Parameters affecting microwave-assisted extraction of organophosphorus pesticides from agricultural soil.
This work describes an optimised method for the determination of six representative organophosphorus pesticides (OPPs) (diazinon, parathion, methyl pirimiphos, methyl parathion, ethoprophos, and fenitrothion) in agricultural soils. The method is based on microwave-assisted extraction using a water-methanol modified mixture for desorption and simultaneous partitioning on n-hexane (MAEP), together with gas chromatography-flame photometric detection (GC-FPD). To improve GC-FPD signals (peak intensity and shape) olive oil was used effectively as a "matrix mimic". The optimisation of the extraction method was achieved in two steps: an initial approach through experimental design and principal component analysis where recovery of compounds using a water-methanol mixture ranged from 54 to 77%, and the second one by studying the addition of KH2PO4 to the extracting solution where recoveries were significantly increased, molecular replacing of OPPs from adsorption sites by phosphate being the probable extraction mechanism. Under optimised conditions, recoveries of pesticides from different soils were higher than 73%, except for methyl parathion in some soils, with SD equal or lower than 11% and detection limits ranging from 0.004 to 0.012 microg g(-1). The proposed method was used to determine OPPs in soil samples from different agricultural zones of Chile.


The choice of surgical procedure for peritonitis due to colonic perforation.
Because the choice of surgical procedure for colonic perforation is still matter of debate, we retrospectively studied peritonitis caused by spontaneous colonic perforation to assess predictors of mortality and the safety of primary resection and anastomosis. Case series. We investigated one hundred thirty-six consecutive patients with peritonitis due to colonic perforation who were surgically treated in an emergency surgery department. Eighty-one patients underwent primary resection and anastomosis, thirty-three underwent the Hartmann procedure, and twenty-two had simple colostomy. The seriousness of peritonitis was assessed in terms of Hinchey stage, the Mannheim Peritonitis Index (MPI), and the acute physiology and chronic health evaluation (APACHE) II score. The overall mortality rate was 20%. The APACHE II scores and MPIs were lower for survivors than for nonsurvivors. The mortality rate was 6% for primary resection and anastomosis, 30% for the Hartmann procedure, and 59% for simple colostomy, but the severity scores were significantly lower in patients who underwent primary resection than those of patients who had the Hartmann procedure and colostomy, respectively. Since primary resection and anastomosis has been shown to be safe, we suggest that is is proper, even in the presence of peritonitis. In spite of this, we conclude that the surgical procedure does not influence outcome but that the mortality rate is related to the severity of peritonitis, accurately measured by APACHE II score and MPI.


High-damage-threshold static laser beam shaping using optically patterned liquid-crystal devices.
Beam shaping of coherent laser beams is demonstrated using liquid crystal (LC) cells with optically patterned pixels. The twist angle of a nematic LC is locally set to either 0 or 90° by an alignment layer prepared via exposure to polarized UV light. The two distinct pixel types induce either no polarization rotation or a 90° polarization rotation, respectively, on a linearly polarized optical field. An LC device placed between polarizers functions as a binary transmission beam shaper with a highly improved damage threshold compared to metal beam shapers. Using a coumarin-based photoalignment layer, various devices have been fabricated and tested, with a measured single-shot nanosecond damage threshold higher than 30 J/cm2.


Fine-scale comparative phylogeography of a sympatric sister species triplet of subterranean diving beetles from a single calcrete aquifer in Western Australia.
Calcrete aquifers in the arid Yilgarn region of central Western Australia are a biodiversity hotspot for stygofauna. A distinct pattern of interspecific size class variation among subterranean dytiscid beetle species has been observed in 29 of these aquifers where either two or three small, medium and/or large sympatric species are found that are in some cases sister species. We used a 3.5 km(2) grid of bores to sample dytiscids on a fine-scale and employed a comparative phylogeographical and population genetic approach to investigate the origins of a sympatric sister species triplet of diving beetles from a single aquifer. Mitochondrial DNA sequence data from the Cytochrome oxidase c subunit I gene revealed that all three species have high levels of haplotype diversity with ancient (approximately 1 million years ago) intra-specific coalescence of haplotypes, but low levels of nucleotide diversity. Population analyses provide evidence for multiple expansion events within each species. There was spatial heterogeneity in the distribution of genetic variation and abundance both within and among the three taxa. Population analyses revealed significant fine-scale differentiation with isolation by distance for Paroster macrosturtensis and P. mesosturtensis, but not the smallest species P. microsturtensis. Haplotype network analyses provided limited or no evidence for past population fragmentation within the large and small species, but substantial historical divergence was observed in P. mesosturtensis that was not spatially structured. A patchy population structure with contemporaneous and historical isolation by distance in the three species is likely to have been a significant isolating and diversifying force, preventing us from ruling out a potential role for allopatric divergence during speciation of this beetle sister triplet.


FimH adhesin of type 1 fimbriae is a potent inducer of innate antimicrobial responses which requires TLR4 and type 1 interferon signalling.
Components of bacteria have been shown to induce innate antiviral immunity via Toll-like receptors (TLRs). We have recently shown that FimH, the adhesin portion of type 1 fimbria, can induce the innate immune system via TLR4. Here we report that FimH induces potent in vitro and in vivo innate antimicrobial responses. FimH induced an innate antiviral state in murine macrophage and primary MEFs which was correlated with IFN-beta production. Moreover, FimH induced the innate antiviral responses in cells from wild type, but not from MyD88(-/-), Trif(-/-), IFN-alpha/betaR(-/-) or IRF3(-/-) mice. Vaginal delivery of FimH, but not LPS, completely protected wild type, but not MyD88(-/-), IFN-alpha/betaR(-/-), IRF3(-/-) or TLR4(-/-) mice from subsequent genital HSV-2 challenge. The FimH-induced innate antiviral immunity correlated with the production of IFN-beta, but not IFN-alpha or IFN-gamma. To examine whether FimH plays a role in innate immune induction in the context of a natural infection, the innate immune responses to wild type uropathogenic E. coli (UPEC) and a FimH null mutant were examined in the urinary tract of C57Bl/6 (B6) mice and TLR4-deficient mice. While UPEC expressing FimH induced a robust polymorphonuclear response in B6, but not TLR4(-/-) mice, mutant bacteria lacking FimH did not. In addition, the presence of TLR4 was essential for innate control of and protection against UPEC. Our results demonstrate that FimH is a potent inducer of innate antimicrobial responses and signals differently, from that of LPS, via TLR4 at mucosal surfaces. Our studies suggest that FimH can potentially be used as an innate microbicide against mucosal pathogens.


Unrelated living donors in 141 kidney transplantations: a one-center study.
Kidney transplantation is the optimal treatment for the majority of patients with end-stage renal disease. However, the shortage of kidneys for transplantation is a global problem, and any attempt to improve the donor situation would be of benefit to the growing number of patients on transplant waiting lists. Since 1984, we have transplanted 141 kidneys from genetically unrelated living donors. Donors were most often spouses and were accepted regardless of HLA match grade. Preemptive transplantation was performed in 39% of the patients. Standard triple-drug immunosuppression with prednisolone, cyclosporine, and azathioprine was used. The patients were followed from 6 months to 13 years. The incidence of acute rejection during the first 3 months after transplantation was higher in recipients of grafts from unrelated donors than in recipients of grafts from related living donors or cadaveric donors. However, unrelated living donor grafts survived significantly better than did cadaveric grafts (P < 0.02) and had a survival rate similar to that of living-related donor grafts mismatched for one or both HLA haplotypes. The perioperative complication rate for the donor was low. We consider unrelated living donors an excellent source for alleviating the shortage of donor kidneys.


Low gas pressure sensor based on a polymer optical fiber grating.
A fiber Bragg grating (FBG) inscribed Zeonex-based novel, to the best of our knowledge, side hole polymer optical fiber (SHPOF) is proposed and demonstrated for low gas pressure measurement above and below the atmospheric pressure. Two different grades of Zeonex have been used to fabricate the core and cladding of this fiber, thereby making it dopant free. The side hole introduced in the cladding is parallel to the fiber core. A few ultrashort pulses with nanosecond duration have been used to write the FBG in the core of this fiber. The incorporation of the side hole leads to enhancement of pressure sensitivity as well as low hysteresis and performance repeatability compared to Zeonex-based conventional polymer optical fiber (CPOF). Above the atmospheric pressure, the proposed probe shows a pressure sensitivity of 0.47 pm/kPa, which is 80% more compared to the Zeonex-based CPOF and 0.48 pm/kPa for regime below atmospheric pressure. The sensor has a resolution of 2.12 kPa and exhibited very low hysteresis.


Driving, dementia and Australian physicians: primum non nocere?
Older Australians are increasingly reliant on automobiles as their sole form of transport. As our population is ageing and the prevalence of dementia is increasing, it is anticipated that the number of drivers with dementia will rise over time. Much of the literature relating to driving and dementia focuses on safety rather than mobility. The objective of this paper is to highlight several topical ethical issues that pertain to Australian drivers with dementia. It is recommended that future research, policy and practice should centre on the crucial mobility and transport needs of our senior citizens.


[Therapy of facial pain].
Facial pain is a rare and often misdiagnosed condition. The most common facial pain syndrome is trigeminal neuralgia (TG), which is characterized by paroxysms of excruciating, sharp, burning or lancinating pain. Most cases are caused by a vascular compression of the trigeminal nerve at its entry zone to the pons. Treatment strategies comprise medical treatment and surgical procedures. Anticonvulsants like carbamazepin or gabapentin are widely used for the treatment of TG. The decision on the individual drug therapy may depend on factors like pharmacokinetic properties and individual drug tolerability. In case of drug failure, surgical treatment options like microvascular decompression are available. Persistent idiopathic facial pain is a rare pain condition. Elaborate diagnostic investigations have to be performed since symptomatic causes may be overlooked. Antidepressant drugs like amitriptyline are the first-line drugs for the treatment of this condition.


