esophagus was examined following application of DiI to the vagus nerve of fixed mouse embryos. Anterogradely-labelled nerve fibres, which arose from both nodose ganglia and the medulla, were already present in the esophagus of embryonic day 12 (E12) mice. Some of the DiI-labelled vagal nerve fibres were present in among the smooth muscle cells of the external muscle layer prior to their transdifferentiation to striated muscle. We conclude that the neurons in the nucleus ambiguus that project to the esophagus differ from other extrinsic neurons in their chemistry as well as their targets within the esophagus. The development of the extrinsic innervation precedes the transdifferentiation of the external muscle to striated muscle, raising the possibility that, during development, smooth muscle of the esophagus is innervated transiently by vagal neurons.


Scale-up of two-step acid-catalysed glycerol pretreatment for production of oleaginous yeast biomass from sugarcane bagasse by Rhodosporidium toruloides.
Two-step dilute acid and acid-catalysed glycerol pretreatment was developed to maximise sugar yield from sugarcane bagasse. At the laboratory scale, dilute acid pretreatment at 130 °C followed by acid-catalysed glycerol pretreatment at 170 °C led to a total sugar (C5 + C6) yield of 82%, 31% higher than that from one-step acid-catalysed glycerol pretreatment. At the pilot scale, the two-step dilute acid and acid-catalysed glycerol pretreatment led to a maximum sugar yield of 74%, 13% higher than that from one-step pretreatment with 52% reduction in glycerol usage. The enzymatic hydrolysate containing glucose and residual glycerol were used to produce microbial oils by a Rhodosporidium toruloides strain. A fed-batch cultivation strategy led to the production of 44.8 g/L cell mass, including 26.6 g/L oil, 8.6 g/L protein and 12.7 mg/L carotenoid. The cell mass and oil yields were 19% higher than those from batch cultivation as feedstock inhibition and catabolite repression were alleviated.


Whole-body cryostimulation does not disturb the homeostasis of the system in physically active men - Pilot study.
Whole-body cryostimulation (W-BC) is commonly used following exercise to accelerate recovery or as a form of therapy to prevent and cure sports injuries. This study aimed to investigate the effect of a series of 24 W-BC sessions on morphological and rheological blood indicators in physically active men. Eighteen physically active men participated in the study (mean age 22.1 ± 0.07). They were divided into two groups depending on their self-reported levels of physical activity: moderate or high physical activity. The participants completed a total of 24 W-BC sessions every second day, over a span of two months. Blood was collected at baseline, immediately after and 24 h after the first treatment, before and after the 12th treatment, before, immediately after, and 24 h after the 24th treatment, and one, two, three, and four weeks after the 24th treatment. Rheological and morphological indicators of blood were examined. The number of leukocytes was decreased in the moderate activity group (p < 0.05) but not in the high intensity group, following the first W-BC session. There were no significant changes in elongation index (EI) at a shear stress of 2.19-31.04 (Pa) in both groups as well as at the following values: aggregation index (AI), the half time (T½) and the amplitude of aggregation (AMP) in both studied groups. Differences between the first and the 12th or the 24th session became apparent in some morphological indices in one or both groups. Changes in the morphological properties were not observed after the first exposure but became evident following repeated W-BC sessions.


Cell permeable BH3-peptides overcome the cytoprotective effect of Bcl-2 and Bcl-X(L).
Peptides corresponding to the BH3 domains of Bax (BaxBH3) or Bcl-2 (Bcl2BH3) are potent inducers of apoptosis when fused to the Atennapedia plasma membrane translocation domain (Ant). BaxBH3Ant and Bcl2BH3Ant caused a mitochondrial membrane permeabilization (MMP) and apoptosis, via a mechanism that was not inhibited by overexpressed Bcl-2 or Bcl-X(L), yet partially inhibited by cyclosporin A (CsA), an inhibitor of the mitochondrial permeability transition pore. When added to isolated mitochondria, BaxBH3 and Bcl2BH3 induced MMP, which was inhibited by CsA. However, Bcl-2 or Bcl-X(L) failed to inhibit MMP induced by BaxBH3 and Bc2BH3 in vitro, while they efficiently suppressed the induction of MMP by the Vpr protein (from human immunodeficiency virus-1), a ligand of the adenine nucleotide translocator (ANT). BaxBH3 but not Bcl2BH3 was found to interact with ANT, and only BaxBH3 (not Bcl2BH3) permeabilized ANT proteoliposomes and induced ANT to form non-specific channels in electrophysiological experiments. In contrast, both BaxBH3 and Bcl2BH3 were able to stimulate channel formation by recombinant Bax protein. Thus, BaxBH3 might induce MMP via an action on at least two targets, ANT and Bax-like proteins. In contrast, Bcl2BH3 would elicit MMP in an ANT-independent fashion. In purified mitochondria, two ligands of ANT, bongkrekic acid and the protein vMIA from cytomegalovirus, failed to prevent MMP induced by BaxBH3 or Bcl2BH3. In conclusion, BaxBH3 and Bcl2BH3 induce MMP and apoptosis through a mechanism which overcomes cytoprotection by Bcl-2 and Bcl-X(L).


Aging of signal transduction pathways, and pathology.
The major cell signaling pathways, and their specific mechanisms of transduction, have been a subject of investigation for many years. As our understanding of these pathways advances, we find that they are evolutionarily well-conserved not only individually, but also at the level of their crosstalk and signal integration. Productive interactions within the key signal transduction networks determine success in embryonic organogenesis, and postnatal tissue repair throughout adulthood. However, aside from clues revealed through examining age-related degenerative diseases, much remains uncertain about imbalances within these pathways during normal aging. Further, little is known about the molecular mechanisms by which alterations in the major cell signal transduction networks cause age-related pathologies. The aim of this review is to describe the complex interplay between the Notch, TGFbeta, WNT, RTK-Ras and Hh signaling pathways, with a specific focus on the changes introduced within these networks by the aging process, and those typical of age-associated human pathologies.


Training Internal Medicine Residents in Difficult Diagnosis: A Novel Diagnostic Second Opinion Clinic Experience.
In primary care clinics, time constraints and lack of exposure to highly complex cases may limit the breadth and depth of learning for internal medicine residents. To address these issues, we piloted a novel experience for residents to evaluate patients with puzzling symptoms referred by another clinician. To increase internal medicine residents' exposure to patients with perplexing presentations and foster a team-based approach to solving diagnostically challenging cases. During the academic year 2020-2021, residents participating in their 2-week primary care "block" rotation were given protected time to evaluate 1-2 patients from the Stanford Consultative Medicine clinic, an internist-led diagnostic second opinion service, and present their patients at the case conference. We assessed the educational value of the program with resident surveys including 5-point Lickert scale and open-ended questions. 21 residents participated in the pilot with a survey response rate of 66.6% (14/21). Both the educational value and overall quality of the experience were rated as 4.8 out of 5 (SD 0.4, range 4-5; 1:"very poor"; 5:"excellent"). Residents learned about new diagnostic tools as well as how to approach complex presentations and diagnostic dilemmas. Residents valued the increased time devoted to patient care, the team-based approach to tackling difficult cases, and the intellectual challenge of these cases. Barriers to implementation include patient case volume, time, and faculty engagement. Evaluation of diagnostically challenging cases in a structured format is a highly valuable experience that offers a framework to enhance outpatient training in internal medicine.


Real-time traceability of sorghum origin by soldering iron-based rapid evaporative ionization mass spectrometry and chemometrics.
Sorghum is an important grain with a high economic value for liquor production. Tracing the geographical origin of sorghum is vital to guarantee the liquor flavor. Soldering iron-based rapid evaporative ionization mass spectrometry (REIMS) combined with chemometrics was developed for the real-time discrimination of the sorghum's geographical origin. The working conditions of soldering iron-based ionization were optimized, and then the obtained MS profiling data were processed using chemometrics analysis methods, including principal component analysis-linear discriminant analysis and orthogonal projection to latent structures discriminant analysis (OPLS-DA). A recognition model was established, and discriminations of sorghum samples from 10 provinces in China were achieved with a correct rate higher than 90%. On the basis of OPLS-DA, the specific ions of m/z 279.2327, 281.2479, and 283.2639 had relatively strong discrimination power for the geographical origins of sorghum. The developed method was successfully applied in the discrimination of sorghum origins. The results indicated that the soldering iron-based REIMS technique combined with chemometrics is a useful tool for direct, fast, and real-time ionization of poor conductivity samples and acquisition of metabolic profiling data.


