Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons.
The reproducibility and repeatability of modern systems for classification of thoracolumbar injuries have not been sufficiently studied. We assessed the interobserver and intraobserver reproducibility of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification and compared it with that of the Denis classification. Our purpose was to determine whether the newer, AO system had better reproducibility than the older, Denis classification. Anteroposterior and lateral radiographs and computerized tomography scans (axial images and sagittal reconstructions) of thirty-one acute traumatic fractures of the thoracolumbar spine were presented to nineteen observers, all trained spine surgeons, who classified the fractures according to both the AO and the Denis classification systems. Three months later, the images of the thirty-one fractures were scrambled into a different order, and the observers repeated the classification. The Cohen kappa (kappa) test was used to determine interobserver and intraobserver agreement, which was measured with regard to the three basic classifications in the AO system (types A, B, and C) as well as the nine subtypes of that system. We also measured the agreement with regard to the four basic types in the Denis classification (compression, burst, seat-belt, and fracture-dislocation) and with regard to the sixteen subtypes of that system. The AO classification was fairly reproducible, with an average kappa of 0.475 (range, 0.389 to 0.598) for the agreement regarding the assignment of the three types and an average kappa of 0.537 for the agreement regarding the nine subtypes. The average kappa for the agreement regarding the assignment of the four Denis fracture types was 0.606 (range, 0.395 to 0.702), and it was 0.173 for agreement regarding the sixteen subtypes. The intraobserver agreement (repeatability) was 82% and 79% for the AO and Denis types, respectively, and 67% and 56%, for the AO and Denis subtypes, respectively. Both the Denis and the AO system for the classification of spine fractures had only moderate reliability and repeatability. The tendency for well-trained spine surgeons to classify the same fracture differently on repeat testing is a matter of some concern.


Toward the Development of a Wearable Optical Respiratory Sensor for Real-Time Use.
Respiration rate is an important vital sign that can provide insight into a patient's status and health progression. This information is used from critical care to sports and human performance evaluation. The current state of the art has demonstrated effectiveness in monitoring respiration rate with the use of wearable sensors. However, their form factor, which refers to the embodiment of approach, size, and shape, makes it difficult to implement within a longterm monitoring setting. Problems relating to form factor, such as compliance, are a major issue in collecting useful and actionable data, because they directly impact comfort and ease of wear. We present a new approach based on an optical computer mouse sensor that can be rendered into a slim, wearable device without the need for a harness or shirt to hold the sensor in place. Its main objective is to achieve similar or better readings than those of the state of the art while reducing the overall size and thus, improve compliance by making it easier, more comfortable to wear. The principle of operation of the sensor allows for enhanced signal and computational noise reduction for movement artifacts. The sensor was tested to determine its limits of detection and was calibrated to expected distance of movement. Then, observations were made under normal breathing conditions, apnea, deep breathing, and hyperventilation covering a spectrum of 0 to 45 breathings per minute (BPM). The performance of the device was described by using the mean average error which was 0.37 and 0.83 under deep breathing and hyperventilation, respectively. Testing revealed that the device produces the best results when worn over the diaphragm and that its readings are comparable to the industry gold standard. The future version we are developing incorporates a slimmer, lighter design, Bluetooth data communication to remove leads and wires, adhesive electrodes and a reusable adhesive that is also waterproof.


Paternal and Maternal Variables Related to Depression in Childhood.
Several studies have highlighted the relationship between parenting styles and depression in children. The aim of this study is to ascertain whether there are differences in the parenting practices received by two groups of children who obtain low-risk and high-risk scores respectively in relation to depression and determine which parenting variables are linked with the presence or absence of this kind of internalizing problem. From a sample of 550 subjects, obtained by probabilistic cluster sampling, we selected 140 children between 3 and 12 years of age who met a set of specific criteria as having high risk scores (70 children) for depression according to the Behavior Assessment System for Children (BASC) or having low scores in this variable (70 children). Then, the Parent-Child Relationship Inventory (PCRI) was applied to both parents. We carried out a binomial logistic regression analysis which resulted in a prediction model for 89.3% of the sample, based on the following parenting variables: limit setting and involvement from the mothers, and parental support, autonomy, satisfaction with parenting, and communication from the fathers. Finally, the usefulness of our results to plan intervention strategies within families of children with depression is discussed.


Do hospital attributes predict guideline-recommended gastric cancer care in the United States?
Hospital attributes have been shown to impact short- and long-term outcomes after cancer surgery. However, the effect of hospital attributes on processes of cancer care in terms of delivery of guideline recommended care has not been evaluated. We examined the impact of hospital attributes (volume and type) on guideline-recommended care in patients treated for gastric cancer. We identified patients who were surgically treated for gastric cancer at Commission on Cancer (CoC) hospitals from 2001 to 2006. Patient, tumor, and treatment factors were compared separately by hospital volume and type. Multivariable analyses were used to evaluate the impact of hospital attributes on delivery of guideline recommended gastric cancer care: adequate lymphadenectomy (≥15 lymph nodes), and adjuvant multimodality therapy (for AJCC Ib-IVM0), controlling for covariates. More than 1,490 CoC hospitals performed 37,124 gastrectomies. High-volume and teaching CoC hospitals were more likely to treat younger patients, non-whites, patients with lower AJCC stage, and to perform adequate lymphadenectomy than low-volume and community CoC hospitals (p ≤ 0.001). Hospital volume and type, however, were not associated with receipt of adjuvant multimodality therapy. These associations persisted in our multivariable analyses to show that CoC hospital attributes were associated with adequate lymphadenectomy, but marginally predictive of receipt of adjuvant multimodality therapy. The strong association between CoC hospital volume or type and guideline-recommended care diminishes after gastric cancer surgery. Variations in referral, insurance, and documentation patterns are potential explanations for these findings. These results highlight some limitations of using hospital attributes as a sole predictor of optimal cancer care.


Effects of Oil-Contaminated Sediments on Submerged Vegetation: An Experimental Assessment of Ruppia maritima.
Oil spills threaten the productivity of ecosystems through the degradation of coastal flora and the ecosystem services these plants provide. While lab and field investigations have quantified the response of numerous species of emergent vegetation to oil, the effects on submerged vegetation remain uncertain. Here, we discuss the implications of oil exposure for Ruppia maritima, one of the most common species of submerged vegetation found in the region affected by the recent Deepwater Horizon oil spill. We grew R. maritima in a range of manipulated sediment oil concentrations: 0, 0.26, 0.53, and 1.05 mL oil /L tank volume, and tracked changes in growth (wet weight and shoot density/length), reproductive activity (inflorescence and seed production), root characteristics (mass, length, diameter, and area), and uprooting force of plants. While no statistical differences were detected in growth, plants exhibited significant changes to reproductive output, root morphology, and uprooting force. We found significant reductions in inflorescences and fruiting bodies at higher oil concentrations. In addition, the roots growing in the high oil were shorter and wider. Plants in medium and high oil required less force to uproot. A second experiment was performed to separate the effects of root morphology and oiled sediment properties and indicated that there were also changes to sediment cohesion that contributed to a reduction in uprooting forces in medium and high oil. Given the importance of sexual reproduction for these plants, oil contamination may have substantial population-level effects. Moreover, areas containing buried oil may be more susceptible to high energy storm events due to the reduction in uprooting force of foundation species such as R. maritima.


Inside the letterbox: how literacy transforms the human brain.
Few issues are as important to the future of humanity as acquiring literacy. Brain-scanning technology and cognitive tests on a variety of subjects by one of the world's foremost cognitive neuroscientists has led to a better understanding of how a region of the brain responds to visual stimuli. The results could profoundly affect learning and help individuals with reading disabilities.


Current perspective for tube feeding in the elderly: from identifying malnutrition to providing of enteral nutrition.
With the number of individuals older than 65 years expected to rise significantly over the next few decades, dramatic changes to our society and health care system will need to take place to meet their needs. Age-related changes in muscle mass and body composition along with medical comorbidities including stroke, dementia, and depression place elderly adults at high risk for developing malnutrition and frailty. This loss of function and decline in muscle mass (ie, sarcopenia) can be associated with reduced mobility and ability to perform the task of daily living, placing the elderly at an increased risk for falls, fractures, and subsequent institutionalization, leading to a decline in the quality of life and increased mortality. There are a number of modifiable factors that can mitigate some of the muscle loss elderly experience especially when hospitalized. Due to this, it is paramount for providers to understand the pathophysiology behind malnutrition and sarcopenia, be able to assess risk factors for malnutrition, and provide appropriate nutrition support. The present review describes the pathophysiology of malnutrition, identifies contributing factors to this condition, discusses tools to assess nutritional status, and proposes key strategies for optimizing enteral nutrition therapy for the elderly.


Beneficial effects of Korean red ginseng on lymphocyte DNA damage, antioxidant enzyme activity, and LDL oxidation in healthy participants: a randomized, double-blind, placebo-controlled trial.
The reported health benefits of Korean red ginseng (KRG) include antioxidant, antitumor, antimutagenic, and immunomodulatory activities; however, the effects on oxidative stress have not yet been evaluated. Therefore, we assessed the effect of KRG on antioxidant enzymes and oxidative stress markers in humans. We conducted a randomized, double-blind, placebo-controlled study with three groups, including placebo, low-dose (3 g/day), and high-dose (6 g/day), which were randomly assigned to healthy subjects aged 20-65 years. Lymphocyte DNA damage, antioxidative enzyme activity, and lipid peroxidation were assessed before and after the 8-week supplementation. Fifty-seven subjects completed the protocol. Plasma superoxide dismutase (SOD) activity after the 8-week KRG supplementation was significantly higher in the low-and high-dose groups compared to baseline. Plasma glutathione peroxidase (GPx) and catalase activities were also increased after the high-dose supplementation. Furthermore, the DNA tail length and tail moment were significantly reduced after the supplementation (low-dose and high-dose), and plasma oxidized low-density lipoprotein (LDL) levels were reduced in low-dose and high-dose groups, but increased in the placebo group. The net changes in oxidized LDL after the supplementation differed significantly between both KRG supplementation groups and the placebo group. Net changes in GPx, SOD and catalase activities, and DNA tail length and tail moment were significantly different between the high-dose group and the placebo group. Additionally, the net changes in urinary 8-epi-PGF(2α) were significantly different between the KRG supplementation groups and the placebo group. KRG supplementation may attenuate lymphocyte DNA damage and LDL oxidation by upregulating antioxidant enzyme activity.


