Characterization of infectious molecular clones of simian immunodeficiency virus (SIVmac) and human immunodeficiency virus type 2: persistent infection of rhesus monkeys with molecularly cloned SIVmac.
Infection of macaque monkeys with simian immunodeficiency virus (SIV) is probably the best animal model currently available for studying acquired immunodeficiency syndrome. In this report, we describe three infectious molecular clones of SIVmac and one of human immunodeficiency virus type 2 (HIV-2) and their use in the study of cell and species specificity, animal infection, and the relationship of gene sequence to function. Replication of the cloned viruses in different cell lines varied dramatically. Some human CD4+ cell lines (HUT 78 and MT-4) supported the replication of SIVmac and HIV-2, while others (CEM and Jurkat-T) supported the replication of HIV-2 but not SIVmac. Growth of cloned virus in macaque lymphocytes in vitro was predictive of macaque infection in vivo. Macaque lymphocytes supported the replication of SIVmac239 and SIVmac251 but not SIVmac142 or HIV-2ROD. Using virus recovery and antibody response as criteria for infection, macaques that received cloned SIVmac251 and SIVmac239 became infected, while macaques receiving cloned SIVmac142 and HIV-2ROD did not become infected. Nucleotide sequences from the envelope region of all four cloned viruses demonstrated that there is considerable flexibility in the location of the translational termination (stop) signal. These infectious molecular clones will be very useful for future studies directed at the molecular basis for persistence, pathogenicity, tropism, and cell and species specificity.


Distribution of macrophages and T cells in syngrafts and allografts after experimental rat lung transplantation.
Macrophages and T cells have a pivotal role in orchestrating the acute lung allograft rejection response. We investigated the spatial and temporal distribution of these immune cells and the synthesis patterns of the T(h)1- and T(h)2-cytokine IL-12 and IL-10 during the early course after transplantation (Tx). Orthotopic single-lung Tx was performed in Lewis to Lewis (syngrafts) and Brown Norway/Lewis F(1) hybrid to Lewis (allografts). Naïve lungs, syngrafts after 5 days and allografts after 3 and 5 days were analyzed for CD68+, CD163+ and CD3+ cells by immunohistochemistry and IL-12 and IL-10 were detected by immunofluorescence. CD68+ macrophages increased in number after allogeneic Tx compared to syngeneic Tx on day 5 (P<.001), CD163+ macrophages sequestrated early around veins (day 3) compared to the accumulation around arteries and bronchioles (P<.001) while CD3+ T cells were scarce. There was a predominance of IL-12 over IL-10 on day 5 after allogeneic Tx (P<.001). CD68+ macrophages were the most abundant cells during acute pulmonary rejection and CD163+ macrophages showed a characteristic distribution pattern over time around vessels and bronchioles. The up-regulation of IL-12 reflects an early response after allo-antigen exposure, indicating a strong impact of the initiation of the T(h)1 pathway at an early phase during acute lung rejection.


HIV Transmission Risk Persists During the First 6 Months of Antiretroviral Therapy.
Combination antiretroviral therapy (ART) decreases the risk of sexual HIV transmission by suppressing blood and genital HIV RNA concentrations. We sought to determine HIV transmission risk prior to achieving complete viral suppression. Prospective cohort study. Using data from the Partners PrEP Study, a prospective study of 4747 heterosexual HIV-serodiscordant couples in Kenya and Uganda, we examined multiple markers of HIV transmission risk during the first months after ART initiation: time to viral suppression in blood, persistence of HIV RNA in genital specimens, sexual risk behavior, pregnancy incidence, and HIV transmission using survival analysis and generalized estimating equations logistic regression. The cumulative probabilities of achieving blood viral suppression (<80 copies per milliliter) 3, 6, and 9 months after ART initiation were 65.3%, 84.8%, and 89.1%, respectively. Endocervical and seminal HIV RNA were detectable in 12% and 21% of samples obtained within 6 months of ART. Pregnancy incidence was 8.8 per 100 person-years during the first 6 months of ART, and sex unprotected by condoms was reported at 10.5% of visits. Among initially uninfected partners, HIV incidence before ART was 2.08 per 100 person-years (55 infections; 2644 person-years), 1.79 for 0-6 months after ART initiation (3 infections; 168 person-years), and 0.00 with >6 months of ART (0 infections; 167 person-years). Residual HIV transmission risk persists during the first 6 months of ART, with incomplete viral suppression in blood and genital compartments. For HIV-serodiscordant couples in which the infected partner starts ART, other prevention options are needed, such as pre-exposure prophylaxis, until viral suppression is achieved.


One-Hour Esophageal String Test: A Nonendoscopic Minimally Invasive Test That Accurately Detects Disease Activity in Eosinophilic Esophagitis.
Eosinophilic esophagitis (EoE), a chronic food allergic disease, lacks sensitive and specific peripheral biomarkers. We hypothesized that levels of EoE-related biomarkers captured using a 1-hour minimally invasive Esophageal String Test (EST) would correlate with mucosal eosinophil counts and tissue concentrations of these same biomarkers. We aimed to determine whether a 1-hour EST accurately distinguishes active from inactive EoE or a normal esophagus. In a prospective, multisite study, children and adults (ages 7-55 years) undergoing a clinically indicated esophagogastroduodenoscopy performed an EST with an esophageal dwell time of 1 hour. Subjects were divided into 3 groups: active EoE, inactive EoE, and normal esophageal mucosa. Eosinophil-associated protein levels were compared between EST effluents and esophageal biopsy extracts. Statistical modeling was performed to select biomarkers that best correlated with and predicted eosinophilic inflammation. One hundred thirty-four subjects (74 children, 60 adults) with active EoE (n = 62), inactive EoE (n = 37), and patient controls with a normal esophagus (n = 35) completed the study. EST-captured eosinophil-associated biomarkers correlated significantly with peak eosinophils/high-power field, endoscopic visual scoring, and the same proteins extracted from mucosal biopsies. Statistical modeling, using combined eotaxin-3 and major basic protein-1 concentrations, led to the development of EoE scores that distinguished subjects with active EoE from inactive EoE or normal esophagi. Eighty-seven percent of children, 95% of parents, and 92% of adults preferred the EST over endoscopy if it provided similar information. The 1-hour EST accurately distinguishes active from inactive EoE in children and adults and may facilitate monitoring of disease activity in a safe and minimally invasive fashion.


Long noncoding RNA SNHG14 promotes ovarian cancer cell proliferation and metastasis via sponging miR-219a-5p.
The ovarian cancer is one of the most common fatal cancers. Recently, the role of long noncoding RNAs (lncRNAs) in tumor progression has attracted much attention in researchers. The aim of this study was to investigate the role of lncRNA SNHG14 in the progression of ovarian cancer and to explore the possible mechanism. Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) was utilized to detect SNHG14 expression in ovarian cancer tissues. To identify the function of SNHG14 in ovarian cancer, functional experiments were conducted in vitro and in vivo. In addition, the luciferase assays and RNA immunoprecipitation assay (RIP) were performed to investigate the underlying mechanism. SNHG14 expression was remarkably higher in ovarian cancer tissues than that of corresponding normal tissues. SNHG14 expression was associated with patients' overall survival time as well. After SNHG14 was silenced in ovarian cancer cells, cell proliferation, migration, and invasion were remarkably inhibited. In addition, the expression of miR-219a-5p was significantly up-regulated after the silence of SNHG14. Further mechanism assays showed that miR-219a-5p was a direct target of SNHG14 in ovarian cancer. SNHG14 serves as a potential oncogene in ovarian cancer. In addition, it enhances ovarian cell metastasis and proliferation via sponging miR-219a-5p.


Integrating health sciences librarians into biomedicine.
Vanderbilt University Medical Center (VUMC) developed a model training program to prepare current and future health sciences librarians for roles that are integrated into the diverse fabric of the health care professions. As a complement to the traditional and theoretical aspects of a librarian's education, this mixture of supplemental coursework and intensive practical training emphasizes active management of information, problem-solving skills, learning in context, and direct participation in research, while providing the opportunity for advanced academic pursuits. The practical training will take place under the auspices of an established Integrated Advanced Information Management Systems (IAIMS) library that is fully integrated with the Health Center Information Management Unit and Academic Biomedical Informatics Unit. During the planning phase, investigators are analyzing the model's aims and requirements, concentrating on (a) refining the current understanding of the roles health sciences librarians occupy; (b) developing educational strategies that prepare librarians to fulfill expanded roles; and (c) planning for an evaluation process that will support iterative revision and refinement of the model.


Advanced heart failure: impact on older patients and informal carers.
This paper reports a study exploring the impact of advanced heart failure on the lives of older patients and their informal carers. Prognosis is poor in heart failure, with more than a third of patients dying within 12 months of diagnosis, and end-of-life symptoms are distressing and poorly controlled. Although end-of-life care for people with heart failure has received increased attention in recent years, there are still few data on the impact of advanced heart failure on the lives of patients and their informal carers. Focused interviews were conducted with 10 older people with advanced heart failure and their nominated informal carer identified from one district general hospital in the United Kingdom (UK). Joint interviews were conducted with patients and carers in their own home. Thematic analysis was used to identify themes and subthemes. Heart failure affected all aspects of the lives of patients and carers and, in particular, curtailed everyday activities. Patients were very concerned about the 'burden' their illness placed on their carer, who in all cases was their partner, although carers did not conceptualize the situation in this way. The socially isolating influence of the condition on both patients and carers was compounded by lack of professional input, and confusion about diagnosis was evident. Concerns about the future were common and, although few participants reported having been explicitly told about their prognosis, many made realistic statements about their limited life expectancy. This older cohort of people suffering from heart failure appears to have needs not unlike those of patients with 'terminal diseases'. When people are diagnosed with more familiar terminal illnesses, in particular cancer, they are given ongoing explanations, reassurance and support. Similar professional input is needed for patients with advanced heart failure and their carers.


