Workplace breastfeeding support for hospital employees.
Breastfeeding initiation rates have been steadily rising in Hong Kong, but most employed women wean prior to returning to work. While health care providers promote breastfeeding, women receive little support from employers. A few health care facilities offer some workplace breastfeeding support, but little is known about the specific types and amount of support that are offered. This paper reports a study whose aim was to describe workplace supports available to breastfeeding women employed by hospitals that provide maternity services in Hong Kong, and to determine if differences in workplace supports exist based on the hospitals' numbers of employees or funding source. In late 2001, a cross-sectional survey was completed by nurse managers or lactation consultants most knowledgeable about supports to breastfeeding employees in 19 hospitals. The number of workplace breastfeeding supports or Breastfeeding Support Score (M = 7.47; sd = 3.37) varied considerably. Mean Breastfeeding Support Score for government-funded hospitals was significantly higher (t = 2.31; P = 0.03) than for private hospitals. Of the 14 hospitals that had a designated space for using a breast pump, only five (26.3%) had a private room with a door that locked. Only two hospitals (11.1%) allowed employees to take breaks as needed to use a pump; employees in 10 (55.6%) had to use their meal and regular break times. Hospitals having a hospital-wide committee that addressed workplace breastfeeding issues had a more supportive environment for breastfeeding employees. Although all surveyed hospitals returned the questionnaire, the sample size was small. It was difficult to ensure accuracy and to differentiate subtle variations in the services provided using a self-report survey. Facilitating continued breastfeeding after employees' return to work requires that employers understand the needs of breastfeeding employees. Policy at the level of the employer and government is an essential component of creating a supportive environment.


Choice, rate of reinforcement, and the changeover delay.
Pigeons distribute their responses on concurrently available variable-interval schedules in the same proportion as reinforcements are distributed on the two schedules only when a changeover delay is used. The present study shows that this equality between proportions of responses and proportions of reinforcements ("matching") is obtained when the value of the changeover delay is varied. When responses are partitioned into the set of rapid response bursts occurring during the delay interval and the set of responses occurring subsequently, the proportion of neither set of responses matches the proportion of reinforcements. Instead, each set deviates from matching but in opposite directions. Matching on the gross level results from the interaction of two patterns evident in the local response rates: (I) the lengthening of the changeover delay response burst is accompanied by a commensurate decrease in the number of changeovers; (2) the changeover delay response burst is longer than the scheduled delay duration. When delay responses are eliminated by introducing a blackout during the delay interval, response matching is eliminated; the pigeon, however, continues to match the proportion of time spent responding on a key to the proportion of reinforcements obtained on that key.


Decreasing cx36 gap junction coupling compensates for overactive KATP channels to restore insulin secretion and prevent hyperglycemia in a mouse model of neonatal diabetes.
Mutations to the ATP-sensitive K(+) channel (KATP channel) that reduce the sensitivity of ATP inhibition cause neonatal diabetes mellitus via suppression of β-cell glucose-stimulated free calcium activity ([Ca(2+)]i) and insulin secretion. Connexin-36 (Cx36) gap junctions also regulate islet electrical activity; upon knockout of Cx36, β-cells show [Ca(2+)]i elevations at basal glucose. We hypothesized that in the presence of overactive ATP-insensitive KATP channels, a reduction in Cx36 would allow elevations in glucose-stimulated [Ca(2+)]i and insulin secretion to improve glucose homeostasis. To test this, we introduced a genetic knockout of Cx36 into mice that express ATP-insensitive KATP channels and measured glucose homeostasis and islet metabolic, electrical, and insulin secretion responses. In the normal presence of Cx36, after expression of ATP-insensitive KATP channels, blood glucose levels rapidly rose to >500 mg/dL. Islets from these mice showed reduced glucose-stimulated [Ca(2+)]i and no insulin secretion. In mice lacking Cx36 after expression of ATP-insensitive KATP channels, normal glucose levels were maintained. Islets from these mice had near-normal glucose-stimulated [Ca(2+)]i and insulin secretion. We therefore demonstrate a novel mechanism by which islet function can be recovered in a monogenic model of diabetes. A reduction of gap junction coupling allows sufficient glucose-stimulated [Ca(2+)]i and insulin secretion to prevent the emergence of diabetes.


Superbunching and Nonclassicality as new Hallmarks of Superradiance.
Superradiance, i.e., spontaneous emission of coherent radiation by an ensemble of two-level atoms in collective states introduced by Dicke in 1954, is one of the enigmatic problems of quantum optics. The startling gist is that even though the atoms have no dipole moment they radiate with increased intensity in particular directions. Following the advances in our understanding of superradiant emission by atoms in entangled W-states we examine the quantum statistical properties of superradiance. Such investigations require the system to have at least two excitations in order to explore the photon-photon correlations of the radiation emitted by such states. We present specifically results for the spatially resolved photon-photon correlations of systems prepared in doubly excited W-states and give conditions when the atomic system emits nonclassial light. Equally, we derive the conditions for the occurrence of bunching and even of superbunching, a rare phenomenon otherwise known only from nonclassical states of light like the squeezed vacuum. We finally investigate the photon-photon cross correlations of the spontaneously scattered light and highlight the nonclassicalty of such correlations. The theoretical findings can be implemented with current technology, e.g., using ions in a linear rf-trap, atoms in an optical lattice or quantum dots in a cavity.


Limited efficacy of injectable aminosidine as single-agent therapy for Colombian cutaneous leishmaniasis.
Ninety military patients with cutaneous leishmaniasis in Colombia were randomly allocated to 3 treatment regimens of parenteral aminosidine sulphate: (i) 12 mg aminosidine base/kg/d for 7 d, (ii) 12 mg/kg/d for 14 d, and (iii) 18 mg/kg/d for 14 d. With the 89 evaluable patients, the cure rates 12 months after the end of treatment were 10%, 45%, and 50%, respectively. Fifty-eight of the 66 patients who were not cured had lesions that enlarged or were unchanged by 1.5 months after treatment follow up. The other 8 patients had lesions that relapsed between 3 and 12 months after therapy. Even in group (iii) the cure rate was inferior to that (> 90%) with antimony or pentamidine previously reported in this patient population. This study indicates that parenteral aminosidine alone is less likely to be successful in the treatment of cutaneous lesihmaniasis than visceral leishmaniasis, for which a 74% cure rate has been reported. Further trials might consider the combination of aminosidine with other antileishmanial drugs.


Blind image restoration with eigen-face subspace.
Performance of conventional image restoration methods is sensitive to signal-to-noise ratios. For heavily blurred and noisy human facial images, information contained in the eigen-face subspace can be used to compensate for the lost details. The blurred image is decomposed into the eigen-face subspace and then restored with a regularized total constrained least square method. With Generalized cross-validation, a cost function is deduced to include two unknown parameters: the regularization factor and one parameter relevant to point spread function. It is shown that, in minimizing the cost function, the cost function dependence of any one unknown parameter can be separated from the other one, which means the cost function can be considered roughly, depending on single variable in an iterative algorithm. With realistic constraints on the regularized factor, a global minimum for the cost function is achieved to determine the unknown parameters. Experiments are presented to demonstrate the effectiveness and robustness of the new method.


The inclusion of functional connectivity information into fMRI-based neurofeedback improves its efficacy in the reduction of cigarette cravings.
Real-time fMRI (rtfMRI) neurofeedback (NF) facilitates volitional control over brain activity and the modulation of associated mental functions. The NF signals of traditional rtfMRI-NF studies predominantly reflect neuronal activity within ROIs. In this study, we describe a novel rtfMRI-NF approach that includes a functional connectivity (FC) component in the NF signal (FC-added rtfMRI-NF). We estimated the efficacy of the FC-added rtfMRI-NF method by applying it to nicotine-dependent heavy smokers in an effort to reduce cigarette craving. ACC and medial pFC as well as the posterior cingulate cortex and precuneus are associated with cigarette craving and were chosen as ROIs. Fourteen heavy smokers were randomly assigned to receive one of two types of NF: traditional activity-based rtfMRI-NF or FC-added rtfMRI-NF. Participants received rtfMRI-NF training during two separate visits after overnight smoking cessation, and cigarette craving score was assessed. The FC-added rtfMRI-NF resulted in greater neuronal activity and increased FC between the targeted ROIs than the traditional activity-based rtfMRI-NF and resulted in lower craving score. In the FC-added rtfMRI-NF condition, the average of neuronal activity and FC was tightly associated with craving score (Bonferroni-corrected p = .028). However, in the activity-based rtfMRI-NF condition, no association was detected (uncorrected p > .081). Non-rtfMRI data analysis also showed enhanced neuronal activity and FC with FC-added NF than with activity-based NF. These results demonstrate that FC-added rtfMRI-NF facilitates greater volitional control over brain activity and connectivity and greater modulation of mental function than activity-based rtfMRI-NF.


Distinct metabolic programs established in the thymus control effector functions of γδ T cell subsets in tumor microenvironments.
Metabolic programming controls immune cell lineages and functions, but little is known about γδ T cell metabolism. Here, we found that γδ T cell subsets making either interferon-γ (IFN-γ) or interleukin (IL)-17 have intrinsically distinct metabolic requirements. Whereas IFN-γ+ γδ T cells were almost exclusively dependent on glycolysis, IL-17+ γδ T cells strongly engaged oxidative metabolism, with increased mitochondrial mass and activity. These distinct metabolic signatures were surprisingly imprinted early during thymic development and were stably maintained in the periphery and within tumors. Moreover, pro-tumoral IL-17+ γδ T cells selectively showed high lipid uptake and intracellular lipid storage and were expanded in obesity and in tumors of obese mice. Conversely, glucose supplementation enhanced the antitumor functions of IFN-γ+ γδ T cells and reduced tumor growth upon adoptive transfer. These findings have important implications for the differentiation of effector γδ T cells and their manipulation in cancer immunotherapy.