Anemia blunts the thermogenic response to environmental cold stress in newborn piglets.
We tested the hypothesis that isovolemic anemia blunts the thermogenic response to environmental cold stress in 3 to 4-day-old newborn piglets. Eight animals were studied in both thermoneutral (31.6-32.8 degrees C) and cold (19.6-20.2 degrees C) environments, before and after an isovolemic, partial volume exchange transfusion which reduced the hematocrit from 26 to 15%. In the nonanemic phase of study, deep rectal temperatures declined but had plateaued by 30 minutes after onset of cold stress and remained within normal limits for newborn piglets. In the anemic phase of study, deep rectal temperature declined continuously throughout cold stress with true body core hypothermia (less than 38 degrees C) observed at all measurement points beyond 15 min of cold stress. Baseline oxygen consumption did not differ between the two study phases (17.6 +/- 1.8 versus 16.7 +/- 2.1 ml/kg-1/min-1, mean +/- SEM). However, during environmental cold stress, oxygen consumption increased by 64% over baseline in the nonanemic phase of study (p less than 0.05) whereas 21% increase over baseline was observed in the anemic phase (p NS). We conclude that isovolemic anemia limited oxygen consumption and heat production during environmental cold stress, resulting in body core hypothermia.


First-derivative spectrophotometric and LC determination of cefuroxime and cefadroxil in urine.
Two methods are presented for the determination of cefuroxime and cefadroxil in human urine using first (1D) derivative spectrophotometry and high-performance liquid chromatography. Cefuroxime and cefadroxil were determined by measurement of their first-derivative amplitude in 0.1 N sodium hydroxide at 292.5 and 267.3 nm, respectively in the concentration range of 2-10 microg ml(-1) for each drug. The HPLC method depends upon using a LiChrospher 100 RP-18 (5 microm) column at ambient temperature for cefuroxime and 35 degrees C for cefadroxil with mobile phases consisting of water-acetonitrile-acetic acid (85:15:0.1 v/v) at a flow rate of 1.5 ml min(-1) for cefuroxime; and 0.02 M potassium dihydrogen phosphate-acetonitrile (95:5 v/v) containing 0.003% (w/v) hexanesulphonic acid sodium salt and adjusted to apparent pH 3 with phosphoric acid at a flow rate of 2 ml min(-1) for cefadroxil. Quantitation was achieved with UV detection at 275 and 260 nm for cefuroxime and cefadroxil, respectively, based on peak area with linear calibration curves at the concentration ranges of 2-10 microg ml(-1) for cefuroxime and 5-20 microg ml(-1) for cefadroxil. The proposed methods were applied to the determination of dissolution rate for tablets and capsules containing each drug. The urinary excretion patterns as the cumulative amounts excreted have been calculated for each drug using the proposed methods.


Review: WRKY transcription factors: Understanding the functional divergence.
WRKY transcription factors (TFs) play crucial roles in the growth and development of plants and their response to environmental changes. WRKY TFs have been detected in sequenced plant genomes. The functions and regulatory networks of many WRKY TFs, especially from Arabidopsis thaliana (AtWRKY TFs), have been revealed, and the origin of WRKY TFs in plants is clear. Nonetheless, the relationship between WRKY TFs function and classification is unclear. Furthermore, the functional divergence of homologous WRKY TFs in plants is unclear. In this review, WRKY TFs were explored based on WRKY-related literature published from 1994 to 2022. WRKY TFs were identified in 234 species at the genome and transcriptome levels. The biological functions of ∼ 71 % of AtWRKY TFs were uncovered. Although functional divergence occurred in homologous WRKY TFs, different WRKY TF groups had no preferential function.


Sensitivity to syntactic changes in garden path sentences.
The results of two text-change experiments are reported. The experiments were designed to investigate the syntactic representation of garden path sentences such as While the man hunted the deer that was brown and graceful ran into the woods, specifically the claim that a significant number of misinterpretations of such sentences are due to incomplete syntactic reanalysis (Christianson et al. Cogn Psychol 42:368-407, 2001). In the experiments reported here, the pronoun it was added (Expt. 1) or deleted (Expt. 2) from short texts containing such sentences. Participants were more or less likely to notice both deletions and additions of it in certain syntactic contexts, as predicted by the incomplete reanalysis account. Correlations with reading times support this interpretation of the results. Overall, the data are consistent with a "good enough" view of language processing (Ferreira et al. J Psycholinguist Res 30:3-20, 2001).


Pilot study comparing the leak pressure of the sleeved stomach with and without reinforcement.
Laparoscopic sleeve gastrectomy (LSG) consists of a longitudinal resection of the stomach on the greater curvature, removing 75-80% of the stomach approximately and creating a cylindrical "sleeve"-like conduit. However, LSG can be associated with significant morbidity, and staple-line failure with dehiscence and gastric leak is one of the most severe complications. The aim of this study was to compare three different methods of gastric closure in terms of staple-line strength and leak pressures of the sleeved stomach. After performing standard stapled sleeve gastrectomies, the gastric specimens were carefully retrieved. Group 1 specimens were left with the staple line intact. In group 2, the staple line was reinforced with a 3-0 polypropylene running suture. The gastric remnants of group 3 were those in which the LSG was performed using Seamguard as the buttressing material. The burst-pressure was assessed using a portable gas sensor. The outcome parameters were: age of the patients, body mass index, buttress material (suture, Seamguard, etc.), leak pressure, volume infused, and leak site, among others. Thirty-six sleeve gastrectomies were included in the final analysis. Each group consisted of 12 gastric specimens. There were no differences between groups in terms of age, sex, body mass index, and patient comorbidities. The leak pressure was significantly higher in group 2 (35 ± 11.7 vs. 102 ± 21.4 vs. 47 ± 19.1; p = <0.0005). The volume of liquid required to cause the leak was much greater in the group 3 (p = <0.001). Oversewing is the reinforcement method that increases better the staple-line strength. It is the least expensive method of reinforcement and does not increase operative times significantly.


Probiotic Properties of New Lactobacillus Strains Intended to Be Used as Feed Additives for Monogastric Animals.
The study aimed to evaluate the safety and probiotic properties of selected Lactobacillus strains, which are intended to be fed to monogastric animals. The Lactobacillus spp. appeared to be safe since they did not degrade mucus and did not exhibit β-haemolysis. Moreover, the survival of Caco-2 cells in the presence of metabolites of the selected strains was high, which also indicated their safety. The analysed strains showed moderate or strong antagonistic activity against Salmonella spp., Listeria monocytogenes, Campylobacter jejuni and Campylobacter coli, which was tested with the usage of the agar slab method. Furthermore, the strains showed high survivability in an acidic environment and the presence of bile salts (~90%). High resistivity or moderate susceptibility to antibiotics was also observed, as a result of the disc diffusion method. The strains were mostly moderately hydrophilic (hydrophobicity: 10.43-41.14%); nevertheless, their auto-aggregation capability exceeded 50% and their co-aggregation with pathogens varied between 12.12 and 85.45%. The ability of the selected strains to adhere to Caco-2 cells was also analysed; they were found to be moderately adhesive (85.09-95.05%) and able to hinder pathogens attaching to the cells (up to 62.58%). The analysed strains exhibit probiotic properties, such as high survivability and adherence to epithelial cells; therefore, they are suitable for administration to monogastric animals. Since the overuse of antibiotic growth promoters in livestock leads to the spread of antibiotic-resistant pathogens and accumulation of chemotherapeutic residues in food of animal origin, it is of vital importance to introduce alternative feed additives.


