Clinical outcomes of children with acute abdominal pain.
To determine the prevalence, associated symptoms, and clinical outcomes of children presenting for a nonscheduled visit with acute abdominal pain. Historical cohort. Inner-city teaching hospital. A total of 1141 consecutive children, ages 2 to 12, presenting for a nonscheduled visit (clinic or emergency department) with a complaint of nontraumatic abdominal pain of < or = 3 days' duration were identified through a manual chart review. Collected data included: 1) demographic characteristics, 2) presenting signs and symptoms, 3) records from the hospital record for all children who returned within 10 days for follow-up, 4) test results, and 5) telephone follow-up. A clinical reviewer used the data to assign a final diagnosis to each patient. The prevalence of children presenting with abdominal pain of < or = 3 days' duration was 5.1%. The most common associated symptoms were history of fever (64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache (29.5%), and sore throat (27.0%). The six most prevalent final diagnoses, accounting for 84% of all final diagnoses, were upper respiratory infection and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute febrile illness (7.8%). Approximately 1% of children required surgical intervention (10/12 for appendicitis). Approximately 7% of children returned within 10 days for reevaluation of their illness; on return, 11 had treatable medical diseases and 4 had diseases requiring surgical intervention. An acute complaint of abdominal pain in children occurs in 5.1% of nonscheduled visits, is frequently accompanied by multiple complaints, and is usually attributed to a self-limited disease. Close follow-up will identify the 1% to 2% who proceed to have a more serious disease process. This epidemiologic data will aid clinic-based physicians who manage children with acute abdominal pain.


Depression and quality of life among heart failure patients in Georgia, Eastern Europe.
The goal of the study was to assess longitudinal changes in quality of life among patients who screened positive for depression and patients who did not enroll in an outpatient heart failure disease management program (HFDMP). Patients with an ejection fraction ≤40% and clinical signs and symptoms of heart failure were enrolled over 11 months from August 2007 to July 2008. Study participants (n=314) were divided at baseline into "depressed" (9-Question Patient Health Questionnaire [PHQ-9] ≥10) and "nondepressed" (PHQ-9 <10) groups. The two cohort groups had quality of life assessed by the Minnesota Living With Heart Failure Questionnaire at baseline and at 1 year while enrolled in the HFDMP. Both groups showed improved quality of life scores, with the depressed group experiencing a greater mean score decrease (14.4 vs 10.8 for nondepressed patients; P<.01). Both patients who screened positive for depression and those who did not enroll in an HFDMP improved their quality of life scores, with depressed patients experiencing a statistically significant greater mean score reduction (better quality of life).


Radiological evaluation of patients with pituitary langerhans cell histiocytosis at diagnosis and at follow-up.
This study evaluated pituitary imaging findings in 13 patients with Langerhans cell histiocytosis (LCH) with diabetes insipidus. Nine patients were evaluated with pituitary magnetic resonance imaging (MRI), 3 with brain computed tomography, and 1 with brain MRI. The infundibulum was thickened in 11 (84.6%) patients, thread-like in 1 (7.7%), and normal in 1 (7.7%). Posterior pituitary intensity was absent in 10 patients (76.9%); in 4 patients, the pituitary gland was small in size, and 2 patients had atrophic pituitary. Three had a small sella. Infundibular thickening and absence of posterior pituitary intensity were the most common radiological findings. MRI imaging should be used to follow up patients with pituitary histiocytosis, and patients with LCH and diabetes insipidus should be followed for pituitary atrophy.


[Survey on tobacco sales in newly registered insurance pharmacies and pharmacies in convenience stores in Japan].
Objectives Pharmacies and pharmacists play an important role in health promotion by supporting citizens' attempts to quit smoking. Nevertheless, some pharmacies sell tobacco themselves. Therefore, we conducted a survey on tobacco sales in pharmacies to investigate regional differences and methods of sale.Methods As a nationwide survey, we merged the Japanese Local Finance Bureau's 2018 list of enterprisers permitted to sell tobacco with the Japanese Regional Bureau of Health and Welfare's list of insurance pharmacies to calculate the number and proportion of new insurance pharmacies that permit tobacco sales. Additionally, we counted the number and proportion of pharmacies in convenience stores selling tobacco based on the data on their websites and the aforementioned insurance pharmacy list. To provide a survey of existing pharmacies, we confirmed the tobacco selling status, presence of smoking space, presence of anti-passive smoking measures, and the coexistence of drugstores or convenience stores among insurance pharmacies in City A (an urban area in Osaka Prefecture) and City B (a rural area in Ishikawa Prefecture). These data were obtained through site visits from December 2018 to February 2019.Results Among 1,766 new insurance pharmacies in Japan, 124 (7.0%) were newly permitted to sell tobacco. Many insurance pharmacies in Kanto (71 of 602 new insurance pharmacies; 11.8%) and Tohoku (9 of 110; 8.2%) sold tobacco, while such pharmacies were rare in Shikoku (0 of 64; 0.0%) and Kyushu (1 of 211; 0.5%). Out of the total of 42 pharmacies in convenience stores in Japan, 34 (81%) of them sold tobacco, specifically in urban areas. To provide an existing insurance pharmacy survey, 1 of 28 pharmacies (4%) in City A and 3 of 29 (10%) in City B sold tobacco. All 4 pharmacies sold tobacco at their checkout counters and were located in drugstores. Three of the pharmacies (one in City A and two in City B) had smoking spaces outside, without offering any preventive measure for passive smoking.Conclusion Many insurance pharmacies sell tobacco in Japan. To encourage pharmacists to support smoking cessation, we need to reach consensus regarding tobacco sales in insurance pharmacies through discussions.


First-order kinetics of muscle oxygen consumption, and an equivalent proportionality between QO2 and phosphorylcreatine level. Implications for the control of respiration.
In frog sartorius muscle, after a tetanus at 20 degrees C, during which an impulse-like increase occurs in the rate of ATP hydrolysis, the rate of O2 consumption (QO2) reaches a peak relatively quickly and then declines monoexponentially, with a time constant not dependent on the tetanus duration (tau = 2.6 min in Rana pipiens and 2.1 min in Rana temporaria). To a good approximation, these kinetics are those of a first-order impulse response, and the scheme of reactions that couple O2 consumption to extramitochondrial ATP hydrolysis thus behaves as a first-order system. It is first deduced and then demonstrated directly that while QO2(t) is monoexponential, it changes in parallel with the levels of creatine and phosphorylcreatine, with proportionality constants +/- 1/tau p, where p is the P/O2 ratio in vivo. From this, it is further deduced that the mitochondrial creatine kinase (CK) reaction is pseudo-first order in vivo. The relationship between [creatine] and QO2 predicted by published models of the control of respiration is markedly different from that actually observed. As shown here, the first-order kinetics of QO2 are consistent with the hypothesis that respiration is rate-limited by the mitochondrial CK reaction; this has as a corollary the "creatine shuttle" hypothesis.


Network centrality for the identification of biomarkers in respondent-driven sampling datasets.
Networks science techniques are frequently used to provide meaningful insights into the populations underlying medical and social data. This paper examines SATHCAP, a dataset related to HIV and drug use in three US cities. In particular, we use network measures such as betweenness centrality, closeness centrality, and eigenvector centrality to find central, important nodes in a network derived from SATHCAP data. We evaluate the attributes of these important nodes and create an exceptionality score based on the number of nodes that share a particular attribute. This score, along with the underlying network itself, is used to reveal insight into the attributes of groups that can be effectively targeted to slow the spread of disease. Our research confirms a known connection between homelessness and HIV, as well as drug abuse and HIV, and shows support for the theory that individuals without easy access to transportation are more likely to be central to the spread of HIV in urban, high risk populations.


B. anthracis associated cardiovascular dysfunction and shock: the potential contribution of both non-toxin and toxin components.
The development of cardiovascular dysfunction and shock in patients with invasive Bacillus anthracis infection has a particularly poor prognosis. Growing evidence indicates that several bacterial components likely play important pathogenic roles in this injury. As with other pathogenic Gram-positive bacteria, the B. anthracis cell wall and its peptidoglycan constituent produce a robust inflammatory response with its attendant tissue injury, disseminated intravascular coagulation and shock. However, B. anthracis also produces lethal and edema toxins that both contribute to shock. Growing evidence suggests that lethal toxin, a metalloprotease, can interfere with endothelial barrier function as well as produce myocardial dysfunction. Edema toxin has potent adenyl cyclase activity and may alter endothelial function, as well as produce direct arterial and venous relaxation. Furthermore, both toxins can weaken host defense and promote infection. Finally, B. anthracis produces non-toxin metalloproteases which new studies show can contribute to tissue injury, coagulopathy and shock. In the future, an understanding of the individual pathogenic effects of these different components and their interactions will be important for improving the management of B. anthracis infection and shock.