Cephalometric Evaluation of Children with Allergic Rhinitis and Mouth Breathing.
Orthodontists frequently treat children with mouth breathing. The purpose of the present study was to examine dental positions, skeletal effects and the pharyngeal airway space of children with chronic allergic rhinitis, when compared with a control group exhibiting a normal breathing pattern. Seventy Caucasian children from Santa Maria University Hospital - North Lisbon Hospital Center were evaluated, between September 2009 and February 2013. The study group comprised of 35 children with chronic allergic rhinitis, both genders, aged 5 - 14, with positive reaction to allergens, mouth breathing and malocclusion. The control group was composed of 35 children, both genders, displaying normal nasal breathing and malocclusion, who resorted to the orthodontic department. Measures of Ricketts, Steiner and McNamara's analysis were used and the t- Student test was applied to the data obtained. Statistically significant differences were observed between the oral and nasal breathers, respectively: lower facial height (49.1/45.9 mm), Frankfurt â mandibular plane angle (30.1/26.9º) and Sela-Nasion - oclusal plane angle (17.3/15º), maxillary length (78.4/82.4 mm), mandibular length (102.4/107 mm), overbite (0.8/3.1mm) and overjet (4/4.7 mm). Comparison between the allergic rhinitis and control group showed that there is an increased lower facial height, larger Frankfurt â mandibular plane angle and Sela-Nasion oclusal plane angle in children with chronic allergic rhinitis. This group also had a shorter maxillary and mandibular length, less overbite and decreased upper airway space. Children with allergic rhinitis and mouth breathing have longer faces, shorter maxillas and mandibles and a narrowed pharyngeal airway space. No statistical differences between the groups in sagital relationships or in dental inclinations were found.


Global health development assistance remained steady in 2013 but did not align with recipients' disease burden.
Tracking development assistance for health for low- and middle-income countries gives policy makers information about spending patterns and potential improvements in resource allocation. We tracked the flows of development assistance and explored the relationship between national income, disease burden, and assistance. We estimated that development assistance for health reached US$31.3 billion in 2013. Increased assistance from the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the GAVI Alliance; and bilateral agencies in the United Kingdom helped raise funding to the highest level to date. The largest portion of health assistance targeted HIV/AIDS (25 percent); 20 percent targeted maternal, newborn, and child health. Disease burden and economic development were significantly associated with development assistance for health, but many countries received considerably more or less aid than these indicators predicted. Five countries received more than five times their expected amount of health aid, and seven others received less than one-fifth their expected funding. The lack of alignment between disease burden, income, and funding reveals the potential for improvement in resource allocation.


Adipokines mediate inflammation and insulin resistance.
For many years, adipose tissue was considered as an inert energy storage organ that accumulates and stores triacylglycerols during energy excess and releases fatty acids in times of systemic energy need. However, over the last two decades adipose tissue depots have been established as highly active endocrine and metabolically important organs that modulate energy expenditure and glucose homeostasis. In rodents, brown adipose tissue plays an essential role in non-shivering thermogenesis and in energy dissipation that can serve to protect against diet-induced obesity. White adipose tissue collectively referred too as either subcutaneous or visceral adipose tissue is responsible for the secretion of an array of signaling molecules, termed adipokines. These adipokines function as classic circulating hormones to communicate with other organs including brain, liver, muscle, the immune system, and adipose tissue itself. The dysregulation of adipokines has been implicated in obesity, type 2 diabetes, and cardiovascular disease. Recently, inflammatory responses in adipose tissue have been shown as a major mechanism to induce peripheral tissue insulin resistance. Although leptin and adiponectin regulate feeding behavior and energy expenditure, these adipokines are also involved in the regulation of inflammatory responses. Adipose tissue secretes various pro- and anti-inflammatory adipokines to modulate inflammation and insulin resistance. In obese humans and rodent models, the expression of pro-inflammatory adipokines is enhanced to induce insulin resistance. Collectively, these findings have suggested that obesity-induced insulin resistance may result, at least in part, from an imbalance in the expression of pro- and anti-inflammatory adipokines. Thus we will review the recent progress regarding the physiological and molecular functions of adipokines in the obesity-induced inflammation and insulin resistance with perspectives on future directions.


Study of the properties of phosphorylating D-glyceraldehyde-3-phosphate dehydrogenase.
The properties of the active center of phosphorylating D-glyceraldehyde-3-phosphate dehydrogenase (GAPDH) are considered with emphasis on the structure of anion-binding sites and their role in catalysis. The results of studies on the molecular mechanism of the effect of NAD+ on the enzyme conformation are discussed. Experimental evidence is presented supporting the idea that negative cooperativity of NAD+ binding and half-of-the-sites reactivity exhibited by GAPDH are generated by different mechanisms. Data obtained with rabbit muscle and Escherichia coli GAPDH point to preexisting asymmetry in these tetramers. Structural determinants that can control the transition of the tetramer from the symmetric to the asymmetric state were found.


Comparison of retention characteristics of Essix and Hawley retainers.
We aimed to compare the retention characteristics of Essix and Hawley retainers. Adolescents undergoing fixed appliance treatment at 2 centers were recruited for this study. Twenty-two patients (16 women and 6 men) wore Essix retainers (Essix group) while 20 (14 women and 6 men) wore Hawley retainers (Hawley group). The mean retention time was 1 year, and the mean follow-up recall time for both groups was 2 years. Two qualified dental examiners evaluated the blind patient data. Maxillary and mandibular dental casts and lateral cephalograms were analyzed at 4 stages: pretreatment (T1), post-treatment (T2), post-retention (T3), and follow-up (T4). The results revealed that Essix appliances were more efficient in retaining the anterior teeth in the mandible during a 1-year retention period. The irregularity index increased in both arches in both groups after a 2-year post-retention period. The mandibular arch lengths increased during treatment and tended to return to their original value after retention in both groups; however, these changes were statistically significant only in the Hawley group. Cephalometric variables did not show any significant differences. The retention characteristics of both Essix and Hawley retainers are similar.


Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall.
PBR characterizes penetration of red blood cells inside glycocalyx and its thickness can have profound impact on microcirculation and other vascular parameters. The goal of our study was to reliably quantify PBR and assess its potential use as a new marker of cardiovascular pathology. The study included 208 patients (123 men and 85 women from 40 to 65 years of age) with various grades of cardiovascular SCORE risk index and IHD. PBR was quantified by sidestream dark field capillaroscopy with green light excitation. Cutaneous microcirculation was evaluated with laser Doppler fluorometry. Elevated PBR values over 2 mm were associated with morphological and functional lesions of arterial wall and microcirculation and lowered levels of ApoA1 lipoprotein. Moreover, elevated PBR values were associated with 2.07-fold increase in prevalence of cerebral atherosclerosis (P = .015) and 2.42-fold increase in prevalence of IHD (P = .024). Increase in PBR was associated with elevated systolic blood pressure. Thus, PBR can be considered a new highly reproducible and promising marker candidate for non-invasive diagnostics of IHD and cerebral atherosclerosis suggesting important role of microcirculation in development and progression of cardiovascular diseases.


Poxvirus targeting of E3 ligase β-TrCP by molecular mimicry: a mechanism to inhibit NF-κB activation and promote immune evasion and virulence.
The transcription factor NF-κB is essential for immune responses against pathogens and its activation requires the phosphorylation, ubiquitination and proteasomal degradation of IκBα. Here we describe an inhibitor of NF-κB from vaccinia virus that has a closely related counterpart in variola virus, the cause of smallpox, and mechanistic similarity with the HIV protein Vpu. Protein A49 blocks NF-κB activation by molecular mimicry and contains a motif conserved in IκBα which, in IκBα, is phosphorylated by IKKβ causing ubiquitination and degradation. Like IκBα, A49 binds the E3 ligase β-TrCP, thereby preventing ubiquitination and degradation of IκBα. Consequently, A49 stabilised phosphorylated IκBα (p-IκBα) and its interaction with p65, so preventing p65 nuclear translocation. Serine-to-alanine mutagenesis within the IκBα-like motif of A49 abolished β-TrCP binding, stabilisation of p-IκBα and inhibition of NF-κB activation. Remarkably, despite encoding nine other inhibitors of NF-κB, a VACV lacking A49 showed reduced virulence in vivo.


Comparison of the genome of the oral pathogen Treponema denticola with other spirochete genomes.
We present the complete 2,843,201-bp genome sequence of Treponema denticola (ATCC 35405) an oral spirochete associated with periodontal disease. Analysis of the T. denticola genome reveals factors mediating coaggregation, cell signaling, stress protection, and other competitive and cooperative measures, consistent with its pathogenic nature and lifestyle within the mixed-species environment of subgingival dental plaque. Comparisons with previously sequenced spirochete genomes revealed specific factors contributing to differences and similarities in spirochete physiology as well as pathogenic potential. The T. denticola genome is considerably larger in size than the genome of the related syphilis-causing spirochete Treponema pallidum. The differences in gene content appear to be attributable to a combination of three phenomena: genome reduction, lineage-specific expansions, and horizontal gene transfer. Genes lost due to reductive evolution appear to be largely involved in metabolism and transport, whereas some of the genes that have arisen due to lineage-specific expansions are implicated in various pathogenic interactions, and genes acquired via horizontal gene transfer are largely phage-related or of unknown function.