Female pelvic floor symptoms before and after bariatric surgery.
Obesity is a risk factor for female pelvic floor disorders. The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery. This was a prospective cohort study of female patients that underwent bariatric surgery. Patients completed a demographic questionnaire, the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) before surgery and at 6 and 12 months following surgery. Body mass index (BMI) was compared between time points using Student's t tests (P < 0.05 significant). Symptom and impact on quality of life prevalence were compared using McNemar's test and questionnaire scores were compared using the Wilcoxon matched pairs test (P < 0.025 significant). At 12 months after surgery, 63 patients had completed the study. Even with significant weight loss (BMI, 43.7 kg/m(2) to BMI, 29 kg/m(2); P < 0.001), there was no significant difference in the prevalence of pelvic floor symptoms before and after surgery (94% to 81%, P = 0.2). Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery (56% to 30%; P = 0.004). Baseline PFDI-20 and PFIQ-7 scores were low; however, there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery (P < 0.001). Prevalence of pelvic floor symptoms did not vary greatly after surgery; however, significant weight reduction did improve the degree of bother and quality of life related to these symptoms.


Laparoscopic and cystoscopic-assisted suprapubic catheter insertion: A case study and technical note.
To describe a new technique for suprapubic urinary catheterisation that can be used in selected patients with high anaesthetic risk, and previous lower abdominal surgery and bowel adhesions. In a 33-year-old woman, laparoscopic guidance with cystoscopic vision was used to ensure the safe passage of a suprapubic catheter. The suprapubic catheter was successfully inserted in this challenging patient; release of adhesions allowed for the passage of the catheter without bowel injury. Laparoscopic and cystoscopic-assisted suprapubic catheter insertion is a novel technique to avoid significant morbidity and mortality in selected patients with high anaesthetic risk, and previous lower abdominal surgery and bowel adhesions.


Mealtime resistance: Hispanic mothers' perspectives on making healthy eating changes within the family.
Several perceived barriers to healthy eating within the family (e.g., cost, lack of time, energy, accessibility) are documented. However, few studies have assessed Hispanic mothers' perceived barriers and strategies in implementing healthy eating changes in the family's meals. The primary goal of this qualitative study was to investigate Mexican and Puerto Rican mothers' barriers and strategies to creating healthy eating changes within the family at home. A sample of 46 Mexican-American and Puerto Rican mothers in California, Illinois, and Texas participated in this study. An average of 5 mothers participated in a focus group session in Spanish and completed a demographic survey. Focus group thematic analysis revealed that major barriers to implementing healthy eating changes within the family include child and spouse resistance as well as meal preparation time. The resistance mothers reported encountering magnify their meal preparation workload. Mothers shared that they sometimes prepared multiple meals in a single mealtime to please family members. Several strategies to promote healthy eating at home, including serving as role models, providing easy access to healthy food items at home, and not purchasing, or hiding, unhealthy food at home, were also discussed. The current study expands the existing literature by emphasizing the need to empower parents to make healthy changes within their family and the importance of taking fathers and children into account in programming so that the whole family is involved in making healthy changes.


Anti-Proliferative and Apoptotic Activities of Müllerian Inhibiting Substance Combined with Calcitriol in Ovarian Cancer Cell Lines.
This study aimed to investigate whether Müllerian inhibiting substance (MIS) in combination with calcitriol modulates proliferation and apoptosis of human ovarian cancer (OCa) cell lines (SKOV3, OVCAR3, and OVCA433) and identify the signaling pathway by which MIS mediates apoptosis. OCa cell lines were treated with MIS in the absence or presence of calcitriol. Cell viability and proliferation were evaluated using the Cell Counting Kit-8 assay and apoptosis was evaluated by DNA fragmentation assay. Western blot and enzyme-linked immunosorbent assay were used to determine the signaling pathway. The cells showed specific staining for the MIS type II receptor. Treatment of OCa cells with MIS and calcitriol led to dose- and time-dependent inhibition of cell growth and survival. The combination treatment significantly suppressed cell growth, down-regulated the expression of B-cell lymphoma 2 (Bcl-2), and up-regulated the expressions of Bcl-2 associated X protein, caspase-3, and caspase-9 through the extracellular signal-regulated kinase signaling pathway. These results, coupled with a much-needed decrease in the toxic side effects of currently employed therapeutic agents, provide a strong rationale for testing the therapeutic potential of MIS, alone or in combination with calcitriol, in the treatment of OCa.


Automated contingent reinforcement of correct posture.
This study evaluated the effectiveness of a mercury switch as a self-monitoring device to improve the sitting posture of an adult male. The participant in this study was a 31 year old man who was blind, nonambulatory, and who had been classified in the moderate range of intellectual functioning and in the severe range of adaptive functioning due to physical impairments. After determining that music practice and listening to a game show on the television channel of a radio were powerful reinforcers, a multiple baseline across the two reinforcing activities was implemented. The participant wore a mercury switch inside of a baseball cap which activated a Casio keyboard during music practice and a radio during the independent leisure activity of listening to a game show. During the treatment condition, the keyboard and radio were activated automatically by upright sitting posture. Results indicated that the participant's sitting posture increased from an average of almost 0% correct upright posture during baseline to an average of 52% during treatment.


Estrogen receptor in human benign prostatic hyperplasia.
Estrogens have been proposed as a major etiological factor in the pathogenesis of benign prostatic hyperplasia in man. The presence of estrogen receptor in benign prostatic hyperplasia would support this concept. Using the receptor stabilizer, sodium molybdate, and a hydroxylapatite assay we assayed human benign prostatic hyperplasia for the presence of cytosolic estrogen receptor. For comparison, we assayed estrogen receptor in cytosols of prostatic cancer and normal tissue, and we also measured androgen receptor and progesterone receptor concentrations in the 3 tissue types. Estrogen receptor was present in 8 of 15 benign prostatic hyperplasia specimens at a mean concentration of 9.2 fmol./mg. protein for the estrogen-receptor-positive samples. Sucrose gradient analysis of the estrogen receptor of benign prostatic hyperplasia revealed that it sedimented in the region of 8S, and steroid specificity studies confirmed that the binding to estrogen receptor was estrogen-specific. Estrogen receptor was also found in normal (3 of 3) and malignant (4 of 6) tissues, and all tissues were positive for androgen receptor. The presence of estrogen receptor in human benign prostatic hyperplasia supports the proposal that circulating estrogens may have a role in the pathogenesis of this disorder.


X-ray refinement study on the binding of cytidylic acid (2'-CMP) to ribonuclease A.
The X-ray structure of the inhibitor complex of bovine ribonuclease A with cytidylic acid (2'-CMP) has been determined at 2.3 A (1 A = 0.1 nm) resolution and refined by restrained least-squares refinement to R = 0.132 for 5650 reflections. Incorporation of the inhibitor molecule has occurred with little disturbance of the protein main-chain atoms, although significant displacement of some side-chain atoms has occurred, particularly in the region of the active site. The binding of 2'-CMP to ribonuclease A is different from that of the related cytidine-N(3)-oxide 2'-phosphate, which has an extra oxygen on N(3) of the cytidine base. The PO4(2-) group is held by hydrogen bond interactions to the side-groups of His 12, Glu 11 and His119. Thr45 is involved in stabilizing the enzyme-ligand complex by forming hydrogen bond interactions between O(gamma) and the pyrimidine base N(3) atom and between the main-chain N(45) and O(2) of the base. Phe120 is much closer to the inhibitor than in the cytidine N(3)-oxide 2'-phosphate structure.


Cytokine patterns in greenhouse workers occupationally exposed to α-cypermethrin: an observational study.
The immunotoxicity of the synthetic pyrethroid α-cypermethrin (αCYP) was assessed in 30 occupationally exposed greenhouse workers and 30 non-exposed controls by comparing plasma levels of IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, TNF-α, TNF-β and INF-γ. Urinary 3-phenoxybenzoic acid was used as an exposure biomarker. Exposed workers showed neither clinical signs of immunosuppression nor alterations in total leukocytes or leukocyte subpopulations, whereas significant differences (p<0.05) were found for IL-12p70 and highly significant differences (p<0.001) for INF-γ, IL-2 and IL-8, which are involved in antitumor immunity and response to infection. Proinflammatory cytokines IL-2, IL-8, IL-12p70 and IFN-γ play a significant role against infection and cancer. We report the first data on the ability of αCYP to reduce proinflammatory cytokine levels in an exposed healthy human population. Findings support the hypothesis that pyrethroid exposure may reduce host defenses against infection and cancer, particularly in subjects with impaired immune capacity.