IRGM is a novel regulator of PD-L1 via promoting S6K1-mediated phosphorylation of YBX1 in hepatocellular carcinoma.
Immunity-related GTPase M (IRGM), an Interferon-inducible protein, functions as a pivotal immunoregulator in multiple autoimmune diseases and infection. However, the role of IRGM in hepatocellular carcinoma (HCC) development remains unveiled. Here, we found interferon-γ (IFN-γ) treatment in HCC drastically triggered the expression of IRGM, and the high level of IRGM indicated poor prognosis in HCC patients. Functionally, IRGM promoted the malignant progression of HCC. Single-cell sequencing revealed that IRGM inhibition promoted the infiltration of CD8+ cytotoxic T lymphocytes (CTLs) with significant downregulation of PD-L1 expression in HCC. Furthermore, Immunoprecipitation-Mass Spectrometry assay revealed that IRGM interacted with transcription factor YBX1, which facilitated PD-L1 transcription. Mechanistically, IRGM promoted the interaction of YBX1 and phosphokinase S6K1, increasing phosphorylation and nuclear localization of YBX1, transcription of PD-L1. Additionally, the combination of IRGM inhibition with α-PD1 demonstrated a stronger anti-tumor effect compared to the single application of α-PD1. In summary, IRGM is a novel regulator of PD-L1, which suppresses CD8+ CTLs infiltration and function in HCC, resulting in cancer progression. This study may raise a novel therapeutic strategy combined with immune checkpoint inhibitors (ICIs) against HCC.


Sex hormone levels as determinants of bone mineral density and osteoporosis in Vietnamese women and men.
This study sought to investigate the prevalence of osteoporosis and the role of sex hormone levels in the determination of bone mineral density (BMD) and osteoporosis in a Vietnamese population of women and men. The cross-sectional study involved 269 women and 222 men aged 13-83 years, who were randomly selected from urban and rural areas in northern Vietnam. Serum concentrations of estradiol and testosterone were analyzed, and BMD was measured by dual X-ray absorptiometry. We found that the prevalence of osteoporosis in postmenopausal women was 18, 17, and 37 % for the femoral neck, total hip, and lumbar spine, respectively. For men aged 50 years or older, the corresponding values were 8, 7, and 12 %. In men, the most important predictors of BMD for the femoral neck and total hip were age, body mass index, and serum levels of estradiol. For the BMD of the lumbar spine, testosterone also had a significant influence. Determinants of osteoporosis in men for the total hip and lumbar spine were age, weight, and serum concentrations of estradiol and testosterone. In postmenopausal women, age, weight, and residence (urban vs rural) were the most important predictors of BMD and osteoporosis. For all women (including those of reproductive age), serum levels of estradiol were also significant. These data suggest that the prevalence of osteoporosis in the Vietnamese population is high also in men, and that estradiol levels are essential for bone mass in both men and women. The results should have clinical implications and increase awareness of an important health issue within Vietnamese society.


Cerebellar volumetry in ataxias: Relation to ataxia severity and duration.
Cerebellar atrophy is the neuropathological hallmark of most ataxias. Hence, quantifying the volume of the cerebellar grey and white matter is of great interest. In this study, we aim to identify volume differences in the cerebellum between spinocerebellar ataxia type 1 (SCA1), SCA3 and SCA6 as well as multiple system atrophy of cerebellar type (MSA-C). Our cross-sectional data set comprised mutation carriers of SCA1 (N=12), SCA3 (N=62), SCA6 (N=14), as well as MSA-C patients (N=16). Cerebellar volumes were obtained from T1-weighted magnetic resonance images. To compare the different atrophy patterns, we performed a z-transformation and plotted the intercept of each patient group's model at the mean of 7 years of ataxia duration as well as at the mean ataxia severity of 14 points in the SARA sum score. In addition, we plotted the extrapolation at ataxia duration of 0 years as well as 0 points in the SARA sum score. Patients with MSA-C demonstrated the most pronounced volume loss, particularly in the cerebellar white matter, at the late time intercept. Patients with SCA6 showed a pronounced volume loss in cerebellar grey matter with increasing ataxia severity compared to all other patient groups. MSA-C, SCA1 and SCA3 showed a prominent atrophy of the cerebellar white matter. Our results (i) confirmed SCA6 being considered as a pure cerebellar gray matter disease, (ii) emphasise the involvement of cerebellar white matter in the neurophatology of SCA1, SCA3 and MSA-C, and (iii) reflect the rapid clinical progression in MSA-C.


Recent Trends in Ovarian Cancer Incidence and Relative Survival in the United States by Race/Ethnicity and Histologic Subtypes.
Background: Incidence and survival rates of nonserous epithelial ovarian cancer in racial/ethnic minorities remain relatively unknown in the United States. We examined the trends in incidence and survival rates for epithelial ovarian cancer by histologic subtypes and race/ethnicity.Methods: Ovarian cancer incidence and mortality data from 2000 to 2013 were obtained from the Surveillance, Epidemiology, and End Results database. Age-adjusted incidence rate, incidence rate ratio, and annual percentage changes (APC) were calculated by histology and race/ethnicity subgroups and stratified by age at diagnosis. Five-year relative survival rates were calculated by stage and race/ethnicity.Results: A small but significant decrease in incidence rates was seen in non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic women (APC -1.58, -0.84, and -1.31, respectively), while incidence rates remained relatively stable in Asian women (APC -0.37). With exception of significant increase in the incidence rate of clear cell carcinoma among Asian woman (APC 1.85), an overall trend toward decreasing incidence rates was seen across histologic subtypes and age-strata, although not all results were statistically significant. Compared with NHW women, NHB women experienced poorer 5-year survival at every stage across histologic subtypes, while Hispanic and Asian women had equivalent or better survival.Conclusions: Over the last decade, incidence rates of epithelial ovarian cancer in the United States have decreased or remained stable across race/ethnic and histologic subgroups, except for clear cell carcinoma. Survival remains poorest among NHB women.Impact: Comparative histologic subtype distribution and incidence trends do not explain the ovarian cancer survival disparity disproportionately affecting NHB women. Cancer Epidemiol Biomarkers Prev; 26(10); 1511-8. ©2017 AACR.


Vaccinia virions lacking the RNA helicase nucleoside triphosphate phosphohydrolase II are defective in early transcription.
Temperature-sensitive mutations (ts10, ts18, and ts39) of the vaccinia virus RNA helicase nucleoside triphosphate phosphohydrolase II (NPH-II) result in the production of noninfectious progeny virions at the restrictive temperature. The noninfectious mutant particles contain the wild-type complement of virion core and envelope polypeptides, as judged by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The results of Western blot (immunoblot) analysis indicate that these particles lack NPH-II, whereas other enzymatic components of the virus core are present. These components include the following: DNA-dependent RNA polymerase subunits rpo147, rpo132, rpo94, rpo35, rpo30, rpo22, and rpo18; early transcription initiation factor subunits A8 and D6; mRNA capping enzyme subunits D1 and D12; RNA cap 2'-O-methyltransferase; A18 DNA helicase; DNA-dependent ATPase NPH-I; and DNA topoisomerase. Although RNA polymerase is encapsidated by the mutant viruses, mRNA synthesis in vitro by permeabilized mutant virions is only 5 to 20% that of the wild-type virus, as judged by nucleoside monophosphate incorporation into acid-insoluble material. Moreover, the transcripts synthesized by the mutant particles are longer than normal and remain virion associated. Transcription initiation by mutant virions occurs accurately at an endogenous genomic promoter, albeit at reduced levels (1 to 7%) compared with that of wild-type virions. In contrast, extracts of the mutant virions catalyze the wild-type level of transcription from an exogenous template containing an early promoter. We conclude that NPH-II is required for early mRNA synthesis uniquely in the context of the virus particle. Possible roles in transcription termination and RNA transport are discussed.


Detection of Chlamydia psittaci by immunofluorescence.
A direct fluorescent-antibody (FA) test was developed to detect Chlamydia psittaci in dural impressions from specimen-inoculated mice. Technical procedures for the test were compared. C. psittaci was found in mice after infection as early by the FA technique as it was by cytochemical staining methods usually used. The lymphogranuloma venereum organism was also stained by conjugated antibody to C. psittaci. A distinctive advantage of the described FA test is that organisms are identified immunologically as members of the genus Chlamydia simultaneously with their detection.


[Irritable bowel syndrome--a multifactorial disease in children and adults].
Irritable bowel syndrome is the most frequent gastrointestinal disorder in Norway. Though there has been huge research activity in the field, no proven single aetiology or effective treatment has emerged. Consensus-based clinical diagnostic criteria have not yet brought diagnostic clarity. Possibly, there are dysfunctions in the processing of sensory stimuli in the "brain-gut" axis that may cause visceral hypersensitivity and secondary motility changes. In some patients, a multifactorial explanation of the mechanisms is useful, including stressful life events or other psychological factors. Psychiatric co-morbidity is probably the most important maintaining factor. Irritable bowel syndrome may serve as a model for the study of the interaction between biological, psychological and social factors in functional disorders. A good therapeutic relationship between the physician and the patient is an important element in the treatment approach.


Human intravenous injection of β-cyfluthrin with minimal toxic effects.
A 28-year-old man presented to the emergency department (ED) 20 minutes after injecting 20 mL of an insecticide containing 0.05% β-cyfluthrin. Upon presentation, he had no complaints; and vital signs demonstrated a sinus tachycardia of 150 beats per minute, blood pressure of 140/65 mm Hg, no fever, and a normal respiratory rate. Further physical examination was notable only for the lack of tremor and the presence of a left antecubital recent injection site. The patient denied use of other drugs that day, but admitted to recent use of methamphetamine. He was taking oxcarbazepine, lurasidone, and venlafaxine for reported bipolar affective disorder and schizophrenia. The ED evaluation included an electrocardiogram demonstrating sinus tachycardia, undetectable acetaminophen and salicylate levels, and a urine drug screen that was positive for methamphetamine and tetrahydrocannabinol. The patient was treated with an intravenous fluid bolus of 2000 mL and observed in the ED. Over the course of the subsequent 3 hours, his pulse rate went down to 90/min. He remained asymptomatic and was transferred to the Psychiatric Assessment Unit after approximately 6 hours of observation. We present the first published case of cyfluthrin parenteral human injection. Although this patient experienced a benign clinical course, vigilance for pyrethroid toxic effects such as seizures, severe tremors, diaphoresis, and choreoathetosis is paramount.