Development and validation of a patient-reported outcome measure in vitiligo: The Self Assessment Vitiligo Extent Score (SA-VES).
The Vitiligo Extent Score (VES) has recently been introduced as a physicians' score for the clinical assessment of the extent of vitiligo, but a good patient self-assessment score is lacking. The objective is to develop and validate a simplified version of the VES as a patient-reported outcome measure (PROM). After extensive pilot testing, patients were asked to score their vitiligo extent twice with an interval of 2 weeks using the Self Assessment Vitiligo Extent Score (SA-VES). The scores were compared with the physicians' evaluation (VES). The SA-VES demonstrated very good test-retest reliability (intraclass correlation = 0.948, 95% confidence interval [CI]: 0.911-0.970) that was not affected by age, skin type, or vitiligo distribution pattern. According to patients, this evaluation method was easy to use (22% very easy; 49% easy; 29% normal) and required <5 minutes in the majority of patients (73%, <5 minutes; 24%, 5-10 minutes; 2%, 10-15 minutes). Comparison of the SA-VES and the VES demonstrated excellent correlation (r = 0.986, P <.001). Few patients had a dark skin type. The results demonstrate excellent reliability of the SA-VES and excellent correlation with its investigator-reported counterpart (VES). This patient-oriented evaluation method provides a useful tool for the assessment of vitiligo extent.


Human Ogg1, a protein involved in the repair of 8-oxoguanine, is inhibited by nitric oxide.
NO-mediated inhibition of base excision DNA repair may potentiate oxidativeDNA damage in cells and could be relevant to carcinogenesis associated with chronic inflammation. Because 8-oxoguanine, a ubiquitous oxidative DNA lesion, is repaired predominantly by human 8-oxoguanine glycosylase (hOgg1), our aim was to determine whether NO directly inhibits its repair activity. Neither induction of NO-generating enzyme inducible NO synthase nor treatment with S-nitroso-N-acetyl-D-L-pencillamine altered expression of hOgg1 in a human cholangiocarcinoma cell line (KMBC). In contrast, both treatments completely inhibited activity of hOgg1 immunoprecipitated from KMBC cells overexpressing hOgg1 and in a cell-free system. Both NO and peroxynitrite were capable of inhibiting hOgg1 activity. Inhibition of hOgg1 protein was characterized by formation of S-nitrosothiol adducts and loss/ejection of zinc ions. Our data indicate that NO, an inflammatory mediator, directly inhibits a key base excision repair enzyme (hOgg1) responsible for base excision repair of 8-oxoguanine. These data support the concept that NO-mediated inhibition of DNA contributes to the mutagenic environment of chronic inflammation.


Cardiac Biomarkers in Pediatric Cardiomyopathy: Study Design and Recruitment Results from the Pediatric Cardiomyopathy Registry.
Cardiomyopathies are a rare cause of pediatric heart disease, but they are one of the leading causes of heart failure admissions, sudden death, and need for heart transplant in childhood. Reports from the Pediatric Cardiomyopathy Registry (PCMR) have shown that almost 40% of children presenting with symptomatic cardiomyopathy either die or undergo heart transplant within 2 years of presentation. Little is known regarding circulating biomarkers as predictors of outcome in pediatric cardiomyopathy. The Cardiac Biomarkers in Pediatric Cardiomyopathy (PCM Biomarkers) study is a multi-center prospective study conducted by the PCMR investigators to identify serum biomarkers for predicting outcome in children with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Patients less than 21 years of age with either DCM or HCM were eligible. Those with DCM were enrolled into cohorts based on time from cardiomyopathy diagnosis: categorized as new onset or chronic. Clinical endpoints included sudden death and progressive heart failure. There were 288 children diagnosed at a mean age of 7.2±6.3 years who enrolled in the PCM Biomarkers Study at a median time from diagnosis to enrollment of 1.9 years. There were 80 children enrolled in the new onset DCM cohort, defined as diagnosis at or 12 months prior to enrollment. The median age at diagnosis for the new onset DCM was 1.7 years and median time from diagnosis to enrollment was 0.1 years. There were 141 children enrolled with either chronic DCM or chronic HCM, defined as children ≥2 years from diagnosis to enrollment. Among children with chronic cardiomyopathy, median age at diagnosis was 3.4 years and median time from diagnosis to enrollment was 4.8 years. The PCM Biomarkers study is evaluating the predictive value of serum biomarkers to aid in the prognosis and management of children with DCM and HCM. The results will provide valuable information where data are lacking in children. https://clinicaltrials.gov/ct2/show/NCT01873976?term=PCM+Biomarker&rank=1.


A novel microwire interface for small diameter peripheral nerves in a chronic, awake murine model.
The vagus nerve has been implicated in a variety of immune responses, and the number of studies using mouse models to unravel key mechanisms has increased. However, as of yet, there is no electrode that can chronically record neural activity from the mouse vagus nerve due to its small diameter. Such recordings are critical to understand the role of these biomarkers for translational research. In this study, we developed a methodology for surgically implanting the wrappable microwires onto the vagus nerve of mice. Similar to a cuff electrode, we wrapped de-insulated ends of microwires around the vagus nerve and re-insulated them on the nerve with Kwik-Sil. The recording fidelity of the wrappable microwire on the vagus nerve was validated in an acute, anesthetized model by comparing performance to commercially-available electrodes. A chronic, awake mouse model was then developed to record spontaneous compound action potentials (CAPs). In an acute setting, the wrappable microwire successfully recorded spontaneous CAPs with similar signal-to-noise ratios (SNR) and peak-to-peak amplitude to commercially available electrodes. In chronic, awake recordings, viable SNRs were obtained from the wrappable microwires between 30 and 60 d (n = 8). Weekly impedance measurements showed no correlation with SNR or time, indicating device stability, and the electrodes recorded CAPs for the duration of the recording period. To the best of our knowledge, this is the first reported chronic, awake neural interface with the mouse vagus nerve. This approach can facilitate clinical translation for bioelectronic medicine in preclinical disease models of interest with the creation of more clinically relevant preclinical models.


Epidemiology of fractures in England and Wales.
Records from the General Practice Research Database were used to derive age- and gender-specific fracture incidence rates for England and Wales during the period 1988-1998. In total, 103,052 men and 119,317 women in the sample of 5 million adults sustained a fracture over 10.4 million and 11.2 million person-years (py) of follow-up. Among women, the most frequent fracture sites were the radius/ulna (30.2 cases per 10,000 py) and femur/hip (17.0 per 10,000 py). In men, the most common fracture was that of the carpal bones (26.2 per 10,000 py); the incidence of femur/hip fracture was 5.3 per 10,000 py. Varying patterns of fracture incidence were observed with increasing age; whereas some fractures became more common in later life (vertebral, distal forearm, hip, proximal humerus, rib, clavicle, pelvis), others were more frequent in childhood and young adulthood (tibia, fibula, carpus, foot, ankle). The lifetime risk of any fracture was 53.2% at age 50 years among women, and 20.7% at the same age among men. Whereas fractures of the proximal femur and vertebral body were associated with excess mortality over a 5 year period following fracture diagnosis among both men and women, fractures of the distal forearm were associated with only slight excess mortality in men. This study provides robust estimates of fracture incidence that will assist health-care planning and delivery.


Community acquired bacteremia in young children from central Nigeria--a pilot study.
Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area. Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site. 969 children aged 2 months-5 years were evaluated. Mean age was 21±15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge. S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.


Altitude preexposure recommendations for inducing acclimatization.
For many low-altitude (<1500 m) residents, their travel itineraries may cause them to ascend rapidly to high (>2400 m) altitudes without having the time to develop an adequate degree of altitude acclimatization. Prior to departing on these trips, low-altitude residents can induce some degree of altitude acclimatization by ascending to moderate (>1500 m) or high altitudes during either continuous or intermittent altitude preexposures. Generally, the degree of altitude acclimatization developed is proportional to the altitude attained and the duration of exposure. The available evidence suggests that continuous residence at 2200 m or higher for 1 to 2 days or daily 1.5- to 4-h exposures to >4000 m induce ventilatory acclimatization. Six days at 2200 m substantially decreases acute mountain sickness (AMS) and improves work performance after rapid ascent to 4300 m. There is evidence that 5 or more days above 3000 m within the last 2 months will significantly decrease AMS during a subsequent rapid ascent to 4500 m. Exercise training during the altitude preexposures may augment improvement in physical performance. The persistence of altitude acclimatization after return to low altitude appears to be proportional to the degree of acclimatization developed. The subsequent ascent to high altitude should be scheduled as soon as possible after the last altitude preexposure.


Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress.
Alcoholism is a chronic relapsing disorder with substantial heritability. Uncovering gene-environment interactions underlying this disease process can aid identification of novel treatment targets. Here, we found a lowered threshold for stress-induced reinstatement of alcohol seeking in Marchigian-Sardinian Preferring (msP) rats genetically selected for high alcohol preference. In situ hybridization for a panel of 20 stress-related genes in 16 brain regions was used to screen for differential gene expression that may underlie this behavioral phenotype. An innate up-regulation of the Crhr1 transcript, encoding the corticotropin-releasing hormone receptor 1 (CRH-R1), was found in several limbic brain areas of msP rats genetically selected for high alcohol preference, was associated with genetic polymorphism of the Crhr1 promoter, and was accompanied by increased CRH-R1 density. A selective CRH-R1 antagonist (antalarmin, 10-20 mg/kg) was devoid of effects on operant alcohol self-administration in unselected Wistar rats but significantly suppressed this behavior in the msP line. Stress-induced reinstatement of alcohol seeking was not significantly affected by antalarmin in Wistar rats but was fully blocked in msP animals. These data demonstrate that Crhr1 genotype and expression interact with environmental stress to reinstate alcohol-seeking behavior.


