Investigation of Content Overlap in Proprietary Medical Mappings.
To manage medical information semantic interoperability is essential. Mapping of concepts and mapping of terminologies are two objectives to reach semantic interoperability. Russian proprietary health information system and FHIR overlaps (60%) were calculated to estimate possibility of standardization. Russian terminology directories and FHIR overlaps were calculated to estimate possibility of use Russian terminologies and codifications in FHIR-based information system. The result is promising, however, requires more wide investigation using automatic tools.


Endothelin-converting enzyme-1 regulates trafficking and signalling of the neurokinin 1 receptor in endosomes of myenteric neurones.
Neuropeptide signalling at the plasma membrane is terminated by neuropeptide degradation by cell-surface peptidases, and by β-arrestin-dependent receptor desensitization and endocytosis. However, receptors continue to signal from endosomes by β-arrestin-dependent processes, and endosomal sorting mediates recycling and resensitization of plasma membrane signalling. The mechanisms that control signalling and trafficking of receptors in endosomes are poorly defined. We report a major role for endothelin-converting enzyme-1 (ECE-1) in controlling substance P (SP) and the neurokinin 1 receptor (NK(1)R) in endosomes of myenteric neurones. ECE-1 mRNA and protein were expressed by myenteric neurones of rat and mouse intestine. SP (10 nM, 10 min) induced interaction of NK(1)R and β-arrestin at the plasma membrane, and the SP-NK(1)R-β-arrestin signalosome complex trafficked by a dynamin-mediated mechanism to ECE-1-containing early endosomes, where ECE-1 can degrade SP. After 120 min, NK(1)R recycled from endosomes to the plasma membrane. ECE-1 inhibitors (SM-19712, PD-069185) and the vacuolar H(+)ATPase inhibitor bafilomycin A(1), which prevent endosomal SP degradation, suppressed NK(1)R recycling by >50%. Preincubation of neurones with SP (10 nM, 5 min) desensitized Ca(2+) transients to a second SP challenge after 10 min, and SP signals resensitized after 60 min. SM-19712 inhibited NK(1)R resensitization by >90%. ECE-1 inhibitors also caused sustained SP-induced activation of extracellular signal-regulated kinases, consistent with stabilization of the SP-NK(1)R-β-arrestin signalosome. By degrading SP and destabilizing endosomal signalosomes, ECE-1 has a dual role in controlling endocytic signalling and trafficking of the NK(1)R: promoting resensitization of G protein-mediated plasma membrane signalling, and terminating β-arrestin-mediated endosomal signalling.


Melatonin attenuates postovulatory oocyte dysfunction by regulating SIRT1 expression.
The quality of postovulatory metaphase II oocytes undergoes a time-dependent deterioration as a result of the aging process. Melatonin is considered to be an anti-aging agent. However, the underlying mechanisms of how melatonin improves the quality of postovulatory aged oocytes remain largely unclear. In this study, by using mouse model, we found that there were elevated reactive oxygen species levels and impaired mitochondrial function demonstrated by reduced mitochondrial membrane potential and increased mitochondrial aggregation in oocytes aged 24 h, accompanied by an increased number of meiotic errors, unregulated autophagy-related proteins and early apoptosis, which led to decreased oocyte quality and disrupted developmental competence. However, all of these events can be largely prevented by supplementing the oocyte culture medium with 10-3 M melatonin. Additionally, we found that the expression of sirtuin family members (SIRT1, 2 and 3) was dramatically reduced in aged oocytes. In addition, in vitro supplementation with melatonin significantly upregulated the expression of SIRT1 and antioxidant enzyme MnSOD, but this action was not observed for SIRT2 and SIRT3. Furthermore, the protective effect of melatonin on the delay of oocyte aging vanished when the SIRT1 inhibitor EX527 was used to simultaneously treat the oocytes with melatonin. Consistent with this finding, we found that the postovulatory oocyte aging process was markedly attenuated when the oocytes were treated with the SIRT1 activator SRT1720. In conclusion, our data strongly indicate that melatonin delays postovulatory mouse oocyte aging via a SIRT1-MnSOD-dependent pathway, which may provide a molecular mechanism support for the further application of melatonin in the assisted reproductive technology field.


A prospective randomized controlled study comparing transforaminal lumbar interbody fusion techniques for degenerative spondylolisthesis: unilateral pedicle screw and 1 cage versus bilateral pedicle screws and 2 cages.
Many surgeons currently prefer to use transforaminal lumbar interbody fusion (TLIF), placing 1 unilateral pedicle screw (PS) and 1 cage. However, no study has examined whether unilateral fixation improves surgical outcome. The authors conducted a prospective randomized controlled trial with a minimum 2-year follow-up to analyze TLIF outcomes for 2 techniques: placement of a unilateral PS and a cage compared with placement of bilateral PSs and 2 cages. Fifty patients with degenerative spondylolisthesis undergoing single-level TLIF were randomly assigned to receive either unilateral or bilateral fixation. Parameters compared between the groups were surgical invasiveness, severity of intermittent claudication, pre- and postoperative visual analog scale (VAS) scores (from 0 to 10 for back pain, lower-extremity pain, and lower-extremity numbness), postoperative disability scores for lumbar spinal disorders (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire [JOABPEQ]), and fusion rates. The mean operative time for TLIF was significantly (p = 0.05) shorter and mean estimated blood loss was significantly lower in the unilateral than in the bilateral group. Intermittent claudication improved in response to each technique, but there was no significant intergroup difference. The unilateral group had a nonsignificant tendency toward less improvement in VAS score for back pain (1.5 vs 3.7 for the bilateral group) and exhibited significantly less improvement in VAS score for lower-extremity pain (2.1 vs 5.1, respectively) and numbness (1.7 vs 4.4). There were no significant differences between the groups in postsurgical scores for all 5 items of the JOABPEQ. The fusion rates were 87.5% (21 of 24 patients) in the unilateral group and 95.7% (22 of 23) in the bilateral group. Transforaminal lumbar interbody fusion involving unilateral PS fixation and a single-cage technique is less invasive than a 2-cage technique and bilateral fixation, and it improved patients' symptoms. However, it resulted in less improvement in back pain, lower-extremity pain, and lower-extremity numbness. When considering unilateral PS fixation and a single cage, the surgeon should be aware of the potential limitations of this technique. Clinical trial registration no.: UMIN000007833 (UMIN).


Working strokes produced by curling protofilaments at disassembling microtubule tips can be biochemically tuned and vary with species.
The disassembly of microtubules can generate force and drive intracellular motility. During mitosis, for example, chromosomes remain persistently attached via kinetochores to the tips of disassembling microtubules, which pull the sister chromatids apart. According to the conformational wave hypothesis, such force generation requires that protofilaments curl outward from the disassembling tips to exert pulling force directly on kinetochores. Rigorously testing this idea will require modifying the mechanical and energetic properties of curling protofilaments, but no way to do so has yet been described. Here, by direct measurement of working strokes generated in vitro by curling protofilaments, we show that their mechanical energy output can be increased by adding magnesium, and that yeast microtubules generate larger and more energetic working strokes than bovine microtubules. Both the magnesium and species-dependent increases in work output can be explained by lengthening the protofilament curls, without any change in their bending stiffness or intrinsic curvature. These observations demonstrate how work output from curling protofilaments can be tuned and suggest evolutionary conservation of the amount of curvature strain energy stored in the microtubule lattice.


Clinical features, treatments, and outcomes of patients with anti-N-methyl-D-aspartate encephalitis-a single-center, retrospective analysis in China.
Objective: To describe the clinical features, laboratory data, treatment, and outcomes of anti-N-methyl-D-aspartate (NMDAR) encephalitis in Chinese patients. Methods: This retrospective study included hospitalized patients definitively diagnosed with anti-NMDAR encephalitis and positive for anti-NMDAR antibodies in the cerebrospinal fluid (CSF) in Shenzhen People's hospital, between November 2015 and February 2020. The clinical manifestation, laboratory data, treatments and outcomes were collected retrospectively. Patients were followed up for more than 1 year. Results: The study included 31 patients (15 men, 48.4%) with a median age of 31 years (interquartile range 21-48). The most common clinical presentations were psychosis (n = 23, 74.2%), seizures (n = 20, 64.5%), and memory impairment (n = 20, 64.5%). Total magnetic resonance imaging abnormalities were found in 11 patients (35.5%), with the medial temporal and frontal lobes as the most commonly involved. Abnormal electroencephalogram was observed in 16 patients (51.6%). Five out of 31 patients (19.5%) were diagnosed as neoplasm, including five females with ovarian teratoma and one male with a central nervous system tumor. Multiple immune antibodies, including anti-SSA antibody in four patients (15.4%), anti-Ro52 antibody in four (15.4%), antinuclear antibody (ANT) in four (15.4%), anti-thyroglobulin antibodies (TGAb) in five (17.2%), and thyroid peroxidase antibodies (TPOAb) in three (10.3%) were present. All patients received first-line immunization therapy (intravenous immunoglobulin, glucocorticoids, or plasmapheresis alone or combined), and only two patients (7.3%) received second-line immunization therapy (rituximab). Mechanical ventilation was more necessary in women (37.5%) than in men (6.7%) (p = 0.04), and 29 (93.5%) had favorable clinical outcomes. At more than 12 months of follow-up, the median modified Rankin Scale score decreased from 4 to 0. Conclusions: Patients with anti-NMDAR encephalitis in China had high rates of psychosis and seizures, with low rates of underlying neoplasms. A higher proportion of female patients required mechanical ventilation. Complications with other positive autoimmune antibodies were a common clinical symptoms of anti-NMDAR encephalitis. Majority of the patients obtained satisfactory outcomes in combination with early first-line and long-term immunization therapy.