Seasonal variation in air pollutant levels and its effects on the sex ratio at birth on Fukue island, Japan.
In general, a slightly higher number of boys are born than girls, and the sex ratio at birth (number of male births/number of female births) is reported to be 1.03-1.07 in many countries. However, pregnant women exposed to high levels of atmospheric particulate matter have a reduced sex ratio at birth. Exposure to air pollutants can also lead to premature birth, suggesting that inflammation within the body may affect pregnancy maintenance and fetal development. On the other hand, the effects of air pollutants carried from afar by monsoons on the sex ratio at birth in downstream areas have not been evaluated. We focused on the Goto Islands, where various air pollutants flow from the Eurasian continent. The objective of this study was to clarify the effects of the atmospheric level of each pollutant on the sex ratio at birth on the Goto Islands. We extracted observation data of particulate matter 2.5, sulfur dioxide, oxidants, nonmethane hydrocarbons, and methane from the National Institute for Environmental Studies database. In addition, the monthly sex ratio at birth was calculated using birth data from the National Statistics Center. To evaluate the effect of substance exposure just before fertilization on the sex ratio at birth, we analyzed the relationship between the observed pollutant level and the sex ratio at birth 9 months later. A stepwise generalized linear model was used to analyze the effects of air pollutant levels on the sex ratio at birth. The observed values for all pollutants were significantly different between seasons, including the particulate matter 2.5 (p < 0.0001), sulfur dioxide (p = 0.0026), oxidant (p < 0.0001), nonmethane hydrocarbon (p < 0.0001), and methane (p < 0.0001) values. In the target population in the target period, the total number of births was 1835, and the sex ratio at birth was 0.967. Univariate analysis showed that the values of particulate matter 2.5 (p = 0.0157) and oxidants (p = 0.0047) correlated negatively with the sex ratio at birth. In addition, the results of multivariate analysis using the stepwise method in the model equation indicated that every 1 ppm increase in the observed OX value resulted in a 0.311 decrease in the sex ratio at birth (p = 0.0034). We evaluated the relationship between seasonal variations in air pollutant levels and the sex ratio at birth 9 months later on the Goto Islands. We found that an increase in oxidant levels just before and after conception may be a risk factor for a lower sex ratio at birth. Due to the previously reported vulnerability of male fetuses, females who become pregnant when air pollutant concentrations are high may be more likely to have a female baby. It is necessary to evaluate the effects of oxidants on various aspects of pregnancy and childbirth.


Deceptive single-locus taxonomy and phylogeography: Wolbachia-associated divergence in mitochondrial DNA is not reflected in morphology and nuclear markers in a butterfly species.
The satyrine butterfly Coenonympha tullia (Nymphalidae: Satyrinae) displays a deep split between two mitochondrial clades, one restricted to northern Alberta, Canada, and the other found throughout Alberta and across North America. We confirm this deep divide and test hypotheses explaining its phylogeographic structure. Neither genitalia morphology nor nuclear gene sequence supports cryptic species as an explanation, instead indicating differences between nuclear and mitochondrial genome histories. Sex-biased dispersal is unlikely to cause such mito-nuclear differences; however, selective sweeps by reproductive parasites could have led to this conflict. About half of the tested samples were infected by Wolbachia bacteria. Using multilocus strain typing for three Wolbachia genes, we show that the divergent mitochondrial clades are associated with two different Wolbachia strains, supporting the hypothesis that the mito-nuclear differences resulted from selection on the mitochondrial genome due to selective sweeps by Wolbachia strains.


Rapid establishment of phenol- and quinoline-degrading consortia driven by the scoured cake layer in an anaerobic baffled ceramic membrane bioreactor.
Although toxic and refractory organics, such as phenol and quinoline, are decomposed by anaerobic bacteria, the establishment of specific degrading consortia is a relatively slow process. An anaerobic membrane bioreactor allows for complete biomass retention that can aid the establishment of phenol- and quinoline-degrading consortia. In this study, the anaerobic digestion of phenol (500 mg L-1) and quinoline (50 mg L-1) was investigated using an anaerobic baffled ceramic membrane bioreactor (ABCMBR). The results showed that, within 30 days, 99% of phenol, 98% of quinoline and 88% of chemical oxygen demand (COD) were removed. The substrate utilisation rates of the cake layer for phenol and quinoline, and specific methanogenic activity of the cake layer, were 7.58 mg phenol g-1 mixed liquor volatile suspended solids (MLVSS) day-1, 8.23 mg quinoline g-1 MLVSS day-1 and 0.55 g CODCH4 g-1 MLVSS day-1, respectively. The contribution of the cake layer to the removals of phenol and quinoline was extremely underestimated because the uncounted scoured cake layer was disregarded. Syntrophus was the key population for phenol and quinoline degradation, and it was more abundant in the cake layer than in the bulk sludge. The highly active scattered cake layer sped up the establishment of phenol- and quinoline-degrading consortia in the ABCMBR.


Large-scale characterization of HeLa cell nuclear phosphoproteins.
Determining the site of a regulatory phosphorylation event is often essential for elucidating specific kinase-substrate relationships, providing a handle for understanding essential signaling pathways and ultimately allowing insights into numerous disease pathologies. Despite intense research efforts to elucidate mechanisms of protein phosphorylation regulation, efficient, large-scale identification and characterization of phosphorylation sites remains an unsolved problem. In this report we describe an application of existing technology for the isolation and identification of phosphorylation sites. By using a strategy based on strong cation exchange chromatography, phosphopeptides were enriched from the nuclear fraction of HeLa cell lysate. From 967 proteins, 2,002 phosphorylation sites were determined by tandem MS. This unprecedented large collection of sites permitted a detailed accounting of known and unknown kinase motifs and substrates.


Exploratory study of the impact of perceived reward on habit formation.
Habits (learned automatic responses to contextual cues) are considered important in sustaining health behaviour change. While habit formation is promoted by repeating behaviour in a stable context, little is known about what other variables may contribute, and whether there are variables which may accelerate the habit formation process. The aim of this study was to explore variables relating to the perceived reward value of behaviour - pleasure, perceived utility, perceived benefits, and intrinsic motivation. The paper tests whether reward has an impact on habit formation which is mediated by behavioural repetition, and whether reward moderates the relationship between repetition and habit formation. Habit formation for flossing and vitamin C tablet adherence was investigated in the general public following an intervention, using a longitudinal, single-group design. Of a total sample of 118 participants, 80 received an online vitamin C intervention at baseline, and all 118 received a face-to-face flossing intervention four weeks later. Behaviour, habit, intention, context stability (whether the behaviour was conducted in the same place and point in routine every time), and reward variables were self-reported every four weeks, for sixteen weeks. Structured equation modelling was used to model reward-related variables as predictors of intention, repetition, and habit, and as moderators of the repetition-habit relationship. Habit strength and behaviour increased for both target behaviours. Intrinsic motivation and pleasure moderated the relationship between behavioural repetition and habit. Neither perceived utility nor perceived benefits predicted behaviour nor interacted with repetition. Limited support was obtained for the mediation hypothesis. Strong intentions unexpectedly weakened the repetition-habit relationship. Context stability mediated and for vitamin C, also moderated the repetition-habit relationship. Pleasure and intrinsic motivation can aid habit formation through promoting greater increase in habit strength per behaviour repetition. Perceived reward can therefore reinforce habits, beyond the impact of reward upon repetition. Habit-formation interventions may be most successful where target behaviours are pleasurable or intrinsically valued.


Light Dark Matter Search with a High-Resolution Athermal Phonon Detector Operated above Ground.
We present limits on spin-independent dark matter-nucleon interactions using a 10.6 g Si athermal phonon detector with a baseline energy resolution of σ_{E}=3.86±0.04(stat)_{-0.00}^{+0.19}(syst) eV. This exclusion analysis sets the most stringent dark matter-nucleon scattering cross-section limits achieved by a cryogenic detector for dark matter particle masses from 93 to 140 MeV/c^{2}, with a raw exposure of 9.9 g d acquired at an above-ground facility. This work illustrates the scientific potential of detectors with athermal phonon sensors with eV-scale energy resolution for future dark matter searches.


Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities.
With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system.


Some characteristics of relations among depression, anxiety, and self-efficacy.
Self-efficacy should be regarded as a cognitive precursor or as a component of anxiety and of depression. Data on depression, anxiety, and self-efficacy were available from a study of the relation of self-concept to depression. Scores on the Children's Depression Scale of Lang and Tisher, State-Trait Anxiety Inventory of Spielberger, Test-Anxiety Inventory of Spielberger, Self-efficacy Scales of Schwarzer, and the Three-Person Test of Backes, were analyzed by multivariate methods. Subjects were 200 high school students ages 15 to 17 yr. The factor solution obtained from the factor analysis provides information regarding state-anxiety, test-anxiety, worry, and self-efficacy. Further research is planned for a better understanding of the linkages among self-efficacy, self-concept, depression, and anxiety.