State-of-the-Art Diagnosis and Treatment of Melanoma: Optimal Multidetector Computed Tomographic Practice to Identify Metastatic Disease and Review of Innovative Therapeutic Agents.
The incidence of melanoma has risen dramatically over the past several decades. Oncologists rely on the ability of radiologists to identify subtle radiographic changes representing metastatic and recurrent melanoma in uncommon locations on multidetector computed tomography (MDCT) as the front-line imaging surveillance tool. To accomplish this goal, MDCT acquisition and display must be optimized and radiologist interpretation and search patterns must be tailored to identify the unique and often subtle metastatic lesions of melanoma. This article describes MDCT acquisition and display techniques that optimize the visibility of melanoma lesions, such as high-contrast display windows and multiplanar reconstructions. In addition, innovative therapies for melanoma, such as immunotherapy and small-molecule therapy, have altered clinical management and outcomes and have also changed the spectrum of therapeutic complications that can be detected on MDCT. Recent advances in melanoma therapy and potential complications that the radiologist can identify on MDCT are reviewed.


Nonadult Supervision of Children in Low- and Middle-Income Countries: Results from 61 National Population-Based Surveys.
Despite scarce empirical research in most countries, evidence has shown that young children are unsupervised or under the supervision of another young child while their adult caregivers attend work or engage in other activities outside the home. Lack of quality supervision has been linked to unintentional childhood injuries and other negative outcomes. Nationally representative, population-based data from rounds four and five of the Multiple Indicator Cluster Surveys (MICS) and four to eight of the Demographic and Health Surveys (DHS) from 61 low- and middle-income countries were used to estimate prevalence and socio-economic factors associated with leaving children under five years old home alone or under the care of another child younger than 10 years of age. Socio-economic factors included age and sex of the child, rurality, wealth, maternal education, and household composition. Large variations in the prevalence rates (0.1⁻35.3% for children home alone and 0.2⁻50.6% for children supervised by another child) and associated factors have been recorded within and across regions and countries. Understanding why and under what conditions children are home alone or under the supervision of another child is crucial to the development of suitable policies and interventions to protect young children, promote healthy growth, and support caregivers.


Contributions and challenges for network models in cognitive neuroscience.
The confluence of new approaches in recording patterns of brain connectivity and quantitative analytic tools from network science has opened new avenues toward understanding the organization and function of brain networks. Descriptive network models of brain structural and functional connectivity have made several important contributions; for example, in the mapping of putative network hubs and network communities. Building on the importance of anatomical and functional interactions, network models have provided insight into the basic structures and mechanisms that enable integrative neural processes. Network models have also been instrumental in understanding the role of structural brain networks in generating spatially and temporally organized brain activity. Despite these contributions, network models are subject to limitations in methodology and interpretation, and they face many challenges as brain connectivity data sets continue to increase in detail and complexity.


Comparison of African swine fever virus prevalence and risk in two contrasting pig-farming systems in South-west and Central Kenya.
We describe a horizontal survey of African swine fever virus (ASFV) prevalence and risk factors associated with virus infection in domestic pigs in two contrasting production systems in Kenya. A free range/tethering, low input production system in Ndhiwa District of South-western Kenya is compared with a medium input stall fed production system in Kiambu District of Central Kenya. Analysis of variance (ANOVA) of data derived from cluster analysis showed that number of animals, number of breeding sows and number of weaner pigs were a significant factor in classifying farms in Nhiwa and Kiambu. Analysis of blood and serum samples using a PCR assay demonstrated an average animal level positivity to ASFV of 28% in two independent samplings in South-western Kenya and 0% PCR positivity in Central Kenya. No animals were sero-positive in either study site using the OIE indirect-ELISA and none of the animals sampled exhibited clinical symptoms of ASF. The farms that contained ASFV positive pigs in Ndhiwa District were located in divisions bordering the Ruma National Park from which bushpig (Potamochoerus larvatus) incursions into farms had been reported. ASFV prevalence (P<0.05) was significantly higher at distances between 6 and 16km from the National Park than at distances closer or further away. One of the 8 bushpigs sampled from the park, from which tissues were obtained was PCR positive for ASFV. The data therefore indicated a potential role for the bushpig in virus transmission in South-western Kenya, but there was no evidence of a direct sylvatic virus transmission cycle in Central Kenya. ASF control strategies implemented in these areas will need to take these epidemiological findings into consideration.


Heritable lymphocyte function-associated antigen-1 deficiency: abnormalities of cytotoxicity and proliferation associated with abnormal expression of LFA-1.
The effect of heritable LFA-1 deficiency on T lymphocyte function was measured. After primary mixed lymphocyte stimulation, all six patients studied showed diminished allospecific T lymphocyte cytolytic and NK activity as compared with kindred and normal controls. MLR and mitogen-induced proliferative responses were consistently depressed. LFA-1-deficient, EBV-transformed B cell lines were poor stimulators of T cell responses. Primary cytolytic responses by lymphocytes from severely LFA-1-deficient patients (less than 0.2% of normal surface expression) were consistently more profoundly depressed than those by lymphocytes from moderately deficient patients (about 5% of normal surface expression). These results demonstrate the importance of LFA-1 in lymphocyte function. After repeated MLR restimulation, proliferative and cytolytic capacity improved and CTL lines could be established from all patients. Cytolysis by lines from one but not a second severe patient, and by four of four moderate patients, was inhibited by anti-LFA-1 MAb, and at 10-fold lower concentrations than required for inhibition of killing by control CTL lines. The locus of inhibition was on the target cell for the severely deficient CTL line, and on both the target and effector cells for moderately deficient CTL lines. In contrast, the locus of inhibition for normal CTL is on the effector cell. These findings show that LFA-1 can participate bidirectionally in cell interactions. The in vitro results are discussed in terms of the clinical findings in patients.


Establishment of a multi-specific monoclonal antibody MsMab-1 recognizing both IDH1 and IDH2 mutations.
Mutations of isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) have been reported in gliomas, cartilaginous tumors, and acute myeloid leukemias. IDH mutations are specific to a single codon in the conserved and functionally important arginine 132 residue (R132) of IDH1 or arginine 172 residue (R172) of IDH2 in gliomas. Although IDH1 and IDH2 catalyze the oxidative carboxylation of isocitrate to α-ketoglutarate in cytosol and mitochondria, respectively, mutated IDH1/2 proteins can possess the ability to change α-ketoglutarate to an oncometabolite R(-)-2-hydroxyglutarate. We have established several monoclonal antibodies (mAbs) specific for IDH1/2 mutations. However, no multi-specific mAb against IDH1/2 mutations has been reported. For this study, we immunized mice with an IDH1-R132G peptide of 19 amino acids (GGVKPIIIGGHAYGDQYRA), and established a novel mAb MsMab-1 that recognizes IDH1-R132G, but not wild type IDH1 in enzyme-linked immunosorbent assay (ELISA). It is particularly interesting that MsMab-1 recognizes all IDH1 mutants (R132H, R132C, R132S, R132G, R132L) in ELISA. Western blot analysis also revealed that MsMab-1 reacted with recombinant proteins of IDH1-R132H, IDH1-R132S, and IDH1-R132G, but not with wild type IDH1 and other IDH1 mutations, indicating that MsMab-1 is a multi-specific anti-mutated IDH1 mAb. Unexpectedly, MsMab-1 recognizes IDH2-R172M protein, despite that the IDH1-R132G peptide shows only 73.7% identity with the equivalent portion of IDH2-R172M (GGTKPITIGMHAHGDQYKA). Moreover, MsMab-1 stained the IDH1-R132S or IDH1-R132G-expressing glioma cells in immunohistochemistry. This report is the first to establish a multi-specific anti-mutated IDH1/2 mAb, that is expected to be useful for immunohistochemical determination of IDH1/2 mutation-bearing tumors.


Cytochrome P450s and other enzymes in drug metabolism and toxicity.
The cytochrome P450 (P450) enzymes are the major catalysts involved in the metabolism of drugs. Bioavailability and toxicity are 2 of the most common barriers in drug development today, and P450 and the conjugation enzymes can influence these effects. The toxicity of drugs can be considered in 5 contexts: on-target toxicity, hypersensitivity and immunological reactions, off-target pharmacology, bioactivation to reactive intermediates, and idiosyncratic drug reactions. The chemistry of bioactivation is reasonably well understood, but the mechanisms underlying biological responses are not. In the article we consider what fraction of drug toxicity actually involves metabolism, and we examine how species and human interindividual variations affect pharmacokinetics and toxicity.


The buzz about bees and poverty alleviation: Identifying drivers and barriers of beekeeping in sub-Saharan Africa.
The potential of beekeeping to mitigate the exposure of rural sub-Sahara African farmers to economic stochasticity has been widely promoted by an array of development agencies. Robust outcome indicators of the success of beekeeping to improve household well-being are unfortunately lacking. This study aimed to identify the key drivers and barriers of beekeeping adoption at the household level, and quantified the associated income contribution in three agro-ecological zones in Uganda. Beekeepers were generally the most economically disadvantaged people in the study areas and tended to adopt beekeeping following contact with non-government organisations and access to training. Whilst incomes were not statistically lower than their non-beekeeping counterparts; their mean household well-being scores were significantly lower than non-beekeeping households. The inability of beekeeping to significantly improve well-being status can in part be attributed to a lack of both training in bee husbandry and protective equipment provision such as suits, gloves and smokers. These are critical tools for beekeepers as they provide the necessary confidence to manage honey bees. Rather than focussing solely on the socio-economic conditions of farmers to effectively adopt beekeeping, future research should also attempt to evaluate the effectiveness of development agencies' provision to the beekeeping sector.