[Endoscopic ultrasonic study of the esophagus].
Endoscopic ultrasonotomography opens a sonographic window to the organs of the mediastinum. With this technique all segments of the oesophagus can be sonographically investigated. Endosonographic investigations on 11 patients with oesophageal tumors and 3 patients with oesophageal varices showed that the diagnosis of oesophageal carcinoma and differentiation between malignant tumors and benign changes are possible. The spread of the tumor in the horizontal and vertical planes can be accurately determined with endoscopic ultrasonography. In addition, paraoesophageal lymph node metastases, as well as other lesions in the mediastinum, can be diagnosed. Ultrasonography of the oesophagus can be simplified by leaving out the optical system.


Carotid ultrasound identifies high risk subclinical atherosclerosis in adults with low framingham risk scores.
Worldwide, cardiovascular (CV) disease remains the most common cause of morbidity and mortality. Although effective in predicting CV risk in select populations, the Framingham risk score (FRS) fails to identify many young individuals who experience premature CV events. Accordingly, the aim of this study was to determine the prevalence of high-risk carotid intima-media thickness (CIMT) or plaque, a marker of atherosclerosis and predictor of CV events, in young asymptomatic individuals with low and intermediate FRS (<2% annualized event rate) using the carotid ultrasound protocol recommended by the American Society of Echocardiography and the Society of Vascular Medicine. Individuals aged < or = 65 years not taking statins and without diabetes mellitus or histories of coronary artery disease underwent CIMT and plaque examination for primary prevention. Clinical variables including lipid values, family history of premature coronary artery disease, and FRS and subsequent pharmacotherapy recommendations were retrospectively collected for statistical analysis. Of 441 subjects (mean age, 49.7 + or - 7.9 years), 184 (42%; 95% confidence interval, 37.3%-46.5%) had high-risk carotid ultrasound findings (CIMT > or = 75th percentile adjusted for age, gender, and race or presence of plaque). Of those with the lowest FRS of < or =5% (n = 336) (mean age, 48.0 + or - 7.6 years; mean FRS, 2.5 + or - 1.5%), 127 (38%; 95% confidence interval, 32.6%-43.0%) had high-risk carotid ultrasound findings. For individuals with FRS < or = 5% and high-risk carotid ultrasound findings (n = 127; mean age, 47.3 + or - 8.1 years; mean FRS, 2.5 + or - 1.5%), lipid-lowering therapy was recommended by their treating physicians in 77 (61%). Thirty-eight percent of asymptomatic young to middle-aged individuals with FRS < or = 5% have abnormal carotid ultrasound findings associated with increased risk for CV events. Pharmacologic therapy for CV prevention was recommended in the majority of these individuals. The lack of radiation exposure, relatively low cost, and ability to detect early-stage atherosclerosis suggest that carotid ultrasound for CIMT and plaque detection should continue to be explored as a primary tool for CV risk stratification in young to middle-aged adults with low FRS.


mTOR Signaling Combined with Cancer Stem Cell Markers as a Survival Predictor in Stage II Colorectal Cancer.
Wnt and mammalian target of rapamycin (mTOR) are major molecular signaling pathways associated with the development and progression of tumor, as well as the maintenance and proliferation of cancer stem cells (CSCs), in colorectal cancer (CRC). Identifying patients at risk of poor prognosis is important to determining whether to add adjuvant treatment in stage II CRC and thus improve survival. In the present study, we evaluated the prognostic value of Wnt, mTOR, and CSC markers as survival predictors in stage II CRC. We identified 148 cases of stage II CRC and acquired their tumor tissue. Tissue microarrays for immunohistochemical staining were constructed, and the expressions of CD166, CD44, EphB2, β-catenin, pS6 were evaluated using immunohistochemical staining. The expressions of CD166 (p=0.045) and pS6 (p=0.045) and co-expression of pS6/CD166 (p=0.005), pS6/CD44 (p=0.042), and pS6/CD44/CD166 (p=0.013) were negatively correlated with cancer-specific survival. Cox proportional hazard analysis showed the combination of CD166/pS6 [hazard ratio, 9.42; 95% confidence interval, 2.36-37.59; p=0.002] to be the most significant predictor related with decreased cancer-specific survival. In addition, co-expression of CD44/CD166 (p=0.017), CD166/β-catenin (p=0.036), CD44/β-catenin (p=0.001), and CD44/CD166/β-catenin (p=0.001) were significant factors associated with liver metastasis. Specific combinations of CSC markers and β-catenin/mTOR signaling could be a significant predictor of poor survival in stage II CRC.


Pancreas transplantation in type II diabetes mellitus.
Although the diagnosis of type 2 diabetes mellitus was once considered a contraindication to simultaneous pancreas-kidney transplantation, a growing body of evidence has revealed that similar graft and patient survival can be achieved when compared to type 1 diabetes mellitus recipients. A cautious strategy regarding candidate selection may limit appropriate candidates from additional benefits in terms of quality of life and potential amelioration of secondary side effects of the disease process. Although our current understanding of the disease has changed, uniform listing characteristics to better define and study this population have limited available data and must be established.


Modeling the effects of material properties on tablet compaction: A building block for controlling both batch and continuous pharmaceutical manufacturing processes.
As the pharmaceutical industry modernizes its manufacturing practices and incorporates more efficient processing approaches, it is important to reevaluate which process design elements affect product quality and the means to study these systems. The purpose of this work is to provide insight on a methodology to correlate the effect of raw material properties to equipment and process performance using both data-driven and semi-empirical models. In this work, lubricated blends of pharmaceutically-relevant materials were made using varying levels of magnesium stearate, ranging from 0.25 to 1.5%. Materials characterization (e.g., compressibility, permeability, density, particle size) was performed for all materials and blends. The blends were compressed using a two by three experimental design, varying tablet fill cam depth and tablet thickness, respectively. Tablet properties (e.g., weight, tensile strength, and thickness) were collected for all tablets. Using the collected tablet property results, models coefficients for the semi-empirical Kuentz and Leuenberger equation, which relates the tablet tensile strength to changes in porosity, were regressed. Empirical models were then developed to correlate the values of the Kuentz and Leuenberger equation coefficients to the blend material properties. The empirical models were then used in conjunction with the Kuentz and Leuenberger equation to evaluate the compression design and operational space, accounting for material properties. This proof of concept work aimed at developing correlations between raw material properties and unit operation models can aid process development, especially in design space characterization and robustness analysis.


Weak metamagnetic-like 1D manganese(II) complex with a double mu(1,1)-azido bridge: a structure and magnetic study.
The azido-bridged manganese complex of formula [Mn(tptz)(mu(1,1)-N3)2]n [1; tptz = 2,4,6-tris(2-pyridyl)-1,3,5-triazine] has been synthesized and characterized by single-crystal X-ray diffraction analysis and a low-temperature magnetic study. The complex 1 crystallizes in the orthorhombic space group Pbcn, with a = 17.911(5) A, b = 15.804(5) A, c = 6.6538(18) A, and Z = 4. The Mn atoms are coordinated by three N atoms of the tptz ligands and connected to each other by double end-on (EO) azide ligands, forming a neutral 1D chain. The adjacent 1D chains are connected by face-to-face pi-pi-stacking interactions and C-H...pi interactions of pyridine rings of the tptz ligands, which leads to the formation of a supramolecular 2D sheet structure. Temperature- and field-dependent magnetic analyses reveal dominant intrachain ferromagnetic interactions with EO azide-bridge and weak interchain antiferromagnetic interactions with overall metamagnetic behavior having 3D magnetic ordering at 2.7 K. The critical field is approximately 80 G, at which the interlayer antiferromagnetic ground-state switches to a ferromagnetic state.


Myringotomy and tube for relief of patulous eustachian tube symptoms.
Reports on the effectiveness of myringotomy and tube for treatment of symptoms of the patulous eustachian tube are discouraging, even though there are no large series substantiating its ineffectiveness. To further investigate this problem, we have reviewed the charts of all patients at the Otologic Medical Group (OMG) from 1974 to 1981 with the diagnosis of patulous eustachian tube who underwent myringotomy and tube for their symptoms. We identified 60 ears of 46 patients with complaints consistent with patulous eustachian tube symptoms. The treatment either eliminated or substantially reduced symptoms in 32 ears (53%). For the other 28 ears, myringotomy and tube were of no benefit. Nine of 13 (70%) ears with a definitive diagnosis based on movement of the tympanic membrane with respiration or tympanometry showed relief of symptoms with myringotomy and tube. Myringotomy and tube will remain part of the treatment regimen because it is relatively simple to perform, reversible, and effective in the majority of patients.