The prevalence, aetiology and clinical significance of pseudo-sinusoidal fetal heart rate patterns in labour.
To investigate the prevalence of sinusoidal and pseudo-sinusoidal fetal heart rate (FHR) patterns in labour and the relation between the characteristics of the FHR pattern and fetal outcome. A prospective observational study over a 6-month period in which all women who had continuous FHR monitoring in labour had their intrapartum cardiotocographs (CTGs) scrutinized for the presence of sinusoidal or pseudo-sinusoidal FHR patterns. John Radcliffe Hospital, Oxford. 1520 women who had fetal monitoring during labour for various reasons. Both internal (electrocardiographic) and external (ultrasound) recordings of the FHR were analysed. Abnormal FHR patterns were related to obstetric characteristics and fetal outcome in terms of Apgar scores, umbilical artery pH and admission to the special care unit. No true sinusoidal FHR patterns were observed, but pseudo-sinusoidal FHR patterns were found in 230 of the 1520 CTGs examined (15%). Of these, 219 were classified as minor (amplitude 5-15 beats/min) and 11 as intermediate (amplitude 16-24 beats/min). Major pseudo-sinusoidal FHR patterns (amplitude greater than 24 beats/min) were not observed. Minor pseudo-sinusoidal FHR patterns had a mean duration of 21 (SD 13) min and typically occurred once or twice early in labour. Using logistic regression analysis a significant, independent relation was demonstrated between the presence of minor pseudo-sinusoidal FHR patterns and the use of pethidine (RR 1.84, 95% CI 1.3 to 2.59, P less than 0.0001) and epidural analgesia (RR 1.85, 95% CI 1.24 to 2.76, P less than 0.001). Intermediate pseudo-sinusoidal FHR patterns were found in association with both in utero fetal sucking and transient episodes of fetal hypoxia such as that caused by periodic umbilical cord compression. Pseudo-sinusoidal FHR patterns in labour will usually be associated with a normal fetal outcome but a careful fetal assessment is mandatory.


Signaling elements involved in the metabolic regulation of mTOR by nutrients, incretins, and growth factors in islets.
Mammalian target of rapamycin (mTOR) is a protein kinase that integrates signals from mitogens and the nutrients, glucose and amino acids, to regulate cellular growth and proliferation. Previous findings demonstrated that glucose robustly activates mTOR in an amino acid-dependent manner in rodent and human islets. Furthermore, activation of mTOR by glucose significantly increases rodent islet DNA synthesis that is abolished by rapamycin. Glucagon-like peptide-1 (GLP-1) agonists, through the production of cAMP, have been shown to enhance glucose-dependent proinsulin biosynthesis and secretion and to stimulate cellular growth and proliferation. The objective of this study was to determine if the glucose-dependent and cAMP-mediated mechanism by which GLP-1 agonists enhance beta-cell growth and proliferation is mediated, in part, through mTOR. Our studies demonstrated that forskolin-generated cAMP resulted in activation of mTOR at basal glucose concentrations as assessed by phosphorylation of S6K1, a downstream effector of mTOR. Conversely, an adenylyl cyclase inhibitor partially blocked glucose-induced S6K1 phosphorylation. Furthermore, the GLP-1 receptor agonist, Exenatide, dose-dependently enhanced phosphorylation of S6K1 at an intermediate glucose concentration (8 mmol/l) in a rapamycin-sensitive manner. To determine the mechanism responsible for this potentiation of mTOR, the effects of intra- and extracellular Ca2+ were examined. Glyburide, an inhibitor of ATP-sensitive K+ channels (K(ATP) channels), provided partial activation of mTOR at basal glucose concentrations due to the influx of extracellular Ca2+, and diazoxide, an activator of KATP channels, resulted in partial inhibition of S6K1 phosphorylation by 20 mmol/l glucose. Furthermore, Exenatide or forskolin reversed the inhibition by diazoxide, probably through mobilization of intracellular Ca2+ stores by cAMP. BAPTA, a chelator of intracellular Ca2+, resulted in inhibition of glucose-stimulated S6K1 phosphorylation due to a reduction in cytosolic Ca2+ concentrations. Selective blockade of glucose-stimulated Ca2+ influx unmasked a protein kinase A (PKA)-sensitive component involved in the mobilization of intracellular Ca2+ stores, as revealed with the PKA inhibitor H-89. Overall, these studies support our hypothesis that incretin-derived cAMP participates in the metabolic activation of mTOR by mobilizing intracellular Ca2+ stores that upregulate mitochondrial dehydrogenases and result in enhanced ATP production. ATP can then modulate KATP channels, serve as a substrate for adenylyl cyclase, and possibly directly regulate mTOR activation.


[Results of hemisections and root amputations in a general practice].
A retrospective study is presented of the treatment of furcation problems and deep, localized periodontal pockets by means of root-resection and the subsequent restorative treatment. The study incorporates 69 teeth in 53 patients, treated in the period 1970-1986. The results indicate that well-indicated root-resections may produce good long-term results. Most of the treated teeth have a survival rate of 10 years. Indications, possibilities and specific restorative problems are discussed.


Health-related quality of life of severely obese children and adolescents.
One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL). To examine the health-related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer. Cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years (mean [SD], 12.1 [3] years), who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z score of 2.6 (0.5). Child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer. Compared with healthy children and adolescents, obese children and adolescents reported significantly (P<.001) lower health-related QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and adolescents; 83 [14.8] for healthy children and adolescents). Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval [CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score (mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or adolescent's BMI z score was significantly inversely correlated with total score (r = -0.246; P =.01), physical functioning (r = -0.263; P<.01), social functioning (r = -0.347; P<.001), and psychosocial functioning (r = -0.209; P =.03). Severely obese children and adolescents have lower health-related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes.


Streamlined Hyperacute Magnetic Resonance Imaging Protocol Identifies Tissue-Type Plasminogen Activator-Eligible Stroke Patients When Clinical Impression Is Stroke Mimic.
Stroke mimics (SM) challenge the initial assessment of patients presenting with possible acute ischemic stroke (AIS). When SM is considered likely, intravenous tissue-type plasminogen activator (tPA) may be withheld, risking an opportunity to treat AIS. Although computed tomography is routinely used for tPA decision making, magnetic resonance imaging (MRI) may diagnose AIS when SM is favored but not certain. We hypothesized that a hyperacute MRI (hMRI) protocol would identify tPA-eligible AIS patients among those initially favored to have SM. A streamlined hMRI protocol was designed based on barriers to rapid patient transport, MRI acquisition, and post-MRI tPA delivery. Neurologists were trained to order hMRI when SM was favored and tPA was being withheld. The use of hMRI for tPA decision making, door-to-needle times, and outcomes were compared before hMRI implementation (pre-hMRI: August 1, 2011 to July 31, 2013) and after (post-hMRI, August 1, 2013, to January 15, 2015). Post hMRI, 57 patients with suspected SM underwent hMRI (median MRI-order-to-start time, 29 minutes), of whom, 11 (19%) were diagnosed with AIS and 7 (12%) received tPA. Pre-hMRI, no tPA-treated patients were screened with hMRI. Post hMRI, 7 of 106 (6.6%) tPA-treated patients underwent hMRI to aid in decision making because of suspected SM (0% versus 6.6%; P=0.001). To ensure standard care was maintained after implementing the hMRI protocol, pre- versus post-hMRI tPA-treated cohorts were compared and did not differ: door-to-needle time (39 versus 37 minutes; P=0.63), symptomatic hemorrhage rate (4.5% versus 1.9%; P=0.32), and favorable discharge location (85% versus 89%; P=0.37). A streamlined hMRI protocol permitted tPA administration to a small, but significant, subset of AIS patients initially considered to have SM.


Temporal frequency spread of optical waves propagating in anisotropic maritime atmospheric turbulence.
Recently, the analytical expressions for the atmospheric-induced frequency spreads of optical waves propagating in anisotropic atmosphere turbulence were derived in our work. Meanwhile, more research also draws on the theoretical survey of maritime atmospheric turbulence. In this paper, the new expressions for the temporal frequency spreads of plane and spherical waves propagating in anisotropic maritime atmospheric turbulence are derived. Based on the new expressions obtained, the combined effects of the power law exponent, turbulence strength, turbulence scales, and the anisotropic parameter are evaluated. The analytical simulation results show that the turbulence strength and the anisotropic parameter significantly affect the curves of the temporal frequency spread. Furthermore, it is important to note that the temporal frequency spreads of optical waves in the anisotropic maritime turbulence and the terrestrial turbulence become almost identical as the value of the anisotropic parameter goes beyond five.


Obesogenic environment and childhood obesity.
The increasing prevalence of obesity in youth has contributed to the growing global burden of chronic diseases (e.g. diabetes, cardiovascular diseases and cancers), which has been largely accounted for by obesogenic behaviours and environments. Previous studies have focused on the influences on obesity of multidimensional environmental indicators, which have mixed effects, for example, built environmental factors, food environmental factors and neighbourhood safety. After a thorough search of all databases, I found a limited body of reviews on the associations of basic environmental factors. A basic environmental factor, from a perspective of geographic information systems, is an indicator constructed by only one-step spatial function, without ambiguous effects on obesity. In contrast to basic obesogenic environmental factors, an example of mixed environmental factor is neighbourhood safety, which is a complex measure of night light, crime rate, traffic volume, speed limit, smoothness of roads and many other factors of injury. Without a sufficient, up-to-date understanding of the roles of basic obesogenic environmental factors in obesity, the uncertainties will propagate and lead to more uncertainties in the association between indicators and obesity.