Hyperplasia and hypertrophy of the gubernaculum during testicular descent in the fetus.
The role of the gubernaculum during testicular descent was investigated in 115 male pig fetuses ranging from 68 to 109 days of gestation. Descent of the testis through the inguinal canal occurred between 77 and 94 days. There was a marked increase in the total and relative wet mass as well as the wet/dry mass ratio of the gubernaculum, denoting an increase in the water content of this structure during descent of the testis. Similar changes were not seen in other fetal tissues. Asymmetrical descent of the testes occurred in seven of the 40 fetuses between 81 and 92 days of gestation. Descended testes had gubernacula with a greater relative wet mass than the gubernacula of undescended testes. These findings indicate that the increase in mass of the gubernaculum plays an important part in testicular descent. An increase in both the DNA content (hyperplasia) and the RNA/DNA ratio (hypertrophy) was noted in the gubernaculum during descent of the testis. Hyperplasia in the gubernaculum occurred at a rapid rate initially and ceased after the completion of descent. Hyperplasia was also seen in the testis and epididymis, but occurred at a slower rate initially, with a rapid acceleration after the completion of descent. Cellular hypertrophy was not noted in the testis and epididymis, but did occur in umbilical cord tissue. If gonadotropins acting via androgen secretion by the testis provide the stimulus for these changes, the observed difference in response between the gubernaculum and testis could be due to a difference in end-organ sensitivity. However, it is also possible that some unidentified non-androgenic gubernaculotropin, possibly secreted by the fetal testis, provides the stimulus for gubernacular growth.


Changes in the concentration of LH, FSH and estrogen in the immature female rat during precocious sexual maturation induced by electrochemical stimulation of the brain.
Electrochemical stimulation of the hypothalamus of 23-day-old female rats induced precocious puberty as judged by occurrence of vaginal opening, the degree of uterine hypertrophy, changes in ovarian steroid content and incidence of first ovulation. Three types of responses were observed: (I) pubertal ovulation within 96 h; (II) pubertal ovulation within 120 h, and (III) vaginal opening at 120 h not followed by ovulation. All treated animals showed a sustained increase in the LH/FSH ratio in both pituitary and plasma. Plasma estrogen was also increased 1 h after stimulation. A preovulatory rise in plasma estrogen and gonadotropins was noted in type I and type II animals. These data lend further support to the suggestion that brain stimulation causes a release of gonadotrophins which induced ovarian steroidogenesis leading to an ovulatory gonadotropin surge via a positive feedback effect.


Neuroglobin protects the brain from experimental stroke in vivo.
Neuroglobin (Ngb) is an O(2)-binding protein localized to cerebral neurons of vertebrates, including humans. Its physiological role is unknown but, like hemoglobin, myoglobin, and cytoglobin/histoglobin, it may transport O(2), detoxify reactive oxygen species, or serve as a hypoxia sensor. We reported recently that hypoxia stimulates transcriptional activation of Ngb in cultured cortical neurons and that antisense inhibition of Ngb expression increases hypoxic neuronal injury, whereas overexpression of Ngb confers resistance to hypoxia. These findings are consistent with a role for Ngb in promoting neuronal survival after hypoxic insults in vitro. Here we report that in rats, intracerebroventricular administration of an Ngb antisense, but not sense, oligodeoxynucleotide increases infarct volume and worsens functional neurological outcome, whereas intracerebral administration of a Ngb-expressing adeno-associated virus vector reduces infarct size and improves functional outcome, after focal cerebral ischemia induced by occlusion of the middle cerebral artery. We conclude that Ngb acts as an endogenous neuroprotective factor in focal cerebral ischemia and may therefore represent a target for the development of new treatments for stroke.


A giant type I polyketide synthase participates in zygospore maturation in Chlamydomonas reinhardtii.
Polyketide synthases (PKSs) occur in many bacteria, fungi and plants. They are highly versatile enzymes involved in the biosynthesis of a large variety of compounds including antimicrobial agents, polymers associated with bacterial cell walls and plant pigments. While harmful algae are known to produce polyketide toxins, sequences of the genomes of non-toxic algae, including those of many green algal species, have surprisingly revealed the presence of genes encoding type I PKSs. The genome of the model alga Chlamydomonas reinhardtii (Chlorophyta) contains a single type I PKS gene, designated PKS1 (Cre10.g449750), which encodes a giant PKS with a predicted mass of 2.3 MDa. Here, we show that PKS1 is induced in 2-day-old zygotes and is required for their development into zygospores, the dormant stage of the zygote. Wild-type zygospores contain knob-like structures (~50 nm diameter) that form at the cell surface and develop a central cell wall layer; both of these structures are absent from homozygous pks1 mutants. Additionally, in contrast to wild-type zygotes, chlorophyll degradation is delayed in homozygous pks1 mutant zygotes, indicating a disruption in zygospore development. In agreement with the role of the PKS in the formation of the highly resistant zygospore wall, mutant zygotes have lost the formidable desiccation tolerance of wild-type zygotes. Together, our results represent functional analyses of a PKS mutant in a photosynthetic eukaryotic microorganism, revealing a central function for polyketides in the sexual cycle and survival under stressful environmental conditions.


Interactions of a Bacterial Cu(I)-ATPase with a Complex Lipid Environment.
Phospholipids and sterols play multiple roles in cells. In addition to establishing barriers between compartments, they also provide the matrix for assembly and function of a large variety of catalytic processes. Lipid composition is a highly regulated feature of biological membranes, yet its implications for membrane proteins are difficult problems to approach. One obstacle is the inherent complexity of observing and describing these interactions and their dynamics at a molecular and atomic level. However, lipid interactions are pivotal for membrane protein function and should be acknowledged. The enzymatic activity of several different P-type ATPases, one of the major families of ion pumping primary active transporters, has previously been shown to exhibit a strong dependence on phospholipids; however, distinguishing the effects of annular and specific lipid interactions is challenging. Here we show that the hydrolytic activity of a bacterial Cu(I)-transporting P-type ATPase (LpCopA) is stimulated by the bacterial, anionic phospholipid cardiolipin and to some extent by phosphatidylglycerol. Furthermore, multiscale molecular dynamics simulations pinpoint lipid hot spots on the membrane-spanning domain of LpCopA. Thus, using two independent methods, our study shows converging evidence that the lipid membrane composition plays an important role for LpCopA.


From theory to practice: molecular strain typing for the clinical and public health setting.
The persistence and transmission of infectious disease is one of the most enduring and daunting concerns in healthcare. Over the years, epidemiological analysis especially of bacterial etiological agents has undergone a remarkable evolutionary metamorphosis. While initially relying on purely phenotypic characterisation, advances in molecular biology have found translational application in a number of approaches to strain typing which commonly centre either on 'epityping' (molecular epidemiology) to characterise outbreaks, perform surveillance, and trace evolutionary pathways, or 'pathotyping' to compare strains based on the presence or absence of specific virulence or resistance genes. A perspective overview of strain typing is presented here considering the issues surrounding analyses which are employed in the localised clinical setting as well as at a more regional/national public health level. The discussion especially considers the shortcomings inherent in epidemiological analysis: less than full isolate characterisation by the typing method and limitations imposed by the available data, context, and time constraints of the epidemiological investigation (i.e. the available epidemiological window). However, the promises outweigh the pitfalls as one considers the potential for advances in genomic characterisation and information technology to provide an unprecedented aggregate of epidemiological information and analysis.


Autologous Bone Marrow Transplantation in Multiple Sclerosis: Biomarker Relevance for Patient Recruitment and Follow up.
Despite the current availability of disease modifying therapies for the treatment of multiple sclerosis, there are still patients who suffer from severe neurological dysfunction in the relapsing-remitting or early progressive forms of the disease. For these patients autologous hematopoietic stem cell transplant offers an important therapeutic solution to prevent progression to irreversible disability. In spite of multiple studies in the last two decades, patient inclusion criteria, protocols for peripheral blood stem cell mobilization and bone marrow cell conditioning and methodology of follow up for autologous hematopoietic stem cell transplant in multiple sclerosis have not been strictly unified. We reviewed five recent clinical studies that confirmed the positive outcome of transplant in spite of disclosing significant differences in methodology of enrollment including patient disease subtypes, disease duration range, disability, regimens of peripheral blood stem cell mobilization and bone marrow cell conditioning, scheduling of imaging studies after transplant, and absence of laboratory biomarkers consistently applied to these studies. Therapy with autologous hematopoietic stem cell transplant has shown best results among young individuals with severe relapsing-remitting or early progressive disease through its ability to maintain no evidence of disease activity status in a significantly higher proportion of patients after transplant in comparison to patients treated with disease modifying therapies. Important cross-sectional differences in the reviewed studies were found. A specific and careful selection of biomarkers, based on the current physiopathological mechanisms known to result in multiple sclerosis, will contribute to a better and earlier patient selection for autologous hematopoietic stem cell transplant and follow up process. An objective and measurable response could be obtained with the determination of biomarkers at the onset of treatment and after follow-up on reconstitution of the immune response. The application of such parameters could also help further our understanding of pathogenesis of the disease.