Your morality, my mortality: conscientious objection and the standard of care.
Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards.


Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety.
Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed. To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety. Participants were 325 pregnant women in Georgia recruited from December 2012 - April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines. Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations. Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy.


Regional scale patterns of fine root lifespan and turnover under current and future climate.
Fine root dynamics control a dominant flux of carbon from plants and into soils and mediate potential uptake and cycling of nutrients and water in terrestrial ecosystems. Understanding of these patterns is needed to accurately describe critical processes like productivity and carbon storage from ecosystem to global scales. However, limited observations of root dynamics make it difficult to define and predict patterns of root dynamics across broad spatial scales. Here, we combine species-specific estimates of fine root dynamics with a model that predicts current distribution and future suitable habitat of temperate tree species across the eastern United States (US). Estimates of fine root lifespan and turnover are based on empirical observations and relationships with fine root and whole-plant traits and apply explicitly to the fine root pool that is relatively short-lived and most active in nutrient and water uptake. Results from the combined model identified patterns of faster root turnover rates in the North Central US and slower turnover rates in the Southeastern US. Portions of Minnesota, Ohio, and Pennsylvania were also predicted to experience >10% increases in root turnover rates given potential shifts in tree species composition under future climate scenarios while root turnover rates in other portions of the eastern US were predicted to decrease. Despite potential regional changes, the average estimates of root lifespan and turnover for the entire study area remained relatively stable between the current and future climate scenarios. Our combined model provides the first empirically based, spatially explicit, and spatially extensive estimates of fine root lifespan and turnover and is a potentially powerful tool allowing researchers to identify reasonable approximations of forest fine root turnover in areas where no direct observations are available. Future efforts should focus on reducing uncertainty in estimates of root dynamics by better understanding how climate and soil factors drive variability in root dynamics of different species.


Infections in children admitted with complicated severe acute malnutrition in Niger.
Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger. Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission. Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses. These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.


Depression and anxiety in children with epilepsy and other chronic health conditions: National estimates of prevalence and risk factors.
This study estimates the national prevalence of depression and anxiety among children with epilepsy and determines which demographic variables and comorbidities increase the risk of these psychopathologies. We also compare the rates of depression and anxiety in pediatric epilepsy with those of other chronic health conditions in childhood. We used the 2009-2010 National Survey of Children with Special Health Care Needs to identify children with epilepsy with and without depression and anxiety. We assessed demographic factors and comorbidities associated with depression and anxiety using weighted multivariable logistic regressions. The rates of psychiatric comorbidity in children with chronic conditions other than epilepsy were also determined. The final sample included 1042 children over the age of five with epilepsy. After applying the sampling weights, we estimated that 283,000 children between 5 and 17 years of age have epilepsy in the United States (U.S.). Among these children, 25% have depression and/or anxiety. This figure was not significantly different from the rates seen among children with asthma (16.5%) or allergies (21.6%) but was significantly lower than the rate seen among children with migraines (43.2%). In our analyses of children with epilepsy, low-income children (regardless of race) and children whose needs for specialist care were unmet (relative to those whose needs were met) were more likely to have depression. Low-income black children were less likely to have anxiety than high-income white children. Gender, age, and epilepsy severity were unrelated to depression or anxiety. One in four U.S. children with epilepsy has depression and/or anxiety. Therefore, physicians should consider the various factors that are related to depression and anxiety in children with epilepsy so that at-risk children can be screened and managed appropriately.


WE-E-BRB-08: Establishing Comprehensive Quality Assurance Program for Volumetric Modulated Arc Therapy - Clinical Study Using Control Point Analysis Software.
to validate the clinical effectiveness of Control Point Analysis (CPA) software and establish a comprehensive quality assurance (QA) program for Volumetric Modulated Arc Therapy (VMAT) treatment. The comparison and gamma analysis of ArcCHECK™ measurement and treatment planning system (TPS) is considered one of the common methods for VMAT QA procedure. However, questions like 'how QA discrepancies affect patient treatment† and † what are the sources of discrepancies† cannot be answered. In this study, 3DVH™ and recently developed CPA software were tested for eight cases, including prostate, brain, head&neck, and TGI 19 phantom cases. All VMAT plans used two arcs, with various settings of couch rotation, collimator rotation, and splitting fields. Each single arc was equally divided into 24 sub-arcs and doses of sub-arcs were exported for CPA analysis. Gamma analyses (3mm/3%) were compared using the ArcCHECK dose, single arc doses, sub-arc doses, and 3DVH patient's dose estimated by Planned Dose Perturbation™ (PDP) algorithm. ArcCHECK composite dose analyses were consistent with CPA sub-arc analysis for most cases. 3DVH generally showed higher passing rate in dose voxel-by-voxel comparison. Cases with failed QA were further analyzed by CPA for each sub-arc to reveal the sources of dose discrepancies, whether they are mechanical errors (i.e. leaf motion failure) or dosimetric modeling errors (i.e. elongated beam spot size or incorrect dynamic leaf gap). CPA analysis showed values for cases with passed QA to detect small discrepancies caused by failed MLC which was otherwise smeared out in the composite dose comparison. CPA analysis expands QA process to a greater level of details without additional work by users. With the additions of CPA analysis and 3DVH™, one can establish a comprehensive VMAT QA program with detailed mapping of composite dose passing rate, the estimated effect of discrepancies on patients, and possible sources of discrepancies.


Nasal Cavity Metastasis From Colorectal Cancer Represents End-Stage Disease and Should Be Palliated.
Nasal metastases from colorectal cancer is rare. The presentation of nasal metastases is often very similar to primary nasal sinus adenocarcinoma. A high index of suspicion is required, especially in patients who have had a previous history of colorectal carcinoma. Histology is ultimately required for diagnosis. We describe 2 cases of nasal metastases from colorectal carcinoma, and discuss the presentation, diagnosis and management of the case. Such metastatic disease ultimately represents end-stage malignancy, and patients should be palliated.


Cardiometabolic risk factors associated with brain age and accelerate brain ageing.
The structure and integrity of the ageing brain is interchangeably linked to physical health, and cardiometabolic risk factors (CMRs) are associated with dementia and other brain disorders. In this mixed cross-sectional and longitudinal study (interval mean = 19.7 months), including 790 healthy individuals (mean age = 46.7 years, 53% women), we investigated CMRs and health indicators including anthropometric measures, lifestyle factors, and blood biomarkers in relation to brain structure using MRI-based morphometry and diffusion tensor imaging (DTI). We performed tissue specific brain age prediction using machine learning and performed Bayesian multilevel modeling to assess changes in each CMR over time, their respective association with brain age gap (BAG), and their interaction effects with time and age on the tissue-specific BAGs. The results showed credible associations between DTI-based BAG and blood levels of phosphate and mean cell volume (MCV), and between T1-based BAG and systolic blood pressure, smoking, pulse, and C-reactive protein (CRP), indicating older-appearing brains in people with higher cardiometabolic risk (smoking, higher blood pressure and pulse, low-grade inflammation). Longitudinal evidence supported interactions between both BAGs and waist-to-hip ratio (WHR), and between DTI-based BAG and systolic blood pressure and smoking, indicating accelerated ageing in people with higher cardiometabolic risk (smoking, higher blood pressure, and WHR). The results demonstrate that cardiometabolic risk factors are associated with brain ageing. While randomized controlled trials are needed to establish causality, our results indicate that public health initiatives and treatment strategies targeting modifiable cardiometabolic risk factors may also improve risk trajectories and delay brain ageing.


Metabolic syndrome increases risk of Barrett esophagus in the absence of gastroesophageal reflux: an analysis of SEER-Medicare Data.
To evaluate the association between metabolic syndrome (MetS) and risk of Barrett esophagus (BE) using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database compared with 2 control groups--Medicare population controls and endoscopy controls. BE principally arises as an adaptation to the proinflammatory state induced by gastroesophageal reflux disease (GERD). The relationship between obesity and BE is presumed to be mediated by GERD. However, evidence suggests central adiposity also increases risk of BE independent of GERD. Central adiposity is one risk factor defining MetS, which confers a systemic proinflammatory state--a potential GERD-independent mechanism by which obesity could increase the risk of BE. MetS was defined as diagnosis of at least 3 of the following conditions: obesity, elevated triglycerides, high blood pressure, and elevated fasting glucose. Multivariable logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. In 2198 incident BE cases, prior MetS was significantly associated with BE (odds ratio, 1.20; 95% confidence interval: 1.07, 1.36) compared with population controls. However, GERD status modified the association; among those without prior GERD, MetS increased risk of BE by 34%; however, no association was observed among those with a prior GERD diagnosis (P-value for effect modification <0.001). MetS was not associated with risk of BE compared with endoscopy controls. MetS increased the risk of BE compared with population controls, an association driven by and confined to the non-GERD stratum. MetS may mediate an association between central adiposity and BE for those without GERD.