Immunological analysis and differential genes screening of venous thromboembolism.
To explore the pathogenesis of venous thromboembolism (VTE) and provide bioinformatics basis for the prevention and treatment of VTE. The R software was used to obtain the gene expression profile data of GSE19151, combining with the CIBERSORT database, obtain immune cells and differentially expressed genes (DEGs) of blood samples of VTE patients and normal control, and analyze DEGs for GO analysis and KEGG pathway enrichment analysis. Then, the protein-protein interaction (PPI) network was constructed by using the STRING database, the key genes (hub genes) and immune differential genes were screened by Cytoscape software, and the transcription factors (TFs) regulating hub genes and immune differential genes were analyzed by the NetworkAnalyst database. Compared with the normal group, monocytes and resting mast cells were significantly expressed in the VTE group, while regulatory T cells were significantly lower. Ribosomes were closely related to the occurrence of VTE. 10 hub genes and immune differential genes were highly expressed in VTE. MYC, SOX2, XRN2, E2F1, SPI1, CREM and CREB1 can regulate the expressions of hub genes and immune differential genes. Ribosomal protein family genes are most relevant to the occurrence and development of VTE, and the immune differential genes may be the key molecules of VTE, which provides new ideas for further explore the pathogenesis of VTE.


Empirical formula for optical absorption by fractal aerosol agglomerates.
An empirical formula for calculating the optical absorption of fractal aerosol agglomerates over a broad frequency range is derived based on extensive calculations made on five smoke agglomerates having a widely varying number of particles ranging from 12 to 372 and an almost constant fractal dimension in the 1.7-1.9 range. The expansion coefficients in the empirical formula were determined by least-squares curve fiting of numerical data obtained using the volume integral equation formulation (VIEF).(1) The formula satisfies the frequency dependence of the absorption at lower frequencies and up to the resonance frequency of the agglomerate. Expressions for the resonance frequency (f(0)), as well as the constant coefficients in the empiricial formula, are derived in terms of the structural dimensions, number and size of the primary particles, and the complex permittivity of the aerosol agglomerate. Numerical results obtained from the empirical formula are generally in good agreement with those calculated by the VIEF for soot particles with a magnitude of complex permittivity |epsilon*| in the 1-7 range. The average error in the absorption calculation is <5%. The formula thus provides a simple and inexpensive method for calculating the optical absorption of aerosol agglomerates, which otherwise require complicated and expensive methods of calculation. This formula also facilitates the implementation of the accurate VIEF results in large climate codes such as the general circulation model.


Progesterone receptor antagonism inhibits progestogen-related carcinogenesis and suppresses tumor cell proliferation.
Blockade of the progestogen-progesterone receptor (PR) axis is a novel but untested strategy for breast cancer prevention. We report preclinical data evaluating telapristone acetate (TPA), ulipristal acetate (UPA), and mifepristone. Tumors were induced with medroxyprogesterone acetate (MPA) plus 7,12-dimethylbenz[a]anthracene (DMBA) in mice, and MPA or progesterone plus N-methyl-N-nitrosourea (MNU) in rats. Mammary gland histology, tumor incidence, latency, multiplicity, burden and histology were evaluated, along with immunohistochemical labeling of pHH3 (proliferation), CD34 (angiogenesis), and estrogen and progesterone receptors (ER and PR). A concentration gradient of TPA, UPA, and mifepristone was tested for growth inhibition of T47D spheroids. In mouse mammary glands, no tumors formed, but TPA opposed the pro-hyperplastic effects of MPA (p = 0.002). In rats, TPA decreased tumor incidence (p = 0.037 for MPA + TPA vs. MPA, and p = 0.032 for progesterone + TPA vs. progesterone) and tumor burden (p = 0.042 for progesterone + TPA vs. progesterone), with significant decreases in pHH3 and CD34 positive cells. TPA and UPA were superior to mifepristone in growth inhibition of T47D spheroids. TPA has consistent anti-tumorigenic effects in several models, which are accompanied by decreases in cell proliferation, angiogenesis, and hormone receptor expression.


[Treatment of drug resistant destructive pulmonary tuberculosis: gemifloxacin and other fluoroquinolones clinical efficiency and tolerance at the end of initial phase of treatment].
Gemifloxacin efficiency and tolerance in comparison to the ofloxacin, levofloxacin and gatifloxacin during the intensive phase of the antituberculosis therapy for drug resistant cases was evaluated. 156 drug resistant TB patients were examined in the open, prospective, randomized research, being divided into 2 groups with similar drug resistance profile. The 1st group received gemifloxacin, the 2nd--other fluoroquinolones. Gemifloxacin efficiency in the treatment regimen for the drug resistant TB patients did not differ from the efficiency of the use of other fluoroquinolones of the 4th generation and was significantly higher in comparison to ofloxacin. At the same time the identical level of side effects was registered in the course of treatment with mentioned drugs. Gemifloxacin is effective and safe at treatment of tuberculosis in comparison to other fluoroquinolones that allows considering it as the drug of choice among fluoroquinolones for treatment of drug resistant TB, including multidrug-resistant TB.


Leukoencephalopathies and leukodystrophies.
The leukoencephalopathies encompass a heterogeneous group of disorders that involve the brain white matter. The cause may be acquired or inherited; in the latter case, mutations have been found in genes that encode protein components of the myelin membrane or enzymes implicated in the turnover of myelin. In patients with cognitive dysfunction and white matter lesions evident on MRI, analysis of the type, pattern, and distribution of lesions can enable a presumptive diagnosis, which can be confirmed by biochemical and/or molecular testing. The presence or absence of peripheral neuropathy and/or autonomic dysfunction can be a helpful clue in differentiating individual diagnoses. Often, patients may be suspected of having and being initially treated inappropriately for a case of primary or secondary progressive multiple sclerosis. In a significant number of patients, the diagnosis may not be made, even after an extensive search. Establishing the cause enables counseling regarding prognosis, family planning, monitoring for disease-related complications, and introducing therapy, when available.


Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in Japan.
Lanthanum carbonate (LC) is a nonaluminum, noncalcium phosphate binder that is effective for hyperphosphatemia in dialysis patients. However, its efficacy and cost-effectiveness as second-line therapy have not been fully examined. We first conducted a multicenter, open-label, 16-week clinical trial to examine the effect of additive LC in 116 hemodialysis patients who had uncontrolled hyperphosphatemia with conventional phosphorus-lowering therapy alone. Based on these clinical data, a state transition model was developed to evaluate the benefits and costs associated with LC as second-line therapy. Reduced risks for cardiovascular morbidity and mortality among patients treated with LC arise through more of the population achieving the target phosphorus levels. Uncertainty was explored through sensitivity analysis. After 16 weeks of additive LC treatment, mean serum phosphorus levels decreased from 7.30 ± 0.90 to 5.71 ± 1.32 mg/dl, without significant changes in serum calcium or intact parathyroid hormone levels. A subsequent cost-effectiveness analysis showed that compared with conventional treatment, additive LC incurred an average additional lifetime cost of $22,054 per person and conferred an additional 0.632 quality-adjusted life years (QALYs). This resulted in an incremental cost-effectiveness ratio of $34,896 per QALY gained. Applying a cost-effectiveness threshold of $50,000 per QALY, a probabilistic sensitivity analysis showed that additive LC had a 97.4% probability of being cost-effective compared with conventional treatment. Our results indicate that the use of LC as second-line therapy would be cost-effective among hemodialysis patients with uncontrolled hyperphosphatemia in Japan.


Inhibition of 1,4-beta-D-xylan xylanohydrolase by the specific aspartic protease inhibitor pepstatin: probing the two-step inhibition mechanism.
This is the first report that describes the inhibition mechanism of xylanase from Thermomonospora sp. by pepstatin A, a specific inhibitor toward aspartic proteases. The kinetic analysis revealed competitive inhibition of xylanase by pepstatin A with an IC50 value 3.6 +/- 0.5 microm. The progress curves were time-depended, consistent with a two-step slow tight binding inhibition. The inhibition followed a rapid equilibrium step to form a reversible enzyme-inhibitor complex (EI), which isomerizes to the second enzyme-inhibitor complex (EI*), which dissociated at a very slow rate. The rate constants determined for the isomerization of EI to EI* and the dissociation of EI* were 15 +/- 1 x 10(-5) and 3.0 +/- 1 x 10(-8) s(-1), respectively. The Ki value for the formation of EI complex was 1.5 +/- 0.5 microm, whereas the overall inhibition constant Ki* was 28.0 +/- 1 nm. The conformational changes induced in Xyl I by pepstatin A were monitored by fluorescence spectroscopy, and the rate constants derived were in agreement with the kinetic data. Thus, the conformational alterations were correlated to the isomerization of EI to EI*. Pepstatin A binds to the active site of the enzyme and disturbs the native interaction between the histidine and lysine, as demonstrated by the abolished isoindole fluorescence of o-phthalaldehyde-labeled xylanase. Our results revealed that the inactivation of xylanase is due to the interference in the electronic microenvironment and disruption of the hydrogen-bonding network between the essential histidine and other residues involved in catalysis, and a model depicting the probable interaction between pepstatin A with xylanase has been proposed.


Pediatric Germ Cell Tumors: A Developmental Perspective.
Germ cell tumors (GCTs) arising in infants, children, and adolescents present a set of special challenges. GCTs make up about 3% of malignancies in children aged 0-18 and nearly 15% of cancers in adolescents. Epidemiologic and molecular evidence suggests that GCTs in young children likely represent a distinct biologic group as compared to GCTs of older adolescents and adults. Despite this difference, pediatric GCTs are typically treated with cisplatin-based multiagent regimens similar to those used in adults. There is evidence that children are particularly vulnerable to late effects of conventional therapy, including ototoxicity, pulmonary abnormalities, and secondary malignancies, motivating the search for molecular targets for novel therapies. Evidence is accumulating that the genes and mechanisms controlling normal germ cell development are particularly relevant to the understanding of germ cell tumorigenesis. Perturbations in the epigenetic program of germ cell differentiation, with resulting effects on the regulation of pluripotency, may contribute to the marked histologic variability of GCTs. Perturbations in the KIT receptor signaling pathway have been identified via next-generation sequencing studies and in genome-wide association studies of testicular cancer susceptibility. Here, we review these and other biological insights that may fuel further translational and clinical research in childhood GCTs.