Functions of inorganic polyphosphates in eukaryotic cells: a coat of many colours.
PolyP (inorganic polyphosphate) is a linear polymer of tens to hundreds of orthophosphate residues linked by high-energy phosphoanhydride bonds. This polymer is present in all living organisms from bacteria to mammals. Until recently, most of the studies on polyP have focused on its function in prokaryotes. In prokaryotes, polyP has been implicated in many unrelated processes ranging from basic metabolism to structural functions. However, polyP analysis and function in higher eukaryotes has been gaining momentum recently. In the present review, we mainly aim to discuss the proposed intracellular functions of polyP in higher eukaryotes and its detection methods.


Differential glioma-associated tumor antigen expression profiles of human glioma cells grown in hypoxia.
Human U251 and D54 glioma cells were tested for expression of 25 glioma-associated tumor antigen precursor proteins (TAPP) under hypoxic (1% O(2)) or normoxic (21% O(2)) conditions. Hypoxic glioma cell lines increased their mRNA expression for nine TAPP (Aim2, Art-4, EphA2, EZH2, Fosl1, PTH-rP, Sox 11, Whsc2 and YKL-40), as assessed by quantitative reverse transcriptase real-time/polymerase chain reaction (qRT-PCR). Increased differences with three hypoxic-induced TAPP: EZH2, Whsc2 and YKL-40 were shown at the protein levels by fluorescent antibody staining and quantitative electrophoretic analysis. Two TAPP (MRP3 and Trp1) were down-regulated by hypoxia in glioma cell lines. Growing the glioma cells under hypoxia for 13 days, followed by returning them back to normoxic conditions for 7 days, and restored the original normoxic TAPP profile. Thus, hypoxia was an environmental factor that stimulated the transient expression of these antigens. Intracranial xenografts grown in nude mice derived from U251 cells that had been cultured under neurosphere stem cell conditions showed increased expression of Whsc2 or YKL-40, demonstrating that these in vitro properties of glioma also occur in vivo. Whsc2-specific cytotoxic T lymphocytes killed the hypoxic U251 glioma cells better than normoxic glioma cells. The antigens expressed by hypoxic tumor cells may be a better source of starting tumor material for loading dendritic cells for novel immunotherapy of glioma using tumor-associated antigens.


Analysis of Cerebrospinal Fluid Pressure Estimation Using Formulae Derived From Clinical Data.
To evaluate a frequently used regression model and a new, modified regression model to estimate cerebrospinal fluid pressure (CSFP). Datasets from the Beijing iCOP study from Tongren Hospital, Beijing, China, and the Mayo Clinic, Rochester, Minnesota, were tested in this retrospective, case-control study. An often-used regression model derived from the Beijing iCOP dataset, but without radiographic data, was used to predict CSFP by using demographic and physiologic data. A regression model was created using the Mayo Clinic dataset and tested against a validation group. The Mayo Clinic-derived formula was also tested against the Beijing Eye Study population. Intraclass correlation was used to assess predicted versus actual CSFP. The Beijing-derived regression equation was reported to have an intraclass correlation coefficient (ICC) of 0.71, indicating strong correlation between predicted and actual CSFP in the study population. The Beijing iCOP regression model poorly predicted CSFP in the Mayo Clinic population with an ICC of 0.14. The Mayo Clinic-derived regression model similarly did not predict CSFP in its Mayo Clinic validation group (ICC 0.28 ± 0.04) nor in the Beijing Eye Study population (ICC 0.06). Formulae used to predict CSFP derived from clinical data fared poorly against a large retrospective dataset. This may be related to differences in lumbar puncture technique, in the populations tested, or the timing of collection of physiologic variables in the Mayo Clinic dataset. Caution should be used when interpreting results based on formulaic derivation of CSFP.


Identification of a novel muscle targeting peptide in mdx mice.
Exon-skipping oligonucleotides are a well-researched therapeutic strategy for Duchenne's muscular dystrophy (DMD). Despite remarkable successes in animal models with intramuscular and intravenous delivery of unmodified oligonucleotides, the ability to specifically target both normal and dystrophic muscle with a simple peptide ligand could decrease the therapeutic dose required and reduce the potential for toxicity. Thus, 3 rounds of in vivo phage display utilizing a 12-mer peptide library were performed with mdx mice and a peptide motif with potential for targeting to muscle but not liver was identified. This motif was shown to have enhanced binding affinity to C2C12 myoblasts over a scrambled control peptide and in vivo application of a fluorescein-labeled peptide containing the identified motif resulted in increased specificity for the heart and quadriceps muscle after tail-vein administration in C57BL/6 mice. This work has many potential applications for oligonucleotide or drug delivery to muscle for myopathies.


The Brassica epithionitrile 1-cyano-2,3-epithiopropane triggers cell death in human liver cancer cells in vitro.
Glucosinolates are secondary metabolites present in Brassica vegetables. Alkenyl glucosinolates are enzymatically degraded forming nitriles or isothiocyanates, but in the presence of epithiospecifier protein, epithionitriles are released. However, studies on the occurrence of epithionitriles in Brassica food and knowledge about their biological effects are scarce. Epithionitrile formation from glucosinolates of seven Brassica vegetables was analyzed using GC-MS and HPLC-DAD. Bioactivity of synthetic and plant-derived 1-cyano-2,3-epithiopropane (CETP) - the predominant epithionitrile in Brassica vegetables - in three human hepatocellular carcinoma (HCC) cell lines and primary murine hepatocytes was also evaluated. The majority of the Brassica vegetables were producers of nitriles or epithionitriles as hydrolysis products and not of isothiocyanates. For example, Brussels sprouts and savoy cabbage contained up to 0.8 μmol CETP/g vegetable. Using formazan dye assays, concentrations of 380-1500 nM CETP were observed to inhibit the mitochondrial dehydrogenase activity of human HCC cells without impairment of cell growth. At 100-fold higher CETP concentrations, cell death was observed. Presence of plant matrix increased CETP-based toxicity. These in vitro data provide no indication that epithionitriles will severely affect human health by Brassica consumption. In contrast to isothiocyanates, no evidence of selective toxicity against HCC cells was found.


Nanoparticle-doped polyimide for controlling the pretilt angle of liquid crystals devices.
The pretilt angles of liquid crystal molecules can be controlled by using conventional polyimide (PI) alignment material doped with different concentrations of Polyhedral Oligomeric Silsequioxanes (POSS) nanoparticles, which have been observed to spontaneously induce vertical alignment. The addition of POSS in the homogenous PI changes the surface energy of the alignment layer and generates a variable pretilt angle. Experimental results demonstrate that the pretilt angle thetap is a function of the POSS concentration, and can be tuned continuously over the range of 0 degrees <thetap<90 degrees. The polar anchoring energy of POSS/PI alignment layer is almost constant regardless of the POSS concentration. This technique is very simple and is compatible with methods familiar in the current LCD industry.


Thermal dissociation of anthracene photodimers in the condensed state: kinetic evaluation and complex phase behaviour.
Thermally and photochemically reversible functional groups, such as photodimers of anthracene derivatives, offer interesting stimuli-responsive behaviour. To evaluate their potential for application in reversible polymer networks, accurate kinetic parameters and knowledge of their thermophysical behaviour are required. Accurate kinetic studies of the thermal dissociation of the photodimers in the condensed state, thus without the influence of solvents on their reactivity, is still lacking. A methodology was set up to accurately evaluate the chemical reaction kinetics and complex phase behaviour during the thermal dissociation of photodimers into their corresponding monomers. Temperature-controlled time-resolved FTIR spectroscopy was used to determine the reaction progress, while non-isothermal DSC measurements were used to study the thermophysical changes, resulting from the thermal dissociation reaction. The thermal dissociation behaviour in the condensed state is more challenging than in the solution state due to the crystallinity of the dimers, stabilizing the dimers and thus slowing down the initial dissociation rates. Distinctly different sets of kinetic parameters were found for the dissociation from the molten and the crystalline state. For experiments performed below the melting temperature of the photodimer, the reaction rate changes abruptly as the dimer is partly dissociated and partly dissolved into the formed monomer. This methodology provides an accurate assessment of the reaction kinetics with detailed knowledge about the complex phase behaviour of the mixture of the anthracene photodimer and monomer during thermal dissociation.


Attentional Bias Associated with Habitual Self-Stigma in People with Mental Illness.
As habitual self-stigma can have a tremendous negative impact on people with mental illness, it is of paramount importance to identify its risk factors. The present study aims to examine the potential contributory role of attentional bias in habitual self-stigma. People with mental illness having strong (n = 47) and weak (n = 47) habitual self-stigma completed a computerized emotional Stroop task which included stigma-related, positive, and non-affective words as stimuli. The strong habit group was found to exhibit faster color-naming of stigma-related words (compared to non-affective words), whereas the weak habit group showed no difference in the speed of response to different stimuli. These findings suggest that people with stronger habitual self-stigma may be more able to ignore the semantic meaning of stigma-related words and focus on the color-naming task. Moreover, people with stronger habitual self-stigma may have greater attentional avoidance of stigma-related material. The present study is the first to demonstrate a specific relationship between habitual self-stigma and biased processing of stigma-related information. In order to further determine the role and the nature of attentional bias in habitual self-stigma, future research should employ a broader range of experimental paradigms and measurement techniques to examine stigma-related attentional bias in people with mental illness.