New Magnetostrictive Transducer Designs for Emerging Application Areas of NDE.
Magnetostrictive transduction has been widely utilized in nondestructive evaluation (NDE) applications, specifically for the generation and reception of guided waves for the long-range inspection of components such as pipes, vessels, and small tubes. Transverse-motion guided wave modes (e.g., torsional vibrations in pipes) are the most common choice for long-range inspection applications, because the wave motion is in the plane of the structure surface, and therefore does not couple well to the surrounding material. Magnetostrictive-based sensors for these wave modes using the Wiedemann effect have been available for several years. An alternative configuration of a sensor for generating and receiving these transverse-motion guided waves swaps the biasing and time-varying magnetic field directions. This alternative design is a reversed Wiedemann effect magnetostrictive transducer. These transducers exhibit a number of unique features compared with the more conventional Wiedemann sensor, including: (1) the use of smaller rare earth permanent magnets to achieve large, uniform, and self-sustained bias field strengths; (2) the use of more efficient electric coil arrangements to induce a stronger time-varying magnetic field for a given coil impedance; (3) beneficial non-linear operating characteristics, given the efficiency improvements in both magnetic fields; and (4) the ability to generate unidirectional guided waves when the field arrangement is combined with a magnetically soft ferromagnetic strip (patch). Reversed Wiedemann effect magnetostrictive transducers will be presented that are suitable for different inspection applications, one using electromagnetic generation and reception directly in a ferromagnetic material, and another design that integrates a magnetostrictive patch to improve its efficiency and enable special operating characteristics.


Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy.
The efficacy of isoniazid (INAH) prophylaxis against tuberculosis (TB) in patients taking corticosteroid remains controversial. Hong Kong is an endemic area for TB, with an annual risk of 0.11/100 in the general population. Patients with systemic lupus erythematosus (SLE) have an increased susceptibility to TB because of their intrinsic immunocompromised state and the use of corticosteroid therapy. We examined the usefulness of INAH in the prevention of recurrences of TB in patients with SLE receiving high dose corticosteroid therapy. Medical records of a cohort of patients with SLE were reviewed. Patients with a history of TB who had previously been adequately treated were retrospectively examined for subsequent recurrence of TB. A comparison was performed based on the use of INAH at the discretion of the attending physician in some patients (INAH group) but not others (non-INAH group) during lupus exacerbation that required the use of prednisolone >/= 15 mg/day or equivalent. A total of 91 episodes of TB from 76 individuals in a cohort of 652 SLE patients with a duration of followup of 13.9 +/- 7.5 years were identified (prevalence of 1.06/100 patient-years). 43 episodes were given INAH while 48 were not. There were 18 recurrences of TB (recurrence rate of 1.66/100 patient-years). Recurrence rates in the INAH and non-INAH groups were 1.59 and 1.74 per 100 patient-years (p = 0.72). However, patients in the INAH group had more lupus exacerbations. Further, extrapulmonary TB was also found to have a higher recurrence rate than pulmonary TB. A case-controlled analysis was thus performed (n = 46) matching patients for the number of lupus exacerbations, cumulative doses of prednisolone, and initial site of TB. There was no difference in the recurrence rates of TB between the matched INAH (0.55/100 patient-years) and non-INAH (1.100 patient-years) groups (p = 0.66). Patients with SLE have a higher prevalence of TB infection than the general population. They are at risk of TB recurrence when given immunosuppressive doses of corticosteroid.


Biologically inert synthetic dural substitutes. Appraisal of a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer.
Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.


Atom Probe Tomography Interlaboratory Study on Clustering Analysis in Experimental Data Using the Maximum Separation Distance Approach.
We summarize the findings from an interlaboratory study conducted between ten international research groups and investigate the use of the commonly used maximum separation distance and local concentration thresholding methods for solute clustering quantification. The study objectives are: to bring clarity to the range of applicability of the methods; identify existing and/or needed modifications; and interpretation of past published data. Participants collected experimental data from a proton-irradiated 304 stainless steel and analyzed Cu-rich and Ni-Si rich clusters. The datasets were also analyzed by one researcher to clarify variability originating from different operators. The Cu distribution fulfills the ideal requirements of the maximum separation method (MSM), namely a dilute matrix Cu concentration and concentrated Cu clusters. This enabled a relatively tight distribution of the cluster number density among the participants. By contrast, the group analysis of the Ni-Si rich clusters by the MSM was complicated by a high Ni matrix concentration and by the presence of Si-decorated dislocations, leading to larger variability among researchers. While local concentration filtering could, in principle, tighten the results, the cluster identification step inevitably maintained a high scatter. Recommendations regarding reporting, selection of analysis method, and expected variability when interpreting published data are discussed.


A simple way to identify insulin resistance in non-diabetic acute coronary syndrome patients with impaired fasting glucose.
The incidence of coronary artery disease (CAD) is increasing in India. Recent data suggesting insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity, or dyslipidemia, so a focus on the relation between acute coronary syndrome (ACS) and insulin resistance is relevant. Several studies addressing serum lipoprotein ratios as surrogates for insulin resistance have found promising results. We analyzed the association of lipoprotein ratios with the homeostatic model assessment of insulin resistance (HOMA-IR). One hundred non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. Admission fasting glucose and insulin concentrations were measured. The HOMA-IR was used to calculate insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG), and high-density lipoprotein (HDL-C) levels are used to calculate following lipid ratios: TC/HDL-C and TG/HDL-C. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratio markers. Lipoprotein ratios were significantly higher in patients with HOMA Index >2 as compared to patients with Index <2. TG/HDL-C ratio and TC/HDL-C ratio were significantly correlated with HOMA-IR (P < 0.05) as obtained by Pearson's correlation analysis (r = 0.4459, P = 0.0012; r = 0.4815, P = 0.0004; r = 0.3993; P = 0.0041, respectively). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratios for predicting insulin resistance was 0.80 (95% CI, 0.67-0.93), 0.78 (95% CI, 0.65-0.91), respectively. A plasma TG/HDL-C ratio and TC/HDL-C ratio provide a simple means of identifying insulin resistant and can be used as the markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.


Clinical Outcomes With Nurse-Coordinated Multidisciplinary Care in Patients With Heart Failure: A Systematic Review and Meta-analysis.
The American Heart Association (AHA) and the European Society of Cardiology (ESC) recommend nurse-inclusive multidisciplinary care for patients with heart failure (HF). However, there is no meta-analysis that focuses specifically on the impact of nurse-coordinated multidisciplinary care. Considering this literature gap, we conducted this review that seeks to systematically synthesize the current evidence available regarding the impact of nurse-coordinated multidisciplinary care on clinical outcomes in patients with HF. A comprehensive search was done using PubMed/Medline, Cochrane Library, and EMBASE from inception till July 2023 for randomized controlled trials (RCTs) comparing nurse-coordinated multidisciplinary care with usual care in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations was extracted, pooled, and analyzed. Forrest plots were generated using the random effects model. A total of 30 RCTs were included in the analysis with a total of 7950 HF patients. Our pooled analysis demonstrated a significant reduction in all-cause mortality in HF patients who received nurse-coordinated multidisciplinary care (RR = 0.80, 95% CI: 0.72-0.88, P = 0.0001). Similarly, there was a significantly lesser risk of HF-related hospitalizations (RR = 0.56, 95% CI: 0.45-0.71, P = 0.00001) and all-cause hospitalizations (RR = 0.78, 95% CI: 0.70-0.87, P = 0.0001) among HF patients with nurse-coordinated multidisciplinary care as compared to the usual care. Nurse-coordinated multidisciplinary care significantly reduces the risk of all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations in HF patients' posthospital discharge.


Vibrissal touch sensing in the harbor seal (Phoca vitulina): how do seals judge size?
"Whisker specialists" such as rats, shrews, and seals actively employ their whiskers to explore their environments and extract object properties such as size, shape, and texture. It has been suggested that whiskers could be used to discriminate between different sized objects in one of two ways: (i) to use whisker positions, such as angular position, spread or amplitude to approximate size; or (ii) to calculate the number of whiskers that contact an object. This study describes in detail how two adult harbor seals use their whiskers to differentiate between three sizes of disk. The seals judged size very fast, taking <400 ms. In addition, they oriented their smaller, most rostral, ventral whiskers to the disks, so that more whiskers contacted the surface, complying to a maximal contact sensing strategy. Data from this study supports the suggestion that it is the number of whisker contacts that predict disk size, rather than how the whiskers are positioned (angular position), the degree to which they are moved (amplitude) or how spread out they are (angular spread).


Blood meal sources of Glossina pallidipes and G. longipennis (Diptera: Glossinidae) in Nguruman, southwest Kenya.
In total, 1,952 Glossina pallidipes Austen and 1,098 G. longipennis Corti adults were collected in forest and savanna habitat in Nguruman, southwestern Kenya, by NG2G traps during the dry season of 1992. Of these, 339 individuals (11.1%) had blood meals, of which 155 (45.7%) were identified by direct enzyme-linked immunosorbent assay. The most frequent blood meal source was bushbuck, followed by ostrich, elephant, buffalo, and warthog. Few meals were taken from cattle. The findings of frequent blood meals from ostriches is new for G. pallidipes and may indicate that ostriches are an important host. More detailed work on the role of ostriches in the epidemiology of trypanosomiasis is required.