Biomechanical evaluation of the modified double-plating fixation for the distal radius fracture.
Distal radius fracture is among the most common type of skeletal injuries. To conquer the surgical and biomechanical complications of the most-frequent used double-plating operation for this fracture, modified double-plating technique was proposed in this study. The aim of this study was to investigate the biomechanical interactions of double-plating, modified double-plating and traditional single plating fixations coupled with various load conditions using nonlinear finite element analysis. A three-dimensional finite element distal radius fracture model with three fixation methods (double-plating, modified double-plating and single) was generated based on computer tomography data. After model verification and validation, frictional (contact) elements were used to simulate the interface condition between the fixation plates and the bony surface. The rigidity, stress values and displacements at the radius end were observed under axial, bending and torsion load conditions. The simulated results showed that the modified double-plating model demonstrated the highest rigidity and the least displacement among the three techniques in bending, but not in axial compression (similar results across the three) and torsion (modified double-plating technique possessed lowest rigidity). The maximum von Mises stress for bone was lower in modified double-plating model as well. These results indicated that modified double-plating technique demonstrated a better structural strength against bending with the least potential of fracture fragments and screw loosening. Although a lower torsional rigidity, modified double-plating technique was a better choice in distal radius fracture fixation since the bending force, which has the potential to separate the fracture ends, is more detrimental in hindering fracture healing.


Relationship between vascular reactivity in vitro and blood flows in rats with cirrhosis.
In cirrhosis there is a hyperdynamic circulation, which occurs mainly in the systemic and splanchnic regions. Using isolated-vessel models, previous studies have shown reduced aortic reactivity to vasoconstrictors in rats with cirrhosis. The aim of the present study was to evaluate and compare the vascular responsiveness to phenylephrine in arterial rings and the blood flows from different regions in rats with cirrhosis and controls. Reactivity was studied in isolated thoracic aortic, superior mesenteric arterial and carotid arterial rings from sham-operated and bile-duct-ligated rats by measuring the cumulative concentration-dependent tension induced by phenylephrine (10(-9)-10(-4) M). Blood flows were measured by the radioactive microsphere method. In rats with cirrhosis, a significant hyporeactivity to phenylephrine was observed in both the aorta and the superior mesenteric artery compared with the corresponding arteries of normal rats. This hyporesponsiveness was corrected by N(omega)-nitro-L-arginine (0.1 mM). In contrast, carotid artery reactivity and the responses to N(omega)-nitro-L-arginine were similar in the cirrhotic and control groups. In each case, cardiac output and mesenteric arterial blood flow were significantly higher in cirrhotic than in normal rats. Cerebral blood flows were not significantly different between the two groups. In cirrhotic rats, arterial hyporeactivity may be a consequence of increased regional blood flow and increased production of nitric oxide.


Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis.
Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77%) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46% of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx (P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.


Factors associated with the interruption of exclusive breastfeeding in infants up to 30 days old.
To identify factors associated with the interruption of exclusive breastfeeding (EBF) in infants up to 30 days old. A cross-sectional study conducted at a university hospital in southern Brazil, from December 2014 to September 2015, with 341 infants up to 30 days old and their mothers. A semi-structured questionnaire was applied consisting of variables related to sociodemographic characteristics, obstetric history of the mother, companion's education, and data of the infant and of breastfeeding. Collected data were subjected to bivariate and multivariate analysis with the estimation of Prevalence Ratios (PR). The prevalence of EBF was 79.5%. The factors associated with the interruption of EBF were babies ≥ 21 days, who received formula supplementation at the hospital, women with difficulties breastfeeding after hospital discharge, and non-white. the factors associated with EBF interruption can help health workers create actions for mothers with difficulties and prevent interruption of EBF.


Organic vapor sensors based on SAW resonator and organic films.
The majority of investigations of SAW devices used as chemical sensors are based on delay line oscillators. However, SAW resonator oscillator offers some advantages over the SAW delay line oscillator for its higher stability. In the incipient stage of fabricating gas sensors based upon SAW resonator, taking detection of organic vapor as an example, the analysis method that combines the SAW theory with organic film technology has been adopted to give an intensive insight into the responses of two-port SAW resonator coated with LB-film and cast-film after exposure to organic vapors.


Evidence for a 'window of opportunity' in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study.
The anti-tumour necrosis factor (TNF)-α adalimumab is the only licenced biologic for moderate-to-severe hidradenitis suppurativa (HS). No predictors of response have been identified so far. To identify clinical parameters predicting response to adalimumab and confirm its efficacy/safety. The data of 389 patients with HS treated with adalimumab in 21 Italian centres were reviewed. Sex, age at onset/diagnosis/baseline, body mass index, smoking, phenotype, previous treatments, concomitant antibiotics and 'therapeutic delay', defined as the time from HS onset to adalimumab initiation, were assessed. Response to adalimumab and its impact on quality of life (QoL) were evaluated using the Hidradenitis Suppurativa Clinical Response (HiSCR) and the Dermatology Life Quality Index (DLQI) or the Visual Analogue Scale for pain (VAS pain), respectively. Logistic regression analysis was performed. The therapeutic delay correlated to lack of response to adalimumab at week 16 [odds ratio (OR) 1·92 for therapeutic delay > 10 years; 95% confidence interval (CI) 1·28-2·89; P = 0·0016). HiSCR was achieved in 43·7% and 53·9% patients at week 16 and 52, respectively. Significant reductions in both DLQI and VAS pain were found between week 16 vs. baseline (P < 0·0001 for both) and week 52 vs. baseline (P < 0·0001 for both). Previous immunosuppressants inversely correlated to HiSCR at week 52 (OR = 1·74, 95% CI 1·04-2·91, P = 0·0342). Inverse correlation between therapeutic delay and clinical response was found, supporting early adalimumab use and providing evidence for a 'window of opportunity' in HS treatment. Adalimumab efficacy and safety were confirmed, along with patients' QoL improvement. Immunosuppressants could negatively influence the response to adalimumab inducing a switch to non-TNF-α-driven pathways.


Oxytocin-induced analgesia and scratching are mediated by the vasopressin-1A receptor in the mouse.
The neuropeptides oxytocin (OXT) and arginine vasopressin (AVP) contribute to the regulation of diverse cognitive and physiological functions including nociception. Indeed, OXT has been reported to be analgesic when administered directly into the brain, the spinal cord, or systemically. Here, we characterized the phenotype of oxytocin receptor (OTR) and vasopressin-1A receptor (V1AR) null mutant mice in a battery of pain assays. Surprisingly, OTR knock-out mice displayed a pain phenotype identical to their wild-type littermates. Moreover, systemic administration of OXT dose-dependently produced analgesia in both wild-type and OTR knock-out mice in three different assays, the radiant-heat paw withdrawal test, the von Frey test of mechanical sensitivity, and the formalin test of inflammatory nociception. In contrast, OXT-induced analgesia was completely absent in V1AR knock-out mice. In wild-type mice, OXT-induced analgesia could be fully prevented by pretreatment with a V1AR but not an OTR antagonist. Receptor binding studies demonstrated that the distribution of OXT and AVP binding sites in mouse lumbar spinal cord resembles the pattern observed in rat. AVP binding sites diffusely label the lumbar spinal cord, whereas OXT binding sites cluster in the substantia gelatinosa of the dorsal horn. In contrast, quantitative real-time reverse transcription (RT)-PCR revealed that V1AR but not OTR mRNA is abundantly expressed in mouse dorsal root ganglia, where it localizes to small- and medium-diameter cells as shown by single-cell RT-PCR. Hence, V1ARs expressed in dorsal root ganglia might represent a previously unrecognized target for the analgesic action of OXT and AVP.


Hepatitis B and the theatre nurse.
On 1st July 1995, an important change was made in DOH policy which affects all staff employed in the operating theatre. It was from this date that staff were required to declare their hepatitis B status. As workers who undertake exposure prone procedures (EPP workers), theatre staff are required to be immunised against this disease and to have their vaccination dates and immunity recorded by their employer's Occupational Health Department. Job applicants will not be offered a post unless they can provide proof of immunisation. This important change has been in force for medical EPP workers since July 1994. Other staff are also recommended to have been immunised against hepatitis B although failure to do so should not preclude them from employment in non-EPP areas. This means that any person working in the operating theatre will be required to prove that he or she: has been successfully immunised has attempted immunisation but failed to respond is not a carrier of the hepatitis B virus (i.e. that they are surface antigen negative) The document issued by the DOH1 states that: 'no-one involved in exposure prone procedures can refuse to be immunised or show that they are not infectious carriers of hepatitis B: refusers will not be allowed to continue EPP work' Non-responders to immunisation will be required to provide fresh blood tests every six months in order to prove their continuing non-carrier status.