The effects of oxalate treatment on the smear layer of ground surfaces of human dentine.
The layer was evaluated by scanning electron microscopy and by measurement of hydraulic conductance before and after 2-min topical treatment with potassium chloride, neutral potassium oxalate, half-neutralized oxalic acid or both neutral and acidic oxalates. The treated smear layers were then re-evaluated microscopically and functionally both before and after acid challenge. The layers treated with KCl were not altered either microscopically or functionally and were susceptible to acid etching. Dentine surfaces treated with either oxalate solutions became less permeable and were acid-resistant.


Eating disorder examination: Factor structure and norms in a clinical female pediatric eating disorder sample.
The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years.


Extraction and determination of elemental selenium in sediments--a comparative study.
This paper proposes a new technique to extract elemental Se from soil and sediment samples. In this study, we have identified that the purchased red elemental selenium standard (PF-Se) was impure and rather consisted of a mixture of CS2 soluble amorphous elemental Se (ca. 10%, w/w), water soluble oxidized Se (ca. 15-17%, w/w) and, CS2 insoluble red monoclinic elemental Se. In more recent studies, a slow oxidation and a mineral phase transition of this sample was also observed. The solubility of the amorphous elemental Se in CS2 was at least 0.64 mg L(-1). The black elemental Se purchased from Sigma-Aldrich had a much lower solubility in CS2 (7.2 microg mL(-1)) compared to that given in the literature. Any selenium compounds with electrical charge and polar nature is insoluble in CS2. In a sodium sulphite solution, PF-Se was completely dissolved thus giving a clear indication of the lack of selectivity in that extraction system. Other comparative studies also demonstrated that over extraction did occur with the Na2SO3 method. Compared to Na2SO3, CS2 extraction of elemental Se is not only much simpler, straightforward and with higher analytical precision, but also much more selective and accurate. With HG-AFS, the detection limit can reach as low as 1.0 ng g(-1) in sediment sample owing to a low reagent blank of CS2 solvent.


Instrumental set-up as a factor influencing the variability of retention index values in high pressure liquid chromatography.
The influence of different laboratory set-ups on HPLC retention index values of selected acidic and basic drugs was investigated. The RI values of drugs were calculated using the alkyrarylketone scale. Two columns filled with different batches of the same Hypersil ODS phase were consecutively used in two laboratories under identical conditions, but using different instrumentation. The study showed that the different laboratory set-ups influence the precision of RI values, and the differences in column filling affect the accuracy.


Low-density lipoprotein apheresis in the treatment of peripheral arterial disease.
Low-density lipoprotein (LDL) apheresis is performed in patients with homozygous familial hyper-cholesterolemia who lack LDL receptors and with heterozygous familial hypercholesterolemia who are LDL receptor deficient with documented, symptomatic coronary artery disease who are resistant to diet changes and maximum drug therapy. LDL apheresis can reduce or abolish anginal symptoms and improve coronary lesions. Several reports reveal the improvement of insufficient peripheral blood flow. By extensively removing blood LDL and changing coagulation factors and various vasoactive substances, LDL apheresis improves blood rheology and thereby peripheral circulation. It seems worth trying on all patients with arteriosclerotic lesions, even if they are normocholesterolemic.


Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial.
To our knowledge, this is the first placebo-controlled randomized clinical trial to evaluate the efficacy of antidepressant pharmacotherapy, with and without complicated grief psychotherapy, in the treatment of complicated grief. To confirm the efficacy of a targeted complicated grief treatment (CGT), determine whether citalopram (CIT) enhances CGT outcome, and examine CIT efficacy without CGT. Included in the study were 395 bereaved adults who met criteria for CG recruited from March 2010 to September 2014 from academic medical centers in Boston, Massachusetts; New York, New York; Pittsburgh, Pennsylvania; and San Diego, California. Co-occurring substance abuse, psychosis, mania, and cognitive impairment were exclusionary. Study participants were randomized using site-specific permuted blocks stratified by major depression into groups prescribed CIT (n = 101), placebo (PLA; n = 99), CGT with CIT (n = 99), and CGT with PLA (n = 96). Independent evaluators conducted monthly assessments for 20 weeks. Response rates were compared under the intention-to-treat principle, including all randomized participants in a logistic regression with inverse probability weighting. All participants received protocolized pharmacotherapy optimized by flexible dosing, psychoeducation, grief monitoring, and encouragement to engage in activities. Half were also randomized to receive manualized CGT in 16 concurrent weekly sessions. Complicated grief-anchored Clinical Global Impression scale measurments every 4 weeks. Response was measured as a rating of "much improved" or "very much improved." Of the 395 study participants, 308 (78.0%) were female and 325 (82.3%) were white. Participants' response to CGT with PLA vs PLA (82.5% vs 54.8%; relative risk [RR], 1.51; 95% CI, 1.16-1.95; P = .002; number needed to treat [NNT], 3.6) suggested the efficacy of CGT, and the addition of CIT did not significantly improve CGT outcome (CGT with CIT vs CGT with PLA: 83.7% vs 82.5%; RR, 1.01; 95% CI, 0.88-1.17; P = .84; NNT, 84). However, depressive symptoms decreased significantly more when CIT was added to treatment (CGT with CIT vs CGT with PLA: model-based adjusted mean [standard error] difference, -2.06 [1.00]; 95% CI, -4.02 to -0.11; P = .04). By contrast, adding CGT improved CIT outcome (CIT vs CGT with CIT: 69.3% vs 83.7%; RR, 1.21; 95% CI, 1.00-1.46; P = .05; NNT, 6.9). Last, participant response to CIT was not significantly different from PLA at week 12 (45.9% vs 37.9%; RR, 1.21; 95% CI, 0.82-1.81; P = .35; NNT, 12.4) or at week 20 (69.3% vs 54.8%; RR, 1.26; 95% CI, 0.95-1.68; P = .11; NNT, 6.9). Rates of suicidal ideation diminished to a substantially greater extent among participants receiving CGT than among those who did not. Complicated grief treatment is the treatment of choice for CG, and the addition of CIT optimizes the treatment of co-occurring depressive symptoms. clinicaltrials.gov Identifier: NCT01179568.


Descriptive study of the general practitioners' perception of direct oral anticoagulants and the risk of genital bleeding in women of childbearing age.
Direct oral anticoagulants (DOA) tend to replace antivitamins K (VKA). The incidence of major and minor hemorrhages is higher in women, a difference potentially linked to genital hemorrhages. The objective is to assess the practices and perception of general practitioners of the use of oral anticoagulant therapy in women of childbearing age. Descriptive, observational, transversal and monocentric study. An 11-items questionnaire was sent to 900 randomized general practitioners, assessing the type of patient, the type of anticoagulant prescribed, the management of genital bleeding, and the assessment of the quality of life of anticoagulated patients. DOA were the most prescribed anticoagulants. Genital hemorrhage was the second leading cause of minor hemorrhage. Most doctors (60.6%) believed they were due to VKAs. 25% reported an alteration in the quality of life of patients following these genital hemorrhages and 47.5% addressed this subject in consultation. Our study suggests that, according to the general practitioners interviewed, genital hemorrhage is more frequent on VKA than on DOA in women of reproductive age, which is contradictory with the data in the literature. The probably taboo subject is rarely mentioned in consultation and is responsible for a deterioration in the quality of life in these young patients. No recommendation exists on the management of this type of genital hemorrhage in these women. An algorithm is proposed for their management.


Urinary Concentrations of Metals and Metalloids in Malaysian Adults.
Exposure to environmental pollutants in humans can be conducted through direct measurement of biological media such as blood, urine or hair. Assessment studies of metals and metalloids in Malaysia is very scarce although cross-sectional nationwide human biomonitoring surveys have been established by the USA, Canada, Germany, Spain, France, and Korea. This study aims to assess urinary metal levels namely cadmium (Cd), nickel (Ni), lead (Pb) and arsenic (As) among Malaysian adults. This was a cross-sectional study involving 1440 adults between the age of 18 and 88 years old. After excluding those with 24 h urine samples of less than 500 ml, urine creatinine levels < 0.3 or > 3.0 g/L and those who refuse to participate in the study, a total of 817 respondents were included for analysis. A questionnaire with socio-demographic information such as age, gender, occupation, ethnic, academic qualification and medical history was administered to the respondents. Twenty-four-hour urine samples were collected in a container before being transported at 4 °C to the laboratory. Samples were then aliquoted into 15 ml tubes and kept at - 80 °C until further analysis. Urine was diluted ten-fold with ultrapure water, filtered and analysed for metals and metalloids using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The geometric mean of urinary As, Ni, Cd and Pb concentrations among adults in Malaysia was 48.21, 4.37, 0.32, and 0.80 µg/L, respectively. Males showed significantly higher urinary metal concentrations compared to females for As, Cd and Pb except for Ni. Those who resided in rural areas exhibited significantly higher As, Cd and Pb urinary concentrations than those who resided in urban areas. As there are no nationwide data on urinary metals, findings from this study could be used to identify high exposure groups, thus enabling policy makers to improve public health strategically.