[Cancer of the gastric stump].
627 cases of gastric cancer treated surgically during the last 5 years, at the Hospital Nacional "Edgardo Rebagliati Martins" from Instituto Peruano de Seguridad Social (Lima-Perú) were revised. 4 of the patients had been operated before of hemigastrectomy or antrectomy with pyloroplasty for peptic ulcer. The time between the first operation and diagnosis of cancer of the gastric stump was more than 20 years. 3 of these cases were able to be resected. The international incidence of cancer in the gastric stump is 1.1% to 9.2% according to different authors. The risk is higher after 15 years. In the pathogenesis are advocated the lower gastric acidity, biliary reflux, the presence of bacteria, the formation of nitrosamines, intestinal metaplasia, etc. Is necessary to perform periodic endoscopic survey in patients who were treated surgically of peptic ulcer with antrectomy or hemigastrectomy with more than 15 years of evolution.


Willingness to participate in HIV vaccine efficacy trials among high risk men and women from fishing communities along Lake Victoria in Uganda.
HIV vaccine efficacy trials conducted in suitable populations are anticipated in sub-Saharan Africa. We assessed the willingness to participate in future vaccine trials among individuals from fishing communities along Lake Victoria, Uganda. From July to October 2012, we described a hypothetical vaccine trial to 328 (62.2% men) adults (18-49 years), at risk of HIV infection within 6 months of enrolment in a cohort and assessed their willingness to participate in the trial. Chi-square and logistic regression models were fitted to assess associations between vaccine trial attributes, participants' characteristics and willingness to participate. Overall, 99.4% expressed willingness to participate in the hypothetical HIV vaccine trial. This decreased marginally with introduction of particular vaccine trial attributes. Delaying pregnancy for 10 months and large blood draw had the largest effects on reducing willingness to participate to 93.5% (p=0.02) and 94.5% (p=0.01) respectively. All the vaccine trial attributes in combination reduced willingness to participate to 90.6%. This overall reduction in willingness to participate was significantly associated with gender and exchange of gifts for sex in multivariable analysis; women were more than three times as likely to have expressed unwillingness to participate in future vaccine trials as men (aOR=3.4, 95% CI: 1.55, 7.33) and participants who never received gifts in exchange for sex were more than four times as likely to have expressed unwillingness as those who received gifts for sex (aOR=4.5; 95%CI 1.30, 16.70). The main motivators of participation were access to HIV counselling and testing services (31.9%), HIV education (18.0%), hope of being prevented from acquiring HIV (16.6%) and health care (12.5%). Our study identifies an important population for inclusion in future HIV prevention trials and provides important insights into acceptability of trial procedures, differences in decisions of women and men and areas for further participant education.


A Meta-Analysis of the Impact of Anaerobic Soil Disinfestation on Pest Suppression and Yield of Horticultural Crops.
Anaerobic soil disinfestation (ASD) is a proven but relatively new strategy to control soil borne pests of horticultural crops through anaerobic decomposition of organic soil amendments. The ASD technique has primarily been used to control soil borne pathogens; however, this technique has also shown potential to control plant parasitic nematodes and weeds. ASD can utilize a broad range of carbon (C) amendments and optimization may improve efficacy across environments. In this context, a meta-analysis using a random-effects model was conducted to determine effect sizes of the ASD effect on soil borne pathogens (533 studies), plant parasitic nematodes (91 studies), and weeds (88 studies) compared with unamended controls. Yield response to ASD was evaluated (123 studies) compared to unamended and fumigated controls. We also examined moderator variables for environmental conditions and amendments to explore the impact of these moderators on ASD effectiveness on pests and yield. Across all pathogen types with the exception of Sclerotinia spp., ASD studies show suppression of bacterial, oomycete and fungal pathogens (59 to 94%). Pathogen suppression was effective under all environmental conditions (50 to 94%) and amendment types (53 to 97%), except when amendments were applied at rates less than 0.3 kg m(-2). The ASD effect ranged from 15 to 56% for nematode suppression and 32 to 81% for weed suppression, but these differences were not significant. Significant nematode moderators included study type, soil type, sampling depth, incubation period, and use of mixed amendments. Weed suppression due to ASD showed significant heterogeneity for all environmental conditions, confirming that these studies do not share a common effect size. Total crop yield was not reduced by ASD when compared to a fumigant control and yield was significantly higher (30%) compared to an unamended control, suggesting ASD as a feasible option to maintain yield without chemical soil fumigants. We conclude ASD is effective against soil borne pathogens and while not conclusive due to a limited number of studies, we expect the same for nematodes and weeds given observed effect sizes. Findings should assist researchers in exploring ASD efficacy in particular environmental conditions and allow for development of standard treatment protocols.


Regional variations and trends in mortality from cardiovascular diseases in population aged 0-64 in Dalmatia and Slavonia, 1998-2009.
The aim of this paper was to analyse the regional variations and trends in mortality from cardiovascular diseases in the population aged 0-64 years in Dalmatia and Slavonia, over the period 1998 to 2009. Mortality data were derived from Central Bureau of Statistics. The results show that age-standardized mortality rates from total cardiovascular diseases, ischaemic heart diseases and cerebrovascular diseases were lower in Dalmatia than rates for Slavonia, for both genders. All mortality rates, except rates for ischaemic heart diseases mortality for men in both regions, showed the trend of decline. Dalmatia has a more protective factors in pattern of Mediterranean diet. The improvement of cardiovascular health and reduction of premature mortality from cardiovascular diseases requires a system and comprehensive intervention approach at all levels of health care and multisectorial coordination.


Improved nuclear medicine uniformity assessment with noise texture analysis.
Because γ cameras are generally susceptible to environmental conditions and system vulnerabilities, they require routine evaluation of uniformity performance. The metrics for such evaluations are commonly pixel value-based. Although these metrics are typically successful at identifying regional nonuniformities, they often do not adequately reflect subtle periodic structures; therefore, additional visual inspections are required. The goal of this project was to develop, test, and validate a new uniformity analysis metric capable of accurately identifying structures and patterns present in nuclear medicine flood-field uniformity images. A new uniformity assessment metric, termed the structured noise index (SNI), was based on the 2-dimensional noise power spectrum (NPS). The contribution of quantum noise was subtracted from the NPS of a flood-field uniformity image, resulting in an NPS representing image artifacts. A visual response filter function was then applied to both the original NPS and the artifact NPS. A single quantitative score was calculated on the basis of the magnitude of the artifact. To verify the validity of the SNI, an observer study was performed with 5 expert nuclear medicine physicists. The correlation between the SNI and the visual score was assessed with Spearman rank correlation analysis. The SNI was also compared with pixel value-based assessment metrics modeled on the National Electrical Manufacturers Association standard for integral uniformity in both the useful field of view (UFOV) and the central field of view (CFOV). The SNI outperformed the pixel value-based metrics in terms of its correlation with the visual score (ρ values for the SNI, integral UFOV, and integral CFOV were 0.86, 0.59, and 0.58, respectively). The SNI had 100% sensitivity for identifying both structured and nonstructured nonuniformities; for the integral UFOV and CFOV metrics, the sensitivities were only 62% and 54%, respectively. The overall positive predictive value of the SNI was 87%; for the integral UFOV and CFOV metrics, the positive predictive values were only 67% and 50%, respectively. The SNI accurately identified both structured and nonstructured flood-field nonuniformities and correlated closely with expert visual assessment. Compared with traditional pixel value-based analysis, the SNI showed superior performance in terms of its correlation with visual perception. The SNI method is effective for detecting and quantifying visually apparent nonuniformities and may reduce the need for more subjective visual analyses.


Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens.
Vaccination rates for healthy senior citizens are lower than those for senior citizens with underlying medical conditions such as chronic heart or lung disease. Uncertainty about the benefits of influenza vaccination for healthy senior citizens may contribute to lower rates of utilization in this group. To clarify the benefits of influenza vaccination among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. All elderly members of a large health maintenance organization were included in each of 6 consecutive study cohorts. Subjects were grouped according to risk status: high risk (having heart or lung disease), intermediate risk (having diabetes, renal disease, stroke and/or dementia, or rheumatologic disease), and low risk. Outcomes were compared between vaccinated and unvaccinated subjects after controlling for baseline demographic and health characteristics. There were more than 20000 subjects in each of the 6 cohorts who provided 147551 person-periods of observation. The pooled vaccination rate was 60%. There were 101 619 person-periods of observation for low-risk subjects, 15 482 for intermediate-risk, and 30 450 for high-risk subjects. Vaccination over the 6 seasons was associated with an overall reduction of 39% for pneumonia hospitalizations (P<.001), a 32% decrease in hospitalizations for all respiratory conditions (P<.001), and a 27% decrease in hospitalizations for congestive heart failure (P<.001). Immunization was also associated with a 50% reduction in all-cause mortality (P<.001). Within the risk subgroups, vaccine effectiveness was 29%, 32%, and 49% for high-, intermediate-, and low-risk senior citizens for reducing hospitalizations for pneumonia and influenza (for high and low risk, P< or =.002; for intermediate risk, P = .11). Effectiveness was 19%, 39%, and 33% (for each, P< or =.008), respectively, for reducing hospitalizations for all respiratory conditions and 49%, 64%, and 55% for reducing deaths from all causes (for each, P<.001). Vaccination was also associated with direct medical care cost savings of $73 per individual vaccinated for all subjects combined (P = .002). Estimates of cost savings within each risk group suggest that vaccination would be cost saving for each subgroup (range of cost savings of $171 per individual vaccinated for high risk to $7 for low risk), although within the subgroups these findings did not reach statistical significance (for each, P> or =.05). This study confirms that healthy senior citizens as well as senior citizens with underlying medical conditions are at risk for the serious complications of influenza and benefit from vaccination. All individuals 65 years or older should be immunized with this vaccine.