Genome-wide genetic diversity is maintained through decades of soybean breeding in Canada.
Genetic diversity in Canadian soybean is maintained over decades of selection in two public breeding programs. Breeders have used a portion of the genetic diversity available in germplasm collections. Both public and private breeding efforts have been critical for the development of soybean cultivars grown around the world. Global genetic diversity of soybean has been well characterized; however, this diversity is not well studied at the breeding program scale. The objective of this study was to characterize genetic diversity over decades of breeding in two public soybean breeding programs at the University of Guelph, Canada. To address this objective, a pedigree-related panel combining 296 soybean accessions from the Ridgetown and Guelph Campus breeding programs was studied. The accessions were genotyped using genotyping-by-sequencing, imputed using the GmHapMap reference genotypes resulting in more than 3.8M SNPs, further filtered to 77k SNPs. Population structure analysis did not identify structure between the breeding programs and historical germplasm. The linkage disequilibrium decay ranged from 400 to 600 kb on average in euchromatic regions. Nucleotide diversity over decades of breeding shows that historical accessions had the highest nucleotide diversity, with significant decreases corresponding to the initial breeding activity in Canada; however, genetic diversity has increased in the last 20 years in both breeding programs. Maturity gene E2 was nearly fixed for e2 in Ridgetown accessions, while unfixed in Guelph accessions. Comparison of the breeding programs to the USDA germplasm collection reveals that breeders have only used a portion of the available genetic diversity, allowing future breeders to exploit this untapped resource. The approach used in this study may be of interest to other breeding programs for evaluating changes in genetic diversity resulting from breeding activities.


Examining motivational pathways from adult attention-deficit/hyperactivity disorder symptoms to cannabis use: Results from a prospective study of veterans.
Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked prospectively to cannabis; however, no study has examined mechanisms underlying this comorbidity. We examined 5 cannabis motives (i.e., coping with negative affect, sleep, social anxiety, perceived low risk of cannabis, and altered perception) as mediators of the prospective ADHD-cannabis relation. Method: Veterans reporting lifetime cannabis use (N = 361; 93% male; 80% White) completed three semiannual assessments. Prospective mediation models using structural equation modeling analyzed the indirect effects of baseline ADHD symptoms on 12-month cannabis use and problems via each motive at 6 months. Zero-inflated negative binomial models were employed for both manifest outcomes and ADHD symptoms and motives were each modeled as 1-factor latent variables. Results: Sleep motives was a robust mediator for cannabis use frequency in single mediator models and was marginally significant when examined simultaneously with other motives after accounting for baseline cannabis use, demographics, other substance use, and other psychopathology. Coping with negative affect was the only significant mediator of ADHD symptoms and subsequent cannabis problem severity. Conclusion: Among veterans with ADHD symptoms, sleep disturbance is a salient motive for cannabis use, whereas coping with negative affect is a proximal predictor of cannabis problems. Findings support addressing sleep disturbance in adults with ADHD symptoms and converge with extant literature demonstrating robust associations between coping motives and substance use problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Scaling and percolation in the small-world network model.
In this paper we study the small-world network model of Watts and Strogatz, which mimics some aspects of the structure of networks of social interactions. We argue that there is one nontrivial length-scale in the model, analogous to the correlation length in other systems, which is well-defined in the limit of infinite system size and which diverges continuously as the randomness in the network tends to zero, giving a normal critical point in this limit. This length-scale governs the crossover from large- to small-world behavior in the model, as well as the number of vertices in a neighborhood of given radius on the network. We derive the value of the single critical exponent controlling behavior in the critical region and the finite size scaling form for the average vertex-vertex distance on the network, and, using series expansion and Padé approximants, find an approximate analytic form for the scaling function. We calculate the effective dimension of small-world graphs and show that this dimension varies as a function of the length-scale on which it is measured, in a manner reminiscent of multifractals. We also study the problem of site percolation on small-world networks as a simple model of disease propagation, and derive an approximate expression for the percolation probability at which a giant component of connected vertices first forms (in epidemiological terms, the point at which an epidemic occurs). The typical cluster radius satisfies the expected finite size scaling form with a cluster size exponent close to that for a random graph. All our analytic results are confirmed by extensive numerical simulations of the model.


Single-chamber ventricular pacing is not associated with worsening heart failure in sick sinus syndrome.
Ventricular pacing (with loss of normal atrioventricular synchrony) has been considered to have a role in the development or progression of congestive heart failure (CHF) in patients with sick sinus syndrome (SSS). No rigorous study has tested this hypothesis. Five hundred seven consecutive patients with SSS who received an initial pacemaker from January 1980 to December 1989 were studied. Atrial or dual-chamber pacemakers were implanted in 395 patients and ventricular pacemakers in 112. After a mean follow-up of 65 +/- 37 months, 97 patients (19%) developed new CHF or increased their New York Heart Association functional class. By univariate analysis, preimplant predictors for these events were left ventricular dysfunction (p < 0.001), valvular heart disease (p = 0.004), peripheral vascular disease (p = 0.005), diabetes (p = 0.02), coronary artery disease (p = 0.02), high New York Heart Association functional class (p = 0.03) and complex ventricular arrhythmia (p = 0.03). By multivariate analysis (logistic regression), the only predictors for CHF were valvular heart disease (p = 0.002; odds ratio [OR] 2.51), peripheral vascular disease (p = 0.003; OR 1.7) and complex ventricular arrhythmia (p = 0.027; OR 2.74). When the analysis was restricted to patients who had preimplant assessment of left ventricular function, independent predictors for CHF were left ventricular dysfunction (p < 0.001; OR 1.66), and complex ventricular arrhythmia (p < 0.001; OR 1.75). In conclusion, progressive or new-onset CHF is a consequence of the underlying cardiovascular disease. In the present population of patients with SSS, ventricular pacing mode was not associated with an increased incidence of CHF.


Relation of membrane potential to basolateral TEA transport in isolated snake proximal renal tubules.
We measured the effects of changes in bath K+ concentration ([K+]) on basolateral membrane potential difference (PD) and [3H]tetraethylammonium (TEA) transport in isolated snake (Thamnophis) proximal renal tubules (25 degrees C; pH 7.4). Increasing bath [K+] from 3 to 65 mM decreased PD from -60 mV (inside of cells negative) to -20 mV and 2-min uptake of [3H]TEA by approximately 25%, indicating that PD influences TEA entry into the cells. Uptake of [3H]TEA was inhibited similarly at both K+ concentrations by unlabeled TEA, indicating that uptake is carrier mediated. Kt (approximately 18 microM) for 2-min uptake of [3H]TEA in 3 mM K+ increased significantly in 65 mM K+, suggesting that the decrease in PD or the increase in [K+] alters the affinity of the transporter for TEA. The steady-state cell-to-bath ratio for [3H]TEA with 3 mM K+ (-60 mV PD) was approximately 16, significantly above the ratio of 10 predicted for passive distribution at electrochemical equilibrium. With 65 mM K+ (-20 mV PD) this ratio decreased to approximately 6, again significantly above the predicted ratio of 2. These data suggest that the PD can account for much, but not all, of the steady-state uptake of TEA. Efflux of [3H]TEA across the basolateral membrane was identical with either 3 or 65 mM K+ in the bath but was almost completely inhibited in either case by tetrapentylammonium, a potent inhibitor of TEA uptake. These data indicate that virtually all TEA transport across the basolateral membrane is carrier mediated and that transport out of the cells is unaffected by PD.


Disease-modifying therapies in Alzheimer's disease.
Alzheimer's disease (AD) is a chronic, progressive, neurodegenerative disorder that places a substantial burden on patients, their families, and society. The disease affects approximately 5 million individuals in the United States, with an annual cost of care greater than $100 billion. During the past dozen years, several agents have been approved that enhance cognition and global function of AD patients, and recent advances in understanding AD pathogenesis has led to the development of numerous compounds that might modify the disease process. A wide array of antiamyloid and neuroprotective therapeutic approaches are under investigation on the basis of the hypothesis that amyloid beta (A beta) protein plays a pivotal role in disease onset and progression and that secondary consequences of A beta generation and deposition, including tau hyperphosphorylation and neurofibrillary tangle formation, oxidation, inflammation, and excitotoxicity, contribute to the disease process. Interventions in these processes with agents that reduce amyloid production, limit aggregation, or increase removal might block the cascade of events comprising AD pathogenesis. Reducing tau hyperphosphorylation, limiting oxidation and excitotoxicity, and controlling inflammation might be beneficial disease-modifying strategies. Potentially neuroprotective and restorative treatments such as neurotrophins, neurotrophic factor enhancers, and stem cell-related approaches are also under investigation.


Random composites of nickel networks supported by porous alumina toward double negative materials.
Random composites with nickel networks hosted randomly in porous alumina are proposed to realize double negative materials. The random composite for DNMs (RC-DNMs) can be prepared by typical processing of material, which makes it possible to explore new DNMs and potential applications, and to feasibly tune their electromagnetic parameters by controlling their composition and microstructure. Hopefully, various new RC-DNMs with improved performance will be proposed in the future.