B-type natriuretic peptide and heart failure in patients with ventricular septal defect: a pilot study.
In adults without congenital heart disease, B-type natriuretic peptide (BNP) has been shown to be a very sensitive and specific marker of heart failure. The utility of BNP as a marker of clinical heart failure in children with a ventricular septal defect (VSD) has yet to be determined. A prospective, observational study evaluated BNP levels and other measures of heart failure. Eligible patients were <2 years old, scheduled to undergo surgical repair of a VSD, and without other significant structural heart disease. Data collected before and after surgical repair included echocardiographic measurements, electrocardiographic (ECG) findings, Ross score, BNP measurements, and weight gain. A total of 21 patients were enrolled and 14 patients had complete postoperative follow-up data. For patients with complete data, mean BNP decreased by 94 pg/ml (118 pre vs. 24 post; paired t-test, p = 0.041), mean left ventricular end-diastolic dimension z-score decreased by 1.75 (+0.86 vs. -0.89; paired t-test, p = 0.013), mean weight z-score change per month increased by 0.35 (-0.25 vs. +0.10; Wilcoxon test, p = 0.013), and the incidence of biventricular hypertrophy on ECG decreased (46% vs. 0%; McNemar test, p = 0.031). The change in BNP showed a trend toward a negative correlation with weight z-score change per month (r = -0.531, p = 0.075). In conclusion, BNP, along with other measures of heart failure, decreased following VSD repair, and the change in BNP was most closely correlated with improved weight gain.


Unusual redox behaviour of the magnetite/hematite core-shell structures processed by the laser floating zone method.
Magnetite (Fe3O4) offers unique physical and chemical properties, being an important material for many industrial applications. Certain limitations on the application conditions are, however, imposed by the redox stability issue. Fine control of the iron oxidation states represents a challenge for materials engineering. The present work explores relevant redox processes in iron oxides, processed under highly non-equilibrium laser floating zone (LFZ) conditions under atmospheres with different oxygen activities. The as-grown fibres showed a structure composed of the Fe3O4 core and the Fe2O3 shell. This study uncovers unexpectedly lower hematite content and shell thickness for the fibres processed under more oxidizing conditions. Combined structural and microstructural studies, supported by the analysis of the existing literature data, strongly suggest that the redox processes during the LFZ process can be rather determined by kinetics of melt crystallization, nuclei formation and heat transfer than by the oxygen content in the gas phase. The proposed mechanisms are further confirmed by electrical and magnetic studies of the composite fibres.


2-Formylpyrrole natural products: origin, structural diversity, bioactivity and synthesis.
Covering: up to April 2018 2-Formylpyrroles are ubiquitous in nature, arising from the non-enzymatic Maillard reactions of amines and sugars. Often confused for secondary metabolites, these Maillard products display interesting biological activities including hepatoprotective, immunostimulatory, antiproliferative and antioxidant effects. This review presents all 2-formylpyrrole natural products reported to date and identifies structural sub-classes for their categorisation. The origin, biological activity and chemical syntheses of these natural products are discussed herein.


Growth consequences of plasticity of plant traits in response to light conditions.
We present a method for quantifying the growth advantage, if any, that results from the plasticity of plant traits in response to growth in high vs. low resource levels. The method, which uses two phenotypes and two resource levels, quantifies the average advantage that a phenotype has, in its own set of conditions, over the other phenotype. The method is applied to the growth of two phenotypes of Abutilon theophrasti, induced by high and low light intensity, in response to two levels of incident light intensity. We calculated the growth advantage first using relative growth rate, and second using whole-plant photosynthetic assimilation rate, as the response variable. Then we used the photosynthetic responses to changes in light intensity to calculate changes in growth rates of each phenotype when exposed to a change in light conditions. These three quantifications of growth advantage broadly agree with one another. Despite the great plasticity of its traits induced by growth in high vs. low light intensity, whole-plant plasticity did not allow Abutilon theophrasti to exhibit a significant growth advantage under these conditions. Indeed, the relative growth rate of the low light phenotype greatly exceeded that of the high light phenotype in high incident light conditions. This may have resulted from the higher leaf area ratio of the low light phenotype. Furthermore, the high light phenotype had significantly greater transpiration rate in both light conditions. For these reasons we suggest that light-induced plasticity of traits in Abutilon theophrasti may confer advantage in response to the variation in vapor pressure deficit that is associated with variation in light intensity. Light-induced plasticity may also be advantageous because under high incident light conditions the high-light phenotype has greater reproductive allocation than the low-light phenotype.


Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research.
Transfusion-related acute lung injury (TRALI) and hemolytic transfusion reactions account for significant transfusion-related morbidity and mortality in the United States. Our study evaluated types and quantities of transfused components as well as occurrence of TRALI, ABO, and Rh incompatibilities among the US elderly in the institutional outpatient setting during 2007 to 2008. This retrospective claims-based study utilized the Centers for Medicare & Medicaid Services' large administrative databases. Transfusions were identified by recorded procedure and revenue center codes, while complications were ascertained via ICD-9-CM diagnosis codes. The study quantified blood use based on revenue center units. Among 26,054,242 and 25,662,864 Medicare elderly in 2007 and 2008, a total of 241,055 (0.9%) and 251,284 (1.0%) had outpatient transfusions. Leukoreduced red blood cells (LR-RBCs) was the most frequently transfused single blood component (60.1 and 61.3%, respectively) each year. Likewise, LR-RBCs and LR pheresis platelets (LR-PLTs) was the most frequent component combination (2.4 and 2.6%, respectively). TRALI rate comparison for RBCs and PLTs versus RBCs only showed higher rate for RBCs and PLTs (p = 0.033). In 2007 and 2008, ABO incompatibility rate comparison for irradiated (IR) LR-RBCs versus LR-RBCs showed higher rates for IR LR-RBCs (rate ratio [RR] 37.4, 95% confidence interval [CI] 10.6-132.6; and RR 31.3, 95% CI 11.6-84.4, respectively). This study shows potential usefulness of Medicare databases in assessment of blood utilization, transfusion-related complications, and risk factors among US elderly in the outpatient setting. It suggests limitations (e.g., need for several years of data to better assess rare complications) and importance of databases as hypothesis-generating tool to supplement blood safety research.


A new "tilt" illusion reveals the relation between border ownership and border binding.
The "association field" models of contour detection predict specific spatial conditions for linking or grouping neighboring elements into smooth contours. We previously suggested that the "association field" model may account for perceptual binding of near-collinear luminance edges of same contrast polarity and their consequent unification into a unique contrast border with illusory tilt. This approach is now developed into a new version of the tilt illusion, the seesaw illusion, in which the contrast border is perceived as inverting concave-convex illusory curvature when background luminance is inverted, indicating that contrast polarity must be incorporated into the notion of "association field" to account for the seesaw illusion. We found that although tile-edge segmentation into alternating black-white segments produces conflicting local tilts, the illusion remains, up to 16 arcmin edge distance. This occurs at extreme background luminance for long segments (where only congruent edge segments of higher contrast bind, the others being perceptually assimilated into the background surface) and, when segments are too short for their orientation to be detected, at all background luminance values except that equidistant from black and white stripes. Our findings provide further confirmation that these are striking border ownership phenomena, demonstrating that figure/ground organization precedes perceptual binding of edges through association fields.


Synthesis of Polyacetylene-like Modified Graphene Oxide Aerogel and Its Enhanced Electrical Properties.
A graphene-based or carbon-based aerogel is a three-dimensional (3D) solid material in which the carbon atoms are arranged in a sheet-like nanostructure. In this study, we report the synthesis of low-density polymer-modified aerogel monoliths by 3D macroassemblies of graphene oxide sheets that exhibit significant internal surface areas (982 m2/g) and high electrical conductivity (∼0.1 to 1 × 102 S/cm). Different types of materials were prepared to obtain a single monolithic solid starting from a suspension of single-layer graphene oxide (GO) sheets and a polymer, made from the precursors 4-carboxybenzaldehyde and poly(vinyl alcohol). These materials were used to cross-link the individual sheets by covalent bonds, resulting in wet-gels that were supercritically dried and then, in some cases, thermally reduced to yield graphene aerogel composites. The average densities were approaching 15-20 mg/cm3. This approach allowed for the modulation of the distance between the sheets, pore dimension, surface area, and related properties. This specific GO/polymer ratio has suitable malleability, making it a viable conductive material for use in 3D printing; it also has other properties suitable for energy storage, catalysis, sensing and biosensing applications, bioelectronics, and superconductors.


Receipt of psychotropic medication by people with intellectual disability in residential settings.
Previous studies have reported that the rate of prescription of antipsychotic medication for people with intellectual disability is far in excess of the expected prevalence of psychoses for this population. Recent research identifying factors which predict the use of psychotropic medication suggests that challenging behaviour may play a key role in determining the receipt of antipsychotic medication. The present study reports the prevalence of psychoactive medication receipt for 500 people with intellectual disability living in different forms of residential provision in the UK. Variables which predict the receipt of psychotropic medication are also identified. The results show differences between forms of residential provision in rates of medication receipt. Analyses of predictors of psychotropic medication receipt suggest that, whilst the receipt of antidepressants is predicted by symptoms of mental ill health, the receipt of both antipsychotics and hypnotics/anxiolytics is predicted by variables related to challenging behaviour.


Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program.
Sodium ibuprofenate in hypertonic saline (NaIHS) administered directly to the lungs by nebulization and inhalation has antibacterial and anti-inflammatory effects, with the potential to deliver these benefits to hypoxic patients. We describe a compassionate use program that offered this therapy to hospitalized COVID-19 patients. NaIHS (50 mg ibuprofen, tid) was provided in addition to standard of care (SOC) to hospitalized COVID-19 patients until oxygen saturation levels of > 94% were achieved on ambient air. Patients wore a containment hood to diminish aerosolization. Outcome data from participating patients treated at multiple hospitals in Argentina between April 4 and October 31, 2020, are summarized. Results were compared with a retrospective contemporaneous control (CC) group of hospitalized COVID-19 patients with SOC alone during the same time frame from a subset of participating hospitals from Córdoba and Buenos Aires. The evolution of 383 patients treated with SOC + NaIHS [56 on mechanical ventilation (MV) at baseline] and 195 CC (21 on MV at baseline) are summarized. At baseline, NaIHS-treated patients had basal oxygen saturation of 90.7 ± 0.2% (74.3% were on supplemental oxygen at baseline) and a basal respiratory rate of 22.7 ± 0.3 breath/min. In the CC group, basal oxygen saturation was 92.6 ± 0.4% (52.1% were on oxygen supplementation at baseline) and respiratory rate was 19.3 ± 0.3 breath/min. Despite greater pulmonary compromise at baseline in the NaIHS-treated group, the length of treatment (LOT) was 9.1 ± 0.2 gs with an average length of stay (ALOS) of 11.5 ± 0.3 days, in comparison with an ALOS of 13.3 ± 0.9 days in the CC group. In patients on MV who received NaIHS, the ALOS was lower than in the CC group. In both NaIHS-treated groups, a rapid reversal of deterioration in oxygenation and NEWS2 scores was observed acutely after initiation of NaIHS therapy. No serious adverse events were considered related to ibuprofen therapy. Mortality was lower in both NaIHS groups compared with CC groups. Treatment of COVID-19 pneumonitis with inhalational nebulized NaIHS was associated with rapid improvement in hypoxia and vital signs, with no serious adverse events attributed to therapy. Nebulized NaIHS s worthy of further study in randomized, placebo-controlled trials (ClinicalTrials.gov: NCT04382768).


The long shadow of the past: risk pooling and the political development of health care reform in the States.
Why do the states seem to be pursuing different types of policy innovation in their health reform? Why so some seem to follow a "solidarity principle," while others seem guided by a commitment to "actuarial fairness"? Our analysis highlights the reciprocal influence of stakeholder mobilization and public policy over time. We find that early policy choices about how to achieve cost containment led the states down different paths of reform. In the 1970s and 1980s, states that featured oligopolistic or near-monopolistic markets for private insurance (usually dominated by Blue Cross) and strong urban-academic hospitals tended to adopt regulatory strategies for cost containment that led to broader forms of pooling and financing the costs of health risks--which subsequently positioned them to pursue major, solidaristic reform on favorable terms. On the other hand, states with competitive markets for private insurance and weak, decentralized hospitals tended to adopt market-based strategies for cost containment that led to the hypersegmentation of risk and the uneven financing of costs--thereby encouraging the proliferation of incremental policies that reinforce the principle of actuarial fairness. We illustrate our analysis with a brief comparison of Massachusetts and California, and we conclude with some thoughts on what our findings imply for the federal role in catalyzing health reform.


Platelet-derived growth factor-induced alterations in vinculin and actin distribution in BALB/c-3T3 cells.
Exposure of BALB/c-3T3 cells (clone A31) to platelet-derived growth factor (PDGF) results in a rapid time- and dose-dependent alteration in the distribution of vinculin and actin. PDGF treatment (6-50 ng/ml) causes vinculin to disappear from adhesion plaques (within 2.5 min after PDGF exposure) and is followed by an accumulation of vinculin in punctate spots in the perinuclear region of the cell. This alteration in vinculin distribution is followed by a disruption of actin-containing stress fibers (within 5 to 10 min after PDGF exposure). Vinculin reappears in adhesion plaques by 60 min after PDGF addition while stress fiber staining is nondetectable at this time. PDGF treatment had no effect on talin, vimentin, or microtubule distribution in BALB/c-3T3 cells; in addition, exposure of cells to 5% platelet-poor plasma (PPP), 0.1% PPP, 30 ng/ml epidermal growth factor (EGF), 30 ng/ml somatomedin C, or 10 microM insulin also had no effect on vinculin or actin distribution. Other competence-inducing factors (fibroblast growth factor, calcium phosphate, and choleragen) and tumor growth factor produced similar alterations in vinculin and actin distribution as did PDGF, though not to the same extent. PDGF treatment of cells for 60 min followed by exposure to EGF (0.1-30 ng/ml for as long as 8 h after PDGF removal), or 5% PPP resulted in the nontransient disappearance of vinculin staining within 10 min after EGF or PPP additions; PDGF followed by 0.1% PPP or 10 microM insulin had no effect. Treatment of cells with low doses of PDGF (3.25 ng/ml), which did not affect vinculin or actin organization in cells, followed by EGF (10 ng/ml), resulted in the disappearance of vinculin staining in adhesion plaques, thus demonstrating the synergistic nature of PDGF and EGF. These data suggest that PDGF-induced competence and stimulation of cell growth in quiescent fibroblasts are associated with specific rapid alterations in the cellular organization of vinculin and actin.


Imaging in polymyalgia rheumatica.
Polymyalgia rheumatica (PMR) is a chronic, inflammatory disorder of unknown cause clinically characterized by pain and prolonged morning stiffness affecting the shoulders and often the pelvic girdle and neck. Imaging has substantially contributed to defining PMR as a disease mainly involving extra-articular structures. This review article analyses the role of the different imaging techniques in the diagnosis and follow-up of patients with PMR with particular emphasis on the role of ultrasound, PET/CT and MRI.


A low noise remotely controllable wireless telemetry system for single-unit recording in rats navigating in a vertical maze.
The use of cables for recording neural activity limits the scope of behavioral tests used in conscious free-moving animals. Particularly, cable attachments make it impossible to record in three-dimensional (3D) mazes where levels are vertically stacked or in enclosed spaces. Such environments are of particular interest in investigations of hippocampal place cells, in which neural activity is correlated with spatial position in the environment. We developed a flexible miniaturized Bluetooth-based wireless data acquisition system. The wireless module included an 8-channel analogue front end, digital controller, and Bluetooth transceiver mounted on a backpack. Our bidirectional wireless design allowed all data channels to be previewed at 1 kHz sample rate, and one channel, selected by remote control, to be sampled at 10 kHz. Extracellular recordings of neuronal activity are highly susceptible to ambient electrical noise due to the high electrode impedance. Through careful design of appropriate shielding and hardware configuration to avoid ground loops, mains power and Bluetooth hopping frequency noise were reduced sufficiently to yield signal quality comparable to those recorded by wired systems. With this system we were able to obtain single-unit recordings of hippocampal place cells in rats running an enclosed vertical maze, over a range of 5 m.


Continuum modeling of bulk metallic glasses and composites.
At low temperatures, monolithic bulk metallic glasses (BMGs) exhibit high strength and large elasticity limits. On the other hand, BMGs lack overall ductility due to highly localized deformation mechanisms. Recent experimental findings suggest that the problem of catastrophic failure by shear band propagation in BMGs can be mitigated by tailoring microstructural features at different length scales to promote more homogeneous plastic deformation. Herein, based on a continuum approach, we present a quantitative analysis of the effects of microstructure on the deformation behavior of monolithic BMGs and BMG composites. In particular, simulations highlight the importance of short-ranged structural correlations on ductility in monolithic BMGs and demonstrate that particle size controls the ductility of BMG composites. In broader terms, our results provide new avenues for further improvements to the mechanical properties of BMGs.


Systemic cholinergic agents induce seizures and brain damage in lithium-treated rats.
Administration of pilocarpine or physostigmine to rats treated with lithium chloride produced sustained limbic seizures, widespread brain damage, and increased concentrations of D-myo-inositol-1-phosphate (a metabolite of the phosphoinositides, lipids involved in membrane receptor function) in the brain. The syndrome was preventable with atropine. The physostigmine doses and concentrations of blood lithium that caused the syndrome are similar to those considered appropriate for psychiatric chemotherapy.


One-step vapor-phase synthesis of transparent high refractive index sulfur-containing polymers.
High refractive index polymers (HRIPs) have recently emerged as an important class of materials for use in a variety of optoelectronic devices including image sensors, lithography, and light-emitting diodes. However, achieving polymers having refractive index exceeding 1.8 while maintaining full transparency in the visible range still remains formidably challenging. Here, we present a unique one-step vapor-phase process, termed sulfur chemical vapor deposition, to generate highly stable, ultrahigh refractive index (n > 1.9) polymers directly from elemental sulfur. The deposition process involved vapor-phase radical polymerization between elemental sulfur and vinyl monomers to provide polymer films with controlled thickness and sulfur content, along with the refractive index as high as 1.91. Notably, the HRIP thin film showed unprecedented optical transparency throughout the visible range, attributed to the absence of long polysulfide segments within the polymer, which will serve as a key component in a wide range of optical devices.