First-principles study of the four polymorphs of crystalline octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine.
The electronic structure and vibrational properties of the four polymorphs of crystalline octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) have been studied using density functional theory within the local density approximation. The results show that the states of N in the ring make more important contributions to the valence bands than these of C and N of NO2 and so N in the ring acts as an active center. From the low frequency to high-frequency region, the molecular motions of the vibrational frequencies for the four HMX polymorphs present unique features. It is also noted that there is a relationship between the band gap and impact sensitivity for the four HMX polymorphs. From the cell bond order per unit volume, we may infer the variation order of crystal bonding for the four polymorphs and so predict their impact sensitivity order as follows: beta-HMX < gamma-HMX < alpha-HMX < delta-HMX, which is in agreement with their experimental order.


Role of sex hormones and the vaginal microbiome in susceptibility and mucosal immunity to HIV-1 in the female genital tract.
While the prevalence of Human immunodeficiency virus-1 (HIV-1) infection has stabilized globally, it continues to be the leading cause of death among women of reproductive age. The majority of new infections are transmitted heterosexually, and women have consistently been found to be more susceptible to HIV-1 infection during heterosexual intercourse compared to men. This emphasizes the need for a deeper understanding of how the microenvironment in the female genital tract (FGT) could influence HIV-1 acquisition. This short review focuses on our current understanding of the interplay between estrogen, progesterone, and the cervicovaginal microbiome and their immunomodulatory effects on the FGT. The role of hormonal contraceptives and bacterial vaginosis on tissue inflammation, T cell immunity and HIV-1 susceptibility is discussed. Taken together, this review provides valuable information for the future development of multi-purpose interventions to prevent HIV-1 infection in women.


Evaluation of seasonality on total water intake, water loss and water balance in the general population in Greece.
Water balance is achieved when water intake from solid and fluid foods and drinking water meets water losses, mainly in sweat, urine and faeces. Seasonality, particularly in Mediterranean countries that have a hot summer, may affect water loss and consequently water balance. Water balance has not been estimated before on a population level and the effect of seasonality has not been evaluated. The present study aimed to compare water balance, intake and loss in summer and winter in a sample of the general population in Greece. The Water Balance Questionnaire (WBQ) was used to evaluate water balance, estimating water intake and loss in summer (n = 480) and in winter (n = 412) on a stratified sample of the general population in Athens, Greece. In winter, mean (SD) water balance was -63 (1478) mL/day(-1) , mean (SD)water intake was 2892 (987) mL/day(-1) and mean (quartile range) water loss was 2637 (1810-3922) mL/day(-1) . In summer, mean (SD) water balance was -58 (2150) mL/day(-1) , mean (SD) water intake was 3875 (1373) mL/day(-1) and mean (quartile range) water loss was 3635 (2365-5258) mL/day(-1) . Water balance did not differ between summer and winter (P = 0.96); however, the data distribution was different; in summer, approximately 8% more participants were falling in the low and high water balance categories. Differences in water intake from different sources were identified (P < 0.05). Water balance in summer and winter was not different. However, water intake and loss were approximately 40% higher in summer than in winter. More people were falling in the low and high water balance categories in summer when comparing the distribution on water balance in winter.


Rapid anharmonic vibrational corrections derived from partial Hessian analysis.
Vibrational analysis within a partial Hessian framework can successfully describe the vibrational properties of a variety of systems where the vibrational modes of interest are localized within a specific region of the system. We have developed a new approach to calculating anharmonic frequencies based on vibrational frequencies and normal modes obtained from a partial Hessian analysis using second-order vibrational perturbation theory and the transition optimized shifted Hermite method. This allows anharmonic frequencies for vibrational modes that are spatially localized to be determined at a significantly reduced computational cost. Several molecular systems are examined in order to demonstrate the effectiveness of this method including organic molecules adsorbed on the Si(100)-2×1 surface, model peptides in solution, and the C-H stretching region of polycyclic aromatic hydrocarbons. Overall, for a range of systems, anharmonic frequencies calculated using the partial Hessian approach are found to be in close agreement with the results obtained using full anharmonic calculations while providing a significant reduction in computational cost.


Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services.
This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic. This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.


Electronic and optical properties of finite carbon nanotubes in an electric field.
The effects, caused by the geometric structure and an electric field (E), on the electronic and optical properties of quasi-zero-dimensional finite carbon nanotubes are explored by employing the tight-binding model coupled with curvature effects. Electronic properties (state energies, symmetry of electronic states, energy spacing and state degeneracy) are significantly affected by the magnitude and the direction of the electric field and the geometric structure (radius, length and chirality). The electric field, by lowering the symmetry of finite carbon nanotubes, modifies the electronic properties. Thus, the optical excitation spectra, excited by electric polarization parallel to the nanotube axis, exhibit rich delta-function-like peaks, which reveal the characteristics of the electronic properties. Therefore it follows that geometric structure and E influence the low-energy absorption spectra, i.e. the change of frequency of the first peak, the alternation of the peak height and the production of the new peaks. There are more absorption peaks when E is oriented closer to the cross-section plane. Moreover, the very complicated optical absorption spectra are characteristic for the individual chiral carbon nanotube due to its specific geometric structure. Above all, the predicted absorption spectra and the associated electronic properties could be verified by optical measurements.


Semen quality and sex hormones among organic and traditional Danish farmers. ASCLEPIOS Study Group.
To confirm or refute the hypothesis that organic farmers have higher sperm concentrations than traditional farmers. Traditional and organic farmers were selected randomly from central registers, and 171 traditional farmers and 85 organic farmers delivered one semen sample before the start of the spraying season. The participation rate was 28.8% among traditional farmers and 42.9% among organic farmers. The median sperm concentration for traditional and organic farmers was 58 million/ml and 64 million/ml, respectively. After adjustment for several confounders, sperm concentration, total count, proportion of non-vital spermatozoa, sperm chromatin structure, and motility variables did not differ significantly between the two groups. The traditional farmers had a significantly lower proportion of normal spermatozoa, but this result was not confirmed in a second sample. Organic farmers had slightly higher inhibin B concentration and testosterone/sex hormone binding globulin ratio. Despite slight differences in concentrations of reproductive hormones, no significant differences in conventional measures of semen quality were found between organic and traditional farmers.


Frequency and luminance-dependent blood flow and K+ ion changes during flicker stimuli in cat optic nerve head.
The purpose of this study was to investigate whether blood flow in the cat optic nerve head (ONH) is related to increased neuronal activity elicited by diffuse luminance flickering light stimulation. ONH blood flow was measured by laser Doppler flowmetry in anesthetized cats during 1 to 3 minutes of flickering light stimulation at controlled luminance and frequency (n = 227 measurements in 18 cats) using either a conventional visual stimulator (repetitive short flashes) or a sinusoidally varying light stimulator. Potassium ion concentration ([K+]) changes in the vitreous humor immediately in front of the optic disk were measured with neutral carrier K+ ionophore liquid membrane microelectrodes. Effects of varying flicker frequency (2 to 80 Hz) at constant luminance were quantified. Effects of luminance were quantified by varying the modulation depth of the stimulus at constant frequency. Both ONH blood flow and [K+] increased during flicker stimulus with an average slope of 0.305% +/- 0.064% (SE)/microM [K+] (257 measurements in 18 cats). The peak ONH blood flow increase was 59% +/- 11% above baseline at 33.3 +/- 3.1 Hz. The peak [K+] increase was 188 +/- 42 microM above baseline at 38.3 +/- 3.3 Hz. Both ONH blood flow and [K+] changes had similar bandpass characteristics with frequency, first increasing, then dropping off at higher frequencies (122 measurements in 10 cats). Both frequency responses were described by power law functions (y = af"). Luminance responses for both ONH blood flow and [K+] changes could be fit by a modified Hill model and were 50% of maximum at light modulation depths of 21.2% +/- 4.6% and 22.5% +/- 3.7%, respectively (53 measurements in 5 cats). Increases in ONH blood flow were correlated with changes in [K+]. Both responses were remarkably similar, with no significant differences in the frequency for peak responses in ONH blood flow or [K+], in low- and high-frequency power law exponents of the two responses, or in the 50% response to light modulation. The results are consistent with close coupling of neuronal activity and ONH blood flow.


Age-dependent decline in hippocampal neurogenesis is not altered by chronic treatment with fluoxetine.
There has been ongoing controversy as to whether selective serotonin reuptake inhibitors (SSRIs) exhibit the same antidepressant efficacy and risk profile within different age groups. Although the etiology of such potential differences is currently not clear, age-dependent differences in the rate of hippocampal neurogenesis offer one possibility. In the current studies we have therefore examined whether fluoxetine, the prototypical selective serotonin reuptake inhibitor, differentially modulates neurogenesis in adolescent, young adult, and aged rats. Proliferation in the dentate gyrus was measured by assaying expression of the endogenous proliferative marker, Ki67. Survival of proliferating cells was assayed by staining with BrdU. We confirmed previous reports that the rate of neurogenesis, as well as the survival of proliferating cells, decreases significantly with age. Moderate decreases were found in young adult rats relative to adolescent rats, and profound decreases were found in aged rats. We additionally found that age did not alter the response to 25 days of treatment with fluoxetine. In fact, we did not observe enhancement of hippocampal neurogenesis, nor enhancement of proliferating cell survival, in any of the three age groups despite using doses of fluoxetine which have been reported to be effective. In addition to finding no age-dependent effects, our data question the general reproducibility of previously reported fluoxetine effects in animals.