Serial murder by healthcare professionals.
The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.


Transcription factor NF-Y is a functional regulator of the transcription of core clock gene Bmal1.
The circadian clock enables organisms to adjust to daily environmental changes and synchronize multiple molecular, biochemical, physiological, and behavioral processes accordingly. In mammalian clock work, Bmal1 is the most important core clock gene, which works with another core clock gene Clock to drive the expression of other clock genes and clock-controlled genes. However, the regulation of Bmal1 has not been fully understood. This work was aimed at identifying the positive regulator(s) of Bmal1 transcription. A series of 5' deletion reporter constructs was generated, and binding site mutations of mouse Bmal1 promoter fragments were cloned into pGL3-basic and pGL3(R2.1)-basic plasmids and transfected into NIH 3T3 cells. Luciferase activity was either measured 48 h after transfection or recorded for 4 days after serum shock. DNA affinity precipitation assay was used to detect the transcription factors binding to Bmal1 promoter. Small interfering RNA against nuclear factor Y, subunit A (NF-YA) and dominant negative NF-YA were employed to study the role of NF-Y in Bmal1 transcription regulation. Deletion and mutation analyses identified two clusters of CCAAT/GC-boxes at the proximal region of Bmal1 promoter as the activating cis-elements. Bmal1 promoter activity was up-regulated by NF-Y and/or Sp1 and repressed by dominant negative NF-YA or siRNA against NF-YA. The activation of Bmal1 promoter activity by NF-Y and Sp1 was inhibited by Rev-Erbα. DNA affinity precipitation assay showed that NF-Y and Sp1 bound to the two CCAAT/GC clusters of Bmal1 promoter. These results indicate that NF-Y is a functional activator of Bmal1 transcription and it cooperates with Sp1 and Rev-Erbα to generate the daily cycle of Bmal1 expression.


Inflammatory transcriptome profiling of human monocytes exposed acutely to cigarette smoke.
Cigarette smoking is responsible for 5 million deaths worldwide each year, and is a major risk factor for cardiovascular and lung diseases. Cigarette smoke contains a complex mixture of over 4000 chemicals containing 10(15) free radicals. Studies show smoke is perceived by cells as an inflammatory and xenobiotic stimulus, which activates an immune response. The specific cellular mechanisms driving cigarette smoke-induced inflammation and disease are not fully understood, although the innate immune system is involved in the pathology of smoking related diseases. To address the impact of smoke as an inflammagen on the innate immune system, THP-1 cells and Human PBMCs were stimulated with 3 and 10% (v/v) cigarette smoke extract (CSE) for 8 and 24 hours. Total RNA was extracted and the transcriptome analysed using Illumina BeadChip arrays. In THP-1 cells, 10% CSE resulted in 80 genes being upregulated and 37 downregulated by ≥1.5 fold after 8 hours. In PBMCs stimulated with 10% CSE for 8 hours, 199 genes were upregulated and 206 genes downregulated by ≥1.5 fold. After 24 hours, the number of genes activated and repressed by ≥1.5 fold had risen to 311 and 306 respectively. The major pathways that were altered are associated with cell survival, such as inducible antioxidants, protein chaperone and folding proteins, and the ubiquitin/proteosome pathway. Our results suggest that cigarette smoke causes inflammation and has detrimental effects on the metabolism and function of innate immune cells. In addition, THP-1 cells provide a genetically stable alternative to primary cells for the study of the effects of cigarette smoke on human monocytes.


Motor pattern of periodic limb movements during sleep.
The pathophysiology of periodic limb movements in sleep (PLMS) in restless legs syndrome (RLS) is unclear. The authors neurophysiologically investigated PLMS in patients with idiopathic RLS in order to obtain information on the origin and pathophysiology of the movements. Ten patients with idiopathic RLS underwent electromyography with nerve conduction velocity (EMG-CV), somatosensory evoked potentials (SEPs), transcranial magnetic stimulation (TMS), nocturnal videopolysomnography, and multiple sleep latency test. The authors analyzed 100 consecutive PLMS for each patient to determine how frequently each muscle was involved in the PLMS; how frequently EMG activity started in a given muscle; and the time delay and pattern of activation between the first and the other activated muscles. EMG-CV, SEPs, and TMS findings were all normal; in PLMS, leg muscles were those more frequently involved, often with alternation of side. Axial muscles were rarely and upper limb muscles sometimes involved. The tibialis anterior was the most frequent starting muscle. There was no constant recruitment pattern from one PLMS episode to another, even in the same patient. There was no ordinate caudal or rostral spread of the EMG activity. The recruitment pattern indicates the engagement of different, independent, and sometimes unsynchronized generators for each PLMS. The authors hypothesize an abnormal hyperexcitability along the entire spinal cord, especially its lumbosacral and cervical segments, as the primary cause of PLMS, triggered by sleep-related factors located at a supraspinal but still unresolved level.


Can low-dose abdominal CT replace abdominal plain film in evaluation of acute abdominal pain?
Non-contrast computed tomography (NCT) has become an important diagnostic tool in acute abdominal pain, but the drawback is the increased radiation dose compared to abdominal plain film (APF). To evaluate whether NCT, including low-dose computed tomography (LDCT, using 50 mAs), provides more diagnostic information than APF in patients presenting with acute non-traumatic abdominal pain and if the use of CT can reduce the total number of additional radiograms. A second aim was to compare the diagnostic outcome between standard-dose computed tomography (SDCT) and LDCT. During 2000, 2002, and 2004 a total of 222 patients were retrospectively reviewed, and 86 patients had APF, 60 had SDCT, and 76 had LDCT. The radiological report of each patient was compared with the final diagnosis obtained from the medical record within 30 days. Additional radiograms were registered, and a total radiation dose excluding or including APF or NCT was calculated. NCT gave a correct diagnosis in 50%, compared to 20% with APF (P < 0.001). The total number of additional radiograms was substantially lower in the computed tomography (CT) group compared to the APF group (P < 0.001), and the average sum of radiation dose was similar for APF and LDCT. NCT was found to be significantly better at providing diagnostic information than APF in patients presenting with acute abdominal pain. It reduced the number of additional radiograms, but the total patient dose remained somewhat higher in the CT group even when using LDCT with 50 mAs.


1H-NMR-derived secondary structure and the overall fold of the potent anti-mammal and anti-insect toxin III from the scorpion Leiurus quinquestriatus quinquestriatus.
We describe the secondary structure and the overall fold of toxin III from the venom of the scorpion Leiurus quinquestriatus quinquestriatus determined using two-dimensional-1H-NMR spectroscopy. This protein, which contains 64 amino acids and 4 disulfide bridges, belongs to the long-chain toxin category and is highly toxic to both mammals and insects. The overall fold was determined on the basis of 1208 inter-proton-distance restraints derived from NOE measurements and 90 psi, phi dihedral-angle restraints derived from NOE connectivities and 3JNH-alphaH coupling constants using the HABAS program. This fold, which mainly consists of an alpha-helix packed against a small antiparallel three-stranded beta-sheet, and of several turns and loops, is similar to that of other long-chain scorpion toxins. Aromatic and non-polar residues form several patches on the surface of the protein which alternate with patches of charged and polar residues. Such a topology should be important in the interactions of toxin III with sodium channels in membranes. Two weakly constrained loops introduce some flexibility to the structure which could be related to the activity of this toxin. The central core of toxin III is compared with the cysteine-stabilized alpha beta motif (an alpha-helix connected to a beta-sheet through two disulfide bridges) found in insect defensins and plant thionins. Defensins and thionins are small proteins (approximately 40--50 amino acid residues) containing three or four disulfide bridges, respectively. This comparison confirms that the cysteine-stabilized alpha beta motif is a common core to a number of small proteins from different origins and having different activities.


Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement.
The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. PARTICIPANTS IN DEVELOPMENT OF SCIENTIFIC STATEMENT: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement. The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorder or condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders. consensus process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolic syndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.


[Influence of the sensorimotor cortex on single neurons of the nucleus gracilis in the cat].
The aim of this study was to investigate the functional role of the cortical projections to gracile nucleus. In unanesthetized cats single nuclear units projecting to the thalamus were tested for microstimulation of cortical foci (area 4) able to evoke single joint movements in contralateral hindlimb. A very significant percentage of gracile cells was influenced, very often in excitatory manner, if their receptive field was overlaying or very close to the joint controlled by a given cortical focus. Conversely, when the location of the receptive field was more distant, the percentage of responses and the incidence of excitatory effects decreased, inhibitions occurring more frequently. From a functional point of view, such an organization of the cortico-gracile control could be effective in modulating transmission of exteroceptive information from the region of the motor target (facilitation) as well as from adjacent ones (suppression). This arrangement could provide an higher resolution of afferent messages, in relation with the cortically induced movements.


Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic.
Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted.