Public Mental Health Crisis during COVID-19 Pandemic, China.
The 2019 novel coronavirus disease emerged in China in late 2019-early 2020 and spread rapidly. China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist. Public mental health interventions should be formally integrated into public health preparedness and emergency response plans.


Orientation direction dependency of cavitation in pre-oriented isotactic polypropylene at large strains.
Orientation direction dependency of whitening activated at large strains was studied using four pre-oriented isotactic polypropylene (iPP) samples with different molecular weights stretched along different directions with respect to the pre-orientation (0°, 45°, and 90°) by means of in situ wide-, small-, and ultra-small-angle X-ray scattering techniques. A macroscopic fracture of iPP materials was also observed following the stress whitening at large strains. These two associated processes in pre-oriented iPP samples at elevated temperatures were found to be governed by not only the molecular weight of iPP but also the pre-orientation direction. For a certain pre-orientation direction of iPP, both the critical stress of cavitation induced-whitening and failure stress increased with increasing molecular weight. For one given molecular weight, the pre-oriented iPP showed the smallest critical stress for whitening and failure stress along the pre-orientation direction (0°) while the samples displayed larger values for the same behaviors when stretched at 45° or 90° with respect to the pre-orientation direction. Such behavior suggested that oriented amorphous networks, with different mechanical strengths, can be generated during the second deformation processes in these pre-oriented iPP samples. The evolution of inter-fibrillar tie chains in highly oriented amorphous networks was considered as the main factor controlling the response of the inner network to the external stress since the cavitation-induced whitening activated at large strains was caused by the failure of load bearing inter-fibrillar tie chains in the oriented amorphous network.


Performance of sulphate- and selenium-reducing biochemical reactors using different ratios of labile to recalcitrant organic materials.
Successful operation of sulphate-reducing bioreactors using complex organic materials depends on providing a balance between more easily degrading material that achieves reasonable kinetics and low hydraulic retention times, and more slowly decomposing material that sustains performance in the long term. In this study, two organic mixtures containing the same ingredients typical of bioreactors used at mine sites (woodchips, hay and cow manure) but with different ratios of wood (recalcitrant) to hay (labile) were tested in six continuous flow bioreactors treating synthetic mine-affected water containing 600 mg/L of sulphate and 15 μg/L of selenium. The reactors were operated for short (5-6 months) and long (435-450 days) periods of time at the same hydraulic retention time of 15 days. There were no differences in the performance of the bioreactors in terms of sulphate-reduction over the short term, but the wood-rich bioreactors experienced variable and sometimes unreliable sulphate-reduction over the long term. Presence of more hay in the organic mixture was able to better sustain reliable performance. Production of dissolved organic compounds due to biodegradation within the bioreactors was detected for the first 175-230 days, after which their depletion coincided with a crash phase observed in the wood-rich bioreactors only.


Effect of ligand substituent on the reactivity of Ni(II) complexes towards oxygen.
Two radical-containing Ni(II) complexes having either parent salicylidene (complex 1) or 3,5-di-tert-butylsalicylidene (complex 2) in the ligand backbone were synthesized. Complex 2 underwent ligand centered C–H activation by aerial oxygen, forming the corresponding amide complex (2a). The UV-Vis/NIR spectral changes upon purging of molecular oxygen to 2 in CH2Cl2, alongwith ESI-MS analysis indicated the generation of Ni–oxygen/dioxygen species as the intermediate(s) for the amide formation. Interestingly, nonparticipation of the ligand centered π-radical in the oxidation process was observed.


[Acute kidney injury as a risk marker for hospital readmission: a single-center pilot study in the general population of the Parma area].
Acute Kidney Injury (AKI) is an important issue for the healthcare system, as it is associated with high mortality and increased risk of readmission, with consequent elevated healthcare resource utilization. We investigated the incidence of AKI based on the examination of the discharge cards of all patients admitted between January 1 2011 and December 31 2015 at the Parma University Hospital, as well as the frequency and type of 30-day hospital readmission in the patients discharged with a first AKI diagnosis (index admission). The mean pooled 5-year incidence of AKI was 2.4%. The mean frequency of 30-day readmission for any disease in patients discharged with a first AKI diagnosis in the selected time interval was 23.1%/year. The main four disease categories, as assessed by the Diagnosis Related Group (DRG) classification, responsible for patient 30-day readmission were a new AKI episode, heart failure, respiratory failure requiring or not requiring mechanical ventilation, and sepsis. The mean lenght of hospital stay of patients discharged with AKI as a principal or secondary diagnosis was 14.4 and 21.8 days, respectively. Based on the evaluation of administrative data from all hospital admissions at the Parma University Hospital in the 2011-2015 5-year period, we conclude that AKI represents a serious challenge for the healthcare system, with high short-term morbidity and increased resource utilization due to frequent hospital readmissions.


Near-fatal cardiac arrest due to cardiac tamponade during percutaneous mitral valvuloplasty.
The incidence of hemopericardium following percutaneous mitral valvuloplasty is reported at 1-3%, being related to either trans-septal puncture, or left ventricular perforation with guide wires or balloons. We report a case of percutaneous mitral valvuloplasty for a middle-aged man with moderately severe rheumatic mitral stenosis. The procedure was performed through a right femoral vein approach, employing the multitrack technique, utilizing 2 balloons (20 and 18 mm). Inadvertently, the procedure was complicated by cardiac tamponade. Despite immediate diagnosis and prompt pericardiocentesis, hemodynamic stability was not maintained. Echocardiography revealed a mass in the posterior pericardial sac. The patient was arrested in asystole, and rigorously resuscitated during transfer to the operating room. Exploration revealed a tear in the left ventricular apex that was adequately sutured. In a few days, the patient gradually regained adequate consciousness, and was ultimately discharged. Post-procedural echocardiography revealed a mitral valve area of 1.9 cm(2), with no mitral regurgitation.


Hospital violence reduction among high-risk patients.
We describe the success of one general hospital in reducing violent behavior among a group of repetitively disruptive patients. Following a pilot phase during which violent incidents at the medical center were characterized by location, type, and person responsible, a group of patients at high risk for repeated violence was identified (N = 48). Data were gathered for 1 year before and after the institution of a program designed to reduce violence, primarily in ambulatory care areas, among this group. Outcome assessment included comparison of the number of violent incidents and the number of visits to the medical center during the 12 months before and after the program was started. The number of incidents declined by 91.6%, and visits to the medical center for any reason decreased by 42.2%. The ratio of violent incidents to visits after the program was begun was less than one sixth the rate before the program. Components of the program are described, including staff resistance and management strategies.


Is intraoperative parathyroid hormone monitoring necessary with ipsilateral parathyroid gland visualization during anticipated unilateral exploration for primary hyperparathyroidism: a two-institution analysis of more than 2,000 patients.
Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity. The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two academic institutions were queried. Patients with ectopic adenoma, familial PHPT, previous parathyroidectomy, planned bilateral exploration, or <6 months follow-up were excluded. Persistence was defined as hypercalcemia at <6 months. From 1998 to 2013, 2,162 patients met inclusion criteria, and the rate of persistent disease was 1.5%. Most (n = 1,353; 63.5%) underwent single-gland resection with ioPTH and no IPG visualization, with 1% persistence. Among patients with a single adenoma resected and a normal IPG visualized, 15.2% had contralateral disease. Resection based on IPG appearance alone would have resulted in 13% persistent disease. In PHPT, the cure rate for initial unilateral exploration guided by ioPTH is 98.5% versus a predicted rate of 87% when decision making is based on IPG appearance alone. Routine visualization of IPG is not necessary during exploration for suspected single adenoma guided by ioPTH. ioPTH remains useful in optimizing outcomes.


Cohesion is established during DNA replication utilising chromosome associated cohesin rings as well as those loaded de novo onto nascent DNAs.
Sister chromatid cohesion essential for mitotic chromosome segregation is thought to involve the co-entrapment of sister DNAs within cohesin rings. Although cohesin can load onto chromosomes throughout the cell cycle, it only builds cohesion during S phase. A key question is whether cohesion is generated by conversion of cohesin complexes associated with un-replicated DNAs ahead of replication forks into cohesive structures behind them, or from nucleoplasmic cohesin that is loaded de novo onto nascent DNAs associated with forks, a process that would be dependent on cohesin's Scc2 subunit. We show here that in S. cerevisiae, both mechanisms exist and that each requires a different set of replisome-associated proteins. Cohesion produced by cohesin conversion requires Tof1/Csm3, Ctf4 and Chl1 but not Scc2 while that created by Scc2-dependent de novo loading at replication forks requires the Ctf18-RFC complex. The association of specific replisome proteins with different types of cohesion establishment opens the way to a mechanistic understanding of an aspect of DNA replication unique to eukaryotic cells.