First Report of Box Blight Caused by Cylindrocladium pseudonaviculatum (C. buxicola) in British Columbia, Canada.
Boxwoods (Buxus spp.) are common woody ornamental hedging plants in Europe and North America, typically propagated by cuttings. In October 2011, shoot dieback and defoliation was observed on Buxus sempervirens 'Suffruticosa' (dwarf English boxwood) and 'Green Balloon' in outdoor, 10-cm pots at a wholesale nursery in Chilliwack, British Columbia. Circular leaf spots with black rings occurred on leaves and black, water-soaked, cankers girdled the stems and petioles. Leaf and stem samples were collected on November 21, 2011, and incubated for 48 h in a moist chamber at room temperature. In addition to Volutella buxi, a Cylindrocladium species producing conidia on white sporodochia was observed on host tissue under the microscope. Leaves with lesions were surface-sterilized in 10% bleach for 30 to 60 s, rinsed in sterile water, and lesions were cut out and plated on PDA and carnation leaf media. The species was identified as Cylindrocladium pseudonaviculatum Crous, J.Z. Groenew. & C.F. Hill 2002 by comparison of conidia and phialide morphology to published descriptions. Conidia were hyaline, one-septate, cylindrical with rounded ends and 38 to 76 μm (mean 51 μm) × 4 to 6 μm on carnation leaf media and 41 to 66 μm (mean 52 μm) × 4 to 6 μm on B. sempervirens 'Suffruticosa' leaves, comparable to the reported range of 40 to 75 × 4 to 6 μm (1,2,3,4). Conidia were produced in clusters on terminal, ellipsoid vesicles at the tips of penicillate conidiophores. Vesicles were 10.2 (7.6 to 12.8 μm) at the widest point, consistent with the 6 to 11 μm reported in (2,3) and tapered to a rounded point; stipe extensions were septate and measured an average of 130 μm (107 to 163 μm) in length to the tip of the vesicle, consistent with the 95 to 155 μm reported in (1), 89 to 170 μm reported in (2), and 95 to 165 μm in (3). Chlamydospores were not observed on host tissue but appeared in older PDA cultures as dark brown microsclerotia. DNA was extracted from single-spore colonies on PDA and the internal transcribed spacer (ITS) region of rDNA was amplified with primers ITS1 and ITS4. The ITS sequence (GenBank Accession No. KC291613) was 100% identical to C. buxicola strain CB-KR001 (HM749646.1) and Calonectria pseudonaviculata strain ATCC MYA-4891 (JX174050.1). In early December 2011, box blight was identified on container-grown B. sinica var. insularis × B. sempervirens 'Green Velvet,' 'Green Gem', and 'Green Mountain' and B. sempervirens L. (common or American boxwood). The pathogen was identified by microscopic examination at three wholesale nurseries in the eastern Fraser Valley and one landscape planting. The isolate has been deposited in the Canadian Collection of Fungal Cultures in Ottawa, Canada (DAOM 242242). References: (1) B. Henricot and A. Culham. Mycologia 94:980, 2002. (2) K. L. Ivors, et al. Plant Dis. 96:1070, 2012. (3) C. Pintos Varela, et al. Plant Dis. 93:670, 2009. (4) M. Saracchi, et al. J. Plant Pathol. 90:581, 2008.


Cure by age and stage at diagnosis for colorectal cancer patients in North West England, 1997-2004: a population-based study.
Stage and age at diagnosis are important prognostic factors for patients with colorectal cancer. However, the proportion cured by stage and age is unknown in England. This population-based study includes 29,563 adult patients who were diagnosed and registered with colorectal cancer during 1997-2004 and followed till 2007 in North West England. Multiple imputation was used to provide more reliable estimates of stage at diagnosis, when these data were missing. Cure mixture models were used to estimate the proportion 'cured' and the median survival of the uncured by age and stage. For both colon and rectal cancer the proportion of patients cured and median survival time of the uncured decreased with advancing stage and increasing age. Patients aged under 65 years had the highest proportion cured and longest median survival of the uncured. Cure of colorectal cancer patients is dependent on stage and age at diagnosis with younger patients or those with less advanced disease having a better prognosis. Further efforts are required, in order to reduce the proportion of patients presenting with stage III and IV disease and ultimately increase the chance of cure.


Phylogenetic relationships, character evolution and biogeography of southern African members of Zygophyllum (Zygophyllaceae) based on three plastid regions.
The plastid coding rbcL and non-coding trnLF regions of 53 of 55 southern African Zygophyllum species were sequenced and used to evaluate the phylogenetic relationships within the southern African representatives of the genus. Published sequences of the same gene regions of Australian, Asian and North African Zygophyllum species were included to assess the relationships of the species from these regions to the southern African species. The addition of Z. stapffii from Namibia, found to be conspecific with Z. orbiculatum from Angola, lead to a greatly resolved tree. The molecular results were largely congruent with a recent sectional classification of the southern African species and supported their subdivision into subgenera Agrophyllum and Zygophyllum. Reconstruction of the character evolution of capsule dehiscence, seed attachment and seed mucilage showed that these characters allowed a division of southern African species into the two subgenera but that this could not be applied to species occurring elsewhere. Other morphological characters were found to vary and unique character combinations, rather than unique characters, were found to be of systematic value in sectional delimitation. The study suggests that repeated radiations from the horn of Africa to southern Africa and Asia and back lead to the present distribution of the taxa in the subfamily Zygophylloideae. Although this study supports some of the recent taxonomic changes in the group, the unresolved relationships between the proposed genera Tetraena and Roepera and those retained as Zygophyllum species suggest that changes to the taxonomy may have been premature.


Development and Validation of Risk Prediction Models for Coronary Heart Disease and Heart Failure After Treatment for Hodgkin Lymphoma.
Previous efforts to predict absolute risk of treatment-related cardiovascular diseases (CVDs) have mostly focused on childhood cancer survivors. We aimed to develop prediction models for risk of coronary heart disease (CHD) and heart failure (HF) for survivors of adolescent/adult Hodgkin lymphoma (HL). For model development, we used a multicenter cohort including 1,433 5-year HL survivors treated between 1965 and 2000 and age 18-50 years at HL diagnosis, with complete data on administered chemotherapy regimens, radiotherapy volumes and doses, and cardiovascular follow-up. Using cause-specific hazard models, covariate-adjusted cumulative incidences for CHD and HF were estimated in the presence of competing risks of death because of other causes than CHD and HF. Age at HL diagnosis, sex, smoking status, radiotherapy, and anthracycline treatment were included as predictors. External validation for the CHD model was performed using a Canadian cohort of 708 HL survivors treated between 1988 and 2004 and age 18-50 years at HL diagnosis. After a median follow-up of 24 years, 341 survivors had developed CHD and 102 had HF. We were able to predict CHD and HF risk at 20 and 30 years after treatment with moderate to good overall calibration and moderate discrimination (areas under the curve: 0.68-0.74), which was confirmed by external validation for the CHD model (areas under the curve: 0.73-0.74). On the basis of our model including prescribed mediastinal radiation dose, 30-year risks ranged from 4% to 78% for CHD and 3% to 46% for HF, depending on risk factors. We developed and validated prediction models for CHD and HF with good overall calibration and moderate discrimination. These models can be used to identify HL survivors who might benefit from targeted screening for CVD and early treatment for CVD risk factors.


[Amniotic band syndrome: pathogenesis, prenatal diagnosis and neonatal management].
Amniotic band syndrome is a collection of fetal congenital malformations, affecting mainly the limbs, but also the craniofacial area and internal organs. Two mains pathogenic mechanisms are proposed: early amnion rupture (exogenous theory) leading to fibrous bands, which entrap the fetal body; the endogenous theory privileges vascular compromise, mesoblastic strings not being a causal agent. The outcome of the disease depends on the gravity of the malformation. Termination of the pregnancy is usually proposed at the time of the diagnostic of severe craniofacial and visceral abnormalities, whereas minor limb defects can be repaired with postnatal surgery. In case of an isolated amniotic band with a constricted limb, in utero lysis of the band can be considered to avoid a natural amputation. However, as the exact etiology of amniotic band syndrome remains unknown and its natural course unpredictable, prenatal surgery continues to be controversial. Doppler studies of the constricted limb could be of useful predictive value of in utero amputation, and therefore could be helpful to determine when in utero treatment should be considered.


Peptide YY release by fatty acids is sufficient to inhibit gastric emptying in dogs.
Peptide YY is a candidate enterogastrone localized to endocrine cells of the ileocolonic mucosa. The purpose of the present study was to determine if blood levels of peptide YY observed after perfusion of the intestine with fatty acids are capable of slowing gastric emptying. Gastric emptying of a 300-ml saline meal was monitored during intravenous infusion of normal saline or graded doses of peptide YY. Gastric emptying was significantly inhibited by infusion of peptide YY in doses of 200 and 400 pmol/kg X h. During the saline control study, 229 +/- 12 ml of the 300-ml saline meal emptied by 10 min. This figure was reduced (p less than 0.01) to 110 +/- 28 ml by the infusion of peptide YY at a dose of 200 pmol/kg X h. This dose of peptide YY produced plasma concentrations (delta PYY = 239 +/- 50 pM) that were lower than those seen in response to intestinal perfusion of oleic acid (delta PYY = 395 +/- 55 pM) in the same animals. We conclude that perfusion of the intestine with oleic acid releases peptide YY in amounts sufficient to slow gastric emptying.