Multicenter experience using telaprevir or boceprevir with peginterferon and ribavirin to treat hepatitis C genotype 1 after liver transplantation.
The safety, efficacy, and effect on immunosuppression levels of telaprevir (TVR) or boceprevir (BOC) in combination with peginterferon (PEG-IFN) and ribavirin (RBV) in recipients of liver transplantation (LT) with hepatitis C virus (HCV) genotype 1 have not been defined. We report our 3 centers' preliminary experiences with administering triple antiviral treatment protocols containing PEG-IFN, RBV, and TVR or BOC. Patients with biopsy-proven HCV recurrence (METAVIR grade ≥ 3 and/or stage ≥ 2) received TVR with PEG-IFN/RBV for 12 weeks and then PEG-IFN/RBV for 36 weeks or BOC with PEG-IFN/RBV for 44 weeks after 4 weeks of lead-in PEG-IFN/RBV. Maintenance immunosuppression was changed to cyclosporine whenever possible, and the levels were followed closely. PEG-IFN/RBV dose adjustments were based on patients' tolerance. Sixty patients started triple antiviral treatment, and they were followed for up to 66 weeks (mean = 35 weeks); all were followed at least 12 weeks. Thirty of the 35 patients treated with TVR (86%) achieved undetectable HCV RNA levels after an average of 6 weeks, whereas 12 patients (48%) in the BOC-treated group achieved undetectable HCV RNA levels after a mean of 11 weeks. According to an intention-to-treat analysis, 14 of 21 TVR-treated patients (67%) and 10 of 22 patients who received BOC (45%) achieved undetectable HCV RNA levels at week 24 without viral breakthrough at the last follow-up. Cytopenias complicated both regimens; all patients required dose reductions of PEG-IFN and/or RBV or the administration of hematological growth factors. One death occurred in each group on triple antiviral treatment. In conclusion, TVR or BOC combined with PEG-IFN/RBV achieved on-treatment virological response rates of approximately 50% to 60% in patients with recurrent HCV after LT, but significant side effects were common.


A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.
Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.


The influence of physician communication style on overweight patients' perceptions of length of encounter and physician being rushed.
Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. There is wide variation in patients' ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family physicians, appear able to conceal that they are feeling rushed.


To neglect or integrate contingency information from outside the task frame, that is the question! Effects of depressed mood.
Evidence shows that there are individual differences in the extent to which people attend to and integrate information into their decisions about the predictive contingencies between events and outcomes. In particular, information about the absence of events or outcomes, presented outside the current task frame, is often neglected. This trend is particularly evident in depression, as well as other psychopathologies, though reasons for information neglect remain unclear. We investigated this phenomenon across two experiments (Experiment 1: N=157; Experiment 2: N=150) in which participants, scoring low and high in the Beck Depression Inventory, were asked to learn a simple predictive relationship between a visual cue and an auditory outcome. We manipulated whether or not participants had prior experience of the visual cue outside of the task frame, whether such experience took place in the same or different context to the learning task, and the nature of the action required to signal occurrence of the auditory outcome. We found that all participants were capable of including extra-task experience into their assessment of the predictive cue-outcome relationship in whatever context it occurred. However, for mildly depressed participants, adjacent behaviours and similarity between the extra-task experience and the main task, influenced information integration, with patterns of 'over-integration' evident, rather than neglect as we had expected. Findings are suggestive of over-generalised experience on the part of mildly depressed participants.


An Innovative, Unobtrusive Approach to Investigate Smartphone Interaction in Nonaddicted Subjects Based on Wearable Sensors: A Pilot Study.
Background and objectives: Smartphones are playing a pivotal role in everyday life, due to the opportunity they grant in terms of simplifying communication, entertainment, education and many other daily activities. Against such positive characteristics, smartphone interaction can result, in particular cases, in dangerous smartphone addiction patterns, possibly leading to several long-term detrimental psychophysiological conditions. Therefore, this pilot aims at assessing the feasibility of using an innovative approach, based on unobtrusive wearable sensors, used for the first time in this specific topic, and psychological questionnaires, to investigate the links between stress and emotions in a group of young, nonaddicted individuals performing smartphone interaction. Materials and methods: 17 volunteers were enrolled for the present study. The study protocol was divided into three phases, with an initial resting state (baseline) of three minutes, a smartphone interaction session (task) of the same length, and a final resting state (recovery), lasting three minutes. In the overall procedure, electrocardiogram (ECG) and galvanic skin response (GSR) measurements, both monitored by wearable sensors, were acquired in order to assess the functioning of the autonomic nervous system (ANS). Results: A significant decrease was seen in pNN50 during the smartphone interaction with respect to the baseline (Z = -2.675, p = 0.007), whereas the Low-to-High Frequency (LF/HF) ratio at task was somewhat correlated with phubbing behaviors (r = 0.655, p = 0.029), assessed through dedicated questionnaires. Conclusions: Taken together with the slight changes in GSR data, such results suggest the feasibility of this approach to characterize the ANS activation during smartphone interaction among young individuals. Further studies should enlarge the study population and involve smartphone-addicted subjects in order to increase the scientific and clinical relevance of such findings.


3D intra-operative ultrasound and MR image guidance: pursuing an ultrasound-based management of brainshift to enhance neuronavigation.
Brainshift is still a major issue in neuronavigation. Incorporating intra-operative ultrasound (iUS) with advanced registration algorithms within the surgical workflow is regarded as a promising approach for a better understanding and management of brainshift. This work is intended to (1) provide three-dimensional (3D) ultrasound reconstructions specifically for brain imaging in order to detect brainshift observed intra-operatively, (2) evaluate a novel iterative intra-operative ultrasound-based deformation correction framework, and (3) validate the performance of the proposed image-registration-based deformation estimation in a clinical environment. Eight patients with brain tumors undergoing surgical resection are enrolled in this study. For each patient, a 3D freehand iUS system is employed in combination with an intra-operative navigation (iNav) system, and intra-operative ultrasound data are acquired at three timepoints during surgery. On this foundation, we present a novel resolution-preserving 3D ultrasound reconstruction, as well as a framework to detect brainshift through iterative registration of iUS images. To validate the system, the target registration error (TRE) is evaluated for each patient, and both rigid and elastic registration algorithms are analyzed. The mean TRE based on 3D-iUS improves significantly using the proposed brainshift compensation compared to neuronavigation (iNav) before (2.7 vs. 5.9 mm; [Formula: see text]) and after dural opening (4.2 vs. 6.2 mm, [Formula: see text]), but not after resection (6.7 vs. 7.5 mm; [Formula: see text]). iUS depicts a significant ([Formula: see text]) dynamic spatial brainshift throughout the three timepoints. Accuracy of registration can be improved through rigid and elastic registrations by 29.2 and 33.3%, respectively, after dural opening, and by 5.2 and 0.4%, after resection. 3D-iUS systems can improve the detection of brainshift and significantly increase the accuracy of the navigation in a real scenario. 3D-iUS can thus be regarded as a robust, reliable, and feasible technology to enhance neuronavigation.


Multi-material bio-fabrication of hydrogel cantilevers and actuators with stereolithography.
Cell-based biohybrid actuators are integrated systems that use biological components including proteins and cells to power material components by converting chemical energy to mechanical energy. The latest progress in cell-based biohybrid actuators has been limited to rigid materials, such as silicon and PDMS, ranging in elastic moduli on the order of mega (10(6)) to giga (10(9)) Pascals. Recent reports in the literature have established a correlation between substrate rigidity and its influence on the contractile behavior of cardiomyocytes (A. J. Engler, C. Carag-Krieger, C. P. Johnson, M. Raab, H. Y. Tang and D. W. Speicher, et al., J. Cell Sci., 2008, 121(Pt 22), 3794-3802, P. Bajaj, X. Tang, T. A. Saif and R. Bashir, J. Biomed. Mater. Res., Part A, 2010, 95(4), 1261-1269). This study explores the fabrication of a more compliant cantilever, similar to that of the native myocardium, with elasticity on the order of kilo (10(3)) Pascals. 3D stereolithographic technology, a layer-by-layer UV polymerizable rapid prototyping system, was used to rapidly fabricate multi-material cantilevers composed of poly(ethylene glycol) diacrylate (PEGDA) and acrylic-PEG-collagen (PC) mixtures. The incorporation of acrylic-PEG-collagen into PEGDA-based materials enhanced cell adhesion, spreading, and organization without altering the ability to vary the elastic modulus through the molecular weight of PEGDA. Cardiomyocytes derived from neonatal rats were seeded on the cantilevers, and the resulting stresses and contractile forces were calculated using finite element simulations validated with classical beam equations. These cantilevers can be used as a mechanical sensor to measure the contractile forces of cardiomyocyte cell sheets, and as an early prototype for the design of optimal cell-based biohybrid actuators.


NaCl responsive taste cells in the mouse fungiform taste buds.
Previous studies have demonstrated that rodents' chorda tympani (CT) nerve fibers responding to NaCl can be classified according to their sensitivities to the epithelial sodium channel (ENaC) blocker amiloride into two groups: amiloride-sensitive (AS) and -insensitive (AI). The AS fibers were shown to respond specifically to NaCl, whereas AI fibers broadly respond to various electrolytes, including NaCl. These data suggest that salt taste transduction in taste cells may be composed of at least two different systems; AS and AI ones. To further address this issue, we investigated the responses to NaCl, KCl and HCl and the amiloride sensitivity of mouse fungiform papilla taste bud cells which are innervated by the CT nerve. Comparable with the CT data, the results indicated that 56 NaCl-responsive cells tested were classified into two groups; 25 cells ( approximately 44%) narrowly responded to NaCl and their NaCl response were inhibited by amiloride (AS cells), whereas the remaining 31 cells ( approximately 56%) responded not only to NaCl, but to KCl and/or HCl and showed no amiloride inhibition of NaCl responses (AI cells). Amiloride applied to the basolateral side of taste cells had no effect on NaCl responses in the AS and AI cells. Single cell reverse transcription-polymerase chain reaction (RT-PCR) experiments indicated that ENaC subunit mRNA was expressed in a subset of AS cells. These findings suggest that the mouse fungiform taste bud is composed of AS and AI cells that can transmit taste information differently to their corresponding types of CT fibers, and apical ENaCs may be involved in the NaCl responses of AS cells.