A high-throughput gene disruption methodology for the entomopathogenic fungus Metarhizium robertsii.
Systematic gene disruption is a direct way to interrogate a fungal genome to functionally characterize the full suite of genes involved in various biological processes. Metarhizium robertsii is extraordinarily versatile, and it is a pathogen of arthropods, a saprophyte and a beneficial colonizer of rhizospheres. Thus, M. robertsii can be used as a representative to simultaneously study several major lifestyles that are not shared by the "model" fungi Saccharomyces cerevisiae and Neurospora crassa; a systematic genetic analysis of M. robertsii will benefit studies in other fungi. In order to systematically disrupt genes in M. robertsii, we developed a high-throughput gene disruption methodology, which includes two technologies. One is the modified OSCAR-based, high-throughput construction of gene disruption plasmids. This technology involves two donor plasmids (pA-Bar-OSCAR with the herbicide resistance genes Bar and pA-Sur-OSCAR with another herbicide resistance gene Sur) and a recipient binary plasmid pPK2-OSCAR-GFP that was produced by replacing the Bar cassette in pPK2-bar-GFP with a ccdB cassette and recombination recognition sites. Using this technology, a gene disruption plasmid can be constructed in one cloning step in two days. The other is a highly efficient gene disruption technology based on homologous recombination using a Ku70 deletion mutant (ΔMrKu70) as the recipient strain. The deletion of MrKu70, a gene encoding a key component involved in nonhomologous end-joining DNA repair in fungi, dramatically increases the gene disruption efficiency. The frequency of disrupting the conidiation-associated gene Cag8 in ΔMrKu70 was 93% compared to 7% in the wild-type strain. Since ΔMrKu70 is not different from the wild-type strain in development, pathogenicity and tolerance to various abiotic stresses, it can be used as a recipient strain for a systematic gene disruption project to characterize the whole suite of genes involved in the biological processes of M. robertsii.


Evaluation of Polygenic Risk Scores for Breast and Ovarian Cancer Risk Prediction in BRCA1 and BRCA2 Mutation Carriers.
Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2×10 -53 ). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2×10 -20 ). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management.


An update on the "empirical turn" in bioethics: analysis of empirical research in nine bioethics journals.
A review of literature published a decade ago noted a significant increase in empirical papers across nine bioethics journals. This study provides an update on the presence of empirical papers in the same nine journals. It first evaluates whether the empirical trend is continuing as noted in the previous study, and second, how it is changing, that is, what are the characteristics of the empirical works published in these nine bioethics journals. A review of the same nine journals (Bioethics; Journal of Medical Ethics; Journal of Clinical Ethics; Nursing Ethics; Cambridge Quarterly of Healthcare Ethics; Hastings Center Report; Theoretical Medicine and Bioethics; Christian Bioethics; and Kennedy Institute of Ethics Journal) was conducted for a 12-year period from 2004 to 2015. Data obtained was analysed descriptively and using a non-parametric Chi-square test. Of the total number of original papers (N = 5567) published in the nine bioethics journals, 18.1% (n = 1007) collected and analysed empirical data. Journal of Medical Ethics and Nursing Ethics led the empirical publications, accounting for 89.4% of all empirical papers. The former published significantly more quantitative papers than qualitative, whereas the latter published more qualitative papers. Our analysis reveals no significant difference (χ2 = 2.857; p = 0.091) between the proportion of empirical papers published in 2004-2009 and 2010-2015. However, the increasing empirical trend has continued in these journals with the proportion of empirical papers increasing from 14.9% in 2004 to 17.8% in 2015. This study presents the current state of affairs regarding empirical research published nine bioethics journals. In the quarter century of data that is available about the nine bioethics journals studied in two reviews, the proportion of empirical publications continues to increase, signifying a trend towards empirical research in bioethics. The growing volume is mainly attributable to two journals: Journal of Medical Ethics and Nursing Ethics. This descriptive study further maps the still developing field of empirical research in bioethics. Additional studies are needed to completely map the nature and extent of empirical research in bioethics to inform the ongoing debate about the value of empirical research for bioethics.


A case of different EGFR mutations in surgically resected synchronous triple lung cancer.
We describe a 77-year-old Japanese woman who presented with three nodule shadows in three different lobes of the right lung, without evidence of lymph node metastasis or distant metastasis. All three tumors were surgically resected. The pathological diagnosis was synchronous multiple primary lung cancer: pT2aN0M0, pStageIB. Based on a differing epidermal growth factor receptor (EGFR) mutation status, no lymph node metastasis, and no distant metastasis, the tumors were characterized as synchronous triple primary rather than intrapulmonary metastases. At eight months after surgery, a new lesion emerged in the right lower lobe. Given that the most advanced tumor had an EGFR del-19 mutation, the patient was orally administered afatinib. Since then, the treatment response of the patient has been assessed as stable disease (SD) for about two years. This is a very rare case of resected triple synchronous primary lung cancer on the same lung side in which the lesions all had a different EGFR mutation status, and this report highlights the clinical utility of surgical resection of multifocal lung nodules without lymph node metastasis or distant metastasis in order to optimize therapy for patients with known driver mutations.


A new Late Triasssic phytogeographical scenario in westernmost Gondwana.
Floral provincialism within the Southern Hemisphere during the Late Triassic (230 Ma) is characterized by the Ipswich and Onslow provinces, recognized originally in eastern Gondwana. However, new palynological assemblages from the Ischigualasto Formation, northwestern Argentina (231-225 Ma), change the phytogeographic interpretation for the Carnian-Norian in the westernmost Gondwana, which was previously considered part of the southern floral Ipswich province. Here we show the presence of diagnostic Euramerican species within assemblages dominated by Gondwanan taxa that allows us to refer the palynofloras to the Onslow province. Our new data extend the Onslow floral belt, previously recognized from the western edge of Tethys to Timor, to the western margin of South America. This has implications for palaeophytogeography, palaeoclimate reconstructions and the palaeoecology of a Triassic ecosystem, which has yielded significant vertebrate remains and is regarded important in the early evolution of groups such as the Dinosauria.


Rapid changes in the range limits of scots pine 4000 years ago.
Paleoecological data provide estimates of response rates to past climate changes. Fossil Pinus sylvestris stumps in far northern Scotland demonstrate former presence of pine trees where conventional pollen evidence of pine forests is lacking. Radiocarbon, dendrochronological, and fine temporal-resolution palynological data show that pine forests were present for about four centuries some 4000 years ago; the forests expanded and then retreated rapidly some 70 to 80 kilometers. Despite the rapidity of this response to climate change, it occurred at rates slower by an order of magnitude than those necessary to maintain equilibrium with forecast climate changes attributed to the greenhouse effect.


Lung cancer risk among cooks when accounting for tobacco smoking: a pooled analysis of case-control studies from Europe, Canada, New Zealand, and China.
To investigate the risk of lung cancer among cooks, while controlling for smoking habits. We used data from the SYNERGY project including pooled information on lifetime work histories and smoking habits from 16 case-control studies conducted in Europe, Canada, New Zealand, and China. Before adjustment for smoking, we observed an increased risk of lung cancer in male cooks, but not in female cooks. After adjusting, there was no increased risk and no significant exposure-response relationship. Nevertheless, subgroup analyses highlighted some possible excess risks of squamous cell carcinoma and small cell carcinoma in female cooks. There is evidence that lung cancer risks among cooks may be confounded by smoking. After adjustment, cooks did not experience an increased risk of lung cancer overall. The subgroup analyses showing some excess risks among female cooks require cautious interpretation.


Clutch cutter is a safe device for performing endoscopic submucosal dissection of superficial esophageal neoplasms: a western experience.
Although the endoscopic submucosal dissection (ESD) has been established to be more efficacious in the treatment of superficial gastrointestinal neoplasia than the piecemeal resection, its use is still limited due to the concern about serious adverse events particularly in the west. Newer ESD knives have been developed that have been said to be safer than the first-generation devices. We aimed to report a Western single center experience regarding the initial safety and performance of ESD for superficial esophageal neoplasia treated with the Clutch Cutter (DP2618DT; Fujifilm Corporation, Tokyo, Japan). Our main outcome was safety in terms of bleeding or perforation. Secondary outcomes included en bloc resection and the R0 resection. Fourteen patients with superficial esophageal neoplasia underwent 15 ESDs using the Clutch Cutter. The mean age was 65 ± 16.7 years and 10 (71.4%) males. Eight (57%) patients had esophageal adenocarcinoma, 3 (21.4%) had high-grade dysplasia, 1 (7%) had nodular low-grade dysplasia, and 2 (14.3%) had squamous cell carcinoma. Mild anticipated intraprocedural bleeding was present with most procedures. However, no significant postoperative bleeding or perforation was encountered. One patient had mild chest pain postprocedure. En bloc resection was achieved in all lesions 100%. Histological R0 was achieved in 5/12 lesions (41.6%). The mean length of the resected area was 24.8 ± 13 mm (IQR: 17-30 mm). All patients were safely discharged home after overnight observation. In conclusion, this is the largest series of esophageal ESD using the multimodal Clutch Cutter in the United States; we found that the device effectively achieved en bloc resection of superficial esophageal neoplasia without significant adverse events. The use of the Clutch Cutter should be considered as one option to minimize adverse events during ESD in the Western population.