Genome assembly and annotation of Arabidopsis halleri, a model for heavy metal hyperaccumulation and evolutionary ecology.
The self-incompatible species Arabidopsis halleri is a close relative of the self-compatible model plant Arabidopsis thaliana. The broad European and Asian distribution and heavy metal hyperaccumulation ability make A. halleri a useful model for ecological genomics studies. We used long-insert mate-pair libraries to improve the genome assembly of the A. halleri ssp. gemmifera Tada mine genotype (W302) collected from a site with high contamination by heavy metals in Japan. After five rounds of forced selfing, heterozygosity was reduced to 0.04%, which facilitated subsequent genome assembly. Our assembly now covers 196 Mb or 78% of the estimated genome size and achieved scaffold N50 length of 712 kb. To validate assembly and annotation, we used synteny of A. halleri Tada mine with a previously published high-quality reference assembly of a closely related species, Arabidopsis lyrata. Further validation of the assembly quality comes from synteny and phylogenetic analysis of the HEAVY METAL ATPASE4 (HMA4) and METAL TOLERANCE PROTEIN1 (MTP1) regions using published sequences from European A. halleri for comparison. Three tandemly duplicated copies of HMA4, key gene involved in cadmium and zinc hyperaccumulation, were assembled on a single scaffold. The assembly will enhance the genomewide studies of A. halleri as well as the allopolyploid Arabidopsis kamchatica derived from A. lyrata and A. halleri.


Quantifying the Additional Difficulty of Pediatric Robot-Assisted Laparoscopic Re-Do Pyeloplasty: A Comparison of Primary and Re-Do Procedures.
Re-do pyeloplasty after failed open or laparoscopic ureteropelvic junction (UPJ) obstruction correction can be a challenging procedure because of scar formation at the previous anastomosis site and decreased vascularity of the ureter. This study compared the perioperative parameters for pediatric robot-assisted laparoscopic (RAL) primary and re-do pyeloplasties with an emphasis on the intra-operative parameters. We compared the perioperative parameters of pediatric RAL procedures performed by a single surgeon at a tertiary care children's hospital for both primary ureteropelvic junction obstruction (UPJO) and recurrent UPJO after a previous open or laparoscopic procedure over 2013-2015. The operative time was subdivided as total operative time, console time, port placement time, dissection time to UPJ, and anastomosis time. A total of 65 pediatric RAL pyeloplasty procedures for UPJO were performed (55 primary and 10 re-do pyeloplasties) during the study period. The console times were 43.3% longer for re-do pyeloplasties than for primary pyeloplasties (133.0 ± 30.7 versus 92.8 ± 24.0 minutes, respectively, P < .01). The re-do cases had longer operative times, especially for UPJ exposure (52.2 ± 21.0 versus 28.0 ± 14.0 minutes, P < .01). There were no conversions to open surgery or significant perioperative complications. There was no difference in hospital pain medication usage and hospital length of stay between the 2 groups. The treatment success rates were 98.2% (54/55) and 100% (10/10), respectively. RAL re-do pyeloplasty is associated with significantly longer operative times as compared with primary pyeloplasties, especially during the exposure of the UPJ, but it is overall a safe and effective surgical modality for persistent/recurrent UPJO in children. As surgeons are increasingly asked for more accurate predictions of operative time lengths when scheduling cases, this information can be helpful for surgeons when scheduling these cases and with counseling families.


Grape seed and skin extract protects against arsenic trioxide induced oxidative stress in rat heart.
Arsenic is a metalloid found in water, soil, and air from natural and anthropogenic sources, and is commonly found in inorganic as well as organic forms. The clinical use of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia (APL) is limited by its cardiotoxic side effects. Grape seed and skin extract (GSSE) is a polyphenolic mixture with antioxidant properties. This study aimed to evaluate the protective effect of GSSE on arsenic-induced cardiac oxidative stress and injury. Animals exposed to 2.5 mg/kg As2O3 for 21 days exhibited a relevant increase in heart lipoperoxidation, protein carbonylation, and inflammation, as well as a drop in the activity of antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx). In addition, As2O3 disturbed heart lipidemia and lipase activity, transition metals distribution and the associated enzymes, intracellular mediators such as calcium and the associated calpain activity, as well as myocardial architecture. Treatment with 4 g/kg GSSE protected against most of the deleterious effects provoked by As2O3. Our data suggest that GSSE has the potential to protect against As2O3-induced cardiotoxicity.


Comparably accelerated vascularization by preincorporation of aortic fragments and mesenchymal stem cells in implanted tissue engineering constructs.
The demanding need for tissue replacement resulted in manifold approaches for the construction of different tissues. One common problem which hampers the clinical usage of tissue engineering constructs is a limited vascularization. In an attempt to accelerate the vascularization of tissue engineering constructs we compared the usage of bone marrow mesenchymal stem cells (bmMSCs) and fragments derived from the aorta in vivo. Tissue engineering constructs composed of PLGA scaffolds containing Matrigel (n = 8), aortic fragments embedded in Matrigel (n = 8), bmMSCs embedded in Matrigel (n = 8), and aortic fragments embedded in Matrigel combined with bmMSCs (n = 8) were implanted into dorsal skinfold chambers of balb/c mice and analyzed repetitively over 14 days. In all groups a weak inflammatory response was transiently apparent. Vascularization was significantly (p = 0.05) accelerated in bmMSC and aortic fragments containing constructs compared with Matrigel alone, demonstrated by a distinctly increased microvascular density throughout the whole experiment. The combination of bmMSCs and aortic fragments showed no additional effect compared with bmMSCs and aortic fragments alone. The accelerated vascularization and microvascular density of tissue engineering constructs triggered by bmMSCs and aortic fragments is comparable. Thus aortic fragments provide a new promising source for clinical relevant tissue engineering constructs.


Global data on earthworm abundance, biomass, diversity and corresponding environmental properties.
Earthworms are an important soil taxon as ecosystem engineers, providing a variety of crucial ecosystem functions and services. Little is known about their diversity and distribution at large spatial scales, despite the availability of considerable amounts of local-scale data. Earthworm diversity data, obtained from the primary literature or provided directly by authors, were collated with information on site locations, including coordinates, habitat cover, and soil properties. Datasets were required, at a minimum, to include abundance or biomass of earthworms at a site. Where possible, site-level species lists were included, as well as the abundance and biomass of individual species and ecological groups. This global dataset contains 10,840 sites, with 184 species, from 60 countries and all continents except Antarctica. The data were obtained from 182 published articles, published between 1973 and 2017, and 17 unpublished datasets. Amalgamating data into a single global database will assist researchers in investigating and answering a wide variety of pressing questions, for example, jointly assessing aboveground and belowground biodiversity distributions and drivers of biodiversity change.


Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study.
Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.


Primitive wing feather arrangement in Archaeopteryx lithographica and Anchiornis huxleyi.
In modern birds (Neornithes), the wing is composed of a layer of long, asymmetrical flight feathers overlain by short covert feathers. It has generally been assumed that wing feathers in the Jurassic bird Archaeopteryx and Cretaceous feathered dinosaurs had the same arrangement. Here, we redescribe the wings of the archaic bird Archaeopteryx lithographica and the dinosaur Anchiornis huxleyi and show that their wings differ from those of Neornithes in being composed of multiple layers of feathers. In Archaeopteryx, primaries are overlapped by long dorsal and ventral coverts. Anchiornis has a similar configuration but is more primitive in having short, slender, symmetrical remiges. Archaeopteryx and Anchiornis therefore appear to represent early experiments in the evolution of the wing. This primitive configuration has important functional implications: although the slender feather shafts of Archaeopteryx and Anchiornis make individual feathers weak, layering of the wing feathers may have produced a strong airfoil. Furthermore, the layered arrangement may have prevented the feathers from forming a slotted tip or separating to reduce drag on the upstroke. The wings of early birds therefore may have lacked the range of functions seen in Neornithes, limiting their flight ability.


A neurocognitive approach to music reading.
Music reading offers a unique perspective on the acquisition of a notational system. Many people cannot read music, but a large proportion are motivated to learn. Musical literacy is therefore amenable to studies of acquisition in a way that language literacy is not. The studies reviewed here investigate how musical symbols on the page are decoded into a musical response. The studies address the nature of the mental representations used in music reading, as well as their instantiation within the brain. The results of a musical Stroop paradigm are described, in which musical notation was present but irrelevant for task performance. The presence of musical notation produced systematic effects on reaction time, demonstrating that reading of the written note, like the written word, is obligatory for those who are musically literate. Spatial interference tasks are also described that suggest that music reading, at least for the pianist, can be characterized as a set of vertical to horizontal mappings. These behavioral findings are mirrored by the results of an fMRI training study in which musically untrained adults were taught to read music and play piano keyboard over a period of three months. Specific learning-related changes were seen in the superior parietal cortex and fusiform gyrus, for melody reading and rhythm reading, respectively. These changes are suggested to correspond to the acquisition of processes that deal with the extraction of spatial and featural properties of notation, respectively.


alphaII-betaV spectrin bridges the plasma membrane and cortical lattice in the lateral wall of the auditory outer hair cells.
The sensitivity and frequency selectivity of the mammalian cochlea involves a mechanical amplification process called electromotility, which requires prestin-dependent length changes of the outer hair cell (OHC) lateral wall in response to changes in membrane electric potential. The cortical lattice, the highly organized cytoskeleton underlying the OHC lateral plasma membrane, is made up of F-actin and spectrin. Here, we show that alphaII and two of the five beta-spectrin subunits, betaII and betaV, are present in OHCs. betaII spectrin is restricted to the cuticular plate, a dense apical network of actin filaments, whereas betaV spectrin is concentrated at the cortical lattice. Moreover, we show that alphaII-betaV spectrin directly interacts with F-actin and band 4.1, two components of the OHC cortical lattice. betaV spectrin is progressively recruited into the cortical lattice between postnatal day 2 (P2) and P10 in the mouse, in parallel with prestin membrane insertion, which itself parallels the maturation of cell electromotility. Although betaV spectrin does not directly interact with prestin, we found that addition of lysates derived from mature auditory organs, but not from the brain or liver, enables betaV spectrin-prestin interaction. Using this assay, betaV spectrin, via its PH domain, indirectly interacts with the C-terminal cytodomain of prestin. We conclude that the cortical network involved in the sound-induced electromotility of OHCs contains alphaII-betaV spectrin, and not the conventional alphaII-betaII spectrin.