Correlation between HHV-6 infection and skin rash after allogeneic bone marrow transplantation.
We investigated whether a causal relationship exists between human herpesvirus 6 (HHV-6) and skin rash resembling acute graft-versus-host disease (GVHD) following bone marrow transplantation (BMT). Isolation of HHV-6 was used to monitor active HHV-6 infection in this study. We analyzed 25 episodes of skin rash in 22 recipients. All recipients were seropositive for HHV-6 before BMT. The onset of skin rash started prior to 30 days post transplantation (group A) in 15 of 25 cases, but after that (group B) in the remaining 10 cases. Twenty-five skin tissue samples were obtained from 22 recipients. The HHV-6 genome was detected in four of 15 skin samples from group A, but not detected in those from group B. HHV-6 was isolated from 11 of 22 recipients around 2 to 3 weeks after BMT (range 14 to 28 days after BMT). HHV-6 was isolated at a time between 10 days before and after the onset of skin rash (skin rash-related viremia) in nine cases in group A. Meanwhile, no skin rash-related viremia was observed in group B. Of the four recipients with positive detection of HHV-6 genome in their skin tissue (group A), two had HHV-6 viremia at the same time. The association between the timing of HHV-6 infection and the onset of skin rash was analyzed statistically. HHV-6 viremia (skin rash-related viremia) was found in nine of 15 (60%) cases in group A, compared with none of 10 (0%) cases in group B. This difference was statistically significant (P = 0.008). Moreover, HHV-6 infection (skin rash-related viremia and/or positive detection of HHV-6 DNA in skin tissue) was demonstrated in 11 of 15 (73.3%) cases in group A, compared with none of 10 (0%) cases in group B (P = 0.001). Thus, this study suggests that HHV-6 may be involved in the development of skin rash in the first month after allogeneic BMT.


Sweating the big stuff: Arousal and stress as functions of self-uncertainty and identification.
Groups serve a variety of crucial functions, one of which is the provision of an identity and belief system that impart self-referent information, thereby reducing self-uncertainty. Entitative groups are more attractive for highly uncertain participants seeking groups for identification and self-uncertainty reduction than less entitative groups. The purpose of the current study was to explore how self-uncertainty impacts physiological arousal and stress responses. Using a mixed-methods design (N = 123), we found that self-uncertainty increased physiological arousal (measured via skin-conductance level) and stress responses (measured via heart rate). Furthermore, we found that uncertainty-activated physiological arousal and stress responses were decreased through identification with a high entitativity group. Our findings expand upon uncertainty identity theory by identifying physiological mechanisms that motivate uncertainty reduction.


Bone resorption induced by 1 alpha,25 dihydroxyvitamin D(3) in vivo is not altered by inactivation of the plasminogen activator inhibitor 1.
One of the proteolytic systems produced by bone cells is the plasminogen activator/plasmin pathway, which involves the two plasminogen activators and the type 1 plasminogen activator inhibitor (PAI-1) and results in plasmin generation. We have recently demonstrated that this pathway plays a specific role in the degradation of the nonmineralized matrix of bone in vitro. To evaluate whether PAI-1 is required during bone resorption in vivo, we studied the effects of PAI-1 inactivation on bone metabolism using systemic administration of 1alpha,25 dihydroxyvitamin D(3) [1, 25(OH)(2)D(3)] as model. PAI-1-deficient (PAI-1-/-) and wild-type (WT) mice were injected intraperitoneally with 1,25(OH)(2)D(3) (2 microg/kg) or vehicle every other day during 4 weeks and analyzed using biochemical parameters of bone turnover, histomorphometric analysis of the proximal tibial metaphysis, and pQCT analysis of the distal femoral metaphysis. PAI-1 inactivation did not affect bone metabolism in vehicle-treated mice. Treatment with 1,25(OH)(2)D(3) induced bone resorption similarly in PAI-1-/- and WT mice, as assessed by the increase in the urinary excretion of calcium (2. 2-fold and 2.3-fold, respectively) and of pyridinoline crosslinks (by 24% and 22%, respectively). In addition, a comparable reduction in bone mass was observed in PAI-1-/- and WT mice after treatment with 1,25(OH)(2)D(3), as evidenced by the decrease in the femoral calcium content (by 25% and 32%, respectively), in the trabecular bone volume (by 50% and 40%, respectively), in the trabecular mineral content (by 17% and 15%, respectively), and in the cortical mineral content (by 45% and 52%, respectively). The parameters of bone turnover also increased after 1,25(OH)(2)D(3) treatment. Serum osteocalcin was, respectively, 25% and 28% higher in PAI-1-/- and WT mice treated with 1,25(OH)(2)D(3) compared with the mice injected with vehicle. Similarly, the osteoid surface increased in 1, 25(OH)(2)D(3)-treated PAI-1-/- and WT mice by 40% and 51%, respectively, the mineral apposition rate increased by 15% and 8%, respectively, and the bone formation rate by 54% and 48%, respectively. These data indicate that PAI-1 is not critical during bone resorption induced by 1,25(OH)(2)D(3) in vivo.


Dynamics of nucleosomes revealed by time-lapse atomic force microscopy.
The dynamics of chromatin provides the access to DNA within nucleosomes, and therefore, this process is critically involved in the regulation of chromatin function. However, our knowledge of the large-range dynamics of nucleosomes is limited. Answers to the questions, such as the range of opening of the nucleosome and the mechanism via which the opening occurs and propagates, remain unknown. Here we applied single-molecule time-lapse atomic force microscopy (AFM) imaging to directly visualize the dynamics of nucleosomes and identify the mechanism of the large range DNA exposure. With this technique, we are able to observe the process of unwrapping of nucleosomes. The unwrapping of nucleosomes proceeds from the ends of the particles, allowing for the unwrapping of DNA regions as large as dozens of base pairs. This process may lead to a complete unfolding of nucleosomes and dissociation of the histone core from the complex. The unwrapping occurs in the absence of proteins involved in the chromatin remodeling that require ATP hydrolysis for their function, suggesting that the inherent dynamics of nucleosomes can contribute to the chromatin unwrapping process. These findings shed a new light on molecular mechanisms of nucleosome dynamics and provide novel hypotheses about the understanding of the action of remodeling proteins as well as other intracellular systems in chromatin dynamics.


Coronary diastolic pressure-flow relation and zero flow pressure explained on the basis of intramyocardial compliance.
In the controversy about the mechanisms determining the high zero flow pressures and the further interpretation of coronary diastolic pressure flow relations, this paper takes a stand in favor of intramyocardial compliance as the primary cause of the high zero flow pressures. An attempt has been made to estimate the compliance distribution within the coronary circulation and to show the specific effect of intramyocardial compliance on arterial and venous pressure-flow relations. Since no data are available on the distensibility of coronary arterioles and capillaries, these data were taken from studies on mesenteric vessels. Based on these data, it is shown that, depending on the transmural pressure, smooth muscle tone may either increase or decrease arteriolar compliance. A compliance distribution has been proposed based on assumed pressure, volume, and distensibility distributions. For all but the venous division of the circulation, experimental data on volume could be found in the literature. Based on this compartmental analysis, it is predicted that overall intramyocardial compliance may exceed epicardial arterial compliance by a factor 45. The literature presenting functional evidence for intramyocardial compliance effects has been reviewed. Experimental results on venous outflow during long diastoles have been analyzed. Pf = 0 coronary pressure at zero flow, is higher when measured later in diastole. It is shown that this may be explained by charging of intramyocardial compliance in the period before flow ceases. The discrepancy between results on pressure-flow relations in the fully dilated bed and autoregulated bed are related to the differences in pressure, resistance, and compliance distributions.


Clinical Pharmacology Tools and Evaluations to Facilitate Comprehensive Dose Finding in Oncology: A Continuous Risk-Benefit Approach.
Targeted therapies are now considered an integral component in the treatment armamentarium for many malignancies, and the approach to developing these drugs needs to be refined from the previous cytotoxic paradigm of toxicity-guided dose finding and identification of maximum tolerated dose to a paradigm driven by target activity. Moving away from the toxicity-driven dose finding and justification model requires an integrated approach in order to adequately characterize the risk-benefit of a drug. This approach starts with understanding the importance of collecting samples for pharmacokinetic and pharmacodynamic assessments in all phases of clinical development to fully characterize the pharmacokinetics and identify covariates and then correlating exposure to key markers of safety and efficacy in pharmacometric analyses to perform a robust risk-benefit assessment and establish the right dose. In addition, for oral agents, decisions on administering the drug with respect to food can impact dose among other clinical trial outcomes such as tolerability and patient compliance. Understanding the importance of model-based drug development as a decision-making tool to support drug development through incorporation of all relevant data allows for a robust risk-benefit assessment at key decision points. Utilization of clinical pharmacology tools and assessments throughout development will provide the key components of a successful oncology development program.


Effects of oral contraceptives on body composition and physical performance in female athletes.
Menstrual disturbances are common among female athletes, and oral contraceptives (OCs) are often recommended as estrogen substitution. However, there is little information about the effects of OC use in athletes, and there is great concern that OCs might impair physical performance. The aim of this study was to investigate the effects of OC use on body composition and physical performance in female athletes. Twenty-six endurance athletes (13 with oligo-/amenorrhea and 13 regularly menstruating athletes) and 12 sedentary controls were examined before and after 10 months of treatment with a low dose, monophasic, combined OC. Significant changes in body composition were recorded in the athletes, but not in the controls. There was an increase in weight and fat mass only in athletes with oligo-/amenorrhea. These changes were associated with a decrease in ovarian androgens. OC treatment also increased bone mineral density, with the largest increase in athletes with a low bone mineral density at baseline. Despite significant changes in body composition, little impact on physical performance was recorded. We have demonstrated that OC treatment in female athletes has predominantly beneficial effects on body composition without adverse effects on physical performance and could be used for the prevention of osteoporosis in athletic amenorrhea. However, it cannot be excluded that a marked increase in fat mass might have unfavorable effects for athletic performance in individual women.