Perceptions of preceptorship in clinical practice after completion of a continuous professional development course- a qualitative study Part II.
For health care professionals, clinical practice is a vital part of education, and in several countries, teaching is a regulated part of the role of nurses and health care staff. The added responsibility of taking on the teaching of students during clinical practice; thus, balancing clinical and educational demands, might lead to feelings of stress and burnout. Being a skilled and experienced professional is not automatically linked to being a skilled educator as teaching of a subject is a completely different story. Preceptors who participate in educational initiatives are better prepared to address challenges and are more satisfied with the preceptor role. The aim of the current study was to evaluate preceptors' experiences of preceptorship in clinical practice after completion of a credit bearing continuous professional development course on advanced level. This was a small-scale interpretative qualitative study drawing data from focus group interviews and written accounts from reflective journals. Data were analysed through the process of naturalistic inquiry. Our findings show that the participants, who took part in and completed the CPD course, had developed skills and competences they believed to be necessary to drive pedagogical development at their respective workplaces. This is illustrated by the main category Leading educational development and explained by four sub-categories: 1/ increased ability to give collegial support; 2/ increased trust in one's abilities; 3/ increased emphasis on reflection; and 4/ increased professional status. A well-structured program based on the needs of preceptors and developed in partnership between educational and clinical settings seems to be successful in terms of preceptors' perceived increase of their competence, abilities and professional status. What seems to be missing, not only from the current study but also from previous research, is to what extent properly prepared preceptors impact on student learning and this needs to be further investigated.


Effects of endotoxin on zinc metabolism in human volunteers.
After stress or trauma, the serum zinc concentration decreases. This study evaluated possible mechanisms for hypozincemia with the use of a human endotoxemia model. Two doses of endotoxin [lipopolysaccharide (LPS)] were administered on consecutive mornings to 12 healthy volunteers, and each subject was also studied after saline injection. Blood was analyzed for zinc, cytokines (tumor necrosis factor-alpha and interleukin-6), albumin, albumin-zinc binding, and C-reactive protein (CRP). Serial 24-h urine collections were analyzed for zinc. Each LPS dose briefly increased plasma cytokine concentrations and decreased the serum zinc concentration. Serum albumin, the major zinc binding protein, did not decrease, but a progressive increase in CRP was found. LPS did not alter zinc binding affinity to serum albumin. Urine zinc losses were not increased. We conclude that hypozincemia in this model cannot be explained by decreased serum albumin, changes in serum albumin-zinc binding, or increased urinary zinc excretion. Because hypozincemia was transient and followed cytokine peaks, we postulate that LPS-stimulated hypozincemia is mediated, at least partly, by a cytokine-directed internal redistribution of zinc.


Measuring Linewidth Enhancement Factor by Relaxation Oscillation Frequency in a Laser with Optical Feedback.
This paper presents a new method for measuring the linewidth enhancement factor (alpha factor) by the relaxation oscillation (RO) frequency of a laser with external optical feedback (EOF). A measurement formula for alpha is derived which shows the alpha can be determined by only using the RO frequencies and no need to know any other parameters related to the internal or external parameters associated to the laser. Unlike the existing EOF based alpha measurement methods which require an external target has a symmetric reciprocate movement. The proposed method only needs to move the target to be in a few different positions along the light beam. Furthermore, this method also suits for the case with alpha less than 1. Both simulation and experiment are performed to verify the proposed method.


Implementation of treatment recommendations for chronic hepatitis B in patients attending specialized hospital care in Denmark - a region wide study.
Objective: To evaluate implementation of national guideline recommendations on treatment initiation for chronic hepatitis B (CHB) in Denmark.Methods: Using DANHEP, a nationwide cohort of chronic hepatitis B and C patients attending specialized hospital care in Denmark, we performed a descriptive cohort study from January 2002 through December 2017. We identified patients with CHB in 3 of 5 Danish regions, with at least two hospital/outpatient clinic visits during the study period.Results: We identified 990 CHB patients who remained untreated throughout the study period, and 265 who initiated treatment. At their last visit 952/990 (96%, 95% CI 95-97) untreated patients did not meet current national criteria for treatment initiation while 198/265 (75%, 95% CI 69-80) who initiated treatment met the national criteria. Overall, 198/236 (84%, 95% CI 79-88) who met national treatment criteria, initiated treatment.Conclusion: The majority of CHB patients received care in line with national guideline recommendations for treatment initiation. We found that only few patients eligible for treatment remained untreated. However, a fourth of patients who received treatment were not eligible according to national guidelines.


Combination therapy of portal vein resection and adjuvant gemcitabine improved prognosis of advanced pancreatic cancer.
Although adjuvant chemotherapy (AC) using gemcitabine improves the prognosis of patients with resectable pancreatic cancer, the effect of gemcitabine AC on the prognosis of patients with borderline resectable pancreatic cancer is not clear. We analyzed the prognosis of patients with pancreatic cancer who underwent curative pancreatoduodenectomy or total pancreatectomy in combination with portal/superior mesenteric vein resection (PVR) [PVR (+) group] or without PVR [PVR(-) group]. MST of the PVR (+) group was significantly shorter than that of the PVR(-) group (p=0.017). In contrast, when we focused on the patients with gemcitabine AC, there was no significant difference in MST between the PVR (+) and the PVR (-) groups (p=0.247). Furthermore, we compared MST of two subgroups in the PVR (+) group depending on gemcitabine AC status. In the PVR (+) group, MST of the patients with gemcitabine AC was significantly longer than that without gemcitabine AC (p=0.003). This was also true for the patients with pancreatic cancer which had histologically proven invasion to portal/superior mesenteric vein (PV/SMV) (p=0.001). The prognosis of patients with pancreatic cancer invading PV/SMV can be improved by combination therapy with PVR and gemcitabine adjuvant chemotherapy.


Caloric restriction prevents age-related decline in skeletal muscle dihydropyridine receptor and ryanodine receptor expression.
The dihydropyridine receptor (DHPR), a voltage-gated L-type Ca2+ channel, and the Ca2+ release channel/ryanodine receptor isoform-1 (RyR1) are key molecules involved in skeletal muscle excitation-contraction coupling. We have reported age-related decreases in the level of DHPR expression in fast- and slow-twitch muscles from Fisher 344 cross Brown Norway (F344BNX) rats (Renganathan, Messi and Delbono, J. Membr. Biol. 157 (1997) 247-253). Based on these studies we postulate that excitation-contraction uncoupling is a basic mechanism for the decline in muscle force with aging (Delbono, Renganathan and Messi, Muscle Nerve Suppl. 5 (1997) S88-92). In the present study, we extended our studies to older ages and we intended to prevent or retard excitation-contraction uncoupling by restricting the caloric intake of the F344BNX rats from 16 weeks of age. Three age groups, 8-, 18-, and 33-month old caloric restricted rats, were compared with ad libitum fed animals. The number of DHPR and RyR1 and DHPR/RyR1 ratio (an index of the level of receptors uncoupling) in skeletal muscles of 8-month and 18-month rats was not significantly different in either ad libitum fed or caloric restricted rats. However, the age-related decrease in the number of DHPR, RyR1 and DHPR/RyR1 ratio observed in 33-month old ad libitum fed rats was absent in 33-month old caloric restricted rats. These results suggest that caloric restriction prevents age-related decreases in the number of DHPR, RyR1 and DHPR/RyR1 ratio observed in fast- and slow-twitch rat skeletal muscles.


Chronic heart failure as a metabolic disorder.
Congestive chronic heart failure (CHF) is a progressive disorder in which a complex interaction of haemodynamic, neurohormonal and metabolic disturbances leads to subsequent immune activation. The greatest attention has been given to the concept that the progression of heart failure is due to neurohormonal abnormalities and this has led to substantial therapeutic benefits for CHF. The aim of this review is to describe a number of the interactions between neurohormonal pathways and metabolic problems relevant in CHF. Besides the renin-angiotensin-aldosterone-system, steroid and thyroid hormones, growth factors, insulin and inflammatory cytokines (e.g. tumour necrosis factor-alpha [TNF-alpha]) are considered. TNF-alpha is potentially a key molecule with enormous interactive opportunities within a regulatory network of energy metabolism, immune function and neuroendocrine and hormonal function. The most dramatic metabolic problem in heart failure patients is the development of cardiac cachexia. Currently, no specific therapy exists and the prognosis is poor. There are promising approaches (counteracting TNF-alpha or applying anabolic growth factors) but these are not without risk and are expensive, and their application may, therefore, be limited to certain subgroups of patients. In the future, it will not be enough to monitor cardiac function and symptomatic status in heart failure patients. Rather, the patients' metabolic status may need to be taken, as well as an assessment of peak oxygen consumption, body composition and hormonal status.


Management of horses showing stereotypic behaviour, owner perception and the implications for welfare.
A telephone survey was conducted of 100 racing stables, 100 riding schools and 100 competition establishments (8,427 horses in total) to determine what management practices were being applied to horses showing stereotypic behaviour, and to determine the underlying reasons for them by assessing the perceptions and opinions of the people working with the horses. The results indicated that horse owners are concerned about stereotypic behaviour, first, because it reduces the performance of the animal (31, 30 and 27 per cent of the owners of racing stables, riding schools and competition establishments respectively), secondly, because it has adverse clinical effects on the horse (52, 55 and 56 per cent), and thirdly, because it reduces the monetary value of the animal (45, 59 and 31 per cent). The belief that these behaviours are learnt or copied also affects the management of affected horses: they are not allowed on to the premises by 4, 32 and 17 per cent of owners of racing stables, riding schools and competition establishments, respectively; attempts are made to remove the causal factors of the stereotypy by 35, 43 and 36 per cent; the behaviours are physically prevented by 77, 67 and 79 per cent, and the affected horses are kept separate from other horses by 39, 30 and 48 per cent.