Kupffer cell-independent acute hepatocellular oxidative stress and decreased bile formation in post-cold-ischemic rat liver.
The purpose of this study was to examine distribution and time history of oxidative stress during the hyperacute period of reperfusion in the liver grafts undergoing cold ischemia and to investigate roles of Kupffer cells as a potential oxidant source. Rat livers were harvested at 4 degrees C in University of Wisconsin solution and followed by reperfusion with Krebs-Henseleit buffer under monitoring bile excretion. To investigate oxidative changes, laser-confocal microfluorography was performed in reperfused livers preloaded with dichlorodihydrofluorescein diacetate succinimidyl ester, a fluorescence precursor sensing intracellular hydroperoxide generation. Livers undergoing the 16-hour cold storage displayed an impaired recovery of bile acid-dependent bile output concurrent with a marked increase in hydroperoxide generation in hepatocytes, which occurred as early as 5 minutes after the onset of reperfusion, whereas the status of lobular perfusion was well maintained. Pretreatment with liposome-encapsulated dichloromethylene diphosphonate, a Kupffer cell-depleting reagent, did neither alter the reperfusion-induced periportal oxidative changes nor improve the recovery of bile output in the graft. On the other hand, EPCK, a hepatotropic antioxidant composed of vitamin E phosphate ester bound to vitamin C, not only diminished the oxidative changes but also improved the reduction of bile acid-dependent bile output. Furthermore, the reagent was capable of inhibiting H(2)O(2)-induced oxidative stress in cultured hepatocytes. These results suggest that hepatocytes constitute a major site of the oxidative insult triggered through Kupffer cell-independent mechanisms and serve as an important cellular component to be protected by antioxidant therapeutics.


Imaging of Pediatric Growth Plate Disturbances.
The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. ©RSNA, 2017.


Can novice sonographers accurately locate an endotracheal tube with a saline-filled cuff in a cadaver model? A pilot study.
No single confirmatory device can accurately distinguish between endotracheal, endobronchial, and esophageal intubation. Bedside ultrasound (US) shows promising potential for endotracheal tube (ETT) verification. Image acquisition depends on the approach used and the experience of the sonographer. Air within the trachea remains a challenge for interpretation of US images. Insufflation of the ETT cuff with saline helps overcome this difficulty and allows easy visualization of the cuff. This novel approach has not been studied in ETT verification among novice sonographers. The objective was to evaluate the accuracy of novice sonographers in identifying proper ETT location and depth using US visualization of a saline-filled cuff. Eight pediatric emergency medicine (PEM) fellows without prior training in airway bedside US participated in this prospective pilot study. Baseline US knowledge was assessed using a pretraining questionnaire. Fellows received a 20-minute didactic training session focused on airway US, followed by a 30-minute practice session. Using a linear US probe placed at the suprasternal notch, fellows identified the saline-filled cuff of an ETT in both the trachea and the esophagus. Following training, the ETT was placed in either the esophagus or the trachea of the cadaver model by the principal investigator. ETT depth (adequacy) was confirmed by chest radiograph. Each PEM fellow, blinded to the placement of the ETT, used bedside US to determine ETT location and depth. If placement was determined to be tracheal, the fellow was asked to comment on adequacy of tube placement. Adequate placement was defined as complete visualization of the ETT cuff within the trachea at the suprasternal notch. This was used as a surrogate for correct depth. This study sequence was repeated five times for each trainee, following varying placement of the ETT in the trachea or esophagus. The PEM fellows displayed limited baseline knowledge of US prior to receiving the training module (average score of 50% on pretest questionnaire). None had any prior airway bedside US experience. Following training, PEM fellows correctly identified ETT location in 39 of 40 scans, with a sensitivity of 96% (23 of 24) for identifying tracheal location. The tube depth was correctly identified in 22 of 23 scans identified as tracheal intubations. PEM fellows, lacking formal airway bedside US training, were able to identify the location and depth of a saline-filled ETT above or at the suprasternal notch in an adult cadaver model following a 50-minute teaching module. Filling the ETT cuff with saline allowed novice sonographers to accurately visualize the ETT within the trachea.


Effects of percutaneous transluminal angioplasty on muscle BOLD-MRI in patients with peripheral arterial occlusive disease: preliminary results.
The purpose was to evaluate the effect of percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) on the blood oxygenation level-dependent (BOLD) signal change in the calf musculature of patients with intermittent claudication. Ten patients (mean age, 63.4+/-11.6 years) with symptomatic peripheral arterial occlusive disease (PAOD) caused by SFA stenoses were investigated before and after PTA. Patients underwent BOLD-MRI 1 day before and 6 weeks after PTA. A T2*-weighted single-shot multi-echo echo-planar MR-imaging technique was applied. The BOLD measurements were acquired at mid-calf level during reactive hyperaemia at 1.5 T. This transient hyperperfusion of the muscle tissue was provoked by suprasystolic cuff compression. Key parameters describing the BOLD signal curve included maximum T2* (T2*(max)), time-to-peak to reach T2*(max) (TTP) and T2* end value (EV) after 600 s of hyperemia. Paired t-tests were applied for statistic comparison. Between baseline and post-PTA, T2*(max) increased from 11.1+/-3.6% to 12.3+/-3.8% (p=0.51), TTP decreased from 48.5+/-20.8 s to 35.3+/-11.6 s (p=0.11) and EV decreased from 6.1+/-6.4% to 5.0+/-4.2% (p=0.69). In conclusion, BOLD-MRI reveals changes of the key parameters T2*(max), TTP, and EV after successful PTA of the calf muscles during reactive hyperaemia.


A 3-year retrospective analysis on the prevalence of antileptospiral antibodies among children in Chennai City, India.
Leptospirosis is a re-emerging infectious disease that has been reported from all over the world, including South India. Several studies have documented the prevalence of Leptospira in the general population. However, the data on leptospirosis in children were limited. We evaluated the prevalence of antileptospiral antibodies and the distribution of Leptospira serovars in children and adolescents. In this retrospective study, details for a total of 5407 children who presented with fever and whose test results for antileptospiral antibodies available were recorded. A microscopic agglutination test (MAT) was performed to detect the presence of anti-leptospiral antibodies and a titre of more than 1 : 80 was considered positive. The antigen panel included the following six serovars: Icterohaemorrhagiae, Canicola, Autumnalis, Australis, Grippotyphosa and Patoc. Demographics such as age and gender were recorded. An overall seropositivity rate of 30.8 % (95 % CI: 21.54-25.81) was observed. More male children (59 %) were infected than female children (41 %). Leptospirosis occurs throughout the year among children. Cases peak in the summer time and during the months of November and December. The most prevalent serovar in this study was L. Canicola followed by L. Australis and L. Autumnalis. This seroprevalence study suggested that leptospirosis occurs among children throughout the year in Chennai, India. This makes it almost mandatory to include it in the differential diagnosis for febrile illnesses in children. Early detection and treatment, together with control measures, may significantly reduce the spread of this endemic pathogen in this city.


Pregnancy-associated thrombosis.
The main reason for the increased risk of thromboembolism in pregnancy is hypercoagulability, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. Women are at a 4- to 5-fold increased risk of thromboembolism during pregnancy and the postpartum period compared with when they are not pregnant. Eighty percent of the thromboembolic events in pregnancy are venous, with an incidence of 0.49 to 1.72 per 1000 pregnancies. Risk factors include a history of thrombosis, inherited and acquired thrombophilia, maternal age greater than 35, certain medical conditions, and various complications of pregnancy and childbirth. Despite the increased risk of venous thromboembolism (VTE) during pregnancy and the postpartum period, most women do not require anticoagulation. Candidates include women with current VTE, a history of VTE, thrombophilia and a history of poor pregnancy outcome, or risk factors for postpartum VTE. The intensity of the anticoagulation will depend on the indication and the monitoring will depend on the intensity. At the time of delivery, anticoagulation should be manipulated to reduce the risk of bleeding complications while minimizing the risk of thrombosis. There are no large trials of anticoagulants in pregnancy, and recommendations are based on case series, extrapolations from nonpregnant patients and the opinion of experts. Nonetheless, anticoagulants are believed to improve the outcome of pregnancy for women who have, or have had, VTE.


Visual search asymmetries within color-coded and intensity-coded displays.
Color and intensity coding provide perceptual cues to segregate categories of objects within a visual display, allowing operators to search more efficiently for needed information. Even within a perceptually distinct subset of display elements, however, it may often be useful to prioritize items representing urgent or task-critical information. The design of symbology to produce search asymmetries (Treisman & Souther, 1985) offers a potential technique for doing this, but it is not obvious from existing models of search that an asymmetry observed in the absence of extraneous visual stimuli will persist within a complex color- or intensity-coded display. To address this issue, in the current study we measured the strength of a visual search asymmetry within displays containing color- or intensity-coded extraneous items. The asymmetry persisted strongly in the presence of extraneous items that were drawn in a different color (Experiment 1) or a lower contrast (Experiment 2) than the search-relevant items, with the targets favored by the search asymmetry producing highly efficient search. The asymmetry was attenuated but not eliminated when extraneous items were drawn in a higher contrast than search-relevant items (Experiment 3). Results imply that the coding of symbology to exploit visual search asymmetries can facilitate visual search for high-priority items even within color- or intensity-coded displays.