Assessment of Serum Zn, Cu, Mn, and Fe Concentration in Women with Endometrial Cancer and Different Endometrial Pathologies.
There is conflicting evidence on the effect of specific micronutrient concentration and cancer risk. In this study, we investigated the differences in serum zinc, copper, iron, and manganese levels and different endometrial pathologies, including endometrial cancer. 110 patients with a confirmed diagnosis of endometrial cancer, benign uterine conditions (endometrial polyp, endometrial hyperplasia, uterine myoma), or normal endometrium were included in the study and assessed in terms of endometrial cancer risk factors. The measurements of serum micronutrients were conducted using inductively coupled plasma optical emission spectrometry. When assessing for differences between serum concentrations of trace metals, we found significant differences in the distribution of Mn (p < 0.001) and Fe (0.034). There was also a significant difference in Cu/Zn ratio between the analyzed groups (p = 0.002). Patients' BMI was found to influence Cu concentration, with obese patients having higher mean copper concentration (p = 0.006). Also, patients' menopausal status was shown to influence Cu concentration with postmenopausal patients having higher Cu levels (p = 0.001). The menopausal status was found to influence Cu/Zn ratio (p = 0.002). Univariable regression analysis did not confirm that any of the micronutrients significantly influence the risk of endometrial cancer. The concentration of specific trace metals varies between different histopathological diagnoses of endometrial pathologies. Menopausal status and patient BMI are endometrial cancer risk factors impacted by the concentrations of Cu and Zn and their ratio.


Developmental and insecticide-resistant insights from the de novo assembled transcriptome of the diamondback moth, Plutella xylostella.
We present here the de novo assembly and annotation of the transcriptome of Plutella xylostella (diamondback moth (DBM)), a widespread destructive pest of cruciferous plants, using short reads generated by Illumina sequencing from different developmental stages and insecticide-resistant strains. A total of 171,262 non-redundant sequences, denoted as unigenes, were obtained. They represented approximately 100-fold of all DBM mRNA and EST sequences in GenBank thus far. We identified 38,255 unigenes highly similar to the known functional protein-coding genes, most of which were annotated using gene ontology (GO) and orthologous groups of proteins (COG). Global profiling of differentially expressed unigenes revealed enriched GOs and biological pathways that were related to specific developmental stages and insecticide resistance. We also evaluated the resistance-related single nucleotide polymorphism (SNP) using this high-throughput genotyping method. The newly developed transcriptome will facilitate researches on the DBM developmental biology and insecticide resistance evolution, and ultimately provide better pest management systems.


HLA-D typing with homozygous lymphoblastoid cell lines.
Lymphoblastoid cell lines (LCL) was established from peripheral blood lymphocytes (PBL) of 2 HLA-DW 3 homozygous siblings. HLA-D typing was performed with the homozygous LCL and PBL in a group of 51 unrelated individuals selected according to their HLA-A,B locus antigens. All the individuals who were typed positive for DW3 with PBL typing cells could also be typed positive with the LCL typing cells. Both homozygous LCL behave very similarly in the tested population. These experiments showed that the same HLA-D determinants were represented both on LCL and PBL cells and that LCL derived from MLC homozygous donors can be used for HLA-D typing.


A validated micellar electrokinetic chromatography method for the quantitation of dexamethasone, ondansetron and aprepitant, antiemetic drugs, in organogel.
A micellar electrokinetic chromatography (MEKC) method was developed for the determination of three anti-vomiting drugs (aprepitant, dexamethasone and ondansetron) in pharmaceutical formulations. The method was optimized using a central composite design (CCD). Four main factors (borate buffer concentration, pH, methanol content and sodium dodecyl sulfate concentration) were optimized in order to obtain best resolutions and peak efficiencies in a minimum runtime. The separation was performed in a fused-silica capillary. After optimization, the background electrolyte consisted of a borate buffer (62.5mM, pH 8.75) containing sodium dodecyl sulfate (77.5mM) and methanol (3.75%). Under these conditions, a complete separation of each antiemetic drug and its respective internal standards was achieved in 38min. The method was validated with trueness values from 94.9 to 107.2% and precision results (repeatability and intermediate precision) lower than 5.9%. MEKC-UV was the first method allowing the separation of aprepitant, dexamethasone and ondansetron and was suitable for the quantitation of these three antiemetic drugs in organogel formulations. The rapid sample preparation coupled with an automated separation technique make this method convenient for quality control of extemporaneous magistral ready-to-use formulation.


Behavioral specificity of non-genomic glucocorticoid effects in rats: effects on risk assessment in the elevated plus-maze and the open-field.
The rapid effects of glucocorticoids on various behaviors suggest that these hormones play a role in rapidly coping with challenging situations. The variety of behaviors affected in different situations raise, however, questions regarding the specificity and roles of glucocorticoids in controlling behavior. To clarify this issue, we assessed the rapid behavioral effects of glucocorticoids in the elevated plus-maze (EPM) and the open-field (OF) tests in male rats. Both tests measure three different kinds of behavioral responses: locomotion, anxiety-like behaviors (central area and open arm exploration in the OF and EPM tests, respectively), and risk assessment (investigating aversive areas in a stretched attend posture). The acute inhibition of glucocorticoid synthesis by metyrapone decreased risk assessment but did not affect locomotion and anxiety-like behaviors. Corticosterone administration increased risk assessment, without affecting locomotion and anxiety-like behaviors. Moreover, plasma corticosterone levels measured immediately after testing strongly correlated with the intensity of risk assessment. The effects of corticosterone were rapid, as occurred even when the hormone was injected 2 min before behavioral testing. In addition, the effect was resistant to protein synthesis inhibition. These data demonstrate that glucocorticoids are able to increase specifically risk assessment behaviors by non-genomic mechanisms in two different, novelty-related, non-social challenging situations. Thus, glucocorticoids appear to rapidly induce specific behavioral adjustments to meet immediate requirements set by the challenge. These data support earlier assumptions on the role of glucocorticoids in coping, and it can be hypothesized that the rapid activation of the HPA-axis may play a role in forming coping responses.


Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial.
A robotic platform has enabled extremely low-pressure pneumoperitoneum (ELPP, 4 mmHg) to reduce surgical insults to human physiology during a minimally invasive surgery. The objective of this study was to investigate the effect of ELPP in single-site robotic cholecystectomy (SSRC) on postoperative pain, shoulder pain, and physiological changes during surgery compared to a standard pressure pneumoperitoneum (SPP, 12-14 mmHg). A total of 182 patients who underwent an elective cholecystectomy were randomized into an ELPP SSRC group (n = 91) and an SPP SSRC group (n = 91). Postoperative pain was assessed at 6, 12, 24, and 48 h after surgery. The number of patients complaining of shoulder pain was observed. Intraoperative changes of ventilatory parameters were also measured. Postoperative pain scores (p = 0.038, p < 0.001, p < 0.001, and p = 0.015 at 6, 12, 24, and 48 h after surgery, respectively) and the number of patients with shoulder pain (p <0.001) were significantly lower in the ELPP SSRC group than in the SPP SSRC group. Intraoperative changes in peak inspiratory pressure (p < 0.001), plateau pressure (p < 0.001), EtCO2 (p < 0.001), and lung compliance (p < 0.001) were also less in the ELPP SSRC group. The ELPP during robotic cholecystectomy could significantly relieve postoperative pain and shoulder pain. In addition, the ELPP can reduce changes in lung compliance during surgery and the demand for postoperative analgesics, thereby improving the quality of life of patients during early stages of postoperative rehabilitation.