Bioturbating shrimp alter the structure and diversity of bacterial communities in coastal marine sediments.
Bioturbation is a key process in coastal sediments, influencing microbially driven cycling of nutrients as well as the physical characteristics of the sediment. However, little is known about the distribution, diversity and function of the microbial communities that inhabit the burrows of infaunal macroorganisms. In this study, terminal-restriction fragment length polymorphism analysis was used to investigate variation in the structure of bacterial communities in sediment bioturbated by the burrowing shrimp Upogebia deltaura or Callianassa subterranea. Analyses of 229 sediment samples revealed significant differences between bacterial communities inhabiting shrimp burrows and those inhabiting ambient surface and subsurface sediments. Bacterial communities in burrows from both shrimp species were more similar to those in surface-ambient than subsurface-ambient sediment (R=0.258, P<0.001). The presence of shrimp was also associated with changes in bacterial community structure in surrounding surface sediment, when compared with sediments uninhabited by shrimp. Bacterial community structure varied with burrow depth, and also between individual burrows, suggesting that the shrimp's burrow construction, irrigation and maintenance behaviour affect the distribution of bacteria within shrimp burrows. Subsequent sequence analysis of bacterial 16S rRNA genes from surface sediments revealed differences in the relative abundance of bacterial taxa between shrimp-inhabited and uninhabited sediments; shrimp-inhabited sediment contained a higher proportion of proteobacterial sequences, including in particular a twofold increase in Gammaproteobacteria. Chao1 and ACE diversity estimates showed that taxon richness within surface bacterial communities in shrimp-inhabited sediment was at least threefold higher than that in uninhabited sediment. This study shows that bioturbation can result in significant structural and compositional changes in sediment bacterial communities, increasing bacterial diversity in surface sediments and resulting in distinct bacterial communities even at depth within the burrow. In an area of high macrofaunal abundance, this could lead to alterations in the microbial transformations of important nutrients at the sediment-water interface.


Validation of a disease-specific questionnaire for measuring parent-reported health-related quality of life in children with allergies.
To evaluate the properties and suitability of a disease-specific questionnaire to assess parent-reported health-related quality of life (HRQL) of children and parents of children suffering from food hypersensitivity (FHS) or allergy to furred pets (AFP). The parents of 202 children with FHS and of 131 children with AFP filled in questionnaires comprising the CHQ-PF28 and the Food-Pet-Allergy in Children (FPAC) Questionnaire. Psychometric properties of the FPAC questionnaire were evaluated separately for FHS and AFP. Analyses resulted in five proposed scales: Limitations of Family/Child Activities (I), Parents' Distress (II), Child's Emotions (III), Child in School (IV) and Family Conflicts (V). Convergent/discriminant validity for scales I, II and III of both questionnaires was high; for scale IV it was moderate. All five FHS and four AFP scales were able to distinguish significantly between children with and without clinical allergy symptoms (known-group validity). Internal consistency reliability was good for scales I, II and III, but poor for scale IV. Three valid scales were determined for both FHS and AFP (Limitations of Family/Child Activities, Parents' Distress and Child's Emotions) and can be used in clinical research.


Effects of subunit interactions on the activity of lactate dehydrogenase studied in immobilized enzyme systems.
Rabbit muscle lactate dehydrogenase (LDH) was coupled to Sepharose in such a way that each molecule is expected to be attached via only one subunit. Dissociation of the bound active enzyme by several methods all yielded immobilized subunit derivatives which were inactive. These derivatives were capable of regenerating activity by interacting specifically with subunits in solution formed transiently during renaturation. This ability to peck up soluble subunits is lost fairly rapidly upon storage of the immobilized subunits. Similarly, LDH subunits attached to Sepharose via disulfide bonds were found to be inactive. When these subunits were detached from the matrix by mild reduction with mercaptoethanol, activity was regenerated. The kinetics of this reactivation process suggests that reassociation is required for appearance of activity. All these results can be interpreted as showing that subunit interactions are essential for LDH activity.


Oxidative stress-induced autophagy in plants: the role of mitochondria.
The strictly regulated removal of oxidized structures is a universal stress response of eukaryotic cells that targets damaged or toxic components for vacuolar or lysosomal degradation. Autophagy stands at the crossroad between cell survival and death. It promotes survival by degrading proteins and organelles damaged during oxidative stress, but it is also activated as a part of death programs, when the damage cannot be overcome. Evidence is accumulating that the cellular sites of ROS production and signaling may be primary targets of autophagy. Therefore, autophagosomal targeting of mitochondria (mitophagy) is of particular importance. Mitophagy is a selective process that can specifically target dysfunctional mitochondria, but also mitophagy may play a role in controlling the number and quality of mitochondria during stress. Here we review the mechanisms of both non-specific autophagy and mitochondrial targeting in plants, drawing analogies and emphasizing differences with yeast and mammalian systems.


An Ultramicroporous Metal-Organic Framework for High Sieving Separation of Propylene from Propane.
Highly selective adsorptive separation of olefin/paraffin through porous materials can produce high purity olefins in a much more energy-efficient way than the traditional cryogenic distillation. Here we report an ultramicroporous cobalt gallate metal-organic framework (Co-gallate) for the highly selective sieving separation of propylene/propane at ambient conditions. This material possesses optimal pore structure for the exact confinement of propylene molecules while excluding the slightly large propane molecules, as clearly demonstrated in the neutron diffraction crystal structure of Co-gallate⊃0.38C3D6. Its high separation performance has been confirmed by the gas sorption isotherms and column breakthrough experiments to produce the high purity of propylene (97.7%) with a high dynamic separation productivity of 36.4 cm3 cm-3 under ambient conditions. The gas adsorption measurement, pore size distribution, and crystallographic and modeling studies comprehensively support the high sieving C3H6/C3H8 separation in this MOF material. It is stable under different environments, providing its potential for the industrial propylene purification.


Characterization of the extracellular matrix during somitogenesis in the long-tailed monkey (Macaca fascicularis).
The composition of the extracellular matrix (ECM) associated with somitogenesis (stages 10-14) in the long-tailed monkey (Macaca fascicularis) was examined using peroxidase immunocytochemistry. A distinct temporal and spatial staining pattern was demonstrated for each component examined. Fibronectin (FN), laminin (LM) and hyaluronic acid (HA) were associated with the somite at each developmental stage, while no chondroitin sulfate (CS) staining was evident until stages 13/14. The basement membrane and matrix fibers linking the somites to the surrounding epithelia stained for FN, LM and HA. Localization of LM and HA between somite cells was observed at each stage, whereas FN and CS reactivity within the somitic tissue was only observed between sclerotome cells at stages 13/14. Whereas FN- and HA-positive fibers surrounded the unsegmented mesoderm, HA, and to a lesser extent LM, were located within the presomitic tissue. Comparisons are made with earlier studies conducted in rodent and avian embryos which indicate that these ECM components may play a regulatory role in primate somitogenesis.


Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.
Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. Case-note review. Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.


Ten-year experience of a private nonprofit telepsychiatry service.
This paper reports the results of a satisfaction survey of telepsychiatry patients at a rural community mental health clinic that had been providing psychiatric services solely via telemedicine for 10 years. The survey examined the perceived telepsychiatric session quality over a relatively long period of time with patients who had been utilizing the services for a number of years or over multiple sessions. One-page optional anonymous surveys were distributed from December 1, 2006, through March 30, 2007, covering 230 telepsychiatry patients, approximately 90% of current telepsychiatry patients at the agency. Of these, 76 patients responded, a 33.0% return rate. Among the respondents, satisfaction was generally very high, with telemedicine services provided over a period of up to 10 years perceived to be of similar (no worse) quality than in-person services. Results were further analyzed by gender, age, and number of telemedicine sessions experienced. Female patients appeared more accepting of the quality of medical care via telemedicine than male patients. Patients aged 20-49 had much higher acceptance rates than patients younger than 20 or older than 49. The least positive responses toward telemedicine were from patients in their 50s. Patients who had experienced 5 to 10 telemedicine sessions were more likely than patients who had experienced fewer than 5 to report that their sessions now run more smoothly than their initial sessions. Patients in their 20s and 30s reported the least need to have a clinician in the room with them to make them feel comfortable during their telemedicine sessions. Eight percent of respondents reacted negatively to the presence of a clinician in the room with them during their telemedicine sessions.