Stress-induced PARP activation mediates recruitment of Drosophila Mi-2 to promote heat shock gene expression.
Eukaryotic cells respond to genomic and environmental stresses, such as DNA damage and heat shock (HS), with the synthesis of poly-[ADP-ribose] (PAR) at specific chromatin regions, such as DNA breaks or HS genes, by PAR polymerases (PARP). Little is known about the role of this modification during cellular stress responses. We show here that the nucleosome remodeler dMi-2 is recruited to active HS genes in a PARP-dependent manner. dMi-2 binds PAR suggesting that this physical interaction is important for recruitment. Indeed, a dMi-2 mutant unable to bind PAR does not localise to active HS loci in vivo. We have identified several dMi-2 regions which bind PAR independently in vitro, including the chromodomains and regions near the N-terminus containing motifs rich in K and R residues. Moreover, upon HS gene activation, dMi-2 associates with nascent HS gene transcripts, and its catalytic activity is required for efficient transcription and co-transcriptional RNA processing. RNA and PAR compete for dMi-2 binding in vitro, suggesting a two step process for dMi-2 association with active HS genes: initial recruitment to the locus via PAR interaction, followed by binding to nascent RNA transcripts. We suggest that stress-induced chromatin PARylation serves to rapidly attract factors that are required for an efficient and timely transcriptional response.


Targeting tumor vasculature with aptamer-functionalized doxorubicin-polylactide nanoconjugates for enhanced cancer therapy.
An A10 aptamer (Apt)-functionalized, sub-100 nm doxorubicin-polylactide (Doxo-PLA) nanoconjugate (NC) with controlled release profile was developed as an intravenous therapeutic strategy to effectively target and cytoreduce canine hemangiosarcoma (cHSA), a naturally occurring solid tumor malignancy composed solely of tumor-associated endothelium. cHSA consists of a pure population of malignant endothelial cells expressing prostate-specific membrane antigen (PSMA) and is an ideal comparative tumor model system for evaluating the specificity and feasibility of tumor-associated endothelial cell targeting by A10 Apt-functionalized NC (A10 NC). In vitro, A10 NCs were selectively internalized across a panel of PSMA-expressing cancer cell lines, and when incorporating Doxo, A10 Doxo-PLA NCs exerted greater cytotoxic effects compared to nonfunctionalized Doxo-PLA NCs and free Doxo. Importantly, intravenously delivered A10 NCs selectively targeted PSMA-expressing tumor-associated endothelial cells at a cellular level in tumor-bearing mice and dramatically increased the uptake of NCs by endothelial cells within the local tumor microenvironment. By virtue of controlled drug release kinetics and selective tumor-associated endothelial cell targeting, A10 Doxo-PLA NCs possess a desirable safety profile in vivo, being well-tolerated following high-dose intravenous infusion in mice, as supported by the absence of any histologic organ toxicity. In cHSA-implanted mice, two consecutive intravenous infusions of A10 Doxo-PLA NCs exerted rapid and substantial cytoreductive activities within a period of 7 days, resulting in greater than 70% reduction in macroscopic tumor-associated endothelial cell burden as a consequence of enhanced cell death and necrosis.


Retrieval of aerosol properties and water-leaving reflectance from multi-angular polarimetric measurements over coastal waters.
Ocean color remote sensing is an important tool to monitor water quality and biogeochemical conditions of ocean. Atmospheric correction, which obtains water-leaving radiance from the total radiance measured by satellite-borne or airborne sensors, remains a challenging task for coastal waters due to the complex optical properties of aerosols and ocean waters. In this paper, we report a research algorithm on aerosol and ocean color retrieval with emphasis on coastal waters, which uses coupled atmosphere and ocean radiative transfer model to fit polarized radiance measurements at multiple viewing angles and multiple wavelengths. Ocean optical properties are characterized by a generalized bio-optical model with direct accounting for the absorption and scattering of phytoplankton, colored dissolved organic matter (CDOM) and non-algal particles (NAP). Our retrieval algorithm can accurately determine the water-leaving radiance and aerosol properties for coastal waters, and may be used to improve the atmospheric correction when apply to a hyperspectral ocean color instrument.


Clindamycin for the treatment of falciparum malaria in Sudan.
Clindamycin, 5 mg/kg twice a day for 5 days, was used to treat falciparum malaria after clinical and parasitological diagnosis at a health station in Faki Hashim, a suburb of Khartoum, Sudan. Twenty out of twenty-six patients enrolled completed the study. Giemsa-stained thick blood films were negative for asexual parasites by day 7 in 17 patients and by day 8 in the remaining 3. All were examined on days 14 or 28; 2 who had initially been cleared by day 6 had asymptomatic low density asexual parasitemia on day 14, which disappeared without treatment by day 28, and 2 others initially cleared by day 5 were similarly positive at day 28. Reinfection in these patients cannot be ruled out. Of the 6 patients withdrawn from the study, 2 took chloroquine independently, 1 developed vomiting, 1 developed diarrhea, 1 acquired a circumoral maculopapular rash, and 1 had an increasing parasitemia on day 3 and was switched to chloroquine. Generally, the treatment was without toxicity and was well received. Clindamycin proved satisfactory for the treatment of simple cases of falciparum malaria in the field in Africa.


Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus.
Long-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM). We evaluated the factors associated with durable glycemic control in a real clinical setting. We retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic control (glycosylated hemoglobin [HbA1c] <7.0%) for 2 years without substitution or adding other glucose-lowering agents. Clinical factors and glycemic markers associated with glycemic durability were compared between two groups: a durability group and a non-durability group. Patients in the durability group had a higher baseline body mass index (26.1 kg/m² vs. 24.9 kg/m²) and lower HbA1c (8.6% vs. 9.7%) than the non-durability group. The initial choice of glucose-lowering agents was similar in both groups, except for insulin and sulfonylureas, which were more frequently prescribed in the non-durability group. In multiple logistic regression analyses, higher levels of education, physical activity, and homeostasis model assessment of β-cell function (HOMA-β) were associated with glycemic durability. Notably, lower HbA1c (<7.0%) at baseline and first follow-up were significantly associated with glycemic durability (adjusted odds ratio [OR], 7.48; 95% confidence interval [CI], 2.51 to 22.3) (adjusted OR, 9.27; 95% CI, 1.62 to 53.1, respectively), after adjusting for confounding variables including the types of glucose-lowering agents. Early achievement of HbA1c level within the glycemic target was a determinant of long-term glycemic durability in new-onset T2DM, as were higher levels of education, physical activity, and HOMA-β.


%TTD and %TUDD: New SAS macro programs to calculate the survival data of the time to deterioration for patient-reported outcomes data in oncology.
Longitudinal analysis of patient-reported outcome (PRO) data remains challenging, as no standardization of statistical methods has been proposed, making comparison of PRO results between clinical trials difficult. In this context, the time to deterioration approach has recently been proposed and is regularly used as a modality of longitudinal PRO analysis in oncology. Two new SAS macro programs were developed, %TTD and %TUDD, which implement longitudinal analysis of PRO data according to the time to deterioration approach. These programs implement the recommended deterioration definitions. We described the programs with their different functionalities. The %TTD macro calculates the time to first or transient deterioration, and the %TUDD macro calculates the time until definitive deterioration. These macros allow to obtain the survival variables from the time to deterioration approach. We illustrate our programs by presenting different applications on the randomized phase II AFUGEM GERCOR clinical trial. The implementation of the deterioration definitions in SAS software allows the dissemination of this approach, in order to move toward the goal of standardization of longitudinal PRO analysis in oncology clinical trials.


Effect of coronary stenosis on myocardial blood flow during exercise in the chronically pressure-overloaded hypertrophied left ventricle.
This study was performed to determine if a coronary artery stenosis would result in more-severe perfusion abnormalities in hypertrophied compared with normal canine hearts during exercise. Studies were performed in eight normal control dogs and in seven adult dogs in which a 67% increase in left ventricular mass wa produced by banding the ascending aorta at 9 weeks of age. Myocardial blood flow was measured by the microsphere method during treadmill exercise in the presence of a coronary artery stenosis that decreased distal coronary perfusion pressure to 55 or 42 mm Hg. At a coronary pressure of 55 mm Hg, mean myocardial blood flow was decreased by 23 +/- 5% in normal control dogs but was decreased by 53 +/- 10% in dogs with left ventricular hypertrophy (LVH) (p less than 0.05, comparing normal vs. LVH dogs). Similarly, at a coronary pressure of 42 mm Hg, mean blood flow was decreased by 53 +/- 6% below control in normal dogs but was decreased by 76 +/- 5% below control values in dogs with LVH (p less than 0.01, comparing normal vs. LVH dogs). In both groups of dogs, the stenosis caused a gradient of hypoperfusion, worsening from epicardium to endocardium. However, for each level of stenosis, subendocardial blood flow and the ratio of subendocardial to subepicardial blood flow was less in LVH than in normal canine hearts. These findings demonstrate that the presence of LVH secondary to long-term pressure overload is associated with an increased vulnerability to myocardial hypoperfusion during exercise in the presence of a coronary artery stenosis.