Return of individual genetic results in a high-risk sample: enthusiasm and positive behavioral change.
The goal of this study was to examine participant responses to disclosure of genetic results in a minority population at high risk for depression and anxiety. Eighty-two subjects in a genetic study of nicotine dependence were offered personalized genetic results. All were nicotine-dependent and 64% self-identified as African American. Pathway Genomics was used to evaluate genetic risks for five complex diseases. Participants returned 4-8 weeks after enrollment for in-person genetic counseling interviews and evaluation of baseline measures. A telephone follow-up was performed 4-8 weeks later to assess responses to results. Fifty of the 82 subjects (61%) were interested in receiving genetic results. These participants had multiple risk factors, including high baseline measures of depression (66%) and anxiety (32%), as well as low rates of employment (46%), adequate health literacy (46%), and health insurance (45%). Pathway Genomics reported "increased risk" for at least one disease in 77% of subjects. Ninety-five percent of participants reported that they appreciated the genetic results, and receiving these results was not associated with changes in symptoms of depression or anxiety. Furthermore, after return of genetic results, smoking cessation attempts increased (P = 0.003). Even in an underserved population at high risk for adverse psychological reactions, subjects responded positively to personalized genetic results.


HIF-1 reduces ischaemia-reperfusion injury in the heart by targeting the mitochondrial permeability transition pore.
Hypoxia-inducible factor-1 (HIF-1) has been reported to promote tolerance against acute myocardial ischaemia-reperfusion injury (IRI). However, the mechanism through which HIF-1 stabilization actually confers this cardioprotection is not clear. We investigated whether HIF-1α stabilization protects the heart against acute IRI by preventing the opening of the mitochondrial permeability transition pore (MPTP) and the potential mechanisms involved. Stabilization of myocardial HIF-1 was achieved by pharmacological inhibition of prolyl hydroxylase (PHD) domain-containing enzyme using GSK360A or using cardiac-specific ablation of von Hippel-Lindau protein (VHL(fl/fl)) in mice. Treatment of HL-1 cardiac cells with GSK360A stabilized HIF-1, increased the expression of HIF-1 target genes pyruvate dehydrogenase kinase-1 (PDK1) and hexokinase II (HKII), and reprogrammed cell metabolism to aerobic glycolysis, thereby resulting in the production of less mitochondrial oxidative stress during IRI, and less MPTP opening, effects which were shown to be dependent on HKII. These findings were further confirmed when HIF-1 stabilization in the rat and murine heart resulted in smaller myocardial infarct sizes (both in vivo and ex vivo), decreased mitochondrial oxidative stress, and inhibited MPTP opening following IRI, effects which were also found to be dependent on HKII. We have demonstrated that acute HIF-1α stabilization using either a pharmacological or genetic approach protected the heart against acute IRI by promoting aerobic glycolysis, decreasing mitochondrial oxidative stress, activating HKII, and inhibiting MPTP opening.


Comparison of topical dry eye medications for the treatment of keratoconjunctivitis sicca in a botulinum toxin B-induced mouse model.
To compare the effects of topical dry eye medications including anti-inflammatory agents and lubricant eyedrops for the treatment of keratoconjunctivitis sicca (KCS) in a botulinum toxin B (BTX-B)-induced mouse model. CBA mice were randomized into 10 groups. The first 5 groups received a transconjunctival injection of saline into the lacrimal gland, and the remaining groups were injected with 0.05 mL of 20 mU BTX-B. Each group received treatment with 0.1% fluorometholone (FML), 0.05% cyclosporine A (CsA), a 50:50 combination of FML and CsA, artificial tears, or saline 3 days after injections. Tear production, corneal staining, and blink rate were compared in each of the 10 groups. Tear production in BTX-B-injected CsA-treated, FML-treated, and combined-treated groups started to return to baseline level within 2 weeks of treatment, whereas those treated with saline or artificial tears still exhibited reduction of lacrimation up to 4 weeks after injection. Topical FML significantly reversed the staining score within 1 week of treatment. The improvement of corneal staining in BTX-B-challenged combined-treated and CsA-treated groups occurred later within 2 weeks after treatment. No significant improvement in corneal staining was observed for the BTX-B-injected mice treated with artificial tears or saline. No significant changes were noted in blink frequency between the control and study groups undergoing the various dry eye therapies. The therapeutic effects of dry eye medications in a BTX-B-induced mouse model of KCS are similar to the human response.


Oncogene expression and genetic background influence the frequency of DNA copy number abnormalities in mouse pancreatic islet cell carcinomas.
Quantitative measurements of tumor genome composition show remarkable heterogeneity in tumors arising from the same anatomical location and/or histopathological class and stage. The factors that contribute to genomic heterogeneity are not clear, but germ-line allelic variation and timing of initiating oncogenic events are likely candidates. We investigated these factors by using array comparative genomic hybridization to measure genomic aberrations in genetically engineered mouse models of pancreatic islet cell carcinoma, in which oncogenic transformation is elicited by the SV40 T antigens expressed under the control of the rat insulin promoter (RIP-Tag). Two distinct transgenic RIP-Tag lines, and three polymorphic sublines of one, enabled us to investigate the effects of genetic background and differing age of oncogene induction. Both parameters were found to bias the spectrum of genomic copy number abnormalities. Specifically, the frequency of losing portions of chromosomes 9 and 16 was significantly modulated by genetic background, with the former being lost at highest rates in the FVB/N background and the latter being lost to greatest extent in both FVB/N and C57Bl/6 tumors compared with C3HeB/Fe tumors. The frequency of losing a region of chromosome 6 varied according to the age when tumorigenesis was initiated; loss of chromosome 6 was significantly higher when oncogene expression was first activated in adulthood. These studies illustrate the utility of transgenic animal models for investigation of factors influencing genomic heterogeneity despite the commonalty of target cell type and initiating oncogene.


Functional plasticity of the ipsilateral primary sensorimotor cortex in an elite long jumper with below-knee amputation.
Functional plasticity of the sensorimotor cortex occurs following motor practice, as well as after limb amputation. However, the joint effect of limb amputation and intensive, long-term motor practice on cortical plasticity remains unclear. Here, we recorded brain activity during unilateral contraction of the hip, knee, and ankle joint muscles from a long jump Paralympic gold medalist with a unilateral below-knee amputation (Amputee Long Jumper, ALJ). He used the amputated leg with a prosthesis for take-off. Under similar conditions to the ALJ, we also recorded brain activity from healthy long jumpers (HLJ) and non-athletes with a below-knee amputation. During a rhythmic isometric contraction of knee extensor muscles with the take-off/prosthetic leg, the ALJ activated not only the contralateral primary sensorimotor cortex (M1/S1), but also the ipsilateral M1/S1. In addition, this ipsilateral M1/S1 activation was significantly greater than that seen in the HLJ. However, we did not find any significant differences between the ALJ and HLJ in M1/S1 activation during knee muscle contraction in the non-take-off/intact leg, nor during hip muscle contraction on either side. Region of interest analysis revealed that the ALJ exhibited a greater difference in M1/S1 activity and activated areas ipsilateral to the movement side between the take-off/prosthetic and non-take-off/intact legs during knee muscle contraction compared with the other two groups. However, difference in activity in M1/S1 contralateral to the movement side did not differ across groups. These results suggest that a combination of below-knee amputation and intensive, prolonged long jump training using a prosthesis (i.e. fine knee joint control) induced an expansion of the functional representation of the take-off/prosthetic leg in the ipsilateral M1/S1 in a muscle-specific manner. These results provide novel insights into the potential for substantial cortical plasticity with an extensive motor rehabilitation program.


Immunotherapy Not Working? Check Your Microbiota.
Gut microbes have ascended to prominence as key modulators of host immunity, raising the possibility that they could influence the outcome of cancer immunotherapy. Two recent studies address this question by identifying specific gut-resident bacteria as drivers of checkpoint blockade immunotherapy in pre-clinical tumor models.


Tailored antiplatelet therapy to improve prognosis in patients exhibiting clopidogrel low-response prior to percutaneous coronary intervention for stable angina or non-ST elevation acute coronary syndrome.
To investigate whether an intensified antiplatelet regimen could improve prognosis in stable or non-ST elevation in acute coronary syndrome (ACS) patients exhibiting high on-treatment platelet reactivity (HTPR) on clopidogrel and treated with percutaneous coronary intervention (PCI). There is a wide variability in the platelet reactivity to clopidogrel and HTPR has been associated with a poor prognosis. In this observational study, 923 consecutive patients without ST-elevation myocardial infarction (STEMI) and adequately pre-treated with clopidogrel were screened for HTPR with multiple electrode aggregometry after assessment of the coronary anatomy. Patients were grouped based on their response to clopidogrel and the assigned antiplatelet strategy. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis. HTPR was demonstrated in 237 patients (25.7%). Of these, 114 continued on conventional clopidogrel therapy, while the remaining 123 received intensified antiplatelet therapy with either double-dose clopidogrel (150 mg daily, n = 55) or the newer P2Y12-inhibitors, prasugrel or ticagrelor (n = 68) for at least 30 days after the index procedure. The median follow-up was 571 days (interquartile range, 373-746). Intensifying antiplatelet therapy reduced the rate of the composite endpoint (p < 0.001). After adjustment for potential confounders, HTPR in combination with conventional clopidogrel therapy remained independently associated with an increased risk of cardiovascular events (hazard ratio (HR), 2.92; 95% CI, 1.90-4.48), whereas intensified treatment reduced the risk to a level equivalent to that of patients exhibiting normal platelet reactivity (HR, 1.08; 95% CI, 0.59-1.99). Tailored antiplatelet therapy significantly reduced the event rate in patients exhibiting HTPR prior to PCI.