New opportunity for enzymatic modification of fats and oils with industrial potentials.
Novozym 435 (Candida antarctica lipase)-catalyzed glycerolysis of commercial oils and fats to produce monoglycerides (MGs) was investigated using a tetraammonium-based ionic liquid (IL) as a reaction medium. A 90% yield of MGs and nearly 100% conversion of triglycerides in this ionic liquid were achieved, markedly higher than in normal solvents. The amphiphilic structure of cocosalkyl pentaethoxi methyl ammonium methosulfate (CPMA.MS) was suggested to be capable of creating a compatible system for glycerol, oils and fats, as well as inducing the shift of reaction equilibrium to the formation of MG. Interestingly, over a wide range of solvent dosage, the higher yields of MG were observed, indicating the good bulky substrate-tolerating capacity of the IL. The universal validity of the protocol was verified by being successfully applied to different commercial oils and fats. Excellent operational stability of the lipase and the reusability of IL were also observed in consecutive batchwise reactions. The results indicate that the protocol developed in this work provides a new environmentally benign "solution" to the enzymatic modification of fats and oils with industrial potentials.


Treatment and prevention of alveolar fractures and related injuries.
Dentoalveolar trauma does not pose a significant morbid risk for the trauma patient. However, the long-term consequences of mismanagement can be devastating. Early, correct diagnosis, and appropriate referral of these injuries can affect the success of treatment. Failure to recognize or obtain appropriate consultation can result in premature tooth or alveolar bone loss, resulting in problematic prosthetic rehabilitation. The purpose of this article is to review the concepts of recognition, management, and prevention of dentoalveolar trauma. In situations where the possibility of trauma is likely, such as in athletics, dentoalveolar and related fractures can be prevented through the use of mouthguards fabricated by health care professionals.


Application of digital radiography to implantology.
Modern digital radiographic techniques can aid the clinician in planning dental implant selection and placement before and during surgery, a well as in the long term assessment of periimplant bone support. Implant treatment planning can be facilitated using computed tomography on film-based motion tomography. During surgery, direct digital radiography allows the clinician to visualize the relationship of the osteotomy sit to important anatomic structures such as the mandibular nerve. Following placement, digital subtraction radiography permits detection of osseous changes too small to be seen by eye with an accuracy approaching 95%. Such sensitivity and specificity encourages early evaluation and, if necessary, intervention on behalf of the ailing implant.


Mycoplasma-induced arthritis in poultry.
Mycoplasmaa-induced arthritis of poultry under field conditions is almost entirely caused by Mycoplasm synoviae (Ms) infection. Experimentally, Mycoplasma synoviae, Mycoplasma gallisepticum, Mycoplasma meleagridis and Mycoplasma iowae have all been shown to cause arthritis, tenosynovitis and lesions of periarticular tissue. However, greatest attention has been given to Ms in this respect. The leg joints are most consistently involved, and of these particularly the tibiotarsal-tarsometatarsal and tarsometatarso-phalangeal joints. Acute amd chronic arthritis have been described, and in the later the arthritic lesions may be progressive. The histopathological changes include invasion with heterophils (polymorphs) and later monocytes. Villus formation is shown by the synovium, and lymphofollicular aggregates appear. In severe cases, there is progressive erosion of articular cartilage and there are degenerative changes in underlying bone. Systemic changes include anemia, reticulitis, arteritis, and atrophy of the thymus and bursa of Fabricius. The mechanism of disease production may involve a direct inflammatory response as well as immunoinflammatory complexes.


Blood lead level and kidney function in US adolescents: The Third National Health and Nutrition Examination Survey.
Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents. Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988-1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C-based and creatinine-based estimating equations, was examined. Median whole blood lead level was 1.5 microg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C-estimated GFR was 112.9 mL/min/1.73 m(2). Participants with lead levels in the highest quartile (> or =3.0 microg/dL) had 6.6 mL/min/1.73 m(2)-lower estimated GFR (95% confidence interval, -0.7 to -12.6 mL/min/1.73 m(2)) compared with those in the first quartile (<1 microg/dL). A doubling of blood lead level was associated with a 2.9 mL/min/1.73 m(2)-lower estimated GFR (95% confidence interval, -0.7 to -5.0 mL/min/1.73 m(2)). Lead levels were also associated with lower creatinine-based estimated GFR levels, but the association was weaker than with cystatin C-based GFR and not statistically significant. Higher blood lead levels in a range below the current Centers for Disease Control and Prevention-designated level of concern (10 microg/dL) were associated with lower estimated GFRs in a representative sample of US adolescents. This finding contributes to the increasing epidemiologic evidence indicating an adverse effect of low-level environmental lead exposure.


Critical sensitivity in hetero-modal interferometric sensor using spectral interrogation.
This paper reports on the finding of a critical working point in the sensitivity of hetero-modal interferometric optical sensors using spectral interrogation. At this point the theoretical sensitivity approaches infinity and the practical sensitivity will depend only on the measurement accuracy and noise sources present. If the critical condition is attained at a point of minimal power transfer, a phenomenon of splitting or bifurcation of the minimum dip is expected as sensing occurs. The conditions for attainment of these critical effects are discussed.


Direct Li+ incorporation during the anodic formation of compact TiO2 layers.
In this work, compact titanium oxide layers are formed by anodization in 1 M H3PO4 aqueous electrolyte containing LiClO4. Elastic Recoil Detection Analysis (ERDA) measurements demonstrate that incorporation of lithium ions occurs during anodization, and cell-voltage transient measurements evidence the different electronic properties of Li-doped TiO2 layers. The mechanism of direct incorporation of Li during the fabrication of TiO2 layers is discussed.


[Revising sanitary norms of microclimate in industrial accommodations].
The article outlines new edition of a project "Sanitary norms of microclimate in industrial compartments". Up-to-date scientific data, results of studies concerning human heat state in experimental and industrial conditions, evaluation of the workers' health state helped to modify optimal and allowable parameters of microclimate, to rectify requirements for measurement conditions and measuring devices. When the recommended temperature could not be maintained, the duration of work in such conditions should be limited for prevention of overheating and overcooling. To examine prophylactic measures against overheating, the authors suggested an integral characteristic of heating environmental load (TNS-index) and set its safe values.


Might Cu(II) binding, DNA cleavage and radical production by YadA fragments be involved in the promotion of F. nucleatum related cancers?
In many cases, human microbiota are associated with cancer progression. It was concluded that Fusobacterium nucleatum increases neoplastic changes. This bacterium is naturally present in human dental plaque. However, if it is present in the colon, it becomes a precursor of cancer. Antibiotic treatment of mice infected with F. nucleatum slowed tumor growth, which agrees with the fundamental role of bacteria in tumorigenesis. Remarkably, recent studies indicate that transition metal complexes with fragments of outer membrane proteins are able to promote reactive oxygen species (ROS) formation and are responsible for oxidative stress, which consequently leads to cell damage. Therefore, in this paper, the formation of copper(II) complexes with fragments of adhesin YadA from F. nucleatum is characterized. Moreover, the ability of the complexes to produce ROS has been shown. Importantly, free ligands are efficient DNA-cleaving agents.


Disease-specific assessment of Vision Impairment in Low Luminance in age-related macular degeneration - a MACUSTAR study report.
To further validate the Vision Impairment in Low Luminance (VILL) questionnaire, which captures visual functioning and vision-related quality of life (VRQoL) under low luminance, low-contrast conditions relevant to age-related macular degeneration (AMD). The VILL was translated from German into English (UK), Danish, Dutch, French, Italian and Portuguese. Rasch analysis was used to assess psychometric characteristics of 716 participants (65% female, mean age 72±7 years, 82% intermediate AMD) from the baseline visit of the MACUSTAR study. In a subset of participants (n=301), test-retest reliability (intraclass correlation coefficient (ICC) and coefficient of repeatability (CoR)) and construct validity were assessed. Four items were removed from the VILL with 37 items due to misfit. The resulting Vision Impairment in Low Luminance with 33 items (VILL-33) has three subscales with no disordered thresholds and no misfitting items. No differential item functioning and no multidimensionality were observed. Person reliability and person separation index were 0.91 and 3.27 for the Vision Impairment in Low Luminance Reading Subscale (VILL-R), 0.87 and 2.58 for the Vision Impairment in Low Luminance Mobility Subscale (VILL-M), and 0.78 and 1.90 for the Vision Impairment in Low Luminance Emotional Subscale (VILL-E). ICC and CoR were 0.92 and 1.9 for VILL-R, 0.93 and 1.8 for VILL-M and 0.82 and 5.0 for VILL-E. Reported VRQoL decreased with advanced AMD stage (p<0.0001) and was lower in the intermediate AMD group than in the no AMD group (p≤0.0053). The VILL is a psychometrically sound patient-reported outcome instrument, and the results further support its reliability and validity across all AMD stages. We recommend the shortened version of the questionnaire with three subscales (VILL-33) for future use. NCT03349801.


Mechanical loosening of total hip prostheses. A radiographic and roentgen stereophotogrammetric study.
Twenty patients were examined by standard radiography and roentgen stereophotogrammetric analysis (RSA) during a two-year period after total hip arthroplasty. Eleven of the acetabular components migrated cranially and three femoral components migrated distally. This migration was most rapid during the first four months after operation. Our findings support the possibility that mechanical loosening is initiated by thermal injury during polymerisation of the cement; the less frequent migration of the metallic femoral component compared with the polyethylene acetabular component may be because the metal acts as a heat sink. Standard radiographs were inadequate for assessment of early mechanical loosening, whereas RSA could reveal migration within four months of the arthroplasty.