Impact of therapeutic education on the choice of renal replacement therapy. Moroccan monocentric experience
Therapeutic patient education (TPE) is gaining importance in the management of patients with chronic kidney disease (CKD). The objective of this study is to assess the interest of TPE in the acquisition of knowledge concerning CKD and renal replacement therapy, as well as the orientation of the patients towards a personalized choice of treatment. Patients with a minimum stage 4 CKD were prospectively included between November 2016 and February 2020. We proposed TPE sessions on CKD and its treatment to all patients. We explained the theoretical part through a slideshow about the definition of end-stage renal disease, its symptoms and the various methods of renal replacement therapy. A "basket" of essential material to illustrate a session of hemodialysis (HD) or peritoneal dialysis (PD) was used to achieve the practical part of the study. Data was collected using two questionnaires: the first one, at the start of the session, included the socio-demographic and clinical characteristics of the patients and evaluated their level of basic knowledge, and the second one, at the end of the session, assessed the evolution of knowledge after TPE, leading to a therapeutic choice. The mean age of the 211 included patients was 55.59 years old (SD = 15.47). Male to female ratio was 0.73. The level of education was low in 69% of the cases of whom 23.7% were employees. The glomerular filtration rate (GFR) was between 15 and 30 mL/min in 56.8% of the cases. Initial nephropathy was known in 60% of patients while the stage of CKD was unknown in 66.4%. Before TPE, patients with a good level of overall knowledge were around 29%, rising to 73% after TPE. A significant correlation was found between the level of education of the patients and their knowledge score before and after TPE. The choice of renal replacement therapy was taken for PD, TR and HD respectively in 36%, 19% and 11.8% of the cases, while 33.2% asked for time to think. Elderly and/or low educated patients most often remained undecided; moreover those who are young and/or educated prefer TR. During the follow-up period, 46% of patients started renal replacement therapy (36.5% started HD, 8.1% PD and 1.4% KT). The choice made by our patients was respected in 42% of the cases: in all the patients who chose HD; in 36% of those who chose PD, and 19% of those who chose kidney transplantation (KT). The final therapeutic modality was strongly linked to the following parameters: age, GFR and level of education. This study highlighted the insufficient level of patients' information about CKD and its treatment and allowed the patients to express their choice of their replacement therapy, which is a complicated process that must integrate the opinion of the nephrologist and the patient's preference to lead to an optimal organization of the therapeutic modality.


Rapid detection and typing of herpes simplex virus DNA in clinical specimens by the hybrid capture II signal amplification probe test.
A second-generation signal amplification, nucleic acid-based test for the rapid detection and typing of herpes simplex virus (HSV) DNA was developed and evaluated with artificial and clinical specimens. The analytical sensitivity of the Hybrid Capture II (HC II) HSV DNA assay was determined by testing either cloned HSV DNA or total genomic HSV DNA titrations and resulted in detection thresholds of between 5 x 10(3) and 1 x 10(4) copies per assay. Specificity was assessed by testing a panel of bacteria and viruses commonly found in the female genital tract. Sensitivity was assessed by testing 112 ulcerative genital lesions by the HC II assay and comparing the results to those obtained by routine cell culture. Discrepant results were resolved by PCR testing. After resolution of the discrepant results, the sensitivity of the HC II assay compared to the consensus result (the results of two of three tests, the HC II assay, culture, and PCR, were in agreement) was 93.2% (41 of 44 specimens), and the specificity was 100% (60 of 60 specimens). Culture gave a sensitivity of 84.1% (37 of 44 specimens) and a specificity of 100% (60 of 60 specimens) compared to the consensus result. The results of HSV typing by the HC II assay and culture agreed in all cases. The HC II assay is a rapid and accurate assay for detecting and typing HSV types 1 and 2, with a sensitivity comparable to that of culture and greater ease of use than culture.


A random batch Ewald method for charged particles in the isothermal-isobaric ensemble.
We develop an accurate, highly efficient, and scalable random batch Ewald (RBE) method to conduct molecular dynamics simulations in the isothermal-isobaric ensemble (the NPT ensemble) for charged particles in a periodic box. After discretizing the Langevin equations of motion derived using suitable Lagrangians, the RBE method builds the mini-batch strategy into the Fourier space in the Ewald summation for the pressure and forces such that the computational cost is reduced to O(N) per time step. We implement the method in the Large-scale Atomic/Molecular Massively Parallel Simulator package and report accurate simulation results for both dynamical quantities and statistics for equilibrium for typical systems including all-atom bulk water and a semi-isotropic membrane system. Numerical simulations on massive supercomputing cluster are also performed to show promising central processing unit efficiency of the RBE.


Oral hygiene care in the pediatric intensive care unit: practice recommendations.
Oral hygiene significantly affects children's well being. It is an integral part of intensive and critical care nursing because intubated and ventilated children in the Pediatric Intensive Care Unit (PICU) are dependent on the health care team to tend to their everyday basic needs. Fourteen articles were identified as being relevant to pediatric oral care in the PICU. These articles were subsequently appraised, and an oral hygiene in the PICU guideline was developed. Research highlighted the relationship between poor oral hygiene in the intensive care unit (ICU) and an increase in dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia. Research and a local, informal audit found the provision of oral hygiene care to PICU children varied widely and was often inadequate. Children in the PICU need their mouths regularly assessed and cleaned. Maintaining consistent, regular, and standardized oral hygiene practices in the PICU will also set an example for children and their families, encouraging and teaching them about the life-long importance of oral hygiene.


Human and mouse enamel phenotypes resulting from mutation or altered expression of AMEL, ENAM, MMP20 and KLK4.
Amelogenesis imperfecta (AI) is caused by AMEL, ENAM, MMP20 and KLK4 gene mutations. Mice lacking expression of the AmelX, Enam and Mmp20 genes have been generated. These mouse models provide tools for understanding enamel formation and AI pathogenesis. This study describes the AI phenotypes and relates them to their mouse model counterparts. Human AI phenotypes were determined in a clinical population of AI families and published cases. Human and murine teeth were evaluated using light and electron microscopy. A total of 463 individuals from 54 families were evaluated and mutations in the AMEL, ENAM and KLK4 genes were identified. The majority of human mutations for genes coding enamel nonproteinase proteins (AMEL and ENAM) resulted in variable hypoplasia ranging from local pitting to a marked, generalized enamel thinning. Specific AMEL mutations were associated with abnormal mineralization and maturation defects. Amel and Enam null murine models displayed marked enamel hypoplasia and a complete loss of prism structure. Human mutations in genes coding for the enamel proteinases (MMP20 and KLK4) cause variable degrees of hypomineralization. The murine Mmp20 null mouse exhibits both hypoplastic and hypomineralized defects. The currently available Amel and Enam mouse models for AI exhibit enamel phenotypes (hypoplastic) that are generally similar to those seen in humans. Mmp20 null mice have a greater degree of hypoplasia than humans with MMP20 mutations. Mice lacking expression of the currently known genes associated with the human AI conditions provide useful models for understanding the pathogenesis of these conditions.


Functional Dissociation of Latency-Variable, Stimulus- and Response-Locked Target P3 Sub-components in Task-Switching.
Cognitive control warrants efficient task performance in dynamic and changing environments through adjustments in executive attention, stimulus and response selection. The well-known P300 component of the human event-related potential (ERP) has long been proposed to index "context-updating"-critical for cognitive control-in simple target detection tasks. However, task switching ERP studies have revealed both target P3 (300-350 ms) and later sustained P3-like potentials (400-1,200 ms) to first targets ensuing transition cues, although it remains unclear whether these target P3-like potentials also reflect context updating operations. To address this question, we applied novel single-trial EEG analyses-residue iteration decomposition (RIDE)-in order to disentangle target P3 sub-components in a sample of 22 young adults while they either repeated or switched (updated) task rules. The rationale was to revise the context updating hypothesis of P300 elicitation in the light of new evidence suggesting that "the context" consists of not only the sensory units of stimulation, but also associated motor units, and intermediate low- and high-order sensorimotor units, all of which may need to be dynamically updated on a trial by trial basis. The results showed functionally distinct target P3-like potentials in stimulus-locked, response-locked, and intermediate RIDE component clusters overlying parietal and frontal regions, implying multiple functionally distinct, though temporarily overlapping context updating operations. These findings support a reformulated version of the context updating hypothesis, and reveal a rich family of distinct target P3-like sub-components during the reactive control of target detection in task-switching, plausibly indexing the complex and dynamic workings of frontoparietal cortical networks subserving cognitive control.


Satellites of the outer planets: thermal models.
Steady-state thermal models for the large satellites of the outer planets strongly indicate that their interiors are currently maintained at temperatures well above the ice-ammonia eutectic temperature by the decay of long-lived radioisotopes of potassium, uranium, and thorium. The present-day steady-state thermal structure of a representative satellite, J IV (Callisto), is shown to be characterized by the presence of a thin icy crust over a deep liquid mantle, with a dense core of hydrous silicates and iron oxides. Some dynamical consequences of this model are briefly discussed.


Meeting the confused patient with confidence: perceived benefits of communication partner training in subacute TBI.
This study aims to explore health professionals' perceived benefits of implementing Communication Partner Training (CPT) using Supported Conversation for Adults with Aphasia (SCA™) in a subacute rehabilitation setting with patients in post-traumatic confusional state (PTCS) after TBI. The study was conducted in a clinical setting using a pre-post questionnaire design to explore change. One hundred and four interdisciplinary clinicians attended CPT in the SCA™ method and subsequent implementation support. Participants completed a questionnaire with both quantitative and qualitative questions before and after the training and implementation period. Data were analyzed using descriptive and inferential statistics and qualitative content analysis. Participants' perceived confidence and self-assessed ability to communicate with patients in PTCS significantly increased after CPT (p = 0.006). While participants still experienced communication challenges, they reported using CPT-related tools and strategies in their interactions. Participants found they could apply strategies to improve patients' comprehension of information and to confirm their understanding of patients' communication. However, using strategies to enhance patients' expressive abilities was perceived as more challenging. Training health professionals in CPT increase their confidence in managing communication with patients in PTCS. Further research is needed to evaluate the efficacy of CPT within a more rigorous research design.