Latest chemical peel innovations.
For decades, chemical peels have remained a trusted option for treatment of aging facial skin. However, emerging technologies are being adopted by many practitioners who may not have had sufficient opportunity to learn the art of chemical peeling. Properly performed peels can improve the condition of the skin, are less expensive than light-based machines, and exfoliate the skin without the thermal damage associated with light-based machines. This article presents a new variation of a trusted method, using a series of low-strength trichloroacetic acid peels and proper skin preparation that is cost-effective and produces excellent results in selected patients.


Uptakes and uses of oxygen, from gametes to maturity: an overview.
How do rates of oxygen uptakes per unit of body weight change with age in mammals? Marked increases occur, starting on the third day after fertilization; small increases occur just after birth. At birth the factor of body size of the species has a small influence. In the old adult the diminished uptake per unit weight resembles that of the newly fertilized zygote. Special roles of RNA and of mitochondria determine the uses to which energy is put. Anaerobic energy is and can be employed temporarily in embryonic stages. Sensitivities to energy demands are revealed in effects of hypoxia, hyperoxia, low temperatures and norepinephrine. Uses of energy for biosyntheses and active transports change during ontogeny; and differ among the tissues. Strategies of development, and their sequences, appear to supply adequate oxygen throughout prenatal stages.


Antigenic variation of Newcastle disease viruses isolated from wild ducks in Japan.
Nineteen strains of Newcastle disease virus (NDV) isolated from wild ducks in Japan were placed into 4 distinct antigenic groups on the basis of their reactivities to 8 monoclonal antibodies against the HN molecule of NDV in hemagglutination inhibition tests. The NDV strains of duck origin were antigenically distinct from NDV-B1 and NDV-Miyadera originated from chickens, and varied in their virulence to chicken embryos. No apparent correlation was found between the antigenicity of the HN molecule and virulence.


Foraging activity of two species of predatory leeches exposed to active and sedentary prey.
The foraging activity of the freshwater leeches Nephelopsis obscura and Erpobdella punctata during acclimation to active or sedentary prey, starvation and refeeding was examined by filming over a 24 h cycle. For both species, the time of activity of individual leeches and the total number of leeches active were significantly correlated. Activity in the dark was significantly higher than in the light with the activity of N. obscura in the dark 16.2 times higher in terms of time and 6.7 times higher in terms of numbers of individuals moving than E. punctata. Large N. obscura were significantly more active than medium or small individuals and encountered more sedentary prey. With lower levels of activity E. punctata encounters and feeds on more active prey, and in lotic ecosystems its lower exposure to fish predation and drift is, at least partially, responsible for its numerical abundance over N. obscura. There were no significant differences in the activity of N. obscura or E. punctata fed on active or sedentary prey during either subsequent starvation of 1 to 10 d, or after refeeding, suggesting that unchanged foraging activity provides the optimun net energy gain during periods of change in prey type and availability.


Administration of histidine to female rats induces changes in oxidative status in cortex and hippocampus of the offspring.
Histidinemia is an inherited metabolic disorder biochemically characterized by high concentrations of histidine in biological fluids. Usually affected patients are asymptomatic although some individuals have mental retardation and speech disorders. Considering the high prevalence of histidinemia and the scarce information on the effects of maternal histidinemia on their progeny, we investigated various parameters of oxidative stress in brain cortex and hippocampus of the offspring from female rats that received histidine (0.5 mg/g of body weight) in the course of pregnancy and lactation. At 21 days of age we found a significant increase of thiobarbituric acid reactive substances (TBARS), 2',7'-dihydrodichlorofluorescein oxidation, superoxide dismutase (SOD) activity, catalase (CAT) activity, total sulfhydryls and glutathione (GSH) content in cerebral cortex and hippocampus. We also verified that at 60 days of age, GSH, SOD and total sulfhydryls returned to normal levels in brain cortex, while the other parameters decreased in the same structure. In the hippocampus, at 60 days of age GSH returned to normal levels, CAT persisted elevated and the other parameters decreased. These results indicate that histidine administration to female rats can induce oxidative stress in the brain from the offspring, which partially recovers 40 days after breastfeeding stopped.


Faculty and nursing staff experiences and perceptions of nursing students' clinical placements in residential aged care facilities: a qualitative systematic review protocol.
The objective of this review is to synthesize evidence on the experiences and perceptions of faculty and staff nurses toward nursing students' clinical placements in residential aged care facilities. Nursing education plays an important role in preparing students to provide quality care to older adults. Recent reports suggest that nursing programs across the globe are championing the integration of content on the care of older adults into their curricula as well as recognizing the value of clinical placements that focus exclusively on care for older adults, such as in residential aged care facilities. Student experiences in residential aged care facilities can play a significant role in helping shape professional identity as well as how the setting is viewed. Student interactions with nursing faculty and staff in the residential care learning environment are both recognized as being influential in this process. This review seeks to explore faculty and staff experiences and perceptions of nursing student placements in such facilities. This review will consider qualitative studies that address the experiences and perceptions of faculty and staff nurses who work with nursing students in residential aged care facilities. Studies published in English and from 1995 onward will be sought. Two reviewers will independently appraise studies and extract qualitative data using the JBI standardized critical appraisal and extraction instruments. Findings from the review will be categorized according to similarity in meaning, and categories subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings.


Activity coefficients of intracellular Na+ and K+ during development of frog oocytes.
The chemical activities, (a), of Na+ and K+ were determined in large mature and in small immature frog oocytes, using open-tipped micropripettes and ion-selective microelectrodes. The average chemical concentrations, c, of Na+ and K+ were determined by spectrophotometry and by electron probe X-ray microanalysis. The apparent activity coefficient (gammaapp) was calculated for each ion as the ratio, a/c. With development, (aNa/ak) decreased four to fivefold and (cNa/cK) increased six to sevenfold. In the large mature oocytes, gammaapp was measured to be 0.08 +/- 0.02 and gammaappK lay within the range 1.15 +/- 0.03 to 1.29 +/- 0.04, constituting the smallest value for Na+ and largest value for K+, respectively, thus far reported. This intracellular value of gammaappK was substantially greater than the activity coefficient of K+ in the external medium (0.76). The data suggest that the inequality of gammaappNa and gammaappK in this and probably other cells reflects the development of subcellular compartmentalization of ions. Possible intracellular sites of ionic compartmentalization are considered.


Reduced Bone Mass and Increased Osteocyte Tartrate-Resistant Acid Phosphatase (TRAP) Activity, But Not Low Mineralized Matrix Around Osteocyte Lacunae, Are Restored After Recovery From Exogenous Hyperthyroidism in Male Mice.
Hyperthyroidism causes secondary osteoporosis through favoring bone resorption over bone formation, leading to bone loss with elevated bone fragility. Osteocytes that reside within lacunae inside the mineralized bone matrix orchestrate the process of bone remodeling and can themselves actively resorb bone upon certain stimuli. Nevertheless, the interaction between thyroid hormones and osteocytes and the impact of hyperthyroidism on osteocyte cell function are still unknown. In a preliminary study, we analyzed bones from male C57BL/6 mice with drug-induced hyperthyroidism, which led to mild osteocytic osteolysis with 1.14-fold larger osteocyte lacunae and by 108.33% higher tartrate-resistant acid phosphatase (TRAP) activity in osteocytes of hyperthyroid mice compared to euthyroid mice. To test whether hyperthyroidism-induced bone changes are reversible, we rendered male mice hyperthyroid by adding levothyroxine into their drinking water for 4 weeks, followed by a weaning period of 4 weeks with access to normal drinking water. Hyperthyroid mice displayed cortical and trabecular bone loss due to high bone turnover, which recovered with weaning. Although canalicular number and osteocyte lacunar area were similar in euthyroid, hyperthyroid and weaned mice, the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL)-positive osteocytes was 100% lower in the weaning group compared to euthyroid mice and the osteocytic TRAP activity was eightfold higher in hyperthyroid animals. The latter, along with a 3.75% lower average mineralization around the osteocyte lacunae in trabecular bone, suggests osteocytic osteolysis activity that, however, did not result in significantly enlarged osteocyte lacunae. In conclusion, we show a recovery of bone microarchitecture and turnover after reversal of hyperthyroidism to a euthyroid state. In contrast, osteocytic osteolysis was initiated in hyperthyroidism, but its effects were not reversed after 4 weeks of weaning. Due to the vast number of osteocytes in bone, we speculate that even minor individual cell functions might contribute to altered bone quality and mineral homeostasis in the setting of hyperthyroidism-induced bone disease. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).