Definition of a Novel Feed-Forward Mechanism for Glycolysis-HIF1α Signaling in Hypoxic Tumors Highlights Aldolase A as a Therapeutic Target.
The hypoxia-inducible transcription factor HIF1α drives expression of many glycolytic enzymes. Here, we show that hypoxic glycolysis, in turn, increases HIF1α transcriptional activity and stimulates tumor growth, revealing a novel feed-forward mechanism of glycolysis-HIF1α signaling. Negative regulation of HIF1α by AMPK1 is bypassed in hypoxic cells, due to ATP elevation by increased glycolysis, thereby preventing phosphorylation and inactivation of the HIF1α transcriptional coactivator p300. Notably, of the HIF1α-activated glycolytic enzymes we evaluated by gene silencing, aldolase A (ALDOA) blockade produced the most robust decrease in glycolysis, HIF-1 activity, and cancer cell proliferation. Furthermore, either RNAi-mediated silencing of ALDOA or systemic treatment with a specific small-molecule inhibitor of aldolase A was sufficient to increase overall survival in a xenograft model of metastatic breast cancer. In establishing a novel glycolysis-HIF-1α feed-forward mechanism in hypoxic tumor cells, our results also provide a preclinical rationale to develop aldolase A inhibitors as a generalized strategy to treat intractable hypoxic cancer cells found widely in most solid tumors. Cancer Res; 76(14); 4259-69. ©2016 AACR.


Cytogenetic variability in several oil seed rape cultivars.
Meiotic study was performed in 23 oil seed rape (Brassica napus) cultivars considering chiasma frequency and distribution as well as chromosomes pairing. All cultivars possessed n = 19 chromosome number (4x). Chromosome stickiness occurred in most of the cultivars from early prophase to late telophase-II leading to the formation of laggard chromosomes and micronuclei. The cultivars studied differed significantly in chiasma frequency and distribution as well as chromosomes association indicating their genomic differences. Cluster analysis and ordination based on principal components analysis grouped those cultivars showing meiotic similarities. Some of the cultivars showed the occurrence of B-chromosomes which significantly changed chiasma frequency and chromosome pairing in the cells possessing them. Unreduced meiocytes and pollen grains were observed in some of the cultivars due to cytomixis, anaphase failure and desynapsis.


Statins and renal disease progression, ophthalmic manifestations, and neurological manifestations in veterans with diabetes: A retrospective cohort study.
Statins increase insulin resistance, which may increase risk of diabetic microvascular complications. Little is known about the impact of statins on renal, ophthalmologic, and neurologic complications of diabetes in practice. The objective of this study was to examine the association of statins with renal disease progression, ophthalmic manifestations, and neurological manifestations in diabetes. This is a retrospective cohort study, new-user active comparator design, that included a national Veterans Health Administration (VA) patients with diabetes from 2003 to 2015. Patients were age 30 years or older and were regular users of the VA with data encompassing clinical encounters, demographics, vital signs, laboratory tests, and medications. Patients were divided into statin users or nonusers (active comparators). Statin users initiated statins and nonusers initiated H2-blockers or proton pump-inhibitors (H2-PPI) as an active comparator. Study outcomes were: 1) Composite renal disease progression outcome; 2) Incident diabetes with ophthalmic manifestations; and 3) Incident diabetes with neurological manifestations. Out of 705,774 eligible patients, we propensity score matched 81,146 pairs of statin users and active comparators. Over a mean (standard deviation) of follow up duration of 4.8 (3) years, renal disease progression occurred in 9.5% of statin users vs 8.3% of nonusers (odds ratio [OR]: 1.16; 95% confidence interval [95%CI]: 1.12-1.20), incident ophthalmic manifestations in 2.7% of statin users vs 2.0% of nonusers (OR: 1.35, 95%CI:1.27-1.44), and incident neurological manifestations in 6.7% of statin users vs 5.7% of nonusers (OR: 1.19, 95%CI:1.15-1.25). Secondary, sensitivity, and post-hoc analyses were consistent and demonstrated highest risks among the healthier subgroup and those with intensive lowering of LDL-cholesterol. Statin use in patients with diabetes was associated with modestly higher risk of renal disease progression, incident ophthalmic, and neurological manifestations. More research is needed to assess the overall harm/benefit balance for statins in the lower risk populations with diabetes and those who receive intensive statin therapy.


[The pathogenesis factors of intraoperative hemolysis in cardiac surgery].
As shown in various studies, hemolysis is revealed in all extracorporeal circuits showing the increasing levels of plasma-free hemoglobin (PfHb) during and after cardiopulmonary bypass (CPB). The pathogenesis factors and mechanisms of intraoperative hemolysis are observed in this article. The role of mechanical blood trauma, oxygen free radical generation, activation of complement, preoperative defects erythrocytes, infusion preparations and other medicaments in postperfusion hemolysis are discussed. Along with the complete red blood cell (RBC) destruction (hemolysis), RBCs can also be damaged on a sublethal level, resulting in altered rheological properties, decreased microcirculation and organ dysfunction caused by hypoxia. The severity of the consequences of RBC damage, the high incidence of this complication and the lack of interventional strategies in cases of suspected or confirmed RBC damage are considered, there may be a need for a treatment algorithm for this phenomenon.


The incidence of ophthalmologic interventions in children with birth weights less than 1251 grams. Results through 5 1/2 years. Cryotherapy for Retinopathy of Prematurity Cooperative Group.
This study aimed to report the frequency of ophthalmologic surgical and medical therapies provided to children with birth weights less than 1251 g who had all stages of retinopathy of prematurity (ROP). In addition, this study aimed to report the initial age at which such procedures are provided and to report the frequency of cerebrospinal fluid shunts. Observational case series with prospective data collection. Children from the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) with birth weights less than 1251 g served as subjects. Group A included 257 children from all 23 CRYO-ROP study centers who had threshold ROP, who had participated in the randomized trial of cryotherapy, and who had survived to age 1 year. Group B included 1208 children from 5 of the 23 study centers who had varying severity of ROP (69 had threshold ROP) and who had participated in a 5 1/2-year study of the natural history of ROP. Investigators documented medical and surgical ophthalmologic interventions through age 5 1/2 years as well as cerebrospinal fluid shunting surgery for hydrocephalus through age 2 years. Group A was composed of 257 children with threshold ROP who underwent 226 ocular interventions in addition to cryotherapy (0.9 intervention per child). The most common treatments performed on the randomized cohort of children were vitrectomy (26% of patients), lensectomy (18%), amblyopia therapy (20%), and strabismus surgery (10%). Cataract surgery not associated with vitrectomy was performed infrequently (2%) and was performed equally often in treated and control eyes. Amblyopia therapy was prescribed as often for treated as for control eyes. Cerebrospinal fluid shunts were placed in 11% of these children. Group B was composed of 1208 natural history patients who underwent 239 ophthalmologic interventions (0.4 intervention per child). Strabismus surgery was the most commonly performed procedure for the natural history cohort of children (6% of the children). Amblyopia therapy was prescribed for 7% of the natural history patients. Cerebrospinal fluid shunts were required by 3% of the natural history infants, more often in children with more severe ROP. These premature infants underwent a large number of ophthalmologic treatments during the first 5 1/2 years of life. The long-term costs of both extreme prematurity and ROP include not only the initial ablative therapy for ROP and societal loss due to blindness that still occurs in some cases, but also the ongoing costs of caring for eye problems.


Mueller matrix approach for determination of optical rotation in chiral turbid media in backscattering geometry.
For in vivo determination of optically active (chiral) substances in turbid media, like for example glucose in human tissue, the backscattering geometry is particularly convenient. However, recent polarimetric measurements performed in the backscattering geometry have shown that, in this geometry, the relatively small rotation of the polarization vector arising due to the optical activity of the medium is totally swamped by the much larger changes in the orientation angle of the polarization vector due to scattering. We show that the change in the orientation angle of the polarization vector arises due to the combined effect of linear diattenuation and linear retardance of light scattered at large angles and can be decoupled from the pure optical rotation component using polar decomposition of Mueller matrix. For this purpose, the method developed earlier for polar decomposition of Mueller matrix was extended to incorporate optical rotation in the medium. The validity of this approach for accurate determination of the degree of optical rotation using the Mueller matrix measured from the medium in both forward and backscattering geometry was tested by conducting studies on chiral turbid samples prepared using known concentration of scatterers and glucose molecules.


Individual response to mTOR inhibition in delaying replicative senescence of mesenchymal stromal cells.
Delaying replicative senescence and extending lifespan of human mesenchymal stromal cells (MSCs) may enhance their potential for tissue engineering and cell based therapies. Accumulating evidence suggests that inhibitors of the mTOR signaling pathway, such as rapamycin, constitute promising pharmacological agents to retard senescence and extend stemness properties of various progenitor cell types. Here, we investigated whether the ability of rapamycin to postpone replicative senescence varies among bone marrow MSC samples (BM-MSCs) derived from different healthy donors, and explored the molecular mechanisms that drive rapamycin-mediated lifespan increment. BM-MSCs at early passages were serially passaged either in absence or continuous presence of rapamycin and the number of cell population doublings until growth arrest was measured. The inhibition of mTOR signaling was assessed by the phosphorylation status of the downstream target RPS6. The expression levels of several senescence and pluripotency markers at early and late/senescent passages were analyzed by RT-qPCR, flow cytometry and western blot. We found that the lifespan extension in response to the continuous rapamycin treatment was highly variable among samples, but effective in most BM-MSCs. Despite all rapamycin-treated cells secreted significantly reduced levels of IL6, a major SASP cytokine, and expressed significantly higher levels of the pluripotency marker NANOG, the expression patterns of these markers were not correlated with the rapamycin-mediated increase in lifespan. Interestingly, rapamycin-mediated life-span extension was significantly associated only with repression of p16INK4A protein accumulation. Taken together, our results suggest that some, but not all, BM-MSC samples would benefit from using rapamycin to postpone replicative arrest and reinforce a critical role of p16INK4A protein downregulation in this process.