Validation of inflationary noninvasive blood pressure monitoring in the emergency room.
The aim of this study was to compare the values of a noninvasive blood pressure (NIBP) measurement during cuff inflation (inflationary NIBP) and deflationary NIBP measurements and to verify whether inflationary NIBP is equivalent to conventional deflationary NIBP and is acceptable for clinical use in the emergency room (ER). A total of 2981 NIBP data points were collected from 175 patients (age, 56.5±22.2 years; range, 7-92 years) who had been treated in the resuscitation area of the ER at Keio University Hospital. The data points were obtained using two alternate algorithms with a standard monitor (BSM-6000). One algorithm consisted of continuous inflationary and deflationary measurements in a single cycle (dual algorithm, 1502 data points); this algorithm was used to verify the success rate and the precision of the data. The second algorithm (1479 data points) consisted of only conventional deflationary measurements and was used to verify the duration of the measurement cycle. The success rate of the inflationary NIBP (completed using only the inflationary method) was 69.0%. Failures in the inflationary measurements were caused by arrhythmia and/or body motions. The mean difference and SD of the systolic pressure and the diastolic pressure between inflationary NIBP and deflationary NIBP were -0.6±8.8 and 3.5±7.5 mmHg, respectively. The confidence intervals were -0.6 (95% confidence interval=-1.1 to -0.1) and 3.5 (95% confidence interval=3.0 to 4.0) mmHg. The coefficients of correlation were 0.96 and 0.93. Inflationary NIBP was capable of determining the NIBP more quickly compared with deflationary NIBP (average of 15.9 vs. 34.2 s; P<0.05). Inflationary NIBP measurements have a reasonable accuracy and a sufficient rapidity, compared with deflationary NIBP measurements, in ER patients.


"More bang for the buck": exploring optimal approaches for guideline implementation through interviews with international developers.
Population based studies show that guidelines are underused. Surveys of international guideline developers found that many do not implement their guidelines. The purpose of this research was to interview guideline developers about implementation approaches and resources. Semi-structured telephone interviews were conducted with representatives of guideline development agencies identified in the National Guideline Clearinghouse and sampled by country, type of developer, and guideline clinical indication. Participants were asked to comment on the benefits and resource implications of three approaches for guideline implementation that varied by responsibility: developers, intermediaries, or users. Thirty individuals from seven countries were interviewed, representing government (n = 12) and professional (n = 18) organizations that produced guidelines for a variety of clinical indications. Organizations with an implementation mandate featured widely inconsistent funding and staffing models, variable approaches for choosing promotional strategies, and an array of dissemination activities. When asked to choose a preferred approach, most participants selected the option of including information within guidelines that would help users to implement them. Given variable mandate and resources for implementation, it was considered the most feasible approach, and therefore most likely to have impact due to potentially broad use. While implementation approaches and strategies need not be standardized across organizations, the findings may be used by health care policy makers and managers, and guideline developers to generate strategic and operational plans that optimize implementation capacity. Further research is needed to examine how to optimize implementation capacity by guideline developers, intermediaries and users.


Metal Concentrations in Two Commercial Tuna Species from an Active Volcanic Region in the Mid-Atlantic Ocean.
Concentrations of cadmium (Cd), mercury (Hg), and lead [Pb (µg g(-1) wet weight)] were determined in liver and muscle samples of 15 bigeye (Thunnus obesus) and 15 skipjack tunas (Katsuwonus pelamis) caught over an active volcanic region in the Mid-Atlantic Ocean (Azores, Portugal) and evaluated regarding consumption safety. None of the muscle samples (edible part) exceeded the European Union (EU) maximum limits (MLs) for Hg and Pb. Cd concentrations in muscle were much greater than EU MLs with 53 and 26 % of the bigeye tuna and skipjack tuna, respectively, in exceedance of the limits. Results obtained in this work, together with other studies in the same region, support the existence of an important volcanic source of Cd in waters of the Mid-Atlantic region, which should be carefully monitored given the importance of many commercial marine species for human consumption, mainly in Europe.


Reframing cervical cancer prevention. Expanding the field towards prevention of human papillomavirus infections and related diseases.
The reframed paradigm of cervical cancer prevention will include strategic combinations of at least four major components: 1) routine introduction of human papillomavirus (HPV) vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. On a global scale, vaccination of newborns and infants is well established and has developed a successful working infrastructure. The hepatitis B virus (HBV) vaccination programs offer a model for HPV introduction in which newborn and infant immunization achieves a rapid reduction in the prevalence of the HBV carrier rates in immunized cohorts of children, and of liver cirrhosis and liver cancer decades later. In contrast, screening for cervical pre-cancer is largely restricted to industrialized populations and upper social classes in developing countries. The expertise gained by vaccination programs worldwide needs to be coordinated with the traditional cervical cancer prevention community of gynecologists and pathologists. Significant political and advocacy efforts at the Global level (World Health Organization, other United Nations agencies and The GAVI Alliance) need to be organized and reinforced to achieve a meaningful reduction in HPV transmission and its related health conditions and cancers. This desirable goal is now scientifically and technologically attainable, and great progress is being made in obtaining financing for global HPV immunization. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.


Distribution of Culicoides sonorensis (Diptera: Ceratopogonidae) in Nebraska, South Dakota, and North Dakota: clarifying the epidemiology of bluetongue disease in the northern Great Plains region of the United States.
The presence or absence of the biting midge Culicoides sonorensis Wirth & Jones (Diptera: Ceratopogonidae), a primary vector of bluetongue viruses (genus Orbivirus, family Reoviridae, BTV) in North America, was assessed on ranches and farms across the Northern Great Plains region of the United States, specifically Nebraska, South Dakota, and North Dakota, as part of a 2-yr regional study of BTV exposure among cattle. Blacklight/suction trap samples totaling 280 2-night intervals were taken at 140 aquatic sites (potential larval habitat for C. sonorensis) on 82 livestock operations (ranches and farms) that span a south-to-north gradient of expected decreasing risk for exposure to BTV. In Nebraska, C. sonorensis populations were common and widespread, present at 15 of 18 operations. Of 32 operations sampled in South Dakota, seven of which were sampled in successive years, 18 were positive for C. sonorensis; 13 of 14 operations located west of the Missouri River were positive, whereas 13 of 18 operations east of the river were negative. Of 32 operations sampled in North Dakota, seven of which were sampled both years, 12 were positive for C. sonorensis. Six of eight operations located west and south of the Missouri River in North Dakota were positive, whereas 18 of 24 operations east and north of the river were negative for C. sonorensis. These data illustrate a well-defined pattern of C. sonorensis spatial distribution, with populations consistently present across Nebraska, western South Dakota, and western North Dakota; western South Dakota, and North Dakota encompass the Northwestern Plains Ecoregion where soils are nonglaciated and evaporation exceeds precipitation. In contrast, C. sonorensis populations were largely absent east of the Missouri River in South Dakota and North Dakota; this area comprises the Northwestern Glaciated Plains Ecoregion and Northern Glaciated Plains Ecoregion where surface soils reflect Wisconsinan glaciation and precipitation exceeds evaporation. In defining a well-demarcated pattern of population presence or absence on a regional scale, the data suggest that biogeographic factors regulate the distribution of C. sonorensis and in turn BTV exposure. These factors, ostensibly climate and soil type as they affect the suitability of larval habitat, may explain the absence of C. sonorensis, hence limited risk for exposure to BTV, across the eastern Northern Plains, upper Midwest, and possibly Northeast, regions of the United States.


Discrete polynuclear manganese(ii) complexes with thiacalixarene ligands: synthesis, structures and photophysical properties.
The synthesis, crystal structure and photophysical properties of the new compound [Mn4(ThiaSO2)2F][K(18-crown-6)], ThiaSO2 = p-tert-butylsulphonylcalix[4]arene, are presented and compared to the ones of [Mn4(ThiaSO2)2F]K. The strong orange luminescence is attributed to the Mn(2+) centred (4)T1→(6)A1 transition. Its temperature and pressure dependence and quenching by molecular dioxygen are reported. The latter is attributed to energy transfer from the (4)T1 state exciting dioxygen to its (1)∑(+)g state. In the solid state, the quenching is much more efficient in [Mn4(ThiaSO2)2F][K(18-crown-6)] than in [Mn4(ThiaSO2)2F]K. This is attributed to the open pore structure of the former allowing fast diffusion of dioxygen into the crystal lattice.


Insights into HIV-1 proviral transcription from integrative structure and dynamics of the Tat:AFF4:P-TEFb:TAR complex.
HIV-1 Tat hijacks the human superelongation complex (SEC) to promote proviral transcription. Here we report the 5.9 Å structure of HIV-1 TAR in complex with HIV-1 Tat and human AFF4, CDK9, and CycT1. The TAR central loop contacts the CycT1 Tat-TAR recognition motif (TRM) and the second Tat Zn2+-binding loop. Hydrogen-deuterium exchange (HDX) shows that AFF4 helix 2 is stabilized in the TAR complex despite not touching the RNA, explaining how it enhances TAR binding to the SEC 50-fold. RNA SHAPE and SAXS data were used to help model the extended (Tat Arginine-Rich Motif) ARM, which enters the TAR major groove between the bulge and the central loop. The structure and functional assays collectively support an integrative structure and a bipartite binding model, wherein the TAR central loop engages the CycT1 TRM and compact core of Tat, while the TAR major groove interacts with the extended Tat ARM.


Characterization and in-vivo evaluation of a multi-resolution foveated laparoscope for minimally invasive surgery.
The state-of-the-art laparoscope lacks the ability to capture high-magnification and wide-angle images simultaneously, which introduces challenges when both close- up views for details and wide-angle overviews for orientation are required in clinical practice. A multi-resolution foveated laparoscope (MRFL) which can provide the surgeon both high-magnification close-up and wide-angle images was proposed to address the limitations of the state-of-art surgical laparoscopes. In this paper, we present the overall system design from both clinical and optical system perspectives along with a set of experiments to characterize the optical performances of our prototype system and describe our preliminary in-vivo evaluation of the prototype with a pig model. The experimental results demonstrate that at the optimum working distance of 120mm, the high-magnification probe has a resolution of 6.35lp/mm and image a surgical area of 53 × 40mm(2); the wide-angle probe provides a surgical area coverage of 160 × 120mm(2) with a resolution of 2.83lp/mm. The in-vivo evaluation demonstrates that MRFL has great potential in clinical applications for improving the safety and efficiency of the laparoscopic surgery.