p53 at the crossroads between cancer and neurodegeneration.
Aging, dementia, and cancer share a critical set of altered cellular functions in response to DNA damage, genotoxic stress, and other insults. Recent data suggest that the molecular machinery involved in maintaining neural function in neurodegenerative disease may be shared with oncogenic pathways. Cancer and neurodegenerative diseases may be influenced by common signaling pathways regulating the balance of cell survival versus death, a decision often governed by checkpoint proteins. This paper focuses on one such protein, p53, which represents one of the most extensively studied proteins because of its role in cancer prevention and which, furthermore, has been recently shown to be involved in aging and Alzheimer disease (AD). The contribution of a conformational change in p53 to aging and neurodegenerative processes has yet to be elucidated. In this review we discuss the multiple functions of p53 and how these correlate between cancer and neurodegeneration, focusing on various factors that may have a role in regulating p53 activity. The observation that aging and AD interfere with proteins controlling duplication and cell cycle may lead to the speculation that, in senescent neurons, aberrations in proteins generally dealing with cell cycle control and apoptosis could affect neuronal plasticity and functioning rather than cell duplication.


One-stop clinic for patients with suspected ovarian cancer: results from a retrospective outcome study of the referral pathway.
Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. This was a retrospective observational outcome study. Data were collected from electronic documents of patients' referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years. 286 were referred from primary care according to the NICE guidelines of '2-week wait for ovarian cancer'. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above. One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.


Antibodies to cell surface ganglioside GD3 perturb inductive epithelial-mesenchymal interactions.
Most epithelial sheets emerge during embryogenesis by a branching and growth of the epithelium. The surrounding mesenchyme is crucial for this process. We report that branching morphogenesis and the formation of a new epithelium from the mesenchyme in the embryonic kidney can be blocked by a monoclonal antibody reacting with a surface glycolipid, disialoganglioside GD3. In contrast, a more than 10-fold excess of antibodies to adhesive glycoproteins (N-CAM, L-CAM, fibronectin) fails to inhibit morphogenesis. Although the anti-GD3 antibody affected epithelial development, the disialoganglioside GD3 was expressed not in the epithelium, but in the mesenchyme surrounding the developing epithelia. The data raise the intriguing possibility that the anti-GD3 antibody inhibits epithelial development by interfering with epithelial-mesenchymal interactions.


A Brief History behind the journal Genetic Epidemiology and the International Genetic Epidemiology Society.
This commentary briefly describes the process and steps that underlie the launching of the journal Genetic Epidemiology in 1984 and the International Genetic Epidemiology Society (IGES, to be pronounced as "I guess") in 1992.


Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries.
Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. PROSPERO- CRD42020167890 .


Development of an oral nanotherapeutics using redox nanoparticles for treatment of colitis-associated colon cancer.
Oral chemotherapy is the preferred treatment for colon cancer. However, this strategy faces many challenges, including instability in the gastrointestinal (GI) tract, insufficient bioavailability, low tumor targeting, and severe adverse effects. In this study, we designed a novel redox nanoparticle (RNP(O)) that is an ideal oral therapeutics for colitis-associated colon cancer treatment. RNP(O) possesses nitroxide radicals in the core, which act as reactive oxygen species (ROS) scavengers. Orally administered RNP(O) highly accumulated in colonic mucosa, and specifically internalized in cancer tissues, but less in normal tissues. Despite of long-term oral administration of RNP(O), no noticeable toxicities were observed in major organs of mice. Because RNP(O) effectively scavenged ROS, it significantly suppressed tumor growth after accumulation at tumor sites. Combination of RNP(O) with the conventional chemotherapy, irinotecan, led to remarkably improved therapeutic efficacy and effectively suppressed its adverse effects on GI tract. Therefore, RNP(O) is promising oral nanotherapeutics for cancer therapies.


The influence of penicillin on experimental wound contamination with staphylococci: studies with chromic catgut and monofilament nylon closure.
This study examines the ability of penicillin to eradicate or modify the pattern of infection in experimental wounds contaminated with Staphylococcus pyrogenes in the presence of chromic catgut or monofilament nylon suture. Penicillin therapy initiated within 4 days of the onset of infection was successful in eradicating infection when compared with untreated controls (P less than 0-01). Infection was modified but not eradicated in penicillin was administered from the seventh day. The response of infection to penicillin was identical in wounds containing monofilament nylon or chromic catgut over a 21-day period. Antibiotics given before wound drainage permitted healing of all chronically infected wounds even in the presence of monofilament nylon. When antibiotics were begun at the time of drainage, wound healing occurred in 50 per cent (P less than 0-01).


Toward a national emission inventory for the catering industry in China.
Catering oil fumes are a major hazard to human health. In particular, the typical Chinese cooking style is characterised by a high temperature frying process that produces high levels of cooking oil fumes. However, limited data relating to this sector mean that national emission inventory data specific to the catering service industry do not exist. To address above deficiency and thus to establish the inventory of a city, or a province, or even a country, a door-to-door survey campaign was launched in the Chinese cities of Heze and Linfen to determine the structure of local catering industries. Data revealed that the number of catering businesses per 104 people was 17 ± 4. Of these, 3.0 ± 1.4, 15.0 ± 1.4, and 82.0 ± 0.0% were classified as large, medium, and small enterprises, respectively. Furthermore, the installation rates of fume purifiers were 74 ± 13, 66 ± 9, and 51 ± 14% for large, medium, and small enterprises, respectively, with net removal efficiencies of 63 ± 11, 50 ± 7, and 31 ± 8%, respectively. This information was extrapolated across all provincial regions of China to construct a provincial and national emission inventory. In 2017, China's national catering industry released approximately 34 kt of volatile organic compounds (VOCs), 38 kt of particulate matter with a diameter less than 2.5 μm (PM2.5), 48 kt of particulate matter with a diameter less than 10 μm (PM10), 1 kt of black carbon (BC), and 27 kt of organic carbon (OC). A significant correlation was observed between vegetable oil consumption and emissions (e.g., for VOCs, y = 14.94 x + 76.50, R2 = 0.87, where y is VOCs emissions and x is vegetable oil consumption), indirectly corroborating the rationality of the inventory. Moreover, this correlation provides the potential for a dynamic inventory based on vegetable oil consumption. Future studies are proposed to address more influential factors to improve the reliability of the national inventory and refer to big data, rather than door-to-door investigation, to identify the amount of catering service businesses in a region.


All-inside arthroscopic modified Broström-Gould procedure for chronic lateral ankle instability with and without anterior talofibular ligament remnant repair produced similar functional results.
The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure. This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group. There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI. III.


The measurement of the β/α anomer composition within amorphous lactose prepared by spray and freeze drying using a simple (1)H-NMR method.
Reports of the anomeric composition of amorphous lactose are rare and state a highly variable range of composition (between 0% and 60% w/w β content). We aimed to develop a quantitative measurement by (1)H-NMR of α and β anomer content in amorphous lactose produced by different production methods. Amorphous lactose was prepared by spray and freeze drying 10% w/v aqueous solutions of lactose. NMR analysis was performed in DMSO; peak areas of partially resolved doublets at 6.3 and 6.6 ppm were used to calculate % of α and β lactose present. Polarimetery was used to determine optical rotation of lactose solutions. Observed specific rotation for supplied crystalline alpha lactose monohydrate of 88° recorded in DMSO was constant for the length of a typical NMR experiment (max. 10 min). β/α anomer contents of amorphous lactose measured by (1)H-NMR had standard deviations as low as 0.1% w/w (n = 6). Drying a lactose solution 4 h after its preparation led to almost 35% w/w difference in anomer composition within solid amorphous material compared to samples dried after only 30 min, e.g. for freeze dried samples, β content was 60 ± 0.1% w/w (4 h) and 25 ± 1.0% w/w (30 min). Mutarotation leads to this increase in β anomer concentration in aqueous solution and within the solid amorphous lactose stored at 25°C. e.g. after 56 d storage the β content of freeze dried lactose (30 min solution) increased from 25±1.0% to 50±0.5% w/w. A simple solution-based (1)H-NMR method for measurement of anomeric composition of lactose has been established. The solution β/α ratio at the time of drying is mirrored in the composition of the resulting solid amorphous material. In order to produce a consistent anomer composition within spray and freeze dried amorphous lactose, the standing time for the feed solution should be greater than 4 h, such that the most dynamic region of the mutarotation profile has been exceeded. If the amorphous material has been formed from a solution that has not been allowed to equilibrate for 4 h, the resulting solid will continue to undergo mutarotation if trace amounts of moisture are present, until the anomeric β/α ratio slowly approaches 1.7.