[Is migraine a progressive cerebral disease?].
Migraine is a primary neurovascular headache which affects approximately 12% of the adult population. Migraine particularly affects women of working age and is associated with significant disability and reduced quality of life. During migraine attacks, the capacity to engage in daily activities such as child care, work, and social activities is reduced, and relationships with family members and friends become strained. In this respect, migraine places a heavy economic burden on both the individual and society. It is also known migraine is a risk factor for ischemic stroke in young women with migraine with aura. Recently, it was reported that some individuals that experience migraine with and without aura may be at an increased risk for subclinical lesions in certain areas of the brain. Cerebral white matter lesions (WMLs) are a common finding on cerebral MRI scans. Although, it appears that cerebral WMLs are more common in migraineurs than in the general population, the nature, association and the clinical significance of cerebral WMLs in migraineurs are not yet conclusive. Furthermore, there is no good evidence to support the notion that cerebral WMLs in migraineurs can predict subclinical or clinical stroke in these individuals. Needless to say, the need for more longitudinal and prospective migraine research is immense. The aim of the future migraine research should be to obtain more information about the natural course of migraine as well as evaluate the association between migraine and cerebral WMLs and their consequences. In addition, continuing genetic identification of key proteins involved in migraine will improve our understanding of this common and sometimes most debilitating disorder, which can strike during the most productive years of a person's life.


Detecting Screen Presence with Activity-Oriented RGB Camera in Egocentric Videos.
Screen time is associated with several health risk behaviors including mindless eating, sedentary behavior, and decreased academic performance. Screen time behavior is traditionally assessed with self-report measures, which are known to be burdensome, inaccurate, and imprecise. Recent methods to automatically detect screen time are geared more towards detecting television screens from wearable cameras that record high-resolution video. Activity-oriented wearable cameras (i.e., cameras oriented towards the wearer with a fisheye lens) have recently been designed and shown to reduce privacy concerns, yet pose a greater challenge in capturing screens due to their orientation and fewer pixels on target. Methods that detect screens from low-power, low-resolution wearable camera video are needed given the increased adoption of such devices in longitudinal studies. We propose a method that leverages deep learning algorithms and lower-resolution images from an activity-oriented camera to detect screen presence from multiple types of screens with high variability of pixel on target (e.g., near and far TV, smartphones, laptops, and tablets). We test our system in a real-world study comprising 10 individuals, 80 hours of data, and 1.2 million low-resolution RGB frames. Our results outperform existing state-of-the-art video screen detection methods yielding an F1-score of 81%. This paper demonstrates the potential for detecting screen-watching behavior in longitudinal studies using activity-oriented cameras, paving the way for a nuanced understanding of screen time's relationship with health risk behaviors.


Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting.
Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PREdicting bleeding Complications in patients undergoing stent Implantation and SubsequEnt Dual AntiPlatelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: -3.86%; 95% confidence interval: -7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: -1.14%; 95% confidence interval: -2.26 to -0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT.


In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported cardiovascular composite outcomes and survival?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In low-risk patients aged >70-75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported composite outcomes and survival? More than 73 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The only low-risk randomized control trial to date [Nordic Aortic Valve Intervention (NOTION)] regarding an elderly population did not show a statistically significant difference between the 2 approaches regarding the composite endpoint of death, stroke or myocardial infarction. A subgroup analysis of elderly patients in the 2 main low-risk randomized control trials did not yield statistically different results from those of the overall population; the results indicated the superiority of transcatheter aortic valve implantation regarding the composite of death, stroke or rehospitalization at 1 year [The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis (PARTNER 3)] and non-inferiority regarding a composite of death or stroke at 2 years [Medtronic Evolut Transcatheter Aortic Valve Replacement in Low-Risk Patients (Evolut LR)]. The results from lower evidence studies are largely consistent with these findings. Overall, there is no compelling evidence indicating that older age should be an isolated criterion for the choice between transcatheter aortic valve replacement and surgical aortic valve replacement in otherwise low-risk patients. The superiority of either technique regarding the aforementioned composite short-term outcomes in this particular subgroup of patients is unclear.


Prevalence of uveitis in an outpatient juvenile arthritis clinic: onset of uveitis more than a decade after onset of arthritis.
To determine the prevalence and severity of uveitis in an outpatient pediatric arthritis clinic in the midwestern United States during the 1990s. The prevalence and clinical characteristics of uveitis were studied retrospectively for all children diagnosed with arthritis at Shriner's Hospital for Crippled Children and followed by the pediatric rheumatology and ophthalmology units of the St Louis Children's Hospital between 1992 and 1995. Seven children (9%) developed uveitis in a population of 78 patients with juvenile arthritis. Six of the seven children were female, and all six females had anti-nuclear antibody (ANA)-positive, juvenile rheumatoid arthritis (JRA). The prevalence of anterior uveitis in females with ANA-positive, pauciarticular JRA was 20%, and in polyarticular JRA, 17%. One of the girls with uveitis had combined JRA and sarcoidosis; the boy with uveitis had juvenile spondylitis. Arthritis preceded the onset of uveitis in each child by 1 to 13 years (average, 6.4 years). Progression of the uveitis in three of the children resulted in band keratopathy and cataract, causing significant visual loss in two (i.e., in 29% of the children who developed uveitis). The prevalence and ocular morbidity of uveitis in juvenile arthritis appears to have remained relatively stable over the last 2 decades. Onset of the uveitis in several of the children in our study population occurred more than a decade after the diagnosis of arthritis. Girls with ANA-positive JRA and boys with juvenile spondylitis may need to be followed by periodic slit-lamp examination for longer periods than recommended previously.


Mechanisms of IL-12 synthesis by human dendritic cells treated with the chemical sensitizer NiSO4.
Allergic contact dermatitis, caused by metallic ions, is a T cell-mediated inflammatory skin disease. IL-12 is a 70-kDa heterodimeric protein composed of IL-12p40 and IL-12p35, playing a major role in the generation of allergen-specific T cell responses. Dendritic cells (DCs) are APCs involved in the induction of primary immune responses, as they possess the ability to stimulate naive T cells. In this study, we address the question whether the sensitizer nickel sulfate (NiSO(4)) itself or in synergy with other signals can induce the secretion of IL-12p70 in human monocyte-derived DCs (Mo-DCs). We found that IL-12p40 was produced by Mo-DC in response to NiSO(4) stimulation. Addition of IFN-gamma concomitantly to NiSO(4) leads to IL-12p70 synthesis. NiSO(4) treatment leads to the activation of MAPK, NF-kappaB pathways, and IFN regulatory factor 1 (IRF-1). We investigated the role of these signaling pathways in IL-12 production using known pharmacological inhibitors of MAPK and NF-kappaB pathways and RNA interference-mediated silencing of IRF-1. Our results showed that p38 MAPK, NF-kappaB, and IRF-1 were involved in IL-12p40 production induced by NiSO(4). Moreover, IRF-1 silencing nearly totally abrogated IL-12p40 and IL-12p70 production provoked by NiSO(4) and IFN-gamma. In response to NiSO(4), we observed that STAT-1 was phosphorylated on both serine and tyrosine residues and participated to NiSO(4)-induced IRF-1 activation. N-acetylcysteine abolished STAT-1 phosphorylation, suggesting that STAT-1 activation may be dependent on NiSO(4)-induced alteration of the redox status of the cell. These results indicate that p38 MAPK, NF-kappaB, and IRF-1 are activated by NiSO(4) in Mo-DC and cooperate for IL-12 production.


Arriving at correct conclusions: the importance of association, causality, and clinical significance.
Declaring that a causal and not solely a correlative relation exists between a risk factor and a disease creates significant implications for patients and physicians. No matter the forum, when investigators or clinicians make such a claim, it is essential to explain how this determination was made so that appropriate recommendations are made in all areas of our professional practice. When we review the medical literature it is similarly crucial to understand this distinction between causality and association. The Bradford Hill criteria of strength of association, consistency, temporality, biological gradient, biological plausibility, coherence, experimental evidence, and analogy can be used to help establish causality. It is also important to understand the distinction between clinical and statistical significance to complete our appraisal of the implications of a clinical study. Statistically significant results, although not the result of chance, may be clinically insignificant. Statistically insignificant results, conversely, may not exclude the possibility of a clinically important relation. This article reviews the concepts of causality and association and clinical versus statistical significance and provides examples from the literature.


Deep learning for AI-based diagnosis of skin-related neglected tropical diseases: A pilot study.
Deep learning, which is a part of a broader concept of artificial intelligence (AI) and/or machine learning has achieved remarkable success in vision tasks. While there is growing interest in the use of this technology in diagnostic support for skin-related neglected tropical diseases (skin NTDs), there have been limited studies in this area and fewer focused on dark skin. In this study, we aimed to develop deep learning based AI models with clinical images we collected for five skin NTDs, namely, Buruli ulcer, leprosy, mycetoma, scabies, and yaws, to understand how diagnostic accuracy can or cannot be improved using different models and training patterns. This study used photographs collected prospectively in Côte d'Ivoire and Ghana through our ongoing studies with use of digital health tools for clinical data documentation and for teledermatology. Our dataset included a total of 1,709 images from 506 patients. Two convolutional neural networks, ResNet-50 and VGG-16 models were adopted to examine the performance of different deep learning architectures and validate their feasibility in diagnosis of the targeted skin NTDs. The two models were able to correctly predict over 70% of the diagnoses, and there was a consistent performance improvement with more training samples. The ResNet-50 model performed better than the VGG-16 model. A model trained with PCR confirmed cases of Buruli ulcer yielded 1-3% increase in prediction accuracy across all diseases, except, for mycetoma, over a model which training sets included unconfirmed cases. Our approach was to have the deep learning model distinguish between multiple pathologies simultaneously-which is close to real-world practice. The more images used for training, the more accurate the diagnosis became. The percentages of correct diagnosis increased with PCR-positive cases of Buruli ulcer. This demonstrated that it may be better to input images from the more accurately diagnosed cases in the training models also for achieving better accuracy in the generated AI models. However, the increase was marginal which may be an indication that the accuracy of clinical diagnosis alone is reliable to an extent for Buruli ulcer. Diagnostic tests also have their flaws, and they are not always reliable. One hope for AI is that it will objectively resolve this gap between diagnostic tests and clinical diagnoses with the addition of another tool. While there are still challenges to be overcome, there is a potential for AI to address the unmet needs where access to medical care is limited, like for those affected by skin NTDs.