Activated carbon cloth: a potential adsorbing/oxidizing catalyst for phenolic wastewater.
An investigation into the use of activated carbon cloth (ACC) as a potential adsorbent and/or catalyst for oxidation processes is reported. The extent of increase/decrease of oxidation/adsorption of phenol, as measured by total organic carbon content (%), is explained by considering the effects of the oxidants such as ozone and hydrogen peroxide on the activated carbon cloth. Results also show that acid pH enhances the catalytic decomposition of H(2)O(2) to hydroxyl radicals, increasing TOC removal from 16 to 55% as a result of oxidation of phenol in addition to adsorption on the ACC surface. Furthermore when using ACC catalysis under optimized conditions, the maximum extent of TOC elimination is approximately 70% with three 15 min doses of ozone at pH 9.


Apple and blackcurrant polyphenol-rich drinks decrease postprandial glucose, insulin and incretin response to a high-carbohydrate meal in healthy men and women.
Postprandial glycemic responses to meals are inhibited by polyphenol-rich plant foods. Combinations of polyphenols may be particularly effective through complementary mechanisms. A randomized, controlled, double-blinded cross-over trial was conducted in healthy volunteers to test the hypothesis that apple and blackcurrant polyphenol-rich drinks would reduce postprandial blood glucose concentrations. Secondary outcomes included insulin and glucose-dependent insulinotropic polypeptide (GIP) secretion. Twenty men (mean age 26 y, SD 8) and 5 postmenopausal women (mean age 57 y, SD 3) consumed a placebo drink (CON) and 2 polyphenol-rich drinks containing fruit extracts: either 1200 mg apple polyphenols (AE), or 600 mg apple polyphenols+600 mg blackcurrant anthocyanins (AE+BE), in random order with a starch and sucrose meal. Incremental areas under the curve (iAUC) for plasma glucose concentrations were lower following AE+BE over 0-30 and 0-120 min compared with CON; mean differences (95% CI) -32 mmol/L·min (-41, -22, P<.0005) and -52 mmol/L min (-94, -9, P<.05), respectively. AE significantly reduced iAUC 0-30 min (mean difference -26 mmol/L min, -35, -18, P<.0005) compared with CON, but the difference over 120 min was not significant. Postprandial insulin, C-peptide and GIP concentrations were significantly reduced relative to CON. A dose response inhibition of glucose transport was demonstrated in Caco-2 cells, including total and GLUT-mediated transport, and SGLT1-mediated glucose transport was strongly inhibited at all doses in Xenopus oocytes, following 10 min incubation with 0.125-4 mg apple polyphenols/ml. In conclusion, ingestion of apple and blackcurrant polyphenols decreased postprandial glycemia, which may be partly related to inhibition of intestinal glucose transport.


Can MRI measure myelin? Systematic review, qualitative assessment, and meta-analysis of studies validating microstructural imaging with myelin histology.
Recent years have seen an increased understanding of the importance of myelination in healthy brain function and neuropsychiatric diseases. Non-invasive microstructural magnetic resonance imaging (MRI) holds the potential to expand and translate these insights to basic and clinical human research, but the sensitivity and specificity of different MR markers to myelination is a subject of debate. To consolidate current knowledge on the topic, we perform a systematic review and meta-analysis of studies that validate microstructural imaging by combining it with myelin histology. We find meta-analytic evidence for correlations between various myelin histology metrics and markers from different MRI modalities, including fractional anisotropy, radial diffusivity, macromolecular pool, magnetization transfer ratio, susceptibility and longitudinal relaxation rate, but not mean diffusivity. Meta-analytic correlation effect sizes range widely, between R2 = 0.26 and R2 = 0.82. However, formal comparisons between MRI-based myelin markers are limited by methodological variability, inconsistent reporting and potential for publication bias, thus preventing the establishment of a single most sensitive strategy to measure myelin with MRI. To facilitate further progress, we provide a detailed characterisation of the evaluated studies as an online resource. We also share a set of 12 recommendations for future studies validating putative MR-based myelin markers and deploying them in vivo in humans.


The genetic organization of the yeast Ty element.
The genetic organization of the yeast transposon Ty resembles that of higher eukaryotic retroviruses and other elements such as the copia-like sequences of Drosophila. The Ty genome is 5.9 kb (10(3) bases) long. It has 340 bp (base pairs) terminal repeats known as delta sequences and it produces a terminally redundant 5.7 kb RNA that starts in the 5' delta and ends in the 3' delta. Ty transcription is directed by signals upstream and downstream of the major RNA start site and is regulated by the mating-type configuration of the cell. The 5.7 kb transcriptional unit is divided into two overlapping open reading frames, TYA and TYB. TYA occupies approximately the first quarter of the transcriptional unit while TYB occupies the rest. TYB overlaps TYA by either 38 or 44 nucleotides, depending on the element, and is in the plus one reading frame with respect to TYA. TYA is expressed to produce protein p1 (50 x 10(3) Mr) and TYB is expressed as a TYA:TYB fusion protein, p3 (190 x 10(3) Mr). Both of these proteins are subsequently cleaved to produce proteins p2, p4, p5, p6, reverse transcriptase and a protease that is responsible for some of these cleavage events. These proteins are assembled into virus-like particles (Ty-VLPs) that contain Ty RNA and reverse transcriptase activity. It is likely that the Ty-VLPs are units of transposition as Ty transposes via an RNA intermediate.


Effect of early release of tourniquet in total knee arthroplasty.
To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Comparative study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed. There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay.


Antagonistic interactions between filamentous heterotrophs and the cyanobacterium Nostoc muscorum.
Little is known about interactions between filamentous heterotrophs and filamentous cyanobacteria. Here, interactions between the filamentous heterotrophic bacteria Fibrella aestuarina (strain BUZ 2) and Fibrisoma limi (BUZ 3) with an axenic strain of the autotrophic filamentous cyanobacterium Nostoc muscorum (SAG 25.82) were studied in mixed cultures under nutrient rich (carbon source present in medium) and poor (carbon source absent in medium) conditions. F. aestuarina BUZ 2 significantly reduced the cyanobacterial population whereas F. limi BUZ 3 did not. Physical contact between heterotrophs and autotroph was observed and the cyanobacterial cells showed some level of damage and lysis. Therefore, either contact lysis or entrapment with production of extracellular compounds in close vicinity of host cells could be considered as potential modes of action.The supernatants from pure heterotrophic cultures did not have an effect on Nostoc cultures. However, supernatant from mixed cultures of BUZ 2 and Nostoc had a negative effect on cyanobacterial growth, indicating that the lytic compounds were only produced in the presence of Nostoc.The growth and survival of tested heterotrophs was enhanced by the presence of Nostoc or its metabolites, suggesting that the heterotrophs could utilize the autotrophs and its products as a nutrient source. However, the autotroph could withstand and out-compete the heterotrophs under nutrient poor conditions. Our results suggest that the nutrients in cultivation media, which boost or reduce the number of heterotrophs, were the important factor influencing the outcome of the interplay between filamentous heterotrophs and autotrophs. For better understanding of these interactions, additional research is needed. In particular, it is necessary to elucidate the mode of action for lysis by heterotrophs, and the possible defense mechanisms of the autotrophs.


Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial.
Maternal obesity is associated with increased birthweight, and obesity and premature mortality in adult offspring. The mechanism by which maternal obesity leads to these outcomes is not well understood, but maternal hyperglycaemia and insulin resistance are both implicated. We aimed to establish whether the insulin sensitising drug metformin improves maternal and fetal outcomes in obese pregnant women without diabetes. We did this randomised, double-blind, placebo-controlled trial in antenatal clinics at 15 National Health Service hospitals in the UK. Pregnant women (aged ≥16 years) between 12 and 16 weeks' gestation who had a BMI of 30 kg/m(2) or more and normal glucose tolerance were randomly assigned (1:1), via a web-based computer-generated block randomisation procedure (block size of two to four), to receive oral metformin 500 mg (increasing to a maximum of 2500 mg) or matched placebo daily from between 12 and 16 weeks' gestation until delivery of the baby. Randomisation was stratified by study site and BMI band (30-39 vs ≥40 kg/m(2)). Participants, caregivers, and study personnel were masked to treatment assignment. The primary outcome was Z score corresponding to the gestational age, parity, and sex-standardised birthweight percentile of liveborn babies delivered at 24 weeks or more of gestation. We did analysis by modified intention to treat. This trial is registered, ISRCTN number 51279843. Between Feb 3, 2011, and Jan 16, 2014, inclusive, we randomly assigned 449 women to either placebo (n=223) or metformin (n=226), of whom 434 (97%) were included in the final modified intention-to-treat analysis. Mean birthweight at delivery was 3463 g (SD 660) in the placebo group and 3462 g (548) in the metformin group. The estimated effect size of metformin on the primary outcome was non-significant (adjusted mean difference -0·029, 95% CI -0·217 to 0·158; p=0·7597). The difference in the number of women reporting the combined adverse outcome of miscarriage, termination of pregnancy, stillbirth, or neonatal death in the metformin group (n=7) versus the placebo group (n=2) was not significant (odds ratio 3·60, 95% CI 0·74-17·50; p=0·11). Metformin has no significant effect on birthweight percentile in obese pregnant women. Further follow-up of babies born to mothers in the EMPOWaR study will identify longer-term outcomes of metformin in this population; in the meantime, metformin should not be used to improve pregnancy outcomes in obese women without diabetes. The Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council and National Institute for Health Research partnership.