Research on liver cancer segmentation method based on PCNN image processing and SE-ResUnet.
As one of the malignant tumors with high mortality, the initial symptoms of liver cancer are not obvious. In addition, the liver is the largest internal organ of the human body, and its structure and distribution are relatively complex. Therefore, in order to help doctors judge liver cancer more accurately, this paper proposes a variant model based on Unet network. Before segmentation, the image is preprocessed, and Pulse Coupled Neural Network (PCNN) algorithm is used to filter the image adaptively to make the image clearer. For the segmentation model, the SE module is used as the input of the residual network, and then its output is connected to the Unet model through bilinear interpolation to perform the down-sampling and up-sampling operations. The dataset is a combination of Hainan Provincial People's Hospital and some public datasets Lits. The results show that this method has better segmentation performance and accuracy than the original Unet method, and the dice coefficient, mIou and other evaluation indicators have increased by at least 2.1%, which is a method that can be applied to cancer segmentation.


Lethal acute diarrhea associated with Clostridioides difficile toxin A and B in a buffy-tufted-ear marmoset (Callithrix aurita).
This is a case of lethal acute diarrhea associated with a mild neutrophilic enteritis in a buffy-tufted-ear marmoset (Callithrix aurita) with detection of A/B toxins and isolation of a toxigenic clade 3 Clostridioides difficile strain (A+ B+ CDT+ , ST5), which should be considered as a potential cause of enteritis in this species.


Burnout in International Medical Graduate Trainees in the United Kingdom Compared to Domestic Medical Graduate Trainees. Analysis of Data from the GMC's National Training Survey in 2019 and 2021.
International Medical Graduates (IMGs) have lower educational attainment and a higher rate of complaints against them compared to Domestic Medical Graduates (DMG). The aim of this study was to investigate the potential role of burnout on these adverse outcomes experienced by IMGs. Every year, the General Medical Council (GMC) conducts the National Training Survey of all doctors in the United Kingdom which includes optional questions on work-related burnout from the Copenhagen Burnout Inventory (CBI). Work-related burnout data for doctors in training, linked to country of Primary Medical Qualification were obtained from the GMC for the years 2019 and 2021. Burnout scores of IMGs and DMGs were compared using Chi2. The total number of eligible participants in 2019 and 2021 was 56,397 and 61,313 respectively. The response rates for all doctors in training to the CBI were 35,739 (63.4%) in 2019, and 28,310 (46.2%) in 2021. IMGs were at a lower risk of burnout compared to DMGs, 2,343 (42.9%) vs 15,497 (51.2%), Odds Ratio (OR) 0.72 (CI 0.68-0.76, P < 0.001) in 2019; and 2,774 (50.2%) vs 13,000 (57.1%), OR 0.76 (CI 0.71-0.80, P < 0.001) in 2021. IMGs, as a group, appear to be at a lower risk of work-related burnout compared to DMGs. Burnout is unlikely to be contributing to lower educational attainment and higher rates of complaints experienced by IMGs compared to DMGs.


Stethoscopes: a potential vector of infection?
To survey emergency care providers about their stethoscope-cleaning measures and to determine the correlation between these measures and the extent of Staphylococcus carriage. Prospective cross-sectional analysis. University-affiliated community hospital ED. One hundred fifty health care providers, comprising emergency medicine house staff and attending physicians (n = 50), ED nurses (n = 50), and prehospital personnel working in Kent County, Michigan (n = 50). Providers were asked how often they cleaned their stethoscopes and which cleaning agents were used. We then cultured each stethoscope by pressing the diaphragm on mannitol agar and incubating the culture aerobically for 48 hours. Staphylococcus aureus was identified by means of standard measures. We examined the effects of different cleaning agents on 24 stethoscopes. The numbers of colony-forming units (CFUs) before and after cleaning with alcohol, nonionic detergent, and antiseptic soap were noted. Overall, 48% of health care providers (74 of 150) cleaned their stethoscopes daily or weekly, 37% monthly, and 7% yearly; and 7% had never cleaned their stethoscopes. No significant differences were found in the hygiene routines of the three groups of providers surveyed. Use of an alcohol swab was the preferred method of cleaning. One hundred thirty-three stethoscopes (89%) grew staphylococci; 25 (19%) yielded S aureus. Mean staphylococcal bacterial counts ( +/- SD) were 52 +/- 78 CFUs per stethoscope among physicians, 46 +/- 92 CFUs among emergency medical service personnel, and 13 +/- 21 CFUs from the nursing staff (ANOVA, P = .01). Cleaning the stethoscope diaphragm resulted in immediate reduction in the bacterial count: by 94% with alcohol swabs, 90% with nonionic detergent, and 75% with antiseptic soap. Our results confirm that stethoscopes used in emergency practice are often contaminated with staphylococci and are therefore a potential vector of infection. This contamination is greatly reduced by frequent cleaning with alcohol or nonionic detergent.


Distribution and excretion of the mercury chelating agent sodium 2,3-dimercaptopropane-1-sulfonate in the rat.
The distribution and excretion of sodium 2,3-dimercapto-1,3 14C-propane-1-sulfonate as dependent on time has been studied in the rat. The highest concentration is found in the kidneys, the lowest in the brain. The excretion is very rapid (T1/2 = 19 min) and follows a monoexponential curve during the first hour after administration. This holds for plasma and most of the organs too. The apparent distribution volume of the radioactivity is equivalent to the volume of the extracellular water. After oral administration, 30-40% is absorbed from the gut. The results lead to the conclusion that a fraction of the drug is weakly bound to plasma- and membrane-proteins. They are discussed with respect to the treatment of heavy metal poisoning.


Demographic And Histopathological Characteristics Of Colorectal Polyps: A Descriptive Study Based On Samples Obtained From Symptomatic Patients: DEMOGRAFSKE IN HISTOPATOLOŠKE ZNAČILNOSTI KOLOREKTALNIH POLIPOV: DESKRIPTIVNA RAZISKAVA NA OSNOVI VZORCEV, PRIDOBLJENIH OD SIMPTOMATSKIH PACIENTOV.
Colorectal polyps (CP) are common among individuals older than 50 years. Some polyp types can precede colorectal cancer (CRC). This study aimed at describing histopathological characteristics of colorectal polyps in relation to age and gender among symptomatic patients referred for a colonoscopy examination during 2011-2014 in Tirana, Albania. Study population included 267 individuals aged ≥ 20 years and diagnosed with ≥ 1 polyp during a colonoscopy examination. A total of 346 polyps were identified, excised and measured, and underwent histopathological examination. Adenomas accounted for 79.8% of all polyps and tubular type was the most frequent one (74.4%). The majority of polyps (42.5%) were small (<1 cm), 38.7% of a medium size (1-2 cm) and 18.8% large (>2 cm). Adenomas were larger than non-adenomatous polyps (p<0.01) There was no gender difference with regard to patient age (p=0.22) or polyp size (p=0.84) Adenomas were more frequent among men compared to women (p=0.02). Age was strongly related to polyp characteristics. The proportion of adenomas increased significantly with age (p<0.01). Within adenomas, the proportion of villous types - a precursor of colorectal cancer - increased remarkably with age (p=0.01). Older age was positively associated with potentially malignant adenomas (defined as adenomas > 1 cm and showing high-grade dysplasia) (p<0.01). Adenomas accounted for the majority of polyps. Their morphology, size and malignant potential were related to patient age.