A prospective study on a cohort of horses and ponies selected for participation in the European Eventing Championship: reasons for withdrawal and predictive value of fitness tests.
Eventing is generally recognized as a challenging equestrian discipline and wastage figures for this discipline are relatively high. There is a need for information that provides insight into the causes of wastage and withdrawal from competition, for animal welfare and economic reasons. The aim of the present investigation was to conduct a prospective study following the entire national selection of event horses (n = 20) and ponies (n = 9) in the Netherlands that prepared for the European Championship in 2010 (ponies) and 2011 (horses), noting causes of withdrawal and monitoring fitness using standardized exercise tests (SETs), with heart rate (HR; beats/min), speed (V; m/s) and plasma lactate concentrations (LA; mmol/L) as measured parameters. In SET-I, performed at the beginning of the season, horses (n = 17) had a mean VLA4 (V at LA 4 mmol/L) of 10.3 ± 0.4 m/s with a mean V200 (V at 200 beats/min) of 11.4 ± 0.8 m/s and ponies (n = 9) a mean VLA4 of 7.8 ± 0.9 m/s and V200 of 9.6 ± 0.7 m/s. Before SET-II, performed six weeks before the European Championship, 16/20 horses and 6/9 ponies were withdrawn. The most common reason for withdrawal was locomotor injury (9/16 horses, 4/6 ponies; P < 0.001 and P = 0.011, respectively). Other reasons included an animal 'not meeting the competition criteria' (4/16 horses, 2/6 ponies) and being sold (3/16 horses). Animals were divided on the basis of VLA4 and recovery-HR during SET-I into good and average performers. Average performers were significantly more likely to be injured (50.0%) than good performers (0%, P = 0.05). In a subpopulation of ten horses, in which all condition training sessions were evaluated for HR and speed, HRpeak was significantly lower in horses that stayed sound (186 ± 9 beats/min) compared with horses withdrawn from training and competition because of injury (201 ± 5 beats/min; P = 0.016). Of the national selection, 45% of all animals were unavailable for the European Championship because of locomotor injuries. Field tests were useful in assessing the potential injury risk, as individuals with better fitness indices (good performers) were less likely to become injured than average performers. Furthermore, monitoring of training sessions showed predictive value for future injuries, as horses withdrawn because of injury later on showed already higher peak HRs during condition training than horses that stayed sound. Therefore the increase in peak HR seemed to precede visible lameness in a horse.


A STAT3 Gene Expression Signature in Gliomas is Associated with a Poor Prognosis.
Gliomas frequently display constitutive activation of the transcription factor STAT3, a protein that is known to be able to mediate neoplastic transformation. STAT3 regulates genes that play a central role in cellular survival, proliferation, self-renewal, and invasion, and a cohort of STAT3 target genes have been found that are commonly coexpressed in human cancers. Thus, these genes likely subserve the transforming ability of constitutively activated STAT3. To determine whether the coordinated expression of STAT3 target genes is present in a subset of human gliomas, and whether this changes the biology of these tumors in patients, gene expression analysis was performed in four distinct human glioma data sets for which patient survival information was available. Coordinate expression of STAT3 targets was significantly associated with poor patient outcome in each data set. Specifically, patients with tumors displaying high expression of STAT3 targets had a shorter median survival time compared to patients whose tumors had low expression of STAT3 targets. These data suggest that constitutively activated STAT3 in gliomas can alter the biology of these tumors, and that development of targeted STAT3 inhibitors would likely be of particular benefit in treatment of this disease.


Analytical "bake-off" of whole genome sequencing quality for the Genome Russia project using a small cohort for autoimmune hepatitis.
A comparative analysis of whole genome sequencing (WGS) and genotype calling was initiated for ten human genome samples sequenced by St. Petersburg State University Peterhof Sequencing Center and by three commercial sequencing centers outside of Russia. The sequence quality, efficiency of DNA variant and genotype calling were compared with each other and with DNA microarrays for each of ten study subjects. We assessed calling of SNPs, indels, copy number variation, and the speed of WGS throughput promised. Twenty separate QC analyses showed high similarities among the sequence quality and called genotypes. The ten genomes tested by the centers included eight American patients afflicted with autoimmune hepatitis (AIH), plus one case's unaffected parents, in a prelude to discovering genetic influences in this rare disease of unknown etiology. The detailed internal replication and parallel analyses allowed the observation of two of eight AIH cases carrying a rare allele genotype for a previously described AIH-associated gene (FTCD), plus multiple occurrences of known HLA-DRB1 alleles associated with AIH (HLA-DRB1-03:01:01, 13:01:01 and 7:01:01). We also list putative SNVs in other genes as suggestive in AIH influence.


Reporting diarrhoea through a vernacular term in Quechua-speaking settings of rural Bolivia.
Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term k'echalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of k'echalera were collected for children aged less than five years. Reported k'echalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported k'echalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to k'echalera. Mucus in the stool was also associated with k'echalera; however, its presence in k'echalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term k'echalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of k'echalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of k'echalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia.


Pretreating poplar cuttings with low nitrogen ameliorates salt stress responses by increasing stored carbohydrates and priming stress signaling pathways.
Soil salinity is a widespread stress in semi-arid forests worldwide, but how to manage nitrogen (N) nutrition to improve plant saline tolerance remains unclear. Here, the cuttings of a widely distributed poplar from central Asia, Populus russikki Jabl., were exposed to either normal or low nitrogen (LN) concentrations for two weeks in semi-controlled greenhouse, and then they were added with moderate salt solution or not for another two weeks to evaluate their physiological, biochemical, metabolites and transcriptomic profile changes. LN-pretreating alleviated the toxicity caused by the subsequent salt stress in the poplar plants, demonstrated by a significant reduction in the influx of Na+ and Cl- and improvement of the K+/Na+ ratio. The other salt-stressed traits were also ameliarated, indicated by the variations of chlorophyll content, PSII photochemical activity and lipid peroxidation. Stress alleviation resulted from two different processes. First, LN pretreatment caused a significant increase of non-structural carbohydrates (NSC), allowed for an increased production of osmolytes and a higher potential fueling ion transport under subsequent salt condition, along with increased transcript levels of the cation/H+ ATPase. Second, LN pretreatment enhanced the transcript levels of stress signaling components and phytohormones pathway as well as antioxidant enzyme activities. The results indicate that early restrictions of N supply could enhance posterior survival under saline stress in poplar plants, which is important for plantation programs and restoration activities in semi-arid areas.


Monoclonal antibodies to glial fibrillary acidic protein in the cytologic diagnosis of brain tumors.
Monoclonal antibodies were used to immunocytochemically demonstrate the presence or absence of glial fibrillary acidic protein (GFAP) in smear preparations from human intracranial tumors. The results show that this approach may be of great help in the histogenetic classification of such tumors.


A ruthenium(II)-curcumin compound modulates NRF2 expression balancing the cancer cell death/survival outcome according to p53 status.
Tumor progression and tumor response to anticancer therapies may be affected by activation of oncogenic pathways such as the antioxidant one induced by NRF2 (nuclear factor erythroid 2-related factor 2) transcription factor and the pathways modified by deregulation of oncosuppressor p53. Often, oncogenic pathways may crosstalk between them increasing tumor progression and resistance to anticancer therapies. Therefore, understanding that interplay is critical to improve cancer cell response to therapies. In this study we aimed at evaluating NRF2 and p53 in several cancer cell lines carrying different endogenous p53 status, using a novel curcumin compound since curcumin has been shown to target both NRF2 and p53 and have anti-tumor activity. We performed biochemical and molecular studies by using pharmacologic of genetic inhibition of NRF2 to evaluate the effect of curcumin compound in cancer cell lines of different tumor types bearing wild-type (wt) p53, mutant (mut) p53 or p53 null status. We found that the curcumin compound induced a certain degree of cell death in all tested cancer cell lines, independently of the p53 status. At molecular level, the curcumin compound induced NRF2 activation, mutp53 degradation and/or wtp53 activation. Pharmacologic or genetic NRF2 inhibition further increased the curcumin-induced cell death in both mutp53- and wtp53-carrying cancer cell lines while it did not increase cell death in p53 null cells, suggesting a cytoprotective role for NRF2 and a critical role for functional p53 to achieve an efficient cancer cell response to therapy. These findings underline the prosurvival role of curcumin-induced NRF2 expression in cancer cells even when cells underwent mutp53 downregulation and/or wtp53 activation. Thus, NRF2 inhibition increased cell demise particularly in cancer cells carrying p53 either wild-type or mutant suggesting that p53 is crucial for efficient cancer cell death. These results may represent a paradigm for better understanding the cancer cell response to therapies in order to design more efficient combined anticancer therapies targeting both NRF2 and p53.


NATURE OF THE ACTION CURRENT IN NITELLA : VI. SIMPLE AND COMPLEX ACTION PATTERNS.
The experiments indicate that the protoplasm of Nitella consists of an aqueous layer W with an outer non-aqueous surface layer X and an inner non-aqueous surface layer Y. The potential at Y is measured by the magnitude of the action curve and the potential at X by the distance from the top of the action curve to the zero line. These potentials appear to be due chiefly to diffusion potentials caused by the activity gradients of KCl across the non-aqueous layers X and Y. The relative mobilities of K(+) and Cl(-) in X and in Y can be computed and an estimate of the activity of KCl in W can be made. In the complete resting state the mobilities of K(+) and Cl(-) in X are not very different from those in Y. The action curve is due to changes in Y which suddenly becomes very permeable, allowing potassium to move from the sap across Y into W, and thus losing its potential. A gradual loss may be due to changes in ionic mobility in Y. When recovery is incomplete and Y has not yet regained its normal potential a stimulus may cause a loss of the potential at Y giving an action curve of small magnitude. The magnitude may vary in successive action curves giving what is called a complex pattern in contrast to the simple pattern observed when recovery is complete and all the action curves are alike. Complex patterns occur chiefly in cells treated with reagents. Untreated cells usually give simple patterns. A variety of complex action patterns is discussed. It is evident that the cells of Nitella show much more variation than such highly specialized cells as muscle and nerve which give stereotyped responses. In some cases it may be doubtful whether the all-or-none law holds.


REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies.
To provide the final results from the REMODEL (randomized evaluation of maxillary antrostomy versus ostial dilation efficacy through long-term follow-up) full-study cohorts and perform meta-analyses of standalone balloon sinus dilation studies to explore long-term outcomes in a large patient sample. Randomized controlled trial and meta-analysis. Final outcomes from the REMODEL randomized trial, including a larger cohort of 135 patients treated with functional endoscopic sinus surgery (FESS) or in-office balloon dilation, were evaluated. One hundred thirty patients had 12-month data, 66 had 18-month data, and 25 had 24-month data. In addition, a meta-analysis evaluated outcomes from six studies including 358 standalone balloon dilation patients with up to 24 months follow-up. Outcomes out to 2 years from the REMODEL full-study cohort are consistent with 6-month and 12-month outcomes. In the meta-analysis of standalone balloon dilation studies, technical success is 97.5%, and mean 20-item Sino-Nasal Outcomes Test scores are significantly and clinically improved at all time points (P < .0001). There are significant reductions (P < .0001) in work/school days missed, homebound days, physician/nurse visits, acute infections, and antibiotic prescriptions. Mean recovery time is 1.4 days. Comparison of 12-month symptom improvements and revision rates between the REMODEL FESS arm (n = 59), REMODEL balloon dilation arm (n = 71), and pooled single-arm standalone balloon dilation studies (n = 243) demonstrated no statistical difference. All outcomes are comparable between FESS and balloon dilation at all time points from 6 months to 24 months. Balloon dilation produces faster recovery, less postoperative pain, and fewer debridements than FESS. There is significant, durable benefit in a large series of 358 patients undergoing standalone balloon dilation.


Pilot Results of a Digital Hypertension Self-management Program Among Adults With Excess Body Weight: Single-Arm Nonrandomized Trial.
Home-measured blood pressure (HMBP) in combination with comprehensive medication support and lifestyle change are the mainstays of evidence-based hypertension (HTN) management. To date, the precise components needed for effective HTN self-management programs have yet to be defined, and access to multicomponent targeted support for HTN management that include telemonitoring remain inaccessible and costly. The aim of this pilot study was to evaluate the impact of a digital HTN self-management program on blood pressure (BP) control among adults with excess body weight. A single-arm, nonrandomized trial was performed to evaluate a digital HTN self-management program that combines comprehensive lifestyle counseling with HTN education, guided HMBP, support for taking medications, and led by either a registered nurse or certified diabetes care and education specialist. A sample of 151 participants were recruited using a web-based research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in systolic BP from baseline to 3 months, and secondary outcomes included change in diastolic BP and medication adherence. Participants' mean age was 44.0 (SD 9.3) years and mean BP was 139/85 mm Hg. At follow-up, systolic and diastolic BP decreased by 7 mm Hg (P<.001, 95% CI -9.3 to -4.7) and 4.7 mm Hg (P<.001, 95% CI -6.3 to -3.2), respectively. Participants who started with baseline BP at goal remained at goal. For participants with stage 1 HTN, systolic and diastolic BP decreased by 3.6 mm Hg (P=.09, 95% CI -7.8 to 0.6) and 2.5 mm Hg (P=.03, 95% CI -4.9 to -0.3). Systolic and diastolic BP decreased by 10.3 mm Hg (P<.001, 95% CI -13.4 to -7.1) and 6.5 mm Hg (P<.001, 95% CI -8.6 to -4.4), respectively, for participants with stage 2 HTN. Medication adherence significantly improved (P=.02). This pilot study provides initial evidence that a digital HTN self-management program improves BP and medication adherence.


Experimental investigation of the quality characteristics of agricultural plastic wastes regarding their recycling and energy recovery potential.
A holistic environmentally sound waste management scheme that transforms agricultural plastic waste (APW) streams into labelled guaranteed quality commodities freely traded in open market has been developed by the European research project LabelAgriWaste. The APW quality is defined by the APW material requirements, translated to technical specifications, for recycling or energy recovery. The present work investigates the characteristics of the APW quality and the key factors affecting it from the introduction of the virgin product to the market to the APW stream reaching the disposer. Samples of APW from different countries were traced from their application to the field through their storage phase and transportation to the final destination. The test results showed that the majority of APW retained their mechanical properties after their use preserving a "very good quality" for recycling in terms of degradation. The degree of soil contamination concerning the APW recycling and energy recovery potential fluctuates depending on the agricultural plastic category and application. The chlorine and heavy metal content of the tested APW materials was much lower than the maximum acceptable limits for their potential use in cement industries.


Clinical factors associated with graft fibrosis in kidney-transplant recipients on steroid-avoidance immunosuppression.
Recent studies have documented good patient and graft outcomes and a low risk of acute rejection with steroid-avoidance immunosuppression in kidney-transplant recipients, but the risk of progressive graft fibrosis is not well studied. All adult primary kidney transplant or combined kidney and pancreas transplant recipients on steroid avoidance immunosuppression were eligible for study. All recipients received induction with antithymocyte globulin or basiliximab. Corticosteroids were stopped after day 4 post-transplantation. Patients were maintained with tacrolimus and mycophenolate mofetil. Protocol biopsies were done at reperfusion and at one, four, and 12 months after transplantation. Eighty one-yr protocol biopsies with adequate specimens were obtained from 132 kidney or kidney-pancreas transplant recipients. Fifteen (19%) of the biopsies showed moderate to severe graft interstitial fibrosis (GIF) (Banff ci score > or = 2). Recipients with GIF were older, had lower body mass index, greater human lymphocyte antigen (HLA) mismatch, older donors, serum creatinine > or = 1.6 mg/dL at one month, a Banff ci score > 0 on one-month biopsy, BK nephropathy, and interstitial cellular infiltrates on the one-yr biopsy. In the unadjusted logistic regression analysis, BK nephropathy, serum creatinine > or =1.6 mg/dL at one month, recipient age, Banff ci score > 0 on one-month biopsy, and donor age were the only variables associated with a higher risk of GIF on the one-year biopsy. In the multivariate logistic regression model adjusted for these variables, BK nephropathy, serum creatinine > or = 1.6 mg/dL at one month after transplantation, and recipient age were independently associated with the risk of GIF on the one-year biopsy. In this small study of primary kidney or combined kidney-pancreas transplant recipients on steroid-avoidance immunosuppression, we found that 19% had GIF on a one-year protocol biopsy. BK nephropathy, serum creatinine > or = 1.6 mg/dL one month after transplantation, and recipient age correlated with an increased risk for GIF on the one-yr biopsy.


Systematic evaluation and comparison of statistical tests for publication bias.
This study evaluates the statistical and discriminatory powers of three statistical test methods (Begg's, Egger's, and Macaskill's) to detect publication bias in meta-analyses. The data sources were 130 reviews from the Cochrane Database of Systematic Reviews 2002 issue, which considered a binary endpoint and contained 10 or more individual studies. Funnel plots with observers'agreements were selected as a reference standard. We evaluated a trade-off between sensitivity and specificity by varying cut-off p-values, power of statistical tests given fixed false positive rates, and area under the receiver operating characteristic curve. In 36 reviews, 733 original studies evaluated 2,874,006 subjects. The number of trials included in each ranged from 10 to 70 (median 14.5). Given that the false positive rate was 0.1, the sensitivity of Egger's method was 0.93, and was larger than that of Begg's method (0.86) and Macaskill's method (0.43). The sensitivities of three statistical tests increased as the cut-off p-values increased without a substantial decrement of specificities. The area under the ROC curve of Egger's method was 0.955 (95% confidence interval, 0.889-1.000) and was not different from that of Begg's method (area=0.913, p=0.2302), but it was larger than that of Macaskill's method (area=0.719, p=0.0116). Egger's linear regression method and Begg's method had stronger statistical and discriminatory powers than Macaskill's method for detecting publication bias given the same type I error level. The power of these methods could be improved by increasing the cut-off p-value without a substantial increment of false positive rate.


Effectiveness of the Miranda Acquiescence Questionnaire for Investigating Impaired Miranda Reasoning.
The capacity of arrestees to comprehend their Miranda rights adequately and to waive them intelligently remains largely unexamined by most defense attorneys and forensic practitioners. Although much is now known about Miranda comprehension, only recently has forensic research emerged on Miranda reasoning. This archival study utilizes an extensive dataset of 847 pretrial detainees who were administered the Standardized Assessment of Miranda Abilities. This study focuses on how forensic practitioners can evaluate Miranda misperceptions that may have contributed to highly consequential decisions to cooperate with law enforcement without seeking legal counsel. Specific items from the Miranda Acquiescence Questionnaire of the Standardized Assessment of Miranda Abilities clearly identified detainees with impaired Miranda reasoning. Two important patterns of Miranda misperceptions were observed: adversarial perspective on arrest and trusting law enforcement. For instance, more than 20 percent of detainees with impaired reasoning wrongly believed that cooperating with police could only have positive outcomes. Even more troubling, more than one fourth of detainees erroneously believed that they must always comply with police requests, which obviously could entail self-incrimination. These findings are then placed in a broader context when examining the professional roles of forensic practitioners in recognizing, understanding, and evaluating for impaired Miranda abilities.