Splicing to Keep Cycling: The Importance of Pre-mRNA Splicing during the Cell Cycle.
Pre-mRNA splicing is a fundamental process in mammalian gene expression, and alternative splicing plays an extensive role in generating protein diversity. Because the majority of genes undergo pre-mRNA splicing, most cellular processes depend on proper spliceosome function. We focus on the cell cycle and describe its dependence on pre-mRNA splicing and accurate alternative splicing. We outline the key cell-cycle factors and their known alternative splicing isoforms. We discuss different levels of pre-mRNA splicing regulation such as post-translational modifications and changes in the expression of splicing factors. We describe the effect of chromatin dynamics on pre-mRNA splicing during the cell cycle. In addition, we focus on spliceosome component SF3B1, which is mutated in many types of cancer, and describe the link between SF3B1 and its inhibitors and the cell cycle.


The Lived Experience of Siblings of Children With Cancer Who Attended a Peer Support Camp in the United States.
Childhood cancer has a profound and negative impact on siblings, yet there are limited studies exploring lived experiences from their perspective. This qualitative study examined the perceptions and experiences of siblings of children with cancer who attended a peer support camp. Semi-structured interviews were conducted three to six weeks after the weeklong peer support camp with a stratified random sample of 10 siblings (six non-bereaved and four bereaved) ages 8 to 16 years. The qualitative data were analyzed using conventional content analysis and an inductive data-driven approach. Four themes emerged: social connection (subthemes: support/feeling of belonging, mentorship, and expressing feelings), personal growth, identity, and freedom to have fun and relax. These findings add to the scant body of research by providing enhanced understanding of the siblings' experiences and new insights into their perceptions of meaning and outcomes associated with participation in a peer support camp. These findings have implications for peer support camp programs and the well-being of siblings of children with cancer.


A three-year experience with medial-pedicle-based breast reduction for different mammary hypertrophy.
The aim of breast reduction is to reduce excessive breast volume, ensuring an adequate vascular supply and sensitivity of the nipple-areola complex, as well as to produce an aesthetically pleasing final shape. The authors report on their experience with medial-pedicle-based breast reduction combined with both vertical and inverted-T skin resection patterns for different types of breast hypertrophy. From January 2012 to June 2015, 27 female patients (mean age: 49 years) underwent reduction mammoplasty with the medial pedicle technique. The choices of medial pedicle base widths were: 6 cm for low-grade mammary hypertrophy (350-500 gr per breast), 6-8 cm for medium-grade hypertrophy (500-1000 gr per breast), or 8-10 cm for severe mammary hypertrophy (>1000 gr per breast). The authors chose the model of vertical skin resection for low-grade breast hypertrophy. The vertical model was used for medium-grade breast hypertrophy, and Wise skin resection was chosen on a case-by-case basis; only the Wise model was applied to severe breast hypertrophy. Results: The mean weight of breast excised was 540 g on the left (range, 207 to 1160 g) and 564.8 g on the right (range, 215 to 1150 g). The complications were minor and self-limiting. All patients reported relief of neck pain, back pain, and bra strap indentations after 6 months of follow-up. Breast reduction surgery must address both functional and aesthetic issue by restoring an aesthetically pleasing shape to ptotic or hypertrophic breasts, repositioning the NAC in a physiological position. Various breast reduction techniques have been attempted to combine the safety of the pedicle with aesthetic and functional results. Surgeons should tailor the best technique to each patient. We found that medial-pedicle-based reduction mammoplasty is effective and reliable because it can be applied to a wide range of breast hypertrophy, with reproducible breast weight reduction and results that are aesthetically satisfactory for both patients and surgeons.


Identification of 3 beta-hydroxy-5,7-pregnadien-20-one and 3 beta-hydroxy-5,7-androstadien-17-one as endogenous steroids in the fetal horse gonad.
The 5,7-dienes, 3 beta-hydroxy-5,7-pregnadien-20-one and 3 beta-hydroxy-5,7-androstadien-17-one were extracted from fetal horse gonads and purified by solvent partition, thin-layer chromatography and high performance liquid chromatography. The isolated steroids were identified by comparison with the synthetic steroids using ultraviolet and mass spectroscopy and by gas chromatography-mass spectroscopy. The identification of these compounds as endogenous steroids, together with the data on their biosynthesis reported previously, support the proposal that in the fetal horse gonad there is a 5,7-diene pathway biosynthesizing 3 beta-hydroxy-5,7-androstadien-17-one, which is the proposed precursor for equilin in the placenta.


Diaqua-(2,9-dimethyl-1,10-phenanthroline-κN,N')(4-hydroxy-benzoato-κO,O')cobalt(II) nitrate dihydrate.
In the title compound, [Co(C(7)H(5)O(3))(C(14)H(12)N(2))(H(2)O)(2)]NO(3)·2H(2)O, the Co(II) ion is six-coordinated by two N atoms of a 2,9-dimethyl-1,10-phenanthroline (dmphen) ligand, two carboxyl-ate O atoms of one 4-hydroxy-benzoate anion and two O atoms of two water mol-ecules, in a distorted octa-hedral environment; the two water mol-ecules occupy the apical positions. In the crystal structure, the ionic units and water mol-ecules are linked through O-H⋯O hydrogen bonds, leading to the formation of a three-dimensional network. In addition, π-π inter-actions between a pyridine ring of the dmphen ligand and the benzene ring of the hydroxy-benzoate anion [centroid-centroid separation = 3.6861 (3) Å] are observed.


Utilization of Educational Videos to Improve Communication and Discharge Instructions.
When discharging a patient from the emergency department (ED), it is crucial to make sure that they understand their disposition and aftercare instructions. However, numerous factors make it difficult to ensure that patients understand their next steps. Our objective was to determine whether patient understanding of ED discharge and aftercare instructions could be improved through instructional videos in addition to standard written discharge instructions. This was a prospective pre- and post-intervention study conducted at a single-center, academic tertiary care ED. Patients presenting with the five selective chief complaints (closed head injury, vaginal bleeding, laceration care, splint care, and upper respiratory infection) were given questionnaires after their discharge instructions to test comprehension. Once video discharge instructions were implemented, patients received standard discharge instructions in addition to video discharge instructions and were given the same questionnaire. A total of 120 patients were enrolled in each group. There were significantly better survey scores after video discharge instructions (VDI) vs standard discharge instructions (SDI) for the closed head injury (27% SDI vs 46% VDI, P = 0.003); upper respiratory infection (28% SDI vs 64% VDI; P < 0.0001); and vaginal bleeding in early pregnancy groups (20% SDI vs 60% VDI, P < 0.0001). There were no significant differences in survey scores between the splint care (53% SDI vs 66% VDI; P = 0.08) and suture care groups (29% SDI vs 31% VDI; P = 0.40). Video discharge instructions supplementing standard written instructions can help improve patient comprehension and information retention. This better understanding of aftercare instructions is essential to patient follow-up and has been shown to improve patient outcomes.


Broad inhibition of plasmodium falciparum cytoadherence by (+)-epigallocatechin gallate.
The surface antigen PfEMP-1 is a key virulence factor of the human malaria parasite implicated in the cytoadherence of Plasmodium falciparum infected erythrocytes to a range of receptors on host endothelium. Among these host receptors, binding to ICAM-1 is related to cerebral malaria. The majority of the mortality in children with cerebral malaria is seen within 24 h of hospital admission despite the use of effective anti-parasite drugs, therefore, the development of adjunctive therapies is urgently needed.The polyphenolic compound (+)-epigallocatechin gallate ((+)-EGCG) has been previously evaluated for anti-adhesive properties using a small number of laboratory parasite isolates. Here, this property is further explored using a new panel of ICAM-1-binding patient isolates of P. falciparum to ascertain if (+)-EGCG might be effective as a broad spectrum inhibitor of ICAM-1-based cytoadherence. Plasmodium falciparum lines, including A4 and ItG as positive controls and nine new ICAM-1 binding patient isolates, were allowed to bind with ICAM-1-Fc protein under static assay conditions in the presence and absence of 50 μM (+)-EGCG. Adhesion levels of all the parasite strains were quantified by microscopy as the mean number of infected erythrocyte (IE) bound per mm(2) of surface area and statistical comparisons were made to demonstrate the effect of (+)-EGCG on the binding of various parasite variants to human ICAM-1. This study revealed that binding of patient isolates to ICAM-1 was reduced significantly with inhibition levels of 37% in patient isolate BC-12 up to a maximum of 80% in patient isolate 8146 at 50 μM (+)-EGCG. Evaluation of the anti-adhesive property of (+)-EGCG against a new panel of ICAM-1-binding patient isolates of P. falciparum showed that this inhibitor, identified as potential mimic of the L43 loop of human ICAM-1, was effective at blocking cytoadherence.