Exercise for improving balance in older people.
In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007. To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011). Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance. Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate. This update included 94 studies (62 new) with 9,917 participants. Most participants were women living in their own home.Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category. 1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) -0.82 s; 95% CI -1.56 to -0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD -4.30 s; 95% CI -7.60 to -1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD -1.30 s; 95% CI -2.40 to -0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).4. General physical activity (walking) (seven studies of which five provided primary outcome data). 5. General physical activity (cycling) (one study which provided data for walking speed). 6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data). 7. Vibration platform used as intervention (three studies of which one provided primary outcome data).8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD -1.63 s; 95% CI -2.28 to -0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI -0.01 to 3.20 s, 176 participants, 2 studies); walking speed (SMD 0.04; 95% CI -0.10 to 0.17, 818 participants, 15 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).Few adverse events were reported but most studies did not monitor or report adverse events.In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing. There is weak evidence that some types of exercise (gait, balance, co-ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.


[Changes in mental health index, serum biochemical parameters and neutrophil function after start of the wheelchair use at a nursing home in Korea].
In Korea, long-term care insurance has been provided to the elderly since 2008. We conducted a health survey of the elderly in a nursing home in Korea from 2007 to 2010. Since the introduction of the insurance system, many of the elderly have started using wheelchairs. We aimed to determine the effect of using wheelchairs on mental health index, serum biochemical parameters, and neutrophil function. The subjects were 32 elderly persons (mean age: 74.44 ± 5.79 years) who could walk unaided in 2007 and were not bedridden until 2010. We classified the subjects into the walking group (subjects could walk unaided or with a cane until 2010; 10 men, 9 women) and the wheelchair group (subjects required the use of a wheelchair from 2007 to 2010; 2 men, 11 women). We determined stress score, stress tolerance, subjective well-being score in accordance with the Philadelphia Geriatric Center Morale Scale, and serum biochemical parameters. We also analyzed oxidant production and phagocytosis by neutrophils and estimated the balance between oxidant production and phagocytosis by correlation analysis. Increases in the stress tolerance of the wheelchair group in 2008 and 2009 and the subjective well-being score in 2009 in the survey were observed. However, in 2010, the stress tolerance and the subjective well-being score decreased to the levels in 2007. In 2010, the levels of serum albumin and high-density lipoprotein cholesterol of the wheelchair group were significantly lower than those of the walking group, and the balance between phagocytosis and oxidant production in the wheelchair group improved.


The role of arthroscopy in evaluation of painful hip arthroplasty.
Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. We describe the use of hip arthroscopy in management of the painful hip arthroplasty, critically evaluate the outcomes of these patients, and refine indications for hip arthroscopy in this setting. We retrospectively reviewed 14 patients (16 hips) who underwent hip arthroscopy after joint replacement. One patient had suspected septic arthritis despite negative aspiration and one had known septic arthritis but was not a candidate for open arthrotomy; two had intraarticular migration of hardware. The remaining 10 patients (11 hips) had persistent pain despite negative diagnostic studies. The two patients (two hips) with infection were successfully treated with arthroscopic lavage and débridement plus intravenous antibiotics. Intraarticular metal fragments and a loose acetabular screw were successfully removed in two patients (three hips). Findings in the remaining 11 hips included a loose acetabular component (one); corrosion at the head-neck junction of a metal-on-metal articulation (one); soft tissue-scar impingement at the head/cup interface (four); synovitis with associated scar tissue (four); and capsular scarring with adhesions (one). Arthroscopy represented a successful treatment or directly led to a successful treatment in 12 of 16 hips. We observed no complications as a result of the arthroscopy. Arthroscopy may be of value in selected patients undergoing hip arthroplasty with unexplained pain after an inconclusive standard workup. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Surgical considerations in pediatric necrotizing fasciitis.
Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management. In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2). Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment. NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.


Tertiary structural changes in the cleft containing the ATP sensitive tryptophan and reactive thiol are consistent with pivoting of the myosin heavy chain at Gly699.
The conformation of myosin subfragment 1 (S1) in the vicinity of the ATP sensitive tryptophan (Trp510) and the highly reactive thiol (SH1), both residing in the "probe-binding" cleft at the junction of the catalytic and lever arm domains, was studied to ascertain its role in the mechanism of energy transduction and force generation. In glycerinated muscle fibers in rigor, a fluorescent probe linked to SH1 detects a strained probe-binding cleft conformation following a length transient by altering emission intensity without detectably rotating. In myosin S1 in solution, the optical activity of Trp510 senses conformation change in the probe-binding cleft caused by substrate analog trapping of S1 in various structures attainable transiently during normal energy transduction. Also in S1 in solution, the induced optical activity of a fluorescein probe linked to SH1 shows sensitivity to changing probe-binding cleft conformation caused by nucleotide binding to the S1 active site. The changes in the optical activity of Trp510 and SH1 bound fluorescein in response to nucleotide or nucleotide analog binding are interpreted structurally using the S1 crystallographic coordinates and aided by a model of energy transduction that pivots at Gly699 to change probe-binding cleft conformation and to displace the S1 lever arm as during force generation. The crystallographic structure of the probe-binding cleft in S1 resembles most the nucleotide bound conformation in the native protein. A different structure, generated by pivoting at Gly699, better resembles the native rigor conformation of the probe-binding cleft. Pivoting at Gly699 rotates probes at SH1 suggesting that length transients on fibers in rigor do not cause pivoting at Gly699 or reverse the power stroke.


Genome-Wide Analysis of the Polygalacturonase Gene Family Sheds Light on the Characteristics, Evolutionary History, and Putative Function of Akebia trifoliata.
Polygalacturonase (PG) is one of the largest families of hydrolytic enzymes in plants. It is involved in the breakdown of pectin in the plant cell wall and even contributes to peel cracks. Here, we characterize PGs and outline their expression profiles using the available reference genome and transcriptome of Akebia trifoliata. The average length and exon number of the 47 identified AktPGs, unevenly assigned on 14 chromosomes and two unassembled contigs, were 5399 bp and 7, respectively. The phylogenetic tree of 191 PGs, including 47, 57, 51, and 36 from A. trifoliata, Durio zibethinus, Actinidia chinensis, and Vitis vinifera, respectively, showed that AktPGs were distributed in all groups except group G and that 10 AktPGs in group E were older, while the remaining 37 AktPGs were younger. Evolutionarily, all AktPGs generally experienced whole-genome duplication (WGD)/segmental repeats and purifying selection. Additionally, the origin of conserved domain III was possibly associated with a histidine residue (H) substitute in motif 8. The results of both the phylogenetic tree and expression profiling indicated that five AktPGs, especially AktPG25, could be associated with the cracking process. Detailed information and data on the PG family are beneficial for further study of the postharvest biology of A. trifoliata.


Differentiation of dermis-derived multipotent cells into insulin-producing pancreatic cells in vitro.
To observe the plasticity of whether dermis-derived multipotent cells to differentiate into insulin-producing pancreatic cells in vitro. A clonal population of dermis-derived multipotent stem cells (DMCs) from newborn rat with the capacity to produce osteocytes, chondrocytes, adipocytes and neurons was used. The gene expression of cultured DMCs was assessed by DNA microarray using rat RGU34A gene expression probe arrays. DMCs were further cultured in the presence of insulin complex components (Insulin-transferrin-selenium, ITS) to observe whether DMCs could be induced into insulin-producing pancreatic cells in vitro. DNA microarray analysis showed that cultured DMCs simultaneously expressed several genes associated with pancreatic cell, neural cell, epithelial cell and hepatocyte, widening its transcriptomic repertoire. When cultured in the specific induction medium containing ITS for pancreatic cells, DMCs differentiated into epithelioid cells that were positive for insulin detected by immunohistochemistry. Our data indicate that dermal multipotent cells may serve as a source of stem/progenitor cells for insulin-producing pancreatic cells.


On the effect of noise on the moore-penrose generalized inverse associative memory.
Monte Carlo simulations of the continuous Moore-Penrose generalized inverse associative memory (Kohonen [l]) have shown that the noise-to-signal ratio is improved on recall in the autoassociative case as long as the number of vector pairs stored is less than the number of components per vector. In the heteroassociative case, however, the noise-to-signal ratio may actually be greatly increased upon recall, particularly as the number of vector pairs stored approaches the number of components per vector. The increase in output noise-to-signal ratio in the heteroassociative case is found to be due to the fact that the inverse of the product of the key vector matrix with its transpose may increase without bound in spite of the fact that the key vectors are linearly independent.


[Clinico-morphological aspects of placental insufficiency].
The paper is concerned with the problems of placental insufficiency diagnosis, pathogenesis and potential effect on the fetus. The diagnosis involves the comparison of the compensatory and adjustment reaction to the number and pattern of pathological placental alterations in line with clinical and laboratory findings. The author employed the methods of macro-, microstereometry, electron microscopy, histochemistry, immunofluorescence. The essential role in placental insufficiency pathogenesis is attributed to the failure of regulatory metabolic mechanisms. This permits further investigation with employment of membrane pathology and biochemical methods of investigation.