Neurobehavioral effects of concurrent exposure to cesium-137 and paraquat during neonatal development in mice.
As a result of nuclear power plants accidents such as Chernobyl or Fukushima, some people were exposed to external and internal ionizing radiation (IR). Human brain is highly sensitive to IR during fetal and postnatal period when the molecular processes are not completely finished. Various studies have shown that exposure to low doses of IR causes a higher incidence of cognitive impairment. On the other hand, in industrialized countries, people are daily exposed to a number of toxicant pollutants. Exposure to environmental chemicals, such as paraquat (PQ), may potentiate the toxic effects induced by radiation on brain development. In this study, we evaluated the cognitive effects of concomitant exposure to low doses of internal radiation ((137)Cs) and PQ during neonatal brain development. At the postnatal day 10 (PND10), two groups of mice (C57BL/6J) were exposed to (137)Cs (4000 and 8000 Bq/kg) and/or PQ (7 mg/kg). To investigate the spontaneous behavior, learning, memory capacities and anxiety, behavioral tests were conducted in the offspring at two months of age. The results showed that cognitive functions were not significantly affected when (137)Cs or PQ were administered alone. However, alterations in the working memory and anxiety were detected in mice exposed to (137)Cs combined with PQ.


Isolation and characterization of cultured human conjunctival goblet cells.
To isolate and characterize goblet cells from normal human conjunctival tissue to determine whether epidermal growth factor (EGF) receptors are present and whether EGF can influence goblet cell proliferation. Goblet cells were isolated from explant cultures established from normal conjunctival tissue harvested from patients during periocular surgery. The cells were grown in RPMI culture medium supplemented with 10% fetal bovine serum and characterized using morphology, histochemistry, indirect immunofluorescence microscopy, molecular biology, and biochemistry. Proliferation was determined with a MTT proliferation assay after exposing goblet cells, which had been serum deprived for 48 hours, to increasing concentrations of epidermal growth factor (EGF; 0-80 ng/mL) for 24 hours. Goblet cells were isolated from conjunctival explants by scraping nongoblet cells from the culture dish. Human goblet cells exhibited positive reactivity with alcian blue-periodic acid Schiff (PAS) reagent, goblet cell-specific cytokeratin-7, HPA lectin, and MUC5AC, but negative reactivity to the stratified squamous epithelial cell marker, cytokeratin-4. The mRNA for MUC5AC was detected using RT-PCR. The presence of the EGF receptors EGFR, ErbB2, and ErbB3 was confirmed through Western blot analysis of cell lysates. EGF elicited a concentration-dependent increase in goblet cell proliferation of 160% +/- 0.5%, 188% +/- 0.45%, 293% +/- 1.3%, and 220% +/- 0.5% of control values with 10, 20, 40, and 80 ng/mL EGF, respectively. Human goblet cells that retain characteristics of goblet cells in vivo can be cultured. EGF receptors are present in human goblet cells, and EGF stimulates their proliferation.


[Exclusive breastfeeding among working women with free daycare available at workplace].
To investigate factors related to the decision of exclusive breastfeeding, and the planned and the actual duration among working women with free daycare available at workplace. A qualitative study was conducted comparing a group of 15 women exclusively breastfeeding their babies with a similar group of women whose babies were already being fed with other food besides maternal milk at the time they started attending a daycare center. Semi-structured interviews and focus groups were carried out for data collection. The factors related to the decision of breastfeeding and maintaining it when women went back to work were: the desire to breastfeed based on the importance women of both groups as well as their husbands and significant others attributed to it. The duration of exclusive breastfeeding was mainly associated to the baby's pediatrician counseling, which differed in each group. The availability of free daycare center at the work place seems an important aspect to breastfeeding maintenance after women go back to work, especially regarding exclusive breastfeeding. The duration of exclusive breastfeeding was related to the information received before and during pregnancy, and also in the postpartum. Women who have exclusively breastfed for almost six months believed the longer they breastfeed the better to their babies' health, while other women believed that three months of exclusive breastfeeding would be enough.


Somatodendritic internalization and perinuclear targeting of neurotensin in the mammalian brain.
Polypeptide hormones and growth factors have long been known to internalize into peripheral target cells as a result of their interaction with cell surface receptors. Studies in culture have suggested that certain neuropeptides might undergo a similar type of translocation in neurons. To investigate this possibility in adult mammalian brain, we have examined by confocal laser microscopy the events that follow the binding of fluorescein-tagged derivatives of the tridecapeptide neurotensin to basal forebrain cholinergic cells. Our results demonstrate a selective time- and temperature-dependent internalization of fluo-neurotensin in these cells. This internalization is receptor mediated, proceeds from the entire somatodendritic membrane of the cells, and utilizes endosome-like organelles which are mobilized from dendrites to perikarya and from the periphery of the cell to its perinuclear region. Parallel studies carried out on Sf9 insect cells expressing the rat neurotensin receptor from a recombinant baculovirus indicated that the internalization process involves receptor-ligand complexes and not merely the fluorescent peptide itself. These data suggest that receptor internalization plays a role in neuropeptide signaling in the brain and that it can be harnessed for selective identification of neuropeptide target cells.


Femtosecond holography in lithium niobate crystals.
Spatial gratings are recorded holographically by two femtosecond pump pulses at 388 nm in lithium niobate (LiNbO3) crystals and read out by a Bragg-matched, temporally delayed probe pulse at 776 nm. We claim, to our knowledge, the first holographic pump-probe experiments with subpicosecond temporal resolution for LiNbO3. An instantaneous grating that is due mostly to the Kerr effect as well as a long-lasting grating that results mainly from the absorption caused by photoexcited carriers was observed. The Kerr coefficient of LiNbO3 for our experimental conditions, i.e., pumped and probed at different wavelengths, was approximately 1.0 x 10(-5) cm2/GW.


A theory of reactant-stationary kinetics for a mechanism of zymogen activation.
A theoretical analysis is performed on the nonlinear ordinary differential equations that govern the dynamics of a reaction mechanism of zymogen activation. The reaction consists of a primary non-observable zymogen activation reaction that it is coupled to an indicator (observable) reaction. The product of the first reaction is the enzyme of the indicator reaction, and both reactions are governed by the Michaelis-Menten reaction mechanism. Using singular perturbation methods, we derive asymptotic solutions that are valid under the quasi-steady-state and reactant-stationary assumptions. In particular, we obtain closed form solutions that are analogous to the Schnell-Mendoza equation for Michaelis-Menten type reactions. These closed-form solutions approximate the evolution of the observable reaction and provide the mathematical link necessary to measure the enzyme activity of the non-observable reaction. Conditions for the validity of the asymptotic solutions are also derived, and we demonstrate that these asymptotic expressions are applicable under reactant-stationary kinetics.


Can infection after anterior cruciate ligament surgery be prevented by inserting a Hemovac drain into graft donor site?
This study aims to investigate the effect of Hemovac drainage placed in graft harvesting area on preventing deep surgical site infection (SSI) and/or septic arthritis through draining the hematoma formed in the graft area in arthroscopic primary anterior cruciate ligament (ACL) reconstruction surgery using hamstring autograft. This retrospective study was conducted between January 2008 and March 2019. A total of 819 patients (769 males, 50 females; mean age 33.7 years; range, 25 to 41 years) who underwent arthroscopic primary ACL reconstruction surgery using hamstring autograft were divided into two groups based on whether a Hemovac drain was also placed at the hamstring graft harvested area. Both groups were compared in terms of the presence of deep SSI and/or development of septic arthritis. In the non-drained group (group 1, n=401), 16 patients (3.9%) had septic arthritis, four (0.9%) had deep SSI, and two (0.49%) had both wound and joint infections. Septic arthritis was identified in only one patient (0.2%) in the drained group (group 2, n=418). In group 2, the mean amount of blood coming from the drain at the graft harvesting region was 36.85 mL (range, 20-50 mL). In arthroscopic primary ACL reconstruction surgery using hamstring tendon autograft, we concluded that the use of a Hemovac drain could be effective in preventing deep SSI through reducing the hematoma occurring in this region. However, future studies are needed to validate the effect of Hemovac drain on preventing the septic arthritis.


RETRACTED: Nut consumption with risk of hypertension and type 2 diabetes mellitus: A meta-analysis of prospective cohort studies.
The consumption of nuts was reported to be associated with risk of hypertension and type 2 diabetes mellitus (T2DM), but the results were inconclusive. The aim of this study was to systematically examine longitudinal studies investigating nut intake in relation to risk of hypertension and T2DM. A systematic search of the PubMed and EMBASE databases to 31 March 2013 was performed. Reference lists of retrieved articles were also screened. Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Q and I2 statistics were used to examine between-study heterogeneity. A total of nine prospective cohort studies (three for hypertension and six for T2DM) were identified. Using random effects models, we found that based on the highest vs lowest analysis, nut consumption were inversely associated with risk of hypertension (SRR = 0.84, 95% CI: 0.76-0.93, pheterogeneity = 0.831, I2 = 0%). Dose-response analyses indicated that nut consumption at more than two servings/wk, but not ne serving/wk, had a preventative role in the hypertension. In addition, nut consumption was not associated with risk of T2DM (SRRs = 0.98, 95% CI: 0.84-1.15; pheterogeneity = 0.008, I2 = 67.7%) on the basis of the highest vs lowest analysis. This null association was also shown in the dose-response analysis. In our meta-analysis, nut consumption is found to be inversely associated with hypertension risk but is not associated with the risk of T2DM.


Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.
In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g/m(2), p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.