Familial amyotrophic lateral sclerosis with a novel Leu126Ser mutation in the copper/zinc superoxide dismutase gene showing mild clinical features and lewy body-like hyaline inclusions.
Mutations in the SOD1 gene are responsible for approximately 25% of all familial amyotrophic lateral sclerosis (ALS) cases. However, the correlation between the clinical and pathological features and the various SOD1 gene mutations has not been well characterized. To screen the SOD1 gene in search of potential mutations and to obtain clinical and pathological data for 2 Japanese families with ALS. Clinical histories and neurological findings, gross and microscopic pathological features, and DNA analysis of the SOD1 gene. The 2 families with ALS showed a novel missense mutation in the SOD1 gene, which was heterozygous for point mutation TTG to TCG, causing substitution of leucine for serine at codon 126 (Leu126Ser) in exon 5. Clinically, patients showed slower disease progression and lack of upper motor neuron signs. Neuropathologically, the autopsied patient showed the form of familial ALS with posterior column involvement, and the pontocerebellar tract and the dentate nuclei of the cerebellum were also involved. Furthermore, abundant Lewy body-like hyaline inclusions were observed in the affected motor and nonmotor neurons. Familial ALS with a novel Leu126Ser mutation in the SOD1 gene showed mild clinical features and lack of upper motor neuron signs. We believe that Leu126Ser might be associated with the clinical features and that the mutation site in the SOD1 gene and disease duration might be associated with the formation of Lewy body-like hyaline inclusions.


Avian high-dose toxicity of cyanobacterial biomass.
Previous studies using oral administration of environmentally relevant doses of cyanobacterial biomass containing microcystins (MCs) induced only sub-lethal effects in experimental birds. Therefore, the objective of this study was to obtain data on avian high-dose toxicity of MCs and compute LD50, if possible, following the natural oral route of administration. Responses of birds to single high-dose exposure to MCs were evaluated in fourteen-day old Japanese quail males (Coturnix coturnix japonica) with average body weight of 50 g which were randomly divided into five groups. Birds from four experimental groups were administered 7.5 ml of cyanobacterial biomass suspension containing increasing MCs quantities of 2500, 5000, 10000, and 20000 µg/kg using oral gavage. Controls received an equal dose of drinking water instead of the test substance. Birds were observed for clinical signs of acute toxicity. Survivors were killed on day 5 to obtain body and liver weights. A five-grade semi-quantitative system for histopathological liver damage scoring was used to compare cyanobacterial-biomass-exposed birds against controls. No mortality occurred during the period of five days post exposure in both control and MCs-exposed groups and this high-dose experiment failed to provide data to compute the LD50. Nevertheless, marked sub-lethal effects were recognised in the damage of liver that included dose-dependent changes in the body/liver ratios and morphological changes ranging from mild vacuolar dystrophy to focal liver necroses in the highest exposure group. Hepatic lesions were mainly observed in the pericentral area of the liver. Though maximum cyanobacterial biomass dose rates that could be administered to birds of the size were used in the present experiment and more pronounced hepatic lesions than after exposure to environmentally relevant doses were observed, birds would probably have survived unless killed for histopathology on day 5 of exposure. These results provide support to previously reported data on sub-lethal effects following exposure to cyanobacterial biomass containing MCs in birds and mortality occurring only in birds under combined action with other stressors.


Current opinion in essential thrombocythemia: pathogenesis, diagnosis, and management.
A working diagnosis of essential thrombocythemia (ET) is made in the presence of nonreactive thrombocytosis and after the exclusion of another chronic myeloid disorder that may mimic ET in its presentation. Clinically, ET is characterized by vasomotor symptoms, thrombohemorrhagic complications, recurrent fetal loss, and transformation of the disease into either myelofibrosis with myeloid metaplasia or acute myeloid leukemia. Median survival in the majority of patients is close to that of an age-adjusted normal population, and current therapy has not been shown to either retard or hasten leukemic transformation, which is reported to occur in 1% to 20% of patients. The use of hydroxyurea in high-risk patients with ET has reduced the incidence of thrombosis, and recent studies have suggested the value of keeping the platelet count below 400 x 10(9)/L in such cases. The incidence of thrombosis in low-risk patients may not be high enough to warrant the use of cytoreductive therapy. Although effective in controlling vasomotor symptoms, aspirin therapy has not been shown to influence the risk of either recurrent thrombosis or first-trimester miscarriage in ET. Recent laboratory studies have suggested that hematopoiesis in ET may not always be clonal. Similarly, there is substantial heterogeneity in both megakaryocyte/platelet surface expression of the thrombopoietin receptor (c-Mpl) and bone marrow microvessel density. Clinicopathologic correlates to these biologic parameters are currently being defined.


Monitoring urban streams: strategies and protocols for humid-region lowland systems.
Governmental mandates and public awareness have forced progressively smaller and less sophisticated agencies and organizations to initiate stream monitoring programs, particularly in urban and urbanizing areas. Yet many of these monitoring efforts lack either a coherent conceptual framework or appropriately chosen methods, and they rely on monitoring techniques that are simply infeasible for these institutional settings. We propose a monitoring strategy, and specific existing monitoring protocols, that will be useful for the management and rehabilitation of streams in urbanizing watersheds. A monitoring strategy must be developed by 1) identifying the management question(s) being addressed, 2) determining the institional level of effort required (and available) to effectively make particular kinds of measurements, and 3) identifying what specific parameters should and can be measured. Only a limited set of parameters show much utility or feasibility in addressing the most common management questions being faced by municipalities in urbanizing, humid-area regions of the United States. These include measures of riparian canopy, bank erosion and bank hardening, and in-stream large woody debris. With some additional expertise useful data can also be included on channel gradient, substrate composition, and pools. Nearly all of the other myriad parameters that have been measured historically on rivers and streams show little apparent value in these watershed and institutional settings.


Intellectual disability and epilepsy in down syndrome.
Down Syndrome (DS) is the most common genetic cause of mental retardation, with a reported frequency of epilepsy between 1.4-17% (1). There is a paucity of data in the literature regarding epilepsy in Down syndrome and its relation to intellectual disability. The purpose of this article is to analyze the association of epilepsy in children with DS - frequency and type of seizures, treatment, outcome and to compare cognitive impairment of children with DS and epilepsy and DS without epilepsy from our cohort. A four years systematic retrospective analysis of the database of the Pediatric Neurology Clinic (January 2010 - December 2013) identified a cohort of 39 pediatric cases with DS and neurological symptoms, 9 of them (23%) associating epileptic seizures. Following data were analysed: clinical and neurological examination, type/s of seizures, electroencephalography (EEG), cerebral magnetic resonance imaging (MRI), psychological examination, psychiatric evaluation in selected cases, electrocardiography (ECG), cardiac ultrasonography, ophthalmologic examination. 23% (9 patients) of the children with DS of our cohort presented epilepsy. Five patients had epileptic spasms (56%), one of these further developed astatic seizures. Focal seizures were observed in three patients (33%) and absence with eyelid myoclonias in one patient (11%). Two of the nine patients with DS and epilepsy had generalized seizures, both with very good response to levetiracetam (LEV). EEG was abnormal at seizure onset, and was improved after treatment. Of the nine children with DS and epilepsy, two (22%) presented mild mental retardation and seven (78%) had moderate to severe cognitive delay. Of the 30 children with DS and without epilepsy, 21 (70%) had mild mental retardation and 9 (30%) had moderate to severe cognitive impairment. The most frequent epileptic syndrome associated with DS is West syndrome, with good response to specific antiepileptics. All children with DS from our cohort have intelectual disability, more severe in those with epilepsy. Slight improvement of intelectual and language capabilities were seen after seizures control.


King Cobra and snakebite envenomation: on the natural history, human-snake relationship and medical importance of Ophiophagus hannah.
King Cobra (Ophiophagus hannah) has a significant place in many cultures, and is a medically important venomous snake in the world. Envenomation by this snake is highly lethal, manifested mainly by neurotoxicity and local tissue damage. King Cobra may be part of a larger species complex, and is widely distributed across Southeast Asia, southern China, northern and eastern regions as well as the Western Ghats of India, indicating potential geographical variation in venom composition. There is, however, only one species-specific King Cobra antivenom available worldwide that is produced in Thailand, using venom from the snake of Thai origin. Issues relating to the management of King Cobra envenomation (e.g., variation in the composition and toxicity of the venom, limited availability and efficacy of antivenom), and challenges faced in the research of venom (in particular proteomics), are rarely addressed. This article reviews the natural history and sociocultural importance of King Cobra, cases of snakebite envenomation caused by this species, current practice of management (preclinical and clinical), and major toxinological studies of the venom with a focus on venom proteomics, toxicity and neutralization. Unfortunately, epidemiological data of King Cobra bite is scarce, and venom proteomes reported in various studies revealed marked discrepancies in details. Challenges, such as inconsistency in snake venom sampling, varying methodology of proteomic analysis, lack of mechanistic and antivenomic studies, and controversy surrounding antivenom use in treating King Cobra envenomation are herein discussed. Future directions are proposed, including the effort to establish a standard, comprehensive Pan-Asian proteomic database of King Cobra venom, from which the venom variation can be determined. Research should be undertaken to characterize the toxin antigenicity, and to develop an antivenom with improved efficacy and wider geographical utility. The endeavors are aligned with the WHO´s roadmap that aims to reduce the disease burden of snakebite by 50% before 2030.